bluuebunny/crossref_metadata_2025 huggingface dataset:
Allelic expression imbalance in articular cartilage and subchondral bone refined genome-wide association signals in osteoarthritis
Authors: Coutinho de Almeida Rodrigo , Tuerlings Margo , Ramos Yolande , Den Hollander Wouter , Suchiman Eka , Lakenberg Nico , Nelissen Rob G H H , Mei Hailiang , Meulenbelt Ingrid
Published: August 2022

Objectives

To present an unbiased approach to identify positional transcript single nucleotide polymorphisms (SNPs) of osteoarthritis (OA) risk loci by allelic expression imbalance (AEI) analyses using RNA sequencing of articular cartilage and subchondral bone from OA patients.

Methods

RNA sequencing from 65 articular cartilage and 24 subchondral bone from OA patients was used for AEI analysis. AEI was determined for all genes present in the 100 regions reported by the genome-wide association studies (GWAS) catalog that were also expressed in cartilage or bone. The count fraction of the alternative allele (φ) was calculated for each heterozygous individual with the risk SNP or with the SNP in linkage disequilibrium (LD) with it (r2 > 0.6). Furthermore, a meta-analysis was performed to generate a meta-φ (null hypothesis median φ = 0.49) and P-value for each SNP.

Results

We identified 30 transcript SNPs (28 in cartilage and two in subchondral bone) subject to AEI in 29 genes. Notably, 10 transcript SNPs were located in genes not previously reported in the GWAS catalog, including two long intergenic non-coding RNAs (lincRNAs), MALAT1 (meta-φ = 0.54, FDR = 1.7×10−4) and ILF3-DT (meta-φ = 0.6, FDR = 1.75×10−5). Moreover, 12 drugs were interacting with seven genes displaying AEI, of which seven drugs have been already approved.

Conclusions

By prioritizing proxy transcript SNPs that mark AEI in cartilage and/or subchondral bone at loci harbouring GWAS signals, we present an unbiased approach to identify the most likely functional OA risk-SNP and gene. We identified 10 new potential OA risk genes ready for further translation towards underlying biological mechanisms.
A data-driven approach finds RNA polymerase III antibody and tendon friction rubs as enrichment tools for early diffuse scleroderma trials
Authors: Domsic Robyn T , Medsger Thomas A , Gao Shiyao , Laffoon Maureen , Huang Suiyuan , Wisniewski Stephen , Spino Cathie , Steen Virginia , Lafyatis Robert , Khanna Dinesh
Published: August 2022

Objective

Clinical trials in early diffuse SSc have consistently shown a placebo group response with a declining modified Rodnan skin score (mRSS), with negative outcomes. Our objective was to identify strategies using clinical characteristics or laboratory values to improve trial design.

Methods

We identified early diffuse SSc patients first seen at the University of Pittsburgh from 1980–2015. Eligible patients had ≥3 visits, with at least two mRSS scores within the first year of follow-up. We performed Kaplan–Meier analyses, group-based trajectory analysis of mRSS scores, followed by multivariable regression analysis and classification tree analysis. We applied the results to the abatacept in early diffuse systemic sclerosis (ASSET) trial outcome data.

Results

We identified 403 patients with <18 months, and 514 with <36 months disease duration. The median number of mRSS follow-up scores was 14 (interquartile range 8, 25). All methodologic approaches identified skin thickness progression rate, RNA polymerase III (RNAP3) antibody positivity and presence of tendon friction rubs (TFR) as predictors of mRSS trajectory over 5 years of follow-up, and thereby as potential enrichment variables. When applied to the ASSET data, adjustment for both RNAP3 and TFR demonstrated reduction of the placebo mRSS response, particularly at 6 months. A significant difference in the ACR Composite Response Index in Systemic Sclerosis (CRISS) score was found with adjustment by RNAP3 at 6 months, and TFR or RNAP3 at 12 months.

Conclusion

Adjustment for both RNAP3 and TFR predicts mRSS trajectory and diminished the mRSS decline in ASSET placebo group, and identified significant differences in CRISS. RNAP3, particularly, is a stratification or enrichment approach to improve early diffuse SSc trial design.
Evaluation of predictive models to determine total morbidity outcome of feedlot cattle based on cohort-level feed delivery data during the first 15 days on feed
Authors: Heinen L , Lancaster P A , White B J , Zwiefel E
Published: August 2022

