bluuebunny/crossref_metadata_2025 huggingface dataset:
Extensor Apparatus Reconstruction Using Prolene Mesh Tube and Medial Gastrocnemius Flap Following Proximal Tibial Endoprosthetic Reconstruction
Authors: Kapoor Love , Banjara Roshan , Khan Shah A. , Majeed Abdul
Published: March 2021

Reconstruction of the extensor mechanism is the most technically challenging aspect of the endoprosthetic reconstruction after resection of tumors of the proximal tibia. Various methods of reconstruction have been described in literature and successful reconstruction should facilitate effective simultaneous mobilization of the patellar tendon and the prosthesis as a functional unit through a stable and firm fixation. This article describes our unique surgical technique of extensor mechanism reconstruction in which we are using a cylindrical tube of prolene mesh attached to the patellar tendon and medial patellar retinaculum. This tube is then passed through a slot in the prosthesis and reattached to itself under adequate tension. We believe that our operative technique provides a secure fixation as the area of interface between the mesh and extensor apparatus (medial patellar retinaculum and patellar tendon) is larger compared with other techniques.
Proximal Femur Endoprosthesis Augmentation With Polymethylmethacrylate and Condylar Plate: Surgical Technique Description
Authors: Leal García Efraim , Gaitán Lee Hernando , Piñeros Rincón Mariana
Published: March 2021

Introduction:

Aseptic loosening by mechanical failure is one of the main causes of proximal femur endoprosthesis failure with different clinical consequences such as pain, inflammation, progressive loosening of muscular volume, and strength with functional limitation.

Materials and Methods:

We present the surgical description of the case of a patient with aseptic loosening of proximal femur endoprosthesis that was treated with a novel technique that combines different methods to achieve primary stability.

Discussion:

Different surgical techniques have been described to treat aseptic loosening of femoral endoprosthesis, including bone allografts, and total femur prosthesis which provides good functional results but high rates of complications such as infection (13%), dislocation (6%), and material failure (3%).

Results:

Proximal femur endoprosthesis augmentation with polymethylmethacrylate and condylar plate is a novel surgical technique that allows primary stabilization of the construct, early rehabilitation, improvement of functionality, and no signs of new loosening in a follow-up period of 6 months.
Extreme elevation of acute phase reactants and shock secondary to dabrafenib–trametinib
Authors: Ayala de Miguel Pablo , Gorospe García Itziar , López Gallego Javier , Borrega García Pablo
Published: March 2021

The emerging role of BRAF and MEK tyrosine-kinase inhibitors has shown new opportunities of treatment for patients with advanced melanoma and BRAF mutations. Its use is associated with some toxicities, as pyrexia, that clinicians may not be familiarized with. We present the case of a patient diagnosed with stage IV melanoma BRAF Val600E mutated who was started on dabrafenib and trametinib and developed three severe episodes of fever, hypotension and acute phase reactants elevation during the first 3 months of therapy, in the absence of microbiological demonstration of infection. The episodes were initially managed as a septic shock with broad-spectrum antibiotics and vasoactive drugs, while treatment with dabrafenib and trametinib was withheld. After two subsequent dose reduction of dabrafenib, the patient did not experience new episodes of fever.
A Series of RET Fusion Spitz Neoplasms With Plaque-Like Silhouette and Dyscohesive Nesting of Epithelioid Melanocytes
Authors: Kim Daniel , Compres Elsy V. , Zhang Bin , Khan Ayesha U. , Sunshine Joel C. , Quan Victor L. , Gerami Pedram
Published: March 2021

Two distinct studies have shown thatRETfusions are found in 3%–4% of Spitz neoplasms.RETfusions have been well described in papillary thyroid cancer, non–small-cell lung cancer, breast cancer, and soft-tissue mesenchymal tumors as well as some other neoplasms. However, there are no comprehensive descriptions to date of the characteristic morphologic, clinical, or genomic findings inRETfusion Spitz neoplasms. In this study, we identified 5 cases ofRETfusion Spitz neoplasms. These tumors showed characteristic morphologic features which included plaque-like silhouette and monotonous epithelioid cytology with expansile and dyscohesive nesting. Four of 5 patients including 1 diagnosed as Spitz melanoma had clinical follow-up all of which was uneventful. Furthermore, we describe the genomic sequences in 4 of these cases, 2 of which have previously describedKIF5B-RETfusion and 2 of which had a novelLMNA-RETfusion. We believe this report significantly contributes to our current knowledge regarding Spitz neoplasms and describes characteristics features which can help with recognition of theRETsubgroup of Spitz.
Synchronous Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Liver and Peritoneal Metastases: A Systematic Review and Meta-analysis
Authors: Flood Michael P. , Das Atandrila A. , Soucisse Mikael L. , Kong Joseph , Ramsay Robert G. , Michael Michael , Loveday Benjamin P.T. , Warrier Satish K. , Heriot Alexander G.
Published: March 2021

BACKGROUND:

Synchronous liver resection, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases have traditionally been contraindicated. More recent clinical practice has begun to promote this aggressive treatment in select patients.

OBJECTIVE:

This study aimed to investigate the perioperative and oncological outcomes of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, with and without liver resection, in the management of metastatic colorectal cancer.

