bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Perioperative Mortality in Kenya
Authors: Newton Mark W. , Hurt Savannah E. , McEvoy Matthew D. , Shi Yaping , Shotwell Matthew S. , Kamau John , Nabulindo Susane , Ngumi Zipporah W. W. , Sandberg Warren S. , Sileshi Bantayehu
Published: December 2019

Background

The global surgery access imbalance will have a dramatic impact on the growing population of the world’s children. In regions of the world with pediatric surgery and anesthesia manpower deficits and pediatric surgery–specific infrastructure and supply chain gaps, this expanding population will present new challenges. Perioperative mortality rate is an established indicator of the quality and safety of surgical care. To establish a baseline pediatric perioperative mortality rate and factors associated with mortality in Kenya, the authors designed a prospective cohort study and measured 24-h, 48-h, and 7-day perioperative mortality.

Methods

The authors trained anesthesia providers to electronically collect 132 data elements for pediatric surgical cases in 24 government and nongovernment facilities at primary, secondary, and tertiary hospitals from January 2014 to December 2016. Data assistants tracked all patients to 7 days postoperative, even if they had been discharged. Adjusted analyses were performed to compare mortality among different hospital levels after adjusting for prespecified risk factors.

Results

Of 6,005 cases analyzed, there were 46 (0.8%) 24-h, 62 (1.1%) 48-h, and 77 (1.7%) 7-day cumulative mortalities reported. In the adjusted analysis, factors associated with a statistically significant increase in 7-day mortality were American Society of Anesthesiologists Physical Status of III or more, night or weekend surgery, and not having the Safe Surgery Checklist performed. The 7-day perioperative mortality rate is less in the secondary (1.4%) and tertiary (2.4%) hospitals when compared with the primary (3.7%) hospitals.

Conclusions

The authors have established a baseline pediatric perioperative mortality rate that is greater than 100 times higher than in high-income countries. The authors have identified factors associated with an increased mortality, such as not using the Safe Surgery Checklist. This analysis may be helpful in establishing pediatric surgical care systems in low–middle income countries and develop research pathways addressing interventions that will assist in decreasing mortality rate.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Gestational Trophoblastic Neoplasia After Human Chorionic Gonadotropin Normalization Following Molar Pregnancy
Authors: Albright Benjamin B. , Shorter Jade M. , Mastroyannis Spyridon A. , Ko Emily M. , Schreiber Courtney A. , Sonalkar Sarita
Published: December 2019

OBJECTIVE:

To estimate the incidence of gestational trophoblastic neoplasia following complete and partial molar pregnancy after reaching normal human chorionic gonadotropin (hCG) levels to guide evidence-based follow-up recommendations.

DATA SOURCES:

MEDLINE, EMBASE, Web of Science, POPLINE, Cochrane, and ClinicalTrials.gov were searched from inception to November 2018, using the intersection of “gestational trophoblastic disease,” “molar pregnancy,” and “human chorionic gonadotropin” themes.

METHODS OF STUDY SELECTION:

Search results were screened to identify cohort studies of molar pregnancy reporting gestational trophoblastic neoplasia development, with at least 6 months of intended normal hCG follow-up.

TABULATION, INTEGRATION, AND RESULTS:

Two reviewers independently identified articles for inclusion. Data were extracted using a standardized form. For meta-analysis, cumulative incidence of gestational trophoblastic neoplasia, with CIs by the Agresti-Coull method, and pooled risk ratios (RRs) comparing complete and partial mole were calculated. Among the 19 eligible studies that reported adequate data for inclusion in the primary meta-analysis, we found low incidence of gestational trophoblastic neoplasia after normal hCG level following both complete mole (64/18,357, 0.35%, 95% CI 0.27–0.45%), and partial mole (5/14,864, 0.03%, 95% CI 0.01–0.08%). There was a significantly higher risk of gestational trophoblastic neoplasia after complete compared with partial molar pregnancy (RR 4.72, 95% CI 1.81–12.3,P=.002). Among gestational trophoblastic neoplasia cases after normal hCG level following complete mole, 89.6% occurred when the time from evacuation to normalization was 56 days or longer, and 60.7% were diagnosed beyond the commonly recommended 6-month surveillance interval. Sensitivity analyses, including those limiting to studies at low risk of bias, did not significantly affect results. We found an overall incidence of gestational trophoblastic neoplasia of 15.7% for complete mole (1,354/8,611, 95% CI 15.0–16.5%) and 3.95% for partial mole (221/5,593, 95% CI 3.47–4.50%).

CONCLUSION:

Gestational trophoblastic neoplasia development after normal hCG level following molar pregnancy is rare. Recommendations for frequency and duration of hCG follow-up can be minimized to lessen burden on patients and informed by the type of molar pregnancy and time interval from uterine evacuation to hCG normalization.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42019116414.
Certification Process of Fetal Centers in Texas and Developing National Guidelines
Authors: Moise Kenneth J. , Johnson Anthony , Tsao Kuojen
Published: December 2019

