bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-Disorder Analysis of Shared Genetic Components Between Cortical Structures and Major Psychiatric Disorders
Authors: Li Zongchang , Li David , He Ying , Wang Kangli , Ma Xiaoqian , Chen Xiaogang
Published: February 2022

Background and Hypothesis

Although large-scale neuroimaging studies have demonstrated similar patterns of structural brain abnormalities across major psychiatric disorders, the underlying genetic etiology behind these similar cross-disorder patterns is not well understood.

Study Design

We quantified the extent of shared genetic components between cortical structures and major psychiatric disorders (CS-MPD) by using genome-wide association study (GWAS) summary statistics of 70 cortical structures (surface area and thickness of the whole cortex and 34 cortical regions) and five major psychiatric disorders, consisting of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SCZ). Cross-disorder analyses were then conducted to estimate the degree of similarity in CS-MPD shared genetic components among these disorders.

Study Results

The CS-MPD shared genetic components have medium-to-strong positive correlations in ADHD, BD, MDD, and SCZ (r = 0.415 to r = 0.806) while ASD was significantly correlated with ADHD, BD, and SCZ (r = 0.388 to r = 0.403). These pairwise correlations of CS-MPD shared genetic components among disorders were significantly associated with corresponding cross-disorder similarities in cortical structural abnormalities (r = 0.668), accounting for 44% variance. In addition, one latent shared factor consisted primarily of BD, MDD, and SCZ, explaining 62.47% of the total variance in CS-MPD shared genetic components of all disorders.

Conclusions

The current results bridge the gap between shared cross-disorder heritability and shared structural brain abnormalities in major psychiatric disorders, providing important implications for a shared genetic basis of cortical structures in these disorders.
Symptom Structure in Schizophrenia: Implications of Latent Variable Modeling vs Network Analysis
Authors: Abplanalp Samuel J , Green Michael F
Published: February 2022

The structure of schizophrenia symptoms has a substantial impact on the development of pharmacological and psychosocial interventions. Typically, reflective latent variable models (eg, confirmatory factor analysis) or formative latent variable models (eg, principal component analysis) have been used to examine the structure of schizophrenia symptoms. More recently, network analysis is appearing as a method to examine symptom structure. However, latent variable modeling and network analysis results can lead to different inferences about the nature of symptoms. Given the critical role of correctly identifying symptom structure in schizophrenia treatment and research, we present an introduction to latent variable modeling and network analysis, along with their distinctions and implications for examining the structure of schizophrenia symptoms. We also provide a simulation demonstration highlighting the statistical equivalence between these models and the subsequent importance of an a priori rationale that should help guide model selection.
Stigmatizing Terminology for Outcomes and Processes (STOP) in Alcohol Research: A Meta-epidemiologic Assessment of Language Used in Clinical Trial Publications
Authors: Hartwell Micah , Lin Vanessa , Hester Mackenzee , Sajjadi Nicholas B. , Dunn Kelly , Morris James , Witkiewitz Katie
Published: February 2022

Introduction

Stigmatizing language used to describe patients and medical conditions is associated with poorer health outcomes. A recent investigation showed that approximately 80% of medical literature focused on alcohol use disorder (AUD) contained stigmatizing terms related to individuals; however, the quantification of stigmatizing terminology for outcomes and processes (STOP) among AUD research is unknown. Thus, our primary objective was to evaluate publications of clinical trials for their inclusion of STOP.

Methods

We performed a systematic search of PubMed for AUD clinical trials between January 1, 2017 and June 30, 2021. Article screening and data extraction were performed in a masked, duplicate manner by 2 investigators. We searched the full text of included manuscripts for STOP. We reported the frequency and percentage of manuscripts with STOP and individual terms. We evaluated associations between STOP usage and several clinical trial characteristics via logistic regression.

Results

Our search returned 1552 articles, which were then randomized and the first 500 were screened for inclusion. Of 147 included articles, 115 (78.2%) included STOP. The most common STOP were “drop out” (38.78%; 57/147), “relapse” (36.05%; 53/ 147), and “adherent, nonadherence” (35.37%; 52/147). No significant associations were found between STOP usage and trial characteristics.

Discussion

STOP was found in a majority of AUD clinical trial publications. As AUD is highly stigmatized, steps should be taken to eliminate usage of STOP in literature pertaining to AUD treatments. Many stigmatizing terms can be replaced by person-centered, more clinically accurate terms to further combat AUD stigma.
World Health Organization Recommendation for Using Uterine Balloon Tamponade to Treat Postpartum Hemorrhage
Authors: Weeks Andrew D. , Akinola Oluwarotimi Ireti , Amorim Melania , Carvalho Brendan , Deneux-Tharaux Catherine , Liabsuetrakul Tippawan , Meremikwu Martin , Miller Suellen , Nabhan Ashraf , Nagai Mari , Wahabi Hayfaa , Walker Dilys
Published: February 2022

