bluuebunny/crossref_metadata_2025 huggingface dataset:
Respiratory Characteristics in Patients With Major Burn Injury and Smoke Inhalation
Authors: Won Yu Hui , Cho Yoon Soo , Joo So Young , Seo Cheong Hoon
Published: June 2021

This study aimed to evaluate pulmonary function measurements and respiratory muscle parameters in patients with major burn injury and smoke inhalation. The inclusion criteria included patients who were diagnosed with a smoke inhalation burn or a major burn of more than 20% of total body surface area (TBSA). All subjects underwent a pulmonary function test, respiratory muscle strength test, peak cough flow and fluoroscopic diaphragmatic movement measurement, and 6-minute walk test before starting pulmonary rehabilitation. Evaluations were conducted on the 88th day after the injury, the average time of admission to the Department of the Rehabilitation Medicine for burn rehabilitation after the completion of the acute treatment. The average degree of burns of the total 67 patients was 34.6% TBSA. All parameters in the patient group were significantly lower than the healthy controls, and a mild restrictive pattern of impairment with a reduction in diffusing capacity and more reduced expiratory muscle, than inspiratory muscle strength were observed. Peak cough flow, respiratory muscle strength, and forced vital capacity in the patient group with inhalation burn were significantly lower than in those without inhalation burn. The conditions of the majority of patients with major burn and inhalation injury were consistent with restrictive impairment and significant reduction in diffusion capacity. The patients had expiratory muscle weakness, decreased diaphragmatic movement, and exercise capacity impairment.
A Cross-sectional Survey of Health Professionals Across Australia and New Zealand to Determine What Outcome Measures Are Important From a Clinical Perspective Post Hand Burn Injury
Authors: Mc Kittrick Andrea , Gustafsson Louise
Published: June 2021

Outcome measures are used in healthcare to evaluate clinical practice, measure efficiencies and to determine the quality of health care provided. The Burns Trauma Rehabilitation: Allied Health Practice Guidelines advocates for the collection of outcome measures post burn injuries across different time points. These guidelines recommend multiple tools which can be utilized when measuring outcomes post burn injuries. The aim of this study was to gather information from specialist clinicians regarding their clinical practice and the outcome measurement tools used post hand burn injuries. This cross-sectional study used a survey design to collect data at one given point in time across a sample population. A total of 43 clinical specialists allied health professionals responded to the survey. Respondents indicated that their patients considered hand dexterity was the most important outcome. Three months post burn injury was the most common timepoint for measurement (n = 31, 72.1%) followed by six months (n = 27, 62.8%). Patient report of hand function (n = 42, 97.7%) and observation (n = 41, 95.3%) were the most frequently reported assessment methods. The Jamar Dynamometer (n = 40, 93%), goniometer (n = 39, 90.7%) and pinch gauge (n = 36, 83.7) were the most frequency cited assessment tools. The findings of this study suggest that clinical specialist allied health collect some outcome measures in their routine practice. Based on the respondent’s perceptions of barriers when using outcome measures and lack of reliable/validated tools to measure hand burn outcomes, there is a need for further studies in this area.
Approaches of Emergency Department Physicians to Pediatric Burns: A Survey Assessment
Authors: Demir Sabri , Oztorun Can Ihsan , Erturk Ahmet , Guney Dogus , Ertoy Ayse , Doruk Hayal , Tanriverdi Fatih , Azili Mujdem Nur , Senel Emrah
Published: June 2021

Burned children generally arrive at emergency departments before referring to specialized burn centers. Their initial treatments are performed by non-burn doctors who work in emergency departments. The aim of this study was to evaluate emergency department doctors’ knowledge regarding the initial interventions and transfer of pediatric burn patients. There were 196 participants who completed the survey: 59 were emergency medicine specialists, 46 were general practitioners, and 91 were emergency medicine residents. Sixty-five stated that they always calculate the burn surface areas, and 144 stated that the Parkland formula should be used to calculate the fluid requirements for the first 24 hours. Of all participants, only 21 marked the correct choice as the Lund–Browder scheme to calculate the total burned surface area in children. Only 52 participants marked the correct choice as the Lactated Ringer’s of the fluid given in the first 24 hours. Only 108 correctly recognized inhalation injury. To the question “What is the first intervention that doctors should do at the emergency room to burned children?,” 127 participants stated correctly as the assessment of airway maintenance. Among the participants, 124 stated that they use lidocaine pomades when covering burned children’s wounds. Incorrect interventions with burned children increase morbidity and mortality. This survey shows that non-burn doctors working in emergency departments have insufficient knowledge about pediatric burns and require further training. Therefore, they should be trained continuously and regularly on the approach to both adult and childhood burns.
The Effect of Transfer on Outcomes in Burns
Authors: Bodily Nathan E , Bruenderman Elizabeth H , Bhutiani Neal , The Selena , Schucht Jessica E , Bozeman Matthew C
Published: June 2021

Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts—those directly admitted to a burn center from the field vs those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percentage of total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs 8 hours, P < .01). Directly admitted patients were more likely to have inhalation burn (18 vs 4, P < .01), require intubation after admission (10 vs 2, P = .03), require an emergent procedure (18 vs 5, P < .01), and develop infectious complications (14 vs 5, P = .04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met American Burn Association criteria for transfer were not affected by short delays in transfer to definitive burn care.
Occurrence of Multiple-Drug Resistance Bacteria and Their Antimicrobial Resistance Patterns in Burn Infections from Southwest of Iran
Authors: Hashemzadeh Mohammad , Heydari Reza , Asareh Zadegan Dezfuli Aram , Saki Morteza , Meghdadi Hossein , Bakhtiyariniya Pejman
Published: June 2021

