bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficient Detection of Cortical Auditory Evoked Potentials in Adults Using Bootstrapped Methods
Authors: Chesnaye Michael Alexander , Bell Steven Lewis , Harte James Michael , Simonsen Lisbeth Birkelund , Visram Anisa Sadru , Stone Michael Anthony , Munro Kevin James , Simpson David Martin
Published: December 2020

Background:

Statistical detection methods are useful tools for assisting clinicians with cortical auditory evoked potential (CAEP) detection, and can help improve the overall efficiency and reliability of the test. However, many of these detection methods rely on parametric distributions when evaluating test significance, and thus make various assumptions regarding the electroencephalogram (EEG) data. When these assumptions are violated, reduced test sensitivities and/or increased or decreased false-positive rates can be expected. As an alternative to the parametric approach, test significance can be evaluated using a bootstrap, which does not require some of the aforementioned assumptions. Bootstrapping also permits a large amount of freedom when choosing or designing the statistical test for response detection, as the distributions underlying the test statistic no longer need to be known prior to the test.

Objectives:

To improve the reliability and efficiency of CAEP-related applications by improving the specificity and sensitivity of objective CAEP detection methods.

Design:

The methods included in the assessment were Hotelling’s T2 test, the Fmp, four modified q-sample statistics, and various template-based detection methods (calculated between the ensemble coherent average and some predefined template), including the correlation coefficient, covariance, and dynamic time-warping (DTW). The assessment was carried out using both simulations and a CAEP threshold series collected from 23 adults with normal hearing.

Results:

The most sensitive method was DTW, evaluated using the bootstrap, with maximum increases in test sensitivity (relative to the conventional Hotelling’s T2 test) of up to 30%. An important factor underlying the performance of DTW is that the template adopted for the analysis correlates well with the subjects’ CAEP.

Conclusion:

When subjects’ CAEP morphology is approximately known before the test, then the DTW algorithm provides a highly sensitive method for CAEP detection.
Factors leading to failure of fixation of femoral neck fractures in young adults: a retrospective study among a cohort of Egyptian population
Authors: Fahmy Mahmoud , Ali Ahmed Abdelmohsen Abdelghany , Abdel-Kader Khaled Fawzy M.
Published: December 2020

Background:

Failed internal fixation of femoral neck fractures in young, active adults is a multifactorial problem leading to poor outcome. Although anatomical reduction and stable fixation are essential for operative success, other factors can be associated with high failure rates. The ideal protocol for management is challenging and a continued topic of study. The aim of our study was to detect factors leading to failure of fixation of femoral neck fractures in young adults.

Materials and Methods:

This retrospective study involved 17 patients with failed femoral neck fracture fixation at Cairo University Hospital. Inclusion criteria were patients from 18 to 60 yr old with all types of femoral neck fractures. Patients data were recorded for demographics, timing of surgery, initial fracture displacement, method of reduction, method of fixation, bone mineral density, and the level of surgeon experience.

Results:

The mean age was 40±10 yr. Accuracy of reduction, junior surgeons, displaced fractures, and poor implant configuration were the main factors associated with failures. In addition, low bone mineral density also was a potential factor for failure. Delayed fixation did not seem to be a significant cause of failure.

Conclusions:

Initial fracture displacement and accuracy of reduction are potential factors for fixation failure of femoral neck fractures. Although dynamic hip screws result in fewer early failures than multiple cannulated screws, this difference did not reach statistical significance. Fixation of femoral neck fractures in young adults should be performed by senior trainees under supervision. We recommend operating when optimal conditions are provided rather than on an emergency basis.

Level of Evidence:

Level III.
Pain and patellofemoral functionality in total knee arthroplasty: a comparative cohort study of two prosthesis designs
Authors: Cely Luis Miguel , Rocha Cesar Hernando
Published: December 2020

Background:

Total knee arthroplasty designs have changed from the original design, with the goal of becoming as close to normal knee biomechanics and anatomy as possible. Since 2009, Optetrak® Logic incorporated modifications to the previous product Optetrak® PS (Exactech, Gainsville, FL), with a change of the anterior surface of the tibial post of the polyethylene insert and the surface that articulates with the femoral component box. Also, the sagittal geometry of the femoral trochlea was changed, which decreased rates of anterior knee pain and “patellar clunk.” The purpose of this study was to determine if there are differences in terms of pain and patellofemoral functionality between Optetrak PS and Optetrak Logic.

Methods:

A prospective follow-up was performed comparing the results of the Kujala pain and patellofemoral functionality scale. Clinical and functional follow-up was performed in 132 knees (66 from the Optetrak Logic group and 66 from the Optetrak PS group) that underwent total knee arthroplasty from January 2015 to August 2019.

Results:

Global results of the functional tests were: Oxford postoperative 50; Knee Society Score postoperative 85; Kujala postoperative 76. In comparing the two groups the Kujala score for Optetrak PS was 71 and the Kujala score for Optetrak Logic was 81.

Conclusions:

Patellofemoral knee pain and functionality before and after total knee arthroplasty must be analyzed with functional scales. The new prosthetic designs are gentler to the patellofemoral joint, and this has been verified by objective analysis with functional scales such as the Kujala scale.

