bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Related to Frailty in Older Cancer Patients Undergoing Colorectal Surgery
Authors: Tsai Hsing-Fang , Liu Chieh-Yu , Yang Shung-Haur , Chiou Ai-Fu
Published: October 2021

Background

Frailty is common in older cancer patients undergoing colorectal surgery, but few studies have focused on frailty and its associations in this population.

Objective

The aim of this study was to investigate the prevalence of frailty and its associations in older cancer patients undergoing colorectal surgery.

Methods

A convenience sample of 88 cancer patients 60 years or older undergoing colorectal surgery was recruited from 1 medical center. Frailty, physical activity, functional status, anxiety, depression, and social support of the patients were assessed before surgery, at discharge post surgery, and at 1 month post surgery.

Results

The prevalence of frailty in cancer patients undergoing colorectal surgery was 22.7% before surgery, decreased to 19.3% before discharge, and was 12.7% at 1 month after surgery. The proportion of prefrail patients significantly increased from 47.7% before surgery to 71.1% before discharge and was 64.6% at 1 month after surgery. Frail patients were more likely to be older and unmarried, have a lower albumin level, have lower physical activity, and be more dependent on others than nonfrail patients.

Conclusion

Older cancer patients undergoing colorectal surgery were more likely to be prefrail after surgery than before surgery. Assessment of frailty and its associated factors is necessary for older cancer patients undergoing colorectal surgery before and after surgery.

Implications for Practice

Frailty may occur in cancer patients after colorectal surgery and is related to malnutrition and low physical activity. Appropriate discharge planning with physical activity tracking and an appropriate diet is encouraged to prevent frailty in cancer patients after colorectal surgery.
Severe Reflux and Symptoms of Anxiety and Depression After Esophageal Cancer Surgery
Authors: Lagergren Pernilla , Johar Asif , Liu Yangjun , Ness-Jensen Eivind , Schandl Anna
Published: October 2021

Background

Approximately 30% of patients suffer from severe reflux after surgery for esophageal cancer, which may serve as a continuous reminder of the cancer and catalyze fear of recurrence.

Objective

The aim of this study was to investigate the association between severe reflux and symptoms of anxiety and depression after esophageal cancer surgery.

Methods

This was a nationwide prospective cohort study including all Swedish patients who underwent esophageal cancer surgery between 2013 and 2018. Patients reported reflux on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for gastroesophageal symptoms and psychological distress on the Hospital Anxiety and Depression Scale at 1 and 2 years after surgery. Repeated-measures logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, body mass index, TNM classification, neoadjuvant therapy, surgery type, postoperative complications, antireflux medication, and elevated headrest at night.

Results

Among 154 included patients, 43 (28%) and 37 (24%) reported severe reflux 1 and 2 years after surgery, respectively. No association between severe reflux and anxiety (OR, 2.1; 95% CI, 0.7–6.3) or depression (OR, 1.2; 95% CI, 0.3–4.6) was found 1 year after surgery. After 2 years, there was still no association between severe reflux and anxiety (OR, 0.9; 95% CI, 0.3–2.8) or depression (OR, 1.2; 95% CI, 0.5–3.3).

Conclusions

Findings suggest that severe reflux is not associated with anxiety or depression after esophageal cancer surgery.

Implications for Practice

For esophageal cancer survivors, other factors than severe reflux may be more important for the psychological recovery.
The Added Value of Family Caregivers' Level of Mastery in Predicting Survival of Glioblastoma Patients
Authors: Boele Florien W. , Weimer Jason , Zamanipoor Najafabadi Amir H. , Murray Louise , Given Charles W. , Given Barbara A. , Donovan Heidi S. , Drappatz Jan , Lieberman Frank S. , Sherwood Paula R.
Published: October 2021

Background

Glioblastoma multiforme (GBM) is an aggressive brain tumor. Patients commonly rely on family caregivers for physical and emotional support. We previously demonstrated that caregiver mastery measured shortly after diagnosis was predictive of GBM patient survival, corrected for known predictors of survival (n = 88).

Objective

The aims of this study were to verify the contribution of caregiver mastery and investigate the added value of mastery over other predictors to predict 15-month survival.

Methods

Data collected for a longitudinal study (NCT02058745) were used. Multivariable Cox regression analyses were performed for models with known clinical predictors (patient age, Karnofsky Performance Status, type of surgery, O6-methylguanine-DNA-methyltransferase promotor methylation status), with and without adding caregiver mastery to predict mortality. The added value of each model in discriminating between patients with the lowest and highest chances of survival at 15 months was investigated through Harrell's concordance index.

Results

In total, 41 caregiver-patient dyads were included. When evaluating solely clinical predictors, Karnofsky Performance Status and patient age were significant predictors of mortality (hazard ratio [HR], 0.974; 95% confidence interval [CI], 0.949–1.000; and HR, 1.045; 95% CI, 1.002–1.091, respectively). Adding caregiver mastery, these clinical predictors remained statistically significant, and mastery showed an HR of 0.843 (95% CI, 0.755–0.940). The discriminative value improved from C = 0.641 (model with known clinical predictors) to C = 0.778 (model with mastery), indicating the latter is superior.

Conclusions

We confirm that caregiver mastery is associated with GBM patient survival.

