bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed posttraumatic vertebral body collapse “Kummell disease”
Authors: Adamska Olga , Modzelewski Krzysztof , Stolarczyk Artur , Kseniuk Jurij
Published: April 2021

Introduction:

Kummell disease(KD) is a relatively rare condition, which refers to a lack of blood supply to the bone leading to collapse. It typically presents in the thoracic vertebrae of elderly patients, as a compressive deformation of the vertebral body and its osteonecrosis. It appears as a result of minor trauma experienced weeks to months before the onset of the disease. Osteoporosis tends to be the biggest risk factor for KD, hence its high frequency in the affected patient population.

Patients concerns:

A 67-year-old female patient presented to the hospital with a back pain deteriorating since 1 year, limiting her daily activities. Over the time it progressed to involve extremities and caused hypersensitivity of the skin at the level of the affected thoracic region. She had a history of osteoporotic vertebral compression fracture 2 years earlier after a fall. It was treated by conservative methods.

Diagnosis:

Computed tomography procedure revealed a compression fracture at the level of Th11. Further investigation and collection of the past medical history showed a delayed nonunion of the vertebral fracture and intravertebral vacuum cleft. The final diagnosis was KD. Conservative treatment of the patient's condition in another hospital resulted in non-healing.

Interventions:

As there is no specific treatment for patients suffering from delayed posttraumatic vertebral body collapse, an attempt of the most promising surgical combination of methods was performed. SpineJack system procedure resulted in satisfactory vertebral height improvement. This included vertebroplasty and minimally invasive percutaneous transpedicular fixation using bone-cement screw augmentation, providing stabilization and kyphotic angle correction. All these procedures facilitated pain relief and alleviation of spinal symptoms.

Outcomes:

The radiological outcomes of the patient's condition showed improvement after the surgery. Patient reported subjective improvement in daily life functioning. Follow up period at 6 and 9 months postoperatively showed stable condition and a satisfactory feedback from the patient.

Conclusion:

The conservative treatment in this patient, provoked an occurrence of markedly diminished vertebral height, debilitating back pain and neurological symptoms. These features caused a significantly lower quality of life. An accurate diagnosis of KD requires a detailed medical history and awareness of this rare condition and its irreversible complications. The treatment chosen for specific cases should primarily involve a meticulous observation of the efficacy of conservative methods. Furthermore, after the appearance of any deterioration of vertebral fracture, surgical method should be planned in order to avoid undesirable effects.
An autopsy case of Nocardia meningitis patient presenting with multiple folliculitis
Authors: Yamamoto Shintaro , Mukai Tomoyuki , Fujita Shunichi , Nishimura Hirotake , Yaguchi Takashi , Morita Yoshitaka
Published: April 2021

Rationale:

Nocardia is widespread in the soil and causes life-threatening infections in the central nervous system, such as meningitis. Nocardia infection can develop in immunocompetent individuals, not just in immunocompromised persons. Nocardia is a slow-growing bacterium, which makes its detection difficult during routine microbial examinations, resulting in a delayed diagnosis and poor prognosis.

Patient concerns:

A 64-year-old Japanese man was admitted with fever, headache with meningeal irritation, and multiple folliculitis on his face and neck. Cerebrospinal fluid revealed neutrophilic pleocytosis. All cultures, including cerebrospinal fluid examination, were negative, and serum procalcitonin levels were normal.

Diagnoses:

The tentative diagnosis was culture-negative bacterial meningitis or meningeal neuro-Behçet disease.

Intervention:

Meropenem was administered for 12 days, along with corticosteroids. His symptoms were temporarily relieved but worsened again, and finally, he died suddenly on the 37th day of hospitalization. An autopsy revealed extensive infiltration of inflammatory cells in the subarachnoid space, especially the brain stem, cerebellum, whole spinal cord, and cerebral base, where Nocardia species were detected. The final diagnosis was Nocardia meningitis.

Lessons:

Given the very close timing of the onset of signs of meningitis and multiple folliculitis, the most reasonable and probable idea is that the patient had disseminated nocardiosis. In patients with meningitis with multiple skin infection lesions, such as folliculitis, nocardiosis should be considered a differential diagnosis.
Stroke Risk Scores as Predictors of Severe Outcomes in Atrial Fibrillation: A Comprehensive Review
Authors: Ivănescu Andreea Cristina , Buzea Cătălin Adrian , Delcea Caterina , Dan Gheorghe-Andrei
Published: April 2021

Background:

Atrial fibrillation (AF) is the most frequent sustained arrhythmia. It increases the risk of stroke, heart failure, death, hospitalizations, and costs.

Area of uncertainty:

Several scores were introduced to stratify the stroke risk and need for anticoagulation in patients (pts) with AF . CHA2DS2-VASc, the most frequently used score, as well as other stroke risk scores have been additionally applied to estimate outcomes for different other conditions, with inhomogeneous results. To date, there has been no consensus regarding the usefulness of these scores to estimate outcomes outside of thromboembolic risk assessment, and their value in estimating different end-point outcomes is still a subject of debate. We conducted this review to investigate whether the stroke risk scores' utility can be extended for the prediction of other severe outcomes in pts with AF.

Data sources:

We searched PubMed database and included studies that stratified the outcome of pts with AF by different stroke risk scores. We also included studies with a separate analysis of the pts with AF subpopulation.

