bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre-Existing and New-Onset Depression and Anxiety Among Workers With Injury or Illness Work Leaves
Authors: Gaspar Fraser W. , Jolivet Daniel N. , Wizner Kerri , Schott Fred , Dewa Carolyn S.
Published: August 2020

Objectives:

To examine the influence of depression and/or anxiety on work leaves and the impact of work leaves on experiencing a new-onset depression and/or anxiety disorder.

Methods:

IBM's MarketScan® research databases were linked to investigate depressive and anxiety disorders in workers with a work leave due to an injury or non-mental health illness (n = 467,930) and without a work leave (n = 2,764,447).

Results:

The odds of a work leave within a year were 2.10 times higher (95%CI: 2.08–2.13) in individuals with depression and/or anxiety compared to those without. The odds of developing a new-onset depression and/or anxiety within a year was 4.21 times higher (95% CI: 4.14–4.27) in individuals with a work leave compared to those without.

Conclusion:

Depression and anxiety are both risk factors for and subsequent outcomes of injuries or illnesses that require a work leave.
Etiological Work-up in Referrals From Neonatal Hearing Screening: 20 Years of Experience
Authors: Boudewyns An , van den Ende Jenneke , Declau Frank , Wuyts Wim , Peeters Nils , Brandt Anouk Hofkens-Van den , Van Camp Guy
Published: August 2020

Background:

Confirmation of permanent hearing loss in a newborn should be followed by a search for an underlying etiology because this may impact hearing loss management and counselling.

Methods:

Retrospective chart review of all newborns seen at a tertiary referral center after referral from newborn hearing screening over a 20-year period. The changes in the diagnostic protocol over the years are outlined and the most recent protocol includes targeted next-generation sequencing using a panel for known hearing loss causing genes, in all cases of bilateral sensorineural hearing loss (SNHL).

Results:

Permanent hearing loss was confirmed in 235 of 1,002 neonates. A complete etiological work-up was performed in 138 cases of SNHL (77 bilateral and 61 unilateral), with the underlying cause found in 77.9% and in 67.2% of patients respectively. Genetic causes explained 55 (58.4%) of bilateral cases and in 17 a genetic cause was identified by the gene panel. Pathogenic variants in GJB2 and MYO15A explained most cases of nonsyndromic SNHL. Waardenburg syndrome was the most frequent syndromic cause. Cochlear nerve deficiency and congenital cytomegalovirus infection accounted for the majority of unilateral SNHL.

Other causes of congenital hearing loss were conductive hearing loss (n = 12) and auditory neuropathy/dyssynchrony (n = 9).

Conclusion:

Implementation of targeted next-generation sequencing in the etiological work-up improves the diagnostic yield in congenital SNHL, leaving only about 20% of bilateral and 30% of unilateral cases unsolved.
The Rise and Fall of Otosclerosis: A Population-based Study of Disease Incidence Spanning 70 Years
Authors: Marinelli John P. , Totten Douglas J. , Chauhan Kiran K. , Lohse Christine M. , Grossardt Brandon R. , Vrabec Jeffrey T. , Carlson Matthew L.
Published: August 2020

Objective:

Although it is commonly held that otosclerosis has become increasingly uncommon over recent decades, no population-based data exist to characterize this trend. Moreover, because most large epidemiologic databases within the United States primarily include cancer data, even the modern incidence of otosclerosis is unknown. The chief objective of the current work was to characterize the trend in the incidence of otosclerosis over 70 years using the unique resources of the Rochester Epidemiology Project.

Study Design:

Population-based study.

Patients:

Residents of Olmsted County, Minnesota diagnosed with otosclerosis.

Main Outcome Measure:

Disease incidence from 1950 to 2017.

Results:

From 1950 to 2017, 614 incident cases of otosclerosis were identified. The incidence rose from 8.9 per 100,000 person-years in the 1950s to a peak of 18.5 from 1970 to 1974. From this peak, the incidence significantly declined to 6.2 per 100,000 person-years by the early-1990s and reached a nadir of 3.2 from 2015 to 2017 (p<0.001). From 1970 to 2017, age at diagnosis (p = 0.23) and the proportion of bilateral cases (p = 0.16) did not significantly change; pure-tone average at diagnosis did not clinically appreciably change over the study period (median difference <5 dB across decades,p = 0.034).

Conclusions:

The incidence of otosclerosis drastically declined since the early-1970s. Historically considered one of the most common causes of acquired hearing loss, the low modern incidence of otosclerosis renders it legally a “rare disease” within the United States. These trends require consideration when determining trainee case requirements and developing practice guidelines.
Laterality of Audiovestibular Symptoms Predicts Laterality of Endolymphatic Hydrops in Hydropic Ear Disease (Menière)
Authors: Gürkov Robert , Todt Ingo , Jadeed Rawad , Sudhoff Holger , Gehl Hans-Björn
Published: August 2020

Background:

For clinical confirmation of the diagnosis of hydropic ear disease (HED) (Menière) by MR imaging, two routes of contrast enhancement of the perilymphatic space are currently being used: intratympanic and intravenous. While unilateral intratympanic contrast application generally enables a higher perilymph signal intensity and image quality, the intravenous route allows for imaging of both inner ears simultaneously. It is conceivable that intratympanic contrast application to one ear would result in a failure to detect endolymphatic hydrops in a given patient if the hydrops is present only in the other ear. Therefore, in this study we examined the question whether the ear with the greater degree of endolymphatic hydrops may be predicted based on clinical features.

