bluuebunny/crossref_metadata_2025 huggingface dataset:
Carpometacarpal Ligament Reconstruction, Surgical Technique and Outcomes
Authors: Pecache Monica B. , Tsai Tsu-Min
Published: February 2022

Basal thumb arthritis is a common condition with the earliest stage described as a period of ligament laxity and joint instability, without radiographic signs of arthritis. The condition is usually managed conservatively but a number of individuals can present with persistence of symptoms. We would like to describe our preferred technique for the management carpometacarpal ligament instability and laxity. This technique utilizes a slip of the flexor carpi radialis tendon and offers reconstruction of the intermetacarpal, dorsoradial and anterior oblique ligaments in an anatomic fashion using standard instruments available. The author has performed this technique in 33 patients over a course of 10 years and long-term outcomes of these cases are presented in this paper.
Use of “Repurposed” Drugs in the Treatment of Epithelial Ovarian Cancer
Authors: Goenka Luxitaa , Dubashi Biswajit , Selvarajan Sandhiya , Ganesan Prasanth
Published: February 2022

Epithelial ovarian cancer has poor outcomes with standard therapy and limited options for treatment of recurrent disease. This systematic review summarizes the data on the clinical use of repurposed drugs. We searched for clinical studies using “repurposed” agents for the treatment of ovarian cancer in the following databases: PubMed, clinicaltrials.gov, Clinical Trial Registry of India, European Clinical Trials Registry, and Chinese Clinical Trial Registry. We excluded reviews, preclinical studies, and non-English language studies. We assessed the quality of included studies. The following agents/class of agents were included: statins, hydroxychloroquine, metformin, itraconazole, nonsteroidal anti-inflammatory drugs, vitamin D, proton pump inhibitors, beta-blockers, and sodium valproate. Only one randomized controlled trial investigated metformin, which found no benefit of metformin. However, this had a high risk of bias (no details of randomization). Among the observational studies, 70% were of high quality (Newcastle-Ottawa scale ≥7). Clinical benefit was seen for itraconazole, beta-blockers, metformin, statins, and proton pump inhibitors. Though multiple studies aim to repurpose agents in epithelial ovarian cancer, the most published literature is observational, and none are practice-changing. Given the solid preclinical data regarding the anticancer efficacy of these agents, well-designed clinical trials are urgently required.
Progression of Infective Dermatitis Associated with HTLV-1 to Adult T-Cell Leukemia/Lymphoma—Case Report and Literature Review
Authors: Rosa Bárbara L. , Silva Thadeu S. , Dias Maria A. , Araujo Iguaracyra , Bittencourt Achiléa L.
Published: February 2022

The human T-cell lymphotropic virus type 1 is a retrovirus that may cause severe diseases such as infective dermatitis associated with HTLV-1 (IDH) and adult T-cell leukemia/lymphoma (ATL). IDH is a chronic relapsing infected eczema of childhood, and ATL is a distinct type of peripheral T-cell leukemia/lymphoma, which is classified into the following types: smoldering, primary cutaneous tumoral, chronic, lymphoma, and acute. Progression of IDH to ATL during the course of IDH has been previously reported in 3 young patients, two of them from Bahia (Brazil). We present the case of a 22-year-old man who had IDH since childhood and developed ATL 18 months ago. The lymphoma lesions were superimposed on previously existing IDH lesions (forehead, axillae, umbilical area, and neck) or in areas generally affected by IDH (external genitalia, hypogastrium, groin, and eyelid). Cutaneous lesions in ATL are very frequent, but in this patient, besides infiltrated plaques and papules presented vesicles on the skin corresponding histologically to dilated Pautrier abscesses. Vesicular ATL is a rare condition. This case constitutes a very demonstrative example of the close correlation between IDH and ATL.
Preferentially Expressed Nuclear Antigen in Melanoma Expression in Melanocytic Activation (Melanotic Macule) of the Nail Unit. A Potential Diagnostic Pitfall? A Study of 3 Cases
Authors: Perrin Christophe
Published: February 2022

Recent studies have argued that melanocyte preferentially expressed nuclear antigen in melanoma (PRAME) is a sensitive and specific immunohistochemical marker of melanoma, including acral melanoma. In addition, loss of p16 expression has recently been suggested to have diagnostic utility in acral melanocytic tumors. The purpose of this study was to report PRAME expression in 3 cases of melanocytic activation (MAN). There were 2 men and 1 woman ranging in age at diagnosis from 46 years to 78 years (mean 61, 6 years). All cases involved a single digit. One lesion was in the fingernail (fifth finger), whereas the remaining 2 lesions were in the toenails (hallux). All the patient presented with a longitudinal melanonychia. The width of the lesions varied from 3 mm (2 cases) to 4 mm (1 case). The duration of the lesions before diagnosis varied from 12 to 24 months. Distinction of MAN from melanoma in situ is not always easy. Some morphological misleading features are illustrated in this study: (1) the suprabasal location of matrix melanocytes with long and thick dendrites within the 2–4 germinative cell layers; (2) the microconfluence of 2 melanocytes and rare melanocytes with a relatively large nucleus, however in a general context of melanocyte scarcity; and (3) the occasional nonspecific nuclear microphtalmia-associated transcription factor (MITF) staining of keratogeneous cells. Such staining could suggest a pagetoid spread of melanocytes in the keratogenous zone. PRAME antibody revealed a strong and diffuse staining in all cases. In addition, all cases were p16 negative. In this study, the melanocyte count inferior to 9 melanocytes/mm and the lack of nuclear atypia or confluence of melanocytes permitted a confident diagnosis of MAN. Limitations of our study lie largely in the small number of cases. Despite this, the expression of PRAME in some MAN seems to hamper its diagnostic value in differentiating benign from malignant lesion.
Meningothelial Hamartoma of the Scalp: Clinicopathologic Review of an Unusual Tumor Mimicking a Vascular Neoplasm With Review of Literature
Authors: Li Liping , Merchant Aziz , Ronen Shira , Suster David I.
Published: February 2022