Level of Evidence:

Level III.
Examining the use of the pressure modulated knee rehabilitation machine (PMKR) with traditional physical therapy versus traditional physical therapy alone following total knee arthroplasty: a randomized control study
Authors: Cien Adam , Riggle Patrick K. , Brazier Brett G. , Popovich John M. , Crawford Stan , Cochran Jason M.
Published: December 2020

Background:

Total knee arthroplasty (TKA) is considered a successful operation, however, 8% to 25% of patients are not satisfied with their TKA after surgery, with contracture being a common reason. The purpose of this study was to compare range of motion (ROM), patient-reported outcomes, and patient satisfaction between patients who utilized the X10™ Pressure Modulated Knee Rehabilitation (PMKR) machine (X10 Therapy, Franklin, MI) in addition to physical therapy and patients who only had physical therapy after TKA.

Methods:

Patients were randomized to either the PMKR plus traditional physical therapy group or the traditional physical therapy only group. Patient-reported outcome scores and ROM were recorded at baseline, 2 wk, 4 wk, and 4 mo postoperatively. Patient satisfaction was also assessed.

Results:

A total of 107 patients underwent TKA surgery (50 PMKR group, 57 traditional therapy alone group). At 4 wk, the PMKR group exceeded the minimally clinical important difference of 5 degrees after TKA; however, this was not sustained at 4 mo. There were no statistically significant differences in the patient-reported outcome scores, but patients in the PMKR group had statistically significantly higher satisfaction.

Conclusions:

In summary, our results demonstrate that patients who utilize a PMKR machine in addition to traditional physical therapy may have an initial increase in postoperative knee ROM; however, this clinical relevance was not sustained at the 4-month time point. Even though this difference in ROM was not maintained over the entire study, patients who used the PMKR machine had greater satisfaction with their TKA than those who underwent traditional physical therapy alone.

Level of Evidence:

Level II.
A Novel Low-Cost Ventilator for Use in a Worldwide Pandemic: The Portsmouth Ventilator
Authors: Cole Jacob H. , Hughey Scott B. , Rector Christopher H. , Booth Gregory J.
Published: December 2020

Objectives:

The ongoing severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019 pandemic has demonstrated the potential need for a low-cost, rapidly deployable ventilator. Based on this premise, we sought to design a ventilator with the following criteria: 1) standard components that are accessible to the public, 2) “open-source” compatibility to allow anyone to easily recreate the system, 3) ability to ventilate in acute respiratory distress syndrome, and 4) lowest possible cost to provide adequate oxygenation and ventilation.

Design:

We pursued development of a pneumatic-type ventilator. The basic design involves three electrically controlled solenoid valves, a pressure chamber, the patient breathing circuit, a positive end-expiratory pressure valve, and an electronics control system. Multiple safety elements were built into the design. The user-friendly interface allows simple control of ventilator settings. The ventilator delivers a hybrid form of pneumatic, assist-control ventilation, with predicted tidal volumes of 300–800 mL, positive end-expiratory pressure 0–20 cm H2O, and Fio
2 21–100%.

Main Results:

The ventilator was extensively tested with two separate high-fidelity lung simulators and a porcine in vivo model. Both lung simulators were able to simulate a variety of pathologic states, including obstructive lung disease and acute respiratory distress syndrome. The ventilator performed well across all simulated scenarios. Similarly, a porcine in vivo model was used to assess performance in live tissue, with a specific emphasis on gas exchange. The ventilator performed well in vivo and demonstrated noninferior ventilation and oxygenation when compared with the standard ventilator.

Conclusions:

The Portsmouth Ventilator was able to perform well across all simulated pathologies and in vivo. All components may be acquired by the public for a cost of approximately $250 U.S.D. Although this ventilator has limited functionality compared with modern ventilators, the simple design appears to be safe and would allow for rapid mass production if ventilator surge demand exceeded supply.
Stability of Do-Not-Resuscitate Orders in Hospitalized Adults: A Population-Based Cohort Study*
Authors: Mehta Anuj B. , Walkey Allan J. , Curran-Everett Douglas , Matlock Daniel , Douglas Ivor S.
Published: December 2020

Objectives:

Prior work has shown substantial between-hospital variation in do-not-resuscitate orders, but stability of do-not-resuscitate preferences between hospitalizations and the institutional influence on do-not-resuscitate reversals are unclear. We determined the extent of do-not-resuscitate reversals between hospitalizations and the association of the readmission hospital with do-not-resuscitate reversal.

Design:

Retrospective cohort study.

Setting:

California Patient Discharge Database, 2016–2018.

Patients:

Nonsurgical patients admitted to an acute care hospital with an early do-not-resuscitate order (within 24 hr of admission).

Interventions:

None.

Measurements and Main Results:

We identified nonsurgical adult patients who survived an initial hospitalization with an early-do-not-resuscitate order and were readmitted within 30 days. The primary outcome was the association of do-not-resuscitate reversal with readmission to the same or different hospital from the initial hospital. Secondary outcomes included association of readmission to a low versus high do-not-resuscitate-rate hospital with do-not-resuscitate reversal. Among 49,336 patients readmitted within 30 days following a first do-not-resuscitate hospitalization, 22,251 (45.1%) experienced do-not-resuscitate reversal upon readmission. Patients readmitted to a different hospital versus the same hospital were at higher risk of do-not-resuscitate reversal (59.5% vs 38.5%; p < 0.001; adjusted odds ratio = 2.4; 95% CI, 2.3–2.5). Patients readmitted to low versus high do-not-resuscitate-rate hospitals were more likely to have do-not-resuscitate reversals (do-not-resuscitate-rate quartile 1 77.0% vs quartile 4 27.2%; p < 0.001; adjusted odds ratio = 11.9; 95% CI, 10.7–13.2). When readmitted to a different versus the same hospital, patients with do-not-resuscitate reversal had higher rates of mechanical ventilation (adjusted odds ratio = 1.9; 95% CI, 1.6–2.1) and hospital death (adjusted odds ratio = 1.2; 95% CI, 1.1–1.3).

