bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain-related Self-efficacy Among People With Back Pain
Authors: Vergeld Vera , Utesch Till
Published: February 2020

Background:

Before an intervention can be implemented to improve pain-related self-efficacy, assessment is required. The aim of the present study was to provide a systematic review on which self-efficacy scales are being used among patients with back pain and to evaluate their psychometric properties.

Methods:

A systematic search was executed in January 2019 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist served as a guide for conducting the study. Electronic databases included Cinahl, Medline, PubMed, PsycINFO, PSYNDEX, and SportDiscus. Publications in English or German language that focused on the adult patient population with back pain and which provided validation or reliability measures on pain-related self-efficacy were included.

Results:

A total of 3512 records were identified resulting in 671 documents after duplicates were removed. A total of 233 studies were screened full-text, and a total of 47 studies addressing 19 different measures of pain-related self-efficacy were included in the quality analysis. The most commonly used instruments were the Pain Self-Efficacy Questionnaire and the Chronic Pain Self-Efficacy Scale. All studies reported internal consistency, but many studies lacked other aspects of reliability and validity.

Conclusions:

Further research should focus on assessing validity and interpretability of these questionnaires, especially in pain-related target groups. Researchers should select questionnaires that are most appropriate for their study aims and the back pain population and contribute to further validation of these scales to best predict future behavior and develop intervention programs. This systematic review aids selection of pain-related assessment tools in back pain both in research and practice.
Significance of Asymmetry of Groin and Thigh Skin Creases in Developmental Dysplasia of the Hip Revisited: Results of a Comparative Study
Authors: Ömeroğlu Hakan , Tatlici Erdem , Köse Nusret
Published: February 2020

Background:

No high level of scientific evidence exists about the use of asymmetry of skin creases (ASC) on the groin and thigh regions in diagnosing developmental dysplasia of the hip. The aim of this comparative study was to revisit whether or not ASC was a significant clinical finding in developmental dysplasia of the hip.

Methods:

This was retrospective analysis of a prospectively collected data. Control group was composed of 1000 consecutive healthy infants (mean age, 46.7 d) whose both hips were considered Graf type I (normal). Study group (SG) was composed of 246 consecutive patients (mean age, 96.5 d) whose treatments by abduction bracing were initiated due to unilateral or bilateral Graf type IIa(−) and worse hips.

Results:

SG included 178 patients with bilateral or unilateral dysplastic hips [Graf type IIa(−), IIb, IIc] and 68 patients with at least 1 decentered hip (Graf type D, III, IV). ASC was seen in 63 of 101 patients (63%) having positive clinical finding(s). The rates of both ASC alone (P<0.001; odds ratio, 3.46) and ASC total (ASC with and without additional findings) (P<0.0001; odds ratio, 7.48) were significantly higher in SG than in control group. ASC was the only clinical finding in 31 patients and 24 of these 31 patients (77%) had unilateral or bilateral dysplastic hips. Sensitivity and specificity of ASC alone were 12.60% and 96.00%, respectively. ASC was accompanied by other clinical findings (mostly Galeazzi sign and limitation of abduction) in 32 patients and 23 of these 32 patients (72%) had at least 1 decentered hip. Sensitivity and specificity of ASC total were 25.61% and 95.60%, respectively.

Conclusions:

ASC is a significant finding, as there is considerable increased risk of having dysplastic or decentered hips in infants having such a finding alone or associated with other findings. ASC alone is more commonly seen in patients with dysplastic hip(s) whereas ASC is mostly accompanied with other clinical finding(s) in patients with decentered hip(s). This study shows that, ASC can be introduced as a risk factor in selected newborn hip screening programs.

Level of Evidence:

Level II—diagnostic study.
Neck-Related Headache in Patients With Cervical Disc Disease After Surgery and Physiotherapy
Authors: Svensson Jard , Hermansen Anna , Wibault Johanna , Löfgren Håkan , Dedering Åsa , Öberg Birgitta , Zsigmond Peter , Peolsson Anneli
Published: February 2020

Study Design.

A prospective randomized multicenter trial.

Objective.

To investigate the effects of surgery with either structured postoperative physiotherapy or standard postoperative approach on neck-related headache in patients with cervical radiculopathy. Secondary, to investigate associations between change in neck-related headache and change in neck muscle endurance, neck mobility, or neck pain.

Summary of Background Data.

The effect of physiotherapy on individuals with neck-related headache after surgery for cervical radiculopathy due to magnetic resonance imaging–verified disc disease is unknown.

Methods.

One hundred six patients with neck-related headache and participating in a randomized controlled trial evaluating the additional effects of physiotherapy after surgery for cervical radiculopathy were included. Patients were randomized preoperatively to structured postoperative physiotherapy (n = 51) or the standard postoperative approach (n = 55). Outcome measures were headache intensity and neck pain intensity, neck muscle endurance, and neck mobility. Measures were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively.

Results.

Headache intensity significantly changed from baseline to 1 year postoperatively (P < 0.001) in both groups. Post-hoc tests showed a significant difference between baseline and 6 weeks (P ≤ 0.05). No significant differences were found between groups (P > 0.05) or between-group differences in changes over time (P > 0.05). The change in current headache intensity over time was associated with a change in current neck pain intensity over time (P = 0.003, β = 0.40).

Conclusion.

