bluuebunny/crossref_metadata_2025 huggingface dataset:
Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis
Authors: Zhang John J Y , Lee Keng Siang , Voisin Mathew R , Hervey-Jumper Shawn L , Berger Mitchel S , Zadeh Gelareh
Published: September 2020

Background

The goal of glioblastoma (GBM) surgery is to maximize the extent of resection (EOR) while minimizing postoperative neurological complications. Awake craniotomy (AC) has been demonstrated to achieve this goal for low-grade gliomas in or near eloquent areas. However, the efficacy of AC for GBM resection has not been established. Therefore, we aimed to investigate the outcomes of AC for surgical resection of GBM using a systematic review and meta-analysis of published studies.

Methods

Systematic searches of Ovid MEDLINE, Embase, Cochrane Controlled Register of Controlled Trials, and PubMed were performed from database inception to September 14, 2019 for published studies reporting outcomes of AC for GBM resection. Outcome measures analyzed included EOR and the event rate of postoperative neurological deficits.

Results

A total of 1928 unique studies were identified. Fourteen studies reporting 278 patients were included in our meta-analysis. Mean age of patients was 46.9 years (95% confidence interval [CI]: 43.9–49.9). Early and late postoperative neurological deficits occurred in 34.5% (95% CI: 21.9–48.2) and 1.9% (95% CI: 0.0–9.2) of patients, respectively. Pooled percentage of gross total resection (GTR) was 74.7% (95% CI: 66.7–82.1), while the pooled percentage reduction in tumor volume was 95.3% (95% CI: 92.2–98.4).

Conclusions

Limited current evidence suggests that the use of AC for resection of supratentorial GBM is associated with a low rate of persistent neurological deficits while achieving an acceptable rate of GTR. Our findings demonstrate the potential viability of AC in GBM resection and highlight the need for further research on this topic.
Clinical impact of COVID-19 on people with substance use disorders
Authors: Vallecillo G , Perelló R , Güerri R , Fonseca F , Torrens M
Published: September 2020

Background

People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders.

Methods

an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020.

Results

Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died.

Conclusion

Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.
Effect of the combinative use of acupotomy therapy and ultrasonic drug penetration in treating knee joint osteoarthritis
Authors: Zhang X , Sun X , Chen G
Published: September 2020

Background/introduction

Knee joint osteoarthritis is a chronic disease that affects the health in aging population.

Aim

We explore a minimally invasive surgery combining the use of ultrasonic drug penetration to treat early stage of knee joint osteoarthritis.

Design

In total, 75 patients were participated in acupotomy therapy and ultrasonic drug penetration to treat joint osteoarthritis.

Methods

The WOMAC (the Western Ontario and McMaster Universities Osteoarthritis Index) scores were used to assess the performance.

Results

There was a significant difference in the WOMAC score between the two groups of patients (P < 0.05). The total performance rate was about 86.4% and 50% in experiment and control groups.

Conclusion

The combination of acupotomy therapy and ultrasonic drug penetration has demonstrated to be effective and promising to treat knee joint osteoarthritis.
EVALUATION OF REPRESENTATIVENESS OF SAMPLES USED FOR INDOOR RADON SURVEYS
Authors: Caprio M , Venoso G , Ampollini M , Antignani S , Carpentieri C , Di Carlo C , Pozzi S , Carelli V , Cordedda C , Bottacchiari F , Bochicchio F
Published: September 2020

The estimation of the indoor radon exposure of the population of a country is generally carried out by the means of surveys designed in order to have sample representativeness as a target (population-based survey). However, the estimates of radon concentration distributions could be affected by biases if sampling was not random or in case of differences between sample and target population characteristics. In this work, we performed a preliminary check of the representativeness of the sample used for the second Italian national survey aimed to evaluate radon concentration distribution in each Province. We found that sampled dwellings are mostly located in the main administrative centres, where average radon concentration is generally lower, as compared with the other towns of the Province. The potential source of bias identified in this work suggests to carefully control the occurrence of a sampling imbalance between ‘main’ cities and other cities of Province and to take it into account in data analysis.
Gender differences in the effect of gamification on weight loss during a daily, neurocognitive training program
Authors: Forman Evan M , Manasse Stephanie M , Dallal Diane H , Crochiere Rebecca J , Berry Michael P , Butryn Meghan L , Juarascio Adrienne S
Published: September 2020

A major contributor to the obesity epidemic is the overconsumption of high-calorie foods, which is partly governed by inhibitory control, that is, the ability to override pre-prepotent impulses and drives. Computerized inhibitory control trainings (ICTs) have demonstrated qualified success at affecting real-world health behaviors, and at improving weight loss, particularly when repeated frequently over an extended duration. It has been proposed that gamification (i.e., incorporating game-like elements such as a storyline, sounds, graphics, and rewards) might enhance participant interest and thus training compliance. Previous findings from a mostly female sample did support this hypothesis; however, it might be expected that the effects of gamification differ by gender such that men, who appear more motivated by gaming elements, stand to benefit more from gamification. The present study evaluated whether gender moderated the effect of a gamified ICT on weight loss. Seventy-six overweight individuals received a no-sugar-added dietary prescription and were randomized to 42 daily and 2 weekly ICTs focused on sweet foods that were either gamified or nongamified. Results supported the hypothesis that gamification elements had a positive effect on weight loss for men and not women (p = .03). However, mechanistic hypotheses for the moderating effect (in terms of enjoyment, compliance, and improvements in inhibitory control) were generally not supported (p’s > .20). These results suggest that gamification of ICTs may boost weight loss outcomes for men and not women, but further research is needed to determine the specific mechanisms driving this effect and to arrive at gamification elements that enhance effects for both men and women.
Effects of caffeine on brain antioxidant status and mitochondrial respiration in acetaminophen-intoxicated mice
Authors: Gonçalves Débora F , Tassi Cintia C , Amaral Guilherme P , Stefanello Silvio T , Dalla Corte Cristiane L , Soares Félix A , Posser Thais , Franco, Jeferson L , Carvalho Nélson R
Published: September 2020

