bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes
Authors: Prussin Aaron J. , Babajanian Eric , Error Marc , Grimmer J. Fredrik , Ku Jessica , McRae Bryan , Meier Jeremy , Thiesset Heather , Skirko Jonathan R.
Published: October 2020

Objective

To analyze patients’ return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation.

Study Design

Randomized double‐blinded clinical trial based on prospective parallel design.

Setting

Academic medical center and tertiary children’s hospital between March 2018 and July 2019.

Methods

Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep‐disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient’s return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events.

Results

Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity (P =. 89), daily pain scores over 15 postoperative days (P =. 46), postoperative narcotic use (P =. 61), or return to hospital for any reason (P =. 60), including bleeding as an adverse event (P =. 13).

Conclusions

As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.
Improving Attendance and Patient Experiences During the Expansion of a Telehealth‐Based Pediatric Otolaryngology Practice
Authors: Kolb Caroline M. , Born Kristen , Banker Karen , Barth Patrick C. , Aaronson Nicole Leigh
Published: October 2020

Objective

To determine the rates and primary causes of missed appointments (MAs) for telehealth visits and present remedies for improvement.

Methods

This cross‐sectional survey was conducted at a tertiary care pediatric otolaryngology practice during expansion of telehealth‐based visits. A review of questionnaire responses was performed for 103 consecutive patients with MAs over 50 business days from March 20, 2020, to May 29, 2020. Families were asked a brief survey regarding the cause of the MA and assisted with technical support and rescheduling. MA rates and causes were analyzed.

Results

The overall MA rate during the initiation of telehealth services was significantly increased at 12.4% as compared with clinic‐based visits of a similar duration before COVID of 5.2% (P <. 001). Technical issues were the most common causes of MAs (51.3%). Of the caregivers, 23.8% forgot or reported cancellation of the appointment. Five percent of patients were non–English speaking and scheduled without translator support. Minorities and patients with public insurance represented 53.6% and 61.9% of MAs, respectively.

Discussion

Technical difficulties were the most commonly reported cause of missed telehealth appointments. Optimization of applications by providing patient reminders, determining need for translator assistance, and reducing required upload/download speeds may significantly reduce rates of MAs and conversions to other communication.

Implications for Practice

Clear, concise education materials on the technical aspects of telehealth, platform optimization, and robust technical and administrative support may be necessary to reduced missed telehealth appointments and support large‐scale telehealth operations. An assessment of institutional capacity is critical when considering telehealth expansion.
Airway Hemangiomas in PHACE Syndrome: A Multicenter Experience
Authors: Czechowicz Josephine A. , Benjamin Tania , Bly Randall A. , Ganti Sheila N. , Balkin Daniel M. , Perkins Jonathan A. , Frieden Ilona J. , Rosbe Kristina W.
Published: October 2020

Objective

To describe the prevalence and clinical characteristics of airway findings in a multi‐institutional cohort of PHACE patients.

Study Design

Multicenter retrospective case series.

Setting

Multidisciplinary vascular anomalies clinics at 2 institutions.

Methods

Data were collected from the electronic medical record, including clinical presentation, airway findings, treatment, and outcomes.

Results

Of 55 PHACE patients, 22 (40%) had airway hemangiomas. Patients with airway involvement were more commonly female (P =. 034, odds ratio [OR] 23, 95% confidence interval [CI] 1.3‐410) and of Caucasian ethnicity (P =. 020, OR 5.3, 95% CI 1.3‐21). Anatomically, patients with bilateral S3 involvement had higher rates of airway disease (P =. 0012, OR 15, 95% CI 2.9‐77). Most patients with airway hemangiomas had stridor (68%). Of the patients managed in the propranolol era (2008 or later, n = 35), 14 had airway involvement. All 14 were treated with propranolol, whereas 13 (62%) of 21 nonairway patients were treated with propranolol. The average treatment duration was longer in the airway patients (22.1 vs 16.7 months). All patients who underwent tracheostomy (n = 4) did so before 2008.

Conclusion

Risk factors for airway involvement in PHACE include female gender, Caucasian ethnicity, and stridor. Since the widespread use of propranolol, fewer patients have required surgical management of their airway disease. Given the high prevalence of airway involvement even in patients without stridor, assessment of the airway is a crucial component of a comprehensive PHACE workup.
A qualitative and quantitative assessment of simultaneous strain, shear wave, and point shear wave elastography to distinguish malignant and benign breast lesions
Authors: Altıntas Yasemin , Bayrak Mehmet , Alabaz Ömer , Celiktas Medih
Published: October 2020

Background

Ultrasound (US) elastography has become a routine instrument in ultrasonographic diagnosis that measures the consistency and stiffness of tissues.

Purpose

To distinguish benign and malignant breast masses using a single US system by comparing the diagnostic parameters of three kinds of breast elastography simultaneously added to B-mode ultrasonography.