There was a significant improvement in headache intensity 1 year postoperatively in patients with cervical radiculopathy and neck-related headache, but there were no differences between groups over time. Change in current headache intensity was only associated with a change in current neck pain intensity.

Level of Evidence: 2
Clinical Performance and Concurrent Validity of the Adult Spinal Deformity Surgical Decision-making Score
Authors: Fujishiro Takashi , Boissière Louis , Cawley Derek Thomas , Larrieu Daniel , Gille Olivier , Vital Jean-Marc , Pellisé Ferran , Pérez-Grueso Francisco Javier Sanchez , Kleinstück Frank , Acaroglu Emre , Alanay Ahmet , Obeid Ibrahim
Published: February 2020

Study Design.

Multicenter, retrospective study.

Objective.

The aim of this study was to examine the performance and concurrent validity of the adult spinal deformity surgical decision-making (ASD-SDM) score compared to decision-making factors in the ASD population.

Summary of Background Data.

The ASD-SDM score, which has been recently proposed, is a scoring system to guide the selection of treatment modality for the ASD population. To secure the justification for its clinical use, it is necessary to verify its clinical performance and concurrent validity.

Methods.

A multicenter prospective ASD database was retrospectively reviewed. The data were analyzed separately in younger (≤40 years) and older (≥41 years) age groups. The discriminating capacity of the ASD-SDM score in cases who selected surgical and nonsurgical management was compared using area under the receiver operator characteristic curves (AUROC). Concurrent validity was examined using Spearman correlation coefficients, comparing factors that are reported to be associated with the decision-making process for ASD, including baseline symptomatology, health-related quality of life measures, and the severity of radiographic spinal deformity.

Results.

There were 338 patients (mean age: 26.6 years; 80.8% female; 129 surgical and 209 nonsurgical) in the younger age group and 750 patients (mean age: 63.5 years; 84.3% female; 410 surgical and 340 nonsurgical) in the older age group. In both younger and older patients, the ASD-SDM score showed a significantly higher performance for discriminating the surgical and nonsurgical cases (AUROC: 0.767, standard error [SE]: 0.026, P < 0.001, 95% confidence interval [CI]: 0.712–0.813; AUROC: 0.781, SE: 0.017, P < 0.001, 95% CI: 0.747–0.812, respectively) compared to the decision-making factors analyzed. In addition, the ASD-SDM showed significant correlations with multiple decision-making factors.

Conclusion.

The ASD-SDM score alone can effectively grade the indication for surgical management whilst considering multiple decision-making factors.

Level of Evidence: 3
Transpedicular Vertebrectomy With Circumferential Spinal Cord Decompression and Reconstruction for Thoracic Spine Metastasis
Authors: Rustagi Tarush , Mashaly Hazem , Ganguly Ranjit , Akhter Asad , Mendel Ehud
Published: February 2020

Study Design.

Retrospective case series.

Objective.

To study the feasibility, outcomes, and complications of transpedicular vertebrectomy (TPV), and reconstruction for metastatic lesions to the thoracic spine.

Summary of Background Data.

Metastatic lesions to the thoracic spine may need surgical treatment requiring anterior–posterior decompression/stabilization. Anterior reconstruction may be performed using poly methyl meth acrylate (PMMA) cement or cages. Use of cement has been reported to be associated with complications.

Methods.

From 2008 to 2016, consecutive cases (single surgeon) undergoing TPV for thoracic spine metastasis (T2–12) were included. Demographic, surgical, and clinical data were collected through chart review. MRI, CT, positron emission tomography images were used to identify extent of disease, epidural spinal cord compression (ESCC), and degree of vertebral body collapse. Hall–Wellner confidence band was used for the survival curve.

Results.

Ninety six patients were studies with a median age 60 years. Most patients 56 (58%) presented with mechanical pain. 29% cases had lung metastasis. Single level TPV was performed in 73 patients (76%). Anterior reconstruction included PMMA in 78 patients (81.25%), and titanium cage in 18 patients (18.25%). Frankel grade improvement was seen in 16 cases (P = 0.013). ESCC improved by a median of 5.9 mm (P < 0.001). Kyphosis reduced by median of 7.5° (P < 0.001). VAS improved by median of seven (P < 0.001). Total 59 deaths were observed. The median survival time was estimated to be 6 months (95% CI: 5, 10). Surgical outcome and complication rates are similar between the two construct types. Correction of kyphosis was seen to be slightly better with the use of PMMA. Overall 29.16% cases developed complications (11.4% major). Two cases developed neurological deficit following epidural hematoma requiring surgery. One case had instrumentation failure from cement migration, needing revision.

Conclusion.

The result of our study shows significantly improved clinical and radiological outcomes for TPV for thoracic metastatic lesions. We also discuss some important steps for use of PMMA to avoid complications.

