bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoplastic and immune single-cell transcriptomics define subgroup-specific intra-tumoral heterogeneity of childhood medulloblastoma
Authors: Riemondy Kent A , Venkataraman Sujatha , Willard Nicholas , Nellan Anandani , Sanford Bridget , Griesinger Andrea M , Amani Vladimir , Mitra Siddhartha , Hankinson Todd C , Handler Michael H , Sill Martin , Ocasio Jennifer , Weir Seth J , Malawsky Daniel S , Gershon Timothy R , Garancher Alexandra , Wechsler-Reya Robert J , Hesselberth Jay R , Foreman Nicholas K , Donson Andrew M , Vibhakar Rajeev
Published: May 2021

Background

Medulloblastoma (MB) is a heterogeneous disease in which neoplastic cells and associated immune cells contribute to disease progression. We aimed to determine the influence of neoplastic and immune cell diversity on MB biology in patient samples and animal models.

Methods

To better characterize cellular heterogeneity in MB we used single-cell RNA sequencing, immunohistochemistry, and deconvolution of transcriptomic data to profile neoplastic and immune populations in patient samples and animal models across childhood MB subgroups.

Results

Neoplastic cells cluster primarily according to individual sample of origin which is influenced by chromosomal copy number variance. Harmony alignment reveals novel MB subgroup/subtype-associated subpopulations that recapitulate neurodevelopmental processes, including photoreceptor and glutamatergic neuron-like cells in molecular subgroups GP3 and GP4, and a specific nodule-associated neuronally differentiated subpopulation in the sonic hedgehog subgroup. We definitively chart the spectrum of MB immune cell infiltrates, which include subpopulations that recapitulate developmentally related neuron-pruning and antigen-presenting myeloid cells. MB cellular diversity matching human samples is mirrored in subgroup-specific mouse models of MB.

Conclusions

These findings provide a clearer understanding of the diverse neoplastic and immune cell subpopulations that constitute the MB microenvironment.
Occupational causes of hypersensitivity pneumonitis: a systematic review and compendium
Authors: Kongsupon N , Walters G I , Sadhra S S
Published: May 2021

Background

Hypersensitivity pneumonitis (HP) is caused by a variety of antigens and low-molecular-weight chemicals, often through occupational exposure. Making a diagnosis of HP and identifying a cause are challenging. Cryptogenic cases are frequently reported, and missing or incomplete exposure histories can cause misclassification.

Aims

To provide an evidence-based compendium of sources of exposure and causes of HP for the clinician, through systematic review of medical literature.

Methods

Articles related to HP causative agents and occupational exposure were searched from the databases OVID Medline (1946 to October 2020) and EMBASE (1974 to October 2020). Abstracts and full texts of articles were screened by two reviewers. Data on causative antigens, occupational source of exposure and any associated eponymous name were extracted and grouped according to source of exposure.

Results

A total of 1790 articles were identified, from which 305 articles met the inclusion criteria. An additional 22 articles were identified from citation lists of the selected review articles. Sources of exposure identified for HP were sorted into 14 categories of work (agricultural, plant matter processing, wood, animal-related, foodstuff, food processing, metal processing, polymers, other manufacturing, chemicals, aerosolized water, service, waste and sewage and wind instruments).

Conclusions

This work is a comprehensive list of occupational causative agents and exposures causing HP. Cases are grouped by source of exposure, allowing an immediately accessible compendium of causes for use during occupational exposure assessment, which could also form the basis for a clinical questionnaire.
The Thought From the Machine: Neural Basis of Thoughts With a Coherent and Diminished Sense of Authorship
Authors: Klock Leonie , Voss Martin , Weichenberger Markus , Kathmann Norbert , Kühn Simone
Published: May 2021

Patients with schizophrenia who experience inserted thoughts report a diminished sense of thought authorship. Based on its elusive neural basis, this functional neuroimaging study used a novel setup to convince healthy participants that a technical device triggers thoughts in their stream of consciousness. Self-reports indicate that participants experienced their thoughts as self-generated when they believed the (fake) device was deactivated, and attributed their thoughts externally when they believed the device was activated—an experience usually only reported by patients diagnosed with schizophrenia. Distinct activations in the medial prefrontal cortex (mPFC) were observed: ventral mPFC activation was linked to a sense of thought authorship and dorsal mPFC activation to a diminished sense of thought authorship. This functional differentiation corresponds to research on self- and other-oriented reflection processes and on patients with schizophrenia who show abnormal mPFC activation. Results thus support the notion that the mPFC might be involved in thought authorship as well as anomalous self-experiences.
Do Skilled Nursing Facilities That Provide More Rehabilitation Therapy Have Lower Rehospitalization Rates?
Authors: Chen Amanda , Unruh Mark Aaron , Jung Hye-Young
Published: May 2021

