bluuebunny/crossref_metadata_2025 huggingface dataset:
Implications of COVID-19 on School Services for Children with Disabilities: Opportunities for Interagency Collaboration
Authors: Harris Bryn , McClain Maryellen Brunson , O'Leary Sonja , Shahidullah Jeffrey D.
Published: February 2021

The transition to virtual and hybrid schooling given the COVID-19 pandemic in the United States has upended the education system and may be widening gaps in service disparities, particularly for children with disabilities. Schools often function as “de facto” service systems for most children with disabilities, particularly those from racially and ethnically minoritized, economically vulnerable, and bilingual populations. The impact of school closures on children with disabilities poses significant ramifications for the medical, behavioral health, and educational systems in which they are served, necessitating the need for pediatric clinicians to collaborate with schools in purposeful ways. This commentary (1) presents an overview of the current guidance for providing school-based services to children with disabilities during the COVID context with many schools operating in virtual or hybrid formats, (2) reviews potential service inequities exacerbated by school closures and lack of on-site services, and (3) offers recommendations for collaborating with school staff and community agencies in support of children and families with disabilities.
Nonsurgical Methods for Penile Augmentation: A Systematic Review
Authors: Salloum Antoine , Bazzi Nagham , Haber Roger
Published: February 2021

BACKGROUND

There is no standardized approach for nonsurgical techniques for penile augmentation despite the increase of demand for this intervention.

OBJECTIVE

To compare the efficacy and safety between different injection techniques.

MATERIALS AND METHODS

On October 8, 2019, a literature search was performed on PubMed, Embase, Ovid, and Cochrane database. All articles describing penile augmentation were included.

RESULTS

Thirteen studies were included in this article with a total of 1,311 patients. Five studies were prospective cohort. The most commonly described technique was hyaluronic acid fillers with a total of 4 articles and 205 patients. The mean injected volume ranged from 20 to 40 mL. In all included studies, a minority of patients had side effects, but some had disabling complications.

CONCLUSION

There are no defined clinical guidelines for penile augmentation techniques implemented yet. Hyaluronic acid seems to be safe, efficient, and with a high satisfaction score. Further randomized control trials are warranted.

EBM (LEVEL OF EVIDENCE-BASED MEDICINE)

2a.
Prior Botulinum Toxin Treatment Does Not Impact Efficacy or Safety in Clinical Trials: Analysis of DaxibotulinumtoxinA for Injection in the SAKURA Program
Authors: Cohen Joel L. , Green Lawrence J. , Beer Kenneth R. , Liu Yan , Gallagher Conor J.
Published: February 2021

BACKGROUND

Pivotal studies of approved botulinum toxin type A (BoNTA) formulations for treatment of glabellar lines have mostly included treatment-naive participants, and the impact of prior BoNTA treatment on efficacy and safety is not well documented.

OBJECTIVE

To evaluate whether prior BoNTA treatment affects efficacy, duration of response, and tolerability for treatment of glabellar lines.

METHODS

Adults with moderate or severe glabellar lines treated with DaxibotulinumtoxinA for Injection (DAXI) or placebo from the randomized, double-blind SAKURA 1/2 trials and the open-label SAKURA 3 safety study were analyzed by prior BoNTA treatment status. Efficacy was evaluated using investigator and participant assessments.

RESULTS

In this analysis, 609 participants (52.2% BoNTA-experienced) from the SAKURA 1/2 trials and 2,380 (38.0% BoNTA-experienced) from the SAKURA 3 study were evaluated. Proportion of participants with none or mild glabellar lines and duration of response were similar between the BoNTA-naive and BoNTA-experienced cohorts in both the DAXI and placebo groups. The incidence of adverse events was also comparable regardless of prior BoNTA treatment status.

CONCLUSION

Efficacy and tolerability were similar with DAXI and placebo regardless of prior BoNTA treatment. Assuming an appropriate washout is observed, future BoNTA trials should enroll both treatment-experienced and treatment-naive participants to reflect clinical practice.
Utility of Debulk Specimens During Mohs Micrographic Surgery for Cutaneous Squamous Cell Carcinoma
Authors: McIlwee Bridget E. , Abidi Nadia Y. , Ravi Manisha , Carr David R.
Published: February 2021

BACKGROUND

Limited literature exists regarding whether intraoperative analysis of frozen debulk specimens during Mohs micrographic surgery (MMS) improves identification of high-risk features (HRF) of cutaneous squamous cell carcinoma (CSCC).

OBJECTIVE

Primary: identification of new HRF on debulk specimens. Secondary: CSCC upstaged after considering debulk data.

MATERIALS AND METHODS

A single-center, retrospective cohort study of patients with biopsy-proven CSCC treated by MMS with intraoperative frozen debulk analysis. Restricted (poor differentiation, new perineural invasion ≥0.1 mm, and Breslow depth >6 mm) and nonrestricted (any worsened tumor differentiation, any new perineural invasion, and Breslow depth >2 mm) analyses were performed.

RESULTS

In restricted analysis, 3.94% of cases had 1 new HRF on debulk analysis. In nonrestricted analysis, 32.9% of cases had ≥1 new HRF; 7.6% increased by 2 HRF. Approximately 2.0% of cases were upstaged by American Joint Committee on Cancer system, eighth edition criteria, 1.4% by Brigham and Women's Hospital. Tumor size ≥2 cm, male sex, and moderate differentiation on biopsy were significantly associated with new HRF identified on debulk analysis.

