bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief Educational Video Improves Patient Understanding of Mohs Surgery: A Randomized Controlled Trial
Authors: Lin Matthew J. , Dubin Danielle P. , Younessi Shannon , Khorasani Hooman
Published: December 2020

BACKGROUND

Patient's retention and recall of material discussed in a medical consultation is often inadequate.

OBJECTIVE

To assess patient's knowledge, anxiety, and understanding of Mohs surgery after viewing a brief educational video.

METHOD

A prospective, investigator-blinded, randomized controlled trial of 120 consecutive patients before the first Mohs surgery procedure. Sixty subjects viewed an instructional video and 60 subjects did not. A survey was administered to both groups, measuring knowledge, anxiety, and understanding of Mohs surgery.

RESULTS

The video group scored higher than the control group on the knowledge portion of the survey (median score 78% vs 56%, p < .01), but there were no differences in anxiety or understanding scores between groups. The percentage of subjects who answered each knowledge question correctly was greater in the video group than in the control group. In the subgroup of patients who had not previously had a consultation with a Mohs surgeon, the video group had higher median knowledge scores (67% vs 44%, p < .01), higher median understanding scores (8 vs 6, p = .05), and lower median visual analogue anxiety scores (4 vs 6, p = .01) compared with the control group.

CONCLUSION

A brief educational video increases patient's knowledge of Mohs surgery. For patients who have not yet had a consultation with a Mohs surgeon, the video may also reduce anxiety.
Fractional CO2 Laser for Transcutaneous Drug Delivery of Onabotulinum Toxin in Palmar Hyperhidrosis
Authors: Agamia Naglaa F. , Sobhy Nagat , Abd-Elraouf Amira , Tawfik Abeer
Published: December 2020

BACKGROUND

Palmar hyperhidrosis is a common disorder of excessive sweating due to over-stimulation of cholinergic receptors on eccrine glands.

OBJECTIVE

To compare the efficacy of laser-assisted drug delivery of onabotulinum toxin A (BoNTA) and intradermal BoNTA injections in the management of palmar hyperhidrosis.

PATIENTS AND METHODS

This intrapatient comparative study was conducted on 30 adult patients with idiopathic palmar hyperhidrosis. The palms of the patients were divided into 2 groups. Group 1 was treated with intradermal injections of 50 units of BoNTA, whereas Group 2 was subjected to laser-assisted transcutaneous BoNTA delivery using fractional CO2 laser at different doses (25, 50, and 75 units). Each treatment modality was evaluated using the iodine starch test, hyperhidrosis disease severity scale, and gravimetric scoring.

RESULTS

Delivery of 75 units of BoNTA to the dermis on the right-sided palms assisted by fractional CO2 laser was clinically equivalent to 50 units of injection on the left side. Pain intensity was significantly higher on the injected side than on the other side.

CONCLUSION

Laser-assisted drug delivery of botulinum toxin can be considered an effective and safe alternative for treatment of palmar hyperhidrosis with minimal side effects and complications.
Polycystic Ovarian Syndrome: Impact on Adult and Fetal Health
Authors: MARTINI ANNE E. , HEALY MAE W.
Published: December 2020

Women with the polycystic ovarian syndrome (PCOS) may have an increased risk for complications in pregnancy including miscarriage, gestational diabetes mellitus, hypertensive disorders of pregnancy, higher rates of cesarean delivery, and abnormalities in fetal growth. In addition, PCOS has been associated with the development of type II diabetes mellitus, hypertension, cardiovascular disease, obstructive sleep apnea, endometrial cancer, depression and anxiety, and nonalcoholic fatty liver disease. In understanding that PCOS is a disease impacting more than just a woman’s fertility, prevention and early identification of risk factors for affiliated conditions is essential.
Polycystic Ovarian Syndrome and Fertility
Authors: LENTSCHER JESSICA A. , SLOCUM BREONNA , TORREALDAY SAIOA
Published: December 2020

Polycystic ovary syndrome (PCOS) is a common endocrinopathy that has been associated with impaired fertility. This chapter reviews the underlying pathophysiology of PCOS and the associated fertility barriers of the condition. Psychologic concerns, hypothalamic-pituitary, ovarian, and mitochondria dysfunction, obesity, and the role of vitamin D in PCOS are considered with respect to fertility. Lastly, pregnancy risk factors associated with PCOS are also reviewed.
Long-term Health of Offspring of Women With Polycystic Ovarian Syndrome
Authors: LINDNER PETER G.
Published: December 2020

Polycystic ovarian syndrome (PCOS) presents as a constellation of clinical manifestations that can be varied among patients; however, the hormonal derangement associated with PCOS is uniformly characterized by excess androgens and abnormal insulin activity. The alteration in the normal hormonal milieu in these patients and subsequently during their pregnancies is theorized to alter the normal development of the fetus. This in utero exposure and its relationship with behavioral development, metabolic disease, and reproductive outcomes in male and female offspring of mothers with PCOS are under investigation and remains controversial.
Coexistence of Meesmann Corneal Dystrophy and a Pseudo-Unilateral Lattice Corneal Dystrophy in a Patient With a Novel Pathogenic Variant in the Keratin K3 Gene: A Case Report
Authors: Abad-Morales Víctor , Barbany Miriam , Gris Oscar , Güell José Luis , Pomares Esther
Published: December 2020

Purpose:

This study aims to clinically and genetically report a case of coexisting Meesmann corneal dystrophy (MECD) and pseudo-unilateral lattice corneal dystrophy (LCD).

