bluuebunny/crossref_metadata_2025 huggingface dataset:
Residual Deformity and Outcome of Ambulatory Adults With Cerebral Palsy: A Long-term Longitudinal Assessment
Authors: Saisongcroh Tanyawat , Shrader Michael W. , Lennon Nancy , Church Chris , Sees Julieanne P. , Miller Freeman
Published: January 2022

Background:

Advances in pediatric orthopaedic care have improved mobility and function for children with cerebral palsy (CP) as mobility declines from adolescence into adulthood. The long-term effectiveness of modern orthopaedic care is not widely reported. This study aimed to report the pediatric orthopaedic surgical burden, residual deformities, and outcomes using objective evidence of mobility in ambulatory adults with CP.

Methods:

An institutional review board–approved prospective cohort study was performed in ambulatory adults with CP between 25 and 45 years, who had an adolescent gait analysis. Orthopaedic interventions were reviewed, and adolescent and adult gait analyses were compared using paired 2-tailed t tests. Adults were categorized by the presence of no, mild, or severe residual deformities in rotation, crouch, stiff knee, equinus, and foot deformity.

Results:

Of 106 adults with CP, Gross Motor Function Classification System (GMFCS) distribution was grade I (22%), II (50%), III (23%), and IV (5%). Sixty-one males and 45 females were tested. The average age was 30±4 years with follow-up of 13±4 years since previous analysis; 279 surgical events (1165 procedures) were performed with a mean per patient of 2.6 events and 11 procedures. Comm on procedures were gastrocsoleus complex (88%) and hamstring lengthening (79%). The mean gait deviation index at adolescent and adult visit were 72.7±13 and 72.3±13 (P=0.78). Mean gait velocity at the adolescent visit was 85±27 and 79±31 cm/s at adult visit (P=0.02). Both gait deviation index and gait velocity change were clinically insignificant. Fifty-seven adults (81 limbs, 54%) had mild residual deformities. Residual hip internal rotation, pes planovalgus, and crouch gait were common. Severe deformities impacting function or causing pain were present in 11 participants (14 limbs, 10%). Seven of the 11 adults with severe deformities were worse compared with their adolescent evaluation; 4 were unchanged.

Conclusions:

Correcting deformities before adulthood has lasting stability with little functional loss in most ambulatory young adults with CP. Increasing deformity after adolescence can occur in young adults but is uncommon.

Level of Evidence:

Level III.
Risk of Adverse Birth Outcomes in Two Cohorts of Pregnant Women With HIV in Zambia
Authors: Price Joan T. , Sebastião Yuri V. , Vwalika Bellington , Cole Stephen R. , Mbewe Felistas M. , Phiri Winifreda M. , Freeman Bethany L. , Kasaro Margaret P. , Peterson Marc , Rouse Dwight J. , Stringer Elizabeth M. , Stringer Jeffrey S. A.
Published: January 2022

Background:

A trial of progesterone to prevent preterm birth among HIV-infected Zambian women [Improving Pregnancy Outcomes with Progesterone (IPOP)] found no treatment effect, but the risk of the primary outcome was among the lowest ever documented in women with HIV. In this secondary analysis, we compare the risks of preterm birth (<37 weeks), stillbirth, and a composite primary outcome comprising the two in IPOP versus an observational pregnancy cohort [Zambian Preterm Birth Prevention Study (ZAPPS)] in Zambia, to evaluate reasons for the low risk in IPOP.

Methods:

Both studies enrolled women before 24 gestational weeks, during August 2015–September 2017 (ZAPPS) and February 2018–January 2020 (IPOP). We used linear probability and log-binomial regression to estimate risk differences and risk ratios (RR), before and after restriction and standardization with inverse probability weights.

Results:

The unadjusted risk of composite outcome was 18% in ZAPPS (N = 1450) and 9% in IPOP (N = 791) (RR = 2.0; 95% CI = 1.6, 2.6). After restricting and standardizing the ZAPPS cohort to the distribution of IPOP baseline characteristics, the risk remained higher in ZAPPS (RR = 1.6; 95% CI = 1.0, 2.4). The lower risk of preterm/stillbirth in IPOP was only partially explained by measured risk factors.

Conclusions:

Possible benefits in IPOP of additional monetary reimbursement, more frequent visits, and group-based care warrant further investigation.
The Course and Interaction of Ventriculomegaly and Cerebellar Tonsillar Herniation in Crouzon Syndrome over Time
Authors: Doerga Priya N. , de Planque Catherine A. , Erler Nicole S. , van Veelen Marie-Lise C. , Mathijssen Irene M.J.
Published: January 2022

Background:

Children with Crouzon syndrome have a higher incidence of cerebellar tonsillar herniation (TH) and ventriculomegaly than the general population, or children with other craniosynostosis syndromes.

Objective:

This retrospective cohort study aimed to determine how ventriculomegaly and TH develop and progress over time, and determine associations between ventriculomegaly and TH in Crouzon patients, treated according to our center’s protocol.

Methods:

Fronto-occipital horn ratio (FOHR) and TH were determined over time using brain-imaging. These data were used to fit a mixed-model to determine associations between them, and with clinical variables, head-circumference, and lambdoid suture synostosis.

