bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes after primary reverse total shoulder arthroplasty in patients with comorbid anxiety and depressive disorders: a retrospective cohort study
Authors: Moore A. Ryves , Brolin Tyler J. , Smith Richard A. , Azar Frederick M. , Throckmorton Thomas W.
Published: November 2020

Background:

Current literature generally indicates that anxiety and depressive disorders have negative effects on the outcomes of orthopaedic procedures. We studied a patient population with primary reverse total shoulder arthroplasty (RTSA) to evaluate the effect of these disorders on 2-year outcomes.

Methods:

Patients were classified as having depression or anxiety by documentation of such in the chart or the use of a prescription mood-stabilizing drug. Pain and function were evaluated with visual analog scale (VAS) and American Shoulder and Elbow Surgeons (ASES) scores, respectively. Data for complications, reoperations, and readmissions were also compiled, and radiographs were assessed for loosening or component failure at the most recent follow-up.

Results:

Database search identified 112 patients (114 shoulders) with primary RTSA and a minimum of 2-year clinical and radiographic follow-up. Thirty-one patients were categorized as having depression and/or anxiety, and 81 (83 shoulders) did not have these disorders. Significantly more women than men were in the anxiety and depression group (P=0.007). There were no significant differences in other patient demographics or VAS, ASES score, range of motion, or strength at 2-year follow-up (all P>0.05). Three complications occurred in the anxiety/depression group, and 16 occurred in the group without these disorders (P=0.34).

Conclusions:

Contrary to most current literature, these results suggest that patients with anxiety and/or depression can expect similar outcomes as those of patients without these disorders after primary RTSA.

Level of Evidence:

Level III.
Accuracy of imageless navigation for functional cup positioning and restoration of leg length in total hip arthroplasty: a matched comparative analysis
Authors: Meftah Morteza , Siddappa Vinay Hosuru , Muir Jeffrey M.
Published: November 2020

Background:

Computer-assisted navigation has the potential to improve the accuracy of cup positioning during total hip arthroplasty (THA) and prevent leg-length discrepancy (LLD). The purpose of this study was to compare acetabular cup position and postoperative LLD after primary THA using posterolateral approach.

Methods:

Between August 2016 to December 2017, 57 THAs using imageless navigation were matched with 57 THA without navigation, based on age, gender, and BMI. Postoperative weight-bearing radiographs were assessed for anteversion, inclination, and LLD. Functional LLD was measured in comparison to the contralateral side. The proportion of cups within Lewinnek’s safe zone and LLD greater than 5 mm were assessed.

Results:

The mean age was 54.9±9.6 yr and 57.6±12.5 yr in control and navigated groups, respectively. Mean cup orientation in the navigated group was 20.6±3.3 degrees (17 to 25) of anteversion and 41.9±4.8 degrees (30 to 51) of inclination, versus 25±11.1 degrees (10 to 31) and 45.7±8.7 degrees (29 to 55) in the control group; these were statistically significant (P=0.005 and P<0.001, respectively). In the navigated group, significantly more acetabular cups were placed within Lewinnek’s safe zone (anteversion: 77% vs. 47%, P=0.005; inclination: 91% vs. 67%, P<0.001). There was no significant difference in mean LLD in the navigation and control groups (3.2±1.5 mm vs. 4.6±3.4 mm, P=0.36), although fewer LLDs of greater than 5 mm were reported in the navigated group (7.1%) than in the control group (31.6%, P=0.007).

Conclusions:

The use of imageless computer-assisted navigation improved the accuracy of acetabular cup components and LLD.

Level of Evidence:

Level III.
Bruegel and the Cost of the Bended Knee
Authors: Rebello Gleeson , Joseph Benjamin
Published: November 2020

In Pieter Bruegel’s painting, “The Seven Acts of Charity” he portrays 2 subjects with flexed knees. One of them cannot walk while the other can walk but does so with excessive energy expenditure.
EFFECTS OF GLYCEMIC VARIABILITY ON THE PROGRESSION OF DIABETIC RETINOPATHY AMONG PATIENTS WITH TYPE 2 DIABETES
Authors: Park Jae Yong , Hwang Je Hyung , Kang Min Ji , Sim Ha Eun , Kim Jae Suk , Ko Kyung Soo
Published: November 2020

Purpose:

To evaluate the effects of glycemic variability on the progression of diabetic retinopathy (DR) among individuals with Type 2 diabetes and to test the hypothesis that consistent glycemic control delays the progression of DR.

Methods:

This retrospective study included 1,125 participants with a follow-up period of more than 5 years and more than 20 glucose laboratory test results. The hazard ratio of ≥3 steps of progression on the Early Treatment Diabetic Retinopathy Study person scale and progression to proliferative DR were assessed.

Results:

An increase in the HbA1c SD was associated with a higher risk of ≥3 step progression (P < 0.001) and progression to proliferative DR (P < 0.001). Not only mean HbA1c, but also HbA1c SD was associated with a lower risk of ≥3 steps of progression (P < 0.001), and progression to proliferative DR (P < 0.001).

Conclusion:

Achievable and consistent glycemic control may contribute to the delay in DR progression.

Clinical Trial Registration Number:

Institutional review board of Inje University (No. 202003014).
THE EFFECT OF ENDOPHTHALMITIS ON RECURRENCE OF MACULAR EDEMA IN EYES RECEIVING INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR
Authors: Uhr Joshua H. , Storey Philip P. , Kuley Brandon , Patel Samir N. , Wibbelsman Turner D. , Pancholy Maitri , Spirn Marc J.
Published: November 2020

Purpose:

Visual outcomes after postinjection endophthalmitis have been well-studied, but the effect of endophthalmitis on the underlying exudative disease process remains unclear. We investigate the need for continued anti–vascular endothelial growth factor injections after endophthalmitis.