Level of Evidence: 4
Continuous Loop Double Cortical Button Technique for Distal Tibiofibular Syndesmosis Stabilization: A Technical Note and Case Series
Authors: Wolfson Theodore S. , Struhl Steven
Published: February 2020

Injury to the distal tibiofibular syndesmosis is common and failure to correct instability may lead to inferior outcomes. Recently, suture-button devices have garnered increasing attention for dynamic syndesmotic fixation. However, current constructs and techniques have been consistently associated with complications such as lateral knot irritation and wound breakdown. In addition, knot slippage, loosening, and osteolysis have been described leading to recurrent syndesmotic diastasis. To address these shortcomings, a continuous loop double cortical button technique has been developed for dynamic syndesmotic stabilization. The continuous loop double cortical button technique has been utilized for coracoclavicular ligament stabilization for both acromioclavicular joint dislocation and distal clavicle fractures with excellent clinical outcomes. This procedure has been adapted for fixation of the distal tibiofibular syndesmosis. The technique utilizes 2 cortical buttons linked by a continuous loop of ultra-high molecular weight polyethylene suture for dynamic knotless syndesmotic fixation. The continuous loop double cortical button technique was performed on 4 consecutive cases of distal tibiofibular syndesmosis diastasis. Accurate, stable fixation was achieved in all cases without loosening or diastasis. At the final follow-up, no evidence of button-related osteolysis or migration was observed. One patient with prominent lateral hardware developed a wound infection requiring reoperation for hardware removal and debridement. Otherwise, no complications related to syndesmotic hardware were observed. The continuous loop double cortical button technique is a reproducible and reliable procedure for fixation of the distal tibiofibular syndesmosis. The construct allows for accurate restoration of the dynamic syndesmotic complex without compromising stability. Knot-related complications are minimized. As with all systems, limiting lateral hardware prominence appears to reduce the risk of wound-related complications.

Level of Evidence: Diagnostic Level IV—case series. See Instructions for Authors for a complete description of levels of evidence.
Robotic-assisted Spine Surgery: A Review of its Development, Outcomes, and Economics on Practice
Authors: Kia Cameron , Esmende Sean
Published: February 2020

Purpose:

Improper pedicle screw placement can lead to increased complications and the need for revision surgery. The purpose of this article is to review the history of robotic assistance in spine surgery, along with the current data on its clinical outcomes, potential advantages, and economics on practice.

Methods:

Review of the literature.

Results:

A review of the current literature demonstrated that intrapedicular accuracy has shown to be either superior or equivalent to a free-hand technique. Radiation exposure with robotic assistance is generally similar to free-hand, with a trend toward a lesser exposure following increased experience. Operative times, outcomes, and complication rates have been variable between prospective and retrospective studies, with mostly equivalent results when compared with free-hand screw placement.

Conclusions:

Higher-level studies (level I and II) have demonstrated similar clinical outcomes and pedicle screw accuracy when compared with the free-hand technique. As with most new technology, a learning curve is apparent, with the potential for a decrease in radiation exposure and economic benefit over time.
Expression of Stromal Cell–Derived Factor-1 by Mesenchymal Stromal Cells Impacts Neutrophil Function During Sepsis
Authors: Kwon Min-Young , Ghanta Sailaja , Ng Julie , Tsoyi Konstantin , Lederer James A. , Bronson Roderick T. , El-Chemaly Souheil , Chung Su Wol , Liu Xiaoli , Perrella Mark A.
Published: February 2020

Objectives:

Sepsis results in organ dysfunction caused by a dysregulated host response, in part related to the immune response of a severe infection. Mesenchymal stromal cells are known to modulate the immune response, and expression of stromal cell–derived factor-1 regulates mobilization of neutrophils from the bone marrow. We are investigating the importance of stromal cell-derived factor-1 in mesenchymal stromal cells and its role in promoting neutrophil function after the onset of cecal ligation and puncture–induced sepsis. Stromal cell–derived factor-1 expression was silenced in mesenchymal stromal cells, compared with the control scrambled construct mesenchymal stromal cells.

Design:

Animal study and cell culture.

Setting:

Laboratory investigation.

Subjects:

BALB/c mice.

Interventions:

Polymicrobial sepsis was induced by cecal ligation and puncture. shSCR mesenchymal stromal cells and shSDF-1 mesenchymal stromal cells were delivered by tail vein injections to septic mice. The mice were assessed for survival, bacterial clearance, and the inflammatory response during sepsis in each of the groups. Mesenchymal stromal cells were also assessed for their ability to promote bacterial phagocytosis by neutrophils.

Measurements and Main Results:

Injection of shSCR mesenchymal stromal cells after the onset of sepsis led to an increase in mouse survival (70%) at 7 days, whereas survival of mice receiving shSDF-1 mesenchymal stromal cells was significantly diminished (33%). The loss of survival benefit in mice receiving shSDF-1 mesenchymal stromal cells was associated with less efficient bacterial clearance compared with shSCR mesenchymal stromal cells. Although shSCR mesenchymal stromal cells, or their conditioned medium, were able to increase neutrophil phagocytosis of bacteria, this effect was significantly blunted with shSDF-1 mesenchymal stromal cells. Assessment of peritoneal inflammation revealed that neutrophils were significantly increased and more immature in septic mice receiving shSDF-1 mesenchymal stromal cells. This response was associated with hypocellularity and increased neutrophil death in the bone marrow of mice receiving shSDF-1 mesenchymal stromal cells.

