bluuebunny/crossref_metadata_2025 huggingface dataset:
Transformational Changes Between Non–Small Cell and Small Cell Lung Cancer—Biological and Clinical Relevance—A Review
Authors: Clamon Gerald , Zeitler William , An Josiah , Hejleh Taher A.
Published: June 2020

During the course of therapy, patients with small cell lung cancer have been noted to develop transformation to non–small cell lung cancer and conversely, patients with non–small cell lung cancer have had transformation to small cell lung cancer or other non–small cell histologies. Transformation may occur after prior tyrosine kinase inhibitors, chemotherapy, immunotherapy or radiation therapy. These changes reflect on the overlapping biology of these cell types and the clinical need for re-biopsy at times of disease progression. The optimum therapy after transformation will depend upon prior therapies received, the functional capacity of the patient, and further research to define the best therapy options.
Associations of pituitary-ovarian hormones and white matter hyperintensities in recently menopausal women using hormone therapy
Authors: Kling Juliana M. , Miller Virginia M. , Tosakulwong Nirubol , Lesnick Timothy , Kantarci Kejal
Published: June 2020

Objective:

Little is known about how menopausal hormone treatment (HT) may influence the development of white matter hyperintensities (WMHs) in the brain. This study evaluated the associations of changes in levels of pituitary-ovarian hormones during HT and changes in WMH.

Methods:

Women (n = 78 adherent to treatment) enrolled in the Kronos Early Estrogen Prevention Study underwent brain magnetic resonance imaging, and blood collection before and after 48 months of randomization to 0.45 mg/d oral conjugated equine estrogen (oCEE) daily, 50 μg/d transdermal 17β estradiol (tE2), or placebo pills and patches. Women in the active treatment groups also received oral 200 mg/d micronized progesterone the first 12 days of the month. Estradiol (E2), estrone (E1), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were measured in serum by high sensitivity liquid chromatography/mass spectrometry at baseline and following 48 months of HT. Longitudinal change in WMH volume was determined from fluid-attenuated inversion recovery magnetic resonance imaging using a semiautomated image segmentation algorithm.

Results:

Serum levels of FSH, LH, E1, or E2 did not associate with WMH volume at baseline. After 48 months of treatment, smaller increases in WMH associated with decreases in FSH from baseline in the tE2 group and increases in E1 in both tE2 and oCEE groups. Changes in LH did not associate with changes in WMH in any group.

Conclusions:

Circulating levels of pituitary-ovarian hormones associate with changes in WMH volume in recently menopausal women using HT. Whether these relationships would be influenced by different doses of tE2 or oCEE remains to be determined.

Video Summary:

http://links.lww.com/MENO/A590.
Effective Dose Coefficients for Intakes of Uranium Via Contaminated Wounds for Reference Adults
Authors: Zhang Bin , Sheng Wei , Feng Tian-Cheng , Xu Ming , Lei Jie-Ying , He Xin-Zhao , Yin Guo-Hui
Published: June 2020

Effective dose coefficients for intakes of uranium radionuclides via contaminated wounds have been calculated for reference adults following the procedures in the ICRP 103 series. The number of transformations in each source region for all members of the radioactive series from time of intake to 50 y post intake are calculated by coupling the NCRP 156 wound model to the ICRP 137 systemic models and ICRP 100 human alimentary tract model. Together with the ICRP 107 nuclear decay data for dosimetric calculations, the ICRP 133 specific absorbed fractions are implemented to calculate the radiation-weighted S coefficient deposited in each target organ or tissue from each transformation in each source region. Effective dose coefficients for different categories of intake materials via contaminated wounds are calculated for the three major uranium isotopes–238U, 235U, and 234U. Originating from the combined effects of the new absorbed fractions, biokinetic and dosimetric models, the new coefficients are generally reduced by a percentage of 23–28% as compared to the old ones. The new dose coefficients benefit the assessment of internal exposures for intakes of uranium via contaminated wounds in actual applications.
Demographics Predict Stage III/IV Colorectal Cancer in Individuals Under Age 50
Authors: Fass Ofer Z. , Poels Kamrine E. , Qian Yingzhi , Zhong Hua , Liang Peter S.
Published: June 2020

Goals:

The goal of this study was to quantify the association between demographic factors and advanced colorectal cancer (CRC) in patients under age 50.

Background:

CRC incidence in the United States has declined in older individuals but increased in those under age 50 (early-onset). More than 60% of early-onset CRC patients present with advanced disease (stage III/IV), but predictors of stage in this population are poorly defined.

Study:

We analyzed CRC cases diagnosed between age 20 and 49 in the United States Surveillance, Epidemiology, and End Results (SEER) 18 database during 2004 to 2015. Logistic regression models were fit to assess the impact of age, sex, race, ethnicity, marital status, and cancer site on the probability of advanced disease.

Results:

The analysis included 37,044 cases. On multivariable regression, age was inversely associated with advanced disease. Relative to 45 to 49-year-olds, 40 to 44-year-olds had 8% greater odds of having advanced CRC, and 20 to 24-year-olds had 53% greater odds. Asians, blacks, and Pacific Islanders had 10%, 12%, and 45% greater odds of advanced disease compared with whites. Compared with nonpartnered individuals, those with partners had 11% lower odds of advanced CRC. Both right-sided and left-sided colon cancer were more likely to be diagnosed at stage IV compared with rectal cancer.

