bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Pelvic Floor Muscle Interventions on Pelvic Floor Dysfunction After Gynecological Cancer Treatment: A Systematic Review
Authors: Brennen Robyn , Lin Kuan-Yin , Denehy Linda , Frawley Helena C
Published: April 2020

Objective

The aim of this systematic review was to identify, evaluate, and synthesize the evidence from studies that have investigated the effect of nonsurgical, nonpharmacological, pelvic floor muscle interventions on any type of pelvic floor dysfunction or health-related quality of life in patients after any type of treatment for gynecological cancer.

Methods

Six electronic databases (Cochrane Library 2018, CINAHL 1982–2018, MEDLINE 1950–2018, EMBASE 1980–2018, PsycINFO 1806–2018, and EMCARE 1995–2018) were systematically searched in June 2018. Reference lists of identified articles were hand searched. Randomized controlled trials (RCTs), cohort studies, and case series were included if they investigated the effects of conservative treatments, including pelvic floor muscle training or dilator training, on bladder, bowel, or sexual function in patients who had received treatment for gynecological cancer. Risk of bias was assessed using the Physiotherapy Evidence Database scale for RCTs and the Newcastle-Ottawa scale for cohort studies.

Results

Five RCTs and 2 retrospective cohort studies were included (n = 886). The results provided moderate-level evidence that pelvic floor muscle training with counseling and yoga or core exercises were beneficial for sexual function (standardized mean difference = −0.96, 95% CI = −1.22 to −0.70, I2 = 0%) and health-related quality of life (standardized mean difference = 0.63, 95% CI = 0.38 to 0.88, I2 = 0%) in survivors of cervical cancer and very low-level evidence that dilator therapy reduced vaginal complications in survivors of cervical and uterine cancer (odds ratio = 0.37, 95% CI = 0.17 to 0.80, I2 = 54%). There were insufficient data for meta-analysis of bladder or bowel function.

Conclusion

Conservative pelvic floor muscle interventions may be beneficial for improving sexual function and health-related quality of life in survivors of gynecological cancer. Given the levels of evidence reported in this review, further high-quality studies are needed, especially to investigate effects on bladder and bowel function.

Impact

This review provides moderate-level evidence for the role of pelvic floor rehabilitation to improve health outcomes in the gynecological cancer survivorship journey. Clinicians and health service providers should consider how to provide cancer survivors the opportunity to participate in supervised pelvic floor rehabilitation programs.
Genome Sequence Resource of Magnaporthe oryzae Laboratory Strain 2539
Authors: Chen Meilian , Wang Baohua , Lu Guodong , Zhong Zhenhui , Wang Zonghua
Published: April 2020

Magnaporthe oryzae causes blast disease on more than 50 species of monocot plants, including important crops such as rice, millet, and most recently wheat. Additionally, it is an important model system for studying host-pathogen interaction. Here, we report a high-quality genome assembly and annotation of a laboratory strain 2539 of M. oryzae, which is a widely used progeny of a rice-infecting isolate and a grass-infecting isolate. The genome sequence of strain 2539 will be useful for studying the evolution, host adaption, and pathogenicity of M. oryzae, which will be beneficial for a better understanding of the mechanisms of host-pathogen interaction.
Fungicide SYP-14288 Inducing Multidrug Resistance in Rhizoctonia solani
Authors: Cheng Xingkai , Man Xuejing , Wang Zitong , Liang Li , Zhang Fan , Wang Zhiwen , Liu Pengfei , Lei Bin , Hao Jianjun , Liu Xili
Published: April 2020

Rhizoctonia solani is a widely distributed soilborne plant pathogen, and can cause significant economic losses to crop production. In chemical controls, SYP-14288 is highly effective against plant pathogens, including R. solani. To examine the sensitivity to SYP-14288, 112 R. solani isolates were collected from infected rice plants. An established baseline sensitivity showed that values of effective concentration for 50% growth inhibition (EC50) ranged from 0.0003 to 0.0138 μg/ml, with an average of 0.0055 ± 0.0030 μg/ml. The frequency distribution of the EC50 was unimodal and the range of variation factor (the ratio of maximal over minimal EC50) was 46.03, indicating that all wild-type strains were sensitive to SYP-14288. To examine the risk of fungicide resistance, 20 SYP-14288-resistant mutants were generated on agar plates amended with SYP-14288. Eighteen mutants remained resistant after 10 transfers, and their fitness was significantly different from the parental strain. All of the mutants grew more slowly but showed high virulence to rice plants, though lower than the parental strain. A cross-resistance assay demonstrated that there was a positive correlation between SYP-14288 and fungicides having or not having the same mode of action with SYP-14288, including fluazinam, fentin chloride, fludioxonil, difenoconazole, cyazofamid, chlorothalonil, and 2,4-dinitrophen. This result showed a multidrug resistance induced by SYP-14288, which could be a concern in increasing the spectrum of resistance in R. solani to commonly used fungicides.
Xylella fastidiosa and Glassy-Winged Sharpshooter Population Dynamics in the Southern San Joaquin Valley of California
Authors: Sisterson Mark S. , Burbank Lindsey P. , Krugner Rodrigo , Haviland David , Stenger Drake C.
Published: April 2020

