bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study Between Minimally Invasive Spine Surgery and Traditional Open Surgery for Patients With Spinal Metastasis
Authors: Zhu Xiaojun , Lu Jinchang , Xu Huaiyuan , Tang Qinglian , Song Guohui , Deng Chuangzhong , Wu Hao , Xu Yanyang , Chen Hongmin , Wang Jin
Published: September 2020

Study Design.

A retrospective study was conducted.

Objective.

This study aims to compare the perioperative outcomes of minimal invasive spine surgery (MISS) and traditional open surgery (TOS) for thoracolumbar spine metastasis.

Summary of Background Data.

TOS for metastatic spinal tumors has many disadvantages, such as significant blood loss and high complication rate. MISS may change the treatment modality, but its safety and efficacy for spinal metastasis are lacking.

Methods.

We retrospectively reviewed clinical data from 154 consecutive patients registered in our institute who underwent separation surgery for spinal metastases from January 2017 to December 2019. Forty-nine patients received MISS and 105 patients had TOS. The demographic and perioperative data were collected and compared between two approaches.

Results.

There were no significant differences in baseline characteristics between the MISS and TOS group, except the sex (P = 0.04). The mean intraoperative blood loss in MISS group was lower than that in TOS group (748.57 vs. 950.48 mL, P = 0.039). The operative time was comparable between both groups (mean 213.45 vs. 221.03 minutes, P = 0.78). The postoperative drainage before discharge in MISS group was remarkably less than that in TOS group (mean 494.02 vs. 1099.10 mL, P = 0.0004). As compared to TOS group, patients in MISS group had lower complication rate, although the difference is not significant (9.52% vs. 6.12%, P = 0.55). The infection rate of MISS group was two-fold lower than that in the TOS group, although the difference is not significant (P = 0.43). The mean hospital stay of MISS group is 7.35 days, which is significantly shorter than TOS group (9.94 days, P = 0.0007). Patients in both groups exhibited similar postoperative neurological outcomes.

Conclusion.

MISS is a safe and effective technique that could be considered the optimal treatment for patients with spinal metastasis and myelopathy and thus is an excellent alternative in managing thoracolumbar spine metastasis.

Level of Evidence: 3
Prevention of Wrong-level Surgery in the Thoracic Spine
Authors: Ishak Basem , Abdul-Jabbar Amir , Tawfik Tamir , Yilmaz Emre , von Glinski Alexander , Unterberg Andreas , Oskouian Rod , Chapman Jens R.
Published: September 2020

Study Design.

Retrospective review.

Objective.

The aim of this study was to evaluate the feasibility, safety,s and complications of computer tomography (CT) fluoroscopy-guided percutaneous transpedicular gold fiducial marker insertion to reduce incidence of wrong-level surgery in the thoracic spine.

Summary of Background Data.

Intraoperative localization of the correct thoracic level can be challenging and time-consuming, especially in obese patients and patients with anatomical variations. In the literature there are very few studies containing low numbers of patients which assessed CT or CT fluoroscopy-guided fiducial marker placement of the thoracic spine. Description of this technique has been similarly scarce.

Methods.

All patients who underwent percutaneous CT fluoroscopy-guided gold fiducial marker placement of the thoracic spine were retrospectively reviewed. Indications for surgery included degenerative disc disease, infection, spinal metastasis, and intra- and extradural tumors. Gold fiducial markers were placed using a percutaneous CT fluoroscopy-guided transpedicular approach with local anesthesia. In addition, sex, age, body mass index (BMI), thoracic level, related pathology, and procedure-related complications were also recorded.

Results.

A total of 57 patients (24 females, 33 males) were included. Mean age was 58.6 ± 15.5 years. No complications during CT fluoroscopy-guided gold fiducial marker placement were recorded. Intraoperative localization was successful in all patients. Mean BMI was 32.98 kg/m2 (range, 18.63–56.03 kg/m2), and 63% of patients were obese (>30 kg/m2). T7 (n = 11) was the most often marked vertebral body, followed by T10 (n = 10) and T6 (n = 7). The most cranial and most caudal levels marked were T2 and T12, respectively.

Conclusion.

Preoperative CT fluoroscopy-guided percutaneous gold fiducial marker placement is safe, feasible, and accurate. The resulting facilitated localization of the intended thoracic level of surgery can reduce the length of surgery and prevent wrong-level surgery. Further studies are needed to evaluate in the effect on exposure to radiation and quantify the difference in operating room time.

Level of Evidence: 4
Medicare Utilization and Reimbursement for Vertebroplasty and Kyphoplasty
Authors: Lopez Cesar D. , Boddapati Venkat , Lombardi Joseph M. , Cerpa Meghan K. , Lee Nathan J. , Mathew Justin , Sardar Zeeshan M. , Lenke Lawrence G. , Lehman Ronald A.
Published: September 2020

Study Design.

Retrospective cohort study

Objective.

This study seeks to identify recent trends in utilization and reimbursements of these procedures between 2012and 2017, a period which experienced a change in national guideline recommendations for these procedures.

Summary of Background Data.

Minimally invasive vertebral augmentation procedures, including vertebroplasty and kyphoplasty, have been typically reserved for fractures associated with refractory pain, deformity, or progressive neurological symptoms. However, controversy exists regarding the safety and effectiveness of these procedures, in particular vertebroplasty.

Methods.

Annual Medicare claims and payments to surgeons were aggregated at the county level to assess regional trends. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates, and reimbursement rates, and to examine associations between county-specific variables and outcome variables.

Results.