Results:

Mortality rates increased with higher CHADS2 [from 2.28% (2.00%–2.58%) to 13.2% (8.24%–20.8%) per year] and CHA2DS2-VASc scores [risk ratio 1.26 (1.21–1.32), P < 0.0001 for score ≥3]. CHADS2 and CHA2DS2-VASc predicted poor outcome in stroke [odds ratio (OR) ranging 1.42–6 for CHADS2 and 1.3–7.3 for CHA2DS2-VASc]. Acute myocardial infarction rates increased with higher CHADS2 [OR 2.120 (1.942–2.315) P < 0.001] and CHA2DS2-VASc [OR 1.63 (1.53–1.75), P < 0.001]. Limited data were reported for ABC( Age, Biomarkers, Clinical histoty) and R2CHADS2. No statistically significant correlation was found for major bleeding.

Conclusions:

CHADS2 and CHA2DS2-VASc are useful tools in identifying pts with AF at higher risk for all-cause death, regardless of other pathologies. Both scores correlated with the development of acute myocardial infarction, cardiovascular hospitalization, outcome in stroke, major adverse cardiovascular events, and major adverse cardiovascular and cerebral events, but not with serious bleeding.
The impact of inflammatory bowel disease on women's lives
Authors: Truta Brindusa
Published: April 2021

Purpose of review

Inflammatory bowel disease (IBD) affects women differently than men. This review outlines the current thinking on the impact of IBD, Crohn's disease and ulcerative colitis, on women's health.

Recent findings

IBD symptoms worsen during the menstrual cycle without corelating to disease activity. Endometriosis is more frequent in women with than those without IBD. Low fertility rate is rather because of voluntary childlessness than severe disease, perianal involvement, and ileal pouch anal anastomosis (IPAA) surgery. For women with ulcerative colitis, in-vitro fertilization successfully overcomes the post-IPAA infertility. The use of biologics and thiopurines throughout pregnancy is well tolerated for both the mother and the child but the use of small molecule therapy still needs more data. These medications increase the risk of cervical cancer, anal cancer, and aggressive vulvar cancer. More screening efforts are required to keep patients healthy. Women with Crohn's disease report worse psychological well being less resilience than men but they develop more escape and avoidance strategies to cope with the disease. Depression impairs the quality of sexual life but sexual dysfunction is rarely discussed with the provider.

Understanding the effects of sex on IBD allows personalized care and improves women's quality of life.
Long-term outcomes of treatments for achalasia
Authors: Nullens Sara , Fockens Paul , Bredenoord Albert J.
Published: April 2021

Purpose of review

Idiopathic achalasia is a primary motility disorder of the esophagus that results in dysphagia, weight loss, and impaired quality of life. Several treatment options are available to gastroenterologists, and insights on the long-term outcome of these modalities are discussed.

Recent findings

Peroral endoscopic myotomy (POEM) represents a novel endoscopic technique in the treatment of achalasia. Studies on long-term outcomes and comparison to other well-known treatment modalities such as laparoscopic Heller myotomy (LHM) and pneumodilation have recently been published. POEM and LHM both have excellent 2-year success rates for relieving achalasia symptoms, but reflux disease and erosive esophagitis are more prevalent following POEM.

Several treatment modalities with excellent long-term outcomes are available for the treatment of achalasia. The different options should be discussed with patients and treatments should be tailored to their individual needs.
The current state of artificial intelligence in cardiac transplantation
Authors: Goswami Rohan
Published: April 2021

Purpose of review

The field of heart transplantation is a complex practice that combines both science and art to optimize the quality and quantity of an organ transplant recipient's life span. In the current age of Transplant Medicine there are many limiting factors that prevent potentially usable organs to be transplanted in addition to the many unknown factors in assessing the risk of posttransplant complications in a proactive manner. This review focuses on the current state, and potential use, and implementation of artificial intelligence technologies in the field of heart transplantation. Furthermore, the utilization of predictive algorithms to assess donor quality, graft function, posttransplant complications and prediction of high-risk complications will be discussed. Artificial intelligence technologies in the pretransplant population is also explored.

Recent findings

Artificial intelligence process use has been increasing over the past decade. Early adoption in radiology and laboratory medicine have shown promise for future applications. Implementation of nascent technologies within the field of transplant medicine remains in its infancy. Cardiac and renal medicine have been recent focuses of large-scale artificial intelligence projects because of the wealth of data, the main limiting factor for producing accurate models. Understanding the true role of artificial intelligence in medicine is key – and has been divided into three areas of focus: data quality, interpretation, and clinical application. These areas allow the clinician to translate problems facing patients into algorithms utilized by data scientists to create solutions, which may provide in-depth analysis and detection of relationships not immediately clear. Although some published data has led to commercial products for cardiac, diabetic, and dermatologic applications -- widespread adoption remains limited to specialized centers.

