bluuebunny/crossref_metadata_2025 huggingface dataset:
Unisexual flower initiation in the monoecious Quercus suber L.: a molecular approach
Authors: Sobral Rómulo , Silva Helena Gomes , Laranjeira Sara , Magalhães Joana , Andrade Luís , Alhinho Ana Teresa , Costa Maria Manuela Ribeiro
Published: April 2020

Several plant species display a temporal separation of the male and female flower organ development to enhance outbreeding; however, little is known regarding the genetic mechanisms controlling this temporal separation. Quercus suber is a monoecious oak tree with accentuated protandry: in late winter, unisexual male flowers emerge adjacent to the swollen buds, whereas unisexual female flowers emerge in the axils of newly formed leaves formed during spring (4–8 weeks after male flowering). Here, a phylogenetic profiling has led to the identification of cork oak homologs of key floral regulatory genes. The role of these cork oak homologs during flower development was identified with functional studies in Arabidopsis thaliana. The expression profile throughout the year of flower regulators (inducers and repressors), in leaves and buds, suggests that the development of male and female flowers may be preceded by separated induction events. Female flowers are most likely induced during the vegetative flush occurring in spring, whereas male flowers may be induced in early summer. Male flowers stay enclosed within the pre-dormant buds, but complete their development before the vegetative flush of the following year, displaying a long period of anthesis that spans the dormant period. Our results portray a genetic mechanism that may explain similar reproductive habits in other monoecious tree species.
A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti
Authors: Deshommes Theony , Nagel Christian , Tucker Richard , Dorcélus Lindsay , Gautier Jacqueline , Koster Michael P , Lechner Beatrice E
Published: April 2020

Introduction

Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children’s hospital neonatal intensive care unit (NICU) in Haiti.

Methods

A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization ‘5 Moments for HH’. Data were analyzed using standard statistical analysis.

Results

HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water.

Conclusion

This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.
Genome Sequence Resources of Colletotrichum truncatum, C. plurivorum, C. musicola, and C. sojae: Four Species Pathogenic to Soybean (Glycine max)
Authors: Rogério Flávia , Boufleur Thaís R. , Ciampi-Guillardi Maisa , Sukno Serenella A. , Thon Michael R. , Massola Júnior Nelson Sidnei , Baroncelli Riccardo
Published: April 2020

Colletotrichum is a large genus of plant pathogenic fungi comprising more than 200 species. In this work, we present the genome sequences of four Colletotrichum species pathogenic to soybean: C. truncatum, C. plurivorum, C. musicola, and C. sojae. While C. truncatum is globally considered the most important pathogen, the other three species have been described and associated with soybean only recently. The genome sequences will provide insights into factors that contribute to pathogenicity toward soybean and will be useful for further research into the evolution of Colletotrichum.
The Top 100 Spine Surgery Articles on Social Media
Authors: Parrish James M. , Jenkins Nathaniel W. , Brundage Thomas S. , Hrynewycz Nadia M. , Singh Kern
Published: April 2020

Study Design.

Literature review.

Objective.

To discern which social media outlets contribute most to spine surgery literature dissemination and to investigate how popular articles compare to articles with most citations.

Summary of Background Data.

Scientific literature is increasingly disseminated through social media. The Altmetric Attention Score (AAS) is defined as an automated, weighted score calculation from counts of all online attention received by various research outputs. Increasing AAS values indicate more online attention. For example, the overall top 100 Altmetric spine surgery peer-reviewed articles since 2010 had an AAS range from 78 to 1537. Among all spine surgery literature reviewed since 2010, the mean AAS was 5.3 with a median of 1.0.

Methods.

We performed an Altmetric database search of nine spine surgery journals from January 2010 to October 2019. Mean AAS was summarized alongside metrics including citation count and impact factor. We assessed correlations between AAS and online sources, readers, and citations. Journals were grouped by impact factor, and analysis-of-variance compared mean AAS. The 100 highest AAS articles were compared to the most cited.

Results.

13,601 articles were included. The mean AAS was 5.3, with Twitter contributing the most. The three highest associations were news (P < 0.001), Twitter (P < 0.001), and Facebook (P < 0.001). There was no significant association between impact factor and AAS. Compared with the most cited articles, the top 100 AAS articles had significantly more article types, more prospective studies, fewer retrospective studies, fewer reviews, and fewer systematic reviews (P < 0.001 for all). Spine contributed the most articles in both top 100 sets.

Conclusion.

Our evaluation revealed Twitter, newsfeeds, and Facebook were the most significant social media outlets. Compared to articles with the most citations, the most popular articles are prospective and encompass broader study designs. Social media plays an integral role in dissemination, both within spine literature and the public sphere.

Level of Evidence: 3
Does Augmented Reality Navigation Increase Pedicle Screw Density Compared to Free-Hand Technique in Deformity Surgery? Single Surgeon Case Series of 44 Patients
Authors: Edström Erik , Burström Gustav , Persson Oscar , Charalampidis Anastasios , Nachabe Rami , Gerdhem Paul , Elmi-Terander Adrian
Published: April 2020

Study Design.

Retrospective comparison between an interventional and a control cohort.

Objective.

The aim of this study was to investigate whether the use of an augmented reality surgical navigation (ARSN) system for pedicle screw (PS) placement in deformity cases could alter the total implant density and PS to hook ratio compared to free-hand (FH) technique.

