bluuebunny/crossref_metadata_2025 huggingface dataset:
Two Successful Livebirths from Both Hemiuteruses After Laparoscopic Cervical Cerclage in a Uterus Didelphys Patient with Cervical Insufficiency
Authors: Zhang Limei , Zhong Xue , Chen Yuqing , Peng Tianyu , Yu Liyun , Cai Jian , Yao Shuzhong , Wang Zilian
Published: March 2022

Uterus didelphys occurs in ∼0.4% of females and is found in ∼11%–20% of all uterus defects. It is a risk factor for cervical insufficiency, consequently contributing to late miscarriage or preterm birth. Thus far, only two prior cases of uterus didelphys accompanied by cervical insufficiency treated through laparoscopic cervical cerclage have been reported; however, livebirth only occurred in one hemiuterus. Herein, we report a case of uterus didelphys in a patient diagnosed with cervical insufficiency. Following the placement of a modified laparoscopic cervical cerclage, the patient had two successful livebirths through both hemiuteruses, respectively, with longer gestation age (ie, >36 weeks). The aim of this case report was to provide useful information for clinical practitioners to make better decisions on the management of cervical insufficiency in patients with uterus didelphys, and identify obstetric complications that clinicians should pay attention to during pregnancy.
Safety of Internal Electronic Fetal Heart Rate Monitoring During Labor
Authors: Liang Yiheng , Li Yun , Huang Chunhua , Li Xiaohong , Cai Qiaoqing , Peng Jiying , Fan Shangrong
Published: March 2022

Objective:

To investigate the safety and efficacy of internal electronic fetal heart rate (FHR) monitoring during labor.

Methods:

This was a retrospective case-control study, which was an analysis of monitoring FHR with a fetal scalp electrode or a Doppler probe (94 pregnant women per group). In the internal monitoring group, when the opening of the uterine orifice was ≥3 cm, the fetal scalp electrode was placed after natural or artificial rupture of the membrane. FHR was simultaneously monitored using a Doppler probe. In the external monitoring group, continuous FHR monitoring was performed using an ultrasound Doppler transducer fixed on the maternal abdomen. The toco transducer was used to record uterine contractions. Pathological examination of the placenta was performed prospectively in 49 and 48 cases in the internal electronic FHR monitoring group and control group, respectively. Maternal-infant outcomes (e.g. fever, puerperal infection, puerperal morbidity, delivery mode, Apgar score, and scalp injury) were recorded. Umbilical artery blood was extracted for blood gas analysis. Differences between the two groups were compared using the paired t-test, χ
2 test, Yates corrected χ
2 test or Fisher exact test.

Results:

Non-statistically significant differences between the internal and external monitoring groups were observed in the incidence of neonatal acidosis (1/94 (1.06%) vs. 3/94 (3.19%), respectively; χ
2 = 0.255, P = 0.613), cesarean section/operative vaginal delivery (8/94 (8.51%) vs. 15/94 (15.96%), respectively; χ
2 = 2.427, P = 0.181), fever during labor (18/94 (19.15%) vs. 15/94 (15.96%), respectively; χ
2 = 0.331, P = 0.565), puerperal morbidity (2/94 (2.13%) vs. 3/94 (3.19%), respectively; χ
2 = 0.000, P 
= 1.000), chorioamnionitis (9/49 (18.37%) vs. 7/48 (14.58%), respectively; χ
2 = 0.252, P 
= 0.616), and neonatal asphyxia (0/94 (0.00%) vs. 1/94 (1.06%), respectively; χ
2 = 0.000, P 
= 1.000). There were no puerperal infections, neonatal scalp injuries, or scalp abscesses found in either group. Using the internal monitoring value as reference, the incidence of FHR false deceleration in external FHR monitoring was 20.21% (19/94 women).

Conclusion:

Internal FHR monitoring during labor does not increase the incidence of adverse perinatal outcomes. External monitoring was associated with FHR false decelerations.
Autologous Breast Reconstruction after Mastectomy for Breast Cancer: A Systematic Review
Authors: Saldanha Ian J. , Broyles Justin M. , Adam Gaelen P. , Cao Wangnan , Bhuma Monika Reddy , Mehta Shivani , Pusic Andrea L. , Dominici Laura S. , Balk Ethan M.
Published: March 2022

Background:

Women undergoing autologous reconstruction (AR) after mastectomy for breast cancer and their surgeons must make decisions regarding timing of the AR and choose among various flap types. We conducted a systematic review to evaluate the comparative benefits and harms of (1) timing of AR relative to chemotherapy and radiation therapy, and (2) various flap types for AR.

Methods:

We searched Medline, Embase, Cochrane CENTRAL, CINAHL, and ClinicalTrials.gov for studies, from inception to March 23, 2021, without language restriction. We assessed risk of bias of individual studies and strength of evidence (SoE) of our findings using standard methods.

Results:

We screened 15,936 citations. Twelve mostly high risk of bias studies, including three randomized controlled trials and nine nonrandomized comparative studies met criteria (total N = 31,833 patients). No studies addressed timing of AR relative to chemotherapy or radiation therapy. Six flap types were compared, but conclusions were feasible for only the comparison between transverse rectus abdominus myocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flaps. The choice of either flap may result in comparable patient satisfaction with breasts and comparable risk of necrosis (low SoE for both outcomes), but TRAM flaps probably pose a greater risk of harm to the area of flap harvest (abdominal bulge/hernia and need for surgical repair) (moderate SoE).

