bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthesia and intraoperative neurophysiological spinal cord monitoring
Authors: Sahinovic Marko M. , Gadella Maria C. , Shils Jay , Dulfer Sebastiaan E. , Drost Gea
Published: July 2021

Purpose of review

We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery.

Recent findings

In recent years, the use of IONM has increased significantly. It has developed into a mature discipline, enabling neurosurgical procedures of ever-increasing complexity. It is thus of growing importance for the anesthesiologist to appreciate the interplay between IONM and anesthesia and to build up experience working in a team with the neurosurgeon and the neurophysiologist.

Safety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM.
The Value of Sentinel Lymph Node Mapping for the Staging of Node-Negative Colon Cancer
Authors: Weixler Benjamin , Ramser Michaela , Warschkow Rene , Viehl Carsten T. , Vaughan-Shaw Peter G. , Zettl Andreas , Kettelhack Christoph , Zuber Markus
Published: July 2021

Objectives:

Mediation analysis to assess the protective impact of sentinel lymph node (SLN) mapping on prognosis and survival of patients with colon cancer through a more precise evaluation of the lymph node (LN) status.

Background:

Up to 20% of patients with node-negative colon cancer develop disease recurrence. Conventional histopathological LN examination may be limited in describing the real metastatic burden of LN.

Methods:

Data of 312 patients with stage I & II colon cancer was collected prospectively. Patients were either staged using intraoperative SLN mapping with multilevel sectioning and immunohistochemical staining of the SLN or conventional techniques. The value of the SLN mapping for the detection of truly node-negative patients was assessed using Cox regression and mediation analysis.

Results:

SLN mapping was performed in 143 patients. Disease recurrence was observed in 13 (9.1%) patients staged with SLN mapping and in 27 (16%) staged conventionally. Five-year overall survival (OS) rate was 82.7% (95% confidence interval [CI], 76.5–89.4%) with SLN mapping compared with 65.8% (95% CI, 58.8–73.7%). Five-year cancer-specific survival (CSS) was 95.1% (95% CI, 91.3–99.0%) with SLN mapping compared with 92.5% (95% CI, 88.0–97.2%). Node-negative staging with SLN mapping was associated with significantly better OS (hazard ratio [HR], 0.64; 95% CI, 0.56–0.72; P < 0.001) and CSS (HR, 0.49; 95% CI, 0.39–0.61; P < 0.001) in multivariate analysis. Mediation analysis confirmed a direct protective effect of SLN mapping on OS (HR, 0.78; 95% CI, 0.52–0.96; P < 0.01) and disease-free survival (DFS) (HR, 0.75; 95% CI, 0.48–0.89; P < 0.01).

Conclusions:

Staging performed by SLN mapping with multilevel sectioning provides more accurate results than conventional staging. The observed clinically relevant and statistically significant benefit in OS and DFS is explained by a more accurate detection of positive LN by SLN mapping.
Considerations for successful therapeutic immunization in HIV cure
Authors: Mothe Beatriz , Brander Christian
Published: July 2021

Purpose of review

In this special issue on human immunodeficiency (HIV) cure, we review the role of therapeutic immunization in strategies aimed to eliminate HIV-infected cells and/or mediate sustained control of viral replication in the absence of antiretroviral treatment.

Recent findings

Recent data emerging from studies in simian immunodeficiency virus macaque models using broadly neutralizing antibodies, given alone or in combination with other immunomodulatory agents, as well as data from human clinical studies with novel therapeutic vaccines are showing encouraging results indicating that achieving viral remission or at least partial viral control of HIV without antiretroviral therapy is feasible.

Although it remains unclear whether current strategies will be able to awaken a sufficient large fraction of the viral reservoir and/or vaccine-boosted immunity will induce effective, long-lasting viral suppression in chronically infected HIV population, emerging results establish cure strategies that can be further improved upon.
American Proctology Before 1899, Part 1: “Shoals of Quacks”—The Itinerant Pile Doctor
Authors: Janssen Diederik F.
Published: July 2021

The early history of the American medical specialty of proctology before the 1899 establishment of the American Proctologic Society was animated by an extensive scene of itinerant pile doctors, from at least as far back as 1871. It was inspired by the initially proprietary carbolic acid injection treatment of hemorrhoids credited to Milton W. Mitchell (1833?–1887), long known only from oral history. Expanded entrepreneurial approaches seen in the 1880s are exemplified by the work of the initial exploiters of Mitchell’s method, Alexander William Brinkerhoff (1821–1887) and son, and a mid-1920s recommercialization of “ambulant proctology” by its ambassador Charles Elton Blanchard.
Spatial Errors in Automated Geocoding of Incident Locations in Australian Suicide Mortality Data
Authors: Torok Michelle , Konings Paul , Passioura Jason , Chen Nicole A. , Hewett Michael , Phillips Matthew , Burnett Alexander , Shand Fiona , Christensen Helen
Published: July 2021

Background:

There is increasing interest in the spatial analysis of suicide data to identify high-risk (often public) locations likely to benefit from access restriction measures. The identification of such locations, however, relies on accurately geocoded data. This study aims to examine the extent to which common completeness and positional spatial errors are present in suicide data due to the underlying geocoding process.