Conclusions:

Expression of stromal cell-derived factor-1 in mesenchymal stromal cells enhances neutrophil function with increased phagocytosis, more efficient clearance of bacteria, and bone marrow protection from depletion of cellular reserves during sepsis.
Digitizing Infectious Disease Clinical Guidelines for Improved Clinician Satisfaction
Authors: Hoelscher Stephanie H. , McBride Susan
Published: February 2020

The purpose of this project was to implement an improved rapid-deployment clinical decision support strategy for the detection and treatment of emerging and reemerging infectious diseases within an electronic health record informed by end-user satisfaction. After a review of the evidence and comprehensive workflow assessments, interdisciplinary focus groups were assembled to determine current infectious disease needs within the electronic health record and what guidance should be provided to clinicians to assist in making the best decisions for both patient care and population health. Education and reeducation issues were handled throughout the implementation process. Using the Plan-Do-Study-Act quality improvement framework for rapid cycle deployment, the design was implemented and monitored. To evaluate efficacy and clinician satisfaction of the implementation, presurvey and postsurvey measurements were employed. The Clinical Information System Implementation Evaluation Scale was used, along with demographic and qualitative textual questions, to evaluate clinician satisfaction. Findings indicate the implementation was successful (P < .05).
Use of Intraventricular Medications in Critically Ill Patients
Authors: Erdman Michael J. , Marrese Alexa R. , Haller J. Tyler , Barthol Colleen A. , Small Clay E.
Published: February 2020

New evidence and increased use of intracranial devices have increased the frequency of intraventricular (IVT) medication administration in the neurologic intensive care unit. Significant benefits and risks are associated with administration of medications directly into the central nervous system. This review summarizes important literature, along with key information for clinicians regarding the administration, dosing, monitoring, and adverse effects related to IVT medication usage. Multiple medications have supporting literature for their use in critically ill patients including amphotericin B, aminoglycosides, colistimethate, daptomycin, quinupristin/dalfopristin, vancomycin, alteplase, and nicardipine. Sterile preparation and delivery, along with different types of devices that support medication administration, are also reviewed. One randomized, placebo-controlled trial of alteplase demonstrated decreased mortality but no change in good functional outcome. Other reports of IVT medication use are mainly limited to case reports and retrospective case series. There is a need for increased research on the topic; however, several practical barriers decrease the likelihood of a large, placebo-controlled, prospective study for most indications. Providers should consider implementing protocols to maximize safety of IVT medication delivery to ensure optimal patient outcomes.
Locoregional Therapy Protocols With and Without Radioembolization for Hepatocellular Carcinoma as Bridge to Liver Transplantation
Authors: Zori Andreas G. , Ismael Media N. , Limaye Alpna R. , Firpi Roberto , Morelli Giuseppe , Soldevila-Pico Consuelo , Suman Amitabh , Vogel Jeffrey D. , Lazarowicz Michael , Geller Brian S. , Toskich Beau , Gonzalo David H. , Johnson Mark W. , Cabrera Roniel
Published: February 2020

Objective:

The objective of this study was to compare posttransplant outcomes in patients undergoing bridging locoregional therapy (LRT) with Y-90 transarterial radioembolization (TARE) based protocol compared with transarterial chemoembolization based protocol for hepatocellular carcinoma (HCC) prior liver transplantation (LT).

Materials and Methods:

Patients listed for LT with HCC within the Milan criteria at our center who had bridging LRT were treated according to transarterial chemoembolization (TACE) based protocol from May 2012 to April 2014 and a TARE based protocol from October 2014 to December 2017. Early posttransplant survival and tumor recurrence were compared between the groups. Tumor response to LRT, microvascular invasion (mVI), and the rate of delisting was also evaluated.

Results:

One hundred three patients who were listed for LT with HCC within the Milan criteria received LRT. LT was performed in 65 patients, 28 treated with TARE protocol and 37 on TACE protocol. There were no statistical differences in baseline pretransplant characteristics and tumor recurrence. There was a trend toward improved 3-year survival in the TARE group (92.9% vs. 75.7%; P=0.052). The mVI was seen in 1/28 (3.6%) explants in the TARE group compared with 10/37 (27%) in the TACE group (P=0.013). The TARE group also required fewer LRT treatments (1.46 vs. 2.43; P=0.001) despite no difference in time on the transplant list.

Conclusions:

Despite requiring fewer LRT treatments, there was significantly less mVI in the explants of patients treated with TARE protocol LRT as a bridge to LT as well as a trend toward improved 3-year survival. Therefore, TARE may be associated with improved tumor control and reduced post-LT recurrence.
Granulomatous Skin Diseases in a Tertiary Care Portuguese Hospital: A 10-Year Retrospective Study
Authors: Queirós Catarina Soares , Uva Luís , Soares de Almeida Luís , Filipe Paulo
Published: February 2020

Granulomatous skin diseases comprise an extensive group of pathologies whose diagnosis usually requires a histopathological examination. At this level, various types of granulomas can be distinguished, namely tuberculoid, sarcoid, necrobiotic, suppurative, xanthogranuloma, and foreign-body granulomas. This study aimed to determine the frequency and pattern of different granulomatous skin lesions in the Dermatopathology Department of Hospital de Santa Maria (Lisboa, Portugal). A retrospective study of all skin biopsies with granulomatous lesions received during a period of 10 years (2008–2017) was performed. Clinical and histopathological characteristics of the selected cases were analyzed, and the lesions were categorized according to histological type of granuloma and etiology. Foreign-body granulomas secondary to ruptured cyst, folliculitis, or suture material were excluded. From a total of 48,253 cutaneous biopsies performed in this period, 461 (1%) granulomatous lesions were included in our study. In the analysis according to type of granuloma, necrobiotic granulomas were the most frequent (N = 111; 27.0%), followed by sarcoidal (N = 72; 17.5%), tuberculoid (N = 51; 12.4%), suppurative (N = 45; 10.9%), foreign body (N = 40; 9.7%), and xanthogranulomas (N = 26; 6.3%). The remaining 20% corresponded to granulomas of other types. During these 10 years, the most frequent etiology was granuloma annulare (N = 98; 88.3%), followed by sarcoidosis (N = 47; 65.3%). Histopathology is a fundamental tool in the diagnosis of granulomatous skin diseases, allowing for the categorization of various types of granulomas and often guiding further investigation of these patients. The geographical area has an influence on the types of granulomas observed, as evidenced by comparing this study with others previously published.
Neighborhood Disorganization and Child-rearing Beliefs Toward Physical Punishment Among Asian American Parents
Authors: Pei Fei , Wang Yixuan , Zhai Fuhua , Gao Qin
Published: February 2020

