bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-invasive stimulation of the social brain: the methodological challenges
Authors: Penton Tegan , Catmur Caroline , Banissy Michael J , Bird Geoffrey , Walsh Vincent
Published: July 2020

Use of non-invasive brain stimulation methods (NIBS) has become a common approach to study social processing in addition to behavioural, imaging and lesion studies. However, research using NIBS to investigate social processing faces challenges. Overcoming these is important to allow valid and reliable interpretation of findings in neurotypical cohorts, but also to allow us to tailor NIBS protocols to atypical groups with social difficulties. In this review, we consider the utility of brain stimulation as a technique to study and modulate social processing. We also discuss challenges that face researchers using NIBS to study social processing in neurotypical adults with a view to highlighting potential solutions. Finally, we discuss additional challenges that face researchers using NIBS to study and modulate social processing in atypical groups. These are important to consider given that NIBS protocols are rarely tailored to atypical groups before use. Instead, many rely on protocols designed for neurotypical adults despite differences in brain function that are likely to impact response to NIBS.
Phylogeographic Estimation and Simulation of Global Diffusive Dispersal
Authors: Louca Stilianos
Published: July 2020

The analysis of time-resolved phylogenies (timetrees) and geographic location data allows estimation of dispersal rates, for example, for invasive species and infectious diseases. Many estimation methods are based on the Brownian Motion model for diffusive dispersal on a 2D plane; however, the accuracy of these methods deteriorates substantially when dispersal occurs at global scales because spherical Brownian motion (SBM) differs from planar Brownian motion. No statistical method exists for estimating SBM diffusion coefficients from a given timetree and tip coordinates, and no method exists for simulating SBM along a given timetree. Here, I present new methods for simulating SBM along a given timetree, and for estimating SBM diffusivity from a given timetree and tip coordinates using a modification of Felsenstein’s independent contrasts and maximum likelihood. My simulation and fitting methods can accommodate arbitrary time-dependent diffusivities and scale efficiently to trees with millions of tips, thus enabling new analyses even in cases where planar BM would be a sufficient approximation. I demonstrate these methods using a timetree of marine and terrestrial Cyanobacterial genomes, as well as timetrees of two globally circulating Influenza B clades. My methods are implemented in the R package “castor.” [Independent contrasts; phylogenetic; random walk; simulation; spherical Brownian motion.]
A Summer to Remember
Authors: Kennedy Maureen Shawn
Published: July 2020

Brutal deaths and continued public health risks have many Americans reeling.
Can Exercise Relieve Dysmenorrhea?
Authors: Scruth Elizabeth
Published: July 2020

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.
Ego State Therapy for the Treatment of Grief and Loss After Death
Authors: Sugara Gian S. , Yulianingsih Yulianingsih , Isti’adah Feida N.L. , Adiputra Sofwan , Muhajirin Muhammad , Fadli Rima P. , Ifdil Ifdil
Published: July 2020

Losing a parent causes grief that impacts the development among adolescents. This often leads to self-internalization problems, such as depression and trauma. Without intervention, grief due to parental death may cause various effects over time. This study used a single case research technique with AB design to analyze the effectiveness of ego state therapy in reducing grief. The subjects consist of 2 adolescents living in the Orphanage with prolonged grief disorder. The results of the study showed a decrease in the level of grief during and after treatment. Ego state therapy can be used to improve the conditions of adolescents experiencing grief.
Can You Stall a Baclofen Pump During a Magnetic Rod Lengthening?
Authors: Hardesty Christina K. , Janas Michelle
Published: July 2020

Introduction:

Baclofen pumps are susceptible to magnetic forces because of the internal drug delivery mechanism. Magnetically controlled growing rods, sometimes implanted in the patients who have pumps, are lengthened using a device that generates a magnetic field. No previous study has determined if the external remote controller (ERC) can stall a baclofen pump during a rod lengthening.

Methods:

Two baclofen pumps were placed in proximity to the ERC while it generated a magnetic field. This process was repeated with variations in the distance between pump and ERC, speed (dose) of the pump, lengthening time, and position of the ERC relative to the pump. The presence or absence of a stall was recorded.

Results:

To stall a baclofen pump, the ERC needed to be running consistently for at least 30 mm of lengthening. The pump would not stall if it was >1 cm away from the ERC. The pump was more likely to stall if it was positioned in front of or behind the magnetic field, as opposed to the center of the field.

Discussion:

As long as the baclofen pump is >1 cm away from the ERC, the pump will not stall, regardless of the length of time the ERC generates a magnetic field.
Predictors and Motivation of Preceptors′ Interest in Precepting of Pharmacy Interns—Do We Have a Useful Questionnaire?
Authors: Golić Jelić Ana , Tasić Ljiljana , Odalović Marina , Stoisavljević Šatara Svjetlana , Stojaković Nataša , Marinković Valentina
Published: July 2020

Purpose:

To determine the potential value of an adapted questionnaire to discover the predictors of preceptors' higher interest in precepting pharmacy interns and to evaluate preceptors' motivational factors and incentives for teaching as well as their professional satisfaction.

Method:

A link to the survey study of adapted questionnaire (JSAMPPP) was e-mailed to all pharmacists registered with the Pharmaceutical Chamber of the Republic of Srpska. Pharmacists' demographic and work experience characteristics, their attitudes related to motivation for precepting, value of incentives for precepting, job satisfaction, and influence of interns on pharmacists' professional practice were obtained.

