bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of subsequent atrial fibrillation in patients with myasthenia gravis
Authors: Liou Yaw-Tzeng , Wei James Cheng-Chung , Hu Kai-Chieh , Hung Yao-Min , Chou Mei-Chia , Chang Renin
Published: May 2021

The purpose of this study was to explore the association between myasthenia gravis (MG) and the risk of atrial fibrillation (AF) in an Asian population. The risk was analyzed in a cohort of 5528 patients with history of MG and 5528 individuals without MG using a hospitalization claim dataset. Both groups were matched by age, sex, index year and baseline comorbidities as an original analysis. A Cox proportional hazard model was used to estimate the hazard ratio and 95% confidence interval of AF after adjusting for demographic and relevant clinical covariates. The adjusted hazard ratio of the MG group compared with that of the non-MG group was 1.03 (95% confidence interval, 0.76–1.38) for AF. A stratified analysis showed that compared with the propensity score matched non-MG group, there was no increased risk of developing AF based on age categories, gender, or comorbidities. Different time follow-up periods results showed no increased risk of AF compared with the non-MG group. Overall, in the Taiwanese cohort, MG is not associated with an increased risk of AF.
Higher volume of water intake is associated with lower risk of albuminuria and chronic kidney disease
Authors: Wang Hung-Wei , Jiang Ming-Yan
Published: May 2021

Increased water intake correlated to lower vasopressin level and may benefit kidney function. However, results of previous studies were conflicted and inconclusive. We aimed to investigate the association between water intake and risk of chronic kidney disease (CKD) and albuminuria.

In this cross-sectional study, the study population were adult participants of 2011–2012 National Health and Nutrition Examination Survey (NHANES) whose estimated glomerular filtration rate (eGFR) were ≥30 ml/min/1.73 m2. Data of water intake were obtained from the NHANES 24-h dietary recall questionnaire. Participants were divided into three groups based on volume of water intake: <500 (low, n = 1589), ≥500 to <1200 (moderate, n = 1359), and ≥1200 ml/day (high, n = 1685). CKD was defined as eGFR <60 ml/min/1.73 m2, and albuminuria as albumin–to–creatinine ratio (ACR) ≥30 mg/g.

Our results showed that 377 out of 4633 participants had CKD; the prevalence inversely correlated to volume of water intake: 10.7% in low, 8.2% in moderate, and 5.6% in high intake groups (P < .001). Prevalence of albuminuria was also lower in high (9.5%) compared with moderate (12.8%) and low intake groups (14.1%), P < .001. Additionally, water intake positively correlated to eGFR and negatively correlated to urinary ACR, as well as plasma and urine osmolality. Multivariable logistic regression showed that low water intake group had higher risk of CKD (OR 1.35, 95% CI 1.01–1.82) and albuminuria when compared to high water intake group (OR 1.42, 95% CI 1.13–1.79).

In conclusion, increased water intake was associated lower risk of CKD and albuminuria. Meticulous studies are needed to elucidate the underlying mechanisms.
Rib fracture detection in computed tomography images using deep convolutional neural networks
Authors: Kaiume Masafumi , Suzuki Shigeru , Yasaka Koichiro , Sugawara Haruto , Shen Yun , Katada Yoshiaki , Ishikawa Takuya , Fukui Rika , Abe Osamu
Published: May 2021

To evaluate the rib fracture detection performance in computed tomography (CT) images using a software based on a deep convolutional neural network (DCNN) and compare it with the rib fracture diagnostic performance of doctors.

We included CT images from 39 patients with thoracic injuries who underwent CT scans. In these images, 256 rib fractures were detected by two radiologists. This result was defined as the gold standard. The performances of rib fracture detection by the software and two interns were compared via the McNemar test and the jackknife alternative free-response receiver operating characteristic (JAFROC) analysis.

The sensitivity of the DCNN software was significantly higher than those of both Intern A (0.645 vs 0.313; P < .001) and Intern B (0.645 vs 0.258; P < .001). Based on the JAFROC analysis, the differences in the figure-of-merits between the results obtained via the DCNN software and those by Interns A and B were 0.057 (95% confidence interval: −0.081, 0.195) and 0.071 (−0.082, 0.224), respectively. As the non-inferiority margin was set to −0.10, the DCNN software is non-inferior to the rib fracture detection performed by both interns.

In the detection of rib fractures, detection by the DCNN software could be an alternative to the interpretation performed by doctors who do not have intensive training experience in image interpretation.
Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization
Authors: Abdulaziz Amal M.A. , You Xuewu , Liu Lu , Sun Yu , Zhang Junhua , Sun Shuqin , Li Xinyue , Sun Wenxiong , Dong Yajie , Liu Hongli , Zhang Youzhong
Published: May 2021

To explore the optimal way to manage patients with high-grade squamous intraepithelial lesion (HSIL) and positive margin by identifying the risk factors for its recurrence and residue.

A retrospective study was conducted on 267 cases of a pathologically confirmed HSIL with positive margin following conization by loop electrosurgical excisional procedure (LEEP) between January 2010 and December 2015. One hundred two cases were selected for regular follow-up every 6 months, and 165 cases were selected for a second surgery (repeat cervical conization or hysterectomy) within 3 months of initial LEEP. We analyzed the association between recurrent or residual diseases and these factors: age, menopausal status, ThinPrep cytologic test (TCT) results, high-risk human papillomavirus (HR-HPV) infection, pathological grades of the margin, number of involved margins, and glandular involvement.

