Role of Pharmacists in Hormonal Contraceptive Access

Pharmacy, Vol. 8, Pages 191: Role of Pharmacists in Hormonal Contraceptive Access: A Survey of North Carolina Pharmacists:

Pharmacy, Vol. 8, Pages 191: Role of Pharmacists in Hormonal Contraceptive Access: A Survey of North Carolina Pharmacists

Pharmacy doi: 10.3390/pharmacy8040191

Authors:
Gwen J Seamon
Allison Burke
Casey R Tak
Amy Lenell
Macary Weck Marciniak
Mollie Ashe Scott


The role of pharmacy in healthcare continues to evolve as pharmacists gain increased clinical responsibilities in the United States, such as the opportunity to prescribe hormonal contraception. Currently, North Carolina (NC) pharmacists do not have this ability. While previous research focused on the perceptions of community pharmacists surrounding this practice, no previous research surveyed all pharmacists in a state. This cross-sectional, web-based survey was distributed to all actively licensed pharmacists residing in the state of NC in November 2018. The primary objective was to determine the likelihood of NC community pharmacists to prescribe hormonal contraception. Secondary outcomes included: evaluation of all respondent support and perceptions of this practice as advocacy occurs on the state organization level and unified support is critical; opinions regarding over-the-counter (OTC) status of contraception; and potential barriers to prescribing. Overall, 83% of community pharmacists were likely to prescribe hormonal contraception. No differences in likelihood to prescribe were detected between geographic settings. Community pharmacists reported that the most common barriers to impact prescribing were added responsibility and liability (69.8%) and time constraints (67.2%). Fewer than 10% of respondents felt that hormonal contraception should be classified as OTC (7.9%). Noncommunity pharmacists were significantly more likely to agree that prescribing hormonal contraception allows pharmacists to practice at a higher level, that increased access to hormonal contraception is an important public health issue, and that rural areas would benefit from pharmacist-prescribed hormonal contraception. Overall, this study found a willingness to prescribe and support from the majority of both community and noncommunity pharmacists. Limitations of the study included a low response rate and potential nonresponse bias. Future research is needed to address solutions to potential barriers and uptake of this practice, if implemented.

Cystocele Repair by a Modified Surgical Technique of Bilateral Pubococcygeus Plication: Long-Term Surgical and Functional Results

JCM, Vol. 9, Pages 3318: Cystocele Repair by a Modified Surgical Technique of Bilateral Pubococcygeus Plication: Long-Term Surgical and Functional Results:

JCM, Vol. 9, Pages 3318: Cystocele Repair by a Modified Surgical Technique of Bilateral Pubococcygeus Plication: Long-Term Surgical and Functional Results

Journal of Clinical Medicine doi: 10.3390/jcm9103318

Authors:
Matteo Balzarro
Emanuele Rubilotta
Alessandro Antonelli


Here we describe our modified surgical technique of bilateral pubococcygeus plication (BPCP) for cystocele repair and assess its safety and long-term outcomes. This is a prospective study of 147 consecutive women who underwent BPCP for cystocele between January 2010 to January 2018. Inclusion criteria was naïve women with symptomatic cystocele ≥ POP-Q 2nd stage. Exclusion criteria: stress urinary incontinence (SUI), urgency urinary incontinence, other associated vaginal wall prolapses ≥ stage 2, neurological diseases, previous SUI surgeries, and previous radiation/surgery of the pelvic area. BPCP was performed by obtaining the medialization of the pubococcygeus muscle fibers of the right and left sides. Statistical analysis was performed. Objective cure was POP-Q < 2nd stage. Subjective cure and functional outcomes were evaluated by validated questionnaires. Patient’s satisfaction was assessed by a Likert-type scale. Mean operative time was 64 min. At a mean follow-up of 82.4 months, objective and subjective success rates were 89.8% and 92.2% respectively. De novo urgency was 3.2%. Surgery did not alter sexual function. Complications occurred in 4.8%, and were: wrong dissection plane, hematoma, and pain lasting between 24–72 h. BPCP for correction of cystocele is safe and effective, with limited risk of complication and good long-term results.

Detection of Usutu virus infection in wild birds

Detection of Usutu virus infection in wild birds in the United Kingdom, 2020:

In August 2020, as part of a long-term disease surveillance programme, Usutu virus was detected in five Eurasian blackbirds (Turdus merula) and one house sparrow (Passer domesticus) from Greater London, England. This was initially detected by reverse transcription-PCR and was confirmed by virus isolation and by immunohistochemical detection of flavivirus in tissues. Phylogenetic analysis identified Usutu virus African 3.2 lineage, which is prevalent in the Netherlands and Belgium, suggesting a potential incursion from mainland Europe.

Detection and discrimination of influenza B Victoria lineage deletion variant viruses by real-time RT-PCR

Detection and discrimination of influenza B Victoria lineage deletion variant viruses by real-time RT-PCR:

Background


During the 2016/17 influenza season, influenza B/VIC lineage variant viruses emerged with two (K162N163) or three (K162N163D164) amino acid (aa) deletions in the haemagglutinin (HA) protein. There are currently five antigenically distinct HA proteins expressed by co-circulating influenza B viruses: B/YAM, B/VIC V1A (no deletion), B/VIC V1A-2DEL (2 aa deletion) and two antigenically distinguishable groups of B/VIC V1A-3DEL (3 aa deletion). The prevalence of these viruses differs across geographical regions, making it critical to have a sensitive, rapid diagnostic assay that detects and distinguishes these influenza B variant viruses during surveillance.

Aim


Our objective was to develop a real-time RT-PCR (rRT-PCR) assay for detection and discrimination of influenza B/VIC lineage variant viruses.

Methods


We designed a diagnostic assay with one pair of conserved primers and three probes specific to each genetic group. We used propagated influenza B/VIC variant viruses and clinical specimens to assess assay performance.

Results


This rRT-PCR assay detects and distinguishes the influenza B/VIC V1A, B/VIC V1A-2DEL, and B/VIC V1A-3DEL variant viruses, with no cross-reactivity. This assay can be run as a multiplex reaction, allowing for increased testing efficiency and reduced cost.

Conclusion


Coupling this assay with the Centers for Disease Control and Prevention’s Human Influenza Virus Real-Time RT-PCR Diagnostic Panel Influenza B Lineage Genotyping Kit results in rapid detection and characterisation of circulating influenza B viruses. Detailed surveillance information on these distinct influenza B variant viruses will provide insight into their prevalence and geographical distribution and could aid in vaccine recommendations.

Neisseria gonorrhoeae isolates

Molecular epidemiological typing of Neisseria gonorrhoeae isolates identifies a novel association between genogroup G10557 (G7072) and decreased susceptibility to cefixime, Germany, 2014 to 2017:

Background


Emerging antimicrobial resistance (AMR) challenges gonorrhoea treatment and requires surveillance.

Aim


This observational study describes the genetic diversity of Neisseria gonorrhoeae isolates in Germany from 2014 to 2017 and identifies N. gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroups associated with AMR or some patient demographics.

Methods


1,220 gonococcal isolates underwent AMR testing and NG-MAST. Associations between genogroups and AMR or sex/age of patients were statistically assessed.

Results


Patients’ median age was 32 years (interquartile range: 25–44); 1,078 isolates (88.4%) originated from men. In total, 432 NG-MAST sequence types including 156 novel ones were identified, resulting in 17 major genogroups covering 59.1% (721/1,220) of all isolates. Genogroups G1407 and G10557 (G7072) were significantly associated with decreased susceptibility to cefixime (Kruskal–Wallis chi-squared: 549.3442, df: 16, p < 0.001). Their prevalences appeared to decline during the study period from 14.2% (15/106) to 6.2% (30/481) and from 6.6% (7/106) to 3.1% (15/481) respectively. Meanwhile, several cefixime susceptible genogroups’ prevalence seemed to increase. Proportions of isolates from men differed among genogroups (Fisher’s exact test, p < 0.001), being e.g. lower for G25 (G51) and G387, and higher for G5441 and G2992. Some genogroups differed relative to each other in affected patients’ median age (Kruskal–Wallis chi-squared:  47.5358, df:  16, p < 0.001), with e.g. G25 (G51) and G387 more frequent among ≤ 30 year olds and G359 and G17420 among ≥ 40 year olds.

Conclusion


AMR monitoring with molecular typing is important. Dual therapy (ceftriaxone plus azithromycin) recommended in 2014 in Germany, or only the ceftriaxone dose of this therapy, might have contributed to cefixime-resistant genogroups decreasing.

Short-term outcomes after a neonatal arterial ischemic stroke

Short-term outcomes after a neonatal arterial ischemic stroke:

Abstract

Purpose

The purpose of this study is to determine the frequency and radiological predictors of recurrent acute symptomatic seizures (RASS) and motor impairment at discharge after a neonatal arterial ischemic stroke (NAIS).

Methods

In a nonconcurrent cohort study, 33 full-term newborns with NAIS confirmed by MRI are admitted into our hospital between January 2003 and December 2012. Stroke size, calculated as stroke volume divided by whole brain volume (WBV), was categorized as > or < 3.3% of WBV. A univariate analysis of categorical variables was performed using Fisher’s exact test. A multivariate analysis was performed using logistic regression models including all variables with a p value < 0.1 in the univariate analysis.

