bluuebunny/crossref_metadata_2025 huggingface dataset:
Quaternary volcanostratigraphy setting in Rawa Danau Caldera, Banten Province
Authors: Santika A D , Syahputra R , Indra T L
Published: July 2020

The volcano complex in the Rawa Danau of Banten Province or called the Dano Volcano has an association with the eruption of the Krakatoa volcano, observed from the direction of the ridge lineament. The Dano volcanic eruptions occurred during the Holocene period, causing the accumulation of volcanic material deposits into the northern part of Banten Province. This research area is covering five mountains which are Mount Parakasak, Mount Marikangen, Mount Tukung-Gede, and Mount Karang (sorted from the oldest to the youngest). Field mapping method we use in accordance with previous research and literature studies, as well as the results of the analysis in the form of the senses and geomorphology, stratigraphy, geological structure, and petrography to conclude volcanic facies in the Rawa Danau and surrounding areas. The results of the study showed that there were 4 volcanic facies around the Dano Volcano area. The central facies comprise of dome of Mount Parakasak with steep morphology while the proximal facies with andesitic lava. The structural geology feature formed from sheeting joints in the Southwest-Northeast direction with azimuth of N15° E/44° and tectonic fractures with Northwest-Southeast direction with azimuth N135° E/70° with steep morphology. The medial facies is tuffs and tuff breccias with gentle slope morphology, and the distal facies only have mud deposit, clay lithology with flat morphology. Rawa Danau in this study is located in the distal zone which consists of swamp deposits resulting from the destruction of the surrounding volcanic material.
1-D shallow water equation, with no viscosity and no rotation, for a topography represented by a quadratic function
Authors: Cortés-Vélez Catalina , Martín-Atienza Beatriz , Hernandez-Walls Rafael
Published: July 2020

Based on the linearized shallow water equations with no rotation and no viscosity, in a rectangular channel with topography, the analytical solution for elevation and velocity was obtained. The bathymetry of the rectangular channel is described by a quadratic function. The analytical solution was determined from generalized power series, resulting in numerically convergent power series. This methodology is a useful and easy tool, which can be used by teachers in the teaching of differential equations and modeling.
Active random forces can drive differential cellular positioning and enhance motor-driven transport
Authors: Wolgemuth Charles W. , Sun Sean X.
Published: July 2020

Random forces from motor proteins acting on the actin cytoskeleton are found to be able to drive size-based cellular positioning.
Future Trade Relations between Canada and the United Kingdom
Authors: Armand de Mestral C M
Published: July 2020

Canada’s trade relations with the UK have been governed by the CETA since the signature of that agreement with the EU in October 2016. Subsequent to the decision of the UK electorate to leave the EU, it became necessary to envisage the creation of a new trade agreement directly between the UK and Canada. Initially, the Government of Canada indicated a willingness to negotiate a new trade agreement with the UK as quickly as possible. But, as the future relationship of the UK to the EU became increasingly uncertain, the Government of Canada decided to hold back until greater clarity could be obtained. As of July 2020, Canada was still waiting. The future trade agreement will reflect the desire of both countries to maintain their long-standing and close relationship. Both have strong interests in trade and investment with the other and both will seek to reinforce these interests. The particular concerns of both countries are outlined in this paper and the outlines of a future trade agreement are set out. In conclusion, the author suggests that it would be in the interests of the UK, rather than seeking simply a bilateral agreement, to seek to negotiate an Atlantic Free Trade Agreement, thereby clarifying its relations not simply with Canada but with all of Europe and North America.
Anti-human Leukocyte Antigen Immune Sensitization Effects of Cryopreserved Allograft and Blood Transfusion
Authors: Tassin David H , Kemp Bohan Phillip M , Cooper Laura E , Fletcher John , Hatem Victoria , Caterson E J , Cancio Leopoldo C , Chan Rodney K
Published: July 2020

Vascularized composite allotransplantation (VCA) is the most advanced reconstructive technique available to patients who suffer devastating burns to the limbs or face. However, VCA requires donor–recipient matching. Burn patients have been reported to experience sensitization, or the development of anti-human leukocyte antigen antibodies, during resuscitation and wound coverage, potentially precluding them from future VCA. This study sought to investigate the contributions of both blood and allograft to sensitization in burn patients. Four groups were compared: burn patients who received blood products and allograft (group 1), burn patients who received blood products only (group 2), trauma patients who received blood products only (group 3), and healthy volunteer controls (group 4). The average calculated panel-reactive antibody (indicating sensitization) was higher in group 1 compared to group 4 (P = .035). Additionally, the incidence of severe sensitization was higher in group 1 relative to the other groups (P = .049). When comparing groups of patients who had no sensitization, mild sensitization, moderate sensitization, and severe sensitization, there were no significant differences in age, sex, blood products received, total body surface area burned, or allograft used between groups, though severely sensitized patients tended to have greater total body surface area involvement and received more units of packed red blood cells and allograft (P = .079, P = .196, and P = .072, respectively). We therefore conclude that while burn patients who received allograft and blood demonstrated a higher incidence of anti-human leukocyte antigen sensitization relative to healthy controls, this difference cannot solely be attributed to either allograft use or transfusion.
Long-acting GLP-1RAs
Authors: Chun Ji Hyun , Butts Amy
Published: July 2020