Conclusions:

Evidence regarding details for AR is mostly of low SoE. New high-quality research among diverse populations of women is needed for the issue of timing of AR and for comparisons among flap types.
A Severe Case of Siliconoma-induced Hypercalcemia due to Illicit Gluteal Silicone Injections
Authors: Huff Mallorie L. , Mehta Nitisha , Jacobs Aaron M. , Miles Marshall G.
Published: March 2022

Siliconoma-induced hypercalcemia is a rare complication of siliconoma, occurring secondary to a foreign body granulomatous process induced by the introduction of silicone into soft tissue. This is a case report of a woman presenting with sequelae of illicit silicone injections performed in an unknown woman’s basement in Florida 20 years before presentation. A 39-year-old woman presented with a 2-month history of 20-pound weight loss, malaise, and intractable vomiting with a remote history of unregulated cosmetic injections to the bilateral gluteal and thigh regions. Her laboratory studies were consistent with severe hypercalcemia secondary to a foreign body granulomatous process. Initially, she was medically managed, with mild improvements in her symptomatic hypercalcemia and later underwent palliative debridement with siliconoma removal. Postoperatively, her course was complicated by delayed wound healing and graft failure, but the surgical defect was later closed successfully with split-thickness skin grafting after months of wound care. Although the procedure was not intended to treat her hypercalcemia, there were significant improvements in serum and ionized calcium in the months following her procedure. Severe hypercalcemia in the context of previous unregulated cosmetic injections or possible silicone implant rupture should prompt consideration of siliconoma-induced hypercalcemia as the underlying etiology. In addition to the established utility of IV fluids, bisphosphonates, and glucocorticoids, there may also be a role for surgical intervention in the management of this unique patient population’s hypercalcemia.
Multimodal Studies in Hepatitis B Virus Associated Hepatocellular Carcinoma
Authors: Xie Runze , You Maojun , Wang Xin , Du Shunda , Wang Fu-Sheng , Yang Pengyuan
Published: March 2022

Hepatocellular carcinoma (HCC) is a highly aggressive cancer that ranks the second leading cause of cancer related death. Hepatitis B virus (HBV) infection is the most prevalent etiological factor, especially in eastern world. However, the underlying mechanism of HBV infection-initialed carcinogenic progression remains largely unknown, making it difficult to improve therapeutic strategies for HBV-associated HCC (HBV+ HCC). The virus drives multi-omics changes in human liver cells, leading to genomic instability, epigenomic modifications, and proteomic alterations. HBV infection also orchestrates the immunosuppressive microenvironment in HBV+ HCC. This review summarized recent research progress with the multimodal methods covering genome, transcriptome, epigenome, and proteome introduced in the mechanistic studies for HBV+ HCC.
Long-term Intraocular Pressure Fluctuation Is a Risk Factor for Visual Field Progression in Advanced Glaucoma
Authors: Lee Jihei Sara , Park Sungeun , Seong Gong Je , Kim Chan Yun , Lee Sang Yeop , Choi Wungrak , Bae Hyoung Won
Published: March 2022

Précis:

Intraocular pressure (IOP) fluctuations increase the risk of visual field progression of primary open-angle glaucoma (POAG) in the advanced stage even when IOP is maintained low on average.

Purpose:

The purpose of this study was to identify risk factors associated with the progression of visual field defect in patients with advanced POAG.

Materials and Methods:

A retrospective review of medical records was conducted to identify patients who met the Hodapp-Parrish-Anderson criteria for advanced POAG. A total of 122 eyes of 122 patients had undergone IOP measurement with Goldmann applanation tonometer, standard automated perimetry, Cirrus optical coherence tomography, and fundus photography at 6-month intervals. Visual field progression was defined as the deterioration of a minimum of 3 visual field locations more than baseline at 5% levels in 4 consecutive visual fields with 24-2 SITA testing.

Results:

Thirty-six eyes of 122 eyes (29.5%, 51.9±13.9 y old) showed visual field progression during 100.7±44.2 months of follow-up. The progression group showed greater long-term IOP fluctuations (2.6±1.4 mm Hg) than the no progression group (53.5±13.5 y; 2.0±1.0 mm Hg, P=0.008). Disc hemorrhage was detected more frequently in the progression group (40.5% vs. 17.4%, P=0.005). Multivariate Cox regression analysis revealed long-term IOP fluctuations [hazard ratio (HR)=2.567, 95% confidence interval (CI): 1.327–5.370, P=0.012] and disc hemorrhage (HR=2.351, 95% CI: 1.120–4.931, P=0.024) to be independent risk factors of visual field progression. Patients who showed both disc hemorrhage and long-term IOP fluctuations were at greater risks of progression (HR=2.675, 95% CI: 1.072–6.457, P=0.035).

Conclusions:

Long-term IOP fluctuations and disc hemorrhage are independent and additive risk factors of visual field progression in advanced glaucoma even at low IOPs. Patients in whom these risk factors are identified require close monitoring and vigorous treatment.
Readability of Online Patient Education Materials for Glaucoma
Authors: Cheng Brian T. , Kim Anne B. , Tanna Angelo P.
Published: March 2022

Précis:

We assessed the readability of online glaucoma patient education materials using seven validated instruments. Overall, glaucoma materials were written at a 10th to 11th grade level, above the recommended seventh grade reading level.

