bluuebunny/crossref_metadata_2025 huggingface dataset:
P14.82 Glioneuronal tumors - a rare tumor entity with diagnostic and therapeutic challenges: report of two cases and review of literature
Authors: Zeitlberger A M , Neidert M C , Velez-Char N , Hundsberger T
Published: September 2021

BACKGROUND

The 2007 WHO classification of brain tumors first encompassed two new entities of glioneuronal tumors, including papillary glioneuronal tumors (PGNT) and rosette-forming glioneuronal tumours. The reviewed version of the 2016 WHO classification additionally included diffuse leptomeningeal glioneuronal tumours. The histopathological, genetic, and clinical understanding of glioneuronal tumors is currently evolving, however there are no guidelines for diagnostic and clinical management yet.

MATERIAL AND METHODS

We report two male patients with glioneuronal tumors and performed a review of literature.

RESULTS

The first patient was diagnosed with a PGNT (MIB-1 proliferation index = 5%) located in the right parietal lobe at the age of 33 years and received surgical resection. Two years later, the tumor recurred in the same location. A second tumor resection was performed followed by concomitant radiochemotherapy with temozolomide (60/2 Gray). A next-generation sequencing gene panel (Oncomine) confirmed the initial diagnosis of a PGNT. The patient has remained in remission for the past 10 years. The second patient developed complex partial seizures which were first misdiagnosed as anxiety disorder at the age of 26 years. An MRI scan revealed a contrast-enhancing bifrontal cystic lesions 5 years later and he received a gross total tumor resection. The diagnosis of a glioneuronal tumor was made, however molecular pathology and methylation analysis were not able to classify the tumor entity further. There was no evidence of tumor recurrence one year after surgery and he remained seizure-free with antiepileptic treatment.

CONCLUSION

Glioneuronal tumors encompass rare and heterogenous tumor entities which primarily present in young patients and often show a favorable clinical course. Although the increasing number of reports in the literature have improved our understanding of these tumors, uncertainty remains in diagnostic challenging cases and patients with progressive disease after surgery. The value of next-generation sequencing and the choice of adjuvant treatment modalities have not been systematically evaluated in this patient group.
P16.13 MenImmune: Evaluation of immune-related and prognostic biomarkers in meningioma
Authors: Truffelli M , Grassi M , Fiaschi P , Roccatagliata L , Bennicelli E , Barletta L , Cella E , Valle L , Zona G , Gaggero G
Published: September 2021

BACKGROUND

Meningiomas are the most common group of adult central nervous system primary tumor. The major known predictors for meningioma recurrence are extent of surgical resection and histological grade. Although grading system is the actual standard for risk classification, there are several exceptions in the clinical behavior. Recent studies have shown that meningiomas can express PD-L1, a known therapeutic target for checkpoint inhibitors. Tumor microenvironment and hormonal setting are known to influence the immune system response. The only standard therapeutic strategies nowadays are surgery and radiotherapy. Meningiomas microenvironment needs to be further studied looking for new therapeutic targets. New prognostic tools combining histological and radiological features (RF) are needed to better address the treatment strategy.

ELIGIBILITY CRITERIA

Patients diagnosed with meningioma who underwent surgery at the Department of Neurosurgery of the IRCCS Ospedale Policlinico San Martino of Genoa from 1998. - Availability of magnetic resonance imaging (MRI) at diagnosis. - Availability of histological samples.

OBJECTIVES

Identification and prevalence of immune-related biomarkers and their correlation with morphological and hormonal features. - Survival analyses in the study population and according to the different characteristics analyzed. - The identification of specific clinical, histological and RF of meningiomas and their inclusion in a prognostic signature.

STUDY DESIGN

This is a retrospective-prospective monocentric study designed to analyze clinical, radiological and histological features of meningioma patients. - Clinical data will be collected from the electronic patient records. - Analyses will be conducted on a cohort of patients enriched with higher grade meningioma to balance the proportion between high and low grade histologies. - Histological specimen will be blindly reviewed and reclassified according to histological type, morphological features and WHO 2016 criteria. - The MRI features will be analyzed at diagnosis.

STUDY ANALYSIS

We retrospectively enrolled 50 patients with available radiological, histological and clinical data.- All histopathological specimens will be examined with slides obtained from material fixed in 10% neutral buffered formalin, included in kerosene, sectioned at 3 µm and stained with hematoxylin-eosin. - We will look for the presence of estrogens and progesterone receptors. - Concerning immune-related biomarkers we will further assess PD-L1 positivity (cut-off: positive 1%, negative <1%), MSI status and the inflammatory infiltrate with immunohistochemistry, in particular TILs (CD45, CD3, CD4, CD8, FOXP3, CTLA4), B cell (CD20), TAM (CD68). - All histological and radiological data will be analyzed and correlated with the clinical characteristics of meningioma patients and their outcomes.
Adoptive Parenting Is More Complex Than Evolutionary Theory Would Predict
Authors: Matthews Jessica A. K. , Pinderhughes Ellen E. , Pott Martha L.
Published: September 2021

