bluuebunny/crossref_metadata_2025 huggingface dataset:
Operational Virtual Health Modalities Increased Combat Power for 1st Squadron, 2nd Cavalry Regiment During the Enhanced Forward Presence Mission
Authors: Cornfeld Robert , Cranney Nathaniel , Rudy Elena
Published: March 2020

Introduction

Virtual Health (VH) is posited to be a force multiplier for Military Medicine, delivering digital healthcare to the point of need for the warfighter. To date, there are no studies on the impact of both synchronous and asynchronous VH modalities during a deployment. VH usage by the 1st Squadron, 2nd Cavalry Regiment (1/2 CR) during a 6 month deployment to rural Poland was evaluated prospectively to identify mission days saved for Commanders.

Materials and Methods

VH Europe staff trained 1/2 CR Garrison and Deployed Medical Staff on VH modalities. Workflows for communication to higher echelons of medical care were developed. Usage of VH was prospectively tracked to identify trends and outcomes.

Results

213 Soldier Mission Days during a 6 month deployment were saved through the use of VH versus in-person travel for care. The predominance of VH was for synchronous video VH for the Warfighter (VIEW) (90%), followed by asynchronous Health Experts onLine Portal (HELP) consultations (10%). Lost Soldier productivity of $87,330 was avoided.

Conclusion

Operational VH is a force multiplier that brings the resources of the Medical Center to the Warfighter at the point of need. The full spectrum of VH modalities offers the greatest benefit for deployed units. Expansion of these technologies throughout the Department of Defense will reduce medical evacuations, increase Active Duty Service Member time on mission, and reduce risks for Commanders.
Cosmic rays from the nearby starburst galaxy NGC 253: the effect of a low-luminosity active galactic nucleus
Authors: Gutiérrez E M , Romero G E , Vieyro F L
Published: March 2020

NGC 253 is a nearby starburst galaxy in the Sculptor group located at a distance of ∼3.5 Mpc that has been suggested by some authors as a potential site for cosmic ray acceleration up to ultrahigh energies. Its nuclear region is heavily obscured by gas and dust, which prevents establishing whether or not the galaxy harbours a supermassive black hole coexisting with the starburst. Some sources have been proposed in the literature as candidates for an active nucleus. In this work, we aim at determining the implications that the presence of a supermassive black hole at the nucleus of NGC 253 might have on cosmic ray acceleration. With this aim, we model the accretion flow on to the putative active nucleus, and we evaluate the feasibility of particle acceleration by the black hole dynamo mechanism. As a by-product, we explore the potential contribution from non-thermal particles in the accretion flow to the high-energy emission of the galaxy. We found that in the three most plausible nucleus candidates, the emission of the accretion flow would inhibit the black hole dynamo mechanism. To rule out completely the influence that a putative nucleus in NGC 253 might have in cosmic ray acceleration, a better clarification concerning the true nature of the nucleus is needed.
A catalogue of intermediate-duration Type I X-ray bursts observed with the INTEGRAL satellite
Authors: Alizai K , Chenevez J , Brandt S , Lund N
Published: March 2020

We present a catalogue of long-duration bursts observed with the Joint European X-ray Monitor and IBIS/ISGRI instruments onboard the INTEGRAL satellite. The 14 bursts have e-folding times ranging from 55 s to ≈17 min, and are therefore classified as intermediate-duration bursts, caused by the ignition of an unusually thick helium layer. Though seven events have already been reported in literature, we have systematically reanalysed the whole sample. We find three new photospheric radius expansion bursts, which are not reported in the literature, allowing us to provide a new estimate of the distances to these sources. We apply the enhanced persistent emission method (also known as the fa method) on sources with detectable persistent emission prior to a burst, in order to follow the evolution of the accretion rate during the burst. Although we do not get significantly better fits, the evolution of the fa factor shows an indicative behaviour, which we discuss.
The influence of a top-heavy integrated galactic IMF and dust on the chemical evolution of high-redshift starbursts
Authors: Palla M , Calura F , Matteucci F , Fan X L , Vincenzo F , Lacchin E
Published: March 2020

We study the effects of the integrated galactic initial mass function (IGIMF) and dust evolution on the abundance patterns of high redshift starburst galaxies. In our chemical models, the rapid collapse of gas clouds triggers an intense and rapid star formation episode, which lasts until the onset of a galactic wind, powered by the thermal energy injected by stellar winds and supernova explosions. Our models follow the evolution of several chemical elements (C, N, α-elements, and Fe) both in the gas and dust phases. We test different values of β, the slope of the embedded cluster mass function for the IGIMF, where lower β values imply a more top-heavy initial mass function (IMF). The computed abundances are compared to high-quality abundance measurements obtained in lensed galaxies and from composite spectra in large samples of star-forming galaxies in the redshift range 2 ≲ z ≲ 3. The adoption of the IGIMF causes a sensible increase of the rate of star formation with respect to a standard Salpeter IMF, with a strong impact on chemical evolution. We find that in order to reproduce the observed abundance patterns in these galaxies, either we need a very top-heavy IGIMF (β < 2) or large amounts of dust. In particular, if dust is important, the IGIMF should have β ≥ 2, which means an IMF slightly more top-heavy than the Salpeter one. The evolution of the dust mass with time for galaxies of different mass and IMF is also computed, highlighting that the dust amount increases with a top-heavier IGIMF.
Data Visualization Tools of Tobacco Product Use Patterns, Transitions and Sex Differences in the PATH Youth Data
Authors: Gueorguieva Ralitza , Buta Eugenia , Simon Patricia , Krishnan-Sarin Suchitra , O’Malley Stephanie S
Published: March 2020

Introduction

Evaluations of multiple tobacco product use and temporal changes in patterns of use are complicated by a large number of combinations and transitions. Visualization tools could easily identify most common patterns and transitions.

