Publications by authors named "Christopher Lee"

970 Publications

Protective Role of Caregiver Preparedness on the Relationship Between Depression and Quality of Life in Stroke Dyads.

Stroke 2021 Sep 9:STROKEAHA120034029. Epub 2021 Sep 9.

Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (E.V.).

Background And Purpose: Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads.

Methods: We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling.

Results: A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older (=70.8, SD=11.9) than their caregivers (=52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological (=0.56, <0.01) and environmental (=0.58, <0.01) QOL at baseline and social QOL over time (=0.24, <0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical (=0.25, <0.01) and environmental (=0.18, <0.05) QOL over time.

Conclusions: Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.
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http://dx.doi.org/10.1161/STROKEAHA.120.034029DOI Listing
September 2021

Overview of Ten Child Mental Health Clinical Outcome Measures: Testing of Psychometric Properties with Diverse Client Populations in the U.S.

Adm Policy Ment Health 2021 Sep 5. Epub 2021 Sep 5.

Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd. #300, Los Angeles, CA, 90024, USA.

While many standardized assessment measures exist to track child mental health treatment outcomes, the degree to which such tools have been adequately tested for reliability and validity across race, ethnicity, and class is uneven. This paper examines the corpus of published tests of psychometric properties for the ten standardized measures used in U.S. child outpatient care, with focus on breadth of testing across these domains. Our goal is to assist care providers, researchers, and legislators in understanding how cultural mismatch impacts measurement accuracy and how to select tools appropriate to the characteristics of their client populations. We also highlight avenues of needed research for measures that are in common use. The list of measures was compiled from (1) U.S. state Department of Mental Health websites; (2) a survey of California county behavioral health agency directors; and (3) exploratory literature scans of published research. Ten measures met inclusion criteria; for each one a systematic review of psychometrics literature was conducted. Diversity of participant research samples was examined as well as differences in reliability and validity by gender, race or ethnicity, and socio-economic class. All measures showed adequate reliability and validity, however half lacked diverse testing across all three domains and all lacked testing with Asian American/Pacific Islander and Native American children. ASEBA, PSC, and SDQ had the broadest testing.
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http://dx.doi.org/10.1007/s10488-021-01157-zDOI Listing
September 2021

Study protocol for the Exercising Together© trial: a randomized, controlled trial of partnered exercise for couples coping with cancer.

Trials 2021 Aug 30;22(1):579. Epub 2021 Aug 30.

Knight Cancer Institute, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.

Background: Most cancer survivors are married, and cancer strains the physical and mental health of each partner and their intimate relationship. We created a partnered strength training program, Exercising Together©, where the survivor and his/her partner exercise as a team in order to improve physical and mental health of both members of the couple as well as the quality of their relationship. We have not yet determined if Exercising Together© is similarly effective in couples coping with different types of cancer nor if training as a team has unique and added benefits over those derived from supervised group training and/or shared behavior change. The purpose of this study is to determine the unique benefits of Exercising Together© on physical, mental, and relational health in couples coping with breast, prostate, or colorectal cancer.

Methods: Survivors of prostate, breast and colorectal cancer (N = 294, 98 per cancer site) and their intimate, co-residing partners are recruited to participate in a single-blind, parallel group, randomized trial comparing three exercise groups that train twice per week for 6 months. Couples are randomized to one of three groups: (1) Exercising Together© where partners train as a team in a supervised group setting; (2) separate supervised group exercise classes for survivors or partners, respectively; (3) unsupervised home exercise program provided to each partner. The primary outcome is relationship quality (dyadic coping by the Dyadic Coping scale, emotional intimacy by the Dyadic Adjustment Scale, physical intimacy by the Physical Intimacy Behavior Scale, and symptom incongruence). Secondary outcomes are physical health (% body fat by DXA, serum fasting lipids (triglycerides, HDL, and LDL cholesterol), insulin resistance (HOMA-IR), resting blood pressure, C-reactive protein, TNF alpha, and physical functioning by the short Physical Performance Battery and SF-36) and mental health (depressive symptoms, anxiety, fear of recurrence) of each partner. Outcomes are collected at baseline, mid (3 months), post-intervention (6 months), and follow-up (12 months).

Discussion: Exercising Together© could shift the paradigm of survivorship care toward novel couple-based approaches that could optimize outcomes for each partner because their health is interdependent on each other and their relationship.

Trial Registration: ClinicalTrials.gov NCT03630354 . Registered August 14, 2018.
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http://dx.doi.org/10.1186/s13063-021-05548-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404361PMC
August 2021

Adverse events in patients with a left ventricular assist device: are patient-reported outcomes affected?

Eur J Cardiovasc Nurs 2021 Aug 28. Epub 2021 Aug 28.

Boston College, Connell School of Nursing, Chestnut Hill, MA, USA.

