bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Features of Sarcopenia in Patients With Lumbar Spinal Stenosis
Authors: Matsuo Sachika , Kawakami Mamoru , Minetama Masakazu , Nakagawa Masafumi , Teraguchi Masatoshi , Kagotani Ryohei , Mera Yoshimasa , Yamamoto Yoshio , Sakon Nana , Nakatani Tomohiro , Sumiya Tadashi , Nakagawa Yukihiro
Published: March 2020

Study Design.

Cross-sectional design.

Objective.

To investigate the prevalence of sarcopenia and identify factors associated with sarcopenia in patients with lumbar spinal stenosis (LSS).

Summary of Background Data.

Patients with LSS have a higher prevalence of sarcopenia compared with healthy older adults. However, the clinical features of sarcopenia in patients with LSS are poorly understood and the factors affecting sarcopenia in patients with LSS remain unclear.

Methods.

Patients diagnosed with LSS based on clinical examination and magnetic resonance imaging findings, and referred to physical therapy, were enrolled. Muscle mass was measured using bioelectrical impedance using InBody S10. We collected a numerical rating scale (NRS) for back pain, the 36-Item Short-Form Survey (SF-36), the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), bone mineral density (BMD), and radiographic measurements of spinal alignment. Sarcopenia was defined according to the Asian Working Group for Sarcopenia guidelines and patients were classified into sarcopenia or nonsarcopenia groups.

Results.

A total of 178 patients were enrolled: 35 in the sarcopenia group and 143 in the nonsarcopenia group. The prevalence of sarcopenia was 19.7%. The average percent of slip (% slip) among patients in the sarcopenia group was significantly higher compared with those in the nonsarcopenia group (P < 0.05). Body mass index (BMI), BMD, physical function as assessed by the SF-36, and gait disturbance as assessed by the JOABPEQ were significantly lower in the sarcopenia group compared with those in the nonsarcopenia group (P < 0.05). A trend was observed toward between-group differences in back pain on the NRS (P < 0.1). In the logistic regression analysis, significant associations were seen between sarcopenia and % slip (odds ratio 1.15, 95% CI 1.01–1.30).

Conclusion.

Patients with LSS and sarcopenia have a higher degree of slippage and lower BMI, BMD, and physical function, and reported more severe low back pain, compared with those without sarcopenia.

Level of Evidence: 4
Success Factors for and Barriers to Integration of Electronic Mental Health Screening in Primary Care
Authors: Mei Carmen , Vaez Kelly
Published: March 2020

Currently, only a third of primary care providers screen for substance use, which is a growing epidemic. This quality improvement study aimed to improve the screening process by integrating the Drug Abuse Screening Test without information systems support into the electronic health record to increase completed screenings and provider interventions for positive screenings in adult patients at an urban primary care clinic. Electronic drug abuse screening should include a prescreen followed by the Drug Abuse Screening Test, interprofessional approach, comprehensive education, and utilization of generic tools to create new screening forms. Staff participated in a new drug abuse screening process, and chart audits and staff interviews were conducted. There was a 9% increase in completed screenings by medical assistants with electronic versus paper screening (30% vs 21%, respectively; P < .001). There was a 33.4% increase in provider intervention for positive screenings with electronic versus paper screening (55% vs 21%, respectively; P = .1081). Primary care providers can play an increased role in drug abuse treatment by using available technology to overcome barriers to screening independent of information systems support. By adopting the new electronic screening documentation process, this clinic was able to increase its screening outcomes.
How bacterial biofilms affect chronic wound healing: a narrative review
Authors: Gajula Bhargav , Munnamgi Sinduja , Basu Somprakas
Published: March 2020

Bacterial biofilm is a formidable influencing factor affecting healing of chronic wound. The mechanisms are as diverse as the bacterial species contained in the biofilm. In an altered environment the biofilm accommodates polymicrobial colonies in which micro-organisms undergo phenotypic and genetic changes to sustain adverse environmental influence. Biofilm bacteria inhibits cell proliferation, prevents cell migration and cause cell kill in a number of ways. It is believed that different bacterium has different mode of action through elaboration of various bioactive factors leading to persistence of low-grade inflammation in the wound bed which is predominantly bacteria-centric. Their ability to survive in low oxygen tension allows them to persist in relatively hypoxic conditions in the wound bed and in presence of increased bioburden. Although the biochemical mechanisms of biofilm influence on chronic wound healing are unfolding slowly, it is difficult to develop clinical studies due to ethical concerns. Therefore, most of the accumulated evidence are based on animal models and in vitro studies. This narrative review attempts to focus on the various mechanisms responsible for delayed healing in presence of bacterial biofilms.
Management of ventricular arrhythmias in patients with LVAD
Authors: Maradey Joan A. , Singleton Matthew J. , O’Neill Thomas J. , Bhave Prashant D.
Published: March 2020

Purpose of review

Left ventricular assist devices (LVADs) have extended the life expectancy of patients with heart failure. The hemodynamic support afforded by LVADs in this population has also resulted in patients having prolonged ventricular arrhythmias. The purpose of this article is to review the mechanisms of ventricular arrhythmias in LVADs and the available management strategies.

Recent findings

Recent evidence suggests that prolonged ventricular arrhythmias may result in increased mortality in patients with LVADs.