The World Health Organization (WHO) recently published a new recommendation on the use of the uterine balloon tamponade for the treatment of postpartum hemorrhage. The recommendation that uterine balloon tamponade should be used only where there is already access to other postpartum hemorrhage treatments (including immediate recourse to surgery) has proved controversial. It is especially problematic for those working in low-level health care facilities in under-resourced settings, where there are already programs that have introduced low-cost uterine balloon tamponade devices for use, even in settings where recourse to surgical interventions is not possible. However, there are now two separate randomized trials that both unexpectedly show unfavorable outcomes in these settings when a condom catheter uterine balloon tamponade device was introduced. Considering the balance of potential benefits and these safety concerns, the WHO postpartum hemorrhage guideline panel therefore recommends that uterine balloon tamponade should be used only in contexts where other supportive postpartum hemorrhage interventions are available if needed.
Point-of-Care Viscoelastic Tests in the Management of Obstetric Hemorrhage
Authors: Nelson David B. , Ogunkua Olutoyosi , Cunningham F. Gary
Published: February 2022

Obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Thromboelastography and rotational thromboelastometry are laboratory methods of assessing the kinetics of blood clot formation through real-time measurement of viscoelastic clot strength and may aid in management of severe hemorrhage. Although first described more than 70 years ago, viscoelastic testing devices are now available that allow for rapid point-of-care use of this technology to aid in real-time management of blood product replacement in cases of severe hemorrhage. These devices can be used to visually estimate multiple facets of hemostasis—coagulation, platelet function, and fibrinolysis—within 10–20 minutes. They have been used successfully in cardiac surgery, trauma, and liver transplantation and have potential for use in management of obstetric hemorrhage. Goals with their use include targeted transfusion of blood and its components for specific coagulation deficiencies. To date, however, published experiences with the use of these viscoelastic tests for obstetric hemorrhage have been limited. Because of the increasing use of the point-of-care tests by anesthesiologists, surgeons, and intensivists, the purpose of this report is to familiarize obstetricians with the technology involved and its use in severe hemorrhage complicating pregnancy.
Postpartum Length of Stay and Hospital Readmission Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic
Authors: Handley Sara C. , Gallagher Kieran , Lindgren Eric , Lo Justin Y. , Burris Heather H. , Dysart Kevin C. , Greenspan Jay , Culhane Jennifer F. , Son Moeun
Published: February 2022

OBJECTIVE:

To compare postpartum hospitalization length of stay (LOS) and hospital readmission among obstetric patients before (March 2017–February 2020; prepandemic) and during the coronavirus disease 2019 (COVID-19) pandemic (March 2020–February 2021).

METHODS:

We conducted a retrospective cohort study, using Epic Systems' Cosmos research platform, of obstetric patients who delivered between March 1, 2017, and February 28, 2021, at 20–44 weeks of gestation and were discharged within 7 days of delivery. The primary outcome was short postpartum hospitalization LOS (less than two midnights for vaginal births and less than three midnights for cesarean births) and secondary outcome was hospital readmission within 6 weeks of postpartum hospitalization discharge. Analyses compared outcomes before and during the pandemic using standardized differences and Bayesian logistic mixed-effects models, among all births and stratified by mode of delivery.

RESULTS:

Of the 994,268 obstetric patients in the study cohort, 742,113 (74.6%) delivered prepandemic and 252,155 (25.4%) delivered during the COVID-19 pandemic. During the COVID-19 pandemic, the percentage of short postpartum hospitalizations increased among all births (28.7–44.5%), vaginal births (25.4–39.5%), and cesarean births (35.3–55.1%), which was consistent with the adjusted analysis (all births: adjusted odds ratio [aOR] 2.35, 99% credible interval 2.32–2.39; vaginal births: aOR 2.14, 99% credible interval 2.11–2.18; cesarean births aOR 2.90, 99% credible interval 2.83–2.98). Although short postpartum hospitalizations were more common during the COVID-19 pandemic, there was no change in readmission in the unadjusted (1.4% vs 1.6%, standardized difference=0.009) or adjusted (aOR 1.02, 99% credible interval 0.97–1.08) analyses for all births or when stratified by mode of delivery.

CONCLUSION:

Short postpartum hospitalization LOS was significantly more common during the COVID-19 pandemic for obstetric patients with no change in hospital readmissions within 6 weeks of postpartum hospitalization discharge. The COVID-19 pandemic created a natural experiment, suggesting shorter postpartum hospitalization may be reasonable for patients who are self-identified or health care professional–identified as appropriate for discharge.
Patient-Centered Safety Outcomes After Hysteroscopic Compared With Laparoscopic Sterilization
Authors: Gariepy Aileen M. , Lewis Carrie , Zuckerman Diana , Tancredi Daniel J. , Murphy Eryn , McDonald-Mosley Raegan , Sonalkar Sarita , Hathaway Mark , Nunez-Eddy Claudia , Schwarz Eleanor Bimla
Published: February 2022

OBJECTIVE:

To evaluate the real-world safety of hysteroscopic compared with laparoscopic surgical sterilization.

METHODS:

We conducted a retrospective cohort study of Medicaid claims for hysteroscopic or laparoscopic sterilization procedures performed in California, 2008–2014, among women aged 18–50 years. After excluding postpartum procedures, we applied log-linear (Poisson) event-history regression models for clustered person-period data, weighted for propensity to receive either sterilization procedures, and adjusted for sociodemographic and clinical characteristics that may affect outcomes of interest to patients and physicians. We assessed the following outcomes: procedural complications, additional surgical procedures (eg, hysterectomy), repeat sterilization procedures, pelvic pain, pelvic inflammatory disease (PID), abdominal pain, nonabdominal pain, and abnormal uterine bleeding.

