bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy, Safety, and Durability of Long-Acting Cabotegravir and Rilpivirine in Adults With Human Immunodeficiency Virus Type 1 Infection: 5-Year Results From the LATTE-2 Study
Authors: Smith Graham H R , Henry W Keith , Podzamczer Daniel , Masiá Maria Del Mar , Bettacchi Christopher J , Arasteh Keikawus , Jaeger Hans , Khuong-Josses Marie-Aude , Montes-Ramírez Maria Luisa , Stellbrink Hans-Jürgen , Yazdanpanah Yazdan , Richmond Gary J , Sutton Kenneth C , Zhang Feifan , McCoig Cynthia C , St Clair Marty H , Vandermeulen Kati , Van Solingen-Ristea Rodica , Smith Kimberly Y , Margolis David A , Spreen William R
Published: August 2021

Background

In the Long-Acting Antiretroviral Treatment Enabling Trial 2 (LATTE-2) phase 2b study, long-acting (LA) injectable cabotegravir + rilpivirine dosed every 8 weeks (Q8W) or every 4 weeks (Q4W) demonstrated comparable efficacy with daily oral antiretroviral therapy (ART) through 96 weeks in ART-naive adults with human immunodeficiency virus type 1 (HIV-1). Here we report efficacy, tolerability, and safety of cabotegravir + rilpivirine LA over approximately 5 years.

Methods

After 20 weeks of oral cabotegravir + abacavir/lamivudine, participants were randomized to cabotegravir + rilpivirine LA Q8W or Q4W or continue oral ART through the 96-week maintenance period. In the extension period through week 256, participants continued their current LA regimen (randomized Q8W/Q4W groups) or switched from oral ART to Q8W or Q4W LA therapy (extension-switch groups). Endpoints assessed included proportion of participants with HIV-1 RNA <50 copies/mL (Snapshot algorithm) and adverse events (AEs).

Results

At week 256, 186 of 230 (81%) participants in randomized Q8W/Q4W groups and 41 of 44 (93%) participants in extension-switch groups had HIV-1 RNA <50 copies/mL. No protocol-defined virologic failures occurred after week 48. Injection wsite reactions infrequently resulted in discontinuation (4 [2%] and 1 [2%] participants in randomized Q8W/Q4W and extension-switch groups, respectively). Three participants in randomized Q8W/Q4W groups experienced drug-related serious AEs, including 1 fatal serious AE (Q4W group); none occurred in extension-switch groups. Of 25 participants with AEs leading to withdrawal, 20 were in the randomized Q4W group; no AE leading to withdrawal occurred in >1 participant.

Conclusions

Cabotegravir + rilpivirine LA exhibited long-term efficacy and tolerability, demonstrating its durability as maintenance therapy for HIV-1 infection.

Clinical Trials Registration. NCT02120352.
Minimally Invasive L5-S1 Oblique Lumbar Interbody Fusion With Simultaneous Robotic Single Position Posterior Fixation: 2-Dimensional Operative Video
Authors: Pham Martin H , Gupta Mihir , Stone Lauren E , Osorio Joseph A , Lehman Ronald A
Published: August 2021

The unique anatomy at L5-S1 presents different challenges and considerations to be made when compared to other areas in the lumbar spine. In this way, the oblique lumbar interbody fusion (OLIF) is more closely related to a supine anterior lumbar interbody fusion (ALIF) except that the former is performed in a lateral position down a smaller minimally invasive retroperitoneal corridor. This lateral positioning at L5-S1, however, provides an opportunity for single-position surgery simultaneously with posterior fixation, which is not afforded by other approaches.

 We present here a case of a 57-yr-old male with a prior right-sided L5-S1 microdiscectomy who presents with worsening lumbar radiculopathy and foot drop. He subsequently underwent a minimally invasive L5-S1 OLIF with posterior instrumentation placed bilaterally while remaining in a single lateral position (Mazor X Stealth Edition, Medtronic, Dublin, Ireland). Both the anterior OLIF surgeon and posterior instrumentation surgeon were able to work simultaneously. There is currently a need for further high-quality operative videos showing the L5-S1 OLIF technique, and to our knowledge, this is the first video demonstrating a 2-surgeon near-simultaneous workflow approach using a spinal robotics platform at this level.

 There is no identifying information in this video. A patient consent was obtained for the surgical procedure and for publishing of the material included in the video.
How Reliable Is the Intraoperative Computed Tomography Angiography in Assessing Complete Surgical Resection of Cerebral Arteriovenous Malformations?
Authors: Alotaibi Fahad Saud , Ntyl Sondous Raid , Almuhaini Tafla Saleh , Bin Abdulqader Sarah , Alotaibi Naif M , Soulami Lahbib , Bafaquh Mohammad , Al Yamany Mahmoud , Alturki Abdulrahman Y , Alzhrani Gmaan , Orz Yasser , Alobaid Abdullah
Published: August 2021

BACKGROUND

Digital subtraction angiography (DSA) is still considered the gold standard test to evaluate arteriovenous malformation's (AVM) residual after microsurgical resection.

OBJECTIVE

To evaluate the safety and reliability of intraoperative computed tomography angiography (iCTA) as an immediate method of evaluating the surgical results of AVM resection.

METHODS

We performed a retrospective review for all cases of cerebral AVMs at our institute from January 2015 to April 2020 who underwent surgical resection of cerebral AVM and had iCTA. All included patients underwent a postoperative DSA, and the results were compared with iCTA.

