bluuebunny/crossref_metadata_2025 huggingface dataset:
Convergent Validity for the Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders
Authors: Carpente John A , Gattino Gustavo Schulz , Berrones Cortez Gisela X , Kelliher Michael , Mulholland Jill
Published: February 2022

A significant percentage of music therapists actively provides services to children with autism spectrum disorder (ASD). There is an absence, however, of a widely accepted clinical instrument, specific to music therapy work with this population, that demonstrates psychometric validation. Establishing commonality in assessing and documenting this particular work within the field would be pivotal to furthering the efforts which have established music therapy as evidenced-based practice. A study was conducted to explore the convergent validity between the Musical Emotion Assessment Rating Scale (MEARS), which is Scale I of the Individual Music-Centered Assessment Profile of the Neurodevelopmental Disorders (IMCAP-ND) assessment tool, with the Social Affect Scale domains and item variables of the Autism Diagnostic Observation Schedule (ADOS). The data revealed statistical significance, thus supporting convergent validity with several specific MEARS scores when compared with the ADOS Social Affect domain score. The current investigation supports the IMCAP-ND’s soundness as an assessment tool possessing valid and reliable psychometric properties. The convergent validity between MEARS and ADOS showed positive results in the area of social affect. Implications of this study are related to clinical practice and may impact how music therapists assess children with autism. Furthermore, this study contributes to the growing body of music therapy assessments that have yielded valid and reliable scores used to evaluate core features of ASD (e.g., social affect).
Oxidation of ferumoxytol by ionizing radiation releases iron. An electron paramagnetic resonance study
Authors: Petronek Michael S , Spitz Douglas R , Buettner Garry R , Allen Bryan G
Published: February 2022

Ferumoxytol (FMX) is an iron oxide nanoparticle that is FDA approved for the treatment of iron deficiency anemia. FMX contains an Fe3O4 core. Currently, the redox chemistry of Fe3O4 nanoparticles remains relatively unexplored. FMX has recently gained interest as an anti-cancer agent. Ionizing radiation (IR) is a treatment modality employed to treat several types of cancer. Utilizing electron paramagnetic resonance (EPR) spectroscopy, we found that the products produced from the radiolysis of water can oxidize the Fe3O4 core of FMX. Because of the limited diffusion of the HO2• and HO• produced, these highly oxidizing species have little direct effect on FMX oxidation. We have determined that H2O2 is the primary oxidant of FMX. In the presence of labile Fe2+, we found that reducing species generated from the radiolysis of H2O are able to reduce the Fe3+ sites of the Fe3O4 core. Importantly, we also have shown that IR stimulates the release of ferric iron from FMX. Because of its release of iron, FMX may serve as an adjuvant to enhance radiotherapy.
Partial nephrectomy of a huge solid-cystic renal mass with final pathology of renal cell carcinoma
Authors: Mohammadi Abdolreza , Aghamir Seyed Mohammad Kazem
Published: February 2022

Partial nephrectomy has been established as a standard treatment of renal mass <4 cm(cT1a), but mostly it is performed in larger tumors of size up to 7 cm (cT2b). The maximum size of a tumor that could undergo partial nephrectomy is controversial. In this case report, we present a case of a large renal mass (17 cm) that underwent open partial nephrectomy successfully. To our knowledge, this case is the giant tumor that underwent partial nephrectomy in the literature. Partial nephrectomy could be performed if technically feasible irrespective of the tumor size.
Noninvasive differentiation of molecular subtypes of adult nonenhancing glioma using MRI perfusion and diffusion parameters
Authors: Pruis Ilanah J , Koene Stephan R , van der Voort Sebastian R , Incekara Fatih , Vincent Arnaud J P E , van den Bent Martin J , Lycklama à Nijeholt Geert J , Nandoe Tewarie Rishi D S , Veldhuijzen van Zanten Sophie E M , Smits Marion
Published: February 2022

Background

Nonenhancing glioma typically have a favorable outcome, but approximately 19–44% have a highly aggressive course due to a glioblastoma genetic profile. The aim of this retrospective study is to use physiological MRI parameters of both perfusion and diffusion to distinguish the molecular profiles of glioma without enhancement at presentation.

Methods

Ninety-nine patients with nonenhancing glioma were included, in whom molecular status (including 1p/19q codeletion status and IDH mutation) and preoperative MRI (T2w/FLAIR, dynamic susceptibility-weighted, and diffusion-weighted imaging) were available. Tumors were segmented semiautomatically using ITK-SNAP to derive whole tumor histograms of relative Cerebral Blood Volume (rCBV) and Apparent Diffusion Coefficient (ADC). Tumors were divided into three clinically relevant molecular profiles: IDH mutation (IDHmt) with (n = 40) or without (n = 41) 1p/19q codeletion, and (n = 18) IDH-wildtype (IDHwt). ANOVA, Kruskal-Wallis, and Chi-Square analyses were performed using SPSS.

Results

rCBV (mean, median, 75th and 85th percentile) and ADC (mean, median, 15th and 25th percentile) showed significant differences across molecular profiles (P < .01). Posthoc analyses revealed that IDHwt and IDHmt 1p/19q codeleted tumors showed significantly higher rCBV compared to IDHmt 1p/19q intact tumors: mean rCBV (mean, SD) 1.46 (0.59) and 1.35 (0.39) versus 1.08 (0.31), P < .05. Also, IDHwt tumors showed significantly lower ADC compared to IDHmt 1p/19q codeleted and IDHmt 1p/19q intact tumors: mean ADC (mean, SD) 1.13 (0.23) versus 1.27 (0.15) and 1.45 (0.20), P < .001).

