bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenging diagnosis of gastrointestinal tuberculosis made simpler with multi-targeted loop-mediated isothermal amplification assay
Authors: Sharma Megha , Sinha Saroj Kant , Sharma Megha , Singh Anupam Kumar , Samanta Jayanta , Sharma Aman , Kochhar Rakesh , Sharma Kusum
Published: May 2020

Background

Prompt and accurate diagnosis of gastrointestinal tuberculosis (GITB) is highly challenging. Current conventional techniques lack sensitivity and are time-consuming. Multi targeted loop-mediated isothermal amplification (LAMP) using two targets (IS6110 and MPB64) is a promising technique for rapid diagnosis of TB.

Methods

LAMP test using IS6110 and MPB64 targets for M. tuberculosis complex was performed on ileocecal biopsy samples of 35 clinically suspected patients of GITB and 30 ileocecal biopsy samples of non-tuberculosis control subjects. Results of IS6110 LAMP and MPB64 LAMP were compared with IS6110 PCR and culture

Inference

Overall LAMP test (using any of the two targets) had a sensitivity and specificity of 100 and 100%, respectively, for confirmed GITB (five culture positive) cases and 85.71 and 100%, respectively, for clinically suspected 30 ileocecal biopsy samples of GITB. Sensitivity of IS6110 LAMP, MPB64 LAMP and IS6110 PCR for clinically suspected cases was 22 (73.33%), 24 (80%) and 21 (70%), respectively. In total 35 GITB patients, the overall sensitivity of microscopy, culture, IS6110 PCR, IS6110 LAMP, MPB64 LAMP and the multi-targeted LAMP assay (if any of the two targets were used) were 5.71, 14.28, 68.57, 74.28, 82.85 and 85.71%, respectively. Specificity of all the tests was 100%. There were three cases which were missed by IS6110 LAMP and two cases by MPB64 LAMP.

Conclusion

Multi-targeted LAMP is a promising technique for rapid and accurate diagnosis of GITB.
A systematic review on the complications and management of hepatic adenomas: a call for a new approach
Authors: Rodrigues Beverly T. , Mei Swee Lin Chen Yi , Fox Adrian , Lubel John S. , Nicoll Amanda J.
Published: May 2020

Hepatic adenomas are benign hepatic lesions with heterogeneous characteristics. Awareness of complications, including haemorrhage and malignant transformation, has improved alongside a concurrent rise in their detection. Monitoring and management guidelines, however, remain inconsistent. This systematic review analyses the natural history of hepatic adenomas, and existing and novel risk factors associated with haemorrhage and malignant transformation. Results of this systematic review commonly identified male sex, and the beta-catenin histopathological hepatic adenoma subtype, as risk factors for malignant transformation, whilst those associated with haemorrhage included lesion size and number, exophytic nature, and recent hormone use. Overall, females demonstrated higher rates of haemorrhage, whilst males exhibited a higher risk of hepatocellular carcinoma development. This systematic review highlights that tumour size and subtype may not be as characteristically linked with complications as previously thought. We have additionally reported novel risk factors contributing to development of hepatic adenoma-related complications. We conclude by highlighting the risk of taking a conservative approach to seemingly low-risk lesions and suggest revised practice guidelines.
Gastroenterologists’ preference and risk perception on the use of immunomodulators and biological therapies in elderly patients with ulcerative colitis: an international survey
Authors: Chan Webber , Kariyawasam Viraj C. , Kim Shin , Pudipeddi Aviv V. , Paramsothy Sudarshan , Shim Hang Hock , Mourad Fadi H. , Ding Nik , Ferrante Marc , Leong Rupert W.
Published: May 2020

Background and aims:

Comorbidities, polypharmacy, malignancies, and infections complicate management of elderly patients with inflammatory bowel diseases (IBD). This study assessed gastroenterologists’ preference in the prescription of medications or surgery to elderly patients with IBD, and the factors associated with their choices.

Methods

An international case-based survey was conducted that presented three cases of steroid-dependent ulcerative colitis assessing young-age versus elderly-age patients, with and without comorbidity. Physician characteristics and practice demographics were collected. Factors associated with selection of different choices of therapy were determined by logistic regression analysis.

Results

A total of 424 respondents from 41 countries were included. Vedolizumab (53.2%) and thiopurines (19.4%) were the top treatment preferences for moderate-to-severe ulcerative colitis (P < 0.0001). Comorbidity and older age were independently associated with more frequent use of vedolizumab (P < 0.0001), and less frequent use of immunomodulators and anti-tumour necrosis factor (TNF; P < 0.0001). Comorbidity was the only independent predictor for selecting colectomy (P < 0.0001). A history of lymphoma (94%) and opportunistic infection (78.3%) were the most frequent conditions precluding the use of thiopurine and anti-TNF in elderly patients with IBD. Only 6.1% of respondents considered patient age a limit for vedolizumab, while 37.9% considered age as a limiting factor in prescribing thiopurines (P < 0.001). Geographical heterogeneity was identified with significantly more physicians from Oceania and North America favouring the use of vedolizumab.

