bluuebunny/crossref_metadata_2025 huggingface dataset:
P628 Risk Factors Associated with Extraintestinal Manifestations in Patients with Inflammatory Bowel Diseases
Authors: Liava C , Sinakos E , Dimitroulas T , Navrozidou C , Akriviadis E
Published: May 2021

Background

Risk factors associated with extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) have been evaluated mainly in retrospective studies. We aimed to determine risk factors associated with EIMs and to compare the frequency of EIMs between ulcerative colitis (UC) and Crohn’s disease (CD), based on retrospectively-prospectively collected data of a cohort of IBD patients followed in daily clinical practice.

Methods

Patients with biopsy-confirmed IBD aged 10–80 years old were included in the study. A comprehensive questionnaire was used to collect data on each site visit from July 2018 until March 2020. Logistic regression analysis and multivariable-adjusted models were used to examine risk factors associated with EIMs and chi-squared test was used to compare the frequency of EIMs between patients with UC and CD.

Results

300 patients with IBD (180 with CD, 113 with UC, and 7 with indeterminate colitis) were evaluated. EIMs were observed in 49% of patients, with a 2-fold increased risk in CD (OR 2.31; 95% CI:1.37–3.89; P<.005). The musculoskeletal system was affected in 38% (43% in CD vs 29% in UC, OR 1.86; 95% CI:1.08–3.20; P<.05) with peripheral arthropathy being the most common manifestation (33% in CD vs 23% in UC, P=.095), followed by dermatological manifestations (13%), with a 4-fold increased risk of erythema nodosum in CD (11% vs 3% in UC, OR 3.95; 95% CI:1.12–13.93; P<.05). On univariate logistic regression analysis history of hospitalization for IBD, history of surgery for IBD, aphthous stomatitis, perianal disease, thyroiditis Hashimoto, age, use of thiopurines, and/or anti-TNF in the past were associated with increased risk of developing EIMs. A trend for increased risk of EIMs was found for family history of IBD in first-degree relatives (OR 2.47; 95% CI:0.91–6.74; P=.078) and fecal calprotectin above 250 μg/g (OR 2.22; 95% CI:0.90–5.47; P<.084). On multivariate analysis only aphthous stomatitis (OR 4.60; 95% CI:2.32–9.13; P<.001), perianal disease (OR 2.30; 95% CI:1.17–4.50; P<.05), thyroiditis Hashimoto (OR 2.82; 95% CI:1.03–7.74; P<.05) and age (2% increase in risk per year, OR 1.02; 95% CI:1.01–1.03; P<.05) were significant for EIMs.

Conclusion

In this retrospective/prospective study 49% of IBD patients developed EIMs with a 2-fold increased risk in CD. Musculoskeletal and dermatological manifestations were the most frequent EIMs. Aphthous stomatitis, perianal disease, thyroiditis Hashimoto and age were associated with increased risk of EIMs.
P633 Clinical epidemiology of Inflammatory Bowel Disease in Lbanon
Authors: Abou Rached A , Saba J , Yared F , Saniour J , Abou Khalil M , Al Bacha R , Khalil P , Bou Jaoude J
Published: May 2021

Background

The worldwide epidemiology of Inflammatory Bowel Disease (IBD) is changing. Increasing Crohn’s disease (CD) and Ulcerative Colitis (UC) incidence and prevalence have been recorded. In Lebanon, the current status of IBD is not well known.

Methods

The aim is to report patients’ characteristics newly diagnosed with IBD in Lebanon based on Montreal classification and to report the prevalence and the incidence of IBD in the Lebanese population during a period of 20 years. This is a retrospective study conducted in collaboration with the National Institute of Pathology, from January 2001 till December 2020 were reviewed. Patients were characterized based on: sex, age at diagnosis, year of diagnosis, location and extension of the disease.

Results

A total of 3101 new IBD cases were identified (1504 UC, 1597 CD), mean age for UC and CD was 41.05 years and 36.5 years, respectively. sex ratio (M/F) of 1.15 and 1.29 in UC and CD, respectively.

In UC, the 3 age groups distribution, ≤ 16 years, 17–40 years and > 40 years were 5.72%, 47.83% and 40.45%, respectively. Regarding the location distribution, E3 was the most prevalent (55.6%), followed by E1 (24.6%) and E2 (19.8%); with no difference between male and female. Similar pattern of location distribution was noted in the 3 age groups. There was no difference in age of diagnosis but a significant increase of E3 from 40% (2001–2010) to 60% (2011–2020) was noted.

In CD, 5.54%, 58.93% and 35.53% of patients were aged ≤ 16 years, 17–40 years and > 40 years, respectively. L1, L2, L3 and L4 represented 57.8%, 16.72%, 23.42% and 1.88% of the location distribution, respectively; without difference between male and female. L1 is significantly higher in the young age groups (≤ 16 years: 68.75% and 17–40 years: 67.72%) compared to the older age group (> 40 years: 39.06%) whereas L2 and L3 were higher in the older age group. When divided into two 10-year periods, there was a significant increase of L1 (63%) in the last 10 years (2010–2020) compared to the 10 years before (40%) and an increase of the disease incidence in the age group 17–40 years.