In recent years there has been a growing trend for physician groups to develop guidelines to establish levels of hospital care based on health care team expertise and physical resources. A growing number of fetal centers have been established as the field of fetal medicine continues to evolve. In 2015, the state of Texas began an initiative to develop guidelines for the certification of fetal centers. After significant input from clinicians, a series of rules was developed by the Department of Health and Human Services. Site visits for certification are expected to begin in the near future. Specific leadership, personnel, and facility requirements were developed. Maternal as well as fetal and neonatal outcomes were mandated to be transparent to the public through websites. A commitment to ongoing research and the education of future fetal interventionists was included. Lessons learned from this process should be considered when a national fetal center certification process is developed. Although the Texas legislation defined only a single level of fetal center, a multi-tier designation system, much like that used to define levels of neonatal and maternity care, would be a more acceptable approach. A level I center would offer diagnostic and needle-based procedures, and a level III center would offer all evidence-based fetal procedures. Because the field of fetal medicine and intervention continues to advance rapidly, a national certification process for fetal centers should be considered.
Cochrane Review Summaries—January 2020
Authors: Haas David M. , Kumar Nimisha , Jahanfar Shayesteh
Published: December 2019

With this issue, the journal launches a new feature titled “Cochrane Review Summaries.” This feature highlights recently published Cochrane Reviews of interest to the readers of Obstetrics & Gynecology. The brief summaries are published below, and the complete references, with hyperlinks to the full Cochrane Review, are listed in Box 1.
Understanding the Radiographic Anatomy of the Proximal Ulna and Avoiding Inadvertent Intraarticular Screw Placement
Authors: Githens Thomas C. , Campbell Sean T. , Salazar Brett , Goodnough L. Henry , DeBaun Malcolm R. , Bishop Julius A. , Gardner Michael J.
Published: December 2019

Objectives:

To map the proximal ulnar articular margins and ensure safe extraarticular placement of implants.

Methods:

Ten fresh frozen adult elbow cadaver specimens were obtained. Radiopaque wire was applied to the articular margin of the articular facets and the central trochlear ridge of the proximal ulna. Fluoroscopic images were obtained demonstrating the articular facet margins. Radiographic measurements were performed and used to identify relative safe screw zones.

Results:

All specimens demonstrated marked extension of the ulnar and radial facets dorsal to the central trochlear ridge. The dorsal extent of the ulnar facets from the central trochlear ridge averaged 9.7 mm (range, 7.9–13 mm; SD, 1.5 mm) and 6.2 mm (range, 3.4–9.4 mm; SD, 1.9 mm), respectively. The average footprint of the posterior ulnar facet occupied 44% (±4.9%) of the total ulnar height from the dorsal cortex to the trochlear ridge.

Conclusions:

The articular margins of the anterior and posterior facets of the proximal ulna are challenging to identify radiographically. A surgical “at-risk zone” exists within 9.7 mm from the radiographic margin of the central trochlear ridge. Implants placed within this zone have the potential to violate the articular surface.
Function Preservation or Oncological Appropriateness in Spinal Bone Tumors?
Authors: Girolami Marco , Boriani Stefano , Ghermandi Riccardo , Bandiera Stefano , Barbanti-Brodano Giovanni , Terzi Silvia , Tedesco Giuseppe , Evangelisti Gisberto , Pipola Valerio , Ricci Alessandro , Cecchinato Riccardo , Gasbarrini Alessandro
Published: December 2019

Study Design.

Retrospective review of prospectively collected data.

Objective.

To evaluate (1) if the segmental resection of the content of the spinal canal could provide an Enneking appropriate tumor-free margin for local control of primary bone tumors surrounding and invading the canal and (2) the safety profile of the segmental resection of the neurostructures.

Summary of Background Data.

Treatment outcomes of primary malignant and benign aggressive bone tumors of the spine have been dramatically changed by the application of the musculoskeletal oncologic principles described by Enneking. However, the efficacy of spinal oncology surgery might be limited by unique features of spinal anatomy.

Methods.

Database search was conducted with the following inclusion criteria: en bloc resection, segmental inclusion of the spinal canal content in the surgical specimen, histologically proven diagnosis, minimum follow-up of 2 years. Exclusion criteria were piecemeal excision of the tumor (debulking) and diagnosis other than primary bone tumors (metastasis, or local extension of extraosseous tumors).

Results.

A consecutive cohort of eight patients (three men, five women) was available for review. Two patients died within 3 months from the surgery for systemic disease progression or sequelae of the surgery. En bloc resection with segmental spinal canal content inclusion was able to achieve local control of the disease in four out of remaining six cases (66.7%) at an average follow-up of 68.7 months (range 12–174 mo). Three patients in whom local control was achieved are free from disease at an average follow-up of 98.7 months (range 38–174), and one died for systemic disease progression (after 38 mo). Seven out of 8 patients (87.5%) experienced overall 16 complications.

Conclusion.

En bloc resection including the spinal canal content (spinal amputation) to achieve a tumor-free margin might be considered to perform an Enneking appropriate treatment for motivated patients.

Level of Evidence: 4
Feasibility and Outcomes of Tubular Decompression in Extreme Stenosis: [RETRACTED]
Authors: Kulkarni Arvind G. , Das Swaroop
Published: December 2019

Study Design.

Retrospective cohort study.

Objectives.

To report the feasibility, nuances, technical tips as well as outcomes of managing single-level grade D (extreme stenosis) and to compare the outcomes with nonextreme stenosis using the tubular retractor system.

Summary of Background Data.

Minimally invasive decompression in extreme stenosis is a challenge due to technical difficulty, feasibility of adequate decompression, and a steep learning curve.

Methods.

Consecutive patients from January 2007 to January 2017 presenting with neurogenic claudication secondary to single-level spinal stenosis operated using tubular retractors were included in the study. The patients were divided into two groups; extreme-stenosis and nonextreme stenosis. The outcomes of surgery were evaluated and compared using visual analogue score (VAS) for leg and back pain, Oswestry disability index (ODI), and MacNab's criteria.