This study examines whether skilled nursing facilities (SNFs) that consistently provided more rehabilitation therapy than other SNFs had lower 30-day rehospitalization rates. A cross-sectional analysis of 11 866 SNFs in the United States compared 30-day rehospitalization rates of SNFs that consistently provided more rehabilitation therapy to other SNFs using linear regression models. High-billing SNFs were defined as the 10% of SNFs with the highest proportions of Medicare fee-for-service claims that just surpassed the therapy minute threshold for the highest payment category. After controlling for patient and facility characteristics, high-billing SNFs had higher 30-day rehospitalization rates as well as longer median length of stay and greater mean cost per stay. Small reductions in the amount of therapy provided are unlikely to increase 30-day rehospitalization rates in SNFs. This has important consequences for the recently implemented patient-driven payment model, which incentivizes SNFs to provide less rehabilitation therapy.
Personality Predicts the Efficacy of a Physician Leadership Development Program
Authors: Fletcher Keaton A. , Garcia Spencer , Satiani Bhagwan , Binkley Philip , Friedman Alan
Published: May 2021

It is imperative for health care organizations to foster leadership skills in their workforce. Leadership development programs offer a potential mechanism to achieve this goal. These development programs are likely not equally effective for all participants. This study evaluates the efficacy of one such program and determines personality predictors of its efficacy. Before and after a 12-month leadership development program, 28 physicians from various disciplines completed self-reported measures of leadership knowledge across 3 domains. At baseline, participants also provided personality data across the Big-5 factors of personality as well as 2 narrow facets (learning-goal orientation and preference for collaboration). Results suggest that leadership development programs can increase knowledge across leadership domains. Extraversion and conscientiousness predict changes in knowledge. Learning-goal-orientation and preference for collaboration personality facets provide incremental predictive power. Leadership development programs can improve self-rated knowledge across a range of leadership domains and is differentially effective for people based on their personalities.
Cell salvage in trauma
Authors: Waters Jonathan H.
Published: June 2021

Purpose of review

The collection of shed blood and its reinfusion has been termed ‘cell salvage’ or ‘autotransfusion’. This review will summarize the historical foundation of cell salvage and summarize recent literature associated with cell salvage use in trauma.

Recent findings

There have been no publications on cell salvage in trauma during the last 2 years. This is based on a PubMed search using the key words, ‘cell salvage’, ‘autologous blood transfusion’ and ‘operative blood salvage’. Although the wars in Iraq and Afghanistan were ongoing, publications focused upon autotranfusion of unwashed blood from the hemothorax and on the resuscitation of the injured in remote settings.

Autotransfusion or cell salvage is markedly under utilized in trauma. Opportunities exist for significant blood savings if it is used more frequently. More research is clearly needed to assess the safety of autotransfusion in the traumatized patient.
National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics
Authors: Du Austin L. , Robbins Kimberly , Waterman Ruth S. , Urman Richard D. , Gabriel Rodney A.
Published: June 2021

Purpose of review

Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends.

Recent findings

National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.

Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings.

NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.
Flouroscopic Control of Tibial Torsion After Intramedullary Nailing: A Technical Trick
Authors: Eckardt Henrik , Morgenstern Mario , Cadosch Dieter , Stoffel Karl
Published: May 2021

After intramedullary nailing of tibia shaft fractures, torsional malalignment greater than 10 degrees occur in up to 41% of operated legs. The reason is the difficult clinical assessment of rotation intraoperatively, the large variation in absolute torsion of the tibia, and the absence of established reliable methods to fluoroscopically evaluate tibial rotation and compare with the contralateral side. We present here a fast and low-tech intraoperative method on how to achieve identical tibial torsion of the operated and noninjured side. The method can be used for tibia shaft and metaphyseal fractures and only requires a normal C-arm fluoroscope with 2 monitors. First, a true lateral image of the knee on the noninjured side with the femoral condyles aligned is obtained. Second, with the leg and the C-arm rotation and tilt fixed, the fluoroscope is moved parallel to the patient axis and a lateral ankle image is obtained and saved. The fibula position relative to the tibia at the level of the Volkmann tubercle on the lateral view defines the torsion of the tibia. The sequence described above is repeated on the operated side after implantation of the nail before proximal locking. On the operated side, the fibula position relative to the tibia should be identical to the noninjured side before proximal locking takes place. Otherwise, a rotational malalignment is present and must be corrected. The comparison between operated and noninjured side is easy on a fluoroscope with 2 monitors. The complete examination takes a few minutes and has minor additional radiation exposure. We performed the intraoperative torsion control in 10 patients and performed a postoperative low-dose Computer Tomography-control of the torsion of both legs and found the rotational deformity to be less than 10 degrees in all patients.
Definitive Fixation Outcomes of Open Tibial Shaft Fractures: Systematic Review and Network Meta-analysis
Authors: Al-Hourani Khalid , Donovan Richard , Stoddart Michael T. , Foote Clary J. , Kelly Michael B. , Tornetta Paul
Published: May 2021

Objectives:

To delineate if there were differences in outcomes between definitive fixation strategies in open tibial shaft fractures.

Data Sources:

MEDLINE, EMBASE, CENTRAL, and OpenGrey.

Study Selection:

Randomized and Quasi-randomized studies analyzing adult patients (>18 years) with open tibial shaft fractures (AO-42), undergoing definitive fixation treatment of any type.

