bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous Lymphoid Hyperplasia With T-Cell Clonality and Monotypic Plasma Cells Secondary to a Tick Bite: A Hidden Critter and the Power of Deeper Levels
Authors: Cho Woo Cheal , Gill Pavandeep , Nagarajan Priyadharsini , Aung Phyu P. , Torres-Cabala Carlos A. , Curry Jonathan L. , Ivan Doina , Lester Laura , Prieto Victor G.
Published: September 2021

Cutaneous lymphoid hyperplasia (CLH) is a benign reactive process with T-cell or B-cell lymphocytic infiltration in the skin, which can simulate cutaneous lymphomas both clinically and histologically. Various antigenic stimuli have been implicated in the development of CLH, including tick bites. Finding histologic evidence of such triggering factors, however, is often difficult. Moreover, the presence of clonality in CLH can potentially be interpreted as a neoplastic process, posing a further diagnostic challenge to dermatopathologists, if one is not aware of such peculiar phenomena. Herein, we describe a case of CLH secondary to a tick bite, featuring both T-cell clonality and monotypic plasma cells with lambda light chain restriction; the diagnostic clue being tick parts, which became evident on assessment of deeper levels. To the best of our knowledge, this is the first reported case of a tick-associated clonal CLH with simultaneous detection of monoclonal T cells and monotypic lambda light chain restriction, mimicking primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder and Borrelia-associated primary cutaneous marginal zone B-cell lymphoma, respectively.
The Role of Childhood Asthma in Obesity Development
Authors: Stratakis Nikos , Garcia Erika , Chandran Aruna , Hsu Tingju , Alshawabkeh Akram , Aris Izzuddin M. , Aschner Judy L. , Breton Carrie , Burbank Allison , Camargo Carlos A. , Carroll Kecia N. , Chen Zhanghua , Claud Erika C. , Dabelea Dana , Dunlop Anne L. , Elliott Amy J. , Ferrara Assiamira , Ganiban Jody M. , Gern James E. , Gold Diane R. , Gower William A. , Hertz-Picciotto Irva , Karagas Margaret R. , Karr Catherine J. , Lester Barry , Leve Leslie D. , Litonjua Augusto A. , Ludena Yunin , McEvoy Cindy T. , Miller Rachel L. , Mueller Noel T. , O’Connor Thomas G. , Oken Emily , O’Shea T. Michael , Perera Frederica , Stanford Joseph B. , Rivera-Spoljaric Katherine , Rundle Andrew , Trasande Leonardo , Wright Rosalind J. , Zhang Yue , Zhu Yeyi , Berhane Kiros , Gilliland Frank , Chatzi Lida
Published: September 2021

Rationale:

Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset.

Objectives:

To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association.

Methods:

We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years).

Measurements and Main Results:

We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = –1.05, –0.23).

Conclusions:

This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.
Astaxanthin engages the l-arginine/NO/cGMP/KATP channel signaling pathway toward antinociceptive effects
Authors: Mohammadi Samira , Fakhri Sajad , Mohammadi-Farani Ahmad , Farzaei Mohammad Hosein , Abbaszadeh Fatemeh
Published: September 2021

One of the main functions of the sensory system in our body is to maintain somatosensory homeostasis. Recent reports have led to a significant advance in our understanding of pain signaling mechanisms; however, the exact mechanisms of pain transmission have remained unclear. There is an urgent need to reveal the precise signaling mediators of pain to provide alternative therapeutic agents with more efficacy and fewer side effects. Accordingly, although the anti-inflammatory, antioxidative and anti-neuropathic effects of astaxanthin (AST) have been previously highlighted, its peripheral antinociceptive mechanisms are not fully understood. In this line, considering the engagement of l-arginine/nitric oxide (NO)/cyclic GMP (cGMP)/potassium channel (KATP) signaling pathway in the antinociceptive responses, the present study evaluated its associated role in the antinociceptive activity of AST. Male mice were intraperitoneally (i.p.) injected with l-arginine (100 mg/kg), SNAP (1 mg/kg), L-NAME (30 mg/kg), sildenafil (5 mg/kg), and glibenclamide (10 mg/kg) alone and prior to the most effective dose of AST. Following AST administration, intraplantarly (i.pl) injection of formalin was done, and pain responses were evaluated in mice during the primary (acute) and secondary (inflammatory) phases of formalin test. The results highlighted that 10 mg/kg i.p. dose of AST showed the greatest antinociceptive effect. Besides, while L-NAME and glibenclamide reduced the antinociceptive effect of AST, it was significantly increased by l-arginine, SNAP and sildenafil during both the primary and secondary phases of formalin test. These data suggest that the antinociceptive activity of AST is passing through the l-arginine/NO/cGMP/KATP pathway.
No antinociceptive synergy between morphine and delta-9-tetrahydrocannabinol in male and female rats with persistent inflammatory pain
Authors: Britch Stevie C. , Craft Rebecca M.
Published: September 2021