Aims: Left ventricular assist devices (LVAD) are used to treat advanced heart failure, and the use of these devices in ever increasing, with over 19 000 people having had a device. However, during device therapy over 50% of patients will have some type of major adverse event. The aim of this study was to examine whether having a major adverse event, including major infection and major bleed, would alter patient-reported outcomes over time, including depressive symptoms and health-related quality of life.

Methods And Results: T-tests and χ2 analyses were used to determine significant differences between patients who had an adverse event and those who did not. Latent curve growth modelling was used to evaluate change over time in those patients with and without and adverse event. The only difference between those with and without an adverse event was pre-implant depressive symptoms and health-related quality of life. The trajectories of both groups were also similar, with only differences at the pre-implant time point.

Conclusion: In response to an adverse event occurring post-LVAD implantation, we found that patient-reported outcomes, including depressive symptoms and health-related quality of life were not significantly impacted.
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http://dx.doi.org/10.1093/eurjcn/zvab070DOI Listing
August 2021

Symptom Frequency and Distress Underestimated in Decompensated Cirrhosis.

Dig Dis Sci 2021 Aug 27. Epub 2021 Aug 27.

William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.

Background: Studies assessing multiple symptoms and the distress of these symptoms in decompensated cirrhosis are lacking.

Aims: The aims of this study were to assess symptom prevalence and distress among patients with decompensated cirrhosis and to describe medical management of the most prevalent symptoms.

Methods: Patients were recruited from hepatology clinics within two health-care systems. Eligibility criteria included a model for end-stage liver disease (MELD-Na) score ≥15. Patients completed the Condensed Memorial Symptom Assessment Scale and Patient Health Questionnaire. Comparative statistics were used to analyze the cross-sectional survey data.

Results: Of the sample (n = 146), most patients were Child-Turcotte-Pugh (CTP) class B (49.7%) and C (46.2%). Mean age was 56.5 years, 65.1% were male, and 88.4% were white. Average MELD-Na score was 19.1 ± 4.5. The most prevalent symptoms were lack of energy and feeling drowsy while the most distressing were lack of energy and difficulty sleeping. Only 24 patients (16.4%) were treated for their difficulty sleeping with sleep medication. Importantly, those prescribed sleep medications had similar distress (3.9 ± 1.2 vs. 3.5 ± 1.2, p = 0.229) compared with patients not prescribed sleep medications. Opioids were prescribed to 57 (39.0%) patients; antidepressants to 34 (23.3%). Forty patients (27.4%) who reported moderate or greater depression were not prescribed an antidepressant.

Conclusions: The study highlights the multiple symptoms and distress experienced by patients with decompensated cirrhosis, and the need for improved medical management by health-care providers through enhanced awareness and attention to these complex symptoms. Future research should focus on improvements in symptom management.
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http://dx.doi.org/10.1007/s10620-021-07216-7DOI Listing
August 2021

Anemia among Women of Reproductive Age: An Overview of Global Burden, Trends, Determinants, and Drivers of Progress in Low- and Middle-Income Countries.

Nutrients 2021 Aug 10;13(8). Epub 2021 Aug 10.

SickKids Centre for Global Child Health, Toronto, ON M5G 0A4, Canada.

Relatively little progress has been made in reducing anemia prevalence among women of reproductive age (WRA anemia). Interventions, policies and programs aimed at reducing WRA anemia have the potential to improve overall not only women's, but also children's health and nutrition outcomes. To our knowledge, this is the first review that aimed to compile evidence on the determinants and drivers of WRA anemia reduction in low- and middle-income countries (LMICs). We synthesized the available evidence on the determinants and drivers, including government policies and programs, of WRA anemia and their mitigation strategies across a wide range of countries and geographies, thus contributing to the complex and multifactorial etiology of anemia. We carried out a systematic review of published peer-reviewed and grey literature assessing national or subnational decline in WRA anemia prevalence and the associated drivers in LMICs. Among the 21 studies meeting our inclusion criteria, proximal determinants of healthcare utilization, especially during pregnancy and with the use of contraceptives, were strong drivers of WRA anemia reduction. Changes in other maternal characteristics, such as an increase in age at first pregnancy, BMI, birth spacing, and reduction in parity, were associated with modest improvements in anemia prevalence. Access to fortified foods, especially iron-fortified flour, was also a predictor of a decrease in WRA anemia. Of the intermediate determinants, an increase in household wealth, educational attainment and access to improved sanitation contributed significantly to WRA anemia reduction. Although several common determinants emerged at the proximal and intermediate levels, the set of anemia determinants and the strength of the association between each driver and WRA anemia reduction were unique in each setting included in this review. Further research is needed to provide targeted recommendations for each country and region where WRA anemia prevalence remains high.
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http://dx.doi.org/10.3390/nu13082745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401240PMC
August 2021

Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma.

J Clin Med 2021 Aug 20;10(16). Epub 2021 Aug 20.

Department of Clinical Psychology, University of Amsterdam, 1000 GG Amsterdam, The Netherlands.

Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.
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http://dx.doi.org/10.3390/jcm10163708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397108PMC
August 2021

Is Radiographic Imaging Necessary for Identifying Late Developmental Dysplasia of the Hip in Breech Infants with Normal Ultrasounds?

