bluuebunny/crossref_metadata_2025 huggingface dataset:
Grain growth for astrophysics with discontinuous Galerkin schemes
Authors: Lombart Maxime , Laibe Guillaume
Published: November 2020

Depending on their sizes, dust grains store more or less charges, catalyse more or less chemical reactions, intercept more or less photons and stick more or less efficiently to form embryos of planets. Hence, the need for an accurate treatment of dust coagulation and fragmentation in numerical modelling. However, existing algorithms for solving the coagulation equation are overdiffusive in the conditions of 3D simulations. We address this challenge by developing a high-order solver based on the discontinuous Galerkin method. This algorithm conserves mass to machine precision and allows to compute accurately the growth of dust grains over several orders of magnitude in size with a very limited number of dust bins.
Chemical modelling of dust–gas chemistry within AGB outflows – III. Photoprocessing of the ice and return to the ISM
Authors: Van de Sande M , Walsh C , Millar T J
Published: November 2020

To explain the properties of dust in the interstellar medium (ISM), the presence of a refractory organic mantle is necessary. The outflows of AGB stars are among the main contributors of stellar dust to the ISM. We present the first study of the refractory organic contribution of AGB stars to the ISM. Based on laboratory experiments, we included a new reaction in our extended chemical kinetics model: the photoprocessing of volatile complex ices into inert refractory organic material. The refractory organic feedback of AGB outflows to the ISM is estimated using observationally motivated parent species and grids of models of C-rich and O-rich outflows. Refractory organic material is mainly inherited from the gas phase through accretion on to the dust and subsequent photoprocessing. Grain-surface chemistry, initiated by photodissociation of ices, produces only a minor part and takes place in a sub-monolayer regime in almost all outflows. The formation of refractory organic material increases with outflow density and depends on the initial gas-phase composition. While O-rich dust is negligibly covered by refractory organics, C-rich dust has an average coverage of $3\!-\!9{{\ \rm per\ cent}}$, but can be as high as $8\!-\!22{{\ \rm per\ cent}}$. Although C-rich dust does not enter the ISM bare, its average coverage is too low to influence its evolution in the ISM or significantly contribute to the coverage of interstellar dust. This study opens up questions on the coverage of other dust-producing environments. It highlights the need for an improved understanding of dust formation and for models specific to density structures within the outflow.
Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study
Authors: Shepard Matthew J , Xu Zhiyuan , Kearns Kathryn , Li Chelsea , Chatrath Ajay , Sheehan Kimball , Sheehan Darrah , Faramand Andrew , Niranjan Ajay , Kano Hideyuki , Gurewitz Jason , Bernstein Kenneth , Liscak Roman , Guseynova Khumar , Grills Inga S , Parzen Jacob S , Cifarelli Christopher P , Rehman Azeem A , Atik Ahmet , Bakhsheshian Joshua , Zada Gabriel , Chang Eric , Giannotta Steven , Speckter Herwin , Wu Hsiu-mei , Kondziolka Douglas , Golfinos John G , Mathieu David , Lee Cheng-chia , Warnick Ronald E , Lunsford L Dade , Sheehan Jason P
Published: November 2020

BACKGROUND

Atypical and anaplastic meningiomas have reduced progression-free/overall survival (PFS/OS) compared to benign meningiomas. Stereotactic radiosurgery (SRS) for atypical meningiomas (AMs) and anaplastic meningiomas (malignant meningiomas, MMs) has not been adequately described.

OBJECTIVE

To define clinical/radiographic outcomes for patients undergoing SRS for AM/MMs.

METHODS

An international, multicenter, retrospective cohort study was performed to define clinical/imaging outcomes for patients receiving SRS for AM/MMs. Tumor progression was assessed with response assessment in neuro-oncology (RANO) criteria. Factors associated with PFS/OS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model.

RESULTS

A total of 271 patients received SRS for AMs (n = 233, 85.9%) or MMs (n = 38, 14.0%). Single-fraction SRS was most commonly employed (n = 264, 97.4%) with a mean target dose of 14.8 Gy. SRS was used as adjuvant treatment (n = 85, 31.4%), salvage therapy (n = 182, 67.2%), or primary therapy (1.5%). The 5-yr PFS/OS rate was 33.6% and 77.0%, respectively. Increasing age (hazard ratio (HR) = 1.01, P < .05) and a Ki-67 index > 15% (HR = 1.66, P < .03) negatively correlated with PFS. MMs (HR = 3.21, P < .05), increased age (HR = 1.04, P = .04), and reduced KPS (HR = 0.95, P = .04) were associated with shortened OS. Adjuvant versus salvage SRS did not impact PFS/OS. A shortened interval between surgery and SRS improved PFS for AMs (HR = 0.99, P = .02) on subgroup analysis. Radiation necrosis occurred in 34 (12.5%) patients. Five-year rates of repeat surgery/radiation were 33.8% and 60.4%, respectively.

