bluuebunny/crossref_metadata_2025 huggingface dataset:
Low Expression of BRCA1 as a Potential Relapse Predictor in B-Cell Acute Lymphoblastic Leukemia
Authors: Villegas-Ruíz Vanessa , Medina-Vera Isabel , Arellano-Perdomo Paulina , Castillo-Villanueva Adriana , Galván-Diaz Cesar A. , Paredes-Aguilera Rogelio , Rivera-Luna Roberto , Juárez-Méndez Sergio
Published: February 2023

B-cell acute lymphoblastic leukemia (B-ALL) is the most common childhood hematological malignancy worldwide. Treatment outcomes have improved dramatically in recent years; despite this, relapse is still a problem, and the potential molecular explanation for this remains an important field of study. We performed microarray and single-cell RNA-Seq data mining, and we selected significant data with a P-value<0.05. We validated BRCA1 gene expression by means of quantitative (reverse transcription-polymerase chain reaction.) We performed statistical analysis and considered a P-value<0.05 significant. We identified the overexpression of breast cancer 1, early onset (BRCA1; P-value=2.52−134), by means of microarray analysis. Moreover, the normal distribution of BRCA1 expression in healthy bone marrow. In addition, we confirmed the increases in BRCA1 expression using real-time (reverse transcription-polymerase chain reaction and determined that it was significantly reduced in patients with relapse (P-values=0.026). Finally, we identified that the expression of the BRCA1 gene could predict early relapse (P-values=0.01). We determined that low expression of BRCA1 was associated with B-cell acute lymphoblastic leukemia relapse and could be a potential molecular prognostic marker.
Safety and Efficacy of Alendronate to Treat Osteopenia in Children During Therapy for Acute Lymphoblastic Leukemia: A Retrospective Cohort Study of Sequential Outcomes
Authors: MacDonald Paula , Cranston Amy , Virdee Misha , Farncombe Troy , Athale Uma , Barr Ronald D.
Published: February 2023

Background:

Low bone mineral density is encountered in children with acute lymphoblastic leukemia (ALL) before, during, and after treatment. Prior experience with alendronate, an oral bisphosphonate, demonstrated high tolerability and evident clinical efficacy. However, concerns have been expressed about the long-term safety and utility of such agents in children.

Procedure:

Sixty-nine children with ALL received alendronate for a mean of 87 weeks after dual-energy radiograph absorptiometry. Dual-energy radiograph absorptiometry was repeated following the completion of alendronate, and 5 to 9 years later in a subgroup of 32 children. Lumbar spine areal bone mineral density (LS aBMD) Z scores were obtained.

Results:

The mean LS aBMD Z score rose from −1.78 to−0.47 (P <0.0001). There was a modest median loss of LS aBMD subsequently in the 32 subjects on long-term follow-up. Almost 80% (N=172) of the children remain in continuous complete remission at a mean of 14.5 years from diagnosis. Of those who received alendronate, which was almost uniformly well tolerated, 7/69 (10.3%) relapsed compared with 19/89 (21.3%) who did not receive the drug.

Discussion:

Alendronate appears to be well tolerated and moderately effective in osteopenic children with ALL. Whether it offers protection against relapse of leukemia needs further study.
Factors influencing the self-perceived mobility of active unilateral lower limb amputees assessed with the Prosthetic Mobility Questionnaire: a brief report
Authors: Morosato Federico , Gentile Cosimo , Di Bernardo Arianna , Gruppioni Emanuele , Miccio Antonella
Published: February 2023

The Prosthetic Mobility Questionnaire (PMQ 2.0) represents a reliable solution for evaluating amputees’ self-perceived mobility. The study aimed to evaluate the perceived mobility of middle-aged users with a traumatic amputation using the PMQ 2.0 and to assess the influence of age, stump and phantom limb pain, amputation level, time since amputation, and prosthesis use on it. Fifty subjects were recruited. The median value of the score was higher than previously published reference values, reflecting the ‘active’ mobility status of the sample. The hours of prosthesis use per day explained about 21% of the variance of the questionnaire score and was a significant predictor of perceived mobility. Reference values for the recently developed PMQ 2.0 survey and relative to active, traumatic amputees were reported. As prosthesis use was a significant predictor of the amputees’ perceived mobility, prolonged use of the artificial limb should be always encouraged in clinical practice.
The Effect of Exercise on Weight and Body Composition of Breast Cancer Patients Undergoing Chemotherapy
Authors: Li Xinyu , Wang Jiaqi , Zhang Jinyu , Zhang Nan , Wu Caiqin , Geng Zhaohui , Zhou Jie , Dong Lu
Published: February 2023

Background

Chemotherapy is a primary adjuvant treatment strategy for breast cancer patients, accompanied by weight gain and negative changes in body composition. However, it is unknown whether exercise is effective in preventing said weight gain and mitigating body composition changes of breast cancer patients undergoing treatment.

Objectives

The current study used meta-analysis with trial sequential analysis to determine exercise effect on weight and body composition of breast cancer patients undergoing chemotherapy.

Methods

Cochrane Library, PubMed, EMBASE, EBSCO, Scopus, and SinoMed were searched (from the database start date up to August 16, 2021) for randomized controlled studies evaluating the effect of exercise on weight or body composition among breast cancer patients during chemotherapy. RevMan software and TSA Software were used to assess the risk of bias and analyze study results.