This chapter focuses on adoptive parenting. At face value, adoption does not fulfill one of the primary goals of evolution: survival and eventual reproduction of one’s genes. Why, then, given our evolutionary history, and the relative difficulty of adoption, is adoption so widespread and usually successful? The chapter is devoted to examining adoption from an evolutionary perspective. It traces the history of adoption and reviews many reasons why adoption has been, and still is, widespread. The human history of adoption reflects many of our evolutionary goals and biological drives. However, one of the unique capacities of humanity is the ability to rise above our baser biology to use logic and reason to overcome gut reactions rooted in animal biology. Modern adoption theory and practice seek to recognize patterns rooted in biology, history, and culture, while encouraging more equitable practices that respect each individual involved in adoption.
Research Synthesis
Authors: Guber Deborah Lynn
Published: September 2021

Digital trace data have the potential to offer rich insight into complex behaviors that were once out of reach, but their use has raised vital and unresolved questions about what is—or is not—public opinion. Building on the work of James Bryce, Lindsay Rogers, Herbert Blumer, Paul Lazarsfeld, and more, this essay revisits the discipline’s historical roots and draws parallels between past theory and present practice. Today, scholars treat public opinion as the summation of individual attitudes, weighted equally and expressed anonymously at static points in time through polls, yet prior to the advent of survey research, it was conceived as something intrinsically social and dynamic. In an era dominated by online discussion boards and social media platforms, the insights of this earlier “classical tradition” offer two pathways forward. First, for those who criticize computational social science as poorly theorized, it provides a strong justification for the work that data scientists do in text mining and sentiment analysis. And second, it offers clues for how emerging technologies might be leveraged effectively for the study of public opinion in the future.
Psychosocial factors correlate with adherence to medications among cardiovascular outpatient clinics in Jordan
Authors: Z Malak Malakeh , J Al-thbetat Ahlam , M AL-Amer Rasmieh
Published: September 2021

Background

Adherence to medications is a significant element of self-care behaviors for patients with cardiovascular diseases (CVDs). Non-adherence to cardiovascular medications is the major risk for poor outcomes following any cardiac event. However, there is a lack of studies that addressed medication adherence among patients with CVDs attending outpatient clinics in Arabic countries, including Jordan. Thus, this study purposed to assess the psychosocial factors (e.g. depression, anxiety, stress, social support and self-esteem) and their correlation with adherence to medications among patients with CVDs attending outpatient clinics in Jordan.

Methods

A total of 395 Jordanian patients attending CVDs outpatient clinics at government, military and private healthcare facilities were recruited.

Results

Our study findings showed that 31.4% of the patients reported complete adherence to their medications. The proportion of psychological reactions reported by the participants was 72.1% for depressive symptoms, 62.6% for anxiety and 50.1% for stress; 79.7% had moderate and normal social support, and 44% had low self-esteem. Depression, anxiety and stress had a significant negative correlation with adherence to medications; however, self-esteem had a significant positive relationship with adherence to medications. In addition, depression, anxiety and stress were the main predictors of adherence to medications.

Conclusion

Our findings might aid in paving the road for designing and developing strategies and interventions to increase adherence to medications and minimize these psychosocial problems among CVD patients in outpatient clinics.
Vascular imaging of patients with refractory Takayasu arteritis treated with tocilizumab: post hoc analysis of a randomized controlled trial
Authors: Nakaoka Yoshikazu , Yanagawa Masahiro , Hata Akinori , Yamashita Katsuhisa , Okada Norihiro , Yamakido Shinji , Hayashi Hiromitsu , Jayne David
Published: September 2021

Objectives

Tocilizumab, an anti-IL-6 receptor antibody, was investigated in patients with refractory Takayasu arteritis (TAK) in a phase 3 randomized controlled trial. In this post hoc analysis, we investigated whether tocilizumab treatment inhibited the progression of vascular lesions caused by TAK in these patients.

Methods

Included patients received at least one dose of tocilizumab and underwent CT at baseline and at week 48 after tocilizumab initiation. Three radiologists not involved in the original trial independently evaluated the CT images. Twenty-two arteries from each patient were assessed for change from baseline in wall thickness (primary endpoint), dilatation/aneurysm, stenosis/occlusion or wall enhancement for at least 96 weeks after tocilizumab initiation. Patient-level assessments were also conducted.

Results

In 28 patients, 86.7% of 22 arteries had improved or stable wall thickness at week 96. Proportions of patients with improved or stable, partially progressed or newly progressed lesions were 57.1%, 10.7% and 28.6%, respectively, for wall thickness; proportions with improved or stable lesions were 92.9% for dilatation/aneurysm, and 85.7% for stenosis/occlusion. Patients with newly progressed lesions, reflecting more refractory disease, were prescribed glucocorticoids at dosages that could not be reduced below 0.1 mg/kg/day at week 96.

Conclusions

Approximately 60% of patients with TAK did not experience progression in wall thickness within 96 weeks after initiation of tocilizumab treatment. Few patients experienced progressed dilatation/aneurysm, or stenosis/occlusion. Wall thickness progression likely resulted from refractory TAK. Patients who experience this should be monitored regularly by imaging, and additional glucocorticoid or immunosuppressive treatment should be considered to avoid vascular progression.

