bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of Unemployment Insurance
Authors: Landais Camille , Spinnewijn Johannes
Published: December 2020

Due to the absence of unemployment insurance (UI) choices, the traditional approach to estimating the value of UI is to infer it from the observed consumption response to job loss under some assumption on risk preferences. Exploiting the rich data and unique policy context in Sweden, we propose two alternative approaches that relax this assumption and we implement all three methods on the same sample of workers. The first approach considers the difference in marginal propensity to consume (MPC) when unemployed versus employed, which allows to identify the difference in prices to smooth consumption in the respective states. The second approach exploits UI choices embedded in the Swedish UI system in a Revealed Preference approach. While the drop in consumption expenditures is relatively small ($\sim$13%), we find that the MPC is around 25% higher when unemployed than employed, translating into a marginal value of transfers that is at least $60$% higher when unemployed than employed. This high value of UI is confirmed by our RP estimates and indicates substantial risk aversion given the relatively small drop in consumption expenditures.
Comorbidities at diagnosis of rheumatoid arthritis: a population-based case-control study
Authors: Tidblad Liselotte , Westerlind Helga , Delcoigne Bénédicte , Askling Johan , Saevarsdottir Saedis
Published: December 2020

Objectives

Comorbidities contribute to the morbidity and mortality in RA, and are thus important to capture and treat early. In contrast to the well-studied comorbidity risks in established RA, less is known about the comorbidity pattern up until diagnosis of RA. We therefore compared whether the occurrence of defined conditions, and the overall comorbidity burden at RA diagnosis, is different from that in the general population, and if it differs between seropositive and seronegative RA.

Methods

Using Swedish national clinical and demographic registers, we identified new-onset RA patients (n = 11 086), and matched (1:5) to general population controls (n = 54 813). Comorbidities prior to RA diagnosis were identified in the Patient and Prescribed Drug Registers, and compared using logistic regression.

Results

At diagnosis of RA, respiratory (odds ratio (OR) = 1.58, 95% CI: 1.44, 1.74), endocrine (OR = 1.39, 95% CI: 1.31, 1.47) and certain neurological diseases (OR = 1.73, 95% CI: 1.59, 1.89) were more common in RA vs controls, with a similar pattern in seropositive and seronegative RA. In contrast, psychiatric disorders (OR = 0.87, 95% CI: 0.82, 0.92) and malignancies (OR = 0.88, 95% CI: 0.79, 0.97) were less commonly diagnosed in RA vs controls. The comorbidity burden was slightly higher in RA patients compared with controls (P <0.0001).

Conclusion

We found several differences in comorbidity prevalence between patients with new-onset seropositive and seronegative RA compared with matched controls from the general population. These findings are important both for our understanding of the evolvement of comorbidities in established RA and for early detection of these conditions.
Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach
Authors: Özen Seza , Sag Erdal , Ben-Chetrit Eldad , Gattorno Marco , Gül Ahmet , Hashkes Philip J , Kone-Paut Isabelle , Lachmann Helen J , Tsitsami Elena , Twilt Marinka , Benedetti Fabrizio de , Kuemmerle-Deschner Jasmin B
Published: December 2020

Objectives

Colchicine is the main treatment for FMF. Although a number of individuals with FMF are intolerant/resistant to colchicine, there is no standard definition of colchicine resistance/intolerance. We developed a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF that may serve as a guide for clinicians and health authorities.

Methods

A set of statements was identified using a modified-Delphi consensus-based approach. The process involved development of an initial colchicine resistance/intolerance-related questionnaire derived from a systematic literature review. The questionnaire, which was completed by an international panel of 11 adult and paediatric rheumatologists with expertise in FMF, was analysed anonymously. The results informed draft consensus statements that were discussed by a round-table expert panel, using a nominal group technique to agree on the selection and wording of the final statements.

Results

Consensus among the panel was achieved on eight core statements defining colchicine resistance/intolerance in patients with FMF. A definition of resistance was agreed upon that included recurrent clinical attacks (average one or more attacks per month over a 3-month period) or persistent laboratory inflammation in between attacks. Other core statements recognize the importance of assessing treatment adherence, and the impact of active disease and intolerance to colchicine on quality of life.

Conclusion

Based on expert opinion, a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF were identified to help guide clinicians and health authorities in the management of patients with FMF.
Work–Family Reconciliation and Children’s Well-Being Disparities across OECD Countries
Authors: Andersson Matthew A , Garcia Michael A , Glass Jennifer
Published: December 2020

Socioeconomic inequalities in health and well-being are large, beginning early in childhood and accumulating over the life course, but they also vary widely across rich, developed nations. Despite this well-known cross-national variation, research has yet to examine why children’s health disparities might be larger or smaller based on national policy contexts and macroeconomic conditions. Parental health and well-being suffer under high work–family or economic strain, which may directly impact children’s health inequalities by family social class. These childhood health disadvantages, if not substantially improved, compound to even larger adult inequalities. To examine the role of national work–family reconciliation in children’s health, we merge country-level policy data with 2006 and 2010 World Health Organization child-level data on mental and physical well-being and family economic disadvantage. Based on adjusted estimates, we find greatly narrowed disparities in children’s self-rated health as work flexibility and vacation-sick leave mandates become more generous. However, cash transfer policies, including family benefits spending and childcare costs, were not associated with the size of children’s health disparities. Taken together, our results suggest the distinctive value of better work–family accommodations, rather than any generic cash allowances, for lessening family-based inequalities in children’s health and human capital development.
Rest-activity rhythms and white matter microstructure across the lifespan
Authors: McMahon Megan , Malneedi Yoshita , Worthy Darrell A , Schnyer David M
Published: December 2020

Study Objectives

The purpose of this study was to examine how rest-activity (RA) rhythm stability may be associated with white matter microstructure across the lifespan in healthy adults free of significant cardiovascular risk.

