bluuebunny/crossref_metadata_2025 huggingface dataset:
Operative Treatment of Cervical Spine Injuries Sustained in Youth Sports
Authors: Verhofste Bram P. , Hedequist Daniel J. , Birch Craig M. , Rademacher Emily S. , Glotzbecker Michael P. , Proctor Mark R. , Yen Yi-Meng
Published: September 2021

Background:

Little data exists on surgical outcomes of sports-related cervical spine injuries (CSI) sustained in children and adolescent athletes. This study reviewed demographics, injury characteristics, management, and operative outcomes of severe CSI encountered in youth sports.

Methods:

Children below 18 years with operative sports-related CSI at a Level 1 pediatric trauma center were reviewed (2004 to 2019). All patients underwent morden cervical spine instrumentation and fusion. Clinical, radiographic, and surgical characteristics were analyzed.

Results:

A total of 3231 patients (mean, 11.3±4.6 y) with neck pain were evaluated for CSI. Sports/recreational activities were the most common etiology in 1358 cases (42.0%). Twenty-nine patients (2.1%) with sports-related CSI (mean age, 14.5 y; range, 6.4 to 17.8 y) required surgical intervention. Twenty-five were males (86%). Operative CSI occurred in football (n=8), wrestling (n=7), gymnastics (n=5), diving (n=4), trampoline (n=2), hockey (n=1), snowboarding (n=1), and biking (n=1). Mechanisms were 27 hyperflexion/axial loading (93%) and 2 hyperextension injuries (7%). Most were cervical fractures (79%) and subaxial injuries (79%). Seven patients (24%) sustained spinal cord injury (SCI) and 3 patients (10%) cord contusion or myelomalacia without neurological deficits. The risk of SCI increased with age (P=0.03). Postoperatively, 2 SCI patients (29%) improved 1 American Spinal Injury Association Impairment Scale Grade and 1 (14%) improved 2 American Spinal Injury Association Impairment Scale Grades. Increased complications developed in SCI than non-SCI cases (mean, 2.0 vs. 0.1 complications;P=0.02). Bony fusion occurred in 26/28 patients (93%) after a median of 7.2 months (interquartile range, 6 to 15 mo). Ten patients (34%) returned to their baseline sport and 9 (31%) to lower-level activities.

Conclusions:

The incidence of sports-related CSI requiring surgery is low with differences in age/sex, sport, and injury patterns. Older males with hyperflexion/axial loading injuries in contact sports were at greatest risk of SCI, complications, and permanent disability. Prevention campaigns, education on proper tackling techniques, and neck strength training are required in sports at high risk of hyperflexion/axial loading injury.

Level of Evidence:

Level III—retrospective cohort study.
Effect of the Implementation of a Surgical Care Bundle in the Incidence of Surgical Site Infection in Spine Surgery
Authors: Vicente-Sánchez Gema , Alonso-García Marcos , Hijas-Gómez Ana Isabel , González-Díaz Rafael , Martinez-Martín Javier , Fahandezh-Saddi Homid , Durán-Poveda Manuel , Gil-de-Miguel Angel , Rodríguez-Caravaca Gil
Published: September 2021

Study Design.

Quasi-experimental intervention study.

Objective.

To assess the effect of a clinical safety and quality improvement plan for patients undergoing spinal fusion surgery on the incidence of surgical site infection (SSI).

Summary of Background Data.

In recent years, infection surveillance and control programs based on care bundles have been included in surgical protocols. These have proven to be essential tools for the prevention and control of SSI, providing indicators for improvement and allowing the characterization of related risk factors.

Methods.

A quasi-experimental study was carried out with analysis before and after the introduction of a preventive care bundle (clinical safety and quality improvement plan). Patients who underwent spinal fusion surgery were included. The incidence of SSI up to 90 days after surgery (maximum incubation period) was assessed. The effect of the intervention was evaluated with the adjusted odds ratio (oR) using a logistic regression model.

Results.

A total of 1554 patients were included, 690 in the period 2007 to 2011 (before) and 864 during 2012 to 2018 (after). SSI incidence decreased from 4.2% to 1.9% after the plan (OR: 0.43; 95% confidence interval: 0.23–0.80; P 
= 0.006). There was also an improvement in the adequacy of antibiotic prophylaxis, preoperative preparation, and hair removal procedure after the introduction of the care bundle.

Conclusion.

After implementation of the care bundle, the incidence of SSI in spine fusion surgery decreased significantly. Multivariate analysis showed that the care bundle was an independent protective factor. The implementation of these measures should be reinforced on the routine medical practice to reduce the SSI incidence.

Level of Evidence: 3
Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients with Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery
Authors: Ko Sangbong , Jun ChungMu , Min Woo-Kie , Son Eunseok , Lee Sukjoong , Lee Gun Woo , Yoo Hyunseung
Published: September 2021

Study Design.

Retrospective study of data collected prospectively.

Objective.

To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life.

Summary of Background Data.

SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter.

Methods.

We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-item Short Form Survey (SF-36) physical component score (PCS) and mental component score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24 months after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24 months after surgery.

Results.

The improvement in LLRP in the short term (6 hours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12 months after SNRB (P = 0.044, correlation coefficient = 0.261). No relationship between pain improvement after SNRB and functional outcome was identified.