An unusual benign skin lesion is reported in a 19-year-old man with no significant medical history. The lesion had been present since he was an infant and had been slowly enlarging over the past 15 years. The lesion caused pain and discomfort, and the patient underwent an excisional biopsy. Histologic examination showed a subcutaneous lesion with ill-defined borders and peripheral areas of infiltration between adnexal structures. The lesion was composed of small round to ovoid cells embedded in a collagenous stroma with prominent cystic pseudovascular appearing channels causing a pseudopapillary or lymphangitic appearance that mimicked a vascular neoplasm. Immunohistochemistry performed showed positive staining for EMA, progesterone receptor, D2-40, and vimentin within the lesional cells. The tumor cells were negative for cytokeratin AE1/AE3, CD34, CD31, HHV-8, STAT6, SMA, Desmin, S-100, Melan A, and HMB45. A next-generation sequencing study using a hybrid capture-based panel examining 50 commonly mutated genes in human neoplasia was performed and showed no molecular alterations suggesting a nonneoplastic nature. Based on the clinical presentation, histologic features, and results of ancillary studies, the case was diagnosed as a hamartoma of the scalp with meningothelial-like elements. Reported cases of this lesion have behaved in a benign manner; however, as the histologic differential includes low-grade malignant vascular neoplasms such as angiosarcoma, it is important to recognize the salient features of this lesion.
Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism
Authors: Gould Lacey M. , Gordon Amanda N. , Cabre Hannah E. , Hoyle Andrew T. , Ryan Eric D. , Hackney Anthony C. , Smith-Ryan Abbie E.
Published: March 2022

Objectives:

To evaluate body composition, fat distribution, and metabolism at rest and during exercise in premenopausal, perimenopausal, and postmenopausal women.

Methods:

This cross-sectional study in 72 women ages 35 to 60 years evaluated body composition via a fourcompartment model, fat distribution using dual-energy x-ray absorptiometry-derived android to gynoid ratio, metabolic measures via indirect calorimetry, and lifestyle factors using surveys. One-way analyses of variance and one-way analyses of covariance covaried for age and hormone levels (estrogen and progesterone) were used to compare groups.

Results:

Body fat percent was significantly lower in premenopausal than perimenopausal women (mean difference ± standard error: - 10.29 ± 2.73%, P = 0.026) despite similarities in fat mass and fat-free mass between groups (P≥0.217). Android to gynoid ratio was significantly lower in premenopausal than perimenopausal women (MD ± SE: -0.16 ± 0.05 a.u., P = 0.031). Resting energy expenditure was similar between groups (P = 0.999). Fat oxidation during moderate intensity cycle ergometer exercise was significantly greater in premenopausal than postmenopausal women (MD ± SE: 0.09 ± 0.03 g/min, P = 0.045). The change in respiratory exchange ratio between rest and moderate intensity exercise was significantly lower in premenopausal women than peri- (MD ± SE: -0.05 ± 0.03 a.u., P = 0.035) and postmenopausal women (MD ± SE: -0.06 ± 0.03 a.u., P = 0.040). Premenopausal women reported significantly fewer menopause symptoms than peri- (MD ± SE: -6.58 ± 1.52 symptoms, P = 0.002) and postmenopausal participants (MD ± SE: -4.63 ± 1.52 symptoms, P = 0.044), while similarities between groups were observed for lifestyle factors including diet and physical activity (P>0.999).

Conclusions:

Perimenopause may be the most opportune window for lifestyle intervention, as this group experienced the onset of unfavorable body composition and metabolic characteristics.

Video Summary:

http://links.lww.com/MENO/A932.
Where does postmenopausal dyspareunia hurt? A cross-sectional report
Authors: Goetsch Martha F. , Garg Bharti , Lillemon Jen , Clark Amanda L.
Published: March 2022

Objective:

A common symptom of genitourinary syndrome of menopause (GSM) is dyspareunia, attributed to vulvovaginal atrophy. Our objective was to systematically describe the pain characteristics and anatomic locations of tenderness in a cohort with moderate/severe dyspareunia likely due to GSM.

Methods:

This cross-sectional study reports the baseline data of postmenopausal women with dyspareunia screened for an intervention trial of topical estrogen. Postmenopausal women not using hormone therapy who had moderate or severe dyspareunia were eligible if estrogen was not contraindicated. Biopsychosocial assessments were performed using the Vulvar Pain Assessment Questionnaire, and participants underwent a systematic vulvovaginal examination that included a visual assessment and cotton swab testing for tenderness rated using the Numerical Rating Scale (0-10). Vaginal pH and mucosal sensitivity were assessed; pelvic floor muscles and pelvic viscera were palpated for tenderness.