Changes in feeding behavior and intake have been used to predict the onset of bovine respiratory disease in individual animals but have not been applied to cohort-level data. Correctly identifying high morbidity cohorts of cattle early in the feeding period could facilitate the administration of interventions to improve health and economic outcomes. The study objective was to determine the ability of feed delivery data from the first 15 days of feed to predict total feeding period morbidity. Data consisted of 518 cohorts (10 feedlots, 56,796 animals) of cattle of varying sex, age, arrival weight, and arrival time of year over a 2-year period. Overall cohort-level morbidity was classified into high (≥15% total morbidity) or low categories with 18.5% of cohorts having high morbidity. Five predictive models (advanced perceptron, decision forest, logistic regression, neural network, and boosted decision tree) were created to predict overall morbidity given cattle characteristics at arrival and feeding characteristics from the first 15 days. The dataset was split into training and testing subsets (75% and 25% of original, respectively), stratified by the outcome of interest. Predictive models were generated in Microsoft Azure using the training set and overall predictive performance was evaluated using the testing set. Performance in the testing set (n = 130) was measured based on final accuracy, sensitivity (Sn, the ability to accurately detect high morbidity cohorts), and specificity (Sp, the ability to accurately detect low morbidity cohorts). The decision forest had the highest Sp (97%) with the greatest ability to accurately identify low morbidity lots (103 of 106 identified correctly), but this model had low Sn (33%). The logistic regression and neural network had similar Sn (both 63%) and Sp (69% and 72%, respectively) with the best ability to correctly identify high morbidity cohorts (15 of 24 correctly identified). Predictor variables with the greatest importance in the predictive models included percent change in feed delivery between days and 4-day moving averages. The most frequent variable with a high level of importance among models was the percent change in feed delivered from d 2 to 3 after arrival. In conclusion, feed delivery data during the first 15 days on feed was a significant predictor of total cohort-level morbidity over the entire feeding period with changes in feed delivery providing important information.
Nursing Faculty’s Perceptions of Climate Change and Sustainability
Authors: Amerson Roxanne M. , Boice Olivia , Mitchell Hannah , Bible Joe
Published: August 2022

AIM

The aim of this research study was to investigate the perceptions of climate change and sustainability of faculty teaching in associate and baccalaureate degree nursing programs in South Carolina and their attitudes toward inclusion of relevant content into the nursing curriculum.

BACKGROUND

Climate change is a topic that receives limited discussion in most nursing education curricula.

METHOD

This cross-sectional, descriptive study gathered data from 21 schools of nursing via an online survey consisting of demographic questions, the New Ecological Paradigm Scale, and the Sustainability Attitudes in Nursing Survey 2 and two questions regarding the current inclusion of content.

RESULTS

Eighty-one percent of respondents did not include health implications of climate change in their teaching content; 67% did not include health implications of sustainability.

CONCLUSION

Results provide preliminary evidence of gaps and areas of need for curricular content related to climate change and sustainability.
Development and Testing of a Communication Intervention to Improve Chronic Pain Management in Primary Care
Authors: Henry Stephen G. , Fenton Joshua J. , Campbell Cynthia I. , Sullivan Mark , Weinberg Gary , Naz Hiba , Graham Wyatt M. , Dossett Michelle L. , Kravitz Richard L.
Published: August 2022

Objectives:

Effective communication skills are essential for optimally managing chronic pain and opioids. This exploratory, sequential mixed methods study tested the effect of a novel framework designed to improve pain-related communication and outcomes.

Methods:

Study 1 developed a novel 5-step framework for helping primary care clinicians discuss chronic pain and opioids with patients. Study 2 pilot tested an intervention for teaching this framework using standardized patient instructors—actors trained to portray patients and provide immediate clinician feedback—deployed during regular clinic hours. Primary care physicians were randomized to receive either the intervention or pain management recommendations from the Centers for Disease Control and Prevention. Primary outcomes were pain-related interference at 2 months and clinician use of targeted communication skills (coded from transcripts of audio-recorded visits); secondary outcomes were pain intensity at 2 months, clinician self-efficacy for communicating about chronic pain, patient experience, and clinician-reported visit difficulty.

Results:

We enrolled 47 primary care physicians from 2 academic teaching clinics and recorded visits with 48 patients taking opioids for chronic pain who had an appointment scheduled with an enrolled physician. The intervention was not associated with significant changes in primary or secondary outcomes other than clinician self-efficacy, which was significantly greater in the intervention group.

Discussion:

This study developed a novel framework and intervention for teaching clinician pain-related communications skills. Although the intervention showed promise, more intensive or multicomponent interventions may be needed to have a significant impact on clinicians’ pain-related communication and pain outcomes.
Characterizing the Residual SCFE Deformity: Utility of the 45-degree Dunn View
Authors: Smith Craig A. , Block Andrew M. , Eisenberg Matthew T. , Shoenecker Perry L. , Clohisy John C. , Nepple Jeffrey J.
Published: August 2022

Background:

After treatment with in situ stabilization, slipped capital femoral epiphysis (SCFE) patients have variable degrees of deformity that can contribute to femoroacetabular impingement (FAI). To evaluate the severity of residual deformity most physicians currently use biplanar radiographs of an anteroposterior pelvis which profiles the lateral head-neck deformity and a frog lateral view which profiles the anterior head-neck deformity. However, the assessment of FAI morphology commonly relies on the 45-degree Dunn view to profile the anterolateral head-neck junction where FAI deformity is maximal. Therefore, the purpose of this study was to compare the magnitude of residual SCFE deformity detected on the frog lateral radiograph to the 45-degree Dunn radiograph.

Methods:

A retrospective review of radiographic images of 50 hips (47 patients) diagnosed with SCFE at a single academic institution from 2014 to 2018 was performed. The group included 25 hips evaluated postoperatively after fixation (Group 1) and 25 hips presenting with residual symptomatic SCFE deformity after previous pinning (Group 2). The alpha angle was assessed on both the 45-degree Dunn and frog lateral views for comparison. The modified Southwick slip angle was assessed on the frog lateral view only as a measure of SCFE severity.