Methods:

Clinical characterization was supported by a complete ophthalmological evaluation, including visual acuity measurement and slit-lamp examination. Molecular diagnosis was performed by whole-exome sequencing analyzing the gelsolin, keratin K3 (KRT3), keratin K12, and transforming growth factor-beta–induced genes.

Results:

A 57-year-old woman presented with recurrent corneal erosions over 17 years and visual impairment in both eyes. Ophthalmological evaluation revealed multiple central tiny cysts in the epithelium of both eyes and lattice linear lesions only in the right cornea. In both eyes, a corneal posterior crocodile shagreen degeneration could also be observed. These findings were compatible with a MECD and a unilateral LCD. Molecular analysis identified the novel heterozygous nucleotide substitution c.1492G>A (amino acid change p.Glu498Lys) in the KRT3 gene, in cosegregation with the MECD familial phenotype. However, no genetic evidence supported the unique LCD phenotype observed in the patient.

Conclusions:

To the best of our knowledge, this is the first report of a pseudo-unilateral LCD in a patient with coexistent MECD. Moreover, the genetic analysis showed a novel mutation in the previously MECD-associated gene KRT3.
Monson small-incision lenticule extraction fixation device
Authors: Dowdle Travis S. , Jenkins Joseph C. , Bertolio Michael , Monson Bryan K.
Published: December 2020

Small-incision lenticule extraction (SMILE) is a stromal based, flapless, minimally invasive form of laser vision correction for the treatment of myopia and myopic astigmatism. SMILE surgery is a more technical procedure compared with other refractive surgeries and generally has a longer skill mastery acquisition period. Thus far, no new stabilization devices or techniques have been proposed. To rectify this, a new distal corneal countertraction device for SMILE surgery, the Monson SMILE Fixation Device, is introduced. This device provides reliable corneal and globe stabilization during delamination and lenticular dissection. It may minimize tissue distortion and manipulation, simplify lenticule dissection, and may decrease operation times and improve cosmesis. Countertraction can also easily be adjusted throughout the procedure.
Flattening the curve: manual method for corneal allogenic intrastromal ring segment implantation
Authors: Parker Jack S. , Dockery Philip W. , Parker John S.
Published: December 2020

Corneal allogenic ring segments are semicircular pieces of donor corneal stroma that may be surgically implanted to flatten keratoconic corneas. Conventionally, these donor segments are inserted into channels created using femtosecond laser dissection. However, access to femtosecond technology is not universal. In this study, an alternate, manual technique for channel creation, which is femtosecond laser independent, is described.
Prospective study to compare axial position stability after fellow-eye implantation of 2 distinct intraocular lens designs
Authors: Hienert Julius , Hirnschall Nino , Ruiss Manuel , Ullrich Marlies , Zwickl Hannah , Findl Oliver
Published: December 2020

Purpose:

To compare the dynamics of axial intraocular lens (IOL) position and stability in the capsular bag after fellow-eye implantation of a 1-piece C-loop and a 4-point haptic IOL.

Setting:

Hanusch Hospital, Vienna.

Design:

Prospective, comparative, randomized bilateral study.

Methods:

One hundred eyes of 50 patients were randomly implanted with a C-loop IOL (CT LUCIA 611P) in 1 eye and a 4-point haptic IOL (CT ASPHINA 409MP) in the other eye. Anterior chamber depth (ACD) was measured at 1 week (W1), 1 month (M1), and 4 to 6 months (M4-6) postoperatively using a swept-source optical coherence tomography device (IOLMaster 700). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, and subjective refraction outcomes were assessed at M4-6 postoperative follow-up.

Results:

Hundred eyes of 50 patient were included. Pseudophakia ACD values at W1, M1, and M4-6 timepoints were significantly different in eyes implanted with the C-loop IOL compared with the 4-point haptic IOL (P < .001). The overall IOL shift was 0.25 ± 0.16 mm for the 4-point haptic IOL and 0.14 ± 0.09 mm for the C-loop IOL (P < .001). The M4-6 mean monocular UDVA outcome for eyes with C-loop IOL was 0.06 ± 0.14 logarithm of the minimum angle of resolution (logMAR) and 0.03 ± 0.10 logMAR for the eyes with 4-point haptic IOL. M4-6 mean spherical equivalent was −0.32 ± 0.48 diopter (D) in the C-loop IOL group and −0.33 ± 0.42 D in the 4-point haptic IOL group.

Conclusions:

Statistically significant differences in IOL design results in different postoperative ACD values. No relevant or statistically significant differences were found in refraction or visual acuity between the groups.
Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients
Authors: Schallhorn Steven C. , Hettinger Keith A. , Pelouskova Martina , Teenan David , Venter Jan A. , Hannan Stephen J. , Schallhorn Julie M.
Published: December 2020

Purpose:

To evaluate the effect of residual astigmatism on postoperative visual acuity and satisfaction after intraocular lens (IOL) surgery.

Setting:

Private practice, United Kingdom.

Design:

Retrospective case series.

Methods:

Postoperative data of patients who had previously undergone refractive lens exchange or cataract surgery were used in a multivariate regression model to assess the effect of residual astigmatism on 3 months postoperative monocular uncorrected distance visual acuity (UDVA) and patient satisfaction. The analysis was based on residual refraction in the dominant eye of each patient. Odds ratios were calculated to demonstrate the effect of increasing residual astigmatism on UDVA and satisfaction with separate calculations for monofocal and multifocal IOLs.

