bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium
Authors: Humphrey John M , Mpofu Philani , Pettit April C , Musick Beverly , Carter E Jane , Messou Eugène , Marcy Olivier , Crabtree-Ramirez Brenda , Yotebieng Marcel , Anastos Kathryn , Sterling Timothy R , Yiannoutsos Constantin , Diero Lameck , Wools-Kaloustian Kara
Published: January 2020

Background

In resource-constrained settings, many people with HIV (PWH) are treated for tuberculosis (TB) without bacteriologic testing. Their mortality compared with those with bacteriologic testing is uncertain.

Methods

We conducted an observational cohort study among PWH ≥15 years of age initiating TB treatment at sites affiliated with 4 International epidemiology Databases to Evaluate AIDS consortium regions from 2012 to 2014: Caribbean, Central and South America, and Central, East, and West Africa. The exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard of death in the 12 months after TB treatment initiation was estimated using a Cox proportional hazard model. Missing covariate values were multiply imputed.

Results

In 2091 PWH, median age 36 years, 53% had CD4 counts ≤200 cells/mm3, and 52% were on antiretroviral therapy (ART) at TB treatment initiation. The adjusted hazard of death was higher in patients with no test compared with those with positive test results (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.08–2.26). The hazard of death was also higher among those with negative compared with positive tests but was not statistically significant (HR, 1.28; 95% CI, 0.91–1.81). Being on ART, having a higher CD4 count, and tertiary facility level were associated with a lower hazard for death.

Conclusions

There was some evidence that PWH treated for TB with no bacteriologic test results were at higher risk of death than those with positive tests. Research is needed to understand the causes of death in PWH treated for TB without bacteriologic testing.
Engineered variants of a lipase from Yarrowia lipolytica with improved trypsin resistance for enzyme replacement therapy
Authors: Zhang Huitu , Liu Huan , Zhang Ying , Sun Tongwei , Wu Guoguo , Zhou Cuixia , Wu Xiaonong , Zhang Jing , Yue Rong , Wang Haikuan , Dai Yujie , Liu Fufeng , Lu Fuping
Published: January 2020

To improve the proteolytic stability of the lipase LIP2 from Yarrowia lipolytica, the peptide bonds susceptible to trypsin in LIP2 were analyzed by tandem mass spectrometry and redesigned by site-directed mutagenesis. Different variants of the enzyme were expressed in Pichia pastoris GS115 and their biochemical properties were subsequently investigated. Although most of the variants were still cleaved by trypsin, some of them did show an evident increase of resistance against proteolytic degradation. The most stable mutant was LIP2-C5, in which five trypsin-cleavage sites were replaced by non-preferred amino acids. Upon incubation with human trypsin for 80 min at 37°C, the mutant LIP2-C5 was found to retain >70% of its initial activity, compared to only 10% for the wild-type.
Predictive factors of facilitating linkage to care for HIV-positive detainees in ICE Health Service Corps-staffed facilities
Authors: Mishreki Alexandra M , Boardman Nicole J , Brodine Stephanie K , Yang Mingan , Lederman Edith R
Published: January 2020

Background

Persons in ICE detention represent a population about whom limited health-related data is available in the literature. Since ICE detention is generally brief, facilitating linkage to care (FLC) for detainees with chronic diseases, including HIV-positive detainees, is challenging, yet critical to encourage continued treatment beyond custody. Between 2015 and 2017, IHSC-staffed facilities implemented intensive training related to HIV care and FLC and increased clinical oversight and consultations. This study examined the impact of these changes in relation to FLC.

Methods

Demographic and clinical data for detainees with known HIV-positive diagnoses at IHSC-staffed facilities entering custody in 2015 and 2017 were obtained via electronic health record. Univariate analysis and multiple logistic regressions were performed to identify factors that may increase FLC.

Results

After adjusting for year of entry into custody, detainees who received an infectious disease (ID) consultation had significantly higher odds (2.4, P < 0.001) of receiving FLC resources compared to those who did not receive an ID consultation. Between 2015 and 2017, the proportion of HIV-positive detainees receiving FLC resources increased from 29 to 62%.

Conclusions

ID consultations significantly improved FLC for HIV-positive detainees. Continued provider training and education is essential to continue improving the rate of FLC for HIV-positive ICE detainees.
Equity Is Cheap for Large Financial Institutions
Authors: Gandhi Priyank , Lustig Hanno , Plazzi Alberto
Published: January 2020

Across a wide panel of countries, the top-10% of financial stocks on average account for over 20% of a country’s market capitalization but earn on average significantly lower returns than do nonfinancial firms of the same size and risk exposures. In a bailout-augmented, rare disasters asset pricing model, the spread in risk-adjusted returns between large and small institutions depends on country characteristics that determine the likelihood of bailouts. Consistent with this model, we find larger spreads in countries with large and interconnected financial sectors, weaker capital regulation and corporate governance, and fiscally stronger governments. Valuation gaps increase in anticipation of financial crises.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Innovating for improved healthcare: Sociotechnical and innovation systems perspectives and lessons from the NHS
Authors: Marjanovic Sonja , Altenhofer Marlene , Hocking Lucy , Chataway Joanna , Ling Tom
Published: January 2020