Conclusion

Vedolizumab was the preferred first-line agent in the treatment of elderly patients with IBD with steroid-dependent moderate-to-severe ulcerative colitis. Older age and presence of comorbidity influenced the selection of medication. Comorbidity was the main predictor of colectomy. Geographical heterogeneity in prescribing habits may relate to medication reimbursement in individual countries.
Comparison of Single-Dose and Extended-Duration Empiric Aminoglycoside Combination Therapy in Patients With Septic Shock
Authors: Sacha Gretchen L. , Srinivas Pavithra , Lam Simon W. , Bass Stephanie N.
Published: May 2020

Background:

Empiric combination antimicrobial therapy is often used in patients with decompensating septic shock. However, the optimal duration of combination therapy is unknown.

Study Question:

The goal of this study was to compare the clinical effects of a single dose of an aminoglycoside to an extended duration of aminoglycosides for combination therapy in patients with septic shock without renal dysfunction.

Study Design:

Retrospective, single-center evaluation of patients with septic shock who received empiric combination therapy with an aminoglycoside.

Measures and Outcomes:

Two patient cohorts were evaluated: those who received a single dose of an aminoglycoside and those who received more than 1 dose of an aminoglycoside. The primary outcome was shock-free days at day 14. Secondary outcomes included mortality, length of stay, clinical cure, and nephrotoxicity. A post hoc subgroup analysis including only patients who received more than 2 doses of an aminoglycoside compared with a single dose was conducted.

Results:

One hundred fifty-one patients were included in this evaluation, 94 in the single-dose aminoglycoside group and 57 in the extended duration group. There was no difference in shock-free days at day 14 between patients who received a single dose of an aminoglycoside or those who received an extended duration (12.0 vs. 11.6 days; P = 0.56). There were no differences in mortality, length of stay, clinical cure rates, or rates of nephrotoxicity between groups (28% for single dose vs. 26% for extended duration; P = 0.86). No differences in outcomes were detected when evaluating patients who received more than 2 doses of an aminoglycoside compared with a single dose.

Conclusions:

Patients with septic shock and normal renal function who received a single dose of an aminoglycoside for combination antimicrobial therapy had no differences detected in shock duration or nephrotoxicity development compared with those who received an extended duration of aminoglycoside combination therapy.
In vivo and ex vivo haematopoietic stem cell expansion
Authors: Yamamoto Ryo , Wilkinson Adam C. , Nakauchi Hiromitsu
Published: May 2020

Purpose of review

Haematopoietic stem cells (HSCs) are characterized by two key features: self-renewal ability and multilineage differentiation potential. Through these cellular activities, HSCs sustain blood and immune system homeostasis throughout life and can also reconstitute the entire haematopoietic system within a bone marrow ablated recipient. This approach of HSC transplantation is used clinically as a curative treatment option for numerous haematological diseases, both malignant and nonmalignant.

Recent findings

Elucidation of the mechanism of HSC expansion represents a major focus within haematology. Here, we review the recent progress towards understanding HSC expansion in vivo and ex vivo, including a discussion of recent clonal transplantation assays and the development of novel ex vivo culture systems.

Recent findings provide exciting promise for improving the safety and efficacy of current HSC-based therapies as well as for the development of new therapeutic paradigms.
Artificial neural network and bioavailability of the immunosuppression drug
Authors: Naushad Shaik Mohammad , Kutala Vijay Kumar
Published: May 2020

Purpose of review

The success of organ transplant is determined by number of demographic, clinical, immunological and genetic variables. Artificial intelligence tools, such as artificial neural networks (ANNs) or classification and regression trees (CART) can handle multiple independent variables and predict the dependent variables by deducing the complex nonlinear relationships between variables.

Recent findings

In the last two decades, several researchers employed these tools to identify donor-recipient matching pairs, to optimize immunosuppressant doses, to predict allograft survival and to minimize adverse drug reactions. These models showed better performance characteristics than the empirical dosing strategies in terms of sensitivity, specificity, overall accuracy, or area under the curve of receiver-operating characteristic curves. The performance of the models was dependent directly on the input variables. Recent studies identified protein biomarkers and pharmacogenetic determinants of immunosuppressants as additional variables that increase the precision in prediction. Accessibility of medical records, proper follow-up of transplant cases, deep understanding of pharmacokinetic and pharmacodynamic pathways of immunosuppressant drugs coupled with genomic and proteomic markers are essential in developing an effective artificial intelligence platform for transplantation.

Artificial intelligence has a greater clinical utility both in pretransplantation and posttransplantation periods to get favourable clinical outcomes, thus ensuring successful graft survival.
Female neurogenic stress urinary incontinence
Authors: Farag Fawzy , Doherty Ruth , Arlandis Salvador
Published: May 2020

Purpose of review

The aim of this article is to look into recent updates on the management of neurogenic stress urinary incontinence (NSUI) in adult females.

Recent findings

Recently, a small number of studies have investigated different surgical modalities in treatment of NSUI in adult females including artificial urinary sphincter (AUS), suburethral tapes (SUT) and adjustable slings and urethral bulking agents. Up to 70% of neurogenic patients who received AUS implants are continent and have not required surgical revision over a 20-year follow-up period. However, the risk for explantation of AUS may be twice as high in neurogenic patients compared with nonneurogenic patients. SUT have success and improvement in quality of life rates of up to 52 and 68%, respectively. However, complications may be as high as 24%. Early data on adjustable slings may suggest up to 80% continence with low complication rates.

