bluuebunny/crossref_metadata_2025 huggingface dataset:
SURG-14. ENDOSCOPIC SURGERY FOR PEDIATRIC INTRAVENTRICULAR TUMOR WITHOUT HYDROCEPHALUS: INDICATION, SURGICAL TECHNIQUE, AVOIDANCE OF COMPLICATION, AND ITS PROSPECT
Authors: Takayanagi Shunsaku , Takami Hirokazu , Tanaka Shota , Shin Masahiro , Saito Nobuhito
Published: December 2020

INTRODUCTION

Neuroendoscopic surgery is useful for intraventricular tumors accompanied by ventriculomegaly. However, it is often challenging for cases with small ventricles. Our institution is actively performing surgeries for pediatric intraventricular tumors without frank ventriculomegaly.

METHODS

Seven cases of intraventricular tumors without ventriculomegaly (5 cases of subependymal giant cell astrocytoma (SEGA) and 2 cases of germ cell tumors (GCTs)) were analyzed. The age ranged between 3 and 14 years (median 5 years). The sizes of SEGA were between 10-27mm, and all the tumors showed an enlargement around the foramen of Monro, which was the indication for surgery. Biopsy and third ventriculostomy were performed for GCTs. For resection, after making a small craniotomy of 2 x 3 cm, ellipse-cone-like sheath with a diameter of 12mm or 17mm was inserted through it to the lateral ventricle, which enabled a wide surgical view. Under a rigid endoscope of 4mm diameter, 2 types of surgical instruments were employed, making the microsurgical procedure like under a microscope, with a wider view, possible. For the cases of tumor resection, septostomy and placement of a drain in the ventricle were performed at the end of surgery.

RESULTS

The lesions were safely approached in all the cases. For resection, endoscopic microsurgery was possible, and tumor was totally removed in all the cases. No postoperative complication was observed in any of them.

CONCLUSIONS

Our experience shows that tumor resection can be safely achieved with the aid of endoscope even for cases without ventriculomegaly.
SURG-17. CLINICAL CHARACTERISTICS AND OUTCOMES OF EPILEPSY-RELATED BRAIN TUMOR IN CHILDREN
Authors: Usami Kenichi , Terashima Keita , Abe Yuichi , Kiyotani Chikako , Ogiwara Hideki
Published: December 2020

OBJECTIVE

Epilepsy is one of the earliest symptoms in pediatric brain tumor. Gross total resection (GTR) of the tumor does not necessarily achieve seizure free, therefore it is controversial whether surrounding epileptic foci should be resected at the initial surgery. The aims of this study are to report clinical characteristics and outcome of pediatric epilepsy-related brain tumor (ERBT) and to discuss treatment strategy.

METHODS

Subjects were children less than 18 years old who underwent surgery for ERBT. Patients in whom epilepsy had been controlled before surgery were excluded. Data were collected from medical record and retrospectively reviewed.

RESULTS

Twenty-one children (8 boys and 13 girls) were analyzed in this study. The mean age at surgery was 6.8 years. Tumor was astrocytic tumor in 10, gangliogioma in 4 and dysembryoplastic neuroepithelial tumor in 3. Intracranial subdural electrodes were placed prior to tumor resection in 5 cases. GTR was achieved in 14 (67%). Seizure free was achieved in 15 (71.4%). GTR was significantly associated with seizure free (p=0.002).

CONCLUSION

In most of ERBT, seizure free can be achieved by lesionectomy alone. However, the resection of surrounding epileptic foci is required in some cases. Detailed examinations to detect the epileptic foci should be performed in ERBT, particularly in case of drug-resistant intractable epilepsy.
SURG-19. COMPLETE RESOLUTION OF ADHD AFTER GROSS TOTAL RESECTION OF DYSEMBRYIOPLASTIC NEUROEPITHELIAL TUMOR
Authors: Navarro Luis Angel Arredondo , del Campo Regina Malinali Navarro Martín , Oliva Lorelay Livier Gutiérrez , Mancilla Juan Luis Soto , Carnalla Maria De Lourdes De La Mora , Ibarra Daniel Perez-Rulfo , Zubieta Fernando Sánchez
Published: December 2020

A 3-year-old boy with a history of attention-deficit/hyperactivity disorder (ADHD) presented a single focal tonic seizure. A thorough physical examination revealed no neurological deficit. A contrast enhanced MRI showed an isointense lesion in the anterior part of the cingulate gyrus extending through the left frontal lobe. After initial evaluation, the parents refused surgical treatment and a close follow up was then considered. At the age of five, the ADHD become more evident and the patient was started on methylphenidate. Poor clinical response was seen with the initiation of stimulant. The boy presented a second generalized seizure and the parents agreed surgical management. An interhemispheric approach was then performed and a gross total resection was achieved. The histopathological diagnosis corresponded to a dysembryoplastic neuroepithelial tumor (DNET). Four years after the resection, the patient is seizure free and the ADHD has also resolved without the need of medication. The disappearance of seizures is common after surgical resection of DNET tumors, but this case establishes an association with ADHD.
SWK-10. TELEHEALTH IN OUTPATIENT PEDIATRIC NEURO-ONCOLOGY CARE
Authors: Raber Shannon , Hoffman Carly , Yarbrough Carol , Branagan Linda , Penumarthy Neela , Manning Jami , Reddy Alyssa , Banerjee Anuradha , Kline Cassie , Mueller Sabine
Published: December 2020

BACKGROUND

Telehealth is an emerging modality that can include patient evaluation, review of test results, and clinical decision-making. Access to care and quality of life are challenges for patients with pediatric brain tumors and their families. Herein we describe the introduction of video visits within our outpatient services led by nurse practitioners and nurse coordinators.