RESULTS

Twenty-eight cases were included. All cases showed complete resection (100%) in the iCTA, and the results were consistent with the postoperative DSA results. The sensitivity of iCTA was 100%. The added operative time ranged from 25 to 30 min. There were no complications related to the use of iCTA.

CONCLUSION

Intraoperative assessment of AVMs surgical results with an iCTA is safe and reliable. The sensitivity of iCTA following AVM resection merits further investigations.
Microsurgical Resection of Hybrid Nerve Sheath Tumor Involving the Orbit and Lateral Wall of the Cavernous Sinus: 2-Dimensional Operative Video
Authors: Matsuo Satoshi , Higaki Rio , Matsukado Koichiro
Published: August 2021

Surgical removal of the tumor involving both the orbital and cavernous sinus remains challenging. Hybrid nerve sheath tumors (HNSTs) are defined as benign peripheral nerve sheath tumors with combined features of more than one type of benign peripheral nerve sheath tumors, including schwannoma, neurofibroma, and perineurinoma.
1
They rarely arise from the orbit.
1-3
This video shows the microsurgical resection of HNST involving both the orbit and lateral wall of the cavernous sinus. A 43-yr-old woman presented with 1-yr history of a slowly growing painless mass in her left medial eyelid. Neuroimaging examinations demonstrated a multilobulated and well-demarcated mass with a heterogeneous enhancement located in the extraconal region, just above the levator muscle, and extending from the eyelid to the middle fossa through the superior orbital fissure. Based on the neuroimaging features, we diagnosed it as trigeminal schwannoma involving the orbit and lateral wall of the cavernous sinus preoperatively. We performed left frontotemporal craniotomy with superolateral orbitotomy to gain access to the tumor. The tumor was grayish yellow and relatively firm. No intact nerve fibers of the frontal and ophthalmic nerves could be identified, making the diagnosis of the tumor originating from both nerves. Finally, we completely resected the tumor, which was confirmed by postoperative magnetic resonance images. Her postoperative course was uneventful, except for transient diplopia and expected left forehead hypesthesia. The pathology returned to HNST containing schwannoma and neurofibroma with no malignancy. The patient consented to the procedure prior to the surgery. And, the patient consented to the publication of their image.
Homeostatic regulation of NREM sleep, but not REM sleep, in Australian magpies
Authors: Johnsson Robin D , Connelly Farley , Vyssotski Alexei L , Roth Timothy C , Lesku John A
Published: August 2021

Study Objectives

We explore non-rapid eye movement (NREM) and rapid eye movement (REM) sleep homeostasis in Australian magpies (Cracticus tibicen tyrannica). We predicted that magpies would recover lost sleep by spending more time in NREM and REM sleep, and by engaging in more intense NREM sleep as indicated by increased slow-wave activity (SWA).

Methods

Continuous 72-h recordings of EEG, EMG, and tri-axial accelerometry, along with EEG spectral analyses, were performed on wild-caught Australian magpies housed in indoor aviaries. Australian magpies were subjected to two protocols of night-time sleep deprivation: full 12-h night (n = 8) and first 6-h half of the night (n = 5), which were preceded by a 36-h baseline recording and followed by a 24-h recovery period.

Results

Australian magpies recovered from lost NREM sleep by sleeping more, with increased NREM sleep consolidation, and increased SWA during recovery sleep. Following 12-h of night-time sleep loss, magpies also showed reduced SWA the following night after napping more during the recovery day. Surprisingly, the magpies did not recover any lost REM sleep.

Conclusions

Only NREM sleep is homeostatically regulated in Australian magpies with the level of SWA reflecting prior sleep/wake history. The significance of emerging patterns on the apparent absence of REM sleep homeostasis, now observed in multiple species, remains unclear.
Global Analysis of Hemileia vastatrix Populations Shows Clonal Reproduction for the Coffee Leaf Rust Pathogen Throughout Most of Its Range
Authors: Ramírez-Camejo Luis A. , Eamvijarn Amnat , Díaz-Valderrama Jorge R. , Karlsen-Ayala Elena , Koch Rachel A. , Johnson Elizabeth , Pruvot-Woehl Sòlene , Mejía Luis C. , Montagnon Christophe , Maldonado-Fuentes Casto , Aime M. Catherine
Published: August 2021

Hemileia vastatrix is the most important fungal pathogen of coffee and the causal agent of recurrent disease epidemics that have invaded nearly every coffee growing region in the world. The development of coffee varieties resistant to H. vastatrix requires fundamental understanding of the biology of the fungus. However, the complete life cycle of H. vastatrix remains unknown, and conflicting studies and interpretations exist as to whether the fungus is undergoing sexual reproduction. Here we used population genetics of H. vastatrix to infer the reproductive mode of the fungus across most of its geographic range, including Central Africa, Southeast Asia, the Caribbean, and South and Central America. The population structure of H. vastatrix was determined via eight simple sequence repeat markers developed for this study. The analyses of the standardized index of association, Hardy–Weinberg equilibrium, and clonal richness all strongly support asexual reproduction of H. vastatrix in all sampled areas. Similarly, a minimum spanning network tree reinforces the interpretation of clonal reproduction in the sampled H. vastatrix populations. These findings may have profound implications for resistance breeding and management programs against H. vastatrix.
Virtual Clinical Experiences in Nursing Education: Applying a Technology-Enhanced Storyboard Technique to Facilitate Contextual Learning in Remote Environments
Authors: Roberts Michele Livich , Mazurak Julia O. E.
Published: August 2021