Methods

Set intersection bar plots describe ever use of five tobacco products among 12–17 years old youth in wave 1 of the Population Assessment of Tobacco and Health (PATH) study (N = 11 497). Heat maps visualize unweighted frequencies of transitions from ever use at wave 1 (2013–2014) to past 12-month use at wave 2 (2014–2015). Weighted calibrated heat maps assess differences in relative frequencies of transitions by pattern at wave 1 and identify differences in transitions by sex.

Results

The most common tobacco product ever use patterns in wave 1 were of cigarettes only, e-cigarettes only or hookah only, followed by ever use of both cigarettes and e-cigarettes. Initiation of use between waves was uncommon. The most frequent transition among those who reported use at wave 2 but not at wave 1 (N = 971) was to e-cigarette use (N = 301). However, among e-cigarette-only ever users at wave 1 (N = 260), about half did not report any product use at wave 2. Use of three or more products remained stable. Adolescent girls compared to boys appeared more likely to report hookah use at both waves.

Conclusion

Set intersection bar plots and heat maps are useful for visualizing tobacco product use patterns and transitions, especially for multiple products. Both techniques could identify common problematic tobacco use patterns across and within populations.

Implications

Given the growing complexity of the youth tobacco use landscape, approaches to efficiently communicate patterns of multiple tobacco product use should be used more often. This study introduces set intersection bar plots and modified versions of heat maps to the tobacco product literature and illustrates their use in the PATH youth sample. These techniques are useful for visualizing absolute and relative frequencies of multiple possible patterns and transitions. They also suggest targets for subsequent statistical inference such as sex differences in hookah use. The methods can be applied more generally for data visualization wherever large number of combinations occurs.
Uncommon causes of noncardiogenic pulmonary edema
Authors: Simko Lynn Coletta , Culleiton Alicia L.
Published: March 2020

Although acute respiratory distress syndrome is the most common cause of noncardiogenic pulmonary edema, NPs also should be familiar with several other less common causes, including transfusion-related acute lung injury, neurogenic pulmonary edema, preeclampsia/eclampsia, opioid overdose, high-altitude pulmonary edema, and pulmonary embolism. This article addresses the pathophysiology, clinical presentation, diagnostics, treatment, and nursing considerations associated with each uncommon cause of noncardiogenic pulmonary edema.
High density all-pedicle screw technique in correction of high-degree (≥70 degrees) scoliosis with sequential derotation without osteotomies
Authors: Michael Fady , Zayan Ibrahim Mohammed , Fathy Ayman
Published: March 2020

Background:

Pedicle screws have become the principal method for scoliosis correction by allowing secure segmental three-column fixation, with many advantages over other fixation methods. This prospective study was conducted in 23 patients to evaluate the efficacy and safety of high-density pedicle screws in the correction of high degrees (≥70 degrees) of adolescent idiopathic scoliosis with sequential derotation without osteotomies.

Methods:

The traditional posterior approach was done with pedicle-screw instrumentation at each level of the concave side unless the pedicle was hypoplastic or markedly deformed and could not support pedicle-screw purchase. For the convex side, the surgeons instrumented at least the three lower-most vertebrae, three upper-most vertebrae, and at least three apical vertebrae. The mean preoperative Cobb angle of the major curve was 82.34 degrees.

Results:

The Cobb angle had been corrected to 19.65 degrees postoperatively and to 20.69 degrees at latest follow-up. The percent of curve correction was 76.1%. The Scoliosis Research Society (SRS) 22 questionnaire score improved significantly from a mean of 2.3 preoperatively to 3 at latest follow-up. There was no metal failure or pseudarthrosis detected during the follow-up period. The high-density screw technique allows control of each vertebra in the curve. Using a tough rod with a rod derotation technique aligns the coronal position of each vertebra.

Conclusions:

A high-density pedicle-screw technique through a posterior-only approach is a safe, effective method for treatment of severe adolescent idiopathic scoliosis avoiding the anterior approach-related complications.

Level of Evidence:

Level IV.
Changes in Cervical Spinal Alignment After Thoracolumbar Corrective Surgery in Adult Patients With Adolescent Idiopathic Scoliosis
Authors: Nagoshi Narihito , Yagi Mitsuru , Daimon Kenshi , Suzuki Satoshi , Tsuji Osahiko , Okada Eijiro , Fujita Nobuyuki , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: March 2020

Study Design.

Case–control study.

Objective.

To examine factors influencing cervical alignment after corrective surgery for adult patients with adolescent idiopathic scoliosis (AdIS)

Summary of Background Data.

Corrective surgery for spinal deformity influences postoperative cervical spinal alignment, but changes in the cervical alignment in adults with AdIS are scarcely reported.

Methods.