Results:

Half of the preceptors who reported feeling satisfied with their professional life also showed interest in teaching. In addition, teaching pharmacy students positively contributed to the overall job satisfaction of the preceptors. Pharmacy preceptors were found to be most motivated by intrinsic factors. The most valued incentives reported were those related to continuing education.

Conclusions:

The adapted questionnaire has potential value and it revealed the following predictors of preceptors' higher interest in precepting: enjoyment of teaching, satisfaction with professional life, satisfaction as a pharmacy preceptor, and interns' influence on preceptors. These identified predictors can be emphasized to improve pharmacy students' internship experiences, thereby reinforcing the pharmacy profession.
Tranexamic Acid for Melasma Treatment: A Split-Face Study
Authors: Ebrahim Howyda M. , Said Abdelshafy Ahmed , Khattab Fathia , Gharib Khaled
Published: July 2020

BACKGROUND

Melasma is an acquired hyperpigmented skin disorder. Tranexamic acid (TXA) prevents ultraviolet radiation induced pigmentation in melasma through interfering with the plasminogen–plasmin pathway.

OBJECTIVE

This study was conducted to evaluate the therapeutic effect and safety of TXA by intradermal injection versus TXA with microneedling for melasma treatment.

METHODS

Fifty-six female patients with bilateral symmetrical melasma were recruited in a split-face study. All patients received an intradermal injection of TXA on one side of the face, and the other side received TXA with microneedling for 6 sessions at 2 weeks intervals. Clinical efficacy was assessed using a modified Melasma Area Severity Index (mMASI) score at the baseline and after treatment. Global photographs underwent blinded review by 2 dermatologists. Patient self-assessment and satisfaction were recorded.

RESULTS

After the treatment, the mMASI score was significantly reduced compared with the baseline in both treated sides (p < .001). No significant difference between both treated sides (p > .05). Patient satisfaction was higher in the microneedling-treated side than the intradermal-injected side (p < .001). No significant adverse effects were observed in both treated sides.

CONCLUSION

Intradermal injection and microneedling of TXA could be safe and effective in melasma treatment. Microneedling of TXA was significantly more satisfying to the patients.
HMB in the Adolescent: A Review of the Modern Approach to Diagnosis and Management
Authors: OLEKA CHIMSOM , DIETRICH JENNIFER E.
Published: July 2020

Heavy menstrual bleeding in the adolescent is a cause for concern whether occurring acutely or chronically. There are a number of important considerations during the initial presentation that will help guide the practitioner during workup, which ultimately guides management strategies. The cornerstone of management in the adolescent is that of medical therapy (hormonal and nonhormonal), with avoidance of invasive and irreversible measures, as maintenance of fertility is paramount. Ultimately, the majority of adolescents can be successfully managed in the acute setting and transitioned to maintenance therapy for long-term control of heavy menses. Here, we will review the modern approach to this condition as well as tips and tricks for the practitioner.
ULTRAWIDEFIELD PSEUDOCOLOR RETINAL IMAGING VERSUS REAL-COLOR FUNDUS PHOTOGRAPHY FOR DETECTION OF INTRARETINAL PIGMENT MIGRATION IN AGE-RELATED MACULAR DEGENERATION
Authors: Ramtohul Prithvi , Gascon Pierre , Comet Alban , Denis Danièle
Published: July 2020

Purpose:

To compare pseudocolor Optos ultrawidefield (UWF) retinal images with conventional real-color fundus photography (CFP) for detecting macular hyperpigmentary changes in intermediate age-related macular degeneration.

Methods:

This retrospective study included 50 patients diagnosed with intermediate age-related macular degeneration. All patients underwent Optos imaging and CFP. The overall accuracy to visualize hyperpigmentation and its morphologic features was graded by two independent readers using a standardized grid. Structural and en face optical coherence tomography images were correlated with UWF and CFP images to determine spatial correspondence of pigment clumping on fundus images and hyperreflective foci on optical coherence tomography.

Results:

One hundred eyes of 50 patients had hyperpigmentary changes on funduscopic examination and were included. The intragraders and intergraders agreements were high for all measurements (P < 0.001). At least one hyperpigmentary changes within the standardized grid was detected in 93% using CFP and 100% using UWF camera (P = 0.02). The total area of hyperpigmentation measured on UWF images was significantly higher than on CFP images (P < 0.001). There was a significant correlation between the presence of hyperpigmentary changes on both CFP and UWF images and hyperreflective foci on structural optical coherence tomography (P < 0.001).

Conclusion:

Ultrawidefield fundus images allow high detection and accurate quantification of macular hyperpigmentary changes in intermediate age-related macular degeneration compared with conventional CFP.
REFRACTIVE OUTCOMES AFTER SUTURELESS INTRASCLERAL FIXATION OF INTRAOCULAR LENS WITH PARS PLANA VITRECTOMY
Authors: Lee Ramon , Govindaraju Viren , Farley Nathan D. , Abbey Ashkan M. , Stem Maxwell S. , Shields Ryan A. , Wa Christianne A. , Williams George A. , Faia Lisa J. , Hassan Tarek S. , Wolfe Jeremy D.
Published: July 2020

Purpose:

To evaluate the refractive outcomes of sutureless intrascleral fixation of intraocular lens with pars plana vitrectomy.

Method:

A retrospective, consecutive cohort from multiple surgeons of a single center. Primary outcomes included spherical equivalent (SEQ) and change in SEQ (ΔSEQ) from preoperative intraocular lens power calculations. Secondary outcomes included refractive outcomes of fixation at 1.5 mm, 2 mm, and 2.5 mm posterior to the limbus.