A total of 24,316 vertebroplasties and 138,778 kyphoplasties were performed in the Medicare population between 2012 and 2017. Annual vertebroplasty volume fell by 48.0% from 5744 procedures in 2012 to 2987 in 2017, with a compound annual growth rate (CAGR) of −12.3%. Annual kyphoplasty volume also declined by 12.7% (CAGR −2.7%), from 24,986 in 2012 to 21,681 in 2017. Surgeon reimbursements for vertebral augmentation procedures increased by a weighted average of 93.7% (inflation-adjusted increase of 78.2%) between 2012 and 2017, which was primarily driven by a dramatic 113.3% (inflation-adjusted increase of 96.2%) increase in mean reimbursements for kyphoplasty procedures from an average of $895 to $1764, between 2012 and 2017, respectively.

Conclusion.

This large national Medicare database study found that vertebroplasty and kyphoplasty procedure volume and utilization of both procedures have declined significantly. Although average reimbursements to surgeons for vertebroplasties have significantly declined, payments for kyphoplasty procedures have risen significantly. Although vertebroplasty volume has significantly decreased, it is still being performed and being reimbursed for, in spite of its controversial role in its treatment of vertebral fractures.

Level of Evidence: 3
Primary Tumor Resection Prolongs Survival in Spinal Chondrosarcoma Patients With Distant Metastasis
Authors: Song Kehan , Lin Kaiyuan , Kang Honglei , Dong Yiming , Guan Hanfeng , Li Feng
Published: September 2020

Study Design.

Retrospective analysis.

Objective.

To investigate (1) whether resection of primary tumor improves survival of metastatic spinal chondrosarcoma patients and (2) which subgroups of metastatic spinal chondrosarcoma patients benefit more from primary tumor resection.

Summary of Background Data.

Surgical resection is the mainstay of treatment for spinal chondrosarcoma, as chondrosarcoma is inherently resistant to radiotherapy and chemotherapy. However, evidence which justifies resection of the primary tumor for patients with metastatic spinal chondrosarcoma is still lacking.

Methods.

We retrospectively included 110 patients with metastatic spinal chondrosarcoma in the Surveillance, Epidemiology, and End Results database from 1983 to 2016. The association between primary tumor resection and survival was evaluated using Kaplan-Meier analyses, log-rank tests, and multivariable Cox analyses. The effect of primary tumor resection on survival was further assessed in subgroups stratified by histologic subtype, tumor grade, and age.

Results.

Overall, 110 patients were divided into surgery group (n = 55, 50%) and nonsurgery group (n = 55, 50%). Primary tumor resection was associated with both prolonged overall survival (hazard ratio 0.262, 95% confidence interval 0.149–0.462, P < 0.001) and cancer-specific survival (hazard ratio 0.228, 95% confidence interval 0.127–0.409, P < 0.001). When we focused on surgical effects in subgroups, primary tumor resection conferred survival advantage on patients with conventional subtype, grade I to III malignancy, and an age younger than 70 years old (P < 0.001 for overall and cancer-specific survival). However, primary tumor resection brought limited survival benefit for patients with dedifferentiated subtype and patients over 70 years old.

Conclusion.

The present population-based study for the first time reports a clear association between primary tumor resection and prolonged survival in metastatic spinal chondrosarcoma patients. Specifically, primary tumor resection was associated with improved survival in patients with conventional subtype, grade I to III malignancy, and an age younger than 70 years old.

Level of Evidence: 4
Can we cure oligometastatic disease? A practical point of view
Authors: Pérez-García José , Cortez Patricia , Gion María , Cortés Javier
Published: September 2020

Purpose of review

To critically analyze the available evidence on oligometastatic breast cancer and to suggest therapeutic approaches for optimal management of these patients.

Recent findings

Unlike metastatic breast cancer, which remains incurable, patients with a limited number and extent of metastatic lesions, that is, oligometastatic disease, might achieve disease control and long-term survival when radical therapy of the primary tumor, if present, and metastatic disease is added to standard systemic therapy. However, the lack of a clear definition, variety of presentations, and the absence of biomarkers makes oligometastatic breast cancer a poorly understood clinical entity for which there is no standard treatment.

Improvements in systemic therapies along with radical treatment of the primary tumor and metastatic lesions, together with optimization in the use of imaging tools, may help to increase the percentage of patients with metastatic breast cancer who achieve no-evidence-of-disease status or, at least, chronification of the disease. However, the fundamental question remains: which patients may benefit the most from a radical therapeutic approach? In this article, we propose strategies for the appropriate selection and comprehensive management of these patients.
Physical approaches to treat glioblastoma
Authors: Latifyan Sofiya , de Micheli Rita , Hottinger Andreas F.
Published: September 2020

Purpose of review

Glioblastoma (GBM) patients have a poor prognosis despite the use of modern synergistic multimodal treatment strategies, with a progression-free survival estimated at 7–8 months, a median survival of 14–16 months and 5-year overall survival of 9.8%.

Recent findings

Physical methods hold the promise to act synergistically with classical treatments to improve the outcome of GBM patients. Fluorescent guided surgery with 5-aminolevulinic acid and tumor-treating fields therapy have already shown positive results in randomized phase III trials and have been incorporated in the standard management. Other techniques such as photodynamic therapy (PDT) and focused ultrasound, often combined whit microbubbles, are reaching clinical development.