Hepatic encephalopathy is a pathophysiological complication of acute liver failure, which may be triggered by hepatotoxic drugs such as acetaminophen (APAP). Although APAP is safe in therapeutic concentration, APAP overdose may induce neurotoxicity, which is mainly associated with oxidative stress. Caffeine is a compound widely found in numerous natural beverages. However, the neuroprotective effect of caffeine remains unclear during APAP intoxication. The present study aimed to investigate the possible modulatory effects of caffeine on brain after APAP intoxication. Mice received intraperitoneal injections of APAP (250 mg/kg) and/or caffeine (20 mg/kg) and, 4 h after APAP administration, samples of brain and blood were collected for the biochemical analysis. APAP enhanced the transaminase activity levels in plasma, increased oxidative stress biomarkers (lipid peroxidation and reactive oxygen species), promoted an imbalance in endogenous antioxidant system in brain homogenate and increased the mortality. In contrast, APAP did not induce dysfunction of the mitochondrial bioenergetics. Co-treatment with caffeine modulated the biomarkers of oxidative stress as well as antioxidant system in brain. Besides, survival assays demonstrated that caffeine protective effects could be dose- and time-dependent. In addition, caffeine promoted an increase of mitochondrial bioenergetics response in brain by the enhancement of the oxidative phosphorylation, which could promote a better energy supply necessary for brain recovery. In conclusion, caffeine prevented APAP-induced biochemical alterations in brain and reduced lethality in APAP-intoxicated mice, these effects may relate to the preservation of the cellular antioxidant status, and these therapeutic properties could be useful in the treatment of hepatic encephalopathy induced by APAP intoxication.
Bisphenol AF and Bisphenol F Induce Similar Feminizing Effects in Chicken Embryo Testis as Bisphenol A
Authors: Mentor Anna , Wänn Mimmi , Brunström Björn , Jönsson Maria , Mattsson Anna
Published: September 2020

The plastic component bisphenol A (BPA) impairs reproductive organ development in various experimental animal species. In birds, effects are similar to those caused by other xenoestrogens. Because of its endocrine disrupting activity, BPA is being substituted with other bisphenols in many applications. Using the chicken embryo model, we explored whether the BPA alternatives bisphenol AF (BPAF), bisphenol F (BPF), and bisphenol S (BPS) can induce effects on reproductive organ development similar to those induced by BPA. Embryos were exposed in ovo from embryonic day 4 (E4) to vehicle, BPAF at 2.1, 21, 210, and 520 nmol/g egg, or to BPA, BPF, or BPS at 210 nmol/g egg and were dissected on embryonic day 19. Similar to BPA, BPAF and BPF induced testis feminization, manifested as eg testis-size asymmetry and ovarian-like cortex in the left testis. In the BPS-group, too few males were alive on day 19 to evaluate any effects on testis development. We found no effects by any treatment on ovaries or Müllerian ducts. BPAF and BPS increased the gallbladder-somatic index and BPAF, BPF and BPS caused increased embryo mortality. The overall lowest-observed-adverse-effect level for BPAF was 210 nmol/g egg based on increased mortality, increased gallbladder-somatic index, and various signs of testis feminization. This study demonstrates that the BPA replacements BPAF, BPF, and BPS are embryotoxic and suggests that BPAF is at least as potent as BPA in inducing estrogen-like effects in chicken embryos. Our results support the notion that these bisphenols are not safe alternatives to BPA.
Community-associated MRSA among Indigenous children in remote settings
Authors: Campbell Rhonda , Martin Donna , Pierce Darlene , Nweze Sochimaobi
Published: September 2020

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major public health concern for Indigenous pediatric populations worldwide. It is the leading cause of skin and soft tissue infections in this demographic. This article reviews the literature and presents an evidence-based algorithm for the assessment and management of CA-MRSA among Indigenous children in remote settings.
Medium-Term Patient-Reported Quality of Life and Activities of Daily Living in Surgically Treated Trauma Patients With Pelvic, Acetabular or Combined Pelvic and Acetabular Fractures in a Retrospective Single-Center Study
Authors: de Krom Maartje A. P. , Kalmet Pishtiwan H. S. , Jagtenberg Eline M. , Jansen Joey J. R. , Versteegh Viktor E. , Verbruggen Jan P. A. M , Seelen Henk A.M. , Poeze Martijn
Published: September 2020

Objective:

To gain more insights in the medium-term patient-reported quality of life (QoL), activities of daily living (ADL), and number of complications in trauma patients with an acetabular fracture (AF), a pelvic fracture (PF), and those with a surgically combined pelvic and AF (PAF).