We retrospectively examined 85 patients with AdIS who underwent posterior corrective surgery for thoracic or lumbar major curve and were followed up for 2 years. Clinical characteristics, radiographic parameters, and health-related quality of life (HRQOL) were evaluated. Cervical deformity (CD) was defined as one of the following cases: (1) T1 tilt minus C2–C7 angle more than 20°, (2) C2–C7 SVA more than 40 mm, (3) and C2–C7 angle less than −10°. Patients were divided into those with and without CD based on the defined criteria; statistically relevant factors were analyzed.

Results.

There were 19 patients in the postoperative CD group. The average age at the time of surgery was lower in the CD group (26.5 vs. 31.4). In the CD group, the average preoperative T1 tilt was smaller (1.1° vs. 12.5°), and the C2–C7 angle was kyphotic (−16.1° vs. 3.0°). The average kyphotic angle at thoracic spine (T5–T12) was lower in the CD group preoperatively (12.5° vs. 19.5°) and postoperatively (15.2° vs. 20.8°). HRQOL outcomes were comparable between the groups. Of the patients with preoperative CD, 51.5% (n = 17) maintained their deformity at the final follow-up, and baseline C2–C7 angle was lower than those who converted to non-CD following surgery (n = 16) (−17.0° vs. −10.3°).

Conclusion.

More than half of the patients with baseline CD maintained their cervical malalignment postoperatively. Patients with postoperative CD presented cervical kyphotic and thoracic hypokyphotic alignments before surgery. Because CD has the potential to lead to cervical degeneration, careful follow-up observation is necessary for these young patients.

Level of Evidence: 3
Postoperative Pain, Narcotics Consumption, and Patient-Reported Outcomes Based on PROMIS Physical Function Following a Single-Level Anterior Cervical Discectomy and Fusion
Authors: Parrish James M. , Jenkins Nathaniel W. , Narain Ankur S. , Hrynewycz Nadia M. , Brundage Thomas S. , Singh Kern
Published: March 2020

Study Design.

Retrospective.

Objective.

To determine the association between preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scores with postoperative pain, narcotics use, and patient-reported outcomes (PRO) following a single-level anterior cervical discectomy and fusion (ACDF) procedure.

Summary of Background Data.

There is a scarcity of prior literature on the ability of baseline PROMIS scores to predict clinical outcomes for patients undergoing ACDF procedures.

Methods.

Patients who underwent a primary ACDF were retrospectively reviewed and stratified into low and high disability cohorts. Preoperative PROMIS PF cohorts were tested for association with demographic and perioperative characteristics using chi-square analysis and one-way analysis of variance. Cohorts were tested for association with inpatient pain scores and narcotics consumption, as well as postoperative improvements in PROMIS PF, neck disability index (NDI), and visual analog scale (VAS) neck and arm pain using linear regression.

Results.

Ninety one patients were included: 39 low disability and 52 high disability. Inpatient postoperative VAS pain scores and narcotic consumption are also compared between cohorts. Patients with greater disability reported higher VAS pain scores (P = 0.003). However, patients in both cohorts consumed comparable amounts of narcotics (P = 0.926). Patients with greater preoperative disability demonstrated lower PROMIS PF scores, greater NDI scores, and greater VAS Neck scores at the preoperative baseline. However, patients demonstrated similar improvement of VAS neck and arm pain, as well as NDI at all postoperative timepoints. Patients with low disability reported worsened physical function at the 6 weeks timepoint.

Conclusion.

Patients with worse preoperative disability as measured by PROMIS PF reported increased pain but comparable narcotics consumption in the immediate postoperative period following a single-level ACDF procedure. Furthermore, patients experienced similar long-term postoperative improvement of PROs regardless of preoperative physical function. PROMIS PF can efficiently quantify physical function before and after the ACDF procedure as self-evaluated by patients.

Level of Evidence: 3
Does Menses Affect the Risk of Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgeries?
Authors: Chiu Chee Kidd , Gani Siti Mariam Abd , Chung Weng Hong , Mihara Yuki , Hasan Mohd Shahnaz , Chan Chris Yin Wei , Kwan Mun Keong
Published: March 2020

Study Design.

Retrospective propensity score matching study.

Objective.

To investigate whether menses affect intraoperative blood loss in female adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgeries.

Summary of Background Data.

There were concerns whether patients having menses will have higher intraoperative blood loss if surgery were to be done during this period.

Methods.

This study included 372 females who were operated between May 2016 to May 2019. Fifty-five patients had menses during surgery (Group 1, G1) and 317 patients did not have menses during surgery (Group 2, G2). Propensity score matching (PSM) analysis with one-to-one, nearest neighbor matching technique and with a match tolerance of 0.001 was used. The main outcome measures were intraoperative blood loss (IBL), volume of blood salvaged, transfusion rate, preoperative hemoglobin, preoperative platelet, preoperative prothrombin time, preoperative activated partial thromboplastin time (APTT), international normalized ratio (INR), and postoperative hemoglobin. Postoperative Cobb angle and correction rate were also documented.

Results.

At the end of PSM analysis, 46 patients from each group were matched and balanced. The average operation duration for G1 was 140.8 ± 43.0 minutes compared with 143.1 ± 48.3 minutes in G2 (P = 0.806). The intraoperative blood loss for G1 was 904.3 ± 496.3 mL and for G2 was 907.9 ± 482.8 mL (P = 0.972). There was no significant difference in terms of normalized blood loss (NBL), volume of blood salvaged during surgery, preoperative hemoglobin, postoperative hemoglobin, hemoglobin drift, estimated blood volume (EBV), IBL per EBV and IBL per level fused (P > 0.05). No postoperative complications were encountered in both groups. On average, the postoperative hospital stay was 3.5 ± 0.8 days for both groups (P = 0.143).