Conclusions:

Among individuals with early-onset CRC, younger age, Asian, black, or Pacific Islander race, and being nonpartnered were predictors of advanced disease at presentation. Colon cancer was more likely to be diagnosed at stage IV than rectal cancer. Patient characteristics associated with advanced CRC may indicate both differences in tumor biology and disparities in health care access.
Association of Gastric Acid Suppression and Sorafenib Efficacy in Advanced Hepatocellular Carcinoma
Authors: Razak Razwan A. , Fletcher Peter , Kunene Victoria , Ma Yuk Ting
Published: June 2020

Background:

Recent studies have revealed that coadministration of gastric acid suppressants reduces the efficacy of the tyrosine kinase inhibitors erlotinib and sunitinib in patients with non–small cell lung cancer and renal cell carcinoma, respectively. The authors have therefore assessed if the concurrent use of gastric acid suppressants and sorafenib impairs outcomes in patients with advanced hepatocellular carcinoma (HCC).

Methods:

A retrospective analysis was conducted on all patients treated with sorafenib for advanced HCC at a single tertiary referral unit in the United Kingdom, between January 2008 and January 2014. A multivariate Cox proportional hazard model was used to assess the effect of the concomitant use of gastric acid suppression and sorafenib on progression-free survival (PFS) and overall survival (OS).

Results:

Data were collected from 197 patients, of which 182 could be assessed for this study; 77 (42%) were on concurrent gastric acid suppression therapy. After adjusting for imbalances between the groups, a Cox regression analysis gave an adjusted hazard ratio for the concurrent acid suppression group compared with the no acid suppression group of 5.4 (95% confidence interval, 3.6-7.9) for PFS and 1.85 (95% confidence interval, 1.3-2.6) for OS.

Conclusions:

This single-center experience shows that patients with advanced HCC taking sorafenib and concomitant gastric acid suppression therapy have significantly inferior PFS and OS. This is the first time that this negative interaction has been reported and further prospective validation is warranted.
Alcohol-associated Cirrhosis and Alcoholic Hepatitis Hospitalization Trends in the United States
Authors: Shirazi Farah , Singal Ashwani K. , Wong Robert J.
Published: June 2020

Goals:

The goals of this study were to evaluate trends in hospitalizations and in-hospital mortality among US adults with alcohol-associated cirrhosis and alcoholic hepatitis.

Background:

Alcohol-associated liver disease contributes to significant liver-related morbidity in the United States, among which inpatient care is a major driver of clinical and economic burden.

Methods:

Using the 2007-2014 National Inpatient Sample, alcohol-associated cirrhosis and alcoholic hepatitis hospitalizations were identified. Survey-weighted annual hospitalization trends were stratified by sex, race/ethnicity, and age and compared using χ2 and Student’s t-test methods. Adjusted multivariate logistic regression models evaluated predictors of in-hospital mortality.

Results:

Among 159,973 alcohol-associated liver disease hospitalizations, 83.7% had a primary diagnosis of alcohol-associated cirrhosis and 18.4% had a primary diagnosis of alcoholic hepatitis. Sex-specific differences in hospitalizations emerged, with significantly higher hospitalization rates seen in males versus females among both alcoholic hepatitis [incidence rate ratio=3.71, 95% confidence interval (CI): 3.47-4.01, P<0.01] and alcohol-associated cirrhosis (incidence rate ratio=2.68, 95% CI: 2.21-3.71, P<0.01). Differences in hospitalization and mortality by ethnicity were observed for both alcohol-associated cirrhosis and alcoholic hepatitis. African Americans with alcohol-associated cirrhosis had significantly higher in-hospital mortality compared with non-Hispanic whites [odds ratio (OR)=1.13, 95% CI: 1.04-1.24, P<0.01], whereas Native Americans (OR=1.88, 95% CI: 1.06-3.34, P=0.030) and Asian/Pacific Islanders (OR=2.02, 95% CI: 1.00-4.06, P=0.048) with alcoholic hepatitis had significantly higher in-hospital mortality compared with non-Hispanic whites.

Conclusions:

This study demonstrated increasing alcohol-associated cirrhosis and alcoholic hepatitis hospitalizations in the United States. The highest rates were observed in men and among Native American and Hispanic ethnic minorities. Significant ethnicity-specific disparities in mortality were observed.
Claims-based Frailty Indices
Authors: Shashikumar Sukruth A. , Huang Kristine , Konetzka R. Tamara , Joynt Maddox Karen E.
Published: June 2020

Objective:

The objective of this study was to evaluate claims-based frailty indices (CFIs) used to assess frailty on a population-based level.

Background:

Frailty is a key determinant of patient outcomes, independent of demographics and comorbidities. Measuring frailty in large populations has implications for targeted interventions, public reporting, and risk adjustment. Frailty indices based on administrative data in health insurance claims allow such population-level assessments of frailty.

Methods:

We used PubMed to search for studies that: (1) were development or validation studies of a CFI that predicted frailty; and (2) used only diagnosis codes within administrative claims or health services claims. We evaluated the CFIs on 6 axes: databases used to build the CFIs; variables used to designate frailty; methods used to build the CFIs; model performance for predicting frailty; model relationship to clinical outcomes; and model limitations.