Summary of Background Data.

Surgical navigation in deformity surgery provides the possibility to place PS in small and deformed pedicles were hooks would otherwise have been placed, and thereby achieve a higher screw density in the constructs that may result in better long-term patient outcomes.

Methods.

Fifteen deformity cases treated with ARSN were compared to 29 cases treated by FH. All surgeries were performed by the same orthopedic spine surgeon. PS, hook, and combined implant density were primary outcomes. Procedure time, deformity correction, length of hospital stay, and blood loss were secondary outcomes. The surgeries in the ARSN group were performed in a hybrid operating room (OR) with a ceiling-mounted robotic C-arm with integrated video cameras for AR navigation. The FH group was operated with or without fluoroscopy as deemed necessary by the surgeon.

Results.

Both groups had an overall high-density construct (>80% total implant density). The ARSN group, had a significantly higher PS density, 86.3% ± 14.6% versus 74.7% ± 13.9% in the FH group (P < 0.05), whereas the hook density was 2.2% ± 3.0% versus 9.7% ± 9.6% (P < 0.001). Neither the total procedure time (min) 431 ± 98 versus 417 ± 145 nor the deformity correction 59.3% ± 16.6% versus 60.1% ± 17.8% between the groups were significantly affected.

Conclusion.

This study indicates that ARSN enables the surgeon to increase the PS density and thereby minimize the use of hooks in deformity surgery without prolonging the OR time. This may result in better constructs with possible long-term advantage and less need for revision surgery.

Level of Evidence: 3
The Rate of Heterotopic Ossification Following Cervical Disc Arthroplasty
Authors: Dowdell James E. , Kim Jun S. , Mikhail Christopher , Overley Samuel C. , Levin Jay Michel , McAnany Steven J. , Mroz Thomas E. , Hecht Andrew C.
Published: April 2020

Study Design.

Systematic review.

Objectives.

The purpose of the current study is to determine the overall incidence of Heterotopic Ossification (HO) following cervical disc arthroplasty (CDA) as well as per annum rates.

Summary of Background Data.

CDA is a well-established surgical modality for treatment of one- and two-level degenerative disc disease that has failed conservative treatment. Despite its proven mid-term clinical success, the potential for accelerated HO following CDA remains an area of clinical concern.

Methods.

A MEDLINE literature search was performed using PubMed, the Cochrane Database of Systematic Reviews, and Embase from January 1980 to February 2018. We included studies involving adult patients, who underwent CDA, documentation of HO, with >12 month follow-up. The pooled results were obtained by calculating the effect size based on the logit event rate. Per annum rates were determined based on weighted averages according to average follow-up period.

Results.

The initial database review resulted in 230 articles, with 19 articles that met inclusion and exclusion criteria. These pooled results included 2151-disc levels and 1732 patients (50% men and 50% women) who underwent CDA and were evaluated for postoperative HO. The mean age was 45 years with a mean follow-up of 60 months. Sixteen studies reported the occurrence of severe HO resulting in 22.8% of disc levels developing severe HO. When stratifying these studies based on funding type, severe HO was reported at a rate of 21.6% by IDE studies and 27.9% by independent studies.

Conclusion.

The findings of the pooled data show the incidence of severe HO following CDA to be 22.8%. However, there is a significant difference in reported rates of mild and severe HO between IDE and independent data. This alludes to possible underreporting of HO and severity of HO in the industry sponsored IDE studies when compared with independent studies.

Level of Evidence: 2
The Prevalence of Abnormalities in the Pediatric Spine on MRI
Authors: van den Heuvel Marleen M. , Oei Edwin H.G. , Bierma-Zeinstra Sita M.A. , van Middelkoop Marienke
Published: April 2020

Study Design.

Systematic review and meta-analysis.

Objective.

The aim of this study was to provide an overview of the prevalence of reported musculoskeletal abnormalities on magnetic resonance imaging (MRI) of the pediatric spine.

Summary of Background Data.

Back pain is a common complaint and significant health issue, already in children. Several studies have investigated musculoskeletal abnormalities of the pediatric spine as possible cause of low back pain (LBP). However, it is not clear which abnormalities are the most prevalent among children.

Methods.

A systematic literature search on the prevalence of musculoskeletal spinal abnormalities on MRI in children was conducted in the Embase, Medline Ovid, and Cochrane CENTRAL databases. Risk of bias (RoB) was assessed using a checklist based on the Downs and Black checklist. General information on study and patient characteristics and the prevalence of spinal abnormalities were extracted from the studies. Prevalence data were presented in three subgroups: nonathletes without LBP, participants with LBP, and athletes. Prevalence data of the most reported abnormalities were pooled using random-effects proportion meta-analysis. The study protocol was prospectively registered in PROSPERO (CRD42017080543).

Results.

The search resulted in 16,783 articles, of which 31 articles (2373 participants) were included in this systematic review. Two-thirds of the studies had a low RoB. The pooled prevalence in nonathletes without LBP, participants with LBP, and athletes without LBP was respectively 22%, 44%, and 22% for disc degeneration, 1%, 38%, and 13% for herniated discs, 5%, 22%, and 11% for endplate changes, and 0%, 30%, and 6% for pars fractures.

Conclusion.