Results:

Sixty-three Crouzon patients were included in this study. Preoperatively, 28% had ventriculomegaly, and 11% had TH ≥ +5 mm. Postoperatively ventriculomegaly increased to 49%. Over time and with treatment, FOHR declined and stabilized around 5 years of age. TH ≥ +5 mm increased to 46% during follow-up. FOHR and TH were associated: expected FOHR with a TH of either 0 mm versus +8.6 mm at 0 years: 0.44 versus 0.49, and at 5 years: 0.34 versus 0.38; 10% increase of FOHR was associated with 1.6 mm increase in TH. Increased head-circumference was associated with increased FOHR. Lambdoid suture synostosis was associated with +6.9 mm TH increase.

Conclusions:

In Crouzon patients, FOHR was large at onset and decreased and stabilized with treatment and time. FOHR was associated with head-circumference and TH. TH was strongly associated with lambdoid suture synostosis and FOHR. Increased head-circumference was associated with an increased FOHR, and closed lambdoid sutures before 1 year of age were associated with a +6.92 mm increase in tonsil position.
Vessel Loop Shoelace Technique followed by Keystone Flap to Treat a Large Mid-back Defect
Authors: Lee Chia-Chun , Wang Tien-Hsiang , Chen Ching-En
Published: January 2022

The keystone design perforator island flap has been gaining popularity for reconstructing large cutaneous defects with sufficient soft tissue laxity. However, for a defect with insufficient local tissue and tense laxity such as upper to mid-back, a single keystone flap may not be so suitable for advancement and mobilization. Instead of an additional flap or double-opposite-designed keystone flaps, we attempted to apply the vessel loop shoelace technique for external expansion before proceeding with only one keystone flap reconstruction for a 15 × 15 cm skin and soft tissue defect on the mid-back. The outcome was a viable flap, with no ischemic flap edge, wound dehiscence, or infection. In our opinion, external expansion with vessel loops followed by a keystone flap might yield fairly good results for the reconstruction of mid-back defects; furthermore, this method may be ideal for defects located in regions lacking sufficient skin laxity.
Readability and Quality Assessment of Online Materials for Syndactyly Release
Authors: Saleh Joseph , Gornitsky Jordan , Jaloux Charlotte , Bougie Emilie
Published: January 2022

Background:

Syndactyly is one of the most common congenital hand malformations, involving an abnormal fusion of digits and with treatment varying according to its complexity. The internet has become a primary source of information for both families and patients with congenital hand anomalies. The purpose of this study was to evaluate both the readability and quality of available web content for syndactyly, using validated instruments.

Methods:

Two independent reviewers conducted searches for “Syndactyly” using three of the largest online search engines: Bing, Google, and Yahoo. The top 10 websites for each search engine, along with any webpage within one click of the parent website, were analyzed. Readability was assessed using seven established quantitative tests. The quality of the web pages was analyzed using the Discern questionnaire and handbook.

Results:

A total of 15 websites were included in the analysis. The average readability of all websites was equivalent to comprehension at a grade 11.3 level. The average Flesch reading ease score was 49.3 out of 100, which is considered difficult to read. Quality was assessed using Discern, a brief questionnaire consisting of 16 questions with five points attributed per question. The mean quality score using Discern was 33.3 points out of a maximum of 80 points.

Conclusions:

Online materials pertaining to the treatment of syndactyly far exceed the recommended sixth-grade reading level, and lack in terms of quality and comprehensiveness of information. Health care professionals should be cognizant of the paucity of available online information and provide patients with more appropriate resources.
RISK OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY
Authors: Lee Ju-Yeun , Bae Kunho
Published: January 2022

Purpose:

To estimate the risk of incident age-related macular degeneration (AMD) in patients with central serous chorioretinopathy (CSC).

Methods:

This population-based cohort study was finally conducted from January 2015 to December 2019. All patients with CSC from the entire population aged between 30 and 80 years were included. The incidence of CSC was estimated. Log-rank analysis and Cox proportional hazards regression analysis was used to evaluate the risk of exudative AMD in the CSC group compared with the non-CSC group.

Results:

During a recent 5-year study period, 36,053 patients were identified as having incident CSC. The annual incidence in the latest year was 19.61 (95% confidence interval, 19.58 to 19.63) per 100,000 people. A total of 11,492 patients were included in the study group and 22,984 in the non-CSC group. The CSC and non-CSC groups included 166 (1.44%) and 73 (0.32%) cases of exudative AMD, respectively. The risk of exudative AMD was significantly higher in the CSC group than in the non-CSC group (adjusted hazard ratio: 4.86; 95% confidence interval: 2.98 to 5.88; P < 0.001).

Conclusion:

This study showed that subjects with CSC are at an increased risk of exudative AMD. This evidence supports a possible link between CSC and exudative AMD, particularly in Asian populations.
THREE-DIMENSIONAL HEAD-UP DISPLAY VERSUS STANDARD OPERATING MICROSCOPE FOR VITRECTOMY SURGERY
Authors: Wang Yuelin , Zhao Xinyu , Zhang Wenfei , Yang Jingyuan , Chen Youxin
Published: January 2022

Purpose:

To evaluate the effects of vitrectomy with three-dimensional head-up display (3D HUD) versus standard operating microscopy (SOM) for retinal diseases.

Methods:

The PubMed, Cochrane Library, and Embase databases were comprehensively searched to identify studies that compared 3D HUD versus SOM in vitrectomy for retinal diseases (PROSPERO protocol CRD42021265827). The primary outcomes are duration of surgical time, postoperative best-corrected visual acuity, endoillumination levels, and intraoperative complications. The secondary outcomes are reattachment rate of rhegmatogenous retinal detachment, macular hole closure rate, and the like.