Burn infection continues to be a major issue of concern globally and causes more harm to developing countries. This study aimed to identify the aerobic bacteriological profiles and antimicrobial resistance patterns of burn infections in three hospitals in Abadan, southwest Iran. The cultures of various clinical samples obtained from 325 burn patients were investigated from January to December 2019. All bacterial isolates were identified based on the standard microbiological procedures. Antibiotic susceptibility tests were performed according to the CLSI. A total of 287 bacterial species were isolated from burn patients. Pseudomonas aeruginosa was the most frequent bacterial isolate in Gram-negative bacteria and S. epidermidis was the most frequent species isolated in Gram-positive bacteria. The maximum resistance was found to ampicillin, gentamicin, ciprofloxacin, while in Gram-negative bacteria, the maximum resistance was found to imipenem, gentamicin, ciprofloxacin, ceftazidime, and amikacin. The occurrence of multidrug resistance phenotype was as follows: P. aeruginosa (30.3%), Enterobacter spp (11.1%), Escherichia coli (10.5%), Citrobacter spp (2.1%), S. epidermidis (2.8%), S. aureus, and S. saprophyticus (0.7%). Owing to the diverse range of bacteria that cause burn wound infection, regular investigation, and diagnosis of common bacteria and their resistance patterns is recommended to determine the proper antibiotic regimen for appropriate therapy.
Sequential activation of uterine epithelial IGF1R by stromal IGF1 and embryonic IGF2 directs normal uterine preparation for embryo implantation
Authors: Zhou Chan , Lv Meiying , Wang Peike , Guo Chuanhui , Ni Zhangli , Bao Haili , Tang Yedong , Cai Han , Lu Jinhua , Deng Wenbo , Yang Xiaoyu , Xia Guoliang , Wang Haibin , Wang Chao , Kong Shuangbo
Published: June 2021

Embryo implantation in both humans and rodents is initiated by the attachment of a blastocyst to the uterine epithelium. For blastocyst attachment, the uterine epithelium needs to transform at both the structural and molecular levels first, and then initiate the interaction with trophectoderm. Any perturbation during this process will result in implantation failure or long-term adverse pregnancy outcomes. Endocrine steroid hormones, which function through nuclear receptors, combine with the local molecules produced by the uteri or embryo to facilitate implantation. The insulin-like growth factor (IGF) signaling has been reported to play a vital role during pregnancy. However, its physiological function during implantation remains elusive. This study revealed that mice with conditional deletion of Igf1r gene in uteri suffered from subfertility, mainly due to the disturbed uterine receptivity and abnormal embryo implantation. Mechanistically, we uncovered that in response to the nidatory estrogen on D4 of pregnancy, the epithelial IGF1R, stimulated by the stromal cell-produced IGF1, facilitated epithelial STAT3 activation to modulate the epithelial depolarity. Furthermore, embryonic derived IGF2 could activate both the epithelial ERK1/2 and STAT3 signaling through IGF1R, which was critical for the transcription of Cox2 and normal attachment reaction. In brief, our data revealed that epithelial IGF1R was sequentially activated by the uterine stromal IGF1 and embryonic IGF2 to guarantee normal epithelium differentiation during the implantation process.
Pediatric Kawasaki Disease Trends Prior to and During COVID-19 Outbreak in Singapore
Authors: Chong Chia Yin , Tan Natalie Woon Hui , Yung Chee Fu , Nadua Karen , Kam Kai Qian , Li Jiahui , Thoon Koh Cheng
Published: June 2021

Kawasaki disease (KD, typical/atypical/partial) admissions (n = 644) were surveyed from 2017 to 2020 and compared to urinary tract infection (UTI) admissions and COVID-19 in 2020. KD admissions decreased by 27% and median KD age decreased in 2020, whereas UTI admissions remained steady. KD admissions showed a seasonality with a peak in April and nadir in February-March. All KD/KD-related pediatric intensive care unit cases tested negative for COVID-19, and no multisystem inflammatory syndrome in children was found.
Comparative toxicity of rod-shaped nano-CeO2 and nano-CePO4 to lettuce
Authors: Liu Yabo , Ma Yuhui , Jiao Chunlei , Liu Mengyao , Luo Wenhe , Dong Chaonan , Fan Shixian , He Xiao , Yang Fang , Zhang Zhiyong
Published: June 2021

The influence of morphology on the biological effects of nanomaterials (NMs) has not been well understood. In the present study, we compared the phytotoxicity of rod-shaped nano-cerium dioxide (R-CeO2) and nano-cerium phosphate (R-CePO4) to lettuce plants. The results showed that R-CeO2 significantly inhibited the root elongation of lettuce, induced oxidative damages, and caused cell death, while R-CePO4 was nontoxic to lettuce. The different distribution and speciation of Ce in plant tissues were determined by transmission electron microscopy (TEM) and X-ray absorption near edge spectroscopy (XANES) combined with linear combination fitting (LCF). The results showed that in the R-CeO2 group, part of Ce was transformed from Ce(IV) to Ce(III), while only Ce(III) was present in the R-CePO4 group. When interacting with plants, R-CeO2 is easier to be dissolved and transformed than R-CePO4, which might be the reason for their different phytotoxicity. Although both are Ce-based NMs and have the same morphology, the toxicity of R-CeO2 seems to come from the released Ce3+ ions rather than its shape. This research emphasizes the importance of chemical composition and reactivity of NMs to their toxicological effects.
Reimagining pilocytic astrocytomas in the context of pediatric low-grade gliomas
Authors: Milde Till , Rodriguez Fausto J , Barnholtz-Sloan Jill S , Patil Nirav , Eberhart Charles G , Gutmann David H
Published: June 2021