Results

In total, 13 studies comprising 1828 participants were included. Meta-analysis showed that exercise could lead to lower weight, body mass index (BMI), and percentage of body fat during chemotherapy for breast cancer patients, and muscular strength showed significant improvement. Trial sequential analysis showed that evidence of muscular strength was sufficient, but BMI evidence requires further confirmation.

Conclusion

This meta-analysis found significant differences in body weight, BMI, percentage of body fat, and muscular strength between exercise intervention groups and control groups.

Implications for Practice

Exercise during chemotherapy is beneficial in preventing weight gain and negative changes in body composition. Medical practitioners should encourage patients to start exercising during chemotherapy. However, further studies are required because insufficient sample sizes meant that outcomes of body composition remain unconfirmed.
Correlates of Health-Related Quality of Life in a National Sample of Older Adult, Long-Term Survivors of Colorectal Cancer
Authors: Burrell Sherry A. , Sasso Gabrielle E. , Greenle Meredith MacKenzie
Published: February 2023

Background

Most survivors of colorectal cancer (CRC) are older adults who are at high risk of experiencing adverse effects and decreased health-related quality of life (HRQOL) related to cancer and its treatments.

Objective

This study aimed to describe HRQOL and the demographic and clinical factors associated with HRQOL among older adult, long-term survivors of CRC.

Methods

A sample of older adult, long-term survivors of CRC (N = 14 458) from the Surveillance Epidemiology and End Results-Medicare Health Outcomes Survey dataset was selected. Hierarchical multiple regression was used to analyze the contribution of demographic and clinical variables to HRQOL as measured by the Veterans Rand 12-item scale.

Results

The mean respondent age was 79 years with an average time from diagnosis to survey being about 13 years. In the final model, gender, race, education, income, previous radiation treatment, cardiovascular disease, inflammatory bowel disease, depression, pain, fatigue, functional status, and general health perception were all significantly correlated with mental HRQOL (R2 = 0.53). For physical HRQOL, age at diagnosis, race, marital status, education, time since diagnosis, comorbid conditions, depression, pain, fatigue, functional status, and general health perception were all significant correlates (R2 = 0.85). Symptoms were the largest contributors to mental and physical HRQOL, accounting for 43% and 50% of the variance, respectively.

Conclusion

Pain, depression, and fatigue significantly affect the HRQOL of older adult survivors of CRC, underscoring the need for long-term survivorship care.

Implication for Practice

Aggressive symptom assessment and management may be key to improving the HRQOL in this population.
Analyzing a Multifactorial Fall Prevention Program Using ARIMA Models
Authors: Mulkey David C. , Fedo Marc A. , Loresto Figaro L.
Published: February 2023

Background:

Preventing inpatient falls is challenging for hospitals to improve and often leads to patient injury.

Purpose:

To describe multifactorial patient-tailored interventions and to evaluate whether they were associated with a sustained decline in total and injury falls.

Methods:

A multifactorial fall prevention program was instituted over the course of several years. An interrupted time series design was used to assess the effect of each intervention on total and injury fall rates. ARIMA models were built to assess the step and ramp change.

Results:

Total fall rates decreased from 4.3 to 3.6 falls per 1000 patient days (16.28% decrease), and injury fall rates decreased from 1.02 to 0.8 falls per 1000 patient days (21.57% decrease). All the interventions contributed to fall reduction, with specific interventions contributing more than others.

Conclusions:

Using multiple interventions that are sustained long enough to demonstrate success reduced the total fall rate and injury fall rate.
Teaching Social Determinants of Health Through an Unfolding Case Study
Authors: Hekel Barbara E. , Pullis Bridgette C. , Edwards Allison P. , Alexander Juane
Published: February 2023

Background:

The impact of social determinants of health (SDOH) was developed to educate nursing students through the use of an unfolding case study.

Problem:

SDOH and population health are critical components of prelicensure nursing education. Unfolding case studies are a strategy to develop critical thinking and teach SDOH to nursing students.

Approach:

A model was used to develop the case study including a community assessment, which follows a male veteran and family through life events. Implementation of the unfolding case study took place over 3 consecutive semesters in a community health nursing course.

Outcomes:

This educational activity achieved standardized examination scores, which are intended to assess student preparedness for the National Council Licensure Examination (NCLEX), above the national averages. Student participation was above 90%.

Conclusion:

Unfolding case studies can present realistic scenarios that are useful to teach critical thinking. As the Next Generation NCLEX moves to scenario-based testing, unfolding case studies are a teaching strategy to prepare students.
MindingMe: A Feasibility Study on Conducting Neuroimaging Research Among Diverse Groups
Authors: Jones Lenette M. , Sullivan Stephen , Cuffee Yendelela , Monroe Korrey , Rafferty Jane , Giordani Bruno
Published: February 2023

Background

Neuroimaging tools, such as functional magnetic resonance imaging, are useful in understanding differences in brain activity that predict behavior change. Designing interventions based on brain activity and response may enhance current self-management regimens. Yet, diverse groups, such as Black women with chronic illness, have historically been left out of neuroimaging research.

Objectives

The aims of this study were to assess (a) the feasibility of conducting neuroimaging research among Black women with hypertension and (b) the predictors of willingness to participate in future studies.