Conclusions:

Do-not-resuscitate reversals at the time of readmission are more common than previously reported. Although changes in patient preferences may partially explain between-hospital differences, we observed a strong hospital effect contributing to high do-not-resuscitate-reversal rates with significant implications for patient outcomes and resource.
Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma With Secondary Cutaneous Involvement: A Diagnostic Challenge
Authors: Olmos-Alpiste Ferran , Vázquez Ivonne , Gallardo Fernando , Sánchez-Gonzalez Blanca , Colomo Luis , Pujol Ramon M.
Published: December 2020

A 45-year-old woman presented with a solitary breast nodule that histologically corresponded to a dense dermal/subcutaneous infiltration of atypical cytotoxic T-lymphocytes (CD3+, CD8+, CD56+, TIA-1+, CD5−, CD4−, CD30−, EBV−), resembling subcutaneous panniculitic T-cell lymphoma. The presence of TCRδ gene rearrangement and the absence of βF1 expression let to suspect the diagnosis of primary cutaneous γδT-cell lymphoma. As a consequence of jejunum perforation following chemotherapy treatment, a mucosal atypical lymphoid infiltration with marked epitheliotropism was observed in the resected intestinal sample, and the diagnosis of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) was finally established. Disease progression appeared with multiple erythematous plaques showing a dense lichenoid atypical cytotoxic T-cell infiltrate with intense epidermotropism, mimicking primary cutaneous epidermotropic aggressive CD8+ T-cell lymphoma. MEITL is an uncommon and aggressive peripheral T-cell lymphoma that often presents in adults with gastrointestinal symptoms. Secondary cutaneous involvement is a rare phenomenon that may show clinicopathologic and immunohistochemical features that overlap with different subtypes of primary cutaneous cytotoxic T-cell lymphomas. In the absence of gastrointestinal symptoms, the diagnosis may be challenging, and only the evidence of underlying MEITL may allow to establish the definite diagnosis.
Ocular Features in a Large Cohort of Indians With Xeroderma Pigmentosum
Authors: Nandyala Sushma , Mohamed Ashik , Chaurasia Sunita , Kaliki Swathi , Ramappa Muralidhar , Vemuganti Geeta K.
Published: December 2020

Purpose:

Xeroderma pigmentosum (XP) is an extreme hypersensitivity to sunlight causing skin freckling and pigmentary changes because of defective DNA repair mechanisms. The purpose of this article is to evaluate the spectrum of ocular and systemic features in XP at a tertiary eye care center in India over 32 years.

Methods:

Data from 418 eyes of 209 patients diagnosed with XP from 1987 to 2018 were reviewed retrospectively for demographics, complaints, ocular features, systemic associations, and their management.

Results:

Median age at diagnosis was 2 years (interquartile range, 0.5–5 years). A total of 124 patients (59.3%) were men. There was parental consanguinity in 74.4% cases. Common ocular complaints were photophobia (47.1%), ocular discomfort (45%), defective vision (36.6%), redness (13.4%), tissue growth (12%), white spot (11.2%), and pain (10.5%). At presentation, 43.5% had corneal scars (45.5% were located inferiorly and 70.9% covered visual axis). Corneal vascularization and limbal stem cell deficiency were noted in 37.4%. A total of 56% of patients had at least 1 tumor, and 6.7% had neurological abnormalities. At least 1 ocular surgery was performed in 37.8% of patients. Ophthalmic surgical interventions included tumor excision (23%), keratoplasty (13.4%), and nontumor ocular surface surgery (3.4%).

Conclusions:

XP is a disorder that has high ocular morbidity in Indian patients. The recognition of common signs and symptoms and relative frequency of various ocular complications with time trends will help in managing and reducing the sequelae of this otherwise untreatable and progressive disease.
Severe Keratitis and Corneal Perforation by Paenibacillus glucanolyticus
Authors: Hassan Ali , Rampat Radhika , Vasquez-Perez Alfonso
Published: December 2020

Purpose:

To report the first case of Paenibacillus glucanolyticus, a spore-forming bacteria, to be isolated in a human ocular infection.

Methods:

We describe a severe case of noncontact lens-related microbial keratitis due to P. glucanolyticus presenting with a large corneal abscess, severe ocular inflammation, and a large epithelial defect.

Results:

The corneal scrapes with no growth initially cultured P. glucanolyticus on blood agar after 48 hours, with sensitivity to gentamicin and fluoroquinolones. No other organism was cultured. The patient had severe keratitis with a protracted course requiring cyanoacrylate glue patching because of keratolysis and perforation. The patient may benefit from a penetrating keratoplasty and extracapsular cataract extraction in due course to aid visual rehabilitation.