Disc degeneration, herniated discs, endplate changes, and spondylolysis are the most reported spinal abnormalities on MRI in children in literature. Spinal abnormalities seen in adults are already prevalent in children with LBP, with the highest prevalence for disc degeneration and herniated discs.

Level of Evidence: 2
Breast Implant Illness: A Biofilm Hypothesis
Authors: Lee Mark , Ponraja Ganesa , McLeod Kevin , Chong Smathi
Published: April 2020

Background:

“Breast implant illness” (BII) is a poorly defined cluster of nonspecific symptoms, attributed by patients as being caused by their breast implants. These symptoms can include joint pain, skin and hair changes, concentration, and fatigue. Many patients complaining of BII symptoms are dismissed as psychosomatic. There are currently over 10,000 peer-reviewed articles on breast implants, but at the time of commencing this study, only 2 articles discussed this entity. At the same time, mainstream media and social media are exploding with nonscientific discussion about BII.

Methods:

We have prospectively followed 50 consecutive patients, self-referring for explantation due to BII. We analyzed their preoperative symptoms and followed up each patient with a Patient-Reported Outcome Questionnaire. All implants and capsules were, if possible, removed en bloc. Explanted implants were photographed. Implant shell and capsule sent for histology and microbiological culture.

Results:

BII symptoms were not shown to correlate with any particular implant type, surface, or fill. There was no significant finding as to duration of implant or location of original surgery. Chronic infection was found in 36% of cases with Propionibacterium acnes the most common finding. Histologically, synoviocyte metaplasia was found in a significantly greater incidence than a matched cohort that had no BII symptoms (P = 0.0164). Eighty-four percent of patients reported partial or complete resolution of BII symptoms on Patient-Reported Outcome Questionnaire. None of the 50 patients would consider having breast implants again.

Conclusion:

The authors believe BII to be a genuine entity worthy of further study. We have identified microbiological and histological abnormalities in a significant number of patients identifying as having BII. A large proportion of these patients have reported resolution or improvement of their symptoms in patient-reported outcomes. Improved microbiology culture techniques may identify a larger proportion of chronic infection, and further investigation of immune phenotypes and toxicology may also be warranted in this group.
Medical Director Responsibilities for Outpatient Pulmonary Rehabilitation Programs in the United States: 2019
Authors: Carlin Brian W. , Bauldoff Gerene S. , Collins Eileen , Garvey Chris , Marciniuk Darcy , Ries Andrew , Limberg Trina , ZuWallack Richard
Published: April 2020

Clinical guidelines have been developed recognizing pulmonary rehabilitation (PR) as a key component in the management of patients with chronic lung disease. The medical director of a PR program is a key player in every program and is a requirement for operation of the program. The medical director must be a licensed physician who has experience in respiratory physiology management. The purpose of this document is to provide an update regarding the clinical, programmatic, legislative, and regulatory issues that impact PR medical directors in North America. It describes the clinical rationale for physician involvement, relevant legislative and regulatory requirements, and resources available that the medical director can utilize to promote evidence-based and cost-effective PR services. All pulmonary rehabilitation (PR) programs must include a medical director. There are many clinical, programmatic, legislative, and regulatory issues that impact the PR medical director. The purpose of this document is to concentrate on the unique roles and responsibilities of the PR medical director.
Measurement of In Vivo Biomechanical Changes Attributable to Epithelial Removal in Keratoconus Using a Noncontact Tonometer
Authors: Ziaei Mohammed , Gokul Akilesh , Vellara Hans , Lu Lucy M. , Patel Dipika V. , McGhee Charles N. J.
Published: April 2020

Purpose:

To compare the biomechanical properties of the cornea after epithelial removal in eyes with keratoconus undergoing corneal cross-linking.

Methods:

Prospective interventional case series at a university hospital tertiary referral center. Corneal biomechanical properties were measured in patients with keratoconus undergoing corneal cross-linking, immediately before and after epithelial debridement by using a dynamic ultrahigh-speed Scheimpflug camera equipped with a noncontact tonometer.

Results:

The study comprised 45 eyes of 45 patients with a mean age of 19.6 ± 4.9 years (range 14–34). The cornea was found to be 23.7 ± 15.7 μm thinner after epithelial removal (P < 0.01). Corneal stiffness was reduced after epithelial removal as demonstrated by a significant decrease of parameters such as stiffness parameter A1 (12.31, P < 0.01), stiffness parameter-highest concavity (2.25, P < 0.01), A1 length (0.13 mm, P = 0.04), highest concavity radius of curvature (0.26 mm, P = 0.01), highest concavity time (0.22 ms, P = 0.04) and an increase in A1 velocity (−0.01 m/s, P = 0.01), A1 deformation amplitude (−0.03 mm, P ≤ 0.01), A1 deflection length (−0.32 mm, P < 0.01), A2 deformation amplitude (−0.03 mm, P = 0.01), and A2 deflection length (−1.00 mm, P < 0.01). There were no significant differences in biomechanical intraocular pressure (0.15 mm Hg, P = 0.78), deformation amplitude (0.03, P = 0.54), maximum inverse radius (−0.01 mm, P = 0.57), and whole eye movement length (−0.02 mm, P = 0.12).