CONCLUSION

AM/MMs remain challenging tumors to treat. Elevated proliferative indices are associated with tumor recurrence, while MMs have worse survival. SRS can control AM/MMs in the short term, but the 5-yr PFS rates are low, underscoring the need for improved treatment options for these patients.
The influence of nutrigenetics on biomarkers of selenium nutritional status
Authors: Donadio Janaina L S , Duarte Graziela B S , Borel Patrick , Cozzolino Silvia M F , Rogero Marcelo M
Published: November 2020

Selenium (Se) is an essential micronutrient for human biology that executes its functions as the amino acid selenocysteine via selenoproteins, which have important functions in, for example, antioxidation, immunomodulation, thyroid metabolism, and human fertility. Se nutritional status is assessed using the quantification of blood Se biomarkers, which are influenced by several factors, including diet, age, gender, smoking status, alcohol consumption, health condition, and the genetic characteristics of individuals. Nutrigenetic studies have identified single nucleotide polymorphisms in selenoproteins that might clarify the high variability in values reported for biomarkers of Se nutritional status in different populations, and the response of these biomarkers to Se supplementation with either organic or inorganic forms of Se. This review aims to (1) define the basic aspects of Se biology, (2) describe the current most commonly used biomarkers of Se nutritional status, and (3) provide a summary of associations between functional single nucleotide polymorphisms in selenoproteins and biomarkers of Se status in healthy populations.
An interesting case of temporal arteritis that manifested as ptosis and diplopia
Authors: Martis Anoka , Hassan Romesa Sajjad , Alburquerque Ana Goico , Kotte Manasa , Martis Anshu , Ahmed Hassan
Published: November 2020

Giant cell arteritis (GCA) or temporal arteritis is a granulomatous vasculitis that affects medium-to-large vessels seen primarily in older Caucasian populations. Here, we describe a 67-year-old male who presented with atypical symptoms of worsening headaches associated with left-sided pupil-sparing, isolated third nerve palsy, blurry vision, diplopia and myalgias in bilateral extremities. He was immediately started on intravenous Methylprednisolone for suspected GCA. Subsequent biopsy of the temporal arteries showed panarteritis without giant cells and disruption of the internal elastic lamina. His symptoms improved in a day following treatment and he was discharged on a Prednisone taper. At the time of writing this case, there are only two cases in the literature of ptosis as a presenting symptom in GCA, thus highlighting the importance of recognizing rare red flag symptoms such as ptosis and diplopia. More study is needed in the prognostic significance of these unusual clinical features.
Acute liver injury in a patient with adult-onset Still’s disease—the challenge of differential diagnosis
Authors: Weber Sabine , Gerbes Alexander L
Published: November 2020

In addition to the cardinal symptoms of fever, rash and arthralgia, liver involvement in patients with adult-onset Still’s disease (AOSD) has been described. However, acute liver injury in AOSD patients can have various other causes: it can be a result of an AOSD-induced macrophage activation syndrome or be associated to the drugs given for the underlying diseases and symptoms. Differential diagnosis can therefore be challenging. We here present a case of a 32-year-old male with acute liver injury following the initial diagnosis of AOSD to discuss the possible underlying reasons.
Hyper IgE syndrome (Job syndrome) in Syria: a case report
Authors: Awad Rama , Kakaje Ameer
Published: November 2020

Hyper IgE syndrome (HIES) is a medical condition that can be sporadic or hereditary. It consists of multiple overlapping primary immunodeficiency conditions and is characterized by a classical triad of high immunoglobulin E (IgE) levels, recurrent pneumonia with pneumatocele and recurrent cold skin abscesses from staphylococcus infections. Eosinophilia is also common in HIES patients. HIES is often underdiagnosed in Syria as it cannot be confirmed without genetic testing, which is unavailable across Syria for HIES. We present the first case from Syria of a suspected child with HIES that has some additional distinct features. Other cases in a regional country carried atypical novel mutations, which may indicate that these mutations may exist in Syria as well. However, our case had findings that were not reported with other HIES cases. Determining these genes in the case presented was not possible, and future studies need to overcome this hurdle.
The impact of different (rheumatoid) arthritis phenotypes on patients’ lives
Authors: Luurssen-Masurel Nathalie , Weel Angelique Elisabeth Adriana Maria , Hazes Johanna Maria Wilhelmina , de Jong Pascal Hendrik Pieter ,   the tREACH group investigators
Published: November 2020

Objectives

To compare patient-reported outcome (PRO) domains between three arthritis phenotypes [undifferentiated arthritis (UA), autoantibody-negative RA (RA−) and autoantibody-positive RA (RA+)] at diagnosis, after 2 years and over time.

Methods

All UA (n = 130), RA− (n = 176) and RA+ (n = 331) patients from the tREACH trial, a stratified single-blinded trial with a treat-to-target approach, were used. PRO comparisons between phenotypes at baseline and after 2 years were performed with analysis of variance, while a linear mixed model compared them over time. Effect sizes were weighted against the minimal clinically important differences (MCIDs) for each PRO.

Results

RA− patients had a higher disease burden compared with RA+ and UA. At baseline and after 2 years, RA− patients had more functional impairment and a poorer Physical Component Summary (PCS) compared with the other phenotypes, while they only scored worse for general health and morning stiffness duration at baseline. The MCIDs were exceeded at baseline, except for functional ability between RA+ and UA, while after 2 years only the MCID of the PCS was exceeded by RA− compared with UA and RA. After 2 years the PROs of all phenotypes improved, but PROs measuring functioning were still worse compared with the general population, even when patients had low disease activity.

Conclusion

RA− patients had the highest disease burden of all phenotypes. Although most patients have low disease activity after treatment, all clinical phenotypes still have a similar significant impact on patients’ lives, which is mainly physical. Therefore it is important to assess and address PROs in daily practice because of persistent disease burden despite low disease activity.