Healthcare systems with limited resources face rising demand pressures. Healthcare decision-makers increasingly recognise the potential of innovation to help respond to this challenge and to support high-quality care. However, comprehensive and actionable evidence on how to realise this potential is lacking. We adopt sociotechnical systems and innovation systems theoretical perspectives to examine conditions that can support and sustain innovating healthcare systems. We use primary data focussing on England (with 670 contributions over time) and triangulate findings against globally-relevant literature. We discuss the complexity of factors influencing an innovating healthcare system’s ability to support the development and uptake of innovations and share practical learning about changes in policy, culture, and behaviour that could support system improvement. Three themes are examined in detail: skills, capabilities, and leadership; motivations and accountabilities; and collaboration and coordination. We also contribute to advancing applications of sociotechnical systems thinking to major societal transformation challenges.
Impact of the Sister Hospital Program on Maternal Mortality and Neonatal Mortality in Nusa Tenggara Timur Province, Indonesia
Authors: Hardhantyo Muhammad , Chuang Ying-Chih
Published: January 2020

The province of Nusa Tenggara Timur (NTT) in the eastern part of Indonesia is known for high maternal mortality ratios (MMRs) and neonatal mortality eates (NMRs). Sister Hospital is a multicenter program, which aims to lower MMRs and NMRs in the deprived areas of Indonesia by providing comprehensive emergency services for maternal and newborn care. In this study, we evaluated the impact of the Sister Hospital program on MMRs and NMRs in 2009–17. We used linear mixed-effects models to analyze the program’s effects. Study results suggested that in general, the Sister Hospital program reduced MMRs by 1.14/100 000 live births after adjusting for other sociodemographic factors. This study also found that the program effects varied by island, and the highest reduction in MMRs, were found on Sumba Island in which the log of MMRs decreased from 2.23 in 2009 to 2.01 in 2017. However, no effects on NMR outcomes by the program were found. These findings suggest that the Sister Hospital program can be a practical solution for lowering MMRs in rural Indonesia.
Beneficiary Views on Cash and In-Kind Payments: Evidence from Ethiopia's Productive Safety Net Programme
Authors: Hirvonen Kalle , Hoddinott John
Published: January 2020

Economists often default to the assumption that cash is always preferable to an in-kind transfer. Do beneficiaries feel the same way? This paper addresses this issue using longitudinal household data from Ethiopia, where a large-scale social safety net intervention (PSNP) operates. Even though most payments are made in cash, and even though the (temporal) transaction costs associated with food payments are higher than payments received as cash, most beneficiaries stated that they prefer their payments only or partly in food. Higher food prices induce shifts in stated preferences toward in-kind transfers. More food-secure households, those closer to food markets and to financial services are more likely to prefer cash. Though shifts occur, the stated preference for food is dominant: In no year do more than 17 percent of households prefer only cash. There is suggestive evidence that stated preferences for food are also driven by self-control concerns.
Phylogeny and reclassification of Carpophilinae (Coleoptera: Nitidulidae), with insights into the origins of anthophily
Authors: Powell Gareth S , Cline Andrew R , Duffy Alexandra G , Zaspel Jennifer M
Published: January 2020

The family Nitidulidae is known for its diverse life histories, with some species considered economically detrimental pests, while others perform critical ecosystem functions. Despite this, their evolutionary relationships still lack support and understanding. A robust phylogenetic hypothesis and revised taxonomic classification for this group, particularly the subfamily Carpophilinae, could help delineate key lineages for assessing the evolution of both beneficial and pestiferous traits. The most complete molecular phylogeny of Carpophilinae to date, based on 37 ingroup taxa, covering four of the six recognized genera, is presented. Six genetic loci were used (16S, 18S, 28S, COI, H3 and ITS2), providing a total of 3500 bp of data. These data were generated using a novel method discussed here: wide-seq. Wide-seq utilizes next-generation sequencing platforms to generate data for specific loci that overlap with traditional Sanger sequences for the group. Carpophilinae recover as a well-supported clade with respect to the outgroup taxa. The genera Nitops, Urophorus and Caplothorax stat. nov. recover as monophyletic with high support. Caplothorax is formally given generic rank with a redescription and diagnosis. Anthophilous behaviour is coded for all taxa and an ancestral state reconstruction is performed, predicting multiple origins of this behaviour within Carpophilinae.
Beyond Resilience
Authors: Cho Eunji , Docherty Sharron L.
Published: January 2020

This article explores the concept of human flourishing in the context of adolescents and young adults with cancer, using Rodgers' Evolutionary Concept Analysis method. We describe flourishing in adolescents and young adults with cancer experience as a continuous and dynamic process of growth and maturity among intrapersonal, interpersonal, and person-environmental dimensions. Flourishing adolescents and young adults with cancer achieve internal integration, evoke positive changes in their environments, and ultimately create a harmonious and balanced existence with the outside world. Human flourishing can be a new health care goal that nurses can apply to this population.
Words Matter
Authors: Blakeman John R.
Published: January 2020