Trial registration

Japan Pharmaceutical Information Centre number, JapicCTI-142616.
Relationship of anifrolumab pharmacokinetics with efficacy and safety in patients with systemic lupus erythematosus
Authors: Chia Yen Lin , Zhang Jianchun , Tummala Raj , Rouse Tomas , Furie Richard A , Morand Eric F
Published: September 2021

Objectives

To characterize the relationship of anifrolumab pharmacokinetics with efficacy and safety in patients with moderate to severe SLE despite standard therapy, using pooled data from two phase 3 trials.

Methods

TULIP-1 and TULIP-2 were randomized, placebo-controlled, 52-week trials of intravenous anifrolumab (every 4 weeks for 48 weeks). For the exposure–response analysis, BILAG-based Composite Lupus Assessment (BICLA) or SLE Responder Index [SRI(4)] response rates at week 52 in each quartile/tertile of average anifrolumab serum concentration (Cave) were compared for anifrolumab and placebo in all-comers, patients who completed treatment, and IFN gene signature (IFNGS)-high patients who completed treatment, using average marginal effect logistic regression. Relationships between exposure and key safety events were assessed graphically.

Results

Of patients in TULIP-1/TULIP-2 who received anifrolumab (150 mg, n = 91; 300 mg, n = 356) or placebo (n = 366), 574 completed treatment, of whom 470 were IFNGS high. In the exposure–efficacy analyses, BICLA and SRI(4) treatment differences favouring anifrolumab 300 mg vs placebo were observed across Cave subgroups and all analysis populations. Logistic regression identified Cave as a significant covariate for predicted BICLA response, as higher anifrolumab Cave predicted greater efficacy. There was no evidence of exposure-driven incidence of key safety events through week 52 in patients receiving anifrolumab 150 or 300 mg.

Conclusion

While higher Cave predicted greater efficacy, consistent positive benefit favouring anifrolumab 300 mg vs placebo was observed in BICLA and SRI(4) responses across Cave subgroups in the TULIP trials. There was no evidence of exposure-driven safety events.

ClinicalTrial.gov numbers

NCT02446912, NCT02446899
Sudanese Refugees and the “Syrian Refugee Response” in Lebanon: Racialised Hierarchies, Processes of Invisibilisation, and Resistance
Authors: Janmyr Maja
Published: September 2021

By focusing on Sudanese refugees and asylum-seekers in Lebanon, who in 2018 constituted 4 per cent of all persons of concern to United Nations High Commissioner for Refugees (UNHCR) in that country, this article explores how the UNHCR protects and assists refugees not encompassed by the mainstream humanitarian response. The article finds that in terms of refugee recognition, resettlement, and overall protection, Sudanese refugees receive differential treatment when compared with the more dominant refugee groups. More precisely, it argues that the humanitarian practices contribute to structural processes of invisibilisation of the particularities of the protection concerns and circumstances of Sudanese refugees. It spotlights how, while racism and racial discrimination remain major protection concerns for the Sudanese community in Lebanon, humanitarian vulnerability assessments are altogether blind to these categories of harm. In examining how Sudanese refugees respond to and resist such processes of invisibilisation, the article also examines two key collective action approaches through which Sudanese refugees seek to access better protection and assistance: the establishment of representative refugee committees, on the one hand, and refugee protest, on the other. It finds that refugee protest was an important means of countering humanitarian processes of invisibilisation.
Intra-host evolution during SARS-CoV-2 prolonged infection
Authors: Voloch Carolina M , da Silva Francisco Jr Ronaldo , de Almeida Luiz G P , Brustolini Otavio J , Cardoso Cynthia C , Gerber Alexandra L , Guimarães Ana Paula de C , Leitão Isabela de Carvalho , Mariani Diana , Ota Victor Akira , Lima Cristiano X , Teixeira Mauro M , Dias Ana Carolina F , Galliez Rafael Mello , Faffe Débora Souza , Pôrto Luís Cristóvão , Aguiar Renato S , Castiñeira Terezinha M P P , Ferreira Orlando C , Tanuri Amilcar , R de Vasconcelos Ana Tereza
Published: September 2021

