bluuebunny/crossref_metadata_2025 huggingface dataset:
Urethral metastasis from esophageal cancer: symptoms of dysuria and cystoscopic diagnosis
Authors: Kitashiro Saya , Kuno Ikumi , Sugano Tenyu , Yamano Yukimasa , Shigeoka Yasushi , Inaba Mayumi
Published: September 2022

Urethral malignant tumors are rare and can lead to stenosis, causing dysuria. We report a case of urethral metastasis secondary to esophageal cancer. At the time of diagnosis, a patient with esophageal squamous cell carcinoma presented with voiding difficulties, feeble stream, terminal dribbling and incomplete voiding. The urethral tumor was diagnosed using cystoscopy, and biopsy was thereafter performed. Histopathology of the urethral tumor microscopically resembled to that of esophageal cancer. On immunohistochemistry, the urothelium markers uroplakin 2 and GATA3 were negative in the carcinomatous component; however, GATA3 was detected on the lesion’s surface. This case demonstrated that esophageal cancer metastasized to the urethra. Medical oncologists should consider this diagnosis in patients with cancer presenting with dysuria.
Long Covid brain fog: a neuroinflammation phenomenon?
Authors: Kavanagh Emma
Published: September 2022

Neuroinflammation is a process triggered by an attack on the immune system. Activation of microglia in response to an immune system challenge can lead to a significant impact on cognitive processes, such as learning, memory and emotional regulation. Long Covid is an ongoing problem, affecting an estimated 1.3 million people within the UK alone, and one of its more significant, and as yet unexplained, symptoms is brain fog. Here, we discuss the potential role of neuroinflammation in Long Covid cognitive difficulties. Inflammatory cytokines have been found to play a significant role in reductions in LTP and LTD, a reduction in neurogenesis, and in dendritic sprouting. The potential behavioural consequences of such impacts are discussed. It is hoped that this article will allow for greater examination of the effects of inflammatory factors on brain function, most particularly in terms of their role in chronic conditions.
An anisotropic negative thermal expansion metamaterial with sign-toggling and sign-programmable Poisson’s ratio
Authors: Lim Teik-Cheng
Published: September 2022

Objectives

A mechanical metamaterial is introduced herein by drawing inspiration from an Aztec geometric pattern. This metamaterial deformation mechanism for Poisson’s ratio and Young’s modulus is based on non-rotating rhombi with rotating triangles, while the shear modulus analysis herein is based on rotating rhombi with non-rotating triangles, hence ‘partially rotating rigid units’.

Methods

The coefficient of thermal expansion was obtained by equating the potential energy expressions from the simple harmonic motion and from the principle of energy equipartition, while the effective-moduli were acquired by equating the strain energy from rotational stiffness with that from the strain energy of deformation based on an assumed homogenized continuum. Due to the zero and extreme Poisson’s ratio based on infinitesimal deformation, the finite approach was employed.

Results

Results indicate that the proposed metamaterial exhibits anisotropic negative thermal expansion with sign-switching Poisson’s ratio when applied stress along one axis is reversed. The Poisson’s ratio for loading in another axis is undefined under tension but can be programmed to exhibit either sign when compressed. The Young’s and shear moduli are directly governed by the rotational stiffness and strongly influenced by the extent of rotation, followed by the aspect ratio of the rotating units.

Conclusion

Due to its uniqueness, the currently considered mechanical metamaterial can be used under specific requirements which are difficult to be attained by other materials with negative properties.
In vivo Imaging Enables Understanding of Seamless Plant Defense Responses to Wounding and Pathogen Attack
Authors: Toyota Masatsugu , Betsuyaku Shigeyuki
Published: September 2022

Plants are exposed to varied biotic stresses, including sequential or simultaneous attack by insects and pathogens. To overcome these complex stresses, plants must perceive each of the stresses, then integrate and relay the information throughout the plant body and eventually activate local and systemic resistance responses. Previous molecular genetic studies identified jasmonic acid and salicylic acid as key plant hormones of wound and immune responses. These hormones, combined with their antagonistic interaction, play critical roles in the initiation and regulation of defense responses against insects and pathogens. Aside from molecular and genetic information, the latest in vivo imaging technology has revealed that plant defense responses are regulated spatially and temporally. In this review, we summarize the current knowledge of local and systemic defense responses against wounding and diseases with a focus on past and recent advances in imaging technologies. We discuss how imaging-based multiparametric analysis has improved our understanding of the spatiotemporal regulation of dynamic plant stress responses. We also emphasize the importance of compiling the knowledge generated from individual studies on plant wounding and immune responses for a more seamless understanding of plant defense responses in the natural environment.
The Effect of Local Anesthetics and Contrast Agents on Radiofrequency Ablation Lesion Size
Authors: Ortiz Nicole , Shahgholi Leili , Kohan Lynn , Wahezi Sayed E
Published: September 2022

Background

Radiofrequency ablation (RFA) is a validated treatment option for the treatment of chronic pain in patients with lumbar spondylosis. Lesion size has been suggested to correlate with good clinical outcomes. This has created an abundance of scientific interest in the development of products with larger lesion characteristics. Needle characteristics, energy transfer, and heat rate are known to modify lesion size. Here, we demonstrate that common intraoperative solutions, such as lidocaine, iodine, and gadolinium-based products, can also affect lesion shape.