Many schools of nursing were not prepared to transition to remote instruction during the COVID-19 pandemic. Virtual and computer-based simulation can offer a substitution for in-person clinical learning. This article describes the use of storyboards, created by faculty, to provide context during remote clinical experiences. The theoretical basis for the design and implementation of the activity is discussed. Faculty observations of student behaviors (i.e., clinical decision-making, reflection on performance, and engagement) were consistent between computer-based and laboratory-based simulation settings.
The Prevent Ovarian Cancer Program (POCP): Identification of Women at Risk for Ovarian Cancer Using Complementary Recruitment Approaches
Authors: Tone Alicia A. , McCuaig Jeanna M. , Ricker Nicole , Boghosian Talin , Romagnuolo Tina , Stickle Natalie , Virtanen Carl , Zhang Tong , Kim Raymond H. , Ferguson Sarah E. , May Taymaa , Laframboise Stephane , Armel Susan , Demsky Rochelle , Volenik Alexandra , Stuart-McEwan Terri , Shaw Patricia , Oza Amit , Kamel-Reid Suzanne , Stockley Tracy , Bernardini Marcus Q.
Published: August 2021

(Abstracted from Gynecol Oncol 2021;162:97–106)

High-grade serous ovarian cancer (HGSOC) accounts for 70% of ovarian cancer cases and is the deadliest subtype of ovarian cancer. Approximately 20% of ovarian cancers are hereditary, and the greatest single risk factor for ovarian cancer is the inheritance of a pathogenic variant (PV) such as BRCA1 or BRCA2.
Medical Management of Induced and Incomplete First-Trimester Abortion by Non-physicians in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Kristiansen Marianne Bogen , Shayo Benjamin C. , Philemon Rune , Khan Khalid Saeed , Rasch Vibeke , Linde Ditte Søndergaard
Published: August 2021

(Abstracted from Acta Obstet Gynecol Scand 2021;100:718–726)

Globally, unsafe abortion results in between 5% and 13% of maternal deaths each year, and 95% of unsafe abortions occur in low- and middle-income countries (LMICs). One cause of this dramatic socioeconomic disparity is insufficient access to safe abortion services driven by strict abortion laws, nonfunctioning health systems, lack of trained health care providers, and lack of services in rural areas.
A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening
Authors: Hillier Teresa A. , Pedula Kathryn L. , Ogasawara Keith K. , Vesco Kimberly K. , Oshiro Caryn E. S. , Lubarsky Suzanne L. , Van Marter Jan
Published: August 2021

(Abstracted from N Engl J Med 2021;384:895–904)

Gestational diabetes mellitus (GDM) affects up to 25% of pregnant women and increases the risk of a number of adverse maternal and neonatal outcomes. There are 2 screening approaches for GDM: 1-step screening preferred by the American Diabetes Association and 2-step screening recommended by the American College of Obstetricians and Gynecologists.
Position and Integrity of Uterine Scar Are Determined by Degree of Cervical Dilatation at Time of Cesarean Section
Authors: Kamel R. , Eissa T. , Sharaf M. , Negm S. , Thilaganathan B.
Published: August 2021

(Abstracted from Ultrasound Obstet Gynecol 2021;57:466–470)

Abnormally invasive placenta (AIP) is a rare and sometimes fatal condition during pregnancy. Abnormally invasive placenta usually is caused by placental implantation over a uterine scar from a previous uterine surgery, most commonly a cesarean section (CS).
Use of Established Guidelines When Reporting on Interprofessional Team-Based Learning in Health Professions Student Education: A Systematic Review
Authors: Burgess Annette W. , McGregor Deborah M.
Published: August 2021

Purpose

Team-based learning (TBL) has gained popularity across the health professions, including in interprofessional contexts. The authors conducted this systematic review to summarize the published evidence regarding the extent, design, and practice of interprofessional TBL within health professions (including medical) degree programs to inform interprofessional education (IPE) educators and curricula designers.

Method

In June 2020, the authors searched PubMed Central, CINAHL, Web of Science, and ERIC for original research articles describing TBL programs with student representation from multiple health professions degree programs that were published between January 2010 and June 2020. Included articles underwent data extraction for study characteristics (e.g., country of origin, topics covered, class descriptors) and the 7 core design elements of TBL: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 Ss (significant problem, same problem, specific choice, and simultaneous reporting), incentive structure, and peer review.

Results

Twelve articles were included. Significant variability was noted in the application and reporting of the 7 core design elements of TBL, which highlighted challenges to the implementation of interprofessional TBL.

Conclusions

Although the structured format of TBL provides a suitable pedagogy for IPE, this review identified challenges associated with the effective integration of IPE into TBL, including: the unequal distribution of students to teams as a result of there being multiple disciplines from different programs; varied levels of student experience with the pedagogy of TBL; a lack of resources required for large groups of students; timetabling requirements for multiple disciplines from different programs; inability to provide more than 1 TBL session; design of patient cases that suit multiple disciplines; alignment of topics within the curricula of multiple disciplines, programs, and universities; inequities in grading for different students within the same TBL program; and limited opportunity for peer review.
Academic Medicine’s Journey Toward Racial Equity Must Be Grounded in History: Recommendations for Becoming an Antiracist Academic Medical Center
Authors: Wilkins Consuelo H. , Williams Mamie , Kaur Karampreet , DeBaun Michael R.
Published: August 2021

The harsh realities of racial inequities related to COVID-19 and civil unrest following police killings of unarmed Black men and women in the United States in 2020 heightened awareness of racial injustices around the world. Racism is deeply embedded in academic medicine, yet the nobility of medicine and nursing has helped health care professionals distance themselves from racism.