Results:

Fifty-five eligible women were examined between July 2017 and August 2019. Mean age was 59.5 ± 6.8 years, and duration of dyspareunia was 6.2 ± 4.3 years. The mean intercourse pain score was 7.3 ± 1.8, most often described as “burning” and “raw.” Ninety-eight percent had physical findings of vulvovaginal atrophy. Median pain scores from swab touch at the vulvar vestibule (just outside the hymen) were 4 to 5/10, and topical lidocaine extinguished pain. Median vaginal mucosal pain was zero.

Conclusions:

Participants described their pain as “burning” and “dry.” Tenderness was most severe and most consistently located at the vulvar vestibule. Correlating the symptom of dyspareunia with genital examination findings may further our understanding of treatment outcomes for GSM.

Video Summary:

http://links.lww.com/MENO/A916.
Sleep apnea in postmenopausal women is associated with joint pain severity and fatigability: a cross-sectional study
Authors: Odai Tamami , Terauchi Masakazu , Umeki Hidenori , Miyasaka Naoyuki , Somekawa Yoshiaki
Published: March 2022

Objective:

This study aimed to investigate the relationships between sleep apnea parameters and various symptoms in postmenopausal women who had treatment-resistant sleep disorders.

Methods:

The respiratory disturbance index (RDI), the number of times apnea-hypopnea occurred in an hour, and transcutaneous oxygen saturation (SpO2) were monitored during one night of sleep using a portable monitoring device in 51 postmenopausal women who did not have an improved subjective sleep quality with the use of hypnotics. Physical and psychological health statuses and subjective sleep disturbance were evaluated using validated questionnaires, including the Epworth Sleepiness Scale, the Cornell Medical Index, and the Questionnaire for Assessment of Climacteric Syndrome in Japanese Women. The associations between RDI, nadir SpO2 and various symptoms, as well as cardiovascular parameters, such as blood pressure, serum lipid profile, and glucose tolerance, were analyzed separately.

Results:

Among the 51 study participants, seven (13.7%) were diagnosed with obstructive sleep apnea. After adjustment for age, body mass index, and the background factors related to RDI and nadir SpO2, the association remained significant between a higher RDI and joint pain (Questionnaire for Assessment of Climacteric Syndrome in Japanese Women) (standardized partial regression coefficient [β] = 0.423, P 
= 0.016), and between lower nadir SpO2 and fatigability (Cornell Medical Index) (β = –0.472, P 
= 0.007).

Conclusions:

Detailed examination of sleep-disordered breathing is warranted in women with severe joint pain and fatigability.
Assessment and Interpretation of Small or Underpowered Randomized Clinical Trials
Authors: AYALA NINA K. , ROUSE DWIGHT J.
Published: February 2022

The randomized controlled trial has long been recognized as the gold standard of research designs. As small or underpowered trials have become increasingly common in obstetrics and gynecology, it is essential to appraise the trial design and results with a critical eye and understand the limitations of these trials including the potential for selection bias, inability to discriminate uncommon outcomes and the imprecision of point estimates. When small or underpowered trials are designed to be assessed in combination with other trials in high-quality meta-analysis, some of these limitations are minimized.
The Invisible Hand of Industry
Authors: Guo X. Mona , Barber Emma L.
Published: February 2022

Over the last decades, federal funding for medical research has decreased, while industry funding has increased. The majority of clinical trials are now industry funded. Involvement of industry raises documented concerns of reporting and publication bias, data suppression, and conclusions that may more favorably align with funder motivations rather than study results. However, industry involvement may also lead to scientific innovation, efficiency, and a more rapid timeline to bring new developments to patients. Through a careful review of a manuscript, the reader can understand the nature of industry involvement and interpret the results in this context.
The evolving field of Big Data: understanding geographic information systems analysis and its transformative potential in ophthalmic research
Authors: Soares Rebecca Russ
Published: February 2022

Purpose of review

The purpose of this review to is to highlight alternative uses of Big Data in the pursuit of ophthalmologic public health. In particular, we highlight geographic information systems (GIS) analysis as a type of Big Data, summarize various GIS methods, and enumerate sources of geographic data.

Recent findings

The recent implementation of the IRIS Registry Data, has expanded our real-world knowledge of ophthalmology in the United States. Such innovations in Big Data allow us to better define ophthalmic diseases, treatments, and outcomes for underserved individuals and subpopulations. One underutilized source of Big Data entails use of geographic information to evaluate geographic heterogeneity and access across the United States.

GIS and Big Data allow for refined epidemiologic estimates of eye disease for specific communities. In particular, how GIS can enable researchers to examine disparities in access to ophthalmic care is reviewed. GIS best practices and some data sources for GIS in ophthalmology are also summarized.
Translational and clinical advancements in management of proliferative vitreoretinopathy
Authors: Shahlaee Abtin , Woeller Collynn F. , Philp Nancy J. , Kuriyan Ajay E.
Published: February 2022

Purpose of review

Despite advancement in the surgical instrumentation and techniques, proliferative vitreoretinopathy (PVR) remains the most common cause for failure of rhegmatogenous retinal detachment (RRD) repair. This review discusses ongoing translational and clinical advancements in PVR.

