bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Value of Plasmacytoid Dendritic Cells in Differentiating Pityriasis Lichenoides et Varioliformis Acuta From Lymphomatoid Papulosis
Authors: Brem Candice E. , Abbas Ossama , Bhawan Jag
Published: September 2021

Pityriasis lichenoides et varioliformis acuta (PLEVA) and lymphomatoid papulosis (LyP) can often demonstrate clinical and histopathologic overlap. A recent study demonstrated significant plasmacytoid dendritic cell (pDC) recruitment in lesions of PLEVA, whereas another study reported minimal pDC recruitment in lesions of LyP. To confirm the possible diagnostic value of pDCs in differentiating PLEVA and LyP, we compared the presence and distribution of pDCs and myxovirus protein A (MxA) expression (an indirect assessment of pDC activity). In total, 19 cases of PLEVA (16 patients) and 14 cases of LyP (11 patients) were examined using immunohistochemical stains for anti–blood-derived dendritic cell antigen-2 and MxA. Individual semiquantitative scoring systems were used to assess the immunohistochemical results, and a Mann–Whitney test with a subsequent 2-tailed P test was performed for statistical analysis. No statistically significant difference in the number of pDCs in both groups was found. However, most PLEVA cases (84%) demonstrated intense and diffuse MxA expression, whereas LyP cases (71%) demonstrated weak patchy staining (P < 0.007). Our study suggests that although additional studies may be needed to determine whether pDCs are more relevant to the pathogenesis of PLEVA or LyP, pDC activity through MxA staining may play a role in differentiating PLEVA from LyP and may serve as a platform for additional studies.
CD8+ Lymphogranulomatous Dermatitis as a Manifestation of Malignancy-Associated Immunodeficiency: Rethinking Paraneoplastic Granulomas
Authors: Stonesifer Connor J. , Trager Megan H. , Magro Cynthia M. , Geskin Larisa J.
Published: September 2021

Paraneoplastic granulomatous disease occurs in approximately 7.3% of patients with non-Hodgkin lymphoma, most commonly among patients with chronic lymphocytic leukemia (CLL). These lesions are often reported to appear similar to sarcoidosis in clinical presentation and under light microscopy. However, comprehensive descriptions of the cytomorphologic characteristics of these paraneoplastic granulomas are lacking, and the mechanisms involved in their formation remain ill-defined. Noninfectious dermal granulomatous reactions have also been reported in many primary immunodeficiencies, including common variable immune deficiency and ataxia-telangiectasia. We present a case of noninfectious CD8+ predominant granulomatous dermatitis with ocular involvement occurring in the setting of CLL and marked hypogammaglobulinemia. Based on the analysis of shared factors in patients with primary immunodeficiencies and CLL, we conclude that the presence of pan-humoral immunodeficiency could itself be a risk factor for developing a CD8+ lymphogranulomatous reaction. This report and associated discussion evince that CD8+ predominant granulomatous reactions, distinct from sarcoidosis, may represent a previously unappreciated segment of the paraneoplastic granulomas observed in hematologic malignancies.
Lymphocyte-Peppered Sclerotic Collagen: An Additional Histological Clue in Lichen Sclerosus, Morphea, and Systemic Sclerosis
Authors: Yadav Deepika , Agarwal Shipra , Thakur Shilpi , Ramam M.
Published: September 2021

Background:

“Line sign,” “cookie cutter sign,” “square biopsy sign,” “high eccrine glands sign” have been previously described in morphoea and lichen sclerosus. We found focal areas of thickened collagen bundles with lymphocytes interspersed between them in several biopsies of these conditions.

Materials and Methods:

We reviewed slides of sclerosing disorders obtained from the archives of the pathology department in our hospital for the period 2013–2019.

Results:

A total of 73 slides including 40 of lichen sclerosus, 24 of morphea, 2 of lichen sclerosus-morphea overlap, and 7 of systemic sclerosis were evaluated. Lymphocytes were noted between sclerotic collagen bundles in 46 (63%) slides, being most common in lichen sclerosus (80%, 32/40) followed by morphea (50%, 12/24), whereas it was seen in one case each of lichen sclerosus with morphea overlap (50%, 1/2) and systemic sclerosis (14.3%, 1/7). The finding was noted in the upper dermis in 20 of 32 (62.5%) slides of lichen sclerosus and in both the superficial and deep dermis in 11 (91.7%) of 12 slides of morphea.

Conclusion:

Lymphocyte-peppered sclerotic collagen may be a useful histological clue to the diagnosis of lichen sclerosus, morphea, and systemic sclerosis.
Squamoid Eccrine Ductal Carcinoma: Treatment and Outcomes
Authors: Lim Megan M. , Macdonald Jillian A.
Published: September 2021

Background:

Squamoid eccrine ductal carcinoma (SEDC) represents a subtype of eccrine carcinomas that are diagnostically challenging for both clinicians and dermatopathologists.

Objective:

To provide an updated review of SEDC and examine patient outcomes with different treatment modalities.

Methods:

A review of Ovid MEDLINE was performed to review the English language medical literature of SEDC.

Results:

A comprehensive review of clinical presentation, histologic findings, rates of lymphovascular and metastatic disease, treatment modalities and recurrence rates are reviewed.

Limitations:

There is a limitation on available data because of the rare incidence.