Results

The median age at NAIS was 2 days (IQR, 1–5.6), 36.4% were girls. The stroke size was > 3.3 of WBV in 48.5% of the cases, and 54.5% showed multifocal lesions. Involvement of the cerebral cortex (54.5%), thalamus (48.5%), posterior limb of the internal capsule (36.4%), basal ganglia (36.4%), and brainstem (28.2%) were found. At discharge, 45.5% of newborns had a motor deficit, and 27.3% had at least two seizures. Multivariate analyses revealed that stroke size > 3.3% of WBV (OR: 8.1, CI: 1.2–53.9) and basal ganglia involvement (OR: 12.8, CI: 1.7–95.4) predicted motor impairment at discharge. Cortical involvement of temporal and frontal lobes (OR: 14, CI: 2.2–88.1; and OR: 9.1, CI: 1.2–72.6) were predictive of RASS.

Conclusion

Stroke size and location are independent risk factors for adverse short-term neurological outcomes in full-term newborns following a NAIS.

Down–regulating miR-217-5p Protects Cardiomyocytes against Ischemia/Reperfusion Injury by Restoring Mitochondrial Function via Targeting SIRT1

Down–regulating miR-217-5p Protects Cardiomyocytes against Ischemia/Reperfusion Injury by Restoring Mitochondrial Function via Targeting SIRT1:

Abstract

Downregulating miR-217-5p could protect cardiomyocytes against ischemia/reperfusion (I/R) injury, but its role in restoring mitochondrial function of I/R-injured cardiomyocytes remained unclear. H9C2 cardiomyocyte-derived cell line with I/R injury was established in vitro on the basis of hypoxia/reperfusion (H/R) model. Cell viability and apoptosis were respectively detected by MTT assay and flow cytometry. Contents of lactate dehydrogenase (LDH) and adenosine triphosphate (ATP) were determined. Flow cytometry was performed to measure the production of reactive oxygen species (ROS) and mitochondrial membrane potential (MMP). Target gene and potential binding sites between miR-217-5p and Sirtuin1 (SIRT1) were predicted by TargetScan and confirmed by dual-luciferase reporter assay. Relative SIRT1 and expressions of autophagy-related and apoptosis-related genes were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. After I/R treatment, the viability of H9C2 cardiomyocyte-derived cell line and ATP contents were reduced, but LDH and ROS contents were increased, at the same time, cell apoptosis and the expressions of miR-217-5p, p62 and cleaved caspase-3 were increased, whereas the expressions of SIRT1, LC3 (light chain 3), PINK1 (PTEN-induced kinase 1), Parkin, Bcl-2, and c-IAP (inhibitor of apoptosis protein) were reduced. However, downregulating miR-217-5p expression reversed the effects of I/R. SIRT1 was predicted and verified to be the target of miR-217-5p, and silencing SIRT1 reversed the effects of downregulating miR-217-5p on I/R-injured cells. Downregulating miR-217-5p could help restore mitochondrial function via targeting SIRT1, so as to protect cardiomyocytes against I/R-induced injury.

Age- and movement-related modulation of cortical oscillations in a mouse model of presbycusis

Age- and movement-related modulation of cortical oscillations in a mouse model of presbycusis:



Publication date: Available online 15 October 2020

Source: Hearing Research

Author(s): J.A. Rumschlag, J.W. Lovelace, K.A. Razak




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Hearing Research
Available online 15 October 2020, 108095
In Press, Journal Pre-proofWhat are Journal Pre-proof articles?

Age- and movement-related modulation of cortical oscillations in a mouse model of presbycusis
Author links open overlay panelJ.A.RumschlagaJ.W.LovelacebK.A.RazakabShow more
https://doi.org/10.1016/j.heares.2020.108095Get rights and content


Highlights


•

Gamma oscillations and entrainment decrease with age in C57bl/6 mice•

Movement increases EEG gamma power in all age groups of mice•

Deficits in temporal processing in aged mice is seen even when responses are robust•

These data provide novel markers of presbycusis-related auditory processing deficits



Abstract


Brain oscillations are associated with specific cognitive and sensory processes. How age-related hearing loss (presbycusis) alters cortical oscillations is unclear. Altered inhibitory neurotransmission and temporal processing deficits contribute to speech recognition impairments in presbycusis. Specifically, age-related reduction in parvalbumin positive interneurons and perineuronal nets in the auditory cortex predicts a reduction in gamma oscillations that may lead to a decline in temporal precision and attention. To test the hypothesis that resting and evoked gamma oscillations decline with presbycusis, EEGs were recorded from the auditory and frontal cortex of awake, freely moving C57BL/6J mice at three ages (3, 14 and 24 months). Resting EEG data were analyzed according to movement state (move versus still). Evoked responses were recorded following presentation of noise bursts or amplitude modulated noise with time varying modulation frequencies. We report an age-related decrease in resting gamma power, a decline in gamma-range synchrony to time varying stimuli, and an increase in noise evoked and induced gamma power. A decline in temporal processing is seen in aged mice that exhibit robust auditory-evoked potentials, dissociating hearing loss from temporal processing deficits. We also report an increase in gamma power when mice moved compared to the still state. However, the movement-related modulation of gamma oscillations did not change with age. Together, these data identify a number of novel markers of presbycusis-related changes in auditory and frontal cortex. Because EEGs are commonly recorded in humans, the mouse data may serve as translation relevant preclinical biomarkers to facilitate the development of therapeutics to delay or reverse central auditory processing deficits in presbycusis.

Keywords
auditory cortex
aging
presbycusis
temporal processing
gamma oscillations
EEG
parvalbumin
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© 2020 Published by Elsevier B.V.

Sialic acids expression in newborn rat lungs: implications for pulmonary developmental biology

Sialic acids expression in newborn rat lungs: implications for pulmonary developmental biology:



Publication date: December 2020

Source: Acta Histochemica, Volume 122, Issue 8

Author(s): Maria de Fátima Martins, Ana Honório-Ferreira, Marco S. Reis, Catarina Cortez-Vaz, Carlos Alberto Gonçalves




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Tables (3)
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Acta Histochemica
Volume 122, Issue 8, December 2020, 151626

Sialic acids expression in newborn rat lungs: implications for pulmonary developmental biology
Author links open overlay panelMariade Fátima MartinsabAnaHonório-FerreiraaMarcoS. ReiscCatarinaCortez-VazaCarlos AlbertoGonçalvesabShow more
https://doi.org/10.1016/j.acthis.2020.151626Get rights and content


Abstract


Mammalian lung development proceeds during the postnatal period and continues throughout life. Intricate tubular systems of airways and vessels lined by epithelial cells are developed during this process. All cells, and particularly epithelial cells, carry an array of glycans on their surfaces. N-acetylneuraminic (Neu5Ac) and N-glycolylneuraminic (Neu5Gc) acids, two most frequently-occurring sialic acid residues, are essential determinants during development and in the homeostasis of cells and organisms. However, systematic data about the presence of cell surface sialic acids in the postnatal lung and their content is still scarce. In the present study, we addressed the histochemical localization of Neu5Ac > Neu5Gc in 0-day-old rat lungs. Furthermore, both residues were separated, identified and quantified in lung membranes isolated from 0-day-old rat lungs using high-performance liquid chromatography (HPLC) methodologies. Finally, we compared these results with those previously reported by us for adult rat lungs. The Neu5Ac > Neu5Gc residues were located on the surface of ciliated and non-ciliated cells and the median values for both residues in the purified lung membranes of newborn rats were 5.365 and 1.935 μg/mg prot., respectively. Comparing these results with those reported for the adults, it was possible to observe a significant difference between the levels of Neu5Ac and Neu5Gc (p < 0.001). A more substantial change was found for the case of Neu5Ac. The preponderance of Neu5Ac and its expressive increase during the postnatal development points towards a more prominent role of this residue. Bearing in mind that sialic acids are negatively charged molecules, the high content of Neu5Ac could contribute to the formation of an anion “shield” and have a role in pulmonary development and physiology.

Penetrating Midface Trauma

Penetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol:



Publication date: Available online 14 October 2020

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Eric Holmgren, Derrek Schartz, Nithya Puttige Ramesh, Kimutai Sylvester, Clifford Eskey




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Journal of Oral and Maxillofacial Surgery
Available online 14 October 2020
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Craniomaxillofacial traumaPenetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol
Author links open overlay panelEricHolmgrenDMD, MD∗DerrekSchartzMD†Nithya PuttigeRameshBDS, MPH‡KimutaiSylvesterMD§CliffordEskeyMD, PhD‖Show more
https://doi.org/10.1016/j.joms.2020.09.031Get rights and content


Purpose

Penetrating facial trauma is an uncommon injury, but patients who present with these dramatic situations require special consideration. We describe the case of a young man who had been shot with an arrow that deeply penetrated his midface as well as report the results of a literature review of penetrating midface injuries. The information gathered was used to create a diagnostic protocol for patients who sustain such injuries.

Methods

A PubMed search up to October 2019 using several key phrases was performed, and 623 unique articles were evaluated. Excluding firearm injuries to the midface, there were 57 unique cases that involved penetrating midface injuries. Clinical and imaging data were compiled and evaluated with descriptive statistical analysis.

