bluuebunny/crossref_metadata_2025 huggingface dataset:
Sarcopenia and obesity in long-term survivors of childhood leukemia/lymphoma: a report from a single institution
Authors: Nakayama Hideki , Noguchi Maiko , Fukano Reiji , Ueda Tamaki , Taguchi Shizu , Yoshimaru Kenichi , Namie Michiko , Shimokawa Mototsugu , Okamura Jun
Published: March 2021

Background

The incidence and background factors of sarcopenia and obesity in long-term survivors of childhood leukemia/lymphoma were not clear in Japan.

Methods

Between August 2018 and September 2019, we recruited adults aged ≥18 years who had childhood leukemia/lymphoma. Blood sampling, body composition measurement by bioelectrical impedance analysis and grip strength test were performed.

Results

Among 81 adult survivors (34 men and 47 women) with a median age of 25.0 years, 9 (11%) had sarcopenia and 10 (12%) had obesity, of whom, 3 had metabolic syndrome. Sarcopenia was observed in 7 (21%) of 33 survivors with hematopoietic stem cell transplantation (HSCT) and 2 (4%) of 48 survivors without hematopoietic stem cell transplantation (P = 0.012). The incidence of obesity was significantly higher in the cranial radiotherapy (P = 0.021) and non-transplanted cases (P = 0.042). Univariate logistic regression analysis revealed that hematopoietic stem cell transplantation for sarcopenia (odds ratio, 6.19; 95% confidence interval, 1.2–32.0; P = 0.03) and cranial radiotherapy for obesity (odds ratio, 5.6; 95% confidence interval, 1.4–22.4; P = 0.015) were significantly associated. Hypertension was more prevalent among the obese survivors, and higher transaminase levels were found more in both the sarcopenia and obese survivors than in others.

Conclusions

Young adult survivors of childhood leukemia/lymphoma could be at risk of developing sarcopenia after hematopoietic stem cell transplantation and obesity after cranial radiotherapy. Further studies are required to assess the body composition of long-term survivors to find detailed risk factors of sarcopenia and metabolic syndrome.
The HelQ human DNA repair helicase utilizes a PWI-like domain for DNA loading through interaction with RPA, triggering DNA unwinding by the HelQ helicase core
Authors: Jenkins Tabitha , Northall Sarah J , Ptchelkine Denis , Lever Rebecca , Cubbon Andrew , Betts Hannah , Taresco Vincenzo , Cooper Christopher D O , McHugh Peter J , Soultanas Panos , Bolt Edward L
Published: March 2021

Genome instability is a characteristic enabling factor for carcinogenesis. HelQ helicase is a component of human DNA maintenance systems that prevent or reverse genome instability arising during DNA replication. Here, we provide details of the molecular mechanisms that underpin HelQ function—its recruitment onto ssDNA through interaction with replication protein A (RPA), and subsequent translocation of HelQ along ssDNA. We describe for the first time a functional role for the non-catalytic N-terminal region of HelQ, by identifying and characterizing its PWI-like domain. We present evidence that this domain of HelQ mediates interaction with RPA that orchestrates loading of the helicase domains onto ssDNA. Once HelQ is loaded onto the ssDNA, ATP-Mg2+ binding in the catalytic site activates the helicase core and triggers translocation along ssDNA as a dimer. Furthermore, we identify HelQ-ssDNA interactions that are critical for the translocation mechanism. Our data are novel and detailed insights into the mechanisms of HelQ function relevant for understanding how human cells avoid genome instability provoking cancers, and also how cells can gain resistance to treatments that rely on DNA crosslinking agents.
Defining and timing of palliative opportunities in children with central nervous system tumors
Authors: Massie A McCauley , Ebelhar Jonathan , Allen Kristen E , DeGroote Nicholas P , Wasilewski-Masker Karen , Brock Katharine E
Published: March 2021

Background

Children with brain and central nervous system (CNS) tumors experience substantial challenges to their quality of life during their disease course. These challenges are opportunities for increased subspecialty palliative care (PC) involvement. Palliative opportunities have been defined in the pediatric oncology population, but the frequency, timing, and factors associated with palliative opportunities in pediatric patients with CNS tumors are unknown.

Methods

A single-institution retrospective review was performed on children ages 0-18 diagnosed with a CNS tumor who died between January 1, 2012 and November 30, 2017. Nine palliative opportunities were defined prior to data collection (progression, relapse, admission for severe symptoms, intensive care admission, bone marrow transplant, phase 1 trial, hospice, do-not-resuscitate (DNR) order). Demographic, disease, treatment, palliative opportunity, and end-of-life data were collected. Opportunities were evaluated over quartiles from diagnosis to death.

Results

Amongst 101 patients with a median age at death of eight years (interquartile range [IQR] = 8.0, range 0-22), there was a median of seven (IQR = 6) palliative opportunities per patient, which increased closer to death. PC consultation occurred in 34 (33.7%) patients, at a median of 2.2 months before death, and was associated with having a DNR order (P = .0028). Hospice was involved for 72 (71.3%) patients.

Conclusion

Children with CNS tumors suffered repeated events warranting PC yet received PC support only one-third of the time. Mapping palliative opportunities over the cancer course promotes earlier timing of PC consultation which can decrease suffering and resuscitation attempts at the end-of-life.
Depressive Symptoms and Cigarette Smoking in Adolescents and Young Adults: Mediating Role of Friends Smoking
Authors: Mendo Christian W , Maurel Marine , Doré Isabelle , O’Loughlin Jennifer , Sylvestre Marie-Pierre
Published: March 2021

Introduction

We examined the mediating role of friends smoking in the association between depressive symptoms and daily/weekly cigarette smoking from adolescence into adulthood.