Conclusions

A combination of low ADC and high rCBV, reflecting high cellularity and high perfusion respectively, separates IDHwt from in particular IDHmt 1p/19q intact glioma.
Bridging oxidase catalysis and oxygen reduction electrocatalysis by model single-atom catalysts
Authors: Lu Xiangyu , Gao Shanshan , Lin Han , Tian Han , Xu Deliang , Shi Jianlin
Published: February 2022

Nanocatalysts with enzyme-like catalytic activities, such as oxidase mimics, are extensively used in biomedicine and environmental treatment. Searching for enzyme-like nanomaterials, clarifying the origins of catalytic activity and developing activity assessment methodologies are therefore of great significance. Here, we report that oxidase catalysis and oxygen reduction reaction (ORR) electrocatalysis can be well bridged based on their identical activity origins, which makes facile electrocatalytic ORR activity measurements intrinsically applicable to oxidase-like activity evaluations. Inspired by natural heme-copper oxidases, Cu/Fe-doped single-atom catalysts (SACs) were first synthesized and used as model catalysts. Chromogenic reactions, electrochemical voltammetric measurements and density functional theory calculations further verified the linear relationship between the oxidase-like and ORR catalytic activities of the catalysts; thus, an effective descriptor ($| {\overline {{j_{\rm{n}}}} } |$) is proposed for rapid enzymatic catalyst evaluation. Evidence suggests that the enhanced tumour therapeutic efficacy of SACs is a result of their oxidase-like/ORR activities, which proves that numerous ORR electrocatalysts are promising candidates for oxidase mimics and tumour therapy. The synergistic catalytic effect of the biomimetic heterobinuclear Cu-Fe centres has also been thoroughly probed.
“Scary and Effective, Definitely Pushes Me to Quit Smoking”: Developing Waterpipe Pictorial Health Warnings Targeting Young Adults in Lebanon
Authors: Asfar Taghrid , Chehab Sara , Schmidt Michael , Ward Kenneth D , Maziak Wasim , Nakkash Rima
Published: February 2022

Introduction

Waterpipe (WP) smoking is the leading tobacco use method among young adults in Lebanon. WP use is harmful, yet misperceptions about its safety exist. Implementing pictorial health warning labels (HWLs) on WP products is a promising strategy to correct this misperception. This study aimed to culturally adapt a set of 12 pictorial HWLs recently developed by an international expert panel to young adults in Lebanon. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes.

Aims and Methods

We conducted nine focus groups among WP smokers and nonsmokers (N = 77; 52% females; age 18–34 years) to explore participants’ perceptions of the developed HWLs on attention, reaction (fear, avoidance), effectiveness (harm perception), and improvement (design/content, relatedness). Sessions were audio-taped, transcribed verbatim, and analyzed using directed qualitative content analysis.

Results

Emotionally provocative warnings were perceived as most effective, while symbolic and abstract warnings were found not believable. Warnings depicting visible bodily health effects and harm to babies seemed most promising. Participants were generally skeptical about Theme 4 because it might encourage switching to cigarettes. For cultural adaptation, participants recommended using shorter text with affirmative phrases, increasing the picture’s size and improving their quality, adding the WP device picture to enhance HWLs’ relatability, and develop testimonial messages that depict real people and stories.

Conclusions

Results will provide Lebanon and perhaps other countries in the Eastern Mediterranean Region with evidence-based HWLs that they can further develop, test, and implement within their specific culture.

Implications

Results provide Lebanon with evidence-based WP-specific pictorial HWLs that can be further developed and tested. HWLs provoking negative affect, with visible health consequences, and depicting harm to babies are promising. Participants recommended using definitive scientific claims presenting the health risks in numerical form. However, this needs to be balanced against protecting the credibility of HWLs scientifically and legally. Increasing the HWLs size and adding the WP device picture to the HWLs can enhance their relatability. Further research can help address some questions raised by this study, such as the potential of testimonial warnings that depict real people.
Spatial dependency in child malnutrition across 640 districts in India: need for context-specific planning and interventions
Authors: Vennam Thirumal Reddy , Agnihotri Satish B , Chinnasamy Pennan
Published: February 2022

Background

Child malnutrition remains a matter of concern in India as the current levels are high and the decline is slow. National Family Health Survey (NFHS–4, 2015-16) data, for the first time, provides credible, good quality data at district level on social, household and health characteristics.

Methods

Techniques of spatial analysis on data in respect of 640 districts were used to identify spatial characteristics of the nutrition levels for children in the 0–60-month age group. Further, the principal component analysis (PCA) was used to identify 7 important correlates of the malnutrition out of 21 relevant components provided in the NFHS-4. The paper further uses three techniques, ordinary least squares (OLS), spatial lag model (SLM) and spatial error model (SEM) to assess the strength of correlation between the malnutrition levels and the shortlisted correlates.

Results

The use of SLM and SEM shows improvement in the strength of the association (high R-square) compared to OLS. Women's height and Iodized salt in stunting, child anaemia in wasting, women's height and child anaemia in underweight were found to be significant factors (P < 0.01) along with spatial autoregressive constant.

