bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation Between Electroencephalography and Automated Pupillometry in Critically Ill Patients: A Pilot Study
Authors: Hasan Sania , Peluso Lorenzo , Ferlini Lorenzo , Legros Benjamin , Calabrò Lorenzo , Oddo Mauro , Creteur Jacques , Vincent Jean-Louis , Gaspard Nicolas , Taccone Fabio S.
Published: July 2019

Background:

Electroencephalography (EEG) is widely used in the monitoring of critically ill comatose patients, but its interpretation is not straightforward. The aim of this study was to evaluate whether there is a correlation between EEG background pattern/reactivity to stimuli and automated pupillometry in critically ill patients.

Methods:

Prospective assessment of pupillary changes to light stimulation was obtained using an automated pupillometry (NeuroLight Algiscan, ID-MED, Marseille, France) in 60 adult patients monitored with continuous EEG. The degree of encephalopathy and EEG reactivity were scored by 3 independent neurophysiologists blinded to the patient’s history. The median values of baseline pupil size, pupillary constriction, constriction velocity, and latency were collected for both eyes. To assess sensitivity and specificity, we calculated areas under the receiver-operating characteristic curve.

Results:

The degree of encephalopathy assessed by EEG was categorized as mild (42%), moderate (37%), severe (10%) or suppression-burst/suppression (12%); a total of 47/60 EEG recordings were classified as “reactive.” There was a significant difference in pupillary size, constriction rate, and constriction velocity, but not latency, among the different EEG categories of encephalopathy. Similarly, reactive EEG tracings were associated with greater pupil size, pupillary constriction rate, and constriction velocity compared with nonreactive recordings; there were no significant differences in latency. Pupillary constriction rate values had an area under the curve of 0.83 to predict the presence of severe encephalopathy or suppression-burst/suppression, with a pupillary constriction rate of < 20% having a sensitivity of 85% and a specificity of 79%.

Conclusions:

Automated pupillometry can contribute to the assessment of cerebral dysfunction in critically ill patients.
Sagittal Plane Considerations During Long Cephalomedullary Nailing: Optimal Distal Positioning and the Role of Intraoperative Nail Bending
Authors: Georgiadis Gregory M. , Stein Cory M. , Bair Jeffrey M. , Tank Jason C. , Georgiadis Andrew G. , Redfern Roberta E.
Published: July 2019

Objective:

To retrospectively review a large population of long cephalomedullary nails with special attention to distal implant position in the sagittal plane and assess the ability to avoid anterior cortical contact (ACC) by bending the distal tip of the nail intraoperatively.

Design:

Retrospective review of single surgeon experience.

Setting:

Single Level 1 trauma center.

Outcomes:

Radiographic position of the cephalomedullary nail with respect to the anterior femoral cortex and the effects of intraoperative bending of the distal tip of the nail.

Patients:

A total of 215 patients who underwent long cephalomedullary nailing for peritrochanteric hip fractures between 2007 and 2017 were reviewed.

Results:

In the period between 2007 and October 2013, ACC of the distal portion of the nail in the sagittal plane was a common finding. Its incidence significantly decreased after intraoperative bending of long cephalomedullary nails was incorporated into practice in cases where sagittal plane impingement was detected (P< 0.0001). ACC was more prevalent if the final nail position was proximal to the level of the patella.

Conclusion:

Careful attention should be paid to sagittal plane anatomy and distal ACC during insertion of a long cephalomedullary nail. One strategy to prevent anterior impingement or perforation may be intraoperative bending of the distal end of the nail.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Passive Mechanical Properties of Muscles and Tendons in Children Affected by Osgood-Schlatter Disease
Authors: Enomoto Shota , Tsushima Aiko , Oda Toshiaki , Kaga Masaru
Published: July 2019

Background:

Osgood-Schlatter disease (OSD) is a sports-related disorder involving apophysitis, which affects the tibial tuberosity. The identification of factors related to OSD is important for its prevention and early recovery from the disease. This study aimed to compare the passive mechanical properties of the muscle-tendon unit in children affected by an OSD and healthy children, by using ultrasound real-time tissue elastography.

Methods:

Eighteen legs affected by OSD (OSD group) and 42 healthy legs (control: CON group) were assessed. The elasticity was obtained from the quadriceps muscles and patella tendon (PT) using real-time tissue elastography. The strain ratio (SR; muscle or tendon/reference ratio: strain rate of the muscle or tendon divided by that of the reference material) was calculated as an indicator of the elasticity of the tissue of interest.

Results:

The SR of the PT in the OSD group was significantly lower than that in the CON group (P<0.05). We found no significant difference between the groups in terms of the SR value of all muscles (P>0.05).

Conclusions:

The results suggest that a PT with a lower SR may be associated with an OSD and that the passive mechanical properties of the quadriceps muscles have limited association with an OSD.

Levels of Evidence:

Level IV.
Inpatient Pain Scores and Narcotic Utilization Based on American Society of Anesthesiologists Score Following Anterior Cervical Discectomy and Fusion
Authors: Yoo Joon S. , Brundage Thomas S. , Hrynewycz Nadia M. , Singh Kern
Published: July 2019

Study Design.

Retrospective.

Objective.

To examine the relationship between American Society of Anesthesiologists (ASA) score and inpatient pain and narcotics consumption following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Higher ASA scores have been previously linked to increased postoperative complication rates, healthcare costs, length of stay, and hospital readmissions. However, to our knowledge, there have not been previous investigations into the association between ASA scores and postoperative inpatient pain and narcotics utilization following ACDF.