Methods

Data were drawn from the Nicotine Dependence In Teens study (NDIT, Canada) and the Avon Longitudinal Study of Parents and Children (ALSPAC, UK) studies. Three age groups were investigated in NDIT: age 13–14 (n = 1189), 15–16 (n = 1107), and 17–18 (n = 1075), and one in ALSPAC (n = 4482, age 18–21). Multivariable mediation models decomposed the total effect (TE) of depressive symptoms on smoking into a natural direct effect (NDE) and natural indirect effect (NIE) through friends smoking.

Results

The odds ratios (ORs) for the TE were relatively constant over time with estimates ranging from 1.12 to 1.35. Friends smoking mediated the association between depressive symptoms and smoking in the two youngest samples (OR [95% confidence interval [CI] 1.09 [1.01,1.17] in 13- to 14-year-olds; 1.10 [1.03,1.18] in 15- to 16-year-olds). In the two older samples, NDE of depressive symptoms was close to the TE, suggestive that mediation was absent or too small to detect.

Conclusion

Friends smoking mediates the association between depressive symptoms and daily/weekly cigarette smoking in young adolescents.

Implications

If young adolescents use cigarettes to self-medicate depressive symptoms, then interventions targeting smoking that ignore depressive symptoms may be ineffective. Our results also underscore the importance of the influence of friends in younger adolescents, suggestive that preventive intervention should target the social environment, including social relationships.
Unraveling a Nosocomial Outbreak of COVID-19: The Role of Whole-Genome Sequence Analysis
Authors: Meijer Suzy E , Harel Noam , Ben-Ami Ronen , Nahari Meital , Yakubovsky Michal , Oster Howard S , Kolomansky Albert , Halutz Ora , Laskar Orly , Henig Oryan , Stern Adi , Paran Yael
Published: March 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic poses many epidemiological challenges. The investigation of nosocomial transmission is usually performed via thorough investigation of an index case and subsequent contact tracing. Notably, this approach has a subjective component, and there is accumulating evidence that whole-genome sequencing of the virus may provide more objective insight.

Methods

We report a large nosocomial outbreak in 1 of the medicine departments in our institution. Following intensive epidemiological investigation, we discovered that 1 of the patients involved was suffering from persistent COVID-19 while initially thought to be a recovering patient. She was therefore deemed to be the most likely source of the outbreak. We then performed whole-genome sequencing of the virus of 14 infected individuals involved in the outbreak.

Results

Surprisingly, the results of whole-genome sequencing refuted our initial hypothesis. A phylogenetic tree of the samples showed multiple introductions of the virus into the ward, 1 of which led to a cluster of 10 of the infected individuals. Importantly, the results pointed in the direction of a specific index patient that was different from the 1 that arose from our initial investigation.

Conclusions

These results underscore the important added value of using whole-genome sequencing in epidemiological investigations as it may reveal unexpected connections between cases and aid in understanding transmission dynamics, especially in the setting of a pandemic where multiple possible index cases exist simultaneously.
Is positron emission tomography/magnetic resonance imaging a reliable tool for detecting vascular activity in treated childhood-onset Takayasu’s arteritis? A multicentre study
Authors: Clemente Gleice , Pereira Rosa M R , Aikawa Nadia , Silva Clovis A , Campos Lucia M A , Alves Gabriel , Buchpiguel Carlos , Lima Marcos , Carneiro Camila , Filho Hilton L , Morbeck Fernando , Neto Guilherme , Filho Vicente O , Souza Alexandre W D , Terreri Maria Teresa
Published: March 2021

Objectives

Toassess whether 18F-fluordeoxiglucose (18F-FDG) PET/MRI) with angiographic sequences can contribute to detecting vessel wall inflammation in patients with childhood-onset Takayasu’s arteritis (c-TA) under immunosuppressive therapy.

Methods

A three-centre cross-sectional study was conducted. 18F-FDG PET/MRI scans were performed in c-TA patients and in oncologic patients, who served as the control group. Clinical and laboratory characteristics were also analysed.

Results

Seventeen c-TA patients (65% females) between the ages of 6 and 21 years with a mean disease duration of 9.4 years were recruited. Only one patient presented clinical disease activity and six (35.6%) had increased ESR and/or CRP levels. The most frequent magnetic resonance angiography (MRA) findings were stenosis and thickening, observed in 82.4 and 70.6% of c-TA patients, respectively. 18F-FDG PET revealed 18F-FDG uptake greater than the liver in at least one arterial segment in 15 (88.2%) patients in a qualitative analysis and a median maximum standardized uptake value (SUVmax) of 3.22 (interquartile range 2.76–3.69) in a semi-quantitative analysis. c-TA patients presented significantly higher SUVmax values than oncologic patients (P < 0.001). A positive correlation between SUVmax and CRP levels (ρ = 0.528, P = 0.029) was seen.

Conclusion

A state-of-the-art imaging modality was used in c-TA patients and revealed a strong arterial FDG uptake even in patients in apparent remission. We suppose that this finding may represent silent activity in the vessel wall; however, we cannot exclude the possibility of arterial remodelling. Importantly, a negative imaging scan may help in immunosuppression withdrawal in daily clinical practice.
Investigating the link between subjective sleep quality, symptoms of PTSD, and level of functioning in a sample of trauma-affected refugees
Authors: Sandahl Hinuga , Carlsson Jessica , Sonne Charlotte , Mortensen Erik Lykke , Jennum Poul , Baandrup Lone
Published: March 2021

Study Objectives

To examine whether baseline sleep quality is associated with baseline symptoms of posttraumatic stress disorder (PTSD) and level of functioning and whether baseline sleep quality and improvement of sleep quality are specific predictors of change in PTSD symptoms and level of functioning.

