bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunotherapy Efficacy in the Initial Lines of Treatment in Advanced Upper Gastrointestinal Malignancies: A Systematic Review of the Literature
Authors: Kamposioras Konstantinos , Ntellas Panagiotis , Nikolaou Michail , Germetaki Theodora , Gazouli Ioanna , Dadouli Katerina , Zarkavelis George , Amylidi Anna-Lea , Tolia Maria , Mauri Davide
Published: November 2021

Background

The therapeutic role of immune checkpoint inhibitors (ICIs) has represented the cutting edge of clinical research in upper gastrointestinal (GI) malignancies, with these agents now included in the armamentarium of treatment options for advanced gastric and esophageal cancers.

Methods

We performed a systematic literature review and pooled analysis to map out the currently available robust clinical evidence for the use of ICIs in upper GI cancers. Immunotherapy (IO), either as monotherapy or in combination with chemotherapy, and its role in first-line, maintenance, and second-line settings, as well as in specific clinical and biological subgroups, were critically appraised. All statistical tests were 2-sided.

Results

ICIs, in combination with chemotherapy, have provided statistically significant overall survival benefit in the first-line setting in gastric and gastro-esophageal adenocarcinomas (hazard ratio [HR] = 0.83, 95% confidence interval [CI] = 0.76 to 0.90, P < .001; based on 4 studies) and esophageal squamous cell carcinoma (HR = 0.72, 95% CI = 0.64 to 0.81, P < .001; based on 3 studies), albeit with heterogeneous efficacy according to biomarker expression. Patients with esophageal squamous cell carcinoma, and in particular high programmed cell death ligand-1 expression, derive survival benefit when treated with IO in the second-line setting (HR = 0.74, 95% CI = 0.68 to 0.82, P < .001; for any level of programmed cell death ligand-1 expression). Clinical trials interrogating the combination of IO with chemotherapy in second-line treatment should be seriously considered in upper GI adenocarcinomas. The role of maintenance IO after initial disease control is still unclear and cannot be recommended. Impressive response rates and survival benefit from IO have been reported in patients with microsatellite instability-high tumors (HR = 0.33, 95% CI = 0.19 to 0.57, P < .001), and this warrants further prospective biomarker-driven studies.

Conclusions

IO is changing the treatment landscape in upper GI malignancies. The rapidly developing evidence in the field needs to be critically appraised while further validation of the existing information from ongoing trials is awaited.
Traumatic colostomy evisceration in an AIDS patient with anal cancer
Authors: Momah Uju , Barnaby Josh , Poulos Constantine , Lewis Robert
Published: November 2021

Intestinal evisceration is a rare event and few cases of colostomy rupture have been documented in the medical literature. Complications of colostomy surgery vary in incidence, with most episodes occurring in the immediate postoperative timeframe, including necrosis, hemorrhage, cellulitis and dehiscence. Here, we document the case of a 35-year-old male patient with a history of immunodeficiency, multiple comorbidities and squamous cell carcinoma of the anus who experienced a unique instance of colostomy evisceration weeks after initial surgery. The patient originally underwent surgery for a sigmoid colostomy for the alleviation of irritation secondary to anal disease. Weeks later, after a traumatic fall injury, he experienced colostomy evisceration. This case will review the factors leading up to this event that put the patient at risk for poor wound healing and ultimately colostomy rupture.
Invasive cutaneous squamous cell carcinoma resulting in arm amputation. Case discussion and literature review
Authors: Eiben Inez , Bahadori Darab , Eiben Paola , Hever PennyLouise
Published: November 2021

Skin cancer is one of the most common cancers in the world. Specifically incidence of non-melanoma malignancy in the UK has increased by 56% in the last decade. Cutaneous squamous cell carcinoma (cSCC) is a type of non-melanoma skin cancer that if caught early can be successfully treated. Conservative excision surgery is the most common treatment modality with high cure rates even if tumours are advanced. Radical surgery is rarely required, and amputations, especially when the distal part of the upper extremity is involved, are very uncommon. Here, we describe a case of an invasive cutaneous squamous cell carcinoma of the elbow that required trans-humeral arm amputation.
Identification of Risk Factors for Daptomycin-Associated Creatine Phosphokinase Elevation and Development of a Risk Prediction Model for Incidence Probability
Authors: Samura Masaru , Hirose Naoki , Kurata Takenori , Takada Keisuke , Nagumo Fumio , Koshioka Sakura , Ishii Junichi , Uchida Masaki , Inoue Junki , Enoki Yuki , Taguchi Kazuaki , Higashita Ryuji , Kunika Norifumi , Tanikawa Koji , Matsumoto Kazuaki
Published: November 2021

Background

In this study, we investigated the risk factors for daptomycin-associated creatine phosphokinase (CPK) elevation and established a risk score for CPK elevation.

Methods

Patients who received daptomycin at our hospital were classified into the non-elevated or elevated CPK group based on their peak CPK levels during daptomycin therapy. Univariable and multivariable analyses were performed, and a risk score and prediction model for the incidence probability of CPK elevation were calculated based on logistic regression analysis.

