bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Anterior-Posterior Versus Posterior-only Spinal Fusion in Treating Dystrophic Neurofibromatosis Scoliosis With Modern Instrumentation
Authors: Jia Fei , Wang Guodong , Sun Jianmin , Liu Xiaoguang
Published: September 2020

Study Design:

This is a systematic review and meta-analysis study.

Objectives:

To compare the efficacy, long-term stability, and safety of combined anterior-posterior spinal fusion (APSF) with posterior-only spinal fusion (PSF) in treating dystrophic neurofibromatosis scoliosis with the use of modern instrumentation.

Summary of Background Data:

When the Harrington or Luque technique was used, APSF had relatively reliable results and had been recommended by many authors. But with the development of instrumentation and techniques, many surgeons performed PSF with satisfactory results. No systematic review and meta-analysis have been conducted to compare the outcomes of the 2 approaches.

Materials and Methods:

Relevant studies on anterior-posterior or posterior fusion of dystrophic neurofibromatosis scoliosis were retrieved from the PubMed, Embase, Cochrane, Springer Link, and Google Scholar databases. Then studies were manually selected for inclusion based on predefined criteria. Data extraction and quality assessment were conducted, and a systematic review and meta-analysis were performed.

Results:

Sixteen eligible studies were included. The angles of scoliosis curves and kyphosis curves were significantly and similarly corrected after surgery in both APSF and PSF group, respectively. At the last follow-up, the loss of correction was significant in the coronal plane but not in the sagittal plane with a similar progression of scoliosis in 2 groups. The overall complication rate was slightly higher in the APSF group, but the difference was not statistically significant. Meanwhile, there was no visible difference in the incidence of pseudarthrosis and instrumentation failures between the 2 groups.

Conclusions:

APSF and PSF by means of the third-generation spinal instrumentation system have similar efficacy, long-term stability, and safety for treating dystrophic scoliosis secondary to type-1 neurofibromatosis.

Level of Evidence:

Level III—systematic review and meta-analysis study.
New Classification Algorithm Guiding Surgical Decision-making for Posterior Longitudinal Ligament Ossification of the Thoracic Spine
Authors: Liu Xiao , Xu Nanfang , Yang Xiaosong , Liu Xiaoguang , Yu Miao , Liu Zhongjun
Published: September 2020

Study Design:

This is a single-center, retrospective, cohort study.

Objective:

The objective of this study was to propose a surgical classification algorithm guiding the choice of surgical approaches for ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine based on the characteristics of each patient’s specific pathology.

Summary of Background Data:

Surgical decision-making in this OPLL patient population requires balancing a more definitive decompression of the thoracic spinal cord through direct decompression against a higher risk of significant complications.

Materials and Methods:

Patients with a primary diagnosis of thoracic OPLL who received surgical decompression in a tertiary spine center between May 2009 and June 2015 were included. Surgical planning was guided by our classification algorithm according to the location and the extent of OPLL in each patient. Patient demographics, neurological function using the 11-point Japanese Orthopaedic Association scale, length of procedure, estimated blood loss, the occurrence of major complications, etc., were extracted from the database of electronic medical record system. The Kruskal-Wallis test and Fisher exact test were used when data were not normally distributed.

Results:

A total of 115 patients (33 men and 82 women) were included in this study, among whom 108 had a follow-up of at least 12 months (average: 51.7±22.2 mo, range: 12–100 mo). On the basis of our classification algorithm, 11 patients were type I, 26 were type II, 60 were type III, 11 were type IV, and the choice of surgical decompression techniques used in each patient followed that recommended by the algorithm in all cases. On average, the Japanese Orthopaedic Association score improved from 5.0±1.8 preoperatively to 8.7±1.7 postoperatively, with a Hirabayashi improvement rate of 63.6%.

Conclusion:

A new surgical classification algorithm guiding the choice of approach for decompression of OPLL in the thoracic spine was validated in a series of 108 patients through an analysis of their clinical outcomes and surgical complications.

Level of Evidence:

Level III.
Feasibility Study of Electromagnetic Muscle Stimulation and Cryolipolysis for Abdominal Contouring
Authors: Kilmer Suzanne L. , Cox Sue Ellen , Zelickson Brian D. , Bachelor Eric P. , Gamio Sylvia , Ostrowski Rafael , Pham Linda D. , Stevens W. Grant
Published: September 2020

BACKGROUND

In addition to reducing subcutaneous fat for body contouring, some patients are interested in toning the underlying muscle layer.

OBJECTIVE

This feasibility study evaluated the safety and efficacy of electromagnetic muscle stimulation (EMMS) alone, cryolipolysis alone, and cryolipolysis with EMMS for noninvasive contouring of abdomen.

METHODS

Abdomens of 50 subjects were treated in a study with 3 cohorts: EMMS alone, Cryolipolysis alone, and Cryolipolysis + EMMS in combination. Electromagnetic muscle stimulation treatments were delivered in 4 sessions over 2 weeks. Cryolipolysis treatments were delivered in one session. Combination treatments consisted of one cryolipolysis and 4 EMMS visits. Efficacy was assessed by independent physician Global Aesthetic Improvement Scale (GAIS), circumferential measurement, Subject GAIS (SGAIS), and Body Satisfaction Questionnaire (BSQ).

