Ocular manifestations of juvenile Sjögren's disease.

Purpose Of Review: This review aims to enhance understanding of juvenile Sjögren's disease (jSjD) by exploring diagnostic criteria, ocular clinical features, ancillary ophthalmic testing, and management strategies specific to this rare pediatric condition.

Recent Findings: Unlike adults, children with jSjD often present with recurrent parotitis and extra-glandular symptoms before developing sicca symptoms. Adult SjD classification criteria do not consider pediatric-specific symptoms and physiological differences.

A Novel Presentation of Refractory Immune Thrombocytopenia in Anti-synthetase Syndrome: A Case Report.

Anti-synthetase syndrome (AS) is a rare autoimmune disorder classified among the idiopathic inflammatory myopathies and is characterized by antibodies directed against aminoacyl-transfer RNA synthetases and the presence of myositis, interstitial lung disease, ±arthritis. Here, we report, for the first time, immune thrombocytopenia (ITP) in a patient with AS. This case reports a new association of AS with ITP and highlights the utility of identifying the underlying driver in secondary ITP to guide therapy.

Missing data: current practice in football research and recommendations for improvement.

Methods: A survey of 136 articles published in 2019 (sampled at random) was conducted to determine whether a statement about missing data was included.

Results: The proportion of studies reporting on missing data was low, at 11.0% (95% confidence interval = 6.

Microtia Reconstruction and Erector Spinae Block in Children: A Case Series With Chart Review.

Objectives: Autologous reconstruction of microtia is advantageous due to its inherent biocompatibility and long-term stability, but postoperative pain associated with costal harvest is a significant issue. A well-planned pain management approach is imperative. Our objective is to introduce the novel application of erector spinae block anesthesia in pediatric microtia reconstruction and evaluate its impact on pain scores, use of opioids, and hospital length of stay.

Less is more: cruroplasty alone is sufficient for revisional hiatal hernia surgery.

Background: Recurrence of hiatal hernia after anti-reflux surgery is common, with past studies reporting recurrence rates of 10-15%. Most patients experience relief from GERD symptoms following initial repair; however, those suffering from recurrence can have symptoms severe enough to warrant another operation. Although the standard of care is to revise the fundoplication or convert to magnetic sphincter augmentation (MSA) in addition to redo cruroplasty, it stands to reason that with an intact fundoplication, a repeat cruroplasty is all that is necessary to alleviate the patients' symptoms.

The association between post-cardiac arrest cerebral oxygenation and survival with favorable neurological outcomes: A multicenter study.

Objective: Cerebral oximetry is a non-invasive system that uses near infrared spectroscopy to measure regional cerebral oxygenation (rSO) in the frontal lobe of the brain. Post-cardiac arrest rSO may be associated with survival and neurological outcomes in out-of-hospital cardiac arrest patients; however, no studies have examined relationships between rSO and neurological outcomes following in-hospital cardiac arrest (IHCA). We tested the hypothesis that rSO following IHCA is associated with survival and favorable neurological outcomes.

Metabolism in pluripotency: Both driver and passenger?

Pluripotent stem cells (PSCs) are highly proliferative cells characterized by robust metabolic demands to power rapid division. For many years considered a passive component or "passenger" of cell-fate determination, cell metabolism is now starting to take center stage as a driver of cell fate outcomes. This review provides an update and analysis of our current understanding of PSC metabolism and its role in self-renewal, differentiation, and somatic cell reprogramming to pluripotency.

Monitoring the Relationship Between Changes in Cerebral Oxygenation and Electroencephalography Patterns During Cardiopulmonary Resuscitation: A Feasibility Study.

Objectives: To date, no studies have examined real-time electroencephalography and cerebral oximetry monitoring during cardiopulmonary resuscitation as markers of the magnitude of global ischemia. We therefore sought to assess the feasibility of combining cerebral oximetry and electroencephalography in patients undergoing cardiopulmonary resuscitation and further to evaluate the electroencephalography patterns during cardiopulmonary resuscitation and their relationship with cerebral oxygenation as measured by cerebral oximetry.

Design: Extended case series of in-hospital and out-of-hospital cardiac arrest subjects.

Cerebral oximetry versus end tidal CO in predicting ROSC after cardiac arrest.