Vanderbilt University Medical Center (VUMC), like many U.S. academic medical centers, affirmed its commitment to racial equity in summer 2020. A Racial Equity Task Force was charged with identifying barriers to achieving racial equity at the medical center and medical school and recommending key actions to rectify long-standing racial inequities. The task force, composed of students, staff, and faculty, produced more than 60 recommendations, and its work brought to light critical areas that need to be addressed in academic medicine broadly. To dismantle structural racism, academic medicine must: (1) confront medicine’s racist past, which has embedded racial inequities in the U.S. health care system; (2) develop and require health care professionals to possess core competencies in the health impacts of structural racism; (3) recognize race as a sociocultural and political construct, and commit to debiologizing its use; (4) invest in benefits and resources for health care workers in lower-paid roles, in which racial and ethnic minorities are often overrepresented; and (5) commit to antiracism at all levels, including changing institutional policies, starting at the executive leadership level with a vision, metrics, and accountability.
Single Impact Injury of Vertebral Endplates Without Structural Disruption, Initiates Disc Degeneration Through Piezo1 Mediated Inflammation and Metabolism Dysfunction
Authors: Sun Zhengang , Zheng Xinfeng , Li Songbo , Zeng Baozhu , Yang Jiaming , Ling Zemin , Liu Xizhe , Wei Fuxin
Published: August 2021

Study Design.

In vitro experimental study.

Objective.

To establish an axial impact injury model of intervertebral disc (IVD) and to investigate if a single impact injury without endplate structural disruption could initiate intervertebral disc degeneration (IDD), and what is the roles of Piezo1 in this process.

Summary of Background Data.

Although IDD process has been confirmed to be associated with structural failures such as endplate fractures, whether a single impact injury of the endplates without structural disruption could initiate IDD remains controversial. Previous studies reported that Piezo1 mediated inflammation participated in the progression of IDD induced by mechanical stretch; however, the roles of Piezo1 in IVD impact injury remain unknown.

Methods.

Rats spinal segments were randomly assigned into Control, Low, and High Impact groups, which were subjected to pure axial impact loading using a custom-made apparatus, and cultured for 14 days. The degenerative process was investigated by using histomorphology, real-time Polymerase Chain Reaction(PCR), western-blot, immunofluorescence, and energy metabolism of IVD cell. The effects of Piezo1 were investigated by using siRNA transfection, real-time PCR, western-blot, and immunofluorescence.

Results.

The discs in both of the impact groups presented degenerative changes after 14 days, which showed significant up-regulation of Piezo1, NLRP3 inflammasome, the catabolic (MMP-9, MMP-13), and pro-inflammatory gene (IL-1β) expression than that of the control group (P < 0.05), accompanied by significantly increased release of ATP, lactate, nitric oxide (NO), and glucose consumption of IVD cells at first 7 days. Silencing Piezo1 reduced the activation of NLRP3 inflammasome and IL-1β expression in the nucleus pulposus induced by impact injury.

Conclusion.

It demonstrated that not only fracture of the endplate but also a single impact injury without structural impairment could also initiate IDD, which might be mediated by activation of Piezo1 induced inflammation and abnormal energy metabolism of IVD cells.

Level of Evidence: N/A.
Potent, Selective CARs as Potential T-Cell Therapeutics for HPV-positive Cancers
Authors: Wang Xueyin , Sandberg Mark L. , Martin Aaron D. , Negri Kathleen R. , Gabrelow Grant B. , Nampe Daniel P. , Wu Ming-Lun , McElvain Michele E. , Toledo Warshaviak Dora , Lee Wen-Hua , Oh Julyun , Daris Mark E. , Chai Falene , Yao Christine , Furney James , Pigott Craig , Kamb Alexander , Xu Han
Published: August 2021

Next-generation T-cell therapies will likely continue to utilize T-cell receptors (TCRs) and chimeric antigen receptors (CARs) because each receptor type has advantages. TCRs often possess exceptional properties even when tested unmodified from patients’ T cells. CARs are generally less sensitive, possibly because their ligand-binding domains are grafted from antibodies selected for binding affinity or avidity and not broadly optimized for a functional response. Because of the disconnect between binding and function among these receptor types, the ultimate potential of CARs optimized for sensitivity and selectivity is not clear. Here, we focus on a thoroughly studied immuno-oncology target, the HLA-A*02/HPV-E629–38 complex, and show that CARs can be optimized by a combination of high-throughput binding screens and low-throughput functional assays to have comparable activity to clinical TCRs in acute assays in vitro. These results provide a case study for the challenges and opportunities of optimizing high-performing CARs, especially in the context of targets utilized naturally by TCRs.
Acute respiratory distress syndrome: focusing on secondary injury
Authors: Pan Pan , Su Long-Xiang , Liu Da-Wei , Wang Xiao-Ting
Published: August 2021