CONCLUSION

Intraoperative frozen debulk analysis can reveal HRF of CSCC not seen on biopsy or MMS stages, particularly among tumors ≥2 cm. American Joint Committee on Cancer system, eighth edition T2 tumors were most likely to be upstaged. Identification of new HRF on debulk analysis can improve CSCC staging and may impact patient treatment and follow-up.
Subanesthetic ketamine with an AMPAkine attenuates motor impulsivity in rats
Authors: Davis-Reyes Brionna D. , Smith Ashley E. , Xu Jimin , Cunningham Kathryn A. , Zhou Jia , Anastasio Noelle C.
Published: February 2021

The concept of ‘impulse control’ has its roots in early psychiatry and today has progressed into a well-described, although poorly understood, multidimensional endophenotype underlying many neuropsychiatric disorders (e.g., attention deficit hyperactivity disorder, schizophrenia, substance use disorders). There is mounting evidence suggesting that the cognitive and/or behavioral dimensions underlying impulsivity are driven by dysfunctional glutamate (Glu) neurotransmission via targeted ionotropic Glu receptor (GluR) [e.g., N-methyl-D-aspartate receptor (NMDAR), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR)] mechanisms and associated synaptic alterations within key brain nodes. Ketamine, a noncompetitive NMDAR antagonist and FDA-approved for treatment-resistant depression, induces a ‘glutamate burst’ that drives resculpting of the synaptic milieu, which lasts for several days to a week. Thus, we hypothesized that single and repeated treatment with a subanesthetic ketamine dose would normalize motor impulsivity. Next, we hypothesized that AMPAR positive allosteric modulation, alone or in combination with ketamine, would attenuate impulsivity and provide insight into the mechanisms underlying GluR dysfunction relevant to motor impulsivity. To measure motor impulsivity, outbred male Sprague–Dawley rats were trained on the one-choice serial reaction time task. Rats pretreated with single or repeated (3 days) administration of ketamine (10 mg/kg; i.p.; 24-h pretreatment) or with the AMPAkine HJC0122 (1 or 10 mg/kg; i.p.; 30-min pretreatment) exhibited lower levels of motor impulsivity vs. control. Combination of single or repeated ketamine plus HJC0122 also attenuated motor impulsivity vs. control. We conclude that ligands designed to promote GluR signaling represent an effective pharmacological approach to normalize impulsivity and subsequently, neuropsychiatric disorders marked by aberrant impulse control.
The selective 5-HT2A receptor agonist 25CN-NBOH does not affect reversal learning in mice
Authors: Odland Anna U. , Kristensen Jesper L. , Andreasen Jesper T.
Published: February 2021

Psychedelic 5-hydroxytryptamine 2A receptor (5-HT2AR) agonists are showing promise in the treatment of psychiatric disorders, such as treatment-resistant depression and anxiety. Human studies suggest that enhanced cognitive flexibility may contribute to their clinical efficacy. Both improvement and impairment of cognitive flexibility has been reported with 5-HT2AR ligands, making the link between 5-HT2AR pharmacology and cognitive flexibility equivocal. We tested the selective 5-HT2AR agonist 25CN-NBOH in healthy male C57BL/6JOlaHsd mice in a touchscreen-based mouse reversal learning test. No effects were observed on acquisition of the new stimulus-reward contingency, learning errors, or perseverative responses during reversal. Our results suggest that 25CN-NBOH does not affect reversal learning in the schedule used in this study.
Effects of 5-HT2A receptor agonist 2,5-dimethoxy-4-iodoamphetamine on alcohol consumption in Long–Evans rats
Authors: Berquist Michael D. , Fantegrossi William E.
Published: February 2021

The objectives of this study were to determine alcohol consumption after administration of (R)(-)-2,5-dimethoxy-4-iodoamphetamine (DOI) or naltrexone in Long–Evans rats, and to assess the effectiveness of these treatments based on individual differences in alcohol consumption. Adult male Long–Evans rats (N = 16) were given opportunities to orally self-administer a 20% (v/v) ethanol (EtOH) solution using an intermittent access, two-bottle (vs. tap water) choice procedure in their home cages. EtOH consumption and preference, total fluid consumption and food intake were measured. Last, we assessed the effects of naltrexone (1 mg/kg; subcutaneous) and (R)(-)-DOI (0.1–1 mg/kg; subcutaneous) on EtOH intake and preference using a quartile analysis. Rats showed stable EtOH (20%) intake and preference after 15 EtOH access sessions. Naltrexone produced a transient decrease in EtOH intake, but an inconsistent effect on EtOH preference, whereas DOI dose-dependently reduced EtOH intake and preference for at least 24 h. Subsequent quartile analyses revealed that rats with the highest EtOH intake during the first 60 min of access to EtOH showed greater reductions in EtOH intake and preference after DOI treatment. This is the first report to show that DOI-elicited reductions in EtOH intake and preference in rats depend on baseline EtOH intake, perhaps supporting a ‘baseline dependency’ hypothesis of effectiveness with phenethylamine psychedelics on EtOH consumption. If so, individuals with greater potential to develop severe AUDs may be particularly responsive to the positive motivational changes produced by treatment with psychedelics that target the 5-HT2 receptor family.
New Concept for Severely Burned Ear Reconstruction: Grafting of the Frame Using Banked Ear Cartilage Combined with Costal Cartilage
Authors: Yotsuyanagi Takatoshi , Yamashita Ken , Sugai Asuka , Kato Shinji , Gonda Ayako , Kitada Ayaka , Onuma Masahiro , Kudo Mami
Published: February 2021

Background:

Damage and loss of ear cartilage can easily occur in a burned ear accompanied by severe extensive burns due to exposure of the cartilage or chondritis. Deformity can also occur due to later development of scar contracture despite minimal damage to the ear cartilage when the injury occurred. We have developed a new technique for treatment of a deep burn in the whole ear.