Conclusion.

Performing corrective surgery during the menstrual phase in female AIS patients is safe without risk of increased blood loss.

Level of Evidence: 4
A Modified Posterior Approach for Decompression of a Multiloculated Atlanto-axial Cyst With Myelopathy
Authors: Patel Bharat K. , Bapat Mihir R. , Upadhyay Arpit S.
Published: March 2020

Study Design.

Case report.

Objective.

To describe a modified posterior approach for decompression and excision of a multiloculated atlanto-axial cyst.

Summary of Background Data.

Atlanto-axial cyst with myelopathy is rare. A direct decompression through anterior approach or an indirect decompression through posterior approach has been proposed. We report a rare multiloculated large C1–C2 cyst extending down to C3 body with myelopathy that created a dilemma in choice of approach. A modified posterior approach was adopted for decompression.

Methods.

A 72-year-old lady, known case of Rheumatoid arthritis, presented with cervical myelopathy which was rapidly progressive since 2 months being her to wheel chair bound. She had clumsiness of gait and bilateral grip weakness. Both upper and lower extremities had nonfunctional power (medical research council scale grade 2). Deep tendon reflexes were exaggerated. Sensation was reduced in trunk and both extremities. Magnetic resonance imaging and computed tomography scan showed a large multiloculated cyst compressing spinal cord. Here author used modified posterior approach from the right side to access the cyst. The C2 ganglion excision, vertebral artery isolation, and resection of the pars allowed an approach similar to transforaminal decompression in the lumbar spine. A large antero-lateral epidural part of the cyst was excised. The retro-dental cyst was decompressed by puncturing cyst. Biopsy confirmed a synovial cyst.

Result.

The patient showed rapid neurological recovery after surgery. Postoperative magnetic resonance imaging at 3 months showed complete resolution of cyst. At 2-year follow-up, there was a complete neurological recovery with residual spasticity.

Conclusion.

A customized posterior approach allowed near total excision of a rare multiloculated large C1-2 cyst extending to the C3 body. This allowed visualisation anterior to the spinal cord without undue retraction that saved an additional anterior decompression.

Level of Evidence: 5
Keeping pace with the competition: His bundle versus biventricular pacing in heart failure
Authors: Upadhyay Gaurav A. , Tung Roderick
Published: March 2020

Purpose of review

His bundle pacing (HBP) has emerged as a novel method to achieve electrical resynchronization in bundle branch block and as an alternative means to deliver cardiac resynchronization therapy (CRT). There are now data on HBP in CRT-eligible patients from cohort studies and a single pilot randomized controlled trial (RCT).

Recent findings

Early clinical data regarding HBP in heart failure have demonstrated echocardiographic and functional improvement similar to traditional biventricular pacing (BiV), mostly when utilized as a bailout to traditional BiV-CRT. A single pilot RCT, His-SYNC, showed a trend toward greater echocardiographic response in an on-treatment analysis, but was underpowered. No large RCTs have reported long-term clinical outcomes. In order to realize any benefit from HBP, output-dependent morphology changes must be demonstrated to ensure the conduction system capture is present. There may be a role for corrective HBP in patients with right bundle branch block and after atrioventricular node ablation, which is theoretically more desirable than traditional BiV. Importantly, however, HBP is likely not to benefit patients with nonspecific intraventricular conduction delay.

HBP is emerging as an alternative strategy for CRT and may have a role in patients in whom traditional BiV is not achievable or ineffective.
Vascular aging and its relationship with lifestyles and other risk factors in the general Spanish population: Early Vascular Ageing Study
Authors: Gomez-Sanchez Marta , Gomez-Sanchez Leticia , Patino-Alonso Maria C. , Cunha Pedro G. , Recio-Rodriguez Jose I. , Alonso-Dominguez Rosario , Sanchez-Aguadero Natalia , Rodriguez-Sanchez Emiliano , Maderuelo-Fernandez Jose A. , Garcia-Ortiz Luis , Gomez-Marcos Manuel A.
Published: March 2020

Objectives:

To describe the prevalence of healthy vascular aging (HVA), normal vascular aging and early vascular aging (EVA) in a sample of Spanish population without cardiovascular disease. The relationship of vascular aging with lifestyle, cardiovascular risk factors, psychological and inflammatory risk factors is also analyzed.

Methods:

A total of 501 participants were recruited (49.70% men, aged 55.90 ± 14.24 years) by random sampling. Vascular aging was defined in three steps: Step 1: participants with vascular damage in carotid arteries or peripheral artery disease were classified as EVA. Step 2: with the percentiles of carotid-to-femoral pulse wave velocity (cfPWV) we used three criteria, first, the 10th and 90th cfPWV percentiles of the population studied by age and sex; second, the 10th and 90th percentiles of the European population reference values and third, the 25th and 75th cfPWV percentiles of the population studied by age and sex. Step 3: participants with hypertension or type 2 diabetes mellitus included in HVA were reclassified as normal vascular aging. Arterial stiffness was assessed with cfPWV using a Sphygmocor device. Physical activity was measured with an accelerometer. Psychological factors, lifestyle and other clinical information were obtained by standard questionnaire.