RESULTS:

We identified 5,906 women who had undergone hysteroscopic and 23,965 who had undergone laparoscopic sterilization. After adjusting for sociodemographic and health history, women who had hysteroscopic sterilization were less likely to have claims for procedural complications (eg, transfusion, P<.001) on the day of surgical sterilization and additional surgical procedures (eg, hysterectomy, P=.002 at day 2–3 months postprocedure) than laparoscopic sterilization. Claims for a repeat attempt at sterilization were more common after hysteroscopic sterilization within 1 year (adjusted incident rate ratio 3.48, 95% CI 2.69–4.27) and within 5 years (adjusted incident rate ratio 2.32, 95% CI 1.84–2.79) than laparoscopic sterilization. Claims for pelvic pain (adjusted incident rate ratio 0.77, 95% CI 0.65–0.92 at 2 years), abdominal pain (adjusted incident rate ratio 0.80, 95% CI 0.68–0.93 at 7–12 months), and PID (adjusted incident rate ratio 0.55, 95% CI 0.33–0.93 at 2 years) were less common after hysteroscopic than laparoscopic sterilization. Although abnormal uterine bleeding claims were more common after hysteroscopic than laparoscopic sterilization up to 12 months postprocedure (adjusted incident rate ratio 1.37, 95% CI 1.06–1.77 at 7–12 months), there were no significant differences between methods 1 year after the procedure.

CONCLUSION:

Compared with laparoscopic sterilization, hysteroscopic sterilization was followed by more claims for repeat sterilization procedures and abnormal uterine bleeding, but fewer procedural complications and fewer claims for pelvic or abdominal pain.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03438682.
Sensitivity of Vowel-Evoked Envelope Following Responses to Spectra and Level of Preceding Phoneme Context
Authors: Easwar Vijayalakshmi , Boothalingam Sriram , Wilson Emily
Published: February 2022

Objective:

Vowel-evoked envelope following responses (EFRs) could be a useful noninvasive tool for evaluating neural activity phase-locked to the fundamental frequency of voice (f
0). Vowel-evoked EFRs are often elicited by vowels in consonant-vowel syllables or words. Considering neural activity is susceptible to temporal masking, EFR characteristics elicited by the same vowel may vary with the features of the preceding phoneme. To this end, the objective of the present study was to evaluate the influence of the spectral and level characteristics of the preceding phoneme context on vowel-evoked EFRs.

Design:

EFRs were elicited by a male-spoken /i/ (stimulus; duration = 350 msec), modified to elicit two EFRs, one from the region of the first formant (F1) and one from the second and higher formants (F2+). The stimulus, presented at 65 dB SPL, was preceded by one of the four contexts: /∫/, /m/, /i/ or a silent gap of duration equal to that of the stimulus. The level of the context phonemes was either 50 or 80 dB SPL, 15 dB lower and higher than the level of the stimulus /i/. In a control condition, EFRs to the stimulus /i/ were elicited in isolation without any preceding phoneme contexts. The stimulus and the contexts were presented monaurally to a randomly chosen test ear in 21 young adults with normal hearing. EFRs were recorded using single-channel electroencephalogram between the vertex and the nape.

Results:

A repeated measures analysis of variance indicated a significant three-way interaction between context type (/∫/, /i/, /m/, silent gap), level (50, 80 dB SPL), and EFR-eliciting formant (F1, F2+). Post hoc analyses indicated no influence of the preceding phoneme context on F1-elicited EFRs. Relative to a silent gap as the preceding context, F2+-elicited EFRs were attenuated by /∫/ and /m/ presented at 50 and 80 dB SPL, as well as by /i/ presented at 80 dB SPL. The average attenuation ranged from 14.9 to 27.9 nV. When the context phonemes were presented at matched levels of 50 or 80 dB SPL, F2+-elicited EFRs were most often attenuated when preceded by /∫/. At 80 dB SPL, relative to the silent preceding gap, the average attenuation was 15.7 nV, and at 50 dB SPL, relative to the preceding context phoneme /i/, the average attenuation was 17.2 nV.

Conclusion:

EFRs elicited by the second and higher formants of /i/ are sensitive to the spectral and level characteristics of the preceding phoneme context. Such sensitivity, measured as an attenuation in the present study, may influence the comparison of EFRs elicited by the same vowel in different consonant-vowel syllables or words. However, the degree of attenuation with realistic context levels exceeded the minimum measurable change only 12% of the time. Although the impact of the preceding context is statistically significant, it is likely to be clinically insignificant a majority of the time.
Immunohistochemistry for Preferentially Expressed Antigen in Melanoma in the Differential Diagnosis of Melanocytic Lesions of the Nail Apparatus
Authors: Krajisnik Andrea , Gharavi Nima M. , Faries Mark B. , Balzer Bonnie L. , Frishberg David P. , Martelli Matthew , Shon Wonwoo
Published: February 2022