Sex and gender are not equivalent concepts, even though these 2 variables are often used interchangeably by researchers. The precise use of variables is critical to ensure that research and theoretical work is of the highest quality. This article defines sex and gender and the importance of recognizing both of these variables as being unique and then demonstrates the benefit of measuring both of these variables using the cardiovascular disease literature as an exemplar. Additionally, recommendations for scholars regarding the use of sex and gender in the research and theoretical literature are provided.
A New Perspective on Spiritual Care
Authors: Donesky DorAnne , Sprague Emily , Joseph Denah
Published: January 2020

Spirituality is a key focus and ethical obligation of nursing practice, but many nurses express uncertainty or discomfort with this aspect of their role. The purpose of this article is to explore the domains of religion, spirituality, and culture as commonly conceptualized by chaplains, as a framework for nurses to provide spiritual care interventions to patients in acute care hospitals. Using anecdotes and illustrations from palliative care practice, this article discusses the enhanced benefits to patients and families when spiritual needs are addressed, with specialty-level chaplain interventions, primary spiritual interventions provided uniquely by nurses, or interventions that require the cooperation of both professions. Lessons learned from the inpatient palliative care team experience can also apply to chaplaincy and nursing care for patients in settings beyond the acute care hospital and in disciplines beyond palliative care.
Development of a Theory of Wisdom-in-Action for Clinical Nursing
Authors: Matney Susan A. , Avant Kay , Clark Lauren , Staggers Nancy
Published: January 2020

Nurses published dialogues on wisdom; yet, a conceptual model is unavailable. We present the development process for a theory of wisdom-in-action for clinical nursing developed in 3 phases: (1) a deductively derived model using derivation and synthesis; (2) inductively, a constructivist grounded theory captured the experience of wisdom in nursing practice; and (3) the 2 theories were synthesized into a nascent theory. The theory describes 2 antecedent dimensions, person-related and setting-related factors, and 2 types of wisdom, general and personal. The theory provides a framework for translating wisdom in nursing practice, depicting both the science and art of nursing.
Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana, 2011–2016
Authors: Mehta Pooja K. , Kieltyka Lyn , Bachhuber Marcus A. , Smiles Dana , Wallace Maeve , Zapata Amy , Gee Rebekah E.
Published: January 2020

OBJECTIVE:

To examine preventable pregnancy-related deaths in Louisiana by race and ethnicity and maternal level of care to inform quality improvement efforts.

METHODS:

We conducted a retrospective observational descriptive analysis of Louisiana Pregnancy-Associated Mortality Review data of 47 confirmed pregnancy-related deaths occurring from 2011 to 2016. The review team determined cause of death, preventability, and contributing factors. We compared preventability by race–ethnicity and maternal level of care of the facility where death occurred (from level I: basic care to level IV: regional perinatal health center) using odds ratios (ORs) and 95% CIs.

RESULTS:

The rate of pregnancy-related death among non-Hispanic black women (22.7/100,000 births, 95% CI 15.5–32.1, n=32/140,785) was 4.1 times the rate among non-Hispanic white women (5.6/100,000, 95% CI 2.8–10.0, n=11/197,630). Hemorrhage (n=8/47, 17%) and cardiomyopathy (n=8/47, 17%) were the most common causes of pregnancy-related death. Among non-Hispanic black women who experienced pregnancy-related death, 59% [n=19] of deaths were deemed potentially preventable, compared with 9% (n=1) among non-Hispanic white women (OR 14.6, 95% CI 1.7–128.4). Of 47 confirmed pregnancy-related deaths, 58% (n=27) occurred at level III or IV birth facilities. Compared with those at level I or II birth facilities (n=2/4, 50%), pregnancy-related deaths occurring at level III or IV birth facilities (n=14/27, 52%) were not less likely to be categorized as preventable (OR 2.0, 95% CI 0.5–8.0).

CONCLUSION:

Compared with non-Hispanic white women, pregnancy-related deaths that occurred among non-Hispanic black women in Louisiana from 2011 to 2016 were more likely to be preventable. The proportion of deaths that were preventable was similar between lower and higher level birth facilities. Hospital-based quality improvement efforts focused on addressing hemorrhage, hypertension, and associated racial inequities may prevent pregnancy-related deaths in Louisiana.
Acute Herpes Simplex Virus Hepatitis in Pregnancy
Authors: Calix Roberto X. , Loeliger Kelsey B. , Burn Martina S. , Campbell Katherine H.
Published: January 2020

BACKGROUND:

Herpes simplex virus (HSV) causes only 2–4% of all acute hepatitis but has high morbidity and mortality. Pregnancy is a risk factor for HSV hepatitis. We describe a case of gestational HSV hepatitis.