Successful management of ventricular arrhythmias in patients with LVAD requires interdisciplinary collaboration between electrophysiology and heart failure specialists. Medical management, including changes to LVAD changes, heart failure medication management, and antiarrhythmics constitute the initial treatment for ventricular arrhythmias. Surgical or endocardial ablation are reasonable options if VAs are refractory.
Blood pressure-related hypoalgesia: a systematic review and meta-analysis
Authors: Makovac Elena , Porciello Giuseppina , Palomba Daniela , Basile Barbara , Ottaviani Cristina
Published: March 2020

Objective:

Spontaneous or experimentally induced high blood pressure (BP) is associated with reduced pain perception, known as BP-related hypoalgesia. Despite its clinical implications, such as the interference with early detection of myocardial infarction in ‘at risk’ groups, the size of the association between high BP and pain has not yet been quantified. Moreover, the distinct association between high BP and physiological or psychological components of pain has not yet been considered so far. The aim of this study was to overcome this gap by performing separate meta-analyses on nociceptive response versus quantifiable perceptual measures of pain in relation to high BP.

Methods:

PubMed and Web of Knowledge databases were searched for English language studies conducted in humans. Fifty-nine studies were eligible for the analyses. Pooled effect sizes (Hedges’ g) were compared. Random effect models were used. Results show that higher BP is significantly associated with lower nociceptive response (g = 0.38; k = 6) and reduced pain perception, assessed by quantifiable measures (g = 0.48; k = 59).

Results:

The association between BP and pain perception, derived from highly heterogeneous studies, was characterized by significant publication bias. BP assessment, pain assessment, site of pain stimulation, percentage of female participants in the sample, and control for potential confounders were significant moderators.

Conclusion:

Current meta-analytic results confirm the presence of BP-related hypoalgesia and point towards the need for a better understanding of its underlying mechanisms.
Locking Y Lateral Canthopexy as a Treatment for Dry Eye Disease Caused by Eyelid Malposition
Authors: Ortega-Evangelio Leticia , Peris-Martínez Cristina , Marco-Campmany Amelia , Ortega-Serrano Joaquín , Tomás-Torrent Juan M.
Published: March 2020

Purpose:

The signs and symptoms of dry eye disease (DED) can affect the quality of life of patients. This study analyzes whether locking Y lateral canthopexy improves patients’ quality of life and in what way it does so (based on the ocular surface disease index questionnaire) and DED signs (measured by the fluorescein breakup time, tear osmolarity, Schirmer test, and corneal staining) in patients with DED caused by a eyelid malposition or impaired blink dynamics.

Methods:

This was a case-control study. Forty eyes of 20 patients with DED and lateral canthal disinsertion examined at the University Hospital La Ribera during a 1-year period from November 2016 to November 2017. The 40 eyes were divided into 2 groups: Group 1 eyes that underwent locking Y lateral canthopexy (i.e., a plication of the superficial lateral canthal tendon to the lateral orbital rim periosteum); and group 2 eyes that underwent observational treatment, without surgery. Symptoms and signs in OU were recorded separately at baseline and 1 month after surgery.

Results:

One month after surgery, the ocular surface disease index reduced in group 1 eyes when compared with those of group 2 (p = 0.001), fluorescein breakup time showed an improvement in the operated eyes (group 1) (p < 0.001) and corneal staining was reduced in group 1 after surgery (p = 0.012). The osmolarity results did not change when compared with eyes from group 2 (p < 0.001).

Conclusions:

Locking Y lateral canthopexy is an effective surgical technique for treating patients with evaporative dry eye caused by a lateral canthal tendón disinsertion by restoring proper eyelid closure and improving blinking dynamics. It improves DED signs and symptoms, thereby enhancing the quality of life of patients.
Comparison of visual performance and satisfaction with a bilateral emmetropic vs a bilateral mild myopic target using a spherical monofocal intraocular lens
Authors: Vinciguerra Paolo , Holladay Jack T. , Pagano Luca , Gramigna Marco , Borgia Alfredo , Lanni Vittoria , Legrottaglie Emanuela , Vinciguerra Riccardo
Published: March 2020

Purpose:

To compare the binocular visual outcomes and satisfaction of patients with emmetropia or mild myopia (−0.50 diopters [D]) implanted with a bilateral spherical monofocal IOL.

Setting:

Ophthalmology Department, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.

Design:

Prospective nonrandomized study.

Methods:

This study comprised 2 groups of 30 patients each. Group 1 included patients implanted with bilateral monofocal IOLs with near emmetropic target (plano to −0.25 D). Group 2 included patients with a postoperative bilateral target of −0.50 D. Both groups underwent uncorrected and corrected distance defocus curves postoperatively and subjective questionnaires were used to investigate patient satisfaction postoperatively.

Results:

The defocus curve showed a significant difference between Group 1 and Group 2 binocular vision (allPvalues <.01 except at −3.00 D wherePvalue = .32) with Group 1 seeing significantly better than Group 2 at +1.00, +0.50, and 0 but significantly worse in all other points of the defocus. In addition, patients of Group 2 at 0 D of defocus curve (infinite) had a visual acuity close to 0 logarithm of the minimum angle of resolution (logMAR) (0.03 ± 0.04). The main outcome of Group 2 defocus curves was that, at defocus point 0 D, even if the mean refraction was −0.67 0.15 × 160, mean uncorrected logMAR visual acuity was 0.0 ± 0.06.