Material and Methods

A total of 163 breast lesions in 159 consecutive women who underwent US-guided core needle biopsy were included in this prospective study. Before the biopsy, the lesions were examined with B-mode ultrasonography and strain (SE), shear wave (SWE), and point shear wave (STQ) elastography. The strain ratio was computed and the Tsukuba score determined. The mean elasticity values using SWE and STQ were computed and converted to Young’s modulus E (kPa).

Results

All SE, SWE, and STQ parameters showed similar diagnostic performance. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax yielded higher specificity than B-mode US alone to differentiate benign and malignant masses. The sensitivity of B-mode US, SWE, and STQ was slightly higher than that of the SE score and SE ratio. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax had significantly higher positive predictive value and diagnostic accuracy than B-mode US alone. The area under the curve for each of these elastography methods in differentiating benign and malignant breast lesions was 0.93, 0.93, 0.98, 0.97, 0.98, and 0.96, respectively; P<0.001 for all measurements.

Conclusion

SE (ratio and score), SWE, and STQ had higher diagnostic performance individually than B-mode US alone in distinguishing between malignant and benign breast masses.
Occupational balance in people with type-2 diabetes: A comparative cross-sectional study
Authors: Binesh Maryam , Aghili Rokhsareh , Mehraban Afsoon Hassani
Published: October 2020

Introduction

Diabetes mellitus may negatively impact individuals’ occupational balance. This study seeks to compare occupational balance in people with and without diabetes and also explore the biological and psychological factors associated with occupational balance in people with diabetes.

Method

This comparative cross-sectional study was conducted using simple non-probability sampling. Participants’ occupational balance was evaluated by the Life Balance Inventory. Blood samples were taken from those with diabetes and analyzed. Psychological distress was also evaluated in the people with diabetes using the Diabetes Distress Scale.

Results

A total of 160 individuals, including 80 people with diabetes and 80 people without diabetes, participated in this study. The mean occupational balance scores for people with and without diabetes were 2.56 and 2.61, respectively. There was no significant difference between the groups in occupational balance. Distress was the only significant factor related to occupational balance in people with diabetes ( p < 0.05).

Conclusion

Distress was the only bio-psychological factor associated with occupational balance in people with diabetes. A higher level of distress is associated with lower occupational balance and also poor glycemic control in this population.
Religious Patronage as Gendered Family Memory in Sixteenth-century England
Authors: Thomson Stephanie , Barclay Katie
Published: October 2020

Through an analysis of a large corpus of sixteenth-century wills and testaments, this article explores Englishwomen’s end-of-life religious patronage a site for the production of family identity and memory, and as a mechanism by which family and faith were woven together. It considers both the influence of the family on women’s post-mortem piety, and their role as executrices for their husbands. In doing so, it argues that women were integral to producing the commemorative practices that ensured their families’ immortality, and that these practices were in turn an important means by which religious practice and belief were renegotiated and refigured during the early English Reformation.
Negotiating Memory and Restoring Identity in Broken Families in Eighteenth-century Denmark
Authors: Koefoed Nina Javette
Published: October 2020

Early modern tugt workhouses are often seen as chaotic, multi-purposed institutions, mixing hardened criminals with marginal people like beggars and troublesome family members. In this article, I focus on the negotiation of family memory and identity between family and authority in cases when disobedient children were committed to these institutions for education and improvement. I argue that these negotiations provided an opportunity to restore parental authority by adjusting private family memory to the state’s expectations of good Christian households and responsible parents. Thereby, the private parental memory of disobedient children and the actions taken to deal with them also contributed to legitimizing the tugt institution by confirming its stated purpose in society, to provide improvement, and education.
Acute effect of resistance exercise on cognitive function in people living with HIV
Authors: de Souza Dayane C , Domingues Wagner JR , Marchini Kauana B , Nunhes Pollyana M , Garcia Alesandro , Hey Lucas F , Ardengue Mariana , Pasinato Isabela , Avelar Ademar
Published: October 2020

People living with HIV are at an increased risk of developing cognitive deficits. Physical exercise is an important strategy to improve the brain health of people living with HIV. This randomized, controlled study aimed to investigate the acute effect of a single resistance exercise session on the cognitive function of people living with HIV. Twenty-three people living with HIV were randomized (1:1) to a control group (n = 12) or the exercise group (n = 11). Cognitive function was assessed by the Stroop test and the Trail Making Test. The exercise group was evaluated before and after the exercise session; meanwhile, the control group was evaluated before and after a 40-minute rest period. No statistical difference was found on the effect of exercise on cognitive function ( p > 0.05). This result suggests that one session of resistance exercise was not capable of improving the cognitive function of people with HIV.
Design and implementation of an interconnection and damping assignment–passivity-based control for grid-integrated hybrid renewable system with energy storage
Authors: Ghanjati Chaima , Tnani Slim , Coirault Patrick , Belhadj Jamel , Cherif Habib
Published: October 2020