METHODS

The pediatric neuro-oncology program at University of California, San Francisco - Benioff Children’s Hospital (UCSF) established a robust telehealth practice to improve access to care for children and young adults with brain and spine tumors. Our nursing team identifies appropriate time points to offer video visits in lieu of in-person visits. Families are guided to connect through secure video conferencing. Data was collected retrospectively through electronic medical record schedules, billing records, and UCSF patient satisfaction surveys.

RESULTS

Since 2015 we have utilized telehealth for over 400 encounters. The service was limited to patients located in California. Introduction of telehealth resulted in savings of 2300 hours of travel by car, over $22,000 in gas, and over 127,000 miles traveled. Surveys indicate patient satisfaction is equal to or better than in-person experiences. Anecdotally, this service allows for face-to-face contact with patients who have significant barriers to travel. Challenges have included technology platforms, native language, provider and patient acceptance, and billing.

CONCLUSION

Overall, telehealth is feasible as a tool to deliver outpatient care in pediatric neuro-oncology. Implementation of video visits in clinical practice increases access to neuro-oncologic care and improves quality of life for patients and families.
SWK-12. PEDIATRIC NEURO-ONCOLOGY PARENT PERSPECTIVE ON ASPECTS OF SOCIAL AND EMOTIONAL SUPPORT FOR ONLINE APPLICATION
Authors: Koch Kendra , Fettig Tatum , Slining Meghan
Published: December 2020

Addressing family needs for social/emotional support is part of the duty of oncology care teams. This research presents a (2020) scoping review and a (2019) focus group initiated to explore pediatric neuro-oncology parent experience of social/emotional support in conjunction with developing an online peer application to address family needs. Currently, the value of online support is in the forefront of clinical conversation. The focus group queried eight parents whose children were under neuro-oncology treatment in the Northwest USA. Thematic findings include—parents want supportive peers who have (1) a personal and deep understanding of parenting a child with serious illness (they “get it”); (2) particular characteristics and skills that promote and sustain relationships, including—(a) good social skills, (b) ability to engage in “balanced” (cancer/non-cancer) conversations, (c) individual similarities (beliefs, age of children, cancer diagnosis/treatment), (d) logistic commonalities (location, availability), (e) pro-social personal characteristics (i.e. sense of humor, emotional/social flexibility), and an (f) ability to navigate and maintain social/emotional boundaries. Parents also initiated discussion about “the burden of supportive relationships” and supporting families doing “normal” activities without worrying about treatment side effects and contagions. The literature review supports finding (1) above; reveals the paucity of evidence-based supports available to this population; underscores the critical need for practitioners and researchers to develop more evidence-based supports and interventions for families of children experiencing cancer; and supports practitioners’ consistently assessing parent and sibling social and emotional needs and then consistently referring or intervening when needs are identified.
TBIO-06. BDNF-TRKB SIGNALING REGULATES NEURON-GLIOMA SYNAPTOGENESIS AND PROMOTES TUMOR PROGRESSION
Authors: Taylor Kathryn , Zhang Helena , Hui Alexa , Gillespie Shawn , Monje Michelle
Published: December 2020

Pediatric high-grade gliomas (pHGG) are a devastating group of diseases that urgently require novel therapeutic options. We have previously demonstrated that pHGGs hijack mechanisms of brain development and plasticity to their advantage. Here, we investigated the role of microenvironmental BDNF on pediatric gliomas, independent of the NTRK fusion events commonly identified in infant HGG. Genetic deletion or pharmacological blockade of NTRK2 (TrkB), in patient-derived pediatric glioma increases survival in multiple DIPG and pGBM patient-derived orthotopic xenograft models. Unlike the paracrine BDNF-TrkB signaling observed between subpopulations of adult HGG malignant cells, pediatric glioma express TrkB, but not BDNF ligand. BDNF is secreted by normal brain cells in response to neuronal activity and conditioned medium experiments from cortical slices of mice indicates the brain microenvironment as the chief source of BDNF ligand. Addition of recombinant BDNF protein increases pediatric glioma cell proliferation and activates the canonical downstream MAPK signaling pathway, an effect that is blocked by genetic or pharmacological TrkB inhibition in pHGG. However, the glioma growth-promoting effects of BDNF in vivo cannot be explained by stimulation of MAPK signaling alone. We therefore examined the effects of BDNF signaling on neuron-to-glioma synapse formation, a newly recognized microenvironmental interaction important for pediatric glioma progression. We find that BDNF-TrkB signaling promotes neuron-to-glioma synaptogenesis in neuron-glioma co-culture. We are presently exploring the role for BDNF-TrkB signaling in glioma synaptic plasticity and function. Funding: Abbie’s Army Foundation
TBIO-07. SINGLE-CELL TRANSCRIPTOMIC PROFILE REVEALS MACROPHAGE HETEROGENEITY IN SONIC-HEDGEHOG MEDULLOBLASTOMA AND THEIR DISTINCT RESPONSES TO DIFFERENT TREATMENT MODALITIES
Authors: Dang Mai , Haldar Malay
Published: December 2020