Data Extraction:

Data regarding patient demographics, definitive bony/soft-tissue management, irrigation, type of antibiotics, and follow-up. Definitive intervention choices included unreamed intramedullary nailing (UN), reamed intramedullary nailing, plate fixation, multiplanar, and uniplanar external fixation (EF). The primary outcome was unplanned reoperation rate. Cochrane risk of bias tool and Grading of Recommendation Assessment, Development and Evaluation systems were used for quality analysis.

Data Synthesis:

A random-effects meta-analysis of head-to-head evidence, followed by a network analysis that modeled direct and indirect data was conducted to provide precise estimates [relative risk (RR) and associated 95% confidence interval (95% CI)].

Results:

In open tibial shaft fractures, direct comparison UN showed a lower risk of unplanned reoperation versus EF (RR 0.67, 95% CI 0.43–1.05, P = 0.08, moderate confidence). In Gustilo type III open fractures, the risk reduction with nailing compared with EF was larger (RR 0.61, 95% CI 0.37–1.01, P = 0.05, moderate confidence). UN had a lower reoperation risk compared with reamed intramedullary nailing (RR 0.91, 95% CI 0.58–1.4, P = 0.68, low confidence); however, this was not significant and did not demonstrate a clear advantage.

Conclusions:

Intramedullary nailing reduces the risk of unplanned reoperation by a third compared with EF, with a slightly larger reduction in type III open fractures. Future trials should focus on major complication rates and health-related quality of life in high-grade tibial shaft fractures.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Hospital and Surgeon Volumes on Complication Rates After Fixation of Peritrochanteric Hip Fractures
Authors: Testa Edward J. , Brodeur Peter , Kahan Lindsey G. , Modest Jacob M. , Cruz Aristides I. , Gil Joseph A.
Published: May 2021

Objective:

This study evaluates the relationship between hospital and surgeon volumes of peritrochanteric hip fracture fixation and complication rates.

Methods:

Adults (60 years of age or older) who underwent surgical fixation for closed peritrochanteric fractures from 2009 to 2015 were identified using International Classification of Diseases 9 and 10 Clinical Modification and Procedural codes in the New York Statewide Planning and Research Cooperative System database. Readmission, reoperations, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes. Statistical significance was set at P < 0.05.

Results:

A total of 29,656 patients were included in the study. Low-volume (LV) facilities had higher rates of readmission [hazard ratio (HR) 1.07, 95% confidence interval (CI), 1.05–1.17], pneumonia (HR 1.36, 95% CI, 1.22–1.51), wound complications (HR 1.24, 95% CI, 1.03–1.49), and mortality (HR 1.15, 95% CI, 1.04–1.27) but lower rates of acute renal failure (HR 0.90, 95% CI, 0.83–0.98), deep vein thrombosis (HR 0.66, 95% CI, 0.55–0.78), and acute respiratory failure (HR 0.77, 95% CI, 0.62–0.95) than high-volume (HV) facilities. Patients treated by LV surgeons had lower rates of readmission (HR 0.92, 95% CI, 0.87–0.97) and deep vein thrombosis (HR 0.78, 95% CI, 0.66–0.94) but higher rates of acute renal failure (HR 1.13, 95% CI, 1.04–1.22) than those treated by HV surgeons.

Conclusions:

There are increased rates of mortality, readmission, and certain complications when peritrochanteric femur fractures are surgically managed at LV hospitals compared with those managed at HV hospitals. Thus, the benefit of a high-volume surgical facility is apparent in mortality and readmissions but not all complications. There was no significant decrease in complications if fixation was performed by HV surgeons relative to LV surgeons.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Treatment of Recalcitrant Femoral Shaft Nonunion With Medial Femoral Condyle Pedicled Autograft: Technical Trick
Authors: DeKeyser Graham J. , Bailey Travis L. , Higgins Thomas F. , Tyser Andrew R.
Published: May 2021

Nonunited fractures of the femoral shaft and distal femur are usually successfully addressed with stabilization with or without autogenous bone grafting. For the small subset of these problems that prove recalcitrant to front-line treatment, a pedicled medial femoral condyle (MFC) bone flap can provide a source of vascularized autograft with minimal donor site morbidity. The MFC has gained recent widespread adoption as a free vascularized bone transfer, and here, we present a surgical technique and retrospective analysis of patients treated with a pedicled MFC technique. This serves as a useful treatment option for these difficult problems and may be especially helpful in low resource environments or where microsurgical anastomosis is not feasible.
Nonoperative Treatment of Select Lateral Compression Type II Pelvic Ring Injuries (OTA/AO 61B2.2) Results in a Low Rate of Radiographic Displacement
Authors: Gibbs Stephen , Colcord Madison , Curtin Patrick , Roomian Tamar , Seymour Rachel , Phelps Kevin , Kempton Laurence , Hsu Joseph , Sims Stephen , Bosse Michael , Swart Eric , Karunakar Madhav
Published: May 2021

Objectives:

To quantify radiographic outcomes and to identify predictors of late displacement in the nonoperative treatment of lateral compression type II (LC-2) pelvic ring injuries.

Design:

Retrospective review.

Setting:

Two Level 1 trauma centers.

Patients/Participants:

Thirty eight patients 18 years of age or older with LC-2 pelvic ring injuries were included in the study.

Intervention:

Nonoperative treatment.