Implications for Practice

Incorporating support and guidance for caregivers into standard care could lead to benefits for caregiver well-being and patient outcomes.
Cancer Pain
Authors: Khatooni Marzieh
Published: October 2021

Background:

Cancer pain is among the most severe types of pain and is among the most common types of cancer-related problems. Yet, many ambiguities surround the concept of cancer pain and its attributes.

Objective:

This study aimed to analyze the concept of cancer pain.

Methods:

This concept analysis was conducted using the Rodgers' evolutionary method. Nursing, psychology, social sciences, and medicine literature were reviewed through searching online databases. In total, 52 articles were included and analyzed through thematic analysis.

Results/Conclusion:

The attributes of cancer pain are known origin, sharp, burning, piercing, or throbbing quality, varying duration (acute, chronic, or breakthrough), intolerability, and moderate to severe intensity. Its antecedents are cognitive system, pain-related beliefs, coping strategies, family and social support, financial status, and cultural, ethnic, racial, and religious values. Its consequences include physical, psychological, existential and spiritual, and social consequences, and reduced quality of life. This concept analysis concludes that cancer pain is different from other types of acute and chronic pain. Thus, specific interventions are needed for its assessment and management.

Implications for Case Management Practice:

The results of this concept analysis can broaden the case manager/health care team and other health care providers' knowledge about cancer pain and help them make better decisions and take more effective interventions for its management. The information in the article can be used to inform the case manager/health care team when it may be time to consider palliative care or even hospice care. Also, the information, itself, is crucial for case managers to understand when a patient has cancer pain.
Celebrations of Life—Why Wait?
Authors: Powell Suzanne K.
Published: October 2021

This past 2 years has been one of many passages. The Celebration of Life is an opportunity for family and friends to pay tribute to a loved one in a personal and unique way. This Editorial proposes that the timing of this event may be celebrated during the life, if the circumstances and wishes are assessed.
Advancing Trauma-Informed Care Education for Hospice and Palliative Staff
Authors: O'Malley Kelly A. , Etchin Anna G. , Auguste Elizabeth J. , Kaiser Anica Pless , Korsun Lynn , Weiskittle Rachel E. , Bashian Hannah M. , Sager Zachary S. , Moye Jennifer
Published: October 2021

Nurses play an essential role in managing mental health conditions, such as posttraumatic stress disorder (PTSD), especially in rural areas where access to mental health care is limited. Posttraumatic stress disorder may emerge at the end of life and complicate health care and is a particular concern for aging Vietnam veterans. We describe the development of 3 videos that illustrate how to recognize PTSD, respond to trauma disclosures, and manage PTSD in cognitive impairment during an in-home hospice nurse visit. Through problem identification and needs assessment, we identified 6 goals and 28 specific content objectives presented through cinematic action with flashbacks or voice-over narration with graphics. Videos were evaluated through a survey (N = 155) and analysis of “chat” responses (N = 186) to targeted questions during a webinar presentation to clinicians (N = 345). Approximately 75% rated videos as “very much” relevant to needs, having helped learn something new, and realistic. Analysis of chat responses showed videos conveyed most content objectives (92%). In addition, participants stated videos were helpful in demonstrating nursing skills of listening, responding, and displaying empathy, as well as showing case presentations involving cognitive impairment and the patient experience. Participants expressed a desire for longer videos/more information including a wider range of PTSD presentations and comorbidities.
Learning Outcomes Attributed to Prelicensure Clinical Education in Nursing
Authors: Leighton Kim , Kardong-Edgren Suzan , McNelis Angela , Sullo Elaine
Published: October 2021

Background

Educators agree that clinical experiences are vital to the development of a graduate nurse; however, there is little research on student learning outcomes related to these experiences.

Purpose

The purpose of this systematic review was to examine qualitative studies of student learning in traditional clinical models.

Methods

A systematic review was conducted following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Nine electronic databases were searched using 43 search terms. Full-text review was completed on 109 articles, with 26 undergoing critical appraisal.

Results

Only 6 qualitative studies reported learning outcomes attributed to clinical education models, focusing on experiences in foreign clinical placements, nurse-run clinics, the night shift, transition to professional identity, practicing as a clinical dyad, and development of caring skills.

Conclusions

The results of the systematic review of qualitative research that studied outcomes of prelicensure clinical education were insufficient to provide recommendations for traditional clinical education that are supported by evidence.
Prognostic Implications of Immune Infiltrates in the Breast Cancer Microenvironment: The Role of Expressions of CTLA-4, PD-1, and LAG-3
Authors: Bagbudar Sidar , Karanlik Hasan , Cabioglu Neslihan , Bayram Aysel , Ibis Kamuran , Aydin Esra , Yavuz Ekrem , Onder Semen
Published: October 2021