Results

The non-elevated and elevated CPK groups included 181 and 17 patients, respectively. Logistic regression analysis revealed that concomitant statin use (odds ratio [OR], 4.45 [95% confidence interval {CI}, 1.40–14.47]; risk score 4), concomitant antihistamine use (OR, 5.66 [95% CI, 1.58–20.75]; risk score 4), and trough concentration (Cmin) between 20 and <30 µg/mL (OR, 14.48 [95% CI, 2.90–87.13]; risk score 5) and ≥30.0 µg/mL (OR, 24.64 [95% CI, 3.21–204.53]; risk score 5) were risk factors for daptomycin-associated CPK elevation. The predicted incidence probabilities of CPK elevation were <10% (low risk), 10%–<25% (moderate risk), and ≥25% (high risk) with total risk scores of ≤4, 5–6, and ≥8, respectively. The risk prediction model exhibited a good fit (area under the receiver operating characteristic curve, 0.85 [95% CI, .74–.95]).

Conclusions

These results suggested that concomitant use of statins with antihistamines and Cmin ≥20 µg/mL were risk factors for daptomycin-associated CPK elevation. Our prediction model might aid in reducing the incidence of daptomycin-associated CPK elevation.
Brexit and control of subsidies
Authors: Crafts Nicholas
Published: November 2021

The paper reviews the implications of the EU–UK Trade and Cooperation Agreement (TCA) for the control of subsidies. Controls will be less strict than under the EU state aid regime but tighter than with no deal and WTO rules. A subsidy control authority will be established by the UK which will oversee the application of broad principles set out in the TCA. A well-designed authority would help to prevent a repeat of the UK experience in the 1970s and 1980s, when subsidies were detrimental to economic performance. Regrettably, however, the government has decided to adopt a politicized approach to subsidy policy.
Regular radial velocity variations in nine G- and K-type giant stars: Eight planets and one planet candidate
Authors: Teng Huan-Yu , Sato Bun’ei , Takarada Takuya , Omiya Masashi , Harakawa Hiroki , Izumiura Hideyuki , Kambe Eiji , Takeda Yoichi , Yoshida Michitoshi , Itoh Yoichi , Ando Hiroyasu , Kokubo Eiichiro
Published: November 2021

We report the detection of radial velocity (RV) variations in nine evolved G- and K-type giant stars. The observations were conducted at Okayama Astrophysical Observatory. Planets or planet candidates can best explain these regular variations. However, a coincidence of near 280 d variability among five of them prevents us from fully ruling out stellar origins for some of the variations, since all nine stars behave similarly in stellar properties. In the planet hypotheses for the RV variations, the planets (including one candidate) may survive close to the boundary of the so-called “planet desert” around evolved stars, having orbital periods between 255 and 555 d. Besides, they are the least-massive giant planets detected around G- and K-type giant stars, with minimum masses between 0.45 MJ and 1.34 MJ. We further investigated other hypotheses for our detection, yet none of them can better explain regular RV variation. With our detection, we can be convinced that year-long regular variation with amplitude down to 15 m s−1 for G- and K-type giant stars is detectable. Moreover, we performed simulations to further confirm the detectability of planets around these stars. Finally, we explored giant planets around intermediate-mass stars, and likewise found a four-Jupiter-mass gap (e.g., Santos et al. 2017, A&A, 603, A30), which is probably a boundary of the giant planet population.
The management of infants, children, and youth at risk for hepatitis C virus infection
Authors: Bitnun Ari
Published: November 2021

Hepatitis C virus (HCV) infection affects 0.5% to 1.0% of the Canadian population. Most paediatric HCV infections are a consequence of vertical transmission or, among youth and young adults, the result of engaging in high-risk behaviours, such as injection drug use and unprotected sexual activity. It is now recommended that all infants, children, and youth with one or more risk factors be screened for HCV infection. Treating chronic HCV infection with direct-acting antivirals has been shown to achieve sustained virologic suppression in 97% to 100% of children as young as 3 years old. Paediatricians and family physicians have an important role in educating youth regarding HCV infection risks and prevention, and in advocating to government and public health authorities for comprehensive harm reduction interventions targeting at-risk youth, accessible treatments, and routine prenatal screening for HCV.
CO2-dependent migration and relocation of LCIB, a pyrenoid-peripheral protein in Chlamydomonas reinhardtii
Authors: Yamano Takashi , Toyokawa Chihana , Shimamura Daisuke , Matsuoka Toshiki , Fukuzawa Hideya
Published: November 2021

Most microalgae overcome the difficulty of acquiring inorganic carbon (Ci) in aquatic environments by inducing a CO2-concentrating mechanism (CCM). In the green alga Chlamydomonas reinhardtii, two distinct photosynthetic acclimation states have been described under CO2-limiting conditions (low-CO2 [LC] and very low-CO2 [VLC]). LC-inducible protein B (LCIB), structurally characterized as carbonic anhydrase, localizes in the chloroplast stroma under CO2-supplied and LC conditions. In VLC conditions, it migrates to aggregate around the pyrenoid, where the CO2-fixing enzyme ribulose 1,5-bisphosphate carboxylase/oxygenase is enriched. Although the physiological importance of LCIB localization changes in the chloroplast has been shown, factors necessary for the localization changes remain uncertain. Here, we examined the effect of pH, light availability, photosynthetic electron flow, and protein synthesis on the localization changes, along with measuring Ci concentrations. LCIB dispersed or localized in the basal region of the chloroplast stroma at 8.3–15 µM CO2, whereas LCIB migrated toward the pyrenoid at 6.5 µM CO2. Furthermore, LCIB relocated toward the pyrenoid at 2.6–3.4 µM CO2, even in cells in the dark or treated with 3-(3,4-dichlorophenyl)-1,1-dimethylurea and cycloheximide in light. In contrast, in the mutant lacking CCM1, a master regulator of CCM, LCIB remained dispersed even at 4.3 µM CO2. Meanwhile, a simultaneous expression of LCIC, an interacting protein of LCIB, induced the localization of several speckled structures at the pyrenoid periphery. These results suggest that the localization changes of LCIB require LCIC and are controlled by CO2 concentration with ∼7 µM as the boundary.
P036 Juvenile Idiopathic Arthritis in adulthood: outcomes of oligo and polyarticular forms?
Authors: Saoussen Miladi , Yasmine Makhlouf , Alia Fazaa , Mariem Sellami , Kmar Ouenniche , Leila Souabni , Selma Kassab , Selma Chekili , Kawther Ben Abdelghani , Ahmed Laatar
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatic disease of childhood that can cause major physical disability, impairing patients' ability to lead a normal adult life. The objective of this study was to assess the outcomes of oligo- and polyarticular JIA in adulthood as well as the progression to authentic rheumatoid arthritis (RA).

