bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial stewardship in community pharmacies in Jordan: assessing current status
Authors: Saleh Doaa , Abu Farha Rana , Darwish El-Hajji Feras
Published: January 2021

Objectives

The aim of this study was to assess knowledge and perceptions of the Jordanian community pharmacists towards antimicrobial resistance and antimicrobial stewardship programmes (ASPs).

Methods

A descriptive cross-sectional questionnaire-based study was conducted between August and September 2020. The validated questionnaire consisted of sections that measure participants’ demographics, knowledge and perceptions towards ASPs, and assess antibiotic prescribing practice. Questionnaires were distributed via social media to be filled by community pharmacists in Jordan. For knowledge questions, participants gained one point for each correct answer and zero point for each incorrect answer. Then, a knowledge score was calculated out of 10.

Key findings

During the study period, a convenience sample of 200 pharmacists were recruited and were asked to fill out the study questionnaire, with a majority claimed attending ASPs workshops previously (n = 162, 81.0%). The main sources of knowledge about antimicrobial resistance were university courses and books. With a median knowledge score of 6/10, participants knew that antimicrobials are not always safe. Although only less than 25% knew that ASPs does not necessarily increase treatment duration, most of the pharmacists had positive perceptions towards ASPs. Barriers against application of ASPs were mainly lack of training and lack of physicians’ cooperation (89.0% and 87.5%, respectively). It was agreed by 90.0% of the respondents that ASPs would boost public health confidence in community pharmacists, and 86.0% believed that ASPs would enhance their job satisfaction. Multivariate linear regression showed that female gender of pharmacist was significantly associated with higher knowledge score (P-value = 0.045).

Conclusions

This study highlighted that community pharmacists have a good knowledge in antibiotics and a positive perception regarding ASPs. Despite not being highly familiar with ASPs concept, pharmacists showed great support for involvement in ASPs. They also encouraged incorporating ASPs within community pharmacy level which is considered crucial to control antimicrobial resistance throughout the world.
Impact of Beta-Lactam Allergies on Selection of Antimicrobials in an Inpatient Setting Among Veteran Population
Authors: Neu Daniel W , Guidry Tommie Jo , Gillion Amanda R , Pattanaik Debendra N
Published: January 2021

Purpose

Beta-lactam antibiotics are among the most common and widely used antibiotics. However, reported allergy to this class of antibiotics is also common, leading to the use of alternative broad-spectrum antibiotics by healthcare providers. This has led to the emergence of various negative health outcomes. The purpose of the study is to investigate the impact of using alternative antibiotics secondary to a beta-lactam allergy among U.S. veterans who have otherwise multiple comorbidities.

Methods

This retrospective observational analysis was conducted over a 5-year period (January 1, 2011 to December 31, 2016) at the Memphis Veterans Affairs Medical Center (VAMC). Admitted patients with a documented beta-lactam allergy were categorized to preferred or non-preferred status based on initial antibiotic therapy antibiotic, allergy history, published guidelines, and local antibiogram. Preferred therapy was defined as the optimal antibiotic treatment for a given indication based on patient allergy history, published Infectious Disease Society of America guidelines, and local antibiogram of Memphis VAMC. The therapy was classified as “non-preferred” if it did not satisfy the preferred therapy criteria. Non-preferred treatments were further assessed for appropriateness based on indication and patient-specific factors. Chi-square and Fisher’s exact tests were conducted to find a difference in rates of negative sequelae among patients receiving preferred vs. non-preferred treatments and appropriate vs. inappropriate treatments.

Findings

Of the 1806 admissions identified, data were collected on 95 unique patients with 147 different antibiotic regimens. There were 68 (52%) preferred treatment regimens and 64 (48%) non-preferred treatment regimens. Of the 64 non-preferred treatments, 43 (67%) were inappropriate. There was a statistically significant decrease in the number of adverse drug events and in the combined negative sequelae outcome among patients receiving preferred therapy vs. non-preferred therapy (2 vs. 12; P < .01 and 11 vs. 23; P < .01, respectively).

Implications

The receipt of non-preferred antibiotic therapy among veterans with a recorded beta-lactam allergy may be associated with an increased risk of developing negative outcomes. Among military personnel, removing unnecessary beta-lactam allergies would improve readiness with optimal antibiotic choices and avoidance of unnecessary risks, expediting return to full duty.
Observing and modelling the young solar analogue EK Draconis: starspot distribution, elemental abundances, and evolutionary status
Authors: Şenavcı H V , Kılıçoğlu T , Işık E , Hussain G A J , Montes D , Bahar E , Solanki S K
Published: January 2021

