bluuebunny/crossref_metadata_2025 huggingface dataset:
Common, But Neglected: A Comprehensive Review of Leg Ulcers in Sickle Cell Disease
Authors: Sahu Tarun , Verma Henu Kumar , Ganguly Satyaki , Sinha Meenakshi , Sinha Ramanjan
Published: July 2021

OBJECTIVE

To compile available evidence to better understand the management of leg ulcers in sickle cell disease (SCD), as well as describe potential therapeutic steps that may be required to improve the quality of life of patients with SCD leg ulcers.

DATA SOURCES

MEDLINE, PubMed, EMBASE, and Web of Science databases

STUDY SELECTION

A comprehensive search was conducted to retrieve relevant studies using the keywords “sickle cell disease and leg ulcer,” “ulcer treatments, diagnosis and sickle cell,” and “wound sickle cell.” Studies published through July 2020 were included.

DATA EXTRACTION

Two independent authors selected all studies that assessed the relationship between leg ulcer and SCD identified from online databases.

DATA SYNTHESIS

The authors have summarized updated information on pathophysiology (vasculopathy linked to chronic hemolysis and endothelial dysfunction), diagnosis, and available treatment options to unravel the dermohematologic connection between leg ulcers and SCD.

CONCLUSIONS

It is the authors’ hope that this detailed discussion of the information available on leg ulcers and SCD will lead to a better appreciation of this clinical problem by the clinicians and researchers and in turn have a long-term positive effect on the quality of life of patients with SCD. Researchers should design new trials considering these insights and potential therapeutic approaches based on current knowledge.
Effect of Masker Head Orientation, Listener Age, and Extended High-Frequency Sensitivity on Speech Recognition in Spatially Separated Speech
Authors: Braza Meredith D. , Corbin Nicole E. , Buss Emily , Monson Brian B.
Published: July 2021

Objectives:

Masked speech recognition is typically assessed as though the target and background talkers are all directly facing the listener. However, background speech in natural environments is often produced by talkers facing other directions, and talker head orientation affects the spectral content of speech, particularly at the extended high frequencies (EHFs; >8 kHz). This study investigated the effect of masker head orientation and listeners’ EHF sensitivity on speech-in-speech recognition and spatial release from masking in children and adults.

Design:

Participants were 5- to 7-year-olds (n = 15) and adults (n = 34), all with normal hearing up to 8 kHz and a range of EHF hearing thresholds. Speech reception thresholds (SRTs) were measured for target sentences recorded from a microphone directly in front of the talker’s mouth and presented from a loudspeaker directly in front of the listener, simulating a target directly in front of and facing the listener. The maskers were two streams of concatenated words recorded from a microphone located at either 0° or 60° azimuth, simulating masker talkers facing the listener or facing away from the listener, respectively. Maskers were presented in one of three spatial conditions: co-located with the target, symmetrically separated on either side of the target (+54° and −54° on the horizontal plane), or asymmetrically separated to the right of the target (both +54° on the horizontal plane).

Results:

Performance was poorer for the facing than for the nonfacing masker head orientation. This benefit of the nonfacing masker head orientation, or head orientation release from masking (HORM), was largest under the co-located condition, but it was also observed for the symmetric and asymmetric masker spatial separation conditions. SRTs were positively correlated with the mean 16-kHz threshold across ears in adults for the nonfacing conditions but not for the facing masker conditions. In adults with normal EHF thresholds, the HORM was comparable in magnitude to the benefit of a symmetric spatial separation of the target and maskers. Although children benefited from the nonfacing masker head orientation, their HORM was reduced compared to adults with normal EHF thresholds. Spatial release from masking was comparable across age groups for symmetric masker placement, but it was larger in adults than children for the asymmetric masker.

Conclusions:

Masker head orientation affects speech-in-speech recognition in children and adults, particularly those with normal EHF thresholds. This is important because masker talkers do not all face the listener under most natural listening conditions, and assuming a midline orientation would tend to overestimate the effect of spatial separation. The benefits associated with EHF audibility for speech-in-speech recognition may warrant clinical evaluation of thresholds above 8 kHz.
Interleukin-7 Reverses Lymphopenia and Improves T-Cell Function in Coronavirus Disease 2019 Patient With Inborn Error of Toll-Like Receptor 3: A Case Report
Authors: Mazer Monty B. , Turnbull Isaiah R. , Miles Sydney , Blood Teresa M. , Sadler Brooke , Hess Annie , Botney Mitchell D. , Martin Robert S. , Bosanquet James P. , Striker David A. , Anand Nitin S. , Morre Michel , Caldwell Charles C. , Brakenridge Scott C. , Moldawer Lyle L. , Di Paola Jorge A. , Hotchkiss Richard S. , Remy Kenneth E.
Published: July 2021

BACKGROUND:

Immunotherapy treatment for coronavirus disease 2019 combined with antiviral therapy and supportive care remains under intense investigation. However, the capacity to distinguish patients who would benefit from immunosuppressive or immune stimulatory therapies remains insufficient. Here, we present a patient with severe coronavirus disease 2019 with a defective immune response, treated successfully with interleukin-7 on compassionate basis with resultant improved adaptive immune function.

CASE SUMMARY:

A previously healthy 43-year-old male developed severe acute respiratory distress syndrome due to the severe acute respiratory syndrome coronavirus 2 virus with acute hypoxemic respiratory failure and persistent, profound lymphopenia. Functional analysis demonstrated depressed lymphocyte function and few antigen-specific T cells. Interleukin-7 administration resulted in reversal of lymphopenia and improved T-cell function. Respiratory function and clinical status rapidly improved, and he was discharged home. Whole exome sequencing identified a deleterious autosomal dominant mutation in TICAM1, associated with a dysfunctional type I interferon antiviral response with increased severity of coronavirus disease 2019 disease.

