bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolation and Characterization of Bacillus velezensis EB14, an Endophytic Bacterial Strain Antagonistic to Poplar Stem Canker Pathogen Sphaerulina musiva and Its Interactions with the Endophytic Fungal Microbiome in Poplar
Authors: Naik Sachin , Palys Sylvester , Di Falco Marcos , Tsang Adrian , Périnet Pierre , Ramanan Uma Shaanker , Dayanandan Selvadurai
Published: March 2021

Species of the genus Populus (commonly known as poplar) are one of the most widely used groups of forest trees in North America and Europe, and play a significant ecological role as a pioneer species in boreal forests and as a dominant species in the riparian forests that serve as wildlife habitats and watersheds. Natural and artificial hybrids of poplar are being extensively used in commercial plantations. However, many hybrid poplar trees are susceptible to Sphaerulina musiva, the pathogenic fungus that causes leaf spots and stem cankers and limits the utility of hybrid poplar as a plantation tree. We isolated an endophytic bacterial strain, Bacillus velezensis EB14, from a Populus hybrid which showed a strong antifungal activity against S. musiva. Through mass spectrometric analyses of cocultured B. velezensis EB14 and S. musiva, we identified five cyclic lipopeptides produced by B. velezensis EB14: iturin A1, iturin A2, iturin A9, subtulene A, and fengycin. In addition, B. velezensis EB14 produced four major unidentified compounds in cocultivation with S. musiva. The cyclopeptide production by B. velezensis EB14 was more pronounced (20- to 1,000-fold) in the cocultured plates due to elicitation by S. musiva. We also discovered that the native endophytic B. velezensis EB14 strain exhibited different levels of interactions against the endophytic fungal microbiomes of Populus sp. Overall, our results indicate that B. velezensis EB14 strain as a promising biocontrol agent that could be used against stem canker and leaf spot diseases caused by S. musiva in poplar plantations.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Biologics in eosinophilic esophagitis
Authors: Zhang Simin , Assa’ad Amal H.
Published: March 2021

Purpose of review

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the oesophagus whose incidence is on the rise. Despite maximal use of guideline-based therapies including food elimination diets and steroids, many patients remain symptomatic. This review serves to summarize safety and efficacy of monoclonal antibodies in treatment of EoE.

Recent findings

There has been an increasing number of biologics under consideration for EoE and several that have undergone clinical trials. mAbs that target specific effectors involved in the disease may offer additional clinical and histologic benefit. In addition, they offer a more benign adverse effect profile than traditional therapies.

Biologics for treatment of EoE may result in symptom and histologic improvement and has the potential to treat disease with minimal side effects.
Impulsivity and Decision-making Style Among Tramadol Drug Addicts and its Relation to Frontal Lobe Volume
Authors: Elbeh Khaled A. , Elserogy Yasser , Seifeldein Gehan S. , Mostafa Sayed , Yousef Hosam A. , Fawzy Mohamed
Published: March 2021

Objectives:

Drug addiction has its effects on different behavioral and personality traits including impulsivity and pattern of decision-making. The frontal lobe was the focus of many of these studies regarding its important role in decision-making and other higher cognitive processes. We aimed to detect the pattern of decision-making styles and impulsivity among people with tramadol addiction, and also to find out if tramadol addiction has effects on the volume of different regions of the frontal lobe.

Materials and Methods:

Two groups were included: group A included 12 patients with tramadol addiction and group B included 23 healthy cross-matching controls. Both groups were subjected to urine drug screening, Iowa gambling task (IGT), UPPS scales (negative urgency, lack of perseverance, lack of premeditation, and sensation seeking), and structural magnetic resonance imaging brain study.

Results:

The patients’ group has shown a significantly lower volume of the brain white matter, gray matter, and cortical thickness (P<0.001). This group has also shown a significantly higher scores of IGT-A and IGT-B (P<0.001 and P=0.02, respectively) and has shown a higher score of all subscales of UPPS.

Conclusions:

Tramadol addiction is associated with a reduced volume of the brain white matter, gray matter, and cortical thickness. All regions of the frontal lobe have shown significant volume reduction in the tramadol group. Tramadol addiction and its duration are associated with risky decision-making style and with higher impulsivity than nonaddicts.
Can We Predict the Need for Unplanned Reoperation After Nonunion Repair?
Authors: Landes Emma K. , Konda Sanjit R. , Davidovitch Roy , Egol Kenneth A.
Published: March 2021

Objectives:

To identify factors associated with the need for reoperations in patients treated surgically for fracture nonunion.

Design:

Retrospective cohort study.

Setting:

One urban Level 1 trauma center and an orthopaedic specialty hospital.

Patients/Participants:

This study included 365 patients who did not and 95 patients who did undergo a reoperation after nonunion repair.

Intervention:

All patients who underwent fracture nonunion repair were identified. Baseline demographic, injury, and surgical information were collected. These factors were compared between patients who did and did not require an unplanned reoperation.