Results

The average patient age was 27 years, with a male predilection. The most common reported etiology was accidental trauma (54%), and a knife was the most common weapon of injury (30%). The most common (32%) specific location of trauma was within the orbital region, including the canthus or the eyelid. In all cases where the patient had not died immediately, surgery was used to remove the penetrating object. We found that computed tomography was the most commonly obtained imaging study (39% of cases). Radiographs were the sole imaging in 28% of cases, with angiography (16%) and magnetic resonance imaging (10%) used less frequently in management. In 28% of cases, deep structures, such as the carotid artery, sphenoid sinus, or skull base, were involved in the injury. In 25% of the cases, there was injury to the central nervous system. Death occurred in 8.8% of cases. Postoperative complications occurred in at least 21% of cases. Statistical analysis also revealed a significant correlation between antibiotic use and full recovery. Penetration of the object posterior to the maxillary sinus was correlated with incomplete recovery or death.

Conclusions

Based on all case reports collected, a Dartmouth Penetrating Midface Protocol was developed to aid the practitioner who may happen to be responsible for these dramatic life-threatening injuries. The Dartmouth Penetrating Midface Protocol is based on the type of imaging available at the treating facility, the neurologic and hemodynamic stability of the patient, and the depth of penetration beyond the posterior wall of the maxillary sinus.



Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.View full text
© 2020 Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons

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Leukocyte and platelet-rich fibrin have same effect as blood clot in the three-dimensional alveolar ridge preservation. A split-mouth randomized clinical trial

Leukocyte and platelet-rich fibrin have same effect as blood clot in the three-dimensional alveolar ridge preservation. A split-mouth randomized clinical trial:



Publication date: Available online 15 October 2020

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Pedro Christian Aravena, Stephania Pilar Sandoval, Felipe Eduardo Pizarro, María Isabel Simpson, Nicolás Castro-Adams, Guillaume Serandour, Cristian Rosas

Permanent iodine-125 implantation with or without external beam radiation therapy

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Publication date: Available online 14 October 2020

Source: Brachytherapy

Author(s): Shinya Sutani, Atsunori Yorozu, Kazuhito Toya, Yutaka Shiraishi, Toru Nishiyama, Yasuto Yagi, Ken Nakamura, Shiro Saito

Radiotherapy or brachytherapy after resection of primary adenoid cystic carcinoma in oral and maxillofacial regions

Comparison of outcomes using radiotherapy or brachytherapy after resection of primary adenoid cystic carcinoma in oral and maxillofacial regions:



Publication date: Available online 14 October 2020

Source: Brachytherapy

Author(s): C. Li, S.M. Liu, L. Zheng, M.W. Huang, Y. Shi, X.M. Lv, J.G. Zhang, X. Peng, J. Zhang

Identification of male infertility-related long non-coding RNAs and their functions based on a competing endogenous RNA network

Identification of male infertility-related long non-coding RNAs and their functions based on a competing endogenous RNA network: Journal of International Medical Research, Volume 48, Issue 10, October 2020.

ObjectiveTo identify male infertility-related long non-coding (lnc)RNAs and an lncRNA-related competing endogenous (ce)RNA network.MethodsExpression data including 13 normospermic and eight teratozoospermic samples from postmortem donors were downloaded from the GEO database (GSE6872). The limma R package was used to discriminate dysregulated lncRNA and micro (m)RNA profiles. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of differentially expressed (DE) mRNAs were performed using the clusterProfiler R package. The ceRNA network of dysregulated genes was visualized by Cytoscape.ResultsA total of 101 DE lncRNAs and 1722 mRNAs were identified as male infertility-specific RNAs with thresholds of |log2FoldChange| >2.0 and adjusted P-value <0.05. GO and KEGG pathways were analyzed for DE mRNAs. Gene set enrichment analysis revealed that DE genes were enriched in embryonic skeletal system development and cytokine–cytokine receptor interactions. A ceRNA network was constructed with 26 key lncRNAs, 33 microRNAs, and 133 mRNAs. DE lncRNAs in male sterility were mainly associated with transferring phosphorus-containing groups and complexes of histone methyltransferases, methyltransferases, PcG proteins, and serine/threonine protein kinases.ConclusionThis provides a novel perspective to study lncRNA-related ceRNA networks in male infertility and assist in identifying new potential biomarkers for diagnostic purposes.

Spontaneous remission of untreated primary amyloidosis of the bladder

Spontaneous remission of untreated primary amyloidosis of the bladder after transurethral resection biopsy: a case report and literature review: Journal of International Medical Research, Volume 48, Issue 10, October 2020.

We herein present a case involving a 23-year-old woman with gross hematuria. Cystoscopy revealed abnormal areas of the mucosa along the anterior and posterior bladder walls. These abnormalities were suspicious for neoplasia; however, a diagnosis was not established by subsequent biopsy. The patient underwent transurethral resection biopsy in which an isolated lesion along the anterior wall was completely resected and the others were left untreated. Pathologic examination and special staining led to a diagnosis of amyloidosis, and the patient elected to undergo transurethral surgery 1 month later. During the operation, the intravesical lesions were found to have significantly improved in both the treated and untreated sites. The operation was cancelled, follow-up was arranged, and no other treatment was administered. Repeat cystoscopy examinations at 3 and 9 months after surgery showed that the lesions had almost completely disappeared.

Post‐herpetic neuralgia

Study on the related factors of post‐herpetic neuralgia in hospitalized patients with herpes zoster in Sichuan Hospital of Traditional Chinese Medicine based on big data analysis:

Abstract

Background

Although various factors were reported to be related to post‐herpetic neuralgia (PHN), studies based on adequate and comprehensive data were absent.

Methods

Data was extracted from cases of hospitalized patients with herpes zoster in dermatology department, Sichuan hospital of traditional Chinese medicine range from December, 2011 to February, 2018, and then cleaned to build prediction model with TREENET algorithms. Following evaluated the prediction model by ROC and confusion matrix, variables importance ranking and variables dependency analysis were performed, resulting in the importance ranking of factors for PHN and the dependency between factors and PHN.

Results

Based on strict inclusion and exclusion criteria, 1303 (571 PHN and 732 normal controls) cases and 2958 indicators were selected. Model evaluation showed high ROC value (training sample = 0.985, test samples = 0.752) and high accuracy value (70.27%), which indicated that the model was predictive. After variables importance ranking and variables dependency analysis, 62 variables in the model were associated with the occurrence of PHN.

Conclusions

Our study identified 62 variables related to PHN and revealed that various variables were the important risk factors for PHN, including age, MCHC, sodium and UA.

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Atypical Bilateral Multifocal Congenital Toxoplasmosis Retinochoroiditis

Atypical Bilateral Multifocal Congenital Toxoplasmosis Retinochoroiditis: Case Report With Literature Review: Journal of Investigative Medicine High Impact Case Reports, Volume 8, Issue , January-December 2020.

BackgroundToxoplasmosis gondii is ubiquitously present on earth and infection, including congenital infection, is common. Neurological, developmental, and ocular effects can be devastating in the congenital toxoplasmosis population. At present, there is no standard, nation-wide neonatal screening for this disease in the United States.Case PresentationA 17-month-old Caucasian female presented to our institution by way of referral for macular scarring. She was diagnosed with intrauterine growth retardation and born with low birth weight and microcephaly at an outside institution, but no systemic workup was conducted at that time. On ocular examination, she was found to have nystagmus and extensive multifocal chorioretinal pigmented scars involving the macula and peripheral retina in both eyes with fibrous vitreous strands extending between scars in the right eye. Toxoplasmosis immunoglobulin G was found to be highly positive. Magnetic resonance imaging of the brain showed supratentorial intracranial calcifications.ConclusionsOur patient presented with severe chorioretinal lesions, microcephaly, and nystagmus with a positive immunoglobulin G toxoplasmosis titer. She did not receive any evaluation, including TORCH infectious panel workup, on being born with low birth weight and microcephaly. There are currently no national programs in place for toxoplasmosis to be included in routine neonatal screening, despite the grave sequelae of congenital infection or that studies in other countries have shown cost-effectiveness in early screening and treatment.

Massive Upper Gastrointestinal Bleeding Following LAMS (Lumen-Apposing Metal Stent) Placement

Massive Upper Gastrointestinal Bleeding Following LAMS (Lumen-Apposing Metal Stent) Placement: Journal of Investigative Medicine High Impact Case Reports, Volume 8, Issue , January-December 2020.