Xylella fastidiosa is a vector-transmitted bacterial plant pathogen that affects a wide array of perennial crops, including grapevines (Pierce’s disease). In the southern San Joaquin Valley of California, epidemics of Pierce’s disease of grapevine were associated with the glassy-winged sharpshooter, Homalodisca vitripennis. During the growing season, rates of X. fastidiosa spread in vineyards are affected by changes in pathogen distribution within chronically infected grapevines and by vector population dynamics. Grapevines chronically infected with X. fastidiosa rarely tested positive for the pathogen prior to July, suggesting vector acquisition of X. fastidiosa from grapevines increases as the season progresses. This hypothesis was supported by an increase in number of X. fastidiosa-positive glassy-winged sharpshooters collected from vineyards during July through September. Analysis of insecticide records indicated that vineyards in the study area were typically treated with a systemic neonicotinoid in spring of each year. As a result, abundance of glassy-winged sharpshooters was typically low in late spring and early summer, with abundance of glassy-winged sharpshooter adults increasing in late June and early July of each year. Collectively, the results suggest that late summer is a crucial time for X. fastidiosa secondary spread in vineyards in the southern San Joaquin Valley, because glassy-winged sharpshooter abundance, number of glassy-winged sharpshooters testing positive for X. fastidiosa, and grapevines with detectable pathogen populations were all greatest during this period.
Pathogens Causing Anthracnose and Fruit Rots of Coffee Associated with the Coffee Berry Borer and the Entomopathogenic Fungus Beauveria bassiana in Puerto Rico
Authors: Serrato-Diaz Luz M. , Mariño Yobana A. , Bayman Paul
Published: April 2020

Fruit rots reduce coffee production worldwide. Eight Colletotrichum species have been reported to cause coffee fruit rots; the most important is C. kahawae, the cause of coffee berry disease (CBD) in Africa. It is unknown whether these fruit rot pathogens can be dispersed by the coffee berry borer (CBB, Hypothenemus hampei) or whether Beauveria bassiana (a natural enemy of CBB) might reduce coffee fruit rots. We identified pathogens causing coffee fruits rots in Puerto Rico and evaluated whether B. bassiana reduced fruit rot and whether CBB could disperse pathogens. A total of 2,333 coffee fruit with CBB damage were collected; of these, 1,197 had visible growth of B. bassiana. C. fructicola, C. siamense, C. theobromicola, and C. tropicale were isolated and identified from the fruit using morphological traits and phylogeny of three nuclear genes. All four species caused internal and external rot after inoculation of healthy green coffee fruit. Coffee fruit treated with B. bassiana had significantly less fruit rot than untreated fruit, suggesting B. bassiana can protect against fruit rot. To test whether B. bassiana had a protective effect, B. bassiana and Colletotrichum were coinoculated on coffee fruit. Fruit inoculated with both B. bassiana and Colletotrichum had significantly less rot than fruit inoculated with Colletotrichum alone. To test if CBBs dispersed the pathogens, CBBs were exposed to Colletotrichum conidia and placed on green fruit, which resulted in fruit rot. This study identifies new pathogens causing coffee fruit rot, shows that C. kahawae is not the only Colletotrichum that attacks green fruits, suggests a role for B. bassiana in disease management and demonstrates CBB can disperse the pathogens.
Draft Genome of the Macadamia Husk Spot Pathogen, Pseudocercospora macadamiae
Authors: Akinsanmi Olufemi A. , Carvalhais Lilia C.
Published: April 2020

Pseudocercospora macadamiae causes husk spot in macadamia in Australia. Lack of genomic resources for this pathogen has restricted acquiring knowledge on the mechanism of disease development, spread, and its role in fruit abscission. To address this gap, we sequenced the genome of P. macadamiae. The sequence was de novo assembled into a draft genome of 40 Mb, which is comparable to closely related species in the family Mycosphaerellaceae. The draft genome comprises 212 scaffolds, of which 99 scaffolds are over 50 kb. The genome has a 49% GC content and is predicted to contain 15,430 protein-coding genes. This draft genome sequence is the first for P. macadamiae and represents a valuable resource for understanding genome evolution and plant disease resistance.
Hypervisible Nurses
Authors: Perron Amélie , Rudge Trudy , Gagnon Marilou
Published: April 2020

Whistleblowing has been examined from various angles over the past 40 years, but not yet as a matter of epistemology. Whistleblowing can be understood as resulting from the improper transmission of critical knowledge in an organization (eg, knowledge about poor care or wrongdoing). Using the sociology of ignorance, we wish to rethink whistleblowing and the failures it brings to light. This article examines how nurses get caught in the strategic circulation of knowledge and ignorance, which can culminate in acts of whistleblowing. The sociology of ignorance helps understand how whistleblowing is borne out of the complex and strategic circulation of knowledge and ignorance that spells multiple and intersecting epistemic positions for nurses. In particular, various organizational blind spots position nurses as untrustworthy and illegitimate speakers in the “business” of the organization. Organizational failings therefore remain concealed while nurses become hypervisible, both as faulty care providers and as problematic information brokers.
Indirect Decompression Effect to Central Canal and Ligamentum Flavum After Extreme Lateral Lumbar Interbody Fusion and Oblique Lumbar Interbody Fusion
Authors: Limthongkul Worawat , Tanasansomboon Teerachat , Yingsakmongkol Wicharn , Tanaviriyachai Terdpong , Radcliff Kris , Singhatanadgige Weerasak
Published: April 2020

Study Design.