Methods:

Using Australian suicide mortality data from the National Coronial Information System for the period of 2008–2017, we compared the custodian automated geocoding process to an alternate multiphase process. Descriptive and kernel density cluster analyses were conducted to ascertain data completeness (address matching rates) and positional accuracy (distance revised) differences between the two datasets.

Results:

The alternate geocoding process initially improved address matching from 67.8% in the custodian dataset to 78.4%. Additional manual identification of nonaddress features (such as cliffs or bridges) improved overall match rates to 94.6%. Nearly half (49.2%) of nonresidential suicide locations were revised more than 1,000 m from data custodian coordinates. Spatial misattribution rates were greatest at the smallest levels of geography. Kernel density maps showed clear misidentification of hotspots relying solely on autogeocoded data.

Conclusion:

Suicide incidents that occur at nonresidential addresses are being erroneously geocoded to centralized fall-back locations in autogeocoding processes, which can lead to misidentification of suicide clusters. Our findings provide insights toward defining the nature of the problem and refining geocoding processes, so that suicide data can be used reliably for the detection of suicide hotspots. See video abstract at, http://links.lww.com/EDE/B862.
Peripheral Hypertrophic Subepithelial Corneal Degeneration on a Laser-Assisted In Situ Keratomileusis Flap
Authors: Li Ye , LaHood Benjamin R.
Published: July 2021

We describe the first reported case of a patient developing peripheral hypertrophic subepithelial corneal degeneration (PHSCD) in the setting of previous femtosecond laser in situ keratomileusis (LASIK). Superficial keratectomy was performed successfully with the complete restoration of the visual acuity, no LASIK flap complications, and no recurrence of PHSCD at 1-year follow-up. Our case indicates that superficial keratectomy can be a safe and effective treatment for PHSCD in the setting of LASIK and raises awareness of the possibility of PHSCD developing in eyes that have undergone prior LASIK.
ROP Risk Management 2021
Authors: Gold Robert S.
Published: July 2021

Purpose of review

It is important for ophthalmologists to keep current with up-to-date recommendations for screening, treating, and follow-up of infants with retinopathy of prematurity (ROP). This paper will review updated ROP Safety Net protocols and Policy Statements to stress that following risk management principles can avoid claims that could arise from poor visual outcomes.

Recent findings

Ophthalmic Mutual Insurance Company (OMIC) has been proactive in ROP risk management with development of the ROP Safety Net in 2006. The most recent updates in 2018 and 2019 address OMIC's claims experience and the factors leading to these claims. Clinical, systems, physician, and parent factors will be clarified. In addition, when to stop ROP screening has evolved and will be delineated and discussed to further aid in the process of care of these high-risk infants.

Ophthalmologists that screen and treat infants with ROP must keep updated with safety net protocols and institute them in their Neonatal Intensive Care Units (NICU) and offices as they take care of these babies to minimize legal risks from a claim. In addition, keeping up with policy statements is essential to successfully following these infants in the most appropriate fashion.
Artificial intelligence in myopia: current and future trends
Authors: Foo Li Lian , Ng Wei Yan , Lim Gilbert Yong San , Tan Tien-En , Ang Marcus , Ting Daniel Shu Wei
Published: July 2021

Purpose of review

Myopia is one of the leading causes of visual impairment, with a projected increase in prevalence globally. One potential approach to address myopia and its complications is early detection and treatment. However, current healthcare systems may not be able to cope with the growing burden. Digital technological solutions such as artificial intelligence (AI) have emerged as a potential adjunct for myopia management.

Recent findings

There are currently four significant domains of AI in myopia, including machine learning (ML), deep learning (DL), genetics and natural language processing (NLP). ML has been demonstrated to be a useful adjunctive for myopia prediction and biometry for cataract surgery in highly myopic individuals. DL techniques, particularly convoluted neural networks, have been applied to various image-related diagnostic and predictive solutions. Applications of AI in genomics and NLP appear to be at a nascent stage.

Current AI research is mainly focused on disease classification and prediction in myopia. Through greater collaborative research, we envision AI will play an increasingly critical role in big data analysis by aggregating a greater variety of parameters including genomics and environmental factors. This may enable the development of generalizable adjunctive DL systems that could help realize predictive and individualized precision medicine for myopic patients.
Persistent negative dysphotopsia and small eyes August consultation #1
Authors: Fram Nicole R.
Published: July 2021

A 56-year-old man with an ocular history of strabismus surgery at age 3 years, anatomically narrow angles, and patent laser peripheral iridotomies in both eyes underwent refractive lens exchange in which a SA60AT (Alcon Laboratories, Inc.) 38 diopter (D) intraocular lens (IOL) was implanted in the right eye and a SA60AT 36 D IOL was implanted in the left eye. He presented with symptoms consistent with negative dysphotopsia (ND) in both eyes immediately after surgery, describing temporal dark arcs that were constantly present and did not improve over the past 2 years. Of note, the patient was most symptomatic in the left eye.