Objectives

To determine whether lidocaine and contrast agents modify lesion characteristics during the performance of monopolar RFA.

Study design

Controlled, ex vivo study using clinically relevant conditions and pre-injections.

Setting

Academic institution in a procedural setting.

Methods

RFA lesion size was compared among six cohorts: 1) lidocaine 1%, 2) lidocaine 2%, 3) iohexol 180, 4) iohexol 240, 5) gadodiamide, and 6) control (no fluid control). Radiofrequency (RF) current was applied for 90 seconds at 80°C via 20-gauge 100-mm standard RFA needles with 10-mm active tips in orgranic chicken breasts without preservative at room temperature (21°C). Twelve lesions were performed for each medication cohort. The length, width, and depth of each lesion were measured. The statistical significance between each medication group and the control group was evaluated by t test.

Results

The mean lesion surface area of monopolar RFA without any pre-injection used was 80.8 mm2. The mean surface area of the monopolar RF lesion with a pre-injection of 0.2 mL of 2% lidocaine was 114 mm2, and the mean surface area of the monopolar RF lesion with a pre-injection of 0.2 mL of iohexol 240 was 130.6 mm2. The statistical analysis demonstrated that the control group had significantly smaller lesion sizes than did the groups in which lidocaine 2% and iohexol 240 were used (P<0.01). There were no statistically significant differences among the groups in which lidocaine 1%, iohexol 180, and gadodiamide were used. A notable difference was a 20% longer lesion with iohexol 240 compared with the control group and a 20% wider lesion with lidocaine 2% compared with the control group.

Limitations

In vivo anatomy within a human was not used in this study, nor were the chicken breasts heated to physiological temperature. Randomization of pieces of chicken breast did not occur, and thus intrinsic differences among the chicken breast pieces could play a confounding role.

Conclusions

Lidocaine 2% and iohexol 240, when used as pre-injections in RFAs, were found to be associated with statistically significant increases in lesion surface area. However, RFAs with lidocaine 1%, iohexol 180, or gadodiamide were not found to produce a statistically significant difference in lesion size compared with monopolar RFA without the use of injectate.
Does Online Professional Development for Physical Therapists Enhance Clinical Practice and Patient Outcomes? Protocol for a Mixed Methods, Randomized Controlled Trial
Authors: Leahy Edmund , Chipchase Lucy , Blackstock Felicity C
Published: September 2022

Objective

Online clinical mentoring has shown potential as a flexible professional development activity that enhances physical therapist practice. Online delivery can overcome time and distance barriers to participation in professional development. The impact of this learning activity on physical therapist practice and patient outcomes has not been rigorously tested. Thus, the aim of this study is to determine whether online clinical mentoring is more effective than asynchronous online lectures at improving physical therapist practice and patient outcomes. An additional aim is to explore the lived experience of physical therapist learners who participate in online clinical mentoring.

Methods

In this mixed methods evaluation, 24 physical therapist learners will be randomized to 1 of 2 online professional development activities. Experimental group physical therapists will complete 6 online clinical mentoring sessions. Control group physical therapists will complete 6 online lectures. The primary outcome evaluated will be the effect on the physical therapist’s patients, using the Patient-Specific Functional Scale. Physical therapist learner secondary outcomes are confidence, self-reflection, and satisfaction. Accounting for possible dropouts, a sample size of 216 patients was determined using a pragmatic sample of 24 physical therapists, power of 0.80, alpha of 0.05, and between-group differences of 1.0 (SD = 2.0) on the Patient-Specific Functional Scale. Consecutive, eligible patients under the care of the physical therapist learners will complete outcome measures at initial appointment and at 4 weeks follow-up. Linear mixed model regression analysis will be used to estimate treatment effects from the posttreatment group means at 4 weeks. Participants undertaking online clinical mentoring will complete semi-structured interviews that will be thematically analyzed using a phenomenological approach.

Impact

This research study will establish the effectiveness of online clinical mentoring to inform future professional development. The qualitative component will identify the potential mechanisms by which online clinical mentoring might be effective, thus informing future implementation of this professional development activity.
Sirenaicks, Guilds and a New Coryate Manuscript
Authors: Neuhauser Julian T S
Published: September 2022

While Thomas Coryate (1577–1617) is most often remembered as an eccentric and pioneering travel writer, his other claim to fame is his participation in a group called ‘right Worshipful Fraternitie of Sireniacal Gentlemen’. Often conflated with the ‘Mermaid Club’, this group met monthly at the Mermaid Tavern to eat, drink and trade jesting verses. Coryate’s role in the group was often that of the comic butt, a position that had classical antecedents in the buffoonish roles of the parasite at Greek symposia and the scurra at Roman convivia. However, a previously overlooked manuscript suggests that Coryate had a closer relationship to at least one of the other Sireniacal Gentlemen, John Hoskins, than simply being his club’s object of ridicule. This new evidence prompts a re-examination of the primary sources related to the ‘Sirenaicks’ (as Coryate called them) as well as the scholarship scrutinizing that group. This essay argues that the Sirenaicks organised themselves as a mock-guild and it begins to develop an understanding of how that social structure affected the group’s mode of literary production.
Development of prediction models to select older RA patients with comorbidities for treatment with chronic low-dose glucocorticoids
Authors: Hartman Linda , da Silva José A P , Buttgereit Frank , Cutolo Maurizio , Opris-Belinski Daniela , Szekanecz Zoltan , Masaryk Pavol , Voshaar Marieke J H , Heymans Martijn W , Lems Willem F , van der Heijde Désirée M F M , Boers Maarten
Published: September 2022

Objective

To develop prediction models for individual patient harm and benefit outcomes in elderly patients with RA and comorbidities treated with chronic low-dose glucocorticoid therapy or placebo.