Methods:

Eyes that developed endophthalmitis after intravitreal injection of anti–vascular endothelial growth factor between January 1, 2016, and May 31, 2018, at a single academic retina practice were identified. Retrospective chart review was performed to determine 1) the proportion of eyes without recurrence of macular edema or subretinal fluid after endophthalmitis and 2) the proportion achieving a 12-week or greater interval between anti–vascular endothelial growth factor injections or exudation after endophthalmitis compared with internal controls before endophthalmitis.

Results:

Of 50 eyes with endophthalmitis, seven (14.0%) had no fluid recurrence at a mean of 98.1 week. Of 43 eyes with recurrence, 48.0% achieved a >12-week recurrence-free interval after endophthalmitis (vs. 8.3% before endophthalmitis; P < 0.0001). Eyes with compared to those without choroidal neovascularization were more likely to achieve this interval (60.5% vs. 8.3%, respectively; P = 0.002).

Conclusion:

Endophthalmitis after anti–vascular endothelial growth factor injection is associated with relative stability of the underlying exudation. Further research is necessary to elucidate the mechanism, which may be useful in developing strategies and targets for the treatment of exudative macular diseases.
Three-year outcomes of mixed astigmatism correction with single-step transepithelial photorefractive keratectomy with a large ablation zone
Authors: Kaluzny Bartlomiej J. , Verma Shwetabh , Piotrowiak-Słupska Ilona , Kaszuba-Modrzejewska Magdalena , Rzeszewska-Zamiara Jagoda , Stachura Joanna , Arba-Mosquera Samuel
Published: November 2020

Purpose:

To evaluate refractive and visual outcomes of single-step transepithelial photorefractive keratectomy (transPRK) in the treatment of mixed astigmatism with the use of an aberration-neutral profile and large ablation zone.

Setting:

Nicolaus Copernicus University and Oftalmika Eye Hospital, Bydgoszcz, Poland.

Design:

Retrospective, observational case series.

Methods:

This study included patients who underwent transPRK to correct mixed astigmatism and completed the 3-year follow-up. Procedures were performed with an Amaris 750S excimer laser using an aberration-neutral profile and optical zone of 7.2 mm or more.

Results:

A total 48 eyes of 39 patients were included. Preoperatively, mean spherical manifest refraction was +1.37 ± 0.98 diopter (D) (0.25 to 4.00 D), and astigmatism was −4.00 ± 0.76 D (−2.25 to −6.00 D). Three years postsurgery, it was −0.17 ± 0.26 D and −0.41 ± 0.44 D, respectively. Attempted spherical equivalent correction within ±0.50 D was achieved in 45 eyes (94%) and cylindrical correction in 34 (71%). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 38 eyes (79%), and postoperative uncorrected was 20/20 or better in 29 eyes (60.0%). No eye had lost 2 or more Snellen lines of CDVA, whereas 3 eyes (6%) gained 2 or more lines. In 4 eyes (8%), haze of low intensity was observed at the periphery, with scores between 0.5 and 1.0, and only 1 eye getting a score of 2 in 0- to 4-degree scale.

Conclusions:

Mixed astigmatism correction with large-ablation-zone transPRK provided good results for efficacy, safety, predictability, and visual outcomes in a 3-year follow-up.
Corneal endothelial damage in phacoemulsification using an anterior chamber maintainer compared with using an ophthalmic viscosurgical device
Authors: Mayali Huseyin , Baser Esin Fatma , Kurt Emin , Ilker Suleyman Sami
Published: November 2020

Purpose:

To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells.

Setting:

Department of Ophthalmology, Celal Bayar University, Manisa, Turkey.

Design:

Prospective randomized controlled trial.

Methods:

Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE.

Results:

This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ± 10.6 years in the OVD group, 64.0 ± 12.6 years in the ACM group (P > .05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P > .05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P = .002, P = .002, and P = .001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P = .003, P = .001, and P = .001, respectively). CV increased and HEX decreased in both groups postoperatively (P > .05 for both). CCT showed a transient increase of less than 10 μm at postoperative 1 month in both groups (P = .296).

Conclusions:

PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve.
Single-port transconjunctival vitrectomy for malignant glaucoma
Authors: Gupta Shikha , Lakra Subodh , Beniwal Abhijeet , Chawla Rohan , Gogia Varun , Gupta Viney
Published: November 2020

The management of malignant glaucoma involves either anterior vitrectomy with zonulectomy and iridectomy or 3-port core pars plana vitrectomy (PPV) by retinal surgeons. The proposed modification can be performed with reasonable success rates. In this technique, synechiolysis and anterior chamber irrigation were performed through a limbal incision, and a single-port 23- or 25-gauge vitrector was introduced through PPV superotemporally to perform anterior vitrectomy and central posterior capsulotomy in pseudophakic eyes. The same procedure can be performed after cataract surgery in phakic eyes. Vitrectomy is continued until anterior chamber deepens, ensuring a conduit between anterior and posterior chambers through the posterior capsulotomy alone, bypassing the need for a posterior iridectomy/zonulectomy. In a series on 9 eyes, all achieved optimization of anterior chamber depth with intraocular pressure normalization in 8 of 9 eyes, without showing any signs of recurrence at a mean follow-up of 8.6 months.
Return of phacoemulsification after emergency status related to COVID-19: experience of a tertiary referral center
Authors: Vieira Rita , Baptista Pedro , Castro Catarina , Leite João , Menéres Maria João , Menéres Pedro
Published: November 2020

Purpose:

To present a protocol of priority criteria for phacoemulsification after the backlog due to severe acute respiratory syndrome coronavirus (SARS-CoV)-2 pandemic status.