CASE:

A 32-year old woman, gravida 2 para 1, presented at 38 2/7 weeks of gestation with back pain and fetal tachycardia. She became febrile after admission, had spontaneous rupture of membranes, and was delivered by cesarean for malpresentation. Postpartum, she became persistently febrile and developed transaminitis, symptomatic hypotension, and pancytopenia despite antibiotics. Imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy. Serum polymerase chain reaction (PCR) screening identified HSV-1 infection. The patient recovered on acyclovir. There was no evidence of neonatal seroconversion.

CONCLUSION:

Herpes simplex virus hepatitis causes significant morbidity, and pregnant women are susceptible to severe infections. Pregnant or peripartum women with acute febrile hepatitis require prompt evaluation for HSV with serum PCR screening.
Association of Oxytocin Use and Artificial Rupture of Membranes With Cesarean Delivery in France
Authors: Girault Aude , Bonnet Camille , Goffinet François , Blondel Béatrice , Le Ray Camille
Published: January 2020

OBJECTIVE:

To evaluate whether the decrease in the frequency of oxytocin administration and artificial rupture of membranes observed between the 2010 and 2016 French Perinatal Surveys was associated with a change in the frequency of cesarean delivery or cesarean delivery indications among women who entered labor spontaneously.

METHODS:

This cross-sectional study included women who participated in the 2010 and 2016 French National surveys who had singleton pregnancies and who gave birth at at least 37 weeks of gestation after spontaneous labor to a liveborn neonate in cephalic presentation. To test whether the observed decrease of oxytocin administration and artificial rupture of membranes between the two study years was explained by the women's individual characteristics and maternity units' organizational characteristics change, multivariable analyses were performed. The same strategy was applied for the change in intrapartum cesarean delivery rates between the 2 years. These analyses were repeated in nulliparous, low obstetric risk women, multiparous low obstetric risk women, and women with a previous cesarean delivery. The cesarean delivery indications were compared in 2010 and 2016.

RESULTS:

Oxytocin administration decreased significantly from 58.3% in 2010 to 45.2% in 2016 (adjusted odds ratio [aOR] 0.51; 95% CI 0.47–0.55), as did artificial rupture of membranes, from 52.4% to 42.6% (aOR 0.66; 95% CI 0.62–0.71). The intrapartum cesarean delivery rate remained stable—6.9% compared with 6.6% (aOR 0.93; 95% CI 0.82–1.06). The same patterns were observed in low risk groups and women with a previous cesarean delivery. The cesarean delivery indications were similar in both years.

CONCLUSION:

The significant decrease in oxytocin administration and artificial rupture of membranes in 2016 compared with 2010 was not accompanied by an increase in the intrapartum cesarean delivery rate for women in France who entered labor spontaneously. These results support the recent international guidelines.
Operative Technique and Experience of One Referral Center With Vaginal Cesarean Delivery
Authors: Delplanque Sophie , Le Lous Maela , Isly Hélène , Coiffic Jean , Lassel Linda , Levêque Jean , Lavoué Vincent , Nyangoh Timoh Krystel
Published: January 2020

BACKGROUND:

To report the experience of vaginal cesarean delivery and describe the surgical technique.

METHOD:

This is a retrospective case series from one referral center of patients who underwent vaginal cesarean delivery from 2000 to 2017, presenting a step-by-step operative technique with a video. The operative technique consists of: 1) development of a transvaginal bladder flap by dissecting the bladder off the cervix, thereby exposing the lower uterine segment; 2) making a vertical segment incision up to the highest part of the lower uterine segment, just below the muscular portion of the uterus; 3) extraction of the fetus; and 4) reconstruction of the lower uterine segment and vagina.

EXPERIENCE:

Seven patients with maternal indications for urgent premature delivery who underwent vaginal cesarean delivery were included. Indications were severe bleeding (n=3), severe previable preeclampsia (n=2), severe heart failure (n=1), and stroke (n=1). The average gestational age at delivery was 21 2/7 weeks (18 2/7–24 1/7 weeks); median fetal birth weight was 300 g (179–500 g). There were no intraoperative complications attributable to the procedure.

CONCLUSION:

Vaginal cesarean delivery is a valuable technique for rapid fetal extraction of deceased or nonviable fetuses for severe maternal indications.
The immunopathogenesis of rheumatic immune adverse events from checkpoint inhibitors: prospects for targeted therapy
Authors: Calabrese Leonard H. , Calabrese Cassandra
Published: January 2020

Purpose of review

The introduction of checkpoint inhibitors as well as other allied advances in cancer immunology has made immunotherapy a pillar in the treatment of cancer. At the same time, these therapies have been associated with a remarkable array of immune-mediated toxicities observed in virtually every organ system, a portion of which are rheumatic in nature or multisystem in expression making them of particular relevance for rheumatologists.