Results:

We included 17 studies. They showed variation in the claims codes used to designate frailty, although themes like limited mobility and neurological and psychiatric impairment were common to most. C-statistics demonstrated an overall strong ability to predict patient frailty and adverse clinical outcomes. All CFIs demonstrated strong associations between frailty and poor outcomes.

Conclusions:

While each CFI has unique strengths and limitations, they also all had striking similarities. Some CFIs have been more broadly used and validated than others. The major takeaway from this review is that frailty is a clinically relevant, highly predictive syndrome that should be incorporated into clinical risk prediction when feasible.
Current state of the art in fat grafting: paradigm shift in surgical techniques and refinements in cleft and craniofacial reconstruction
Authors: Denadai Rafael , Lo Lun-Jou
Published: June 2020

Purpose of review

The purpose of this review is to provide an update on current practice and trends in fat graft surgery. The present review covers postoperative fat graft survival and phases, recipient bed and fat tissue enrichment issues, the spectrum of clinical applications in the cleft-craniofacial field, surgical techniques, and predictive factors for different outcomes.

Recent findings

Current investigations have led to a better understanding of fat graft survival and postoperative clinical progress. Fat grafting has been successfully adopted in a broad spectrum of cleft-related, craniofacial contour-related, burn-related, and radiation-related indications. Many variations on harvesting, processing, and delivery techniques and the use of recipient-site preconditioning and cell-enriched methods to increase the efficiency of fat grafting have been described, but little consensus exists about which technique is optimal. The development of predictors for fat grafting-related outcomes can aid multidisciplinary teams in providing better preoperative counseling, selecting the most suitable candidates for treatment, and establishing patient-specific postoperative care profiles.

The addition of modern fat graft surgery to the surgeon's toolbox revolutionized the delivery of surgical cleft and craniofacial care. Further investigation is necessary to assist surgeons in selecting the best candidates and optimal techniques.
Optimizing speech outcomes for cleft palate
Authors: Lindeborg Michael M. , Shakya Pramila , Rai Shankar Man , Shaye David A.
Published: June 2020

Purpose of review

Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate.

Recent findings

The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10–14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics.

According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.
Analysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children
Authors: Mack David R. , Saul Bradley , Boyle Brendan , Griffiths Anne , Sauer Cary , Markowitz James , LeLeiko Neal , Keljo David , Rosh Joel R. , Baker Susan S. , Steiner Steve , Heyman Melvin B. , Patel Ashish S. , Baldassano Robert , Noe Joshua , Rufo Paul , Kugathasan Subra , Walters Thomas , Marquis Alison , Thomas Sonia M. , Denson Lee , Hyams Jeffrey ,   PROTECT STUDY GROUP
Published: June 2020

Objectives:

The aim of this study was to assess common laboratory tests in identifying severe ulcerative colitis in children at diagnosis.

Methods:

A cohort of 427 children 4 to 17 years of age newly diagnosed with ulcerative colitis (UC) was prospectively enrolled. Boosted classification trees were used to characterize predictive ability of disease attributes based on clinical disease severity using Pediatric Ulcerative Colitis Activity Index (PUCAI), severe (65+) versus not severe (<65) and total Mayo score, severe (10–12) versus not severe (<10); mucosal disease by Mayo endoscopic subscore, severe (3) versus not severe (<3); and extensive disease versus not extensive (left‐sided and proctosigmoiditis).

Results:

Mean age was 12.7 years; 49.6% (n = 212) were girls, and 83% (n = 351) were Caucasian. Severe total Mayo score was present in 28% (n = 120), mean PUCAI score was 49.8 ± 20.1, and 33% (n = 142) had severe mucosal disease with extensive involvement in 82% (n = 353). Classification and regression trees identified white blood cell count, erythrocyte sedimentation rate, and platelet count (PLT) as the set of 3 best blood laboratory tests to predict disease extent and severity. For mucosal severity, albumin (Alb) replaced PLT. Classification models for PUCAI and total Mayo provided sensitivity of at least 0.65 using standard clinical cut‐points with misclassification rates of approximately 30%.

Conclusions:

A combination of the white blood cell count, erythrocyte sedimentation rate, and either PLT or albumin is the best predictive subset of standard laboratory tests to identify severe from nonsevere clinical or mucosal disease at diagnosis in relation to objective clinical scores.
The Potential Impact and Availability of Sexual Health Services During the COVID-19 Pandemic
Authors: Nagendra Gowri , Carnevale Caroline , Neu Natalie , Cohall Alwyn , Zucker Jason
Published: June 2020

As the COVID-19 pandemic causes upheaval in New York City (NYC), 1 consequence is the accessibility of sexual health services. The NYC STD Prevention Training Center at Columbia University administered an online provider survey to understand how the COVID-19 pandemic is affecting the availability of sexual health care services regionally.
Carriage of Neisseria meningitidis in Men Who Have Sex With Men Presenting to Public Sexual Health Clinics, New York City
Authors: Ngai Stephanie , Weiss Don , Bell Julie Anne , Majrud Difaa , Zayas Greicy , Crawley Addie , Kornblum John , Rodriguez-Rivera Lorraine D. , Quinlan Tammy , Halse Tanya A. , Retchless Adam C. , MacNeil Jessica , Pathela Preeti
Published: June 2020

Background

We conducted a Neisseria meningitidis (Nm) carriage study among men who have sex with men (MSM) to explore possible sexual transmission.