Conclusions:

SEDC is a rare adnexal neoplasm with a relatively high rate of local recurrence, lymphovascular invasion, perineural invasion, and metastases. Clinicians should be aware of this entity as close follow-up is essential to detect recurrence and metastatic disease. Mohs micrographic surgery seems to result in superior patient outcomes.
A Young Boy With Hemophagocytic Lymphohistiocytosis Presenting With Vaccine-Related Granulomatous Dermatitis: A Case Report and Literature Review
Authors: Zengin Hatice B. , Reyes-Barron Cynthia , Cusick Elizabeth , Cordisco Maria , Katzman Philip J. , Burack W. Richard , Scott Glynis
Published: September 2021

Cutaneous eruptions associated with hemophagocytic lymphohistiocytosis (HLH) have been reported in 6%–63% of patients. Clinical findings of these skin lesions vary widely and include maculopapular rashes, ulcers, and violaceous nodules. Corresponding histologic findings are also variable and are considered nonspecific. We report the case of a 4-year-old boy who initially developed a widespread popular–pustular rash 2 weeks after his 12-month measles, mumps, and rubella vaccinations. These resolved with scarring then recurred following his 24-month vaccinations. Multiple skin biopsies were negative for infectious organisms and showed a granulomatous infiltrate with perforation and necrobiosis. The differential diagnosis included perforating granuloma annulare, infection, or rheumatoid nodules. At the age of 4, he developed fever, hepatosplenomegaly, pancytopenia and other laboratory abnormalities, requiring hospitalization. A number of studies were performed including biopsies of bone marrow and liver. Molecular testing revealed 2 mutations in UNC13D known to be associated with familial HLH. His prior cutaneous lesions were likely caused by immune dysregulation exacerbated by immunizations because of underlying familial HLH. This case illustrates the importance of recognizing an unusual cutaneous manifestation of a rare disease to arrive at an earlier diagnosis in a pediatric patient. Although cutaneous eruptions usually develop concurrently with other systemic symptoms of HLH, preceding unusual skin lesions may be the first indication of this rare disease.
A Case of CD5-Positive Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type Secondary to Chronic Lymphedema
Authors: Sun Liting , Sun Yuzhen , Xin Wuyan , He Jiangman , Hu Yuan , Zhang Hanyin , Yu Jianbin , Zhang Jiang-an
Published: September 2021

Primary cutaneous lymphoma occurring at the site of lymphedema is a rare complication. A total of 13 cases of primary cutaneous lymphoma associated with chronic lymphedema have been reported in international studies. We reported a case of cutaneous diffuse large B-cell lymphoma (DLBCL) (leg type) secondary to chronic lymphedema of the lower limbs. Histopathology showed hyperkeratosis of epidermis, acanthosis, and significant edema in the superficial dermis, with diffuse mononuclear infiltration in the dermis. Immunohistochemical studies revealed the expression of CD5, CD20, Pax-5, Bcl-2, Bcl-6, MUM-1, c-myc, and Ki-67. Therefore, the diagnosis of cutaneous DLBCL (leg type) was made. The study further confirmed the association between lymphoma and lymphedema. Especially, it showed CD5 expression. CD5-positive DLBCLs is a specific subgroup of DLBCLs, only approximately 10% of DLBCLs express CD5.
Risk of Serious Infection With Low-dose Glucocorticoids in Patients With Rheumatoid Arthritis
Authors: George Michael D. , Hsu Jesse Y. , Hennessy Sean , Chen Lang , Xie Fenglong , Curtis Jeffrey R. , Baker Joshua F.
Published: September 2021

Background:

Low-dose glucocorticoids are commonly used in the treatment of rheumatoid arthritis (RA). Observational studies have found an increased risk of serious infection associated with low-dose glucocorticoids, but concerns about residual confounding remain.

Methods:

We identified adults with RA on stable immunomodulatory therapy for >6 months receiving no glucocorticoids or ≤5 mg/day using Medicare data from 2006 to 2015. We used provider preference for glucocorticoids as an instrumental variable (IV) to assess associations between low-dose glucocorticoid use and the risk of infection requiring hospitalization using a cause-specific proportional hazards model.

Results:

We identified 163,603 qualifying treatment episodes among 120,656 patients. Glucocorticoids ≤5 mg/day were used by 25,373/81,802 (31.0%) of patients seen by a rheumatologist with low provider preference for glucocorticoids and by 36,087/81,801 (44.1%) of patients seen by a rheumatologist with high provider preference for glucocorticoids (adjusted odds ratio 1.81, 95% confidence interval 1.77, 1.84 for association between provider preference and glucocorticoids). Chronic obstructive pulmonary disease, opioids, antibiotics, previous emergency department visits, hospitalizations, and infections requiring hospitalization infections were unbalanced with regard to exposure but not to the IV. The incidence of infection requiring hospitalization was 8.0/100 person–years among patients unexposed to glucocorticoids versus 11.7/100 person–years among those exposed. The association between glucocorticoids and infection requiring hospitalization from IV analysis (hazard ratio 1.26 [1.02–1.56]) was similar to results from a standard multivariable model (hazard ratio 1.24 [1.21–1.28]).

Conclusions:

Among patients with RA on stable immunomodulatory therapy, IV analysis based on provider preference demonstrated an increased risk of infection requiring hospitalization associated with low-dose glucocorticoids, similar to a traditional analysis.
CHOROIDAL VASCULARITY INDEX IS ASSOCIATED WITH GEOGRAPHIC ATROPHY PROGRESSION
Authors: Sacconi Riccardo , Battista Marco , Borrelli Enrico , Senni Carlotta , Tombolini Beatrice , Grosso Domenico , Querques Lea , Bandello Francesco , Querques Giuseppe
Published: September 2021

Purpose:

To investigate the correlation between choroidal vascularity index and the enlargement of geographic atrophy (GA) lesion secondary to age-related macular degeneration during the 2-year follow-up.