Long-term infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a challenge to virus dispersion and the control of coronavirus disease 2019 (COVID-19) pandemic. The reason why some people have prolonged infection and how the virus persists for so long are still not fully understood. Recent studies suggested that the accumulation of intra-host single nucleotide variants (iSNVs) over the course of the infection might play an important role in persistence as well as emergence of mutations of concern. For this reason, we aimed to investigate the intra-host evolution of SARS-CoV-2 during prolonged infection. Thirty-three patients who remained reverse transcription polymerase chain reaction (RT-PCR) positive in the nasopharynx for on average 18 days from the symptoms onset were included in this study. Whole-genome sequences were obtained for each patient at two different time points. Phylogenetic, populational, and computational analyses of viral sequences were consistent with prolonged infection without evidence of coinfection in our cohort. We observed an elevated within-host genomic diversity at the second time point samples positively correlated with cycle threshold (Ct) values (lower viral load). Direct transmission was also confirmed in a small cluster of healthcare professionals that shared the same workplace by the presence of common iSNVs. A differential accumulation of missense variants between the time points was detected targeting crucial structural and non-structural proteins such as Spike and helicase. Interestingly, longitudinal acquisition of iSNVs in Spike protein coincided in many cases with SARS-CoV-2 reactive and predicted T cell epitopes. We observed a distinguishing pattern of mutations over the course of the infection mainly driven by increasing A→U and decreasing G→A signatures. G→A mutations may be associated with RNA-editing enzyme activities; therefore, the mutational profiles observed in our analysis were suggestive of innate immune mechanisms of the host cell defense. Therefore, we unveiled a dynamic and complex landscape of host and pathogen interaction during prolonged infection of SARS-CoV-2, suggesting that the host’s innate immunity shapes the increase of intra-host diversity. Our findings may also shed light on possible mechanisms underlying the emergence and spread of new variants resistant to the host immune response as recently observed in COVID-19 pandemic.
The Role of Subcutaneous Depot Medroxyprogesterone Acetate in Equitable Contraceptive Care
Authors: Burlando Audrey M. , Flynn Anne N. , Gutman Sarah , McAllister Arden , Roe Andrea H. , Schreiber Courtney A. , Sonalkar Sarita
Published: September 2021

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, health care professionals have made swift accommodations to provide consistent and safe care, including emphasizing remote access to allow physical distancing. Depot medroxyprogesterone acetate intramuscular injection (DMPA-IM) prescription is typically administered by a health care professional, whereas DMPA-subcutaneous has the potential to be safely self-injected by patients, avoiding contact with a health care professional. However, DMPA-subcutaneous is rarely prescribed despite its U.S. Food and Drug Administration approval in 2004 and widespread coverage by both state Medicaid providers and many private insurers. Depot medroxyprogesterone acetate users are disproportionately non-White, and thus the restriction in DMPA-subcutaneous prescribing may both stem from and contribute to systemic racial health disparities. We review evidence on acceptability, safety, and continuation rates of DMPA-subcutaneous, consider sources of implicit bias that may impede prescription of this contraceptive method, and provide recommendations for implementing DMPA-subcutaneous prescribing.
Intraoperative Use of Robotics With Navigation for Pedicle Screw Placement in Treatment of Pediatric High-grade Spondylolisthesis: A Preliminary Report
Authors: Linden Gabriel S. , Birch Craig M. , Hresko M. Timothy , Cook Danielle , Hedequist Daniel J.
Published: September 2021

Background:

Accurate pedicle screw placement is critical to surgically correct pediatric high-grade spondylolisthesis (HGS). The recent advent of robotics coupled with computer-assisted navigation (RAN) may represent a novel option to improve surgical outcomes of HGS, secondary to enhanced pedicle screw placement safety. This series presents the HGS-RAN technique adopted by our site, describing its surgical outcomes and feasibility.

Methods:

Consecutive patients with a diagnosis of HGS (Meyerding grade III to V), operated on using RAN from 2019 to 2020 at a single-center were reviewed. Demographics, screw accuracy, sagittal L5-S1 parameters, complications, and perioperative outcomes were described. All patients were treated with instrumentation, decompression, posterior lumbar interbody fusion, and reduction. Robotic time included anatomic registration to end of screw placement. Screw accuracy—defined as a screw placed safely within the planned intrapedicular trajectory—was characterized by the Gertzbein-Robbins system for patients with additional 3-dimensional imaging.

Results:

Ten HGS patients, with an average age of 13.7 years old, were included in the series. All 62 screws were placed without neurological deficit or complication. Seven patients had additional 3-dimensional imaging to assess screw accuracy (42 of 62 screws). One hundred percent of screws were placed safely with no pedicle breaches (Gertzbein-Robbins—grade A). Thirty screws (48%) were placed through separate incisions that were percutaneous/transmuscular and 32 screws (52%) were inserted through the main incision. There were statistically significant improvements in L5 slippage (P=0.002) and lumbosacral angle (P=0.002), reflecting successful HGS correction. The total median operative time was 324 minutes with the robotic usage time consuming a median of 72 minutes. Median estimated blood loss was 150 mL, and length-of-stay was a median 3 days.

Conclusions:

This case-series demonstrates that RAN represents a viable option for HGS repair, indicated by high screw placement accuracy, safety, and L5-S1 slippage correction. Surgeons looking to adopt an emerging technique to enhance safety and correction of pediatric HGS should consider the RAN platform.

Level of Evidence:

Level IV—therapeutic study.
Functional Outcomes of Arthroscopic Os Trigonum Excision in Adolescents
Authors: Chun Liane , Bastrom Tracey P. , Carroll Alyssa N. , Edmonds Eric W.
Published: September 2021

Background:

Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population. This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients.

Methods:

A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery.