Results.

A total of 325 patients (out of 446 patients after excluding the multilevel cases) fulfilled the inclusion criteria. One hundred forty patients were cases of extreme stenosis and 185 were nonextreme stenosis. The mean VAS for back and leg pain for extreme stenosis improved from 3.23 ± 1.30 to 2.15 ± 0.91 and 7.33 ± 0.78 to 1.66 ± 1.03 respectively as compared with nonextreme stenosis where the mean VAS for back and leg pain improved from 3.01 ± 1.15 to 1.86 ± 1.10 and 6.57 ± 1.00 to 1.54 ± 1.12 respectively. The mean ODI changed from 66.47 ± 7.53 to 19.95 ± 2.90 in extreme stenosis as compared with nonextreme stenosis where mean ODI changed from 59.05 ± 5.08 to 19.88 ± 2.67. As per MacNab's criteria 102 (of 120 patients) and 139 (of 157 patients) reported excellent and good outcomes in extreme and nonextreme stenosis respectively.

Conclusion.

Tubular decompression is feasible in patients with extreme-stenosis with no difference in the outcomes as well as complication rates when compared with a cohort of nonextreme stenosis.

Level of Evidence: 3
Validity of Patient Health Questionnaire-9 in Minimally Invasive Lumbar Interbody Fusion
Authors: Jenkins Nathaniel W. , Parrish James M. , Brundage Thomas S. , Hrynewycz Nadia M. , Yoo Joon S. , Singh Kern
Published: December 2019

Study Design.

Retrospective.

Objective.

The aim of this study was to evaluate the validity of Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive (MIS) lumbar interbody fusion.

Summary of Background Data.

Few studies have evaluated the utility and concurrent validity of the PHQ-9 survey in patients undergoing spinal procedures.

Methods.

Patients undergoing a one- or two-level MIS lumbar interbody fusion were retrospectively reviewed. Patient-reported outcome surveys were completed preoperatively and at 6-week, 12-week, 6-month, and 1-year timepoints. Postoperative survey scores were compared to preoperative values using paired t tests. PHQ-9 scores were compared with the Mental Component Summary (MCS) scores of the Short Form-12 (SF-12) and the Veterans RAND-12 (VR-12) surveys at each timepoint using the Pearson correlation coefficient.

Results.

A total of 215 patients were included in the analysis. The mean preoperative scores for the PHQ-9, SF-12 MCS, and VR-12 MCS were 6.78, 49.55, and 50.39, respectively. Significant improvements in each survey outcome measure were observed at all postoperative timepoints. Strong correlations with PHQ-9 scores were identified for SF-12 MCS scores and VR-12 MCS scores at preoperative and postoperative timepoints (|r| ≥ 0.5 and P < 0.05 for each).

Conclusion.

This study demonstrated that mental health, as measured by the PHQ-9, SF-12 MCS, and VR-12 MCS surveys, improves significantly after MIS lumbar fusion. In addition, PHQ-9 scores were strongly correlated with SF-12 and VR-12 scores. These results suggest that PHQ-9 can be a valid assessment of baseline mental health and postoperative improvement after MIS lumbar fusion. Concordant results among PHQ-9, SF-12 MCS, and VR-12 indicate that the simultaneous utilization of multiple survey instruments may not be necessary. Limiting the number of questionnaires that are administered in the evaluation of mental health could also help reduce survey burden placed on patients.

Level of Evidence: 3
An epidemiology study of fecal incontinence in adult Chinese women living in urban areas
Authors: Yuan Yuan , Qiu Lin , Li Zhi-Yi , Zhang Lei , Xu Tao , Lang Jing-He , Li Zhao-Ai , Gong Jian , Liu Qing , Liu Xiao-Chun , Wang Jun-Tao , Xia Zhi-Jun , Zhu Lan
Published: December 2019

Background:

Fecal incontinence (FI) has been shown to be a common symptom in Western countries; however, there is few researches focusing on its epidemic condition in Chinese women. We conducted this national population-based epidemiology study to estimate the prevalence and risk factors of FI among adult Chinese women living in urban regions.

Methods:

This is a subgroup analysis of a national population-based epidemiology study of FI. Total 28,196 adult women from urban regions of six provinces and municipalities participated in this research from 2014 to 2015. They finished the questionnaire under the direction of trained interviewers. FI was defined as accidental leakage of flatus and/or liquid or solid stool at least once in the past. The FI prevalence trend and risk factors were identified by the Cochran-Armitage test, Chi-square test, and multivariable logistic regression.

Results:

The prevalence of FI in adult females in urban China was 0.43% (95% confidence interval: 0.35%–0.51%). Among women with FI, 42.96%, 82.96%, and 42.22% reported having leakage of solid, liquid stool, and gas, respectively. The overall FI prevalence and the incidence rate of solid stool/liquid stool/gas leakage increased with age. The mean Wexner score was 4.0% and 12.0% FI patients reported Wexner score ≥9. Body mass index ≥24 kg/m2, pelvic organ prolapses, chronic constipation, chronic cough, alcohol consumption, physical diseases including chronic bronchitis and cancer, gynecological diseases like gynecological inflammation are risk factors for FI. Vaginal delivery was the risk factor for FI in females with labor history.

