bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of 18F-FLT positron emission tomography/computed tomography imaging in pediatrics with myeloproliferative neoplasms
Authors: Yassin Mohamed A. , Ismail Omar M. , Soliman Dina S. , Nashwan Abdulqadir J.
Published: April 2021

Although Myeloproliferative Neoplasms (MPNs) are diseases of the elderly, MPNs are diagnosed in younger age groups in a considerable number of cases. Since most of the available data, as well as current WHO classification criteria, emphasize on the “average” patients with MPNs who range in age between 55 and 65 years. Less consistent data are available in the groups of patients presenting below this median age, such as children and younger adults which we’re planning to reveal.

The main purpose of this project to study the uptake pattern of 18FLT-Positron Emission Tomography (PET) and it is value in assessing the malignant hematopoiesis in MPNs within the pediatric age group in terms of diagnosis, staging and monitoring response to therapy. As well as evaluating 18FLT-PET as a novel non-invasive technique in cases with MPNs and its role in comparison to the standard bone marrow biopsy with regard to disease diagnosis, assessment of disease activity, detection of transformation, monitoring of treatment response and grading of fibrosis. Furthermore, we aim to study the association of 18FLT-PET uptake patterns with different genetic makeup (Janus kinase 2, Calreticulin positive, myeloproliferative leukemia protein, or Triple-negative disease) or allele burden in cases of Pre- prefibrotic/early primary myelofibrosis with the ability of FLT-PET to differentiate between Pre- prefibrotic/early primary myelofibrosis and essential thrombocythemia.

This trial is registered in ClinicalTrials.gov with number NCT03121599. Protocol version: June 2017
Dasatinib versus nilotinib as upfront therapy for treatment naïve chronic myeloid leukemia chronic phase
Authors: Yassin Mohamed A. , Hamad Anas A. , Hussein Radwa M. , Basha Ahmed M. , Adel Ahmad M. , Chandra Prem , Nashwan Abdulqadir J.
Published: April 2021

This is a randomized, phase 3 clinical trial comparing ’head to head’ nilotinib versus dasatinib as upfront therapy for patient with chronic myeloid leukemia. The efficacy of both drugs will be tested by measuring BCR/ABL using European LeukemiaNet recommendations. The study will be conducted in the National Center for Cancer Care & Research (NCCCR).

Adult patients will be eligible within 6 months after the diagnosis of Philadelphia chromosome positive Chronic Myeloid Leukemia in the chronic phase. Diagnosis will be determined by conventional cytogenetic analysis of bone marrow containing at least 1 Philadelphia chromosome–positive metaphase cell. The definition of chronic-phase Chronic Myeloid Leukemia as per WHO 2016. Patients will be recruited from hematology outpatient department or in-patient wards after confirmation of the diagnosis; vulnerable subjects will be excluded from the study.

The primary efficacy end point will be the rate of major molecular response at 12 months, defined as a BCR-ABL transcript level of 0.1% or less in peripheral blood on RQ-PCR assay, as expressed on the International Scale. This corresponds to a reduction of 3 log10 copies or more in BCR-ABL transcripts, as compared with the standardized baseline established in IRIS.

The key secondary end point will be a durable major molecular response by 24 months. Furthermore, for this study, the rate of complete cytogenetic response by 12 months will be the main secondary end point.

This trial is registered in ClinicalTrials.gov with number NCT03079505. Protocol version: August 2017
Complete recovery of delay of p13 latency in the cervical vestibular evoked myogenic potentials of a patient with earpick-induced inner ear injury
Authors: Takakura Hiromasa , Shojaku Hideo , Tsubota Masahito , Ito Shinsuke , Abe Hideharu
Published: April 2021

Introduction:

Cervical vestibular evoked myogenic potentials (cVEMP) testing is a vestibular function test for evaluating the saccular and inferior vestibular nerve function. The diagnostic value of p13 latency on the cVEMP in inner ear disorders is still unknown.

Patients concerns:

When a 21-year-old man was removing earwax from his right ear with an earpick, his girlfriend accidentally bumped against him. Immediately thereafter, he noticed right otalgia, right hearing loss and vertiginous attack with vomiting.

Diagnosis:

The patient showed a perforation in his right eardrum and spontaneous nystagmus directed to the left, indicating right perilymphatic fistula caused by the earpick injury.

Interventions:

cVEMP, caloric test and audiometry were repeated from 2 to 28 months after the injury.

Outcomes:

One month after the injury, the perforation of the tympanic membrane had closed, and the fistula test was negative. Two months after the injury, he had no spontaneous nystagmus. Four months after the injury, delay of p13 latency in the affected ear was observed on the cVEMP, but at 10 months after the injury, the p13 delay had disappeared and was normal. Although the patient's hearing level was normal at 2 months after the injury, severe semicircular canal dysfunction existed in the affected ear, and remained unchanged up to 28 months after the injury.