Results:

The Dunn view showed the maximal residual SCFE deformity as measured by the alpha angle in 88% (44/50) of cases. Overall, the mean alpha angle (70.7 degree vs. 60.1 degree, P<0.001) was significantly larger on the Dunn view as compared with frog lateral. Subgroup analysis showed a larger alpha angle on Dunn view compared with frog lateral in both immediate postoperative and residual SCFE deformities as well: Group 1 (69.5 degree vs. 60.9 degree, P<0.001) and Group 2 (71.9 degree vs. 59.3 degree, P<0.001).

Conclusion:

In patients with SCFE, the maximal residual deformity of the proximal femur can typically be seen on the 45-degree Dunn view, rather than on the frog lateral view. Our findings suggest the 45-degree Dunn view may be beneficial part of the postoperative assessment of SCFEs to quantify the true maximal deformity present.

Level of Evidence:

Level IV.
The Influence of Retrograde Femoral Nail Removal With and Without Interpositional Fat Grafting on Distal Femoral Physeal Behavior: A Sheep Study
Authors: Ren Bryan O. , Amakoutou Kouami , Knapik Derrick M. , Benedick Alex , Anderson James M. , Zirkle Lewis G. , Liu Raymond W.
Published: August 2022

Background:

Previous investigations have demonstrated that up to 7% of the distal femoral physis can be violated using a rigid, retrograde nail without growth inhibition or arrest. The purpose of this investigation was to evaluate the behavior of the distal femoral physis after retrograde femoral nail removal in a sheep model, with and without placement of an interpositional fat graft.

Methods:

Retrograde femoral nails were placed in 8 skeletally immature sheep. Implants were removed at 8 weeks, with the residual defects left open (n=4) or filled with autologous fat graft (n=4). Differences in femoral length between surgical versus contralateral control femurs were measured after an additional 3 (n=4) or 5 months (n=4) before sacrifice, and the physis was evaluated histologically.

Results:

When compared with control limbs, femoral length was significantly shorter in limbs sacrificed at 3 months (mean: 3.9±1.3 mm; range: 2.7 to 5.7 mm) compared with limbs at 5 months (mean: 1.0±0.4 mm; range: 0.4 to 1.2 mm) (P=0.005). No significant difference in mean shortening was appreciated in limbs without (2.4±1.6 mm) versus with fat grafting (2.5±2.3 mm) (P=0.94). Histologic analysis revealed no osteoid formation across the physis in sheep sacrificed at 3 months, whereas there was evidence of early osteoid formation across the physis in sheep at 5 months. All specimens demonstrated evidence of an active physes.

Conclusions:

Femurs undergoing retrograde implant placement were significantly shorter when compared with control limbs in sheep sacrificed at 3 months, whereas differences were nominal in sheep sacrificed at 5 months after retrograde implant removal, suggesting growth inhibition with nail removal improved with time. Fat grafting across the distal femoral physis did not result in a significant difference in femoral lengths. Histologic evidence at 5 months revealed early development of a bone bridge, emphasizing the importance of follow-up to skeletal maturity in patients treated with retrograde nailing across an open physis.

Level of Evidence:

Level IV.
Modulation of the Association Between Age and Death by Risk Factor Burden in Critically Ill Patients With COVID-19
Authors: Sunderraj Ashwin , Cho Chloe , Cai Xuan , Gupta Shruti , Mehta Rupal , Isakova Tamara , Leaf David E. , Srivastava Anand ,   STOP-COVID Investigators
Published: August 2022

OBJECTIVES:

Older age is a key risk factor for adverse outcomes in critically ill patients with COVID-19. However, few studies have investigated whether preexisting comorbidities and acute physiologic ICU factors modify the association between age and death.

DESIGN:

Multicenter cohort study.

SETTING:

ICUs at 68 hospitals across the United States.

PATIENTS:

A total of 5,037 critically ill adults with COVID-19 admitted to ICUs between March 1, 2020, and July 1, 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary exposure was age, modeled as a continuous variable. The primary outcome was 28-day inhospital mortality. Multivariable logistic regression tested the association between age and death. Effect modification by the number of risk factors was assessed through a multiplicative interaction term in the logistic regression model. Among the 5,037 patients included (mean age, 60.9 yr [± 14.7], 3,179 [63.1%] male), 1,786 (35.4%) died within 28 days. Age had a nonlinear association with 28-day mortality (p for nonlinearity <0.001) after adjustment for covariates that included demographics, preexisting comorbidities, acute physiologic ICU factors, number of ICU beds, and treatments for COVID-19. The number of preexisting comorbidities and acute physiologic ICU factors modified the association between age and 28-day mortality (p for interaction <0.001), but this effect modification was modest as age still had an exponential relationship with death in subgroups stratified by the number of risk factors.

CONCLUSIONS:

In a large population of critically ill patients with COVID-19, age had an independent exponential association with death. The number of preexisting comorbidities and acute physiologic ICU factors modified the association between age and death, but age still had an exponential association with death in subgroups according to the number of risk factors present. Additional studies are needed to identify the mechanisms underpinning why older age confers an increased risk of death in critically ill patients with COVID-19.
Additional single third trimester ultrasound scan in detection of large for gestational age fetuses
Authors: Kwok ManHo , Angioni Valeria
Published: August 2022

Purpose of review

To evaluate the accuracy of growth scans in the third trimester. To evaluate the accuracy of universal third trimester ultrasound scans in the detection of large for gestational age (LGA) fetuses. To investigate how universal ultrasound scans affect the delivery and outcomes.