Acute respiratory distress syndrome (ARDS) is one of the most common severe diseases seen in the clinical setting. With the continuous exploration of ARDS in recent decades, the understanding of ARDS has improved. ARDS is not a simple lung disease but a clinical syndrome with various etiologies and pathophysiological changes. However, in the intensive care unit, ARDS often occurs a few days after primary lung injury or after a few days of treatment for other severe extrapulmonary diseases. Under such conditions, ARDS often progresses rapidly to severe ARDS and is difficult to treat. The occurrence and development of ARDS in these circumstances are thus not related to primary lung injury; the real cause of ARDS may be the “second hit” caused by inappropriate treatment. In view of the limited effective treatments for ARDS, the strategic focus has shifted to identifying potential or high-risk ARDS patients during the early stages of the disease and implementing treatment strategies aimed at reducing ARDS and related organ failure. Future research should focus on the prevention of ARDS.
Aseptic cystitis induced by nivolumab and ipilimumab combination for metastatic melanoma
Authors: Schneider Sophie , Alezra Eric , Yacoub Mokrane , Ducharme Océane , Gerard Emilie , Dutriaux Caroline , Prey Sorilla
Published: August 2021

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced melanoma. Combination of ICI with ipilimumab cytotoxic T-lymphocyte antigen-4 and nivolumab [anti-programmed cell death-1 (PD-1)] improves tumoral response compared to anti-PD1 monotherapy in melanoma patients, but is associated with more severe and multiple immune-related adverse events. We report the first case of aseptic cystitis induced by ipilimumab and nivolumab combination in a 61-year-old melanoma patient. She described after two infusions, diarrhea, pollakiuria, intense bladder pain, urinary urgency, and nocturia. Repeated negative urine culture tests led to perform cystoscopy. Mucosal bladder biopsies showed lymphocytic T-cells infiltration in intraepithelial and in subepithelial connective tissue, which were consistent with the diagnosis of immune-related aseptic cystitis. Aseptic cystitis is a rare and poorly known side-effect related to ICI. Only four other cases with anti-PD1 monotherapy were found in literature, only in Japanese patients. It simulates bacterial cystitis with negative urinary tests, and is often associated with atypical symptoms like diarrhea, which may delay the diagnosis. Oral steroids appear to be the most efficient therapeutic options.
Nonmotor Symptoms in Amyotrophic Lateral Sclerosis and Their Correlation With Disease Progression
Authors: Jaafar Nesreen , Malek Elia , Ismail Helen , Salameh Johnny
Published: August 2021

Objectives:

Motor neuron disease is a progressive neurodegenerative disease involving upper and lower motor neurons. Nonmotor symptoms (NMS) are part of disease manifestation. We aim to report the prevalence and severity of NMS in patients with motor neuron disease (MND) in Lebanon. 

Methods:

Fifty-eight patients diagnosed with MND at the American University of Beirut Medical Center were interviewed using the NMS Scale. The prevalence of these symptoms was assessed and correlated with disease progression.

Results:

All our patients had at least 2 NMS with an average total score of 15.8. Symptoms reported in more than half of the patients were fatigue, depression, dysphagia, lack of motivation, pain, change in weight, anxiety, constipation, and lack of pleasure. A significant correlation was found between the total NMS score and Amyotrophic Lateral Sclerosis Functional Rating Scale score (P = 0.002) and between the NMS score corresponding to mental health and Amyotrophic Lateral Sclerosis Functional Rating Scale score (P = 0.012). Patients with bulbar symptoms had a significantly higher NMS score corresponding to gastrointestinal symptoms (P < 0.0001). It is important to note that NMS such as dysphagia could be related to motor neuron involvement.

Conclusions:

NMS are commonly reported in patients with MND and seem to positively correlate with disease progression. Treating NMS is a critical aspect of the clinical care delivered to patients with MND to maintain a good quality of life.
Variable Presentation of Hereditary Transthyretin-Mediated Amyloidosis at a Single Center
Authors: Hussain Yessar
Published: August 2021

Objectives:

Describe atypical presentations of hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy.

Methods:

Initial symptoms, diagnoses, and follow-up were recorded at the Austin Neuromuscular Center for 12 patients with nonclassical presentation of hATTR amyloidosis.

Results:

Common initial symptoms were hand and/or feet sensory manifestations (83%), muscle weakness (58%), and, less frequently, gastrointestinal and orthostatic impairment and carpal tunnel syndrome. Initial diagnoses were polyneuropathy (83%) and/or myopathy (25%). During follow-up, 10 patients (83%) developed cardiac symptoms (dyspnea, 67% and ankle edema, 17%), resulting in revised diagnoses of heart disease. Multisystem involvement raised suspicion of amyloidosis, which was confirmed by biopsy or nuclear scintigraphy, and genetic testing. All patients had polyneuropathy; 8 (67%) had cardiomyopathy-associated transthyretin mutations (V122I or T60A). Time from symptom onset to diagnosis was up to 10 years (median 5 years), during which patients' health deteriorated, although with recognition of disease signs/symptoms the diagnosis of hATTR amyloidosis was made in approximately 2–6 months from presentation at our center.