Tumor-associated macrophages (TAMs) are an important component of the tumor microenvironment. Pro-inflammatory macrophages can suppress while anti-inflammatory macrophages can promote tumor growth. Despite their abundance in many tumors, the origins and diversity of TAMs are not well understood, especially in pediatric brain tumors. Using single-cell RNA sequencing in a genetically engineered mouse model (Ptch+/-:p53-/-) of SHH-MB, we identified the dual microglia and monocytic origin of macrophage and their transcriptomic heterogeneity. We demonstrate differential recruitment and function of macrophages under distinct modalities of tumor therapy of molecular targeted hedgehog inhibition versus radiation. We additionally identify a monocytic macrophage population recruited post-radiation that is immune suppressive, suggesting a mechanism for radiation treatment failure. These insights uncover potential strategies for immunomodulation as adjunctive therapy for radiation.
TBIO-27. RASOPATHIES AND BRAIN TUMOROGENESIS: ARE SOS1 MUTATIONS ARE CONCERNED?
Authors: Abdelmoula Nouha Bouayed , Louati Rim , Abdelmoula Balkiss , Aloulou Samir
Published: December 2020

Germ line gain-of-function mutations in several members of the RAS/MAPK pathway, including PTPN11 are associated with signalopathies named Rasopathies and known as Noonan syndrome and closely related conditions. Patients harboring Rasopathies are at increased risk of myeloproliferative diseases and solid tumors, such as neuroblastoma. Mutations of SOS1, the gene encoding a guanine nucleotide exchange factor for Ras, represent the second most frequent genetic defect in Rasopathies. However, SOS1 mutations are rare in human malignancies and patients with germline SOS1 mutations may not be at increased risk of developing cancer. Here, we report a SOS1 variant found to segregate in a Tunisian pedigree with many members affected by brain tumors as well as epileptic disorder. During our genetic counselling for congenital heart diseases, a 9-year-old female born at Sfax from a consanguineous couple and having pulmonic valvular stenosis, has been investigated at the molecular level. Screening of mutations in the entire coding sequence of PTPN11, Braf and SOS1, was conducted using HRM analysis and bidirectional sequencing. Heterozygous single nucleotide substitution of SOS1 gene: c.1655 G>A was confirmed. This mutation affected the PH-REM linker domain with substitution of residue Arg552 to Lys: p.Arg552Lys. This mutation accounts for one-third of all mutations reported in SOS1 during Rasopathies. Although no other molecular exploration was done, family history revealed other affected children by neurodevelopmental and epileptic conditions as well as recurrent brain malignancies in the paternal family. Two aunts developed blindness and then died subsequently to tumor progression.
THER-02. EVALUATION OF THE ONCOLYTIC VIRUS DELTA24-RGD AS AN ANTI-TUMOR AGENT IN PRECLINICAL MODELS OF LOCALIZED AND DISSEMINATED AT/RT
Authors: Garcia-Moure Marc , González-Huarriz Marisol , de la Nava Daniel , Marrodán Lucía , Gomez-Manzano Cande , Fueyo Juan , Patiño-García Ana , Alonso Marta M
Published: December 2020

Current therapies for atypical teratoid/rhabdoid tumors (AT/RTs) are suboptimal, resulting in a 2-year OS below 20% and the development of severe side effects. Therefore, we need to explore alternative therapeutic approaches for this disease. Since the virus Delta24-RGD has already demonstrated its efficacy and safety as a therapeutic agent for brain tumors, including pediatric patients, here we propose to evaluate the anti-tumor effect of Delta24-RGD in AT/RT. In vitro, Delta24-RGD infects and replicates in AT/RT cultures followed by oncolysis, obtaining IC50 values below 1 PFU/cell. In vivo, a single local injection of Delta-24-RGD in three infratentorial AT/RT models (BT-12, CHLA-06 and CHLA-266) extended significantly the median OS (50 to 78 days BT-12; 21 to 31 days CHLA-06; 64 to 110 days CHLA-266). Delta-24-RGD also increased the survival of mice bearing supratentorial CHLA-266 tumors (from 93 to 132 days). Next, we evaluated the efficacy of Delta24-RGD in a model mimicking metastatic disease through intraventricular injection of BT-12-luciferase cells. Administration of Delta24-RGD inhibited tumor growth and development of metastases, leading to an increased OS and nearly 70% of long-term survivors. The interaction between Delta24-RGD and the immune system was evaluated in humanized mice models bearing CHLA-06. In this model, Delta24-RGD treatment extended OS (from 23 to 34 days) and we characterized the anti-tumor immune landscape in control and Delta24-RGD treated mice by transcriptional and functional analyses. These results underscore the potential of Delta24-RGD as a promising therapeutic choice for patients affected by AT/RT.
Obturator Nerve Blockade vs. Neuromuscular Blockade for the Prevention of Adductor Spasm in Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized Controlled Trial
Authors: Soberón José R , Awoniyi Caleb A , Perez Melissa Alvarez , Vasilopoulos Terrie , Canales Benjamin K
Published: December 2020

Background

The obturator nerve runs along the posterolateral walls of the bladder and electrosurgical stimulation in this region can result in adductor spasm which can occur suddenly and unexpectedly with potentially catastrophic results.

Methods

Sixty patients were prospectively randomized to receive either a single-injection ultrasound-guided obturator nerve block (ONB) or intravenous rocuronium after induction of general anesthesia (i.e., neuromuscular block [NMB]). The primary objective was to compare the incidence of adductor spasm during posterolateral bladder tumor resection when ONB or NMB was used. Secondary objectives included assessment of fall risk and incidence of adverse events.