Methods:

In this longitudinal observational study, 26 eyes (26 patients, mean age 75.7 ± 8.8 years) affected by GA were included. Choroidal vascularity index was calculated in the subfoveal 3000-µm area. The main outcome measure included correlation analysis between baseline choroidal vascularity index and the rate of GA enlargement.

Results:

During the 2-year follow-up, the mean GA area increased from 6.99 ± 5.28 mm2 to 10.69 ± 6.61 mm2(P < 0.001), accounting for a growth rate of 0.35 ± 0.20 and 0.31 ± 0.17 mm/year after the square root transformation in the first and second year of follow-up, respectively. Stromal choroidal area significantly decreased during the 2-year follow-up (P = 0.002). Interestingly, there was a significant correlation between the baseline choroidal vascularity index and the rate of GA enlargement (r=−0.432, P = 0.027) and between stromal choroidal area and the rate of GA enlargement (r = 0.422, P = 0.032). No other significant relationship was disclosed among choroidal parameters with the rate of GA enlargement.

Conclusion:

Choroidal vascularity index impairment is strictly related to the rate of GA enlargement during the 1-year and 2-year follow-up in patients affected by GA. For this reason, choroidal vascularity index could be considered a predictor of GA progression in the clinical setting, and it could be considered as a new potential biomarker in the efficacy evaluation of new GA interventions.
Diabetes Mellitus Type 1 has a Higher Impact on Corneal Endothelial Cell Density and Pachymetry than Diabetes Mellitus Type 2, Independent of Age: A Meta-Regression Model
Authors: Amador-Muñoz Diana Patricia , Conforti Valentina , Matheus Luisa Marina , Molano-Gonzalez Nicolas , Payán-Gómez César
Published: September 2021

Purpose:

Patients with diabetes mellitus (DM) often have keratopathy. However, the compromise of the corneal endothelium in type 1 DM (T1DM) and type 2 DM (T2DM) has so far not been well characterized.

Methods:

We performed a systematic literature search to find articles on humans combining T1DM and/or T2DM and the corneal endothelium. The period was from inception to June 2020. The meta-regression evaluated the role of each type of DM on corneal endothelial cell density (CED) and pachymetry. The statistical models included age as a modulator to discriminate between the normal changes due to age and the effect of the disease and to determine the impact of the disease duration.

Results:

The initial search identified 752 records, of which 17 were included in the meta-regression. Patients with T1DM had, on average, 193 cells/mm2 lesser than control patients (P < 0.00001). Patients with T2DM had 151 cells/mm2 less compared with control patients (P < 0.00001). The loss of corneal endothelial cells was expected because the aging was similar in patients with T1DM and T2DM and their control groups. Patients with T1DM and T2DM showed an increase in pachymetry versus control patients, and in both groups, it was associated with the duration of the disease.

Conclusions:

Both types of DM reduced CED and increased pachymetry. These differences were higher in patients with T1DM versus control patients than patients with T2DM versus control patients. In T1DM, CED reduction was not correlated with the time from diagnosis. In both groups, patients had CED reduction due to aging similar to that of their matched control patients.
Coronavirus Disease 2019 Cluster Originating in a Primary School Teachers’ Room in Japan
Authors: Aizawa Yuta , Shobugawa Yugo , Tomiyama Nobuko , Nakayama Hitoshi , Takahashi Masako , Yanagiya Junko , Kaji Noriko , Ikuse Tatsuki , Izumita Ryohei , Yamanaka Takayuki , Hasegawa Satoshi , Tamura Tsutomu , Saito Reiko , Saitoh Akihiko
Published: September 2021

Background:

School closures are a subject of debate during the present coronavirus disease 2019 (COVID-19) pandemic. Because children are not the main driver of COVID-19 transmission in the community, school education must be prioritized in conjunction with appropriate infection prevention and control measures, as determined by local COVID-19 incidence.

Methods:

We investigated the causes and transmission routes of a primary school cluster of COVID-19 that occurred during November and December 2020 in Niigata, Japan.

Results:

In the cluster, the virus spread among teachers, then from teachers to students, and then to their family members. This primary school cluster comprised 26 infected patients and included teachers (13/33, 39%), students (9/211, 4%), and family members (4/65, 6%). The secondary attack rate from the 3 index teachers to the remaining 30 teachers was 33%; however, the rate to students was only 4%. Factors contributing to cluster formation include the fact that 2 of the index teachers continued working while symptomatic and that the environment and infection prevention measures in the teachers’ room were inadequate.

Conclusions:

To open schools safely and without interruption, adequate measures to prevent COVID-19 infection in schools should be emphasized not only for children but also for teachers and their environment.
Evaluation of ophthalmic surgical simulators for continuous curvilinear capsulorhexis training
Authors: Raval Nilesh , Hawn Vivian , Kim Mimi , Xie Xianhong , Shrivastava Anurag
Published: September 2021

Purpose:

To evaluate performance and assessments by expert surgeons tasked to create a continuous curvilinear capsulorhexis (CCC) on 3 commercially available surgical simulators.

Setting:

Montefiore Medical Center Department of Ophthalmology and Visual Sciences, Bronx, New York.

Design:

Randomized, cross-sectional, comparative study.

Methods:

Expert cataract surgeons (N = 7) were tasked to create a 5.5-mm CCC on 3 surgical simulators (Bioniko, Kitaro, and SimulEYE). Surgeons rated how well each simulator approximated human tissue on a modified Likert scale (1 to 7). Duration, size, and number of forceps grabs were evaluated.