Results:

In total, 84 eyes of 80 patients were included. Preoperative logarithm of the minimum angle of resolution visual acuity was 1.21 ± 0.68 (20/320). The mean follow-up time was 2.33 ± 1.36 years. At 3 months, SEQ was −0.50 ± 1.59 D and ΔSEQ was 0.58 ± 1.49 D. At 1 year, SEQ was −0.55 ± 1.32 D and ΔSEQ was 0.39 ± 1.42 D. At the last follow-up, logarithm of the minimum angle of resolution visual acuity was 0.34 ± 0.34 (20/40), SEQ was −0.51 ± 1.44 D, and ΔSEQ was 0.57 ± 1.27 D. There was no difference between SEQ or ΔSEQ throughout follow-up (P = 0.97 and P = 0.96, respectively). At fixation distances more posterior to the limbus, mean ΔSEQ was more hyperopic at 3 months, 1-year, and the last follow-up (P = 0.02, P = 0.01, and P = 0.006, respectively).

Conclusion:

Refractive outcomes for sutureless intrascleral fixation of intraocular lens with pars plana vitrectomy were favorable and showed stability postoperatively. These results may aid surgeons achieve better desired refractive outcomes for this technique.
AQUEOUS HUMOR CYTOKINE LEVELS AND REBOUND MACULAR EDEMA AFTER CONBERCEPT TREATMENT IN PATIENTS WITH CENTRAL RETINAL VEIN OCCLUSION
Authors: Yang Kai-Bo , Sun Xu-Yang , Sun Li-Ping , Li Jun , Liu Zhe-Li , Zhang Han
Published: July 2020

Purpose:

This study aimed to investigate the effect of intravitreal conbercept (IVC) injections on the aqueous humor concentrations of angiogenic and inflammatory cytokines in patients with macular edema (ME) due to central retinal vein occlusion and to determine whether changes in cytokine levels after IVC are associated with the development of rebound ME.

Methods:

Forty-nine patients with ME caused by central retinal vein occlusion were included in this retrospective study. Monthly doses of IVC were administered for three months, followed by a Pro Re Nata dosing regimen. Rebound ME was defined as ≥110% increase in the foveal thickness compared with the baseline. Whenever injections were administered, aqueous humor samples were obtained. Multiplex bead assay was used to measure seven angiogenic and inflammatory cytokines in aqueous humor samples.

Results:

At baseline, patients with central retinal vein occlusion showed significantly higher aqueous humor concentrations of vascular endothelial growth factor, placental growth factor, monocyte chemoattractant protein-1, platelet-derived growth factor-AA, IL-6, IL-8, and IL-12. At 1-month and 2-month follow-up after IVC, significantly decreased concentrations of all cytokines were observed. During the 12-month follow-up period, 6 of the 49 eyes (12.2%) showed rebound ME after IVC. Patients with rebound ME showed significantly elevated levels of inflammatory but not angiogenic cytokines.

Conclusion:

Angiogenic and inflammatory cytokines were overexpressed in patients with ME caused by central retinal vein occlusion. Conbercept treatment influenced the concentrations of various inflammatory cytokines and reduced aqueous vascular endothelial growth factor and placental growth factor concentrations. Rebound ME may occur due to disruption of the balance between angiogenic and inflammatory cytokines and an accompanying excess of inflammatory cytokines but not angiogenic cytokines, after antivascular endothelial growth factor therapy.
Intradural artery dilation during experimentally induced migraine attacks
Authors: Christensen Casper E. , Younis Samaira , Lindberg Ulrich , de Koning Patrick , Tolnai Daniel , Paulson Olaf B. , Larsson Henrik B.W. , Amin Faisal M. , Ashina Messoud
Published: July 2020

The middle meningeal artery is a proposed surrogate marker for activation of trigeminal nociceptors during migraine. Previous studies focused on the extracranial part of the artery; hence, vasoreactivity in the intradural arteries during migraine is unknown. Thirty-four patients with migraine without aura were given sildenafil on one day and calcitonin gene-related peptide on another in double-blind crossover fashion. Patients were scanned with 3.0 T MR angiography before drug administration and again 6 hours later during induced attacks of migraine. We measured circumference of the intradural segment of the middle meningeal artery before and during induced migraine attacks. The middle cerebral and superficial temporal arteries were also examined. Fourteen patients had attacks during the second scan after both study drugs and 11 had a migraine after either one or the other, resulting in a total of 39 attacks included in the final analysis. Mean circumference of the intradural middle meningeal artery at baseline was 3.18 mm with an increase of 0.11 mm during attacks (P = 0.005), corresponding to a relative dilation of 3.6% [95% CI: 1.4%-5.7%]. Middle cerebral artery dilated by 9.4% [95% CI: 7.1%-11.7%] and superficial temporal artery by 2.3% [95% CI: 0.2%-4.4%]. Our study shows that the intradural middle meningeal artery and the middle cerebral artery are dilated during migraine induced by calcitonin gene-related peptide as well as sildenafil. We propose that intradural vasculature is affected by migraine-driven activation of trigeminal afferents during migraine attacks.
Trigeminal neuralgia diffusivities using Gaussian process classification and merged group tractography
Authors: Chen David Qixiang , Zhong Jidan , Chu Powell P.W. , Fei Li Cathy Meng , Hodaie Mojgan
Published: July 2020

