bluuebunny/crossref_metadata_2025 huggingface dataset:
Offspring of translocated individuals drive the successful reintroduction of Columbian Sharp-tailed Grouse in Nevada, USA
Authors: Mathews Steven R , Coates Peter S , Prochazka Brian G , Espinosa Shawn P , Delehanty David J
Published: September 2021

Translocations of North American prairie-grouse (genus Tympanuchus) present a conservation paradox wherein they are performed to augment, restore, or reintroduce populations, but translocated individuals exhibit a diminished ability to contribute to population restoration. For reintroduced populations without immigration, persistence can only be achieved through reproductive contributions by translocated individuals and their progeny. Due to the disruptive nature of translocation (e.g., physiological chronic stress), progeny produced at restoration sites may outperform founder populations in terms of demographics, but this hypothesis has yet to be tested. We reintroduced Columbian Sharp-tailed Grouse (T. phasianellus columbianus; CSTG) to north central Nevada from 2013 to 2017 and used integrated population models (IPMs) to evaluate the process of population establishment and estimate latent contributions of progeny hatched at the restoration site to population rate of change (λ^). Specifically, we used annual lek (i.e. communal breeding arenas) counts and demographic data from translocated individuals to build two separate IPMs to estimate λ^. While keeping demographic contributions by translocated individuals identical between models, one IPM assumed local progeny performance was demographically similar to translocated individuals (i.e. the baseline-IPM), and the second assumed that local progeny performed demographically similar to non-translocated CSTG (i.e. the informative-IPM). The baseline-IPM predicted strong population declines following the conclusion of translocations and extirpation by 2020, and it failed to predict observed lek counts. Conversely, the informative-IPM predicted population growth rates (λ^ = 1.17, 95% credible interval [CI]: 0.74–1.50) that were more similar to field observations. Offspring of translocated individuals likely perform at similar levels to non-translocated populations, and by not accounting for demographic differences between translocated individuals and non-translocated progeny hatched at the restoration site, managers could underestimate population performance and persistence. Thus, translocation practices that maximize the number of offspring immediately recruited into restoration sites are likely to be the most successful.
The treatment of Merkel cell carcinoma with immune checkpoint inhibitors: implications for patients with rheumatoid arthritis
Authors: Klee Gina , Kisch Tobias , Kümpers Christiane , Perner Sven , Schinke Susanne , Zillikens Detlef , Langan Ewan A , Terheyden Patrick
Published: September 2021

Objectives

Merkel cell carcinoma (MCC) is a rare, highly aggressive neuroendocrine skin cancer, which typically affects elderly and immunocompromised and/or immunosuppressed patients. The checkpoint inhibitor avelumab, a mAb targeting the anti-programmed cell death ligand 1 (anti-PD-L1), has revolutionized the treatment of metastatic MCC, achieving dramatic improvements in disease control and overall survival. However, checkpoint inhibitors are associated with the development of immune-related adverse events, such as exacerbation of pre-existing RA. Although most immune-related adverse events can be managed successfully with CSs, their frequent and/or long-term use runs the risk of undermining the efficacy of immune checkpoint inhibition.

Methods

We report two cases of MCC, in which immunosuppressive therapy for the management of RA was administered.

Results

Immunosuppression for (i) pre-existing and (ii) immune checkpoint inhibitor-exacerbated RA was associated with progression of metastatic MCC.

Conclusion

Any decision to initiate immunosuppressive treatment for RA in patients receiving immune checkpoint inhibitor therapy should include careful consideration of the risk of potentially fatal cancer progression and be taken after consultation with the patient’s oncologist and rheumatologist. When the immunosuppressive treatment is required, it should be administered for as short a time as possible and under strict clinical and radiological surveillance.
The Melampsora americana Population on Salix purpurea in the Great Lakes Region Is Highly Diverse with a Contributory Influence of Clonality
Authors: Crowell Chase R. , Wilkerson Dustin G. , Beckauri Mariami , Cala Ali R. , McMullen Patrick W. , Mondo Stephen , Andreopoulos William , Lipzen Anna , Lail Kathleen , Yan Mi , Ng Vivian , Grigoriev Igor V. , Smart Lawrence B. , Smart Christine D.
Published: September 2021

Shrub willows (Salix spp.) are emerging as a viable lignocellulosic, second-generation bioenergy crop with many growth characteristics favorable for marginal lands in New York State and surrounding areas. Willow rust, caused by members of the genus Melampsora, is the most limiting disease of shrub willow in this region and remains extremely understudied. In this study, genetic diversity, genetic structure, and pathogen clonality were examined in Melampsora americana over two growing seasons via genotyping-by-sequencing to identify single-nucleotide polymorphism markers. In conjunction with this project, a reference genome of rust isolate R15-033-03 was generated to aid in variant discovery. Sampling between years allowed regional and site-specific investigation into population dynamics, in the context of both wild and cultivated hosts within high-density plantings. This work revealed that this pathogen is largely panmictic over the sampled areas, with few sites showing moderate genetic differentiation. These data support the hypothesis of sexual recombination between growing seasons because no genotype persisted across the two years of sampling. Additionally, clonality was determined as a driver of pathogen populations within cultivated fields and single shrubs; however, there is also evidence of high genetic diversity of rust isolates in all settings. This work provides a framework for M. americana population structure in the Great Lakes region, providing crucial information that can aid in future resistance breeding efforts.
The Watchman device for preventing stroke in patients with atrial fibrillation
Authors: Zapata James , Paamoni Arielle , Rinard Benjamin , Abdou Amir , Zimmer Drew , Letherer Cathy Chang
Published: September 2021