Recent findings

PVR represents an exaggerated and protracted scarring process that can occur after RRD. The primary cell types involved are retinal pigment epithelium, glial, and inflammatory cells. They interact with growth factors and cytokines derived from the breakdown of the blood–retinal barrier that trigger a cascade of cellular processes, such as epithelial–mesenchymal transition, cell migration, chemotaxis, proliferation, elaboration of basement membrane and collagen and cellular contraction, leading to overt retinal pathology. Although there are currently no medical therapies proven to be effective against PVR in humans, increased understanding of the risks factors and pathophysiology have helped guide investigations for molecular targets of PVR. The leading therapeutic candidates are drugs that mitigate growth factors, inflammation, and proliferation are the leading therapeutic candidates.

Although multiple molecular targets have been investigated to prevent and treat PVR, none have yet demonstrated substantial evidence of clinical benefit in humans though some show promise. Advancements in our understanding of the pathophysiology of PVR may help develop a multipronged approach for this condition.
Rationale and Development of an OCT-Based Method for Detection of Glaucomatous Optic Neuropathy
Authors: Liebmann Jeffrey M. , Hood Donald C. , de Moraes Carlos Gustavo , Blumberg Dana M. , Harizman Noga , Kresch Yocheved S. , Tsamis Emmanouil , Cioffi George A.
Published: February 2022

A specific, sensitive, and intersubjectively verifiable definition of disease for clinical care and research remains an important unmet need in the field of glaucoma. Using an iterative, consensus-building approach and employing pilot data, an optical coherence tomography (OCT)-based method to aid in the detection of glaucomatous optic neuropathy was sought to address this challenge. To maximize the chance of success, we utilized all available information from the OCT circle and cube scans, applied both quantitative and semiquantitative data analysis methods, and aimed to limit the use of perimetry to cases where it is absolutely necessary. The outcome of this approach was an OCT-based method for the diagnosis of glaucomatous optic neuropathy that did not require the use of perimetry for initial diagnosis. A decision tree was devised for testing and implementation in clinical practice and research that can be used by reading centers, researchers, and clinicians. While initial pilot data were encouraging, future testing and validation will be needed to establish its utility in clinical practice, as well as for research.
Smartphone Gonioscopy With a Magnifying Intraocular Lens: A Cost-effective Angle Imaging Device
Authors: Chandrakanth Prithvi , Chavan Sneha , Verghese Shishir , Gosalia Hirika , Raman Ganesh V. , Shettigar Chandrakanth K. , Narendran Venkatapathy
Published: February 2022

Gonioscopy is an important part of glaucoma diagnosis and management. Imaging and documentation of the anterior chamber angle has been previously performed using slit-lamp–assisted photography or using smartphones with or without an attached macro lens. Smartphones have transformed ophthalmic imaging by virtue of their availability, easy use, and portability. In this report, the authors aim to demonstrate gonio-imaging using a smartphone attached with an intraocular lens which behaves like a macro lens. With the patient in a sitting position or in the supine position, a goniolens is placed on the patient’s cornea. A smartphone with a 10 D intraocular lens attachment over its camera is used to take images or videos of the anterior chamber angle with high magnification. This imaging modality is cost-effective and can be used for screening and photographic documentation of the angle, and can be of immense benefit, especially in primary health care centers.
The Use of Hemoglobin-Based Oxygen Carriers in Ex Vivo Machine Perfusion of Donor Organs for Transplantation
Authors: Lodhi Sirat , Stone John P. , Entwistle Timothy R. , Fildes James E.
Published: February 2022

There has been significant progress in the development of ex vivo machine perfusion for the nonischemic preservation of donor organs. However, several complications remain, including the logistics of using human blood for graft oxygenation and hemolysis occurring as a result of mechanical technology. Recently, hemoglobin-based oxygen carriers, originally developed for use as blood substitutes, have been studied as an alternative to red blood cell–based perfusates. Although research in this field is somewhat limited, the findings are promising. We offer a brief review of the use of hemoglobin-based oxygen carriers in ex vivo machine perfusion and discuss future directions that will likely have a major impact in progressing oxygen carrier use in clinical practice.
Incidence and Prevalence of Intraductal Papillary Mucinous Neoplasms in Individuals With BRCA1 and BRCA2 Pathogenic Variant
Authors: Shah Ishani , Silva-Santisteban Andy , Germansky Katharine A. , Wadhwa Vaibhav , Tung Nadine , Huang Dora C. , Kandasamy Cinthana , Mlabasati Jack , Bilal Mohammad , Sawhney Mandeep S.
Published: February 2022

Background:

The natural history of branch-duct intraductal papillary neoplasm (BD-IPMN) in BRCA1/2 patients is unknown. Our goal was to estimate the incidence and prevalence of BD-IPMN and other pancreatic lesions in BRCA1/2 patients and compare it to that for average-risk individuals.

Methods:

We identified a cohort of BRCA1/2 patients followed at our institution between 1995 and 2020. Medical records and imaging results were reviewed to determine prevalence of pancreatic lesions. We then identified those who had undergone follow-up imaging and determined the incidence of new pancreatic lesions. We categorized pancreatic lesions as low, intermediate, or high-risk based on their malignant potential.