Methods

In the Glucocorticoid Low-dose Outcome in Rheumatoid Arthritis (GLORIA) study, 451 RA patients ≥65 years of age were randomized to 2 years 5 mg/day prednisolone or placebo. Eight prediction models were developed from the dataset in a stepwise procedure based on prior knowledge. The first set of four models disregarded study treatment and examined general predictive factors. The second set of four models was similar but examined the additional role of low-dose prednisolone. In each set, two models focused on harm [the occurrence of one or more adverse events of special interest (AESIs) and the number of AESIs per year) and two on benefit (early clinical response/disease activity and a lack of joint damage progression). Linear and logistic multivariable regression methods with backward selection were used to develop the models. The final models were assessed and internally validated with bootstrapping techniques.

Results

A few variables were slightly predictive for one of the outcomes in the models, but none were of immediate clinical value. The quality of the prediction models was sufficient and the performance was low to moderate (explained variance 12–15%, area under the curve 0.67–0.69).

Conclusion

Baseline factors are not helpful in selecting elderly RA patients for treatment with low-dose prednisolone given their low power to predict the chance of benefit or harm.

Trial registration

https://clinicaltrials.gov; NCT02585258.
A novel long non-coding RNA, lnc-RNU12, influences the T-cell cycle via c-JUN and CCNL2 in rheumatoid arthritis
Authors: Mo Xing-Bo , Sun Yang-Hua , Wu Long-Fei , He Pei , Cao Rong-Rong , Lu Xin , Zhang Yong-Hong , Deng Fei-Yan , Lei Shu-Feng
Published: September 2022

Objectives

Long non-coding RNAs (lncRNAs) play important roles in RA pathogenesis. However, specific lncRNAs that regulate gene expression in RA pathogenesis are poorly known. This study was undertaken to characterize a novel lncRNA (lnc-RNU12) that has a lower-than-normal expression level in RA patients.

Methods

We performed initial genome-wide lncRNA microarray screening in peripheral blood mononuclear cells from 28 RA cases and 18 controls. Multiple methods were used to validate the detected associations between lncRNAs and RA. Furthermore, we identified the source and characteristics of the highlighted lncRNAs, detected the target genes, and determined the functional effect on immune cells through lncRNA knock-down in Jurkat T cell lines.

Results

lnc-RNU12 was downregulated in peripheral blood mononuclear cells and T cell subtypes of RA patients and was genetically associated with RA risk. lnc-RNU12 mediates the effect of microbiome alterations on RA risk. Activation of T cells caused low expression of lnc-RNU12. Knock-down of lnc-RNU12 in Jurkat T cells caused cell cycle S-phase arrest and altered the expression of protein-coding genes related to the cell cycle and apoptosis (e.g. c-JUN, CCNL2, CDK6, MYC, RNF40, PKM, VPS35, DNAJB6 and FLCN). Finally, c-JUN and CCNL2 were identified as target genes of lnc-RNU12 at the mRNA and protein expression levels. RNA-binding protein immunoprecipitation assays verified the interaction between lnc-RNU12 and the two proteins (c-Jun and cyclin L2) in Jurkat cells.

Conclusions

Our study suggested that lnc-RNU12 was involved in the pathogenesis of RA by influencing the T cell cycle by targeting c-JUN and CCNL2.
Precious Neighbors: The Value of Co-Locating with the Government
Authors: Stahl Jörg R
Published: September 2022

In many countries, disproportionately many firms locate their headquarters in the capital city. Spatial proximity to a country’s leading politicians may be beneficial for a number of reasons. Since neither firms nor governments move randomly, the effects of firms’ co-locating with the government are normally hard to identify. I solve this problem by examining a unique event—the decision to relocate the German federal government from Bonn to Berlin in 1991. Following reunification, there was a free vote in the German parliament on the future location of the government. Berlin won by a narrow margin, an event that could not be anticipated even days before and that is free from confounding factors. Firms with corporate headquarters in Berlin experience abnormal equity returns of more than 3% following the relocation decision.
Using the Health Belief Model to improve influenza vaccination rates
Authors: Gutierrez Felicia , Wolfe Justin
Published: September 2022

Vaccination rates for influenza are lower than expected each year in the United States. Multiple factors contribute to low vaccination rates, including poor access to healthcare, lack of insurance, and patient perception of risk and benefit. A better working understanding of the Health Belief Model can help clinicians understand the psychologic factors that contribute to low vaccination rates and help clinicians improve patient understanding and uptake of the influenza vaccine.
Allergen immunotherapy, cancer, and immune disorders
Authors: El-Qutob David , Matheu Victor , Fernandez-Caldas Enrique
Published: September 2022

Purpose of review

The purpose of this review is to provide an update on the intriguing relationships between allergies, allergen immunotherapy, cancer, and immune disorders. Allergic diseases and cancer are increasing in incidence and prevalence and a potential relationship, or not, between these diseases have been suggested for many years.