Artificial intelligence applications with clinically relevant models in transplant medicine have the potential to optimize organ utilization, prediction of complications, and potential pretransplant management, which may mitigate the need for transplant. Further translational projects are under development at major centers, with proof of concepts demonstrating validity and safety in the clinical setting. Limiting factors of infrastructure, expertise, and data availability continue to be addressed. Ongoing efforts for commercialization and large-scale trials will provide a foundation for the development of artificial intelligence applications in transplant medicine.
Lung transplantation: candidate selection and timing of transplant
Authors: Shah Purav , Neujahr David C.
Published: April 2021

Purpose of review

Over the past two decades, lung transplant has become the mainstay of treatment for several end-stage lung diseases. As the field continues to evolve, the criteria for referral and listing have also changed. The last update to these guidelines was in 2014 and several studies since then have changed how patients are transplanted. Our article aims to briefly discuss these updates in lung transplantation.

Recent findings

This article discusses the importance of early referral of patients for lung transplantation and the concept of the ‘transplant window’. We review the referral and listing criteria for some common pulmonary diseases and also cite the updated literature surrounding the absolute and relative contraindications keeping in mind that they are a constantly moving target. Frailty and psychosocial barriers are difficult to assess with the current assessment tools but continue to impact posttransplant outcomes. Finally, we discuss the limited data on transplantation in acute respiratory distress syndrome (ARDS) due to COVID19 as well as extracorporeal membrane oxygenation bridge to transplantation.

The findings discussed in this article will strongly impact, if not already, how we select candidates for lung transplantation. It also addresses some aspects of lung transplant such as frailty and ARDS, which need better assessment tools and clinical data.
Electrodermal Activity of Auricular Acupoints in Pediatric Patients With Functional Abdominal Pain Disorders
Authors: Borlack Rachel E. , Shan Sophie , Zong Amanda M. , Khlevner Julie , Garbers Samantha , Gold Melanie A.
Published: April 2021

Objectives:

Functional abdominal pain disorders (FAPD) affect approximately 13.5% of children. Pharmacotherapy is often ineffective, leaving providers, and families seeking adjunctive therapies. Auriculotherapy provides treatment for pain and other symptoms, without a defined protocol for FAPD. A handheld point‐finder device measuring transdermal electrical current determines active acupoints, with a higher current indicating a more active acupoint. Our objectives were to determine auricular acupoint (AA) activity in FAPD and to assess participants’ attitudes towards auriculotherapy.

Methods:

This is a prospective double‐blind study evaluating the electrodermal activity of AAs in pediatric‐aged female participants with FAPD compared to healthy controls (HC). Participants completed surveys regarding demographics and interest in auriculotherapy. The electrodermal assessment evaluated 20 AAs per ear using a point‐finder device. Each AA current measurement was analyzed by average relative rank and median, with a median current measurement ≥50 μA considered active.

Results:

We enrolled 46 female participants, 22 FAPD (mean age 15.8 years) and 24 HC (mean age 15.4 years). In FAPD, 12 of 40 AAs were active, of which only six were also active in HC. Comparison of median current and average ranking between participants demonstrated consistency. In the post‐assessment survey, 86.4% of FAPD expressed interest in receiving auricular acupressure and 68.2% would travel to the clinic solely for treatment.

Conclusions:

Based on electrodermal measurements, we propose a treatment protocol using auriculotherapy for FAPD symptom‐management. We demonstrated there is considerable patient interest in auriculotherapy. Further studies are needed to confirm the findings in a larger sample size and validate the efficacy of this treatment protocol.
Superior Mesenteric Artery Blood Flow in Parenterally Fed Versus Enterally Fed Preterm Infants
Authors: Elgendy Marwa M. , El Sharkawy Hamed M. , Elrazek Hussein Abd , Zayton Hossam A. , Aly Hany
Published: April 2021

Objectives:

The aim of the study was to compare superior mesenteric artery (SMA) flow in premature infants with parenteral and enteral nutrition.

Methods:

A prospective study was conducted on 2 groups of preterm infants with gestational age of 280/7 to 366/7 weeks: group 1 did not qualify for early enteral feeds and received parenteral nutrition (PN), and group 2 received early enteral feeding. SMA peak systolic velocity (PSV), end diastolic velocity (EDV), and pulsatility index (PI) were measured using Doppler ultrasound before starting feeds at day 1 and at day 5.

Results:

The study recruited 40 infants; 20 in each group. At baseline, PSV, EDV, and PI did not differ between groups. At day 5, enteral nutrition was associated with significant increases in PSV (91.53 ± 29.15 vs 65.49 ± 19.18, P = 0.003) and EDV (15.91 ± 7.01 vs 11.65 ± 5.58, P = 0.026) and a decrease in PI (1.28 ± 0.40 vs 2.48 ± 0.83, P < 0.001). Regression analysis to control for confounders showed enterally fed infants to have increased PSV (adjusted odds ratio [aOR] = 25.45; 95% confidence interval [CI]: 8.53–42.38, P = 0.004) and EDV (aOR 8.630; 95% CI: 2.987–14.273, P = 004) and decreased PI (aOR = −1.133; 95% CI: −1.603 to −0.664, P < 0.001). Infants in the PN group later developed more frequent feeding intolerance when compared with the enterally fed group (65% vs 15%, respectively, P < 0.001).