Results:

During the study period, 359 eligible BRCA1/2 patients were identified. Average patient age was 56.8 years, 88.3% were women, and 51.5% had BRCA1. The prevalence of low-risk pancreatic lesions was 14.4%, intermediate-risk 13.9%, and high-risk 3.3%. The prevalence of BD-IPMN was 13.6% with mean cyst size 7.7 mm (range: 2 to 34 mm). The prevalence of pancreatic cancer was 3.1%. Subsequent imaging was performed in 169 patents with mean follow-up interval of 5.3 years (range: 0 to 19.7 y). The incidence of BD-IPMN was 20.1%, with median cyst size 5.5 mm (range: 2 to 30 mm). The incidence of pancreatic cancer was 2.9%. BRCA2 patients were almost 4-times more likely to develop pancreatic cancer than BRCA1 patients, however, there was no difference in incidence or prevalence of BD-IPMN.

Conclusions:

Incidence and prevalence of BD-IPMNs in BRCA1/2 patients was similar to that reported for average-risk individuals. BRCA2 patients were more likely than BRCA1 patients to develop pancreatic cancer but had similar rates of BD-IPMN.
The Attributes and Influence of Individuals Associated With Newly Licensed Registered Nurses in Nurse Residency Programs
Authors: Kiger Christina L. , Draucker Claire B. , Otte Julie L.
Published: February 2022

Nurse residency programs address the preparation–practice gap by improving the confidence and skills of newly licensed registered nurses and increasing retention rates. Little is known about how persons involved in nurse residency programs influence new nurses’ transition to practice. A qualitative descriptive study revealed five attributes of residency program directors, educators, preceptors, mentors, unit leaders, colleagues, and peers that either hindered or facilitated new nurses’ transition to practice. Implications for residency program development are addressed.
Thoracic SMARCA2-deficient But SMARCA4-preserved Tumors With Undifferentiated Morphology Combined With Claudin-4 Negativity
Authors: Iwakoshi Akari , Sasaki Eiichi , Sato Mariko , Sugiyama Keiji , Kogure Yoshihito , Kitagawa Chiyoe , Nishimura Rieko
Published: February 2022

Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a recently recognized tumor characterized by inactivation of SMARCA4, a SWItch/Sucrose NonFermentable chromatin remodeler, detectable by immunohistochemistry. SMARCA4-UT shows undifferentiated or rhabdoid morphology with claudin-4 negativity. However, thoracic undifferentiated tumors with the same histologic features as SMARCA4-UTs but a preserved SMARCA4 expression have so far been underrecognized. We herein report 3 cases of thoracic undifferentiated tumors with isolated loss of SMARCA2 but retained expression of SMARCA4 and SMARCB1. The present tumors were found in 2 men and 1 woman, 40 to 50 years old. All patients were heavy smokers (≥20 pack-years). The tumors were generally large masses located in the mediastinum, lung>chest wall, or lung and composed of relatively monotonous, round to epithelioid cells with variably rhabdoid cells. Immunohistochemically, the tumors showed claudin-4 negativity with variable expression of cytokeratin. All cases showed highly aggressive clinical behavior with overall survival of 2 to 10 months. These SMARCA2-deficient tumors with preserved SMARCA4 expression appeared to be clinicopathologically indistinguishable from SMARCA4-UTs, except for in their SMARCA4 status. This variant may expand the spectrum of SWItch/Sucrose NonFermentable–deficient undifferentiated tumors of the thoracic region beyond SMARCA4-UT.
Clinical Features Associated With Need for Mechanical Ventilation in Children With Guillain-Barré Syndrome: Retrospective Cohort From India
Authors: Randhawa Manjinder Singh , Iyer Rajalakshmi , Bansal Arun , Mukund Bal , Angurana Suresh Kumar , Nallasamy Karthi , Jayashree Muralidharan , Singhi Sunit C. , Singhi Pratibha , Baranwal Arun Kumar , Sankhyan Naveen
Published: February 2022

OBJECTIVES:

To analyze the clinical features associated with the need for mechanical ventilation (MV) in children with Guillain-Barré syndrome (GBS).

DESIGN:

Retrospective cohort study, 2010–2019.

SETTING:

PICU.

PATIENTS:

All children, 1 month to 12 years old, diagnosed with GBS in our single-center PICU.

Intervention:

Retrospective chart and data review.

MEASUREMENTS AND MAIN RESULTS:

Out of 189 children identified with a diagnosis of GBS, 130 were boys (69%). The median (interquartile range [IQR]) age was 6 years (3–9 yr). At admission, the Hughes disability score was 5 (4–5), and cranial nerve palsies were present in 81 children (42%). Autonomic instability subsequently occurred in a total of 97 children (51%). In the 159 children with nerve conduction studies, the axonal variant of GBS (102/159; 64%) predominated, followed by the demyelinating variant (38/189; 24%). All children received IV immunoglobulins as first-line therapy at the time of admission. The median (IQR) length of PICU stay was 12 days (3–30.5 d). Ninety-nine children (52%) underwent invasive MV, and median duration of MV was 25 days (19–37 d). At admission, upper limb power less than or equal to 3 (p = 0.037; odds ratio (OR), 3.5 [1.1–11.5]), lower limb power less than or equal to 2 (p = 0.008; OR, 3.5 [1.4–8.9]), and cranial nerve palsy (p = 0.001; OR, 3.2 [1.6–6.1]) were associated with subsequent need for MV. Prolonged (> 21 d) MV was associated with more severe examination findings at admission: upper limb power less than or equal to 2 (p < 0.0001; OR, 4.2 [2.5–6.9]) and lower limb power less than or equal to 1 (p < 0.0001; OR, 4.5 [2.6–7.9]).

