bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multifaceted Physical Therapy Approach in Male Adolescent With Coccydynia: A Case Report
Authors: Knepper Lauren 
Published: April 2022

Background:
Coccydynia is a rare condition in the adolescent population, especially in adolescent boys. Chronic coccydynia negatively impacts quality of life, participation in school, and recreational activities. Evidence is largely lacking for physical therapy approach to treatment for chronic coccydynia.

Case Description:
This case report describes a 14-year–old adolescent boy, presenting with chronic coccydynia. This patient presented with poor posture, myofascial restrictions, coccyx hypomobility, and deficits in soft tissue length and core strength. Treatment was 45 to 60 minutes, twice per week for 12 sessions, then reduced to once per week for 2 sessions.

Outcomes:
Symptoms appeared to be as a result of prolonged poor posture, contributing to adaptive shortening of soft tissues and pelvic floor overactivity. Treatment focused on improving posture, restoring soft tissue length, addressing myofascial restrictions in the abdomen, and improving core strength to maintain proper posture. Symptoms decreased as diaphragmatic motor control improved, and myofascial restrictions lessened with instrument-assisted soft tissue mobilization and cupping. The patient was able to resume prior level of function with few activity modifications.

Discussion:
A multifaceted physical therapy treatment approach was utilized, including a combination of therapeutic exercise and manual therapies. Myofascial trigger points were difficult to address due to patient sensitivity with myofascial techniques; instrument-assisted soft tissue mobilization and cupping were effective in treatment of trigger points. Physical therapy was effective in resolving this case of coccydynia.
Distinct Worst Pain Profiles in Oncology Outpatients Undergoing Chemotherapy
Authors: Shin Joosun , Oppegaard Kate , Calvo-Schimmel Alejandra , Harris Carolyn , Cooper Bruce A. , Paul Steven M. , Conley Yvette P. , Hammer Marilyn J. , Cartwright Frances , Kober Kord M. , Levine Jon D. , Miaskowski Christine 
Published: April 2022

Background
While pain is a significant problem for oncology patients, little is known about interindividual variability in pain characteristics.

Objective
The aims of this study were to identify subgroups of patients with distinct worst pain severity profiles and evaluate for differences among these subgroups in demographic, clinical, and pain characteristics and stress and symptom scores.

Methods
Patients (n = 934) completed questionnaires 6 times over 2 chemotherapy cycles. Worst pain intensity was assessed using a 0- to 10-point numeric rating scale. Brief Pain Inventory was used to assess various pain characteristics. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles.

Results
Three worst pain profiles were identified (low [17.5%], moderate [39.9%], severe [42.6%]). Compared with the other 2 classes, severe class was more likely to be single and unemployed and had a lower annual household income, a higher body mass index, a higher level of comorbidity, and a poorer functional status. Severe class was more likely to have both cancer and noncancer pain, a higher number of pain locations, higher frequency and duration of pain, worse pain quality scores, and higher pain interference scores. Compared with the other 2 classes, severe class reported lower satisfaction with pain management and higher global, disease-specific, and cumulative life stress, as well as higher anxiety, depression, fatigue, sleep disturbance, and cognitive dysfunction scores.

Conclusions
Unrelieved pain is a significant problem for more than 80% of outpatients.

Implications for Practice
Clinicians need to perform comprehensive pain assessments; prescribe pharmacologic and nonpharmacologic interventions; and initiate referrals for pain management and psychological services.
Ethical and Moral Conflicts in the Nursing Care of Pediatric Patients With Cancer and Their Families
Authors: dos Santos Maiara R. , da Silva Lucas T. P. , de Araújo Marina M. , Ferro Taís A. , Silva Isabella N. , Szylit Regina 
Published: April 2022

Background
Pediatric oncology nurses encounter ethical and moral dilemmas when providing comprehensive care to pediatric patients with cancer and their families.

Objective
The aim of this study was to explore ethical and moral conflicts arising in the field of pediatric oncology from the perspective of nursing professionals.

Method
This qualitative secondary analysis was conducted with 10 nursing professionals from a pediatric cancer hospital through semistructured interviews and analyzed using thematic data analysis.