Methods

Data were derived from a four-armed randomized controlled superiority trial (N = 219 trauma-affected refugees). All four groups received treatment as usual consisting of a 10–12 months bio-psycho-social treatment program with an additional differential treatment component added to each arm. We performed bivariate correlation analyses, multiple linear regression analyses, and mediation analyses to examine associations between baseline sleep quality, change in sleep quality, and treatment response for PTSD symptoms and level of functioning.

Results

Baseline sleep quality correlated with symptoms of PTSD (r = 0.33) and level of functioning (r = 0.15). Baseline sleep quality, improvement of sleep quality, and improvement of general well-being were predictors of treatment response for symptoms of PTSD and level of functioning when controlling for age, gender, and baseline symptoms of PTSD and depression.

Conclusions

We found that good sleep quality at baseline and improvement of sleep quality were predictors of PTSD treatment response. However, treatment response was more closely associated with improvement in general well-being. The results indicate that the effect of improved sleep quality was partly mediated by a more general mental state improvement. Further research is needed to differentiate if a selected subgroup of patients may profit from sleep-enhancing treatment.

ClinicalTrials.gov registration

NCT02761161.
Facebook usage, participation patterns, and social support from Facebook activity among smokers with mobility impairments
Authors: Borrelli Belinda , Endrighi Romano , Quintiliani Lisa M , Hughes Rosemary B , Pagoto Sherry
Published: March 2021

People with mobility impairments (MIs; use assistive devices to ambulate) have twice the smoking prevalence versus the general population. A Facebook intervention could improve reach to smokers with MIs, but use and patterns of use are unknown. The study examined: (a) Facebook use and relationship with Facebook-based social support and (b) whether Facebook use differs by motivation to quit smoking. Participants (N = 510; 56.3% female, mean age = 42.4 years) were recruited via a recruitment company to complete a one-time online survey assessing motivation to quit within 30 days, Facebook use (Facebook Activities Scale), reasons for use (Facebook Motives Scale), attitudes (Facebook Intensity Scale), and social support (Facebook Measure of Social Support). The vast majority said that Facebook is part of their daily routine (92.9%), 83% checked Facebook >once a day, and 69% spent >30 min/day on Facebook. Facebook was used to connect with similar others (68.4%), participate in groups (72.9%), decrease loneliness (69.2%), and obtain health information (62.5%); 88% said that they would join a Facebook program to help them quit smoking. A greater number of Facebook friends (rs = .18–.22, p < .001) and greater Facebook use (rs = .20 to rs = .59; p < .001) were correlated with greater perceived social and emotional support. Those motivated to quit posted more frequently (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.10, 2.22) and were more likely to indicate that they would join a Facebook group for smoking cessation (OR = 4.15, 95% CI = 2.05, 8.38) than those not motivated. Facebook could circumvent disability and environmental barriers to accessing cessation among this health disparity population.
Downregulated ribosomal protein L39 inhibits trophoblast cell migration and invasion by targeting E‐cadherin in the placenta of patients with preeclampsia
Authors: Jie Qiuling , Sun Fei , Li Qi , Zhu Juan , Wei Yunjian , Yang Huamei , Long Ping , Wang Zhen , Yang Xiaohui , Li Dan , Huang Liping , Ma Yanlin
Published: March 2021

Early‐onset preeclampsia (PE) is a pregnancy complication that can lead to severe adverse maternal and fetal outcomes. However, the mechanisms underlying the development of early‐onset PE are not fully understood. Ribosomal protein L39 (RPL39) is a member of the S39E family of ribosomal proteins that plays an important role in stem cell self‐renewal, cancer metastasis, and chemoresistance. In this study, we aimed to explore the potential function of RPL39 in placental trophoblast cells. We analyzed the expression of RPL39 in early‐onset PE and normal placental tissues using real‐time PCR, western blot analysis, and immunohistochemistry. The results showed that RPL39 was markedly downregulated in early‐onset PE placental tissues. RPL39 knockdown inhibited trophoblast cell proliferation, migration, and invasion, as well as placental explant outgrowth. Flow cytometry analysis suggested that knockdown of RPL39 resulted in cell cycle arrest at the G0/G1 phase, but had no significant effect on cell apoptosis. We also found that RPL39 knockdown could alter cell morphology. We then measured the expression of the epithelial cell marker E‐cadherin following knockdown of RPL39 in Bewo and HTR8/SVneo cells. RPL39 knockdown increased the expression of E‐cadherin. Furthermore, E‐cadherin expression was upregulated in placental explant outgrowth tissues transfected with RPL39 small interfering RNA. In conclusion, RPL39 plays an essential role in proliferation, invasion, and migration of trophoblast cells by targeting E‐cadherin. Our findings provide novel insight into the mechanisms underlying the occurrence of early‐onset PE.
AMPK is indispensable for overload‐induced muscle glucose uptake and glycogenesis but dispensable for inducing hypertrophy in mice
Authors: Kido Kohei , Egawa Tatsuro , Fujiyoshi Haruna , Suzuki Hikari , Kawanaka Kentaro , Hayashi Tatsuya
Published: March 2021