DATA SOURCES:

Medline, Embase, and Cochrane Library databases were searched up to July 2020.

STUDY SELECTION:

Cohort studies comparing outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with and without liver resection for metastatic colorectal cancer were reviewed. No randomized controlled trials were available.

INTERVENTION:

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with or without synchronous liver resection were compared.

MAIN OUTCOME MEASURES:

The primary outcome measures were perioperative mortality and major morbidity. Secondary outcomes included 3- and 5-year overall survival and 1- and 3-year disease-free survival.

RESULTS:

Fourteen studies fitted the inclusion criteria, with 8 studies included in the meta-analysis. On pooled analysis, there was no significant difference in perioperative morbidity and mortality between the two groups. Patients that underwent concomitant liver resection had worse 1- and 3-year disease-free survival and 3- and 5-year overall survival.

LIMITATIONS:

Only a limited number of studies were available, with a moderate degree of heterogeneity.

CONCLUSIONS:

The addition of synchronous liver resection to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of resectable metastatic colorectal cancer was not associated with increased perioperative major morbidity and mortality in comparison with cytoreduction and hyperthermic intraperitoneal chemotherapy alone. However, the presence of liver metastases was associated with inferior disease-free and overall survival. These data support the continued practice of liver resection, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy in the management of select patients with such stage IV disease.
Causal Organic Indirect and Direct Effects: Closer to the Original Approach to Mediation Analysis, with a Product Method for Binary Mediators
Authors: Lok Judith J. , Bosch Ronald J.
Published: March 2021

Mediation analysis, which started in the mid-1980s, is used extensively by applied researchers. Indirect and direct effects are the part of a treatment effect that is mediated by a covariate and the part that is not. Subsequent work on natural indirect and direct effects provides a formal causal interpretation, based on cross-worlds counterfactuals: outcomes under treatment with the mediator set to its value without treatment. Organic indirect and direct effects avoid cross-worlds counterfactuals, using so-called organic interventions on the mediator while keeping the initial treatment fixed at treatment. Organic indirect and direct effects apply also to settings where the mediator cannot be set. In linear models where the outcome model does not have treatment–mediator interaction, both organic and natural indirect and direct effects lead to the same estimators as in the original formulation of mediation analysis. Here, we generalize organic interventions on the mediator to include interventions combined with the initial treatment fixed at no treatment. We show that the product method holds in linear models for organic indirect and direct effects relative to no treatment even if there is treatment–mediator interaction. Moreover, we find a product method for binary mediators. Furthermore, we argue that the organic indirect effect relative to no treatment is very relevant for drug development. We illustrate the benefits of our approach by estimating the organic indirect effect of curative HIV treatments mediated by two HIV persistence measures, using data on interruption of antiretroviral therapy without curative HIV treatments combined with an estimated or hypothesized effect of the curative HIV treatments on these mediators. See video abstract at http://links.lww.com/EDE/B796.
Incorporating Information on Control Diseases Across Space and Time to Improve Estimation of the Population-level Impact of Vaccines
Authors: Shioda Kayoko , Cai Jiachen , Warren Joshua L. , Weinberger Daniel M.
Published: March 2021

Background:

The synthetic control method evaluates the impact of vaccines while adjusting for a set of control time series representing diseases that are unaffected by the vaccine. However, noise in control time series, particularly in areas with small counts, can obscure the association with the outcome, preventing proper adjustments. To overcome this issue, we investigated the use of temporal and spatial aggregation methods to smooth the controls and allow for adjustment of underlying trends.

Methods:

We evaluated the impact of pneumococcal conjugate vaccine on all-cause pneumonia hospitalizations among adults ≥80 years of age in 25 states in Brazil from 2005 to 2015. Pneumonia hospitalizations in this group indicated a strong increasing secular trend over time that may influence estimation of the vaccine impact. First, we aggregated control time series separately by time or space before incorporation into the synthetic control model. Next, we developed distributed lags models (DLMs) to automatically determine what level of aggregation was most appropriate for each control.

Results:

The aggregation of control time series enabled the synthetic control model to identify stronger associations between outcome and controls. As a result, the aggregation models and DLMs succeeded in adjusting for long-term trends even in smaller states with sparse data, leading to more reliable estimates of vaccine impact.

Conclusions:

When synthetic control struggles to identify important prevaccine associations due to noise in control time series, users can aggregate controls over time or space to generate more robust estimates of the vaccine impact. DLMs automate this process without requiring prespecification of the aggregation level.
Bleeding and antithrombotic therapy during pregnancy in women with poor aPL-related obstetric outcomes
Authors: Alijotas-Reig Jaume , Esteve-Valverde Enrique , Ferrer-Oliveras Raquel , Sáez-Comet Luis , Lefkou Elmina , Mekinian Arsène , Belizna Cristina , Ruffatti Amelia , Tincani Angela , Pardos-Gea Josep , Nalli Cecilia , Marozio Luca , Espinosa Gerard , De Carolis Sara , Latino Omar , Sebastian Udry , LLurba Elisa , Trespidi Laura , Chighizola Cecilia , Pengo Vittorio , Rovere-Querini Patrizia , Canti Valentina , Mayer-Pickel Karoline , Reshetnyak Tatiana , Tabacco Sara , Arnau Anna
Published: March 2021

BACKGROUND

The combination of low-dose aspirin (LDA) and low-molecular-weight heparin (LMWH) until the end of gestation are the currently the accepted standard of care for the treatment of antiphospholipid-related obstetric disorders. In refractory cases, hydroxychloroquine (HCQ) can be added to this standard of care.