Pediatric low-grade gliomas (pLGGs) are the most common brain tumor in children and are associated with lifelong clinical morbidity. Relative to their high-grade adult counterparts or other malignant childhood brain tumors, there is a paucity of authenticated preclinical models for these pLGGs and an incomplete understanding of their molecular and cellular pathogenesis. While large-scale genomic profiling efforts have identified the majority of pathogenic driver mutations, which converge on the MAPK/ERK signaling pathway, it is now appreciated that these events may not be sufficient by themselves for gliomagenesis and clinical progression. In light of the recent World Health Organization reclassification of pLGGs, and pilocytic astrocytoma (PA), in particular, we review our current understanding of these pediatric brain tumors, provide a conceptual framework for future mechanistic studies, and outline the challenges and pressing needs for the pLGG clinical and research communities.
The oscillation-outbreaks characteristic of the COVID-19 pandemic
Authors: Huang Jianping , Liu Xiaoyue , Zhang Li , Zhao Yingjie , Wang Danfeng , Gao Jinfeng , Lian Xinbo , Liu Chuwei
Published: June 2021

The evolution of the COVID-19 pandemic features the alternation of oscillations and abrupt rises. The oscillations are attributable to weekly and seasonal modulations, while abrupt rises are stimulated by mass gatherings.
Trends in Antibiotic Use in United States Hospitals During the Coronavirus Disease 2019 Pandemic
Authors: Rose Ashley N , Baggs James , Wolford Hannah , Neuhauser Melinda M , Srinivasan Arjun , Gundlapalli Adi V , Reddy Sujan , Kompaniyets Lyudmyla , Pennington Audrey F , Grigg Cheri , Kabbani Sarah
Published: June 2021

We described antibiotic use among inpatients with coronavirus disease 2019 (COVID-19). Most COVID-19 inpatients received antibiotic therapy. We also described hospital-wide antibiotic use during 2020 compared with 2019, stratified by hospital COVID-19 burden. Although total antibiotic use decreased between years, certain antibiotic use increased with higher COVID-19 burden.
Comparative Analysis of Emerging B.1.1.7+E484K SARS-CoV-2 Isolates
Authors: Moustafa Ahmed M , Bianco Colleen , Denu Lidiya , Ahmed Azad , Coffin Susan E , Neide Brandy , Everett John , Reddy Shantan , Rabut Emilie , Deseignora Jasmine , Feldman Michael D , Rodino Kyle G , Bushman Frederic , Harris Rebecca M , Chang Mell Josh , Planet Paul J
Published: June 2021

We report the genome of a B.1.1.7+E484K severe acute respiratory syndrome coronavirus 2 from Southeastern Pennsylvania and compare it with all high-coverage B.1.1.7+E484K genomes (n = 235) available. Analyses showed the existence of at least 4 distinct clades of this variant circulating in the United States and the possibility of at least 59 independent acquisitions of the E484K mutation.
Physical Possibility and Determinate Number Theory
Authors: Berry Sharon
Published: June 2021

It is currently fashionable to take Putnamian model-theoretic worries seriously for mathematics, but not for discussions of ordinary physical objects and the sciences. However, I will argue that (under certain mild assumptions) merely securing determinate reference to physical possibility suffices to rule out the kind of nonstandard interpretations of our number talk Putnam invokes. So, anyone who accepts determinate reference to physical possibility should not reject determinate reference to the natural numbers on Putnamian model-theoretic grounds.
The Filipino community pantries: a manifestation of the spirituality of ‘Alay Kapwa’ in the time of the pandemic
Authors: Canete Jonathan James O , Rocha Ian Christopher , Dolosa Jian Dennis P
Published: June 2021

The coronavirus disease of 2019 pandemic has brought not only disaster to humanity but also the best in each human individual. Filipinos, in a special way, have exhibited the inherent greatness of the human person in the construction of the community pantries where people who can sustain their needs in time of pandemic would donate some provisions to those who are needy. The establishment of various community pantries across the Philippines embodies the spirituality of ‘Alay Kapwa’, a spirituality that connects people together especially in time of crisis to be persons for others rather than harboring an unnaturalistic human and primitive attitude of self-centeredness.
Public health impact of the COVID-19 pandemic on the emergency healthcare system
Authors: Stirparo G , Oradini-Alacreu A , Migliori M , Villa G F , Botteri M , Fagoni N , Signorelli C , Sechi G M , Zoli A
Published: June 2021

Background

The Lombardy region has been the Italian region most affected by the coronavirus disease 2019 (COVID-19) pandemic in 2020. The emergency healthcare system was under deep stress throughout the past year due to the admission of COVID-19 patients to the emergency department (ED) and had to be thoroughly reorganized.

Methods

We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL (Emergenza e Urgenza OnLine). We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020.

