bluuebunny/crossref_metadata_2025 huggingface dataset:
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN PIGMENTED PARAVENOUS CHORIORETINAL ATROPHY
Authors: Battaglia Parodi Maurizio , Arrigo Alessandro , Chowers Itay , Jarc-Vidmar Martina , Shpigel Michal , Bandello Francesco , Michaelidis Michel
Published: January 2022

Purpose:

To analyze the retino-choroidal vascular characteristics of patients affected by pigmented paravenous chorio-retinal atrophy by means of optical coherence tomography (OCT) angiography.

Methods:

This study was designed as an observational, cross-sectional case series. Multimodal imaging included fundus autofluorescence, structural OCT, and OCT angiography. The quantitative OCT angiography analyses included the calculation of the vessel density and choriocapillaris porosity.

Results:

Overall, 12 patients (24 eyes) affected by pigmented paravenous chorio-retinal atrophy were recruited. Structural OCT of the areas involved by pigmented paravenous chorio-retinal atrophy as visualized on the fundus autofluorescence showed a complete ellipsoid zone and external limiting membrane absence, with thinning of ganglion cell complex, outer nuclear layer, and outer plexiform layer, but associated with the optical partial preservation of the retinal pigment epithelium. Optical coherence tomography angiography quantitative assessment of the retinal regions affected by PPRCA, as visualized by fundus autofluorescence, was characterized by normal vessel density at the level of superficial capillary plexus but significantly altered vessel density of deep capillary plexus and choriocapillaris, with higher choriocapillaris porosity. The presence of macular atrophy was significantly correlated with worse deep capillary plexus and choriocapillaris vessel density values. Furthermore, a statistically significant correlation between the fundus autofluorescence patterns and the retinal vascular status was found.

Conclusion:

Optical coherence tomography angiography quantitative analyses in pigmented paravenous chorio-retinal atrophy demonstrate a specific impairment at the level of the deep capillary plexus, which could in turn bring about a thinning of ganglion cell complex and outer nuclear layer. The alterations at the level of the choriocapillaris and the choroid, in general, could then represent a secondary effect.
UNSUSPECTED CENTRAL VISION DECREASE FROM MACULAR GANGLION CELL LOSS AFTER POSTERIOR SEGMENT SURGERY
Authors: Spaide Richard F.
Published: January 2022

Purpose:

To describe a novel postsurgical complication of circumscribed macula ganglion cell loss as an apparent cause of unsuspected vision loss following posterior segment surgery.

Methods:

Patients were seen in referral and were evaluated with comprehensive examination to include optical coherence tomography and microperimetry.

Results:

All eight patients had a sudden central vision loss following vitrectomy, and many patients suspected the central loss was present even before the eye patch was removed on the first postoperative day. Of the eight patients, one had a vitrectomy with no membrane peeling, whereas the remaining seven had membrane peeling. The mean postoperative visual acuity was 20/200. The mean ganglion cell layer volume was 0.69 µm3 in the involved eye and 1.035 µm3 in the fellow eye (P < 0.001). The global retinal nerve fiber layer thicknesses in the involved and fellow eyes were 81.3 and 90 µm, respectively (P = 0.08). The outer retinal architecture was unremarkable in the involved eyes and did not appear to explain the poor acuity. The ganglion cell layer volume loss was not necessarily associated with retinal nerve fiber layer thicknesses that were in the abnormal range or in optic nerve pallor. Microperimetry showed severe depression of the threshold sensitivities.

Conclusion:

Severe loss of the macular ganglion cells may occur after vitrectomy and is associated with central vision loss. The diagnosis is made by having a high index of suspicion when examining optical coherence tomography B-scan images and by evaluating ganglion cell layer volumes. The frequency of this occurrence is currently unknown.
SCLERAL EXCAVATION AT OBLIQUE MUSCLE INSERTIONS: IMAGING CHARACTERISTICS AND CORRELATION WITH SCLERAL PLAQUES AND SCLEROCHOROIDAL CALCIFICATION
Authors: Cabral Diogo , Fisher Yale L. , Freund K. Bailey
Published: January 2022

Purpose:

To compare the imaging features of lesions showing hyporeflective posterior scleral excavation found near the insertions of the oblique extraocular muscles to the features and the natural course of Cogan scleral plaques.

Methods:

Multimodal imaging with color fundus photography, spectral-domain optical coherence tomography (OCT), swept-source optical coherence tomography, and B-scan ultrasonography.

Results:

A 71-year-old man and an 89-year-old man presented with ring-shaped hypopigmented lesions measuring between 200 μm and 300 μm transversally, and located along the superior vascular arcade and temporal to the fovea. All lesions were identified near the insertion of oblique muscles, with one observed in the temporal macula, and two found along the superotemporal arcades. Enhanced depth imaging-optical coherence tomography showed hyporeflective boat-shaped areas of scleral excavation with reduced choroidal thickness along their margins. B-scan ultrasonography showed the lesions to be intensely reflective with varying degrees of posterior shadowing.

Conclusion:

To our knowledge, this is the first report of excavated hyporeflective scleral lesions found near the oblique muscle insertions. Imaging and clinical data support the diagnosis of a posterior form of Cogan scleral plaque and are consistent with the natural course of this entity.
Telemedicine for Preoperative Evaluation of Upper Eyelid Malposition: Reliability of Diagnosis and Surgical Plan
Authors: Wagner Lilly H. , Fairbanks Aaron M. , Hodge David O. , Bradley Elizabeth A.
Published: January 2022

Purpose:

Outpatient visits and surgeries for nonurgent indications in ophthalmology have intermittently been restricted during the COVID-19 pandemic. Telemedicine services have rapidly gained acceptance during this period, and could improve patient access for routine oculoplastic evaluations in the future. The objective of this study is to investigate interobserver and intraobserver reliability of eyelid and brow position assessment and surgical plan when comparing photography-based and face-to-face evaluation.