Methods:

In the new technique, the ear is amputated, and soft tissues are denuded. The cartilage is banked in a subcutaneous pocket in the chest and later regrafted in combination with costal cartilage.

Results:

Although techniques for regrafting banked ear cartilage have been reported, the reconstructed ear cannot acquire a good shape because of absorption of the cartilage or lack of intensity to sustain the outline of the ear. Meanwhile, when we tried to reconstruct an ear by only using costal cartilage, we found it difficult to fabricate a frame because most patients are adults in whom the costal cartilage is too rigid and fragile to be shaved or combined. In our technique, the frame has both the advantages of sufficient intensity in costal cartilage and a smooth curved surface together with elasticity in the ear cartilage. Ears reconstructed by our technique have a natural appearance.

Conclusion:

Our technique can be used for cases in which treatment for another large area of the body surface needs to be performed first to save the patient’s life.
Interdisciplinary Care for Amputees Network: A Novel Approach to the Management of Amputee Patient Populations
Authors: Sobti Nikhil , Park Andy , Crandell David , Smith Felicia A. , Valerio Ian , Lozano-Calderon Santiago A. , Eberlin Kyle R. , Heng Marilyn
Published: February 2021

Extremity amputation remains a common intervention for limb-threatening conditions. With advancement in surgical technique to address deleterious postoperative sequelae of limb removal, there is a salient need to develop and operationalize interdisciplinary care frameworks to provide more comprehensive care to an otherwise challenging patient population. Herein, we describe our interdisciplinary approach to the management of amputee patient populations at our institution, referred to as the Interdisciplinary Care for Amputees Network (ICAN). This novel framework focuses on 3 fundamental areas: combined preoperative patient evaluation, orthoplastic surgical intervention, and multi-specialty postoperative functional and psychosocial rehabilitation. Importantly, the successful implementation of a combined orthoplastic clinic requires establishing a working relationship among providers to leverage increased provider familiarity. This, coupled with sufficient clinic space, dedicated operating room time, and standardized patient workflow, serves to improve care and meet patient goals of pain minimization, return to desired functional status, and improvement in quality of life.
Subjective Cognitive Functioning in Silicone Breast Implant Patients: A Cohort Study
Authors: Colaris Maartje J. L. , Cohen Tervaert Jan Willem , Ponds Rudolf W. H. M. , Wilmink Johan , van der Hulst Rene R. W. J.
Published: February 2021

Background:

Cognitive impairment is frequently reported by silicone breast implant (SBI) patients. The aim of our study is to investigate whether subjective cognitive failure indeed is more frequent in a cohort of SBI patients compared with healthy controls (HCs). Furthermore, the severity of this cognitive failure and a possible relation to other symptoms as well as the duration of SBI exposure was examined. In addition, we assessed the effect of ruptures and reinterventions on cognitive failure severity.

Methods:

A cohort study was performed, including 376 women and consisting of 3 different groups of patients; 143 SBI patients (group 1), 94 age- and sex-matched HC patients (group 2), and 139 women with SBI and health issues who registered themselves at a Dutch foundation for women with illness due to SBI (group 3). All patients filled in the Cognitive Failure Questionnaire (CFQ). The American College of Rheumatology Fibromyalgia Diagnostic Criteria (2010) were used to score other symptoms.

Results:

Completed CFQ data from 222 patients were available for analysis: n = 79 for group 1, n = 62 for group 2, and n = 81 for group 3. SBI patients from group 3 had a significantly higher prevalence of subjective cognitive dysfunction (CFQ score ≥ 43) compared with SBI patients from group 1 and HC (60.5% versus 13.9% and 12.9%; P = 0.000). Linear regression showed a statistically significant relation between subjective cognitive functioning scores and other symptoms (P = 0.000). Implant duration as well as rupture rate and reinterventions were not found to significantly influence CFQ scores.

Conclusion:

An increased risk of cognitive failure in consecutive SBI patients when compared with HCs could not be found.
A Standardized Hand Fracture Fixation Training Framework using Novel 3D Printed Ex Vivo Hand Models: Our Experience as a Unit
Authors: Papavasiliou Theodora , Chatzimichail Stelios , Chan Jeffrey C. Y. , Bain Charles J. , Uppal Lauren
Published: February 2021

Background:

Surgery for hand trauma accounts for a significant proportion of the plastic surgery training curriculum. The aim of this study was to create a standardized simulation training module for hand fracture fixation with Kirschner wire (K-wire) techniques for residents to create a standardized hand training framework that universally hones their skill and prepares them for their first encounter in a clinical setting.

Methods:

A step-ladder approach training with 6 levels of difficulty on 3-dimensional (3D) printed ex vivo hand biomimetics was employed on a cohort of 20 plastic surgery residents (n = 20). Assessment of skills using a score system (global rating scale) was performed in the beginning and at the end of the module by hand experts of our unit.

