bluuebunny/crossref_metadata_2025 huggingface dataset:
Form, Structure, and Function: How Plants vs. Animals Solve Physical Problems
Authors: Müller Ulrike K , Poppinga Simon
Published: August 2020

Synopsis

Plants and animals have evolved solutions for a wide range of mechanical problems, such as adhesion and dispersal. Several of these solutions have been sources for bio-inspiration, like the Lotus Effect for self-cleaning surfaces or Velcro for adhesion. This symposium brought together plant and animal biomechanics researchers who tackle similar problems in different systems under the unifying theme of structure–function relations with relevance to bio-inspiration. For both communities it holds true that the structural systems, which have evolved in the respective organisms to address the mechanical challenges mentioned above, are often highly complex. This requires interdisciplinary research involving “classical” experimental biology approaches in combination with advanced imaging methods and computational modeling. The transfer of such systems into biomimetic technical materials and structures comes with even more challenges, like scalability issues and applicability. Having brought all these topics under one umbrella, this symposium presented the forefront of biophysical basic and application-oriented international research with the goal of facilitation knowledge transfer across systems and disciplines.
The utilization of cluster externalities and recessionary shocks
Authors: Holtermann Linus , Hundt Christian , Steeger Jonas , Bersch Johannes
Published: August 2020

In this article, we examine the impact of cluster externalities on the economic performance of firms. Specifically, we focus on how the utilization of these externalities by firms is affected by the macroeconomic instability caused by the recessionary shock of 2008/2009 and on how the impact of the crisis affects firms with different combinative capabilities. Using data from more than 16,000 manufacturing and business service firms located in 390 German regions, we employ within-firm regression techniques to estimate the impact of cross-level interactions between firm- and cluster-level determinants on phase-related differences in firm performance between a pre-crisis (2004–2007) and a crisis period (2009–2011). Our empirical results suggest that firms particularly benefit from the interaction of broad combinative capabilities and variety-driven cluster externalities, thereby implying that externalities are effectively utilized by firms. Furthermore, the results indicate that both strength and direction of these cross-level interactions strongly depend on the prevailing macroeconomic cycle: while the utilization of cluster externalities works best within a stable macroeconomic environment (2004–2007), it is seemingly interrupted when being exposed to economic turmoil (2009–2011). Yet, the crisis-induced interruption of the utilization is mainly restricted to the national recession in 2009. As soon as the macroeconomic pressure diminishes (2010–2011), we observe a reversion of the utilization mechanisms to the pre-crisis level.
Off-pump hypoplastic aortic arch ± aortic coarctation repair via median sternotomy using a temporary shunt
Authors: Al Halees Zohair , Abdullah Ibrahim
Published: August 2020

An off-pump technique was developed to surgically manage the problem of aortic arch hypoplasia frequently associated with coarctation of the aorta and borderline size left-sided structures. The technique was successfully utilized in 5 patients adequately repairing the arch without any side effects.
Management of isolated dissection of the abdominal aorta: a single-centre experience
Authors: Wang Yingliang , Liu Dehan , Ye Tianhe , Dong Xiangjun , Su Yangbo , Liang Huimin
Published: August 2020

OBJECTIVES

Isolated abdominal aortic dissection (IAAD) is a rare disease. Currently, there is no consensus on the management of IAAD. Our goal was to report our experience with the management of IAAD.

METHODS

A cohort of 45 consecutive patients with IAAD was treated between January 2010 and December 2018. We reviewed the demographics, clinical features, therapeutic modalities and follow-up results.

RESULTS

A total of 33 patients had successful endovascular repair (EVAR) and 12 patients underwent conservative treatment initially. During a mean follow-up of 16.6 months, 2 of the patients in the EVAR group had endoleak; neither of them needed reintervention. Complete or partial thrombosis of the false lumens was seen in all patients (88% and 12%) on the latest computed tomographic angiography images, and a significant enlargement of the true lumen and regression of the false lumen and maximal abdominal aortic diameter were observed in all patients (P < 0.001). In the group receiving conservative treatment, 3 patients were lost to follow-up; 1 patient died; 2 patients had small re-entry sites, neither of which needed intervention; 1 patient had EVAR; and the others remain symptom-free. The latest computed tomographic angiography images showed that 1 patient had spontaneous healing with complete thrombosis of the false lumen, 7 patients had partial thrombosis and the diameter of the maximal abdominal aortic and false lumen remained stable or was less decreased.

CONCLUSIONS

For patients with IAAD, close surveillance is necessary. In addition, EVAR is an effective therapeutic method with a high technical success rate and low complication rate for carefully selected patients.
Postnatal exposure to hypobaric hypoxia and its impact on inflammation and injury indexes after a cardiac valve procedure
Authors: Jiang Qin , Li Hanyu , Huang Xiyu , Yu Lu , Lueck Sabrina , Hu Shengshou
Published: August 2020

OBJECTIVES

There is accumulating evidence that hypobaric hypoxia adaptation confers cardiac protection. We investigated whether postnatal exposure to a high-altitude hypoxia environment results in less inflammation injury and better clinical indexes after a cardiac valve procedure.