Purpose:

Online health information is increasingly used by patients, yet previous studies show online patient education materials are often difficult to understand. As such, the American Medical Association recommends that patient education materials are written at or below a seventh grade reading level. This study aimed to assess the readability of online glaucoma patient education materials.

Methods:

Glaucoma was entered into the Google search engine, and the first 30 search results were assessed for readability using seven validated readability instruments. Scientific articles, forums, and dictionary entries were excluded. Single sample t tests were used to assess whether online glaucoma materials were written above the recommended seventh grade level.

Results:

Overall, glaucoma materials were written at a mean grade level of 10.33 (SD: 2.02). Across 6 grade level readability instruments, these patient education materials were written above the recommended seventh grade reading level (P<0.0001 for all). Glaucoma education materials only on the first page of Google search results were of a similar reading level: mean 10.56 (SD: 2.13). The readability instruments used in this study showed strong consistency.

Conclusions:

Glaucoma patient education materials are written above the recommended reading level to promote accessibility of education materials. This may contribute to lower patient engagement, worse clinical outcomes, and greater racial and ethnic disparities in glaucoma management. There is a need for reliable, simple glaucoma information to improve patient outcomes.
Practice Transformation to Improve Cancer Screening Outcomes at an Academic Medical Center
Authors: Jones Rebecca T. , Schott Mysti , Leverence Robert , Cancino Ramon S.
Published: March 2022

In 2011, Texas received federal approval of the 1115 Healthcare Transformation waiver, which went to support the Texas Delivery System Reform Incentive Payment Program (DSRIP) incentivizing the transformation of service delivery practices which included expanded coverage of preventive cancer screenings. There is limited evidence that quality improvement initiatives stemming from DSRIP improve cancer screening outcomes for the Medicaid, low-income, and uninsured (MLIU) patient population. The present the results of a quality initiative to improve breast, cervical, and colorectal cancer screening rates for MLIU patients receiving primary care at an academic medical center. The initiative included engaging multidisciplinary primary care teams, health information technology (IT), and quality departments to standardize workflows. We found significantly improved rates of cervical and colorectal cancer screening among patients eligible to receive one or more screenings. Aligning primary care, IT, and quality processes resulted in significant improvement in cancer screening.
The Effects of Cooling Time on the Dimensional Stability of Thermoforming Polypropylene
Authors: Ojeda Sersun David J. , Swafford Katie , Orosco Heather , Rodgers Chelsie , Davidson Michael , Bains Gurinder , Becerra Ben
Published: March 2022

Introduction

Documented by the International Committee of the Red Cross, consolidation time for polypropylene (PP) plastic must be left on the plaster model for 24 hrs. If not followed, this will result in an incorrect shape and volume of PP plastic. To the best of our knowledge, there are no studies that address the comparison of PP plastic expansion at various time domains of plastic cooling after being thermoformed.

The purpose of this research was to compare plastic expansion or shrinkage and heat ratio (dimensional stability [DS]) of PP plastic through cooling periods of 6, 12, 18, and 24 hrs, respectively.

Materials and Methods

Forty-one identical plaster models were made. Vacuum was applied at times of 6, 12, 18, and 24 hrs, respectively. PP was cut and removed. Measurements were taken and recorded at initial times and after 24 hrs.

Results

DS was not significantly different across the four time groups of 6, 12, 18, and 24 hrs, respectively (P = 0.10). There was a statistically significant linear relationship between DS with room temperature (P = 0.01) and oven temperature (P = 0.04).

Conclusions

There is no scientific foundation to perform a 24-hr wait before finishing a device. This translates to an effective time frame for removing the plastic from the model, saving time and resources, quicker delivery to the patient, and improvement in whole patient care.

Clinical Relevance

This article has important implications for the O&P clinic. Creating more dimensionally stable PP devices faster translates to better fitting braces fabricated in a shorter time, thus benefiting patients and clinics and increasing the success rate when delivering this device.
Running During Pregnancy and Postpartum, Part B: How Does Running-Related Advice and Guidance Received During Pregnancy and Postpartum Affect Women's Running Habits?
Authors: Donnelly Gráinne M. , James Megan L. , Coltman Celeste E. , Brockwell Emma , Perkins Joanna , Moore Isabel S.
Published: March 2022

Background:

Women are unsure about the suitability and safety of running when pregnant and postpartum, with advice from medical professionals often conflicting.

Aim:

To explore the exercise and running-related advice pregnant and postpartum women received and the impact it has on their running habits.

Study Design:

Observational, cross-sectional.

Methods:

A total of 883 postpartum women completed an online survey. Questions were developed using pregnancy exercise guidance and clinical postpartum running guidelines. Odds ratios (ORs) were used to assess associations between receiving prenatal advice and receiving postpartum advice, receiving prenatal advice and continuing to run through pregnancy and return-to-running postpartum and receiving broadly sourced running-related guidance.

Results:

Postpartum women who received prenatal exercise advice and broadly sourced postpartum running advice were 37% and 31%, respectively. Those who received prenatal advice were more likely to receive postpartum advice (OR: 1.78, 95% confidence interval [CI]: 1.33-2.38). Receiving exercise-related advice was not associated with continuing to run during pregnancy (OR: 1.17, CI: 0.89-1.54). Having returned to running postpartum was associated with receiving broadly sourced postpartum running-related guidance (OR: 2.19, CI: 1.45-3.32). Women who were aware of the return-to-running clinical guidelines took longer to return-to-running than those who were not aware [14 (10-20) vs 10 (6-16.5) weeks, respectively, U = 34 889, P < .001].