Methods

We paired information on patient characteristics with oropharyngeal, rectal, and urethral Nm culture results to assess associations with Nm carriage among 706 MSM at New York City sexual health clinics. The Nm isolates were characterized by whole genome sequencing.

Results

Twenty-three percent (163 of 706) of MSM were Nm carriers. Oropharyngeal carriage was 22.6% (159 of 703), rectal 0.9% (6 of 695), and urethral 0.4% (3 of 696). Oropharyngeal carriage was associated with the following recent (past 30 days) exposures: 3 or more men kissed (adjusted relative risk [aRR], 1.38; 95% confidence interval [CI], 1.03–1.86), performing oral sex (aRR, 1.81; 95% CI, 1.04–3.18), and antibiotic use (aRR, 0.33; 95% CI, 0.19–0.57). Sixteen clonal complexes were identified; 27% belonged to invasive lineages.

Conclusions

Our findings suggest that oral sex and the number of recent kissing partners contribute to Nm carriage in MSM.
An Unusual Method of Suicide
Authors: Jackson Nicole R. , Paul Ian D.
Published: June 2020

Suicidal ligature strangulation is a relatively rare event—far more common is suicide by hanging or homicidal ligature strangulation. With the increasing rate of suicide in the United States, use of atypical ligatures is likely to increase as well. Herein, we present such a rare case, a man who died by tightening cable ties around his own neck, and discuss the necessity of full scene and autopsy investigation to ensure proper certification of manner of death.
Recurrent Loss of SMARCA4 in Sinonasal Teratocarcinosarcoma
Authors: Rooper Lisa M. , Uddin Nasir , Gagan Jeffrey , Brosens Lodewijk A.A. , Magliocca Kelly R. , Edgar Mark A. , Thompson Lester D.R. , Agaimy Abbas , Bishop Justin A.
Published: June 2020

Molecular analysis has reshaped the landscape of high grade sinonasal tumors by defining novel entities and identifying recurrent mutations in established tumor types. However, sinonasal teratocarcinosarcoma (TCS), a rare and aggressive tumor with intermixed teratomatous, carcinomatous, and sarcomatous elements, remains poorly understood. The multiphenotypic differentiation of TCS has engendered persistent controversy about its histogenesis and leads to diagnostic overlap with several other malignancies. In this study, we evaluated the molecular underpinnings of TCS to clarify its pathogenesis and diagnosis. We performed SMARCA4 immunohistochemistry (IHC) on 22 TCS and 153 other sinonasal tumors. We identified loss of SMARCA4 expression in 18 TCS (82%), including 15 (68%) with complete loss and 3 (14%) with partial loss. Although we also identified partial SMARCA4 loss in 1 of 8 SMARCB1-deficient sinonasal carcinomas (13%), SMARCA4 was intact in all other sinonasal carcinomas and neuroendocrine tumors. We then selected 3 TCS with complete SMARCA4 loss by IHC for a targeted next-generation sequencing panel that included 1425 cancer-related genes. We confirmed biallelic somatic inactivation of SMARCA4 without other known oncogenic mutations in these 3 cases. Overall, these findings suggest that SMARCA4 inactivation may be the dominant genetic event in TCS, expanding understanding of this gene’s role in sinonasal tumorigenesis. They also raise the possibility that TCS is on a diagnostic spectrum with the newly described SMARCA4-deficient sinonasal carcinoma, blurring the lines between established and emerging sinonasal entities. In addition, SMARCA4 IHC may provide a useful adjunct for confirming a diagnosis of TCS in limited material.
Histopathologic Analysis of Signet-ring Cell Carcinoma In Situ in Patients With Hereditary Diffuse Gastric Cancer
Authors: Tsugeno Yuta , Nakano Kaoru , Nakajima Takeshi , Namikawa Ken , Takamatsu Manabu , Yamamoto Noriko , Fujisaki Junko , Nunobe Souya , Kitagawa Masanobu , Takeuchi Kengo , Kawachi Hiroshi
Published: June 2020