METHODS

A total of 326 consecutively eligible patients undergoing mitral valve surgery from May 2013 through May 2019 in Sichuan Provincial People’s Hospital were retrospectively included and stratified by the altitude of residence: the northwest Sichuan plateau residents (altitude 3000–4000 m, group A, n = 101) and the Sichuan basin residents (altitude <1000 m, group B, n = 225). The primary end point indexes included myocardial injury and inflammatory response indexes, which were assessed by measurements of the levels of cardiac troponin I and high-sensitivity C-reactive protein and of the neutrophil–lymphocyte ratio, in addition to lactate levels. Secondary end point outcomes were ventilation time, chest tube drainage volume and length of stay in the intensive care unit and the hospital.

RESULTS

No differences in baseline data except for haemoglobin concentration were observed between the 2 groups. The serum levels of high-sensitivity C-reactive protein, cardiac troponin I and lactate and the neutrophil–lymphocyte ratio at each time point within 24 h postoperatively were lower in group A than in group B, respectively. The ventilation time was 9 ± 5 and 11 ± 7 h in group A and in group B, respectively (P = 0.004). The chest tube drainage volume was 647 ± 231 and 715 ± 164 ml in group A and in group B, respectively (P = 0.003).

CONCLUSIONS

Compared with the low-altitude residents, high-altitude patients exposed to postnatal hypoxia experienced less severe inflammatory reactions, less ischaemic injury and favourable postoperative recovery when undergoing a primary mitral valve procedure.
Transient Lymphopenia and Interstitial Pneumonia With Endotheliitis in SARS-CoV-2–Infected Macaques
Authors: Koo Bon-Sang , Oh Hanseul , Kim Green , Hwang Eun-Ha , Jung Hoyin , Lee Youngjeon , Kang Philyong , Park Jae-Hak , Ryu Choong-Min , Hong Jung Joo
Published: August 2020

Using a reliable primate model is critical for developing therapeutic advances to treat humans infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Here, we exposed macaques to high titers of SARS-CoV-2 via combined transmission routes. We observed acute interstitial pneumonia with endotheliitis in the lungs of all infected macaques. All macaques had a significant loss of total lymphocytes during infection, which were restored over time. These data show that SARS-CoV-2 causes a coronavirus disease 2019 (COVID-19)-like disease in macaques. This new model could investigate the interaction between SARS-CoV-2 and the immune system to test therapeutic strategies.
Emergence of livestock-associated MRSA ST398 from bulk tank milk, China
Authors: Cui Mingquan , Li Jiyun , Ali Tariq , Kalim Khisrao , Wang Hejia , Song Li , Li Zekun , Ren Xiaoxia , Ma Feiyang , Zou Ming , Shen Shan , Xu Shixin
Published: August 2020

Objectives

To detect livestock-associated MRSA (LA-MRSA) ST398 from bulk tank milk in China and to determine the phenotypic and genomic characteristics of the strains.

Methods

LA-MRSA ST398 strains were isolated from bulk tank milk samples in Shanghai and their susceptibilities to antimicrobials were determined using the broth dilution method. Genomic characterization of MRSA ST398 strains was performed by WGS and their evolutionary relationships were assessed by phylogenetic analysis.

Results

Two LA-MRSA ST398 isolates were recovered from bulk tank milk samples in two geographically distant farms in China. Whole-genome analysis strongly suggested that the LA-MRSA ST398 strains were closely related to the highly virulent hospital-associated MRSA (HA-MRSA) ST398 strains in China.

Conclusions

The presence of LA-MRSA ST398 in bulk tank milk might be a serious threat to public health, highlighting the need for active surveillance of LA-MRSA in healthy cattle in China.
Palpable Masses after Mastectomy: Differentiating Benign Postoperative Findings from Recurrent Disease
Authors: Pryce Cherah , Owen Wendi
Published: August 2020

Due to postoperative changes, imaging evaluation of patients with palpable masses after mastectomy can be challenging. There is considerable overlap between the imaging characteristics of recurrent disease and benign postoperative findings in patients with or without breast reconstruction. US is the initial modality of choice for evaluating palpable masses in most patients after mastectomy. In cases where US findings are not classic, however, other modalities are useful in problem solving, including both mammography and MRI. It is imperative that radiologists are educated about benign and malignant imaging characteristics, further workup considerations, and appropriate management. In cases where findings are not characteristic across multiple imaging modalities, biopsy may be warranted.
Artisans Meet Design: The Reception of the Turkish Handicraft Development Office in Turkey1
Authors: Emgin Bahar
Published: August 2020

Peter Müller-Munk Associates, an American industrial design firm, established the Turkish Handicraft Development Office in 1957 in Ankara as part of the US technical assistance program to developing nations. The aim of the program was to improve selected local crafts products in order to make them appealing for the American market. To this end, American designers and local craftspeople produced about 150 prototypes formed by creative combinations of meerschaum, copperware, ceramics, woodwork and basket weaving. When the office was closed in the early 1960s because of its failure to mass-produce the samples, it left behind a lively debate regarding the improvement of craft production and its relation to industrialization and economic growth. This article focuses on these debates to determine the place allocated to design within the discussions of crafts as a socio-economic activity. The article will focus on the reception of the design assistance program among the local actors to answer how Turkish crafts practitioners and officials perceived design, how the emergent concept of design was linked with handicraft and artisanal production, and how it took place as part of the agenda of economic and industrial development.
Certifying Biodiversity: The Union for Ethical BioTrade and the Search for Ethical Sourcing
Authors: Stamboulakis Drossos , Sanderson Jay
Published: August 2020