Methods:

Retrospective study of 50 patients with HED confirmed on MR imaging. Three tesla MR imaging with 3D fluid attenuated inversion recovery 4 hours after intravenous gadolinium contrast application was used to detect endolymphatic hydrops. The index ear was defined by auditory symptoms during attacks, low frequency hearing loss, and caloric canal paresis.

Results:

In all patients the ear with more severe symptoms corresponded with the ear showing the more severe hydrops on MR imaging.

Conclusion:

In summary, in this study population the degree of low-frequency hearing loss (250 Hz–1 kHz) in combination with auditory symptoms during attacks identified the ear with the greater extent of endolymphatic hydrops in all patients. In conclusion, intratympanic contrast application to the index ear seems to be sufficient to confirm the diagnosis of HED (Menière) on MR imaging.
Correlations between indices of dynamic components of ambulatory blood pressure and renal damage in elderly Chinese male with essential hypertension
Authors: Leng Wen-Xiu , Zhang Meng , Cui Hua , Zeng Long-Huan , Hu Yi-Xin
Published: August 2020

Objective

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is an accurate method to document changes in blood pressure (BP) and is more predictive than office and home BP monitoring for cardiovascular outcomes in elderly people. We aimed to determine the relationship between ABPM indices and renal damage in elderly Chinese male patients with essential hypertension.

Methods

We investigated 998 Chinese men (mean age of 78.44 ± 12.02 years) with essential hypertension. Renal function, laboratory testing, and ABPM, including ABP, BP variability, and BP circadian rhythms were investigated. Data were shown according to BP controlling status. The relationships between ABPM indices and renal damage [expressed by urine protein, urine albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN)] were assessed using multiple regression analysis.

Results

After adjustments for age, common cardiovascular risk factors, and medications, uACR level was positively associated with 24-h mean systolic blood pressure (SBP), 24-h mean pulse pressure (PP), and 24-h SBP percent time of elevation. eGFR level was negatively associated with the 24-h mean SBP and 24-h mean PP. BUN level was positively correlated with the 24-h mean SBP, 24-h mean PP, and 24-h SBP percent time of elevation, whereas the BUN level was negatively associated with the 24-h DBP SD.

Conclusion

The ABPM indices associated with renal damage may be regarded as an early predictive marker for renal function impairment in Chinese elderly male patients with hypertension.
Recent advances in clinical probiotic research for sport
Authors: Jäger Ralf , Mohr Alex E. , Pugh Jamie N.
Published: August 2020

Purpose of review

This is a review of the most up-to-date research on the effectiveness of probiotic supplementation for outcomes related to athletes and physical activity. The focus is on clinical research incorporating exercise and/or physically active participants on the nutritional effectiveness of single and multistrain preparations.

Recent findings

Findings of the included clinical studies support the notion that certain probiotics could play important roles in maintaining normal physiology and energy production during exercise which may lead to performance-improvement and antifatigue effects, improve exercise-induced gastrointestinal symptoms and permeability, stimulate/modulate of the immune system, and improve the ability to digest, absorb, and metabolize macro and micronutrients important to exercise performance and recovery/health status of those physically active.

The current body of literature highlights the specificity of probiotic strain/dose and potential mechanisms of action for application in sport. These novel findings open new areas research, potential use for human health, and reinforce the potential role for probiotic's in exercise performance. While encouraging, more well designed studies of probiotic supplementation in various sport applications are warranted.
Proton pump inhibitors reduce phlebotomy burden in patients with HFE-related hemochromatosis: a systematic review and meta-analysis
Authors: Dirweesh Ahmed , Anugwom Chimaobi M. , Li Yiting , Vaughn Byron P. , Lake John
Published: August 2020

Background and aims

Proton pump inhibitors (PPIs) may reduce iron absorption and serum ferritin levels in patients with homeostatic iron regulator (HFE)-related hemochromatosis, reducing the need for frequent phlebotomies. Our study aimed to perform for the first time a meta-analysis of existing observational and randomized controlled studies to ascertain the overall effect of PPI use in patients with HFE-related hemochromatosis.

Methods

Studies in adults reporting the outcomes of PPIs use in hereditary hemochromatosis patients from Medline, Embase, Scopus and Google Scholar databases from inception to December 2019 were systematically searched. The study outcomes were the serum ferritin levels and annual requirement for phlebotomies. Pooled mean difference, and 95% confidence intervals (CIs) were obtained by the random-effects model. Forrest plots were constructed to show the summary pooled estimate. Heterogeneity was assessed by using I2 measure of inconsistency.

Results

Following an initial search of 202 manuscripts, a total of three studies involving 68 patients with hemochromatosis (34 in the PPIs group and 34 in the placebo or non-PPI group) were included. A minimum duration of PPI use was 1 year. Patients who received PPIs therapy did not have a statistically significant lower serum ferritin levels (mean difference: −18.86, 95% CI: −60.44, 22.72, P = 0.37, I
2 = 88%) but required significantly less sessions of phlebotomies annually (mean difference: −3.10, 95% CI: −4.46, −3.08, P < 0.00001, I
2 = 93%). No publication bias was found on Egger (P = 0.94) or Begg (P = 0.98) tests.

Conclusion

PPIs can be used as an adjuvant therapy to reduce phlebotomy burden in patients with HFE-related hemochromatosis.
Risk Factors for Acute Kidney Injury in Acute Pancreatitis
Authors: Yu Bingjun , He Wen-Hua , Lu Nonghua
Published: August 2020

Objective

The aim of our study was to investigate the risk factors for acute kidney injury (AKI) in patients with acute pancreatitis (AP).