Nail unit melanocytic lesions present a unique set of diagnostic challenges because of the unfamiliarity with clinical assessment and the lack of experience with histologic examination. Because the first surgical specimen received in the pathology laboratory is typically small, sometimes suboptimal biopsy, the distinction between melanoma and its histologic mimics can be difficult. For this reason, there has been a continued interest in the development of ancillary markers that may assist in the differential diagnosis of nail unit melanocytic lesions. Upregulation of preferentially expressed antigen in melanoma (PRAME) has been reported to be a common event in melanomas, and PRAME immunohistochemistry has been shown to be helpful in evaluating various melanocytic neoplasms. In this study, we evaluated PRAME protein expression in a series of nail unit melanocytic lesions. Twenty-five nail unit melanomas (including small biopsy and amputation specimens) and 32 control benign melanocytic lesions were retrospectively retrieved. Nuclear PRAME staining was scored as percentage and intensity labeling. All melanoma cases showed the nuclear expression of PRAME, which was usually diffuse and strong. In specimens where the neoplastic cells are limited in number, the staining was restricted to the tumor cells, corresponding to the initial H&E impression. All control cases were negative for PRAME expression. PRAME expression is helpful in distinguishing between melanomas and other nail unit melanocytic lesions. This antibody also proved to be diagnostically valuable in detecting melanoma cells in small specimens with minimal disease.
BRAF Immunoexpression Can Be Intralesionally Heterogeneous but BRAF V600E Mutation Status Is Intralesionally Homogeneous and Interlesionally Concordant in Melanoma: A Study of 140 Lesions From 98 Patients
Authors: Tachibana Kota , Goto Keisuke , Kukita Yoji , Honma Keiichiro , Isei Taiki , Sugihara Satoru , Taniguchi Kohei , Yamasaki Osamu
Published: February 2022

This study sought to confirm the homogeneity of BRAF V600E mutation status in melanoma. BRAF immunohistochemistry was performed on 102 lesions from 60 patients of melanoma with BRAF V600E mutation and 38 negative-control melanoma lesions from 38 patients, both of which were confirmed by real-time PCR or the MassARRAY System. In the positive-control lesions, 9 lesions from 7 patients with preceding BRAF-inhibitor therapy were included. Of the 102 BRAF-mutant lesions, 101 (99.0%) showed diffuse BRAF immunoexpression, but 39 (38.2%) of them showed various heterogeneous intensities. The heterogeneous intensity of immunostaining was due to necrosis (n = 10), minimal or clear cytoplasm (n = 5), tissue crush (n = 8), insufficient fixation (n = 24), or technical error (n = 4). Only 1 lesion (1.0%) with nondiffuse immunoexpression harbored 80% weakly BRAF-positive tumor area and 20% BRAF-negative area with tissue damage. Sanger sequencing performed on the weak or negative regions in 7 lesions revealed BRAF V600E mutation in all the tested lesions. By contrast, all 38 negative-control lesions demonstrated no BRAF immunoexpression. This study demonstrated intralesional homogeneity and interlesional concordance for BRAF V600E mutation status and intralesional frequent heterogeneity for BRAF immunoexpression. The abovementioned 5 phenomena caused substantial reduction in BRAF immunostaining intensity. In 9 lesions within this study, BRAF immunoexpression and BRAF V600E point mutation status were not affected by preceding BRAF inhibitor therapy. Our data would also support the position that it does not matter whether we select primary or metastatic samples for BRAF mutation analysis.
Feasibility of Smartphone Application in Plastic Surgery Operative Assessments
Authors: Almufarrej Faisal , O’Brien Matthew , Shahait Awni , Nava Guillermina
Published: February 2022

Background:

The evaluation model of operative competence is based on aggregate tabulations of procedures and end-of-rotation feedback from faculty members. Procedural tabulations do not detail the level of resident involvement in the case, and end of rotation feedback is infrequent and inaccurate due to the necessity of long-term recall. Smart phone-based evaluation systems provide residents with immediate and permanent feedback for surgical encounters. In this study, we examine the feasibility of smart phone-based evaluations in plastic surgery residency.

Methods:

This was a 6-month prospective, single institution pilot study at three teaching hospitals, assessing all PGY levels. We utilized our department mobile application (Wayne State University Surgery Department application), which includes intraoperative evaluations based on the Zwisch scale. Prestudy and poststudy surveys were conducted. An unstructured interview of the Clinical Competency Committee provided feedback for the new evaluation tool against the previous evaluation forms.

Results:

Eleven physicians participated in the study, resulting in 126 encounters and 184 procedures. A 10-question prestudy survey was given with answers ranging from 1 (strongly disagree) to 5 (strongly agree). The Clinical Competency Committee faculty ranked the prestudy resident assessment tool 2.82 of 5, whereas the poststudy survey scored 4.64 of 5.

Conclusions:

Residents and faculty both rated the smartphone application as a useful tool for evaluating residents. The success of the application proves its feasibility within plastic surgery residency and may play an important role in rating resident operative competency in the future.
Cutting Edge: Topical Recombinant Nerve Growth Factor for the Treatment of Neurotrophic Keratopathy—Biologicals as a Novel Therapy for Neurotrophic Keratopathy
Authors: Hamrah Pedram , Yavuz Saricay Leyla , Ozmen M. Cuneyt
Published: February 2022