This article is concerned with the potential for private action to improve sourcing practices to promote biodiversity. More specifically this article examines the Union for Ethical BioTrade (UEBT) and its verification and certification of ‘sourcing with respect’: that is, sourcing ingredients from biodiversity in a way that is respectful to both the local environment and people. While key international biodiversity treaties and instruments—such as the Convention on Biological Diversity (CBD) and Nagoya Protocol—encourage public actors to work with private actors to develop methods for the sustainable use of biological resources, our examination of UEBT shows that there are concerns over the standards, implementation and enforcement of private initiatives. In conclusion, we suggest two key ways in which transnational or public/private initiatives can be strengthened. First, via more proactively promoting public/private cooperation, including about how certification is used to reduce inconsistency and consumer overload or confusion. Secondly, by placing greater emphasis on mechanisms that place pressure on supply chain actors to source in ways that promote biodiversity.
Phylogeographic analysis reveals mito-nuclear discordance in Dasypterus intermedius
Authors: Decker Sydney K , Ammerman Loren K
Published: August 2020

Northern yellow bats (Dasypterus intermedius) are tree-roosting bats in the family Vespertilionidae comprised of two subspecies: D. intermedius intermedius and D. intermedius floridanus. The two subspecies are thought to be geographically separated. Due to their cryptic morphology, this hypothesis has never been tested and can benefit from being examined within a molecular framework. In this study, mitochondrial sequence data from 38 D. intermedius and nuclear sequence data from 14 D. intermedius from across their range were used to test the hypothesis that genetically defined groups correspond geographically with the two morphologically defined subspecies. Although high levels of divergence of the mitochondrial sequence (11.6%) suggest genetically distinct clusters sympatric in southern Texas, no genetic structure was recovered with the nuclear marker. Moreover, the mitochondrial sequence data recovered a paraphyletic relationship between the two subspecies of D. intermedius with the Cuban yellow bat (D. insularis), whereas no such paraphyly was recovered from analysis of the nuclear marker. Divergence time based on analyses of mitochondrial sequence for the two subspecies was approximately 5.5 Ma. The patterns observed are hypothesized to be the result of past isolation of lineages and secondary contact that is currently contributing to gene flow.
Intergenerational Choir: A Qualitative Exploration of Lived Experiences of Older Adults and Student Music Therapists
Authors: Jang Sekyung
Published: August 2020

The purpose of this phenomenological study was to explore the essence of an intergenerational choir experience for older adults and student music therapists. Data were gathered through a series of open-ended individual interviews with older adult participants (n = 10) and student participants (n = 5). Analysis of data revealed four emerging themes common to both older adults and students: mutual learning, social bonding and support, feelings of accomplishment, and appreciation and enjoyment. Emerging themes unique to the older adult community members were that (a) participation challenges came from differences in musical culture; (b) intergenerational choir promoted experience of emotional health and helped maintain an active lifestyle; and (c) community members were passionate about recruiting new members to expand the choir. Emerging themes unique to the student music therapists were that (a) intergenerational choir provided unique ensemble experiences and (b) students reported positive changes in perception of older adults. Implications of intergenerational music engagement for music therapy clinical practice, research, and education are discussed.
Understanding Sex Differences in Children’s Injury Risk as Pedestrians
Authors: Morrongiello Barbara A , Corbett Michael , Stewart Julia
Published: August 2020

Objective

Boys experience more injuries as pedestrians than girls. The aim of this study was to compare how boys and girls cross streets in order to identify factors that differentially influence their injury risk as pedestrians.

Methods

Using a fully immersive virtual reality (VR) system interfaced with a 3D movement measurement system, various measures of children’s street-crossing behaviors were taken.

Results

At the start of the crossing, boys selected smaller (riskier) inter-vehicle gaps to cross into than girls. Subsequently, as they crossed, they showed greater attention to traffic, shorter start delay, and more evasive action than girls, which are strategies that could reduce risk as a pedestrian. Despite these efforts, however, boys experienced more hits and close calls than girls.

Conclusion

To enhance their safety as pedestrians, girls adopt a proactive approach and select larger inter-vehicle gaps to cross into, whereas boys apply a reactive approach aimed at managing the risk created by having selected smaller (riskier) gaps. Girls’ proactive approach yielded safer outcomes than boys’ reactive strategy.
Advancing the evidence in altitude and wilderness medicine
Authors: Zafren Ken , Shlim David R , Basnyat Buddha , Visser Jenny
Published: August 2020

The themes of this special issue of the Journal of Travel Medicine are wilderness and adventure travel. We hope that the wilderness medicine and travel medicine communities can work together on these areas of mutual interest.
Highly dynamic, coordinated, and stage-specific profiles are revealed by a multi-omics integrative analysis during tuberous root development in cassava
Authors: Ding Zehong , Fu Lili , Tie Weiwei , Yan Yan , Wu Chunlai , Dai Jing , Zhang Jiaming , Hu Wei
Published: August 2020

