bluuebunny/crossref_metadata_2025 huggingface dataset:
X-ray reverberation models of the disc wind in ultraluminous X-ray source NGC 5408 X−1
Authors: Luangtip W , Chainakun P , Loekkesee S , Deesamer C , Ngonsamrong T , Sintusiri T
Published: September 2021

Majority of ultraluminous X-ray sources (ULXs) are believed to be super-Eddington objects, providing a nearby prototype for studying an accretion in supercritical regime. In this work, we present the study of time-lag spectra of the ULX NGC 5408 X−1 using a reverberation mapping technique. The time-lag data were binned using two different methods: time-averaged-based and luminosity-based spectral bins. These spectra were fitted using two proposed geometric models: single and multiple photon scattering models. While both models similarly assume that a fraction of hard photons emitted from inner accretion disc could be downscattered with the super-Eddington outflowing wind becoming lagged, soft photons, they are different by the number that the hard photons scattering with the wind, i.e. single versus multiple times. In case of an averaged spectrum, both models consistently constrained the mass of ULX in the range of  ∼80–500 M⊙. However, for the modelling results from the luminosity-based spectra, the confidence interval of the BH mass is significantly improved and is constrained to the range of  ∼75–90 M⊙. In addition, the models suggest that the wind geometry is extended in which the photons could downscatter with the wind at the distance of ∼104–10$^{6}\, r_{\rm g}$. The results also suggest the variability of the lag spectra as a function of ULX luminosity, but the clear trend of changing accretion disc geometry with the spectral variability is not observed.
A rheumatoid arthritis patient with delivery who started certolizumab pegol and tacrolimus during pregnancy
Authors: Ito Satoshi , Ishikawa Hajime , Kato Ryuta
Published: September 2021

We experienced a patient in her 30s with rheumatoid arthritis (RA) who achieved delivery with the use of certolizumab pegol (CZP) and tacrolimus (TAC) during pregnancy. She developed RA in X - 3 year and was treated with salazosulfapyridine (SASP). In X - 2 year, she became pregnant and discontinued SASP and had a normal delivery despite joint pain during pregnancy. She restarted SASP in X - 1 year and became pregnant again in X year. She experienced a flare-up of RA and was referred to our rheumatic centre. We introduced CZP and TAC, and she discontinued these agents and started prednisolone just before delivery. There is reportedly minimal placental transfer of CZP because of its Fc-free structure, since the Fc part of CZP is replaced by polyethylene glycol. TAC was contraindicated during pregnancy until 2018, but its usage in such patients is now approved. Despite the flare-up of RA during pregnancy, we were able to reduce the disease activity by introducing CZP and TAC during pregnancy. We believe that the present findings support the efficacy of this approach for treating RA flare during pregnancy.
Digital Mandates and Their Management: Strategies for Usage of Social Media by Brazilian Federal Legislators
Authors: de Barros Antonio Teixeira , Bernardes Cristiane Brum , de Faria Cristiano Ferri Soares , Busanello Elisabete
Published: September 2021

The study aims to analyse the strategies adopted by the Brazilian Federal Chamber of Deputies during the period 2019–2022 (56th legislature) on social media platforms. The survey with political advisers includes the following platforms: Facebook, Instagram, YouTube, Twitter, WhatsApp, Telegram and LinkedIn. The sample consists of 155 informants, 30.21% of the total of 513 parliamentary offices. The conclusions show that 65% of the offices adopt specific strategies for each type of social media, although there is a wider principle, which is the constitution of multi-networks, in a coordinated and complementary way. Within these strategies, the disclosure regarding the parliamentarian’s own actions and the agenda of their electoral bases is prioritized over institutional legislative activities.
Plant 3D Chromatin Organization: Important Insights from Chromosome Conformation Capture Analyses of the Last 10 Years
Authors: Zhang Xinxin , Wang Tianzuo
Published: September 2021

Over the past few decades, eukaryotic linear genomes and epigenomes have been widely and extensively studied for understanding gene expression regulation. More recently, the three-dimensional (3D) chromatin organization was found to be important for determining genome functionality, finely tuning physiological processes for appropriate cellular responses. With the development of visualization techniques and chromatin conformation capture (3C)-based techniques, increasing evidence indicates that chromosomal architecture characteristics and chromatin domains with different epigenetic modifications in the nucleus are correlated with transcriptional activities. Subsequent studies have further explored the intricate interplay between 3D genome organization and the function of interacting regions. In this review, we summarize spatial distribution patterns of chromatin, including chromatin positioning, configurations and domains, with a particular focus on the effect of a unique form of interaction between varieties of factors that shape the 3D genome conformation in plants. We further discuss the methods, advantages and limitations of various 3C-based techniques, highlighting the applications of these technologies in plants to identify chromatin domains, and address their dynamic changes and functional implications in evolution, and adaptation to development and changing environmental conditions. Moreover, the future implications and emerging research directions of 3D genome organization are discussed.
Evaluating the Efficacy of Intratympanic Dexamethasone in Protecting Against Irreversible Hearing Loss in Patients on Cisplatin-Based Cancer Treatment: A Randomized Controlled Phase IIIB Clinical Trial
Authors: Moreno Inmaculada , Belinchon Antonio
Published: September 2021

Objective:

To determine the efficacy of long-term high-dose intratympanic dexamethasone in protecting the hearing capacity of cancer patients undergoing cisplatin-based ototoxic treatment.

