bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic hysteresis of magnetite at high temperature: grain size variation
Authors: Dunlop David J
Published: April 2021

Thermoremanent magnetization (TRM), the primary magnetic memory of igneous rocks, depends for its stability through geologic time on mineral carriers with high coercivities and high unblocking temperatures. The palaeomagnetic record of past magnetic field directions and intensities is the key to unraveling Earth's tectonic history. Yet we still do not fully understand how the familiar mineral magnetite, in the micrometer grain size range typically responsible for stable TRM, acquires and holds its signal. Direct indicators of magnetite remanence-carrying capacity and coercivity at high temperature T are saturation remanence relative to saturation magnetization Mrs/Ms and coercive force Hc. This study is the first to measure the variation of these hysteresis properties for magnetite, from room temperature to the Curie point, across the entire size range from 25 nm to 135 µm, covering superparamagnetic, single-domain, vortex, pseudo-single-domain and multidomain magnetic behaviour. The paper focuses on: (1) Hc(T) and Mrs(T) observations and their reproducibility; (2) mathematical relationships of Hc(T) and Mrs(T) to Ms(T), used in modelling TRM and for unbiased comparisons of thermal variations; (3) the shapes of magnetite grains and the number of domains they contain, revealed by demagnetizing factors N = Hc/Mrs and (4) the grain size dependences of Hc and Mrs at ordinary and elevated T, delineating domain structure changes and mechanisms of coercivity.
Random Interpolating Sequences in Dirichlet Spaces
Authors: Chalmoukis Nikolaos , Hartmann Andreas , Kellay Karim , Wick Brett Duane
Published: April 2021

We discuss random interpolating sequences in weighted Dirichlet spaces ${{\mathcal{D}}}_\alpha $, $0\leq \alpha \leq 1$, when the radii of the sequence points are fixed a priori and the arguments are uniformly distributed. Although conditions for deterministic interpolation in these spaces depend on capacities, which are very hard to estimate in general, we show that random interpolation is driven by surprisingly simple distribution conditions. As a consequence, we obtain a breakpoint at $\alpha =1/2$ in the behavior of these random interpolating sequences showing more precisely that almost sure interpolating sequences for ${{\mathcal{D}}}_\alpha $ are exactly the almost sure separated sequences when $0\le \alpha <1/2$ (which includes the Hardy space $H^2={{\mathcal{D}}}_0$), and they are exactly the almost sure zero sequences for ${{\mathcal{D}}}_\alpha $ when $1/2 \leq \alpha \le 1$ (which includes the classical Dirichlet space ${{\mathcal{D}}}={{\mathcal{D}}}_1$).
Validation Study for PathogenDx EnviroX-Rv Assay for the Detection of SARS-CoV-2 from Stainless Steel Environmental Surface Swabs Performance Tested MethodSM 122003
Authors: Katchman* Benjamin A , Newland Cory S , Rivas Candy M , O’Brien Kevin , Eggers Rick , Wen Fushi , Hogan Mike
Published: April 2021

Background

The PathogenDx EnviroX-Rv uses endpoint PCR + DNA microarray technology to detect SARS-CoV-2, the causative agent of COVID-19, from stainless-steel environmental sample swabs.

Objective

To validate the PathogenDx EnviroX-Rv assay as part of the Emergency Response Validation (ERV) Performance Tested Method(s)SM (PTM) program.

Method

The PathogenDx EnviroX-Rv assay was evaluated for specificity using in silico analysis of ≥41 000 SARS-CoV-2 sequences and over 50 exclusivity organisms (both near neighbors and background organisms). The candidate method was evaluated in an unpaired study design for one environmental surface (stainless steel) and compared to the US Centers for Disease Control and Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time-Polymerase Chain Reaction (RT-PCR) Diagnostic Panel, Instructions for Use (Revision 4, Effective 6/12/2020).

Results

Results of the in silico analysis demonstrated the high specificity of the method in being able to detect target SARS-CoV-2 sequences and discriminate them from near neighbors and environmental background organisms. In the matrix study, the candidate method demonstrated a statistically significant difference when compared to the results of the CDC method utilized in this study, with the candidate method resulting in more positive replicates as it only requires one target to be present for a positive sample.

Conclusions

The EnviroX-Rv assay rapidly and accurately detected SARS-CoV-2 RNA on environmental swabs from stainless-steel surfaces at a concentration of 2000 genomic copies per 2 × 2” test area.