Chronic muscle loading (overload) induces skeletal muscles to undergo hypertrophy and to increase glucose uptake. Although AMP‐activated protein kinase (AMPK) reportedly serves as a negative regulator of hypertrophy and a positive regulator of glucose uptake, its role in overload‐induced skeletal muscle hypertrophy and glucose uptake is unclear. This study aimed to determine whether AMPK regulates overload‐induced hypertrophy and glucose uptake in skeletal muscles. To this end, skeletal muscle overload was induced through unilateral synergist ablations in wild‐type (WT) and transgenic mice, expressing the dominant‐negative mutation of AMPK (AMPK‐DN). After 14 days, parameters, including muscle fiber cross‐sectional area (CSA), glycogen level, and in vivo [3H]‐2‐deoxy‐D‐glucose uptake, were assessed. No significant difference was observed in body weight or blood glucose level between the WT and AMPK‐DN mice. However, the 14‐day muscle overload activated the AMPK pathway in WT mice skeletal muscle, whereas this response was impaired in the AMPK‐DN mice. Despite a normal CSA gain in each fiber type, the AMPK‐DN mice demonstrated a significant impairment of overload‐induced muscle glucose uptake and glycogenesis, compared to WT mice. Moreover, 14‐day overload‐induced changes in GLUT4 and HKII expression levels were reduced in AMPK‐DN mice, compared to WT mice. This study demonstrated that AMPK activation is indispensable for overload‐induced muscle glucose uptake and glycogenesis; however, it is dispensable for the induction of hypertrophy in AMPK‐DN mice. Furthermore, the AMPK/GLUT4 and HKII axes may regulate overload‐induced muscle glucose uptake and glycogenesis.
The Ponseti Method for the Treatment of Clubfeet Associated With Amniotic Band Syndrome: A Single Institution 20-Year Experience
Authors: Esparza Melissa , Tran Elaine , Richards Benjamin Stephens , Jo Chan-hee , Shivers Claire , Karacz Chelsea , Polk Jordan , Riccio Anthony I.
Published: March 2021

Background:

Amniotic band syndrome (ABS) is a congenital disorder resulting in fibrous bands that can cause limb anomalies, amputations, and deformities. Clubfoot has been reported in up to 50% of patients with ABS. The purpose of this study is to compare treatment characteristics and outcomes of clubfoot patients with ABS to those with idiopathic clubfoot treated with the Ponseti method.

Methods:

An Institution Review Board (IRB) approved retrospective review of prospectively gathered data was performed at a single pediatric hospital over a 20-year period. Patients with either idiopathic clubfeet or clubfeet associated with concomitant ABS who were <1 year of age and treated by the Ponseti method were included. Initial Dimeglio score, number of casts, need for heel cord tenotomy, recurrence, and need for further surgery were recorded. Outcomes were classified as “good” (plantigrade foot±heel cord tenotomy), “fair” (need for a limited procedure), or “poor” (need for a full posteromedial release).

Results:

Forty-three clubfeet in 32 patients with ABS, and 320 idiopathic clubfeet in 215 patients were identified. Average age at last follow up was not different between ABS and idiopathic cohorts (7.4 vs. 5.2 y, P=0.233). Average Dimeglio score was lower in the ABS cohort (12.3 vs. 13.7, P=0.006). Recurrence rate was significantly higher in the ABS (62.8%) compared with idiopathic cohort (37.2%) (P=0.001). Clinical outcomes were significantly better in the idiopathic cohort (69.4% “good”, 26.9% “fair”, 3.8% “poor”) compared with the ABS cohort (41.9% “good”, 34.9% “fair”, and 23.3% “poor”) (P<0.001). Within the ABS cohort, no significant differences in clinical outcomes were found based upon location, severity, or presence of an ipsilateral lower extremity band.

Conclusion:

Clubfeet associated with ABS have higher rates of recurrence, a greater need for later surgery, and worse clinical outcomes than idiopathic clubfeet. This information may prove helpful in counseling parents of infants with ABS associated clubfeet.

Level of Evidence:

Level III.
Later in Career Surgeon Performance Assessment: Why, When, What, and by Whom
Authors: Waters Peter M. , Williams David
Published: March 2021

Background:

The average age of practicing surgeons is increasing, consistent with the overall population; one third of Americans are over 55 years of age. Aging is clearly associated with varying loss of skills, yet there are no age-based state or federal requirements for professional skill assessment; or age-specific criteria for board certification, recertification, or retirement. Capability based policies are preferred to age based criteria (3) but very few organizations have such policies in place.

Methods:

A Delphi method study was utilized to answer: When should a surgeon’s performance be assessed? If mandatory, then at what age? If adverse events triggered, then what events? What should be assessed? By whom? And, who determines the result-based actions? A systematic literature review indicated institutional stakeholders. On the basis of this a 20-member expert panel was created drawing from 13 US pediatric institutions: orthopaedic surgical department—division chiefs (14), children’s hospital general counsel (3), surgical chief responsible for hospital bylaws-medical peer review (1), OR nursing managers (2). Three rounds of iterative questionnaires were utilized.

Results:

A 100% response rate was achieved. Consensus supported recommendations included: Mandatory assessments should start at the age of 65 years, after a medical disability, and or at the request of other health care professionals. Assessments should include criteria for behavioral health, mental capacity, physical health, surgical performance, 360 human resource reviews, and surgical adverse events. Assessments should be performed by an external group with validated tools and reviewed by the department and overall surgeon-in-chief. The final decisions for an action plan based on results should be made by departmental and overall surgeon-in-chief.

Conclusions:

Our expert panel Delphi method study recognized aging is a risk factor in performance and recommended surgeon assessments should be automatically triggered by the age of 65 years, negative health events, or serious performance concerns. Assessments should be multifaceted, fair, reliable with minimal bias, and performed by an external professional group. Decisions should be managed by departmental and surgical chiefs.