A retrospective study (level of evidence: level 4).

Objective.

To evaluate the radiographic outcomes after extreme lateral lumbar interbody fusion (XLIF) and oblique lateral lumbar interbody fusion (OLIF) procedures especially the effect of indirect decompression to the ligamentum flavum and to evaluate the effect of facet degeneration to the radiographic outcomes of these procedures.

Summary of Background Data.

Indirect decompression via lateral lumbar interbody fusion provides spinal canal area expansion. However, the effect to the ligamentum flavum area and thickness at the operated spinal level is unclear.

Methods.

Thirty-five patients (57 lumbar levels) underwent XLIF or OLIF with percutaneous pedicle screw fixation (PPS) without direct posterior decompression were retrospectively studied. Radiographic parameters including ligamentum flavum area (LFA), ligamentum flavum thickness (LFT), cross-sectional area (CSA) of thecal sac, posterior disc height, foraminal height, cage alignment, and facet degeneration were measured on magnetic resonance image (MRI). Cage position was assessed with plain radiography.

Results.

All of the radiographic parameters were significantly improved. Comparing pre- and postoperative value, mean LFA decreased from 78.9 ± 24.9 mm2 to 66.9 ± 26.8 mm2 (–14.2%; P-value < 0.00625). Mean right LFT decreased from 2.9 ± 0.9 mm to 2.3 ± 0.7 (–17.0%; P-value < 0.00625). Mean left LFT decreased from 3.3 ± 1.6 mm to 2.6 ± 0.9 mm (–17.6%; P-value < 0.00625). Mean CSA of thecal sac increased from 93.1 ± 43.0 mm2 to 127.3 ± 52.5 mm2 (50.8%; P-value < 0.00625). All radiographic outcomes were not significant difference between lumbar levels that have grade 0–1 and grade 2–3 or between grade 2 and grade 3 facet degeneration.

Conclusion.

Ligamentum flavum area and thickness were significantly reduced after lateral lumbar interbody fusion through both XLIF and OLIF. Unbuckling of the ligamentum flavum played an important role for improvement of spinal canal area after the indirect decompression.

Level of Evidence: 4
Association Between Modic Changes and Low Back Pain in Middle Age
Authors: Saukkonen Jesperi , Määttä Juhani , Oura Petteri , Kyllönen Eero , Tervonen Osmo , Niinimäki Jaakko , Auvinen Juha , Karppinen Jaro
Published: April 2020

Study Design.

A cross-sectional study of the Northern Finland Birth Cohort 1966 (NFBC1966).

Objective.

The aim of this study was to evaluate the association between the type, size, and location of lumbar Modic changes (MC), and prolonged disabling low back pain (LBP).

Summary of Background Data.

LBP is the leading cause of disability worldwide and it affects all age- and socioeconomical groups. Only a small proportion of LBP patients are diagnosed with a specific cause: In most cases no single nociceptive cause for the pain can be identified. MC are visualized in magnetic resonance imaging (MRI) as a signal intensity change in vertebral bone marrow and have been proposed to represent a specific degenerative imaging phenotype associated with LBP. MC can be classified into several subtypes, of which inflammatory Type 1 (MC1) is suggested as being more likely to be associated with LBP.

Methods.

We assessed lumbar MRI (n = 1512) for the presence, type, and size of MC. The associations of MC characteristics with prolonged (≥30 days during the past year) and disabling (bothersomeness of LBP at least 6 on a 0–10 Numeric Rating Scale) LBP, evaluated at the time of imaging at 47 years, were analyzed using binary logistic regression, adjusted for sex, BMI, smoking, educational status, lumbar disc degeneration, and disc herniations.

Results.

Any MC and MC1 were associated with prolonged disabling LBP (odds ratio [OR] after full adjustments 1.50 [95% confidence interval, CI 1.05–2.15] and 1.50 [95% CI 1.10–2.05], respectively). Furthermore, MC covering the whole anterior-posterior direction or the whole endplate, as well as the height of MC, were significantly associated with prolonged disabling LBP (OR after full adjustments 1.59 [95% CI 1.14–2.20], 1.67 [95% CI 1.13–2.46] and 1.26 [95% CI 1.13–1.42], respectively).

Conclusion.

Our study showed a significant and independent association between MC and clinically relevant LBP.

Level of Evidence: 3
Whole Spine CT Scan for the Detection of Acute Spinal Fractures in Diffuse Idiopathic Skeletal Hyperostosis Patients Who Sustained Low-energy Trauma
Authors: Dan Lantsman Christine , Barkay Gal , Friedlander Alon , Barbi Merav , Stern Myriam , Eshed Iris
Published: April 2020

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to evaluate the role and value of whole-spine computerized tomography (WSCT) versus radiographs and targeted CT to tender spinal regions in patients with diffuse idiopathic skeletal hyperostosis (DISH) after low-energy trauma.

Summary of Background Data.

Subjects with DISH are prone to spinal fractures even after low-impact trauma due to a rigid spinal structure.

Methods.