Methods

We analyzed multi-shell diffusion tensor images from 103 healthy young and older adults using tract-based spatial statistics (TBSS) to examine relationships between white matter microstructure and RA rhythm stability. RA measures were computed using both cosinor and non-parametric methods derived from 7 days of actigraphy data. Fractional anisotropy (FA) and mean diffusivity (MD) were examined in this analysis. Because prior studies have suggested that the corpus callosum (CC) is sensitive to sleep physiology and RA rhythms, we also conducted a focused region of interest analysis on the CC.

Results

Greater rest-activity rhythm stability was associated with greater FA across both young and older adults, primarily in the CC and anterior corona radiata. This effect was not moderated by age group. While RA measures were associated with sleep metrics, RA rhythm measures uniquely accounted for the variance in white matter integrity.

Conclusions

This study strengthens existing evidence for a relationship between brain white matter structure and RA rhythm stability in the absence of health risk factors. While there are differences in RA stability between age groups, the relationship with brain white matter was present across both young and older adults. RA rhythms may be a useful biomarker of brain health across both periods of adult development.
The protective effect of gastrodin against the synergistic effect of HIV-Tat protein and METH on the blood–brain barrier via glucose transporter 1 and glucose transporter 3
Authors: Li Juan , Huang Jian , He Yongwang , Wang Wenguang , Leung Chi-Kwan , Zhang Dongxian , Zhang Ruilin , Wang Shangwen , Li Yuanyuan , Liu Liu , Zeng Xiaofeng , Li Zhen
Published: December 2020

Many individuals infected with human immunodeficiency virus (HIV) are also afflicted with HIV-associated neurocognitive disorders (HANDs). Methamphetamine (METH) abuse puts HIV-1 patients at risk for HANDs because METH and HIV-1 proteins, such as trans-activator of transcription (Tat), can synergistically damage the blood–brain barrier (BBB). However, the underlying mechanism of METH- and HIV-Tat-induced BBB damage remains unclear. In this study, male adult tree shrews and human brain capillary endothelial cells were treated with HIV-Tat, METH, and gastrodin. We used western blotting to examine the expressions of glucose transporters (GLUT1 and GLUT3), tight junctions, and junctional adhesion molecule A (JAMA) and to evaluate the damage and detect Evans blue (EB) and fluorescein sodium in the brain to assess BBB permeability to study the effect of METH and the HIV-1 Tat protein on BBB function in vitro and in vivo. The results showed that the group treated with Tat and METH experienced a significant change at the ultrastructural level of the tree shrew cerebral cortex, decreased protein levels of occluding, claudin-5, Zonula occludens 1 (ZO1), and JAMA in vitro and in vivo, and increased levels of EB and fluorescein sodium in the tree shrew cerebral cortex. The protein levels of GLUT1 and GLUT3 was downregulated in patients with Tat- and METH-induced BBB damage. Pretreatment with gastrodin significantly increased the levels of EB and fluorescein sodium in the tree shrew cerebral cortex and increased the expressions of occluding, ZO1, JAMA, and GLUT1 and GLUT. These results indicate that gastrodin may offer a potential therapeutic option for patients with HANDs.
Biomarkers and the Prediction of Adverse Outcomes in Preeclampsia
Authors: Lim Sean , Li Wentao , Kemper Jessica , Nguyen Andrew , Mol Ben Willem , Reddy Maya
Published: December 2020

OBJECTIVE:

To systematically review the performance of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and the sFlt-1/PlGF ratio in predicting adverse outcomes in women with preeclampsia.

DATA SOURCES:

We performed a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, ClinicalTrials.gov, and Emcare databases from 1989 to March 2019 to identify studies correlating sFlt-1, PlGF, and the sFlt-1/PlGF ratio with the occurrence of adverse outcomes in women with preeclampsia.

METHODS OF STUDY SELECTION:

Two independent reviewers screened 3,194 studies using Covidence. Studies were included if they examined the performance of sFLT-1, PlGF, or the sFLT-1/PlGF ratio in predicting adverse outcomes in women with suspected or confirmed preeclampsia.

TABULATION, INTEGRATION, AND RESULTS:

We extracted contingency tables with true-positive, false-positive, true-negative, and false-negative results. We calculated sensitivity, specificity, diagnostic odds ratios, and area under the summary receiver operating characteristic curve (area sROC) through a bivariate mixed-effects meta-analysis. Our literature search identified 3,194 articles, of which 33 (n=9,426 patients) were included. There was significant variation in the included studies with regard to the biomarkers and outcomes assessed. As such, few studies (n=4–8) were included in the meta-analysis component with significant heterogeneity between studies (I2=33–99). Nonetheless, both PlGF and the sFlt-1/PlGF ratio demonstrated area sROC values between 0.68 and 0.87 for the prediction of composite adverse maternal and perinatal outcomes, preterm birth and fetal growth restriction.