Glob Pediatr Health 2021 18;8:2333794X211040977. Epub 2021 Aug 18.

Children's Hospital Los Angeles, Los Angeles, CA, USA.

. The goal of our study was to investigate the prevalence of late DDH cases in breech infants who had a normal screening hip ultrasound and subsequent follow-up hip x-ray imaging. . Infants with a history of intrauterine breech position, normal hip ultrasound within 3-months of birth, and follow-up hip x-rays within 2-years were included. Acetabular indices were measured on a supine AP pelvis radiograph. . Fifty-six patients had breech presentation at birth, a normal hip ultrasound, and returned for radiographic evaluation within 2 years. Of those, 11/112 (10%) of hips had late DDH based on their radiographic images at 1 standard deviation greater than normative values from age-adjusted controls. No infants showed hip dysplasia at 2 standard deviations greater than normative values from age-adjusted controls. . Our results support previous studies that follow up should be considered for infants with breech presentation and normal hip ultrasounds near birth. . II.
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http://dx.doi.org/10.1177/2333794X211040977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381449PMC
August 2021

Characterizing right-angled vessel in macular telangiectasia type 2 with structural optical coherence tomography.

Sci Rep 2021 Aug 25;11(1):17198. Epub 2021 Aug 25.

Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Korea.

We investigated the structural findings on spectral-domain optical coherence tomography (SD-OCT) related to the presence of right-angled vessels (RAV) in patients with macular telangiectasia (MacTel) type 2 with severity 3 in Korea. A retrospective multicenter cross-sectional study was conducted in six tertiary hospitals in Korea; the study included 116 MacTel type 2 eyes with severity 3. The SD-OCT findings were compared between eyes with RAV on fundus photography or fluorescein angiography and those without RAV. Logistic regression was performed to determine factors associated with the presence of RAV. Fifty eyes presented with RAV and 61 eyes without RAV. More eyes presented with only inner retinal (IR) cavities on SD-OCT among eyes without RAV than among those with RAV (P < 0.001). However, eyes with RAV presented with IR disorganization, outer retinal (OR) cavity, and ellipsoid zone (EZ) disruption more frequently than eyes without RAV did (all P < 0.001). These SD-OCT findings were significantly associated with the presence of RAV. The presence of RAV was closely related to IR disorganization, OR cavities, and EZ disruption on SD-OCT. These findings suggest an advanced phase of MacTel type 2.
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http://dx.doi.org/10.1038/s41598-021-96789-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387352PMC
August 2021

Characterizing Sex Differences in Physical Frailty Phenotypes in Heart Failure.

Circ Heart Fail 2021 Aug 25:CIRCHEARTFAILURE120008076. Epub 2021 Aug 25.

Boston College William F. Connell School of Nursing, Chestnut Hill, MA (C.S.L.).

Background: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF.

Methods: We prospectively enrolled adults with class I-IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used.

Results: The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81-11.84], =0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non-physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non-physically frail men.

Conclusions: Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.120.008076DOI Listing
August 2021

Short-Term Outcomes following "Switching" to Monthly Ranibizumab in Neovascular Age-Related Macular Degeneration Showing Insufficient Response to Bimonthly Aflibercept.

J Ophthalmol 2021 12;2021:5547686. Epub 2021 Aug 12.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Results: CRT and logMAR VA were 349.62 ± 223.51 m and 0.50 ± 0.23 at the baseline and 274.69 ± 148.77 m and 0.46 ± 0.24, 311.54 ± 192.90 m and 0.45 ± 0.20 at 1 month after the first and third ranibizumab injections, respectively. The CRT decrease during three ranibizumab injections was statistically significant (38.08 ± 69.52 m, =0.033). Change in VA was not statistically significant. The percentage of eyes with SRF was 100% at baseline and 53.8%, 76.9%, and 69.2% one month after each ranibizumab injections. The percentage of eyes with IRF was 38.5% at baseline and 23.1%, 23.1%, and 15.4%, respectively, after switching.

Conclusion: Switching to monthly ranibizumab in nAMD showing an insufficient response to bimonthly aflibercept led to immediate anatomical improvement. It can be considered in countries where the healthcare insurance system limits the minimum injection interval of aflibercept.
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http://dx.doi.org/10.1155/2021/5547686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376439PMC
August 2021

Pneumothorax presentation in endometrial sarcoma patients receiving chemotherapy: A case series.

Rare Tumors 2020 29;12:2036361320972865. Epub 2020 Nov 29.

Norris Comprehensive Cancer Center, Los Angeles, CA, USA.

