bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental Drivers of Gulf Coast Tick (Acari: Ixodidae) Range Expansion in the United States
Authors: Flenniken J Matthew , Tuten Holly C , Rose Vineer Hannah , Phillips Victoria C , Stone Chris M , Allan Brian F
Published: July 2022

In the United States, the Gulf Coast tick (Amblyomma maculatum Koch) is a species of growing medical and veterinary significance, serving as the primary vector of the pathogenic bacterium, Rickettsia parkeri (Rickettsiales: Rickettsiaceae), in humans and the apicomplexan parasite, Hepatozoon americanum, in canines. Ongoing reports of A. maculatum from locations outside its historically reported distribution in the southeastern United States suggest the possibility of current and continuing range expansion. Using an ecological niche modeling approach, we combined new occurrence records with high-resolution climate and land cover data to investigate environmental drivers of the current distribution of A. maculatum in the United States. We found that environmental suitability for A. maculatum varied regionally and was primarily driven by climatic factors such as annual temperature variation and seasonality of precipitation. We also found that presence of A. maculatum was associated with open habitat with minimal canopy cover. Our model predicts large areas beyond the current distribution of A. maculatum to be environmentally suitable, suggesting the possibility of future northward and westward range expansion. These predictions of environmental suitability may be used to identify areas at potential risk for establishment and to guide future surveillance of A. maculatum in the United States.
WHERE DOES RESPONSIBILITY LIE? ANALYSING LEGAL AND REGULATORY RESPONSES TO FLAWED CLINICAL DECISION SUPPORT SYSTEMS WHEN PATIENTS SUFFER HARM
Authors: Prictor Megan
Published: July 2022

Clinical decision support systems (CDSSs) are digital healthcare information systems that apply algorithms to patient data to generate tailored recommendations. They are designed to support, but neither dictate nor execute, clinical decisions. CDSSs can introduce new risks, both by design features that heighten clinician burden and by outright errors that generate faulty recommendations for care. In the latter instance, if such unintercepted recommendations were to result in harm to the patient, novel legal questions emerge. Does legal responsibility for this harm lie with the clinician, the software developer or both? What is the clearest path to a remedy? Further, how does the Australian regulatory framework provide for oversight and redress? This article analyses the potential forms of legal redress in negligence, contract and under statutory consumer law, for the patient and the clinician. It also examines the Australian regulatory framework, specifically in relation to the Australian Competition and Consumer Commission and the Therapeutic Goods Administration, and reflects on the framework’s adequacy to protect patients and clinicians. It finds that the regulatory approach and the contour of legal risk still centre upon the clinician’s duty to exercise decisional autonomy and to intercept flawed recommendations generated by algorithmic errors within CDSSs.
Prediction of radiographic progression during a treat-to-target strategy by the sequential application of MRI-proven bone marrow oedema and power-Doppler grade ≥2 articular synovitis in rheumatoid arthritis: Retrospective observational study
Authors: Takatani Ayuko , Tamai Mami , Ohki Nozomi , Okamoto Momoko , Endo Yushiro , Tsuji Sousuke , Shimizu Toshimasa , Umeda Masataka , Fukui Shoichi , Sumiyoshi Remi , Nishino Ayako , Koga Tomohiro , Kawashiri Shin-ya , Iwamoto Naoki , Igawa Takashi , Ichinose Kunihiro , Arima Kazuhiko , Nakamura Hideki , Origuchi Tomoki , Uetani Masataka , Kawakami Atsushi
Published: July 2022

Objectives

To investigate the appropriate timing, useful findings and combination of magnetic resonance imaging (MRI) and ultrasound (US) for predicting the radiographic progression in early rheumatoid arthritis (RA).

Methods

Forty-four active RA patients, who examined by both of MRI and US in the symptomatic wrist and finger joints, were recruited in Nagasaki University Hospital from 2010 to 2017 and treated by the treat-to-target therapeutic strategy for 1 year. MRI was evaluated by RA MRI scoring and US by Outcomes Measures in Rheumatology Clinical Trial, respectively. Plain radiographs were assessed by the Genant-modified Sharp score for the symptomatic side in the same manner as MRI and US. Radiographic progression was defined as an annual increase ≥0.75 at 1 year. Factors associated with radiographic progression were analysed. Also, the optimal combination of MRI and US at each timepoint was considered.

Results

Logistic regression model revealed that MRI-proven bone marrow oedema at baseline and 6 months and joint counts of power-Doppler grade ≥2 articular synovitis at 3 or 6 months were significantly associated with radiographic progression at 1 year.

Conclusion

This study may suggest the favourable timing and combination of MRI and US at each point to predict radiographic progression in patients with early-stage RA.
The bioimpedance phase angle may be associated with frailty in rheumatoid arthritis patients: Results from a prospective, cohort study
Authors: Matsumoto Yoshinari , Tada Masahiro , Yamada Yutaro , Mandai Koji , Hidaka Noriaki , Koike Tatsuya
Published: July 2022

Objectives

This study investigated whether the phase angle (PhA) on bioelectrical impedance analysis is related to frailty in rheumatoid arthritis (RA) patients.