Results:

The global prevalence of HVA was 8 and 14% (men 8 and 10%, women 9 and 18%), and 22 and 18% (men 26 and 23%, women 17 and 12%) for EVA, using criteria a and b, respectively. In the logistic regression analysis, vascular aging maintains positive associations with more sedentary time [odds ratio (OR) = 2.37 and 4.51], having triglycerides above 150 mg/dl (OR = 6.55 and 4.06), abdominal obesity (OR = 2.73 and 2.90), increased uric acid (OR = 4.63 and 2.98) and insulin resistance index homeostatic model assessment (OR = 4.05 and 6.78), and a negative association with less physical activity (OR = 0.29 and 0.28) using criteria a and b, respectively.

Conclusion:

One in 10 has HVA and one in five EVA. The prevalence of EVA is higher in men. Study results suggest that preventive strategies aimed at increasing physical activity, reducing sedentary time and decreasing obesity and insulin resistance improve vascular aging.
Hypertension in aortic stenosis: a focused review and recommendations for clinical practice
Authors: Saeed Sahrai , Scalise Filippo , Chambers John B. , Mancia Giuseppe
Published: March 2020

In patients with aortic stenosis, the presence of hypertension negatively affects the hemodynamic severity of the stenosis, and worsens adverse left ventricular remodeling. It accelerates the progression of the stenosis and is associated with worse prognosis. Proper management of hypertension is thus crucial but there are concerns about the safety and efficacy of antihypertensive medications as well as uncertainty about optimal blood pressure (BP) targets and their impact on left ventricular mass regression and survival benefits. In the present review, we discuss these issues based on the evidence available in the current literature. Focus is first directed on the consequences of a persistently elevated BP before and after surgical aortic valve replacement or transcatheter valve implantation, and the clinical significance of an abnormal BP response during exercise in patients with significant aortic stenosis. Available data on use of antihypertensive drugs are then critically addressed, the conclusion being that calcium channel blockers may be associated with lower survival, and that diuretics may have disadvantages in patients with left ventricular hypertrophy and smaller left ventricular cavity dimensions, β-blockers may be well tolerated and a better choice for patients with concomitant coronary artery disease and arrhythmias. Renin--angiotensin system blockers improve survival given either before or after valve intervention. Emphasis is placed on the fact that evidence is not derived from randomized trials but only from observational studies. Finally, we discuss the optimal SBP level to reach in patients with aortic stenosis. Again, randomized trials are not available but observational evidence suggests that values between 130 and 139 mmHg systolic and 70–90 mmHg diastolic might represent the best option, and lower BP targets should probably be avoided.
The retina revolution: signaling pathway therapies, genetic therapies, mitochondrial therapies, artificial intelligence
Authors: Wood Edward H. , Korot Edward , Storey Philip P. , Muscat Stephanie , Williams George A. , Drenser Kimberly A.
Published: March 2020

Purpose of review

The aim of this article is to review and discuss the history, current state, and future implications of promising biomedical offerings in the field of retina.

Recent findings

The technologies discussed are some of the more recent promising biomedical developments within the field of retina. There is a US Food and Drug Administration-approved gene therapy product and artificial intelligence device for retina, with many other offerings in the pipeline.

Signaling pathway therapies, genetic therapies, mitochondrial therapies, and artificial intelligence have shaped retina care as we know it and are poised to further impact the future of retina care. Retina specialists have the privilege and responsibility of shaping this future for the visual health of current and future generations.
Cohort Study of Nonmelanoma Skin Cancer and the Risk of Exfoliation Glaucoma
Authors: Kang Jae H. , VoPham Trang , Laden Francine , Rosner Bernard A. , Wirostko Barbara , Ritch Robert , Wiggs Janey L. , Qureshi Abrar , Nan Hongmei , Pasquale Louis R.
Published: March 2020

Precis:

In a cohort study of 120,307 participants with 25+ years of follow-up, a history of nonmelanoma skin cancer (NMSC) was associated with a 40% higher exfoliation glaucoma (XFG) risk.

Purpose:

The purpose of this study was to evaluate the relationship between NMSC (a marker of ultraviolet radiation exposure) and XFG.

Methods:

We performed a cohort study of US women (n=79,102; 1980-2014) and men (n=41,205; 1986-2014), aged 40+ years and at risk for glaucoma who reported eye examinations. From 1984 (women)/1988 (men), we asked about basal cell carcinoma or squamous cell carcinoma history separately; in prior years, we asked about any NMSC history in a single question. Squamous cell carcinoma was confirmed with histopathology reports while basal cell carcinoma and any early (<1984/<1988) NMSC history was self-reported. Incident XFG cases (362 women and 83 men) were confirmed with medical records. Using pooled data, we estimated multivariable-adjusted relative risks [MVRRs; 95% confidence intervals (CIs)] with Cox proportional hazards models that were stratified by age (in mo), 2-year time period at risk and average lifetime residential latitude.

Results:

In multivariable-adjusted analyses, we observed a 40% higher XFG risk with any NMSC history (MVRR=1.40; 95% CI=1.08-1.82); the association was observed even with 4 and 8-year lags in NMSC history. Also, the NMSC association was stronger in younger (below 65 y; MVRR=2.56; 95% CI=1.62-4.05) versus older participants (65 y and above; MVRR=1.25; 95% CI=0.94-1.66;Pfor interaction=0.01) and those living in the northern latitudes (≥42°N; MVRR=1.92; 95% CI=1.28-2.88) versus more southern latitudes (<42°N; MVRR=1.19; 95% CI=0.86-1.66;Pfor interaction=0.04).

