bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Cefazolin Shortage on Surgical Site Infection Following Spine Surgery in Japan
Authors: Nakarai Hiroyuki , Yamada Koji , Tonosu Juichi , Abe Hiroaki , Watanabe Kenichi , Yoshida Yuichi , Ohya Junichi , Sato Yusuke , Hara Nobuhiro , Okazaki Rentaro , Azuma Seiichi , Nakamoto Hideki , Kato So , Oshima Yasushi , Tanaka Sakae , Higashikawa Akiro
Published: January 2021

Study Design.

Retrospective study using prospectively collected data.

Objective.

This study aimed to investigate the effect of alternative antimicrobial prophylaxis agents on surgical site infections (SSIs) after spine surgery.

Summary of Background Data.

Although the use of alternative antimicrobial prophylaxis agents might have a negative effect on SSI prevention, their association with SSI risk in spine surgery remains unclear.

Methods.

We used the registry data of consecutive patients undergoing spine surgery from April 2017 to January 2020 in four institutions participating in the University of Tokyo Spine Group. Before March 2019, all institutions used cefazolin for antimicrobial prophylaxis. After March 2019, the institutions used broad-spectrum beta-lactam agents as an alternative due to a cefazolin shortage in Japan.

Results.

Among the 3841 enrolled patients (2289 males), 2024 received cefazolin and 1117 received alternative agents. The risk of reoperation for deep SSI within 30 days of spine surgery was significantly higher in the alternative antimicrobial prophylaxis agent group (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI], 1.15–3.35; P = 0.014). In subgroup analyses, the SSI risk was significantly higher in the thoracolumbar surgery group (aOR 1.98; 95% CI, 1.06–3.73; P = 0.03). A nonsignificant consistent trend was found in all other subgroups: posterior decompression (aOR 1.91; 95% CI, 0.86–4.21; P = 0.11); posterior fixation (aOR 2.05; 95% CI, 0.99–4.24; P = 0.05); and cervical spine surgery (aOR 2.30; 95% CI, 0.82–6.46; P = 0.11).

Conclusion.

Alternative antimicrobial prophylaxis agents increased the risk of reoperation for SSI after spine surgery compared with cefazolin. Our study supports the current practice of using first-generation cephalosporins as first-line antimicrobial prophylaxis agents in spine surgery as recommended in multiple guidelines.

Level of Evidence: 3
Epithelioid Kaposi Sarcoma: A New Histological Variant
Authors: Alvarez Patricia , Salinas Cesar , Bravo Francisco , Sangueza Omar
Published: January 2021

Cutaneous Kaposi sarcoma (KS) covers a broad spectrum both clinically and pathologically. Some histological patterns of KS may be difficult to recognize and must be differentiated from other vascular neoplasms. We report on a 56-year-old Peruvian man who had been diagnosed with classical KS on the right foot 2 years before the present episode. He presented in our clinic with new lesions on the left foot. Histopathological findings included areas showing epithelioid cells with moderate pleomorphism, growing in solid sheets. Immunohistochemistry showed strong nuclear staining with a granular nuclear staining pattern for human herpesvirus 8 in the epithelioid cells. A diagnosis of epithelioid Kaposi sarcoma was made, which should be considered a new histological variant.
Melanoma Arising From a Pre-existing Neurofibroma in a Patient With No Prior Diagnosis of Systemic Neurofibromatosis 1 or 2: A Case Report
Authors: Nasir Wasim , Howard Tara , Weiss Eduardo
Published: January 2021

The pathophysiology of melanoma involves malignant transformation of melanocytes. These can arise de novo or result from malignant transformation of a pre-existing nevus. This case report presents a patient with a new pigmented lesion, arising from a pre-existing neurofibroma, on her left scapula and no personal or family history of systemic neurofibromatosis. Biopsy confirmed the lesion to be malignant melanoma and, after excision, postoperative pathology showed a pre-existing neurofibroma. A review of the literature suggests there may be a link between the pathogenesis of neurofibroma and malignant melanoma, because NF1 mutations are observed in both neurofibromatosis and malignant melanoma. We hypothesize that the pre-existing neurofibroma created a proliferative environment that gave rise to the adjacent neoplasm. Further research is required to understand the shared pathway, because this may lead to novel forms of surveillance and treatment.
Pleomorphic Leiomyosarcoma Presenting as a Upper Back Epidermal Inclusion Cyst
Authors: Smith Christian Taylor , Grider Douglas J.
Published: January 2021

Leiomyosarcoma is a common sarcoma of both organs and soft tissues; however, large intradermal tumors are extremely rare. Presented is a pleomorphic leiomyosarcoma in a 64-year-old man, initially considered to be a ruptured epidermal inclusion cyst. The patient had a mildly tender, enlarging soft-tissue mass with a central pore on his right upper back. Incomplete extirpation showed a 5 × 5 cm heterogeneous, predominantly pleomorphic sarcoma with areas of fascicular and storiform spindled cells infiltrating the subcutaneous soft tissue to the underlying fascia and extending upward into the middle and upper dermis with prominent extension into pilosebaceous units. There were small foci with myxoid stroma and large areas of necrosis. CD31 demonstrated thin-walled curvilinear vessels throughout the tumor. The first desmin immunohistochemical stain near areas with myxoid stroma was negative but smooth muscle actin positive. However, desmin positivity was strong and diffuse in the spindled and more pleomorphic areas on 2 additional tissue sections. No rhabdomyoblasts or striated muscle fibers were seen. A diagnosis of pleomorphic leiomyosarcoma was rendered. This case highlights a unique clinical and histological presentation of a leiomyosarcoma initially mistaken to be a ruptured epidermal inclusion cyst, and the need to sometimes apply ancillary immunohistochemical studies to sections from more than one tissue block to accurately differentiate heterogeneous sarcomas with similar histologic features.
Fertility awareness and quality of life: assessment and impact of fertility problems and infertility
Authors: Bayoumi Rasha R. , van der Poel Sheryl Z. , Koert Emily , Boivin Jacky
Published: January 2021