One-hundred forty-seven subjects (average age: 83 years, M:F 64/83) with verified DISH (Resnick and Niwayama radiographic criteria) on WSCT who were admitted to the emergency room (ER) after low-energy trauma and for whom there were radiographs of at least the thoracic and lumbar spine were evaluated for the presence of acute spinal fractures on both radiographs and WSCT. Agreement between fracture location and spinal tenderness location (cervical, thoracic, or lumbar) as reported in the medical record was evaluated.

Results.

Significantly more acute fractures were detected on WSCT compared to radiographs (55 and 32, P < 0.00001, respectively). The site of tenderness was not indicative of the fractured spinal segment in 57% of all acute fractures (seven cervical, 15 thoracic, and 16 lumbar). No fracture was detected on WSCT in 10 subjects with an unspecified pain location. Multilevel distant fractures were detected in two patients with a specified pain location to only one of the fractures.

Conclusion.

WSCT in DISH subjects after low-impact trauma is mandatory due to the high prevalence of acute fractures and the low specificity for fracture detection on radiographs. A targeted CT approach to the tender spinal segment proved to be inadequate and would have missed 57% of the acute single fractures with incompatible spinal tenderness location. These results support the significant role of WSCT in the ER setting for detecting and pinpointing the spinal fracture site of DISH subjects who present with low-impact trauma.

Level of Evidence: 3
Treatment in Disproportionately Minority Hospitals Is Associated With Increased Risk of Mortality in Sepsis: A National Analysis*
Authors: Rush Barret , Danziger John , Walley Keith R. , Kumar Anand , Celi Leo Anthony
Published: April 2020

Objectives:

Treatment in a disproportionately minority-serving hospital has been associated with worse outcomes in a variety of illnesses. We examined the association of treatment in disproportionately minority hospitals on outcomes in patients with sepsis across the United States.

Design:

Retrospective cohort analysis. Disproportionately minority hospitals were defined as hospitals having twice the relative minority patient population than the surrounding geographical mean. Minority hospitals for Black and Hispanic patient populations were identified based on U.S. Census demographic information. A multivariate model employing a validated algorithm for mortality in sepsis using administrative data was used.

Setting:

The National Inpatient Sample from 2008 to 2014.

Patients:

Patients over 18 years of age with sepsis.

Interventions:

None.

Measurements and Main Results:

A total of 4,221,221 patients with sepsis were identified. Of these, 612,217 patients (14.5%) were treated at hospitals disproportionately serving the black community (Black hospitals), whereas 181,141 (4.3%) were treated at hospitals disproportionately serving the Hispanic community (Hispanic hospitals). After multivariate analysis, treatment in a Black hospital was associated with a 4% higher risk of mortality compared to treatment in a nonminority hospital (odds ratio, 1.04; 95% CI, 1.03–1.05; p < 0.01). Treatment in a Hispanic hospital was associated with a 9% higher risk of mortality (odds ratio, 1.09; 95% CI, 1.07–1.11; p < 0.01). Median hospital length of stay was almost 1 day longer at each of the disproportionately minority hospitals (nonminority hospitals: 5.9 d; interquartile range, 3.1–11.0 d vs Hispanic: 6.9 d; interquartile range, 3.6–12.9 d and Black: 6.7 d, interquartile range, 3.4–13.2 d; both p < 0.01).

Conclusions:

Patients with sepsis regardless of race who were treated in disproportionately high minority hospitals suffered significantly higher rates of in-hospital mortality.
Diagnosis of the accurate genotype of HKαα carriers in patients with thalassemia using multiplex ligation-dependent probe amplification combined with nested polymerase chain reaction
Authors: Chen Dong-Mei , Ma Shi , Tang Xiang-Lan , Yang Ji-Yun , Yang Zheng-Lin
Published: April 2020

Background:

Patients carrying the HongKongαα (HKαα) allele and -α

3.7

/ααα

anti-4.2
could be misdiagnosed as -α
3.7/αα by the current conventional thalassemia detection methods, leading to inaccurate genetic counseling and an incorrect prenatal diagnosis. This study was aimed to accurately analyze the genotypes of HKαα carriers and -α
3.7/ααα
anti-4.2.

Methods:

Samples were collected in our hospital from July 2017 to October 2019. Twenty-four common types of Chinese thalassemia were screened by gap-polymerase chain reaction (Gap-PCR) and reverse dot blot (RDB). Anti-4.2 multiplex-PCR was used to confirm carriers of the ααα
anti-4.2 duplication with -α
3.7 deletion. Two-round nested PCR and multiplex ligation-dependent probe amplification (MLPA) were applied to accurately identify and confirm their genotypes. For data analysis, we used descriptive statistics and Fisher's exact tests.

Results:

Two thousand five hundred and forty-four cases were identified as thalassemia in 5488 peripheral blood samples. The results showed that α, β, and αβ compound thalassemia were identified in 1190 (46.78%), 1286 (50.55%), and 68 (2.67%) cases, respectively. A total of 227 samples from thalassemia patients were identified as -α
3.7/αα by Gap-PCR, and the genotypes of two samples were uncertain. There was a difference between Gap-PCR and combined groups (Gap-PCR combined with nested PCR and MLPA) in detecting HKαα (P < 0.05). Among the 229 patients, 20 patients were identified as HKαα carriers and one was identified as -α
3.7/ααα
anti-4.2 by two-round nested PCR and MLPA, including 15 patients with HKαα/αα, three with HKαα/αα and β-thalassemia coinheritance, one with HKαα/--SEA, one with HKαα/-α4.2 and β-thalassemia coinheritance, and one with -α
3.7/ααα
anti-4.2 and β-thalassemia coinheritance.