Results

The number of admissions to the ED decreased by 32.5% in 2020 compared with 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalized after ED significantly increased in 2020 compared with 2019 (P < 0.0001), reflecting the management of patients with a more severe clinical condition. More patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019; P < 0.0001), particularly during March and April.

Conclusions

This analysis showed the importance of monitoring the pandemic’s evolution in order to treat more critically ill patients, despite a lower number of patients.
Assessing the psychometric properties of the PROMIS sleep measures in persons with psychosis
Authors: Savage Christina L G , Orth Ryan D , Jacome Anyela M , Bennett Melanie E , Blanchard Jack J
Published: June 2021

An accumulation of research has indicated that persons with psychotic disorders experience a variety of sleep disturbances. However, few studies have examined the psychometric properties of sleep assessments that are utilized in this population. We conducted two studies to examine the reliability and validity of the PROMISTM Sleep Disturbance and Sleep-Related Impairment scales in outpatient samples of persons with psychosis. In Study 1, we examined the internal consistency and convergent validity of the PROMIS sleep scales in individuals with various psychotic disorders (N = 98) and healthy controls (N = 22). The PROMIS sleep scales showed acceptable internal consistency and convergent validity in both healthy controls and individuals with psychotic disorders. In addition, replicating prior research, the PROMIS scales identified greater sleep disturbance and sleep-related impairment in participants with psychotic disorders compared to healthy controls. In Study 2, we examined the test-retest reliability (M = 358 days) of the PROMIS sleep scales in a subset (N = 37) of persons with psychotic disorders who previously participated in Study 1. We also assessed the relation between these self-report measures and actigraph sleep parameters. The results showed that PROMIS sleep measures demonstrated modest temporal stability in the current sample. Contrary to our hypothesis, there was a lack of correspondence between these scales and actigraph sleep parameters. Overall, these findings indicate that the PROMIS sleep scales are psychometrically sound measures for populations with psychosis and highlight the importance of utilizing a multi-method approach to assess sleep.
PQ v RS [2019] EWHC 1643 (Ch): a case note
Authors: Campbell Emily
Published: June 2021

Many older settlements appear to restrict the class of children and issue who may benefit to those who are legitimate. Whether this is the full story and what trustees can do about it, given the impact of the issue on family harmony, was considered by Chief Master Marsh in the recent case of PQ v RS. The case is of particular interest on the point of the use of powers of appointment (rather than powers of advancement) to benefit non-objects.
Radial and axial water movement in adult trees recorded by stable isotope tracing
Authors: Treydte Kerstin , Lehmann Marco M , Wyczesany Tomasz , Pfautsch Sebastian
Published: June 2021

The capacity of trees to release water from storage compartments into the transpiration stream can mitigate damage to hydraulic functioning. However, the location of these ‘transient’ water sources and also the pathways of water movement other than vertical through tree stems still remain poorly understood. We conducted an experiment on two tree species in a common garden in eastern Australia that naturally grow in regions of high (Eucalyptus tereticornis, ‘Red Gum’) and low (Eucalyptus sideroxylon, ‘Ironbark’) annual precipitation rates. Deuterium-enriched water (1350% label strength) was directly introduced into the transpiration stream of three trees per species for four consecutive days. Subsequently, the trees were felled, woody tissue samples were collected from different heights and azimuthal positions of the stems, and stable isotope ratios were determined on the water extracted from all samples. The presence/absence of the tracer along the radial and vertical stem axes in combination with xylem hydraulic properties inferred from sapflow, leaf and stem water potentials, wood moisture contents and anatomical sapwood characteristics elucidated species-specific patterns of short-term stem water storage and movement. The distribution of water isotopes at natural abundance among woody tissues indicated systematic differences with highest values of sapwood water and lower values in inner bark and heartwood. Presence of tracer in water of the inner bark highlighted the importance of this tissue as capacitor. Although injected at the northern side of stems, tracer was also discovered at the southern side, providing empirical evidence for circumferential flow in sapwood, particularly of Ironbark. Greater vertical water transport in Red Gum compared with more radial and circumferential water transport in Ironbark were associated with species-specific sapwood anatomy. Our study highlights the value of combining information from stable isotope tracers and wood anatomy to investigate patterns of water transport and storage of tall trees in situ.
V The Early Sixteenth Century
Authors: Smith Edward
Published: June 2021

This chapter has six sections: 1. General: Prose; 2. General: Verse; 3. More; 4. Skelton; 5. Surrey; 6. Wyatt.
Baseline Sensitivity of Alternaria alternata and A. arborescens to Natamycin and Control of Alternaria Rot on Stored Mandarin Fruit
Authors: Wang Fei , Saito Seiya , Michailides Themis J. , Xiao Chang-Lin
Published: June 2021