Conclusions:

FI was not a common symptom in adult Chinese women living in urban areas and there were some potential modifiable risk factors.

Trial Registration:

Chinses Clinical Trial Registry: ChiCTR-OCS-14004675; http://www.chictr.org.cn/showproj.aspx?proj=4898
Age-specific differences in non-cardiac comorbidities among elderly patients hospitalized with heart failure: a special focus on young-old, old-old, and oldest-old
Authors: Yang Meng-Xi , An Hui , Fan Xue-Qiang , Tao Li-Yuan , Tu Qiang , Qin Li , Zhang Li-Fang , Feng Dong-Ping , Wang Yu , Sun Li , Gao Si , Guan Wen-Zhuo , Zheng Jin-Gang , Ren Jing-Yi
Published: December 2019

Background

Despite the growing epidemic of heart failure (HF), there is limited data available to systematically compare non-cardiac comorbidities in the young-old, old-old, and oldest-old patients hospitalized for HF. The precise differences will add valuable information for better management of HF in elderly patients.

Methods

A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study. Patients were compared among three age groups: (1) young-old: 65 to 74 years, (2) old-old: 75 to 84 years, and (3) oldest-old: ≥85 years. Clinical details of presentation, comorbidities, and prescribed medications were recorded.

Results

The mean age was 76.7 years and 12.7% were 85 years or older. Most elderly patients with HF (97.5%) had at least one of the non-cardiac comorbidities. The patterns of common non-cardiac comorbidities were different between the young-old and oldest-old group. The three most common non-cardiac comorbidities were anemia (53.6%), hyperlipidemia (45.9%), and diabetes (42.4%) in the young-old group, while anemia (73.1%), infection (58.2%), and chronic kidney disease (44.0%) in the oldest-old group. Polypharmacy was observed in 93.0% elderly patients with HF. Additionally, 29.2% patients were diagnosed with infection, and 67.0% patients were prescribed antibiotics. However, 60.4% patients were diagnosed with anemia with only 8.9% of them receiving iron repletion.

Conclusions

Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age, and inappropriate medications are very common in elderly patients with HF. Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.
Not Everyone Should be a Nurse Practitioner
Authors: Nielson Mary Hugo , Halloran Laurel
Published: December 2019

There has been an increase in student enrollment in advanced practice nurse programs, but limited information regarding attrition and dropout rates in nurse practitioner (NP) programs. Management of NP students includes student evaluations, preceptor guidance and support, student support, and use of reflective practice. Program directors, faculty members, and preceptors must assist NP students with role transitioning and help those who are not meeting the rigors of NP education to leave the program and discover alternative nursing roles.
Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Seborrheic Keratoses
Authors: Hruza George J. , Zelickson Brian D. , Selim Mona M. , Rohrer Thomas E. , Newman James , Park Hyoung , Jauregui Lauren , Nuccitelli Richard , Knape William A. , Ebbers Edward , Uecker Darrin
Published: December 2019

BACKGROUND

Nanosecond pulsed electric field technology (also known as Nano-Pulse Stimulation or NPS) is a nonthermal, drug-free, energy-based technology that has demonstrated effects on cellular structures of the dermis and epidermis in previous clinical studies.

OBJECTIVE

To evaluate the safety and efficacy of a single NPS treatment for clearing seborrheic keratoses (SKs).

MATERIALS AND METHODS

This study was a prospective, randomized, open-label, multisite, nonsignificant risk trial in which each subject served as their own control. Fifty-eight subjects had 3 of 4 confirmed SK lesions treated, resulting in 174 total treated lesions. Subjects returned for 5 to 6 follow-up evaluations and photographs.

RESULTS

At 106 days after NPS treatment, 82% of treated seborrheic keratoses were rated clear or mostly clear by the assessing physician. Seventy-one percent of lesions were rated clear or mostly clear by the 3 independent reviewers based on the 106-day photographs. All treated subjects returned for all study visits, and 78% of the subjects were satisfied or mostly satisfied with the outcome of the treatment. No adverse events were reported.

CONCLUSION

The NPS procedure was well tolerated and effective in the removal of SKs.
Assessment of Bias in Estimates of Sexual Network Degree using Prospective Cohort Data
Authors: Uong Stephen , Rosenberg Eli S. , Goodreau Steven M. , Luisi Nicole , Sullivan Patrick , Jenness Samuel M.
Published: December 2019

Background:

Sexual network degree, a count of ongoing partnerships, plays a critical role in the transmission dynamics of human immunodeficiency virus and other sexually transmitted infections. Researchers often quantify degree using self-reported cross-sectional data on the day of survey, which may result in bias because of uncertainty about future sexual activity.

Methods:

We evaluated the bias of a cross-sectional degree measure with a prospective cohort study of men who have sex with men (MSM). At baseline, we asked men about whether recent sexual partnerships were ongoing. We confirmed the true, ongoing status of those partnerships at baseline at follow-up. With logistic regression, we estimated the partnership-level predictors of baseline measure accuracy. With Poisson regression, we estimated the longitudinally confirmed degree as a function of baseline predicted degree.

Results:

Across partnership types, the baseline ongoing status measure was 70% accurate, with higher negative predictive value (91%) than positive predictive value (39%). Partnership exclusivity and racial pairing were associated with higher accuracy. Baseline degree generally overestimated confirmed degree. Bias, or number of ongoing partners different than predicted at baseline, was −0.28 overall, ranging from −1.91 to −0.41 for MSM with any ongoing partnerships at baseline. Comparing MSM of the same baseline degree, the level of bias was stronger for black compared with white MSM, and for younger compared with older MSM.