Methods:

This was an observational study conducted at a single academic center. Thirty randomly selected patients who had completed an in-office evaluation for chief complaint of “drooping eyelids” between June 2019 and March 2020 were included. Virtual assessment of brow position, dermatochalasis, blepharoptosis, and margin-reflex distance 1 was performed by 2 oculoplastic surgeons based on external photographs, and a surgical plan was formulated. Fraction of agreement and Cohen’s κ were determined to evaluate reliability of the virtual assessment compared to face-to-face examination.

Results:

For 60 eyes from 30 study subjects, diagnostic reliability for observer A was near perfect for brow ptosis, substantial for blepharoptosis and moderate for dermatochalasis (κ = 0.86, 0.67, and 0.57, respectively); for observer B, reliability was moderate for brow and blepharoptosis and substantial for dermatochalasis (0.47, 0.59, and 0.79). Fraction of agreement for blepharoptosis was 94% in eyes where the eyelid margin was visible, and 66% in eyes where the eyelid margin was obscured by overhanging skin. Virtual margin-reflex distance 1 measurements were highly correlated with those obtained face to face (r = 0.77, p < 0.01). Fraction of agreement for surgical plan after virtual examination by observer A/B, respectively, was 100%/94% for brow lift, 90%/87% for blepharoptosis repair and 83%/83% for functional upper blepharoplasty.

Conclusions:

Virtual evaluation of upper eyelid and brow malposition can be performed with acceptable reliability. Co-existing dermatochalasis or brow ptosis may require special photographic technique or video examination to ensure an appropriate diagnosis. A photography-based preliminary surgical plan offers a viable alternative to face-to-face encounters.
Bilateral Enophthalmos as an Unusual Presenting Feature of Non-Hodgkin’s Orbital Lymphoma
Authors: O’Rourke Micheal A. , McKelvie Penelope A. , Hardy Thomas G. , McNab Alan A.
Published: January 2022

Lymphoma is the commonest orbital malignancy. The typical presentation is proptosis or swelling, which warrants imaging and confirmation by tissue biopsy. Enophthalmos is a much rarer clinical sign and if bilateral and symmetrical can often present late. We describe a patient who presented with bilateral enophthalmos and symptomatic, secondary entropion due to bilateral non-Hodgkin’s lymphoma in which orbital fat was replaced by a monoclonal proliferation of small B cells. Low-dose orbital radiotherapy and entropion surgery relieved the patient’s symptoms.
Phacoemulsification with vitreous loss using phacoemulsifier and vitrector concurrently: bimanual-bipedal technique
Authors: Ninomiya Yoshihiko , Fuchihata Mutsumi , Ninomiya Sayuri
Published: January 2022

Vitreous loss is one of the adverse complications that can occur during phacoemulsification. Once vitreous loss is identified, procedural guidelines advise that phacoemulsification be ceased and the probe carefully withdrawn to minimize traction on the vitreous. Bimanual-bipedal technique described in this study holds the phacoemulsification probe in place and inserts the vitrectomy cutter through the pars plana port with the other hand. After removal of vitreous around the phacoemulsification tip, the vitrectomy cutter is switched to a cutting rate of zero. phacoemulsification can then be resumed with the vitrectomy cutter as a retainer of the lens fragments, similar to the hook of bimanual technique. Lens fragments are synergistically retained through aspiration between the vitrectomy cutter and phacoemulsification probe to prevent displacement. The bimanual-bipedal technique may offer a more streamlined and potentially safer approach for phacoemulsification with vitreous loss.
Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure
Authors: Ozasa Neiko , Kato Takao , Morimoto Takeshi , Yaku Hidenori , Yamamoto Erika , Inuzuka Yasutaka , Tamaki Yodo , Kitai Takeshi , Washida Koichi , Seko Yuta , Yoshikawa Yusuke , Sato Yukihito , Motoki Hirohiko , Kuwahara Koichiro , Kimura Takeshi
Published: January 2022

Background

Polypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities.

Objective

The aim of this study was to define the number of medications at hospital discharge and whether it is associated with clinical outcomes at 1 year.

Methods

We evaluated the number of medications in 2578 patients with ADHF who were ambulatory at hospital discharge in the Kyoto Congestive Heart Failure Registry and compared 1-year outcomes in 4 groups categorized by quartiles of the number of medications (quartile 1, ≤ 5; quartile 2, 6–8; quartile 3, 9–11; and quartile 4, ≥ 12).

Results

At hospital discharge, the median number of medications was 8 (interquartile range, 6–11) with 81.5% and 27.8% taking more than 5 and more than 10 medications, respectively. The cumulative 1-year incidence of a composite of death or rehospitalization (primary outcome measure) increased incrementally with an increasing number of medications (quartile 1, 30.8%; quartile 2, 31.6%; quartile 3, 39.7%; quartile 4, 50.3%; P < .0001). After adjusting for confounders, the excess risks of quartile 4 relative to those of quartile 1 remained significant (P = .01).