Conclusion:

We report the first case of a complete recovery of the delay of p13 latency in the cVEMP caused by an inner ear injury. Delay of p13 latency on the cVEMP has been used to diagnose retrolabyrinthine disorders. Not only asymmetric p13-n23 amplitude but also delay of p13 latency could be sensitive tools for diagnosing unilateral saccular dysfunction.
The effect of convalescent plasma therapy in treating severe coronvirus disease 2019
Authors: Wang Guangyao , Hong Xiaohua , Zhao Mei , Li Jiao , Li Guosheng , Yu Dan , Xu Guanglan
Published: April 2021

Background:

Since the outbreak globally of coronvirus disease 2019 (COVID-19), although active treatment has been taken, a large number of patients in severe condition have increased and clinical pressure is high. Convalescent plasma (CP) therapy is an important method of preventing and treating infectious diseases. antibody-rich blood is collected from recovered donors and then infused into other infected patients. So CP is a form of passive immunization. CP has been tried clinically and shown some effectiveness. Considering the absence of specific medicine for COVID-19, CP can be used as a potential therapy for COVID-19 patients. However, the curative effectiveness and safety of the CP for COVID-19 are still lacking evidence. Therefore, this systematic review and meta-analysis protocol is planned to evaluate the effectiveness and safety of the CP.

Methods:

This systematic search of articles will be indexed in nine databases: PubMed, Medline, Embase, Cochrane Library, World Health Organization International Clinical Trials Registry Platform, Wan-fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database and Chinese Biomedical Literature Database. As well as the grey literature on other database for COVID-19 to evaluate the effectiveness and safety of the CP. Two reviewers will independently conduct the primary screening of the articles and data extraction. And then, they will select eligible sources after discussing non-conformities. Search keywords will include convalescent plasma therapy, COVID-19, severe condition. Survival, Mortality, Viral load, and antibody level will be used as the main outcome. Length of hospital stay, and adverse events as the secondary outcome. This protocol will use RevMan5.3.5.

Results:

The results of this systematic review will provide the curative effectiveness and safety of the CP for COVID-19 with high-quality evidence currently.

Conclusion:

The conclusion of this systematic review will provide for judging whether CP benefits the severe COVID-19 patients.

Ethics and dissemination:

Ethical approval are not required for systematic review. Externally peer reviewed.

PROSPERO registration number:

PROSPERO CRD42020215456
Extensive subdural ossification with meningioma
Authors: Feng Yang , Zeng Xi , Tan Renzhao , Xu Xueyou , Yang Hua
Published: April 2021

Rationale:

Intracranial tumors can stimulate the occurrence of intracranial ossification, and previous studies have reported intracranial ossification with astrocytoma, glioblastoma multiforme and growth hormone adenoma. For meningiomas derived from arachnoid cells, the outcome of abnormal arachnoid cells is not only tumorigenesis, but also calcium deposition. To the best of our knowledge, meningioma with subdural ossification has not been reported.

Patient concerns:

A 60 year old woman was admitted to the hospital with a 1-year-old history of right blepharoptosis.

Diagnoses:

The preoperative examination of the patient was suggestive of meningioma on magnetic resonance imaging plain scan and enhancement. After the surgery, Endothelial cell type meningioma (WHO I grade) with intracranial ossification was diagnosed.

Interventions:

The patient underwent right extended pterional approach craniotomy and the neoplasm was gross totally resected. The patient was scheduled for follow-up and regular observation of the intracranial ossification.

Outcomes:

Intracranial computed tomography showed that extensive ossification still existed, but the symptoms of right blepharoptosis were significantly improved.

Lessons:

The authors report a rare case of meningioma complicated with extensive subdural ossification. Further studies are needed to confirm whether intracranial ossification in meningioma is related to arachnoid granulosa cells.
Granulomatosis with polyangiitis associated with rapidly progressive glomerulonephritis, diffuse alveolar hemorrhage, cerebral vasculitis, and peripheral nerve neuropathy
Authors: Nawata Takashi , Oishi Keiji , Shibuya Masaki , Sano Yasuteru , Kubo Makoto , Obayashi Masakazu , Kawai Motoharu , Yano Masafumi
Published: April 2021

Rationale:

Granulomatosis with polyangiitis (GPA) is a type of anti-neutrophil cytoplasmic antibody-associated vasculitis which predominantly affects systemic small and medium-sized blood vessels. GPA involving multiple organs can lead to a fatal outcome if left untreated.

Patient concerns:

An 83-year-old Japanese woman with rapidly progressive glomerulonephritis, diffuse alveolar hemorrhage, cerebral vasculitis, and peripheral neuropathy was admitted to our hospital. Her multiple organ involvement increased during an untreated period following the patient's initial decision not to receive immunotherapy.

Diagnoses:

GPA associated with rapidly progressive glomerulonephritis, diffuse alveolar hemorrhage, cerebral vasculitis, and peripheral nerve neuropathy.

Interventions:

The patient was treated with glucocorticoids and rituximab.

Outcomes:

Therapy with glucocorticoids and rituximab achieved remission.

Lessons:

This case suggests the clinical course of GPA may progress to involve multiple organs and appropriate immunosuppressive therapy should be considered even for elderly patients.
Marchiafava-bignami disease in a chinese patient with mild cognitive impairment
Authors: Wang Jie , Lu Li , Wu Lirong
Published: April 2021

Introduction:

Marchiafava-Bignami disease (MBD) is a rare outcome often associated with chronic alcohol abuse. Clinical manifestations are diverse. Recently, brain magnetic resonance imaging has paved the way for the diagnosis of MBD.

