bluuebunny/crossref_metadata_2025 huggingface dataset:
SELF-DESIGNATION OF THE TREATED EYE BEFORE INTRAVITREAL INJECTIONS
Authors: Mimouni Michael , Naftali Ben Haim Liron , Rozenberg Eldad , Shapira Yinon , Beiran Itzchak , Zayit-Soudry Shiri
Published: August 2020

Purpose:

To identify risk factors for incorrect self-identification of the treatment eye before intravitreal injections.

Methods:

This prospective study included consecutive patients who were asked to designate the eye for which the intravitreal injection was intended and were subsequently divided into two groups according to whether or not they identified the correct eye.

Results:

Overall, 349 eyes (n = 349) were included, and 8.6% (n = 30) designated the incorrect eye or did not know which eye was intended for treatment. Incorrect designation was associated with diabetic macular edema (odds ratio [OR] = 0.33 [0.15–0.75]), first injection in the intended eye or ≥1 year since previous injection (OR = 0.34 [0.14–0.87]), Arabic native tongue (OR = 0.48 [0.22–1.01]), previous injection to the fellow eye (OR = 0.26 [0.10–0.64]), and concurrent treatment of both eyes (OR = 0.35 [0.16–0.74]). Multivariate analysis showed the first injection or ≥1 year since last injection in the treatment eye (R2 = 2.24%, P = 0.004, OR = 0.20 [0.07–0.57]) and previous injection in the fellow eye (R2 = 6.55%, P < 0.001, OR = 0.20 [0.07–0.52]) as significant independent predictors of incorrect identification.

Conclusion:

Several factors are associated with a greater probability for incorrect patient's self-identification of the eye laterality intended for intravitreal injections. These findings may help identify patients with a higher risk of such potential errors.
Risks and Benefits of Surgical Excision of Orbital Cavernous Venous Malformations (So-Called Cavernous Hemangioma): Factors Influencing the Outcome
Authors: Strianese Diego , Bonavolontà Giulio , Iuliano Adriana , Mariniello Giuseppe , Elefante Andrea , Liuzzi Raffaele
Published: August 2020

Purpose:

To assess risks and benefits associated with surgical excision of orbital cavernous venous malformation and analyze factors influencing the outcome.

Methods:

Design: cohort study. Participants: 164 consecutive patients undergoing surgical removal of orbital cavernous venous malformation. Intervention: lateral or anterior orbitotomy. Outcome measures: visual acuity, visual field, pupillary function, ocular motility, and fundus examination. Influence of the mass volume and tumor location on the outcome was evaluated. The threshold value and risk group for the volume were evaluated using the receiver operating characteristic analysis; 8 orbital different quadrants, extraconal/intraconal position, and orbital apex extension were considered as variables to evaluate the location.

Results:

Postoperatively overall visual acuity (p = 0.0084), visual field (p < 0.0001), diplopia (p < 0.0001), proptosis (p < 0.0001), ocular motility (p = 0.02), ptosis (p = 0.033), choroidal fold (p < 0.0001), disk edema (p = 0.0004) were significantly improved. The commonest location was the lateral quadrant (28%). Choroidal folds were associated with tumor greater than 1100 mm3 (p = 0.001). Visual loss occurred in 2 patients (1.2%) and tonic pupil in 5 (3%,) Visual deterioration was associated with the apical extension (p = 0.001). Pupil efferent defect was associated with lateral quadrant location (p = 0.011) and apical extension (p = 0.05).

Conclusions:

Surgical removal of orbital cavernous venous malformation is a useful treatment modality, particularly for large size tumors. Removal of cavernous venous malformations located at the lateral aspect of the orbit carries an increased risk of permanent tonic pupil. Postoperative blindness is rarely seen and is often associated with the apical extension. Tailoring the surgical approach, depending on the relative position to the optic nerve, may have an important bearing on outcome.
Tarsal Epithelial Cysts: Prevalence, Case Series, and Synthesis of Existing Literature
Authors: Ahmad Meleha , Chen Hung-Chang , Chang Jessica R. , Hodgson Nickisa , McDonnell Emma C. , Henderson Amanda D. , Siadati Sepideh , Eberhart Charles G. , McCulley Timothy J.
Published: August 2020

Purpose:

Tarsal epithelial cysts (TECs) are squamous epithelial-lined lesions of the eyelid that are often mistaken for chalazia or epidermal inclusion cysts. They remain poorly described in the literature. This study is designed to characterize the prevalence and clinical features of TEC.

Methods:

We conducted a single-center retrospective review of adult patients with a diagnosis of eyelid neoplasm, eyelid cyst, hordeolum, stye, or chalazion between January 1, 2011 and July 1, 2017. Among this cohort, we identified patients with a histopathologic diagnosis of TEC. We also conducted a PubMed literature review and synthesis of existing clinical data of patients reported to have TEC, noting common clinical and histopathological features.

Results:

Of 7,516 patients, we identified 6 patients with a histopathological diagnosis of TEC, amounting to a prevalence of 0.08% amongst patients with eyelid lesions. Average age was 49.7 years (range 18–76 years), with a 1:1 male to female ratio. The most common presenting symptom was a painless eyelid mass, and the majority (66.6%) had a preoperative diagnosis of chalazion. All but 1 patient had surgical excision from the posterior approach and there was 1 recurrence in the follow-up period. On review of the literature, we identified 68 prior cases of TEC from 18 clinical studies, with clinical features mirroring our case series.