Methods.

Patients who underwent a single-level, primary ACDF were retrospectively reviewed and stratified into two cohorts based on ASA score less than or equal to 2 or ASA score more than 2. ASA score was tested for association with demographic variables and perioperative characteristics using student's t test, chi-squared analysis, and Fisher exact test. Inpatient pain scores and narcotics consumption on each postoperative day were then compared between cohorts using bivariate linear regression.

Results.

Two hundred eleven patients who underwent ACDF were included: 184 had an ASA score less than or equal to 2 and 27 had an ASA score more than 2. Higher ASA score was associated with older age, higher comorbidity burden as measured by the modified Charlson Comorbidity Index (CCI), and lower prevalence of obesity. Higher ASA scores were associated with longer duration of hospital stay, while other perioperative characteristics were similar between ASA score cohorts. There were no differences in inpatient Visual Analog Scale (VAS) pain scores, or hourly, daily, and cumulative inpatient narcotic consumption between cohorts on any postoperative day.

Conclusion.

This retrospective investigation demonstrated that a higher ASA score is associated with increased operative time following ACDF. However, ASA score was determined not to be an independent risk factor that can predict postoperative pain or narcotics consumption among patients who undergo ACDF. Therefore, postoperative pain in the inpatient setting can be managed with similar modalities regardless of ASA score for patients undergoing ACDF.

Level of Evidence: 3
Efficacy and Safety of Atlantoaxial Fluoroscopy-guided Pedicle Screw Fixation in Patients Younger Than 12 Years
Authors: Zhang Yue-Hui , Zhou Fu-Chao , Zhang Jing , Song Jia , Shao Jiang
Published: July 2019

Study Design.

A retrospective clinical study.

Objective.

The aim of this study was to evaluate the efficacy and safety of fluoroscopy-guided atlantoaxial pedicle screw fixation in patients younger than 12 years.

Summary of Background Data.

C1–C2 pedicle screw fixation is a widely accepted treatment method for atlantoaxial dislocation (AAD). However, data regarding its use for atlantoaxial fusion (AAF) in children are limited.

Methods.

Thirty-six consecutive patients younger than 12 years underwent C1–C2 pedicle screw fixation for AAD between 2007 and 2017. Anatomical parameters of the C1 pedicle were measured on preoperative computed tomography (CT). Accuracy of pedicle screw fixation was assessed on postoperative CT using the following definitions: Type I, screw threads completely within the bone; Type II, less than half the diameter of the screw violating the surrounding cortex; and Type III, clear violation of the transverse foramen or spinal canal. Demographic, surgical, radiation dose, and clinical data were recorded.

Results.

Patients underwent 144 screw fixations (67 C1 pedicle screws, 68 C2 pedicle screws, 5 C1 lateral mass screws, and 4 C-2 laminar screws) for a variety of pediatric AADs, with 36.5 ± 8.5 months of follow-up. Among the 135 pedicle screws, 96.3% were deemed “safe” (Type I or II) and 80.7% (109/135) of the screws were rated as being ideal (Type I); five screws (3.7%) were identified as unacceptable (Type III). Average estimated blood loss (EBL) was 92 mL, and the average total radiation exposure during the operation was 6.2 mGy (in the final 26 cases). There were no neurovascular injuries. All patients showed radiographic stability and symptom resolution.

Conclusion.

C1–C2 pedicle screw fixation under fluoroscopy is safe and effective for the treatment of AAD in children younger than 12 years. However, it may be technically challenging owing to the special anatomical features of children and should be performed by experienced surgeons.

Level of Evidence: 3
Use of Cell Cycle Arrest Biomarkers in Conjunction With Classical Markers of Acute Kidney Injury
Authors: Joannidis Michael , Forni Lui G. , Haase Michael , Koyner Jay , Shi Jing , Kashani Kianoush , Chawla Lakhmir S. , Kellum John A.
Published: July 2019

Objectives:

Decreased urine output and/or increased serum creatinine may herald the development of acute kidney injury or reflect normal physiology. In this secondary analysis of the Sapphire study, we examined biomarkers of cell cycle arrest in the settings of oliguria and/or azotemia to improve risk assessment when used with conventional indices in predicting severe acute kidney injury (Kidney Disease: Improving Global Outcomes 3 defined by the need for renal replacement therapy or changes in urine output, serum creatinine or both) or death.

Design:

Prospective, international, Sapphire study.

Setting:

Academic Medical Center.

Patients:

Patients without acute kidney injury Kidney Disease: Improving Global Outcomes stage 2 or 3.

Interventions:

None.

Measurements and Main Results:

The primary endpoint being development of severe acute kidney injury or death within 1 week. Secondary analysis examined the relationship between tissue inhibitor of metalloproteinases-2 ([TIMP-2]) and insulin growth factor binding protein 7 ([IGFBP7]) and 9-month death or dialysis conditioned on progression to stage 2–3 acute kidney injury within 1 week. Seventy-nine patients reached the primary endpoint and were more likely to be surgical, with higher nonrenal Acute Physiology and Chronic Health Evaluation III scores and more chronic kidney disease. Stage 1 urine output, serum creatinine, and urinary [TIMP-2]•[IGFBP7] greater than 2.0 were all predictive of progression to the primary endpoint independent from nonrenal Acute Physiology and Chronic Health Evaluation III score. Combinations of predictors increased the hazard ratios considerably (from 2.17 to 4.14 to 10.05, respectively). In the presence of acute kidney injury (stage 1), [TIMP-2]•[IGFBP7] greater than 2.0 leads to an increased risk of death or dialysis at 9 months even in the absence of progression of acute kidney injury (stage 2–3) within 7 days.