The assessment of immune infiltrate in invasive breast carcinomas (IBCs), most commonly referred to as tumor infiltrating lymphocytes (TILs), is gaining importance in the current quest for optimal biomarker selection and prediction of prognosis. In this study, the impact of intensity of TILs and expressions of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death-1 (PD-1), and lymphocyte activation gene 3 (LAG-3) in a group of breast carcinomas with regards to the prognosis and conventional pathologic parameters was scrutinized. For this purpose, 238 patients with IBCs containing different proportions of TILs were included in the study. IBCs with higher proportion of TILs were usually grade III carcinomas and correlated with poor prognostic features like receptor negativity, nonluminal intrinsic subtype (P<0.001). Similarly, PD-1 and LAG-3 positivity in immune cells (IC) were more likely to be positive in grade III IBC cases (P=0.004). In addition, PD-1 positivity in IC was more frequent in estrogen receptor-negative tumors (P=0.011) whereas LAG-3 positivity increased in large sized, estrogen receptor and progesterone receptor-negative tumors (P=0.050, 0.023, 0.04, respectively). CTLA-4 positivity in IC was more frequent in large-sized tumors (P=0.040). These 3 markers were also significantly associated with one another and also with the amount of TILs. In survival analysis, cases with prominent-TILs especially displaying CTLA-4, PD-1, and LAG-3 positivity appeared to have longer disease-free and overall survival (CTLA-4: P=0.027, P=0.024; PD-1: P=0.030, P=0.026; LAG-3: P=0.006, P=0.012, respectively). We conclude that the high proportion of TILs and as well as high expression of CTLA-4, PD-1, and LAG-3 in TILs have positively contributed to the outcome despite their correlation with poor conventional pathologic features. We suggest that these 3 immune markers can be used for the determination of proper treatment as well as prediction of prognosis in IBCs with TILs.
Zinc Finger Protein 24 is a Prognostic Factor in Ovarian Serous Carcinoma
Authors: Chen Jia , Guo Juan , Yuan Yujuan , Wang Yadong
Published: October 2021

Objective:

As a member of the zinc finger protein family, zinc finger protein 24 (ZNF24) contains a Cys2His2 zinc finger domain and acts as a transcription factor. ZNF24 has been reported to be downregulated in gastric cancer and breast cancer. However, little is known about its expression and function in ovarian serous carcinoma (OSC).

Patients and Methods:

We collected 117 OSC patients during 2011 to 2017 and retrospectively retrieved their clinicopathologic characteristics as well as their survival data. Protein level was analyzed by immunohistochemistry, mRNA level was evaluated by RT-qPCR assay, and transcriptional data was obtained from TCGA data sets. The correlations between ZNF24 expression and patients’ features were assessed using χ2 test. Univariate and multivariate analyses were used to identify the prognosis predicative potential of ZNF24 in OSC. The function of ZNF24 in the epithelial ovarian cancer cells was also verified by in vitro cellular experiments.

Results:

Among the 117 cases, ZNF24 was downregulated in 52 OSC samples (44.6%) and significantly correlated with tumor stages. According to univariate and multivariate analyses, ZNF24 can act as an independent prognostic indicator for the overall survival of OSC patients, whose lower expression was associated with poorer clinical outcomes. Ectopic overexpression and knockdown assays indicated that ZNF24 can negatively regulate the OSC cell viability.

Conclusions:

OSC patients with low level of ZNF24 have worse overall survival compared with those possess high-ZNF24 expression. Downregulated ZNF24 may be involved in the proliferation of OSC, and ZNF24 expression can serve as an independent survival predictor.
National Trends in Emergency Department Visits for Child Maltreatment, 2007–2014
Authors: Suglia Shakira F. , Cammack Alison L. , Sharperson Camara , Brown Jocelyn , Martins Silvia S.
Published: October 2021

Objective

To understand the prevalence of child maltreatment-related emergency department (ED) visits in the United States, we examined data from the 2007 to 2014 Nationwide Emergency Department Sample.

Methods

Based on existing literature, International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9 CM) ED discharge codes for children less than 10 years of age were characterized as specified child maltreatment, defined as visits with an explicit maltreatment ICD-9 CM or external causes of injury codes. The prevalence of child maltreatment visits per 100,000 children in the United States (based on Center for Disease Control Wide-ranging ONline Data for Epidemiologic Research estimates) overall and by sociodemographic factors was examined, and tests for trends over time were evaluated with Cochran-Armitage tests. Analyses were conducted in 2019.

Results

The prevalence of child maltreatment based in ICD-9 CM discharge codes ED visits dropped from 69.2 visits per 100,000 in 2007 to 65.9 visits per 100,000 in 2014; this trend was statistically significant. The prevalence was lowest in 2010 (60.1 visits per 100,000 children). There were increases observed for some demographic groups in this period. Throughout the 8-year period examined, the prevalence of child maltreatment visits was highest for physical abuse compared with other forms of maltreatment, higher for boys compared with girls; highest for children younger than 1 year, and higher for children living in neighborhoods with the lowest median income compared with children in higher-income neighborhoods.

Conclusions

The Nationwide Emergency Department Sample data set is a valuable surveillance tool for examining trends in child maltreatment. Future studies should explore what factors may explain variations in child maltreatment over time to best develop prevention strategies.
A Bibliometric Analysis of Global Pediatric Emergency Medicine Research Networks
Authors: Barrett Michael Joseph , Dalziel Stuart , Lyttle Mark , O'Sullivan Ronan ,   for the Pediatric Emergency Research Networks (PERN)
Published: October 2021

Objectives

During the last 3 decades newly formed pediatric emergency medicine (PEM) research networks have been publishing research. A desire of these networks is to produce and disseminate research to improve patient health and outcomes. The aims of the study were to quantitatively analyze and compare the literature by PEM research networks globally through numeric and visual bibliometrics.