Over recent decades, an improved understanding of the pathophysiology of type 2 diabetes mellitus (T2DM) and glucose regulation has led to innovative research and new treatment paradigms. The discovery of the gut peptide glucagon-like peptide-1 (GLP-1) and its role in glucose regulation paved the way for the class of GLP-1 receptor agonist compounds, or GLP-1RAs. The long-acting GLP-1RAs (dulaglutide, exenatide extended-release, liraglutide, semaglutide [injectable and oral]) are classified as such based on a minimum 24-hour duration of clinically relevant effects after administration. In phase 3 clinical trial programs of long-acting GLP-1RAs, A1C typically was reduced in the range of 1% to 1.5%, with reductions close to 2% in some studies. GLP-1RAs when used alone (without sulfonylureas or insulin) have a low risk of hypoglycemia because, like endogenous GLP-1, their insulinotropic effects are glucose-dependent. In addition to local actions in the gastrointestinal (GI) tract, GLP-1RAs stimulate receptors in the central nervous system to increase satiety, resulting in weight loss. All long-acting GLP-1RAs have, at minimum, been shown to be safe and not increase cardiovascular (CV) risk and most (liraglutide, semaglutide injectable, dulaglutide, albiglutide) have been shown in CV outcomes trials (CVOTs) to significantly reduce the risk of major cardiac adverse events. The class has good tolerability overall, with generally transient GI adverse events being most common. The weekly injectable agents offer scheduling convenience and may promote treatment adherence. One long-acting GLP-1RA is available as an oral daily tablet, which may be preferable for some patients and providers.
Incorporating Future of Nursing Competencies Into a Clinical and Simulation Assessment Tool: Validating the Clinical Simulation Competency Assessment Tool
Authors: Beauvais Audrey Marie , Phillips Kathryn E.
Published: July 2020

AIM

The purpose of the study was to evaluate the validity of the Clinical Simulation Competency Assessment Tool (ClinSimCAT).

BACKGROUND

The 2011 Future of Nursing report encouraged nursing programs to move toward a competency-based approach to education. As no tool was found to holistically evaluate nursing student competency in clinical and simulation settings, we developed the ClinSimCAT based on the Institute of Medicine recommended competencies.

METHOD

A Delphi study with three rounds was conducted. A national sample of nursing education and simulation leaders was used to achieve consensus about the competencies.

RESULTS

The process resulted in a set of 20 competencies across eight domains (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, informatics, professionalism, and systems-based practice).

CONCLUSION

The ClinSimCAT has demonstrated evidence of content validity and can be used for evaluation of clinical and simulation across a variety of undergraduate nursing courses.
The emergence of cannabinoid hyperemesis syndrome
Authors: Scannell Meredith
Published: July 2020

Get up-to-date information on this condition, which is increasingly being identified with the legalization of medical and recreational marijuana use.
Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Clinical Outcomes of a Multicenter 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients
Authors: Slobogean Gerard P. , Sprague Sheila , Bzovsky Sofia , Scott Taryn , Thabane Lehana , Heels-Ansdell Diane , O'Toole Robert V. , Howe Andrea , Gaski Greg E. , Hill Lauren C. , Brown Krista M. , Viskontas Darius , Zomar Mauri , Della Rocca Gregory J. , O'Hara Nathan N. , Bhandari Mohit ,   FAITH-2 Investigators*
Published: July 2020

Objective:

To assess whether the fixation method and vitamin D supplementation affect the risk of patient-important outcomes within 12 months of injury in nongeriatric femoral neck fracture patients.

Design:

A pilot factorial randomized controlled trial.

Setting:

Fifteen North American clinical sites.

Participants:

Ninety-one adults 18–60 years of age with a femoral neck fracture requiring surgical fixation.

Intervention:

Participants were randomized to a surgical intervention (sliding hip screw or cancellous screws) and a vitamin D intervention (vitamin D3 4000 IU daily vs. placebo for 6 months).

Main Outcome Measurements:

The primary clinical outcome was a composite of patient-important complications (reoperation, femoral head osteonecrosis, severe femoral neck malunion, and nonunion). Secondary outcomes included fracture-healing complications and radiographic fracture healing.

Results:

Eighty-six participants with a mean age of 41 years were included. We found no statistically significant difference in the risk of patient-important outcomes between the surgical treatment arms (hazard ratio 0.90, 95% confidence interval 0.40–2.02, P = 0.80) and vitamin D supplementation treatment arms (hazard ratio 0.96, 95% confidence interval 0.42–2.18, P = 0.92).

Conclusions:

These pilot trial results continue to describe the results of current fixation implants, inform the challenges of improving outcomes in this fracture population, and may guide future vitamin D trials to improve healing outcomes in young fracture populations. Although the pilot trial was not adequately powered to detect treatment effects, publishing these results may facilitate future meta-analyses on this topic.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Overexpressed osteoactivin reduced osteoclastic callus resorption during distraction osteogenesis in mice
Authors: Yukata Kiminori , Nikawa Takeshi , Takahashi Mitsuhiko , Yasui Natsuo
Published: July 2020