RESULTS

Safety was demonstrated for all study cohorts with no device- or procedure-related adverse events. Independent photo review showed greatest mean GAIS score for the Cryolipolysis + EMMS cohort followed by Cryolipolysis only, then EMMS only cohort. BSQ showed greatest average score increase for Cryolipolysis + EMMS cohort followed by Cryolipolysis only cohort, then EMMS only cohort. Mean circumferential reduction measurements were greatest for Cryolipolysis + EMMS cohort followed by Cryolipolysis only, and then EMMS only cohort. The mean SGAIS improvement score was equal for the Cryolipolysis only and Cryolipolysis + EMMS cohorts, followed by the EMMS only cohort.

CONCLUSION

A multimodal approach using cryolipolysis and EMMS was safe and demonstrated enhanced body contouring efficacy for this feasibility study.
Poly-l-Lactic Acid for Gluteal Augmentation found to be Safe and Effective in Retrospective Clinical Review of 60 Patients
Authors: Durairaj Kalpna K. , Devgan Lara , Lee, BS Alexandria , Khachatourian, BS Nooneh , Nguyen, BS Vivian , Issa, BS Thomas , Baker Omer
Published: September 2020

BACKGROUND

Poly-l-lactic acid (PLLA) is a well-established biostimulator that induces neocollagenesis, allowing for volume loss correction. Although PLLA is FDA approved to treat mid-to-lower facial wrinkling, it has grown increasingly popular as a nonsurgical, minimally invasive procedure for soft-tissue volume augmentation of other extremities. However, research detailing PLLA buttock injections is still lacking.

OBJECTIVE

The purpose of this study is to determine the safety and efficacy of PLLA for buttock augmentation.

MATERIALS AND METHODS

A clinical retrospective review of 60 patients (ages 23–54 years) were followed for 2 years by 2 investigators. Patients underwent 1 to 3 treatments, spaced 4 to 6 weeks apart, and received 2 to 12 vials per session (based on the patient budget). Pretreatment and post-treatment photographs were assessed by the primary and secondary investigator in blinded and double-blinded surveys, respectively. The Global Aesthetic Improvement Scale was used to quantify improvements in volume, skin texture, and cellulite dimpling.

RESULTS

Poly-l-lactic acid allows for visible volume amplification, improved skin texture, and softened cellulite dimpling in the buttocks when at least 20 vials are used.

CONCLUSION

Poly-l-lactic acid is safe and effective for overall aesthetic enhancement of the buttocks if used in adequate quantity (minimum 20 vials) for all women, independent of age or the number of sessions.
History through the eyes of a pandemic
Authors: Graversen Veronica Kon , Hamichi Sophia El , Gold Aaron , Murray Timothy G.
Published: September 2020

Purpose of review

This review provides a historic perspective of the impact that major pandemics have had on human and their relationship with ophthalmology. The novel coronavirus epidemic is also analyzed, highlighting the relevance of the eye as a possible source of transmission, infection, and prognosis for the disease.

Results

Smallpox is suspected to be present for more than 12 000 years. However, trachoma seems to be the first recorded ophthalmological infectious disease. The deadliest pandemics include the bubonic plague, smallpox, and Spanish flu. The CoVID-19 epidemic is still developing and measures need to be implemented to prevent further escalation of the crisis.

Understanding the current facts in light of earlier historical evidence may help us prepare better to minimize the spread of infections in the future.
Conversion of Flow-restrictive Ahmed Glaucoma Valve to a Nonrestrictive Drainage Implant by Slicing the Valve Leaflets: An In Vitro Study
Authors: Senthil Sirisha , Kumar Gaddam Manoj , Sri Harsha Chittajallu Sai Naga , Choudhari Nikhil S. , Garudadri Chandrasekar , Richhariya Ashutosh
Published: September 2020

Precis:

With a newly designed blade, slicing of the Ahmed glaucoma valve (AGV) leaflets helped to convert the flow-restrictive AGV into a non–flow-restrictive device. Flow characteristics by our in-vitro study confirmed the loss of resistance of AGV valve leaflets.

Purpose:

To describe a new blade to destroy the valve leaflets of AGV and to report the in-vitro flow characteristics of AGV after valve destruction.

Methods:

All the newly opened AGV implants and the Aurolab aqueous drainage implants (AADI, used as controls) were tested by connecting to a 27-G cannula, open manometer, digital manometer, and automated infusion pump. Data logging was done using a digital manometer at 4 Hz using computerized software. When the AGV’s flow characterization reached the steady phase, their valve functionality was destroyed by disrupting the valve leaflets, using a specially designed blade. The flow characteristics after valve slicing were compared with that of AADI.

Results:

A total of 5 FP7 AGVs and 2 AADIs were tested. After initial resistance to flow (5, 8 mm Hg) observed in the case of AADI for 1 to 3 hours, it dropped to 1 mm Hg in both the implants. The flow-restrictive AGV showed 3 distinct phases in the flow characterization. The first phase included the transient phase followed by the steady phase wherein the pressure was 11.2±2.6 (min 7, max 14) mm Hg. The pressure resistance of the AGV dropped significantly (P<0.001) to a mean of 0.4±0.54 mm Hg (1 mm Hg in 2 devices and 0 mm Hg in 3 devices) after the valve functionality was destroyed. The average time taken for this drop in pressure resistance after valve slicing was 10.2±3.0 minutes (min 7, max 15).