Methods

Acute pancreatitis patients were retrospectively divided into 2 groups: AKI and non-AKI. We used logistic regression analysis to investigate the risk factors for AP patients with AKI. We also compared the incidence of complications and mortality between the non-AKI and AKI groups.

Results

A total of 1255 AP patients without AKI and 430 AP patients with AKI were included. The risk factors for AKI in AP were hypertriglyceridemia (P = 0.001), severity (P = 0.001), etiology (P = 0.001), and Acute Physiology and Chronic Health Evaluation II scores (P = 0.001). The incidences of organ failure (P = 0.001), pancreatic necrosis (P = 0.001), and mortality (P = 0.001) were greater in the AKI group than in the non-AKI group.

Conclusions

Hypertriglyceridemia, severity, etiology, and Acute Physiology and Chronic Health Evaluation II scores are independent risk factors for AKI in AP patients. Those patients have serious outcomes such as high rate of organ failure, pancreatic necrosis, and debridement of necrosis.
Left Ventricular Assist Device Therapy and Acute Pancreatitis
Authors: Corral Juan E. , Kröner Paul T. , Yarlagadda Bhavya , Vemireddy Lalitha P.R. , Wijarnpreecha Karn , Goswami Rohan M. , Raimondo Massimo , Bi Yan
Published: August 2020

Objective

The aim of the study was to compare incidence and outcomes of acute pancreatitis among advanced heart failure therapies.

Methods

Two retrospective cohorts are as follows: A, patients with heart failure presenting to our hospitals and B, the US National Inpatient Sample. Three groups were compared: left ventricular assist device (LVAD) recipients, transplant recipients, and controls who did not qualify for advanced therapies. Primary outcomes were pancreatitis incidence and mortality. Secondary outcomes included kidney failure, multiorgan failure, shock, and health care utilization.

Results

Cohort A included 1344 heart failure patients, and cohort B included 677,905 patients with acute pancreatitis. In cohort A, annual pancreatitis incidence was 6.7 cases per 1000 LVAD recipients, 4.1 per 1000 LVAD bridge-to-transplant, 2.3 per 1000 transplant recipients, and 3.2 per 1000 heart failure controls (P = 0.03). Combined, the incidence was 5.6 per 1000 LVAD users and 2.7 in 1000 non-LVAD users (relative risk, 2.1; P = 0.009). In cohort B, increased mortality was seen in LVAD users, but not in transplant recipients. Left ventricular assist device patients had higher odds of kidney failure, multiorgan failure, shock, and intensive care.

Conclusions

Patients with LVAD have double risk of pancreatitis, worse clinical outcomes, and increased healthcare utilization. Studies elucidating the mechanisms behind pancreatic injury in advanced heart failure are suggested.
Prospective Analysis of the Impact of 68Ga-DOTATOC Positron Emission Tomography–Computerized Axial Tomography on Management of Pancreatic and Small Bowel Neuroendocrine Tumors
Authors: Ghobrial Silvia N. , Menda Yusuf , Zamba Gideon K. , Mott Sarah L. , Gaimari-Varner Kristin , Dick David , Dillon Joseph , Howe James R. , Graham Michael , Sunderland John , Bellizzi Andrew , O’Dorisio Thomas M. , O’Dorisio M. Sue
Published: August 2020

Objectives

A prospective clinical trial evaluated the effect of 68Ga-DOTATOC positron emission tomography–computerized axial tomography (PET-CT) on change in management of patients with lung, pancreatic, and small bowel neuroendocrine tumors. The primary eligibility criterion was a histologically proven tumor with positive somatostatin receptor subtype 2A immunohistochemistry. The primary and secondary end points were change in patient management and safety.

Methods

Referring physicians completed questionnaires pre– and post–68Ga-DOTATOC PET-CT, stating current and planned patient management, respectively, with tumor board adjudication of final management decisions. Change in management was categorized as follows: no change; minor change (additional imaging, supportive care); or major change (octreotide/lanreotide therapy, tumor biopsy, surgery, peptide receptor radiotherapy, chemotherapy, biological therapy, liver embolization).

Results

A major change in management was recommended for 54 (47.37%) of 114 subjects and a minor change for 6 (5.26%) of 114 subjects, with no change for 54 (47.37%) of 114 subjects. Grade 1 adverse events were observed in 26 of 114 subjects (nausea, headache, back pain, diarrhea); one grade 2 (petechiae) and one grade 3 (abdominal pain) adverse event were observed. No grade 2 or 3 adverse events were related to study drug and none required intervention.

Conclusions

Imaging with 68Ga-DOTATOC PET-CT has a significant impact on management of patients with neuroendocrine tumors.
Malignant Granular Cell Tumor of the Lower Extremity in an Adolescent Male
Authors: Shah Karina , Fulbright Joy , Katz Alexander , Zhang Lei , Jarka Dale , Lypka Michael
Published: August 2020

Granular cell tumors (GCTs) are extremely rare soft tissue tumors, with only 2% of tumors being malignant. Malignant GCTs are more often seen in women between the ages 40 and 60. There has been no case reported of a malignant GCT in a pediatric patient. We present a case of a 14-year-old male who presented with a large mass in his left lower extremity. After being biopsied, the mass was diagnosed as a malignant GCT. The tumor was completely excised with wide margins and close follow-up with the patient continued.
High Risk of HBV Infection Among Vaccinated Polytransfused Children With Malignancy
Authors: El-Sayed Manal H. , Said Zeinab N.A. , Abo-Elmagd Enas K. , Ebeid Fatma S.E. , Salama Iman I.
Published: August 2020

Aim of the Study:

The national Egyptian hepatitis B virus (HBV) vaccination program coverage of all infants started in 1992. The study aimed to assess immunity against HBV and occurrence of HBV breakthrough infections in vaccinated polytransfused children with malignancies.