Methods

Data from a prospective cohort study of RA patients were analysed. The PhA was assessed by the bioelectrical impedance analysis method, and frailty was assessed by the Kihon Check List (KCL) annually. The cut-off value of the PhA for frailty was calculated by receiver-operating characteristic analysis. The relationships between the PhA and frailty were evaluated by logistic regression analysis. The relationships between the change in PhA and frailty status and the KCL score were evaluated by analysis of covariance and multiple regression analysis.

Results

A total of 170 patients (81.2% female, 66.2 ± 13.1 years) were included in the analysis. A PhA of less than the cut-off for frailty was significantly associated with frailty (odds ratio: 4.75, 95% confidence interval: 1.86, 12.17). The change in the PhA was significantly associated with the change in the KCL score (β = −0.15). In robust patients, there was a significant difference in the rate of change of the PhA between the group that became pre-frail in the next year and the group that remained robust.

Conclusions

The PhA may be associated with frailty in RA patients.
Family caregiver constructs and outcome measures in neuro-oncology: A systematic review
Authors: Boele Florien , Hertler Caroline , Dirven Linda , Piil Karin , Sherwood Paula
Published: July 2022

Background

As a first step to reach consensus on the key constructs and outcomes in neuro-oncology caregiver research, we performed a systematic review to evaluate the constructs that are being evaluated in research studies and how these have been assessed.

Methods

All peer-reviewed publications with primary data reporting on outcomes of family caregivers of adult primary brain tumor patients were eligible. Electronic databases PubMed/Medline, Embase, Web of Science, Emcare, Cochrane Library, and PsycINFO were searched up to September 2021. Using Covidence, title and abstract screening, full-text review, and data extraction were done by two researchers independently, with a third guiding consensus. Constructs as reported in each study, and how these were assessed were the primary result.

Results

Searches yielded 1090 unique records, with 213 remaining after title/abstract screening. Of these, 157 publications met inclusion criteria, comprising 120 unique studies. These originated from 18 countries and were published between 1996 and 2022. Most were observational (75%) cross-sectional (61%) studies, reporting on quantitative methods (62%). Twenty-seven different constructs were assessed and mapped along the Caregiver Health Model (CGHM) categories, namely, caregiver health, needs, tasks, beliefs and attitudes, and environment. Seventeen questionnaires were used >2 times to measure the same construct, with the vast majority of questionnaires only used across one or two studies.

Conclusions

Neuro-oncology caregiving research is a field gaining traction, but lags behind in clear definition of key constructs, and consistency in assessment of these constructs. Developing consensus or guidance will improve comparability of studies, meta-analyses, and advance the science more quickly.
Anlotinib Combined with Toripalimab as Second-Line Therapy for Advanced, Relapsed Gastric or Gastroesophageal Junction Carcinoma
Authors: Jiang Man , Zhang Chuantao , Hu Yabin , Li Tianjun , Yang Guangjie , Wang Guanqun , Zhu Jingjuan , Shao Changfeng , Hou Helei , Zhou Na , Liu Kewei , Zhang Xiaochun
Published: July 2022

Our study aimed to explore the efficacy and safety of anlotinib–toripalimab combination therapy as a second-line treatment for advanced relapsed gastric or gastroesophageal junction carcinoma (GC/GEJC). In this single arm, single-center extension clinical trial, patients with advanced relapsed GC/GEJC received toripalimab (240 mg, intravenously over 60 minutes, once every 2 weeks) plus anlotinib (12 mg/day, orally, 2 weeks on and 1 week off, every 3 weeks) as second-line therapy. There were 29 patients who achieved partial response, and the ORR was 32.3% (95% CI, 26.6%-38.5%). Grade 3 treatment-related adverse events (TRAEs) were recorded in 7 participants (11.3%), all of which were manageable. The PFS and OS were 4.0 and 11.1 months, respectively. Patients with programmed death-ligand 1 (PD-L1) positive expression showed numerically longer OS than the negative ones although the difference was not significantly. The tumor mutational burden-high (TMB-H) group showed a significantly better OS (P = .05) than the TMB-Low (TMB-L) group. Next-generation sequencing (NGS) revealed that fibroblast growth factor receptor 2 (FGFR2) mutations positively correlated with target lesion reduction (odds ratio [OR] = 0.14; P = .02). The new regimen increased tumor-infiltration of CD8+ T and CD3+ T cells. Furthermore, a patient-derived organoid (PDO) study indicated that anlotinib could promote an immune-supportive tumor microenvironment. As conclusion, the anlotinib-toripalimab combination showed promising efficacy and favorable safety as a second-line treatment for advanced, relapsed GC/GEJC. The PD-L1 expression, TMB, and FGFR2 mutation are potential biomarkers for predicting the efficacy of this regimen (ClinicalTrials.gov registration number: NCT04713059).
An analysis of the recent US dietary guidelines process in light of its federal mandate and a National Academies report
Authors: Achterberg Cheryl , Astrup Arne , Bier Dennis M , King Janet C , Krauss Ronald M , Teicholz Nina , Volek Jeff S
Published: July 2022