Conclusions:

It was possible to convert the flow-restrictive AGV into a non–flow-restrictive device by destroying the functionality of the valve leaflets. The pressure of the AGVs was similar to AADI after destroying its valve functionality.
Remote Screening for Optic Nerve Cupping Using Smartphone-based Nonmydriatic Fundus Photography
Authors: LaMonica Lauren C. , Bhardwaj Mahesh K. , Hawley Nicola L. , Naseri Take , Reupena Muagatutia S. , Cooper Michael L. , Cotran Paul R. , Roh Shiyoung , Ramsey David J.
Published: September 2020

Précis:

Evaluation of nonmydriatic fundus photographs captured with a low-cost, smartphone-based camera facilitated remote screening of patients for enlarged optic nerve cup-to-disc ratio in the Independent Nation of Samoa, an underserved setting with one full-time ophthalmologist in the entire country.

Purpose:

To investigate factors that impact inter-rater agreement of glaucoma suspect optic disc status using a low-cost, handheld nonmydriatic fundus camera.

Methods:

Color fundus photographs were obtained using the PanOptic iExaminer attached to an iPhone 6S by a lay examiner on 206 participants in the Independent Nation of Samoa. Images were remotely graded by an ophthalmologist and optometrist, and images from participants identified as at-risk for glaucoma were escalated to a glaucoma subspecialist for review. Fundus photo brightness, contrast, and focus were measured using the cup, rim, and temporal regions of the disc. Stereoscopic image pairs were subsequently generated from a subset of individual nonmydriatic photographs.

Results:

Features suggestive of glaucoma based on optic disc cupping were identified in 16.0% (33/206) of participants. There was moderately strong agreement between graders (90.3%) with κ=0.53 [95% confidence interval (CI)=0.33-0.73]. The intraclass correlation coefficients for the cup-to-disc ratio (CDR) and its difference were 0.84 (95% CI=0.81-0.87) and 0.68 (95% CI=0.59-0.75). Of the 33 participants identified, 94% had clinical risk criteria for potential glaucoma when reviewed by a subspecialist. Color fundus photograph cup brightness was significantly associated with cup-to-disc (CDR) grade, R
2=0.36 (P<0.001), in which a brighter disc yielded a higher CDR.

Conclusions:

Smartphone-based screening is a simple, low-cost method capable of measuring the CDR of the optic nerve. When combined with testing for other glaucoma risk factors such as intraocular pressure, this method of measuring CDR may help identify those patients who should be referred for further ophthalmologic assessment. We are currently conducting studies to assess the sensitivity and specificity of smart phone-based remote screening.
Ophthalmic Artery and Superior Ophthalmic Vein Blood Flow Dynamics in Glaucoma Investigated by Phase Contrast Magnetic Resonance Imaging
Authors: Promelle Veronique , Bouzerar Roger , Daouk Joel , Iscar Claire , Milazzo Solange , Balédent Olivier
Published: September 2020

Precis:

Ophthalmic artery (OA) and superior ophthalmic vein (SOV) blood flow were quantified by phase contrast magnetic resonance imaging (PC MRI) and seemed lower in glaucoma. Venous flow dynamics was different in glaucoma patients with a significantly decreased pulsatility.

Introduction:

Studies using color Doppler imaging and optical coherence tomography flowmetry strongly suggested that vascular changes are involved in the pathophysiology of glaucoma, but the venous outflow has been little studied beyond the episcleral veins. This study measured the OA and the SOV flow by PC MRI in glaucoma patients compared with controls.

Methods:

Eleven primary open-angle glaucoma patients, with a mean±SD visual field deficit of −2.3±2.7 dB and retinal nerve fiber layer thickness of 92±13 µ, and 10 controls of similar age, were examined by PC MRI. The mean, maximal and minimal flow over cardiac cycle were measured. The variation of flow (ΔQ) was calculated.

Results:

The OA mean±SD mean flow was 13.21±6.79 in patients and 15.09±7.62 mL/min in controls (P=0.35) and the OA maximal flow was 25.70±12.08 mL/min in patients, and 28.45±10.64 mL/min in controls (P=0.22). In the SOV the mean±SD mean flow was 6.46±5.50 mL/min in patients and 7.21±6.04 mL/min in controls (P=0.81) and the maximal flow was 9.06±6.67 in patients versus 11.96±9.29 mL/min in controls (P=0.47). The ΔQ in the SOV was significantly lower in patients (5.45±2.54 mL/min) than in controls (9.09±5.74 mL/min) (P=0.04).

Discussion:

Although no significant difference was found, the mean and maximal flow in the OA and SOV seemed lower in glaucoma patients than in controls. The SOV flow waveform might be affected in glaucoma, corroborating the hypothesis of an impairment of venous outflow in those patients.
Patients' perceptions of the pathways linking chronic pain with problematic substance use
Authors: Wyse Jessica J. , Lovejoy Jennette , Holloway Julia , Morasco Benjamin J. , Dobscha Steven K. , Hagedorn Hildi , Lovejoy Travis I.
Published: September 2020