Conclusions:

This is the first reported ocular case of P. glucanolyticus demonstrating its bacterial virulence and pathogenic potential when infecting the cornea. Rapid identification with newer technology enable us to accurately identify these opportunistic bacteria and may give a more favorable visual outcome as correct sensitivities lead to timely treatment administration.
Trends in Female Authorship in Cornea From 2007 to 2019
Authors: Amarasekera Dilru C. , Lam Sophia S. , Rapuano Christopher J. , Syed Zeba A.
Published: December 2020

Purpose:

To identify female authorship trends in first author and last author positions in Cornea from 2007 to 2019.

Methods:

First and last authors of all Clinical Science and Basic Investigation publications in Cornea over 13 years were sorted by sex. Identification of sex was based on the author's institutional profile or a Google-based name identifier in cases of equivocal names. The proportion of female board-certified ophthalmologists between 2007 and 2019 was collected from the American Board of Ophthalmology total roster of certified diplomats.

Results:

First and last author sexes were collected from 2313 publications (1837 Clinical Science and 476 Basic Investigation). Between 2007 and 2019, the percentage of female first authors increased from 30.5% to 41.5%, although this change was not significant (P = 0.240). Female last author percentage increased significantly from 14.9% to 26.6% (P = 0.016). The percentage of female American Board of Ophthalmology–certified diplomats also increased significantly from 17.4% to 24.5% (P < 0.001). Similarly, when comparing 2007 and 2008 with 2018 and 2019, we noted a significant increase in the proportion of women in the last author (P < 0.001) but not in the first author (P = 0.208) position. We also identified a significantly higher proportion of female first authors than that of female board-certified ophthalmologists (P < 0.001). Finally, there was a strong association between first author sex and last author sex (P < 0.001) across manuscripts.

Conclusions:

The proportion of women in last author positions increased over 13 years among manuscripts in Cornea. Despite these advances in academic female representation within the cornea subspecialty, a gender gap in authorship persists.
Herpes Simplex Virus–Related Conjunctivitis Resistant to Aciclovir: A Case Report and Review of the Literature
Authors: Esra Nira , Hollhumer Roland
Published: December 2020

Purpose:

To report a rare case of herpes virus type 2–related conjunctivitis, resistant to aciclovir (ACV).

Methods:

Case report and review of literature.

Results:

A 28-year-old human immunodeficiency virus-positive man presented with chronic, recurrent follicular conjunctivitis. Multiplex reverse transcription polymerase chain reaction assay testing was positive for herpes simplex virus (HSV); subsequent typing with HSV assay revealed the presence of HSV type 2. Oral ACV failed to control the disease, and the patient continued to worsen clinically until resistance testing was performed. This revealed an M183stop within thymidine kinase, thus confirming the suspected resistance. The patient improved after 14 days of high-dose continuous intravenous infusion of ACV.

Conclusions:

This is a rare case of isolated conjunctivitis due to herpes virus type 2, in an human immunodeficiency virus-positive patient, which was found to be resistant to ACV. Drug-resistant HSV is likely to emerge as an important clinical entity in the future, increasing the need for new drugs with novel mechanisms of action.
Psychosexual knowledge and education in autism spectrum disorder individuals
Authors: Chianese Alexander A. , Jackson Stefanie Z. , Souders Margaret C.
Published: December 2020

Background:

Autism spectrum disorder (ASD) is a highly prevalent neurodevelopmental condition. Autism spectrum disorder individuals are interested in sexual activity and pursuing romantic relationships, yet they often lack psychosexual knowledge and engage in risky sexual behaviors. The special learning needs of ASD individuals influence their exclusion from educational and social settings, resulting in fewer opportunities to acquire sex knowledge from reliable sources.

Objectives:

This review aimed to explore factors influencing sexual knowledge and evaluate outcomes of comprehensive, ASD-tailored psychosexual education.

Data sources:

PubMed, PsychINFO, and EBSCOhost databases were used to locate peer-reviewed articles in English in the 5 years between 2013 and 2018. Keywords included “autism spectrum disorder,” “child abuse,” “sexual,” “sexual offenses,” “sexual abuse,” and “sexual education.”

Conclusions:

Nine articles were included in the review. Compared with neurotypical adults, ASD adults had less sex-related knowledge, more victimization experiences, and obtained sexual information from more nonsocial sources. Knowledge is a partial mediator between ASD diagnosis and sexual victimization. Parents expressed having little support to educate their offspring and provided less sex education to children with intellectual disability and severe symptoms. Psychosexual education programs that are tailored to suit developmental and cognitive differences of ASD individuals increase knowledge and improve parent–child communication, especially for younger adolescents.

Implications for practice:

Nurse practitioners who care for ASD individuals should assess knowledge and victimization experiences, assess parent perceptions and concerns, and provide guidance for developmentally and intellectually appropriate sex education. These should be incorporated into practice starting at a young age and continue across the lifespan.
Relationship Between the Cochlear Aqueduct and Internal Auditory Canal: Surgical Implications for Transcanal Transpromontorial Approaches to the Lateral Skull Base
Authors: Molinari Giulia , Yacoub Abraam , Bonali Marco , Wimmer Wilhelm , Alicandri-Ciufelli Matteo , Caversaccio Marco , Presutti Livio , Anschuetz Lukas
Published: December 2020

Hypothesis:

The cochlear aqueduct (CA) is subject to considerable anatomical variability. We hypothesize a topographical relationship between the CA and the internal auditory canal (IAC).