Main Outcome Measurements:

An unplanned reoperation after index fracture nonunion surgery.

Results:

When compared with patients who did not undergo a reoperation after their index fracture nonunion surgery, patients who underwent at least 1 reoperation had a greater proportion of those who sustained an open fracture, a high-energy injury, initial neurologic or vascular injuries, the need for a flap or soft tissue graft at initial treatment, and lower extremity injuries with univariate analysis. Unplanned reoperation was also associated with diagnosis of “infected” nonunion at initial nonunion surgery. Multivariate analysis confirmed initial nerve or vascular injuries and positive infection status were statistically significant predictors of a reoperation.

Conclusions:

Initial injury characteristics such as nerve or vascular injury at initial injury and positive infection status at the index nonunion surgery were associated with the need for a secondary surgery after nonunion repair. Appropriate care of these patients should be aimed at adjusting expectations of unplanned reoperation in the future and potentially enhanced treatment strategies.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effectiveness of Gravity and Manual Stress Radiographs and the Use of Lateral Talar Displacement in Determining Ankle Stability of Supination-External Rotation Type Ankle Fractures
Authors: Ali Raheel A. , Mitchell Wes , Bora Varun G. , Dawson John R. , Atassi Omar H. , Perkins Christopher H.
Published: March 2021

Objectives:

(1) To evaluate adequacy and reproducibility of the gravity and manual stress imaging in the diagnosis of unstable ankle fractures and (2) to evaluate the diagnostic utility of lateral talar displacement ratio (LTDR) derived in relation to the talar body width on ankle stress imaging.

Design:

Retrospective cohort study.

Setting:

Level 1 Trauma Center.

Patients:

One hundred seventy consecutive patients who presented with supination-external rotation 2 ankle fractures (OTA/AO 44-B2.1) requiring dynamic stress testing.

Intervention:

Dynamic stress imaging to determine ankle stability.

Main Outcome Measure:

Ankle instability and subsequent need for surgical fixation as determined by dynamic stress imaging.

Results:

No statistical significant difference was found between the adequacy of gravity stress radiographs and manual stress images in regards to surgical decision-making (P = 0.595). Using manual and gravity stress images, receiver operating characteristic curves were generated for medial clear space (MCS) (area under the curve = 0.793, 0.901) and LTDR (0.849, 0.850), corresponding to thresholds of 10.5% and 10.2% for manual and gravity, respectively. Seventy-three of 105 patients (69.5%) with MCS > 5 mm and 62 of 75 patients (82.7%) with LTDR > 10% were offered surgical intervention. Sixty-two of the 77 patients (80.5%) offered surgery had both MCS > 5 mm and LTDR > 10%.

Conclusion:

This study shows that manual stress radiographs are just as effective as gravity stress radiographs in making an assessment of ankle fracture stability as there was no difference in diagnostic value between gravity and manual stress imaging in regards to surgical decision-making. Use of additional radiographic measurements such as the LTDR can provide additional information in determining stability when MCS is within a clinical gray area.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Posterior Lumbar Spinal Surgery on Biomechanical Properties of Rat Paraspinal Muscles 13 Weeks After Surgery
Authors: Yamamoto Shun , Malakoutian Masoud , Theret Marine , Street John , Rossi Fabio , Brown Stephen H. M. , Saito Mitsuru , Oxland Thomas R.
Published: March 2021

Study Design.

Preclinical study in rodents.

Objective.

To investigate changes in biomechanical properties of paraspinal muscles following a posterior spinal surgery in an animal model.

Summary of Background Data.

Posterior spine surgery damages paraspinal musculature per histological and imaging studies. The biomechanical effects of these changes are unknown.

Methods.

12 Sprague-Dawley rats were divided equally into sham and surgical injury (SI) groups. For sham, the skin and lumbodorsal fascia were incised at midline. For SI, the paraspinal muscles were detached from the vertebrae, per normal procedure. Thirteen weeks postsurgery, multifidus and longissimus biopsies at L1, L3, and L5 levels were harvested on the right. From each biopsy, three fibers and three to six bundles of fibers (∼10–20 fibers ensheathed in their extracellular matrix) were tested mechanically to measure their passive elastic modulus. The collagen content and fatty infiltration of each biopsy were also examined histologically by immunofluorescence staining. Nonparametric statistical methods were used with a 1.25% level of significance.

Results.

A total of 220 fibers and 279 bundles of fibers were tested. The elastic moduli of the multifidus and longissimus fibers and longissimus fiber bundles were not significantly different between the SI and sham groups. However, the elastic modulus of multifidus fiber bundles was significantly greater in the SI group compared to sham (SI median 82 kPa, range 23–284; sham median 38 kPa, range 23–50, P = 0.0004). The elastic modulus of multifidus fiber bundles in the SI group was not statistically different between spinal levels (P = 0.023). For histology, only collagen I deposition in multifidus was significantly greater in the SI group (median 20.8% vs. 5.8% for sham, P < 0.0001).

Conclusion.