Based on all these data, we calculated the incidence of UC and CD and their progression during this period of 20 years. We noted a progressive increase of the incidence of IBD, especially for CD in the last 3 years. The cumulative incidence of UC and CD were 4.686 and 4.582, respectively. The prevalence of UC and CD were 69.9 par 100000 and 68.35 per 100000, respectively.

Conclusion

The mean age of IBD in Lebanon is higher than that described in Europe and North America. Pancolitis in UC and ileal involvement in CD remain the most common forms found. There was an increase of the incidence of IBD during the last 20 years and especially of CD during the last 3 years
Long-term changes of plumage between urban and rural populations of white-crowned sparrows (Zonotrichia leucophrys)
Authors: Smith Shawn H , Hessong-Brown Jesi , Lipshutz Sara E , Phillips Jennifer N , Rochefort Catherine , Derryberry Elizabeth P , Luther David A
Published: May 2021

Urbanization is one of the most extreme forms of land transformation and results in changes to ecosystems and species compositions. As a result, there are strong directional selection pressures compared to nearby rural areas. Despite a surge in research on the different selection pressures on acoustic communication in urban and rural areas, there has been comparatively little investigation into traits involved with visual communication. We measured the plumage of museum specimens of white-crowned sparrows (Zonotrichia leucophrys) from urban and adjacent rural habitats in San Francisco, CA, to assess the effects of divergent habitats on plumage. We found significant differences in dorsal plumage, but not crown plumage, between urban and rural populations that have been diverging over the past 100 years. Urban birds have increasingly darker and duller dorsal plumage, whereas rural birds in adjacent areas have plumage with richer hues and more color complexity. Our findings suggest a newly observed adaptation to urban environments by native species and suggest that many traits, in addition to acoustic signals, may be changing in response to urban selection pressures. Additional collections in urban areas are needed to explore likely divergences in plumage coloration between urban and rural environments.
Incidence, Geographical Distribution, and Genetic Diversity of Sugarcane Striate Virus in Saccharum Species in China
Authors: Lin Yinfu , Ali Niyaz , Hajimorad M. R. , Zhang Lijuan , Qi Xiaohang , Zhou Longwu , Wen Ronghui , Chen Baoshan
Published: May 2021

A novel virus of the genus Mastrevirus, family Geminivirdae, has been reported in sugarcane germplasm collections in Florida, Guadeloupe, and Réunion, and was named sugarcane striate virus (SStrV). Although the full-length sequence of an SStrV isolate from China was obtained in 2015, the incidence, geographical distribution, and genetic diversity of this virus remained unclear. A single leaf sample from 2,368 sugarcane plants from main sugarcane-producing regions of China and germplasm collections were tested for SStrV by PCR. Average virus incidence was 25.1% for field-collected samples, and SStrV was detected in most Saccharum species and two sugarcane-related species, with the highest incidence in Saccharum officinarum (44.1%) followed by Saccharum spp. local varieties (33.3%) grown for chewing cane for a long time. The virus incidence was much lower (6.8%) in modern commercial cultivars (Saccharum spp. hybrids). Phylogenetic trees based on full-length genomes of 157 SStrV isolates revealed that Chinese isolates comprised strains A and B, but not C and D, that were reported in Florida, U.S.A. SStrV strain A was the most prominent (98.7%) and widespread strain in China and was further divided into eight subgroups. Almost half (45.6%) of the SStrV-positive samples from S. officinarum and Saccharum spp. local varieties were coinfected with sugarcane mosaic disease viruses or sugarcane yellow leaf virus. Interestingly, most of the plants infected by strain A of SStrV were asymptomatic. SStrV appears to be widespread in China, and its influence on chewing cane deserves further investigation.
Challenges for Family Medicine Residents in Attaining the CanMEDS Professional Role: A Thematic Analysis of Preceptor Field Notes
Authors: Kazevman Gill , Ng Jessica C.Y. , Marshall Jessica L. , Slater Morgan , Leung Fok-Han , Guiang Charlie B.
Published: May 2021

Purpose

Among the roles of the competent physician is that of a professional, according to the Canadian Medical Education Directives for Specialists (CanMEDS) framework, which describes the abilities physicians require to effectively meet the health care needs of the people they serve. Through examination of preceptor field notes on resident performance, the authors identified aspects of this role with which family medicine residents struggle.

Method

The authors used a structured thematic analysis in this qualitative study to explore the written feedback postgraduate medical learners receive at the University of Toronto Department of Family and Community Medicine. Seventy field notes written between 2015 and 2017 by clinical educators for residents who scored “below expectation” in the CanMEDS professional role were analyzed. From free-text comments, the authors derived inductive codes, amalgamated the codes into themes, and measured the frequency of the occurrence of the codes. The authors then mapped the themes to the key competencies of the CanMEDS professional role.

Results

From the field notes, 7 themes emerged that described reasons for poor performance. Lack of collegiality, failure to adhere to standards of practice or legal guidelines, and lack of reflection or self-learning were identified as major issues. Other themes were failure to maintain boundaries, taking actions that could have a negative impact on patient care, failure to maintain patient confidentiality, and failure to engage in self-care. When the themes were mapped to the key competencies in the CanMEDS professional role, most related to the competency “commitment to the profession.”