Background:

The CA represents the lower limit of dissection during transcanal transpromontorial approaches to the lateral skull base due to its close relationship to the lower cranial nerves and jugular vein.

Methods:

Three-dimensional models from high-resolution computed tomography scans of normal human temporal bones were created using threshold-based segmentation. The CA was classified into four categories. Five points were determined on the three-dimensional models to measure the surgically relevant relationships.

Results:

Segmentation was performed on 26 high-resolution computed tomography scans. The average length of the virtual and visual part of the CA was 6.6 mm (SD ±1.7 mm) and 5.5 mm (SD ±1.3 mm) respectively. The mean distance between the IAC and the medial end of the visual part of the CA was 3.8 mm (±0.7 mm), while the average distance between the IAC and the lateral end was 1.4 mm (±0.6 mm). The distance between the visual part of the CA and the IAC increased by 0.25 mm per from the fundus of the IAC.

Conclusion:

A close relationship between the CA and the IAC could be established, despite the anatomical variability of the CA. The distance between CA and IAC increases by 0.25 per mm from the fundus to the porus of the IAC. These findings quantify the inferior limit of dissection of the transcanal transpromontorial approach to the lateral skull base.
Fluctuating Posterior Canal Function in Benign Paroxysmal Positional Vertigo Depending on How and Where Otoconia Are Disposed
Authors: Castellucci Andrea , Malara Pasquale , Martellucci Salvatore , Delmonte Silvia , Ghidini Angelo
Published: December 2020

Objective:

Though fluctuations in vestibular function represent a common finding in Menière's disease, we describe how benign paroxysmal positional vertigo (BPPV) may result in fluctuations of vestibulo-ocular reflex for the involved canal depending on the disposition of otoliths.

Patient:

A 54-year-old woman suffering from refractory posterior canal (PC)-BPPV resulting in fluctuating PC function.

Interventions:

Diagnostic evaluation and rehabilitative treatment for BPPV involving the affected PC.

Main Outcome Measures:

Video-Frenzel and video-head impulse test (vHIT) findings before and after canalith repositioning procedures for PC-BPPV.

Results:

BPPV involving the nonampullary arm of right PC was diagnosed based on presenting positional downbeat nystagmus and selective right PC hypofunction at the vHIT. During physical treatment, nystagmus first became positional paroxysmal upbeat likely due to a shift of debris into the ampullary arm of the canal, then turned to spontaneous downbeat nystagmus consistently with a plug effect exerted by particles entrapped within the nonampullary arm of PC and finally receded proving an otoliths fall within the utriculus. Simultaneously, vHIT documented fluctuations for right PC vestibulo-ocular reflex gain as it first increased to normal values, then severely declined and finally normalized, respectively. High-resolution computed tomography scan detected ipsilateral superior canal dehiscence.

Conclusions:

In accordance with recently reported vHIT findings in different types of BPPV, fluctuation of PC function could be likely explained by the effect of particles on cupular dynamic responses depending on the portion of the canal gradually involved. Superior canal dehiscence may have played a role facilitating otoliths mobilization by reducing labyrinthine impedance.
Determinants of Vestibular Schwannoma Growth
Authors: Sethi Mantegh , Borsetto Daniele , Bance Manohar , Cho Yeajoon , Gair Juliette , Gamazo Nicola , Joannides Alexis , Jefferies Sarah , Mannion Richard , Macfarlane Robert , Donnelly Neil , Tysome James R. , Axon Patrick
Published: December 2020

Objective:

Management of vestibular schwannomas (VS) involves surgery, radiotherapy, or surveillance, based on patient and tumor factors. We recently described conditional probability as a more accurate method for stratifying VS growth risk. Building on this, we now describe determinants of VS growth, allowing clinicians to move toward a more personalized approach to growth-risk profiling.

Methods:

Retrospective analysis of a prospectively collected database in a tertiary referral skull base unit between 2005 and 2014. Inclusion of patients with unilateral VS managed on surveillance protocol for a minimum of 5 years. Analysis of patient age, sex, tumor location, tumor size, and symptomology using conditional probability.

Results:

A total of 340 patients met inclusion criteria. The conditional probability of growth of extracanalicular VS was significantly higher versus intracanalicular (IC) VS (30% versus 13%, p < 0.001) as was small-sized VS versus IC VS (28 versus 13%, p = 0.002), but only in the first year after diagnosis. Sex, age, and presenting symptoms did not significantly affect VS growth.

Conclusion:

In our series, extracanalicular VS were more likely to grow than IC VS and small-sized VS more likely to grow than IC VS, but only in the first year after diagnosis. Conversely, sex, age, and presenting symptoms did not affect the conditional probability of VS growth.
Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires
Authors: Duncan Daniel R. , DiFilippo Courtney , Kane Madeline , Lurie Margot , McSweeney Maireade E. , Rosen Rachel L.
Published: December 2020

Objectives:

Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I‐GERQ‐R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I‐GERQ‐R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool‐10 (Pedi‐EAT‐10) and videofluoroscopic swallow study (VFSS).

Methods:

We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi‐EAT‐10 and I‐GERQ‐R as a quality initiative to address parental feeding concerns. I‐GERQ‐R results were compared with Pedi‐EAT‐10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1‐way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results.