Level of Evidence:

Level V.
Venous Thromboembolism After Pelvic Osteotomy in Adolescent Patients: A Database Study Characterizing Rates and Current Practices
Authors: Allahabadi Sachin , Faust Millis , Swarup Ishaan
Published: March 2021

Background:

Current risks and practices in medical prophylaxis of venous thromboembolism (VTE) after major elective lower extremity surgeries such as pelvic osteotomies have not been well-defined in the pediatric population. The purpose of this study was to (1) evaluate population rates of VTE in adolescents undergoing pelvic osteotomies, and (2) characterize current practices on types of VTE prophylaxis being utilized after pelvic osteotomies.

Methods:

The study evaluated the Pediatric Health Information System database between October 1, 2015 and January 1, 2020 for patients between 10 and 18 years of age meeting selected ICD-10 procedure and diagnosis codes relating to pelvic osteotomies. The rate of VTE was calculated within 90 days of index procedure. Types of pharmacologic prophylaxis were characterized. Continuous variables were compared with 2-samplettests; proportions and categorical variables were compared with Fisher exact or χ2tests, all with 2-tailed significance <0.05.

Results:

Of 1480 included patients, 9 were diagnosed with VTE within 90 days of surgery (VTE rate: 0.61%). Four of 9 (44.4%) had received pharmacologic prophylaxis postoperatively. There were no differences in baseline demographics or length of stay between patients that did or did not develop VTE (P>0.05). Overall, 52.0% received at least one form of pharmacologic prophylaxis postoperatively. The most common pharmacologic prophylaxis used was aspirin (47.6%), of which 64.4% received 81 mg dosing. There was no difference in VTE rates in those with or without prophylaxis (0.52% vs. 0.70%,P=0.75). However, those prescribed prophylaxis were significantly older (15.2±2.3 vs. 13.6±2.4 y,P<0.0001) and had a higher proportion of females (71.8% vs. 54.6%,P<0.01).

Conclusions:

The overall rate of VTE in pediatric patients after pelvic osteotomies is non-negligible. There is heterogeneity in the type of anticoagulant utilized; however, VTE prophylaxis is most commonly prescribed in older adolescents and female patients. Guidelines for medical prevention of deep venous thrombosis and pulmonary embolism in the pediatric population are warranted after hip preservation surgery.

Level of Evidence:

Level IV, case series.
The Long-term Fate of Asymptomatic Proximal Junctional Kyphosis Following Long Instrumented Fusion in Elderly Patients with Sagittal Imbalance
Authors: Park Se-Jun , Park Jin-Sung , Nam Yun-Jin , Choi Youn-Taek , Lee Chong-Suh
Published: March 2021

Study Design.

Retrospective study.

Objective.

The aim of this study was to investigate the long-term fate of asymptomatic PJK focusing on the elderly patients with sagittal imbalance by comparing the patients with and without PJK.

Summary of Background Data.

Most of previous studies demonstrated that PJK does not negatively affect the clinical outcome compared to that of the patients without PJK. The question “will the asymptomatic PJK remain asymptomatic even in long-term follow-up?” has not been answered yet because the previous results were based on the short follow-up duration.

Methods.

Patients >60 years who underwent four or more level fusions to the sacrum for sagittal imbalance were followed up for >5 years. The radiographic and clinical outcomes were compared between PJK (n = 30) and non-PJK groups (n = 43). PJK was defined by proximal junctional angle (PJA) >10°. Only patients with >3 years of follow-up duration after PJK development were included in PJK group. The clinical outcome measures included visual analog scale (VAS) for the back and leg, Oswestry disability index (ODI), and Scoliosis Research Society (SRS)-22 scores.

Results.

The mean age was 69.2 years. Total follow-up duration was 92.4 months. Time between PJK development and the last follow-up was 67.4 months in PJK group. Although there were no differences between the two groups in terms of pelvic incidence-lumbar lordosis mismatch, pelvic tilt, or sacral vertical axis, PJA significantly increased from 6.5° postoperatively to 21.2° at the final follow-up in the PJK group. The clinical outcomes were worse (such as VAS for the back, ODI, and SRS-22 scores) in the PJK group than in non-PJK group, except for the satisfaction domain. Three (10%) of 30 patients underwent a revision surgery for PJK progression.

Conclusion.

Even if PJK was asymptomatic at initial development, it progressed radiographically with time and eventually gave a negative impact on the clinical outcomes in long-term follow-up.

Level of Evidence: 3
Severe Acute Respiratory Syndrome–Associated Coronavirus 2 Infection and Organ Dysfunction in the ICU: Opportunities for Translational Research
Authors: Verhoef Philip A. , Kannan Sujatha , Sturgill Jamie L. , Tucker Elizabeth W. , Morris Peter E. , Miller Andrew C. , Sexton Travis R. , Koyner Jay L. , Hejal Rana , Brakenridge Scott C. , Moldawer Lyle L. , Hotchkiss Richard S. , Blood Teresa M. , Mazer Monty B. , Bolesta Scott , Alexander Sheila A. , Armaignac Donna Lee , Shein Steven L. , Jones Christopher , Hoemann Caroline D. , Doctor Allan , Friess Stuart H. , Parker Robert I. , Rotta Alexandre T. , Remy Kenneth E.
Published: March 2021

Objectives:

Since the beginning of the coronavirus disease 2019 pandemic, hundreds of thousands of patients have been treated in ICUs across the globe. The severe acute respiratory syndrome–associated coronavirus 2 virus enters cells via the angiotensin-converting enzyme 2 receptor and activates several distinct inflammatory pathways, resulting in hematologic abnormalities and dysfunction in respiratory, cardiac, gastrointestinal renal, endocrine, dermatologic, and neurologic systems. This review summarizes the current state of research in coronavirus disease 2019 pathophysiology within the context of potential organ-based disease mechanisms and opportunities for translational research.