Results:

7 surgeons performed a total of 63 trials. Bioniko required a greater number (6.53 ± 3.14) of forceps grabs for CCC creation than Kitaro (4.90 ± 2.47, P = .01) and SimulEYE (3.90 ± 1.34, P < .0001). Surgeons created the 5.5-mm CCC most accurately on Bioniko and SimulEYE, with the largest mean CCC performed on Kitaro (8.00 ± 0.84) compared with that on Bioniko (5.24 ± 0.60, P < .0001) and SimulEYE (5.11 ± 0.41, P < .0001). Surgeons spent more time (seconds) performing the CCC on Bioniko (41.95 ± 26.70) than that on Kitaro (32.05 ± 14.99, P = .02) and SimulEYE (28.90 ± 15.18, P = .002). Kitaro (4.56 ± 0.84, P < .0001) and SimulEYE (4.19 ± 0.92, P < .0001) were rated as more realistic than Bioniko (1.38 ± 0.80).

Conclusions:

SimulEYE and Kitaro were believed to most closely approximate human capsular tissue, and surgeons performed the CCC fastest on these models. However, surgeons created a 5.5-mm CCC most accurately on SimulEYE and Bioniko. SimulEYE had the best overall performance and fidelity across all studied metrics; however, each simulator demonstrated its own unique advantages and disadvantages. Larger validation studies will help residency programs best use training tools for novice surgeons.
Comparison of different methods to calculate the axial length measured by optical biometry
Authors: Savini Giacomo , Hoffer Kenneth J. , Carballo Laura , Taroni Leonardo , Schiano-Lomoriello Domenico
Published: September 2021

Purpose:

To compare axial length (AL) measurements in long eyes by 2 swept-source optical coherence tomography (SS-OCT) biometers, one based on the group refractive index (IOLMaster 700, Zeiss) and the other based on sum of segments (Argos, Movu Inc.), and compare these measurements with previously published methods to optimize AL.

Setting:

G.B. Bietti Foundation I.R.C.C.S., Rome, Italy.

Design:

Prospective case series.

Methods:

AL was measured with both optical biometers in patients with myopia (AL > 24.0 mm) and compared with the values obtained with Wang-Koch adjustment, polynomial equations for the Holladay 1 and 2 formulas, and Cooke-modified AL (CMAL).

Results:

In 102 eyes of 55 subjects, a statistically significant difference (P < .0001) was found among the 6 AL values. Posttest revealed that Argos measurements (26.90 ± 1.61 mm) were significantly lower compared with those provided by all methods (P < .001) but CMAL, whereas IOLMaster 700 measurements (27.01 ± 1.65) were higher (P < .001). No difference was found between the 2 Holladay equations. CMAL values did not reveal any difference compared with those of the Argos, but a proportional bias showed that in longer eyes, CMAL provided smaller values (P < .0001, r = −0.7221). AL overestimation by the IOLMaster 700 AL compared with the Argos was higher, the longer the eye was (P < .0001, r = 0.6959, r2 = 0.4842).

Conclusions:

The SS-OCT optical biometer based on the group refractive index overestimates AL compared with the device using segmented AL. CMAL provides the measurements closest to those of the device using segmented AL.
Transcriptional and cellular signatures of cortical morphometric remodelling in chronic pain
Authors: Martins Daniel , Dipasquale Ottavia , Veronese Mattia , Turkheimer Federico , Loggia Marco L. , McMahon Stephen , Howard Matthew A. , Williams Steven C.R.
Published: September 2021

Chronic pain is a highly debilitating and difficult to treat condition, which affects the structure of the brain. Although the development of chronic pain is moderately heritable, how disease-related alterations at the microscopic genetic architecture drive macroscopic brain abnormalities is currently largely unknown. Here, we examined alterations in morphometric similarity (MS) and applied an integrative imaging transcriptomics approach to identify transcriptional and cellular correlates of these MS changes, in 3 independent small cohorts of patients with distinct chronic pain syndromes (knee osteoarthritis, low back pain, and fibromyalgia) and age-matched and sex-matched pain-free controls. We uncover a novel pattern of cortical MS remodelling involving mostly small-to-medium MS increases in the insula and limbic cortex (none of these changes survived stringent false discovery rate correction for the number of regions tested). This pattern of changes is different from that observed in patients with major depression and cuts across the boundaries of specific pain syndromes. By leveraging transcriptomic data from Allen Human Brain Atlas, we show that cortical MS remodelling in chronic pain spatially correlates with the brain-wide expression of genes related to pain and broadly involved in the glial immune response and neuronal plasticity. Our findings bridge levels to connect genes, cell classes, and biological pathways to in vivo imaging correlates of chronic pain. Although correlational, our data suggest that cortical remodelling in chronic pain might be shaped by multiple elements of the cellular architecture of the brain and identifies several pathways that could be prioritized in future genetic association or drug development studies.
Flow-diverter stent to manage intracranial aneurysms: A single center experience
Authors: Feng Shao-Wei , Luo Chao-Bao , Lee Chien-Hui , Chang Feng-Chi , Lin Chung-Jung
Published: September 2021

Background:

Endovascular coil embolization is an important method for managing intracranial aneurysms. However, aneurysm coiling may fail or be insufficient in geographically difficult aneurysms. A flow-diverter stent (FDS) is an alternative in these difficult coiling aneurysms. Thus, this study reports the experience and outcome of FDS management of intracranial aneurysms.

Methods:

Over 29 months, FDS treated 125 patients with 163 intracranial unruptured aneurysms. This study enrolled 31 men and 94 women, ranging from 17 to 81 years (mean, 58 years). Clinical data, aneurysm characteristics, and angiographic and clinical outcomes of patients treated by FDS were retrospectively assessed.