Methods

A bibliometric analysis of articles published from 1994 to 2019 (26 years) by authors from PEM research networks globally were retrieved using PubMed, Web of Science (Thompson Reuters), and accessing individual research network databases. Bibliometric analysis was performed utilizing Web of Science, VOSviewer, and Dimensions. Research was quantified to ascertain the number of articles, related articles, citations, and Altmetric attention score.

Results

A total of 493 articles were published across 9 research networks in 3 decades. Pediatric Emergency Care Applied Research Network produced the most articles, citations, and h-index of all networks. We identified 3 main groupings of productive authors across the networks who collaborate globally. The sex of the first author was female in 46% of publications, and the corresponding author(s) was female in 45%. A nonsignificant moderate positive correlation between the number of years publishing and the number of publications was identified. There was nonsignificant moderate negative association between the number of countries in a network and total publications per annum.

Conclusions

This study is the first bibliometric analysis of publications from PEM research networks that collaborate globally. Exploring the relationships of numerical bibliometric indicators and visualizations of productivity will benefit the understanding of the generation, reach, and dissemination of PEM research within the global research community.
Navigating the Storm of COVID-19 Literature Through Academic-Practice Partnership in Washington State: The COVID-19 Literature Situation Report
Authors: Simckes Maayan , Shah Anar , Guthrie Brandon L. , Ross Jennifer M. , Wasserheit Judith , Wickersham Kevin , Wasserman Cathy
Published: October 2021

Context:

Shortly after the first COVID-19 case in the United States was identified in Washington, the Washington State Department of Health (WA DOH) determined that real-time knowledge of scientific findings related to SARS-CoV-2 was critical for an effective response. Epidemiologists at the WA DOH established the Daily Literature Situation Report (Lit Rep), within the agency's incident management team, to support public health and state leaders in evidence-based decision making. However, from January to May, the scale of the pandemic response and daily volume of emerging information grew beyond the capacity of the WA DOH epidemiology team tasked with gathering, reviewing, summarizing, and disseminating it daily.

Objective:

To ensure public health leaders maintained awareness of the rapidly evolving scientific literature during the pandemic to support evidence-based practice.

Design:

The WA DOH contracted the University of Washington (UW) Alliance for Pandemic Preparedness to assemble a team of faculty and students to continue producing the Lit Rep.

Main Outcome:

In addition to the daily Lit Rep, the UW team developed in-depth reports addressing questions from public health leadership and further evolved the methodology for the daily reports to support long-term sustainability and broader accessibility.

Results:

Throughout its existence, the Lit Rep had summarized more than 4300 articles from more than 150 000 citations and had more than 5600 subscribers from public health practice, academia, and the general public, both domestic and international.

Conclusions:

The flexible Lit Rep model sets a standard for responding to emerging public health threats and communicating complex scientific information to government leaders, public health staff, and other interested parties. The WA DOH and the UW have exemplified how a mutually beneficial partnership can be established to support more effective public health practice based on real-time evidence both during a crisis and potentially for future public health challenges.
Sit-to-Stand Weight-Bearing Symmetry Performance in Total Knee Arthroplasty
Authors: Pua Yong-Hao , Tan John Wei-Ming , Poon Cheryl Lian-Li , Chew Eleanor Shu-Xian , Seah Felicia Jie-Ting , Thumboo Julian , Yeo Seng-Jin , Woon Ee-Lin , Clark Ross Allan
Published: October 2021

Objective

After total knee arthroplasty, the ability to weight bear symmetrically during the sit-to-stand task provides important information regarding altered movement patterns. Despite this, comprehensive recovery curves and validity data for sit-to-stand weight-bearing symmetry are lacking in the total knee arthroplasty population. Our study aimed to (1) develop recovery curves with reference ranges, (2) identify the correlates of standard and constrained sit-to-stand weight-bearing symmetry, and (3) evaluate their predictive validity with gait speed.

Design

We performed a retrospective longitudinal study of 706 patients with primary unilateral total knee arthroplasty. Monthly, for 4 mos after surgery, sit-to-stand weight-bearing symmetry, knee pain, knee range of motion, quadriceps strength, and gait speed were quantified.

Results

Standard and constrained sit-to-stand weight-bearing symmetry measures improved nonlinearly over time. Standard sit-to-stand weight-bearing symmetry was most strongly associated with bilateral quadriceps strength, whereas constrained sit-to-stand weight-bearing symmetry was most strongly associated with ipsilateral quadriceps strength. Knee range of motion and contralateral knee pain were additional correlates. Both standard sit-to-stand and constrained sit-to-stand weight-bearing symmetry were independently and nonlinearly associated with gait speed in multivariable models.

Conclusions

Our study provided recovery curves and validity data to support routine clinical measurement of sit-to-stand weight-bearing symmetry in total knee arthroplasty. Our results also indicate that constrained sit-to-stand may promote greater use of the operated limb than standard sit-to-stand.
Insurance and Employment Status Are Correlated With the Presence of Waddell Signs
Authors: Radoslovich Stephanie S. , Smith Spencer , Haag Carter , Carlson Hans , Carlson Nels , Ensrud Erik , Yoo Jung U.
Published: October 2021

Objective

The aim of the study was to determine whether employment or insurance status is associated with the presence and number of Waddell signs.