Patients and Methods:

Eighty-nine polytransfused children with malignancies were recruited; 37 were on chemotherapy (male:female 20:17; mean age 7.7±4.0 y), and there were 52 naive patients (male:female 31:21; mean age 7.6±3.2 y). In addition, 162 age-matched and sex-matched healthy controls were recruited. Patients’ sera were tested for quantitative anti-hepatitis B surface (HBs) (enzyme-linked immunoassays technique), hepatitis B surface antigen (HBsAg), total anti-hepatitis B core, and HBV-DNA (nested polymerase chain reaction for surface, core, and x-regions).

Results:

There was a significant lower percentage of having protective anti-HBs (10 to 100 IU/L) level among those receiving chemotherapy (13.5%) than those without (44.2%) and controls (32.1%). Twenty-one (67.7%) of those on chemotherapy were HBsAg positive compared with 10 (32.2%) of those without. Overall, 46 patients were HBV-DNA positive; 38 were c-region positive, 5 were s-region positive, 2 positive for the c-region and the s-region, and 1 tested positive for the c-region and the x-region. Of 46 patients, 20 were also positive for HBsAg (overt infection), while 26 had occult HBV infection (HBsAg-negative). Anti-HBs ≥10 IU/L co-existed among 45% of patients with overt infection and in 50% of those with occult infection. There was nonsignificant impact of receiving chemotherapy on the level of HBV-DNA.

Conclusions:

Vaccinated children with malignancies, especially those under chemotherapy, are at a significant risk of HBV infection. The co-existence of anti-HBs with HBsAg and/or HBV-DNA may represent a possible residual transfusion-transmission risk with mutant HBV strains.
An Evaluation of a Fluorescence In Situ Hybridization Strategy Using Air-dried Blood and Bone-marrow Smears in the Risk Stratification of Pediatric B-Lineage Acute Lymphoblastic Leukemia in Resource-limited Settings
Authors: Sharma Praveen , Rana Sonia , Sreedharanunni Sreejesh , Gautam Arambam , Sachdeva Man Updesh Singh , Naseem Shano , Varma Neelam , Jain Richa , Bansal Deepak , Trehan Amita
Published: August 2020

Cytogenetic abnormalities (CAs), one of the strongest influencers of therapeutic outcome in pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL), can be identified by different techniques. Despite several technological advances, many centers with resource-limited settings continue to use either reverse-transcriptase polymerase chain reaction (RT-PCR) and/or fluorescence in situ hybridization (FISH) to identify prognostically relevant CAs. We evaluated a simple and cost-effective triple-probe FISH strategy on air-dried blood and bone-marrow smears and compared its performance with a multiplex RT-PCR-based approach in the prognostication of pediatric BCP-ALL patients. Three hundred twenty BCP-ALL patients were tested prospectively and in parallel by FISH on air-dried blood or bone-marrow smears and RT-PCR. The FISH strategy correctly diagnosed all genetic abnormalities identified by RT-PCR. Prognostically relevant genetic abnormalities were missed by RT-PCR in 24 (8.1%) patients. In another 20 children (6%), with samples inadequate for RT-PCR testing (dry taps or due to poor sample quality), a successful FISH testing could be performed on bone-marrow aspirate or trephine-imprint smears. In addition, FISH detected ploidy changes, which could be confirmed by FxCycle Violet-based flow-cytometry. FISH testing on air-dried smears identified more prognostically relevant CAs, provided information on the ploidy status, and could be successfully performed in children with difficulty in bone-marrow sampling.
Screening for Iron Deficiency Anemia in Infants in a Thalassemia-endemic Region
Authors: Nanta Natthawadee , Natesirinilkul Rungrote , Kittisakmontri Kulnipa , Chimnuan Kamolchanok , Manowong Suphara , Suanta Sudjai , Charoenkwan Pimlak
Published: August 2020

Screening for iron deficiency anemia (IDA) in infants is usually carried out by hemoglobin (Hb) level and mean corpuscular volume (MCV). A coinherited thalassemia carrier may confound the diagnosis of IDA. This study aimed to characterize the hematologic parameters in infants with IDA and in thalassemia carriers, and to study the use of red cell parameters in IDA screening in a thalassemia-endemic area. Healthy infants, 6 to 12 months of age were enrolled. Blood samples were taken for complete blood count, ferritin level, Hb analysis, and polymerase chain reaction for alpha0-thalassemia. IDA was defined as Hb <11.0 g/dL and ferritin <12 μg/L. Formulae calculated from red cell parameters to distinguish thalassemia carriers were analyzed. Eighty-five infants, 8.3±2.4 months of age, including 48 (56.5%) male infants were enrolled. Sixteen infants (18.8%) had IDA. There were 25 thalassemia carriers (29.4%), 1 Hb H disease, and 1 homozygous Hb E. Hb levels and MCV in the IDA and thalassemia carrier groups were significantly lower than those in the normal group. Area under the curve of Mentzer index (MCV/red blood cell count <13) to suggest thalassemia carriers was 0.867 (95% confidence interval: 0.784-0.951), and the sensitivity and specificity were 92.6% and 72.4%, respectively. In conclusion, both Hb level and Mentzer index are recommended for screening of IDA and thalassemia carriers in the population.
Sclerosing Encapsulating Peritonitis in a Pediatric Patient Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Authors: Whitlock Richard S. , Malik Tahir , Smith Valeria , Mahajan Priya , Hayes-Jordan Andrea , Vasudevan Sanjeev A.
Published: August 2020

Background:

Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition characterized by small bowel encapsulation by a thick fibrocollagenous membrane. Patients with SEP often present with nonspecific symptoms, such as abdominal pain and distension, however some patients may present with symptoms suggestive of intestinal obstruction. Secondary SEP has been reported in patients undergoing peritoneal dialysis and has been recently described in adults following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Observations:

We report a clinical case of a 13-year-old female who presented with worsening abdominal pain and distension and persistent emesis who was found to have SEP 13 months following CRS and HIPEC for management of desmoplastic small round cell tumor and subsequently required operative intervention.