Conclusions:

Bilateral monofocal IOLs implanted with mild myopic target provided better intermediate visual acuity compared with emmetropia at a minimal cost in terms of uncorrected distance visual acuity.
Placebo hypoalgesia: racial differences
Authors: Okusogu Chika , Wang Yang , Akintola Titilola , Haycock Nathaniel R. , Raghuraman Nandini , Greenspan Joel D. , Phillips Jane , Dorsey Susan G. , Campbell Claudia M. , Colloca Luana
Published: March 2020

No large-cohort studies that examine potential racial effects on placebo hypoalgesic effects exist. To fill this void, we studied placebo effects in healthy and chronic pain participants self-identified as either African American/black (AA/black) or white. We enrolled 372 study participants, 186 with a diagnosis of temporomandibular disorder (TMD) and 186 race-, sex-, and age-matched healthy participants to participate in a placebo experiment. Using a well-established paradigm of classical conditioning with verbal suggestions, each individual pain sensitivity was measured to calibrate the temperatures for high- and low-pain stimuli in the conditioning protocol. These 2 temperatures were then paired with a red and green screen, respectively, and participants were told that the analgesic intervention would activate during the green screens to reduce pain. Participants then rated the painfulness of each stimulus on a visual analog scale ranging from 0 to 100. Racial influences were tested on conditioning strength, reinforced expectations, and placebo hypoalgesia. We found that white participants reported greater conditioning effects, reinforced relief expectations, and placebo effects when compared with their AA/black counterparts. Racial effects on placebo were observed in TMD, although negligible, short-lasting, and mediated by conditioning strength. Secondary analyses on the effect of experimenter-participant race and sex concordance indicated that same experimenter-participant race induced greater placebo hypoalgesia in TMDs while different sex induced greater placebo hypoalgesia in healthy participants. This is the first and largest study to analyze racial effects on placebo hypoalgesia and has implications for both clinical research and treatment outcomes.
Liver metastases from pancreatic ductal adenocarcinoma: is there a place for surgery in the modern era?
Authors: Imai Katsunori , Margonis Georgios A. , Wang Jaeyun , Wolfgang Christopher L. , Baba Hideo , Weiss Matthew J.
Published: March 2020

Pancreatic ductal adenocarcinoma (PDAC) represents one of the most aggressive malignancies, and the majority of patients with PDAC present with metastatic disease, mainly in the liver, at the time of diagnosis. Surgical resection is the only treatment that can offer prolonged survival and possible cure. However, the indications for surgery for patients with PDAC metastases remain extremely limited to highly selected patients with localized disease, and metastatic disease is generally regarded as a contraindication to surgery. Recently, however, the advent of more effective chemotherapy has changed the treatment strategy for metastatic PDAC. In fact, cases in which resection of synchronous or metachronous PDAC liver metastases lead to prolonged survival in highly selected patients have been reported. In this review, we provide current data regarding survival outcomes after surgery, and discuss the role of surgical resection and selection criteria for patients with PDAC liver metastases in the modern era.
Fat Grafting Improves Fibrosis and Scarring in Vulvar Lichen Sclerosus: Results From a Prospective Cohort Study
Authors: Almadori Aurora , Hansen Esther , Boyle Deborah , Zenner Nicole , Swale Victoria , Reid Wendy , Maclane Allan , Butler Peter E.M.
Published: March 2020

Objective

The aim of the study was to evaluate the effect of lipotransfer in women presenting with fibrosis and scarring due to lichen sclerosus.

Materials and Methods

This prospective cohort study included 33 women attending the vulvar clinic of a public hospital. Patients received one lipotransfer treatment. Validated measures were used prospectively to assess the sexual function (Female Sexual Function Index, Female Sexual Distress Scale); symptoms (visual analog scale for itching, burning, soreness), pain (Pain Anxiety Symptoms Scale 20); psychological status and quality of life (Hospital Anxiety and Depression Scale, Relationship Assessment Scale, Wound Management Questionnaire Revised); physician-based disease signs (Vulvar Architecture Severity Scale). Data were analyzed using paired t test with nonparametric Wilcoxon matched-pairs signed rank test and unpaired t test with nonparametric Mann-Whitney test (Prism6 Software).

Results

The mean (SD) follow-up was 12.9 (3.5) months. Sexual function improved after treatment (p < .001), as well as the distress associated with sexuality (p < .0001). A significant improvement was reported in itching (p < .001), burning (p < .05), soreness (p < .001), and pain (p < .0001). Patients reported a significant improvement in romantic relationship (p < .05), anxiety (p < .0001), and depression (p < .0001). Improvement was not significant in the self-care associated with self-disgust assessment (p = .42). The clinical physician-based score showed an overall improvement in all the treated areas to lesser or greater extent.

Conclusions

The use of fat grafting in lichen sclerosus is promising. Further studies are required to rule out a potential placebo effect and to better understand the underlying molecular mechanism of action.
Features of the Vaginal and Vestibular Microbioma in Patients With Vestibulodynia: A Case-Control Study
Authors: Murina Filippo , Caimi Camilla , Di Pierro Francesco , Di Francesco Stefania , Cetin Irene
Published: March 2020

Objective

Our objective was to determine the role of vaginal and/or vestibular microbiota disturbance as an associated factor of symptom characteristic of provoked vestibulodynia (PVD).

Study Design

In an observational case-control study, the bacterial microbiomes in the vagina and vestibule from 20 women with PVD and 18 healthy controls were compared using a 16S rRNA gene-based molecular analysis. Clinical data were recorded through a 0- to 10-point visual analog scale related to dyspareunia and vulvovaginal pain/burning.