Conclusions:

TEC has stereotypical clinical and histologic features that distinguish it from other tarsal lesions. Our review identified TEC as a relatively rare cause of eyelid lesions.
Effects of sex on placebo effects in chronic pain participants: a cross-sectional study
Authors: Olson Elizabeth M. , Akintola Titilola , Phillips Jane , Blasini Maxie , Haycock Nathaniel R. , Martinez Pedro E. , Greenspan Joel D. , Dorsey Susan G. , Wang Yang , Colloca Luana
Published: August 2020

Sex-related differences can influence outcomes of randomized clinical trials and may jeopardize the effectiveness of pain management and other therapeutics. Thus, it is essential to understand the mechanistic and translational aspects of sex differences in placebo outcomes. Recently, studies in healthy participants have shed light on how sex-related placebo effects might influence outcomes, yet no research has been conducted in a patient population. Herein, we used a tripartite approach to evaluate the interaction of prior therapeutic experience (eg, conditioning), expectations, and placebo effects in 280 chronic (orofacial) pain patients (215 women). In this cross-sectional study, we assessed sex differences in placebo effects, conditioning as a proxy of prior therapeutic effects, and expectations evaluated before and after the exposure to positive outcomes, taking into account participant–experimenter sex concordance and hormonal levels (estradiol and progesterone assessed in premenopausal women). We used mediation analysis to determine how conditioning strength and expectations impacted sex differences in placebo outcomes. Independent of gonadal hormone levels, women showed stronger placebo effects than men. We also found significant statistical sex differences in the conditioning strength and reinforced expectations whereby reinforced expectations mediated the sex-related placebo effects. In addition, the participant–experimenter sex concordance influenced conditioning strength, reinforced expectations, and placebo effects in women but not in men. Our findings suggest that women experience larger conditioning effects, expectations, and placebo effects emphasizing the need to consider sex as a biological variable when placebo components of any outcomes are part of drug development trials and in pain management.
Hyporesponsivity to mu-opioid receptor agonism in the Wistar-Kyoto rat model of altered nociceptive responding associated with negative affective state
Authors: Ferdousi Mehnaz I. , Calcagno Patricia , Clarke Morgane , Aggarwal Sonali , Sanchez Connie , Smith Karen L. , Eyerman David J. , Kelly John P. , Roche Michelle , Finn David P.
Published: August 2020

Chronic pain is often comorbid with anxiety and depression, altering the level of perceived pain, which negatively affects therapeutic outcomes. The role of the endogenous mu-opioid receptor (MOP) system in pain–negative affect interactions and the influence of genetic background thereon are poorly understood. The inbred Wistar-Kyoto (WKY) rat, which mimics aspects of anxiety and depression, displays increased sensitivity (hyperalgesia) to noxious stimuli, compared with Sprague-Dawley (SD) rats. Here, we report that WKY rats are hyporesponsive to the antinociceptive effects of systemically administered MOP agonist morphine in the hot plate and formalin tests, compared with SD counterparts. Equivalent plasma morphine levels in the 2 rat strains suggested that these differences in morphine sensitivity were unlikely to be due to strain-related differences in morphine pharmacokinetics. Although MOP expression in the ventrolateral periaqueductal gray (vlPAG) did not differ between WKY and SD rats, the vlPAG was identified as a key locus for the hyporesponsivity to MOP agonism in WKY rats in the formalin test. Moreover, morphine-induced effects on c-Fos (a marker of neuronal activity) in regions downstream of the vlPAG, namely, the rostral ventromedial medulla and lumbar spinal dorsal horn, were blunted in the WKY rats. Together, these findings suggest that a deficit in the MOP-induced recruitment of the descending inhibitory pain pathway may underlie hyperalgesia to noxious inflammatory pain in the WKY rat strain genetically predisposed to negative affect.
Nociceptive afferent phenotyping reveals that transient receptor potential ankyrin 1 promotes cold pain through neurogenic inflammation upstream of the neurotrophic factor receptor GFRα3 and the menthol receptor transient receptor potential melastatin 8
Authors: Yamaki Shanni , Chau Amanda , Gonzales Luigi , McKemy David D.
Published: August 2020

The proper detection and behavioral response to painfully cold temperatures is critical for avoiding potentially harmful tissue damage. Cold allodynia and hyperalgesia, pain associated with innocuous cooling and exaggerated pain with noxious cold, respectively, are common in patients with chronic pain. In peripheral somatosensory afferents, the ion channels transient receptor potential melastatin 8 (TRPM8) and transient receptor potential ankyrin 1 (TRPA1) are candidate receptors for innocuous and noxious cold temperatures, respectively. However, the role of TRPA1 as a cold sensor has remained controversial, and recent evidence suggests that TRPM8 channels and afferents mediate the detection of both pleasant and painful cold. To determine the role of TRPA1 afferents in cold-induced mouse behaviors in vivo, we used functional phenotyping by targeted nerve conduction block with the cell-impermeant lidocaine derivative QX-314. Surprisingly, we find that injection of QX-314 with TRPA1 agonists reduces cold-induced behaviors in mice, but does so in a TRPM8-dependent manner. Moreover, this effect is sexually dimorphic and requires the glial cell line–derived neurotrophic factor receptor GFRα3, as does cold hypersensitivity produced by the activation of TRPA1 channels. Taken together, these results suggest that under conditions of neurogenic inflammation, TRPA1 works upstream of GFRα3 and TRPM8 to produce cold hypersensitivity, providing novel insights into the role of TRPA1 channels in cold pain.
Caring for the Workforce of a Health System During the COVID-19 Epidemic in Brazil
Authors: Duim Etienne , Guimarães Mariana Tavares , Ornelas Rafael Herrera , Brito Natalia Tatiani Gonçalves , Daher Gustavo , Seko Cristiane Yahara , Borges-Junior Flavio Araujo , Szlejf Claudia
Published: August 2020

Objectives:

To describe the strategies to monitor and expand access to care for a health system workers in the first 2 months of the COVID-19 epidemic in Brazil.