Hereditary diffuse gastric cancer (HDGC) is a rare autosomal dominant syndrome associated with an increased risk of developing Laurén’s diffuse-type gastric carcinoma and lobular breast carcinoma. Although signet-ring cell carcinoma (SRCC) in situ (SRCC-pTis) has been reported as a characteristic lesion in HDGC cases with CDH1 germline mutations (CDH1 pathogenic variant), and a precursor of conventional intramucosal SRCC (SRCC-pT1a), its histopathologic features and specificity have not been sufficiently clarified. Here, we examined gastrectomy samples from 6 Japanese HDGC patients with CDH1 germline mutation, belonging to 4 families, and analyzed SRCC lesions histologically and immunohistochemically. Of the 274 foci found in the 6 samples, SRCC-pT1a accounted for 225 lesions (range: 8 to 107, mean 45.7 lesions per patient), while 46 foci were of SRCC-pTis (range: 1 to 15, mean 7.67 foci per patient). All SRCC-pTis foci were observed in the fundic gland area and on the superficial side of the mucosa. Histologically, tumor cells of SRCC-pTis were found between normal foveolar epithelial cells and the basement membrane, following a typical pagetoid spread pattern. Immunohistochemically, E-cadherin expression was lost in SRCC-pTis (27/28, 96.4%) more frequently than in SRCC-pT1a (95/197, 48.2%; P<0.001). To elucidate the specificity of SRCC-pTis for HDGC, 60 samples (range: 0.12 to 1.49 m, total 28.8 m of mucosal length) from gastric cancer cases were analyzed as controls, in which no SRCC-pTis were identified. Our results indicate that SRCC-pTis is a distinct histologic feature with high specificity for HDGC cases with CDH1 germline mutations.
Association Between Changes in Subjective and Objective Measures of Mobility in People With Lower Limb Amputations After Inpatient Rehabilitation
Authors: Cieslak Gabrielle , Omana Humberto , Madou Edward , Frengopoulos Courtney , Viana Ricardo , Payne Michael W. , Hunter Susan W.
Published: June 2020

Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Assessment times: discharge and 4-mo follow-up. Gait velocity and the L Test under single- and dual-task conditions measured objective mobility. The Prosthetic Evaluation Questionnaire (section 4 and question 5b) measured subjective mobility. Paired t tests and Pearson correlation analysis evaluated change over time and the association between mobility types, respectively. Twenty-one people with lower limb amputations (61.6 ± 8.2 yrs) participated. Gait velocity significantly improved (single- and dual-task: P < 0.001). L Test significantly improved for single-task (P = 0.002) but not dual-task conditions. No statistically significant Prosthetic Evaluation Questionnaire changes were observed. One subjective mobility question (sidewalk walking) correlated with objective mobility at follow-up (L Test single- and dual-task: r = −0.77; P < 0.001). Objective mobility improved after discharge; however, subjective reporting had no change. Lack of association may represent a mismatch between quantitative outcomes and subjective self-assessment. Both subjective and objective measures of mobility should be collected to provide a holistic picture of clinical and patient-relevant outcomes in people with lower limb amputations.
The Effect of Extracorporeal Shock Wave Therapy on Pain Intensity and Neck Disability for Patients With Myofascial Pain Syndrome in the Neck and Shoulder
Authors: Jun Ji Hyun , Park Geun-Young , Chae Choong Sik , Suh Dong-Churl
Published: June 2020

Objective

The aim of the study was to investigate the efficacy of extracorporeal shock wave therapy on myofascial pain syndrome in the neck and shoulder compared with that of other treatments.

Data Sources

PubMed, Embase, and Web of Science were systematically searched until May 30, 2019, to select randomized controlled trials.

Review Methods

The randomized controlled trials comparing extracorporeal shock wave therapy with sham extracorporeal shock wave therapy or other treatments for patients with myofascial pain syndrome in the neck and shoulder patients were included. Two reviewers independently identified eligible studies. The Cochrane Handbook was used to evaluate the methodological quality of the included randomized controlled trials. Main outcomes associated with pain intensity, pressure pain threshold, and neck disability were selected. The study was registered with PROSPERO (Registration Number CRD 42019137459).

Results

A total of 11 randomized controlled trials were finally included. The results indicated that extracorporeal shock wave therapy had a large effect size on improving pain intensity (standardized mean difference [SMD] = 0.67, 95% confidence interval = 0.11 to 1.23, P = 0.02) and pressure pain threshold (SMD = 1.19, 95% confidence interval = 0.27 to l2.12, P = 0.01) at postintervention. However, there was no significant effect on neck disability at postintervention (SMD = 0.03, 95% confidence interval = −0.76 to 0.83, P = 0.93). After the subgroup analyses on the type of extracorporeal shock wave therapy, focused extracorporeal shock wave therapy had a significant effect on improving pain intensity (SMD = 0.75, 95% confidence interval = 0.13 to 1.36, P = 0.02) and pressure pain threshold (SMD = 1.70, 95% confidence interval = 0.21 to 3.18, P = 0.03) at postintervention in comparison with that of other treatments.

Conclusions

Extracorporeal shock wave therapy is superior to other treatments in terms of alleviating the pain intensity and pressure pain threshold of patients with myofascial pain syndrome in the neck and shoulder at postintervention. In particular, focused extracorporeal shock wave therapy shows significant improvement in pain relief. However, radical extracorporeal shock wave therapy for myofascial pain syndrome treatment still remains unclear.
Natural History of Serum Enzyme Levels in Duchenne Muscular Dystrophy and Implications for Clinical Practice
Authors: Rodríguez-Cruz Maricela , Almeida-Becerril Tomas , Atilano-Miguel Salvador , Cárdenas-Conejo Alan , Bernabe-García Mariela
Published: June 2020

Objective

In Duchenne muscular dystrophy, creatine kinase and transaminases are released into the circulation, indicating muscle injury. Their usefulness in monitoring muscle injury or disease progression has not yet been fully evaluated. Thus, this study examined serum creatine kinase and transaminase concentrations at different ages in patients with Duchenne muscular dystrophy and evaluated their association with muscle injury.