Studies have demonstrated antinociceptive synergy between morphine and delta-9-tetrahydrocannabinol (THC) in animals, but whether such synergy occurs against all types of pain and in humans is unclear. Because a majority of chronic pain patients are women, and sex differences in morphine and THC potencies have been observed in rodents, the present study examined sex-specific effects of morphine and THC given alone and in combination, in rats with persistent inflammatory pain. On day 1, baseline mechanical and thermal response thresholds, hindpaw weight-bearing, locomotor activity, and hindpaw thickness were determined. Inflammation was then induced via hindpaw injection of complete Freund’s adjuvant (CFA). Three days later, morphine (s.c.), THC (i.p) or a morphine-THC combination (1:1, 3:1 and 1:3 dose ratios) was administered, and behavioral testing was conducted at 30–240 min postinjection. Morphine alone was antiallodynic and antihyperalgesic, with no sex differences, but at some doses increased weight-bearing on the CFA-treated paw more in males than females. THC alone reduced mechanical allodynia with similar potency in both sexes, but reduced thermal hyperalgesia and locomotor activity with greater potency in females than males. All morphine-THC combinations reduced allodynia and hyperalgesia, but isobolographic analysis of mechanical allodynia data showed no significant morphine-THC synergy in either sex. Additionally, whereas morphine alone was antinociceptive at doses that did not suppress locomotion, morphine-THC combinations suppressed locomotion and did not increase weight-bearing on the inflamed paw. These results suggest that THC is unlikely to be a beneficial adjuvant when given in combination with morphine for reducing established inflammatory pain.
Exercise ECG Testing and Stress Cardiac Magnetic Resonance for Risk Prediction in Patients With Chronic Coronary Syndrome
Authors: Marcos-Garces Victor , Merenciano-Gonzalez Hector , Gabaldon-Perez Ana , Nuñez-Marin Gonzalo , Lorenzo-Hernandez Miguel , Gavara Jose , Perez Nerea , Rios-Navarro Cesar , De Dios Elena , Bonanad Clara , Racugno Paolo , Lopez-Lereu Maria Pilar , Monmeneu Jose Vicente , Chorro Francisco Javier , Bodi Vicente
Published: September 2021

Purpose:

Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear.

Methods:

We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death.

Results:

During a mean follow-up of 4.2 ± 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndrome, eight admissions for heart failure, and four all-cause deaths). Once adjusted for clinical, ExECG, and VS-CMR parameters associated with SAE, the only independent predictors were HRmax in ExECG (HR = 0.98: 95% CI, 0.96-0.99; P = .01) and more extensive stress-induced perfusion defects (PDs, number of segments) in VS-CMR (HR = 1.19: 95% CI, 1.07-1.34; P < .01). Adding HRmax significantly improved the predictive power of the multivariable model for SAE, including PDs (continuous reclassification improvement index: 0.47: 95% CI, 0.10-0.81; P < .05). The annualized SAE rate was 1% (if PD < 2 segments and HRmax > 130 bpm), 2% (if PD < 2 segments and HRmax ≤ 130 bpm), 3.2% (if PD ≥ 2 segments and HRmax > 130 bpm), and 6.3% (if PD ≥ 2 segments and HRmax ≤ 130 bpm), P < .01, for the trend. In patients on β-blocker therapy, however, only PDs in VS-CMR, but not HRmax, predicted SAE.

Conclusions:

We conclude that ExECG contributes significantly to prognostic information beyond VS-CMR in patients with known or suspected CCS.
Cognition and Exercise
Authors: Gaalema Diann E. , Mahoney Katharine , Ballon Jacob S.
Published: September 2021

Performance of endurance exercise is associated with a broad range of cognitive benefits, with notable improvements shown across a wide variety of populations including healthy populations as well as those with impaired cognition. By examining the effects of exercise in general populations, as well in populations where cognitive deficits are pronounced, and critical to self-care, we can learn more about using exercise to ameliorate cognitive issues and apply that knowledge to other patient populations, such as those eligible for cardiac rehabilitation (CR). Cognitive challenges are a concern within CR, as management of a chronic disease is cognitively taxing, and, as expected, deficits in cognition predict worse outcomes, including lower attendance at CR. Some subsets of patients within CR may be particularly at high risk for cognitive challenges including those with heart failure with low ejection fraction, recent coronary bypass surgery, multiple chronic conditions, and patients of lower socioeconomic status. Attendance at CR is associated with cognitive gains, likely through the progressive exercise component, with larger amounts of exercise over longer periods having greater benefits. Programs should identify at-risk patients, who could gain the most from completing CR, and provide additional support to keep those patients engaged. While engaged in CR, patients should be encouraged to exercise, at least at moderate intensity, and transitioned to a long-term exercise regimen. Overall, CR programs are well-positioned to support these patients and make significant contributions to their long-term well-being.
LONGITUDINAL ELLIPSOID ZONE AND OUTER RETINAL INTEGRITY DYNAMICS AFTER EPIRETINAL MEMBRANE SURGERY
Authors: Tuifua Tisileli S. , Abraham Joseph R. , Srivastava Sunil K. , Kaiser Peter K. , Reese Jamie , Ehlers Justis P.
Published: September 2021

Purpose:

To quantify ellipsoid zone (EZ) changes in integrity after epiretinal membrane (ERM) surgery, correlate findings to visual acuity, and determine predictors for prognosis.

Methods:

A post hoc analysis of eyes undergoing ERM surgery pooled from the prospective DISCOVER intraoperative optical coherence tomography study and eyes undergoing conventional ERM surgery without intraoperative optical coherence tomography. Quantitative EZ features were extracted using a multilayer machine learning enabled automated segmentation platform after image analyst review/correction for segmentation accuracy. Visual acuity and EZ integrity were quantitatively assessed and correlated before and after ERM surgery. Multiple linear regression was performed to assess preoperative visual acuity and EZ features as predictors for improvement in visual acuity or EZ integrity.

