bluuebunny/crossref_metadata_2025 huggingface dataset:
Algorithmic prognostication in critical care: a promising but unproven technology for supporting difficult decisions
Authors: Weissman Gary E. , Liu Vincent X.
Published: July 2021

Purpose of review

Patients, surrogate decision makers, and clinicians face weighty and urgent decisions under uncertainty in the ICU, which could be aided by risk prediction. Although emerging artificial intelligence/machine learning (AI/ML) algorithms could reduce uncertainty surrounding these life and death decisions, certain criteria must be met to ensure their bedside value.

Recent findings

Although ICU severity of illness scores have existed for decades, these tools have not been shown to predict well or to improve outcomes for individual patients. Novel AI/ML tools offer the promise of personalized ICU care but remain untested in clinical trials. Ensuring that these predictive models account for heterogeneity in patient characteristics and treatments, are not only specific to a clinical action but also consider the longitudinal course of critical illness, and address patient-centered outcomes related to equity, transparency, and shared decision-making will increase the likelihood that these tools improve outcomes. Improved clarity around standards and contributions from institutions and critical care departments will be essential.

Improved ICU prognostication, enabled by advanced ML/AI methods, offer a promising approach to inform difficult and urgent decisions under uncertainty. However, critical knowledge gaps around performance, equity, safety, and effectiveness must be filled and prospective, randomized testing of predictive interventions are still needed.
Distinguishing diabetes secondary to pancreatic diseases from type 2 diabetes mellitus
Authors: Hart Phil A. , Andersen Dana K. , Petrov Maxim S. , Goodarzi Mark O.
Published: July 2021

Purpose of review

Diabetes secondary to pancreatic diseases (i.e., acute pancreatitis, chronic pancreatitis, and pancreatic cancer) is increasingly studied, but remains challenging to distinguish from type 2 diabetes (T2DM). We review the clinical significance and potential biomarkers that may help differentiate these types of diabetes.

Recent findings

Recent studies have identified several complications (including nonvascular) that occur more frequently in patients with diabetes secondary to acute and chronic pancreatitis than T2DM, and biomarkers to differentiate these types of diabetes. There have been advances that may enable the enrichment of a population of adults with new onset diabetes to potentially screen for occult pancreatic cancer, but efforts are needed to identify and validate promising diagnostic biomarkers.

High-quality studies are needed to more precisely understand the risk factors and natural course of diabetes secondary to pancreatic diseases. Mechanistic and interventional studies are awaited to provide insights that will distinguish diabetes secondary to pancreatic diseases and refine the management of hyperglycemia in this patient population.
Tips for successful deep enteroscopy
Authors: Lo Simon K. , Paski Shirley , Liu Quin
Published: July 2021

Purpose of review

The aim of this study was to provide practical tips to readers on how to perform deep enteroscopy efficiently.

Recent findings

Deep enteroscopy has revolutionized the diagnosis and management of small intestinal conditions in recent years. They are extremely valuable, but may be technically challenging to perform, regardless if it is double balloon enteroscopy, single balloon enteroscopy or spiral enteroscopy. The common issues to these procedures are repetitive motion, extended procedure duration and physical exertion during scope advancement. These situations may in turn lead to a variety of ergonomic issues that need to be addressed accordingly to prevent occupational injuries to the endoscopists and their assistants. Depending on the clinical indications, the technical approach and execution of these procedures may be carried out differently. Some guiding principles may be applied to make performing these procedures more smoothly, effectively and deeply.

Careful planning and skilful manipulations are essential to performing an efficient and stress-free deep enteroscopy. There are many simple ways to improve on the ergonomics and performance of these procedures.
Effect of robotic-assisted gait training on functional status, walking and quality of life in complete spinal cord injury
Authors: Çinar Çiğdem , Yildirim Mustafa Aziz , Öneş Kadriye , Gökşenoğlu Gökşen
Published: July 2021

The purpose of this study was to investigate the effect of robotic-assisted gait training (RAGT) on functional status and the quality of life in patients with subacute complete spinal cord injury (SCI). Thirty-seven patients with complete SCI were included in this study. All patients underwent conventional rehabilitation 5 days a week for 8 weeks. The patients were divided into two groups: those who received RAGT (group I, n = 17) and those who received only conventional rehabilitation (group II, n = 20) for 30 min twice a week for a total of 8 weeks. Evaluations were performed using the Walking Index SCI II (WISCI II) for ambulation, Functional Independence Measure (FIM) for functional status and Short Form 36 (SF-36) for the quality of life at the beginning and end of rehabilitation. The mean duration of injury was 3.5 ± 2.1 months in group I and 3.8 ± 2.6 months in group II (P > 0.05). Significant improvement was observed in both groups as per WISCI II and FIM scores (P < 0.05). However, no significant inter-group difference was noted in pre- and post-treatment FIM and WISCI II change scores (P > 0.05). In groups I and II, there was significant improvement only in physical activity scores of SF-36 compared with baseline scores (P < 0.05); however, other SF-36 subparameter scores did not differ significantly between pre- and post-treatment (P > 0.05). Treatment with RAGT has positive effects on functional independence, ambulation and the quality of life in patients with subacute complete SCI. RAGT combined with conventional therapy in patients with complete SCI may facilitate the improvement of patient condition more than conventional therapy alone.
Prevalence and predictors of hospital-acquired functional decline in patients with sepsis admitted to the intensive care unit
Authors: Takahashi Yuta , Morisawa Tomoyuki , Okamoto Hiroshi , Aoki Kazuhiro , Saitoh Masakazu , Takahashi Tetsuya , Fujiwara Toshiyuki
Published: July 2021