Methods

We conducted a retrospective study including adult patients with JIA (diagnosed according to the International League of Associations for Rheumatology [ILAR]). Data collected included age, gender, disease characteristics (JIA subtype, disease duration). The progression to an authentic RA was determined by checking the response to the ACR/EULAR 2010 classification criteria.

Results

Twenty-eight patients were included in this study. There was a female predominance with a sex ratio of 1.5. The mean age of disease onset was 6 years and 2 months [2–17]. The mean age at inclusion was 29.5 years [18–64]. The frequency of each JIA subtype was as follows: polyarticular with RF + (n = 14), polyarticular with RF- (n = 9), oligoarthritis (n = 5). The polyarticular forms: RF+ and RF- evolved into genuine seropositive and seronegative RA in 71.4% and 66.7% of cases, respectively.

Among the oligoarticular JIA subtype, an extension of the disease to a seronegative RA was noted in one patient (20%). Hip involvement was noted in 20% of patients. Carpal tunnel syndrome and elbow arthritis were found in 28.5% and 14.3% of patients, respectively. Regarding treatment modalities and at the time of recruitment, 36.3% of RAs were treated with Methotrexate, and 33% were on biological treatment. Ten percent of the patients dropped out of school because of disease flares and deformities.

Conclusion

Our study showed oligo- and polyarticular JIA evolves in most of the cases towards an authentic RA causing deformities and handicaps. Earlier management is necessary to allow a better transition to adulthood.
P079 Multi-systemic inflammatory syndrome in children: skin tropism
Authors: Guedri Rahma , Glai Mariem , Fitouri Zohra , Ben Becher Saayda
Published: November 2021

Background

Multisystem inflammatory syndrome in children (MIS-C) is a severe immune-mediated syndrome that occurs after COVID-19 infection. It mainly affects children and presents several clinical aspects. The cutaneous and mucous signs are very much part of the diagnostic criteria. The aimisto describe the clinical and evolutionary aspects of the muco-cutaneous signs during MIS-C

Patients and methods

It was a descriptive retrospective study conducted over a period of 9 months (March 1, 2020 - December 31, 2020) including children admitted to COVID isolation unit with suspicion of MIS-C syndrome.

Results

We included 17 patients. The average age was 7 years (1–11 years). The sex ratio was 2.2 (11 boys and 6 girls). There was o history of dermatological disease has been reported. Fever was present in all patients. Mucosal signs were present in 13 patients. Conjunctival hyperemia without purulent secretions was noted in 12 patients. Conjunctivitis was bilateral in 11 cases. A rash was found in 10 cases. It was macular (6 cases), maculopapular (2 cases) and vesicular cluster in one 1 case. It was itchy in 2 cases. It was located in the limbs (7 cases), thorax and/or abdomen (5 cases), pelvis (4 cases), palms and/or soles (3 cases) and the face in one case. Cheilitis was found in 6 cases and stomatitis or glossitis in 5 cases. oEdema of the extremities was present in three patients and oedema of the face was noted in one patient. All children received intravenous immunoglobulin therapy combined with high-dose corticosteroids and acetylsalicylic acid at anti-aggregating doses. The course was marked by the disappearance of the muco-cutaneous signs without recurrence in all cases.

Conclusion

Mucocutaneous involvement is a characteristic manifestation of multisystem inflammatory syndrome. It is one of the various diagnostic criteria for this syndrome.
P084 Recurrent fever in children: why not a mevalonate kinase deficiency?
Authors: Ouahbi K , Gacem O , Boukandoura F , Benmekhmouf H , Hamadouche N , Hadjyoucef N , Chouiki H , Mehaba N , Abba K , Mansouri N , Achir M , Ladj M S
Published: November 2021

Background

Mevalonate kinase deficiency (MKD) is a rare autosomal recessive auto inflammatory disease. The clinical spectrum of this disease is a continuum ranging from the moderate form of Hyper-IgD syndrome (HIDS) to lethal forms of mevalonic aciduria (MA). An autoinflammatory disease should be considered in children with recurrent fever of unexplained origin.