Previous studies have indicated that neighborhood disorganization affects child-rearing beliefs in the United States, but few studies have focused on such influences among Asian American parents. Largely due to Asian American parents' immigration experiences, neighborhood disorganization factors inevitably intersect with their traditional cultures, which may lead to different patterns in their parental beliefs. Using structural equation modeling, this study found that neighborhood disorganization factors directly influenced Asian American parents' beliefs toward physical punishment and parenting stress mediated this relationship. These findings suggest that the integration of family and neighborhood-level practices in social services may reduce the risk of physical abuse.
Enriching Nutrition Programs to Better Serve the Needs of a Diversifying Aging Population
Authors: Sadarangani Tina R. , Beasley Jeannette M. , Yi Stella S. , Chodosh Joshua
Published: February 2020

Racial minorities experience a high burden of food insecurity relative to non-Hispanic whites. Government-subsidized nutrition programs can positively impact food insecurity and nutritional risk among older adults. Yet, in New York City, where nearly 60% of people over 65 years are non-white, older minorities participate in government nutrition programs at very low rates. In this commentary, we focus on 2 programs: the Child and Adult Care Food Program and Older Americans Act Nutrition Services Programs. We identify opportunities for strengthening these programs to improve their reach and engagement with diverse older adults in New York City and similarly diverse urban communities.
Preliminary Effects of Tailoring an Obesity Prevention Intervention Program for Latino Immigrant Families
Authors: Linville Deanna , Mintz Brianna , Martinez Charles , Gau Jeff M. , Shune Samantha , Stice Eric
Published: February 2020

An obesity preventive intervention program for preschool families, Healthy Balance, was tested in 2 sequential pilot trials. The first pilot tested the original and translated group intervention in a heterogeneous population (65 families), and the second tested the feasibility of a culturally adapted version for Latinx immigrant families (27 families). No significant study 1 intervention effects were found. However, in study 2, there were significant improvements in parent body mass index, neck circumference, and blood pressure. These studies suggest that targeting family system change and tailoring the intervention for Latinx immigrant populations is feasible and has the potential to improve obesity-related biomarkers.
Early Termination of Cardiac Rehabilitation Is More Common With Heart Failure With Reduced Ejection Fraction Than With Ischemic Heart Disease
Authors: Bostrom John , Searcy Ryan , Walia Ahana , Rzucidlo Justyna , Banco Darcy , Quien Mary , Sweeney Greg , Pierre Alicia , Tang Ying , Mola Ana , Xia Yuhe , Whiteson Jonathan , Dodson John A.
Published: February 2020

Purpose:

Despite known benefits of cardiac rehabilitation (CR), early termination (failure to complete >1 mo of CR) attenuates these benefits. We analyzed whether early termination varied by referral indication in the context of recent growth in patients referred for heart failure with reduced ejection fraction (HFrEF).

Methods:

We reviewed records from 1111 consecutive patients enrolled in the NYU Langone Health Rusk CR program (2013-2017). Sessions attended, demographics, and comorbidities were abstracted, as well as primary referral indication: HFrEF or ischemic heart disease (IHD; including post-coronary revascularization, post-acute myocardial infarction, or chronic stable angina). We compared rates of early termination between HFrEF and IHD, and used multivariable logistic regression to determine whether differences persisted after adjusting for relevant characteristics (age, race, ethnicity, body mass index, smoking, hypertension, chronic obstructive pulmonary disease, and depression).

Results:

Mean patient age was 64 yr, 31% were female, and 28% were nonwhite. Most referrals (85%) were for IHD; 15% were for HFrEF. Early termination occurred in 206 patients (18%) and was more common in HFrEF (26%) than in IHD (17%) (P < .01). After multivariable adjustment, patients with HFrEF remained at higher risk of early termination than patients with IHD (unadjusted OR = 1.73, 95% CI, 1.17-2.54; adjusted OR = 1.53, 95% CI, 1.01-2.31).

Conclusions:

Nearly 1 in 5 patients in our program terminated CR within 1 mo, with HFrEF patients at higher risk than IHD patients. While broad efforts at preventing early termination are warranted, particular attention may be required in patients with HFrEF.
Antihypertensive polytherapy in Australia: prevalence of inappropriate combinations, 2013–2018
Authors: Falster Michael O. , Buckley Nicholas A. , Brieger David , Pearson Sallie-Anne
Published: February 2020

Objectives:

To estimate the prevalence of inappropriate antihypertensive polytherapy in Australia.