Atrial fibrillation (AF) is one of the most common sustained dysrhythmias that increases in prevalence with age, and is associated with strokes that can lead to significant patient morbidity and mortality. AF prevalence is projected to double over the next 25 years, demonstrating the need for innovative and effective stroke prevention modalities. Two options are direct oral anticoagulants and left atrial appendage occlusion. This article discusses the Watchman device, a left atrial appendage occlusion device that provides an option for patients with contraindications for anticoagulation.
Curriculum essentials of an entry-level PA doctoral degree
Authors: Kayingo Gerald , Gordes Karen L. , Jun Hyun-Jin , Fleming Shani , Kulo Violet , Cawley James F.
Published: September 2021

Objectives:

With increasing discussion of physician assistant (PA) doctoral education, investigation of curriculum essentials and competencies has become relevant.

Methods:

We conducted a national mixed-methods study comprising a survey and semistructured interviews to capture stakeholders' views on essential curricular elements for PA doctoral education.

Results:

If the PA profession decides to transition to a terminal doctoral degree, 75% of respondents indicated this would require new content, with half indicating it would require significant change to the curriculum, enhance PA educational rigor, and change the competencies of the new graduate. The majority of respondents favored a bridge program model and the Doctor of Medical Science (DMSc) as the degree title.

Conclusions:

Overall, respondents agreed that transition to an entry-level PA doctoral degree would affect various aspects of the curriculum. As the prospect of an entry-level PA doctoral degree gains further attention, additional debate on curriculum essentials and competencies is warranted.
Screening pediatric surgical patients during the COVID-19 pandemic
Authors: Dibbs Rami P. , Ferry Andrew M. , Mehl Steven C. , Ferguson Susannah M. , Versalovic James , Dunn James J. , Enochs Joyce , Monson Laura A. , Hollier Larry H.
Published: September 2021

SARS-CoV-2 has profoundly affected the way healthcare is delivered and has created significant strain on medical facilities globally. As a result, hospitals have had to continuously adapt in order to provide optimal patient care while minimizing the risk of SARS-CoV-2 transmission, particularly in the surgical setting. Texas Children's Hospital developed a set of protocols for surgical screening and clearance of patients in the context of the COVID-19 pandemic. These screening protocols were designed to mitigate the risk of exposing patients and healthcare providers to SARS-CoV-2 and have evolved significantly as a result of the emerging changes in medicine, technology, and governmental regulations. In this article, we share the reasoning behind the development, implementation, and successive modification of our institutional screening protocols.
Flying too close to the sun
Authors: Hickman Kevin A.
Published: September 2021

Increasingly, physician assistants (PAs), advanced practice nurses, and physicians are financially involved with healthcare product manufacturers. Although the relationships themselves might not be illegal, when the transaction influences the healthcare provider's medical decision-making, patients can be harmed and the healthcare provider and manufacturer can face accusations of violating federal and state law. In 2019, the federal government recouped $2.6 billion from healthcare fraud and abuse by healthcare stakeholders. PAs' and NPs' behaviors violating the Anti-Kickback Statute (AKS) and False Claims Act (FCA) were partially responsible for the reported amount. To increase the transparency of the financial relationships between healthcare providers and healthcare manufacturers, the federal Centers for Medicare and Medicaid Services, under statutory obligation, created the Open Payments program, which will begin reporting PAs' and advanced practice nurses' financial relationships with manufacturers in 2022.
Perinatal depression screening
Authors: Ellington Kelly
Published: September 2021

Recommendations for social distancing and avoidance of mass gatherings during the COVID-19 pandemic have correlated with increased depressive symptoms in some individuals, such as loss of interest in daily activities, sleeplessness, or sadness. Perinatal depression screening using established, validated tools can aid with early diagnosis, guide management strategies, and optimize outcomes for pregnant women and their families. Identifying at-risk patients early in pregnancy and implementing a plan of care with appropriate mental health resources such as counseling or therapy have been shown to decrease clinical depression by more than 40%.
Intraoperative Electrocochleography in Subjects Affected by Vestibular Schwannoma and Ménière’s Disease: Comparison of Results
Authors: Trecca Eleonora M. C. , Adunka Oliver F. , Hiss Meghan M. , Mattingly Jameson K. , Moberly Aaron C. , Dodson Edward E. , Cassano Michele , Prevedello Daniel M. , Riggs William J.
Published: September 2021

Objectives:

Histologic reports of temporal bones of ears with vestibular schwannomas (VSs) have indicated findings of endolymphatic hydrops (ELH) in some cases. The main goal of this investigation was to test ears with VSs to determine if they exhibit electrophysiological characteristics similar to those of ears expected to experience ELH.