Preventative interventions particularly in the form of health awareness have gained prominence as sustainable mechanisms that improve and address gaps in access to health care, including fertility care, especially in low and middle-income countries. Increasingly targeted are preventative as well as supportive care interventions which can impact the quality of life experienced by individuals with fertility problems and infertility. The aim of this brief report is to draw attention to two inexpensive self-administered tools that can be used to begin to tackle these issues; the Fertility Status Awareness tool (FertiSTAT) and the Fertility Quality of Life (FertiQoL) tool. These tools can be utilized in research and clinical settings to help address fertility care needs and identify interventions required at individual and community level. The FertiSTAT and FertiQoL tools have the potential to assess signs, symptoms and preventable causes as well as psychological and social care needs of individuals experiencing fertility problems and infertility. In addition, these tools can function either independently or together within various communication channels, as well as educational and service delivery systems.
Infertility in Uganda: a missed opportunity to improve reproductive knowledge and health
Authors: Kudesia Rashmi , Muyingo Mark , Tran Nam , Shah Meera , Merkatz Irwin , Klatsky Peter
Published: January 2021

Introduction:

Fertility care is an important unmet need in sub-Saharan Africa and considered low priority by donor countries and agencies. Understanding the social context of infertility may increase effectiveness of reproductive health programs.

Methods:

We conducted a cross-sectional study of fertile and infertile women in Kampala, Uganda, evaluating reproductive knowledge, quality of life (QOL), and infertility-related social morbidity using validated instruments and survey techniques.

Results:

QOL scores were lower than previously reported scores in Europe (P<0.001). A majority of respondents (53%) reported that they would rather contract HIV than live with infertility. In all, 46.7% of women listed “family planning” or a reversible contraceptive as a cause of infertility. Reproductive knowledge was low, with only 16.7% of women able to give 3 accurate causes of infertility. Infertile women reported higher rates of interpersonal violence, but these differences were not statistically significant.

Conclusions:

Infertility in Uganda decreases QOL comparably to other severe medical conditions and more than in prior studies. Common beliefs linking infertility to contraception may hinder implementation of family planning, though the infertility evaluation may help correct misconceptions. The connections between infertility, low reproductive knowledge, contraceptive uptake, and violence demonstrated here merit further study and may assist in designing culturally competent basic reproductive health programs in communities with limited resources.
Detecting Glaucoma in Rural Kenya: Results From a Teleglaucoma Pilot Project in Nyamira, Kenya
Authors: Marco Sheila A. , Amin Samreen , Virani Aleena , Rudnisky Christopher J. , Ishani Sarah , Kiage Dan , Damji Karim F.
Published: January 2021

Precis:

A teleglaucoma (TG) case-finding model was used in Kenya. Of the patients, 3.46% had definite glaucoma and 4.12% were glaucoma suspects. Most cases were of moderate to advanced stage and referred for further assessment.

Purpose:

The aim was to evaluate glaucoma prevalence in a high-risk population using a TG model.

Methods:

Patients aged 35 or over were referred to the TG program from the outpatient diabetic and hypertensive clinics at Nyamira District Hospital (NDH) and from community awareness programs. Comprehensive ophthalmic examination included structured history, visual acuity, intraocular pressure, central corneal thickness, stereoptic nerve, and macular images. A glaucoma specialist provided diagnosis and management recommendation through virtual consultation. Glaucoma diagnosis and staging were based on at least 1 eye meeting the optic nerve criteria as specified by the Canadian glaucoma guidelines.

Results:

In all, 1206 participants were seen and 19 of these could not complete the examination. Of 1187 patients, 56% were women and the mean age was 56.60±12.36 years. Of the patients, 11.8% had images that were ungradable in at least 1 eye. The prevalence of glaucoma and glaucoma suspects was 3.46% (n=42) and 4.12% (n=50), respectively. The proportion of patients with early, moderate, advanced, and absolute glaucoma was 2.4%, 33.3%, 52.4%, and 2.4%, respectively. Other diagnoses (pathology in at least 1 eye) included cataract in 13.2%, diabetic retinopathy in 1.48%, and optic atrophy in 1.98%. Of the patients, 28.2% were referred to the Innovation Eye Centre, Kisii, for further assessment.