Highlights

The EnviroX-Rv assay employs dual PCR and hybridization techniques to provide highly accurate results when detecting SARS-CoV-2 from surfaces.
VirtualTaste: a web server for the prediction of organoleptic properties of chemical compounds
Authors: Fritz Franziska , Preissner Robert , Banerjee Priyanka
Published: April 2021

Taste is one of the crucial organoleptic properties involved in the perception of food by humans. Taste of a chemical compound present in food stimulates us to take in food and avoid poisons. Bitter taste of drugs presents compliance problems and early flagging of potential bitterness of a drug candidate may help with its further development. Similarly, the taste of chemicals present in food is important for evaluation of food quality in the industry. In this work, we have implemented machine learning models to predict three different taste endpoints—sweet, bitter and sour. The VirtualTaste models achieved an overall accuracy of 90% and an AUC of 0.98 in 10-fold cross-validation and in an independent test set. The web server takes a two-dimensional chemical structure as input and reports the chemical's taste profile for three tastes—using molecular fingerprints along with confidence scores, including information on similar compounds with known activity from the training set and an overall radar chart. Additionally, insights into 25 bitter receptors are also provided via target prediction for the predicted bitter compounds. VirtualTaste, to the best of our knowledge, is the first freely available web-based platform for the prediction of three different tastes of compounds. It is accessible via http://virtualtaste.charite.de/VirtualTaste/without any login requirements and is free to use.
MutViz 2.0: visual analysis of somatic mutations and the impact of mutational signatures on selected genomic regions
Authors: Gulino Andrea , Stamoulakatou Eirini , Piro Rosario M
Published: April 2021

Patterns of somatic single nucleotide variants observed in human cancers vary widely between different tumor types. They depend not only on the activity of diverse mutational processes, such as exposure to ultraviolet light and the deamination of methylated cytosines, but largely also on the sequence content of different genomic regions on which these processes act. With MutViz (http://gmql.eu/mutviz/), we have presented a user-friendly web tool for the identification of mutation enrichments that offers preloaded mutations from public datasets for a variety of cancer types, well organized within an effective database architecture. Somatic mutation patterns can be visually and statistically analyzed within arbitrary sets of small, user-provided genomic regions, such as promoters or collections of transcription factor binding sites. Here, we present MutViz 2.0, a largely extended and consolidated version of the tool: we took into account the immediate (trinucleotide) sequence context of mutations, improved the representation of clinical annotation of tumor samples and devised a method for signature refitting on limited genomic regions to infer the contribution of individual mutational processes to the mutation patterns observed in these regions. We described both the features of MutViz 2.0, concentrating on the novelties, and the substantial re-engineering of the cloud-based architecture.
BARTweb: a web server for transcriptional regulator association analysis
Authors: Ma Wenjing , Wang Zhenjia , Zhang Yifan , Magee Neal E , Feng Yayi , Shi Ruoyao , Chen Yang , Zang Chongzhi
Published: April 2021

Identifying active transcriptional regulators (TRs) associating with cis-regulatory elements in the genome to regulate gene expression is a key task in gene regulation research. TR binding profiles from numerous public ChIP-seq data can be utilized for association analysis with query data for TR identification, as an alternative to DNA sequence motif analysis. However, integration of the massive ChIP-seq datasets has been a major challenge in such approaches. Here we present BARTweb, an interactive web server for identifying TRs whose genomic binding patterns associate with input genomic features, by leveraging over 13 000 public ChIP-seq datasets for human and mouse. Using an updated binding analysis for regulation of transcription (BART) algorithm, BARTweb can identify functional TRs that regulate a gene set, have a binding profile correlated with a ChIP-seq profile or are enriched in a genomic region set, without a priori information of the cell type. BARTweb can be a useful web server for performing functional analysis of gene regulation. BARTweb is freely available at http://bartweb.org and the source code is available at https://github.com/zanglab/bart2.
Timing of glioblastoma surgery and patient outcomes: a multicenter cohort study
Authors: Müller Domenique M J , De Swart Merijn E , Ardon Hilko , Barkhof Frederik , Bello Lorenzo , Berger Mitchel S , Bouwknegt Wim , Van den Brink Wimar A , Conti Nibali Marco , Eijgelaar Roelant S , Furtner Julia , Han Seunggu J , Hervey-Jumper Shawn , Idema Albert J S , Kiesel Barbara , Kloet Alfred , Mandonnet Emmanuel , Robe Pierre A J T , Rossi Marco , Sciortino Tommaso , Vandertop W Peter , Visser Martin , Wagemakers Michiel , Widhalm Georg , Witte Marnix G , De Witt Hamer Philip C
Published: April 2021

Background

The impact of time-to-surgery on clinical outcome for patients with glioblastoma has not been determined. Any delay in treatment is perceived as detrimental, but guidelines do not specify acceptable timings. In this study, we relate the time to glioblastoma surgery with the extent of resection and residual tumor volume, performance change, and survival, and we explore the identification of patients for urgent surgery.

Methods

Adults with first-time surgery in 2012–2013 treated by 12 neuro-oncological teams were included in this study. We defined time-to-surgery as the number of days between the diagnostic MR scan and surgery. The relation between time-to-surgery and patient and tumor characteristics was explored in time-to-event analysis and proportional hazard models. Outcome according to time-to-surgery was analyzed by volumetric measurements, changes in performance status, and survival analysis with patient and tumor characteristics as modifiers.

Results

Included were 1033 patients of whom 729 had a resection and 304 a biopsy. The overall median time-to-surgery was 13 days. Surgery was within 3 days for 235 (23%) patients, and within a month for 889 (86%). The median volumetric doubling time was 22 days. Lower performance status (hazard ratio [HR] 0.942, 95% confidence interval [CI] 0.893–0.994) and larger tumor volume (HR 1.012, 95% CI 1.010–1.014) were independently associated with a shorter time-to-surgery. Extent of resection, residual tumor volume, postoperative performance change, and overall survival were not associated with time-to-surgery.