The US Dietary Guidelines for Americans is an enormously influential policy that has guided US nutrition programs since 1980. During these last 40 years, some researchers have expressed concern that the guidelines are based on an insufficiently rigorous assessment of the scientific evidence, a view that was largely substantiated by a Congressionally mandated 2017 report by the National Academies of Sciences, Engineering, and Medicine, which identified a need for enhanced transparency, greater scientific rigor, and updates to the scientific methodology for the DGA process. This paper traces the history of these ideas and contextualizes the DGA within the law and regulations that govern its process. The paper also discusses how recent iterations of the Dietary Guidelines have not fully adhered to these guiding documents, which has resulted in diminished independence of the expert committee in charge of evaluating the science for the DGA and a continued lack of a fully rigorous scientific process for producing consistent and trustworthy guidelines for the public.
N-Acetylcysteine (NAC) in Schizophrenia Resistant to Clozapine: A Double-Blind, Randomized, Placebo-Controlled Trial Targeting Negative Symptoms
Authors: Neill Erica , Rossell Susan L , Yolland Caitlin , Meyer Denny , Galletly Cherrie , Harris Anthony , Siskind Dan , Berk Michael , Bozaoglu Kiymet , Dark Frances , Dean Olivia M , Francis Paul S , Liu Dennis , Phillipou Andrea , Sarris Jerome , Castle David J
Published: July 2022

Background and Hypothesis

Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, yet a significant proportion of individuals on clozapine continue to experience disabling symptoms, despite being treated with an adequate dose. There is a need for adjunct treatments to augment clozapine, notably for negative and cognitive symptoms. One such potential agent is the glutathione precursor N-acetylcysteine (NAC).

Study Design

A randomized double-blind, multi-center, placebo-controlled trial for clozapine patients with enduring psychotic symptoms (n = 84) was undertaken to investigate the efficacy of adjunctive NAC (2 g daily) for negative symptoms, cognition and quality of life (QoL). Efficacy was assessed at 8, 24, and 52 weeks.

Study Results

NAC did not significantly improve negative symptoms (P = .62), overall cognition (P = .71) or quality of life (Manchester quality of life: P = .11; Assessment of quality of life: P = .57) at any time point over a 1-year period of treatment. There were no differences in reported side effects between the groups (P = .26).

Conclusions

NAC did not significantly improve schizophrenia symptoms, cognition, or quality of life in treatment-resistant patients taking clozapine. This trial was registered with “Australian and New Zealand Clinical Trials” on the 30 May, 2016 (Registration Number: ACTRN12615001273572).
Ants (Hymenoptera: Formicidae) from Miocene Ethiopian amber: filling gaps in the geological record of African terrestrial biota
Authors: Perrichot Vincent , Boudinot Brendon E , Engel Michael S , Xu Chunpeng , Bojarski Błażej , Szwedo Jacek
Published: July 2022

The Early Miocene (16–23 Mya) amber of Ethiopia constitutes a new source of fossil ants for Africa, where they are otherwise poorly documented. Here we report a diversified assemblage of six subfamilies and at least 19 genera that are still predominantly alive in the Afrotropics today. In this first account, a particular reference is made to the subfamily Dolichoderinae, with the description of two new species: Technomyrmex svojtkai Perrichot & Engel sp. nov. and Ravavy goldmani Boudinot & Perrichot sp. nov. The first is illustrated and described based on synchrotron-radiation microcomputed tomography, and the second represents the first fossil record for the tribe Bothriomyrmecini and Ravavy, a Malagasy and Afrotropical genus that was hitherto monotypic. The ant composition in Ethiopian amber is congruent with the global pattern emerging across ants and showing a Neogene diversification almost exclusively within extant genera.
Could X-ray Predict Long-term Complications in Patients with Diabetic Foot Osteomyelitis?
Authors: Tardáguila-García Aroa , García-Álvarez Yolanda , Sanz-Corbalán Irene , López-Moral Mateo , Molines-Barroso Raúl J. , Lázaro-Martínez José Luis
Published: July 2022

OBJECTIVE:

To analyze the association between radiologic changes on plain X-rays in patients with diabetic foot osteomyelitis and the development of complications at the 1-year follow-up.

METHODS:

A prospective, observational study was conducted involving 115 patients with diabetic foot osteomyelitis. X-ray features that were evaluated during 1-year follow-up visits included affected bone marrow, active periosteal reaction, sequestrum, cortical disruption, and other types of signs. Researchers analyzed the association between the presence of X-ray changes and complication development, such as bone or soft tissue infections, ulcer recurrence, reulceration, amputation, death, and other diabetic foot disease-related events.

RESULTS:

During follow-up, of 115 patients included in the study, 33 patients (28.7%) showed radiologic changes, and 85 (73.9%) developed complications. The presence of radiologic changes after ulcer healing had a significant association with complication development during the 1-year follow-up in addition to those found at different follow-up visits. Patients who showed radiologic changes had higher percentages of complications during the 1-year follow-up, and patients without radiologic changes had lower percentages of complications.

CONCLUSIONS:

The presence of radiologic changes is related to the development of complications in patients who suffer from diabetic foot osteomyelitis.
The 2021 Update on Pressure Injuries: A Review of the Literature
Authors: Saindon Kelley , Nguyen Tran D. , Berlowitz Dan R.
Published: July 2022

GENERAL PURPOSE

To provide a review of the recent literature on the epidemiology and treatment of pressure injuries (PIs).

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Identify risk factors for developing PIs.