Conclusions:

Dynamic ultrahigh-speed Scheimpflug camera equipped with a noncontact tonometer offers an alternative method for in vivo measurements of the epithelial layer's contribution to corneal biomechanical properties. Our results suggest that corneal epithelium may play a more significant role in corneal biomechanical properties in patients with keratoconus than previously described.
Anterior Segment Findings in Patients With Osteogenesis Imperfecta: A Case-Control Study
Authors: Keleş Ali , Doğuizi Sibel , Şahin Nursel Muratoğlu , Koç Mustafa , Aycan Zehra
Published: April 2020

Purpose:

To evaluate the anterior segment parameters in patients with osteogenesis imperfecta (OI) compared with healthy control subjects.

Methods:

Seventeen patients with OI and 19 age-matched healthy controls were included into this cross-sectional case-control study. Corneal topographic, topometric and Belin–Ambrósio Enhanced Ectasia Display III analysis, corneal densitometry (12-mm corneal diameter), and lens densitometry measurements were obtained by using the Pentacam HR-Scheimpflug imaging system (Oculus, Wetzlar, Germany). The corneal endothelial cell properties were determined by specular microscopy.

Results:

In comparison to the control group, patients with OI had significantly higher front astigmatism (0.8 ± 0.4 vs. 1.4 ± 1.1 mm, P = 0.026), thinner thinnest corneal thickness (556.4 ± 32.7 μm vs. 482.5 ± 66.9 μm, P = 0.002), smaller corneal volume (62.4 ± 3.5 mm3 vs. 53.7 ± 6.4 mm3, P < 0.001), lower anterior chamber depth (3.2 ± 0.3 mm vs. 3.0 ± 0.2 mm, P = 0.009), higher index of vertical asymmetry (0.1 ± 0.04 vs. 0.2 ± 0.11, P < 0.001), higher posterior elevation (6.0 ± 2.7 μm vs. 11.9 ± 7.8 μm, P = 0.002), lower maximum Ambrósio relational thickness indice (456.6 ± 67.5 vs. 365.6 ± 115.7, P = 0.009), and higher final “D” value (0.7 ± 0.4 vs. 2.0 ± 1.6, P = 0.002). The corneal and lens densitometry values were similar in all concentric zones and layers in both groups except that 6 to 10 mm in the center. Corneal densitometry was higher in eyes with OI than that in the control group (9.8 ± 1.7 and 8.8 ± 1.0, P = 0.010). There was no difference in endothelial cell morphology between the groups (P > 0.05).

Conclusions:

The morphologic parameters determined on the corneal analysis are in general agreement with the known pathophysiology of OI. Corneal analysis may prove useful in monitoring patients with OI in clinical practice.
Longitudinal changes of the macular structure after lens removal combined with anterior vitrectomy after pediatric cataract surgery
Authors: Wang Dandan , Tian Tong , Wang Jiajun , Li Zhangliang , Chang Pingjun , Ding Xixia , Zhao Yinying , Zhao Yun-e
Published: April 2020

Purpose:

To explore the macular thickness changes after lens removal combined with anterior vitrectomy for pediatric cataract surgery.

Setting:

The Eye Hospital of Wenzhou Medical University, Zhejiang, China.

Design:

Prospective study.

Methods:

Thirty children (40 eyes) aged between 3 years and 9 years with pediatric cataracts, including 20 children (20 eyes) with unilateral cataracts and 10 children (20 eyes) with bilateral cataracts, were enrolled. Spectral-domain optical coherence tomography was used to obtain macular images. Central subfield thickness (CST) and retinal thickness in the Early Treatment Diabetic Retinopathy Study subfields (inner 1.0 to 3.0 mm annulus and outer 3.0 to 6.0 mm annulus) were recorded preoperatively as well as at 1, 3, 6, and 12 months postoperatively.

Results:

Forty eyes of 30 children were included. Retinal thickness in every subfield significantly thickened at 3 months postoperatively (all P < .05). CST significantly thickened compared with preoperative levels (228.03 ± 18.58 vs 240.35 ± 17.41, P = .005) at 3 months postoperatively; macular thickness gradually decreased in the following months. At 6 months postoperatively, retinal thickness in inner nasal, inferior, temporal, and outer nasal subfields remained significantly thicker compared with preoperative levels (P = .048, P = .036, P = .029, and P = .017, respectively). At 12 months, the retinal thickness in all subfields reached the preoperative level.

Conclusions:

The influence on macular thickness lasted until 12 months after pediatric cataract surgery. The inner macular thickness increased for a longer time than the outer macular thickness postoperatively.
Acute Effects of Iron Sucrose and Iron Carboxymaltose on Endothelial Function in Nondialysis Chronic Kidney Disease Patients
Authors: Mehedinti Ana Maria , Lipan Mariana , Stancu Simona , Mircescu Gabriel , Capusa Cristina
Published: April 2020

Background:

Intravenous iron is commonly prescribed in chronic kidney disease (CKD) patients. Iron sucrose (IS) and ferric carboxymaltose (FCM) are 2 frequently used formulations. Experimental data showed that this 2 intravenous iron preparations have different potential to induce oxidative stress and by that endothelial dysfunction. Still, direct comparisons in clinical settings are rather scarce.

Study Question:

Are there any acute changes in endothelial function after single intravenous iron infusions of IS and FCM in nondialysis CKD patients?

Study Design:

This was a prospective, crossover study in which 31 patients with CKD stages 3–5 (80% stages 3 and 4, 81% female, 55% older than 60 years, 23% diabetes mellitus, and 94% arterial hypertension) who required intravenous iron as part of their routine medical care were enrolled.