Methods:

Description of the implemented strategy based on the guidelines developed to address the surveillance and care of a large health system's workforce in the COVID-19 epidemic.

Results:

During phase 1, the surveillance strategy focused on monitoring suspected cases among employees. In phase 2, surveillance was restricted to employees with confirmed COVID-19, aiming at monitoring of symptoms and following hospitalizations. Access to care was expanded. A total of 1089 employees were diagnosed with COVID-19, 89 required hospitalizations and none had died.

Conclusion:

The strategies adopted were promptly implemented and could be adapted to the changing epidemic dynamics, allowing low rates of adverse outcomes in this high-risk population.
Acute Immune Response in Venoarterial and Venovenous Extracorporeal Membrane Oxygenation Models of Rats
Authors: Cho Hwa-Jin , Kayumov Mukhammad , Kim Dowan , Lee Kyoseon , Onyekachi Francis Obiweluozor , Jeung Kyung-Woon , Kim Yongsook , Suen Jacky Y. , Fraser John F. , Jeong In-Seok
Published: August 2020

Although experimental extracorporeal membrane oxygenation (ECMO) animal models have been reported, there are few studies on the immune response to ECMO. We developed the venoarterial (VA) and venovenous (VV) model in rats and serially investigated the changes in the distribution of immune cells. Forty rats underwent both VA and VV modes of ECMO, and blood samples were collected at 1 day before ECMO (D-1), at the end of ECMO run (D+0), and 3 days after the ECMO (D+3). Flow cytometry was used to characterize surface marker expression (CD3, CD4, CD8, CD43, CD45, CD45R, CD161, and His48) on immune cells. Granulocytes were initially activated in both ECMO types and were further reduced but not normalized until 3 days of decannulation. Monocyte and natural killer cells were decreased initially in VA mode. B lymphocytes, helper T lymphocytes, and cytotoxic T lymphocytes also significantly decreased in VA modes after ECMO, but this phenomenon was not prominent in the VV modes. Overall immune cells proportion changed after ECMO run in both modes, and the immunologic balance altered significantly in the VA than in VV mode. Our ECMO model is feasible for the hemodynamic and immunologic research, and further long-term evaluation is needed.
Analysis of phenotype and genotype of a family with hereditary coagulation factor V deficiency caused by the compound heterozygous mutations
Authors: Luo Shasha , Liu Siqi , Xu Mengjie , Li Xiaolong , Zhang Haiyue , Jin Yanhui , Yang Lihong , Wang Mingshan
Published: August 2020

To analyze the causative gene and the molecular pathogenesis in a pedigree with compound hereditary coagulation factor V deficiency. Routine blood coagulation indexes and factor V antigen (FV:Ag) were detected by the one-stage clotting method and ELISA. Function of the mutant protein was evaluated by the method Calibrated Automated Thrombogram (CAT). The factor V gene was amplified by PCR with direct sequencing. The possible impact of the mutations were analyzed by bioinformatics tools. The proband's factor V activity and FV:Ag were reduced to 3 and 6%. Gene sequencing revealed compound heterozygous mutations c.911G>A (Gly276Glu) in exon 6 and c.5343C>G (Ser1781Arg) in exon 16. The thrombin generation test showed that the mutant protein markedly decreased thrombin. Bioinformatics indicated that mutations were deleterious. The compound heterozygous mutations Gly276Glu and Ser1781Arg were responsible for the decrease of factor V activity and FV:Ag, of which Ser1781Arg was first reported in the world.
System performance evaluation of the cobas t 711 and cobas t 511 coagulation analyzers in routine laboratory settings
Authors: Kitchen Steve , de Maat Moniek , Nagler Michael , Jones Robert , Lowe Anna , Burden John , Groneberg Kai , Rozsnyai Gergely
Published: August 2020

Utility of coagulation analyzers in real-world settings depends on characteristics that are often not studied comprehensively. This study aimed to investigate the analytical performance, system functionality, practicability, consistency and throughput of two new automated coagulation analyzers in routine laboratory practice. Real-world settings were simulated in three major European hemostasis laboratories and multiple assays were performed in anonymized plasma samples in parallel with routine clinical practice on the cobas t 711 (high-throughput) and cobas t 511 (mid-throughput) analyzers using activated partial thromboplastin time (aPTT), aPTT Lupus, aPTT Screen, Antithrombin (AT), d-Dimer, Fibrinogen, Prothrombin Time (PT)-derived Fibrinogen, PT Owren, PT Rec (recombinant human thromboplastin reagent) and Thrombin Time assays. Precision was tested in a 21-day experiment and accuracy was compared with reference methods of the same laboratory. A number of experiments simulated challenging real-life situations. Pearson's correlation coefficient was more than 0.98 in all assays. Across assays, coefficients of variation ranged from 0.0 to 1.5% for intermediate precision; 0.2 to 3.0% for repeatability and 0.4 to 3.7% for total precision. Good between-run comparability was seen when testing samples under random conditions. Calculated maximum throughput was 197 and 387–402 tests/h for the cobas t 511 and 711 analyzers, respectively. Practicability met or exceeded user expectations in 98% of cases. In a simulated real-life setting of three major laboratories, the new cobas t 511 and cobas t 711 coagulation analyzers demonstrated a good functionality, practicability and performance and the throughput was high.
‘Pulmonary thrombosis in situ’: risk factors, clinic characteristics and long-term evolution
Authors: Fletcher-Sanfeliu Delfina , Redón Josep , García-Granero Álvaro , Frasson Matteo , Barreira Ignacio , Martínez-León Juan , García-Fuster María J.
Published: August 2020