Study Objective: Both end tidal CO (ETCO) and cerebral oxygen saturations (rSO) have been studied to determine their ability to monitor the effectiveness of CPR and predict return of spontaneous circulation (ROSC). We compared the accuracy of ETCO and rSO at predicting ROSC in ED patients with out-of-hospital cardiac arrest (OHCA).

Methods: We performed a prospective, observational study of adult ED patients presenting in cardiac arrest.

Effects of epinephrine on cerebral oxygenation during cardiopulmonary resuscitation: A prospective cohort study.

Background: Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation (rSO) during CPR has not been documented in the clinical setting.

Methods: rSO was measured continuously using cerebral oximetry in patients with in-hospital cardiac arrest.

Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival.

Objectives: Cardiac arrest is associated with morbidity and mortality because of cerebral ischemia. Therefore, we tested the hypothesis that higher regional cerebral oxygenation during resuscitation is associated with improved return of spontaneous circulation, survival, and neurologic outcomes at hospital discharge. We further examined the validity of regional cerebral oxygenation as a test to predict these outcomes.

Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups.

Objective: Online patient portals are being widely implemented; however, no studies have examined whether portals influence health behaviors or outcomes similarly across patient racial/ethnic subgroups. We evaluated longitudinal changes in statin adherence to determine whether racial/ethnic minorities initiating use of the online refill function in patient portals had similar changes over time compared with Whites.

Methods: We examined a retrospective cohort of diabetes patients who were existing patient portal users.

Method to Reduce Muscle Fatigue During Transcutaneous Neuromuscular Electrical Stimulation in Major Knee and Ankle Muscle Groups.

Background: A critical limitation with transcutaneous neuromuscular electrical stimulation as a rehabilitative approach is the rapid onset of muscle fatigue during repeated contractions. We have developed a method called spatially distributed sequential stimulation (SDSS) to reduce muscle fatigue by distributing the center of electrical field over a wide area within a single stimulation site, using an array of surface electrodes.

Objective: To extend the previous findings and to prove feasibility of the method by exploring the fatigue-reducing ability of SDSS for lower limb muscle groups in the able-bodied population, as well as in individuals with spinal cord injury (SCI).

Reducing muscle fatigue during transcutaneous neuromuscular electrical stimulation by spatially and sequentially distributing electrical stimulation sources.

Purpose: A critical limitation with transcutaneous neuromuscular electrical stimulation is the rapid onset of muscle fatigue. We have previously demonstrated that spatially distributed sequential stimulation (SDSS) shows a drastically greater fatigue-reducing ability compared to a single active electrode stimulation (SES). The purposes of this study were to investigate (1) the fatigue-reducing ability of SDSS in more detail focusing on the muscle contractile properties and (2) the mechanism of this effect using array-arranged electromyogram (EMG).

Use of the refill function through an online patient portal is associated with improved adherence to statins in an integrated health system.

Background: Online patient portals are being widely implemented, but their impact on health behaviors are not well-studied.

Objective: To determine whether statin adherence improved after initiating use of the portal refill function.

Research Design: Observational cohort study within an integrated health care delivery system.

Spatially distributed sequential stimulation reduces fatigue in paralyzed triceps surae muscles: a case study.

Functional electrical stimulation (FES) is limited by the rapid onset of muscle fatigue caused by localized nerve excitation repeatedly activating only a subset of motor units. The purpose of this study was to investigate reducing fatigue by sequentially changing, pulse by pulse, the area of stimulation using multiple surface electrodes that cover the same area as one electrode during conventional stimulation. Paralyzed triceps surae muscles of an individual with complete spinal cord injury were stimulated, via the tibial nerve, through four active electrodes using spatially distributed sequential stimulation (SDSS) that was delivered by sending a stimulation pulse to each electrode one after another with 90° phase shift between successive electrodes.

Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access.

The authors investigated use of the internet-based patient portal, kp.org, among a well-characterized population of adults with diabetes in Northern California. Among 14,102 diverse patients, 5671 (40%) requested a password for the patient portal.

The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE).

Internet-based patient portals are intended to improve access and quality, and will play an increasingly important role in health care, especially for diabetes and other chronic diseases. Diabetes patients with limited health literacy have worse health outcomes, and limited health literacy may be a barrier to effectively utilizing internet-based health access services. We investigated use of an internet-based patient portal among a well characterized population of adults with diabetes.