Patient concerns:

A 62-year-old man was admitted to our hospital because of headache and mild cognitive impairment. He had an alcohol consumption (500 g/d) history for over 20 years.

Diagnosis:

Based on Magnetic Resonance Imaging, he was diagnosed with Marchiafava-Bignami disease (MBD).

Interventions:

The patient was asked to stop alcohol consumption, and was prescribed with B-vitamins (thiamine, B6, B12) to improve his symptoms.

Outcomes:

After one week of treatment, the patient could communicate with others fluently. His memory improved significantly.

Conclusion:

Acute MBD is not always fatal; early diagnosis and prompt treatment can greatly improve its prognosis. Radiological findings can aid the clinical diagnosis of MBD. The lesions are usually localized in or spread throughout the corpus callosum.
Endobronchial blood patch with thrombin injection
Authors: Perwaiz Muhammad K. , Pasrich Rajiv , Grewal Gurjot , Durrance Richard J.
Published: April 2021

Introduction:

Persistent pulmonary air leaks present a challenging clinical problem, often requiring surgical intervention that not all patients can withstand.

Patient concerns:

An elderly female with severe emphysematous Chronic Obstructive Pulmonary Disease and dependent on continuous home oxygen supplementation developed recurrent pneumothoraces. On evaluation, the patient was considered a poor surgical candidate for Video assisted thoracoscopic surgery, and therefore a less invasive approach to treat the recurrent pneumothoraces was required.

Diagnosis:

A diagnosis of recurrent right pneumothorax due to Pulmonary-parenchymal fistula (either alveolo-pleural fistula or broncho-pleural fistula) was made

Interventions:

Due to the fragile overall condition of the patient, the peri-procedure risk of video assisted thoracoscopic surgery was not acceptable. Hence bronchoscopic evaluation with an endobronchial blood patch with thrombin injection was performed using a swan-ganz catheter.

Outcomes:

The patient had significant reduction in air leak post procedure and achieved complete resolution on day 3. She was successfully discharged home later.

Conclusion:

In patients with significant comorbidities that preclude standard interventions for persistent pulmonary-pleural fistulas, endobronchial blood patch repair with thrombin injection can be safely performed utilizing a swan-ganz catheter.
Congenital erythropoietic porphyria
Authors: Li Xiao-Ling
Published: April 2021

Rationale:

Congenital erythropoietic porphyria (CEP) is an autosomal recessive, hereditary disorder. Its rarity underlies a general low awareness by clinicians, and only scarce reports of CEP exist in the literature. Herein we report a rare case of CEP and its treatment strategies.

Patient concerns:

A 4-year-old female suffered from papular vesicles and blisters on the face and hands, which had originally developed 3 years prior. Upon presentation at our clinic, we noted old facial appearance, cutaneous atrophic scaring, brown teeth (fluorescing pink under Wood's light), and dark-brown urine (fluorescing orange-red under Wood's light). The major findings of laboratory examinations were elevated 1.6 gHb for intracellular porphyrin, and strong positivity (2+) for urinary porphyrin.

Diagnoses:

The final diagnosis was CEP.

Interventions:

Sun protection and oral administration of β-carotene (15 mg/d).

Outcomes:

After 2 months, the papules and papulovesicles were significantly reduced.

Lessons:

CEP is a rare, autosomal recessive, hereditary disorder. The decrease in or lack of uroporogen III synthetase is the major pathogenic factor and there is no specific treatment for this disease. Through this study of a case of CEP, it is suggested that clinicians should strengthen their understanding of the typical clinical manifestations and laboratory findings of this disease.
Ticagrelor Utilization in Patients With Non-ST Elevation Acute Coronary Syndromes in Romania
Authors: Cotoban Alexandru-George , Udroiu Cristian Alexandru , Vinereanu Dragos
Published: April 2021

BACKGROUND:

Dual antiplatelet therapy (DAPT) represents a major tool of non-ST elevation acute coronary syndrome (NSTE-ACS) management. The real-world usage of potent P2Y12 inhibitors within DAPT in middle-income countries is poorly described.

STUDY QUESTION:

To assess the factors that influence P2Y12 inhibitor choice at discharge in invasively managed NSTE-ACS patients, without an indication for oral anticoagulation, treated across Romania.

STUDY DESIGN:

The Romanian National NSTE-ACS Registry allows the consecutive enrollment of NSTE-ACS patients admitted in 11 (of 24) interventional centers reimbursed from public funds.

MEASURES AND OUTCOMES:

NSTE-ACS patients that received DAPT at discharge were identified. Deceased patients, those with an indication for oral anticoagulation or not receiving DAPT at discharge, were excluded. P2Y12 inhibitor choice was analyzed based on demographic, clinical, and invasive management characteristics.

RESULTS:

One thousand fifty (63 ± 10 years, 73% male) of 1418 patients enrolled between 2016 and 2019 were analyzed. The P2Y12 inhibitor pretreatment rate was 90%. Obstructive coronary artery disease was found in 95.3% of patients. 84.6% underwent percutaneous coronary interventions (PCIs). Single vessel PCI was reported in 84% of PCI patients. The clopidogrel usage rate was 49.6%, ticagrelor 50.0%, and prasugrel 0.4%. Overall, higher ticagrelor usage was associated with: non-ST elevation myocardial infarction (P 0.035), age below 65 (P < 0.001), prior treatment with ticagrelor (P < 0.001), PCI during admission (P < 0.001), and its full 12-month reimbursement (since November 2017). Reimbursement increased the use of ticagrelor from 23.7% in 2016–2017 to 56.9% in 2018–2019 (P < 0.001). In PCI patients, ticagrelor use was associated with PCI with stenting (P 0.016) and multivessel PCI (0.013).