Results:

Fifteen studies of 2,889 eyes were included. Compared with SOM, 3D HUD vitrectomy took a longer surgical time (weighted mean difference = 1.48; 95% confidence interval, 0.13–2.82), but it needed lower endoillumination levels (weighted mean difference = −16.04, 95% confidence interval, −18.33 to −13.75) than SOM. There were no significant differences in the postoperative best-corrected visual acuity, intraoperative complications, reattachment rate of rhegmatogenous retinal detachment, or closure rate of macular hole.

Conclusion:

Our results suggested that 3D HUD provides lower retinal illumine toxicities but with a longer surgical time. The surgical results and complications of vitrectomy were equally comparable for 3D HUD and SOM.
The Rational Combination Strategy of Immunomodulatory Latency Reversing Agents and Novel Immunotherapy to Achieve HIV-1 Cure
Authors: Li Yangyang , Hong Junxian , Zhang Linqi
Published: January 2022

Human immunodeficiency virus (HIV)-1 infection creates a persistent latent reservoir even after antiretroviral therapy, which is the main barrier to HIV cure. One of the most explored strategies is the use of latent reversal agents (LRAs) to activate HIV latent reservoirs, followed by immunotherapy to remove infected cells. Immunomodulatory LRAs have the dual advantage of activating viral latency and promoting immune cell elimination of HIV-infected cells. The emergence of novel immunotherapies has also enhanced the possibility of HIV clearance. Here we review the activity and potential mechanisms of immunomodulatory agonists and immunotherapies. The possible combinational strategies to achieve HIV functional cure and the problems encountered using this approach are discussed.
Introduction of the Japanese Society for Pediatric Infectious Diseases
Authors: Saitoh Akihiko , Ouchi Kazunobu , Moriuchi Hiroyuki
Published: January 2022

The Pediatric Infectious Disease Journal became an official English journal of the Japanese Society for Pediatric Infectious Diseases starting from 2022. Japanese Society for Pediatric Infectious Diseases, with a history of more than 50 years and more than 3200 members in Japan, would like to contribute to the enhancement of child health and well-being in the field of pediatric infectious diseases by collaborating academic societies and organizations worldwide through the Pediatric Infectious Disease Journal.
Plasma Metagenomic Sequencing Expedites Diagnosis of Disseminated BCG in an Infant With IKBKB Mutation
Authors: Taylor Margaret G. , Nicholas Sarah K. , Forbes Satter Lisa R. , Martinez Caridad , Cameron Lindsay H.
Published: January 2022

Background:

Infants with inborn errors of immunity (IEI), born in countries where Bacillus-Calmette-Guerin (BCG) vaccination is recommended at birth, are at risk of developing infectious complications following vaccination. A prompt diagnosis of disseminated BCG infection in these infants is essential, as many will require stem cell transplantation (SCT) for the immunologic cure. In patients with IEI, the mortality risk from disseminated mycobacterial infection is high, both before and following SCT.

Methods:

A 7-month-old Qatari infant with an IEI, homozygous IKBKB gene mutation, was evaluated at our institution for SCT. He had a history of recurrent pneumonias, but pretransplant evaluation revealed negative cultures from bronchoalveolar fluid, blood and urine. At 8 months of age, the infant developed skin nodules of unclear etiology, prompting additional evaluation.

Results:

Given his profound immunosuppression and receipt of broad-spectrum antimicrobials, plasma metagenomic next-generation sequencing (mNGS) was obtained and identified Mycobacterium tuberculosis complex within 72 hours. A skin biopsy was performed, and antimycobacterial therapy was initiated. Mycobacterium bovis-BCG was confirmed from cultures 3 weeks later. Treatment was complicated by elevated serum liver transaminases and aminoglycoside-associated high-frequency hearing loss. The infant completed 14 months of treatment from engraftment. Evaluation for active BCG infection after SCT was negative.

Conclusion:

In an infant with a unique IEI, plasma mNGS provided the first diagnosis of disseminated BCG infection. We believe that early initiation of antimycobacterial treatment improved the infant’s clinical outcome. Plasma mNGS testing should be considered as a noninvasive screen for infectious pathogens in children with IEIs before SCT.
Attitudes Towards Mental Health Among Physician Assistant Students with Shared Living Experiences Through Synchronous Videoconferencing
Authors: Neary Stephanie , Ruggeri Mary , Roman Christopher , Kamauf Renée , Chilton Julie , Martin Andrés
Published: January 2022

Purpose

We tested the hypothesis that physician assistant (PA) students can benefit from exposure to senior PAs who share their living experiences with mental illness.

Methods

First-year students from 5 PA programs were asked to participate in this mixed methods study. After completing a pre-activity survey, students from 3 programs participated in an intervention consisting of senior PA faculty sharing their mental health experiences, including treatment and recovery. A facilitated discussion followed, and students not exposed to the intervention served as controls. The qualitative component of the study was based on transcripts from 3 focus groups of students in the exposed group.