Results:

There were 177 eyes from 177 subjects that underwent ERM surgery from the DISCOVER and conventional arms. Improvement in visual acuity and multiple EZ integrity features was noted after ERM surgery, including EZ partial attenuation and EZ-retinal pigment epithelium (RPE) volume (P < 0.05). A reduction in EZ partial attenuation and increase in EZ-RPE central subfield thickness (EZ-RPE CST) was significantly correlated with improved visual acuity after ERM surgery (P < 0.05). More robust EZ-RPE CST at baseline predicted visual acuity improvement after ERM peel in regression modeling (β = 0.005, P < 0.05).

Conclusions:

Longitudinal assessment of EZ features demonstrates significant postoperative improvement in multiple EZ integrity metrics after ERM surgery. Improving EZ integrity was correlated to improving the visual acuity. Ellipsoid zone integrity and visual acuity were significant predictors in regression modeling and may have value in clinical prognostication.
Do Rotavirus Strains Affect Vaccine Effectiveness? A Systematic Review and Meta-analysis
Authors: Cates Jordan E. , Amin Avnika B. , Tate Jacqueline E. , Lopman Ben , Parashar Umesh
Published: September 2021

Background:

Rotavirus causes 215,000 deaths from severe childhood diarrhea annually. Concerns exist that a monovalent vaccine (RV1) and a pentavalent vaccine (RV5) may be less effective against rotavirus strains not contained in the vaccines. We estimated the vaccine effectiveness (VE) of RV1 and RV5 against severe rotavirus gastroenteritis caused by vaccine (homotypic) and nonvaccine (partially and fully heterotypic) strains.

Methods:

After conducting a systematic review, we meta-analyzed 31 case-control studies (N = 27,293) conducted between 2006 and 2020 using a random-effects regression model.

Results:

In high-income countries, RV1 VE was 10% lower against partially heterotypic (P = 0.04) and fully heterotypic (P = 0.10) compared with homotypic strains (homotypic VE: 90% [95% confidence intervals (CI): 82–94]; partially heterotypic VE: 79% [95% CI: 71–85]; fully heterotypic VE: 80% [95% CI: 65–88]). In middle-income countries, RV1 VE was 14–16% lower against partially heterotypic (P = 0.06) and fully heterotypic (P = 0.04) compared with homotypic strains (homotypic VE: 81% [95% CI: 69–88]; partially heterotypic VE: 67% [95% CI: 54–76]; fully heterotypic VE: 65% [95% CI: 51–75]). Strain-specific RV5 VE differences were less pronounced, and primarily derived from high-income countries. Limited data were available from low-income countries.

Conclusions:

Vaccine effectiveness of RV1 and RV5 was somewhat lower against nonvaccine than vaccine strains. Ongoing surveillance is important to continue long-term monitoring for strain replacement, particularly in low-income settings where data are limited.
Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola
Authors: Pelkonen Tuula , Urtti Suvi , Cardoso Ondina , Roine Irmeli , Kyaw Moe H. , Peltola Heikki
Published: September 2021

Background:

The diagnosis of bacterial meningitis (BM) is problematic in young infants, as clinical features may be nonspecific or even absent. Cerebrospinal fluid (CSF) analysis usually confirms the diagnosis, but the CSF parameters can be normal also in culture-proven BM. Our objective was to identify the clinical and CSF indices, that quickly and without laboratory likely lead to the diagnosis of confirmed of probable BM in young infants in Angola.

Methods:

We conducted a prospective, observational, single-site study from February 2016 to October 2017 in the Pediatric Hospital of Luanda. All assessed infants showed symptoms and signs compatible of BM or neonatal sepsis and were <90 days of age.

Results:

Of the 1088 infants, 212 (19%) showed bacteria in CSF, while 88 (8%) had probable BM. Independent clinical indicators of BM were not-clear CSF, seizures, weight <2500 g and illness >7 days. In infants with BM, CSF leukocytes were >10 × 106/L in 46%, CSF glucose <25 mg/dL in 43% and CSF protein >120 mg/dL in 58%. All measured parameters were in normal range in 25% of patients. In 515 infants with normal CSF parameters, bacteria were found in 74 (14%). In these infants, illness >7 days, weight <2500 g and malnutrition increased the probability of BM.

Conclusions:

Our study confirms and underlines the problems in diagnosing BM in young infants. While the CSF parameters were normal in 25% of infants, the easily recognizable unclear appearance of CSF was the single strongest predictor of BM.
Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics
Authors: Camacho-Cruz Jhon , Gutiérrez Iván Felipe , Brand-López Katherine , Sosa-Rodríguez Yeni Andrea , Vásquez-Hoyos Pablo , Gómez-Cortés Leydi Cristina , Romero-Higuera Laura Natalia , Rojas-Rojas Diana Paola , Ortiz-Mendez Cesar Alfredo , Camacho-Moreno Germán , Wilches-Cuadros Maria Angelica , Hernandez-Vargas Juan Camilo , Velandia-Páez Jessica Paola , Mancera-Gutiérrez Luz Angela , Palacios-Ariza María Alejandra , Beltrán-Higuera Sandra Jaqueline
Published: September 2021

Background:

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such as skin and soft tissue infection, osteoarticular, bacteremia or pneumonia in a pediatric population from Bogota, Colombia.