Results

Comparative assessment of the bacterial taxa (cutoff ≥15%) revealed 105 genera in the vaginal samples of PVD patients and 113 genera in the vestibular samples. Similarly, 120 genera were detected in the vaginal samples and 151 in the vestibular samples of the control group. Bacterial complexity was higher in the vestibular samples than in vaginal samples in both groups, without statistically significant differences. The following 3 dominant taxonomic units were found: Lactobacillus, Gardnerella, and Atopobium in PVD patients and Lactobacillus, Gardnerella, and Bifidobacterium in the control group. Lactobacillus gasseri was dominant only in women with PVD, showing a significant correlation with burning/pain intensity and dyspareunia severity (0.255 and 0.357, respectively, p < .001).

Conclusions

Our data suggest that bacterial communities in vaginal discharge are an important contributor to the vestibular microbiota. Lactobacillus gasseri may be an element of vulnerability toward the development of vaginal dysbiosis. We can postulate its association as a potential etiologic organism in some individuals, either by itself or in some combination with other trigger factors.
Adult Vulvar Lichen Sclerosus: Can Experts Agree on the Assessment of Disease Severity?
Authors: Sheinis Michal , Green Nicole , Vieira-Baptista Pedro , Carriero Carmine , Fischer Gayle , Leclair Catherine , Madnani Nina , Moyal-Barracco Micheline , Selk Amanda
Published: March 2020

Objective

The objective of this study was to test the severity rating of the signs and architectural changes for interrater reliability among world experts via analysis of lichen sclerosus (LS) photographs.

Methods

A recent Delphi consensus exercise established a list of symptoms, signs, and architectural changes, which experts feel are important to include in a severity scale. Photographs of vulvar LS were manually extracted from patient charts and 50 photographs with a range of severity of signs and architectural changes were chosen. Lichen sclerosus experts were invited to take part in the study and 3 dermatologists and 3 gynecologists were selected for their expertise and geographic variety. Raters assessed the photographs for multiple signs and architectural changes as well as an overall impression of disease severity on a 4-point Likert scale. Intraclass correlation coefficients were calculated.

Results

The intraclass correlation coefficients were very poor for individual signs and architectural changes as well as for overall disease severity when analyzed for all 6 raters as well as when analyzed with dermatologists' and gynecologists' responses grouped separately. There were no statistically significant correlations found.

Conclusions

Global experts were unable to agree on any signs, architectural changes, or an overall global impression to assess vulvar LS disease severity based on analysis of vulvar photographs. Standardized descriptions regarding what constitutes mild, moderate, and severe signs and anatomical changes are required before further scale development can occur.
Retrospective 15-Year Review of Anal Cytology Screening in Women at Mayo Clinic Rochester, Minnesota
Authors: Marnach Mary L. , Larish Alyssa M. , Kim Sharon J. , Mara Kristin C. , Henry Michael R. , Chantigian Paula D. M.
Published: March 2020

Objectives

Anal cytology is a modality for anal cancer screening in high-risk women. In this retrospective study, we review risk factors associated with abnormal anal cytology and unsatisfactory anal cytology rates, and correlate findings of cytology with histological results.

Methods

A retrospective cohort study of anal cytology screening in women at Mayo Clinic in Rochester, Minnesota from 2002 to 2018 was conducted.

Results

Three hundred fifty-seven women had a total of 592 anal cytologies performed. Three hundred seventeen women had screening anal cytology, whereas 40 women had anal cytology for surveillance given a history of anal intraepithelial neoplasia (AIN) or anal cancer. An unsatisfactory anal cytology result was found in 14.7%. Risk factors, type of follow-up, and correlation with histologic specimens were also reviewed. Histologic finding of AIN 2/3 correlated with abnormal anal cytology 84% of the time in this cohort.

Conclusions

High-risk women should be screened on a periodic basis for anal cancer. Anal cytology is one possible modality that can be used. Further insight into AIN progression, regression, recurrence, and outcome after treatment will help direct future screening recommendations.
Risk Factors for Mortality in Refractory Pediatric Septic Shock Supported with Extracorporeal Life Support
Authors: Workman Jennifer K. , Bailly David K. , Reeder Ron W. , Dalton Heidi J. , Berg Robert A. , Shanley Thomas P. , Newth Christopher J. L. , Pollack Murray M. , Wessel David , Carcillo Joseph , Harrison Rick , Dean J. Michael , Meert Kathleen L. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)
Published: March 2020

Risk factors for mortality in children with refractory pediatric septic shock who are supported with extracorporeal life support (ECLS) are largely unknown. Therefore, we performed univariable and multivariable analyses to determine risk factors for mortality among children (<19 years) who underwent an ECLS run between January 2012 and September 2014 at eight tertiary pediatric hospitals, and who had septic shock based on 2005 International Consensus Criteria. Of the 514 children treated with ECLS during the study period, 70 were identified with septic shock. The mortality rate was similar between those with (54.3%) and without septic shock (43.7%). Among those with septic shock, significant risk factors for mortality included cardiac failure or extracorporeal cardiopulmonary resuscitation (ECPR) as indication for ECLS cannulation compared with respiratory failure (P = 0.003), having a new neurologic event following cannulation (P = 0.032), acquiring a new infection following cannulation (P = 0.005), inability to normalize pH in the 48 hours following ECLS cannulation (P = 0.010), and requiring higher daily volume of platelet transfusions (P = 0.005). These findings can be used to help guide clinical decision making for children with septic shock that is refractory to medical management.
Testosterone therapy and other treatment modalities for female sexual dysfunction
Authors: Ingram Catherine F. , Payne Kelly S. , Messore Marisa , Scovell Jason M.
Published: March 2020

Purpose of review

Recently in October 2019 a Global Consensus Position on the use of Testosterone Therapy for Women was published. The use of testosterone and other agents for female sexual dysfunction (FSD) is an important topic for the urologist focusing on sexual health. This review describes the known causes for FSD, and discusses the role of androgens in this disorder, the evidence for using testosterone treatment, and other current and emerging therapies.