Several clinical trials to evaluate the feasibility and efficacy of ultrasound devices to disrupt the blood–brain barrier are ongoing. PDT enables the creation of a safety margin or treatment of non-resecable tumors. However, randomized trials are urgently required to validate the efficacy of these promising approaches. We aim to critically review physical approaches to treat GBM, focusing on available clinical trial data.
ARHGEF4 Regulates an Essential Oncogenic Program in t(12;21)‐Associated Acute Lymphoblastic Leukemia
Authors: Virely Clemence , Gasparoli Luca , Mangolini Maurizio , Clesham Katherine , Inglott Sarah , Edwards Darren , Adams Stuart , Bartram Jack , Samarasinghe Sujith , Ancliff Philip , Vora Ajay , de Boer Jasper , Williams Owen
Published: September 2020

Supplemental Digital Content is available in the text
Three-dimensional Neuroretinal Rim Thickness and Visual Fields in Glaucoma: A Broken-stick Model
Authors: Liu Wendy W. , McClurkin Michael , Tsikata Edem , Hui Pui-Chuen , Elze Tobias , Celebi Ali R.C. , Khoueir Ziad , Lee Ramon , Shieh Eric , Simavli Huseyin , Que Christian , Guo Rong , de Boer Johannes , Chen Teresa C.
Published: September 2020

Precis:

In open-angle glaucoma, when neuroretinal rim tissue measured by volumetric optical coherence tomography (OCT) scans is below a third of the normal value, visual field (VF) damage becomes detectable.

Purpose:

To determine the amount of neuroretinal rim tissue thickness below which VF damage becomes detectable.

Methods:

In a retrospective cross-sectional study, 1 eye per subject (of 57 healthy and 100 open-angle glaucoma patients) at an academic institution had eye examinations, VF testing, spectral-domain OCT retinal nerve fiber layer (RNFL) thickness measurements, and optic nerve volumetric scans. Using custom algorithms, the minimum distance band (MDB) neuroretinal rim thickness was calculated from optic nerve scans. “Broken-stick” regression was performed for estimating both the MDB and RNFL thickness tipping-point thresholds, below which were associated with initial VF defects in the decibel scale. The slopes for the structure-function relationship above and below the thresholds were computed. Smoothing curves of the MDB and RNFL thickness covariates were evaluated to examine the consistency of the independently identified tipping-point pairs.

Results:

Plots of VF total deviation against MDB thickness revealed plateaus of VF total deviation unrelated to MDB thickness. Below the thresholds, VF total deviation decreased with MDB thickness, with the associated slopes significantly greater than those above the thresholds (P<0.014). Below 31% of global MDB thickness, and 36.8% and 43.6% of superior and inferior MDB thickness, VF damage becomes detectable. The MDB and RNFL tipping points were in good accordance with the correlation of the MDB and RNFL thickness covariates.

Conclusions:

When neuroretinal rim tissue, characterized by MDB thickness in OCT, is below a third of the normal value, VF damage in the decibel scale becomes detectable.
Impact of Video Education on Patient Knowledge, Anxiety, and Satisfaction in Selective Laser Trabeculoplasty: A Pilot Study
Authors: Robbins Cason B. , Wisely C. Ellis , Rosdahl Jullia A. , Muir Kelly W. , Gupta Divakar
Published: September 2020

Précis:

In patients undergoing selective laser trabeculoplasty, preoperative video education did not improve patient knowledge regarding the procedure, decrease anxiety, or increase satisfaction, as these metrics were already favorable across all patients in this study.

Purpose:

To assess the effect of an educational video on patient knowledge, anxiety, and satisfaction at a selective laser trabeculoplasty (SLT) procedure visit.

Materials and Methods:

This is a prospective, randomized trial. Patients at a single academic medical center completed a survey at their procedure visit for SLT; patients were randomized to view an educational video or no video before survey administration. Knowledge was assessed with a 10-item questionnaire. The 6-item State-Trait Anxiety Inventory scale (STAI-6) assessed anxiety (score >40 defined significant anxiety). Perceptions of visit quality were assessed using a Likert scale.

Results:

Twenty-two patients were randomized into video (n=11) and control (n=11) groups. No difference in knowledge was observed between groups (83.6% control vs. 82.7% video group, P=0.635). No patient had significant anxiety (STAI-6 range, 20 to 40, average 29) and scores were similar between groups (P=0.385). Overall, patients had positive perceptions of visit quality, and there was no significant difference between groups (P=0.999).

Conclusion:

Patients undergoing SLT had high levels of knowledge, low levels of anxiety, and high levels of satisfaction. In this clinical setting, an educational video seemed to have no additional benefit on these metrics and thus, may be omitted. Further research may be directed toward optimizing patient education regarding SLT, particularly in settings with poor health literacy, limited resources, or limited access to glaucoma specialists.
Pediatric Endobronchial Ultrasound-Transbronchial Needle Aspiration Under Conscious Sedation for Suspected Tuberculosis in London
Authors: Park Mirae , Owles Harriet , Williams Amanda , Williams Bhanu , Whittaker Elizabeth , Kon Onn Min
Published: September 2020