Case report

M, 28 months old boy from a non-consanguineous marriage of Algerian parents, presented since the age of two months’ episodes of unexplained fever resistant to antibiotics and requiring several hospitalizations. Family history found that the mother and a maternal uncle experienced an unexplained recurrent fever. Personal history found episodes of fever lasting in average 6 days, with no obvious cause and recurring every 15–20 days; associated with bilateral cervical adenopathy, mouth ulcers, arthralgia, abdominal pain with vomiting and diarrhea. Clinical examination confirmed the fever with temperature of 38.7°, Chills and irritability, Multiple cervical adenopathy oral aphthae, tongue of geographical aspect, cervical pain and large joint arthralgia, tender abdomen with no organomegaly. Biologic workups found major inflammatory syndrome with hyper leucocytosis at 14X103/mm3 predominantly polynuclear, high CRP level, high ESR at 110 mm. Blood cultures and viral serologies were negative. Immunoelectrophoresis found elevated IgA, IgG and IgM with a normal IgD level. Chest X-ray and abdominal ultrasound were normal. The diagnosis of MKD in its moderate form was supported by elevated urinary mevalonic acid excretion to 5.1 mmol/mol during the febrile episode and subsequently confirmed by a 2nd contributory urine assay during another febrile episode.

Conclusion

MKD is a rare disease. The clinical spectrum of this condition is variable and could benefit of an effective treatment. Our patient developed a moderate form with a better long-term prognosis.
P091 Osteoid osteoma of the trapezoid bone: a diagnostic pitfall of a wrist chronic monoarthritis
Authors: Rym Fakhfakh , Baccouche Khadija , Elamri Nejla , Laataoui Sadok , Zegaloui Hela , Bouajina Elyes
Published: November 2021

Background

Osteoid osteoma is a benign bone tumor representing ∼10% of all benign bone tumors. Although osteoid osteoma of the long bones is usual, the location in the carpus, especially, in the trapezoid bone is rare [1,2]. The Objective is toreport a case of osteoid osteoma of the trapezoid bone with extension to the adjacent second metacarpal bone that was missed diagnosis at initial presentation.

Methods

We describe the clinical, radiological features and outcomes after surgical resection.

Results

A 24-year-old right-handed female, presented with a three-year history of pain at the left wrist, particularly, in the radial-side. She didn’t report any trauma to the wrist. The pain increased over time. She couldn’t use her hand in daily activities and could hardly sleep because of increasing pain at night. Before being referred to our department, she consulted a surgeon. She was treated with oral anti-inflammatory drugs, steroids, several intraarticular steroid injections without relieving pain. The Magnetic resonance imaging (MRI) showed bone marrow oedema in the trapezium and the trapezoid bone, synovial effusion, and tenosynovitis of the flexors of the thumb. A synovectomy was performed and the histopathology revealed non-specific chronic inflammation.

One year later in our department, examination showed wrist swelling, tenderness and pain on palpation. The erythrocyte sedimentation rate was 12 mm/h and the mean C-reactive protein was 2 mg/l. Autoantibodies testing were negative. Initial radiography was read as normal. Initially, Naproxen (550 mg/day) and Morphine (60 mg/day) were prescribed with partially relieving pain. Scintigraphy showed increased uptake of 99mTc in the radial-side of the left wrist. Then, a bone tumor was suspected. The Computed tomography (CT) images revealed a well-demarcated sclerotic nidus surrounded by a halo of radiolucent osteoid tissue, consistent with an osteoid osteoma of the trapezoid bone and the adjacent second metacarpal bone. Surgical resection of the osteoid osteoma was performed. Histopathological examination confirmed the diagnosis. The patient reported complete pain relief since her surgery. She had no recurrence to date.

Conclusion

Osteoid osteoma should be in the differential diagnosis list of chronic wrist pain/arthritis. In this case, careful attention is necessary for patients unresponsive to treatment with long-lasting symptoms. If radiographs are inconclusive, CT or MRI should be considered to better visualize the nidus of osteoid osteoma in the small bones of the hand.
P095 Camptodactyly, arthropathy, coxa-vara, pericarditis syndrome: a case report
Authors: Ferhat A , Mechid F , Rahmoune A , Ifticene M A , Benaziez R , Aboura R , Dahou-Makhloufi C
Published: November 2021

Background

Camptodactyly, arthropathy, coxa vara, pericarditis (CACP) syndrome is a rare genetic disorder with autosomal recessive transmission including camptodactyly, synovial hyperplasia-related arthropathy, progressive coxa vara deformity and non-inflammatory pericarditis. We report the observation of a case.

Observation

S.Y aged 8.5 years, from a consanguineous marriage, presented with a chronic arthropathy affecting wrists, knees and ankles that had been evolving for 6 years and currently, elbows are also affected. The history includes surgery for claw deformity of the hands at the age of 3. No similar cases in the family.

Osteoarticular examination showed symmetrical swelling of the elbows, wrists (Fig. 1),knees (Fig. 2) and ankles (Fig. 3.The affected joints were neither red, painful nor warm on palpation, with normal mobility.

The onset of symptoms could not be determined due to the indolence of the condition and the rest of the clinical examination was unremarkable.

Discussion

CACP syndrome is a more common condition in the Middle East and North Africa, with about 20 cases reported worldwide. This syndrome is still poorly understood and is often confused with juvenile idiopathic arthritis. It should be suspected in the presence of any congenital claw deformity of the hands (camptodactyly) with a chronic non-inflammatory arthropathy, which are constant signs. Coxa-vara and pericarditis (found respectively in 60 and 30% of cases) should be systematically sought. The consanguinity reported in the literature is also present in our case. However, there are no similar cases in siblings. The diagnosis is important, thus avoiding the initiation of unnecessary treatments such as corticosteroids, DMARDs or biotherapy.