Results:

Three months postoperative outcomes of 17 152 dominant eyes were used in multivariate regression analysis. Compared with eyes with 0.00 diopter (D) residual astigmatism, the odds of not achieving 20/20 vision in eyes with 0.25 to 0.50 D residual astigmatism increased by a factor of 1.7 and 1.9 (P < .0001) in monofocal and multifocal IOLs, respectively. For the residual astigmatism 0.75 to 1.00 D, the odds ratio for not achieving 20/20 vision compared with eyes with no astigmatism was 6.1 for monofocal and 6.5 for multifocal IOLs (P < .0001). The effect of residual astigmatism on satisfaction was more evident at the 0.75 to 1.00 D level, where the odds of not being satisfied with vision increased by a factor of 2.0 and 1.5 in patients with monofocal and multifocal IOLs, respectively (P < .0001). The orientation of astigmatism was not a significant predictor in multivariate analysis.

Conclusions:

Multivariate analysis in a large population of patients demonstrated that low levels of residual astigmatism can degrade visual acuity. Corneal astigmatism of 0.50 D or greater should be included in surgical planning.
New methodology for measuring intraocular lens performance using acuity reserve
Authors: Lapid-Gortzak Ruth , Bala Chandra , Schwiegerling Jim , Suryakumar Rajaraman
Published: December 2020

Purpose:

To validate a new methodology of intraocular lens (IOL) assessment using acuity reserve analysis via area under the curve (AUC) to assess intermediate vision.

Setting:

Study 1 was conducted at 17 sites in Australia, Chile, and Europe. Study 2 was conducted at 15 sites in Australia, Brazil, and Europe.

Design:

Post hoc analyses of defocus curve results from 2 clinical trials (study 1: single-arm investigation of the AcrySof IQ PanOptix Trifocal IOL [model TFNT00; Alcon Research LLC]; study 2: comparative investigation of AcrySof PanOptix Trifocal IOL vs the AT LISA Trifocal IOL [model 839MP; Carl Zeiss Meditec AG]).

Methods:

Acuity reserve was calculated using AUC compared with visual demand (logMAR) at various distances. Study 1 validated the model; study 2 compared acuity reserve, for a range of defocus levels, for the 2 IOLs.

Results:

The defocus curve (study 1 [149 patients; 298 eyes]) showed good visual acuity (ie, >20/25) at all defocus levels; the AUC estimate showed 2 lines or more of reserve at −2.50 diopters. Comparative post hoc analysis (study 2 [182 patients]) demonstrated significantly improved acuity reserve with PanOptix IOL vs AT LISA IOL at 20 to 40 days postoperatively (P < .001) and 120 to 180 days postoperatively (P < .001).

Conclusions:

Acuity reserve analysis using AUC represents a new methodology for comparative IOL assessment, providing additional detail beyond defocus curve analysis. This method demonstrated that the PanOptix Trifocal IOL was superior to the AT LISA Trifocal IOL (model 839MP) for visual acuity at near to intermediate distances with visual acuity reserve analysis.
Nanocurcumin as an Add-on to Antipsychotic Drugs for Treatment of Negative Symptoms in Patients With Chronic Schizophrenia
Authors: Hosseininasab Masumeh , Zarghami Mehran , Mazhari Shahrzad , Salehifar Ebrahim , Moosazadeh Mahmood , Fariborzifar Arghavan , Babaeirad Sareh , Hendouei Narjes
Published: December 2020

Purpose/Background

It is well documented that one of the pathophysiological mechanisms of negative symptoms in patients with schizophrenia is hypofunction of N-methyl-d-aspartate receptors. This double-blind, placebo-controlled clinical trial was designed to assess the efficacy and safety of nanocurcumin as an adjuvant agent on psychotic symptoms, especially negative symptoms, in patients with chronic schizophrenia.

Methods/Procedures

Fifty-six inpatients with stable chronic schizophrenia and predominant negative symptoms were randomized in a 1:1 ratio to nanocurcumin soft gel capsule (160 mg/d) and control groups, along with their antipsychotic regimen for 16 weeks. The efficacy of treatment was assessed by Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Clinical Global Impressions—Severity, and Clinical Global Impressions—Improvement scales. Extrapyramidal symptoms were evaluated by Simpson-Angus Scale and Barnes Akathisia Rating Scale. Patients were assessed at baseline and weeks 4, 8, 12, and 16 after the medication started.

Findings/Results

No significant differences were observed in demographic or clinical variables between both groups at baseline. The nanocurcumin group showed significantly greater improvement on the negative subscale (P = 0.05), the general psychopathology subscale (P < 0.001), the positive subscale (P = 0.004), total Positive and Negative Syndrome Scale (P < 0.001), Clinical Global Impressions—Severity (P < 0.001), and Clinical Global Impressions—Improvement scores (P < 0.001) in comparison with the control group at the endpoint. Extrapyramidal symptom rating scales and Calgary Depression Scale for Schizophrenia and frequency of other adverse effects were comparable between 2 groups.

Implications/Conclusions

The present study indicates nanocurcumin as a safe and potential adjunctive treatment strategy for treatment of primary negative symptoms of schizophrenia.
Does Propulsive Force Asymmetry during Gait Provide Additional Objective Functional Information to Augment the Traditional Assessment of Prosthetic Fit?
Authors: White Hank , Jacobs Cale , Augsburger Sam , Miller Eric , Walker Janet , Iwinski Henry
Published: December 2020

Introduction

A poorly fitting prosthesis can cause pain and result in a less efficient and a less symmetrical gait pattern for children with amputations; however, fit is generally determined by subjective patient reports of discomfort and/or clinical observation when walking. The purpose of this study was to determine if peak propulsive forces during gait provide clinically relevant objective information to augment the traditional prosthesis fit assessment.