Conclusion:

NMSC was associated with higher XFG risk, particularly among younger participants and those living in the Northern US.
Upper Eyelid Isolated Arterio-Venous Malformation Treated With Embolization in a Patient With Keloid-Prone Skin
Authors: Capasso Raffaella , Russo Camilla , Iuliano Adriana , Cocozza Sirio , Pontillo Giuseppe , Tortora Fabio , Strianese Diego , Elefante Andrea , Briganti Francesco
Published: March 2020

Ocular adnexal aterio-venous malformations (AVMs) are rare congenital disabling anomalies, which may enlarge causing disfiguring deformity and rarely severe hemorrhage. These lesions are generally treated by preliminary endovascular embolization to shrink the arterio-venous malformation, followed by surgical gross total resection. The authors report a case of eyelid arterio-venous malformation in a 12-year-old girl, which progressively increased in size in few months. The patient complained mild itching, blurring of the vision, and mild tenderness. Magnetic resonance imaging showed an expansive mass with multiple arterial vessels at the left superior eyelid and left forehead. The diagnosis of arterio-venous malformation was then confirmed by digital subtraction angiography. Primary surgical excision was excluded because of the high risk of intrasurgical bleeding. Embolization through superselective cannulation of the left external carotid feeder vessels was performed resulting in flow exclusion up to the 80% of the nidus. Subsequent surgical resection was not recommended due to clinical evidence of keloid-prone skin.
Preterm Birth
Authors: Gupta Rahul , Froeb Katherine
Published: March 2020

In July 2019, the Centers for Disease Control and Prevention released data for 2018 that indicated a rise in preterm births (birth at <37 weeks' gestation). This increase marks the fourth consecutive year that the United States has seen an increase in infants born too soon or too small. March of Dimes examined these data for its annual report card, giving the nation a “C” letter grade for this dismal outcome. This rise coincides with an ongoing increase in pregnancy-related death, the rate of which has more than doubled over the last 25 years in the United States. Racial and ethnic minorities suffer inequitably. Women of color are up to 50% more likely to give birth prematurely. Black, American Indian, and Alaska Native women are 2 to 3 times more likely to die from pregnancy-related causes than white women. A new approach is needed to address these crises. That approach must consider a range of population-based systems-level solutions.
A clinical algorithm for management of fertility in adolescents with the Klinefelter syndrome
Authors: Masterson Thomas A. , Nassau Daniel E. , Ramasamy Ranjith
Published: March 2020

Purpose of review

The review presents a clinical algorithm for the evaluation and treatment for adolescents with Klinefelter's syndrome who desire fertility preservation.

Recent findings

Sperm is present in the ejaculate in around 8% of men with Klinefelter's syndrome. Although most are severely oligospermic/azoospermic, 43–45% of men will have sperm found during a testicular sperm extraction, reaching up to 70% in adolescents.

Klinefelter's syndrome (47, XXY) causes hypogonadotophic hypogonadism and severe oligospermia/azoospermia rendering natural conception rare. During puberty, boys often require testosterone replacement therapy to develop secondary sexual characteristics, which can further decrease spermatogenesis. There is a progressive decrease of testicular germ cells after the onset of puberty, suggesting that fertility evaluation and preservation should begin shortly thereafter. In adolescents desiring fertility evaluation, any testosterone therapy should be discontinued, hormones and gonadotrophins measured, and a semen analysis obtained. Adolescents with low testosterone are administered aromatase inhibitors, selective estrogen receptors modulators and/or human chorionic gonadotropin to increase endogenous testosterone production. After testosterone levels are normalized, semen analysis is performed, and cryopreservation encouraged if sperm is present. For those without sperm in the ejaculate, a testicular sperm extraction is offered.
Advanced sperm testing
Authors: Softness Kenneth A. , Trussler James T. , Carrasquillo Robert J.
Published: March 2020

Purpose of review

The sensitivity of semen analysis for detection of infertility remains low. Many factors not measured in traditional semen analysis may contribute to male factor infertility. DNA fragmentation, oxidative stress, and sperm aneuploidy are three factors that may contribute further information to the evaluation when semen analysis is inconclusive.

Recent findings

DNA fragmentation measures the destruction of and failure to repair damage to DNA. Increased DNA fragmentation has been used as a marker for oxidative stress as well as toxic exposure. The oxidative stress adduct measures DNA aberrations, which sperm cannot repair and has been used to support use of antioxidants. Lastly, the aneuploid sperm frequency is a quantitative measure of deviation from the normal chromosomal complement. Although elevated sperm aneuploid frequency has been associated with recurrent pregnancy loss and implantation failures, barriers remain to its routine use.