Biology

no inflammatory syndrome, FAN negatives.

Standard X-ray of the pelvis

presence of a coxa-vara on the right

Joint ultrasound

common tenosynovitis of the extensors of the fingers, effusion with synovial hypertrophy without a Doppler catch of the elbows, knees and ankles

Myelogram without abnormality.

Cardiac ultrasound without pericarditis.

The diagnosis of CACP was made in view of: a history of camptodactyly, chronic non-inflammatory arthropathy and coxa-vara.

Analgesic treatment was instituted in case of pain, with cardiac monitoring by ultrasound every 6 months.

Conclusion

CACP syndrome is a rare disease often confused with juvenile idiopathic arthritis. Congenital camptodactyly and non-inflammatory arthropathy are very evocative of the diagnosis. The absence of similar cases in siblings makes our observation special.
O002. Factors facilitating the self- and shared-management of Juvenile Idiopathic Arthritis
Authors: Stones Simon
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) requires some form of lifelong management, with at least one third of children symptomatic in adulthood. Therefore, empowering children to competently self-manage their health and wellbeing across the lifecourse is logical, while supporting families in their shared-management role during childhood. However, there was a limited theoretical basis to the self- and shared-management of JIA across the lifecourse. The objective is to explore the factors facilitating the self- and shared-management of JIA using a realist approach to evaluation.

Methods

Guided by the Individual and Family Self-management Theory, a three-stage realist approach to evaluation was undertaken: 1) initial JIA self- and shared-management question theories were elicited from literature reviews and stakeholder insights [1]; 2) seven initial question theories were tested using teacher-learner cycle interviews with 20 participants; 3) findings were analysed using a theory-driven approach to thematic analysis, using deductive, inductive, and retroductive reasoning to extend or refute the initial question theories, in order to identify demi-regularities in the data.

Results

Six refined JIA self- and shared-management question theories emerged: 1) meaningful and bespoke self-management support across the life course for children and young people with JIA; 2) recognised and valued shared-management support for the families of children and young people with JIA, with autonomy in mind; 3) individual healthcare plans as a shared management communication tool to facilitate optimal management of JIA; 4) consistent recognition, value, and encourage of self- and shared-management support from the paediatric rheumatology multi-disciplinary team and associated professionals; 5) child, young-person, and family-focused paediatric rheumatology care and support services across the lifecourse; and 6) bespoke and inclusive approaches by education providers to enable children and young people with JIA to feel safe, supported, and able to fulfil their potential.

Conclusion

There is an increasing recognition of the importance of self- and shared-management of JIA and other paediatric-onset chronic conditions. However, there is a lack of an overall, cohesive approach to self- and shared-management between healthcare providers, education providers, and patient/parent organisations. The findings from this study illuminate the factors facilitating JIA self- and shared-management at individual, interpersonal, institutional and infrastructural levels, bearing relevance to individuals and organisations involved in caring for, and supporting children with JIA and their families.
Protestant Missionaries Are Associated With Reduced Community Cohesion
Authors: Hager Anselm
Published: November 2021

Do Protestant missionaries affect community cohesion? This study puts forth two mechanisms that link missionaries to trusting, cooperative community life: pro-social preferences and social networks. On the one hand, Protestant missionaries espouse charity, and they establish regular venues of social interaction. On the other hand, Protestant missionaries propagate an individualist faith, and they provide an identity along which communities may separate. The effect of Protestant missionaries on community cohesion is thus unclear. To make headway on these conflicting theoretical predictions, we study variation in missionary activity in southeastern Peru. We document that villages with Protestant missions show lower levels of community cohesion compared to non-missionized, Catholic villages. We point to weakened networks as the most likely causal channel and show that effect sizes are particularly large among Pentecostal missionaries.
Devaluing Women’s Lives through Law: Familyism Ideologies in Abortion and Violence against Women Laws in El Salvador
Authors: Diossa-Jiménez Leydy , Menjívar Cecilia
Published: November 2021

El Salvador’s violence against women (VAW) and antiabortion laws present optimal empirical ground to examine the intersection of familyism ideology, laws, and the state relevant beyond this case. Analyzing legal documents, content of laws, and newspapers, we juxtapose these two laws that have followed different applications within the same socio-legal context and historical time, legal reasoning, and juridical structure to identify a common thread: the control of women’s bodies and devaluation of women’s lives enshrined in the legal system. “Familyism” ideology embedded in the law prioritizes family over women’s rights where social class emerges as a central factor. The analysis centers the state, as it interacts with and responds to pressures from the international community and domestic political forces to create, align, and implement antiabortion and VAW laws while devaluing gender ideologies that seek to protect women. In sum, both laws prioritize family at the expense of women’s rights and lives, especially poor and socially disadvantaged women.
Dynamic Risk Prediction for Hospital-Acquired Pressure Injury in Adult Critical Care Patients
Authors: Shui Amy M. , Kim Phillip , Aribindi Vamsi , Huang Chiung-Yu , Kim Mi-Ok , Rangarajan Sachin , Schorger Kaelan , Aldrich J. Matthew , Lee Hanmin
Published: November 2021

IMPORTANCE:

Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Time-dependent risk factors for pressure injury development in the adult intensive care unit setting are not well understood.

OBJECTIVES:

To develop and validate a dynamic risk prediction model to estimate the risk of developing a hospital-acquired pressure injury among adult ICU patients.