Conclusions

With current decision-making for urgent surgery in selected patients with glioblastoma and surgery typically within 1 month, we found equal extent of resection, residual tumor volume, performance status, and survival after longer times-to-surgery.
Are Monthly Market Returns Predictable?
Authors: Keppo Jussi , Shumway Tyler , Weagley Daniel
Published: April 2021

We document significant persistence in the market timing performance of active individual investors, suggesting that some investors are skilled at timing. Using data on all trades by active Finnish individual investors over almost 15 years, we also show that the net purchases of skilled versus unskilled investors predict monthly market returns. Our results lend credibility to the view that market returns are predictable, without having to specify which variables active investors use to successfully time the market. (JEL G10, G11, G12, G14, G15).
Goal-directed Fluid Therapy Versus Conventional Fluid Therapy During Craniotomy and Clipping of Cerebral Aneurysm: A Prospective Randomized Controlled Trial
Authors: Bloria Summit D. , Panda Nidhi B. , Jangra Kiran , Bhagat Hemant , Mandal Banashree , Kataria Ketan , Chauhan Rajeev , Luthra Ankur , Soni Shiv Lal , Kaloria Narender , Mahajan Shalvi , Paul Shamik Kr , Gupta Shailesh , Agrawal Sanket , Singla Navneet
Published: April 2021

Background:

Fluid imbalance is common after aneurysmal subarachnoid hemorrhage and negatively impacts clinical outcomes. We compared intraoperative goal-directed fluid therapy (GDFT) using left ventricular outflow tract velocity time integral (LVOT-VTI) measured by transesophageal echocardiography with central venous pressure (CVP)-guided fluid therapy during aneurysm clipping in aneurysmal subarachnoid hemorrhage patients.

Methods:

Fifty adults scheduled for urgent craniotomy for aneurysm clipping were randomly allocated to 2 groups: group G (n=25) received GDFT guided by LVOT-VTI and group C (n=25) received CVP-guided fluid management. The primary outcome was intraoperative mean arterial pressure (MAP). Secondary outcomes included volume of fluid administered and several other intraoperative and postoperative variables, including neurological outcome at hospital discharge and at 30 and 90 days.

Results:

There was no difference in MAP between the 2 groups despite patients in group G receiving lower volumes of fluid compared with patients in group C (2503.6±534.3 vs. 3732.8±676.5 mL, respectively; P<0.0001). Heart rate and diastolic blood pressure were also comparable between groups, whereas systolic blood pressure was higher in group G than in group C at several intraoperative time points. Other intraoperative variables, including blood loss, urine output, and lactate levels were not different between the 2 groups. Postoperative variables, including creatinine, duration of postoperative mechanical ventilation, length of intensive care unit and hospital stay, and incidence of acute kidney injury, pneumonitis, and vasospasm were also comparable between groups. There was no difference in neurological outcome at hospital discharge (modified Rankin scale) and at 30 and 90 days (Extended Glasgow Outcome Scale) between the 2 groups.

Conclusion:

Compared with CVP-guided fluid therapy, transesophageal echocardiography–guided GDFT maintains MAP with lower volumes of intravenous fluid in patients undergoing clipping of intracranial aneurysms with no adverse impact on postoperative complications.
Trends in Emergency Department Utilization Among Women With Leiomyomas in the United States
Authors: Fortin Chelsea N. , Jiang Charley , Caldwell Martina T. , As-Sanie Sawsan , Dalton Vanessa , Marsh Erica E.
Published: April 2021

OBJECTIVE:

To describe trends in emergency department (ED) visits in the United States with a primary diagnosis of leiomyomas, subsequent admissions, and associated charges.

METHODS:

The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database was used to retrospectively identify all ED visits from 2006 to 2017 among women aged 18–55 years with a primary diagnosis of leiomyomas as indicated by International Classification of Diseases (ICD) diagnosis codes. Trends in ED visits and subsequent admissions were analyzed and stratified by patient and hospital characteristics. Secondary ICD codes, Current Procedural Terminology codes, and hospital charges were analyzed. A multivariate regression model was used to identify predictors of admission.

RESULTS:

Although the number of ED visits for leiomyomas increased from 28,732 in 2006 to 65,685 in 2017, the admission rate decreased, from 23.9% in 2006 to 11.1% in 2017. Emergency department visits for leiomyomas were highest among women who were aged 36–45 years (44.5%), in the lowest income quartile (36.1%), privately insured (38.3%), and living in the South (46.2%). Admission was more likely at nonteaching hospitals (odds ratio [OR] 1.23, 95% CI 1.08–1.39) or those located in the Northeast (OR 1.39, 95% CI 1.15–1.68). Patient characteristics associated with admission included older age (26–35 years: OR 1.42, 95% CI 1.21–1.66; 36–45 years: OR 2.01, 95% CI 1.72–2.34; 46–55 years: OR 2.60, 95% CI 2.23–3.03) and bleeding-related complaints (OR 14.92, 95% CI 14.00–15.90). Admission was least likely in uninsured patients (Medicare: OR 1.37, 95% CI 1.21–1.54; Medicaid: OR 1.26, 95% CI 1.16–1.36; private: OR 1.44, 95% CI 1.32–1.56).