Conclusions:

Increased awareness of the diverse initial hATTR amyloidosis symptoms could shorten time to diagnosis, enabling earlier treatment and improved patient outcomes.
Severe Paraproteinemic Demyelinating Neuropathy With Impaired Excitability of the Distal Segments of the Peripheral Nerves
Authors: Khodulev Vasily I. , Kabaeva Katsiaryna N. , Stepanova Julia I. , Shcharbina Natallia Y.
Published: August 2021

We report clinical and detailed nerve conduction findings in case of polyneuropathy associated with kappa light chains monoclonal gammopathy of undetermined significance with progression to lymphoproliferative disorder. A 55-year-old man had a predominantly distal, chronic (5 years duration), slowly progressive, symmetric, predominantly sensory impairment with sensory ataxia, and mild weakness. M protein was identified by serum protein electrophoresis. The kappa/lambda ratio of free light chains was significantly elevated to 11.96. The cerebrospinal fluid protein level was elevated at 3.5 g/L. This case study has revealed 2 unusual electrophysiological phenomena—a very unusual prolongation of distal motor latencies of compound muscle action potentials (CMAP) up to 86.5 ms and impaired excitability of the distal segments of the peripheral nerves. The distal CMAP areas were considerably lower compared with the proximal CMAP areas. Radiography of the skull revealed osteolytic lesions.
Granulomatous Myositis Associated With Acetylcholine Receptor Antibodies Without Clinical Myasthenia
Authors: Jin Jingxiao , Isfort Michael C. , Ascherman Dana P. , Lacomis David
Published: August 2021

Myasthenia gravis associated with concurrent inflammatory myopathy is a rare but well-described syndrome, most often seen in patients with thymoma. We present a case of biopsy-proven granulomatous myositis associated with positive acetylcholine receptor binding, blocking, and modulating and antistriated antibodies, without clear clinical symptoms of myasthenia gravis and in the absence of thymoma. In addition, we include rarely reported neuromuscular ultrasound findings of granulomatous myositis in a patient without sarcoidosis. Inflammatory myopathy may precede development of myasthenia gravis in myasthenia gravis associated with concurrent inflammatory myopathy, and it is important to remain vigilant for symptoms suggestive of myasthenia gravis, especially in the presence of positive myasthenia-associated antibodies.
Pediatric Extraspinal Subcutaneous Sacrococcygeal Myxopapillary Ependymoma: Case Report and Minireview
Authors: Liu Yufei , Peng Yang , Wang Xiaolu , Guo Zhaokun , Xiang Chao , Wan Weisong , Wang Xingfu , Hu Yuchang
Published: August 2021

A 9-year-old girl presented with a slow-growing and painless mass for 7 months in the soft tissue of the sacrococcygeal region. Magnetic resonance imaging revealed a well-circumscribed solid mass located in the subcutaneous soft tissue of the sacrococcygeal area, but not affecting bone structures. The mass was completely removed, and the disorder was diagnosed as myxopapillary ependymoma. In addition, the MYCN gene amplification status of the tumor was evaluated. Extra-axial ependymomas are very rare tumors with a tendency to metastasis, but they are usually regarded as low-grade ependymomas. Long-time surveillance and follow-up are necessary even after complete excision. Besides, we also discuss the diagnosis of primary soft tissue myxopapillary ependymoma.
Nevus Sebaceous of the Scalp With Stepwise Progression Into Invasive Syringocystadenocarcinoma Papilliferum
Authors: Kneitz Hermann , Goebeler Matthias , Rütten Arno
Published: August 2021

Abstract:

Syringocystadenocarcinoma papilliferum (SCACP), the malignant counterpart of syringocystadenoma papilliferum (SCAP), is an extremely rare malignant adnexal neoplasm. It is described by the World Health Organization as a malignant transformation of SCAP occurring in middle-aged to elderly individuals with a predilection for the head and neck. SCACP seems to arise from a long-standing syringocystadenoma probably on a background of nevus sebaceous (NS) through a multistep progression. A 75-year-old man was referred to our department with a long-standing NS with a recent newly developing nodule on his scalp. The tumor was excised. On histology, the overall architecture of the tumor still resembled an unusual SCAP within NS but simultaneously showed transition to syringocystadenocarcinoma papilliferum in situ and invasive SCACP as recognizable by the presence of areas of nuclear atypia, increased proliferative activity, and infiltrative growth. In summary, we report an extremely rare case of an invasive SCACP of the scalp that demonstrates histological evidence for all transitive steps in the hypothetical multistep progression from NS to invasive SCACP in one single lesion. The implications of these findings are discussed in the light of the relevant literature.
Primary Eccrine Porocarcinoma of the Thumb With Metastasis: A Rare Case Report and Literature Review
Authors: Ma Chunguang , Huang Kaikai , Liu Mingna , Huang Xiaobao , Chen Xiaohong , Zhu Zhe , Chen Mukai , Han Jiande
Published: August 2021

Eccrine porocarcinoma (EPC) is a rare malignant sweat gland tumor that accounts for approximately 0.005% of all cutaneous carcinomas. It favors the lower extremities. Only 3% of EPCs are on the hand, and only 6 cases occurring specifically on fingers have been previously documented. However, we met a patient with EPC presenting the primary lesion on the left thumb and an extensive cutaneous metastasis on the left forearm. Pathologic findings of axillary lymph nodes confirmed lymphatic metastasis.
Gamma–Delta and CD20 Mycosis Fungoides: Two Cases Uncovered by Broad-Spectrum Immunostaining
Authors: Patel Payal , Fraga Garth R.
Published: August 2021

Mycosis fungoides (MF) expresses T-cell markers and the alpha–beta T-cell receptor (TCR) complex. Here, we describe a case of MF with dual expression of TCR delta and TCR beta and a case of MF expressing the B-cell marker CD20. Both anomalies were detected after we instituted a broad-spectrum immunostaining panel for cutaneous T-cell lymphomas. These findings suggest anomalous immunophenotypes may be more common in MF than previously appreciated. Histopathologists should be aware of unexpected malleability in the immunophenotype of MF to avoid confusion with other subtypes of cutaneous lymphoma. Further research into the prevalence and significance of CD20 and TCR-delta expression in MF is encouraged.
Efficacy of Erbium-Doped Yttrium Aluminium Garnet 2,940 and 1,064 nm Laser Treatment for Facial Rejuvenation—A Randomized Controlled Split-Face Clinical Trial
Authors: Song Wenting , Tian Yangzi , Tan Wenbin , Wang Gang , Gao Lin
Published: August 2021

BACKGROUND

The 2,940 nm erbium-doped yttrium aluminium garnet and 1,064 nm neodymium-doped yttrium aluminium garnet lasers have been widely applied in facial rejuvenation, but no randomized trials exist to evaluate the efficacy of the combination treatment.