Conclusions

Such analysis, in combination with PCA, has shown to be more effective in prioritizing the programme interventions for tackling child malnutrition.
A taxonomy of high school students’ levels of understanding in solving algebraic problems
Authors: Egodawatte Gunawardena
Published: February 2022

The research reported in this article sought to develop a taxonomy of grade 11 students’ levels of understanding in algebraic problem-solving tasks. The student sample was from high schools in the province of Ontario in Canada. Problems from four areas in algebra namely, variables, expressions, equations and word problems were chosen to be represented in the test paper. A six-level taxonomy was constructed by analyzing the structure of students’ written responses and their subsequent interview transcripts. The first three levels of the taxonomy belong to the application of lower level thinking skills while the last two levels belong to the application of higher level thinking skills. The taxonomy serves two purposes. Teachers can use it for formulating objectives in classroom teaching, and they can also use it as an evaluation tool in constructing assessment items.
Old Enough to Perceive Things Differently? Detecting Measurement Invariance Across Age Groups Using Item-Focused Tree
Authors: Guo Feng , Min Hanyi , Jex Steve , Choi Yeeun
Published: February 2022

The current study applies a new technique, item-focused tree (IFT), to investigate measurement invariance (MI) across age groups. MI is violated when differential item functioning (DIF) is detected. Compared to traditional DIF techniques, IFT does not require researchers to artificially split respondents into multiple groups when the covariate is continuous (e.g., age). Moreover, with IFT, researchers can examine DIF induced by multiple covariates at one time. The current study applies IFT technique to better understand how items in various measures may be perceived differently by respondents of varying ages, where IFT examined DIF induced by sex, work experience, and age simultaneously. Results from a two-wave dataset suggested that age was the sole covariate associated with all the DIF identified. Specifically, across both waves, older workers were more likely to express disapproval toward a few negative stated items (e.g., not learning, not picking up new skills, and having no positive effect on others), with moderate effect sizes. The DIF tree plots built by IFT algorithm further indicated the age of 50 years old as the key point to split 2 age subgroups where DIF is mostly like to be observed. Additionally, education was found to induce DIF jointly with age in the exploratory analyses. Implications, limitations, and future directions are discussed. A brief tutorial on how to conduct IFT using R is also included.
Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis
Authors: Reale Sharon C. , Bauer Melissa E. , Klumpner Thomas T. , Aziz Michael F. , Fields Kara G. , Hurwitz Rachel , Saad Manal , Kheterpal Sachin , Bateman Brian T. ,   Multicenter Perioperative Outcomes Group Collaborators
Published: February 2022

Background

Estimates for the incidence of difficult intubation in the obstetric population vary widely, although previous studies reporting rates of difficult intubation in obstetrics are older and limited by smaller samples. The goals of this study were to provide a contemporary estimate of the frequency of difficult and failed intubation in women undergoing general anesthesia for cesarean delivery and to elucidate risk factors for difficult intubation in women undergoing general anesthesia for cesarean delivery.

Methods

This is a multicenter, retrospective cohort study utilizing the Multicenter Perioperative Outcomes Group database. The study population included women aged 15 to 44 yr undergoing general anesthesia for cesarean delivery between 2004 and 2019 at 1 of 45 medical centers. Coprimary outcomes included the frequencies of difficult and failed intubation. Difficult intubation was defined as Cormack–Lehane view of 3 or greater, three or more intubation attempts, rescue fiberoptic intubation, rescue supraglottic airway, or surgical airway. Failed intubation was defined as any attempt at intubation without successful endotracheal tube placement. The rates of difficult and failed intubation were assessed. Several patient demographic, anatomical, and obstetric factors were evaluated for potential associations with difficult intubation.

Results

This study identified 14,748 cases of cesarean delivery performed under general anesthesia. There were 295 cases of difficult intubation, with a frequency of 1:49 (95% CI, 1:55 to 1:44; n = 14,531). There were 18 cases of failed intubation, with a frequency of 1:808 (95% CI, 1:1,276 to 1:511; n = 14,537). Factors with the highest point estimates for the odds of difficult intubation included increased body mass index, Mallampati score III or IV, small hyoid-to-mentum distance, limited jaw protrusion, limited mouth opening, and cervical spine limitations.

Conclusions

In this large, multicenter, contemporary study of more than 14,000 general anesthetics for cesarean delivery, an overall risk of difficult intubation of 1:49 and a risk of failed intubation of 1:808 were observed. Most risk factors for difficult intubation were nonobstetric in nature. These data demonstrate that difficult intubation in obstetrics remains an ongoing concern.

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Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative
Authors: Weigel Wade A. , Williams Barbara L. , Hanson Neil A. , Blackmore C. Craig , Johnson Randy L. , Nissen Gary M. , James Andrew B. , Strodtbeck Wyndam M.
Published: February 2022

Background

Residual neuromuscular blockade can be avoided with quantitative neuromuscular monitoring. The authors embarked on a professional practice initiative to attain documented train-of-four ratios greater than or equal to 0.90 in all patients for improved patient outcomes through reducing residual paralysis.

Methods

The authors utilized equipment trials, educational videos, quantitative monitors in all anesthetizing locations, and electronic clinical decision support with real-time alerts, and initiated an ongoing professional practice metric. This was a retrospective assessment (2016 to 2020) of train-of-four ratios greater than or equal to 0.9 that were documented before extubation. Anesthesia records were manually reviewed for neuromuscular blockade management details. Medical charts of surgical patients who received a neuromuscular blocking drug were electronically searched for patient characteristics and outcomes.

