bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining Inequities Associated With Changes in Obstetric and Gynecologic Care Delivery During the Coronavirus Disease 2019 (COVID-19) Pandemic
Authors: Onwuzurike Chiamaka , Meadows Audra R. , Nour Nawal M.
Published: April 2020

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency requiring significant changes in obstetric and gynecologic health care delivery to minimize the risk of transmission to healthy patients and health care workers. Although these changes are necessary, they will differentially affect patients in a way that highlights and exacerbates existing inequities in health care access and outcomes. Socially vulnerable groups are already disproportionately affected by COVID-19 infection and more likely to experience severe morbidity and mortality. Some reasons for this include a limited ability to practice risk-reducing behaviors such as physical distancing, higher prevalence of chronic medical conditions, and less access to medical care. Additionally, the structural changes now taking place in health care delivery have negatively affected the ability of socially vulnerable groups to obtain necessary obstetric and gynecologic care, which may lead to poorer outcomes. As physician–leaders enact new policies to respond to the COVID-19 public health crisis, it is important to consider the potential for exacerbating existing health inequities and to be proactive in creating policies that promote equity.
The Incidence of Venous Thromboembolism Following Pelvic and Lower Extremity Trauma Despite Adherence to Modern Prophylactic Protocols
Authors: Lowe Jason A. , Mitchell Sean M. , Agarwal Sumit , Jones Clifford B.
Published: April 2020

Objectives:

Describe the incidence of venous thromboembolism (VTE) in patients with pelvic and lower extremity long bone trauma in the setting of modern prophylaxis.

Design:

Retrospective health-system database study.

Setting:

Multi-center health care system.

Patients:

Database query from 2010 to 2017 identified 11,313 adult trauma patients who received open reduction internal fixation of pelvic, acetabular, femoral neck, or intertrochanteric fractures, or received intramedullary nailing (IMN) of the femoral or tibial shaft. Patients with incomplete prophylaxis, prior history of VTE, coagulopathy, or concomitant lower extremity fracture were excluded.

Intervention:

Mechanical and chemical VTE prophylaxis following pelvic or lower extremity fracture fixation.

Main Outcome Measurements:

VTE rates.

Results:

The overall VTE rate was 0.82% [0.39% deep venous thromboses (DVT); 0.43% pulmonary emboli (PE)]. By procedure, pelvic open reduction and internal fixation (ORIF) and femoral IMN had the highest VTE rates 1.70% (0.98% DVT; 0.78% PE) and 1.33% (0.75% DVT; 0.58% PE), whereas tibial IMN had the lowest incidence of VTE 0.34% (0.17% DVT; 0.17% PE). Among hip fractures, femoral neck ORIF had a VTE rate of 0.98% (0.59% DVT; 0.39% PE), whereas intertrochanteric ORIF had lower rates of 0.59% (0.20% DVT; 0.39% PE).

Conclusions:

Despite adherence to modern VTEp protocols, nonpreventable VTE occur in 0.82% of pelvic and lower extremity orthopaedic trauma patients. Incidence ranged between 0.34% and 1.70% depending on injury/fixation method with the highest rate observed in pelvis ORIF followed by femoral IMN. In the era of pay for quality performance, it is important for health systems and auditing agencies to reconcile the difference between preventable and nonpreventable VTEs.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Perioperative Complications Between Anterior Fusion and Posterior Fusion for Osteoporotic Vertebral Fractures in Elderly Patients
Authors: Morishita Shingo , Yoshii Toshitaka , Okawa Atsushi , Inose Hiroyuki , Hirai Takashi , Ogawa Takahisa , Fushimi Kiyohide , Fujiwara Takeo
Published: April 2020

Study Design:

This was a retrospective cohort study using a nationwide inpatient database.

Objective:

The objective of this study was to evaluate the perioperative complications post–anterior fusion (AF) and posterior fusion (PF) for osteoporotic vertebral fractures (OVFs) with a large National Inpatient Database.

Summary of Background Data:

OVF of the thoracolumbar spine often occur because of bone fragility and low-energy trauma in elderly patients. Though AF and PF are 2 representative surgical methods, there have been few studies focusing on perioperative complications of each method.

Materials and Methods:

The total 2446 (AF: 435 cases, PF: 2011 cases) patients who diagnosed thoracic or lumbar OVF and received either AF or PF were included from 2012 to 2016 with the Diagnosis Procedure Combination (DPC) database. After one-to-one propensity score–matching, total 866 cases were analyzed to evaluate systemic and local complication rates, reoperation rates, costs, and mortality.

Results:

A total of 433 pairs were made between the surgical procedures after matching. At least 1 systemic complication was seen in 26.6% of the AF group compared with 16.9% of the PF group (P=0.001). Specifically, the incidence of pulmonary embolism (P=0.045), urinary tract infection (P=0.012), and pleurisy (P=0.004) were significantly higher in the AF group. Blood transfusion (P=0.007) and the operation for systemic complications (P=0.020) were required more often in the AF group. The cost for hospitalization was also higher in the AF group (P<0.001). There were no differences in the mortality rates between the 2 groups.

Conclusions:

More systemic complications were observed in the AF group. Surgeons need to take careful consideration of the merits and demerits described in this study when deciding the surgical method for OVF.