Design:

A randomized controlled phase IIIB clinical trial to evaluate the efficacy of dexamethasone in protecting against hearing loss in patients undergoing cisplatin treatment. The subjects participating in the clinical trial were patients with a neoplastic disease whose treatment protocol included cisplatin. The average dose of cisplatin was 444.87 mg (SD 235.2 mg). Treatment consisted of intratympanically administering dexamethasone via a passive diffusion device called Microwick (8 mg/24 h dose) from the start of treatment with cisplatin to 3 weeks after the last cycle. Patients were administered the medication to one ear, and the contralateral ear was used as the control. The treated ears were randomly chosen using a computer system (randomization). The hearing threshold was evaluated using pure tone audiometry before each cisplatin cycle.

Results:

Thirty-four patients were recruited over a 2-year period at a reference tertiary hospital, of whom 11 were excluded. Forty-six ears were analyzed (23 treated and 23 control ears). When treatment was completed, the audiometric analysis showed a higher hearing threshold in the study group than in the control group. Differences were statistically significant at frequencies of 500, 1000, and 6000 Hz: 4.9 dB (1.1 to 8.7), 5.5 dB (0.8 to 10.3), and 16 dB (3.2 to 28.7), respectively, (p < 0.05, 95% confidence interval), but were not clinically significant according to the ASHA hearing loss criteria. Both 8.69% infection complications during treatment and 34.8% permanent perforation at 6 mo were detected after device removal.

Conclusions:

Long-term high-dose intratympanic dexamethasone treatment did not prevent cisplatin-induced hearing loss.
Epidemiology and factors predicting survival of amyotrophic lateral sclerosis in a large Chinese cohort
Authors: Gao Ming , Liu Na , Li Xue-Mei , Chao Liu-Wen , Lin Hong-Qi , Wang Yan , Sun Yan , Huang Chen , Li Xiao-Gang , Deng Min
Published: September 2021

Background:

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder associated with loss of motor neurons. Our objective was to explore the epidemiology, clinical features, and survival factors of 1809 patients with ALS.

Methods:

We analyzed 1809 ALS patients, who were recruited from the Peking University Third Hospital from January 2005 to December 2015. Demographic data and disease-related parameters were collected. Kaplan-Meier curves were used to compare survival time. Cox proportional hazards function and the hazard ratio were used to identify adjusted prognostic predictors.

Results:

The results showed that the average annual incidence in Beijing alone was 0.38 cases/100,000 person-years and the mean age of onset was 48.88 ± 11.35 (95% confidence interval [CI]: 48.17–49.85) years. The median survival time from onset to death/tracheostomy was 58.89 ± 33.03 (95% CI: 51.46–63.84) months. In the adjusted Cox proportional hazard model, age of onset, diagnosis delay, rate of disease progression (Amyotrophic Lateral Sclerosis Functional Rating Scale Revised decline [points/month]), and body mass index all had an independent effect on survival in ALS.

Conclusions:

Our study provides information on epidemiology, clinical features, and survival factors of patients with ALS in China. These results can be helpful in clinical practice, clinical trial design, and validation of new tools to predict disease progression.
Concordance of Squamous Cell Carcinoma Histologic Grading Among Dermatopathologists and Mohs Surgeons
Authors: Prezzano James C. , Scott Glynis A. , Lambert Smith Franki , Mannava Kathleen A. , Ibrahim Sherrif F.
Published: September 2021

BACKGROUND

Current staging systems for cutaneous squamous cell carcinoma (cSCC) incorporate histologic grade. There are no universally agreed on criteria to define differentiation for cSCC.

OBJECTIVE

To determine the interrater and intrarater reliability among dermatopathologists and Mohs surgeons in grading histological differentiation for cSCC.

METHODS AND MATERIALS

One hundred thirty-one archived slides were selected. Three dermatopathologists and 3 Mohs surgeons graded the tumors in a blinded manner (Round 1). In an attempt to improve concordance, all 6 participants were then asked to regrade the tumors based on a devised quantitative grading scale (Round 2).

RESULTS

For Round 1, overall κ was 0.56 corresponding to a weak agreement. κ for well, moderate, and poorly differentiated tumors was 0.68, 0.39, and 0.59, respectively, corresponding to moderate, minimal, and weak concordance. For Round 2 of the study, overall κ was 0.60, with κ = 0.75, 0.46, and 0.61 for well, moderate, and poorly differentiated tumors, respectively. Overall intrarater reliability was 0.70 (κ = 0.70, 0.77, 0.68, 0.71, 0.56, and 0.75), corresponding to a moderate concordance.

CONCLUSION

Overall concordance for cSCC histologic grading is weak to moderate among the experimental group. Substantial differences in concordance exist among histological degrees of differentiation, with lowest agreement in moderately differentiated tumors.
Antidepressant activity of Riparin A in murine model
Authors: Prinholato da Silva Cássio , Oliveira Denise Dias , Benincasa Bruno Iglesias , Barbar Bruna , Facchin Ana Lúcia , Beleboni Rene Oliveira
Published: September 2021