Conclusions

This study highlights aspects of professional conduct with which residents struggle and suggests that the way professionalism is taught in residency programs—and at all medical training levels—should be reassessed. Educational interventions that emphasize learners’ commitment to the profession could enhance the development of more practitioners who are consummate professionals.
Evaluation of the Parameters Affecting Respiratory Functions at Adolescent Idiopathic Scoliosis Patients
Authors: Çimen Osman , Öner Ali , Köksal Alper , Dirvar Ferdi , Mert Muhammed
Published: May 2021

Study Design:

This was a retrospective observational study.

Objective:

The objective of the study was to evaluate the spinal and extraspinal factors responsible for pulmonary dysfunction in adolescent idiopathic scoliosis patients.

Summary of Background Data:

Development of thoracic deformity due to scoliosis results with the restrictive ventilatory pattern and the reduced pulmonary function. To prevent pulmonary function deterioration, it is imperative to understand which factors are causing the restrictive lung disease in adolescent idiopathic scoliosis patients.

Materials and Methods:

An online database search was conducted in a hospital computerized archive between 2008 and 2018 years. Cobb angle of >30 degrees, Lenke type 1 and 2 patients treated in a single spine unit were included. Coronal and sagittal Cobb angle, bending correction rate for evaluation of flexibility, Risser score, apical vertebra rotation (AVR), and pulmonary function test of patients were obtained.

Results:

There was a moderate negative correlation between forced expiratory volume in the first second, forced vital capacity, and AVR. There was no correlation between forced expiratory volume in the first second and forced vital capacity with age, sex, Cobb angle, Risser score, kyphosis, and bending correction rate.

Conclusions:

When considering the results of the current study and the other studies in the literature there is not any strong correlation between the features of scoliotic curvature and respiratory functions. In the current study, 52 (72.22%) of 72 patients with moderate to severe scoliosis had mild to severe respiratory dysfunction. Considering the age-related physiological respiratory loss, to evaluate the necessity of surgical treatment in patients with moderate and severe scoliosis, especially in patients with high AVR, the respiratory functions of the patient should also be evaluated.

Level of Evidence:

Level III.
C1−C2 Arthrodesis With C1 Lateral Mass and C2 Parsicle Screws Combined With Interlaminar Arthrodesis and Wiring
Authors: Rasouli Jonathan J. , Momin Arbaz , Fiani Brian , Shao Jianning , Moore Timothy A.
Published: May 2021

C1−C2 arthrodesis is a common procedure performed for the correction of atlantoaxial instability due to a host of pathologies, including degenerative, neoplastic, congenital, and trauma. While there is clinical equipoise, C1−C2 fusion is associated with a lower morbidity than occipital-cervical fusion. However, due to the unique morphometric characteristics of the C1 lateral mass, and the challenges that its fixation presents, some surgeons may elect to extend the construct to the occiput rather than attempt a C1−C2 fusion. Here, we describe our freehand technique of safely and expeditiously performing a C1−C2 fusion with C1 lateral mass and C2 “parsicle” screws. In patients with high preprocedural probability to develop pseudarthrosis, we combine our instrumented fusion with interlaminar bone graft wiring, as similarly described by Gallie. We believe the C2 “parsicle” screw avoids the technical challenges of placing a traditional C2 pedicle screw and accommodates a much larger screw length than those placed in the C2 pars. Practical surgical tips, pearls, and potential complications are discussed in detail.
Perinatal Infections With Ureaplasma
Authors: Stol Kim , Jans Jop , Ott de Bruin Lisa , Unger Wendy , van Rossum Annemarie
Published: May 2021

Ureaplasma species are increasingly recognized as relevant pathogens in prenatal, perinatal and postnatal morbidity. They are commonly found as commensals on the mucous membranes of the lower urogenital tract of pregnant women, but when ascending, they can cause bacterial vaginosis, chorioamnionitis, premature birth and postnatal morbidities such as bronchopulmonary dysplasia, and early-onset neonatal sepsis and meningitis. The detection of Ureaplasma species is challenging and is not covered by routine diagnostics, and current empiric antibiotic treatment in neonates suspected of infection is not directed against Ureaplasma species. The aim of this review is to discuss the pathophysiology of Ureaplasma infections, the clinical consequences and the current difficulties in diagnosis and treatment by providing an overview of the current literature.
IgA Vasculitis With Henoch-Schönlein Purpura as an Immune Complication Associated With Left Ventricle Assist Device Insertion
Authors: Ait-Tigrine Souhila , Liaudet Lucas , Bogiatzi Sofia , Yerly Patrick , Hullin Roger , Kirsch Matthias
Published: May 2021

The implantation of left ventricular assist devices (LVADs) in patients with end-stage heart failure can be associated with some forms of immune dysregulation and systemic inflammatory response. These abnormalities may be related to impaired T-lymphocyte-dependent immunity and B-lymphocyte hyper-reactivity and may lead to the development of autoimmune processes and the occurrence of severe infections. We present here the first observation of a peculiar immune complication associated with the implantation of an LVAD, characterized by an IgA vasculitis clinically manifested as Henoch-Schönlein purpura. The vasculitis was biologically associated with a significant increase of the plasma levels of C-X-C motif chemokine ligand (CXCL)13, a CXC motif chemokine produced by follicular dendritic cells, which targets CXCR5, a receptor primarily expressed by B lymphocytes, to promote their chemotaxis and expansion. Spontaneous resolution of the vasculitis occurred over time, concomitantly to a decrease of CXCL13 expression. These findings suggest that CXCL13 might be an interesting biomarker to detect auto-antigen sampling and the risk of secondary immune complications following LVAD implantation.
Late HeartMate 3 Thrombosis
Authors: Pienta Michael J. , Knott Kevin , Bitar Abbas , Haft Jonathan W.
Published: May 2021