Level of Evidence:

Level 3.
Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers
Authors: Philipp-Dormston Wolfgang G. , Goodman Greg J. , De Boulle Koenraad , Swift Arthur , Delorenzi Claudio , Jones Derek , Heydenrych Izolda , Trindade De Almeida Ada , Batniji Rami K.
Published: April 2020

Background:

Delayed-onset adverse reactions to hyaluronic acid (HA) fillers are uncommon but have received increased attention, particularly with regard to late-onset nodules. Globally, there is a need for comprehensive prevention and management strategies.

Methods:

Experts with clinical practices in diverse regions of the world and extensive experience in managing complications related to HA fillers convened to propose and evaluate approaches to prevent delayed-onset adverse reactions after HA filler administration and manage late-onset nodules.

Results:

The expert panel agreed to define delayed-onset adverse reactions as those presenting more than 4 weeks posttreatment, with swelling, induration, and nodulation being the most common clinical signs. The panel recommended 5 general key approaches for the prevention of delayed-onset reactions (patient selection, anatomic location of injection/product selection, aseptic technique, injection procedure/filler, and posttreatment care). Strategies recommended for managing late-onset nodules included oral antibiotics, oral steroids, nonsteroidal anti-inflammatory drugs if needed, hyaluronidase for noninflammatory nodules (recognizing the limitations and regional availability of this treatment), intralesional antibiotics, intralesional immunosuppressive drugs such as steroids and fluorouracil, and surgical excision as a last resort. The panel noted that late-onset nodules may vary in both clinical presentation and etiology, making them challenging to address or prevent, and stressed individualized treatment based on clinical presentation. Regional differences in aseptic protocols, antibiotic selection, and steroid formulations were described.

Conclusion:

Insights from global experts on approaches to prevent and manage delayed-onset adverse reactions following HA filler administration, including late-onset nodules, support clinicians worldwide in optimizing patient outcomes and safety.
Functional Validation of a New Alginate-based Hydrogel Scaffold Combined with Mesenchymal Stem Cells in a Rat Hard Palate Cleft Model
Authors: Naudot Marie , Davrou Julien , Djebara Az-Eddine , Barre Anaïs , Lavagen Nolwenn , Lardière Sandrine , Azdad Soufiane Zakaria , Zabijak Luciane , Lack Stéphane , Devauchelle Bernard , Marolleau Jean-Pierre , Le Ricousse Sophie
Published: April 2020

Background:

One of the major difficulties in cleft palate repair is the requirement for several surgical procedures and autologous bone grafting to form a bony bridge across the cleft defect. Engineered tissue, composed of a biomaterial scaffold and multipotent stem cells, may be a useful alternative for minimizing the non-negligible risk of donor site morbidity. The present study was designed to confirm the healing and osteogenic properties of a novel alginate-based hydrogel in palate repair.

Methods:

Matrix constructs, seeded with allogeneic bone marrow–derived mesenchymal stem cells (BM-MSCs) or not, were incorporated into a surgically created, critical-sized cleft palate defect in the rat. Control with no scaffold was also tested. Bone formation was assessed using microcomputed tomography at weeks 2, 4, 8, and 12 and a histologic analysis at week 12.

Results:

At 12 weeks, the proportion of bone filling associated with the use of hydrogel scaffold alone did not differ significantly from the values observed in the scaffold-free experiment (61.01% ± 5.288% versus 36.91% ± 5.132%; p = 0.1620). The addition of BM-MSCs stimulated bone formation not only at the margin of the defect but also in the center of the implant.

Conclusions:

In a relevant in vivo model of cleft palate in the rat, we confirmed the alginate-based hydrogel’s biocompatibility and real advantages for tissue healing. Addition of BM-MSCs stimulated bone formation in the center of the implant, demonstrating the new biomaterial’s potential for use as a bone substitute grafting material for cleft palate repair.
“Tissues in a Dish”: A Review of Organoids in Plastic Surgery
Authors: Chinta Malini S. , desJardins-Park Heather E. , Wan Derrick C. , Longaker Michael T.
Published: April 2020

Summary: Organoids are in vitro miniaturized organ models—or, colloquially, “organs in a dish.” These 3-dimensional, multicellular structures are classically derived from pluripotent or multipotent stem cells. When guided by tissue-specific molecular factors, these cells exhibit self-organizing abilities that allow them to accurately recapitulate the architecture and function of the organ of interest. Organoid technology is a rapidly expanding field that endows researchers with an unprecedented ability to recreate, study, and manipulate complex biologic processes in vitro. When compared with standard 2- and 3-dimensional culture systems, which rely on co-culturing pre-established cell types, organoids provide a more biomimetic model with which to study the intercellular interactions necessary for in vivo organ function and architecture. Organoids have the potential to impact all avenues of medicine, including those fields most relevant to plastic and reconstructive surgery such as wound healing, oncology, craniofacial reconstruction, and burn care. In addition to their ability to serve as a novel tool for studying human-specific disease, organoids may be used for tissue engineering with the goal of developing biomimetic soft-tissue substitutes, which would be especially valuable to the plastic surgeon. Although organoids hold great promise for the field of plastic surgery, technical challenges in creating vascularized, multilineage organoids must be overcome to allow for the integration of this technology in clinical practice. This review provides a brief history of the organoid, highlights its potential clinical applications, discusses certain limitations, and examines the impact that this technology may have on the field of plastic and reconstructive surgery.
Three-dimensional Cryolipolysis for Submental and Lateral Neck Fat Reduction
Authors: Rodopoulou Stavroula , Gavala Maria-Ioanna , Keramidas Evangelos
Published: April 2020