Results:

Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 y) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 y). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0±15.5, 76.3±29.1, and 88.6±15.1, respectively. A chronic duration of symptoms before surgery was associated with a lower FAAM Sports current level of function score (P=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (P=0.01), Sports subscale (P<0.001), and SANE scores (P=0.002).

Conclusions:

Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long-term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport.

Level of Evidence:

Level IV—case series.
Parents' Concerns Are Associated with Early Intervention Evaluation and Eligibility Outcomes
Authors: Solgi Mohadeseh , Feryn Alicia , Chavez Alison E. , Wilson Laura , King Margaret , Scholz Julie , Fombonne Eric , Zuckerman Katharine E.
Published: September 2021

Objective:

To test the association of parents' concerns with early intervention (EI) developmental services outcomes including evaluation, eligibility, and enrollment in services.

Method:

We collected survey data on parents' concerns and EI service use data from a sample of 428 children referred to EI from 2016 to 2018 in 6 Oregon primary care clinics serving lower-income families as part of a developmental and autism spectrum disorder screening intervention. We assessed EI service use trajectories and associations of the presence of parent concern, age of child at the time of parents' concerns, number of concerns, and type of provider concern, with EI evaluation, EI eligibility, and enrollment in EI services, using bivariate testing and multivariable logistic regression.

Results:

Only 22.9% of children referred to EI were enrolled in services 6 months later. Children whose parents had developmental and/or behavioral concerns were more likely to receive an EI evaluation and were also more likely to be eligible for services, compared with children whose parents had no concerns. There was no association between age, number of concerns, and type of concern with EI evaluation, eligibility, or services enrollment.

Conclusion:

Although only a minority of children referred to EI enrolled in services, the presence of parent concern is strongly associated with EI services evaluation and eligibility outcomes. Study results suggest that providers should assess the presence of parent concern when deciding on EI referrals and provide more support to parents who are not concerned at all.
Clinical Profiles of Glaucomatous Patients With High-tension and Low-tension Optic Disc Hemorrhages: A Comparative Study
Authors: Almeida Izabela N.F. , Dias Diego T. , Alhadeff Paula A. , Lopes Flavio S.S. , Paranhos Augusto , Ritch Robert , Gracitelli Carolina P.B. , Prata Tiago S.
Published: September 2021

Précis:

Patients with low-tension optic disc hemorrhages (DHs) are more frequently women, have a diagnosis of normal-tension glaucoma (NTG) diagnosis and greater visual field (VF) loss. Symptoms of vascular dysregulation and Asian race also seem to be more prevalent in this clinical subtype.

Purpose:

Optic DH is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high-tension disc hemorrhage (HTDH) and low-tension disc hemorrhage (LTDH).

Patients and Methods:

In this cross-sectional study, treated glaucomatous patients with DHs from 2 glaucoma services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by 2 glaucoma specialists. After inclusion, patients were classified on HTDH (IOP≥16 mm Hg) and LTDH (IOP<16 mm Hg; median split). Clinical and ocular data from the time of DH detection were compared between groups.

Results:

One hundred thirty-three DH patients were included (LTDH=66 eyes; HTDH=67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs. 42%; P=0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs. 9%; P=0.058) and symptoms suggestive of vascular dysregulation (34% vs. 14%; P=0.057) in LTDH patients. Eyes with LTDH also had worse VF mean deviation index (P=0.037), higher prevalence of NTG diagnosis (46% vs. 17%; P<0.001), and tended to have thinner central corneas (P=0.066).

Conclusions:

Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these 2 clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP.
Influenza-associated Neurologic Complications in Hospitalized Pediatric Patients
Authors: Choi Gwang-Jun , Park Ji Young , Choi Joon-Sik , Choi Sae Rom , Kim Dongsub , Lee Jun Hwa , Woo Young-Jong , Lee Jeehun , Kim Yae-Jean
Published: September 2021

Background:

The rates of influenza-associated neurologic complications are variable among studies, and a difference has been observed between the Western and Asian countries. The study aims to evaluate the frequency and characteristics of influenza-associated neurologic complications.

Methods:

We performed a retrospective review of hospitalized cases of influenza infection from October 2010 to April 2017 from 3 referral hospitals.

Results:

A total of 1988 influenza cases were identified. Influenza-associated neurologic complications were 161 cases (8.1%); influenza virus A was detected in 113 (70.2%) cases, B in 47 (29.2%) cases and both A and B in 1 case (0.6%). Twenty-four patients (15%) had underlying neurologic diseases. The most common diagnosis was a simple febrile convulsion (44%), followed by complex febrile convulsion (29%), fever-provoked seizure under pre-existing neurologic disease or afebrile seizure (14%), encephalopathy/encephalitis (8%) and meningitis (5%). Most of the patients fully recovered (96%). Three patients (1.9%) died of myocarditis (n = 1), encephalopathy (n = 1), and simultaneous encephalitis and myocarditis (n = 1). Pre-existing neurologic disease, age groups of 6 months to 6 years and 6–12 years were a risk factor of influenza-associated neurologic complications with an adjusted odds ratio of 5.41 (95% confidence interval [CI] 3.23–9.06, P < 0.001), 12.99 (95% CI 1.77–95.19, P = 0.01) and 8.54 (95% CI 1.14–64.79, P = 0.04), respectively. There was no association between neuropsychiatric adverse events and oseltamivir prescription (P = 0.17).