CONCLUSION:

Although ED visits for leiomyomas are increasing, admission rates for these visits are decreasing. The substantial decline in admissions suggests many of these visits could potentially be addressed in a non–acute-care setting. However, when women with leiomyomas present with a bleeding-related complaint, the odds of admission increase 15-fold. There is an apparent disparity in likelihood of admission based on insurance type.
Malnourishment-Associated Acetaminophen Toxicity in Pregnancy
Authors: Dom Aaron M. , Royzer Rebecca , Olson-Chen Courtney
Published: April 2021

BACKGROUND:

Although acetaminophen is commonly used in pregnancy, it can deplete glutathione concentrations and cause accumulation of 5-oxoproline, with subsequent metabolic acidosis.

CASE:

A malnourished 25-year-old woman, G2P1001, with chronic acetaminophen use presented with abdominal pain and high anion gap metabolic acidosis. After ruling out other potential causes, her urine 5-oxoproline level was found to be elevated. She received N-acetylcysteine, with resolution of the acidosis.

CONCLUSION:

Those who care for pregnant patients should remain alert to 5-oxoprolinemia as a cause of metabolic acidosis during pregnancy. Care must be taken when using acetaminophen in states of malnutrition. N-acetylcysteine seems to be an effective antidote.
Health Care Use by Commercially Insured Postpartum and Nonpostpartum Women in the United States
Authors: Steenland Maria W. , Kozhimannil Katy B. , Werner Erika F. , Daw Jamie R.
Published: April 2021

OBJECTIVE:

To compare the type, frequency, and timing of health care use among commercially insured postpartum and nonpostpartum women.

METHODS:

This retrospective cohort study used data from a large national commercial claims database. Women between 18 and 44 years of age who gave birth in 2016 (n=149,563) and women who were neither pregnant nor postpartum between 2015 and 2017 (n=2,048,831) (nonpostpartum) were included. We examined hospitalization, and preventive visits, problem visits, and emergency department (ED) visits among postpartum women during the early postpartum period (less than 21 days after childbirth), the postpartum period (21–60 days postpartum), and extended postpartum period (61–365 days after childbirth). Visits among nonpostpartum women were assessed during time periods of equivalent duration.

RESULTS:

Almost 24% of postpartum women had a problem visit in the early postpartum period, compared with 19.7% of nonpostpartum women (adjusted difference 4.8 percentage points [95% CI 4.6–5.0]). Approximately 3% of postpartum women had an early ED visit, more than double the percentage among nonpostpartum women (adjusted difference 2.3 percentage points [95% CI 2.2–2.4]). Both problem visits and ED visits among postpartum women remained elevated relative to nonpostpartum women during the postpartum and extended postpartum periods. Although postpartum women were more likely than nonpostpartum women to receive preventive care during the early and postpartum periods, only 43% of postpartum women had a preventive visit during the extended postpartum period, a rate 1.8 (95% CI −2.1 to −1.5) percentage points lower than that of nonpostpartum women. Adjusted hospitalization rates among postpartum women in the early (0.8%), postpartum (0.3%), and extended postpartum (1.4%) periods were higher than those of nonpostpartum women (0.1%, 0.2%, and 1.6%, respectively).

CONCLUSIONS:

Commercially insured postpartum women use more health care than nonpostpartum women, including inpatient care. Differences are largest in the early postpartum period and persist beyond 60 days postpartum.
Barriers to Exercise in Postpartum Women: A Mixed-Methods Systematic Review
Authors: Edie Rebekah , Lacewell Alexis , Streisel Christine , Wheeler Lauren , George Ellie , Wrigley Jordan , Pietrosimone Laura , Figuers Carol
Published: April 2021

Background:

Exercise is a safe and beneficial way of improving physical and psychological well-being in postpartum people; yet, postpartum people are less likely to meet the recommended guidelines for physical activity. Identifying the barriers to exercise in the postpartum period may assist health care professionals to better understand how to counsel this population on strategies for exercise.

Objective:

To synthesize the current literature on barriers to exercise in postpartum people.

Study Design:

A mixed-methods systematic review.

Methods:

A systematic literature search was conducted in MEDLINE/PubMed, EMBASE, Scopus, and CINAHL databases of both qualitative and quantitative studies that examined the barriers to exercise among postpartum people. The articles were selected on the basis of predetermined inclusion and exclusion criteria. The Downs and Black Checklist of Methodological Quality was used to assess study quality.

Results:

Ten studies met the inclusion criteria (7 qualitative and 3 quantitative). Barriers were categorized into the following categories: intrapersonal, interpersonal, sociocultural/demographic, physical environment, and health care environment. The most reported barriers in each category were tiredness and/or lack of sleep (7 out of 10 mentioned), time and/or unpredictable routines/schedule and busy with domestic chores/care/responsibilities (both 8 out of 10 mentioned), lack of support from family, friends, and other mothers (9 out of 10 mentioned), weather (7 out of 10 mentioned), and breastfeeding (3 out of 10 mentioned), respectively.