Depression and anxiety are common neuropsychiatric disorders that usually appear as comorbidities. The development of new drugs is crucial for safer and more effective clinical management of both disorders. Riparin A is a synthetic chemical analog of riparins that naturally occur in several medicinal plants. Marked pharmacological effects such as anxiolytic and antidepressant properties characterize this class of compounds. However, little is known about the potential anxiolytic and antidepressant effects of Riparin A. In this work, we showed that, unlike other riparins, Riparin A exerts only a very mild anxiolytic-like effect as demonstrated by the results of classical behavioral tests such as the elevated plus-maze, light–dark box and open-field tests in rats. However, all doses of Riparin A (2.5; 5.0 and 10 mg/kg; intraperitoneal) have shown significant antidepressant activity in rats submitted to forced swimming test. In addition to this interesting pharmacological property, Riparin A did not promote any important alterations in the locomotor performance of the animals as specifically demonstrated by the rotarod test. Furthermore, Riparin A did not induce sedation in treated animals; instead, this compound appears to increase the animal’s state of alertness as measured by the latency time to loss of reflexes and time to recovery from sleep in rats submitted to the pentobarbital-induced sleep time test. The present results point to an antidepressant effect of Riparin A and reinforce the pharmaceutical interest in the group of riparins, particularly their high potential for use in new studies investigating the structure-activity relationships between member compounds.
Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management
Authors: Dzaye Omar , Razavi Alexander C. , Blaha Michael J. , Mortensen Martin Bødtker
Published: September 2021

Purpose of review

To provide a summary of recent literature on the relative impact of luminal stenosis versus atherosclerotic plaque burden in atherosclerotic cardiovascular disease (ASCVD) risk stratification and management.

Recent findings

Recent results from both randomized controlled clinical trials as well as observational cohort studies have demonstrated that ASCVD risk is mediated mainly by the extent of atherosclerotic disease burden rather than by the presence of coronary stenosis or inducible ischemia. Although patients with obstructive CAD are generally at higher risk for ASCVD events than patients with nonobstructive CAD, this is driven by a higher plaque burden in those with obstructive CAD. Accordingly, the ASCVD risk for a given plaque burden is similar in patients with and without obstructive CAD. Accompanying these observations are randomized controlled trial data, which show that optimization of medical therapy instead of early revascularization is most important for improving prognosis in patients with stable obstructive CAD.

Emerging evidence shows that atherosclerotic plaque burden, and not stenosis per se, is the main driver of ASCVD risk in patients with CAD. This information challenges the current paradigm of selecting patients for intensive secondary prevention measures based primarily on the presence of obstructive CAD.
Distinct pathological mechanisms distinguish acute coronary syndrome caused by plaque erosion from plaque rupture
Authors: Meteva Denitsa , Seppelt Claudio , Abdelwahed Youssef S. , Leistner David M.
Published: September 2021

Purpose of review

The current systematic review aims to provide novel insights into the distinct pathological features of acute coronary syndrome (ACS) with intact fibrous cap, also known as ‘plaque erosion’. A more detailed understanding of its underlying pathomechanisms provides the basis for future personalized therapeutic approaches to ACS.

Recent findings

In the past years, a mounting proportion of evidence point towards the concept of plaque erosion being responsible for more than one-third of all cases of ACS and representing an autonomous ACS-causing entity driven by biomechanical forces, immunological alternations and systemic elevation of inflammatory mediators. First pilot studies proved a therapeutic paradigm shift from primary PCI at the ACS-causing culprit lesion to systemic therapies in patients with ACS caused by plaque erosion.

This review provides the current status of the broad basic and clinical studies focused to the topic of plaque erosion: a new ACS-causing pathophysiology with different pathological aspects providing appropriate implications for personalized therapies in ACS.
Current evidence on the safety and efficacy of combined atrial fibrillation ablation and left atrial appendage closure
Authors: Mo Bin-Feng , Lian Xiao-Ming , Li Yi-Gang
Published: September 2021

Purpose of review

Combined atrial fibrillation (AF) ablation and left atrial (LA) appendage (LAA) closure (LAAC) has been practiced for management of both the symptoms and the high stroke risk of AF. The purpose of this review is to review recent evidence regarding the combined procedure.

Recent findings

Newly acquired long-term data of combined AF ablation and LAAC supplied satisfactory evidence on the safety and efficacy of the combined procedure. Studies also showed LA structural remodeling following combined procedure was mainly affected by sinus rhythm status post catheter ablation, not by LAAC. A cost-effectiveness study revealed that combined procedure was a cost-effective therapeutic option in symptomatic AF patients with high stroke and bleeding risk. Due to recent evidence of high incidences of LAA thrombus formation after LAA electrical isolation (LAAEI) and benefit of LAAC after LAAEI, an extended combined procedure of standard AF ablation plus LAAEI and LAAC was considered as a potential therapeutic option for persistent AF patients with high stroke risk.

In conclusion, combined AF ablation and LAAC serve as a promising option for patients with symptomatic AF and high risk of stroke and/or bleeding.
The Treatment of Obesity in Cardiac Rehabilitation
Authors: Ades Philip A. , Savage Patrick D.
Published: September 2021

Background:

Cardiac rehabilitation (CR) programs have evolved from exercise-only programs designed to improve cardiorespiratory fitness to secondary prevention programs with a broader mandate to alter lifestyle-related behaviors that control cardiac risk factors and, thereby, reduce overall cardiovascular risk. As the obesity epidemic has evolved in the late 20th and early 21st centuries, the prevalence of type 2 diabetes mellitus and the metabolic syndrome have soared and blunted the otherwise expected downturn in deaths from coronary heart disease related to better control of risk factors. In that the causes of obesity are behavioral in origin, the most effective treatment strategy requires a comprehensive, behavioral-based approach.

Purpose:

In this review, we outline optimal lifestyle approaches that can be delivered in the CR setting to assist cardiac patients with their long-term goals of reducing weight and improving cardiac risk factors while concurrently improving cardiorespiratory fitness. We also performed a survey of CR program throughout the United States and found that only 8% currently deliver a behavioral weight programs.