Design

This is a prospective cohort study that included 110 patients with Duchenne muscular dystrophy categorized by age groups. Creatine kinase and transaminases were quantified in the serum; the Vignos scale evaluated the muscle function.

Results

Creatine kinase and transaminase levels were higher in ambulatory than that in nonambulatory patients, which significantly decreased as age increased. Serum creatine kinase and transaminase concentrations were elevated in all ages, and those aged 3–4 yrs had the highest concentrations. Age and Vignos Scale were significantly correlated with creatine kinase and transaminase concentrations. Age, creatine kinase, and transaminases explained the 42.5% of loss of muscle function.

Conclusions

This study added the knowledge on the natural history of Duchenne muscular dystrophy at different ages and confirmed that creatine kinase and transaminases decrease with age and loss of muscle function, making them generally inappropriate for monitoring response to therapy, although they are useful for the clinical diagnosis.
Assessing Patient-Reported Outcomes After Female Cosmetic Genital Surgery
Authors: Sinnott Catherine J. , Glickman Laurence T. , Natoli Noel B. , Dobryansky Michael , Veeramachaneni Haritha B.
Published: June 2020

Purpose

Patient-reported outcomes after female cosmetic genital surgery (FCGS) have been well documented; however, methods vary widely between studies and are often very detailed, time-consuming, and difficult to reproduce. The purpose of this study was to assess patient-reported outcomes after FCGS using a novel method and survey as well as to present the results of a pilot study aimed at validating this survey.

Methods

A retrospective chart review identified patients who underwent FCGS. Demographic, clinical, operative, and outcome characteristics were recorded. A novel survey, including 14 items administered by telephone interview, was developed and extrapolated from the BREAST-Q for augmentation mammaplasty, to assess patient-reported outcomes after FCGS with regard to satisfaction with outcome and physical, psychosocial, and sexual well-being.

Results

The survey response rate was 50.6% (39 patients). Over a mean time after surgery of 56 months, 14 complications occurred in 11 patients (28.2%), and 10 complications required revision surgery. Postoperative asymmetry and dehiscence were the most common complications. Despite the higher complication and revision surgery rates, 97.4% agreed that the surgery was a good experience and were satisfied with the results after surgery. In addition, patient-reported outcomes after FCGS showed significant improvement in physical well-being, psychosocial well-being, and sexual well-being (P < 0.001).

Conclusions

This novel survey can be used to assess patient-reported outcomes after FCGS in an efficient approach. Despite the potential complications and need for revision surgery, the vast majority of patients who undergo FCGS feel that it is a good experience, are satisfied with the results after surgery, and show significant improvement in physical, psychosocial, and sexual well-being after surgery.
Outcomes, Techniques, and Risk Factors for Dehiscence in Central Wedge Labiaplasty
Authors: Sinnott Catherine J. , Glickman Laurence T. , Natoli Noel B. , Dobryansky Michael , Veeramachaneni Haritha B.
Published: June 2020

Purpose

Outcomes after female cosmetic genital surgery (FCGS) performed by plastic surgeons working in a group practice setting have not been well documented. This article aimed to assess outcomes and to describe FCGS techniques used in a large group private plastic surgery practice.

Methods

A retrospective chart review identified patients who underwent FCGS from 2009 to 2018. Demographic, clinical, and operative information was reviewed and recorded. Outcomes were assessed by evaluating postoperative complications and the need for revision surgery.

Results

Seventy-seven women between the ages of 14 and 53 years underwent FCGS performed by 1 of 6 surgeons. Forty-five patients underwent central wedge excision for labia minora hypertrophy, whereas 32 patients underwent extended central wedge excision for labia minora and clitoral hood hypertrophy. Four patients underwent liposuction of the mons pubis as an additional procedure. Over a mean follow-up of 37.4 months, postoperative asymmetry/redundancy occurred in 12 patients, requiring revision in 10. Wound dehiscence occurred in 12 patients, requiring revision in 9. There was one hematoma postoperatively requiring evacuation, one case of dyspareunia, and one case of decreased sensation. A single-layer wound closure (P = 0.050) and mons liposuction (P = 0.011) were risk factors for wound dehiscence.

Conclusions

Central wedge excision and extended central wedge excision labiaplasty were the techniques used in a large group plastic surgery practice. Postoperative asymmetry and dehiscence were the most common complications, and the revision surgery rate was high. A single-layer wound closure and additional mons liposuction were risk factors for dehiscence after central wedge labiaplasty.
Satisfaction and Regret Following Uterosacral Ligament Suspension and Sacrocolpopexy: A Prospective Multicenter Analysis From the Fellows’ Pelvic Research Network
Authors: Bastawros Dina , Rabon Hannah , Noor Nabila , Florian-Rodriguez Marian E. , Hobson Deslyn , Tarr Megan E.
Published: June 2020

Objectives

The primary objective was to compare levels of satisfaction, regret, and Patient Global Impression of Improvement (PGI-I) scores between women who underwent vaginal uterosacral ligament suspension (USLS) and minimally invasive sacrocolpopexy (SCP). Secondary objectives were to identify which preoperative counseling resources were most useful.

Methods

This was a multicenter, retrospective cohort study through the Fellows’ Pelvic Research Network that included women who underwent a USLS or SCP between January 2013 and January 2016 with 1-year follow-up. Women completed the Decision Regret Scale for Pelvic Floor Disorders, Satisfaction with Decision Scale for Pelvic Floor Disorders, and PGI-I. Data were also collected on usefulness of various educational preoperative resources.