CONCLUSION:

Placental growth factor and the sFlt-1/PlGF ratio show prognostic promise for adverse outcomes in preeclampsia, but study heterogeneity limits their clinical utility.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42019136207.
A Model for Exploring Compatibility Between Applicants and Residency Programs
Authors: Winkel Abigail Ford , Morgan Helen Kang , Burk-Rafel Jesse , Dalrymple John L. , Chiang Seine , Marzano David , Major Carol , Katz Nadine T. , Ollendorff Arthur T. , Hammoud Maya M.
Published: December 2020

Holistic review of residency applications is touted as the gold standard for selection, yet vast application numbers leave programs reliant on screening using filters such as United States Medical Licensing Examination scores that do not reliably predict resident performance and may threaten diversity. Applicants struggle to identify which programs to apply to, and devote attention to these processes throughout most of the fourth year, distracting from their clinical education. In this perspective, educators across the undergraduate and graduate medical education continuum propose new models for student-program compatibility based on design thinking sessions with stakeholders in obstetrics and gynecology education from a broad range of training environments. First, we describe a framework for applicant-program compatibility based on applicant priorities and program offerings, including clinical training, academic training, practice setting, residency culture, personal life, and professional goals. Second, a conceptual model for applicant screening based on metrics, experiences, attributes, and alignment with program priorities is presented that might facilitate holistic review. We call for design and validation of novel metrics, such as situational judgment tests for professionalism. Together, these steps could improve the transparency, efficiency and fidelity of the residency application process. The models presented can be adapted to the priorities and values of other specialties.
Fetal Head Station at Second-Stage Dystocia and Subsequent Trial of Labor After Cesarean Delivery Success Rate
Authors: Rottenstreich Amihai , Meyer Raanan , Rottenstreich Misgav , Elami Matan , Lewkowicz Aya , Yagel Simcha , Tsur Abraham , Rosenbloom Joshua I. , Yagel Itay , Yinon Yoav , Levin Gabriel
Published: December 2020

OBJECTIVE:

To investigate whether fetal head station at the index cesarean delivery is associated with a subsequent trial of labor success rate among primiparous women.

METHODS:

A retrospective cohort study conducted at two tertiary medical centers included all primiparous women with subsequent delivery after cesarean delivery for second-stage dystocia during 2009–2019, identified from the electronic medical record databases. Univariate and multivariate analyses were performed to assess the factors associated with successful trial of labor after cesarean (TOLAC) (primary outcome). Additionally, all women with failed TOLAC were matched one-to-one to women with successful TOLAC, according to factors identified in the univariate analysis.

RESULTS:

Of 481 primiparous women with prior cesarean delivery for second-stage dystocia, 64.4% (n=310) attempted TOLAC, and 222 (71.6%) successfully delivered vaginally. The rate of successful TOLAC was significantly higher in those with fetal head station below the ischial spines at the index cesarean delivery, as compared with those with higher head station (79.0% vs 60.5%, odds ratio [OR] 2.46, 95% CI 1.49–4.08). The proportion of neonates weighing more than 3,500 g in the subsequent delivery was lower in those with successful TOLAC compared with failed TOLAC (29.7% vs 43.2%, OR 0.56, 95% CI 0.33–0.93). In a multivariable analysis, lower fetal head station at the index cesarean delivery was the only independent factor associated with TOLAC success (adjusted OR 2.38, 95% CI 1.43–3.96). Matching all women with failed TOLAC one-to-one to women with successful TOLAC, according to birth weight and second-stage duration at the subsequent delivery, lower fetal head station at the index cesarean delivery remained the only factor associated with successful TOLAC.

CONCLUSION:

Lower fetal head station at the index cesarean delivery for second-stage dystocia was independently associated with a higher vaginal birth after cesarean rate, with an overall acceptable success rate. These findings should improve patient counseling and reassure those who wish to deliver vaginally after prior second-stage arrest.
Recreational Cannabis Use Before and After Legalization in Women With Pelvic Pain
Authors: Geoffrion Roxana , Yang Emily C. , Koenig Nicole A. , Brotto Lori A. , Barr Alasdair M. , Lee Terry , Allaire Catherine , Bedaiwy Mohamed A. , Yong Paul J.
Published: December 2020

OBJECTIVE:

To evaluate the prevalence and characteristics of recreational cannabis use in women with pelvic pain, and to examine the influence of cannabis legalization on these parameters.

METHODS:

We conducted a retrospective analysis of a prospective registry of women with self-reported moderate-to-severe pelvic pain referred to a tertiary care clinic in Vancouver, Canada, 2013–2019. We excluded patients aged 18 years or younger and those with unknown data on cannabis use. Demographic, clinical, and validated questionnaire data were extracted for two main analyses: 1) comparison of current cannabis users with current nonusers, and 2) comparison of current cannabis users who entered the registry before cannabis legalization (October 17, 2018) with those who entered the registry on or after legalization.

RESULTS:

Overall, 14.9% (509/3,426) of patients were classified as current cannabis users. Compared with nonusers, cannabis users were younger (P<.001), had lower levels of education (P<.001) and lower household income (P<.001), were taking opioids (P<.001), antiinflammatories (P=.003), neuromodulators (P=.020), and herbal medications (P<.001) more frequently. They had worse questionnaire scores for depression, anxiety, pain catastrophizing, quality of life, and pelvic pain severity (P<.001 for all). After cannabis legalization, prevalence of current cannabis use increased from 13.3% (366/2,760) to 21.5% (143/666) (P<.001). Compared with prelegalization, postlegalization users were associated with higher levels of education (P<.001), worse anxiety (P=.036), and worse pain catastrophizing (P<.001) scores. They were taking fewer antiinflammatories (P<.001), neuroleptics (P=.027) and daily opioids or narcotics (P=.026), but more herbal medications (P=.010).