Methods

A survey designed to assess interest in participating in neuroimaging research was distributed through a Facebook campaign targeting Metro-Detroit Blacks with hypertension. A 10-minute, 44-item survey queried the women regarding their perspectives related to participation in neuroimaging studies. Logistic regression analyses were conducted to predict willingness to participate in a future study; they included a range of predictors: demographic indicators, history of blood pressure diagnosis, systolic and diastolic blood pressure, and availability of a support person who could accompany the participant to a future study session.

Results

Two hundred fifty-seven Black women completed the survey. On average, the women were 59 years old, had been diagnosed with hypertension for 14 years, and had a systolic blood pressure of 141 mmHg. Participants were willing to travel 40 miles to participate, and many preferred to drive a personal vehicle. Some women were claustrophobic (20%) or had metal in their bodies (13%) and, therefore, would likely be ineligible to participate in neuroimaging studies. Some were nervous about the “small space” of a scanner, but others stated they would “enjoy participating” and wanted to “help future people…get well.” Women who had a support person to attend their appointment with them were almost 4 times more likely to state they would participate in future studies. Those who had been diagnosed with hypertension for more than 11 years (the median) were almost 3 times more likely to report interest in participating in a future study than those participants who had been diagnosed with hypertension for 11 years or less.

Discussion

Black women with hypertension were interested and eligible to participate in neuroimaging research. Despite some of the facilitators and barriers we identified, the women in our sample were interested in participating in future studies. The presence of a support person and length of time with a hypertension diagnosis are important predictors of willingness to participate in a future study.
Research Protocol for Sleep in Families With a Preterm Infant
Authors: Lebel Valérie , Forest Geneviève , Gervais Christine , Chénard Josée , Hamel-Hilaréguy Paméla , Axelin Anna
Published: February 2023

Background

Specificities regarding the quality and quantity of sleep of preterm infants and their parents following discharge of the preterm infant from the hospital are not well known. Given this lack of knowledge, the links between the sleep characteristics of these parents, family functioning, and their psychological well-being are also unclear.

Objectives

The purpose of this article is to summarize the research protocol of a cross-sectional, mixed-methods, convergent design study, which aims to evaluate the sleep patterns of preterm infants and both their parents and document the associations between sleep quality, parents’ psychological well-being, and family functioning during the posthospitalization period.

Methods

A convenience sample is used to recruit 30 families. For quantitative data collection, a questionnaire booklet consisting of validated questionnaires is used to measure sleep quality of each family member, parental psychological well-being, and family functioning completed by each parent. An actigraph and a sleep diary measure sleep quantity of each parent and the preterm infant. Afterward, semistructured interviews are carried out with each parent to explore their perceptions and needs concerning their infant’s and their own sleep quality. For data analysis, qualitative and quantitative data are analyzed separately and then merged to allow for an integrative interpretation of the results.

Results

The research project is ongoing; 25 of 30 families have completed the data collection. Data analysis is underway.

Discussion

This research will provide a global portrait of the families’ sleep 1 month after the preterm infant is discharged from the hospital, which is not well known to date. The results will help healthcare providers involved with preterm infants and their families after discharge from the hospital to increase their comprehension of the families’ reality and adapt their interventions to meet these needs.
Optic Perineuritis in an Asymptomatic SARS-CoV-2 Infection
Authors: Kollar Ryan , Patel Smit D. , Krothapalli Neeharika , Yan Lulu E. , Dimaandal Ian , Wolansky Leo J. , Leeman-Markowski Mason , Waitzman David
Published: February 2023

Introduction:

Optic perineuritis (OPN) is a previously undescribed sequela of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here we present a case of OPN that developed several weeks after initial confirmation of the presence of novel coronavirus RNA in the nasopharynx by polymerase chain reaction assay and subsequent confirmation of SARS-CoV-2 IgG seropositivity in the absence of other systemic inflammatory or infectious markers.

Case Report:

An asymptomatic 71-year-old man with noninsulin-dependent diabetes mellitus (NIDDM) tested RNA positive for SARS-CoV-2 during a routine screening of patients at a skilled nursing facility. ~3 weeks after the positive SARS-CoV-2 polymerase chain reaction test, the patient developed subacute ophthalmoparesis of the left eye, horizontal diplopia, retro-orbital pain, and frontal headache. An urgent magnetic resonance imaging of the head and orbits suggested OPN. Cerebrospinal fluid studies were without evidence of other infectious, inflammatory, neoplastic, or paraneoplastic processes. He was started on a 5-day course of high-dose intravenous steroids and later transitioned to oral steroid therapy. Sixteen days after the initiation of steroid therapy, the patient had no headache or retro-orbital pain and demonstrated a marked improvement in horizontal gaze.

Conclusion:

SARS-CoV-2-associated neurological sequelae have been increasingly recognized during the current coronavirus disease 2019 pandemic. The present case suggests that patients with confirmed SARS-CoV-2 positivity, even without pulmonary or other classic manifestations of active infection, may manifest diverse clinical presentations including postinfectious OPN that could be related to an underlying autoimmune reactive inflammatory response.
Impact of the Early COVID-19 Pandemic on the Number of HIV Preexposure Prophylaxis Uses and the Proportion of Preexposure Prophylaxis Users Receiving Sexually Transmitted Infection Testing Services
Authors: Schmidt Mark A. , Salas Suzanne B. , Donald Judy L. , Gift Thomas L. , Tao Guoyu
Published: February 2023

Background

With the potential impact of the COVID-19 pandemic on HIV preexposure prophylaxis (PrEP) care management, we assessed the number of PrEP users and sexually transmitted infection (STI) testing–eligible PrEP users, STI testing rates, and prevalence between prepandemic (January 1, 2018–March 31, 2020) and early-pandemic (April 1, 2020–September 30, 2020) periods.