Imaging of trigeminal neuralgia (TN) has demonstrated key diffusion tensor imaging-based diffusivity alterations in the trigeminal nerve; however, imaging has primarily focused on the peripheral nerve segment because of previous limitations in reliably segmenting small fiber bundles across multiple subjects. We used Selective Automated Group Integrated Tractography to study 36 subjects with TN (right-sided pain) and 36 sex-matched controls to examine the trigeminal nerve (fifth cranial nerve [CN V]), pontine decussation (TPT), and thalamocortical fibers (S1). Gaussian process classifiers were trained by scrolling a moving window over CN V, TPT, and S1 tractography centroids. Fractional anisotropy (FA), generalized FA, radial diffusivity, axial diffusivity, and mean diffusivity metrics were evaluated for both groups, analyzing TN vs control groups and affected vs unaffected sides. Classifiers that performed at greater-than-or-equal-to 70% accuracy were included. Gaussian process classifier consistently demonstrated bilateral trigeminal changes, differentiating them from controls with an accuracy of 80%. Affected and unaffected sides could be differentiated from each other with 75% accuracy. Bilateral TPT could be distinguished from controls with at least 85% accuracy. TPT left–right classification achieved 98% accuracy. Bilateral S1 could be differentiated from controls, where the affected S1 radial diffusivity classifier achieved 87% accuracy. This is the first TN study that combines group-wise merged tractography, machine learning classification, and analysis of the complete trigeminal pathways from the peripheral fibers to S1 cortex. This analysis demonstrates that TN is characterized by bilateral abnormalities throughout the trigeminal pathway compared with controls and abnormalities between affected and unaffected sides. This full pathway tractography study of TN demonstrates bilateral changes throughout the trigeminal pathway and changes between affected and unaffected sides.
Increasing Pump Speed During Exercise Training Improves Exercise Capacity in Children with Ventricular Assist Devices
Authors: Burstein Danielle S. , Mcbride Michael G. , Rossano Joseph W. , O’Connor Matthew J. , Lin Kimberly Y. , Mascio Christopher E. , White Rachel , Iacobellis Katherine , Rosenthal Tami , Paridon Stephen M.
Published: July 2020

Exercise rehabilitation during pediatric ventricular assist device (VAD) support aims to improve musculoskeletal strengthening while awaiting heart transplantation (HT). This study aimed to determine whether increasing VAD pump speed during exercise testing and training improves exercise capacity. A single-center cohort study was performed comparing changes in exercise capacity on serial cardiopulmonary exercise testing (CPET) after exercise training at a fixed VAD pump speed (historical cohort from 2014 to 2017) compared with a prospective cohort (2017–2019) who underwent increasing pump speed during exercise training. All children were supported with intracorporeal continuous-flow VAD. Four subjects (13 ± 2.8 years) were included in the historical cohort, and 6 subjects (14 ± 1.7 years) were enrolled in the prospective cohort. Ninety percent had dilated cardiomyopathy, and one had single ventricle Fontan physiology. Baseline maximal oxygen consumption (VO2) was 19 ± 6.3 ml/kg/min. After exercise training with increased pump speed, there was substantial improvement in aerobic capacity (maximal VO2 increased 42% vs. decreased 3%, respectively) and working capacity (maximal work increased 49% vs. 13%, respectively) compared with fixed pump speed. There were no adverse events reported in either the fixed or increased pump speed cohorts. Increasing VAD pump speed during exercise training results in substantial improvement in both physical working and aerobic capacity compared a fixed pump speed in children on VAD support regardless of single or biventricular ventricle physiology. Further study of a larger cohort is needed to validate these findings to improve the approach to pediatric cardiac rehabilitation in this population.
Use of pulse contour technology for continuous blood pressure monitoring in pediatric patients
Authors: Alharash Hussam , Hossain Md Jobayer , Bhattacharjee Abhishek , Levenbrown Yosef
Published: July 2020

Objectives

This study evaluates the accuracy of continuous blood pressure monitoring using pulse contour technology with the ClearSight monitoring device, a noninvasive alternative to placing an invasive arterial line, in pediatric patients.

Methods

Children younger than 18 years admitted to a pediatric ICU, who required an arterial line, and fit into the ClearSight finger cuff were included. Blood pressure measurement for systolic, diastolic, and mean arterial pressures (MAP) obtained by the ClearSight device were compared with those obtained with the intra-arterial catheter as well as automated cuff measurements using the mixed-effects model. Analysis was conducted for entire cohort, and measurements obtained with and without vasopressor use.

Results

There were 213 measurements from 10 patients. There was a statistically significant difference in systolic blood pressure when comparing arterial line and ClearSight systolic and diastolic measurements between the two methods (P < 0.001). There was no statistical difference between arterial MAP and ClearSight MAP (P = 0.957). Results were similar when ClearSight measurements were compared with automated cuff measurements. Both the vasopressor use and nonvasopressor use groups showed a statistically significant difference between arterial and ClearSight measurements for systolic and diastolic pressures, but not for the MAP.

Conclusions

Measurements of MAP obtained by the ClearSight device were almost identical to those obtained by the intra-arterial catheter. Although there was a difference in systolic blood pressures between the two methods, in those patients receiving inotropic support, the difference was within the range of what is considered acceptable in validating blood pressure devices.
Molecular profiling in sarcoidosis
Authors: Arger Nicholas K. , O’Connor Brian , Koth Laura L.
Published: July 2020

Purpose of review

Sarcoidosis is a systemic disease characterized by granulomatous inflammation of unknown cause. There is extensive heterogeneity between patients with respect to the number and types of organs involved, disease course, and response to therapy. Recent research in the field has leveraged ‘omics’ techniques such as transcriptomics to identify important ‘molecular profiles’ in the disease. These tools may help in identifying clinically useful biomarkers and targets for therapy.