Conclusion.

The degree of improvement in symptoms 6 hours after SNRB can predict the degree of improvement in LLRP at 12 months after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.

Level of Evidence: 4
Management and Outcomes of Hematological Immune-related Adverse Events: Systematic Review and Meta-analysis
Authors: Wilson Nathaniel R. , Lockhart Jonathan R. , Garcia-Perdomo Herney A. , Oo Thein H. , Rojas-Hernandez Cristhiam M.
Published: September 2021

Data regarding clinical outcomes and management of hematological manifestations of immune checkpoint inhibition (ICI) is limited to case reports, series, and a few retrospective reviews. We aimed to determine the rate of response of hematological immune-related adverse events (irAEs) to immunosuppressive therapy. MEDLINE (OVID), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to the present day. Retrospective reports were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration’s tool. The primary outcome of this study was the rate of response to immunosuppression. Eighty studies (14 case series and 66 individual case reports) were analyzed with a total of 135 patients with ICI-related hematological irAEs. Data analysis showed an average proportional response rate to immunosuppression among hematological irAE entities of 50% (range: 25%–70%). The heterogeneity index (I
2) was 0% among reports within each entity. There is a wide spectrum of hematological manifestations to ICI therapy, and to date there is no large randomized-controlled trial data to evaluate the efficacy of treatment strategies for hematological irAEs. We found a variable overall response rate to immunosuppression therapy of around 50%, without statistically significant heterogeneity among different irAE types but significant differences among the different countries of publication. Future studies evaluating the optimal dose and duration of immunosuppressive agents for patients with hematological irAEs should be undertaken.
Efficacy and Safety of Gemcitabine Plus Cisplatin as Potential Preoperative Chemotherapy in Locally Advanced Intrahepatic, Perihilar, and Mid-Cholangiocarcinoma
Authors: Nooijen Lynn E. , Franken Lotte C. , Belkouz Ali , Oulad Abdennabi Ikrame , Besselink Marc G. , Busch Olivier R. , Swijnenburg Rutger-Jan , Klümpen Heinz-Josef , Erdmann Joris I.
Published: September 2021

Background:

In this retrospective cohort study, the potential of gemcitabine (gem)/cisplatin (cis) chemotherapy as future preoperative therapy for patients with unresectable locally advanced or borderline resectable intrahepatic, perihilar, and mid-cholangiocarcinoma was investigated.

Methods:

All patients with intrahepatic, perihilar, and mid-cholangiocarcinoma presented at Amsterdam UMC between January 2016 and October 2019 were included. The radiologic response after 3 and/or 6 cycles of gem/cis chemotherapy in patients with unresectable locally advanced or borderline resectable disease was derived from the original radiologic reports and subsequently re-evaluated for surgical exploration by consensus reading of 2 HPB surgeons and 1 radiologist.

Results:

Overall, 65 of 364 patients had a locally advanced or borderline resectable disease. Twenty-eight patients were treated with palliative chemotherapy, including 25 (89.3%) patients who received more than 3 cycles. Twenty-two patients (88.0%) and 13 patients (46.4%) showed RECIST stable disease or partial response after 3 and 6 cycles of chemotherapy, respectively. Three patients experienced grade 3 adverse events. Consensus reading concluded that exploration could have been reconsidered in 7 of 28 patients (25.0%).

Conclusion:

Gem/cis may be a safe and feasible preoperative treatment in initially unresectable locally advanced or borderline resectable cholangiocarcinoma. In addition, the findings of this study support to always rediscuss patients with stable or responsive disease in multidisciplinary team meetings to reconsider resection. Besides, prospective studies are needed to investigate this effect further and, based on these preliminary data, seem feasible in this setting.
Automated Microneedling Versus Fractional CO2 Laser in Treatment of Traumatic Scars: A Clinical and Histochemical Study
Authors: Esmat Samia , Shokeir Hisham Ali , Samy Nevien Ahmed , Mahmoud Sara Bahaa , Sayed Safinaz Salah EL Din , Shaker Enas , Hilal Rana Fathy
Published: September 2021

BACKGROUND/OBJECTIVES

Microneedling has shown satisfactory effects in scar rejuvenation. Comparisons of its results with fractional laser are limited. This study aims to compare the efficacy and safety of automated microneedling versus fractional carbon dioxide (CO2) laser in treatment of traumatic scars on clinical and histochemical bases.

MATERIALS AND METHODS

Thirty patients with traumatic facial scars were randomized to treatment with 4 monthly sessions of either automated microneedling or fractional CO2 laser. Assessment of scars was performed at baseline and 3 months after the last treatment session, clinically by the modified Vancouver Scar Scale (mVSS) and histochemically by quantitative assessment of collagen and elastic fibers.

RESULTS

Both groups showed improvement in mVSS, collagen, and elastin contents after treatment. Percentage improvement of collagen and elastin content was higher after treatment by a laser compared with microneedling, in case of the collagen content. Percentage increase in the collagen content after treatment was higher in atrophic scars of the laser group than those of the microneedling group.