Tuberculosis (TB) is an important cause of childhood death and morbidity worldwide. The diagnosis in the pediatric population remains challenging due to the paucibacillary nature of the disease. Intrathoracic lymphadenopathy is one of the most common manifestations of primary disease but is often difficult to sample. A retrospective case review was performed of children (younger than 16 years) suspected with intrathoracic TB lymphadenopathy who underwent an endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) between January 2010 and 2020 in a London TB center. Ten children between 11 years 4 months and 15 years 9 months, with weights ranging from 48 to 95 kg, underwent EBUS-TBNA. All procedures were performed under conscious sedation with no reported complications. Six of 10 cases showed granulomas on rapid onsite histologic evaluation. Nine of 10 cases were confirmed to have Mycobacterium tuberculosis. Seven of 10 cases were culture positive with a mean turn-around time of 13.7 days; of these, 4 of 7 were smear positive. Six of 7 culture positive cases were also TB polymerase chain reaction (PCR) positive. TB PCR identified 2 further cases where microscopy and culture remained negative. One case had multidrug-resistant TB identified on TB PCR allowing early initiation of correct drug therapy. In our cohort, we show EBUS-TBNA is a safe and effective way of investigating intrathoracic TB lymphadenitis in children and a high diagnostic rate can be achieved. In high-resource settings, we should approach childhood TB with a standardized diagnostic approach and utilize EBUS-TBNA as a diagnostic modality. Samples should be sent for culture but also for molecular assays to timely identify TB and drug-resistant disease.
Follow-up Study of Long-time Positive RT-PCR in Stool Specimens From Asymptomatic Children Infected With SARS-CoV-2
Authors: Xie Jun , Long Xiaoru , Ren Chongsong , He Ronghui , Yan Xiaofeng , Li Weiguo , Luo Zhengxiu , Li Qiu , Xu Hongmei , Liu Enmei
Published: September 2020

In the current study, we report on 4 children with confirmed SARS-CoV-2 infection, of which 3 of them were asymptomatic. These patients had both pharyngeal swabs and anal swabs testing during hospital or after discharge. All the 4 children showed long-time positive viral RNA in the stool specimens after pharyngeal swabs turned negative during the follow-up stage, especially in the asymptomatic children. The positive RNA in stool specimens of asymptomatic children last for more than 54 days after admission or 30 days after discharge.
Gastrointestinal Symptoms in Severe COVID-19 Children
Authors: Giacomet Vania , Barcellini Lucia , Stracuzzi Marta , Longoni Emma , Folgori Laura , Leone Alessandro , Zuccotti Gian Vincenzo ,   on behalf of COVID-19 Pediatric network
Published: September 2020

There are growing evidence of clinical manifestations other than acute respiratory syndrome in severe acute respiratory syndrome associated with coronavirus 2-infected children. In our multicenter retrospective analysis, we observed among 127 severe acute respiratory syndrome associated with coronavirus 2 positive children that the presence of gastrointestinal symptoms was more frequently associated with severe and critical phenotype (P = 0.029). Moreover, having gastrointestinal symptoms was more frequently reported in patients who developed cardiac impairment.
A Multicentered Study on Epidemiologic and Clinical Characteristics of 37 Neonates With Community-acquired COVID-19
Authors: Kanburoglu Mehmet Kenan , Tayman Cuneyt , Oncel Mehmet Yekta , Akin Ilke Mungan , Can Emrah , Demir Nihat , Arayici Sema , Baser Demet Orhan , Caner Ibrahim , Memisoglu Asli , Uygun Saime Sundus , Akar Selahattin , Akin Mustafa Ali , Ataoglu Emel , Bezirganoglu Handan , Bilgin Leyla , Bozdag Senol , Comert Serdar , Gurpinar Resat , Imamoglu Ebru Yalin , Imdadoglu Timucin , Narter Fatma , Ozdemir Ramazan , Toptan Handan Hakyemez , Yalinbas Emine Esin , Yaman Akan , Erdeve Omer , Koc Esin
Published: September 2020

Background:

Coronavirus disease 2019 (COVID-19) primarily affects adults and spares children, whereas very little is known about neonates. We tried to define the clinical characteristics, risk factors, laboratory, and imagining results of neonates with community-acquired COVID-19.

Methods:

This prospective multicentered cohort study included 24 neonatal intensive care units around Turkey, wherein outpatient neonates with COVID-19 were registered in an online national database. Full-term and premature neonates diagnosed with COVID-19 were included in the study, whether hospitalized or followed up as ambulatory patients. Neonates without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were excluded.

Results:

Thirty-seven symptomatic neonates were included. The most frequent findings were fever, hypoxemia, and cough (49%, 41%, 27%, respectively). Oxygen administration (41%) and noninvasive ventilation (16%) were frequently required; however, mechanical ventilation (3%) was rarely needed. Median hospitalization was 11 days (1–35 days). One patient with Down syndrome and congenital cardiovascular disorders died in the study period. C-reactive protein (CRP) and prothrombin time (PT) levels were found to be higher in patients who needed supplemental oxygen (0.9 [0.1–8.6] vs. 5.8 [0.3–69.2] p = 0.002, 11.9 [10.1–17.2] vs. 15.2 [11.7–18.0] p = 0.01, respectively) or who were severe/critical (1.0 [0.01–8.6] vs. 4.5 [0.1–69.2] p = 0.01, 11.7 [10.1–13.9] vs. 15.0 [11.7–18.0] p = 0.001, respectively).

Conclusions:

Symptomatic neonates with COVID-19 had high rates of respiratory support requirements. High CRP levels or a greater PT should alert the physician to more severe disease.
Infection Risk of COVID-19 in Dentistry Remains Unknown: A Preliminary Systematic Review
Authors: Levit Michael , Levit Leah
Published: September 2020

Background

COVID-19 is a novel viral respiratory disease caused by a member of the coronavirus family, SARS-CoV-2, and has been declared as a pandemic on March 2020. Dental practitioners are routinely exposed to infectious bodily excretions, for example, saliva, blood, and respiratory excretions. Therefore, they are in the first line of SARS-CoV-2 infection-prone health care providers. The purposes of the current review are to trace documented cases of COVID-19 transmission inside dental settings worldwide and to explore the clinical management of these cases.