Design:

Fifty-three subjects with surgically confirmed VS aged ≥18 and with normal middle ear status were included in this study. In addition, a second group of adult subjects (n = 24) undergoing labyrinthectomy (n = 6) or endolymphatic sac decompression and shunt (ELS) placement (n = 18) for poorly controlled vestibular symptoms associated with Meniere’s disease (MD) participated in this research. Intraoperative electrocochleography (ECochG) from the round window was performed using tone burst stimuli. Audiometric testing and word recognition scores (WRS) were performed preoperatively. ECochG amplitudes, cochlear microphonic/auditory nerve neurophonic (ANN) in the form of the “ongoing” response and summation potential, were analyzed and compared between the two groups of subjects. In addition, to evaluate any effect of auditory nerve function, the auditory nerve score was calculated for each subject. Pure-tone averages were obtained using the average air conduction thresholds at 0.5, 1, and 2 kHz while WRS was assessed using Northwestern University Auditory Test No. 6 word lists.

Results:

In the VS group the average pure-tone averages and WRS were 59.6 dB HL and 44.8%, respectively, while in the MD group they were 52.3 dB HL and 73.8%. ECochG findings in both groups revealed a reduced trend in amplitude of the ongoing response with increased stimulus frequency. The summation potential amplitudes of subjects with VS were found to be less negative than the MD subjects for nearly all test frequencies. Finally, the VS group exhibited poorer amounts of auditory nerve function compared to the MD group.

Conclusions:

The current findings suggest cochlear pathology (e.g., hair cell loss) in both groups but do not support the hypothesis that VSs cause ELH.
Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm: A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial
Authors: Spoormans Eva M. , Lemkes Jorrit S. , Janssens Gladys N. , van der Hoeven Nina W. , Jewbali Lucia S. D. , Dubois Eric A. , Meuwissen Martijn , Rijpstra Tom A. , Bosker Hans A. , Blans Michiel J. , Bleeker Gabe B. , Baak Remon , Vlachojannis Georgios J. , Eikemans Bob J. W. , Girbes Armand R. J. , van der Harst Pim , van der Horst Iwan C. C. , Voskuil Michiel , van der Heijden Joris J. , Beishuizen Albertus , Stoel Martin , Camaro Cyril , van der Hoeven Hans , Henriques José P. , Vlaar Alexander P. J. , Vink Maarten A. , van den Bogaard Bas , Heestermans Ton A. C. M. , de Ruijter Wouter , Delnoij Thijs S. R. , Crijns Harry J. G. M. , Jessurun Gillian A. J. , Oemrawsingh Pranobe V. , Gosselink Marcel T. M. , Plomp Koos , Magro Michael , van de Ven Peter M. , van Royen Niels , Elbers Paul W. G.
Published: September 2021

OBJECTIVES:

The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and 36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.

DESIGN:

Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.

SETTING:

Nineteen hospitals in The Netherlands.

PATIENTS:

The Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0–34.0°C) or targeted normothermia (36.0–37.0°C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

After 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 [95% CI, 0.62–1.18]; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45–1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d [3–7 d] vs 3 d [2–5 d]; ratio of geometric means, 1.32; 95% CI, 1.15–1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups.

CONCLUSIONS:

In the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.
Continuous Versus Routine Standardized Electroencephalogram for Outcome Prediction in Critically Ill Adults: Analysis From a Randomized Trial
Authors: Beuchat Isabelle , Rossetti Andrea O. , Novy Jan , Schindler Kaspar , Rüegg Stephan , Alvarez Vincent
Published: September 2021

OBJECTIVES:

To investigate electroencephalogram (EEG) features’ relation with mortality or functional outcome after disorder of consciousness, stratifying patients between continuous EEG and routine EEG.

DESIGN:

Retrospective analysis of data from a randomized controlled trial.

SETTING:

Multiple adult ICUs.

PATIENTS:

Data from 364 adults with acute disorder of consciousness, randomized to continuous EEG (30–48 hr; n = 182) or repeated 20-minute routine electroencephalogram (n = 182).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Correlations between electrographic features and mortality and modified Rankin scale at 6 months (good 0–2) were assessed. Background continuity, higher frequency, and reactivity correlated with survival and good modified Rankin scale. Rhythmic and periodic patterns carried dual prognostic information: lateralized periodic discharges were associated with mortality and bad modified Rankin scale. Generalized rhythmic delta activity correlated with survival, good modified Rankin scale, and lower occurrence of status epilepticus. Presence of sleep-spindles and continuous EEG background was associated with good outcome in the continuous EEG subgroup. In the routine EEG group, a model combining background frequency, continuity, reactivity, sleep-spindles, and lateralized periodic discharges was associated with mortality at 70.91% (95% CI, 59.62–80.10%) positive predictive value and 63.93% (95% CI, 58.67–68.89%) negative predictive value. In the continuous EEG group, a model combining background continuity, reactivity, generalized rhythmic delta activity, and lateralized periodic discharges was associated with mortality at 84.62% (95%CI, 75.02–90.97) positive predictive value and 74.77% (95% CI, 68.50–80.16) negative predictive value.