Conclusion:

A structured TG program detected glaucoma in 3.46% of a rural Kenyan population. Timely patient referral was also initiated.
Acute Angle Closure in Knobloch Syndrome
Authors: Wawrzynski James , Than Jonathan , Gillam Matthew , Foster Paul J.
Published: January 2021

We report cases of acute angle closure in 2 young highly myopic siblings with Knobloch syndrome. To our knowledge, this is the first report of acute angle closure in Knobloch syndrome. Both patients were homozygous for a likely pathogenic variant in COL18A1. Both responded to treatment with cyclophotocoagulation and remained stable despite declining or being medically unfit for clear lens extraction. We argue that the recent implication of heterozygous mutations in COL18A1 in familial angle closure supports the argument that acute angle closure in these 2 patients was likely to be a thus far unreported feature of Knobloch syndrome. In addition, these cases also support the hypothesis that pathogenic variants in COL18A1 may be a risk factor for acute angle closure.
Operative Complications of Glaucoma Drainage Implant Tube Insertion Through the Sulcus for Pseudophakic Eye
Authors: Asaoka Satoko , Kasuga Toshimitsu , Matsunaga Toru , Hayashi Yusuke , Asada Yosuke , Iwamoto Satoshi , Hirakata Toshiaki , Honda Rio , Obazawa Hanako , Sasaki Hidenori , Ohta Toshihiko , Matsuda Akira
Published: January 2021

Precis:

Malposition of the tube through the ciliary sulcus is more frequently observed with the Ahmed glaucoma valve (AGV) than the Baerveldt drainage implant (BDI) due to the weaker rigidity of the Ahmed tube.

Purpose:

To report intraoperative and early postoperative complications of ciliary sulcus tube insertion of glaucoma drainage implants (GDIs).

Patients and Methods:

We performed retrospective analysis of 104 eyes of 94 patients with GDI tube insertion through the ciliary sulcus were performed. The rigidities of tubes were also examined using a microcompression tester.

Results:

The mean observation period was 20.0 (range, 6 to 60) months. Thirteen eyes were treated with the BDI and 91 were with the AGV. The mean age of the patients was 69.3 (34 to 90) years. The mean intraocular pressure was 27.9 mm Hg before surgery and 12.9 mm Hg after surgery (P<0.01). Upon tube insertion 42/91 eyes (46%) with the AGV required reinsertion of the tube due to malpositioning, whereas only 1/13 (8%) eyes with BDI did (P<0.01). Transient hyphema (12 eyes) and hypotony (12 eyes) were observed as early postoperative complications with the AGV. Seven eyes with hypotony were treated by proline stenting of the tube. We could not accomplish sulcus insertions in 4 eyes. Microcompression analysis of the tubes showed that the BGI tube was more rigid than that of the AGV.

Conclusions:

Ciliary sulcus insertion of the tube is an effective method to control intraocular pressure. The tube of the AGV was more difficult to insert through the sulcus than the BDI due to its weaker rigidity.
Surgical Technique for Pars Plana Ahmed Glaucoma Valve Implantation in Advanced Glaucoma: The Upside-Down Technique
Authors: Masuda Yoichiro , Saito Yuka , Oki Tetsutaro , Hayashi Takaaki , Takahashi Genichiro , Nakano Tadashi
Published: January 2021

Précis:

Ahmed glaucoma valve (AGV) implantation using the upside-down technique resulted in an aqueous humor outflow pathway, occurring primarily on the scleral side and secondarily on the conjunctival side, and was effective in treating refractory glaucoma.

Purpose:

To describe the AGV surgical technique, which results in changes in the primary aqueous humor outflow pathway to the scleral side (upside-down technique), and to evaluate the clinical effects and distribution of bleb fluid after surgery in patients with refractory glaucoma.

Patients and Methods:

In this retrospective study, the upside-down technique was used for pars plana AGV implantation in 10 eyes of 10 patients with refractory glaucoma. Surgical success was defined by complications, intraocular pressure (IOP), the glaucoma medication score, and bleb fluid distribution determined by magnetic resonance imaging.

Results:

Postoperatively, there were significant reductions in the IOP and medication score at 23 and 27 months, respectively (P<0.05). Although a transient hypertensive phase was observed in 7 patients, it was controlled without ocular massage and additional surgery. A patient who had suprachoroidal hemorrhage during surgery lost light perception 7 months after the surgery, and another patient developed hypotony at 3 and 4 months after surgery, which spontaneously improved during subsequent examinations. Magnetic resonance imaging showed that the double bleb layer adjacent to the endplate tended to have more bleb fluid on the conjunctival side than on the scleral side facing the outlet (n=8; 1 to 29 mo after surgery).

Conclusions:

Pars plana AGV implantation using the upside-down technique was a relatively effective alternative to manage inadequate IOP control in patients with refractory glaucoma.
Using Best–Worst Scaling to Determine the Most Burdensome Menopausal Symptoms in Cambodian Women Living With HIV
Authors: Yang Youngran , Thapa Roshna , Lewis Frances Marcus
Published: January 2021