Data Sources:

Investigators from the Research Section of the Society of Critical Care Medicine were selected based on expertise in specific organ systems and research focus. Data were obtained from searches conducted in Medline via the PubMed portal, Directory of Open Access Journals, Excerpta Medica database, Latin American and Caribbean Health Sciences Literature, and Web of Science from an initial search from December 2019 to October 15, 2020, with a revised search to February 3, 2021. The medRxiv, Research Square, and clinical trial registries preprint servers also were searched to limit publication bias.

Study Selection:

Content experts selected studies that included mechanism-based relevance to the severe acute respiratory syndrome–associated coronavirus 2 virus or coronavirus disease 2019 disease.

Data Extraction:

Not applicable.

Data Synthesis:

Not applicable.

Conclusions:

Efforts to improve the care of critically ill coronavirus disease 2019 patients should be centered on understanding how severe acute respiratory syndrome–associated coronavirus 2 infection affects organ function. This review articulates specific targets for further research.
Decision-Making Authority During Tele-ICU Care Reduces Mortality and Length of Stay—A Systematic Review and Meta-Analysis*
Authors: Kalvelage Christina , Rademacher Susanne , Dohmen Sandra , Marx Gernot , Benstoem Carina
Published: March 2021

OBJECTIVES:

Although the current coronavirus disease 2019 pandemic demonstrates the urgent need for the integration of tele-ICUs, there is still a lack of uniform regulations regarding the level of authority. We conducted a systematic review and meta-analysis to evaluate the impact of the level of authority in tele-ICU care on patient outcomes.

DATA SOURCES:

We searched MEDLINE, EMBASE, CENTRAL, and Web of Science from inception until August 30, 2020.

STUDY SELECTION:

We searched for randomized controlled trials and observational studies comparing standard care plus tele-ICU care with standard care alone in critically ill patients.

DATA EXTRACTION:

Two authors performed data extraction and risk of bias assessment. Mean differences and risk ratios were calculated using a random-effects model.

DATA SYNTHESIS:

A total of 20 studies with 477,637 patients (n
tele-ICU care = 292,319, n
control = 185,318) were included. Although “decision-making authority” as the level of authority was associated with a significant reduction in ICU mortality (pooled risk ratio, 0.82; 95% CI, 0.71–0.94; p = 0.006), we found no advantage of tele-ICU care in studies with “expert tele-consultation” as the level of authority. With regard to length of stay, “decision-making authority” resulted in an advantage of tele-ICU care (ICU length of stay: pooled mean difference, –0.78; 95% CI, –1.46 to –0.10; p = 0.14; hospital length of stay: pooled mean difference, –1.54; 95% CI, –3.13 to 0.05; p = 0.06), whereas “expert tele-consultation” resulted in an advantage of standard care (ICU length of stay: pooled mean difference, 0.31; 95% CI, 0.10–0.53; p = 0.005; hospital length of stay: pooled mean difference, 0.58; 95% CI, –0.04 to 1.21; p = 0.07).

CONCLUSIONS:

In contrast to expert tele-consultations, decision-making authority during tele-ICU care reduces mortality and length of stay in the ICU. This work confirms the urgent need for evidence-based ICU telemedicine guidelines and reveals potential benefits of uniform regulations regarding the level of authority when providing tele-ICU care.
Current status of home monitoring technology for age-related macular degeneration
Authors: Busquets Miguel A. , Sabbagh Osama
Published: March 2021

Purpose of review

Evidence suggests that patients present with exudative age-related macular degeneration (AMD) in a delayed fashion. Increased lesion size associated with this delay directly impacts visual acuity. Upon treatment initiation, patients are monitored largely with optical coherence tomography (OCT) technology to determine the need for treatment. Home-monitoring systems using preferential hyperacuity perimetry (PHP) and OCT may optimize management.

Recent findings

Comparison of Age-related Macular Degeneration Treatment Trials study and American Academy of Ophthalmology's Intelligent Research in Sight registry data suggest smaller lesion size and better visual acuity upon choroidal neovascularization (CNV) capture are associated with better final visual acuity with therapy. The HOME study and recent PHP-based ForeseeHome data indicate that this modality leads to earlier detection of CNV. Results of a real-world data analysis demonstrate 82% retention of ≥20/40 vision with median visual acuity of 20/40 at time of CNV detection using PHP home-monitoring. Home OCT data suggests excellent patient useability, with >90% of patients obtaining analyzable images. The Notal OCT Analyzer demonstrates superiority over human interpreters regarding the ability to detect intraretinal and subretinal fluid (82% vs. 47% sensitivity).

PHP may improve treatment outcomes for exudative AMD by allowing for earlier detection of lesions. Home OCT platforms could allow for more convenient monitoring of patients undergoing treatment for exudative AMD and better enable true PRN models.
Risk factors for anastomotic leakage after gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a retrospective case-control study
Authors: Li Yibo , Shi Yinan , You Jun , Hu Wenqing , Xu Yingying , Wei Haotang , Abe Masanobu , Cheng Jiajia , Zong Liang , Dong Jianhong
Published: March 2021

Objective:

To identify risk factors for anastomotic leakage after gastrectomy in patients with Siewert type II/III adenocarcinoma (AEG) of the esophagogastric junction.