Conclusions:

In preterm neonates, early EF is associated with increased SMA blood flow, decreased vascular intestinal resistance, and less frequent incidence of feeding intolerance.
PedsQL™ Gastroparesis Symptoms Module Domain and Item Development
Authors: Varni James W. , Shulman Robert J. , Self Mariella M. , Febo‐Rodriguez Liz , Charron Heather , Williams Kent , Nurko Sam , Rosen Rachel L. , Chumpitazi Bruno P. ,   Gastroparesis Research Consortium (GpCRC)
Published: April 2021

Objectives:

Like adults, children suffer from gastroparesis; however, there are currently no validated instruments to determine the impact of gastroparesis in pediatric patients. The objective of this study was to develop the items and domains to support the content validity of the new Pediatric Quality of Life Inventory (PedsQL™) Gastroparesis Symptoms Module.

Methods:

Patients were recruited from the National Institute of Diabetes and Digestive and Kidney Diseases Pediatric Gastroparesis Registry. The qualitative methods involved an iterative process comprising a literature review of existing questionnaires and gastroparesis clinical research, an expert review panel of pediatric gastroenterologists who provided feedback on the conceptual framework in developing the semi‐structured interview, and in‐depth focus interviews with six pediatric patients with gastroparesis and five of their parents (one did not participate) in developing relevant domains and item content. In the subsequent cognitive interviews phase, five additional patients with gastroparesis and their parents provided detailed feedback on item content, relevance, importance, and understandability of the domains and items.

Results:

Ten domains/scales were derived from the qualitative methods, with item content saturation achieved at 67 items, with no further themes or content identified during the final cognitive interviews. The Module is comprised of 10 individual scales measuring nausea, stomach fullness when eating, vomiting, dry heaves, heartburn and reflux, stomach pain and hurt, food and drink limits, bloating, appetite, and worry.

Conclusions:

Our study supports the content validity of the new PedsQL Gastroparesis Symptoms Module. The Module field test study will be conducted in a multisite national study.
Long-term follow-up of patients with chronic musculoskeletal pain attending interdisciplinary pain rehabilitation: outcomes and predictive factors
Authors: Boonstra Anne M. , Hoogers Judith M.B. , Stewart Roy E. , Reneman Michiel F. , Schiphorst Preuper Henrica R.
Published: April 2021

The long-term outcomes of interdisciplinary pain rehabilitation (IPR) in patients with chronic musculoskeletal pain (CMP) and its predictors has been studied to a limited extent. In this historical cohort study, functioning, satisfaction with life domains, and pain were assessed at baseline, discharge, and at 6–15 years follow-up. At follow-up, most patients (77%) rated the effects of the IPR as temporarily or persistently positive. The gains in functioning, satisfaction with life domains, and pain made during IPR remained for 6–15 years after the IPR. Patients who were single, retired, or not in work, and those having higher pain and lower functioning at baseline, had lower functioning at follow-up, while patients with traumatic pain disorders had higher functioning at follow-up. Gains made during IPR, particularly gains in social and mental functioning and in pain predicted functioning at follow-up. Treatments and events between discharge and follow-up also influenced the long-term outcome. In conclusion, on average, outcomes achieved during IPR persisted at long-term follow-up. Predictors of a better long-term outcome were mainly baseline characteristics.
Barriers to and Facilitators of Bedside Nursing Handover
Authors: Clari Marco , Conti Alessio , Chiarini Daniela , Martin Barbara , Dimonte Valerio , Campagna Sara
Published: April 2021

Background:

Bedside nursing handover (BNH) has been recognized as a contributor to patient-centered care. However, concerns about its effectiveness suggest that contextual factors should be considered before and after BNH implementation.

Purpose:

This review aimed to identify, evaluate, and synthetize the qualitative literature on the barriers to and facilitators of BNH as experienced by nurses and patients.

Methods:

The Joanna Briggs Institute meta-aggregation method was applied. A systematic search was performed to identify qualitative studies published from inception to June 30, 2020. Two independent researchers assessed methodological quality and extracted data.

Results:

Twenty-four articles were included, comprising 161 findings, and 5 synthesized findings emerged with a moderate level of confidence.

Conclusions:

BNH ensures patient safety and increases satisfaction and recognition among patients and nurses. This evidence on the barriers to and facilitators of BNH could help health care providers who have implemented or plan to implement this practice.
Addressing Suffering in Patients With Psychiatric Disorders
Authors: Yager Joel
Published: April 2021

Background

Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians' concerns, it is not even indexed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Generally connoting severe, prolonged distress, suffering can be distinguished from pain, depression, and anxiety. The aims of this article are to consider whether attending to suffering per se in psychiatric patients merits attention independent of other commonly assessed psychiatric symptoms such as anxiety, depression, and conventional distress, and how targeting suffering per se might add value to psychiatric patient care.

Methods

Sources for this article were obtained via a selective literature search in PubMed using the terms “suffering” in the title and the terms “psychiatric disorder,” “mental illness,” “assessment,” “measurement,” “scale,” “existential suffering,” and “unbearable suffering.” Articles of interest were followed up using a snowball technique to examine “similar articles” and “cited by” titles to find additional pertinent articles.

Results

Definitions of suffering in the medical literature stress its subjectivity, particularity, complexity, and connection to a wide variety of noxious sensations, as well as real and anticipated deficits, losses, and thwarted motivations. These can affect the entire spectrum of universal human needs, from basic biological issues through intrapsychic, interpersonal, and social issues, encompassing existential concerns of meaning, purpose, and transcendence. Based on these factors, a definition of suffering in patients with psychiatric disorders is proposed. Although efforts to measure suffering have been limited and numerous gaps in the literature are evident, several scales may offer suitable bases for the study of suffering in patients with psychiatric disorders.