Design

In this cross-sectional study, adult low back pain patients were seen at a tertiary academic center for thoracic or lumbar back pain, due to a degenerative condition. Frequency data were compared with contingency table analysis, including χ2 and logistic regression.

Results

Of 462 patients, 26% had any Waddell signs and 10% had clinically significant Waddell signs. Nonemployed patients had a higher prevalence of Waddell signs than employed and retired patients (P = 0.0004 and P = 0.001, respectively). Subgroups of Medicaid participants as well as patients with secondary gain issues, including worker’s compensation and motor vehicle accident, had a higher prevalence of 1+ Waddell signs than patients of other insurances (P < 0.0001 and P = 0.01, respectively). Medicaid participants had a higher prevalence of 3+ Waddell signs than other insurances (P = 0.002).

Conclusions

The presence of Waddell signs is associated with employment and insurance status. This suggests that social factors may affect patients’ perceptions of their thoracic or low back pain. Clinicians aware of these factors can provide individualized care to their patients prone to poor outcomes.
A pilot study of microbial signatures of liver disease in those with HIV mono-infection in Rio de Janeiro, Brazil
Authors: Yanavich Carolyn , Perazzo Hugo , Li Fan , Tobin Nicole , Lee David , Zabih Sara , Morata Michelle , Almeida Cristiane , Veloso Valdilea G. , Grinsztejn Beatriz , Aldrovandi Grace M.
Published: October 2021

Objective:

The rectal microbiome was examined to assess the relationship between the microbiome and liver disease in HIV-infection.

Design:

Eighty-two HIV-1 mono-infected individuals from the PROSPEC-HIV-study (NCT02542020) were grouped into three liver health categories based on results of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) of transient elastography: normal (n = 30), steatosis (n = 30), or fibrosis (n = 22).

Methods:

Liver steatosis and fibrosis were defined by CAP at least 248 dB/m and LSM at least 8.0 kPa, respectively. 16S rRNA gene and whole genome shotgun metagenomic sequencing were performed on rectal swabs. Bacterial differences were assessed using zero-inflated negative binomial regression and random forests modeling; taxonomic drivers of functional shifts were identified using FishTaco.

Results:

Liver health status explained four percentage of the overall variation (r
2 = 0.04, P = 0.003) in bacterial composition. Participants with steatosis had depletions of Akkermansia muciniphila and Bacteroides dorei and enrichment of Prevotella copri, Finegoldia magna, and Ruminococcus bromii. Participants with fibrosis had depletions of Bacteroides stercoris and Parabacteroides distasonis and enrichment of Sneathia sanguinegens. In steatosis, functional analysis revealed increases in primary and secondary bile acid synthesis encoded by increased Eubacterium rectale, F. magna, and Faecalibacterium prausnitzii and decreased A. muciniphila, Bacteroides fragilis and B. dorei. Decreased folate biosynthesis was driven by similar changes in microbial composition.

Conclusion:

HIV mono-infection with steatosis or fibrosis had distinct microbial profiles. Some taxa are similar to those associated with non-alcoholic fatty liver disease in HIV-negative populations. Further studies are needed to define the role of the gut microbiota in the pathogenesis of liver disease in HIV-infected persons.
Cytomegalovirus in primary immunodeficiency
Authors: Godsell Jack , Chan Samantha , Slade Charlotte , Bryant Vanessa , Douglass Jo Anne , Sasadeusz Joe , Yong Michelle K.
Published: October 2021

Purpose of review

Cytomegalovirus (CMV) infection and disease are well described in the setting of secondary immunodeficiency. Less is known about CMV in the context of primary immunodeficiencies (PIDs), where inborn errors in one or more arms of the immune system result in variable degrees of CMV susceptibility.

Recent findings

PID presents unique challenges in the diagnosis and management of CMV disease. The clinical presentation of CMV in PID is often severe, accelerated by underlying immune dysregulation and iatrogenic immunosuppression. Here we describe the clinical significance of CMV infection in PID, the key components of immune defence against CMV and how these are affected in specific PIDs. CMV disease is under-recognized as a complication of common variable immunodeficiency (CVID). High rates of CMV end-organ disease, mortality, development of CMV resistance and prolonged antiviral use have been observed in individuals with CVID.

We recommend that clinicians tailor their approach to the individual based on their underlying immune deficit and maintain a high index of suspicion and low threshold for treatment. More research is required to improve stratification of CMV risk in PID, develop new diagnostic tools and manage end-organ disease in this cohort.
A Medical Records Review Study Assessing Safety of Zoster Vaccine Recombinant, Adjuvanted in Patients With Rheumatic Disease
Authors: Gupta Surbhi , Arasaratnam Reuben J. , Solow E. Blair , Bajaj Puneet
Published: October 2021

Objective

Patients with rheumatic disease are at increased risk for herpes zoster infection. Because of limited safety data in this population and concerns over vaccine-precipitated flares, there are no guidelines for vaccination with the zoster vaccine recombinant, adjuvanted (ZRA). We evaluated self-reported adverse events (AEs) and disease activity after ZRA administration in adults with rheumatic disease.