Conclusion:

Physical therapists and other health care professionals should be aware of the major reported barriers to exercise among postpartum people, as this will help guide them in providing meaningful education and counseling strategies to increase exercise in this unique population. Further research is needed to capture a more diverse group of postpartum people, as well as considering how policy may affect exercise postpartum.
Effectiveness and Safety of EUS Rendezvous After Failed Biliary Cannulation With ERCP
Authors: Klair Jagpal S. , Zafar Yousaf , Ashat Munish , Bomman Shivanand , Murali Arvind R. , Jayaraj Mahendran , Law Joanna , Larsen Michael , Singh Dhruv P. , Rustagi Tarun , Irani Shayan , Ross Andrew , Kozarek Richard , Krishnamoorthi Rajesh
Published: April 2021

Background:

Endoscopic ultrasound–guided rendezvous (EUS-RV) endoscopic retrograde cholangiopancreatography (ERCP) is an alternative to interventional radiology–guided rendezvous ERCP in patients who failed biliary cannulation with conventional ERCP. However, there is significant variation in reported rates of success and adverse events associated with EUS-RV-assisted ERCP. We performed a systematic review and a proportion meta-analysis to reliably assess the effectiveness and safety of the EUS-RV-assisted ERCP.

Materials and Methods:

We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through August 2020) to identify studies reporting EUS-RV-assisted ERCP in patients who failed biliary cannulation with conventional ERCP techniques. Using the random-effects model described by DerSimonian and Laird, we calculated the pooled rates of technical success, clinical success, and adverse events of EUS-RV-assisted ERCP.

Results:

Twelve studies reporting a total of 342 patients were included in the meta-analysis. The pooled rate of technical success (12 studies reporting a total of 342 patients) was 86.1% [95% confidence interval (CI): 78.4-91.3]. The pooled rate of clinical success (4 studies reporting a total of 94 patients) was 80.8% (95% CI: 64.1-90.8). The pooled rate of overall adverse events (12 studies; 42 events in 342 patients) was 14% (95% CI: 10.5-18.4). Low to moderate heterogeneity was noted in the analyses.

Conclusions:

EUS-RV-assisted ERCP appears to be effective and safe in patients who failed biliary cannulation with conventional ERCP. Given the risk of adverse events, it should be performed in centers with expertise in therapeutic endoscopic ultrasound.
The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty
Authors: Lee Yan Ho , Lee Jonathan Y. , Luo Jiajun , Lawson William , Westreich Richard
Published: April 2021

Background:

A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors’ objective is to show the effects of the subalar graft in improving nostril symmetry and to propose an algorithm for using this graft in open and endonasal rhinoplasty.

Methods:

A retrospective case series was performed on patients who had undergone rhinoplasty performed by the senior author (R.W.) from September of 2008 to July of 2015. Patients with at least 3 months of follow-up and adequate photographs were included. The mean follow-up period was 11.0 months (range, 3 to 72 months). A total of 68 patients were included. Preoperative and postoperative photographs were analyzed to measure changes in nasal axis deviation, alar facial angle on base view, alar facial angle on frontal view, and nostril show bilaterally.

Results:

Of the 68 patients, statistically significant improvement of nasal axis deviation of 4.32 degrees toward the midline was observed. Alar facial angle on base view was improved 1.01 degrees toward the horizontal. Nostril symmetry also improved based on the ratio between the shorter side and the longer side. The mean change in nostril show ratio was 0.19 toward a 1:1 ratio.

Conclusions:

Previous studies have shown that the subalar grafting technique is an important adjunctive technique in rhinoplasty for patients with midfacial asymmetries. This case series demonstrates that this technique can provide sustained results in the correction of the nasal foundation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Rhinosurgery during and after the COVID-19 Pandemic: International Consensus Conference Statement on Preliminary Perioperative Safety Measures
Authors: Haug Martin D. , Lekakis Garyfalia , Bussi Mario , Cerkes Nazim , Calvert Jay , East Charles , Gerbault Olivier , Gubisch Wolfgang , Heppt Werner , Kamburoglu Haldun , Most Sam , Oranges Carlo M. , Vavrina Josef , Rohrich Rod J. , Robotti Enrico
Published: April 2021

Background:

The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society.

Methods:

A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel’s recommendations were based on current evidence and expert opinions. The resulting report was circulated in an iterative open e-mail process until consensus was obtained.

Results:

Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures.

Conclusion:

The implementation of the panel’s recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.
Is It Worth the Risk? Contralateral Prophylactic Mastectomy With Immediate Bilateral Breast Reconstruction
Authors: Chadab Tara M. , Bernstein Jaime L. , Lifrieri Andrea , Ascherman Jeffrey A. , Grant Robert T. , Rohde Christine H.
Published: April 2021

Background

An increasing number of women are choosing to undergo contralateral prophylactic mastectomy with immediate bilateral breast reconstruction. Operating on the contralateral noncancer side is not without its own set of risks. We sought to compare complication rates between the cancerous and contralateral prophylactic breasts.