CONCLUSIONS:

Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening severe coronavirus disease 2019 infections, particularly by applying a precision medicine approach in selecting patients expressing an immunosuppressive phenotype.
Trends in ICU Mortality From Coronavirus Disease 2019: A Tale of Three Surges
Authors: Auld Sara C. , Harrington Kristin R. V. , Adelman Max W. , Robichaux Chad J. , Overton Elizabeth C. , Caridi-Scheible Mark , Coopersmith Craig M. , Murphy David J. ,   the Emory COVID-19 Quality and Clinical Research Collaborative
Published: July 2021

OBJECTIVES:

To determine the association between time period of hospitalization and hospital mortality among critically ill adults with coronavirus disease 2019.

DESIGN:

Observational cohort study from March 6, 2020, to January 31, 2021.

SETTING:

ICUs at four hospitals within an academic health center network in Atlanta, GA.

PATIENTS:

Adults greater than or equal to 18 years with coronavirus disease 2019 admitted to an ICU during the study period (i.e., Surge 1: March to April, Lull 1: May to June, Surge 2: July to August, Lull 2: September to November, Surge 3: December to January).

MEASUREMENTS AND MAIN RESULTS:

Among 1,686 patients with coronavirus disease 2019 admitted to an ICU during the study period, all-cause hospital mortality was 29.7%. Mortality differed significantly over time: 28.7% in Surge 1, 21.3% in Lull 1, 25.2% in Surge 2, 30.2% in Lull 2, 34.7% in Surge 3 (p = 0.007). Mortality was significantly associated with 1) preexisting risk factors (older age, race, ethnicity, lower body mass index, higher Elixhauser Comorbidity Index, admission from a nursing home); 2) clinical status at ICU admission (higher Sequential Organ Failure Assessment score, higher d-dimer, higher C-reactive protein); and 3) ICU interventions (receipt of mechanical ventilation, vasopressors, renal replacement therapy, inhaled vasodilators). After adjusting for baseline and clinical variables, there was a significantly increased risk of mortality associated with admission during Lull 2 (relative risk, 1.37 [95% CI = 1.03–1.81]) and Surge 3 (relative risk, 1.35 [95% CI = 1.04–1.77]) as compared to Surge 1.

CONCLUSIONS:

Despite increased experience and evidence-based treatments, the risk of death for patients admitted to the ICU with coronavirus disease 2019 was highest during the fall and winter of 2020. Reasons for this increased mortality are not clear.
Coronavirus Disease 2019 as Cause of Viral Sepsis: A Systematic Review and Meta-Analysis*
Authors: Karakike Eleni , Giamarellos-Bourboulis Evangelos J. , Kyprianou Miltiades , Fleischmann-Struzek Carolin , Pletz Mathias W. , Netea Mihai G. , Reinhart Konrad , Kyriazopoulou Evdoxia
Published: July 2021

Objective:

Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ dysfunction syndrome in its severe forms. The prevalence of coronavirus disease 2019–related sepsis is still unclear; we aimed to describe this in a systematic review.

Data Sources:

MEDLINE (PubMed), Cochrane, and Google Scholar databases were searched based on a prespecified protocol (International Prospective Register for Systematic Reviews: CRD42020202018).

Study Selection:

Studies reporting on patients with confirmed coronavirus disease 2019 diagnosed with sepsis according to sepsis-3 or according to the presence of infection-related organ dysfunctions necessitating organ support/replacement were included in the analysis. The primary end point was prevalence of coronavirus disease 2019–related sepsis among adults hospitalized in the ICU and the general ward. Among secondary end points were the need for ICU admission among patients initially hospitalized in the general ward and the prevalence of new onset of organ dysfunction in the ICU. Outcomes were expressed as proportions with respective 95% CI.

Data Extraction:

Two reviewers independently screened and reviewed existing literature and assessed study quality with the Newcastle-Ottawa Scale and the Methodological index for nonrandomized studies.

Data Synthesis:

Of 3,825 articles, 151 were analyzed, only five of which directly reported sepsis prevalence. Noting the high heterogeneity observed, coronavirus disease 2019–related sepsis prevalence was 77.9% (95% CI, 75.9–79.8; I
2 = 91%; 57 studies) in the ICU, and 33.3% (95% CI, 30.3–36.4; I
2 = 99%; 86 studies) in the general ward. ICU admission was required for 17.7% (95% CI, 12.9–23.6; I
2 = 100%) of ward patients. Acute respiratory distress syndrome was the most common organ dysfunction in the ICU (87.5%; 95% CI, 83.3–90.7; I
2 = 98%).

CONCLUSIONS:

The majority of coronavirus disease 2019 patients hospitalized in the ICU meet Sepsis-3 criteria and present infection-associated organ dysfunction. The medical and scientific community should be aware and systematically report viral sepsis for prognostic and treatment implications.
The Impact of Strict Public Health Restrictions on Pediatric Critical Illness*
Authors: Maddux Aline B. , Campbell Kristen , Woodruff Alan G. , LaVelle Jaime , Lutmer Jeffrey , Kennedy Curt E. , Malakooti Marcelo , McGuire John K. , Shekerdemian Lara , Harris Z. Leah , McCrory Michael C. , Carpenter Todd C.
Published: July 2021

OBJECTIVES:

To characterize the impact of public health interventions on the volume and characteristics of admissions to the PICU.

DESIGN:

Multicenter retrospective cohort study.

SETTING:

Six U.S. referral PICUs during February 15, 2020–May 14, 2020, compared with the same months during 2017–2019 (baseline).