Distraction osteogenesis is a widely used surgical technique to treat bone deformity and shortening. Several biological treatments have been studied to enhance bone formation during distraction osteogenesis in animals. However, role of osteoactivin in the osseous tissues during distraction osteogenesis remains poorly understood. In this animal experimental study, we investigated the spatiotemporal expression of osteoactivin by immunohistochemistry and real-time PCR using a mouse model for tibial lengthening. Furthermore, to address the role of osteoactivin in bone lengthening, we subjected the osteoactivin-transgenic mice to distraction osteogenesis model. During the lag phase, the fibroblast-like cells (possible progenitors of the osteoblasts or chondrocytes), which mainly express osteoactivin, were infiltrated into the osteotomy site. Osteoactivin was ubiquitously expressed in the lengthened segment during the distraction and consolidation phases. Consistent with the immunohistochemical analysis, the levels of the osteoactivin transcripts in the tibias were significantly increased throughout the distraction osteogenesis process. The bone mineral content in the osteoactivin-transgenic mice calculated using peripheral quantitative computed tomography was also significantly increased at the remodeling zone. The histomorphometric analysis revealed that newly formed callus resorption in the remodeling zone was significantly reduced but bone formation was not altered in the osteoactivin-transgenic mice. We conclude that osteoactivin functions as an inhibitor of callus resorption during the consolidation phase of distraction osteogenesis.
Digital Storytelling
Authors: Beck Melissa Schwartz , Neil Janice A.
Published: July 2020

Many years ago, the National League for Nursing voiced the need to improve nursing education through innovative pedagogies supported by research. Digital stories are one of the newest pedagogical tools using storytelling in the digital world. This descriptive qualitative study reports the benefits, challenges, and solutions of digital story use in nursing education. Twelve nurse educators from Europe and the United States who had published or demonstrated use of digital stories in the classroom were recruited and interviewed. Data analysis revealed themes about the benefits and challenges associated with digital story use. The benefits identified were a greater depth of discussion, making points, engaging students, and promoting reflection and empathy. Development of critical thinking and the use of information technology skills were also identified. Challenges associated with digital stories included finding an appropriate digital story, legal issues involved, and the ability to assess student learning. Time in class to show digital stories and recognition of intended points by students were also uncovered. Solutions to some of these issues are also presented. This study revealed that the new pedagogy of digital stories engages students in the learning process.
An atypical sarcoid-like reaction during anti-protein death 1 treatment in a patient with metastatic melanoma
Authors: Keukeleire Stijn De , Schwarze Julia , Awada Gil , Everaert Hendrik , Van Binst Anne Marie , Cras Louise , Neyns Bart , Aspeslagh Sandrine
Published: July 2020

We report a case of anti-protein death 1-induced sarcoid-like reaction in a 63-year-old Caucasian male who was diagnosed with stage IV-M1a melanoma. He was initially treated with pembrolizumab monotherapy (Q3W) and had a complete response after 14 cycles. However, relapse was suspected 3 months later with appearance of hilar, mediastinal and hepatic hilar lymph nodes as well as a skin lesion. Biopsy of both the hilar lymph nodes and the skin lesion demonstrated sarcomatoid granulomatosis. Pembrolizumab was discontinued temporarily. While on 18F-FDG-PET/CT, all sarcoid-like lesions regressed in size and activity, a new hypermetabolic solitary skeletal lesion was detected in a lumbar vertebra, suspicious for metastasis. However, since the patient was asymptomatic, a watchful-waiting attitude was taken. During this period, a spontaneous and complete resolution of the metabolic activity was observed of the skeletal lesion. Until today, the patient remains in complete remission. Current case presents an atypical presentation and evolution of anti-PD-1-induced sarcoid-like reaction, illustrating the difficulty of differentiating it from disease progression. Before considering (re-)initiation of anti-melanoma therapy, a tissue biopsy of one of the suspected lesions may be performed to confirm diagnosis. Physicians treating patients with ICI should be aware of this difficulty and critically assess the nature of lesions suspect of progression in patients responding to ICI and presenting with a sarcoid-like reaction.
Concomitant development of neurologic and cardiac immune-related adverse effects in patients treated with immune checkpoint inhibitors for melanoma
Authors: Diamantopoulos Panagiotis T. , Tsatsou Katerina , Benopoulou Olga , Bonou Maria , Anastasopoulou Amalia , Mastrogianni Elpida , Gogas Helen
Published: July 2020

Immune checkpoint inhibitors (ICI) have altered the prognosis of patients with melanoma over the past few years, with immune-related adverse effects (irAEs) being the only factor limiting their use. Neurologic and cardiac irAEs are rare, but usually severe. We reviewed the files of patients with melanoma treated with ICIs in one center to retrieve data from patients with neurologic irAEs. Patients with a combination of neurologic and cardiac manifestations were further analyzed. We also reviewed the literature for similar syndromes. Five out of 482 (1.01%) patients developed a neurologic syndrome and we present three patients with a constellation of neurologic and cardiac irAEs. A 66-year-old woman and a 68-year-old man presented with a constellation of findings after being treated with ipilimumab and nivolumab, respectively, for melanoma in the adjuvant setting and were eventually diagnosed with myasthenia gravis with cardiac involvement. An 80-year-old woman developed diffuse asymmetric muscle weakness, bilateral ptosis and asymptomatic high serum troponin levels after adjuvant treatment with nivolumab and ipilimumab for a stage IIIB melanoma. After excluding ischemic heart disease, she was diagnosed with axonal polyradiculoneuropathy and myocarditis. Neurologic or cardiac irAEs in patients treated with ICIs are uncommon (<1%), but usually severe, with high rates of morbidity and fatality. The co-development of neurologic and cardiac irAEs is even more rare and can arise soon after exposure to ICIs and escalate rapidly. Since more and more patients are now treated with ICIs in the adjuvant setting, prompt identification and management are essential to avoid serious complications or death.
Clinical and molecular features of subungual melanomas are site-specific and distinct from acral melanomas
Authors: Holman Blair N. , Van Gulick Robert J. , Amato Carol M. , MacBeth Morgan L. , Davies Kurtis D. , Aisner Dara L. , Robinson William A. , Couts Kasey L.
Published: July 2020