OBJECTIVE

The efficacy of the combined treatment for facial rejuvenation.

MATERIALS AND METHODS

A total of 20 subjects with facial aging were enrolled and randomly assigned into 2 groups: one side of the face was treated with a 2,940 nm or 1,064 nm laser alone and the other side was treated with the combined lasers. The patients were treated by 3 sessions with 1-month intervals. The efficacies were quantitatively accessed by digitalized high-resolution photographs.

RESULTS

The 1,064 nm laser alone showed significant improvements on indexes of skin texture, spore, brown spots, elasticity, and melanin as compared with the baseline (p < .05). The 2,940 nm laser alone showed significant improvements on indexes of wrinkle, texture, pore, and elasticity (p < .05). The combined treatments showed significant improvements on the abovementioned indexes as compared with either a 1,064 nm or 2,940 nm laser treatment (p < .05).

CONCLUSION

A combination of 1,064 nm and 2,940 nm laser treatment renders significantly better efficacies for facial rejuvenation as compared with a 2,940 nm or 1,064 nm laser alone.
Outcomes of Lymphovenous Anastomosis for Upper Extremity Lymphedema: A Systematic Review
Authors: Gupta Nikita , Verhey Erik M. , Torres-Guzman Ricardo A. , Avila Francisco R. , Jorge Forte Antonio , Rebecca Alanna M. , Teven Chad M.
Published: August 2021

Background:

Lymphovenous anastomosis (LVA) is an accepted microsurgical treatment for lymphedema of the upper extremity (UE). This study summarizes and analyzes recent data on the outcomes associated with LVA for UE lymphedema at varying degrees of severity.

Methods:

A literature search was conducted in the PubMed database to extract articles published through June 19, 2020. Studies reporting data on postoperative improvement in limb circumference/volume or subjective improvement in quality of life for patients with primary or secondary lymphedema of the UE were included. Extracted data consisted of demographic data, number of patients and upper limbs, duration of symptoms before LVA, surgical technique, follow-up, and objective and subjective outcomes.

Results:

A total of 92 articles were identified, of which 16 studies were eligible for final inclusion comprising a total of 349 patients and 244 upper limbs. The average age of patients ranged from 38.4 to 64 years. The duration of lymphedema before LVA ranged from 9 months to 7 years. The mean length of follow-up ranged from 6 months to 8 years. Fourteen studies reported an objective improvement in limb circumference or volume measurements following LVA, ranging from 0% to 100%. Patients included had varying severity of lymphedema, ranging from Campisi stage I to IV. The maximal improvement in objective measurements was found in patients with lower stage lymphedema.

Conclusion:

LVA is a safe, effective technique for the treatment of UE lymphedema refractory to decompressive treatment. Results of LVA indicate greater efficacy in earlier stages of lymphedema before advanced lymphatic sclerosis.
A Deep-Rooted Culture Evolves to Support Healthcare Heroes
Authors: Dunn Jim
Published: August 2021

Enhancing employee well-being and creating a distinct employee experience are crucial to the success of Atrium Health. Our strategies for listening, well-being, and experience have always been deep-rooted in our culture, and the COVID-19 pandemic brought extraordinary opportunities to refresh those strategies as we carried out our mission during a time of uncertainty, crisis, and disruption to our everyday lives. From the start of the pandemic, we have deliberately anticipated the needs of our employees to provide support when they need it most. As the pandemic eases, we continue to make relevant and timely resources available to increase resilience and overall well-being. Our efforts have evolved to support our heroes—including our nonclinical workers—and to better position Atrium Health for future challenges that come our way. Although we are constantly changing, our primary focus remains the same. Employee well-being and experience are a significant part of who we are and an essential element of the care we all provide at Atrium Health.
Learning from the Past to Face the Worst with Our Best
Authors: Berdan Barclay E.
Published: August 2021

At Texas Health Resources, the well-being of our patients, our workforce, and our communities has long been at the core of who we are and the driving force behind business decisions, employee interactions, programs, practices, and the patient care we deliver. It is in our DNA, from our vision “to partner with you for a lifetime of health and well-being” to Our Texas Health Promise: Individuals Caring for Individuals, Together. That solid foundation—always the basis of our business preparations—made it possible for us to weather the challenges brought by the COVID-19 pandemic and to prepare ourselves for what comes next, emerging stronger and with sustained energy to transform the enterprise on the other end.
Pandemic Hastens Cleveland Clinic’s Unified Well-Being Strategy
Authors: Hancock K. Kelly , Minor Chad V.
Published: August 2021