Conclusions:

ααα
anti-4.2 and HKαα genotypes of patients carrying -α
3.7 need to be detected to reduce the misdiagnosis rate of patients carrying HKαα and -α3.7/ααα
anti-4.2 alleles. More accurate genetic counseling can be provided in the clinic using nested PCR combined with MLPA.
The Role of Executive and General Cognitive Functioning in the Attention Problems of Very and Extremely Preterm Adults
Authors: Eves Robert , von Mühlenen Adrian , Mendonça Marina , Johnson Samantha , O'Reilly Helen , Bartmann Peter , Marlow Neil , Wolke Dieter
Published: April 2020

Objective:

To determine whether the attention problems in adults born very preterm/very low birth weight (VP/VLBW; <32 weeks' gestation/<1500 g) or extremely preterm (EP; <26 weeks' gestation) are associated with specific executive or general cognitive deficits.

Method:

Cohorts of VP/VLBW (the Bavarian Longitudinal Study [BLS]) and EP (the EPICure Study) participants were followed from birth to early adulthood, each also following a respective control group. Adult attention deficit hyperactivity disorder (ADHD) symptoms were assessed via self-report in both cohorts and additionally by parent report in the BLS. Participants in both cohorts also had their attention span rated by trained observers. Performed separately in each cohort, hierarchical regression analyses were used to assess whether the association between preterm birth status and attention problems remained after accounting for executive functioning (inhibitory control and working memory) in adulthood, childhood intelligence score (IQ), or sex.

Results:

In the discovery cohort of the BLS, significant differences were found between VP/VLBW adults and controls for parent-rated inattention (p < 0.001). However, for self-reported measures of ADHD, no significant differences were found in the BLS or in the EPICure replication cohort. In both cohorts, observer-rated attention spans were lower for VP/VLBW and EP participants in comparison to their respective control groups (p < 0.001). In final models for the BLS, inhibitory control and childhood IQ were significantly associated with parent-rated inattention symptoms (p < 0.006), whereas working memory and childhood IQ were significantly associated with observer-rated attention span (p < 0.001). The effect of childhood IQ on observer-rated attention span was replicated in EPICure.

Conclusion:

VP/VLBW and EP adults are at increased risk of observer-rated attention problems. These problems were predominantly associated with poorer general cognitive ability in early childhood and somewhat with adult executive functioning.
Treatment for vaginal atrophy using microablative fractional CO2 laser: a randomized double-blinded sham-controlled trial
Authors: Ruanphoo Purim , Bunyavejchevin Suvit
Published: April 2020

Objective:

The aim of this study was to evaluate the efficacy of vaginal CO2 laser for the treatment of vaginal atrophy compared to the sham procedure.

Methods:

Between June 2016 and May 2017, postmenopausal women with moderate to severe intensity of any vaginal atrophy symptoms (VAS) were invited to participate in the study. A total of 88 women were randomized to receive treatment with either vaginal CO2 laser or sham procedures every 4 weeks for three sessions. Both the participants and the evaluators were blinded to the treatment. Vaginal Health Index (VHI) score (primary outcome), VAS score, and the item for vaginal dryness from the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms questionnaire were compared between the two groups by intention-to-treat analysis at 12 weeks after treatment.

Results:

Eighty-eight women were enrolled into the study and nine women were lost to follow-up. After 12 weeks of laser treatment, the VHI, VAS, and International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (item for vaginal dryness) scores were significantly improved. For VHI and VAS scores the mean difference between the laser group versus the sham group was 1.37 (95% CI: 0.12-2.63), P < 0.001 and −1.52 (95% CI: −2.21 to −0.82), P = 0.03, respectively.

Conclusions:

This study demonstrated that the application of microablative fractional CO2 laser was effective in treating vaginal atrophy. It could be a promising alternative treatment for postmenopausal women with vaginal atrophy.

Video Summary:

http://links.lww.com/MENO/A582.
Results of Resorbable and Running Sutured Amniotic Multilayers in Sterile Deep Corneal Ulcers and Perforations
Authors: Brücher Viktoria C. , Eter Nicole , Uhlig Constantin E.
Published: April 2020

Purpose:

To present the results of a modified surgical technique for secure tightening and fixation of multilayer amniotic membranes (AMs) in sterile deep or perforating corneal ulcers.

Methods:

We retrospectively analyzed the data of patients suffering from corneal ulcers who had been treated between February 2016 and June 2018 with running and resorbable sutures to fixate multilayer AMs. The parameters analyzed were gender, age, etiology of corneal ulcer, ulcer diameter, corneal thickness (CST) before and after the microsurgical procedure as measured with optical coherence tomography, number of inlays, repeat surgical procedures, follow-up duration in months, and rate of success (defined as a stable anterior chamber with improved CST, a negative Seidel test, and no need for any microsurgical keratoplasty during the first 6 months after treatment). The results were statistically evaluated using the Wilcoxon test. A P-value ≤0.05 was considered to show a statistically significant difference.