Results
Two themes emerged: (1) living with conflicts intrinsic to the relationships, which describes multiple sources of conflict in the relationships of nursing professionals with the team, with the family, and with seriously ill children, summarizing trigger-sensitive topics to be addressed for its mediation; (2) developing moral resilience, which represents how nurses reframe the conflicts and make use of strategies to avoid being personally harmful.

Conclusions
The results highlight the challenging work environment of pediatric oncology, recognizing the multiple natures of sensitive topics to nursing professionals during clinical decision making and the incipient strategies in dealing with ethical and moral conflicts.

Implications for Practice
This study reveals self-reflection and intuitive strategies as protective factors, which could be applied as a step to support nurses encountering ethical and moral conflicts in pediatric oncology daily practice. Furthermore, because of the limited support services for nursing professionals, it is necessary to foresee institutional policies to embrace the development of moral resilience.
Fat embolism syndrome in patients with bilateral femur fractures: a systematic review and case comparison
Authors: Kalbas Yannik , Seaver Thomas , Kumabe Yohei , Halvachizadeh Sascha , Lempert Maximilian , Pfeifer Roman , Marcantonio Andrew , Pape Hans-Christoph 
Published: April 2022

Abstract

Objectives:
Fat embolism and fat embolism syndrome (FES) remain common complications following long bone fractures. Incidence is highest after bilateral femur fractures. We performed a systematic review of FES after bilateral femur fractures and present two cases.

Data sources:
Systematic literature search of the Cochrane, EMBASE, MEDLINE, Scopus, and, Web of Science Library databases was performed in August 2021. Terms used including plural and alternate spellings: “fat embolism,”“fat embolism syndrome,”“fat embolus,” and “bilateral femur fracture.” Articles in German and English were considered. No time frame was applied.

Study selection:
Original studies, case series and case reports on fat embolism after bilateral femur fracture were included. Insufficient documentation or patients with relevant previous heath conditions were excluded.

Data extraction:
Abstracts were organized using EndNote X9 by Carivate. Three authors independently screened the abstracts; cross check of the extracted data was performed by the senior author.

Data synthesis:
Scarcity of articles only allowed for a qualitative synthesis. Data was compared with our cases and situated within the scientific background.

Results:
Ten articles were included for qualitative synthesis (n = 144 patients). The symptoms were inhomogeneous with neurological deficits being most prominent. Degree of displacement was high, when reported. Although the modes and timing of surgery varied, this appeared unrelated with outcome.

Conclusions:
FES remains a relevant complication after bilateral femur fractures, despite damage control strategies and improved reaming techniques. Fracture displacement and reduction maneuvers might play a more substantial role in the formation than previously accredited.

Level of evidence:
4
Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature
Authors: Petfield Joseph L. , Visscher Luke E. , Gueorguiev Boyko , Stoffel Karl , Pape Hans-Christoph 
Published: April 2022

Abstract

Objective:
To describe the surgical aspects potentially contributing to hardware failure of cephalomedullary nails.

Data Sources:
A search of the Embase, PubMed (MEDLINE), Web of Science, and the Cochrane library for reports of hardware failures after intramedullary fixation of proximal femur fractures. Issues of cut out and cut through phenomena related to technique were excluded. Expert opinion of 3 surgeons, each trained on several fixation systems at Level | trauma centers is reported.

Data Extraction:
Three authors extracted data using a predesigned form. Implant type, reported failure mechanism, and associated factors with implant failure were recorded as well as potential bias.

Results:
Of 2182 search results screened, 64 articles were deemed relevant for our research question and were included. The authors identified factors associated with implant failure: preoperative patient and fracture characteristics, intraoperative reduction, implant handling, and postoperative nonunion. Issues were identified as independent modifiable intraoperative risk factors: inadequate fracture reduction, varus position of femoral neck, direct damage of the cephalomedullary nail aperture by eccentric drilling related to guide sleeve handling, and implant design mechanism failures.

Conclusions:
Multiple factors associated with intraoperative handling can influence the healing of proximal femur fractures. Although many of these have been well described and are taught in fracture courses, surgeons should be aware of subtle intraoperative complications reported in the literature that can weaken implants and add to the likelihood of early failure.