Design:

Retrospective single-center study.

Setting:

Level I academic trauma center.

Patients/Participants:

51 trauma patients with PF, AF, or PAF who were surgically treated between 2014 and 2017.

Intervention:

Open reduction and internal fixation.

Main Outcome Measurements:

Primary outcome measures are patient-reported outcome questionnaire, which includes 2 items, the QoL, as measured with the Short Form-12, and the ADL, as measured with the Lower Extremity Functional Scale. The secondary outcome parameter was the occurrence of complications during a follow-up of at least 2 years.

Results:

The mean physical component score (PCS) of the QoL (P = 0.03) and the ADL (P = 0.03) were significantly higher in patients with AF compared with patients with PF. The incidence of the overall postoperative complications did not significantly differ between the PF, AF, and PAF groups (P = 0.28).

Conclusions:

This study found that the PCS of the QoL and the ADL in surgically treated trauma patients with PF were significantly lower compared with patients with AF. No significant differences were found in overall complication rate between the PF, AF, and PAF groups.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effect of a 6 am–9 am Dedicated Orthopaedic Trauma Room on Hip Fracture Outcomes in a Community Level II Trauma Center
Authors: McDonald Michael , Ward Lawrence , Wortham Heather , Sorenson Breanna , Jarski Robert , El-Yussif Eddie
Published: September 2020

Objective:

To assess the outcomes of elderly hip fracture surgeries performed 12 months before and 12 months after the implementation of a daily 6 am–9 am dedicated orthopaedic trauma room (DOTR) at a Level II community trauma center.

Design:

Retrospective cohort study.

Setting:

Level II academic trauma center.

Patients:

A total of 431 consecutive trauma patients undergoing surgical management of isolated low-energy hip fractures from January 1, 2018, to December 31, 2019.

Intervention:

Implementation of a 6 am–9 am DOTR Monday through Friday.

Main Outcome Measures:

Time to surgery, number of cases performed after hours, surgical time, 90-day morbidity and mortality, and time to therapy.

Results:

Retrospective analysis showed that despite a 24% increase in surgical hip fracture volume, implementation of a part-time DOTR led to a decrease in after-hours surgery (32.4% vs. 19.6%; P = 0.008) and patients requiring the intensive care unit postoperatively (7% vs. 3.8%; P = 0.036). Surgeries performed after hours were longer than that of surgeries performed during the daytime (82.0 vs. 68 minutes; P = 0.003) and had more complications (pneumonia, pulmonary embolism, and surgical site infection; P = 0.002, 0.047, 0.024, respectively).

Conclusions:

Our results show that a part-time DOTR in a community Level II hospital is associated with improvement in patient care.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Protocolized Tracheal and Thoracic Ultrasound for Confirmation of Endotracheal Intubation and Positioning: A Multicenter Observational Study
Authors: Senussi Mourad H. , Kantamneni Phani C. , Latifi Mani , Omranian Ali P. , Krveshi Lirim , Barakat Amr F. , Masri Ahmad , Schmidhofer Mark
Published: September 2020

Objectives:

To determine the feasibility of a combination of tracheal and thoracic ultrasonography to confirm adequate positioning of endotracheal tube placement in a cohort of critically ill patients.

Design:

Prospective, multicenter, observational study from January 2019 to May 2020.

Setting:

Multicenter study conducted in multiple ICUs across four different academic tertiary and community hospitals.

Patients:

Eligible patients were adults (≥ 18 yr) requiring endotracheal intubation and intensive care.

Intervention:

Tracheal and thoracic ultrasonography were performed during intubation attempts to rule out esophageal intubations, to detect mainstem intubations, and to confirm and adjust endotracheal tube position.

Measurements and Main Results:

Among 118 patients, median age was 66 years (interquartile range 56–73 yr), body mass index 28 (interquartile range 25–34), and 63.6 % were males. Using the ultrasound protocol, one esophageal (0.9%) and five main stem intubations (4.2%) were detected. 97.5% of final endotracheal tube positions confirmed by ultrasound were in concordance with the next occurring chest radiograph, with only three (2.5%) requiring minor post-chest radiograph adjustments.

Conclusions:

A protocolized, systematic approach using tracheal and thoracic ultrasonography can be used to confirm endotracheal intubation, detect main stem intubations, and guide tube positioning in the critically ill. This ultrasonographic approach is easily applicable, safe, and comparable to chest radiography. This approach may serve as a potential alternative or adjunct when chest radiography is not available or ideal. This has the potential to be used for routine intensive care, out-of-hospital or resource-poor settings, or situations which require isolation precautions to mitigate the use of chest radiography.
Different distributions of nerve demyelination in chronic acquired multifocal polyneuropathies
Authors: Zhou Xia-Jun , Zhu Ying , Zhu De-Sheng , Han Lu , Liu Qian-Yun , Liang Xiao-Niu , Hao Yong , Li Ze-Zhi , Guan Yang-Tai
Published: September 2020

Background

Multifocal motor neuropathy (MMN), Lewis-Sumner syndrome (LSS), and many chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs) are representative of acquired multifocal polyneuropathy and are characterized by conduction block (CB). This retrospective study aimed to investigate the demyelinating distribution and the selective vulnerability of MMN, LSS, and CIDP with CB (CIDP-CB) in nerves.