Recent findings

A recent meta-analysis, published in The Lancet Diabetes & Endocrinology evaluated a total of 36 randomized control trials spanning 1990–2018 and includes a total of 8480 patients. The primary findings were that testosterone therapy (TTh) increased sexual function including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness, and self-image when compared with either a placebo or drug-control (e.g., estrogen ± progestogen). In addition, TTh reduced sexual concerns and distress in postmenopausal women. Side effects included an increase in weight, acne, and hair growth, but there was no increase in serious adverse events. Importantly, TTh duration was greater than 12 weeks in all randomized control trials included in this meta-analysis.

TTh is effective to treat FSD in postmenopausal women. More data is required to evaluate the long-term safety data on the effects of TTh on cardiovascular health, breast health, cognitive function, and the musculoskeletal system in women.
Metastasectomy in patients with renal cell carcinoma: when and how?
Authors: Omid Sara , Abufaraj Mohammad , Remzi Mesut
Published: March 2020

Purpose of review

The role of metastasectomy in the management of metastatic renal cell carcinoma (mRCC) remains controversial. The aim of this review is to summarize and evaluate the recent findings about the surgical treatment of patients with mRCC focusing on the literature published in the last 2 years.

Recent findings

Despite the lack of randomized controlled trials, the benefit of metastasectomy in term of cancer-specific and overall survival have been demonstrated in large observational studies. Results of ongoing clinical trials evaluating the impact of combination of surgical and systemic therapies are eagerly awaited and may shed the light on a new treatment armamentarium in this subset of patients.

Several novel systemic agents have emerged and is continuously changing the treatment paradigm in patients with advanced RCC. However, surgical resection of the primary tumor and metastatic deposits represents a definitive cure option in well selected patients.
Comparison of Recommendations for Treatment of Chronic Hepatitis C Virus Infection in Children and Adolescents
Authors: Indolfi Giuseppe , Fischler Björn , Gonzalez‐Peralta Regino P. , Ciocca Mirta , Porta Gilda , Neelam Mohan , El‐Guindi Mohamed , Kelly Deirdre , Ni Yen‐Hsuan , Sibal Anupan , Leung Daniel H. , Chang Mei Hwei ,   Hepatitis Expert Team of the Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN)
Published: March 2020

Objective:

This position paper written by the Hepatitis Expert Team of the Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition aimed to systematically evaluate clinical practice guidelines (CPGs), medical consensus, and position papers on the use of direct‐acting antivirals (DAA) to treat chronic hepatitis C virus (HCV) infection in adolescents and children in order to compare recommendations and provide the basis for developing a unified position statement.

Methods:

MEDLINE, Cochrane‐Library, National Guideline Clearinghouse and select websites of relevant societies/organizations were used to identify CPGs, medical consensus and position papers between 2011‐2019.

Results:

A total of 5 documents were analysed: 3 CPGs, 1 medical consensus, and 1 position paper. All publications were consistent in recommending DAA treatment for adolescents (12–17 years old) with chronic HCV infection. Similarly, all of these publications consistently recommended deferring therapy for children between 3 and 11 years of age until DAA became available as standard of care. Finally, none of the included publications recommended treating children younger than 3 years old. By contrast, there was significant discrepancy across the retrieved documents regarding specific DAA regimens and treatment strategies.

Conclusions:

There is strong consensus on treating all adolescents with chronic HCV infection with DAA and on delaying therapy in younger children until these agents are approved for them. Interferon‐based therapies should be avoided. Specific recommendations regarding which DAA regimen to use and treatment duration varied significantly. Key stakeholders need to convene to standardize therapeutic strategies at a global level if we are to eradicate HCV in children.
Longitudinal Description of Gonadal Function in Sickle-cell Patients Treated With Hematopoietic Stem Cell Transplant Using Alkylator-based Conditioning Regimens
Authors: Elchuri Swati V. , Williamson Lewis Rebecca , Quarmyne Maa-Ohui , Haight Ann E. , Cottrell Hanh N. , Meacham Lillian R.
Published: March 2020

Objectives:

This study describes the hormone profiles for gonadal late effects after alkylator-based hematopoietic stem cell transplant (HSCT) regimens used for sickle-cell disease (SCD).

Methods:

This is a retrospective chart review of subjects followed in the post-HSCT clinic for sickle-cell disease. Patient demographics, pubertal development, characteristics of pre-HSCT disease severity, treatment before HSCT, conditioning regimens, presence of graft versus host disease and follicle-stimulating hormone, anti-Müllerian hormone (AMH), luteinizing hormone and testosterone were abstracted from the medical record.