Endometrial stromal sarcomas (ESS) account for 10-15% of uterine malignancies and are classified into four categories: endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS) and undifferentiated uterine sarcoma (USS). Depending on stage, ESS is treated with surgery, hormone therapy, chemotherapy or targeted therapy. A rare complication of ESS with metastatic pulmonary disease is recurrent, bilateral pneumothoraces. The current literature has reported on patients with ESS who either presented with pneumothoraces at their initial diagnosis, and thus were untreated, or after treatment with surgical resection and hormone therapy. There have been no case reports of patients with ESS who presented with pneumothoraces while receiving chemotherapy. Furthermore, there have been no reported cases of patients with HG-ESS presenting with this rare complication. We would like to expand the literature by reporting on two patients with HG-ESS who presented with pneumothoraces while concurrently receiving chemotherapy.
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http://dx.doi.org/10.1177/2036361320972865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351025PMC
November 2020

Enrolling Caregivers in Obesity Interventions to Improve Obesity-Related Outcomes in Children.

West J Nurs Res 2021 Aug 5:1939459211037057. Epub 2021 Aug 5.

School of Nursing, Oregon Health & Science University, Portland, OR, USA.

In this study, we assessed the influences of change in moderate-to-vigorous physical activity (MVPA)/sedentary time (ST) of caregivers participating in a commercial weight-loss program on their children's change in MVPA/ST. Data from 29 caregivers and their children were collected over 8 weeks. We used multivariable linear regression to assess associations of changes in caregiver's percent of time spent in MVPA/ST and changes in their child's percent of time spent in MVPA/ST. For caregivers that decreased body mass index (BMI) over 8 weeks, changes in caregivers' MVPA was strongly associated with the change in children's MVPA (β = 2.61 [95% CI: 0.45, 4.77]) compared to caregivers who maintained/increased BMI (β = 0.24 [-2.16, 2.64]). Changes in caregivers' ST was strongly associated with changes in children's ST (β = 2.42 [1.02, 3.81]) compared to caregivers who maintained/increased BMI (β = 0.35 [-0.45, 1.14]). Findings reinforce encouraging caregivers to enroll in weight-loss programs for the benefit of their children as well as for themselves.
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http://dx.doi.org/10.1177/01939459211037057DOI Listing
August 2021

The impact of childhood maltreatment on the severity of childhood-related posttraumatic stress disorder in adults.

Child Abuse Negl 2021 Oct 28;120:105208. Epub 2021 Jul 28.

Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.

Background: Childhood maltreatment is relatively common and is related to a range of negative consequences, such as Posttraumatic Stress Disorder (PTSD). There are indications that various maltreatment types are related to PTSD severity, although not all types, such as emotional abuse, meet the PTSD Criterion-A.

Objective: The aim of the present study was to examine the relationship between 5 types of childhood maltreatment (i.e., sexual, physical, and emotional abuse, and physical and emotional neglect) and the severity of adult PTSD and PTSD symptoms.

Participants And Setting: Adult participants (N = 147) with Childhood-related PTSD (Ch-PTSD) recruited from clinical sites completed the Childhood Trauma Questionnaire-short form (CTQ-sf) and 2 PTSD measures: The Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5).

Methods: Childhood maltreatment predictors and 2 covariates, age and gender, were analysed in multivariate multilevel models as participants were nested within sites. A model selection procedure, in which all combinations of predictors were examined, was used to select a final set of predictors.

Results: The results indicated that emotional abuse was the only trauma type that was significantly related to severity of PTSD and to the severity of specific PTSD symptom clusters (r between 0.130 and 0.338). The final models explained between 6.5% and 16.7% of the variance in PTSD severity.

Conclusions: The findings suggest that emotional abuse plays a more important role in Ch-PTSD than hitherto assumed, and that treatment should not neglect processing of childhood emotional abuse.
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http://dx.doi.org/10.1016/j.chiabu.2021.105208DOI Listing
October 2021

Fatigue in Persons With Heart Failure: A Systematic Literature Review and Meta-Synthesis Using the Biopsychosocial Model of Health.

J Card Fail 2021 Jul 28. Epub 2021 Jul 28.

Johns Hopkins School of Nursing.

Background: Fatigue is a common and distressing symptom of heart failure (HF) and has important implications for patient-reported and clinical outcomes. Despite being a common and bothersome symptom, fatigue has been understudied in HF. We sought to synthesize existing literature on fatigue in HF through a systematic literature review guided by the biopsychosocial model of health.

Methods And Results: A systematic search of the literature was performed on March 18, 2020, using Pubmed, Embase, and CINAHL. Full-text, primary research articles, written in English, in which fatigue was a primary symptom of interest in adults with a diagnosis of HF, were included. The search yielded 1138 articles; 33 articles that met inclusion criteria were selected for extraction and synthesis. Biological and psychological factors associated with fatigue were New York Heart Association functional class, hemoglobin level, history of stroke, and depression. However, there are limited HF-specific factors linked to fatigue. Social factors related to fatigue included social roles, relationship strain, and loneliness and isolation. Few nonpharmacologic interventions have been tested by show some promise for alleviating fatigue in HF. Studies show conflicting evidence related to the prognostic implications of fatigue.