Alternaria rot caused by Alternaria alternata and A. arborescens is one of the major postharvest diseases on mandarin fruit in California. In this study, natamycin, a newly registered biofungicide, was evaluated for its potential as a postharvest treatment to control Alternaria rot on mandarin fruit. The baseline sensitivities of A. alternata and A. arborescens to natamycin were determined. Effective concentration inhibiting 50% of fungal growth (EC50) values of natamycin for 70 A. alternata isolates ranged from 0.694 to 1.275 µg/ml (mean = 0.921 µg/ml) in a conidial germination assay and from 2.001 to 3.788 µg/ml (mean = 2.797 µg/ml) for 40 A. alternata isolates in a mycelial growth assay. EC50 values of natamycin for 30 A. arborescens isolates ranged from 0.698 to 1.203 µg/ml (mean = 0.923 µg/ml) in a conidial germination assay and from 2.035 to 3.368 µg/ml (mean = 2.658 µg/ml) for 20 A. arborescens isolates in a mycelial growth assay. Control tests on detached mandarin fruit showed that natamycin at both low (460 µg/ml) and high (920 µg/ml) recommended rates significantly reduced disease incidence and severity on mandarin fruit inoculated with Alternaria isolates, regardless of species. High rate of natamycin significantly reduced disease incidence and severity compared with the nontreated control even when natamycin treatment was delayed for 6, 12, and 18 h after inoculation. Our results suggested that natamycin can be an effective postharvest fungicide for control of Alternaria rot on mandarin fruit.
Development and Implementation of a Strong Mentoring Program to Increase Scholarly Productivity and Support Nurse Faculty Retention
Authors: Volkert Delene
Published: June 2021

This article discusses the development of a nurse faculty mentoring program at a public, four-year, comprehensive university in southeastern United States. The faculty mentoring program was designed to build the professional and scholarly development of both new faculty and their experienced faculty mentors. An additional goal was to encourage retention within the department.
The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects
Authors: Maale Gerhard E. , Srinivasaraghavan Aniruth , Mohammadi Daniel K. , Kennard Nicole , Angobaldo Diego
Published: June 2021

Introduction:

No good mechanisms are available for reconstruction of large anterior soft tissue defects associated with infected total knees [periprosthetic joint infections of the knee (PJI-K)]. Patellectomy is usually required due to involvement with adjacent large anterior soft tissue defects left after radical debridement, free flaps are required for closure. This type of flap necessitates the use of a drop lock brace in ambulation. Our question is whether the proximal placement of the knee joint with longer tibial segments can reduce the number of free flaps and reduce the need for a drop lock brace by reattaching the quadriceps directly to the hinged tibial component.

Methods:

We retrospectively analyzed 35 cases with a minimum 2-year follow-up. Of 1-stage total knee revisions for PJI-K with the proximal placement of the knee joint for large anterior soft tissue defects left after debridement.

Results:

The average knee joint displacement was 85 mm. Eleven recurred with infection and 4 required amputation. Eighteen had enough extensor power to walk with a cane or walker as opposed to requiring a drop lock brace. Fifteen patients did not need any free or local flaps, rather these patients only required adjacent soft tissue transfer during surgery.

Discussion:

This novel proximal placement of the knee joint in patients with PJI-K who have large anterior soft tissue defects lessens the need for free flaps. The proximal placement also allows for reconstruction of what is left of the quadriceps mechanism into the tibial component and usually provides enough extensor power to lock the hinge joint.
Caregiving for Aging Parents as a Source of Blessing
Authors: Conway Kimberly A.
Published: June 2021

This phenomenological secondary analysis of original research explored how adult caregivers of aging parents define the concept of being blessed. The disadvantages of caregiving dominate literature, but few research studies focus on positive aspects where caregivers emerge emotionally optimistic. Study participants expressed being blessed, such as being thankful, gaining a sense of peacefulness, reward, and meaningfulness. A conceptual definition of being blessed is proposed.
Acral Calcified Vascular Leiomyoma: Report of 3 Cases and Literature Review
Authors: Suárez-Peñaranda Jose M. , Pita da Veiga Gabriela , Pérez-Muñoz Noelia , Fernández-Figueras María-Teresa
Published: June 2021

Angioleiomyomas are benign neoplasms, which usually present as solitary, slow-growing nodules on the skin of lower extremities, but acral location on the hands or feet is unusual. Yet, microscopically, they may show many histopathological variants, focal calcification is uncommon. Extensive calcification masquerading the real nature of the tumor has been rarely reported, the term acral calcified leiomyoma having been proposed for this entity. This change is more often in distal locations and has been interpreted as degenerative in nature, probably related to repetitive minor trauma. We report 3 examples of this unusual condition on the feet of 2 male and one female subjects (aged, 68, 69, and 80 years) and make a review of the 31 cases available in the literature. Two of our cases are associated with highly uncommon features, such as transepidermal calcium elimination and concomitant calcaneal spur.
Papillary Dermal Elastolysis Secondary to Combination Nivolumab and Cabiralizumab Therapy: Histiocytes and Dermal Mucin as Clues to the Diagnosis
Authors: Yin Lu , Criscito Maressa C. , Stokar Evan , Siolas Despina , Haimovic Adele , Lo Sicco Kristen , Brinster Nooshin K.
Published: June 2021

Papillary dermal elastolysis has been described in the setting of experimental combination nivolumab and cabiralizumab immunotherapy. We report a third patient with distinctive, generalized atrophic macules that developed after a morbilliform eruption during a clinical trial for treatment of metastatic pancreatic adenocarcinoma. Histopathological findings demonstrated diminished elastic fibers in the papillary dermis, associated with a histiocyte-rich infiltrate and increased dermal mucin, features that should clue the dermatopathologist to this condition.
Diagnostic Dilemma of Cutaneous Tuberculosis: Opening of the Pandora's Box
Authors: Chatterjee Debajyoti , Saikia Uma Nahar , Ramesh V.
Published: June 2021