Methods

In this retrospective cohort study, a PrEP user for a given quarter is defined as either a previous PrEP user or a PrEP initiator who has at least 1-day coverage of tenofovir/emtricitabine in the given quarter. The STI testing–eligible PrEP users for a given quarter were defined as those persons whose runout date (previous dispense date + days of tenofovir/emtricitabine supply) was in the given quarter.

Results

The quarterly number of PrEP users increased from the first quarter of 2018 to the first quarter of 2020 and then decreased in the second and third quarter of 2020. Among STI testing–eligible PrEP users who had ≤14 days between runout and next refill date, gonorrhea and chlamydia screening testing rates were 95.1% for prepandemic and 93.4% for early pandemic (P = 0.1011). Among all STI testing–eligible PrEP users who were tested for gonorrhea and chlamydia, gonorrhea prevalence was 6.7% for prepandemic and 5.7% for early pandemic (P = 0.3096), and chlamydia prevalence was 7.0% for prepandemic and 5.8% for early pandemic (P = 0.2158).

Conclusions

Although the early COVID-19 pandemic resulted in lower numbers of PrEP users and PrEP initiators, individuals who remained continuous users of PrEP maintained extremely high rates of bacterial STI screening. With high STI prevalence among PrEP users, assessments of PrEP care management are continuously needed.
Measuring Success: Disease Intervention Specialists Performance Metrics and Outcome Assessments
Authors: Cope Anna Barry , Mobley Victoria L. , Samoff Erika
Published: February 2023

Disease intervention specialists (DIS) are the cornerstone of public health. However, the incremental gains of DIS-led interventions are difficult to detect at the population level. Health departments attempt to quantify the impact of key DIS activities through performance measures that assess how many and how quickly both patients are interviewed, and contacts are notified, tested, and treated. However, DIS work encompasses more than case finding and existing performance measures may not capture the full value DIS provide to health departments. In this article, we first describe how DIS investigations and contact tracing are conducted for sexually transmitted diseases and other communicable diseases to understand how the definition of effectiveness may vary by disease. Then, we examine the benefits and limitations of traditional performance measures using syphilis investigations as an example. Recognizing the limits of existing measures will improve our understanding of DIS impact and assist in the development of new measures of effectiveness that better represent the totality of DIS work.
Chlamydia trachomatis Coinfection Does Not Influence Mycoplasma genitalium Bacterial Load in Urogenital Samples
Authors: Dirks Jeanne A.M.C. , van Loo Inge H.M. , Dukers-Muijrers Nicole H.T.M. , Wolffs Petra F.G. , Hoebe Christian J.P.A.
Published: February 2023

Background

Mycoplasma genitalium (MG) is associated with urethritis in men and weakly associated with pelvic inflammatory disease in women. Mycoplasma genitalium coinfections with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are commonly reported; however, little is known about their interaction. One study suggested that MG/NG coinfections might increase the bacterial load of NG, which has been shown to have a higher transmission potential. As even less is known about the impact of a simultaneous MG/CT infection, we assessed whether patients with urogenital MG/CT coinfections have a higher bacterial load than patients with a single infection.

Methods

There were 1673 urogenital samples from patients from a population-based chlamydia study, and our sexually transmitted infection clinic tested for both CT and MG. When positive, the load was quantified. Nonparametric tests compared the CT and MG load, and linear regression analyses tested the association of the CT and MG load within a patient.

Results

In 60 MG-positive patients, MG load ranged from 1.7 to 6.0 log10 copies/ml, similar to the CT load distribution. Only 6 patients were MG-positive and CT-negative, but the MG load distribution was similar to that of CT-positive patients (n.s.). The MG and CT load was unrelated in coinfected persons (n.s.).

Conclusions

We found no correlation between the CT and MG load in urogenital samples, and the MG load distribution was similar in CT-positive and CT-negative patients. These results could have implications for the transmission risk of these infections.
The limitation of accessing hospital services due to COVID-19 pandemic: a pilot study of the telephone triage to re-organize the access to a Center for Sexual Health in North-West Italy
Authors: Mastorino Luca , Delmonte Sergio , Ribero Simone , Quaglino Pietro , Testi Roberto ,   CeMuSS Nurse Staff Group, Dal Conte Ivano
Published: February 2023

Background

The COVID-19 pandemic-related health crisis has imposed measures aimed at reducing the overcrowding of health facilities, by developing telemedicine and by forcing many STI clinics to book appointments by telephone. In this work we evaluate the performance of the nursing telephone triage system, introduced in the major STI center in Northwest Italy, for the adequacy of clinical pathways for of symptomatic STI patients.

Methods

From January to March 2021, all symptomatic patients wishing to access the CeMuSS center first underwent nurse-led telephone triage. Symptoms suggestive of STIs were further classified into four syndromic presentations: cutaneous neoformations, genital and oral ulcers, ano-genital discharge, and finally other dermatological manifestations. All other clinical pictures were properly managed and eventually referred to other centres and not considered in the analysis. During the following medical examinations, the concordance between presumptive syndromic diagnosis and confirmed clinical diagnosis were recorded. Cohen's K-test was used to assess concordance.