As persons living with HIV live longer, it is important to understand the symptoms experienced by menopausal women living with HIV (WLWH). This study used best–worst scaling (BWS) to determine the menopausal symptoms that are most burdensome for Cambodian WLWH. Participants were asked to rate a list of menopausal symptoms in terms of the most and least burdensome in their lives via BWS. The final analysis included 183 participants, 67 of whom were premenopausal, 47 perimenopausal, and 69 postmenopausal women. Physical and mental exhaustion (mean best–worst score = 319) was rated as the most burdensome symptom, and hot flushes and sweating were the least burdensome (mean best–worst score = −181). The BWS provides information on priorities for the distribution of health care resources. Understanding how Cambodian WLWH prioritize burdensome menopausal symptoms is crucial for choosing the most contextually sensitive method to provide health care services and interventions.
The Intersection of Cognitive Ability and HIV: A Review of the State of the Nursing Science
Authors: Waldrop Drenna , Irwin Crista , Nicholson W. Chance , Lee Cheryl A. , Webel Allison , Fazeli Pariya L. , Vance David E.
Published: January 2021

Neurocognitive problems have been endemic to the HIV epidemic since its beginning. Four decades later, these problems persist, but currently, they are attributed to HIV-induced inflammation, the long-term effects of combination antiretroviral therapy, lifestyle (i.e., physical activity, drug use), psychiatric, and age-associated comorbidities (i.e., heart disease, hypertension). In many cases, persons living with HIV (PLWH) may develop cognitive problems as a function of accelerated or accentuated normal aging and lifestyle rather than HIV itself. Nonetheless, such cognitive impairments can interfere with HIV care, including medication adherence and attending clinic appointments. With more than half of PLWH 50 years and older, and 30%–50% of all PLWH meeting the criteria for HIV-associated neurocognitive disorder, those aging with HIV may be more vulnerable to developing cognitive problems. This state of the science article provides an overview of current issues and provides implications for practice, policy, and research to promote successful cognitive functioning in PLWH.
A residency style transition to practice program in trauma and critical care: The George Washington University Hospital experience
Authors: Messing Jonathan , Peters Miranda , Vota Amy , Seneff Michael , Sarani Babak
Published: January 2021

Transition to practice programs for nurse practitioners and physician assistants are gaining popularity and becoming more specialized. As these providers seek opportunities to strengthen their clinical skills and bridge the gap from school to practice, it is important to recognize the benefits and barriers of such programs. In this article, The George Washington University Hospital shares its experience in managing a transition to practice program for trauma and critical care.
Evaluation of an international program for nurse practitioner students
Authors: Steinke Mary K. , Rogers Melanie
Published: January 2021

Background:

There are few opportunities for nurse practitioner (NP) students to develop relationships and exchange ideas with international counterparts. In addition, discovering differences in instructional pedagogy between programs is beneficial for every student.

Purpose:

To facilitate an international understanding of health care services and compare curricula of advanced practice programs through an international experience for first year NP students from the United Kingdom and the United States.

Methodological orientation:

The study used a qualitative analysis of responses from specified questions provided to both cohorts of students before and after the experience.

Sample:

A virtual global exchange between 23 advanced practice students and their professors in the spring of 2018 culminated in a trip by the UK students and faculty to the United States in April of that year.

Conclusions:

The UK and US NP students positively evaluated the international encounter and pointed out specific educational activities that were most helpful to their training.

Implications for practice:

International experiences offer NP students the opportunity to experience health care delivery in an alternative cultural milieu.
Modern surgical strategies in the management of complex ureteral strictures
Authors: Paffenholz Pia , Heidenreich Axel
Published: January 2021

Purpose of review

The purpose of this article is to outline the various therapeutic options of ureteral strictures.

Recent findings

Ureteral strictures with consecutive hydronephrosis can be due to endourological and surgical procedures, inflammatory processes, radiation therapy as well as spontaneous passage of ureteral calculi. When planning surgical correction, stricture length, anatomical location as well as patients’ characteristics like age, comorbidities and previous treatment in the peritoneal cavity, retroperitoneum or pelvis should be taken into consideration. Treatment options include not only surgical reconstruction techniques like simple stricture excision, end-to-end anastomosis, ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement, but also minimally invasive procedures such as self-expandable thermostents and pyelovesical bypass prosthesis.

Various therapeutic options can be offered in the treatment of ureteral strictures, potentially leading to long-term success rate of more than 90% and a rate of significant complications < 5%.
An Examination of Work Characteristics, Fatigue, and Recovery Among Acute Care Nurses
Authors: Cochran Karen R.
Published: January 2021

OBJECTIVE

To examine self-perceived fatigue among nurses and to quantify levels of fatigue and the ability to recover from fatigue between worked shifts across various work characteristics.

BACKGROUND

Fatigue is associated with working long hours, disruption of sleep, and inadequate time to recover between shifts. Fatigue degrades the nurses' performance leading to poorer patient outcomes and increased occupational injuries.

METHODS

This quantitative study surveyed 573 nurses across 5 hospitals in the southeastern United States.

RESULTS

Significant levels of acute fatigue were associated with working labor and delivery and medical-surgical units and working a 12-hour shift. Nurses working night shift and on the behavioral health unit showed a significantly lower ability to recover between worked shifts.

CONCLUSIONS

Fatigue threatens safety and the quality of patient care. Leaders should ensure that nurses take duty-free breaks and schedule adequate time off to recover between worked shifts.
Interactive Learning for Nurses Through Gamification
Authors: Garrison Elisabeth , Colin Sharon , Lemberger Olivia , Lugod Maureen
Published: January 2021

OBJECTIVE

The nursing professional development department purchased technology to create an innovative structure to engage nurses in educational offerings. The purpose of this study is to examine the effect of incorporating gamification on knowledge acquisition.

