bluuebunny/crossref_metadata_2025 huggingface dataset:
Preclinical study of a self-expanding pulmonary valve for the treatment of pulmonary valve disease
Authors: Kuang Dajun , Lei Yang , Yang Li , Wang Yunbing
Published: August 2020

In the past decade, balloon-expandable percutaneous pulmonary valves have been developed and applied in clinical practice. However, all the existing products of pulmonary artery interventional valves in the market have a straight structure design, and they require a preset support frame and balloon expansion. This shape design of the valve limits the application range. In addition, the age of the population with pulmonary artery disease is generally low, and the existing products cannot meet the needs of anti-calcification properties and valve material durability. In this study, through optimization of the support frame and leaflet design, a self-expanding pulmonary valve product with a double bell-shaped frame was designed to improve the match of the valve and the implantation site. A loading and deployment study showed that the biomaterial of the valve was not damaged after being compressed. Pulsatile flow and fatigue in vitro tests showed that the fabricated pulmonary valve met the hydrodynamic requirements after 2 × 108 accelerated fatigue cycles. The safety and efficacy of the pulmonary valve product were demonstrated in studies of pulmonary valve implantation in 11 pigs. Angiography and echocardiography showed that the pulmonary valves were implanted in a good position, and they had normal closure and acceptable valvular regurgitation. The 180 days’ implantation results showed that the calcium content was 0.31–1.39 mg/g in the anti-calcification treatment group, which was significantly lower than that in the control valve without anti-calcification treatment (16.69 mg/g). Our new interventional pulmonary valve product was ready for clinical trials and product registration.
Haste or Waste? Peer Pressure and Productivity in the Emergency Department
Authors: Silver David
Published: August 2020

Motivated by wide cross-sectional variations in intensity of care that are unrelated to quality of care, researchers and policymakers commonly claim that healthcare providers waste considerable resources, engaging in so-called “flat-of-the-curve” medicine. A key yet elusive prediction of this hypothesis is that providers ought to be able to cut back on care without sacrificing quality. This article examines the effects of a particular form of provider cutbacks—those generated by physicians working in high-pressure peer group environments. Using expansive, time-stamped discharge data from 137 hospital-based emergency departments, I document that physicians systematically alter their pace and intensity of care across frequently shuffled peer groups. Peer groups that induce a physician to work faster also induce her to order fewer tests and spend less money. Contrary to the flat-of-the-curve hypothesis, these cutbacks lead to large reductions in quality of care. This evidence, paired with the fact that slower physicians do not produce better average outcomes, suggests that cross-physician differences in resource utilization reflect substantial differences in physician productivity within a hospital.
Marketing Mutual Funds
Authors: Roussanov Nikolai , Ruan Hongxun , Wei Yanhao
Published: August 2020

Marketing and distribution expenses are responsible for about one-third of the cost of active management in the mutual fund industry. Estimating a structural model with costly investor search and learning about fund skill, we find that marketing is nearly as important as performance and fees in determining fund size. Eliminating marketing substantially improves welfare: capital shifts toward cheaper funds and competition decreases fees; active funds shrink and capital allocation becomes more closely aligned with skill. Declining investor search costs imply a reduction in marketing expenses and management fees as well as a shift toward passive investing, as observed empirically.
Pecan pericarp extract protects against carbon tetrachloride-induced liver injury through oxidative mechanism in rats
Authors: Dorsaf Hallegue , Sabrine Moujahed , Houda Ben Lamine , Khémais Ben Rhouma , Mohsen Sakly , Olfa Tebourbi
Published: August 2020

The purpose of this study was to quantify the proanthocyanidin content of pecan (Carya illinoinensis) pericarp extract (PPE) and to assess its useful impacts against carbon tetrachloride (CCl4)-induced hepatotoxicity. Rats were randomly divided into four groups: Group 1: received intraperitoneal injection of saline solution, Group 2: was injected with PPE (25 mg/kg body weight) for 10 consecutive days, Group 3: received CCl4 (0.5 ml/kg, subcutaneous injection), Group 4: was coadministred with PPE + CCl4. The CCl4 was administered every 3 days during 10 days. Results revealed the presence of a high amount of total proanthocyanidins in the PPE (81.01 ± 0.21 mg TAE.g−1DW). CCl4 injection induced significant reductions in hepatic antioxidants but increased hepatic lipid peroxidation (LPO) as well as serum injury biomarkers. However, cotreatment with PPE significantly (P < 0.05) inverted CCl4-induced increase in plasma alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase activities, respectively to 74%, 77%, 60%, and 82% compared with CCl4 group. No significant toxic effects were observed following treatment with plant extract alone. PPE cotreatment also decreased significant (P < 0.05) the hepatic malondialdehyde formation (21%) and enhanced the liver catalase activity (107%) in CCl4-intoxicated rats. The histopathological examination showed inflammatory infiltration and degenerative changes in the hepatic tissue following CCl4 injection. The hepatoprotective activity of PPE against CCl4 exposure was supported by the maintenance of structural integrity of liver histopathology. In conclusion, the current study illustrated that PPE pretreatment significantly improved all examined parameters, restored the hepatic architecture and successfully alleviates oxidative damage induced by CCl4 intoxication.
Applicability of hiPSC-Derived Neuronal Cocultures and Rodent Primary Cortical Cultures for In Vitro Seizure Liability Assessment
Authors: Tukker Anke M , Wijnolts Fiona M J , de Groot Aart , Westerink Remco H S
Published: August 2020

