bluuebunny/crossref_metadata_2025 huggingface dataset:
A Revision of Parasecia (Trombidiformes: Trombiculidae) With a Description of a New Species, a New Genus and a Key to Species
Authors: Bassini-Silva Ricardo , Jacinavicius Fernando de Castro , Oliveira Mariana , Peinado Laura Contreras , Faxina Claudenice , Moreira-Lima Luciano , Welbourn Cal , Ochoa Ronald , Fischer Erich , Hingst-Zaher Erika , Famadas Kátia M , Faccini João Luiz Horacio , Barros-Battesti Darci Moraes
Published: August 2020

Chiggers of the genus Parasecia Loomis parasitize birds, mammals, and reptiles in the Nearctic and Neotropical regions. In the present review, we examined 18 species previously included in the genus, 15 of them being retained in the genus Parasecia, one genus is created, Nahuacarus bulbocalcarn. gen. (Trombidiformes: Trombiculidae), and new combinations are proposed for two species: Lorillatum lasiurusn. comb. and Lorillatum orphanan. comb. (Trombidiformes: Trombiculidae). In addition, Parasecia kansasensis (Loomis) (Trombidiformes: Trombiculidae) is synonymized with Parasecia gurneyi (Ewing) (Trombidiformes: Trombiculidae), Parasecia gilbetoin. sp. (Trombidiformes: Trombiculidae) is described and new locality and host records are added for Parasecia chara (Wharton), Parasecia longicalcar (Brennan and Jones), Parasecia manueli (Brennan and Jones), and Parasecia thalurania (Brennan) (Trombidiformes: Trombiculidae).
Case report of enterocutaneous fistula due to non-functioning ventriculoperitoneal shunt
Authors: Prabhat Jha , Dhoj Joshi Bijendra
Published: August 2020

Abdominal complications after placement of ventriculoperitoneal (VP) shunt are commonly reported but asymptomatic bowel perforation with enterocutaneous fistula (ECF) is rare. This case describes a young male patient who underwent VP shunt for hydrocephalus 10 years ago. He presented with ECF due to the non-functioning abdominal end of the shunt. Patient was managed with laparotomy with fistulectomy with bowel resection and anastomosis. ECF is a rare complication of VP shunt.
Nonparametric Mass Imputation for Data Integration
Authors: Chen Sixia , Yang Shu , Kim Jae Kwang
Published: August 2020

Data integration combining a probability sample with another nonprobability sample is an emerging area of research in survey sampling. We consider the case when the study variable of interest is measured only in the nonprobability sample, but comparable auxiliary information is available for both data sources. We consider mass imputation for the probability sample using the nonprobability data as the training set for imputation. The parametric mass imputation is sensitive to parametric model assumptions. To develop improved and robust methods, we consider nonparametric mass imputation for data integration. In particular, we consider kernel smoothing for a low-dimensional covariate and generalized additive models for a relatively high-dimensional covariate for imputation. Asymptotic theories and variance estimation are developed. Simulation studies and real applications show the benefits of our proposed methods over parametric counterparts.
Casino tourism destinations: health risk for travellers with gambling disorder and related medical conditions
Authors: Bonny-Noach Hagit , Sagiv-Alayoff Moran
Published: August 2020

Casino tourism destinations have expanded worldwide in the last two decades, and they attracted recreational, social, and professional gamblers, as well as travelers with addictive gambling disorder and other medical conditions. Greater health and social attention should be payed to these vulnerable travelers before, during, and after travel.
What will travel medicine look like in the COVID-19 pandemic era?
Authors: Shlim David R , Connor Bradley A , Taylor David N
Published: August 2020

Travel medicine has virtually stopped in light of the coronavirus pandemic. It is worth contemplating how travel medicine will be affected by the ongoing pandemic when international travel starts to become more possible. How will we advise patients and use the coming vaccines that may be available? Travel medicine practices are well-suited to play a major role in advising travellers in the pandemic era.
Multireceptor targeting of glioblastoma
Authors: Sharma Puja , Sonawane Poonam , Herpai Denise , D’Agostino Ralph , Rossmeisl John , Tatter Stephen , Debinski Waldemar
Published: August 2020

Background

Treatment for glioblastoma (GBM) remains an unmet need in medicine. Novel therapies that address GBM complexity and heterogeneity in particular are warranted. To this end, we target 4 tumor-associated receptors at a time that span virtually all of the GBM microenvironment including bulk tumor cells, infiltrating tumor cells, neovasculature, and tumor-infiltrating cells with one pharmaceutical agent delivering a cytotoxic load.

Methods

We engineered multivalent ligand-based vector proteins termed QUAD with an ability to bind to 4 of the following GBM-associated receptors: IL-13RA2, EphA2, EphA3, and EphB2. We conjugated QUAD with a modified bacterial toxin PE38QQR and tested it in vitro and in vivo.

Results

The QUAD variants preserved functional characteristics of the respective ligands for the 4 receptors. The QUAD 3.0 variant conjugate was highly cytotoxic to GBM cells, but it was nontoxic in mice, and the conjugate exhibited strong antitumor effect in a dog with spontaneous GBM.