Median and lateral neck areas are quite challenging to improve. Three-dimensional cryolipolysis is a noninvasive technique for localized fat reduction. We investigated the efficacy and safety of the technique when applied to these areas. A prospective study of patients treated with one session of 3-dimensional (3D) cryolipolysis is performed. Clinical outcomes are assessed using caliper measurements, patient surveys, and independent, blinded plastic surgeons’ photographic evaluation. The studies are conducted using a commercially available noninvasive medical device for 3D cryolipolysis. All patients received gentle massage of the treated areas for 3 minutes, and the final follow-up is after 3 months. Thirty-nine patients are enrolled in our study from June 2018 to December 2018. All 39 subjects received treatment on at least one intended area (median, right, and left lateral neck). Comparison of the pre- and posttreatment caliper measurements demonstrated a significant reduction of the treated areas at 3 months. Posttreatment, 82.05% of patients marked the results of fat reduction as exceptional or very improved, 12.82% as improved, 5.13% as no result, and 0% as worse. Improved patients and the blinded plastic surgeons noticed at these patients’ groups a bonus tightening effect. No serious adverse reactions are observed; thus, 3D cryolipolysis considered as a safe and effective noninvasive localized fat reduction technique with an extra, almost regularly observed, tightening effect.
Frontal Trigger Site Deactivation for Migraine Surgical Therapy
Authors: Raposio Edoardo , Simonacci Francesco
Published: April 2020

Background:

The World Health Organization ranked migraine as the 19th worldwide disease causing disability. Recent insights into the pathogenesis of migraine headache substantiate a neuronal hyperexcitability and inflammation involving compressed peripheral craniofacial nerves, and these trigger points can be eliminated by surgery. In this study, we report our experience with minimally invasive surgical procedures for frontal migraine headache treatment.

Methods:

From June 2011 to May 2019, we performed 70 frontal migraine decompression surgeries of both supratrochlear and supraorbital nerves (65 bilateral and 5 unilateral) by an endoscopic or transpalpebral approach. In 24 patients (34.2%), frontal migraine emerges as a secondary trigger point following primary occipital and/or temporal migraine surgery.

Results:

After a mean follow-up of 24 months (range, 3–97 months), patients with frontal trigger site migraine reported a 94% positive response to surgery (32% complete relief and 62% significant improvement); 6% had no change in their symptoms.

Conclusions:

Based on our experience, the operation has not caused any serious complication or side effects, and surgical decompression of supraorbital and supratrochlear nerves might be recommended to patients who suffer from a moderate to severe chronic frontal migraine not responding to conventional therapy.
OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY PARAMETERS IN PATIENTS WITH PHACOMATOSIS
Authors: Marta Ana , Malheiro Luísa , Coelho João , Poças João , Gonçalves Nadine , Sousa Paulo , Figueiredo Ana , Araújo Maria , Maia Sofia , Miranda Vasco , Parreira Ricardo , Menéres Pedro
Published: April 2020

Purpose:

To compare the retinal vasculature characteristics between eyes of patients with and without phacomatosis.

Methods:

Case–control observational study with retinal vasculature evaluation by optical coherence tomography and optical coherence tomography angiography of the macula and disk.

Results:

The study included 80 eyes. Neurofibromatosis Type 1 patients presented with a higher central macular thickness (P = 0.007), a lower optical disk nervous fiber layer (P = 0.006), a lower perimeter, area, and circularity of the foveal avascular zone (P < 0.05), a higher vascular density of macular avascular layer (AMVD) (P = 0.004), and a lower papillary vascular density of superficial capillary plexus (SPVD) (P = 0.048). Patients with tuberous sclerosis presented with an increase in central macular thickness (P = 0.024) and in vascular densities (P < 0.05) [except for macular vascular density of deep capillary plexus (PMVD), AMVD, and SPVD]. Patients with Sturge–Weber syndrome showed a decrease in optical disk nervous fiber layer (P < 0.001), subfoveal choroid thickness (P = 0.011), macular vascular density of superficial capillary plexus (SMVD) (P = 0.036), and SPVD (P < 0.001).

Conclusion:

Phacomatosis patients showed statistically significant differences of retinal vasculature characteristics, compared to eyes without pathology. Further studies are needed to determine when and if these parameters change with the course of the disease and if they can be used as biomarkers for disease severity or progression.
IMPLICATIONS OF THE MORPHOLOGIC PATTERNS OF TYPE 1 MACULAR NEOVASCULARIZATION ON MACULAR ATROPHY GROWTH ON PATIENTS UNDER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT
Authors: Cabral Diogo , Coscas Florence , Pereira Telmo , Laiginhas Rita , Rodrigues Catarina , Français Catherine , Nogueira Vanda , Falcão Manuel , Miere Alexandra , Lupidi Marco , Coscas Gabriel , Souied Eric
Published: April 2020

Purpose:

To evaluate the correspondence between macular atrophy (MA) progression and Type 1 macular neovascularization morphology during long-term anti–vascular endothelial growth factor treatment for exudative neovascular age-related macular degeneration.