Setting:

Ophthalmology department of Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal.

Design:

Cross-sectional, nonrandomized, retrospective study.

Methodology:

Data of all patients waiting for cataract surgery were analyzed at the beginning of May 2020, after 2 months without performing elective surgery. The waiting time since surgical inscription was considered an independent and overriding factor. In addition, higher priority was given to patients with white or brunescent cataracts and patients with low visual acuity: corrected distance visual acuity (CDVA) of 20/200 or less in binocular patients or CDVA of 20/63 or less in monocular patients. Criteria of medium priority included patients who remained with anisometropia and patients with glaucoma or low to moderate risk for chronic angle closure. Data of scheduled surgeries in the following months were then analyzed.

Results:

A total of 717 patients were waiting for phacoemulsification. One hundred ninety-one patients (26.64%) were on the waiting list more than 4.5 months; the medium waiting time was 3.51 ± 1.57 months. According to both priority criteria and waiting time, 348 (48.6%) were categorized as priority cases. A total of 158 patients (22.0%) met the highest priority; 61 patients (8.5%) met the medium priority criteria. In 129 patients (18.0%), priority was considered based solely on higher waiting time. This algorithm allowed surgeons to operate on all priority cases within the first 3 months.

Conclusions:

The presented protocol showed to be effective, providing a timely surgical opportunity for priority cases.
Neuropathic pain generates silent synapses in thalamic projection to anterior cingulate cortex
Authors: Wang Yao Q. , Wang Junshi , Xia Sun-hui , Gutstein Howard B. , Huang Yanhua H. , Schlüter Oliver M. , Cao Jun-Li , Dong Yan
Published: November 2020

Pain experience can change the central processing of nociceptive inputs, resulting in persistent allodynia and hyperalgesia. However, the underlying circuit mechanisms remain underexplored. Here, we focus on pain-induced remodeling of the projection from the mediodorsal thalamus (MD) to the anterior cingulate cortex (ACC), a projection that relays spinal nociceptive input for central processing. Using optogenetics combined with slice electrophysiology, we detected in male mice that 7 days of chronic constriction injury (CCI; achieved by loose ligation of the sciatic nerve) generated AMPA receptor (AMPAR)-silent glutamatergic synapses within the contralateral MD-to-ACC projection. AMPAR-silent synapses are typically GluN2B-enriched nascent glutamatergic synapses that mediate the initial formation of neural circuits during early development. During development, some silent synapses mature and become “unsilenced” by recruiting and stabilizing AMPARs, consolidating and strengthening the newly formed circuits. Consistent with these synaptogenic features, pain-induced generation of silent synapses was accompanied by increased densities of immature dendritic spines in ACC neurons and increased synaptic weight of GluN2B-containing NMDA receptors (NMDARs) in the MD-to-ACC projection. After prolonged (∼30 days) CCI, injury-generated silent synapses declined to low levels, which likely resulted from a synaptic maturation process that strengthens AMPAR-mediated MD-to-ACC transmission. Consistent with this hypothesis, viral-mediated knockdown of GluN2B in ACC neurons, which prevented pain-induced generation of silent synapses and silent synapse-mediated strengthening of MD-to-ACC projection after prolonged CCI, prevented the development of allodynia. Taken together, our results depict a silent synapse-mediated mechanism through which key supraspinal neural circuits that regulate pain sensitivity are remodeled to induce allodynia and hyperalgesia.
Evolution of robotic-assisted kidney transplant: successes and barriers to overcome
Authors: Matthew Ashley N. , Hampton Lance J. , Autorino Riccardo , Bhati Chandra S.
Published: November 2020

Purpose of review

The aim of this study was to provide an updated review of robotic-assisted kidney transplant (RAKT) with an emphasis on advantages over the open kidney transplant (OKT), utility in special populations and resources available to overcome the learning curve of robotic surgery.

Recent findings

The majority of the reported studies showed that RAKT and OKT have similar functional outcomes including similar ischemia times and time to postoperative normalization of creatinine. However, RAKT results in fewer wound complications, decreased estimated blood loss and pain. Given these benefits, RAKT is a promising approach for obese patient across BMI subtypes and several studies showed decreased wound complications in this population compared with the open approach. Moreover, new 3D-print techniques are promising resources for robotic simulation, which may decrease the learning curve of robotic surgery.

Overall, RAKT is a feasible approach especially in obese patients. However, more data with long-term follow-up are needed to fully elucidate the advantages over OKT before universal implementation of this approach is possible.
Advanced ureteroscopic techniques for the management of kidney stones
Authors: Falagario Ugo Giovanni , Calò Beppe , Auciello Mario , Carrieri Giuseppe , Cormio Luigi
Published: November 2020

Purpose of review

Recent years witnessed significant changes in the endourological management of renal tones because of the development of new, more advanced instruments. Retrograde intrarenal surgery (RIRS) has gained particular advantage from such technological progress and now tends to be considered the gold standard treatment for uncomplicated less than 20 mm renal stones. Using a step-by-step approach, this review aims to highlight current achievements but also unsolved problems in RIRS.