AUS can provide satisfactory continence levels with acceptable rates of revision and explantation. SUT are effective but more than half of patients may require additional procedures. Adjustable slings could be a promising option. Further high-quality studies with careful attention to methodology and standardization of both definitions used and outcome reporting are required to help us reach safe conclusions.
Use of real-time visual feedback during overground walking training on gait symmetry and velocity in patients with post-stroke hemiparesis: randomized controlled, single-blind study
Authors: Kim Jin-Seop , Oh Duck-Won
Published: May 2020

This study aimed to determine the efficacy of using real-time visual feedback during overground walking training to improve walking function in patients with post-stroke hemiparesis. Twenty-four patients with post-stroke hemiparesis who were able to walk independently under less impact of synergy pattern on the affected lower limbs (Brunnstrom stage IV or V) were randomly assigned to either the experimental group or the control group. All subjects performed overground walking for 30 min, three times a week for 6 weeks, with real-time visual feedback (weight load to the affected lower limb) provided during training for subjects in the experimental group. Outcome measures comprised the timed up-and-go test and gait parameters (step length, stride length, single and double support times, step and stride length ratios, and single support time ratio). In between-group comparison, the changes between pre-test and post-test scores in all parameters were significantly greater in the experimental group than in the control group (P < 0.05), except for double support time and step length ratio. Furthermore, post-test values of all parameters were significantly more improved in the experimental group than in the control group (P < 0.05). Our findings suggest that real-time visual feedback may be an advantageous therapeutic adjunct to reinforce the effects of overground walking training in patients with post-stroke hemiparesis.
The Evolving Role of the Professional Case Manager
Authors: Tahan Hussein M. , Kurland MaryBeth , Baker Michelle
Published: May 2020

Purpose:

The purpose of the national role and function study was to identify the essential activities and necessary knowledge areas for effective professional case management practice from the perspective of those directly involved. The study also aimed to inform the relevance and currency of the blueprint for the case management certification examination.

Primary Practice Settings:

The national study covered the diverse case management practices and/or work settings across the full continuum of health and human services and numerous professional disciplines.

Methodology and Sample:

This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of 2,810 certified and not yet certified case managers who responded to an open participation link made available as an online survey. The final study sample supported the conduct of meaningful statistical analyses including multiple subgroup comparisons.

Results:

The study identified the common activities (6 domains) and knowledge areas (5 domains) necessary for effective performance by professional case managers. Part I of this 2-part article series described the background of the participants and their perspectives of the practice and the knowledge applied by those responsible for the case manager's role. Part II, as shared in this article, reports on the factor/principal component analysis and how such activity informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination. The update reflects the continued evolution of the professional case management practice and ensures that the examination remains current and relevant. Of special note is the maturation of the case management practice; for example, greater emphasis on quality, safety, and outcomes; baccalaureate or higher education; and recognition of the value of certification. In addition, the 2019 role and function study has revealed that utilization review/management is evolving potentially as a function that is separate from that of the case manager.

Implications for Case Management Practice:

The study has identified the essential activities and knowledge areas of case management practice at both the micro and macro levels. These findings represent the substantive evidence of practice, keeping the CCM credentialing examination evidence-based and maintaining its validity for evaluating the competency of professional case managers. They have also documented the evolution of the practice over the past 5 years. Moreover, the findings may inform the development of programs and curricula for the training and advancement of case managers. The study instrument also is beneficial for use in further research into professional case management practice.
Reliability and Concurrent Validity of Life Space Assessment in Individuals With Vestibular Disorders
Authors: Alshebber Kefah M. , Dunlap Pamela M. , Whitney Susan L.
Published: May 2020

Background and Purpose:

The Life Space Assessment (LSA) is a self-report measure that allows clinicians to determine how often someone moves around in his or her environment with or without assistance. Presently, there are no reliable and valid measures that capture all 3 aspects of mobility (ie, mobility frequency, distance, and assistance needed) for individuals with vestibular disorders. The purpose of this study was to describe life space and to determine the reliability and concurrent validity of the LSA as a tool to measure mobility and function in individuals with balance and vestibular disorders.

Methods:

One hundred twenty-eight participants (mean age of 55 ± 16.7 years) experiencing dizziness or imbalance who were seeking the care of an otoneurologist were recruited. Participants completed the LSA, Dizziness Handicap Inventory (DHI), and the 12-Item Short Form Health Survey (SF-12).

Results:

The mean LSA score of the sample was 75/120 ± 30. The LSA demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.91). The LSA was negatively correlated with the DHI total score (ρ = −0.326, P < 0.01), DHI physical subscore (ρ = −0.229, P = 0.02), DHI functional subscore (ρ = −0.406, P < 0.01), and DHI emotional subscore (ρ = −0.282, P < 0.01). The LSA was positively correlated with both the physical (ρ = 0.422, P < 0.01) and mental (ρ = 0.362, P < 0.01) composite scores of the SF-12.