CONCLUSION

In this small study, microneedling was as safe as fractional CO2 laser for rejuvenation of traumatic scars with comparable clinical effects. Fractional CO2 laser is more powerful in stimulating neocollagenesis. Automated microneedling is effective for treatment of hypertrophic scars.
Posterior Placenta Accreta Spectrum Disorders: Risk Factors, Diagnostic Accuracy, and Surgical Management
Authors: Palacios-Jaraquemada José Miguel , D’Antonio Francesco
Published: September 2021

Posterior placenta accreta spectrum (PAS) disorders are infrequent but potentially associated with significant maternal mortality and morbidity, especially if not diagnosed prenatally. Analysis of published literature is problematic since most experiences included only a few cases. Knowledge of the risk factors associated with posterior PAS is crucial to identifying mothers at higher risk and ask for high sensitivity studies. Ultrasound has poor diagnostic accuracy in detecting posterior PAS, while magnetic resonance imaging better delineates the posterior uterine wall. In comparison, prenatal imaging's diagnostic performance in detecting posterior PAS is significantly lower than anterior placenta invasion. Management of posterior PAS depends on several factors, including maternal hemodynamic status, available resources, clinical presentation, and invasion severity. For accreta or increta cases, a compression suture is habitually enough to perform hemostasis. Nevertheless, organ involvement habitually requires a multidisciplinary team with the assistant of a general or coloproctology surgeon. The present article aims to update the risk factors, prenatal diagnosis, and surgical management of pregnancies complicated by posterior PAS.
Scleral Lens–Induced Corneal Edema After Radial Keratotomy
Authors: Arnold Thomas P. , Vincent Stephen J.
Published: September 2021

This case series examines the magnitude and regional variation in scleral lens–induced corneal edema in postradial keratotomy (RK) eyes. Scheimpflug imaging was used to measure corneal thickness across the central 6 mm before and after scleral lens wear in nine post-RK eyes (median age 64 years). Variations in corneal edema were examined as a function of distance from the corneal center (six 0.5-mm annuli) and from 0° to 360°. The median central corneal edema was 2.19% (interquartile range 1.03%–3.18%; P=0.02) and increased in magnitude and variability further from the central cornea (from 1.30% in the central 0–0.5 mm to 3.12% in the 2.5–3.0 mm midperiphery) (P=0.02). Scleral lens–induced corneal edema in post-RK eyes was greater in magnitude further from the corneal center and at the approximate location of corneal incisions.
High-Dose Oral Posaconazole for the Treatment of Recalcitrant Fungal Keratitis
Authors: Ferguson Tanner J. , Downes Rachel A. , Isada Carlos M. , Goshe Jeff M.
Published: September 2021

Purpose:

To report the successful treatment of 3 cases of recalcitrant fungal keratitis (FK) with high-dose oral posaconazole.

Methods:

This is a series of 3 patients from a single academic center with a culture-positive FK who were treated with oral posaconazole after failing to respond to conventional treatments.

Results:

All 3 patients had a history of contact lens wear. Two of the 3 cases were culture positive for Fusarium and the other for Paecilomyces. The infections of all 3 failed to respond to conventional antifungal therapies including varying combinations of topical, systemic, and intraocular antifungal therapies. All 3 cases rapidly responded to high-dose oral posaconazole ranging from 500 to 600 mg once daily. In 1 case, multiple courses of high-dose therapy were required to treat delayed recurrences of a latent infection. There were no significant adverse effects with the elevated dose, and treatment was administered with the guidance of an infectious disease specialist.

Conclusions:

In cases of recalcitrant FK failing to respond to conventional therapies, high-dose posaconazole, in the delayed-release tablet formulation, can be an effective treatment option.
Corneal Remodeling After Myopic SMILE Versus FS-LASIK: A Spatial Analysis of Short- and Mid-Term Corneal Thickness, Volume, and Shape Changes
Authors: Lazaridis Apostolos , Spiru Bogdan , Giallouros Elefterios , Droutsas Konstantinos , Messerschmidt-Roth Anke , Sekundo Walter
Published: September 2021

Purpose:

To evaluate the short- and mid-term changes of corneal thickness spatial profile (CTSP), corneal volume distribution (CVD), and corneal asphericity after small-incision lenticule extraction (SMILE) for correction of myopia and astigmatism and compare the results with femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK).

Method:

Thirty eyes of 18 patients who underwent SMILE were compared with a group of 30 eyes of 16 patients who underwent FS-LASIK. The groups were matched for preoperative central corneal thickness and lenticule thickness/ablation depth. Scheimpflug corneal tomography was performed preoperatively and postoperatively at 2 months and 3 years. The CTSP was evaluated on 4 concentric rings (2, 4, 6, and 8 mm). The CVD was evaluated at 3 concentric zones (3, 5, and 7 mm). Changes in the anterior and posterior asphericity at a 6-mm zone were also evaluated.

Results:

Between the 2-month and 3-year examination, the CTSP showed a similar increase for both groups at all measured points and rings (P ≥ 0.168). The CVD also showed a similar increase for both groups at all measured zones (P ≥ 0.278). The anterior corneal asphericity remained stable after SMILE (2-mo Q = 0.46 ± 0.27; 3-yr Q = 0.45 ± 0.27; P = 0.711) but decreased significantly after FS-LASIK (2-mo Q = 0.52 ± 0.47; 3-yr Q = 0.47 ± 0.44; P = 0.028). Similarly, the posterior corneal asphericity remained stable after SMILE (2-mo Q = −0.11 ± 0.15; 3-yr Q = −0.11 ± 0.13; P = 0.902) but decreased significantly after FS-LASIK (2-mo Q = −0.13 ± 0.14; 3-yr Q = −0.16 ± 0.15; P = 0.034).