Materials and Methods

This prospective study compares propulsive force asymmetry with traditional assessments of prosthesis fit. Subjects were between 4 and 21 years of age, with unilateral lower-limb deficiencies, currently wearing the same prosthesis for at least 1 year, and able to walk independently without an assistive device. The absolute asymmetry indexes of peak propulsive forces between the involved and uninvolved limbs were calculated from force data collected from three trials of overground walking at a self-selected velocity. Asymmetry indexes greater than 36.4% were considered clinically meaningful and were associated with poor prosthesis function. A physician and/or a prosthetist, blinded to the results of the gait assessments, then determined the quality of prosthesis fit.

Results

Thirty-one subjects (20 males, 11 females; mean age, 13.1 years) participated. The traditional prosthetic fit assessment identified 13 prostheses as properly fitting and 18 as poorly fitting. Peak propulsive force asymmetry exceeded the threshold of 36.4% for 15 subjects and categorized as functioning poorly. The proportion of positive agreement of correct fit and correct function was 71% (κ coefficient = 0.42).

Conclusions

Peak propulsive force asymmetries offer clinically meaningful objective functional data to augment the traditional fit assessment.
Postoperative Recurrent Cholesteatoma in Rural Versus Urban Populations
Authors: Kennedy Kenneth L. , Connolly Kevin M. , Albert Christy L. , Goldman Julie L. , Cash Elizabeth D. , Severtson Mark Allen
Published: December 2020

Objective:

Chronic ear disease presents a unique challenge to otolaryngologists in both rural and urban settings. Cholesteatoma remains a difficult disease to treat in rural populations due to limited healthcare access and high risk of recurrence. The purpose of this study was to determine if there are differences in surgical outcomes among patients with acquired cholesteatoma residing in rural versus urban settings.

Study Design:

Single-surgeon retrospective case series with chart review.

Setting:

Tertiary care private otolaryngology practice.

Patients:

One hundred twenty-two patients presenting to the Kentuckiana ENT otology and neurotology practice from January 2011 to May 2017.

Main Outcome Measures:

Surgical outcomes including recurrence, air-bone gap improvement, ossicular integrity, and complications were reviewed and compared between the rural and urban cohorts.

Results:

Presence of postoperative residual cholesteatoma (OR = 8.667, 95% CI = 2.022–37.141, p = 0.008) and number of surgeries per patient (OR = 5.185, 95% CI = 1.086–24.763, p = 0.024) were significantly increased among patients in rural nonmetropolitan areas. No significant differences were found when comparing risk of recurrence, size of cholesteatoma, presence of complications, air-bone gap improvement, and ossicular chain integrity. There were significantly more second-look surgeries performed in privately insured patients (OR = 8.582, 95% CI = 1.937–38.017, p = 0.001).

Conclusions:

Patients in rural communities have an increased number of surgeries and postoperative risk for residual cholesteatoma compared to patients residing in urban settings. This study provides the basis for larger, multicenter, prospective examinations of outcomes among urban versus rural patients, which would enable a better understanding of difference in surgical outcomes between rural and urban cohorts.

Level of Evidence: IV
Microbiome of the Healthy External Auditory Canal
Authors: Sjövall Atte , Aho Velma T.E. , Hyyrynen Taneli , Kinnari Teemu J. , Auvinen Petri , Silvola Juha , Aarnisalo Antti , Laulajainen-Hongisto Anu
Published: December 2020

Objective:

To investigate the microbiota of the healthy external auditory canal (EAC) culture-independently and to evaluate the usefulness of the swabbing method in collecting EAC microbiota samples.

Study Design:

Cohort study.

Patients:

Fifty healthy asymptomatic working-age volunteers.

Intervention:

Samples were harvested with DNA-free swabs from the volunteers’ EACs.

Main Outcome Measures:

Amplicon sequencing of the 16S rRNA gene was used to characterize the microbial communities in the samples.

Results:

The swabbing method is feasible for EAC microbiota sample collection. The analyzed 41 samples came from 27 female and 14 male subjects; 4 samples were excluded due to recent antimicrobial treatment and 5 because of low sequence count or suspected contaminant microbes. The four most frequent amplicon sequence variants in the microbiota data were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. Typically, the dominant amplicon sequence variant in a sample was one of the most frequent bacteria, but there were also subjects where the dominant species was not among the most frequent ones. The genus Alloiococcus was least common in females who reported cleaning their ears. Subjects with a high relative abundance of Alloiococcus typically had a low abundance of Staphylococcus, which may be a sign of the two being competing members of the microbial community.

Conclusions:

The most common bacteria in the microbiome of the healthy EAC were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. The EAC microbiota seems more diverse and individualized than previously thought. Also, ear cleaning habits seem to alter the EAC microbiome.
Nonauditory Functions in Low-performing Adult Cochlear Implant Users
Authors: Völter Christiane , Oberländer Kirsten , Carroll Rebecca , Dazert Stefan , Lentz Benjamin , Martin Rainer , Thomas Jan Peter
Published: December 2020

Introduction:

Despite substantial benefits of cochlear implantation (CI) there is a high variability in speech recognition, the reasons for which are not fully understood. Especially the group of low-performing CI users is under-researched. Because of limited perceptual quality, top-down mechanisms play an important role in decoding the speech signal transmitted by the CI. Thereby, differences in cognitive functioning and linguistic skills may explain speech outcome in these CI subjects.