Seizures are life-threatening adverse drug reactions which are investigated late in drug development using rodent models. Consequently, if seizures are detected, a lot of time, money and animals have been used. Thus, there is a need for in vitro screening models using human cells to circumvent interspecies translation. We assessed the suitability of cocultures of human-induced pluripotent stem cell (hiPSC)-derived neurons and astrocytes compared with rodent primary cortical cultures for in vitro seizure liability assessment using microelectrode arrays. hiPSC-derived and rodent primary cortical neuronal cocultures were exposed to 9 known (non)seizurogenic compounds (pentylenetetrazole, amoxapine, enoxacin, amoxicillin, linopirdine, pilocarpine, chlorpromazine, phenytoin, and acetaminophen) to assess effects on neuronal network activity using microelectrode array recordings. All compounds affect activity in hiPSC-derived cocultures. In rodent primary cultures all compounds, except amoxicillin changed activity. Changes in activity patterns for both cell models differ for different classes of compounds. Both models had a comparable sensitivity for exposure to amoxapine (lowest observed effect concentration [LOEC] 0.03 µM), linopirdine (LOEC 1 µM), and pilocarpine (LOEC 0.3 µM). However, hiPSC-derived cultures were about 3 times more sensitive for exposure to pentylenetetrazole (LOEC 30 µM) than rodent primary cortical cultures (LOEC 100 µM). Sensitivity of hiPSC-derived cultures for chlorpromazine, phenytoin, and enoxacin was 10-30 times higher (LOECs 0.1, 0.3, and 0.1 µM, respectively) than in rodent cultures (LOECs 10, 3, and 3 µM, respectively). Our data indicate that hiPSC-derived neuronal cocultures may outperform rodent primary cortical cultures with respect to detecting seizures, thereby paving the way towards animal-free seizure assessment.
Problem-Based Learning and Case Scenarios: An Interprofessional Pharmacology Experience
Authors: Rosenbloom Sylvie , Nemec Eric C.
Published: August 2020

Interprofessional education (IPE) is a required component of the nursing curriculum as it can foster students’ abilities to become integral members of the health care team. To facilitate this requirement, an IPE experience focusing on cardiovascular pharmacology was created for nurse practitioner and physician assistant students. The authors developed and utilized a problem-based learning activity and two minicase scenarios. The Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education-Revised was administered before and after the activity to assess students’ attitudes toward IPE. This article reviews the planning, development, and implementation of this IPE experience and discusses its challenges.
Towards Equitable AI Interventions for People Who Use Drugs: Key Areas That Require Ethical Investment
Authors: Ti Lianping , Ho Anita , Knight Rod
Published: August 2020

There has been growing investment in artificial intelligence (AI) interventions to combat the opioid-driven overdose epidemic plaguing North America. Although the evidence for the use of technology and AI in medicine is mounting, there are a number of ethical, social, and political implications that need to be considered when designing AI interventions. In this commentary, we describe 2 key areas that will require ethical deliberation in order to ensure that AI is being applied ethically with socially vulnerable populations such as people who use drugs: (1) perpetuation of biases in data and (2) consent. We offer ways forward to guide and provide opportunities for interventionists to develop substance use-related AI technologies that account for the inherent biases embedded within conventional data systems. This includes a discussion of how other data generation techniques (eg, qualitative and community-based approaches) can be integrated within AI intervention development efforts to mitigate the limitations of relying on electronic health record data. Finally, we emphasize the need to involve people who use drugs as stakeholders in all phases of AI intervention development.
Trajectories of Disability and Low Back Pain Impact
Authors: Dutmer Alisa L. , Schiphorst Preuper Henrica R. , Stewart Roy E. , Soer Remko , Reneman Michiel F. , Wolff André P.
Published: August 2020

Study Design.

Prospective cohort study.

Objective.

The aim of this study was to identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories.

Summary of Background Data.

Treatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disability could identify patients at risk for less favorable outcome. This knowledge will help improve shared decision-making.

Methods.

Adult patients with LBP completed questionnaires on disability (Pain Disability Index) and LBP impact (Impact Stratification of the National Institutes of Health minimal dataset) at baseline, 6, 12, 18, and 24 months’ follow-up. Latent class analyses were applied to identify trajectories of disability and LBP impact. Baseline sociodemographic and clinical patient characteristics were compared between trajectory subgroups.

Results.

Follow-up was available for 996 patients on disability and 707 patients on LBP impact. Six trajectories were identified for both outcome measures. Three disability trajectories remained stable at distinct levels of severity (68% of patients) and three trajectories showed patterns of recovery (32%). For LBP impact there was one stable trajectory (17%), two slightly improving (59%), two recovering (15%), and one with a pattern of recovery and relapse (15%). Significant differences between trajectories were observed for almost all baseline patient characteristics.