On examination, the manifest refractions and corrected distance visual acuities were −0.50 +1.50 × 20 and 20/20 in the right eye and +0.75 −1.25 × 158 and 20/20 in the left eye; visual fields, extraocular motility, and pupils were normal. Intraocular pressures were normal as measured by applanation tonometry at 10 mm Hg in both eyes.

Slitlamp examination revealed trace meibomian gland disease in both eyes, normal tear lake and cornea, and patent peripheral laser iridotomies at the 11 o'clock position in the right eye and the 1 o'clock position in the left eye. The anterior chamber was slightly shallow temporally but deep centrally and quiet in both eyes. The lens examination revealed 4.0 mm anterior fibrotic capsule openings with well-positioned SA60AT posterior chamber IOLs in the bag with haptics at 1 and 7 o'clock in both eyes (Figure 1

JOURNAL/jcrs/04.03/02158034-202108000-00022/figure1/v/2023-08-19T002614Z/r/image-tiff

). The posterior capsule was intact with trace posterior capsule opacification in both eyes and striae in the posterior capsules. Dilated fundus examination was unremarkable with a cup-to-disc ratio of 0.4 in the right eye and 0.3 in the left eye and normal pink neuroretinal rims.

What strategies would you offer this patient to treat the ND and what specific testing and counseling do you provide for patients with this condition?
Occupational Exposure to Metalworking Fluid and the Effect on Health Symptoms—An Intervention Study
Authors: Thornéus Erik , Graff Pål , Bryngelsson Ing-Liss , Nordenberg Eva , Ghafouri Bijar , Johansson Henrik , Fornander Louise
Published: July 2021

Exposure to metalworking fluid has been shown to cause health problems among workers. The aim of this study was to compare health outcomes and levels of exposure among workers exposed to metalworking fluid before and after the implementation of preventive measures. The frequencies of self-reported symptoms, as well as the concentrations of measured substances were lower after the implementation of preventive measures. Logistic regression showed statistically significant differences in the report of irritations, a stuffy or runny nose, eye irritation, a hoarse or dry throat, and a cough with odds ratios of 0.31 (95% confidence interval [CI] 0.21 to 0.47), 0.12 (95% CI 0.05 to 0.29), 0.13 (95% CI 0.06 to 0.28), and 0.24 (95% CI 0.12 to 0.46), respectively. This confirms the efficiency of the performed intervention and highlights the importance of eliminating the recirculation of contaminated air.
Results of a Virtual Migraine Education Program in an Employed Population
Authors: Burton Wayne N. , Schultz Alyssa B. , Shepherd Martha E. , McCluskey Maureen , Hines David
Published: July 2021

Objective:

Migraine affects about 15% of the world's population and disproportionately affects adults who are working age. It is associated with higher healthcare costs, absenteeism, and lost productivity. A metropolitan school district in the southern United States offered a virtual migraine education program to their teaching employees.

Methods:

Seventy-nine employees completed a migraine questionnaire at both baseline and 3-month follow-up. The program included webinars, educational videos, and other intranet-based resources.

Results:

Results found that program participants reported a significant improvement in the frequency and severity of migraine as well as a reduction in lost on-the-job productivity. A majority of participants reported making positive changes to reduce triggers and better manage stress.

Conclusions:

An employer-offered migraine education program distributed virtually to remote workers has the potential to improve migraine symptoms and treatment as well as productivity.
Neuroblastoma-associated Renal Cell Carcinoma: A Case Report and Review of the Literature
Authors: Ogunbiyi Margaret Olabisi , Rodriguez-Justo Manuel , Gaunt Trevor , Shankar Ananth
Published: July 2021

Neuroblastoma-associated renal cell carcinoma (RCC) is a very rare subtype of renal neoplasia and only a handful of cases have been reported. Here we present a 15-year-old boy with metastatic RCC with a previous history of advanced stage neuroblastoma and germline mutation in the TP53 tumor suppressor gene. The probability of the RCC and indeed, the neuroblastoma itself being related to a cancer predisposition syndrome rather than a therapy induced second malignancy, is discussed.
Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer
Authors: Sfetsiori Angeliki-Eleni , Doganis Dimitrios , Doudoulakakis Anastasios , Spyridis Nikolaos , Pourtsidis Apostolos , Servitzoglou Marina , Nikita Maria , Papachristidou Smaragda , Magkou Evgenia , Dana Helen , Lebessi Evangelia , Kosmidis Helen , Baka Margarita , Tsolia Maria
Published: July 2021

Background:

Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment.

Materials and Methods:

Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria.

Results:

Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis.