Cassava (Manihot esculenta) is an important starchy root crop that provides food for millions of people worldwide, but little is known about the regulation of the development of its tuberous root at the multi-omics level. In this study, the transcriptome, proteome, and metabolome were examined in parallel at seven time-points during the development of the tuberous root from the early to late stages of its growth. Overall, highly dynamic and stage-specific changes in the expression of genes/proteins were observed during development. Cell wall and auxin genes, which were regulated exclusively at the transcriptomic level, mainly functioned during the early stages. Starch biosynthesis, which was controlled at both the transcriptomic and proteomic levels, was mainly activated in the early stages and was greatly restricted during the late stages. Two main branches of lignin biosynthesis, coniferyl alcohol and sinapyl alcohol, also functioned during the early stages of development at both the transcriptomic and proteomic levels. Metabolomic analysis further supported the stage-specific roles of particular genes/proteins. Metabolites related to lignin and flavonoid biosynthesis showed high abundance during the early stages, those related to lipids exhibited high abundance at both the early and middle stages, while those related to amino acids were highly accumulated during the late stages. Our findings provide a comprehensive resource for broadening our understanding of tuberous root development and will facilitate future genetic improvement of cassava.
Natural alkaloid tryptanthrin exhibits novel anticryptococcal activity
Authors: Lin Chi-Jan , Chang Ya-Lin , Yang Yu-Liang , Chen Ying-Lien
Published: August 2020

Cryptococcal meningitis is a prevalent invasive fungal infection that causes around 180 000 deaths annually. Currently, treatment for cryptococcal meningitis is limited and new therapeutic options are needed. Historically, medicinal plants are used to treat infectious and inflammatory skin infections. Tryptanthrin is a natural product commonly found in these plants. In this study, we demonstrated that tryptanthrin had antifungal activity with minimum inhibitory concentration (MIC) of 2 μg/ml against Cryptococcus species and of 8 μg/ml against Trichophyton rubrum. Further analysis demonstrated that tryptanthrin exerted fungistatic and potent antifungal activity at elevated temperature. In addition, tryptanthrin exhibited a synergistic effect with the calcineurin inhibitors FK506 and cyclosporine A against Cryptococcus neoformans. Furthermore, our data showed that tryptanthrin induced cell cycle arrest at the G1/S phase by regulating the expression of genes encoding cyclins and the SBF/MBF complex (CLN1, MBS1, PCL1, and WHI5) in C. neoformans. Screening of a C. neoformans mutant library further revealed that tryptanthrin was associated with various transporters and signaling pathways such as the calcium transporter (Pmc1) and protein kinase A signaling pathway. In conclusion, tryptanthrin exerted novel antifungal activity against Cryptococcus species through a mechanism that interferes with the cell cycle and signaling pathways.
Evolutionary History of Major Chemosensory Gene Families across Panarthropoda
Authors: Vizueta Joel , Escuer Paula , Frías-López Cristina , Guirao-Rico Sara , Hering Lars , Mayer Georg , Rozas Julio , Sánchez-Gracia Alejandro
Published: August 2020

Chemosensory perception is a fundamental biological process of particular relevance in basic and applied arthropod research. However, apart from insects, there is little knowledge of specific molecules involved in this system, which is restricted to a few taxa with uneven phylogenetic sampling across lineages. From an evolutionary perspective, onychophorans (velvet worms) and tardigrades (water bears) are of special interest since they represent the closest living relatives of arthropods, altogether comprising the Panarthropoda. To get insights into the evolutionary origin and diversification of the chemosensory gene repertoire in panarthropods, we sequenced the antenna- and head-specific transcriptomes of the velvet worm Euperipatoides rowelli and analyzed members of all major chemosensory families in representative genomes of onychophorans, tardigrades, and arthropods. Our results suggest that the NPC2 gene family was the only family encoding soluble proteins in the panarthropod ancestor and that onychophorans might have lost many arthropod-like chemoreceptors, including the highly conserved IR25a receptor of protostomes. On the other hand, the eutardigrade genomes lack genes encoding the DEG-ENaC and CD36-sensory neuron membrane proteins, the chemosensory members of which have been retained in arthropods; these losses might be related to lineage-specific adaptive strategies of tardigrades to survive extreme environmental conditions. Although the results of this study need to be further substantiated by an increased taxon sampling, our findings shed light on the diversification of chemosensory gene families in Panarthropoda and contribute to a better understanding of the evolution of animal chemical senses.
Fragmentation of extracellular ribosomes and tRNAs shapes the extracellular RNAome
Authors: Tosar Juan Pablo , Segovia Mercedes , Castellano Mauricio , Gámbaro Fabiana , Akiyama Yasutoshi , Fagúndez Pablo , Olivera Álvaro , Costa Bruno , Possi Tania , Hill Marcelo , Ivanov Pavel , Cayota Alfonso
Published: August 2020