Conclusion.

On average, patients show moderate improvements in disability and LBP impact 2 years after visiting a multidisciplinary tertiary spine center. However, latent class analyses revealed that most patients belong to subgroups experiencing stable levels of disability and LBP impact. Differences in baseline patient characteristics were mostly associated with baseline levels of functioning, instead of (un)favorable outcome during follow-up.

Level of Evidence: 2
Adjacent Level Ossification Development Following Anterior Cervical Fusion
Authors: Lee Dong-Ho , Park Sehan , Park Jae-Woo , Hwang Chang-Ju , Cho Jae Hwan , Lee Choon Sung , Riew K. Daniel
Published: August 2020

Study Design.

Retrospective matched cohort analysis.

Objective.

The aim of this study was to investigate the impact of adjacent level ossification development (ALOD) on the affected as well as the next-level discs with regards to range of motion (ROM) and degenerative changes.

Summary of Background Data.

Although ALOD is not a rare condition in patients who undergo anterior cervical fusion procedures, there has been little discussion to date about its clinical implications.

Methods.

Patients who underwent anterior cervical instrumented fusion with a minimum 2-year follow-up were reviewed. Twelve patients with each respective ossification grade (totally 48 patients) were matched based on age, sex, and number of fusion levels. On the preoperative and final follow-up x-rays, disc height, osteophytes, ROM, and maximal listhesis were assessed at the segments which were one- (the adjacent segment) and two-level cranial (the next segment) to the uppermost fused disc. Then, the patients were divided into two groups according to ALOD degree: group 1 (grade 0–1, N = 24) versus group 2 (grade 2–3, N = 24). The changes of all variables were compared between the two groups.

Results.

The mean ROM of the adjacent segment increased by 3.6 degree in group 1 and conversely decreased by 2.8 degree in group 2 (P = 0.002). The mean ROM increase of the next segment was significantly greater in group 2 than in group 1 (4.5 vs. 1.2 degree, P = 0.016). The osteophyte growth and the progression of listhesis at the next segment were significantly greater in group 2 (P < 0.05). Disc height of the next segment significantly decreased in group 2, but did not change in group 1.

Conclusion.

Severe ALOD (grade 2–3) following anterior cervical fusion significantly reduced ROM at the affected segment and conversely increased motion at the next segment. This increased motion probably accelerated the degeneration of the next-level disc.

Level of Evidence: 3
Design and Validation of a Spinal Surgical Navigation System Based on Spatial Augmented Reality
Authors: Xu Bin , Yang Zhiyong , Jiang Shan , Zhou Zeyang , Jiang Bowen , Yin Shiwu
Published: August 2020

Study Design.

Prospective observational study.

Objective.

This article aims to develop a spatial augmented reality-based surgical navigation system to assist in the placement of pedicle screws in minimally invasive spine surgery and to verify the accuracy of this method.

Summary of Background Data.

Due to their high accuracy and good visualization ability, augmented reality surgical navigation systems have been used in minimally invasive surgeries. However, augmented reality does not allow information to be shared and restricts doctors.

Methods.

A surgical navigation system that implements augmented reality based on a projector can be used to realize the external visualization of virtual organs and surgical information through an improved multiple information fusion method. Using fiducial markers and imaging technology, the patient's spatial position is tracked and registered in real time. All the information is accurately fused with the patient's back skin, and the surgeon can see surgical information such as the preoperative plan and bones. Phantom experiments were used to verify the accuracy and effectiveness of the system.

Results.

In the phantom experiments, the accuracy of the pedicle screw insertion point on the dummy's skin was 0.441 ± 0.214 mm, the average location error into the dummy's body was 1.645 ± 0.355 mm, and the average axial and sagittal angulation errors were <0.9°.

Conclusion.

This article introduces and verifies the design of a new surgical navigation system based on spatial augmented reality for lumbar pedicle screw implantation. The system passed a series of phantom accuracy experiments. Compared with the traditional augmented reality navigation system, this system avoids the use of glasses and truly realizes the effect of naked-eye 3D, which is more convenient for doctors to use for communication during an operation.

Level of Evidence: N/A
Perioperative ADministration of Dexamethasone And blood Glucose concentrations in patients undergoing elective non-cardiac surgery – the randomised controlled PADDAG trial
Authors: Corcoran Tomás B. , O’Loughlin Edmond , Chan Matthew T.V. , Ho Kwok M.
Published: August 2020

BACKGROUND

The hyperglycaemic effect of dexamethasone in diabetic and nondiabetic patients in the peri-operative period is unknown.

OBJECTIVE

To assess the effect of a single dose of intra-operative dexamethasone on peri-operative blood glucose.

DESIGN

Multicentre, stratified, randomised trial.

SETTING

University hospitals in Australia and Hong Kong.

PATIENTS

A total of 302 adults scheduled for elective, noncardiac and nonobstetric surgical procedures under general anaesthesia, stratified by diabetes mellitus status, were randomised to receive placebo, 4 or 8 mg dexamethasone administered intravenously after induction of anaesthesia.