Recent findings

Universal third trimester screening for LGA recorded a 22% positive predictive value (PPV), and 96% negative predicted value (NPV). The sensitivity in most studies reaches around 70% or more, of all the LGA fetuses delivered, there are different studies for and against universal ultrasonic screening of LGA. Estimated fetal weight (>4 kg/90th centile) and abdominal circumference are the best predictors of LGA with nearly 70% sensitivity. One study reported that an antenatal ultrasonic diagnosis of LGA in a low risk population has a weak association with the incidence of shoulder dystocia or poor neonatal outcomes. Universal screening in the third trimester for LGAs is not cost effective.

Low risk pregnancies constitute the majority of the pregnancy population. All low risk pregnancy women will only receive two routine scans throughout the whole pregnancy. There is no evidence at present that conclusively demonstrates that an additional scan at 36 weeks improves maternal and neonatal outcomes and is cost effective.
Risk Factors Predicting Loss to Follow-Up, Medication Noncompliance, and Poor Visual Outcomes Among Patients With Infectious Keratitis at a Public County Hospital
Authors: Lopez Jacqueline B. , Chan Lawrence , Saifee Murtaza , Padmanabhan Sriranjani , Yung Madeline , Chan Matilda F.
Published: August 2022

Purpose:

Infectious keratitis is a vision-threatening condition requiring close follow-up and disciplined eye drop administration to achieve resolution. Although patients presenting to county hospitals often have more severe presentations, there is a paucity of risk and outcomes data in this setting. This study investigates risk factors predicting loss to follow-up (LTFU), medication noncompliance, and poor outcomes for infectious keratitis in the county hospital setting.

Methods:

This was a retrospective case-control study at Zuckerberg San Francisco General Hospital and Trauma Center. Inclusion criteria were patients who had corneal cultures for suspected infectious bacterial or fungal keratitis between 2010 and 2021. Exclusion criteria were patients with viral keratitis only. Multivariable logistic regression was used to analyze the relationship of social and medical risk factors with LTFU, medication noncompliance, worsened visual acuity (VA), and delayed resolution time.

Results:

Of 174 patients with infectious keratitis in this analysis, 69 (40.0%) had LTFU. Unemployment was associated with increased risk of LTFU (odds ratio 2.58, P = 0.049) and worse final VA (P = 0.001). Noncompliance trended toward an association with homelessness (odds ratio 3.48, P = 0.095). Increasing age correlated with longer resolution time, with each 1-year increase associated with delayed resolution by 0.549 days (P = 0.042).

Conclusions:

Patients experiencing unemployment, homelessness, or increased age demonstrate higher risk for treatment barriers including loss to follow-up and medication noncompliance, resulting in worse VA and delayed time to resolution. These risk factors should be considered when determining the need for more deliberate follow-up measures in patients with infectious keratitis.
Infectious Crystalline Keratopathy Secondary to Mycobacterium chelonae
Authors: Bonnet Clémence , Onishi Alex C. , Aldave Anthony J.
Published: August 2022

Purpose:

The aim of this study was to describe the clinical presentation and multimodal imaging of a patient diagnosed with infectious crystalline keratitis (ICK) secondary to Mycobacterium chelonae.

Methods:

This is a case report of a patient with a crystalline corneal infiltrate imaged with anterior segment optical coherence tomography and in vivo scanning laser confocal microscopy. Bacterial, fungal, acanthamoeba, and acid-fast cultures were performed to identify the causal pathogen.

Results:

Examination revealed a white stellate opacity in the midstroma underlying the scalloped border of an area of central corneal stromal thinning, consistent with a diagnosis of ICK. Anterior segment optical coherence tomography demonstrated a hyperreflective diamond-shaped opacity located at a depth of 334 μm, which demonstrated multiple stellate projections on in vivo scanning laser confocal microscopy. The acid-fast culture was positive for Mycobacterium chelonae.

Conclusions:

Although ICK is most commonly associated with Streptococcus species, it may be secondary to atypical bacteria including Mycobacterium species, underscoring the importance of diagnostic imaging and collecting corneal cultures to identify the pathogenic organism.
High-Risk Patient Experiences Associated With an Intensive Primary Care Management Program in the Veterans Health Administration
Authors: Schuttner Linnaea , Guo Rong , Wong Edwin , Jimenez Elvira , Klein Melissa , Roy Sudip , Rosland Ann-Marie , Chang Evelyn T.
Published: August 2022

Intensive management programs may improve health care experiences among high-risk and complex patients. We assessed patient experience among (1) prior enrollees (n = 59) of an intensive management program (2014-2018); (2) nonenrollees (n = 356) at program sites; and (3) nonprogram site patients (n = 728), using a patient survey based on the Consumer Assessment of Healthcare Providers and Systems in 2019. Outcomes included patient ratings of patient-centered care; overall health care experience; and satisfaction with their usual outpatient care provider. In multivariate models, enrollees were more satisfied with their current provider versus nonenrollees within program sites (adjusted odds ratio 2.36; 95% confidence interval 1.15-4.85).
PRKG1
mutation identified by whole-exome sequencing: a potential genetic etiology for He-Zhao deficiency
Authors: Hu Xiaowen , Wang Dandan , Yang Xuhan , Song Zhongchen , Wang Zuolin , Zhang Juan , Wan Chunling , He Lin
Published: August 2022

Objective:

He-Zhao deficiency was originally described as a severe type of nonsyndromic hypodontia, and the causative gene locus was mapped to chromosome 10q11.2. The aim of this study was to identify potential genetic mutations that could cause He-Zhao deficiency.