Results:

Forty subjects (24 female individuals) with SCD were 9 (±4.3) years old at HSCT and 7.9 years (±5.6) from HSCT. At the time of transplant, 8% of female individuals and no male individuals were pubertal and 58% of female individuals and 38% of male individuals had been treated with hydroxyurea. Post-HSCT, all of the female individuals had diminished ovarian reserve on the basis of low AMH values and 10 of the pubertal female individuals (71%) had premature ovarian insufficiency defined as follicle-stimulating hormone >40 mIU/mL ×2. There was no ovarian recovery and AMH remained very low or undetectable up to 13 years post-HSCT. In male individuals, luteinizing hormone and testosterone levels were normal for age.

Conclusions:

Post-HSCT for SCD, all female individuals had diminished ovarian reserve and most female individuals had POI, whereas male individuals had normal testosterone hormone production.
Establishment of Reference Ranges for Normal Organ Weights in Malaysian Adults at Autopsy
Authors: Jothee Shatishraj , Shafie Mohamed Swarhib , Vijayaretnam Suthaa Veni , Nor Faridah Mohd
Published: March 2020

Organ weights are routinely measured during autopsies as a crude screening tool to detect possible organ pathology. In several centers, inclusion of major organ weights indicates whether an autopsy report has achieved its standard of practice, which in turn should be subjected to an audit. Previous studies show statistical variation in organ weights across different populations. Malaysian pathologists have relied on Western data and crude subjective determination in the interpretation of normal organ weights. Hence, the need for a reference range as a guide for pathologists is acute. Organ weights from traumatic deaths between 2004 and 2017 were analyzed in the UKM Medical Centre. Statistical analysis was performed to form reference ranges for normal weights of the brain, heart, lung, liver, spleen, and kidneys. In addition, the data were compared between sexes, races, and body mass index values to determine whether organ weights were affected by these parameters. In this study, reference ranges for organ weights are presented for Malaysian adult men and women.
Committing Suicide With Handgun Wounds in the Head Using a Defective Firearm
Authors: Durfort Céline , Cappy Julien , Lorin de la Grandmaison Geoffroy
Published: March 2020

We report 2 unusual autopsy cases with head handgun wounds using defective firearms in a suicidal context. In the first case, a 78-year-old man was found hanged from a tree, with a Lefaucheux revolver lying on the tree. In the right temporal region, there was an entrance wound with a bullet still in place, responsible for a mild cerebral contusion, without bone defect. The main cause of death was hanging. In the second case, a 60-year-old man died at home after shooting himself in the head several times with a 22-long rifle revolver. The autopsy showed 13 entrance wounds on the scalp. Most of the bullets remained along the skull vault. In each of 2 cases, the manner of death, the feasibility of suicidal gesture, and the consequences of a brain injury on the time to the occurrence of incapacity were questioned. These unusual autopsy cases underline how important it is to take into account the defective nature of firearms.
An Algorithmic Immunohistochemical Approach to Define Tumor Type and Assign Site of Origin
Authors: Bellizzi Andrew M.
Published: March 2020

Immunohistochemistry represents an indispensable complement to an epidemiology and morphology-driven approach to tumor diagnosis and site of origin assignment. This review reflects the state of my current practice, based on 15-years’ experience in Pathology and a deep-dive into the literature, always striving to be better equipped to answer the age old questions, “What is it, and where is it from?” The tables and figures in this manuscript are the ones I “pull up on the computer” when I am teaching at the microscope and turn to myself when I am (frequently) stuck. This field is so exciting because I firmly believe that, through the application of next-generation immunohistochemistry, we can provide better answers than ever before. Specific topics covered in this review include (1) broad tumor classification and associated screening markers; (2) the role of cancer epidemiology in determining pretest probability; (3) broad-spectrum epithelial markers; (4) noncanonical expression of broad tumor class screening markers; (5) a morphologic pattern-based approach to poorly to undifferentiated malignant neoplasms; (6) a morphologic and immunohistochemical approach to define 4 main carcinoma types; (7) CK7/CK20 coordinate expression; (8) added value of semiquantitative immunohistochemical stain assessment; algorithmic immunohistochemical approaches to (9) “garden variety” adenocarcinomas presenting in the liver, (10) large polygonal cell adenocarcinomas, (11) the distinction of primary surface ovarian epithelial tumors with mucinous features from metastasis, (12) tumors presenting at alternative anatomic sites, (13) squamous cell carcinoma versus urothelial carcinoma, and neuroendocrine neoplasms, including (14) the distinction of pheochromocytoma/paraganglioma from well-differentiated neuroendocrine tumor, site of origin assignment in (15) well-differentiated neuroendocrine tumor and (16) poorly differentiated neuroendocrine carcinoma, and (17) the distinction of well-differentiated neuroendocrine tumor G3 from poorly differentiated neuroendocrine carcinoma; it concludes with (18) a discussion of diagnostic considerations in the broad-spectrum keratin/CD45/S-100-“triple-negative” neoplasm.
Report From the International Society of Urological Pathology (ISUP) Consultation Conference on Molecular Pathology of Urogenital Cancers
Authors: Looijenga Leendert H.J. , Van der Kwast Theodorus H. , Grignon David , Egevad Lars , Kristiansen Glen , Kao Chia-Sui , Idrees Muhammad T.
Published: March 2020