Main Outcome Measurements:

Crescent fracture displacement (CFD) was measured on initial axial computed tomography scan. Change in pelvic ring alignment was measured by the deformity index, simple ratio, and inlet and outlet ratios on successive plain radiographs.

Results:

Patients in this study had minimally displaced LC-2 pelvic ring injuries, with median initial CFD of 2 mm and median initial deformity index of 2%. No patients had a change of more than or equal to 10 percentage points in deformity index over the treatment period, but small amounts of displacement were seen on the other ratios. No patients initially selected for nonoperative treatment converted to operative treatment. No radiographic predictors of late displacement were identified. Bilateral pubic rami fractures and the presence of a complete sacral fracture ipsilateral to the crescent fracture were not associated with late displacement.

Conclusions:

A spectrum of injury severity and stability exists in the LC-2 pattern. Nonoperative treatment of LC-2 injuries with low initial deformity and CFD results in minimal subsequent displacement.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Resuscitative Endovascular Balloon Occlusion of the Aorta in Hemodynamically Unstable Patients With Pelvic Ring Injuries
Authors: Marchand Lucas S. , Sepehri Aresh , Hannan Zachary D. , Zaidi Raza , DuBose Joseph J. , Morrison Jonathan J. , O'Toole Robert V. , Slobogean Gerard M.
Published: May 2021

Objective:

To evaluate the outcomes of patients with pelvic ring injuries managed with resuscitative endovascular balloon occlusion of the aorta (REBOA).

Design:

Retrospective case series.

Setting:

Academic, Level 1 trauma center in North America.

Patients:

Twenty-five patients with disruption of the pelvic ring and hemodynamic instability.

Intervention:

Placement of a REBOA device as an adjuvant treatment to trauma resuscitation.

Main Outcome Measure:

Death and ischemic-related complications.

Results:

The average age of patients was 43 years (range: 17–85). Patients presented with a median lactate of 6.3 mmol/L, systolic blood pressure of 116 mm Hg, heart rate of 121 beats/minute, and injury severity score of 34. The median unit of packed red blood cells received through transfusion in the first 24 hours of hospital admission was 13 (interquartile range: 8–28). Young–Burgess injury patterns included fractures of the following types: 5 lateral compression (LC)-1, 1 LC-2, 8 LC-3, 4 anteroposterior compression-2, and 7 anteroposterior compression-3. Angiography and embolization were performed in 24 (96%) patients. Selective embolization occurred in 18 (72%) patients, with nonselective angiography of the iliac system occurring in 7 (24%) patients. There were 12 (48%) deaths, 7 (28%) patients requiring lower extremity fasciotomy, and 5 (20%) patients requiring lower extremity amputations, and there was 1 (4%) patient requiring thrombectomy.

Conclusions:

REBOA use in pelvic ring injuries is rare and most frequently used in critically ill patients with polytrauma. Successful pelvic embolization can occur in concert with REBOA use; however, the severity of injury is associated with a high complication profile. In this series of 25 patients, in-hospital mortality was 48%. For those patients who survived, 54% experienced a major complication (fasciotomy, amputation, and deep infection). Further investigation is required to evaluate the role REBOA may play in managing these patients.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Application and Evaluation of an Independent Robotic Arm System in K-wire Placement for Lumbar Fusion
Authors: Li Junyu , Wang Zizhen , Zeng Lin , Liu Zhongjun , Hu Wanheng , Yu Miao
Published: May 2021

Study Design:

A single-center randomized controlled study.

Objective:

The objective of this study was to introduce a novel robotic system with an independent arm (“Orthbot Intelligent Orthopedic Minimally Invasive System”; Xin Junte Surgical Technologies) that has been developed and tested as a surgical assistant for autoplacement of the Kirschner wire (K-wire) in lumbar fusion, and to evaluate its accuracy by comparing it with the conventional free-hand instrumentation.

Summary of Background Data:

Robotic technology has performed excellently in spine surgeries and has demonstrated high clinical value and potential. Robot-assisted spinal surgery is now being promoted as a paradigm for technology-led advancement.

Materials and Methods:

A total of 24 patients were recruited and assigned randomly to the robotic arm group (RG) or the free-hand group (FG). Deviation distance and deviation angle (DA) of K-wire placement were measured and compared between the RG and the FG.

Results:

The average deviation distance was 0.88±0.08 mm in the RG and 5.13±1.68 mm in the FG (P<0.001). In both coronal and sagittal radiographs, the average DA of K-wire placement was smaller in the RG (P<0.05), and in both axial and sagittal computed tomography scans, the average DA of pedicle screw placement was also lower in the RG (P<0.05), which indicated higher accuracy of the robotic system.