Conclusions

In the contemporary cohort of patients with ADHF in Japan, polypharmacy at hospital discharge was common, and excessive polypharmacy was associated with a higher risk of mortality and rehospitalizations within a 1-year period. Collaborative disease management programs that include a careful review of medication lists and an appropriate deprescribing protocol should be implemented for these patients.
Reliability and Validity of the State-Trait Hopelessness Scale in a Primarily Rural Population of Adults With Ischemic Heart Disease in the US Great Plains
Authors: Dunn Susan L. , Bomgaars Deb , Van De Griend Kristin M. , Jensen Gwenneth A. , White Lynn L. , Goodyke Madison P. , Luong Anna , Gutierrez-Kapheim Melissa , Tintle Nathan L.
Published: January 2022

Purpose

Hopelessness and rurality are each independently associated with increased mortality in adults with ischemic heart disease (IHD), yet there is no known research examining hopelessness in rural patients with IHD. The authors of this study evaluated the reliability and validity of the State-Trait Hopelessness Scale (STHS) in a primarily rural population of adults with IHD living in West North Central United States (US Great Plains).

Methods

Reliability, concurrent validity, and convergent validity were evaluated for 115 adults hospitalized for IHD. Rural-Urban Commuting Area codes were used to stratify participants by rurality level, with 66% categorized as rural. Principal component analysis was used to examine potential factor structure of the STHS.

Findings

Cronbach α for the State and Trait Hopelessness subscales were 0.884 and 0.903, respectively. Concurrent validity was supported for the State and Trait subscales using the Patient Health Questionnaire-8 (State: r = 0.50, P < .001; Trait: r = 0.35, P < .001). Convergent validity was supported for the State subscale using the Duke Activity Status Index (r = −0.23, P = .013). Principal component analysis showed 2 factors (hopelessness present and hopelessness absent) for the State and Trait subscales, accounting for 63% and 58% of variance, respectively.

Conclusions

Findings support the reliability and validity of the STHS for evaluation of hopelessness in rural adults with IHD in clinical and research settings. Results replicated the same factor structure found in testing of the STHS in a primarily urban sample. Because of the prevalence of hopelessness in rural adults with IHD and association with increased mortality, hopelessness should be assessed during hospitalization and in the recovery period.
Gastric and colonic metastasis from NSCLC
Authors: Catalano Martina , Marini Andrea , Ferrari Katia , Voltolini Luca , Cianchi Fabio , Comin Camilla Eva , Castiglione Francesca , Roviello Giandomenico , Mini Enrico
Published: January 2022

Rationale:

Lung cancer is the most common cause of cancer-related deaths worldwide. Approximately 50% of patients is metastatic at diagnosis and the most common metastatic sites are bone, lungs, brain, adrenal glands, liver, and extra thoracic lymph nodes. The occurrence of gastrointestinal metastasis from lung carcinoma is rare and seems more commonly related to small cell lung cancer compared to non-small cell lung cancer (NSCLC).

Patient information and diagnosis:

A 78-year-old man with completely surgically resected NSCLC and no initial evidence of distant metastases developed colon and gastric metastases 7 months after diagnosis, confirmed by serial radiological examinations and endoscopic biopsies.

Interventions:

The patient was subjected to total gastrectomy with D2 lymph node dissection plus partial colectomy for intraoperative detection of a transverse colon neoformation. Subsequent instrumental imaging showed bilateral lung tumor recurrence, treated with gemcitabine monotherapy for 8 months as first line chemotherapy for lung adenocarcinoma.

Results:

The patient presented complete response to therapy and was disease-free for 4 years.

Lessons:

Colonic and gastric metastasis are very infrequent in NSCLC. The resection of gastrointestinal metastasis may provide benefits in terms of both symptom control and survival in patients properly selected.
Diagnostic value of calcaneal quantitative ultrasound in the evaluation of osteoporosis in middle-aged and elderly patients
Authors: Li Changzhou , Sun Jifeng , Yu Li
Published: January 2022

To study the correlation between calcaneal quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA), and analyze the diagnostic value of calcaneal QUS in the evaluation of middle-aged and elderly osteoporosis.

We assessed bone mineral density (BMD) at the femoral neck and intertrochanteric of left hip and lumbar spine (L1–L4) sites with DXA and QUS parameters of the right and left calcanei in a cohort of 82 patients over the age of 50 years. Using DXA parameters as the gold standard for the diagnosis of osteoporosis, the correlation coefficient between BMD and QUS parameters was calculated. Receiver operating characteristic curve was generated and areas under the curves were evaluated. Cut-off values for QUS were defined.

In men, there was a moderate correlation between calcaneal QUS and proximal femoral BMD (P < .05), but no significant correlation between calcaneal QUS and lumbar BMD (P > .05). In women, calcaneal QUS were moderately correlated with lumbar spine and proximal femoral BMD (P < .05). Using DXA as the gold standard, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of calcaneal QUS in the diagnosis of osteoporosis were 90.2%, 89.2%, 100%, 100%, and 50.0%, respectively. According to the receiver operating characteristic curve, when the QUS T-score of calcaneum was –1.8, the area under the curve was 0.888, the sensitivity was 73.21%, and the specificity was 92.31% (P < .05). When the QUS T-score of calcaneum was –2.35, the sensitivity was 37.2% and the specificity was 100%.