DESIGN:

ICU admission data were split into training and validation sets. With death as a competing event, both static and dynamic Fine-Gray models were developed to predict hospital-acquired pressure injury development less than 24, 72, and 168 hours postadmission. Model performance was evaluated using Wolbers’ concordance index, Brier score, net reclassification improvement, and integrated discrimination improvement.

SETTING AND PARTICIPANTS:

We performed a retrospective cohort study of ICU patients in a tertiary care hospital located in San Francisco, CA, from November 2013 to August 2017.

MAIN OUTCOMES AND MEASURES:

Data were extracted from electronic medical records of 18,019 ICU patients (age ≥ 18 yr; 21,220 encounters). Record of hospital-acquired pressure injury data was captured in our institution’s incident reporting system. The information is periodically reviewed by our wound care team. Presence of hospital-acquired pressure injury during an encounter and hospital-acquired pressure injury diagnosis date were provided.

RESULTS:

The dynamic model predicting hospital-acquired pressure injury more than 24 hours postadmission, including predictors age, body mass index, lactate serum, Braden scale score, and use of vasopressor and antifungal medications, had adequate discrimination ability within 6 days from time of prediction (c = 0.73). All dynamic models produced more accurate risk estimates than static models within 26 days postadmission. There were no significant differences in Brier scores between dynamic and static models.

CONCLUSIONS AND RELEVANCE:

A dynamic risk prediction model predicting hospital-acquired pressure injury development less than 24 hours postadmission in ICU patients for up to 7 days postadmission was developed and validated using a large dataset of clinical variables readily available in the electronic medical record.
Low-level viremia in nucleoside analog-treated chronic hepatitis B patients
Authors: Zhang Qian , Cai Da-Chuan , Hu Peng , Ren Hong
Published: November 2021

Low-level viremia (LLV) was defined as persistent or intermittent episodes of detectable hepatitis B virus (HBV) DNA (<2000 IU/mL, detection limit of 10 IU/mL) after 48 weeks of antiviral treatment. Effective antiviral therapies for chronic hepatitis B (CHB) patients, such as entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), have been shown to inhibit the replication of HBV DNA and prevent liver-related complications. However, even with long-term antiviral therapy, there are still a number of patients with persistent or intermittent LLV. At present, the research on LLV to address whether adversely affect the clinical outcome is limited, and the follow-up treatment for these patients is open to question. At the same time, the mechanism of LLV is not clear. In this review, we summarize the incidence of LLV, the association between LLV and long-term outcomes, possible mechanisms, and management strategies in these patient populations.
Efficacy and safety of a parylene-coated occluder for atrial septal defect: a prospective, multi-center, randomized controlled clinical trial
Authors: Yang Kai , Lyu Jian-Hua , Hu Hai-Bo , Wu Wen-Hui , Zhang Ge-Jun , Jin Jing-Lin , Liu Yu-Hao , Feng Yuan , Wang Li-Ming , Zhao Shi-Hua , Jiang Shi-Liang , Li Wei , Pan Xiang-Bin
Published: November 2021

Background:

Nitinol-containing devices are widely used in clinical practice. However, there are concerns about nickel release after nitinol-containing device implantation. This study aimed to compare the efficacy and safety of a parylene-coated occluder vs. a traditional nitinol-containing device for atrial septal defect (ASD).

Methods:

One-hundred-and-eight patients with ASD were prospectively enrolled and randomly assigned to either the trial group to receive a parylene-coated occluder (n = 54) or the control group to receive a traditional occluder (n = 54). The plugging success rate at 6 months after device implantation and the pre- and post-implantation serum nickel levels were compared between the two groups. A non-inferiority design was used to prove that the therapeutic effect of the parylene-coated device was non-inferior to that of the traditional device. The Cochran–Mantel–Haenszel chi-squared test with adjustment for central effects was used for the comparison between groups.

Results:

At 6 months after implantation, successful ASD closure was achieved in 52 of 53 patients (98.11%) in both the trial and control groups (95% confidence interval (CI): [−4.90, 5.16]) based on per-protocol set analysis. The absolute value of the lower limit of the 95% CI was 4.90%, which was less than the specified non-inferiority margin of 8%. No deaths or severe complications occurred during 6 months of follow-up. The serum nickel levels were significantly increased at 2 weeks and reached the maximum value at 1 month after implantation in the control group (P < 0.05 vs. baseline). In the trial group, there was no significant difference in the serum nickel level before vs. after device implantation (P > 0.05).

Conclusions:

The efficacy of a parylene-coated ASD occluder is non-inferior to that of a traditional uncoated ASD occluder. The parylene-coated occluder prevents nickel release after device implantation and may be an alternative for ASD, especially in patients with a nickel allergy.
Effectiveness of Automatic Planning of Fronto-orbital Advancement for the Surgical Correction of Metopic Craniosynostosis
Authors: García-Mato David , Porras Antonio R. , Ochandiano Santiago , Rogers Gary F. , García-Leal Roberto , Salmerón José I. , Pascau Javier , Linguraru Marius George
Published: November 2021

Background:

The surgical correction of metopic craniosynostosis usually relies on the subjective judgment of surgeons to determine the configuration of the cranial bone fragments and the degree of overcorrection. This study evaluates the effectiveness of a new approach for automatic planning of fronto-orbital advancement based on statistical shape models and including overcorrection.