Conclusions: Important biological correlates of fatigue were identified; however, psychological and social variables were limited to qualitative description. There is need for expanded models to better understand the complex physiologic nature of fatigue in HF. Additionally, more research is needed to (1) define the relationships between fatigue and both psychological and social factors, (2) better describe the prognostic implications of fatigue, and (3) develop more therapeutic approaches to alleviate fatigue with the goal of improving overall quality of life.
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http://dx.doi.org/10.1016/j.cardfail.2021.07.005DOI Listing
July 2021

Evaluation and Management of Posterior Wall Acetabulum Fractures.

J Am Acad Orthop Surg 2021 Jul 23. Epub 2021 Jul 23.

From the Department of Orthopaedic Surgery (Perdue, Toney), Christiana Hospital, Newark, DE (Tainter) Virginia Commonwealth University, Richmond, VA, and the Department of Orthopaedic Surgery (Lee), University of California, Los Angeles, Los Angeles, CA.

Posterior wall acetabulum fractures typically result from high-energy mechanisms and can be associated with various orthopaedic and nonorthopaedic injuries. They range from isolated simple patterns to multifragmentary with or without marginal impaction. Determination of hip stability, which can depend on fragment location, size, and displacement, directs management. Although important in the assessment of posterior wall fractures, CT is unreliable when used to determine stability. The dynamic fluoroscopic examination under anesthesia (EUA) is the benchmark in assessment of hip stability, and fractures deemed stable by EUA have good radiographic and functional outcomes. In fractures that meet surgical criteria, accurate joint reduction guides outcomes. Joint débridement, identification and elevation of impaction, and adjunctive fixation of posterosuperior and peripheral rim fragments along with standard buttress plate fixation are critical. Complications of the fracture and surgical fixation include sciatic nerve injury, posttraumatic osteoarthritis, osteonecrosis of the femoral head, and heterotopic ossification. Although accuracy of joint reduction is paramount for successful results, other factors out of the surgeon's control such as comminution, femoral head lesions, and dislocation contribute to poor outcomes. Even with anatomic restoration of the joint surface, good clinical outcomes are not guaranteed and residual functional deficits can be expected.
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http://dx.doi.org/10.5435/JAAOS-D-20-01301DOI Listing
July 2021

Independent Markov decomposition: Toward modeling kinetics of biomolecular complexes.

Proc Natl Acad Sci U S A 2021 Aug;118(31)

Department of Mathematics and Computer Science, Freie Universität Berlin, 14195 Berlin, Germany;

To advance the mission of in silico cell biology, modeling the interactions of large and complex biological systems becomes increasingly relevant. The combination of molecular dynamics (MD) simulations and Markov state models (MSMs) has enabled the construction of simplified models of molecular kinetics on long timescales. Despite its success, this approach is inherently limited by the size of the molecular system. With increasing size of macromolecular complexes, the number of independent or weakly coupled subsystems increases, and the number of global system states increases exponentially, making the sampling of all distinct global states unfeasible. In this work, we present a technique called independent Markov decomposition (IMD) that leverages weak coupling between subsystems to compute a global kinetic model without requiring the sampling of all combinatorial states of subsystems. We give a theoretical basis for IMD and propose an approach for finding and validating such a decomposition. Using empirical few-state MSMs of ion channel models that are well established in electrophysiology, we demonstrate that IMD models can reproduce experimental conductance measurements with a major reduction in sampling compared with a standard MSM approach. We further show how to find the optimal partition of all-atom protein simulations into weakly coupled subunits.
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http://dx.doi.org/10.1073/pnas.2105230118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346863PMC
August 2021

Predictive Factors for Long-Term Outcomes of Cataract Surgery in Patients Receiving Active Treatment for Neovascular Age-Related Macular Degeneration.

J Clin Med 2021 Jul 15;10(14). Epub 2021 Jul 15.

Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul 03722, Korea.

Background: the safety and efficacy of cataract surgery in eyes with exudative neovascular age-related macular degeneration (nAMD), receiving active treatment, remain unclear. We evaluated the long-term outcomes and associated predictive factors of cataract surgery in eyes with exudative nAMD.

Methods: this retrospective cohort study included 65 eyes (61 patients) treated with anti-vascular endothelial growth factor (VEGF) injections within six months preoperatively. Changes in best-corrected visual acuity (BCVA) and anti-VEGF treatment patterns from before to up to four years after surgery were assessed. Predictive factors were identified in association with one-year surgical outcomes.

Results: the BCVA improved at six months ( < 0.001) and was maintained for three years postoperatively. The interval between anti-VEGF injections increased 3.4 times postoperatively ( = 0.001). Risk factors for poor BCVA were low preoperative BCVA ( < 0.001) and prolonged nAMD duration ( = 0.003). Prolonged nAMD duration and short exudation-free period were associated with more frequent postoperative anti-VEGF treatments ( = 0.028 and = 0.003, respectively). AMD subtypes were not associated with both vision and injection pattern outcomes.