Methods:

Patients with He-Zhao deficiency and their unaffected relatives of the large pedigree were investigated. The whole-exome sequencing using next-generation sequencing was employed to identify genetic variants. The data generated from the whole-exome sequencing using the Illumina Novaseq 6000 system were further analyzed by Burrows-Wheeler Aligner software, Sequence Alignment/Map tools and ANNOVAR tool. In vitro luciferase assay was used to investigate the effect of the detected mutation on gene expression. R environment was used to conduct
t
-tests. The study protocol was approved by the Research Ethics Committee of Bio-X Institutes, Shanghai Jiao Tong University (M2011004).

Results:

The exomes of five patients with He-Zhao deficiency and two of their unaffected relatives identified a mutation in
PRKG1α
as the molecular etiology of the disease. The variant c.-144 C>A of
PRKG1
isoform 1 cosegregated with permanent tooth agenesis in 93 family members who were older than 12, at which time the primary teeth should have been replaced with permanent teeth. Functional studies suggested that the mutant allele promotes gene transcription by increasing its promoter activity.

Conclusion:

c.-144 C>A variant of
PRKG1α
involving odontoclast-associated root resorption is responsible for He-Zhao deficiency, unlike other forms of hypodontia, which typically involve odontoblast dysfunction.
Relationships Between Physical Activity Metrics of Intensity and Diabetes
Authors: Moxley Elizabeth , Habtezgi Desale , Subramanian Vasanth , Hwang Sungsoon , Yalla Sai , Attewell Lauren
Published: August 2022

Introduction

Physical activity (PA) prevents diabetes-associated complications. Little is known about what constitutes effective PA interventions to mitigate diabetes. Identifying PA metrics associated with the efficacy of PA interventions will provide insight into devising strategies to treat diabetes.

Purpose

The aim of this study was to analyze the relationships between preclinical and postclinical variables from a 10-week intervention designed to increase PA in adults with diabetes.

Methods

A secondary analysis was performed to evaluate data using Wilcoxon rank sum test, permutation test and Spearman correlation to analyze hemoglobin A1c (HbA1c), weight, and PA metrics (maximum steps per episode, cadence, daily steps, and 6-minute walk).

Results

Poststudy HbA1c level was associated with maximum steps (r = −0.63, P = .03) and 6-minute walk (r = −0.50, P = .09). Baseline weight was associated with average cadence (r = −0.76, P = .007), and poststudy weight was associated with average cadence (r = −0.60, P = .041) and maximum steps (r = −0.62, P = .03).

Conclusions

Cadence and maximum steps per episode reflect PA intensity and were associated with HbA1c and weight in adults with diabetes.
Team-Based Care for Cancer Survivors With Comorbidities: A Systematic Review
Authors: Doose Michelle , Verhoeven Dana , Sanchez Janeth I. , Livinski Alicia A. , Mollica Michelle , Chollette Veronica , Weaver Sallie J.
Published: August 2022

Coordination of quality care for the growing population of cancer survivors with comorbidities remains poorly understood, especially among health disparity populations who are more likely to have comorbidities at the time of cancer diagnosis. This systematic review synthesized the literature from 2000 to 2022 on team-based care for cancer survivors with comorbidities and assessed team-based care conceptualization, teamwork processes, and outcomes. Six databases were searched for original articles on adults with cancer and comorbidity, which defined care team composition and comparison group, and assessed clinical or teamwork processes or outcomes. We identified 1,821 articles of which 13 met the inclusion criteria. Most studies occurred during active cancer treatment and nine focused on depression management. Four studies focused on Hispanic or Black cancer survivors and one recruited rural residents. The conceptualization of team-based care varied across articles. Teamwork processes were not explicitly measured, but teamwork concepts such as communication and mental models were mentioned. Despite team-based care being a cornerstone of quality cancer care, studies that simultaneously assessed care delivery and outcomes for cancer and comorbidities were largely absent. Improving care coordination will be key to addressing disparities and promoting health equity for cancer survivors with comorbidities.
Free flap volume changes: can we predict ideal flap size and future volume loss?
Authors: Dennis Steven K. , Masheeb Zahrah , Abouyared Marianne
Published: August 2022

Purpose of review

Under anticipating free flap volume may lead to deficits in functional and aesthetic outcomes. Alternatively, over anticipating may compromise airway patency, lead to prolonged tracheostomy dependence or poor oral intake, and cause poor cosmetic outcomes. Surgeons face a fine balance in creating a functional reconstruction that accounts adequately for volume changes in the future.

Recent findings

Recent studies are elucidating the complex and multifactorial volume changes of free flaps that are dependent on postoperative radiation, flap composition, weight fluctuations, and site of reconstruction. Radial forearm free flaps typically lose about 40% of their volume, regardless of patient-dependent variables. Muscle flaps exhibit significant fluctuations with patient-dependent variables. Adipose-prevalent flaps are likely more resistant to radiation effects but are more dependent on postoperative weight changes in the patient.