Material and Methods:

Fifteen post-lingually deaf CI recipients with a maximum speech perception of 30% in the Freiburger monosyllabic test (low performer = LP) underwent visually presented neurocognitive and linguistic test batteries assessing attention, memory, inhibition, working memory, lexical access, phonological input as well as automatic naming. Nineteen high performer (HP) with a speech perception of more than 70% were included as a control. Pairwise comparison of the two extreme groups and discrimination analysis were carried out.

Results:

Significant differences were found between LP and HP in phonological input lexicon and word retrieval (p = 0.0039∗∗). HP were faster in lexical access (p = 0.017∗) and distinguished more reliably between non-existing and existing words (p = 0.0021∗∗). Furthermore, HP outperformed LP in neurocognitive subtests, most prominently in attention (p = 0.003∗∗). LP and HP were primarily discriminated by linguistic performance and to a smaller extent by cognitive functioning (canonic r = 0.68, p = 0.0075). Poor rapid automatic naming of numbers helped to discriminate LP from HP CI users 91.7% of the time.

Conclusion:

Severe phonologically based deficits in fast automatic speech processing contribute significantly to distinguish LP from HP CI users. Cognitive functions might partially help to overcome these difficulties.
Universal Prenatal Screening and Testing and Chlamydia trachomatis Conjunctivitis in Infants
Authors: Kohlhoff Stephan , Roblin Patricia M. , Clement Sheinese , Banniettis Natalie , Hammerschlag Margaret R.
Published: December 2020

We retrospectively reviewed all infant Chlamydia trachomatis eye cultures submitted to the Chlamydia Research Laboratory from 1986 to 2002. The positivity rate was 15.6% during the period before the implementation of universal prenatal screening (1986–1993) compared with 1.8% during the screening period (1994–2002).
Sexually Transmitted Infections in Association With Area-Level Prostitution and Drug-Related Arrests
Authors: Magee Lauren A. , Fortenberry James Dennis , Nelson Tammie , Roth Alexis , Arno Janet , Wiehe Sarah E.
Published: December 2020

Objectives

This study aimed to examine the mediators and moderators of area-level prostitution arrests and sexually transmitted infections (STIs) using population-level data.

Methods

Using justice and public health STI/HIV data in Marion County (Indianapolis), Indiana, during an 18-year period, we assessed the overall association of area-level prostitution and drug-related arrests and STI/HIV, and mediators and moderators of the relationship. Point-level arrests were geocoded and aggregated by a census block group.

Results

Results indicate a positive relationship between numbers of prostitution arrests and area-level STI rates. There was a dose-response relationship between prostitution arrests and STI rates when accounting for drug-related arrests. The highest quintile block groups had significantly higher rates of reported chlamydia (incident rate ratio [IRR], 3.29; 95% confidence interval [CI], 2.82–3.84), gonorrhea (IRR, 4.73; 95% CI, 3.90–5.57), syphilis (IRR, 4.28; 95% CI, 3.47–5.29), and HIV (IRR, 2.76; 95% CI, 2.24–3.39) compared with the lowest quintile. When including drug arrests, the second (IRR, 1.19; 95% CI, 1.03–1.38) and the third (IRR, 1.20; 95% CI, 1.02–1.41) highest quintile block groups had lower IRR for reported rates of chlamydia, indicating that drug arrests mediated the prostitution arrest effect.

Conclusions

These findings inform public health agencies and community-based organizations that conduct outreach in these areas to expand their efforts to include harm reduction and HIV/STI testing for both sex workers and individuals experiencing substance use disorder. Another implication of these data is the importance of greater collaboration in public health and policing efforts to address overlapping epidemics that engage both health and legal interventions.
Performance of Sexually Transmitted Disease Laboratories for Chlamydia trachomatis Detection in Guangdong, China
Authors: Su Xin , Qin Xiaolin , Chen Wentao , Yu Xueyin , Liao Yiwen , Xu Qingqing , Xue Yaohua , Huang Jinmei , Zheng Heping
Published: December 2020

Background

Chlamydia trachomatis detection plays a crucial role in early diagnosis and treatment of C. trachomatis infection. In the current study, the capability of sexually transmitted disease (STD) laboratories to detect C. trachomatis was investigated in Guangdong, China.

Methods

An external quality assessment panel, including 5 positive samples with different C. trachomatis loads and 2 negative samples was distributed to 654 participating laboratories in October 2019, and the test results were analyzed by Guangdong Central STD Laboratory. The use of various C. trachomatis detection methods in Guangdong from 2015 to 2019 was also retrospectively investigated.

Results

Of the 654 participating STD laboratories, 559 (85.47%) used immune chromatographic-rapid diagnostic tests (IC-RDTs) to detect C. trachomatis in 2019, and 95 (14.53%) used nucleic acid amplification tests (NAATs). The rate of NAATs use increased approximately 4-fold from 2015 to 2019. The sensitivity of IC-RDTs decreased markedly from 97.32% to 30.89% with decreasing C. trachomatis load, whereas that of NAATs was 97.62% to 100% in all positive samples. With respect to negative samples the specificity of IC-RDTs was 97.13% to 97.30% and that of NAATs was 98.95% to 100%. Laboratories using IC-RDTs were less likely to detect C. trachomatis than those using NAATs in samples with C. trachomatis loads of 20000 copies/mL or less (P < 0.0001). Further analysis indicated no significant difference (P > 0.05) in detection rate among the 4 IC-RDT assays commonly used by the participating laboratories.