Measures and Outcomes:

The effect of flow-mediated vasodilatation infusions containing 250-mL 10% glucose, 500-mg FCM, and 200-mg IS, both in 250-mL 0.9% saline solution, was compared. The infusions were administered over 30 minutes, 72 hours apart, in the mentioned order. Ultrasound measurement of the brachial artery flow-mediated vasodilation (FMD) performed 15 minutes before and after each infusion was used to assess endothelial function. The outcome was the post/preinfusion difference (Δ) in FMD.

Results:

The baseline FMD was similar before each study intervention. The arterial reactivity significantly decreased only after IS infusion [ΔFMD −2.3 (−5.65 to −0.33) vs. 1.0 (−1.49 to 1.80) after glucose, P = 0.01], but not after FCM [ΔFMD −0.8 (−2.50 to 0.65), P = 0.27 vs. glucose]. Moreover, the arterial reactivity was higher after IS as compared to FCM.

Conclusions:

Endothelial dysfunction seems to be acutely induced by a single dose of intravenous IS, but not by FCM, in nondialysis CKD patients.
Trends in Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men After Rapid Scale-up of Preexposure Prophylaxis in Victoria, Australia
Authors: Ryan Kathleen E. , Asselin Jason , Fairley Chistopher K. , Armishaw Judy , Lal Luxi , Nguyen Long , Murphy Dean , Traeger Michael , Hellard Margaret , Hoy Jennifer , Stoové Mark , Wright Edwina
Published: April 2020

Objective

Scale-up of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has raised concerns regarding its impact on clinic capacity and access to HIV testing. We describe enrolment in PrEPX, a large PrEP implementation study in Victoria, Australia, and the impact of PrEP uptake and maintenance on existing health services.

Methods

We describe enrolment between July 26, 2016, and March 31, 2018, and trends in HIV testing among PrEPX participating and nonparticipating gay and bisexual and other men who have sex with men (GBM) at 5 study clinics participating in a sentinel surveillance system (ACCESS). We evaluated HIV and STI testing trends using segmented linear regression across the prestudy (January 2015 to June 2016) and PrEPX study (July 2016 to March 2018) periods.

Findings

There were 2,049 individuals who registered interest in study participation: 72% enrolled into the study. Study clinics enrolled participants rapidly; of 4265 people enrolled in PrEPX (98% GBM), 1000 enrolled by week 3, 88% (n = 876) of whom enrolled at ACCESS sites.

Prestudy period HIV testing rates were increasing at all ACCESS sites. In the month PrEPX commenced, there was an additional 247 HIV tests among PrEPX participants (P < 0.01) and no significant change among non-PrEPX GBM (P = 0.72). Across the study period, HIV testing increased by 7.2 (P < 0.01) and 8.9 (P < 0.01) tests/month among PrEPX participants and non-PrEPX GBM, respectively. The HIV testing increased among non-PrEPX GBM at sexual health clinics (18.8 tests/month, P < 0.01) and primary care clinics (7.9 tests/month, P < 0.01). Similar trends were observed across testing for all measured STIs.

Conclusions

Rapid PrEP scale-up is possible without a reduction in HIV testing among GBM not using PrEP.
Virtual Pediatric Emergency Department Telehealth Network Program
Authors: Cotton James , Bullard-Berent Jeffrey , Sapien Robert
Published: April 2020

Objectives

Pediatric patients living in rural, underserved areas have reduced access to medical care. There is a lack of research describing the use of telemedicine (TM) for general pediatric emergency medicine (PEM). In 2013, we established the Child Ready Virtual Pediatric Emergency Department Telehealth Network (CR-VPED), a PEM TM consultation service serving rural hospitals across the state of New Mexico. The aim of this article is to describe our experience for 6 years (2013–2018).

Methods

We describe the process of establishing the CR-VPED Telehealth Network. We reviewed all the TM consultations completed from June 22, 2013, to September 6, 2018. In our review, we focus on patient demographics, medical complaint, transfer status, type of referring provider, and problems encountered with each TM consultation.

Results

We had a total of 58 PEM TM consultations between June 22, 2013, and September 6, 2018. All consultations occurred at 6 of the 12 established sites. Most TM consultations (71%; 41/58) were with Indian Health Service sites. Among all TM consultations, patients ranged in age from 30 days to 17 years (mean, 54 months; median, 32 months). Only 26% (15/58) of the patients with TM consultations were transferred to the tertiary care hospital. There was a heterogeneous mix of chief complaints and diagnoses. Rash was the most common chief complaint (24%; 14/58). There was a mix of referring providers, with family medicine physicians being most common (31%; 18/58). Common technical issues were not properly recording the encounter into the electronic medical record (12%; 7/58) and difficulty logging into the CR-VPED Telehealth Network (9%; 5/58).

Conclusions

Previous studies have investigated the use of TM in pediatric acute care, but most studies have focused on critical care or subspecialty care in the office setting. Our experience with CR-VPED has shown that it has been feasible to provide general pediatric emergency care to patients in underserved, rural emergency departments across New Mexico. Patients requiring TM consultation were heterogeneous in age and presentation.
Occult Breast Carcinoma Is More Common in Women Undergoing Breast Reduction after Contralateral Cancer: A Systematic Review and Meta-Analysis
Authors: Fitzpatrick Siobhan E. , Lam Thomas C.
Published: April 2020

Background:

Occult breast carcinoma is occasionally found in breast reduction specimens. Although its incidence varies widely, there is a trend toward an increased incidence for women with a history of breast cancer. The authors performed a systematic review and meta-analysis of occult carcinoma incidence in breast reduction specimens.