Discussion and Conclusions:

Similar to the findings in community-dwelling older adults, the LSA demonstrated excellent test-retest and internal consistency in individuals with vestibular disorders. The LSA is a valid and reliable tool for measuring mobility and function in individuals with vestibular disorders.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A317).
Whole Slide Imaging: Technology and Applications
Authors: Hanna Matthew G. , Parwani Anil , Sirintrapun Sahussapont Joseph
Published: May 2020

Pathology has benefited from advanced innovation with novel technology to implement a digital solution. Whole slide imaging is a disruptive technology where glass slides are scanned to produce digital images. There have been significant advances in whole slide scanning hardware and software that have allowed for ready access of whole slide images. The digital images, or whole slide images, can be viewed comparable to glass slides in a microscope, as digital files. Whole slide imaging has increased in adoption among pathologists, pathology departments, and scientists for clinical, educational, and research initiatives. Worldwide usage of whole slide imaging has grown significantly. Pathology regulatory organizations (ie, College of American Pathologists) have put forth guidelines for clinical validation, and the US Food and Drug Administration have also approved whole slide imaging for primary diagnosis. This article will review the digital pathology ecosystem and discuss clinical and nonclinical applications of its use.
Relationship Satisfaction and Depression After Traumatic Brain Injury
Authors: McKee Grace B. , Perrin Paul B. , Rodriguez Agudelo Yaneth , Olivera Plaza Silvia Leonor , Quijano-Martinez Maria Cristina , Ohayagha Chimdindu , Kuzu Duygu , Cariello Annahir N. , Arango-Lasprilla Juan Carlos
Published: May 2020

Objective

Traumatic brain injury represents a major public health concern, particularly in low- and middle-income countries like in Latin America. Family members are often caregivers for individuals with traumatic brain injury, which can result in significant stress. Research is needed to examine depression and quality of the caregiving relationship in these dyads. This study examined relationship quality and depression longitudinally after traumatic brain injury within the caregiving relationship.

Design

Dyads (N = 109) composed of individuals with traumatic brain injury and their caregivers were recruited from three hospitals in Mexico and Colombia. They self-reported depression and relationship satisfaction during hospitalization and at 2 and 4 mos after hospitalization.

Results

A 2-lag Actor Partner Interdependence Model demonstrated that patients and caregivers reporting high relationship satisfaction at baseline experienced lower depression 2 mos later, which then predicted higher caregiver relationship satisfaction at 4 mos. Moreover, patients with high relationship satisfaction at baseline had caregivers with lower depression at 2 mos, which was then associated with patients’ higher satisfaction at 4 mos.

Conclusions

Within individuals with traumatic brain injury and caregivers, depression and relationship satisfaction seem to be inversely related. Furthermore, patients’ and caregivers’ depression and relationship satisfaction impact each other over time, demonstrating interdependence within the caregiving relationship.
Is Our Effort Appropriately Valued? An Analysis of Work Relative Value Units in Immediate Breast Reconstruction
Authors: Doval Andres F. , Gratzon Andrew C. , Neese Virginia , Shuck John W. , Friedman Jeffrey , Echo Anthony
Published: May 2020

Background:

The work relative value units system was developed as a quantifier of physician labor, technical skill, and training time required to complete surgical procedures. Thus, more complex surgical procedures that require greater technical skills and are more time consuming should yield a greater compensation. It is known that prosthetic breast reconstruction reimburses more per hour than autologous breast reconstruction. However, there are limited data comparing work relative value units and operative times in breast reconstruction procedures. Therefore, this study aims to compare mean operative times and work relative value units per minute across three different modalities of breast reconstruction.

Methods:

A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed to identify all patients undergoing implant-, pedicle-, and free flap–based reconstruction over a 6-year period. Calculation and comparison of median operative times, work relative value units, and dollars per minute was performed.

Results:

A total of 3135 patients were included in the analysis: 2249 (71.7 percent) underwent immediate implant-based reconstruction, 745 (23.8 percent) underwent immediate free flap–based breast reconstruction, and 141 (4.5 percent) underwent immediate pedicle flap–based reconstruction. Patients were distributed in unilateral and bilateral cases. Consistently, median operative time was greater for free flap breast reconstruction, followed by pedicle flap– and implant-based reconstruction (p < 0.0001). However, work relative value units per minute and dollars per minute were found to be higher for prosthetic reconstruction in all comparisons (p < 0.0001).

Conclusion:

In the authors’ analysis, more complex and time-consuming procedures resulted in a lower reimbursement in dollars and work relative value units per minute for the procedure.
Development of a Patient-Based Goniometric System for the Assessment of Contracture Conditions in Dupuytren’s Disease
Authors: Baringer Magnus , Prantl Lukas , Eaton Charles , Reichert Bert
Published: May 2020

Background:

Treatment outcomes of Dupuytren’s disease depend largely on degree of contracture and biological severity. Longitudinal assessment of each is crucial for effective care and long-term outcome assessment. Ideally, each Dupuytren’s patient should have ongoing interval evaluations. Because of the large number of Dupuytren’s patients, it would be impractical and costly for health care professionals to examine every patient in person on a regular basis. Patient-based evaluations might provide a useful and cost-effective alternative to office-based examination.