Methods

Fifteen LSS subjects (107 nerves), 24 MMN subjects (176 nerves), and 17 CIDP-CB subjects (110 nerves) were included. Their clinical information was recorded, blood and cerebrospinal fluid tests were conducted, and nerve conductions of the median, ulnar, radial, peroneal, and tibial nerves were evaluated. CB, temporal dispersion, distal motor latency (DML), and F-wave latency were recorded, and nerve conduction velocity, terminal latency index, and modified F-wave ratio were calculated.

Results

CB was more likely to occur around the elbow in CIDP-CB than in MMN (78.6%vs. 6.8%,P < 0.01) but less likely to occur between the wrist and the elbow than in LSS (10.7%vs. 39.3%,P < 0.05). Tibial nerve CB was most frequently observed in MMN (47.4%,P < 0.05). CIDP-CB was characterized by a prolonged DML in all nerves, and slow motor nerve velocity of the upper limb was significant when CB nerves were excluded (P < 0.05).

Conclusions

We report the different distributions of segmental and diffuse demyelination of the ulnar and tibial nerves in LSS, MMN, and CIDP-CB. These distinct distributions could help in differentiating among these conditions.
Valve-in-Valve Transcatheter Aortic Valve Replacement: A Review of Procedural Details, Safety, and Clinical Implications
Authors: Hameed Irbaz , Ahmed Adham , Ullah Najih , Salemi Arash
Published: September 2020

Bioprosthetic valves are increasingly being used to treat young patients needing surgical intervention. The rising number of young patients undergoing bioprosthesis implantation also means that many of these patients will ultimately require reintervention due to the deteriorative nature of these valves. Recently, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become the preferred procedure to treat high-risk patients requiring repeat surgical aortic valve replacement. Despite being less invasive, ViV TAVR is accompanied by risks, including coronary obstruction, valvular thrombosis, and postoperative residual gradients. Furthermore, there are limited long-term data on ViV TAVR detailing prognosis, and operators often rely on anecdotal experience and personal judgment for clinical decision-making. In this article, we review the procedural details, safety, and clinical implications of ViV TAVR.
Cancer of the Vulva: A Review
Authors: Michalski Basia M. , Pfeifer John D. , Mutch David , Council M. Laurin
Published: September 2020

BACKGROUND

Vulvar cancers, although rare, are becoming an increasingly serious threat to women's health. Cancer of the vulva accounted for 0.3% of all new cancers in the United States in 2019, with 6,070 newly diagnosed cases. This review details the epidemiology, pathogenesis, diagnosis, staging, and treatment of vulvar malignancies.

OBJECTIVE

To review cancer entities of the vulva, including vulvar intraepithelial neoplasms, squamous cell carcinoma (SCC), malignant melanoma, basal cell carcinoma, neuroendocrine tumors, and adenocarcinomas.

MATERIALS AND METHODS

Literature review using PubMed search for articles related to cancer of the vulva.

RESULTS

Vulvar intraepithelial neoplasms represent premalignant precursors to SCC of the vulva. There are several different histopathologic subtypes of SCC, and treatment is dependent on characteristics of primary tumor and lymph node involvement. Melanoma is the second most common cancer to affect the vulva, and staging is based on tumor, node, and metastatic spread.

CONCLUSION

Vulvar malignancies are rare, and diagnosis is dependent on biopsy and pathologic evaluation. Treatment for vulvar malignancies depends on histopathologic diagnosis but ranges from wide local excision with or without lymph node biopsy or dissection to radiation therapy with chemo- or immunotherapy. Overall survival varies by diagnosis.
State-Level Numbers and Rates of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths by Age, 2014
Authors: Sarmiento Kelly , Thomas Karen , Daugherty Jill , Haarbauer-Krupa Juliet , Waltzman Dana
Published: September 2020

Objective:

To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by age group for 2014.

Setting and Participants:

Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states.

Design:

Cross-sectional.

Main Measures:

Number and population-based incidence rates of TBI-related ED visits, hospitalizations, and deaths by age group—children and young adults (0-24 years), adults (25-64 years), and older adults (≥65 years)—in 36 states.

Results:

South Dakota had the lowest rates of TBI-related ED visits for all age groups—children and young adults: 566.2 (95% CI: 539.2-593.3) per 100 000; adults: 269.2 (95% CI: 253.0-285.4) per 100 000; and older adults: 324.3 (95% CI: 293.4-355.2) per 100 000. Rhode Island had the lowest rate of TBI-related hospitalizations for children and young adults—25.9 (95% CI: 20.7-32.0) per 100 000. The lowest rate of TBI-related hospitalizations among adults and older adults was in Virginia—39.6 (95% CI: 37.7-41.4) per 100 000—and Ohio—129.3 (95% CI: 124.0-134.6) per 100 000—respectively. Maryland had the lowest rate of TBI-related deaths for children and young adults—3.1 (95% CI: 2.3-3.9) per 100 000. Rhode Island had the lowest rate of TBI-related deaths for adults—7.2 (95% CI: 5.2-9.8) per 100 000—and New Jersey had the lowest rate of TBI-related deaths for older adults—29.4 (95% CI: 26.5-32.4) per 100 000.