Methods:

Retrospective review of consecutive patients with complete retinal pigment epithelium and outer retina atrophy overlying or in the proximity of macular neovascularization. The assessment of MA was based on spectral domain optical coherence tomography, en-face near infra-red imaging and fundus autofluorescence. Macular neovascularization blood flow morphology was evaluated by swept-source optical coherence tomography-angiography. Qualitative features were categorized per ETDRS sector as: immature, mature; and hypermature pattern. An automatic analysis was designed in MATLAB coding language to compute MA per ETDRS. Measurements were compared between the baseline and the last follow-up visit.

Results:

Twenty eyes from 20 patients were included; the mean age was 85.4 (8.3) years. The median follow-up was 1.85 (1.0–2.4) years and the median anti–vascular endothelial growth factor injection rate during follow-up was 4.0 (2.0–5.0) injections/year. During follow-up, sectors with persistence of an immature blood flow pattern had a lower MA growth rate than sectors with mature macular neovascularization flow patterns (P = 0.001).

Conclusion:

The presence of an immature blood flow pattern on optical coherence tomography-angiography is associated with a lower progression rate of MA.
Novel biosensor platforms for the detection of coronavirus infection and severe acute respiratory syndrome coronavirus 2
Authors: Liang Kung-Hao , Chang Tai-Jay , Wang Mong-Lien , Tsai Ping-Hsing , Lin Ta-Hsien , Wang Chin-Tien , Yang De-Ming
Published: April 2020

The recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been causing respiratory diseases globally, damaging wide ranges of social-economic activities. This virus is transmitted through personal contact and possibly also through ambient air. Effective biosensor platforms for the detection of this virus and the related host response are in urgent demand. These platforms can facilitate routine diagnostic assays in certified clinical laboratories. They can also be integrated into point-of-care products. Furthermore, environmental biosensors can be designed to detect SARS-CoV-2 in the ambient air or in the intensive care ventilators. Here, we evaluate technical components of biosensors, including the biological targets of recognition, the recognition methods, and the signal amplification and transduction systems. Effective SARS-CoV-2 detectors can be designed by an adequate combination of these technologies.
Ultrasound-guided dextrose injection treatment for chronic myofascial pain syndrome: A retrospective case series
Authors: Chou Yen , Chiou Hong-Jen , Wang Hsin-Kai , Lai Yi-Chen
Published: April 2020

Background:

Due to the lack of an evidence-based consensus, managing refractory myofascial pain syndrome is challenging for clinicians. Dextrose injection (dextrose prolotherapy) emerged as a promising, cost-effective treatment. This study evaluated the efficacy of targeted ultrasound-guided dextrose injection for localized myofascial pain syndrome.

Methods:

We retrospectively reviewed the clinical outcomes of 45 patients with myofascial pain syndrome refractory to alternative treatments with targeted ultrasound-guided dextrose injection. Pretreatment symptom severity and symptomatic response 1 month after treatment were statistically analyzed using a visual analog scale (VAS)-based scoring system.

Results:

Of 45 patients, 8 (24.4%) reported complete resolution of symptoms at the treated site. In total, 36 (80.0%) patients reported greater than 50% improvement in their symptoms. The mean pretreatment and posttreatment VAS scores were 7.0 and 2.44 (p < 0.001), indicating an overall 65.0% reduction in symptom severity.

Conclusion:

Targeted ultrasound-guided dextrose injection was remarkably effective for refractory localized myofascial pain syndrome, significantly reducing symptom intensities in the majority of treated patients within 1 month after a single injection.
Reappraisal of Primary Epstein-Barr Virus (EBV)-positive Diffuse Large B-Cell Lymphoma of the Gastrointestinal Tract
Authors: Miyagi Shouhei , Ishikawa Eri , Nakamura Masanao , Shimada Kazuyuki , Yamamura Takeshi , Furukawa Kazuhiro , Tanaka Tsutomu , Mabuchi Seiyo , Tsuyuki Yuta , Kohno Kei , Sakakibara Ayako , Satou Akira , Kato Seiichi , Fujishiro Mitsuhiro , Nakamura Shigeo
Published: April 2020

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoproliferation encompasses a broad range of clinicopathologic findings, including specific subtypes, for example, EBV+ mucocutaneous ulcer. Here we reassessed 36 cases of primary EBV+ diffuse large B-cell lymphomas (16 men and 20 women; median age, 69.5 y; range, 35 to 84 y), including 8 immunosuppressed patients (Lugano stage II-IV; median age, 74 y), 7 nonimmunosuppressed patients with stage I disease (median age, 69 y), and 21 nonimmunosuppressed patients with stage II-IV disease (median age, 69 y). All immunosuppressed patients exhibited iatrogenic immunodeficiency and an ulcerative appearance, with ulcer sites including the stomach (1 patient), small intestine (6 patients), and rectum (1 patient). Four patients were in the setting of treated lymphoma-associated immunosuppression. Immunosuppressed patients had higher incidences of intestinal involvement (P=0.001) and perforation (n=2) compared with advanced stage nonimmunosuppressed patients. Among nonimmunosuppressed stage I patients, lesions were restricted to the stomach, none showed multiple lesions or elevated serum lactate dehydrogenase, and the overall survival curve plateaued, although it was not statistically significant (P=0.0581). One nonimmunosuppressed stage I patient with a polypoid lesion exhibited spontaneous regression within 2 months after diagnosis, while another with bulky disease pursued an aggressive clinical course. Nonimmunosuppressed stage I cases without bulky masses may be considered EBV mucocutaneous ulcer with local progression. Our results demonstrated that primary EBV+ gastrointestinal diffuse large B-cell lymphoma could be delineated into 3 groups based on immune status and clinical stage, revealing distinguishing features useful as a pragmatic guide for diagnostic and therapeutic approaches.
Rosai-Dorfman Disease—Utility of 18F-FDG PET/CT for Initial Evaluation and Follow-up
Authors: Mahajan Sonia , Nakajima Reiko , Yabe Mariko , Dogan Ahmet , Ulaner Gary A. , Yahalom Joachim , Noy Ariela , Diamond Eli L. , Schöder Heiko
Published: April 2020