Conclusions:

CTSP and CVD between the 2-month and 3-year examination showed a similar increase after SMILE and FS-LASIK. During the postoperative course, the anterior and posterior corneal asphericity remained more stable after SMILE compared with FS-LASIK.
Epidemiology of Pemphigus: A Single Center Experience in Morocco
Authors: El Hadadi Farah , Mezni Line , Senouci Karima , Benzekri Laila , Ismaili Nadia , Meziane Mariame
Published: September 2021

Objective:

Pemphigus is a life threatening autoimmune bullous disease which involves the skin and mucous membranes of the stratified squamous epithelium. The global distribution of Pemphigus varies according to genetic, ethnic, socioeconomic, and cultural backgrounds. The purpose of our study is to evaluate the epidemiological features of pemphigus a single center in Morocco and compare our results with those reported elsewhere.

Methods:

A retrospective analysis was conducted of 302 pemphigus patients seen between 1990 and 2020 in the Dermatology Department of Ibn Sina Hospital (Rabat, Morocco). We further collected all the Moroccan scientific researches published by now to compare.

Results:

The average annual incidence was 0.32/100,000 inhabitants. The incidence doubled to 0.72 in 2020. The most common variant was pemphigus vulgaris (125 cases) followed by pemphigus erythematosus (99 cases), pemphigus foliaceous (40 cases), and vegetans (27 cases). The female to male ratio was 0.75, the average age at onset was 53years old and the mean duration of the disease before diagnosis was 13.36months.

Conclusion:

This study joins the main characteristics of pemphigus in the Maghreb and around the world (pemphigus vulgaris most frequent subtype). In 2020, an epidemiological peak occurred during the coronavirus disease 2019 pandemic; probably related to stress and delayed time consultation for fear of contracting the severe acute respiratory syndrome coronavirus 2.
Describing cognitive function and psychosocial outcomes of COVID-19 survivors: A cross-sectional analysis
Authors: Henneghan Ashley M. , Lewis Kimberly A. , Gill Eliana , Franco-Rocha Oscar Y. , Vela Ruben D. , Medick Sarah , Kesler Shelli R.
Published: September 2021

Background:

Neurological and psychological symptoms are increasingly realized in the post-acute phase of COVID-19.

Purpose:

To examine and characterize cognitive and related psychosocial symptoms in adults (21–75 years) who tested positive for or were treated as positive for COVID-19.

Methods:

In this cross-sectional study, data collection included a cognitive testing battery (Trails B; Digit Symbol; Stroop; Immediate and Delayed Verbal Learning) and surveys (demographic/clinical history; self-reported cognitive functioning depressive symptoms, fatigue, anxiety, sleep disturbance, social role performance, and stress). Results were compared with published norms, rates of deficits (more than 1 standard deviation (SD) from the norm) were described, and correlations were explored.

Results:

We enrolled 52 participants (mean age 37.33 years; 78.85% female) who were, on average, 4 months post illness. The majority had a history of mild or moderate COVID-19 severity. Forty percent of participants demonstrated scores that were 1 SD or more below the population norm on one or more of the cognitive tests. A subset had greater anxiety (21.15%), depressive symptoms (23.07%), and sleep disturbance (19.23%) than population norms. Age differences were identified in Stroop, Digit Symbol, and Trails B scores by quartile (p < .01), with worse performance in those 28–33 years old.

Conclusions:

Cognitive dysfunction and psychological symptoms may be present in the weeks or months after COVID-19 diagnosis, even in those with mild to moderate illness severity.

Implications for practice:

Clinicians need to be aware and educate patients about the potential late/long-term cognitive and psychological effects of COVID-19, even in mild to moderate disease.
Narrative Nursing
Authors: Fitzpatrick Joyce J.
Published: September 2021

Narrative Nursing is a form of storytelling that is used as an intervention with nurses to empower them to share their profound experiences in the nurse-patient relationship. Nurses participating in the Narrative Nursing workshops each share an individual encounter that was meaningful in their own nursing career. The shared experience serves to acclaim the power of nurses as leaders at the point of care and nurse leaders mentoring others. Four stories of nurse leadership are included in this article, 2 from clinical nurses providing care at the bedside and 2 from nurses in leadership roles. Participants in Narrative Nursing describe the workshops as inspirational, affirming, and empowering of the essence of professional nursing. Leadership lessons learned from the Narrative Nursing experiences thus far are included as are plans for future work to inspire all nurses at all levels of leadership. The future work includes embedding the intervention within relationship-based leadership theories.
Using Text Messages to Support Nurse Well-being
Authors: Kelly Lesly A. , Schaeffer Robin , Roe Sue , Buchda Vicki L.
Published: September 2021