Results

Five patients in the ONB group and six in the NMB group had nonlateral wall lesions. One patient in the ONB group suffered a cardiac arrest after induction of general anesthesia. Of the remaining 48 patients, six (10.2%) experienced adductor spasm. Most of these patients were in the NMB group (5/24, 20.8%), with only one patient (1/24, 4.2%) experiencing obturator reflex in the ONB group; this difference was not statistically significant (P=0.19). Patients in the ONB group had a greater decrease in mean hip adductor strength. Our study population was found to be at high risk of falls before surgery. There were no statistically significant group differences in the Timed Up and Go test, with time to perform the test increasing in both groups.

Conclusions

Both techniques are safe and efficacious for preventing adductor spasm. Our data and experience suggest that the ONB is relatively easy to perform and should be considered in patients with posterolateral bladder tumors.
Antiphospholipid patterns predict risk of thrombosis in systemic lupus erythematosus
Authors: Demir Selcan , Li Jessica , Magder Laurence S , Petri Michelle
Published: December 2020

Objective

We evaluated which aPL combinations increase the risk of future thrombosis in patients with SLE.

Methods

This prospective cohort study consisted of SLE patients who had been tested for all seven aPL (LA, aCL isotypes IgM, IgG and IgA, and anti-β2-glycoprotein I isotypes IgM, IgG and IgA). Pooled logistic regression was used to assess the relationship between aPL and thrombosis.

Results

There were 821 SLE patients with a total of 75 048 person-months of follow-up. During the follow-up we observed 88 incident cases of thrombosis: 48 patients with arterial, 37 with venous and 3 with both arterial and venous thrombosis. In individual models, LA was the most predictive of any [age-adjusted rate ratio 3.56 (95% CI 2.01, 6.30), P < 0.0001], venous [4.89 (2.25, 10.64), P < 0.0001] and arterial [3.14 (1.41, 6.97), P = 0.005] thrombosis. Anti-β2-glycoprotein I IgA positivity was a significant risk factor for any [2.00 (1.22, 3.3), P = 0.0065] and venous [2.8 (1.42, 5.51), P = 0.0029] thrombosis. Only anti-β2-glycoprotein I IgA appeared to add significant risk to any [1.73 (1.04, 2.88), P = 0.0362] and venous [2.27 (1.13, 4.59), P = 0.0218] thrombosis among those with LA. We created an interaction model with four categories based on combinations of LA and other aPL to look at the relationships between combinations and the risk of thrombosis. In this model LA remained the best predictor of thrombosis.

Conclusion

Our study demonstrated that in SLE, LA remained the best predictor of thrombosis and adding additional aPL did not add to the risk, with the exception of anti-β2-glycoprotein I IgA.
Caring for children with septo-optic dysplasia
Authors: Julian Marcia K. , Nguyen Akilia Hang
Published: December 2020

Nurses involved in the care of children may encounter this brain disorder, which occurs in 1 out of 10,000 live births.
Taming the trauma
Authors: Ensz Catherine E.F.
Published: December 2020

Learn how nurses working on the front lines of the COVID-19 pandemic can positively impact the short- and long-term mental health of their patients and themselves.
Assessing Unperceived Learning Needs in Continuing Medical Education for Primary Care Physicians: A Scoping Review
Authors: Armson Heather , Perrier Laure , Roder Stefanie , Shommu Nusrat S. , Wakefield Jacqueline , Shaw Elizabeth , Zahorka Stephanie , Elmslie Tom , Lofft Meghan
Published: December 2020

Introduction:

Assessing needs before developing continuing medical education/continuing professional development (CME/CPD) programs is a crucial step in the education process. A previous systematic literature review described a lack of objective evaluation for learning needs assessments in primary care physicians. This scoping review updates the literature on uses of objective evaluations to assess physicians' unperceived learning needs in CME/CPD. Identifying and understanding these approaches can inform the development of educational programs that are relevant to clinical practice and patient care. The study objectives were to (1) scope the literature since the last systematic review published in 1999; (2) conduct a comprehensive search for studies and reports that explore innovative tools and approaches to identify physicians' unperceived learning needs; (3) summarize, compare, and classify the identified approaches; and (4) map any gaps in the literature to identify future areas of research.

Methods:

A scoping review was used to “map” the literature on current knowledge regarding approaches to unperceived needs assessment using conceptual frameworks for planning and assessing CME/CPD activities.

Results:

Two prominent gaps were identified: (1) performance-based assessment strategies are highly recommended in nonresearch articles yet have low levels of implementation in published studies and (2) analysis of secondary data through patient input or environmental scanning is emphasized in grey literature implementation strategies more so than in peer-reviewed theoretical and research articles.

Discussion:

Future evaluations should continue to incorporate multiple strategies and focus on making unperceived needs assessments actionable by describing strategies for resource management.
Opioid Misuse and Overdose: Changes in Pharmacist Practices and Outcomes
Authors: Eukel Heidi , Steig Jayme , Frenzel Oliver , Skoy Elizabeth , Werremeyer Amy , Strand Mark
Published: December 2020

Background:

Continuing education (CE) provides educational opportunities for health professionals to adequately respond to issues in practice but infrequently evaluate sustained practice change. The opioid epidemic has risen to the forefront of health priorities in our nation. The Opioid and Naloxone Education (ONE Rx) CE program provides pharmacists the opportunity to expand their abilities and impact in the opioid crisis.

Methods:

ONE Rx CE included risk assessment for opioid misuse/overdose, role of naloxone, disease of addiction, and communication strategies for patients and providers. Pharmacists who completed the CE screened patients and provided interventions over 12 months. CE participants were provided presurveys, postsurveys, and delayed postsurveys coordinated with the educational program. The Kirkpatrick Model was used to evaluate the effectiveness of the program by examining the four levels of assessment: reaction, commitment, behavior, and results.