A major proportion of extracellular RNAs (exRNAs) do not copurify with extracellular vesicles (EVs) and remain in ultracentrifugation supernatants of cell-conditioned medium or mammalian blood serum. However, little is known about exRNAs beyond EVs. We have previously shown that the composition of the nonvesicular exRNA fraction is highly biased toward specific tRNA-derived fragments capable of forming RNase-protecting dimers. To solve the problem of stability in exRNA analysis, we developed a method based on sequencing the size exclusion chromatography (SEC) fractions of nonvesicular extracellular samples treated with RNase inhibitors (RI). This method revealed dramatic compositional changes in exRNA population when enzymatic RNA degradation was inhibited. We demonstrated the presence of ribosomes and full-length tRNAs in cell-conditioned medium of a variety of mammalian cell lines. Their fragmentation generates some small RNAs that are highly resistant to degradation. The extracellular biogenesis of some of the most abundant exRNAs demonstrates that extracellular abundance is not a reliable input to estimate RNA secretion rates. Finally, we showed that chromatographic fractions containing extracellular ribosomes are probably not silent from an immunological perspective and could possibly be decoded as damage-associated molecular patterns.
Predicting pediatric optic pathway glioma progression using advanced magnetic resonance image analysis and machine learning
Authors: Pisapia Jared M , Akbari Hamed , Rozycki Martin , Thawani Jayesh P , Storm Phillip B , Avery Robert A , Vossough Arastoo , Fisher Michael J , Heuer Gregory G , Davatzikos Christos
Published: August 2020

Background

Optic pathway gliomas (OPGs) are low-grade tumors of the white matter of the visual system with a highly variable clinical course. The aim of the study was to generate a magnetic resonance imaging (MRI)-based predictive model of OPG tumor progression using advanced image analysis and machine learning techniques.

Methods

We performed a retrospective case–control study of OPG patients managed between 2009 and 2015 at an academic children’s hospital. Progression was defined as radiographic tumor growth or vision decline. To generate the model, optic nerves were manually highlighted and optic radiations (ORs) were segmented using diffusion tractography tools. For each patient, intensity distributions were obtained from within the segmented regions on all imaging sequences, including derivatives of diffusion tensor imaging (DTI). A machine learning algorithm determined the combination of features most predictive of progression.

Results

Nineteen OPG patients with progression were matched to 19 OPG patients without progression. The mean time between most recent follow-up and most recently analyzed MRI was 3.5 ± 1.7 years. Eighty-three MRI studies and 532 extracted features were included. The predictive model achieved an accuracy of 86%, sensitivity of 89%, and specificity of 81%. Fractional anisotropy of the ORs was among the most predictive features (area under the curve 0.83, P < 0.05).

Conclusions

Our findings show that image analysis and machine learning can be applied to OPGs to generate a MRI-based predictive model with high accuracy. As OPGs grow along the visual pathway, the most predictive features relate to white matter changes as detected by DTI, especially within ORs.
COVID-19 in Hospitalized Adults With HIV
Authors: Stoeckle Kate , Johnston Carrie D , Jannat-Khah Deanna P , Williams Samuel C , Ellman Tanya M , Vogler Mary A , Gulick Roy M , Glesby Marshall J , Choi Justin J
Published: August 2020

Background

The spread of SARS-CoV-2 and the COVID-19 pandemic have caused significant morbidity and mortality worldwide. The clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 and HIV co-infection remain uncertain.

Methods

We conducted a matched retrospective cohort study of adults hospitalized with a COVID-19 illness in New York City between March 3, 2020, and May 15, 2020. We matched 30 people with HIV (PWH) with 90 control group patients without HIV based on age, sex, and race/ethnicity. Using electronic health record data, we compared demographic characteristics, clinical characteristics, and clinical outcomes between PWH and control patients.

Results

In our study, the median age (interquartile range) was 60.5 (56.6–70.0) years, 20% were female, 30% were black, 27% were white, and 24% were of Hispanic/Latino/ethnicity. There were no significant differences between PWH and control patients in presenting symptoms, duration of symptoms before hospitalization, laboratory markers, or radiographic findings on chest x-ray. More patients without HIV required a higher level of supplemental oxygen on presentation than PWH. There were no differences in the need for invasive mechanical ventilation during hospitalization, length of stay, or in-hospital mortality.

Conclusions

The clinical manifestations and outcomes of COVID-19 among patients with SARS-CoV-2 and HIV co-infection were not significantly different than patients without HIV co-infection. However, PWH were hospitalized with less severe hypoxemia, a finding that warrants further investigation.
L’administration postnatale de corticostéroïdes pour prévenir ou traiter la dysplasie bronchopulmonaire chez les nouveau-nés prématurés
Authors: Lemyre Brigitte , Dunn Michael , Thebaud Bernard
Published: August 2020