This article introduces a unified Hamiltonian formulation for controlling grid-connected direct current microgrid via interconnection and damping assignment–passivity-based control. The direct current microgrid includes hydro–solar–wind hybrid renewable energy systems and battery/supercapacitor hybrid energy storage system. Hybrid renewable energy systems are integrated as a disturbed direct current source, while hybrid energy storage system is integrated via semi-active topology, where the battery is connected to the direct current bus through a bidirectional dc-to-dc converter. The proposed Hamiltonian approach allows us to design a control strategy for the bidirectional dc-to-dc converter and the grid-connected three-phase inverter to (1) reject power disturbances in the direct current bus via the supercapacitor and ensure smooth current in the battery as well as in the grid and (2) assign the system to a desired equilibrium after sharp changes. In the studied article, the stability of the system under the interconnection and damping assignment–passivity-based control controller is investigated. The interconnection and damping assignment–passivity-based control controller is compared with two conventional proportional–integral–based controllers through simulations under the MATLAB/Simulink environment. The main contributions in this article are the unified hybrid modelling for dc-to-dc power converter and grid-connected inverter using port-Hamiltonian approach, external disturbance rejection in the multi-source power system using interconnection and damping assignment–passivity-based control, and the assurance of global asymptotic stability of the closed-loop system.
Cancers Cells in Traps? The Pathways of NETs Formation in Response to OSCC in Humans—A Pilot Study
Authors: Garley Marzena , Jabłońska Ewa , Miltyk Wojciech , Grubczak Kamil , Surażyński Arkadiusz , Ratajczak-Wrona Wioletta , Grudzińska Małgorzata , Nowacka Kinga H. , Moniuszko Marcin , Pałka Jerzy A. , Borys Jan , Dziemiańczyk-Pakieła Dorota
Published: October 2020

The aim of the experiment was to evaluate the process of neutrophil extracellular traps (NETs) formation in patients with oral squamous cell carcinoma (OSCC) in response to direct or indirect contact with SCC cells in comparison to results obtained in the cells of healthy subjects. To fulfill study objectives CAL 27 cell line and blood were obtained from cancer patients and control subjects. Parameters related to NETs formation were analyzed utilizing flow cytometry, fluorescence microscopy, and ELISA-type tests. The expression of selected phosphorylated proteins of the PI3K/Akt/PBK pathway in neutrophils was evaluated using the Western blot method. An increase in NETs formation was observed in a coculture of neutrophils with SCC cells, with the largest amount of NETs formed after stimulation with a supernatant obtained from the SCC culture. The enhanced process of NETs formation was accompanied by changes in the expression of proteins from the PI3K/Akt/PBK pathway. The obtained results prove the existence of interactions between neutrophils and cancer cells resulting in NETosis with the participation of the PI3K/Akt/PBK pathway in patients with OSCC.
National Physician Survey for Nonvalvular Atrial Fibrillation (NVAF) Anticoagulation Comparing Knowledge, Attitudes and Practice of Cardiologist to PCPs
Authors: Saeed Haseeb , Ovalle Oscar Garza , Bokhary Ujala , Jermihov Anastasia , Lepkowska Kamila , Bauer Victoria , Kuchta Kristine , Wright Marcia , Glosner Scott , Frazer Margaret , Quintero Andres , Hlavacek Patrick , Mardekian Jack , Tafur Alfonso , Metzl Mark , Saucedo Jorge
Published: October 2020

Introduction:

NVAF is estimated to affect between 6.4 and 7.4 million Americans in 2018, and increases the risk of stroke 5-fold. To mitigate this risk, guidelines recommend anticoagulating AF patients unless their stroke risk is very low. Despite these recommendations, 30.0-60.0% of NVAF patients do not receive indicated anticoagulation. To better understand why this may be, we surveyed PCPs and cardiologists nationwide on their attitudes, knowledge and practices toward managing NVAF with warfarin and direct-acting oral anticoagulants (DOACs).

Methods:

We surveyed 1,000 PCPs and 500 cardiologists selected randomly from a master list of the American Medical Association, using a paper based, anonymous, self-administered, mailed scannable survey. The survey contained questions on key demographics and data concerning attitudes, knowledge and practices related to prescribing DOACs. The surveys went out in the fall/winter of 2017-8 with a $10 incentive gift card. Survey responses were scanned into an Excel database and analyzed using SAS 9.3 (Cary, NC) for descriptive and inferential statistics.

Results:

Two hundred and forty-nine providers (167 PCPs, 82 cardiologists) participated in the study with a response rate of 18.8% (249/1320). Respondent mean years ±SD of experience since completing residency was 23.2 ± 13.8. Relative to cardiologists, less PCPs use CHADsVASC (36.8% vs. 74.4%) (p < 0.0001); more have never used HAS-BLED, HEMORR2HAGES, or ATRIA (38.5% vs. 9.8%) (p < .0001); more felt that their lack of knowledge/experience with DOACs was a barrier to prescribing the agents (p = 0.005); and more reported that they could use additional education on DOACs (87.0% vs. 47.0%) (p < 0.0001). Overall, cardiologists were more concerned about ischemic stroke outcomes, while PCPs were more concerned with GI bleeding. Cardiologists also felt that clinical trial data were most helpful in choosing the most appropriate DOAC for their patients, while PCPs felt that Real World Data was most useful.