Background

The role of imaging in the management of Rosai-Dorfman disease (RDD), a rare non-Langerhans cell histiocytosis, is not clearly defined. We present an analysis of FDG PET/CT findings obtained for initial disease characterization, follow-up evaluation, and treatment planning for this disease.

Methods

From an institutional pathology database (2001–2018), we identified RDD patients who underwent FDG PET/CT scans either as part of clinical care or when done as part of clinical trials. For all scans, sites of abnormal FDG uptake were assessed, and SUVmax was measured. Comparison of PET/CT findings was made with anatomic (CT/MRI-based) imaging, where available. Instances of changing treatment based on PET/CT were recorded.

Results

We reviewed 109 FDG PET/CT scans in 27 patients with RDD. Five of 27 patients had only nodal/cutaneous disease, whereas 22 patients had extranodal disease, most commonly in bone (n = 9) and central nervous system (n = 7). PET/CT identified sites of active disease in 24 of 27 patients. All identified bone and extraskeletal lesions, except for a brain lesion in 1 patient, were FDG-avid. In 6 of 20 patients (30%) with available prior CT or MRI, PET/CT demonstrated additional RDD lesions (bones: n = 5, pleura: n = 1) that were not apparent on anatomic imaging; 3 of these lesions were outside the CT field of view, and 3 were not recognized on CT. Overall, 13 of 109 PET/CT scans led to a change in management, affecting 41% (11/27) of patients.

Conclusion

FDG PET/CT was valuable in defining disease extent and optimizing treatment strategy in patients with RDD.
Combined 68Ga-DOTATOC and 18F-FDG PET Predicts a Double Component With Different Grade of a Pancreatic Neuroendocrine Tumor in a Patient With Multiple Endocrine Neoplasia Type 1
Authors: Paepegaey Anne-Cécile , Gaujoux Sébastien , Meyer Céline , Rouquette Alexandre , Libé Rossella
Published: April 2020

Managing decisions of pancreatic neuroendocrine tumors (pNETs) can be challenging because of different clinical presentations and prognosis. A 31-year-old woman with multiple endocrine neoplasia type 1, including a suspicious pNET, was assessed with 68Ga-DOTATOC and 18F-FDG PET. A high 68Ga-DOTATOC uptake was visualized in the entire pNET, whereas a high 18F-FDG PET uptake was present only in the upper part of the tumor. After surgery, pathology confirmed the pNET with a double component: an upper grade 2 with a Ki67 of 11% with the high 18F-FDG PET uptake, and a lower grade 1 with a Ki67 of 2%. Combined 68Ga-DOTATOC/18F-FDG PET predicts the grade in heterogeneous pNETs.
PET/CT in Evaluation of Low Backache Due to Sacral Nerve Root Involvement
Authors: Yadav Divya , Angamuthu Meivel , Subudhi T. Kishan , Das Chandan J. , Kumar Rakesh
Published: April 2020

Low back pain with radiation to lower limbs is due to nerve root impingement or involvement in most cases. 18F-FDG PET/CT has shown sacral nerve root involvement in several peripheral nerve pathologies, including neurolymphomatosis, peripheral nerve sheath tumor, and plexopathies. We present 2 cases of a low back pain with ulcerative colitis and metastatic neuroendocrine tumor who underwent 18F-FDG PET/CT and 68Ga-DOTANOC PET/CT, respectively. PET/CT can be used as an adjunct tool to evaluate sacral nerve root involvement to look for malignant or inflammatory nerve involvement.
Is COVID Evolution Due to Occurrence of Pulmonary Vascular Thrombosis?
Authors: Saba Luca , Sverzellati Nicola
Published: April 2020

In this hypothesis paper, we suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce intravascular pulmonary thrombosis, which may result in the rapid worsening of clinical conditions and, eventually, exitus. Previously published papers have demonstrated that increased levels of D-dimer at hospital admission correlate with a more severe disease (0.5 mg/L) or occurrence of death (1 mg/L). The potential prothrombotic action of the SARS-CoV-2 is supported by the topographical involvement of the lung regions with a predilection for the lower lobe with peripheral involvement. If this hypothesis is demonstrated, this could suggest the benefit of using antithrombotic/coagulation regimens for SARS-CoV-2 and, at the same time, the urgency to identify drugs that could alter the inflammatory storm, thus protecting the vessel wall.
Reliability and Versatility of Reverse Sural Island Neurofasciocutaneous Leg Flaps
Authors: Stevanovic Goran R. , Dakovic-Bjelakovic Marija Z. , Paravina Jadranka M. , Momčilović Stefan , Golubovic Ivan Z. , Ignjatovic Nebojsa S. , Jankovic Irena D. , Radojkovic Milan , Nestorovic Milica , Rancic Dejan , Rancic Zoran
Published: April 2020

Background

Distally based sural neurofasciocutaneous (NFC) flaps are a commonly used method for foot and ankle reconstruction given that they are much simpler and, at the same time, still efficient alternative to perforator flaps and free style free flaps.