Conclusion

The QUAD addresses, to a large extent, the issues of intra- and intertumoral heterogeneity and, at the same time, it targets several pathophysiologically important tumor compartments in GBM through multiple receptors overexpressed in tumors allowing for what we call “molecular resection.” QUAD-based targeted agents warrant further pre- and clinical development.
Genome-Wide Association Studies of Schizophrenia and Bipolar Disorder in a Diverse Cohort of US Veterans
Authors: Bigdeli Tim B , Fanous Ayman H , Li Yuli , Rajeevan Nallakkandi , Sayward Frederick , Genovese Giulio , Gupta Rishab , Radhakrishnan Krishnan , Malhotra Anil K , Sun Ning , Lu Qiongshi , Hu Yiming , Li Boyang , Chen Quan , Mane Shrikant , Miller Perry , Cheung Kei-Hoi , Gur Raquel E , Greenwood Tiffany A , Braff David L ,   Consortium on the Genetics of Schizophrenia (COGS), Achtyes Eric D , Buckley Peter F , Escamilla Michael A , Lehrer Douglas , Malaspina Dolores P , McCarroll Steven A , Rapaport Mark H , Vawter Marquis P , Pato Michele T , Pato Carlos N ,   Genomic Psychiatry Cohort (GPC) Investigators, Zhao Hongyu , Kosten Thomas R , Brophy Mary , Pyarajan Saiju , Shi Yunling , O’Leary Timothy J , Gleason Theresa , Przygodzki Ronald , Muralidhar Sumitra , Gaziano J Michael ,   Million Veteran Program (MVP), Huang Grant D , Concato John , Siever Larry J , Aslan Mihaela , Harvey Philip D
Published: August 2020

Background

Schizophrenia (SCZ) and bipolar disorder (BIP) are debilitating neuropsychiatric disorders, collectively affecting 2% of the world’s population. Recognizing the major impact of these psychiatric disorders on the psychosocial function of more than 200 000 US Veterans, the Department of Veterans Affairs (VA) recently completed genotyping of more than 8000 veterans with SCZ and BIP in the Cooperative Studies Program (CSP) #572.

Methods

We performed genome-wide association studies (GWAS) in CSP #572 and benchmarked the predictive value of polygenic risk scores (PRS) constructed from published findings. We combined our results with available summary statistics from several recent GWAS, realizing the largest and most diverse studies of these disorders to date.

Results

Our primary GWAS uncovered new associations between CHD7 variants and SCZ, and novel BIP associations with variants in Sortilin Related VPS10 Domain Containing Receptor 3 (SORCS3) and downstream of PCDH11X. Combining our results with published summary statistics for SCZ yielded 39 novel susceptibility loci including CRHR1, and we identified 10 additional findings for BIP (28 326 cases and 90 570 controls). PRS trained on published GWAS were significantly associated with case-control status among European American (P < 10–30) and African American (P < .0005) participants in CSP #572.

Conclusions

We have demonstrated that published findings for SCZ and BIP are robustly generalizable to a diverse cohort of US veterans. Leveraging available summary statistics from GWAS of global populations, we report 52 new susceptibility loci and improved fine-mapping resolution for dozens of previously reported associations.
Automatic sleep stage classification with deep residual networks in a mixed-cohort setting
Authors: Olesen Alexander Neergaard , Jørgen Jennum Poul , Mignot Emmanuel , Sorensen Helge Bjarup Dissing
Published: August 2020

Study Objectives

Sleep stage scoring is performed manually by sleep experts and is prone to subjective interpretation of scoring rules with low intra- and interscorer reliability. Many automatic systems rely on few small-scale databases for developing models, and generalizability to new datasets is thus unknown. We investigated a novel deep neural network to assess the generalizability of several large-scale cohorts.

Methods

A deep neural network model was developed using 15,684 polysomnography studies from five different cohorts. We applied four different scenarios: (1) impact of varying timescales in the model; (2) performance of a single cohort on other cohorts of smaller, greater, or equal size relative to the performance of other cohorts on a single cohort; (3) varying the fraction of mixed-cohort training data compared with using single-origin data; and (4) comparing models trained on combinations of data from 2, 3, and 4 cohorts.

Results

Overall classification accuracy improved with increasing fractions of training data (0.25%: 0.782 ± 0.097, 95% CI [0.777–0.787]; 100%: 0.869 ± 0.064, 95% CI [0.864–0.872]), and with increasing number of data sources (2: 0.788 ± 0.102, 95% CI [0.787–0.790]; 3: 0.808 ± 0.092, 95% CI [0.807–0.810]; 4: 0.821 ± 0.085, 95% CI [0.819–0.823]). Different cohorts show varying levels of generalization to other cohorts.

Conclusions

Automatic sleep stage scoring systems based on deep learning algorithms should consider as much data as possible from as many sources available to ensure proper generalization. Public datasets for benchmarking should be made available for future research.
Health, social, and economic consequences of rapid eye movement sleep behavior disorder: a controlled national study evaluating societal effects
Authors: Frandsen Rune , Asah Cresta , Ibsen Rikke , Kjellberg Jakob , Jennum Poul Jørgen
Published: August 2020

Study Objectives

Parkinson’s disease (PD) causes significant socioeconomic burdens. One of the strongest predictors of PD is rapid eye movement (REM) sleep behavior disorder (RBD; when there is no known other cause of RBD, referred to as idiopathic RBD [iRBD]), but there is no information about its factual welfare burden. We estimated the direct and indirect total costs of iRBD in a national sample of patients, based on a national register-based cohort study with matched controls.