Conclusions

Immune chromatographic-rapid diagnostic tests are commonly used for C. trachomatis detection by many laboratories in Guangdong, but their low sensitivity may lead to missed diagnoses. Nucleic acid amplification tests exhibit high sensitivity and specificity and should be recommended for C. trachomatis detection in STD laboratories.
Evaluation of the Ossification Stage of Proximal Humeral Epiphysis by 1.5-T Magnetic Resonance Imaging for Determination of Skeletal Age
Authors: Cekdemir Yasin Ertug , Mutlu Uygar , Karaman Gokce , Guleryuz Handan
Published: December 2020

Purpose

The aim of the study was to investigate whether the skeletal age can be evaluated assessed by means of analysis of ossification stage at proximal humeral epiphysis using magnetic resonance imaging (MRI).

Methods

This retrospective study was carried out in the radiology department of a tertiary healthcare center and 1.5-T MRI views of the shoulder obtained from 203 patients aged 8 to 29 years were evaluated. The ossification stage of proximal humeral epiphysis was evaluated on T1-weighted MRI sequences, and its correlation with age was sought.

Results

Our series consisted of 77 women (37.9%) and 126 men (62.1%). One hundred forty-seven right humerus (72.4%) and 56 (27.6%) left humerus were examined. The mean age of the patients was 20.60 ± 4.41 years. The patients were in stages 4 (n = 148, 72.9%), 3c (n = 18, 8.9%), 3b (n = 14, 6.9%), 2c (n = 13, 6.4%), and 3a (n = 10, 4.9%). Analysis of the relationship between age and ossification stage of proximal humerus epiphysis indicated that stage increased with the advancement of age. There was a significant correlation between the stage and age variables at a rate of 77% in the positive direction (P < 0.001).

Conclusions

Our results demonstrated that MRI of proximal humeral epiphysis can have valuable implications for estimation of the skeletal age. Future prospective studies must be implemented with patients grouped according to socioeconomic status, nutritional habits, and physical activities to explore the actual investigative potential of MRI.
Rupture of the Ascending Aorta Surgical Area Detected Using Isolated Cardiopulmonary Organ Computed Tomography Angiography
Authors: Tian Zhiling , Wang Zhuoqun , Wan Lei , Zhang Jianhua , Dong Hewen , Liu Ningguo , Chen Yijiu
Published: December 2020

We report cause of death after cardiac surgery using isolated cardiopulmonary organ computed tomography angiography (CTA) and a conventional autopsy. A 56-year-old man underwent aortic valve replacement and coronary artery bypass graft surgery under extracorporeal circulation. Massive bleeding occurred suddenly, and the patient died 25 days later. An autopsy revealed fibrinous exudate in the mediastinum and tight attachment of the pericardium to the heart; there were also clots and inflammatory exudate in the chest cavity. Separating the organs in the chest cavity was difficult, especially in the surgical area. We extracted the heart and lungs together and performed cardiovascular CTA and image reconstruction. Results showed spillage of the contrast agent from the anterior wall of the ascending aorta, approximately 4.5 cm from the replaced aortic valve. A histological examination confirmed that the site of contrast agent spillage was the sutured area of the ascending aorta, which was infected, necrotic, and had ruptured. Using the CTA approach for isolated cardiopulmonary organ imaging can accurately display the location of an aortic rupture, which further guides organ inspection and tissue sampling, and avoids irreversible damage to key regions. In conclusion, the approach we describe can provide evidence for determining cause of death.
The Pattern of Injuries Among Motorcyclists in Fatal Road Traffic Accidents
Authors: Mohd Saman Siti Asma’ , Jothee Shatishraj , Nor Faridah Mohd , Shafie Mohamed Swarhib
Published: December 2020

Introduction

In recent years, there has been a significant increase in mortality among motorcyclists, which warrants a need to analyze the epidemiology and pattern of injuries among road users in Malaysia. Hence, prioritizing road safety in the government policy by implementing targeted actions is justified to reduce injury and fatality.

Materials and Methods

Cases of road accident deaths in motorcyclists received by UKM Medical Centre were studied over a period of 10 years, that is, between 2010 and 2019. This study was based on forensic autopsy records database and forensic autopsy.

Results

The most affected age group by road fatalities were young men. The most common injuries were intracranial hemorrhage (74%), thoracic hemorrhage (73%), and lung laceration (85.7%). About 39 (31%) fatally injured riders were positive for illicit drug and/or alcohol.

Conclusions

This study showed that men in the third decade of life are the major victims of motorcycle fatalities. Hence, urgent measures are necessary to establish road safety policy to reduce such fatalities.
Fatal Drowning Caused by A Swimming Pool Drainage System
Authors: Atilgan Mehmet , Bulgur-Kirbas Derya , Akman Refik , Deveci Cemyigit
Published: December 2020

In swimming pools, malfunctions in the pool water drainage system can result with severe injuries, or even death, and mostly children are affected by these accidents. In this case report, the death scene and postmortem examination findings of a 12-year-old girl, who was trapped by her feet in the pool water drainage system, are reported. The external examination revealed ecchymotic areas with abrasions on both lower legs and both feet, suggesting suction of both feet through the uncovered pool drainage system opening. To prevent such accidents, safety practices related to the water circulation system should be developed in swimming pools and similar areas; children should be supervised at all times; and emergency medical teams, as well as lifeguards, should be available for immediate intervention.
Early Spontaneous Movements of Infants With Hypoxic-Ischemic Encephalopathy
Authors: Alkan Halil , Kahraman Aysu , Mutlu Akmer
Published: December 2020

Objective:

The aim of this study was to determine motor repertoire at 3 to 5 months of age in infants with hypoxic-ischemic encephalopathy (HIE) and to examine changes according to HIE severity.