Conclusions:

Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria.
Factors Associated With Colorectal Cancer Screening Among First-Degree Relatives of Patients With Colorectal Cancer in China
Authors: Du Qianqian , Chen Jingyu , Meng Ya , Gong Ni , Wu Xiaodan , Lyu Qiyuan , Zhang Yiheng , Wu Xiaoyu , Zhang Meifen
Published: July 2021

Background

First-degree relatives of patients with colorectal cancer have an elevated risk of colorectal cancer. However, the behavior and factors potential influencing first-degree relatives regarding colorectal cancer screening in China remain unknown.

Objective

The aim of this study was to explore the screening behavior and related factors of first-degree relatives of colorectal cancer patients.

Methods

A cross-sectional design was applied, and 201 first-degree relatives participated from August 2018 to July 2019. Data were collected about demographic information, the “Colorectal Cancer Perceptions Scale,” and screening behavior of first-degree relatives. Factors associated with screening behavior were identified using logistic regression analysis.

Results

Only 18.9% of first-degree relatives had participated in colonoscopy screening. Two Health Belief Model factors were the influencing factors of their participation in colorectal cancer screening. Higher possibility of colorectal cancer screening of first-degree relatives was associated with higher perceived susceptibility (odds ratio, 1.224; 95% confidence interval, 1.075–1.395) and lower perception of barriers (odds ratio, 0.880; 95% confidence interval, 0.820–0.944) of first-degree relatives.

Conclusions

Participation in colorectal cancer screening by first-degree relatives requires improvement; perceived susceptibility and perception of barriers were the most important predictors.

Implications for Practice

Health professionals can enhance awareness of colorectal cancer susceptibility and address barriers to colorectal cancer screening among first-degree relatives at both individual and social levels.
Individual, Interpersonal, and Home Environmental Factors Influencing Health Behaviors Among Chinese Childhood Cancer Survivors
Authors: Zheng Junyi , Zhou Xuezhen , Cai Ruiqing , Liu Qiuchan , Yu Runting , Liu Ke
Published: July 2021

Background

Childhood cancer survivors (CCSs) are at increased risk of chronic health conditions, which could be controlled with health behaviors. However, the health behaviors and related factors of Chinese CCSs remain unclear.

Objective

The aims of this study were to examine multiple health behaviors among Chinese CCSs and explore the individual, interpersonal, and home environmental factors affecting health behaviors.

Methods

This cross-sectional study recruited 204 participants from 3 grade-A tertiary hospitals in Guangzhou, China. Participants provided data on health behaviors (smoking, drinking, drug use, screen time, internet addiction, dietary behaviors, physical activity, and sleep behaviors) and their determining factors. Structural equation modeling was used to analyze the data.

Results

Chinese CCSs reported low rates of smoking, drinking, and drug use (0%–6.4%), but only 51% of survivors met screen time recommendations, and 24.5% of them had Internet addiction. Few survivors reported frequent soft-drink, sugar, and fast-food intake (2.0 to 7.4%), but many were finicky eaters (55.4%) or seldom drank milk (41.7%). In addition, 67.6% and 47.5% of survivors did not meet physical activity and sleep time recommendations. Childhood cancer survivors’ health behaviors were influenced by the individual (age, education level, and time since diagnosis), interpersonal (peer and family support), and home environmental (residential location, parents’ educations level, and household income) factors.

Conclusions

There were suboptimal health behaviors among Chinese CCSs. Targeted interventions should consider their individual, interpersonal, and home environmental factors.

Implications for Practice

Knowledge of health behaviors and related factors of Chinese CCSs would help healthcare professionals develop further interventions to improve their care of this population.
Building Therapeutic Commitment in University Nursing Students
Authors: Dion Kimberly , Choi Jeungok , Griggs Stephanie
Published: July 2021

Background:

Nurses report feeling unprepared to care for people with a substance use disorder (SUD).

Purpose:

The purpose was to determine whether targeted antistigma interventions improved nursing students' attitudes and perceived stigma toward people with SUD.

Methods:

This was a quasi-experimental, repeated-measures survey study. Participants completed the 20-item Drug and Drug Problems Questionnaire (DDPPQ) and the 8-item Perceived Stigma of Substance Abuse Scale (PSAS) at baseline and postintervention in their first clinical semester. Booster sessions were held for 2 additional clinical semesters after the initial intervention in the first clinical semester. The DDPPQ and PSAS were completed at the end of each semester for 3 semesters of the nursing program.

Results:

After the educational interventions, there was a significant improvement in overall therapeutic attitudes except for 1 sub-scale, role-related self-esteem.

Conclusions:

Antistigma interventions led to a decrease in stigma and improved overall therapeutic attitudes toward people with SUD.
Which general functional outcome measure does a better job of capturing change in clinical status in pelvic and acetabular fracture patients? An analysis of responsiveness over the first year of recovery
Authors: Ko Sebastian J. , O’Brien Peter J. , Broekhuyse Henry M. , Guy Pierre , Lefaivre Kelly A.
Published: July 2021

Objective:

To compare the responsiveness of the Short Form-36 (SF-36) physical component score (PCS) to the Short Musculoskeletal Function Assessment (SMFA) dysfunction index (DI) in pelvic and acetabular fracture patients over multiple time points in the first year of recovery.