Results:

One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi‐EAT‐10 and I‐GERQ‐R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I‐GERQ‐R had relative risk 1.148 (95% confidence interval [CI] 1.043–1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04).

Conclusions:

I‐GERQ‐R and the Pedi‐EAT‐10 are highly correlated. I‐GERQ‐R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.
One‐year Experience With Composite Intravenous Lipid Emulsion in Children on Home Parenteral Nutrition
Authors: Raphael Bram P. , Mitchell Paul D. , Carey Alexandra , Gura Kathleen M. , Puder Mark
Published: December 2020

Background:

Composite lipid emulsion (CLE) composed of soybean oil, medium‐chain triglycerides, olive oil, and fish oil is approved in the US for parenterally fed adults. For stable children discharged on home parenteral nutrition (HPN) without cholestasis (direct bilirubin > 2.0 mg/dL), CLE has theoretical benefits over soybean‐based intravenous lipid emulsion due to reduced phytosterol exposure with higher calorie support to permit reduced glucose infusion rates (GIRs), omega‐3 supplementation, and supplemental α‐tocopherol.

Methods:

In this prospective, single‐center open‐label research study, safety and efficacy outcomes were evaluated in patients on HPN younger than 18 years treated with CLE at 1 to 3 g · kg−1 · day−1 over 12 months. The primary outcome was change in anthropometrics and GIRs compared with baseline. Secondary outcomes were changes in fatty acid profiles and liver function and enzyme tests compared with baseline.

Results:

Fifty‐seven subjects were treated with a median age of 7 years. The diagnosis was short bowel syndrome in 72%. Change in practice was associated with a decrease in mean GIRs from 17 to 14 mg · kg−1 · h−1 at 4 to 6 months postbaseline and beyond with a coincidental decline in mean arachidonic acid and stable growth parameters. No significant adverse events were noted.

Conclusions:

CLE was safe and well‐tolerated in stable children on HPN at 1 year, but further studies are needed in this population to appreciate long‐term outcomes.
High genetic diversity among diarrheagenic Escherichia coli isolates from patients with acute diarrhea in Khuzestan province, Southwestern Iran
Authors: Owlia Parviz , Bouzari Saeid , Saderi Horieh , Ghanavati Roya , Darbandi Atieh
Published: December 2020

Background:

Diarrheagenic Escherichia coli (DEC) is an enteric pathogen that causes a wide variety of gastrointestinal diseases in developing countries. In our previous study, the prevalence of DEC pathotypes from acute diarrhea patients in Khuzestan province was determined. In this study, we investigated the antimicrobial resistance profile and molecular genetic characteristics of this isolate.

Methods:

Antibiotic susceptibility testing of bacterial isolates was determined by disc diffusion technique on Muller Hinton agar. The production of extended-spectrum beta-lactamases (ESBLs) was confirmed by the Double Disc Synergy Test (DDST). The genetic diversity of isolates was determinate by pulsed-field gel electrophoresis (PFGE).

Results:

Among all DEC strains, 100% were resistant to at least one commonly prescribed antibiotic. Strains were resistant to first-line antibiotics, such as tetracycline, ampicillin, and sulfamethoxazole-trimethoprim. Furthermore, 72% of DEC isolates were multidrug-resistant and aEPEC and STEC were the categories with a major proportion of this feature. ESBL-producing strains were observed in 38% of all DEC isolates. PFGE analysis showed 19 unique pulsotypes of 22 studied DEC pathotypes. However, a few isolates were found to be clonal (clusters A, B, and C).

Conclusion:

The current study provides novel information about the presence of DEC isolates particularly with the rate of high antibiotic resistance among acute diarrheal samples in Khuzestan, Iran. Our data revealed that there was almost high heterogeneity among isolated DEC pathotypes. Proper infection control policies are needed to be implemented in order for the infections to be effectively controlled.
Nurse Sensemaking for Responding to Patient and Family Safety Concerns
Authors: Groves Patricia S. , Bunch Jacinda L. , Cannava Kaitlin E. , Sabadosa Kathryn A. , Williams Janet K.
Published: December 2020

Background

Hospitals need to prevent, respond to, and learn from safety risks and events perceived by patients and families, who in turn rely on nurses to respond to and report their safety concerns.

Objectives

The aim of the study was to describe the process by which bedside nurses evaluate and determine the appropriate response to safety concerns expressed by patients or their families.

Methods

A qualitative design was employed. We recruited inpatient bedside nurses in an 811-bed Midwest academic medical center. Nurses provided demographic information and participated in semistructured interviews designed to elicit narratives related to evaluation and response to patient- or family-expressed safety concerns. Data analysis and interpretation were guided by grounded theory.

Results

We enrolled 25 nurses representing 22 units. Based on these nurses’ experiences, we developed a grounded theory explaining how nurses evaluate a patient or family safety concern. Nurses make sense of the patient’s or family’s safety concern in order to take action. Achieving this goal requires evaluation of the meaningfulness and reasonableness of the concern, as well as the potential effect of the concern on the patient. Based on this nursing evaluation, nurses respond in ways designed to (a) manage emotions, (b) immediately resolve concerns, (c) involve other team members, and (d) address fear or uncertain grounding in reality. Nurses reported routinely handling safety concerns at the bedside without use of incident reporting.