The recurrence rate among 102 cases who underwent follow-up was 17.6% (18/102). The factors: atypical squamous cells of undetermined significance cannot exclude HSIL (ASC-H) or higher lesions in the pre-LEEP TCT (P = .038), persistent HR-HPV infection at the 6th month post-LEEP (P = .03), HSIL-positive margin (P = .003), and multifocal-involved margin (P = .002) were significantly associated with recurrent disease, while age, menopause, and pre-LEEP HR-HPV infection were not associated with recurrent disease (P > .05). The residual rate among 165 patients who underwent a second surgery was 45.5% (75/165), of which 15 cases were residual cervical cancer. The factors: menopause (P = .02), ≥ASC-H in pre-LEEP TCT (P = .04), pre-LEEP HR-HPV infection (P = .04), ≥HSIL-positive margin (P < .001), and multifocal-involved margin (P < .001) significantly increased the risk of residual disease. No correlation existed between residual disease and age or glandular involvement (P > .05).

For patients with a positive margin after LEEP, regular follow-up or second surgery should be selected according to fertility requirement and pathological characteristics of the positive margin, as well as TCT and HR-HPV infection condition.
Efficacy of Helicobacter pylori eradication therapy for treatment of functional dyspepsia
Authors: Wang Jue , Gu Sai , Qin Bo
Published: May 2021

Objective:

The effect of Helicobacter pylori (H pylori) eradication therapy in functional dyspepsia (FD) patients was inconsistent in previously published randomized controlled trials. Therefore, we performed a comprehensive protocol for systematic review and meta-analysis in order to assess whether H pylori eradication therapy benefits patients with FD.

Methods:

In this systematic review and meta-analysis, we will search Web of Science, Embase, PubMed, Wanfang Data, Medline, Science Direct, Cochrane Library through April, 2021. The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Data extraction was performed independently and only randomized clinical trials were included in this study. The risk of bias assessment was performed using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. All calculations were carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom).

Results:

We hypothesized that H pylori eradication therapy compared to no eradication therapy has a statistically significant benefit for symptom relief and can also reduce the development of peptic ulcer disease.

Conclusion:

This study expects to provide credible and scientific evidence for the efficacy of H pylori eradication therapy for patients with FD.

OSF registration number:

10.17605/OSF.IO/4EHRB
Comparative efficacy and acceptability of psychotropic drugs for functional dyspepsia in adults
Authors: Zhou Wan , Li Xia , Huang Yin , Xu Xiaoxiao , Liu Yan , Wang Jiayan , Nie Gang , Zhou Dongdong
Published: May 2021

Psychotropic drugs are frequently used for functional dyspepsia (FD); however, the efficacy of these drugs for treating FD remains controversial. We aimed to comprehensively compare the relative efficacies of different psychotropic drugs for FD in adults.

To conduct this study, we searched the PubMed, Embase, and Cochrane Library databases on March 10, 2019, and conducted a frequentist network meta-analysis on the search results. The primary outcome was treatment efficacy estimated by the proportion of patients who achieved a certain percentage decrease in symptoms or who dropped below the threshold of the global FD symptom scores. The secondary outcome was acceptability, defined as all-cause discontinuation. Odds ratios (ORs) were reported with 95% confidence intervals (CIs).

We deemed 10 trials to be eligible for analysis, and these trials included 970 participants and 10 psychotropic drugs. Flupentixol + melitracen (F + M) (OR, 10.00; 95% CI, 1.59 to 62.73), tandospirone (3.24, 1.38 to 7.60), imipramine (2.21, 1.02 to 4.79), and amitriptyline (1.71, 1.06 to 3.09) were significantly superior to placebo. According to the surface under the cumulative ranking curve, the most effective treatment was F + M (89.0%), whereas the least effective was R137696 (13.6%). In terms of acceptability, escitalopram (0.32, 0.11 to 0.92) was ranked as the worst drug (12.6%), followed by imipramine and sertraline.

The present network meta-analysis suggests that F + M, tandospirone, imipramine, and amitriptyline are more effective than placebo as treatment for FD. Our results indicate that among the ten psychotropic drugs included, F + M is likely to be the most effective drug for alleviating dyspepsia symptoms.
Ineffective esophageal motility assessment in patients with and without pathological esophageal acid reflux
Authors: Pakoz Zehra Betul , Sari Sevil Ozer , Vatansever Sezgin , Uran Berna Nilgun Ozgursoy , Camyar Hakan , Gur Emine Ozlem , Gumus Zeynep Zehra , Akbulut Sabiye
Published: May 2021

Ineffective esophageal motility (IEM), defined as minor esophageal motility disorder, is also the most common esophageal motility disorder. The relationship between gastro-esophageal reflux disease is still controversial. Our aim in this study is to evaluate whether there are differences in terms of demographic, endoscopic, or motility findings between IEM patients with pathological esophageal acid reflux and physiological reflux.

Patients diagnosed with IEM according to the Chicago classification v3 with high-resolution manometry (HRM) before acid monitoring constituted the study group of our investigation. The patients were divided into 2 groups as patients with pathological esophageal reflux and patients with physiological reflux according to 24-hour acid monitoring. Demographic data, endoscopic findings, and HRM findings were compared between 2 groups.

A total of 62 patients who were diagnosed with IEM according to the Chicago classification v3 were included in the study. Patients in the physiological reflux group were 7 years younger on average than the pathological reflux group. Esophagitis rates were significantly higher in the pathological reflux group (P = .033). Lower esophageal sphincter resting pressure, integrated relaxation pressure, and the presence of hernia were found to be similar in the 2 groups (P = 392, P = 182, P = 657, respectively). The rate of severe IEM was also similar between the 2 groups (P = .143).