Conclusions:

Cell cycle arrest biomarkers, TIMP-2 and IGFBP7, improve risk stratification for severe outcomes in patients with stage 1 acute kidney injury by urine output, serum creatinine or both, with risk increasing with each acute kidney injury indicator. Longer term outcomes demonstrate that the associated risks of a [TIMP-2]•[IGFBP7] greater than 2.0 is equivalent to acute kidney injury progression even where no progression from stage 1 acute kidney injury is observed.
Exploring the long noncoding RNAs-based biomarkers and pathogenesis of malignant transformation from dysplasia to oral squamous cell carcinoma by bioinformatics method
Authors: Jia Hongcheng , Wang Xuan , Sun Zheng
Published: July 2019

Long noncoding RNAs (lncRNAs) play an important role in many biological processes and carcinogenesis. We aimed to explore lncRNA-based pathogenesis, diagnostic biomarkers, and predictive factors of malignant transformation from dysplasia to oral squamous cell carcinoma (OSCC). Microarray data of GSE30784 consisting of 167 OSCC, 17 dysplasia, and 45 normal oral tissues were downloaded from the GEO database. The differentially expressed genes (DEGs) and lncRNAs between the three samples were identified using R, followed by lncRNA-mRNA coexpression and coregulation network analysis for the prediction of lncRNA target genes. Gene Ontology and Kyoto encydopedia of gene and genomes pathway analysis were performed to further characterize potential interactions. A total of 4462 DEGs and 76 differentially expressed lncRNAs were screened between the three groups, and 200 DEGs and only double homeobox A pseudogene 10 (DUXAP10) were screened among the three groups. A total of 1662 interactions of 46 lncRNAs and their coexpressed target genes were predicted, and 38 pairs of lncRNA-lncRNA coregulated 843 target genes. The coregulated target genes significantly enriched in antigen adaptive immune response, activation of phagocytosis receptor signaling, mast granule NF-κB inflammation, etc. Overall, lncRNAs were differentially expressed in OSCC and dysplasia. The target genes might play an important role in the carcinogenesis and development of OSCC. These results improve our understanding regarding the lncRNA-based pathogenesis and identify some potential targets for early diagnosis of malignant transformation from dysplasia to OSCC.
Efficacy and Safety of 3 New Resilient Hyaluronic Acid Fillers, Crosslinked With Decreased BDDE, for the Treatment of Dynamic Wrinkles: Results of an 18-Month, Randomized Controlled Trial Versus Already Available Comparators
Authors: Rzany Berthold , Converset-Viethel Sophie , Hartmann Melanie , Larrouy Jean-Claude , Ribé Natalia , Sito Giuseppe , Noize-Pin Carole
Published: July 2019

BACKGROUND

Three new hyaluronic acid (HA)-based fillers made of long chains crosslinked with reduced amounts of 1,4-butanediol diglycidyl ether (BDDE) were developed for the treatment of dynamic facial areas. Their resilience and increased stretching ability were optimized to ease injectors' practice and provide patients with most natural aesthetic results.

OBJECTIVE

This study aimed at evaluating the efficacy, durability, and safety of these resilient HA fillers versus commercially available comparator gels.

METHODS

A prospective, monocentric, split-face, double-blinded, randomized, controlled trial was performed on 90 subjects presenting moderate to severe bilateral nasolabial folds (NLFs). Efficacy parameters were assessed over 18 months, including improvement on the Wrinkle Severity Rating Scale and Global Aesthetic Improvement Scale, as well as quantitative imaging and analysis of NLF correction. Physicians' and subjects' satisfaction, together with safety, were assessed throughout the study.

RESULTS

The new HA fillers offered efficacy and safety profiles at least equivalent to comparators. These dynamic facial fillers elicited higher satisfaction immediately after injection but also on the long run, according to both investigators and subjects.

CONCLUSION

This pilot trial demonstrated the numerous benefits of 3 new resilient HA fillers with decreased BDDE crosslinking in the treatment of dynamic wrinkles.
Exercise Training in Adults With Congenital Heart Disease
Authors: Li Xin , Chen Nan , Zhou Xuan , Yang Yuqi , Chen Sun , Song Yuanyuan , Sun Kun , Du Qing
Published: July 2019

Background:

Evidence from many studies demonstrates that regular exercise has a favorable effect on cardiovascular disease, but it is still unclear whether adults with congenital heart disease (ACHD) benefit from exercise training. The aim of this study was to assess the effects of exercise training on ACHD.

Methods:

PubMed, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched. Differences were expressed using mean difference (MD) with 95% CI. The statistical analysis was performed using Review Manager (RevMan 5.3). Outcomes, including cardiorespiratory fitness, neurohumoral activation (NT-proBNP levels), rating of perceived exertion (Borg scale), and safety status, were investigated.