Although sepsis is known to cause functional decline, the prevalence and predictors of hospital-acquired functional decline (HAFD) in patients with sepsis are unclear. The purpose of this study was to investigate the prevalence and predictors of HAFD in patients with sepsis admitted to the ICU. This study is a single-center retrospective observational study from January 2014 to December 2019. We included all consecutive patients with sepsis who received rehabilitation in our ICU. The primary outcome was HAFD, which was defined as a decrease in at least five points of the Barthel index mobility score from prehospital to hospital discharge. We described the prevalence of HAFD and investigated the predictors of HAFD using the multivariate logistic regression analysis adjusting for potential confounders. Among 134 patients, 57 patients (42.5%) had HAFD. The longer time to initial ambulation and lower prehospital walking ability were associated with HAFD (adjusted odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03–1.10 and adjusted OR 0.79; 95% CI, 0.66–0.95, respectively). In conclusion, nearly half of the patients with sepsis who received rehabilitation developed HAFD. Lower functional status prior to hospitalization and the longer time to initial ambulation was associated with HAFD, indicating the potential importance of early ambulation among septic patients in the ICU.
Topical Review: Understanding Vision Impairment and Sports Performance through a Look at Paralympic Classification
Authors: Chun Robert , Creese Marieke , Massof Robert W.
Published: July 2021

SIGNIFICANCE: To provide meaningful competition that is equitable for Paralympic athletes, classification systems are vital to determine which athletes are eligible to compete in adapted forms of sports and to group athletes for competition. Our discussion has important implications to inform how we should approach visual function assessment in sports performance.

Sport participation positively benefits individuals with low vision. In particular, adapted sports exist to provide people with visual disabilities an avenue for participating in recreational activity. High-performance low-vision athletes can participate in Paralympic sports but need to be properly classified based on the severity of their vision impairment. The model for Paralympic classification was initiated by Sir Ludwig Guttmann in 1952 in a rehabilitation clinic for soldiers with spinal cord injuries. Today, the International Paralympic Committee mandates that international sports federations develop evidence-based sport-specific classification systems to ensure that eligible disabled athletes have an opportunity for meaningful competition. With the current classification system, only visual acuity and visual field measures are considered to determine an athlete's eligibility to compete, leaving room to expand our understanding of visual function requirements for individual sports. In this topical review, we discuss the origins of Paralympic sports, limitations of current classification methods, and requirements toward achieving evidence-based sport-specific evaluation systems.
Athletes Demonstrate Superior Dynamic Visual Acuity
Authors: Yee Alan , Thompson Benjamin , Irving Elizabeth , Dalton Kristine
Published: July 2021

SIGNIFICANCE

Athletes exhibit better dynamic visual acuity (DVA) compared with nonathletes, whereas action video game players (VGPs) perform more similarly to controls despite having similar static visual acuity and refractive errors. The differences in DVA between groups were not related to differences in static visual acuity, refractive error, or smooth pursuit gain.

PURPOSE

The purpose of the study was to examine whether athletes and VGPs have superior DVA than controls (nonathletes, nongamers).

METHODS

Forty-six participants (15 athletes, 11 VGPs, 20 controls) aged 21.7 years (standard deviation, 2.8 years) were recruited. Participants were emmetropic with equivalent monocular and binocular static visual acuity between groups. Dynamic visual acuity was assessed using predictable (horizontal) and unpredictable (random) motion targets at velocities of 5, 10, 20, and 30°/s. Smooth pursuit eye movements were assessed using a horizontal motion step-ramp stimulus at the same speeds. This study was pre-registered with the Center for Open Science (https://osf.io/eu7qc).

RESULTS

At 30°/s, there were significant main effects of group (F = 4.762, P = .01) and motion type (F = 9.538, P = .004). Tukey post hoc analysis for groups indicated that athletes performed better than did the control group (t = −2.919, P < .02). An omnibus (group × motion type × speed) repeated measures ANOVA showed a main effect of speed (F = 110.137, P < .001) and a speed × motion-type interaction (F = 27.825, P < .001). Dynamic visual acuity decreased as speed increased, and the slope of the change was greater for random than for horizontal motion. Smooth pursuit gains were not significantly different between groups (P > .05).

CONCLUSIONS

Athletes have superior dynamic visual acuity performance compared with controls at 30°/s. This between-group difference cannot be fully explained by differences in smooth pursuit eye movements and therefore may reflect other differences between the groups.
The Uses of Vision Data in Selecting Players for the Major League Baseball Draft
Authors: Kirschen David G. , Laby Daniel M.
Published: July 2021

SIGNIFICANCE

This report illustrates the potential uses of vision data in helping teams select players during the draft.