Results

A total of 175/367 (47.6%) women participated; 45 (25.7%) and 130 (74.3%) in the USLS and SCP groups, respectively. Mean Decision Scale for Pelvic Floor Disorders scores were 4.6 ± 0.8 and 4.5 ± 0.7 (P = 0.30) in the USLS and SCP groups, respectively, indicating a high level of satisfaction with surgical decision. The mean Decision Regret Scale for Pelvic Floor Disorders score was 1.5 ± 0.8 in USLS and 1.6 ± 0.8 in SCP (P = 0.53). The SCP group had higher PGI-I scores (1.7 ± 1.4 vs 2.0 ± 1.3, P = 0.02), indicating lower perceived postoperative improvement. Most women (151 [86.3%] of 175) reported that verbal counseling was sufficient and would not have found additional resources helpful.

Conclusions

Women have high satisfaction and low regret with their decision to pursue surgical correction with USLS or SCP. Most are satisfied with only verbal preoperative counseling.
Feasibility and Learning Curve of Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Hysterectomy and Uterosacral Ligament Suspension in Apical Compartment Prolapse
Authors: Lowenstein Lior , Matanes Emad , Lauterbach Roy , Mor Omer , Burke Yechiel Z. , Weiner Zeev , Baekelandt Jan
Published: June 2020

Objective

The aim of this study was to describe our experience with transvaginal natural orifice transluminal endoscopic surgery (vNOTES) uterosacral ligament suspension (USLS) and to evaluate the learning curve of mastering the skills to operate this procedure.

Methods

This is a prospective study of the first 35 vNOTES hysterectomy and USLS surgeries performed between October 2018 and April 2019 at Rambam Health Care Campus (Israel) (n = 26) and Imelda Hospital (Belgium) (n = 9). The primary outcome was surgical time. Secondary outcomes included intraoperative bleeding, length of hospitalization, pain during the first 24 hours postoperative pain, and the need for analgesia, intraoperative, and postoperative adverse events.

Results

The median age was 55 years (range, 40–81). The median operative time was 113 minutes (range, 89–233). For the procedures performed at Rambam, total operative time decreased from the first 13 to the following 13: from 149 minutes (range, 89–233 minutes) to 103 (89–170) (<0.001); Pearson correlation demonstrated a moderate negative significant correlation of surgery duration with surgeon experience (rho = −0.445, P < 0.001). The median estimated blood loss was 30 mL (20–200). The median hospital stay was 2 days (1–3). There were no intraoperative adverse events. The median visual analogue scale score for pain assessment during the first 24 hours after surgery was 1 (range, 1–3).

Conclusions

vNOTES USLS is a feasible procedure that showed marked improvement in surgical performance in a short period, as evidenced by the decrease in surgical time and the low rate of minor associated perioperative complications. Outcomes of long-term follow-up should be investigated.
Takotsubo Cardiomyopathy in an Alzheimer Disease Patient
Authors: Moulin Mares Stephanie R.A. , Groner Jaqueline S. , de Oliveira Melissa P. , Lírio Ludmilla V. , Coutinho Paulo C. , Luchi Weverton M.
Published: June 2020

Takotsubo cardiomyopathy (TC) is an acute cardiac dysfunction, clinically similar to myocardial ischemia. The physiopathology of the syndrome seems to be related to excessive sympathetic activity that is triggered by physical or emotional stress factors. We report the case of an 83-year-old woman with advanced Alzheimer disease who had recently used nortriptyline and sertraline and was admitted with chest pain. An electrocardiogram showed ST-elevation, and markers of myocardial necrosis were slightly increased. However, coronariography did not demonstrate stenotic lesions. Transthoracic echocardiography and ventriculography identified decreased ventricular function, apical akinesia, and compensatory hyperkinesia of other segments that were compatible with TC. The patient evolved with cardiogenic shock and died. Alzheimer patients may be more susceptible to develop TC, both because of the disease itself and because of the multiple medications they are exposed to that increase catecholamine levels. In this case, antidepressant drugs were considered to be a potential factor that enhanced the susceptibility.
Magnetic resonance spectroscopy of isocitrate dehydrogenase mutated gliomas: current knowledge on the neurochemical profile
Authors: Branzoli Francesca , Marjańska Małgorzata
Published: June 2020

Purpose of review

Magnetic resonance spectroscopy (MRS) may play a key role for the management of patients with glioma. We highlighted the utility of MRS in the noninvasive diagnosis of gliomas with mutations in isocitrate dehydrogenase (IDH) genes, by providing an overview of the neurochemical alterations observed in different glioma subtypes, as well as during treatment and progression, both in vivo and ex vivo.

Recent findings

D-2-hydroxyglutarate (2HG) decrease during anticancer treatments was recently shown to be associated with altered levels of other metabolites, including lactate, glutamate and glutathione, suggesting that tumour treatment leads to a metabolic reprogramming beyond 2HG depletion. In combination with 2HG quantification, cystathionine and glycine seem to be the most promising candidates for higher specific identification of glioma subtypes and follow-up of disease progression and response to treatment.