Ophthalmologists find management of neurotrophic keratopathy (NK) challenging because conventional therapy lacks efficacy and may result in permanent loss of vision. Recombinant nerve growth factor (cenegermin) targets the underlying pathogenesis of NK by regenerating corneal nerves and healing the corneal epithelium through promotion of proliferation, maturing corneal epithelial cells. It has been approved as Food Drug Association-approved treatment of NK. In this article, the background, clinical trials, and impact of recombinant nerve growth factor as the first neurotrophic factor for the restoration of corneal integrity, homeostasis, and corneal nerve regeneration are discussed.
Prevalence of Sleep Disorders and Associated Factors in People Living With HIV in the Ceará, Brazil: A Cross-sectional Study
Authors: Cunha Gilmara Holanda da , Ramalho Ane Kelly Lima , Fontenele Marina Soares Monteiro , Siqueira Larissa Rodrigues , Fechine Francisco Vagnaldo , Medeiros Melissa Soares
Published: February 2022

The aim of this study was to determine the prevalence of sleep disorders and associated factors in people living with HIV (PLWH). This was a cross-sectional study with a sample of 385 participants followed-up on an outpatient basis in Fortaleza, Ceará, Brazil. Interviews were conducted using the Sociodemographic, Epidemiological and Clinical Form for PLWH and the Pittsburgh Sleep Quality Index. Descriptive statistics and univariate and multivariate logistic regression analysis were performed, and the odds ratio (OR) and 95% confidence interval (95% CI) were calculated, considering p < .05 as statistically significant. The prevalence of sleep disorders was 43.38%. Having children (p = .0054; OR = 1.91; 95% CI = 1.21–3.01), less than 8 years of education (p = .0013; OR = 2.11; 95% CI = 1.34–3.34), and not engaging in regular physical exercise (p = .0001; OR = 2.61; 95% CI = 1.61–4.23) were factors associated with the occurrence of sleep disorders. It was concluded that almost half of the sample had sleep disorders, especially those with children, low level education, and sedentary habits. These data point to the need for increased guidance on sleep hygiene, in addition to the practice of regular physical exercise for this population.
Material Selection for Diabetic Custom Insoles: A Systematic Review of Insole Materials and Their Properties
Authors: Nilsen Fredrik , Molund Marius , Lium Eva Marie , Hvaal Kjetil Harald
Published: February 2022

Introduction

Diabetic foot ulceration is one of the most significant causes of infection and amputation in neuropathic patients. Most often, the plantar surface of the foot is affected. Offloading the foot by custom-molded insoles is considered a crucial step in prevention of diabetic foot ulcers, although the most beneficial choice of materials is not well documented. This review focuses on identifying the most suitable materials and material compositions for offloading the diabetic foot.

Materials and Methods

A systematic review was performed with the aid of a clinical librarian on September 9, 2020. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included based on the following eligibility criteria: interventions in terms of material selection/properties with outcomes reported as either pressure reduction and/or ulcer prevention. Bench studies were also included. At each level of selection, records were reviewed by two independent reviewers. Clinical studies were appraised using the ROBINS-1 tool.

Results

Through database search, 1131 records were identified and an additional eight records were identified through references and other sources. After removal of duplicates, 927 records were screened, which resulted in 74 full-text records assessed for eligibility. Thirty-seven studies were included in the qualitative synthesis. Twelve studies examined material properties by bench testing. Five studies were based on finite element analysis. Nineteen clinical studies on material parameters were identified. Six studies supported the use of moderately deformable materials for insole production. Six studies showed better performance of combination material insoles in offloading and under sustained loading. Five studies concluded that increasing the thickness of insoles increased the offloading capabilities.

Conclusions

The diversity of studies and study designs to date precludes the ability to recommend one type of material over the other. Still some general considerations can be made. For solo-material insoles, moderately deformable materials are preferable, balancing the need for offloading with the need for durability. Increasing the thickness may increase the longevity of the insoles. Combining materials of different properties seems to enhance both the offloading capability and durability of insoles.

Clinical Relevance

When using a single-material design, moderately deformable materials are preferable. Combining materials of different properties enhances both the offloading capability and durability of insoles.
Clinical and Nonclinical Factors Affecting Quality of Life in Individuals with Lower-Limb Amputation
Authors: Qa'dan Wa'el Nafith , Damhoureyeh Mohammad , Day Sarah
Published: February 2022

Introduction

Amputations lead to great challenges for individuals with amputation that can affect their quality of life (QoL). Clinical and nonclinical factors are expected to affect QoL of individuals with amputation.

Materials and Methods

Seventy-nine individuals with lower-limb amputation participated in the study. The Arabic version of the PEQ and a short added questionnaire evaluating the studied factors were used to evaluate QoL of individuals with amputation. Exploratory factor analysis was used to investigate which factors may have greater effect on QoL.

Results

Age at amputation, etiology, and age of the person with amputation were found to be the factors explaining most of the variance.

Discussion

Age at amputation dictates how much time is available for the individual to adapt to using the prosthesis. Etiology controls how well the individual is. Age is a decisive factor in the general well-being of the person with amputation.

Conclusions

This study shows that age at amputation, etiology, and age of the individual with amputation are the most important factors affecting the QoL of individuals with amputation.

Clinical Relevance

As QoL determines the success of prosthetic rehabilitation, and as several factors affect QoL in individuals with amputation, determining these factors enables providing a better prosthetic experience, resulting in improved prosthetic satisfaction.
An Experiential Learning Activity Using an Online Judgment-Based Pediatric Functional Measure During Hybrid Instruction With Doctor of Physical Therapy Students
Authors: Dumas Helene M. , Golub-Victor Ann C.
Published: February 2022

Background and Purpose.