Methods

A retrospective review was conducted of all patients undergoing immediate postmastectomy bilateral breast reconstruction for unilateral breast cancer between January 2008 and January 2019 at a single institution. Data were collected on patient demographics, cancer and adjuvant/neoadjuvant treatments, tumor, reconstruction, hospital stay, and complications. Complications were compared between the cancerous and the noncancerous breasts.

Results

One hundred sixty patients met the inclusion criteria of this study. Of these 160 patients, 33 (20.6%) had complications (major and minor) only to the cancerous breast, 7 (4.4%) had complications only to the noncancerous breast, and 7 (4.4%) had bilateral complications. Most patients underwent tissue expander/implant reconstruction (93.8%) with the rest (6.2%) undergoing abdominally based flap or latissimus dorsi flap reconstruction. Patients with complications were more likely to have hypertension, diabetes, exposure to radiation, and neoadjuvant chemotherapy. Complications included wound dehiscence, hematoma, cellulitis, seroma, capsular contracture, infected implant, and skin necrosis. Overall, there were significantly more complications to the cancerous breasts than the noncancerous breasts (P < 0.001). In addition, although exposure to radiation to the affected side significantly increased the likelihood of complications to that side (P < 0.0001), patients who were not exposed to any radiation were also more likely to have complications to the cancer side than to the noncancer side (P = 0.00065). However, after controlling for the effects of radiation, there was no significant difference in complications between the cancer side and the prophylactic side when stratifying by specific complications.

Conclusions

Although contralateral prophylactic mastectomy with immediate bilateral reconstruction is not without added risk when compared with a unilateral procedure, this study shows that the incidence of complications to the noncancerous breast is less than that to the cancerous breast. This information can be used to help counsel patients with unilateral breast cancer on their treatment options and associated risks.
Evaluating the Effects of Enhanced Recovery Pathways in Craniosynostosis
Authors: Wu Shannon S. , Cai Yida , Sunshine Kerrin , Boas Samuel R. , Kumar Anand R.
Published: April 2021

Background

Enhanced Recovery After Surgery (ERAS) pathways are multimodal approaches aimed at minimizing postoperative surgical stress, reducing hospitalization time, and lowering hospitalization charges. Enhanced Recovery After Surgery is broadly and increasingly implemented in hospitals across the country. Early reports have shown ERAS to reduce length of stay (LOS) after commonly performed pediatric surgeries. However, LOS and hospital charges after craniosynostosis have not been studied. We hypothesized that extended hospital LOS is correlated with increased hospitalization charges associated with open cranial vault surgery (CVS) and that over a multiyear timeframe, LOS and cost would decrease because of the increased adoption of ERAS in pediatric surgery.

Methods

The Healthcare Cost and Utilization Project's National Inpatient Sample database was analyzed from January 2007 to December 2014. All patients who were diagnosed with craniosynostosis who underwent CVS were included. Variables of interest included demographic data, hospital characteristics, hospitalization data, and total hospital charges. Univariate and generalized linear regression models were used to examine associations between selected variables and the hospitalization charges.

Results

There were 54,583 patients diagnosed with craniosynostosis between 2007 and 2014. Of these patients, 22,916 (41.9%) received CVS. The median total hospital charge was $66,605.77 (interquartile range, $44,095.60–$101,071.17). The median LOS was 3 days (interquartile range, 2–4 days), and there was no significant change in LOS by year (P = 0.979). However, despite a stable LOS, mean hospitalization charge increased significantly by year (P < 0.01). Regression analysis demonstrated the proportion of eligible patients who underwent CVS substantially increased over the selected timeframe (P < 0.01). Most procedures were performed in urban teaching hospitals and high-volume hospitals. There was no significant association between hospital volume and hospitalization charge (P = 0.331).

Conclusions

Increasing hospital charges despite constant LOS for craniosynostosis CVS procedures was observed between 2007 and 2014. Although ERAS has reduced LOS for common pediatric surgical procedures, no decrease in LOS for CVS has been observed. The charges significantly increased over the same period including high-volume centers. Further study to safely lower LOS and hospitalization charges for this procedure may reduce the overall health care burden.
The Coverage of Soft-Tissue Defects Around the Foot and Ankle Using Free or Local Flaps
Authors: Yuan Kaizong , Zhang Feng , Lineaweaver William C. , Chen Xinglong , Li Zhijie , Yan Hede
Published: April 2021

Background

The purpose of this study was to compare the reconstructive outcomes of soft-tissue defects around foot and ankle with local or free flaps and attempt to provide an optimal strategy for these patients in comparison with the conventional guidelines.

Methods

A retrospective review of all continuous patients with foot and ankle reconstruction using different flaps from 2010 to 2018 was performed. Based on the flap types, the patients were divided into 2 groups: local flap group and free flap group. Outcomes were assessed according to the flap survival rate, recipient complications, aesthetic outcomes, and donor-site complications.

Result

A total of 130 flaps including 47 free flaps and 83 local flaps were collected. There was no difference in flap survival rate between the 2 groups; however, a significant difference in aesthetic outcomes was noted between them: the free flap group presented a better overall aesthetic outcomes in comparison with the local flap group in terms of color and contour match. Moreover, local flaps had more donor-site morbidities including the need for skin grafting and wound infection.