Conclusions:

The novel robotic system in this study has shown certain advantages over the conventional free-hand approach in K-wire placement for lumbar fusion, including being more accurate in K-wire placement, fully automatic, and more adaptive to preoperative plans. Although the robotic arm proves to be promising in our results, the small sample size in this clinical study necessitates further multicenter, large sample follow-up studies to verify its advantages.
A Comparison of Teaching Methods for a Baccalaureate Nursing Health Assessment Course
Authors: Markwick Laura , Sacco Tara L.
Published: May 2021

New teaching methods are designed and implemented to ensure student success and application of knowledge. One of these designs is the flipped classroom. Nursing programs are also integrating technology, including simulation, into nursing education in order to enhance student engagement. Although several research studies support flipped classroom methodology, no studies have compared traditional and flipped classroom teaching methods, as well as the use of a technology-enhanced classroom, in a baccalaureate nursing health assessment course. The purpose of this study was to compare learning outcomes and student satisfaction in an undergraduate health assessment course across three teaching methods: traditional lecture, flipped classroom, and a technology-enhanced interactive flipped classroom. All three methods incorporated virtual patient simulation. Using a quasi-experimental design, formative and summative assignment grades were compared. Student course evaluations were compared to assess satisfaction with each teaching method. Significant differences in mean grades were found in 12 of the 23 assignments. The technology-enhanced interactive flipped classroom section outperformed the traditional and flipped classroom sections on most of these assessments. Only one difference was noted in student satisfaction. The results showed that a technology-enhanced interactive flipped classroom design supported student learning. A longitudinal analysis of student performance is recommended.
Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients
Authors: Hogan Quigley Beth , Renz Susan M. , Bradway Christine
Published: May 2021

Falls and fall-associated injuries continue to occur in hospitals worldwide. Video monitoring using virtual sitters is a novel, cost-effective concept that has emerged as an intervention to address falls and maintain safety for hospitalized patients. This literature review examines the evidence regarding hospital-associated falls and fall-related injuries when video monitoring and virtual sitters were included as an intervention. Ten observational studies and two quasi-experimental studies (N = 12) were identified for inclusion from the Cumulative Index of Nursing and Allied Health Literature, Scopus, and PubMed databases. Overall, current evidence is focused on fall rates and cost savings. Eight studies demonstrated a fall reduction and the remaining three showed no statistical difference in fall rates with the use of video surveillance or virtual sitters. Cost savings for these interventions are based on the transition from 1:1 observation to virtual sitters; all 12 studies reported decreased overall costs transitioning to virtual sitters. Small sample size and limited studies are the primary limitations of current published evidence. As the novel clinical practice evolves and more hospitals are equipped with video capability, future research with virtual sitters should include expanded patient populations, a focus on fall-related injuries, and examinations of staff safety.
A Guide for Intentional Home Telehealth Assessment
Authors: Bethel Claire , Towers Victoria , Crist Janice D. , Silva Graciela E. , Shea Kim
Published: May 2021

Telehealth can provide expanded access to healthcare. The Comprehensive Patient Assessment for Using Telehealth at Home is a comprehensive approach for an intentional remote patient meeting that provides a high-quality patient encounter when using technology. In this study, we describe the perspectives of seriously ill older adults and their caregivers on the usability of the Comprehensive Patient Assessment for Using Telehealth at Home using technology to meet remotely and assess patients in their own homes. This study used qualitative description with semistructured interviews to explore participants' user experience of the telehealth visit using the Comprehensive Patient Assessment for Using Telehealth at Home. The overarching theme of participants' experiences with the Comprehensive Patient Assessment for Using Telehealth at Home intervention was of a continuum of acceptance of technology use. Participants felt that a combination of in-person and telehealth visits was ideal, and telehealth visits were appropriate for routine visits. In-person assessments would be necessary if the communication was not adequately received through remote technology. Other themes were satisfaction and detractors, usability of the technology, privacy and confidentiality, and timing of the telehealth visit. Telehealth presents new opportunities for patients to engage and connect with providers, allowing them to seek care in the comfort of their own home. In some circumstances, telehealth is appropriate but is not a permanent replacement for in-person visits.
Bullying Victimization and Perpetration Among US Children with and Without Tourette Syndrome
Authors: Charania Sana N. , Danielson Melissa L. , Claussen Angelika H. , Lebrun-Harris Lydie A. , Kaminski Jennifer W. , Bitsko Rebecca H.
Published: May 2021

Objective:

Tourette syndrome (TS) and co-occurring mental, behavioral, and developmental disorders (MBDDs) have been shown to affect peer relationships. This study provides nationally representative estimates of diagnosed TS prevalence and the prevalence of parent-reported bullying victimization and perpetration among US children with and without TS.

Methods:

This study included 2016–2017 National Survey of Children's Health data on children aged 6 to 17 years (N = 51,001) with parent-reported responses about TS diagnosis and their child's experiences with bullying victimization and perpetration. We calculated weighted prevalence estimates of diagnosed TS and of bullying indicators among children ever diagnosed with TS compared with peers without TS. We conducted a logistic regression analysis to estimate adjusted prevalence ratios of bullying involvement by TS status, controlling for age, sex, and co-occurring MBDDs.

Results:

By parent report, 0.3% of US children had ever received a diagnosis of TS; most children with a TS diagnosis (83.2%) had a co-occurring MBDD. Among children with TS, 56.1% experienced bullying victimization, 20.7% experienced bullying perpetration, and 15.9% experienced both, compared with 21.6%, 6.0%, and 4.1% for children without TS, respectively. After adjusting for age, sex, and co-occurring MBDDs, only the association between TS and bullying victimization remained statistically significant.