Results

According to the Cohen’s K-test a good concordance between telephone presumptive diagnoses and medical clinical assessment was found (73.79% with a k = 0.611), whereas only an scarcely acceptable concordance between expected and real waiting time was established (75.51%, k = 0.34).

Conclusion

Concordance between nursing syndromic diagnosis and syndromic medically confirmed diagnosis is good from a clinical point of view but there is a limitation when considering a public health perspective. An optimal training of nurses may improve the method of telephone triage. For future ongoing emergencies, the implementation of telemedicine with accurate patient management systems is mandatory.
A Note on Pre-exposure prophylaxis (PrEP) preferences among women who inject drugs
Authors: Miley Kerry L. , Tran Nguyen K. , Elopre Latesha , Groves Allison , Stockman Jamila K. , Bazzi Angela R. , Carrico Adam , Mazzella Silvana , Roth Alexis M.
Published: February 2023

We informed women who inject drugs about different pre-exposure prophylaxis (PrEP) formulations; they then ranked their preferences. Daily oral PrEP was most preferred, followed by injectable PrEP and vaginal rings/gels, especially among women of color. Multiple PrEP options should be discussed with women who inject drugs to increase uptake.
Assortative Sexual Mixing by Age, Region of Birth, and Time of Arrival in Male-Female Partnerships in Melbourne, Australia
Authors: Greaves Kate E. , Fairley Christopher K. , Engel Jaimie L. , Ong Jason J. , Aung Ei T. , Phillips Tiffany R. , Chow Eric P.F.
Published: February 2023

Background

Patterns of sexual mixing may be influenced by demographic factors where individuals show a preference for partners with particular traits and may have different levels of risk for HIV and sexually transmitted infection transmission. We aimed to explore age differences and mixing by region of birth among male-female partnerships.

Methods

Male-female partnerships who presented to Melbourne Sexual Health Centre in Australia between 2015 and 2019 were investigated. Age and country of birth of sexual partners were collected. We calculated the age differences between partners and created tables demonstrating partnership mixing by age groups and by international region of birth.

Results

A total of 2112 male-female partnerships (i.e., 4224 individuals) were included. The median age was 27 years (interquartile range, 23–31 years). Between men and women in partnerships, the median age difference was 1 year. Nearly half of all individuals (49.1% [2072 of 4224]) were in a partnership with another individual in the same 5-year interval age group as their own, and a majority of individuals (58.5% [2334 of 3988]) were in a partnership with another individual from the same region of birth when compared with other regions.

Conclusions

There is a strong assortative sexual mixing pattern by age and region of birth among male-female partnerships in Melbourne, Australia. These results may have applications in further research to understand sexually transmitted infection transmission among clients attending sexual health centers, particularly those born overseas.
Topical Review: Optometry in Nepal—Clinical Practice, Research Advances, and Challenges
Authors: Khanal Safal , Paudel Nabin , Adhikary Rabindra , Joshi Mahesh Raj
Published: February 2023

SIGNIFICANCE

This article reviews educational standard, clinical practice, research advances, and challenges associated with optometry in Nepal and provides critical considerations for contemporary and new optometry programs in countries with similar socioeconomic status and health care systems.

Optometry education started in Nepal in 1998 with the primary objective of addressing the unmet needs of eye health and vision care in the country. Over the last two decades, this program has made significant contributions to facilitating and improving the delivery of quality eye care and establishing the nation's eye health system as an exemplary model in South Asia. Despite the positive impact in a short time, optometry education and the profession continue to face several challenges, including a shortage of training resources and facilities, poor quality control and regulation of practice standards, lack of professional recognition, limited pathways for entry to governmental jobs via the national public service commission, and limited clinical and academic opportunities in existing eye care programs. This article reviews current education and clinical practice standards, highlights research advances, and discusses present and future challenges in sustaining and improving the quality of education and advancing the scope of practice of optometry in Nepal. Given the limited access to primary eye care services in Nepal, appropriate professional recognition and integration into the national health system, and initiatives targeted at improving the delivery of optometry education in alignment with successful international models may provide a long-sought solution to making eye care services accessible to all and lowering the burden of visual impairment in the country.
Anterior Corneal High-order Aberrations in Fuchs’ Endothelial Corneal Dystrophy Classified by Scheimpflug Tomography
Authors: Bolac Ruveyde , Yildiz Elvin , Balci Sevcan
Published: February 2023

SIGNIFICANCE

Visual acuity may be limited after endothelial keratoplasty in Fuchs’ endothelial corneal dystrophy. This may be due to increased anterior high-order aberrations that persist after endothelial keratoplasty. It is not clear at what stage these aberrations begin. We aimed to evaluate how subclinical corneal edema affects anterior corneal high-order aberrations.

PURPOSE

We aimed to evaluate anterior corneal high-order aberrations according to the presence of subclinical corneal edema in Fuchs’ endothelial corneal dystrophy using Scheimpflug topography.