Mandated remote instruction provided an opportunity to introduce Doctor of Physical Therapy (DPT) students to online judgment-based measures used in clinical practice. In this method/model presentation, we report the operational feasibility, educational outcomes, and student satisfaction of a new learning activity providing entry-level DPT students with the experience to administer, score, and interpret the results of a pediatric, online, judgment-based functional assessment.

Method/Model Description and Evaluation.

Following introduction and demonstration, student pairs completed the web-based Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) using written case information detailing a child's typical functional mobility performance. Students then completed a course assignment to interpret test results, identify a complementary performance-based test, and develop intervention goals. Operational feasibility (time, technical, and economic needs), educational outcomes (PEDI-CAT scoring accuracy, assignment results), and student survey feedback were retrospectively evaluated.

Outcomes.

Within a 3-semester hour course, 2 hours (13%) were devoted to this activity, which was completed using a free test application and the university-supported learning management system. Student-generated PEDI-CAT normative scores were 100% consistent with instructor scores, and 43 of 46 student pairs (94%) generated scaled scores within the 95% confidence interval for the instructor's PEDI-CAT-generated score. Assignment results (mean grade = 45.7/50) indicated comprehension of material evidenced by test result interpretation and development of a physical therapist (PT) Evaluation and intervention goals. Student feedback was positive for the use of case-based learning and web-based test administration experience as a learning activity.

Discussion and Conclusion.

Use of a written case and an online judgment-based assessment proved feasible and successful for exposing entry-level DPT students to test administration, item content, normative and standard scoring differences, and developing a PT Evaluation statement and intervention goals setting. During mandated hybrid instruction, this learning activity addressed the curriculum objectives related to PT examination in preparation for clinical practice.
Physical Therapy Student Stress During the COVID-19 Pandemic: A Qualitative Study
Authors: Anderson Christina E. P. , Dutton Lisa L.
Published: February 2022

Introduction.

According to research studies and surveys conducted by the Centers for Disease Control and Prevention, the prevalence of stress, depression, and anxiety have increased with the onset of the COVID-19 pandemic. This is especially true for young adults and has the potential to affect students’ learning outcomes and long-term well-being.

Review of Literature.

Current research on the experience of stress for students in the health professions has focused on nursing and medical students. There are no published studies exploring pandemic-related stress in physical therapy. The purpose of this study was to explore the experience of stress for Doctor of Physical Therapy (DPT) students during the onset of the COVID-19 pandemic.

Subjects.

Twenty-four students in their first, second, and third year of study from 3 physical therapist education programs.

Methods.

Using a phenomenological qualitative approach, 60-minute semi-structured interviews were conducted with each participant through video conference in April and May of 2020. Inductive thematic analysis was used to identify and refine codes and construct themes and subthemes.

Results.

Four themes resulted from analyses of these data: sources of stress, stress management, stress modifiers, and positive aspects of COVID. Sources of stress were related to academics, uncertainty, personal circumstances, and finances. DPT students described stress associated with the transition to online learning related to focus, engagement, workload, and reduced opportunities to practice hands-on skills. Uncertainty was particularly stressful for third-year students who were anxious about clinical experiences, board examinations, and future employment. Stress management strategies were centered on cognitive reappraisal, physical activity, and social support.

Discussion and Conclusion.

While students identified several sources of stress during the onset of the COVID 19 pandemic, important stress modifiers, such as faculty and cohort-based peer support, were highlighted that have the potential to reduce stress for students both in times of crisis and under more typical circumstances. These factors, in combination with findings suggesting that increased flexibility and agency over learning mediated stress responses, have potential implications for instructional delivery and academic program design.
Developmental Disruptions of the Human Stapes
Authors: Elias Thaís Gomes Abrahão , Santos Felipe
Published: February 2022

Objective:

To evaluate and classify developmental malformations of the human stapes.

Methods:

Twenty-five temporal bone specimens from 18 patients with congenital stapes malformations were identified in the Mass Eye and Ear temporal bone collection. Serial sections stained with hematoxylin and eosin were examined by light microscopy and the morphology of the stapes was compared to age-matched controls.

Results:

Each case of stapes malformation could be classified into one of four malformation types based on our current understanding of the embryologic origin of the subunits of the stapes and timing of development. Twenty-seven percent of stapes malformations had a Type I morphology characterized by a hypoplastic or absent inner footplate and hypoplastic to absent mesoderm footplate or oval window. The crura and capitulum may be absent, monopodal or dysmorphic. Eleven percent expressed a Type II malformation with dysmorphic or monopodal capitulum and crura and a fixed footplate. Twenty-seven percent were of Type III with a dysmorphic or monopodal capitulum and or crura. The footplate, and thereby oval window is present and without fixation. The most common malformation, Type IV, was isolated footplate fixation observed in 33% of cases.