Calcaneal QUS can be used to predict proximal femoral BMD in middle-aged and elderly people, as well as lumbar BMD in women. As a screening method for osteoporosis, calcaneal QUS has good specificity, so it can be recommended to use it as a pre-screening tool to reduce the number of DXA screening. When the QUS T-score of calcaneum is –1.8, it has the greatest diagnostic efficiency for osteoporosis; when the QUS T-score of calcaneum is ≤–2.35, it can be diagnosed as osteoporosis.
Dosimetric comparison between intensity-modulated radiotherapy and volumetric-modulated arc therapy in patients of left-sided breast cancer treated with modified radical mastectomy
Authors: Wang Rui , Shen Jun , Yan Huanhuan , Gao Xitao , Dong Tianfu , Li Shuqin , Wang Peishun , Zhou Jun
Published: January 2022

Volumetric-modulated arc therapy (VMAT) is a novel treatment strategy that protects normal tissues and enhances target volume coverage during radiotherapy.

This study aimed to clarify whether VMAT is superior to intensity-modulated radiotherapy (IMRT) in treatment planning for left-sided breast cancer patients after modified radical mastectomy.

Left-sided breast cancer patients treated with modified radical mastectomy were eligible for analysis. The dose distribution of both planning target volume and organs at risk were analyzed by using dose volume histograms.

Twenty-four patients were eligible for analysis. Both VMAT and IMRT plans were sufficient in planning target volume coverage. In terms of conformity, VMAT was superior to IMRT (P = .034). Dmean, V5, and V10 of the heart were significantly decreased in VMAT plans when compared with IMRT plans. VMAT was as effective as IMRT plans in sparing of other normal tissues. In addition, both the mean number of monitor units and treatment time were significantly reduced when VMAT was compared with IMRT.

VMAT plans was equivalent or superior to IMRT plans in dose distribution, and was associated with slightly advantage in sparing of the heart and coronary arteries. Our analyses suggested VMAT as a preferred option in left-sided breast cancer patients treated with modified radical mastectomy.
Evolution of an invasive ductal carcinoma to a small cell carcinoma of the breast
Authors: Hussain Marya , Abbott Marcia , Zargham Ramin , Pabani Aliyah , Khan Omar F.
Published: January 2022

Rationale:

Small cell carcinoma (SCC) is a rare subtype of breast cancer and presents a complex diagnostic and treatment challenge, due to paucity of data. To the best of our knowledge, most cases of breast SCC reported in the literature describe a de novo breast primary. Our case is unique as it describes the evolution of an invasive ductal carcinoma after treatment into a SCC of the breast.

Patient concerns and diagnosis:

We report a case of a 53-year-old female, lifelong non-smoker, who initially presented with breast mass noted on self examination. Breast and axillary lymph node biopsy demonstrated a hormone receptor positive invasive ductal carcinoma with a metastatic T3 lesion.

Intervention:

She was treated with first-line palbociclib/letrozole with initial clinical response, and at progression was switched to capecitabine with no response. Repeat biopsy of the axillary lesion showed evolution of the tumor into a triple negative breast cancer. She was then treated with third-line paclitaxel and radiation therapy with good initial response. She eventually had further disease progression and presented with a new mediastinal lymphadenopathy causing SVC syndrome. Biopsy of this showed a small cell variant of breast neuroendocrine carcinoma. Due to the evolution of histology in this case, a retrospective review of her initial breast specimen as well as the second biopsy from the axilla was conducted which confirmed that the mediastinal lymphadenopathy was metastatic from the original breast tumor.

Outcomes and lessons:

We speculate that the initial treatment allowed a minority of treatment-resistant neuroendocrine cells to grow and become the dominant face of the tumor. Our patient had an excellent response to carboplatin/etoposide and consolidative locoregional radiotherapy but presented with an early intracranial recurrence. This is a similar pattern of metastases as seen in lung SCC and highlights a potential role for prophylactic cranial irradiation in breast SCC. Further studies are needed to better understand the biology and treatment of breast SCC which continues to present a challenge for clinicians.
Lipid accumulation product as useful predictors of stroke
Authors: Zhang Bing , Wang Xiao , Zhong Li , Wang Yu-Shan
Published: January 2022

Objective:

To investigate the relationship between lipid accumulation index and cerebral hemodynamic integral value in 3264 people undergoing physical examination, so as to analyze the correlation between different lipid accumulation product index (LAP) levels and stroke risk factors.

Methods:

This cross-sectional study was conducted from January to December 2019 on 3264 adults at the age of 19 to 85 living in Urumqi, Xinjiang. The stroke related risk factors were evaluated by the questionnaire survey. The enrolled subjects were divided into Q1 group (n = 817), Q2 group (n = 815), Q3 group (n = 816) and Q4 group (n = 816) according to the quartile site at a low-to-high-score manner.

Results:

The proportion of males was significantly higher than that of females in Q2, Q3, and Q4 groups. The proportion of middle-aged people and the elderly in Q2, Q3, and Q4 groups was significantly higher than that of youths (P < .05). The proportion of patients with history of hypertension, hyperlipidemia, physical inactivity, and smoking, and the levels of systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, high-density cholesterol, low-density cholesterol, triglyceride, body mass index, waist circumference increased with the increase of LAP level in different groups (P < .05). On both sides of the cerebral hemodynamic integral value (CVHI) index, Vmean, Vmax, Vmin showed a decreasing trend whereas peripheral resistance, pulse velocity, Zcv, dynamic resistance, critical pressure level, difference between diastolic and critical pressure showed an increase trend with the increase of LAP level. The normal rate of CVHI in 4 groups (>75 points) was 97.4%, 89.7%, 87.0, and 80.8%, respectively, showing a decreasing trend. Logistic regression results showed that the higher the LAP, the higher the abnormal risk of CVHI.