Pulmonary embolism typically occurs from deep venous thrombosis (DVT). However, not always a DVT can be identified, and ‘in situ’ generation of pulmonary embolism has been considered, referred to in the literature as ‘De novo pulmonary embolism’ (DNPE). The objective of the study is to assess risk factors, comorbidities, clinic characteristics and long-term evolution of patients with pulmonary embolism in the absence of an identified source. Retrospective study of 280 patients with pulmonary embolism, 190 pulmonary embolisms with DVT group and 90 (32%) pulmonary embolism without DVT (DNPE group), admitted to an Internal Medicine Department of a tertiary hospital from January 2012 to December 2015. In the DNPE group, segmental and subsegmental arteries were more frequently affected (P = 0.01). As compared with pulmonary embolisms with DVT group: older age, female sex, sedentary lifestyle, diabetes mellitus, arterial hypertension, heart failure, respiratory infections and chronic obstructive pulmonary disease (COPD) were significantly more frequent in DNPE. In multivariate analysis, respiratory infection [odds ratio (OR) 12.2, P < 0.0001], COPD (OR 8.7, P < 0.0001) and female sex (OR 3.0, P = 0.003) were independently associated risk factors. Long-term mortality (median follow-up 15 months) was also higher in DNPE group (34 vs. 16%, P = 0.01). De novo pulmonary embolism occurred in 32% of cases of pulmonary embolisms and was more frequent in female and COPD patients or those with respiratory infections as compared with pulmonary embolisms in which DVT was identified as a source of embolism.
Deep intronic F8 c.5999-27A>G variant causes exon 19 skipping and leads to moderate hemophilia A
Authors: Wang Xiong , Hu Qun , Tang Ning , Lu Yanjun , Deng Jun
Published: August 2020

Hemophilia A, an X-linked recessive bleeding disorder, is caused by mutations of F8 gene. In about 2% hemophilia A patients, no exonic mutation of F8 gene was found. We aimed to identify deep intronic mutations of F8 gene. We reanalyzed the next-generation sequencing data of six hemophilia A patients with negative F8 variant in either coding region or splice site. Deep intronic F8 c.5999-27A>G variant (NM_000132.3) was found in two unrelated moderate hemophilia A patients from different region, and one patient's mother was mild hemophilia A patient. Splice site prediction algorithms showed no impact of this variant on F8 mRNA splicing of exon 19, including Human Splicing Finder 3.1, NNSPLICE 0.9, NetGene2, and Transcript-inferred Pathogenicity score. Exonic splicing enhancer was predicted by ESEfinder, and no difference was found between the wild type and mutant sequence. The branch point predicted by SVM-BPfinder suggested that F8 c.5999-27A>G variant may disrupt the branch point in intron 18 and affect the acceptor site splicing of F8 exon 19. Sanger sequencing of F8 cDNA from peripheral blood mononuclear cells confirmed that F8 c.5999-27A>G variant caused F8 exon 19 skipping in proband and his mother. Skewed X chromosome inactivation was found in another X chromosome of this mother, combined with F8 c.5999-27A>G variant in trans. In conclusion, our study suggests that deep intronic F8 c.5999-27A>G variant may be responsible for F8 exon 19 skipping and lead to moderate hemophilia A. Systematic reanalysis of next-generation sequencing data could promote the diagnostic yields.
Asymmetric sensorineural hearing loss and vestibular schwannoma: when to image?
Authors: Conley Morgan , Diaz Rodney C.
Published: August 2020

Purpose of review

We review the literature on the use of audiometric protocols in the guidance of when to obtain MRI for detection of vestibular schwannoma. This discussion will focus on the sensitivity, specificity, and cost-effective analysis of audiometric criteria of asymmetric sensorineural hearing loss (ASNHL) when used to decide when MRI scans should be performed.

Recent findings

The sensitivity for detecting vestibular schwannomas when invoking published audiometric protocols for triggering MRI acquisition in ASNHL ranged from 50 to 100%. Specificity of these protocols ranged from 23 to 83%. Such audiometric protocols are efficient, achieving sensitivity and specificity at these rates while reducing the screening rate to 18 to 35%. The reduced procurement of MRI while using such audiometric protocols is associated with annual cost savings of between 23 and 82%. While no definitive recommendations can be made from this review, some audiometric protocols offer a better balance of sensitivity and specificity than others.

Audiometric protocols for triggering MRI acquisition in ASNHL for evaluation of vestibular schwannoma can be both sensitive and specific. These are competitive measures, and so no protocol is both 100% sensitive and specific. Such protocols become less effective in populations with increased incidence of noise-induced hearing loss. Invocation of such audiometric protocols can considerably reduce the annual cost of MRI evaluation for vestibular schwannomas.
Reconstructive options following orbital exenteration
Authors: Yesensky Jessica , Lebo Nicole
Published: August 2020

Purpose of review

The purpose of this review is to examine current trends in reconstruction following orbital exenteration. Defects ranging from isolated exenteration to more complex midface resections are explored.