Across the healthcare landscape, the COVID-19 pandemic has been incredibly challenging. It also has been a catalyst for change. It has ignited a redesign of the US health system and presented opportunities in areas such as caregiver and patient communication, digital practice, telehealth and virtual care, and more. Notably, the pandemic also has shined a new light on caregiver well-being. As executive leaders of Cleveland Clinic’s Caregiver Office, our top priority throughout the pandemic has been to support our caregivers professionally and personally—to help them be their best for themselves and for their fellow caregivers, our patients, our organization, and our communities. Today, Cleveland Clinic is realizing the profound impact of many of the strategies put in place during the pandemic and seeing how COVID-19 accelerated our organization’s unified vision for caregiver well-being. This article offers insight into Cleveland Clinic’s commitment to caregiver well-being, highlights actions we undertook during the pandemic, shares the resulting lessons we learned, and showcases how those lessons are shaping our future caregiver well-being strategy.
Improving Appropriate Use of Omega-3 Fatty Acids for Patients With Dyslipidemia: Effect of Online CME
Authors: Spyropoulos Jelena , Boutsalis George , Lucero Katie , Waskelo Joyce , Wilson Kanetha , Anderson David R.
Published: August 2021

Hypertriglyceridemia is associated with an increased risk of atherosclerotic cardiovascular (CV) disease. Clinical trials have demonstrated the effectiveness of eicosapentaenoic acid ethyl ester (EPA), an omega-3 polyunsaturated fatty acid, on triglyceride lowering and on CV risk reduction. However, many clinicians have limited understanding of the effects of EPA and limited experience using EPA to reduce the risk of CV disease. An analysis was conducted to determine whether an online continuing medical education (CME) intervention could improve knowledge and competence of primary care physicians (PCPs) and cardiologists related to the role of EPA in management of CV risk in patients with dyslipidemia. The intervention comprised 2 online video-based CME activities. The effects of education were assessed for learners who completed 4 pre- and postassessment questions for each activity, using a matched pre-/postassessment design. For all questions combined, a McNemar’s χ2 test assessed differences from pre- to postassessment. Matched-learner data indicated that 34% of PCPs improved their knowledge as a result of participating in the activities, and 42% had their knowledge reinforced. Among cardiologists, 28% improved their knowledge, and 61% had their knowledge reinforced. For these learner subsets, there was a significant 17% relative increase in self-assessed confidence in appropriate use of EPA for PCPs (n = 1644, P < 0.001) and a 12% increase for cardiologists (n = 524; P < 0.001). The improvements observed in this online CME intervention demonstrate the benefits of educating the appropriate target audience base and suggest that this type of intervention can translate into improvements in clinical care.
Enhancing Quality Supervision for the Delivery of Mental Health Care Through Nonspecialist Clinicians in Resource-Limited Settings
Authors: Collier Stephanie , Meyen Rachel , Smith Stephanie L. , Valentin Cidna , Eustache Fr. Eddy
Published: August 2021

Supervision of nonspecialist clinicians by trained mental health professionals is integral to developing capacity for providing mental health care in low-resource settings. Current supervision efforts in low-resource settings, however, are often variable in quality. Scant published literature addresses how supervision practices affect treatment outcomes; only a few studies have been published on evidence-based supervision methods. Additionally, in low-resource settings many systems-level obstacles exist in providing adequate mental health supervision to nonspecialist clinicians. This article seeks to address psychiatrists’ role in providing supervision and promoting quality of care in low-resource settings. We review the literature on evidence-based supervision practices, address obstacles and current practices of providing high-quality mental health supervision in low-resource settings, and weave this knowledge with our experiences learning from the clinicians at Partners in Health in Haiti. We also discuss feasible strategies and provide recommendations for strengthening the supervision process in resource-limited settings.
Overactive bladder syndrome is associated with detrusor overactivity and abnormal voiding pattern in nulliparous women
Authors: Fang Jessica Jay , Wu Ming-Ping , Yen Yu-Chun , Wu Jeng-Cheng , Chin Hung-Yen
Published: August 2021

Background:

Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial.

Methods:

This study investigated abnormal voiding patterns and detrusor overactivity (DO) among NP women with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) was recorded. Data were analyzed using analysis of variance, χ2 tests, and independent t tests.

Results:

Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO, and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP, respectively, especially in the NP group.

Conclusion:

We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.
Upper airway muscles: influence on obstructive sleep apnoea pathophysiology and pharmacological and technical treatment options
Authors: Perger Elisa , Taranto-Montemurro Luigi
Published: August 2021

Purpose of review

Obstructive sleep apnoea (OSA) is highly prevalent with numerous deleterious effects on neurocognitive and cardiovascular health. It is characterized by collapse of the upper airway during sleep, due to the decrease in both basal and compensatory UA muscle activities. However, the leading treatment, continuous positive airway pressure, is often poorly tolerated. This review presents latest works focusing on novel interventions targeting upper airway muscles to alleviate OSA severity.

Recent findings

In the last years, researchers have focused on the development of alternative treatment strategies targeting UA muscle activation, including pharmacological and nonpharmacological interventions.

Among the nonpharmacological treatments, hypoglossal nerve stimulation aims to increase upper airway muscle phasic activity during sleep through electrical stimulation, while myofunctional therapy improves the activity and coordination of upper airway dilator muscles.

Regarding OSA pharmacotherapy, recent findings strongly suggest that selective norepinephrine reuptake inhibitors such as atomoxetine and reboxetine, when administered with antimuscarinics such as oxybutynin, can alleviate OSA in most patients increasing pharyngeal dilator muscles activity during sleep. New combinations of norepinephrine reuptake inhibitors and antimuscarinics have further been explored with variable success and animal models showed that leptin, thyrothropin releasing hormone analogues and gene therapy hold potential for the future of OSA pharmacotherapy.