Conclusions:

Cardiac rehabilitation programs need to take on an important challenge of secondary prevention, which is to develop behavioral weight loss programs to assist cardiac patients to lose weight and, thereby, improve multiple risk factors and long-term prognosis.
CLINICAL CHARACTERISTICS AND VISUAL OUTCOMES IN ENDOPHTHALMITIS AFTER KERATOPROSTHESIS IMPLANTATION
Authors: Lee Terry , Robbins Cason B. , Wisely Clayton E. , Grewal Dilraj S. , Daluvoy Melissa B. , Fekrat Sharon
Published: September 2021

Purpose:

To describe the presentation, microbiology, management, and prognosis of eyes with endophthalmitis after Boston keratoprosthesis implantation.

Methods:

Retrospective case series with history, diagnostics, management, and outcomes data in endophthalmitis after keratoprosthesis implantation presenting to a tertiary center between 2009 and 2020.

Results:

Of 137 keratoprosthesis-implanted eyes, 7 eyes of 7 patients (5%) developed endophthalmitis. On presentation, 6 (86%) reported decreased visual acuity, and only 1 (14%) reported pain. Peripheral corneal ulcers were present in 2 eyes (29%). Seidel testing was negative in all cases. Six eyes (86%) had retroprosthetic membranes. One (14%) underwent initial pars plana vitrectomy with mechanical vitreous biopsy, whereas 6 (86%) received a needle vitreous tap—half of which were dry. Organisms were isolated after vitreous tap in two eyes:Streptococcus intermediusandMycobacterium abscessus. The mean visual acuity preendophthalmitis, at presentation, and at 6 months were 20/267, 20/5,944, and 20/734, respectively. The visual acuity improved 9.08 ± 11.78 Early Treatment Diabetic Retinopathy Study lines from presentation to 6 months. Six-month visual acuity was correlated with preendophthalmitis visual acuity (r = 0.92,P= 0.003) but not presenting visual acuity (P= 0.838).

Conclusion:

Visual acuity at 6 months is correlated with preendophthalmitis visual acuity, not presenting visual acuity. Endophthalmitis should be considered in the differential diagnosis of painless intraocular inflammation any time after keratoprosthesis implantation, even if Seidel negative.
Bilateral Immune-Mediated Keratolysis After Immunization With SARS-CoV-2 Recombinant Viral Vector Vaccine
Authors: Khan Tanveer Alam , Sidhu Navneet , Khan Livia , Sen Seema , Hussain Nishat , Tandon Radhika , Gupta Noopur
Published: September 2021

Purpose:

The purpose of this study was to report an unusual case of bilateral immune-mediated corneal melting and necrosis after ChAdOx1 nCoV-19 (Covishield) vaccination.

Methods:

This is a case report and literature review.

Results:

A 48-year-old man presented to the ophthalmic emergency department with progressive bilateral corneal melting 5 weeks after receiving the first dose of ChAdOx1 nCoV-19 (Covishield) vaccine. Systemic complaints of fever, diarrhea, and vomiting were noted in the first 2 weeks, which subsided before the onset of ocular symptoms at day 21 of vaccine administration. The patient could only perceive light bilaterally and demonstrated features of bilateral keratolysis with choroidal detachment on ultrasonography. The microbiological scraping specimen did not reveal growth of any microorganism. Tectonic penetrating keratoplasty was performed, and the host corneal tissue was sent for histopathology, bacterial culture, fungal culture, polymerase chain reaction for herpes simplex virus, varicella zoster virus, cytomegalovirus, adenovirus, and SARS-CoV-2. Microbial culture was sterile, and viral polymerase chain reaction reports were negative. Histopathological examination revealed dense inflammatory cell infiltration. Detailed systemic workup revealed no underlying systemic or autoimmune pathology.

Conclusions:

Immune-mediated keratolysis after ChAdOx1 nCoV-19 (Covishield) vaccination is a rare entity, and we believe that this is the first report of a temporal association between a serious ocular adverse event after a single dose of any SARS-CoV-19 vaccine. It may be included as a possible adverse event associated with this vaccine.
Effect of Azithromycin on the Ocular Surface Microbiome of Children in a High Prevalence Trachoma Area
Authors: Doan Thuy , Gebre Teshome , Ayele Berhan , Zerihun Mulat , Hinterwirth Armin , Zhong Lina , Chen Cindi , Ruder Kevin , Zhou Zhaoxia , Emerson Paul M. , Porco Travis C. , Keenan Jeremy D. , Lietman Thomas M.
Published: September 2021

Purpose:

The aim of this study was to evaluate the effect of the 4 times per year mass azithromycin distributions on the ocular surface microbiome of children in a trachoma endemic area.

Methods:

In this cluster-randomized controlled trial, children aged 1 to 10 years in rural communities in the Goncha Seso Enesie district of Ethiopia were randomized to either no treatment or treatment with a single dose of oral azithromycin (height-based dosing to approximate 20 mg/kg) every 3 months for 1 year. Post hoc analysis of ocular surface Chlamydia trachomatis load, microbial community diversity, and macrolide resistance determinants was performed to evaluate differences between treatment arms.