The surgical injury increased the passive stiffness of the multifidus fiber bundles. Increased collagen content in the extracellular matrix is the likely reason and these changes may be important in the postoperative compensation of the spine.

Level of Evidence: N/A
Severity of Myelopathy is Closely Associated With Advanced Age and Signal Intensity Change in Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Hirai Takashi , Yoshii Toshitaka , Egawa Satoru , Sakai Kenichiro , Kusano Kazuo , Nakagawa Yukihiro , Wada Kanichiro , Katsumi Keiichi , Fujii Kengo , Kimura Atsushi , Furuya Takeo , Nagoshi Narihito , Kanchiku Tsukasa , Nagamoto Yukitaka , Oshima Yasushi , Ando Kei , Takahata Masahiko , Mori Kanji , Nakajima Hideaki , Murata Kazuma , Matsunaga Shunji , Kaito Takashi , Yamada Kei , Kobayashi Sho , Kato Satoshi , Ohba Tetsuro , Inami Satoshi , Fujibayashi Shunsuke , Katoh Hiroyuki , Kanno Haruo , Imagama Shiro , Koda Masao , Kawaguchi Yoshiharu , Takeshita Katsushi , Matsumoto Morio , Yamazaki Masashi , Okawa Atsushi
Published: March 2021

Study Design:

Prospective, nationwide case series.

Objective:

To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data:

Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL.

Materials and Methods:

Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2–7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2–7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned.

Results:

Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2–7 according to the type of OPLL, significant differences were observed in a range of motion at C2–7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging.

Conclusions:

This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery.

Level of Evidence:

Level II.
Association Between C5 Palsy and the Anterior Decompression Procedures, Corpectomy and Discectomy
Authors: Odate Seiichi , Shikata Jitsuhiko , Yamamura Satoru , Okahata Akinori , Kawaguchi Shinji
Published: March 2021

Study Design:

This is a retrospective study.

Objective:

The aim was to evaluate the influence of various decompression procedures on the incidence of C5 palsy (C5P).

Summary of Background Data:

C5P is a well-known but unsolved complication of cervical spine surgery. Among anterior cervical decompressive procedures, both corpectomy and discectomy are important surgical methods, whose effects on the incidence of C5P are unknown.

Methods:

We retrospectively analyzed 818 patients (529 men; mean age: 59.2±11.6 y) who underwent anterior cervical decompression and fusion. The surgical choice to use corpectomy, discectomy, or hybrid decompression was based on standard treatment strategies depending on local compressive pathology and presenting clinical symptoms. We introduced an original “decompression combination score” as a means of quantifying the effects of the procedures on the development of C5P. The scores were based on the relative severity of various risk factors associated with the eventual development of C5P and were assigned as follows: C4 corpectomy, 1 point; C5 corpectomy, 1 point; C3 corpectomy successive to C4 corpectomy, 0.5 point; C6 or C7 corpectomy successive to C5 corpectomy, 0.5 point; C4/5 discectomy, 0.5 point; discectomy at another segment, 0 point. Each patient’s decompression combination score was then comprised of the sum of these points.

Results:

C5P occurred in 55 (47 men, mean age: 65.7±8.7 y) of the 818 (6.7%) patients. A larger number of operated disc segments was significantly associated with C5P. Higher decompression combination score was significantly associated with C5P. Multivariate analysis revealed that male sex, higher decompression combination score, and older age were significant risk factors.

Conclusions:

Corpectomy increased the incidence of C5P, while discectomy decreased the risk. The lower incidence of postoperative C5P after discectomy may be because of minimizing tethering effect to the C5 nerve root. As a preventive measure against C5P, corpectomy should be avoided, while discectomy is recommended as much as possible.

Level of Evidence:

Levels of Evidence: Step IV—Oxford Center for Evidence-Based Medicine 2011.
Comparison of Immunohistochemical Expression of Cytokeratin 19, c-KIT, BerEP4, GATA3, and NUTM1 Between Porocarcinoma and Squamous Cell Carcinoma
Authors: Goto Keisuke , Ishikawa Misawo , Hamada Kengo , Muramatsu Koji , Naka Miho , Honma Keiichiro , Sugino Takashi
Published: March 2021