Tuberculosis in all forms, that is, pulmonary (PTB) or extrapulmonary (EPTB), is a universal health problem. Cutaneous tuberculosis (CTb) remains one of the least studied and often under-reported variants of EPTB because of its wide and protean clinical presentation. The diagnosis of CTb remains challenging because of lack of sensitive and specific investigations for its diagnosis. The sensitivity of some of the traditional tests is low because of low concentration of mycobacteria in paucibacillary lesions. Besides it is difficult to distinguish betweenM. tuberculosis(MTb) and other mycobacterial species in skin biopsies morphologically. Molecular methods may target either MTb DNA or RNA, and serve as promising tools in the diagnosis of various forms of CTb, with high sensitivity and rapidity. This review is focused on diagnostic challenges of CTb and to discuss various methods and newer technologies for diagnosing CTb. This will help the dermatologists and dermatopathologists to elucidate and accurately diagnose CTb from other infectious granulomatous dermatitis for appropriate timely treatment of the patient.
Epithelioid Fibrous Histiocytoma With Chondroblastoma-Like Features: A Report of a Rare Entity and Discussion of Related Diagnostic Challenges
Authors: Wright Glenda R. , Archibald Curtis W. , Fontaine Daniel , Dakin-Hache Kelly , Walsh Noreen M.
Published: June 2021

Epithelioid fibrous histiocytoma (EFH) is an uncommon benign skin lesion. It is distinct from FH by virtue of its recurrent anaplastic lymphoma kinase (ALK) gene rearrangements and immunohistochemical expression of ALK protein. It often poses a challenge in interpretation. Clinically, it is characterized by a flesh-colored papule/nodule on an extremity of a young to middle-aged individual. Microscopically, it is represented by a circumscribed dermal papule/nodule composed of sheets of plump epithelioid cells, forming whorled aggregates around numerous intralesional vessels. Immunohistochemistry, notably ALK positivity and relevant negative stains, serves to distinguish EFH from its morphological mimics. Rare examples of chondroblastoma-like EFH and EFH with osseous metaplasia are recorded in the literature. Our case is of a 58-year-old man who attended an oculoplastic surgeon because of an exophytic cutaneous nodule on the right upper eyelid. The lesion was excised. Microscopically, it displayed morphological and immunohistochemical features of EFH. Of interest, discrete foci of chondro-osseous change, including chondroblastoma-like pericellular calcification, osteoid formation, and osteoclast-like giant cells, were noted throughout the lesion. A diagnosis of EFH with chondroblastoma-like features was made. Of interest, the changes observed in this EFH serve to link the previously reported examples of pure chondroblastoma-like EFH and EFH with osseous metaplasia. This morphological variant of EFH adds to the existing diagnostic challenge presented by these lesions, particularly in the distinction from other calcifying tumors of the skin.
Association of Age of Enrollment in Early Intervention with Emergent Literacy in Children Who Are Deaf or Hard of Hearing
Authors: Meinzen-Derr Jareen , Altaye Mekibib , Grove Wendy , Folger Alonzo T. , Wiley Susan
Published: June 2021

Objective:

Literacy skill development in deaf or hard of hearing (DHH) children is essential for success in school and beyond. Our objective was to evaluate the association between age of early intervention (EI) enrollment for DHH children and emergent literacy in preschool.

Methods:

This was a population-based study that leveraged state public health and education data on all children identified with hearing loss. The sample included children born between 2008 and 2014 enrolled in EI for hearing loss who received preschool supports (years 2011–2014) through the Ohio Department of Education. The Get it! Got it! Go!, measuring emergent literacy domains of picture naming, rhyming, and alliteration, was administered during preschool in fall and spring. Exposure was enrollment into EI before age 6 months (early) versus at/after 6 months (later). Propensity score matching and mixed model analyses were used to examine associations between EI enrollment and outcomes over time. Model least square means with 95% confidence intervals (CIs) were reported.

Results:

One hundred two successful matches were made for 256 preschoolers. Children enrolled in EI early had significantly higher mean scores (mean [95% CI]) over time for emerging literacy domains of picture naming (2.42 [0.47–4.37]), rhyming (1.2 [0.35–2.06]), and alliteration (0.61 [0.15–1.07]) compared with later enrolled children. Children enrolled early had significantly higher emergent literacy scores at entry, although literacy development was similar between groups.

Conclusion:

Children enrolled in EI before age 6 months had consistently higher scores in emergent literacy components over time compared with children enrolled at/after age 6 months.
The cardio-ankle vascular index as a predictor of adverse pregnancy outcomes
Authors: Rueangjaroen Patcharee , Luewan Suchaya , Phrommintikul Arintaya , Leemasawat Krit , Tongsong Theera
Published: June 2021

Objective:

To assess the association between maternal hemodynamic parameters; cardio-ankle vascular index (CAVI), representing arterial stiffness; mean arterial pressure (MAP), uterine artery pulsatility index (Ut-PI), and adverse pregnancy outcomes including preeclampsia (PE), fetal growth restriction (FGR), and gestational diabetes mellitus (GDM).

Methods:

A prospective cohort study was conducted on low-risk pregnancies. All were serially measured for the mean CAVI, MAP, and Ut-PI for four times at gestational age (GA) 11–14, 18–22, 28–32, and after 36 weeks. Also, the women were followed up for pregnancy outcomes, focusing on PE, FGR, and GDM.