Level of Evidence: IV
The Confounding Ultrasound Diagnosis of Ectopic Pregnancy: Lessons From Peer Learning
Authors: Yun Jung H. , Horrow Mindy M. , Goykhman Igor , Rodgers Shuchi K. 
Published: April 2022

Abstract
As the treatment of ectopic pregnancy (EP) has shifted increasingly to medical therapies, the ultrasound (US) diagnosis of EP must necessarily favor specificity over sensitivity. Our review of peer learning cases of EP and early intrauterine pregnancies found several types of pitfalls and problems, which will be described in this essay. These issues include the following: differentiation of tubal EP from a corpus luteum by echogenicity relative to ovarian parenchyma, push technique, and claw sign; how to distinguish interstitial EP from eccentrically located intrauterine pregnancies (angular); use of trophoblastic flow in abnormal intrauterine locations to help identify cesarean scar or cervical implantations; recognition that hemoperitoneum without visualized EP may be due to EP or hemorrhagic cyst; and that distinguishing an abortion in progress from a pregnancy of unknown location may not always be possible and requires clinical follow-up. This essay will also illustrate the consensus terminology that our radiology department has developed in conjunction with our obstetrics and gynecology colleagues to communicate clear diagnoses and reduce the risk of misdiagnosis and adverse outcomes.
Effect of Temporal Artery Biopsy Length and Laterality on Diagnostic Yield
Authors: Shen Alice , Gruener Anna M. , Carey Andrew R. , Henderson Amanda D. , Poostchi Ali , McCulley Timothy J. , Chang Jessica R. 
Published: April 2022

Background:
Giant cell arteritis (GCA) is the most common vasculitis in adults and is associated with significant morbidity and mortality. Temporal artery biopsy (TAB) remains the gold standard for diagnosis in the United States; however, practices vary in the length of artery obtained and whether bilateral simultaneous biopsies are obtained.

Methods:
Retrospective chart review of all TABs performed at the Johns Hopkins Wilmer Eye Institute between July 1, 2007, and September 30, 2017.

Results:
Five hundred eighty-six patients underwent TAB to evaluate for GCA. Of 404 unilateral biopsies, 68 (16.8%) were positive. Of 182 patients with bilateral biopsies, 25 (13.7%) had biopsies that were positive and 5 patients (2.7%) had biopsies that were discordant, meaning only 1 side was positive. There was no significant difference in the average postfixation length of positive and negative TAB specimens (positive mean length 1.38 ± 0.61 cm, negative mean length 1.39 ± 0.62 cm, P = 0.9).

Conclusions:
There is no significant association between greater length of biopsy and a positive TAB result in our data. Although the rate of positive results was not higher in the bilateral group compared with the unilateral group, 2.7% of bilateral biopsies were discordant, similar to previously published rates. Overall, this suggests that initial bilateral biopsy may increase diagnostic yield, albeit by a small amount.
Comparison of 1.5 Tesla and 3.0 Tesla Magnetic Resonance Imaging in the Evaluation of Acute Demyelinating Optic Neuritis
Authors: Hur Minjun , Madhavan Ajay A. , Hodge David O. , Eckel Laurence J. , Pittock Sean J. , Flanagan Eoin P. , Bhatti M. Tariq , Chen John J. 
Published: April 2022

Background:
Optic neuritis (ON) is the most common optic neuropathy in young adults. MRI is reported to have a high sensitivity for ON. Higher signal strengths of MRI may enhance resolution and lead to better detection of ON. We sought to compare the sensitivity of 3.0 Tesla (T) MRI to that of 1.5 T MRI in detecting acute demyelinating ON.

Methods:
A retrospective chart review was performed on patients with a clinical diagnosis of optic neuritis at Mayo Clinic Health System from January 2010 to April 2020. Among 1,850 patients identified, 126 patients met the eligibility criteria. Exclusion criteria comprised questionable or alternative diagnosis, diagnosis of ON before the study period, eye examinations performed elsewhere, or absence of fat-saturated head and orbits MRIs performed locally within 30 days of symptom onset. Gadolinium contrast enhancement, T2 hyperintensity, and the radiologic diagnosis of ON were recorded by a neuro-radiologist who was masked to the clinical history and the magnet strength of the MRI.