Distinguishing porocarcinoma from squamous cell carcinoma (SCC) is clinically significant; however, differential diagnosis can often be challenging. This study sought to confirm the diagnostic utility of cytokeratin 19, c-KIT, BerEP4, GATA3, and NUTM1 immunohistochemistry in distinguishing porocarcinoma from SCC. Immunohistochemical analysis of cytokeratin 19, c-KIT, BerEP4, GATA3, and NUTM1 in 14 porocarcinomas and 22 SCCs was performed; the extents and intensities of expression of these markers were recorded. The statistical associations of the immunoexpression between porocarcinoma and SCC were analyzed using the Pearson χ2 test. Cytokeratin 19 was positive in 13 (92.9%) of 14 porocarcinomas, and for all the positive cases, staining was strong and evident in >20% of the tumor cells. By contrast, 9 (40.9%) of 22 SCCs expressed cytokeratin 19 (P = 0.0018), of which 6 showed extremely focal (≤10% of the tumor cells) expression. Of the 14 porocarcinomas, 11 (78.6%) cases showed c-KIT positivity, whereas only 3 of 22 SCCs (13.6%) expressed c-KIT focally (P = 0.0001). In addition, BerEP4 immunostaining differed between porocarcinomas and SCCs (57.1% vs. 9.1%, respectively; P = 0.0017). However, no significant difference between the groups was reported in terms of GATA3 expression (57.1% vs. 72.7%, respectively; P = 0.3336). NUTM1 was expressed in 4/14 (28.6%) porocarcinomas but not in the SCCs. Immunohistochemistry for cytokeratin 19, c-KIT, and BerEP4 could be helpful in distinguishing porocarcinomas from SCCs. In addition, NUTM1 immunoexpression is highly specific, although not sensitive, to porocarcinomas. GATA3 immunohistochemistry has no meaningful implications in the differential diagnosis of porocarcinoma and SCC.
Accounting for Repeat Pregnancies in Risk Prediction Models
Authors: Grandi Sonia M. , Filion Kristian B. , Hutcheon Jennifer A. , Rosella Laura C. , Platt Robert W.
Published: March 2021

Background:

In perinatal epidemiology, the development of risk prediction models is complicated by parity; how repeat pregnancies influence the predictive accuracy of models that include obstetrical history is unclear.

Methods:

To assess the influence of repeat pregnancies on the association between predictors and the outcomes, as well as the influence of ignoring the nonindependence between pregnancies, we created four analytical cohorts using the Clinical Practice Research Datalink. The cohorts included (1) first deliveries, (2) a random sample of one delivery per woman, (3) all eligible deliveries per woman, and (4) all eligible deliveries and censoring of follow-up at subsequent pregnancies. Using Plasmode simulations, we varied the predictor–outcome association across cohorts.

Results:

We found minimal differences in the relative contribution of predictors to the overall predictions and the discriminative accuracy of models in the cohort of randomly sampled deliveries versus the all deliveries cohort (C-statistic: 0.62 vs. 0.63; Nagelkerke’s R2: 0.03 for both). Accounting for clustering and censoring upon subsequent pregnancies also had negligible influence on model performance. We found important differences in model performance between the models developed in the cohort of first deliveries and the random sample of deliveries.

Conclusions:

In our study, a model including first deliveries had the best predictive accuracy but was not generalizable to women of varying parities. Moreover, including repeat pregnancies did not improve the predictive accuracy of the models. Multiple models may be needed to improve the transportability and accuracy of prediction models when the outcome of interest is influenced by parity.
Dengue, Severity Paradox, and Socioeconomic Distribution Among Afro-Colombians
Authors: Carabali Mabel , Maheu-Giroux Mathieu , Kaufman Jay S.
Published: March 2021

Background:

The clinical presentation of dengue ranges from self-limited mild illness to severe forms, including death. African ancestry is often described as protective against dengue severity. However, in the Latin American context, African ancestry has been associated with increased mortality. This “severity paradox” has been hypothesized as resulting from confounding or heterogeneity by socioeconomic status (SES). However, few systematic analyses have been conducted to investigate the presence and nature of the disparity paradox.

Methods:

We fit Bayesian hierarchical spatiotemporal models using individual-level surveillance data from Cali, Colombia (2012–2017), to assess the overall morbidity and severity burden of notified dengue. We fitted overall and ethnic-specific models to assess the presence of heterogeneity by SES across and within ethnic groups (Afro-Colombian vs. non-Afro-Colombians), conducting sensitivity analyses to account for potential underreporting.

Results:

Our study included 65,402 dengue cases and 13,732 (21%) hospitalizations. Overall notified dengue incidence rates did not vary across ethnic groups. Severity risk was higher among Afro-Colombians (risk ratio [RR] = 1.16; 95% Credible Interval [95% CrI] = 1.08, 1.24) but after accounting for underreporting by ethnicity this association was nearly null (RR = 1.02; 95% CrI = 0.97, 1.07). Subsidized health insurance and low-SES were associated with increased overall dengue rates and severity.

Conclusion:

The paradoxically increased severity among Afro-Colombians can be attributed to differential health-seeking behaviors and reporting among Afro-Colombians. Such differential reporting can be understood as a type of intersectionality between SES, insurance scheme, and ethnicity that requires a quantitative assessment in future studies.
Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature
Authors: Berrocal María H. , Acaba-Berrocal Luis
Published: March 2021

Purpose of review

Diabetic retinopathy (DR) is one of the leading causes of preventable vision loss in the world and its prevalence continues to increase worldwide. One of the ultimate and visually impairing complications of DR is proliferative diabetic retinopathy (PDR) and subsequent tractional retinal detachment. Treatment modalities, surgical techniques, and a better understanding of the pathophysiology of DR and PDR continue to change the way we approach the disease. The goal of this review is to provide an update on recent treatment modalities and outcomes of proliferative diabetic retinopathy and its complications including tractional retinal detachment.