Subungual melanomas (SUM) arise beneath the nails of the hands and feet, and account for 0.7–3.5% of all malignant melanomas. Most studies include SUM in the category of acral melanoma, but understanding the specific features of SUM is critical for improving patient care. In this study, we performed a site-specific comparison of the clinical and molecular features between 54 cases of SUM and 78 cases of nonsubungual acral melanoma. Compared to patients with acral melanoma, patients with SUM were younger at diagnosis, had a higher prevalence of primary melanomas on the hand, and had more frequent reports of previous trauma at the tumor site. SUM was deeper than acral melanoma at diagnosis, which correlated with an increased frequency of metastases. Analysis of common melanoma driver genes revealed KIT and KRAS mutations were predominantly found in SUM, whereas BRAF and NRAS mutations occurred almost exclusively in acral melanoma. We also discovered molecular differences in the cell cycle pathway, where CDK4/CCND1 amplifications were more frequent in SUM and CDKN2A/B loss occurred mostly in acral melanoma, and in the PI3K/mTOR pathway, where RICTOR amplification and TSC1 K587R mutations were exclusively in SUM and PTEN loss and AKT1 mutations were exclusively in acral melanoma. Comparison of hand versus foot tumors revealed more frequent ulceration of SUM foot tumors, which correlated with more distal metastases and poorer overall survival. In summary, we find SUM are both clinically and molecularly distinct from acral melanoma, and our data suggest KIT, CDK4/6, and mTOR inhibitors may be particularly relevant and effective treatments for patients with SUM.
A selective serotonin receptor agonist for weight loss and management of menopausal vasomotor symptoms in overweight midlife women: a pilot study
Authors: Kapoor Ekta , Faubion Stephanie , Hurt Ryan T. , Fischer Karen , Schroeder Darrell , Fokken Shawn , Croghan Ivana T.
Published: July 2020

Objective:

Weight gain and vasomotor symptoms (VMS) are common complaints in midlife women going through the menopause transition. A selective serotonin 2C (5-HT2C) receptor agonist, lorcaserin, which was previously approved by the Food and Drug Administration for weight loss, has unreported observational evidence suggesting improvement in VMS with its use. The goal of this pilot study was to evaluate the efficacy of lorcaserin for weight loss and management of VMS in overweight midlife women.

Methods:

This was a 24-week open label pilot study of 20 overweight midlife women, aged 45-60 years, who were experiencing severe VMS. Participants received lorcaserin at the standard dose of 10 mg twice daily for 12 weeks, followed by 12 weeks of observation off the drug. The primary outcomes were changes in weight and subjectively reported VMS.

Results:

At the end of 12 weeks, mean change in weight was −2.4 kg (90% CI, −3.2 to −1.7, P < 0.001). However, the participants returned to the baseline weight at 24 weeks. Participants also reported significant subjective improvement in VMS, with a mean ± SD change in self-reported hot flash frequency from baseline to week 12 of −5.4 ± 3.9 (decrease of 1.4 standard deviations). There was a rapid increase in the frequency of VMS within 2 weeks of discontinuation of lorcaserin with a tendency to approach the baseline frequency of VMS.

Conclusions:

In addition to its weight loss-inducing effect, 5-HT2C receptor modulation may have an additional beneficial effect on VMS in midlife women. A treatment option that targets both weight and VMS in midlife women is attractive.

Video Summary:

http://links.lww.com/MENO/A622.
17β-estradiol/progesterone in a single, oral, softgel capsule (TX-001HR) significantly increased the number of vasomotor symptom-free days in the REPLENISH trial
Authors: Kaunitz Andrew M. , Bitner Diana , Constantine Ginger D. , Bernick Brian , Graham Shelli , Mirkin Sebastian
Published: July 2020

Objective:

To examine responder rates and vasomotor symptom-free days with oral 17β-estradiol/progesterone (E2/P4; TX-001HR) versus placebo in the REPLENISH trial.

Methods:

REPLENISH (NCT01942668) was a phase 3, randomized, double-blind, placebo-controlled, multicenter trial, evaluating single, oral, softgel E2/P4 capsules in postmenopausal women (40-65 y) with a uterus and vasomotor symptoms (VMS). Women with moderate to severe hot flushes (≥7/d or ≥50/wk) were randomized (VMS substudy) to daily E2/P4 (mg/mg) of 1/100, 0.5/100, 0.5/50, 0.25/50, or placebo. Proportions of women with ≥50% or ≥75% reductions in moderate to severe VMS (responders), and those with no severe VMS as well as the weekly number of days without moderate to severe VMS with TX-001HR versus placebo were determined. Mixed model repeated measures was used to analyze data and Fisher exact test was employed to compare E2/P4 versus placebo.

Results:

Seven hundred twenty-six women were eligible for the VMS efficacy analysis (E2/P4 1/100 [n = 141], 0.5/100 [n = 149], 0.5/50 [n = 147], 0.25/50 [n = 154], or placebo [n = 135]). Significantly more women treated with all E2/P4 doses versus placebo were ≥50% responders and ≥75% responders at weeks 4 and 12 (P < 0.05) and also had significantly more days per week without moderate to severe VMS at week 12 (1.9-3.0 d for E2/P4 versus 1.3 d for placebo; P < 0.05). The proportion of women without severe hot flushes at week 12 was 43% to 56% for all E2/P4 doses versus 26% for placebo (P ≤ 0.01).