METHODS

All the patients underwent corneal topography (Sirius Scheimpflug-Placido disc camera; CSO Ophthalmic, Scandicci, Italy). Fifty-two eyes of 31 patients with Fuchs’ endothelial corneal dystrophy and 52 eyes of 35 patients without corneal problems were included. In addition, patients with Fuchs’ endothelial corneal dystrophy were divided into two groups according to subclinical corneal edema as with Fuchs’ endothelial corneal dystrophy-edema and Fuchs’ endothelial corneal dystrophy-nonedema. Subclinical corneal edema was defined based on the presence of at least two of three findings of the loss of regular isopachs, displacement of the thinnest point of the cornea, and posterior depression. High-order aberrations were expressed as Zernike polynomials in the 4- and 6-mm optical zone.

RESULTS

We found that subclinical corneal edema in Fuchs’ endothelial corneal dystrophy caused a larger 4-mm trefoil II and a smaller 6-mm spherical aberration II measurements than the nonedema group. The 6-mm total high-order aberrations, 6-mm coma aberration, and 4- and 6-mm trefoil II aberration measurements were larger, and the 6-mm spherical aberration II was smaller in Fuchs’ endothelial corneal dystrophy patients with edema compared with the healthy eyes.

CONCLUSIONS

The presence of subclinical corneal edema in Fuchs’ endothelial corneal dystrophy results in larger 4-mm trefoil II and smaller 6-mm spherical aberration II measurements. More patients with intermediate values are needed to evaluate the effect of these aberrations on visual acuity.
Measurement of Aniseikonia Tolerance in Binocular Fusion
Authors: Hoshikawa Rie , Handa Tomoya , Akaishizawa Chiho , Shoji Nobuyuki
Published: February 2023

SIGNIFICANCE

The determination of aniseikonia tolerance may aid in developing optimal treatment plans for cataract surgery, refractive surgery, and refractive correction with glasses and contact lenses.

PURPOSE

This study aimed to measure aniseikonia tolerance.

METHODS

We included 33 patients (mean age ± standard deviation, 28.9 ± 6.4 years; male/female, 12:21) with anisometropia ≤1.0 D and best spectacle-corrected visual acuity of 20/20 or more in both eyes, with no ophthalmologic disease other than refractive errors and no history of ocular surgery. The exclusion criteria were anisometropia >1.0 D, axial length difference >0.5 mm, corneal refractive power difference >0.5 D, astigmatism >3.0 D, stereoacuity threshold >100 arcsec according to the Titmus Stereo Test, and >0% aniseikonia according to the New Aniseikonia Test. Aniseikonia tolerance was assessed using Eyemark Hello, a haploscope using gaze detection technology. Although the optotype of one eye was enlarged or reduced at a speed of 2%/s, the patients were instructed to press a button on the controller to indicate blurring, flickering, and diplopia. The value at which the patient responded was considered the aniseikonia tolerance value and assessed thrice per eye, five times if the values were highly variable, and then averaged.

RESULTS

The mean aniseikonia tolerance was approximately 3%; the median value was approximately 2% (range, 1.0 to 11.5%; dominant eye, 3.3 ± 2.6%; nondominant eye, 2.9 ± 1.8%). No significant difference in aniseikonia tolerance between the dominant and nondominant eyes was observed for the enlarged optotypes. No case showed changes in the ocular alignment before discomfort occurred. No significant correlation was observed between aniseikonia tolerance and anisometropia, axial length difference, corneal power difference, and ocular deviation.

CONCLUSIONS

Aniseikonia should be maintained at <2% for a comfortable visual environment. Aniseikonia tolerance may be an important indicator for cataract surgery, refractive surgery, and spectacle correction.
Determining the Association Between Emergency Department Crowding and Debriefing After Pediatric Trauma Resuscitations
Authors: Soriano Pamela , Kanis Jessica , Abulebda Kamal , Schwab Sandra , Coffee R. Lane , Wagers Brian
Published: February 2023

Background

Debriefing in the pediatric emergency department (PED) is an invaluable tool to improve team well-being, communication, and performance. Despite evidence, surveys have reported heavy workload as a barrier to debriefing leading to missed opportunities for improvement in an already busy ED. The study aims to determine the association between the incidence of debriefing after pediatric trauma resuscitations and PED crowding.

Methods

A total of 491 Trauma One activations in Riley Children's Hospital Pediatric Emergency Department that presented between April 2018 to December 2019 were included in the study. Debriefing documentations, patient demographics, time and date of presentation, mechanism of injury, injury severity score, disposition from PED, and length of stay (LOS) were collected and analyzed. The National Emergency Department Overcrowding Scale score at arrival, Average LOS, total PED census, total PED waiting room census, and rates of left without being seen were compared between groups.

Results

Of 491 Trauma One activations presented to our PED, 50 (10%) trauma evaluations had documented debriefing. The National Emergency Department Overcrowding Scale score at presentation was significantly lower in those with debriefing versus without debriefing. In addition, the PED hourly census, waiting room census, average LOS, and left without being seen were also significantly lower in the group with debriefing. In addition, trauma cases with debriefing had a higher proportion of patients with profound injuries and discharges to the morgue.