Objective

This study aims to evaluate the reliability and versatility of reverse sural island NFC flaps as a powerful and efficient method that can be used for repair of lower leg skin defects. This method does not require microsurgical facilities or extensive training.

Methodology

Patients with soft tissue defects of the distal third of the leg and ankle region received reverse sural island NFC flaps. Inclusion criteria included an absence of damage to the sural neurovascular axis or communicating perforators, absence of peripheral vascular disease, and the presence of soft tissue defects deep enough to expose tendon or bone. Patients were assessed for flap (defect) size, pedicle length and location of defects, postoperative flap survival rates, and complications. Donor sites were closed directly or skin grafted.

Results

Of 24 consecutive patient (20 male; 4 female), all flaps except 1 (4.16%), survived, although partial necrosis was observed in 2 patients (8.33%). The overall major complication rate was 12.50%. Epidermolysis was noted in 1 patient (4.16%). Three cases of transient venous congestion resolved without additional complications. The overall minor complication rate was 16.66%. Minimal complications were associated with healing of donor sites.

Conclusions

Reverse sural island NFC flaps provide adequate and aesthetically very acceptable coverage of soft tissue defects of the distal lower leg and proximal foot with no functional impairment.
A Simplified Approach to Myelomeningocele Defect Repair
Authors: Brown Owen H. , Makar Katelyn G. , Ulma Raquel M. , Buchman Steven R. , Kasten Steven J. , Muraszko Karin M. , Vercler Christian J.
Published: April 2020

Background

Repair of the soft tissue defect in myelomeningoceles remains challenging. The literature currently lacks a systematic approach, reporting high rates of complications. We present outcomes from the largest series to date and describe a simplified approach that minimizes morbidity and streamlines decision making.

Methods

Patients 1 year or younger who underwent myelomeningocele repair between 2008 and 2018 were reviewed. Flap types were categorized by tissue composition. Complications were dichotomized into early and late (<30 days and >30 days postoperative, respectively). Logistic regression was used to measure the impact of flap tissue composition and skin closure technique on odds of postoperative complications.

Results

Ninety-seven patients met inclusion criteria. Reoperation was required in only 3 (3.0%) patients—1 for wound dehiscence and 2 for surgical site infections. Zero cases of tethered cord or cerebrospinal fluid leak occurred. The most common minor complications were early wound complications (n = 18, 18.6%) and early infection (n = 5, 5.2%). Fascia-only flaps and muscle + other tissue flaps were not associated with higher odds of complications compared with muscle-only flaps (odds ratio [OR], 2.13; 95% confidence interval [CI], 0.53–8.50, P = 0.29; OR = 2.87, 95% CI 0.66–12.51, P = 0.16, respectively). Rhomboid flaps for skin closure were associated with higher odds of complications (OR, 4.47; 95% CI, 1.00–19.97; P = 0.05).

Conclusions

Our approach to myelomeningocele repair demonstrated no cases of secondary tethered cord or cerebrospinal fluid leak, and reoperative rates were extremely low. Because complications were unrelated to flap type, we recommend a simplified approach using any tissue type for dural coverage and 2-layer primary closure of the skin.
Effectiveness of isolation, testing, contact tracing and physical distancing on reducing transmission of SARS-CoV-2 in different settings
Authors: Kucharski Adam , Klepac Petra , Conlan Andrew , Kissler Stephen , Tang Maria , Fry Hannah , Gog Julia , Edmunds John ,   CMMID COVID-19 working group
Published: April 2020

Background

Isolation of symptomatic cases and tracing of contacts has been used as an early COVID-19 containment measure in many countries, with additional physical distancing measures also introduced as outbreaks have grown. To maintain control of infection while also reducing disruption to populations, there is a need to understand what combination of measures – including novel digital tracing approaches and less intensive physical distancing – may be required to reduce transmission.

Methods

Using a model of individual-level transmission stratified by setting (household, work, school, other) based on BBC Pandemic data from 40,162 UK participants, we simulated the impact of a range of different testing, isolation, tracing and physical distancing scenarios. As well as estimating reduction in effective reproduction number, we estimated, for a given level of COVID-19 incidence, the number of contacts that would be newly quarantined each day under different strategies.

Results

Under optimistic but plausible assumptions, we estimated that combined testing and tracing strategies would reduce transmission more than mass testing or self-isolation alone (50–65% compared to 2–30%). If limits are placed on gatherings outside of home/school/work (e.g. maximum of 4 daily contacts in other settings), then manual contact tracing of acquaintances only could have a similar effect on transmission reduction as detailed contact tracing. In a scenario where there were 10,000 new symptomatic cases per day, we estimated in most contact tracing strategies, 140,000 to 390,000 contacts would be newly quarantined each day.

Conclusions

Consistent with previous modelling studies and country-specific COVID-19 responses to date, our analysis estimates that a high proportion of cases would need to self-isolate and a high proportion of their contacts to be successfully traced to ensure an effective reproduction number that is below one in the absence of other measures. If combined with moderate physical distancing measures, self-isolation and contact tracing would be more likely to achieve control.