Conclusions

Free flaps in wound coverage of foot and ankle can achieve better outcomes than local flaps in terms of recipient benefits and donor-site compromise with a comparable flap survival rate.
Anatomic Variations and Malformations as Rare Causes of Median Nerve Compression in Adults
Authors: Peperkamp Kirsten , Natroshvili Tina , Malyar Masoud A. , Heine Erwin P. , Walbeehm Erik T.
Published: April 2021

Objective

The median nerve can become compressed at multiple points in the arm, causing carpal tunnel-, pronator-, anterior interosseous-, or lacertus syndrome. Anatomical variations are potential reasons of persisting or recurrent symptoms of median nerve compression and are often recognized late. The objective of this study is to provide a comprehensive list of rare anatomical variations and malformations causing median nerve compression.

Methods

A total of 62 studies describing median nerve compression due to an anatomical structure in adults published from 2000 in English were included. The findings were: 35 tenomuscular, 16 vascular causes, and 4 cases with nerve involvement. Only 1 osseous and 18 combined anomalies caused compression. In 18 cases, the anomaly was found in the proximal forearm.

Results

In 44 cases, the median nerve was surgical released and 35 anomalies were completely resected. Persistent or recurrent symptoms were present in 13 cases. During follow-up, 1 case of recurrence was reported.

Standard operative option for median nerve compression consists of an open median nerve release.

Conclusions

In case of persistent or recurrent carpal tunnel syndrome, unilateral symptoms, the presence of a palpable mass, manifestation of symptoms at young age and pain in the forearm or upper arm, the surgeon has to rule out the presence of an anatomical anomaly. Complete resection of the anomaly is not always necessary. The surgeon should be aware of potential anomalies to avoid inadvertent damage at surgery.
The Effect of Vibration on Pain During Intravenous Injection of Propofol
Authors: Hwang Lyahn K. , Nash David W. , Yedlin Adam , Greige Nicolas , Larios-Valencia Jessie , Choice Curtis , Pothula Aravind
Published: April 2021

Purpose

Pain is a common side effect of intravenous injection of propofol. We conducted a randomized, prospective, single-blinded controlled trial to assess the efficacy of vibration analgesia on pain during propofol infusion in ambulatory surgery.

Methods

After institutional review board approval, 100 patients undergoing elective ambulatory surgery with general anesthesia were randomized into 2 groups. A control group (n = 50) consisted of patients who received infusion of propofol without vibration analgesia. A treatment group (n = 50) consisted of patients who received infusion of propofol with vibration analgesia using the Buzzy device. Pain was assessed using a 4-point pain manifestation scale scored by 2 independent, blinded observers.

Results

Participants in the treatment group with vibration analgesia were 0.47 times less likely (95% confidence interval, 0.24–0.94;P= 0.03) to experience any pain than the control group. The median summative pain score in the treatment group was significantly less than that of the control group [1 (interquartile range, 1–2) vs 2 (interquartile range, 2–4);P< 0.01] among participants who experienced any pain. Agreement between the 2 blinded observers regarding pain scores was excellent withκw= 0.82 (P< 0.001). Age, sex, body mass index, needle location or size, and medication doses did not differ significantly between the 2 groups.

Conclusion

Vibration analgesia is an effective, low-risk modality that reduces the pain of intravenous propofol injection in general anesthesia.
Technical Considerations and Clinical Applications of the Free Anterior Branch Split Latissimus Dorsi Flap
Authors: Cohen-Shohet Rachel N. , Samant Sonja S. , Chim Harvey
Published: April 2021

Background

The free anterior branch split latissimus dorsi flap has a reliable anatomy and advantages over the traditional latissimus dorsi flap. By preserving the posterior branch of the thoracodorsal nerve, morbidity at the donor site is reduced, preserving shoulder strength.

Methodology

The purpose of this article is to review our experience with the split latissimus flap, describe our surgical technique, and finally review representative cases of reconstruction in different anatomical regions.

Results

From April 2017 to October 2020, 39 free split latissimus flaps were performed at a single center. Flaps were performed for coverage in the upper extremity (n = 2), lower extremity (n = 32), and head and neck (n = 5). Flap success rate was 97.4%. Mean dimensions of the flap were 17.0 × 8.3 cm, with a mean area of 145 cm2.

Conclusions

The flap has a broad application and can be utilized in many different reconstructive scenarios including for coverage of defects in the extremities, trunk, and head and neck.
Financial Decisions and Reopening a Practice During the COVID-19 Pandemic
Authors: Crowley Jiwon Sarah , Reghunathan Meera , Kadakia Nikita , Barttelbort Scott , Gosman Amanda
Published: April 2021

Background

On March 11, 2020, the World Health Organization declared COVID-19 as a global pandemic. As a response, the United States shut down public gatherings and businesses in an effort to quarantine. This included the stopping of elective operations, which greatly affected plastic surgeons and their practices during the initial shutdown.

Objectives

We aim to study the early impact of COVID-19 on the financial implications and practice patterns of plastic surgeons in the state of California during the initial shutdown of elective surgery and provide guidelines for effective management during future crises.