Observations and modelling of stars with near-solar masses in their early phases of evolution are critical for a better understanding of how dynamos of solar-type stars evolve. We examine the chemical composition and the spot distribution of the pre-main-sequence solar analogue EK Dra. Using spectra from the HERMES Spectrograph (La Palma), we obtain the abundances of 23 elements with respect to the solar ones, which lead to a [Fe/H] = 0.03, with significant overabundance of Li and Ba. The s-process elements Sr, Y, and Ce are marginally overabundant, while Co, Ni, Cu, Zn are marginally deficient compared to solar abundances. The overabundance of Ba is most likely due to the assumption of depth-independent microturbulent velocity. Li abundance is consistent with the age and the other abundances may indicate distinct initial conditions of the pre-stellar nebula. We estimate a mass of 1.04 M⊙ and an age of $27^{+11}_{-8}$ Myr using various spectroscopic and photometric indicators. We study the surface distribution of dark spots, using 17 spectra collected during 15 nights using the CAFE Spectrograph (Calar Alto). We also conduct flux emergence and transport (FEAT) simulations for EK Dra’s parameters and produce 15-d-averaged synoptic maps of the likely starspot distributions. Using Doppler imaging, we reconstruct the surface brightness distributions for the observed spectra and FEAT simulations, which show overall agreement for polar and mid-latitude spots, while in the simulations there is a lack of low-latitude spots compared to the observed image. We find indications that cross-equatorial extensions of mid-latitude spots can be artefacts of the less visible southern-hemisphere activity.
Bayesian forward modelling of cosmic shear data
Authors: Porqueres Natalia , Heavens Alan , Mortlock Daniel , Lavaux Guilhem
Published: January 2021

We present a Bayesian hierarchical modelling approach to infer the cosmic matter density field, and the lensing and the matter power spectra, from cosmic shear data. This method uses a physical model of cosmic structure formation to infer physically plausible cosmic structures, which accounts for the non-Gaussian features of the gravitationally evolved matter distribution and light-cone effects. We test and validate our framework with realistic simulated shear data, demonstrating that the method recovers the unbiased matter distribution and the correct lensing and matter power spectrum. While the cosmology is fixed in this test, and the method employs a prior power spectrum, we demonstrate that the lensing results are sensitive to the true power spectrum when this differs from the prior. In this case, the density field samples are generated with a power spectrum that deviates from the prior, and the method recovers the true lensing power spectrum. The method also recovers the matter power spectrum across the sky, but as currently implemented, it cannot determine the radial power since isotropy is not imposed. In summary, our method provides physically plausible inference of the dark matter distribution from cosmic shear data, allowing us to extract information beyond the two-point statistics and exploiting the full information content of the cosmological fields.
Annihilating dark matter search with 12 yr of Fermi LAT data in nearby galaxy clusters
Authors: Thorpe-Morgan Charles , Malyshev Denys , Stegen Christoph-Alexander , Santangelo Andrea , Jochum Josef
Published: January 2021

Galaxy clusters are the largest virialized objects in the Universe and, as such, have high dark matter (DM) concentrations. This abundance of dark matter makes them promising targets for indirect DM searches. Here we report the details of a search, utilizing almost 12 yr of Fermi/LAT data, for gamma-ray signatures from the pair annihilation of WIMP dark matter in the GeV energy band. From this, we present the constraints on the annihilation cross-section for the $b\overline{b}$, W+W−, and γγ channels, derived from the non-detection of a characteristic signal from five nearby, high Galactic latitude, galaxy clusters (Centaurus, Coma, Virgo, Perseus, and Fornax). We discuss the potential of a boost to the signal due to the presence of substructures in the DM haloes of selected objects, as well as the impact of uncertainties in DM profiles on the presented results. We assert that the obtained limits are, within a small factor, comparable to the best available limits of those based on Fermi/LAT observations of dwarf spheroidal galaxies.
NuSTAR measurement of the cosmic X-ray background in the 3–20 keV energy band
Authors: Krivonos Roman , Wik Daniel , Grefenstette Brian , Madsen Kristin , Perez Kerstin , Rossland Steven , Sazonov Sergey , Zoglauer Andreas
Published: January 2021

We present measurements of the intensity of the cosmic X-ray background (CXB) with the Nuclear Spectroscopic Telescope Array (NuSTAR) telescope in the 3–20 keV energy range. Our method uses spatial modulation of the CXB signal on the NuSTAR detectors through the telescope’s side aperture. Based on the NuSTAR observations of selected extragalactic fields with a total exposure of 7 Ms, we have estimated the CXB 3–20 keV flux to be 2.8 × 10−11 erg s−1 cm−2 deg−2, which is $\sim \! 8{{\ \rm per\ cent}}$ higher than that measured with HEAO-1 and consistent with the INTEGRAL measurement. The inferred CXB spectral shape in the 3–20 keV energy band is consistent with the canonical model of Gruber et al. We demonstrate that the spatially modulated CXB signal measured by NuSTAR is not contaminated by systematic noise and is limited by photon statistics. The measured relative scatter of the CXB intensity between different sky directions is compatible with cosmic variance, which opens new possibilities for studying CXB anisotropy over the whole sky with NuSTAR.
Evidence of a population of dark subhaloes from Gaia and Pan-STARRS observations of the GD-1 stream
Authors: Banik Nilanjan , Bovy Jo , Bertone Gianfranco , Erkal Denis , de Boer T J L
Published: January 2021