Results:

The CST increased significantly after AM transplantation (from 206.26 ± 114.93 μm at baseline to 454.70 ± 244.08 μm at 1–3 months; P < 0.001). Repeat multilayer transplantation was required in 7 of the 23 patients included (30.4%), in 6 of whom the treated eye was stable at month 6. In 2 of the 23 patients, perforating keratoplasty became necessary. One patient also demanded such a procedure to improve his visual acuity. The success rate was 91.3% (n = 21).

Conclusions:

Running resorbable suture fixation of multilayer AMs proved to be an efficient means for the treatment of noninfectious deep or small perforating corneal ulcers.
A randomized, double-blind, placebo-controlled study of daily cannabidiol for the treatment of canine osteoarthritis pain
Authors: Verrico Chris D. , Wesson Shonda , Konduri Vanaja , Hofferek Colby J. , Vazquez-Perez Jonathan , Blair Emek , Dunner Kenneth , Salimpour Pedram , Decker William K. , Halpert Matthew M.
Published: April 2020

Over the last 2 decades, affirmative diagnoses of osteoarthritis (OA) in the United States have tripled due to increasing rates of obesity and an aging population. Hemp-derived cannabidiol (CBD) is the major nontetrahydrocannabinol component of cannabis and has been promoted as a potential treatment for a wide variety of disparate inflammatory conditions. Here, we evaluated CBD for its ability to modulate the production of proinflammatory cytokines in vitro and in murine models of induced inflammation and further validated the ability of a liposomal formulation to increase bioavailability in mice and in humans. Subsequently, the therapeutic potential of both naked and liposomally encapsulated CBD was explored in a 4-week, randomized placebo-controlled, double-blinded study in a spontaneous canine model of OA. In vitro and in mouse models, CBD significantly attenuated the production of proinflammatory cytokines IL-6 and TNF-α while elevating levels of anti-inflammatory IL-10. In the veterinary study, CBD significantly decreased pain and increased mobility in a dose-dependent fashion among animals with an affirmative diagnosis of OA. Liposomal CBD (20 mg/day) was as effective as the highest dose of nonliposomal CBD (50 mg/day) in improving clinical outcomes. Hematocrit, comprehensive metabolic profile, and clinical chemistry indicated no significant detrimental impact of CBD administration over the 4-week analysis period. This study supports the safety and therapeutic potential of hemp-derived CBD for relieving arthritic pain and suggests follow-up investigations in humans are warranted.
Virtual reality: physiological and behavioral mechanisms to increase individual pain tolerance limits
Authors: Colloca Luana , Raghuraman Nandini , Wang Yang , Akintola Titilola , Brawn-Cinani Barbara , Colloca GianCarlo , Kier Craig , Varshney Amitabh , Murthi Sarah
Published: April 2020

Immersive virtual reality (VR) consists of immersion in artificial environments through the use of real-time render technologies and the latest generation devices. The users feel just as immersed as they would feel in an everyday life situation, and this sense of presence seems to have therapeutic potentials. However, the VR mechanisms remain only partially known. This study is novel in that, for the first time in VR research, appropriate controls for VR contexts, immersive characteristics (ie, control VR), and multifaceted objective and subjective outcomes were included in a within-subject study design conducted on healthy participants. Participants received heat thermal stimulations to determine how VR can increase individual heat-pain tolerance limits (primary outcome) measured in degrees Celsius and seconds while recording concurrent autonomic responses. We also assessed changes in pain unpleasantness, mood, situational anxiety, and level of enjoyment (secondary outcomes). The VR induced a net gain in heat-pain tolerance limits that was paralleled by an increase of the parasympathetic responses. VR improved mood, situational anxiety, and pain unpleasantness when participants perceived the context as enjoyable, but these changes did not influence the increases in pain tolerance limits. Distraction increased pain tolerance limits but did not induce such mood and physiological changes. Immersive VR has been anecdotally applied to improve acute symptoms in contexts such as battlefield, emergency, and operating rooms. This study provides a mechanistic framework for VR as a low-risk, nonpharmacological intervention, which regulates autonomic, affective (mood and situational anxiety), and evaluative (subjective pain and enjoyment ratings) responses associated with acute pain.
Community-Based Interventions for Stroke Provided by Nurses and Community Health Workers: A Review of the Literature
Authors: Magwood Gayenell S. , Nichols Michelle , Jenkins Carolyn , Logan Ayaba , Qanungo Suparna , Zigbuo-Wenzler Enia , Ellis Charles
Published: April 2020

BACKGROUND

Community-based interventions are vital for facilitating poststroke recovery, increasing community participation, and raising awareness about stroke survivors. To optimize recovery and community reintegration, there is a need to understand research findings on community-based interventions that focus on stroke survivors and their caregivers. Although nurses and community health workers (CHWs) are commonly involved in community-based interventions, less is known about their roles relative to other poststroke rehabilitation professionals (physical therapists, occupational therapists, and speech-language pathologists). Thus, the purpose of this review is to explore research focused on improving community-based stroke recovery for adult stroke survivors, caregivers, or both when delivered by nurses or CHWs.