Results:

Nine trials with 403 ACHD were included. The following outcomes were statistically significant: peak

JOURNAL/jcprh/04.03/01273116-201909000-00004/4FSM1/v/2023-09-11T074719Z/r/image-gif

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2 (MD = 1.96, 95% CI, 0.70-3.23; P = .002); maximal workload (MD = 11.46, 95% CI, 7.06-15.87; P < .00001); and maximal exercise duration (MD = 2.04, 95% CI, 1.00-3.07; P = .0001). But no significant decrease was reported regarding neurohumoral activation or the rating of perceived exertion. Furthermore, no major adverse events were reported. The overall quality of evidence ranged from moderate to very low.

Conclusions:

Evidence was underpowered to suggest that exercise training is effective in the management of ACHD. Future studies with longer follow-up are needed.
Effects of Different Rehabilitation Protocols in Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery
Authors: Zanini Maurice , Nery Rosane Maria , de Lima Juliana Beust , Buhler Raquel Petry , da Silveira Anderson Donelli , Stein Ricardo
Published: July 2019

Purpose:

Patients undergoing coronary artery bypass graft (CABG) surgery typically experience loss of cardiopulmonary capacity in the post-operative period. The purpose of this study was to evaluate the effects of different rehabilitation protocols used in inpatient cardiac rehabilitation on functional capacity and pulmonary function in patient status post-CABG surgery.

Methods:

This was a single-blind randomized controlled trial. The primary endpoint of functional capacity and secondary endpoints of lung capacity and respiratory muscle function were assessed in patients scheduled to undergo CABG. After surgery, 40 patients were randomly assigned across 1 of 4 inpatient cardiac rehabilitation groups: G1, inspiratory muscle training, active upper limb and lower limb exercise training, and early ambulation; G2, same protocol as G1 without inspiratory muscle training; G3, inspiratory muscle training alone; and G4, control. All groups received chest physical therapy and expiratory positive airway pressure. Patients were reassessed on post-operative day 6 and post-discharge day 30 (including cardiopulmonary exercise testing).

Results:

The 6-min walk distance on post-operative day 6 was significantly higher in groups that included exercise training (G1 and G2), remaining higher at 30 d post-discharge (P < .001 between groups). Peak oxygen uptake on day 30 was also higher in G1 and G2 (P = .005). All groups achieved similar recovery of lung function.

Conclusion:

Protocols G1 and G2, which included a systematic plan for early ambulation and upper and lower limb exercise, attenuated fitness losses while in the hospital and significantly enhanced recovery 1 mo after CABG.
Wearable Cardioverter Defibrillator–Guided 6-Min Walk Test Performed at Home Is Accurate and Reliable
Authors: Burch Ashley E. , Scherr Daniel , Rieth Andreas , Griffin John , Bianco Nicole R. , Odeneg Tanja , Sears Samuel F.
Published: July 2019

Purpose:

The 6-min walk test (6MWT) is broadly used to evaluate the functional ability of patients with heart failure (HF). The purpose of this study was to evaluate the accuracy and reliability of the wearable cardioverter defibrillator (WCD)–guided 6MWT performed at home by patients with HF versus in-clinic testing.

Methods:

Patients (n = 197) with HF and a low ejection fraction prescribed a WCD were randomized to 2 groups. Group 1 completed an in-clinic clinician-guided 6MWT while wearing the WCD; results were recorded by the clinician. Group 2 completed a WCD-guided 6MWT, also performed in the clinic; results were recorded by the WCD accelerometer. Both groups performed weekly unsupervised WCD-guided 6MWTs at home, with results recorded by the WCD.

Results:

The initial in-clinic 6MWT showed no significant group difference in distance walked (group 1 = 306 m; group 2 = 297 m). For patients in group 2 who completed at least one 6MWT at home, there was a 15-step decrease between the in-clinic WCD-guided 6MWT and the first at-home 6MWT, 558 and 543 median steps (P = .001), respectively. Among patients with at least 8 weekly home WCD-guided 6MWTs (n = 70), there was no significant difference in the number of steps walked during the 6MWT from week to week.

Conclusions:

Results of the in-clinic 6MWT are similar between clinician-guided and WCD-guided patients across objective distances. Distances walked with a WCD-guided walk test were consistent whether conducted in the clinic or at home and were reliable over time.
PERSISTENT PLACOID MACULOPATHY-LIKE FINDINGS IN PATIENTS WITH GIANT CELL ARTERITIS
Authors: Starr Matthew R. , Fairbanks Aaron M. , Geraets Ryan , Chen John , Pulido Jose S.
Published: July 2019

Purpose:

To describe two patients with giant cell arteritis who presented with macular lesions mimicking persistent placoid maculopathy.

Methods:

Retrospective case reports.

Patient:

Two patients, a 74-year-old man and an 85-year-old woman both were diagnosed with biopsy-confirmed giant cell arteritis with vision loss in one eye due to arteritic ischemic optic neuropathy. Both presented many years later with acute vision loss in the remaining eye.

Results:

Both patients had bilateral retinal whitening in the parafovea, and the second also had sectoral optic disk swelling. On fluorescein angiography, these areas of retinal whitening in both patients were hypofluorescent early with late hyperfluorescence staining. On indocyanine green angiography, there were areas of foveal hypocyanescence bilaterally in both patients that persisted throughout the imaging and were more apparent late. These findings can be seen in patients with bilateral persistent placoid maculopathy.