Methods:

The MEDLINE and Embase databases were searched for peer-reviewed studies with no language restrictions for studies that recorded the incidence of occult carcinoma in breast reduction specimens. Cancer incidence per specimen was pooled for women with and without a history of breast cancer.

Results:

Forty-two studies were eligible for inclusion, of which 29 were quantitatively analyzed. The pooled incidence of carcinoma was higher within specimens from women with breast cancer (3.4 percent; 95 percent CI, 2.2 to 5.3 percent) than without (0.6 percent; 95 percent CI, 0.4 to 0.8 percent), and this increased likelihood was significant when populations were compared directly (OR, 6.02; 95 percent CI, 3.06 to 11.86; p < 0.0001).

Conclusions:

Women with a history of breast cancer have an increased incidence of occult breast carcinoma within their breast reduction specimens compared with women with no breast cancer history. There is a need for preoperative radiology screening, counseling, and histopathology guidelines to ensure adequate diagnosis and management of these women.
Skin Excursion with Cannula Lipodissection and the Anatomical Implications of Superficial Musculoaponeurotic System Movement in the Tumescent Face Lift
Authors: Mirzabeigi Michael N. , Stark Ran Y. , Chang Catherine S. , Weissler Jason M. , Carney Martin J. , Bucky Louis P.
Published: April 2020

Background:

The tumescent face lift uses the concept of subcutaneous cannula lipodissection of the neck, as opposed to wide skin undermining. Lipodissection mobilizes soft tissue while preserving perforating neurovascular branches. The purpose of this study is two-fold: (1) to compare the skin recruitment with subcutaneous lipodissection of the neck alone versus wide undermining and (2) to examine the effect of superiorly oriented superficial musculoaponeurotic system (SMAS) movement on jowl excursion in the tumescent face lift.

Methods:

A cadaveric study was performed on five fresh tissue cadavers. Postauricular skin excursion was measured following subcutaneous lipodissection and then measured again after traditional, wide undermining of the neck skin. Jowl excursion (in reference to the mandibular border) was measured following superiorly oriented SMAS excursion. An electronic force gauge was used to measure force application during measurements.

Results:

Cannula lipodissection resulted in a mean skin excursion of 41.9 mm. There was no significant difference in skin excursion compared to wide undermining (41.9 mm versus 42.1 mm; p = 0.785). Jowl position, in reference to the mandibular border, moved superiorly by a mean distance of 18.3 mm with vertical SMAS excursion.

Conclusions:

Subcutaneous cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining of the neck. A superior vector of pull on the SMAS results in vertical excursion of the jowl in reference to the mandibular border.
Plastic Surgery Chairs and Program Directors: Are the Qualifications Different for Men and Women?
Authors: Zhang Ben , Chen Kevin , Ha Grace , Smith Mark L. , Bradley James P. , Thorne Charles H. , Kasabian Armen K. , Pusic Andrea L. , Tanna Neil
Published: April 2020

Background:

The gender disparity between the number of female and male chairs and program directors has been previously established. The aim of this study was to determine whether any differences in objective credentials existed between male and female plastic surgery department chairs/division chiefs and program directors.

Methods:

Information about each plastic surgery program director and chair/chief was extracted from the websites of all institutions affiliated with a plastic surgery residency program. For each individual, information about the length of their career, number of fellowships completed, and number of publications was recorded. The two-tailed t test was used to compare differences between male and female chairs and program directors.

Results:

A total of 99 chairs were recorded, of which nine (9.1 percent) were female. Of the 99 program directors, 13 (13.1 percent) were female. There was no difference in the number of years in practice or number of fellowships between men and women for either position. On average, male chairs had significantly fewer publications than female chairs (71.9 versus 128; p < 0.05). There was no significant difference in the number of publications between male and female program directors. Compared to program directors, chairs had significantly more years in practice and numbers of publications, which held true for both men and women.

Conclusions:

Women are not only underrepresented in the department chair and program director positions, but also possess higher qualifications that may reflect differences in standards for promotion and appointment. Additional research is needed to elucidate the reasons behind the observed differences in qualifications.
Psychological Symptoms and Quality of Life After Simultaneous Kidney and Pancreas Transplantation
Authors: Nijhoff Michiel F. , Hovens Jacqueline G.F.M. , Huisman Sasja D. , Ringers Jan , Rabelink Ton A.J. , de Fijter Hans J.W. , van der Boog Paul J.M. , de Koning Eelco J.P.
Published: April 2020

Background.

Patients that have undergone successful simultaneous pancreas/kidney (SPK) transplantation attain normoglycemia and are free from dialysis. However, only a minor improvement in quality of life (QOL) has been demonstrated. Here, we evaluated the role of psychological symptoms in QOL after SPK transplantation.

Methods.