Methods:

This study presents a planning software to automatically estimate osteotomies in the fronto-orbital region and calculate the optimal configuration of the bone fragments required to achieve an optimal postoperative shape. The optimal cranial shape is obtained using a statistical head shape model built from 201 healthy subjects (age 23 ± 20 months; 89 girls). Automatic virtual plans were computed for nine patients (age 10.68 ± 1.73 months; four girls) with different degrees of overcorrection, and compared with manual plans designed by experienced surgeons.

Results:

Postoperative cranial shapes generated by automatic interventional plans present accurate matching with normative morphology and enable to reduce the malformations in the fronto-orbital region by 82.01 ± 6.07%. The system took on average 19.22 seconds to provide the automatic plan, and allows for personalized levels of overcorrection. The automatic plans with an overcorrection of 7 mm in minimal frontal breadth provided the closest match (no significant difference) to the manual plans.

Conclusions:

The automatic software technology effectively achieves correct cranial morphometrics and volumetrics with respect to normative cranial shapes. The automatic approach has the potential to reduce the duration of preoperative planning, reduce inter-surgeon variability, and provide consistent surgical outcomes.
INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE WITHOUT POSTOPERATIVE FACE-DOWN POSITIONING FOR MACULAR HOLE REPAIR
Authors: Ruparelia Sunil , Tuli Raman , Park John S.Y. , Shoham-Hazon Nir , Berco Efraim
Published: November 2021

Purpose:

To describe the outcomes of the inverted internal limiting membrane flap technique without postoperative face-down positioning for macular hole (MH) closure.

Methods:

This retrospective longitudinal study identified patients who had undergone surgical repair for large (>400 µm), idiopathic MHs and did not maintain face-down positioning postoperatively. Outcome measures included anatomical success, defined as confirmation of hole closure by the optical coherence tomography scan and functional success and defined as improved best-corrected visual acuity from baseline at the last follow-up.

Results:

Of the 63 eyes enrolled in the study, 94% patients (59 of 63) achieved anatomical success and 91% patients (57 of 63) achieved functional success. Fifteen (15) of these patients presented with a MH >600 µm. This subgroup achieved an anatomical success rate of 93% and a functional success rate of 87%. Statistically significant improvement in best-corrected visual acuity was demonstrated for all subgroups of MH size (P < 0.001).

Conclusion:

We report a high success rate of large, idiopathic MH closure with the inverted internal limiting membrane flap technique without postoperative face-down positioning. The results described in this study are favorable. However, larger studies with prospective design are warranted to explore this further.
Outcomes of Penetrating Keratoplasty After Open Globe Injury
Authors: Li Katie X. , Durrani Asad F. , Zhou Yunshu , Zhao Peter Y. , Tannen Bradford L. , Mian Shahzad I. , Musch David C. , Zacks David N.
Published: November 2021

Purpose:

The purpose of this study was to investigate the clinical features, surgical outcomes, and prognostic factors of penetrating keratoplasty (PKP) after open globe injury (OGI).

Methods:

A retrospective review of all patients treated for OGI between January 2000 and July 2017 was conducted. Demographic, preoperative, perioperative, and postoperative data were collected for those who underwent PKP after OGI. The predictive value of each preoperative variable on graft failure was assessed using univariate and multivariable Cox proportional hazards models, and the predictive value of variables on post-PKP visual outcome was assessed using both univariate and multivariable logistic regression models. All eyes that underwent PKP after OGI were included unless they had less than 365 days of follow-up.

Results:

Forty-six eyes that underwent PKP met inclusion criteria. The median age was 46 years (interquartile range = 23.00–61.25), median follow-up was 78.5 months (interquartile range = 38.63–122.02), and 37 of 46 subjects (80.4%) were male. The observed 1- and 5-year graft survival estimates were 80.4% and 41.7%, respectively. Factors statistically associated with graft failure in multivariable analyses were rejection episode, hazard ratio (HR) = 3.29; retinal detachment (RD), HR = 3.47; and endophthalmitis, HR = 6.27. Fifteen of 42 eyes (35.7%) regained ambulatory vision (20/200 or better). The strongest predictors of vision worse than 20/200 at the last follow-up were RD, odds ratio (OR) = 43.88; graft rejection, OR = 12.42; and injury outside the workplace, OR = 25.05.

Conclusions:

Despite a high graft survival at 1 year, most of the patients did not regain ambulatory vision. Graft rejection, RD, and endophthalmitis were risk factors for graft failure. These factors should be considered when counseling patients regarding PKP after OGI.
A Novel Treatment of Painful Medial Collateral Ligament Calcification (Pellegrini–Stieda Syndrome): A Case Report
Authors: Greidanus Benjamin D.
Published: November 2021

A 63-year-old healthy woman was diagnosed clinically and radiographically with Pellegrini–Stieda syndrome. She had failed to improve with 6 months of conservative management using oral anti-inflammatories and physiotherapy. Local corticosteroid injections were offered on 2 occasions, 4 months apart, and provided excellent but only temporary relief of symptoms. The patient agreed to undergo ultrasound-guided percutaneous lavage, followed by platelet-rich plasma infiltration of the Pellegrini–Stieda lesion instead of being referred for surgery. The patient was assessed clinically and radiographically at 12 weeks and 18 months postprocedure. At both appointments, the patient reported a significant reduction in pain and improvement in function as rated by the Lower Extremity Function Scale (improvement of 20 points at 12 weeks and an improvement of 16 points at 18 months postprocedure). Radiographically, the Pellegrini–Stieda lesion was no longer visible at either follow-up interval. In conclusion, ultrasound-guided percutaneous calcific lavage followed by autologous platelet-rich plasma infiltration may be an effective way to treat refractory cases of Pellegrini–Stieda syndrome.
Midseason Screening for Groin Pain, Severity, and Disability in 101 Elite American Youth Soccer Players: A Cross-Sectional Study
Authors: DeLang Matthew D. , Garrison J. Craig , Hannon Joseph P. , McGovern Ryan P. , Sheedy Philip J. , Christoforetti John J. , Thorborg Kristian
Published: November 2021

Objective:

To (1) systematically screen for groin pain and type in young elite soccer players and (2) assess whether hip and groin-related severity and disability differed between players with different levels of groin pain and tenderness.