Methods

In this medical records review study at our large academic center, patients who had received at least 1 dose of ZRA from January 1, 2018 to March 11, 2020 were assessed. Self-reported AEs and disease activity were monitored 3 months after each ZRA administration. Measures of disease activity were reviewed 6 months before ZRA in those who received both doses, or 3 months before ZRA in those who received 1 dose.

Results

We identified 65 patients, of whom 34 (52.3%) received both doses of ZRA. Four patients (6.2%) self-reported AEs after receiving ZRA, all of which were minor and systemic. Three patients (9.2%) developed a flare after receiving ZRA, compared with 8 (12.3%) who experienced a flare in the baseline period. There was no significant change in flare incidence or disease activity after vaccination. Subgroup analysis of those on biologic and nonbiologic disease-modifying antirheumatic drugs revealed no differences in frequency of postvaccination AEs, flares, or disease activity.

Conclusions

In our cohort, disease activity seemed stable when comparing disease markers before and after ZRA administration. In addition, ZRA was well-tolerated with minor AEs. Further studies are needed to guide formal vaccination recommendations.
Treatment of Benign Lesion of Levels I or II of the Parotid Gland: Long Term Results of Partial Superficial Parotidectomy
Authors: Visconti Irene Claudia , lannella Giannicola , Meccariello Giuseppe , Cammaroto Giovanni , Gulotta Giampiero , Greco Antonio , de Vincentiis Marco , Magliulo Giuseppe , Pelucchi Stefano , Maniaci Antonino , Cocuzza Salvatore , La Mantia Ignazio , Brevi Bruno , Vicini Claudio
Published: October 2021

The correct surgical approach to benign parotid gland tumors is still matter of debate, it should be chosen considering the possibility of local recurrence or facial nerve complications in case of “not necessary” facial nerve dissection. In the era of minimally invasive surgery, more sparing approaches such as extracapsular dissection or partial superficial parotidectomy (PSP) are gaining popularity. The aim of the study is to present surgical results and long-term outcomes of PSP (level i or ii) in a large group of patients. Six hundred fifty-one patients who underwent parotid surgery between 2004 and 2020 were initially considered. Five hundred forty patients with benign lesions treated with PSP, enucleation, ECD were enrolled. Clinical features, surgical data, postoperative scarring, seroma, dehiscence, neuroma, outcomes as Frey syndrome, and delayed facial nerve dysfunction have been evaluated. 65.5% PSP, 25.2% enucleation, and 9.2% extracapsular dissection. No statistical difference in surgical time has been found (P 0.16). P 
> 0.05 for seroma, neuroma, Frey syndrome, and facial palsy between different type of surgery. Frey syndrome in PSP: 6/135 (4.4%) in 2004 to 2012 and 2/219 (0.9%) in 2013 to 2020. The reduction between periods is significant (P < 0.04). Recurrence: 0.8% (3/354) for PSP patients, 3.4% (5/ 136) in enucleation and 10% (5/50) in ECD (P = 0.02). Partial superficial parotidectomy can be considered a minimally invasive and quick procedure with low complication rate. Our data seem to support this statement (large case series and long-term follow-up).
Characteristic of Cleft Lip and Palate Cases Attended to Khoula Hospital Cleft Center
Authors: Balushi Taimoor Al , Sahib Meera , Abduwani Zahra Al , Viswapurna P. S. , Zeinalddin Mohammad
Published: October 2021

Cleft lip and/or palate are one of the most common birth defects around the world. This cross sectional study aimed to study characteristic of cleft lip and plate cases attended Khaula Hospital Cleft Center.

Methods:

The data were collected from Plastic Surgery Department of Khaula Hospital Muscat, Oman, between years 2010 and 2019. Data was collected using a form that included demographic distribution of patients, gender, age, birth weight, region, age when first attended hospital, associated congenital anomalies and syndromes, type of delivery, mother consumption of Folic Acid, types of cleft lip/palate, and surgeries done.

Results:

During 9 years period the total number of recorded patients having cleft Lip/Palate was 1899. 43.7% of cases had CLP, 36% had CP, 20.3% had complete fissuring of the lip. Sixty-eight percent of the children were between 0 and 3 months of age when they first attended Hospital. 6.2% of children had siblings with orofacial clefts. Congenital malformations associated with CL/P or syndromic cleft were seen in 31.1% of cases. 86.8% of children got operated at Hospital and most common types of surgeries were lip and palate repair. Twenty-three percent of patients had undergone orthodontic treatment, 49.3% of patients had speech therapy, 32.5% referred for ENT consultation, and 20.5% of patients got grommet inserted.

Conclusion:

Prevalence of CL/P in Oman is 2.6 in 1000 live births. Two main possible reasons contributing to the increase seen in this prevalence can be increase in the number of live births in Oman and parent's education toward cleft treatment that led more patients attending hospital for treatment.
Anxiety and Performance in Prehospital Emergency Care Simulation Assessments
Authors: Stein Christopher
Published: October 2021

Introduction

Anxiety experienced by students participating in simulations may impede their learning and performance. The added anxiety brought about by the socioevaluative nature of simulation assessments may accentuate this effect. This study aimed to assess the relationship between anxiety experienced by emergency care students and performance in an authentic prehospital emergency care simulation assessment.