Recent findings

Panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF), and pars plana vitrectomy are the mainstay of PDR treatment. However, PRP and anti-VEGF are associated with significant treatment burden and multiple subsequent treatments. Early vitrectomy is associated with vision preservation, less treatment burden, and less subsequent treatments than therapy with PRP and anti-VEGF.

Concerning costs, high rates of noncompliance in the diabetic population and significant rates of subsequent treatments with initial PRP and anti-VEGF, early vitrectomy for diabetic retinopathy in patients at risk of PDR is a cost-effective long-term stabilizing treatment for diabetics with advanced disease.
The corneal endothelium: clinical review of endothelial cell health and function
Authors: Gupta Preeya K. , Berdahl John P. , Chan Clara C. , Rocha Karolinne M. , Yeu Elizabeth , Ayres Brandon , Farid Marjan , Lee W. Barry , Beckman Kenneth A. , Kim Terry , Holland Edward J. , Mah Francis S. ,   from the ASCRS Cornea Clinical Committee
Published: March 2021

The endothelial cell is a critical structure within the cornea and is responsible for maintaining corneal clarity through its pump function. Endothelial cells are lost over time naturally but can be injured medically, surgically, or as a part of various dystrophies. Monitoring of endothelial cells can be performed clinically or more formally with specular microscopy. In cases of significant compromise, endothelial cells can be transplanted by various endothelial keratoplasty techniques. The future pipeline is bright for possible endothelial cell regeneration and rehabilitation. This article reviews these topics in depth to provide a comprehensive look at the structure and function of the endothelial cell, etiologies of endothelial cell damage, detailed review of iatrogenic causes of endothelial cell loss, and management strategies.
“The lesser of two evils”: a framework analysis of consumers' perspectives on opioid deprescribing and the development of opioid deprescribing guidelines
Authors: Langford Aili V. , Gnjidic Danijela , Lin Chung-Wei Christine , Bero Lisa , Blyth Fiona , Penm Jonathan , Schneider Carl R.
Published: March 2021

Deprescribing opioids has been identified as an intervention to mitigate opioid harm; however, it is often challenging to implement interventions and communicate deprescribing decisions to consumers. The development of opioid deprescribing guidelines may provide guidance and support on when and how to reduce or cease opioids in routine care. This study aimed to explore the perspectives of opioid consumers on opioid deprescribing and determine factors to be considered in the development of opioid deprescribing guidelines. A purposive sample of 20 consumers using opioids for pain was recruited. Semistructured interviews were conducted, audio recorded, and transcribed verbatim. Inductive thematic analysis was undertaken, followed by a framework analysis informed by Bandura's Social Cognitive Theory. Behavioral, cognitive, and environmental factors influence consumers' attitudes and actions regarding opioid deprescribing. Significant barriers to opioid deprescribing were identified, including fears of pain and withdrawal effects, opioid-related stigma, and perceived inadequacies of the healthcare system. Improved communication between healthcare professionals and consumers regarding expectations of deprescribing and goals of care, as well as the provision of greater opportunities for consumer engagement in decision making were identified as avenues to improve the success of opioid deprescribing. For opioid deprescribing guidelines to be effective and achieve the intended goal of optimizing opioid use, consumers need to feel empowered to engage in opioid reduction or cessation. The findings of this study may facilitate a patient-centred approach for practitioners and guideline developers in creating recommendations and interventions to enable opioid deprescribing through targeting behavioral change.
Responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study
Authors: Kennedy Donna L. , Vollert Jan , Ridout Deborah , Alexander Caroline M. , Rice Andrew S.C.
Published: March 2021

The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism-associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy. With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated before and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change. Quantitative sensory testing results (n = 76) were compared with healthy controls (n = 54). At 6 months postsurgery, 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (P < 0.001). Change in QST parameters occurred for thermal detection, thermal pain, and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures was not statistically significant. Change occurred in sensory phenotype postsurgery (P < 0.001); sensory phenotype was associated with symptom subgroup (P = 0.03) and patient-rated surgical outcome (P = 0.02). Quantitative sensory testing-derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease-modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
Outcome comparison between vaginoscopy and standard hysteroscopy: A retrospective cohort study
Authors: Tien Chin-Tzu , Li Pei-Chen , Ding Dah-Ching
Published: March 2021

Background:

Hysteroscopy is a traditional diagnostic method, whereas vaginoscopy is a more recent but proven approach. However, most physicians are unfamiliar with vaginoscopy. We aimed to compare the feasibility and tolerability between the two techniques to increase clinical awareness.

Methods:

We retrospectively reviewed the data of 100 patients who underwent office hysteroscopy with either the standard approach or the vaginoscopic approach between May and July 2019. While the standard hysteroscopy group underwent speculum insertion and the cervix was grasped with forceps, the vaginoscopy group did not. The primary outcome was a successfully completed examination. Related outcomes were the pain score, complications, and absence of signs of infection at 1 week after completing the examination.