Conclusions:

Cardiologists were more concerned with ischemic stroke while anticoagulating patients and utilized screening instruments like CHADsVASC in a majority of their patients. PCPs were concerned with GI bleeds when anticoagulating but nearly 40.0% utilized no screening tools to assess bleeding risk. Our findings show that future education about DOACs would be warranted especially with PCPs.
The Evolving Role of Medical Assistants in Primary Care Practice: Divergent and Concordant Perspectives from MAs and Family Physicians
Authors: Fraher Erin P. , Cummings Allison , Neutze Dana
Published: October 2020

Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their perspectives about MA roles, training, and confidence in performing activities related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. For most activities, we did not find evidence of role confusion between MAs and physicians, physician resistance to delegate tasks to properly trained MAs, or MA reluctance to pursue training to take on new roles. Three areas emerged where the gap between the potential and actual implementation of MA role transformation could be narrowed—population health and panel management; patient education, coaching, and counseling; and scribing. Closing these gaps will become increasingly important as our health care system moves toward value-based models of care.
Experiences With Help Seeking Among Non–Service-Engaged Survivors of IPV: Survivors’ Recommendations for Service Providers
Authors: Voth Schrag Rachel J. , Ravi Kristen , Robinson Sarah , Schroeder Elyssa , Padilla-Medina Diana
Published: October 2020

Engaging with formal intimate partner violence (IPV) services can buffer the impacts of violence and reduce future risk. Many survivors do not access or engage with such services. However, much of our knowledge related to the experiences and perspectives of IPV survivors comes from samples drawn from those seeking formal services. Qualitative interviews with 23 survivors of violence who are not currently engaged with formal IPV services were conducted, focused on the process and outcomes of choosing to seek help. Themes emerged within the categories of formal help-seeking experiences, informal help seeking, and recommendations for providers.
A psychological support group for parents in the care of families with gender diverse children and adolescents
Authors: Caldarera Angela M , Davidson Sarah , Vitiello Benedetto , Baietto Chiara
Published: October 2020

Parenting gender diverse children and adolescents can be a challenging experience, entailing doubts about how to protect and support them during their development. Parental reactions impact on the child’s sense of security and well-being. Therefore, when caring for families with gender diverse children, it is important to offer support to parents. In this article we present an experience with a 12-month support group for parents of young people who attended the service for gender identity development at a paediatric hospital. We describe the group structure and methodology, together with the process for evaluating the intervention. At 6-month intervals, parents were asked to indicate the most important topics that had emerged during the monthly sessions. At 12 months, they completed a semi-structured feedback questionnaire about their experience in the group, including possible difficulties encountered. Thematic analysis showed an evolution in time, with participants taking a more complex perspective on gender diversity and the needs of their children, while feeling more able to deal with the uncertainties related to gender identity development. After attending the group, parents reported feeling less lonely, more confident, and better able to communicate with their children. They related these positive changes to the opportunity of sharing experiences and mutual learning. This feed-back provides preliminary evidence that the psychological support group was perceived to be a useful resource by parents of gender diverse young people.
Post-occupancy evaluation: A diagnostic tool to establish and sustain inclusive access in Kyrenia Town Centre
Authors: Güvenbaş Gizem , Polay Mukaddes
Published: October 2020

The purpose of this article is to examine inclusive access criteria and explore the significance of post-occupancy evaluation (POE) for establishing and sustaining social inclusion in urban centres. Since the post-occupancy evaluation research framework was drawn on for appraising urban open space's accessibility and usability for people with and without physical disabilities, the POE methodology could be adapted for similar urban contexts and was tested on the upgrade projects in Kyrenia Town Centre (KTC) for use by both disabled and non-disabled people. A survey and structured observations with behavioural mapping were used to test urban space user's preferences, needs and satisfaction levels regarding desirable qualities of urban centres: adaptability, safety, comfort, dignity, density, legibility and autonomy. Using representative samples, a survey (sample size = 383) was initially conducted and then systematic observations (sample size = 1620) were performed to obtain data necessary to complete behavioural maps. The survey findings showed that the KTC possesses physical and social barriers, which represent challenges for both disabled and non-disabled users. Therefore, post-occupancy evaluation could be beneficial for the development of inclusive design policy and should be a necessary component of design process in order for determining what is needed to create the most inclusive environment by including disabled segments of the community.
Who is the typical psychedelics user? Methodological challenges for research in psychedelics use and its consequences
Authors: Johnstad Petter Grahl
Published: October 2020

Aims:

This article argues that despite a resurgence in research on psychedelics over the last two decades, we still have little insight into the psychedelics user population. Furthermore, there is currently little agreement between researchers as to the long-term mental health consequences of psychedelics use.