Free flap volume over anticipation recommendations range from 1.1 to 1.4 times the final volume to account for future atrophy but patient characteristics including postoperative radiation, anticipated weight loss, and flap composition should be incorporated into intraoperative decisions for final flap volume.
Robotics and cochlear implant surgery: goals and developments
Authors: Shoman Nael M.
Published: August 2022

Purpose of review

Cochlear implantation (CI) is a viable option for patients with severe sensorineural hearing loss. Advances in CI have focused on minimizing cochlear trauma to improve hearing preservation outcomes, and in doing so expanding candidacy to patients with useful cochlear reserve. Robotics holds promise as a potential tool to minimize intracochlear trauma with electrode insertion, improve surgical efficiency, and reduce surgical complications. The purpose of this review is to summarize efforts and advances in the field of robotic-assisted CI.

Recent findings

Work on robotics and CI over the past few decades has explored distinct surgical aspects, including image-based surgical planning and intraoperative guidance, minimally invasive robotic-assisted approaches mainly through percutaneous keyhole direct cochlear access, robotic electrode insertion systems, robotic manipulators, and drilling feedback control through end effector sensors. Feasibility and safety have been established and many devices are undergoing clinical trials for clinical adoption, with some having already achieved approval of national licensing bodies.

Significant work has been done over the past two decades that has shown robotic-assisted CI to be feasible and safe. Wider clinical adoption can potentially result in improved hearing preservation and quality of life outcomes to more CI candidates.
Inflammation-related Gene Polymorphisms Associated With Childhood Acute Lymphoblastic Leukemia
Authors: Ji Hongyan , Li Fu , Song Li , Xing Yuqian , Liu Gongrang , Lu Yunfeng , Zhao Ping
Published: August 2022

Background:

Acute lymphoblastic leukemia (ALL) is a malignant hematological disease and is often accompanied by a variety of genetic abnormalities. The pathogenesis of inflammation-related single-nucleotide polymorphism (SNP) in children with ALL remains unclear.

Objective:

This study was to discover the association of the SNP sites of some inflammation-related genes and the susceptibility and treatment response of ALL in children, so as to provide personalized treatment for ALL in children.

Procedure:

One hundred sixty-five childhood ALL patients and 175 age-matched healthy participants were recruited in this study. We investigated the involvement of 31 SNPs of the inflammation-related genes in the pathogenesis and treatment response of childhood ALL.

Results:

Statistical analysis revealed that rs2280714 in IRF5, rs2297630 in SDF-1, rs4353135 in NLRP3, rs1946518 in interleukin-18 were related to the susceptibility to pediatric ALL. Interleukin-1β rs16944 SNP was correlated with ALL risk stage in children. Rs7633631 in CD226 and rs10818488 in TRAF1 were related to the minimal residual disease (MRD) on day 15 and day 33.

Conclusions:

Certain SNPs of inflammation genes were associated with the susceptibility and treatment response of ALL children. These findings may help in the early detection, diagnostic evaluation, and making individual chemotherapy regimen for ALL children according to the genotype of these sites at the time of initial diagnosis.
Adding Insult to Injury
Authors: Hasking Penelope , Staniland Lexy , Boyes Mark , Lewis Stephen P.
Published: August 2022

Language is a powerful form of communication that not only conveys ideas and knowledge but also can assign meaning and value to the world around us. As such, language has the power to shape our attitudes toward individuals, behaviors, and ideas, by labeling them (indirectly or not) as “good” or “bad.” In this way, language can be used to propagate stigma and other unhelpful attitudes toward individuals who already experience stigma. One behavior that may be particularly prone to the impact of unhelpful language is nonsuicidal self-injury (NSSI). In this article, we draw on Staniland's NSSI stigma framework to demonstrate how an individual with lived experience of NSSI may be exposed to stigmatizing messaging through 30 different channels, and propose that the accumulation of these messages may be particularly damaging. We conclude by offering practical tips for clinicians and researchers wishing to empathically work with individuals who self-injure.
An Autopsy Case Report of Homicide by Methanol Intoxication With Pinkish Bilateral Putamina
Authors: Takahashi Motonori , Kondo Takeshi , Yamasaki Gentaro , Sugimoto Marie , Yoshida Haruhi , Harada Kazuo , Matsumoto Hiroshi , Asano Migiwa , Ueno Yasuhiro
Published: August 2022

Many deaths caused by methanol occur as a result of intentional suicide attempts or accidental ingestion, and several investigators have quantified methanol and formic acid in blood and organs. However, to the best of our knowledge, no reports have described regional differences in the concentration of methanol in the brain. A man in his 50s drank alcohol that had been deliberately contaminated with methanol by his wife, and he died of multiple-organ failure after 4 days of intensive medical treatment including hemodialysis. On medicolegal autopsy, cross sections of the brain showed scattered petechial hemorrhage in the brain stem and microscopic hemorrhage with congestion in the bilateral putamina, which showed pinkish discoloration. The concentrations of methanol, formic acid, and ethanol in autopsy samples were measured by headspace gas chromatography, revealing relatively high concentrations of residual methanol and formic acid in the brain (especially in the basal ganglia), although methanol had been eliminated from the blood. Even after 4 days of medical treatment, postmortem toxicological analysis of the brain tissue indicated methanol ingestion. The accumulation of formic acid and the consequent local metabolic acidosis may cause brain lesions.
Virtual Care Adoption—Challenges and Opportunities From the Lens of Academic Primary Care Practitioners
Authors: Teng Kathryn , Russo Francesca , Kanuch Stephanie , Caron Aleece
Published: August 2022