Results:

The Kirkpatrick Model was used to evaluate the impact of the CE. Reaction: 97% of respondents recommended the ONE Rx program. Commitment: 77% of respondents indicated commitment to provide ONE Rx opioid risk screening and interventions to patients. Behavior: Twelve months after training, pharmacists registered to prescribe naloxone increased by 67% and the number of pharmacists reporting naloxone dispensing doubled from 23% to 46%. Outcomes: Pharmacist interventions included medication take back programs explained (88.4%), naloxone dispensing to high-risk patients (10.9%), and discussion of opioid use disorder with patients with risk factors (49%).

Conclusion:

By using the Kirkpatrick Model, the ONE Rx CE program demonstrated high-quality opioid and naloxone education to pharmacists. Survey results and opioid harm reduction interventions indicate the CE resulted in sustained pharmacy practice behavior change.
Journal Club Using Virtual Breakout Rooms: Interactive Continuing Education with No Learner Preparation During COVID-19
Authors: Cadieux Magalie , Campos-Zamora Melissa , Zagury-Orly Ivry , Dzara Kristina
Published: December 2020

Introduction:

As a result of the COVID-19 pandemic, the authors rapidly transitioned an in-person, learner-led medical education journal club (MEJC) to the virtual environment. The “interactive, no-prep” approach, using breakout rooms within a videoconferencing system, required no prior learner preparation.

Methods:

From March to May 2020, learners were invited to participate in a monthly 60-minute virtual MEJC. A needs assessment survey informed article selection. Facilitators developed a presentation to provide background and describe the article's research question(s). In breakout groups, learners generated study designs to answer the research question(s). After the actual study methodology and results were revealed, learners engaged in facilitated open discussion. After the session, learners completed an electronic survey to rate perceived usefulness and suggest improvement areas.

Results:

A total of 15 learners participated; most completed the survey (13/15; 87%). The MEJC was rated as very or extremely useful. Qualitative feedback indicated that it was convenient, allowed creativity, and enabled rich discussion without prior preparation. When possible, improvement suggestions were implemented.

Discussion:

The authors offer an evidence-based MEJC approach that is free, interactive with virtual breakout rooms and requires no prior learner preparation. Early indicators suggest that others navigating the COVID-19 crisis may want to implement this approach.
Pregnancy outcomes of the first thawing cycle in “freeze-all” strategy of infertility patients with fever during oocyte recruitment: a matched-pair study
Authors: Lin Ming-Mei , Niu Zi-Ru , Zhang Hua , Li Rong
Published: December 2020

Background:

It is currently unknown whether patients with a fever after controlled ovulation during egg retrieval could increase the risk of pelvic infection or not, and fever itself may affect endometrial receptivity or embryo quality with poor pregnancy outcomes. The aim of this study was to analyze the outcomes of patients with fever during oocyte retrieval after the first frozen-thawed embryo transfer (FET) cycle.

Methods:

This was a 1:3 retrospective paired study matched for age. In this study, 58 infertility patients (Group 1) had a fever during the control ovulation, and the time of the oocyte retrieval was within 72 hours, they underwent ovum pick up and whole embryo freezing (“freeze-all” strategy). The control subjects (Group 2) are 174 patients matched for age who underwent whole embryo freezing for other reasons. The baseline characteristics, clinical data of ovarian stimulation, and outcomes, such as the clinical pregnancy rate, ongoing clinical pregnancy rate were compared between the two groups in the subsequent FET cycle.

Results:

All patients had no pelvic inflammatory disease after oocyte retrieval. Anti-Mullerian hormone (AMH) levels (4.2 vs. 2.2, P <0.001) were higher in group 2, and the number of oocytes retrieved, and fertilization rate were lower in group 1 (P < 0.001), but the endometrial thickness, the number of embryo transfers, and the type of luteal support supplementation were similar between the two groups. Regarding pregnancy outcomes in the subsequent FET cycle, the implantation rate, clinical pregnancy rate, early spontaneous rate, ectopic pregnancy rate, and ongoing pregnancy rate were all not significantly different. Further regression analyses showed that the clinical pregnancy rate and ongoing pregnancy rate were also not significantly different.

Conclusions:

Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a safe and minimally invasive method for patients with fever. Moreover, the fever had almost no effect on embryo quality.
Student Nurses' Perceptions of Mercy
Authors: Thiel Linda M. , Razmus Ivy , Nauta Becky , Keep Suzanne , Thomas Roberta , Moran Katherine
Published: December 2020

Mercy is a valued nursing attribute. It often identifies faith-based educational institutions, clinics, and hospitals and has been a quality valued and taught by the Catholic Sisters of Mercy through nursing's history. This qualitative study explored the meaning of mercy as expressed by undergraduate nursing students attending a faith-based nursing school. This article presents the findings of a question posed to students: What does mercy mean to me? Nursing practice and education implications are also presented.
Hand or foot train-of-four tests and surgical site muscle relaxation assessed with multiple motor evoked potentials
Authors: Betz Michael , Aguirre José , Schubert Martin , Götschi Tobias , Huber Barbara , Schüpbach Regula , Brada Muriel , Spirig José M. , Farshad Mazda
Published: December 2020

BACKGROUND

Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity.

OBJECTIVE

The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials.

DESIGN

Prospective observational study.

SETTING

A single-centre study performed between February 2016 and December 2018 at the Balgrist University Hospital, Zurich, Switzerland.

PATIENTS

Twenty patients scheduled for elective lumbar spinal fusion were prospectively enrolled in this study after giving written informed consent.