Conclusions:

Influenza-associated neurologic complications are not uncommon, and most patients fully recovered. The frequency of influenza-associated neurologic complications in Korean children was not significantly different from that of children in Western countries.
Cytomegalovirus Colitis in Immunocompetent and Immunocompromised Children
Authors: Bayrak Nevzat Aykut , Polat Esra , Erdogan Furkan
Published: September 2021

Background:

Data about cytomegalovirus (CMV) colitis in children are scarce. We aimed to describe the characteristics of childhood CMV colitis in terms of risk factors, clinical symptoms, diagnosis, therapeutic approaches, and outcomes.

Methods:

Inflammatory bowel disease (IBD) and non-IBD patients with CMV colitis diagnosed by histology and tissue CMV PCR at 2 tertiary centers between January 2017 and November 2019 were studied. Clinical and laboratory data were retrieved from medical records. Underlying conditions, immune status, response to therapy and outcomes were described and followed up to 6 months after diagnosis.

Results:

A total of 16 children (8 non-IBD, 7 ulcerative colitis and 1 Crohn’s disease) with CMV colitis were included. All patients had persistent diarrhea (bloody in 13 cases). There was a significant age difference between IBD and non-IBD children (P < 0.05). The final diagnosis in 1 patient was immunodeficiency with a mutation in JAK1 gene. Three children were categorized as apparently immunocompromised and 4 children as apparently immunocompetent. Ulcer was not visible in 2 children from the non-IBD group. The mean fecal calprotectin level of IBD children was significantly higher than that of non-IBD children (376.12 ± 231.21 µg/g vs. 160.96 ± 69.94 µg/g, P < 0.05). After follow-up, 1 patient died because of another reason. Ganciclovir was used in 14 of 16 children for 3 weeks and the treatment was continued with valganciclovir in selected 6 children.

Conclusions:

CMV colitis is a rare but overlooked cause of prolonged diarrhea in immunocompetent and immunocompromised children. CMV colitis might present without any ulcer formation at colonoscopy in infants.
Break-even Analysis of Respirable Crystalline Silica (RCS) Exposure Interventions in the Construction Sector
Authors: Tompa Emile , Mofidi Amirabbas , Song Chaojie , Arrandale Victoria , Jardine Katherine J. , Davies Hugh , Tenkate Thomas , Demers Paul A.
Published: September 2021

Objective:

We investigated long-term economic impacts of respirable crystalline silica (RCS) removal interventions in the construction at the societal level.

Methods:

We estimated costs and benefits of two RCS exposure interventions, use of “respirators” and “wet method,” over a 30-year time period. We identified economic impacts of the interventions under four different scenarios.

Results:

Under current practices, we estimated that approximately 125 lung cancer cases attributable to RCS exposure would arise in 2060. Under the full exposure removal scenario, we estimated there would be 53 new cases. Over the 30-year time period, the estimated cumulative averted cases are 787 and 482 for respirators and wet method, respectively, which amount to net benefits of $422.13 and $394.92 million.

Conclusions:

Findings provide important information for policymakers seeking to reduce the economic burden of occupational lung cancer in society.
Correlation between preoperative inflammatory markers, Ki-67 and the pathological grade of glioma
Authors: Xu Guangda , Li Chengxue , Wang Yanguo , Ma Jinan , Zhang Junchen
Published: September 2021

To investigate the correlation between preoperative inflammatory markers, Ki-67 expression and the pathological grade of glioma, and to provide a reference for clinical prediction of glioma prognosis.

A total of 45 glioma patients who underwent surgery with complete clinical and pathological data were in our hospital from January 2012 to December 2018 were enrolled. Glioma was divided into WHO grade I to IV. Forty-five healthy health examiners with matched clinical characteristics were included to the control group. Blood routine tests were recorded at admission in both the glioma and control group. The ratio of neutrophil to lymphocyte cytometry (NLR), derived neutrophil to lymphocyte ratio (dNLR) (white blood cell count – neutrophil count to neutrophil count), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI, serum albumin content + 5 × lymphocyte count) were calculated. The expression of Ki-67 in glioma was detected by immunohistochemistry. The relationship between the above markers, Ki-67 expression and pathological grade of glioma was evaluated with receiver operating characteristics curve analysis and Spearman correlation test. The correlation between the markers and Ki-67 were also determined.

NLR, dNLR, PLR were increased in the glioma group (P < .001, <.001, .002), whereas red blood cell distribution width (RDW) was decreased (P = .009). All the glioma samples expressed Ki-67 with varying degree. Receiver operating characteristics curve analysis reveals NLR, dNLR, PLR, and RDW have significant discriminating ability in differentiating the glioma and control sample. NLR, PLR, PNI, and Ki-67 were significantly correlated with glioma pathology grade (P = .023, .006, .019, <.05), while dNLR and RDW were not associated with glioma grade. Finally, NLR and PLR were related to Ki-67 expression in glioma patients (P = .002, .022), while dNLR and RDW were not related to Ki-67 expression.