Conclusions: patients with cataracts receiving nAMD treatment can safely undergo surgery with favorable long-term visual benefits. The preoperative BCVA, nAMD duration, and exudation-free period are potential predictors of surgery outcomes.
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http://dx.doi.org/10.3390/jcm10143124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306055PMC
July 2021

Trauma-focused treatments for depression. A systematic review and meta-analysis.

PLoS One 2021 22;16(7):e0254778. Epub 2021 Jul 22.

School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia.

Background: Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern.

Methods: A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored.

Results: Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified.

Conclusions: Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254778PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297785PMC
July 2021

Surgical Tips and Tricks for Distal Femur Plating.

J Am Acad Orthop Surg 2021 Sep;29(18):770-779

From the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA.

Distal femur fractures are challenging fractures to treat, with nonunion rates as high as 22%. Precontoured locking plates have mitigated some earlier causes of failure, while introducing new challenges. The recognition of troublesome injury patterns and appropriate preoperative planning can avoid common pitfalls. Adjunctive techniques, including the use of a radiolucent triangle, an external fixator, unicortical plates, and crossing K-wires, can assist with fracture reduction and maintenance. It is important to understand the common pitfalls involved with distal femur plating and to consider a wide array of techniques to combat these challenges.
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http://dx.doi.org/10.5435/JAAOS-D-20-01221DOI Listing
September 2021

Association of Clear Cell Likelihood Score on MRI and Growth Kinetics of Small Solid Renal Masses on Active Surveillance.

AJR Am J Roentgenol 2021 Jul 21. Epub 2021 Jul 21.

Department of Radiology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390.

The lack of validated imaging markers to characterize biologic aggressiveness of small renal masses (SRMs; cT1a, ≤4 cm) hinders medical decision making amongst available initial management strategies. To explore the association of the clear cell likelihood score (ccLS) on MRI with growth rates and progression of SRMs. This retrospective study included consecutive SRMs assigned a ccLS on clinical MRI examinations performed between June 2016 and November 2019 at an academic tertiary-care medical center or its affiliated safety net hospital system. The ccLS scores the likelihood that the SRM represents clear cell renal cell carcinoma (ccRCC) from 1 (very unlikely) to 5 (very likely). The ccLS was extracted from clinical reports. Tumor size measurements were extracted from available prior and follow-up cross-sectional imaging examinations, through June 2020. Serial tumor size measurements were fit to linear and exponential growth curves. Estimated growth rates were grouped by the assigned ccLS. Tumor progression was defined by development of large size (>4 cm in at least two measurements) and/or rapid growth (doubling of volume within 1 year). Differences among ccLS groups were evaluated using Kruskal-Wallis tests. Correlation between ccLS and growth rate were evaluated by Spearman correlation (ρ). Growth rates of 386 SRMs (100 ccLS1-2, 75 ccLS3, and 211 ccLS4-5) from 339 patients (median age 65 years; 198 men, 141 women) were analyzed. Median follow-up was 1.16 years. The ccLS was correlated with growth rates by size (ρ=0.19, p<.001; ccLS4-5: 9%/year, ccLS1-2: 5%/year, p<.001) and by volume (ρ=0.136, p=.008; ccLS4-5: 29%/year, ccLS1-2: 16%/year, p<.001). Disease progression (observed in 49 SRMs) was not significantly associated with ccLS group (p=.61). Two patients (0.6%) developed metastases during active surveillance (AS): one ccLS1 that was a type 2 papillary renal cell carcinoma and one ccLS4 that was ccRCC. Growth is associated with ccLS in SRMs, with higher ccLS correlating with faster growth. The non-invasive clear cell likelihood score (ccLS), derived from MRI, correlates with growth rate of SRMs and may help guide personalized management. SRMs with lower ccLS may be considered for AS, whereas SRMs with higher ccLS may warrant earlier intervention.
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http://dx.doi.org/10.2214/AJR.21.25979DOI Listing
July 2021

Yield of a second right colon segment examination during colonoscopy after a first examination using a mucosal exposure device.

Gastrointest Endosc 2021 Jul 17. Epub 2021 Jul 17.

Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address:

Background And Aims: Double right colon examination during colonoscopy has been advocated to reduce the risk of interval cancer in the right colon segment. Whether 2 examinations are necessary when the first examination is performed with a mucosal exposure device is uncertain. We documented the rates of missed adenomas, sessile serrated lesions, and hyperplastic polyps after an initial right colon segment examination by a high level detector using a mucosal exposure device.

Methods: At a single tertiary hospital outpatient practice, we prospectively collected data on the yield of a second examination of the right colon segment, after initial examination by a single high-detecting colonoscopist using a mucosal exposure device.

Results: During the study period, 1331 eligible consecutive patients underwent colonoscopy. Right colon adenoma, sessile serrated lesion, and hyperplastic polyp miss rates were 15.8%, 14.1%, and 16.7%, respectively. Four percent of patients had adenomas detected in the right colon segment only with a second examination.