Methods:

This was a retrospective case-control study of 903 patients with Siewert type II/III AEG treated from January 2012 to January 2015 at the Shanxi Cancer Hospital in China. All patients underwent gastrectomy, and their clinical characteristics were analyzed to identify associations with anastomotic leakage. Independent risk factors were identified by binary logistic regression. The 2-year disease-free survival was calculated and compared between patients with anastomotic leakage and control patients. The study was approved by the Institutional Review Board of Shanxi Medical University (approval No. 2014-09-39) on September 19, 2014.

Results:

Out of the 903 patients were included in the study, 80 (8.86%, 80/903) experienced anastomotic leakage. The mortality rate attributed to anastomotic leakage was 8.75% (7/80). Logistic regression analysis revealed that preoperative hypoalbuminemia (odds ratio (
OR
)=3.249, 95% confidence interval (
CI
): 1.569-6.725,
P
=0.002), type of reconstruction (
OR
=1.795, 95%
CI
: 1.026-3.142,
P
=0.040), and combined organ resection (
OR
=1.807, 95%
CI
: 1.069-3.055,
P
=0.027) were independent risk factors for anastomotic leakage.

Conclusion:

Preoperative hypoalbuminemia, type of reconstruction, and combined organ resection were identified as risk factors for anastomotic leakage in patients undergoing gastrectomy for Siewert type II/III AEG.
Successful Treatment of Infraorbital Trapdoor Following Transposition Flap Using Intralesional Corticosteroid: A Case Report
Authors: Djawad Khairuddin
Published: March 2021

Introduction:

The trapdoor effect can pose a significant cosmetic issue after transposition flap surgery or trauma. It is characterized with bulging of tissue around a circular or semi-circular scar commonly found after removal of cutaneous tumors.

Here, we report a female with infraorbital trapdoor successfully treated by intralesional corticosteroid.

Case presentation:

A 60-year-old female patient with trapdoor effect after surgery was successfully treated with long-term non-invasive technique of intralesional triamcinolone acetate set with a biweekly interval for twelve months.

Discussion:

There are currently no definitive methods of removing this condition. Non-surgical approach is often more preferred by patients, such as with the use of intralesional corticosteroid of triamcinolone acetate. However, information about this is still limited. In this case, the patient experienced satisfying result without observed complications related to corticosteroids injection on the infraorbital region.

Conclusion:

Intralesional corticosteroid is a safe and economical method to treat the trapdoor effect.
Perioperative Nimodipine to Improve Cranial Nerve Function: A Systematic Review and Meta-Analysis
Authors: Chorath Kevin , Go Beatrice C. , Kaufman Adam , Brant Jason , Moreira Alvaro , Rajasekaran Karthik
Published: March 2021

Objective:

Nimodipine has emerged as a promising strategy for protection of cranial nerves following vestibular schwannoma (VS) resections. Our goal was to conduct a comprehensive analysis of clinical studies to determine the therapeutic efficacy of nimodipine in improving facial nerve and cochlear nerve function.

Database reviewed:

We searched PubMed, Scopus, Cochrane Clinical Trial Registry, Clinicaltrials.gov, World Health Organization's International Clinical Trials Registry Platform, and EU Clinical Trials Registry to identify clinical studies up to May 11, 2020.

Methods:

We included studies evaluating perioperative administration of nimodipine as a strategy to prevent or treat facial nerve or cochlear nerve dysfunction following VS resections. Primary outcomes included preservation or recovery of House–Brackman scale for facial nerve function and Hearing and Equilibrium Guidelines for cochlear nerve function at the latest follow-up visit. Secondary outcomes included adverse events and administration strategies of nimodipine.

Results:

Nine studies (603 patients) met inclusion, of which seven studies (559 patients) were included in the quantitative analysis. Overall, nimodipine significantly increased the odds of cranial nerve recovery compared with controls (odds ratio [OR] 2.87, 95% confidence intervals [CI] [2.08, 3.95]; I

2
 = 0%). Subgroup analysis demonstrated that nimodipine was only effective for cochlear nerve preservation (OR 2.78, 95% CI [1.74, 4.45]; I

2
 = 0%), but not for facial nerve function (OR 4.54, 95% CI [0.25, 82.42]; I

2
 = 33%).

Conclusion:

Although there is evidence supporting the perioperative role of nimodipine for VS resections, more studies are warranted to help clarify the effects of nimodipine therapy on cranial nerve preservation.
Cochlear Duct Length Calculation: Comparison Between Using Otoplan and Curved Multiplanar Reconstruction in Nonmalformed Cochlea
Authors: Chen Ying , Chen Jianqing , Tan Haoyue , Jiang Mengda , Wu Yingwei , Zhang Zhihua , Li Yun , Jia Huan , Wu Hao
Published: March 2021

Objective:

To describe a new method to measure the cochlear parameters using Otoplan software, and to compare it with the traditional method using curved multiplanar reconstruction (cMPR).

Study Design:

Retrospective analysis using internal consistency reliability and paired sample t test.

Setting:

Tertiary referral center.

Patients:

Thirty-four patients including 68 ears from a clinical trial were retrospectively reviewed.

Main Outcome Measures:

The length, width, height (distances A, B, H), and cochlear duct length of each cochlea were measured independently using two modalities: Otoplan and cMPR. Internal consistency reliability of the two modalities was analyzed. The time spent on each measurement was also recorded.