Methods

Using records from the Danish National Patient Registry, patient’s diagnosis with RBD from 2006 to 2016 were identified. We excluded patients with a prior diagnosis of narcolepsy, PD, and other neurodegenerative diseases. We identified and compared randomly chosen controls matched for age, gender, geographic area, and civil status. Direct costs included frequencies of primary and secondary sector contacts and procedures, and medication. Indirect costs included the effect on labor supply. Social-transfer payments were included to illustrate the effect on national accounts.

Results

A total of 246 iRBD patients and 982 matched controls were registered. iRBD patients had significantly higher rates of health-related contacts and of medication use, and higher socioeconomic costs than controls. The total additional direct net healthcare costs after the diagnosis (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) was €13,088 for patients compared with controls. Patients already exhibited a negative social- and health-related status several years before the first diagnosis.

Conclusions

Diagnoses of iRBD have major socioeconomic consequences for patients, their partners, and society.
Is Sexual Conflict a Driver of Speciation? A Case Study With a Tribe of Brush-footed Butterflies
Authors: Carvalho Ana Paula S , St Laurent Ryan A , Toussaint Emmanuel F A , Storer Caroline , Dexter Kelly M , Aduse-Poku Kwaku , Kawahara Akito Y
Published: August 2020

Understanding the evolutionary mechanisms governing the uneven distribution of species richness across the tree of life is a great challenge in biology. Scientists have long argued that sexual conflict is a key driver of speciation. This hypothesis, however, has been highly debated in light of empirical evidence. Recent advances in the study of macroevolution make it possible to test this hypothesis with more data and increased accuracy. In the present study, we use phylogenomics combined with four different diversification rate analytical approaches to test whether sexual conflict is a driver of speciation in brush-footed butterflies of the tribe Acraeini. The presence of a sphragis, an external mating plug found in most species among Acraeini, was used as a proxy for sexual conflict. Diversification analyses statistically rejected the hypothesis that sexual conflict is associated with shifts in diversification rates in Acraeini. This result contrasts with earlier studies and suggests that the underlying mechanisms driving diversification are more complex than previously considered. In the case of butterflies, natural history traits acting in concert with abiotic factors possibly play a stronger role in triggering speciation than does sexual conflict. [Acraeini butterflies; arms race; exon capture phylogenomics; Lepidoptera macroevolution; sexual selection; sphragis.]
Neurological complications of chimeric antigen receptor T cells and immune-checkpoint inhibitors: ongoing challenges in daily practice
Authors: Berzero Giulia , Picca Alberto , Psimaras Dimitri
Published: August 2020

Purpose of review

The aim of this review is to summarize the most recent advances in the management of neurological toxicities associated with immune-checkpoint inhibitors (ICIs) and chimeric antigen receptor (CAR)-T cells.

Recent findings

The advent of cancer immunotherapies has dramatically improved the prognosis of several refractory and advanced neoplasms. Owing to their mechanism of action, cancer immunotherapies have been associated with a variety of immune-related adverse events (irAE). Neurological irAE are uncommon compared with other irAE, but they are associated with significant morbidity and mortality. Despite the efforts to draft common protocols and guidelines, the management of neurological irAE remains challenging. Our ability to predict the development of neurotoxicity is still limited, hampering to elaborate prevention strategies. Treatment heavily relies on the administration of high-dose corticosteroids that, however, have the potential to impair oncological efficacy. The experimentation of novel strategies to avoid resorting to corticosteroids is hindered by the lack of an adequate understanding of the pathogenetic mechanisms driving the development of irAE.

In this review, we will discuss the most recent advances on the diagnosis and management of neurological irAE associated with ICIs and CAR-T cells, focusing on the issues that remain most challenging in clinical practice.
Cancer Management During the COVID-19 Pandemic in the United States
Authors: Hui Jane Yuet Ching , Yuan Jianling , Teoh Deanna , Thomaier Lauren , Jewett Patricia , Beckwith Heather , Parsons Helen , Lou Emil , Blaes Anne H. , Vogel Rachel I.
Published: August 2020

Objectives:

The coronavirus disease 2019 (COVID-19) has significantly impacted health care delivery across the United States, including treatment of cancer. We aim to describe the determinants of treatment plan changes from the perspective of oncology physicians across the United States during the COVID-19 pandemic.

Methods:

Participants were recruited to an anonymous cross-sectional online survey of oncology physicians (surgeons, medical oncologists, and radiation oncologists) using social media from March 27 to April 10, 2020. Physician demographics, practice characteristics, and cancer treatment decisions were collected.