Results:

One thousand two hundred fifty-five children from 24 communities were included in the study. The mean azithromycin coverage in the treated communities was 80% (95% CI: 73%–86%). The average age was 5 years (95% CI: 4–5). Ocular surface C. trachomatis load was reduced in children treated with the 4 times per year azithromycin (P = 0.0003). Neisseria gonorrhoeae, Neisseria lactamica, and Neisseria meningitidis were more abundant in the no-treatment arm compared with the treated arm. The macrolide resistance gene ermB was not different between arms (P = 0.63), but mefA/E was increased (P = 0.04) in the azithromycin-treated arm.

Conclusions:

We found a reduction in the load of C. trachomatis and 3 Neisseria species in communities treated with azithromycin. These benefits came at the cost of selection for macrolide resistance.
Correlation of hair cortisol and interleukin 6 with structural change in the active progression of keratoconus
Authors: Stival Larissa R. , Avila Laryssa P. , Araujo Daniella C. , Chaves Luis F. , Toledo Marcia C. , Silva Artur C. , Cunha Luiz C. , Oliveira Tiago F. , Santhiago Marcony R.
Published: September 2021

Purpose:

To evaluate interleukin (IL) and hair cortisol concentrations (HCCs) in progressive keratoconus (KC) and compare them with KC-stable eyes and healthy control, and to determine the correlation of these inflammatory mediators and HCCs and their relationship with structural damage represented by increased corneal curvature.

Setting:

University of Sao Paulo, Brazil.

Design:

Prospective observational comparative study.

Methods:

133 eyes of 74 patients were included. The concentrations of tear cytokines: IL1B, IL6, IL8, IL10, IL12p70, and tumor necrosis factor α were obtained by capillary flow and measured using a flow cytometer. HCCs were determined from the most proximal hair segment as an index of cumulative secretion and measured by liquid chromatography mass spectrometry.

Results:

133 eyes of 74 patients. Only IL6 was increased in progressive KC tears compared with stable KC (6.59 ± 3.25 pg/mL vs 4.72 ± 1.91 pg/mL; P < .0001) with a positive correlation between IL6 and maximum keratometry (Kmax) (P < .0001). Progressive KC exhibited significantly higher HCC than stable KC (0.624 ± 0.160 ng/mg vs 0.368 ± 0.0647 ng/mg; P < .0001) and healthy controls (0.624 ± 0.160 ng/mg vs 0.351 ± 0.0896 ng/mg; P < .0001). There was a significant correlation between HCC and Kmax (P < .0001).

Conclusions:

KC eyes that are progressing have a higher concentration of IL6 and long-term cortisol than patients with stable forms of KC; second, there is a significant correlation between this increase in IL6 and cortisol with corneal structural damage. Finally, there is a meaningful relationship between this interleukin and the previous few months' cortisol levels.
Evaluation of intraoperative aphakic eye axial length measurements using swept-source OCT
Authors: Hienert Julius , Amir-Asgari Sahand , Matz Holger , Hirnschall Nino , Findl Oliver
Published: September 2021

Purpose:

To evaluate intraoperative aphakic eye axial length (AL) measurements using swept-source optical coherence tomography (SS-OCT).

Setting:

Hanusch Hospital, Vienna, Austria.

Design:

Prospective single-center study.

Methods:

Patients scheduled for cataract surgery were measured using SS-OCT (IOLMaster 700, Carl Zeiss Meditec AG) to assess the AL. Intraoperatively (intra-OP), SS-OCT measurements were performed with a prototype device (IOLMaster 700 connected to an OPMI Lumera 700 microscope, CZM) at the beginning of cataract surgery furthermore of the aphakic eye and 2 months after surgery.

Results:

106 patients were included. Of the 59 eyes of 59 patients, the phakic median AL preoperatively and intra-OP was 23.61 mm ± 0.96 (standard deviation [SD]) and 23.51 mm ± 0.96 (SD), respectively. The absolute median difference was 0.028 ± 0.02 (SD) (P = .049). Median phakic AL intra-OP vs 2 months postoperatively (post-OP) was 23.51 mm ± 0.97 (SD) vs 23.49 mm ± 0.95 (SD). The absolute median difference was 0.049 ± 0.04 (SD) (P = .000). Median AL intra-OP aphakic vs 2 months post-OP pseudophakic was 23.42 mm ± 0.97 (SD) vs 23.42 mm ± 0.97 (SD), respectively. Absolute median difference was 0.038 ± 0.04 (SD) (P = .379).

Conclusions:

Intra-OP, SS-OCT technology of the phakic and aphakic eye shows excellent comparability to preoperative and postoperative measurements. This technique allows AL measurements with high precision in cases in which preoperative biometric measurements are not possible.
Beneath the Surface: Mental Health and Harassment and Abuse of Athletes Participating in the FINA (Aquatics) World Championships, 2019
Authors: Mountjoy Margo , Junge Astrid , Magnusson Christer , Shahpar Farhad Moradi , Ortiz Lizcano Edgar Ivan , Varvodic Josip , Wang Xinzhai , Cherif Mohamed Yahia , Hill Lee , Miller Jim
Published: September 2021

Objective:

To assess the mental health and experience of sport-related harassment and abuse of elite aquatic athletes and to analyze it in relation to gender and discipline.

Design:

Cross-sectional study using an anonymous survey.

Setting:

The FINA World Championships 2019.

Participants:

Registered athletes in the disciplines of swimming, diving, high diving, water polo, artistic swimming, and open water swimming.

Interventions:

Athletes completed an online or paper-based questionnaire.