Conclusion:

Although there have been published reports of adult patients experiencing cases of SEP following CRS/HIPEC, this is the first published case of secondary SEP occurring in a pediatric oncology patient.
More Than Meets the Eye? A Cautionary Tale of Malignant Ectomesenchymoma Treated as Low-risk Orbital Rhabdomyosarcoma
Authors: Rashid Tooba , Bagatell Rochelle , Pawel Bruce , Bentley Rex C. , Kreissman Susan G. , Deel Michael D.
Published: August 2020

Malignant ectomesenchymoma (MEM) is a rare multiphenotypic tumor comprised of mesenchymal and neuroectodermal components. MEM is typically diagnosed in infants and younger children and outcomes are variable. The current approach for treating MEM includes targeting the more aggressive mesenchymal component of the tumor, which is often rhabdomyosarcoma. Here, we describe a case of an orbital tumor initially diagnosed and treated as low-risk rhabdomyosarcoma. Local failure prompting a second biopsy revealed neuronal differentiation consistent with a diagnosis of MEM. Intensifying therapy and local radiotherapy led to a long-term cure. This case offers a cautionary tale that while outcomes for MEM were similar to matched rhabdomyosarcoma cohorts when treated on conventional Intergroup Rhabdomyosarcoma Study Group (IRSG) III/IV protocols, treating MEM using a decreased intensity low-risk rhabdomyosarcoma regimen may not be sufficient.
Anaplastic Lymphoma Kinase Inhibitor in Treatment of Inflammatory Myofibroblastic Tumor of the Tongue in Infancy
Authors: Rao Karishma , Farooki Sana , Guest Erin , Chastain Katherine , Gener Melissa , Akangire Gangaram
Published: August 2020

Inflammatory myofibroblastic tumors (IMTs) are rare in neonates. IMTs of the tongue are also very rare in infancy, with only 1 case reported in this age group. The mainstay of therapy has traditionally been surgery, which can be devastating to surrounding structures and negatively impact prognosis. Approximately 50% of IMTs harbor a translocation involving the anaplastic lymphoma kinase gene. We describe a case of IMT of the tongue in a neonate treated with debulking and an anaplastic lymphoma kinase inhibitor. The patient achieved complete response and remains disease-free 1.5 year following completion of therapy.
Isolated Central Nervous System Progression During Systemic Treatment With Brentuximab Vedotin Monotherapy in a Pediatric Patient With Recurrent ALK-negative Anaplastic Large Cell Lymphoma
Authors: Kim Yuhwa , Sudo Akina , Oyama Ryo , Keino Dai , Tomizawa Daisuke , Kato Motohiro , Osumi Tomoo , Mori Tetsuya
Published: August 2020

Central nervous system (CNS) involvement in anaplastic large cell lymphoma (ALCL) is uncommon. CNS prophylaxis is not regularly included in second-line treatments for patients who develop CNS-negative relapses. We report a pediatric case of recurrent ALK-negative ALCL who developed isolated CNS progression during the treatment with brentuximab vedotin monotherapy. The patient achieved CNS remission after receiving the CNS-directed treatments including craniospinal irradiation. There is no evidence regarding whether brentuximab vedotin can cross the blood-brain barrier. CNS prophylaxis should be considered in high-risk patients with relapsed ALCL who receive second-line treatments containing agents with limited CNS penetration.
The Experiences of Well-being of Palliative Care Providers in Malaysia
Authors: Tan Seng Beng , Lee Yan Li , Tan Shir Nee , Ng Tze Ying , Teo Yong Teck , Lim Poh Khuen , Loh Ee Chin , Lam Chee Long
Published: August 2020

Palliative care providers find meaning in their work, even though stress, burnout, and compassion fatigue can be a concern. In this study, we aimed to explore the experiences of well-being of palliative care providers in Malaysia. Data collected using semistructured interviews were thematically analyzed. Eighteen palliative care providers participated: 9 doctors and 9 nurses. Five subthemes were generated: (1) values and strengths, (2) coping and work-life balance, (3) social support and spirituality, (4) passion and satisfaction, and (5) learning, growth, and transformation. These subthemes were further categorized into 2 themes: resilience and reward. The results may inform the development of interventions in the promotion and sustenance of well-being of palliative care providers.
Technical Report: Guidelines for Handling of Multipatient Contact Lenses in the Clinical Setting
Authors: Sindt Christine , Bennett Ed , Szczotka-Flynn Loretta , Sclafani Louise , Barnett Melissa ,   for The American Academy of Optometry (AAO) Section on Cornea, Contact Lenses & Refractive Technologies, and The American Optometric Association (AOA) Contact Lens and Cornea Section
Published: August 2020

SIGNIFICANCE

Standardized guidelines that are clinically practical are needed to assist the prescriber in minimizing the risk of conveying infection through multiuse diagnostic contact lens use and reuse.