We identified these three adjunctive tests, which have the potential to alter either management or counseling of patients with regards to male factor infertility. Elevated DNA fragmentation or significant sperm aneuploidy may suggest the need for further investigation or further preimplantation genetic testing prior to IVF. The oxidative stress adduct may lend further explanation and improved counseling of the infertile patient.
Frontiers in combining immune checkpoint inhibitors for advanced urothelial cancer management
Authors: Rebhan Katharina , Laukhtina Ekaterina , Shariat Shahrokh F. , Gust Kilian M.
Published: March 2020

Purpose of review

This review provides an overview of currently ongoing clinical trials evaluating the combination of immune checkpoint inhibitors (CPI) with other therapies in locally advanced or metastatic urothelial cancer and the rationale for this combination approach. We discuss the preliminary results from early data presented at recent meetings regarding the efficacy and safety of novel combination therapies including a CPI for metastatic urothelial cancer.

Recent findings

CPI emerged as novel first-line or second-line treatment options in advanced and metastatic urothelial cancer (mUC). Although the response rates and their sustainability are promising, it is far from a home run. Combination therapies have already shown improved efficacy in several other tumor entities.

Numerous clinical trials currently investigate combinations of CPI with other CPI, previously established systemic chemotherapy, targeted therapies, vaccines, or accompanied with radiotherapy. Preliminary data shows promising results. These results suggest that targeting pathways of immune response combined with established or novel oncological therapies may lead to a synergistic antitumor effect.
Postmortem Magnetic Resonance Imaging and Postmortem Computed Tomography in Ligature and Manual Strangulation
Authors: Deininger-Czermak Eva , Heimer Jakob , Tappero Carlo , Thali Michael J. , Gascho Dominic
Published: March 2020

Purpose

The aim of this study was to evaluate magnetic resonance imaging (MRI) findings in cases of fatal manual or ligature strangulation. Verification of strangulation by computed tomography (CT), MRI, and at autopsy as well as its detectability in each modality was assessed.

Methods

We retrospectively analyzed 6 manual and ligature strangulation cases between 2013 and 2019 who all underwent a whole-body CT, head and neck MRI, and an autopsy. Two radiologists examined head and neck imaging data and compared the data to autopsy findings.

Results

Magnetic resonance imaging showed a high efficiency in verifying intramuscular hemorrhages, which were confirmed in autopsy. Moreover, in one case without a visible strangulation mark, soft tissue injuries associated with strangulation were detected. Fractures, especially thyroid cartilage fractures, were successfully diagnosed by CT.

Conclusions

As MRI showed a successful detection of soft tissue lesions in relation to strangulation, it can serve as an alternative method or provide additional value to an autopsy. Intramuscular hemorrhages are a common finding in manual and ligature strangulation, providing a useful sign of applied pressure on the neck. However, to evaluate fractures, an additional CT or autopsy is recommended.
Oligometastatic and Oligoprogression Disease and Local Therapies in Prostate Cancer
Authors: Deek Matthew P. , Tran Phuoc T.
Published: March 2020

Our understanding of metastatic disease is rapidly advancing, with recent evidence supporting an oligometastatic state currently defined by patients having a limited (typically ≤5) number of metastatic deposits. The optimal management of these patients is also shifting toward increased integration of local therapies, with emerging evidence suggesting metastasis-directed therapy can improve overall survival. Additionally, the use of stereotactic ablative radiation therapy within castration-sensitive oligometastatic prostate cancer cohorts appears to forestall the need to initiate systemic therapy, which has unfavorable side effect profiles, such as androgen deprivation therapy, while itself being associated with little toxicity. We review the literature surrounding the use of metastasis-directed therapy in the treatment of oligometastatic prostate cancer by reviewing the evidence for its use within 3 subgroups: de novo synchronous, oligorecurrent, and oligoprogressive disease.
Radiomics, Radiogenomics, and Next-Generation Molecular Imaging to Augment Diagnosis of Hepatocellular Carcinoma
Authors: Bell Meghan , Turkbey Evrim B. , Escorcia Freddy E.
Published: March 2020

Ultrasound, computed tomography, magnetic resonance imaging, and [18F]F-fluorodeoxyglucose positron emission tomography are invaluable in the clinical evaluation of human cancers. Radiomics and radiogenomics tools may allow clinicians to standardize interpretation of these conventional imaging modalities, while better linking radiographic hallmarks to disease biology and prognosis. These advances, coupled with next-generation positron emission tomography imaging tracers capable of providing biologically relevant tumor information, may further expand the tools available in our armamentarium against human cancers. We present current imaging methods and explore emerging research that may improve diagnosis and monitoring of local, oligometastatic, and disseminated cancers exhibiting heterogeneous uptake of [18F]F-fluorodeoxyglucose, using hepatocellular carcinoma as an example.
Radiation in the Treatment of Oligometastatic and Oligoprogressive Disease
Authors: Zayed Sondos , Correa Rohann J.M. , Palma David A.
Published: March 2020

The use of local ablative therapy or metastasis-directed therapy is an emerging management paradigm in oligometastatic and oligoprogressive cancer. Recent randomized evidence has demonstrated that stereotactic ablative radiotherapy (SABR) targeting all metastatic deposits is tolerable and can improve progression-free and overall survival. While SABR is noninvasive, minimally toxic, and generally safe, rare grade 5 events have been reported. Given this and recognizing the often-uncertain prognosis of patients with metastatic disease, equipoise persists regarding the therapeutic window within which to deploy SABR for this indication. Ongoing phase III trials are aimed at validating the demonstrated safety, tolerability, and survival benefits while also refining patient selection, possibly with the aid of novel biomarkers. This narrative review of the role of SABR in oligometastatic and oligoprogressive disease summarizes recent randomized evidence and ongoing clinical trials, discusses our rationale for treatment and key management principles, and posits that SABR should be considered the preferred modality for multisite, metastasis-directed ablative therapy.
Augmenting Interpretation of Chest Radiographs With Deep Learning Probability Maps
Authors: Hurt Brian , Yen Andrew , Kligerman Seth , Hsiao Albert
Published: March 2020

Purpose:

Pneumonia is a common clinical diagnosis for which chest radiographs are often an important part of the diagnostic workup. Deep learning has the potential to expedite and improve the clinical interpretation of chest radiographs. While earlier approaches have emphasized the feasibility of “binary classification” to accomplish this task, alternative strategies may be possible. We explore the feasibility of a “semantic segmentation” deep learning approach to highlight the potential foci of pneumonia on frontal chest radiographs.