New data from the Gaia satellite, when combined with accurate photometry from the Pan-STARRS survey, allow us to accurately estimate the properties of the GD-1 stream. Here, we analyse the stellar density variations in the GD-1 stream and show that they cannot be due to known baryonic structures such as giant molecular clouds, globular clusters, or the Milky Way’s bar or spiral arms. A joint analysis of the GD-1 and Pal 5 streams instead requires a population of dark substructures with masses ≈107–$10^9 \ \rm {M}_{\odot }$. We infer a total abundance of dark subhaloes normalized to standard cold dark matter $n_{\rm sub}/n_{\rm sub, CDM} = 0.4 ^{+0.3}_{-0.2}$ (68 per cent), which corresponds to a mass fraction contained in the subhaloes $f_{\rm {sub}} = 0.14 ^{+0.11}_{-0.07} {{\ \rm per\ cent}}$, compatible with the predictions of hydrodynamical simulation of cold dark matter with baryons.
Differences in Syphilis Incidence Using a Laboratory Algorithm in People With and Without HIV in an 11-Year Nationwide Cohort Study
Authors: Maier Marissa M , Gylys-Colwell Ina , Lowy Elliott , Borgerding Joleen , Van Epps Puja , Ohl Michael , Hauser Ronald G , Chartier Maggie , Beste Lauren
Published: January 2021

Background

To measure the incidence of syphilis diagnoses among people with HIV vs those without HIV in a national multiyear retrospective cohort.

Methods

Treponemal and nontreponemal tests, HIV status, and demographic data were identified among all individuals receiving Veterans Health Administration (VHA) care between January 1, 2009, and December 31, 2019. Syphilis testing rates and incident syphilis diagnoses as defined by a laboratory algorithm were stratified by HIV status.

Results

Syphilis was diagnosed in 1.2% (n = 2283) of 194 322 tested individuals in VHA care in 2019. Among individuals with HIV tested for syphilis, 6.1% met criteria for syphilis compared with 0.7% without HIV. Syphilis incidence in 2019 was 35/100 000, a 17% increase from 2009 (30/100 000). In 2019, syphilis incidence was 3381 per 100 000 persons among individuals with HIV and 19 per 100 000 in those without HIV.

Conclusions

Using a laboratory-based diagnostic algorithm, a 178-fold difference in syphilis incidence was observed between individuals with and without HIV in 2019. US syphilis incidence data that incorporate HIV status are needed. Interventions to monitor and prevent sexually transmitted infections should address the role of HIV status.
Tetraventricular Hydrocephalus Following Eosinophilic Meningitis due to Angiostrongylus cantonensis in a 14-Month-Old Boy From Mayotte: A Case Report
Authors: Cattaneo Chiara , Hoarau Marion , Valois Sophie , Chamouine Abdourahim , Dembele Yacouba , Collet Luis , Sarton Raphaëlle
Published: January 2021

Angiostrongylus cantonensis is endemic in Mayotte, and cases of meningitis due to angiostrongyliasis are regularly diagnosed in young children. In a 14-month-old boy with slow-onset psychomotor regression, brain magnetic resonance imaging revealed communicating hydrocephalus. Reverse transcription polymerase chain reaction for A. cantonensis on cerebrospinal fluid was positive. The evolution was favorable with repeated lumbar punctures and a 2-week treatment with albendazole and high-dose corticosteroids.
Combined Transradial and Transfemoral Approach Using a Compliant Balloon for Emboli Protection at the Vertebral Artery During Subclavian Stenosis Stenting: 2-Dimensional Operative Video
Authors: Mendez Aldo A , Mendez-Ruiz Alan , Fakih Rami , Farooqui Mudassir , Dandapat Sudeepta , Ortega-Gutierrez Santiago
Published: January 2021

Endovascular intervention has become the mainstay of treatment for subclavian artery stenosis in many centers, with high technical success and low complication rates.
1

,

2
However, potential embolization during proximal subclavian artery intervention can lead to catastrophic posterior circulation ischemic complications.3–5
-

5
Although considered a rare complication, the presence of a contralateral hypoplastic vertebral artery with persisting anterograde vertebral blood flow on the affected side is likely to increase the risk of embolization.
3
The use of embolic protection devices, such as filters and noncompliant balloons, has been previously described.
3

,

6

,

7
However, there is still a risk of distal embolization and vessel injury with the use of these devices.
7
We present a technical video of a patient in their 80s with left subclavian stenosis who underwent subclavian stent-assisted percutaneous transluminal angioplasty (SAPTA) using an anterograde-retrograde access technique with a dual-lumen compliant balloon catheter (Scepter XC; MicroVention, Aliso Viejo, California) placed at the proximal segment of the left vertebral artery. With this approach, the compliant balloon provides adequate protection while minimizing the risk of endothelial injury and distal embolization.

Written informed consent was obtained for the procedure. Patient consent was waived because all health information was deidentified.
Manual Therapy in Preadolescent Children: A Delphi Investigation of Physical Therapists in the United States
Authors: Dice Jenifer L , Dendy Doug , Sizer Phillip S , Cook Chad E , Feuling Sara , Brismée Jean-Michel
Published: January 2021

Objective

Limited research has investigated the use of manual therapy to treat the preadolescent (0–12 years of age) population with musculoskeletal and neurological impairments. The purpose of this study was to identify the following among physical therapists holding advanced credentials in pediatrics, neurodevelopmental treatment, or manual therapy: (1) consensus regarding effective techniques in the preadolescent population, (2) differences in opinion, and (3) perceived decision-making barriers and factors regarding use of manual therapy techniques.