Trial registration

ISRCTN26791028.
OSL CHARACTERISTICS: THEORY AND EXPERIMENTS
Authors: Chruścińska Alicja , Palczewski Piotr
Published: November 2020

Fundamental effects such as the participation of crystal lattice vibrations should be taken into account while considering photo-ionisation in solids at measurement temperatures characteristic for dosimetric applications. The impact of these effects on the optically stimulated luminescence (OSL) can be recognised for example by changes in the optical cross-section of the trap with the stimulation energy and the temperature. The OSL signal observed during the stimulation with variable energy, during the linear heating of a sample or during the stimulation with modulation of the shape of a spectral band can provide important information about the properties of the trap. Moreover, such methods when applied with carefully selected experimental parameters enable the effective separation of the OSL signal originating from different traps. The consequences of such an approach to optical stimulation will be presented using the modelling of the OSL process and compared with experimental results.
Clinico-Etiological Profile of Children with Pericardial Effusion in a Tertiary Care Hospital in Eastern India
Authors: Malgope Rahul , Basu Suprit , Sinha Malay Kumar
Published: November 2020

Introduction

Pericardial effusion may be due to various causes. With the changing scenario of newer generation antibiotics and robust immunization program our aim is to identify the change, if any, in etiology and disease menifestations.

Methodology

This is a hospital-based uni-center prospective study with a population of 30 children for a period of 1½ year. Clinico-epidemiological features, investigations, complications and short-term outcome were assessed.

Results

We found 13 (43.33%) patients having mild, 11 (36.67%) had moderate and 6 (20%) had severe pericardial effusion. Cardiac tamponade was present in six cases. Among the study population 9 (30%) patients were diagnosed as having pyogenic pericardial effusion and 8 (26.67%) had tubercular effusion. The predominant symptoms of pericardial effusion in our children were fever and tachycardia (83.33%).Other symptoms at presentation were tachycardia (76.67%), cough (63.33%), chest pain (50%), orthopnea (43.33%) and skin rash (16.67%). Pericardiocentesis was done in 14 cases (46.67%) of which 4 patients (13.33%) required pig tail catheterization.

Discussion

Infectious etiology still remains the primary cause of pericardial effusion in our country. The presenting clinical signs are very much nonspecific and also not so prominent unless hemodynamic compromisation occurs.

Conclusion

This study showed that bacterial and tubercular pericardial effusions are still two most prevalent etiological diagnosis in this part of country. Early diagnosis and treatment has good outcome.
Disability, mental health, stigma and discrimination and neglected tropical diseases
Authors: Kuper Hannah
Published: November 2020

The neglected tropical disease (NTD) agenda should include a focus on disability when ‘planning for the next decade of progress’. Millions of people are currently living with the disabling consequences of NTDs and mental health conditions are frequent among people living with NTDs. Stigma around NTDs is also common. However, these aspects of NTDs are often ignored by programmes that focus on infectious disease control. NTD programmes must broaden in scope to include provision of rehabilitation and linkages to mental health support and tackling stigma through demystifying NTDs. These efforts will promote the inclusion and well-being of people living with NTDs.
Novel NGS pipeline for virus discovery from a wide spectrum of hosts and sample types
Authors: Plyusnin Ilya , Kant Ravi , Jääskeläinen Anne J , Sironen Tarja , Holm Liisa , Vapalahti Olli , Smura Teemu
Published: November 2020

The study of the microbiome data holds great potential for elucidating the biological and metabolic functioning of living organisms and their role in the environment. Metagenomic analyses have shown that humans, along with for example, domestic animals, wildlife and arthropods, are colonized by an immense community of viruses. The current Coronavirus pandemic (COVID-19) heightens the need to rapidly detect previously unknown viruses in an unbiased way. The increasing availability of metagenomic data in this era of next-generation sequencing (NGS), along with increasingly affordable sequencing technologies, highlight the need for reliable and comprehensive methods to manage such data. In this article, we present a novel bioinformatics pipeline called LAZYPIPE for identifying both previously known and novel viruses in host associated or environmental samples and give examples of virus discovery based on it. LAZYPIPE is a Unix-based pipeline for automated assembling and taxonomic profiling of NGS libraries implemented as a collection of C++, Perl, and R scripts.
Addressing Climate Change and Its Effects on Human Health: A Call to Action for Medical Schools
Authors: Goshua Anna , Gomez Jason , Erny Barbara , Burke Marshall , Luby Stephen , Sokolow Susanne , LaBeaud A. Desiree , Auerbach Paul , Gisondi Michael A. , Nadeau Kari
Published: November 2020

Human health is increasingly threatened by rapid and widespread changes in the environment and climate, including rising temperatures, air and water pollution, disease vector migration, floods, and droughts. In the United States, many medical schools, the American Medical Association, and the National Academy of Sciences have published calls for physicians and physicians-in-training to develop a basic knowledge of the science of climate change and an awareness of the associated health risks. The authors—all medical students and educators—argue for the expeditious redesign of medical school curricula to teach students to recognize, diagnose, and treat the many health conditions exacerbated by climate change as well as understand public health issues. In this Invited Commentary, the authors briefly review the health impacts of climate change, examine current climate change course offerings and proposals, and describe the rationale for promptly and comprehensively including climate science education in medical school curricula. Efforts in training physicians now will benefit those physicians’ communities whose health will be impacted by a period of remarkable climate change. The bottom line is that the health effects of climate reality cannot be ignored, and people everywhere must adapt as quickly as possible.
Association of Chloride Ion and Sodium-Chloride Difference With Acute Kidney Injury and Mortality in Critically Ill Patients
Authors: Kimura Satoshi , de la Hoz Miguel Angel Armengol , Raines Nathan Hutzel , Celi Leo Anthony
Published: November 2020

Objectives:

Derangements of chloride ion concentration ([Cl–]) have been shown to be associated with acute kidney injury and other adverse outcomes. For a physicochemical approach, however, chloride ion concentration should be considered with sodium ion concentration. This study aimed to examine the association of chloride ion concentration and the main strong ion difference (difference between sodium ion concentration and chloride ion concentration) during the first 24 hours after admission into ICU with the development of acute kidney injury and mortality.