MAIN OUTCOME MEASURES

Maximum blood glucose within 24 h of surgery, and the interaction between glycated haemoglobin (HbA1c) and dexamethasone were the primary and secondary outcomes.

RESULTS

The median [IQR] baseline blood glucose in the nondiabetes stratum in the placebo (n=81), 4 mg (n=81) and 8 mg dexamethasone (n=77) trial arms were respectively 5.3 [4.6 to 5.8], 5.0 [4.7 to 5.4] and 5.0 [4.2 to 5.9] mmol l−1. In the diabetes stratum these values were 6.6 [6.0 to 8.3]; (n=22), 6.1 [5.5 to 10.4]; (n=22) and 6.7 [5.6 to 8.3]; (n=19) mmol l−1. The median [IQR] maximum peri-operative blood glucose values in the nondiabetes stratum were 6.0 [5.3 to 6.8], 6.3 [5.5 to 7.3] and 6.3 [5.8 to 7.4] mmol l−1 in the control, dexamethasone 4 mg and dexamethasone 8 mg arms, respectively. In the diabetes stratum these values were 10.3 [8.1 to 12.4], 12.6 [10.3 to 18.3] and 13.6 [11.2 to 20.1] mmol l−1. There was a significant interaction between pre-operative HbA1c value and 8 mg dexamethasone: every 1% increment in HbA1c produced a 4.0 mmol l−1 elevation in maximal peri-operative glucose concentration.

CONCLUSION

Dexamethasone 4 mg or 8 mg did not induce greater hyperglycaemia compared with placebo for nondiabetic and well controlled diabetic patients. Maximal peri-operative blood glucose concentrations in patients with diabetes were related to baseline HbA1c values in a concentration-dependent fashion after 8 mg of dexamethasone.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Registry (ACTRN12614001145695): URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367272.
Ultrasound-guided interscalene block combined with intermediate or superficial cervical plexus block for clavicle surgery
Authors: Arjun B. Krishna , Vinod Chinnamaregowda N. , Puneeth Jayanna , Narendrababu Madappa C.
Published: August 2020

BACKGROUND

The complex innervation of the clavicle makes general anaesthesia a preferred technique for clavicular surgeries in current practice. The role and approach of regional anaesthesia remains unanswered.

OBJECTIVES

This study aims to delineate the relative effectiveness between interscalene brachial plexus block with either intermediate cervical plexus or superficial cervical plexus block (CPB) as the anaesthetics for clavicular surgery.

DESIGN

A randomised, double-blind prospective study.

SETTING

Single-centre, tertiary care medical college and research institute.

PATIENTS

Fifty patients with American Society of Anesthesiologist's (ASA) grade I to III, aged 18 to 70 years, scheduled for clavicular surgery, during May 2018 to April 2019 were enrolled in this study.

INTERVENTION

All patients received interscalene block with 10 ml of 0.5% bupivacaine. Patients were randomised to undergo additional ultrasound-guided intermediate CPB (Group-1) or superficial CPB (Group-2) with 10 ml of 0.5% bupivacaine.

MAIN OUTCOME MEASURES

The block success rate, sensory block onset time, haemodynamic parameters, duration of postoperative analgesia and complications were noted. Categorical data were analysed using the chi-square test and Fisher's exact test. Continuous data were analysed using Student's t-test.

RESULT

In Group 1, block success was 100%. In Group 2, five patients failed to achieve adequate surgical anaesthesia (P = 0.02). The average sensory block onset time in Group 1 was 2.5 ± 0.4 min and was longer in Group 2, 4.3 ± 0.5 min (P < 0.001). There was no difference between the groups with respect to haemodynamic parameters and complications. The mean duration of postoperative analgesia was longer in Group 1 (7.5 ± 0.8 h) as compared with Group 2 (5.7 ± 0.4 h, P < 0.001).

CONCLUSION

Ultrasound-guided combined interscalene and intermediate CPB had a better success rate, with faster sensory block onset time and prolonged postoperative analgesia as compared with interscalene and superficial CPB in patients undergoing clavicle surgery.

TRIAL REGISTRATION

Clinical trial registry of India (www.ctri.nic.in) - CTRI/2018/05/013785
What to do after a mid-urethral sling fails
Authors: Speed Jacqueline M. , Mishra Kavita
Published: August 2020

Purpose of review

After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated.

Recent findings

Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling.

MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
Ultrasound in the investigation of pelvic floor disorders
Authors: Dietz Hans Peter
Published: August 2020

Purpose of review

Translabial ultrasound with systems designed for obstetric imaging is now the commonest diagnostic modality in pelvic floor medicine. This review will outline current clinical utility and introduce recent research in the investigation of pelvic floor disorders, such as urinary and anal incontinence, pelvic organ prolapse, obstructed defecation and of complications after sling and mesh surgery.