The fact that the physiological reflux patient group is younger may suggest that the IEM develops in the early period and then reflux accompanies the picture with advancing age.
Gestational obesity and subclinical inflammation
Authors: Rugină Cosmin , Mărginean Cristina Oana , Meliţ Lorena Elena , Huţanu Adina , Ghiga Dana Valentina , Modi Viviana , Mărginean Claudiu
Published: May 2021

Maternal obesity and excessive gestational weight gain (GWG) are associated with pregnancy-related complications, poor birth outcomes, and increased birth weight (BW).

The aims
of this study were to assess the relationship between excessive GWG and gestational inflammatory status in terms of blood parameters, as well as its influence on newborn's outcomes.

We performed a prospective study on 176 pregnant women divided into 2 groups depending on the GWG: group 1—normal GWG, 80 cases; and group 2—high GWG, 96 cases. The statistical analysis was performed using the GraphPad Prism program, trial variant. We performed a thorough anamnesis and clinical examination in all mothers and their newborns, as well as an assessment of multiple laboratory parameters.

The levels of both platelets and triglycerides were significantly higher in pregnant women from high GWG group (P = .0165/P = .0247). The newborns whose mothers presented an excessive GWG were found with a significantly higher BW as compared to those with normal GWG mothers (P = .0023). We obtained a positive correlation between the mothers’ and newborns’ values for hemoglobin, high-density lipoprotein, leucocytes, and platelets/lymphocytes ratio (P = .0002/P = .0313/P = .0137). Moreover, a significant positive correlation was found between GWG and BW (r = 0.2049, 95% CI: 0.0588–0.3425, P = .0064).

Our findings sustain the hypothesis that maternal obesity is a risk factor for macrosomia and childhood obesity since we found a positive correlation between GWG and BW. Women with high GWG expressed significantly higher levels of platelets and triglycerides suggesting a subclinical inflammation associated to excessive fat accumulation. The inflammation transfer from mother to fetus in our study was suggested by the positive correlations between maternal and neonatal leukocytes and platelets/lymphocytes ratio.
Comparison of multiple statistical models for the development of clinical prediction scores to detect advanced colorectal neoplasms in asymptomatic Thai patients
Authors: Soonklang Kamonwan , Siribumrungwong Boonying , Siripongpreeda Bunchorn , Auewarakul Chirayu
Published: May 2021

A good clinical prediction score can help in the risk stratification of patients with colorectal cancer (CRC) undergoing colonoscopy screening. The aim of our study was to compare model performance of binary logistic regression (BLR), polytomous logistic regression (PLR), and classification and regression tree (CART) between the clinical prediction scores of advanced colorectal neoplasia (ACN) in asymptomatic Thai patients.

We conducted a cross-sectional study of 1311 asymptomatic Thai patients to develop a clinical prediction model. The possible predictive variables included sex, age, body mass index, family history of CRC in first-degree relatives, smoking, diabetes mellitus, and the fecal immunochemical test in the univariate analysis. Variables with a P value of .1 were included in the multivariable analysis, using the BLR, CART, and PLR models. Model performance, including the area under the receiver operator characteristic curve (AUROC), was compared between the model types.

ACN was diagnosed in 53 patients (4.04%). The AUROCs were not significantly different between the BLR and CART models for ACN prediction with an AUROC of 0.774 (95% confidence interval [95% CI]: 0.706–0.842) and 0.765 (95% CI: 0.698–0.832), respectively (P = .712). A significant difference was observed between the PLR and CART models in predicting average to moderate ACN risk with an AUROC of 0.767 (95% CI: 0.695–0.839 vs AUROC 0.675 [95% CI: 0.599–0.751], respectively; P = .009).

The BLR and CART models yielded similar accuracies for the prediction of ACN in Thai patients. The PLR model provided higher accuracy for ACN prediction than the CART model.
ST-segment elevation due to myocardial invasion of lung cancer mimicking ST elevation myocardial infarction
Authors: Jung Hae Won
Published: May 2021

Introduction:

When a cancer patient presents with ST-segment elevation on an electrocardiogram (ECG), several causes including acute myocardial infarction (MI) should be considered. Myocardial metastasis is one of the rare causes of ST-segment elevation in cancer patients and its clinical silence makes it difficult to diagnose.

Patient concerns:

A 78-year-old man with lung cancer presented to the emergency room for chest pain. ECG revealed ST-segment elevation in inferior and lateral leads.

Interventions:

After emergent coronary angiography, percutaneous coronary intervention (PCI) on proximal right coronary artery was performed.

Outcomes:

Even 7 days after PCI, ST-segment elevation in inferior and lateral leads still existed. Cardiac markers continued to be within the normal range.

Diagnosis:

We found evidence of metastasis of lung cancer on the inferolateral wall of the myocardium by trans thoracic echocardiogram and positron emission tomography (PET)/computed tomography (CT). We diagnosed myocardial metastasis as the cause of ST-segment elevation in the patient.

Conclusion:

Myocardial metastasis is one of the differential diagnosis of ST-segment elevation in cancer patients. Periodic ECG is necessary for lung cancer patients and rapid cardiac work-up is recommended when ST-segment elevation is newly discovered.
PET/computed tomography in inpatients: part 1, international survey
Authors: Dibble Elizabeth H. , Baird Grayson L. , Fahey Frederic H. , Hyun Hyewon
Published: May 2021

Purpose

The purposes of this study are to (1) identify patterns of inpatient PET/computed tomography (CT) use in and outside of the USA and (2) characterize inpatient PET/CT use by location and indication.