Preoperative inflammatory markers NLR, PLR, PNI, and postoperative Ki-67 expression are associated with pathological grade of glioma. Detection of these markers may aid in better prediction of glioma prognosis.
The correlation between myocardial resilience after high-intensity exercise and markers of myocardial injury in swimmers
Authors: Gao Can , Liang Chen , Zhang Jianhong , Ma Yun , Mu Xiuxia , Xie Minhao
Published: September 2021

To investigate how high-intensity exercise influences an athlete's myocardial resilience and the correlation between myocardial resilience and markers of myocardial ischemic injury.

Fifteen swimmers participated in high-intensity exercises. Cardiac ultrasound was performed before and after exercise on each subject. Left ventricular general strain, systolic general strain rate, and the differences (▴general strain and ▴ general strain rate, respectively), before and after exercise were analyzed. Blood was collected at the morning of the exercise day and 6 hours after exercise to measure cardiac enzyme indicators.

The correlation between myocardial resilience and markers of myocardial injury were evaluated. Most cardiac enzymes concentrations increased after exercise (P < .05). Cardiac troponin I, creatine kinase MB, and cardiac troponin T were all correlated with the degree of ▴ peak strain (differential value of posterior wall basal segment before and after exercise) and ▴ peak strain rate (differential value before and after exercise) (P < .05).

After high-intensity exercise, the concentrations of creatine kinase MB and cardiac troponin T in the blood are positively correlated with two-dimensional ultrasound deformation indices, proving the fact that the seindices can be used as a diagnostic basis for myocardial injury, and are more sensitive than general strain. The two-dimensional strain echocardiogram is non-invasive and easily accepted by the patient. It can make up for the shortage of myocardial enzymes in the injury areas, including weak timeliness and the inability to locate injury.
Risk factors associated with the mortality rate of oral squamous cell carcinoma patients
Authors: Ahmad Paras , Nawaz Rubbia , Qurban Maria , Shaikh Gul Muhammad , Mohamed Roshan Noor , Nagarajappa Anil Kumar , Asif Jawaad Ahmed , Alam Mohammad Khursheed
Published: September 2021

In Malaysia, oral cancer is very common and the reported 5-year survival of such patients is nearly 50% after treatment with surgery and radiotherapy, much lower than most of the developed countries. This study aimed to investigate the socio-demographic and clinicopathological parameters that influence the mortality rate of the patients suffering from oral squamous cell carcinoma (OSCC) in the Kelantanse population.

In this retrospective study, data regarding socio-demographic, clinicopathological factors, and treatment outcome associated with OSCC were gathered from the archives of the medical records office of Hospital Universiti Sains Malaysia. For statistical analysis, simple and multiple logistic regression were performed. The significance level was set to P < .25.

A total of 211 OSCC cases were registered in Hospital Universiti Sains Malaysia from January 1, 2000 to December 31, 2018. Majority of them were male (57.82%), non-smoker (54.97%), non-alcohol consumer (91.94%), and non-betel quid chewer (93.83%) Malay (60.66%) patients. The tongue was the most commonly involved part of the oral cavity (41.52%). Histologically, the majority of the cases had moderately-differentiated OSCC (52.82%). Most of the patients were diagnosed at stage IV at the time of diagnosis (61.61%). When this study was performed, the survival status of the majority of the patients was alive (68.24%).

Within the analyzed socio-demographic and clinicopathological parameters, gender, alcohol consumption, T-classification, histological grading, and treatment status have been demonstrated as an independent risk factors for mortality rate in multivariate analysis. Hence, these parameters need to be taken into account for the individualized therapy management of OSCC patients.
Malakoplakia and xanthogranulomatous pyelonephritis treated with nephrectomy
Authors: Pan Yueh , Hong Ying Chui , Shih Hung-Jen , Chang Chin-Pao , Huang Sheng-Hsien , Wu Sheng-Chuan , Lee Liang-Ming , Wen Yu-Ching , Hsu Chih-Chen , Hsiao Chi-Hao
Published: September 2021

Rationale:

Malakoplakia and xanthogranulomatous pyelonephritis are chronic inflammatory conditions of the kidney characterized by the infiltration of inflammatory cells.

Patient concerns:

An 82-year-old female patient had a history of hypertension, type 2 diabetes mellitus, dyslipidemia, and end-stage renal disease under hemodialysis. She was admitted repeatedly 4 times within 4 months due to urosepsis.

Diagnosis:

The enlarged right kidney with a low-density lesion at the right middle calyx, and a well-enhanced ureter were noted on the computed tomography scan. Therefore, xanthogranulomatous inflammation was suspected. Semi-rigid ureteroscopy with biopsy was performed, and xanthogranulomatous inflammation of the ureter was confirmed on the pathology report.

Interventions:

After right open radical nephrectomy was performed, the final pathology report revealed malakoplakia with xanthogranulomatous pyelonephritis.