Recent findings

Recent findings suggest that there may be some causative effects between certain types of cancer and allergic diseases, as described in the text. Some types of cancer may be more linked to the presence of an allergic disease, than others. However, epigenetic factors, such as tobacco smoke alcohol and toxic substances should also be taken into consideration.

The association between allergy and cancer is complex and depends on the specific allergy and the specific organ under consideration. Regarding pancreatic cancer, colorectal cancer (CRC), and glioma, all types of allergies were shown to be a protective factor. Conversely, asthma is a risk factor for lung cancer as is atopic dermatitis for skin cancer. Despite extensive research, no definite relationship has been determined, and no clear relationship, either positive or negative, to allergies can be observed. These results should be corroborated with large epidemiological well designed prospective studies due to some weaknesses in the previous investigations.
Longitudinal Development of Verbal and Nonverbal Intelligence After Cochlear Implantation According to Wechsler Tests in German-speaking Children: A Preliminary Study
Authors: Fei Peipei , Shehata-Dieler Wafaa , Huestegge Lynn , Hagen Rudolf , Kühn Heike
Published: September 2022

Objectives:

Intelligence as a construct of cognitive abilities is the basis of knowledge and skill acquisition and the main predictor of academic achievement. As a broad construct, it is usually divided into subdomains, such as nonverbal and verbal intelligence. Verbal intelligence is one domain of intelligence but is not synonymous with specific linguistic abilities like grammar proficiency. We aim to address the general expectation that early cochlear implantation enables children who are hard of hearing to develop comprehensively, including with respect to verbal intelligence. The primary purpose of this study is to trace the longitudinal development of verbal and nonverbal intelligence in children with cochlear implants (CIs).

Design:

Sixteen children with congenital hearing loss who received unilateral or bilateral implants and completed at least two intelligence assessments around the age of school entrance were included in the study. The first assessment was performed around 3 years after CI fitting (chronological age range: 3.93 to 7.03 years). The second assessment was performed approximately 2 years after the first assessment. To analyze verbal and nonverbal IQ in conjunction and across children at different ages, we used corresponding standardized and normalized tests from the same test family (Wechsler Preschool and Primary Scale of Intelligence and/or Wechsler Intelligence Scale for Children).

Results:

Regarding longitudinal development, both verbal and nonverbal IQ increased, but verbal IQ increased more substantially over time. At the time of the second measurement, verbal and nonverbal IQ were on a comparable level. Nevertheless, we also observed strong inter-individual differences. The duration between both assessments was significantly associated with verbal IQ at the second measurement time point and thus with verbal IQ gain over time. Education mode (regular vs. special kindergarten/school) was significantly correlated with nonverbal IQ at the second assessment time point.

Conclusions:

The results, despite the small sample size, clearly suggest that children with CIs can achieve intellectual abilities comparable to those of their normal-hearing peers by around the third year after initial CI fitting, and they continue to improve over the following 2 years. We recommend further research focusing on verbal IQ assessed around the age of school entrance to be used as a predictor for further development and for the establishment of an individual educational program.
Effect of aspirin in preventing deep vein thrombosis (DVT) after lumbar canal spinal stenosis surgeries: a double-blind parallel randomized clinical trial
Authors: Nikouei Farshad , Chehrassan Mohammadreza , Shakeri Mohammadreza , Mahdavi Seyed Mani , Ameri Ebrahim , Eslami Arvin , Habibollahzadeh Ali , Ghandhari Hasan
Published: September 2022

Background:

Deep vein thrombosis (DVT) is a great postoperative challenge in all orthopaedic surgeries. To the authors’ knowledge, this study is the first to evaluate the efficacy of aspirin administration in the prevention of DVT in patients undergoing lumbar spinal surgery.

Methods:

In this double-blind parallel randomized clinical trial, a total of 126 candidates (age 40 yr and older) were admitted between June 2021 to December 2021. Patients were randomly assigned to the intervention chemoprophylaxis group (41 patients receiving 325 mg aspirin) and controls. The DVT occurrence was recorded by clinical features (Well’s criteria), Doppler lower limbs ultrasound, and D-dimer levels in all participants at baseline (24 hr before the time of surgery) and 2, 6, and 12 wk after surgery in postoperative visits.

Results:

The mean age of the participants was 63.72±6.87 yr. Baseline demographic values were similar in both groups (P>0.05). The mean follow-up duration was 6.11±2.33 mo. No cases of DVT or abnormal findings on Doppler ultrasound were observed in either group. The mean duration of hospitalization or intensive care unit (ICU) admission was similar between the two groups. Mean baseline D-dimer levels were significantly higher in the intervention group compared with the controls (P=0.047), while it was similar in both groups 3 mo after the operation (P=0.13).

Conclusions:

In the current study, no case of DVT was observed in either study group. These data do not support the use of aspirin as an anticoagulant for DVT prophylaxis following regular lumbar spinal surgeries.

Level of Evidence:

Level II.
The utility of patient-reported outcome measures in orthopaedic trauma research: a systematic review
Authors: Magnusson Erik A. , Novak Avrey , Bagley Joshua , Walterscheid Zakkary , Jackson Madeleine , Claudi Carolin , Elhaddad Moamen , Albaba Adam , Doan Jessica , Vo Kiet , Firoozabadi Reza
Published: September 2022

Background:

Patient-reported outcome score measures (PROM) are valuable tools in assessing patient function following management of orthopaedic conditions. The purpose of this study was to investigate and characterize the use of PROM in the orthopaedic trauma literature.