2. Differentiate factors that could affect the healing of PIs.

3. Select strategies that have an impact on the development of PIs.

Keeping up with the literature on pressure injuries is always a challenge for busy clinicians. In this article, the authors summarize six important articles published in 2021. Articles cover a range of topics including epidemiology, treatment, precision medicine, nurse staffing, and patient preferences for care. For each article, a description of the study results is provided along with a comment on why the results are important. This information is intended to help clinicians incorporate new data into their clinical practice.
Can Rater Training Improve the Quality and Accuracy of Workplace-Based Assessment Narrative Comments and Entrustment Ratings? A Randomized Controlled Trial
Authors: Kogan Jennifer R. , Dine C. Jessica , Conforti Lisa N. , Holmboe Eric S.
Published: July 2022

Purpose

Prior research evaluating workplace-based assessment (WBA) rater training effectiveness has not measured improvement in narrative comment quality and accuracy, nor accuracy of prospective entrustment-supervision ratings. The purpose of this study was to determine whether rater training, using performance dimension and frame of reference training, could improve WBA narrative comment quality and accuracy. A secondary aim was to assess impact on entrustment rating accuracy.

Method

This single-blind, multi-institution, randomized controlled trial of a multifaceted, longitudinal rater training intervention consisted of in-person training followed by asynchronous online spaced learning. In 2018, investigators randomized 94 internal medicine and family medicine physicians involved with resident education. Participants assessed 10 scripted standardized resident–patient videos at baseline and follow-up. Differences in holistic assessment of narrative comment accuracy and specificity, accuracy of individual scenario observations, and entrustment rating accuracy were evaluated with t tests. Linear regression assessed impact of participant demographics and baseline performance.

Results

Seventy-seven participants completed the study. At follow-up, the intervention group (n = 41), compared with the control group (n = 36), had higher scores for narrative holistic specificity (2.76 vs 2.31, P < .001, Cohen V = .25), accuracy (2.37 vs 2.06, P < .001, Cohen V = .20) and mean quantity of accurate (6.14 vs 4.33, P < .001), inaccurate (3.53 vs 2.41, P < .001), and overall observations (2.61 vs 1.92, P = .002, Cohen V = .47). In aggregate, the intervention group had more accurate entrustment ratings (58.1% vs 49.7%, P = .006, Phi = .30). Baseline performance was significantly associated with performance on final assessments.

Conclusions

Quality and specificity of narrative comments improved with rater training; the effect was mitigated by inappropriate stringency. Training improved accuracy of prospective entrustment-supervision ratings, but the effect was more limited. Participants with lower baseline rating skill may benefit most from training.
A Blueprint for Increasing Ethnic and Racial Diversity in U.S. Residency Training Programs
Authors: Butler Paris D. , Fowler Jessica C. , Meer Elana , Rosen Ilene M. , Reyes Iris M. , Berns Jeffrey S.
Published: July 2022

Problem

People who identify as African Americans, Latinos, or from indigenous backgrounds, are dramatically underrepresented in the U.S. physician workforce. It is critical for academic health centers to recognize racial and ethnic diversity at the residency level and implement changes to enhance diversity among trainees.

Approach

The Office of Graduate Medical Education (GME) at the University of Pennsylvania Health System (UPHS) developed a multipronged approach to enhance diversity and inclusion (D&I) among residency trainees. The approach included the development of an underrepresented in medicine (UIM) professional network; UIM-focused visiting clerkship programs; holistic review implementation by selection committees; and targeted outreach to UIM candidates, overseen by an associate designated institutional official for UIM Affairs. The authors reported demographic data on residency applicants invited for interviews and matching for all programs at UPHS from 2014–2015 (baseline) to 2020–2021. They also reported data on maximum ranking number programs reached to fill their positions and the average United States Medical License Examination (USMLE) Step 1 scores of matched candidates. Finally, they discussed the implications for leaders who wish to enhance D&I at academic health centers.

Outcomes

During the baseline year (2014–2015), UIMs represented 12.1% of interviewees and 8.7% of all matched candidates into UPHS residency programs. Over the successive 6 years after incremental implementation of the approach, UIM representation steadily increased. In 2020–2021, UIMs represented 23.2% of interviewees and 26.4% of matched candidates. Programs’ maximum rank number to fill and USMLE Step 1 scores of matched candidates remained relatively unchanged.

Next Steps

The UPHS Office of GME incorporated a purposeful approach to enhance the D&I of its residents. Across 6 years of implementation, UIM representation among resident matches tripled while quantitative program and candidate metrics remained unchanged. Similar efforts should be given further consideration for implementation and evaluation nationwide.
Look in the Mirror, Not Out the Window
Authors: Altan Defne , Ahuja Vanita , Kelleher Cassandra M. , Chang David C.
Published: July 2022

Over the past few decades, institutions have developed complex systems to compare themselves to others with the goal of improving healthcare quality. This process of comparison to others, called external benchmarking, has become the standard approach for quality improvement. However, external benchmarking is resource intensive, may not be flexible enough to focus on problems unique to individual institutions, and may lead to complacency for institutions ranking near the top of the quality bell curve for the measured metrics. Our singular focus on external benchmarking could also divert resources from other approaches. Here, we describe how the use of internal benchmarking, in which an institution focuses on improving their own processes over time, can offer unique advantages as well as offset the limitations of external benchmarking. We advocate for investment in both internal and external benchmarking as complimentary tools to improve healthcare quality.
Fertility preservation for patients with melanoma
Authors: Filippi Francesca , Serra Nicole , Vigano Paola , Boeri Luca , Cimminiello Carolina , Di Guardo Lorenza , Somigliana Edgardo , Del Vecchio Michele
Published: July 2022