Results:

The analytic cohort included 411 physicians: 241 (58.6%) surgeons, 106 (25.8%) medical oncologists, and 64 (15.6%) radiation oncologists. In all, 38.0% were practicing in states with 1001 to 5000 confirmed COVID-19 cases as of April 3, 2020, and 37.2% were in states with >5000 cases. Most physicians (N=285; 70.0% of surgeons, 64.4% of medical oncologists, and 73.4% of radiation oncologists) had altered cancer treatment plans. Most respondents were concerned about their patients’ COVID-19 exposure risks, but this was the primary driver for treatment alterations only for medical oncologists. For surgeons, the primary driver for treatment alterations was conservation of personal protective equipment, institutional mandates, and external society recommendations. Radiation oncologists were primarily driven by operational changes such as visitor restrictions.

Conclusions:

The COVID-19 pandemic has caused a majority of oncologists to alter their treatment plans, but the primary motivators for changes differed by oncologic specialty. This has implications for reinstitution of standard cancer treatment, which may occur at differing time points by treatment modality.
A Pilot Validation Study of the Newborn Behavioral Observations System: Associations with Salivary Cortisol and Temperament
Authors: Congdon Jayme L. , Nugent J. Kevin , McManus Beth M. , Coccia Michael , Bush Nicole R.
Published: August 2020

Objective:

There are few standardized neonatal neurobehavioral instruments available for longitudinal child development research. We adapted an established clinical tool, the Newborn Behavioral Observations (NBO) system, for research by standardizing the administration protocol and expanding the 3-point coding scale to 5 points.

Methods:

We administered the 5-point NBO to 144 racially/ethnically diverse late preterm or term infants born to low-income women (average age 5 weeks). Cronbach's alphas were calculated to determine internal consistency reliability of Autonomic, Motor, Organization of State, and Responsivity subscales. We examined concurrent validity using subscale associations with infant salivary cortisol reactivity to the NBO and maternally reported infant temperament.

Results:

Two of the 4 NBO subscales, Organization of State and Responsivity, had excellent (0.91) and good (0.76) reliability, respectively, and were retained for further analyses. Infants with higher Organization of State scores (more optimal regulation) demonstrated lower cortisol reactivity (r = −0.30, p < 0.01) and temperamental negativity (r = −0.16, p < 0.05). Responsivity was unrelated to cortisol reactivity or temperament.

Conclusions:

State regulation, as measured by the 5-point NBO, was associated with a biologic marker of infant stress response to the NBO administration and reported temperament. Poor reliability of the NBO's 3-item Autonomic and 7-item Motor subscales suggests that further psychometric research in other samples and likely refinement are needed. Given the paucity of neurobehavioral assessment tools for infants, these findings justify such research as next steps in the incremental progression toward the development of a practical, reliable, and predictive measure of early neurobehavioral development.
Ethyl Alcohol Versus Botulinum Toxin A: A Comparative Study of the Visual and Histopathological Outcomes in the Rabbit Anterior Auricular Muscle Model
Authors: Ince Bilsev , Uyanik Orkun , Oltulu Pembe , Ismayilzade Majid , Dadaci Mehmet , Savaci Nedim
Published: August 2020

BACKGROUND

Botulinum toxin has long been known for its paralytic effects at the neuromuscular junction. Although it has been widely used for vascular and nervous tissues, there has been no study of the aesthetic effects of the application of ethanol to muscle tissues to date.

OBJECTIVE

The authors aimed to demonstrate the effects of the application of ethanol to muscle tissues after an intramuscular injection and to compare the effects of botulinum toxin A (BTA) and ethanol.

METHODS AND MATERIALS:

A total of 28 rabbits were divided into 4 groups (n = 7 each). Botulinum toxin A (5 units) and different concentrations of ethanol (5 cc) were injected into the left and right anterior auricular muscles of all rabbits, respectively. Ear ptosis was assessed, and histopathological examination was performed after all rabbits were euthanized in the eighth week.

RESULTS

Muscle function was affected earlier in ethanol-treated ears than in botulinum-treated ears; however, the ptotic effect lasted for a significantly shorter duration in ethanol-injected ears than in BTA-applied ears.

CONCLUSION

Ethanol can block muscle function reversibly and can serve as an alternative to BTA, particularly when rapid results are desirable.
Types of Cosmetic Procedures Requested by Different Types of Patients and the Reasons for These Preferences
Authors: Maisel Amanda , Waldman Abigail , Poon Emily , Alam Murad
Published: August 2020

BACKGROUND

The type of cosmetic dermatologic procedures patients' desire may be influenced by demographic factors.

OBJECTIVE

To better understand the type of cosmetic procedures requested by patients of different age, gender, education, race, and geographic location. To understand the most common motivations of patients who requested particular types of treatments.

MATERIALS AND METHODS

Multicenter data from the Cosmetic Motivation Database were analyzed. Bivariable analyses and linear regressions were undertaken to determine whether patient demographic features were associated with particular procedures of interest.

RESULTS

Patients younger than 45 years were more interested in acne scar treatment, laser hair removal, liposuction, and tattoo removal. Older patients were more likely to want soft-tissue fillers and wrinkles and jowls tightening treatment. Non-White patients were more likely to be interested in laser hair removal, liposuction, cellulite treatment, and tattoo removal. Types of procedures desired varied by the geographic region but not by the educational level. Different motivations drove patients who wanted different types of treatments.