Conclusion:

There is a positive correlation between LAP and CVHI, the higher the LAP, the higher the risk of CVHI abnormality, which should be concerned seriously.
Can acupuncture improve sleep quality and anxiety among women during perimenopause?
Authors: Ping Yanpei , Liang Chao , Fan Xixi , Zhang Lili , Ying Dashi , Wang Zhongnan
Published: January 2022

Background:

The decrease in estrogen levels during the perimenopausal period can cause women to have various symptoms such as insomnia, emotional anxiety, and even depression. Therefore, whether the green therapy of acupuncture can improve the sleep quality and anxiety of perimenopausal women has attracted more and more attention. The purpose of this systematic evaluation was to assess the efficacy of acupuncture on insomnia and anxiety in perimenopausal women.

Methods:

We will search for clinical observational pilot studies or cohort studies of acupuncture for insomnia, anxiety, or depression included in PubMed, Cochrane Library, Embase, Web of science, China Knowledge Network (CNKI), Wanfang, VIP and China Biomedical Database (CBM), etc. The search period will be from the establishment of the database until November 2021. Two researchers will independently perform literature screening, data extraction, and quality assessment. Finally, data analysis will be performed using Revman and Stata software.

Results:

The purpose of this study was to evaluate the effectiveness and safety of acupuncture therapy for the treatment of insomnia, anxiety, and depression in perimenopausal women.

Conclusion:

This study will provide new evidence on the effectiveness and safety of acupuncture for the treatment of insomnia, anxiety, and depression in perimenopausal women, and provide additional options for clinicians and patients to improve insomnia and anxiety.

Registration Number:

INPLASY2021120012
Discontinuation of methotrexate in rheumatoid arthritis patients achieving clinical remission by treatment with upadacitinib plus methotrexate (DOPPLER study)
Authors: Shimizu Toshimasa , Kawashiri Shin-ya , Sato Shuntaro , Kawazoe Yurika , Kuroda Shohei , Kawasaki Rina , Ito Yasuko , Morimoto Shimpei , Yamamoto Hiroshi , Kawakami Atsushi
Published: January 2022

Background:

The administration of Janus kinase inhibitors as well as biological disease-modifying anti-rheumatic drugs has dramatically improved the clinical outcomes of patients with rheumatoid arthritis (RA). Previous trials have shown that upadacitinib, a Janus kinase inhibitor, can effectively improve disease activity and prevent progression of joint destruction in RA patients with inadequate responses to methotrexate (MTX). It remains unclear whether reduced disease activity can be maintained after discontinuation of MTX in patients treated with upadacitinib plus MTX. Thus, the aim of this study is to evaluate changes in disease activity after administration of upadacitinib plus MTX in RA patients who failed to achieve an adequate response to MTX and to determine whether clinical relapse can be avoided after discontinuation of MTX in those who achieved clinical remission.

Methods/design:

The proposed study is an interventional, multicenter, open-label, single-arm clinical trial with a 48-week follow-up. The cohort will include 155 RA patients with at least moderate disease activity during treatment with MTX. Patients will receive upadacitinib and MTX will be discontinued for those who achieve clinical remission. Disease activity will be evaluated longitudinally by measuring clinical disease activity indices and with musculoskeletal ultrasound (MSUS). The primary endpoint is the proportion of patients who sustain a disease activity score-28- C reactive protein score of ≤3.2 from week 24 to 48 after a disease activity score-28- C reactive protein score of <2.6 at week 24. Important secondary endpoints are changes from baseline MSUS scores. Serum levels of multiple biomarkers, including cytokines and chemokines, will be comprehensively analyzed.

Discussion:

The study results are expected to show the clinical benefit of the discontinuation of MTX after achieving clinical remission by treatment with upadacitinib plus MTX combination therapy. The strength of this study is the prospective evaluation of therapeutic efficacy using clinical disease activity indices and standardized MSUS, which can accurately and objectively evaluate disease activity at the joint level among patients drawn from multiple centers. Furthermore, parameters to predict clinical remission after administration of upadacitinib plus MTX combination therapy and nonclinical relapse after discontinuation of MTX will be screened by integrated multilateral assessments (i.e., clinical disease activity indices, MSUS findings, and serum biomarkers).
Health disparities among Black deaf and hard of hearing Americans as compared to Black hearing Americans
Authors: Perrodin-Njoku Emmanuel , Corbett Carolyn , Moges-Riedel Rezenet , Simms Laurene , Kushalnagar Poorna
Published: January 2022

There is a dearth of literature on health outcomes for Black people who identify as deaf or hard of hearing (DHH). Black DHH individuals generally experience at least 2 types of oppression, racism and audism, both of which contribute to health disparities within the Black and Deaf communities.

To understand the prevalence of health outcomes in a Black DHH adult sample and compare this to a Black hearing sample.

A descriptive cross-sectional study with primary Health Information National Trends Survey (HINTS)- American Sign Language survey data from Black DHH adults and secondary National Cancer Institute-HINTS English survey data from Black hearing adults.

Black DHH adults and Black hearing adults (18 years or older).

Using NCI's health information national trends survey in American Sign Language and English, self-reported data was gathered for all medical conditions as diagnosed by healthcare providers.

The study showed that Black DHH adults had a higher likelihood for diabetes, hypertension, lung disease, cancer, and comorbidity compared to their hearing Black counterparts.