Recent findings

There has been significant progress in standardization of imaging methods, and the International Urogynecology Association has developed an online course encouraging this standardization. Tomographic methods are increasingly used for imaging of the levator ani and anal canal. Several comparative studies have investigated concordance between tomographic translabial imaging and competing methods, and the widespread availability of equipment has facilitated interethnic comparative studies. Several meta- analyses have investigated risk factors for major pelvic floor trauma and the role of pelvic floor abnormalities in prolapse recurrence after surgery.

The widespread use of imaging has the potential to change the management of pelvic floor morbidity, such as urinary and anal incontinence, pelvic organ prolapse and related conditions. Even in units and locations where the required systems are not easily accessible, the insights provided by real-time imaging will enhance diagnostic and therapeutic capabilities.
Serum 25-Hydroxy Vitamin D, Vitamin B12, and Folic Acid Levels in Progressive and Nonprogressive Keratoconus
Authors: Aslan Mehmet Gökhan , Fındık Hüseyin , Okutucu Murat , Aydın Emre , Oruç Yavuz , Arpa Medeni , Uzun Feyzahan
Published: August 2020

Purpose:

To evaluate the serum 25-hydroxy vitamin D, vitamin B12, and folic acid (FA) levels in progressive and nonprogressive patients with keratoconus (KCN).

Methods:

Fifty-five patients with KCN (28 progressive and 27 nonprogressive) who were followed up for at least 12 months were recruited and separated into 2 groups according to corneal topographic progression criteria. Age- and sex-matched 30 healthy individuals formed the control group. Serum vitamin D, B12, FA, and Ca levels were compared among control, nonprogressive, and progressive groups. The effect of gender, age, vitamin D, B12, and FA parameters on KCN progression was investigated.

Results:

Serum vitamin D levels were 12.77 ± 5.52, 11.78 ± 4.32, and 17.40 ± 5.12 ng/mL in nonprogressive, progressive, and control groups, respectively. The serum vitamin D levels in KCN groups (nonprogressive and progressive) were significantly lower than the control group (P = 0.002 and P < 0.001, respectively). There was no significant difference between all groups in serum vitamin B12, FA, and Ca levels (P > 0.05). Decreased vitamin D levels significantly increased nonprogressive KCN probability 1.23 times and progressive KCN probability 1.29 times more than the control group (P = 0.002, 95% confidence interval, 0.708–0.925; P < 0.001, 95% confidence interval, 0.668–0.888, respectively).

Conclusions:

Serum vitamin D levels were significantly decreased in both KCN groups. However, serum vitamin B12, FA, and Ca levels were similar in all groups. Serum vitamin D evaluation of patients with KCN at onset and follow-up examinations may help to predict the course of the disease.
Chromoblastomycosis
Authors: Joseph Joel Joby , Paul Aby , Sebastian Stelvin , Saijan Sanjo , Vilapurathu Jobin Kunjumon
Published: August 2020

Chromoblastomycosis (CBM) is a chronic progressive cutaneous fungal infection caused by several naturally pigmented fungi which are commonly seen in tropical and subtropical climates. The infection is secondary to trauma or autoinoculation. A majority of the cases from India are reported from the sub-Himalayan belt and South India. Fungal diseases other than mycetoma are considered neglected diseases by the World Health Organization. The global burden of CBM could be even greater than mycetoma and can lead to potential incapacity for labor. Here, we present a case of cutaneous CBM from Kerala, India. A 57-year-old male farmer presented with a history of itching and warty growth over the posterior aspect of the right ankle. Histopathology revealed the occurrence of hyperkeratosis papillomatosis, acanthosis, pseudoepitheliomatous hyperplasia, and chronic granulomatous dermatitis with medlar bodies. The patient was managed with a combination of itraconazole and terbinafine for 6 months. After 6 months of follow-up, lesions showed significant improvement.
Severe Rhabdomyolysis Due to SARS CoV-2 Infection in a Young Adult
Authors: Johns Christina B. , Zimmerman Chloe O. , Rowan Cherise , Grossman Matthew R.
Published: August 2020

This report describes a case of severe rhabdomyolysis secondary to severe acute respiratory syndrome coronavirus 2 infection in an otherwise healthy young adult with few other manifestations of the infection.
Development of a Score to Predict Positive Colonic Histology in Chronic Diarrhea Assessed in Open-access Colonoscopy
Authors: Atieh Jessica , Chedid Victor , Khoshbin Katayoun , Kane Sunanda , Camilleri Michael
Published: August 2020

Goals:

To evaluate the diagnostic yield of colonoscopy and esophagogastroduodenoscopy with biopsies and to identify predictors of positive colonic histology in patients with chronic diarrhea.

Background:

Colonoscopy with biopsies is performed in chronic diarrhea with negative initial work-up.

Study:

We reviewed electronic medical records of 1022 consecutive patients with chronic diarrhea referred for a first colonoscopy (including 25% open-access referrals). Predictors of positive colonic histology were investigated using logistic regression.