Design:

Prospective cohort study.

Setting:

Level 1 trauma center.

Patients/Participants:

Four hundred seventy-three patients with surgically treated pelvic and acetabular fractures (Orthopaedic Trauma Association B or C-type pelvic ring disruption or acetabular fracture) were enrolled into the center's prospective orthopaedic trauma database between January 2005 and February 2015. Functional outcome data were collected at baseline, 6 months, and 12 months.

Main outcome measurements:

Evaluation was performed using the SF-36 Survey and Short Musculoskeletal Function Assessment. Responsiveness was assessed by calculating the standard response mean (SRM), the minimal clinically important difference (MCID), and floor and ceiling effects.

Results:

Three hundred five patients had complete data for both outcome scores. SF-36 PCS and SMFA DI scores showed strong correlation for all time intervals (r = −0.55 at baseline, r = −0.78 at 6 months, and r = −0.85 at 12 months). The SRM of the SF-36 PCS was greater in magnitude than the SRM of SMFA DI at all time points; this was statistically significant between baseline and 6 months (P < .001), but not between 6 and 12 months (P = .29). Similarly, the proportion of patients achieving MCID in SF-36 PCS was significantly greater than the proportion achieving MCID in SMFA DI between baseline and 6 months (84.6% vs 69.8%, P < .001), and between 6 and 12 months (48.5% vs 35.7%, P = .01). There were no ceiling or floor effects found for SF-36 PCS at any time intervals. However, 16.1% of patients achieved the highest level of functioning detectable by the SMFA DI at baseline, along with smaller ceiling effects at 6 months (1.3%) and 12 months (3.3%).

Conclusions:

SF-36 PCS is a more responsive measure of functional outcome than the SFMA DI over the first year of recovery in patients who sustain a pelvic ring disruption or acetabular fracture. This superiority was found in using the SRM, proportion of patients meeting MCID, and ceiling effects. Furthermore, the SF-36 PCS correlated with the more disease-specific SMFA DI.

Level of evidence:

Prognostic Level II.
Trends in Chlamydia and Gonorrhea Testing and Positivity Rates in a Safety Net Hospital in Georgia: 2014 to 2017
Authors: Karlow Samantha L. , McCool-Myers Megan , Henn Megan C. , Sheth Anandi N. , Owens Sallie , Kottke Melissa J.
Published: July 2021

Background

Sexually transmitted infections (STIs) in the United States continue to increase at an alarming rate. Since 2015, reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC), the 2 most prevalent reportable STIs, have increased by 19% and 56%, respectively. Characterizing testing patterns could elucidate how CT/GC care and positivity have evolved over time in a high-risk urban setting and illustrate how patients use the health care system for their STI needs.

Methods

Using electronic medical record data from a large safety net hospital in Georgia, patient demographics and clinical characteristics were extracted for all nucleic acid amplification tests ordered from 2014 to 2017 (n = 124,793). Descriptive statistics were performed to understand testing patterns and assess positivity rates.

Results

Annual nucleic acid amplification test volume grew by 12.0% from 2014 to 2017. Obstetrics/gynecology consistently accounted for half of all tests ordered; volume in emergency medicine grew by 45.2% (n = 4108 in 2014 to n = 5963 in 2017), whereas primary care volume fell by −4.3% (n = 4186 in 2014 to n = 4005 in 2017). The largest number of positive results was detected among 15- to 24-year-olds. The positivity of CT was higher among females, and GC among males. The percent positivity of CT remained stable (range, 6.4%–7.0%). The percent positivity of GC increased from 2.7% to 4.3% over time.

Conclusions

Testing volume in emergency medicine has increased at a faster rate than other specialties; point-of-care testing could ensure more accurate treatment and improve antibiotic stewardship. The rates of CT/GC were high among adolescents and young adults. Tailored approaches are needed to lower barriers to care for this vulnerable population.
The Impact of Continuous Passive Motion on Heterotopic Ossification Maturation
Authors: Vasileiadis George I. , Varvarousis Dimitrios N. , Manolis Ioannis , Ploumis Avraam
Published: July 2021