Design:

In a methodological review of a range of studies in psychedelics use, it is demonstrated that these studies tend to focus on specific segments of the user population while excluding others. These population segments are probably connected to different patterns of use, which in turn are likely to result in different long-term consequences.

Results:

The divergent findings on the consequences of psychedelics use may be explained, at least in part, by the fact that different research strategies explore different segments of the user population. Studies focusing on user segments with problematic usage patterns tend to find that psychedelics use is negative for mental health, while studies on infrequent users tend to find that psychedelics use is positive for mental health.

Conclusion:

Because the field of psychedelics studies lacks a reliable model of the user population, it is difficult for researchers to contextualise and assess the broader validity of their findings. To remedy this situation, the article presents three theoretical models of the user population that afford us with tentative means of contextualising findings and thereby may clarify present disagreements.
Frequency of Recent Binge Drinking Is Associated With Sex-Specific Cognitive Deficits: Evidence for Condition-Dependent Trait Expression in Humans
Authors: Hone Liana S. E. , Scofield John E. , Bartholow Bruce D. , Geary David C.
Published: October 2020

Evolutionary theory suggests that commonly found sex differences are largest in healthy populations and smaller in populations that have been exposed to stressors. We tested this idea in the context of men’s typical advantage (vs. women) in visuospatial abilities (e.g., mental rotation) and women’s typical advantage (vs. men) in social-cognitive (e.g., facial-expression decoding) abilities, as related to frequent binge drinking. Four hundred nineteen undergraduates classified as frequent or infrequent binge drinkers were assessed in these domains. Trial-level multilevel models were used to test a priori Sex × Group (binge drinking) interactions for visuospatial and social-cognitive tasks. Among infrequent binge drinkers, men’s typical advantage in visuospatial abilities and women’s typical advantage in social-cognitive abilities was confirmed. Among frequent binge drinkers, men’s advantage was reduced for one visuospatial task (Δ d = 0.29) and eliminated for another (Δ d = 0.75), and women’s advantage on the social-cognitive task was eliminated (Δ d = 0.12). Males who frequently engaged in extreme binges had exaggerated deficits on one of the visuospatial tasks, as did their female counterparts on the social-cognitive task. The results suggest sex-specific vulnerabilities associated with recent, frequent binge drinking, and support an evolutionary approach to the study of these vulnerabilities.
Development of a Novel Clinical Prognostic Model for Patients With Angioimmunoblastic T-Cell Lymphoma
Authors: Huang Chen , Zhang Huichao , Gao Yuhuan , Diao Lanping , Liu Lihong
Published: October 2020

In this study we aimed to identify a set of prognostic factors for angioimmunoblastic T-cell lymphoma (AITL) and establish a novel prognostic model. The clinical data of 64 AITL patients enrolled to the Fourth Hospital of Hebei Medical University (from 2012 Jan to 2017 May) were retrospectively analyzed. The estimated 5-year overall survival and progression-free survival of this cohort of patients were 45.8% and 30.8%, respectively. Univariate analysis showed that age > 60 years, performance status ≥2, Ann Arbor stage III/IV, lactate dehydrogenase > 250 U/L, serum albumin (ALB) < 30 g/l, Coombs test positive, and Ki-67 rate ≥ 70% were significantly associated with poor prognosis. Multivariate analysis demonstrated that age > 60 years, ALB < 30 g/l, Ki-67 rate ≥ 70%, and Coombs test positive were independent prognosis factors for AITL. Here a new prognostic model, named as AITLI, was constructed using the top 5 significant prognostic factors for AITL prognostic prediction. The AITL patients were stratified into 3 risk groups: low, intermediate, and high risk groups. The new prognostic model AITLI showed better performance in predicting prognosis than the International Prognostic Index (IPI) and the prognostic index for PTCL, not otherwise specified (PIT) that were wisely used to predict the outcome for patients with other subtypes of lymphoma.
Nonpharmacological Management of Diabetic Foot Ulcers: An Update
Authors: Eleftheriadou Ioanna , Samakidou Georgia , Tentolouris Anastasios , Papanas Nikolaos , Tentolouris Nikolaos
Published: October 2020

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus that is associated with increased morbidity and mortality, as well as substantial economic burden for the health care system. The standard of care for DFUs includes pressure off-loading, sharp debridement, and wound moisture balance, along with infection control and management of peripheral arterial disease. A variety of advanced modalities that target distinct pathophysiological aspects of impaired wound healing in diabetes are being studied as possible adjunct therapies for difficult to heal ulcers. These modalities include growth factors, stem cells, cultured fibroblasts and keratinocytes, bioengineered skin substitutes, acellular bioproducts, human amniotic membranes, oxygen therapy, negative pressure wound therapy, and energy therapies. Additionally, the use of advanced biomaterials and gene delivery systems is being investigated as a method of effective delivery of substances to the wound bed. In the present narrative review, we outline the latest advances in the nonpharmacological management of DFUs and summarize the efficacy of various standard and advanced treatment modalities.
A Systematic Review of Peripheral Neuropathies in Breast Cancer–Related Lymphedema
Authors: Forte Antonio J. , Huayllani Maria T. , Boczar Daniel , Manrique Oscar J. , Lu Xiaona , McLaughlin Sarah A. , Kung Theodore A.
Published: October 2020