We assessed patients with type 1 diabetes and end-stage renal disease waitlisted for SPK transplantation (pre-SPK, n = 47), and recipients of an SPK transplant (post-SPK, n = 72). Matched patients with type 1 diabetes without end-stage renal disease were included as reference group (type 1 diabetes [T1D] reference group, n = 42). The brief symptom inventory (BSI) was used to measure psychological symptoms. The Short Form-36 (SF-36) was used to determine QOL.

Results.

Post-SPK patients scored slightly better on the SF-36 than pre-SPK patients (“General health” 47.2 ± 23.1 versus 37.5 ± 18.1 [P = 0.017]). In the T1D reference group, this score was 60.6 ± 22.3. Post- and pre-SPK patients had similar BSI scores (0.54 ± 0.55 and 0.45 ± 0.42, respectively [P = 0.34]). This score was better in the T1D reference group (BSI score 0.32 ± 0.33). The BSI score inversely correlated with the SF-36 (r = −0.61, P < 0.001).

Conclusions.

Psychological symptoms are prevalent in both pre-SPK and post-SPK patients and could play an important role in the reduced QOL observed in these groups.
Prevalence of Optic Disc Drusen in Young Patients With Nonarteritic Anterior Ischemic Optic Neuropathy: A 10-Year Retrospective Study
Authors: Fraser J. Alexander , Rueløkke Lea L. , Malmqvist Lasse , Hamann Steffen
Published: April 2020

Background:

Nonarteritic anterior ischemic optic neuropathy (NAION) in young patients (age ≤50) accounts for a minority of all cases of NAION and is more highly associated with crowding of the optic nerves and bilateral involvement than NAION in older patients. Optic disc drusen (ODD) are likewise associated with crowded optic nerves and are located in the prelaminar optic nerve head where they could contribute to NAION pathogenesis. The purpose of this study was to determine the prevalence of ODD in the eyes of young NAION patients using modern imaging methods and to compare it to the baseline 1.8%–2.0% prevalence of ODD in the general population.

Methods:

In this retrospective study, all young NAION patients (ages 18–50 years, inclusive) seen in 2 tertiary care neuro-ophthalmology clinics (in London, Canada and Copenhagen, Denmark) in the ten-year interval between April 1, 2009, and March 31, 2019, were identified and their medical charts reviewed. Patients were included in the study if ODD were diagnosed by any method (including ophthalmoscopy, ultrasound [US], fundus autofluorescence [FAF], computed tomography [CT], or any optical coherence tomography [OCT] method), or if ODD were excluded by enhanced-depth imaging OCT (EDI-OCT) using the ODD Studies (ODDS) Consortium protocol. The presence or absence of ODD was recorded for each eye.

Results:

There were 37 eligible patients (74 eyes). Mean age of NAION onset was 38.5 ± 10.0 years, and 23 patients (62%) were men. Patients had undergone the following methods of ODD detection: ophthalmoscopy (37 patients), EDI-OCT (36 patients), FAF (31 patients), US (9 patients), and CT orbits (8 patients). We found a prevalence of ODD of 56.7% in NAION–affected patients and 53.3% in NAION–affected eyes. Only 35.9% of ODD were visible on ophthalmoscopy. Twenty of 21 ODD patients (95.2%) had bilateral ODD. Age of onset and sex did not differ significantly between the ODD-positive group and the ODD-negative group. EDI-OCT outperformed any combination of ophthalmoscopy, US, FAF, and CT at detecting ODD.

Conclusion:

ODD were found with much higher prevalence in young patients with NAION than in the general population and were usually bilateral and buried. ODD may contribute to NAION pathogenesis by exacerbating an underlying compartment syndrome in the crowded “disc at risk.” EDI-OCT may be the best imaging modality for ODD detection in future studies.
Emergency Medical Services resource capacity and competency amid COVID-19 in the United States: Preliminary findings from a national survey
Authors: Gibson Cody V. , Ventura Christian A. , Collier George D. , Baang Hyewon Sabrina , Denton Edward , Knauth Christopher , Van Court Emily , Saraya Maya , Kameen Paul
Published: April 2020

OBJECTIVE

This study aimed to investigate available resources, Personal Protective Equipment (PPE) availability, sanitation practices, institutional policies, and opinions among EMS professionals in the United States amid the COVID-19 pandemic using a self-report survey questionnaire.

METHODS

An online 42-question multiple choice survey was randomly distributed between April 1, 2020, and April 12, 2020 to various active Emergency Medical Services (EMS) paid personnel in all 50 U.S. states including the District of Columbia (n=165). We approximate a 95% confidence interval (± 0.0755).

RESULTS

An overwhelming number of EMS providers report having limited access to N95 respirators, receiving little or no benefits from COVID-19 related work, and report no institutional policy on social distancing practices despite CDC recommendations. For providers who do have access to N95 respirators, 31% report having to use the same mask for 1 week or longer. Approximately ⅓ of the surveyed participants were unsure of when a COVID-19 patient is infectious. The data suggests regular decontamination of EMS equipment after each patient contact is not a regular practice.

DISCUSSION

Current practices to educate EMS providers on appropriate response to the novel coronavirus may not be sufficient, and future patients may benefit from a nationally established COVID-19 EMS response protocol. Further investigation on whether current EMS practices are contributing to the spread of infection is warranted. The data reveals concerning deficits in COVID-19 related education and administrative protocols which pose as a serious public health concern that should be urgently addressed.