Recent findings

Most of our knowledge of these immune-related adverse events (irAEs) stems from clinical descriptive reports; we lack detailed understanding on immunopathogenesis for most complications. Therapeutic approaches are currently empiric and rely heavily on glucocorticoids and inhibitors of tumor necrosis factor. Serious consideration must now be given to advance our understanding of the immunopathogenesis of this emergent field and to exploit the full depth and breadth of the rich armamentarium of targeted therapies currently available to treat autoimmune and autoinflammatory diseases.

irAEs are and will continue to increase in incidence and pose major hurdles to the continuing success and evolution of cancer immunotherapy. Basic and translational research into pathogenesis of irAEs and clinical trials of targeted therapies for these complications is urgently needed. Rheumatologists are well poised to actively contribute to the care and research of these complications.
Klippel Feil Syndrome
Authors: Hachem Laureen D. , Mathieu Francois , Lamberti-Pasculli Maria , Hanak Brian W. , Zeller Reinhard , Kulkarni Abhaya V. , Drake James , Ibrahim George M.
Published: January 2020

Study Design.

Retrospective study.

Objective.

To define distinct Klippel-Feil syndrome (KFS) patient phenotypes that are associated with the need for surgical intervention.

Summary of Background Data.

KFS is characterized by the congenital fusion of cervical vertebrae; however, patients often present with a variety of other spinal and extraspinal anomalies suggesting this syndrome encompasses a heterogeneous patient population. Moreover, it remains unclear how the abnormalities seen in KFS correlate to neurological outcomes and the need for surgical intervention.

Methods.

Principal component (PC) analysis was performed on 132 KFS patients treated at a large pediatric hospital between 1981 and 2018. Thirty-five variables pertaining to patient/disease-related factors were examined. Significant PCs were included as independent variables in multivariable logistic regression models designed to test associations with three primary outcomes: cervical spine surgery, thoracolumbar/sacral spine surgery, and cranial surgery.

Results.

Fourteen significant PCs accounting for 70% of the variance were identified. Five components, representing four distinct phenotypes, were significantly associated with surgical intervention. The first group consisted of predominantly subaxial cervical spine fusions, thoracic spine abnormalities and was associated with thoracolumbar/sacral spine surgery. The second group was largely represented by axial cervical spine anomalies and had high association with cervical subluxation and cervical spine surgery. A third group, heavily represented by Chiari malformation, was associated with cranial surgery. Lastly, a fourth group was defined by thoracic vertebral anomalies and associations with sacral agenesis and scoliosis. This phenotype was associated with thoracolumbar/sacral spine surgery.

Conclusion.

This is the first data-driven analysis designed to relate KFS patient phenotypes to surgical intervention and provides important insight that may inform targeted follow-up regimens and surgical decision-making.

Level of Evidence: 3
The Benefits of Sparing Lumbar Motion Segments in Spinal Fusion for Adolescent Idiopathic Scoliosis Are Evident at 10 Years Postoperatively
Authors: Ohashi Masayuki , Bastrom Tracey P. , Marks Michelle C. , Bartley Carrie E. , Newton Peter O.
Published: January 2020

Study Design.

A prospective multicenter study.

Objective.

To evaluate the effects of sparing lumbar motion segments on spinal mobility and Scoliosis Research Society-22 scores at 10 years after spinal fusion for major thoracic adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

In surgical correction for major thoracic AIS, the long-term benefits of sparing lumbar motion segments remain unclear.

Methods.

A prospective multicenter registry was reviewed and patients with major thoracic AIS (Lenke types 1–4) and availability of both preoperative and 10-year postoperative mobility data were included. Spinal fusions ending at L1 or above were defined as thoracic fusions (T), and at L2 or below as thoracic and lumber fusions (T + L). Spinal mobility was evaluated with a measuring tape. The excursions between the starting and ending positions were measured using the distance from the spinous processes of C7 to S1 for forward flexion (FF), and the distance from the tip of the middle finger to the floor for lateral flexion (LF). Substantial reduction of mobility was defined as a reduction rate (a ratio of postoperative change divided by preoperative mobility) of 40% or more. Motion data were correlated with lowest instrumented vertebra levels and group comparisons were performed.

Results.

We identified 151 patients (average age, 25.1 years). The spinal mobility decreased with more distal lowest instrumented vertebrae (FF, rho = 0.208; right LF, 0.257; left LF, 0.371; P ≤ 0.01). Consequently, the incidence of substantial reduction of mobility was lower in the T group (n = 109) than in the T + L group (n = 42) (FF: 17.4% vs. 50%, LF: 14.8% vs. 51.2%; P < 0.001). Patients with substantial reduction in LF had lower Scoliosis Research Society-22 scores for pain, function, satisfaction, and total scores than those without substantial reduction at 10-year follow-up (P < 0.05).

Conclusion.

The sparing of lumbar motion segments demonstrated clinically significant benefits at 10-year postoperatively.

Level of Evidence: 2
Do PROMIS Physical Function, Pain Interference, and Depression Correlate to the Oswestry Disability Index and Neck Disability Index in Spine Trauma Patients?
Authors: Bernstein David N. , Greenstein Alexander S. , D’Amore Taylor , Mesfin Addisu
Published: January 2020

Study Design.

Correlational study.

Objective.