CONCLUSION:

Recreational cannabis use increased among patients with pelvic pain after legalization in Canada. Cannabis users had worse pain-related morbidities. Postlegalization, cannabis users were less likely to require daily opioids compared with cannabis users before legalization. The role, perceived benefits, and possible risks of cannabis for pelvic pain require further investigation.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02911090.
Cochrane Review Summaries—January 2021
Authors: Tursunova Roziya , Guise Jeanne-Marie , Patanwala Insiyyah Y. , Haas David M.
Published: December 2020

In this month's issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we highlight two interventions related to labor induction and initiation as well as a review of adhesion-prevention techniques in gynecologic surgery. The summaries are published below. The complete references with hyperlinks are listed in Box 1.
Long-term Patient Perception Following Surgery for Adolescent Idiopathic Scoliosis if Dissatisfied at 2-year Follow-up
Authors: Hughes Jessica , Yaszay Burt , Bastrom Tracey P. , Bartley Carrie E. , Parent Stefan , Cahill Patrick J. , Lonner Baron , Shah Suken A. , Samdani Amer , Newton Peter O.
Published: December 2020

Study Design.

Longitudinal.

Objectives.

To evaluate whether the rate of patients who report low health-related quality of life (HRQOL) scores at 2 years following surgical correction of adolescent idiopathic scoliosis (AIS) improves by 5 years postoperatively.

Summary of Background Data.

HRQOL scores are dependent upon a number of factors and even in instances of good surgical correction of a spinal deformity, are not guaranteed to be high postoperatively. Understanding how a low HRQOL score varies over the postoperative period can help surgeons more effectively counsel patients and temper expectations.

Methods.

A multicenter database was reviewed for patients with both 2 and 5-year follow-up after spinal fusion and instrumentation for AIS. From a cohort of 916 patients, 52 patients with low HRQOL scores at their 2-year follow-up were identified and reevaluated at 5-year follow-up. A low HRQOL outcome was defined as having SRS-22 domain or total scores less than 2 standard deviations below the mean score. Reoperations were also evaluated to determine if they were associated with HRQOL scores.

Results.

Of those patients with low SRS-22 HRQOL scores at 2 years postoperatively, improvements were seen in all SRS-22 domains and total scores at the 5-year time point. The greatest change was seen in the satisfaction category where 41 patients showed improvement. The rate of reoperations during this period did not significantly impact patient-reported outcomes.

Conclusions.

Having a low HRQOL score 2 years after surgery for AIS does not guarantee a low score 5 years after surgery. Promisingly, most patients demonstrate some improvement in all domains for patient-reported SRS-22 scores at 5-year compared to 2-year follow-up. Understanding the longer term postoperative evolution in patient-reported outcomes may help surgeons to effectively manage and counsel patients who are dissatisfied in the short term.

Level of Evidence: 3
Simulation of Implant Impingement After Spinal Corrective Fusion Surgery in Patients with Previous Total Hip Arthroplasty: A Retrospective Case Series
Authors: Yamato Yu , Furuhashi Hiroki , Hasegawa Tomohiko , Yoshida Go , Yasuda Tatsuya , Banno Tomohiro , Oe Shin , Arima Hideyuki , Shimizu Yuta , Hoshino Hironobu , Matsuyama Yukihiro
Published: December 2020

Study Design.

A retrospective case series.

Objective.

The aim of this study was to introduce the prevention of total hip arthroplasty (THA) dislocation using an implant impingement simulation after spinal corrective fusion and to verify the outcomes.

Summary of Background Data.

A high dislocation rate was found among patients who underwent spinal deformity corrective fusion with previous THA. To avoid dislocation, an appropriate position of the stem and cup is important, but the pelvic inclination may change after corrective fusion for spinal deformity.

Methods.

Twelve consecutive patients (two men, 10 women; average age, 72.1 [range, 55–81] years during spine surgery) with previous THA were included. Data were retrospectively retrieved from a single-center's prospectively collected database of adult spinal deformity operation. Before surgery, anterior implant impingement simulation in THA was performed using computed tomography-based software. The tolerable pelvic tilt (PT) in which the anterior implant impingement occurred in the hip at the 120° flexion position was measured. The lumbar lordosis angle was deliberately reduced during spinal surgery according to the tolerable PT. The effect of the implant impingement simulation was verified by comparison with patients who underwent surgery before simulation (before 2014).

Results.

THA dislocation occurred in six patients: four of five (80%) in the non-simulation, and two of seven (28.6%) in the simulation group. The difference between the preoperative and tolerable PT angles was−25° to 33°, and three patients had negative angles. In these three patients, the risk of anterior impingement and THA dislocation significantly increased with correction of lumbar lordosis if the PT was anterior. Two patients experienced repeated THA dislocation with postoperative and tolerable PT angle differences of 2° and −23°

Conclusion.

Our simulation of anterior implant impingement and subsequent adjustment of the degree of spinal correction was useful to prevent dislocation. However, this method did not prevent dislocation in some patients.