PURPOSE

Visual performance has gradually gained recognition in baseball as a tool that can optimize on-field performance. It also may be useful in player development programs that gradually move players toward the major league.

METHODS

Recently, over the past 5 years, vision data from six different major league teams were used by the authors to assess prospective players before the annual Major League Baseball (MLB) draft. One thousand three hundred forty-three vision forms were evaluated representing 759 different players. Their vision data were retrospectively analyzed using a novel grading method to advise teams on the visual readiness of prospects for success in MLB.

RESULTS

On a one (best)-to-six (worst) vision scale, the average vision score was 2.080 ± 1.171. Sixty-eight percent (320/473) of the players with good vision scores were drafted, 66% (185/281) of the players with moderate vision scores were drafted, and only 1 player with a poor vision score was drafted. There was a statistically significant difference in the amount of signing bonus received by draftees with better vision scores compared with those with lower vision scores (P < .003 to P < .001). Draftees with the highest vision scores also received the highest signing bonuses as they entered MLB.

CONCLUSIONS

For both potential draftees and teams, the vision score seems to be a valuable tool in selecting players for the MLB draft. Adding the pre-draft visual assessment score to a team's projection model could help reduce the uncertainty surrounding the player draft and future service to the team.
Primary Cilia Are Preserved in Cellular Blue and Atypical Blue Nevi and Lost in Blue Nevus–like Melanoma
Authors: Sheahon Kathleen M. , Jankowski Tyler , Yeh Iwei , North Jeffrey P. , Pincus Laura B. , LeBoit Philip E. , McCalmont Timothy H. , Lang Ursula E.
Published: July 2021

Distinguishing cellular blue nevi (CBNs) and atypical CBNs from blue nevus–like melanoma (BNLM) can be diagnostically challenging. Immunohistochemistry may inform the diagnosis in a subset of cases but is not always diagnostic. Further, ancillary molecular testing is expensive and often requires significant tissue to complete. Primary cilia are cell-surface organelles with roles in signal transduction pathways and have been shown to be preserved in conventional melanocytic nevi but lost in melanoma. Immunofluorescence staining of primary cilia can be performed using a single standard-thickness formalin-fixed paraffin-embedded tissue section and has a turnaround time similar to immunohistochemistry. The percentage of tumoral melanocytes retaining a primary cilium is quantified and reported as the ciliation index. In the current study, we explored the utility of the ciliation index in a series of 31 blue nevus–like lesions, including CBNs (12), atypical CBNs (15), and BNLM (4). The average ciliation index for the CBNs was 59±18%, with a median of 60 (range: 28 to 87). The average ciliation index for atypical CBNs was 59±23, with a median of 59 (range: 20 to 93). The average ciliation index for BNLM was 4±3, with a median of 3 (range: 1 to 8). There was no significant difference in ciliation index between the CBN and atypical CBN categories. There was a significant difference between CBN and BNLM and between atypical CBNs and BNLM (P<0.001 for each). Here, we show that ciliation index is a quantitative diagnostic tool useful in the setting of blue nevus–like neoplasms, with benefits including cost and time efficiency.
Intraductal Carcinoma of the Prostate
Authors: Samaratunga Hemamali , Delahunt Brett , Yaxley John W. , Johannsen Shulammite , Egevad Lars
Published: July 2021

High-grade prostatic adenocarcinoma involving duct/acinar structures is labeled intraductal carcinoma of the prostate (IDCP). As numerous studies have shown that IDCP is associated with high stage disease with a significant negative impact on cancer-specific survival, accurate diagnosis is crucial to ensure appropriate patient management. The definition of IDCP recommended by 2016 World Health Organization (WHO) classification suggests that cases of IDCP with micropapillary or loose cribriform architecture without comedonecrosis should have cells with ≥6× nuclear enlargement. It is unclear how this size criterion was derived and which of the parameters of nuclear size (nuclear diameter, nuclear surface area, or nuclear perimeter) it relates to. To evaluate the extent of nuclear enlargement in IDCP, we performed morphometric analyses relating to each of these parameters in 100 radical prostatectomy specimens. One hundred nuclei from foci of IDCP and 50 nuclei from foci of normal luminal epithelium were examined for each patient. Diagnosis of IDCP was based on cells with definite features of carcinoma present within duct/acinar structures. Comparing the means of each of the parameters between IDCP cells and benign luminal cells, there was a statistically significant enlargement in nuclear perimeter (P<0.0005), nuclear area (P<0.0005), and nuclear diameter (P<0.0005); however, the difference in mean nuclear size was limited to factors of 1.3×, 1.6×, and 1.3×, respectively. Three patients each had rare large nuclei (largest perimeter 45, 45, and 44 μm; maximum nuclear area 135, 136, and 136 μm2; and the largest diameter 18 µm in each). For these rare cells, the nuclear size difference, when compared with benign nuclei was; nuclear perimeter 2.0×, 2.1×, and 2.1×; nuclear area 3.6×, 3.8×, and 3.8×; and nuclear maximum diameter 3.0×, 2.5×, and 2.5×. The definition of nuclear enlargement of ≥6× was not reached in any of our cases, all of which clearly showed features of duct invasive carcinoma. In these cases, reliance on nuclear size criteria would have resulted in underdiagnosis of IDCP. This is of concern as failure to recognize IDCP, particularly in needle biopsies, could lead to delays in the timely treatment of aggressive high-grade prostate cancer, resulting in cancer progression and suboptimal patient oncological outcomes.
Vulvar Yolk Sac Tumors Are Somatically Derived SMARCB1 (INI-1)-Deficient Neoplasms
Authors: Kolin David L. , Konstantinopoulos Panagiotis A. , Campos Susana M. , Toumi Gisele , Kolahi Kevin A. , Gars Eric J. , Howitt Brooke E.
Published: July 2021