INTERVENTIONS

To assess neuromuscular blockade (NMB) with the intermediate duration nondepolarising neuromuscular blocking agent rocuronium, hand TOF (adductor pollicis) and foot TOF (flexor hallucis brevis) monitoring, and muscle motor evoked potentials (MMEPs) from the upper and lower extremities were assessed prior to surgery under general anaesthesia. Following baseline measurements, muscle relaxation was performed with rocuronium until the spinal surgeon observed sufficient relaxation for surgical intervention. At this timepoint, NMB was assessed by TOF and MMEP.

MAIN OUTCOME MEASURES

The primary outcome was to determine the different effect of rocuronium on muscle relaxation comparing hand and foot TOF with the paraspinal musculature assessed by MMEP.

RESULTS

Hand TOF was more resistant to NMB and had a shorter recovery time than foot TOF. When comparing MMEPs, muscle relaxation occurred first in the hip abductors, and the paraspinal and deltoid muscles. The most resistant muscle to NMB was the abductor digiti minimi. Direct comparison showed that repetitive MMEPs simultaneously recorded from various muscles at the upper and lower extremities and from paraspinal muscles reflect muscle relaxation similar to TOF testing.

CONCLUSION

Hand TOF is superior to foot TOF in assessing muscle relaxation during spinal surgery. Hand TOF adequately represents the degree of muscle relaxation not only for the paraspinal muscles but also for all orthopaedic surgical sites where NMB is crucial for good surgical conditions.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03318718).
BMI and malignant hyperthermia pathogenic ryanodine receptor type 1 sequence variants in Switzerland
Authors: Gonzalez Asensio , Girard Thierry , Dell-Kuster Salome , Urwyler Albert , Bandschapp Oliver
Published: December 2020

BACKGROUND

Ryanodine receptor type 1 (RYR1) sequence variants are pathogenic for malignant hyperthermia. Variant carriers have a subtle increase in resting myoplasmic calcium concentration compared with nonaffected individuals, but whether this has metabolic effects in daily life is unknown.

OBJECTIVES

We analysed the potential effect of malignant hyperthermia-pathogenic RYR1 sequence variants on BMI as a single factor. Due to the heterogeneity of genetic variants predisposing to malignant hyperthermia, and to incomplete information about their regional distribution, we describe the prevalence of RYR1 variants in our population.

DESIGN

A retrospective cohort study.

SETTING

A single University hospital.

PATIENTS

Patients from malignant hyperthermia families with pathogenic RYR1 sequence variants were selected if BMI was available.

OUTCOME MEASURES

BMI values were compared amongst malignant hyperthermia susceptible (MHS) and malignant hyperthermia-negative individuals using hierarchical multivariable analyses adjusted for age and sex and considering family clustering. Variant prevalence was calculated.

RESULTS

The study included 281 individuals from 42 unrelated malignant hyperthermia families, 109 of whom were MHS and carriers of the familial RYR1 sequence variants. Median [IQR] BMI in MHS individuals with pathogenic RYR1 variants was 22.5 kg m−2 [21.3 to 25.6 kg m−2]. In malignant hyperthermia-negative individuals without variants, median BMI was 23.4 kg m−2 [21.0 to 26.3 kg m−2]. Using multivariable regression adjusted for age and sex, the mean difference was −0.73 (95% CI −1.51 to 0.05). No carrier of a pathogenic RYR1 sequence variant was found to have BMI higher than 30 kg m−2. Only 10 RYR1 variants from the list of the European MH Group were found in our cohort, the most common being p.Val2168Met (39% of families), p.Arg2336His (24%) and p.Arg614Cys (12%).

CONCLUSION

The observed tendency towards lower BMI values in carriers of malignant hyperthermia-pathogenic RYR1 sequence variants points to a possible protective effect on obesity. This study confirms regional differences of the prevalence of malignant hyperthermia-pathogenic RYR1 sequence variants, with just three variants covering 75% of Swiss MHS families.

TRIAL REGISTRATION

This manuscript is based on a retrospective analysis.
Effect of positive end-expiratory pressure during anaesthesia induction on non-hypoxic apnoea time in infants
Authors: Kim Eun-Hee , Lee Ji-Hyun , Jang Young-Eun , Ji Sang-Hwan , Cho Sung-Ae , Kim Jin-Tae , Kim Hee-Soo
Published: December 2020

BACKGROUND

Hypoxaemia occurs frequently in infants during anaesthetic induction.

OBJECTIVE

We evaluated the effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants.

DESIGN

Randomised controlled trial.

SETTING

Tertiary care children's hospital, single centre, from November 2018 to October 2019.

PATIENTS

We included patients under 1 year of age receiving general anaesthesia.

INTERVENTION

We assigned infants to a 7 cmH2O or 0 cmH2O positive end-expiratory pressure group. Anaesthesia was induced with 0.02 mg kg−1 atropine, 5 mg kg−1 thiopental sodium and 3 to 5% sevoflurane, and neuromuscular blockade with 0.6 mg kg−1 rocuronium. Thereafter, 100% oxygen was provided via face mask with volume-controlled ventilation of 6 ml kg−1 tidal volume, and either 7 cmH2O or no positive end-expiratory pressure. After 3 min of ventilation, the infants’ trachea was intubated but disconnected from the breathing circuit, and ventilation resumed when pulse oximetry reached 95%.

MAIN OUTCOME MEASURE

The primary outcome was nonhypoxic apnoea time defined as the time from cessation of ventilation to a pulse oximeter reading of 95%, whereas the secondary outcome was the incidence of significant atelectasis (consolidation score ≥2) assessed by lung ultrasound.