Methods:

Finger goniometry is the standard metric for office-based evaluation of Dupuytren’s disease. This study’s goal was to develop a new patient-reported goniometric system. The authors developed a completely Web-based goniometric software for patients to use without supervision and without undue effort or cost. They then evaluated the validity and precision of the core measurement system and the reliability of its patient-based application.

Results:

With a correlation of 0.992 (p < 0.01), a mean deviation of −0.25 degree, and a standard deviation of 2.74 degrees in patient-based application, the authors found their goniometric software to be comparable to practitioner-based, conventional goniometry. The authors believe patient-based goniometry to be a sufficiently accurate, valid, and reliable approach for longitudinal clinical assessment of Dupuytren’s disease.

Conclusions:

Patient-based goniometric approaches have great potential for inexpensive, accurate, and accessible longitudinal assessment of the large population of Dupuytren’s patients. Such approaches could help to substantially improve overall care of Dupuytren’s disease through early diagnosis and timely treatment. In addition, being able to collect reliable patient data on a regular basis and on a larger scale could help improve understanding of the natural history of Dupuytren’s disease.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, I.
Identification of High-Quality Fat Based on Precision Centrifugation in Lipoaspirates Using Marker Floats
Authors: Guan Jingyan , He Yunfan , Wang Xinhui , Yao Yao , Li Ye , Wang Zijue , Chen Yunzi , Dong Ziqing , Lu Feng
Published: May 2020

Background:

Centrifugation creates “graded densities” of fat with varying cellular and biological compositions that influence graft retention. This study aimed to find an accurate method to identify fat fractions that are suitable for implantation.

Methods:

Five marker floats (0.925, 0.930, 0.935, 0.940, and 0.945 g/ml) were added to human lipoaspirates that were then centrifuged at 1200 g for 3 minutes to grade the density of centrifuged lipoaspirates. After centrifugation, four fat fractions divided by floats were collected for fat characteristics analysis and in vivo grafting, with Coleman fat as a control.

Results:

Fat characteristics varied significantly between the centrifuged fat fractions divided by the 0.935-g/ml marker float. Compared with low-quality fat (<0.935 g/ml), high-quality fat (>0.935 g/ml) contains more stromal vascular fraction, adipose-derived stem cells, and extracellular matrix content. Furthermore, adipocytes were found to be significantly smaller in high-quality fat than in low-quality fat, and high-quality fat persisted at a greater volume compared with low-quality fat in vivo at week 12.

Conclusions:

High-quality fat contains more stromal vascular fraction cells, extracellular matrix content, and small adipocytes, leading to the highest implant volume retention, whereas low-quality fat contains more fragile large adipocytes, leading to the least volume retention. Marker floats can be used to grade the density of lipoaspirates, with fat greater than 0.935 g/ml recommended as a suitable alternative for implantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Dental Implant Survival in Vascularized Bone Flaps: A Systematic Review and Meta-Analysis
Authors: Panchal Hina , Shamsunder Meghana G. , Petrovic Ivana , Rosen Evan B. , Allen Robert J. , Hernandez Marisol , Ganly Ian , Boyle Jay O. , Matros Evan , Nelson Jonas A.
Published: May 2020

Background:

Maxillofacial reconstruction with vascularized bone restores facial contour and provides structural support and a foundation for dental rehabilitation. Routine implant placement in such cases, however, remains uncommon. This study aims to determine dental implant survival in patients undergoing vascularized maxillary or mandibular reconstruction through a systematic review of the literature.

Methods:

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature was queried for implant placement in reconstructed jaws using Medical Subject Headings terms on PubMed, Embase, and Cochrane platforms. Weighted implant survivals were calculated for the entire cohort and subcohorts stratified by radiotherapy. Meta-analyses were performed to estimate effect of radiation on implant osseointegration.

Results:

Of 3965 publications identified, 42 were reviewed, including 1084 patients with 3636 dental implants. Weighted implant survival was 92.2 percent at a median follow-up of 36 months. Survival was 97.0 percent in 269 implants placed immediately in 60 patients versus 89.9 percent in 1897 delayed implants placed in 597 patients, with follow-up of 14 and 40 months, respectively. Dental implants without radiotherapy exposure had better survival than those exposed to radiation (95.3 versus 84.6 percent; p < 0.01) at a median follow-up of 36 months. Meta-analyses showed that radiation significantly increased the risk of implant failure (risk ratio, 4.74; p < 0.01) and suggested that implants placed before radiotherapy trended toward better survival (88.9 percent versus 83.4 percent, p = 0.07; risk ratio, 0.52; p = 0.14).

Conclusions:

Overall implant survival was 92.2 percent; however, radiotherapy adversely impacted outcomes. Implants placed before radiotherapy may demonstrate superior survival than implants placed after.
Restoration of Spinopelvic Continuity with the Free Fibula Flap after Limb-Sparing Oncologic Resection Is Associated with a High Union Rate and Superior Functional Outcomes
Authors: Mericli Alexander F. , Boukovalas Stefanos , Roubaud Margaret S. , Kai-Cheng Chu Carrie , Bird Justin , Lewis Valerae O. , Rhines Laurence D. , Chang Edward I. , Adelman David M. , Hanasono Matthew M.
Published: May 2020

Background:

Type 1 internal hemipelvectomies and total sacrectomies cause significant biomechanical instability, demanding pelvic ring reconstruction for ambulation and torso support. Previously described methods include autografts, allografts, and implants, commonly with poor long-term outcomes. The authors hypothesized that the free fibula flap for spinopelvic reconstruction is safe and effective, and associated with a high bony union rate and superior functional outcomes.