CONCLUSIONS:

Standardized EEG interpretation provides reliable prognostic information. Continuous EEG provides more information than routine EEG.
Association of Catecholamine Dose, Lactate, and Shock Duration at Vasopressin Initiation With Mortality in Patients With Septic Shock*
Authors: Sacha Gretchen L. , Lam Simon W. , Wang Lu , Duggal Abhijit , Reddy Anita J. , Bauer Seth R.
Published: September 2021

OBJECTIVES:

To determine the association of catecholamine dose, lactate concentration, and timing from shock onset at vasopressin initiation with in-hospital mortality.

DESIGN:

Retrospective, observational study using segmented and multivariable logistic regression to evaluate the associations of catecholamine dose, lactate concentration, and timing from shock onset at vasopressin initiation with in-hospital mortality.

SETTING:

Multiple hospitals within the Cleveland Clinic Health System.

PATIENTS:

Adult patients who met criteria for septic shock based on the U.S. Centers for Disease Control and Prevention Adult Sepsis Event definition.

INTERVENTIONS:

All patients received continuous infusion vasopressin as an adjunct to catecholamine vasopressors.

MEASUREMENTS AND MAIN RESULTS:

In total, 1,610 patients were included with a mean Acute Physiology and Chronic Health Evaluation III 109.0 ± 35.1 and Sequential Organ Failure Assessment 14.0 ± 3.5; 41% of patients survived the hospital admission. At the time of vasopressin initiation, patients had median (interquartile range) lactate concentration 3.9 mmol/L (2.3–7.2 mmol/L), norepinephrine-equivalent dose 25 µg/min (18–40 µg/min), and 5.3 hours (2.1–12.2 hr) elapsed since shock onset. The odds of in-hospital mortality increased 20.7% for every 10 µg/min increase in norepinephrine-equivalent dose up to 60 µg/min at the time of vasopressin initiation (adjusted odds ratio, 1.21 [95% CI, 1.09–1.34]), but no association was detected when the norepinephrine-equivalent dose exceeded 60 µg/min (adjusted odds ratio, 0.96 [95% CI, 0.84–1.10]). There was a significant interaction between timing of vasopressin initiation and lactate concentration (p = 0.02) for the association with in-hospital mortality. A linear association between increasing in-hospital mortality was detected for increasing lactate concentration at the time of vasopressin initiation, but no association was detected for time elapsed from shock onset.

CONCLUSIONS:

Higher norepinephrine-equivalent dose at vasopressin initiation and higher lactate concentration at vasopressin initiation were each associated higher in-hospital mortality in patients with septic shock who received vasopressin.
Vascular Thrombosis in Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Multicenter Study
Authors: Weir-McCall Jonathan R. , Galea Gabriel , Mun Mak Sze , Joshi Kushal , Agrawal Bobby , Screaton Nicholas , Toshner Mark , Ruggiero Alessandro , Benedetti Giulia , Brozik Jan , Machin Ruth , Das Indrajeet , Kotnik Marusa , Sun Julia , Mackay Michael , Jacob Joseph , Rodrigues Jonathan C. L. , Camporota Luigi , Vuylsteke Alain
Published: September 2021

OBJECTIVES:

Coronavirus disease 2019 has been reported to be a prothrombotic condition; however, multicenter data comparing this with other viral pneumonias in those requiring extracorporeal membrane oxygenation are lacking. We conducted a multicenter study using whole-body CT to examine the prevalence, severity, and nature of vascular complications in coronavirus disease 2019 in comparison with patients with other viral pneumonias.

DESIGN:

We analyzed whole-body CT scans for the presence of vascular thrombosis (defined as pulmonary artery thrombus, venous thrombus, systemic arterial thrombus, or end-organ infarct). The severity, distribution, and morphology of pulmonary artery thrombus were characterized. Competing risk cumulative incidence analysis was used to compare survival with discharge.

SETTING:

Three centers of the English national extracorporeal membrane oxygenation service.

PATIENTS:

Consecutive patients admitted with either coronavirus disease 2019 or noncoronavirus disease 2019 viral pneumonia admitted from January 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

One-hundred thirty-six patients (45.2 ± 10.6 yr old, 39/146 [27%] female) requiring extracorporeal membrane oxygenation support underwent whole-body CT scans at admission. Of these, 86 had coronavirus disease 2019 pneumonia, and 50 had noncoronavirus disease 2019 viral pneumonia. Vascular thrombosis was seen more often in patients with coronavirus disease 2019 (odds ratio, 12.9 [95% CI 4.5–36.8]). In those with coronavirus disease 2019, 57 (73%) demonstrated pulmonary artery thrombus or pulmonary perfusion defects. Eighty-two percent of thrombus exhibited emboli-like morphology. The location of pulmonary artery thrombus and parenchymal perfusion defects was only concordant in 30% of cases. The risk of mortality was higher in those with coronavirus disease 2019 compared with noncoronavirus disease 2019 pneumonia (χ2 = 3.94; p = 0.047). Mortality was no different in coronavirus disease 2019 patients with or without vascular thrombosis (χ2 = 0.44; p = 0.51).