Conclusion:

Giant cell arteritis should be included in the differential diagnosis of persistent placoid maculopathy.
Unusual Case of Concurrent Retroperitoneal Congenital Infantile Fibrosarcoma and Cellular Type Congenital Mesoblastic Nephroma
Authors: Monsereenusorn Chalinee , Supakul Nucharin , Satayasoontorn Kantang , Traivaree Chanchai , Rujkijyanont Piya
Published: July 2019

Background:

Although congenital infantile fibrosarcoma (cIFS) is a rare soft tissue sarcoma among children, it constitutes one of the most common soft tissue sarcomas during the first year of life. Congenital mesoblastic nephroma (CMN) is the most common benign renal tumor usually developing during the first 3 months of life. cIFS and cellular type CMN (cCMN) share not only similar histopathologic features but identical molecular genetic abnormality including the ETV6/NTRK3 fusion gene. Here, we report an unusual case of cIFS occurring with cCMN.

Case Presentation:

An 18-month-old girl presented with a 1-month history of abdominal distension and a few days’ history of a palpable abdominal mass. A large heterogenous mass sized 9.0×11.2×11.6 cm on the right side of the abdomen and an isolated heterogenous lesion sized 4×4.5 cm within the right kidney were noted from the imaging study. Pathologic findings were consistent with cIFS and cCMN of the right kidney. In addition, both pathologic specimens contained the ETV6/NTRK3 fusion gene.

Conclusion:

Although cIFS and cCMN share similar histopathologic features and molecular genetic abnormality, simultaneous occurrence of these 2 types of tumor is exceedingly rare. To our knowledge, this is the first unusual case report of concurrent cIFS and cCMN.
Inv(11)(q21q23); KMT2A-MAML2, a Recurrent Genetic Abnormality in T-Cell Therapy–related Acute Lymphoblastic Leukemia
Authors: Mariani Rachel A. , Silva Mercedes , Caparelli Edward , Jennings Lawrence J. , Yap Kai Lee , Leuer Katrin M. , Weinstein Joanna , Gong Shunyou
Published: July 2019

T-cell therapy–related acute lymphoblastic leukemia (T-t-ALL) is a rare condition associated with previous cytotoxic therapy for another disease. Here we report T-t-ALL with inv(11)(q21q23), which involves KMT2A and MAML2, a transcriptional coactivator of NOTCH proteins, that occurred after chemotherapy for Philadelphia chromosome–positive B-cell acute lymphoblastic leukemia. This case describes the youngest patient with T-t-ALL harboring inv(11)(q21q23) and is the first independent report following an initial series also occurring in children. Our results lend further support to the observation that the KMT2A-MAML2 fusion gene resulting from inv(11)(q21q23) is likely a recurrent cytogenetic abnormality in T-t-ALL and appears to be associated with pediatric cases.
Primary Prevention to Maintain Cognition and Prevent Acute Delirium Following Orthopaedic Surgery
Authors: Holly Cheryl
Published: July 2019

Cognitive impairment is a recognized predictor of acute delirium, particularly in the postoperative period. Estimates of up to 24% of patients experiencing delirium and its associated cognitive impairment during any orthopaedic procedure have been reported, with higher rates for those patients undergoing hip fracture repair. Primary prevention is the most effective strategy to maintain cognition and prevent delirium. The purpose of this article is to provide evidence-based recommendations to prevent acute delirium using bundles of care. Bundles of care are a set of 3–5 independent, evidence-based interventions that, when implemented together, result in significantly better outcomes than when implemented individually. The bundle consists of ongoing assessment of cognition, continuing orientation, and early mobilization and socialization.
Another Step Toward Clarifying the Benefits and Burdens of Selective Serotonin Reuptake Inhibitors
Authors: Wulsin Lawson R.
Published: July 2019

Selective serotonin reuptake inhibitors (SSRIs) have substantial beneficial effects for the treatment of major depressive mood disorders and other conditions but can also result in unwanted clinical outcomes. One of the reported disadvantages of SSRIs, based on cross-sectional studies, is their adverse effects on glycemic control. However, in this issue of Psychosomatic Medicine, Tharmaraja et al. report a meta-analysis of 16 randomized controlled trials, demonstrating beneficial effects of SSRIs on changes in glycemia. In this editorial, the advantages of meta-analysis in biobehavioral medicine are highlighted as well as the importance of the study designs (observational studies versus randomized controlled trials) on which the meta-analyses are based. This article concludes with an outline for future research directions in the area of SSRIs and glycemic control.
Normal Lacrimal Gland Volumes by Magnetic Resonance Imaging and the Relationship of Lacrimal Gland Volume to Orbital Size
Authors: Tenzel Phillip A. , Moffa Diana , Decilveo Alexander P. , Reddy Harsha S.
Published: July 2019

Purpose:

The aim of this study was to measure volumes of normal lacrimal glands (LGs) using magnetic resonance imaging in African-Americans (AAs) and whites and to evaluate relationships of LG volumes to demographic factors.

Methods:

A retrospective chart review was performed searching for “optic neuropathy” and “optic neuritis,” cross-referencing patients who had orbital MRI with and without contrast. Cases were excluded with known history of orbital trauma or surgery, previous diagnoses known to affect LG size, and poor image quality. LGs were outlined in consecutive axial and coronal slices, and volumes were generated using OsiriX software; cross-sectional area of the orbit was measured by outlining the bony orbit in largest axial section.

Results:

One hundred orbits from 50 patients were included (26 AAs, 24 whites). Mean LG volumes as measured in coronal and axial section were 0.714 and 0.671 cm3, respectively; mean orbital area was 10.42 cm2. Axial orbital size was found to be highly correlated (P < 0.01) with LG volume. No significant correlation was found with LG volume and age, sex, race, or laterality.