RESULTS

Sixty patients were included in the final analysis. Apnoea time in the 7 cmH2O positive end-expiratory pressure group (105.2 s) increased compared with that in the control group (92.1 s) (P = 0.011, mean difference 13.0 s, 95% CI, 3.1 to 22.9 s). Significant atelectasis was observed in all patients without positive end-expiratory pressure and 66.7% of those with 7 cmH2O positive end-expiratory pressure (P = 0.019, 95% CI, 1.7 to 563.1, odds ratio 31.2).

CONCLUSION

Positive end-expiratory pressure during anaesthesia induction with face mask ventilation increased nonhypoxic apnoea time in infants.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov, NCT03540940.
Pectoral nerve blocks for breast surgery
Authors: Meißner Michael , Austenfeld Ece , Kranke Peter , Zahn Peter K. , Pogatzki-Zahn Esther M. , Meyer-Frießem Christine H. , Weibel Stephanie , Schnabel Alexander
Published: December 2020

BACKGROUND

Pectoral nerve blocks (PECS block) might be an interesting new regional anaesthetic technique in patients undergoing breast surgery.

OBJECTIVE

The aim of this meta-analysis was to investigate postoperative pain outcomes and adverse events of a PECS block compared with no treatment, sham treatment or other regional anaesthetic techniques in women undergoing breast surgery.

DESIGN

We performed a systematic review of randomised controlled trials (RCT) with meta-analysis and risk of bias assessment.

DATA SOURCES

The databases MEDLINE, CENTRAL (until December 2019) and clinicaltrials.gov were systematically searched.

ELIGIBILITY CRITERIA

All RCTs investigating the efficacy and adverse events of PECS compared with sham treatment, no treatment or other regional anaesthetic techniques in women undergoing breast surgery with general anaesthesia were included.

RESULTS

A total of 24 RCTs (1565 patients) were included. PECS (compared with no treatment) block might reduce pain at rest [mean difference −1.14, 95% confidence interval (CI), −2.1 to −0.18, moderate quality evidence] but we are uncertain regarding the effect on pain during movement at 24 h after surgery (mean difference −1.79, 95% CI, −3.5 to −0.08, very low-quality evidence). We are also uncertain about the effect of PECS block on pain at rest at 24 h compared with sham block (mean difference −0.83, 95% CI, −1.80 to 0.14) or compared with paravertebral block (PVB) (mean difference −0.18, 95% CI, −1.0 to 0.65), both with very low-quality evidence. PECS block may have no effect on pain on movement at 24 h after surgery compared with PVB block (mean difference −0.56, 95% CI, −1.53 to 0.41, low-quality evidence). Block-related complications were generally poorly reported.

CONCLUSION

There is moderate quality evidence that PECS block compared with no treatment reduces postoperative pain intensity at rest. The observed results were less pronounced if patients received a sham block. Furthermore, PECS blocks might be equally effective as PVBs. Due to mostly low-quality or very low-quality evidence level, further research is warranted.

PROTOCOL REGISTRATION

CRD42019126733.
Scleral Lens Visual Rehabilitation of Sequential Bilateral Corneal Hydrops With Post-LASIK Ectasia
Authors: Kumar Mukesh , Shetty Rohit , Lalgudi Vaitheeswaran G. , Khamar Pooja , Vincent Stephen J.
Published: December 2020

This case report describes a unique presentation of bilateral sequential acute corneal hydrops that manifested several years after laser in situ keratomileusis. Initial management included anterior chamber perfluoropropane gas injection and corneal suturing. Longer-term visual rehabilitation involved the use of scleral lenses which significantly reduced lower- and higher-order ocular aberrations.
Ocular Surface Squamous Neoplasia Managed With Primary Interferon α2b: A Comparative Analysis of 212 Tumors in Smokers Versus Nonsmokers
Authors: Shields Carol L. , Paulose Sefy A. , Yaghy Antonio , Dalvin Lauren A. , Constantinescu Alexandru B. , Lally Sara E. , Shields Jerry A.
Published: December 2020

Purpose:

To explore clinical features and outcomes of ocular surface squamous neoplasia (OSSN) treated with primary interferon (IFN)-α2b, based on patient cigarette smoking status.

Methods:

Retrospective nonrandomized, interventional cohort study on 212 consecutive tumors in 194 patients, all of whom were treated with topical and/or injection IFNα2b.

Results:

There were 88 tumors in 76 patients with current or past smoking history (smokers) and 124 tumors in 118 nonsmoking patients (nonsmokers). A comparison (smokers vs. nonsmokers) revealed smokers with more frequent bilateral disease (16% vs. 3%, P = 0.003), more frequent involvement of inferior forniceal (34% vs. 21%, P = 0.03) and inferior tarsal conjunctiva (38% vs. 24%, P = 0.04), greater mean number of clock hour involvement (4.1 vs. 3.5 clock hours, P = 0.04), and greater dome growth pattern (30% vs. 15%, P = 0.01). There was no difference regarding method of IFNα2b administration as topical (61% vs. 71%, P = 0.14), injection (10% vs. 6%, P = 0.32), or combination topical/injection (28% vs. 23%, P = 0.33). A comparison revealed smokers with more frequent recurrence after initial response (23% vs. 13%, P = 0.04). There was no difference regarding initial tumor response or time to response, treatment side effects, or systemic outcomes.