Methods:

The authors performed a retrospective review of all patients who underwent free fibula flap surgery after internal hemipelvectomy or total sacrectomy at M. D. Anderson Cancer Center from 2003 to 2018. The primary outcome was radiographic evidence of bony union. Secondary outcomes included surgical-site occurrence and lower extremity function. Univariate and multivariate logistic regression analyses were performed.

Results:

Forty-seven patients were included (internal hemipelvectomy,n= 38; total sacrectomy,n= 9). The mean follow-up was 3.3 years and the most common abnormality was chondrosarcoma (30.4 percent). The nonunion rate was 9.7 percent and the surgical-site occurrence rate was 34 percent; there were no flap losses. Greater age was significantly associated with nonunion (OR, 1.1; 95 percent CI, 1 to 1.2;p= 0.003), whereas obesity was the only independent predictor of surgical-site occurrence (OR, 9.2; 95 percent CI, 1.2 to 71.3;p= 0.03). Functional metrics approached those of adult norms by 3 years postoperatively. Compared to internal hemipelvectomy patients, patients undergoing total sacrectomy had more comorbidities, a higher complication rate, and a worse functional outcome.

Conclusion:

The free fibula flap for spinopelvic reconstruction is safe and effective, and is associated with a high bony union rate and superior functional outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
18F-FDG PET/CT Imaging of Adrenal Liposarcoma
Authors: Wang Rang , Fan Qiuping , Tian Rong
Published: May 2020

Liposarcoma is a common soft tissue sarcoma in retroperitoneum, but adrenal liposarcoma is rare. We here described a 61-year-old man with left-upper-quadrant pain, hypertension, and weight loss. Abdominal CT showed a large, heterogeneously enhanced mass on the left adrenal area, which compressed the surrounding pancreas, spleen, and left kidney. Subsequent FDG PET/CT demonstrated heterogeneous uptake by the lesion. Postoperative pathological findings confirmed the diagnosis of adrenal liposarcoma.
Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults
Authors: Canovai Emilio , Ceulemans Laurens J. , Peers Guido , De Pourcq Lutgart , Pijpops Marleen , Hoffman Ilse , De Hertogh Gert , Hiele Martin , Jochmans Ina , Monbaliu Diethard , Vanuytsel Tim , Pirenne Jacques
Published: May 2020

Background.

Intestinal transplantation (ITx) is the most expensive abdominal organ transplant. Detailed studies about exact costs and cost-effectiveness compared to home parenteral nutrition (HPN) therapy in chronic intestinal failure are lacking. The aim is to provide an in-depth analysis of ITx costs and evaluate cost-effectiveness compared to HPN.

Methods.

To calculate costs before and after ITx, costs were analyzed in 12 adult patients. To calculate the costs of patients with uncomplicated chronic intestinal failure, 28 adults, stable HPN patients were studied. Total costs including surgery, admissions, diagnostics, HPN therapy, medication, and ambulatory care were included. Median (range) costs are given.

Results.

Costs before ITx were €69 160 (€60 682–90 891) in year 2, and €104 146 (€83 854–186 412) in year 1. After ITx, costs were €172 133 (€122 483–351 407) in the 1st year, €40 619 (€3905–113 154) in the 2nd year, and dropped to €15 743 (€4408–138 906) in the 3rd year. In stable HPN patients, the costs were €83 402 (€35 364–169 146) in the 1st year, €70 945 (€31 955–117 913) in the 2nd year, and stabilized to €60 242 (€29 161–238 136) in the 3rd year.

Conclusions.

ITx, although initially very expensive, is cost-effective compared to HPN in adults by year 4, and cost-saving by year 5.
Brainstem correlates of cochlear nonlinearity measured via the scalp-recorded frequency-following response.
Authors: Bidelman Gavin M. , Bhagat Shaum
Published: May 2020

The frequency-following response (FFR) is an EEG-based potential used to characterize the brainstem encoding of complex sounds. Adopting techniques from auditory signal processing, we assessed the degree to which FFRs encode important properties of cochlear processing (e.g. nonlinearities) and their relation to speech-in-noise (SIN) listening skills. Based on the premise that normal cochlear transduction is characterized by rectification and compression, we reasoned these nonlinearities would create measurable harmonic distortion in FFRs in response to even pure tone input. We recorded FFRs to nonspeech (pure- and amplitude-modulated-tones) stimuli in normal-hearing individuals. We then compared conventional indices of cochlear nonlinearity, via distortion product otoacoustic emission (DPOAE) I/O functions, to total harmonic distortion measured from neural FFRs (FFRTHD). Analysis of DPOAE growth and the FFRTHD revealed listeners with higher cochlear compression thresholds had lower neural FFRTHD distortion (i.e. more linear FFRs), thus linking cochlear and brainstem correlates of auditory nonlinearity. Importantly, FFRTHD was also negatively correlated with SIN perception whereby listeners with higher FFRTHD (i.e. more nonlinear responses) showed better performance on the QuickSIN. We infer individual differences in SIN perception and FFR nonlinearity even in normal-hearing individuals may reflect subtle differences in auditory health and suprathreshold hearing skills not captured by normal audiometric evaluation. Future studies in hearing-impaired individuals and animal models are necessary to confirm the diagnostic utility of FFRTHD and its relation to cochlear hearing loss or peripheral neurodegeneration in humans.
The effect of ascorbic acid pretreatment on amphetamine-induced dopamine depletion in male and female mice
Authors: Gifford Janace J. , Wagner George C.
Published: May 2020