Key Messages

What is already known on this subject

COVID-19 presents as a national emergency in the United States, and all efforts to mitigate the spread of disease should be considered

Emergency Medical Services personnel play a pivotal role in patient outcomes and are often the first healthcare providers to make contact with COVID-19 patients

The CDC has provided an Interim guidance for EMS professionals amid the COVID-19 pandemic

What this study adds

Due to varied decontamination practices and administrative protocols that are non-compliant with CDC recommendations, EMS providers may inadvertently contribute to the spread of infection

Due to varied knowledge and opinions of EMS providers on COVID-19, current pandemic education approaches may need to be revisited
Modelling of Systemic versus Pulmonary Chloroquine Exposure in Man for COVID-19 Dose Selection
Authors: Aljayyoussi Ghaith , Rajoli Rajith KR , Pertinez Henry , Pennington Shaun H , Hong W. David , O’Neill Paul M. , Owen Andrew , Ward Steve A , Biagini Giancarlo A
Published: April 2020

Chloroquine has attracted intense attention as a potential clinical candidate for prevention and treatment of COVID-19 based on reports ofin-vitroefficacy against SARS-CoV-2. While the pharmacokinetic-pharmacodynamic (PK-PD) relationship of chloroquine is well established for malaria, there is sparse information regarding its dose-effect relationship in the context of COVID-19.

Here, we explore the PK-PD relationship of chloroquine for COVID-19 by modelling both achievable systemic and pulmonary drug concentrations. Our data indicate that the standard anti-malarial treatment dose of 25mg/kg over three days does not deliver sufficient systemic drug exposures for the inhibition of viral replication. In contrast, PK predictions of chloroquine in the lungs usingin-vivodata or human physiologically-based PK models, suggest that doses as low as 3mg/kg/day for 3 days could deliver exposures that are significantly higher than reported antiviral-EC90s for up to a week. Moreover, if pulmonary exposure is a driver for prevention, simulations show that chronic daily dosing of chloroquine may be unnecessary for prophylaxis purposes. Instead, once weekly doses of 5mg/kg would be sufficient to achieve a continuous cover of therapeutically active pulmonary exposures.

These findings reveal a highly compartmentalised distribution of chloroquine in man that may significantly affect its therapeutic potential against COVID-19. The systemic circulation is shown as one site where chloroquine exposure is insufficient to inhibit SARS-CoV-2 replication. However, if therapeutic activity is driven by pulmonary exposure, it should be possible to reduce the chloroquine dose to safe levels. Carefully designed randomized controlled trials are urgently required to address these outstanding issues.
Novel indicator of change in COVID-19 spread status
Authors: Nakano Takashi , Ikeda Yoichi
Published: April 2020

In the fight against the pandemic of COVID-19, it is important to be quick to detect changes in the rate of spread and to be precise to predict the future. We have succeeded in formulating a new indicator based on daily number of infected people from publicly available data, which enables us to do the both. We show the validity of the indicator by demonstrating that a universal analysis of current status of COVID-19 spreading over countries can predict effects of measures such as the blockage of cities and social distancing, signs of new spread, and possible regional dependence in the formation of herd immunity.
Solvable delay model for epidemic spreading: the case of Covid-19 in Italy
Authors: Dell’Anna Luca
Published: April 2020

We present a simple but realistic model for describing the diffusion of an infectious disease on a population of individuals. The dynamics is governed by a single functional delay differential equation, which, in the case of a large population, can be solved exactly, even in the presence of a time-dependent infection rate. This delay model has a higher degree of accuracy than the so-called SIR model, commonly used in epidemiology, which, instead, is formulated in terms of a set of three ordinary differential equations. We apply our model to describe the outbreak of the new virus COVID-19 in Italy, taking into account the containment measures implemented by the government in order to mitigate the spreading of the virus and the social costs for the population.
Discovery of isoplumbagin as a novel NQO1 substrate and anti-cancer quinone
Authors: Tsao Yen-Chi , Chang Yu-Jung , Wang Chun-Hsien , Chen Linyi
Published: April 2020

Isoplumbagin (5-hydroxy-3-methyl-1,4-naphthoquinone), a naturally occurring quinone fromLawsonia inermisandPlumbago europaea, that has been reported to have anti-inflammatory and anti-microbial activity. Inflammation has long been implicated in cancer progression. In this study, we examined the anti-cancer effect of chemically-synthesized isoplumbagin. Our results revealed that isoplumbagin treatment suppressed cell viability and invasion of highly invasive oral squamous cell carcinoma (OSCC) OC3-IV2 cells, glioblastoma U87 cells, non-small cell lung carcinoma H1299 cells, prostate cancer PC3 cells, and cervical cancer Hela cells by using MTT and Boyden chamber assays.In vivostudies demonstrate the inhibitory effect of 2 mg/kg isoplumbagin on the growth of orthotopic xenograft tumors derived from OSCC cells. Mechanistically, isoplumbagin exerts its cytotoxic effect through acting as a substrate of NAD(P)H quinone dehydrogenase 1 (NQO1) to generate hydroquinone, which reverses mitochondrial fission phenotype, reduces mitochondrial complex IV activity and thus compromises mitochondrial function. Collectively, this work reveals an anti-cancer activity of isoplumbagin mainly through modulating mitochondrial dynamics and function.

Chemical compounds:Isoplumbagin (PubChem CID: 375105)