The COVID-19 pandemic caused significant nurse stress and contributed to burnout for a number of reasons, including but not limited to personal protective equipment shortages, furloughs, overtime, reassignment to unfamiliar work environments, and alternate staffing patterns, all of which contribute to grief, loss, fear, and anger. While the nursing profession and employers offered support and psychological first-aid resources, there was a disconnect in effectively linking stressed nurses with these needed resources. An innovative statewide pilot project in Arizona, RNconnect 2 Wellbeing, was created to determine whether nurses might respond to and use supportive resources via opt-in text messages. Over a 12-week enrollment trial, 2997 nurse users opted to receive brief, twice weekly, well-being text messages about subjects, such as increasing awareness, self-care, and gratitude. By the end of the pilot, 2777 nurse users remained enrolled (7% opt out). Convenience evaluation surveys were conducted at midpoint (n = 294) and pilot completion (n = 404). Satisfaction with the messages ranged from 73% to 86%. Forty-eight percent indicated they had integrated the resources into their daily lives. RNconnect 2 Wellbeing, an innovative and cost-effective approach to communicating with nurses, has laid the groundwork for the use of technology via brief text messages to improve nurse well-being.
Racism as a Preventable Harm
Authors: Watson Laura , Malcolm Mia
Published: September 2021

Since 1619, racism has been a preexisting condition placing Black people at higher risk of death in America. Generational harm done to the Black community has eroded trust in the health care system. Racial biases, largely unconscious, held by health care professionals can directly result in morbidity and mortality. These biases are amenable to intervention, and thus, these events are preventable. Health care institutions must choose to view racism as a preventable harm and address it with the same fervency devoted to other preventable harms that have been prioritized for decades. Prior attempts to address racism in health care institutions have not resulted in sustained cultural change because unconscious racial biases have not been addressed. Antiracism bundle elements are proposed as evidence-based, conscious tools for subverting unconscious racial biases held by health care providers, thus empowering leaders and staff to prevent further trauma to Black patients and families, with the goal of decreasing racialized health disparities.
Acute Movement Disorders in Childhood
Authors: Benrhouma Hanene , Nasri Amina , Klaa Hedia , Ben Achour Nedia , Rouissi Aida , Kraoua Ichraf , Turki Ilhem
Published: September 2021

Objectives

Acute movement disorders (AMD) are frequent in neurological and pediatric emergencies. Few studies analyzed AMD in children, none in Tunisia or other African country. The purpose of this study was to describe the peculiarities of AMD in a Tunisian pediatric population with a literature review.

Methods

We conducted a retrospective descriptive study over 8 years including 80 children (sex ratio, 1.05; mean age of onset, 4.8 years) with AMD, followed in tertiary referral Child Neurology Department in North Tunisia.

Results

Acute movement disorders were mainly hyperkinetic (n = 67 with dystonia (n = 33; mostly due to inherited metabolic diseases (IMD) in 11; with status epilepticus in 10 children), chorea (n = 14; with Sydenham chorea in 5); myoclonus (n = 14; mostly with opsoclonus-myoclonus syndrome in 10) and tremor (n = 6; of posttraumatic origin in half). Hypokinetic movement disorder (MD) included acute parkinsonism in 5 children of infectious (n = 3), postinfectious (n = 1, malaria) and posttraumatic origin (n = 1). Mixed MD, found in 8 children, were mainly due to IMD in half of them, and to familial lupus in two. Paroxysmal MDs were seen in 2 children, one with multiple sclerosis and one of idiopathic origin. Psychogenic MDs were found in 7 patients mainly of dystonic type. Management of AMD comprised symptomatic treatment according to the phenomenology of the MD and causative treatment depending on its etiology.

Conclusions

Our study illustrated the broad range of AMD in children and the wide spectrum of their etiologies. In our series, we described some exceptional findings and etiologies of AMD in children. These findings may denote a specific profile in of AMD in our country with predominant infectious, postinfectious, and IMD.
Multiphysics modelling of photon, mass and heat transfer in coral microenvironments
Authors: Taylor Parkins Shannara Kayleigh , Murthy Swathi , Picioreanu Cristian , Kühl Michael
Published: September 2021

Coral reefs are constructed by calcifying coral animals that engage in a symbiosis with dinoflagellate microalgae harboured in their tissue. The symbiosis takes place in the presence of steep and dynamic gradients of light, temperature and chemical species that are affected by the structural and optical properties of the coral and their interaction with incident irradiance and water flow. Microenvironmental analyses have enabled quantification of such gradients and bulk coral tissue and skeleton optical properties, but the multi-layered nature of corals and its implications for the optical, thermal and chemical microenvironment remains to be studied in more detail. Here, we present a multiphysics modelling approach, where three-dimensional Monte Carlo simulations of the light field in a simple coral slab morphology with multiple tissue layers were used as input for modelling the heat dissipation and photosynthetic oxygen production driven by photon absorption. By coupling photon, heat and mass transfer, the model predicts light, temperature and O
2
gradients in the coral tissue and skeleton, under environmental conditions simulating, for example, tissue contraction/expansion, symbiont loss via coral bleaching or different distributions of coral host pigments. The model reveals basic structure–function mechanisms that shape the microenvironment and ecophysiology of the coral symbiosis in response to environmental change.
Haem-responsive gene transporter enables mobilization of host haem in ticks
Authors: Perner J. , Hatalova T. , Cabello-Donayre M. , Urbanova V. , Sojka D. , Frantova H. , Hartmann D. , Jirsova D. , Pérez-Victoria J. M. , Kopacek P.
Published: September 2021