Methods

The State-Trait Anxiety Inventory (STAI) was completed before and after a simulation assessment by 58 emergency care students across all academic years of study of a 4-year degree program in prehospital emergency care. The state anxiety component of the STAI was plotted together with marks obtained by each student using a standardized assessment tool, and curve estimation was used to determine the nature of the relationship between state anxiety scores and marks.

Results

Mean preassessment STAI scores were lower than mean postassessment scores (48.74 vs. 57.74), but mean scores from both groups were greater than normal mean scores for college students. The relationship of both preassessment and postassessment STAI scores with assessment marks was best described by a quadratic curve suggesting that performance was better at both the lower and higher ends of the range of STAI scores compared with the middle. Postassessment STAI scores provided a better fit with simulation assessment marks.

Conclusions

This study did not confirm the expected decrease in performance associated with increasing anxiety but rather suggests that some students may have the ability to respond positively to the highest levels of anxiety during simulation assessments.
Evaluation of Uroflowmetry Curve Patterns and Nomogram Construct in Healthy Nulliparous Female Adults
Authors: Taylor Danielle Lynn , Dueñas-Garcia Omar F. , Maheshwari Deepali , Sierra Tania , Leung Katherine , Hall Cynthia , Flynn Michael
Published: October 2021

Objective

The aims of the study were to construct uroflowmetry nomograms, evaluate uroflowmetry flow rate patterns, and graphically illustrate overlaid uroflowmetry curves in nulliparous female adult volunteers.

Methods

We performed a prospective cross-sectional study evaluating uroflowmetry curve and flow rate patterns on a cohort of nulliparous female adult volunteers. Primary outcome was construction of uroflowmetry maximum and average flow rate nomograms. Secondary outcomes included evaluation of uroflowmetry flow rate patterns and graphical illustrations of overlaid uroflowmetry curves. Uroflowmetry printouts were overlaid and used to create a model of uroflow patterns, and nomogram curves were analyzed in 5 groups based on voided volumes.

Results

We enrolled 164 participants and 158 had voided volumes between 50 mL and 800 mL. Participants' mean age and body mass index were 25 years and 23, respectively. Maximum and average flow rate nomograms were created, and analysis of uroflow parameters was performed. Median voided volume was 241 mL (149–431 mL), the median maximum flow was 29 mL/s (20–38 mL/s), and the median average flow was 15 mL/s (10–19 mL/s). Participants were divided into 5 groups based on voided volumes. The nomogram patterns for each voided volume group were visually different from typical nomogram patterns.

Conclusions

Uroflowmetry curves and flow rates vary significantly according to voided volume. Our study suggests that in normal healthy nulliparous female adults there is likely a broader range of normal flow rates and uroflowmetry curves than what has been previously reported. Further research is needed to investigate the accuracy of these finding.
International Travel for Liver Transplantation: A Comprehensive Assessment of the Impact on the United States Transplant System
Authors: Braun Hillary J. , Amara Dominic , Shui Amy M. , Stock Peter G. , Hirose Ryutaro , Delmonico Francis L. , Ascher Nancy L.
Published: October 2021

Background.

International travel for transplantation remains a global issue as countries continue to struggle in establishing self-sufficiency. In the United States, the United Network for Organ Sharing (UNOS) requires citizenship classification at time of waitlisting to remain transparent and understand to whom our organs are allocated. This study provides an assessment of patients who travel internationally for liver transplantation and their outcomes using the current citizenship classification used by UNOS.

Methods.

Adult liver UNOS data from 2003 to 2019 were used. Patients were identified as citizens, noncitizen, nonresidents (NCNR), or noncitizen residents (NC-R) according to citizenship status. Descriptive statistics compared demographics among the waitlisted patients and demographics and donor characteristics among transplant recipients. A competing risks model was used to examine waitlist outcomes. The Kaplan-Meier method and Cox proportional hazards were used for posttransplant outcomes.

Results.

There were significant demographic differences according to citizenship group among waitlisted (n = 125 652) and transplanted (n = 71 536) patients. Compared with US citizens, NCNR was associated with a 9% increase in transplant (subdistribution hazard ratio [SHR], 1.09; 95% confidence interval [CI], 1.00-1.18; P = 0.04), and NC-R was associated with a 24% decrease in transplant (SHR, 0.76; 95% CI, 0.72-0.79; P < 0.0001) and a 23% increase in death or removal for being too sick (SHR, 1.23; 95% CI, 1.14-1.33; P < 0.0001). US citizens had significantly inferior graft and patient survival (P < 0.001).

Conclusions.

Though the purpose of the citizenship classification system is transparency, the results of this study highlight significant disparities in the access to and outcomes following liver transplantation according to citizenship status.
Targeting gene fusions in glioma
Authors: Kim Peter L.
Published: October 2021

Purpose of review

Glioma represents of variety of brain malignancies, the majority of which confer a poor prognosis despite treatment. With the widespread use of next-generation sequencing, gene fusions are being found in greater numbers. Gene fusions in glioma represent an opportunity to deliver targeted therapies to those with limited options for treatment.

Recent findings

Extensive studies on these gene fusions have shown that they can exhibit distinct phenotypes, such as PTPRZ1-MET fusions in secondary glioblastoma or FGFR3-TACC3 fusions in IDH wildtype gliomas. Responses have been observed with the use of targeted therapies but some have been short lived because of the development of treatment resistance.