Conclusions:

This article presents normal values for LG volumes by MRI of AAs and whites. LG volumes were highly correlated with orbital size, a relationship which has not been explored in the recent literature.1–4 Such an assessment of LG size relative to patients’ orbital dimensions may be more clinically useful than comparison to population-based measures of normal LG volume alone. We found no statistically significant relationship between LG volume and race, sex, age, or laterality.
Incidence of Pneumothorax Experienced After Orthognathic Surgery
Authors: Liu Kai , Zhang Tianjia , Wang Shuze , Zhang Lei , Wang Xudong
Published: July 2019

The purpose of this study is to evaluate the frequency of pneumothorax following orthognathic surgery and describe its clinical presentation. A retrospective analysis of a hospital database was carried out on consecutive patients with normal presurgical clinical assessment, laboratory findings, and chest X-ray who underwent orthognathic surgery from January 2007 to September 2018 in the Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Two patients (0.038%), 1 male (age 20 years) and 1 female (age 32 years), complained of respiratory difficulty and chest pain and were clearly diagnosed with postoperative pneumothorax by radiographic chest X-rays from a sample of 5229 consecutive patients during the study period. Intercostal drainage under local anesthesia was performed immediately and the treatment effects for both patients were satisfactory. The present study findings indicate that although orthognathic surgeries can be safely performed in patients with craniofacial anomalies, some unexpected complications such as pneumothorax may occur. Therefore, accurate postoperative follow-up must be done in every patient to monitor possible clinical complications. Patients who experience respiratory difficulty and postoperative chest pain may have pneumothorax, and once it is diagnosed, treatment should be promptly carried out to eliminate further severe sequelae.
Use of Stock Titanium Mesh Plates in Cranioplasty
Authors: Madaree Anil , Moyeni Nondabula , Le Roux Petrus Andries Jacobus , Pillay Trishan
Published: July 2019

Craniofacial surgeons are often confronted with major defects of the calvarium. These most commonly are post-traumatic but could also be consequent upon neurosurgical procedures, infection, or tumor removal. There are several options available to reconstruct these defects including autogenous, heterogeneous, and alloplastic material. The goal is to have a method that is easy, cost-effective, with minimal complications, and long-lasting. In our unit we review 100 cases of the use of stock titanium mesh during a 5-year period. Complications occurred in 5 patients (5%) with 3 exposures, 1 late seroma and 1 case requiring repositioning of the plate following trauma. None of the patients required removal of the plate.
Critical call for hospital-based domestic violence intervention: The Davis Challenge
Authors: Aboutanos Michel B. , Altonen Maria , Vincent Amy , Broering Beth , Maher Kathryn , Thomson Nicholas D.
Published: July 2019

BACKGROUND

Fifty percent of women killed in intimate partner violence (IPV) were seen by a health care provider within a year of their death. As guest speaker to Virginia Commonwealth University Trauma Center (VCU-TC), Dr. James Davis (Western Trauma Association past president) challenged VCU-TC to develop a hospital-based IPV program. This research examines the development and impact of an integrated hospital/VCU-TC-based IPV program.

METHODS

The IPV survey was carried out to determine need for training and screening. Hospital forensic nurse examiners case logs were evaluated to determine IPV prevalence. An integrated IPV program—Project Empower was developed, consisting of staff education, patient screening, victim crisis fund, and interdisciplinary sexual assault/domestic violence intervention team. Between 2014 and 2018, patients admitted with an IPV consult to Project Empower were entered into a secure database capturing demographics, mechanisms, income data, and social determinants of risk. Program feasibility was evaluated on patient engagement via screening and case management. Program impact was evaluated on crisis intervention, safety planning, and community referral.

RESULTS

Forensic nurse examiner data and IPV survey evaluation noted 20% IPV prevalence and lack of IPV screening and training. The IPV patients (N = 799) were women (90%), unmarried (79%) and African-American (60%). Primary mechanisms were firearm (44%) or stabbing (34%). Survivors were perpetrated by a cohabiting (42%) or dating partner (18%). Monthly income averaged US $622. Forty percent had no health insurance. Advocates provided 62% case management. Survivors received victim crisis funds (16%), safety planning (68%), crisis intervention (78%), sexual and domestic violence education (83%), and community referral (83%). Within 5 years, 35 (4%) were reinjured and seen in the emergency department. Thirty-one (4%) were readmitted for IPV-related injuries. Two deaths were attributed to IPV.

CONCLUSION

Critical call for hospital-based IPV intervention programs as a priority for trauma centers to adopt cannot be underestimated but can be answered in a comprehensive integrated model.

LEVEL OF EVIDENCE

Therapeutic, level I.
An Exploration of Falls and Dual Tasking
Authors: Quinn Gillian , Comber Laura , O' Malley Nicola , McGuigan Chris , Galvin Rose , Coote Susan
Published: July 2019

Objective:

To explore the relationship between dual-task cost and falls in people with multiple sclerosis.

Methods:

One hundred participants completed a falls screening questionnaire, Timed Up and Go (TUG), and TUG-Cognitive (TUG-C) at baseline. Dual-task cost was the percentage change in performance between TUG and TUG-C. Falls were recorded prospectively for 3 months.

Results:

Dual-task cost was not associated with increased risk of falls (P = .90, odds ratio = 1.00). Answering yes to a question about problems doing 2 things at once increased likelihood of falls (risk ratio = 2.07).