Results:

The current study found 151 (93%) aneurysms in the internal carotid artery. Most aneurysms (n = 118; 72%) were small (<7 mm). The mean aneurysm size was 6.2 mm (range, 2–38 mm). Follow-up angiography was available in 53 patients with 74 aneurysms (mean, 13 months). Successful FDS deployment in an ideal position was found in 125 of 130 patients (96%). Complete obliteration (CO) was achieved in 58 aneurysms (78%) in the mean 13-month angiographic follow-up. Smaller aneurysms (<7 mm) had a CO tendency than larger aneurysms (p < 0.01) in midterm follow-up. Seven patients (5.6%) had intraprocedural complications (in-stent thrombosis, three patients; distal embolic, two patients; iatrogenic carotid-cavernous fistula, and subarachnoid hemorrhage, one patient). Two patients (1.6%) suffered from permanent procedure-related morbidity (n = 1) or mortality (n = 1). No late hemorrhagic events or stent displacement occurred during the follow-up period.

Conclusion:

Despite few procedural complications and some pieces of evidence of insufficient aneurismal treatment in a midterm angiographic follow-up, FDS was effective and safe in managing intracranial unruptured aneurysms, particularly in smaller aneurysms, which had better CO than larger ones.
Glycemic control was associated with nonprostate cancer and overall mortalities in diabetic patients with prostate cancer
Authors: Lin Chih-Chung , Wu Ming-Fen , Chang Yen-Lin , Sheu Wayne Huey-Herng , Liou Wen-Shyong
Published: September 2021

Background:

Diabetes mellitus (DM) can worsen the prognosis or survival in prostate cancer (PC) patients. We investigated whether glycemic control impacts mortality in PC patients with existing diabetes.

Methods:

All PC patients with or without preexisting DM were enrolled from 2006 to 2017. Mean hemoglobin A1c (HbA1c) values (<7%, 7%-9%, ≥9%) were used to represent glycemic control. Major outcomes included all-cause, PC-specific, and non-PC mortalities. Statistical analyses were performed using Cox regression models with adjusted mean HbA1c and other related confounders.

Results:

A total of 831 PC patients were enrolled (non-DM group, n = 690; DM group with a record of mean HbA1c values, n = 141). Results showed that the DM group with mean HbA1c level ≥ 9% (n = 14) had significantly increased risk for all-cause and non-PC mortality (hazard ratio [HR], 3.09; 95% CIs, 1.15-8.32; p=0.025 and HR, 5.49; 95% CIs, 1.66-18.16; p = 0.005, respectively), but not for PC-specific mortality (HR, 1.03; 95% CIs, 0.13-8.44; p = 0.975), compared with the non-DM group.

Conclusion:

Our findings indicate that PC patients with DM who had a mean HbA1c level ≥ 9% had higher risks of all-cause and non-PC mortality compared with non-DM subjects. Further large and long-term studies are needed to verify the effect of glycemic control in PC patients with DM.
I’m Just a Person: Self-Labeling Following Sexual Assault
Authors: Graham Amy C. , Knopp Andrea F. , Beers Kymber
Published: September 2021

Objective

The purpose of this study was to examine college women’s self-labeling as a victim or a survivor following a sexual assault and describe the relationship of self-labeling with mental health, self-blame, control over recovery, and help-seeking.

Methods

This cross-sectional study collected data in an online anonymous survey in November and December of 2018. Participants (N = 375) were recruited from two public universities, were 18- to 24-year-old undergraduate students, identified as female, and had experienced a sexual assault since entering college.

Results

Most respondents (46.4%, 174/375) chose labels other than victim or survivor. Statistically significant differences were found between choice of label (survivor, victim, or other) and depression, well-being, characterological self-blame, and perceived control over recovery. Short-answer responses revealed three major themes for alternative labels: choosing no label, normalizing, and seeking congruence.

Conclusion

As when caring for a patient with any diagnosis, nurses and other healthcare providers should see a person—not a patient, a survivor, or a victim.
The German Version of the Satisfaction with Prosthesis Questionnaire: Translation, Adaptation, Reliability, and Validity in Adults with Major Lower-Limb Amputation
Authors: Wahl Beke , Gutenbrunner Christoph , Greitemann Bernhard , Oergel Marcus , Somoza López Diego , Schiller Jörg , Ranker Alexander
Published: September 2021

Introduction

The aim of this study was to translate and cross-culturally adapt the Satisfaction with Prosthesis Questionnaire (SAT-PRO) into German and to evaluate its validity and reliability.

Materials and Methods

The 2-fold forward and backward translations were carried out according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. Subsequently, the German version of the SAT-PRO was administered to 68 patients with major lower-limb amputation (LLA) fitted with a prosthesis. The internal consistency, floor and ceiling effects, item-to-total correlation, and test-retest reliability were determined. In addition, the standard error of the mean (SEM) and minimal detectable change (MDC) were calculated. Convergent construct validity was assessed by correlation to a Numerical Rating Scale for Satisfaction Level (NRS-SAT), the 36-Item Short-Form Health Survey (SF-36), the Rivermead Mobility Index (RMI), and the Medicare Functional Classification Level (K-Levels). Descriptive subgroup analysis included levels of amputation (transtibial vs. transfemoral persons with amputations) and user type (long-term vs. subacute users).

Results

The mean SAT-PRO total score was 32.27 ± 6.89 (77.6%). Internal consistency was high (Cronbach α = 0.88), and reproducibility demonstrated excellent findings with an intraclass correlation coefficient (ICC2,1) of 0.90 (95% confidence interval [CI], 0.84–0.94). Floor or ceiling effects were not detected. Convergent construct validity indicated a strong correlation to the NRS-SAT (r = 0.89), K-Levels (r = 0.66), and RMI (r = 0.52, all with P < 0.001). Moderate to high correlations were shown to all eight domains of the SF-36 (in a range of r = 0.55 [physical function] to r = 0.39 [mental health], all with P < 0.001). MDC was 2.32 (MDC% = 3.4%).