Outcomes:

After the surgery, she has no longer suffered from urosepsis for 8 months, and there were no adverse event or recurrence noted.

Lessons:

With this case report, we aim to emphasize that these 2 diseases are not mutually exclusive, but they may exist simultaneously in the same patient.
Plexiform fibromyxoma
Authors: Lin Min , Song Lu , Qin Shuming , Li Daosheng , Hou Gang , Li Xiaomei
Published: September 2021

Plexiform fibromyxoma (PF) is a rare mesenchymal neoplasm which can be misdiagnosed as the gastrointestinal stromal tumor. This tumor almost formed a lobulated intramural/submucosal mass in the gastric antrum and prepyloric area. It was considered as a benign tumor that exhibited no recurrence, metastasis, or tumor-related mortality. In this study, we reported 2 cases of gastric PF. The first case was a PF patient coexisting with gastric adenocarcinoma. The second case occurred in the gastric upper body close to gastric fundus. They underwent distal gastrectomy and laparoscopic partial gastric resection, respectively. Both of them exhibited a plexiform growth pattern in the submucosa, muscularis propria, and subserosal adipose tissues. The nodules were composed of abundant myxoid or fibromyxoid matrix riching in small thin-walled blood vessels and bland-looking spindle cells. The first case partially showed staggered growth pattern of PF and adenocarcinoma. Immunohistochemically, the spindle cells were diffusely immunoreactive for SMA and vimentin, and focally immunoreactive for CD10. It was important to distinguish the PF from other spindle cell tumors involving the stomach.
Researching on the compliance of epilepsy patients of the Phenobarbital Epilepsy Management Project in a rural area of China
Authors: Feng Xiang-Lin , Luo Bang-An , Qin Lu-Lu
Published: September 2021

The aim of this study was to explore the compliance of epilepsy patients in the Phenobarbital Epilepsy Management Project in a rural area of China and its influencing factors, so as to provide the basis for further strategies.

A retrospective study researching on the compliance of epilepsy patients in the Phenobarbital Epilepsy Management Project of Rural China was conducted. The Nan County, Hunan Province as a typical rural China was selected as the study site. We collected the compliance and other relative factors from 2017 to 2019 though the Phenobarbital Epilepsy Management Project data system.

The good compliance patients in the Phenobarbital Epilepsy Management Project in a rural area of China were 98.99% (393/397); only 4 cases had poor compliance. The factors affecting the compliance of epilepsy patients were “adverse reactions of digestive tract symptoms,” “how the patient felt physically, mentally, or working and learning ability during this period," and “the ratio of the attack to the previous one.”

The rate of good compliance among the epilepsy patients in the Phenobarbital Epilepsy Management Project in a rural area of China was high. More attention to education, patients’ psychology, and the curative effect of family members may improve the compliance of patients with epilepsy further.
Mapping the Location of Health Centers in Relation to “Maternity Care Deserts”
Authors: Markus Anne R. , Pillai Drishti
Published: September 2021

Background and Objectives:

The aim was to explore the association between community health centers’ (CHC) distance to a “maternity care desert” (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors.

Measures:

Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff.

Research Design:

Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a “desert” were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234).

Results:

Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to “deserts” had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care.

Conclusions:

CHCs located closer to “deserts” and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.
Functional assessment of long bone fracture healing in Samburu County Referral Hospital (Kenya): the squat and smile challenge
Authors: Sciuto Daniele , Marzorati Mauro , Shearer David W. , Lanfranconi Francesca
Published: September 2021

Background:

The burden of musculoskeletal trauma is increasing in low- and middle-income countries. Due to the low clinical follow-up rates in these regions, the Squat-and-Smile test (S&S) has previously been proposed as a proxy to assess bone healing (BH) capacity after surgery involving bone fractures. This study deals with various aspects of using S&S and bone radiography examination to obtain information about an individual's ability to recover after a trauma. In summary, we performed the S&S test to assess the possibility of recovering biomechanical function in lower limbs in a remote area of Kenya (Samburu County).

Methods:

Eighty-nine patients (17.9% F; 31.7 ± 18.9 yrs) who underwent intramedullary nail treatment for femur or tibia fractures were enrolled in this study. Both S&S [evaluated by a goal attainment scale (GAS)] and x-ray (evaluated by REBORNE, Bone Healing Score) were performed at 6 and 24 weeks, postoperatively. An acceptable margin for satisfactory S&S GAS scores was determined by assessing its validity, reliability, and sensitivity.

Results:

S&S GAS scores increased over time: 80.2% of patients performed a satisfactory S&S at the 24-weeks follow-up with a complete BH. A high correlation between S&S GAS and REBORNE at the 6- and 24- weeks’ timepoint was found. Facial expression correlated partially with BH. The S&S proved to be accurate at correctly depicting the BH process (75% area fell under the Receiver Operator Curve).

Conclusion:

The S&S provides a possible substitution for bone x-ray during BH assessment. The potential to remotely follow up the BH is certainly appealing in low- and middle-income countries, but also in high-income countries; as was recently observed with the Covid-19 pandemic when access to a hospital is not conceivable.