Materials and methods

The study was deemed exempt by the Institutional Review Board. A survey link through REDCap was emailed to the Society of Nuclear Medicine and Molecular Imaging (SNMMI) members and PET Centers of Excellence members and posted on the SNMMI website. Data were collected from May 2018 to August 2018. Analyses were conducted using SAS Software 9.4 with the NPAR1WAY procedure. Differences were evaluated using the Kruskal–Wallis test with statistical significance defined as P ≤ 0.05.

Results

A total of 124 people responded to the survey, 71.8% (89/124) in the USA, and 26.6% (33/124) outside the USA [1.6% (2/124) no response]. 81.5% (101/124) read inpatient PET/CTs. Median percent of inpatient PET/CTs was 8.0% (range 0–100). Use of inpatient PET/CT was different (P < 0.0001) in the USA (5%, range 0–80%) versus outside USA (17.7%, range 0–100%). Use of inpatient PET/CT was different by institution type: median percent of inpatient PET/CTs in community teaching hospitals was 4.5% (range 0–50) versus 1.1% (range 0–20) in community nonteaching, 10% (range 0–80) in academic medical centers, and 20.0% (range 6.3–40) in government-affiliated institutions (P = 0.0001).

Conclusions

Most US and non-US respondents read inpatients PET/CTs. Non-US respondents read a higher percentage of inpatient PET/CTs than US respondents. Respondents in government-affiliated institutions read the highest percent of inpatient PET/CTs and community nonteaching institutions the least. Results of this survey may help physicians evaluate whether their practice of providing inpatient PET/CT fits with current practice patterns.
The radio-europium impurities in [153Sm]-EDTMP production: a review of isolation methods
Authors: Naseri Fatemeh , Charkhi Amir , Salek Nafise , Vosoughi Sara
Published: May 2021

Many human cancers predominantly metastasize to the bone which causes bone pain and other symptoms. However, the management of bone metastases is challenging. Radionuclide therapy using low-energy beta-emitting radionuclides has yielded encouraging results. The aim of this therapy is to deliver the maximum dose to the metastatic sites but a minimal dose to the normal tissue. Samarium-153 [153Sm]Sm-Ethylenediamine tetramethylene phosphonate (EDTMP) is an FDA and European Medicine Agency approved (Quadramet) radionuclide and is widely used for bone pain palliation. 153Sm is reactor produced, and the presence of europium impurities is thus unavoidable. This in turn causes an increase in the hospital radioactive waste burden and in radiation absorbed doses to the patients, and therefore it is a concern. The effective removal of these impurities is thus highly desirable before its administration to the patients. In this article, we present a detailed review of the various methods described in the literature for separation of 153Sm and Eu, that is solvent extraction, ion-exchange chromatography, electrochromatography, electrochemical separation and supported ionic liquid phase.
Simulation of the distribution of astatine-211 solution dispersion in a lab room
Authors: Kubo Hitoshi , Takahashi Kazuhiro , Shimoyama Saki , Zhao Songji , Ukon Naoyuki , Ito Hiroshi
Published: May 2021

Objective

This study aimed to evaluate the distribution of Astatine-211 (211At) solution dispersion in a small animal cage using autoradiography imaging to simulate the dispersion of 211At in a lab room to eventually prevent user’s risk of internal exposure in terms of radiation safety.

Methods

211At radiation sources with two chemical properties (Na211At and Free 211At) were prepared. The solutions of 211At were placed onto a dish with paper, and then, it was placed in a small animal cage for 3 h. After removing the dish, an imaging plate with attaching reference sources was placed at four walls of the cage for 15 h in a lead box. Imaging plates were read, and all pixel data were calculated using Microsoft Excel 2016 to obtain three-dimensional (3D) distribution. Calculated results were depicted using a 3D sphere model.

Results

The mean activity of Free 211At was 2.3 times higher than that of Na211At on all autoradiography images. In the cage, the shape of the dispersion of Na211At was almost homogeneous, whereas that of Free 211At was more heterogeneous.

Conclusion

We found that the solution of 211At vaporized naturally and was distributed heterogeneously in the cage, and the chemical properties of 211At influenced their behaviors. These results must be considered to minimize the risks of radiation safety.
Subdorsal Z-flap: a modification of the Cottle technique in dorsal preservation rhinoplasty
Authors: Kovacevic Milos , Veit Johannes A. , Toriumi Dean M.
Published: May 2021

Purpose of review

To present the novel technique of subdorsal Z-flap in dorsal preservation rhinoplasty and give an overview on current available dorsal preservation techniques in the literature.

Recent findings

The subdorsal Z-flap combines the advantages of the high and low septal strip techniques in dorsal preservation rhinoplasty and ensures well tolerated treatment of the dorsal hump and structural stability.