Controversy exists regarding the influence of breast cancer–related lymphedema (BCRL) in the development of peripheral neuropathies. Our aim was to evaluate the association of secondary lymphedema with peripheral neuropathies in patients with breast cancer. We performed a systematic review by querying PubMed, EMBASE, Ovid Medline and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Cochrane Central Register of Controlled Trials databases. The keywords “lymphedema” AND (“neuropathy” OR “carpal tunnel syndrome” OR “cubital tunnel syndrome” OR “neuropathic pain”) and synonyms in titles and abstracts were used to perform the search. Seventeen articles met the inclusion criteria. Discrepancies were found in studies that analyzed whether a cause-effect association exists between carpal tunnel syndrome (CTS) and secondary lymphedema. No evidence indicated that lymphedema predisposes to developing peripheral neuropathies such as CTS or brachial plexopathy. No studies found an association between patients with breast cancer at risk of or with lymphedema and the development or worsening of CTS. Carpal tunnel release can be safely performed in patients with BCRL. Neuropathic pain worsens with lymphedema, and treatment seems to improve the pain. Our study did not find enough evidence to conclude that BCRL is associated with the development of peripheral neuropathies. Carpal tunnel release is a safe procedure that can be performed in patients with BCRL and does not influence the development or worsening of lymphedema. Neuropathic pain seems to worsen after development of lymphedema, and treatment has been found to improve neuropathic pain.
Metacarpophalangeal Joint Denervation in the Treatment of Dieterich Disease: A Case Report
Authors: Bailey James Ross , Gorman Paul W. , Mitchelson Andrew J.
Published: October 2020

Avascular necrosis of the metacarpal head, known as Dieterich disease, is rare. The underlying pathogenesis of the disease is not clearly understood, and there are few cases reported in the literature. Nonoperative treatment with rest and nonsteroidal anti-inflammatory drugs is often successful, but surgical management is sometimes indicated. The case outlined here describes a novel application of the known technique of metacarpophalangeal joint denervation to relieve pain while maintaining joint mechanics and grip strength.
Antimicrobial Activities and Chemical Compositions of Daniellia oliveri and Leptoderris micrantha (Fabaceae) Essential Oils From Nigeria
Authors: Owolabi Moses S. , Ogundajo Akintayo , Ndukwe Nelly , Dosoky Noura S. , Setzer William N.
Published: October 2020

The stem bark and leaves of Daniellia oliveri were obtained from two sites, Batsari and Zurmi, in Nigeria. Leaves of Leptoderris micrantha were obtained from Agbagi, Nigeria. Essential oils of these plants were obtained by hydrodistillation and analyzed by gas chromatography-mass spectrometry. The major components in the bark essential oil of D. oliveri were δ-cadinene (12.8%), α-muurolene (6.7%), α-calacorene (5.9%), and caryophyllene oxide (5.5%). The major components in the leaf essential oils from Batsari and Zurmi, respectively, were humulene epoxide II (8.0% and 16.3%), caryophyllene oxide (7.4% and 12.4%), pentadecanal (8.9% and 6.0%), phytone (6.5% and 2.2%), δ-cadinene (5.3% and 3.0%), and α-muurolene (5.3% and 2.6%). The major components in the leaf essential oil of L. micrantha were incensole (16.2%), phytone (15.4%), pentadecanal (13.7%), α-pinene (7.7%), and iso-phytol (5.2%). The essential oils were screened for antibacterial activity against Bacillus cereus, Cutibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Pseudomonas aeruginosa, and Serratia marcescens, and for antifungal activity against Aspergillus fumigatus, Aspergillus niger, Cryptococcus neoformans, Microsporum canis, Microsporum gypseum, Trichophyton mentagrophytes, Trichophyton rubrum, and Candida albicans, using the microbroth dilution method. The leaf essential oils of D. oliveri and L. micrantha showed only marginal activity against the panel of microorganisms. However, D. oliveri bark essential oil showed notable antifungal activity against Aspergillus niger and Trichophyton rubrum with a minimum inhibitory concentration of 78.1 µg/mL for each. This is the first report on the essential oil compositions of D. oliveri and L. micrantha from Nigeria and their antimicrobial activities.
Infliximab clearance decreases in the second and third trimesters of pregnancy in inflammatory bowel disease
Authors: Grišić Ana‐Marija , Dorn‐Rasmussen Maria , Ungar Bella , Brynskov Jørn , Ilvemark Johan F. K. F. , Bolstad Nils , Warren David J. , Ainsworth Mark A. , Huisinga Wilhelm , Ben‐Horin Shomron , Kloft Charlotte , Steenholdt Casper
Published: October 2020

Background

Infliximab therapy during pregnancy in inflammatory bowel disease is challenged by a dilemma between maintaining adequate maternal disease control while minimizing fetal infliximab exposure. We investigated the effects of pregnancy on infliximab pharmacokinetics.