CONCLUSIONS:

In patients who received extracorporeal membrane oxygenation, coronavirus disease 2019 is associated with a higher prevalence of vascular thrombosis compared with noncoronavirus disease viral pneumonias. The pattern of pulmonary vascular changes suggests concurrent embolic disease and small vessel disease. Despite this, vascular thrombosis was not linked to poorer short-term prognosis in those with coronavirus disease 2019.
Marginal Sufficient Component Cause Model
Authors: Suzuki Etsuji , Yamamoto Eiji
Published: September 2021

For decades, the sufficient cause model and the counterfactual model have shaped our understanding of causation in biomedical science, and the link between these two models has enabled us to obtain a deeper understanding of causality. Recently, a new causal model—the marginal sufficient component cause model—was proposed and applied in the context of interaction or mediation. The proponents of this model have emphasized its utility in visualizing the presence of “agonism” (a subtype of mechanistic interaction) in the counterfactual framework, claiming that the concept of agonism has not been clearly defined in causal inference and that agonistic interaction cannot be visualized by the conventional sufficient cause model. In this article, we illustrate that careful scrutiny based on the conventional sufficient cause model yields further insights into the concept of agonism in a more biologic sense. We primarily focus on the following three points: (1) “agonism” defined in the counterfactual model can be visualized as sets of sufficient causes in the conventional sufficient cause model; (2) although the so-called independent competing assumption or no redundancy assumption may seem irrelevant in the marginal sufficient component cause model, researchers do need to assume that potential completion times of relevant marginal sufficient causes differ; and (3) possibly differing potential completion times of marginal sufficient causes cannot be discerned until their hidden mechanistic paths are considered in the conventional sufficient cause model. In this rapidly progressing field of research, decades after its introduction, the sufficient cause model retains its worth.
MULTIMODAL IMAGING OF UNILATERAL ACUTE IDIOPATHIC MACULOPATHY IN A CHILD PATIENT
Authors: Ava Sedat , Hazar Leyla , Karahan Mine , Erdem Seyfettin , Dursun Mehmet Emin
Published: September 2021

Purpose:

To report a case of the clinical manifestation of unilateral acute idiopathic maculopathy in a child patient.

Methods:

Case report.

Results:

An 11-year-old male patient complaining of visual impairment in the left eye that had persisted for 3 weeks was admitted to the Dicle University Ophthalmology Clinic. Fundus examination, optical coherence tomography (OCT), enhanced depth imaging OCT, fundus autofluorescence, and fundus fluorescence angiography examinations were conducted. During the fundus examination, a yellowish gray area of swelling with yellowish granules spanning approximately half the diameter of the disk was found on the left macula. Optical coherence tomography revealed serous detachment and hyperreflective debris, OCT angiography showed hyperreflective spots on the outer retina, enhanced depth imaging OCT revealed an increase in choroidal thickness, fundus autofluorescence showed hyperreflective spots, and fundus fluorescence angiography revealed late-phase hyperfluorescence accumulation. Acute idiopathic maculopathy was diagnosed from these findings.

Conclusion:

Acute idiopathic maculopathy should be considered in the differential diagnosis of children presenting with a complaint of unilateral low vision.
BACILLARY LAYER DETACHMENT AFTER PHOTODYNAMIC THERAPY FOR CENTRAL SEROUS CHORIORETINOPATHY
Authors: Ledesma-Gil Gerardo , Desmettre Thomas , Mainster Martin A.
Published: September 2021

Purpose:

To report the clinical and optical coherence tomography findings of a patient with chronic central serous chorioretinopathy who developed a short-term bacillary layer detachment after photodynamic therapy (PDT).

Methods:

A 56-year-old man presented with metamorphopsia and 20/100 visual acuity in his right eye. He was diagnosed with active, chronic central serous chorioretinopathy based on clinical findings and multimodal imaging. His visual problems and retinal findings persisted for 3 months before he was treated with half-fluence, half-dose verteporfin PDT.

Results:

The patient had a prominent decrease in his vision postoperatively. Two days after treatment, multimodal imaging showed a marked increase in exudation that merged preoperative neurosensory retinal detachments. A prominent subfoveal bacillary layer detachment was also present. The subretinal fluid and bacillary layer detachment resolved over the next 8 weeks, with a return of visual acuity to its baseline level and normalization of retinal structures except for a small zone of subfoveal ellipsoid zone and interdigitation zone disruption.

Conclusion:

Half-fluence, half-dose verteporfin PDT caused a fulminant increase in subretinal fluid and an associated subfoveal bacillary layer detachment. We hypothesize that chronic central serous chorioretinopathy-related chorioretinal dysfunction contributed to the severe PDT-induced local inflammatory reaction that caused the patient's bacillary layer detachment. Hyperacute choroidal exudation too fulminant for containment in subretinal space extended into and exceeded photoreceptor inner segment tensile strength, cleaving the myoid layer and/or dissecting it from the ellipsoid layer. This finding broadens the causality spectrum of bacillary layer detachments and vision losses that can follow PDT.
HIGH-RESOLUTION SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY OF MULTIPLE EVANESCENT WHITE DOT SYNDROME
Authors: Spaide Richard F. , Lally David R.
Published: September 2021

Purpose:

To evaluate a patient with multiple evanescent white dot syndrome with multimodal imaging including high-resolution spectral-domain optical coherence tomography.