Methods:

We used a nationally representative 10% sample of Pharmaceutical Benefits Scheme (PBS) eligible Australians and their dispensing history to identify people aged 18+ years exposed to at least one PBS-listed antihypertensive between 2012 and 2018. We measured prevalence of antihypertensive polypharmacy (≥40 days concomitant exposure), inappropriate antihypertensive combinations (against guideline recommendations; within-class polytherapy) and combinations to be used with caution.

Results:

Almost half (47.5%) of people using antihypertensives in 2018 experienced polytherapy. Among these, 2.4% had an inappropriate combination (1.5% against guidelines; 1.0% within-class polytherapy). Inappropriate combinations were more prevalent in people experiencing polytherapy with three (3.7%) or four (16.1%) antihypertensive medicines than people on dual therapy (0.7%). Inappropriate combinations occurred at a lower rate in people using fixed-dose rather than free-drug combinations for dual therapy (0 vs. 0.7%) and in those using three antihypertensives (2.4 vs. 7.3%); this was not the case for people using four or more antihypertensives (15.5 vs. 16.1%). Between 2013 and 2018, the prevalence of antihypertensive polytherapy was relatively stable (49–47%); however, the prevalence of inappropriate combinations among these patients halved (from 5.1 to 2.4%).

Conclusion:

Antihypertensive polytherapy in Australia is common, but the prevalence of inappropriate combinations is low and decreasing over time, suggesting strong awareness of Australian clinical guidelines. However, in 2018, approximately 49 000 Australian adults experienced inappropriate polytherapy; prescribing of fixed-dose combinations in patients on dual or triple therapy may further reduce this inappropriate care, although increased vigilance treating patients with more than 3 antihypertensives is required.
PURTSCHER-LIKE RETINOPATHY AND PARACENTRAL ACUTE MIDDLE MACULOPATHY CAUSED BY INDUSTRIAL SILICONE EMBOLISM
Authors: de Oliveira Bruno Mauricio Rodrigues , Moraes de Souza Leonardo , Andrade Gabriel Costa , Lobos Claudio Zett , Cunha de Souza Eduardo , Bueno de Moraes Nilva Simeren
Published: February 2020

Purpose:

This article describes a rare occurrence of acute vision loss in a healthy young patient after a cosmetic procedure.

Methods:

Findings on clinical examination, color fundus photography, and swept-source optical coherence tomography angiography.

Results:

A previously healthy 26-year-old male-to-female transsexual presented with dyspnea, fever, and hypoxemia 1 day after cosmetic injection of industrial silicone for buttock augmentation. The patient reported decreased vision on the right eye 4 days later and decreased vision on the left eye 5 days later. Fundus examination revealed bilateral retinal precapillary occlusion, demonstrating intraretinal hemorrhages, cotton wool spots, and Purtscher flecks within the posterior pole of both eyes. Optical coherence tomography angiography revealed capillary ischemia and an enlarged foveal avascular zone.

Conclusion:

Swept-source optical coherence tomography is a valuable tool for evaluation of Purtscher-like retinopathy and paracentral acute middle maculopathy.
Genomic Characterization of TBK1 Duplication in Korean Normal-tension Glaucoma Patients
Authors: Kim Man Jin , Kim Yong Woo , Jeoung Jin Wook , Seong Moon-Woo , Lee Jee-Soo , Kim Dong Myung , Ahn Joo Hyun , Song Ji Yun , Cho Sung Im , Park Sung Sup , Kim Ji Yeon
Published: February 2020

Précis:

One (0.2%) of 418 Korean normal-tension glaucoma (NTG) patients had TBK1 duplication. The putative mechanism of TBK1 duplication in Korean NTG patients is the nonhomologous end-joining.

Purpose:

TBK1 duplication is a genomic cause of familial NTG. NTG accounts for up to 90% of primary open-angle glaucoma in Koreans, with genetic tendency. We aimed to investigate the prevalence of TBK1 duplication in Korean NTG patients and to identify their genomic structure and duplication mechanism.

Materials and Methods:

We obtained DNA samples from 418 NTG patients and 195 healthy controls for evaluating TBK1 copy number variations using a semiquantitative polymerase chain reaction (PCR). The samples with TBK1 gene duplication were further confirmed using droplet digital PCR. The whole-genome sequencing of patient samples with duplications was performed to identify the accurate breakpoints and to elucidate the genomic structure. Ophthalmic evaluation and confirmation of TBK1 duplication using junction PCR were performed in families of positive patients.

Results:

TBK1 duplication was found in 1 of 418 NTG cases (0.2%). The duplication range was from g.64,803,151 to g.64,927,214 (124,063 bp). It is the smallest region of overlapping duplication in TBK1. Any repetitive sequences were not found near the breakpoints of our case. Inserted sequences were found within the breakpoints. A brother and a niece of the positive case appeared the typical clinical features of NTG and shared the same TBK1 duplications with the index case.

Conclusions:

In Korea, the prevalence of TBK1 duplication was 0.2% and the smallest reported TBK1 duplication associated with NTG was found. The mechanism of TBK1 duplication was suggested to be nonhomologous end-joining while a previous report pointed out the mechanism of TBK1 duplications as nonallelic homologous recombination.
Neonatal and Neurodevelopmental Outcomes Following Linezolid for Coagulase-negative Staphylococcal Infection
Authors: Sicard Mélanie , Moussa Ahmed , Barrington Keith , Martin Brigitte , Luu Thuy Mai , Ting Joseph Y. , Roberts Ashley , Paquette Vanessa , Shah Prakesh S. , Kelly Edmond , Autmizguine Julie
Published: February 2020

Background:

Coagulase-negative staphylococci (CoNS) frequently causes late-onset sepsis in preterm infants. Vancomycin is the first-line therapy, but the emergence of reduced vancomycin-susceptibility strains has resulted in linezolid use, of which long-term safety in preterm infants is unknown.