Methods

The study population comprised 23 retrospectively identified pregnancies. Patients with inflammatory bowel disease were generally in clinical remission at pregnancy conception (74%) and received steady infliximab maintenance therapy (5 mg/kg q8w n = 17; q6w n = 4; q10w n = 1; 10 mg/kg q8w n = 1). Trough blood samples had been obtained in the same patients prior to pregnancy (n = 119), the first trimester (n = 16), second trimester (n = 18), third trimester (n = 7), and postpregnancy (n = 12). Data were analyzed using nonlinear mixed‐effects population pharmacokinetic modeling.

Results

Dose‐normalized infliximab concentrations were significantly higher during the second trimester (median 15 mg/ml/kg, interquartile range 10–21) compared to prepregnancy (7, 2–12; p = 0.003), the first trimester (9, 1–12; p = 0.04), or postpregnancy (6, interquartile range 3–11; p > 0.05) in patients with inflammatory bowel disease. Similar trends were observed in the third trimester (13, 7–36; p > 0.05). A one‐compartment model with linear elimination described the pharmacokinetics of infliximab (volume of distribution n = 18.2 L; clearance 0.61 L/day). Maternal infliximab exposure was influenced by the second and third trimester of pregnancy and anti‐infliximab antibodies, and not by pregnancy‐imposed physiological changes in, for example, body weight or albumin. Infliximab clearance decreased significantly during the second and third trimesters by up to 15% as compared to pre‐ and postpregnancy and the first trimester. The increased maternal infliximab exposure was weakly associated with lowered clinical disease activity. Pharmacokinetic model simulations of virtual patients indicated the increased maternal infliximab trough concentrations imposed by pregnancy will not completely counteract the decrease in infliximab concentration if therapy is paused in the third trimester.

Conclusion

Infliximab clearance decreases significantly in the second and third trimesters, leading to increasing maternal infliximab concentrations in any given regimen. Maternal infliximab levels may thus be maintained as constant in a de‐intensified regimen by therapeutic drug monitoring guidance in inflammatory bowel disease.
Application of ultrasound in the diagnosis of gastrointestinal tumors
Authors: Yu XianZhe , Yang YanNi , Li JianGuo
Published: October 2020

Gastrointestinal tumors are common tumors in the digestive system. Early diagnosis of gastrointestinal tumors is the key to improve prognosis and curative effect of patients with tumors. Compared with other methods of examination and diagnosis, ultrasound examination has the advantages of simple operation, non-invasive, economical, and repeatable operation. With the advancement of ultrasound technology and the development of ultrasound contrast agents, ultrasound examination is more and more applied to gastrointestinal examination. Ultrasound cannot only observe the gastrointestinal wall, but also evaluate the surrounding lesions and metastases, as well as preoperative analysis and postoperative follow-up of gastrointestinal tumors. We reviewed the diagnostic applications of ultrasound in gastrointestinal tumors.
Ultrasonic Tenotomy and Debridement for Calcific Tendinopathy of the Shoulder: A Pilot Case Series
Authors: Erickson Jacob L. , Jagim Andrew R.
Published: October 2020

Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain and debility. Minimally invasive treatment options have been employed for management; however, ultrasonic tenotomy has not been previously described for management of calcific tendinopathy of the shoulder. The purpose of the current case series was to provide preliminary evidence in support of a novel treatment modality for calcific tendinopathy of the rotator cuff. This descriptive pilot case series included a total of 8 patients with calcific tendinopathy of the supraspinatus that underwent ultrasound-guided ultrasonic debridement in the sports medicine clinic. All procedures were performed by the same physician (JLE). All patients had confirmation of the diagnosis with MRI and ultrasound imaging. Pain was measured pre-procedure and followed until 3-months post-procedure. Very large, statistically significant, reductions (P < .01) in pain scores were observed at 1 (ES = 1.93), 2 (ES = 1.84) and 3 (ES = 2.20) months post-procedure, respectively. All patients experienced a significant reduction in pain scores, regardless of hardness of the calcium deposit, at 1 month post-procedure with pain scores remaining lower than at baseline at 2 and 3 months post-procedure. No adverse events were noted in any patients. Ultrasonic tenotomy and debridement appears to be a safe and effective treatment option for patients with calcific tendinopathy of the supraspinatus.
A New Approach to Automated Solid Phase Synthesis Based on Centrifugation of Tilted Plates
Authors: Lebl Michal
Published: October 2020