Methods

Credentialed physical therapists in the United States were recruited for a 3-round Delphi investigation. An electronic survey in Round 1 identified musculoskeletal and neurological impairments and the manual techniques considered effective to treat such conditions, in addition to factors and barriers. Responses were used to create the second round, during which a 4-point Likert scale was used to score each survey item. A third round of scoring established consensus. Descriptive statistics and composite scores were calculated for each manual technique by impairment. Between-group differences were calculated using the Mann-Whitney U test with Bonferroni correction.

Results

Consensus was determined for several concepts. First, neuromuscular techniques were considered effective across all impairments, and joint mobilizations (grades I–IV) were believed to be effective to treat joint and muscle and myofascial impairments. Second, visceral manipulation and craniosacral therapy were considered ineffective in treating most impairments. There was lack of consensus and clear differences of opinion regarding the use of grade V mobilizations and dry needling. Significant barriers to use of manual therapy were: lack of knowledge, lack of evidence, and fear of litigation and harming patients.

Conclusion

This study is an initial step for developing manual therapy guidelines, research, and educational opportunities regarding manual therapy in pediatric physical therapy.
Towards Evaluating the Research Impact made by Universities of Applied Sciences
Authors: Coombs Sarah K , Meijer Ingeborg
Published: January 2021

Given the mandate of Universities of Applied Sciences (UASs) to create an impact on society, the evaluation of their research impact is of great importance. And yet, the methodology for evaluating this impact appear less explicitly in research literature then other forms of research. The purpose of this article is to present a literature-based analysis to discover from the complex world of existing theories and frameworks what criteria, assumptions and requirements are relevant for evaluating the impact of applied research. This article will also discuss the relevancy of frameworks currently used for research impact evaluation and the potential they have for operationalising, enriching and supporting the current national evaluation framework used by Dutch UASs. Finally, this article will conclude that the recommendations necessitate the creation of a new framework where the context and process of practice-based research and their stakeholders are included.
Exports vs. investment: How political discourse shapes popular support for external imbalances
Authors: Ferrara Federico Maria , Stefan Haas Jörg , Peterson Andrew , Sattler Thomas
Published: January 2021

The economic imbalances that characterize the world economy have unequally distributed costs and benefits. That raises the question of how countries could run long-term external surpluses and deficits without significant opposition against the policies that generate them. We show that political discourse helps to secure public support for these policies and the resulting economic outcomes. First, a content analysis of 32 000 newspaper articles finds that the dominant interpretations of current account balances in Australia and Germany concur with very distinct perspectives: external surpluses are seen as evidence of competitiveness in Germany, while external deficits are interpreted as evidence of attractiveness for investments in Australia. Second, survey experiments in both countries suggest that exposure to these diverging interpretations has a causal effect on citizens’ support for their country’s economic strategy. Political discourse, thus, is crucial to provide the societal foundation of national growth strategies.
Not Seeing Like a State: Mandated Reporting, State-Adjacent Actors and the Production of Illegible Subjects
Authors: Greenberg Max A
Published: January 2021

Previous scholarship has described how the state “sees” subjects and is itself seen, but has not adequately considered the unfolding interactional dynamics through which subjects become legible or not. This article devises an analytical approach to the micro-dynamics of legibility. Drawing on ethnographic and interview data from violence prevention programs in Los Angeles high schools, the author examines the street-level enactment of third-party mandated reporting, which tasks state-adjacent actors with reporting when a student discloses harm. While the delegation of reporting broadens the state’s horizon of visibility, it also disrupts taken for granted mechanisms of state legibility and perception. This study maps a sequence of micro-level dynamics through which illegible subjects are produced. First, third-party mandated reporters distanced themselves from the visible marks of the state in interactions with young people and presented themselves using markers of interpersonal connection. Second, students applied pre-existing situational definitions of interactions with non-state adults, opening up space for accounts of harm to emerge. Finally, facilitators produced illegibility as they discouraged young people from engagement with the state and trained them in interactional strategies of vagueness and de-personalization to make their harm illegible to policy mechanisms.
Application of Bayesian networks to the prediction of the AMEn: a new methodology in broiler nutrition
Authors: Alvarenga Tatiane C , Lima Renato R , Bueno Filho Júlio S S , Simão Sérgio D , Mariano Flávia C Q , Alvarenga Renata R , Rodrigues Paulo B
Published: January 2021