Results

We recruited 167 students from 5 PA training programs, 112 of whom (67%) completed baseline and endpoint assessments (37 in the exposed group, 75 in the control). The intervention resulted in significant improvements on the Opening Minds to Stigma (OMS-HC, p = 0.002, Cohen's d = 0.38) and Self-Stigma of Seeking Help (SSOSH, p = 0.006, d = 0.31) scales. Change in the OMS-HC was driven by its social distance (p = 0.003) and disclosure (p = 0.02) subscales. No comparable changes were found in the control group. We identified 3 overarching themes: 1) active elements of the intervention; 2) mutuality; and 3) peer relationships.

Conclusions

Senior PAs sharing their lived experiences with mental illness proved to be an effective anti-stigma intervention for PA students. A candid, intimate, and confidential virtual learning space was feasible through synchronized videoconferencing. Our findings can inform programmatic interventions to address stigma, self-stigma, help-seeking behaviors, and the overall mental health of PA students.
Nurse practitioners as primary care site champions for the screening and treatment of hepatitis C virus
Authors: Dale Cheryl H. , Smith Elizabeth , Biondi Mia J.
Published: January 2022

Background:

Primary care providers are often the first point of contact for hepatitis C virus (HCV) care, yet treatment initiation in primary care continues to be low. Nurse practitioners (NPs) are autonomous providers who, in Ontario, currently prescribe HCV therapy; however, methods to engage primary care NPs in HCV care have not occurred.

Purpose:

To assess the feasibility of a systematic approach to train and support NPs in HCV testing, care, and treatment.

Methodology:

Nurse practitioners from Canada's largest family health team (FHT) were recruited. Nurse practitioners received six hours of training and develop approaches to screen and treat at FHT sites. Treatment algorithms were given, and the number and types of inquiries from NPs were recorded.

Results:

Over 1 year, 9 NPs screened 1,026 patients; 87.4% were screened based on the identification of a risk factor. A mail-out approach for birth cohort screening occurred at a single site, resulting in rapid uptake in screening. Antibody prevalence was 1.66%, with 76.5% RNA positivity. All RNA-positive treatment-eligible individuals were treated by an NP and completed treatment. Thirty-eight consults occurred over 1 year, the majority related to HCV or liver disease staging.

Conclusions:

Formalized initiatives to engage and educate NPs lead to innovative strategies to test for HCV. Nurse practitioners can safely and effectively treat HCV in primary care with minimal support.

Implications:

This work could be extrapolated to NPs in other primary care settings. Implementing formalized strategies has the potential to create NP leaders in the treatment and elimination of HCV in Ontario, Canada, and globally.
Optimizing oxygen delivery to the injured brain
Authors: Taran Shaurya , Pelosi Paolo , Robba Chiara
Published: January 2022

Purpose of review

The principle of optimizing oxygen delivery to the injured brain rests on the premise that both hypoxia and hyperoxia are important mediators of secondary brain injury and should be avoided. This rationale has prompted a move towards incorporating oxygenation endpoints into the management of neurocritical care patients, particularly those with traumatic brain injury. The present review will seek to describe clinical strategies to optimize oxygenation in the acutely brain-injured patient, drawing upon relevant physiologic principles and clinical data, where it exists.

Recent findings

A phase II randomized trial found that a protocolized approach to improving oxygen delivery resulted in less duration of brain hypoxia and a trend towards lower mortality among patients with severe traumatic brain injury. Recent clinical protocols have been published to guide oxygen delivery based on core physiologic principles: increasing oxygen supply via modulation of mean arterial pressure and intracranial pressure, blood oxygen carrying capacity, and cerebral vasoreactivity; and decreasing oxygen demand via sedation, pharmacologic coma, and hypothermia.

Although there is growing interest in the use of brain tissue oxygenation as a resuscitative endpoint, many of these therapies are based on physiologic principles with little robust clinical evidence to guide their application. Clinicians must be mindful of this and balance the putative benefits of improving oxygenation against the risks associated with the use of such therapies.
The liver-gut-axis: initiator and responder to sepsis
Authors: Bauer Michael
Published: January 2022

Purpose of review

The ‘gut-liver axis’ is thought to play an important role in pathogenesis of sepsis. Despite a wealth of experimental data to support the concept of reciprocal crosstalk between gut and liver through bacterial translocation and shaping of the microbiome by liver-derived molecules, for example bile acids, clinical data, and in particular diagnostic and therapeutic options, are limited.

Recent findings

Assessment of organ failure in the current definition of sepsis is operationalized by means of the Sequential Organ Failure Assessment (SOFA) score, including exclusively bilirubin to reflect the complex functions of the liver but ignoring the gut. However, our understanding of the intestinal microbiome and how it is affected by critical illness has clearly improved. Microbiota maintain gut-barrier function and modulate the innate and adaptive immune system. The best-defined intervention affecting the gut microbiome, that is selective decontamination of the digestive tract (SDD) is clinically studied regarding prevention of nosocomial lung infection and antibiotic resistance patterns, although its impact on liver function has not been systematically evaluated in critical illness.

Characterization of liver function beyond bilirubin and the microbiome can be achieved with contemporary sequencing and metabolomic techniques. Such studies are essential to understand how gut-liver crosstalk and ‘dysbiosis’ affect susceptibility to and outcome of sepsis.
Enteroendocrine cell differentiation and function in the intestine
Authors: Sanchez J. Guillermo , Enriquez Jacob R. , Wells James M.
Published: January 2022

Purpose of review

The intestinal enteroendocrine cells (EECs) are specialized hormone-secreting cells that respond to both circulating and luminal cues. Collectively, EECs constitute the largest endocrine organ of the body and signal to a multitude of targets including locally to neighboring intestinal cells, enteric neurons, as well as systemically to other organs, such as the pancreas and brain. To accomplish their wide range of downstream signaling effects, EECs secrete multiple hormones; however, the mechanisms that influence EEC development in the embryo and differentiation in adults are not well defined.