Methods

A 20-question survey was sent using Qualtrics XM software to 851 surgeon members of the California Society of Plastic Surgeons. The survey was open from May 13, 2020, to May 29, 2020. Standard statistical analysis was completed to compare private practice and nonprivate practice plastic surgeons.

Results

We had a total of 140 respondents to our survey for a 16.5% response rate. The majority (77.1%) of the respondents were in a private practice setting. Private practice plastic surgeons reported a higher financial impact with a 79% reduction in financial income compared with nonprivate practice plastic surgeons at a 37% reduction (P < 0.0001). Additionally, private practice plastic surgeons demonstrated a higher reduction in case volume and were more likely to lay off or furlough staff, close their practice, and apply for loans (P < 0.001).

Conclusions

Our survey study showed that private practice plastic surgeons in the state of California faced the most financial hardship during the early shutdown of the COVID-19 pandemic. It serves as a valuable snapshot in our economic history and depicts the heavy financial impact of the stopping of elective surgery. Since the reopening of practices, new guidelines have been implemented to maintain safe elective surgery while the pandemic continues. Further follow-up studies on both the state and national level need to be completed to see the continued financial effects on private and nonprivate plastic surgery practices since the reopening and resumption of elective surgery.
Do Organizational Characteristics of Lung Procurement Operations Matter: The Association Between Transplant Center Centrality and Volume With Total Ischemic Time
Authors: Placona Andrew , Shay Patrick , Goff Rebecca R. , Carrico Bob
Published: April 2021

Background.

To understand the association of 2 organizational characteristics of transplant center (TXC), volume and closeness centrality, with total ischemic time for deceased donor lung transplants in conjunction with the removal of donation service area (DSA) lung allocation policy. The organization of donor procurements has received increased attention since DSA was removed from allocation policy. Consistent with network theories of organization, organizational characteristics of a TXC could affect procurement efficiency, as volume and closeness centrality (measuring how connected a TXC is within the Organ Procurement and Transplantation Network) could be associated with total ischemic time. These associations could have changed because of the removal of DSA from allocation policy.

Methods.

We conducted a retrospective, pooled cross-sectional study of total ischemic time for nonperfused deceased donor lung transplants (n = 9281) between 2015 and 2019, using within-between regression.

Results.

Higher volume TXCs exhibited lower total ischemic times after the removal of DSA from lung allocation policy (P = 0.011); however, all TXCs that had increased volumes, after the removal of DSA from lung allocation policy, exhibited higher levels of total ischemic time (P ≤ 0.001). Before the removal of DSA, TXCs that had increased volumes exhibited lower levels of ischemic time (P ≤ 0.001). Both within and between closeness centrality exhibited u-shaped associations with total ischemic time (P = 0.012; P = 0.006) and the effect of closeness centrality on total ischemic time was different after DSA removal (P < 0.001).

Conclusions.

Organizational characteristics were associated with the efficiency of deceased organ procurements. The effects on total ischemic time were dependent on whether DSA was used for lung allocation.
Septic polyarthritis with Mycoplasma salivarium in a patient with common variable immunodeficiency: case report and review of the literature
Authors: Totten Arthur H. , Xiao Li , Crabb Donna M. , Ratliff Amy E. , Waites Ken B. , Hwangpo Tracy , Atkinson T. Prescott
Published: April 2021

Mycoplasma salivarium

is a common mycoplasma usually isolated from human oropharynx, particularly from individuals with periodontal disease. It is also among the more common mycoplasmal contaminants of eukaryotic cell cultures. Although

M. salivarium

has been isolated occasionally from abscesses and other sterile sites, to our knowledge, only three cases of septic arthritis have been documented in the past due to this organism, all in patients with humoral immunodeficiency. We now report a fourth case of septic polyarthritis in a patient with profound hypoimmunoglobulinemia who had experienced dental abscesses within the preceding 2 years. Our case highlights the importance of considering invasive mycoplasmal infection in hypogammaglobulinemic patients. It is likely of significance that the patient had suffered recurrent dental abscesses as a source of infection with

M. salivarium

.
Identifiability and predictability of integer- and fractional-order epidemiological models using physics-informed neural networks
Authors: Kharazmi Ehsan , Cai Min , Zheng Xiaoning , Lin Guang , Karniadakis George Em
Published: April 2021

We analyze a plurality of epidemiological models through the lens of physics-informed neural networks (PINNs) that enable us to identify multiple time-dependent parameters and to discover new data-driven fractional differential operators. In particular, we consider several variations of the classical susceptible-infectious-removed (SIR) model by introducing more compartments and delay in the dynamics described by integer-order, fractional-order, and time-delay models. We report the results for the spread of COVID-19 in New York City, Rhode Island and Michigan states, and Italy, by simultaneously inferring the unknown parameters and the unobserved dynamics. For integer-order and time-delay models, we fit the available data by identifying time-dependent parameters, which are represented by neural networks (NNs). In contrast, for fractional differential models, we fit the data by determining different time-dependent derivative orders for each compartment, which we represent by NNs. We investigate the identifiability of these unknown functions for different datasets, and quantify the uncertainty associated with NNs and with control measures in forecasting the pandemic.