Les corticostéroïdes ont longtemps été administrés pendant la période postnatale pour prévenir et traiter la dysplasie bronchopulmonaire (DBP), une cause importante de morbidité et de mortalité chez les nouveau-nés prématurés. L’administration préventive de dexaméthasone pendant la première semaine de vie est liée à une augmentation du risque de paralysie cérébrale, et l’administration précoce de corticostéroïdes inhalés semble être associée à une hausse du risque de mortalité. À l’heure actuelle, aucune de ces deux approches n’est recommandée pour prévenir la DBP. Selon de nouvelles données probantes, un traitement prophylactique d’hydrocortisone à des doses physiologiques, entrepris avant 48 heures de vie sans ajout d’indométacine, améliore la survie sans DBP, et n’a pas d’effets neurodéveloppementaux indésirables à l’âge de deux ans. Les cliniciens peuvent envisager ce traitement pour les nouveau-nés les plus à risque de DBP. Il n’est pas recommandé d’entreprendre un traitement systématique de dexaméthasone pour tous les nouveau-nés sous assistance respiratoire, mais après la première semaine de vie, les cliniciens peuvent envisager un court traitement de dexaméthasone à faible dose (0,15 mg/kg/jour à 0,2 mg/kg/jour) pour certains nouveau-nés à haut risque de DBP ou atteints d’une DBP évolutive. Aucune donnée probante n’indique que l’hydrocortisone remplace la dexaméthasone avec efficacité ou innocuité dans le traitement d’une DBP évolutive ou établie. Les données à jour n’appuient pas l’administration de corticostéroïdes inhalés pour traiter la DBP.
Benefits and Harms of Short-Term International Academic Experiences Among Rehabilitation Students: A Systematic Review
Authors: Lembo Kerri , Majewski Katharine , Seraphin Andy , Hayes Madison , Quintin Daniel , Garcia Alessandra Narcisco
Published: August 2020

Objective

More rehabilitation students are engaging in short-term international experiences to gain clinical experience with a novel population or setting. Further investigation of the impacts on the students and host populations resulting from these initiatives is needed. The purpose of this study was to examine the benefits and harms of short-term international academic experiences completed by rehabilitation students for both the student and the host populations.

Methods

PubMed, Embase, and CINAHL were searched for studies from 1998 through March 2019; any study design was eligible for review. Independent reviewers screened and selected studies. To be eligible, articles had to include a rehabilitation student participating in a short-term clinical or community-based experience. Two independent reviewers extracted data from included studies. Outcomes included benefits and harms of international academic experiences on students and host populations. Oxford Level of Evidence was used for quality assessment. Nineteen studies met eligibility criteria.

Results

The most prevalent benefits and harms to students were increases in cultural and clinical competence and emotional health risks. The most prevalent benefits and harms to hosts were novel training and decreased productivity.

Conclusions

Highlighting benefits and harms serves a pivotal role in investigating ways to create more effective, mutually beneficial relationships between home and host populations. Future research should aim for a deeper analysis of the impact of short-term international academic experiences on host populations to develop and deepen sustainable partnerships.

Impact

With more rehabilitation students engaging in short-term international academic experiences, this review provides important guidance for the profession, including the recommendation that outcomes regarding the potential benefits and harms for home and host populations should be collected at 3 key times: immediately pre-departure for the host country, immediately post-departure in the home country, and 1-year post-arrival in the home country.
Confidence gap between men and women in medicine: a systematic review
Authors: Vajapey Sravya P. , Weber Kristy L. , Samora Julie Balch
Published: August 2020

Background:

The aim of this study was to examine the existing data on disparities between men and women in the field of medicine in terms of self-confidence, self-efficacy, impostor syndrome, and other self-assessment factors.

Methods:

A systematic review of the literature was performed using keywords “confidence gap,” “male female residents,” “self-perception,” “self-confidence,” “self-worth,” “self-assessment,” “impostor syndrome,” “medicine self-esteem,” and “gender differences medicine.” Articles meeting the inclusion criteria were sorted and reviewed. Type of study, outcome measures, and results were recorded in Excel. Qualitative analysis was performed on the data collected.

Results:

Of the 31 studies included in this review, 24 studies demonstrated that men’s self-reported scores in clinical knowledge, skills, procedural confidence, operative experience, and other competencies were higher than women’s self-reported scores. Women at graduate and post-graduate training levels rated themselves lower in perceived clinical skills, performance, confidence in procedures, identification with the role of doctor, interpersonal/communication skills, and preparedness for leadership positions. Furthermore, the rate of identification with impostor syndrome, stress, and burnout are higher in women than men. Evidence did not demonstrate any objective differences in actual performance or skills between men and women at any level of training in medicine.

Conclusions:

Even though women and men do not differ in their clinical performance, women in healthcare fields may perceive deficiencies in their abilities more often than their male counterparts. However, these results are tempered by the fact that the level of evidence of the studies included in the review is low.

Level of Evidence:

Level III.
Effect of medial meniscal posterior horn tears on tibial translation in ACL-intact knees: a case control study based on MRI
Authors: Ulusoy Gökhan Ragip , Kizilgöz Volkan
Published: August 2020

Background:

This aim of this study was to determine the relationship between medial meniscal tear and tibial translation in the anterior cruciate ligament (ACL)-intact knees.

Methods:

MRI of 278 patients, ages 18 to 50 yr, with medial meniscus posterior horn tears were evaluated. Two reviewers independently measured lateral and medial anterior tibial translation (ATT). Intraclass correlation coefficient (ICC) analysis was used to compare the results.

Results:

The ICC values of measurements of lateral ATT and medial ATT were 0.995 and 0.998, respectively; these values demonstrated almost perfect agreements. Age showed no significant difference between the control and patient groups (P>0.05). Lateral ATT values were lower in the patient group than those in the control group; however, there were no statistically significant differences between the groups (P=0.81). Medial ATT values were significantly lower in the patient groups than in the controls (P<0.05).