Methods:

Retrospective cohort study using clinical records of patients under 18 years of age treated at the participating centers in Bogota, Colombia, between 2014 and 2018. The first positive S. aureus culture was studied. MSSA and MRSA were compared. The χ2 test, Fisher exact test, and Kruskal-Wallis test were calculated, and the statistical significance was presented using the difference and its 95% CI.

Results:

Five hundred fifty-one patients were included; 211 (38%) corresponded to MRSA and 340 (62%) to MSSA for a total of 703 cultures. A significantly higher probability of having an MSSA infection than MRSA was found in patients with previous heart disease (3.3% vs. 0.5%), neurologic disease (5.9% vs. 2.5%), recent major surgeries (11% vs. 5%) or who has an implanted device (11% vs. 4%). In contrast, in severe MRSA infections (bacteremia, osteoarticular infections and pneumonia), a higher rate of complications was seen (admission to the pediatric intensive care unit, mechanical ventilation and vasoactive support), and in osteoarticular MRSA, more than 1 surgery per case was seen (89% vs. 61%). Laboratory results and mortality were similar.

Conclusions:

MRSA was associated with a more severe course in bacteremia, osteoarticular infections and pneumonia. Some classical risk factors associated with MRSA infections were found to be related to MSSA. In general, with the exception of skin and soft tissue infection, there was an increased risk of pediatric intensive care unit admission and mechanical and inotropic support with MRSA in a pediatric population.
U.S. military implantable collamer lens surgical outcomes: 11-year retrospective review
Authors: Packer Kyle T. , Vlasov Anton , Greenburg David L. , Coggin Andrew , Weightman James W. , Beltran Thomas , Berry-Cabán Cristóbal S. , Carroll Robert B.
Published: September 2021

Purpose:

To examine the long-term efficacy and safety of myopic implantable collamer lens (ICL) implantation in active duty personnel of U.S. military.

Setting:

Hospital practice.

Design:

Retrospective longitudinal observational study.

Methods:

1485 patients (median age 25, interquartile range 22 to 29) underwent ICL surgery. Patients received a preoperative examination including uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), manifest refraction measuring corrected distance visual acuity (CDVA), corneal topography and tomography, qualitative grading of perceived ectatic risk, ophthalmic biometry, and baseline endothelial cell counts (ECCs). Outcome measures included UDVA, IOP, vault size, manifest refraction, CDVA, and ECCs. The long-term follow-up data ware drawn from the U.S. military medical record system.

Results:

A total of 3105 eyes were evaluated. Patients received ICLs because of either abnormal topography (2111 eyes [68%]) or high myopia (994 eyes [32%]). 94 eyes (80%) maintained UDVA of 20/25 or better up to 8 years postoperatively. The rate of achieving the desired refractive correction was 97% (503 eyes) at 1 year and 90% (81 eyes) at 8 years. Stability of these outcomes was also shown by minimal change in manifest refraction. Documented mean ECC loss was 22% at postoperative year 5. The overall rate of adverse events was 1.2% (36 eyes) including visually significant cataract formation, glaucoma, retinal detachment, and traumatic incision opening. A removal or replacement rate of 4.5% (135 eyes) was observed.

Conclusions:

ICL implantation was found to be effective and safe. Vault sizes decreased over time, suggesting an increased risk of cataract formation after 7 years. Further study is necessary to assess long-term clinical significance of ECC decline.
Predicted vs measured posterior corneal astigmatism for toric intraocular lens calculations
Authors: Shammas H. John , Yu Fei , Shammas Maya C , Jivrajka Renu , Hakimeh Christine
Published: September 2021

Purpose:

To evaluate the astigmatic correction obtained with a toric intraocular lens using the keratometric readings (Ks) from a swept-source optical coherence tomography (SS-OCT) biometer and the Barrett toric formula with its predicted posterior corneal astigmatism (PCA) value and to compare the results with those expected by using the OCT Ks and a measured PCA from a scheimpflug topographer and by using the SimKs and the measured PCA from the Scheimpflug topographer.

Setting:

Private practice, Lynwood, California.

Design:

Retrospective observational study.

Methods:

All measurements were performed by the SS-OCT biometer and the Scheimpflug topographer and using the Barrett toric formula.

Results:

We evaluated 122 eyes of 122 patients. The mean absolute errors in predicted residual astigmatism for the entire series were 0.41 ± 0.19 diopters (D) (0.00 to 0.85 D) using the OCT Ks and predicted PCA, 0.45 ± 0.25 D (0.00 to 1.01 D) using the OCT Ks and measured PCA, and 0.49 ± 0.25 D (0.00 to 1.30 D) using the SimKs and measured PCA. The statistically significant differences between the errors had a P value of .062 for the entire series (n = 122), .26 for the subgroup with against-the-rule astigmatism (n = 68), .47 for the subgroup with oblique astigmatism (n = 11), and .05 for the subgroup with with-the-rule astigmatism (n = 43). The percentage of eyes within ±0.50 D were 74% (n = 90), 71% (n = 87) and 64% (n = 78) (P = .13) and within ±0.75 D were 99% (n = 121), 95% (n = 116) and 84% (n = 102) (P < .001), respectively.

Conclusions:

The Barrett toric formula and its predicted PCA performed better with the OCT K readings than with the topographer SimKs and a measured PCA.
Effect of a 7.0 mm intraocular lens optic on peripheral retinal illumination with implications for negative dysphotopsia
Authors: Erie Jay C. , Simpson Michael J. , Mahr Michael A.
Published: September 2021

Purpose:

To use optical modeling to compare a 6.0 mm and 7.0 mm intraocular lens (IOL) optic diameters on peripheral retinal illumination with implications for negative dysphotopsia.