CONCLUSIONS:

In children with GBS, referred to our center in North India, severe neuromuscular weakness at admission was associated with the need for MV. Furthermore, greater severity of this examination was associated with need for prolonged (> 21 d) MV. Identification of these signs may help in prioritizing critical care needs and early PICU transfer.
Risk factors for atrial fibrillation in a multicenter United States clinical cohort of people with HIV infection
Authors: Nance Robin M. , Delaney Joseph A.C. , Floyd James S. , Saag Michael S. , Moore Richard D. , Keruly Jeanne C. , Kitahata Mari M. , Whitney Bridget M. , Mathews W. Chris , Cachay Edward R. , Burkholder Greer , Willig Amanda L. , Eron Joseph J. , Napravnik Sonia , Crane Heidi M. , Heckbert Susan R.
Published: February 2022

To assess atrial fibrillation risk factors in people with HIV, we identified incident atrial fibrillation in a large clinical cohort of people receiving care. Compared with 970 controls without atrial fibrillation, the 97 with adjudicated incident atrial fibrillation were older, less likely Hispanic, and had more coronary disease, heart failure, and chronic obstructive pulmonary disease. In multivariable analysis, nonuse of antiretroviral therapy and prescription of antiretroviral regimens with multiple core agents were associated with increased atrial fibrillation risk.
Contrast Media–Enhanced Breast Computed Tomography With a Photon-Counting Detector
Authors: Berger Nicole , Marcon Magda , Wieler Jann , Vorburger Denise , Dedes Konstantin J. , Frauenfelder Thomas , Varga Zsuzsanna , Boss Andreas
Published: February 2022

Objectives

The aim of this study was to investigate the feasibility, the image quality, and the correlation with histology of dedicated spiral breast computed tomography (B-CT) equipped with a photon-counting detector in patients with suspicious breast lesions after application of iodinated contrast media.

Materials and Methods

The local ethics committee approved this prospective study. Twelve women with suspicious breast lesions found in mammography or B-CT underwent contrast-enhanced spiral B-CT and supplementary ultrasound. For all lesions, biopsy-proven diagnosis and histological workup after surgical resection were obtained including the size of cancer/ductal carcinoma in situ, which were correlated to sizes measured in B-CT. Signal-to-noise ratio and contrast-to-noise ratio were evaluated for tumor, glandular tissue, and fatty tissue.

Results

Of the 12 patients, 15 suspicious lesions were found, 14 were malignant, and 1 benign lesion corresponded to a chronic inflammation. All lesions showed strong contrast media uptake with a signal-to-noise ratio of 119.7 ± 52.5 with a contrast-to-noise ratio between glandular tissue and breast cancer lesion of 12.6 ± 5.9. The correlation of the size of invasive tumors measured in B-CT compared with histological size was significant and strong R = 0.77 (P < 0.05), whereas the correlation with the size of the peritumoral ductal carcinoma in situ was not significant R = 0.80 (P = 0.11).

Conclusions

Contrast-enhanced B-CT shows high contrast between breast cancer and surrounding glandular tissue; therefore, it is a promising technique for cancer detection and staging depicting both soft tissue lesions and microcalcifications, which might be a substantial advantage over breast MRI.
Modified Blair Approach for the Treatment of Mandibular Condyle Fractures
Authors: Özer Cem , Tamer Yusuf , Bayram Burak , Pektaş Zafer Özgür
Published: February 2022

Purpose:

The management of fractures of the condyle of the mandible has been a topic of debate and still no consensus exists in the literature about the most appropriate approach. The objective of this study was to evaluate the efficacy and safety of the modified Blair approach for the open reduction and internal fixation of mandibular condyle fractures.

Methods:

A retrospective study was conducted on 18 patients with 20 mandibular condyle fractures from 2014 to 2020. All patients were treated surgically using the modified Blair approach. Postoperative occlusion status and mouth opening were assessed for treatment outcomes. Also, the rate of complications such as facial nerve paralysis, wound infection, hematoma, salivary fistula, Frey syndrome, and greater auricular nerve paraeesthesia evaluated.

Results:

Seventeen out of 18 patients (94.4%) achieved their original pretraumatic occlusion after the surgery. One patient (5.5%) had postoperative occlusal interference due to premature dental contact. The maximal postoperative interincisal distance was measured with a range between 33 and 41 mm (mean 37.6 mm). One patient (5.6%) had transient facial nerve palsy. Also, salivary fistula developed in 1 (5.6%) patient in the postoperative period.

Conclusion:

The results of this study revealed that the modified Blair approach provides satisfactory clinical outcomes with low complication rates and may offer an alternative, safe, and effective method for open reduction and internal fixation of mandibular condyle fracture.
Anatomical Characteristics of the Anterior Jugular Vein and Its Clinical Relevance
Authors: Lee Dong Hoon , Cho Young-Suk , Jung Wook Hyun , Lim Sang Chul , Nam Kwang Il
Published: February 2022

Introduction:

The anterior jugular vein (AJV) is part of the superficial venous drainage system of the head and neck. Recently, interest in AJV is increasing as various surgical procedures have been developed. The authors conducted a cadaveric study to determine characteristics of AJV in Koreans.