Pancreatic pseudocyst is a common complication of pancreatitis. Pseudocysts may require decompression when they become painful, infected, or start compressing surrounding organs. Decompression is achieved by endoscopic cystogastrostomy. Recently, the use of lumen-apposing metal stent (LAMS) for cystogastrostomy has gained popularity due to ease of use and high technical success. LAMS has a wider lumen, which allows for direct endoscopic necrosectomy in the cases of walled-off necrosis. Our patient is a 30-year-old male who presented with massive hematemesis and dizziness. He had a history of chronic alcohol-induced pancreatitis. Three weeks before the presentation, he underwent a cystogastrostomy with LAMS placement to treat a 10-cm walled-off necrosis. Urgent computed tomography (CT) scan did not reveal any acute finding suggestive of bleeding. Esophagogastroduodenoscopy showed blood protruding from the LAMS with a large clot formation. Attempts to stop bleeding were unsuccessful. He underwent CT angiography of the abdomen. CT angiography showed a bleeding pseudoaneurysm (PA) believed to be a complication of the LAMS. Subsequently, multiple coils were placed in the splenic artery near the PA. The patient continued to improve without a further drop in hemoglobin and was eventually discharged. PA formation and subsequent rupture is a rare delayed complication of LAMS. It may lead to massive gastrointestinal bleeding with a high mortality rate. Diagnostic delays have resulted in increased mortality by 60%. In this article, we present a case of massive gastrointestinal bleeding due to a ruptured splenic artery PA presenting as a delayed complication of LAMS.

Subacute Aspergillosis “Fungal Balls”

Subacute Aspergillosis “Fungal Balls” Complicating COVID-19: Journal of Investigative Medicine High Impact Case Reports, Volume 8, Issue , January-December 2020.

Severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2), commonly known as COVID-19 (coronavirus disease-2019), began in the Wuhan District of Hubei Province, China. It is regarded as one of the worst pandemics, which has consumed both human lives and the world economy. COVID-19 infection mainly affects the lungs triggering severe hypoxemic respiratory failure, also providing a nidus for superimposed bacterial and fungal infections. We report the case of a 73-year-old male who presented with progressive dyspnea; diagnosed with SARS-CoV-2–related severe acute respiratory distress syndrome and complicated with lung cavitations growing Aspergillus sp. COVID-19, to our knowledge, has rarely been associated with subacute invasive pulmonary aspergillosis with aspergillomas. Subacute invasive pulmonary aspergillosis as a superimposed infection in patients with SARS-CoV-2 is a rare entity. By reporting this case, we would like to make the readers aware of this association.

Eosinophilic Myocarditis

A Progressive Case of Eosinophilic Myocarditis Due to Eosinophilic Granulomatosis With Polyangiitis in a Caucasian Male: Journal of Investigative Medicine High Impact Case Reports, Volume 8, Issue , January-December 2020.

Vasculitis is an inflammatory process involving blood vessels of various sizes, including the small vessels in the kidneys to the large vessels, such as the aorta. This inflammatory condition is usually autoimmune in nature and is associated with involvement of many locations, such as the sinuses, lungs, kidneys, and even the heart. Specifically, eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis that may initially hide as asthma, allergic rhinitis, and/or sinusitis. However, it is known to become a lethal disease once progressed to include cardiovascular manifestations. It is important to remember EGPA as a differential for any patient with a history of asthma, allergic rhinitis, and/or sinusitis who also presents with cardiovascular complaints and eosinophilia. Treatment recommendations focus on immunosuppression in such cases. In this article, we discuss the case of a 62-year-old male, with a known history of asthma, who presented to the emergency department with concern for his chest pain and right-sided weakness. He was later diagnosed with EGPA with eosinophilic myocarditis. Diagnosis and treatment are described.

Oxygen therapy strategies and techniques to treat hypoxia

Oxygen therapy strategies and techniques to treat hypoxia in COVID-19 patients:

OBJECTIVE: Hypoxia is one of the primary causes that leads to multiple organ injuries and death in COVID-19 patients. Aggressive oxygen therapy for the treatment of hypoxia is important in saving these patients. We have summarized the mechanisms, efficacy, and side effects of various oxygen therapy techniques and their status or the potential to treat hypoxia in COVID-19 patients. The benefit to risk ratio of each oxygen therapy technique and strategy to use them in COVID-19 patients are discussed. High flow nasal cannula oxygen (HFNO) should be considered a better choice as an early stage oxygen therapy. Supraglottic jet oxygenation and ventilation (SJOV) is a promising alternative for HFNO with potential benefits.

L'articolo Oxygen therapy strategies and techniques to treat hypoxia in COVID-19 patients sembra essere il primo su European Review.

Conventionally Versus Digitally Fabricated Denture

A Comparison of Conventionally Versus Digitally Fabricated Denture Outcomes in a University Dental Clinic:

Abstract

Purpose

The purpose of this retrospective, cross‐sectional study is to evaluate if there is a difference in number of visits (including fabrication and post‐operative) and remake rate when comparing conventionally fabricated and digitally fabricated complete dentures by dental students in a pre‐doctoral student dental clinic.

Materials and Methods

This two‐year retrospective cross‐sectional study consisted of a chart review for patients receiving maxillary and/or mandibular complete dentures between 2017 and 2019 (n = 314) at the UNC Adams School of Dentistry pre‐doctoral student clinic. No control group was determined for this study. Data were extracted for 242 conventional dentures and 39 digital dentures. Objective treatment outcomes were obtained for each included denture: the number of patient appointments from preliminary impressions to denture placement, the number of post‐operative visits, any complications noted, and any need for remakes. Fisher's Exact Test and Cochran‐Mantel‐Haenszel analysis were completed with statistical significance set at p<.05.

Results

For the number of visits from preliminary impression to placement, 50% of conventionally fabricated dentures had 6 or more visits, while only 5% of digitally fabricated dentures had 6 or more visits. This difference for the number of patient visits was statistically significant (p<.05). Additionally, conventionally fabricated dentures required an average of 2–3 post‐operative visits, whereas digitally fabricated dentures required 1–2 post‐operative visits. This difference was also statistically significant (p<.05). For the number of dentures requiring remake, there was no statistical difference (p = .1904).

Conclusions

When comparing conventionally fabricated and digitally fabricated dentures in the pre‐doctoral clinic, the digitally fabricated dentures required fewer patient appointments from start to finish, and fewer post‐operative appointments than conventionally fabricated dentures. Fewer visits may be an important consideration for patients, especially those with limited access to care.

This article is protected by copyright. All rights reserved

Lectin Drug Conjugate Therapy for Colorectal Cancer

Lectin Drug Conjugate Therapy for Colorectal Cancer:

Abstract

Drug resistance represents an obstacle in colorectal cancer treatment because of its association with poor prognoses. rBC2LCN is a lectin isolated from Burkholderia that binds cell surface glycans that have fucose moieties. Since fucosylation is often enhanced in many types of cancers, this lectin could be an efficient drug carrier if colorectal cancer cells specifically present such glycans. Therefore, we examined the therapeutic efficacy and toxicity of lectin drug conjugate therapy in colorectal cancer mouse xenograft models. The affinity of rBC2LCN for human colorectal cancer cell lines HT‐29, LoVo, LS174T, and DLD‐1 was assessed in vitro. The cytocidal efficacy of a lectin drug conjugate, rBC2LCN‐PE38, was evaluated by MTT‐assay. The therapeutic effects and toxicity for each colorectal cancer cell line derived mouse xenograft model were compared between the intervention and control groups. LS174T and DLD‐1 cell lines showed a strong affinity for rBC2LCN. In the xenograft model, the tumor volume in the rBC2LCN‐PE38 group was significantly reduced compared with that using control treatment alone. However, the HT‐29 cell line showed weak affinity and poor therapeutic efficacy. No significant toxicities or adverse responses were observed. In conclusion, we demonstrated that rBC2LCN lectin binds colorectal cancer cells and that rBC2LCN‐PE38 significantly suppressed tumor growth in vivo. In addition, the efficacy of the drug conjugate correlated with its binding affinity for each colorectal cancer cell line. These results suggest that lectin drug conjugate therapy has the potential as a novel targeted therapy for colorectal cancer cell surface glycans.

What causes hidradenitis suppurativa ?

What causes hidradenitis suppurativa ? – 15 years after:

Abstract

The 14 authors of the first review article on hidradenitis suppurativa (HS) pathogenesis published 2008 in EXPERIMENTAL DERMATOLOGY cumulating from the 1^st International Hidradenitis Suppurativa Research Symposium held March 30–April 2, 2006 in Dessau, Germany with 33 participants were prophetic when they wrote “Hopefully, this heralds a welcome new tradition: to get to the molecular heart of HS pathogenesis, which can only be achieved by a renaissance of solid basic HS research, as the key to developing more effective HS therapy.” (Kurzen et al. What causes hidradenitis suppurativa?. Exp Dermatol 2008;17:455). Fifteen years later, there is no doubt that the wished renaissance of solid basic HS research is ongoing with rapid steps and that HS has developed deep roots among inflammatory diseases in Dermatology and beyond, recognized as “the only inflammatory skin disease than can be healed”. This anniversary article of 43 research‐performing authors from all around the globe in the official journal of the European Hidradenitis Suppurativa Foundation e.V. (EHSF e.V.) and the Hidradenitis Suppurativa Foundation, Inc. (HSF USA) summarizes the evidence of the intense HS clinical and experimental research during the last 15 years in all aspects of the disease and provides information of the developments to come in the near future.

Genome‐wide association analysis of psoriasis patients treated with anti‐TNF drugs

Genome‐wide association analysis of psoriasis patients treated with anti‐TNF drugs:

Abstract

Background

While anti‐TNF therapies are effective against psoriasis, 30‐50% of patients do not show an adequate response to these drugs. Different candidate‐gene pharmacogenetics studies have identified single nucleotide polymorphisms that may predict anti‐TNF drugs response in psoriasis. Nevertheless, only one paper has undertaken a pharmacogenomic approach failing to find significant biomarkers of biological drug response along the whole genome. Furthermore, most of the pharmacogenetic candidate biomarkers identified previously have not been confirmed in a different cohort of patients.