OBJECTIVE

To evaluate the haemostatic safety of LDA and LMWH (medium to high prophylactic doses) during pregnancy and the puerperium in women with both full-blown obstetric antiphospholipid syndrome (OAPS) (Sydney criteria) and noncriteria – incomplete – OAPS.

STUDY DESIGN

Retrospective/prospective multicentre observational study. Obstetric background, laboratory categories, delivery mode, antithrombotic regimens and bleeding complications were compared.

SETTING

A total of 30 tertiary European hospitals.

PATIENTS

Mainly, Caucasian/Arian pregnant women were included. Other ethnicities were minimally present. Women were controlled throughout pregnancy and puerperium.

MAIN OUTCOME MEASURES

The primary end-point was to evaluate the number of major and minor haemorrhagic complications in this cohort of women. Neuraxial anaesthetic bleeding complications were particularly assessed. Secondly, we aimed to compare local/general bleeding events between groups.

RESULTS

We studied 1650 women, of whom 1000 fulfilled the Sydney criteria of the OAPS and 650 did not (noncriteria OAPS). Data on antithrombotic-related complications were available in 1075 cases (65.15%). Overall, 53 (4.93%) women had bleeding complications, with 34 being considered minor (3.16%) and 19 major (1.76%). Neither obstetric complications nor laboratory categories were bleeding-related. Assisted vaginal delivery and caesarean section were related to local haemorrhage. Heparin doses and platelet count were not associated with major bleeding.

CONCLUSIONS

LDA and medium to high prophylactic LMWH during pregnancy in women with full-blown OAPS/noncriteria OAPS are safe. A slight increase in bleeding risk was noted in instrumental deliveries. No women who underwent spinal or epidural anaesthesia suffered bleeding complications. No haemorrhage was observed in cases where HCQ was added to standard therapy.
Technical factors to consider when developing an Expanded Carrier Screening platform
Authors: Fabiani Marco , Cogo Francesco , Poli Maurizio , Capalbo Antonio
Published: March 2021

Purpose of review

Expanded Carrier Screening (ECS) is a genetic test able to detect carriers for a large number of autosomal recessive and X-linked diseases. Its clinical utilization is increasing but some technical aspects for its implementation are still controversial.

Recent findings

In the current literature, several aspects of ECS panel implementation have been addressed. One of the most relevant topics involves which genes/pathologies should be included in an optimized ECS panel and which variants should be reported.

Here, we review the best practice criteria to refine and improve clinical utility and validity of an ECS panel. The criteria for optimal ECS panel implementation include the severity of pathologies, the prevalence of diseases in general population and a definitive or strong gene/disease association. Moreover, we discuss the main complications associated with the reporting of Variant of Uncertain Significance and the need for periodic reassessment.
The Mindful Path to Nursing Accuracy
Authors: Ekkens Connie Lynne , Gordon Pamela Ann
Published: March 2021

Achieving error-free health care is critically vital and includes freedom from the occurrence of medication errors, which, as yet, is an unrealized goal in the United States. The purpose of this study was to minimize or potentially eliminate medication errors by adding training in mindfulness thinking to the current system protocol. The goal of this quantitative, quasi-experimental study was to determine whether training nurses in mindfulness thinking founded on the Dossey Integral Theory changed the frequency and severity of medication administration errors. Data analysis included the following steps: recording of data using the NCC MERP (National Coordinating Council for Medication Error Reporting) instrument, statistical analysis using pairedttest, and a logistical interpretation of descriptive statistics. An error reduction of 73.3% between pre- and posttraining mean for the experimental group was observed. This study may add to the limited body of research related to mindfulness and the resultant reduction in medication errors.
Geographic atrophy: where we are now and where we are going
Authors: Richard Alyse J. , Duker Jacob S. , Reichel Elias
Published: March 2021

Purpose of review

Age-related macular degeneration (AMD) affects a significant percentage of the elderly population and end-stage disease classified by either geographic atrophy (GA) or neovascular AMD (nvAMD) is one of the leading causes of vision loss worldwide. Despite the fact that there are currently treatments for nvAMD, there are no treatments in practice to prevent disease onset or progression of GA. This topic is at the forefront of ophthalmic research demonstrated by the recent advances in disease characterization, genetic and environmental risk factor classification, biomarker discovery and mechanism of pathogenesis categorization. There are also numerous clinical treatment trials underway, targeting proposed pathways and biomarkers associated with GA that are promising.

Recent findings

With several clinical trials of potential treatments underway and numerous recent publications on disease diagnosis and classification, the understanding of GA pathogenesis has increased substantially. Although the exact mechanism of pathology is still elusive, recent literature has highlighted the utilization of current and new ophthalmic imaging modalities and discovery of objective and functional markers that can lead to earlier diagnosis and treatment.