The advent of immunotherapy and targeted therapy has outstandingly improved the prognosis in subjects with melanoma. Their use is now advocated also in earlier stages as an adjuvant therapy, and some neoadjuvant clinical trials are ongoing. Consequently, survivors free of disease are increasing, as well as those exposed to these new agents. Parenthood in survivors is, therefore, receiving growing interest. Evidence on the effects of immunotherapy and targeted therapy on future fertility is limited, but not entirely reassuring, in particular for immunotherapy. The necessity of delaying pregnancy seeking up to the end of treatments and follow-up (iatrogenic aging) is an additional albeit neglected source of concern, in particular for women in their late 30s. Subjects with melanoma should be informed on the multifaceted issue of future fertility at the time of cancer diagnosis. Available options of fertility preservations, including sperm and oocytes storage, should also be discussed, especially considering that at the age 0–39, melanoma represents the second most frequent neoplasia. In the decision-making process, most attention should be given to sex, age, and exposure to immunotherapy.
Echo-guided Lower-back Sculpture and Volumization as a Complement to High-definition Liposuction (XPINE-FAT)
Authors: Manzaneda Cipriani Raul Martin , Viaro Mauricio , Adrianzen Gerardo A.
Published: July 2022

Background:

Knowledge about lower-back aesthetics is very limited, especially regarding surgical techniques that improve its appearance. Thus, this study aimed to describe a high-definition liposuction technique with intramuscular grafting of erector spinae muscles (longissimus).

Methods:

A total of 15 female patients 25–48 years of age were recruited between November 2021 and January 2022, who underwent body contouring surgery and subsequently underwent a low-back lipodefinition and echo-guided intramuscular erector spinae (longissimus) fat graft to complement the procedure. As part of the study, measurements were performed before surgery and in the immediate postoperative period. The data were stored in a database and analyzed with the SPSS Version 25 statistical software.

Results:

The patients’ ages ranged from 25 to 48 years (mean: 37 years), with a body mass index of 18.6–29.3 (mean: 25.5). The surgical times ranged between 1 and 8 hours (mean: 3.73 hours); hospitalization times were 0.7–1 days (mean: 0.940 days). Lipograft was performed on the erector spinae muscles (longissimus), the right one with a range of 20–60 cm3 (mean: 43.33 cm3) and percentage increase of 65.3% (P < 0.0001). Regarding the left erector, similar volumes between 20 and 60 cm3 (mean: 44.67 cm3) were grafted with a percentage increase of 66.4% (P < 0.0001).

Conclusions:

XPINE-FAT is a safe technique that allows an increase in the immediate intramuscular thickness of the erector spinae muscles (longissimus). We observed no adverse events during the study.
Chimeric Anterolateral Thigh Flap for One-stage Reconstruction after Cervical Exenteration with Anterior Mediastinal Tracheostomy
Authors: Liu Pin-Han , Hung Chung-Jye , Tseng Yau-Lin , Lee Yao-Chou
Published: July 2022

Cervical exenteration with anterior mediastinal tracheostomy is rarely performed for extensive cervicothoracic malignancies. Although it provides effective palliation and occasional cure, reconstruction remains a formidable challenge owing to its complexity and high mortality. The resultant defects usually require an intestinal flap or tubed skin flap to restore the alimentary tract, soft-tissue interposition to separate the relocated trachea from the innominate artery, and another tubed or fenestrated skin flap to create a tension-free tracheocutaneous anastomosis and provide coverage for the exposed vessels, hopefully in one stage. We report a case involving a 60-year-old woman with recurrent medullary thyroid cancer who developed dyspnea and dysphagia. Salvage cervical exenteration and anterior mediastinal tracheostomy were complicated by tissue fibrosis caused by previous surgical and radiation therapies, resulting in complex defects with segmental loss of the esophagus, a short stump of trachea incapable of tracheocutaneous anastomosis, and great-vessel exposure. We used a chimeric anterolateral thigh flap consisting of a tubed skin flap for pharyngoesophageal reconstruction, a fenestrated skin flap for tracheostomy and neck coverage, and a vastus lateralis muscle bulk to separate the innominate artery from the relocated trachea. To our knowledge, this is the first report describing the reconstruction of such a complex defect with a single skin flap in a single stage.
CULTURE POSITIVITY RATES OF DEEP VITREOUS BIOPSY UNDER AIR VIS-À-VIS CONVENTIONAL ANTERIOR VITREOUS BIOPSY IN ENDOGENOUS ENDOPHTHALMITIS
Authors: Dave Vivek Pravin , Vithalani Nidhi , Sheba Esther , Joseph Joveeta , Pathengay Avinash
Published: July 2022

Purpose:

To describe the comparison of the culture positivity rates of deep vitreous biopsy under air and conventional anterior vitreous biopsy in endogenous endophthalmitis.

Materials:

A retrospective, consecutive, comparative series including cases of endogenous endophthalmitis from January 2014 to January 2021. They were divided into those where conventional anterior vitreous biopsy was taken and those where a deep biopsy was taken under air (DBA group). The culture positivity rate among the two groups was compared, and factors affecting the same were analyzed by a regression analysis.