Heterotopic ossification is the formation of pathological bone in soft tissues. It is postulated that continuous passive motion is a helpful adjuvant in the halt of the heterotopic ossification progression and the maintenance or increase of the joint mobility. The purpose of this clinical case study is to present the effectiveness of continuous passive motion. A 46-yr-old male patient experiencing right hemiparesis arrived in our rehabilitation department with limitation on passive flexion of the right hip. On x-ray of the pelvis, immature heterotopic bone formation was found. To halt this ongoing process of heterotopic bone formation, a program of continuous passive motion was implemented. In addition, risedronate was administrated. We started the continuous passive motion at 50 degrees of flexion for 30 mins that was increased to 100 degrees for 3 hrs daily. The final range of motion at the hip was: flexion 85 degrees, extension 0 degrees, internal rotation 10 degrees, external rotation 10 degrees, abduction 10 degrees, and adduction 10 degrees. Based on our results, continuous passive motion plays a role in heterotopic ossification maturation. The effectiveness of continuous passive motion implementation against HO should be further investigated for selected cases.
COVID-19–Related Stressors, Sex Behaviors, and HIV Status Neutral Care Among Black Men Who Have Sex With Men and Transgender Women in Chicago, USA
Authors: Chen Yen-Tyng , Duncan Dustin T. , Del Vecchio Natascha , Timmins Liadh , Pagkas-Bather Jade , Lacap Shaina , Hotton Anna , Knox Justin , Hanson Hillary , Koli Kangkana , Durrell Mainza , Dehlin Jessica , Schneider John A.
Published: July 2021

Background:

COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW.

Methods:

As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April–July 2020). Survey questions included multilevel COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access.

Results:

Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 [adjusted prevalence ratio [aPR] = 2.1; confidence interval (CI): 1.3 to 3.5] and being in close proximity with someone diagnosed with COVID-19 (aPR = 1.7; CI: 1.1 to 2.8) were associated with current PrEP use. Intimate partner violence (aPR = 2.7; CI: 1.0 to 7.2) and losing health insurance (aPR = 3.5; CI: 1.1 to 10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR = 3.2; CI: 1.0 to 10.1) and ART (aPR = 6.2; CI: 1.6 to 24.3).

Conclusions:

Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (eg, promoting telehealth and decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.
Zoonoses and global epidemics
Authors: Judson Seth D. , Rabinowitz Peter M.
Published: July 2021

Purpose of review

The purpose of the review is to summarize recent advances in understanding the origins, drivers and clinical context of zoonotic disease epidemics and pandemics. In addition, we aimed to highlight the role of clinicians in identifying sentinel cases of zoonotic disease outbreaks.

Recent findings

The majority of emerging infectious disease events over recent decades, including the COVID-19 pandemic, have been caused by zoonotic viruses and bacteria. In particular, coronaviruses, haemorrhagic fever viruses, arboviruses and influenza A viruses have caused significant epidemics globally. There have been recent advances in understanding the origins and drivers of zoonotic epidemics, yet there are gaps in diagnostic capacity and clinical training about zoonoses.

Identifying the origins of zoonotic pathogens, understanding factors influencing disease transmission and improving the diagnostic capacity of clinicians will be crucial to early detection and prevention of further epidemics of zoonoses.
New antibiotics for the treatment of nonfermenting Gram-negative bacteria
Authors: Bassetti Matteo , Russo Chiara , Vena Antonio , Giacobbe Daniele Roberto
Published: July 2021

Purpose of review

To discuss the current literature on novel agents for the treatment of carbapenem-resistant nonfermenting Gram-negative bacteria (NF-GNB) infections.

Recent findings

Some novel agents have recently become available that are expected to replace classical polymyxins as the first-line options for the treatment of carbapenem-resistant NF-GNB infections.

In this narrative review, we provide a brief overview of the differential activity of various recently approved agents against NF-GNB most encountered in the daily clinical practice, as well as the results from phase-3 randomized clinical trials and large postapproval observational studies, with special focus on NF-GNB. Since resistance to novel agents has already been reported, the use of novel agents needs to be optimized, based on their differential activity (not only in terms of targeted bacteria, but also of resistance determinants), the local microbiological epidemiology, and the most updated pharmacokinetic/pharmacodynamic data. Large real-life experiences remain of crucial importance for further refining the optimal treatment of NF-GNB infections in the daily clinical practice.
COVID-19 transmission and the safety of air travel during the pandemic: a scoping review
Authors: Khatib Aisha N. , McGuinness Sarah , Wilder-Smith Annelies
Published: July 2021

Purpose of review

To examine the literature assessing safety of air travel relating to coronavirus disease 2019 (COVID-19) transmission from January 2020 to May 2021. The COVID-19 pandemic has had an unprecedented impact on air travel and global mobility, and various efforts are being implemented to determine a safe way forward. As the pandemic evolves, so do the challenges that force various stakeholders, including the aviation industry, health authorities, and governments, to reassess and adapt their practices to ensure the safety of travellers.

Recent findings

The literature was reviewed for multiple aspects of air travel safety during the COVID-19 pandemic. Recurring themes that surfaced included the pivotal role of commercial air travel in the geographic spread of COVID-19, the efficacy of travel restrictions and quarantines, inflight transmission risk and the role of preventive measures, the utility of pre and post flight testing, the development of effective vaccines and subsequent challenges of vaccine passports, and the ongoing threat of novel highly transmissible variants.