Conclusions:

Women treated with E2/P4 had a greater response to treatment with more VMS-free days than with placebo. The E2/P4 1/100 dose (Bijuva [E2 and P4] capsules) represents an oral treatment option for postmenopausal women with moderate to severe VMS and a uterus.
CHOROIDAL BLOOD FLOW
Authors: Spaide Richard F.
Published: July 2020

Purpose:

To review control mechanisms for blood flow in the choroid, propose a system by which venous outflow is controlled by a Starling resistor, and propose an explanation for the choroidal venous architectural anatomy.

Methods:

The main blood flow control mechanisms were reviewed including autoregulation, neurovascular coupling, and myogenic regulation. Applicable blood flow control mechanisms in the brain, a high flow organ in a low compliance outer shell, were used to examine analogous processes that may be occurring in the choroid.

Results:

There does not seem to be effective autoregulation in the choroid, although myogenic mechanisms may be present. There is a sophisticated neural innervation that provides partial control. Like the brain, the eye has a high pulsatile blood flow rate and is encased in a noncompliant casing. As part of modulating pulsatile pressure in the cranium, the brain uses venous storage and a Starling resistor effect to modulate venous outflow. An analogous function in the eye could be provided by the choroid, which contains fascicles of large veins that converge in vortices to drain out of the eye. This vortex area seems to be where the Starling resistor effect is possible. This mechanism would have important impact on theories of many ocular diseases including central serous chorioretinopathy and spaceflight-associated neuroocular syndrome.

Conclusion:

Control of blood flow is critical in the choroid, and this control seems to extend to the venous outflow system. Abnormalities in venous outflow may critically affect function in predictable pathogenic mechanisms.
PATTERN DYSTROPHY-LIKE CHANGES ASSOCIATED WITH A VERY HIGH SERUM FERRITIN LEVEL IN β-THALASSEMIA MAJOR
Authors: Kurnia King Hans , Elvioza Elvioza , Sidik Mohamad , Sari Teny Tjitra , Sitorus Rita S.
Published: July 2020

Purpose:

To report a rare case of pattern dystrophy-like retinal changes in a young β-thalassemia major patient with a very high serum ferritin level.

Methods:

Observational case report of a β-thalassemia major patient with bilateral pattern dystrophy-like retinal changes.

Results:

An 18-year-old man experienced blurring of vision in both eyes. Patient had a very high serum ferritin level and had a history of using various iron-chelating drugs. Funduscopy revealed bilateral widespread retinal pigment epithelium changes with macular involvement, which resembled pattern dystrophy-like changes. Fundus autofluorescence imaging showed extensive area of decreased autofluorescence signal interspersed with increased autofluorescence signals, whereas optical coherence tomography demonstrated macular retinal pigment epithelium thinning and interdigitation zone disruption corresponding to retinal pigment epithelium damage and atrophy.

Conclusion:

Pattern dystrophy-like changes should be considered as a possible manifestation of retinal changes in patients with β-thalassemia major. Iron overload, which is indicated by a very high serum ferritin level, might have a role in the formation of this rare retinal manifestation in β-thalassemia major.
One-Year Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty Versus Non-Preloaded Descemet Membrane Endothelial Keratoplasty
Authors: Böhm Myriam S. , Wylegala Adam , Leon Pia , Ong Tone Stephan , Ciolino Joseph B. , Jurkunas Ula V.
Published: July 2020

Purpose:

To compare the one-year outcomes of preloaded Descemet membrane endothelial keratoplasty (pDMEK) and non-preloaded DMEK (n-pDMEK) in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods:

This retrospective comparative cohort study consecutively included 68 eyes with Fuchs endothelial corneal dystrophy who underwent either pDMEK (n = 38) or n-pDMEK (n = 30) performed by cornea fellows with an experienced surgeon between 2016 and 2018 at the Massachusetts Eye and Ear Infirmary. Exclusion criteria were previous surgery (other than uncomplicated cataract surgery) and any documented evidence of macular or other corneal diseases. Corrected distance visual acuity (CDVA), central corneal thickness, intraocular pressure, patient characteristics, postprocessing endothelial cell count, donor graft data, and complications were compared.

Results:

CDVA showed similar results for pDMEK (0.12 ± 0.11 logarithm of the minimal angle of resolution [LogMAR]) and n-pDMEK (0.13 ± 0.13 LogMAR) (P = 0.827). Sixty-six percent of the pDMEK eyes and 57% of the n-pDMEK eyes achieved a VA of ≥0.1 LogMAR, and 95% and 97%, respectively, achieved a CDVA ≥0.3 LogMAR. The preoperative central corneal thickness of pDMEK and n-pDMEK (644 ± 62.2 μm, 660.5 ± 56.2 μm) decreased significantly after surgery (525.1 ± 43.6 μm, 526.5 ± 45.2 μm, P < 0.001), with no difference between groups (P = 0.840). The postprocessing endothelial cell count did not differ between pDMEK (2959.2 ± 182.9 cells/mm2) and n-pDMEK (2939.3 ± 278.7 cells/mm2) (P = 0.484). Complication rates were comparable with just the rebubbling performed in a minor procedure room showing a lower rate for pDMEK (13.16%) compared with n-pDMEK (33.33%) (P < 0.045).