CONCLUSIONS:

DAPT, P2Y12 inhibitor pretreatment, and single vessel PCI are the standards of care in invasively managed NSTE-ACS patients in Romania. Besides the clinical and invasive characteristics that favor its use, the full reimbursement of ticagrelor introduced in November 2017 doubled its yearly usage.
Optimal inflammatory bowel disease management during the global coronavirus disease 2019 pandemic
Authors: El Ouali Sara , Rubin David T. , Cohen Benjamin L. , Regueiro Miguel D. , Rieder Florian
Published: April 2021

Purpose of review

This review aims to summarize the current evidence regarding the risks and implications of coronavirus disease 2019 (COVID-19) in patients with inflammatory bowel disease (IBD) and discuss optimal management of IBD during this pandemic.

Recent findings

Patients with IBD are not at increased risk of COVID-19 but several risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection) have been identified, such as active IBD, obesity, and corticosteroid use. COVID-19 outcomes are similar among patients with IBD and the overall population. Although biologics have not been shown to increase the risk of severe COVID-19 complications, several risk factors have been associated with negative COVID-19 outcomes in patients with IBD, including older age, obesity, the presence of comorbidities, active disease, and corticosteroid use. IBD therapy should, therefore, be continued with the aim of attaining or maintaining remission, except for corticosteroids, which should be held or reduced to the minimal effective dose. Although it has been recommended that immunosuppressive therapy be held during a case of COVID-19, the half-lives of these drugs and data on the timing of restarting therapy limit the strength of these recommendations. We recommend COVID-19 vaccination for IBD patients whenever available, as benefits to the individual and to society outweigh the risks.

As our understanding of SARS-CoV-2 and COVID-19 continues to evolve, we are learning more about its impact in patients with IBD and how to better manage patients in this setting. Managing IBD during this pandemic has also highlighted the importance of restructuring services in order to adapt to current and potential future outbreaks. The COVID-19 pandemic has transformed IBD care through the expansion of telemedicine and development of novel approaches to remote monitoring.
Social media in inflammatory bowel disease: the patient and physician perspective
Authors: Ahmed Waseem , Taft Tiffany H. , Charabaty Aline
Published: April 2021

Purpose of review

Social media use by patients with inflammatory bowel disease (IBD) and their respective providers continues to increase, promoting disease awareness and scholarship. In this review article, we summarize the current literature regarding social media use and IBD, discuss both the patient and physician perspective, and provide guidance to avoid commonly encountered pitfalls.

Recent findings

Patients and providers commonly rely on social media to share medical information, advocate for improved IBD care, and to network and collaborate on common research interests. This shift from more traditional formats of education and networking continues to grow exponentially, and even more rapidly so during the COVID-19 pandemic.

Social media use in the IBD community will continue to grow and lead to further innovation. Providers should be aware of social media as a valuable tool for their patients and themselves.
Depression and cardiovascular disease
Authors: Hare David L.
Published: April 2021

Purpose of review

The purpose of this review is to outline the relationship between cardiovascular disease (CVD) and depression, both as a cause of and a result of CVD.

Recent findings

The prevalence of depression seems to be increasing in the general population.

It is likely that depression will be even more of a problem for CVD patients in the post-COVID-19 pandemic era.

New studies confirm the independent association of depression with later incident CVD, although perhaps not as strong as suggested by some previous studies.

Depression seems to be becoming even more prevalent in CVD patients, with new data for stroke and peripheral arterial disease patients.

Cardiologists rarely screen for depression and most do not believe that they have a responsibility for detecting or treating depression.

There are new data suggesting that patients who are more in control of their lives have better outcomes and that change is possible.

Depression is preventable and treatable. It is imperative to detect and manage depression in CVD patients. Additional research is required to see whether or not comprehensive patient screening for depression translates into both better quality of life and improved clinical outcomes.
Organ allocation and procurement in cardiac transplantation
Authors: Altshuler Peter J. , Helmers Mark R. , Atluri Pavan
Published: April 2021

Purpose of review

There is a critical shortage of organs in cardiac transplantation. Recent advancements in both organ allocation and donor utilization have intended to address this shortage and optimally allocate allografts. This review evaluates several important aspects of recipient and donor management. For recipients, the focus is placed on the evolving mechanical circulatory support population and its bidirectional impact on organ allocation. From the donor standpoint, organ utilization is assessed with respect to increasing access to previously unused allografts.

Recent findings

Implementation of the new heart allocation system in the United States has better stratified waitlist candidates by illness acuity. Compared to the prior system, those requiring venoarterial extracorporeal membrane oxygenation support are less likely to die on the waitlist, although conflicting data exists whether this has improved their posttransplant survival. The use of pretransplant intra-aortic balloon pumps has markedly increased, whereas transplantation of patients with dischargeable left ventricular assist devices has decreased. Although some studies have reported inferior short- to mid-term posttransplant survival in the new system compared to its predecessor, others report similar outcomes.