Recent findings

Several technical details of RIRS, including preoperative stenting, use of ureteral access sheets, lithotripsy method, and renal drainage, remain open to discussion and linked to surgeon's preference. Moreover, there is a wide range of variation in efficacy and safety data, with major complications being episodic but often under-reported.

RIRS has gained increased popularity among the urological community. This is certainly because of the continuous technological advancements, which have continuously improved the RIRS performance but also to the perception of ease and safety of this procedure when compared with the other available treatment modalities, particularly percutaneous nephrolitotomy. Indeed, the reported advances in RIRS technique have significantly improved the outcomes of this procedure but care should be taken not to underestimate its potential challenges.
Clinical Outcomes Following Therapeutic Endoscopic Retrograde Cholangiopancreatography in Children With Pancreas Divisum
Authors: Lin Tom K. , Pathak Sagar J. , Hornung Lindsey N. , Vitale David S. , Nathan Jaimie D. , Abu‐El‐Haija Maisam
Published: November 2020

Objectives:

Pancreas divisum (PD) is a risk factor in children for the development of acute pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (mPES) may be of clinical benefit, however, the clinical outcomes from endotherapy remain unclear. We sought to review the outcomes and safety of therapeutic ERCP in children with PD.

Methods:

We performed a retrospective chart of children with PD who underwent an ERCP between February 2012 and December 2018. Pertinent patient, clinical and procedure information was collected including procedure‐related adverse events. A follow‐up questionnaire of the parent was conducted to determine the clinical impact from endotherapy.

Results:

Fifty‐eight ERCPs were performed in 27 patients (14 boys; mean age: 9.7 years, range 2‐19) with PD. All patients underwent a successful mPES. A genetic variant was identified in 19/26 (73%) tested patients. Post‐ERCP pancreatitis (PEP) was the only observed adverse event; 21% (12/58). Median follow‐up interval from first ERCP intervention to questionnaire completion was 31.5 months (range: 4‐‐72 months). Of the 20 questionnaire responders, 13 reported clinical improvement from endotherapy.

Conclusions:

The majority of children from our PD cohort possessed at least 1 genetic variant. Most questionnaire responders had a favorable response to endotherapy. PEP rate was comparable with that of prior reports in adult patients.
Clinical Experience With Performing Esophageal Function Testing in Children
Authors: van Lennep Marinde , Leijdekkers Marin L. , Oors Jac M. , Benninga Marc A. , van Wijk Michiel P. , Singendonk Maartje M.J.
Published: November 2020

Objectives:

Pediatric high‐resolution manometry (HRM) and 24‐hour pH‐impedance with/without ambulatory manometry (pH‐MII+/‐mano) tests are generally performed using adult‐derived protocols. We aimed to assess the feasibility of these protocols in children, the occurrence of patient‐related imperfections and their influence on test interpretability.

Methods:

Esophageal function tests performed between 2015 and 2018 were retrospectively analyzed. All tests were subcategorized into uninterpretable or interpretable tests (regardless of occurrence of patient‐related imperfections). For HRM, the following patient‐related imperfections were scored: patient‐related artefacts, multiple swallowing and/or inability to establish baseline characteristics. For pH‐MII(+/‐mano), incorrect symptom registration and/or premature catheter removal were scored. Results were compared between age‐groups (0–3, 4–12, and >12 years).

Results:

In total 106 HRM, 60 pH‐MII, and 23 pH‐MII‐mano could be fully analyzed. Of these, 94.8% HRM, 91.9% pH‐MII, and 95.7% pH‐MII‐mano were interpretable. Overall, HRM contained imperfections in 78.3% overall and in 8/8 (100%) in the youngest age group, 36/42 (85.7%) in 4 to 12 years and in 37/56 (66.1%) in children above 12 years; P = 0.011. These imperfections led to uninterpretable results in 4 HRM (3.8%), of which 3 were in the youngest age group (3/8, 37.5%). Imperfections were found in 10% of pH‐MII and 17.4% of pH‐MII‐mano. These led to uninterpretable results in 5.0% and 4.3%, respectively. No age‐effect was found.

Conclusions:

Esophageal function tests in children are interpretable in more than 90% overall. In children under the age of 4 years, all patients had imperfect HRM and 3/8 tests were uninterpretable. HRM in older children and pH‐MII+/‐mano were interpretable in the vast majority.
Ferric Carboxymaltose Across All Ages in Paediatric Gastroenterology Shows Efficacy Without Increased Safety Concerns
Authors: Sasankan Natasha , Duncan Hazel , Curtis Lee , McGuckin Christina , Shannon Claire , Barclay Andrew , Fraser Simon , Nair Mridula , Russell Richard K. , Hansen Richard
Published: November 2020

Objectives:

The aim of the study was to assess the efficacy, safety and side‐effect profile of ferric carboxymaltose (FCM) for correcting IDA in children and adolescents in paediatric gastroenterology, hepatology, and nutrition.

Method:

This was a retrospective study of all gastroenterology patients <18 years who had FCM (October 2015 to October 2017). Haematological and biochemical parameters were recorded pre‐infusion, at 4 weeks, 3 months, 6 months, and 1 year post‐infusion. Recognised side‐effects were documented.