Black DHH adults are at disparity for certain medical conditions compared to the general Black adult population. Future directions are needed to ensure that anti-racist policies include consideration of people with sensory disabilities. Inclusion of cultural and language needs of Black DHH patients in cultural humility training for healthcare providers is recommended to address health disparity in this population.
Does influenza vaccination help reduce incidence of COVID-19 infection among hospital employees?
Authors: Shosha Soha H. , Ajlan Dana I. , Al-Ghatam Rana
Published: January 2022

To facilitate the understanding of the interaction between severe acute respiratory syndrome coronavirus 2 causing the corona virus disease 2019 (COVID-19) and other pathogens causing respiratory system affection we investigated the effect of influenza vaccination on the incidence and severity of COVID-19 among members of staff working in the Bahrain Defense Force Hospital.

All staff members working in the hospital between February 2020 and March 2021 were divided into 2 main groups based on whether or not they received influenza vaccination. None of the participants had received any of the COVID-19 vaccines throughout this time period. The records of each were scrutinized to see the effect of influenza vaccination on incidence and severity of COVID-19. Severity measures were: need for hospital and intensive care unit admission and total length of hospital stay.

Incidence of affection with COVID-19 was much lower in the vaccinated group (3.7% vs 8.1%, P < .001). Influenza vaccination also reduced total length of hospital stay (6.2 days vs 12.7 days, P < .05) and need for intensive care unit admission among the patients.

Influenza vaccine reduces both the incidence of affection as well as the overall burden of COVID-19. This is of particular importance for people working in the healthcare field during the serious COVID-19 pandemic.
Functional evaluation of immunoregulatory molecules HLA-G, galectin-1, and IL-10 in people living with HIV
Authors: Cortelette Natalia Alves , Souza Nayana De Oliveira , Cataldi-Rodrigues Lilian , Arthur Connie , Stowell Sean R. , Dias-Baruffi Marcelo , Guimarães Daniela Amorim Melgaço , Ayres Lorena Rocha , Trés Pancoto João Alexandre
Published: January 2022

Objective(s):

Investigate polymorphisms and expressions of human leukocyte antigen-G (HLA-G), galectin-1 (Gal-1), and interleukin-10 (IL-10) in people living with HIV (PLHIV) with and without comorbidities to help understanding the mechanisms involved in triggering these disorders in PLHIV and in their prognosis.

Design:

Here we evaluated the potential correlation between the genetic polymorphism and/or protein levels of HLA-G, Gal-1, and IL-10 with and without comorbidities of PLHIV.

Methods:

Two hundred HIV patients under antiretroviral treatment (83 with comorbidities and 117 without comorbidities) and 200 healthy individuals (controls) were genotyped, using PCR, for HLA-G 14-base pair polymorphism located at the 3’ untranslated region in exon 8 insertion/insertion (Ins/Ins: low HLA-G expression) or deletion/deletion (Del/Del: high HLA-G expression). Soluble levels of HLA-G (sHLA-G), Gal-1, and IL-10 were quantified by enzyme-linked immunosorbet assay.

Results:

HIV patients without comorbidities exhibited higher frequency of 14-base pair Del/Del genotype than HIV patients with comorbidities. As expected, HIV patients Ins/Ins with and without comorbidities produced less sHLA-G than controls. However, HIV patients Del/Del with comorbidities expressed sHLA-G more than controls and HIV patients Del/Del without comorbidities. Interestingly, patients that showed low levels sHLA-G, and presence of comorbidities, exhibited high Gal-1 serum levels. However, an increase in soluble levels of IL-10 in PLHIV was observed when compared to controls, especially in the PLHIV group without comorbidities suggesting, a protective role of IL-10 in the development of comorbidities.

Conclusions:

These data suggested that the high expression of sHLA-G and IL-10 or Gal-1 could be associated and could be associated with the development or not of comorbidities in PLHIV.
Beliefs about medication and their association with adherence in Chinese patients with non-dialysis chronic kidney disease stages 3–5
Authors: Bai He-He , Nie Xiao-Jing , Chen Xiao-Lin , Liang Ning-Jing , Peng Li-Rong , Yao Yan-Qin
Published: January 2022

There is a scarcity of research into the impact of medication beliefs on adherence in patients with non-dialysis chronic kidney disease (CKD). This study is to determine the psychometric properties of the Chinese version of the Beliefs about Medicines Questionnaire (BMQ)-Specific among patients with non-dialysis CKD stages 3–5, and to assess the beliefs of CKD patients and their association with medication adherence.

A cross-sectional study was conducted in CKD patients who recruited at the nephrology clinics of Xi’an Central Hospital, Xi’an, Shaanxi, China. The original BMQ-Specific was translated into Chinese. The internal consistency and test–retest reliability of the Chinese version of the BMQ-Specific scale were assessed, while exploratory and confirmatory factor analyses were also applied to determine its reliability and validity. The Kruskal–Wallis test and multiple ordered logistic regression were performed to identify the relationship between beliefs about and adherence to medication among CKD patients.

This study recruited 248 patients. Cronbach's α values of the BMQ-Specific necessity and concern subscales were 0.826 and 0.820, respectively, with intraclass correlation coefficients of 0.784 and 0.732. Factor analysis showed that BMQ-Specific provided a good fit to the two-factor model. The adherence of patients was positively correlated with perceived necessity (r = 0.264, P < .001) and negatively correlated with concern (r = –0.294, P < .001). Medication adherence was significantly higher for the accepting group (high necessity and low concern scores) than for the ambivalent group (high necessity and concern scores; β = –0.880, 95% confidence interval [CI] = –1.475 to –0.285), skeptical group (low necessity and high concern scores; β = –2.620, 95% CI = –4.209 to –1.031) and indifferent group (low necessity and concern scores; β = –0.918, 95% CI = –1.724 to –0.112).