Conclusions:

Research studies may overestimate degree when it is quantified cross-sectionally. Adjustment and structured sensitivity analyses may account for bias in studies of human immunodeficiency virus or sexually transmitted infection prevention interventions.
Proton-pump Inhibitor Use and Myocardial Infarction
Authors: Qian Yiran , Jick Susan
Published: December 2019

Background:

Use of proton-pump inhibitors (PPIs) is suggested to be associated with adverse cardiovascular (CV) events via. endothelial dysfunction. Studies show that PPIs are associated with increased risk of myocardial infarction (MI) among patients with preexisting CV disease. However, little is known about their risk among people without known CV disease.

Methods:

We conducted a nested case–control study in the UK Clinical Practice Research Datalink (CPRD) GOLD to evaluate the association between PPI use and risk of MI in patients without known CV disease. From among PPIs users age 25 to 65 between 1988 and 2017, we identified 32,793 MI cases and 127,291 controls matched 4:1 on age, sex, general practice setting, and calendar time. Using logistic regression, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) for MI comparing PPI users to nonusers, adjusting for body mass index, smoking, alcohol abuse, drug abuse, type 2 diabetes, hyperlipidemia, hypertension, and peripheral artery disease. We repeated this analysis in users of histamine 2 receptor antagonists (H2RA), a drug with a similar indication, to assess protopathic bias.

Results:

The risk of MI was elevated in new users of PPIs with one to five prescriptions (adjusted OR = 2.8; 95% CI = 2.6, 3.0), but not in any other exposure category. The results among H2RA users were similar across all exposure categories, suggesting that protopathic bias likely explains the results.

Conclusions:

Our study results were not consistent with the hypothesis that PPI use increases MI risk among people without known heart disease.
The Influence of Translaminar Pressure Gradient and Intracranial Pressure in Glaucoma: A Review
Authors: Price David A. , Harris Alon , Siesky Brent , Mathew Sunu
Published: December 2019

The current evidence associating intracranial pressure (ICP) with glaucoma, the translaminar pressure gradient hypothesis, and anatomic factors likely affecting the relationship between ICP and retrolaminar tissue pressure including the size of the optic canal and lamina cribrosa thickness are reviewed. In addition, the evidence of diurnal and positional variation on the translaminar pressure gradient, effects of glaucoma medications, evidence of ICP helping to maintain cerebrospinal fluid flow in the optic nerve to prevent glaucomatous damage, and the effect of intraocular pressure variation in glaucoma are also reviewed. We find that while low ICP is associated with glaucoma disease in most studies, evidence is mixed on how closely ICP matches retrolaminar tissue pressure, and it appears the relationship is affected by the size of the optic canal, thickness of the lamina cribrosa, and lymphatic outflow from the optic nerve. Future studies can likely strengthen associations by measuring and controlling for some of these factors.
Electrophysiology in Glaucoma
Authors: Senger Cassia , Moreto Renata , Watanabe Sung E.S. , Matos Alexis G. , Paula Jayter S.
Published: December 2019

Objectives:

Electrophysiological testing of the visual system has been continuously used in studies involving the evaluation of retinal ganglion cells and the diagnosis of glaucoma. This study aims to review the results of recent studies regarding the clinical applicability of electrophysiological tests to glaucoma.

Methods:

A systematic review of the literature was carried out by 2 independent reviewers using the PubMed and EMBASE electronic databases, searching for articles published in English from January 1, 2014 to July 1, 2019 using a combination of the following keywords: (“glaucoma” OR “ocular hypertension”) AND (“electrophysiolog” OR “electroretinogra” OR “ERG” OR “mfERG” OR “Pattern-reversal electroretinography” OR “PERG” OR “mfPERG” OR “photopic negative response” OR “pattern electroretinogram” OR “visual evoked potential” OR “multifocal electroretinography” OR “multifocal electroretinogram” OR “electro-oculography” OR “multifocal VEP” OR “mf-ERG”). A total of 38 studies were selected and the data of 30 of them were tabulated in this review.

Results:

Among the 30 studies selected, the photopic negative response and the reversal pattern electroretinogram were found to be the major methods used to record the electroretinographic responses generated by the retinal ganglion cell. Their multifocal versions and the multifocal visual evoked potential were also proposed during this period. In general, the results underscored a consistent but general correlation between the amplitude and latency measures and routine tests for glaucoma, such as perimetry and optical coherence tomography.

Discussion:

In agreement with previous reviews, clinical electrophysiological testing of the visual system reasonably matched with both the structural and functional analyses for glaucoma. No definitive indications of these tests have been established either at early detection or during follow-up of the disease, and easier protocols and better topographical correspondence with current glaucoma tests are warranted for their routine use.
Use of Meshed Acellular Dermal Allograft as a Lining Material After Orbital Exenteration
Authors: Young Stephanie Ming , Park Ji Woong , Kim Yoon-Duck , Woo Kyung In
Published: December 2019

Purpose:

To evaluate the surgical outcome and safety of acellular human dermal allograft as a new lining material to the exposed orbit after exenteration.

Methods:

Retrospective case series of patients who underwent orbital exenteration followed by reconstruction with meshed-type acellular dermal allograft from 2009 to 2018 in a single tertiary institution.