METHODS

A systematic review using Scopus, PubMed, EBSCOhost, MEDLINE, CINAHL Complete, and PsycInfo was completed to identify community-based poststroke intervention studies using nurses or CHWs through August 2018.

RESULTS

Eighteen studies meeting inclusion criteria from 9 countries were identified. Details regarding nurses' and CHWs' roles were limited or not discussed. Interventions emphasized stroke survivor self-care and caregiver support and were offered face-to-face and in group sessions in the community and home. A wide range of instruments were used to measure outcomes. The results of the interventions provided were mixed. Improvements were observed in perceptions of health, quality of life, knowledge, self-efficacy, self-management, and caregiver support.

CONCLUSION

Nurses and CHWs play a pivotal role in community-based care. Evidence suggests community-based interventions facilitate the necessary support for stroke survivors, caregivers, families, and communities to optimize stroke recovery. Data from this review illustrate a continued need for comprehensive programs designed to address the complex needs of stroke survivors and families when they return to their homes and communities.
Blood, Sweat, and Fears: A Novel Mutation Associated With Anaphylaxis and Nonresponse in a Patient With Afibrinogenemia
Authors: Hsieh Emily , Conneely Shannon , Teruya Jun , Nicholas Sarah , Miller Jennifer , Lee-Kim YoungNa
Published: April 2020

Congenital afibrinogenemia is a rare disorder characterized by a lack of detectable fibrinogen. The mainstay of treatment for acute bleeding episodes or perioperative management is replacement with fibrinogen concentrate or fibrinogen-containing blood products. The development of neutralizing antibodies and severe allergic reactions to fibrinogen replacement is rarely reported in afibrinogenemia patients. Here the treatment regimen is described for a 6-year-old girl with a severe allergic reaction to multiple fibrinogen-containing products who became refractory to treatment because of a presumed inhibitor to fibrinogen.
Aberrant Expression of E-cadherin, N-cadherin, and P-cadherin in Clear Cell Renal Cell Carcinoma: Association With Adverse Clinicopathologic Factors and Poor Prognosis
Authors: Jang Nu-Ri , Choi Joon Hyuk , Gu Mi Jin
Published: April 2020

Objective:

Aberrant expression of cadherins is known to be associated with tumor aggression. However, their role in clear cell renal cell carcinoma (CCRCC) is not well elucidated. This study investigated the expression of epithelial cadherin (E-cadherin), neural cadherin (N-cadherin), and placental cadherin (P-cadherin) in CCRCC, and assessed their prognostic significance and clinicopathologic association.

Materials and Methods:

We enrolled 254 patients with CCRCC who underwent radical or partial nephrectomy. E-cadherin, N-cadherin, and P-cadherin expression was evaluated by immunohistochemistry in a tissue microarray.

Results:

Low E-cadherin expression was associated with larger tumor size, lymphovascular invasion, higher pT stage, lymph node and distant metastasis, and higher stage. High N-cadherin expression was significantly associated with larger tumor size, higher nuclear grade, and tumor necrosis. P-cadherin expression was found to be significantly associated with higher nuclear grade, distant metastasis, and higher stage. Univariate analysis revealed that aberrant expression of the 3 cadherins was significantly related to shorter overall survival (OS). Loss of E-cadherin, high P-cadherin expression, and higher stage were independent prognostic factors for OS. For recurrence-free survival, lymphovascular invasion, high P-cadherin expression, and higher stage were independent prognostic factors. Cadherin switch was significantly associated with aggressive clinicopathologic factors and poor outcomes.

Conclusions:

Aberrant expression of E-cadherin, N-cadherin, and P-cadherin was associated with adverse clinicopathologic factors and worse OS. Low E-cadherin and high P-cadherin expression were significantly associated with distant metastasis and independent prognostic factors. Therefore, cadherin expression may be used as a prognostic marker and therapeutic target, and cadherin switch plays an important role in CCRCC progression.
Routine Health Outcome Measurement: Development, Design, and Implementation of the Hand and Wrist Cohort
Authors: Selles Ruud W. , Wouters Robbert M. , Poelstra Ralph , van der Oest Mark J. W. , Porsius Jarry T. , Hovius Steven E. R. , Moojen Thybout M. , van Kooij Yara , Pennehouat Pierre-Yves , van Huis Rob , Vermeulen Guus M. , Feitz Reinier , Slijper Harm P. ,   For the Hand-Wrist Study Group
Published: April 2020

Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five “measurement tracks,” including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.
Technical Description and Microsurgical Outcomes in Phalloplasty Using the Deep Inferior Epigastric Artery and Locoregional Veins
Authors: Danker Sara , Annen Alvin W. , Cylinder Isabel , Esmonde Nick O. , Berli Jens U.
Published: April 2020

Background:

Phalloplasty often requires free tissue transfer. There is ample literature describing flap-related outcomes, but the microsurgical technique used, including choice of recipient vessels, has been an overlooked yet important topic. In this study, the authors review the outcomes of their experience with the deep inferior epigastric artery and locoregional veins and outline technical modifications that occurred during the study period.

Methods:

A retrospective chart analysis of patients who underwent microsurgical phalloplasty between September of 2016 and July of 2019 was performed. Variables included flap design, donor site, and recipient vessels. The outcome measures were return to the operating room for flap compromise and partial or complete flap loss.