Results:

The success rates of vaginoscopy and standard hysteroscopy were comparable (95.5% vs 96.3%). The median time to complete a vaginoscopy (135 seconds) was significantly shorter than to complete a standard hysteroscopy (190 seconds, p = 0.02). The median pain score was 3 for vaginoscopy, which was significantly lower than that for standard hysteroscopy (5; p = 0.01). There were no differences in the surgical complication rate between vaginoscopy (n = 4) and standard hysteroscopy (n = 3) (relative risk = 0.81, 95% confidence interval = 0.11-6.00).

Conclusion:

Vaginoscopy required a shorter time for the completion of the examination and involved lesser pain than the standard hysteroscopy. The success rates were comparable between the two techniques. Therefore, vaginoscopy is a good option for office hysteroscopic examinations.
Vaccine Hesitancy Against SARS-CoV-2 in Health Personnel of Northeastern Mexico and Its Determinants
Authors: Castañeda-Vasquez David Emmanuel , Ruiz-Padilla Juan Pablo , Botello-Hernandez Edgar
Published: March 2021

With the emergence of effective vaccines against SARS-CoV-2, the need to find the determinants for its correct distribution is created, with health personnel being an essential group where coverage must be ensured.

Materials and Methods:

A cross-sectional study was conducted through an electronic survey that was distributed to health personnel in the state of Nuevo Leon, Mexico. Potential determinants for vaccine hesitancy were covered including their intention to be vaccinated against SARS-CoV-2.

Results:

A total of 543 responses were collected from health professionals, which 30 (5.5%) of the subjects stated that they would reject SARS-CoV-2 vaccination. How well informed the subjects were was the most determining factor, where misinformation related to vaccination and COVID-19 was the most important cause of vaccine rejection.

Conclusion:

The implementation of educational strategies for health personnel are required.
Donor Aorta as Conduit for Ex Vivo Lung Perfusion
Authors: Shukrallah Bassam , Ganapathi Asvin M. , Whitson Bryan A.
Published: March 2021

For ex vivo lung perfusion (EVLP), there is often inadequate pulmonary artery for effective EVLP. Creation of a neopulmonary artery conduit with donor aorta alleviates this shortcoming. This technique will become of more importance and need as there are more donation after circulatory death donor (DCD) heart procurements as this is a common source of EVLP. With the time constraints associated with the DCD recovery approach, there is a high likelihood of having a short native pulmonary artery with the lung block necessitating this approach.
Efficacy of Combining Aggressive Hydration With Rectal Indomethacin in Preventing Post-ERCP Pancreatitis
Authors: Radadiya Dhruvil , Brahmbhatt Bhaumik , Reddy Chakradhar , Devani Kalpit
Published: March 2021

Postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography pancreatitis (ERCP). No randomized controlled trial (RCT) has compared the efficacy of the American Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy recommended interventions for PEP prevention. We assessed the effectiveness of these interventions using network meta-analysis. PubMed, EMBASE, and Cochrane databases were searched to identify RCTs investigating guideline-recommended interventions and their combinations [rectal nonsteroidal anti-inflammatory drugs (NSAIDs): indomethacin or diclofenac, pancreatic stent (PS), aggressive hydration (AH), sublingual nitrate) for PEP prevention. We performed direct and Bayesian network meta-analysis, and the surface under the cumulative ranking curve to rank interventions. Subgroup network meta-analysis for high-risk populations was also performed. We identified a total of 38 RCTs with 10 different interventions. Each intervention was protective against PEP on direct and network meta-analysis compared with controls. Except AH+diclofenac and NSAIDs+ sublingual nitrate, AH+indomethacin was associated with a significant reduction in risk of PEP compared with PS [odds ratio (OR), 0.09; credible interval (CrI), 0.003-0.71], indomethcin+PS (OR, 0.09; CrI, 0.003-0.85), diclofenac (OR, 0.09; CrI, 0.003-0.65), AH (OR, 0.09; CrI, 0.003-0.65), sublingual nitrate (OR, 0.07; CrI, 0.002-0.63), and indomethacin (OR, 0.06; CrI, 0.002-0.43). AH with either rectal NSAIDs or sublingual nitrate had similar efficacy. AH+indomethacin was the best intervention for preventing PEP with 95.3% probability of being ranked first. For high-risk patients, although the efficacy of PS and indomethacin were comparable, PS had an 80.8% probability of being ranked first. AH+indomethacin seems the best intervention for preventing PEP. For high-risk patients, PS seems the most effective strategy. The potential of combination of interventions need to be explored further.
New insights into muscle function in chronic kidney disease and metabolic acidosis
Authors: Chalupsky Megan , Goodson David Alex , Gamboa Jorge L. , Roshanravan Baback
Published: March 2021

Purpose of review

: Sarcopenia, defined as decreased muscle mass or function, is prevalent in chronic kidney disease (CKD) increasing the risk of mobility impairment and frailty. CKD leads to metabolic acidosis (MA) and retention of uremic toxins contributing to insulin resistance and impaired muscle mitochondrial energetics. Here we focus on the central role of muscle mitochondrial metabolism in muscle function.