Approximately one-half of patients with substance use disorders (SUDs) experience chronic pain. Yet, how patients perceive the relationship between their substance use and chronic pain remains poorly understood. We sought to identify how patients with comorbid SUD and chronic pain describe the relationship between, and mechanisms linking, these conditions. We conducted qualitative interviews with 34 patients engaged in SUD treatment who were also diagnosed with chronic pain. Interviews were transcribed verbatim and coded by both primary and secondary coders. Qualitative content analysis guided coding and analysis. Patient interviews revealed 3 primary pathways. One group of participants described SUD as developing independently from their experiences of chronic pain. A second group of participants described turning to substances to self-manage or cope with the physical and emotional aspects of chronic pain. A third group of participants described encounters with opioid medications as the causal agent initiating a SUD. Our findings build on research that has identified chronic pain and SUD as developmentally similar and mutually reinforcing, by revealing the ways in which patients themselves understand and experience the interconnections between their substance use and chronic pain.
Compassion Fatigue in Nurses Caring for Medically Complex Children
Authors: Bleazard Mark
Published: September 2020

The number of children living with chronic, complex medical needs is steadily increasing secondary to advances in clinical technology and disease management. As a result, patient care requirements become multifaceted with the need for specific therapies and treatments that require extensive knowledge and skills. As these children are managed throughout the health care continuum, nurses are challenged to offer specialized care for complex conditions, while meeting the personnel and financial demands of the changing health care environment. It is well established that medically complex children can put a burden on family life, resulting in compassion fatigue for nonclinical caregivers. It is possible that, secondary to frequent and lengthy hospitalizations, nurses may also be affected. Therefore, a review of compassion fatigue or professional burnout in nurses caring for medically complex children was conducted. Appropriate identification of nurses at risk for compassion fatigue is imperative to provide the necessary interventions and support. Reducing compassion fatigue is likely to improve outcomes, including nursing turnover, nursing professional engagement, and job satisfaction, thus improving the care delivery experience for children with complex conditions.
Optimizing Recruitment Strategies and Physician Engagement for Stroke Recovery Research
Authors: Morton Allegra , Myers Moira , Whitaker Alicen A. , Kempf Katie S. , Eickmeyer Sarah M. , Abraham Michael , Rippee Michael A. , Billinger Sandra A.
Published: September 2020

Background and Purpose:

A major challenge for stroke rehabilitation and recovery research is the recruitment and retention of participants. Our prior challenges and successes have influenced our team to rethink our approach and the potential for large-scale stroke recruitment.

Summary of Key Points:

In this special interest article, we highlight how the adoption and implementation of recruitment strategies such as physician engagement and a streamlined “customer service” approach helped us improve our enrollment and maximize efficiency. Another positive outcome of enrollment was increased representation of those who identify as underrepresented minority or live in rural areas.

Recommendations for Clinical Practice:

Rethinking our recruitment processes and infrastructure allowed for greater interprofessional interactions, minimal burden for our stroke physician team members, and maximized enrollment into our stroke studies.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A324).
Detection of COVID-19 Using Deep Learning Algorithms on Chest Radiographs
Authors: Chiu Wan Hang Keith , Vardhanabhuti Varut , Poplavskiy Dmytro , Yu Philip Leung Ho , Du Richard , Yap Alistair Yun Hee , Zhang Sailong , Fong Ambrose Ho-Tung , Chin Thomas Wing-Yan , Lee Jonan Chun Yin , Leung Siu Ting , Lo Christine Shing Yen , Lui Macy Mei-Sze , Fang Benjamin Xin Hao , Ng Ming-Yen , Kuo Michael D.
Published: September 2020

Purpose:

To evaluate the performance of a deep learning (DL) algorithm for the detection of COVID-19 on chest radiographs (CXR).

Materials and Methods:

In this retrospective study, a DL model was trained on 112,120 CXR images with 14 labeled classifiers (ChestX-ray14) and fine-tuned using initial CXR on hospital admission of 509 patients, who had undergone COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR). The test set consisted of a CXR on presentation of 248 individuals suspected of COVID-19 pneumonia between February 16 and March 3, 2020 from 4 centers (72 RT-PCR positives and 176 RT-PCR negatives). The CXR were independently reviewed by 3 radiologists and using the DL algorithm. Diagnostic performance was compared with radiologists’ performance and was assessed by area under the receiver operating characteristics (AUC).

Results:

The median age of the subjects in the test set was 61 (interquartile range: 39 to 79) years (51% male). The DL algorithm achieved an AUC of 0.81, sensitivity of 0.85, and specificity of 0.72 in detecting COVID-19 using RT-PCR as the reference standard. On subgroup analyses, the model achieved an AUC of 0.79, sensitivity of 0.80, and specificity of 0.74 in detecting COVID-19 in patients presented with fever or respiratory systems and an AUC of 0.87, sensitivity of 0.85, and specificity of 0.81 in distinguishing COVID-19 from other forms of pneumonia. The algorithm significantly outperforms human readers (P<0.001 using DeLong test) with higher sensitivity (P=0.01 using McNemar test).

Conclusions:

A DL algorithm (COV19NET) for the detection of COVID-19 on chest radiographs can potentially be an effective tool in triaging patients, particularly in resource-stretched health-care systems.
Beauty Is in the Eye of the Beholder: Esthetic Outcome Assessment in Smile Reanimation Surgery in Patients With Facial Palsy
Authors: van Veen Martinus M. , Broekstra Dieuwke C. , Mureau Marc A.M. , Werker Paul M.N. , Dijkstra Pieter U.
Published: September 2020

Layperson assessments are becoming increasingly important in the evaluation of surgical procedures of the face, including smile reanimation. In this study, the authors set out to answer 3 questions: (1) are esthetic scores more dependent on the assessor or the person that is being assessed, (2) how does smile reanimation change esthetic scores, (3) do sex and age of the patient and assessor explain some of the esthetic outcomes?