CONCLUSION

Different types of patients demand different types of cosmetic treatments, and the motivations of patients who ask for particular procedures also differ. Better understanding of patient preferences may help physicians allocate resources and meet patient needs.
Weathering the Storm: How Superstorm Sandy Shaped the Response to COVID-19
Authors: Simon Maxine dellaBadia
Published: August 2020

Catastrophic weather, like a pandemic, can wreak havoc on hospital operations. NYU Langone Health in New York City has experienced the extremes of both phenomena. In 2012, Superstorm Sandy severely damaged the system's core facilities, disabled operations, and forced the evacuation of more than 220 patients to other health systems. In 2020, the arrival of the novel coronavirus severely disrupted operations again—but this time, we were better prepared. Our experience in dealing with Superstorm Sandy taught us critical lessons that supported our readiness for COVID-19. Those lessons can be summed up as preparation, organization, and innovation.
COVID-19: Implications for Supply Chain Management
Authors: Francis James R.
Published: August 2020

The COVID-19 pandemic has created global health and economic disruption. Hospitals and other healthcare providers have been hit particularly hard. While efforts to effectively treat and eradicate the coronavirus continue, so do the efforts of supply chains to support the provision of patient care in the event of a resurgence or future pandemic. Supply chain leaders must continuously evaluate their strategic and tactical positions to address critical supply needs. Whether the supply chain can meet expectations remains uncertain, given rolling supply shortages of personal protective equipment (PPE) and other medical–surgical supplies as healthcare providers resume prepandemic levels of operations. The ability to ensure a reliable, sustainable supply of critical PPE in the near term will remain a challenge. Longer-term substantive changes to the function and performance of healthcare supply chains will be necessary across multiple areas to meet demand more effectively during a crisis.
Baseline SCAT Performance in Men and Women: Comparison of Baseline Concussion Screens Between 6288 Elite Men's and 764 Women's Rugby Players
Authors: Tucker Ross , Falvey Eanna , Fuller Gordon , Brown James , Raftery Martin
Published: August 2020

Objective:

This study compared Sports Concussion Assessment Tool (SCAT) performance in elite male (6288 players) and female (764 players) rugby players, to determine whether reference limits used for the management and diagnosis of concussion should differ between sexes.

Design:

Cross-sectional census sample.

Setting:

Data from World Rugby's Head Injury Assessment management system were analyzed. This data set covers global professional rugby.

Participants:

All professional players who underwent baseline SCAT testing as part of World Rugby's concussion management requirement formed the study cohort. Ten thousand seven hundred fifty-four SCAT assessments from 6288 elite male rugby players and 1071 assessments from 764 elite female players were analyzed.

Intervention:

Elite men and women rugby players are independent variables.

Main Outcome Measures:

Sports Concussion Assessment Tool performance, including symptoms endorsed, cognitive submode performance, and balance performance.

Results:

Women endorsed significantly more symptoms, with greater symptom severity, than men (relative ratio 1.34, 95% confidence interval, 1.25-1.45 women vs men). Women outperformed men in cognitive submodes with the exception of immediate memory and delayed recall and made fewer balance errors than men during the modified Balance Error Scoring System. Clinical reference limits, defined as submode score achieved by the worst-performing 50% of the cohort, did not differ between men and women.

Conclusions:

Women and men perform differently during SCAT baseline testing, although differences are small and do not affect either the baseline or clinical reference limits that identify abnormal test results for most submodes. The greater endorsement of symptoms by women suggests increased risk of adverse concussion outcomes and highlights the importance of accurate evaluation of any symptom endorsement at baseline.
Epidemiology of Injuries in Elite Badminton Players: A Prospective Study
Authors: Guermont Henri , Le Van Philippe , Marcelli Christian , Reboursière Emmanuel , Drigny Joffrey
Published: August 2020

Objective:

To determine the incidence and characteristics of injuries in elite badminton players over a competitive season.

Design:

Prospective cohort study.

Setting:

The French National Institute of Sport, Expertise, and Performance (INSEP).

Participants:

Twenty international elite badminton players.

Independent Variables:

The type, the location, the occurrence of the injury (match or training), the footwork type, the type of shot, and the perceived fatigue were collected.

Main Outcome Measures:

Injury incidence rates were calculated per 1000 hours of play (Hop).

Results:

Thirty-five injuries were collected over 10 210 hours of player exposure with an overall incidence rate of 3.4 injuries per 1000 Hop, with higher incidence during matches than training (11.6 vs 2.08; P < 0.05). Lower-limb injuries (LLI) were the most frequent (54.3%) especially on the foot (22.9%), and upper-limb injury rate (37.1%) was higher compared with previous studies. The most common type was musculotendinous injuries (51.4%). The smash and the lunge were the most frequent causes of upper-limb injury and LLI, respectively. Injuries occurred mostly during the first third of play (46.2%).