Results:

There were 140 eyes in the conventional anterior vitreous biopsy group and 44 eyes in the DBA group. Sex, age, duration of symptoms, underlying systemic illness, presenting vision in logMAR, and total number of vitreous interventions were comparable between the two groups. Visual outcome was better in patients undergoing DBA as compared with those who underwent conventional anterior vitreous biopsy , (1.28 ± 1.01 logMAR, 20/380 vs. 1.88 ± 1.33 logMAR, 20/1,500, P = 0.03). No case in the DBA group developed retinal detachment or any complication attributable to the technique. In the conventional anterior vitreous biopsy group, the culture positivity was seen in 43/140 samples (30.71%), and in the DBA group, it was noted in 29/44 samples (65.9%). Taking a DBA was the only factor that was significant both in bivariate (odds ratio 4.36, 95% confidence interval 2.12–8.95, P < 0.0001) and multivariate analysis (odds ratio 4.02, 95% confidence interval 3.1–7.43, P < 0.0001).

Conclusion:

Vitreous sampling can be performed from the deep vitreous cavity in endogenous endophthalmitis safely and effectively under air infusion, improving the culture positivity rates.
INFUSION-ASSISTED EVACUATION OF SUBMACULAR HEMORRHAGE
Authors: Park Jong G. , Wolfe Jeremy D.
Published: July 2022

Purpose:

To report a novel surgical technique for evacuating submacular hemorrhage using the infusion stream of a 25-gauge vitrectomy system.

Methods:

Surgical case and video.

Results:

A 54-year-old man was taken to the operating room for a total hyphema, nonclearing vitreous hemorrhage, and elevated intraocular pressure after multiple tractional retinal detachment repairs by an outside surgeon. Intraoperatively, the hyphema and vitreous hemorrhage were cleared, and the source of bleeding was discovered to be an avulsed vessel through a pre-existing retinal break just superior to the optic nerve. A large submacular hemorrhage was also present that was unable to be drained through the break by aspiration alone. With the vitreous cavity under fluid, the infusion cannula was manipulated to guide the infusion stream onto the macula. The stream was directed in a distal to proximal manner toward the retinal break, and the submacular blood was successfully expressed out through the break. Postoperatively, the retina remained attached with almost complete resolution of the submacular hemorrhage.

Conclusion:

Using the mechanical pressure of the infusion stream can be an effective method for evacuating large subretinal hemorrhages.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER COVID-19: MULTIMODAL EVALUATION
Authors: Castro Catarina S. , Ferreira André S. , Silva Nisa P. , Lume Miguel R. , Furtado Maria J.
Published: July 2022

Purpose:

To report the case and multimodal imaging findings of a healthy young woman who developed paracentral acute middle maculopathy 9 weeks after COVID-19.

Methods:

Case report. Ultra-widefield fundus photography, macular spectral domain optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography were performed.

Results:

A 36-year-old woman went to the emergency department with sudden, painless, left eye vision loss. The only relevant medical history was COVID-19 9 weeks before. The best-corrected visual acuity was 20/200, a left eye relative afferent pupillary defect was present, and superficial hemorrhages throughout the macular area and peripheral retina were found. Nearly 4 hours after admission, the left eye best-corrected visual acuity recovered to 20/20 without relative afferent pupillary defect. Five days after presentation in the emergency department, the patient returned with recurrent left eye vision loss, with spontaneous recovery within 12 hours. Macular spectral domain optical coherence tomography revealed hyperreflectivity of the inner plexiform and inner nuclear layers, and the diagnosis of paracentral acute middle maculopathy was established. The patient started oral acetylsalicylic acid and oral prednisolone. The patient did not report any new episodes of vision loss, and there was a progressive resolution of abnormal fundus findings.

Conclusion:

SARS-CoV-2 infection increases the risk of vascular thrombotic events with possible involvement of the retinal circulation, and paracentral acute middle maculopathy may present as a possible complication. Ophthalmologists should be able to recognize it promptly through multimodal imaging findings.
BILATERAL PERIPAPILLARY CHOROIDAL NEOVASCULARIZATION IN AN OTHERWISE HEALTHY TEENAGER TREATED WITH ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS
Authors: Hassoun Mohamad R. , Couvillion Austin , Pieramici Dante J.
Published: July 2022

Purpose:

This case report describes the presentation, diagnostic reasoning, and successful management of a 14-year-old teenage boy found to have bilateral peripapillary choroidal neovascularization.

Methods:

This is a case of a teenage boy with an unremarkable ocular and systemic history presenting with decreased visual acuity, macular edema, and bilateral peripapillary choroidal neovascularization.

Results:

After intravitreal antivascular endothelial growth factor injections, the patient's visual acuity improved. Imaging further revealed that the initially present macular edema, subretinal fluid, and peripapillary choroidal neovascularizations markedly improved after treatment.

Conclusion:

Peripapillary choroidal neovascularizations are often not trivial to diagnose. As this report illustrates, work-up with different modalities is extremely valuable, and antivascular endothelial growth factor injections may help decrease exudation and improve visual outcomes.
The Vision Correction Questionnaire: an electronic patient-reported outcome measure for refractive surgery
Authors: Frings Andreas , Ziaei Mohammed , Lundström Mats , Allan Bruce D.
Published: July 2022

Purpose:

To develop a psychometrically robust electronic patient reported outcome measure (ePROM) for refractive surgery.