Several recent advancements in donor utilization have also been noted. Coinciding with the global increase in drug overdose deaths, efforts have been made to increase use of these donors who are frequently considered ‘increased risk’ and are hepatitis C-positive. Grafts from these donors appear safe to use. These, alongside donation after circulatory death donors, represent potentially underutilized populations that may effectively expand the donor pool.

Recent changes in organ allocation, alongside efforts to expand the donor pool, have attempted to improve cardiac allograft utilization and reduce the imbalance between organ supply and demand. Ongoing monitoring and continuous re-evaluation of these efforts will help guide future practice.
A Quality Improvement Initiative to Reduce the Frequency of Delays in Initiation and Restarts of Continuous Renal Replacement Therapy
Authors: Cordoza Makayla , Rachinski Kristen , Nathan Kristin , Crain Elisa B. , Braxmeyer Diane , Gore Sarah , Dubuc Stephanie D. , Wright Joel
Published: April 2021

Background:

Continuous renal replacement therapy (CRRT) is a lifesaving intervention for critically ill patients. Delays in initiation, or an inability to resume CRRT following a temporary suspension in therapy (CRRT restart), can result in suboptimal CRRT delivery.

Local Problem:

Intensive care units across the health care system were experiencing significant delays in CRRT initiation and restarts.

Approach:

A multimodal quality improvement initiative was implemented across 7 adult intensive care units, which allowed unit-based staff nurses to initiate and restart CRRT, a task that had previously been delegated to non–unit-based dialysis nurses.

Outcomes:

A 75% reduction in CRRT initiation delays and a 90% reduction in CRRT restart delays were observed in the 12 months following the initiative. There were no adverse events or increased disposable CRRT circuit usage following the initiative.

Conclusions:

Implementation of CRRT initiation and restarts by unit-based nurses were achievable and resulted in substantial improvements in timeliness of CRRT delivery.
Does Nurse Preceptor Role Frequency Make a Difference in Preceptor Job Satisfaction?
Authors: Fordham Wendy
Published: April 2021

This study identified nurse preceptor role frequency to newly licensed registered nurses and how it made a difference to the preceptors’ job satisfaction. Statistical analysis revealed there was no difference in job satisfaction in preceptors who performed in the role one to four times than those who served five times or more, F(4, 124) = 0.261, p > .05. The study found variation in preceptor role preparation and differing registered nurse practice experience prior to performing as a preceptor.
Implementing a Nursing Skills Practice Laboratory Using Social Distancing During the COVID-19 Pandemic
Authors: Hemann Michele , Blizzard Theresa , Carver Rachel , Finke-Pike Gretchen , Grimsley Amy
Published: April 2021

The COVID-19 pandemic emphasized the importance of preparing nursing staff at healthcare organizations to adequately respond and care for the influx of patients infected with the virus. Training redeployed nursing staff on equipment basics of acute care nursing while following social distancing guidelines posed a challenge. A skills practice laboratory was implemented utilizing a self-learning methodology while adhering to social distancing guidelines. This had favorable results in meeting objectives and improving anxiety and confidence.
Biomechanical models: key considerations in study design
Authors: Augat Peter , Hast Michael W. , Schemitsch Geoffrey , Heyland Mark , Trepczynski Adam , Borgiani Edoardo , Russow Gabriele , Märdian Sven , Duda Georg N. , Hollensteiner Marianne , Bottlang Michael , Schemitsch Emil H.
Published: April 2021

This manuscript summarizes presentations of a symposium on key considerations in design of biomechanical models at the 2019 Basic Science Focus Forum of the Orthopaedic Trauma Association. The first section outlines the most important characteristics of a high-quality biomechanical study. The second section considers choices associated with designing experiments using finite element modeling versus synthetic bones versus human specimens. The third section discusses appropriate selection of experimental protocols and finite element analyses. The fourth section considers the pros and cons of use of biomechanical research for implant design. Finally, the fifth section examines how results from biomechanical studies can be used when clinical evidence is lacking or contradictory. When taken together, these presentations emphasize the critical importance of biomechanical research and the need to carefully consider and optimize models when designing a biomechanical study.
The induced membrane technique for bone defects: Basic science, clinical evidence, and technical tips
Authors: Hoit Graeme , Kain Michael S. , Sparkman Jeremy W. , Norris Brent L. , Conway Janet D. , Watson J. Tracy , Tornetta Paul , Nauth Aaron
Published: April 2021

The clinical management of large bone defects continues to be a difficult clinical problem to manage for treating surgeons. The induced membrane technique is a commonly employed strategy to manage these complex injuries and achieve bone union. Basic science and clinical evidence continue to expand to address questions related to the biology of the membrane and how interventions may impact clinical outcomes. In this review, we discuss the basic science and clinical evidence for the induced membrane technique as well as provide indications for the procedure and technical tips for performing the induced membrane technique.
A Pilot Evaluation of Expedited Partner Treatment and Partner Human Immunodeficiency Virus Self-Testing Among Adolescent Girls and Young Women Diagnosed With Chlamydia trachomatis and Neisseria gonorrhoeae in Kisumu, Kenya
Authors: Omollo Victor , Bukusi Elizabeth A. , Kidoguchi Lara , Mogaka Felix , Odoyo Josephine B. , Celum Connie , Morton Jennifer , Johnson Rachel , Baeten Jared M.
Published: April 2021

Background

Expedited partner treatment (EPT) is effective for preventing sexually transmitted infection recurrence, but concerns about intimate partner violence and missed opportunities for human immunology virus (HIV) testing have limited its use in African settings.