Results:

Four hundred thirteen patients with macroscopically normal colon were divided into derivation (n=275) and validation (n=138) cohorts. All patients underwent colonoscopy; 369 had ileoscopy (biopsies in 43%), and 289 underwent esophagogastroduodenoscopy (duodenal biopsies in 93%). In patients with endoscopically normal colon, histology was positive in 13.3%: 10.6% microscopic colitis; 1.5% other colitides. Among 358 patients with negative histology, the recorded diagnoses were: 48% unexplained, 25% irritable bowel syndrome, 5.6% small intestinal bacterial overgrowth, and 4.7% bile acid diarrhea. The rates of diagnoses based on positive histologies were 4% for ileal and 5% for duodenal biopsies. Older age [odds ratio (OR)=1.05] was a positive predictor, whereas body mass index (OR=0.93) and duration of diarrhea (OR=0.98) were negative predictors of positive histology. A clinical diagnostic scoring system could correctly predict 41% to 54% of patients with normal colonic histology, with a false-negative rate of 0.8% to 2.6% and a negative predictive value of 95% to 98%.

Conclusions:

Positive colonic biopsies were detected in <15% of patients with chronic diarrhea with normal colonoscopy; a clinical score correctly predicts likelihood of normal histology in about half the patients.
Update on celiac disease
Authors: Alkalay Michele J.
Published: August 2020

Purpose of review

The purpose of this review is to describe current updates in celiac disease.

Recent findings

Recent developments in the understanding of the pathogenesis of celiac disease continue to emerge that may implicate the role of gluten exposure. Several studies have shown that the amount of gluten consumed by the infant may affect the age of onset of celiac disease in genetically predisposed individuals. New guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition allow serology-based celiac diagnosis, omitting endoscopic biopsies, in children. Recent data and updated guidelines in adults no longer support biopsies in all patients who are genetically susceptible with celiac disease who have been identified by serology with clinical signs and symptoms of celiac disease. A new assay was identified in the immune response to epitopes of the tissue transglutaminase–deamidated gliadin peptide complex. In addition, a recent study shows that serum IL-2 elevations correlate with timing and severity of symptoms after gluten ingested in celiac disease patients. Measuring gluten immunogenic peptides (GIPs) in the stool of celiac patients may help monitor adherence to a gluten-free diet (GFD). Of importance, we should be aware that the quality of life is affected in celiac disease patients. During adolescence, the education on the importance of long-term follow-up with an adult gastroenterologist is associated with more successful rates of medical care transition for young adults with celiac disease. Latiglutenase, an orally administered mixture of two gluten-specific recombinant proteases that degrades gluten proteins into small physiologically irrelevant fragments, is currently in a phase 2 trial. Latiglutenase has shown to be safe and effective in reducing symptoms of celiac disease patients upon a GFD with improvement of quality of life. Lastly, a recent study describes a mouse model that is characteristic of celiac disease.

Our knowledge of celiac disease continues to grow with increasing evidence of contributory factors to its pathogenesis. There is some evidence that the quantity ingested of gluten by the infant effects the age of onset of celiac disease in genetically susceptible patients. Changes have been made to the guidelines in the diagnosis of celiac disease proposed by new studies. Recent studies have shown the significant effects on quality of life for celiac patients. As improved laboratory methods continue to be developed, these tests can have utility in both diagnosis of celiac disease and monitoring adherence to the GFD. Current therapeutic trials offer promising nondietary treatment for celiac patients. The development of an animal model can provide a better understanding of the pathogenesis of celiac disease.
Ethical considerations in xenotransplantation: a review
Authors: Cengiz Nezerith , Wareham Christopher Simon
Published: August 2020

Purpose of review

The purpose of this review is to present and analyse recent literature on the patterns, trends, and developments of ethical considerations concerning xenotransplantation by appraising normative aspects within a coherent framework.

Recent findings

Developments within xenotransplantation may soon allow for pig-to-human xenotransplantation to take place. Ethical analysis of xenotransplantation commonly follows an anthropocentric cost–benefit analysis, which may imprecisely measure costs. Xenotransplantation should not merely be approached from an anthropocentric perspective. Rather, the potential risks presented to human and nonhuman donors, recipients, and third parties should all be thoroughly considered.

The range of feasible alternatives to xenotransplantation to increase organ supply should be examined before resorting to xenotransplantation because of the moral distinction between imposing certain risks on others before, or after, alternative solutions have been exhausted.
The emerging psychosocial profile of the adult congenital heart disease patient
Authors: Coleman Amy , Chan Alice , Zaidi Ali N.
Published: August 2020

Purpose of review

With advances in the diagnosis and treatment of congenital heart disease (CHD), over 90% of infants born with CHD now reach adulthood. Patients with CHD require lifelong care and are at an increased risk of psychological distress, neurocognitive deficits, social challenges, and a lower quality of life (QOL). There exists limited research on how to best to support the long-term mental healthcare needs of this unique cohort. There remains limited data on directed mental health interventions and their long-term results in adults with CHD (ACHD).

Recent findings

Recent findings indicate high incidences of anxiety and depression in this growing population and how key concepts such as trauma, illness identity, and resilience maybe playing a role in the lives of adult patients with CHD. Attention must be focused to theorize and conduct further research to determine the effectiveness of treatment options based upon these new findings.