Methods:

The patient was evaluated with wide-field color and autofluorescence imaging, microperimetry, and near-infrared imaging. Spectral-domain optical coherence tomography was performed using an instrument capable of 3-μm axial resolution, the high-resolution Heidelberg Spectralis.

Results:

A 28-year-old woman developed photopsias and a scotoma in the field of vision of her left eye. She had multiple whitish spots with granularity in her fovea, consistent with the diagnosis of multiple evanescent white dot syndrome. She had supportive fluorescein angiographic and autofluorescence findings. Because of the high resolution and good layer contrast, it was possible to create en face slab images of the external limiting membrane, ellipsoid zone, interdigitation zone, and retinal pigment epithelium. The external limiting membrane showed no abnormalities. There were multiple regions of decreased reflectance in the ellipsoid zone slab but even more prominent changes in the interdigitation zone. The retinal pigment epithelium showed nearly no variation in layer reflectivity. With resolution of symptoms, the color and autofluorescence images returned to normal, the defects in the ellipsoid zone almost completely resolved, and the interdigitation zone continued to show abnormalities.

Conclusion:

Although past studies concluded that the ellipsoid zone was the main region of involvement in multiple evanescent white dot syndrome, high-resolution spectral-domain optical coherence tomography suggests the interdigitation zone was more prominently affected in this case.
Cancer Risk in Patients With Fuchs Endothelial Corneal Dystrophy
Authors: Xu Timothy T. , Baratz Keith H. , Fautsch Michael P. , Hodge David O. , Mahr Michael A.
Published: September 2021

Purpose:

The purpose of this study is to quantify cancer risk in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods:

Using the 2014 to 2016 Medicare Limited 5% Data Sets—Carrier Line File, US Medicare fee-for-service beneficiaries (aged 65 years or older) with FECD and cancer were identified through International Classification of Diseases, ninth and 10th Revision diagnostic codes from January 1, 2014, to December 31, 2016. The main outcome measures were odds ratios (ORs) of cancer at various anatomic locations in patients with versus without FECD.

Results:

Of the 1,462,740 Medicare beneficiaries, 15,534 patients (1.1%) had an International Classification of Disease code for FECD. Compared with US Medicare beneficiaries without FECD, patients with FECD were at increased risk for the following malignancies: breast [OR: 1.32; 95% confidence interval (CI): 1.22–1.43; P < 0.001], cutaneous basal cell (OR: 1.42; 95% CI: 1.35–1.49; P < 0.001), cutaneous melanoma (OR: 1.20; 95% CI: 1.03–1.40; P = 0.02), cutaneous squamous cell (OR: 1.45; 95% CI: 1.38–1.53; P < 0.001), ovarian (OR: 1.84; 95% CI: 1.48–2.30; P < 0.001), and thyroid (OR: 1.32; 95% CI: 1.04–1.68; P = 0.02). By contrast, FECD cases were at lower odds of having lung (OR: 0.81; 95% CI: 0.71–0.93; P = 0.003) and prostate cancer diagnoses (OR: 0.88; 95% CI: 0.81–0.96; P = 0.002).

Conclusions:

Patients with FECD aged 65 years or older may be at increased risk for cancer at several anatomic locations. Follow-up studies are needed to further explore the association of FECD and malignancy, elucidate potential disease mechanisms, and identify genetic and/or environmental risk factors.
Penetrating Keratoplasty With Minimal Endothelial Replacement: A Novel Technique for High-Risk Large-Diameter Corneal Grafting
Authors: Suchismitha Thotapalli
Published: September 2021

Purpose:

The purpose of this study was to analyze the outcome of large-diameter penetrating keratoplasty with minimal endothelial replacement (PKMER).

Methods:

Two eyes (2 patients) with advanced keratoconus and central full-thickness pathology, namely, scar and failed graft, were studied. Both eyes had relatively healthy endothelium in the periphery. They were operated using the PKMER technique that involved a large-diameter keratoplasty with retained central island of endothelium in the donor corresponding to the visual axis, whereas the peripheral Descemet membrane was removed. In effect, the peripheral endothelium and deep stroma of the recipient were preserved. Patients were followed up using anterior segment optical coherence tomography and specular microscopy postoperatively for a minimum period of 6 months in one eye and 3 years in the other.

Results:

In both eyes, the central cornea maintained clarity throughout follow-up. The astigmatism reduced significantly, and the final uncorrected and best-corrected vision improved from hand motions close to the face to 6/12/n8 in one eye and 6/12/n12 in the other. Anterior segment optical coherence tomography in both eyes showed satisfactory apposition of interfaces at 1 month postkeratoplasty, and the same was maintained throughout follow-up. Both eyes withstood phacoemulsification for preexisting cataracts, which was performed in the second sitting after the PKMER. There were no complications noted except a temporary initial detachment of the peripheral interface in some quadrants in the early postoperative period.