Herein, we will provide an overview and discussion of the current status of GA including advances in mechanism of pathogenesis, diagnosis, classification and current treatment modalities.
Risk Factors for Acquisition of Extended-spectrum Beta-lactamase and AmpC Resistant Gram-negative Bacteria in Critically Ill Infants With Congenital Heart Disease
Authors: Borst Andrea K. , Khuon Daliya , Ogrin Sara L. , Olivero Anthony D. , Olivero Rosemary M.
Published: March 2021

In a cohort of 257 infants with congenital heart disease admitted to the pediatric intensive care unit, 22 infants had positive cultures for extended-spectrum beta-lactamase or AmpC Gram-negative bacteria. These infants had longer exposure to broad-spectrum antibiotics, greater support with invasive devices and longer intensive care and hospital lengths of stay.
Locked in Permanent Employment—Longitudinal Associations With Depressive and Functional Somatic Symptoms
Authors: Virtanen Pekka , Hammarström Anne , Janlert Urban
Published: March 2021

Objective:

To study mental health as a precedent and an outcome of not being in the preferred job (“locked-in situation”).

Methods:

Longitudinal data from age 16 to 43 were derived from surveys of the Northern Swedish Cohort. Changes in mental health were studied with analyses of variance for repeated measures.

Results:

Getting out of locked-in situation was associated with improving and getting into locked-in with worsening mental health between age 30 and age 43. The worsening was more pronounced and the improvement less pronounced in white-collar than in blue-collar employees. Poor mental health at age 16 predicted locked-in situation in early middle age.

Conclusions:

The findings clarify the bidirectional nature of the associations between locked-in situation and poor mental health, as well as the importance of social class in assessing these associations.
Alterations in Metabolic and Cardiovascular Risk Factors During Critical Training in Wildland Firefighters
Authors: Gurney Shae C. , Christison Katherine S. , Williamson-Reisdorph Cassie M. , Sol Joseph A. , Quindry Tiffany S. , Quindry John C. , Dumke Charles L.
Published: March 2021

Objective:

To identify physiologic stressors related to cardiovascular disease via changes in metabolic, inflammatory, and oxidative stress biomarkers during 2 weeks of preseason training in wildland firefighters (WLFFs).

Methods:

Participants were recruited from a local hotshot crew and monitored during preseason training. Fitness was assessed via the Bureau of Land Management fitness challenge. Venipuncture blood was collected on days 1, 4, 8, and 11 and analyzed for changes in a lipid and glucose panel, C-reactive protein, and oxidative stress markers 8-isoprostane (8ISO), 3-nitrotyrosine (3NT), lipid hydroperoxides (LOOH), and protein carbonyls.

Results:

The high physical demands of training resulted in significant (P < 0.05) reductions in total cholesterol, glucose, and hemoglobin A1c. A main effect for time was observed in 8ISO, 3NT, and LOOH.

Conclusions:

Alterations in metabolic and oxidative stress markers suggest an acute, high-intensity physical stress during WLFF preseason training.
Health Care Utilization, Lost Work Days, and Bed Days Among U.S. Workers With COPD, by Industry and Occupation
Authors: Kurth Laura , Syamlal Girija
Published: March 2021

Objective:

To assess health care utilization, lost work days, and bed days among workers with chronic obstructive pulmonary disease (COPD) by industry and occupation.

Methods:

The 2014 to 2018 National Health Interview Survey data were analyzed.

Results:

Among workers with COPD the highest odds of reporting an emergency room (ER) visit and lost work days were observed among workers aged ≥65 years, females, those with no health insurance, and current combustible tobacco users. Workers with COPD in the information industry and computer and mathematical occupation reported highest odds of an ER visit and utilities industry workers reported highest odds for lost work days.

Conclusions:

The high health care utilization and lost work days among workers with COPD in certain industries and occupations underscores the importance of continued surveillance and tailored interventions to reduce disease burden and improve worker health.
The Relationship Between the Functional Gait Assessment and Quality-of-Life Data in Patients Undergoing Vestibular Schwannoma Resection
Authors: Said Mena , Lee Jason , Moshtaghi Omid , Saliba Joe , Richardson Alexander J.W. , Ngo Victoria , Mehranpour Pasha , Schwartz Marc S. , Friedman Rick A.
Published: March 2021

Objective:

To examine the relationship between the Functional Gait Assessment (FGA) and quality of life (QOL) measurements relating to balance before and after vestibular schwannoma (VS) resection and to assess the role of preoperative FGA in predicting postoperative QOL.

Study Design:

A prospective clinical study of adult patients undergoing VS resection between September 2018 and December 2019. FGA was administered 1 week before and after surgery. Dizziness Handicap Inventory (DHI) and Penn Acoustic Neuroma Quality of Life (PANQOL) were administered preoperatively and at 3 months postoperatively.

Setting:

Single tertiary center.

Patients:

Patients (age ≥ 18 years old) with VS undergoing microsurgical resection. Excluded were patient with previous surgery or radiation.

Intervention:

VS resection.

Main Outcomes and Measures:

Primary outcome: correlation between FGA and QOL surveys. Secondary outcome: correlation between preoperative measurements of balance and postoperative PANQOL.