Results:

The overall average scores of the cohort before and after assessment were 23.75/40 (59.4%) and 34.7/40 (86.8%), respectively. Significant (P < 0.01) difference of improvement of skills was noted on all trainees. All trainees confirmed that the simulated models provided in this module were akin to the patient scenario and noted that it helped them improve their skills with regard to K-wire fixation techniques, including improvement of their understanding of the 3D bone topography.

Conclusions:

We demonstrate a standardized simulation training framework that employs 3D printed ex vivo hand biomimetics proved to improve the skills of residents and that paves the way to more universal, standardized and validated training across hand surgery. This is, to our knowledge, the first standardized method of simulated training on such hand surgical cases.
Expanding the Horizon: Single-port Robotic Vascularized Omentum Lymphatic Transplant
Authors: Teven Chad M. , Yi Johnny , Hammond Jacob B. , Aime Victoria L. , Pallace Nathan M. , Pearson David G. , Casey William J. , Rebecca Alanna M.
Published: February 2021

Vascularized omentum lymphatic transplant is frequently used for the treatment of lymphedema due to demonstrated efficacy, a reduced complication profile, and, in particular, negligible risk of donor site lymphedema. Historically harvested by open laparotomy, more recent techniques involve laparoscopic omental harvest. Although effective and reproducible, laparoscopy may be limited by reduced visualization, minimal tactile feedback, multiple port sites, and imprecise instrumentation. Therefore, we employed the da Vinci Single-Port (SP) surgical robot system for vascularized omentum lymphatic transplant. A 52-year-old man with a 3-year history of progressive left lower extremity swelling and lymphoscintigraphy and magnetic resonance lymphangiogram consistent with lymphedema of unknown etiology underwent vascularized omentum lymphatic transplant to the left groin. A 2.5-cm infraumbilical incision was used for placement of the primary trocar, through which the camera and operating instruments were passed. Following robotic harvest, the omental lymph node flap was transferred to the left groin for microsurgical anastomosis. The procedure was uneventful, and the patient was discharged on postoperative day 1. At 6 weeks, there were no complications. Here, we show for the first time the safety and feasibility of robotic omental lymph node flap harvest for extremity lymphedema using the da Vinci Single-Port robotic system. The benefits of this technology include a minimally-invasive approach that allows for flap dissection and removal through a single 2.5-cm incision. Further investigation is necessary to characterize the indications and limitations of this technique in plastic surgery.
Open Dislocation Injury of the Metacarpophalangeal Joints III–V: Case Report
Authors: Beylich Tino , Schmidt Ingo
Published: February 2021

A 79-year-old man sustained left open metacarpophalangeal joints III–V dislocation injury in the dorsal direction associated with avulsions of the volar fibrocartilaginous plates. Surgical revision became necessary. Three months after the injury, the patient was very satisfied with his intermedium outcome; however, complete restoration of hand function was not observed at this time. To our knowledge, this is the first case presentation in the literature that describes such an injury involving the metacarpophalangeal joints III–V.
Thermal Imaging in a Clinically Non-assessable Free Flap Reconstruction of the Face
Authors: Frohwitter Gesche , Nobis Christopher-Philipp , Weber Manuel , Oetter Nicolai , Rau Andrea , Kesting Marco R. , Lutz Rainer
Published: February 2021

Free flap monitoring and early detection of malperfusion are a central aspect in reconstructive surgery. Warm ischemia, measured as the time a certain tissue is able to survive without any additional medical or thermal treatment, ranges from hours in muscle and nerval tissue up to days in bony tissue. Hence, meticulous flap monitoring is essential to discover early signs of malperfusion and decide upon timely re-intervention. Besides clinical examination techniques and Doppler sonography, a multitude of mostly experimental procedures are available to evaluate free flap perfusion. Particularly in older patients, the assessment of the skin island in microvascular grafts is a demanding task because the natural loss of elasticity, the reduction of subcutaneous tissue, and the decrease in water content limit the visibility of capillary filling and favor hematomas. We report a case of a 90-year-old woman with an extensive cutaneous squamous cell carcinoma of the right zygomatic and lateral orbital region without any locoregional or distant metastasis. Due to the resilient health status, we decided for a surgical approach with consecutive microvascular radial forearm flap reconstruction. On account of the difficult assessment of elderly skin after microvascular transplantation, we decided on additional flap monitoring by thermal heat imaging during the operation and aftercare. This case report discusses the successful application of thermal heat imaging in a clinical non-assessable free flap and discusses the application of dynamic infrared thermography as a monitoring tool in microvascular free flap surgery.
Benefits of Cardiac Rehabilitation on Functional Status and Mood Disorders in Elderly and Very Elderly Patients
Authors: Cañas Felipe , Giraldo German C. , Murillo Angela , Perafán Pablo E. , Quintero Orlando
Published: February 2021

Purpose:

Patients ≥80 yr are not frequently referred for cardiac rehabilitation (CR). This study aimed to describe the benefit of CR in the very elderly population in comparison with patients ≤65 and 66-79 yr in terms of gain in functional status and improvement of mood disorders.

Methods:

We conducted a prospective, cohort, single-center study. Physical performance was evaluated with a 6-min walk test (6MWT). Anxiety, depression, and overall psychological distress were evaluated with Hospital Anxiety and Depression Scale (HADS) scores. Primary outcomes were the percent improvement in the predicted distance and the reduction in the prevalence of anxiety, depression, and overall psychological distress.