Results

From pre- to postimplementation, more patients were assigned American Society of Anesthesiologists Physical Status III to V, fewer were inpatients, the rocuronium average dose was higher, and more patients had a prereversal train-of-four count less than 4. Manually reviewed anesthesia records (n = 2,807) had 2 of 172 (1%) cases with documentation of train-of-four ratios greater than or equal to 0.90 in November 2016, which was fewer than the cases in December 2020 (250 of 269 [93%]). Postimplementation (February 1, 2020, to December 31, 2020), sugammadex (650 of 935 [70%]), neostigmine (195 of 935 [21%]), and no reversal (90 of 935 [10%]) were used to attain train-of-four ratios greater than or equal to 0.90 in 856 of 935 (92%) of patients. In the electronically searched medical charts (n = 20,181), postimplementation inpatients had shorter postanesthesia care unit lengths of stay (7% difference; median [in min] [25th, 75th interquartile range], 73 [55, 102] to 68 [49, 95]; P < 0.001), pulmonary complications were less (43% difference; 94 of 4,138 [2.3%] to 23 of 1,817 [1.3%]; P = 0.010; −1.0% difference [95% CI, –1.7 to –0.3%]), and hospital length of stay was shorter (median [in days] [25th, 75th], 3 [2, 5] to 2 [1, 4]; P < 0.001).

Conclusions

In this professional practice initiative, documentation of train-of-four ratios greater than or equal to 0.90 occurred for 93% of patients in a busy clinical practice. Return-of-strength documentation is an intermediate outcome, and only one of many factors contributing to patient outcomes.

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Improving In-Hospital Patient Rescue: What Are Studies on Early Warning Scores Missing? A Scoping Review
Authors: Esmaeilzadeh Sarvie , Lane Conor M. , Gerberi Danielle J. , Wakeam Elliot , Pickering Brian W. , Herasevich Vitaly , Hyder Joseph A.
Published: February 2022

OBJECTIVES:

Administrative and clinical efforts to improve hospital mortality and intensive care utilization commonly focus on patient rescue, where deteriorating patients are systematically identified and intervened upon. Patient rescue is known to depend on hospital context inclusive of technologic environment, structural features, and hospital organizational behavioral features. With widespread adoption of electronic medical records, early warning score (EWS) systems, which assign points to clinical data elements, are increasingly promoted as a tool for timely patient rescue by referencing their prediction of patient deterioration. We describe the extent to which EWS intervention studies describe the hospital environment of the intervention—details that would be critical for hospital leaders attempting to determine the real-world utility of EWSs in their own hospitals.

DATA SOURCES:

We searched CINAHL, PubMed, and Scopus databases for English language EWS implementation research published between 2009 and 2021 in adult medical-surgical inpatients.

STUDY SELECTION:

Studies including pediatric, obstetric, psychiatric, prehospital, outpatient, step-down, or ICU patients were excluded.

DATA EXTRACTION:

Two investigators independently reviewed titles/abstracts for eligibility based on prespecified exclusion criteria.

DATA SYNTHESIS:

We identified 1,434 studies for title/abstract screening. In all, 352 studies underwent full-text review and 21 studies were summarized. The 21 studies (18 before-and-after, three randomized trials) detailed 1,107,883 patients across 54 hospitals. Twelve reported the staff composition of an EWS response team. Ten reported the proportion of surgical patients. One reported nursing ratios; none reported intensive care staffing with in-house critical-care physicians. None measured changes in bed utilization or availability. While 16 qualitatively described resources for education/technologic implementation, none estimated costs. None described workforce composition such as team stability or culture of safety in the hospitals.

CONCLUSIONS:

Despite hundreds of EWS-related publications, most do not report details of hospital context that would inform decisions about real-world EWS adoption. To make informed decisions about whether EWS implementation improves hospital quality, decision-makers may require alternatives such as peer networks and implementation pilots nested within local health systems.
Progressive Multiple Mononeuropathy in a Patient With Familial Transthyretin Amyloidosis After Liver Transplantation
Authors: Seibert Kaitlin , Wlodarski Richard , Sarswat Nitasha , Appelbaum Daniel , Issa Naoum P. , Soliven Betty , Rezania Kourosh
Published: February 2022

Valine 122 isoleucine (V122I) is the most common mutation associated with familial transthyretin-related amyloidosis (fATTR) in the metropolitan United States. V122I-related fATTR usually presents with cardiomyopathy. When polyneuropathy is encountered, it is usually mild, distal, and axonal in nature. Although liver transplantation improves survival for fATTR neuropathy patients, neuropathy may progress post liver transplantation because of the deposition of wild-type transthyretin. We report a patient with homozygous V122I mutation who presented with asymmetrical, upper limb predominant neuropathy rather early in his disease course, which progressed for a period of 5 years after liver transplantation before stabilization with the initiation of patisiran.
MULTICOLOR CONFOCAL SCANNING LASER OPHTHALMOSCOPE IMAGING IN POSTERIOR UVEITIS
Authors: Gupta Kajree , Agarwal Aniruddha , Arora Atul , Aggarwal Kanika , Bansal Reema , Katoch Deeksha , Marchese Alessandro , Singh Simar R. , Agrawal Rupesh , Gupta Vishali
Published: February 2022

Purpose:

To study the utility of MultiColor confocal scanning laser ophthalmoscope imaging (MCI) in identifying the morphology of uveitic lesions compared with conventional color fundus photography (CFP) in patients with posterior uveitis.

Methods:

In this prospective observational study, subjects with posterior uveitis underwent MCI and CFP. The images obtained by the two modalities were analyzed by two independent reviewers for vitreoretinal surface abnormalities, retinal fluid and hemorrhages, and depth/location of lesions. These findings were compared with the clinical findings and other imaging techniques.