The International Society of Urological Pathology (ISUP) organized a Consultation Conference in March 2019 dealing with applications of molecular pathology in Urogenital Pathology, including testicular tumors (with a focus on germ cell tumors [GCTs]), preceded by a survey among its members to get insight into current practices in testicular germ cell tumor (TGCT) diagnostics and adoption of the ISUP immunohistochemical guidelines published in 2014. On the basis of the premeeting survey, the most commonly used immunomarker panel includes OCT3/4, placental alkaline phosphate, D2-40, SALL4, CD117, and CD30 for GCTs and the documentation of germ cell neoplasia in situ (GCNIS). Molecular testing, specifically 12p copy gain, is informative to distinguish non-GCNIS versus GCNIS related GCTs, and establishing germ cell origin of tumors both in the context of primary and metastatic lesions. Other molecular methodologies currently available but not widely utilized for TGCTs include genome-wide and targeted approaches for specific genetic anomalies, P53 mutations, genomic MDM2 amplification, and detection of the p53 inactivating miR-371a-3p. The latter also holds promise as a serum marker for malignant TGCTs. This manuscript provides an update on the classification of TGCTs, and describes the current and future role of molecular-genetic testing. The following recommendations are made: (1) Presence of GCNIS should be documented in all cases along with extent of spermatogenesis; (2) Immunohistochemical staining is optional in the following scenarios: identification of GCNIS, distinguishing embryonal carcinoma from seminoma, confirming presence of yolk sac tumor and/or choriocarcinoma, and differentiating spermatocytic tumor from potential mimics; (3) Detection of gain of the short arm of chromosome 12 is diagnostic to differentiate between non-GCNIS versus GCNIS related GCTs and supportive to the germ cell origin of both primary and metastatic tumors.
Oligometastatic Disease and Interventional Oncology
Authors: Murali Nikitha , Ludwig Johannes M. , Nezami Nariman , Kim Hyun S.
Published: March 2020

Oligometastatic disease (OMD) is generally defined as a stage of clinically or radiographically demonstrated metastatic disease limited in total disease burden and without rapid spread. Interventional oncology performs local therapies for primary and metastatic cancers, including OMD. Interventional oncology treatments can be pursued both as definitive therapy and for palliative purposes. Applied to OMD, these interventions can offer patients a decreasing overall tumor burden, minimizing cancer morbidity, and early evidence suggests a survival benefit. Here, we discuss the range of interventional oncology treatments, including ablation, chemoembolization, radioembolization, and irreversible electroporation. We describe the rationale for their application to OMD and discuss future directions for research.
Brief Report: Effects of Low-Volume High-Intensity Interval Training in Hispanic HIV+ Women: A Nonrandomized Study
Authors: Ramírez-Marrero Farah A. , Pérez-Frontera Sigrid , Amalbert-Birriel Marcos A. , Matos Miriam , Santana-Bagur Jorge , Frontera Walter R. , Wojna Valerie
Published: March 2020

Background:

Low cardiorespiratory fitness (CRF) is usually observed in people living with HIV. The effect of a low-volume high-intensity interval training (LV-HIIT) on CRF in HIV+ and HIV− Hispanic women was evaluated in this study.

Setting:

A nonrandomized clinical trial with pre-test and post-test using a LV-HIIT intervention was conducted in the AIDS Clinical Trials Unit and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico Medical Sciences Campus.

Methods:

Twenty-nine HIV+ and 13 HIV− Hispanic women recruited from community-based programs and clinics, and able to engage in daily physical activities, volunteered to participate. Of these, 20 HIV+ (69%) and 11 HIV− (85%) completed the study and were included in the analyses. LV-HIIT consisted of 6-week, 3 d/wk, 8–10 high-intensity and low-intensity intervals on a cycle ergometer at 80%–90% of heart rate reserve. Main outcome measures were CRF (defined as VO2peak), peak workload, and time to peak exercise.

Results:

Average peak workload and time to peak exercise increased after training (P < 0.05) in both groups. However, average CRF was significantly higher after training only in the HIV− group. Gains in CRF were observed in 100% of HIV− and 50% of HIV+ women. This was not influenced by exercise testing, habitual physical activity, or anthropometric variables.

Conclusions:

Given the lack of change in CRF observed in the HIV+ group after LV-HIIT intervention, it is important to focus on variations that may occur within groups.
Artificial Intelligence in Diagnostic Imaging
Authors: Sharma Puneet , Suehling Michael , Flohr Thomas , Comaniciu Dorin
Published: March 2020

In this review article, the current and future impact of artificial intelligence (AI) technologies on diagnostic imaging is discussed, with a focus on cardio-thoracic applications. The processing of imaging data is described at 4 levels of increasing complexity and wider implications. At the examination level, AI aims at improving, simplifying, and standardizing image acquisition and processing. Systems for AI-driven automatic patient iso-centering before a computed tomography (CT) scan, patient-specific adaptation of image acquisition parameters, and creation of optimized and standardized visualizations, for example, automatic rib-unfolding, are discussed. At the reading and reporting levels, AI focuses on automatic detection and characterization of features and on automatic measurements in the images. A recently introduced AI system for chest CT imaging is presented that reports specific findings such as nodules, low-attenuation parenchyma, and coronary calcifications, including automatic measurements of, for example, aortic diameters. At the prediction and prescription levels, AI focuses on risk prediction and stratification, as opposed to merely detecting, measuring, and quantifying images. An AI-based approach for individualizing radiation dose in lung stereotactic body radiotherapy is discussed. The digital twin is presented as a concept of individualized computational modeling of human physiology, with AI-based CT-fractional flow reserve modeling as a first example. Finally, at the cohort and population analysis levels, the focus of AI shifts from clinical decision-making to operational decisions.
Do Postoperative Prophylactic Antibiotics Reduce Highly Virulent Infections?
Authors: Monroig Kaitlin , Ghosh Kanad , Marquez Jocellie E. , Medrano Christopher , Marmor William A. , McAuliffe Phoebe , Ferrier Austin , Kapadia Kailash , Rogoff Hunter , Huston Tara , Ganz Jason , Khan Sami , Dagum Alexander , Bui Duc
Published: March 2020