Objectives

To find biomarkers that could predict anti‐TNF drugs response along the whole genome and validate biomarkers identified previously.

Methods

A genome‐wide association study (GWAS) was performed using the Human Omni Express‐8 v1.2 Beadchips in 243 psoriasis patients treated with anti‐TNF drugs. This study was multicentric and did not interfere with clinical practice. Associations between single nucleotide polymorphisms (SNP) and PASI75 (a 75% reduction with respect to baseline PASI) at 3 months were evaluated. Imputation was performed using SNPs with R²>0.7.

Results

There were two SNPs located in NPFFR2 that were close to the significant threshold of 5x10^‐8.

Conclusion

These data suggest that NPFFR2 might be associated with anti‐TNF drug response. However, further studies involving a larger cohort of patients are needed in order to confirm these results.

An active endoscope with small sweep volume that preserves image orientation for arthroscopic surgery

An active endoscope with small sweep volume that preserves image orientation for arthroscopic surgery:

Abstract

Background

Microsurgery is generally performed in narrow spaces with limited movement. Endoscopes that allow for angle changes have been developed using elastic materials, but they require a large bending space. We propose a new endoscope with a small sweep volume for angle changes.

Methods

We fabricated a prototype with a thumb‐operated joystick. The image sensor is attached to the tooltip. The image signal is input to a motor control board which computes inverse kinematics and transforms it into joint angle values. Each axis is positioned according to these values.

Results

The tooltip sweeping volume was 104 mm³. Surgeons at Asan Medical Center used our endoscope to obtain images of the biceps tendon and subscapularis joints of a cadaver.

Conclusion

Currently, a low‐resolution image sensor is attached to endoscope tooltips. In the future, we will develop a high‐resolution image module equipped with an ultra‐small Complementary Metal Oxide Semiconductor (CMOS) sensor.

This article is protected by copyright. All rights reserved.

Emergency Airway Management During Awake Craniotomy

Emergency Airway Management During Awake Craniotomy: Comparison of 5 Techniques in a Cadaveric Model:



Background:

During awake craniotomy, securing the patient’s airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation.

Methods:

After completing a questionnaire, 9 anesthesia providers attempted airway management in a cadaver positioned to simulate awake craniotomy conditions. Following the simulation, participants rated and ranked the devices in their order of preference.

Results:

Only 3 approaches resulted in the successful securement of an airway device for 100% of participants: LMA (median; interquartile range time to secure the airway 6 s, 5 to 10 s), fiberoptic bronchoscopy through an LMA (41 s; 23 to 51 s), and video laryngoscopy (49 s; 43 to 127 s). In contrast, the oral and nasal fiberoptic approaches demonstrated only 44.4% (154.5 s; 134.25 to 182 s) and 55.6% (75 s; 50 to 117 s) success rates, respectively. The LMA was the fastest and most reliable primary method to secure the airway (P=0.001). After the simulation, 100% of participants reported that an LMA would be their first choice for emergency airway management, followed by fiberoptic intubation through the LMA (7 of 9 participants) if the LMA failed to properly seat.

Conclusions:

We demonstrated that an LMA was the fastest and most reliable primary method to secure an airway in a laterally positioned cadaver with 3-pin skull fixation. Fiberoptic and video laryngoscope airway equipment should be readily available during awake craniotomy procedures, and an attempt to visualize the vocal cords through the LMA should be attempted before removing it for alternative techniques.

The abstract for this study was presented at the 2019 Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Annual Meeting in Phoenix, AZ.

A.Q.-H. is supported by the Mayo Clinic Professorship, a Clinician Investigator Award, the Florida Department of Health Cancer Research Chair Fund, and the National Institute of Health (R43CA221490, R01CA200399, R01CA195503, and R01CA216855). B.F.G. is supported by a grant from the Foundation for Anesthesia Education and Research and a Clinical Translational Science Award from the National Center for Advancing Translational Science, a component of the National Institute of Health (UL1TR001863). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official view of the National Institute of Health.

The authors have no conflicts of interest to disclose.

Address correspondence to: Shaun E. Gruenbaum, MD, PhD. E-mail: gruenbaum.shaun@mayo.edu.

Received June 9, 2020

Accepted August 26, 2020

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Electroencephalographic Alpha and Delta Oscillation Dynamics in Response to Increasing Doses of Propofol

Electroencephalographic Alpha and Delta Oscillation Dynamics in Response to Increasing Doses of Propofol:



Background:

The electroencephalogram (EEG) may be useful for monitoring anesthetic depth and avoiding overdose. We aimed to characterize EEG-recorded brain oscillations during increasing depth of anesthesia in a real-life surgical scenario. We hypothesized that alpha power and coherency will diminish as propofol dose increases between loss of consciousness (LOC) and an EEG burst suppression (BS) pattern.

Methods:

This nonrandomized dose-response clinical trial with concurrent control included EEG monitoring in 16 patients receiving slowly increasing doses of propofol. We assessed 3 intraoperative EEG segments (LOC, middle-dose, and BS) with spectral analysis.

Results:

Alpha band power diminished with each step increase in propofol dose. Average alpha power and average delta power during the BS step (−1.4±3.8 and 6.2±3.1 dB, respectively) were significantly lower than during the LOC step (2.8±2.6; P=0.004 and 10.1±5.2 dB; P=0.03, respectively). Peak alpha power was significantly higher during the LOC (5.4±2.6 dB) compared with middle-dose (2.6±3.6; P=0.04) and BS (0.7±3.2; P=0.0002) steps. In addition, as propofol dose increased, alpha band coherence between the F7 and F8 electrodes decreased, whereas delta band coherence exhibited a biphasic response (initial increase between LOC and middle-dose steps and decrease between middle-dose and BS steps).

Conclusion:

We report compelling data regarding EEG patterns associated with increases in propofol dose. This information may more accurately define “therapeutic windows” for anesthesia and provide insights into brain dynamics that are sequentially affected by increased anesthetic doses.

This study was supported by FONDECYT (Fondo nacional de desarollo de ciencia y tecnología) de Iniciación 2015 (Grant ID Number, 11150416; granted to A.P.).

The authors have no conflicts of interest to disclose.

Address correspondence to: Antonello Penna, MD, PhD, E-mail: apenna@uchile.cl.

Received July 8, 2020

Accepted September 5, 2020

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

Role of Dexmedetomidine in Aneurysmal Subarachnoid Hemorrhage

Role of Dexmedetomidine in Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Scoping Review:



Dexmedetomidine (DEX), an α2-adrenergic agonist, has been widely used for anesthesia, pain control, and intensive care unit sedation. Besides sleep-like sedation, DEX has many other beneficial effects, such as anti-inflammation, antioxidation, and anticell death. Subarachnoid hemorrhage (SAH), a severe and potentially fatal form of stroke, is a complex disease that is divided into 2 phases: early brain injury and delayed cerebral ischemia. In each phase, several pathologic changes are involved, including disturbed intracranial homeostasis, metabolic failure, blood-brain barrier damage, vasospasm, microthrombosis, and cortical spreading depolarization. DEX has been shown to have an effect on these SAH-related pathologic processes. Research shows that DEX could serve as a protective therapy for patients with SAH due to its ability to maintain stable intracerebral homeostasis, balance coagulation-fibrinolysis, repair a damaged blood-brain barrier as well as prevent vasospasm and suppress cortical spreading depolarization by anti-inflammatory, antioxidative, antiapoptotic, and vasoconstriction-dilation effects. In this scoping review, we critically assess the existing data on the potential protective effect of DEX after SAH. So far, only 1 retrospective clinical trial assessing the effect of DEX on clinical outcomes after SAH has been performed. Hence, more trials are still needed as well as translational research bringing results from bench to bedside.

This review was supported in part by the National Institutes of Health (R21NS095166, R21NS110008), the American Heart Association (17GRNT33450010), and the Brain Aneurysm Foundation.

The authors have no conflicts of interest to disclose.

Address correspondence to: Sylvain Doré, PhD, FAHA, E-mail: sdore@ufl.edu.

Received March 27, 2020

Accepted August 5, 2020

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved

A Curious Case of Persistent Throat Pain......a man in his 20s who presented with persistent, severe, right-sided, throbbing throat pain and dysphagia and was found to have bony mass in the parapharyngeal space following a tonsillectomy

A Curious Case of Persistent Throat Pain:



This case report describes a man in his 20s who presented with persistent, severe, right-sided, throbbing throat pain and dysphagia and was found to have bony mass in the parapharyngeal space following a tonsillectomy.