Recent findings

This review highlights the recent discoveries in EEC differentiation and function while also discussing newly revealed roles of transcription factors and signaling networks involved in the allocation of EEC subtypes that were discovered using a combination of novel intestinal model systems and genetic sequencing. We also discuss the potential of these new experimental models that study the mechanisms regulating EEC function and development both to uncover novel therapeutic targets.

Several EEC hormones are being used to treat various metabolic disorders, such as type 2 diabetes and obesity. Therefore, understanding the signaling pathways and gene regulatory networks that facilitate EEC formation is paramount to the development of novel therapies.
The Role of Financial Security on Physical and Mental Health in Young-Midlife Couples Surviving Cancer
Authors: Lyons Karen S. , Firkins Jenny , Hanan Diana M. , Hansen Lissi , Hayes-Lattin Brandon
Published: January 2022

Background

A cancer diagnosis carries a significant economic burden. Yet little is known about perceived financial security on the health of couples with a partner diagnosed with cancer.

Objective

The current study explored perceived financial security in young-midlife couples.

Methods

The study included 49 couples (aged 27-58 years) 1 to 3 years after diagnosis. Multilevel modeling was used to examine the association of perceived financial security on physical and mental health of couples controlling for interdependent data; hierarchical linear regression was used to examine perceived financial security on survivor symptoms and partner care strain.

Results

Mean age of survivors was 43.5 (±9.0) years. Most survivors were female (69%) and 2.2 (±0.6) years after diagnosis. Lower levels of perceived financial security were significantly associated with poorer physical (P < .001) and mental (P < .05) health status for survivors, controlling for age, sex, education, and years since diagnosis; there were no significant associations with partner health status. Lower levels of perceived financial security were significantly associated with higher survivor pain severity (P < .001), pain interference (P < .001), and fatigue (P < .01); there was no significant association with partner care strain.

Conclusions

Financial security plays a role on the physical and mental health of couples after diagnosis.

Implications for Practice

Screening for financial hardship at diagnosis and posttreatment can identify couples at high risk and in need of additional resources and counseling. Greater assessment and reporting of financial security in studies of families surviving cancer are needed to understand the impact on health outcomes.
Patients’ Perceptions at Diagnosis: Lung Cancer Discovery and Provider Relationships
Authors: Somayaji Darryl , Mohedat Heba , Dean Grace E. , Dickerson Suzanne S.
Published: January 2022

Background

In the United States, most lung cancer cases are diagnosed at advanced stages, limiting treatment options and impacting survival. This study presents patients’ perspectives on the complexity of factors influencing a lung cancer diagnosis. Lung cancer awareness regarding risks, symptoms, smoking behaviors, family history, and environmental factors can lead to preventative and early detection measures.

Objective

The aim of this study was to explore lung cancer patient perspectives on lung cancer awareness within the context of an earlier study to understand sleep-wake disturbances in adults with non–small cell lung cancer.

Methods

A content analysis was used to analyze the original deidentified longitudinal interview data collected from 26 patients diagnosed with lung cancer.

Results

Of the original 26 participants, 16 were included in this secondary data analysis. The participants were primarily females (n = 10) and Whites (n = 13), with ages ranging between 49 and 83 years. Half of the sample was diagnosed with stage IV lung cancer and most of the sample was on chemotherapy (n = 10). Two key themes were identified: the lung cancer discovery and the patient-physician relationship.

Conclusions

Unspecific initial symptoms, lack of knowledge and screening, as well as fear of the diagnosis delayed seeking medical care. Patient-physician relationships were hindered by smoking-associated stigma, inadequate sharing of information, and lack of coordinated, holistic care. Positive communication strategies are critical between patients and providers to meet patients’ specific needs.

Implications for Practice

Educational interventions that enhance lung cancer awareness may improve prevention and screening actions, improve timely healthcare intervention, and reduce incidence and mortality.
The Impact of Body Mass Index Classification on Outcomes After Stroke Rehabilitation
Authors: Weidman Melissa , MacDonald Shannon L.
Published: January 2022

With improving stroke mortality rates, more individuals are living with the consequences of stroke. Obesity is a known risk factor for stroke, but its effect on functional outcomes poststroke is less clear. The aim of this study was to determine the association between body mass index classification (underweight, normal weight, overweight, and obese) and functional outcomes, as measured by Functional Independence Measure change, Functional Independence Measure efficiency, and rehabilitation length of stay after inpatient stroke rehabilitation. A retrospective cohort study of individuals with a diagnosis of stroke admitted to a high-intensity inpatient rehabilitation program was performed. Patients were divided into 4 groups based on body mass index category using normal body mass index as the reference. Overall, 34 individuals (4.5%) were classified as underweight, 303 (40.1%) had body mass indices within the normal range, 269 (35.6%) were overweight, and 149 (19.7%) were obese. Ischemic stroke was the most common stroke type across all body mass index categories. Patients in the overweight and obese groups tended to be younger. There were no statistically significant differences in rehabilitation length of stay, Functional Independence Measure change, or Functional Independence Measure efficiency with all groups demonstrating significant functional improvements. Based on these findings, patients admitted for inpatient rehabilitation after stroke can be expected to make similar functional improvements regardless of BMI class.
Congenital Facial Paralysis Revealing an Aplasic Facial Nerve
Authors: Tomé Sónia , Matos Joana , Barreto José , Carvalho João , Leal Joana , Aguiar Branco Catarina
Published: January 2022