The Chinese version of BMQ-Specific exhibited satisfactory reliability and validity for use in patients with non-dialysis CKD stages 3–5 and has been demonstrated to be a reliable screening tool for clinicians to use to predict and identify the non-adherence behaviors of patients.
Tranexamic acid use decreases transfusion rate in children with cerebral palsy undergoing proximal femoral varus derotational osteotomy
Authors: Compton Edward , Goldstein Rachel Y. , Nazareth Alexander , Shymon Stephen J. , Andras Lydia , Kay Robert M.
Published: January 2022

Previous studies demonstrated the safety of tranexamic acid (TXA) use in cerebral palsy (CP) patients undergoing proximal femoral varus derotational osteotomy (VDRO), but were underpowered to determine if TXA alters transfusion rates or estimated blood loss (EBL). The purpose of this study was to investigate if intraoperative TXA administration alters transfusion rates or EBL in patients with CP undergoing VDRO surgery.

We conducted a retrospective review of 390 patients with CP who underwent VDRO surgery between January 2004 and August 2019 at a single institution. Patients without sufficient clinical data and patients with preexisting bleeding or coagulation disorders were excluded. Patients were divided into 2 groups: those who received intraoperative TXA and those who did not.

Out of 390 patients (mean age 9.4 ± 3.8 years), 80 received intravenous TXA (TXA group) and 310 did not (No-TXA group). There was no difference in mean weight at surgery (P = .25), Gross Motor Function Classification System level (P = .99), American Society of Anesthesiologist classification (P = .50), preoperative feeding status (P = .16), operative time (P = .91), or number of procedures performed (P = .12) between the groups. The overall transfusion rate was lower in the TXA group (13.8%; 11/80) than the No-TXA group (25.2%; 78/310) (P = .04), as was the postoperative transfusion rate (7.5%; 6/80 in the TXA group vs 18.4%; 57/310 in the No-TXA group) (P = .02). The intraoperative transfusion rate was similar for the 2 groups (TXA: 7.5%; 6/80 vs No-TXA: 10.3%; 32/310; P = .53). The EBL was slightly lower in the TXA group, although this was not significant (TXA: 142.9 ± 113.1 mL vs No-TXA: 177.4 ± 169.1 mL; P = .09). The standard deviation for EBL was greater in the No-TXA group due to more high EBL outliers. The percentage of blood loss based on weight was similar between the groups (TXA: 9.2% vs No-TXA: 10.1%; P = .40). The number needed to treat (NNT) with TXA to avoid one peri-operative blood transfusion in this series was 9.

The use of intraoperative TXA in patients with CP undergoing VDRO surgery lowers overall and postoperative transfusion rates.

Level of evidence: III, Retrospective Comparative Study.
Comparison of effects of energy based devices on quality of life after sutureless thyroidectomy
Authors: Arikan Akif Enes , Ozyegin Mustafa Ates
Published: January 2022

Objective:

In current literature, no studies evaluated effect of energy-based vessel-sealing-devices on quality of life after sutureless total thyroidectomies. This study aimed to identify any potential differences between two energy-based vessel-sealing-devices (Harmonic Focus, Ligasure LF1212) in patients with benign thyroid disorders who underwent sutureless total thyroidectomy.

Materials and methods:

Differences in quality of life of patients were evaluated using data obtained by Thy-PRO-39-Tr questionnaire prior to and four-week after surgery. Total and domain-based alterations in quality of life were compared between groups according to energy-based vessel-sealing-devices type (Group L, Group H). Additionally, data including demographics, height, weight, body mass index, neck circumference, sternomental distance were collected.

Results:

Of 1032 patients, 200 were eligible for study, at the end 193 were analysed. There were no differences between groups in terms of age, sex, body mass index, tobacco use. Analysis did not reveal any differences in overall quality of life between groups (P = .42). However, in “eye symptoms” (P < .001) and “cognitive functions” (P = .002) domains, Harmonic provided statistically improved quality of life. Effect on cognitive function was greater in patients of advanced age.

Conclusions:

Especially in elderly patients with worsening eye conditions and cognitive functions, use of Harmonic may enhance patients’ outcome by increasing quality of life in addition to optimizing surgical outcome when compared to Ligasure.
Metastases to duodenum in cervical squamous cell carcinoma
Authors: Chen Yihan , Zhang Hao , Zhou Qingjie , Lu Lijie , Lin Jiejun
Published: January 2022

Rationale:

Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature.

Patient concerns:

We present the case of a 66-year-old woman with duodenal metastasis of cervical squamous cell carcinoma who presented with nausea and vomiting within the past 12 days.

Diagnosis:

Esophagogastroduodenoscopy revealed a circular narrowed 2nd part of the duodenum with congested and edematous mucosa, which was biopsied for a suspected neoplastic lesion. The pathological diagnosis indicated squamous cell carcinoma identical to the original tumor, confirming duodenal metastasis.

Interventions:

The patient received total parenteral nutrition on admission, but symptoms of jaundice soon appeared in the following week, suggesting infiltration of carcinoma into the common bile duct. After percutaneous transhepatic cholangial drainage was performed, jaundice eased in the following 3 days, and an uncovered self-expandable metallic stent was subsequently inserted into the stenosis of 2nd and 3rd part of the duodenum. Subsequently, the patient's diet quickly resumed.

Outcomes:

The patient refused further intervention and was discharged home to continue palliative care at the local hospital.