Contact lens prescribers face the specter of transferring potential pathogens from one patient to another when reusing diagnostic (trial) contact lenses on multiple patients because infectious organisms have been recovered from worn contact lenses, although there is no evidence of transmission through this mechanism. These pathogens can be introduced into the system from one patient to another, or they may be introduced by clinician lens handling, storage, or both. These pathogens can cause acute or chronic systemic or ocular infection that can lead to significant morbidity (temporary or permanent) that includes vision loss.
Lipid Analysis on Block Copolymer–containing Packaging Solution and Lens Care Regimens: A Randomized Clinical Trial
Authors: Shows Amanda , Redfern Rachel L. , Sickenberger Wolfgang , Fogt Jennifer S. , Schulze Marc , Lievens Christopher , Szczotka-Flynn Loretta , Schwarz Stefan , Tichenor Anna A. , Marx Sebastian , Lemp-Hull Jessie M.
Published: August 2020

SIGNIFICANCE

Lotrafilcon B lenses packaged in and cared for with block copolymer–containing (polyoxyethylene-polyoxybutylene; EOBO) lens care solutions resulted in lower cholesterol extraction than each of the habitual silicone hydrogel lens/multipurpose solution (MPS) regimens tested.

PURPOSE

This study aimed to compare the extracted cholesterol of lotrafilcon B lenses packaged in and cared for with EOBO-containing lens care solutions with the extracted cholesterol of habitual silicone hydrogel lenses cared for with MPS not containing EOBO.

METHODS

In this prospective, randomized, observer-masked parallel study, habitual wearers of senofilcon C, senofilcon A, comfilcon A, and samfilcon A contact lenses using a non-EOBO MPS were randomized 1:1 to lotrafilcon B lenses packaged in and cared for with EOBO-containing solutions or to their habitual lenses and MPS. Subjects randomized to lotrafilcon B were further randomized to one of two EOBO-containing lens care solutions, OPTI-FREE PUREMOIST or CLEAR CARE PLUS with HydraGlyde (Alcon Laboratories, Inc., Fort Worth, TX). A subset of right eye lenses was collected after wear, and total cholesterol was extracted and measured using a fluorometric enzymatic assay.

RESULTS

Of 143 lenses analyzed, 95 were from subjects randomized to their habitual lenses/MPS and 48 to lotrafilcon B + EOBO lenses plus CLEAR CARE PLUS with HydraGlyde or OPTI-FREE PUREMOIST. The mean amounts of cholesterol extracted from lotrafilcon B + EOBO lenses cared for with CLEAR CARE PLUS with HydraGlyde (0.28 ± 0.18 μg/lens) and OPTI-FREE PUREMOIST (0.28 ± 0.48 μg/lens) were significantly lower than those extracted from senofilcon C (4.18 ± 3.25 μg/lens), senofilcon A (2.19 ± 2.69 μg/lens), comfilcon A (2.17 ± 1.47 μg/lens), and samfilcon A (2.07 ± 1.48 μg/lens) lenses used with MPS (P< .0001 each).

CONCLUSIONS

Cholesterol sorption was significantly lower in wearers of lotrafilcon B lenses cared for with polyoxyethylene-polyoxybutylene–containing lens care solutions than in users of habitual silicone hydrogel lenses cared for with non–polyoxyethylene-polyoxybutylene MPS.
Fatal Fluorosilicic Acid Exposure After a Motor Vehicle Crash
Authors: Yorke Jake A. , McNaughton-Filion Louise , Herath Jayantha C.
Published: August 2020

Fluorosilicic acid (FSA) is a corrosive liquid used in manufacturing and other processes. High-level exposures to FSA cause fluoride toxicity resulting in profound hypocalcemia, potentially leading to sudden death. Prompt recognition of exposure risk allows appropriate environmental management precautions, reducing the risk of further casualties. Herein, we present a case report of death due to FSA exposure sustained during a motor vehicle crash involving a truck transporting the material and the management thereof.
CTNNB1 Mutations and Aberrant β-Catenin Expression in Ovarian Endometrioid Carcinoma
Authors: Zyla Roman E. , Olkhov-Mitsel Ekaterina , Amemiya Yutaka , Bassiouny Dina , Seth Arun , Djordjevic Bojana , Nofech-Mozes Sharon , Parra-Herran Carlos
Published: August 2020

CTNNB1 mutations and aberrant β-catenin expression have adverse prognosis in endometrial endometrioid carcinoma, and recent evidence suggests a prognostic role of β-catenin in ovarian endometrioid carcinoma. Thus, we aimed to determine the prognostic value of the CTNNB1 mutational status, and its correlation with β-catenin expression, in a well-annotated cohort of 51 ovarian endometrioid carcinomas. We performed immunohistochemistry for β-catenin and developed an 11-gene next-generation sequencing panel that included whole exome sequencing of CTNNB1 and TP53. Results were correlated with clinicopathologic variables including disease-free and disease-specific survival. Tumor recurrence was documented in 14 patients (27%), and cancer-related death in 8 patients (16%). CTNNB1 mutations were found in 22 cases (43%), and nuclear β-catenin in 26 cases (51%). CTNNB1 mutation highly correlated with nuclear β-catenin (P<0.05). Mutated CTNNB1 status was statistically associated with better disease-free survival (P=0.04, log-rank test) and approached significance for better disease-specific survival (P=0.07). It also correlated with earlier International Federation of Gynecology and Obstetrics stage (P<0.05). Nuclear β-catenin, TP53 mutations, age, ProMisE group, surface involvement, tumor grade and stage also correlated with disease-free survival. There was no association between membranous β-catenin expression and disease-free or disease-specific survival. CTNNB1 mutations and nuclear β-catenin expression are associated with better progression-free survival in patients with OEC. This relationship may be in part due to a trend of CTNNB1-mutated tumors to present at early stage. β-catenin immunohistochemistry may serve as a prognostic biomarker and a surrogate for CTNN1B mutations in the evaluation of patients with ovarian endometrioid neoplasia, particularly those in reproductive-age or found incidentally without upfront staging surgery.
Molecular Characterization of Neuroendocrine Carcinomas of the Endometrium
Authors: Howitt Brooke E. , Dong Fei , Vivero Marina , Shah Varsha , Lindeman Neal , Schoolmeester J. Kenneth , Baltay Michele , MacConaill Laura , Sholl Lynette M. , Nucci Marisa R. , McCluggage W. Glenn
Published: August 2020