Discussion

Safety requires an interpersonal and evaluative nursing process with actions responsive to patient and family concerns. Safety interventions designed to be used by nurses should be developed with the dynamic, cognitive, sensemaking nature of nurses’ routine safety work in mind. Being sensitive to the vulnerability of patients, respecting patient and family input, and understanding the consequences of dismissing patient and family safety concerns are critical to making sense of the situation and taking appropriate action to maintain safety. Measuring patient safety or planning improvement based on patient or family expression of safety concerns would be a difficult undertaking using only standard approaches. A more complex approach incorporating direct patient engagement in data collection is necessary to gain a complete safety picture.
Integrated Review of Psychosocial and Behavioral Health Assessments and Interventions in Pulmonary Hypertension
Authors: Von Visger Tania T. , Lee Diana , Lyons Amy , Chang Yu-Ping
Published: December 2020

Background

The medical management of patients with pulmonary hypertension (PH) has advanced, with few evidence-based recommendations about psychosocial and behavioral health interventions. There is also a lack of comprehensive understanding of PH psychosocial and behavioral health needs. Some psychosocial and behavioral health interventions have been tested; however, there is a gap in the systematic evaluation of nonpharmacological complementary approaches to augment PH management when addressing psychosocial and behavioral health needs.

Objectives

The objectives are to explore psychosocial and behavioral health needs and describe psychosocial and behavioral health interventions for patients with PH.

Methods

We conducted an integrative systematic review of publications between January 1, 2010, and January 31, 2020, obtained from electronic databases: EMBASE, PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane, PsycINFO, and Web of Science. The literature searches focused on empirical literature reporting psychosocial needs and psychosocial and behavioral health interventions for adult PH patients. We included peer-reviewed studies published in English. Search terms used in the study were: “hypertension,” “pulmonary hypertension,” “psychosocial,” “depression,” “anxiety,” “quality of life,” “behavioral health,” “self-management,” “psychosocial intervention,” and “psychological distress.” Excluded were opinion and discussion publications, reviews, non-PH populations, and pediatric articles. We used the constant comparison method to guide the synthesis of reports applying the Joanna Briggs quality assessment guidelines.

Results

A total of 44 articles meeting the criteria were included for final consideration. We conducted an integrative systematic review of 27 quantitative studies, narrative synthesis of 10 qualitative studies, and 7 psychosocial and behavioral health intervention studies. PH patients reported psychosocial needs, such as financial, social connections, sexual health, and palliative care needs, as well as levels of psychological distress symptoms. The results from both quantitative and qualitative studies revealed similar overarching psychosocial and behavioral health conceptual categories. Patients described their ongoing needs in PH management by relying on their psychosocial and behavioral health capabilities to adjust to changes at each stage of disease progression. Patients had high levels of psychosocial and behavioral health needs requiring interventions beyond medical treatment.

Discussion

Pilot studies testing psychosocial and behavioral health interventions reported improvement in levels of anxiety and depression and health-related quality of life. Larger scale studies are needed to advance this knowledge. Psychosocial and behavioral health interventions with cognitive-guided foci have the potential of meeting these unmet needs.
Diagnostic Value of TROP2 Expression in Papillary Thyroid Carcinoma
Authors: Saffar Hana , Jahanbin Behnaz , Ameli Fereshteh , Farhang Fatemeh , Tavangar Seyed M. , Saffar Hiva
Published: December 2020

Papillary thyroid carcinoma (PTC) represents the most common primary malignant thyroid lesion in all age groups. As diagnosis of PTC could be challenging in some cases and borderline nuclear features could be seen in some benign mimickers, several immunohistochemical markers are proposed to be helpful for making the correct diagnosis. In this study the authors investigated the diagnostic value of transmembrane glycoprotein (TROP2) for differentiating PTC from other thyroid follicular lesions. A total of 155 total thyroidectomy specimens including 84 cases of PTC and 71 cases of non-PTC were investigated. Among non-PTC group, 45 cases were follicular neoplasms and 26 cases were Hashimoto thyroiditis. TROP2 expression was observed in 82 of 84 cases of PTC group. In contrast only 5 cases of non-PTC group, all from Hashimoto thyroiditis specimens, showed positive expression. The sensitivity, specificity, positive predictive value, and negative predictive value of TROP2 for diagnosis of PTC was 98%, 93%, 94%, and 97%, respectively. The authors concluded that high sensitivity and specificity of TROP2 as well as its uniform negative reaction in follicular adenoma and carcinoma makes it a valuable immunohistochemical marker for diagnosis of PTC.
Clear Cell Tumor With Melanocytic Differentiation and ACTIN-MITF Translocation
Authors: de la Fouchardiere Arnaud , Pissaloux Daniel , Tirode Franck , Karanian Marie , Fletcher Christopher D.M. , Hanna John
Published: December 2020