Conclusions:

Our results demonstrated significantly lower medial ATT values in patients with medial meniscus posterior horn tear in ACL-intact knees. However, most studies are dynamic and performed with ACL-ruptured knees or after meniscectomies in either ACL-intact or ACL-ruptured knees.

Level of Evidence:

Level III.
Cervicothoracic fixation using a tapered rod with posterior en bloc multilevel laminectomy for treatment of cervicothoracic pathology: a prospective case series
Authors: Ibrahim Fady Michael , Ibrahim Mohammed Zayan
Published: August 2020

Background:

Cervicothoracic junction pathologies are difficult to treat because of the biomechanical and anatomical considerations of this area. Anterior approaches in this area are highly demanding and often result in long-term morbidities. Posterior fixation of the cervicothoracic junction is difficult because of the change in anatomy of the vertebrae between the cervical and thoracic vertebrae. Traditional laminectomy may be hazardous to the spinal cord. The purpose of this study was to evaluate the results of cervicothoracic fixation using tapered rods and en bloc multilevel laminectomy for treatment of different pathologies in terms of effectiveness, neurological improvement, and complications.

Methods:

A prospective study was done between 2013 to 2016 on 17 patients with cervicothoracic pathologies. The mean age was 50.05±16.48 yr. There were seven patients with tumors, five patients with traumatic fractures (including one patient with ankylosing spondylitis), and five patients with cervicothoracic myelopathy due to degenerative disorders. The patients underwent a detailed history and clinical examination, and they were investigated with radiographs, CT scans, and MRI. The patients’ neurological functions were classified according to Frankel grades of paraplegia. All patients had preoperative neurological impairment.

Results:

All patients were operated through posterior approach. En bloc laminectomy and posterior fixation of at least the lower 3 cervical and upper 3 thoracic vertebrae were done using a tapered rod. The mean operative time was 164.40 min. The mean operative blood loss was 960.6 mL. One case had superficial infection that was treated with antibiotics and daily dressings until wound healing. Patients with spinal metastases received postoperative radiation 1 mo after surgery. No neurological deterioration occurred. The improvement in patients was gradual throughout the follow-up but started in some patients from 2 days postoperatively. Gait improved in all patients. No case of metal failure was observed during follow-up.

Conclusions:

Multilevel en bloc laminectomy is a safe technique that provides adequate decompression of the spinal cord and neurological improvement for patients suffering from cervicothoracic myelopathy due to various pathologies. The use of a tapered rod is a good alternative for connection of screws across the cervicothoracic region, with easy handling and minimal complications.

Level of Evidence:

Level IV.
F. Brunelli Ligamentoplasty as Treatment in Thumb Basal Joint Arthritis: Up to 9 Years Follow-up
Authors: Fulchignoni Camillo , Morini Alessandro , Panzera Rocco M. , Merendi Gianfranco , Rocchi Lorenzo
Published: August 2020

Thumb basal joint arthritis treatment with biological arthroplasty is a widely used procedure in hand surgery centers. The several described techniques are based on the use of different tendons of the wrist, implying frequently a tenoplasty around flexor carpi radialis or transosseous tunnels to stabilize the articulation. The authors have been using, for many years, the technique conceived by F. Brunelli that relies on the anchorage of the volar band of the abductor pollicis longus tendon to the first intermetacarpal ligament, to obtain a suspension arthroplasty. Technical details are discussed. Sixty-seven patients in Eaton-Littler stage 2 or 3 with >4 years follow-up after surgery were evaluated. Each patient expressed a subjective evaluation relating to pain, functionality, strength, esthetic aspect, and general satisfaction. The following parameters have been considered as objective data: the angle of the first web space, the abduction and opposition of the first digit, the pinch, and the strength. X-rays were also performed to verify the distance between the scaphoid and the first metacarpal. In 84% of cases, a significant improvement was found in the considered parameters. Joint space was maintained in 76% of cases at radiologic follow-up. No patient needed surgical revision. The tenoplasty conceived by F. Brunelli presents several advantages, including the simple and reproducible execution, short surgical time, and comfortable postoperative course for the patient. After mid-term follow-up, authors believe this procedure is particularly respectful of the anatomy and physiology of the first ray and gives optimal results in most of the cases, but, in patients with severe subluxation of the 1st metacarpal (identifiable as Eaton-Littler stage 3), it is less reliable, because of the degeneration of the intermetacarpal ligament.
Volar Approach to the First Extensor Compartment for Surgical Treatment of DeQuervain Tenosynovitis
Authors: Park Adam Y. , Smith Dean W.
Published: August 2020

Many surgical techniques have been published in regards to the operative management of DeQuervain tenosynovitis. As it has been classically described, stenosing tenosynovitis of the first extensor tendon compartment is a common tendinopathy along the radial side of the wrist causing pain and swelling in the affected area. When surgery is necessary, decompression of the abductor pollicis longus and extensor pollicis brevis tendons decreases first extensor compartment friction and has been shown to successfully alleviate symptoms. A number of varying techniques have been reported in the literature to achieve adequate decompression and minimize postoperative complications such as sensory nerve injury, incomplete decompression, and tendon subluxation. We describe a novel volar approach to the first extensor compartment, which allows direct visualization of the retinaculum and a midline retinacular release. In addition, the volar approach has an associated decreased risk of iatrogenic nerve injury by passing volar and deep to the more superficial sensory nerves that overly the retinaculum. On the basis of our experience, patients do not experience an increased risk of volar tendon subluxation with this approach.
Advances in immunotherapy for cervical cancer
Authors: Wendel Naumann R. , Leath Charles A.
Published: August 2020

Purpose of review

Novel therapies are needed for the treatment of recurrent cervical cancer. The best chemotherapy regimen to date has a response rate of 48% with an overall survival of 17 months, with limited options for second-line chemotherapy. Immunotherapy can induce a strong immune response in cervical cancer due to retained viral antigens and is reviewed in this article.