Conclusion:

Compared with children without TS, children with TS overall experience more bullying victimization and perpetration. Health care professionals treating children with TS could assess challenges with peer relationships and co-occurring disorders to provide targeted support and referral.
Serum MicroRNA-137 Serves as a Novel Biomarker for Cerebral Atherosclerosis Diagnosis and Cerebrovascular Event Prediction
Authors: Xuan Jingjing , Shang Meiling , Li Xuelian
Published: May 2021

MicroRNAs have been reported as biomarkers for various diseases, including cerebral atherosclerosis (AS). In this study, whether serum microRNA-137 (miR-137) could be used as a biomarker for diagnosing cerebral AS and predicting cerebrovascular event was investigated. Quantitative real-time PCR was used to measure the expression of miR-137 in serum. Logistic analysis was used to evaluate the risk factors for the occurrence of cerebral AS, and receiver operating characteristic curves were used to estimate the diagnostic value of miR-137 and other risk factors for AS occurrence. Furthermore, the prognostic value of miR-137 for patients with AS was estimated using Kaplan–Meier survival analysis and Cox regression analysis. The results indicated that serum miR-137 levels were decreased in patients with cerebral AS. The expression of miR-137 was negatively correlated with total cholesterol and low-density lipoprotein cholesterol levels in patients with cerebral AS. The levels of miR-137, total cholesterol, low-density lipoprotein cholesterol, and hypersensitivity C response protein may serve as risk factors for the occurrence of cerebral AS, and miR-137 had diagnostic value for AS screening. Cerebral AS patients with positive cerebrovascular events have low miR-137 expression. Patients with high miR-137 expression had a lower incidence of cerebrovascular adverse events (log-rank P = 0.013), and miR-137 was an independent prognostic marker for the prediction of cerebrovascular event occurrence in patients with cerebral AS. In conclusions, our findings indicate that serum miR-137 levels are decreased in patients with cerebral AS and may be a new biomarker for diagnosing cerebral AS and predicting cerebrovascular events.
Long Noncoding RNA MALAT1 Regulates the Progression of Atherosclerosis by miR-330-5p/NF-κB Signal Pathway
Authors: Shi Zhifeng , Zheng Zhixiong , Lin Xiaodan , Ma Hengzhang
Published: May 2021

Long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was reported to be related to atherosclerosis (AS) progression. However, the underlying mechanism of MALAT1 in AS remains unknown. Quantitative real-time polymerase chain reaction was performed to detect the expression of MALAT1 and miR-330-5p. Western blot was applied to assess the protein levels of cluster of differentiation 36, interleukin-1β, interleukin-6 and tumor necrosis factor-α, phosphorylation of nuclear factor kappa-B inhibitor alpha and phosphorylation of p65. Flow cytometry assay, cell counting kit 8 assay, triglyceride, and total cholesterol detection assays were used to detect the apoptosis, viability, and lipid indexes of THP-1 macrophages-derived foam cells. Online database starbasev2.0 was used to predict the binding sequences between MALAT1 and miR-330-5p and it was verified by dual-luciferase reporter system and RNA immunoprecipitation assay. Besides, an AS mice model was used to evaluate the effect of MALAT1 in vivo. As a result, MALAT1 was overexpressed, whereas miR-330-5p was downregulated in THP-1 macrophages-derived foam cells. MiR-330-5p was a target of MALAT1. MALAT1 depletion inhibited cell formation, apoptosis, and inflammation in THP-1 macrophages-derived foam cells. Besides, MALAT1 overexpression promoted the inflammation in AS mice model, which promoted the pathogenesis of AS. Furthermore, miR-330-5p regulated the nuclear factor kappa light chain enhancer of activated B cells (NF-κB) pathway in THP-1 macrophages-derived foam cells. Moreover, MALAT1 regulated NF-κB signal pathway to mediate the pathogenesis of AS by sponging miR-330-5p. MALAT1 sponges miR-330-5p to activate NF-κB signal pathway in THP-1 macrophages-derived foam cells. This finding may provide a novel biomarker for AS diagnosis.
Caveolin-1 Deficiency Induces Atrial Fibrosis and Increases Susceptibility to Atrial Fibrillation by the STAT3 Signaling Pathway
Authors: Zhang Meixia , Wang Hechuan , Bie Mengjun , Wang Xiaowen , Lu Kai , Xiao Hua
Published: May 2021