Conclusions:

Malformations of the human stapes follow consistent patterns of early or late disruptions of the stapes subunits of mesodermal and/or neural crest origin. While the molecular events, including temporal coordination, that lead to a normally formed stapes are not yet fully understood, the observed patterns of human stapes malformation can be consistently classified into one of four patterns of developmental disruption.
Optimal Time for Recirculation with Ultrafiltration to Remove Disinfectant in Reused Dialyzer
Authors: Itthipongsakul Panpanat , Srimongkol Wanchanart , Sorthananusak Amphorn , Shayakul Chairat
Published: February 2022

The practice of dialyzer reuse is common in developing countries. One essential technique for safe dialyzer reprocessing is to remove disinfectants properly to the recommended standards before treatment initiation, using dialysis machine recirculation with ultrafiltration. This study was conducted to identify the most effective time for carrying out this procedure, and the factors affecting it. We studied 420 high-flux dialyzers with three different membrane types: FB210U (cellulose triacetate), F80S (polysulfone), and Elisio-210HR (polyethersulfone) at four reused cycles (5th, 10th, 15th, and 19th). Peracetic acid was used as the disinfectant at a concentration of 0.16%. The total cell volume (TCV) and clot inspection grade of the reused dialyzer were recorded before the procedure. The optimal time for disinfectant removal was independently determined by two observers using the residual peroxide strip test of the ultrafiltrate. We observed that disinfectant removal was dependent on the recirculation time and became undetectable at 5 minutes. The type of dialyzer had a significant effect on the effective recirculation time (shortest for FB210U followed by Elisio-210HR and F80S; p < 0.001), but the reused number, TCV, and clot inspection grade did not. It is conceivable that the dialyzer membrane type might affect peracetic acid removal. In conclusion, the interval for carrying out dialysis machine recirculation with ultrafiltration depends on the dialyzer type, and 5 minutes is the optimal time for the operation. This result can be implemented to improve further practice in dialyzer reprocessing.
Associations of leucocyte telomere length with cardio-metabolic risk profile in a South African HIV-infected population
Authors: Ngwa Ndonwi Elvis , Peer Nasheeta , Matsha Tandi E. , de Villiers Anniza , Sobngwi Eugene , Kengne Andre P.
Published: February 2022

Leukocyte Telomere length (LTL) is an independent predictor of cardio-metabolic diseases (CMDs) and Human Immuno Virus (HIV) infection. However, studies are lacking on the association between LTL with CMD profile in people with HIV. Accordingly, we investigated the association between LTL and CMD profile in HIV-infected adult South Africans.

This cross-sectional study included 728 HIV patients (20.6% men; median age 38 years) recruited across 17 public healthcare facilities in Cape Town. CMD markers were compared across quartiles of LTL, and spearman correlations assessed the continuous association of LTL with CMD markers. Linear and logistic regressions were then used to relate LTL with CMD risk profile, with appropriate adjustment for confounders.

The prevalence of obesity, hypertension and diabetes were 34.8%, 36.8%, and 8.4%, respectively. In age, sex and body mass index adjusted models, increasing Log10LTL was associated with decreasing systolic (β = −10.52) and diastolic (β = −6.74) blood pressures, HOMA-β (β = −70.72), increasing total cholesterol (β = 0.544), non-high-density lipoprotein cholesterol (β = 0.472), and waist-to-height-ratio > 0.5 (odds ratio [OR] = 5.67), all P < .05. Compared to those in the bottom quarter, those in the top LTL quarter had lower prevalence of hypertension (OR = 0.65), and higher prevalence of total cholesterol > 5 mmol/L (OR = 1.94), and low-density lipoprotein-cholesterol > 3 mmol/L (OR = 1.62), all P < .05. LTL was not associated with diabetes nor general obesity. It was associated with Alanine Transaminase (ALT) and heart rate in univariable analyses.

LTL shortening was associated with some CMD risk factors in HIV-infected adults on anti-retroviral therapy in South Africa. Prospective research is needed to explore the direction and implications of these associations.
A case of systemic mastocytosis mimicking POEMS syndrome
Authors: Hou Yanqiu , Jiang Suyu , Zhang Lu , Wang Yan , Zhang Liubo , Bao Hongyu , Meng Qingqi , Han Xue , Chen Wanru , Li Tiantian , Peng Jie , Zhu Yilin , Huang Rong , Liu Jingan , Wang Jianning , Fang Chao , Shi Xiaofeng
Published: February 2022

Rationale:

POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome is a rare and complicated disease related to multiple organs and systems. Here, we report a case of systemic mastocytosis (SM) that was misdiagnosed as a POEMS syndrome.

Patient concerns:

A 42-year-old man presented with skin changes, diarrhea, and limb numbness.

Diagnoses:

Positron emission tomography/computed tomography revealed extravascular volume overload, organomegaly, lymphadenopathy, and bone lesions with mixed lesions of osteosclerosis and osteolysis. Therefore, POEMS syndrome was suspected. Further histopathological and immunohistochemical examination of the bone marrow, lymph nodes, and gastric mucosa suggested a diagnosis of mastocytosis. The c-Kit D816V mutation confirmed the diagnosis of SM.

Interventions:

The patient received the treatment of pegylated interferon-alpha weekly and glucocorticoid daily.

Outcomes:

The symptoms relieved significantly.