Conclusion:

This analysis demonstrated that there are variations in TBI-related ED visits, hospitalizations, and deaths by age. State public health professionals may use these findings to develop state-based strategies to address TBI.
State-Level Numbers and Rates of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths by Sex, 2014
Authors: Waltzman Dana , Haarbauer-Krupa Juliet , Daugherty Jill , Thomas Karen , Sarmiento Kelly
Published: September 2020

Objective:

To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by sex for 2014.

Setting and Participants:

Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states.

Design:

Cross-sectional.

Main Measures:

Number and rate of TBI-related ED visits, hospitalizations, and deaths (indicators) by sex in over 25 states.

Results:

Across all states that supplied data, males had higher rates of TBI-related ED visits, hospitalizations, and deaths than females. However, for some indicators, high rates for both sexes and low rates for both sexes appeared clustered in a specific region of the United States. There was also within-state variability in TBI rates by indicator and sex. For example, within-state variability between sexes ranged from as low as 2.8% for ED visits and as high as 335% for deaths.

Conclusion:

TBI-related ED visits, hospitalizations, and deaths varied by state and by sex, and evidence was found for within-state variability in TBI rates by indicator and sex in 2014. Differences in TBI indicators by sex may have important implications for public health professionals implementing TBI prevention and care strategies at the state level.
Effects of Terpinen-4-ol on Meibomian Gland Epithelial Cells In Vitro
Authors: Chen Di , Wang Jingyi , Sullivan David A. , Kam Wendy R. , Liu Yang
Published: September 2020

Purpose:

Infestation with demodex mites has been linked to the development of chalazion, meibomian gland dysfunction, and blepharitis. An effective treatment is the eyelid application of terpinen-4-ol (T4O), a tea tree oil component. However, T4O is also known to be toxic to nonocular epithelial cells. We hypothesize that T4O toxicity also extends to human meibomian gland epithelial cells (HMGECs).

Methods:

Immortalized (I) HMGECs were cultured with varying concentrations (1.0%–0.001%) of T4O under proliferating or differentiating conditions up to 5 days. Experimental procedures included analyses of cell appearance, survival, P-Akt signaling, lysosome accumulation, and neutral lipid content.

Results:

Our findings show that T4O causes a dose- and time-dependent decrease in the cell survival of IHMGECs. After 15 minutes of exposure to 1% T4O, IHMGECs exhibited rounding, atrophy, and poor adherence. Within 90 minutes of such treatment, almost all cells died. Reducing the T4O concentration to 0.1% also led to a marked decrease in P-Akt signaling and cell survival of IHMGECs. Decreasing the T4O amount to 0.01% caused a slight, but significant, reduction in the IHMGEC number after 5 days of culture and did not influence the ability of these cells to differentiate.

Conclusions:

T4O, even at levels 10-fold to 100-fold lower than demodicidal concentrations, is toxic to HMGECs in vitro.
Tuck In Femtosecond Laser Assisted Anterior Lamellar Keratoplasty (T-FALK) for the Management of Superficial Anterior Corneal Scars—A Modified Technique
Authors: Sharma Vijay K. , Sati Alok , Kaushik Jaya , Kumar Santosh , Agarwal Manisha
Published: September 2020

Purpose:

To report a modified sutureless and glue-less technique, termed tuck in femtosecond laser assisted anterior lamellar keratoplasty (T-FALK), and to achieve a good graft–host junction apposition.

Methods:

This is a prospective interventional case series of 15 eyes of 15 patients who underwent T-FALK. Depth of the anterior corneal scar was assessed using anterior segment optical coherence tomography (ASOCT). The donor and recipient lenticules were prepared using femtosecond laser. After removing the recipient anterior scarred lenticule, the transparent donor lenticule was positioned on the recipient bed and margins tucked in under the recipient cornea. A bandage contact lens was applied for 3 weeks. Postoperatively, topical antibiotic and steroid combination eye drops were given, and the assessment of healing of the graft-host junction was done using ASOCT.

Results:

A total of 15 patients (8 men and 7 women) underwent T-FALK. Six patients had superficial corneal opacities after healed microbial keratitis, 5 patients had spheroidal corneal degeneration, 3 patients had Salzman nodular degeneration, and 1 patient had vortex keratopathy. No intraoperative or postoperative complications were noted during T-FALK. All patients had good graft–host junction apposition postoperatively, as demonstrated by ASOCT.

Conclusions:

Sutureless and glue-less T-FALK can be the best way ahead for management of superficial anterior corneal scars with good visual outcome.
Successful Treatment of a Pediatric Neurotrophic Keratopathy With Cenegermin
Authors: Papadopoulos Kosmas , Besgen Volker , Sekundo Walter
Published: September 2020

Purpose:

We present a challenging case of a 9-year-old patient with refractory neurotrophic keratopathy (NK) who was successfully treated with cenegermin eye drops.

Methods:

A 7-year-old boy developed an ocular infection after a visit to a public swimming pool. After having been unsuccessfully treated for 2 years with antibiotics, steroids, and artificial tears, the patient presented to our clinic with a therapy-refractory NK. We initiated treatment with autologous serum eye drops that showed only weak response. Therefore, treatment with cenegermin eye drops was started.

Results:

After cenegermin therapy, a complete restoration of the corneal surface and an increase in visual acuity were achieved.