Objective:

Evaluate the association between linezolid exposure and neurodevelopmental impairment (NDI) or death at 18–21 months of corrected age, in preterm infants with CoNS sepsis.

Methods:

Multicentric retrospective cohort study comparing long-term outcomes of preterm infants exposed to linezolid versus other antistaphylococcal antimicrobials. We included infants ≤28 weeks’ gestational age (GA), with CoNS sepsis, admitted between January 2011 and June 2015 in 3 level-3 Canadian NICUs. Primary outcome was a composite of death or significant NDI (sNDI) at 18–21 months of corrected age. Secondary outcomes included NDI and individual components of the primary outcome. We assessed the relationship between linezolid exposure and outcomes using a multivariable logistic regression.

Results:

Of 274 infants included, 67 (24.4%) were exposed to linezolid. Median GA was 26 weeks and clinical characteristics were similar between groups. There was no difference in composite outcome of death or sNDI among the infants of both groups, but significantly more death by 18–21 months in the linezolid group (29.9% vs. 17.6%; P = 0.01).

Conclusions:

Linezolid exposure was not associated with composite outcome of death or sNDI at 18–21 months. The association between linezolid and death may be due to indication bias. Further studies are warranted.
RGS5 rs4657251 polymorphism is associated with small vessel occlusion stroke in Taiwan Han Chinese
Authors: Hsu Li-Chi , Hsu Li-Sung , Lee Tsong-Hai
Published: February 2020

Background:

The regulator of G-protein signaling protein 5 (RGS5) has been demonstrated to play a role in regulating blood pressure and cardiovascular function. Studies have shown that RGS5 polymorphisms exhibit susceptibility to hypertension. However, no study has yet been performed among stroke patients.

Methods:

To evaluate whether RGS5 rs4657251 is a susceptibility gene for stroke, we performed a case-control association study involving 714 large-artery atherosclerosis (LAA) patients, 383 small vessel occlusion (SVO) patients, 401 hypertensive intracranial hemorrhages (HICH), and 626 controls. The RGS5 rs4657251 polymorphism was analyzed through polymerase chain reaction.

Results:

The TC genotype was significantly higher in the SVO group compared with that in the control group (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.02-1.76, p = 0.035). In addition, the dominant phenotype (TC + CC vs TT) was also significantly different between the SVO and the control groups (OR = 1.31, 95% CI = 1.01-1.70, p = 0.046). However, no association was found between RGS5 rs4657251 and LAA an HICH. After adjustment with gender, diabetes, smoking, cholesterol and low-density lipoprotein levels, RGS5 rs4657251 polymorphism remained an independent risk factor for SVO (OR = 1.49; 95% CI = 1.12-1.98) but not for LAA or HICH.

Conclusion:

Our findings, obtained among Taiwan Han Chinese subjects, provide the first evidence that RGS5 rs4657251 polymorphism is an independent risk factor for SVO.
Psychometric Properties of the Persian Version of Cardiovascular Management Self-efficacy Scale
Authors: Rajati Fatemeh , Sharifiebad Tahereh , Tavakol Kamran , Almasi Afshin , Karami Sahar , Jamshidi Hanieh Sadat , Pashaei Tahereh , Greco Andrea , Steca Patrizia
Published: February 2020

Background

Self-efficacy plays a major role in the management of cardiovascular disease (CVD). The original Cardiovascular Management Self-efficacy Scale (CMSS) was developed in 2016 in Italian patients with CVD; however, no such scale exists for Iranian patients with CVD.

Objective

We translated the CMSS into Persian and assessed its validity, reliability, and psychometric properties in Iranian patients with CVD.

Methods

This study was conducted for 4 months in 2017 on a group of consenting patients with CVD (N = 363) recruited from a cardiovascular hospital in Kermanshah, Iran. The reliability of the Persian CMSS was evaluated. We assessed validity, including face, content, construct, convergent, divergent, and discriminate validity, using the General Self-efficacy Scale, the Hospital Anxiety and Depression Scale, and the 36-item Short Form Health Survey Scale. Known-group validity was assessed among patients with high blood pressure.

Results

The Persian CMSS had acceptable face and content validity. No floor or ceiling effects were found for the total scale. Cronbach α was calculated as .68. Test-retest reliability was confirmed by intraclass correlation coefficient (ICC1,3 = 0.98, P < .001). Using exploratory factor analysis, 3 subscales were identified, similar to the original version. Significant correlations were found between the Persian CMSS and both the General Self-efficacy Scale (r = 0.94, P < .001) and Hospital Anxiety and Depression Scale (r = −0.35, P < .05). Self-efficacy measured using the Persian CMSS was statistically different between 2 levels of patients' health status (P < .05). Patients with hypertension had a lower level of self-efficacy than those in the healthy group (P < .05).