Ticks, notorious blood-feeders and disease-vectors, have lost a part of their genetic complement encoding haem biosynthetic enzymes and are, therefore, dependent on the acquisition and distribution of host haem. Solute carrier protein SLC48A1, aka haem-responsive gene 1 protein (HRG1), has been implicated in haem transport, regulating the availability of intracellular haem. HRG1 transporter has been identified in both free-living and parasitic organisms ranging from unicellular kinetoplastids, nematodes, up to vertebrates. However, an HRG1 homologue in the arthropod lineage has not yet been identified. We have identified a single HRG1 homologue in the midgut transcriptome of the tick
Ixodes ricinus,
denoted as
Ir
HRG, and have elucidated its role as a haem transporter. Data from haem biosynthesis-deficient yeast growth assays, systemic RNA interference and the evaluation of gallium protoporphyrin IX-mediated toxicity through tick membrane feeding clearly show that
Ir
HRG is the
bona fide
tetrapyrrole transporter. We argue that during evolution, ticks profited from retaining a functional
hrg1
gene in the genome because its protein product facilitates host haem escort from intracellularly digested haemoglobin, rendering haem bioavailable for a haem-dependent network of enzymes.
Reconstructing a point source from diffusion fluxes to narrow windows in three dimensions
Authors: Dobramysl U. , Holcman D.
Published: September 2021

We develop a computational approach to locate the source of a steady-state gradient of diffusing particles from the fluxes through narrow windows distributed either on the boundary of a three-dimensional half-space or on a sphere. This approach is based on solving the mixed boundary stationary diffusion equation with Neumann–Green’s function. The method of matched asymptotic expansions enables the computation of the probability fluxes. To explore the range of validity of this expansion, we develop a fast analytical-Brownian numerical scheme. This scheme accelerates the simulation time by avoiding the explicit computation of Brownian trajectories in the infinite domain. The results obtained from our derived analytical formulae and the fast numerical simulation scheme agree on a large range of parameters. Using the analytical representation of the particle fluxes, we show how to reconstruct the location of the point source. Furthermore, we investigate the uncertainty in the source reconstruction due to additive fluctuations present in the fluxes. We also study the influence of various window configurations: clustered versus uniform distributions on recovering the source position. Finally, we discuss possible applications for cell navigation in biology.
Temporally balanced selection during development of larval Pacific oysters (Crassostrea gigas) inherently preserves genetic diversity within offspring
Authors: Durland Evan , De Wit Pierre , Langdon Chris
Published: September 2021

Balancing selection is one of the mechanisms which has been proposed to explain the maintenance of genetic diversity in species across generations. For species with large populations and complex life histories, however, heterogeneous selection pressures may create a scenario in which the net effects of selection are balanced across developmental stages. With replicated cultures and a pooled sequencing approach, we show that genotype-dependent mortality in larvae of the Pacific oyster (Crassostrea gigas) is largely temporally dynamic and inconsistently in favour of a single genotype or allelic variant at each locus. Overall, the patterns of genetic change we observe to be taking place are more complex than what would be expected under classical examples of additive or dominant genetic interactions. They are also not easily explained by our current understanding of the effects of genetic load. Collectively, temporally heterogeneous selection pressures across different larval developmental stages may act to maintain genetic diversity, while also inherently sheltering genetic load within oyster populations.
A sink host allows a specialist herbivore to persist in a seasonal source
Authors: Laska Alicja , Magalhães Sara , Lewandowski Mariusz , Puchalska Ewa , Karpicka-Ignatowska Kamila , Radwańska Anna , Meagher Shawn , Kuczyński Lechosław , Skoracka Anna
Published: September 2021

In seasonal environments, sinks that are more persistent than sources may serve as temporal stepping stones for specialists. However, this possibility has to our knowledge, not been demonstrated to date, as such environments are thought to select for generalists, and the role of sinks, both in the field and in the laboratory, is difficult to document. Here, we used laboratory experiments to show that herbivorous arthropods associated with seasonally absent main (source) habitats can endure on a suboptimal (sink) host for several generations, albeit with a negative growth rate. Additionally, they dispersed towards this host less often than towards the main host and accepted it less often than the main host. Finally, repeated experimental evolution attempts revealed no adaptation to the suboptimal host. Nevertheless, field observations showed that arthropods are found in suboptimal habitats when the main habitat is unavailable. Together, these results show that evolutionary rescue in the suboptimal habitat is not possible. Instead, the sink habitat functions as a temporal stepping stone, allowing for the persistence of a specialist when the source habitat is gone.
wMel Wolbachia genome remains stable after 7 years in Australian Aedes aegypti field populations
Authors: Dainty Kimberley R. , Hawkey Jane , Judd Louise M. , Pacidônio Etiene C. , Duyvestyn Johanna M. , Gonçalves Daniela S. , Lin Silk Yu , O'Donnell Tanya B. , O'Neill Scott L. , Simmons Cameron P. , Holt Kathryn E. , Flores Heather A.
Published: September 2021