The technique and concept of Dorsal Preservation Rhinoplasty (DPR) has been used for more than a century but only recently gained significant popularity along with specific technical refinements. The advantage of DPR lies in the preservation of the delicate triangular cartilaginous unity of the septal and upper lateral cartilages with its functional and esthetic implications in contrast to all resecting techniques. A variety of modifications of DPR have been published in recent years, each with advantages and disadvantages. The issue of hump recurrence remains a major concern in DPR. We describe the ‘subdorsal Z-flap’ and related techniques of DPR in detail, present two clinical case studies and discuss alternative technical modifications. The ‘subdorsal Z -flap’ combines the advantages of the high septal strip procedure with the advantages of the traditional ‘low septal strip’ or Cottle technique. By starting the incision at a high level, final septal height can be adjusted precisely. By creating a triangular shape with a vertical cut below the K-Area, which is usually the highest point of the hump, significant leverage can be applied from below the hump and the septal overlap may be sutured securely for a stable correction. In combination with Piezo osteotomy and full open approach, great precision and predictability can be achieved. In a recent publication, we presented more than 100 consecutive cases of subdorsal Z-flap DPR with good functional and esthetic outcomes. The subdorsal Z-flap modification is a combination of two popular DPR techniques, fusing their advantages while minimizing risk profile. A slightly higher degree of technical difficulty and necessary tissue dissection provides the benefits of better predictability and reduction of adverse outcomes.
Surgical management of the orbit in thyroid eye disease: lateral orbital decompression
Authors: Williams Jonathan S. , Sahu Priya D.
Published: May 2021

Purpose of review

Lateral orbital wall decompression is one of many well established techniques available to surgeons in management of patients with clinically significant thyroid eye disease (TED). Several different surgical approaches have been described in the literature and are reviewed herein.

Recent findings

Lateral orbital wall decompression remains a popular technique for surgical management of TED, with a recent American Society of Ophthalmic Plastic and Reconstructive Surgery survey showing that 22.6% of respondents preferred a single-wall procedure, with 36.8% of that subset preferring lateral wall decompression alone. Surgical techniques for lateral orbital wall decompression differ based on several steps, such as the incisional approach, whether to take an ab-interno versus ab-externo approach, and whether to remove orbital fat to achieve further decompression. In addition, technological advances have produced an array of tools available to the orbital surgeon to achieve efficient and accurate bone removal.

Lateral orbital wall decompression for TED, despite being an older technique, remains a popular and well established procedure for orbital decompression. Though no randomized controlled clinical trial supports one decompression technique over another for TED, lateral orbital wall decompression offers many benefits such as its ease of access and visualization of the orbital space.
Novel treatments for pediatric atopic dermatitis
Authors: Scott Jennifer B. , Paller Amy S.
Published: May 2021

Purpose of review

To describe new and emerging therapies for pediatric atopic dermatitis (AD).

Recent findings

Recent investigations have highlighted the importance of type 2 immunity and interrelationships among the skin immune system, epidermal barrier, and microbiome in the pathogenesis of AD, including in infants and children. These discoveries have translated into more targeted therapy. Crisaborole ointment, a topical phosphodiesterase 4 (PDE4) inhibitor, and dupilumab, a subcutaneously injected interleukin (IL)-4 receptor inhibitor, are now Food and Drug Administration-approved. Topical agents under investigation for use in the pediatric population include Janus kinase (JAK) inhibitors, PDE4 inhibitors, an aryl hydrocarbon receptor agonist, an antimicrobial peptide, and commensal skin bacteria. Emerging systemic agents for pediatric AD include biologics targeting IL-13, the IL-31 receptor, and the IL-5 receptor, as well as oral JAK inhibitors.

Increased understanding of AD pathogenesis has resulted in the development of new, more targeted therapies that show promising safety and efficacy results in Phase 2 and 3 clinical trials, although long-term safety remains to be evaluated. AD is a heterogeneous disease and having choices of therapies with different mechanisms of action will allow a broader group of children and adolescents with moderate-to-severe disease to achieve disease control.
Severe Vincristine-related Neurotoxicity in 5 Patients With Pediatric Acute Lymphoblastic Leukemia Requiring Discontinuation of Vincristine: A Description of Long-term Outcome
Authors: Egan-Sherry Dana , Bhuta Roma , Cole Peter D. , Gennarini Lisa M. , Kahn Justine M. , Sulis Maria Luisa , DeNardo Bradley D. , Welch Jennifer J.G.
Published: May 2021

Vincristine, a key agent in the treatment of many pediatric malignancies, causes sensory, motor and autonomic neuropathy. We report the clinical courses of 5 patients who required cessation of vincristine after developing severe neurotoxicity during treatment for acute lymphoblastic leukemia. All 5 patients lost the ability to ambulate and 3 had additional severe neurotoxic side effects including vision loss and vocal cord dysfunction. Although prior literature reports poor outcomes for children in whom vincristine was discontinued during acute lymphoblastic leukemia therapy, all 5 patients described here achieved and have maintained complete continuous remission.
Establishing Sickle Cell Disease Stroke Prevention Teams in Africa is Feasible: Program Evaluation Using the RE-AIM Framework
Authors: Ghafuri Djamila L. , Abdullahi Shehu U. , Dambatta Abdu H. , Galadanci Jamil , Tabari Musa A. , Bello-Manga Halima , Idris Nura , Inuwa Hauwa , Tijjani Aliyu , Suleiman Aisha A. , Jibir Binta W. , Gambo Safiya , Gambo Awwal I. , Khalifa Yusuf , Haliru Lawal , Abdulrasheed Sani , Zakari Mohammed A. , Greene Brittany C. , Trevathan Edwin , Jordan Lori C. , Aliyu Muktar H. , Baumann Ana A. , DeBaun Michael R.
Published: May 2021