High-grade neuroendocrine carcinomas (NEC) of the endometrium are rare and account for <1% of all endometrial carcinomas. Both small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC) morphologies have been reported. Little is known regarding the molecular features of endometrial NEC including how they compare to pulmonary NEC (the most common site for these neoplasms) and the more common endometrial carcinoma histotypes. In this study, we investigated the molecular alterations in a series of endometrial NEC using a targeted next generation sequencing panel (Oncopanel). Fourteen NEC were sequenced; pure NEC (n=4) and mixed (n=10) with endometrioid adenocarcinoma (n=9) or carcinosarcoma (n=1). The NEC components of mixed tumors comprised LCNEC (n=6) and SCNEC (n=4). The 4 pure NEC comprised LCNEC (n=2) and SCNEC (n=2). Molecular analysis classified tumors into the 4 The Cancer Genome Atlas groups: (1) POLE-mutated/ultramutated (1/14; 7%), (2) microsatellite instability/hypermutated (6/14; 43%), (3) TP53 mutated/copy number high (2/14; 14%), or (4) no specific molecular profile (5/14; 36%). Overall, 50% of cases were ultramutated or hypermutated. In 8 cases of mixed carcinomas, the different histologic components were macrodissected and separately sequenced; molecular alterations were nearly identical among the 2 components, with the non-NEC component harboring slightly increased tumor mutational burden. Only 2 carcinomas (both with pure SCNEC morphology) had a molecular profile that would be expected in typical pulmonary SCNEC (RB1 deletion and TP53 mutations). Our findings, similar to data from NECs of other anatomic sites, suggest that the molecular context may be important when selecting therapies for women with endometrial NEC. Immune checkpoint inhibition may be a reasonable approach to treatment of microsatellite instability-NEC and we thus recommend that all endometrial NEC be tested for mismatch repair abnormalities, either molecularly or by mismatch repair protein immunohistochemistry.
Use of a Servo-Controlled Cooling Gel Pad System to Regulate Body Temperature in Critically Ill Children
Authors: Pérez Gema , Manrique Gema , García Julia , de la Mata Sara , Sanz Débora , López-Herce Jesús
Published: August 2020

Objectives:

To assess the efficacy and safety of a servo-controlled cooling pad system for target temperature management in critically ill pediatric patients.

Design:

A prospective, single-center, observational study.

Setting:

PICU of a tertiary hospital from September 2018 to September 2019.

Patients:

Children from 28 days to 16 years old subjected to servo-controlled body temperature control.

Methods:

The Arctic Sun 5000 system (Bard Medical, Covington, GA) and Arctic Gel Hydrogel pads were used for the purposes of the study. Data collected included demographics, indication of therapy, patient’s body temperature, target temperature, time-to-target temperature, duration of therapy, and need to start or increase sedation and/or muscle relaxants.

Measurements and Main Results:

A total of 16 patients were included, of whom 68.8% were male; mean age was 4.7 years. The most frequent indication was fever associated with hemodynamic instability (62.5%). The target temperature was normothermia (36 or 36.5°C) in 81% of cases. Mean baseline body temperature was 37.6°C (± 1.2°C), and 50% of patients had fever (> 38°C). The mean speed of cooling was 1.2°C/hr (± 1°C/hr). Mean time to target temperature was 118 minutes (± 98.8 min). Mean duration of therapy was 68.7 hours (± 58.3 hr). Two patients had fever related to device disconnection during the treatment. At the start of the therapy, 15 patients were receiving sedative and analgesic drugs, and four received muscle relaxants. A patient required increased sedation, whereas another patient needed to start muscle relaxants. One of the patients developed a skin lesion in the axilla, no other adverse events were registered.

Conclusions:

Despite the small sample size, the results of the study showed that target temperature management by the servo-controlled gel pad system in critically ill pediatric patients was effective in achieving satisfactory temperature control and it was well-tolerated.
School Performance After Pediatric Intensive Care—Association of Mental Well-Being, Chronic Illnesses, and Family Socioeconomic Status
Authors: Kyösti Elina , Peltoniemi Outi , Liisanantti Janne H. , Ohtonen Pasi , Ebeling Hanna , Spalding Michael , Rautiainen Paula , Kataja Janne , Ala-Kokko Tero I.
Published: August 2020

Objectives:

To describe school performance in pediatric intensive care survivors, as well as the influence of chronic diseases, psychological well-being, and family socioeconomic status on poor school performance.

Design:

Register-based observational descriptive follow-up study.

Setting:

A multicenter national study.

Patients:

All pediatric patients who were admitted to an ICU in Finland in 2009–2010. Children and adolescents of or beyond school age.

Interventions:

None.