Results:

Sixty‐six children received FCM during this period. Data was analysed on 61 children, 5 excluded because of inadequate data. The median age at administration was 14 years (IQR 7). Thirty‐two (52%) were boys. Twenty‐six (42%) were <14 years old. Seven (11.5%) were <5 years old. Seventeen (28%) were switched from oral iron supplements to FCM. The median dose of FCM delivered was 19 mg/kg. The median haemoglobin increased from 108 to 126 g/L at 1 month post‐infusion (P value <0.00001). The mean cell volume also improved from 80 to 84 fL at 1 month post‐infusion (P value = 0.0007). Forty‐eight (94%) children corrected their anaemia after receiving FCM. Two patients (3%) reported side‐effects with skin bruising and staining.

Conclusions:

FCM appears to be effective in correcting IDA in children across a wide range of gastroenterology indications and all ages. It is effective and generally well tolerated including in very young patients. Potential side‐effects can be avoided by careful monitoring during infusions.
Stuttering Priapism in a Teenage Boy: Lesson to be Learnt
Authors: Sachdeva Pallavi , Kalra Manas , Thatikonda Kasi B. , Aggarwal Satish K. , Sachdeva Divij , Sachdeva Anupam
Published: November 2020

Untreated priapism can lead to ischemic damage of the penis and impotence. This case report describes a 14-year-old boy who presented with a history of priapism for 2 months, which was undiagnosed, ridiculed, and ignored even by medical practitioners. The underlying etiology was later identified to be chronic myeloid leukemia. Despite the usage of multimodal treatment, it took 7 days for control of priapism. The young boy is now left with an erectile dysfunction. The case highlights that priapism in children is a medical emergency needing aggressive evaluation and treatment.
A Very Rare Type of Leukemia in a Young Pediatric Patient Treated With Hematopoietic Stem Cell Transplantation: Blastic Plasmacytoid Dendritic Cell Neoplasm
Authors: Tekkeşin Funda , Asarcikli Fikret , Yildirim Ülkü M. , Zemheri Itir E. , Kiliç Suar Çaki
Published: November 2020

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a newly identified, very rare, highly aggressive hematopoietic neoplasm, primarily found in elderly males. They typically present in the form of skin involvement with a high frequency of lymph node and bone marrow involvement. BPDCN has a very poor prognosis, with no consensus on a widely accepted treatment modality. Here we present a very young patient with BPDCN, who presented with generalized lymphadenopathy, skin involvement, and leukemic blasts in the bone marrow. She was treated with high-risk acute lymphocytic leukemia protocol, followed by allogeneic hematopoietic stem-cell transplantation, and has been in clinical remission for 12 months.
Treatment of Primary Central Nervous System Germinomas With Short-course Induction Chemotherapy Followed by Low-dose Radiotherapy Without a Tumor Bed Boost: Prognostic Impact of Human Chorionic Gonadotropin
Authors: Chou Yung-Chih , Wu Yao-Yu , Hung Sheng-Ping , Tsang Ngan-Ming , Pai Ping-Ching , Jaing Tang-Her , Lin Chien-Yu , Hsieh Cheng-En , Fan Kang-Hsing , Kao Wei-Heng , Tseng Chen-Kan
Published: November 2020

Objective:

To investigate the clinical utility of short-course induction chemotherapy followed by low-dose radiotherapy without a tumor bed boost in patients with primary central nervous system (CNS) germinomas.

Methods:

We retrospectively reviewed the clinical records of patients with primary CNS germinomas who received short-course induction chemotherapy (2 cycles of cisplatin 20 mg/m2 plus etoposide 40 or 100 mg/m2 for 5 days) followed by low-dose radiotherapy (dose: 2340 cGy) without a tumor bed boost. Disease-free survival and overall survival served as the main outcome measures.

Results:

Between February 2002 and June 2018, 24 patients (20 males and 4 females; median age: 14.1 y; age range: 7.9 to 21.2 y) with pathology-proven CNS germinomas were included. The median follow-up time was 106 months (range: 17 to 169 mo). Isolated and multifocal lesions were identified in 13 and 11 patients, respectively. Tumor location was as follows: pineal gland (n=17), suprasellar region (n=13), periventricular region (n=7), and basal ganglia (n=2). Five patients had increased levels (>5 mIU/mL) of beta-human chorionic gonadotropin (β-hCG), whereas alpha-fetoprotein concentrations were within the reference range in all participants. A total of 16 patients achieved remission after induction chemotherapy. The complete response rates of patients with increased and normal β-hCG levels were 40.0% and 72.2%, respectively (P=0.208). Low-dose radiotherapy without a tumor bed boost was subsequently delivered to either the whole ventricle (n=16) or the whole brain (n=8), resulting in complete remission in all participants. Compared with patients without increased β-hCG levels, those with β-hCG-secreting germinomas had less favorable 5-year disease-free survival rates (100% vs. 60%, respectively, P=0.000115).