There are few reports of HeartMate 3 pump thrombosis, with existing reports relating to outflow occlusion or early perioperative thrombosis. We present a case of late pump thrombosis requiring pump exchange.
Alarms and Their Outcomes in Left Ventricular Assist Device Patients
Authors: Lim Zi Z. , Robson DesireE , Muthiah Kavitha , Jansz Paul , Macdonald Peter S. , Hayward Christopher S.
Published: May 2021

Low flow and suction alarms are provided to alert caregivers of changes in left ventricular assist device pump function but may be reset in clinical practice. We investigated the incidence and underlying causes of these alarms as well as their prognostic significance. HeartWare ventricular assist device patients (n = 113) were divided into quartiles based on their frequency of low flow and suction alarms. Survival and adverse events (thrombus, stroke, bleeding, and right heart failure) were compared between quartiles. Low flow alarms peaked in the first few months of pump support before dropping down to near negligible levels. Suction alarm frequency remained relatively constant throughout pump support. Although pump speeds (p < 0.001) and flow (p = 0.01) decreased over time, there was an increase in suction alarm frequency (p = 0.018), with no changes in low flow alarms. Patients with smaller body size (p = 0.016) and lower pump flows (p = 0.008) had higher frequencies of low flow alarms on multiple regression (p < 0.001). Patients with the highest low flow alarm frequency demonstrated poorer survival (p = 0.026). There was no relationship between suction alarm frequency and survival. There was also no relationship between either low flow or suction alarm frequency with strokes, gastrointestinal bleeds, pump thrombus, or right ventricular failure. Duration of alarm and intervention in response to the alarm was not assessed in this study. Further studies examining alarm duration and responses may inform future pump alarm algorithms.
A trauma-informed guide to caring for adolescents following sexual assault
Authors: Wiener Susan J. , Fitzgerald Susan , Einhorn Honora
Published: May 2021

Purpose of review

Sexual assault is common among adolescents worldwide. Survivors of sexual assault may experience various immediate and long-term effects on their physical and mental health. It is important that pediatric healthcare providers (HCPs) are aware of the high prevalence of sexual assault and recognize the impact on their adolescent patients. The aim of this update is to discuss how pediatric HCPs can embody a trauma-informed approach when caring for survivors of sexual assault across various settings.

Recent findings

All adolescent patients should be screened for sexual assault during routine clinical visits; in responding to a disclosure, providers should exhibit compassion, express validation, and help connect the patient to resources to aid in healing. Caring for survivors of sexual assault should ideally be multidisciplinary, involving treatment of the medical complications (including the possibility of pregnancy or infection) and mental health sequelae (including increased likelihood of depression, posttraumatic symptoms, and suicidality).

A trauma-informed approach can be applied to all aspects of caring for survivors of sexual assault, from screening for sexual assault and responding to disclosure, to providing acute and longitudinal care following sexual assault.
Choice and duration of antifungal prophylaxis and treatment in high-risk haematology patients
Authors: Coussement Julien , Lindsay Julian , Teh Benjamin W. , Slavin Monica
Published: May 2021

Purpose of review

This review aims to summarize available guidelines as well as the emerging evidence for the prevention and treatment of invasive fungal diseases in high-risk haematology patients.

Recent findings

Primary mould-active prophylaxis is the strategy used in many centres to manage the risk of invasive fungal disease in high-risk haematology patients, and posaconazole remains the antifungal of choice for most of these patients. Data on the use of other antifungals for primary prophylaxis, including isavuconazole, are limited. There is considerable interest in identifying a strategy that would limit the use of mould-active agents to the patients who are the most likely to benefit from them. In this regard, a recent trial demonstrated that the preemptive strategy is noninferior to the empiric strategy. For primary treatment of invasive aspergillosis, two randomized trials found isavuconazole and posaconazole to be noninferior to voriconazole. Isavuconazole does not appear to require therapeutic drug monitoring.

Prophylaxis and treatment of invasive fungal diseases in high-risk haematology patients is a rapidly evolving field. Critical clinical questions remain unanswered, especially regarding the management of suspected invasive fungal diseases breaking through mould-active prophylaxis, and the duration of antifungal therapy for invasive mould infections.
Military deployment’s impact on the surgeon’s practice
Authors: Hall Andrew , Qureshi Iram , Vasquez Matthew , Iverson Kyle , Tadlock Matthew D. , McClendon Hampton , Davis Elizabeth , Glaser Jacob , Hanson Matthew , Taylor Jonathan , Gurney Jennifer M.
Published: May 2021

BACKGROUND

As the United States withdraws from overseas conflicts, general surgeons remain deployed in support of global operations. Surgeons and surgical teams are foundational to combat casualty care; however, currently, there are few casualty producing events. Low surgical volume and acuity can have detrimental effects on surgical readiness for those frequently deployed. The surgical team cycle of deployment involves predeployment training, drawdown of clinical practice, deployment, postdeployment reintegration, and rebuilding of a patient panel. This study aims to assess these effects on typical general surgeon practices. Quantifying the overall impact of deployment may help refine and implement measures to mitigate the effects on skill retention and patient care.