Aerosol Transmission of Infectious Agents During Mastoid Drilling

A Cost-effective Solution to Limit Aerosol Transmission of Infectious Agents During Mastoid Drilling:



To the Editor We were interested by the recent article by Carron, et al “A Simple Technique for Droplet Control During Mastoid Surgery” because we have also been considering the challenges of performing mastoidectomy in the coronavirus disease 2019 era. Mastoidectomy is an aerosol-generating procedure (AGP) owing to the use of drills and presence of potentially virus-containing respiratory mucosa lining the mastoid air cells. The recommended personal protective equipment for AGPs is a FFP3 mask and a face visor to prevent aerosolized particles coming into contact with mucosal surfaces of the face, including the nose, mouth, and eyes. As the authors point out “using a microscope with a face shield is virtually impossible.” Clamp and Broomfield quantified this, demonstrating that face shields reduced the surgical view to a median of 4%. Although the use of plastic drapes are 1 alternative to a face shield, they are somewhat problematic. Instruments have to be passed beneath the drapes by the scrub nurse, which is slow and cumbersome. The seal is not airtight, and lifting drapes to change instruments releases viral particles into the theater environment. Third, there is the contamination risk to the surgical team and environment when removing the drapes afterwards.

Facial Nerve Intraneural Perineurioma

Facial Nerve Intraneural Perineurioma Masquerading as a Schwannoma:



This case report describes a woman in her 30s who presented with worsening left-sided facial weakness and was diagnosed with a perineurioma.

a man in his 20s who presented with a 4-week history of progressive swelling of the midline forehead, recurrent headache, and sinus pain..................Atypical Presentation of Langerhans Cell Histiocytosis of the Skull

Atypical Presentation of Langerhans Cell Histiocytosis of the Skull:



This case report describes a man in his 20s who presented with a 4-week history of progressive swelling of the midline forehead, recurrent headache, and sinus pain, and was subsequently diagnosed with Langerhans cell histiocytosis.

Eustachian Tube Rhabdomyomatous Mesenchymal Hamartoma in a Pediatric Patient

Eustachian Tube Rhabdomyomatous Mesenchymal Hamartoma in a Pediatric Patient:



This case report describes a young girl who presented with a history of chronic, unilateral middle ear effusion that was treated with a pressure equalization tube.

Predictors of OSA following Adenotonsillectomy in Children with Trisomy 21

Predictors of OSA following Adenotonsillectomy in Children with Trisomy 21:

Abstract

Objectives

Given that 30‐50% of children with trisomy 21 have persistent obstructive sleep apnea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA severity after adenotonsillectomy.

Design

Retrospective study.

Setting

Secondary care hospital.

Participants

Retrospective review of 32 children with the diagnosis of trisomy 21 and OSA by polysomnography who underwent adenotonsillectomy, from January 2010 to December 2018.

Main outcome and measure

Non‐parametric analysis was used to compare pre and postoperative factors, regression was used to model persistent OSA and OSA severity.

Results

Thirty‐two children were included (17 males, median age 10.00 ± 8.00 years, median body mass index z‐score 0.89 ± 1.25). Overall, adenotonsillectomy resulted in a significant improvement in median obstructive apnea‐hypopnea index (oAHI) from 7.5 ± 8.95 to 4.40 ± 4.38 events per hour (p<0.001) and in median OSA‐18 score from 85.00 ± 12.00 to 61.00 ± 37.75 (p<0.001). Persistent OSA was found in 56.25% of the children. Univariate regression suggests that postoperative OSA‐18 score was associated with persistent OSA after adenotonsillectomy. Preoperative oAHI, preoperative oxygen desaturation index, pre and postoperative OSA‐18 scores correlated with OSA severity after adenotonsillectomy. However, in a multivariate model only the postoperative OSA‐18 score correlated with OSA severity after adenotonsillectomy.

Conclusions

Although adenotonsillectomy results in a significant improvement of OSA in children with trisomy 21, more than half of the children had persistent OSA. The postoperative OSA‐18 score was associated both with persistent OSA and OSA severity after adenotonsillectomy.

Evaluation of cerebral arteriovenous shunts

Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography:

Abstract

Purpose

Time-of-flight (TOF)-MR angiography (MRA) is an important imaging sequence for the surveillance and analysis of cerebral arteriovenous shunt (AVS), including arteriovenous malformation (AVM) and arteriovenous fistula (AVF). However, this technique has the disadvantage of a relatively long scan time. The aim of this study was to compare diagnostic accuracy between compressed sensing (CS)-TOF and conventional parallel imaging (PI)-TOF-MRA for detecting and characterizing AVS.

Methods

This study was approved by the institutional review board for human studies. Participants comprised 56 patients who underwent both CS-TOF-MRA and PI-TOF-MRA on a 3-T MR unit with or without cerebral AVS between June 2016 and September 2018. Imaging parameters for both sequences were almost identical, except the acceleration factor of 3× for PI-TOF-MRA and 6.5× for CS-TOF-MRA, and the scan time of 5 min 19 s for PI-TOF-MRA and 2 min 26 s for CS-TOF-MRA. Two neuroradiologists assessed the accuracy of AVS detection on each sequence and analyzed AVS angioarchitecture. Concordance between CS-TOF, PI-TOF, and digital subtraction angiography was calculated using unweighted and weighted kappa statistics.

Results

Both CS-TOF-MRA and PI-TOF-MRA yielded excellent sensitivity and specificity for detecting intracranial AVS (reviewer 1, 97.3%, 94.7%; reviewer 2, 100%, 100%, respectively). Interrater agreement on the angioarchitectural features of intracranial AVS on CS-MRA and PI-MRA was moderate to good.

Conclusion

The diagnostic performance of CS-TOF-MRA is comparable to that of PI-TOF-MRA in detecting and classifying AVS with a reduced scan time under 2.5 min.

Activation of 5‐HT7 receptor but not NOS is necessary for chronic 5‐HT‐induced hypotension

Activation of 5‐HT7 receptor but not NOS is necessary for chronic 5‐HT‐induced hypotension:

New Findings

What is the central question of this study?


What mechanisms account for the hypotension observed during chronic elevations in circulating 5‐hydroxytryptamine in rats?


What is the main finding and its importance?


Chronic 5‐hydroxytryptamine induced hypotension requires continued activation of the 5‐HT₇ receptor subtype but does not require NO, an outcome that resolves previous conflicting results. Therapeutic interruption of the hypotensive actions of 5‐HT under pathophysiological conditions can only be achieved through blockade of the 5‐HT₇ receptor.

Abstract

Low dose infusion of 5‐hydroxytryptamine (5‐HT) to rats causes both an acute and chronic fall in arterial blood pressure. The 5‐HT₇ receptor subtype plays a critical part in the observed hypotension. Acute (minutes to hours) 5‐HT infusion shows no depressor role for NO, but 5‐HT depressor responses under chronic conditions suggest that NO production may be critical. We test the hypothesis that NO contributes to the chronic, but not acute, depressor response to 5‐HT. We compared the role of NO and 5‐HT₇ receptors in 5‐HT induced hypotension under acute and chronic conditions in the same animal. Mean arterial pressure (MAP) and heart rate (HR) were measured via radiotelemetry in conscious rats during 5 days of saline or 5‐HT (25 μg/kg/min; osmotic pump) infusion and for two days after infusion was stopped. To quantify the contributions of NO and the 5‐HT₇ receptor to 5‐HT‐induced hypotension, the nitric oxide synthase (NOS) inhibitor L‐NAME or the selective 5‐HT₇ receptor antagonist SB267790 were given at 1, 3 and 5 days of chronic infusion, and 1 day after 5‐HT infusion pumps were removed. L‐NAME caused a pressor response of the same magnitude in the absence or presence of 5‐HT infusion. Conversely, SB269970 did not affect MAP in the absence of 5‐HT infusion and reversed the 5‐HT‐induced depressor response at each time point. Our findings demonstrate that acute and chronic 5‐HT induced hypotension does not require NOS activation but does require continued activation of the 5‐HT₇ receptor.

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Sleep restriction alters physiological and emotional responses to emotion induction

Sleep restriction alters physiological and emotional responses to emotion induction:

New Findings

The aim of the present study was to assess the effects of sleep restriction on self report and autonomic responses to neutral and sad film clips. Ratings of sadness and heart rate deceleration were greater while watching the sad clip, with no effect of sleep restriction; whereas heart rate variability and skin conductance were impacted by sleep restriction and to a lesser extent by film clips. Results suggest that autonomic function was adaptively altered by sleep restriction, so as to maintain a ‘normal’ response to emotional cues, despite mounting fatigue.

Abstract

Habitual insufficient sleep has long‐term health consequences via its impact on the autonomic nervous system (ANS) function and on emotion regulation. To our knowledge, the effects of insufficient sleep on emotion‐induced ANS function has not been tested. The present study aimed to address this lacuna. Using an emotion induction procedure, the effects of sleep restriction on physiological responses to validated neutral and sad film clips were assessed in a 2‐by‐2, pseudo‐randomized, cross‐over design. Thirty‐one participants, ages 20–33, were assessed after sleeping either 5 hrs (sleep restricted, SR) or 8 hrs (well rested, WR) per night, three consecutive nights. Physiological measures included heart rate (HR), heart rate variability (HRV), skin conductance response (SCR), and participants’ ratings of affect and fatigue. There was no effect of sleep condition on self‐reported negative affect, however watching the sad clip reduced self‐reported fatigue in the SR condition. There was greater HR deceleration while watching sad relative to neutral clips, independent of the sleep condition. SR increased HRV measures with no effect of emotion induction. There was an interaction of emotion induction by sleep condition for SCR, with more SCRs to sad relative to neutral clips in the WR condition, and the opposite effect in the SR condition. Combined the results suggest that ANS response to an emotional cue was altered by sleep restriction. The results suggest an adaptive ANS response to mild, but chronic, sleep restriction, resulting in constant HR response and self‐reported experience across well‐rested and sleep deprived conditions, despite mounting fatigue.