Level of Evidence: 4
Management of Small Unruptured Intracranial Aneurysms
Authors: Elkun Yuval , Cooper Jared , Kamal Haris , Dakay Katarina , Nuoaman Halla , Adnan Yasir Ammar , Dodson Vincent , Nuoman Rolla , Kaur Kavneet , Kurian Christeena , Sahni Ramandeep , Gandhi Chirag , Al-Mufti Fawaz
Published: December 2020

Unruptured intracranial aneurysms measuring <7 mm in diameter have become increasingly prevalent due to advances in diagnostic imaging. The most feared complication is aneurysm rupture leading to a subarachnoid hemorrhage. Based on the current literature, the 3 main treatments for an unruptured intracranial aneurysm are conservative management with follow-up imaging, endovascular coiling, or surgical clipping. However, there remains no consensus on the best treatment approach. The natural history of the aneurysm and risk factors for aneurysm rupture must be considered to individualize treatment. Models including population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from a prior aneurysm, site of aneurysm score, Unruptured Intracranial Aneurysm Treatment Score, and advanced neuroimaging can assist physicians in assessing the risk of aneurysm rupture. Macrophages and other inflammatory modulators have been elucidated as playing a role in intracranial aneurysm progression and eventual rupture. Further studies need to be conducted to explore the effects of therapeutic drugs targeting inflammatory modulators.
Metabolic dysfunction modifies the influence of traffic-related air pollution and noise exposure on late-life dementia and cognitive impairment
Authors: Yu Yu , Haan Mary , Paul Kimberly C. , Mayeda Elizabeth Rose , Jerrett Michael , Wu Jun , Lee Eunice , Su Jason , Shih I-Fan , Inoue Kosuke , Ritz Beate R
Published: December 2020

Background:

Cognitive impairment has been linked to traffic-related air pollution and noise exposure as well as to metabolic syndrome or some of its individual components. Here, we investigate whether the presence of metabolic dysfunction modifies associations between air pollution or noise exposures and incident dementia or cognitive impairment without dementia (CIND).

Methods:

For 1,612 elderly Mexican-American participants of the Sacramento Area Latino Study on Aging (SALSA) followed for up to 10 years, we estimated residential-based local traffic-related exposures relying on the California Line Source Dispersion Model version 4 (CALINE4) for nitrogen oxides (NOx) and the SoundPLAN software package (Version 8.0; NAVCON, Fullerton, CA) that implements the Federal Highway Administration Traffic Noise Model (TNM) for noise, respectively. We used Cox proportional hazard models to estimate the joint effects of NOx or noise exposures and obesity, hyperglycemia, or low high-density lipoprotein (HDL) cholesterol.

Results:

The risk of developing dementia/CIND among participants with hyperglycemia who also were exposed to high levels of NOx (≥3.44 parts per billion [ppb] [75th percentile]) or noise (≥65 dB) was 2.4 (1.4, 4.0) and 2.2 (1.7, 3.9), respectively. For participants with low HDL-cholesterol, the estimated hazard ratios for dementia/CIND were 2.5 (1.4, 4.3) and 1.8 (1.0, 3.0) for those also exposed to high levels of NOx (≥3.44 ppb) or noise (≥65 dB), respectively, compared with those without metabolic dysfunction exposed to low traffic-related air pollution or noise levels.

Conclusions:

Exposure to traffic-related air pollution or noise most strongly increases the risk of dementia/CIND among older Mexican-Americans living in California who also exhibit hyperglycemia or low HDL-cholesterol.
Mask-induced Artifact Impacts Intraocular Pressure Measurement Using Goldmann Applanation Tonometry
Authors: Davanian Arash M. , Donahue Sean P. , Mogil Rachel S. , Groth Sylvia L.
Published: December 2020

Purpose:

The coronavirus (COVID-19) pandemic has impacted ophthalmology practices significantly. American Academy of Ophthalmology and Center for Disease Control guidelines suggest mandatory masking of patients and physicians during outpatient visits. We have recently become aware of a mask-induced phenomenon, whereby the intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) is artificially elevated due to mechanical interference from the mask.

Clinical Presentation:

A 37-year-old male with a history of primary open-angle glaucoma on triple therapy presented for a routine visit.

Clinical Findings:

When measuring IOP by GAT the right eye measured 16 mm Hg, but the left eye measured 20 mm Hg. The patient’s mask was noted to be touching the base of the sensor rod on the tonometer. This patient’s IOP was falsely elevated due to the lateral edge of his mask touching the base of the applanation tonometer, changing the relationship between the bi-prism tip and the weighted balance below, and eliminating the weighted balance from the pressure measuring mechanism. The patient’s mask was adjusted to ensure there was no touch and repeat measurement showed an IOP of 16 mm Hg in the left eye.

Conclusion:

Recognizing mask-induced alteration in IOP is essential as it could lead to unnecessary escalation of treatment. We recommend flattening the area of mask protrusion during applanation and ensuring that the sensor arm remains clear of the mask while the tonometer tip approaches the cornea, especially at the moment the mires become visible during corneal contact.
Central-most Visual Field Defects in Early Glaucoma
Authors: Chakravarti Tutul , Moghimi Sasan , De Moraes Carlos Gustavo , Weinreb Robert N.
Published: December 2020

Précis:

This study demonstrates the substantial association between visual field (VF) defect within the central-most 4 points in 24-2 VF and the VF defect exhibited by 10-2 test pattern relative to the initial defect in 24-2 VF.