Conclusion:

Exercise and running guidance was only provided to a small proportion of women. To influence exercise habits and return-to-running, guidance needs to be individualized and specific to the needs of perinatal women.
Evaluating the Revised Work Rehabilitation Questionnaire in Cochlear Implant Users Cochlear Implant Outcome Assessment Based on the International Classification of Functioning, Disability, and Health (ICF)
Authors: Andries Ellen , Lorens Artur , Skarżyński Piotr Henryk , SkarZynski Henryk , Calvino Miryam , Gavilan Javier , Lassaletta Luis , Tavora-Vieira Dayse , Acharya Aanand , Kurz Anja , Hagen Rudolf , Anderson Ilona , Amann Edda , Van de Heyning Paul , Van Rompaey Vincent , Mertens Griet
Published: March 2022

Objectives:

The 59-item Work Rehabilitation Questionnaire (WORQ) was developed based on the International Classification of Functioning, Disability and Health (ICF) core set for vocational rehabilitation to assess work related functioning. It was revised to include 17 questions, assigned to 14 ICF categories relevant to cochlear implant (CI) users. This cross-sectional multicenter study aimed to evaluate CI users’ responses on the WORQ questions to describe and generate ICF qualifiers for the revised WORQ in CI users, forming part of a broader framework of CI outcome measures linked to the ICF.

Methods:

One hundred seventy-seven adults over the age of 18 years with a minimum of one year's device experience were included in the analysis. The WORQ was completed by the participants at a routine visit to the clinic, via email, or via post.

Results:

Most of the CI users perceived no problem on the WORQ questions (53.7%-91%), finished secondary school (54.2%) or obtained a college or university degree (32.8%) and are either employed (41.2%) or retired (34.5%). CI users that are currently working mostly have a full-time position (34.5%). Subjects reported no problem (91%) with sensation of falling, while handling communication devices and techniques (10.9%) and tinnitus (9.6%) showed the highest number of subjects reporting a complete problem.

Conclusions:

Overall, most of the CI users experienced no impairment, restriction or limitation on the WORQ questions and their assigned ICF categories. Their education level resembles the education level of the general population and they seem to integrate or reintegrate well in professional life postoperatively.
Symptom Burden and Recovery in the First Year After Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Eriksson Linda Victoria , Holmberg Katarina , Lundh Hagelin Carina , Wengström Yvonne , Bergkvist Karin , Winterling Jeanette
Published: March 2022

Background

Patients are affected by various symptoms after allogeneic hematopoietic stem cell transplantation (allo-HSCT) that can affect recovery. Research has mainly focused on symptom occurrence; thus, little is known about patients’ overall symptom burden.

Objective

The aim of this study was to examine patient-reported symptom burden in the first year after allo-HSCT and whether a high symptom burden 4 months after allo-HSCT predicts recovery, that is, general health and sick leave, 1 year after transplantation.

Methods

Allo-HSCT patients aged 18 to 65 years were included (n = 189). Questionnaire data were collected on admission to the allo-HSCT unit, as well as 4 and 7 months and 1 year after allo-HSCT. Logistic regression evaluated relationships between demographic characteristics, chronic graft-versus-host disease, physical activity, and a high symptom burden.

Results

Tiredness, susceptibility to infection, disinterest in sex, and physical weakness remained the most frequent symptoms, while distressing symptoms varied during the first year after allo-HSCT.

Poor general health 1 year after allo-HSCT was associated with older age, low physical activity, and a high symptom burden 4 months after allo-HSCT. Full-time sick leave 1 year after allo-HSCT was associated with chronic graft-versus-host disease, low physical activity, and a high symptom burden 4 months after transplantation.

Conclusions

Experiencing a high symptom burden 4 months after allo-HSCT can affect recovery 1 year after transplantation. Furthermore, low physical activity 4 months after allo-HSCT can predict both general health and sick leave 1 year after transplantation.

Implications for Practice

Repeated symptom assessment, including experienced distress, is central for reducing overall symptom burden and supporting recovery after allo-HSCT.
Exploring Clinicians’ Perspectives of Barriers to Chemotherapy-Induced Peripheral Neuropathy Assessment and Management in Oncology Practice
Authors: Knoerl Robert , Wallar Jessica , Fox Erica , Hong Fangxin , Salehi Elahe , McCleary Nadine , Ligibel Jennifer A. , Reyes Kaitlen , Berry Donna L.
Published: March 2022

Background

Quantitative reports suggest that the assessment and management of chemotherapy-induced peripheral neuropathy (CIPN) in practice is suboptimal.

Objective

The purpose of this qualitative analysis was to explore clinician-related perspectives of CIPN assessment, management, and the use of a CIPN decision support tool.

Methods

Clinicians from the breast oncology, gastrointestinal oncology, or multiple myeloma disease centers at Dana-Farber Cancer Institute who interacted with a CIPN clinician decision support algorithm were eligible to participate in the semi-structured interviews. The interview guide included questions about CIPN assessment, management, and clinician-decision support tool use. All interviews were audio-recorded, transcribed, and analyzed using inductive content analysis.