BACKGROUND

Nursing administrators should support the use of gamification to improve the nurses' acquisition of knowledge. The clinical educators traditionally utilize lecture-based educational offerings preventing students from active participation. Gamification promotes learner engagement, critical thinking, and enjoyment.

METHODS

A quasi-experimental study design with a 230-person convenience sample compared the knowledge acquisition of nurses before and after new hire orientation and basic electrocardiogram course. Technology purchased included iPad, GoPro, mobile apps, and websites.

RESULTS

Incorporating gamification technology resulted in an increase in knowledge acquisition and engagement of learners.

CONCLUSION

Findings demonstrate gamification as an effective way to increase knowledge acquisition when compared with traditional methods.
Examining Associations With Mental, Well-Being and Faith in Nurses (LIFT)
Authors: Harris Stephanie L. , Green Jeanette F. , Tao Hong , Robinson Patricia S.
Published: January 2021

OBJECTIVE

The aim of this study was to explore the association between religion/spirituality (r/s) and mental health outcomes in hospital-based nursing staff.

BACKGROUND

The relationship between r/s and health has been studied extensively. Most frequently, r/s has been studied in association with mental health outcomes, including depression, anxiety, and distress among patients. However, hospital-based nurses suffer from the mental health effects of working in high-stress work environments. To date, little research has focused on the relationship between r/s and mental health outcomes in nurses.

METHODS

A cross-sectional online survey was completed by 207 nurses from 6 community hospitals.

RESULTS

Approximately half of the nurses sampled identified as religious, whereas nearly 75% identified as spiritual. There were significant associations between measures of r/s and mental health outcomes such as depression, anxiety, and mental well-being.

CONCLUSIONS

This whole-person assessment of nurses may inform future retention and engagement strategies focused on faith-based interventions.
Deep Learning‐Based Automated Abdominal Organ Segmentation in the UK Biobank and German National Cohort Magnetic Resonance Imaging Studies
Authors: Kart Turkay , Fischer Marc , Küstner Thomas , Hepp Tobias , Bamberg Fabian , Winzeck Stefan , Glocker Ben , Rueckert Daniel , Gatidis Sergios
Published: January 2021

Purpose

The aims of this study were to train and evaluate deep learning models for automated segmentation of abdominal organs in whole-body magnetic resonance (MR) images from the UK Biobank (UKBB) and German National Cohort (GNC) MR imaging studies and to make these models available to the scientific community for analysis of these data sets.

Methods

A total of 200 T1-weighted MR image data sets of healthy volunteers each from UKBB and GNC (400 data sets in total) were available in this study. Liver, spleen, left and right kidney, and pancreas were segmented manually on all 400 data sets, providing labeled ground truth data for training of a previously described U-Net-based deep learning framework for automated medical image segmentation (nnU-Net). The trained models were tested on all data sets using a 4-fold cross-validation scheme. Qualitative analysis of automated segmentation results was performed visually; performance metrics between automated and manual segmentation results were computed for quantitative analysis. In addition, interobserver segmentation variability between 2 human readers was assessed on a subset of the data.

Results

Automated abdominal organ segmentation was performed with high qualitative and quantitative accuracy on UKBB and GNC data. In more than 90% of data sets, no or only minor visually detectable qualitative segmentation errors occurred. Mean Dice scores of automated segmentations compared with manual reference segmentations were well higher than 0.9 for the liver, spleen, and kidneys on UKBB and GNC data and around 0.82 and 0.89 for the pancreas on UKBB and GNC data, respectively. Mean average symmetric surface distance was between 0.3 and 1.5 mm for the liver, spleen, and kidneys and between 2 and 2.2 mm for pancreas segmentation. The quantitative accuracy of automated segmentation was comparable with the agreement between 2 human readers for all organs on UKBB and GNC data.

Conclusion

Automated segmentation of abdominal organs is possible with high qualitative and quantitative accuracy on whole-body MR imaging data acquired as part of UKBB and GNC. The results obtained and deep learning models trained in this study can be used as a foundation for automated analysis of thousands of MR data sets of UKBB and GNC and thus contribute to tackling topical and original scientific questions.
A Multicenter Analysis of Wide Excision and Reconstruction for Severe Anogenital Hidradenitis Suppurativa
Authors: Ovadja Zachri N. , Bartelink Sophieke A.W. , Hadi Kany , van de Kar Annekatrien L. , van der Horst Chantal M.A.M. , Lapid Oren
Published: January 2021

Background

An appropriate reconstruction strategy after wide excision for severe cases of anogenital hidradenitis suppurativa (aHS) is important to optimize outcomes, but there is no consensus on which reconstruction strategy should be preferred.

Objective

Evaluate which reconstruction strategy after wide excision in patients with severe aHS is associated with the best outcomes in terms of recurrence rate, complications and patient-reported outcomes on range of motion, pain, appearance, sexual health and satisfaction.

Methods

Multicenter retrospective analysis between 2009 and 2019 of wide excision and reconstruction by primary closure, secondary intention healing, split-thickness skin grafts or fasciocutaneous flaps (FCF). The recurrence rate was the primary endpoint of multivariable logistic regressions to determine variables with an independent effect on recurrence.