Results:

There were 45 (9%) patients ≥80 yr among 499 participants. There were no significant differences in the percent improvement of the predicted distance in the 6MWT among age groups, being +15 (7, 25)%, +15 (7, 25)%, and +10 (4, 26)% for ≤65, 66-79, and ≥80-yr groups, respectively (P = .11). The elderly group had a higher prevalence of depression, anxiety, and overall psychological distress (72%, 51%, and 38%, respectively). After CR, there was a significant improvement in HADS scores in all groups. The prevalence of depression was reduced by 38%, anxiety by 60%, and overall psychological distress by 58%.

Conclusion:

Patients ≥80 yr have decreased physical performance and a higher prevalence of mood disorders than their younger counterparts. Nevertheless, they improved significantly in all outcomes measured.
Precision Medicine in Hematology 2021: Definitions, Tools, Perspectives, and Open Questions
Authors: Valent Peter , Orfao Alberto , Kubicek Stefan , Staber Philipp , Haferlach Torsten , Deininger Michael , Kollmann Karoline , Lion Thomas , Virgolini Irene , Winter Georg , Hantschel Oliver , Kenner Lukas , Zuber Johannes , Grebien Florian , Moriggl Richard , Hoermann Gregor , Hermine Olivier , Andreeff Michael , Bock Christoph , Mughal Tariq , Constantinescu Stefan N. , Kralovics Robert , Sexl Veronika , Skoda Radek , Superti-Furga Giulio , Jäger Ulrich
Published: February 2021

During the past few years, our understanding of molecular mechanisms and cellular interactions relevant to malignant blood cell disorders has improved substantially. New insights include a detailed knowledge about disease-initiating exogenous factors, endogenous (genetic, somatic, epigenetic) elicitors or facilitators of disease evolution, and drug actions and interactions that underlie efficacy and adverse event profiles in defined cohorts of patients. As a result, precision medicine and personalized medicine are rapidly growing new disciplines that support the clinician in making the correct diagnosis, in predicting outcomes, and in optimally selecting patients for interventional therapies. In addition, precision medicine tools are greatly facilitating the development of new drugs, therapeutic approaches, and new multiparametric prognostic scoring models. However, although the emerging roles of precision medicine and personalized medicine in hematology and oncology are clearly visible, several questions remain. For example, it remains unknown how precision medicine tools can be implemented in healthcare systems and whether all possible approaches are also affordable. In addition, there is a need to define terminologies and to relate these to specific and context-related tools and strategies in basic and applied science. To discuss these issues, a working conference was organized in September 2019. The outcomes of this conference are summarized herein and include a proposal for definitions, terminologies, and applications of precision and personalized medicine concepts and tools in hematologic neoplasms. We also provide proposals aimed at reducing costs, thereby making these applications affordable in daily practice.
Corneal Stromal Regeneration Therapy for Advanced Keratoconus: Long-term Outcomes at 3 Years
Authors: El Zarif Mona , Alió Jorge L. , Alió del Barrio Jorge L. , Abdul Jawad Karim , Palazón-Bru Antonio , Abdul Jawad Ziad , De Miguel María P. , Makdissy Nehman
Published: February 2021

Purpose:

To report the 3-year clinical outcomes of corneal stromal cell therapy consisting of the intrastromal implantation with autologous adipose-derived adult stem cells (ADASCs), and decellularized or ADASC-recellularized human donor corneal laminas in advanced keratoconus.

Methods:

Fourteen patients were enrolled in 3 experimental groups. Group 1 (G-1) patients underwent implantation of ADASCs alone (3 × 106 cells/1 mL) (n = 5). Group 2 (G-2) patients received a 120-μm decellularized corneal stroma lamina (n = 5). Group 3 (G-3) patients received a 120-μm lamina recellularized with ADASCs (1 × 106 cells/1 mL) (n = 4). ADASCs were obtained by elective liposuction. Implantation was performed into a femtosecond pocket under topical anesthesia.

Results:

At 3 years, a significant improvement of 1 to 2 logMAR lines in uncorrected distance visual acuity was observed in all groups. A statistically significant decrease in corrected distance visual acuity was obtained in G-2 and G-3 (P < 0.001) when compared with that of G-1. Rigid contact lens distance visual acuity showed a statistically significant worsening in G-2 (P < 0.001) compared with that of G-1. A statistically significant increase in central corneal thickness was observed in G-2 (P = 0.012) and G-3 (P < 0.001); in the Scheimpflug corneal topography, the thinnest point was observed in G-2 (P = 0.007) and G-3 (P = 0.001) when compared with that of G-1.

Conclusions:

Intrastromal implantation of ADASCs and decellularized or ADASC-recellularized human corneal stroma laminas did not have complications at 3 years. The technique showed a moderate improvement in (uncorrected distance visual acuity) and (corrected distance visual acuity) in advanced keratoconus.
Corneal Donor Characteristics and Descemet Membrane Endothelial Keratoplasty Success: A Scoping Review
Authors: Luke Weinel , Tamme Golding-holbrook , Yee Chen Jern , Richard Mills
Published: February 2021

Purpose:

The purpose of this study was to review published data on donor characteristics and the influence on preoperative Descemet membrane endothelial keratoplasty (DMEK) preparation and intraoperative graft manipulation.

Methods:

A systematic review of PubMed, EMBASE, OVID MEDLINE, and EBSCOhost was conducted up to April 2020. Studies were screened and predefined data criteria extracted. Eleven studies were found to meet the inclusion criteria.