Conclusions:

This is the first prospective study to investigate badminton injuries among international badminton players. Further studies are needed to confirm our results on larger samples.
Adjunct use of radiofrequency coblation for osteochondritis dissecans in children
Authors: Estes Reed
Published: August 2020

Rationale:

Osteochondritis dissecans (OCD) lesions involve disruption of the osteochondral unit along articular surfaces, with significant potential for joint deterioration if not managed appropriately.

Patient concerns:

A 15-year-old male presented with persistent and insidious right knee pain, which had worsened following a collision with another player during a basketball game, resulting in episodes of locking.

Diagnoses:

Magnetic resonance imaging revealed a lateral trochlear OCD extending into the anterior lateral femoral condyle.

Interventions:

Chondral fraying was observed along the margins of the OCD. Retrograde drilling ensued with use of a 0.045-inch Kirschner wire throughout the lesion to a depth that would allow for penetration of healthy underlying subchondral bone to create an influx of healing factors. Three resorbable pegs were arthroscopically placed through an accessory portal overlying the lesion to stabilize the fracture and compress the gapped cartilage mantle to reduce flow of synovial fluid behind the lesion. Bipolar radiofrequency coblation was used to stabilize the chondral fraying and seal the gap along the periphery of the lesion.

Outcomes:

The patient was put on a nonweight bearing protocol for 6 weeks, after which crutches and brace were discontinued, but therapy persisted. Repeat imaging at 3 months demonstrated excellent interval healing. The patient was released to slowly engage impact activities. Although he returned at approximately 8 months postoperatively with a contralateral anterior cruciate ligament tear, he reported the operative knee with the OCD was doing extremely well.

Lessons:

Radiofrequency coblation appears to be a viable strategy as an adjunct to management for OCD in children.
Chronic bilateral asynchronous achilles tendon rupture treated using modified whole flexor hallucis longus transfer reconstruction
Authors: Zhang Xiangfeng , Ruan Feng , Wu Yongping , Lu Huang
Published: August 2020

Introduction:

Achilles tendon rupture is common, but bilateral ruptures are very rare. Treatment of chronic Achilles tendon rupture is very challenging due tendon retraction and atrophied. We report a case of bilateral asynchronous Achilles tendon rupture patient who was treated with modified minimally invasive whole flexor hallucis longus (FHL) tendon transfer to repair the defects.

Patient concerns:

A 52-year-old male farmer presented to our hospital complaining of bilateral heel pain that had disrupted his walking for 6 months. The patient had been misdiagnosed and under-treated for 1 year. Physical examination showed that his plantar flexors were tender and weak, with marked hypotrophy of the calf muscles. Bilateral ankle radiographs of both X-ray and computed topography (CT) revealed no bone injure.

Diagnosis:

Magnetic resonance imaging (MRI) indicated a bilateral Achilles tendon rupture. The diagnosis was further confirmed by postoperative histological examination, which revealed Achilles tendonitis accompanied by regional calcification and chondrometaplasia.

Interventions:

Surgical reconstruction of the ruptured Achilles tendons was done through a modified minimally invasive whole FHL tendon transfer followed by physiotherapy.

Outcomes:

The patient was immobilized in a cast for the next 6 weeks, gradual weight bearing gradually was then encouraged for another 6 weeks, and full weight-bearing started 3 months after surgery. By 6-month postoperation, the patient could walk and jog normally returned to his pre-injury working condition.

Conclusion:

Surgical intervention is among the primary treatment of chronic Achilles tendon rupture. However, one of the challenges in its treatment is providing suitable graft for tendon reconstruction. Our case presents a successful reconstruction procedure using less-invasive whole FHL transfer technique. This surgical technique provides satisfactory clinical and functional outcome and can be considered for future therapy.
Ultrasound-guided suprainguinal fascia iliaca block combined with a sacral plexus block for lower extremity surgery
Authors: Zhao Jie , Huang Yanming , Fu Mingjie , Tao Fan
Published: August 2020

Rationale:

The anesthetic management of patients with severe pulmonary hypertension is different from that of normal, healthy patients, and regional nerve blocks are commonly used for them. Due to the individual variability of the course, distribution, and branching of the nerves below the inguinal ligament, the supra-inguinal fascia iliaca (SIFI) block has a wider and more stable blocking area. In combination with the sacral plexus block, they can satisfy the needs of surgical anesthesia below the hip.

Patient concerns:

A 46-year-old man with tuberculosis, chronic obstructive pulmonary disease, pulmonary heart disease, World Health Organization (WHO) class III pulmonary hypertension and right heart dysfunction, and American Society of Anesthesiologists physical status class III needed fixation of an intramedullary nail in the left lower extremity. Additionally, he had broken his left lower limb after a recent fall. Both general anesthesia and epidural anesthesia were not appropriate.

Diagnoses:

The patient had a clear history of tuberculosis, computerized tomography scan displayed destructive pneumonophthisis. Furthermore, he had chronic obstructive pulmonary disease and pulmonary heart disease.

Interventions:

An ultrasound-guided SIFI combined with a sacral plexus block was successfully performed for surgical anesthesia and avoided all hemodynamic fluctuations.

Outcomes:

We successfully performed an ultrasound-guided SIFI combined with a sacral plexus block for surgical anesthesia and avoided all hemodynamic fluctuations.