Thirty-five assessors scored pre and postoperative photographs of 21 facial palsy patients undergoing smile reanimation. Linear mixed-effect models were used to investigate the effects of assessor and patient factors on esthetic outcome assessments, to examine changes after smile reanimation, and to determine whether sex and age explained part of the esthetic outcomes.

Fifty-eight percent of variation in the esthetic scores can be explained by some assessors being more positive in their esthetic scoring compared to other assessors. Twenty-nine percent was attributed to patient baseline esthetic scores. Overall esthetic scores improved after smile reanimation. Sex and age of the patient and assessor could not explain variation in the esthetic scores.

Esthetic appearance highly depends on “who is looking.” These findings are important for preoperative counseling, and for those treating and educating patients with facial palsy.
Pediatric Mandibular Central Giant Cell Granuloma: Neoadjuvant Immunotherapy to Minimize Surgical Resection
Authors: Lin Jason , Mecham Jeffrey C. , Hall S. Ryan , Oh Christine , Lettieri Salvatore
Published: September 2020

Central giant cell granuloma (CGCG) is a relatively uncommon benign bony lesion accounting for approximately 7% of all non-neoplastic lesions of the jaw. The clinical behavior of CGCG can vary from a slow-growing, painless lesion to fast-growing and locally destructive. When such a lesion involves the mandible, this can be quite debilitating for the patient, inhibiting oral intake and requiring an extensive resection and bone graft reconstruction. The authors present a case of effectively decreasing the surgical morbidity associated with a large and rapidly growing CGCG of the mandible in a pediatric patient. Neoadjuvant immunotherapy with denosumab (human monoclonal antibody) facilitated treatment of the tumor without the need for a large resection which would have otherwise necessitated a vascularized bony mandibular reconstruction. Consideration of neoadjuvant medical management of CGCG as the primary treatment is advocated.
A Mobile Application Patient Decision Aid for Treatment of Overactive Bladder
Authors: Khanijow Kavita D. , Leri Damien , Arya Lily A. , Andy Uduak U.
Published: September 2020

Objective

The aim of this study was to develop and validate a mobile application patient decision aid (mPDA) for providing treatment options to women with overactive bladder (OAB).

Methods

We performed a mixed methods study. We conducted cognitive interviews to gain insight about treatment decisions for OAB. We then developed an evidence-based mPDA and conducted a prospective cohort study to validate it. Women completed the validated Decisional Conflict Scale. Construct validity was determined by comparing Decisional Conflict Scale scores before and after use of the decision aid. Concurrent validity was assessed by determining the relationship between change in Decision Conflict Scale score and a validated Patient Satisfaction Questionnaire. Discriminant validity was assessed by comparing the change in Decision Conflict Scale score in women who had failed 2 or less versus 3 or more prior treatments.

Results

Fifteen women participated in cognitive interviews. Thematic analysis revealed that women want information about adverse events, personalization of treatment options, and supplemental interactive sources. Sixty-five women participated in the validation study. Decision Conflict Scale scores improved significantly after use of the decision aid (60.2 ± 22.3 vs 18.7 ± 19.5, P < 0.001). Change in Decision Conflict Scale score correlated moderately with Patient Satisfaction Questionnaire score (r = 0.437, P = 0.003). Women with 3 or more prior treatment failures had greater improvement in Decision Conflict Scale score than women with 2 or less prior treatment failures (P < 0.001).

Conclusions

The mPDA is a valuable adjunct to physician counseling for treatment options in women with OAB.
Visual Outcomes in Leber Hereditary Optic Neuropathy Patients With the m.11778G>A (MTND4) Mitochondrial DNA Mutation
Authors: Newman Nancy J. , Carelli Valerio , Taiel Magali , Yu-Wai-Man Patrick
Published: September 2020

Background:

Leber hereditary optic neuropathy (LHON) is a maternally inherited bilaterally blinding optic neuropathy, predominantly affecting otherwise healthy young individuals, mostly men. The visual prognosis is generally poor, with most patients worsening to at least 20/200 visual acuity. The m.11778G>A (MTND4) mitochondrial DNA mutation is the most common cause of LHON and is associated with poor outcomes and limited potential for meaningful visual recovery. Treatments for LHON are limited, and clinical trials are hampered by inadequate data regarding the natural history of visual loss and recovery. In this article, we review the current literature specifically related to visual function of LHON patients with the m.11778G>A mutation.

Evidence acquisition:

Literature review was performed using MEDLINE through PubMed, Cochrane Reviews Library, and Orpha.net with search terms of “Leber hereditary optic neuropathy,” “LHON,” “ND4,” “G11778A,” “visual acuity,” “nadir,” “natural history,” and “registry.” All English-language, peer-reviewed publications with study cohorts of at least 5 LHON patients with the molecularly confirmed m.11778G>A mutation were included.

Results:

Meta-analysis of 12 retrospective and 3 prospective studies provided visual function information on 695 LHON patients with the m.11778G>A mutation, 100 (14.4%) of whom were reported to have “recovered” some vision, although definitions of “recovery” varied among studies and idebenone use could not always be excluded. When incorporating age at onset of visual loss into the analyses, and specifically addressing those patients aged 15 years or older, meaningful visual recovery occurred in 23 of 204 (11.3%) patients. A younger age at onset, especially less than 12 years, portends a better visual prognosis and a different natural history of visual loss progression and recovery than in adults.