Methods:

Articles published in the Journal of Orthopaedic Trauma (JOT), Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Foot and Ankle International (FAI), Journal of Hand Surgery (JHS), and Journal of Shoulder and Elbow Surgery (JSES) from 2011 to 2019 were reviewed. Publications pertaining to outcomes after trauma were included. Publication year, number of patient-reported outcome measures (PROM) used, and the specific PROMs published per study were recorded.

Results:

Of the 11,873 articles reviewed, 3,583 (30%) articles pertained to trauma. Twenty-nine percent of orthopaedic trauma articles utilized at least one PROM. There was a gradual increase in trauma publications with PROMs over 9 yr. An average of two PROMs were reported per publication. The percentage of trauma studies that included PROMs varied by journal. In JOT, 35% of trauma articles published included PROM, 30% of articles published in JBJS, 27% in CORR, 48% in JSES, 30% in JHS, and 49% of trauma articles in FAI utilized PROM. The most commonly used PROMs included: visual analog scale (VAS) (n=411), Disabilities of the Arm and Hand Score (DASH) (n=281), Constant-Murley Score (n=145), Short Form Survey-36 (n=123), the Mayo Elbow Performance Index (n=101), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (n=93).

Conclusions:

Clinical outcome studies utilizing PROMs after orthopaedic trauma represented a minority of publications across six major journals between 2011 to 2019. Standardization of PROMs is lacking, making comparison between studies challenging. The VAS and DASH scores were the most frequently PROMs reported followed by additional PROMs for the upper extremity. Characterizing the use of PROMs directs future investigators toward selecting applicable PROMs to evaluate patient outcomes following orthopaedic trauma.

Level of Evidence:

Level IV.
Causes and outcomes of hepatic fibrosis in persons living with HIV
Authors: Yen Debra W. , Sherman Kenneth E.
Published: September 2022

Purpose of review

The epidemiology of liver disease in people living with HIV has evolved since the arrival of effective hepatitis C virus (HCV) treatment. Nonalcoholic fatty liver disease (NAFLD) in HIV patients is highly prevalent while hepatitis D, hepatitis E, and occult hepatitis B remain underappreciated. We discuss mechanisms of fibrosis in HIV and review clinical outcomes of HIV-associated liver diseases.

Recent findings

HIV-HCV co-infection is receding as a cause of progressive liver disease, but fibrosis biomarkers after HCV treatment remain elevated. Antiretroviral therapy (ART) with anti-hepatitis B virus (HBV) activity promotes stable liver disease, but oversimplifying ART regimens in unrecognized suppressed HBV may lead to activation of HBV. A high prevalence of fibrosis and rapid progression of fibrosis are seen in HIV-associated NAFLD, with visceral fat as a major risk factor. Newer ART such as integrase strand inhibitors may have limited intrinsic hepatoxicity but do increase weight, which may secondarily lead to hepatic steatosis. Promising therapies for HIV-associated NAFLD include tesamorelin and CCR5 blockade agents.

Our understanding of the natural history and pathogenesis of liver diseases in HIV has advanced and adapted to the changing landscape of liver disease in this population. Future research should evaluate long-term clinical and histological outcomes, prevention strategies, and treatment options to improve morbidity and mortality in HIV-related liver diseases.
Pelviureteric junction obstruction in adults: A systematic review of the literature
Authors: O'Sullivan Niall J. , Anderson Steven
Published: September 2022

Background

Pelviureteric junction obstruction (PUJO) is a common urological disorder that can present at any stage of life. The underlying etiology in children has been well studied; however, a gap exists in the literature for the adult population. Herein, we performed a systematic review of the literature to evaluate the current evidence on the underlying etiologies of adult patients presenting with PUJO.

Materials and methods

Four electronic databases were searched for relevant studies assessing the underlying etiologies of pelviureteric junction obstruction in adults. Studies were assessed for eligibility based on predefined inclusion and exclusion criteria, and a critical appraisal of methodological quality and risk of bias was performed. Finally, qualitative and quantitative data analyses were performed.

Results

Twelve studies comprising a total of 513 patients with radiologically confirmed PUJO met the inclusion criteria and were included in our analysis. The most common finding was crossing vessels, which were observed in 50.5% of patients, followed by intrinsic ureteral stenosis (27.1%), adhesions (15.3%), and high insertion of the ureter (10.1%).

Conclusions

The underlying etiologies of PUJO in adults remain unclear. This study indicated that obstruction secondary to crossing vessels is the most common cause of obstruction in adults and occurs more frequently than in the pediatric population.
Laser speckle contrast imaging compared with indocyanine green in renal perfusion of a porcine model
Authors: Noël Jonathan , Mascarenhas Anya , Nwaiwu Chibueze A. , Liu Yao , Moschovas Marcio , Buharin Vasiliy E. , Oberlin John , Mehrotra Saloni , Dechert Alyson F. , Kim Peter C. W. , Patel Vipul
Published: September 2022

Background

When viewed under near-infrared light, indocyanine green (ICG) signal for kidney perfusion can be utilized in partial nephrectomy. Laser speckle contrast imaging (LSCI) uses coherent light to detect perfusion during real-time laparoscopic surgery.