We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate a Stroke Prevention Team’s readiness to prevent strokes in children with sickle cell anemia living in northern Nigeria. The NIH sponsored Stroke Prevention Trial in Nigeria included a goal of a sustainable stroke prevention program. The program’s 1-year reach for transcranial Doppler screening was 14.7% (4710/32,000) of which 6.0% (281/4710) had abnormal velocities (≥200 cm/s). All participants with abnormal transcranial Doppler velocities were started on hydroxyurea (effectiveness). The leaders of all 5 hospitals agreed to adopt the program. After 1 year, program-implementation and maintenance rates were 100%, demonstrating the program’s feasibility and short-term sustainability.
Unusual Clinical Presentation of Hodgkin Lymphoma in a Child: Both Spinal Cord Compression and Hydronephrosis
Authors: Bayram Nihan , Yaman Yontem , Elli Murat , Dogan Mehmet S. , Ayyildiz Suat , Telhan Leyla , Çakir Asli , Unal Dilek , Sebirli Fatih , Anak Sema
Published: May 2021

Background:

Hodgkin lymphoma (HL) is predominantly a nodal disease with extranodal presentation being uncommon. Presentation with neurological symptoms is not uncommon in adult patients with HL. Subdiaphragmatic involvements are less common especially in childhood. In the literature, there has been no case which presented with both spinal cord compression and bilateral hydronephrosis in pediatric patients with HL.

Observation:

We report a 9-year-old boy diagnosed with HL who presented with bilateral hydronephrosis and epidural involvement.

Conclusion:

Differential diagnosis of abdominal mass in patients presenting with spinal cord compression and/or hydronephrosis should include HL. Retrograde J ureteral stenting is the treatment of choice for malignant ureteral obstruction.
Mortality and Causes of Death From Sickle Cell Disease in The Netherlands, 1985-2017
Authors: Rettenbacher Eva , Zaal Joëlle , Heijboer Harriët , van der Plas Evelyn M. , Hof Michel , Biemond Bart J. , Fijnvandraat Karin
Published: May 2021

In the Netherlands, between 1985 and 2007 secular changes in the health care of patients with sickle cell disease (SCD) have taken place, such as penicillin prophylaxis, vaccination programs and stroke prevention. We investigated the number and causes of death in a cohort of 298 SCD patients, established in 2007, before introduction of neonatal screening, to determine preventable deaths. All patients were diagnosed with SCD before the age of 18 (median age at diagnosis 5.1 y). Their vital status was determined up to January 2017. After a total follow-up period of 4565 patient years and a median time of follow-up of 15 years for all patients, 230 patients (77%) were still alive, 45 patients (15%) were lost to follow-up and a total of 23 patients (8%) had died. Estimated survival to 18 years was 92% with a global mortality rate of 0.48 deaths/100 patient years. Leading causes of death were infection (35%) followed by neurologic complications (22%) and death in the course of a painful episode (13%). Nine of the 20 known causes of death were preventable. These results strongly suggest the benefit of comprehensive care measures for patients with SCD in the Netherlands to further prevent morbidity and mortality.
Ovarian Mucinous Carcinoma in a Pediatric Patient With Maroteaux-Lamy Syndrome
Authors: Yazal Erdem Arzu , Özyörük Derya
Published: May 2021

Mucopolysaccharidoses (MPS) are autosomal recessive lysosomal storage disorder (LSD). Mucinous ovarian cancer is a rare tumor and seldom encounters among adolescents. Here we describe an adolescent female with MPS type VI diagnosed with mucinous ovarian cancer. To our knowledge, this is the first case report of ovarian mucinous carcinoma in a patient with MPS. The association between MPS and cancer has never been described so far, but some LSD are known to have an increased risk of malignancies. The pathogenetic link between LSD and cancer is not well understood. Several potential mechanisms have been proposed for pathogenesis, which include chronic inflammation, abnormal function of activated macrophages, and genetic modifiers. Further studies are required, to understand the role of LSD in cancer.
Myeloablative Carboplatin and Thiotepa With Autologous Stem Cell Rescue for Nonmedulloblastoma High-risk CNS Tumors in Young Children
Authors: Fries Carol , Girvin Angela R. , Korones David N. , Weintraub Lauren , Fitzpatrick Lorna , Andolina Jeffrey R.
Published: May 2021

Malignant central nervous system (CNS) tumors in young children have a poor prognosis and pose a therapeutic challenge. We describe 11 patients with high-risk CNS tumors (6 atypical teratoid/rhabdoid tumor, 4 nonmedulloblastoma CNS embryonal tumors, and 1 glioblastoma multiforme) who received 32 consolidation cycles of myeloablative carboplatin/thiotepa followed by autologous peripheral blood stem cell rescue. All patients underwent successful stem cell harvest without significant complications. Mean time to absolute neutrophil count ≥0.5×103/µL was 10.2±1.3 days and the mean length of hospital stay was 15.7±3.0 days. There were no regimen-related deaths. Five-year event-free survival and overall survival were 45.5±15.0% and 58.4±16.3%, respectively. Tandem carboplatin/thiotepa consolidation with autologous stem cell rescue is well-tolerated in young children with nonmedulloblastoma CNS tumors.
Screening for Chemotherapy-induced Peripheral Neuropathy and Utilization of Physical Therapy in Pediatric Patients Receiving Treatment for Hematologic Malignancies
Authors: Wang Cassandra P. , Syrkin-Nikolau Mashette , Farnaes Lauge , Shen Doris , Kanegaye Maria , Kuo Dennis J.
Published: May 2021