Designing balanced rations for broilers depends on precise knowledge of nitrogen-corrected apparent metabolizable energy (AMEn) and the chemical composition of the feedstuffs. The equations that include the measurements of the chemical composition of the feedstuff can be used in the prediction of AMEn. In the literature, there are studies that obtained prediction equations through multiple regression, meta-analysis, and neural networks. However, other statistical methodologies with promising potential can be used to obtain better predictions of energy values. The objective of the present study was to propose and evaluate the use of Bayesian networks (BN) to the prediction of the AMEn values of energy and protein feedstuffs of vegetable origin used in the formulation of broiler rations. In addition, verify that the predictions of energy values using this methodology are the most accurate and, consequently, are recommended to Animal Science professionals area for the preparation of balanced feeds. BN are models that consist of graphical and probabilistic representations of conditional and joint distributions of the random variables. BN uses machine learning algorithms, being a methodology of artificial intelligence. The bnlearn package in R software was used to predict AMEn from the following covariates: crude protein, crude fiber, ethereal extract, mineral matter, as well as food category, i.e., energy (corn, corn by-products, and others) or protein (soybean, soy by-products, and others) and the type of animal (chick or cockerel). The data come from 568 feeding experiments carried out in Brazil. Additional data from metabolic experiments were obtained from the Federal University of Lavras (UFLA) – Lavras, Minas Gerais, Brazil. The model with the highest accuracy (mean squared error = 66529.8 and multiple coefficients of determination = 0.87) was fitted with the max-min hill climbing algorithm (MMHC) using 80% and 20% of the data for training and test sets, respectively. The accuracy of the models was evaluated based on their values of mean squared error, mean absolute deviation, and mean absolute percentage error. The equations proposed by a new methodology in avian nutrition can be used by the broiler industry in the determination of rations.
Physical activity and healthy eating behavior changes among rural women: an exploratory mediation analysis of a randomized multilevel intervention trial
Authors: Lo Brian K , Graham Meredith L , Folta Sara C , Strogatz David , Parry Stephen A , Seguin-Fowler Rebecca A
Published: January 2021

Rural women experience disproportionately higher levels of obesity in comparison to their non-rural counterparts. The present exploratory mediation analysis sought to identify mechanisms that might have contributed to rural women’s physical activity and diet changes after participating in a 6-month multilevel community-randomized trial: Strong Hearts, Healthy Communities (SHHC). SHHC was conducted in 16 rural towns in Montana and New York, between 2015 and 2016; 194 overweight, sedentary midlife, and older women (mean age 59; 26.8% overweight; 73.2% obese) participated. Participants in eight towns received the SHHC intervention (n = 101), which focused on healthy behavior change at the individual level as well as creating supportive social and built environments for physical activity and healthy eating. Participants in the other eight towns received an education-only control intervention (n = 93). We investigated the direct and indirect effects of the SHHC intervention through changes to self-efficacy, social support, and built environment perception, on changes in participants’ physical activity and diet. Compared to the controls, SHHC intervention participants increased their social support from friends for physical activity (p = 0.009) and healthy eating (p = 0.032). Participants’ improved social support from friends marginally mediated the intervention effects for walking metabolic equivalent minutes per week, explaining 40.5% of the total effect (indirect effect = +45.24, 95% CI: –1.51, +91.99; p = 0.059). Increasing social support from friends appears to be helpful in encouraging rural women to become more active. Further investigations are needed to better understand how multilevel interventions work in rural communities.
Genetic or Toxicant-Induced Disruption of Vesicular Monoamine Storage and Global Metabolic Profiling inCaenorhabditis elegans
Authors: Bradner Joshua M , Kalia Vrinda , Lau Fion K , Sharma Monica , Bucher Meghan L , Johnson Michelle , Chen Merry , Walker Douglas I , Jones Dean P , Miller Gary W
Published: January 2021

The proper storage and release of monoamines contributes to a wide range of neuronal activity. Here, we examine the effects of altered vesicular monoamine transport in the nematode Caenorhabditis elegans. The gene cat-1 is responsible for the encoding of the vesicular monoamine transporter (VMAT) in C. elegans and is analogous to the mammalian vesicular monoamine transporter 2 (VMAT2). Our laboratory has previously shown that reduced VMAT2 activity confers vulnerability on catecholamine neurons in mice. The purpose of this article was to determine whether this function is conserved and to determine the impact of reduced VMAT activity in C. elegans. Here we show that deletion of cat-1/VMAT increases sensitivity to the neurotoxicant 1-methyl-4-phenylpyridinium (MPP+) as measured by enhanced degeneration of dopamine neurons. Reduced cat-1/VMAT also induces changes in dopamine-mediated behaviors. High-resolution mass spectrometry-based metabolomics in the whole organism reveals changes in amino acid metabolism, including tyrosine metabolism in the cat-1/VMAT mutants. Treatment with MPP+ disrupted tryptophan metabolism. Both conditions altered glycerophospholipid metabolism, suggesting a convergent pathway of neuronal dysfunction. Our results demonstrate the evolutionarily conserved nature of monoamine function in C. elegans and further suggest that high-resolution mass spectrometry-based metabolomics can be used in this model to study environmental and genetic contributors to complex human disease.
Treatment of Subarachnoid Hemorrhage-associated Delayed Cerebral Ischemia With Milrinone: A Review and Proposal
Authors: Bernier Thomas D. , Schontz Michael J. , Izzy Saef , Chung David Y. , Nelson Sarah E. , Leslie-Mazwi Thabele M. , Henderson Galen V. , Dasenbrock Hormuzdiyar , Patel Nirav , Aziz-Sultan Mohammad A. , Feske Steven , Du Rose , Abulhasan Yasser B. , Angle Mark R.
Published: January 2021

Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage continues to be associated with high levels of morbidity and mortality. This complication had long been thought to occur secondary to severe cerebral vasospasm, but expert opinion now favors a multifactorial etiology, opening the possibility of new therapies. To date, no definitive treatment option for DCI has been recommended as standard of care, highlighting a need for further research into potential therapies. Milrinone has been identified as a promising therapeutic agent for DCI, possessing a mechanism of action for the reversal of cerebral vasospasm as well as potentially anti-inflammatory effects to treat the underlying etiology of DCI. Intra-arterial and intravenous administration of milrinone has been evaluated for the treatment of DCI in single-center case series and cohorts and appears safe and associated with improved clinical outcomes. Recent results have also brought attention to the potential outcome benefits of early, more aggressive dosing and titration of milrinone. Limitations exist within the available data, however, and questions remain about the generalizability of results across a broader spectrum of patients suffering from DCI. The development of a standardized protocol for milrinone use in DCI, specifically addressing areas requiring further clarification, is needed. Data generated from a standardized protocol may provide the impetus for a multicenter, randomized control trial. We review the current literature on milrinone for the treatment of DCI and propose a preliminary standardized protocol for further evaluation of both safety and efficacy of milrinone.
The Use of Clinically Measurable Cochlear Parameters in Cochlear Implant Surgery as Indicators for Size, Shape, and Orientation of the Scala Tympani
Authors: Schurzig Daniel , Timm Max E. , Majdani Omid , Lenarz Thomas , Rau Thomas S.
Published: January 2021

Objectives:

(1) To assess variations of the human intracochlear anatomy and quantify factors which might be relevant for cochlear implantation (CI) regarding surgical technique and electrode design. (2) Search for correlations of these factors with clinically assessable measurements.

Design:

Human temporal bone study with micro computed tomography (μCT) data and analysis of intracochlear geometrical variations: μCT data of 15 fresh human temporal bones was generated, and the intracochlear lumina scala tympani (ST) and scala vestibuli were manually segmented using custom software specifically designed for accurate cochlear segmentation. The corresponding datasets were processed yielding 15 detailed, three-dimensional cochlear models which were investigated in terms of the scalae height, cross-sectional size, and rotation as well as the interrelation of these factors and correlations to others.

Results:

The greatest anatomical variability was observed within the round window region of the cochlea (basal 45°), especially regarding the cross-sectional size of the ST and its orientation relative to the scala vestibuli, which were found to be correlated (p < 0.001). The cross-sectional height of the ST changes substantially for both increasing cochlear angles and lateral wall distances. Even small cochleae were found to contain enough space for all commercially available CI arrays. Significant correlations of individual intracochlear parameters to clinically assessable ones were found despite the small sample size.

Conclusion:

While there is generally enough space within the ST for CI, strong intracochlear anatomical variations could be observed highlighting the relevance of both soft surgical technique as well as a highly flexible and self-adapting cochlear implant electrode array design. Cochlear dimensions (especially at the round window) could potentially be used to indicate surgically challenging anatomies.
Notoginsenoside R1 attenuates breast cancer progression by targeting CCND2 and YBX3
Authors: Qin Hai-Long , Wang Xue-Jun , Yang Bi-Xian , Du Bin , Yun Xue-Lin
Published: January 2021

Background:

Breast cancer (BC) is a common malignancy with highly female incidence. So far the function of notoginsenoside R1 (NGR1), the extract from Panax notoginseng, has not been clearly elucidated in BC.

Methods:

Optimal culture concentration and time of NGR1 were investigated by cell counting kit-8 assay. Cell proliferation ability was measured by colony formation assays. Transwell assay was used to detect the effect of NGR1 on cell migration and invasion. The apoptosis rate of cells between each group was measured by TUNEL assay.

Results:

NGR1 treatment has an inhibitory effect on proliferation, migration, invasion, and angiogenesis and a stimulating effect on cell cycle arrest and apoptosis of Michigan Cancer Foundation-7 (MCF-7) cells. The 50% growth inhibitory concentration for MCF-7 cells at 24 h was 148.9 mmol/L. The proportions of MCF-7 cells arrested in the G0/G1 phase were 36.94±6.78%, 45.06±5.60%, and 59.46±5.60% in the control group, 75, and 150 mmol/L groups, respectively. Furthermore, we revealed that NGR1 treatment attenuates BC progression by targeted downregulating CCND2 and YBX3 genes. Additionally, YBX3 activates phosphatidylinositol 3-phosphate kinase (PI3K)/protein kinase B (Akt) signaling pathway by activating kirsten rat sarcoma viral oncogene, which is an activator of the PI3K/Akt signaling pathway.

Conclusion:

These results suggest that NGR1 can act as an efficacious drug candidate that targets the YBX3/PI3K/Akt axis in patients with BC.
Intraoperative Invasive Blood Pressure Monitoring in Flap-Based Breast Reconstruction: Does It Change Outcomes?
Authors: Dekker Paige K. , Noe Niki , Bekeny Jenna C. , Lavin Christopher , Zolper Elizabeth G. , Song David H. , Fan Kenneth L.
Published: January 2021

Background:

Despite the lack of guidelines regarding the use of intra-arterial lines in postmastectomy breast reconstruction (PMBR), they continue to be used in this setting. In this study of patients undergoing PMBR, we aimed to (1) identify factors associated with intra-arterial line placement, (2) analyze the correlation between intra-arterial monitoring and noninvasive blood pressure (NIBP) monitoring, and (3) investigate whether hemodynamic management differs significantly between patients undergoing intra-arterial blood pressure monitoring versus NIBP.