Patients:

PICU admissions excluding admissions for illnesses due to severe acute respiratory syndrome coronavirus 2 and readmissions during the same hospitalization.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Primary outcome was admission volumes during the period of stay-at-home orders (March 15, 2020–May 14, 2020) compared with baseline. Secondary outcomes were hospitalization characteristics including advanced support (e.g., invasive mechanical ventilation), PICU and hospital lengths of stay, and mortality. We used generalized linear mixed modeling to compare patient and admission characteristics during the stay-at-home orders period to baseline. We evaluated 7,960 admissions including 1,327 during March 15, 2020–May 14, 2020. Daily admissions and patients days were lower during the period of stay-at-home orders compared with baseline: median admissions 21 (interquartile range, 17–25) versus 36 (interquartile range, 30–42) (p < 0.001) and median patient days 93.0 (interquartile range, 55.9–136.7) versus 143.6 (interquartile range, 108.5–189.2) (p < 0.001). Admissions during the period of stay-at-home orders were less common in young children and for respiratory and infectious illnesses and more common for poisonings, endocrinopathies and for children with race/ethnicity categorized as other/unspecified. There were no differences in hospitalization characteristics except fewer patients received noninvasive ventilation during the period of stay-at-home orders.

CONCLUSIONS:

Reductions in PICU admissions suggest that much of pediatric critical illness in younger children and for respiratory and infectious illnesses may be preventable through targeted public health strategies.
Recognizing Vaccine-Induced Immune Thrombotic Thrombocytopenia
Authors: Iba Toshiaki , Levy Jerrold H. , Warkentin Theodore E.
Published: July 2021

OBJECTIVES:

Vaccine-induced immune thrombotic thrombocytopenia is an unexpected consequence of the coronavirus disease 2019 pandemic era. We reviewed the pathogenesis, clinical presentation, diagnosis, and treatment of this rare side effect.

DATA SOURCES:

Online search of published medical literature through PubMed, Scopus, Web of Science, and Google Scholar using the terms “COVID-19,” “vaccine,” “thrombosis” was performed.

STUDY SELECTION:

Articles were chosen for inclusion based on their relevance to coronavirus disease 2019, vaccine, and thrombosis.

DATA SYNTHESIS:

Vaccine-induced immune thrombotic thrombocytopenia manifests most often as unusual thromboses (cerebral venous sinus thrombosis, splanchnic vein thrombosis) but sometimes also “usual” thromboses (arterial stroke, pulmonary embolism, deep-vein thrombosis), with oftentimes severe thrombocytopenia, that becomes clinically evident 5–30 days after adenovirus-vectored coronavirus disease 2019 vaccine administration. Most patients have disseminated intravascular coagulation. These features are the result of vaccine-triggered formation of anti-platelet factor 4 immunoglobulin G that activate platelets, clinically mimicking autoimmune heparin-induced thrombocytopenia. Early recognition based on thrombosis (sometimes, hemorrhage), thrombocytopenia, and d-dimer elevation within the day 5–30 postvaccine “window” is important given treatment with high-dose IV immunoglobulin plus nonheparin anticoagulation.

CONCLUSIONS:

Vaccine-induced immune thrombotic thrombocytopenia is a serious complication of vaccination that is not feasible to anticipate or prevent. When the patient presents with sustained headache, neurologic symptoms/signs, abdominal pain, dyspnea, or limb pain/swelling beginning 5–30 days post vaccination, platelet count and d-dimer must be measured, and imaging for thrombosis performed. Confirmation of vaccine-induced immune thrombotic thrombocytopenia diagnosis should be ordered (platelet factor 4/polyanion enzyme-linked immunosorbent assay; platelet factor 4–enhanced platelet activation testing) as treatment is initiated (nonheparin anticoagulation, IV immunoglobulin).
Preparing women experiencing symptoms of menopause for shared decision making about treatment
Authors: Dayaratna Sandra , Sifri Randa , Jackson Rebecca , Powell Rhea , Sherif Katherine , DiCarlo Melissa , Hegarty Sarah E. , Petrich Anett , Lambert Emily , Quinn Anna , Myers Ronald
Published: July 2021

Objective:

To develop a decision support intervention that can be used with women experiencing menopausal symptoms to facilitate treatment shared decision making.

Methods:

Our research team contacted patients with reported menopausal symptoms by telephone to obtain consent and administer a baseline survey. Subsequently, we sent participants a booklet on the treatment of menopausal symptoms. A nurse educator then contacted participants by telephone to review the booklet and guide them through a structured decision counseling exercise designed to help clarify treatment preference. A 60-day endpoint telephone survey was completed.

Results:

Forty-eight consenting participants completed the baseline survey and 37 (77%) also completed a decision counseling session. At baseline, 19 of the women who had decision counseling were not being treated for menopausal symptoms and 18 were being treated. After decision counseling, 13 (68%) participants who were not being treated and 14 (78%) who were being treated identified a preferred treatment. Comparison of baseline and endpoint survey data showed that participant treatment knowledge increased (P = 0.007) and treatment decisional conflict decreased (P < 0.001). Furthermore, 71% of participants reported that they had received new information about treatment and 94% said they believed better prepared to discuss treatment with their healthcare provider.

Conclusions:

Nurse-led decision counseling increased participant treatment knowledge, reduced treatment decisional conflict, and helped to clarify treatment preference. Implementation of this strategy could help to facilitate provider-patient shared decision making about the treatment of menopausal symptoms.
Risk Factors Associated With 30-Day Mortality Among Neonates With A. baumannii Sepsis
Authors: Thatrimontrichai Anucha , Tonjit Pichitra , Janjindamai Waricha , Dissaneevate Supaporn , Maneenil Gunlawadee , Phatigomet Manapat
Published: July 2021

Background:

Acinetobacter baumannii sepsis constitutes an extreme threat with a poor prognosis and is a difficult infection to control, especially in Asia. Moreover, a knowledge gap in the risk of mortality in neonatal A. baumannii sepsis still exists.