Purpose:

To evaluate the significance of central-most visual field defects (CMVFDs) in 24-2 VF in early glaucoma.

Methods:

This cross-sectional study examined 29 eyes of 28 glaucoma patients with CMVFDs. CMVFD was defined as a glaucomatous defect with at least 1 abnormal point at P<1% within the central 5 degrees on 3 consecutive 24-2 VF tests. 10-2 VFs were categorized into 3 groups by severity of pattern defects: deep arcuate, partial arcuate, and minimal defect. The deep arcuate group was interpreted as the most severe defect on the 10-2 VF. Mann-Whitney test was used to compare the perimetric parameters differences between 24-2 VFs with CMVFD and 10-2 VFs related to the initial defect.

Results:

CMVFD was observed in 82% eyes, predominantly in the superior hemifield (86%). Arcuate-like defects (72%) on the 10-2 VF were mostly in superior hemifield (82%). The deep arcuate group showed significantly worse mean deviation (MD) and pattern standard deviation (PSD), (MD= −9.1±4, PSD =10.7±2.1 dB), than partial arcuate and minimal defect groups (all P<0.001). Eyes with deep arcuate defect had severely depressed defect depth (−26 to −35 dB) and low sensitivity (<0 to 10 dB) at abnormal points in the central 5 degrees in 24-2 VF. A significant difference among deep arcuate, partial arcuate (P<0.001), and minimal defect groups (P<0.001) was observed at abnormal points’ threshold sensitivity and defect depth.

Conclusions:

Given the significance and effect of perimetric factors at abnormal test points in the central 5 degrees of 24-2 VFs, these eyes deserve attention to determine the severity of and functional impact on the CMVFD in early glaucoma by performing 10-2 test.
Drive-through Intraocular Pressure Checks During the COVID-19 Pandemic
Authors: Baughman Brittanie D. , Hansemann Beth K. , Shah Manjool M. , Weizer Jennifer S.
Published: December 2020

Precis:

A drive-through clinic was created to obtain intraocular pressure measurements before a virtual visit with their provider, in order to provide care for patients in the Kellogg Glaucoma Clinic while minimizing risk of COVID-19 transmission.

Purpose:

The aim of this study was to establish a drive-through clinic model to provide glaucoma care for patients while minimizing the risk of COVID-19 transmission.

Patients and Methods:

A drive-through clinic was created by adapting a 1-lane, 1-way driveway adjacent to the Kellogg Eye Center building entrance. Patients were physicianselected from the Glaucoma Clinic at Kellogg Eye Center as existing patients who required intraocular pressure (IOP) checks and therapeutic management and were chosen based on their ability to be managed with an IOP measurement primarily. The entrance was otherwise closed to the public, allowing staff to utilize an adjacent vestibule with glass walls and sliding doors as a staffroom. Patients were instructed to arrive within a 15-minute time window at which time they would drive through the lane and stop their cars under an awning over the driveway. Ophthalmic technicians wearing appropriate personal protective equipment then approached each car, confirmed patient information, and measured IOP. Once the data were recorded using a mobile workstation, the physician was able to complete each visit by discussing the findings and therapeutic plan with the patient, either in-person in real time or virtually by phone or video visit at a later time.

Results:

A total of 241 visits were completed over 14 half day clinic sessions, with number of drive-through visits ranging from 5 to 45 per session.

Conclusions:

It is possible to institute a drive-through model of IOP checks for glaucoma patients which is efficient and minimizes the risk of exposure to COVID-19 for patients and staff.
Ocular findings in metabolic syndrome: a review
Authors: Lima-Fontes Mário , Barata Pedro , Falcão Manuel , Carneiro Ângela
Published: December 2020

Metabolic syndrome (MetS) has emerged as a worldwide health hazard of the modern lifestyle, representing a cluster of metabolic abnormalities and a risk factor for cardiovascular disease. Eye diseases, such as diabetic retinopathy, central retinal artery occlusion, cataract, age-related macular degeneration, glaucoma, and dry eye syndrome have been linked with many of MetS components. Their relationship with MetS itself is, however, a recent topic of investigation. This review aims to gather published evidence supporting associations between ocular findings and MetS and to explore the related physiopathological processes that congregate in this syndrome and lead to these diseases. Despite compiling interesting and compelling evidence, it raises awareness to the need of further studies in this field to keep solidifying these associations and unveiling the pathological processes that support them. It ultimately targets MetS patients as a population of individuals who are at increased risk of developing age-related eye diseases and vision loss.
Health-Related Quality of Life Declines Over 3 Years for Congenital Heart Disease Survivors
Authors: Jackson Jamie L. , DeSalvo Jennifer , Leslie Carine E. , Rausch Joseph R.
Published: December 2020

Background

Because of medical advancements, many congenital heart disease (CHD) survivors are relatively symptom-free until adulthood, at which time complications may occur. Worsening health status likely drives a change in patient-reported outcomes, such as health-related quality of life (HRQoL), although change in HRQoL has not been investigated among adolescent and young adult CHD survivors.

Objective

The aims of the current mixed cross-sectional and longitudinal study were to (1) examine changes in HRQoL over 3 years and (2) identify any demographic (age, sex, estimated family income, and distance from medical center) and medical predictors (functional status and number of cardiac-related medications) of that change.