Results:

Research regarding donor characteristics and the relationship to DMEK graft preparation and intraoperative graft manipulation was found to be limited because of the overall low-quality data. However, there was a trend of evidence supporting donor diabetes increasing the risk of graft tearing and consequent preparation failure and younger donors producing tighter scrolls complicating intraoperative graft unfolding.

Conclusions:

Further research into the area is warranted to better understand how donor characteristics impact preoperative DMEK graft preparation and intraoperative graft manipulation.
Impact of Antecedent Antibiotic Usage on Community-associated Clostridioides difficile Infection in Pediatrics
Authors: Dang Rebecca , Alabaster Amy , Miranda-Katz Margot , Parmar Deepika , Greenhow Tara L.
Published: February 2021

Children exposed to antibiotics develop community-associated Clostridioides difficile infections in the 12 weeks following exposure. This secondary analysis was a retrospective review of children with filled prescriptions for commonly prescribed antibiotics between January 1, 2012, and December 31, 2016. Compared with amoxicillin, incident rates of community-associated Clostridioides difficile infections were highest following clindamycin, cephalosporins, and amoxicillin-clavulanate.
VA-MENGOC-BC Vaccination Induces Serum and Mucosal Anti Neisseria gonorrhoeae Immune Responses and Reduces the Incidence of Gonorrhea
Authors: Reyes Díaz Laura M. , Lastre González Miriam de S.J.B. , Cuello Maribel , Sierra-González V. Gustavo , Ramos Pupo Raúl , Lantero Maria Isela , Harandi Ali M. , Black Steven , Pérez Oliver
Published: February 2021

Background:

Overall, there are over 30 different sexually transmitted infections with Neisseria gonorrhoeae being the third most frequent with a reported 78 million cases per year. Gonococcal infection causes genital inflammation, which can be a risk factor for others sexually transmitted infections, particularly human immunodeficiency virus. Gonorrhea is a treatable disease, but recently an increase in antibiotic resistance has been of concern. There are currently no vaccines available. However, parenteral vaccination with anti N. meningitidis serogroup B vaccine has been reported to decrease the incidence of gonococcal burden in New Zealand and in Cuba despite the fact that parenteral vaccination is not deemed to induce mucosal IgA. Here we explore possible mechanisms of protection against gonococcal infection through parenteral meningococcal B vaccination.

Methods:

Ninety-two serum, saliva and oropharyngeal swabs samples of young adults (healthy and Neisseria carriers) of the internal higher school were obtained. They have been vaccinated with VA-MENGOC-BC (MBV) during their infancy and boosted with a third dose during this study. Serum and saliva samples were analyzed by ELISA and Western blot to measured IgG and IgA antibodies against N. meningitidis and N. gonorrhoeae antigens. N. meningitidis carriers were determined by standard microbiologic test. In addition, we reviewed epidemiologic data for N. meningitidis and N. gonorrhoeae infections in Cuba.

Results:

Epidemiologic data show the influence of MBV over gonorrhea incidence suggesting to be dependent of sexual arrival age of vaccines but not over syphilis. Laboratorial data permit the detection of 70 and 22 noncarriers and carriers of N. meningitidis, respectively. Serum anti-MBV antigens (PL) responses were boosted by a third dose and were independent of carriage stages, but saliva anti-PL IgA responses were only present and were significant induced in carriers subjects. Carriers boosted with a third dose of MBV induced similar antigonococcal and -PL saliva IgA and serum IgG responses; meanwhile, serum antigonococcal IgG was significantly lower. In saliva, at least 2 gonococcal antigens were identified by Western blot. Finally, gonococcal-specific mucosal IgA antibody responses, in addition to the serum IgG antibodies, might contributed to the reduction of the incidence of N. gonorrhoeae. We hypothesize that this might have contributed to the observed reductions of the incidence of N. gonorrhoeae.

Conclusion:

These results suggest a mechanism for the influence of a Proteoliposome-based meningococcal BC vaccine on gonococcal incidence.
Choice of Transport to Hospital in Nonurban Areas in Life-Threatening Situations
Authors: Cohen Ayala , Awawdi Khaled , Dessau Nurit , Khatib Mohammad , Ofir Gutler Marganit
Published: February 2021

The time it takes to begin treatment in life-threatening situations is critical. Ambulance transport to the hospital in such situations ensures quick and effective treatment but is not always readily available in nonurban areas, or not preferred by the public, for various reasons. The purpose of this qualitative study was to examine the factors that deter or encourage ambulance use in life-threatening situations in the geographic periphery from clients' perspectives. We conducted interviews with 71 patients in 3 medical centers who had arrived by ambulance or by private transport, and with the 3 emergency department directors. The findings revealed that awareness of the clinical situation and health literacy, accessibility of emergency services, geographical conditions, and social and economic factors are central in the decision to utilize this service. We detail research recommendations for strengthening public health literacy and access to services.
Comprehensive analysis of gene expression and DNA methylation for preeclampsia progression
Authors: Wang Jianrong , Song Hongxian , Zhang Yanhua
Published: February 2021

Background:

The purpose of our study is to identify novel preeclampsia (PE)-related methylation genes and uncover the molecular mechanism of PE.

Methods:

All the datasets of gene expression and DNA methylation datasets for PE and normal samples were obtained from the Gene Expression Omnibus database. We first identified the differentially expressed genes (DEGs) and differential methylation genes (DMGs) between PE and normal samples followed by the functional enrichment analysis. Comprehensive analysis of DEGs and DMGs was also conducted for the identification of valuable PE-related biomarkers. The methylation validation was also performed with MassARRAY.