Infection of wMel

Wolbachia

in Aedes aegypti imparts two signature features that enable its application for biocontrol of dengue. First, the susceptibility of mosquitoes to viruses such as dengue and Zika is reduced. Second, a reproductive manipulation is caused that enables wMel introgression into wild-type mosquito populations. The long-term success of this method relies, in part, on evolution of the wMel genome not compromising the critical features that make it an attractive biocontrol tool. This study compared the wMel

Wolbachia

genome at the time of initial releases and 1–7 years post-release in Cairns, Australia. Our results show the wMel genome remains highly conserved up to 7 years post-release in gene sequence, content, synteny and structure. This work suggests the wMel genome is stable in its new mosquito host and, therefore, provides reassurance on the potential for wMel to deliver long-term public-health impacts.
Childhood Socioeconomic Status and Polygenic Scores for Cognition Have Independent Associations with Cognitive Performance During Middle Childhood
Authors: Paul S.E. , Elsayed N.M. , Bogdan R. , Colbert S.M.C. , Hatoum A.S. , Barch D.M.
Published: September 2021

Childhood cognitive abilities are heritable and influenced by malleable environmental factors such as socioeconomic status (SES). As cognition and SES share genetic architecture, it is critical to understand the extent to which SES is associated with cognition beyond genetic propensity to inform the potential benefit of SES-based interventions. Previous investigations conducted in small samples have suggested that SES is linked with cognitive ability independent of polygenic prediction for educational attainment. Here, we extend this work to a large sample (total n = 4,650) of children (ages 9-10) of genomically-confirmed European ancestry. We find that an SES composite (i.e., family income-to-needs, caregiver education, and neighborhood median income) and a polygenic cognition score composite created using genomic structural equation modeling (COG PGS; Educational Attainment, Intelligence, and Executive Function) are associated with cognitive performance indices (i.e., general ability, executive function, learning/memory, fluid intelligence) that are largely independent of one another. SES x COG PGS interactions are not associated with cognition. These findings provide further evidence for the significant role of modifiable environmental factors in the development of cognitive abilities in youth.
Too many yet too few caesarean section deliveries in Bangladesh: an ongoing public health challenge to improve maternal and child health
Authors: Khan Md Nuruzzaman , Kabir Md Awal , Shariff Asma Ahmad , Rahman Md Mostafizur
Published: September 2021

Background

Caesarean section (CS) use is on the rise in Bangladesh, particularly among women in improved socio-economic condition. However, the deficit use of CS remains common among disadvantage women in terms of employment, education, wealth quintile, and place of residence. This increases risks of long-term obstetric complications as well as maternal and child deaths. We aimed to determine the interaction effects of women’s disadvantage characteristics on CS use in Bangladesh.

Methods

Total of 27,093 women data analysed extracted from five rounds of Bangladesh Demographic and Health Survey, conducted between 2004 and 2017/18. The inclusion criteria used to select these women were: (i) having at least one child within three prior to the survey, (ii) reported delivery methods and place, and (iii) do not have twin or more ordered pregnancy for the most recent live birth. The major exposure variables were type of health facilities, divisions, place of residence, economic status, and maternal education. Other factors considered were factors at the individual and household level. The outcome variable was CS use, coded as use (1) and non-use (0). Multilevel logistic regression model was used to determine association of CS with socio-demographic characteristics and the interactions of the working status and wealth quintile with place of residence.

Results

We reported a 751% increase of CS use over the last 13 years — from 3.88% in 2004 to 33% in 2017/18. Nearly, 80% of these occurred in the private health facilities followed by the government health facilities (15%). Rural women with no engagement of formal income generating activity showed 11% (OR, 0.89, 95% CI, 0.71-0.99) lower use of CS in 2004. This association was further strengthened with the year passes, and a 51% (OR, 0.49, 0.03-0.65) lower in CS use was reported in 2017/18. Similarly, around 12%-83% lower likelihoods of CS use were found among rural poor and poorer women.

Conclusion

Bangladesh is facing a double burden of CS, that is a group of women with improved socio-economic condition using this life saving procedure without medical necessity while their counterpart of disadvantage characteristics could not access this service. Improved monitoring from the government along with support to use CS services for the disadvantage groups on necessity are important.
Viral loads of Delta-variant SARS-CoV2 breakthrough infections following vaccination and booster with the BNT162b2 vaccine
Authors: Levine-Tiefenbrun Matan , Yelin Idan , Alapi Hillel , Katz Rachel , Herzel Esma , Kuint Jacob , Chodick Gabriel , Gazit Sivan , Patalon Tal , Kishony Roy
Published: September 2021

The BNT162b2 vaccine showed high real-life effectiveness both at preventing disease and in reducing viral loads of breakthrough infections, but coincidental with the rise of the Delta-variant SARS-CoV2, these protective effects have been decreasing, prompting a third, booster, vaccine inoculation. Here, analyzing viral loads of over 11,000 infections during the current wave in Israel, we find that even though this wave is dominated by the Delta-variant, breakthrough infections in recently vaccinated patients, still within 2 months post their second vaccine inoculation, do have lower viral loads compared to unvaccinated patients, with the extent of viral load reduction similar to pre-Delta breakthrough observations. Yet, this infectiousness protection starts diminishing for patients two months post vaccination and ultimately vanishes for patients 6 months or longer post vaccination. Encouragingly, we find that this diminishing vaccine effectiveness on breakthrough infection viral loads is restored following the booster vaccine. These results suggest that the vaccine is initially effective in reducing infectiousness of breakthrough infections even with the Delta variant, and that while this protectiveness effect declines with time it can be restored, at least temporarily, with a booster vaccine.
Clinical autism subscales have common genetic liabilities that are heritable, pleiotropic, and generalizable to the general population
Authors: Thomas Taylor R. , Koomar Tanner , Casten Lucas G. , Tener Ashton J. , Bahl Ethan , Michaelson Jacob J.
Published: September 2021