Results:

There were 14 eyes (2 right, 12 left) of 14 patients (6 men, 8 women). Mean age at operation was 69.1 ± 16.5 years. Indication for surgery was malignancy in all patients. One patient underwent subtotal exenteration, while the rest underwent total exenteration. SureDerm Meshed was used in 12 patients, AlloDerm Meshed in 1, and CGDerm Meshed in 1. Mean follow-up period was 12.1 months. Full or nearly full epithelialization occurred in 10 of 14 patients (71.4%) at 1 month and 9 of 12 patients (75.0%) at 3 months. There was delayed epithelialization in 3 patients due to poor wound care (n = 1), adjuvant radiotherapy (n = 1), and adjuvant radiotherapy followed by cerebrospinal fluid leak (n = 1).

Conclusions:

Meshed acellular human dermal allograft showed good success in reconstruction after orbital exenteration and may be considered as an alternative lining material to split-thickness skin graft after orbital exenteration.
Genetic Subtypes of Systemic Anaplastic Large Cell Lymphoma Show Distinct Differences in PD-L1 Expression and Regulatory and Cytotoxic T Cells in the Tumor Microenvironment
Authors: Ferreira Cristiane R. , Manohar Vidhya , Zhao Shuchun , Bangs Charles D. , Cherry Athena , Azevedo Raymundo Soares , Lage Luis A.P.C. , Pereira Juliana , Zerbini Maria C.N. , Gratzinger Dita , Natkunam Yasodha
Published: December 2019

Anaplastic large cell lymphomas (ALCL) encompass several subgroups that differ in their clinical presentation, genetic features, and prognosis. We characterized the genetic subgroups of 74 patients with ALCL and correlated programmed death ligand 1 (PD-L1) protein expression and compared the densities and ratios of FOXP3+ T regulatory cells and CD8+ tumor-infiltrating lymphocytes (TILs) in tumor cells and the immune microenvironment. The subgroups included anaplastic lymphoma kinase (ALK)-positive (ALK+) ALCL and ALK-negative (ALK−) ALCL and DUSP22-rearranged and nonrearranged ALK− ALCL. None of our cases represented the TP63-rearrangement ALK− ALCL subgroup. Our results showed that ALK+ ALCL had a higher expression of PD-L1 in the tumor cells, in contrast to ALK− ALCL, which expressed high PD-L1 in tumor-associated macrophages (TAMs). DUSP22-rearranged ALK− ALCL lacked PD-L1 expression in the tumor cells and instead expressed PD-L1 only in TAMs. There was a significant positive correlation of PD-L1 expression between tumor and TAMs in ALK+ ALCL with a negative correlation in ALK− ALCL. Systemic ALCL subgroups had similar densities of CD8+ tumor-infiltrating lymphocytes and FOXP3 T regulatory cells, but differences were observed in the ratio of CD8/FOXP3. Our results suggest that alterations in tumor microenvironment and immune responses exist among systemic ALCL subgroups and these features may account for different clinical behavior and prognosis.
Evaluation of Longitudinal Assessment for Use in Maintenance of Certification
Authors: Robinson Lawrence R. , Raddatz Mikaela M. , Kinney Carolyn L.
Published: December 2019

Objective

The aim of the study was to evaluate a longitudinal assessment program for physical medicine and rehabilitation (LA-PM&R) as a replacement for the American Board of Physical Medicine and Rehabilitation maintenance of certification examination.

Design

In this quality improvement study, randomly selected American Board of Physical Medicine and Rehabilitation diplomates were invited to participate in the LA-PM&R. Participants’ maintenance of certification scaled scores were compared with LA-PM&R nonparticipants. We examined the association between LA-PM&R scores and maintenance of certification scaled scores and performance on clone items placed on both examinations.

Results

There were 2222 American Board of Physical Medicine and Rehabilitation diplomates eligible to take the maintenance of certification examination from February 2018 to February 2019. Invitations were sent to 1050 randomly selected diplomates, of whom 448 initially agreed. Three hundred eighteen individuals completed more than two quarters of LA-PM&R participation and took the maintenance of certification examination. Two hundred sixty-six diplomates took the maintenance of certification examination in the same period who did not participate in LA-PM&R. The LA-PM&R group scored higher on the maintenance of certification examination than the control group (P < 0.05). Performance on the two examinations were highly correlated, r = .50, P < 0.0001. On clone items, LA-PM&R participants had 74% correct on the LA-PM&R but 86% correct on the maintenance of certification examination (P < 0.01).

Conclusions

The LA-PM&R program leads to better learning and retention of information than the 10-yr maintenance of certification examination.
Motivators for and Barriers to Exercise Rehabilitation in Hemodialysis Centers
Authors: Wang Xin-Xin , Lin Ze-Hua , Wang Ying , Xu Ming-Cheng , Kang Zhi-Min , Zeng Wen , Ma Ying-Chun
Published: December 2019

Objectives

The aim of the study was to explore motivators for and barriers to exercise rehabilitation in hemodialysis patients and the barriers perceived by the hemodialysis center staff.

Design

A cross-sectional study was performed in five hemodialysis centers using patient questionnaires designed for this study to evaluate the motivators for and barriers to exercise rehabilitation. Questionnaires were not yet validated.