Methods:

Participants were 38 infants aged 3 to 5 months with HIE and 38 infants in the comparison group. The general movement assessment and the Motor Optimality Score (MOS) were used.

Results:

Infants in the HIE group had a significantly lower total MOS and scores for fidgety movements, age adequacy of motor repertoire, and quality of movement patterns compared with the comparison group. Infants with grade III HIE compared with grade I had a significantly lower MOS.

Conclusions:

Infants with HIE had poorer motor repertoire at age 3 to 5 months when compared with peers. Motor repertoire deteriorated as HIE severity increased. Detecting potential developmental delays as early as possible allows for early intervention and rehabilitation in this population.
Testing the Child PROMIS Physical Activity Measurement in Youth Attending a Large Community Event
Authors: Hooke Mary C. , Neumann Jessie , Tucker Carole A.
Published: December 2020

Purpose:

The study's purpose was to evaluate the concurrent validity of the Child Patient-Reported Outcomes Measurement Information System (PROMIS) PA with the Youth Activity Profile (YAP) and examine its relationship to PROMIS measures of sedentary behavior and fatigue. The PROMIS Pediatric Activity (PA) measure is a newly developed, valid instrument used to collect data on children's lived experiences of short bouts of moderate to rigorous physical activity.

Methods:

Participants were ages 8 to 20 years attending a state fair. Child PROMIS measures—PA, Sedentary Behavior, and Fatigue—and the YAP were completed on an iPad.

Results:

The PROMIS PA and YAP had a positive correlation. The PROMIS PA was not associated with sedentary behavior or fatigue measurements.

Conclusion:

As expected, the PROMIS PA and YAP measure-related PA constructs, the YAP focuses on energy expended while the PROMIS PA indicates perceived response to activity.
Therapeutic Implementation of a Custom Dynamic Elbow Brace for Children With Neonatal Brachial Plexus Palsy: A Case Report
Authors: Torrey Michelle
Published: December 2020

Purpose:

The objective of this analysis is to present the benefits and functional outcomes when using a custom dynamic elbow brace as an adjunct to therapeutic interventions for a child with neonatal brachial plexus palsy.

Summary of Key Points:

Impairments associated with neonatal brachial plexus palsy can cause lifelong limitations of mobility, dexterity, and functional use of the involved upper extremity. The functional design of the custom dynamic elbow brace provided therapeutic versatility including immobilization, active-assisted controlled movement, and resistance exercise. These features facilitated efficient and functional muscle activation patterns, negating compensatory or substitute movements.

Conclusions and Recommendations for Clinical Practice:

The brace provided opportunities for focused muscle activation and subsequent improvements in strength, development of motor control, and functional mobility. Using a custom dynamic elbow brace was an effective therapeutic tool, used in conjunction with a comprehensive treatment program, and contributed to a successful outcome.
Salary Differences Between Schools of Medicine and Schools of Public Health for Nonclinical PhD Faculty: A Case Study of One Large Multicampus University System
Authors: Agana-Norman Denny Fe G. , Hansen Michael A. , Zoorob Roger J. , Liaw Winston , Salemi Jason L.
Published: December 2020

There are no evidence-based findings to assist professionals with advanced public health and social science degrees in choosing the appropriate academic location. A cross-sectional case study in 2019 was conducted using publicly available online data of full-time, nonclinical, doctoral-level academic faculty in schools of public health (SOPHs) and schools of medicine (SOMs), within one large university system. Analyses included descriptive statistics and generalized linear regression models comparing salaries between school types by academic rank, after gender and race/ethnicity adjustment. The study included 181 faculty members, 35.8% assistant, 34.1% associate, and 30.1% full professors. After accounting for race/ethnicity and gender, SOM assistant and associate professors had 9% (P = .03) and 14% (P = .008) higher mean salaries than SOPH counterparts. Findings suggest slight salary advantages for SOM faculty for early- to mid-career PhDs in one university system. Factors such as start-up packages, time to promotion, and grant funding need further exploration.
Addressing Barriers to On-site HIV and HCV Testing Services in Methadone Maintenance Treatment Programs in the United States: Findings From a National Multisite Qualitative Study
Authors: Behrends Czarina N. , Kapadia Shashi N. , Schackman Bruce R. , Frimpong Jemima A.
Published: December 2020

Context:

Few substance use disorder (SUD) treatment programs provide on-site human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) testing, despite evidence that these tests are cost-effective.

Objective:

To understand how methadone maintenance treatment (MMT) programs that offer on-site HIV/HCV testing have integrated testing services, and the challenges related to offering on-site HIV/HCV testing.

Design:

We used the 2014 National Drug Abuse Treatment System Survey to identify outpatient SUD treatment programs that reported offering on-site HIV/HCV testing to 75% or more of their clients. We stratified the sample to identify programs based on combinations of funding source, type of drug treatment offered, and Medicaid-managed care arrangements. We conducted semi-structured qualitative interviews with leadership and staff in 2017-2018 using a directed content analysis approach to identify dominant themes.