Congenital facial palsy is a rare condition, usually related to a traumatic event during birth or as a feature of a syndrome. In this report, two cases of infants with peripheral facial palsy since birth are described, in which magnetic resonance imaging demonstrated unilateral aplasia of the facial nerve. There are only a few cases with similar findings described in the literature. A multidisciplinary approach is recommended to provide the best care. Although no reinnervation of the facial muscles is likely to occur, rehabilitative therapies may be valuable as complementary treatments.
Psychosocial Intervention in Chronic Obstructive Pulmonary Disease: Meta-Analysis of Randomized Controlled Trials
Authors: Farver-Vestergaard Ingeborg , Danielsen Josefine Tingdal Taube , Løkke Anders , Zachariae Robert
Published: January 2022

Objective

Many patients with chronic obstructive pulmonary disease (COPD) experience persistent interrelated psychological and physical symptoms despite optimal treatment. Several studies of psychosocial intervention in COPD have been published in recent years. The present study aimed to conduct a quantitative summary of the efficacy of such interventions on psychological and physical outcomes.

Methods

Two independent raters screened PubMed, PsycINFO, Embase, Web of Science, Cochrane Library, and CINAHL for eligible studies. In all, 35 independent, randomized controlled trials with a total of 3,120 patients with COPD were included, assessed for their methodological quality, and subjected to meta-analytic evaluation.

Results

Meta-analyses revealed small, statistically significant effects of psychosocial intervention on combined psychological (Hedges’s g = 0.28; 95%CI: 0.16–0.41) and physical outcomes (g = 0.21; 95%CI: 0.07–0.35) with no indications of publication bias. Supplementary Bayesian meta-analyses provided strong evidence for a non-zero overall effect on psychological outcomes (Bayes factor (BF) = 305) and moderate support for physical outcomes (BF = 6.1). Exploring sources of heterogeneity with meta-regression indicated that older age of patients and longer duration of interventions were associated with smaller effects on psychological outcomes.

Conclusions

The results support psychosocial intervention as an additional, useful tool in multidisciplinary respiratory care with the potential to improve both psychological and physical outcomes. Future studies are recommended to monitor adverse effects, apply blinding of active control conditions, and determine sample sizes with a priori power calculations.

Registration

Registered with Prospero (www.crd.york.ac.uk/prospero/) prior to initiation of the literature search (Reg. ID: CRD42020170083).
Prevalent Drug Usage Practices in Adults and Children With Idiopathic Inflammatory Myopathies
Authors: Mehta Pankti , Rathore Upendra , Naveen R. , Chatterjee Rudrarpan , Agarwal Vikas , Aggarwal Rohit , Gupta Latika
Published: January 2022

Background

Idiopathic inflammatory myopathies (IIMs) form a heterogeneous group of disorders with a deficit of quality evidence regarding its management. Therefore, we aimed to explore the prevalent treatment practices in the MyoCite cohort from India.

Methods

Drug usage patterns, their predictors, drug retention rates, efficacy, and adverse drug reactions were analyzed for adults and children newly diagnosed with IIM (2017–2020) and followed prospectively and compared with real-world data by performing a medical records review. GraphPad Prism version 8.4.2 was used for statistical analysis.

Results

Of 181 adults (male-to-female ratio, 1:4.6) and 30 children (M:F, 1.3:1), dermatomyositis (41% adults, 93% children) was the most common subtype. Methotrexate (MTX) was the drug of choice (67% adult, 90% children) followed by azathioprine (AZA) and mycophenolate mofetil (MMF). The MMF, AZA, cyclophosphamide, and rituximab (RTX) were preferred for those with antisynthetase syndrome (ASSD) and those with lung involvement, whereas MTX was avoided in them. Functional class and family income did not determine drug preferences. Glucocorticoids were initiated at a lower dose in overlap myositis (45% vs 80%, p = 0.001), and the time to achieve the lowest dose of glucocorticoids was longer than 24 months for ASSD (77% vs 14%, p = 0.002).

Over a median of 35 months, the overall retention rate was the highest for RTX (75%) followed by MTX (58%). Relapse-free survival was the highest for RTX followed by MTX. The most common reasons for discontinuation were adverse drug reactions for MTX and MMF, inefficacy for AZA, and cost for RTX.

Conclusions

In this first analysis of drug usage and retention in patients with IIM in Northern India, MTX emerged as the most preferred drug in both adults and children, with the exception of those with ASSD or lung disease. Organ involvement and subtype of IIM are key determinants of drug preference. Overall, RTX and MTX were well-tolerated with high retention rates, followed by AZA and MMF.
eConsults' Impact on Care Access and Wait Times in Rheumatology
Authors: Malcolm Elizabeth J. , Brandon Zachary , Wilson Lauren E. , Shoup John Paul , King Heather A. , Lewinski Allison , Greiner Melissa A. , Malone Shauna , Miller Julie , Keenan Robert T. , Tarrant Teresa K. , Phinney Donna , Cho Alex , Bosworth Hayden B. , Shah Kevin
Published: January 2022

Background/Objective

A growing number of health systems have implemented eConsults to improve access to specialty advice, but few studies have described their use in rheumatology or impact on visit wait times. We evaluated the uptake of an eConsult program and its impact on wait times for in-person rheumatology visits.