Many individuals with CHD do not receive appropriate mental health screening and care. The authors advocate for effective psychosocial interventions to address patients’ illness identity and resilience, with the goal of an improved QOL in mind.
Research priorities in Fontan-associated liver disease
Authors: Khan Sara , Aziz Hassan , Emamaullee Juliet
Published: August 2020

Purpose of review

Fontan-associated liver disease (FALD) is an emerging condition in patients who have undergone surgical correction of univentricular congenital heart disease. There is little known about the epidemiology of FALD, including risk factors for end-organ failure or hepatocellular carcinoma nor a consensus on surveillance guidelines. Furthermore, there is a need to understand the role of heart versus combined heart–liver transplantation in this population. Research is limited by systemic barriers hindering the ability to track longitudinal FALD outcomes.

Recent findings

Nearly all patients post-Fontan develop histological features of FALD as a function of time post-Fontan, regardless of Fontan hemodynamics. In cases of end-organ disease, single-center studies have shown promising outcomes of combined heart–liver transplant in this population, with decreased rates of acute rejection. However, despite the burden of disease, it is not currently possible to identify the population of patients with FALD using existing clinical databases and registries due to a lack of diagnostic codes.

Strategies proposed to address barriers to understanding FALD include developing appropriate diagnostic and transplant-related codes for existing registries. Efforts should also be targeted at initiating prospective studies to understand recognized comorbidities related to Fontan physiology, guided by a team of multidisciplinary subspecialists.
Psychometric Development of an Instrument Measuring Social Bullying in Nursing Academia
Authors: Beitz Janice M. , Beckmann Claudia A.
Published: August 2020

Background

Social bullying in academic nursing schools is an understudied area, yet extant research shows it is prevalent.

Purpose

The purpose of this study was to generate a formal definition for academic social bullying and content validate an instrument measuring it in academic nursing.

Methods

Classic psychometric theory and survey design were used to develop an instrument measuring academic social bullying. Extensive literature review and analysis of existing instruments were conducted; 108 items indicating bullying behaviors and organizational characteristics were created. This study targeted establishing initial content validity. Forty nurse experts who had experienced or published on academic bullying were invited; 24 responded. Experts rated agreement with relevance/appropriateness of items using a Likert scale and provided comments.

Results

Forty items with content validity indexes near 0.80 and supportive comments were retained. A formal definition was developed from experts' feedback.

Conclusions

Insights regarding differences between bullying and incivility were obtained.
Strategy for Bone Conservation in the Two-Stage Correction of Hypertelorism in Craniofrontonasal Dysplasia
Authors: Paternoster Giovanna , Haber Samer E. , Britto Jonathan A. , Benderbous Djamila , James Syril , Legros Christophe , Khonsari Roman H. , Arnaud Éric
Published: August 2020

Pre-emptive planning to optimize safety and outcome is a defining principle of pediatric craniofacial surgery, in which “procedures that come before” should enhance and not compromise procedures that are planned to follow.

A technical modification of fronto-orbital advancement/remodeling in 2-stage hypertelorism surgery for craniofrontonasal dysplasia is presented, where orbital hypertelorism is accompanied by coronal craniosynostosis. Fronto-orbital advancement/remodeling undertaken by this approach preserves bone in the supero-lateral bandeau and provides optimal quality bone stock for the subsequent orbital box shift osteotomy. In this way the second procedure is protected and enhanced by optimal planning of the primary procedure, with potential benefits to safety, quality, and outcome of the final result.
Long-Term Morphologic Changes on Sagittal Synostosis Patients Who Underwent a Modified Pi Technique
Authors: Monte Thais Miguel , Denadai Rafael , Raposo-Amaral Cesar Augusto , Ghizoni Enrico , Raposo-Amaral Cassio Eduardo
Published: August 2020

Background:

There are paucity of studies focused on the long-term assessment of the craniofacial changes after a pi-plasty procedure and self-reported quality of life outcomes. Thus, this study aimed to assess long-term morphologic changes and quality of life of patients with sagittal synostosis who underwent surgery with a modified pi-plasty.

Methods:

Consecutive patients with sagittal synostosis who underwent surgery and had more than 5 years of follow-up and standard preoperative and 1, 3, and 5 years right profile view photographs were included. Nasofrontal angle and angle of total facial convexity were evaluated using computerized photogrammetric measurements. Additionally, quality of life outcome was evaluated by the Quality of Life Scale Short Form.

Results:

The total facial convexity angle and nasofrontal angle increased significantly (P < 0.05), with aP-value of 0.013 and 0.012, respectively. Patients had quality of life scores >80 in all of the 4 domains, with the highest scores being: physical health domain 80.0 ± 0, psychologic domain 85.0 ± 5, social relationships domain 86.6 ± 0, and environmental domain 98.13 ± 2.42.