Conclusions:

The use of cenegermin is effective in treating pediatric NK.
Mini-Scleral Lenses Improve Vision-Related Quality of Life in Keratoconus
Authors: Kreps Elke O. , Pesudovs Konrad , Claerhout Ilse , Koppen Carina
Published: September 2020

Purpose:

To evaluate the effects of mini-scleral lenses on visual acuity (VA) and visual functioning in patients with keratoconus.

Methods:

This prospective, interventional study examined the effects of mini-scleral lenses on VA and visual functioning in patients with keratoconus. Patients younger than 18 years or with a history of refractive surgery or corneal graft surgery were excluded. Patients were fitted with mini-Misa lenses, Senso mini-scleral lenses, or Zenlens mini-scleral lenses. Outcome measures were scleral lens–corrected VA and vision-related quality of life as assessed with the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-39).

Results:

Eighty-nine eyes of 50 keratoconus patients were included in the study. Median baseline logarithm of the minimal angle of resolution VA with habitual correction was 0.22 (range 0.02–1.04). Mini-scleral lens fitting resulted in a statistically significant visual improvement (median 0; P < 0.0001). At the 6-month follow-up, 11 patients (22%) had abandoned mini-scleral lens wear, primarily because of difficulties with lens handling (7 patients). Of the 39 patients with continued wear, 33 patients (84.6%) wore their lenses for a daily average of 12 hours. NEI-VFQ scoring in these patients showed significantly improved results for both visual functioning and socioemotional scales after scleral lens fitting (P < 0.0001).

Conclusions:

Mini-scleral lenses significantly improve VA and visual functioning on NEI-VFQ in patients with keratoconus. Difficulties with lens insertion and removal are the principal reason for lens dropout.
Prevalence and Risk Factors Associated With Corneal Perforation in Chronic Ocular Graft-Versus-Host-Disease
Authors: Sinha Shruti , Singh Rohan Bir , Dohlman Thomas H. , Taketani Yukako , Yin Jia , Dana Reza
Published: September 2020

Purpose:

To determine the prevalence and risk factors associated with corneal perforation in patients with chronic ocular graft-versus-host disease (oGVHD).

Methods:

We reviewed the case records of 405 patients diagnosed with chronic oGVHD over 8 years at a single academic center and assessed the prevalence of corneal perforation in the cohort. We reviewed patient demographics, indication for and type of hematopoietic stem cell transplantation (HSCT), time elapsed between HSCT and perforation, and clinical characteristics including oGVHD severity scores, ocular comorbidities, and topical medications at the time of perforation. Data were analyzed to determine the characteristics of patients with corneal perforation and establish the risk factors.

Results:

Of the 405 patients with chronic oGVHD, 15 (3.7%) developed a corneal perforation. The mean age of patients at the time of perforation was 64 ± 11 years and 10 (67%) were men. The median time to corneal perforation was 3.3 years post-HSCT. Although perforation occurred unilaterally in all cases, 44% had epithelial defects and 38% had stromal abnormalities in the contralateral eye. Of the patients with corneal perforation, 9 (60%) had a National Institute of Health oGVHD severity score of 2 and 6 (40%) had a score of 3. Patients with chronic oGVHD on antiglaucoma drops had a significantly higher risk of corneal perforation (P < 0.001).

Conclusions

Corneal perforation is a rare but vision-threatening complication of chronic oGVHD. Our study emphasizes the need for frequent and long-term follow-up of patients with oGVHD regardless of the severity of disease. In particular, patients with chronic oGVHD on topical antiglaucoma medications should be monitored closely due to a higher risk for corneal perforation.
Treatment and Outcomes of Children With Febrile Urinary Tract Infection Due to Extended Spectrum Beta-lactamase-producing Bacteria in Europe
Authors: Vazouras Konstantinos , Hsia Yingfen , Folgori Laura , Bielicki Julia , Aguadisch Elise , Bamford Alasdair , Brett Ana , Caseris Marion , Cerkauskiene Rimante , De Luca Maia , Iosifidis Elias , Kopsidas John , Manzanares Ángela , Planche Tim , Riordan Andrew , Srovin Tina Plankar , Valdivielso Martínez Ana Isabel , Vergadi Eleni , Sharland Mike , Basmaci Romain
Published: September 2020

Background:

The prevalence of extended-spectrum beta-lactamase producing Εnterobacteriaceae (ESBL-PE) is increasing globally. ESBL-PE are an important cause of urinary tract infections (UTIs) in children. We aimed to characterize the clinical presentation, treatment and outcomes of childhood UTI caused by ESBL-PE in Europe.

Methods:

Multicenter retrospective cohort study. Children 0 to 18 years of age with fever, positive urinalysis and positive urine culture for an ESBL-PE uropathogen, seen in a participating hospital from January 2016 to July 2017, were included.

Main Outcome Measures:

Primary outcome measure: day of defervescence was compared between (1) initial microbiologically effective treatment (IET) versus initial microbiologically ineffective treatment (IIT) and (2) single initial antibiotic treatment versus combined initial antibiotic treatment. Secondary outcome measures: Clinical and microbiologic failure of initial treatment.