Methods

Baseline and 3-year follow-up data were obtained via an online survey of 172 CHD survivors (15–39 years old at baseline; 25% simple, 45% moderate, 30% complex) recruited from a pediatric hospital and an adult hospital. Medical predictors were abstracted from electronic medical records.

Results

After controlling for New York Heart Association functional class, mixed-effects models identified significant declines in all subscales of the Research and Development Corporation 36-Item Health Survey 1.0 across the 3-year timeframe. A lower estimated family income (≤$35 000) predicted more decline in physical functioning (b = 0.5, 95% confidence interval, 0.2–0.8; P = .001) and emotional functioning (b = 0.3, 95% confidence interval, 0.1–0.5; P = .017). No other significant demographic or medical predictors were identified.

Conclusions

Study findings highlight the importance of tracking patient-reported outcomes over time, suggesting that medical staff should discuss HRQoL with CHD survivors during late adolescence and early adulthood before decline.
Pilot Study of the Performance of 19-G Needle in Endobronchial Ultrasound-guided Transbronchial Aspiration for the Diagnosis and Testing of Molecular Markers in Lung Cancer
Authors: Wahidi Momen M. , Davidson Kevin , Shofer Scott , Mahmood Kamran , Cheng George , Giovacchini Coral , Jones Claudia , Jug Rachel , Pavlisko Elizabeth N. , Wang Xiaofei , Gu Lin , Weimholt Cody , Zhou Zhongren , Chen Alexander
Published: December 2020

Background:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the standard for diagnosis and staging of lung cancer. Historically, 21- and 22-G needles have been paired with EBUS. We evaluated the performance of EBUS-TBNA using a larger 19-G needle in the assessment of tumor tissue obtained and success of testing for molecular markers.

Methods:

We prospectively enrolled adult patients with lymphadenopathy concerning for metastatic lung cancer. Patients underwent diagnostic EBUS-TBNA utilizing 19-G needles. Cases of non–small cell lung cancer (NSCLC) were evaluated for programmed cell death receptor ligand (PD-L1) expression. Cases of adenocarcinoma or undifferentiated NSCLC were further evaluated for 3 molecular markers for driver mutations: epidermal growth factor receptor (EGFR), c-ros oncogene 1 (ROS-1), and anaplastic lymphoma kinase (ALK).

Results:

Fifty patients were enrolled and underwent EBUS-TBNA using 19-G needles. PD-L1 assay was successfully performed in 90% of NSCLC cases. In adenocarcinoma or undifferentiated NSCLC cases, the success rate in testing was 90% for EGFR and 86% for ALK. ROS-1 testing had a success rate of 67%; 24% of these specimens had adequate tumor cells but there was technical difficulty with the assay. Block quality was judged by total number of tumor cells per hematoxylin and eosin–stained slide of each cell block (58% of specimens had >500 cells and 22% had 200 to 500 cells). There were no adverse events.

Conclusion:

EBUS-TBNA using 19-G needles can obtain a high number of tumor cells and has a high rate of success in performing assays for PD-L1, EGFR, and ALK in NSCLC patients without an increase in adverse events. The success rate of ROS-1 testing was lower.
Correlation Between Anatomic Variations of Sphenoid Sinuses and Pituitary Adenoma
Authors: Guo Fang , Li Zhongzhen , Tian Chao , Yan Yujia , Yao Xiuhua , Tong Xiaoguang , Yan Hua
Published: December 2020

Background:

Many persons have studied relationship between anatomic variations (AVs) of sphenoid sinuses (SS) and paranasal disease, but no research has been done to reveal the correlation between AVs of SS and sellar region lesions.

Objective:

To compare AVs of SS between sellar region lesions and healthy persons and analyze factors affecting the volume of SS and explore the correlation between AVs of SS and pituitary adenomas (PAs).

Methods:

Clinical data of 53 PAs as experiment group and 30 healthy persons as control team was reviewed. Computed tomography images of SS performed at Tianjin Huanhu Hospital were studied. The AVs of SS including degree of pneumatization, type of intersinus septum (IS), and volume of SS were evaluated by ITK-SNAP software.

Results:

Age, gender, degree of pneumatization, and type of IS had no significant difference between groups, while the volume of SS in experiment group was smaller than that in control group (P < 0.05). The volume of SS was associated with age, sex, degree of pneumatization, type of IS in control group, and degree of pneumatization, type of IS in experiment group. In experiment group, patients with postoperative pathological examination ki67 ≥ 3% had bigger volume and higher recurrent rate (P < 0.05).

Conclusion:

Visualizing different orientations and 3D model of SS is conducive to the success of trans-sphenoid surgery. Pituitary adenomas can deform the SS leading to smaller volume. The volume of SS can be a factor used to predict the outcome of PAs.
Safe and Efficient Removal of Massive Head and Neck Vascular Malformations Using Vessel Sealing Energy Devices
Authors: Tom Alan , Powers Jeremy M. , Chaiyasate Kongkrit
Published: December 2020