METHODS

Surgeon case logs of eligible surgeons deploying between January 1, 2017, and January 1, 2020, were included from participating military treatment facilities. Eligible surgeons were surgeons whose case logs were primarily at a single military treatment facility 26 weeks before and after deployment and whose deployment duration, location, and number of deployed cases were obtainable.

RESULTS

Starting 26 weeks prior to deployment, analyzing in 1-week intervals toward deployment time, case count decreased by 4.8% (p < 0.0001). With each 1-week interval, postdeployment up to the 26-week mark, case count increased by 6% (p < 0.0001). Cases volumes most prominently drop 3 weeks prior to deployment and do not reach normal levels until approximately 7 weeks postdeployment. Case volumes were similar across service branches.

CONCLUSION

There is a significant decrease in the number of cases performed before deployment and increase after return regardless of military branch. The perideployment surgical volume decline should be understood and mitigated appropriately; predeployment training, surgical skill retention, and measures to safely reintegrate surgeons back into their practice should be further developed and implemented.

LEVEL OF EVIDENCE

Economic/Decision, Level III.
Saving the brain after mild-to-moderate traumatic injury: A report on new insights of the physiology underlying adequate maintenance of cerebral perfusion
Authors: Convertino Victor A. , Cardin Sylvain , Cap Andre P. , Crowder Alicia T. , Stackle Mark E. , Talley Michael J. , Lurie Keith G.
Published: May 2021

Traumatic brain injury (TBI) is associated with increased morbidity and mortality in civilian trauma and battlefield settings. It has been classified across a continuum of dysfunctions, with as much as 80% to 90% of cases diagnosed as mild to moderate in combat casualties. In this report, a framework is presented that focuses on the potential benefits for acute noninvasive treatment of reduced cerebral perfusion associated with mild TBI by harnessing the natural transfer of negative intrathoracic pressure during inspiration. This process is known as intrathoracic pressure regulation (IPR) therapy, which can be applied by having a patient breath against a small inspiratory resistance created by an impedance threshold device. Intrathoracic pressure regulation therapy leverages two fundamental principles for improving blood flow to the brain: (1) greater negative intrathoracic pressure enhances venous return, cardiac output, and arterial blood pressure; and (2) lowering of intracranial pressure provides less resistance to cerebral blood flow. These two effects work together to produce a greater pressure gradient that results in an improvement in cerebral perfusion pressure. In this way, IPR therapy has the potential to counter hypotension and hypoxia, potentially significant contributing factors to secondary brain injury, particularly in conditions of multiple injuries that include severe hemorrhage. By implementing IPR therapy in patients with mild-to-moderate TBI, a potential exists to provide early neuroprotection at the point of injury and a bridge to more definitive care, particularly in settings of prolonged delays in evacuation such as those anticipated in future multidomain operations.

LEVEL OF EVIDENCE

Report.
Trends in prehospital pain management following the introduction of new clinical practice guidelines
Authors: Vysokovsky Moshe , Avital Guy , Betelman-Mahalo Yaar , Gelikas Shaul , Fridrich Lidar , Radomislensky Irina , Tsur Avishai M. , Glassberg Elon , Benov Avi
Published: May 2021

BACKGROUND

Early pain treatment following injury has been shown to improve long-term outcomes, while untreated pain can facilitate higher posttraumatic stress disorder rates and worsen outcomes. Nonetheless, trauma casualties frequently receive inadequate analgesia. In June 2013, a new clinical practice guideline (CPG) regarding pain management was introduced in the Israel Defense Forces (IDF) Medical Corps, recommending oral transmucosal fentanyl citrate (OTFC) and low-dose intravenous (IV)/intramuscular ketamine. The purpose of this study was to examine trends in prehospital pain management in the IDF.

METHODS

All cases documented in the IDF trauma registry between 2008 and 2020 were examined. This study compared casualty parameters before and after the introduction of analgesia CPG in 2013. Parameters compared included demographics, injury parameters, treatment modalities, and types of analgesia provided.

RESULT

Overall, 5,653 casualties were included in our study. During the 6 years before the introduction of the CPG, 289 (26.7%) of 1,084 casualties received an analgesic treatment, compared with 1,578 (34.5%) of 4,569 casualties during the 7 years following (p < 0.001). Since its introduction, OTFC was administered to 41.8% of all casualties who received analgesia and became the most used analgesic drug in 2020 (61.1% of casualties receiving analgesia). The rate of IV morphine significantly decreased after 2013 (22.6–16%, p < 0.001).

CONCLUSION

Pain management has become more common in trauma patients’ prehospital care in the IDF in recent years. There has been a significant increase in analgesia administration, with the increased use of OTFC, along with a significant reduction in the use of IV morphine. These results may be attributed to introducing a pain management CPG and implementing OTFC among medical teams. The perception of OTFC as a safe user-friendly analgesic may have contributed to its use by medical providers, increasing analgesia rates overall.