Materials and Methods:

In this retrospective study, we trained a U-net convolutional neural network (CNN) to predict pixel-wise probability maps for pneumonia using a public data set provided by the Radiological Society of North America (RSNA) comprised of 22,000 radiographs and radiologist-defined bounding boxes. We reserved 3684 radiographs as an independent validation data set and assessed overall performance for localization using Dice overlap and classification performance using the area under the receiver-operator characteristic curve.

Results:

For classification/detection of pneumonia, area under the receiver-operator characteristic curve on frontal radiographs was 0.854 with a sensitivity of 82.8% and specificity of 72.6%. Using this strategy of neural network training, probability maps localized pneumonia to lung parenchyma for essentially all validation cases. For segmentation of pneumonia for positive cases, predicted probability maps had a mean Dice score (±SD) of 0.603±0.204, and 60.0% of these had a Dice score >0.5.

Conclusions:

A “semantic segmentation” deep learning approach can provide a probabilistic map to assist in the diagnosis of pneumonia. In combination with the patient’s history, clinical findings and other imaging, this strategy may help expedite and improve diagnosis.
Pretest and Posttest Evaluation of a Longitudinal, Residency-Integrated Microsurgery Course
Authors: Chacon Miranda A. , Myers Paige L. , Patel Alap U. , Mitchell Drew C. , Langstein Howard N. , Leckenby Jonathan I.
Published: March 2020

Introduction

Current microsurgical training courses average 5 consecutive 8-hour days and cost US $1500 to US $2500/individual, making training a challenge for residents who are unable to take leave from clinical duties. This residency-integrated microsurgery course was designed for integration with a residency program, averaging 3 hours/week over 7 weeks. This allows for one-on-one training, beginning with synthetic tissue and concluding with in vivo stimulation. This study was performed to validate this longitudinal training course.

Methods

After recruitment and before the start of coursework, subjects completed a baseline anastomosis without guidance and a survey regarding microsurgical experience. Subjects completed approximately 3 hours/week of practical exercises. Weeks 1 to 5 used synthetic models, whereas 6 to 7 used in vivo rodent models. Nine minimum anastomoses of increasing complexity were completed and assessed with the Anastomosis Lapse Index and the Stanford Microsurgery and Residency Training scale. Scoring was performed by 3 independent reviewers and averaged for comparison.

Results

Five subjects completed the course for study. Presurvey results showed an average confidence in theoretical knowledge of 2/5; technical ability to perform procedures, 1.8/5; and ability to manage complications, 1.8/5. Postsurvey revealed confidence in theoretical knowledge of 2.5/5; technical ability to perform procedures, 2.25/5; and ability to manage complications, 2.25/5. None of these differences were significant. Each individual component of the Stanford Microsurgery and Residency Training scale scoring system improved postcourse with P < 0.05, and overall performance score improved from an average of 2.6 to 3.9 (P = 0.006). The total number of errors recorded using the Anastomosis Lapse Index reduced from 6.58 to 3.41 (P = 0.02). Time to completion reduced from an average of 28 minutes, 8 seconds to 24 minutes, 5 seconds (P = 0.003).

Conclusions

Despite a lack in significant confidence improvement, completion of the residency-integrated microsurgery course leads to significant and quantifiable improvement in resident microsurgical skill and efficiency.
Effect of addition of sweet potato on physiochemical properties of Kochujang
Authors: Park Su-Ah , Kim Dong-Han
Published: March 2020

Kochujang was prepared by replacement of rice (25%, control) with pumpkin or purple sweet potato by 0. 5, 10, and 15% (total addition ratio of rice and sweet potato=25% of sample). Effects of the addition of sweet potato on physiochemical properties of fermented Kochujang were investigated. Viable cells of yeast decreased in the sweet potato-added Kochujang at the later stage of fermentation, while there was no significant difference in the number of bacteria among the test groups. As the addition ratio sweet potato increased, α-amylase activity increased while protease activity decreased. Hunter L, a, and b values of Kochujang prepared with purple sweet potato were lower than those with pumpkin sweet potato. Changes in ΔE value was greater in Kochujang prepared with pumpkin sweet potato than that with purple sweet potato. Oxidation-reduction potential and water activity were higher in sweet potato-Kochujang than control, but reducing sugar content was higher in control. Alcohol and amino-type nitrogen contents were higher in Kochujang prepared with pumpkin sweet potato than that with purple sweet potato, but it was not significant. Overall sensory acceptability was highest in Kochujang prepared with 10% of purple sweet potato while that with 15% pumpkin sweet potato was the least preferred.