Recent findings

Current clinical trials include treatment with Listeria that elicits an immune response against the E7 oncoprotein and active vaccines against the E7 oncoprotein. Although the response rates to programmed cell death 1 (PD-1) inhibition alone have been modest, the landmark survival reported in these trials suggests the activity of these agents may not be measured by RECIST criteria. The KEYNOTE-158 trial has led to the approval of pembrolizumab in recurrent programmed cell death ligand 1 (PD-L1) positive cervical cancer. Combinations of programmed cell death 1 and anticytotoxic T-lymphocyte-associated protein 4 inhibitors (CTLA4) inhibitors have shown promising and durable activity. There is active research with new combinations of checkpoint inhibitors, as well as combinations of these drugs with chemotherapy and radiation, and other novel approaches.

Immune therapy has broad activity in cervical cancer. Responses to immunotherapy can be dramatic and durable. Continued work to find the optimal combination and setting for immunotherapy is ongoing.
Long-term Outcomes After Definitive Radiation Therapy for Solitary Plasmacytoma
Authors: Curry Jayden , O’steen Lillie , Morris Christopher G. , Kirwan Jessica M. , Mendenhall William M.
Published: August 2020

Objective:

Definitive radiotherapy (RT) with or without surgery is the standard of care for solitary plasmacytoma. Here, we report clinical outcomes for this rare malignant neoplasm.

Patients and Methods:

We retrospectively reviewed the medical records of adults with solitary plasmacytoma treated with definitive RT between 1963 and 2015 at a single institution, and assessed disease control, survival, and toxicity per Common Terminology Criteria for Adverse Events (CTCAE), version 4.

Results:

A total of 42 patients with solitary plasmacytoma of the bone (SPB, n=27) or extramedullary plasmacytoma (EMP, n=15) were treated with definitive RT with (n=11) or without (n=31) surgical resection. The median age at diagnosis was 59 years (range: 28 to 76 y).Twenty-two patients had tumors ≥5 cm and 20 had tumors <5 cm. Immunoglobulins were elevated in 23 patients and M-protein in 14. The median RT dose was 45 Gy (range: 15 to 54 Gy) over a median 25 fractions (range: 1 to 38 fractions) with 3 patients receiving twice-daily fractionation and 6 received elective nodal irradiation. No patients received adjuvant chemotherapy. The median follow-up was 10.3 years. The 10-year local control rate after RT was 88%. Five patients who developed a local recurrence had SPB ≥5 cm. The 10-year multiple myeloma-free survival rates were: overall, 47%; SPB, 24%; and EMP, 87% (P=0.0012). The 10-year cause-specific survival rate was 75%: 64% for SPB versus 93% for EMP (P=0.0116). The 10-year overall survival rate was 60%. Three patients experienced late grade 2+ toxicity.

Conclusions:

Definitive RT with moderate doses results in excellent local control. We observed a higher rate of progression to multiple myeloma and lower survival in patients with SPB compared with EMP.
Diagnostic Biopsy via In-Office Frozen Sections for Clinical Nonmelanoma Skin Cancer
Authors: Mulvaney Patrick M. , Piris Adriano , Besaw Robert J. , Schmults Chrysalyne D.
Published: August 2020

BACKGROUND

Treatment of nonmelanoma skin cancer (NMSC) by Mohs surgery has traditionally relied on previous pathologic evaluation of paraffin-embedded tissue. Tissue processing by frozen sections allows for expedited diagnosis and treatment; however, data on its accuracy are limited.

OBJECTIVE

To measure the accuracy and outcomes of biopsy via frozen sections for clinical NMSC.

METHODS

Biopsies of clinical NMSCs processed via frozen sections with in-office diagnosis rendered by one Mohs surgeon were retrospectively reviewed by one board-certified dermatopathologist. Discordant diagnoses were re-read in blinded fashion by both physicians. If still discordant, final diagnosis was determined by consensus discussion. Inter-rater reliability was calculated using Cohen's kappa statistic.

RESULTS

Two hundred ninety-seven lesions from 208 patients were included. Correlation between in-office and final diagnosis was 0.876 indicating “almost perfect” concordance. Sensitivity and specificity of in-office diagnosis for detecting malignancy were 98.1% and 94.4%. Seven cases (2.0%) had a clinically relevant change in final diagnosis, but appropriate treatment had been rendered. Two benign lesions (0.7%) initially diagnosed as malignant underwent excision.

CONCLUSION

In-office biopsy via frozen sections is highly accurate in confirming NMSC. This practice may speed diagnosis and treatment thus improving outcomes and patient satisfaction.