LEVEL OF EVIDENCE

Therapeutic/care management, level III.
Don’t mess with the pancreas! A multicenter analysis of the management of low-grade pancreatic injuries
Authors: Biffl Walter L. , Ball Chad G. , Moore Ernest E. , Lees Jason , Todd S. Rob , Wydo Salina , Privette Alicia , Weaver Jessica L. , Koenig Samantha M. , Meagher Ashley , Dultz Linda , Udekwu Pascal (Osi) , Harrell Kevin , Chen Allen K. , Callcut Rachael , Kornblith Lucy , Jurkovich Gregory J. , Castelo Matthew , Schaffer Kathryn B. ,   the WTA Multicenter Trials Group on Pancreatic Injuries
Published: May 2021

INTRODUCTION

Current guidelines recommend nonoperative management (NOM) of low-grade (American Association for the Surgery of Trauma-Organ Injury Scale Grade I–II) pancreatic injuries (LGPIs), and drainage rather than resection for those undergoing operative management, but they are based on low-quality evidence. The purpose of this study was to review the contemporary management and outcomes of LGPIs and identify risk factors for morbidity.

METHODS

Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018. The primary outcome was pancreas-related complications (PRCs). Predictors of PRCs were analyzed using multivariate logistic regression.

RESULTS

Twenty-nine centers submitted data on 728 patients with LGPI (76% men; mean age, 38 years; 37% penetrating; 51% Grade I; median Injury Severity Score, 24). Among 24-hour survivors, definitive management was NOM in 31%, surgical drainage alone in 54%, resection in 10%, and pancreatic debridement or suturing in 5%. The incidence of PRCs was 21% overall and was 42% after resection, 26% after drainage, and 4% after NOM. On multivariate analysis, independent risk factors for PRC were other intra-abdominal injury (odds ratio [OR], 2.30; 95% confidence interval [95% CI], 1.16–15.28), low volume (OR, 2.88; 1.65, 5.06), and penetrating injury (OR, 3.42; 95% CI, 1.80–6.58). Resection was very close to significance (OR, 2.06; 95% CI, 0.97–4.34) (p = 0.0584).

CONCLUSION

The incidence of PRCs is significant after LGPIs. Patients who undergo pancreatic resection have PRC rates equivalent to patients resected for high-grade pancreatic injuries. Those who underwent surgical drainage had slightly lower PRC rate, but only 4% of those who underwent NOM had PRCs. In patients with LGPIs, resection should be avoided. The NOM strategy should be used whenever possible and studied prospectively, particularly in penetrating trauma.

LEVEL OF EVIDENCE

Therapeutic Study, level IV.
A multi-registry analysis of military and civilian penetrating cervical carotid artery injury
Authors: Ronaldi Alley E. , Polcz Jeanette E. , Robertson Henry T. , Walker Patrick F. , Bozzay Joseph D. , Dubose Joseph J. , White Paul W. , Rasmussen Todd E. , White Joseph M.
Published: May 2021

INTRODUCTION

Penetrating cervical carotid artery injury is an uncommon but high-stake scenario associated with stroke and death. The objective of this study was to characterize and compare penetrating carotid injury in the military and civilian setting, as well as provide considerations for management.

METHODS

Cohorts with penetrating cervical carotid artery injury from the Department of Defense Trauma Registry (2002–2015) and the American Association for the Surgery of Trauma Prospective Observation Vascular Injury Treatment Registry (2012–2018) were analyzed. A least absolute shrinkage and selection operator multivariate analysis using random forest-based imputation was performed to identify risk factors affecting stroke and mortality.

RESULTS

There were a total of 157 patients included in the study, of which 56 (35.7%) were military and 101 (64.3%) were civilian. The military cohort was more likely to have been managed with open surgery (87.5% vs. 44.6%, p < 0.001) and to have had any procedure to restore or maintain flow to the brain (71.4% vs. 35.6%, p < 0.001), while the civilian cohort was more likely to undergo nonoperative management (45.5% vs. 12.5%, p < 0.001). Stroke rate was higher within the military cohort (41.1% vs. 13.9%, p < 0.001); however, mortality did not differ between the groups (12.5% vs. 17.8%, p = 0.52). On multivariate analysis, predictors for stroke were presence of a battle injury (log odds, 2.1; p < 0.001) and internal or common carotid artery ligation (log odds 1.5, p = 0.009). For mortality outcome, protective factors included a high Glasgow Coma Scale on admission (log odds, −0.21 per point; p < 0.001). Increased admission Injury Severity Score was a predictor of mortality (log odds, 0.05 per point; p = 0.005).

CONCLUSION

The stroke rate was higher in the military cohort, possibly reflecting complexity of injury; however, there was no difference in mortality between military and civilian patients. For significant injuries, concerted efforts should be made at carotid reconstruction to reduce the occurrence of stroke.