Conclusions:

PKMER may be considered as an alternative technique to large-diameter full-thickness keratoplasty. It is a relatively easier and cost-effective manual technique, which may be used as an alternative to traditional mushroom keratoplasty in selected cases.
Long-term alterations in somatosensory functioning in survivors of childhood cancer
Authors: Tutelman Perri R. , Chambers Christine T. , Cornelissen Laura , Fernandez Conrad V. , Flanders Annette , MacLeod Julia , Sherry Simon B. , Stewart Sherry H. , Urquhart Robin , de Gagne Sitara , Guilcher Gregory M.T. , Hashmi Javeria , Heathcote Lauren C. , Noel Melanie , Schulte Fiona S.M. , Stinson Jennifer N. , Stern Maya
Published: September 2021

Cancer and its treatment can have lasting consequences on somatosensation, including pain, which is often underrecognized and undertreated. Research characterizing the impact of cancer on pain and sensory processing in survivors of childhood cancer is scarce. This study aimed to quantify generalized differences in pain and sensory processing in survivors of childhood cancer compared with reference data using a standardized thermal and mechanical quantitative sensory testing (QST) protocol. The association between demographic, clinical (eg, leukemia vs other cancers and treatment exposures), and psychosocial (eg, anxiety and pain catastrophizing) variables and sensitivity to pain and sensory stimuli were also evaluated. Participants were 56 survivors of various types of childhood cancer (52% male, Mage = 13.5 years, SD = 3.2, range = 8-17 years). On average, children were 7 years (SD = 4.1, range = 1.2-16.5) post treatment. Almost all participants (86%) had at least 1 abnormal QST parameter compared with age- and sex-matched reference data; however, few participants self-reported the presence of sensory abnormalities. Generally, participants exhibited reduced sensitivity across the QST parameters examined (Ps < 0.05, ds = 0.40-3.45). A significant minority (45%) also exhibited pain sensitization (P <0.001, d = 0.42). Several risk factors for changes in sensory processing were identified, including current age, history of leukemia, certain treatment exposures (eg, vincristine cumulative dose, major surgery, and bone marrow or stem cell transplant), time off treatment, and higher anxiety and pain catastrophizing scores. Overall, this study demonstrated that somatosensory changes are prevalent in survivors of childhood cancer years after the completion of treatment. Future research is needed to understand long-term implications of altered somatosensation in this complex population.
Modulation of the nociceptive flexion reflex by conservative therapy in patients and healthy people: a systematic review and meta-analysis
Authors: Dhondt Evy , Van Oosterwijck Sophie , Van Branteghem Thomas , Rhudy Jamie L. , Danneels Lieven , Van Oosterwijck Jessica
Published: September 2021

The nociceptive flexion reflex (NFR) is a spinally mediated withdrawal response and is used as an electrophysiological marker of descending modulation of spinal nociception. Chemical and pharmacological modulation of nociceptive neurotransmission at the spinal level has been evidenced by direct effects of neurotransmitters and pharmacological agents on the NFR. Largely unexplored are, however, the effects of nonpharmacological noninvasive conservative interventions on the NFR. Therefore, a systematic review and meta-analysis was performed and reported following the PRISMA guidelines to determine whether and to what extent spinal nociception measured through the assessment of the NFR is modulated by conservative therapy in patients and healthy individuals. Five electronic databases were searched to identify relevant articles. Retrieved articles were screened on eligibility using the predefined inclusion criteria. Risk of bias was investigated according to Version 2 of the Cochrane risk-of-bias assessment tool for randomized trials. The evidence synthesis for this review was conducted in accordance with the Grading of Recommendations Assessment, Development and Evaluation. Thirty-six articles were included. Meta-analyses provided low-quality evidence showing that conservative therapy decreases NFR area and NFR magnitude and moderate-quality evidence for increases in NFR latency. This suggests that conservative interventions can exert immediate central effects by activating descending inhibitory pathways to reduce spinal nociception. Such interventions may help prevent and treat chronic pain characterized by enhanced spinal nociception. Furthermore, given the responsiveness of the NFR to conservative interventions, the NFR assessment seems to be an appropriate tool in empirical evaluations of treatment strategies.

PROSPERO registration number: CRD42020164495.
Efficacy of nonpharmacological interventions for individual features of fibromyalgia: a systematic review and meta-analysis of randomised controlled trials
Authors: Kundakci Burak , Kaur Jaspreet , Goh Siew Li , Hall Michelle , Doherty Michael , Zhang Weiya , Abhishek Abhishek
Published: September 2021

Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Nonpharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of nonpharmacological interventions on symptoms and disease-specific quality of life. Seven databases were searched from their inception until June 1, 2020. Randomised controlled trials comparing any nonpharmacological intervention to usual care, waiting list, or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference and 95% confidence interval were calculated using random effects model. The risk of bias was evaluated using the modified Cochrane tool. Of the 16,251 studies identified, 167 randomised controlled trials (n = 11,012) assessing 22 nonpharmacological interventions were included. Exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (effect size [ES] −0.72 to −0.96) and depression (ES −0.35 to −1.22) except for flexibility exercise. Mind–body and strengthening exercises improved fatigue (ES −0.77 to −1.00), whereas aerobic and strengthening exercises improved sleep (ES −0.74 to −1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES −0.35 to −0.55) but not fatigue. The findings of this study suggest that nonpharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
Community Health Workers Connecting Communities During COVID-19
Authors: John Julie St. , Hernández-Gordon Wandy , Martínez Sahida , Hernández Ilda
Published: September 2021