Setting:

Mayo Clinic, Rochester, Minnesota, and Simpson Optics LLC, Arlington, Texas.

Design:

Model eye.

Methods:

Ray-tracing software was used to simulate retinal illumination from an extended light source for a pseudophakic eye with in-the-bag biconvex IOLs (refractive index [n] = 1.46 and 1.55) and a 2.5 mm pupil. Ray-tracing diagrams and simulated retina illumination profiles were compared using the 6.0 mm and 7.0 mm optic diameter IOLs. Retinal locations were scaled to relative visual angles from 70 to 110 degrees horizontally.

Results:

A 7.0 mm optic (n = 1.46) expands the image field by 2.8 degrees compared with a 6.0 mm optic. High-angle input light misses a 7.0 mm optic at a larger visual angle than a 6.0 mm optic, shifting illumination of the peripheral retina by this light anteriorly by 5.6 degrees. Consequently, a region of nonilluminated peripheral nasal retina is enlarged and shifted peripherally using a 7.0 mm optic (visual angle, 86.3 to 96.3 degrees) compared with a 6.0 mm optic (visual angle, 83.5 to 90.7 degrees). Similar illumination changes were seen modeling a 1.55 n IOL.

Conclusions:

A narrow dark region in the nasal retina when using a 6.0 mm optic is changed to a broader, more peripheral dark region when using a 7.0 mm optic. An extended, more peripheral dark nasal region may make a temporal shadow less bothersome and explain lower negative dysphotopsia rates using a 7.0 mm optic.
In-N-Out technique: double-flanged suture ab interno iridodialysis repair
Authors: Rosenberg Eric D. , Levi Maxwell A. , Nattis Alanna S.
Published: September 2021

In this study, a procedure for iridodialysis repair using an elegant, cost-effective, and quick technique using 6-0 polypropylene sutures, low-temperature electrocautery, and a 27-gauge needle is presented. Previously, all methods required performing a conjunctival peritomy to expose bare sclera and then typically intricate movements and knot tying. The method described in this study combined the sewing machine technique and a modified Yamane scleral-fixation technique to treat iridodialysis that required no knots, peritomies, or specialized equipment.
Examination of the contribution of Nav1.7 to axonal propagation in nociceptors
Authors: Goodwin George , McMurray Sheridan , Stevens Edward B. , Denk Franziska , McMahon Stephen B.
Published: September 2021

Nav1.7 is a promising drug target for the treatment of pain. However, there is a mismatch between the analgesia produced by Nav1.7 loss-of-function and the peripherally restricted Nav1.7 inhibitors, which may reflect a lack of understanding of the function of Nav1.7 in the transmission of nociceptive information. In the periphery, the role of Nav1.7 in transduction at nociceptive peripheral terminals has been comprehensively examined, but its role in axonal propagation in these neurons is less clearly defined. In this study, we examined the contribution of Nav1.7 to axonal propagation in nociceptors using sodium channel blockers in in vivo electrophysiological and calcium imaging recordings in mice. Using the sodium channel blocker tetrodotoxin (TTX) (1-10 µM) to inhibit Nav1.7 and other tetrodotoxin-sensitive sodium channels along the sciatic nerve, we first showed that around two-thirds of nociceptive L4 dorsal root ganglion neurons innervating the skin, but a lower proportion innervating the muscle (45%), are blocked by TTX. By contrast, nearly all large-sized cutaneous afferents (95%-100%) were blocked by axonal TTX. Many cutaneous nociceptors resistant to TTX were polymodal (57%) and capsaicin sensitive (57%). Next, we applied PF-05198007 (300 nM-1 µM) to the sciatic nerve between stimulating and recording sites to selectively block axonal Nav1.7 channels. One hundred to three hundred nanomolar PF-05198007 blocked propagation in 63% of C-fiber sensory neurons, whereas similar concentrations produced minimal block (5%) in rapidly conducting A-fiber neurons. We conclude that Nav1.7 is essential for axonal propagation in around two-thirds of nociceptive cutaneous C-fiber neurons and a lower proportion (≤45%) of nociceptive neurons innervating muscle.
Tyrosine kinase type A–specific signalling pathways are critical for mechanical allodynia development and bone alterations in a mouse model of rheumatoid arthritis
Authors: Delay Lauriane , Barbier Julie , Aissouni Youssef , Jurczak Alexandra , Boudieu Ludivine , Briat Arnaud , Auzeloux Philippe , Barrachina Célia , Dubois Emeric , Ardid Denis , Miot-Noirault Elisabeth , Svensson Camilla I. , Moqrich Aziz , Marchand Fabien
Published: September 2021