Recent findings

Several studies have used gene expression profiling of predesignated lists or the entire genome to find genes and markers that differentiate sarcoidosis from healthy controls, but only a few have compared sarcoidosis patients based on disease phenotypes and organ involvement. The common gene pathways that have been repeatedly identified include those related to the interferon response, T-cell receptor signaling, and the major histocompatibility complex.

While the molecular profiling studies to date offer the ability to compare sarcoidosis and health as well as across tissues, further longitudinal studies that include sarcoidosis patients with varying outcomes with respect to organ involvement and response to treatment are needed to identify clinically important phenotypes in the disease that can then be differentiated based on molecular features.
Contemporary evaluation and management of tall cell variant of papillary thyroid carcinoma
Authors: Cartwright Sara , Fingeret Abbey
Published: July 2020

Purpose of review

The purpose of this review is to describe the contemporary evaluation and management of tall cell variant of papillary thyroid carcinoma with an emphasis on the clinical features.

Recent findings

Tall cell variant of papillary thyroid carcinoma is the most common aggressive subtype. Within the last few years, the diagnostic criteria for this entity have evolved. Studies have elucidated a better understanding of the clinical implications and pathophysiology of this variant. In this review, the studies presented reflect cumulative and aggregated data from metaanalyses, systematic reviews, and large database investigations utilizing the current diagnostic criteria.

Overall, tall cell variant of papillary thyroid carcinoma represents an aggressive subtype of well-differentiated thyroid carcinoma with more prevalent high-risk features and a poorer clinical outcome.
Secretion of severe acute respiratory syndrome coronavirus 2 in urine
Authors: Brönimann Stephan , Rebhan Katharina , Lemberger Ursula , Misrai Vincent , Shariat Shahrokh F. , Pradere Benjamin
Published: July 2020

Purpose of review

Despite the plethora of publications discussing the severe respiratory coronavirus 2 (SARS-CoV-2), evidence of viral secretion in urine is sparse.

Recent findings

We could identify 34 publications including a total of 2172 patients. Among those, 549 patients were tested for SARS-CoV-2 secretion in urine, which was detected in only 38 patients (6.9%). Within the seven studies displaying positive results, the majority of positive patients (86.8%) was from not yet peer-reviewed studies including weak data and heterogeneous techniques for sample testing. Furthermore, none of the studies available in the literature addressed the virulence of detected viral RNA in urine.

Overall, only seven studies were able to detect SARS-CoV-2 secretion in urine, all of them with a considerably low rate of positivity. However, these studies were of rather low quality considering their methodology. Despite this, as SARS-CoV-2 has been detected in urine, it is of importance to discuss safety and urinary hygiene protocols. Until further research provides valid data on viral shedding and virulence in urine, potential risk of transmission through urine cannot be ruled out. Therefore, safety and hygiene measures need to be discussed.
Radiographic Pneumonia in Febrile Infants 60 Days and Younger
Authors: Florin Todd A. , Ramilo Octavio , Hoyle John D. , Jaffe David M. , Tzimenatos Leah , Atabaki Shireen M. , Cohen Daniel M. , VanBuren John M. , Mahajan Prashant , Kuppermann Nathan ,   for the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
Published: July 2020

Objective

Few prospective studies have assessed the occurrence of radiographic pneumonia in young febrile infants. We analyzed factors associated with radiographic pneumonias in febrile infants 60 days or younger evaluated in pediatric emergency departments.

Study Design

We conducted a planned secondary analysis of a prospective cohort study within 26 emergency departments in a pediatric research network from 2008 to 2013. Febrile (≥38°C) infants 60 days or younger who received chest radiographs were included. Chest radiograph reports were categorized as “no,” “possible,” or “definite” pneumonia. We compared demographics, Yale Observation Scale scores (>10 implying ill appearance), laboratory markers, blood cultures, and viral testing among groups.

Results

Of 4778 infants, 1724 (36.1%) had chest radiographs performed; 2.7% (n = 46) had definite pneumonias, and 3.9% (n = 67) had possible pneumonias. Patients with definite (13/46 [28.3%]) or possible (15/67 [22.7%]) pneumonias more frequently had Yale Observation Scale score >10 compared with those without pneumonias (210/1611 [13.2%], P = 0.002) in univariable and multivariable analyses. Median white blood cell count (WBC), absolute neutrophil count (ANC), and procalcitonin (PCT) were higher in the definite (WBC, 11.5 [interquartile range, 9.8–15.5]; ANC, 5.0 [3.2–7.6]; PCT, 0.4 [0.2–2.1]) versus no pneumonia (WBC, 10.0 [7.6–13.3]; ANC, 3.4 [2.1–5.4]; PCT, 0.2 [0.2–0.3]; WBC, P = 0.006; ANC, P = 0.002; PCT, P = 0.046) groups, but of unclear clinical significance. There were no cases of bacteremia in the definite pneumonia group. Viral infections were more frequent in groups with definite (25/38 [65.8%]) and possible (28/55 [50.9%]) pneumonias than no pneumonias (534/1185 [45.1%], P = 0.02).