Coronavirus disease-2019 (COVID-19) has adversely impacted vulnerable communities. Community health workers (CHWs) are an evidence-based solution for helping communities navigate challenges and barriers. This case study describes the work of CHWs in a large Hispanic Chicago neighborhood who experienced a disproportionate number of COVID-19 cases. Methods included semistructured interviews and conventional qualitative content analysis. Results describe the problem; the situation; CHWs' roles, motivations and actions; outcomes; lessons learned; and recommendations. The case study concludes with a discussion of effective CHW engagement—particularly for underresourced communities—and presents recommendations for CHW workforce development and policies to strengthen the health care and public health systems.
Immunosuppression after uterus transplantation
Authors: Martin Friederike , Tullius Stefan G.
Published: September 2021

Purpose of review

Clinical uterus transplantation (UTx) is growing rapidly. The procedure represents the only therapy for women with absolute uterine factor infertility to give birth to a biological baby. Immunosuppression after UTx needs to carefully balance effects with the healthy mother and baby. Unique for UTx is the ‘temporary’ character of the procedure with a transplant hysterectomy being performed after delivery. Most of the practice on immunosuppression in UTx is currently based on the experience in solid organ transplantation (SOT).

Recent findings

Clinical UTx-trials have been performed in centers worldwide during the recent years and experience on immunosuppression has accumulated.

Immunosuppression in UTx has been successfully applied as maintenance treatment in addition to effectively treating acute T- and B-cell mediated rejections. Understanding the biology of UTx in more detail is expected to refine future approaches.
Timing of Nerve Recovery After Nerve Grafting in Obstetrical Brachial Plexus Palsy Patients With Isolated Upper Trunk Neuromas
Authors: Lee Jessica A. , Smith Brandon T. , Egro Francesco M. , Stanger Meg , Koster Wendy , Grunwaldt Lorelei J.
Published: September 2021

Background

The timing of nerve recovery after nerve grafting in obstetrical brachial plexus palsy patients has not been well reported. One prior study reported a return to baseline function at 3 to 6 months postoperatively. However, there is a paucity of studies to corroborate this timing, and there have been no studies delineating the timeline to obtain clinically meaningful function.

Methods

OBPP patients with upper trunk neuromas-in-continuity who were treated with resection and sural nerve grafting at a single institution were studied. Time to return to baseline function was assessed by Active Movement Scale (AMS) scores preoperatively and postoperatively. Time to clinically meaningful function, defined as an AMS score of ≥6, was also assessed.

Results

Eleven patients with isolated upper trunk neuromas-in-continuity underwent excision and reversed sural nerve grafting. Three of 11 patients also underwent spinal accessory to suprascapular nerve transfers. Average age at surgery was 9.8 ± 1.9 months. One patient did not have follow-up data and was excluded. Average follow-up was 37.1 ± 16.8 months. Average return to baseline AMS score was approximately 4 to 8 months for shoulder abduction, shoulder flexion, shoulder external rotation, elbow flexion, and forearm supination. Clinically meaningful function was obtained in most patients between 9 and 15 months. The remaining patients who did not achieve clinically meaningful function had all obtained scores of 5, which reflects less than one half normal range of motion against gravity.

Conclusions

Nerve recovery after surgical intervention in OBPP patients who undergo resection of an upper trunk neuroma-in-continuity and nerve grafting is more rapid than in adults but longer than previously reported in OBPP literature. This study provides an important data point in delineating the timeline of nerve recovery.
Surgical Results and Patient Satisfaction After A New Surgical Technique for Asian Medial Epicanthoplasty
Authors: Mo Young Woong , Jung Gyu Yong
Published: September 2021

Background

The double eyelid operation is the most common cosmetic procedure conducted in Asians. However, the epicanthal fold presents a conundrum that limits the cosmetic results of double eyelid surgery. Despite not being a pathologic condition, numerous procedures have been developed and introduced to address this issue, but these techniques have potential disadvantages that include an unnatural ciliary position of the lower lids and prominent scarring.

Method

A total of 156 patients who underwent a double eyelid operation with medial epicanthoplasty using the modified skin redraping method using a horizontal point incision and staged dog ear correction between 2015 and 2019 at our medical center were enrolled in the study. A single senior plastic surgeon performed all surgical procedures. The Patient-Reported Outcome Measures (PROM) questionnaire was used to obtain objective satisfaction scores, and patient satisfaction scores were obtained using some criteria.

Result

Of 147 patients, 8 (0.05) complained of visible scarring at the medial epicanthal and upper fold line region; there were only 2 (0.01%) epicanthal fold recurrences and 1.36% wound-related complications. The PROM scores and patient satisfaction scores showed a strong positive linear correlation according to linear regression analysis (P < 0.001).

Conclusion

We performed double eyelidplasty with epicanthoplasty by using “a modified skin redraping method using a horizontal point incision and a staged ‘Y-shaped’ dog ear correction.” Few complications were encountered, and almost all patients were satisfied with their surgical outcome as determined by the PROM questionnaire.