Materials and methods

Laser speckle contrast imaging or ActivSight, an imaging sensor adapter, was used during laparoscopy of an anesthetized porcine kidney model. ActivSight's “perfusion mode” and “quantification mode” displayed the blood flow as a heatmap and numerical signal intensity, respectively.

Results

After the upper segmental renal artery was clamped, ICG was seen in the lower pole, and LSCI showed low unit (dark color) quantification and perfusion in the upper pole. Indocyanine green was retained in the lower pole after the upper segmental artery was unclamped, and LSCI perfusion was demonstrated in the entire kidney.

Conclusions

Laser speckle contrast imaging is a dye-free, repeatable, real-time adjunct for renal parenchymal perfusion assessment applicable to minimally invasive renal surgery to complement the technology of ICG near-infrared fluorescence and advance digital surgery.
Using Latent Profile Analysis to Identify Associations Between Gestational Chemical Mixtures and Child Neurodevelopment
Authors: Yonkman Amanda M. , Alampi Joshua D. , Kaida Angela , Allen Ryan W. , Chen Aimin , Lanphear Bruce P. , Braun Joseph M. , Muckle Gina , Arbuckle Tye E. , McCandless Lawrence C.
Published: September 2022

Background:

Unsupervised machine learning techniques have become increasingly popular for studying associations between gestational exposure mixtures and human health. Latent profile analysis is one method that has not been fully explored.

Methods:

We estimated associations between gestational chemical mixtures and child neurodevelopment using latent profile analysis. Using data from the Maternal-Infant Research on Environmental Chemicals (MIREC) research platform, a longitudinal cohort of pregnant Canadian women and their children, we generated latent profiles from 27 gestational exposure biomarkers. We then examined the associations between these profiles and child Verbal IQ, Performance IQ, and Full-Scale IQ, measured with the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III). We validated our findings using k-means clustering.

Results:

Latent profile analysis detected five latent profiles of exposure: a reference profile containing 61% of the study participants, a high monoethyl phthalate (MEP) profile with moderately low persistent organic pollutants (POPs) containing 26%, a high POP profile containing 6%, a low POP profile containing 4%, and a smoking chemicals profile containing 3%. We observed negative associations between both the smoking chemicals and high MEP profiles and all IQ scores and between the high POP profile and Full-Scale and Verbal IQ scores. We also found a positive association between the low POP profile and Full-Scale and Performance IQ scores. All associations had wide 95% confidence intervals.

Conclusions:

Latent profile analysis is a promising technique for identifying patterns of chemical exposure and is worthy of further study for its use in examining complicated exposure mixtures.
Functional Significance of Angiotensin Receptor Type 2 in the Neuroplasticity of Autonomic Ganglia in (mRen2)27 Transgenic Hypertensive Rats
Authors: Swami Vetha Berwin Singh , Byrum Rachel , Peele Kaisi , Diz Debra , Aileru Azeez
Published: September 2022

The over-expression of Ren-2d gene in (mRen2)27 rats leads to development of hypertension mediated by the renin-angiotensin-system axis and exaggerated sympathetic nerve activity. Exogenously applied angiotensin II (AngII) on the superior cervical ganglion evokes ganglionic compound action potentials (gCAP) and ganglionic long-term potentiation (gLTP). We studied the functional role of angiotensin receptors and expression of reactive oxygen species marker, nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) proteins in AngII–induced postganglionic transmission. Bath-applied AngII revealed that the indices of ganglionic transmission, synaptic strength of gCAP, and decay time for gLTP are remarkably prolonged in (mRen2)27 rats and were abolished by an angiotensin receptor blocker (ARB), suggesting postganglionic AngII Type 1 (AT1) receptor localization and mediation. Receptor density for AT1 was similar in (mRen2)27 and control animals, and quantitative reverse transcription polymerase chain reaction revealed that it is consistent with the mRNA profile. Furthermore, immunocytochemistry analysis showed similar AT1 receptor distribution and signals. However, assessment of Type 2 (AT2), Ang-(1-7)-MAS and NOX4-specific proteins showed that AT2 receptor protein expression was 4-fold lower, consistent with a low mRNA profile. MAS receptor expression was 10-fold lower and NOX4 protein was 2-fold lower. Despite similarity in the densities of AT1 receptor, the low levels of the components of the protective arm of the renin-angiotensin system at the ganglia may contribute to the differential superior cervical ganglion sensitivity to AngII. The lower NOX4 affects reactive oxygen species balance and possibly results in activation of downstream pathways to promote increased sympathetic nerve activity. We speculate that the significant diminution in AT2, MAS, and NOX4 protein expressions may play an indirect role in the alteration and efficacy of gCAP and gLTP in hypertension.
Pregnancy options counseling
Authors: Owens Sarah N. , Shorter Jade M.
Published: September 2022

Purpose of Review

This article reviews key aspects of pregnancy options counseling, and highlights how inappropriate counseling can create barriers to timely and safe abortion care.

Recent Findings

Access to safe abortion services in the United States is increasingly constrained. One way to combat this hostile environment is to ensure that individuals presenting for care early in pregnancy have access to comprehensive and unbiased pregnancy options counseling. There are unfortunately many barriers to individuals receiving adequate pregnancy options counseling, and marginalized groups experience disproportionate effects of inappropriate counseling. Research shows that individuals desire appropriate pregnancy options counseling when seeking early pregnancy care, and that providers often serve as a barrier to this care. Provider miseducation and opposition to pregnancy options counseling, particularly as it concerns abortion care, creates challenges and delays for people seeking abortion services. Crisis Pregnancy Centers use misinformation to further these barriers to appropriate care.