Results:

We included 142 children from 14 hospitals in 8 countries. Sixty-one children had IET and 77 IIT. There was no statistical difference in time to defervescence for effective/ineffective groups (P = 0.722) and single/combination therapy groups (P = 0.574). Two of 59 (3.4%) and 4/66 (6.1%) patients exhibited clinical failure during treatment (P = 0.683) when receiving IET or IIT, respectively. Eight of 51 (15.7%) receiving IET and 6/58 (10.3%) receiving IIT patients (P = 0.568) had recurring symptoms/signs suggestive of a UTI. Recurrence of a UTI occurred 15.5 days (interquartile range, 9.0–19.0) after the end of treatment.

Conclusions:

Time to defervescence and clinical failure did not differ between IET/IIT groups. Non-carbapenem beta-lactam antibiotics may be used for the empiric treatment of ESBL febrile UTIs, until susceptibility testing results become available.
Clinical and Epidemiologic Characteristics of Pertussis in Hospitalized Children: A Prospective and Standardized Long-term Surveillance Study
Authors: Zumstein Jana , Heininger Ulrich
Published: September 2020

Background:

Surveillance of incidence and severity of pertussis is key to control success and shortcomings of vaccination programs followed by adaptations of recommendations if necessary. In Switzerland, nationwide reporting of hospitalizations due to pertussis in children has a long tradition and resumed in 2013 to evaluate the effects of pertussis immunization in pregnancy introduced in 2013.

Methods:

Since 2013, all patients <16 years of age hospitalized with suspected or proven pertussis have been reported to the Swiss Pediatric Surveillance Unit. Patient data comprising clinical and epidemiologic characteristics and laboratory confirmation were assessed in a standardized fashion, and case definitions were applied to all cases reported until the end of 2019.

Results:

Two hundred thirteen of 294 cases were valid cases of pertussis. Of these, 168 (79%) occurred in <6-month-old infants. Mean duration of hospitalization was 8 days (median 5, range 2–47) overall and highest in neonates (14.2 days); 85% of all patients had ≥1 complication, most commonly cyanosis and dyspnea, especially in infants. Overall, case fatality rate was 1.4% (8.7% in neonates). Only 4 (2%) of 168 mothers of infants <6 months had been vaccinated during pregnancy; 14 (12%) of 112 patients with precise records of immunization had completed their primary series and were up-to-date for age.

Conclusions:

Despite a decline of cases associated with the introduction of immunization against pertussis in pregnancy, control of the disease remains challenging, mainly due to failure to vaccinate rather than vaccine failure.
Intrastromal cannula injury in cataract surgery
Authors: Tong C. Maya , Rudnisky Christopher J.
Published: September 2020

Iatrogenic ocular injuries from unexpected cannula ejection during ophthalmic surgery are rare and can cause vision-threatening damage. This report describes 2 cases of cannula-associated ocular injuries that resulted in good visual outcome, despite the cannula traveling intrastromally through the visual axis.
Mobile 3D Intraprocedural Fluoroscopy in Combination With Ultrathin Bronchoscopy for Biopsy of Peripheral Lung Nodules
Authors: Sadoughi Ali , Virdi Sahil
Published: September 2020

Despite development of multiple technologies, distinguishing benign from malignant lung nodules when they are still small in size is challenging. A high yield and minimally invasive bronchoscopic technology with low cost for diagnosis of small lung lesions is needed in pulmonary and lung cancer clinical practice. Peripheral airway bronchoscopy using thin and most recently ultrathin bronchoscopes improve visualization of small airways. The novel mobile 2D/3D C-Arm fluoroscopy system is a complementary tool along with radial endobronchial ultrasound in detecting small lung nodules with real-time high-quality multidimensional image confirmation during bronchoscopy. This combined technology can be easily acquired in any bronchoscopy room, and potentially affect lung nodule practice significantly.
Disparities in Care Experienced by American Indian and Alaska Native Medicare Beneficiaries
Authors: Martino Steven C. , Elliott Marc N. , Hambarsoomian Katrin , Garcia Andrea N. , Wilson-Frederick Shondelle , Gaillot Sarah , Weech-Maldonado Robert , Haviland Amelia M.
Published: September 2020

Background:

Little is known about the health care experiences of American Indians and Alaska Natives (AIANs) due to limited data.

Objective:

The objective of this study was to investigate the health care experiences of AIAN Medicare beneficiaries relative to non-Hispanic Whites using national survey data pooled over 5 years.

Subjects:

A total of 1,193,248 beneficiaries who responded to the nationally representative 2012–2016 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

Methods:

Linear regression models predicted CAHPS measures from race and ethnicity. Scores on the CAHPS measures were linearly transformed to a 0–100 range and case-mix adjusted. Three AIAN groups were compared with non-Hispanic Whites: single-race AIANs (n=2491; 0.4% of the total sample), multiple-race AIANs (n=15,502; 1.3%), and Hispanic AIANs (n=2264; 0.2%).

Results:

Among AIAN groups, single-race AIANs were most likely to live in rural areas and areas served by the Indian Health Service; Hispanic AIANs were most likely to be Spanish-language-preferring (P’s<0.05). Compared with non-Hispanic Whites, single-race AIANs reported worse experiences with getting needed care (adjusted disparity of −5 points; a “large” difference), getting care quickly (−4 points; a “medium” difference), doctor communication (−2 points; a “small” difference), care coordination (−2 points), and customer service (−7 points; P<0.001 for all comparisons). Disparities were similar for Hispanic AIANs but more limited for multiple-race AIANs.