Results:
Fifty-three patients (42.1%) had 3.0 T MRI, and 73 patients (57.9%) had 1.5 T MRI. Overall, 88.9% (112/126) of patients were determined to have a positive MRI for ON. The radiographic sensitivity for ON was higher in the 3.0 T group compared with the 1.5 T group (98.1% vs 82.2%, respectively [P = 0.004]). The frequency of gadolinium enhancement was found to be greater in the 3 T group compared with the 1.5 T group (98.1% vs 76.7%, respectively [P < 0.001]). T2 hyperintensity was also more often seen in the 3.0 T group compared with the 1.5 T group (88.7% vs 68.5%, respectively [P = 0.01]).

Conclusions:
3.0 T MRI is more sensitive than 1.5 T MRI in detecting ON. This finding suggests that 3.0 T MRI is a preferred imaging modality for the confirmation of ON.
Prevalence of Macular Microcystoid Lacunae in Autosomal Dominant Optic Atrophy Assessed With Adaptive Optics
Authors: Eckmann-Hansen Christina , Bek Toke , Sander Birgit , Grønskov Karen , Larsen Michael 
Published: April 2022

Background:
To assess the prevalence of macular microcystoid lacunae in patients with autosomal dominant optic atrophy (ADOA) and its association with visual function and inner retinal morphology.

Methods:
The study included 140 participants with ADOA, with a mean age of 44 (SD ±19, range 7–82) years. Study participants with a genetically verified sequence variant in the OPA1 gene were examined with best-corrected visual acuity, contrast sensitivity, optical coherence tomography (Spectralis, Heidelberg) and adaptive optics fundus photography (rtx1, Imagine Eyes). Optically empty microcystoid spaces in the ganglion cell layer and inner plexiform layer were mapped by inspection of the 2 sets of images. Data were analyzed with a mixed model adjusted for age and sex with family and individual as random effect.

Results:
Microcystoid lacunae were present in 32 of 140 participants (23%) including 18 males and 14 females. Microcystoid lacunae were associated with younger age (P = 0.0503) and a smaller nerve fiber layer volume (P = 0.035). No association was found between presence of microcystoid lacunae and visual acuity (P = 0.2), contrast sensitivity (P = 0.8), axial length (P = 0.7), or ganglion cell layer volume (P = 0.2). The analysis showed moderately reduced visual acuity in patients with microcystoid lacunae. Normal and severely impaired visual function were seen only in participants without microcystoid lacunae.

Conclusion:
In ADOA, macular microcystoid lacunae were found in 23% of the study participants and tended to be present in younger participants with moderate visual acuity reduction and a smaller nerve fiber layer volume. Further studies are needed to investigate whether cavities left by dead ganglion cells are predictors of decrease in visual function.
An optimized flow cytometry protocol for simultaneous detection of T cell activation induced markers and intracellular cytokines: application to SARS-Cov-2 vaccinated individuals
Authors: Altosole Tiziana , Rotta Gianluca , Bornheimer Scott J. , Fenoglio Daniela 
Published: April 2022

ABSTRACTAntigen (ag)-specific T cell analysis is an important step for investigation of cellular immunity in many settings, such as infectious diseases, cancer and vaccines. Multiparameter flow cytometry has advantages in studying both the rarity and heterogeneity of these cells. In the cellular immunologist’s toolbox, the expression of activation-induced markers (AIM) following antigen exposure has made possible the study and sorting of ag-specific T cells without using human leukocyte antigen (HLA)-multimers. In parallel, assessing the cytokine profile of responding T cells would support a more comprehensive description of the ongoing immune response. Here, a method and flow cytometry panel were optimized to combine the detection of activated CD4+ and CD8+ T cells in a TCR-dependent manner with the evaluation of cytokine production by intracellular staining, without affecting the positivity of activation markers. In particular, the expression of CD134 (OX40) and CD69 have been tested in conjunction with intracellular (ic) CD137 (4-1BB) to detect SARS-Cov-2 Spike protein-specific activated T cells. In our setting, assessing CD134 provided minimal contribution to detect the pool of AIM+ T cells, whereas a key role was described for ic-CD69, which was co-expressed with ic-CD137 in both CD4+ and CD8+ lymphocytes. Moreover, the analysis of TCR-triggered cytokine-producing T cells (IFNγ, TNFα and IL-2 were assessed) further confirmed the capacity of ic-CD69 to identify functionally responsive antigen-specific T cells, which were often largely negative or poorly positive for CD134 expression. In parallel, the use of CD45RA, CCR7 and CXCR5 allowed us to describe the T cell matuarion curve and detect T helper follicular CD4+ cells, including the antigen-specific activated subsets.In conclusion, we optimized a method and flow cytometry panel combining assessment of activation induced markers and intracellular cytokines that will be useful for measuring TCR stimulation-dependent activation of CD4+ and CD8+ T cells.
Pathogen- and type-specific changes in invasive bacterial disease epidemiology during the first year of the COVID-19 pandemic in the Netherlands
Authors: Steens Anneke , Knol Mirjam J. , Graaf Wieke Freudenburg-de , de Melker Hester E. , van der Ende Arie , van Sorge Nina M. 
Published: April 2022