Results

Of the 39 eligible clinicians, 15 agreed to be interviewed. Interviewed clinicians were mainly physicians (73.3) and White, non-Hispanic (93.3%). Main themes from the interviews included (1) CIPN management practice patterns (eg, endorsement of non-recommended management strategies or lack of standardization for chemotherapy dose reduction) and barriers (eg, insurance prior authorizations required for duloxetine prescription), (2) CIPN assessment practice patterns (eg, use of subjective instead of objective CIPN assessment approaches) and barriers (eg, difficult to interpret patients’ CIPN report between visits), and (3) utilization of the clinician decision support tool (eg, all assessment tasks lead to same management options).

Conclusions

There are several barriers to clinicians’ use of evidence-based CIPN assessment and management strategies.

Implications for Practice

Future work should be focused on addressing barriers to duloxetine prescription, developing evidence-based CIPN assessment and management strategies, improving symptom monitoring, and facilitating referrals to existing supportive care services.
Retiring From Pediatric Emergency Medicine Too Soon?
Authors: Bansal Bharati Beatrix , Mathew Matthew Sunil , Booker-Nubie Quiera , Messiah Sarah E. , Wang Vincent J.
Published: March 2022

Objective

Pediatric emergency medicine is a subspecialty known for high acuity, high stress, and variable scheduling that may be difficult to maintain as one gets older. This survey sought to gain information on the reasons or plans for early retirement in pediatric emergency medicine and offer ways to address these concerns to improve longevity in the field.

Methods

A cross-sectional survey was sent via email to board-certified pediatric emergency medicine physicians who were older than 50 years to assess preretirement and postretirement considerations. Results were collected from October 3, 2019, through March 15, 2020.

Results

Pediatric emergency medicine physicians who find it more difficult to perform simple procedures are 3.02 (1.23–7.36) times more likely to retire before the age of 66 years. In addition, women were significantly more likely to report an intention to retire before the age of 66 years versus men (50% vs 31%, P = 0.022).

Discussion

The topic of retirement in a field that requires a wide range of procedural skills as well as constantly evolving technology is important. Understanding when and why physicians choose to retire may identify strategies to make it possible for pediatric emergency medicine physicians to prolong their careers. This may involve changes in work hours, a shift in responsibilities to a greater educational or mentor role, and/or providing opportunities to maintain skills.

Conclusions

Perceived basic procedure skills deterioration significantly increased the risk for early retirement. In addition, women were significantly more likely to express intention to retire before the age of 66 years. Further research should be directed toward obtaining more detailed information to develop strategies to retain pediatric emergency medicine physicians in a capacity that benefits the physician, their institution, and their patients.
The chronic disease helplessness survey: developing and validating a better measure of helplessness for chronic conditions
Authors: Yessick Lindsey R. , Salomons Tim V.
Published: March 2022

Introduction:

Learned helplessness develops with prolonged exposure to uncontrollable stressors and is therefore germane to individuals living with pain or other poorly controlled chronic diseases. This study has developed a helplessness scale for chronic conditions distinct from previous scales that blur the conceptualization of control constructs. Extant measures commonly examine controllability, not the three pillars of helplessness identified by Maier and Seligman (1976): cognitive, emotional, and motivational/motor deficits.

Methods:

Individuals who self-report a chronic pain condition (N = 350) responded to a Chronic Disease Helplessness Survey (CDHS) constructed to capture cognitive, motivational/motor, and emotion deficits. Exploratory factor analysis (EFA; N = 200) and confirmatory factor analysis (CFA; N = 150) were performed. The CDHS was assessed for convergent and discriminant validity.

Results:

A three-factor solution corresponding to cognitive, emotional, and motivational/motor factors was identified by EFA. The solution exhibited sufficient model fit and each factor had a high degree of internal consistency. The CDHS was significantly associated with greater pain intensity and interference, PCS helplessness, lower perceived pain control, and lower general self-efficacy. Individuals with diabetes generally experience greater control strategies over daily symptoms (e.g., diet, oral medications, and insulin) than patients with chronic pain and in this study displayed significantly lower CDHS scores compared to individuals with chronic pain, demonstrating discriminant validity.

Conclusions:

This study provides preliminary evidence that the three-factor CDHS is a psychometrically sound measure of helplessness in individuals with chronic pain.
Safety of Mandibular Osteotomies in Infants with Pierre Robin Sequence: Computer-Aided Modeling to Characterize the Risks of Various Techniques
Authors: Siska Robert C. , Prabhu Shamit S. , Lor Lyfong S. , Emmerich Veronica , Massary Dominic , Pan Brian S. , Flores Roberto L. , Runyan Christopher M.
Published: March 2022

Background:

Mandibular distraction osteogenesis is effective for the correction of severe tongue-based airway obstruction in infants with Pierre Robin sequence. Involved osteotomies may damage developing tooth buds and/or the inferior alveolar nerve. The authors evaluated the theoretical safety of various osteotomy techniques to better define infantile mandibular anatomy using computer-aided modeling.

Methods:

Seven mandibular osteotomy techniques (oblique, inverted-L, multiangular, walking stick, high oblique, vertical/high inverted-L, and horizontal) were simulated using computed tomography studies from infants with Pierre Robin sequence and without other associated conditions. Software was used to manually segment the mandibular bone, inferior alveolar nerve, and tooth buds.