Main Outcome Measures:

The main outcome measures included screening for depression (10-item version of the Center for Epidemiological Studies Depression Scale revised), eating disorders (Brief Eating Disorders in Athletes Questionnaire), the subjective need for psychotherapeutic support, and the experience of sport-related harassment and/or abuse.

Results:

A quarter (24.6%) of the 377 responding athletes were classified as depressed and 2.5% as having an eating disorder. More than 40% of the athletes stated that they wanted or needed psychotherapeutic support. Fifty-one athletes (14.9%) had experienced harassment/abuse in sport themselves, and 31 (9%) had witnessed it in another athlete. The experiences of harassment and abuse ranged from unwanted comments about body or appearance (40.2%) to rewards in sport for sexual favors (2.5%) and rape (0.3%). Athletes who had experienced harassment/abuse in sport themselves had higher average scores for depression and eating disorders, and more of them felt they needed psychotherapeutic support. Up to a third would not talk or report to anybody if they saw or experienced harassment/abuse, and less than 20% would talk to an official for help.

Conclusion:

Targeted initiatives are required to address mental health issues and harassment and abuse in sport in the FINA aquatic disciplines.
Practical Management: Telehealth Examination for Sport-Related Concussion in the Outpatient Setting
Authors: McPherson Jacob I. , Saleem Ghazala T. , Haider M. Nadir , Leddy John J. , Torres Daniel M. , Willer Barry
Published: September 2021

This article presents the telehealth version of the Buffalo Concussion Physical Examination (BCPE) (Tele-BCPE). It is a brief, focused telehealth PE for use in the outpatient setting by sports medicine physicians, pediatricians, neurologists, and primary care physicians. It is derived from the BCPE and includes general considerations for providers performing telehealth services and instructions for adapting traditional clinical tests for virtual use. The Tele-BCPE includes an orthostatic intolerance screen, examination of the cranial nerves, and tests of the oculomotor, vestibular, and cervical systems. It is meant to be used at initial and follow-up outpatient visits for patients acutely after concussion and in those with prolonged symptoms. This telehealth PE, when combined with other assessments, can help provide direct treatment to patients at any stage after concussion and reduce barriers to healthcare access posed by the COVID-19 pandemic and for patients living in rural or underserved areas.
How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning
Authors: Trahanas John M. , Li Selena S. , Crowley Jerome C. , Ton Van-Khue , Funamoto Masaki , Cudemus Deseda Gaston A. , Villavicencio Mauricio A. , D’Alessandro David A.
Published: September 2021

Adequate and durable recovery in patients supported with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be challenging to predict. Extracorporeal membrane oxygenation weaning is the process by which the ECMO flows are decreased to assess if a patient is ready for decannulation. The optimal strategies for deciding who to wean and how to wean VA ECMO remain undefined. A retrospective literature review was performed to understand the evidence supporting current practices in ECMO weaning and in particular patient selection and methods. Most published work and expert opinions agree that once the underlying process has resolved, the minimum required physiologic parameters for weaning from ECMO include: hemodynamic stability and cardiac pulsatility, adequate lung function to support oxygenation and ventilation, and evidence of recovered end organ function. Echocardiography is universally used to assess cardiac function during the weaning process. Currently, there is no consensus regarding who is eligible to wean or how to wean ECMO in adults. We have reviewed the literature to summarize the evidence and expert opinions behind VA ECMO weaning, and give an example of the protocol used at our center. We believe this protocol optimizes patient selection for weaning and helps to predict successful decannulation.
Optimal extent of lymphadenectomy for radical surgery of pancreatic head adenocarcinoma
Authors: Wang Ziyao , Ke Nengwen , Wang Xin , Wang Xing , Chen Yonghua , Chen Hongyu , Liu Jinheng , He Du , Tian Bole , Li Ang , Hu Weiming , Li Kezhou , Liu Xubao
Published: September 2021

Background:

Radical pancreaticoduodenectomy is the only possible cure for pancreatic head adenocarcinoma, and although several RCT studies have suggested the extent of lymph node dissection, this issue remains controversial. This article wanted to evaluate the survival benefit of different lymph node dissection extent for radical surgical treatment of pancreatic head adenocarcinoma.

Methods:

A total of 240 patients were assessed for eligibility in the study, 212 of whom were randomly divided into standard lymphadenectomy group (SG) or extended lymphadenectomy group (EG), there were 97 patients in SG and 95 patients in EG receiving the radical pancreaticoduodenectomy.

Result:

The demography, histopathology and clinical characteristics were similar between the 2 groups. The 2-year overall survival rate in the SG was higher than the EG (39.5% vs 25.3%; P = .034). The 2-year overall survival rate in the SG who received postoperative adjuvant chemotherapy was higher than the EG (60.7% vs 37.1%; P = .021). There was no significant difference in the overall incidence of complications between the 2 groups (P = .502). The overall recurrence rate in the SG and EG (70.7% vs 77.5%; P = .349), and the patterns of recurrence between 2 groups were no significant differences.

Conclusion:

In multimodality therapy system, the efficacy of chemotherapy should be based on the appropriate lymphadenectomy extent, and the standard extent of lymphadenectomy is optimal for resectable pancreatic head adenocarcinoma. The postoperative slowing of peripheral blood lymphocyte recovery might be 1 of the reasons why extended lymphadenectomy did not result in survival benefits.

Clinical trial registration:

This trial was registered at ClinicalTrials.gov (NCT02928081) in October 7, 2016. https://clinicaltrials.gov/
Successful endovascular therapy for an adolescent patient with cerebral venous sinus thrombosis
Authors: Peng Tao , Zhang Zini , Zu Bifeng , Dan Bitang
Published: September 2021

Rationale:

Cerebral venous sinus thrombosis associated with protein S deficiency is rare in adolescent patients and has high disability and fatality.