Rheumatoid arthritis is frequently associated with chronic pain that still remains difficult to treat. Targeting nerve growth factor (NGF) seems very effective to reduce pain in at least osteoarthritis and chronic low back pain but leads to some potential adverse events. Our aim was to better understand the involvement of the intracellular signalling pathways activated by NGF through its specific tyrosine kinase type A (TrkA) receptor in the pathophysiology of rheumatoid arthritis using the complete Freund adjuvant model in our knock-in TrkA/C mice. Our multimodal study demonstrated that knock-in TrkA/C mice exhibited a specific decrease of mechanical allodynia, weight-bearing deficit, peptidergic (CGRP+) and sympathetic (TH+) peripheral nerve sprouting in the joints, a reduction in osteoclast activity and bone resorption markers, and a decrease of CD68-positive cells in the joint with no apparent changes in joint inflammation compared with wild-type mice after arthritis. Finally, transcriptomic analysis shows several differences in dorsal root ganglion mRNA expression of putative mechanotransducers, such as acid-sensing ionic channel 3 and TWIK-related arachidonic acid activated K+ channel, as well as intracellular pathways, such as c-Jun, in the joint or dorsal root ganglia. These results suggest that TrkA-specific intracellular signalling pathways are specifically involved in mechanical hypersensitivity and bone alterations after arthritis using TrkA/C mice.
Transcranial direct current stimulation of 3 cortical targets is no more effective than placebo as treatment for fibromyalgia: a double-blind sham-controlled clinical trial
Authors: Samartin-Veiga Noelia , Pidal-Miranda Marina , González-Villar Alberto J. , Bradley Claire , Garcia-Larrea Luis , O'Brien Anthony T. , Carrillo-de-la-Peña María T.
Published: September 2021

Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) and the dorsolateral prefrontal cortex seem to improve pain and other symptoms of fibromyalgia (FM), although the evidence on the effectiveness of tDCS and the optimal stimulation target is not robust enough. Our main objective was to establish the optimal area of stimulation, comparing the 2 classical targets and a novel pain-related area, the operculo-insular cortex, in a sham-controlled trial. Using a double-blind design, we randomly assigned 130 women with FM to 4 treatment groups (M1, dorsolateral prefrontal cortex, operculo-insular cortex, and sham), each receiving fifteen 20-minute sessions of 2 mA anodal tDCS over the left hemisphere. Our primary outcome was pain intensity. The secondary outcomes were the other core symptoms of FM (fatigue, mood, cognitive and sleep disorders, and hyperalgesia measured by the pressure pain threshold). We performed the assessment at 3 time points (before, immediately after treatment, and at 6 months follow-up). The linear mixed-model analysis of variances showed significant treatment effects across time for clinical pain and for fatigue, cognitive and sleep disturbances, and experimental pain, irrespective of the group. In mood, the 3 active tDCS groups showed a significantly larger improvement in anxiety and depression than sham. Our findings provide evidence of a placebo effect, support the use of tDCS for the treatment of affective symptoms, and challenge the effectiveness of tDCS as treatment of FM.
Time course prevalence of post-COVID pain symptoms of musculoskeletal origin in patients who had survived severe acute respiratory syndrome coronavirus 2 infection: a systematic review and meta-analysis
Authors: Fernández-de-las-Peñas César , Navarro-Santana Marcos , Plaza-Manzano Gustavo , Palacios-Ceña Domingo , Arendt-Nielsen Lars
Published: September 2021

The aim of this review or meta-analysis is to synthesize the prevalence of post-coronavirus disease (COVID) pain symptoms of musculoskeletal origin in hospitalized or nonhospitalized patients recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were searched up to May 1, 2021. Studies or preprints reporting data on post-COVID pain symptoms such as myalgias, arthralgias, or chest pain after SARS-CoV-2 infection and collected by personal, telephonic, or electronical interview were included. The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale. Random-effects models were used for meta-analytical pooled prevalence of each post-COVID musculoskeletal pain symptom. Data synthesis was categorized at onset or hospital admission and at 30, 60, and 90, and ≥180 days after. From a total of 12,123 studies identified, 27 peer-reviewed studies and 6 preprints were included. The sample included 14,639 hospitalized and 11,070 nonhospitalized COVID-19 patients. The methodological quality of almost 70% studies was fair. The overall prevalence of post-COVID myalgia, joint pain, and chest pain ranged from 5.65% to 18.15%, 4.6% to 12.1%, and 7.8% to 23.6%, respectively, at different follow-up periods during the first year postinfection. Time trend analysis showed a decrease prevalence of musculoskeletal post-COVID pain from the symptom's onset to 30 days after, an increase 60 days after, but with a second decrease ≥180 days after. This meta-analysis has shown that almost 10% of individuals infected by SARS-CoV-2 will suffer from musculoskeletal post-COVID pain symptomatology at some time during the first year after the infection.
Sleep problems in pain patients entering tertiary pain care: the role of pain-related anxiety, medication use, self-reported diseases, and sleep disorders
Authors: Miettinen Teemu , Sverloff Jaana , Lappalainen Olli-Pekka , Linton Steven J. , Sipilä Kirsi , Kalso Eija
Published: September 2021