Design:

Retrospective analyses using the eICU Collaborative Research Database.

Setting:

ICUs in 208 hospitals across the United States between 2014 and 2015.

Patients:

Critically ill patients who were admitted into the ICU.

Interventions:

None.

Measurements and Main Results:

A total of 34,801 patients records were analyzed. A multivariable logistic regression analysis for the development of acute kidney injury within 7 days of ICU admission shows that, compared with main strong iron difference 32–34 mEq/as a reference, there were significantly high odds for the development of acute kidney injury in nearly all groups with main strong iron difference more than 34 mEq/L (main strong iron difference = 34–36 mEq/L, odds ratio = 1.17, p = 0.02; main strong iron difference = 38–40 mEq/L, odds ratio = 1.40, p < 0.001; main strong iron difference = 40–42 mEq/L, odds ratio = 1.46, p = 0.001; main strong iron difference > 42 mEq/L, odds ratio = 1.56, p < 0.001). With chloride ion concentration 104–106 mEq/L as a reference, the odds for acute kidney injury were significantly higher only in chloride ion concentration less than or equal to 94 mEq/L and chloride ion concentration 98–100 mEq/L groups. Analyses conducted using inverse probability weighting showed significantly greater odds for ICU mortality in all groups with main strong iron difference greater than 34mEq/L other than the 36–38mEq/L group, as well as in the less than 26-mEq/L group.

Conclusions:

Main strong iron difference measured on ICU presentation to the ICU predicts acute kidney injury within 7 days, with low and, in particular, high values representing increased risk. The association between the chloride levels and acute kidney injury is statistically insignificant in models incorporating main strong iron difference, suggesting main strong iron difference is a better predictive marker than chloride on ICU admission.
Patients’ and Their Caregivers’ Interest in Learning About Post-ICU Syndrome and Seeking Help for It
Authors: Weinhouse Gerald L. , Salomon Stacey , Nisotel Lauren , Levy-Carrick Nomi C. , Lamas Daniela
Published: November 2020

Critical Illness Recovery Programs report low attendance. We aimed to provide information about postintensive care syndrome and to learn which patients would pursue help in a Critical Illness Recovery Clinic.

All patients who checked in to our Lung Center were given a survey regarding their ICU experience and offered information about postintensive care syndrome and an appointment in the clinic.

Nine hundred and twenty respondents reported having had an ICU experience: 37% of former ICU patients reported difficulty returning to their normal lives afterward compared with 21% who were family or close friends of a former ICU patient. Only 5% requested information and less than 1% requested a dedicated appointment.

More than one of three former ICU patients and one in five close friends or relatives of former ICU patients reported difficulty returning to their normal lives after their ICU experience. Very few pursued the opportunity to learn more about it or seek help.
Digital PCR for BCR‐ABL1 Quantification in CML: Current Applications in Clinical Practice
Authors: Kockerols Camille C.B. , Valk Peter J.M. , Levin Mark‐David , Pallisgaard Niels , Cornelissen Jan J. , Westerweel Peter E.
Published: November 2020

Molecular monitoring of the BCR‐ABL1 transcript for patients with chronic phase chronic myeloid leukemia (CML) has become increasingly demanding. Real‐time quantitative PCR (qPCR) is the routinely used method, but has limitations in quantification accuracy due to its inherent technical variation. Treatment recommendations rely on specific BCR‐ABL1 values set at timed response milestones, making precise measurement of BCR‐ABL1 a requisite. Furthermore, the sensitivity of qPCR may be insufficient to reliably quantify low levels of residual BCR‐ABL1 in patients in deep molecular response (DMR) who could qualify for an attempt to discontinue Tyrosine Kinase Inhibitor (TKI) therapy. We reviewed the current use of digital PCR (dPCR) as a promising alternative for response monitoring in CML. dPCR offers an absolute BCR‐ABL1 quantification at various disease levels with remarkable precision and a clinical sensitivity reaching down to at least MR5.0. Moreover, dPCR has been validated in multiple studies as prognostic marker for successful TKI treatment discontinuation, while this could not be achieved using classical qPCR. dPCR may thus prospectively be the preferred method to reliably identify patients achieving treatment milestones after initiation of TKI therapy as well as for the selection and timing for TKI discontinuation.
A Journey Through Myeloma Evolution: From the Normal Plasma Cell to Disease Complexity
Authors: Da Vià Matteo C. , Ziccheddu Bachisio , Maeda Akihiro , Bagnoli Filippo , Perrone Giulia , Bolli Niccolò
Published: November 2020