Lessons:

Clinicians should be alert to patients’ past medical history to ensure that duodenal metastasis of other tumors is considered in the differential diagnosis. For endoscopists, awareness of such patterns of duodenal stenosis is vital for the accurate recognition of such infrequent diseases.
Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome patients with erectile dysfunction
Authors: Daneshwar Datesh , Nordin Abid
Published: January 2022

Introduction:

In this study, the efficacy of low intensity shock wave therapy (LSWT) in improving symptoms of chronic pelvic pain syndrome (CPPS) and erectile dysfunction (ED) was investigated.

Methods:

Men diagnosed with CPPS and ED (n = 50) were prescribed with LSWT. The LSWT was administered in 10 sessions over the course of 5 weeks at 3,000 pulses with .25 mJ/mm2 energy flow and 5 Hz frequency. Outcome parameters were measured before and after LSWT.

Results:

Clinical symptoms related to CPPS and ED were measured using four validated questionnaires namely National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function (IIEF), the International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM). The effect of LSWT on each of the three domains of NIH-CPSI, namely Pain, Symptoms, and Quality of Life (QoL) were also analyzed. Uroflowmetry was measured to assess LSWT effect on urine voiding. The mean baseline CPPS symptoms on NIH-CPSI domains of pain, symptoms and QoL were 9.92 ± 5.72 (mean ± SD), 5.14 ± 14.5, and 8.02 ± 3.17, respectively. LSWT resulted in significant reduction of CPPS symptoms on all NIH-CPSI domains (Pain = .9 ± 1.37; Symptoms = .74 ± 1.03; QoL = 1.16 ± 1.78). The baseline means of CPPS symptoms on IIEF, IPSS, and SHIM were 45.42 ± 16.24, 24.68 ± 9.28, and 14.28 ± 6.02, respectively. LSWT significant improved CPPS symptoms on IIEF (49.48 ± 28.30) and IPSS (9.04 ± 7.01) but not on SHIM (16.02 ± 9.85). No statistically significant differences were observed with all uroflowmetry parameters.

Conclusion:

The current study demonstrated for the first time the safety and efficacy of LSWT administered in 10 sessions over 5 weeks in improving symptoms of CPPS and ED without causing any significant adverse effect to the patient.
Primary spindle cell sarcoma of gallbladder
Authors: Long Xin , Chen Yan , Chen Wei-Xun , Wu Yu , Song Jia , Chen Jin , Zhang Lei
Published: January 2022

Introduction:

Primary spindle cell sarcoma of the gallbladder is a rare condition.

Patient concerns:

A 67-year-old woman was admitted to a local hospital with a chief complaint of abdominal pain in the right upper quadrant for the past 2 months.

Diagnosis and intervention:

Surgical resection was performed following the diagnosis of primary gallbladder sarcoma with local hepatic metastasis. Histological examination confirmed a diagnosis of primary spindle cell sarcoma and hepatic metastasis with simultaneous cholecystolithiasis.

Outcomes:

Adjuvant chemoradiation therapy was not performed because the patient refused treatment. Three months after the surgery, a relapsed lesion was diagnosed. The patient underwent transcatheter arterial chemoembolization.

Conclusions:

The disease should be differentially diagnosed from gallbladder carcinoma or carcinosarcoma with hepatic metastasis. An aggressive surgical approach should be based on a balance between the risk of surgery and the outcome.
Safety of the BNT162b2 mRNA COVID-19 vaccine in oncologic patients undergoing numerous cancer treatment options
Authors: Kian Waleed , Zemel Melanie , Kestenbaum Emily H. , Rouvinov Keren , Alguayn Wafeek , Levitas Dina , Ievko Anna , Michlin Regina , Abod Moataz A. , Massalha Ismaell , Chernomordikov Elena , Sharb Adam A. , Shalata Walid , Levison Esther , Roisman Laila C. , Lavrenkov Konstantin , Peled Nir , Nesher Lior , Yakobson Alexander
Published: January 2022

The COVID-19 pandemic, caused by the SARS-CoV2 virus, has infected millions worldwide with cancer patients demonstrating a higher prevalence for severe disease and poorer outcomes. Recently, the BNT162b2 mRNA COVID-19 vaccine was released as the primary means to combat COVID-19. The currently reported incidence of local and systemic side effects was 27% in the general public. The safety of the BNT162b2 mRNA COVID-19 vaccine has not been studied in patients with an active cancer diagnosis who are either ongoing or plan to undergo oncologic therapy.

This single center study reviewed the charts of 210 patients with active cancer diagnoses that received both doses of the BNT162b2 mRNA COVID-19 vaccine. The development of side effects from the vaccine, hospitalizations or exacerbations from various oncologic treatment were documented. Type of oncologic treatment (immunotherapy, chemotherapy, hormonal, biologic, radiation or mixed) was documented to identify if side effects were related to treatment type. The time at which the vaccine was administered in relation to treatment onset (on long term therapy, within 1 month of therapy or prior to therapy) was also documented to identify any relationships.

Sixty five (31%) participants experienced side effects from the BNT162b2 mRNA COVID-19 vaccine, however most were mild to moderate. Treatment protocol was not linked to the development of vaccine related side effects (P = .202), nor was immunotherapy (P = .942). The timing of vaccine administered in relation to treatment onset was also not related to vaccine related side effects (P = .653). Six (2.9%) participants were hospitalized and 4 (2%) died.

The incidence of side effects in cancer patients is similar to what has been reported for the general public (31% vs 27%). Therefore, we believe that the BNT162b2 mRNA COVID-19 vaccine is safe in oncologic patients undergoing numerous cancer treatments.