Conclusions:

One-year clinical outcomes were similar between pDMEK and n-pDMEK procedures, rendering eye bank–prepared pDMEK tissues a useful tool in the treatment of endothelial dysfunction.
Reliability of 3 Strategies of Orbital Tumor Volume Measurement Using Phantom Modeling
Authors: Tooley Andrea A. , Maher Mary , Cooper Cathleen , Godfrey Kyle J. , Tran Ann Q. , Kazim Michael
Published: July 2020

Purpose:

The reliability of 3 volume measurement strategies was investigated using MRI and a simple method for creating phantom orbit tumors.

Methods:

Water-based starch was molded into orbital “tumors” of 3 shapes (sphere, ovoid, diffuse); water displacement was used to calculate volume. “Tumors” were placed into 3D-printed orbit phantoms, MRIs were obtained and volume analysis was performed. Observers measured tumor volume using ellipsoid volume (EV), manual segmentation, and semi-automated segmentation strategies. Intraclass correlation coefficients were calculated comparing observer measurements to true volumes. The coefficient of repeatability determined the percentage of tumor volume change required for each method to detect tumor growth.

Results:

Intraclass correlation coefficients comparing measured volumes to true volumes using EV, manual segmentation, and semi-automated segmentation were 0.61, 0.98, and 0.99 for spherical, 0.64, 0.97, and 0.98 for ovoid, and 0.18, 0.82, and 0.87 for diffuse tumors. Semi-automated segmentation followed by manual segmentation had the highest correlation between measured and true tumor volume for all 3 tumor geometries. EV had low correlation with true volume for all tumor geometries. Diffuse tumors had high variability and low correlation for all 3 measurement techniques.

Conclusions:

This study shows the reliability of 3 strategies to measure orbital tumor volume with MRI based on tumor geometry, using a simple phantom model. EV, the most commonly employed strategy in clinical practice, had low correlation and high variability across tumor shapes. Using manual segmentation and semi-automated segmentation, a measured change in volume greater than 25% may be considered true growth, while the EV strategy required a 40%–400% change in volume to reliably measure tumor growth.
Outcomes Associated With Antibiotic Cessation in Oncology Patients With Positive Respiratory Viral Panel Polymerase Chain Reaction Results
Authors: Smith Stephanie M. , Pineda Elmor D. , Oda Julie , Chavda Rihin , Herrington Jon D.
Published: July 2020

Background

The discontinuation of antibiotics is ideal if a viral infection is diagnosed. However, it remains uncertain whether in clinical practice, this applies to immunocompromised patients.

Purpose

The purpose of this study was to evaluate the outcomes of hospitalized febrile oncology patients that cease or continue antibiotics with positive respiratory viral panels (RVP) with negative bacterial cultures.

Methods

This retrospective study evaluated hospitalized febrile oncology patients divided into 2 groups: patients with antibiotics discontinued within 72 hours of a positive RVP and those continued on antibiotics beyond 72 hours of a positive RVP. Patients were included if they were at least 18 years of age, had active malignant disease, a positive RVP result, and negative bacterial cultures. The primary endpoint was a composite of readmissions, escalation of care to intensive care unit, or death.

Results

A total of 243 charts were reviewed with 127 admissions meeting inclusion criteria. Sixty-three patients were included in the antibiotics discontinued within 72 hours group and 64 patients were included in the antibiotics continued after 72 hours group. The most common defined malignancy was lymphoma (22%), and the 3 most common viruses identified were rhinovirus/enterovirus (56.7%), influenza A (12.6%), and human metapneumovirus (12.6%). The composite primary outcome occurred in 26.2% of patients in the antibiotic-continued group compared with 27% in the antibiotic-discontinued group.

Conclusions

Discontinuing antibiotics in oncology patients with a positive RVP result without concurrent bacterial infections did not lead to a significant increase in 30-day readmission, intensive care unit admission, or death.
Prevalence of mitochondrial DNA common deletion in patients with gliomas and meningiomas: A first report from a Malaysian study group
Authors: Mohamed Yusoff Abdul Aziz , Mohd Khair Siti Zulaikha Nashwa , Abd Radzak Siti Muslihah , Idris Zamzuri , Lee Hsin-Chen
Published: July 2020

Background:

The 4977-bp common deletion (mtDNA4977) is a well-established mitochondrial genome alteration that has been described in various types of human cancers. However, to date, no studies on mtDNA4977in brain tumors have been reported. The present study aimed to determine mtDNA4977prevalence in common brain tumors, specifically, low- and high-grade gliomas (LGGs and HGGs), and meningiomas in Malaysian cases. Its correlation with clinicopathological parameters was also evaluated.

Methods:

A total of 50 patients with pathologically confirmed brain tumors (13 LGGs, 20 HGGs, and 17 meningiomas) were enrolled in this study. mtDNA4977was detected by using polymerase chain reaction (PCR) technique and later confirmed via Sanger DNA sequencing.

Results:

Overall, mtDNA4977was observed in 16 (32%) patients and it was significantly correlated with the type of tumor group and sex, being more common in the HGG group and in male patients.