Design:

Cross-sectional observational.

Setting:

Elite American soccer academy at midseason.

Participants:

One hundred one academy soccer players (mean age 14.3 ± 1.8 years).

Intervention:

All players underwent clinical examinations to classify groin pain by the Doha agreement taxonomy.

Main Outcome Measures:

Tests for groin-related severity and disability included the Copenhagen 5-second squeeze test, Copenhagen Hip and Groin Outcome Score (HAGOS), and Hip Outcome Score (HOS). Players were stratified into 3 groups: those with groin pain, those with tenderness, and those with no groin pain or tenderness.

Results:

Twenty-two players (22%) reported groin pain. Adductor-related groin pain was the most common (n = 14), followed by iliopsoas-related (n = 3), and pubic-related (n = 2). Multiple locations were present in 3 players. Thirty-nine players (39%) did not have groin pain but were tender to palpation in 1 or more structures related to the Doha agreement taxonomy. Copenhagen 5-second squeeze test differentiated between players with and without groin pain (groin pain vs tenderness group: P = 0.011; groin pain vs no groin pain group P < 0.001). Four HAGOS subscales (pain, symptoms, sport/recreation, and quality of life) differentiated between players with and without groin pain (P < 0.05).

Conclusions:

One in five academy soccer players experiences groin pain with adductor-related most common during a midseason screening. Both Copenhagen 5-second squeeze test and HAGOS subscales can differentiate between players with and without groin pain.
Ischemic stroke in an adolescent as a sequelae of smear negative tuberculous meningitis
Authors: Acharya Ayushma , Bhattarai Suraj , Singh Pramod , Bhattarai Tulsi
Published: November 2021

Introduction:

Tuberculous meningitis (TBM) is fatal in approximately one-third of patients, and the sequelae of the disease in those who survive is challenging. It should be suspected in people residing in endemic areas with meningitis features. However, diagnosis of TBM is still a daunting challenge because it is usually based on clinical suspicion, cerebrospinal fluid findings, imaging techniques, and response to anti-tubercular therapy. Stroke is a rare complication of TBM, and it usually involves multiple areas supplied by perforating and cortical branches of the cerebral circulation rather than particular zones.

Patient concerns:

A 17-year-old male presented to the outpatient unit with fever and headache for 7 days, and altered sensorium for 1 day. The patient was unable to recognize his friends and family for 1 day and occasionally showed aggressive behavior. On examination, the patient had neck rigidity, positive Kernig's sign, and diminished breath sounds in the right lower zone of the right lung.

Diagnosis:

The patient was diagnosed with smear-negative TBM with pulmonary focus, which later developed into an ischemic stroke.

Outcomes:

The patient was treated with antitubercular therapy as per the national tuberculosis management protocol. Aspirin was added for stroke prevention and levetiracetam for seizure control.

Conclusion:

Stroke due to cerebral infarction can develop in a significant proportion of TBM patients, including adolescents. Hence, clinicians should have a high degree of clinical suspicion of TBM in endemic settings to prevent fatal complications such as stroke that may arise due to delayed diagnosis and treatment.
Lymphangitis Carcinomatosa in Neck Soft Tissue: Computed Tomography Findings With Emphasis on Differentiation From Cellulitis
Authors: Kim Dae Geun , Yoon Dae Young , Hong Ji Hyun , Moon Ji Yoon , Yun Eun Joo , Kim Eun Soo , Lee Yul
Published: November 2021

Objective

Lymphangitis carcinomatosa (LC) is a rare form of metastasis. The purposes of this study were to evaluate computed tomography (CT) findings associated with LC in neck soft tissue and to determine those that were useful in distinguishing LC from cellulitis.

Methods

Contrast-enhanced CT images of 26 patients with pathologically confirmed LC (n = 5) and clinically proven cellulitis (n = 21) were reviewed retrospectively. The following CT findings were evaluated and compared between the 2 groups: subcutaneous fat infiltration, enlargement of muscle, thick irregular enhancement of the superficial cervical fascia, grouping of micronodules, focal intramuscular enhancement, localized fluid collection, and nodular skin thickening.

Results

Thick irregular enhancement of the superficial cervical fascia (80.0% vs 0%, P < 0.0005), grouping of micronodules (60.0% vs 0%, P < 0.005), and focal intramuscular enhancement (60.0% vs 4.8%, P < 0.05) were significantly more frequent in LC than in cellulitis. Other findings did not show statistical significance between both groups.

Conclusions

When soft tissue swelling is present in the neck with either thick irregular enhancement of the superficial cervical fascia, grouping of micronodules, or focal intramuscular enhancement, the possibility of LC should be considered especially in patients with underlying malignancy.