Conclusions

The translation according to ISPOR guidelines and cross-cultural adaptation of the SAT-PRO into German were successfully conducted in the pilot study. The psychometric testing showed high reliability and validity of the German version of the SAT-PRO. Hence, it can be used as an outcome measure to assess a patient's satisfaction with prosthesis in a German-speaking population.

Clinical Relevance Statement

The SAT-PRO can make an important contribution to the treatment of patients with major LLA. The use of objective measurement parameters and guideline-based translation should be applied to increase the validity and comparability of the data.
Learning Curves for Electromagnetic Navigation Bronchoscopy Using CUSUM Analysis
Authors: Toennesen Louise L. , Vindum Helene H. , Risom Ellen , Pulga Alexis , Nessar Rafi M. , Arshad Arman , Christophersen Alice , Konge Lars , Clementsen Paul F.
Published: September 2021

Background:

Electromagnetic navigation bronchoscopy (ENB) is a relatively new and technically demanding procedure for the guidance of bronchoscopic biopsy to help locate small lung lesions. The results in experienced hands are well described. However, we do not know the results in unexperienced hands—in other words, we have no knowledge about how fast you can learn the procedure.

Aim:

The aim of this study was to draw learning curves for beginners in ENB using Cumulated Sum (CUSUM) analysis, a method for quantitative evaluation of the learning curves for clinical procedures.

Methods:

Four operators from 3 centers without prior ENB experience were enrolled. The outcome of consecutive ENB procedures was assessed and classified as either diagnostic or nondiagnostic based on sample adequacy. Learning curves were drawn based on diagnostic yield.

Results:

A total of 215 procedures were assessed. For 2 of the operators (operators 1 and 4), at least 25 to 30 procedures were necessary to obtain competency whereas operators 2 and 3 showed more horizontal learning curves indicating an overweight of diagnostic procedures from the beginning.

Conclusion:

Operators achieve competences in ENB at different paces. This must be taken in account when beginners start to learn the procedure. There is a huge need for a structured educational program and a validated test to determine competences.
Computational Fluid Dynamics Model of Continuous-Flow Total Artificial Heart: Right Pump Impeller Design Changes to Improve Biocompatibility
Authors: Goodin Mark S. , Horvath David J. , Kuban Barry D. , Polakowski Anthony R. , Fukamachi Kiyotaka , Flick Christine R. , Karimov Jamshid H.
Published: September 2021

Cleveland Clinic is developing a continuous-flow total artificial heart (CFTAH). This novel design operates without valves and is suspended both axially and radially through the balancing of the magnetic and hydrodynamic forces. A series of long-term animal studies with no anticoagulation demonstrated good biocompatibility, without any thromboemboli or infarctions in the organs. However, we observed varying degrees of thrombus attached to the right impeller blades following device explant. No thrombus was found attached to the left impeller blades. The goals for this study were: (1) to use computational fluid dynamics (CFD) to gain insight into the differences in the flow fields surrounding both impellers, and (2) to leverage that knowledge in identifying an improved next-generation right impeller design that could reduce the potential for thrombus formation. Transient CFD simulations of the CFTAH at a blood flow rate and impeller rotational speed mimicking in vivo conditions revealed significant blade tip-induced flow separation and clustered regions of low wall shear stress near the right impeller that were not present for the left impeller. Numerous right impeller design variations were modeled, including changes to the impeller cone angle, number of blades, blade pattern, blade shape, and inlet housing design. The preferred, next-generation right impeller design incorporated a steeper cone angle, a primary/splitter blade design similar to the left impeller, and an increased blade curvature to better align the incoming flow with the impeller blade tips. The next-generation impeller design reduced both the extent of low shear regions near the right impeller surface and flow separation from the blade leading edges, while maintaining the desired hydraulic performance of the original CFTAH design.
Evaluation of the activated partial thromboplastin time and its influential factors in ischemic heart disease patients under heparin treatment
Authors: Rezagholizadeh Afra , Adib Zainab-Kubra , Entezari-Maleki Taher
Published: September 2021

This study aimed to detect the defects of the current methods used to monitor unfractionated heparin (UFH) anticoagulant effect and find possible assistive parameters for activated partial thromboplastin time (aPTT) test to improve treatment performance. The required information was gathered from patients’ case records, treatment charts and laboratory reports. Kendall's tau correlation coefficient was calculated for analysing the relationship between variables. The partial least squares (PLS) and the stepwise multiple regression were operated, and the area under the receiver operating characteristic curve (AUC) and the r-squared (r
2) were used to show the analytical ability of the models, respectively. Overall, 102 UFH-receiving ischemic heart disease patients participated in this study. The aPTT value varied from 30 to 95 s (mean ± SD = 44 ± 14). Therapeutic aPTT values were observed in 15% of hospitalization days. The aPTT value showed statistically significant correlations with mean UFH infusion (U/kg/h), age, prothrombin time (PT), smoking, international normalized ratio, haemoglobin (Hgb) and blood triglyceride level. Triglyceride level and PT were efficacious predictors of aPTT value (P < 0.001, r
2 = 0.336). Moreover, blood urea nitrogen (BUN) and blood creatinine (Cr) levels were the best predictors for mortality. The mean BUN/Cr ratio was 18 ± 5 and 25 ± 12 in nonexpired and expired subjects, respectively. If calibrated institution-specific therapeutic aPTT ranges and updated weight-based UFH nomograms get employed, aPTT test, along with the BUN/Cr ratio and Hgb level, as assistive parameters for predicting haemorrhagic incidents, would be near ideal monitoring method in UFH-receiving patients.
Timing of renal-replacement therapy in intensive care unit-related acute kidney injury
Authors: Jeong Rachel , Wald Ron , Bagshaw Sean M.
Published: September 2021

Purpose of review

The optimal timing of renal-replacement therapy (RRT) initiation for the management of acute kidney injury (AKI) in the intensive care unit (ICU) is frequently controversial. An earlier-strategy has biological rationale, even in the absence of urgent indications; however, a delayed-strategy may prevent selected patients from receiving RRT and avoid complications related to RRT.