Results:

One hundred thirty-eight patients were analyzed (mean age: 48 years old, 65.9% female). The translabyrinthine approach was most commonly performed. Under multivariate analysis, preoperative FGA significantly correlated with preoperative PANQOL balance score (p < 0.0001), preoperative PANQOL total score (p = 0.0002), and preoperative DHI (p < 0.0001). However, postoperative FGA did not significantly correlate with postoperative PANQOL balance or total scores (p = 0.446 and p = 0.4, respectively), or postoperative DHI (p = 0.3). Univariate analysis demonstrated that preoperative DHI and preoperative FGA were predictive of changes in postoperative PANQOL balance and total scores. However under multivariate analysis, preoperative FGA did not predict changes in postoperative PANQOL balance or total score (p = 0.24; p = 0.28, respectively). Preoperative DHI remained predictive of changes in postoperative PANQOL balance (p = 0.03) score but not of postoperative PANQOL total score (p = 0.37).

Conclusions:

Although FGA and QOL data significantly correlated in the preoperative setting, our results did not suggest that preoperative FGA can be used to determine postoperative QOL. Additionally, the lack of correlation between FGA and QOL measurements in the acute postoperative setting suggests that further research is needed to determine contributors to postoperative QOL.
Endoscopic Anatomy of the Chorda Tympani: Systematic Dissection, Novel Anatomic Classification, and Surgical Implications
Authors: Molinari Giulia , Yacoub Abraam , Alicandri-Ciufelli Matteo , Monzani Daniele , Presutti Livio , Caversaccio Marco , Anschuetz Lukas
Published: March 2021

Hypothesis:

A transcanal endoscopic approach enables visualization of the variable course of the chorda tympani inside the middle ear.

Background:

The chorda tympani is the longest intrapetrous branch of the facial nerve. Despite having been investigated in several studies, a description of its tympanic tract from an endoscopic point of view is lacking in the literature.

Methods:

We performed transcanal endoscopic dissections of 44 human cadaveric head and ear specimens. The entry point of the chorda tympani into the middle ear was classified into four categories according to its location, and as covered or dehiscent according to its appearance. The chordal eminence (CE) was defined as absent, shallow, intermediate, prominent, or fused, based on its shape and extension. The relationship of the chorda tympani to adjacent bony and ligamental structures was assessed.

Results:

The tympanic tract of the chorda tympani was divided into three portions. The periannular segment was dehiscent in 54.5% of specimens, with type II being the most frequent entry point configuration (52.3%). In the interossicular segment, the nerve consistently passed lateral to the incus and medial to the malleus. The course of the intrapetrous segment was independent from the conformation of the tensor fold and supratubal recess.

Conclusion:

The transcanal endoscopic approach allows a detailed description of tympanic segment of the chorda tympani. Novel anatomic classifications of the chorda tympani and CE are proposed herein to highlight their possible surgical implications during otologic procedures.
Efficacy of Mirror Biofeedback Rehabilitation on Synkinesis in Acute Stage Facial Palsy in Children
Authors: Baba Shintaro , Kondo Kenji , Yoshitomi Ai , Kanemaru Asako , Nakaya Muneo , Yamasoba Tatsuya
Published: March 2021

Objectives:

To evaluate the efficacy of mirror biofeedback rehabilitation for synkinesis in severe acute facial paralysis in children.

Methods:

Eight pediatric patients with facial paralysis with an initial electroneurography (ENoG) value less than 10% who underwent mirror biofeedback rehabilitation (the child-rehabilitation group) were enrolled. Seven infants (under age 2 yr) who were unable to undergo rehabilitation (the infant-and-toddler control group) and adult patients (n = 13, range, 33–56 yr) who underwent rehabilitation (the adult-rehabilitation group) comprised the control groups. All the patients enrolled were baseline House–Brackmann (H–B) grade VI at onset. The patients began daily facial biofeedback rehabilitation using a mirror at the first sign of muscle contraction on the affected side and were instructed to keep their eyes symmetrically open using a mirror during mouth movements. The training was continued for 12 months after the onset of facial paralysis. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry in eye opening width during mouth movements. The synkinesis index was calculated as a percentage of the interpalpebral space width ([normal side – affected side]/normal side). Statistical analyses used non-parametric tests (the Kruskal–Wallis test and Steel–Dwass posthoc test).

Results:

The synkinesis index was significantly lower in the child-rehabilitation group than in the infant-and-toddler control group or the adult-rehabilitation group (p < 0.001).

Conclusion:

Children who underwent mirror biofeedback rehabilitation had less synkinesis than the infant-and-toddler control group, suggesting that mirror biofeedback rehabilitation is more effective in preventing the exacerbation of synkinesis in children.
Clinical factors associated with adverse outcomes in the acute period of management of submassive pulmonary embolism
Authors: Nguyen Hong T. , Leffers Patrick , Smotherman Carmen , Ferreira Jason A.
Published: March 2021

The majority of patients with intermediate-to-severe submassive pulmonary embolism are hemodynamically stable upon presentation. There is a lack of evidence for the clinical relevance and safety of initially employed therapies in this population. The objective of current analysis was to determine predictors associated with adverse outcomes in submassive pulmonary embolism patients. This was a single-center, retrospective chart review identifying patient characteristics and clinical factors associated with adverse outcomes within the management of patients presenting to the emergency department for submassive pulmonary embolism. A total of 122 admissions for submassive pulmonary embolism were included. Among these patients, 41% (n = 50) of admissions had an adverse outcomes. Fluid volume was associated with adverse events in an incremental manner (odds ratio 2.1, 95% confidence interval, 1.4–3.2). These findings demonstrate a significant incidence of adverse events in patients with submassive pulmonary embolism and an incremental increase in likelihood of adverse events with each liter of fluid.
Assessment of endothelial progenitor cells, VEGF-A and SDF-1α in Hodgkin's lymphoma
Authors: Filipiak Jan , Boinska Joanna , Ziołkowska Katarzyna , Zduńska Magdalena , Zarychta Elżbieta , Rość Danuta
Published: March 2021