Lessons:

Ultrasound-guided suprainguinal fascia iliaca block combined with a sacral plexus block can be suitable for anesthesia for patients with severe circulatory compromise.
Aggressive variant of splenic marginal zone lymphoma characterized using a cancer panel test and treated with rituximab-containing chemotherapy
Authors: Ishiguro Kazuya , Sasaki Yasushi , Takagi Yoshitake , Niinuma Takeshi , Suzuki Hiromu , Tokino Takashi , Hayashi Toshiaki , Takahashi Tohru , Igarashi Tetsuyuki , Matsuno Yoshihiro
Published: August 2020

Rationale:

Aggressive variant of splenic marginal zone lymphoma (AV-SMZL) is a very rare disease that is often associated with TP53 mutations and has a poor prognosis. On the other hand, recent advances in genome sequencing techniques enable us to understand the molecular characteristics of rare cancers such as AV-SMZL. Here we present a case of AV-SMZL analyzed using a genetic test.

Patient Concerns:

A 66-year-old woman was admitted with splenomegaly and lymphocytosis. Computed tomography revealed marked splenomegaly without lymphadenopathy in any other areas. The serum soluble interleukin-2 receptor (sIL-2R) level was significantly elevated. Peripheral and bone marrow blood tests showed an increase in abnormal lymphocytes.

Diagnosis:

A splenectomy revealed an SMZL pattern with increased numbers of large cells and mitotic cells and a high Ki-67 positivity rate, which led to a diagnosis of AV-SMZL. Although TP53 mutation was not detected, mutations in NOTCH2, NCOA4, PTEN, EPHA3, and KMT2D were identified. Among these, the mutations in NCOA4, PTEN, and EPHA3 were novel pathogenic mutations in SMZL, which suggests they may be related to the aggressiveness and persistence of the disease.

Interventions:

The patient was administered a rituximab-containing regimen and rituximab-maintenance therapy.

Outcomes:

The patient continues to exhibit a complete response.

Lessons:

This is a case of AV-SMZL in which a cancer panel test successfully detected genetic alterations that are potentially associated with its pathogenesis. These findings suggest that genetic analysis is useful for making diagnoses as well as for determining treatment strategies in AV-SMZL.
Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion for the treatment of multilevel cervical spondylosis
Authors: Li Ning , Wang Rui , Teng Wei , Yu Jinhua
Published: August 2020

Background:

The objective of this meta-analysis was to summarize and identify the available evidence from these studies to estimate which device was better for multilevel cervical spondylotic myelopathy (MCSM). And provides clinicians with evidence on which to base their clinical decision making.

Methods:

This review will include all studies comparing the new Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion (ACDF) for the treatment of MCSM. The search strategy will be performed in 9 databases. We will not establish any limitations to language and publication status, published from inception to the July, 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is operative time, blood loss, clinical function outcome, radiologic outcomes, and complications. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software.

Results:

This study will summarize current evidence to assess the efficacy and safety of Zero-profile versus cage-plate interbody fusion system in ACDF for the treatment of MCSM.

Conclusion:

The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as comparing the 2 devices in ACDF for MCSM

Registration number:

INPLASY202070095 (DOI number: 10.37766/inplasy2020.7.0095).
A Systematic Review of Nonsurgical Vulvovaginal Restoration Devices: An Evidence-Based Examination of Safety and Efficacy
Authors: Preminger B. Aviva , Kurtzman Joey S. , Dayan Erez
Published: August 2020

Background:

The efficacy and safety of vulvovaginal restoration devices were called into question in a U.S. Food and Drug Administration statement on July 30, 2018, claiming that women are being harmed by laser and other energy-based devices. The goal of this systematic literature review was to assess existing data, determine gaps in evidence, and propose opportunities for continued investigation pertaining to laser and energy-based vaginal restoration techniques.

Methods:

A review of literature using PubMed, Cochrane Library databases, Embase, MEDLINE, and the Cumulative Index to Nursing and Allied Health Literature was conducted on January 9, 2019, and articles up to this point were considered. For inclusion, studies had to be available or translated in English and relate to clinical medicine, direct patient care, and nonsurgical energy-based vulvovaginal procedures.

Results:

The authors found five level I studies, 19 level II studies, four level III studies, and 46 level IV studies that used 15 different devices. Various degrees of improvement of symptoms were reported in all studies. Adverse events/side effects were noted in two of the 13 radiofrequency device studies, 15 of the 23 erbium:yttrium-aluminum-garnet device studies, and 17 of the 37 carbon dioxide device studies. The majority of adverse events were considered mild.

Conclusions:

The majority of studies resulted in mild to no adverse side effects. However, there is a large gap in level I evidence. As a result, the authors emphasize the necessity of supplemental data surrounding this subject and suggest that additional randomized sham-controlled studies be conducted to further investigate vulvovaginal restoration devices in an effort to address women’s health issues.
The Baker Classification for Capsular Contracture in Breast Implant Surgery Is Unreliable as a Diagnostic Tool
Authors: de Bakker Erik , Rots Mathijs , Buncamper Marlon E. , Niessen Frank B. , Smit Jan Maerten , Winters Henri A. H. , Özer Müjde , de Vet Henrica C. W. , Mullender Margriet G.
Published: August 2020

Background:

Breast implants are frequently used in cosmetic and reconstructive breast surgery. Capsular contracture, the most common long-term complication, is usually graded using the Baker classification. Despite its widespread use, the reliability of the Baker classification has never been established. The aim of this study was to determine the interobserver reliability and agreement of the Baker classification.