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The acute effect of resistance exercise on limb blood flow

The acute effect of resistance exercise on limb blood flow:

New Findings

What is the central question of this study?


How does resistance exercise affect peripheral haemodynamics in the active and inactive limb?


What is the main finding and its importance?


Preliminary data indicate that resistance exercise increases flow and shear rate in the active limb transiently. The same exercise has minimal, short‐lasting influence on peripheral haemodynamics in the inactive limb, but further research is required to elaborate on resistance‐exercise mediated changes in vascular function in active and inactive limbs.

Abstract

Current evidence indicates that to achieve maximum health benefits, regular resistance exercise should be a key component of structured physical activity. Several studies have revealed that regular resistance exercise may be associated with impaired vascular function, although this finding is inconsistent. Proposed explanations for impairment include substantial increases in blood pressure, and increased retrograde blood flow in active limbs promoted by resistance exercise. However, few studies have examined the acute haemodynamics of resistance exercise in active – and even fewer in inactive – limbs. The purpose of this study was to characterise the haemodynamic responses in peripheral arteries in active and inactive limbs in response to resistance exercise using upper and lower limbs. Ten participants (5 male, 5 female) familiar with resistance training, performed 3 sets of 10 isotonic repetitions of right‐sided bicep curls or knee extensions on separate days. Blood flow, shear rate and muscle oxygenation in the active and inactive limb, and blood pressure were measured before and for 3 min after each set. Blood flow increased in response to resistance exercise in the active limb (∼8‐fold and ∼6‐fold for the upper and lower limb respectively), with concurrent significant increases in mean and antegrade shear rate. In the inactive limb, blood flow more than doubled for both upper and lower limb exercise, transiently, with no significant change in retrograde shear rate. These acute blood flow profiles following resistance exercise are not indicative of long‐term vessel impairment based on current understanding of blood flow and shear stress patterns.

This article is protected by copyright. All rights reserved

Optimising sleep and performance during night float

Optimising sleep and performance during night float: A systematic review of evidence and implications for graduate medical education trainees:

Abstract

Graduate medical education (GME) training commonly requires residents and fellows to engage in night float shift work. This review aims to assess the effectiveness of interventions for trainees when preparing for, completing, and recovering from working night float shifts. We reviewed all available studies published prior to September 2019 using PubMed, Scopus, CINAHL, the Cochrane library, PsycINFO, and Google Scholar databases. We included all original, primary research articles assessing either non‐pharmacological or pharmacological interventions on the chronobiological and physiological effects of night float shift work among GME trainees. Five studies (n = 179 patients) met inclusion criteria. Interventions included melatonin in the morning before sleep after night float shifts, napping during night float shifts, modafinil after a night of sleep deprivation, and caffeinated energy drinks after 6 consecutive night float shifts. Melatonin improved one measure of attention. A 2‐hr nap was associated with improved speed related to task switching. Modafinil improved performance in tests of cognition. Caffeinated energy drinks led to improvement in select driving performance variables and reaction time. Effect sizes for outcome variables were calculated. Heterogeneity among the studies precluded combining the data in a meta‐analysis. According to GRADE criteria, the quality of the evidence in these studies was low or very low. Our findings suggest GME trainees may benefit from utilising a limited number of interventions when preparing for or recovering from night float shift work. More investigation is needed to identify interventions that could help GME trainees adapt to and recover from working night float shifts.

Intestinal obstruction secondary to shiitake mushroom intake

A case series of intestinal obstruction secondary to shiitake mushroom intake during Chinese New Year:

Abstract

Shiitake mushroom is a common ingredient in East Asian cuisines. Food processing/preparation can cause the mushroom to be soft and slimy, leading to accidental swallowing. Due to its high insoluble fibre content, it remains the same size and shape in the intestinal tract. We present two cases of small bowel obstruction caused by shiitake mushroom requiring surgical intervention. Preoperative imaging showed dilated small bowel with a suspicious mass in the ileum. However, the exact cause was unclear. For both cases, exploratory laparotomy and enterotomy were then performed and undigested shiitake mushroom was found. Both patients recovered well from the surgery.

Ankylosis of the temporomandibular joint

Ankylosis of the temporomandibular joint—impression free CAD/CAM based joint replacement using patient-specific implants:

Abstract

In recent years, alloplastic temporomandibular joint (TMJ) replacement has become a permissible procedure for the reconstruction of severely destroyed TMJs. The use of computer-aided design/computer-aided manufacturing (CAD/CAM) has extended the range of applications to complex anatomical situations. The aim of the treatment is to improve the usually restricted mouth opening and thus oral hygiene and nutrition, which leads to a regular improvement in the general quality of life. The following case report describes the bilateral replacement of ankylotically destroyed TMJs using patient-specific endoprostheses with simultaneous displacement of the maxilla. Innovative in the case described is the impression-free CAD/CAM planning, whereby the upper and lower prostheses were produced on the basis of 3D printed patient models.

Effect of chitosan solutions with or without fluoride on the protection against dentin erosion in vitro

Effect of chitosan solutions with or without fluoride on the protection against dentin erosion in vitro:

The aim of this study was to assess the protective effect of experimental solutions containing chitosan at different viscosities with or without fluoride (TiF₄/NaF) on dentin loss in vitro. Bovine dentin samples (n = 15) were prepared and allocated to one of the following treatments: (i) 0.5% chitosan (500 mPas); (ii) 0.5% chitosan (2,000 mPas); (iii) 0.042% NaF and 0.049% TiF₄; (iv) as (iii) with addition of 0.5% chitosan (500 mPas); (v) as (iii) with addition of 0.5% chitosan (2,000 mPas); (vi) commercial solution with SnCl₂/AmF/NaF (positive control); or (vii) deionized water (negative control). The samples were submitted to pH cycling for 7 d (0.1% citric acid, 4 × 90 s d⁻¹). The treatment was applied once a day for 30 s. The dentin loss was quantified using a contact profilometer. Three samples per group were evaluated using scanning electron microscopy. The dentin loss (μm) was submitted to anova and Tukey's test for differences between treatments. Among the treatments tested, only chitosan 500 mPas was able to statistically significantly reduce the dentin loss compared to the negative control, being similar to the positive control. TiF₄/NaF, whether with or without chitosan, had no protective effect. Chitosan 500 mPas and SnCl₂/AmF/NaF solutions have comparable protective effect against dentin erosion in vitro.

Rosai‐Dorfman disease of the pancreas

Rosai‐Dorfman disease of the pancreas: Cytologic analysis of three cases presenting as pancreatic masses:

Abstract

Rosai‐Dorfman Disease (RDD), or sinus histiocytosis with massive lymphadenopathy, is a rare entity characterized by proliferating S100‐positive histiocytes. It is most commonly found in lymph nodes with extranodal involvement usually occurring in the head and neck. Pancreatic involvement is extremely rare. The pathology department archives were searched for fine needle aspirations and pancreatic resections showing evidence of RDD. Clinicopathologic features, cytologic smears, cell blocks, immunocytochemical stains and surgical resections were reviewed. Three cases were identified. They were all females, aged 65, 69 and 75, with involvement of the pancreatic tail or head by solid masses of median size 2.3 cm (range 2.1‐4.5 cm). Cytologic findings on smears included multiple histiocyte clusters resembling loosely cohesive epithelioid granulomas, singly dispersed histiocytes with moderate to marked nuclear atypia and characteristic emperipolesis. These atypical histiocytes stained positively for CD68, CD163 and S100. Smear background contained variable mixed inflammatory cells, necrotic debris and stromal fragments. The RDD diagnosis was further confirmed on pancreatic resection in two patients and core biopsy in one. The latter patient required three separate procedures before a definitive diagnosis was made. RDD of pancreas is a rare benign inflammatory condition that is diagnostically challenging on cytology. This can cause delays in cytologic diagnosis and/or misdiagnosis. Identification of characteristic cytologic features, primarily histiocytes with emperipolesis, and matching immunocytochemical profile can ensure accurate diagnosis and distinction from mimics.

Epilepsy and movement disorders in Congenital glycosylation disorders (CDG)

Epilepsy and movement disorders in CDG: Report on the oldest‐known MOGS‐CDG patient:

Abstract

Congenital glycosylation disorders (CDG) are inherited metabolic diseases due to defective glycoprotein and glycolipid glycan assembly and attachment. MOGS‐CDG is a rare disorder with seven patients from five families reported worldwide. We report on a 19‐year‐old girl with MOGS‐CDG. At birth she presented facial dysmorphism, marked hypotonia, and drug‐resistant tonic seizures. In the following months, her motility was strongly limited by dystonia, with forced posture of the head and of both hands. She showed a peculiar hyperkinetic movement disorder with a rhythmic and repetitive pattern repeatedly documented on EEG‐polygraphy recordings. Brain MRI showed progressive cortical and subcortical atrophy. Epileptic spasms appeared in first months and ceased by the age of 7 years, while tonic seizures were still present at last assessment (19 years). We report the oldest‐known MOGS‐CDG patient and broaden the neurological phenotype of this CDG.