The complexity of autism’s phenotypic spectra is well-known, yet most genetic research uses case-control status as the target trait. It is undetermined if autistic symptom domain severity underlying this heterogeneity is heritable and pleiotropic with other psychiatric and behavior traits in the same manner as autism case-control status. In N = 6,064 autistic children in the SPARK cohort, we investigated the common genetic properties of twelve subscales from three clinical autism instruments measuring autistic traits: the Social Communication Questionnaire (SCQ), the Repetitive Behavior Scale-Revised (RBS-R), and the Developmental Coordination Disorder Questionnaire (DCDQ). Educational attainment polygenic scores (PGS) were significantly negatively correlated with eleven subscales, while ADHD and major depression PGS were positively correlated with ten and eight of the autism subscales, respectively. Loneliness and neuroticism PGS were also positively correlated with many subscales. Significant PGS by sex interactions were found –– surprisingly, the autism case-control PGS was negatively correlated in females and had no strong correlation in males. SNP-heritability of the DCDQ subscales ranged from 0.04 to 0.08, RBS-R subscales ranged from 0.09 - 0.24, and SCQ subscales ranged from 0 to 0.12. GWAS in SPARK followed by estimation of polygenic scores (PGS) in the typically-developing ABCD cohort (N = 5,285), revealed significant associations of RBS-R subscale PGS with autism-related behavioral traits, with several subscale PGS more strongly correlated than the autism case-control PGS. Overall, our analyses suggest that the clinical autism subscale traits show variability in SNP-heritability, PGS associations, and significant PGS by sex interactions, underscoring the heterogeneity in autistic traits at a genetic level. Furthermore, of the three instruments investigated, the RBS-R shows the greatest evidence of genetic signal in both (1) autistic samples (greater heritability) and (2) general population samples (strongest PGS associations).
Correlations between metabolites in the synovial fluid and serum: a mouse injury study
Authors: Wallace Cameron W. , Hislop Brady , Hahn Alyssa K. , Erdogan Ayten E. , Brahmachary Priyanka P. , June Ronald K.
Published: September 2021

Osteoarthritis, the most common degenerative joint disease, occurs more frequently in joints that have sustained injury. Currently, osteoarthritis is diagnosed with imaging that finds radiographic changes after the disease has already progressed to multiple tissues. The primary objective of this study was to compare potential metabolomic biomarkers of joint injury between the synovial fluid and serum in a mouse model of post-traumatic osteoarthritis. The secondary objective was to gain insight into the pathophysiology of osteoarthritis by examining metabolomic profiles after joint injury. 12-week-old adult female C57BL/6 mice (n=12) were randomly assigned to control, day 1 post injury, or day 8 post injury groups. Randomly selected stifle (i.e., knee) joints were placed into a non-invasive injury apparatus and subjected to a single dynamic axial compression causing anterior translation of the tibia relative to the femur to tear the anterior cruciate ligament. At days 1 and 8 post injury, serum was extracted then mice were immediately euthanized prior to synovial fluid collection. Metabolites were extracted and analyzed by liquid chromatography coupled to mass spectrometry. We detected ~2500 metabolites across serum and synovial fluid. Of these metabolites 179 were positively correlated and 51 were negatively correlated between synovial fluid and serum, indicating potential for the development of metabolomic biomarkers. Synovial fluid appeared to capture differences in metabolomic profiles between injured mice at both day 1 and 8 after injury whereas serum did not. However, synovial fluid and serum were distinct at both days 1 and 8 after injury. In the synovial fluid, pathways of interest across different time points mapped to amino acid synthesis and degradation, bupropion degradation, and the tRNA charging pathway. In the serum, notable pathways across time points were amino acid synthesis and degradation, the phospholipase pathway, and nicotine degradation. These results provide a rich picture of the injury response at early time points following traumatic joint injury. Furthermore, the correlations between synovial fluid and serum metabolites suggest that there is potential to gain insight into intra-articular pathophysiology through analysis of serum metabolites.
Quantifying biochemical reaction rates from static population variability within complex networks
Authors: Wittenstein Timon , Leibovich Nava , Hilfinger Andreas
Published: September 2021

Quantifying biochemical reaction rates within complex cellular processes remains a key challenge of systems biology even as high-throughput single-cell data have become available to characterize snapshots of population variability. That is because complex systems with stochastic and non-linear interactions are difficult to analyze when not all components can be observed simultaneously and systems cannot be followed over time. Instead of using descriptive statistical models, we show that incompletely specified mechanistic models can be used to translate qualitative knowledge of interactions into reaction rate functions from covariability data between pairs of components. This promises to turn a globally intractable problem into a sequence of solvable inference problems to quantify complex interaction networks from incomplete snapshots of their stochastic fluctuations.