Atrial fibrillation (AF) is a common arrhythmia in the clinic. Ablation failure and recurrence after cardioversion have become medical problems worldwide. An important pathological feature of AF is atrial fibrosis, which increases susceptibility to AF. As an important target of fibrosis signal integration, the signal transducer and activator of transcription 3 (STAT3) signaling pathway plays an important role in fibrosis. Caveolin-1 (CAV1), a cell membrane protein, is involved in a variety of the biological functions of cells. However, the role of CAV1 in atrial fibrosis remains unclear. In this study, Masson's trichrome staining was used to detect the degree of atrial fibrosis, and the expression of CAV1 in the human atrium was evaluated by immunohistochemistry. To further study the role of CAV1, its expression in cultured rat atrial fibroblasts was silenced using siRNAs. Atrial fibroblasts were treated with angiotensin II to observe the effects on CAV1 and the transforming growth factor-β1 and STAT3 signaling pathways. We also detected the effects of CAV1 scaffolding domain (CSD) peptide on fibrosis through the addition of exogenous CSD peptide. The results showed that CAV1 expression decreased with the aggravation of atrial fibrosis and that this effect increased the incidence of AF. The depletion of CAV1 induced excessive extracellular matrix deposition by activating the STAT3 and transforming growth factor-β1/SMAD2 signaling pathways, and this effect was exacerbated by stimulation with angiotensin II and improved by CSD peptide. These data suggested that CAV1 not only plays a critical role in fibrosis progression but also provides a target for the treatment of atrial fibrosis and AF.
Bioactive Compounds From Coptidis Rhizoma Alleviate Pulmonary Arterial Hypertension by Inhibiting Pulmonary Artery Smooth Muscle Cells' Proliferation and Migration
Authors: Luo Shuai , Kan Junyan , Zhang Juan , Ye Peng , Wang Dongchen , Jiang Xiaomin , Li Minghui , Zhu Linlin , Gu Yue
Published: May 2021

Pulmonary arterial hypertension (PAH) is a devastating disorder characterized by excessive proliferation and vasoconstriction of small pulmonary artery vascular smooth muscle cells (PASMCs). Coptidis rhizoma (CR) because of the complexity of the components, the underlying pharmacological role and mechanism of it on PAH remains unknown. In this article, the network pharmacological analysis was used to screen the main active constituents of CR and the molecular targets that these constituents act on. Then, we evaluated the importance of berberine and quercetin (biologically active components of CR) on the proliferation and migration of PASMCs and vascular remodeling in experimental models of PAH. Our results showed that berberine and quercetin effectively inhibited the proliferation and migration of hypoxia-induced PASMCs in a manner likely to be mediated by the suppression of MAPK1, NADPH oxidase 4 (NOX4), and cytochrome P450 1B1 (CYP1B1) expression. Furthermore, berberine and quercetin treatment attenuates pulmonary hypertension, reduces right ventricular hypertrophy, and improves pulmonary artery remodeling in monocrotaline-induced pulmonary hypertension in rat models. In conclusion, this research demonstrates CR might be a promising treatment option for PAH, and the network pharmacology approach can be an effective tool to reveal the potential mechanisms of Chinese herbal medicine.
Time to Peak International Normalized Ratio Rise in Acute and Acute-on-Chronic Warfarin Overdoses
Authors: Minhaj Faisal Syed , Leonard James B. , Seung Hyunuk , Klein-Schwartz Wendy
Published: May 2021

Guidelines exist on the management of supratherapeutic/subtherapeutic international normalized ratio (INR) values for patients on warfarin. However, there is a paucity of the literature relating to an acute overdose of warfarin. This is a retrospective cohort study for all acute and acute-on-chronic (AOC) warfarin overdoses reported to the Maryland Poison Center in patients ≥12 years between January 1st, 2000, until October 31st, 2019, managed in a health care facility. The primary outcome was to determine the time after presentation to peak INR. Secondary outcomes included risk factors associated with INR >10 and describing patient characteristics. A total of 163 overdoses were included, 68 acute and 95 AOC. In patients who did not receive reversal therapies, INR peaked at a median value of 3.8 (interquartile range 2.6–5.5) between 24 and 36 hours. The median time to phytonadione was 22.0 hours. Most patients received phytonadione (62.0%), with fewer receiving blood products (16.6%). The median warfarin dose ingested was 75 mg. The AOC group had a greater mean age (56 vs. 43 years), median INR value (2.4 vs. 1.4), and men (62.1% vs. 41.2%). Factors associated with an INR > 10 included initial INR and reported quantity ingested. Peak INR was greater in the AOC than the acute overdose group (6.1 vs. 3.4), although the bleeding rate was similar. Peak INR values after warfarin overdose occur between 24 and 36 hours after presentation. Initial INRs and reported quantity ingested may be useful to predict those needing treatment.
MODIFIED SUTURELESS INTRASCLERAL FIXATION TECHNIQUE FOR SECONDARY INTRAOCULAR LENS IMPLANTATION
Authors: Januschowski Kai , Boden Karl T. , Macek Andrej M. , Szurman Peter , Bisorca-Gassendorf Lukas , Hoogmartens Caroline , Rickmann Annekatrin
Published: May 2021

Background/Purpose:

To demonstrate possible complications of a new intraocular lens for sutureless secondary scleral implantation and modifications of the surgical technique to optimize outcomes.

Methods:

A retrospective study of 16 eyes (16 patients) who underwent a secondary intraocular lens implantation using the Carlevale intraocular lens (Soleko, Italy) with two anchor haptics for intrascleral implantation (mean follow-up 2.2 months).

Results:

The visual acuity did not improve statistically significantly postoperatively (P = 0.601). Seven (44%) patients suffered from postoperative hypotonia (intraocular pressure <5 mmHg) during the first three postoperative days.