Recent findings

: Mitochondrial dysfunction underlies muscle wasting and poor physical endurance in CKD. Uremic toxins accumulate in muscle disrupting mitochondrial respiration and enzymes. Changes in mitochondrial quantity, quality, and oxidative capacity contribute to mobility impairment in CKD. Major determinants of muscle mitochondrial function are kidney function, inflammation, and oxidative stress. In CKD, MA is the major determinant of muscle mitochondrial function. Metabolomics reveals defects in pathways linked to mitochondrial energy metabolism and acid-base homeostasis underlying insulin resistance in CKD.

: Decreased mitochondrial capacity and quality control can impair muscle function contributing to decreased physical endurance. MA augments insulin resistance perpetuating the catabolic state underlying muscle wasting in CKD. Further studies are needed to investigate if targeting of MA improves muscle mitochondrial function and insulin resistance translating into meaningful improvements in physical endurance.
Transarterial Radioembolization Treatment as a Bridge to Surgical Resection in Pediatric Hepatocellular Carcinoma
Authors: Whitlock Richard S. , Loo Caitlyn , Patel Kalyani , Bista Ranjan , Goss John A. , Heczey Andras , Khan Osman , Lopez-Terrada Dolores , Masand Prakash , Nguyen HaiThuy , Mahvash Armeen , Vasudevan Sanjeev A. , Kukreja Kamlesh
Published: March 2021

Background:

Children with unresectable hepatocellular carcinoma (HCC) have a poor prognosis and limited treatment options. Transarterial radioembolization (TARE) using Yttrium-90 (Y90) has emerged as a potential bridge therapy to hepatic resection or transplantation for HCC with very limited studies in children.

Observations:

Here we present the clinical course of 2 children successfully treated with TARE Y90 for initially unresectable fibrolamellar HCC (FL-HCC) and bridged to partial hemihepatectomy with >1-year overall survival post-TARE.

Conclusion:

Although there have been prior published reports of pediatric patients with HCC being treated with TARE Y90 and some being able to undergo subsequent orthotopic liver transplantation, this is the first report of pediatric HCC patients treated with TARE Y90 as a bridge to nontransplant resections and going on to have >1-year overall survival.
Stage IV Classical Hodgkin Lymphoma-type Posttransplant Lymphoproliferative Disorder in a Pediatric Liver Transplant Patient: A Case Report and Review of the Literature
Authors: Choi Sujin , Hong Kyung Taek , Choi Jung Yoon , Ahn Hong Yul , Ko Jae Sung , Suh Kyung-Suk , Park Sung-Hye , Cheon Jung-Eun , Shin Hee Young , Kang Hyoung Jin
Published: March 2021

Posttransplant lymphoproliferative disorder (PTLD) is a heterogeneous group of diseases with abnormal proliferation of lymphoid tissue and classical Hodgkin lymphoma (CHL) type PTLD is a very rare subtype. We describe a successfully diagnosed and treated CHL-PTLD stage IV pediatric patient, 8 years after liver transplantation. The patient was treated with standard CHL (Children’s Cancer Group 5942 group 3) chemotherapy, rituximab and reduction of immunosuppressant. The patient remains in complete remission after 3 years with stable graft function. To our best knowledge, this is the first pediatric case report of a successfully treated stage IV CHL-PTLD after a liver transplant.
Acquired Thrombotic Thrombocytopenic Purpura in a 5-Year-old Child With Wiskott-Aldrich Syndrome
Authors: Özdemir Öner , Orhan Mehmet Fatih , Büyükavcı Mustafa , Görükmez Orhan
Published: March 2021

Thrombocytopenia is often seen as a laboratory finding during childhood. A supposed idiopathic thrombocytopenic purpura patient who was later diagnosed as Wiskott-Aldrich syndrome (WAS) and developed acquired thrombotic thrombocytopenic purpura (aTTP). Although autoimmune manifestations in WAS described, aTTP was reported just once. Five-year-old-boy was initially brought with cough, bloody stool (diarrhea), oral mucosal bleeding at 12th months of age. Following diagnosed with idiopathic thrombocytopenic purpura and receiving intravenous immunoglobulin, platelet count raised from 20,000 to 50,000/µL. One year after WAS diagnosis by mutation analysis, he presented with complaints of resistant fever, epistaxis, and melena. Hemoglobin decreased from 10 to 5.9 g/dL. Schistocytes in peripheral blood smear and high anti-ADAMTS-13 antibody level indicated development of aTTP.
TeamSTEPPS Curricular-Wide Integration
Authors: Ross Jennifer Gunberg , Latz Eleanor , Meakim Colleen H. , Mariani Bette
Published: March 2021

Background

To promote safe patient care, nurses must work collaboratively with members of the interprofessional health care team.