The implementation of advanced MRS methods in the routine clinical practice will allow the quantification of metabolites that are not detectable with conventional methods and may enable immediate, accurate diagnosis of gliomas, which is crucial for planning optimal therapeutic strategies and follow-up examinations. The role of different metabolites as predictors of patient outcome still needs to be elucidated.
Contribution of PET-MRI in brain diseases in clinical practice
Authors: Pyatigorskaya Nadya , Habert Marie-Odile , Rozenblum Laura
Published: June 2020

Purpose of review

Hybrid PET- MRI is a technique that has the ability to improve diagnostic accuracy in many applications, whereas PET and MRI performed separately often fail to provide accurate responses to clinical questions. Here, we review recent studies and current developments in PET-MRI, focusing on clinical applications.

Recent findings

The combination of PET and MRI imaging methods aims at increasing the potential of each individual modality. Combined methods of image reconstruction and correction of PET-MRI attenuation are being developed, and a number of applications are being introduced into clinical practice. To date, the value of PET-MRI has been demonstrated for the evaluation of brain tumours in epilepsy and neurodegenerative diseases. Continued advances in data analysis regularly improve the efficiency and the potential application of multimodal biomarkers.

PET-MRI provides simultaneous of anatomical, functional, biochemical and metabolic information for the personalized characterization and monitoring of neurological diseases. In this review, we show the advantage of the complementarity of different biomarkers obtained using PET-MRI data. We also present the recent advances made in this hybrid imaging modality and its advantages in clinical practice compared with MRI and PET separately.
Digital technology for management of severe mental disorders in low-income and middle-income countries
Authors: Merchant Rutvij , Torous John , Rodriguez-Villa Elena , Naslund John A.
Published: June 2020

Purpose of review

Increasingly, digital technologies, especially mobile telecommunications and smartphone apps, are seen as a novel tool for managing severe mental disorders (SMDs) in low-income and middle-income countries (LMICs). However, there is a need to identify best practices in the use of digital technologies to effectively reach, support, and manage care for patients living with SMDs. In this review, we summarize recent studies using digital technology to manage symptoms and support clinical care for this patient population and discuss new opportunities to advance digital psychiatry research and practice in LMICs.

Recent findings

Studies evaluating digital interventions for clinical populations living with SMDs in LMICs are limited. Yet, across recent articles surveyed, digital technology appears to yield diverse benefits for this at-risk patient population. These benefits include improved medication adherence, appointment adherence, reduced instances of relapse, and fewer re-hospitalizations.

Continued rigorous research evaluating effectiveness and cost-effectiveness of digital technologies in reaching, treating, and managing symptoms and supporting clinical care for patients with SMDs in LMICs is vital. The urgency for remote approaches for delivering specialized psychiatric care is particularly pronounced because of the immediate and long-term impact of the coronavirus (COVID-19) pandemic on access to in-person services. Future research should emphasize participatory approaches rooted in a process of codesign with target users, in order to achieve clinically effective remotely delivered digital mental health interventions.
Assessing crowd management strategies for the 2010 Love Parade disaster using computer simulations and virtual reality
Authors: Zhao Hantao , Thrash Tyler , Kapadia Mubbasir , Wolff Katja , Hölscher Christoph , Helbing Dirk , Schinazi Victor R.
Published: June 2020

Dense crowds in public spaces have often caused serious security issues at large events. In this paper, we study the 2010 Love Parade disaster, for which a large amount of data (e.g. research papers, professional reports and video footage) exist. We reproduce the Love Parade disaster in a three-dimensional computer simulation calibrated with data from the actual event and using the social force model for pedestrian behaviour. Moreover, we simulate several crowd management strategies and investigate their ability to prevent the disaster. We evaluate these strategies in virtual reality (VR) by measuring the response and arousal of participants while experiencing the simulated event from a festival attendee’s perspective. Overall, we find that opening an additional exit and removing the police cordons could have significantly reduced the number of casualties. We also find that this strategy affects the physiological responses of the participants in VR.
Developmental origins of cognitive offloading
Authors: Armitage Kristy L. , Bulley Adam , Redshaw Jonathan
Published: June 2020

Many animals manipulate their environments in ways that appear to augment cognitive processing. Adult humans show remarkable flexibility in this domain, typically relying on internal cognitive processing when adequate but turning to external support in situations of high internal demand. We use calendars, calculators, navigational aids and other external means to compensate for our natural cognitive shortcomings and achieve otherwise unattainable feats of intelligence. As yet, however, the developmental origins of this fundamental capacity forcognitive offloadingremain largely unknown. In two studies, children aged 4–11 years (n= 258) were given an opportunity to manually rotate a turntable to eliminate the internal demands of mental rotation––to solve the problem in the world rather than in their heads. In study 1, even the youngest children showed a linear relationship between mental rotation demand and likelihood of using the external strategy, paralleling the classic relationship between angle of mental rotation and reaction time. In study 2, children were introduced to a version of the task where manually rotating inverted stimuli was sometimes beneficial to performance and other times redundant. With increasing age, children were significantly more likely to manually rotate the turntable only when it would benefit them. These results show how humans gradually calibrate their cognitive offloading strategies throughout childhood and thereby uncover the developmental origins of this central facet of intelligence.