Results:

Sixty-nine eyes of 43 patients (25 men) with mean age of 33.5 ± 13.9 years were studied. MultiColor imaging had better sensitivity and specificity in detecting vitreoretinal interface abnormalities, such as epiretinal membrane and inner retinal striae, compared with CFP. MultiColor imaging failed to detect retinochoroiditis lesions in 5 of 6 eyes (83%) and choroiditis in 9 46 eyes (20%), which were detected on CFP and clinical examination. Also, MCI showed a high false-positive rate of 34% in detecting intraretinal hemorrhages.

Conclusion:

Retinochoroidal lesions in posterior uveitis may be poorly identified on MCI compared with CFP and clinical examination. One must exercise caution in commenting on disease morphology based on MCI alone.
POSTERIOR VITREOUS DETACHMENT STATUS AS A PREDICTIVE FACTOR FOR OUTCOMES OF VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE
Authors: Tandias Rachel , Lemire Colin A. , Palvadi Karishma , Arroyo Jorge G.
Published: February 2022

Purpose:

The purpose of this study was to evaluate the prognostic utility of the degree of vitreous attachment for predicting outcomes of vitrectomy for nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy.

Methods:

Medical records of patients who underwent primary vitrectomy for dense nonclearing vitreous hemorrhage secondary to proliferative diabetic retinopathy were examined retrospectively. Eyes were divided into four groups based on the intraoperatively assessed stage of posterior vitreous detachment (PVD), ranging from Stage 0/1 (complete or near-complete vitreoretinal adhesion) to Stage 4 (complete PVD).

Results:

Overall, 136 eyes (117 patients) were included. In comparison with eyes with a partial or complete PVD (Stages 2–4), eyes with no PVD (Stage 0/1) had a higher incidence of postoperative hypotony (8%, P = 0.03) and traction retinal detachment (27%, P = 0.002), an increased rate of repeat vitrectomy (49%, P = 0.04), and poorer best-corrected visual acuity at 6 months and 1 year postoperatively (P = 0.04 and P = 0.01, respectively). Presence of a complete PVD at baseline was independently associated with improved postoperative vision at 6 months (P = 0.04).

Conclusion:

More extensive vitreoretinal adhesion is associated with higher rates of reoperation and poorer visual outcomes after vitrectomy for dense nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy. Preoperative determination of PVD status using B-scan ultrasonography may be useful for predicting anatomical and functional outcomes after vitrectomy in these patients.
Tear Cytokines as Biomarkers for Acute Ocular Graft-Versus-Host Disease
Authors: Qiu Yuan , Hu Bohao , Peng Rong-mei , Huang Jing-Feng , Hong Jing
Published: February 2022

Purpose:

The purpose of this study was to analyze tear cytokine and complement levels in patients diagnosed with acute ocular graft-versus-host disease (oGVHD) and examine the consistency of these levels with the severity of clinical manifestations.

Methods:

Ten patients with acute oGVHD (20 eyes) were enrolled for the assessment of tear cytokine levels and ocular surface parameters, and 18 healthy people (36 eyes) were selected as the control group. The tear cytokine and complement levels were measured using microsphere-based immunoassay analysis.

Results:

The main clinical manifestations of acute oGVHD include eye redness, a large amount of purulent exudate, eye pain, and even false membranes. The levels of intercellular cell adhesion molecule-1, interleukin 6 (IL-6), interleukin 1 beta (IL-1β), interleukin 8, epidermal growth factor (EGF), interleukin 7 (IL-7), B-cell activating factor, granulocyte-macrophage colony-stimulating factor (GM-CSF), and complement in patients with acute oGVHD showed significant differences compared with those in normal people. Furthermore, the levels of IL-6, IL-1β, EGF, GM-CSF, IL-7, and C3a showed a stronger correlation with ocular surface parameters.

Conclusions:

Our study was the first to enroll patients with acute oGVHD to assess tear cytokine levels as a method contributing to the diagnosis of acute oGVHD. In addition, it has been demonstrated that certain tear cytokines, including intercellular cell adhesion molecule-1, IL-6, IL-1β, interleukin 8, B-cell activating factor, GM-CSF, IL-7, EGF, and complement, may be new diagnostic biomarkers for acute oGVHD.
Endolymphatic Hydrops Magnetic Resonance Imaging in Menire's Disease Patients on a Vertigo Attack
Authors: Chen Wei , Geng Yue , Niu Yue , Lin Mengyan , Lin Naier , Sha Yan
Published: February 2022

Objective:

To investigate the characteristics of endolymphatic hydrops (EH) in Menire's disease (MD) patient on a vertigo attack.

Study Design:

Prospective study.

Setting:

Tertiary referral center.

Patients:

Thirty-six MD patients underwent the enhanced magnetic resonance imaging (MRI) examinations of the inner ear on a vertigo attack were enrolled.

Main Outcome Measures:

All patients met the diagnostic criteria for MD and underwent intravenous gadolinium injection 4 hours before the MRI examinations. The MRI examinations were performed in MD patients on a vertigo attack.

Results:

Various degrees of vestibular EH appeared in almost all affected ears (2 ears had no EH, 11 ears had mild EH, 26 ears had significant EH). The positive rate of vestibular EH was 37/39 (94.9%). Cochlear EH occurred in 29 ears among 39 affected ears (17 ears had mild EH, 12 ears had significant EH).