Recently, there is great interest in vasculogenesis, a process of the formation of new blood vessels from progenitor cells or angioblasts, in the pathogenesis of cancer. To the best of our knowledge, the evaluation of endothelial progenitor cells (EPCs) in Hodgkin's lymphoma has not yet been reported.

The aim of the present study was to assess the number of EPCs and selected cytokines, such as vascular endothelial growth factor (VEGF-A) and stromal cell-derived factor (SDF-1α) involved in vasculogenesis in Hodgkin's lymphoma patients.

The study was conducted in a group of 42 patients with Hodgkin's lymphoma (eight patients with relapsed Hodgkin's lymphoma and 34 patients before the first treatment) and 30 healthy controls. The number of EPCs defined as CD31(+), CD34(+), CD45(−), CD133(+) was analysed on FacsCalibur flow cytometer and the concentration of VEGF-A and SDF-1α was assessed by ELISA.

The study showed that there was a significantly higher EPCs number and VEGF-A concentration in the blood of Hodgkin's lymphoma patients compared to healthy individuals (8.20 vs. 0.55 cells/μl; P < 0.000001; 85.10 vs. 25.33 pg/ml, P = 0.000017; respectively). Detailed analysis revealed that there was elevated EPCs number in both study subgroups as compared to the control group. However, there was no difference in VEGF concentration between recurrent Hodgkin's lymphoma patients and the control group. A significant positive correlation was found between the number of EPCs and VEGF-A concentration (R = 0.31, P = 0.047).

Significantly higher EPCs number combined with increased VEGF-A concentration, found in Hodgkin's lymphoma patients before the first treatment, suggest stimulation of new blood vessels formation, which may in turn contribute to tumour growth and metastasis in these patients.
Screening hemostatic defects in Saudi University students with unexplained menorrhagia: a diagnosis, which could be missed
Authors: Bakr Salwa , Almutairi Ameera Abdullah , Dawalibi Ahmad , Owaidah Mustafa , Almughiyri Anwar Abdullah , Owaidah Tarek
Published: March 2021

Bleeding disorders are a common cause of unexplained menorrhagia in adolescents. However, there is lack of information provided on Arab girls. To estimate the prevalence of coagulation factor deficiencies and platelet dysfunction among Saudi university students with unexplained menorrhagia. In this cross sectional study, 463 adolescent girls surveyed for having heavy menses for further evaluation of underlying bleeding tendencies using screening standardized questionnaire. Only 109 girls out of the total 463 girls reported menorrhagia and were included in the evaluation. All girls with menorrhagia were evaluated by Pictorial blood assessment chart (PBAC) for precise evaluation of menstrual blood loss (PBAC score >100), had underwent pelvic ultrasonography and screening of hemostatic abnormalities (complete blood count, PFA-100, PT, aPTT, vWF:RCo, vWF:Ag, coagulation factors assay). On the basis of the score of PBAC more than 100, 25.6% (28/109) of adolescent women (age ranged: 17–25 years old) had confirmed menorrhagia. In 30.8% of them, an ultimate diagnosis of bleeding tendency or hemostatic abnormality was detected [five cases of probable von Willebrand disease (vWD) or low level of vWF:Ag and/or vWF:RCo, two cases of probable platelet dysfunction, and one case of factorV (FV) deficiency]. Anemia was found in 39.28% (11/28) of them; however, only 4 (36%) had received iron supplements. Our study demonstrated that hemostatic defects are not uncommon in Saudi adolescent women presenting with menorrhagia but mostly unrecognized and untreated. It is probably advisable to screen women with menorrhagia for these defects.
Validation of the blood pressure measurement device Beurer BM 28 according to the European Society of Hypertension International Protocol revision 2010
Authors: Deutsch Cornelia , Bramlage Carsten , Botta Beate , Krüger Ralf , Forstner Klaus , Bramlage Peter , Beime Beate
Published: March 2021

Objective

The aim of the present study was to validate the blood pressure (BP) monitor Beurer BM 28 according to the International Protocol of the European Society of Hypertension (ESH-IP) revision 2010.

Methods

In 33 subjects of age 27–81 years, BP measurements were performed according to the ESH-IP protocol, which alternates reference mercury sphygmomanometer and device-under-test (Beurer BM 28) measurements, resulting in a total of 99 comparisons.