Conclusions and Implications

Ascertaining sources of suffering may require new types of inquiry and additional time. Well-described, evidence-informed strategies and time-honored psychotherapy techniques are available for addressing the numerous concerns that contribute to suffering. Patients with psychiatric disorders whose distinct, multidimensional sources of suffering are identified, acknowledged, and addressed may experience better treatment quality, greater treatment satisfaction, and possibly better outcomes than those whose clinicians' attention is limited to conventional psychiatric signs and symptoms.
Hospital Nurse Competency to Care for Patients With Behavioral Health Concerns
Authors: Winokur Elizabeth , Zamil Taqialdeen , Loucks Jeannine , Munoz Katrina , Rutledge Dana N.
Published: April 2021

Nonpsychiatric nurses care for hospital patients with behavioral health (BH) conditions. This study found BH care competencies of hospital nurses slightly changed from those 9 years earlier. On average, nurses reported moderate to strong perceived competence about assessing/intervening and accessing resources to care for BH patients. They perceived less competence in recommending psychotropic drugs for patients who may need them. Staff development programs that aim to enhance nurse BH care competencies are needed.
The polytrauma patient: Current concepts and evolving care
Authors: Lee Christopher , Rasmussen Todd E. , Pape Hans-Christoph , Gary Joshua L. , Stannard James P. , Haller Justin M.
Published: April 2021

Principles of care in the polytraumatized patient have continued to evolve with advancements in technology. Although hemorrhage has remained a primary cause of morbidity and mortality in acute trauma, emerging strategies that can be applied pre-medical facility as well as in-hospital have continued to improve care. Exo-vascular modalities, including the use of devices to address torso hemorrhage and areas not amenable to traditional tourniquets, have revolutionized prehospital treatment. Endovascular advancements including the resuscitative endovascular balloon occlusion of the aorta (REBOA), have led to dramatic improvements in systolic blood pressure, although not without their own unique complications. Although novel treatment options have continued to emerge, so too have concepts regarding optimal time frames for intervention. Though prior care has focused on Injury Severity Score (ISS) as a marker to determine timing of intervention, current consensus contends that unnecessary delays in fracture care should be avoided, while respecting the complex physiology of certain patient groups that may remain at increased risk for complications. Thromboelastography (TEG) has been one technique that focuses on the unique pathophysiology of each patient, providing guidance for resuscitation in addition to providing information in recognizing the at-risk patient for venous thromboembolism. Negative pressure wound therapy (NPWT) has emerged as a therapeutic adjuvant for select trauma patients with significant soft tissue defects and open wounds. With significant advancements in medical technology and improved understanding of patient physiology, the optimal approach to the polytrauma patient continues to evolve.
Finding the Gaps in Retesting for Chlamydia and Gonorrhea: Differences Across High-Volume Testing Departments in an Urban Health Care Setting
Authors: McCool-Myers Megan , Turner Daria , Henn Megan C. , Sheth Anandi N. , Karlow Samantha L. , Kottke Melissa J.
Published: April 2021

Background

The Centers of Disease Control and Prevention guidelines recommend that all patients be retested 3 months after a positive chlamydia (CT) or gonorrhea (GC) result. However, retest rates are generally low, and only a quarter of patients return to clinic for retesting. This analysis explored retesting patterns in a high sexually transmitted infection (STI)/human immunodeficiency virus (HIV)-risk setting to illuminate gaps in adherence to guideline recommendations.

Methods

Retrospective chart data from a large urban safety-net institution were analyzed descriptively. Patients who received a positive CT/GC test from January to February 2017 were followed up for at least 4 months to assess if retesting occurred within approximately 3 months.

Results

Our sample of 207 patients was primarily non-Hispanic Black (92.8%), younger than 25 years (63.3%) and women (60.4%). Over half had been initially diagnosed with CT, one-third with GC, and one-tenth with both CT and GC. Eighty-nine (43.0%) patients were retested during the observed period; mean time between tests was 2.7 months. Retesting was most common in infectious diseases/HIV primary care (73.6%) and obstetrics/gynecology (44.9%). Patients who were first diagnosed in emergency medicine were significantly less likely to be retested. Retested patients included a large number of HIV-positive men (31 of 89 total) and pregnant women (23 of 54 women).

Conclusions

Forty-three percent of patients were retested within approximately 3 months of their initial positive CT/GC diagnosis, exceeding previously published rates. Nonetheless, in light of the growing STI epidemic, health care systems should prioritize retesting across high-volume testing specialties, rethink retesting models, and facilitate referrals to ensure that patients receive guideline-recommended, comprehensive STI care.
Case Report: Idiopathic Sclerosing Orbital Inflammation
Authors: Bachman Groth Jane A. , Harris Gerald J.
Published: April 2021

SIGNIFICANCE

Idiopathic sclerosing orbital inflammation (ISOI) is characterized by insidious, chronic, progressive inflammation and fibrosis that damage ocular structures and produce a mass effect. This case highlights the challenges in diagnosis and management of ISOI, as well as the associated ocular morbidities, including potential vision loss.