Results:

Three DNA methylation and three gene expression datasets were incorporated. We obtained 1754 DEGs and 99 DMGs in PE samples with the thresholds of p value <0.05, |Δbeta| > 0.1, and p value <0.05, respectively. Functional analysis of DEGs obtained cell adhesion molecules and leukocyte transendothelial migration. Besides, several valuable biomarkers of PE, including OCA2, CDK2AP1, and ADAM12, were identified through the integrated analysis of gene expression and DNA methylation datasets. Four methylation sites (cg03449867, cg09084244, cg09247979, and cg24194674) were validated, among which cg03449867 and cg09084244 were found to be hypermethylated and the related genes of OCA2 and CDK2AP1 were downregulated in PE compared with normal samples simultaneously. cg24194674 was hypomethylated and its correlated gene ADAM12 was upregulated in PE compared with normal samples simultaneously.

Conclusion:

Our study should be helpful for the development of potential biomarkers and therapeutic targets for PE.
Impact of the extent of negative lymph nodes in gastric adenocarcinoma undergoing primary surgical resection: An institutional report
Authors: Chen Yen-Jen , Yeh Shin-Ting , Ou Liang-Hung , Lin Chen-Sung , Chien Chiang-Ting
Published: February 2021

Background:

Sub-total/total gastrectomy with lymph node dissection (LND) remains an effective therapeutic strategy for resectable gastric adenocarcinomas (GACs). Despite the prognostic significance of positive lymph nodes (PLNs) defined in N-status, few have appraised the impacts of negative lymph nodes (NLNs) and the percentage of NLN (=number of NLNs/number of total lymph nodes [TLNs], %), as well as the extent of TLNs to be dissected in GACs.

Methods:

We retrospectively analyzed 62 GAC patients (mean age of 67.1 years; 41 men) undergoing primary sub-total/total gastrectomy from a single institute. Candidate variables, including the number of NLNs (≤9 and >9) and the percentage of NLN (≤37.5, 37.5-80.6 and >80.6, %), were evaluated to determine their prognostic impacts and hazard ratios (HRs).

Results:

Under the multivariate Cox proportional-hazards regression model, tumor length exceeding 4 cm (p = 0.017; HR = 2.828), perineural invasion (p = 0.037; HR = 3.182), and lower percentage of NLN (p = 0.016 and p = 0.060; HRs = 1.000, 0.327, and 0.333 for subgroups ≤37.5, 37.5-80.6, and >80.6, respectively) were three independent predictors with elevated HRs for poor prognosis. GAC patients with the percentage of NLN > 80.6 were highly related to those with NLNs > 9 (p < 0.001), and GAC patients with NLNs > 9 were highly related to those with TLNs > 15 (p < 0.001). For all 62 GAC or 42 N(+) GAC patients, those who underwent LND with TLNs>15 tended to have more PLNs (p = 0.018, p = 0.003) and more NLNs (p < 0.001, p = 0.029) than did those with TLNs ≤ 15. Among the 42 GAC patients with TLNs > 15, a lower percentage of NLN (p = 0.026 and p = 0.015; HRs = 1.000, 0.272, and 0.180 for subgroups ≤37.5, 37.5-80.6, and >80.6, respectively) remained an independent predictor of poor prognosis.

Conclusion:

The percentage of NLN could predict the prognosis of GAC patients properly. However, an accurate percentage of NLN needs a minimal requirement of TLNs > 15 to detect an adequate number of PLNs and sufficient number of NLNs.
Readmitted Patients With Heart Failure Sick, Tired, and Symptomatic
Authors: Hoke Linda M. , Bradway Christine , Trotta Rebecca L. , Wald Joyce
Published: February 2021

Background and Objective

Heart failure (HF) readmissions will continue to grow unless we have a better understanding of why patients with HF are readmitted. Our purpose was to gain an understanding, from the patients' perspective, of how patients with HF viewed their discharge instructions and how they felt when they got home and were then readmitted in less than 30 days.

Methods and Results

We used a qualitative descriptive approach using semistructured interviews with 22 patients with HF. Most participants had multimorbidities, were classified as New York Heart Association class III (n = 13) with reduced ejection fraction (n = 20), and were on home inotrope therapy (n = 13). The overarching theme that emerged was that these participants were sick, tired, and symptomatic. Additional categories within this theme highlight discharge instructions as being clear and easily understood; rich descriptions of physical, emotional, and other symptoms leading up to readmission; and reports of daily activities including what “good” and “not good” days looked like. Moreover, when participants experienced an exacerbation of their HF symptoms, they were sick enough to be readmitted to the hospital.

Conclusion

Our findings confirm ongoing challenges with a complex group of sick patients with HF, with the majority on home inotropes with reduced ejection fraction, who developed an unavoidable progression of their illness and subsequent hospital readmission.
Testing the Construct Validity and Responsiveness of the Single-Item Presenteeism Question
Authors: Muramatsu Kenji , Nakao Kyoko , Ide Hiroo , Furui Yuji
Published: February 2021

Objective:

We tested the construct validity and responsiveness of a single-item instrument for measuring absolute presenteeism—the single-item presenteeism question (SPQ).

Methods:

Two self-report questionnaire surveys were conducted among employees of 24 small- or medium-sized companies (N = 1021) concerning the recognized predictors of presenteeism–absenteeism, subjective health risks, work engagement, and workplace social capital. Responsiveness was measured by determining whether changes in the presence of predictors between the surveys were accompanied by commensurate changes in SPQ presenteeism.