Funding

Wellcome Trust, EPSRC, European Commission.
Epidemiological and clinical characteristics of discharged patients infected with SARS-CoV-2 on the Qinghai plateau
Authors: Xi Aiqi , Zhuo Ma , Dai Jingtao , Ding Yuehe , Ma Xiuzhen , Ma Xiaoli , Wang Xiaoyi , Shi Lianmeng , Bai Huanying , Zheng Hongying , Nuermberger Eric , Xu Jian
Published: April 2020

Since the outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, a series of confirmed cases of COVID-19 were found on the Qinghai-Tibet plateau. We aimed to describe the epidemiological, clinical characteristics, and outcomes of all confirmed cases in Qinghai, a province at high altitude. With efficient measures to stop the spread of coronavirus, no new cases were found in Qinghai Province for 60 consecutive days between Feb 6 and April 6, 2020. Of all 18 patients with confirmed SARS-CoV-2 infection, 15 patients comprising 4 transmission clusters were identified. Three patients were infected by direct contact without travel history to Wuhan. Seven patients were asymptomatic on admission. Of 18 patients, 10 patients showed bilateral pneumonia and 2 patients showed no abnormalities. Three patients with comorbidities such as hypertension, liver diseases or diabetes developed severe illness. High C-reactive protein levels and elevations of both ALT and AST were observed in 3 severely ill patients on admission. All 18 patients were eventually discharged, including the 3 severe patients who recovered after treatment with non-invasive mechanical ventilation, convalescent plasma and other therapies. Our findings confirmed human-to-human transmission of SARS-CoV-2 in clusters. The strategies of early diagnosis, early isolation, and early treatment are important to prevent the spread of COVID-19 and improve the cure rate. Patients with comorbidities are more likely to develop severe illness and could benefit from convalescent plasma transfusion.
Clinical Characteristics and Short-Term Outcomes of Severe Patients with COVID-19 in Wuhan, China
Authors: Feng Xiaobo , Li Peiyun , Ma Liang , Liang Hang , Lei Jie , Li Wenqiang , Wang Kun , Song Yu , Li Shuai , Yang Wei , Yang Cao
Published: April 2020

Objective

A novel pneumonia (COVID-19) which is sweeping the globe was started in December, 2019, in Wuhan, China. Most deaths occurred in severe and critically cases, but information on prognostic risk factors for severe ill patients is incomplete. Further research is urgently needed to guide clinicians, so we prospectively evaluate the clinical outcomes of 114 severe ill patients with COVID-19 for short-term in the Union Hospital in Wuhan, China.

Methods

In this single-centered, prospective and observational study, we enrolled 114 severe ill patients with confirmed COVID-19 from Jan 23, 2020 to February 22, 2020. Epidemiological, demographic and laboratory information were collected at baseline, data on treatment and outcome were collected until the day of death or discharge or for the first 28 days after severe ill diagnosis, whichever was shorter. Univariate and multivariate Cox proportional hazard models were used to determine hazard ratios (HRs) and 95% confidence intervals (CIs) of poor outcome.

Results

Among enrolled 114 patients, 94 (82.5%) had good outcome while 20 (17.5%) had poor outcome. No significant differences were showed in age, gender and the prevalence of coexisting disorders between outcome groups. Results of multivariate Cox analyses indicated that higher levels of oxygen saturation (HR, 0.123; 95% CI, 0.041-0.369), albumin (HR, 0.060; 95% CI, 0.008-0.460) and arterial partial pressure of oxygen (HR, 0.321; 95% CI, 0.106-0.973) were associated with decreased risk of developing poor outcome within 28 days. In the other hand, higher levels of leucocytes (HR, 5.575; 95% CI, 2.080-14.943), neutrophils (HR, 2.566; 95% CI, 1.022-6.443), total bilirubin (HR, 6.171; 95% CI, 2.458- 15.496), globulin (HR, 2.526; 95% CI, 1.027-6.211), blood urea nitrogen (HR, 5.640; 95% CI, 2.193-14.509), creatine kinase-MB (HR, 3.032; 95% CI, 1.203-7.644), lactate dehydrogenase (HR, 4.607; 95% CI, 1.057-20.090), hypersensitive cardiac troponin I (HR, 5.023; 95% CI, 1.921-13.136), lactate concentration (HR,15.721; 95% CI, 2.099-117.777), Interleukin-10 (HR, 3.551; 95% CI, 1.280-9.857) and C-reactive protein (HR, 5.275; 95% CI, 1.517-18.344) were associated with increased risk of poor outcome development. We also found that traditional Chinese medicine can significantly improve the patient’s condition, which is conducive to the transformation from severe to mild.