Recent findings

Previous studies assessing the optimal timing of RRT initiation found conflicting results, contributing to variation in clinical practice. The recent multinational trial, standard vs. accelerated initiation of renal replacement therapy in acute kidney injury (STARRT-AKI) found no survival benefit and a higher risk of RRT dependence with an accelerated compared to a standard RRT initiation strategy in critically ill patients with severe AKI. Nearly 40% of patients allocated to the standard-strategy group did not receive RRT. The Artificial Kidney Initiation in Kidney Injury-2 (AKIKI-2) trial further assessed delayed compared to more-delayed strategies for RRT initiation. The more-delayed strategy did not confer an increase in RRT-free days and was associated with a higher risk of death.

Early preemptive initiation of RRT in critically ill patients with AKI does not confer clear clinical benefits. However, protracted delays in RRT initiation may be harmful.
Serum Levels of PCSK9 Are Increased in Patients With Active Ulcerative Colitis Representing a Potential Biomarker of Disease Activity
Authors: Marinelli Carla , Zingone Fabiana , Lupo Maria Giovanna , Marin Raffaella , D’Incà Renata , Gubbiotti Alessandro , Massimi Davide , Casadei Cesare , Barberio Brigida , Ferri Nicola , Savarino Edoardo
Published: September 2021

Background/Goal:

Ulcerative colitis (UC) is characterized by chronic inflammation and progressive course, with potential extraintestinal complications including cardiovascular mortality. Serum proprotein convertase subtilisin/kexin type 9 (PCSK9) levels have been recently recognized as biomarkers of low-grade inflammation and cardiovascular disease. The aim of our study was to evaluate PCSK9 levels in patients with UC and different degrees of disease activity.

Methods:

We prospectively recruited consecutive patients with UC attending our center at the University Hospital of Padua. Demographics, clinical characteristics, and biochemical data, including PCSK9, high sensitivity C-reactive protein, and fecal calprotectin, were recorded. Moreover, endoscopic procedures were performed in all subjects.

Results:

We included 112 patients with UC (mean age=52.62±12.84 y; 52.62% males). Patients with UC and abnormal fecal calprotectin (≥250 µg/g) and/or C-reactive protein (≥3 mg/L) had greater levels of PCSK9 compared with UC patients with normal fecal calprotectin and high sensitivity C-reactive protein (P=0.03 and 0.005, respectively). Higher endoscopic scores in UC were characterized by greater levels of PCSK9 (P=0.03). Furthermore, we found a positive correlation between PCSK9 levels and fecal calprotectin (r=0.18, P=0.04), endoscopic Mayo Score (r=0.25, P=0.007), and UC-Riley Index (r=0.22, P=0.01). We also found a positive correlation between PCSK9 levels and both total and low-density lipoprotein cholesterol values (P<0.05).

Conclusions:

Serum PCSK9 levels are increased in patients with biochemical and endoscopic evidence of active disease in UC. Further longitudinal studies are necessary to evaluate the role of PCSK9 as a potential biomarker of disease activity and cardiovascular risk in UC.
Significance of validated symptom assessment versus breath testing for malabsorption after lactose load in children
Authors: Sterniste Georg , Hammer Karin , Memaran Nima , Huber Wolf-Dietrich , Hammer Johann
Published: September 2021

Background and objectives

Lactose malabsorption and lactose-induced symptoms are poorly correlated, as shown by breath tests and various symptom assessment methods. Validated assessment is the key to overcome the limitations of biased symptom measurements. We characterized lactose-induced symptoms with the population-specific, validated paediatric carbohydrate perception questionnaire (pCPQ) and their correlation with the history of symptoms (HoS).

Methods

A total of 130 patients with functional gastrointestinal symptoms underwent a lactose hydrogen breath and tolerance test (LBTT) allowing for a diagnosis of malabsorption (M+) and lactose sensitivity (S+). HoS indicative of lactose-induced symptoms (abdominal pain, nausea, bloating, flatulence, diarrhoea) in the 4 weeks preceding the test was determined using a validated questionnaire. The pCPQ was used to score lactose-induced symptoms.

Main results

The LBTT revealed 41 children (31.5%) with lactose malabsorption (M+), 56 (43.1%) with lactose sensitivity (S+) and 24 (18.5%) were M+/S+. Sensitivity correlated with HoS (P < 0.001), regardless of whether malabsorption was detectable. Malabsorption status did not correlate with HoS (NS). The odds of lactose sensitivity significantly increased when abdominal pain [odds ratio (OR) 3.5, confidence interval (CI) 1.6–7.8], nausea (OR 2.3, CI, 1.1–4.9) and flatulence (OR 3.1, CI 1.4–6.8) were reported in the 4 weeks preceding the LBTT. Symptoms after the lactose load were similar for M+/S+ and M−/S+, except for flatulence, which was more frequent in malabsorbers (P < 0.01).