Nondirective and patient-centered pregnancy options counseling is standard of care. People seeking pregnancy options counseling desire and deserve comprehensive and accurate information. Providers must not serve as barriers to safe and appropriate care. Increasing nondirective pregnancy options counseling research, education, and training is crucial to ensuring access to safe and appropriate abortion care.
Limited evidence of a threshold effect for increasing adiposity on risk of symptoms at midlife
Authors: Sievert Lynnette Leidy , Whitcomb Brian W. , Verjee Mohamud A. , Gerber Linda M.
Published: September 2022

Objective

To assess the nature of relationships between increasing body mass index (BMI) and the prevalence of midlife symptoms in a population with high adiposity.

Methods

In the cross-sectional Study of Women's Health in Qatar, 841 participants aged 40 to 60 years were recruited from nine primary health centers in Doha. Face-to-face interviews collected demographic, menopause, and symptom information. BMI (kg/m2) was categorized as healthy, overweight, or class I, II, or III obesity. Multivariate logistic regression models were used to examine aches/stiffness in joints, trouble sleeping, shortness of breath, urinary incontinence, and hot flashes with BMI categories. Restricted cubic splines (RCSs) were used to estimate relationships between continuous BMI and each symptom and to conduct formal tests of nonlinearity.

Results

Mean BMI was 34.3 kg/m2 (SD, 6.0 kg/m2). Women with class II and III obesity had higher odds of reporting aches/stiffness than women with a healthy BMI, and the odds of reporting urinary incontinence were three times higher among women with class III obesity (odds ratio, 3.08; 95% confidence interval, 1.17-8.14). Using restricted cubic spline models, a significant nonlinear association (P = 0.002) was observed between aches/stiffness and BMI with an apparent threshold of 38 kg/m2. Linear relationships were observed with BMI for urinary incontinence (P < 0.001 for linear trend) and shortness of breath (P = 0.005 for linear trend). Trouble sleeping and hot flashes were not associated with BMI.

Conclusions

Even at very high levels of BMI, likelihood of urinary incontinence and shortness of breath increases with BMI. In contrast, likelihood of aches/stiffness has a nonlinear relationship with BMI, increasing to a threshold level.
Vitamin D supplements and prevalent overactive bladder in women from midlife through older ages
Authors: Vaughan Camille P. , Markland Alayne D. , Huang Alison J. , Tangpricha Vin , Grodstein Francine
Published: September 2022

Objective

The objective of this study is to determine if vitamin D supplementation is associated with prevalent overactive bladder (OAB) in women across the aging spectrum.

Methods

We used the Nurses' Health Study (NHS) I (initiated in 1976) and NHS II (initiated in 1989) cohorts to evaluate the association of vitamin D supplements with prevalent OAB, all of which were reported by participants in 2019 in both NHS cohorts. OAB was defined as the self-reported need to rush to toilet to urinate at least sometimes. Further, OAB/wet included incontinence at least monthly because of urgency, whereas OAB/dry included incontinence once per month or less, or stress-predominant incontinence. Multivariable-adjusted odds ratios and 95% confidence intervals of OAB/dry and OAB/wet subtypes were estimated using logistic regression models.

Results

Among the 75,316 women (age range, 55‐98 y) from NHS and NHS II OAB prevalence was 26%. Increasing prevalence was observed across each older age group, with 41% of women 85 years or older reporting OAB symptoms. OAB/dry was more common (18%) than OAB/wet (8%). After multivariable adjustment, no clinically significant association between vitamin D supplementation and prevalent OAB or OAB type was observed.

Conclusions

OAB symptoms are highly prevalent across adult women, including the oldest old, who are often excluded from treatment trials. Despite interest in vitamin D supplementation as a low-cost strategy to address OAB, our findings indicate oral vitamin D is not associated with prevalent OAB in middle-aged and older women.
EFFICACY OF INNER WALL RETINECTOMY FOR BULLOUS SCHISIS CAVITY HANGING OVER OR THREATENING THE MACULA IN PATIENTS WITH CONGENITAL X-LINKED RETINOSCHISIS
Authors: Iwahashi Chiharu , Matsushita Itsuka , Kuniyoshi Kazuki , Kondo Hiroyuki , Kusaka Shunji
Published: September 2022

Purpose:

To present the clinical characteristics, surgical outcomes, and surgical complications of patients with congenital X-linked retinoschisis who underwent vitrectomy for bullous schisis cavity hanging over or threatening the macula.

Methods:

Nine patients with congenital X-linked retinoschisis (12 eyes) who underwent vitrectomy at three tertiary hospitals and completed ≥3 years of postoperative follow-up were retrospectively investigated. Data were collected from patients' charts, including age at vitrectomy, surgical procedures, and postoperative complications.

Results:

The age at vitrectomy ranged 4 months to 103 months (median: 14 months). Inner wall retinectomy was performed during the initial vitrectomy in eight eyes. Among the eight eyes that initially underwent inner wall retinectomy, one (12.5%) required subsequent retinal surgery for postoperative complication. Furthermore, four eyes did not undergo initial inner wall retinectomy but required subsequent retinal surgeries for postoperative complications. Three of five eyes (60.0%) treated with silicone oil tamponade and two of seven eyes (28.6%) that were not treated with silicone oil tamponade during the initial vitrectomy required subsequent retinal surgeries for postoperative complications. All eyes maintained a clear central visual axis at the last examination.