Methods

In this quality improvement project, we analyzed electronic health record data from 4 intervention clinics and 4 comparison clinics, 12 months before and after implementation of an eConsult program. We compared median wait time for rheumatology appointments using a pre-post difference-in-differences analysis and quantile regression, adjusting for patient age, race, sex, clinic pair, and primary insurance payer. We also interviewed 11 primary care providers from the intervention clinics and conducted a rheumatology provider focus group (n = 4) to elucidate experiences with the program.

Results

Rheumatologists recommended management in primary care or referral to another specialty for 41% of eConsults, reducing initial demand for in-person visits. The median wait times dropped in the intervention and the comparison clinics (42 and 25 days, respectively). Intervention clinic median wait time dropped 17 days more than comparison clinics, and this was nonstatistically significant (p = 0.089). eConsults fit provider care tasks best for triage or initial workup for diagnosis, and less well when tests required interpretation, or when back and forth communication was needed to manage the patient's condition.

Conclusions

Implementation of eConsults for rheumatology was associated with reduced wait times for rheumatology appointments and supported primary care providers in the triage and workup for a substantial portion of patients.
Perceived Risk of SARS-CoV-2 at the Start of the COVID-19 Pandemic and Subsequent Vaccination Attitudes in Patients With Rheumatic Diseases
Authors: Duculan Roland , Mancuso Carol A.
Published: January 2022

Objective

In a cohort assembled at the start of the pandemic in New York City, objectives of this longitudinal study were to ascertain whether perspectives about SARS-CoV-2 risks obtained at enrollment were associated with clinical course and vaccination intent obtained at follow-up with the advent of vaccines.

Methods

Patients with diverse rheumatologist-diagnosed diseases taking immunosuppressive medications were interviewed in April 2020 during the height of mortality-associated COVID-19 in New York City and were asked whether they perceived greater infection risk due to rheumatic diseases/medications. Patients were interviewed again when vaccines became available and asked about flares, medication changes, disease activity during the pandemic, and current disease status. They also reported SARS-CoV-2 testing, vaccination intent, and vaccination concerns.

Results

Ninety-six patients had follow-ups (January–March 2021; 83% women; mean age, 50 years). At enrollment, 53%/57% perceived much greater infection risk from autoimmune disease/medications; at follow-up, patients reported flares (63%), greater/unpredictable disease activity (40%), and more medications (44%). Current disease was excellent/very good/good (73%) and fair/poor (27%). Enrollment perspectives were not associated with follow-up status. Seventy percent had SARS-CoV-2 testing. Twenty-three percent would not/were hesitant about vaccination. In multivariable analysis, younger age, concern about effects on rheumatic disease, and distrusting vaccine information were main reasons for not intending/hesitancy to be vaccinated. Eighty-six percent did not report rheumatologists as sources of vaccine information.

Conclusions

Clinical status at follow-up and vaccination intent were not associated with perceived SARS-CoV-2 risk at the start of the pandemic. Concern about vaccine effects on rheumatic disease and distrust in vaccine information deterred patients from vaccination.
Extracellular Volume Quantification With Cardiac Late Enhancement Scanning Using Dual-Source Photon-Counting Detector CT
Authors: Mergen Victor , Sartoretti Thomas , Klotz Ernst , Schmidt Bernhard , Jungblut Lisa , Higashigaito Kai , Manka Robert , Euler André , Kasel Markus , Eberhard Matthias , Alkadhi Hatem
Published: January 2022

Objectives

The aim of this study was to evaluate the feasibility and accuracy of cardiac late enhancement (LE) scanning for extracellular volume (ECV) quantification with dual-source photon-counting detector computed tomography (PCD-CT).

Materials and Methods

In this institutional review board–approved study, 30 patients (mean age, 79 years; 12 women; mean body mass index, 28 kg/m2) with severe aortic stenosis undergoing PCD-CT as part of their preprocedural workup for transcatheter aortic valve replacement were included. The scan protocol consisted of a nonenhanced calcium-scoring scan, coronary CT angiography (CTA) followed by CTA of the thoracoabdominal aorta, and a low-dose LE scan 5 minutes after the administration of 100 mL contrast media (all scans electrocardiogram-gated). Virtual monoenergetic (65 keV) and dual-energy (DE) iodine images were reconstructed from the LE scan. Extracellular volume was calculated using the iodine ratios of myocardium and blood-pool of the LE scan, and additionally based on single-energy (SE) subtraction of the nonenhanced scan from the LE scan. Three-dimensional analysis was performed automatically for the whole-heart myocardial volume by matching a heart model generated from the respective coronary CTA data. Bland-Altman and correlation analysis were used to compare the ECV values determined by both methods.

Results

The median dose length product for the LE scan was 84 mGy·cm (interquartile range, 69; 125 mGy·cm). Extracellular volume quantification was feasible in all patients. The median ECV value was 30.5% (interquartile range, 28.4%–33.6%). Two focal ECV elevations matched known prior myocardial infarction. The DE- and SE-based ECV quantification correlated well (r = 0.87, P < 0.001). Bland-Altman analysis showed small mean errors between DE- and SE-based ECV quantification (0.9%; 95% confidence interval, 0.1%–1.6%) with narrow limits of agreement (−3.3% to 5.0%).