Conclusions:

Regarding ocular surface squamous neoplasia, smokers more often display bilateral, dome-shaped tumors with inferior forniceal or tarsal involvement, and greater extent than nonsmokers. After treatment with topical and/or injection IFNα2b, control is equivalent, but smokers show greater recurrence.
Effect of telephone-based health education intervention models on cervical cancer screening compliance
Authors: Liu Yinchun , Zhang Qiang , Chen Yanli , Wang Chun
Published: December 2020

Background:

Screening is an effective strategy for preventing and controlling the cervical cancer. Unfortunately, women are often less likely to adhere to cervical cancer screening procedures. Related research shows that the telephone-based health education model can improve the compliance of screening. At present, however, this practice is lack of persuasion. Therefore, this study makes a systematic meta-analysis on whether the telephone-based health education model can improve the compliance of screening by women.

Methods:

Retrievals will be made on PubMed, Web of Science, the Cochrane Library, EMBASE, and some clinical trial registration websites, and information on related randomized controlled trials (RCTs) will collected. After 2 researchers independently screen the literatures, they will extract the data and evaluate the bias risk contained in the collected studies, before meta-analysis is carried out with RevMan 5.3 software.

Results:

The available evidence will be systematically reviewed in terms of compliance with cervical cancer screening.

Conclusion:

The findings of this study will produce comprehensive evidence to identify whether the telephone-based health education model can improve women's compliance with cervical cancer screening.
Machine-learning prediction of unplanned 30-day rehospitalization using the French hospital medico-administrative database
Authors: Jaotombo Franck , Pauly Vanessa , Auquier Pascal , Orleans Veronica , Boucekine Mohamed , Fond Guillaume , Ghattas Badih , Boyer Laurent
Published: December 2020

Predicting unplanned rehospitalizations has traditionally employed logistic regression models. Machine learning (ML) methods have been introduced in health service research and may improve the prediction of health outcomes. The objective of this work was to develop a ML model to predict 30-day all-cause rehospitalizations based on the French hospital medico-administrative database.

This was a retrospective cohort study of all discharges in the year 2015 from acute-care inpatient hospitalizations in a tertiary-care university center comprising 4 French hospitals. The study endpoint was unplanned 30-day all-cause rehospitalization. Logistic regression (LR), classification and regression trees (CART), random forest (RF), gradient boosting (GB), and neural networks (NN) were applied to the collected data. The predictive performance of the models was evaluated using the H-measure and the area under the ROC curve (AUC).

Our analysis included 118,650 hospitalizations, of which 4127 (3.5%) led to rehospitalizations via emergency departments. The RF model was the most performant model according to the H-measure (0.29) and the AUC (0.79). The performances of the RF, GB and NN models (H-measures ranged from 0.18 to 0. 29, AUC ranged from 0.74 to 0.79) were better than those of the LR model (H-measure = 0.18, AUC = 0.74); all P values <.001. In contrast, LR was superior to CART (H-measure = 0.16, AUC = 0.70), P < .0001.

The use of ML may be an alternative to regression models to predict health outcomes. The integration of ML, particularly the RF algorithm, in the prediction of unplanned rehospitalization may help health service providers target patients at high risk of rehospitalizations and propose effective interventions at the hospital level.
Application of MR diffusion imaging for non-invasive assessment of acute kidney injury after lung transplantation
Authors: Derlin Katja , Hellms Susanne , Gutberlet Marcel , Peperhove Matti , Jang Mi-Sun , Greite Robert , Hartung Dagmar , Derlin Thorsten , Fegbeutel Christine , Tudorache Igor , Jüttner Björn , Wiese Birgitt , Lichtinghagen Ralf , Haller Hermann , Haverich Axel , Wacker Frank , Warnecke Gregor , Gueler Faikah
Published: December 2020

To assess whether MR diffusion imaging may be applied for non-invasive detection of renal changes correlating with clinical diagnosis of acute kidney injury (AKI) in patients after lung transplantation (lutx).

Fifty-four patients (mean age 49.6, range 26–64 years) after lutx were enrolled in a prospective clinical study and underwent functional MR imaging of the kidneys in the early postoperative period. Baseline s-creatinine ranged from 39 to 112 μmol/L. For comparison, 14 healthy volunteers (mean age 42.1, range 24–59 years) underwent magnetic resonance imaging (MRI) using the same protocol. Renal tissue injury was evaluated using quantification of diffusion and diffusion anisotropy with diffusion-weighted (DWI) and diffusion-tensor imaging (DTI). Renal function was monitored and AKI was defined according to Acute-Kidney-Injury-Network criteria. Statistical analysis comprised one-way ANOVA and Pearson correlation.

67% of lutx patients (36/54) developed AKI, 47% (17/36) had AKI stage 1, 42% (15/36) AKI stage 2, and 8% (3/36) severe AKI stage 3. Renal apparent diffusion coefficients (ADCs) were reduced in patients with AKI, but preserved in transplant patients without AKI and healthy volunteers (2.07 ± 0.02 vs 2.18 ± 0.05 vs 2.21 ± 0.03 × 10–3 mm2/s, P < .05). Diffusion anisotropy was reduced in all lutx recipients compared with healthy volunteers (AKI: 0.27 ± 0.01 vs no AKI: 0.28 ± 0.01 vs healthy: 0.33 ± 0.02; P < .01). Reduction of renal ADC correlated significantly with acute loss of renal function after lutx (decrease of renal function in the postoperative period and glomerular filtration rate on the day of MRI).

MR diffusion imaging enables non-invasive assessment of renal changes correlating with AKI early after lutx. Reduction of diffusion anisotropy was present in all patients after lutx, whereas marked reduction of renal ADC was observed only in the group of lutx recipients with AKI and correlated with renal function impairment.