Conclusions:

The classic presentation of LHON patients with the m.11778G>A mutation of severe visual loss with rare or poor recovery from nadir still holds true for most affected individuals. Among patients 15 years and older, recovery of meaningful vision likely occurs in less than 20% of patients, irrespective of how recovery is defined, and ultimate visual acuities of better than 20/200 are rare. Adequate prospective studies with sufficient sample sizes of genotypically homogeneous untreated LHON patients stratified by age, immediately enrolled when symptomatic, followed regularly for adequate periods of time with consistent measures of visual function, and analyzed with a standard definition of visual improvement are unfortunately lacking. Future clinical trials for LHON will require more standardized reporting of the natural history of this disorder.
Targeting the glycan of receptor binding domain with jacalin as a novel approach to develop a treatment against COVID-19
Authors: Rajendaran Senthilnathan , Jothi Arunchalam , Anbazhagan Veerappan
Published: September 2020

In silico
analysis revealed that a lectin, jacalin from jackfruit seeds, recognizes a glycosylated region of the receptor-binding domain (RBD) of SARS-CoV2. Jacalin binding induces conformational changes in RBD and significantly affects its interaction with human angiotensin-converting enzyme 2. The result may open up exploration of lectin-based strategies against COVID-19.
Covid-19 Cases in India: A Visual Exploratory Data Analysis Model
Authors: Jayesh S , Sreedharan Shilpa
Published: September 2020

Covid-19 outbreak was first reported in Wuhan, China. The deadly virus spread not just the disease, but fear around the globe. On January 2020, WHO declared COVID-19 as a Public Health Emergency of International Concern (PHEIC). First case of Covid-19 in India was reported on January 30, 2020. By the time, India was prepared in fighting against the virus. India has taken various measures to tackle the situation. In this paper, an exploratory data analysis of Covid-19 cases in India is carried out. Data namely number of cases, testing done, Case Fatality ratio, Number of deaths, change in visits stringency index and measures taken by the government is used for modelling and visual exploratory data analysis.
Detection of SARS-CoV-2 RNA in fourteen wastewater treatment systems in Uttarakhand and Rajasthan States of North India
Authors: Arora Sudipti , Nag Aditi , Rajpal Ankur , Tiwari Satya Brat , Sethi Jasmine , Sutaria Devanshi , Rajvanshi Jayana , Saxena Sonika , Srivastava Sandeep , Kazmi A. A. , Tyagi Vinay Kumar
Published: September 2020

We investigated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA at different treatment stages of 15 wastewater treatment plants (WWTPs) in two North Indian states of Rajasthan and Uttarakhand. Untreated (influent), biologically treated, and disinfected wastewater samples were collected from May to August 2020. The qualitative analysis of the wastewater for the presence of SARS-CoV-2 RNA was done using different pre-processing methods. SARS-CoV-2 RNA was detected in 11 out of 39 wastewater samples in Jaipur district and 5 out of 17 wastewater samples in Haridwar District using Reverse-Transcriptase Quantitative Polymerase Chain Reaction (RT-qPCR) for qualitative detection. None of the 56 samples tested for post-secondary or tertiary treatment were found positive for SARS-CoV-2 RNA. The findings indicate that there are no SARS-CoV-2 related risks involved with using the treated effluent for non-potable applications. In contrast, untreated wastewater may be a potential route of viral transmission to the WWTP and sanitation workers. Future studies are imperative to understand the survival rates of these viruses in wastewater.

Graphical Abstract

Highlights

Mild to moderate genome load observed in the municipal wastewater samples.

Increased patient numbers post-lockdown correspond to a decrease in the CTvalue of genes.

Presence of SARS-CoV-2 genome load was observed in untreated wastewater.

E gene was present in abundance in wastewaters as compared to the N gene and RdRp gene.

SARS-CoV-2 genome load was absent in secondary and tertiary treated effluent.
COVerAGE-DB: A database of age-structured COVID-19 cases and deaths
Authors: Riffe Tim , Acosta Enrique ,   COVerAGE-DB project team
Published: September 2020

COVerAGE-DB is an open access database including cumulative counts of confirmed COVID-19 cases, deaths, and tests by age and sex. Original data and sources are provided alongside data and measures in age-harmonized formats. The database is still in development, and at this writing, it includes 87 countries, and 195 subnational areas. Cumulative counts of COVID-19 cases, deaths, and tests are recorded daily (when possible) since January 2020. Many time series thus fully capture the first pandemic wave and the beginning of later waves. An international team, composed of more than 60 researchers, contributed to the collection of data and metadata in COVerAGE-DB from governmental institutions, as well as to the design and implementation of the data processing and validation pipeline. We encourage researchers interested in supporting this project to send a message to the email: coverage-db@demogr.mpg.de
Environmental risk factors for gastric cancer: a protocol for umbrella review of meta-analyses
Authors: Kim Min Seo , Kim Seungwon , Park Sungsoo
Published: September 2020