Conclusions

Pediatric emergency department crowding is a significant barrier to debriefing after trauma resuscitations. However, profound injuries and traumatic pediatric deaths remain the strongest predictors in conducting debriefing regardless of PED crowding status.
Targeted Molecular Testing in Endometrial Carcinoma: Validation of a Clinically Driven Selective ProMisE Testing Protocol
Authors: Talhouk Aline , Jamieson Amy , Crosbie Emma J. , Taylor Alexandra , Chiu Derek , Leung Samuel , Grube Marcel , Kommoss Stefan , Gilks C. Blake , McAlpine Jessica N. , Singh Naveena
Published: February 2023

Incorporation of molecular classification into clinicopathologic assessment of endometrial carcinoma (EC) improves risk stratification. Four EC molecular subtypes, as identified by The Cancer Genome Atlas, can be diagnosed through a validated algorithm Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) using p53 and mismatch repair (MMR) protein immunohistochemistry (IHC), and DNA polymerase epsilon (POLE) mutational testing. Cost and access are major barriers to universal testing, particularly POLE analysis. We assessed a selective ProMisE algorithm (ProMisE-S): p53 and MMR IHC on all EC’s with POLE testing restricted to those with abnormal MMR or p53 IHC (to identify POLEmut EC with secondary abnormalities in MMR and/or p53) and those with high-grade or non-endometrioid morphology, stage >IA or presence of lymphovascular space invasion (so as to avoid testing on the lowest risk tumors). We retrospectively compared the known ProMisE molecular classification to ProMisE-S in 912 EC. We defined a group of “very low-risk” EC (G1/G2, endometrioid, MMR-proficient, p53 wild-type, stage IA, no lymphovascular space invasion) in whom POLE testing will not impact on patient care; using ProMisE-S, POLE testing would not be required in 55% of biopsies and 38% of all EC’s, after evaluation of the hysterectomy specimen, in a population-based cohort. “Very low-risk” endometrioid EC with unknown POLE status showed excellent clinical outcomes. Fifteen of 166 (9%) of all p53abn EC showed G1/G2 endometrioid morphology, supporting the potential value of universal p53 IHC. The addition of molecular testing changed the risk category in 89/896 (10%) EC’s. In routine practice, POLE testing could be further restricted to only those patients in whom this would alter adjuvant therapy recommendations.
Nonsquamous Malignancies of Vagina and Vulva: 23-Year Experience at a Tertiary Center in the United Kingdom
Authors: Elshennawy Rawda A. , Aird Charlotte , Boyle William , Yap Jason , Williams Anthony , Ganesan Raji
Published: February 2023

Under 10% of gynaecological cancers are diagnosed in the vulva and vagina, mostly squamous cell carcinomas. Melanoma, Paget disease, basal cell carcinomas, and other cancers can present with vulval/vaginal symptoms. The pathology information system of a tertiary referral center for vulvo-vaginal cancers was searched for cancers of the vulva and vagina from 1996 to 2019. Squamous carcinomas were excluded, and the remaining entities were catalogued. A total of 221 nonsquamous cancers were found, including 135 vaginal and 86 vulval cases. One hundred eight cases of metastatic carcinomas from the endometrium, cervix, ovary, bowel, bladder, kidney, and breast formed the largest category. Basal cell carcinomas constituted the second largest category. Others included melanomas, Paget disease, and adenoid cystic carcinomas. Primary adenocarcinomas included porocarcinoma, mammary type carcinoma, enteric type carcinoma, clear cell carcinoma, Bartholin gland adenocarcinoma and malignant transformation of hidradenoma papilliferum. The vulva and vagina can harbor a wide range of nonsquamous malignancies. The most challenging of these are adenocarcinomas which can be metastatic from other sites. The dominance of metastatic carcinomas in this series is likely to reflect consultation practice of specialist pathologists.
Development and Evaluation of Syndromic Surveillance Definitions for Fall- and Hip Fracture–Related Emergency Department Visits Among Adults Aged 65 Years and Older, United States 2017-2018
Authors: Moreland Briana , Shakya Iju , Idaikkadar Nimi
Published: February 2023

Objective:

To develop syndromic surveillance definitions for unintentional fall- and hip fracture–related emergency department (ED) visits among older adults (aged ≥65 years) for use in the Centers for Disease Control and Prevention's National Syndromic Surveillance Program (NSSP) data and compare the percentage of ED visits captured using these new syndromes with ED visits from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), a nationally representative administrative data set.

Design/Setting:

Syndromic definitions were developed using chief complaint terms and discharge diagnosis codes in NSSP data. The percentages of ED visits among older adults related to falls and hip fractures in NSSP were compared with the percentages in HCUP-NEDS in 2017 and 2018.

Measures:

Prevalence ratios were calculated as the relative difference in the percentage of ED visits related to falls or hip fractures in NSSP compared with HCUP-NEDS. Counts and percentages calculated using HCUP-NEDS were weighted to produce nationally representative estimates. Data were analyzed overall and by sex and age group.

Results:

The percentage of ED visits among older adults related to falls in NSSP was 12% less in 2017 (10.81%) and 7% less in 2018 (11.42%) compared with HCUP-NEDS (2017: 12.30%; 2018: 12.26%). The percentage of ED visits among older adults related to hip fractures in NSSP was 41% less in 2017 (0.65%) and 30% less in 2018 (0.76%) compared with HCUP-NEDS (2017: 1.10%; 2018: 1.09%). In both 2017 and 2018, a higher percentage of ED visits among older women and adults aged 85 years or older were related to falls or hip fractures compared with older men and younger age groups across both data sets.