Setting:

Seven MMT programs located in 6 states in the United States.

Participants:

Fifteen leadership and staff from 7 MMT programs with on-site HIV/HCV testing.

Main Outcome Measure:

Themes related to integration of on-site HIV/HCV testing.

Results:

Methadone maintenance treatment programs identified 3 domains related to the integration of HIV/HCV testing on-site at MMT programs: (1) payment and billing, (2) internal and external stakeholders, and (3) medical and SUD treatment coordination. Programs identified the absence of state policies that facilitate medical billing and inconsistent grant funding as major barriers. Testing availability was limited by the frequency at which external organizations could provide services on-site, the reliability of those external relationships, and MMT staffing. Poor electronic health record systems and privacy policies that prevent medical information sharing between medical and SUD treatment providers also limited effective care coordination.

Conclusion:

Effective and sustainable integration of on-site HIV/HCV testing by MMT programs in the United States will require more consistent funding, improved billing options, technical assistance, electronic health record system enhancement and coordination, and policy changes related to privacy.
Effects of Negative-Pressure Wound Therapy With Instillation versus Standard of Care in Multiple Wound Types: Systematic Literature Review and Meta-Analysis
Authors: Gabriel Allen , Camardo Mark , O’Rorke Erin , Gold Rebecca , Kim Paul J.
Published: December 2020

Background:

Large randomized controlled trials that evaluate the effects of negative-pressure wound therapy with instillation of a topical solution and dwell time (NPWTi-d) are lacking. There is a need to synthesize existing data across multiple studies to provide a more precise estimate of the clinical effects of NPWTi-d.

Methods:

A systematic literature review and a meta-analysis of comparative studies were performed to determine the effects of NPWTi-d versus control therapy in the adjunctive management of complex wounds. Weighted standardized mean difference or odds ratios and 95% confidence intervals were calculated to pool study and control group results in each publication for analysis.

Results:

Thirteen studies comprising 720 patients were included in the analysis. Significantly fewer surgical debridements were performed in NPWTi-d patients versus control patients (P = 0.01). Wounds in the NPWTi-d group were ready for closure faster than control wounds (P = 0.03). The odds of reducing bacterial count from baseline in the NPWTi-d group was 4.4 times greater than control group wounds (P = 0.003), and percent reduction of bacterial count in NPWTi-d wounds was evident in all studies that captured that endpoint. There was a significantly shorter length of therapy in NPWTi-d patients versus control patients (P = 0.03). Wounds in NPWTi-d group were 2.39 times more likely to close than control group wounds (P = 0.01). Length of hospital stay was not significantly reduced for NPWTi-d patients compared with that for control patients (P = 0.06).

Conclusion:

Results of this meta-analysis show a positive effect with use of NPWTi-d in various wound types.
The Diagnostic Value of Apparent Diffusion Coefficient and Proton Magnetic Resonance Spectroscopy in the Grading of Pediatric Gliomas
Authors: Yao Rong , Cheng Ailan , Liu Menglin , Zhang Zhengwei , Jin Biao , Yu Hong
Published: December 2020

Objective

The aims of this retrospective study were to assess the value of the quantitative analysis of apparent diffusion coefficient (ADC) and proton magnetic resonance spectroscopy (1H-MRS) metabolites in differentiating grades of pediatric gliomas.

Patients and Methods

Two hundred and nine pathology-confirmed pediatric gliomas (143 low-grade gliomas [LGGs] and 66 high-grade gliomas [HGGs]) were retrospectively analyzed on preoperative diffusion-weighted magnetic resonance imaging, of which 84 also underwent 1H-MRS. The mean tumor ADC (ADCmean), minimum tumor ADC (ADCmin), tumor/normal brain ADC ratio (ADC ratio), and metabolites (choline/creatine ratio [Cho/Cr], N-acetylaspartate/creatine ratio [NAA/Cr], N-acetylaspartate/choline ratio [NAA/Cho], presence of lactate and lipid peaks) between LGGs and HGGs were analyzed.

Results

There were significant negative correlations between the ADC values and glioma grade. Receiver operating characteristic analysis showed that the cutoff ADCmean value of 1.192 × 10−3 mm2/s for the differentiation between low- and high-grade pediatric gliomas provided a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 77.6%, 80.3%, 78.5%, 89.5% and 62.4%, respectively; the cutoff ADCmin value of 0.973 × 10−3 mm2/s resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 86.0%, 90.9%, 87.6%, 95.3%, and 75.0%, respectively; the cutoff ADC ratio value of 1.384 resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 73.4%, 87.9%, 78.0%, 92.9%, and 60.4%, respectively. A tendency for a positive correlation was found between Cho/Cr and glioma grade. A negative correlation was demonstrated between NAA/Cr or NAA/Cho and glioma grade. Statistical analysis demonstrated a threshold value of 2.601 for Cho/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 81.8%, 51.7%, 71.4%, 76.3%, and 60.0%, respectively, in dividing LGGs and HGGs; a threshold value of 0.705 for NAA/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 76.4%, 75.9%, 76.2%, 85.7%, and 62.9%, respectively; a threshold value of 0.349 for NAA/Cho to provide a sensitivity, specificity, accuracy, PPV, and NPV of 87.3%, 86.2%, 86.9%, 92.3%, and 78.1%, respectively.

Conclusions

The ADC values and metabolites appeared to be significantly correlated to grade in pediatric gliomas. The predictive values may be helpful for preoperative diagnostic predictions.