Recent findings

Goals of reconstruction include separating the sino-orbital cavities and creating a safe, stable wound that can withstand adjuvant radiation. When planning for orbital rehabilitation, it is important to create a concave cavity that can accommodate a prosthesis. This is primarily achieved through secondary granulation or split-thickness skin grafts. Recently, the use of dermal allografts has been investigated and shown good success with epithelization of the orbital cavity. For complex orbitomaxillectomy defects, musculocutaneous free tissue flaps remain the mainstay for reconstruction.

Reconstructive options following orbital exenteration are based on extent of the defect, need for postoperative radiation, and plans for orbital rehabilitation with prosthesis.
A Higher Incidence of Isolated Biliary Atresia in Rural Areas
Authors: Nomden Mark , van Wessel Daan B.E. , Ioannou Solomon , Verkade Henkjan J. , de Kleine Ruben H. , Alizadeh Behrooz Z. , Bruggink Janneke L.M. , Hulscher Jan B.F.
Published: August 2020

Objectives:

Environmental factors may be involved in the pathogenesis of biliary atresia (BA). This epidemiological study aimed to analyze the relationships between the incidence of BA, the incidence of confirmed viral or bacterial infections and population density, and geographical and temporal clustering of BA in the Netherlands.

Study Design:

Correlations between the monthly incidence of BA and the number of confirmed infections were assessed. BA incidence per province was calculated and compared to the province with highest population density. Birthplaces were classified as rural or urban. Temporal clustering of month of birth and month of conception were analyzed. We performed analyses for isolated BA (IBA) and syndromic BA (SBA) separately. Chi2, logistic regression, and Walter and Elwood test were used.

Results:

A total of 262 IBA and 49 SBA patients, born between 1987 and 2018, were included. IBA incidence correlated to the number of confirmed infections of, for example, Chlamydia trachomatis (R = 0.14; P = 0.02) and adenovirus (R = 0.22; P = 0.005). We observed a higher incidence of IBA (0.75/10,000; odds ratio [OR] = 1.86; P = 0.04) and SBA (0.27/10,000; OR = 6.91; P = 0.001) in Groningen and a higher incidence of SBA in Gelderland (0.13/10,000; OR = 3.35; P = 0.03). IBA incidence was 68% higher in rural (0.67/10,000) versus urban areas (0.40/10,000) (P = 0.02). The estimated month of conception of patients with SBA clustered in November (85% increase compared to average SBA incidence [0.09/10,000; P = 0.04]).

Conclusions:

IBA incidence correlated weakly with national confirmed infections. IBA and SBA incidence varied geographically in the Netherlands. IBA incidence was higher in rural than in urban areas, which may be explained decreased exposure to pathogens. Our results provide support for a role of environmental factors in the pathogenesis of IBA.
Gastric Bezoar
Authors: Shah Monisha , Wan David Q. , Liu Yuying , Rhoads Jon Marc
Published: August 2020

Objectives:

To determine the demographics, potential risk factors, endoscopic interventions and outcomes relating to gastric bezoars in pediatric patients; and comparing results with previously published literature.

Methods:

Retrospective series by chart review of patients identified by International Classification of Diseases‐9 codes 938 and 935, using the following Medical Subject Headings: 1, term bezoar; 2, Keywords gastric bezoar* or gastric foreign body*.

Results:

Thirty pediatric patients between ages of 2 to 18 years were found with gastric bezoars, with a female predominance. Majority had a phytobezoar. Six patients were diagnosed with dysautonomia, implying possible role of autonomic dysfunction contributing to abnormal gastric retention. Frequent symptoms included abdominal pain, nausea and vomiting, a decrease in appetite, and unintentional weight loss. A higher prevalence of underlying gastrointestinal disorders was found in those with bezoars. Nuclear medicine gastric emptying scan performed in 13 children was significantly abnormal in only 4 of these children. Most patients were treated with endoscopic removal of the bezoar. Endoscopic removal was accomplished by Roth net, generally requiring multiple passes. At follow‐up, most of the children had improvement of symptoms, with bezoar recurrence in 1 patient.

Conclusions:

This is to our knowledge the largest series of gastric bezoars in pediatrics. On the basis of our review, phytobezoars may be under‐reported in pediatrics. Bezoars should be considered in children presenting with chronic abdominal pain, nausea, and vomiting; even in developmentally normal children and those with normal gastric emptying. We suggest that dysautonomia and underlying gastrointestinal disorders may be potential risk factors.
Mixed-Methods Analysis of Evaluations From In-Person and Remote Nursing Symposium Participants
Authors: Fritz Elizabeth A. , Weiler Stacey
Published: August 2020

Many healthcare organizations offer symposia for sharing nursing research, evidence-based practice, and quality improvement efforts across the system. Significant resources are spent in planning events, with added complexity when symposia are conferenced across sites. A mixed-methods study was conducted to examine the relationship between quantitative and qualitative evaluation results of onsite and remote participants at a multisite nursing symposium. Results may be used by nursing professional development practitioners to inform development of future symposia.
The Impact of Age Beyond Ploidy: Outcome Data From 8175 Euploid Single Embryo Transfers
Authors: Reig Andres , Franasiak Jason , Scott Richard T. , Seli Emre
Published: August 2020

(Abstracted from J Assist Reprod Genet 2020;37:595–602)