Methods:

A total of 44 cadavers were dissected. Anatomical characteristics were analyzed for 34 cadavers in which AJV was well observed.

Results:

In this study, 21 were males and 13 were females. There were 8 cadavers with only 1 AJV from both sides. There was no significant difference in anatomical characteristics according to gender or AJV variation except for a difference in the length of the neck according to gender. However, it was possible to find a safety zone at the main landmark of the neck that could avoid AJV damage.

Conclusions:

By using this safety zone, it is possible to prevent damage to the AJV and reduce complications during various surgical procedures on the head and neck.
Impact of Infection Control Education on Gastrointestinal Endoscopy Procedural Staff
Authors: Karels Elissa M. , Voss Jo , Arends Robin , Horsley Leann , Andree Elizabeth
Published: February 2022

To date, minimal research has been conducted on proper use of personal protective equipment and hand hygiene within endoscopy. The American Society for Gastrointestinal Endoscopy has developed guidelines for infection control within the endoscopy suite. A practice change based upon these guidelines was implemented. Education was provided to endoscopy procedural staff within a Midwestern hospital based upon the World Health Organization 5 Moments for Hand Hygiene initiative and included personal protective equipment. Knowledge, skills, and attitudes of the participant group were compared from paired pre- to posteducation surveys pertaining to hand hygiene and personal protective equipment. Observation of personal protective equipment use and hand hygiene implementation during procedures was also documented pre- to posteducation. The project results revealed both willingness to implement proper donning and doffing of personal protective equipment and improved technique as evidenced by improved observed technique with the endoscopy suite and moderately improved hand hygiene questionnaire results. Although conducted as a quality improvement project, clinical significance was found via observation following education. These practices can aid in reduction of organism transmission from patients to staff.
The Hidden Impact of Neonatology Boot Camp
Authors: Yang Kesi C. , Hu Helen H. , Ades Anne M.
Published: February 2022

Introduction

Simulation-based boot camps have been evaluated by fellows as an effective way to learn, to improve self-confidence, and to prepare for new responsibilities. However, existing studies do not explore how boot camps may contribute to other critical aspects of trainee development. Our objective was to use qualitative research methodology to characterize trainees' experiences of boot camp and its impact on their professional development.

Methods

This study used a phenomenological framework to explore fellows' experience of boot camp. Semistructured phone interviews were conducted with first-year neonatology fellows after attending the Regional Neonatology Boot Camp. Interviews were transcribed and coded for themes. The authors continually evaluated the coding categories in an iterative process until consensus was reached.

Results

Seventy-seven first-year neonatal-perinatal medicine fellows representing 16 fellowship programs participated in the Regional Neonatology Boot Camp in 2016 and 2017. Fifteen fellows from 10 institutions were interviewed before reaching thematic saturation. Five themes were identified: introspection about starting fellowship, learning to lead and communicate, gaining reassurance from the shared experience, understanding the fellow role, and developing future identity as a neonatologist.

Conclusions

Participation in boot camp enhances fellows' professional identity formation (PIF) by incorporating key aspects of socialization, including role models and mentors, a variety of experiential learning, and opportunities for conscious self-reflection. In designing future boot camp experiences, educators should integrate these elements into the curriculum to support PIF and explicitly state PIF as a learning objective.
The Relationship Between Depression and Pain During Acute Electroconvulsive Therapy and Follow-Up Period for Patients With Treatment-Resistant Depression
Authors: Lin Ching-Hua , Yang Wei-Cheng , Chan Min-Ho , Chen Cheng-Chung
Published: February 2022

Objectives

We explored the relationships between depression and pain during acute electroconvulsive therapy (ECT) and the follow-up period for patients with treatment-resistant depression and concomitant pain.

Methods

During the acute ECT phase, treatment-resistant depression patients (N = 97) were randomized to receive ECT plus agomelatine 50 mg/d, or ECT plus placebo. Depression and pain severities were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), and the pain subscale of the Depression and Somatic Symptoms Scale at baseline, after every 3 ECT treatments, and after acute ECT. If patients achieved response (ie, a ≥ 50% reduction in HAMD-17) or received at least 6 ECT treatments, they were prescribed agomelatine 50 mg/d and participated in a 12-week follow-up trial. The HAMD-17 and pain subscale were assessed at 4-week intervals. Both HAMD-17 and pain subscale scores were converted to T score units to compare the degrees of changes between depression and pain during acute ECT and the follow-up period.

Results

Eighty-two patients completing at least the first 3 ECT treatments entered the analysis. Both HAMD-17 and pain subscale decreased significantly after acute ECT. Changes of HAMD-17 T scores were significantly greater than changes of pain subscale T scores during acute ECT and follow-up period.