Conclusions:

Some children with primary CNS germinoma may benefit from short-course induction chemotherapy followed by low-dose radiotherapy to the whole ventricle without a tumor bed boost. The validity of our findings needs to be confirmed in a randomized phase II study for children with β-hCG levels <5 mIU/mL.
Cognitive Functions of Pediatric Brain Tumor Survivors Treated With Proton Beam Therapy: A Case Series
Authors: Hidaka Kyoko , Fukushima Hiroko , Hosaka Sho , Muroi Ai , Yamamoto Tetsuya , Mizumoto Masashi , Sakurai Hideyuki , Takada Hidetoshi
Published: November 2020

Pediatric brain tumor survivors who received proton beam therapy at the University of Tsukuba Hospital from 2004 to 2011 were retrospectively evaluated for cognitive function. Five patients were included. The median age of diagnosis was 5.4 years (range: 1.5 to 12.5 y) and the median follow-up time was 5.8 years (range: 3.1 to 8.1 y). IQ scores at follow-up were decreased in 2 of 5 patients; 1 underwent whole-brain irradiation and the other was examined just after surgical removal of recurrent tumors. Local proton beam therapy may preserve cognitive function in survivors of pediatric brain tumors.
Finding the Needle in the Hay Stack: Population-based Study of Prediagnostic Symptomatic Interval in Children With CNS Tumors
Authors: Goldman Ran D. , Cochrane D. Douglas , Dahiya Anita , Mah Heidi , Buttar Arsh , Lambert Clare , Cheng Sylvia
Published: November 2020

Central nervous system (CNS) tumors in children are a devastating diagnosis and delay in diagnosis is well documented in the literature. The aim of this study was to document and characterize time to diagnosis of CNS tumors among children 0 to 17 years of age in a pediatric center. A retrospective chart review was conducted of medical records of children with CNS tumors from 2000 to 2016 in British Columbia, Canada and 148 reports were available for review. Average age at diagnosis was 87.8 months (SD=59.7; median=72). One third (30%) were diagnosed after a single visit to a health care provider and 11 (7.7%) after more than 4 visits. Median time to diagnosis (prediagnostic symptomatic interval [PSI]) was 62 days (average 197±341 d; range, 0 to 2047 d). Longest period was time from first symptom to first health care provider visit (PSI1, median 37 d). Tumors in the posterior fossa and symptoms of ataxia or paresis were associated with a significantly shorter PSI. CNS tumors in children continue to pose a diagnostic challenge with variability in time to diagnosis. Our population-based study suggests variability in time to diagnosis with a need for education of families to identify symptoms associated with CNS tumors.
Management of an Immunocompromised Pediatric Patient With Multiple Hospitalizations for Symptomatic COVID-19
Authors: DeVine Mackenzie N. , Maxwell Sarah , Haynes Andrew S. , MacBrayne Christine E. , Boguniewicz Juri
Published: November 2020

Relapse of infection due to SARS-CoV-2 has been rarely described and there is little guidance regarding the management of such cases in immunocompromised hosts. We present a case of an adolescent female with B-cell acute lymphoblastic leukemia hospitalized multiple times for symptomatic SARS-CoV-2 infection who was safely treated with 2 courses of remdesivir (RDV) and has had no additional readmissions to date. Though additional studies are needed to confirm the safety and efficacy of an additional course of RDV in the setting of relapsed or prolonged severe COVID-19, our observations suggest that a second course of RDV may be considered.
Current Salvage Treatment Strategies for Younger Children (<10 y of Age) With Progressive Low-grade Glioma After Initial Chemotherapy in North America: A Web-based Survey
Authors: Moorman Blakeley , Barbour Mustafa , Huang Michael A.
Published: November 2020

Pediatric low-grade gliomas (LGGs) are the most common brain tumors in children. Treatment of pediatric LGG can often be challenging, particularly when not resectable and refractory or recurrent following standard chemotherapy regimens. There is no current accepted standard of care salvage regimen for progressive LGG after the failure of first-line chemotherapy. A web-based survey was distributed to pediatric cancer centers throughout North America to inquire regarding institutional preferences of salvage treatment strategies after initial chemotherapy for LGG in children less than 10 years of age, as well as molecular testing preferences. Highlights from the survey results were as follows: vincristine/carboplatin (VC) and vinblastine (VBL) were the top 2 preferred salvage regimens for non–BRAF-altered pediatric LGG. BRAF and MEK inhibitors were the most preferred salvage regimens for BRAF V600e-mutated and BRAF fusion-positive pediatric LGG, respectively. VC ranked second. As high as 47.8% of North American centers would use conformal radiation for younger children with non-neurofibromatosis type 1 LGG after failing 2 to 3 chemotherapy regimens. Overall, 87% (87%) of North American institutions obtain some type of routine molecular testing for non–neurofibromatosis type 1-associated pediatric LGG cases. Less than 60% of centers obtain routine H3 K27M molecular testing for pediatric LGG with a midline location.
Severe Rare Bleeding Disorders: A Single-center Experience
Authors: Öner Nergiz , Özek Gülcihan
Published: November 2020

Although rare bleeding disorders (RBDs) are not common diseases, they are important for life-threatening bleedings and prophylaxis approaches, especially in severe forms. In this retrospective study, the authors have analyzed data from children with severe RBDs who were examined at the center over a period of 10 years to describe the distribution, clinical features, treatment patterns, and outcome of severe RBDs in patients. Data from all children (age under 18 y) with RBDs who were examined in the center between 2005 and 2015 were retrospectively reviewed. In total, 12 patients were included in the study. Four of the cases had factor (F) VII (33.3%), 6 had FX (50%), 1 had FXIII (8.3%), and 1 had fibrinogen deficiency (8.3%). Of the 12 children with severe RBDs, 8 (67%) experienced at least 1 major bleeding. Prophylaxis was applied to 10 patients. In conclusion, RBDs are more common in our country because of the high parental consanguinity rates. So, it is necessary to raise public awareness about the risks of consanguineous marriages and increase access to genetic counseling and testing facilities. Delayed diagnosis and lack of adequate prophylactic replacement therapy are the most important risk factors that increase life-threatening bleeding.
Pediatric Gliosarcoma With and Without Neurofibromatosis Type 1: A Whole-exome Comparison of 2 Patients
Authors: Graham Richard T. , Bell Erica H. , Webb Amy , Zhao Yue , Timmers Cynthia , Fleming Jessica L. , Sells Blake E. , Robison Nathan J. , Palmer Joshua D. , Finlay Jonathan L. , Chakravarti Arnab
Published: November 2020