Results:

Of 335 recruited cases meeting the inclusion criteria, 16 cases developed PE, 24 cases had FGR, and 83 cases had GDM. Compared to the non-PE group, women developing PE had a significant increase in CAVI at 18–22, 28–32, and after 36 weeks (P-value = 0.021, 0.003, and <0.001, respectively), a significant increase in MAP at all of the four periods (P-value < 0.001, for all periods), and a significant increase in Ut-PI during GA 18–22 weeks (P-value = 0.021). In pregnancies with FGR, there was a significant increase of CAVI at GA 18–22, 28–32 and after 36 weeks (P-value = 0.012, 0.015, and 0.004, respectively), an increase in Ut-PI in all gestational periods (P-value < 0.05) but no changes of MAP throughout pregnancy. In GDM, the three parameters were not significantly different from those in the non-GDM group in all of the four periods. CAVI could predict PE and FGR with AUC of 0.655–0.835 and 0.673–0.760, respectively. CAVI added predictive values when combined with MAP or Ut-PI.

Conclusion:

Increased CAVI, like MAP and Ut-PI, can be used as a predictor of PE and FGR but not GDM. Also, it has an added predictive value when combined with MAP or Ut-PI.
Pathophysiology of Coagulopathy in Hematological Malignancies and in COVID-19
Authors: Levi Marcel
Published: June 2021

Many severe illnesses with a systemic impact may cause activation of coagulation. While systemic activation of coagulation leads to a coagulopathy that follows many common activation pathways and failure of endogenous regulatory anticoagulant systems, underlying conditions may utilize distinctive pathogenetic routes and may vary in clinical manifestations of the coagulopathy. The coagulation derangement associated with hematological malignancies and the coagulopathy of coronavirus disease 2019 (COVID-19) clearly demonstrate such differences. Malignancies are associated with venous thromboembolism due to the biological effect of malignant cells, frequent medical interventions, or the presence of indwelling vascular catheters. The underlying pathogenesis of cancer-associated coagulopathy relies on tissue factor-mediated activation of coagulation, cytokine-controlled defective anticoagulant pathways, fibrinolytic changes, and dysfunctional endothelium. There is an additional risk caused by anti-cancer agents including chemotherapy and immunotherapy. The underlying pathogenetic factor that contributes to the thrombotic risk associated with chemotherapy is endothelial cell injury (or loss of protection of endothelial integrity, for example, by vascular endothelial growth factor inhibition). In addition, individual anti-cancer agents may have specific prothrombotic effects. One of the remarkable features of severe COVID-19 infections is a coagulopathy that mimics but is not identical to the disseminated intravascular coagulation and thrombotic microangiopathy and has been identified as a strong marker for an adverse outcome. Severe COVID-19 infections cause inflammation-induced changes in coagulation in combination with severe endothelial cell injury. This coagulopathy likely contributes to pulmonary microvascular thrombosis, bronchoalveolar fibrin deposition (which is a hallmark of acute respiratory distress syndrome) and venous thromboembolic complications.
Immune Thrombocytopenia: Recent Advances in Pathogenesis and Treatments
Authors: Audia Sylvain , Mahévas Matthieu , Nivet Martin , Ouandji Sethi , Ciudad Marion , Bonnotte Bernard
Published: June 2021

Immune thrombocytopenia (ITP) is a rare autoimmune disease due to both a peripheral destruction of platelets and an inappropriate bone marrow production. Although the primary triggering factors of ITP remain unknown, a loss of immune tolerance—mostly represented by a regulatory T-cell defect—allows T follicular helper cells to stimulate autoreactive splenic B cells that differentiate into antiplatelet antibody-producing plasma cells. Glycoprotein IIb/IIIa is the main target of antiplatelet antibodies leading to platelet phagocytosis by splenic macrophages, through interactions with Fc gamma receptors (FcγRs) and complement receptors. This allows macrophages to activate autoreactive T cells by their antigen-presenting functions. Moreover, the activation of the classical complement pathway participates to platelet opsonization and also to their destruction by complement-dependent cytotoxicity. Platelet destruction is also mediated by a FcγR-independent pathway, involving platelet desialylation that favors their binding to the Ashwell-Morell receptor and their clearance in the liver. Cytotoxic T cells also contribute to ITP pathogenesis by mediating cytotoxicity against megakaryocytes and peripheral platelets. The deficient megakaryopoiesis resulting from both the humoral and the cytotoxic immune responses is sustained by inappropriate levels of thrombopoietin, the major growth factor of megakaryocytes. The better understanding of ITP pathogenesis has provided important therapeutic advances. B cell-targeting therapies and thrombopoietin-receptor agonists (TPO-RAs) have been used for years. New emerging therapeutic strategies that inhibit FcγR signaling, the neonatal Fc receptor or the classical complement pathway, will deeply modify the management of ITP in the near future.
Intraocular Pressure Elevation Following Intravitreal Anti-VEGF Injections: Short- and Long-term Considerations
Authors: Levin Ariana M. , Chaya Craig J. , Kahook Malik Y. , Wirostko Barbara M.
Published: June 2021

Published studies agree that transient intraocular pressure (IOP) spikes are common after intravitreal injections of anti–vascular endothelial growth factor agents. Currently, there is no standard of care guiding if and when to prevent these IOP spikes. Furthermore, there are challenges in determining the impact of postinjection IOP elevation on the health of the retinal ganglion cells, particularly given the often-existing comorbidities of retinal and glaucoma pathology. This review highlights the current literature regarding both acute and chronic postinjection IOP elevations and discusses management of postinjection IOP elevation, especially in patients at high risk for glaucomatous damage.
Effect of Prostaglandin Analogues on Corneal Biomechanical Parameters Measured With a Dynamic Scheimpflug Analyzer
Authors: Yasukura Yuichi , Miki Atsuya , Maeda Naoyuki , Koh Shizuka , Nishida Kohji
Published: June 2021

Précis:

Treatment with topical prostaglandin analogues (PGAs) induces increased corneal compliance in glaucoma eyes measured with a dynamic Scheimpflug analyzer.