Much uncertainty lies ahead within the domains of these findings, and ongoing research, discourse and review will be necessary to navigate and determine the future direction and safety of air travel. Recovery will be slow, necessitating innovative, multipronged and collaborative solutions.
Treatment of Refractory Medicine Related Osteonecrosis of Jaw With Piezosurgical Debridement and Autologous Platelet Rich Fibrin: Feasibility Study
Authors: Gurav Sandeep , Dholam Kanchan P. , Singh Gurkaran Preet
Published: July 2021

Medicine related osteonecrosis of jaw (MRONJ) is incidental in patients receiving certain bone modifying agents in oncology. These lesions may not respond to conservative management and aggravate. Autologous platelet derivatives contain bone growth factors, which help in bone regeneration. The aim of this pilot study is to develop protocol for treatment of refractory MRONJ with pizosurgical debridement and advanced platelet rich fibrin.

In this feasibility study, refractory MRONJ lesions were treated by piezosurgical debridement and insertion of autologous advanced platelet rich fibrin in 15 patients. One patient had 2 lesion sites, so in all 16 MRONJ sites were treated. These patients were evaluated at the end of 1 month and 4 months for healing of MRONJ lesion. Statistical analysis was done by using Fisher test for response assessment in relation to variable. Eight lesions (50%) showed complete healing at the end of 1 month. At the end of 4 months 13 lesions (81.50%) were completely healed, 2 lesions (12.5%) were downgrades, and 1 lesion (6.25%) did not respond to treatment. Number of doses of bone modifying agent was only factor found associated with nonhealing of MRONJ when treated with this protocol.

In this pilot study, feasibility of use of piezosurgical debridement and platelet rich fibrin was evaluated. The results of the study suggest complete healing can be achieved with this treatment protocol. Further research with increased sample size is warranted to determine optimum use of autologous platelet concentrates in treatment of MRONJ.
Anterior Nasal Spine Relocation With Cleft Orthognathic Surgery
Authors: Choi Jong Woo , Park Hojin , Kwon Soon-Man , Koh Kyung S.
Published: July 2021

Background:

In unilateral cleft nasal deformity, the skeletal, and cartilaginous framework of nose is deformed. The anterior nasal spine (ANS) is usually displaced to the non-cleft-side. In cleft orthognathic surgery, ANS relocation can help correct the deviated ANS and nasal septum and might lead to an improved esthetic and functional outcome.

Methods:

Patients with unilateral cleft lip who underwent two-jaw orthognathic surgery between July 2016 and July 2020 were reviewed retrospectively. During conventional two-jaw orthognathic surgery, the ANS was separated from the maxilla. The separated ANS with the attached septum was fixed on the maxillary midline by wiring. Computed tomography scan was used to measure the septal deviation angle and septal deviation from the midline.

Results:

The septal deviation from the maxillary midline decreased following surgery (preoperative versus postoperative: 4.6 ± 1.0 mm versus 3.2 ± 1.2 mm; P = 0.016). The coronal septal deviation angle was widened after ANS relocation, although the transverse septal deviation angle remained unchanged (coronal septal deviation angle, preoperative versus postoperative: 146.7 ± 12.6 versus 159.8 ± 7.6; P = 0.01; transverse septal deviation angle, preoperative versus postoperative: 156.5 ± 11.7 versus 162.8 ± 7.7; P = 0.128).

Conclusions:

This study suggests that simultaneous ANS relocation with orthognathic surgery is a viable option for cleft-related deformities, considering the resultant caudal septum straightening and stable structural support observed in the long-term.
Pott Puffy Tumor Caused by Dental Infection: A Case Report and Literature Review
Authors: Yang Hui Joon , Paik Seung Won , Park Dong-Joon , Lee Eun Jung
Published: July 2021

Pott puffy tumor (PPT), first described by Sir Percivall Pott in 1760, is a rare clinical entity characterized by a subperiosteal abscess associated with osteomyelitis of the frontal bone caused by direct or hematogenous spread. Although rare in this modern age of antibiotics, this tumor usually occurs as a complication of sinusitis. Moreover, intracranial complications such as subdural abscess, meningitis, sinus thrombosis, or brain abscess can occur concomitantly with the underlying sinusitis, despite the administration of antibiotics. Herein, we present the case of a 48-year-old man who was diagnosed with PPT using computed tomography and treated medically and surgically. The infection remained uncontrollable after surgery and drain removal, owing to the persistence of the original dental focus of the infection. This case highlights the importance of treating the source of the infection in addition to the local area of inflammation, to facilitate complete infection control in PPT.
Assembling Facial Muscles in a Skull Model for Plastic Surgery Trainees
Authors: Yun Seon Mi , Hwang Kun , Park Chan Yong
Published: July 2021

The aim of this study was to report the results of a training workshop on assembling facial muscles in a skull model, with a focus on the depth and intermingling of the muscles.