Conclusion

Our findings fit well with the emerging view of the important role of a validated symptom assessment after a lactose load. The determination of symptoms may be more relevant than malabsorption for the clinical outcomes of paediatric patients with lactose-related gastrointestinal symptoms.
Safety and efficacy of sofosbuvir/ledipasvir and sofosbuvir/daclatasvir in the treatment of hepatitis C in patients with decompensated cirrhosis
Authors: El Kassas Mohamed , Abdeen Nermeen , Omran Dalia , Alboraie Mohamed , Salaheldin Mohamed , Eltabbakh Mohamed , Farghaly Rasha , Emadeldeen Mohammed , Afify Shimaa , Sweedy Ahmad , Ghalwash Ahmed , Abbass Amr , Ezzat Sameera , Tahoon Marwa , ELshazly Helmy M. , Hamdy Hassan , Omar Heba
Published: September 2021

Background

Hepatitis C virus (HCV)-related decompensated cirrhosis is a severe life-threatening illness. The safety of direct-acting antivirals (DAAs) has opened a gate of hope for that subgroup of patients who were previously contraindicated for interferon therapy.

Objective

We aimed at the investigation of the safety and efficacy of different DAAs regimens in the treatment of HCV-related decompensated cirrhosis patients, to determine sustained virological response (SVR)12 rates and to analyze the factors associated with response.

Methods

A retrospective, single-center study including HCV-related decompensated cirrhosis patients who received DAAs. Demographic, laboratory and clinical data were analyzed. The SVR12 rate was the primary outcome measure. Secondary outcomes included the predictors of response, changes in the baseline model for end-stage liver disease and child-turcotte-pugh (CTP) scores, and fibroindices (APRI and fibrosis-4 index) at 12 weeks after treatment.

Results

In total, 145 eligible patients (141 with CTP class B and 4 with class C) were enrolled in this study. SVR12 was achieved by 88.06% (118/134) of efficacy population on different DAAs regimens, Treatment was discontinued in 11 patients because of severe side effects without any deaths. Younger age showed a significant positive association with SVR12.

Conclusions

DAAs can be used for the treatment of HCV-related decompensated liver disease, with acceptable SVR12 rates and safety profiles.
Healthcare practitioners’ diagnostic and treatment practice patterns of nonalcoholic fatty liver disease in Poland: a cross-sectional survey
Authors: Hartleb Marek , Mastalerz-Migas Agnieszka , Kowalski Piotr , Okopień Bogusław , Popovic Branko , Proga Katarzyna , Cywińska-Durczak Beata
Published: September 2021

Background

Nonalcoholic fatty liver disease (NAFLD) awareness is low. NAFLD diagnosis and management by gastroenterologists (GEs) and general practitioners (GPs) in Poland were evaluated.

Methods

RESTORE was an observational, noninterventional, retrospective cross-sectional survey performed among GEs and GPs with at least 3 years’ experience. Computer-assisted web interviews were completed. GEs provided information from patient records.

Results

Mean experience was 14.2 (95 GEs) and 22.6 (115 GPs) years. Mean patient numbers with liver disorders consulted per month were 36 (13%; GEs) and 51 (6%; GPs); ~50% were patients with NAFLD. All GEs/GPs used ultrasound; most evaluated transaminases and gamma-glutamyl transferase. More GEs used other imaging techniques and a larger spectrum of laboratory tests than GPs. Physician-identified NAFLD key symptoms were similar for GEs/GPs. GEs noticed less obvious symptoms (abdominal discomfort, drowsiness, fatigability, lack of energy) vs. GPs (abdominal pain/discomfort, dyspepsia). Common comorbidities in NAFLD were similar in GE/GP responses. NAFLD interventions by GEs/GPs (% patients) were diet/lifestyle/pharmacological interventions (54%/59%), diet/lifestyle changes alone (41%/31%) or pharmacological interventions alone (5%/10%). The top three criteria for supportive pharmacological selection were efficacy, tolerability and quality of life improvement for GEs/GPs. The five supportive treatments most commonly prescribed by GEs/GPs were essential phospholipids, ursodeoxycholic acid, timonacic, silybinin/silymarin and ornithine + choline. Information from patient records (n = 380) confirmed GEs responses.

Conclusions

NAFLD is not a silent disease as physicians and patients reported many, albeit nonspecific, symptoms. This cross-sectional survey provides important insights into clinical management of NAFLD by GEs and GPs in Poland.
Gastroparesis
Authors: Cangemi David J. , Lacy Brian E.
Published: September 2021

Purpose of review

This review highlights recent research advances regarding the pathophysiology and treatment of gastroparesis.

Recent findings

Differences in brain activity have been identified on functional MRI imaging in gastroparesis patients with nausea. Abdominal pain is common in patients with gastroparesis and does not correlate with the severity of gastric emptying delay, though may be associated with depression and anxiety. Autonomic dysfunction may play an important role in the pathophysiology of gastroparesis. There is increasing sentiment that gastroparesis should be considered a part of the same spectrum of gastric neuromuscular disorders. The risk of tardive dyskinesia with metoclopramide has likely been significantly overestimated historically. Endoscopic BoTox injection of the pylorus and gastric electrical stimulation remain controversial treatments for gastroparesis. New, highly selective 5-hydroxytryptamine 4 (5-HT4) agonists appear safe and may be effective in improving symptoms of gastric emptying. Long-term data assessing the use of gastric peroral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis suggest durable clinical improvement.

Altered central processing and autonomic dysfunction may be important factors in the pathogenesis of gastroparesis. While the risk of tardive dyskinesia appears much lower than historically advertised, there is increasing hope for novel therapeutics with the advent of new 5-HT4 agonists, neurokinin-1 receptor (N1KR) antagonists, and G-POEM.