Conclusions

Radiographic pneumonias were uncommon, often had viruses detected, and were associated with ill appearance, but few other predictors, in febrile infants 60 days or younger.
Uncommon Complication of Pediatric Umbilical Hernia-Spontaneous Evisceration
Authors: Chouikh Taieb , Echaieb Anis , Belkhir Dahmane , Audry Georges , Raquillet Claire
Published: July 2020

The umbilical hernia is common in children. Most of the cases have a spontaneous regression around the age of 3 years. Complications are very rare, and thus surgery is not routinely indicated before the age of 3 years. We report an exceptional case of spontaneous rupture of an umbilical hernia with emphasis on the management of this rare complication and a literature review of similar cases.
Effects of High-Frequency Neuronavigated Repetitive Transcranial Magnetic Stimulation in Fibromyalgia Syndrome
Authors: Bilir Ibrahim , Askin Ayhan , Sengul Ilker , Tosun Aliye
Published: July 2020

Objective

The primary aim of the study was to investigate the effect of 10-Hz repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex on pain in fibromyalgia. Secondary aims were to determine its effects on stiffness, fatigue, quality of life, depression/anxiety, and cognitive functions.

Design

Twenty participants were randomized into two groups. Group A received 10-Hz repetitive transcranial magnetic stimulation to left dorsolateral prefrontal cortex and group B received sham stimulation. Visual analog scale for pain, visual analog scale–stiffness, Fibromyalgia Impact Questionnaire, and Fatigue Severity Scale were assessed at the baseline, 2nd, and 6th weeks, whereas Hospital Anxiety Depression Scale and Addenbrooke’s cognitive examination were assessed at the baseline and 6th week.

Results

There was no significant difference in visual analog scale–pain and Fatigue Severity Scale within and between groups over time (P > 0.05). In group A, significant improvement was found in visual analog scale–stiffness and fibromyalgia impact questionnaire at the 2nd week in comparison to the baseline (P < 0.05). However, no significant difference was detected in comparison with group B. There was no significant change in Hospital Anxiety Depression Scale scores between and within groups. All cognitive measures were similar in terms of differences from baseline between the groups (P > 0.05).

Conclusions

High-frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex did not show any significant beneficial effect on pain, stiffness, fatigue, quality of life, mood, and cognitive state over sham stimulation.
Influence of Pulse Waveform and Frequency on Evoked Torque, Stimulation Efficiency, and Discomfort in Healthy Subjects
Authors: Rabello Rodrigo , Fröhlich Matias , Maffiuletti Nicola Angelo , Vaz Marco Aurélio
Published: July 2020

Objective

The aim of the study was to determine the influence of neuromuscular electrical stimulation pulse waveform and frequency on evoked torque, stimulation efficiency, and discomfort at two neuromuscular electrical stimulation levels.

Design

This is a repeated measures study. The quadriceps muscle of 24 healthy men was stimulated at submaximal (neuromuscular electrical stimulationsub) and maximal (neuromuscular electrical stimulationmax) levels using two pulse waveforms (symmetrical, asymmetrical) and three pulse frequencies (60, 80, 100 Hz). Repeated measures analysis of variance and effect sizes were used to verify the effect of pulse waveform and pulse frequency on stimulation efficiency (evoked torque/current intensity) and discomfort and to assess the magnitude of the differences, respectively.

Results

Stimulation efficiency was higher for symmetrical (neuromuscular electrical stimulationsub = 0.88 ± 0.21 Nm/mA; neuromuscular electrical stimulationmax = 1.27 ± 0.46 Nm/mA) compared with asymmetrical (neuromuscular electrical stimulationsub = 0.77 ± 0.21 Nm/mA; neuromuscular electrical stimulationmax = 1.02 ± 0.34 Nm/mA; P ≤ 0.001; effect size = 0.56–0.66) but did not significantly differ between frequencies (P = 0.17). At both neuromuscular electrical stimulation levels, there were no statistically significant differences in discomfort between pulse waveforms or frequencies.

Conclusions

The higher stimulation efficiency of symmetrical pulses suggests that this waveform would be preferred to asymmetrical pulses in clinical practice. Stimulation frequencies between 60 and 100 Hz can be used interchangeably because of similar efficiency and discomfort.
Comparison of Ultrasound-Guided Local Ozone (O2-O3) Injection Versus Corticosteroid Injection in Patients With Mild to Moderate Carpal Tunnel Syndrome
Authors: Forogh Bijan , Mohamadi Hossein , Fadavi Hamid Reza , Madani Seyed Pezhman , Aflakian Negar , Ghazaie Fateme , Babaei-Ghazani Arash
Published: July 2020

Objective

Recently, ozone injection has been used to treat various musculoskeletal diseases. This study was performed to compare ultrasound-guided corticosteroid versus ozone injections in the treatment of carpal tunnel syndrome.

Design

Forty patients with mild to moderate carpal tunnel syndrome were enrolled and randomly placed in one of the two groups of receiving a corticosteroid or ozone injection under ultrasound guidance. To determine the effectiveness of both injection techniques and compare their outcomes, visual analog scale and scores of Boston Carpal Tunnel Questionnaire, as well as ultrasound and electrodiagnostic criteria, were followed at 0, 6, and 12 wks after the injection.

Results

Both groups showed improvement in visual analog scale and Boston Carpal Tunnel Questionnaire at week 6, and this improvement continued until the 12th week after the injections. However, electrodiagnostic values of sensory nerve action potentials and compound motor action potentials latency, and ultrasound carpal tunnel syndrome criteria showed significant improvement only among the subjects in the corticosteroid group at 6 and 12 wks after the injection (P < 0.05).