Methods

We conducted a pilot prospective evaluation of EPT among adolescent girls and young women (AGYW) accessing HIV preexposure prophylaxis in an implementation project in Kisumu, Kenya. Those with etiologic diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae were treated and given the option of delivering sexually transmitted infection medication and HIV self-test kits to their current sexual partner(s). At enrollment, we assessed their reasons for declining. Three months after they delivered medication and kits to the partner(s), we assessed their reasons for failing to deliver medication and kits to their partner and reported partner's reactions.

Results

Between September 2018 and March 2020, 63 AGYW were enrolled. The majority (59/63 [94%]) accepted EPT, and 50 (79%) of 63 partner HIV self-testing (HIVST). Three quarters (46/59) of those accepting EPT returned for the assessment visit with 41 (89%) of 46 successfully delivering medication to 54 partners, of whom 49 (91%) used it. Seventy percent (35/50) who took partner HIVST kits returned for the assessment, with 80% (28/35) reporting providing kits to 40 partners, of whom 38 (95%) used it. Reported barriers to EPT and partner HIVST uptake among women who declined included anticipated fear that their partner could become angry or violent and loss of relationship.

Conclusions

Both EPT and partner HIVST were acceptable despite noted barriers among Kenyan AGYW with etiologic diagnosis of Chlamydia trachomatis/Neisseria gonorrhoeae and their partners.
Spatial and Temporal Epidemiology of Infectious Syphilis in Victoria, Australia, 2015–2018
Authors: Aung Ei T. , Chen Marcus Y. , Fairley Christopher K. , Higgins Nasra , Williamson Deborah A. , Tomnay Jane E. , Cook Kathryn A. , Peel Joanne , Dharmakulasinghe Vino , Alpren Charles , Chow Eric P.F.
Published: April 2021

This analysis of notified syphilis cases in Victoria, Australia between 2015 and 2018 shows that the syphilis epidemic in Victoria has become more generalized, with increases among heterosexual men and women residing in outer Melbourne suburbs—areas that differ from those of gay men.
Risk of HIV Diagnosis Following Bacterial Sexually Transmitted Infections in Tennessee, 2013–2017
Authors: Grome Heather N. , Rebeiro Peter F. , Brantley Meredith , Herrera-Vasquez Dyanne , Mathieson Samantha A. , Pettit April C.
Published: April 2021

Background

Data on associations between sexually transmitted infections (STIs) and incident human immunodeficiency virus (HIV) diagnoses beyond men who have sex with men (MSM) are lacking. Identifying STIs associated with greatest risk of incident HIV diagnosis could help better target HIV testing and prevention interventions.

Methods

The STI and HIV surveillance data from individuals 13 years or older in Tennessee from January 2013 to December 2017 were cross-matched. Individuals without diagnosed HIV, but with reportable STIs (chlamydia, gonorrhea, syphilis) were followed up from first STI diagnosis until HIV diagnosis or end of study. Cox regression with time-varying STI exposure was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for subsequent HIV diagnosis; results were stratified by self-reported MSM.

Results

We included 148,465 individuals without HIV (3831 MSM; 144,634 non-MSM, including heterosexual men and women) diagnosed with reportable STIs; 473 had incident HIV diagnoses over 377,823 person-years (p-y) of follow-up (median, 2.6 p-y). Controlling for demographic and behavioral factors, diagnoses of gonorrhea, early syphilis, late syphilis, and STI coinfection were independently associated with incident HIV diagnosis compared with chlamydia. Early syphilis was associated with highest HIV diagnosis risk overall (aHR, 5.5; 95% CI, 3.5–5.8); this risk was higher for non-MSM (aHR, 12.3; 95% CI, 6.8–22.3) versus MSM (aHR, 2.9; 95% CI, 1.7–4.7).

Conclusions

While public health efforts often focus on MSM, non-MSM with STIs is also a subgroup at high risk of incident HIV diagnosis. Non-MSM and MSM with any STI, particularly syphilis, should be prioritized for HIV testing and prevention interventions.
Measuring the Impact of the COVID-19 Pandemic on Sexually Transmitted Diseases Public Health Surveillance and Program Operations in the State of California
Authors: Johnson Kelly A. , Burghardt Nicole O. , Tang Eric C. , Long Pike , Plotzker Rosalyn , Gilson Denise , Murphy Ryan , Jacobson Kathleen
Published: April 2021

Background

As public health personnel and resources are redirected to COVID-19, sexually transmitted diseases (STD) programs have been unable to sustain pre–COVID-19 activities.

Methods

We used California (CA) surveillance data to describe trends in case reporting for gonorrhea, chlamydia, and syphilis of any stage in the pre– versus post–COVID-19 eras (January–June 2019 and January–June 2020). We also analyzed data from an electronic survey administered by the CA STD Control Branch to local health jurisdictions in April, June, and September of 2020, assessing the impact of COVID-19 on STD programs.