Conclusions

Dual-source PCD-CT enables accurate ECV quantification using an LE cardiac DE scan at low radiation dose. Extracellular volume calculation from iodine ratios of the LE scan obviates the need for acquisition of a true nonenhanced scan and is not affected by potential misregistration between 2 separate scans.
Comparative Study of En Bloc Excision and Dermal Shaving in Treating Axillary Osmidrosis
Authors: Hong Jamin , Jo Taehee , Jeong Woonhyeok , Choi Jaehoon , Kim Junhyung
Published: January 2022

Background

Axillary osmidrosis is a distressing problem caused by hyperactivity of apocrine glands. There have been numerous studies on various surgical treatment methods. In this study, we evaluated the effectiveness of en bloc excision in comparison with dermal shaving.

Methods

The electronic records of 146 patients (286 axillae) who underwent surgery at our center for axillary osmidrosis between January 2009 and December 2020 were reviewed. Twenty-five patients (49 axillae) underwent en bloc excision and 121 (237 axillae) underwent dermal shaving. Patients in the en bloc excision group underwent Minor test preoperatively to detect sweating areas. Severity of osmidrosis was graded using a 4-point scale (0–3). A satisfaction questionnaire was used to evaluate patient experiences in the 2 types.

Results

Mean operation time was significantly shorter in the en bloc excision group than in dermal shaving group. Most en bloc excisions were performed on an outpatient basis under local anesthesia. Both groups showed an improvement in osmidrosis score at 6 months after surgery. A satisfaction questionnaire revealed better perioperative experiences in the en bloc excision group. Various surgical complications such as hematoma, wound dehiscence, and flap necrosis occurred in the dermal shaving group, and the en bloc excision group experienced significantly fewer complications that required intervention.

Conclusions

En bloc excision combined with Minor test effectively reduces malodor without causing severe complications. In addition, perioperative patient satisfaction was better in the en bloc excision group than in the dermal shaving group as en bloc excision provided more rapid returns to normality and simplified communications with patients.
Two Decades of Hand Transplantation
Authors: Wells Michael W. , Rampazzo Antonio , Papay Francis , Gharb Bahar Bassiri
Published: January 2022

Hand transplantation for upper extremity amputation provides a unique treatment that restores form and function, which may not be achieved by traditional reconstruction and prosthetics. However, despite enhancing quality of life, hand transplantation remains controversial, because of immunological complications, transplant rejection, and medication effects. This systematic literature review sought to collect information on current experiences and outcomes of hand transplants to determine the efficacy and utility of hand transplants. The databases PubMed, Scopus, and Embase were analyzed with combinations of “hand” or “upper extremity” or “arm” and “transplant” or “allograft,” with information collected on recipient characteristics, details of transplant, immunological outcomes, functional outcomes, and complications. Functional outcomes, as measured by Disabilities of Arm, Shoulder and Hand score, were compared between patient groups using Wilcoxon signed-rank test or 1-way analysis of variance test and post hoc Tukey test. Within the 108 articles that fulfilled inclusion and exclusion criteria, there were 96 patients with 148 hand transplants. There were 57 patients who experienced acute rejection and 5 patients with chronic rejection. Disabilities of the Arm, Shoulder and Hand scores significantly decreased after hand transplantation and were significantly lower for distal transplants compared with proximal transplants. There were 3 patients with concurrent face transplantation and 2 patients with simultaneous leg transplants. Sixteen patients experienced amputation of the hand transplant, and there were 5 deaths. This study found that hand transplantation provides significant restoration of function and form, especially for proximal transplants. Reduction in complications, such as rejection and amputation, can be achieved by decreasing medication cost and patient education.
Preliminary Study in Relationship Between Cleft Lip and Palatal Bony Defect in Submucous Cleft Palate
Authors: Du Chang Jiang , Zhou Xia , Ma Lian
Published: January 2022

Submucous cleft palate, presenting as varying degrees of palatal bony defect, can be difficult to detect in its early stage. The connection between submucous cleft palate and cleft lip has been noticed by clinicians but are rarely reported in literature.

Aims:

To investigate the correlation between the degree of deformity of palatal bony defect and that of cleft lip.

Patients and Methods:

Thirty-four patients with unilateral (n = 23) or bilateral (n = 11) cleft lip presenting with submucous cleft palate were included. Patients were divided into 3 groups according to the degree of malformation of cleft lip (microform, incomplete, and complete). The length and width of palatal bony defect was then measured from the palatal computer tomography.

Results:

In patients with unilateral cleft lip, the proportions of microform cleft lip, incomplete cleft lip, and complete cleft lip were 17.4%, 60.9%, and 21.7%, respectively. In patients with bilateral cleft lip, there were 3 cases with microform and 1 case with incomplete cleft lip on both sides. No correlation was found between the length or relative width of palatal bony defect with the side (P length = 1.000; P relative width = 0.262) or the severity (P length = 0.605; P relative width = 0.254) of cleft lip.

Conclusions:

The form of cleft lip presenting with submucous cleft palate varies, and there was no correlation with the length or relative width of palatal bony defect. Advanced imaging techniques for children with cleft lip may assist the early diagnosis of submucous cleft palate.