Methods:

This study aimed to identify the risk factors of mortality in neonates with A. baumannii sepsis in Thailand from 1996 to 2019. A multivariable logistic regression model was analyzed for nonsurvivors and survivors of neonatal A. baumannii sepsis.

Results:

In a 24-year period, 91 neonates with A. baumannii sepsis were reviewed. The median (interquartile range) gestational age and birth weight were 33 (28.5, 37.5) weeks and 1740 (987.5, 2730.0) g, respectively. The 30-day case fatality rate was 36.3% (33/91). In univariable analysis, nonsurvivors of neonatal A. baumannii sepsis was associated with smaller neonates, lower Apgar scores, septic shock, mechanical ventilation, umbilical catheterization, neutropenia, severe thrombocytopenia, carbapenem-resistant A. baumannii sepsis, inadequate empiric antimicrobial therapy, and acute kidney injury. In multivariable analysis, nonsurvivors of neonatal A. baumannii sepsis were associated with septic shock (adjusted odds ratio [OR] = 41.38; 95% confidence intervals [CI]: 3.42–501.13; P = 0.003), severe thrombocytopenia (adjusted OR = 33.70; 95% CI: 3.44–330.55; P = 0.002), and inadequate empiric antimicrobial therapy (adjusted OR = 10.05; 95% CI: 1.40–71.98; P = 0.02).

Conclusion:

In high multidrug-resistant areas, empiric treatment with broader spectrum antimicrobials should be considered in neonates with sepsis shock or severe thrombocytopenia.
Delayed Bronchiolitis Epidemic in French Primary Care Setting Driven by Respiratory Syncytial Virus: Preliminary Data from the Oursyn Study, March 2021
Authors: Rybak Alexis , Levy Corinne , Jung Camille , Béchet Stéphane , Batard Christophe , Hassid Frédéric , Zouari Morched , Cahn-Sellem Fabienne , Bangert Mathieu , Cohen Robert
Published: July 2021

We report early results from a prospective primary care bronchiolitis surveillance study in France in which a 10-week delayed epidemic was detected from February to March 2021. Among 225 children under 2 years with swab testing for a first bronchiolitis episode, 55% had a positive test for RSV, 0 for influenza, and 1 for severe acute respiratory syndrome coronavirus 2.
Effect of abatacept treatment on serum osteoclast-related biomarkers in patients with rheumatoid arthritis (RA)
Authors: Kawashiri Shin-Ya , Endo Yushiro , Nishino Ayako , Okamoto Momoko , Tsuji Sosuke , Takatani Ayuko , Shimizu Toshimasa , Sumiyoshi Remi , Koga Tomohiro , Iwamoto Naoki , Ichinose Kunihiro , Tamai Mami , Nakamura Hideki , Origuchi Tomoki , Aramaki Toshiyuki , Ueki Yukitaka , Yoshitama Tamami , Eiraku Nobutaka , Matsuoka Naoki , Okada Akitomo , Fujikawa Keita , Hamada Hiroaki , Nagano Shuji , Tada Yoshifumi , Kawakami Atsushi
Published: July 2021

We evaluated the effect of abatacept treatment on osteoclast-related biomarkers and explored whether the biomarkers are associated with the therapeutic response in rheumatoid arthritis (RA) patients treated with abatacept.

We enrolled 44 RA patients treated with abatacept from a multicenter prospective ultrasound cohort study of patients who received biologic or targeted synthetic disease-modifying antirheumatic drug therapy. We evaluated the disease activity score (DAS) 28-CRP (C-reactive protein), musculoskeletal ultrasound scores including the total grayscale score (GS)/power Doppler (PD) score and the serum concentrations of isoform 5b of tartrate-resistant acid phosphate (TRACP-5b) and soluble receptor activator of nuclear factor-κB ligand (sRANKL) at baseline and at 3 and 6 months of treatment. “PD responder” was defined as a patient whose Δtotal PD score over 6 months was greater than the median change of that.

Abatacept significantly improved DAS28-CRP as well as the total GS/PD score over 6 months. Serum TRACP-5b was significantly elevated and serum sRANKL was significantly decreased at 6 months (P < .0001 and P < .01, respectively). At 6 months, serum sRANKL was significantly decreased in the patients who achieved DAS28-CRP remission and the PD responders but not in those who did not. However, serum TRACP-5b rose regardless of the therapeutic response.

Among RA patients treated with abatacept, serum sRANKL decreased in the patients with a good therapeutic response, but serum TRACP-5b elevated paradoxically regardless of the therapeutic response.
Evaluation of the position of the needle tip during thoracentesis
Authors: Shimoda Masafumi , Morimoto Kozo , Tanaka Yoshiaki , Yoshimori Kozo , Ohta Ken
Published: July 2021

Introduction:

Thoracentesis is performed to both diagnose and/or treat pleural effusion, and several important complications of thoracentesis are occasionally observed. To assess precise thoracentesis procedures, we evaluated the position of the needle tip during thoracentesis by using a thoracentesis unit, comparing experienced and inexperienced groups.

Methods:

Twenty eight physicians (19 board-certified pulmonologists as an experienced group and the remaining 9 as an inexperienced group) participated at Fukujuji Hospital in January 2021. All participants performed 2 punctures with a handmade thoracentesis unit and measured the needle‘s angle to the midline.