So-called primary yolk sac tumors of the vulva are very rare and often have an aggressive disease course. Their molecular features have not been previously characterized. There is also a well-documented group of SMARCB1 (INI-1)-deficient vulvar neoplasms, which includes proximal-type epithelioid sarcoma and myoepithelial carcinoma. Until now, “vulvar yolk sac tumors” and SMARCB1-deficient neoplasms were considered unrelated diseases. After reviewing an index case of a vulvar yolk sac tumor with loss of SMARCB1 by immunohistochemistry, we retrospectively identified 2 additional cases diagnosed as vulvar yolk sac tumors. Patient ages were 34, 32, and 25 years old, and 2 tumors were associated with a pregnancy. All 3 cases showed morphology typical of a yolk sac tumor, and by immunohistochemistry all were positive for SALL4, glypican-3, keratins, and lacked CD34 positivity. All tumors also demonstrated loss of SMARCB1 in tumor cells. Targeted molecular profiling was performed in 2 cases and identified 2 copy deletion of SMARCB1, without genomic alterations typically seen in gonadal yolk sac tumors. In the third case, isochromosome 12p was not identified by fluorescence in situ hybridization. All 3 patients had either local recurrences or distant metastases, and 2 died of disease. One patient had progressive disease while receiving the enhancer of zeste homolog 2 inhibitor tazemetostat. Overall, these findings suggest that vulvar tumors with pure yolk sac-like morphology may represent morphologic variants of SMARCB1-deficient tumors and not veritable germ cell neoplasia. This potential reclassification may have both prognostic and treatment implications and warrants study of additional extragonadal yolk sac tumors.
An Atypical Presentation of Hirayama Disease With Lower Limb Myelopathic Symptoms Only
Authors: Mattson Laura M. , Alomar-Jimenez Walter O. , Hearn Sandra L.
Published: July 2021

Hirayama disease is a rare neuromuscular disease, which classically presents as lower motor neuron weakness and atrophy in the upper limbs and specifically the C7–T1 myotomes. Proposed pathogenesis relates to microcirculatory dysfunction in the territory of the anterior spinal artery caused by epidural venous plexus engorgement with forward displacement of the posterior dura and spinal cord during neck flexion, leading to chronic ischemic changes in the lower cervical anterior horn cells. Diagnosis hinges upon clinical and radiographic findings, and treatment is generally conservative given the self-limited nature of the disease. Here, we present a case with classic radiologic findings of Hirayama disease with lower limb myelopathic findings alone. This case raises the question of whether the pathophysiology leading to focal anterior cervical myelopathy in forward flexion could present along a broader clinical spectrum than previously recognized, from complete asymptomaticity, to classic Hirayama disease with C7–T1 atrophy, to cervical myelopathy with long tract signs.
Contemplative Mental Training Reduces Hair Glucocorticoid Levels in a Randomized Clinical Trial
Authors: Puhlmann Lara M.C. , Vrtička Pascal , Linz Roman , Stalder Tobias , Kirschbaum Clemens , Engert Veronika , Singer Tania
Published: July 2021

Objective

This study aimed to investigate the effect of regular contemplative mental training on endocrine and psychological indices of long-term stress.

Methods

An open-label efficacy trial that comprised three distinct 3-month long modules targeting attention and interoception, socioaffective, or sociocognitive abilities through dyadic exercises and secularized meditation practices was conducted with healthy adults. Participants underwent the training for 3 or 9 months, or were assigned to a retest control cohort. Chronic stress indices were assayed at four time points: pretraining and after 3, 6, and 9 months. The main outcome measures were cortisol (HC) and cortisone (HE) concentration in hair and self-reported long-term stress.