Methods

We searched MEDLINE and Google Scholar for all possible reported cases of COVID-19 transmission in dental practice as of December 1, 2019, until May 13, 2020. Multiple terms and combinations were used, including “coronavirus,” “COVID-19,” “SARS-CoV-2,” “dental,” “dentistry,” “transmission,” and “nosocomial.” Articles that were not written in English were excluded.

Results

A total of 78 articles were found from December 29, 2019, until May 13, 2020. Of these, 31 articles discussed the risks related to dental practice and recommended infection management protocols for dental health care personnel. Of these articles, only 1 had reported data on transmission of COVID-19 in dental practice. Two possible transmissions of COVID-19 to dental personnel were reported in China before its recognition as an epidemic.

Conclusions

Although it seems that there are almost no reported cases of infection by SARS-CoV-2 during dental treatments, occupational or nosocomial transmission could not be ruled out. Hence, further prospective assessment of COVID-19 transmission is urgently required, and careful and protective measurements are necessary to avoid infection during dental practice.
Capital Expenditures Increased at Rural Hospitals That Merged Between 2012 and 2015
Authors: Williams Dunc , Pink George H. , Song Paula H. , Reiter Kristin L. , Holmes G. Mark
Published: September 2020

EXECUTIVE SUMMARY

The number of rural hospital mergers has increased substantially in recent years. A commonly reported reason for merging is to increase access to capital. However, no empirical evidence exists to show whether capital expenditures increased at rural hospitals after a merger. We used a difference-in-differences approach to determine whether total capital expenditures changed at rural hospitals after a merger. The comparison group (rural hospitals that did not merge during the 2012 through 2015 study period) was weighted using inverse probability of treatment weights. The key outcome measure was logged total capital expenditures.

Merging resulted in a 26% increase in capital expenditures and also was associated with a significant improvement in plant age. The postmerger improvement in plant age may have been partially attributable to merger-related accounting changes and partially attributable to increased capital expenses, possibly on long-term asset renovations and replacement.

These findings suggest that through mergers, rural hospital board members and executives who have accepted or are considering a merger may improve a hospital’s ability to increase capital expenditures. Further, increased capital investments in rural hospitals may be an important signal to the community that the acquirer intends to keep the rural hospital open and continue providing some volume and level of services within the community. Future research should determine how capital is spent after a merger.
How Women and Men Executives Perceive Healthcare Workplaces
Authors: Athey Leslie A. , Kimball Peter A.
Published: September 2020

EXECUTIVE SUMMARY

Healthcare organizations that can attract and retain talented women executives have the advantage over their peers. In 2018, the American College of Healthcare Executives (ACHE) conducted the sixth in a series of surveys of its members to compare the career attainments, attitudes, and workplace experiences of men and women healthcare executives. Data from the 2018 survey indicate that women healthcare executives with 5 to 20 years of experience in the field are significantly less likely than their male peers to perceive their employers as gender-neutral regarding key employment factors such as hiring, promotion, evaluation, and compensation. Further, the results indicate there has been little to no improvement in many of these outcomes since ACHE began measuring these perceptions more than a decade ago. The perception that an employing organization is lacking in gender equity is also associated with lower overall satisfaction, engagement, and willingness to stay with the organization on the part of women executives.
Respiratory and sleep-related complications of multiple system atrophy
Authors: Ralls Frank , Cutchen Lisa
Published: September 2020

Purpose of review

The purpose of this article is to provide a contemporary review of sleep issues affecting patients with multiple system atrophy (MSA).

Recent findings

Prodromal symptoms of MSA may occur years prior to diagnosis, including autonomic dysfunction such as orthostatic hypotension, urogenital dysfunction, rapid eye movement (REM) sleep behavior disorder (RBD), and stridor. Patients may also develop sleep-related respiratory disorders such as obstructive sleep apnea (OSA), central sleep apnea (CSA), and stridor. The development of stridor is associated with a shortened lifespan and sudden death, which may be further accelerated by autonomic instability. MSA appears to follow a ‘prion-like’ disease progression.

MSA is a rapidly progressive neurodegenerative disease characterized by a combination of autonomic failure and motor symptoms. MSA is often misdiagnosed as the initial presentation mimics other neurodegenerative disorders. There are diagnostic criteria to identify possible, probable, and definite MSA. Prodromal symptoms may occur years prior to diagnosis, including autonomic dysfunction such as orthostatic hypotension, urogenital dysfunction, REM RBD, and stridor. In previous years, treatment consisted of tracheostomy but did not address the component of CSA, which commonly coexisted or developed later because of destruction of medullary chemoreceptors. Positive airway pressure may be as effective as tracheostomy alone in ameliorating obstruction at the vocal cord level.
Obstructive sleep apnea and cancer: a complex relationship
Authors: Marrone Oreste , Bonsignore Maria R.
Published: September 2020

Purpose of review

Obstructive sleep apnea (OSA) has been recognized as a risk factor for cancer mainly through hypoxia, based on studies that did not distinguish among cancer types. The purpose of this review is to discuss the most recent data on epidemiology and pathophysiology of the OSA–cancer association.

Recent findings

According to epidemiological studies, OSA may have different influences on each type of cancer, either increasing or decreasing its incidence and aggressiveness. Time spent with oxygen saturation below 90% appears the polysomnographic variable most strongly associated with unfavorable effects on cancer. Experimental studies support the role of hypoxia as an important risk factor for cancer growth and aggressiveness, especially when it shows an intermittent pattern. These effects are largely mediated by the hypoxia-inducible factor, which controls the synthesis of molecules with effects on inflammation, immune surveillance and cell proliferation. Sleep fragmentation participates in increasing cancer risk. Modulating effects of age remain controversial.