Gastric cancer is the fifth most commonly diagnosed cancer globally, accounting for 5.7% of the new cancer cases in 2018[1]. Gastric cancer remains an important global concern because it is the third leading cause of cancer death[1] and its increasing incidence[2]. Therefore, it is crucial to develop prevention strategies for gastric cancer. Helicobacter pylori infection, a WHO class I carcinogen, is a significant risk factor of gastric cancer; however, only 0.5% of infected individuals would develop gastric cancer[3]. This data suggests that there are other additional risk factors for gastric cancer. A large body of research has been performed to investigate the association between various environmental factors and gastric cancer, including dietary factors, tobacco smoking, and alcohol drinking. However, the precision and strength of these existing studies need to be clarified. Umbrella review is one of the most useful tools for a clear understanding of a broad topic area. It provides a comprehensive overall picture of findings for specific questions based on high-level evidence of published systemic reviews and meta-analyses[4]. Thus, this study aimed to conduct an umbrella review of systemic reviews and meta-analyses that investigated gastric cancer risk factors.
Microfluidic Affinity Profiling reveals a Broad Range of Target Affinities for Anti-SARS-CoV-2 Antibodies in Plasma of COVID-19 Survivors
Authors: Schneider Matthias M. , Emmenegger Marc , Xu Catherine K. , Morales Itzel Condado , Meisl Georg , Turelli Priscilla , Zografou Chryssa , Zimmermann Manuela R. , Frey Beat M. , Fiedler Sebastian , Denninger Viola , Jacquat Raphaël P. B. , Madrigal Lidia , Ilsley Alison , Kosmoliaptsis Vasilis , Fiegler Heike , Trono Didier , Knowles Tuomas P. J. , Aguzzi Adriano
Published: September 2020

The clinical outcome of SARS-CoV-2 infections, which can range from asymptomatic to lethal, is crucially shaped by the concentration of antiviral antibodies and by their affinity to their targets. However, the affinity of polyclonal antibody responses in plasma is difficult to measure. Here we used Microfluidic Antibody Affinity Profiling (MAAP) to determine the aggregate affinities and concentrations of anti-SARS-CoV-2 antibodies in plasma samples of 42 seropositive individuals, 19 of which were healthy donors, 20 displayed mild symptoms, and 3 were critically ill. We found that dissociation constants, Kd, of anti-receptor binding domain antibodies spanned 2.5 orders of magnitude from sub-nanomolar to 43 nM. Using MAAP we found that antibodies of seropositive individuals induced the dissociation of pre-formed spike-ACE2 receptor complexes, which indicates that MAAP can be adapted as a complementary receptor competition assay. By comparison with cytopathic-effect based neutralisation assays, we show that MAAP can reliably predict the cellular neutralisation ability of sera, which may be an important consideration when selecting the most effective samples for therapeutic plasmapheresis and tracking the success of vaccinations.
Maintenance Electroconvulsive Therapy and hospital re-admission days among patients with mental illness in Malaysia
Authors: Francis Benedict , Han Ng Yit , Ip Julian Wong Joon , Thin Ling Shiau , Gill Jesjeet Singh , Hui Koh Ong , Petrus Chiara Francine , Sulaiman Ahmad Hatim
Published: September 2020

Background

Relapse prevention strategies are important as part of optimal patient care. As such, maintenance electroconvulsive therapy (mECT) is an important treatment modality to keep patients in remission longer. However, the practice of mECT in Malaysia, specifically and Asia generally, is still scarce.

Aims

Our study aimed to explore the characteristics of patients receiving maintenance ECT (mECT) and further investigate whether this treatment modality reduces re-admission days in patients with severe mental illness.

Methods

A retrospective chart review study design was employed. The medical records of 22 patients followed up at University Malaya Medical Centre, Malaysia were analysed with regards to the outcome measures, which was days of re-admission post mECT, Potential confounders were controlled for via stratification analysis.

Results

There was a significant reduction in re-admission days post mECT (p<0.001, r:0.85) across all the variables analysed. The variable with the biggest effect size were patients younger than 60 years old (p:0.01, r:0.70), followed by medication with polypharmacy (p:0.002, r: 0.65). The magnitude of reduction in re-admissions was greater in the schizophrenia spectrum group compared to the affective disorders group (r: 0.64 vs. 0.57).

Conclusion

Our study provides data regarding the efficacy of mECT in significantly reducing days of re-admission in patients with treatment resistant schizophrenia spectrum illness and affective disorders. As widespread usage of mECT is still lacking in Asia, our results is encouraging for more practitioners to prescribe mECT for their patients in order to reduce rates of hospital re-admission.
Molecular diagnosis of non-syndromic hearing loss patients using a stepwise approach
Authors: Wang Jing , Xiang Jiale , Chen Lisha , Luo Hongyu , Xu Xiuhua , Li Nan , Cui Chunming , Xu Jingjing , Song Nana , Peng Jiguang , Peng Zhiyu
Published: September 2020

Background

Hearing loss is one of the most common birth disorders in humans with an estimated prevalence of 1-3 in every 1000 newborns. This study has investigated the molecular etiology of a deaf cohort using a stepwise strategy to effectively diagnose patients and the challenges faced to verify genetic heterogenicity and the variable mutation spectrums of hearing loss.

Methods

In order to target known pathogenic variants, multiplex PCR plus next-generation sequencing was applied in the first tier, while undiagnosed cases were further referred to exome sequencing. A total of 92 unrelated patients with nonsyndromic hearing loss were enrolled.

Results

In total, 64% (59/92) of patients were molecularly diagnosed, 44 of which were identified in the first tier by multiplex PCR plus sequencing. Of 48 undiagnosed patients from the first tier, exome sequencing identified eleven diagnoses (23%, 11/48) and four probably diagnoses (8%, 4/48). The rate of secondary findings of exome sequencing in our cohort is 3.4%.