Patient concerns: A 15-year-old male student presented in the hospital with sudden headache, nausea, and vomiting and was diagnosed with protein S deficiency by gene testing.

Diagnoses:

Cerebral venous sinus thrombosis due to protein S deficiency was diagnosed in this adolescent patient, who underwent successful endovascular therapy (EVT).

Interventions:

The patient was treated with standard anti-coagulation therapy including low-molecular-weight heparin (90 IU/kg/Q12 h) and dehydrant (mannitol 125 mL Q8 h); however, the symptoms were not alleviated. Successful EVT was implemented.

Outcomes:

Both the superior sagittal sinus and bilateral transverse sinus were recanalized after thrombus clearance. The patient achieved a complete recovery without any other stroke recurrence during follow-up.

Lessons:

EVT can be performed with favorable and effective clinical outcomes in adolescent cerebral venous sinus thrombosis patients with protein S deficiency. EVT associated with standard anti-coagulation therapy may improve the prognosis and reduce mortality among such patients.
Analysis of the clinical manifestations and 18F-FDG PET-CT findings in 40 patients with histiocytic necrotizing lymphadenitis
Authors: Zhang Rui , Liang Lidan , Li Daoming , Bai Yuling , Li Xiangzhou
Published: September 2021

Histiocytic necrotizing lymphadenitis (HNL) is a rare, benign, and self-limiting inflammatory disease that mainly involves the lymph nodes. There is a lack of large sample studies concerning the clinical manifestations and imaging features of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) of HNL.

The clinical symptoms, laboratory examination results, 18F-FDG PET/CT imaging features, and treatment outcome were investigated in this retrospective study.

A total of 40 HNL patients were recruited. The onset age was between 14 and 65 years, with a median of 25 years. The white blood cell count was 3.9 (2.9, 7.1) × 109/L, C-reactive protein level was 20.2 (6.6, 63.8) mg/L, erythrocyte sedimentation rate was 29.0 (18.0,45.0) mm/h, and ferritin was 616.5 (205.6, 2118.1) ng/mL. An abnormal liver function was observed in 23 patients. 18F-FDG PET-CT showed that an abnormal lymph node metabolism was observed in 38 patients, among which the highest 18F-FDG maximal standard uptake value (SUVmax) of the lymph nodes ranged between 3.4 and 41.9; the nodes were mainly distributed in the neck and axilla regions. Meanwhile, a total of 2502 lymph nodes (721 lymph nodes with a short axis greater than 10 mm) were found in the 38 patients, including 1837 lymph nodes with an 18F-FDG SUVmax ≥ 2.5. The 18F-FDG SUVmax of the spleen ranged from 2.5 to 9.2 in 20 patients, while that of central and peripheral bone marrow ranged from 2.7 to 36.0 in 30 patients. After follow-up for an average period of 1 month, the symptoms improved after prednisone treatment.

HNL often occurs in adolescents. Scanning with 18F-FDG PET/CT showed that most patients had multiple involved lymph nodes that were hypermetabolic, and only few lymph nodes are enlarged. Besides, the spleen or central and peripheral bone marrow could sometimes be hypermetabolic. Glucocorticoid treatment for the HNL patients is effective.
Circulating platelet count and glycans
Authors: Rivadeneyra Leonardo , Falet Hervé , Hoffmeister Karin M.
Published: September 2021

Purpose of the review

This review highlights recent advancements in understanding the regulation of platelet numbers, focusing on mechanisms by which carbohydrates (glycans) link platelet removal with platelet production in the bone marrow in health and disease.

Recent findings

This review is focused on the role of carbohydrates, specifically sialic acid moieties, as a central mediator of platelet clearance. We discuss recently identified novel mechanisms of carbohydrate-mediated platelet removal and carbohydrate-binding receptors that mediate platelet removal.

The platelet production rate by megakaryocytes and removal kinetics controls the circulating platelet count. Alterations in either process can lead to thrombocytopenia (low platelet count) or thrombocytosis (high platelet count) are associated with the risk of bleeding or overt thrombus formation and serious complications. Thus, regulation of a steady-state platelet count is vital in preventing adverse events. There are few mechanisms delineated that shed light on carbohydrates’ role in the complex and massive platelet removal process. This review focuses on carbohydrate-related mechanisms that contribute to the control of platelet numbers.
Associations Between Transcranial Doppler Flow Velocities, Laboratory Parameters, and Clinical Features in Turkish Children With Sickle Cell Disease
Authors: Aydin Sultan , Yeral Hakan , Oktay Gönül , Çoban Yasemin , Akbaş Yilmaz , Köker Alper , Öz Tunçer Gökçen
Published: September 2021

Objective:

Stroke is one of the major complications of sickle cell disease (SCD). Stroke features either occlusion of, or stenosis at, the origin of one of the large intracerebral arteries, the internal carotid artery (ICA), and/or the middle cerebral artery (MCA).

Purpose:

We sought correlations between cerebral blood flow velocities and the laboratory and clinical findings of patients with SCD.

Materials and Methods:

Fifty-three pediatric SCD patients (39 with HbSS, 14 with HbSβ0) were analyzed. The mean patient age was 12.9±3.9 years. The control group contained 24 healthy individuals. The time-averaged maximum mean velocity (TAMMV) and resistive index (RI) of the MCA, the TAMMVs of the ICA and vertebral artery (VA), and the diameter of the VA were estimated through transcranial Doppler ultrasonography using a 2.5 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. We evaluated the relationships between the TAMMVs, laboratory parameters, and clinical findings.