In spine trauma patients, we aimed to assess the correlation of patient-reported outcome measurement information system (PROMIS) physical function (PF), pain interference (PI), and Depression scores with Oswestry Disability Index (ODI) and Neck Disability Index (NDI) ODI/NDI scores.

Summary of Background Data.

The ODI and NDI were intended as patient-reported outcome measures (PROMs) to evaluate clinical outcomes in patients seeking spine care. To date, the PROMIS has not been studied in the spine trauma population.

Methods.

Between January 1, 2015 and December 13, 2017, patients presenting to a single, level 1 trauma center spine clinic with known spine trauma were identified. A total of 56 patients (52 operative, 4 nonoperative) representing 181 encounters were identified. PROMIS PF, PI, and Depression, as well as the ODI or NDI, were administered to patients. Spearman rho (ρ) were calculated between PROMs.

Results.

A strong correlation exists between PROMIS PI and the ODI (ρ = 0.79, P < 0.001), while a strong-moderate correlation exists between PROMIS PF and the ODI (ρ = −0.61, P < 0.001). A moderate correlation exists between PROMIS Depression and the ODI (ρ = 0.54, P < 0.001). Strong correlations exist between PROMIS PI and the NDI (ρ = 0.71, P < 0.001) and PROMIS Depression and the NDI (ρ = 0.73, P < 0.001). A poor correlation exists between PROMIS PF and the NDI (ρ = −0.28, P = 0.005).

Conclusion.

PROMIS PF, PI, and Depression domains significantly correlate with the ODI and NDI; however, only PROMIS PI strongly correlates with both the NDI and ODI. This suggests that PROMIS PI can be used to capture similar information to that of the ODI or NDI but that PROMIS PF and Depression may offer additional clinical information.

Level of Evidence: 2
Arthroscopic Treatment of Ankle Impingement
Authors: Espinosa Norman , Wirth Stephan H.
Published: January 2020

The current article briefly discusses the impingement pathologies around the ankle joint and provides a short overview of the surgical technique.
Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis
Authors: Chaudhuri Dipayan , Granton David , Wang Dominic Xiang , Einav Sharon , Helviz Yigal , Mauri Tommaso , Ricard Jean-Damien , Mancebo Jordi , Frat Jean-Pierre , Jog Sameer , Hernandez Gonzalo , Maggiore Salvatore M. , Hodgson Carol , Jaber Samir , Brochard Laurent , Burns Karen E. A. , Rochwerg Bram
Published: January 2020

Objective:

The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period.

Data Sources:

We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).

Study Selection:

We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period.

Data Extraction:

Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, Pao
2 before and after intubation, Paco
2 after intubation, ICU length of stay, and short-term mortality.

Data Synthesis:

We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68–1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71–1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), Pao
2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or Pao
2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation Paco
2, ICU length of stay, or 28-day mortality.

Conclusions:

We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.
Protective role of functional food in cognitive deficit in young and senile rats
Authors: Attia Hanan Naeim , Ahmed Kawkab A.
Published: January 2020

Cognitive decline and neurodegenerative diseases pose a significant burden on healthcare resources both in developed and developing countries which is a major socio-economic and healthcare concern. Alzheimer’s disease is the most common form of progressive neurodegenerative dementia of the aged brain. Aluminum is a constituent of antacids, deodorants, kitchenware and food additives which allows easy access into the body posing risk to development of senile dementia of Alzheimer’s type. Virgin coconut oil was declared as a potential cognitive strengthener. Assessment of cognitive and memory-enhancing effects of virgin coconut oil in senile and young rats to gain vital insights into its effective use in the prevention of neurodegeneration in dementia/Alzheimer’s disease-like manifestations and alleviate cognitive dysfunction and learning impairment with neuronal damage imparted by daily oral intake of aluminum. Alzheimer’s disease-like symptoms and memory impairment were experimentally induced using oral anhydrous aluminum chloride given daily for five successive weeks in young and old age albino rats. Treatment groups received virgin coconut oil to assess protection during the experimental period. Behavioral test, Morris water maze was conducted before/after induction/treatment. At the end of the experimental period, cholinergic, dopaminergic, noradrenergic and serotonergic neurotransmission as well as brain-derived neurotrophic factor were being investigated, in addition to immunochemical and histopathological examination of targeted brain regions. Virgin coconut oil significantly improved cholinergic activity and monoaminergic neurotransmission. Moreover, immunochemical and histopathological examination revealed marked protection with virgin coconut oil against aluminum-induced Alzheimer’s disease-like pathology and cognitive deficit.
Direct Oral Anticoagulants and Coronary Artery Disease: The Debacle of the Aspirin Era?
Authors: García-Ropero Álvaro , Vargas-Delgado Ariana P. , Santos-Gallego Carlos G. , Badimon Juan J.
Published: January 2020