AbstractThe COVID-19 control measures have resulted in a decline in invasive bacterial disease caused byNeisseria meningitidis(IMD),Streptococcus pneumoniae(IPD), andHaemophilus influenzae(Hi-D). The species comprise different serogroups and serotypes that impact transmissibility and virulence. We evaluated type- and pathogen-specific changes in invasive bacterial disease epidemiology in the Netherlands during the first year of the SARS-CoV-2 pandemic. Cases were based on nationwide surveillance for five bacterial species with either respiratory (IMD, IPD, Hi-D) or non-respiratory (controls) transmission routes and compared between the pre-COVID period (April 2015-March 2020) and the first COVID-19 year (April 2020-March 2021). IMD, IPD, and Hi-D cases decreased by 78%, 67%, and 35%, respectively, in the first COVID-19 year compared to the pre-COVID period although effects differed per age group. Serogroup B-IMD declined by 61%, while serogroup W and Y-IMD decreased >90%. IPD caused by serotypes 7F, 15A, 12F, 33F, and 8 showed the most pronounced decline (≥76%). In contrast to an overall decrease in Hi-D cases, vaccine-preventable serotype b (Hib) increased by 51%. COVID-19 control measures had pathogen- and type-specific effects related to invasive infections. Continued surveillance is critical to monitor potential rebound effects once restriction measures are lifted and transmission is resumed.
cvlr:Finding heterogeneously methylated genomic regions using ONT reads
Authors: Raineri Emanuele , Alberola i Pla Mariona , Dabad Marc , Heath Simon 
Published: April 2022

AbstractSummaryNanopore reads encode information on the methylation status of cytosines in CpG dinucleotides. The length of the reads makes it comparatively easy to look at patterns consisting of multiple loci; here we exploit this property to look for regions where one can define subpopulations of cells based on methylation patterns. As a benchmark we run our clustering algorithm on known imprinted genes and show that the clustering based on methylation is consistent with the phasing of the genome; we then scan chromosome 15 looking for windows corresponding to heterogeneous methylation. We can also compute the covariance of methylation across these regions while keeping into account the mixture of different types of reads.Availabilityhttps://github.com/EmanueleRaineri/releasesContactemanuele.raineri@cnag.crg.eu, simon.heath@cnag.crg.euSupplementary informationTables, figures, and some further explanations of the algorithms are available as online supplementary information.
How special am I? Consumer responses to promotion individualization and notification exclusivity
Authors: Lee Luri , Kim Donghoon 
Published: April 2022

PurposeAlthough there are at least two important characteristics of targeted promotions—promotion individualization (i.e. whether the offer is personalized for the recipient) and notification exclusivity (i.e. how small the number of recipients is)—most previous studies on targeted promotion have conceptualized them synonymously. The purpose of this study is to investigate the effect of targeted promotion on consumer purchases by conceptualizing these separately and incorporating them in a single model. Also, this study explores how the effects of these differ depending on customer loyalty. We particularly examine the promotional responses of extremely loyal customers, distinguishing them from other loyal customers.Design/methodology/approachUsing actual customer purchase data, we develop a two-stage model of the consumer decision-making process involving decisions of whether and how much to purchase. The two characteristics of targeted promotions—promotion individualization and notification exclusivity—first influence the probability of purchase and then the purchase amount given purchase.FindingsThe results show that customers respond positively to individualization and exclusivity. The effect of individualization is reduced as customer loyalty increases from loyal customers to extremely loyal customers while that of exclusivity remains the same.Originality/valueBy clearly identifying the two characteristics of targeted promotions and developing an empirical model that captures the effects of these separately, this paper provides new academic and managerial insights that were not clearly identified in the current literature.