The repeated administration of high doses of amphetamine has been shown to cause long-lasting depletions of striatal dopamine which, when substantial enough, have been shown to result in cognitive and motor impairment. These amphetamine-induced lesions are slightly larger in males than that in females and can be partially ameliorated by pretreatment with antioxidants. The objective of the present study was to replicate these two latter observations using an amphetamine dosing regimen that yields only minor depletions of dopamine. It was found that a low-dose treatment of amphetamine using only two subcutaneous injections caused a 57% depletion of striatal dopamine with males slightly more affected than females. Furthermore, pretreatment with ascorbic acid reduced the magnitude of this dopamine depletion with males exhibiting a slightly enhanced protection as compared to females. Compared to the traditionally used high-dose regimens, these effects were mild but in the same direction. The advantage of this regimen is that it better reflects amphetamine-induced depletions of dopamine in humans.
Facial trustworthiness affects outcome evaluation: an event-related potential study.
Authors: Leng Haizhou , Liu Ying , Li Qian , Wu Qi , Yang Zongyu , Jiang Zhongqing
Published: May 2020

Facial trustworthiness can influence trust behavior. The outcome may be concordant (a person with a trustworthy face who engages in reciprocal behavior) or conflicting (a person with a trustworthy face who does not reciprocate). This study investigated the temporal features of processing different outcomes following trustworthy or untrustworthy faces. Thirty-one college students participated in a decision-making task in which they were shown a face and were asked to judge whether the person would behave in a trustworthy or an untrustworthy manner in a hypothetical scenario, and feedback was then provided about the target person’s behavior in the scenario, while the event-related potential of the electroencephalography of participants’ brains was recorded. In the feedback presentation stage, there was a significant interaction between face type and feedback. Trustworthy faces with losses induced the largest feedback-related negativity (FRN), whereas trustworthy faces with gains induced the smallest FRN. For untrustworthy faces, there was no significant difference between losses and gains. Trustworthy faces with losses and untrustworthy faces with gains induced more positive P300. FRN is possibly sensitive to both negative outcomes and expectation violations. P300 is mainly sensitive to expectation violations. Individuals have high positive expectations for trustworthy faces. When the behavior of a trustee with trustworthy face was negative, so as to violate the trustor’s expectation, it will elicit a more serious conflict in the mind of the trustor.
Geographical, temporal and individual factors influencing foraging behaviour and consistency in Australasian gannets
Authors: Rodríguez-Malagón Marlenne A. , Camprasse Elodie C. M. , Angel Lauren P. , Arnould John P. Y.
Published: May 2020

Foraging is a behaviour that can be influenced by multiple factors and is highly plastic. Recent studies have shown consistency in individual foraging behaviour has serious ecological and evolutionary implications within species and populations. Such information is crucial to understand how species select habitats, and how such selection might allow them to adapt to the environmental changes they face. Five foraging metrics (maximum distance from the colony, bearing from the colony to the most distal point, tortuosity index, total number of dives and mean vectorial dynamic body acceleration were obtained using GPS tracking and accelerometry data in adult Australasian gannets (
Morus serrator
) from two colonies in southeastern Australia. Individuals were instrumented over two breeding seasons to obtain data to assess factors influencing foraging behaviour and behavioural consistency over multiple timescales (consecutive trips, breeding stages and years) and habitats (pelagic, mixed pelagic and inshore, and inshore). Colony, breeding stage and year were the factors which had the greatest influence on foraging behaviour, followed by sex. Behavioural consistency, measured as the contribution of the individual to the observed variance, was low to moderate for all foraging metrics (0.0–27.05%), with the higher values occurring over shorter timescales. In addition, behavioural consistency was driven by spatio-temporal factors rather than intrinsic characteristics. Behavioural consistency was higher in individuals foraging in inshore than pelagic habitats or mixed pelagic/inshore strategy, supporting suggestions that consistency is favoured in stable environments.
Messinian vegetation and climate of the intermontane Florina–Ptolemais–Servia Basin, NW Greece inferred from palaeobotanical data: how well do plant fossils reflect past environments?
Authors: Bouchal Johannes M. , Güner Tuncay H. , Velitzelos Dimitrios , Velitzelos Evangelos , Denk Thomas
Published: May 2020