Despite advances in the efficacy of assisted-reproductive technology (ART), age-related decline in female fertility remains robust with an approximate 4% live birth rate (LBR) in women older than 42. Although a clear correlation between advancing maternal age and increased rate of aneuploidy has been established, whether or not selection of euploid embryos in these women would mitigate the decline in age-related fertility remain unclear.
Performance of First-Trimester Fetal Echocardiography in Diagnosing Fetal Heart Defects: Meta-analysis and Systematic Review
Authors: Yu Dongmei , Sui Lun , Zhang Nan
Published: August 2020

(Abstracted from J Ultrasound Med 2020;39:471–480)

Improvements in ultrasound technology, with better resolution and color mapping, have made it possible to assess the fetal heart both transvaginally and transabdominally as early as the first trimester. There is a growing interest in using this technology for the early detection of congenital heart defects (CHDs), which occurs in 5 to 9 per 1000 live births.
Aortic Calcification in Takayasu Arteritis
Authors: Meléndez-Ramírez Gabriela , Soto Maria Elena , Meave Aloha , Ruiz-Elizondo Luis Alberto , Kimura Eric , Alexanderson Erick
Published: August 2020

Introduction

Aortic calcification is a frequent finding in Takayasu arteritis (TA). The aim of this study was to evaluate the risk factors for aortic calcification in TA and its relationship with disease activity and the presence and type of vascular lesion.

Methods

Nineteen patients with TA underwent nonenhanced computed tomography to measure the calcium score of the aorta and its main branches, which were divided into 13 segments. In each segment, the type of vascular lesion was evaluated by noninvasive angiography. Clinical risk factors and disease activity scores were recorded.

Results

Eighteen of 19 patients (95%) were women, with a median age of 25 years. Median of calcium score was 69 AU (0–12,465 AU). Eleven of 19 patients (57.9%) had calcium score greater than 0. Age, evolution time, and dyslipidemia were higher in patients with calcium, whereas the National Institutes Health and Dabague disease activity scores were lower. There was no association between the presence of calcium and vascular lesion: 60 of 160 segments (37.5%) without calcium had some lesion, compared with 24 of 68 (35.3%) with calcium score greater than 0, p = 0.75. However, occlusion was more frequent in patients with calcium, whereas wall thickening was in those without calcium.

Conclusions

Aortic calcification in TA is related to age, evolution time, and abnormalities in lipid profile and occlusion and, inversely with some activity scores. Identification of calcification could be useful in identifying patients that even without significant lesions might have accelerated atherosclerosis, and who might be benefited with specific treatment.
Upper Extremity Volume/Total Body Volume Ratio for Evaluation of Upper Extremity Lymphedema
Authors: Hattori Yasunori , Hayashi Kota , Sakamoto Sotetsu , Doi Kazuteru
Published: August 2020

Background

Measurement of extremity volume is the most commonly used method for evaluation of lymphedema. However, volumetry would be inappropriate for comparing patients with different physiques, because body-type significantly affects extremity volume. Thus, we cannot evaluate using absolute values. To overcome this problem, we developed a simple index of proportion of the upper-extremity volume to total body volume (upper-extremity volume/total body volume ratio [UVR]) for body type–corrected volume evaluation of upper-extremity lymphedema. The purpose of this study was to compare upper-extremity volume and UVR in nonedematous upper extremities and to establish normative values of UVR in adult women.

Methods

Eighty-five normal female subjects were included in this study. The average age was 38 ± 12 years, and the average body mass index (BMI) was 21.4 ± 2.9. Volumetry of both upper extremities using water displacement method was tested in all subjects. Upper-extremity volume/total body volume ratio was calculated by dividing upper-extremity volume by total body volume. Total body volume was calculated by dividing body weight (g) by body density (g/mL). We used linear regression equation (body density = 1.0560 − 0.0005 × age) to calculate body density.

Results

UVR of 170 upper extremities averaged 2.580 ± 0.202%. Although there was significant relationship between upper-extremity volume and BMI, there was no relationship between UVR and BMI.

Conclusions

Although further studies are necessary to establish usefulness of UVR, UVR has a potential to allow better body type–corrected volume evaluation for upper-extremity lymphedema.
Long-term Oncologic Results After Stenting as a Bridge to Surgery Versus Emergency Surgery for Malignant Left-sided Colonic Obstruction
Authors: Arezzo Alberto , Forcignanò Edoardo , Bonino Marco Augusto , Balagué Carmen , Targarona Eduardo , Borghi Felice , Giraudo Giorgio , Ghezzo Luigi , Passera Roberto , Morino Mario
Published: August 2020

Objective:

To assess overall (OS), time to progression (TTP), and disease-free survival (DFS) at 3 years after treatment, comparing stenting as bridge-to-surgery (SBTS) versus emergency surgery (ES) in neoplastic left colon obstruction, secondary endpoints of the previously published randomized controlled trial.

Background:

While SBTS in neoplastic colon obstruction may reduce morbidity and need for a stoma compared with ES, concern has been raised, about long-term survival.

Methods:

Individuals affected by left-sided malignant large-bowel obstruction were enrolled from 5 European hospitals and randomly assigned (1:1 ratio) to receive SBTS or ES. The computer-generated randomization sequence was stratified by center on cT and concealed by the use of a web-based application. Investigators and participants were unmasked to treatment assignment. The secondary outcomes analyzed here were OS, TTP, and DFS. Analysis was by intention to treat. This study is registered, ID-code NCT00591695.