Novel GLI3 pathogenic variants in complex pre‐ and postaxial polysyndactyly and Greig cephalopolysyndactyly syndrome

Novel GLI3 pathogenic variants in complex pre‐ and postaxial polysyndactyly and Greig cephalopolysyndactyly syndrome:

Abstract

Polydactyly is a limb malformation and can occur as nonsyndromic polydactyly, syndromic polydactyly, or along with other limb defects. A few genes have been identified that cause various forms of syndromic and nonsyndromic polydactyly, of which GLI3 has been extensively explored. In the present study, GLI3 gene was screened by direct resequencing in 15 polydactyly cases with or without other anomalies. GLI3 screening revealed two novel pathogenic variants, NM_000168.6:c.3414delC [p.(H1138Qfs*68)] and NM_000168.6:c.1862C>T [p.(P621L)], found in two unrelated cases of familial complex pre‐ and postaxial polysyndactyly and sporadic Greig cephalopolysyndactyly syndrome (GCPS), respectively. The first pathogenic GLI3 variant, NM_000168.6:c.3414delC, causes premature protein truncation at the C‐terminal domain of GLI3. Alternatively, the second pathogenic variant, NM_000168.6:c.1862C>T, lies in the DNA binding domain of GLI3 protein and may affect its hydrophobic interaction with DNA. Both pathogenic GLI3 variants had reduced transcriptional activity in HEK293 cells that likely had led to haploinsufficiency and, consequently, the clinical phenotypes. Overall, the present study reports a novel familial case of complex pre‐ and postaxial polysyndactyly and the underlying novel pathogenic GLI3 variant expanding the clinical criteria for GLI3 mutational spectrum to complex pre‐ and postaxial polysyndactyly. Furthermore, this study also reports a novel GLI3 pathogenic variant linked to GCPS, highlighting the known genotype–phenotype correlation.

Multiple Cranial Neuropathies as the Presenting Sign in a Patient with Metastatic BRAF-Mutated Lung Adenocarcinoma with Leptomeningeal Involvement

Multiple Cranial Neuropathies as the Presenting Sign in a Patient with Metastatic BRAF-Mutated Lung Adenocarcinoma with Leptomeningeal Involvement:



Leptomeningeal carcinomatosis accounts for only 4% of cases of multiple cranial neuropathies. Here, we report the case of a patient who presented with multiple synchronous cranial neuropathies. After treatment for neuroborreliosis and broad infectious workup, endobronchial ultrasound-guided mediastinal lymph node biopsy confirmed a diagnosis of metastatic BRAF-mutated lung adenocarcinoma with leptomeningeal involvement. To our knowledge, this is the first reported case of metastatic BRAF-driven lung adenocarcinoma with leptomeningeal disease at diagnosis. In this case, the presence of leptomeningeal carcinomatosis at diagnosis, not as a late manifestation of heavily pretreated disease, alludes to a possible association between leptomeningeal involvement and BRAF-mutated non-small cell lung cancer.

Case Rep Oncol 2020;13:1258–1262

RT-qPCR versus Digital PCR: How Do They Impact Differently on Clinical Management of Chronic Myeloid Leukemia Patients?

RT-qPCR versus Digital PCR: How Do They Impact Differently on Clinical Management of Chronic Myeloid Leukemia Patients?:



Real-time quantitative PCR (RT-qPCR) is the gold standard to quantify the BCR-ABL1 transcript for molecular response monitoring in chronic myeloid leukemia (CML) patients, and it plays a pivotal role in clinical decision-making process, even if it presents technical limits. Increasing data suggest that digital PCR (dPCR) is more accurate and reliable than RT-qPCR in CML minimal residual disease monitoring and in patients’ selection for treatment discontinuation. But what about the identification of treatment discontinuation failures? We present the case of a CML patient enrolled both in a study aiming to comparatively assess molecular response by RT-qPCR and dPCR and in the progressive arm of the OPTkIMA trial. This is a phase III trial including CML patients randomized to receive a fixed versus a progressive intermittent tyrosine kinase inhibitor regimen. At 24 months, because of two consecutive detections of MR^2.0 by RT-qPCR, the patient resumed daily treatment. Conversely, dPCR revealed a stability of molecular response and even a slight decreasing of transcript over time. An additional specimen was sampled one month after the first MR^2.0 detection because of clinical decision: RT-qPCR resulted MR^3.0 and dPCR confirmed the transcript’s stability. Nowadays, the resumption of therapy is RT-qPCR-driven despite its limits in detection and robustness. In this case, according to dPCR, the patient could have continued intermittent treatment and the stability of response was then confirmed by RT-qPCR. So, dPCR could be able to better identify peculiar clinical response to therapy.

Case Rep Oncol 2020;13:1263–1269

Acquired Pure Red Cell Aplasia Associated with Chronic Myelomonocytic Leukemia: Too Many of One, Not Enough of the Other

Acquired Pure Red Cell Aplasia Associated with Chronic Myelomonocytic Leukemia: Too Many of One, Not Enough of the Other:



There is a growing body of literature outlining the association between certain hematological malignancies, such as chronic myelomonocytic leukemia (CMML), and systemic autoimmune diseases. Diagnosis and management can be difficult, particularly when autoimmune phenomena overlap with features of the underlying illness. This is especially the case in patients who develop immune-mediated cytopenias in the context of underlying bone marrow disease. CMML associated with immune thrombocytopenia and hemolytic anemia has been reported a number of times in the literature; however, there are only scattered case reports describing CMML associated with acquired pure red cell aplasia. Here, we describe the diagnostic and management approach to a patient who developed both diseases.

Case Rep Oncol 2020;13:1270–1274

Microsatellite-Stable Radiation-Induced Angiosarcoma after Breast-Conserving Surgery: A Case Report

Microsatellite-Stable Radiation-Induced Angiosarcoma after Breast-Conserving Surgery: A Case Report:



Radiation-induced angiosarcoma (RIAS) after breast-conserving surgery is quite rare. Risk factors for RIAS have yet to be identified, due largely to the very low incidence of this disease. The etiologic mechanisms of RIAS are not understood, although some reports suggest that genome instability may contribute to RIAS development. An 81-year-old Japanese woman presented to our hospital after developing multiple dark purple nodules on her left breast. She had undergone breast-conserving surgery for left breast cancer and adjuvant radiotherapy for the conserved breast 9 years earlier. Punch biopsy of one of the dark purple nodules was performed and the pathological diagnosis was angiosarcoma. She underwent total mastectomy with an adequate margin, and skin collected from her left thigh was grafted onto the site. Pathologically, the surgical margin was negative. The tumor was negative for microsatellite instability (MSI). Considering her age, she has remained under careful observation with neither systemic treatment nor adjuvant radiation. The only standard therapy for RIAS currently available is complete resection. Hence, early detection is crucial to obtain an adequate margin, followed by careful observation after breast-conserving surgery. It is also essential to reveal the tumor etiology, and for that purpose, we believe that the MSI status may be beneficial for the further investigation of RIAS.

Case Rep Oncol 2020;13:1275–1280

physical activity (PA) and sedentary time (ST) with the combined outcome of incident stroke, myocardial infarction (MI)

Associations of Objectively Measured Physical Activity and Sedentary Time with the Risk of Stroke, Myocardial Infarction or All-Cause Mortality in 70-Year-Old Men and Women: A Prospective Cohort Study:

Abstract

Objective

To study the associations of objectively measured physical activity (PA) and sedentary time (ST) with the combined outcome of incident stroke, myocardial infarction (MI) or all-cause mortality in older adults.

Methods

N = 3343 men and women aged 70 who participated in a health survey between 2012 and 2017 were included. Actigraph GT3X+ accelerometers were used to measure light-intensity PA (LPA), moderate-intensity PA (MPA) and ST for 1 week. Incident cases of cardiovascular disease (CVD) in terms of stroke or MI, and all-cause mortality were identified using national registers. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable-adjusted Cox regressions.

Results

During a mean follow-up of 2.7 years (0.1–5.6), there were 124 events of CVD or all-cause mortality. After adjusting for potential confounders and mediators, every 30-min/day increment in LPA was associated with 11% lower risk of CVD or all-cause mortality (HR 0.89, 95% CI 0.82–0.97), and every 30-min/day increment in MPA was associated with 36% lower risk (HR 0.64, 95% CI 0.48–0.84). Every 1-h/day increment in ST increased the risk of the outcomes by 33% (HR 1.33, 95% CI 1.14–1.56), although there was no significant association among participants who performed ≥ 30 min/day MPA (HR 1.11, 95% CI 0.82–1.50, P = 0.034 for interaction). None of the associations were modified by sex (P > 0.4 for all).

Conclusion

Objectively measured LPA and MPA are each associated with lower risk of stroke, MI or all-cause mortality in 70-year-old individuals, while ST is associated with increased risk. The greatest risk reduction is observed for MPA, which also appears to attenuate some of the increased risks associated with ST.