Results:

The median distance from the needle tip to the midline when the needle was inserted 5 cm (D5) was 0.47 cm (range 0.06–1.05), and the median difference between D5 on the 1st puncture (D51st) and D5 on the 2nd puncture (D52nd) was 0.22 cm (range 0.00–0.69). D5 was shorter in the experienced group than in the inexperienced group (median 0.40 cm (range 0.06–0.66) vs 0.58 cm (range 0.44–1.05), P < .001). There were no significant differences in the D51st and D52nd distances between the experienced and inexperienced groups (median 0.22 cm (range 0.00–0.40) vs 0.41 cm (range 0.04–0.69), P = .094). When 4 areas were divided by the x-axis and y-axis, 32 punctures (55.2%) deviated to the right-upper quadrant, and 25 (86.2%) of participants made the 1st puncture and 2nd puncture in the same direction.

Conclusions:

All doctors should know that the needle direction might shift by approximately 1 cm, and more than half of the practitioners punctured towards the upper right.
Cardiovascular disease and prevention among people living with HIV in South Florida
Authors: Pyarali Fahim , Iordanov Roumen , Ebner Bertrand , Grant Jelani , Vincent Louis , Toirac Alexander , Haque Tahir , Zablah Gerardo , Kapoor Kunal , Powell Alexis , Boulanger Catherine , Hurwitz Barry , Alcaide Maria , Martinez Claudia
Published: July 2021

Antiretroviral therapy (ART) has improved survival of patients living with HIV (PLWH); however, this has been accompanied by an increase in cardiovascular disease (CVD). Although preventative measures for CVD among the general population are well described, information is limited about CVD prevention among PLWH. The goal of this study was to characterize the prevalence of CVD in our population and to assess the use of primary and secondary prevention.

We performed a retrospective review of PLWH receiving primary care at a large academic center in Miami, Florida. We characterized the prevalence of CVD, CVD risk, and the use of aspirin and statins for primary and secondary CVD prevention.

A total of 985 charts were reviewed (45% women, 55% men). Average age was 52.2 years. Average CD4 count was 568 cells/microL. 92.9% were receiving ART, and 71% were virologically suppressed. The median 10-year ASCVD risk was 7.3%. The prevalence of CVD was 10.4% (N = 102). The odds of having CVD was lower in patients on ART (OR 0.47, 95% CI: 0.25–0.90, P = .02). The use of medications for primary and secondary prevention of CVD based on current guidelines was low: 15% and 37% for aspirin respectively, and 25% and 44% for statins.

CVD risk and rates of CVD are high among PLWH and receiving ART could protect against CVD. However, the use of medications for primary and secondary prevention is low. Increased awareness of CVD risk-reduction strategies is needed among providers of PLWH to decrease the burden of CVD.
BCL7B is a potential novel diagnosis and prognosis biomarker for sarcomas using bioinformatics analysis
Authors: Yang Dinglong , Gu Xiaodong , Li Chunjiang , Shi Junjun , Chen Yujing , Dong Mingjie , Zhang Zhiqiang
Published: July 2021

BCL7B plays a potential role in the progression of various cancers, while its role in sarcomas is unknown. We aimed to evaluate BCL7B's diagnostic and prognostic value, and potential BCL7B-related mechanisms in sarcomas based on The Cancer Genome Atlas (TCGA) database. We collected patients with sarcoma from TCGA. Wilcoxon rank sum test was used to compare the expression of BCL7B in sarcoma samples with different clinical-pathologic features. Univariate Cox regression analysis and multivariate Cox regression analysis were used to evaluate prognosis factors for sarcoma. Gene set enrichment analysis (GSEA) was conducted to elucidate the significant functions and pathways associated with BCL7B. BCL7B was a potential biomarker for distinguishing normal and tumor tissues with the analysis of ROC curve (AUC = 0.588). Low BCL7B expression was significantly correlated with tumor multifocal (OR = 0.39 for yes vs no), larger residual tumor (OR = 0.40 for R1,R2 vs RO), male gender (OR = 0.48 for male vs female) and White race (OR = 0.29 for White vs Asian, Black or African American). High BCL7B expression was correlated with leiomyosarcoma histological type (OR = 6.08 for leiomyosarcoma vs dedifferentiated liposarcoma, pleomorphic sarcoma). Univariate and multivariate Cox regression analysis showed that low BCL7B expression was independently associated with poor overall survival (P = .008). GSEA showed that GPCR (G protein-coupled receptors) ligand binding, secreted factors, class A1 rhodopsin-like receptors, extracellular matrix organization, core matrisome, Fc epsilon receptor I mediated NF-κB activation, and WNT signaling pathway were differentially enriched in BCL7B low expression phenotype (|NES| > 1, adjusted P value <.05, and FDR value <0.25). BCL7B may play an important role in sarcoma progression and may be a potential biomarker for prognosis and diagnosis in sarcomas.
Association of vitamin D receptor gene polymorphism with type 1 diabetes mellitus risk in children
Authors: Ran Yalin , Hu Suyuan , Yu Xiaohua , Li Renjun
Published: July 2021

Background:

Recent genetic association studies showed that there are contradictory results on the relationship between vitamin D receptor (VDR) gene polymorphisms and type 1 diabetes mellitus (T1DM) risk in children. The purpose of this systematic review is to collect the currently available evidence to evaluate the relationship between VDR gene polymorphisms and the risk of T1DM in children.

Methods:

Such medical databases as Wanfang Data, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chongqing VIP Chinese Science and Technology Periodical Database, PubMed, Embase, and Web of Science were extensively searched for relevant literatures published before June 2021 with the focus on the relationship between VDR gene polymorphisms and the risk of T1DM in children. The risk of bias was evaluated as per the Newcastle-Ottawa Scale by 2 independent researchers. Meta-analysis was performed to quantify the relationship between VDR gene polymorphisms and T1DM risk in children.

Results:

The results of this meta-analysis would be submitted to a peer-reviewed journal for publication.

Conclusion:

The relationship between VDR gene polymorphisms and T1DM risk in children is explored via this meta-analysis.