The late Miocene is marked by pronounced environmental changes and the appearance of strong temperature and precipitation seasonality. Although environmental heterogeneity is to be expected during this time, it is challenging to reconstruct palaeoenvironments using plant fossils. We investigated leaves and dispersed spores/pollen from 6.4 to 6 Ma strata in the intermontane Florina–Ptolemais–Servia Basin (FPS) of northwestern Greece. To assess how well plant fossils reflect the actual vegetation of the FPS, we assigned fossil taxa to biomes providing a measure for environmental heterogeneity. Additionally, the palynological assemblage was compared with pollen spectra from modern lake sediments to assess biases in spore/pollen representation in the pollen record. We found a close match of the Vegora assemblage with modern
Fagus–Abies
forests of Turkey. Using taxonomic affinities of leaf fossils, we further established close similarities of the Vegora assemblage with modern laurophyllous oak forests of Afghanistan. Finally, using information from sedimentary environment and taphonomy, we distinguished local and distantly growing vegetation types. We then subjected the plant assemblage of Vegora to different methods of climate reconstruction and discussed their potentials and limitations. Leaf and spore/pollen records allow accurate reconstructions of palaeoenvironments in the FPS, whereas extra-regional vegetation from coastal lowlands is probably not captured.
Foraging movements are density-independent among straw-coloured fruit bats
Authors: Calderón-Capote María C. , Dechmann Dina K. N. , Fahr Jakob , Wikelski Martin , Kays Roland , O'Mara M. Teague
Published: May 2020

Intraspecific competition in large aggregations of animals should generate density-dependent effects on foraging patterns. To test how large differences in colony size affect foraging movements, we tracked seasonal movements of the African straw-coloured fruit bat (Eidolon helvum) from four colonies that range from 4000 up to 10 million animals. Contrary to initial predictions, we found that mean distance flown per night (9–99 km), number of nightly foraging sites (2–3) and foraging and commuting times were largely independent of colony size. Bats showed classic central-place foraging and typically returned to the same day roost each night. However, roost switching was evident among individuals in three of the four colonies especially towards the onset of migration. The relatively consistent foraging patterns across seasons and colonies indicate that these bats seek out roosts close to highly productive landscapes. Once foraging effort starts to increase due to local resource depletion they migrate to landscapes with seasonally increasing resources. This minimizes high intraspecific competition and may help to explain why long-distance migration, otherwise rare in bats, evolved in this highly gregarious species.
Mesohalobacter halotolerans gen. nov., sp. nov., isolated from a marine solar saltern
Authors: Feng Xi , Zhang Jin-Yu , Sang Jin , Mu Da-Shuai , Du Zong-Jun
Published: May 2020

A Gram-stain-negative, non-motile, fine rod or short filament shaped, jacinth pigmented bacterium, designated strain WDS2C27T, was isolated from a marine solar saltern in Wendeng, Weihai, PR China (37°31′5″ N, 122°1′47″ E). Growth of WDS2C27T occurred at 20–42 °C (optimum 37 °C) and pH 6.5–8.5 (optimal pH 7.0–8.0). Optimal growth occurred in modified marine broth containing 6 % (w/v) NaCl. The major polar lipids in WDS2C27T were phosphatidylethanolamine, two unidentified aminolipids and one unidentified lipid. The major respiratory quinone of WDS2C27T was MK-6. The dominant fatty acids were iso-C15 : 0 and anteiso-C15 : 0. The DNA G+C content was 35.0 mol%. The nucleotide sequence of the 16S rRNA gene indicated that the most closely related strain was

Psychroflexus planctonicus

X15M-8T (92.0 % over 1452 bp). WDS2C27T showed 60.7 % average amino acid identity, 55.6 % percentage of conserved proteins, 75.0 % average nucleotide identity and 13.1 % digital DNA–DNA hybridization identity with the type species of the genus

Psychroflexus

,

Psychroflexus torquis

ATCC 700755T. The phenotypic and genotypic properties and phylogenetic inference indicated that WDS2C27T could be assigned to a novel species within a novel genus, for which the name Mesohalobacter halotolerans gen. nov., sp. nov. is proposed. Strain WDS2C27T (=MCCC 1H00133T=KCTC 52044T) is the type strain.
Tensions between research and public health: modelling the risks and benefits of SARS-CoV-2 vaccine field trials versus human infection challenge studies.
Authors: Heriot George S , Jamrozik Euzebiusz , Selgelid Michael J
Published: May 2020

Background: Human infection challenge studies (HICS) with SARS-CoV-2 are under consideration as a way of accelerating vaccine development. We evaluate potential vaccine research strategies under a range of epidemic conditions determined, in part, by the intensity of public health interventions.
Methods: We constructed a compartmental epidemiological model incorporating public health interventions, vaccine efficacy trials and a post-trial population vaccination campaign. The model was used to estimate the duration and benefits of large-scale field trials in comparison with HICS accompanied by an expanded safety trial, and to assess the marginal risk faced by HICS participants.
Results: Field trials may demonstrate vaccine efficacy more rapidly than a HICS strategy under epidemic conditions consistent with moderate mitigation policies. A HICS strategy is the only feasible option for testing vaccine efficacy under epidemic suppression, and maximises the benefits of post-trial vaccination. Less successful or absent mitigation results in minimal or no benefit from post-trial vaccination, irrespective of trial design.
Conclusions: SARS-CoV-2 HICS are the optimal method of vaccine testing for populations maintained under epidemic suppression, where vaccination offers the greatest benefits to the local population.