Purpose:

The purpose of this study was to evaluate the effect of topical PGAs on the corneal biomechanical properties.

Methods:

We retrospectively studied the biomechanical parameters of 31 eyes of 19 consecutive patients with glaucoma measured using a dynamic Scheimpflug analyzer (Corvis ST) before and after initiation of treatment with topical PGAs. No patients had a history of glaucoma treatment before the study and no other antiglaucoma medication was used during the study period. Nine biomechanical parameters were evaluated before and 61.6±28.5 days (range: 21 to 105 d) after initiation of the treatment. The changes in the corneal biomechanical parameters before and after treatment were analyzed using multivariable models adjusting for intraocular pressure and central corneal thickness. The Benjamini–Hochberg method was used to correct for multiple comparison.

Results:

In multivariable models, PGA treatment resulted in shorter inward applanation time (P=0.016, coefficient=−0.151) and larger deflection amplitude (P=0.023, coefficient=0.055), peak distance (P=0.042, coefficient=0.131), and deformation amplitude ratio at 1 mm (P=0.018, coefficient=0.028). These associations consistently indicated increased corneal compliance (deformability) after PGA treatment.

Conclusion:

Topical PGAs resulted in greater corneal compliance, suggesting that the changes in the corneal biomechanical properties may lead to overestimation of the intraocular pressure–lowering effects.
Bilateral Nonpenetrating Deep Sclerectomy: Difference in Outcomes Between First- and Second-Operated Eyes at 24 Months
Authors: Gillmann Kevin , Meduri Enrico , Paillard Archibald , Bravetti Giorgio E. , Rao Harsha L. , Mermoud André , Mansouri Kaweh
Published: June 2021

Background/Aim:

The aim of this study was to assess the difference in outcome between the first-operated and the second-operated eyes after nonpenetrating deep sclerectomy (DS), and to identify potential success predictors for the second eye.

Methods:

This single-surgeon, retrospective study analyzed the outcomes of all bilateral nonsimultaneous DS with at least 24 months of follow-up. Its main outcome measure was surgical success, defined as unmedicated intraocular pressure (IOP) ≤15 mm Hg associated with a relative reduction ≥20%.

Results:

In all, 104 eyes of 52 patients who underwent bilateral (standalone or combined) DS, within a mean of 344.3±526.3 days of each other, were analyzed. Postoperatively, the mean medicated IOP decreased from 20.7±7.9 (first-operated eyes) and 19.3±6.6 mm Hg (second-operated eyes) at baseline (P=0.107) to 13.8±4.8 [(−33.3%; P<0.001) first-operated eyes) and 12.7±3.8 mm Hg [(−34.2%; P<0.001) second-operated eyes] after 2 years (P=0.619). Postoperative IOP and treatment reduction, respectively, showed fair (r=0.53) and good (r=0.71) levels of correlation between fellow eyes. The rates of complete success were comparable between first-operated and second-operated eyes (32.7% and 40.4%, respectively; P=0.364). At 2 years, among patients whose first-operated eyes were considered a success, 82.4% of surgeries in second eyes were successful (P=0.001). The odds ratio of a second-operated eye experiencing complete success were 6.32 (P=0.011) if the first-operated eye experienced complete success.

Conclusions:

The present study demonstrated a strong association between first-operated and second-operated eyes after DS, in terms of surgical outcomes and IOP reduction. In effect, surgical success in the first-operated eye increases the odds of success in the second eye by 6-fold.
Plasma Cell Vulvitis: A Systematic Review of Interventions
Authors: Yun Jenny S. W. , Veysey Emma
Published: June 2021

Objectives

Plasma cell vulvitis (PCV) is a rare chronic inflammatory disorder, where the symptoms can be severe and may affect patient's quality of life. However, there are currently no evidence-based treatment guidelines. The aims of this systematic review were to evaluate efficacy of individual treatments and to inform future research.

Materials and Methods

A systematic search was conducted of publication between 1952 and August 2020 via MEDLINE, Embase, and Emcare. All publications that evaluated the efficacy of treatments for patients with PCV were included. Forty-seven publications comprising 45 case reports and case series and 2 cohort studies were included.

Results

To date, there are no randomized controlled trials evaluating the efficacy of different treatment options. There are also no studies that assess the impact of treatment on quality of life. Topical corticosteroids are the most frequently used first-line therapy, with limited evidence to support their efficacy, followed by topical imiquimod and surgical excision. The least supported intervention is cryotherapy.

Conclusions

Although descriptive studies support the use of topical corticosteroids and, to a lesser degree, topical calcineurin inhibitors and imiquimod, this review highlights the need for standardized outcome measures and randomized clinical trials for more definitive therapeutic recommendations for women with PCV.