Conclusions:

Quality improvement efforts are needed to reduce disparities faced by older AIANs. These findings may assist in developing targeted efforts to address cultural, communication, and health system factors presumed to underlie disparities in health care access and customer service.
Racial and Citizenship Disparities in Health Care Among Middle Eastern Americans
Authors: Samari Goleen , Sharif Mienah Z. , Alcalá Héctor E.
Published: September 2020

Objective:

To assess differences in health access and utilization among Middle Eastern American adults by White racial identity and citizenship.

Methods:

Data from the 2011 to 2018 National Health Interview Surveys (N=1013) and survey-weighted logistic regression analyses compare Middle Eastern immigrants by race and citizenship on access and utilization of health care in the United States.

Results:

White respondents had 71% lower odds of delaying care [adjusted odds ratio (AOR)=0.34; 95% confidence interval (CI)=0.13, 0.71] and 84% lower odds of being rejected by a doctor as a new patient (AOR=0.16; 95% CI=0.03, 0.88) compared to non-White respondents. US citizens had higher odds of visiting the doctor in the past 12 months compared with noncitizens (AOR=1.76; 95% CI=1.25, 2.76).

Conclusion:

Middle Eastern immigrants who do not identify as White and who are not US citizens are significantly less likely to access and utilize health care compared with those who identify as White and are US citizens.

Policy Implications:

This study shows that racial and citizenship disparities persist among Middle Eastern Americans at a national-level, playing a critical role in access to and use of health care.
Palliative Care Knowledge and Characteristics in Caregivers of Chronically Ill Children
Authors: Johnston Emily E. , Currie Erin R. , Chen Yanjun , Kent Erin E. , Ornstein Katherine A. , Bhatia Smita , Dionne-Odom J. Nicholas , Rosenberg Abby R.
Published: September 2020

There is a growing population of children with complex chronic conditions (CCCs) whose caregivers would benefit from palliative care (PC). However, little is known about caregivers' PC awareness. We aimed to describe PC awareness among caregivers of children with CCCs and identify factors associated with lack of PC awareness. We used the National Cancer Institute's national Health Information National Trends Survey 2018 data to determine the percentage of caregivers of ill children who have PC awareness. After matching, caregiver PC awareness was compared with that of (1) the general survey population, (2) other caregivers, and (3) caregivers not caring for children. We used multivariable regression to determine factors associated with lack of PC awareness. Of 131 caregivers, 60% had “never heard of” PC. Caregivers of children were no more likely to have heard of PC than the general survey population (P = .76), noncaregivers (P = .97), or caregivers of nonchildren (P = .13). Caregivers younger than 40 years and without a college degree were less likely to have PC awareness than their peers. Most caregivers of ill children have no PC awareness, with no more PC awareness than the general population. Nurses caring for children with CCCs can help educate families and other health care team members about PC.
Timing of Fluid Overload and Association With Patient Outcome
Authors: Lima Lisa , Menon Shina , Goldstein Stuart L. , Basu Rajit K.
Published: September 2020

Objectives:

To determine if the timing of excess fluid accumulation (fluid overload) is associated with adverse patient outcomes.

Design:

Secondary analysis of a prospectively collected dataset.

Setting:

PICU of a tertiary care hospital.

Patients:

Children 3 months to 25 years old admitted to the PICU with expected length of stay greater than or equal to 48 hours.

Interventions:

Patients were dichotomized by time of peak overload: peak fluid overload from ICU admission (Day0) to 48 hours (Day3–7) and peak fluid overload value after 48 hours of ICU admission, as well as time of first-time negative daily fluid balance: net fluid out greater than net fluid in for that 24-hour period.

Measurements and Main Results:

There were 177 patients who met inclusion criteria, 92 (52%) male, with an overall mortality rate of 7% (n = 12). There were no differences in severity of illness scores or fluid overload on Day0 between peak fluid overload from ICU admission (Day0) to 48 hours (Day3–7) (n = 97; 55%) and peak fluid overload value after 48 hours of ICU admission (n = 80; 45%) groups. Peak fluid overload value after 48 hours of ICU admission was associated with a longer median ICU course (8 [4–15] vs 4 d [3–8 d]; p ≤ 0.001], hospital length of stay (18 [10–38) vs 12 [8–24]; p = 0.01], and increased risk of mortality (n = 10 [13%] vs 2 [2%]; χ2 = 7.6; p = 0.006]. ICU length of stay was also longer in the peak fluid overload value after 48 hours of ICU admission group when only patients with at least 7 days of ICU stay were analyzed (p = 0.02). Timing of negative fluid balance was also correlated with outcome. Compared with Day0–2, a negative daily fluid balance on Day3–7 was associated with increased length of mechanical ventilation (3 [1–7] vs 1 d [2–10 d]; p ≤ 0.001) and increased hospital (17 [10–35] vs 11 d [7–26 d]; p = 0.006) and ICU (7 [4–13] vs 4 d [3–7 d]; p ≤ 0.001) length of stay compared with a negative fluid balance between Day0–2.

Conclusions:

Our results show timing of fluid accumulation not just peak percentage accumulated is associated with patient outcome. Further exploration of the association between time and fluid accumulation is warranted.