Clear cell morphology is an uncommon finding in tumors. A subset of clear cell neoplasms also shows melanocytic differentiation, including clear cell sarcoma, PEComa, and some subtypes of renal cell carcinoma. A hallmark of these tumor types is the activation of a member of the MIT/TFE family of transcription factors, which includes MITF, TFE3, TFEB, and TFEC. Microphthalmia transcription factor (MITF is the master regulator of melanin synthesis, while TFEB plays a critical role in lysosome biogenesis. Cytogenetic translocations involving TFE3 and TFEB are now well described in multiple tumor types, but there has been little evidence to suggest similar regulation of MITF. Here we describe a series of 7 clear cell cutaneous neoplasms with melanocytic differentiation that are characterized by ACTIN-MITF gene fusions, either ACTB-MITF or ACTG1-MITF. The chromosomal breakpoints preserve MITF’s dimerization and transcriptional activation domains, suggesting that these fusion proteins likely result in hyperactive MITF function, analogously to the previously reported TFE3 and TFEB fusions. Our findings indicate that MITF gene rearrangements may be key drivers of tumor pathogenesis and expand the spectrum of neoplasia associated with the MIT/TFE family.
Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women With Early Life Abuse: A Randomized Controlled Trial
Authors: Andersen Elizabeth , Geiger Paul , Schiller Crystal , Bluth Karen , Watkins Lana , Zhang Ying , Xia Kai , Tauseef Hafsah , Leserman Jane , Girdler Susan , Gaylord Susan
Published: December 2020

Objective

Early life abuse (ELAb) initiates pathophysiological cascades resulting in long-term maladaptive stress responsivity, hyperalgesia, and an increased risk of psychopathology. Mindfulness-based stress reduction (MBSR) is effective in modifying psychological and somatic symptoms; thus, we predicted that MBSR would be particularly efficacious for women with ELAb.

Method

Medically healthy women (mean age = 31 years) with or without a history of early (≤13 years) physical or sexual abuse provided self-report measures and were tested in the laboratory before and after randomization to standard MBSR (n = 52) or social support (SSG) (n = 60) for 8 weeks. The laboratory procedure involved pain testing using the cold pressor and temporal summation of heat pain (indexing central sensitization) procedures, and exposure to the Trier Social Stress Test. Plasma cortisol in response to the experimental protocol was assessed as area under the curve (AUC).

Results

The interventions differentially impacted pain sensitivity and cortisol AUC for women with ELAb, as MBSR increased the temporal summation of heat pain intensity ratings (p = .024) and reduced cortisol AUC (p = .004). For women without ELAb, MBSR decreased cold pressor tolerance (p = .045) and decreased the temporal summation of heat pain intensity ratings relative to SSG (p = .024). Both MBSR and SSG improved depression symptoms and emotion regulation abilities (p values < .001); however, MBSR was associated with greater benefits in describing emotions (p = .008) and impulse control (p = .017) for women with ELAb.

Conclusions

Women with ELAb benefited from MBSR-specific improvements in central sensitization, mindfulness skills, and emotion regulation abilities. This is the first study to examine the efficacy of MBSR in modifying affective and somatic symptoms based on ELAb status and provides evidence for considering ELAb in tailoring treatment approaches.

Trial Registration: ClinicalTrials.gov Identifier: NCT01995916; https://clinicaltrials.gov/ct2/show/NCT01995916.
Efficacy and Safety of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide as Maintenance Treatment in HIV/HBV-Coinfected Patients
Authors: Huang Yu-Shan , Cheng Chien-Yu , Liou Bo-Huang , Lu Po-Liang , Cheng Shu-Hsing , Lee Yuan-Ti , Liu Chun-Eng , Sun Hsin-Yun , Yang Chia-Jui , Tang Hung-Jen , Lin Shih-Ping , Ho Mao-Wang , Huang Sung-Hsi , Tsai Hung-Chin , Lee Chen-Hsiang , Hung Chien-Ching ,   on behalf of the Taiwan HIV Study Group
Published: December 2020

Background:

The efficacy and safety of switching from tenofovir disoproxil fumarate-based antiretroviral therapy to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (E/C/F/TAF) has not been widely investigated in HIV/hepatitis B virus (HBV)-coinfected Asian population.

Methods:

Between February and October 2018, HIV/HBV-coinfected patients who had achieved HIV viral suppression with tenofovir disoproxil fumarate-containing regimens were switched to E/C/F/TAF. Assessments of plasma HBV and HIV viral load, HBV serology, renal function, lipid profiles, and bone mineral density (BMD) were performed at weeks 24 and 48 after switch.

Results:

A total of 274 HIV/HBV-coinfected participants were enrolled, with 12.8% testing HBeAg-positive and 94.2% having plasma HBV DNA <20 IU/mL at baseline. At weeks 24 and 48, 92.7% and 89.8% achieved plasma HBV DNA <20 IU/mL; 4.7% and 5.1% had HBV DNA ≥20 IU/mL; and 2.6% and 5.1% had no data, respectively. At weeks 24 and 48, 95.6% and 94.2% of participants maintained HIV RNA <50 copies/mL, respectively. Compared with baseline, the median urine β2-microglobulin-to-creatinine ratio at week 48 decreased significantly from 165 to 90 μg/g (P < 0.001). The mean BMD of the spine and hip improved at week 48 (+1.77% and +1.33%, respectively). Significantly higher lipid profiles were observed after switch to E/C/F/TAF. Thirteen (4.7%) patients withdrew from the study before week 48, with 7 (2.6%) patients because of adverse effects.

Conclusions:

Switch to E/C/F/TAF maintained HBV and HIV viral suppression and resulted in the improvement of proteinuria and BMD of the spine and hip but increased lipid levels in HIV/HBV-coinfected patients at week 48.