Results

A total of 93 patients were included. The overall recurrence rate was 62% after a median follow-up of 43 months, without statistical significance between reconstruction strategies (P = 0.737). The number of interventions during follow-up was an independent risk factor for recurrence (odds ratio, 2.55; confidence interval, 1.24–5.25; P = 0.011). Complications (37%) were more severe after FCF (P = 0.007). The mean score regarding patient-reported outcomes was 14.9 ± 2.8, of 24, with best appearance after FCF (P = 0.042).

Conclusions

These long-term follow-up data on severe aHS demonstrate a high recurrence rate after wide excision and reconstruction. Patients should be informed that treatment consists of long-term medicinal and surgical interventions with high recurrence rates, and surgeons may choose their own preferred reconstruction methods. Furthermore, more attention should be paid to the sexual health of patients with aHS.
Transoral Approach to the Giant Deep Lobe Parotid Gland Pleomorphic Adenoma
Authors: Yavuz Haluk , Vural Omer
Published: January 2021

Parapharyngeal space tumors are rare tumors that make up about 0.5% to 1% of all head and neck neoplasms. The majority of parapharyngeal space tumors, which are usually benign, consist of salivary gland tumors and neurogenic tumors. Although the transcervical, transparotid or transmandibular approach is generally preferred for the excision of these tumors, the transoral approach, which is more advantageous in terms of cosmetics and function, can be applied in selected cases. This article presents a case in which the giant pleomorphic adenoma originating from the deep lobe of the parotid gland is removed by transoral approach.
Vigilance for Medical Products of Human Origin—Progress on the Notify Library’s Global Effort to Share Information and Learning
Authors: Petrisli Evangelia , Carella Claudia , Navarro Aurora , Fehily Deirdre , Strong Douglas Michael , Cardillo Massimo
Published: January 2021

Background.

World Health Assembly Resolution 63.22 mandated World Health Organization to facilitate Member State access to appropriate information on medical products of human origin (MPHO), including collecting data on serious adverse events and reactions. To meet this challenge, the Italian National Transplant Center, with a mandate from World Health Organization, has built and maintained an open-access searchable database of instructive records on disease transmission and other MPHO adverse occurrences.

Methods.

One record in the Notify Library describes a specific type of adverse occurrence in 1 type of MPHO and might be linked with 1 or multiple different references. The record inclusion criteria are that it has been reliably documented in a published article or official vigilance reporting system and that it has instructive value for the fields of transfusion, transplantation, or assisted reproduction. The selection and review of references for publication is performed by international experts who collaborate in 5 topic-specific editorial groups: infection transmission, malignancy transmission, living-donor reactions, process-related incidents, and clinical complications. New relevant references are identified through systematic searches and proactive communication by the experts.

Results.

The Library contains 1733 records, quoting 2632 references. Of the records, 41.8% are related to organs, 20.8% to blood and blood components, 16.5% to hematopoietic progenitor cells, 15.2% to tissues, 4.2% to reproductive tissues and cells, and 1.5% to other MPHO.

Conclusions.

Notify Library is the first open-access, searchable database of systematically identified reports of disease transmission and other adverse occurrences arising from the donation and clinical application of MPHO.
Incidence and Risk Factors for Fatal Graft-versus-host Disease After Liver Transplantation
Authors: Kitajima Toshihiro , Henry Matthew , Ivanics Tommy , Yeddula Sirisha , Collins Kelly , Rizzari Michael , Yoshida Atsushi , Abouljoud Marwan S. , Nagai Shunji , Moonka Dilip
Published: January 2021

Background.

Graft-versus-host disease (GVHD) after liver transplantation (LT) is a rare but serious complication. The aim of this study is to identify risk factors, including immunosuppressive regimens, for mortality due to GVHD (fatal GVHD).

Methods.

Using data from the Organ Procurement and Transplantation Network and United Network for Organ Sharing registry, 77 416 adult patients who underwent LT between 2003 and 2018 were assessed. Risk factors for fatal GVHD were analyzed by focusing on induction and maintenance immunosuppression regimens.

Results.

The incidence of fatal GVHD was 0.2% (121 of 77 416), of whom 105 (87%) died within 180 d and 13 (11%) died between 181 d and 1 y. Median survival after LT was 68.0 (49.5–125.5) d. Recipient age minus donor age >20 y (hazard ratio [HR], 2.57;P< 0.001) and basiliximab induction (HR, 1.69;P= 0.018) were independent risk factors for fatal GVHD. Maintenance therapy with mycophenolate mofetil (MMF) was associated with a decrease in fatal GVHD (HR, 0.51;P= 0.001). In an increased risk cohort of patients with recipient-donor age discrepancy >20 y, MMF use was associated with a 50% decline in fatal GVHD (HR, 0.50;P< 0.001).

Conclusions.

Recipient age minus donor age >20 y remains a significant risk factor for fatal GVHD. The risk of fatal GVHD significantly increases in association with basiliximab induction and decreases with MMF maintenance. These associations were pronounced in patients with recipient minus donor age >20 y. These results emphasize the importance of donor age and individualized immunosuppression regimens on the risk of fatal GVHD.
Changes in Functional Status Among Kidney Transplant Recipients: Data From the Scientific Registry of Transplant Recipients
Authors: Chu Nadia M. , Chen Xiaomeng , Bae Sunjae , Brennan Daniel C. , Segev Dorry L. , McAdams-DeMarco Mara A.
Published: January 2021

Background.