Conclusions

Pain changed more slowly than did depression while measuring both during acute ECT and the follow-up period. Pain can, therefore, be considered a separate entity from depression.
Simulated Electroconvulsive Therapy
Authors: McManus Kaitlin R. , Lapid Maria I. , Forester Brent P. , Mueller Martina , Hermida Adriana P. , Nykamp Louis , Harper David G. , Seiner Stephen J. , Sanghani Sohag , Patrick Regan , Gentry Melanie T. , Kung Simon , Leal Janette C. , Johnson Emily K. , Petrides Georgios
Published: February 2022

Objectives

Agitation is the most common behavioral symptom of Alzheimer disease (AD) affecting approximately 40% to 60% of the AD population, yet there are no Food and Drug Administration–approved therapies for the myriad of behavioral or psychological symptoms of dementia. There is growing evidence from naturalistic studies that electroconvulsive therapy (ECT) is a safe and effective treatment for agitation in AD patients who are refractory to pharmacotherapy and behavioral interventions. Despite the existing evidence, ECT remains underused because of stigma, lack of education, and concerns regarding adverse cognitive effects. Randomized controlled clinical trials of ECT are an opportunity to provide high-quality evidence of ECT as a safe and efficacious treatment for agitation in the AD population. We describe the methods for the Electroconvulsive Therapy in Alzheimer's Dementia study, which uses a novel, simulated ECT (S-ECT) control group to conduct a single-blind efficacy study of ECT for the treatment of agitation and aggression in individuals with moderate to severe AD.

Methods

We discuss the rationale, study design, methodology, ethical and practical challenges, and management strategies in using an S-ECT group as the comparator arm in this randomized controlled trial of ECT in AD-related treatment refractory agitation and aggression.

Conclusions

Validation of the safety and efficacy of ECT in patients with advanced AD with refractory agitation and aggression is necessary. This can be accomplished through creative formulation of S-ECT groups that effectively maintain the blind while providing scientific integrity.
Electroconvulsive Therapy Reverses Cerebral Hypoperfusion in a Patient With Psychotic Depression and Catatonia
Authors: Howells David , Rees John , Townsend Rebecca , Kirov George
Published: February 2022

A 72-year-old man suffering with severe depression with psychotic symptoms, marked apathy, and psychomotor retardation was treated with electroconvulsive therapy (ECT) after resistance to treatment with psychotropic medications. His age, comorbidities, and dysexecutive syndrome prompted consideration of a diagnosis of frontotemporal dementia (FTD), and a 99mTechnetium-labeled hexamethyl propylene amine oxime single-photon emission computed tomography (SPECT) brain perfusion scan showed bilateral perfusion defects that were most pronounced in the frontal regions of the brain. The scan was judged to be abnormal and in keeping with a neurodegenerative dementia. We reasoned that the fluctuation in symptoms was inconsistent with a diagnosis of FTD and that his severe depression could be improved with ECT even if he had FTD, so we decided to proceed with this treatment. A course of 12 sessions of ECT resulted in remission of his psychiatric symptoms and improvement in cognitive performance. A repeat SPECT scan 5 weeks after the last ECT demonstrated a substantial improvement in cerebral blood flow, favoring the diagnosis of depression, rather than dementia. Similar case reports from the literature suggest that ECT does reverse brain hypoperfusion in severe cases of depression and catatonia. Clinicians should be aware that abnormal SPECT findings are nonspecific and can be caused by various conditions, including psychiatric illness, and are not necessarily diagnostic of a neurodegenerative disease.
Effect of Modified Bifrontotemporal Electroconvulsive Therapy on Executive Function in Patients With Psychiatric Illness
Authors: Garg Ankita , PJ Pratheesh , Shirahatti Bhargavi
Published: February 2022

Objective

The study was conducted to compare the pre–electroconvulsive therapy (ECT) and post-ECT status of the executive functions of patients and report any deficits found at long-term follow-up. The secondary objective of the study was to compare the performance at executive function tests after ECT with patient characteristics and ECT parameters.

Methodology

In a prospective longitudinal observational study, 50 patients in the age group of 18 to 65 years who were receiving modified bifrontotemporal ECT for the first time and admitted in psychiatry ward of a tertiary care hospital from July 2015 to June 2016 were assessed for executive functions using a neuropsychological battery consisting of digit span forward, digit span backward, spatial span forward, spatial span backward, phonemic verbal fluency test, semantic verbal fluency test, Stroop test, and Wisconsin Card Sorting Test, a day before ECT and then followed up at 3 and 6 months.

Results

Patients' score improved on all the tests of executive function at 3-month follow-up and was significant for some tests. Improvement was sustained for all the tests 6 months after ECT. Number of years of formal education of patients before illness significantly influenced patients' performance on most of the executive function tests after ECT. Younger age of the patient positively influenced patients' performance on digit span forward and backwards and semantic verbal fluency.

Conclusions

There are no executive function deficits 3 to 6 months after brief pulse modified ECT with bilateral electrode placement. A higher premorbid education level is associated with better performance on executive functions after ECT.
Catatonia After COVID-19
Authors: Nikayin Sina , Chaffkin Jessica , Ostroff Robert B.
Published: February 2022

Coronavirus disease 2019 (COVID-19) has affected more than a hundred million people worldwide. In addition to the devastating number of deaths caused by this disease, it can cause significant morbidity in some survivors. The understanding of the morbidity associated with COVID-19 is rapidly evolving. This report describes 3 cases of catatonia associated with COVID-19. Catatonia is easily confused with other forms of delirium but if recognized can be effectively treated. We hope that awareness gained from these cases would help clinicians better recognize and diagnose catatonia following COVID-19 infection.