Chronic pain and sleep problems frequently co-occur. Pain itself disturbs sleep, but other factors may also contribute to sleep problems in pain patients. This cross-sectional study of 473 patients (69.9% female, mean age 47 years) entering tertiary pain management compared normally sleeping pain patients with those having recurring sleep problems to determine the relationship between pain and sleep. Groups were compared for pain and pain aetiology, pain-related anxiety, childhood adversities, use of sleep and pain medications, self-reported diseases, and sleep disorders. Furthermore, the association of pain-related anxiety (cognitive anxiety, escape/avoidance, fear, and physiological anxiety) with more disturbing sleep problems was investigated in the whole cohort. The main results were that those with sleep problems more often reported multiple health conditions than those sleeping normally (depression 31.6% vs 5.0%; angina pectoris 6.5% vs 0.0%; asthma 19.6% vs 1.7%; low back problems 55.1% vs 23.3%; joint disease other than rheumatoid arthritis 32.3% vs 18.3%). Accumulations of 5 or more childhood adversities were more often present in those with sleep problems. Restless legs symptoms were more common in those with sleep problems than those sleeping normally (33.2% vs 11.7%). Patients having sleep problems reported more use of sleep and pain medications than those sleeping normally. Findings about pain-related anxiety suggest physiological reactions as significant factors for increased sleep disturbances. These factors need to be addressed in the management of the comorbidity of pain and sleep problems, and research to understand mechanisms in these is sorely needed.
Association of sensory phenotype with quality of life, functionality, and emotional well-being in patients suffering from neuropathic pain
Authors: Gierthmühlen Janne , Böhmer Johann , Attal Nadine , Bouhassira Didier , Freynhagen Rainer , Haanpää Maija , Hansson Per , Jensen Troels Staehelin , Kennedy Jeffrey , Maier Christoph , Rice Andrew S.C. , Sachau Juliane , Segerdahl Märta , Sindrup Sören , Tölle Thomas , Treede Rolf-Detlef , Ventzel Lise , Vollert Jan , Baron Ralf
Published: September 2021

Neuropathic pain highly affects quality of life, well-being, and function. It has recently been shown based on cluster analysis studies that most patients with neuropathic pain may be categorized into 1 of 3 sensory phenotypes: sensory loss, mechanical hyperalgesia, and thermal hyperalgesia. If these phenotypes reflect underlying pathophysiological mechanisms, they may be more relevant for patient management than underlying neurological diagnosis or pain intensity. The aim of this study was thus to examine the impact of these sensory phenotypes on mental health, functionality, and quality of life. Data of 433 patients from the IMI/EuroPain network database were analyzed, and results of HADS-D/A, Pain Catastrophizing Scale, Euro Quality of Life 5D/-VAS, Brief Pain Inventory, and Graded Chronic Pain Scale between the sensory phenotypes were compared using multiple regression analysis. There was no difference in chronic pain grade, pain intensity, depression, or anxiety scores between phenotypes. Pain interference (Brief Pain Inventory) was higher (P = 0.002); self-reported health state lower (Euro Quality of Life 5D VAS, P = 0.02); and problems regarding mobility (P = 0.008), usual activities (P = 0.004), and self-care (P = 0.039) more prominent (EQ5-D) in the sensory loss compared with the thermal hyperalgesia phenotype. Patients with sensory loss also showed higher pain catastrophizing scores (P = 0.006 and 0.022, respectively) compared with the 2 other groups. Sensory phenotype is associated with the impact of neuropathic pain conditions on well-being, daily functionality, and quality of life but is less associated with pain intensity. These results suggest that the somatosensory phenotype should be considered for personalized pain management.
Clinical outcomes and metastatic behavior between de novo versus recurrent HER2-positive metastatic breast cancer: A 17-year single-institution cohort study at Taipei Veterans General Hospital
Authors: Cheng Han-Fang , Tsai Yi-Fang , Huang Chi-Cheng , Lien Pei-Ju , Wang Yu-Ling , Hsu Chih-Yi , Chen Yen-Jen , Liu Chun-Yu , Chao Ta-Chung , Lin Yen-Shu , Feng Chin-Jung , Chiu Jen-Hwey , Chau Gar-Yang , Tseng Ling-Ming
Published: September 2021

Background:

To assess the clinical outcomes and metastatic behavior between de novo versus recurrent human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) based on a single-institution database in Taiwan.

Methods:

We retrospectively identified patients diagnosed between January 2000 and December 2017 with de novo stage IV or recurrent HER2-positive MBC. Several variables were recorded in patients with recurrent disease: age at diagnosis, metastatic site, hormone receptor (HR) status, HER2 status, and disease-free interval (DFI). Treatments and metastatic patterns were compared between de novo stage IV and recurrent MBC cohorts. Post-metastasis survival (PMS) was estimated using the Kaplan-Meier method with log-rank tests. Hazard ratios and 95% CIs were estimated using Cox regression analysis.

Results:

In total, 1360 patients were diagnosed with breast cancer with HER2 overexpression. At baseline, de novo stage IV patients were older than recurrent MBC patients (median age 58 vs 53). The majority of the de novo stage IV patients were diagnosed after 2010, while most of the recurrent MBC patients were diagnosed during 2000-2009. An increased number of de novo stage IV patients underwent targeted therapy than recurrent MBC patients was also noted. PMS in patients with de novo stage IV and recurrent MBC was 79.2 months and 61.8 months, respectively, which indicated significant better survival in de novo stage IV than those with recurrent MBC disease. Longer survival was also noted in de novo stage IV and recurrent MBC with DFI >24 months than in those with recurrent MBC with DFI <24 months and in patients receiving HER2-targeted therapy after MBC diagnosis than in those not receiving the therapy. However, median PMS showed no significant difference between patients with the luminal B2 (HR-positive, HER2-negative) and HER2-enriched (HR-negative, HER2-positive) subtypes. After adjustment in multivariate analysis, a low risk of BC-specific death was observed in patients aged >50 years, those receiving HER2-targeted therapy for MBC, and those with oligometastasis, while patients with first metastases to the liver or brain showed a higher risk of BC-specific death than those without metastases.