The knowledge of cancer origin and the subsequent tracking of disease evolution represent unmet needs that will soon be within clinical reach. This will provide the opportunity to improve patient's stratification and to personalize treatments based on cancer biology along its life history. In this review, we focus on the molecular pathogenesis of multiple myeloma (MM), a hematologic malignancy with a well‐known multi‐stage disease course, where such approach can sooner translate into a clinical benefit. We describe novel insights into modes and timing of disease initiation. We dissect the biology of the preclinical and pre‐malignant phases, elucidating how knowledge of the genomics of the disease and the composition of the microenvironment allow stratification of patients based on risk of disease progression. Then, we explore cell‐intrinsic and cell‐extrinsic drivers of MM evolution to symptomatic disease. Finally, we discuss how this may relate to the development of refractory disease after treatment. By integrating an evolutionary view of myeloma biology with the recent acquisitions on its clonal heterogeneity, we envision a way to drive the clinical management of the disease based on its detailed biological features more than surrogates of disease burden.
SILICONE OIL VERSUS PERFLUOROPROPANE GAS TAMPONADE DURING VITRECTOMY FOR TRACTIONAL RETINAL DETACHMENT OR FIBROUS PROLIFERATION
Authors: Rush Ryan B. , Del Valle Penella Agustin , Reinauer Robert M. , Rush Sloan W. , Bastar Pedro G.
Published: November 2020

Purpose:

To compare vitreous substitution with silicone oil to perfluoropropane gas in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy (PPV) for the treatment of tractional retinal detachment or extensive fibrous proliferation.

Design:

Randomized clinical trial.

Methods:

Three hundred and two proliferative diabetic retinopathy subjects with tractional retinal detachment or extensive fibrous proliferation requiring PPV were enrolled into the trial. Subjects were prospectively randomized into one of two vitreous substitution groups during PPV: Group A subjects underwent 1,000 centistoke silicone oil tamponade, whereas Group B subjects underwent 14% to 16% silicone oil to perfluoropropane gas tamponade. The principal outcome was the best-corrected visual acuity at 6-month follow-up. Secondary outcomes were postoperative complications and unplanned PPV during the 6-month trial interval.

Results:

Two hundred and fifty-eight subjects were randomized to receive a vitreous substitute and completed 6-month follow-up. Group B had better best-corrected visual acuity, more subjects ending up with 0.4 logarithm of the minimum angle of resolution (20/50) or better visual acuity, and more subjects ending up with 1 logarithm of the minimum angle of resolution (20/200) or better visual acuity at 6 months compared with Group A (P < 0.001, P = 0.02, P < 0.001, respectively). There were no significant differences in baseline characteristics, intraoperative or postoperative complications, or incidence of unplanned PPV between groups.

Conclusion:

This trial demonstrated that vitreous substitution with silicone oil to perfluoropropane gas resulted in better visual acuity at 6 months compared with silicone oil tamponade in proliferative diabetic retinopathy patients undergoing PPV for tractional retinal detachment or extensive fibrous proliferation. Surgeons should consider silicone oil to perfluoropropane gas tamponade as the first-line vitreous substitute in this patient population.
Aerosol generation during phacoemulsification in live patient cataract surgery environment
Authors: Kaur Simerdip , Kopsachilis Nick , Zia Rashid
Published: November 2020

Purpose:

To investigate whether phacoemulsification is an aerosol-generating procedure in a live patient environment.

Setting:

New Hayesbank Ophthalmology Services, Kent, United Kingdom.

Design:

In vivo experimental human eyes study.

Methods:

Aerosol particle counts sized 0.3 μm or lesser, more than 0.3 to 0.5 μm or lesser, more than 0.5 to 1 μm or lesser, more than 1 to 2.5 μm or lesser, more than 2.5 to 5 μm or lesser, and more than 5 to 10 μm or lesser were measured during elective phacoemulsification surgery of 25 eyes. The baseline particle count in the operating theater was measured on 2 separate days to assess for fluctuation. Then, 5 readings each during prephacoemulsification and phacoemulsification of all eyes were measured. The difference in aerosol generation during prephacoemulsification and phacoemulsification was also measured with the use of the mobile laminar air flow (LAF) machine. Finally, aerosol generation during phacoemulsification was measured using 2% hydroxypropyl methylcellulose (HPMC).

Results:

There was no statistically significant difference in measurement of aerosol between the baseline measurements on both days and between each patient's prephacoemulsification and phacoemulsification stages of surgery. The LAF system showed statistically significant reduction in particles size of 0.3 μm or lesser, more than 0.3 to 0.5 μm or lesser, more than 0.5 to 1 μm or lesser, more than 1 to 2.5 μm or lesser, more than 2.5 to 5 μm or lesser, and more than 5 to 10 μm during phacoemulsification compared with that during prephacoemulsification (P value .00 for all particle sizes, t test). The use of 2% HPMC did not show any statistically significant reduction in particle measurements.

Conclusions:

Aerosol particles sized less than 10 μm are not produced during phacoemulsification of human crystalline lens in a live patient setting. The use of a mobile LAF machine significantly reduced the number of particles sized 10 μm or lesser within the surgical field.
Systemic supplemental oxygen therapy during accelerated corneal crosslinking for progressive keratoconus: randomized clinical trial
Authors: Faramarzi Amir , Hassanpour Kiana , Rahmani Baharan , Yazdani Shahin , Kheiri Bahareh , Sadoughi Mohammad-Mehdi
Published: November 2020

Purpose:

To investigate the potential additive effect of systemic supplemental oxygen administered during accelerated corneal crosslinking (CXL) for progressive keratoconus (KC).