Results

As to part 1 of the protocol, an absolute difference within 5 mmHg between the Beurer BM 28 and the test device was found in 83 out of 99 comparisons for the SBP and 82 out of 99 comparisons for the DBP. In 95 out of 99 SBP comparisons and 96 out of 99 DBP comparisons, the difference was found to be within 10 mmHg, whereas only one outlier was noted with an SBP difference higher than 15 mmHg. Mean difference between the test device and the reference was 0.4 ± 4.4 mmHg for SBP, and 0.5 ± 4.3 mmHg for DBP. According to part 2 of the protocol, 30 out of 33 subjects for SBP, and 28 out of 33 for DBP had a minimum of two out of three comparisons staying within the range of 5 mmHg. In none of the subjects, all three comparisons stayed outside the 5 mmHg absolute difference, while in three subjects this was the case for the DBP.

Conclusion

The Beurer BM 28 met all requirements of the ESH-IP revision 2010 and can be recommended for BP measurements in the study population under investigation.
Non-invasive cuff-less blood pressure machine learning algorithm using photoplethysmography and prior physiological data
Authors: Yang Sen , Morgan Stephen P. , Cho Siu-Yeung , Correia Ricardo , Wen Long , Zhang Yaping
Published: March 2021

Conventional blood pressure (BP) measurement methods have a number of drawbacks such as being invasive, cuff-based or requiring manual operation. Many studies are focussed on emerging methods of noninvasive, cuff-less and continuous BP measurement, and using only photoplethysmography to estimate BP has become popular. Although it is well known that physiological characteristics of the subject are important in BP estimation, this has not been widely explored. This article presents a novel method which adopts photoplethysmography and prior knowledge of a subject’s physiological features to estimate DBP and SBP. Features extracted from a fingertip photoplethysmography signal and prior knowledge of a subject’s physiological characteristics, such as gender, age, height, weight and BMI is used to estimate BP using three different machine learning models: artificial neural networks, support vector machine and least absolute shrinkage and selection operator regression. The accuracy of BP estimation obtained when prior knowledge of the physiological characteristics are incorporated into the model is superior to those which do not take the physiological characteristics into consideration. In this study, the best performing algorithm is an artificial neural network which obtains a mean absolute error and SD of 4.74 ± 5.55 mm Hg for DBP and 9.18 ± 12.57 mm Hg for SBP compared to 6.61 ± 8.04 mm Hg for DBP and 11.12 ± 14.20 mm Hg for SBP without prior knowledge. The inclusion of prior knowledge of the physiological characteristics can improve the accuracy of BP estimation using machine learning methods, and the incorporation of more physiological characteristics enhances the accuracy of the BP estimation.
Correlation of orthostatic hypotension with extracranial carotid and intracranial cerebral arteries atherosclerosis in patients with acute ischemic stroke under cerebral angiography
Authors: Tang Xianbi , Wu Bin , Liu Li , Yi Ziwei , Shao Xi , Jing Kaiquan , Fan Jiangli , Pan Chuzheng
Published: March 2021

Objective

The clinical management of patients with acute ischemic stroke (AIS) is complicated by orthostatic hypotension, which might have close relationship with the atherosclerosis of cerebral arteries. The primary objectives were to evaluate the relationship of orthostatic hypotension with extracranial carotid arteries atherosclerosis (ECAS) and intracranial atherosclerosis (ICAS) in AIS patients.

Methods

This study was a prospective cohort analysis of consecutive AIS patients under cerebrovascular angiography. A total of 289 patients were included. orthostatic hypotension was defined as a systolic BP decline ≥20 mmHg or a diastolic BP decline ≥10 mmHg within 3 min of standing. Univariate and multivariate analysis were performed to investigate the association of the clinical variables with orthostatic hypotension.

Results

Orthostatic hypotension was identified in 80 (27.7%) of all patients. ECAS (≥70%) and ICAS (≥50%) was found in 39 (13.5%) and 71 (24.6%) respectively. In multivariate analysis, only diabetes mellitus (odds ratio = 2.00, 95% confidence interval, 1.12–3.58, P = 0.019) and ECAS (odds ratio = 1.97, 95% confidence interval, 1.54–2.51, P < 0.001) were independent risk factors for orthostatic hypotension.

Conclusions

Orthostatic hypotension is a relatively common finding among patients with AIS. AIS patients should be screened for orthostatic hypotension, especially combined with severe ECAS and diabetes mellitus.
Automated office blood pressure measurement by elderly patients in the waiting room
Authors: Toba Ayumi , Ishikawa Joji , Suzuki Ayumi , Harada Kazumasa
Published: March 2021

Objective

Unattended automated office blood pressure (AOBP) may be a better estimate of true blood pressure (BP) than conventional office BP by physicians or nurses. However, measurement of AOBP is cumbersome in general clinical practice. We compared unattended AOBP by the patients themselves using the rigid cuff in the waiting room with attended AOBP and home BP (HBP) (N = 72).

Methods

Unattended AOBP by patients was measured in the waiting room using a rigid cuff with the fully automated device (Omron, HEM-907, triple BP readings taken at 1-min intervals after 5 min of rest). Attended AOBP was measured using a soft cuff by a physician in an examination room without specific resting time. HBP was measured for 5 consecutive days.