PURPOSE

The purpose of this study was to provide education regarding a rare condition that exhibits variable presentation and has an unpredictable success rate with regard to treatment paradigm. Improved therapeutic options are promising. Ultimately, early detection and management are key and may allow for better visual outcome.

CASE REPORT

A 46-year-old woman presented with complaints of chronic right-sided facial headaches and eye pain and gradual right globe prominence over the previous 6 months. Worsening vision and decreased right peripheral visual field were also noted. Upon examination, an afferent pupillary defect and florid disc edema were evident. Imaging studies revealed an orbital and extraorbital infiltrative mass involving the right orbital apex, inferior orbital fissure, pterygopalatine fossa, and cavernous sinus. Right anterior orbitotomy with biopsy revealed fragments of fibroconnective and adipose tissue with sclerosis and chronic focal inflammation, consistent with ISOI. Treatment included intravenous methylprednisone, followed by oral prednisone, beginning at 60 mg/d with a slow taper thereafter. Signs and symptoms improved dramatically and eventually resolved. Vision significantly improved, and the afferent pupillary defect resolved. The patient remained asymptomatic at 3-month follow-up.

CONCLUSIONS

Idiopathic sclerosing orbital inflammation is difficult to diagnose and manage. No large studies exist because of the rare nature of the disease. Slowly progressive, nonspecific signs and symptoms may delay recognition and treatment. Orbital imaging and histopathologic analysis are critical for definitive diagnosis. Conventional treatment with corticosteroids is not uniformly successful, but newer combined therapy options can improve outcomes. Early identification and treatment are key to management and ultimate preservation of function and vision.
Near-point Findings in Children with Autism Spectrum Disorder and in Typical Peers
Authors: Coulter Rachel Anastasia , Bade Annette , Jenewein Erin C. , Tea Yin C. , Mitchell G. Lynn
Published: April 2021

SIGNIFICANCE

Clinicians can better diagnose and manage vision problems of autism spectrum disorder (ASD) children by establishing a standard of care for this population. Results also reinforce the importance of a comprehensive binocular vision evaluation in all patients with ASD.

PURPOSE

The purposes of this study were to compare near-point and ocular motility test findings in ASD children and typically developing (TD) peers and to compare findings among ASD children by level of verbal communication.

METHODS

Sixty-one children and adolescents (ASD, 34; TD, 27) aged 9 to 17 years completed an eye examination protocol including tests of distance and near phoria, near point of convergence, near fusional convergence and divergence, accommodative response, and Northeastern State University College of Optometry oculomotor testing. Testing was completed through refractive correction. Parents of ASD children provided information regarding subjects' verbal communication level (nonverbal, uses short words, verbal).

RESULTS

Distance phoria did not differ significantly between groups. Near phoria of ASD subjects was more exophoric (difference, 2.8 prism diopters). Mean near point of convergence break and recovery were 7.0 and 8.02 cm, respectively, in ASD subjects and 2.19 and 3.99 cm in TD subjects. Near fusional divergence and convergence showed no significant difference. Autism spectrum disorder subjects had significantly poorer stereoacuity (P < .0001) and, on Northeastern State University College of Optometry Oculomotor Testing, reduced fixation, poorer accuracy and stamina/ability, and increased head and body movement. Monocular estimation method retinoscopy results did not differ significantly between ASD and TD subjects. No significant differences in phoria, near point of convergence, and near fusional divergence or convergence were observed between ASD subgroups (nonverbal, uses short words, verbal).

CONCLUSIONS

Autism spectrum disorder children are more likely to show receded near point of convergence, poor fixation, inaccurate saccades, erratic pursuits, and exophoric posture. These differences occur, regardless of reported verbal communication level.
Longitudinal Opioid Surveillance Project Involving Toxicologic Analysis of Postmortem Specimens from 9 Counties in Michigan Suggests the Discovery of New High-Intensity Drug Trafficking Areas
Authors: Stevens Christine , Li Tong , Ton Erinn , Zou Jalynn , Douglas Elizabeth , Jones Prentiss
Published: April 2021

Acetyl fentanyl (AF) is a Schedule I fentanyl analog that has been increasingly seen in heroin and fentanyl polydrug toxicity overdoses in Michigan (MI). Drug users are often unaware of the presence of AF in their drugs because it is often sold mixed into or disguised as heroin. High levels of AF in heroin drug products can cause increased incidence of overdose. This article describes data from a longitudinal opioid surveillance program and details 102 decedents in MI who were found to have evidence of heroin in their postmortem blood. A large portion of these decedents were also found to have evidence of fentanyl and AF. Our data further show significant overlap in incidence rates of AF and heroin-related overdose deaths in several MI counties, suggesting that AF is becoming enmeshed in heroin trafficking. Furthermore, we report unprecedented high incidence rates of AF and heroin-related overdose deaths in Calhoun county, and we propose that it is a high-intensity drug trafficking area. Highways US-131 and US-31 are likely used to transport these drugs. More study is needed into the drug trafficking trends in MI to ascertain drug sources and monitor the ever developing and dangerous polydrug heroin combinations.
Lymphoepithelioma-like Intrahepatic Cholangiocarcinoma Is a Distinct Entity With Frequent pTERT/TP53 Mutations and Comprises 2 Subgroups Based on Epstein-Barr Virus Infection
Authors: Tsai Jia-Huei , Liau Jau-Yu , Lee Chia-Hsiang , Jeng Yung-Ming
Published: April 2021