Measurements and Main Results:

Questionnaires regarding the child’s coping in school classes, chronic illnesses, as well as family socioeconomic factors were sent to every child alive 6 years after discharge from intensive care in Finland. Mental well-being was measured with the Strengths and Difficulties Questionnaire. There were 1,109 responders in an ICU group of 3,674 children. Seven-hundred fifty-three of the respondents were of school age or older. Of these, 13% (101/753) demonstrated poor school performance. Children with difficulties in school more often had a need for regular medication (71.3% vs 32.4%; p < 0.001), healthcare visits (91.1% vs 80.6%; p = 0.01), some regular therapy (60.4% vs 13.7%; p < 0.001), chronic illnesses (86.3% vs 48.4%; p < 0.001), or additional ICU admissions (36.5% vs 14.9%; p = 0.003). Schooling difficulties were reported more often in children with abnormal Strengths and Difficulties Questionnaire scores compared to those with normal or borderline scores (24.8% vs 5.4%; p < 0.001). In an adjusted logistic regression model, which included age, number of chronic diseases, and need for therapy, poor school performance was predicted by abnormal Strengths and Difficulties Questionnaire scores, nonacademic parental education, and paternal manual labor status.

Conclusions:

Difficulties in school were more frequent when the child had chronic comorbid illnesses, especially neurologic or chromosomal abnormalities, had poor mental health, father was employed in manual labor, or parents were uneducated.
Voluntary Separations and Workforce Planning: How Intent to Leave Public Health Agencies Manifests in Actual Departure in the United States
Authors: Leider Jonathon P. , Sellers Katie , Bogaert Kyle , Liss-Levinson Rivka , Castrucci Brian C.
Published: August 2020

Objectives:

To ascertain levels of turnover in public health staff between 2014 and 2017 due to retirement or quitting and to project levels of turnover for the whole of the state and local governmental public health in the United States nationally.

Design:

Turnover outcomes were analyzed for 15 128 staff from public health agencies between 2014 and 2017. Determinants of turnover were assessed using a logit model, associated with actually leaving one's organization. A microsimulation model was used to project expected turnover onto the broader workforce.

Results:

Between 2014 and 2017, 33% of staff left their agency. Half of the staff who indicated they were considering leaving in 2014 had done so by 2017, as did a quarter of the staff who had said they were not considering leaving. Staff younger than 30 years constituted 6% of the workforce but 13% of those who left (P < .001).

Conclusions:

Public health agencies are expected to experience turnover in 60 000 of 200 000 staff positions between 2017 and 2020.

Implications:

As much as one-third of the US public health workforce is expected to leave in the coming years. Retention efforts, especially around younger staff, must be a priority. Succession planning for those retiring is also a significant concern.
Effects of Prism Adaptation on Unilateral Neglect After Stroke
Authors: Qiu Huaide , Wang Jiayue , Yi Wenchao , Yin Zhifei , Wang Hongxing , Li Jianan
Published: August 2020

Objective

The aim of this study was to investigate the effects of prism adaptation (PA) on unilateral neglect after stroke.

Methods

Randomized clinical trials, published up to January 31, 2020, comparing PA with neutral goggles or no goggles were systematically searched and included. Two independent reviewers performed data extraction and assessed the quality of studies using the Physiotherapy Evidence Database scale.

Results

A total of seven randomized trials, involving 211 participants, satisfied the inclusion criteria. There was no significant immediate benefit of PA as measured by Behavioral Inattention Test (BIT) (weighted mean difference [WMD], 5.10; [95% confidence interval (CI), −6.68 to 16.88]), behavioral subset (BIT-B; WMD, 3.40 [95% CI, −3.97 to 10.76), conventional subset (BIT-C; WMD, 9.98 [95% CI, −0.42 to 20.38]), and Catherine Bergego Scale (WMD, −0.52 [95% CI, −1.98 to 0.93]). No statistical difference was observed between PA and control on the long-term effect (BIT: WMD, 1.92 [95% CI, −9.34 to 13.18]; BIT-B: WMD, −3.28 [95% CI, −11.89 to 5.34]; BIT-C: WMD, 2.66 [95% CI, −10.35 to 11.67]; Catherine Bergego Scale: WMD, −1.22 [95% CI, −3.05 to 0.62]).

Conclusions

PA did not show a greater improvement on neglect symptoms in post-stroke patients with unilateral neglect, compared with placebo or no treatment. These findings do not support the routine use of PA in patients with unilateral neglect after stroke.
The Essentials of Brain Anatomy for Physiatrists
Authors: Choo Yoo Jin , Boudier-Revéret Mathieu , Chang Min Cheol
Published: August 2020

Detailed knowledge of the brain anatomy is important for the treatment of patients with brain disorders. In this study, we conducted a review of essential parts of human brain anatomy based on magnetic resonance imaging of the brain. Using T2-weighted brain magnetic resonance imaging, we explained how to recognize several structures in each brain lobe (the frontal, parietal, temporal, and occipital lobes). We depicted the boundary of each structure on brain magnetic resonance imaging and described their functions. The limbic system controls various functions such as emotion, motivation, behavior, memory, and olfaction. Broca’s and Wernicke’s areas and arcuate fasciculus are important structures for human language functions. Emotion, memory, and language function are one of the main functions of human. Therefore, the anatomical knowledge of the limbic system and language-related structures is important for physiatrists. We described the anatomical location and function of each substructure of the limbic system and language centers. In addition, we indicated the exact points of motor- and sensory-related neural tracts (corticospinal tract, corticoreticular pathway, medial lemniscus, and spinothalamic tract) on brain magnetic resonance imaging. We believe that our review on brain anatomy would be helpful for physiatrists to accurately identify the damage of each function from brain disorders and elucidate proper plan for rehabilitative treatment.