Results:

SPQ presenteeism exhibited significant associations with the predictors, denoting adequate construct validity. Regarding responsiveness, unfavorable changes in most predictors were associated with increased SPQ presenteeism, as expected.

Conclusions:

We confirmed the construct validity and responsiveness of the SPQ—an instrument that can be employed to promote workplace health and productivity management.
Association Between Implementation of a Universal Face Mask Policy for Healthcare Workers in a Health Care System and SARS-CoV-2 Positivity Testing Rate in Healthcare Workers
Authors: Wang Dee Dee , O’Neill William W. , Zervos Marcus J. , McKinnon John E. , Allard David , Alangaden George J. , Schultz Lonni R. , Poisson Laila M. , Chu Betty S. , Kalkanis Steven N. , Suleyman Geehan
Published: February 2021

Objective:

Examine the effect of a universal facemask policy for healthcare workers (HCW) and incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity.

Methods:

Daily number of symptomatic HCW tested, SARS-CoV-2 positivity rates, and HCW job-descriptions were collected pre and post Universal HCW facemask policy (March 26, 2020). Multiple change point regression was used to model positive-test-rate data. SARS-CoV-2 testing and positivity rates were compared for pre-intervention, transition, post-intervention, and follow-up periods.

Results:

Between March 12 and August 10, 2020, 19.2% of HCW were symptomatic for COVID-19 and underwent SARS-CoV-2 testing. A single change point was identified ∼March 28–30 (95% probability). Before the change point, the odds of a tested HCW having a positive result doubled every 4.5 to 7.5 days. Post-change-point, the odds of a tested HCW having a positive result halved every 10.5 to 13.5 days.

Conclusions:

Universal facemasks were associated with reducing HCW's risk of acquiring COVID-19.
Nurse Practitioner-Managed Clinic Reduces Emergency Department Visits for Parents of Children With Problematic Gastrostomy Tubes
Authors: Maselli Kathryn M. , Camacho Linda , Delaplain Patrick T. , Nguyen Michelle V. L. , Mallicote Michael , Philippe-Auguste Michael , Gayer Christopher P.
Published: February 2021

Background

Gastrostomy tube (G-tube) placement is commonly performed on pediatric patients but has high rates of emergency department (ED) utilization. We hypothesized that a nurse-practitioner-driven G-tube clinic would reduce ED visits and complications and improve provider and patient satisfaction.

Methods

After institutional review board approval, a retrospective chart review was conducted for all patients < 18 years old undergoing G-tube placement between January 2014 and June 2018. Data collected included demographics, indication, and type of G-tube as well as ED visits, clinic visits, and outcomes up to 1-year postoperative. Surveys were distributed to providers and parents to assess attitudes toward the clinic.

Results

There was a decrease in the number of physician clinic visits, but there was no difference in overall 30- or 90-day ED visits after institution of the G-Tube Clinic. In the cohort of patients who had problematic G-tube-related problems, such as granulation, plugged tube, or tube dislodgement, creation of the G-Tube Clinic significantly reduced 30-day (0.37 vs. 0.07, p = .0008), 90-day (0.27 vs. 0.73, p = .0031), and 1-year (0.6 vs. 1.18, p = .014) ED visits. Surgeon and patient satisfaction were improved with clinic implementation.

Conclusions

Implementation of a nurse-practitioner-managed clinic resulted in reduction in 30-day, 90-day, and 1-year ED visits among patients with gastrostomy issues and is associated with high levels of patient and provider satisfaction.
Pre-existing Vestibular Symptoms Are Associated With Acute Vestibular Symptoms After Gamma Knife Therapy for Vestibular Schwannoma
Authors: Bojrab Dennis I. , Fritz Christian G. , Lin Kenny F. , Schutt Christopher A. , Hong Robert S. , Babu Seilesh C. , Chen Peter Y. , Maitz Ann , Bojrab Dennis I.
Published: February 2021

Objective:

To identify pretreatment variables associated with the development of acute vestibular symptoms after Gamma Knife (GK) treatment for Vestibular Schwannoma (VS).

Study Design:

Retrospective case series.

Setting:

Tertiary neurotology referral center.

Patients:

Patients treated with GK radiosurgery for VS between March 2007 and March 2017 were considered for this study. Patients with neurofibromatosis type II, previous VS surgery, follow-up less than 6 months, or the lack of T2 magnetic resonance imaging (MRI) sequences from the day of treatment were excluded.

Main Outcome Measure(s):

The presence of acute vestibular symptoms arising within 6 months after GK was the main outcome variable. Tumor, patient, and treatment characteristics were gathered from the medical record.

Results:

In total, 98 patients met inclusion criteria. The incidence of acute vestibular symptoms occurring within 6 months after GK treatment was 46.9%. Post-GK vestibular symptoms were reported at a significantly higher frequency among subjects who had reported vestibular symptoms before their treatment (p = 0.001). Tumor size was not associated with a propensity to develop acute vestibular symptoms (p = 0.397). The likelihood of receiving a referral to vestibular rehabilitation services was not significantly different among patients with larger versus smaller tumor size, as defined by 1.6 cm and 1.4 cm thresholds (p = 0.896, p = 0.654).

Conclusions:

Inquiries aimed at revealing a history of vestibular complaints may prove useful in counseling patients on the likelihood of experiencing acute vestibular symptoms after treatment of Vestibular Schwannoma with Gamma Knife therapy.