Setting:

Academic center.

Design:

Randomized clinical trial.

Methods:

Eyes with progressive KC randomized to 3 different CXL protocols were included. The first group (OA-CXL) included 19 eyes that underwent an accelerated CXL protocol (9 mW/cm2 for 10 minutes) while receiving systemic oxygen at a rate of 5 L/min for 10 minutes. The second group consisted of 14 eyes undergoing the same accelerated CXL protocol without supplemental oxygen therapy (A-CXL). The third group (C-CXL) comprised 14 eyes undergoing conventional CXL according to the Dresden protocol. All subjects were followed up for at least 6 months. Visual acuity, keratometry and corneal biomechanical parameters including corneal hysteresis and corneal resistance factor (CRF) were measured preoperatively and 6 months postoperatively.

Results:

Reduction in maximum keratometry (Kmax) was significantly greater in the OA-CXL group (P = .01). At baseline, the mean Kmax was 54.31 ± 3.64 diopters (D) in the OA-CXL group, 54.66 ± 4.99 D in the A-CXL group, and 56.03 ± 5.28 D in the C-CXL group (P = .58), which reached 53.58 ± 3.24 D, 54.59 ± 4.65 D, and 55.87 ± 4.73 D at 6 months in the 3 study groups, respectively (P = .115). The mean CRF increased significantly only in the OA-CXL group from a baseline value of 6.32 ± 2.12 mm Hg to 7.38 ± 1.88 mm Hg at 6 months (P = .009).

Conclusions:

This study suggests superior efficacy of an accelerated CXL protocol coupled with systemic oxygen supplementation when compared with the accelerated CXL protocol and the conventional protocol in eyes with progressive KC. In addition to greater reduction in Kmax as the primary outcome, improvement in corneal biomechanics was also observed at 6 months.
Headache in girls and boys growing up from age 11 to 20 years: the Prevention and Incidence of Asthma and Mite Allergy birth cohort study
Authors: Wijga Alet H. , Gehring Ulrike , van de Putte Elise M. , Koppelman Gerard H. , Vader Sarah , Schmits Ruben J.H. , van der Wouden Johannes C. , Picavet H. Susan J.
Published: November 2020

The striking difference between men and women in headache prevalence is suggested to develop in adolescence. Although headaches are common and affect quality of life and daily functioning, the evidence needed to develop effective counselling and preventive approaches is still limited. Using data collected at age 11, 14, 17, and 20 years in the Dutch Prevention and Incidence of Asthma and Mite Allergy birth cohort study (n = 3064 with ≥ 1 questionnaire), we assessed headache prevalence and incidence in girls and boys and explored associations with early life, environmental, lifestyle, health, and psychosocial factors. Associations were analysed longitudinally with generalized linear mixed models and discrete time hazard models. From age 11 to 20 years, the prevalence of headache increased from 9.4% to 19.8% in girls and hardly changed in boys (7.6%-6.1%). Headache commonly co-occurred with other unfavorable health and psychosocial conditions. Eighty-eight percent of the girls and 76% of boys with headache also reported at least one of the following at age 17: sleeping problems, asthma, hay fever, musculoskeletal complaints, fatigue, low mental health, or worrying. Results suggest higher headache prevalence in adolescents following lower educational tracks, in those who skip breakfast ≥2 days per week, and in boys exposed to tobacco smoke in infancy. In girls, sleeping problems and musculoskeletal complaints were associated with higher odds of incident headache and residential greenness with lower odds of incident headache. The high prevalence and strong female predominance of headache, already in adolescence and often with comorbidities, deserve recognition by professionals in (preventive) health care settings and schools.
Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts transcutaneous electrical nerve stimulation responders in women with fibromyalgia
Authors: Vance Carol G.T. , Zimmerman M. Bridget , Dailey Dana L. , Rakel Barbara A. , Geasland Katharine M. , Chimenti Ruth L. , Williams Jon M. , Golchha Meenakshi , Crofford Leslie J. , Sluka Kathleen A.
Published: November 2020

We previously showed that 1 month of transcutaneous electrical nerve stimulation (TENS) reduces movement-evoked pain and fatigue in women with fibromyalgia (FM). Using data from this study (Fibromyalgia Activity Study with TENS [FAST]), we performed a responder analysis to identify predictors of clinical improvement in pain and fatigue with TENS, validated these models using receiver operator characteristic, and determined number needed to treat and number needed to harm. Participants were randomly assigned to active-TENS (2-125 Hz; highest-tolerable intensity), placebo-TENS, or no-TENS for 1 month. At the end of the randomized phase, placebo-TENS and no-TENS groups received active-TENS for 1 month. The predictor model was developed using data from the randomized phase for the active-TENS group (n = 103) and validated using data from placebo-TENS and no-TENS groups after active-TENS for 1 month (n = 155). Participant characteristics, initial response to TENS for pain and fatigue, sleep, psychological factors, and function were screened for association with changes in pain or fatigue using a logistic regression model. Predictors of clinical improvement in pain were initial response to pain and widespread pain index (area under the curve was 0.80; 95% confidence interval: 0.73-0.87). Predictors of clinical improvement in fatigue were marital status, sleep impairment, and initial response to TENS (area under the curve was 0.67; 95% confidence interval: 0.58-0.75). Number needed to treat for pain and fatigue ranged between 3.3 and 5.3. Number needed to harm ranged from 20 to 100 for minor TENS-related adverse events. The response to an initial 30-minute TENS treatment predicts who responds to longer-term TENS use in women with FM, making this a clinically useful procedure. Number needed to treat and number needed to harm suggest that TENS is effective and safe for managing pain and fatigue in FM.
Immunoreactive Acellular Keratin in Sentinel Lymph Nodes From a Patient With Endometrioid Carcinoma of the Endometrium With Squamous Differentiation: A Case Report of a Potential Diagnostic Pitfall
Authors: Salisbury Taylor , Gilks C. Blake
Published: November 2020