Conclusions

The Persian version of CMSS provides a practical, reliable, and valid scale for evaluating self-efficacy in the clinical management of Persian Iranian patients with CVD.
Cardiovascular Risk Factor Knowledge and Behaviors Among Low-Income Urban Women in Mysore, India
Authors: Krupp Karl , Wilcox Meredith L. , Srinivas Arun , Srinivas Vijaya , Madhivanan Purnima , Bastida Elena
Published: February 2020

Background

Cardiovascular diseases (CVDs) are the leading causes of death among women globally. Cardiovascular disease–related events are more common in older women compared with men and are more likely to result in death. Although research in high-income countries suggests that women have unique sociobiological CVD risk factors, only a few study authors have examined risk factor knowledge among women from low- and middle-income countries.

Objective

The aim of this study was to assess CVD risk factor knowledge among low-income urban Indian women.

Methods

A cross-sectional study was conducted among a nonprobability sample of 607 slum-dwelling women, 40 to 64 years old, living in Mysore, India, between October 2017 and May 2018. Participants underwent an interviewer-administered questionnaire measuring demographics, CVD risk factor knowledge, and medical history.

Results

Cardiovascular disease risk factor knowledge was low in this population and was associated with age, education, income, and caste. Approximately half of the participants (47%) answered less than 50% of the questions correctly, and a third had knowledge scores greater than 70%, which we defined as “good knowledge.” Only 4 of 7 traditional CVD risk factors (ie, physical activity, smoking, overweight, and high cholesterol) were recognized by greater than half of the participants. The lowest knowledge levels were among older single women with no education and monthly household incomes less than Rs 3000 (approximately US $42).

Conclusions

Previous research among slum dwellers in India reported a high prevalence of modifiable CVD risk factors compared with more affluent urban peers. Interventions aimed at CVD risk factor knowledge may be an important first step in controlling heart disease in this vulnerable population.
The Creation of a Pediatric Health Care Learning Network: The ACTION Quality Improvement Collaborative
Authors: Lorts Angela , Smyth Lauren , Gajarski Robert J. , VanderPluym Christina J. , Mehegan Mary , Villa Chet R. , Murray Jenna M. , Niebler Robert A. , Almond Christopher S. , Thrush Philip , O’Connor Matthew J. , Conway Jennifer , Sutcliffe David L. , Lantz Jodi E. , Zafar Farhan , Morales David L.S. , Peng David M. , Rosenthal David N.
Published: February 2020

Improving the outcomes of pediatric patients with congenital heart disease with end-stage heart failure depends on the collaboration of all stakeholders; this includes providers, patients and families, and industry representatives. Because of the rarity of this condition and the heterogeneity of heart failure etiologies that occur at pediatric centers, learnings must be shared between institutions and all disciplines to move the field forward. To foster collaboration, excel discovery, and bring data to the bedside, a new, collaborative quality improvement science network—ACTION (Advanced Cardiac Therapies Improving Outcomes Network)—was developed to meet the needs of the field. Existing gaps in care and the methods of improvement that will be used are described, along with the mission and vision, utility of real-world data for regulatory purposes, and the organizational structure of ACTION is described.
Substantial tumor regression in prostate cancer patient with extensive skeletal metastases upon Immunotherapy (APCEDEN)
Authors: Sharan Bandana , Chiliveru Srikanth , Bagga Jasmine , Kohli Sakshi , Bharadwaj Asmi , Vaid Ashok K. , Kumar Chaitanya
Published: February 2020

Rationale:

Prostate cancer along with colorectal and lung cancers accounts for 42% of cancer cases in men globally. It is the first cancer indication for which the use of active immunotherapy, Sipuleucel-T (Provenge) was granted by the FDA in 2010. This study presents a case of prostate carcinoma and the tumour remission observed after administration of a personalised Dendritic cell vaccine (APCEDEN).

Patient concerns:

A 58 years old Caucasian male diagnosed with prostate carcinoma with GLEASON score 8. The patient had previously been diagnosed with Renal Cell Carcinoma (RCC) in 1996 and had undergone nephrectomy of the right kidney. PET CT scan revealed multiple intensely PSMA avid lesions noted in both lobes of the prostate gland with SUVmax −28.3 and the prostate gland measuring 3.2 × 3.2 cm displaying maximum dimensions.

Diagnosis:

FNAC followed by PETCT confirmed CA Prostate and further supported by increased serum PSA level.

Interventions:

The patient underwent personalised Dendritic Cell Immunotherapy APCEDEN regimen of six doses biweekly, in a time frame of 3 months were given both via intravenous and intradermal route. Six months post completion of APCEDEN, the patient was administered 6 booster shots for 6 months.

Outcomes:

Progressive remission of carcinoma was observed along with reduction in PSA and Testosterone levels. PET CT showed decline in PSMA avidity by 50% with SUVmax −14.0 and normal size and shape of prostate gland.

Lessons:

Prostate carcinoma is the second most common cancer in men with majority of them exhibiting locally advanced disease. Apparently 20% to 30% of them are categorized as relapsed cases after various therapeutic interventions. Modulating immune system is an emerging therapy termed as Immunotherapy and potentiates the killing cancer cells via immune activation. Interestingly, prostate cancer is slow growing and it provides the scope and time to mount an anti-tumor response which makes it an attractive target for immunotherapy. This case study demonstrates the efficacy of APCEDEN Immunotherapy regimen resulting in a significant disease remission benefiting the patient.