Results

Of 362 initially randomized individuals, 30 dropped out before study initiation (n = 332; mean [SD] age = 40.7 [9.2] years; 197 women). Hair-based glucocorticoid assays were available from n = 227, and questionnaire data from n = 326. Results from three separate training cohorts (TC1–3) revealed consistent decreases in HC and HE levels over the first three (TC3) to 6 months (TC1 and TC2) of training, with no further reduction at the final 9-month mark (baseline to end of training differences, HC, TC1: t(355) = 2.59, p = .010, contrast estimate (est.) [SE] = 0.35 [0.14]; HC, TC2: t(363) = 4.06, p < .001, est. = 0.48 [0.12]; HC, TC3: t(368) = 3.18, p = .002, est. = 0.41 [0.13]; HE, TC1: t(435) = 3.23, p = .001, est. = 0.45 [0.14]; HE, TC2: t(442) = 2.60, p = .010, est. = 0.33 [0.13]; HE, TC3: t(446) = 4.18, p < .001, est. = 0.57 [0.14]). Training effects on HC increased with individual compliance (practice frequency), and effects on both HC and HE were independent of training content and unrelated to change in self-reported chronic stress. Self-reported stress, and cortisol-to-dehydroepiandrosterone ratios as an exploratory endpoint, were also reduced, albeit less consistently.

Conclusions

Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners’ health.

Trial Registration: ClinicalTrials.gov identifier: NCT01833104.
Cardiovascular Stress Reactivity and Health: Recent Questions and Future Directions
Authors: Whittaker Anna C. , Ginty Annie , Hughes Brian M. , Steptoe Andrew , Lovallo William R.
Published: July 2021

Objective

High cardiovascular reactions to psychological stress are associated with the development of hypertension, systemic atherosclerosis, and cardiovascular disease. However, it has become apparent that low biological stress reactivity also may have serious consequences for health, although less is known about the mechanisms of this. The objectives of this narrative review and opinion article are to summarize and consider where we are now in terms of the usefulness of the reactivity hypothesis and reactivity research, given that both ends of the reactivity spectrum seem to be associated with poor health, and to address some of the key criticisms and future challenges for the research area.

Methods

This review is authored by the members of a panel discussion held at the American Psychosomatic Society meeting in 2019, which included questions such as the following: How do we measure high and low reactivity? Can high reactivity ever indicate better health? Does low or blunted reactivity simply reflect less effort on task challenges? Where does low reactivity originate from, and what is a low reactor?

Results

Cardiovascular (and cortisol) stress reactivity are used as a model to demonstrate an increased understanding of the different individual pathways from stress responses to health/disease and show the challenges of how to understand and best use the reconstruction of the long-standing reactivity hypothesis given recent data.

Conclusions

This discussion elucidates the gaps in knowledge and key research issues that still remain to be addressed in this field, and that systematic reviews and meta-analyses continue to be required.
The School-Ladder Effect: Subjective Socioeconomic Status and Diurnal Cortisol Profile Among Adolescents
Authors: Chen Lihua , Du Hongfei , Zilioli Samuele , Zhao Shan , Nie Yangang , Chi Peilian
Published: July 2021

Objective

Subjective socioeconomic status (SES) is a well-established psychosocial determinant of adolescents’ self-report health. However, whether low subjective SES is associated with stress-related physiological risks (e.g., dysregulations in the hypothalamic-pituitary-adrenal axis activity) remains uncertain. This study examined the impact of subjective SES with different reference groups (i.e., perception of family SES relative to other students in the school versus other people in the city) on adolescents’ diurnal cortisol profiles.

Methods

A sample of 255 adolescents (aged 11–14 years; 53.7% boys) completed a battery of psychological scales, including school-referenced subjective SES and city-referenced subjective SES. Diurnal cortisol was assessed by collecting saliva samples four times a day across two consecutive days. Four cortisol parameters (cortisol at awakening, cortisol awakening response [CAR], cortisol slope, and total cortisol secretion [area under the curve with respect to ground {AUCg}]) were derived.

Results

Higher levels of school-referenced subjective SES were associated with higher cortisol levels at awakening (β = 0.0483, standard error [SE] = 0.0219, p = .028), steeper cortisol slopes (β = −0.0036, SE = 0.0017, p = .034), and higher cortisol AUCg (b = 0.50, SE = 0.24, p = .036), but not with CAR (p = .77), after adjusting for covariates. In contrast, city-referenced subjective SES was not associated with any of the cortisol parameters (cortisol at awakening [p = .90], CAR [p = .74], cortisol slope [p = .84], and cortisol AUCg [p = .68]).

Conclusions

Our findings highlight the importance of the reference group for subjective SES and provide a further understanding of socioeconomic disparities in adolescents’ stress physiology.
Offering a choice of daily and event-driven preexposure prophylaxis for men who have sex with men in the Netherlands: a cost-effectiveness analysis
Authors: van Hoek Albert Jan , Reitsema Maarten , Xiridou Maria , van Sighem Ard , van Benthem Birgit , Wallinga Jacco , van Duijnhoven Yvonne , van der Loeff Maarten Schim , Prins Maria , Hoornenborg Elske
Published: July 2021

Objectives:

To assess the cost-effectiveness of a preexposure prophylaxis (PrEP) programme offering a choice of daily and event-driven PrEP for men who have sex with men (MSM) in the Netherlands.

Methods:

We used an agent-based transmission model and an economic model to simulate a programme offering only daily PrEP and a programme offering daily and event-driven PrEP. Use of PrEP medication and preference for daily versus event-driven PrEP were estimated from the Amsterdam PrEP Demonstration Project (AMPrEP). We calculated costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER), over 2018–2027. An ICER less than €20 000 per QALY gained was considered cost-effective.