Results:

Between March 2008 and November 2015, 144 patients were randomly assigned to undergo either SBTS or ES; 115 (SBTS n = 56, ES n = 59) were eligible for analysis, while 20 participants were excluded for a benign disease, 1 for unavailability of the endoscopist while 8 withdrew from the trial. With a median follow-up of 37 months (range 1–62), no difference was observed in the SBTS group compared with ES in terms of OS (HR 0.93 (95% CI 0.49–1.76), P = 0.822), TTP (HR 0.81 (95% CI 0.42–1.54), P = 0.512), and DFS (HR 1.01 (95% CI 0.56–1.81), P = 0.972). Planned subgroup analysis showed no difference in respect to age, sex, American Society for Anesthesiology score, body mass index, and pT between SBTS and ES groups. Those participants randomized for the SBTS group whose obstruction was located in the descending colon had a better TTP compared with ES group (HR 0.44 (95% CI 0.20–0.97), P = 0.042), but no difference was observed in terms of OS (HR 0.73 (95% CI 0.33–1.63), P = 0.442) and DFS (HR 0.68 (95% CI 0.34–1.34), P = 0.261) in the same individuals.

Conclusions:

This randomized controlled trial shows that, although not powered for these seconday outcomes, OS, TTP, and DFS did not differ between groups at a minimum follow-up of 36 months.
Referring Patients to Expert Centers After Pancreatectomy Is Too Late to Improve Outcome. Inter-hospital Transfer Analysis in Nationwide Study of 19,938 Patients
Authors: El Amrani Mehdi , Lenne Xavier , Clément Guillaume , Turrini Olivier , Theis Didier , Pruvot François-René , Bruandet Amelie , Truant Stéphanie
Published: August 2020

Objectives:

We aimed to analyze the outcomes of interhospital transfer (IHT) patients after pancreatectomy, describe the characteristics of transferring hospitals, and determine the risk factors of transfer and mortality in IHT patients.

Background:

Implementation of the centralization process is complex and currently unrealized in France. Alternatively, centralization of patients with postoperative complications to high volume centers could reduce postoperative mortality (POM) and failure to rescue (FTR).

Methods:

All patients undergoing pancreatectomy for cancer between 2012 and 2018 were included. Hospitals’ and patients’ characteristics were analyzed to determine predictive factors for transfer and FTR. POM was defined as death occurring during the hospital stay and FTR as POM rate among patients with major complications.

Results:

Overall, 19,938 patients who underwent pancreatectomy were included, 1164 (5.8%) of whom were transferred. IHT patients were mostly originated from low volume hospitals (60.3% vs 39.7%), from facilities without intensive care unit (46.9% vs 22.4%) or interventional radiology (22.8% vs 12.8%). Among IHT patients, 51% underwent reoperation before transfer and 34.9% experienced hemorrhage complications. The POM was 5.2% and varied significantly between transfer and nontransfer patients (13.3% vs 4.7%, P < 0.001). Patients who experienced major complications after pancreatectomy in low volume hospitals had greater odds of being transferred (Odds Ratio (OR) = 2.46, confidence intervals (CI)95%[1.734; 3.516], P < 0.001). Also, transfer (OR = 2.17, CI95%[1.814; 2.709], P < 0.001) and especially transfer after pancreatectomy in low volume centers (OR = 3.76, CI95%[2.83; 5.01], P < 0.001) were associated with increased FTR rates.

Conclusions:

Transfers after pancreatectomy were associated with high rates of FTR, especially for patients undergoing surgery in low volume hospitals. Local expertise, resources, and volume of hospitals are mandatory to provide appropriate care after pancreatectomy.
Diagnostic Error of Neuro-ophthalmologic Conditions: State of the Science
Authors: Stunkel Leanne , Newman-Toker David E. , Newman Nancy J. , Biousse Valérie
Published: August 2020

Background:

Diagnostic error is prevalent and costly, occurring in up to 15% of US medical encounters and affecting up to 5% of the US population. One-third of malpractice payments are related to diagnostic error. A complex and specialized diagnostic process makes neuro-ophthalmologic conditions particularly vulnerable to diagnostic error.

Evidence Acquisition:

English-language literature on diagnostic errors in neuro-ophthalmology and neurology was identified through electronic search of PubMed and Google Scholar and hand search.

Results:

Studies investigating diagnostic error of neuro-ophthalmologic conditions have revealed misdiagnosis rates as high as 60%–70% before evaluation by a neuro-ophthalmology specialist, resulting in unnecessary tests and treatments. Correct performance and interpretation of the physical examination, appropriate ordering and interpretation of neuroimaging tests, and generation of a differential diagnosis were identified as pitfalls in the diagnostic process. Most studies did not directly assess patient harms or financial costs of diagnostic error.

Conclusions:

As an emerging field, diagnostic error in neuro-ophthalmology offers rich opportunities for further research and improvement of quality of care.
Oculomotor Nerve Palsy Due to Unusual Causes
Authors: Tian Guohong , Kardon Randy , Feng Chaoyi , Hong Rujian , Sha Yan , Sun Xinghuai , Wang Min
Published: August 2020

Background:

An isolated oculomotor nerve (CN III) palsy is a diagnostic concern because of the potential for serious morbidity or life-threatening causes. We present 5 unusual causes of oculomotor nerve palsy that escaped initial diagnosis in order to raise awareness of their associated features that will facilitate correct diagnosis.

Methods:

This study consisted of a retrospective analysis of clinical features and imaging of 5 patients who were referred for neuro-ophthalmologic evaluation with presumed diagnosis of oculomotor nerve palsy of unknown reasons.