With stressors of dialysis prekidney transplantation (KT) and restoration of kidney function post-KT, it is likely that KT recipients experience a decline in functional status while on the waitlist and improvements post-KT.

Methods.

We leveraged 224 832 KT recipients from the national registry (SRTR, February 1990–May 2019) with measured Karnofsky Performance Status (KPS, 0%–100%) at listing, KT admission, and post-KT. We quantified the change in KPS from listing to KT using generalized linear models. We described post-KT KPS trajectories using adjusted mixed-effects models and tested whether those trajectories differed by age, sex, race, and diabetes status using a Wald test among all KT recipients. We then quantified risk adverse post-KT outcomes (mortality and all-cause graft loss [ACGL]) by preoperative KPS and time-varying KPS.

Results.

Mean KPS declined from listing (83.7%) to admission (78.9%) (mean = 4.76%, 95% confidence interval [CI]: −4.82, −4.70). After adjustment, mean KPS improved post-KT (slope = 0.89%/y, 95% CI: 0.87, 0.91); younger, female, non-Black, and diabetic recipients experienced greater post-KT improvements (Pinteractions< 0.001). Lower KPS (per 10% decrease) at admission was associated with greater mortality (adjusted hazard ratio [aHR] = 1.11, 95% CI: 1.10, 1.11) and ACGL (aHR = 1.08, 95% CI: 1.08, 1.09) risk. Lower post-KT KPS (per 10% decrease; time-varying) were more strongly associated with mortality (aHR = 1.93, 95% CI: 1.92, 1.94) and ACGL (aHR = 1.84, 95% CI: 1.83, 1.85).

Conclusions.

Functional status declines pre-KT and improves post-KT in the national registry. Despite post-KT improvements, poorer functional status at KT and post-KT are associated with greater mortality and ACGL risk. Because of its dynamic nature, clinicians should repeatedly screen for lower functional status pre-KT to refer vulnerable patients to prehabilitation in hopes of reducing risk of adverse post-KT outcomes.
Traumatic subarachnoid hemorrhage: a scoping review
Authors: Griswold Dylan P , Fernandez Laura , Rubiano Andres M
Published: January 2021

Sixty-nine million people suffer from traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (tSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. However, a limited number of studies evaluate recent trends in the diagnostic and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of traumatic subarachnoid hemorrhage. This scoping review was conducted following the JBI methodology for scoping reviews. The review included adults who suffered SAH secondary to trauma. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: tSAH associated with mild TBI (n=13), and severe TBI (n=3); clinical management and diagnosis (n=9); imaging (n=3); and 5) aneurysmal tSAH (n=1). Of the 30 studies, two came from a low-and middle-income country (LMIC); excluding China, nearly a high-income country. Patients with tSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be managed conservatively when considering ICU admission. The Helsinki and Stockholm CT scoring systems, in addition to the AIS, Cr, age decision tree, may be valuable tools to use when predicting outcome and mortality.
Lack of evidence for interactions between APOE and Klotho genotypes on cognitive, dementia and brain imaging metrics in UK Biobank
Authors: Tank Rachana , Ward Joey , Smith Daniel J. , Flegal Kristin E. , Lyall Donald M.
Published: January 2021

Importance

Recent research has suggested that genetic variation in the Klotho (KL) locus may modify the association between apolipoprotein e (APOE) e4 genotype and cognitive impairment.

Objective

Large-scale testing for associations and interactions between KL and APOE genotypes vs. risk of dementia (n=1,570 cases), cognitive abilities (n=174,513) and brain structure (n = 13,158) in older (60+ years) participants.

Design, setting and participants

Cross-sectional and prospective data (UK Biobank).

Main outcomes and measures

KL status was indexed with heterozygosity of the rs9536314 polymorphism (vs. not), in unrelated people with vs. without APOE e4 genotype, using regression and interaction tests. We assessed non-demented cognitive scores (processing speed; reasoning; memory; executive function), multiple structural brain imaging, and clinical dementia outcomes. All tests were corrected for age, sex, assessment centre, eight principal components for population stratification, genotypic array, smoking history, deprivation, and self-reported medication history.

Results

APOE e4 presence (vs. not) was associated with increased risk of dementia, worse cognitive abilities and brain structure differences. KL heterozygosity was associated with less frontal lobe grey matter. There were no significant APOE/KL interactions for cognitive, dementia or brain imaging measures (all P>0.05).

Conclusions and relevance

We found no evidence of APOE/KL interactions on cognitive, dementia or brain imaging outcomes. This could be due to some degree of cognitive test imprecision, generally preserved participant health potentially due to relatively young age, type-1 error in prior studies, or indicative of a significant age-dependent KL effect only in the context of marked AD pathology.

Key points

Question: Klotho genotype has been previously shown to ‘offset’ a substantial amount of the APOE e4/cognitive impairment association. Is this modification effect apparent in large-scale independent data, in terms of non-demented cognitive abilities, brain structure and dementia prevalence?

Findings: In aged 60 years and above participants from UK Biobank, we found significant associations of APOE and Klotho genotypes on cognitive, structural brain and dementia outcomes, but no significant interactions.