LEVEL OF EVIDENCE

Retrospective cohort analysis, level III.
Covid-19 and Mental Health of Individuals with Different Personalities
Authors: Proto Eugenio , Zhang Anwen
Published: May 2021

Several studies have been devoted to establishing the effects of the Covid-19 pandemic on mental health across gender, age and ethnicity. However, much less attention has been paid to the differential effect of lockdown according to different personalities. We do this using the UKHLS longitudinal dataset, representative of the UK population. The UKHLS dataset allows us to assess the mental health of the same respondent during the Covid-19 period and the year before based on their personality “Big Five” traits and cognitive skills. We find that during the Covid-19 period individuals who have more Extrovert and Open personality report a higher mental health deterioration, while the ones scoring higher in Agreeableness are less affected. The effect of Openness is particularly strong: one more standard deviation predict one more symptom on the GHQ12 test for about 1 respondent over 4. In female respondents, Cognitive Skills and Openness are particularly strong predictors of deterioration. Neuroticism seems to predict more mental health deterioration, as it is normal to expect, but this effect is not significant in the main specifications of the estimated model. The study’s results are robust to the inclusion of potential confounding variables such as changes in: physical health, household income and job status (like unemployed or furloughed).
PROMIS scales for assessment of the impact of post-COVID syndrome: A Cross Sectional Study
Authors: Ganesh Ravindra , Ghosh Aditya K , Nyman Mark A , Croghan Ivana T , Grach Stephanie L , Anstine Christopher V , Hurt Ryan T
Published: May 2021

The post-COVID syndrome is estimated to occur in up to 10% of patients who have had COVID-19. This condition manifests as lingering symptoms which persist for weeks to months after resolution of the acute illness. The syndrome is poorly understood and efforts are just beginning to appropriately characterize the symptoms expressed by this population. We present a population of patients with persistent symptoms as measured by a select number of PROMIS surveys (i.e. fatigue, sleep, pain, physical functioning, and social roles). We believe this to be the first use of the PROMIS survey data collected in this population and one of the first to attempt to measure social dysfunction secondary to the post-COVID syndrome. Our patient population is notably younger (30.9% were between 40-59 years of age), with a majority being female (60.5%). They also reported deficits in social roles (34.5%), and greater fatigue (14.7%), and pain (15.9%); along with a variety of disease severity ranging from asymptomatic to requiring admission. Despite this increased heterogeneity of population, the symptomatology of the post-COVID syndrome is preserved. These findings differ significantly from previously published data that demonstrated that outpatients can have duration of post-COVID syndrome similar to those who were hospitalized.
Convolutional neural networks trained with a developmental sequence of blurry to clear images reveal core differences between face and object processing
Authors: Jang Hojin , Tong Frank
Published: May 2021

Although convolutional neural networks (CNNs) provide a promising model for understanding human vision, most CNNs lack robustness to challenging viewing conditions such as image blur, whereas human vision is much more reliable. Might robustness to blur be attributable to vision during infancy, given that acuity is initially poor but improves considerably over the first several months of life? Here, we evaluated the potential consequences of such early experiences by training CNN models on face and object recognition tasks while gradually reducing the amount of blur applied to the training images. For CNNs trained on blurry to clear faces, we observed sustained robustness to blur, consistent with a recent report by Vogelsang and colleagues (2018). By contrast, CNNs trained with blurry to clear objects failed to retain robustness to blur. Further analyses revealed that the spatial frequency tuning of the two CNNs was profoundly different. The blurry to clear face-trained network successfully retained a preference for low spatial frequencies, whereas the blurry to clear object-trained CNN exhibited a progressive shift toward higher spatial frequencies. Our findings provide novel computational evidence showing how face recognition, unlike object recognition, allows for more holistic processing. Moreover, our results suggest that blurry vision during infancy is insufficient to account for the robustness of adult vision to blurry objects.
Midfrontal theta tACS facilitates motor coordination in dyadic human-avatar motor interactions
Authors: Boukarras Sarah , Özkan Duru Gun , Era Vanessa , Moreau Quentin , Tieri Gaetano , Candidi Matteo
Published: May 2021

Synchronous interpersonal motor interactions require moment-to-moment predictions and proactive monitoring of the partner’s actions. Neurophysiologically, this is highlighted by an enhancement of midfrontal theta activity. In the present study we explored the causal role of midfrontal theta for interpersonal motor interactions employing transcranial alternating current stimulation (tACS). We implemented a realistic human-avatar interaction task in immersive virtual reality (IVR) where participants controlled a virtual arm and hand to press a button synchronously with a virtual partner. Participants completed the task while receiving theta (Experiment 1) or beta (control frequency, Experiment 2) EEG-informed tACS over the frontal midline, as well as sham stimulation as a control. Results showed that frontal theta tACS significantly improved behavioural performance (by reducing interpersonal asynchrony) and participants’ motor strategies (by increasing movement times and reducing reaction times), while beta tACS had no effect on these measures. These results suggest that theta tACS over frontal areas facilitates action monitoring and motor abilities supporting interpersonal interactions.
Genome-wide evolutionary response of European oaks since the Little Ice Age
Authors: Saleh Dounia , Chen Jun , Leplé Jean-Charles , Leroy Thibault , Truffaut Laura , Dencausse Benjamin , Lalanne Céline , Labadie Karine , Lesur Isabelle , Bert Didier , Lagane Frédéric , Morneau François , Aury Jean-Marc , Plomion Christophe , Lascoux Martin , Kremer Antoine
Published: May 2021