Conclusion:

MRI with intravenous gadolinium injection can provide a better assessment of EH in MD patient on a vertigo attack. Vestibular EH seems to be closely related with the vertigo attacks in MD patients, which needs further study.
Predictors of Recurrence After Sub-total or Near-total Resection of Vestibular Schwannoma: Importance of Tumor Volume and Ventral Extension
Authors: Manzoor Nauman F. , Nassiri Ashley M. , Sherry Alexander D. , Dang Sabina , Yancey Kristen L. , Monsour Meredith , Perkins Elizabeth L. , Khattab Mohamed H. , Thompson Reid C. , O’Malley Matthew R. , Bennett Marc L. , Rivas Alejandro C. , Haynes David S.
Published: February 2022

Objective:

To evaluate the predictors of remnant tumor regrowth and need for salvage therapy after less than gross total resection (GTR) of vestibular schwannoma (VS).

Study Design:

Retrospective chart review.

Setting:

Tertiary neurotologic referral center.

Patients:

Patients who underwent VS resection between 2008 and 2019 either with GTR, near total resection (NTR), and subtotal resection (STR).

Interventions:

Microsurgical resection, salvage radiosurgery.

Main Outcome Measures:

Regrowth free interval, salvage free interval, tumor doubling rate.

Results:

Three hundred eighty five cases (GTR = 236, NTR = 77, and STR = 71) from 2008 to 2019 were included. STR cohort had much larger and complex tumors with significant differences in tumor volume, ventral extension and brainstem compression (p 
< 0.001). On single predictor analysis, tumor volume, ventral extension, brainstem compression as well as STR strategy was associated with significant increased risk of regrowth and need for salvage therapy. Multivariate analysis revealed STR strategy as significant predictor of regrowth (hazard ratio 3.79, p 
< 0.0005). Absolute remnant volume and extent of resection (EOR) did not predict regrowth. A small proportion of cases (NTR = 4%, STR = 15%) eventually needed salvage radiosurgery with excellent ultimate local tumor control with no known recurrence to date.

Conclusions:

Conservative surgical strategy employing NTR or STR can be employed safely in large and complex VS. While there is increased risk of regrowth in the STR cohort, excellent local control can be achieved with appropriate use of salvage radiosurgery. No disceret radiologic or operative predictors of regrowth were identified.
Pars plana vitrectomy surgery for kyrieleis plaques with retinal detachment
Authors: Yang Jianjun , Pan Hanying
Published: February 2022

Introduction:

Kyrieleis plaques complicated by retinal detachment are rare. To date, there has been no pathological diagnosis of Kyrieleis plaques.

Patient concerns:

A 39-year-old male patient had blurred vision in his left eye, which was previously healthy.

Diagnosis:

We considered the clinical picture of kyrieleis plaques complicated by retinal detachment.

Interventions:

Pars Plana vitrectomy surgery was performed

Outcomes:

Retinal detachment recovered partially and after one year of follow-up, he had good vision in his left eye.

Conclusion:

Viral infection is a possible cause of Kyrieleis plaques. Endothelial cells of retinal arteries may be involved in this process. Pars Plana Vitrectomy can be a good method to treat Kyrieleis plaques complicated by retinal detachment.
Evolution of International Pediatric Endoscopic Practice Changes During the Coronavirus Disease 2019 Pandemic
Authors: Ruan Wenly , Fishman Douglas S. , Lerner Diana G. , Furlano Raoul I. , Thomson Mike , Walsh Catharine M.
Published: February 2022

Objectives:

The coronavirus disease 2019 (COVID‐19) pandemic has drastically altered endoscopic practices. We initially reported the international impact of COVID‐19 on pediatric endoscopic practice. This follow‐up study aimed to assess changes 7 months following the initial survey to delineate practice change patterns as the pandemic evolved.

Methods:

Pediatric gastroenterologists who responded to the initial survey were re‐surveyed seven months later using Research Electronic Data Capture (REDCap). The survey recorded information on changes in pediatric endoscopic practice patterns, including COVID‐19 screening and testing processes and personal protective equipment (PPE) utilization. Additionally, endoscopists’ risk tolerance of COVID‐19 transmission was evaluated.

Results:

Seventy‐five unique institutions from 21 countries completed surveys from the 145 initial responses (51.7% response rate). Procedural volumes increased at most institutions (70.7%) and most were performing previously postponed cases (90.7%). Ninety‐seven percent of institutions were performing pre‐endoscopy screening with 78.7% testing all patients. Many institutions (34.7%) have performed procedures on COVID‐19 positive patients. There was significantly less PPE reuse (P < 0.05) and fewer institutions recommending full PPE for all endoscopies (43.2% vs 59.2%, P = 0.013). Overall, pediatric endoscopists’ risk tolerance of COVID‐19 transmission is low.

Conclusions:

This is the first survey to highlight the evolution of pediatric endoscopic practices related to the COVID‐19 pandemic, underscoring the need for ongoing pandemic‐related guidance for pediatric endoscopic practice.
Life Events, Barriers to Care, and Outcomes Among Minority Women Experiencing Depression
Authors: Tieu Lina , Walton Quenette L. , Sherbourne Cathy D. , Miranda Jeanne M. , Wells Kenneth B. , Tang Lingqi , Williams Pluscedia , Anderson Gera L. , Booker-Vaughns Juanita , Pulido Esmeralda , Carr Themba , Heller S. Megan , Bromley Elizabeth
Published: February 2022