The molecular characteristics of lymphoepithelioma-like intrahepatic cholangiocarcinoma (LELCC) remain elusive. We examined 27 LELCC cases through next-generation sequencing using a panel of genes commonly mutated in primary liver cancers. Alterations in BAP1, ARID1A, ARID2, and PBRM1 were detected through immunohistochemistry. Fluorescence in situ hybridization was performed to analyze FGFR2 fusions and CCND1 amplification. LELCC is histologically classified as predominantly undifferentiated or glandular. Epstein-Barr virus–encoded small RNA (EBER) expression was found in 16 LELCCs. Approximately 50% of LELCCs expressed programmed death-ligand 1 strongly. Notably, recurrent pTERT and TP53 mutations were detected in 9 (38%) and 8 (33%) tumors, respectively. Only 2 LELCCs exhibited loss of expression for PBRM1. Alterations in genes typically involved in intrahepatic cholangiocarcinoma, including IDH1, IDH2, ARID1A, ARID2, and BAP1, and FGFR2 fusions, were not identified. The 2-step clustering analysis showed 2 distinct subgroups in LELCC, which were separated by EBER expression. A meta-analysis of all reported cases (n=85) has shown that EBER+ LELCC is strongly associated with the female sex, younger age, and exhibited predominantly glandular differentiation (P=0.001, 0.012, and <0.001, respectively). Patients with EBER− LELCC were more likely to have viral hepatitis and cirrhosis (P=0.003 and 0.005, respectively). Genetic analysis demonstrated that EBER− LELCC was significantly associated with pTERT and TP53 mutations (P=0.033 and 0.008, respectively). In conclusion, LELCC is genetically distinct from intrahepatic cholangiocarcinoma. EBER− LELCC may exhibit a different pathogenesis from EBER+ LELCC. High programmed death-ligand 1 expression in LELCC has implications for potential immunotherapeutic strategies.
PDGFRA Immunohistochemistry Predicts PDGFRA Mutations in Gastrointestinal Stromal Tumors
Authors: Papke David J. , Forgó Erna , Charville Gregory W. , Hornick Jason L.
Published: April 2021

Platelet-derived growth factor receptor A (PDGFRA) is a receptor tyrosine kinase that is activated by mutations in 10% of gastrointestinal stromal tumors (GISTs) and 55% to 70% of inflammatory fibroid polyps. PDGFRA-mutant GISTs are usually epithelioid and occur predominantly in the stomach. Succinate dehydrogenase–deficient GISTs also arise in the stomach and are usually epithelioid, as are some KIT-mutant GISTs. Recently, avapritinib was approved to treat PDGFRA D842V-mutant GISTs, which do not respond to conventional targeted therapy. Here, we evaluate the utility of PDGFRA immunohistochemistry (IHC) to predict PDGFRA mutations to direct targeted therapy. PDGFRA IHC was performed at 1:3000 and 1:10,000 dilutions on a tissue microarray containing 153 GISTs (126 KIT-mutant, 17 PDGFRA-mutant, and 10 succinate dehydrogenase–deficient). The “positive” staining threshold was defined as 50% of neoplastic cells staining at moderate intensity. PDGFRA IHC was 75.0% and 80.9% specific for PDGFRA mutations at 1:3000 and 1:10,000 dilutions, respectively, and it was 100% sensitive at both. On the basis of its higher specificity, a 1:10,000 dilution was used to stain whole-tissue sections of GISTs and other gastric tumor types. Combining tissue microarray and whole-tissue data, PDGFRA IHC was 94.4% sensitive and 81.0% specific for PDGFRA-mutant GIST among all 210 GISTs, and it was 84.1% specific among 149 GISTs with an epithelioid component. PDGFRA was positive in a subset of inflammatory fibroid polyps (15/30; 50%), monophasic synovial sarcomas (5/10; 50%), inflammatory myofibroblastic tumors (5/10; 50%), and plexiform fibromyxomas (2/8; 25%). It was negative in poorly differentiated adenocarcinoma (0/20), diffuse large B-cell lymphoma (0/10), glomus tumor (0/10), gastrointestinal neuroectodermal tumor (0/10), leiomyoma (0/10), gastric schwannoma (0/8), and gastroblastoma (0/3). Among GISTs, PDGFRA IHC is highly sensitive and moderately specific for PDGFRA-mutant tumors; it also can be positive in inflammatory fibroid polyp and some other mesenchymal tumor types. PDGFRA positivity could be used to triage epithelioid GISTs for PDGFRA sequencing to determine optimal therapy.
Ovarian Primitive Neuroectodermal Tumor: Are You Central or Peripheral?
Authors: Bachert Sara E. , Baldwin Lauren A. , Dueber Julie C. , Piecoro Dava W.
Published: April 2021

Primitive neuroectodermal tumors (PNETs) of the ovary are rare, highly aggressive neoplasms with fewer than 100 cases described. PNETs of the ovary can be classified as either peripheral or central types. The peripheral PNETs have small round cells with or without rosette formation, and the central PNETs can be further delineated based on the CNS tumor they morphologically resemble. We present a case of a central type ovarian PNET in a young female presenting with a pelvic mass and elevated serum tumor markers.
Meaning of fabric orthoses to long-term users with multiple sclerosis: An interpretative phenomenological analysis
Authors: Snowdon Nicola , Booth Susan , McLean Sionnadh , Wheat Jon , Piercy Hilary
Published: April 2021

Background:

Fabric orthoses are elasticated garments designed to provide support to the musculoskeletal system. They may benefit people with multiple sclerosis; however, in this population, their acceptability is largely unexplored.