Telehealth and virtual care quickly became important tools in caring for patients while the COVID-19 pandemic evolved. Telehealth implementation can increase affordability for patients, eliminate access barriers, and improve patient satisfaction. Multiple challenges to successful telehealth implementation have been documented in the literature and are generally categorized as structural barriers of the health system, clinical barriers of the provider, and patient-centered barriers. In this study, we sought to collect themes and observations about this rapid transition to telehealth from practicing primary care clinicians, with the goal of identifying opportunities to improve adoption of telehealth. Themes reported in this article emerged from physician and physician assistant fellows of 2 HRSA-funded grants: (1) Primary Care Training and Enhancement (PCTE) and (2) Primary Care Training and Enhancement Training Primary Care Champions (Champions). The PCTE participants consisted of 8 providers from The MetroHealth System (MHS). The Champions participants consisted of 20 providers from MHS and Federally Qualified Health Centers in Northeast Ohio and Michigan. Participants identified 5 major themes that affected telehealth delivery in an academic medical system: reimbursement and productivity; social determinants of health; privacy and environment of care concerns; teaching; and communication skills. Examples within each theme are provided along with an identified improvement opportunity. As we create solutions to address these challenges, our hope is to pool our experience with others so that we can collectively learn how to best evolve and improve the telehealth experience for all.
Resource Savings Associated With Use of an Automated Symptom Monitoring Tool for COVID-19 Public Health Response, Summer 2020-Summer 2021
Authors: Sweeney Kellen F. , Halter Heather M. , Krell Kerry , McCormick Donald , Brown Janet , Simons Aimee , Santiago-Rosas Christian J. , Luna-Anavitate Sylvianette , Ramos-Colon Miriam V. , Marzán-Rodriguez Melissa , Bezold Carla P.
Published: August 2022

Context:

Active symptom monitoring is a key component of the public health response to COVID-19, but these activities are resource-intensive. Digital tools can help reduce the burden of staff time required for active symptom monitoring by automating routine outreach activities.

Program:

Sara Alert is an open-source, Web-based automated symptom monitoring tool launched in April 2020 to support state, tribal, local, and territorial jurisdictions in their symptom monitoring efforts.

Implementation:

As of October 2021, a total of 23 public health jurisdictions in the United States had used Sara Alert to perform daily symptom monitoring for more than 6.1 million individuals. This analysis estimates staff time and cost saved in 3 jurisdictions that used Sara Alert as part of their COVID-19 response, across 2 use cases: monitoring of close contacts exposed to COVID-19 (Arkansas; Fairfax County, Virginia), and traveler monitoring (Puerto Rico).

Evaluation:

A model-based approach was used to estimate the additional staff resources that would have been required to perform the active symptom monitoring automated by Sara Alert, if monitoring instead relied on traditional methods such as telephone outreach. Arkansas monitored 283 705 individuals over a 10-month study period, generating estimated savings of 61.9 to 100.6 full-time equivalent (FTE) staff, or $2 798 922 to $4 548 249. Fairfax County monitored 63 989 individuals over a 13-month study period, for an estimated savings of 24.8 to 41.4 FTEs, or $2 826 939 to $4 711 566. In Puerto Rico, where Sara Alert was used to monitor 2 631 306 travelers over the 11-month study period, estimated resource savings were 849 to 1698 FTEs, or $26 243 161 to $52 486 322.

Discussion:

Automated symptom monitoring helped reduce the staff time required for active symptom monitoring activities. Jurisdictions reported that this efficiency supported a rapid and comprehensive COVID-19 response even when experiencing challenges with quickly scaling up their public health workforce.
Telehealth and Public Health Practice in the United States—Before, During, and After the COVID-19 Pandemic
Authors: Neri Antonio J. , Whitfield Geoffrey P. , Umeakunne Erica T. , Hall Jeffrey E. , DeFrances Carol J. , Shah Ami B. , Sandhu Paramjit K. , Demeke Hanna B. , Board Amy R. , Iqbal Naureen J. , Martinez Katia , Harris Aaron M. , Strona Frank V.
Published: August 2022

Telehealth is the use of electronic information and telecommunication technologies to provide care when the patient and the provider are not in the same room at the same time. Telehealth accounted for less than 1% of all Medicare Fee-for-Service outpatient visits in the United States in 2019 but grew to account for 46% of all visits in April 2020. Changes in reimbursement and licensure policies during the COVID-19 pandemic appeared to greatly facilitate this increased use. Telehealth will continue to account for a substantial portion of care provided in the United States and globally. A better understanding of telehealth approaches and their evidence base by public health practitioners may help improve their ability to collaborate with health care organizations to improve population health. The article summarizes the Centers for Disease Control and Prevention's (CDC's) approach to understanding the evidence base for telehealth in public health practice, possible applications for telehealth in public health practice, and CDC's use of telehealth to improve population health.
Head-to-head Rasch comparison of the Prosthesis Evaluation Questionnaire-Mobility Section and the Prosthetic Mobility Questionnaire 2.0 in Italian lower-limb prosthesis users
Authors: Franchignoni Franco , Giordano Andrea , Monticone Marco
Published: August 2022

Background:

The Prosthesis Evaluation Questionnaire-Mobility Section (PEQ-MS) and the Prosthetic Mobility Questionnaire (PMQ 2.0) are two validated self-report questionnaires assessing mobility in people with lower-limb amputation.