Setting:

Moorfields Eye Hospital, London, United Kingdom.

Design:

Questionnaire development study.

Methods:

Items were derived in 6 domains (spectacle dependence, visual quality, eye comfort, functional freedom, emotional wellbeing, and satisfaction with treatment) from existing Rasch adjusted instruments, patient and surgeon feedback, and refinement in semistructured interviews before administration to a field test cohort (n = 360) of patients undergoing routine refractive surgery. Spectacle dependence and satisfaction with treatment items were used to provide descriptive statistical information only. Contemporary criteria for item reduction and Rasch modeling were applied to the remaining domains. The finalized questionnaire was then administered to a second patient cohort (n = 120) before and after surgery to assess sensitivity to change.

Results:

A 5-item scale derived for emotional wellbeing was unidimensional and a good fit to the Rasch model with ordered category response profiles, adequate precision (person separation 2.22 logits, reliability coefficient 0.83), and no misfitting items. Mean logit scores were 0.91 higher after treatment (effect size 1.26) suggesting a positive impact on emotional wellbeing. Functional scales could not be derived for visual quality, eye comfort, or functional freedom. Single-item ratings for visual quality and eye comfort were retained in our final 11-item questionnaire.

Conclusions:

This short ePROM should integrate well with routine clinical care and clinical trials in refractive surgery. The Rasch adjusted emotional wellbeing scale may help quantify the way patients feel about refractive surgery, with the remaining items providing useful descriptive information.
Does Learner Self-Efficacy Influence Accurate Identification of Heart Sound Descriptions?
Authors: Garvick Sarah , Gillette Chris , Geigler Bryan , Gao Hong , Crandall Sonia
Published: July 2022

Introduction

Although physician assistant (PA) training includes cardiac instruction, there is a lack of theory-based research investigating skill and behavioral development in PA students. The objective of this study was to examine the relationship between self-efficacy and ability to correctly identify heart sounds.

Methods

A cross-sectional study was conducted among 2 cohorts of PA students at one institution. Students answered self-efficacy items using 5-point Likert-type answers and identified specific heart sounds from text descriptions. Data from 154 students were analyzed using Cronbach’s alpha and bivariate statistical tests.

Results

Second-year students identified more heart sounds correctly than first-year students (8 v. 7, Z = −2.64, p = 0.01). Students with more confidence were more likely to correctly identify specific heart sounds.

Discussion

Results are consistent with social cognitive theory showing that self-efficacy may be related to outcome performance in PA students. Educational processes that cultivate self-efficacy may increase proficiency in cardiac auscultation.
A Tale of Two Curriculums: The Implications of Curriculum Design on Student Burnout
Authors: Sivahop Jacqueline , Broadfoot Kirsten , Bowser Jonathan
Published: July 2022

Introduction

The purpose of this study was to determine whether a difference exists in the 3 subconstructs of burnout between 2 cohorts of physician assistant (PA) students in different curricula, and the impact of 4 modifiable curricular factors on student experiences of burnout.

Methods

Using a mixed-methods study design, 86 students completed the Maslach Burnout Inventory–General Survey for Students (MBI-GSS) 8 months postmatriculation. Focus group interviews expanded on the quantitative results and effects of the 4 modifiable factors.

Results

No significant statistical difference was found in the emotional exhaustion (p = 0.35), cynicism (p = 0.29), or professional efficacy (p = 0.23) scores between the 2 cohorts of PA students. Students did not describe the exact dimensions of burnout; however, qualitative data provided 5 emergent codes based on their experiences.

Discussion

Despite curricular modifications to address student burnout in the Colorado Curriculum, a statistical difference in burnout scores was not found between the 2 student cohorts. Qualitative findings suggest that PA education programs should examine external factors and student-lived experiences that contribute to burnout in addition to curricular components.
Needs of Parents of Children With Spina Bifida
Authors: Joseph Rachel
Published: July 2022

Spina bifida (SB) is a birth defect involving the neural tube of the spine. The severity of the condition depends on the extent of the defect. The most severe cases of SB are debilitating and can significantly affect the quality of life of babies born with the defect.

Complications of SB can include mobility issues, orthopedic abnormalities, elimination impairments, infections, cognitive delays, and frequent hospitalizations, and these can span the lifetime of the child. The complications and needs associated with SB become very specific as the child reaches adulthood. According to the Centers for Disease Control and Prevention, approximately one in every 2,758 babies born annually in the United States are diagnosed with SB. Learning that a child will be born with a birth defect can be devastating for parents. Several decisions need to be made at birth and as the child grows. Many parents facing such news are overwhelmed and experience a range of emotions. The needs of parents caring for children with SB will vary based on their understanding of the disease process, ability to access resources, availability of a support system, and the capacity to cope with the challenges that arise when caring for a child born with this condition. Nurses must be diligent in exploring the needs of this parent population. This article is intended to raise awareness among nurses regarding parental needs so that they can support and assist parents in developing more effective ways to navigate through their journey.
Drug-induced comorbidities in patients with sarcoidosis
Authors: Drent Marjolein , Jessurun Naomi T. , Wijnen Petal A. , Bekers Otto , Bast Aalt
Published: July 2022

Purpose of review

Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology with a wide range of highly variable clinical manifestations and unpredictable disease course. Sarcoidosis patients may present with specific organ-related symptoms involving functional impairments, and less specific symptoms. The decision whether and when to treat a sarcoidosis patient with pharmacotherapy depends on two major factors: risk of organ failure and/or death and impairment of quality of life. This decision is complex and not standardized.