Conclusion:

A single question asking about dual tasking may be a useful screen for falls risk assessment.
Side-to-Side Variability in Muscle Function With Parkinson Disease
Authors: Stone Emily , Kluger Benzi , Schenkman Margaret , Stevens-Lapsley Jennifer
Published: July 2019

Purpose of this study was to characterize side-to-side differences in quadriceps, hamstrings strength, and quadriceps activation in individuals with Parkinson disease (PD). Participants were individuals with PD (n = 17) with Unified Parkinson's Disease Rating Scale motor scores ranging from 9.5 to 61.0. Paired t tests compared strength and muscle activation between limbs for all individuals. The stronger quadriceps was 15.2% stronger (P < .001) and the stronger hamstring was 12.9% stronger (P = .001). Side-to-side differences in quadriceps activation was 18.9%, but insignificant (P = .072). No pattern explained side-to-side differences. Muscle strength asymmetry is variable, but present across a range of PD disease severity, which emphasizes the importance of a detailed clinical examination.
National Variation in Increased Infectious Risk Kidney Offer Acceptance
Authors: Holscher Courtenay M. , Bowring Mary G. , Haugen Christine E. , Zhou Sheng , Massie Allan B. , Gentry Sommer E. , Segev Dorry L. , Garonzik Wang Jacqueline M.
Published: July 2019

Background.

Despite providing survival benefit, increased risk for infectious disease (IRD) kidney offers are declined at 1.5 times the rate of non-IRD kidneys. Elucidating sources of variation in IRD kidney offer acceptance may highlight opportunities to expand use of these life-saving organs.

Methods.

To explore center-level variation in offer acceptance, we studied 6765 transplanted IRD kidneys offered to 187 transplant centers between 2009 and 2017 using Scientific Registry of Transplant Recipients data. We used multilevel logistic regression to determine characteristics associated with offer acceptance and to calculate the median odds ratio (MOR) of acceptance (higher MOR indicates greater heterogeneity).

Results.

Higher quality kidneys (per 10 units kidney donor profile index; adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.92-0.95), higher yearly volume (per 10 deceased donor kidney transplants; aOR, 1.08, 95% CI, 1.06-1.10), smaller waitlist size (per 100 candidates; aOR, 0.97; 95% CI, 0.95-0.98), and fewer transplant centers in the donor service area (per center; aOR, 0.88; 95% CI, 0.85-0.91) were associated with greater odds of IRD acceptance. Adjusting for donor and center characteristics, we found wide heterogeneity in IRD offer acceptance (MOR, 1.96). In other words, if listed at a center with more aggressive acceptance practices, a candidate could be 2 times more likely to have an IRD kidney offer accepted.

Conclusions.

Wide national variation in IRD kidney offer acceptance limits access to life-saving kidneys for many transplant candidates.
Favorable Outcome of Lung Transplantation for Severe Pulmonary Graft Versus Host Disease: An Australian Multicenter Case Series
Authors: Kliman David S. , Kotecha Sakhee R. , Abelson David C. , Snell Gregory I. , Glanville Allan R. , Ma David D.F.
Published: July 2019

Background.

Severe pulmonary chronic graft versus host disease (GVHD) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation. Few treatments influence outcome, with 5-year overall survival as low as 13%. Lung transplantation (LTx) has been reported in small numbers of patients worldwide.

Methods.

We investigated the outcomes of LTx performed for this indication at 2 large Australian LTx centers.

Results.

Eighteen patients (aged 10–64 y; median, 29.6 y) received bilateral deceased lung transplants for pulmonary chronic GVHD between 2002 and 2017. LTx was performed at a median of 8.6 years after allogeneic stem cell transplantation (range, 2–23 y) with a median interval of 16 months from the time of transplant unit review to LTx. There were 2 early infective deaths and 3 further deaths from pulmonary infection and lung allograft rejection. There were no primary disease relapses. At a median follow-up of 5 years, the 5-year overall survival post-LTx is 80% and comparable to the Australia and New Zealand registry data of 64% for LTx performed for all indications.

Conclusions.

From one of the largest series of deceased LTx for this indication, we conclude that it is a feasible option for selected patients with severe pulmonary GVHD. The outcomes appear superior to that of non–LTx-based therapies and similar to the survival of the general LTx population. Establishing guidance on referral triggers, patient eligibility, organ selection, prophylaxis of allograft rejection, and supportive care would assist hematopoietic and lung transplant units in optimizing resource allocation and patient outcomes.
Practice and Attitudes of Donor Coordinator Roles Regarding Physical Examination of Potential Organ and Tissue Donors in Australia
Authors: Holloway Justine A.C. , Ranse Kristen , Bail Kasia , Jamieson Maggie , Van Haren Frank
Published: July 2019

Background.

Physical examination of potential organ and tissue donors is standard practice to mitigate risks and optimize outcomes for transplant recipients, but the content and process of the examination has not been investigated. The aim of this study was to determine current practice of performing a physical examination on potential organ and tissue donors in Australia.

Methods.

An online cross-sectional survey was circulated to all Australian Donor Coordinators (n = 125).

Results.

There were 75 responses (60% response rate) to the online survey. Respondents perform a mean 10.5 physical examinations per year. Inconsistencies were observed in the approach to the physical examination, inclusive of assessment techniques used to perform the examination such as palpation. Specific staff training and education to perform the examination was reportedly provided to 77% of respondents. There was less variation reported in examination findings classified as higher risk and escalation procedures with the 3 most common findings of injection sites / track marks (86%), suspicious moles (77%), and unexplained scarring (51%), and with 97% seeking a second opinion. Current and previously removed melanomas were the main examination findings that stopped a donation from proceeding, as reported to have occurred by 18 respondents.