Results:

Forty-two phalloplasties using the deep inferior epigastric artery were identified. There were six take-backs for flap compromise, and four patients required venous revision, one of whom lost his urethral flap on postoperative day 9. There was a decrease in take-back rate from 30 percent in the first 20 patients to 0 percent in the second 22 patients in the study period. A total of 11.9 percent of patients had partial flap loss. This decreased from 15 percent to 9 percent in the two groups.

Conclusion:

After an initial learning curve, the combination of deep inferior epigastric artery, deep inferior epigastric vein, and great saphenous vein combined with specific technical modifications such as targeted coagulation of the vasa nervorum of the clitoral nerve has proven to be a reliable technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Systematic Review of Patient-Report Safety Climate Measures in Health Care
Authors: Madden Caoimhe , Lydon Sinéad , O’Dowd Emily , Murphy Andrew W. , O’Connor Paul
Published: April 2020

Objectives

Patients are a valuable, yet underutilized source of information for safety measurement and improvement in health care. The aim of this review was to identify patient-report safety climate (SC) measures described in the literature, analyze the included items to consider their alignment with previously established SC domains, evaluate their validity and reliability, and make recommendations for best practice in using patient-report measures of SC in health care.

Methods

Searches were conducted, with no limit on publication year, using MEDLINE, EMBASE, CINAHL, PsycINFO, and Academic Search Complete in November 2019. Reference lists of included studies and existing reviews were also screened. English-language, peer-reviewed studies that described the development or use of a patient-report measure to assess SC in health care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool.

Results

A total of 5060 studies were screened, with 44 included. Included studies described 31 different SC measures. There was much variability in the coverage of SC domains across included measures. Poor measure quality was marked by inadequacies in the testing and reporting of validity and reliability. There was also a lack of usability testing among measures.

Conclusions

This review identified the extant patient-reported SC measures in health care and demonstrated significant variance in their coverage of SC domains, validity and reliability, and usability. Findings suggest a pressing need for a stand-alone measure that has a high validity and reliability, and assess core SC domains from the patient perspective, particularly in primary care.
Brief Report: Frailty and HIV Disease Severity Synergistically Increase Risk of HIV-Associated Neurocognitive Disorders
Authors: Sun-Suslow Ni , Paolillo Emily W. , Morgan Erin E. , Letendre Scott , Iudicello Jennifer , Moore David J.
Published: April 2020

Background:

Frailty disproportionally affects people with HIV (PWH) and increased frailty in this already vulnerable population is associated with worse neurocognitive functioning. Whether frailty interacts with current and modifiable markers of HIV disease severity to synergistically increase risk for HIV-associated neurocognitive disorders (HAND), however, is unknown and important for informing the clinical care of aging PWH.

Setting:

UC San Diego's HIV Neurobehavioral Research Program.

Methods:

Participants were 178 PWH evaluated between 2014 and 2019. HIV disease severity was measured by current CD4 count and plasma HIV RNA. HAND diagnoses were made according to the Frascati criteria using a 7-domain neuropsychological battery, and the Fried phenotype criteria were used to assess frailty syndrome (0–5 symptoms). The independent and interactive effects of frailty and current HIV disease severity (ie, CD4 count and plasma HIV RNA) on HAND were examined using multiple logistic regressions.

Results:

There was an interaction between CD4 count and frailty on HAND. Simple slopes showed that CD4 count and the likelihood of HAND were negatively associated at >1.25 symptoms of frailty, and conversely, frailty and HAND were negatively associated at 642 or less cells/mm3. There were no significant independent or interactive effects of plasma HIV RNA and frailty on the likelihood of HAND.

Conclusions:

In addition to monitoring CD4 count, assessing for frailty may be critical in older adults with HIV to potentially mitigate poor neurobehavioral outcomes. Longitudinal follow-up studies are needed to determine the directionality of these findings.
Detection of Myocardial Tissue Alterations in Hypertrophic Cardiomyopathy Using Texture Analysis of T2-Weighted Short Inversion Time Inversion Recovery Magnetic Resonance Imaging
Authors: Amano Yasuo , Yanagisawa Fumi , Omori Yuko , Suzuki Yasuyuki , Ando Chisato , Yamamoto Hiroshi , Matsumoto Naoya
Published: April 2020

Objective

The aim of this study was to evaluate the usefulness of texture analysis of T2-weighted short inversion time inversion recovery (T2-STIR) for detecting myocardial tissue alterations in hypertrophic cardiomyopathy (HCM).

Methods

Twenty patients with HCM and 11 controls were examined. Texture analysis was performed for the hypertrophied regions with and without and abnormal hyperintensity (AHI) and for the interventricular septum of the controls on T2-STIR. T2 mapping was performed to measure myocardial T2 values.

Results

A gray-level nonuniformity value of 64.7 was the best discriminator between patients and controls with an area under the curve of 0.93 on a receiver operating characteristic curve. T2 values did not differ between them. The gray-level nonuniformity was significantly smaller in AHI regions than in the hypertrophied regions without AHI in HCM patients.

Conclusions

Texture analysis is useful for quantitatively detecting myocardial tissue altenations, including AHI, associated with HCM on T2-STIR.