Lessons:

There are many similar features between POEMS syndrome and SM, probably leading to misdiagnosis. This study analyzed the different points between them which can provide help for differentiation.
Subacute thyroiditis complicated with multiple organ failure
Authors: Jiang Hui , Chen Xiaoluo , Wang Li , Qian Xiaoqin , Zhang Yan , Wu Jing , Shao Shihe
Published: February 2022

Rationale:

Subacute thyroiditis is an inflammatory disease of the thyroid gland that is often caused by viral infections. Multiple organ failure (MOF) is mainly caused by acute inflammatory reactions resulting from severe infection or trauma. MOF due to subacute thyroiditis is extremely rare.

Patient concerns:

A 48-year-old woman with a history of type 2 diabetes mellitus was admitted to our hospital because of subacute thyroiditis. However, the patient developed MOF during hospitalization.

Diagnosis:

The patient was diagnosed with subacute thyroiditis complicated by MOF based on clinical symptoms and laboratory tests.

Interventions:

The patient was initially admitted to the endocrinology ward for glucocorticoid and insulin therapies. When the condition deteriorated to MOF, the patient was transferred to the intensive care unit. Ventilator-assisted breathing, blood transfusion, albumin infusion, improved cardiac function, oral glucocorticoids, and insulin were administered to the patient.

Outcomes:

The patient was followed-up at 2-weeks intervals for over 2 months. Her thyroid function returned to normal and her blood sugar level was stable. Transaminase, serum creatinine, albumin, and myocardial enzyme levels were normal.

Lessons:

MOF due to subacute thyroiditis is extremely rare. Especially in patients with elevated blood glucose or other immune dysfunctions, we should be alert to the occurrence of subacute thyroiditis with MOF.
Opacification of refractive bifocal intraocular lens in one month
Authors: Zeng Yanfeng , Liang Min , Fan Cheng , Xu Sen , Liu Fengting , Zhou Xiaoli , Tan Xin , Wang Xiaoqin
Published: February 2022

Rationale:

Multifocal intraocular lenses (IOLs) are used widely. However, the discovery of LS-313 MF15/30 (Oculentis B.V.) opacity during surgery has not yet been reported. This article reports 3 cases of LS-313 MF15/30 (Oculentis B.V.) IOL opacity found during cataract surgery implantation within 1 month.

Patient concerns:

Three patients underwent cataract surgery, and opacification of their IOL (LS-313 MF15/30, Oculentis B.V.) was found intraoperatively.

Diagnosis:

The patient was diagnosed with a postoperative intraocular opacity.

Interventions:

In case 1, the surgeon scrubbed the IOL with intraocular perfusion fluid and a gelatin sponge swab to reduce opacity in the central optical area of the IOL and then implanted it into the capsule bag. In case 2, the surgeon used the infusion-aspiration polishing mode for cleaning. To avoid IOL wear and bag damage, washing was stopped when turbidity in the center of the optical area was reduced. In case 3, we learned from our previous experience that the surgeon cut the IOL into 2 pieces and moved it out at the main incision, which was replaced and implanted with a brand new IOL, after the implanted IOL was again found cloudy.

Outcomes:

In case 1, more than 10 months after the surgery, the IOL was restored to transparency, no obvious eye discomfort was noted, and uncorrected visual acuity was 20/25. In case 2, the patient's IOL surrounding area was still partially turbid after more than 10 months of follow-up. In case 3, the patient's uncorrected visual acuity on postoperative day 1 was 20/20, and the best-corrected visual acuity was 20/20.

Lesson:

There are many reasons for the opacification of the IOL. In addition to the patient's own factors, the material, production, and packaging of the IOL, as well as the influence of external environmental temperature, the influence of the IOL implant instrument should not be ignored and needs to be considered.
Bohring-Opitz syndrome caused by a novel ASXL1 mutation (c.3762delT) in an IVF baby
Authors: Wang Dongbo , Yuan Xin , Guo Haichun , Yan Shuyuan , Wang Guohong , Wang Yanling , Wang Tuanmei , He Jun , Peng Xiangwen
Published: February 2022

Rationale:

Bohring-Opitz syndrome is a severe congenital disorder associated with a de novo mutation in the additional sex combs-like 1 (ASXL1) gene, and it is characterized by symptoms that include developmental delay and musculoskeletal and neurological features.

Patient concerns:

The patient was a girl, an in vitro fertilization (IVF) baby, with delayed motor development, drooling, short stature, slow growth, low muscle tone, image diagnosis of hypoplasia of the corpus callosum, delayed tooth eruption, high palatal arch, adduction of the thumb, drooling, not chewing, excessive joint activity, and ligament relaxation.

Diagnosis:

Whole-exome sequencing analysis detected 1 novel disruptive frameshift mutation in ASXL1 in the proband but wild-type ASXL1 in both parents.

Interventions:

Approximately 1 year of rehabilitation training, which included exercise therapy, toy imitation operation, cognition of daily objects, daily living skills training, gesture language training, oral muscle training, and hand movement training.

Outcomes:

After approximately 1 year of training, the patient was 3 years old and able to eat normally without drooling. She was able to grasp objects and pick them up after they fell. She was able to grasp small objects and actively played with toys. In addition, she was able to crawl on the floor (at slow speed, with poor initiative), stand with assistance, and walk with assistance; she was unstable when standing unassisted (standing unassisted for 8 seconds at most during training).

Lesson:

ASXL1 c.3762delT is a novel mutation that may be caused by IVF. This finding suggests that appropriate gene mutation detection approaches may be necessary for IVF technology.