Conclusion:

The prevalence of mtDNA4977in Malaysian glioma and meningioma cases has been described for the first time and it was, indeed, comparable with previously published studies. This study provides initial insights into mtDNA4977in brain tumor and these findings can serve as new data for the global mitochondrial DNA mutations database.
Effects of Hydraulic Ankle-Foot Prostheses on Gait in Individuals with Transtibial Limb Loss: A Scoping Review
Authors: Chang Sarah R. , Miller Corinne H. , Kaluf Brian
Published: July 2020

Introduction

The purpose of this scoping review was to determine if sufficient evidence exists to conduct a formal systematic review or meta-analysis of hydraulic ankle-foot (HAF) prostheses and to determine if evidence statements could be synthesized relative to the effects of HAF prostheses on gait in individuals with transtibial limb loss.

Methods

Electronic database searches were conducted in MEDLINE, Embase, Web of Science, Scopus, and Proquest covering 1788 to 2017. Two reviewers independently completed screening and data extraction.

Results

The scoping review resulted in 15 articles that satisfied the inclusion/exclusion criteria. The majority of studies were completed in the United Kingdom and consisted of prospective protocols performed in research laboratories. All studies used the same HAF prosthesis intervention. The intervention studies reported a variety of biomechanical and patient-reported outcome measures.

Conclusions

Results of the scoping review indicate that there is a need to evaluate the quality of the HAF prosthetic literature with a systematic review or meta-analysis.

Clinical Relevance

There has been an increase in the number of commercially available passive hydraulic ankle-foot prostheses. This study provides an overview of evidence related to the effects of these HAF prostheses on transtibial prosthesis users' gait biomechanics and patient-reported outcomes. Walking speed was consistently reported as improved when using a hydraulic ankle-foot prosthesis as compared with a nonhydraulic ankle-foot prosthesis.
Colchicine therapy in patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials
Authors: Al-Abdouh Ahmad , Barbarawi Mahmoud , Khan Safi U. , Osman Mohammed , Upadhrasta Sireesha , Solipuram Vinod , Abusnina Waiel , Radaideh Qais , Zhao Di , Michos Erin D.
Published: July 2020

Introduction

Inflammation is a substantial mediator of atherosclerosis. Colchicine has anti-inflammatory effects and has been investigated in many randomized controlled trials (RCTs) in patients with coronary artery disease (CAD).

Methods

We searched PubMed/MEDLINE, Cochrane library, and Embase databases (inception through 28 February 2020) for RCTs evaluating colchicine in CAD patients. The outcomes of interest were major adverse cardiovascular events (MACE), myocardial infarction (MI), all-cause mortality, cardiovascular mortality, and stroke. Estimates were pooled using inverse-variance random-effects model. We reported effect sizes as risk difference (RD) with 95% confidence interval (CI).

Results

A total of six RCTs with 6154 patients were included. The mean age ± SD for the patients in the colchicine group was 61.6 ± 10.8 and control group was 61.5 ± 10.7 years. At the median follow-up of 3.5 months, use of colchicine in patients with CAD was not associated with statistically significant reduction of MACE (RD −0.032; 95% CI −0.083 to 0.018; P = 0.15; I2 = 75%; low level of evidence), MI (RD −0.011; 95% CI −0.030 to 0.007; P = 0.16; I2 = 11.3%; low level of evidence), all-cause mortality (RD −0.001; 95% CI −0.009 to 0.006; P = 0.65; I2 = 0%; low level of evidence), cardiovascular mortality (RD −0.003; 95% CI −0.010 to 0.004; P = 0.34; I2 = 0%; low level of evidence), and stroke (RD −0.001, 95% CI −0.005 to 0.004; P = 0.69; I2 = 0%; very low level of evidence).

Conclusion

This meta-analysis suggests that colchicine was not associated with a significant decrease in cardiovascular endpoints and mortality in patients with CAD.
Standardized uptake values and ratios on 68Ga-DOTATATE PET-computed tomography for normal organs and malignant lesions and their correlation with Krenning score in patients with metastatic neuroendocrine tumors
Authors: Menon Biju K , Kalshetty Ashwini , Bhattacharjee Atanu , Basu Sandip
Published: July 2020

The aim was to estimate the physiological standardized uptake values (SUVs) on 68Ga-DOTATATE PET-computed tomography (CT) in normal organs and metastatic tumor lesions (both standard and delayed), and correlating the uptake values and ratios with Krenning Scores (K-score) in patients with metastatic/advanced neuroendocrine tumors (NETs) undergoing PET-CT studies for their management work-up. A total of 32 patients of metastatic NET with 95 discrete tumor lesions were included in this analysis. These patients underwent standard whole-body PET-CT following injection of 2–3 mCi (74–111 MBq) of 68Ga-DOTATATE at 1–1.5 h. The normal physiological SUVmean of the liver and spleen and SUVmax and SUVmean of tumor lesions were estimated by an in-built automated procedure. These patients also underwent a delayed scan (2.5–3 h) and the same parameters were obtained for the delayed study. The tumorous lesions were further classified on the basis of K-score, and this was correlated with the mean SUVmax on both early and delayed scans. SUVmean ratios (tumor-to-liver and tumor-to-spleen) were also calculated for both time-points and correlated with individual K-scores. In lesions with K-score 4, the mean SUVmax was 32.5 in early and 30.5 in delayed scan, for lesions with K-score of 3 and 2, the mean SUVmax were 17.3, 20, and 9.3, 9.2, respectively, while in K-score 1 (n = 1), the delayed mean SUVmax was found to be more than early mean SUVmax (3.2 to 2.3). Statistical significance was evaluated by paired t test, and the changes in SUVmax was found to be statistically insignificant (P > 0.05) in all 3 K-scores. The paired t test was also performed between early and delayed tumor/liver and tumor/spleen mean SUVmean ratios, and no significant changes were observed across all K scores. The mean SUVmean values of the liver in the standard 1-h scan and delayed scans were 8.05 (range: 3–15) and 8.17 (range: 3.2–16), while for spleen, the values were 18 (range: 8.4–36.7) and 20 (range: 10–38.6), respectively. Statistically significant changes were observed in delayed spleen SUVmean values compared to the early scan (P < 0.05), while for liver SUVmean, the difference was not significant. Thus, in the present study, the SUVmax and SUVmean (range and mean values) for normal liver and spleen, and malignant NET lesions, and tumor-to-liver and tumor-to-spleen SUVmean ratios of different K-scores were generated. As could be theoretically expected in receptor-based PET-CT, there was no significant change in the delayed scan compared to the standard 1–1.5 h values
A Fatal Case of Cardiac Contusion After Blunt Chest Injury
Authors: Farkašová Iannaccone Silvia , Ginelliová Alžbeta , Sopková Dorota , Mistríková Lucia , Fröhlichová Lucia , Dettmeyer Reinhard , Farkaš Daniel
Published: July 2020