Results:

Sixty-five computed tomography scans were included, yielding 130 hemimandibles. The horizontal osteotomy pattern had significantly lower theoretical risk of tooth bud (p < 0.001) and inferior alveolar nerve involvement (p < 0.001) than all other patterns. Osteotomies with high vertical components (i.e., vertical, walking stick, and multiangular) had lower theoretical tooth bud involvement than the more proximal oblique and inverted-L osteotomies (p < 0.001). Average lingula location was measured at a point 65 percent of the mandibular width from anterior mandibular border and 63 percent of the mandibular height from the inferior mandibular border.

Conclusions:

Surgical planning with computed tomography scans can help evaluate an infant’s mandibular anatomy to select an osteotomy that reduces morbidity risks. Regardless of technique, tooth buds and the inferior alveolar nerve are often included in osteotomies. The lingula location in this study demonstrates a position more superior and posterior than that previously described.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Buccal Fat Pad: Adjunctive Procedure for Lateral Defect Coverage following Primary Palatoplasty
Authors: Thanapaisal Chantaramon , Punyavong Pattama , Jenwitheesuk Kamonwan , Surakunprapha Palakorn , Winaikosol Kengkart
Published: March 2022

Background:

The buccal fat flap is an encapsulated mass originating from a specific fat tissue that is easily accessed and richly vascularized. The aim of this study was to report the effect of using the buccal fat flap on the oronasal fistula rate in primary palatoplasty.

Methods:

A case-controlled study of 94 patients who underwent primary cleft palate repair. Patients were divided into two groups: (1) two-flap palatoplasty with buccal fat flap for coverage of lateral hard palate defect and (2) conventional two-flap palatoplasty. The incidence of oronasal fistula and postoperative complications were compared between groups. Multivariate analysis was performed to determine the risk factors of oronasal fistula development.

Result:

Forty-seven patients in each group demonstrated the same baseline characteristics. The buccal fat group showed a significant lower postoperative oronasal fistula rate (2.13 percent versus 21.28 percent, p = 0.008) and smaller fistula size (2 mm versus 4 mm, p = 0.049). A cleft width wider than 11.5 mm increased the odds ratio of fistula formation by 8.44-fold (p = 0.047), and the use of buccal fat protected against postoperative palatal fistula formation (OR, 0.08, p = 0.019).

Conclusion:

The use of buccal fat flaps for lateral hard palatal defect coverage in primary palatoplasty can reduce the rate of postoperative palatal fistula, especially in cases of wide palatal cleft.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Evolving patterns of antiretroviral drug interactions in people with HIV in British Columbia, Canada
Authors: Lepik Katherine J. , Wang Lu , Harris Marianne , McLinden Taylor , Guliani Sidhant , Akagi Linda , Toy Junine , Sereda Paul , Lima Viviane D. , Montaner Julio S.G. , Barrios Rolando
Published: March 2022

Objectives:

To characterize the annual prevalence of antiretroviral/nonantiretroviral drug interactions in relation to antiretroviral therapy (ART)-prescribing patterns, and to describe drug interaction-related ART changes.

Design/methods:

This cohort study included ART-treated adults in British Columbia, Canada between 01 January 2010 and 31 December 2016. Medication dispensing records were abstracted from a population-based, linked administrative-health dataset and used to identify antiretroviral-comedication drug interactions (’caution’/’avoid’ drug interactions in HIV-focused drug interaction checkers). We identified temporal trends in annual drug interaction prevalence and quantified the association between taking higher drug interaction-risk ART and receiving nonrecommended antiretroviral-comedication combinations using Poisson regression models, modified for binary outcomes and correlated data. Clinician-reported, drug interaction-related ART changes and associated adverse events were abstracted from an HIV drug treatment registry and summarized descriptively.

Results:

Among 8571 ART-treated adults who received nonantiretroviral comedications, prevalence of having any drug interaction or receiving nonrecommended drug combination(s) significantly declined from 85 to 71% and 5.6 to 3.2%, respectively, between 2010 and 2016 (P < 0.001). This paralleled a shift from higher drug interaction-risk ART (e.g. ritonavir/cobicistat-boosted protease inhibitors) to lower drug interaction-risk ART (e.g. unboosted integrase inhibitors). Risk of receiving a nonrecommended antiretroviral-comedication combination was greater for persons taking higher vs. lower drug interaction-risk ART [adjusted risk ratio (aRR) 3.12, 95% confidence interval (CI) 2.24–4.35]. Boosted antiretroviral-inhaled corticosteroid drug interactions accounted for the most commonly dispensed, nonrecommended drug combinations, and the most commonly reported drug interaction-related adverse events (adrenal insufficiency).

Conclusion:

The prevalence of antiretroviral-comedication drug interactions is declining as ART shifts towards antiretrovirals with lower drug interaction potential but nonrecommended drug combinations remain a concern. Healthcare providers should screen for drug interactions whenever drugs are prescribed or dispensed.
Five-year Outcome of an Early Everolimus-based Quadruple Immunosuppression in Lung Transplant Recipients: Follow-up of the 4EVERLUNG Study
Authors: Kneidinger Nikolaus , Valtin Christina , Hettich Ina , Frye Björn Christian , Wald Alexandra , Wilkens Heinrike , Bessa Vasiliki , Gottlieb Jens
Published: March 2022

Background.

Everolimus-based quadruple low calcineurin inhibitor (CNI) maintenance immunosuppression has been shown to be effective in preserving short-term renal function without compromising efficacy or safety after lung transplantation; however, long-term benefit remains unknown.

Methods.