Methods:

Sixty women who had undergone cosmetic breast augmentation were included. They were examined independently by two plastic surgeons from an observer pool. The Baker score was determined, along with firmness, dislocation, symmetry, and pain using four-point scales. Patients were asked to complete the BREAST-Q postaugmentation module. The interobserver reliability and agreement were calculated for all variables with a quadratic weighted kappa.

Results:

The interobserver reliability of the Baker classification was poor (kappa, 0.55; 95 percent CI, 0.37 to 0.72). Interobserver reliability of the clinical parameters firmness (0.64; 95 percent CI, 0.49 to 0.79), dislocation (0.49; 95 percent CI, 0.26 to 0.73), and symmetry (0.61; 95 percent CI, 0.34 to 0.88) was also poor. Pain scores seemed more reliable (0.72; 95 percent CI, 0.56 to 0.89); however, most patients had no pain. The interobserver agreement for the Baker score was 48 percent; in 43 percent, the observers differed one category; and in 12 percent, the difference was more than one category.

Conclusions:

Interobserver reliability and observer agreement of the Baker classification for capsular contracture were poor. Consensus about how to adequately rate the symptoms of capsular complaints is lacking. A more reliable method of measurement or description is needed, especially for scientific research purposes, to assess the long-term problems associated with breast implants.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Navigating the Insurance Landscape for Coverage of Reduction Mammaplasty
Authors: Rawes Catherine M. A. , Ngaage Ledibabari M. , Borrelli Mimi R. , Puthumana Joseph , Slezak Sheri , Rasko Yvonne M.
Published: August 2020

Background:

Reduction mammaplasty provides symptomatic relief to patients with macromastia. Insurance companies act as gatekeepers of health care by determining the medical necessity of surgical procedures, including reduction mammaplasty. The authors sought to evaluate insurance coverage and policy criteria for reduction mammaplasty.

Methods:

The authors conducted a cross-sectional analysis of U.S. insurance policies on reduction mammaplasty. Insurance providers were selected based on their enrolment data and market share. The authors conducted telephone interviews and Web-based searches to identify the policies. Medical necessity criteria were abstracted from the publicly available policies that offered coverage.

Results:

The authors reviewed 63 insurers. One in 10 insurers had no established policy for reduction mammaplasty. Of the 48 publicly available policies, shoulder pain and backache were the most common symptoms required for preapproval (98 percent and 98 percent). A minimum resection volume was requested by 88 percent of policies. One-third of policies (31 percent) offered a choice between removal of a minimum weight per breast or a volume based on body surface area. Over half of companies (54 percent) used body surface area calculations to predict minimum resection volume. Medical necessity that extended beyond national recommendations included trial of weight loss (23 percent) and nipple position (10 percent).

Conclusions:

Insurance policy criteria for reduction mammaplasty are discordant with current national recommendations and current clinical evidence. Many policies use outdated criteria that do not correlate with symptom relief and consequently limit access to reduction mammaplasty. Here, the authors propose a comprehensive guideline to maximize coverage of reduction mammaplasty.
Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis
Authors: Retrouvey Helene , Sander Beate , von Schroeder Herbert P. , Binhammer Paul , Baltzer Heather L.
Published: August 2020

Background:

The authors conducted a cost-effectiveness analysis to answer the question: Which motion-preserving surgical strategy, (1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty, used for the treatment of wrist osteoarthritis, is the most cost-effective?

Methods:

A simulation model was created to model a hypothetical cohort of wrist osteoarthritis patients (mean age, 45 years) presenting with painful wrist and having failed conservative management. Three initial surgical treatment strategies—(1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty—were compared from a hospital perspective. Outcomes included clinical outcomes and cost-effectiveness outcomes (quality-adjusted life-years and cost) over a lifetime.

Results:

The highest complication rates were seen in the four-corner fusion cohort: 27.1 percent compared to 20.9 percent for total wrist arthroplasty and 17.4 percent for proximal row carpectomy. Secondary surgery was common for all procedures: 87 percent for four-corner fusion, 57 percent for proximal row carpectomy, and 46 percent for total wrist arthroplasty. Proximal row carpectomy generated the highest quality-adjusted life-years (30.5) over the lifetime time horizon, compared to 30.3 quality-adjusted life-years for total wrist arthroplasty and 30.2 quality-adjusted life-years for four-corner fusion. Proximal row carpectomy was the least costly; the mean expected lifetime cost for patients starting with proximal row carpectomy was $6003, compared to $11,033 for total wrist arthroplasty and $13,632 for four-corner fusion.

Conclusions:

The authors’ analysis suggests that proximal row carpectomy was the most cost-effective strategy, regardless of patient and parameter level uncertainties. These are important findings for policy makers and clinicians working within a universal health care system.