Results:

A complete CN III palsy and an inferior division CN III palsy were diagnosed with a schwannoma in the cavernous sinus and orbital apex portion, respectively; a middle-aged woman with aberrant regeneration was found to have a small meningioma; an adult man with ptosis was diagnosed with cyclic oculomotor paresis with spasms; and a patient after radiation was diagnosed with neuromyotonia.

Conclusions:

Localizing the lesion of oculomotor nerve palsy and careful examination of the imaging is crucial. Aberrant regeneration, cyclic pupil changes, and past medical history of amblyopia, strabismus, or radiation are also very helpful for diagnosis.
A simulated single ventilator/dual patient ventilation strategy for acute respiratory distress syndrome during the COVID-19 pandemic
Authors: Solís-Lemus José A. , Costar Edward , Doorly Denis , Kerrigan Eric C. , Kennedy Caroline H. , Tait Frances , Niederer Steven , Vincent Peter E. , Williams Steven E.
Published: August 2020

The potential for acute shortages of ventilators at the peak of the COVID-19 pandemic has raised the possibility of needing to support two patients from a single ventilator. To provide a system for understanding and prototyping designs, we have developed a mathematical model of two patients supported by a mechanical ventilator. We propose a standard set-up where we simulate the introduction of T-splitters to supply air to two patients and a modified set-up where we introduce a variable resistance in each inhalation pathway and one-way valves in each exhalation pathway. Using the standard set-up, we demonstrate that ventilating two patients with mismatched lung compliances from a single ventilator will lead to clinically significant reductions in tidal volume in the patient with the lowest respiratory compliance. Using the modified set-up, we demonstrate that it could be possible to achieve the same tidal volumes in two patients with mismatched lung compliances, and we show that the tidal volume of one patient can be manipulated independently of the other. The results indicate that, with appropriate modifications, two patients could be supported from a single ventilator with independent control of tidal volumes.
Going with the flow: insights fromCaenorhabditis eleganszygote polarization
Authors: Gubieda Alicia G. , Packer John R. , Squires Iolo , Martin Jack , Rodriguez Josana
Published: August 2020

Cell polarity is the asymmetric distribution of cellular components along a defined axis. Polarity relies on complex signalling networks between conserved patterning proteins, including the PAR (partitioning defective) proteins, which become segregated in response to upstream symmetry breaking cues. Although the mechanisms that drive the asymmetric localization of these proteins are dependent upon cell type and context, in many cases the regulation of actomyosin cytoskeleton dynamics is central to the transport, recruitment and/or stabilization of these polarity effectors into defined subcellular domains. The transport or advection of PAR proteins by an actomyosin flow was first observed in theCaenorhabditis elegans zygote more than a decade ago. Since then a multifaceted approach, using molecular methods, high-throughput screens, and biophysical and computational models, has revealed further aspects of this flow and how polarity regulators respond to and modulate it. Here, we review recent findings on the interplay between actomyosin flow and the PAR patterning networks in the polarization of theC. eleganszygote. We also discuss how these discoveries and developed methods are shaping our understanding of other flow-dependent polarizing systems.

This article is part of a discussion meeting issue ‘Contemporary morphogenesis’.
Mesoderm patterning by a dynamic gradient of retinoic acid signalling
Authors: Bernheim Ségolène , Meilhac Sigolène M.
Published: August 2020

Retinoic acid (RA), derived from vitamin A, is a major teratogen, clinically recognized in 1983. Identification of its natural presence in the embryo and dissection of its molecular mechanism of action became possible in the animal model with the advent of molecular biology, starting with the cloning of its nuclear receptor. In normal development, the dose of RA is tightly controlled to regulate organ formation. Its production depends on enzymes, which have a dynamic expression profile during embryonic development. As a small molecule, it diffuses rapidly and acts as a morphogen. Here, we review advances in deciphering how endogenously produced RA provides positional information to cells. We compare three mesodermal tissues, the limb, the somites and the heart, and discuss how RA signalling regulates antero-posterior and left–right patterning. A common principle is the establishment of its spatio-temporal dynamics by positive and negative feedback mechanisms and by antagonistic signalling by FGF. However, the response is cell-specific, pointing to the existence of cofactors and effectors, which are as yet incompletely characterized.

This article is part of a discussion meeting issue ‘Contemporary morphogenesis’.
Spatial protein analysis in developing tissues: a sampling-based image processing approach
Authors: Leonavicius Karolis , Royer Christophe , Miranda Antonio M. A. , Tyser Richard C. V. , Kip Annemarie , Srinivas Shankar
Published: August 2020

Advances in fluorescence microscopy approaches have made it relatively easy to generate multi-dimensional image volumes and have highlighted the need for flexible image analysis tools for the extraction of quantitative information from such data. Here we demonstrate that by focusing on simplified feature-based nuclear segmentation and probabilistic cytoplasmic detection we can create a tool that is able to extract geometry-based information from diverse mammalian tissue images. Our open-source image analysis platform, called ‘SilentMark’, can cope with three-dimensional noisy images and with crowded fields of cells to quantify signal intensity in different cellular compartments. Additionally, it provides tissue geometry related information, which allows one to quantify protein distribution with respect to marked regions of interest. The lightweight SilentMark algorithms have the advantage of not requiring multiple processors, graphics cards or training datasets and can be run even with just several hundred megabytes of memory. This makes it possible to use the method as a Web application, effectively eliminating setup hurdles and compatibility issues with operating systems. We test this platform on mouse pre-implantation embryos, embryonic stem cell-derived embryoid bodies and mouse embryonic heart, and relate protein localization to tissue geometry.

This article is part of a discussion meeting issue ‘Contemporary morphogenesis’.