Conclusion:

Facial angles significantly changed over 5 years of follow-up. Self-reported quality of life instrument showed that patients are satisfied with their own appearance, contributing positively to their quality of life.
Roberts Syndrome With a Bilateral Cleft Lip and Palate
Authors: Máximo Geiza , Raposo-Amaral Cesar Augusto , Paez Ana Beatriz Affonseca , Raposo-Amaral Cassio Eduardo
Published: August 2020

Roberts syndrome (RBS) is a rare craniofacial anomaly associated with tetraphocomelia, growth and mental retardation, cardiac and renal abnormalities. The RBS is caused by homozygous mutation in the ESCO2 gene on chromosome 8p21. In this report, the authors describe a 5-year-old female infant with RBS and bilateral cleft lip and cleft palate, an extremely rare condition.
A Progressive Enlarging Intraparenchymal Pericatheter Cyst and Cerebral Spinal Fluid Edema Following Ommaya Reservoir Placement
Authors: Chen Yan , Fu Xiaoling , Wang Jing , Cui Lihong , Wang Chunyan , Yuan Xunhui , An Yanyan
Published: August 2020

Spread of cerebral spinal fluid (CSF) into the brain parenchyma is a very rare complication of Ommaya reservoir placement and can take form of CSF edema or an intraparenchymal pericatheter cyst. Herein, we described an extremely rare case of a progressive enlarging intraparenchymal pericatheter cyst and CSF edema in a patient with cerebral cysticercosis following Ommaya reservoir placement. A heightened index of suspicion of this rare complication is required to prevent misdiagnosis as a tumor or brain abscess that may lead to unnecessary surgical explorations.
Three-Dimensional Cephalometric Analysis: The Changes in Condylar Position Pre- and Post-Orthognathic Surgery With Skeletal Class III Malocclusion
Authors: Shrestha Abhinav , Song Shao Hua , Aung Han Nyein , Sangwatanakul Jirayus , Zhou Nuo
Published: August 2020

The study includes 21 adult patients with skeletal class III malocclusion who underwent orthognathic surgery and had computed tomography images records presurgery (T0) up to 6 months after the surgery (T1). The computed tomography images were analyzed three-dimensionally using the Proplan CMF 3.0 software. Different skeletal and dental parameters were used in analyzing the cephalometric analysis of the patients. The change in the condylar axis angle was evaluated on 3 planes: axial, coronal, and sagittal. The anteroposterior position of the condyle in relation to the glenoid fossa was evaluated in the sagittal plane. ∠SNB, ∠ANB, ∠Left Y-axis, ∠Right Y-axis were statistically significant (P < 0.01). Significant differences on the condylar axis angle were found between the groups on the sagittal plane (P < 0.05) whereas no significant differences were noted on the axial and the coronal plane. In the anteroposterior condylar position related to the glenoid fossa, the condyle exhibited different displacement on different condyles. The right condyle exhibited more of the posterior displacement whereas the left condyle exhibited more of anterior displacement of the condyle in relation to the glenoid fossa. Numerous studies have done regarding the changes after postsurgery using the two-dimensional cephalometric analysis. Using the 3D techniques helps us to identify the cephalometric point more accurately which thus enhances the accuracy in the cephalometric analysis. However, care should be taken not to change the axis of rotation of the condyle to prevent from the treatment relapse and to avoid temporo-mandibular disorders.
Morphologic and Aerodynamic Changes of Upper Airway in Pediatric Hemifacial Microsomia Patients Undergoing Distraction Osteogenesis
Authors: Wang Rongyang , Chen Shuai , Yang Ruimei , Liu Hong , Liu Yinli , Liu Dongxu
Published: August 2020

Current studies on hemifacial microsomia (HFM) patients undergoing unilateral distraction osteogenesis (DO) mainly confined to description of facial morphology. This study was to investigate the effect of unilateral DO on upper airway in pediatric HFM patients using computational fluid dynamics. The investigators implemented the present retrospective study composed of 20 patients (age 9.5 ± 2.5 years, 11 males, 9 females) with moderate HFM performed unilateral DO on the ramus of mandible. Computational fluid dynamics models of the upper airway were obtained based on the computed tomography data sets which were taken before and 6 months after distraction. Morphologic and aerodynamic parameters were respectively computed and compared at peak inspiration. Paired t-tests were used to compare the differences between the before and after parameters with the significance set at P < 0.05. The authors observed that after DO, oropharynx and nasopharynx were the major expanded regions, average pressure increased in all cross-sections, average velocity decreased significantly except in the superior border of the epiglottis plane, and the airflow resistance significantly reduced in the whole upper airway (P < 0.05). The results indicate that unilateral DO may expand the constricted oropharynx and nasopharynx, obtain a relatively symmetrical airway shape and decrease the airflow resistance which consequently reduce the workload necessary for breathing and facilitate inspiration.
Coexistence of Cerebral Calcified Cavernous Malformation and Developmental Venous Anomaly
Authors: Aydin Fahri , Ogul Hayri
Published: August 2020

Cerebral cavernous malformations are common vascular malformation of the central nervous system. It may cause various symptoms, such as seizures, intracranial hemorrhage, but most are asymptomatic and diagnosed incidentally. The authors present a case of a 75-year-old man who has a complaint about a headache. On radiological imaging, we descripted that the patient has a calcified cavernoma and a meningioma synchronously. Cavernoma with calcification associated with developmental venous anomaly is a rare condition.