Purpose

The purposes of this study were to explore the effect of a curricular-wide integration of TeamSTEPPS training on baccalaureate nursing students' teamwork knowledge and attitudes and to describe students' perceptions of TeamSTEPPS curricular-wide integration.

Methods

In this quasi-experimental, mixed-methods study, the experimental group engaged in a curricular-wide integration of TeamSTEPPS throughout the baccalaureate nursing program, whereas the control group received no TeamSTEPPS training.

Results

The experimental group had significantly higher teamwork knowledge than the control group after training. The curricular-wide integration of TeamSTEPPS was positively received by students.

Conclusions

This study demonstrated the feasibility and benefits of integrating TeamSTEPPS teamwork training throughout a baccalaureate nursing curriculum, as well as the knowledge gained by students because of this curricular-wide integration. With further research, TeamSTEPPS could offer an evidence-based approach to promote the interprofessional teamwork knowledge and skills nursing students need for safe patient care.
A Survey of Mental Health in Graduate Nursing Students during the COVID-19 Pandemic
Authors: Rosenthal Laura , Lee Stephanie , Jenkins Peggy , Arbet Jaron , Carrington Suzanne , Hoon Shane , Purcell Sue K. , Nodine Priscilla
Published: March 2021

Background

Elevated levels of stress, anxiety, and depression are common symptoms in graduate students pursuing a degree in the health care professions. The onset of the COVID-19 pandemic likely complicated these existing issues.

Purpose

To confirm this hypothesis, researchers created a survey to examine the experiences of graduate nursing students during COVID-19.

Methods

Graduate nursing students (n = 222) completed the survey, which included 2 instruments: the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Events Scale (IES-R).

Results

Nearly 25% of students expressed moderate to extremely severe levels of negative emotional states on the DASS-21, and 23.8% of students scored within the area of clinical concern for the presence of posttraumatic stress disorder on the IES-R.

Conclusions

Understanding levels of mental health and associated factors that may contribute to changes can assist administration, faculty, and staff in targeting resources and interventions to support graduate nursing students to continue their education.
Treatment and outcomes of pediatric supracondylar humeral fractures in Korle Bu Teaching Hospital
Authors: Baidoo Paa Kwesi , Kumah-Ametepey Raphael , Segbefia Michael , Buunaaim Alexis Dun Bo-ib
Published: March 2021

Objectives:

Supracondylar humeral fractures (SCHF) are the most common elbow injury in the pediatric population. The treatment, outcome, and health-related quality of life (HRQoL) following these injuries are described.

Methods:

Patients with SCHF who were treated depending on the fracture type were evaluated. Medical records stored in the REDCap database were reviewed to obtain information on demographics, mechanisms of injury, neurovascular status, infection rates, and postoperative complications. Outcomes were assessed using Flynn's criteria and Pediatric Quality of Life (PedsQL) version 4.0. Follow-up was for 6 months.

Results:

A total of 101 patients with a mean age of 5.2 years (SD ± 2.3) were seen. Most of the injuries occurred at home (64.3%). The left-arm (nondominant) was the most injured (62%), though 92% of patients were right hand dominant. Ninety-six percent of the fractures were the extension type. A total of 98% had satisfactory outcomes using Flynn's criteria and older patients were likely to sustain Gartland type III SCHF (P 
= .01). There was a significant difference in mean scores of PedsQL (all P values < .01) at 6 months.

Conclusions:

In this prospective study, the quality of life of patients following SCHF diminished at the time of the injury and returned to the population normal 6 months after. There was no significant difference in HRQoL scores between patients who presented early and those who presented late. The delayed presentation and management did not also affect the functional outcome and complications. Therefore, surgical management of these injuries after late presentation is still safe.
Placenta Teratoma or Acardiac Fetus Amorphous: A Case Study by DNA Genotyping
Authors: McHenry Austin , Morotti Raffaella , Hui Pei
Published: March 2021

To date, 40 cases of placental teratoma and 21 cases of umbilical cord teratoma have been reported in the literature. Such entities are purportedly described as originating from ectopically derived totipotential germ cells forming 1 or more of 3 germ layers, similar to teratomas arising in other sites. These entities have been described as distinct from acardiac twins based on the absence of both an axial skeleton and/or separate umbilical cord attachment. We present a case that would be compatible with placental teratoma according to these criteria. However, DNA genotyping analysis of the “teratoma” and its corresponding normal placental tissue revealed an identical genetic profile at all microsatellite polymorphic loci with exception of one locus demonstrating loss of heterozygosity involving 1 of 2 “teratoma” samples tested. Our finding established that the “teratoma” in fact represented a monozygotic acardiac (amorphous) twin with aberrant division of embryogenesis as a continuum of the monozygotic twinning phenomenon. In summary, this is the first case study of so-called placental teratoma by DNA genotyping investigation. We conclude that the diagnostic term “placental teratoma” should be discouraged unless evidence of monozygotic twining can be ruled out by molecular genotyping.