Objectives:

This study aimed to explore the meaning that fabric orthoses hold for people with multiple sclerosis and factors influencing acceptability.

Study Design:

This is a qualitative study using an interpretative phenomenological analysis to explore the meaning ascribed to lived experience.

Methods:

Four people with multiple sclerosis participated in face-to-face semi-structured interviews. Two used upper limb orthotic sleeves for involuntary movement control, one used orthotic shorts, and one used a soft ankle brace. Three participants had fabric orthoses they no longer used. Themes were validated by peer review.

Findings:

Two themes were identified. “Giving back control” describes how perceived physical benefits, such as decreased involuntary movement and improved stability, led to important benefits in autonomy and self-image. Orthoses were not worn longer-term where self-image was not improved. “Learning to live with an orthosis” captures the way in which participants learnt from experience over months or years how to maximize effectiveness and overcome disadvantages. Acceptability was determined specific to the contexts in which the orthoses were used, with the social appropriateness of appearance and the demands of tasks being important considerations.

Conclusions:

Fabric orthoses can be acceptable to people with multiple sclerosis. Professionals should be mindful of the active learning process that users engage in as they learn about the pros and cons of orthotic use. Further research into effectiveness is needed.
Immediate effect of prefabricated and UCBL foot orthoses on alignment of midfoot and forefoot in young people with symptomatic flexible flatfoot: A radiographic evaluation
Authors: Mahdiyar Zahra , Saeedi Hassan , Vasaghi-Gharamaleki Behnoosh , Abdollah Vahid
Published: April 2021

Background:

Radiographic imaging has been considered the gold standard in evaluating the skeletal alignment of the foot in static weightbearing. The effects of foot orthoses on the alignment of foot bones have been mostly evaluated using lateral view x-rays. The posterior–anterior view has not been investigated extensively.

Objectives:

To investigate the effects of 2 foot orthoses: University of California Biomechanics Laboratory Orthosis (UCBL) and a prefabricated orthosis (P-FFO) on the alignment of foot bones on anterior–posterior x-rays in young people with symptomatic flexible flatfoot (SFF).

Study Design:

This is a randomized, crossover study.

Methods:

Fifteen participants (mean [SD], 23.67 ± 2 years) with SFF were randomly imaged in 3 different conditions: shoes only, shoes + P-FFO, and shoes + UCBL. The talonavicular coverage, the first and the second talometatarsal angles, the intermetatarsal angle, and the cuboid abduction angle (CAA) were measured on weightbearing, anterior–posterior x-ray images for each condition.

Results:

Both orthotic designs demonstrated a significant reduction in the talonavicular coverage, the first and the second talometatarsal angles, and the CAA compared with the shoe-only condition (P< .001). The talonavicular coverage angle reduced by ∼11% using P-FFO compared with UCBL (P< .005). No significant differences were observed for other angles between the 2 orthotic conditions.

Conclusions:

Both orthotic conditions improved the talonavicular coverage, first and the second talometatarsal angle, and CAA in young people with SFF. The walls of the UCBL orthosis did not result in further correction of the talonavicular coverage angle compared with the prefabricated FFO design.
Understanding the effects of quantitatively prescribing passive-dynamic ankle-foot orthosis bending stiffness for individuals after stroke
Authors: Koller Corey , Reisman Darcy , Richards James , Arch Elisa
Published: April 2021

Background:

Passive-dynamic ankle-foot orthosis (PD-AFO) bending stiffness, which assists plantar flexor function, can be prescribed to improve poststroke gait. However, outcomes with PD-AFOs are variable likely because of improper personalization. We implemented a prescription model that objectively personalizes PD-AFO bending stiffness based on each individual's level of plantar flexor weakness (quantitatively prescribed PD-AFO).

Objectives:

To evaluate whether a quantitatively prescribed PD-AFO improves peak paretic plantar flexion moment compared with the original AFO for individuals after stroke and to examine the immediate effects of wearing a quantitatively prescribed PD-AFO.

Study Design:

This is a repeated-measures study.

Methods:

PD-AFO bending stiffness was personalized for 10 individuals after stroke through the previously developed prescription model. Participants underwent an instrumented gait analysis while wearing their original AFO and the quantitatively prescribed PD-AFO.

Results:

Participants' peak paretic plantar flexion moment significantly increased while wearing the quantitatively prescribed PD-AFO compared with the original AFO. In addition, participants showed different levels of improvements in a series of other key biomechanical and walking performance parameters with PD-AFO use. Some participants showed improvements in all parameters, whereas others showed moderate to no improvements.

Conclusions:

Quantitatively prescribed PD-AFO bending stiffness resulted in inconsistent improvements in biomechanical and walking performance parameters, which warrants further investigation. Future work should investigate whether more consistent benefits are seen with faster walking speeds and longer-term PD-AFO use. In addition, future work should conduct larger-scale studies that aim to understand and optimize orthosis-patient matching for all AFO designs/characteristics.