In this article, we report the autopsy findings of a 48-year-old man who sustained blunt trauma to the thorax. A medical record review revealed no history of cardiac disease. He presented to the hospital with a computed tomography–verified fracture of the left fourth and fifth ribs, and pulmonary and cardiac contusion. He was released from the hospital in stable condition at his own request 7 days later. Because of sudden deterioration, he was readmitted to the hospital the next day. Electrocardiogram detected cardiac arrhythmia on the 15th day after chest trauma. Electrocardiography detected pericardial effusion and severe mitral insufficiency resulting in left ventricular failure. Death was attributed to diffuse alveolar damage–complicating pneumonia due to cardiac contusion with mitral insufficiency occurring 25 days after hospital admission. Internal examination revealed diffuse fibrinous pericarditis, left atrial tear right above the anterior mitral valve leaflet with intrapericardial granulation tissue, and no sign of myocardial damage. Immunohistochemistry showed significantly more CD68-positive macrophages within tissue taken from the heart, a finding indicative of previous atrial and ventricular myocardial contusion. This case report demonstrates that routine hematoxylin and eosin staining may not always reveal significant myocardial damage.
Current and Future MR Contrast Agents
Authors: Lancelot Eric , Raynaud Jean-Sébastien , Desché Pierre
Published: July 2020

This review summarizes 30 years of experience in the development and clinical use of magnetic resonance (MR) contrast agents. Despite their undisputable usefulness for disease diagnosis, gadolinium (Gd)-based contrast agents (GBCAs) have gone through 2 major safety crises. Approximately 10 years ago, the regulatory agencies decided to restrict the use of GBCAs to minimize the risk of nephrogenic systemic fibrosis in patients with severe renal insufficiency. Yet, following the recent discovery of Gd retention in brain, the same agencies adopted different positions ranging from suspension of marketing authorizations, changes in GBCA safety labeling, and performing preclinical and clinical studies to assess the potential long-term consequences of Gd accumulation on motor and cognitive functions. Besides, magnetic resonance imaging (MRI) has benefited from MR technological advances, which provide alternative solutions to increase the MR signal, generate new contrasts on MRI scans, and accelerate their acquisition and analysis. Altogether, GBCAs in combination with new MR techniques have found their place in the diagnostic pathway of various diseases. Despite the large research efforts to identify and develop alternative Gd-free MR agents, manganese- and iron-based contrast agents have failed to reach market approval. In this context, the development of next-generation MR contrast agents should focus on high-stability and high-relaxivity GBCAs, such as gadopiclenol, which offer the possibility to adapt the administered Gd dose to each indication while ensuring an optimal patient safety.
A Standardized Electrode Nomenclature for Stereoelectroencephalography Applications
Authors: Stone Scellig , Madsen Joseph R. , Bolton Jeffrey , Pearl Phillip L. , Chavakula Vamsidhar , Day Emily
Published: July 2020

Purpose:

Stereoelectroencephalography (SEEG) is widely performed on individuals with medically refractory epilepsy for whom invasive seizure localization is desired. Despite increasing adoption in many centers across the world, no standardized electrode naming convention exists, generating confusion among both clinical and research teams.

Methods:

We have developed a novel nomenclature, named the Standardized Electrode Nomenclature for SEEG Applications system. Concise, unique, informative, and unambiguous labels provide information about entry point, deep targets, and relationships between electrodes. Inter-rater agreement was evaluated by comparing original electrode names from 10 randomly sampled cases (including 136 electrodes) with those prospectively assigned by four additional blinded raters.

Results:

The Standardized Electrode Nomenclature for SEEG Application system was prospectively implemented in 40 consecutive patients undergoing SEEG monitoring at our institution, creating unique electrode names in all cases, and facilitating implantation design, SEEG recording and mapping interpretation, and treatment planning among neurosurgeons, neurologists, and neurophysiologists. The inter-rater percent agreement for electrode names among two neurosurgeons, two epilepsy neurologists, and one neurosurgical fellow was 97.5%.

Conclusions:

This standardized naming convention, Standardized Electrode Nomenclature for SEEG Application, provides a simple, concise, reproducible, and informative method for specifying the target(s) and relative position of each SEEG electrode in each patient, allowing for successful sharing of information in both the clinical and research settings. General adoption of this nomenclature could pave the way for improved communication and collaboration between institutions.