Conclusions

Ozone might be as effective as corticosteroid injection in reducing pain and improving the function. Objective improvements in electrodiagnostic and ultrasound criteria of carpal tunnel syndrome were shown only among patients after corticosteroid injection.
Feasibility and Efficacy of Cardiopulmonary Rehabilitation After COVID-19
Authors: Hermann Matthias , Pekacka-Egli Anna-Maria , Witassek Fabienne , Baumgaertner Reiner , Schoendorf Sabine , Spielmanns Marc
Published: July 2020

The COVID-19 pandemic affects a large number of patients with a rapid progression of respiratory failure often requiring hospitalization or intensive care unit treatment in some patients. Survivors of severe COVID-19 experience persistent weakness and cardiorespiratory failure. Feasibility and potential benefit of cardiopulmonary rehabilitation after COVID-19 remains unclear. Therefore, we retrospectively analyzed a cohort of COVID-19 patients in a single-center inpatient rehabilitation clinic and describe performance and outcome during cardiopulmonary rehabilitation.

Patients were referred from acute care hospitals for rehabilitation after severe COVID-19. The cohort (N = 28) was divided in ventilated or not ventilated patients for further analysis. Fifty percent were female, the mean age was 66 yrs, and patients stayed in the acute hospital for 19.3 ± 10.7 days before referral for cardiopulmonary rehabilitation. Seventeen patients (61%) needed previous intensive care unit treatment in the acute care hospital. Risk factors, assessments, and questionnaires on admission were comparable in both groups. Significant enhancements were observed in 6-min walking test and feeling thermometer, which were independent of previous ventilation status.

In conclusion, comprehensive cardiopulmonary rehabilitation after COVID-19 is safe, feasible, and effective. Improvements in physical performance and subjective health status were independent of previous ventilation.
Cancer Drugs in Asian Populations
Authors: Goh Boon-Cher , Lim Jeremy Fung-Yen
Published: July 2020

Accessibility to effective cancer treatments is a goal of Universal Health Coverage; yet, achieving this in the context of escalating costs in a diversity of Asian nations with different socioeconomic development is extremely challenging. Value-based assessments within the context of each health care system, financing infrastructure that will facilitate appropriate prioritization of high-cost medications, transparency in international pricing and reducing out-of-pocket costs through national insurance programs are measures that Asian countries should take toward Universal Health Coverage for cancer care. Encouraging sharing data on pricing through the World Health Organization, sharing expertise in health technology assessments and regulatory approvals, and exploring bulk negotiations would also strengthen the process of price control. For each individual country, rational selection of national cancer formulary, aiming at price reduction and sound procurement strategies for each drug, is important toward ensuring affordable access to quality cancer medications.
Interventional Pharmacoeconomics
Authors: Goldstein Daniel A. , Strohbehn Garth W. , Serritella Anthony V. , Hyman David A. , Lichter Allen S. , Ratain Mark J.
Published: July 2020

The increasing cost of health care is a major challenge around the world, but particularly in the United States. One reason for increased costs is the rapidly rising cost of oncology drugs. Potential solutions to this problem involve broad changes to health policy. However, an alternative solution is the development of lower-cost off-label treatment regimens, based on pharmacologic rationale, with significant potential economic impact. The pharmacologic and clinical properties of many drugs allow for a variety of different strategies. We describe this approach of interventional pharmacoeconomics and provide multiple individual examples.
HIV-associated plasmablastic lymphoma in the era of HAART: a single-center experience of 21 patients
Authors: Mai Brenda , Wang Wei , Lin Mei , Hu Shimin , Wang Xiaohong I. , Chen Lei , Wahed Amer , Nguyen Andy , Ma Hillary Y. , Medeiros L. Jeffrey , Hu Zhihong
Published: July 2020

Objectives:

Patients with HIV infection have an increased risk of developing plasmablastic lymphoma (PBL). In this study, we reviewed the clinicopathologic features of PBL in HIV+ patients in the era of HAART from a single health center.

Design:

Retrospective study.

Methods:

The morphologic, immunophenotypic, and clinical features were reviewed in these HIV+ patients with PBL and univariate analysis was employed to determine the survival prognosis.

Results:

During the interval of 1 January 2008 to 30 December 2018, we identified 95 HIV+ patients with aggressive non-Hodgkin B-cell lymphomas. Among these patients, there were 21 (22%) patients with PBL (19 men and two women; median age: 45 years). Seven patients had PBL at their initial HIV diagnosis and 14 developed PBL after a median interval of 7.7 months of HIV diagnosis. Lymph nodes (n = 10), oral cavity/sinonasal mass (n = 6), and rectal masses (n = 5) were the common involved sites, and five of 15 (33%) had bone marrow involvement. Lymphoma cells were immunoreactive for MUM-1/IRF4 (100%), CD138 (90%), CD45 (63%), CD79a (47%), and CD30 (25%). Proliferation rate assessed by Ki67 was at least 90% in 18 of 20 cases. Eighteen patients received chemotherapy including etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (n = 13) and cyclophosphamide, doxorubicin, vincristine, and prednisone (n = 2). With a median follow-up time of 19 months, nine out of 17 patients died. Bone marrow involvement was associated with a poorer overall survival (median: 4.7 months, P = 0.015).