The pace of tree microevolution during Anthropocene warming is largely unknown. We used a retrospective approach to monitor genomic changes in oak trees since the Little Ice Age (LIA). Allelic frequency changes were assessed from whole-genome pooled sequences for four age-structured cohorts of sessile oak (Quercus petraea) dating back to 1680, in each of three different oak forests in France. The genetic covariances of allelic frequency changes increased between successive time periods, highlighting genome-wide effects of linked selection. We found imprints of convergent linked selection in the three forests during the late LIA, and a shift of selection during more recent time periods. The changes in allelic covariances within and between forests mirrored the documented changes in the occurrence of extreme events (droughts and frosts) over the last three hundred years. The genomic regions with the highest covariances were enriched in genes involved in plant responses to pathogens and abiotic stresses (temperature and drought). These responses are consistent with the reported sequence of frost (or drought) and disease damage ultimately leading to the oak dieback after extreme events. Our results therefore provide evidence of selection operating on long-lived species during recent climatic changes.
Precise genotyping of circular mobile elements uncovers human associated plasmids with surprisingly recent common ancestors
Authors: Shalon Nitan , Relman David , Yaffe Eitan
Published: May 2021

Mobile genetic elements with circular genomes play a key role in the evolution of microbial communities. These circular genomes correspond to cyclic paths in metagenome graphs, and yet, assemblies derived from natural microbial communities produce graphs riddled with spurious cycles, complicating the accurate reconstruction of circular genomes. We present an algorithm that reconstructs true circular genomes based on the identification of so-called ‘dominant’ cycles. Our algorithm leverages paired reads to bridge gaps between assembly contigs and scrutinizes cycles through a nucleotide-level analysis, making the approach robust to mis-assembly artifacts. We validated the approach using simulated and reference data. Application of this approach to 32 publicly available DNA shotgun sequence data sets from diverse natural environments led to the reconstruction of hundreds of circular mobile genomes. Clustering revealed 20 clusters of cryptic, prevalent, and abundant plasmids that have clonal population structures with surprisingly recent common ancestors. This work enables the robust study of evolution and spread of mobile elements in natural settings.
Towards increased shading potential: a combined phenotypic and genetic analysis of rice shoot architecture
Authors: Huber Martina , Julkowska Magdalena M. , Snoek Basten L. , van Veen Hans , Toulotte Justine , Kumar Virender , Kajala Kaisa , Sasidharan Rashmi , Pierik Ronald
Published: May 2021

Rice feeds more than half of the world’s human population. In modern rice farming, a major constraint for productivity is weed proliferation and the ecological impact of herbicide application. Increased weed competitiveness of commercial rice varieties requires enhanced shade casting to limit growth of shade-sensitive weeds and the need for herbicide. We aimed to identify traits that enhance rice shading capacity based on the canopy architecture and the underlying genetic components. We performed a phenotypic screen of a rice diversity panel comprised of 344 varieties, examining 13 canopy architecture traits linked with shading capacity in 4-week-old plants. The analysis revealed a vast range of phenotypic variation across the diversity panel. We used trait correlation and clustering to identify core traits that define shading capacity to be shoot area, number of leaves, culm and solidity (the compactness of the shoot). To simplify the complex canopy architecture, these traits were combined into a Shading Rank metric that is indicative of a plant’s ability to cast shade. Genome wide association study (GWAS) revealed genetic loci underlying canopy architecture traits, out of which five loci were substantially contributing to shading potential. Subsequent haplotype analysis further explored allelic variation and identified seven haplotypes associated with increased shading. Identification of traits contributing to shading capacity and underlying allelic variation presented in this study will serve future genomic assisted breeding programmes. The investigated diversity panel, including widely grown varieties, shows that there is big potential and genetic resources for improvement of elite breeding lines. Implementing increased shading in rice breeding will make its farming less dependent on herbicides and contribute towards more environmentally sustainable agriculture.

One sentence summary

Through screening a rice diversity panel for variation in shoot architecture, we identified traits corresponding to plant shading potential and their genetic constituents.
Extraordinarily Precise Nematode Sex Ratios: Adaptive Responses to Vanishingly Rare Mating Options
Authors: Van Goor Justin , Herre Edward Allen , Gómez Adalberto , Nason John D.
Published: May 2021

Sex ratio theory predicts both mean sex ratio and variance under a range of population structures. Here, we compare two genera of phoretic nematodes (Parasitodiplogaster and Ficophagus spp.) associated with twelve fig-pollinating wasp species in Panama. The host wasps exhibit classic Local Mate Competition: only inseminated females disperse from natal figs, and their offspring form mating pools that consist of scores of the adult offspring contributed by one or a few foundress mothers. In contrast, in both nematode genera, only sexually undifferentiated juveniles disperse, and their mating pools routinely consist of eight or fewer adults. Across all mating pool sizes, the sex ratios observed in both nematode genera are consistently female-biased (~0.34 males), which is markedly less female-biased than is often observed in the host wasps (~0.10 males). In further contrast with their hosts, variances in nematode sex ratios are also consistently precise (significantly less than binomial). The constraints associated with predictably small mating pools within highly subdivided populations appear to select for precise sex ratios that contribute both to the reproductive success of individual nematodes, and to the evolutionary persistence of nematode species. We suggest that some form of environmental sex determination underlies these precise sex ratios.