An investigator-initiated 5-y follow-up analysis of the 4EVERLUNG study (NCT01404325), comparing everolimus-based quadruple low CNI with standard triple regimen, was performed. Patients who remained on the randomized drug regimen until the end of the 5-y observation were analyzed as the per protocol (PP) population. Patients in whom the assigned regimen was switched were analyzed as the intention-to-treat (ITT) population.

Results.

In total, 123 patients (95%) from the core study were analyzed. During the observation period in 11 patients (19%) of the standard triple regimen and in 30 patients (46%) of the quadruple low CNI regimen, the assigned immunosuppressive regimen was switched (P = 0.002). Estimated glomerular filtration rate at 5-y follow-up did not differ between the groups in both the ITT (56 [48–73] versus 58 [48–69] mL/min; P=0.951) and PP (59 [50–73] versus 59 [48–69] mL/min; P = 0.946) populations. Thromboembolic events occurred more frequently in the quadruple low CNI regimen (ITT: 11% versus 24%, P = 0.048; PP: 11% versus 22%, P = 0.162). There was a trend for a higher chronic lung allograft dysfunction–free survival for the quadruple low CNI regimen in the PP population (P = 0.082). No difference in the graft survival was found.

Conclusions.

Initiation of an early everolimus-based quadruple low CNI regimen may have no long-term benefit on renal function. The immunosuppressive efficacy and safety profile seems comparable with the standard triple regimen.
Mechanisms of coronavirus infectious disease 2019-related neurologic diseases
Authors: Klein Robyn S.
Published: March 2022

Purpose of review

As of January 8, 2022, a global pandemic caused by infection with severe acute respiratory syndrome coronavirus (SARS-CoV)-2, a new RNA virus, has resulted in 304,896,785 cases in over 222 countries and regions, with over 5,500,683 deaths (www.worldometers.info/coronavirus/). Reports of neurological and psychiatric symptoms in the context of coronavirus infectious disease 2019 (COVID-19) range from headache, anosmia, and dysgeusia, to depression, fatigue, psychosis, seizures, delirium, suicide, meningitis, encephalitis, inflammatory demyelination, infarction, and acute hemorrhagic necrotizing encephalopathy. Moreover, 30–50% of COVID-19 survivors develop long-lasting neurologic symptoms, including a dysexecutive syndrome, with inattention and disorientation, and/or poor movement coordination. Detection of SARS-CoV-2 RNA within the central nervous system (CNS) of patients is rare, and mechanisms of neurological damage and ongoing neurologic diseases in COVID-19 patients are unknown. However, studies demonstrating viral glycoprotein effects on coagulation and cerebral vasculature, and hypoxia- and cytokine-mediated coagulopathy and CNS immunopathology suggest both virus-specific and neuroimmune responses may be involved. This review explores potential mechanistic insights that could contribute to COVID-19-related neurologic disease.

Recent findings

While the development of neurologic diseases during acute COVID-19 is rarely associated with evidence of viral neuroinvasion, new evidence suggests SARS-CoV-2 Spike (S) protein exhibits direct inflammatory and pro-coagulation effects. This, in conjunction with immune dysregulation resulting in cytokine release syndrome (CRS) may result in acute cerebrovascular or neuroinflammatory diseases. Additionally, CRS-mediated loss of blood-brain barrier integrity in specific brain regions may contribute to the expression of proinflammatory mediators by neural cells that may impact brain function long after resolution of acute infection. Importantly, host co-morbid diseases that affect vascular, pulmonary, or CNS function may contribute to the type of neurologic disease triggered by SARS-COV-2 infection.

Distinct effects of SARS-CoV-2 S protein and CNS compartment- and region-specific responses to CRS may underlie acute and chronic neuroinflammatory diseases associated with COVID-19.
Einstein flow with matter sources: stability and convergence
Authors: Moncrief Vincent , Mondal Puskar
Published: March 2022

Two recent articles (Moncrief V. 2015 InGeneral relativity and gravitation-A centennial perspective(eds A Asthekar, B Berger, J Isenberg, M MacCallum), pp. 480–498. Cambridge, UK: Cambridge University Press; Moncrief V, Mondal P. 2019Pure Appl. Math. Q.15, 921–965. (doi:10.4310/PAMQ.2019.v15.n3.a7)) suggested an interesting dynamical mechanism within the framework of the vacuum Einstein flow (orEinstein-Λflow if a positive cosmological constantΛis included) which suggests that many closed (compact without boundary) manifolds that do not support homogeneous and isotropic metricsat allwill nevertheless evolve to be asymptotically compatible with the observed approximate homogeneity and isotropy of the physical universe. These studies however did not include matter sources. Therefore, the aim of the present study is to include suitable matter sources and investigate whether one is able to draw a similar conclusion.

This article is part of the theme issue ‘The future of mathematical cosmology, Volume 1’.
100 years of mathematical cosmology: Models, theories, and problems, Part A
Authors: Cotsakis Spiros , Yefremov A. P.
Published: March 2022

An elementary survey of mathematical cosmology is presented. We cover certain key ideas and developments in a qualitative way, from the time of the Einstein static universe in 1917 until today. We divide our presentation into four main periods, the first one containing important cosmologies discovered until 1960. The second period (1960–80) contains discussions of geometric extensions of the standard cosmology, singularities, chaotic behaviour and the initial input of particle physics ideas into cosmology. Our survey for the third period (1980–2000) continues with brief descriptions of the main ideas of inflation, the multiverse, quantum, Kaluza-Klein and string cosmologies, wormholes and baby universes, cosmological stability and modified gravity. The last period that ends today includes various more advanced topics such as M-theoretic cosmology, braneworlds, the landscape, topological issues, the measure problem, genericity, dynamical singularities and dark energy. We emphasize certain threads that run throughout the whole period of development of theoretical cosmology and underline their importance in the overall structure of the field. This is Part A of our survey covering the first two periods of development of the subject. The second part will include the third and fourth periods. We end this outline with an inclusion of the abstracts of all papers contributed to the Philosophical Transactions of the Royal Society A theme issue, ‘The Future of Mathematical Cosmology’.