Recent findings

Glucocorticoids (GCs) are recommended as initial treatment, when needed. Subsequent GC-sparing alternatives frequently follow. Comorbidities or adverse drug reactions (ADRs) from drugs used in sarcoidosis treatment are sometimes very hard to differentiate from symptoms associated with the disease itself, which may cause diagnostic dilemmas. An ideal approach to minimalize ADRs would involve genetic screening prior to prescribing certain ‘high-risk drugs’ and therapeutic drug monitoring during treatment. Pharmacogenomic testing aims to guide appropriate selection of medicines, with the potential of reducing unnecessary polypharmacy while improving clinical outcomes.

A multidisciplinary approach to the management of sarcoidosis may avoid unnecessary ADRs. It is important to consider the possibility of drug-induced damage in sarcoidosis, especially if the clinical situation deteriorates after the introduction of a particular drug.
Pleuroparenchymal fibroelastosis
Authors: Cottin Vincent , Si-Mohamed Salim , Diesler Rémi , Bonniaud Philippe , Valenzuela Claudia
Published: July 2022

Purpose of review

Pleuroparenchymal fibroelastosis (PPFE) is a clinico-radiologic-pathologic interstitial lung disease (ILD) characterized by fibrosis that has upper lobe and subpleural predominance, involving both the visceral pleura and the subjacent subpleural lung parenchyma, and comprises dense fibroelastic changes with prominent elastosis of the alveolar walls together with fibrous thickening of the visceral pleura. The goal of this review is to summarize the state-of-the-art understanding in PPFE.

Recent findings

PPFE was described in an increasing number of conditions. The course of disease is heterogeneous. Idiopathic PPFE, cases associated with telomerase-related gene mutations, cases related to a history of chemotherapy, and cases combining PPFE with a pattern of usual interstitial pneumonia, may have a particularly poor prognosis. Well-conducted retrospective studies identified marked PPFE features in approximately 10% of patients with idiopathic pulmonary fibrosis, 11% of patients with systemic sclerosis-associated ILD, 6.5% of patients with rheumatoid arthritis-associated ILD, and 23% of patients with hypersensitivity pneumonitis. Drug therapy has not been evaluated prospectively. A small retrospective study suggests that nintedanib may slow disease progression. However, whether the efficacy of antifibrotics is comparable in PPFE and in other forms of progressive pulmonary fibrosis warrants further evaluation.

Accumulating data indicate that PPFE features are associated with poor prognosis in fibrosing ILDs. Further research on the management of PPFE is warranted.
Women and thyroid cancer incidence: overdiagnosis versus biological risk
Authors: Lam Diana , Davies Louise , Sawka Anna M.
Published: July 2022

Purpose of the review

Our aim is to discuss the concepts of sex and gender in the context of thyroid cancer epidemiology.

Recent findings

It has been long-established in global epidemiologic data that thyroid cancer incidence rates are higher in women than men. However, what has been less well understood is whether this reflects sex disparities in cancer susceptibility, gender disparities in detection, or a combination. A recent meta-analysis of autopsy data from individuals who were not known to have thyroid cancer in their lifetime demonstrated no difference in the prevalence of thyroid cancer in women and men, suggesting that gender differences may be the reason for gender-based differences in thyroid cancer detection. This finding, and sex differences in auto immunity and other factors that may affect cancer susceptibility are explored.

Additional research to explore gender- and sex-specific data on thyroid cancer would inform our understanding of the differences and similarities between men and women in susceptibility and detection of thyroid cancer and help to optimize disease management for all genders and both sexes.
Normothermic machine perfusion of kidneys: current strategies and future perspectives
Authors: Messner Franka , Bogensperger Christina , Hunter James P. , Kaths Moritz J. , Moers Cyril , Weissenbacher Annemarie
Published: July 2022

Purpose of review

This review aims to summarize the latest original preclinical and clinical articles in the setting of normothermic machine perfusion (NMP) of kidney grafts.

Recent findings

Kidney NMP can be safely translated into the clinical routine and there is increasing evidence that NMP may be beneficial in graft preservation especially in marginal kidney grafts. Due to the near-physiological state during NMP, this technology may be used as an ex-vivo organ assessment and treatment platform. There are reports on the application of mesenchymal stromal/stem cells, multipotent adult progenitor cells and microRNA during kidney NMP, with first data indicating that these therapies indeed lead to a decrease in inflammatory response and kidney injury. Together with the demonstrated possibility of prolonged ex-vivo perfusion without significant graft damage, NMP could not only be used as a tool to perform preimplant graft assessment. Some evidence exists that it truly has the potential to be a platform to treat and repair injured kidney grafts, thereby significantly reducing the number of declined organs.

Kidney NMP is feasible and can potentially increase the donor pool not only by preimplant graft assessment, but also by ex-vivo graft treatment.