Conclusion:

Owing to the early postoperative hypotony, we decided to modify the surgical technique. We present several suggestions to optimize the technique and outcome such as positioning the sclerotomies at the 2 and 8 o'clock positions, using 27 G trocars alone and suturing the frown incisions using self-resorbing sutures.
POSTERIOR SEGMENT INJURIES IN OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM
Authors: Wold Aaron M. , Justin Grant A. , Hobbs Samuel D. , Baker Katherine M. , Brady Derek P. , Aden James K. , Ryan Denise S. , Weichel Eric D. , Colyer Marcus H.
Published: May 2021

Background/Purpose:

To characterize the nature of posterior segment ocular injuries in combat trauma.

Methods:

Eyes in the Walter Reed Ocular Trauma Database were evaluated for the presence of posterior segment injury. Final visual outcomes in open-globe versus closed-globe injuries and by zone of injury and the types of posterior segment injuries in open-globe versus closed-globe injuries were assessed.

Results:

Four hundred fifty-two of 890 eyes (50.8%) had at least one posterior segment injury. The mechanism of injury was most commonly an improvised explosive device in 280 (62.0%) eyes. Sixty-one patients (13.5%) had a Zone I injury, 50 (11.1%) a Zone II injury, and 341 (75.4%) a Zone III injury. Patients with Zone I injuries were more likely to have a final visual acuity of 20/200 or better compared with patients with either a Zone II (P < 0.001) or Zone III injury (P = 0.007). Eyes with a closed-globe injury were more likely to have a final visual acuity of 20/200 or better compared with those with an open-globe injury (P < 0.001). Furthermore, closed-globe injury compared with open-globe injury had a lower risk of vitreous hemorrhage (odds ratio 0.32, P < 0.001), proliferative vitreoretinopathy (odds ratio 0.14, P < 0.001), and retinal detachment (odds ratio 0.18, P < 0.001) but a higher risk of chorioretinal rupture (odds ratio 2.82, P < 0.001) and macular hole (odds ratio 3.46, P = 0.004).

Conclusion:

Patients with combat ophthalmic trauma had similar posterior segment injury patterns to civilian trauma in open-globe versus closed-globe injuries. Zone II and III injuries were associated with a worse visual prognosis.
MICROVASCULAR LEAKAGE IS A POOR PROGNOSTIC FACTOR FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Kwon Han Jo , Park Sung Who , Lee Ji Eun , Byon Iksoo
Published: May 2021

Purpose:

To investigate the angiographic findings assessed using fluorescein angiography and their prognostic values of idiopathic epiretinal membrane.

Methods:

Seventy-three eyes of idiopathic epiretinal membrane that had been followed up for 6 months after surgical treatment were included. Midphase fluorescein angiography images were obtained at baseline. Structural changes, including central subfield macular thickness, intraretinal cystic lesion, and ectopic inner retinal layer on the fovea, were assessed using optical coherence tomography. The main outcome measures were microvascular leakage (ML) and its association with optical coherence tomography findings and best-corrected visual acuity (BCVA).

Results:

Of a total of 73 eyes, 37 showed ML and had worse BCVA (P = 0.040), greater central subfield macular thickness (P = 0.028), and more ectopic inner retinal layer (P < 0.001) than those without ML at baseline. Also, ML was associated with worse postoperative BCVA (P < 0.001) and ectopic inner retinal layers (P < 0.001; P = 0.034) at baseline and 6 months. The baseline factors associated with postoperative BCVA of ≥20/25 were better BCVA (P = 0.027) and the absence of ML (P < 0.001).

Conclusion:

Half of the idiopathic epiretinal membrane eyes showed that ML was associated with inner retinal deformity and poor visual recovery. Fluorescein angiography helped to predict visual prognosis after idiopathic epiretinal membrane surgery.
PIGMENT EPITHELIAL DETACHMENT IN AGE-RELATED MACULAR DEGENERATION
Authors: Gui Wei , Au Adrian , Rabina Gilad , Kapelushnik Noa , Cohen Shai , Masarwa Dua , Hosseini Hamid , Heilweil Gad , Schwartz Shulamit , Loewenstein Anat , Schwartz Steven D.
Published: May 2021

Purpose:

To define injection index (II) and assess its impact on visual acuity (VA) in pigment epithelial detachment from age-related macular degeneration over 5 years.

Methods:

Injection index is defined as the mean anti–vascular endothelial growth factor injections per year from presentation. A retrospective study of 256 eyes in 213 patients was performed. Patients were stratified by II (high: ≥9, low: <9).

Results:

Baseline characteristics showed no differences across II groups. Mean (range) follow-up, in years, was 5.02 (1.04–12.74) for all patients. Mean logMAR VA (Snellen VA) were 0.60 (20/80) and 0.56 (20/73) at baseline, 0.52 (20/66) and 0.59 (20/78) at Year 1, 0.45 (20/56) and 0.67 (20/94) at Year 2, 0.38 (20/48) and 0.66 (20/91) at Year 3, 0.41 (20/51) and 0.89 (20/155) at Year 4, and 0.35 (20/45) and 0.79 (20/123) at Year 5 for the high and low II groups, respectively. Linear regression analysis showed a gain of 0.5 approxETDRS letters with each additional injection per year.

Conclusion:

Increased II was associated with better mean VA, suggesting that long-term continuous vascular endothelial growth factor suppression may improve VA in eyes thought to carry poor prognoses.