Physical therapy (PT) has been shown to be a helpful intervention in the treatment of chemotherapy-induced peripheral neuropathy (CIPN). Our aim was to screen for CIPN in patients with hematologic malignancies receiving vincristine chemotherapy and obtain a baseline assessment on the percentage of patients utilizing PT in the treatment of CIPN. A retrospective review of surveys administered to parents and patients regarding the severity of peripheral neuropathy symptoms from October 2016 through March 2018 was conducted. Of 116 patients, a total of 102 patients (67 male and 35 female; 4 to 10 y of age, N=63; 11 to 15 y of age, N=19; 16 to 20 y of age, N=20) were eligible for the study, with 67.6% (N=69) reporting symptoms of CIPN. Of these patients, 16.7% scored 4 or greater on the surveys, suggesting clinically severe CIPN. Common parental concerns included decreased strength, difficulty walking up stairs, tripping, and foot drops. Approximately 55.1% of the 69 patients who reported CIPN symptoms were referred to outpatient PT, while 44.9% were not referred. A simple survey consisting of 4 questions that only took several minutes to administer was capable of identifying CIPN in 67.6% of patients receiving vincristine chemotherapy.
Gonadotrophin-independent Precocious Puberty Secondary to an Estrogen Secreting Adrenal Tumor
Authors: Tseretopoulou Xanthippi , Murray Matthew J. , Buck Jackie , Hook C. Elizabeth , Jackson Claire , Kosmoliaptsis Vasilis , Hughes Jacqueline , Gorman Samantha , Williams Rachel M.
Published: May 2021

Background:

Adrenal masses are rare in children and most commonly present with clinical features of virilization in the absence of activation of the pituitary axis—gonadotrophin-independent precocious puberty.

Observations:

We report an unusual case of a 7-year-old girl who presented with clinical signs suggestive of exposure to both androgens and estrogens. Imaging revealed a left-sided adrenal mass with no evidence of metastasis. She underwent successful laparoscopic unilateral adrenalectomy. Histology confirmed an adrenal adenoma.

Conclusion:

We conclude that adrenocortical tumors should be considered in children presenting with gonadotrophin-independent precocious puberty and raised estrogens.
COVID-19 Pandemic
Authors: Marklund LeRoy A. , Nohrenberg Jana L. , Mulcahy Angela M.
Published: May 2021

Registered nurses (RNs) are national assets who provide quality patient care, especially during the corona virus disease 2019 pandemic. Currently, healthcare organizations are overwhelmed with ill patients who require RNs with specialty experiences. Curtailment and cancellation by healthcare organizations of civilian and military transition-to-practice programs for newly licensed RNs are at risk. If this phenomenon continues, current and future nursing shortages will prevail.
Improving Postoperative Outcomes in Lower Extremity Amputees Utilizing a Quality Improvement Approach
Authors: Loker Kristin M.
Published: May 2021

This project focused on adult lower extremity amputees from March 2017 through March 2019. The aim was to improve 30-day surgical site infection (SSI) rates by 10% in two orthopaedic populations. Subaims focused on 30-day readmission rates, length of stay, and 30-day mortality rates. The primary intervention of incisional negative pressure wound vac therapy (iNPWT) device application was instituted. This was supported by World Health Organization recommendations, meta-analyses, and consensus statements advising the utilization of iNPWT devices. Plan–Do–Study–Act cycles were aimed at education, operation efficiency, and patient engagement. By March 2019, goals were met for SSI and 30-day readmission rates in each division. Cost analysis showed a savings of $38,500. Improved clinical significance was noted in SSI rates, 30-day readmission rates, and cost in lower extremity amputees. It is unclear whether the innovation led to improvement in the other subaims; however, this revealed areas for additional areas for improvement.
Ketamine for Pain Management
Authors: Caruso Kelsea , Tyler Dion , Lyden Abbie
Published: May 2021

Ketamine is a dissociative anesthetic used increasingly as analgesia for different manifestations of pain, including acute, chronic, cancer and perioperative pain as well as pain in the critically ill patient population. Its distinctive pharmacologic properties may provide benefits to individuals suffering from pain, including increased pain control and reduction in opioid consumption and tolerance. Despite wide variability in proposed dosing and method of administration when used for analgesia, it is important all clinicians be familiar with the pharmacodynamics of ketamine in order to appropriately anticipate its therapeutic and adverse effects.
Outcomes of orthopaedic trauma surgery in COVID-19 positive patients
Authors: Al-Humadi Samer M. , Tantone Ryan , Nazemi Alireza K. , Hays Thomas , Pawlak Amanda , Komatsu David E. , Namm Joshua D.
Published: May 2021

Objectives:

To investigate outcomes for operative orthopaedic trauma in patients who tested positive for coronavirus disease 2019 (COVID-19) during the height of the COVID-19 pandemic in New York.

Design:

Retrospective case series.

Setting:

Urban Level-1 academic trauma center.

Patients/participants:

Thirteen patients diagnosed with COVID-19 who underwent surgical management for orthopaedic trauma between January 21, 2020 and May 11, 2020.

Intervention:

Does not apply to this study.

Main outcome measurements:

Complications including death, coma lasting more than 24 hours, prolonged mechanical ventilation, unplanned intubation, blood transfusion, postoperative pneumonia, cerebrovascular event, thromboembolic event, myocardial infarction, urinary tract infection, acute renal failure, septic shock, return to the operating room, wound dehiscence, surgical site infection, graft/prosthesis/flap failure, and peripheral nerve injury.

Results:

Two (18%) patients had symptoms of COVID-19 (cough, shortness of breath, fevers, chills, nausea/vomiting, diarrhea, abdominal cramps/pains) on admission. Average length of stay (standard deviation) was 6.6 (4.31) days. Average time to follow up was 29 (10.77) days. Three (27%) patients developed pneumonia postoperatively and 1 (9%) underwent unplanned intubation. One (9%) patient was intubated for greater than 48 hours. Two (18%) patients developed postoperative deep venous thromboembolism. Three (27%) patients developed acute renal failure postoperatively. Six (55%) patients underwent blood transfusion intraoperatively or postoperatively. Two (18%) patients died postoperatively.