Conclusion

In summary, we firstly reported this single-centered, prospective and observational study for short-term outcome in severe patients with COVID-19. We found that cytokine storm and uncontrolled inflammation responses, liver, kidney, cardiac dysfunction may play important roles in final outcome of severe ill patients with COVID-19. Our study will provide clinicians to be benefit to rapidly estimate the likelihood risk of short-term poor outcome for severe patients.
Contextualizing covid-19 spread: a county level analysis, urban versus rural, and implications for preparing for the next wave
Authors: Rao J. Sunil , Zhang Hang , Mantero Alejandro
Published: April 2020

Paraphrasing [Morano and Holt, 2017], contextual determinants of health including social, environmental, healthcare and others, are a so-called deck of cards one is dealt. The ability to modify health outcomes varies then based upon how one’s hand is played. It is thus of great interest to understand how these determinants associate with the emerging pandemic covid-19. To this end, we conducted a deep-dive analysis into this problem using a recently curated public dataset on covid-19 that connects infection spread over time to a rich collection of contextual determinants for all counties of the U.S and Washington, D.C. Using random forest machine learning methodology, we identified a relevant constellation of contextual factors of disease spread which manifest differently for urban and rural counties. The findings also have clear implications for better preparing for the next wave of disease.
The Relationship between Cannabis Use and Cognition in People with Bipolar Disorder: A Systematic Scoping Review
Authors: Walter T. Jordan , Pocuca Nina , Young Jared W. , Geyer Mark A. , Minassian Arpi , Perry William
Published: April 2020

Bipolar disorder (BD) and cannabis use are highly comorbid and are each associated with cognitive impairment. It is therefore important to understand the relationship between cannabis use and cognition in people with BD, as cannabis use in BD may be associated with greater cognitive impairment. We performed a scoping review to determine how much and what is currently known in this field. We systematically searched PubMed, Embase, CINAHL, Web of Science, and PsycINFO for studies on the relationship between cannabis and cognition in people with BD or relevant animal models. Six observational human studies met inclusion criteria. Two studies found cannabis use in BD was associated with better performance in some cognitive domains, while three studies found no association. One study found cannabis use in BD was associated with worse overall cognition. Overall, most identified studies suggest cannabis use is not associated with significant cognitive impairment in BD; however, the scope of knowledge in this field is limited, and more systematic studies are clearly required. Future studies should focus on longitudinal and experimental trials, as well as well-controlled observational studies with rigorous quantification of the onset, frequency, quantity, duration, and type of cannabis use.
Intra-host site-specific polymorphisms of SARS-CoV-2 is consistent across multiple samples and methodologies
Authors: Rose Rebecca , Nolan David J. , Moot Samual , Feehan Amy , Cross Sissy , Garcia-Diaz Julia , Lamers Susanna L.
Published: April 2020

Despite the potential relevance to clinical outcome, intra-host dynamics of SARS-CoV-2 are unclear. Here, we quantify and characterize intra-host variation in SARS-CoV-2 raw sequence data uploaded to SRA as of 14 April 2020, and compare results between two sequencing methods (amplicon and RNA-Seq). Raw fastq files were quality filtered and trimmed using Trimmomatic, mapped to the WuhanHu1 reference genome using Bowtie2, and variants called with bcftools mpileup. To ensure sufficient coverage, we only included samples with 10X coverage for >90% of the genome (n=406 samples), and only variants with a depth >=10. Derived (i.e. non-reference) alleles were found at 408 sites. The number of polymorphic sites (i.e. sites with multiple alleles) within samples ranged from 0-13, with 72% of samples (295/406) having at least one polymorphic site. Correlation between number of polymorphic sites and coverage was very low for both sequencing methods (R2 < 0.1, p < 0.05). Polymorphisms were observed >1 sample at 66 sites (range: 2-38 samples). The minor allele frequency (MAF) at each shared polymorphic site was 0.03% - 48.5%. 33/66 sites occurred in ORF1a1b, and 37/66 changes were non-synonymous. At 10/66 sites, derived alleles were found in samples sequenced using both methods. Polymorphic amplicon samples were found at 10/10 positions, while polymorphic RNA-Seq samples were found at 7/10 positions. In conclusion, our results suggest that intra-host variation is prevalent among clinical samples. While mutations resulting from amplification and/or sequencing errors cannot be excluded, the observation of shared polymorphic sites with high MAF across multiple samples and sequencing methods is consistent with true underlying variation. Further investigation into intra-host evolutionary dynamics, particularly with longitudinal sampling, is critical for broader understanding of disease progression.
KAT7 is a therapeutic vulnerability ofMLL-rearranged acute myeloid leukemia
Authors: Au Yan Zi , Gu Muxin , De Braekeleer Etienne , Yu Jason , Ong Swee Hoe , Gozdecka Malgorzata , Chen Xi , Tzelepis Konstantinos , Huntly Brian J.P , Vassiliou George , Yusa Kosuke
Published: April 2020

Histone acetyltransferases (HATs) catalyze the transfer of an acetyl group from acetyl-CoA to lysine residues of histones and play a central role in transcriptional regulation in diverse biological processes. Dysregulation of HAT activity can lead to human diseases including developmental disorders and cancer. Through genome-wide CRISPR-Cas9 screens, we identified several HATs of the MYST family as fitness genes for acute myeloid leukaemia (AML). Here we investigate the essentiality of lysine acetyltransferase KAT7 in AMLs driven by theMLL-Xgene fusions. We found that KAT7 loss leads to a rapid and complete loss of both H3K14ac and H4K12ac marks, in association with reduced proliferation, increased apoptosis and differentiation of AML cells. Acetyltransferase activity of KAT7 is essential for the proliferation of these cells. Mechanistically, our data propose that acetylated histones provide a platform for the recruitment of MLL-fusion-associated adaptor proteins such as BRD4 and AF4 to gene promoters. Upon KAT7 loss, these factors together with RNA polymerase II rapidly dissociate from several MLL-fusion target genes that are essential for AML cell proliferation, includingMEIS1, PBX3andSENP6. Our findings reveal that KAT7 is a plausible therapeutic target for this poor prognosis AML subtype.