Large vascular malformations (VMs) pose several difficult clinical challenges to the plastic surgeon. Traditionally surgical dissection was labor-intensive and required a significant amount of time and technique. The advent of more advanced vessel sealing devices has resulted in easier vascular and lymphatic control during resection surgery. The authors present 2 cases of large VMs resected using newer energy devices. First, an infant who was born with a large neck AVM that was acutely bleeding requiring immediate control. The authors utilized the Impact Ligasure device to perform a subtotal resection, stabilize the patient, and returned for definitive resection in the future. In the second case, an adult male with a large complex tongue/lip AVM, presented for elective resection. He underwent staged sclerotherapy, followed by resection using the Harmonic Scalpel. The use of vessel sealing devices allows for a safe and efficient resection for a previously difficult surgery.
Rare Cause of Blurred Vision: Unilateral Primary Dural Ectasia of the Optic Nerve Sheath
Authors: Gozgec Elif , Ogul Hayri
Published: December 2020

Dural ectasia, also known as meningocele of the optic nerve sheath, is a rare benign pathology. Magnetic resonance imaging has a great role in the diagnosis of this condition, which has nonspecific symptoms such as progressive blurred vision. It is observed as cerebrospinal fluid accumulation within the expanded nerve sheath around the optic nerve. Treatment is planned after differential diagnosis of other pathologies such as mass and inflammation in addition to diagnosis with magnetic resonance imaging. Medical treatment is usually sufficient, and surgical treatment is planned for progressive patients.
A Novel Application of the Modified Angoff Method to Rate Case Difficulty in Simulation-Based Research
Authors: Joseph Melissa N. , Chang Jungsoo , Buck Samuel G. , Auerbach Marc A. , Wong Ambrose H. , Beardsley Thomas D. , Reeves Philip M. , Ray Jessica M. , Evans Leigh V.
Published: December 2020

Introduction

Simulation use in research is often limited by controlling for scenario difficulty when using repeated measures. Our study assesses the feasibility of the Modified Angoff Method to reach expert consensus regarding difficulty of medical simulations. We compared scores with participant physiologic stress.

Methods

Emergency medicine physicians with expertise in simulation education were asked to review 8 scenarios and estimate the percentage of resident physicians who would perform all critical actions using the modified Angoff method. A standard deviation (SD) of less than 10% of estimated percentage correct signified consensus. Twenty-five residents then performed the 6 scenarios that met consensus and heart rate variability (HRV) was measured.

Results

During round 1, experts rated 4/8 scenarios within a 10% SD for postgraduate year 3 (PGY3) and 3/8 for PGY4 residents. In round 2, 6/8 simulation scenarios were within an SD of 10% points for both years. Intraclass correlation coefficient was 0.84 for PGY3 ratings and 0.89 for PGY4 ratings. A mixed effects analysis of variance showed no significant difference in HRV change from rest to simulation between teams or scenarios. Modified Angoff Score was not a predictor of HRV (multiple R
2 = 0.0176).

Conclusions

Modified Angoff ratings demonstrated consensus in quantifying the estimated percentage of participants who would complete all critical actions for most scenarios. Although participant HRV did decrease during the scenarios, we were unable to significantly correlate this with ratings. This modified Angoff method is a feasible approach to evaluate simulation difficulty for educational and research purposes and may decrease the time and resources necessary for scenario piloting.
B-cell Deficiency Attenuates Transplant Glomerulopathy in a Rat Model of Chronic Active Antibody-mediated Rejection
Authors: Reese Shannon R. , Wilson Nancy A. , Huang Yabing , Ptak Lucille , Degner Kenna R. , Xiang Ding , Redfield Robert R. , Zhong Weixiong , Panzer Sarah E.
Published: December 2020

Background.

Transplant glomerulopathy (TG) is a pathological feature of chronic active antibody-mediated rejection (cAMR) and is associated with renal allograft failure. The specific role of B cells in the pathogenesis of TG is unclear.

Methods.

We used a minor mismatched rat kidney transplant model with B cell–deficient recipients, generated by clustered regularly interspaced short palindromic repeats/Cas9 technology, to investigate the impact of B-cell depletion on the pathogenesis of TG. We hypothesized that B-cell deficiency would prevent TG in the rat kidney transplant model of cAMR. Treatment groups included syngeneic, allogeneic, sensitized allogeneic, and B cell–deficient allogeneic transplant recipients.

Results.

B cell–deficient recipients demonstrated reduced TG lesions, decreased microvascular inflammation, reduced allograft infiltrating macrophages, and reduced interferon gamma transcripts within the allograft. Allograft transcript levels of interferon gamma, monocyte chemoattractant protein-1, and interleukin-1β correlated with numbers of intragraft macrophages. B cell–deficient recipients lacked circulating donor-specific antibodies and had an increased splenic regulatory T-cell population.

Conclusions.

In this model of cAMR, B-cell depletion attenuated the development of TG with effects on T cell and innate immunity.
Microbes Against Humanity, a workshop game for horrible students: using a creative card game in higher education microbiology teaching
Authors: Efthimiou Georgios , Tucker Nicholas P.
Published: December 2020

Introducing creative workshops in higher education curricula, in addition to formal lectures, is an excellent way of reinforcing knowledge and encouraging creative thinking. In particular, the use of card games as a tool for inducing student engagement and enthusiasm has been reported to be a very effective approach. Here, we report an innovative card game-based workshop for use at the intermediate undergraduate level. The name of the game is Microbes Against Humanity and has been adapted from the widely known party game Cards Against Humanity, which is freely available under a creative commons licence. Overall, 64 students and two academics participated in this 2 h workshop. Our students found the workshop to be very enjoyable, considered it to be helpful for their learning and suggested interesting ideas for further improvement. In conclusion, it was shown that such exciting workshops can trigger students’ enthusiasm for microbiology and enhance their learning potential.