Conclusion: A second examination of the right colon segment is warranted, even when using a distal mucosal exposure device to perform colonoscopy.
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http://dx.doi.org/10.1016/j.gie.2021.07.012DOI Listing
July 2021

A Case of Spontaneous Regression and Recurrence of Primary Vitreoretinal Lymphoma.

Ocul Immunol Inflamm 2021 Jul 13:1-4. Epub 2021 Jul 13.

Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

: To report a case of primary vitreoretinal lymphoma (PVRL) showing recurrence after spontaneous regression, diagnosed with the aid of next-generation sequencing (NGS).: Retrospective case report.: A 61-year-old immunocompetent Korean woman presented with subretinal lesions suspected of PVRL, which resolved spontaneously in 2 months. After 8 months, the lesion recurred and diagnostic vitrectomy was performed. The cytologic examination of the vitreous was indeterminate as there was only minimal vitreous opacity present at the time of surgery. NGS identified significant mutations including single nucleotide variants in L265P, which is a unique hallmark of VRL, in vitreous sample, and the diagnosis of PVRL was made.: This case showed PVRL can spontaneously regress almost completely, then recur, so careful ophthalmic and systemic follow-ups are warranted. When cytological confirmation is challenging due to the minimal disease involvement in the vitreous, NGS is effective in confirming the mutation profiles of PVRL.
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http://dx.doi.org/10.1080/09273948.2021.1916040DOI Listing
July 2021

Respiring to infect: Emerging links between mitochondria, the electron transport chain, and fungal pathogenesis.

PLoS Pathog 2021 Jul 8;17(7):e1009661. Epub 2021 Jul 8.

Michael Smith Laboratories, Department of Microbiology & Immunology, University of British Columbia, Vancouver, Canada.

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http://dx.doi.org/10.1371/journal.ppat.1009661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266039PMC
July 2021

Triceps-Sparing Approach for Distal Humerus Fixation.

J Orthop Trauma 2021 08;35(Suppl 2):S5-S6

University of California Los Angeles, Department of Orthopaedic Surgery.

Summary: The triceps-sparing approach to the posterior humerus affords broad exposure for fracture fixation with a minor risk of radial nerve palsy. By using a muscle-sparing interval, the approach facilitates reduction and fixation of humeral shaft and extra-articular distal humerus fractures without injury to the triceps. This video demonstrates the triceps-sparing approach used in the surgical treatment of a 23-year-old man with an extra-articular distal humerus fracture.
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http://dx.doi.org/10.1097/BOT.0000000000002178DOI Listing
August 2021

Reovirus Nonstructural Protein σNS Recruits Viral RNA to Replication Organelles.

mBio 2021 Aug 6;12(4):e0140821. Epub 2021 Jul 6.

Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicinegrid.471408.e, Pittsburgh, Pennsylvania, USA.

The function of the mammalian orthoreovirus (reovirus) σNS nonstructural protein is enigmatic. σNS is an RNA-binding protein that forms oligomers and enhances the stability of bound RNAs, but the mechanisms by which it contributes to reovirus replication are unknown. To determine the function of σNS-RNA binding in reovirus replication, we engineered σNS mutants deficient in RNA-binding capacity. We found that alanine substitutions of positively charged residues in a predicted RNA-binding domain decrease RNA-dependent oligomerization. To define steps in reovirus replication facilitated by the RNA-binding property of σNS, we established a complementation system in which wild-type or mutant forms of σNS could be tested for the capacity to overcome inhibition of σNS expression. Mutations in σNS that disrupt RNA binding also diminish viral replication and σNS distribution to viral factories. Moreover, viral mRNAs only incorporate into viral factories or factory-like structures (formed following expression of nonstructural protein μNS) when σNS is present and capable of binding RNA. Collectively, these findings indicate that σNS requires positively charged residues in a putative RNA-binding domain to recruit viral mRNAs to sites of viral replication and establish a function for σNS in reovirus replication. Viral replication requires the formation of neoorganelles in infected cells to concentrate essential viral and host components. However, for many viruses, it is unclear how these components coalesce into neoorganelles to form factories for viral replication. We discovered that two mammalian reovirus nonstructural proteins act in concert to form functioning viral factories. Reovirus μNS proteins assemble into exclusive factory scaffolds that require reovirus σNS proteins for efficient viral mRNA incorporation. Our results demonstrate a role for σNS in RNA recruitment to reovirus factories and, more broadly, show how a cytoplasmic non-membrane-enclosed factory is formed by an RNA virus. Understanding the mechanisms of viral factory formation will help identify new targets for antiviral therapeutics that disrupt assembly of these structures and inform the use of nonpathogenic viruses for biotechnological applications.
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http://dx.doi.org/10.1128/mBio.01408-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406312PMC
August 2021

The Application of the Adult Self-Report and the Adult Behavior Checklist Form to Chinese Adults: Syndrome Structure, Inter-Informant Agreement, and Cultural Comparison.

Int J Environ Res Public Health 2021 06 11;18(12). Epub 2021 Jun 11.

Department of Psychiatry, University of Vermont, Burlington, VT 05405, USA.