The long-term course of depression is not well-understood among minority women. We assessed depression trajectory, barriers to depression care, and life difficulties among minority women accessing health and social service programs as part of the Community Partners in Care study. Data include surveys (N = 339) and interviews (n = 58) administered at 3-year follow-up with African American and Latina women with improved versus persistent depression. The majority of the sample reported persistent depression (224/339, 66.1%), ≥1 barrier to mental health care (226/339, 72.4%), and multiple life difficulties (mean, 2.7; SD, 2.3). Many barriers to care (i.e., related to stigma and care experience, finances, and logistics) and life difficulties (i.e., related to finances, trauma, and relationships) were more common among individuals reporting persistent depression. Results suggest the importance of past experiences with depression treatment, ongoing barriers to care, and negative life events as contributors to inequities in depression outcomes experienced by minority women.
Instrumented Gait Analysis (IGA) for Management of Children With Cerebral Palsy: A Needs Assessment Survey
Authors: Godwin Ellen M. , Salem Yasser , States Rebecca A. , Krzak Joseph J. , McMulkin Mark , Bodkin-Winter Amy
Published: February 2022

Purpose:

This needs assessment survey identifies the priorities of the clinical and research communities involved with the use of instrumented gait analysis (IGA) for a clinical practice guideline on IGA use with children with cerebral palsy (CP).

Methods:

Thirteen Likert scale questions asked about the importance of topics related to IGA. Other questions addressed respondents' demographics, experience with IGA, patient populations, and gait laboratory characteristics. Several open-ended questions were included and analyzed.

Results:

The survey was completed by 43 physical therapists and 53 non–physical therapists involved with IGA. More than 90% rated the following as critically or highly important: reliability and validity of IGA to identify gait pathology (94%); ability to longitudinally track gait pathology (93%); use in planning interventions (93%); use in evaluating outcomes (93%); and definition of IGA (90%).

Conclusions and Recommendations for Clinical Practice:

This needs assessment survey identified the topic priorities of clinicians and practitioners who use IGA for the management of children with CP. These results will guide the development of a clinical practice guideline on the use of IGA for the management of CP.
Skeletal and Dental Outcomes after Facial Allotransplantation: The Cleveland Clinic Experience and Systematic Review of the Literature
Authors: Coombs Demetrius M. , Bassiri Gharb Bahar , Tuncer Fatma B. , Djohan Risal S. , Gastman Brian R. , Bernard Steven L. , Schwarz Graham S. , Gurunian Raffi , Siemionow Maria Z. , Papay Frank A. , Rampazzo Antonio
Published: February 2022

Background:

Most of the literature surrounding face transplantation focuses on technique, immunology, and psychology. Dental and skeletal outcomes remain persistently underreported. This study critically examined the worldwide face transplant experience to evaluate such outcomes.

Methods:

A systematic review of all composite allografts containing midface and/or mandible was performed. Dental and skeletal complications were recorded. Formal imaging and photographs available in the literature were analyzed using skeletal measurements, soft-tissue cephalometrics, and the Angle classification. Outcomes of our face transplant patients, including condylar assessment and airway volume measurements, is also presented.

Results:

Twenty-five patients received allografts containing midface (n = 7) or mandible (n = 2), whereas 16 contained a double-jaw. All midface-only transplants developed skeletal deformity; 57 percent developed a palatal fistula. Both partial and full arch transplantation patients developed skeletal deformity. Among double-jaw transplants, 69 percent developed palatal fistula or floor-of-mouth dehiscence, 66 percent developed malocclusion, 50 percent developed trismus, and 31 percent required corrective orthognathic surgery. In 40 percent of patients, malocclusion recurred after corrective orthognathic surgery. Forty percent of all patients developed dental cavities or periodontal disease. All of our patients received midface and/or mandible. One patient required corrective orthognathic surgery. Midfacial segments showed clockwise rotation. Airway volumes decreased over time.

Conclusions:

Skeletal and dental complications remain extremely common after facial allotransplantation involving either single- or double-jaw composites. Corrective orthognathic surgery and dental extraction is often necessitated. These data will aid face transplant teams during surgical planning and preoperative counseling.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Persistent HIV transcription and variable antiretroviral drug penetration in lymph nodes during plasma viral suppression
Authors: Fletcher Courtney V. , Kroon Eugène , Schacker Timothy , Pinyakorn Suteeraporn , Chomont Nicolas , Chottanapund Suthat , Prueksakaew Peeriya , Benjapornpong Khunthalee , Buranapraditkun Supranee , Phanuphak Nittaya , Ananworanich Jintanat , Vasan Sandhya , Hsu Denise
Published: February 2022

Objective:

The ability of antiretroviral drugs to penetrate and suppress viral replication in tissue reservoir sites is critical for HIV remission. We evaluated antiretroviral concentrations in lymph nodes and their impact on HIV transcription.

Methods:

Participants of the RV254/SEARCH010 Acute HIV Infection Cohort in Thailand were enrolled. Group 1 (n 
= 6) initiated and continued antiretrovirals with two nucleoside reverse transcriptase inhibitors (NRTIs), dolutegravir (DTG) and mar- aviroc (MVC). Group 2 (n = 12) initiated antiretrovirals with two NRTIs as well as efavirenz and were switched to two NRTIs as well as DTG. Antiretroviral concentrations were measured by mass spectroscopy. HIV RNA+ and DNA+ cells were measured by in-situ hybridization.