Effects of OSA on cancer may largely vary among neoplastic diseases, both in their magnitude and direction. The worse risk associated with intermittent rather than persistent hypoxia, and the effects of OSA therapy on cancer natural history are still poorly known, and deserve new careful studies.
Head-to-head comparison of the hybrid tracer indocyanine green-99mTc-nanocolloid with 99mTc-Senti-Scint using sentinel node lymphoscintigraphy and single-photon emission computed tomography combined with computer tomography in melanoma
Authors: Rietbergen Daphne D.D. , Meershoek Philippa , KleinJan Gijs H. , Donswijk Maarten , Valdés Olmos Renato A. , van Leeuwen Fijs W.B. , Klop Martin W.M.C. , van der Hage Jos A.
Published: September 2020

Objective

The hybrid tracer indocyanine green (ICG)-99mTc-nanocolloid has been introduced for sentinel node imaging. However, until now, a comparison of this tracer with other radiocolloids with a larger particle size has not been effectuated. Based on a head-to-head evaluation in patients with melanoma, we have compared ICG-99mTc-nanocolloid (particle size 5–80 nm) with 99mTc-Senti-Scint (particle size 100–600 nm) to establish differences in drainage pattern and sentinel node localization using lymphoscintigraphy and single-photon emission computed tomography combined with computer tomography (SPECT-CT) in melanoma patients scheduled for sentinel node biopsy.

Methods

Twenty-five patients (mean age: 56.9 years, range: 25–79 years) with a melanoma scheduled for SLN biopsy prior to (re)excision of the primary lesion (scar) were prospectively included following a two-day procedure. The first day, after 99mTc-Senti-Scint injection in four intradermal depots around the primary lesion or scar, early/delayed lymphoscintigraphy and SPECT-CT images were acquired. The injection sites were marked. The second day, after assessing lymph node radioactivity using planar scintigraphy, ICG-99mTc-nanocolloid was injected at the previously marked skin points and imaging was performed. The paired planar and SPECT-CT images of both tracers were evaluated with respect to drainage patterns, SLN visualization and non-SLN appearing.

Results

Twenty-four out of 25 patients were evaluable. SLN visualization on a patient basis was 100% for ICG-99mTc-nanocolloid and 96% for 99mTc-Senti-Scint, whereas uptake in non-SLNs was found in, respectively, 71% (17/24) and 61% (14/23). Concordance in drainage to 45 lymph node basins was 91%. Discordant drainage was found for two melanomas in the head-and-neck and one in the clavicular area. Unique lymph node basins were seen in 44/45 (98%) for ICG-99mTc-nanocolloid and 42/45 (93%) for 99mTc-Senti-Scint. Concerning identified SLNs, the number was similar for both tracers (n = 58); however, more non-SLNs (65 vs 50) were visualized with ICG-99mTc-nanocolloid than with 99mTc-Senti-Scint.

Conclusion

A slightly higher SLN visualization accompanied by a tendency to depict more non-SLNs was found for ICG-99mTc-nanocolloid. Excepting the head and neck area, an overall high concordance in drainage was found for both radiotracers. With an additional value for the hybrid tracer due to the combination of preoperative imaging and the additional visual signal in the operation room, added by the fluorescent component of the hybrid tracer, there was a preference for ICG-99mTc-nanocolloid.
18F-FDG PET/computed tomography may predict the outcome of newly diagnosed indolent non-Hodgkin lymphoma in patients managed with initial ‘watch-and-wait’ approach
Authors: Luo Yaping , Zhang Ying , Pan Qingqing , Zhang Yan , Li Fang
Published: September 2020

Objective

The aim of this study was to investigate the role of 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the outcome of non-Hodgkin lymphoma (NHL) in patients managed with initial ‘watch-and-wait’ treatment.

Methods

Sixteen patients with newly diagnosed NHL treated with initial watchful waiting were retrospectively recruited. They had a baseline 18F-FDG PET/CT and at least one follow-up PET/CT. The standard uptake values (SUV), metabolic tumor volume (MTV) and total lesions glycolysis (TLG) of lymphoma were measured in PET/CT. They were followed up for at least 2 years or until disease progression. The endpoint was the time to initiation of lymphoma treatment (TLT).

Results

Comparing the baseline and the follow-up PET/CT, four out of 16 patients showed spontaneous regression of lymphoma, three of the 16 patients had stable disease and the remaining nine of the 16 patients had progressive disease in the follow-up PET/CT. After a median follow-up of 32 months (range 14–90 months), 10/16 patients had progressive disease and chemotherapy was initiated. The median TLT was 21.0 months. In univariate analysis, MTV and TLG in baseline PET/CT were significant to predict TLT. Kaplan–Meier curves showed a statistical difference for TLT in the two groups of patients stratified by MTV or TLG at baseline (median TLT, 66.0 months vs. 12.0 months, P = 0.007). However, patients’ age, Ann Arbor staging, International Prognostic Index and SUVmax were not significant.