Given the global public health burden of mental illness, there is a critical need for culturally validated psychopathology assessment tools that perform well in diverse societies. This study examines the psychometric properties of the Adult Self-Report (ASR) and Adult Behavioral Checklist (ABCL) from the Achenbach System of Empirically Based Assessments in adults in China. Chinese adults (N = 1276) and their spouses completed the ASR and ABCL, respectively. We conducted confirmatory factor analysis on 99 ASR items and 93 ABCL items. Estimators of model fit confirmed that both measures demonstrated excellent fit (e.g., root mean square error of approximation = 0.016 and 0.018, respectively). Syndrome loadings on both measures were satisfactory but generally higher on the ASR. Neither gender nor education had significant effects, but there were informant x gender effects on most problem scales. Cross-informant agreement correlations between the ASR and ABCL were medium to large. Findings from this novel sample of Chinese adults are consistent with previous validation studies supporting the dimensionality, syndrome structure, gender differences, and inter-informant agreement of the ASR and ABCL. Our findings contribute to the cross-cultural understanding of mental health assessment and offer a psychometrically sound approach to measuring adult psychopathology in Chinese populations.
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http://dx.doi.org/10.3390/ijerph18126352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296167PMC
June 2021

Short-term outcomes of periprosthetic compared to native distal femur fractures, a national database study.

Arch Orthop Trauma Surg 2021 Jun 29. Epub 2021 Jun 29.

Department of Orthopaedic Surgery, David Geffen School of Medicine At UCLA, 1255 15th St, Suite 2100, Santa Monica, Los Angeles, CA, 90404, USA.

Background: Distal femur fractures (DFFx) are highly morbid injuries with a complication rate comparable to hip fractures. Rising rates of total knee arthroplasty (TKA) have led to increasing rates of periprosthetic DFFx (pDFFx). We sought to determine how pDFFx complication rates differed from native DFFx (nDFFx).

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was used to identify patients who sustained pDFFx or nDFFx between 2012 and 2018. Patients were further stratified by operative treatment: open reduction internal fixation (ORIF) or distal femur replacement (DFR). Multivariate logistic regression was used to compare 30-day complication rates between pDFFx versus nDFFx and, among pDFFx patients, ORIF versus DFR or revision TKA (rTKA).

Results: 563 patients with pDFFx and 2259 patients with nDFFx were identified between 2012 and 2018. pDFFx patients had significantly lower rates of ORIF than nDFFx patients (36.4 vs 95.4%, p < 0.001). On multivariate analysis, pDFFx were associated with a higher rate of surgical site complications (OR 2.48, p = 0.009) compared to nDFFx. There were no differences in mortality, reoperations, major complications, rate of blood transfusion, venous thromboembolism and disposition. In patients with pDFFx, patients undergoing DFR/rTKA were more likely to be discharged home versus a rehab facility, compared to those undergoing ORIF (OR 2.62, p < 0.001).

Conclusions: In this first large registry study comparing pDFFx and nDFFx, we find similar outcomes between these groups in the first 30 days after surgery. Patients with pDFFx did have higher rates of surgical site complications, including infection and dehiscence. In pDFFx patients, those undergoing DFR were more likely to return home post-operatively.
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http://dx.doi.org/10.1007/s00402-021-04000-0DOI Listing
June 2021

In Silico identification of a common mobile element insertion in exon 4 of RP1.

Sci Rep 2021 Jun 28;11(1):13381. Epub 2021 Jun 28.

Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnamgu, Seoul, 06273, South Korea.

Mobile element insertions (MEIs) typically exceed the read lengths of short-read sequencing technologies and are therefore frequently missed. Recently, a founder Alu insertion in exon 4 of RP1 has been detected in Japanese patients with macular dystrophy by PCR and gel electrophoresis. We aimed to develop a grep search program for the detection of the Alu insertion in exon 4 of RP1 using unprocessed short reads. Among 494 unrelated Korean patients with inherited eye diseases, 273 patients with specific retinal phenotypes who were previously genotyped by targeted panel or whole exome sequencing were selected. Five probands had a single heterozygous truncating RP1 variant, and one of their unaffected parents also carry this variant. To find a hidden genetic variant, whole genome sequencing was performed in two patients, and it revealed AluY c.4052_4053ins328/p.(Tyr1352Alafs*9) insertion in RP1 exon 4. This AluY insertion was additionally identified in other 3 families, which was confirmed by PCR and gel electrophoresis. We developed simplified grep search program to detect this AluY insertion in RP1 exon 4. The simple grep search revealed a median variant allele frequency of 0.282 (interquartile range, 0.232-0.383), with no false-positive results using 120 control samples. The MEI in RP1 exon 4 was a common founder mutation in Korean, occurring in 1.8% of our cohort. The RP1-Alu grep program efficiently detected the AluY insertion, without the preprocessing of raw data or complex installation processes.
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http://dx.doi.org/10.1038/s41598-021-92834-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238996PMC
June 2021
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