Conclusion

The research presented a molecular diagnosis spectrum of 92 non-syndromic hearing loss patients and demonstrated the benefits of using the stepwise diagnostic approach in the genetic test of the non-syndromic hearing loss patient cohort.
Urban versus rural prevalence of intestinal parasites using multi-parallel qPCR in Colombia
Authors: Bryan Patricia E. , Romero Marcela , Sánchez Miryan , Torres Giovanny , Gómez Wilber , Restrepo Marcos , Restrepo Alejandro , Mejia Rojelio
Published: September 2020

Stool samples from 122 children from urban slum (n = 72) and rural (n = 50) areas were analyzed using multi-parallel real-time qPCR to determine the prevalence of intestinal parasites from two communities in Colombia. Findings indicated a prevalence of 86.1% Blastocystis spp., 62.5% Giardia intestinalis, 19.4% Cryptosporidium spp., 19.4% Ascaris lumbricoides, and 5.6% Trichuris trichiura in an urban slum; and 76% Blastocystis spp., 68% Giardia intestinalis, 20% Entamoeba histolytica, 50% Ascaris lumbricoides, 46% Trichuris trichiura and 2% Strongyloides stercoralis in rural areas. Polyparasitism was higher in rural (58%) compared to urban (25%) areas (p = 0.001). Trichuris trichiura burden was higher in the rural area (p = 0.002). Over 40% of helminth infections in rural areas had a heavy parasite burden by WHO classification. Over half of urban and rural children were infected with Giardia intestinalis and Blastocystis spp. Our data provides accurate epidemiologic surveillance for public health interventions.
First quarter chronicle of COVID-19: an attempt to measure governments’ response
Authors: Şahin Şule , del Carmen Boado-Penas María , Constantinescu Corina , Eisenberg Julia , Henshaw Kira , Hu Maoqi , Wang Jing , Zhu Wei
Published: September 2020

The crisis caused by COVID-19 revealed the global unpreparedness for handling the impact of a pandemic. In this paper, we present a first quarter chronicle of COVID-19 in Hubei China, Italy and Spain, specifically their infection speed, death and fatality rates. By fitting distributions to these rates, we look for the effectiveness of government measures during the pandemic through a number of statistical approaches.
Putting (Big) Data in Action: Saving Lives with Countrywide Population Movement Monitoring Using Mobile Devices during the COVID‐19 Crisis
Authors: Szocska Miklos , Pollner Peter , Schiszler Istvan , Joo Tamas , Palicz Tamas , McKee Martin , Telekom Nyrt. Magyar , Magyarorszag Zrt. Telenor , Sohonyai Adam , Szoke Jozsef , Toth Adam , Gaal Peter
Published: September 2020

Many countries have implemented strict social distancing measures in the hope of reducing transmission of SARS-CoV-2 but the effectiveness of these measures is determined by the willingness of populations to comply with restrictions. Consequently, a system of monitoring population movement using existing data sources can inform those making decisions about policy responses to the COVID-19 pandemic.

We describe a collaboration with all 3 major domestic telecommunication companies in Hungary to use aggregated anonymous mobile phone usage data to calculate two indices for assessing the effect of movement restrictions: a “mobility-index” and a “stay-at-home (or resting) index”. The strengths and weaknesses of this approach are compared with the smartphone-based, COVID-19 Community Mobility Reports from Google.

Data generated by mobile phones have long been identified as a potential means to analyse mass population movement, but its operationalisation raises several technical questions, such as making sense of Call Detail Records, collation of data from different mobile network providers, and personal data protection concerns. The method described here addresses these issues and offers an effective and inexpensive tool to monitor the impact of social distancing measures, achieving high levels of accuracy and resolution. Especially in populations where uptake of smartphones is modest, this method has certain advantages over app-based solutions, with greater population coverage, but it is not an alternative to smartphone-based solutions used for contact tracing and quarantine monitoring. We believe that this method can easily be adapted by other countries.
Downregulation of Defensin genes in SARS-CoV-2 infection
Authors: Idris Mohammed M , Banu Sarena , Siva Archana B , Nagaraj Ramakrishnan
Published: September 2020

Defensins, crucial components of the innate immune system, play a vital role against infection as part of frontline immunity. Association of SARS-CoV-2 infection with defensins has not been investigated till date. In this study, we have investigated the expression of defensin genes in the buccal cavity during COVID-19 infection. Nasopharyngeal/Oropharyngeal swab samples collected for screening SARS-CoV-2 infection were analyzed for the expression of major defensin genes by the quantitative real-time reverse transcription polymerase chain reaction, qRT-PCR. 40 SARS-CoV-2 infected positive and 40 negative swab samples were selected for the study. Based on the RT-PCR analysis involving gene specific primer for defensin genes, 10 defensin genes were found to be expressed in the Nasopharyngeal/Oropharyngeal cavity. Six defensin genes were further found to be significantly downregulated in SARS-CoV-2 infected patients as against the control, negative samples based on differential expression analysis. The genes significantly downregulated were defensin beta 4A, 4B, 106B, 107B, 103A and defensin alpha 1B. Downregulation of several defensin genes suggests that innate immunity provided by defensins is or may be compromised in SARS-CoV-2 infection resulting in progression of the disease caused by the virus. Upregulation of defensin gene expression and use of defensin peptides could be attractive therapeutic interventions.