Conclusions.

This study has identified variations in current physical examination practice and provided the evidence to pursue practice improvement. The inconsistencies can be partly attributed to discrepancies in training and education of staff and no standardized national guidelines to clearly outline expected practice.
Excellent Contemporary Graft Survival for Adult Liver Retransplantation: An Australian and New Zealand Registry Analysis From 1986 to 2017
Authors: Jeffrey Angus W. , Delriviere Luc , McCaughan Geoff , Crawford Michael , Angus Peter , Jones Robert , Macdonald Graeme A. , Fawcett Jonathan , Wigg Alan , Chen John , Gane Ed , Munn Stephen , Jeffrey Gary P.
Published: July 2019

Background.

Liver retransplantation is technically challenging, and historical outcomes are significantly worse than for first transplantations. This study aimed to assess graft and patient survival in all Australian and New Zealand liver transplantation units.

Methods.

A retrospective cohort analysis was performed using data from the Australia and New Zealand Liver Transplant Registry. Graft and patient survival were analyzed according to era. Cox regression was used to determine recipient, donor, or intraoperative variables associated with outcomes.

Results.

Between 1986 and 2017, Australia and New Zealand performed 4514 adult liver transplants, 302 (6.7%) of which were retransplantations (278 with 2, 22 with 3, 2 with 4). The main causes of graft failure were hepatic artery or portal vein thrombosis (29%), disease recurrence (21%), and graft nonfunction (15%). Patients retransplanted after 2000 had a graft survival of 85% at 1 year, 75% at 5 years, and 64% at 10 years. Patient survival was 89%, 81%, and 74%, respectively. This was higher than retransplantations before 2000 (P < 0.001). Univariate analysis found that increased recipient age (P = 0.001), recipient weight (P = 0.019), and donor age (P = 0.011) were associated with decreased graft survival prior to 2000; however, only increased patient weight was significant after 2000 (P = 0.041). Multivariate analysis found only increased recipient weight (P = 0.042) and donor age (P = 0.025) was significant prior to 2000. There was no difference in survival for second and third retransplants or comparing time to retransplant.

Conclusions.

Australia and New Zealand have excellent survival following liver retransplantation. These contemporary results should be utilized for transplant waitlist methods.
Duration of Antipsychotic Medication Use by Aged Care Facility Residents With Dementia
Authors: Lind Kimberly E. , Raban Magdalena Z. , Georgiou Andrew , Westbrook Johanna I.
Published: July 2019

Introduction:

Guidelines recommend short-term targeted use of antipsychotic medications for behavioral and psychological symptoms of dementia only when other strategies have failed. Antipsychotic prescribing in dementia is common internationally, but data on duration of use are limited. Our objectives were to determine duration, time to initiation, and prevalence of antipsychotic use among people with dementia.

Methods:

This work was a retrospective dynamic cohort study of people aged 65 years or above with dementia in 68 residential aged facilities during the period spanning from 2014 to 2017. Medication administration records were used to identify antipsychotic medication use. Medication outcomes (prevalence, duration, and time to initiation) were estimated using regression. Covariates included comorbidities and sociodemographic and facility characteristics.

Results:

A total of 5825 residents with dementia were identified. The annual prevalence of antipsychotic use ranged from 27.6% to 32.6%. Mean time to initiation after admission was 308.4 days (for female individuals) and 173.2 days (for male individuals). An overall 65% of people who used antipsychotics did so for >3 months even without psychiatric comorbidities; mean durations were 212.74 (95% confidence interval: 170.24, 255.25) days (for female individuals) and 216.10 (95% confidence interval: 165.31, 266.89) days (for male individuals) at median ages.

Discussion:

Antipsychotics are often used longer than recommended. Current guidelines and restrictions may be insufficient to limit antipsychotic medication use. Further efforts are needed to ensure that antipsychotic medications are used as recommended in dementia.
Mimicry-dependent lateralization in the visual inspection of foreign eggs by American robins
Authors: Scharf Hannah M. , Stenstrom Katharine , Dainson Miri , Benson Thomas J. , Fernandez-Juricic Esteban , Hauber Mark E.
Published: July 2019

Brain lateralization, or the specialization of function in the left versus right brain hemispheres, has been found in a variety of lineages in contexts ranging from foraging to social and sexual behaviours, including the recognition of conspecific social partners. Here we studied whether the recognition and rejection of avian brood parasitic eggs, another context for species recognition, may also involve lateralized visual processing. We focused on American robins (
Turdus migratorius
), an egg-rejecter host to occasional brood parasitism by brown-headed cowbirds (
Molothrus ater
) and tested if robins preferentially used one visual hemifield over the other to inspect mimetic versus non-mimetic model eggs. At the population level, robins showed a significantly lateralized absolute eyedness index (EI) when viewing mimetic model eggs, but individuals varied in left versus right visual hemifield preference. By contrast, absolute EI was significantly lower when viewing non-mimetic eggs. We also found that robins with more lateralized eye usage rejected model eggs at higher rates. We suggest that the inspection and recognition of foreign eggs represent a specialized and lateralized context of species recognition in this and perhaps in other egg-rejecter hosts of brood parasites.