Conclusion:

PBL is the second most common type of aggressive lymphoma and often presents in lymph nodes of patients with poorly controlled HIV infection. Bone marrow involvement is associated with a poorer outcome.
Hounsfield's Legacy
Authors: Wildberger Joachim Ernst , Prokop Mathias
Published: July 2020

Computed tomography (CT) has evolved over decades, offering superb morphologic imaging with isotropic resolution at rapid acquisition times. The latest developments in hardware, such as photon-counting and ultrahigh-resolution detectors, together with breakthroughs in software technology have further improved spatial and temporal resolution while steadily reducing radiation exposure. These achievements enable CT for functional imaging and make high-quality imaging more accessible through workflow automation. Radiomics, integrated diagnostics, and data science will further push CT applications beyond their current limits.
Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction
Authors: Rasilainen Suvi , Mentula Panu , Salminen Paulina , Koivukangas Vesa , Hyöty Marja , Mäntymäki Leena-Mari , Pinta Tarja , Haikonen Jyrki , Rintala Jukka , Rantanen Tuomo , Strander Tapani , Leppäniemi Ari
Published: July 2020

BACKGROUND

Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with limited number of comparative studies. The present study was done to examine risk factors for failed delayed primary fascial closure (DPFC) and risk factors for mortality in patients treated with OA.

METHODS

This study was a multicenter retrospective analysis of the hospital records of all consecutive patients treated with OA during the years 2009 to 2016 at five tertiary referral hospitals and three secondary referral centers in Finland.

RESULTS

Six hundred seventy-six patients treated with OA were included in the study. Vacuum-assisted closure with continuous mesh-mediated fascial traction (VACM) was the most popular TAC method used (N = 398, 59%) followed by VAC (N = 128, 19%), Bogota bag (N = 128, 19%), and self-designed methods (N = 22, 3%). In multivariate analysis, enteroatmospheric fistula and the number of needed TAC changes increased the risk for failed DPFC (odds ratio [OR], 8.9; 95% confidence interval [CI], 6.2–12.8; p < 0.001 and OR, 1.1; 95% CI, 1.0–1.3; p < 0.001, respectively). Instead, VACM and ruptured abdominal aortic aneurysm as cause for OA both decreased the risk for failed DPFC (OR, 0.1; 95% CI, 0.0–0.3; p < 0.001 and OR, 0.2; 95% CI, 0.1–0.7; p = 0.012). The overall mortality rate was 30%. In multivariate analysis for mortality, multiorgan dysfunction (OR, 2.4; 95% CI, 1.6–3.6; p < 0.001), and increasing age (OR, 4.5; 95% CI, 2.0–9.7; p < 0.001) predicted increased mortality. Institutional large annual patient volume (OR, 0.4; 95% CI, 0.3–0.6; p < 0.001) and ileus and postoperative peritonitis in comparison to severe acute pancreatitis associated with decreased mortality (OR, 0.2; 95% CI, 0.1–0.4; p < 0.001; OR, 0.5; 95% CI, 0.3–0.8; p = 0.009). Kaplan-Meier analysis showed increased survival in patients treated with VACM in comparison with other TAC methods (LogRank p = 0.019).

CONCLUSION

We report superior role for VACM methodology in terms of successful primary fascial closure and increased survival in patients with OA.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.
Predictors of Dementia in the Oldest Old
Authors: Jia Yichen , Chang Chung-Chou H. , Hughes Tiffany F. , Jacobsen Erin , Wang Shu , Berman Sarah B. , Kamboh M. Ilyas , Ganguli Mary
Published: July 2020

Background:

Incidence of dementia increases exponentially with age; little is known about its risk factors in the ninth and 10th decades of life. We identified predictors of dementia with onset after age 85 years in a longitudinal population-based cohort.

Methods:

On the basis of annual assessments, incident cases of dementia were defined as those newly receiving Clinical Dementia Rating (CDR) ≥1. We used a machine learning method, Markov modeling with hybrid density-based and partition-based clustering, to identify variables associated with subsequent incident dementia.

Results:

Of 1439 participants, 641 reached age 85 years during 10 years of follow-up and 45 of these became incident dementia cases. Using hybrid density-based and partition-based, among those aged 85+ years, probability of incident dementia was associated with worse self-rated health, more prescription drugs, subjective memory complaints, heart disease, cardiac arrhythmia, thyroid disease, arthritis, reported hypertension, higher systolic and diastolic blood pressure, and hearing impairment. In the subgroup aged 85 to 89 years, risk of dementia was also associated with depression symptoms, not currently smoking, and lacking confidantes.

Conclusions:

An atheoretical machine learning method revealed several factors associated with increased probability of dementia after age 85 years in a population-based cohort. If independently validated in other cohorts, these findings could help identify the oldest-old at the highest risk of dementia.
Evolution of bodily distress disorders
Authors: Basavarajappa Chethan , Dahale Ajit Bhalchandra , Desai Geetha
Published: July 2020

Purpose of review

The nomenclature and classification of somatoform disorders have undergone revisions in the fifth edition of the Diagnostic and Statistical Manual (DSM 5) and the upcoming eleventh edition of the International Classification of Diseases (ICD-11). The present review describes the changes that have evolved and highlight the possible challenges.

Recent findings

Bodily distress disorders replace the term somatoform disorders. The emphasis on the symptoms to be medically unexplained has been removed. The need to have a certain number of symptoms associated with different organ systems has made way to the presence of one or more distressing bodily symptoms. The focus on psychological aspects like excessive attention, thoughts, and behaviors associated with bodily symptoms have been added to make it a more diagnosis of inclusion rather than exclusion. An additional qualifier of severity has been added, which highlights the importance of impairment associated with these symptoms.

The diagnostic criteria for bodily distress disorders is a step towards making the diagnostic criteria clinically useful and appears to be applicable across the healthcare settings. However, the ability to discern this diagnosis with the newly revised classification of chronic pain and the possibility of over psychologizing the medical disorders need to be researched.