Meaning: This could reflect somewhat healthy participants, prior type 1 error or cognitive/dementia ascertainment imprecision, and/or that Klotho genotypic effects are age and neuropathology dependent.
An optimised protocol for detection of SARS-CoV-2 in stool
Authors: Li T , Garcia-Gutierrez E , Scadden J , Davies J , Hutchins C , Aydin A , Romano S , Sayavedra L , O’Grady J , Narbad A
Published: January 2021

Aim

SARS-CoV-2 has been detected in stool samples of COVID-19 patients, with potential implications for faecal-oral transmission. Compared to swab samples, the complexity of the stool matrix poses a challenge in the detection of the virus that has not yet been solved. The aim of this study was to establish a sensitive and reliable method for detecting SARS-CoV-2 in stool samples.

Methods

Stool samples from individuals free of SARS-CoV-2 were homogenised in saline buffer and spiked with a known titre of inactivated virus ranging from 50 to 750 viral particles per 100 mg stool. Debris was removed via centrifugation and supernatants were concentrated by ultrafiltration. RNA was then extracted from the concentrated material using a commercial kit and SARS-CoV-2 was detected via real-time reverse-transcription polymerase chain reaction (RT-qPCR) using the CDC primers and probes.

Results

The RNA extraction procedure we used allowed the detection of SARS-CoV-2 via RT-qPCR in most of the stool samples tested. We could detect as few as 50 viral particles per 100 mg of stool. However, high variability was observed across samples at low viral titres. The primer set targeting the N1 region provided more reliable and precise results and for this primer set our method had a limit of detection of 1 viral particle per mg of stool.

Conclusions

Here we describe a sensitive method for detecting SARS-CoV-2 in stool samples. This method can be used to establish the persistence of SARS-CoV-2 in stool and ensure the safety of clinical practices such as faecal microbiota transplant (FMT).
Delayed bystander CD8 T cell activation, early immune pathology and persistent dysregulation characterise severe COVID-19
Authors: Bergamaschi Laura , Mescia Federica , Turner Lorinda , Hanson Aimee , Kotagiri Prasanti , Dunmore Benjamin J. , Ruffieux Hélène , De Sa Aloka , Huhn Oisín , Morgan Michael D , Gerber Pehuen Pereyra , Wills Mark R. , Baker Stephen , Calero-Nieto Fernando J , Doffinger Rainer , Dougan Gordon , Elmer Anne , Goodfellow Ian G , Gupta Ravindra K. , Hosmillo Myra , Hunter Kelvin , Kingston Nathalie , Lehner Paul J. , Matheson Nicholas J. , Nicholson Jeremy K. , Petrunkina Anna M. , Richardson Sylvia , Saunders Caroline , Thaventhiran James E.D. , Toonen Erik J. M. , Weekes Michael P. ,   Cambridge Institute of Therapeutic Immunology and Infectious Disease-National Institute of Health Research (CITIID-NIHR) COVID BioResource Collaboration, Göttgens Berthold , Toshner Mark , Hess Christoph , Bradley John R. , Lyons Paul A. , Smith Kenneth G.C.
Published: January 2021

In a study of 207 SARS-CoV2-infected individuals with a range of severities followed over 12 weeks from symptom onset, we demonstrate that an early robust bystander CD8 T cell immune response, without systemic inflammation, is characteristic of asymptomatic or mild disease. Those presenting to hospital had delayed bystander responses and systemic inflammation already evident at around symptom onset. Such early evidence of inflammation suggests immunopathology may be inevitable in some individuals, or that preventative intervention might be needed before symptom onset. Viral load does not correlate with the development of this pathological response, but does with its subsequent severity. Immune recovery is complex, with profound persistent cellular abnormalities correlating with a change in the nature of the inflammatory response, where signatures characteristic of increased oxidative phosphorylation and reactive-oxygen species-associated inflammation replace those driven by TNF and IL-6. These late immunometabolic inflammatory changes and unresolved immune defects may have clinical implications.
A Viral Fragmentation Signature for SARS-CoV-2 in Clinical Samples Correlating with Contagiousness
Authors: Choudhury Yukti , Cher Chae Yin , Wan Zi Yi , Xie Chao , Lim Jing Shan , Virk Ramandeep Kaur , Tan Min Han , Jing Teo Alvin Kuo , Hsu Li Yang
Published: January 2021

The viral load of SARS-CoV-2 in clinical samples as measured by the primary diagnostic tool of RT-PCR is an imperfect readout for infection potential as most targeted assays designed for sensitivity, indiscriminately detect short and long RNA fragments, although infectivity is embodied only in the whole virus and its intact genome. Here, we used next-generation sequencing (NGS) to characterize 155 clinical samples and show sensitive and quantitative detection of viral RNA which confirmed subgenomic RNA in 57.6% of samples and provided a novel method to determine relative integrity of viral RNA in samples. The relative abundance of long fragments quantified as a viral fragmentation score was positively associated with viral load and inversely related to time from disease onset. An empirically determined score cut-off for presence of substantially fragmented RNA was able to identify 100% of samples collected after 8 days of illness with poor infection potential in line with current clinical understanding of infectiousness of SARS-CoV-2. The quantification of longer fragments in addition to existing short targets in an NGS or RT-PCR-based assay could provide a valuable readout of infection potential simultaneous to the detection of any fragments of SARS-CoV-2 RNA in test samples.