Results:

Using AMPrEP data, we estimated that 27% of PrEP users chose event-driven PrEP with a median of 12 pills per month; daily PrEP users used a median of 30 pills per month. With PrEP, 3740 HIV infections were averted and 1482 QALYs were gained over 2018–2027, compared to the scenario without PrEP. The probability of the PrEP programme being cost-effective (compared to not having a PrEP programme) increased from 91% with daily PrEP to 94% with a choice of daily and event-driven PrEP. The probability of being cost-saving increased from 42% with only daily PrEP to 48% with choice of daily and event-driven PrEP.

Conclusions:

A daily PrEP programme for MSM would be cost-effective. Providing a choice of daily and event-driven PrEP can result in savings and is more likely to be cost-effective and cost-saving, compared to a programme offering only daily PrEP.
Perceived HIV Acquisition Risk and Low Uptake of PrEP Among a Cohort of Transgender Women With PrEP Indication in the Eastern and Southern United States
Authors: Malone Jowanna , Reisner Sari L. , Cooney Erin E. , Poteat Tonia , Cannon Christopher M. , Schneider Jason S. , Radix Asa , Mayer Kenneth H. , Haw J. Sonya , Althoff Keri N. , Wawrzyniak Andrew J. , Beyrer Chris , Wirtz Andrea L. ,   For the American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group
Published: July 2021

Introduction:

Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood.

Methods:

This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women–specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum.

Results:

PrEP indication prevalence using transgender women–specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk.

Conclusions:

These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
Cerebrovascular Contributions to Neurocognitive Disorders in People Living With HIV
Authors: Gutierrez Jose , Porras Tiffany N. , Yoo-Jeong Moka , Khasiyev Farid , Igwe Kay C. , Laing Krystal K. , Brickman Adam M. , Pavol Marykay , Schnall Rebecca
Published: July 2021

Background:

To investigate a comprehensive array of magnetic resonance imaging (MRI)-based biomarkers of cerebrovascular disease (CVD) in a cohort of people living with HIV (PLWH) and relate these imaging biomarkers to cognition.

Settings:

Cross-sectional, community-based study.

Methods:

Participants were PLWH in New York City, aged 50 years or older. They underwent a brain magnetic resonance angiography or MRI to ascertain 7 MRI markers of CVD: silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition.

Results:

We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic Black), most of them with well-controlled HIV (75% with CD4 cell count > 200 cells/mm3and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these 3 MRI markers of CVD was associated with lower working memory (B = −0.213,P= 0.028), list learning (B = −0.275,P= 0.019), and global cognition (B = −0.129,P= 0.007).

Conclusions:

We identified silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity as exposures that may be modifiable and may, therefore, influence cognitive decline. In addition, these MRI markers of CVD may help in identifying PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.
Undisclosed HIV Status to Sex Partners and Its Unintended Consequences in the Era of Undetectable = Untransmittable
Authors: Kalichman Seth C. , Kalichman Moira O. , Eaton Lisa A.
Published: July 2021

Background:

Adherence to antiretroviral therapy (ART) and sustained HIV suppression virtually eliminate HIV transmission, eg, having an undetectable viral load renders HIV untransmittable (U=U). Owing to the greatly reduced likelihood of HIV transmission when viral load is undetectable, we studied one behavioral ramification of adopting a U=U prevention strategy—not disclosing HIV status to sex partners.

Setting:

Cisgender men recruited through community outreach in the state of Georgia, USA.

Methods:

We examined HIV status disclosure to sex partners among 345 young (median age = 29 years) men receiving ART. Data were collected using computerized interviews, daily sexual behavior surveys over 28 days, unannounced pill counts for ART adherence, urine tests for drug use and urogenital health, and blood samples for HIV viral load.

Results:

One in 3 participants (34%) engaged in condomless anal/vaginal intercourse with an HIV-negative/unknown HIV status partner over 28 days. Average ART adherence was 76%, and one in 5 men had detectable HIV viral loads. Men who engaged in condomless sex with undisclosed partners demonstrated significantly less HIV disclosure to family and friends and had fewer enacted stigma experiences. Hierarchical regression models showed that endorsing U=U as a personal HIV prevention strategy predicted undisclosed condomless sex over and above substance use, HIV stigma experiences, disclosure to family and friends, ART adherence, and HIV viral load.

Conclusions:

Interventions are needed to improve ART adherence and assist men living with HIV in their decisions to disclose HIV status to sex partners.
18F-FDG PET/CT Imaging of Immune Checkpoint Inhibitor–Related “Retroperitoneal Panniculitis”
Authors: Minutoli Fabio , Parisi Silvana , Laudicella Riccardo , Pergolizzi Stefano , Baldari Sergio
Published: July 2021