Results

The mean age was 76.5 ± 8.6 years. The mean systolic unattended AOBP by patients, attended AOBP and HBP were 139.3 ± 16.6, 144.8 ± 17.1 and 139.1 ± 14.4 mmHg, respectively. Unattended AOBP by patients was significantly related to attended AOBP (r = 0.798; P < 0.01) and to HBP (r = 0.404; P < 0.001). It was significantly lower than attended AOBP (difference 5.5 ± 10.7 mmHg; P < 0.001) and comparable with HBP (difference 0.26 ± 17.0 mmHg; P = 0.90) in Bland–Altman plots. However, 22% of patients had a difference of over 20 mmHg between unattended AOBP by patients and HBP. Multivariate regression demonstrated older age (B = −0.73; P = 0.002) to be related to the difference between unattended AOBP by patients and HBP.

Conclusion

The mean unattended AOBP by patients was lower than attended AOBP and comparable with HBP, but older age affected the difference between unattended AOBP by patients and HBP.
Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future
Authors: Donlon Padraig , Dennedy Michael Conall
Published: March 2021

Purpose of review

To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland.

Recent findings

Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma.

Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.
Potential application value of PET/computed tomography in retroperitoneal leiomyosarcoma and a literature review
Authors: Gao Yu-jie , Yang Zhi , Yu Jiang-yuan , Li Na , Wang Xue-juan , Zhou Ni-na
Published: March 2021

Objective

To analyze the fluorine-18 fludeoxyglucose PET/computed tomography (18F-FDG PET/CT) findings of retroperitoneal leiomyosarcoma (RLMS) and the role of this method in differentiating between benign and malignant masses and classifying the malignant degree to improve the understanding of this rare disease.

Methods

Eight leiomyomas (A group), 13 RLMSs (B group), and 20 postoperative recurrence/metastasis RLMSs (C group) were enrolled. PET/CT features of B group were analyzed. The differences of metabolic parameters between three groups were compared, receiver operating characteristic (ROC) curve analysis was performed to group A and B, and correlation analysis was performed to subgroup B.

Results

(1) The RLMS patients were more likely to be female, and PET/CT showed a high degree of heterogeneous metabolism in the soft tissue mass. (2) The standardized uptake value (SUV) of RLMS were significantly higher than those of benign leiomyomas (P < 0.05). The area under the ROC curve was 0.909, the sensitivity and specificity for diagnosing RLMS were 0.923 and 0.750, respectively, The SUVmax and SUVstd of primary RLMS were moderately associated with the Ki67 index. The mean SUVmax in the G1, G2 and G3 subgroups increased successively (4.15 ± 0.35, 6.47 ± 0.83, and 10.13 ± 4.29, respectively). (3) Primary RLMS was characterized by local invasion, but hematogenous metastasis and lymph node metastasis were rare. Postoperative recurrence/metastasis of RLMS was characterized by local recurrence and hematogenous metastasis, but lymph node metastasis was rare.

Conclusion

PET/CT has potential value in the preoperative staging, benign and malignant differentiation, malignant degree classification and postoperative follow-up of RLMS.
18F-FAZA PET/CT in pretreatment assessment of hypoxic status in high-grade glioma: correlation with hypoxia immunohistochemical biomarkers
Authors: Mapelli Paola , Callea Marcella , Fallanca Federico , Castellano Antonella , Bailo Michele , Scifo Paola , Bettinardi Valentino , Conte Gian Marco , Monterisi Cristina , Rancoita Paola Maria Vittoria , Incerti Elena , Vuozzo Marta , Gianolli Luigi , Terreni Mariarosa , Anzalone Nicoletta , Picchio Maria
Published: March 2021

Background

To investigate the correlation between 18F-labeled fluoroazomycinarabinoside (18F-FAZA) PET data and hypoxia immunohistochemical markers in patients with high-grade glioma (HGG).

Patients and methods

Prospective study including 20 patients with brain MRI suggestive for HGG and undergoing 18F-FAZA PET/CT before treatment for hypoxia assessment. For each 18F-FAZA PET scan SUVmax, SUVmean and 18F-FAZA tumour volume (FTV) at 40, 50 and 60% threshold of SUVmax were calculated; hypoxic volume was estimated by applying different thresholds (1.2, 1.3 and 1.4) to tumour/blood ratio. Seventeen patients were analysed. The immunohistochemical analysis assessed the following parameters: hypoxia-inducible factor 1α, carbonic anhydrase IX (CA-IX), glucose transporter-1, tumour vascularity and Ki-67.

Results

18F-FAZA PET showed a single lesion in 15/17 patients and multiple lesions in 2/17 patients. Twelve/17 patients had grade IV glioma and 5/17 with grade III glioma. Bioptic and surgical samples have been analysed separately. In the surgical subgroup (n = 7) a positive correlation was observed between CA-IX and SUVmax (P = 0.0002), SUVmean40 (P = 0.0058), SUVmean50 (P = 0.009), SUVmean60 (P = 0.0153), FTV–40–50–60 (P = 0.0424) and hypoxic volume1.2–1.3–1.4 (P = 0.0058). In the bioptic group (n = 10) tumour vascularisation was inversely correlated with SUVmax (P = 0.0094), SUVmean40 (P = 0.0107), SUVmean50 (P = 0.0094) and SUVmean60 (P = 0.0154).

Conclusions

The correlation of 18F-FAZA PET parameters with CD31 and CA-IX represents a reliable method for assessing tumour hypoxia in HGG. The inverse correlation between tumour vascularisation, SUVmax and SUVmean suggest that highly vascularized tumours might present more oxygen supply than hypoxia.