Sentinel lymph node biopsy is gaining increasing acceptance as a less morbid way to assess lymph node status in patients with endometrial carcinoma, compared with full pelvic node dissection. The sentinel nodes are usually subjected to ultrastaging, with sections taken at multiple levels from each block and immunstaining for keratin performed, in order to detect micrometastses. We report a case of an 80-yr-old woman who underwent a right sentinel lymph node biopsy at the time of surgery for clinically and radiologically apparent stage I endometrial endometrioid adenocarcinoma. The immunostains for AE1/AE3 performed on the 2 right pelvic sentinel lymph nodes were positive, corresponding to subcapsular acellular keratin on hematoxylin and eosin; however, carcinoma cells could not be identified on the hematoxylin and eosin–stained slides. Immunomarkers for Ber-EP4 and EMA, both of which were strongly expressed in the endometrial carcinoma cells, were negative on the nodal tissue, and we concluded that the sentinel lymph nodes were negative for metastatic carcinoma, despite the positive keratin immunostains. To our knowledge, this unusual finding is not described in the literature; recognition of this phenomenon and study of additional cases is warranted.
Mitotically Active Cellular Fibroma of the Ovary Recurring After the Longest Interval of Time (16 yr): A Challenging Case With Systematic Literature Review
Authors: Olivadese Rocco , Ramponi Antonio , Boldorini Renzo , Dalla Dea Giulia , Palicelli Andrea
Published: November 2020

Cellular fibromas represent ~10% of ovarian fibromas. Mitotically active cellular fibromas show mild nuclear atypia but ≥4 mitoses/10 high-power fields: the clinical course is usually uneventful but literature review is lacking. A 34-yr-old woman underwent left oophorectomy for a 9-cm ovarian mitotically active cellular fibroma at another hospital. The tumor was cellular (spindle cells in fascicular and storiform patterns) revealing mild atypia and 4 nonatypical mitoses/10 high-power fields without necrotic areas. After 16 yr, the tumor recurred as a 5-cm peritoneal nodule on the anterior sigmoid wall near the sigmoid-rectal junction. Frozen section revealed a spindle cell tumor invading the intestinal tunica muscularis propria: a gastrointestinal stromal tumor was favored as previous history was unavailable at that time. Intestinal resection was performed: no residual tumor was found. The patient was followed-up for 8 yr without further recurrences. The peritoneal nodule showed 2 mitoses/10 high-power fields and pericellular reticulin staining. The tumor was variably positive for vimentin/bcl-2/melan-A/CD56/ER/PR/α-inhibin/CD10/calretinin, focally positive for desmin, negative for pan-cytokeratin/actin/EMA/CD34/HMB45/CD117/CD99/S100/synaptophysin. The Ki67-index was ~9%. To our systematic literature review, 7 additional recurrent cases were reported. We describe a mitotically active cellular fibroma recurring after the longest interval of time. Extensive sampling of difficult cases should exclude malignant areas. Moderate nuclear atypia, tumor rupture, adhesions to pelvic/abdominal organs, infarction with extraovarian involvement, and incomplete excision may lead to relapse but there are conflicting data: prolonged follow-up can be suggested in these cases.
Influence of Monobloc/Le Fort III Surgery on the Developing Posterior Maxillary Dentition and Its Resultant Effect on Orthognathic Surgery
Authors: Yang Robin , Shakoori Pasha , Lanni Michael A. , Nah Hyun-Duck , Scott Michelle , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: November 2020

Background:

Timing of frontofacial surgery for the syndromic craniosynostosis as it relates to various surgical risks has not been adequately studied. The purpose of this study was to investigate posterior dental complications of midface advancement in patients with syndromic craniosynostosis undergoing surgery at different ages and the effects on subsequent orthognathic surgery.

Methods:

A retrospective chart review of patients with syndromic craniosynostosis treated with midface advancement (monobloc or Le Fort III) from 1999 to 2018 was carried out. Patient demographics, records, and imaging studies were reviewed. A subanalysis of those patients who were also treated with orthognathic surgery from 2014 to 2018 with imaging studies available for analysis was also performed.

Results:

Thirty-seven patients met the inclusion criteria. Sixty-four percent of the patients had radiographic evidence of maxillary molar dental abnormality. Older age at the time of surgery was significantly associated with a lower odds of sustaining dental injury (OR, 0.55; p = 0.034). The odds of damaging second or third maxillary molars was significantly higher with a younger age at the time of surgery (p = 0.021 and p = 0.034). The odds of sustaining dental injury increased moving posteriorly, showing the risk of abnormal pattern of M3 greater than M2 greater than M1. Advanced age at the time of surgery was significantly associated with decreased odds of dental injury (OR, 0.55; p = 0.034).