A 71-year-old woman was operated on for undifferentiated lung adenocarcinoma. Four months after surgery, she developed bone and adrenal metastases. She underwent palliative radiation therapy of left scapula and right iliac bone. Thereafter, she started immune checkpoint inhibitor (ICI) therapy with anti–PD-1 antibodies achieving complete tumor response. Twenty months later, a follow-up 18F-FDG PET/CT confirmed tumor response and revealed high radiotracer accumulation in correspondence of retroperitoneal and subcutaneous fat opacities. The contiguous fasciae were mildly thickened. The temporal relation with ICI therapy together with tumor response and corticosteroids therapy effectiveness led to conclude for ICI-related adverse events.
Two Cases of Epstein-Barr Virus–Positive Mucocutaneous Ulcer Mimicking Head and Neck Cancers in 18F-FDG PET/CT
Authors: Kawamura Hitomi , Koyasu Sho , Sugimoto Akihiko , Nakamoto Yuji
Published: July 2021

Epstein-Barr virus–positive mucocutaneous ulcer is a newly recognized clinicopathological entity among mature B-cell neoplasms according to the 2016 revision of the World Health Organization diagnostic criteria. Here, we present FDG PET/CT images of 2 Epstein-Barr virus–positive mucocutaneous ulcer cases. Both cases shown in the images mimicked head and neck cancers, which are similar to carcinomas of the tonsil and gingiva, respectively, and both lesions showed intense FDG uptake on PET scan.
Cavernous Hemangioma
Authors: Scolozzi Valentina , Giancipoli Romina Grazia , Macciomei Maria Cristina , Vigna Leonardo , Leccisotti Lucia
Published: July 2021

We report the case of a 72-year-old woman who underwent neoadjuvant chemotherapy, right quadrantectomy (invasive ductal carcinoma, G3, pT2pN1pMx), and adjuvant radiotherapy. Two years later, a follow-up CT revealed a hepatic nodule of approximately 1 cm suspected for metastasis. 18F-FDG PET/CT was performed for restaging. Standard total-body 18F-FDG PET/CT acquisition showed no abnormal 18F-FDG uptake in the hepatic nodule. A delayed 18F-FDG PET/CT acquisition of upper abdomen was performed at 180 minutes postradiopharmaceutical injection and showed increased 18F-FDG uptake in the hepatic nodule. After nodule resection, the histological examination proved a cavernous hemangioma.
A4 Pulley Reconstruction Using the Superficialis Oblique Flap and the Transverse Double Loop Techniques
Authors: Galán Ricardo , Manrique Oscar J. , Bustos Samyd S. , Arango Diego , Correa Diana , Terán Diego , Vergara María , Moran Steven L.
Published: July 2021

Background

The pulley system plays an important role in flexion mechanism. Reconstruction after trauma can be challenging. Numerous techniques have been described with several drawbacks. Herein, we describe the superficialis flap oblique technique for A4 pulley reconstruction using an animal model.

Methods

Forty-two fresh legs of 21 eight-week-old chickens were used to evaluate the maximum flexion angle (MFA) and force at maximum flexion (FMF) in intact and sectioned A4 pulley equivalents of the third digit after reconstruction with the transverse double loop (TDL) technique and the superficialis oblique flap (SOF) technique. Biomechanical measurements were obtained in an exclusively designed instrument. Descriptive statistics were reported, and mean differences between the reconstructive techniques were analyzed.

Results

Intact and severed A4 pulley equivalent average MFA were 96.50° ± 1.70° and 115.60° ± 1.50°, respectively. Average FMF were 8.16 ± 0.23 psi with the intact pulley and 6.92 ± 0.20 psi with the sectioned pulley (P < 0.001). After reconstruction with TDL and SOF techniques, the legs reached an average MFA at the distal interphalangeal joint of 98.13° ± 1.20° and 96.90° ± 1.30°, respectively. Mean MFA difference was 1.23° (P = 0.03). Force at maximum flexion was 8.12 psi and 8.10 psi for the TDL and SOF techniques (P = 0.6), respectively.

Conclusions

The authors believe that SOF technique for A4 pulley reconstruction can be used as first option when available, taking into account its theoretical advantages and its proven biomechanical characteristics. Long-term functional results should be assessed to translate these results into the clinical setting.
Anthropometric Analysis of the Orbital Region in Children With Autism Spectrum Disorder and Healthy Controls
Authors: Topal Zehra , Bahşi Ilhan , Karadag Mehmet , Sarp Ayse Sevde , Akkaya Canan , Gokcen Cem
Published: July 2021

It was aimed to examine the orbital region in children with autism spectrum disorder and comparison with the healthy controls in the present study. A total of 195 children and adolescents (101 of them were in the autism group, 94 of them were in healthy group) were evaluated. Anterior view photographs were taken, and endocanthion (en), exocanthion (ex), and pupil were determined bilaterally on the photographs. Outer canthal (ex-ex), intercanthal (ex-en), inner canthal (en-en) and interpupillary distances were measured and intercanthal index [(en-en / ex-ex) × 100] was calculated. There was a statistically significant difference between the groups for males for all parameters, while a statistically significant difference was not observed for females. All orbital region distances were higher in male autistic children. Although minor physical anomalies in children and adolescents with autism have been reported before, anthropometric measurements in individuals with autism may differ between genders. Further studies are needed to investigate the differences between genders in autism spectrum disorder.
Comparison of the Stability of Sandblasted, Large-Grit, and Acid-Etched Treated Mini-Screws With Two Different Surface Roughness Values: A Histomorphometric Study
Authors: Seker Elif Dilara , Yavuz Ibrahim , Yucesoy Turker , Cenkci Ebru , Yay Arzu
Published: July 2021

Purpose:

To evaluate the effects of 2 different surface roughness values produced by sandblasted, large-grit, and acid-etched treatments at different loading conditions on the stability of mini-screws.