Results

There were sharp declines in cases of all reportable bacterial STDs occurring in conjunction with the March 19, 2020 CA stay-at-home order, most of which did not return to baseline by July. Comparing January–June 2020 to January–June of 2019, there were decreases in reported cases of chlamydia (31%), late syphilis (19%), primary/secondary syphilis (15%), early nonprimary nonsecondary syphilis (14%), and gonorrhea (13%). The largest percentage declines in STD case reporting were among Hispanic, Asian/Pacific Islander, and Black persons. Seventy-eight percent of local health jurisdiction respondents indicated that half or more of their workforce had been redeployed to COVID-19 by September 2020.

Conclusions

During the COVID-19 era, STD case reporting and programmatic functions have diminished throughout CA. Because this may contribute to decreases or delays in STD diagnosis and treatment—with resultant increases in STD transmission—providers and public health officials should prepare for potential increases in STD-related morbidity in the months and years to come.
Evaluation of Online Information on Complementary and Alternative Treatments for Dry Eye Disease
Authors: Rapata Micah E. J. , Meyer Jay J.
Published: April 2021

SIGNIFICANCE

Dry eye disease is a common condition with many complementary and alternative therapies promoted online. Patients may inquire about these therapies, and clinicians should be aware of the existence, safety, and efficacy of these therapies, as well as the quality of available online information.

PURPOSE

Complementary and alternative medicine is a multibillion-dollar industry with increasing popularity. Dry eye disease is a chronic condition with many complementary and alternative therapies described online. Patients may inquire about and elect to forgo conventional treatments in favor of these therapies. This study identified alternative treatments for dry eye disease described online and evaluated the Web sites that described them.

METHODS

An Internet search algorithm identified Web sites describing complementary and alternative therapies for dry eye disease. Web site quality was assessed using the Sandvik score to evaluate Web site ownership, authorship, source, currency, interactivity, navigability, and balance. The potential risk of Web sites to patients was assessed using a risk scoring system. A list of described therapies was compiled.

RESULTS

Eight Web sites describing complementary and alternative therapies for dry eye disease were assessed. The Sandvik score classified more than half of the Web sites as “satisfactory” and none as “poor.” The overall mean risk score was low at 0.9. One Web site displayed information that discouraged the use of conventional medicine, whereas no Web sites discouraged adhering to clinicians' advice. The Web sites listed 12 therapies with a further 32 found in Web site comments. The most common therapies were acupuncture, vitamin supplements, homeopathic eye drops, castor oil, coconut oil, and chamomile eye wash.

CONCLUSIONS

The majority of analyzed Web sites were of satisfactory quality with a low potential risk to patients. However, some Web sites were biased toward their own therapies, lacked proper referencing, and/or did not identify authorship. Further research is required to ascertain the efficacy and safety of these therapies.
An Autopsy Case of Spontaneous Coronary Artery Dissection With Eosinophilic Coronary Periarteritis and Degeneration of Medial Smooth Muscles
Authors: Fukuta Mamiko , Kurose Akira , Horita Tetsuya , Otaki Jun , Nakamura Yoshimi , Kanno Sanae , Kato Hideaki , Aoki Yasuhiro
Published: April 2021

A 45-year-old woman with no known medical history died suddenly shortly after complaining of anterior chest discomfort. The autopsy revealed a dissection at the anterior descending branch of the left coronary artery, and eosinophilic adventitial inflammation was observed both in the right coronary artery and in the vicinity of the dissection. Furthermore, there was degeneration of the tunica media in the right coronary artery, and this was thought to be a predissection lesion. In the degenerated area of the tunica media, probable apoptosis of smooth muscle cells was noted, suggesting that the degeneration was not due only to the effect of eosinophilic lytic enzymes. These findings also indicated that eosinophilic infiltration preceded the dissection. Eosinophilic infiltration around the coronary arteries is occasionally observed in cases of sudden death, but although it might be associated with the death, the pathological mechanism is yet to be elucidated. Eosinophilic periarteritis has also been observed around the site of spontaneous coronary artery dissection, although a causal relationship is unproven. The histopathology of this case indicated that the eosinophilic infiltration preceded the dissection. Detailed pathological findings are presented, together with a review of the literature.
Understanding parents' use of a knowledge translation tool to manage children's vaccination pain
Authors: MacKenzie Nicole E. , Tutelman Perri R. , Chambers Christine T. , Parker Jennifer A. , MacDonald Noni E. , McMurtry C. Meghan , Pluye Pierre , Granikov Vera , Taddio Anna , Barwick Melanie , Birnie Kathryn A. , Boerner Katelynn E.
Published: April 2021

Introduction:

Although several evidence-based strategies for managing children's vaccination pain exist, many parents report being unaware of them. Knowledge translation (KT) tools present evidence-based information in plain language.

Objectives:

This two-phase study assessed parents/caregivers' uptake of evidence-based pain management strategies via a KT tool and considered factors related to parents' planned, actual, and future use of these strategies.

Methods:

In phase 1, parents were exposed to an online KT tool on physical, psychological, and pharmacological vaccination pain management strategies, and their impressions were assessed by questionnaires including the Information Assessment Method for Parents. In phase 2, after vaccination, parents completed a follow-up survey on their uptake and experiences using the information.