Ethics and dissemination:

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

Osf Registration Number:

DOI 10.17605/OSF.IO/Q8XA5.
Intermittent pneumatic compression for prolonged standing workers with leg edema and pain
Authors: Won Yu Hui , Ko Myoung-Hwan , Kim Dong Hyun
Published: July 2021

Even healthy individuals often encounter leg venous symptoms such as heaviness, pain, and swelling especially after prolonged standing work. Intermittent pneumatic compression (IPC) is a widely used simple therapy for preventing deep vein thrombosis and for treating lymphedema and chronic venous insufficiency. However, IPC has not been evaluated for its effect in relieving venous symptoms of healthy people.

This was single center, cross-over study to investigate the effect of IPC for 20 healthy volunteers who usually stand on duty and complain of leg pain and swelling. The primary outcome was pain (measured using a visual analogue scale) and secondary outcomes were leg circumference and volume. Three different interventions included natural rest, sequential mode of IPC, and circular mode of IPC. Outcomes were measured before work and immediately after work (T1), after 30 minutes of intervention (T2), and 30 minutes of rest after intervention (T3).

Pain and leg circumferences were significantly improved at T2 and T3 compared with those at T1. Sequential and circular IPC led to significantly greater improvement in pain and leg circumferences than just natural rest, but there was no difference in its effect according to the 2 modes of IPC. Leg volume was reduced significantly at T2 and T3 as compared with T1 in all 3 interventions, but effects did not differ among 3 intervention groups.

IPC is effective for reducing leg pain and circumferences more than natural rest in healthy adults with prolonged standing work, without causing adverse events.
Successful management of thrombocytopenia by partial splenic embolization in patients with advanced gastric cancer and invasion of the splenic vein
Authors: Nakatsubo Ryosuke , Yamauchi Yoshiya , Hiraizumi Taisho , Naruse Fumi , Kanda Ryoya , Suzuki Yuka , Kakegawa Tatsuya , Kurosawa Takashi , Yoshimasu Yu , Saguchi Toru , Sofuni Atsushi , Itoi Takao
Published: July 2021

Rationale:

Hypersplenism causes thrombocytopenia, which may lead to the reduction or discontinuation of chemotherapy. Partial splenic embolization (PSE) is an effective treatment for thrombocytopenia associated with hypersplenism. However, there have been no reports of patients with gastric cancer who have resumed and continued chemotherapy after PSE for splenic hypersplenism associated with tumor infiltration.

Here, we report two cases in which we performed PSE for hypersplenism associated with gastric cancer that had invaded the splenic vein. Chemotherapy was continued in both cases.

Patient concerns:

Both patients developed thrombocytopenia with splenomegaly due to advanced gastric cancer that required discontinuation of chemotherapy.

Diagnosis:

Upper gastrointestinal endoscopy and computed tomography showed advanced gastric cancer with invasion of the splenic vein and splenomegaly. Both patients developed thrombocytopenia.

Interventions:

Patients were treated with PSE.

Outcomes:

PSE produced an increase in thrombocyte count, and chemotherapy could be resumed.

Lessons:

PSE seems to be a useful treatment for thrombocytopenia with splenomegaly associated with advanced gastric cancer and may allow continuation of chemotherapy.
Efficacy of virtual reality therapy in ideomotor apraxia rehabilitation
Authors: Park Wookyung , Kim Jongwook , Kim MinYoung
Published: July 2021

Rationale:

We report the possible therapeutic efficacy of immersive virtual reality (VR) rehabilitation for the treatment of ideomotor apraxia in a patient with stroke.

Patient concerns:

A 56-year-old man with sudden weakness of his left side caused by right frontal, parietal, and corpus callosal infarction was transferred to rehabilitation medicine center for intensive rehabilitation. Although his left-sided weakness had almost subsided 10 days after the onset of symptoms, he presented difficulty using his left hand and required assistance in most activities of daily living.

Diagnoses:

Ideomotor apraxia in a patient with right hemispheric infarction.

Interventions:

VR content was displayed to the study participants using a head-mounted display that involved catching of moving fish in the sea by grasping. Before and after of rehabilitative intervention including VR, functional measurements incorporating the Test of Upper Limb Apraxia (TULIA) were conducted. To directly compare therapeutic potencies under different conditions, success rates of consecutive grasping gesture performance were observed in VR, conventional occupational therapy setting, and augmented reality intervention.

Outcomes:

The patient demonstrated remarkable amelioration of apraxic symptoms while performing the task in the VR environment. At 1 and 3 months after the training, he showed significant improvement in most functions, and the TULIA score increased to 176 from 121 at the initiation of therapy. The number of successful grasps during 30 trials of each grasp trial was 28 in VR, 8 in the occupational therapy setting, and 20 in augmented reality.

Lessons:

This case report suggests the possible therapeutic efficacy of immersive VR training as a rehabilitative measure for ideomotor apraxia.
Safety of Venous Thromboprophylaxis With Low‐molecular‐weight Heparin in Children With Ulcerative Colitis
Authors: Story Eden , Bijelic Vid , Penney Chelsea , Benchimol Eric I. , Halton Jacqueline , Mack David R.
Published: July 2021

Objectives:

To evaluate for increased rectal bleeding following enoxaparin thromboprophylaxis in children hospitalized for ulcerative colitis (UC).

Methods:

Retrospective cohort study (2007‐‐2016) of 218 inpatients with active UC. Patients receiving enoxaparin were compared with a nonenoxaparin‐treated patient group. Severity of UC was determined using the Pediatric Ulcerative Colitis Activity Index (PUCAI). Hemoglobin (Hb) values and packed red blood cell (pRBC) transfusions were reviewed for a 7‐day period following hospital admission. A linear mixed effect model was used to compare change in Hb values between the groups. Risk of pRBC transfusion was compared using a log‐rank test and Cox proportional hazard regression. A sub‐analysis was also conducted restricting to patients with severe UC to provide more generalizable insight into safety profile of enoxaparin.