Conclusion:

A smaller percentage of older adults' ED visits met the falls and hip fracture definitions in NSSP compared with HCUP-NEDS in 2017 and 2018. However, demographic trends remained similar across both data sets.
The Differential Impact of the COVID-19 Pandemic on Prenatal Care Utilization Among US Women by Medicaid Expansion and Race and Ethnicity
Authors: Lee Hyunjung , Singh Gopal K.
Published: February 2023

Background:

The 2014 Medicaid expansion improved racial and ethnic equity in insurance coverage and access to maternal care among women of reproductive age. This study examines differential effects of the COVID-19 pandemic on prenatal care utilization by Medicaid expansion and by race and ethnicity.

Methods:

Using the pooled 2019-2020 National Natality file (N = 7 361 190), logistic regression was used to estimate the effect of COVID-19 on prenatal care utilization among US women aged 10 to 54 years after controlling for maternal age, race, ethnicity, marital status, parity, nativity/immigrant status, education, payment type, and smoking during pregnancy. Outcome measures were having no care and delayed prenatal care (third trimester or no care). Stratified models by race/ethnicity and Medicaid expansion status yielded the differential effects of COVID-19 on prenatal care utilization.

Results:

During the COVID-19 pandemic, the adjusted odds of having no prenatal care decreased by 4% (adjusted odds ratio [AOR] = 0.96; 95% confidence interval [CI], 0.94-0.97) in expansion states but increased by 13% (AOR = 1.13; 95% CI, 1.11-1.15) in nonexpansion states. While most racial and ethnic groups in expansion states experienced a decrease in having no prenatal care, the adjusted odds of having no prenatal care increased by 15% for non-Hispanic Whites, 9% for non-Hispanic Blacks, 33% for American Indians/Alaska Natives, 25% for Asian/Pacific Islanders, and 13% for Hispanics in nonexpansion states. Women in expansion states experienced no change in delayed prenatal care during the pandemic, but women in nonexpansion states experienced an increase in delayed care.

Conclusions:

Prenatal care utilization decreased during the pandemic among women in nonexpansion states, particularly for American Indians/Alaska Natives and Asian/Pacific Islanders, compared with expansion states.
Comparison of different rehabilitation techniques of traditional Chinese and western medicine in the treatment of motor dysfunction after stroke based on frequency method: A network meta-analysis
Authors: Li Ruo Yang , Chen Ke-Yu , Wang Xiao-Rong , Yu Qian , Xu Li
Published: February 2023

Objective

To evaluate the effect of different traditional Chinese and western medicine rehabilitation techniques on motor dysfunction after stroke using a network meta-analysis

Methods

CNKI, Wanfang, PubMed, EMBASE, and Cochrane databases were searched from inception to September 2022. We independently searched and screened randomized controlled trials (RCTs) of rehabilitation techniques for post-stroke motor dysfunction treatment, evaluated the quality, and analyzed the data using Stata 14.0.

Results

Seventy-four RCTs involving nine rehabilitation techniques and 5128 patients were included. The results of network meta-analysis showed the following orders regarding improvement of the total scores of Fugl Meyer assessment (FMA), action research arm test, and Berg Balance Scale: biofeedback therapy (BT) > mirror therapy (MT) > repetitive transcranial magnetic stimulation (rTMS) > acupuncture therapy (AT) > transcranial direct current stimulation (tDCS) > Taichi > common therapy (CT), virtual reality (VR) > tDCS > rTMS > MT > CT, and AT > VR > neuromuscular electrical stimulation (NMES) > MT > CT > tDCS, respectively.

Conclusion

BT had the best comprehensive effect, while VR was the best intervention for improving the index of action research arm test and FMA-lower extremity. AT improved lower limb balance function.
Abdominal Wall Reconstruction with Retrorectus Self-Adhering Mesh: A Single-Center Long-Term Follow-up
Authors: Bashian Elizabeth , Daoud Georges , Khansa Ibrahim , Janis Jeffrey E.
Published: February 2023

Introduction:

Mesh repair has been demonstrated to be superior to suture alone in ventral hernia repair. In a previous short-term pilot study, we found lower postoperative narcotic requirements with self-adhering mesh. The aim of this study is to follow-up on that pilot study, using long term data.

Methods:

This is a retrospective review of a prospectively collected database. All patients who underwent ventral hernia repair with retrorectus mesh and who had at least 12-months follow-up were reviewed. Comparisons were performed between patients who received self-adhering mesh and those who received transfascially-sutured mesh, using matched-pair analysis, examining perioperative outcomes, surgical-site occurrences (SSOs), and hernia recurrence/bulge.

Results:

Forty-two patients were included in the study, with 21 patients undergoing repair with transfacially sutured mesh and 21 patients receiving self-adhering mesh. Average length of follow-up was 1,078 days. There were no significant differences between the two groups in baseline characteristics. Patients receiving self-adhering mesh had significantly shorter surgery, and a shorter hospital length-of-stay. They also had a tendency towards lower narcotic requirements. There were no significant differences in the rate of SSOs, hernia recurrences, or bulge between the two groups.

Discussion:

This long-term study shows that self-adhering mesh in ventral hernia repair results in similar long-term outcomes to transfascially-sutured mesh, with shorter surgery, shorter length-of-stay and a tendency towards improved pain control. These findings mirror the known advantages of self-adhering mesh in inguinal hernia repair. Further research is needed to study the incidence of chronic pain and the cost-effectiveness of self-adhering mesh.