Long-standing aspirin is the cornerstone to prevent recurrence of thrombotic events in patients with ischemic heart disease. However, clopidogrel, a more potent antiplatelet agent, is preferred over aspirin in targeted populations, including those with a high risk of gastrointestinal bleeding. In addition, clopidogrel offers superior oral tolerance, and it may reduce the rates of intracranial hemorrhages compared with aspirin. However, an extensive inhibition of the coagulation cascade seems to be reasonable to minimize thrombotic events in such patients. After several failed exploratory investigations in the past with vitamin K antagonists, the newest direct oral anticoagulants may represent an alternative. To counterbalance bleeding complications, a low dose of these agents should be considered. Few publications have already showed promising results with the combination of clopidogrel and low-dose direct oral anticoagulants. Further investigations should be addressed to elucidate whether this is the downfall of the aspirin era for secondary prevention of atherosclerotic cardiovascular events.
Physical Activity in Adults With Wearable Cardioverter Defibrillators in the Post–Myocardial Infarction Period
Authors: Tripp Connor , Burch Ashley E. , Erath Julia W. , Hain Andreas , Sears Samuel F.
Published: January 2020

Purpose:

Wearable cardioverter defibrillators (WCDs) provide lifesaving defibrillation and are equipped with accelerometers, capable of providing information on patient wear time and physical activity (PA). The purpose of this study was to report on patient PA while wearing a WCD.

Methods:

This study derived data from the WCD vendor in patients prescribed WCD post–myocardial infarction (MI) with left ventricular ejection fraction ≤35% in 2016. Using the device accelerometer, the relationship between wear time and PA was examined in a sample of consistent wearers of the WCD. Demographic variables, including sex and age, were examined for impact on wear time and PA. Changes in PA over time were also examined.

Results:

A total of 1952 patients (71% male) with a median age of 63 yr were included. Descriptive analyses indicated that overall median wear time was 23.8 hr/d; PA was 5568 steps/d. Significant differences in PA over time were identified, with median steps increasing by 67% from the first week of wear to the last week of wear. Patient age and wear time significantly predicted PA; patient age also significantly predicted patient wear time. There were significant differences in median hours of wear time, as well as median steps, based on sex.

Conclusions:

PA in adults early after hospital discharge is modest and improves over the course of the 90-d WCD prescription in regular wearers. Improved health status may account for this change. The WCD accelerometer may have value in future clinical care and research by providing a window into daily patient PA levels via remote monitoring.
5-Fluorouracil Management of Oculofacial Scars: A Systematic Literature Review
Authors: Bui Anh D. , Grob Seanna R. , Tao Jeremiah P.
Published: January 2020

Purpose:

To review the literature for the safety and efficacy of intralesional 5-fluorouracil (5-FU) in the management of oculofacial scars.

Methods:

A literature search was performed in July 2019 in the PubMed database to identify reports of the use of 5-FU injections for modulating oculofacial cutaneous scars. The search yielded 152 articles, of which 15 met criteria outlined for assessment. Data were abstracted from these 15 relevant articles.

Results:

While there were no high-level prospective randomized controlled trials, 8 were lower-quality randomized controlled trial, 3 were retrospective cohort studies, and 4 were case series. Most studies pooled results of facial and nonfacial cutaneous applications. Three studies focused solely on oculofacial applications, and these were all lower-level evidence studies. The study outcomes included scar dimension reduction, erythema, patient satisfaction score, observer assessment of scar improvement, and recurrence rates. 5-Fluorouracil was administered as monotherapy or as part of multimodality treatment with other agents (usually corticosteroids) or with CO2 laser, radiotherapy, or pulsed dye laser. 5-Fluorouracil was usually given as an intralesional injection, but in some studies, it was applied topically after micropuncture of the skin. The number and timing of treatments varied between studies. Overall, the level of safety of 5-FU was high. Pain with injection was the most common reported side effect. Other common adverse side effects included pruritus, telangiectasias, changes in pigmentation, and purpura, and 2 studies noted more serious events, such as ulceration, superficial necrosis, and local infection. There were no severe side effects such as anaphylaxis, immune suppression, secondary malignancy, systemic infection, blindness, or death. In all studies, 5-FU was associated with prophylaxis of oculofacial scars or improvement of keloids or hypertrophic scars in terms of reducing size, erythema, and pruritus. 5-Fluorouracil application was associated with favorable patient satisfaction and observer assessment scores especially compared with corticosteroid injections alone.

Conclusions:

High-quality randomized controlled trials are currently lacking, and the existing literature is predominately not specific to use of 5-FU on the face. These studies, however, suggest that intralesional 5-FU is safe and probably more effective than other options in the management of cutaneous scars in the oculofacial region. The delivery methods, timing, dosing, and concomitant therapies were highly variable. Further high-quality controlled studies specific to oculofacial scars may be indicated to assess the efficacy of 5-FU and to establish the best protocols for administering this medication.
Removal of Orbital Metallic Foreign Bodies With Image-Guided Surgical Navigation
Authors: Zhao Yiping , Li Yinwei , Li Zhengkang , Deng Yuan
Published: January 2020

Purpose:

To describe the use of an image-guided 3-dimensional surgical navigation system for the removal of metallic foreign bodies from the human intraorbital region.