Methods:

All patients undergoing flap-based PMBR between 2017 and 2019 were retrospectively reviewed. Patients were pair-matched based on flap donor site, BMI, and age to identify factors associated with intra-arterial line placement. Methods described by Bland and Altman
1
were utilized to determine agreement between intra-arterial line measurements and NIBP.

Results:

Thirty-two patients were included with 16 patients in the intra-arterial line group and 16 in the NIBP group. None of the factors studied were significantly related to the likelihood of intra-arterial line placement. Agreement analysis demonstrated that mean arterial pressures calculated from intra-arterial line readings were as much as 23 points lower or 12 points higher than those from NIBP. Bias calculations with this extent of difference suggest poor correlation between intra-arterial line readings and NIBP. There was no difference between groups in rate of administration of blood-pressure altering medications (hypertensive: n = 3, 18.8%, P = 1.000; hypotensive: n = 7, 3.8%, P = 1.000).

Conclusion:

Our findings highlight the need for more definitive guidance regarding the use of intra-arterial monitoring in patients undergoing PMBR.
The Cost of Applying to Integrated Plastic Surgery Residency
Authors: Sarac Benjamin A. , Rangwani Shiva M. , Schoenbrunner Anna R. , Drolet Brian C. , Janis Jeffrey E.
Published: January 2021

Background:

Integrated plastic surgery remains one of the most competitive specialties within the National Resident Matching Program. Although the burden of applying to surgical residencies has been studied, the literature lacks data specific to integrated plastic surgery applicants. This study reports the current total cost, along with the outcomes of applying to and interviewing for integrated plastic surgery residency.

Methods:

A survey was sent to applicants in the 2018–2020 integrated plastic surgery application cycles. Survey questions focused on applicant demographics and home medical school characteristics, application processes, interview attendance, interview cost, and applicant financing. Comparative and regression analyses were performed on survey responses.

Results:

The survey was distributed to 493 applicants. An estimated 245 (49.7%) applicants responded. On average, applicants applied to 68.3 ± 16.4 (mean ± SD) programs, received 17.6 ± 11.4 interview invites, and attended 12.6 ± 5.7 of the interviews they received. On average, each applicant spent a total of $6690 ± $4045 during the interview season, with individual interviews costing $531. Residency programs providing financial assistance supplemented $73 ± $64 per interviewee, corresponding to 13.7% of per-interview cost. To cover costs, 33.8% of applicants sought additional funding, and 30.7% of applicants stated that they had supplemental income, with an average monthly supplemental income of $1971 ± $1558.

Conclusions:

This study quantifies the recent total and per-interview cost of applying to integrated plastic surgery residency. It also identifies the importance of cost to applicants and how the cost burden of residency applications is supported.
Four Lessons Learned from Complications in Head and Neck Microvascular Reconstructions and Prevention Strategies
Authors: Vieira Luís , Isacson Daniel , Dimovska Eleonora O. F. , Rodriguez-Lorenzo Andres
Published: January 2021

Background:

Free flap reconstruction in the head and neck region is a complex field in which patient comorbidities, radiation therapy, tumor recurrence, and variability of clinical scenarios make some cases particularly challenging and prone to devastating complications. Despite low free flap failure rates, the impact of flap failure has enormous consequences for the patients.

Methods:

Acknowledging and predicting high risk intra- and postoperative situations and having planned strategies on how to deal with them can decrease their rate and improve the patient’s reconstructive journey.

Results:

Herein, the authors present 4 examples of significant complications in complex microvascular head and neck cancer reconstruction, encountered for the last 10 years: compression and kinking of the vascular pedicle, lack of planning of external skin coverage in osteoradionecrosis, management of the vessel-depleted neck, and vascular donor site morbidity after fibula harvest.

Conclusion:

The authors reflect on the causes and propose preventative strategies in each peri-operative stage.
Neosagittal Suture Formation after Endoscopic Sagittal Strip Craniectomy: A Case Report and Literature Review
Authors: Rochlin Danielle H. , Mittermiller Paul A. , Menard Robert M.
Published: January 2021

The fate of the excised synostotic suture in craniosynostosis remains relatively understudied. The purpose of this report is to describe a case of neosagittal suture formation following endoscopic excision of a pathology-proven synostotic suture, with CT demonstration of complete reossification in the areas adjacent to the neosagittal suture. We additionally review the existing literature on neosuture formation that has been published over the past 50 years. We conclude that continued investigation is warranted, both through histological comparison of normal and neosutures and through studies to determine clinical risk factors, as this may improve our understanding of the underlying mechanism of pathologic premature suture fusion in craniosynostosis.
Evaluating CNVII Recovery after Reconstruction with Vascularized Nerve Grafts: A Retrospective Case Series
Authors: Hatchell Alexandra C. , Chandarana Shamir P. , Matthews Jennifer L. , McKenzie C. David , Matthews T. Wayne , Hart Robert D. , Dort Joseph C. , Schrag Christiaan H. , Harrop A. Robertson
Published: January 2021