Increasing detection of gene fusions in glioma along with basket trials have helped define different fusion phenotypes and paved the way for targeted kinase inhibitor-based therapies. Targeting NTRK fusions has been the most successful fusion-guided therapy to date and evaluating all patients for these fusions may be warranted.
Is there a role for neoadjuvant anti-PD-1 therapies in glioma?
Authors: Sun Lu , Lai Thomas J. , Prins Robert M.
Published: October 2021

Purpose of review

In this review, we summarized recent findings that highlight the progress for checkpoint blockade immunotherapy in glioblastoma (GBM) patients.

Recent findings

We reviewed new data from our group and others that suggest that the timing of when immunotherapy is applied can impact the antitumor immune response and, potentially, the ultimate clinical benefit of patients.

The neoadjuvant priming and expansion of exhausted T cells within the GBM microenvironment, followed by the removal of an immune suppressive tumor microenvironment through surgical resection, may lead to enhanced antitumor immune responses that are beneficial clinically. As such, neoadjuvant immunotherapeutic approaches and rational combinations may be helpful scientifically to understand how immunotherapeutic interventions influence the tumor microenvironment, as well benefit the patients.
Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury
Authors: Jogia Trisha , Kopp Marcel A. , Schwab Jan M. , Ruitenberg Marc J.
Published: October 2021

Purpose of review

To date, prognostication of patients after acute traumatic spinal cord injury (SCI) mostly relies on the neurological assessment of residual function attributed to lesion characteristics. With emerging treatment candidates awaiting to be tested in early clinical trials, there is a need for wholistic high-yield prognostic biomarkers that integrate both neurogenic and nonneurogenic SCI pathophysiology as well as premorbid patient characteristics.

Recent findings

It is becoming clearer that effective prognostication after acute SCI would benefit from integrating an assessment of pathophysiological changes on a systemic level, and with that, extend from a lesion-centric approach. Immunological markers mirror tissue injury as well as host immune function and are easily accessible through routine blood sampling. New studies have highlighted the value of circulating white blood cells, neutrophils and lymphocytes in particular, as prognostic systemic indicators of SCI severity and outcomes.

We survey recent advances in methods and approaches that may allow for a more refined diagnosis and better prognostication after acute SCI, discuss how these may help deepen our understanding of SCI pathophysiology, and be of use in clinical trials.
Primary brain cell infection by
Toxoplasma gondii
reveals the extent and dynamics of parasite differentiation and its impact on neuron biology
Authors: Mouveaux Thomas , Roger Emmanuel , Gueye Alioune , Eysert Fanny , Huot Ludovic , Grenier-Boley Benjamin , Lambert Jean-Charles , Gissot Mathieu
Published: October 2021

Toxoplasma gondii
is a eukaryotic parasite that forms latent cysts in the brain of immunocompetent individuals. The latent parasite infection of the immune-privileged central nervous system is linked to most complications. With no drug currently available to eliminate the latent cysts in the brain of infected hosts, the consequences of neurons' long-term infection are unknown. It has long been known that
T. gondii
specifically differentiates into a latent form (bradyzoite) in neurons, but how the infected neuron responds to the infection remains to be elucidated. We have established a new
in vitro
model resulting in the production of mature bradyzoite cysts in brain cells. Using dual, host and parasite RNA-seq, we characterized the dynamics of differentiation of the parasite, revealing the involvement of key pathways in this process. Moreover, we identified how the infected brain cells responded to the parasite infection revealing the drastic changes that take place. We showed that neuronal-specific pathways are strongly affected, with synapse signalling being particularly affected, especially glutamatergic synapse signalling. The establishment of this new
in vitro
model allows investigating both the dynamics of parasite differentiation and the specific response of neurons to long-term infection by this parasite.
Emerging evidence implicating a role for neurexins in neurodegenerative and neuropsychiatric disorders
Authors: Cuttler Katelyn , Hassan Maryam , Carr Jonathan , Cloete Ruben , Bardien Soraya
Published: October 2021

Synaptopathies are brain disorders characterized by dysfunctional synapses, which are specialized junctions between neurons that are essential for the transmission of information. Synaptic dysfunction can occur due to mutations that alter the structure and function of synaptic components or abnormal expression levels of a synaptic protein. One class of synaptic proteins that are essential to their biology are cell adhesion proteins that connect the pre- and post-synaptic compartments. Neurexins are one type of synaptic cell adhesion molecule that have, recently, gained more pathological interest. Variants in both neurexins and their common binding partners, neuroligins, have been associated with several neuropsychiatric disorders. In this review, we summarize some of the key physiological functions of the neurexin protein family and the protein networks they are involved in. Furthermore, examination of published literature has implicated neurexins in both neuropsychiatric and neurodegenerative disorders. There is a clear link between neurexins and neuropsychiatric disorders, such as autism spectrum disorder and schizophrenia. However, multiple expression studies have also shown changes in neurexin expression in several neurodegenerative disorders, including Alzheimer's disease and Parkinson's disease. Therefore, this review highlights the potential importance of neurexins in brain disorders and the importance of doing more targeted studies on these genes and proteins.