Objective:

The aim of this study was to assess and compare the psychometric properties of PEQ-MS and PMQ 2.0 in a sample of 100 Italian lower-limb prosthesis users.

Methods:

We conducted a secondary Rasch analysis of data from a prospective single-group observational study, comparing the PEQ-MS and PMQ 2.0 head to head and then cocalibrating them onto a common interval-scaled metric, through common-person equating, to compare their operational range.

Results:

The PMQ 2.0 showed good measurement qualities. The PEQ-MS had acceptable psychometric properties, despite some weakness in item selection. Cocalibration of the two questionnaires indicated that they assess the same underlying construct (prosthetic mobility), but PMQ 2.0 items have a wider range of difficulty (by one logit). Finally, we created a nomogram allowing to “cross-walk” between scores of the two questionnaires.

Conclusions:

Comparison of the two questionnaires showed that the PMQ 2.0 has a better measurement performance and larger operational range than the PEQ-MS, making it more suitable for assessing lower-limb prosthesis users with a large range of locomotor abilities, in particular those with higher mobility levels.
Psychometric properties of the Turkish version of the Pectus Carinatum Evaluation Questionnaire used in patients with pectus carinatum treated with compression orthosis
Authors: Alaca Nuray , Arslan Dilek Çağrı , Alaca İhsan , Yüksel Mustafa
Published: August 2022

Background:

The Pectus Carinatum Evaluation Questionnaire (PCEQ) was developed for use in patients with pectus carinatum (PC) treated with compression orthosis. The questionnaire can be used to develop a strict program in the early follow-up period or to improve patients’ compliance with the treatment after treatment initiation and to improve the quality of life.

Objective:

This study aimed to evaluate the psychometric properties of the Turkish version of the PCEQ in patients with PC treated with compression orthosis.

Study design:

Validity and reliability study.

Methods:

This study included 52 volunteer patients with PC, aged 10–18 years. The Cronbach α coefficient, a measure of internal consistency, was used to check questionnaire reliability, and test-retest reliability (intraclass correlation coefficient) was used to check consistency over time. Construct validity was analyzed (correlation analysis) with the days/hours of orthosis use.

Results:

The reliability of the Turkish version of the PCEQ was found to have acceptable-to-sufficient-to-excellent internal consistency (Cronbach α coefficient = 0.701–915). Test-retest reliability calculated for investigating the reliability of the questionnaire over time was found to be excellent (intraclass correlation coefficient = 0.880–0.941). Furthermore, treatment compliance hours (r = 0.280, P = 0.044) and days (r = 0.299, P = 0.032) were found to be associated with parents’ influence at a low level and with time to compliance at a moderate level (r = −0.449–457, P = 0.001).

Conclusion:

The Turkish version of the PCEQ used in patients with PC treated with compression orthosis was found to have sufficient-to-excellent validity and reliability and could be used to develop a strict program for patients with PC using the orthosis or to improve patients’ treatment compliance after treatment initiation. Using this questionnaire may be important to assist the team members in the clinical decision-making process.
The effects of a custom foot orthosis on dynamic plantar pressure in patients with chronic plantar fasciitis: A randomized controlled trial
Authors: Nakhaee Masoomeh , Mohseni-Bandpei MohammadAli , Mousavi Mohammad Ebrahim , Shakourirad Ali , Safari Reza , Kashani Reza Vahab , Mimar Raghad , Amiri Houshang , Nakhaei Masoud
Published: August 2022

Background:

Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia supports the longitudinal arch and absorbs ground reaction forces during the static and dynamic phase(s) of weight-bearing. The purpose of this randomized controlled trial study was to determine the effects of CAD/CAM foot orthoses that were designed based on the dynamic plantar pressure in patients with plantar fasciitis.

Methods:

This study was performed on 34 patients with plantar fasciitis. Outcomes were compared based on plantar fascia thickness; peak pressure, mean pressure, and maximum force; and pain, activity of daily living, quality of life, and sports activity that were evaluated by ultrasound, plantar pressure platform, and the Foot and Ankle Outcome Score, respectively. The patients were randomly assigned into two groups: the experimental group (CAD/CAM orthoses and night splint) and the control group (night splint only). All data were recorded again after 4 weeks.

Results:

Pain (P = 0.002) and plantar fascia thickness (P = 0.001) decreased significantly after 1 month of intervention. Activity of daily living (P = 0.044) and quality of life (P = 0.001) showed a significant increase. There was a trend in increasing peak pressure in all masking regions in both groups. The maximum force remarkably reduced in the experimental group in all regions.

Conclusions:

The results demonstrated that CAD/CAM foot orthoses designed based on dynamic plantar pressure with night splint can reduce the plantar fascia thickness and pain associated with plantar fasciitis and increase the activity of daily living, quality of life, and sports activity.