High throughput solid phase synthesis can be performed with application of the centrifugation based liquid removal. This technique uses readily available standard microtiterplates and eliminates filtration step. It is therefore applicable to simultaneous processing of unlimited number of reaction compartments. Its use is illustrated on the synthesis of an array of 380 tetrahydroisoquinolinones.
Concordance of Identified Cases of Pediatric HA-VTE with American College of Physicians and Cincinnati Children’s Hospital HA-VTE Prophylaxis Guidelines Over a 10-Year Period
Authors: Fan Elaine M. , Lewis Deirdre , Presti Thomas , El-Haj Nura , Chang Weijen W.
Published: October 2020

Objective: Our aim is to (1) ascertain the proportion of pediatric patients at a tertiary hospital in Western Massachusetts over a 10-year period with hospital-acquired venous thromboembolism (VTE) of particular characteristics and (2) determine whether ACCP or Cincinnati Children’s guidelines would have recommended VTE prophylaxis in these patients. Setting: Urban teaching hospital in the United States. Participants: Data from 98 477 pediatric hospital admissions (roughly 10 000 admission per year) from 2008 to 2017 were reviewed. There were a total of 177 VTE cases identified. Outcome measures: Hospital-acquired venous thromboembolism (including deep venous thrombosis and pulmonary embolism). Result: 177 charts were extracted that carried the diagnosis of VTE based on ICD-9 and ICD-10 codes over a 10-year-period. Among these patients, 34 (19%) met the inclusion criteria for HA-VTE; 5 (16%) would qualify for prophylaxis according to ACCP and 7 (21%) according to Cincinnati Children’s guideline. The most common age group to have a VTE was infants under 1 year of age (41%), and the most common characteristic was the presence of a central line (82%). Age outside of the recommended range was the sole reason that excluded patients from prophylaxis qualification per Cincinnati Children’s. Conclusion: HA-VTE carries increased morbidity and mortality. Although recognition and prevention of HA-VTE in adult populations are routine, prophylaxis for pediatric HA-VTE is not commonly practiced. This may be due to paucity of strong evidence supporting prophylaxis and the challenge of identifying risk factors for HA-VTE. Our results suggest that published guidelines recommend prophylaxis in only a minority of pediatric patients who would have subsequently developed HA-VTE. Further modification and validation of current guidelines are needed to effectively prevent pediatric HA-VTE.
Fatigue predicts future reduced social participation, not reduced physical function or quality of life in people with systemic sclerosis
Authors: Murphy Susan L , Whibley Daniel , Kratz Anna L , Poole Janet L , Khanna Dinesh
Published: October 2020

Objective:

Although fatigue is one of the most problematic symptoms for people with systemic sclerosis, little is known about how fatigue impacts daily life over time. Such information is important when developing fatigue management interventions. This study was conducted to examine (1) if fatigue severity predicted outcomes of worse functioning (social participation, physical function), and quality of life and (2) if level of self-efficacy moderated significant relationships between fatigue and these outcomes.

Methods:

Data were utilized from a clinical trial in which an online self-management intervention was tested (N = 267). Fatigue, social participation, and physical function were assessed by PROMIS measures. Quality of life was assessed by the EuroQol 5-domain instrument. Linear regressions were performed to examine how baseline fatigue related to functioning and quality of life outcomes 16 weeks later controlling for relevant covariates. PROMIS measures were used to measure self-efficacy in managing symptoms, daily activities, medications and treatments, emotions, and social interactions.

Results:

Fatigue at baseline significantly predicted social participation 16 weeks later, but did not predict physical functioning or quality of life. Self-efficacy variables did not moderate the association between fatigue and social participation.

Conclusion:

Fatigue severity predicted decreased social participation in people with systemic sclerosis. Interventions targeting fatigue should include support to maintain participation of social roles and activities. The level of reported self-efficacy did not vary the strength of the association between fatigue and decline in social participation indicating that there may be other targets to treat fatigue intervention beyond self-management.
The effects of activity-related contexts on individual sound exposures: A time–geographic approach to soundscape studies
Authors: Kou Lirong , Kwan Mei-Po , Chai Yanwei
Published: October 2020

Noise is an ever-growing problem in cities. Conventional noise mitigation approaches may not necessarily control noise pollution, since whether a sound is perceived as noise is largely influenced by its specific contexts. Based on an activity-centric framework, this study examines the effects of activity-related contexts and measured sound levels based on individuals’ sound evaluations as they undertake daily activities at different geographic locations and times. Data for the study were collected from 33 participants in Chicago (USA) using Global Positioning System-equipped mobile phones, portable sound sensors, and activity diaries. Multilevel logistic modeling was used to examine the relationships among measured sound levels, sound evaluations, and activity-related contexts for each recorded activity of the participants. The results indicate that activity-related contexts significantly influence individuals’ sound evaluations as they perform their daily activities. When activity-related contexts are taken into account, the measured sound levels that individuals experienced when performing an activity are no longer significant in influencing their sound evaluations. These results support the notion that sound is not only a physical feature but also a socio-psychological construct. It is crucial to adopt a human-centric and context-aware approach in urban planning through understanding the circumstances in which a sound is perceived as noise. Such an approach would help improve sound-related urban environments and construct livable and healthy cities.