Results:

A total of 312 participants reported their plans for KT tool use. Parents who found the KT tool relevant were more likely to plan to use it at their child's upcoming vaccination. A total of 128 parents (93% mothers) completed both surveys. Nearly all parents who planned to use the information did so during their child's subsequent vaccination (90%). When the KT tool was relevant to their needs, parents were more likely to use the information during their child's vaccination. Parents who felt confident using the tool were significantly more likely to report plans for future tool use.

Discussion:

This study demonstrates the effectiveness of a KT tool that was relevant to parents' needs and built confidence to increase parent-reported uptake of evidence-based strategies. Proper pain management could positively impact parents' uptake of vaccinations for children.
Development of a physical mobility prediction model to guide prosthetic rehabilitation
Authors: Anderson Chelsey B. , Wurdeman Shane R. , Miller Matthew J. , Christiansen Cory L. , Kittelson Andrew J.
Published: April 2021

Background:

Prosthetic rehabilitation decisions depend on estimating a patient's mobility potential. However, no validated prediction models of mobility outcomes exist for people with lower-limb amputation (LLA).

Objectives:

To develop and test predictions for self-reported mobility after LLA, using the Prosthetic Limb Users Survey of Mobility (PLUS-M).

Study Design:

This is a retrospective cohort analysis.

Methods:

Eight hundred thirty-one patient records (1,860 PLUS-M observations) were used to develop and test a neighbors-based prediction model, using previous patient data to predict the 6-month PLUS-M T-score trajectory for a new patient (based on matching characteristics). The prediction model was developed in a training data set (n = 552 patients) and tested in an out-of-sample data set of 279 patients with later visit dates. Prediction performance was assessed using bias, coverage, and precision. Prediction calibration was also assessed.

Results:

The average prediction bias for the model was 0.01 SDs, average coverage was 0.498 (ideal proportion within the 50% prediction interval = 0.5), and prediction interval was 8.4 PLUS-M T-score points (40% improvement over population-level estimates). Predictions were well calibrated, with the median predicted scores falling within the standard error of the median of observed scores, across all deciles of the data.

Conclusions:

This neighbors-based prediction approach allows for accurate estimates of PLUS-M T-score trajectories for people with LLA.
A systematic review of health economic evaluation in orthotics and prosthetics: Part 2—orthotics
Authors: Clarke Leigh , Dillon Michael P , Shiell Alan
Published: April 2021

Background:

Health economic evaluations (HEEs) in orthotics are in their infancy. Identification of evidence gaps and method design issues will inform the design of future HEEs that advance knowledge and contributes to policy and investment decisions.

Objectives:

The aim of this systematic review was to critically appraise the existing orthotic/prosthetic health economic evaluation literature and therefore determine evidence gaps, critical method design issues, and the extent to which the literature informs orthotic policy and investment decisions.

Study Design:

Systematic review.

Methods:

A range of databases were searched using intervention- and HEE-related terms. The Consolidated Health Economic Checklist—Extended and the Checklist for Health Economic Evaluation Reporting Standards were used to identify issues with method design and reporting.

Results:

Nine orthotic HEEs were narrowly focused on the cost-effectiveness of low-cost orthotic devices (eg, ankle orthoses for ankle sprains). Method design (eg, cost identification and valuation) and reporting issues (eg, lack of detail about the study population) limited the extent to which this literature can inform policy and investment decisions.

Conclusions:

HEEs comparing a wider variety of interventions are required, particularly for commonly used orthoses (eg, ankle-foot orthoses) and clinical presentations (eg, post-stroke). There are opportunities to strengthen future orthotic HEEs by adopting method design features (eg, microcosting and sensitivity analyses) as recommended by HEE appraisal and reporting tools.
Functional performance differences between carbon fiber and fiberglass prosthetic feet
Authors: Kaufman Kenton R. , Bernhardt Kathie
Published: April 2021

Background:

Persons with lower limb amputation require increased functionality. The largest category of feet for active individuals with a transtibial amputation is energy storage and return (ESR) feet. These feet are typically constructed of carbon fiber composite materials. Recently, a prosthetic foot composed of a fiberglass composite has emerged in the market. However, there are no comparative studies of these devices.

Objectives:

Compare the biomechanical performance and prosthesis-related quality of life when using a fiberglass prosthetic foot design compared with traditional carbon fiber ESR designs.

Study Design:

This is a repeated-measures randomized cross-over trial.

Methods:

Gait analysis was performed on 10 experienced male subjects with unilateral transtibial amputations (K-level III) while walking on level ground and a ramp. Patient-reported outcomes were collected using the Prosthesis Evaluation Questionnaire.

Results:

Gait data demonstrated increased ankle dorsiflexion (P < .01), similar ankle moments (P = .07), and increased ankle power generation (P = .01) when using the fiberglass foot. The increased power generation occurred at the correct time in the gait cycle such that the timing and magnitude of peak knee flexion was unaffected (P > .19). The fiberglass foot had greater energy absorption during gait (P = .01) with no difference in energy return (P = .37). The subjects expressed improved prosthesis-related quality of life with the fiberglass foot (P = .01).

Conclusions:

The findings of this study demonstrate that the new ESR foot comprising a fiberglass material had better performance than traditional designs using a carbon fiber material.