Results:

Children hospitalized for UC and receiving enoxaparin were more likely to have severe disease, received infliximab therapy and be admitted after 2010. Use of enoxaparin showed there was not a difference (P = 0.60) in the fall of Hb detected among those with acute severe colitis (initial PUCAI ≥65) during the week following admission. Moreover, there was no difference in the risk of requiring a pRBC transfusion with enoxaparin use (log‐rank test all patients: P = 0.80; severe UC: P = 0.88; Cox proportional hazard regression all patients: P = 0.72; severe UC: 0.85).

Conclusions:

There was no difference in Hb levels or need for blood transfusions in children hospitalized for severe UC (PUCAI ≥65) whether or not they received enoxaparin for thromboembolism prophylaxis.
A Retrospective Review of Primary Percutaneous Endoscopic Gastrostomy and Laparoscopic Gastrostomy Tube Placement
Authors: McSweeney Maireade E. , Mitchell Paul D. , Smithers C. Jason , Doherty Ashley , Perkins Julia , Rosen Rachel
Published: July 2021

Objectives:

The laparoscopic‐assisted gastrostomy tube placement (LAP) has increasingly become the preferred method for placing gastrostomy tubes in infants and children. The goal of this retrospective review was to examine our institutional experiences with our transition from the percutaneous endoscopic gastrostomy (PEG) procedure to LAP technique.

Methods:

All patients undergoing primary PEG or LAP gastrostomy at Boston Children's Hospital between January 2010 and June 2015 were identified. The primary aim was to compare complication rates within the first 6 months after tube placement; differences in total hospital procedural costs, hospital resource utilization, and postoperative gastroesophageal reflux disease were examined.

Results:

Nine hundred and eighty‐seven patients (442 PEG and 545 LAP gastrostomy tubes) were included. No differences in total complications within 6 months were seen. Patients undergoing PEG placement had more gastrostomy‐related complications (PEG 30 [6.7%] vs LAP 13 [2.4%], P = 0.0007) and cellulitis (PEG 23 [5.1%] vs LAP 2 [0.4%], P = 0.03) within the first week of placement. Patients undergoing LAP procedures had more granulation tissue episodes (PEG 19 [4.4%] vs LAP 107 [19.8%], P = 0.005). No differences in emergency room visits, hospital readmissions, or postoperative gastroesophageal reflux disease were seen, although transition to a gastrojejunal tube was higher in patients undergoing LAP procedure (PEG 20 patients [4.6%] vs LAP 51 patients [9.5%], P = 0.0008).

Conclusions:

Total complications were similar between patients undergoing PEG versus LAP gastrostomy tube placement. Patients with the PEG procedure had more complications within the first week of placement versus patients with the LAP procedure had more granulation skin complications.
The Expanding Role of Posterior Vault Distraction Osteogenesis in Idiopathic Intracranial Hypertension and Slit Ventricle Syndrome
Authors: Zapatero Zachary D. , Kalmar Christopher L. , Kosyk Mychajlo S. , Humphries Laura S. , Swanson Jordan W. , Bartlett Scott P. , Heuer Gregory G. , Taylor Jesse A.
Published: July 2021

The purpose of this study was to compare perioperative safety and efficacy of posterior vault distraction osteogenesis (PVDO) in patients with primary nonsynostotic cephalo-cranial disproportion, namely slit ventricle syndrome and idiopathic intracranial hypertension (IIH), to a cohort of patients with craniosynostosis (CS). A retrospective review of patients undergoing PVDO from 2009 to 2019 at our institution was performed. Craniosynostosis patients were matched by sex and age at PVDO to the nonsynostotic cohort. Operative details, perioperative outcomes, and distraction patterns were analyzed with appropriate statistics. Nine patients met inclusion criteria for the non-CS cohort. Six patients (67%) underwent PVDO for slit ventricle and the remaining 3 patients (33%) underwent PVDO for IIH. The majority of CS patients were syndromic (n = 6, 67%) and had multisuture synostosis (n = 7, 78%). The non-CS cohort underwent PVDO at a median 56.1 months old [Q1 41.1, Q3 86.6] versus the CS cohort at 55.7 months [Q1 39.6, Q3 76.0] (P = 0.931). Total hospital length of stay was longer in the non-CS patients (median days 5 [Q1 4, Q3 6] versus 3 [Q1 3, Q3 4], P = 0.021). Non-CS patients with ventriculoperitoneal shunts had significantly less shunt operations for ICP concerns post-PVDO (median rate: 1.74/year [Q1 1.30, Q3 3.00] versus median: 0.18/year [Q1 0.0, Q3 0.7]; P = 0.046). In this pilot study using PVDO to treat slit ventricle syndrome and IIH, safety appears similar to PVDO in the synostotic setting. The cohort lacks adequate follow-up to assess long term efficacy, although short-midterm follow-up demonstrates promising results with less need for shunt revision and symptomatic relief. Future studies are warranted to identify the preferred surgical approach in these complex patients.
Consistency of Cranial Shape Measures Obtained From Laser Surface and Computed Tomography Imaging
Authors: Shock Leslie A. , Greer Sean , Sheahan Lucy D. , Muzaffar Arshad R. , Aldridge Kristina
Published: July 2021

Objective:

Children with cranial shape abnormalities are often subjected to radiation from computed tomography (CT) for evaluation and clinical decision making. The STARscanner Laser Data Acquisition System (Orthomerica, Orlando, FL) may be a noninvasive alternate. The purpose of this study is to determine whether the STARscanner provides valid and accurate cranial measurements compared to CT.