Results:

Otoplan software was compatible with all radiological data in this series. Distances A, B, and H showed no significant differences between Otoplan (9.33 ± 0.365, 6.61 ± 0.359, and 2.91 ± 0.312 mm) and cMPR (9.32 ± 0.314, 6.59 ± 0.342, and 2.93 ± 0.250 mm). The average cochlear duct length calculated by Otoplan was 34.37 ± 1.481 mm, which was not significantly different from that calculated by cMPR (34.55 ± 1.903mm, p = 0.215). The measurements with Otoplan had better internal consistency reliability compared with those by cMPR, and measurements with a higher peak kilovoltage (140 kVp) CT scan showed further higher internal consistency reliability. Time spent on each cochlea by Otoplan was 5.9 ± 0.69 min, significantly shorter than that by cMPR (9.3 ± 0.72 min).

Conclusion:

Otoplan provides more rapid and reliable measurement of the cochlea than cMPR. Furthermore, it can be easily used in the laptop computer.
Xiaoyao-san, a traditional Chinese herbal formula, for the treatment of irritable bowel syndrome
Authors: Lee JiHo , Sung Won-Suk , Kim Eun-Jung , Kim Young Woo
Published: March 2021

Background:

Irritable bowel syndrome (IBS) is a disorder which has considerable effect to patient's quality of life and social functioning. Its main symptoms include recurrent abdominal pain and/or bloating associated with abnormal stool form or frequency. The recommendable treatment of IBS is a medication including loperamide, cimetropium, tricyclic antidepressants, and selective serotonin receptor inhibitors, but it has limited effects and several side effects dissatisfy IBS patients. As an alternative therapy, Xiaoyao-san (XYS) is gaining interest for IBS patients. XYS, a traditional Chinese medicine (TCM), has wide scope of indications and it can be prescribed for various gastrointestinal disorders in TCM syndromes but there has been no systematic review on IBS. Therefore, this review aims on systematically validating the curative effect of XYS on IBS.

Methods:

Electronic databases, manual search, and contact to author e-mail will be used for searching randomized controlled trials about the use of XYS for IBS. We will select studies by the predefined criteria and collect the data on study participants, interventions, control groups, outcome measurement, adverse events, and risk of bias. Primary outcome will be the efficacy rate, and secondary outcomes will be the IBS-centered indices (abdominal pain score, abdominal distension score, diarrhea or constipation score, bowel symptom severity scale), index about quality of life, and adverse events. Review Manager software and Cochrane Collaboration “risk of bias” tools will be used for meta-analysis and assessment of risk of bias.

Results:

This review will identify the clinical evidence of XYS's effectiveness and safety for IBS according to formal evaluation aspects.

Conclusion:

This review will further support the evidence-based usage of XYS for IBS treatment.

Ethics and dissemination:

No ethical approval is required since there is no personal information collection and patient recruitment.

Trial registration number:

Research Registry; reviewregistry986.
Low-grade ductal carcinoma in situ (DCIS) arising in a fibroadenoma of the breast during 5 years follow-up
Authors: Shojaku Hiroko , Hori Ryota , Yoshida Toru , Matsui Kazuhiro , Shimada Katsuo , Takayanagi Nobutatsu , Noguchi Kyo
Published: March 2021

Rationale:

Fibroadenoma (FA) is a common type of benign breast tumors but ductal carcinoma in situ (DCIS) rarely arises within this tumor type.

Patient concerns:

This case report presents a non-symptomatic 61-year-old woman with FA that was coincidentally found during a breast cancer screening program performed 5 years ago by her city of residence. She had subsequently been followed-up with mammography and breast ultrasound (US). US showed a slightly enlarged tumor and dynamic magnetic resonance imaging (MRI) indicated malignancy within the FA.

Diagnosis:

The pathological examination revealed low-grade DCIS within the FA.

Interventions:

The patient underwent a core needle biopsy followed by breast-conserving therapy with sentinel lymph node biopsy and then postoperative radiation therapy.

Outcomes:

Currently, she has been followed-up for 2 years without no signs of recurrence.

Lessons:

Careful observation with US followed by dynamic MRI is essential in the early diagnosis of DCIS originating in a FA.
Associations of sleep duration and fruit and vegetable intake with the risk of metabolic syndrome in Chinese adults
Authors: Wang Ming-hui , Shi Tong , Li Qiang , Chen Hong-Mei , Liu Ming-wei , Lu Yuan-an , He Qiqiang , Chen Rui
Published: March 2021

To understand the adverse association of short sleep duration and insufficient fruit and vegetable intake (FVI) with and their combined effect on metabolic syndrome (MetS) in Chinese adults.

This cross-sectional study analyzed 7052 adults aged 18∼64 years old in 2009, with fasting blood samples collected. Participants were divided into short/normal/long sleep duration groups and sufficient/insufficient FVI groups in accordance with self-reported information. Metabolic syndrome was defined by National Cholesterol Education Program's Adult Treatment Panel III criteria.

The prevalence of MetS among the study subjects was 21.74%. Participants were classified into short (<7 h/d), normal (7∼9 h/d), and long (>9 h/d) groups according to their daily sleep duration. Participants with less than 500 g of FVI per day was considered as insufficient FVI. After adjusting for confounders, the negative effect of short sleep duration on MetS was statistically significant, with an OR of 1.29 (95%CI = 1.06∼1.56); and high fasting glucose levels were significantly associated with insufficient FVI. Compared with subjects with normal sleep duration and sufficient FVI, participants with short sleep time and insufficient FVI had the highest risk of MetS (OR = 1.37, 95% CI: 1.04–1.66).

This study revealed that insufficient FVI and short sleep duration were significantly associated with an increased risk of MetS among Chinese adults. Increasing FVI and normal sleep duration during Chinese adults could be significant targets for reducing the prevalence of MetS.