Conclusion:

Inner wall retinectomy seems beneficial in achieving a clear visual axis in eyes with bullous schisis cavity hanging over or threatening the macula in patients with congenital X-linked retinoschisis.
BILATERAL MACULAR CHOROIDAL ABNORMALITIES WITH DRUSENOID DEPOSITS IN PATIENTS WITH UNILATERAL PERIPHERAL EXUDATIVE HEMORRHAGIC CHORIORETINOPATHY
Authors: Choi Eun Young , Kim Hae Rang , Jung Jaehoon , Byeon Suk Ho , Kim Sung Soo , Kim Min
Published: September 2022

Purpose:

To investigate bilateral macular features on optical coherence tomography in patients with unilateral peripheral exudative hemorrhagic chorioretinopathy (PEHCR).

Methods:

In this cross-sectional study, optical coherence tomography features of affected eyes (PEHCR group, n = 30) and unaffected contralateral eyes (contralateral group, n = 30) were investigated. Age-matched and sex-matched patients with polypoidal choroidal vasculopathy (PCV group, n = 51) and healthy controls (normal group, n = 50) were included to compare choroidal thickness, measured at six points apart from the fovea, with the PEHCR group.

Results:

Subretinal drusenoid deposits were the most common feature in the PEHCR (20%) and contralateral (23%) groups, followed by soft drusen. Although the macular choroid was comparably thin in both the PEHCR and contralateral groups, pachyvessels were also observed. The choroids of the PEHCR group were significantly thinner than those of the normal group at the subfovea and 1-mm temporal to the fovea and considerably thinner than those of the polypoidal choroidal vasculopathy group from 3-mm nasal to 3-mm temporal to the fovea.

Conclusion:

In patients with unilateral PEHCR, bilateral choroidal thinning and drusenoid deposit accumulation were noted in the macula. The pathophysiology of PEHCR may be a rare peripheral complication of age-related macular degeneration with pathologic choroid.
Approach to the diagnosis and management of nutritional optic neuropathies
Authors: Bhat Nita , Bakaeva Tatiana
Published: September 2022

Purpose of review

Nutritional deficiency is an under-recognized cause of optic neuropathy. The purpose of this review is to discuss how to identify, diagnose, and appropriately manage patients with nutritional optic neuropathy.

Recent findings

Nutritional deficiencies have long been thought to be more prevalent in the developing countries. However, with the advent of bariatric surgery, restrictive/selective diets, and the increase in alcohol dependence, it is not uncommon to see nutritional optic neuropathies in the developed world.

Although nutritional optic neuropathy can cause severe and debilitating vision loss, it is often reversible when it is diagnosed and treated in a timely manner.
Peripheral ulcerative keratitis due to systemic diseases
Authors: Sura Amol A. , McCallum Rex M.
Published: September 2022

Purpose of review

To discuss peripheral ulcerative keratitis, with a focus on the evaluation and management of associated systemic diseases.

Recent findings

Peripheral ulcerative keratitis (PUK) is a sight-threatening condition that is often defined by the presence of a crescent-shaped area of peripheral corneal thinning, an epithelial defect, and an inflammatory corneal infiltrate. It is highly associated with rheumatoid arthritis, systemic necrotizing vasculitides like granulomatosis with polyangiitis, and collagen vascular diseases like systemic lupus erythematosus. Undertreated PUK carries a risk of vision loss and premature death.

Multidisciplinary collaboration between the ophthalmologist, rheumatologist, and other consultants is required. Early and aggressive steroid-sparing therapy should be considered in cases due to noninfectious systemic disease.
Current concepts in granulomatosis poly angiitis and the eye
Authors: Sivaraman Bala Murugan , Majumder Parthopratim Dutta , Mahendradas Padmamalini , Somanath Anjana , Pyare Richa , Patil Aditya
Published: September 2022

Purpose of review

Granulomatosis with polyangiitis (GPA), a multisystem disease with diverse systemic and protean ocular manifestations. Its pathophysiology, spectrum of the ocular manifestations, changing paradigms in the diagnosis of the disease, recent updates in the treatment patterns are clinically relevant to the treating clinician. They are described in this review.

Recent findings

The changing trends in the diagnosis, treatment can be adapted to real time clinical practice to provide the best quality of life to patients with GPA.
Cataract surgery considerations in patients with prior history of keratoconus and ectasia
Authors: Moshirfar Majid , Ziari Melody , Ronquillo Yasmyne C.
Published: September 2022

Purpose of review

Preoperative workup for cataract surgery in patients with keratoconus poses certain challenges, particularly in patients with moderate-to-severe disease. This review aims to outline the appropriate preoperative, intraoperative, and postoperative considerations and provides an algorithm to help guide the workup prior to surgery.

Recent findings

A new system for keratoconus progression and staging has been proposed and additional studies comparing intraocular lens (IOL) formulas calculations and biometry devices have been conducted.

Patients with severe keratoconus have unpredictable results and have an increased risk of a hyperopic refraction postoperatively. Although studies have compared IOL calculation formulas, there is no consensus on management. Clinical considerations and an approach to the workup are presented; however, additional studies are required to determine the most appropriate management of cataracts in severe keratoconus.