Few studies have evaluated vascularized nerve grafts (VNGs) for facial nerve (CNVII) reconstruction. We sought to evaluate long-term outcomes for CNVII recovery following reconstruction with VNGs. A retrospective review of all patients at a tertiary centre who underwent radical parotidectomy and immediate CNVII reconstruction with VNGs was performed (January 2009–December 2019). Preoperative demographics, perioperative factors (flap type, source of VNGs), and postoperative factors [complications, adjuvant therapy, revisionary procedures, length of follow-up, and CNVII function via the House-Brackmann scale (HB)] were collected. Data were summarized qualitatively. Twelve patients (Mage= 53 ± 18 years) with a mean follow-up of 33 (± 23) months were included. Six patients underwent reconstruction with a radial forearm flap and dorsal sensory branches of the radial nerve. Six patients underwent reconstruction with an anterolateral thigh flap and only deep motor branches of the femoral nerve to the vastus lateralis (n = 4) or combined with the lateral femoral cutaneous nerve (n = 2). Two patients regained nearly normal function (HB = 2). Eight patients regained at least resting symmetry (HB = 3 for n = 7; HB = 4 for n = 1). One patient regained a flicker of movement (HB = 5). One patient did not regain function (HB = 6). Six patients had static revision procedures to improve symmetry. Five patients had disease recurrence; 3 died from their disease. VNGs offer a practical and viable addition to the CNVII reconstruction strategy, and result in good functional recovery with acceptable donor site deficits. The associated adipofascial component of these flaps can also augment the soft tissue defect left after tumor ablation.
LABORATORY EVALUATION OF INTRAOCULAR SILICONE OIL REMOVED AFTER 23 YEARS IN SITU
Authors: Liu Yingna , Canbolat Özgü , Bever Greg J. , Stewart Jay M.
Published: January 2021

Purpose:

To report the clinicopathologic correlation and biochemical analysis of silicone oil removed after 23 years in an eye.

Methods:

A 63-years-old man with a history of HIV/AIDS and cytomegalovirus retinitis, status post retinal detachment repair with silicone oil at the age of 39 years, presented with several weeks of worse vision. He was found to have a shallow fovea-off tractional retinal detachment. After the silicone oil was removed during retinal detachment repair, it was analyzed by Fourier-transform infrared spectroscopy and gas chromatography with mass spectrometry.

Results:

In addition to cyclic and linear silicone oil, cholesterol was found in the removed silicone oil, which was not present in unused silicone oil samples. No other chemical alterations were identified in the extracted silicone oil.

Conclusion:

Silicone oil left inside an eye over an extended period may extract lipophilic substances from adjacent tissue, with possible pathophysiologic effects. However, no other major potentially toxic substance was identified from the long-standing silicone oil sample, suggesting relative chemical stability of the tamponade agent over time.
The Reliability of Successive Scheimpflug Imaging and Anterior Segment Optical Coherence Tomography Measurements Decreases With Increasing Keratoconus Severity
Authors: Flockerzi Elias , Elzer Berit , Daas Loay , Xanthopoulou Kassandra , Eppig Timo , Langenbucher Achim , Seitz Berthold
Published: January 2021

Purpose:

This study assesses the reliability of successive measurements of tomographic parameters in different keratoconus (KC) stages with 2 different devices.

Methods:

A total of 125 eyes (13 controls: 24 eyes, and 73 patients with KC: stages 1|2|3|4, n = 24|24|26|27 according to Topographical KC Classification) were repeatedly examined 5 times with the rotating Scheimpflug tomograph (Pentacam HR, Oculus, Wetzlar, Germany) and an anterior segment optical coherence tomograph (Casia 2, Tomey, Nagoya, Japan). Outcome measures included 1) mean anterior (KA) and 2) mean posterior powers (KP), 3) mean anterior (AC) and 4) posterior cylinders (PC), 5) maximal anterior power (Kmax), and 6) thinnest corneal thickness (TCT). The results were compared using the Wilcoxon matched pairs test considering P values <0.05 as statistically significant. Standard deviations (SDs) of repeated measurements with both devices were compared between and within the KC stages.

Results:

The Pentacam values for PC, Kmax, and TCT were significantly elevated compared with those of the anterior segment optical coherence tomograph (P < 0.0001). The SDs of successive measurements of KA and KP, AC and posterior cylinders, Kmax, and TCT increased from (Casia 2|Pentacam) 0.10|0.09 diopter (D), 0.01|0.02 D, 0.15|0.08 D, 0.02|0.05 D, 0.17|0.18 D, and 0.92|5.25 μm in controls to 0.47|0.66 D, 0.1|0.2 D, 0.86|0.9 D, 0.17|0.3 D, 0.89|1.65 D, and 7.68|15 μm in TKC4. Significant differences occurred between the 2 devices for eyes within the same KC stage.

Conclusions:

The reproducibility of measurements decreases with increasing KC severity in both devices. Although both devices seem reliable, the interdevice differences regarding measured tomographic parameters lead to the conclusion that Pentacam HR and Casia 2 measurements are not interchangeable in neither healthy nor KC corneas.