Conclusion:

De novo and recurrent MBC have distinct characteristic, metastatic patterns and outcomes in Asian HER2-positive breast cancer patients. The age distribution and survivals between HR+/– status were different to non-Asian group. These differences should be further investigated in the future considering ethnic factor.
Sexual Assault Against Women: A Retrospective Study of 292 Cases in Fujian Province, China
Authors: Shi Lei , Lu Ting , Li Yuan , Deng Zhen-hua
Published: September 2021

Introduction

In China, rape is defined as forced sexual intercourse against a woman's will by violence, coercion, or any other means or intentionally having sexual intercourse with a girl under the age of 14 years who is legally incompetent of giving consent.

Method

A retrospective study of 292 cases of rape in Fujian Province, China, between the years 2014 and 2017 was conducted. Sociodemographic characteristics of victims and perpetrators, perpetration patterns of rape, and associated factors were reviewed and analyzed.

Results

Over a quarter of rape victims were under the age of 18 years. In over half of cases, the perpetrators were known to the victims, which was more frequent in minors than in adult victims. Over half of perpetrators were within the age range of 18–30 years. Most perpetrators had received a low level of education and were from low-income populations. Nighttime has the highest occurrence of rapes: 39.9% of rapes occurred during late night; and 24.6%, during early night. Victim perpetrator relationship and the location were significantly related (χ2 = 23.667; df = 3, 266; p < 0.001). Risk evaluation showed that 30.8% and 28.1% of cases occurred under medium- and high-risk settings, respectively. Sexual motivation was present in over 95% of cases. Physical force was used in almost half of cases. Less than half of victims received forensic clinical examination after perpetration.

Conclusions

The findings provide population-based data to contribute to the future development of prevention strategies and to raise awareness of the urgent need for victim assistance services.
The Effect of Rigid Spinal Orthosis on the Muscular Capacity of Patients With Low Back Pain - A 3-Month Follow-up Study
Authors: Rimaud Diana , Rieffel Naomi , Fayolle-Minon Isabelle , Vedreine Philippe , Ebermeyer Eric , Salmochi Jean-François , Jacquin Olivier , Dye Emmanuel , Mazel Clément , Calmels Paul
Published: September 2021

Introduction

In chronic low back pain, the use of lumbar orthosis treatment is not part of general recommendations due to a lack of supporting evidence. However, interest in segmental immobilization at the mechanical and postural level is still current in practice, with, however, the belief of negative effects on muscular capacity. The objective of our study was to assess the evolution of muscle capacity after wearing custom-made rigid corset in patients with chronic low back pain.

Materials and Methods

This is a multicenter study in patients with chronic low back pain, for which the wearing of a rigid postural immobilization corset for 3 months was prescribed. Twenty-two patients completed all follow-up assessments at baseline, 45 days, and 3 months. Evaluations included Biering-Sørensen test, Shirado test, chair test, hand/ground test, lateral inclination test, Quebec scale, and visual analog scale.

Results

The results revealed a significant improvement of Biering-Sørensen test after 3 months (37.0 ± 53.6 seconds at D0, 41.3 ± 51.7 seconds at D45, and 53.2 ± 60.5 seconds at D90; P < 0.05), in hand/ground distance (21.8 ± 28.5 cm at D0, 15.5 ± 17.8 cm at D45, and 12.2 ± 15.5 cm at D90; P < 0.05), in disability based on the Quebec questionnaire (0.52 ± 0.21 at D0, 0.45 ± 0.19 at D45, and 0.39 ± 0.19 at D90; P < 0.05), and significant reductions in visual analog scale measures of pain (6.0 ± 1.7 at D0, 3.7 ± 1.7 at D45, and 2.7 ± 1.9 at D90; P < 0.05).

Conclusions

This study shows that the wearing of a rigid orthosis does not alter the muscular endurance capacities of the trunk muscles. In view of the results, wearing a rigid orthosis may be an alternative to treating chronic low back pain. It does not induce muscle loss and may even contribute to motor disinhibition, resulting in improved spinal mobility and functional abilities.

Clinical Relevance

The common belief that wearing a spinal orthosis leads to muscle loss should no longer be an obstacle to its prescription since it helps to maintain muscle capacity and reduces pain.
Impacts of a Robotic Arm on People with Upper-Limb Disabilities Due to Neuromuscular Disorder
Authors: Routhier François , Lettre Josiane , Bouffard Jason , Archambault Philippe , Lemay Martin , Gélinas Isabelle
Published: September 2021

Introduction

Research is still limited on the impacts of robotic arms in improving independent living and social participation of individuals with upper-limb disabilities, and several knowledge gaps remain. This study aims to investigate the impacts of the JACO robotic arm on individuals with upper-limb impairments due to a neuromuscular disease.

Methods

For this prospective study, participants used the robotic arm in their daily life for a 2-month period. The effectiveness of the robotic arm was objectively observed during activities performed in a controlled environment. The perception of the users and of their main family caregivers was also documented. Finally, the nature and importance of activities carried out with the robotic arm in a community-living environment were explored.

Results

Participants' abilities with the JACO robotic arm improved continuously during the trial duration. Participants actively took part in more life habits, perceived fewer difficulties, and were more satisfied with their social participation. Despite these findings, very few life habits could be performed completely independently, limiting the impacts on global caregivers' burden.

Conclusions

Even if participants encountered some difficulties, this study demonstrates short-term benefits of the robotic arm for individuals with upper-limb impairments due to a neuromuscular disorder. Future studies should mainly focus on the psychosocial, economic, and occupational long-term impacts of the robotic arm. The development of services to assist the integration of such devices in people's lives could optimize their impacts.

Clinical Relevance

The results of this study contribute to the body of knowledge of clinicians for the prescription of a robotic arm.