Results:

The mean±SD MCA TAMMV was 161.2±35.4 cm/s in patients with HbSS and 185.8±62.9 cm/s in patients with HbSβ0. The mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 168.5±43.9 cm/s, 0.63±0.06, 116.8±25.5 cm/s, 69.2±18.5 cm/s, and 3.5±0.61 mm for all SCD patients, respectively. In the control group, the mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 103.8±28.8 cm/s, 0.53±0.04, 96.4±27.8 cm/s, 40.3±12.1 cm/s, and 3.4±0.6 mm, respectively. Although the differences were not significant, TAMMVs were higher in HbSβ0 patients taking hydroxyurea; those with hemoglobin levels <8 g/dL, ferritin levels >1000 ng/dL, mean platelet volume >12 fL, or red cell distribution width >18%; or required chelation, or were below the third percentiles of weight and height. The TAMMV was significantly higher only in SCD patients who complained of headache.

Conclusions:

High ferritin and low hemoglobin levels, a high mean platelet volume, a high red cell distribution width, low weight (below the third percentile), and a short height (below the third percentile) may be associated with elevated cerebral blood flow velocities and an increased stroke risk in children with SCD. Children with such features should be closely followed-up through transcranial Doppler ultrasonography examination.
A 12-Year-old Girl With Chronic Pediculosis Infestation Presenting With Severe Iron Deficiency Anemia
Authors: Fustino Nicholas J. , Waddell Joel P. , Panzer Zachary R.
Published: September 2021

Iron deficiency is the leading etiology of anemia worldwide. Excessive cow’s milk intake and menorrhagia are the most common etiologies in the pediatric population in the United States, with parasitic infections a more common cause in lower-resource countries. Here we present a case of a 12-year-old female in the midwestern United States with severe iron deficiency anemia (hemoglobin 4.7 g/dL) and chronic pediculosis infestation. Anemia resolved with transfusion, iron supplementation, and eradication of the parasite. We believe this is the only reported case of a child in the United States with severe iron deficiency anemia secondary to chronic severe lice infestation.
Refractory Extracutaneous Juvenile Xanthogranuloma With Multiple Intracranial Nodular Lesions Successfully Treated With 2-Chlorodeoxyadenosine
Authors: Matsukawa Yukihiro , Sakamoto Kenichi , Shioda Yoko
Published: September 2021

Juvenile xanthogranulomatosis (JXG) is a rare histiocytic disease that is usually limited to the skin, but some JXG cases involve other organs. JXG involving the central nervous system (CNS) is rare and its treatment is inadequate. The optimum treatment for refractory JXG involving the CNS remains unknown. We report here a case of refractory pediatric extracutaneous JXG (extra-JXG) involving the CNS with multiple intracranial masses treated with 2-chlorodeoxyadenosine resulting in achievement of long-term complete remission. 2-Chlorodeoxyadenosine, with favorable CNS penetration in the cerebrospinal fluid, is apparently an effective treatment for extra-JXG and systemic JXG (sJXG) with CNS involvement.
Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life
Authors: Svynarenko Radion , Beebe Lora Humphrey , Lindley Lisa C.
Published: September 2021

Children, who enroll in hospice, have complex mental and behavioral health (MHBH) problems. There is limited literature on patterns of these problems among children at their end of life. Using the national database of 6195 children enrolled in hospice between January 1, 2011, and December 31, 2013, and latent class analysis, this study identified 4 distinctive classes of children. Neurodevelopment and anxiety class (26.5% of the sample) had 41.3% of children of 15 years or older, who had an average of 1.4 MHBH comorbidities and took 17 medications; 29.1% had physical health comorbidities, and 23% were dependent on technology. In the Behavior and Neurodevelopment class (20%), 53.1% of the children were between ages 6 and 14 years, who had an average of 2 MHBH comorbidities and took 17 medications. In the Physiology class (43.4%), 65.5% of children were younger than 5 years, had 1 MHBH comorbidity, and took 19 medications. In the Mood, Behaviors, and Anxiety class (10.2%), more than 90% of children were older than 6 years, had 4 MHBH comorbidities, and took 30 medications. In the latter 3 classes, approximately half of the children either had physical health comorbidities or were technology dependent. These findings highlight the importance of end-of-life care that accounts for the likely presence of complicated patterns of MHBH conditions.
Assessment of Primary Care Content in a Nursing Curriculum
Authors: Dolansky Mary A. , Nikstenas Colleen , Badders Ashley , Brannack Lisa , Burant Patricia A.
Published: September 2021

Background

Because of the rapidly emerging need for more RNs in primary care, schools of nursing are challenged with preparing students for these roles.

Purpose

The purpose of the project was to use the Faculty Primary Care Assessment Tool to evaluate the extent of primary care content in the prelicensure curriculum and identify strategies for primary care content integration.

Methods

A quality improvement approach was used for this evaluation. Thirty-one faculty (44%) completed the Faculty Primary Care Assessment Tool.

Results

The majority of the content items were scored between 1.55 and 3.4, indicating minimal integration of primary care concepts. Courses that had high integration of primary care content were leadership and psychiatric-mental health courses.

Conclusions

Our findings provide a valuable tool to assist with the integration of primary care content in the prelicensure curriculum.