Results

Of the 471 recruited patients, 63.3% were willing to participant in exercise rehabilitation. The greatest motivators included improving quality of life (98.0%) and wanting to be healthier (98.0%). Perceived barriers included discomfort (59.0%), concerns regarding safety (36.7%), and disinterest (27.0%). Among these, unwillingness, disinterest, and having peripheral arterial disease were independent risk factors of lack of participation in exercise rehabilitation. The most common perceived barriers among the 90 employees that participated were lack of professional guidance and advice from rehabilitation therapists (93.1%), lack of exercise rehabilitation knowledge (86.2%), and lack of special exercise equipment (86.2%).

Conclusions

Most patients were willing to exercise to improve their health and quality of life. Barriers to exercise rehabilitation included patient and staff factors. It is essential to establish a rehabilitation team within dialysis centers, including general staff and rehabilitation therapists. These centers require improved rehabilitation policies and access to specialized rehabilitation equipment.
Use of HIV Pre-exposure Prophylaxis (PrEP) Associated With Lower HIV Anxiety Among Gay and Bisexual Men in Australia Who Are at High Risk of HIV Infection: Results From the Flux Study
Authors: Keen Phillip , Hammoud Mohamed A. , Bourne Adam , Bavinton Benjamin R. , Holt Martin , Vaccher Stefanie , Haire Bridget , Saxton Peter , Jin Fengyi , Maher Lisa , Grulich Andrew E. , Prestage Garrett
Published: December 2019

Background:

Many gay and bisexual men (GBM) experience HIV anxiety, particularly around condomless anal intercourse. HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that may reduce HIV anxiety among GBM.

Methods:

The Following Lives Undergoing Change (Flux) Study is a national, online, open-prospective observational study of licit and illicit drug use among GBM in Australia. In 2018, participants responded to newly included items regarding anxiety about HIV transmission. Stratifying GBM as high or low risk as determined by the Australian PrEP Guidelines, we assess whether PrEP use is associated with lower levels of HIV anxiety. Multivariate logistic regression was used to compare factors associated with PrEP use among GBM at high risk (PrEP-eligible) and low risk (PrEP-ineligible) of HIV infection. Results are reported as adjusted odds ratios and corresponding 95% confidence intervals.

Results:

Among 1547 men, the mean age was 37.1 years (SD 13.1). Men aged 25 years or younger had higher HIV anxiety scores than older men. Among PrEP-eligible men, men who use PrEP reported lower levels of HIV anxiety (adjusted odds ratio = 0.92; 95% confidence interval = 0.87 to 0.99; P < 0.001). No differences were observed on HIV anxiety among PrEP-ineligible men.

Conclusions:

Among PrEP-eligible men, PrEP use was independently associated with lower levels of HIV anxiety. In addition to avoiding HIV infection, PrEP use may help reduce anxiety among men at risk of HIV. This feature of PrEP could be promoted as part of demand creation initiatives to increase PrEP uptake.
Brief Report: Anal Intercourse, HIV-1 Risk, and Efficacy in a Trial of a Dapivirine Vaginal Ring for HIV-1 Prevention
Authors: Peebles Kathryn , van der Straten Ariane , Palanee-Phillips Thesla , Reddy Krishnaveni , Hillier Sharon L. , Hendrix Craig W. , Harkoo Ishana , Gati Mirembe Brenda , Jeenarain Nitesha , Baeten Jared M. , Brown Elizabeth R. ,   on behalf of the MTN-020/ASPIRE Study Team
Published: December 2019

Objectives:

To describe receptive anal intercourse (RAI) behaviors and correlates in a cohort of sub-Saharan African women, evaluate the association of RAI with HIV-1 risk, and evaluate whether the HIV-1 prevention efficacy of a dapivirine vaginal ring differs among women who reported RAI.

Design:

Secondary analysis of the MTN-020/ASPIRE trial, a randomized, double-blind, placebo-controlled trial evaluating a dapivirine vaginal ring for HIV-1 prevention.

Methods:

At enrollment and month 3, women reported RAI in the prior 3 months in audio computer-assisted self-interviews. We evaluated associations between RAI and participant characteristics with χ2 and t-tests adjusted for study site. Cox proportional hazards models stratified by study site tested the association of RAI with HIV-1 acquisition and effect modification by RAI.

Results:

Eighteen percent of women reported any RAI at enrollment and/or month 3, with a median of 2 (interquartile range: 1–4) RAI acts in the prior 3 months, accounting for 1.5% of total sex acts. RAI prevalence was higher among women with lower educational attainment and those reporting transactional sex. In adjusted models, RAI was not associated with HIV-1 acquisition (aHR: 0.93, 95% CI: 0.57 to 1.54). The ring reduced HIV-1 risk by 27% (95% CI: −5 to 49) among women reporting no RAI and by 18% (95% CI: −57 to 57) among women reporting any RAI (interaction P-value = 0.77).

Conclusions:

RAI was modestly infrequent and was not associated with reduced HIV-1 protection from the ring, suggesting that, in populations with rates of RAI similar to this cohort, RAI may not appreciably reduce the population-level impact of the dapivirine vaginal ring.
Neuro-protection and neuro-regeneration of the optic nerve: recent advances and future directions
Authors: Gokoffski Kimberly K. , Peng Micalla , Alas Basheer , Lam Phillip
Published: December 2019

Purpose of review

Optic neuropathies refer to a collection of diseases in which retinal ganglion cells (RGCs), the specialized neuron of the retina whose axons make up the optic nerve, are selectively damaged. Blindness secondary to optic neuropathies is irreversible as RGCs do not have the capacity for self-renewal and have a limited capacity for self-repair. Numerous strategies are being developed to either prevent further RGC degeneration or replace the cells that have degenerated. In this review, we aim to discuss known limitations to regeneration in central nervous system (CNS), followed by a discussion of previous, current, and future strategies for optic nerve neuroprotection as well as approaches for neuro-regeneration, with an emphasis on developments in the past two years.