This article is part of the theme issue ‘The future of mathematical cosmology, Volume 1’.
New futures for cosmological models
Authors: Fernández-Jambrina Leonardo , Lazkoz Ruth
Published: March 2022

The discovery of accelerated expansion of the Universe opened up the possibility of new scenarios for the doom of our space–time, besides eternal expansion and a final contraction. In this paper, we review the chances that may await our universe. In particular, there are new possible singular fates (sudden singularities, big rip, etc.), but there also other evolutions that cannot be considered as singular. In addition to this, some of the singular fates are not strong enough in the sense that the space–time can be extended beyond the singularity. For deriving our results, we make use of generalized power and asymptotic expansions of the scale factor of the Universe.

This article is part of the theme issue ‘The future of mathematical cosmology, Volume 1’.
ACE2 gene expression and inflammatory conditions in periodontal microenvironment of COVID-19 patients with and without diabetes evaluated by qPCR
Authors: Bachtiar Boy M. , Bachtiar Endang W. , Sunarto Hari , Soeroso Yuniarti , Sulijaya Benso , Theodorea Citra Fragrantia , Pratomo Irandi Putra , Yudhistira  , Kusumaningrum Ardiana , Efendi Defi , Apriyanti Efa , Utami Nastiti Rilo , Deviana Astri , Andriyani Anissa Dien
Published: March 2022

Objective

Chronic periodontitis has been proposed to be linked to coronavirus disease (COVID-19) on the basis of its inflammation mechanism. We aimed to evaluate this association by investigating the expression of Angiotensin Converting Enzyme-2 (ACE2) in periodontal compartments, which contain dysbiosis-associated pathogenic bacteria, and how it can be directly or indirectly involved in exacerbating inflammation in periodontal tissue.

Material and Methods

This observational clinical study included 23 adult hospitalized patients admitted to Universitas Indonesia Hospital with PCR-confirmed COVID-19, while 6 non-COVID-19 participants come to periodontal clinic were included as control. Using real time-PCR (qPCR) and gingival crevicular fluids (GCF) samples from COVID-19 patients with and without diabetes and periodontitis, we assessed the mRNA expression of angiotensin-converting enzyme 2 (ACE2), IL-6, IL-8, complement C3, and LL-37 as well as the relative proportion of Porphyromonas gingivalis, Fusobacterium nucleatum, and Veillonella parvula to represent the dysbiosis condition in periodontal microenvironment. All analyses were performed to determine their relationship.

Results

ACE2 mRNA expression was detected in the GCF of periodontitis-COVID-19 patients with and without diabetes. However, only periodontitis-COVID-19 patients with diabetes showed a positive relationship between ACE2 expression and inflammatory conditions in the periodontal microenvironment. In addition, the interplay between pro-inflammatory cytokine (IL-6) and complement C3 could be used as a predictor of the severity of periodontal inflammation in COVID-19 patients with diabetes.

Conclusion

The study data show that the SARS-CoV-2 entry gene is expressed in the GCF of patients with COVID-19, and its expression correlates with inflammatory markers.
Presence of Mediastinal Lymphadenopathy in Hospitalized Covid-19 Patients in a Tertiary Care Hospital in Pakistan – A cross-sectional study
Authors: Bhatti Faryal S. , Malik Amyn A. , Malik Adeel A.
Published: March 2022

Background

The aim of this study was to investigate the presence of mediastinal lymphadenopathy in hospitalized Covid-19 patients in a tertiary care hospital in the metropolitan city of Lahore, Pakistan from September 2020 till July 2021.

Methods

We retrospectively collected data of Covid-19 patients hospitalized from September 2020 till July 2021. Only those patients who tested PCR positive through a nasopharyngeal swab, were enrolled in the study. Patients’ whose data were missing were excluded from this study. Our exclusion criteria included patients who tested negative on Covid-19 PCR, patients with comorbidities that may cause enlarged mediastinal lymphadenopathies such as haemophagocytic lymphohistiocytosis, neoplasia, tuberculosis, sarcoidosis or a systemic disease. The extent of lung involvement in Covid-19 patients was quantified by using a 25-point visual quantitative assessment called the Chest Computed Tomography Score. This score was then correlated with the presence of mediastinal lymphadenopathy.

Findings

Of the 210 hospitalized patients included in the study, 131 (62.4%) had mediastinal lymphadenopathy. The mean and median Severity Score of Covid-19 patients with mediastinal lymphadenopathy (mean: 17.1, SD:5.7; median: 17, IQR: 13-23) were higher as compared to those without mediastinal lymphadenopathy (mean: 12.3, SD:5.4; median: 12, IQR:9-16)

Interpretation

Our study documents a high prevalence of mediastinal lymphadenopathy in hospitalized patients with Covid-19 with the severity score being higher in its presence representing a more severe course of disease.