Material and Methods:

A total of 56 mini-screws (Group 1; 28 with Ra value of 1 μm, Group 2; 28 with Ra value of 1.5 μm) were inserted into the tibia of fourteen New Zealand rabbits. Surface analysis was performed before the placement of the miniscrews using multi-technique characterization. The mini-screws were loaded with 500 grf after different healing times: unloaded, immediate, 4 and 8 weeks. Resonance frequency analyses were performed immediately after mini-screw placement and at the end of loading. Biomechanical and histomorphometric analyses were also performed at the end of the loading period.

Results:

All mini-screws preserved their stability at the end of the loading period. However, the resonance frequency analyses showed higher implant stability quotient scores for 8-week group, unlike the immediate loading and unloaded groups (P< 0.05). According to the infinite focus microscopy results, prolongation of healing time resulted in a greater bone area on the loaded mini-screws in Group 2 (P< 0.05). Similarly, the histomorphometric analysis revealed higher bone-to-implant contact values in the 8-week group. There was no significant difference in the stability between the miniscrews with the Ra values of 1 and 1.5 μm.

Conclusions:

Sandblasted, large-grit, and acid-etched treated mini-screws showed significantly higher stability with healing time under heavy forces. Sandblasted, large-grit, and acid-etched treated mini-screws can be removed without fracture of the screw or the bone surfaces.
Diffuse Large B-Cell Lymphoma Arising in the Lacrimal Sac
Authors: Kim Jonghyun , Kim Joohyun , Baek Sehyun
Published: July 2021

The authors report a single case of diffuse large B-cell lymphoma arising in the lacrimal sac. Diffuse large B-cell lymphoma is a third most common primary ocular adnexal lymphoma, which is the most common primary ocular malignant disease in adults. A patient came to our clinic with epiphora and a growing mass in the lacrimal sac. Enhanced computed tomography imaging suggested the presence of a malignant tumor and surgical excision and biopsy were performed. A final diagnosis of diffuse large B-cell lymphoma was reached by immunohistological and immunochemical staining. Two months after surgery, diffuse large B-cell lymphoma relapse occurred in the lacrimal sac and the patient underwent 6 cycles of chemotherapy. Diffuse large B-cell lymphoma is a curable disease when diagnosed early, and aggressive biopsy during surgery of the lacrimal sac is necessary to diagnose diffuse large B-cell lymphoma in the early stage. It is important to distinguish diffuse large B-cell lymphoma from other lacrimal system diseases.
Cervical Oblique Corpectomy: Revitalizing the Underused Surgical Approach With Step-By-Step Simulation in Cadavers
Authors: Balak Naci , Baran Oguz , Denli Yalvac Emine Seyma , Esen Aydin Aysegul , Kumbasar Ali , Tanriover Necmettin
Published: July 2021

Recently, the World Federation of Neurosurgical Societies Spine committee recommended that additional research on cost-benefit analysis of various surgical approaches for cervical spondylotic myelopathy be carried out and their efficacy with long-term outcomes be compared. Unfortunately, it is highly probable that the oblique corpectomy (OC) will not be included in cost-benefit investigations due to its infrequent application by neurosurgeons dealing with the spine. In this cadaveric study, head and necks of 5 adult human cadavers stained with colored latex and preserved in 70% alcohol solution were dissected under a table-mounted surgical microscope using 3× to 40× magnifications. The OC approach was performed to simulate real surgery, and the neurovascular structures encountered during the procedure and their relations with each other were examined. Oblique corpectomy was performed unilaterally, although neck dissections were performed bilaterally on 10 sides in all 5 cadavers. At each stage of the dissection, multiple three-dimensional photographs were obtained from different angles and distances. For an optimal OC, both the anterior spinal cord must be sufficiently decompressed and sufficient bone must be left in place to prevent instability in the cervical spine. Oblique corpectomy is a valid and potentially low cost alternative to other anterior and posterior approaches in the surgical treatment of cervical spondylotic myelopathy. However, meticulous cadaver studies are essential before starting real surgical practice on patients in order to perform it effectively and to avoid the risks of the technique.
Exploring the Opportunities and Challenges of a Virtual Community-Based Older Adult Fall Prevention Program During COVID-19
Authors: Collins Kayla , Layne Kelly
Published: July 2021

Rehabilitation therapists have traditionally been key players in the development and delivery of community-based programs, and the value of those programs is well documented. The onset of COVID-19 necessitated the closure or shift of many of these programs to virtual delivery, resulting in a change in the role of the rehabilitation therapist. The challenges and opportunities of traditional and virtual programming are explored. Factors influencing the participation of seniors in these programs are examined. The impact of COVID-19 and the resulting digital resources on future community-based practice is discussed.