Conclusion

A proportion of patients with NHL might experience spontaneous regression of lymphoma. 18F-FDG PET/CT turned out as a prognostic factor for TLT in patients with NHL under watchful waiting.
Olfactory Impairment in Children and Adolescents With Obsessive-Compulsive Disorder
Authors: Bora Adem , Uzun Cicek Ayla
Published: September 2020

In this study, we aimed to examine the olfactory function of adolescents with obsessive-compulsive disorder (OCD). We investigated olfactory function of 50 adolescents with OCD and 50 healthy controls (min-max, 12–17 years) by the “Sniffin' Sticks” extended test. OCD and depression symptomatology were assessed with the Maudsley Obsessive-Compulsive Inventory (MOCI) and the Children's Depression Inventory (CDI). Adolescents with OCD had lower olfactory performance than healthy controls. The patients who responded positively to the treatment exhibited performance superior to the patients with partial response and those untreated. All olfactory measurements were significantly inversely correlated with MOCI and CDI total scores and OCD duration. Our results show that OCD has a significant impact on all olfactory tests, and olfactory impairment is related to symptom severity, duration, and course of OCD. The decrease in olfactory function may be a noninvasive state marker for OCD. Further investigations in longitudinal studies are required to confirm our results.
Autotraumatic Stress Disorders
Authors: Yager Joel , Kay Jerald
Published: September 2020

Autotraumatic stress disorders (ATSD), variants of posttraumatic stress disorder PTSD, may develop in individuals after traumatic stressors for which they carry some responsibility, for example, serious self-injury and injury or death to others after murderous rages or careless vehicular driving. In ATSD, the individual is both the causative actor and casualty. As a result, in ATSD, distinctive negative psychological sequelae are grafted onto the usual distressing symptoms of PTSD, differentiating them from both PTSD and complex-PTSD. Whether the actions were intentional or unintentional and regardless of complications by comorbid psychiatric disorders, individuals with ATSD additionally experience some or all of the following symptoms stemming from actions for which they were responsible, wholly or in part: severe and unrelenting reality-based guilt, shame, remorse, regret, bitterness, self-betrayal, inability to trust oneself, and moral injury. Empirical studies investigating trauma-associated guilt and moral injury provide evidence to support these formulations. Clinical vignettes illustrate a range of circumstances leading to ATSD, in each instance adding significantly to the individual's distress, impeding recovery, and often requiring specific psychotherapeutic attention over and above that required for PTSD or complex-PTSD. These psychotherapeutic strategies have included intense, prolonged, noninterruptive, open-minded listening; avoiding premature whitewashing of responsibility and guilt; facilitating grief over lost innocence; helping create personal narratives that permit self-acceptance despite permanently altered damaged self-image; and, for some individuals, guiding repentance and restorative actions. Systematic case series and additional studies are necessary to ascertain how intentionality, self-harm versus harming others, and various comorbidities shape ATSD presentations, and to better delineate effective treatment strategies.
Noninvasive Cerebral Perfusion and Oxygenation Monitoring Augment Prolonged Field Care in a Non-Human Primate Model of Decompensated Hemorrhage and Resuscitation
Authors: Morgan Clifford G. , Neidert Leslie E. , Stigall Kyle S. , Rodriguez Gerardo J. , Pratt Gilbert A. , Lonowski Dominic , Harrell Kelly , McNeal Neal D. , Tiller Michael M. , Cardin Sylvain , Glaser Jacob J.
Published: September 2020

Background:

Decompensated hemorrhagic shock (DHS) is the leading cause of preventable death in combat casualties. “Golden hour” resuscitation effects on cerebral blood flow and perfusion following DHS in prolonged field care (PFC) are not well investigated. Using an established non-human primate model of DHS, we hypothesized noninvasive regional tissue oxygenation (rSO2) and Transcranial Doppler (TCD) would correlate to the invasive measurement of partial pressure of oxygen (PtO2) and mean arterial pressure (MAP) in guiding hypotensive resuscitation in a PFC setting.

Methods:

Ten rhesus macaques underwent DHS followed by a 2 h PFC phase (T0–T120), and subsequent 4 h hospital resuscitation phase (T120–T360). Invasive monitoring (PtO2, MAP) was compared against noninvasive monitoring systems (rSO2, TCD). Results were analyzed using t tests and one-way repeated measures ANOVA. Linear correlation was determined via Pearson r. Significance = P < 0.05.

Results:

MAP, PtO2, rSO2, and mean flow velocity (MFV) significantly decreased from baseline at T0. MAP and PtO2 were restored to baseline by T15, while rSO2 was delayed through T30. At T120, MFV returned to baseline, while the Pulsatility Index significantly elevated by T120 (1.50 ± 0.31). PtO2 versus rSO2 (R2 = 0.2099) and MAP versus MFV (R2 = 0.2891) shared very weak effect sizes, MAP versus rSO2 (R2 = 0.4636) displayed a low effect size, and PtO2 versus MFV displayed a moderate effect size (R2 = 0.5540).

Conclusions:

Though noninvasive monitoring methods assessed here did not correlate strongly enough against invasive methods to warrant a surrogate in the field, they do effectively augment and direct resuscitation, while potentially serving as a substitute in the absence of invasive capabilities.
TBK1/IKKε Negatively Regulate LPS-Induced Neutrophil Necroptosis and Lung Inflammation
Authors: Wang Jieyan , Luan Yingyi , Fan Erica K. , Scott Melanie J. , Li Yuehua , Billiar Timothy R. , Wilson Mark A. , Jiang Yong , Fan Jie
Published: September 2020