Patients and methods:

Between January 2016 and June 2019, 30 patients with metallic foreign bodies in the orbital area underwent image-guided 3-dimensional surgical navigational removal at the authors’ center, and their data were retrospectively analyzed. Patients’ age, gender, complaints, cause of initial injury, location, interval between injury, and surgery were recorded. Preoperative CT scans of the orbits were obtained and used for preoperative planning. The 3-dimensional navigation system was used for intraoperative navigation.

Results:

In all 30 patients, the foreign bodies were removed by minimally invasive access without any severe complications. The intraoperative average depth of foreign bodies was 19.98 ± 11.47 mm which was consistent with the depth measured in preoperative planning. The mean length, width, and height of foreign bodies determined in preoperative planning were confirmed by postoperative measurements. There was no significant difference between preoperative and postoperative mean logarithm of Mininal Angle Resolution (logMAR) best-corrected visual acuity. According to the postoperative CT scan, all 30 patients’ metallic foreign bodies were successfully removed by surgeries using the surgical navigation system. Most patients who presented with diplopia, eye movement pain, and paresthesia were improved after surgery.

Conclusion:

This study demonstrated that computer-assisted image-guided 3-dimensional surgical navigation had the advantages of accurate real-time localization of foreign bodies, minimizing collateral damage, determining the appropriate surgical path, and increasing the successful rate of foreign body retrieval.
Factors Influencing Time to Cochlear Implantation
Authors: Dornhoffer James R. , Holcomb Meredith A. , Meyer Ted A. , Dubno Judy R. , McRackan Theodore R.
Published: January 2020

Objective:

To determine demographic and audiologic factors associated with time to treatment with cochlear implantation.

Methods:

Retrospective review of a prospectively maintained adult cochlear implant database. A total of 492 patients were implanted from 2012 to 2017. Time to implantation, preimplantation audiologic outcomes, and demographic data were collected. Multivariate analysis was undertaken to establish demographic/audiologic factors that predict time to cochlear implantation.

Results:

Using multivariate analysis, nonwhite race (hazard ratio 0.157, p = 0.038) and increased age (hazard ratio 0.970, p = 0.038) were associated with increased time to cochlear implantation. Nonwhite patients had significantly higher pure-tone averages and lower speech recognition scores (consonant–nucleus–consonant words and AzBio sentences in quiet) and were less likely to use hearing aids as compared with white patients (all p < 0.001). Sex (p = 0.188), health insurance type (p = 0.255), preoperative hearing aid use (p = 0.174), and audiologic outcomes were not significant predictors of time to implantation.

Conclusion:

Nonwhite patients have poorer preoperative hearing and speech recognition and lower hearing aid use and are at risk for delay in referral and treatment for severe to profound sensorineural hearing loss. Other demographic factors, notably health insurance status, did not significantly predict time to cochlear implantation. Given the observed hearing healthcare disparities, special outreach programs may be needed to ensure timely cochlear implantation and effective hearing screening and rehabilitation.
Monitoring Cochlear Nerve Integrity During Vestibular Schwannoma Microsurgery in Real-Time Using Cochlear Implant Evoked Auditory Brainstem Response and Streaming Neural Response Imaging
Authors: Patel Neil S. , Saoji Aniket A. , Olund Amy P. , Carlson Matthew L.
Published: January 2020

Objective:

Intraoperative far-field auditory brainstem response (ABR) and direct cochlear nerve action potential monitoring using neural response imaging (NRI) are techniques for monitoring the cochlear nerve during vestibular schwannoma (VS) surgery. A new paradigm has developed where the cochlear nerve is anatomically preserved during tumor removal to facilitate cochlear implantation in select circumstances. This report describes the use of an unmodified commercial cochlear implant (CI) to elicit electrically-evoked direct cochlear nerve and far-field ABR monitoring to evaluate the status of the cochlear nerve during tumor resection in real time.

Patients:

Adult female with unilateral, sporadic VS.

Intervention(s):

Cochlear implantation followed by translabyrinthine resection of VS in single operation.

Main Outcome Measures:

During tumor resection intra-cochlear electrodes were used to deliver electrical stimulation and measure NRI or the cochlear nerve action potential. Electrically-evoked ABR (eABR) was measured using surface electrodes and wave V was monitored (far-field ABR) during surgery.

Results:

A 61-year-old female was evaluated for a unilateral, enlarging intracanalicular VS with asymmetric SNHL. The patient opted for microsurgery and due to her bilateral hearing loss was a candidate for CI. Cochlear implantation with an unmodified, commercially available lateral wall electrode was performed. The remainder of the approach and tumor resection was performed under continuous eABR and NRI monitoring. Gross total resection was achieved with intact eABR and NRI at the conclusion of the case. Changes in ABR and NRI consistently recovered after modifying dissection strategy. The patient reported auditory percepts with her cochlear implant postoperatively.

Conclusions:

This report demonstrates the feasibility of using real-time NRI and eABR with a CI to facilitate preservation of the cochlear nerve during VS microsurgery. Using this method to mitigate cochlear nerve trauma during microsurgery may preserve the option of CI for hearing rehabilitation.