Results:

All participants were MSM. At lymph node biopsy, all had plasma HIV RNA less than 20 copies/ml. Group 2 had longer durations of antiretroviral and DTG use (medians of 135 and 63 weeks, respectively) compared with Group 1 (median 44 weeks for both). TFV-DP, 3TC-TP, DTG and MVC were quantifiable in all lymph node samples from participants receiving those drugs versus carbovir-triphosphate (CBV-TP) in four out of 14. Median ratios of lymph node to peripheral blood concentrations were DTG, 0.014; MVC, 6.9; CBV-TP, 0.38; 3TC-TP, 0.32; and TFV-DP, 3.78. Median inhibitory quotients [ratios of lymph node concentrations to in-vitro inhibitory levels (IC50-or-90)] were DTG, 0.8; MVC, 38.8; CBV-TP, 0.5; 3TC- TP, 4.1; and TFV-DP, 1.8. Ongoing viral transcription was detected in lymph node of all participants. Median lymph node RNA+ cells were 71 350 versus 99 750 cells/g for Groups 1 and 2, respectively (P = 0.111).

Conclusion:

MVC has enhanced lymph node penetration and thereby may contribute to more complete viral suppression in the lymph node.
Whole-Body Magnetic Resonance Imaging in the Large Population-Based German National Cohort Study
Authors: Schuppert Christopher , Krüchten Ricarda von , Hirsch Jochen G. , Rospleszcz Susanne , Hoinkiss Daniel C. , Selder Sonja , Köhn Alexander , Stackelberg Oyunbileg von , Peters Annette , Völzke Henry , Kröncke Thomas , Niendorf Thoralf , Forsting Michael , Hosten Norbert , Hendel Thomas , Pischon Tobias , Jöckel Karl-Heinz , Kaaks Rudolf , Bamberg Fabian , Kauczor Hans-Ulrich , Günther Matthias , Schlett Christopher L. ,   for The German National Cohort MRI Study Investigators
Published: February 2022

Background

Reproducible image quality is of high relevance for large cohort studies and can be challenging for magnetic resonance imaging (MRI). Automated image quality assessment may contribute to conducting radiologic studies effectively.

Purpose

The aims of this study were to assess protocol repetition frequency in population-based whole-body MRI along with its effect on examination time and to examine the applicability of automated image quality assessment for predicting decision-making regarding repeated acquisitions.

Materials and Methods

All participants enrolled in the prospective, multicenter German National Cohort (NAKO) study who underwent whole-body MRI at 1 of 5 sites from 2014 to 2016 were included in this analysis (n = 11,347). A standardized examination program of 12 protocols was used. Acquisitions were carried out by certified radiologic technologists, who were authorized to repeat protocols based on their visual perception of image quality. Eleven image quality parameters were derived fully automatically from the acquired images, and their discrimination ability regarding baseline acquisitions and repetitions was tested.

Results

At least 1 protocol was repeated in 12% (n = 1359) of participants, and more than 1 protocol in 1.6% (n = 181). The repetition frequency differed across protocols (P < 0.001), imaging sites (P < 0.001), and over the study period (P < 0.001). The mean total scan time was 62.6 minutes in participants without and 67.4 minutes in participants with protocol repetitions (mean difference, 4.8 minutes; 95% confidence interval, 4.5–5.2 minutes). Ten of the automatically derived image quality parameters were individually retrospectively predictive for the repetition of particular protocols; for instance, “signal-to-noise ratio” alone provided an area under the curve of 0.65 (P < 0.001) for repetition of the Cardio Cine SSFP SAX protocol. Combinations generally improved prediction ability, as exemplified by “image sharpness” plus “foreground ratio” yielding an area under the curve of 0.89 (P < 0.001) for repetition of the Neuro T1w 3D MPRAGE protocol, versus 0.85 (P < 0.001) and 0.68 (P < 0.001) as individual parameters.

Conclusions

Magnetic resonance imaging protocol repetitions were necessary in approximately 12% of scans even in the highly standardized setting of a large cohort study. Automated image quality assessment shows predictive value for the technologists' decision to perform protocol repetitions and has the potential to improve imaging efficiency.
Removal of Fracture Fragments in Intracapsular Condylar Fractures: An Alternative Treatment Option
Authors: Cui Meng-Juan , Yang Rui-Cong , Zhou Hai-Hua , Lv Kun , Yang Rong-Tao , Li Zhi , Li Zu-Bing
Published: February 2022

Objective:

This study aimed to explore bone remodeling after condylar fracture fragments have been removed from patients with intracapsular condylar fractures. it also evaluated whether condyle fracture removal can be used alternatively when the authors treat patients with comminuted or small pieces of fracture or in extremely difficult operations.

Methods:

Records of patients who sustained intracapsular condylar fractures and treated by removal of fragments for the period of February 2013 to September 2019 were retrieved. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fracture, treatment methods and time of review were recorded and analyzed. Image dates of pre- and post-treatment (including the time of review) were also recorded.

Results:

The data of a total of 103 patients ranging from 5 to 84 years old were retrieved during this study. A total of 135 sides of condylar fragments were removed. Almost all of the patients with comminuted condyle head fracture or type A fracture presented apparent shortening of the ramus height, and none of them showed osteogenesis (or new bone formation) during their follow-up. Present study only observed osteogenesis in few patients who sustained type B/C intracapsular condylar fractures during their follow-up. The younger the patient was, the longer the follow-up time was, and the higher the possibility of new bone formation was. No correlation was found between the amount of osteogenesis and follow-up time, the amount of osteogenesis was generally small, and no patient could form a new condyle head similar to the normal (or original) condyle head. Condylar hypertrophy only occurred in children. Four patients developed temporomandibular joint ankylosis.

Conclusions:

Removal of fracture fragments is an alternative treatment option for patients who sustained comminuted or small pieces of fracture or in extremely difficult operations.