Conclusion:

In this small series surgical management in Coronavirus-19 positive patients with skeletal injuries was successfully accomplished with patient anticoagulation, hematologic, and pulmonary status in mind. Therapeutic anticoagulation and patient hematologic status were optimized prior to the operating room to minimize development of venous thromboembolism and avoid blood transfusion.

Level of evidence:

Level IV prognostic
Core Stability Exercises Yield Multiple Benefits for Patients With Chronic Stroke
Authors: Karthikbabu Suruliraj , Ganesan Sailakshmi , Ellajosyula Ratnavalli , Solomon John M. , Kedambadi Rakshith C. , Mahabala Chakrapani
Published: May 2021

Objective

This study examined the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of people with chronic stroke.

Design

This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigned to three training groups. Two experimental groups practiced core stability exercises either on stable or on unstable support surfaces. In contrast, the control group received standard physiotherapy. All the participants underwent an hour-long training session a day, thrice a week over a 6-wk duration, and followed-up after 12 mos. Trunk Impairment Scale, core muscle strength, weight-bearing asymmetry in standing, and Activities-specific Balance Confidence scale were the outcome measures.

Results

Compared with the control group, the two experimental groups demonstrated a significant improvement on all the outcome measures from baseline to posttraining and from baseline to 12-mo follow-up (P < 0.001). The two experimental groups demonstrated no significant difference between them on all the measures (P > 0.05).

Conclusions

Core stability exercises on stable and unstable support surfaces are equally beneficial in improving trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of ambulatory patients with chronic stroke than the standard physiotherapy.
The Effects of Inactive Platelet-rich Plasma at Different Injection Time on Prefabricated Flap Viability in Rabbits
Authors: Zhang Hua , Zhang Tiran , Chen Hongbo , Zeng Yan , Su Zhiguo , Fan Jincai
Published: May 2021

Purpose

To evaluate the effect of inactive form of platelet-rich plasma (PRP) at different injection time on the prefabricated flap viability in rabbits.

Methods

A thoracodorsal artery vascular bundle prefabricated flap was established on the back of 30 healthy male New Zealand white rabbits by 2 phases of operations. A total of 60 sides were randomly divided into the experimental side and the control side. The experimental side was injected with autologous inactive PRP around the thoracodorsal vascular bundle, and the control side was injected with the same amount of normal saline. According to preoperative (group A), intraoperative (group B), and postoperative (group C) injection of PRP, 30 rabbits were divided into 3 groups of 10 each. Histological and immunohistochemical observation, vascular density measurement, and lead oxide angiography were used to compare the differences in the survival of prefabricated flaps between the 3 groups of rabbits injected with inactive PRP at different injection time.

Results

The flap survival ratio, microvessels density, vascular endothelial growth factor and vascular endothelial growth factor receptor 2 expression of PRP injection side were significantly improved compared with the control side. In the comparison of 3 injection time groups, we found that group A and group B could achieve better results, and especially group B had the most significant effect on the revascularization and flap viability.

Conclusion

Autologous inactive PRP can promote the survival of the prefabricated flap, and the intraoperative injection can significantly improve the survival rate of the prefabricated flap. It provides a theoretical guidance for obtaining a larger area of prefabricated axial flap in clinical practice.
Alkalicella caledoniensis gen. nov., sp. nov., a novel alkaliphilic anaerobic bacterium isolated from ‘La Crouen’ alkaline thermal spring, New Caledonia
Authors: Quéméneur Marianne , Erauso Gaël , Bartoli Manon , Vandecasteele Céline , Wils Laura , Gil Lisa , Monnin Christophe , Pelletier Bernard , Postec Anne
Published: May 2021

A novel anaerobic, alkaliphilic, mesophilic, Gram-stain-positive, endospore-forming bacterium was isolated from an alkaline thermal spring (42 °C, pH 9.0) in New Caledonia. This bacterium, designated strain LB2T, grew at 25–50 °C (optimum, 37 °C) and pH 8.2–10.8 (optimum, pH 9.5). Added NaCl was not required for growth (optimum, 0–1 %) but was tolerated up to 7 %. Strain LB2T utilized a limited range of substrates, such as peptone, pyruvate, yeast extract and xylose. End products detected from pyruvate fermentation were acetate and formate. Both ferric citrate and thiosulfate were used as electron acceptors. Elemental sulphur, nitrate, nitrite, fumarate, sulphate, sulfite and DMSO were not used as terminal electron acceptors. The two major cellular fatty acids were iso-C15 : 0 and C16 : 0. The genome consists of a circular chromosome (3.7 Mb) containing 3626 predicted protein-encoding genes with a G+C content of 36.2 mol%. Phylogenetic analysis based on the 16S rRNA gene sequence indicated that the isolate is a member of the family

Proteinivoraceae

, order

Clostridiales

within the phylum

Firmicutes

. Strain LB2T was most closely related to the thermophilic

Anaerobranca gottschalkii

LBS3T (93.2 % 16S rRNA gene sequence identity). Genome-based analysis of average nucleotide identity and digital DNA–DNA hybridization of strain LB2T with

A. gottschalkii

LBS3T showed respective values of 70.8 and 13.4 %. Based on phylogenetic, genomic, chemotaxonomic and physiological properties, strain LB2T is proposed to represent the first species of a novel genus, for which the name Alkalicella caledoniensis gen. nov., sp. nov. is proposed (type strain LB2T=DSM 100588T=JCM 30958T).