Cell necroptosis, a form of regulated inflammatory cell death, is one of the mechanisms that controls cell release of inflammatory mediators from innate immune cells, such as polymorphonuclear neutrophils (PMNs), and critically regulates the progress of inflammation. Cell necroptosis features receptor-interacting protein (RIPK) 1 activation and necroptosome formation. This leads to loss of plasma membrane integrity, the release of cell contents into the extracellular space, and subsequent increased inflammation. Here, we report an intra-PMN mechanism of negative regulation of necroptosis mediated through TBK1/IKKε. Using an in vivo mouse model of intratracheal injection (i.t.) of LPS and in vitro LPS stimulation of mouse PMN, we found that LPS-TLR4 signaling in PMNs activates and phosphorylates TBK1 and IKKε, which in turn suppress LPS-induced formation of the RIPK1–RIPK3–MLKL (necrosome) complex. TBK1 dysfunction by knockdown or inhibitor significantly increases the phosphorylation of RIPK1 (∼67%), RIPK3 (∼68%), and MLKL (∼50%) and promotes RIPK1–RIPK3 and RIPK3–MLKL interactions and increases PMN necroptosis (∼83%) in response to LPS, with subsequent augmented lung inflammation. These findings suggest that the LPS-TLR4-TBK1 axis serves as a negative regulator for PMN necroptosis and might be a therapeutic target for modulating PMN death and inflammation.
State-of-the-Art Review—Endovascular Resuscitation
Authors: Madurska Marta J. , Ross James D. , Scalea Thomas M. , Morrison Jonathan J.
Published: September 2020

The emerging concept of endovascular resuscitation applies catheter-based techniques in the management of patients in shock to manipulate physiology, optimize hemodynamics, and bridge to definitive care. These interventions hope to address an unmet need in the care of severely injured patients, or those with refractory non-traumatic cardiac arrest, who were previously deemed non-survivable. These evolving techniques include Resuscitative Endovascular Balloon Occlusion of Aorta, Selective Aortic Arch Perfusion, and Extracorporeal Membrane Oxygenation and there is a growing literature base behind them. This review presents the up-to-date techniques and interventions, along with their application, evidence base, and controversy within the new era of endovascular resuscitation.
Prehospital Whole Blood Resuscitation Reduces Fluid Requirement While Maintaining Critical Physiology in a Model of Penetrating Traumatic Brain Injury and Hemorrhage: Implications on Resource-Limited Combat Casualty Care
Authors: Bailey Zachary S. , Leung Lai Yee , Yang Xiaofang , Cardiff Katherine , Gilsdorf Janice , Shear Deborah , Kochanek Patrick M.
Published: September 2020

Prehospital resuscitation using whole blood (WB) is the standard of care for hemorrhagic shock (HS) but there is no consensus recommendation for resuscitation in the presence of traumatic brain injury (TBI) due to a lack of sufficient evidence. In order to evaluate the optimal resuscitation strategies for TBI+HS, Sprague-Dawley rats were randomized into four groups based on resuscitation fluid and prehospital mean arterial pressure (MAP) threshold (n = 9–10/group): Lactated Ringer's (LR)-60 mm Hg (LR60), LR-70 mm Hg (LR70), WB-60 mm Hg (WB60), WB-70 mm Hg (WB70). All groups received a frontal penetrating ballistic-like brain injury followed by a 35-min period of HS. During the prehospital phase, rats received an initial bolus of resuscitation fluid (WB or LR) followed by LR as needed to maintain MAP above the designated threshold for 90 min. During the in-hospital phase, rats received definitive resuscitation with shed WB. Physiological parameters were recorded continuously and cerebral edema was measured at 3 and 24 h postinjury. The WB60 group demonstrated a significantly lower prehospital fluid requirement compared WB70, LR60, and LR70 (P < 0.05). Compared to the respective LR groups, both the WB60 and WB70 groups also demonstrated improved MAP, cerebral perfusion pressure, brain tissue oxygen tension, and cerebral edema. The edema benefits were observed at 3 h, but not 24 h postinjury, and were localized to the injury site. Together, these results provide evidence that prehospital WB resuscitation and lower MAP resuscitation thresholds can reduce the prehospital fluid requirement while still maintaining critical cerebral physiology in a model of HS and concomitant TBI.
Presepsin Values Predict Septic Acute Kidney Injury, Acute Respiratory Distress Syndrome, Disseminated Intravascular Coagulation, and Shock
Authors: Shimoyama Yuichiro , Umegaki Osamu , Kadono Noriko , Minami Toshiaki
Published: September 2020

Background:

Sepsis remains a major cause of mortality in critically ill patients. This study aimed to determine whether presepsin is a predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and shock.

Methods:

A total of 83 adult patients diagnosed with sepsis were prospectively examined. Presepsin values were measured immediately after intensive care unit (ICU) admission and on Days 2, 3, and 5 after ICU admission. Glasgow Prognostic Score (GPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, Prognostic Index, and Prognostic Nutritional Index were also examined at baseline. For category classification, total scores were calculated (hereafter, “inflammation-presepsin scores [iPS]”) as follows: a score of 1 was assigned if the presepsin value and inflammation-based prognostic scores at baseline were above cutoffs determined by receiver operating characteristic (ROC) curve analysis for 28-day mortality; a score of 0 was assigned if they were below the cutoffs (total score range, 0–2 points). Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with septic AKI, ARDS, DIC, or shock and those without these disorders.

Results:

ROC curve analyses identified the following variables as predictors: presepsin on Days 1 and 2 for septic AKI; presepsin on Days 1 to 3; and iPS-GPS for septic ARDS; and presepsin on Day 2 and Δpresepsin (Day 2–Day 1) for septic DIC. Multivariate analysis revealed presepsin on Day 2 to be a predictor of septic DIC.

Conclusion:

Presepsin is a predictor of septic AKI, ARDS, and DIC. Combining presepsin values with GPS improved the specificity for predicting septic ARDS relative to using baseline presepsin values alone.