Design:

We performed an institutional review board-approved retrospective review of a prospectively maintained database of patients with metopic suture abnormalities from 2013 to 2016.

Setting:

Plastic surgery clinic in an institutional tertiary care center.

Patients:

Eight patients were included that presented with metopic suture abnormalities, age less than 1 year, and CT and STARscanner imaging within 30 days of one another.

Main Outcome Measures:

Cranial measurements were collected twice from 3 scan types: STARscanner, CT windowed for soft tissue, and CT windowed for bone. Measurements included: intracranial volume, height, base width, maximum antero-posterior length, maximum medio-lateral width, and oblique diameters. Nested analysis of variance were performed to determine the proportion of error attributable to: between-subject variance, scan type, and rater.

Results:

Measurements from STARscanner and both CT scans windows were highly consistent, with less than 1% of total error attributable to scan type for all measures.

Conclusions:

Cranial shape measurements obtained from STARscanner images are highly consistent with those obtained from CT scans. The STARscanner has added benefits of speed of acquisition, minimal cost, and lack of radiation.
A Concept of “Boundary Determination” by the Combination of a Local Flap and Free Tissue Transfer Useful for the Prevention of Postoperative Complications After Complex and Widespread Skull Base Reconstruction
Authors: Tanaka Kentaro , Sugawara Takashi , Asakage Takahiro , Okazaki Mutsumi
Published: July 2021

The transplanted tissue is sutured to the stumps of the bones in skull base reconstruction. Concerning reconstruction by free tissue transfer, it is difficult that the tissue is accurately sutured/fixed to a complex three-dimensional structure. The authors devised a technique in which free tissue transfer is combined with a local flap. A pericranial flap is sutured/fixed onto the irregular border between the cranial and nasal cavities. A free tissue graft is transplanted cranial or caudal to the determined border. Clinical presentation 1 is a patient with carcinoma of the frontal sinus (T4bN0M0). Resection of the frontal bone/nasal bone/medial and superior walls of the orbit, frontal lobectomy was performed. Clinical presentation 2 is a patient with carcinoma of the maxillary sinus (T4aN0M0). Extended total maxillectomy, simultaneous resection of the facial skin/temporal muscle were performed. There were no serious postoperative complications related to compression or occlusion of the cerebral parenchyma or paranasal sinus.
Correction of Metopic Craniosynostosis Using Limited Incision Strip Craniectomy Versus Open Fronto-Orbital Reconstruction: An Assessment of Aesthetic Outcomes
Authors: Benkler Michal , Hallac Rami R. , Geisler Emily L. , Kane Alex A.
Published: July 2021

Background:

Metopic craniosynostosis is traditionally repaired with fronto-orbital advancement (FOA) or, alternatively, limited short scar strip craniectomy (LSSSC) followed by helmet therapy. There is controversy among surgeons regarding resultant head shape outcomes between the 2 methods. This study aims to assess how surgeons perceive the postoperative aesthetic results of the 2 metopic craniosynostosis repair methods.

Methods:

A retrospective analysis was performed on 13 (n = 6 LSSSC; n = 7 FOA) patients who presented for surgical correction of isolated metopic craniosynostosis via either LSSSC (followed by helmet therapy) or FOA. Clinical photographs at 1 year postop were shown to 10 craniofacial surgeons who rated the aesthetic outcomes on a Likert scale of 1 (poor) to 5 (excellent) and guessed which surgical method was performed.

Results:

Mean age at the time of the procedure was younger in LSSSC than FOA (3.1 ± 1.0 versus 17.5 ± 8.5 months; P < 0.001). Mean blood loss was significantly lower with LSSSC versus FOA (202.0 ± 361.2 versus 371.43 ± 122.9 mL; P < 0.001), as was mean blood transfusion requirement (92.5 ± 49.9 versus 151.3 ± 51.2 mL; P < 0.001) and mean duration of the operation (3:06 ± 0:24 versus 7:53 ± 0:31 hours; P < 0.001). Mean surgeon scores of aesthetic outcomes were similar between groups: LSSSC, 3.27 ± 1.09; FOA, 3.51 ± 0.95 (P = 0.171). When asked to identify which procedure patients had received, only 63.8% of responses were correct.

Conclusions:

Limited short scar strip craniectomy offers an important alternative to traditional open FOA and should be considered as an option for children diagnosed with metopic craniosynostosis.
Surgical Correction of Craniofacial Fibrous Dysplasia Involving Orbits: A Unique Application of Patient-Specific Implants
Authors: Dasukil Saubhik , Boyina Kiran Kumar , Nayak Bhagabat , Chakraborty Koyel , C.S Lalitha , Panda Ritesh
Published: July 2021

Craniofacial fibrous dysplasia is a slow-growing bony disorder causing asymmetry of the face; leading to aesthetic, functional, and psychological ramifications. Surgical recontouring is the most accepted form of treatment. Reconstruction of the orbit poses a serious challenge to the surgeon; hence the present study is intended to describe and evaluate a most anatomically accurate virtual treatment planning and defect-specific implant technique, enumerating postoperative functional and esthetic outcome. The study highlights a valid application of three-dimensional models and computer-guided surgical splints. The current study included 5 patients with craniofacial fibrous dysplasia involving orbits with a mean age of 19.6 years. Detailed pre- and post-operative ophthalmologic workup were documented for one year. All the participants showed improvement in eyeball position and movement. Visual acuity and intraocular pressure have returned to near normal values, and astigmatism was reduced significantly. No recurrence was noted in any of the subjects. The current technique was found helpful in reconstructing the complex orbital anatomy; however, long-term follow-up studies with a greater number of patients are recommended.