Gliosarcoma is rare among pediatric patients and among individuals with Neurofibromatosis Type 1 (NF1). Here we compare 2 pediatric gliosarcoma patients, one of whom has NF1. We performed whole-exome sequencing, methylation, and copy number analysis on tumor and blood for both patients. Whole-exome sequencing showed higher mutational burden in the tumor of the patient without NF1. Copy number analysis showed differences in chromosomal losses/gains between the tumors. Neither tumor showed O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. The NF1 patient survived without progression while the other expired. This is the first reported case of gliosarcoma in a child with NF1.
Care Coordination in a SARS-CoV-2-infected Child With Newly Diagnosed Medulloblastoma and Fanconi Anemia
Authors: Field Mary T. , Chapple Alayne , Hoeppner Corrine , Boiko Julie R. , Tellinghuisen Amy , Joshi Sarita , Vitanza Nicholas A.
Published: November 2020

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for a global pandemic that can cause severe infections in children, especially those with comorbid conditions. Here, we report a case of a child with a newly diagnosed medulloblastoma, Fanconi Anemia, and SARS-CoV-2 infection. Through multidisciplinary care coordination and meticulous planning, we were able to safely initiate this patient’s oncology care and implement a long-term model to address the patient’s care. This approach could be replicated with any newly diagnosed pediatric patient that requires monitoring for signs of COVID-19 with concurrent oncology care.
Who Is an Expert? Who Gets to Decide?
Authors: Weaver Connie M.
Published: November 2020

Much progress has been made on developing guidelines for increasing scientific integrity, the cornerstone of which is transparency both in industry-funded research and public-private partnerships in the nutrition and food science domains. This article reviews that progress and calls for development of additional guidelines to improve transparency in the selection of expert panels involving public policy in food and nutrition to improve scientific integrity and public trust.
The Effect of Caffeine Intake on Body Fluids Replacement After Exercise-Induced Dehydration
Authors: Zavvos Athanasios , Miliotis Panagiotis , Stergiopoulos Dimitris , Koskolou Maria , Geladas Nickos
Published: November 2020

We studied the effect of a plain espresso coffee (171 ± 8.9 mg caffeine) which is roughly the amount in a cup of regular coffee or caffeine soda drink on fluid replacement in mildly dehydrated healthy subjects following moderate exercise, which induced dehydration to approximately 1.2% of their body weight. Subjects then rehydrated by drinking either water alone as control or caffeinated beverage plus up to 150% of the body weight they had lost. All subjects underwent both conditions. There were differences between the control and caffeine in urine specific gravity (control: 1.018 ± 0.00 vs caffeine: 1.024 ± 0.00, P = .001), urine volume (control: 200 ± 71 mL vs caffeine: 302 ± 151 mL, P = .05), and urine color (control: 2 ± 0.9 and caffeine: 4 ± 1.66, P = .00). We conclude that intake of an espresso coffee possibly impedes replacement of body fluids.
The Effect of Breakfast With Low Glycemic Index on Cognitive Ability in Indonesian High School Students
Authors: Rizal Mochammad , Taufiqurrahman  , Pengge Nuning Marina
Published: November 2020

Numerous studies have investigated the importance of low-glycemic-index (GI) breakfast on cognitive performance. However, until recently, none has used rice and noodles, which are staple foods in Indonesia. This pilot study examined the effect of a low-GI breakfast on cognitive ability of an arithmetic task using locally based food approach. This randomized, crossover study involved 64 high school students (32 male and 32 female students) aged 12 to 15 years. They were provided with a low-GI breakfast or placebo with high GI, which were matched by ±10% for energy amount, serving size, and macronutrient composition. The arithmetic ability Uchida-Kraepelin test was performed 2 hours after breakfast. Paired t test was used to analyze the difference between meals on the outcome. Students consuming the low-GI breakfast had higher scores than those on the high-GI breakfast (80.7 ± 15.9 vs 73.7 ± 17.1), a significant difference (P = .008). The low-GI breakfast was beneficial on these scores, suggesting that further investigations are warranted and that locally based food sources with lower GIs at breakfast might be in order. More tests of cognitive ability are needed to ensure findings are valid, with careful consideration on the issues appearing in this study.
Accuracy of Mandible-First versus Maxilla-First Approach and of Thick versus Thin Splints for Skeletal Position after Two-Jaw Orthognathic Surgery
Authors: Borikanphanitphaisan Thatchawee , Lin Cheng-Hui , Chen Ying-An , Ko Ellen Wen-Ching
Published: November 2020

Background:

The aim of this study was to investigate the accuracy of bimaxillary orthognathic surgery regarding different sequencing (maxilla-first or mandible-first surgery) and different thicknesses of intermediate splints.

Methods:

This retrospective cohort study evaluated the accuracy of postoperative outcome in accordance with virtual planning in 57 patients requiring bimaxillary osteotomies with different operation sequence: maxilla-first (n = 31) or mandible-first (n = 26) surgery. The effect of different splint thicknesses (i.e., thick, n = 22; and thin, n = 35) was also evaluated. The 1-week postoperative cone-beam computed tomographic craniofacial images were superimposed onto preoperative simulated images to measure the discrepancy of the three-dimensional cephalometric landmarks.