Recent findings

Neuro-regeneration in the CNS is limited by both intrinsic and extrinsic factors. Environmental barriers to axon regeneration can be divided into two major categories: failure to clear myelin and formation of glial scar. Although inflammatory scars block axon growth past the site of injury, inflammation also provides important signals that activate reparative and regenerative pathways in RGCs. Neuroprotection with neurotrophins as monotherapy is not effective at preventing RGC degeneration likely secondary to rapid clearance of growth factors. Novel approaches involve exploiting different technologies to provide sustained delivery of neurotrophins. Other approaches include application of anti-apoptosis molecules and anti-axon retraction molecules. Although stem cells are becoming a viable option for generating RGCs for cell-replacement-based strategies, there are still many critical barriers to overcome before they can be used in clinical practice. Adjuvant treatments, such as application of electrical fields, scaffolds, and magnetic field stimulation, may be useful in helping transplanted RGCs extend axons in the proper orientation and assist with new synapse formation.

Different optic neuropathies will benefit from neuro-protective versus neuro-regenerative approaches. Developing clinically effective treatments for optic nerve disease will require a collaborative approach that not only employs neurotrophic factors but also incorporates signals that promote axonogenesis, direct axon growth towards intended targets, and promote appropriate synaptogenesis.
Prevention of bone loss and fractures following solid organ transplantations: Protocol for a systematic review and network meta-analysis
Authors: Deng Jiawen , Hou Wenteng
Published: December 2019

Purpose

Solid organ transplant (SOT) recipients can develop skeletal diseases caused by underlying conditions and the use of immunosuppressants. As a result, SOT recipients are at risk for decreased bone mineral density (BMD) and increased fracture incidences. We propose a network meta-analysis (NMA) that incorporates all available RCT data to provide the most comprehensive ranking of antiresorptive interventions according to their ability to decrease fracture incidences and increase BMD in SOT recipients.

Methods

We will search MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL and Chinese literature sources for RCTs, and we will include adult SOT recipients who took antiresorptive therapies starting at the time of transplant with relevant outcomes. We will perform title and full-text screening as well as data extraction in duplicate. We will report changes in BMD as weighted or standardized mean differences, and fracture incidences as risk ratios. We will use SUCRA scores to provide rankings of interventions, and we will examine the quality of evidence using risk of bias and CINeMA.

Results

The results of this systematic review and network meta-analysis will be published in a peer-reviewed journal.

Conclusions

To our knowledge, this systematic review and network meta-analysis will be the most comprehensive quantitative analysis regarding the management of bone loss and fractures in SOT recipients. Our analysis should be able to provide physicians and patients with an up-to-date recommendation for pharmacotherapies in reducing incidences of bone loss and fractures associated with SOT.

CONFLICT OF INTEREST

Jiawen Deng, and Wenteng Hou declare that they have no conflict of interest.

MINI ABSTRACT

We propose a network meta-analysis investigating the use of antiresorptive interventions to prevent bone loss and fractures in solid organ transplant (SOT) recipients. We aim to provide a comprehensive ranking of antiresorptive therapies in terms of their ability to increase bone mineral density and decrease fracture incidence in SOT recipients.
Acetobacteraceae in the honey bee gut comprise two distant clades with diverging metabolism and ecological niches
Authors: Bonilla-Rosso G , Paredes Juan C , Das S , Ellegaard KM , Emery O , Garcia-Garcera M , Glover N , Hadadi N , van der Meer JR ,   SAGE class 2017-18, Tagini F , Engel P
Published: December 2019

Various bacteria of the family Acetobacteraceae are associated with the gut environment of insects. Honey bees harbor two distinct Acetobacteraceae in their gut, Alpha2.1 and Alpha2.2. While Alpha2.1 seems to be a gut specialist, Alpha2.2 is also found in the diet (e.g. royal jelly), the hypopharyngeal glands, and the larvae of honey bees. Here, we combined amplicon and genome sequencing to better understand functional differences associated with the ecology of Alpha2.1 and Alpha2.2. We find that the two phylotypes are differentially distributed along the worker and queen bee gut. Phylogenetic analysis shows that Alpha2.2 is nested within the acetic acid bacteria and consists of two separate sub-lineages, whereas Alpha2.1 belongs to a basal lineage with an unusual GC content for Acetobacteraceae. Gene content analysis revealed major differences in the central carbon and respiratory metabolism between the two phylotypes. While Alpha2.2 encodes two periplasmic dehydrogenases to carry out oxidative fermentation, Alpha2.1 lacks this capability, but instead harbors a diverse set of cytoplasmic dehydrogenases. These differences are accompanied by the loss of the TCA cycle in Alpha2.2, but not in Alpha2.1. We speculate that Alpha2.2 has specialized for fast-resource utilization through incomplete carbohydrate oxidation, giving it an advantage in sugar-rich environments such as royal jelly. On the contrary, the broader metabolic range of Alpha2.1 may provide an advantage in the worker bee hindgut, where competition with other bacteria and flexibility in resource utilization may be relevant for persistence. Our results show that bacteria belonging to the same family may utilize vastly different strategies to colonize niches associated with the animal gut.