Conclusions:

Damage to the developing permanent maxillary molars may affect orthodontic management, mastication, and potentially maxillary development. Delaying frontofacial surgery until development of the permanent maxillary dentition should be considered if other indications do not mandate earlier intervention.
Human CD206+ Macrophages Show Antifibrotic Effects on Human Fibroblasts through an IL-6–Dependent Mechanism In Vitro
Authors: Kurachi Isao , Kurita Erina , Takushima Akihiko , Suga Hirotaka
Published: November 2020

Background:

Pathologic scarring including keloid and hypertrophic scar causes aesthetic and physical problems, and there are clinical difficulties (e.g., posttreatment recurrence) in dealing with pathologic scarring. Understanding the mechanisms that underlie scar control in wound healing will help prevent and treat pathologic scarring. The authors focused on CD206+ macrophages in the wound-healing process, and hypothesized that CD206+ macrophages have antifibrotic effects on fibroblasts.

Methods:

The authors established a co-culture system for CD206+ macrophages and fibroblasts (cell ratio, 1:1). The authors examined the CD206+ macrophages’ antifibrotic effects on fibroblasts after a 72-hour culture, focusing on fibrosis-related genes. To identify key factor(s) in the interaction between CD206+ macrophages and fibroblasts, the authors analyzed cytokines in a conditioned medium of the co-culture system.

Results:

Under co-culture with CD206+ macrophages, expression of the following in the fibroblasts was significantly down-regulated: type 1 (fold change, 0.38) and type 3 collagen (0.45), alpha smooth muscle actin (0.24), connective tissue growth factor (0.40), and transforming growth factor-beta (0.66); the expression of matrix metalloproteinase 1 was significantly up-regulated (1.92). Conditioned medium in the co-culture showed a high interleukin (IL)-6 concentration (419 ± 88 pg/ml). When IL-6 was added to fibroblasts, antifibrotic changes in gene expression (as observed under the co-culture) occurred in the fibroblasts.

Conclusions:

The authors’ in vitro results revealed that CD206+ macrophages have antifibrotic effects on fibroblasts by means of a paracrine mechanism involving IL-6. Understanding these effects, especially in vivo, will help elucidate the mechanism of scar control in wound healing and contribute to the development of new scar treatments.
Standardized Perioperative Patient Education Decreases Opioid Use after Hand Surgery: A Randomized Controlled Trial
Authors: Stepan Jeffrey G. , Sacks Hayley A. , Verret Claire Isabelle , Wessel Lauren E. , Kumar Kanupriya , Fufa Duretti T.
Published: November 2020

Background:

Despite the growing hand surgery literature on postoperative opioid use, there is little research focused on patient-centered interventions. The purpose of this randomized controlled trial was to create a standardized patient education program regarding postoperative pain management after hand surgery and to determine whether that education program would decrease postoperative opioid use.

Methods:

Patients scheduled to undergo ambulatory hand surgery were recruited and randomized to standardized pain management education or standard of care. All patients received a webinar with instructions for study participation, whereas the education group received an additional 10 minutes of education on postoperative pain management. All patients completed a postoperative daily log documenting opioid consumption. The total number of opioid pills consumed was compared between groups. The authors constructed a linear regression model to determine risk factors for postoperative opioid use after surgery.

Results:

A total of 267 patients were enrolled in the study. One hundred ninety-one patients completed the study (standardized education, n = 93; control group, n = 97). Patients in the standardized education group were more likely to take no opioid medication (42 percent versus 25 percent; p = 0.01) and took significantly fewer opioid pills (median, two) than those in the control group (median, five) (p < 0.001). Standardized education predicted decreased postoperative opioid pill consumption, whereas higher number of pills prescribed and a history of psychiatric illness were risk factors for increasing opioid use.

Conclusion:

Perioperative patient education and limitation of postoperative opioid prescription sizes reduced postoperative opioid use following ambulatory hand surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Efficacy of cariprazine in bipolar I depression across patient characteristics: a post hoc analysis of pooled randomized, placebo-controlled studies
Authors: Patel Mehul , Jain Rakesh , Tohen Mauricio , Maletic Vladimir , Earley Willie R. , Yatham Lakshmi N.
Published: November 2020

Patients who experience bipolar depression have diverse demographic and clinical characteristics that have the potential to impact treatment. The efficacy of cariprazine in bipolar I depression was evaluated in patient subgroups defined by baseline demographic and clinical characteristics. Post hoc analyses of data from three randomized, double-blind, placebo-controlled trials in bipolar I depression (NCT01396447, NCT02670538 and NCT02670551) evaluated mean change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total scores for pooled cariprazine 1.5–3 mg/d versus placebo in subgroups defined by demographic and clinical characteristics. The least-squares mean difference in MADRS total score change from baseline was statistically significant for cariprazine 1.5–3 mg/d versus placebo in all patient subgroups analyzed (P < 0.05 all subgroups): demographic characteristics (age, sex, white or black race and obese/nonobese BMI); episode characteristics (defined by current episode duration, number of previous manic/mixed and depressive episodes, and prior bipolar disorder medication use) and disease severity (groups above and below Clinical Global Impressions-Severity and MADRS cutoff scores). Cariprazine 1.5–3 mg/d consistently improved depressive symptoms in all patient subgroups without regard to differences in baseline demographic and clinical characteristics, suggesting broad efficacy across a spectrum of patients with bipolar I depression.