Results:

Neither sequencing approach differed in overall accuracy (1-week postoperative to preoperative simulated image discrepancy): maxilla-first, 1.69 ± 0.53 mm; versus mandible-first, 1.44 ± 0.52 mm. In detailed comparison, mandible-first surgery resulted in more accuracy in the vertical dimension. Thick intermediate splints provided better control (less error) of upper central incisors in the sagittal position (thick splint, 1.38 ± 1.17 mm; thin splint, 2.13 ± 1.38 mm). However, overall accuracy was not affected by splint thickness. Conditions affecting sequencing predilection included skeletal class III with vertical excess, maxillary down-grafting, counterclockwise rotation of the maxillomandibular complex, and simulated mandibular opening for splint fabrication clearance.

Conclusions:

Despite both means of sequencing being performed similarly, mandible-first surgery was more precise in the vertical dimension. Thick intermediate splints seemed to yield better control of central incisors in the sagittal position. However, under appropriate selection of intermediate splints to maintain interim condylar position, splint thickness has no effect on overall accuracy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Quality and Quantity–Cultured Human Mononuclear Cells Improve Human Fat Graft Vascularization and Survival in an In Vivo Murine Experimental Model
Authors: Geeroms Maxim , Fujimura Satoshi , Aiba Emiko , Orgun Doruk , Arita Kayo , Kitamura Rie , Senda Daiki , Mizuno Hiroshi , Hamdi Moustapha , Tanaka Rica
Published: November 2020

Background:

Fat graft ischemia impedes us from having satisfying long-term results. The quality and quantity culture is a 1-week cell culture that increases the vasculogenic potential of peripheral blood mononuclear cells (PBMNC). This in vivo murine model investigates whether enrichment with quality and quantity–cultured human mononuclear cells (MNC-QQ) improves the vascularization in the human fat graft and whether this decreases the tissue loss.

Methods:

Human adipose tissue, PBMNC, MNC-QQ, and stromal vascular fraction were prepared. First, PBMNC, MNC-QQ, and stromal vascular fraction were compared in vitro for vasculogenic potential by endothelial progenitor cell colony-forming and culture assays. Second, 0.25-g fat grafts were created with 1 × 106 PBMNC (n = 16), 1 × 106 MNC-QQ (n = 16), 1 × 106 stromal vascular fraction (n = 16), or phosphate-buffered saline as control (n = 16) before grafting in BALB/c nude mice. Grafts were analyzed for weight persistence, vessel formation by CD31 immunohistochemistry, and angiogenic markers by quantitative polymerase chain reaction.

Results:

MNC-QQ develop more definitive endothelial progenitor cell colonies and more functional endothelial progenitor cells compared to PBMNC and stromal vascular fraction. Weight persistence after 7 weeks was significantly higher in grafts with MNC-QQ (89.8 ± 3.5 percent) or stromal vascular fraction (90.1 ± 4.2 percent) compared with control (70.4 ± 6.3 percent; p < 0.05). MNC-QQ–enriched grafts had the highest vessel density (96.6 ± 6.5 vessels/mm2; control, 70.4 ± 5.6 vessels/mm2; p < 0.05). MNC-QQ exerted a direct vasculogenic effect through vascular integration and a potential paracrine vascular endothelial growth factor–mediated effect.

Conclusion:

Quality and quantity–cultured human mononuclear cells containing endothelial progenitor cells stimulate fat graft vascularization and enhance graft survival in a rodent recipient.
Unusual presentation of metastatic malignant melanoma: a case report
Authors: Sah Mukesh Kumar , Barakoti Rimmy , Shrestha Nirajan , Gautam Neha , Sharma Upama , Kafle Monique
Published: November 2020

Introduction:

The presentation of metastatic lesion of malignant melanoma (MM) may be unusual, as this case, in which the lesions were multicystic swelling over right arm and necrotized swelling at right chest wall. Identifying the unusual variants of MM is important to allow application of the most appropriate treatment strategies before something wrong happens.

Methods:

This case report has been prepared following the SCARE guideline 2018, a surgical case report guidelines.

Presentation of the case:

A 60-year-old man presented with a 14-month history of swelling on right arm and anterior chest wall with the chief complain of blackish discharge from the latter. Six months ago, he amputated his right thumb for melanoma after a histopathology evaluation. It was an unusual presentation of a metastatic lesion of MM. On the basis of the histopathology report, the final diagnosis of our patient was subcuticular metastatic MM which has a very poor prognosis. According to TNM classification, the final diagnosis of the case was T4bN0M1a. Although he has been under regular follow-up, the lesions are still present and his health condition is deteriorating.

Discussion:

Metastatic melanomas are often rare; their misdiagnosis potentially jeopardizes patients’ health and survival, and have medico-legal implications. Melanoma often has a protracted disease course, in which patients have a disease-free period following surgical excision of the primary tumor, only to discover visceral metastases—months, years, or even decades later. Melanoma metastasis is an ominous sign as it generally predicts a poor prognosis. This case is an unusual presentation of metastatic melanoma where, with the elaboration of history and proper examination of lesion, the diagnosis of metastatic melanoma was made.

Conclusion:

Metastatic MM has a very poor prognosis and an early diagnosis with clinical presentation is very essential in a country where health facilities are not well developed. Knowing the unusual variants of MM is important to allow application of the most appropriate treatment strategies before something wrong happens.