Background

Many surgeons are reluctant to discontinue prophylactic antibiotics after 24 hours in tissue expander breast reconstruction (TEBR) because of fear of increased risk of surgical site infection (SSI). Currently, there is no consensus regarding antibiotic prophylaxis duration in TEBR. In addition, there remains a lack of research investigating microorganisms involved in SSI across various perioperative antibiotic protocols. The purpose of this study was to examine how 2 different prophylactic antibiotic regimens impacted the bacterial profiles of SSI and rate of implant loss after TEBR.

Methods

A single-institution retrospective review of immediate TEBRs between 2001 and 2018 was performed. Surgical site infections requiring hospitalization before stage 2 were included. Highly virulent organisms were defined as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species). Implant loss was defined as removal of tissue expander without immediate replacement.

Results

Of 660 TEBRs, 85 (12.9%) developed an SSI requiring hospitalization before stage 2. Fifty-six (65.9%) received less than 24 hours of perioperative intravenous antibiotics and oral antibiotics after discharge (group 1), and 29 (34.1%) received less than 24 hours of intravenous antibiotics only (group 2). There was no significant difference in demographics, preoperative chemotherapy/radiation, acellular dermal matrix usage, or treatment of SSI between groups. In group 1, 64% (n = 36) developed culture positive SSIs, compared with 83% (n = 24) in group 2 (P = 0.076). Staphylococcus aureus was the most common bacteria in both groups. Group 2 demonstrated a significantly increased incidence of gram-positive organisms (46.4% vs 72.4%, P = 0.022) and S. aureus (21.4% vs 55.2%, P = 0.002). However, there was no significant difference in overall highly virulent (P = 0.168), gram-negative (P = 0.416), or total isolated organisms (P = 0.192). Implant loss between groups 1 and 2 (62.5% vs 62.1%, P = 0.969) respectively, was nearly identical.

Conclusions

Our study demonstrates that, despite differences in bacterial profiles between 2 antibiotic protocols, prolonged postoperative antibiotic use did not protect against overall highly virulent infections or implant loss. Antibiotic stewardship guidelines against the overuse of prolonged prophylactic regimens should be considered. Further analysis regarding timing of SSIs and antibiotic treatment is warranted.
Free Anterolateral Thigh Versus Vastus Lateralis Muscle Flaps for Coverage of Lower Extremity Defects in Chronic Wounds
Authors: Black Cara K. , Zolper Elizabeth G. , Ormiston Laurel D. , Schwitzer Jonathan A. , Luvisa Kyle , Attinger Christopher E. , Fan Kenneth L. , Evans Karen K.
Published: March 2020

Introduction

The thigh has been called the reconstructive warehouse. The anterolateral thigh (ALT) and vastus lateralis (VL) flaps are popular options for free tissue transfer in lower extremity reconstruction. We sought to review the largest experience of these flaps in the chronic wound population.

Methods

We retrospectively reviewed patients who underwent lower extremity reconstruction using ALT or VL flaps by a single surgeon between 2012 and 2018.

Results

Fifty ALT and 34 VL flaps were identified. Comorbidities were similar between groups with the exception of body mass index (ALT, 26.8; VL, 30.1;P= 0.0121). There was also a significant difference rate of independent ambulation preoperatively (ALT, 98.0%; VL, 85.3%;P= 0.0375). An adjunct was needed for recipient site coverage in 31.5% (19/50) of ALT patients and 100% (34/34) of VL patients. Of the patients who received skin grafts, delayed placement was more frequent in the ALT (53.3%) versus VL cohort (18.2%) (P= 0.0192). Median graft take and the rate of skin graft revision were not statistically different. Flap success rates were similar: ALT, 92.0%; and VL, 94.1%. Overall complication rates were not significantly different: ALT, 26.0%; and VL, 38.2%. Infectious complications were also comparable. Subsequent debulking procedures were performed on 8.0% of ALT flaps and 11.8% VL flaps (P= 0.7092). Limb salvage rates were similar between both cohorts (ALT, 82.0%; VL, 88.2%). Ambulation rate was significantly higher for the ALT cohort at 92.0% compared with 73.5% for the VL cohort (P= 0.0216). Median follow-up was similar for both groups.

Conclusions

We present the largest comparison study of ALT and VL flaps in lower extremity salvage. Complication rates, flap success, and limb salvage were similar between the 2 cohorts. Despite a high prevalence of osteomyelitis in both cohorts, there was no difference in infectious complications. Although the need for skin grafting remains an inherent disadvantage of the VL flap, a significant proportion of ALT recipients also needed an adjunct for recipient site coverage. Ambulation rate was significantly greater in the ALT group. However, flap type was no longer significant for ambulation when controlling for preoperative ambulatory status.