A commercially available model with facial and masticatory muscles was used and this has 33 muscle pieces removable and attachable by magnets. Seven participants were recruited for workshop. At first stage, they were asked to assemble 33 detached pieces. Atlases of facial anatomy and Google searches except scientific articles were available. The time required to complete the assembly was measured. At second stage, a review article on facial anatomy was provided and they were again asked to assemble the pieces and the time was also measured. They were asked to rate their satisfaction with the outcomes on a Likert scale.

In the second stage, the time was significantly shortened (from 66.9 ± 22.2 to 27.9 ± 15.0 minutes,P = 0.002). The reasons for this improvement we think are: first, repeating an activity itself shortens time, and second, reading a review article about the anatomy of the face, especially the depth and relationship of each muscle, provided participants with deeper anatomical knowledge. Upon finishing the 2-stage workshop, the participants’ knowledge of the name (P = 0.019), origin and insertion of each muscle (P = 0.017), as well as the relationships of all neighboring muscles (including their depth) increased significantly (P = 0.002).

This model would be useful for anatomy classes at the undergraduate level in medical schools or developing a station as part of the objective structured clinical examination for board certification.
Heterogeneity of Accompanying Phenotypes and Genomic Variants Involved in Microtia
Authors: Huang Xin , Si Nuo , Guo Peipei , Wang Changchen , Hu Zhensheng , Pan Bo
Published: July 2021

Objectives:

The symptoms associated with microtia are ever-changing and not to stick to 1 pattern. The symptoms associated with microtia are constantly changing and are not set in stone. The aim of this article was to describe the various phenotypes from multiple systems found in microtitis patients included in the DatabasE of genomiC varIation and Phenotype in Humans using Ensembl Resources database, and to analyze possible pathogenic mutations.

Methods:

DatabasE of genomiC varIation and Phenotype in Humans using Ensembl Resources is an interactive web-based database, which incorporates a suite of tools designed to aid the interpretation of genomic variants. The term “microtia” was used as the search term, and the data extracted from the DatabasE of genomiC varIation and Phenotype in Humans using Ensembl Resources for this study was updated until October 2020. Pearson chi-squared test was used to test associations between types of genomic variants and the pathogenicity of variants.

Results:

Of the 386 cases enrolled in the study, 99% (n = 382) had 1 or more associated abnormalities. The most frequently detected abnormalities were those of the face and neck (n = 362 [93.8% of all cases]); musculoskeletal system (n = 337 [87.3%]); and nervous system (n = 334 [86.5%]), followed by abnormalities of limbs (n = 252 [65.3%]); the eye (n = 212 [54.9%]); and the integument (n = 200 [51.8%]). Besides, a total of 479 genomic variants were determined, including sequence variants and copy number variants (loss and gain). The pathogenicity of loss-type variants was significantly higher among other types (P < 0.001). Twelve sharing variants had more than 5 repeats, and the repeated fragments were concentrated on chromosome 3, 7, 9, 10, 11, 15, 17, 18, and 22.

Conclusions:

Identification of the relation between phenotypes and genotypes will facilitate the uncovering of the mechanism of microtia and the study of potential therapeutic targets.
Efficacy and Safety of Migraine Surgery
Authors: ElHawary Hassan , Barone Natasha , Baradaran Aslan , Janis Jeffrey E.
Published: July 2021

Objective:

The objectives of this study are to assess the efficacy and safety of peripheral nerve surgery for migraine headaches and to bibliometrically analyze all anatomical studies relevant to migraine surgery.

Summary Background Data:

Migraines rank as the second leading cause of disability worldwide. Despite the availability of conservative management options, individuals suffer from refractive migraines which are associated with poor quality of life. Migraine surgery, defined as the peripheral nerve decompression/trigger site deactivation, is a relatively novel treatment strategy for refractory migraines.

Methods:

EMBASE and the National Library of Medicine (PubMed) were systematically searched for relevant articles according to the PRISMA guidelines. Data was extracted from studies which met the inclusion criteria. Pooled analyses were performed to assess complication rates. Meta-analyses were run using the random effects model for overall effects and within subgroup fixed-effect models were used.

Results:

A total of 68 studies (38 clinical, 30 anatomical) were included in this review. There was a significant overall reduction in migraine intensity (P < 0.001, SE = 0.22, I
2 = 97.9), frequency (P < 0.001, SE = 0.17, I
2 = 97.7), duration (P < 0.001, SE = 0.15, I
2 = 97), and migraine headache index (MHI, P < 0.001, SE = 0.19, I
2 = 97.2) at follow-up. A total of 35 studies reported on migraine improvement (range: 68.3%–100% of participants) and migraine elimination (range: 8.3%–86.5% of participants). 32.1% of participants in the clinical studies reported complications for which the most commonly reported complications being paresthesia and numbness, which was mostly transient, (12.11%) and itching (4.89%).

Conclusion:

This study demonstrates improved migraine outcomes and an overall decrease in MHI as well as strong evidence for the safety profile and complication rate of migraine surgery.