bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescription Antibiotic Use Among the US population 1999–2018: National Health and Nutrition Examination Surveys
Authors: Petersen Molly R , Cosgrove Sara E , Quinn Thomas C , Patel Eshan U , Kate Grabowski M , Tobian Aaron A R
Published: May 2021

Background

Antibiotic resistance has been identified as a public health threat both in the United States and globally. The United States published the National Strategy for Combating Antibiotic Resistance in 2014, which included goals to reduce inappropriate outpatient antibiotic use.

Methods

This cross-sectional study was conducted using National Health and Nutrition Examination Surveys (NHANES) years 1999–2018. Weighted prevalence of past 30-day nontopical outpatient antibiotic use was calculated, as well as the change in prevalence from 1999–2002 to 2015–2018 and 2007–2010 to 2015–2018, both overall and for subgroups. Associations with past 30-day nontopical outpatient antibiotic use in 2015–2018 were examined using predictive margins calculated by multivariable logistic regression.

Results

The overall prevalence of past 30-day nontopical outpatient antibiotic use adjusted for age, sex, race/ethnicity, poverty status, time of year of the interview, and insurance status from 1999–2002 to 2015–2018 changed significantly from 4.9% (95% CI, 3.9% to 5.0%) to 3.0% (95% CI, 2.6% to 3.0%), with the largest decrease among children age 0–1 years. From 2007–2010 to 2015–2018, there was no significant change (adjusted prevalence ratio [adjPR], 1.0; 95% CI, 0.8 to 1.2). Age was significantly associated with antibiotic use, with children age 0–1 years having significantly higher antibiotic use than all other age categories >6 years. Being non-Hispanic Black was negatively associated with antibiotic use as compared with being non-Hispanic White (adjPR, 0.6; 95% CI, 0.4 to 0.8).

Conclusions

While there were declines in antibiotic use from 1999–2002 to 2015–2018, there were no observed declines during the last decade.
The Path to Surgical Robotics in Neurosurgery
Authors: Khanna Omaditya , Beasley Ryan , Franco Daniel , DiMaio Simon
Published: May 2021

Robotic systems may help efficiently execute complicated tasks that require a high degree of accuracy, and this, in large part, explains why robotics have garnered widespread use in a variety of neurosurgical applications, including intracranial biopsies, spinal instrumentation, and placement of intracranial leads. The use of robotics in neurosurgery confers many benefits, and inherent limitations, to both surgeons and their patients. In this narrative review, we provide a historical overview of robotics and its implementation across various surgical specialties, and discuss the various robotic systems that have been developed specifically for neurosurgical applications. We also discuss the relative advantages of robotic systems compared to traditional surgical techniques, particularly as it pertains to integration of image guidance with the ability of the robotic arm to reliably execute pre-planned tasks. As more neurosurgeons adopt the use of robotics in their practice, we postulate that further technological advancements will become available that will help achieve improved technical capabilities, user experience, and overall patient clinical outcomes.
Evidence of Bilateral Localized, but Not Widespread, Pressure Pain Hypersensitivity in Patients With Upper Extremity Tendinopathy/Overuse Injury: A Systematic Review and Meta-Analysis
Authors: Fernández-de-las-Peñas César , Navarro-Santana Marcos J , Cleland Joshua A , Arias-Buría José L , Plaza-Manzano Gustavo
Published: May 2021

Objective

The presence of altered nociceptive pain processing in patients with upper extremity tendinopathy/overuse injury is conflicting. Our aim was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas between patients with upper extremity tendinopathy/overuse injury and controls.

Methods

Five databases were searched from inception to October 15, 2020. The authors selected case-control studies comparing PPTs between individuals with upper extremity tendinopathy/overuse injury and pain-free controls. Data were extracted for population, diagnosis, sample size, outcome, and type of algometer. Results were extracted by 3 reviewers. The methodological quality/risk of bias (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development and Evaluation approach) were assessed. Meta-analyses of symptomatic, segment-related, and distant pain-free areas were compared.

Results

The search identified 807 publications with 19 studies (6 shoulder, 13 elbow) eligible for inclusion. The methodological quality ranged from fair (48%) to good (37%). Patients exhibited lower bilateral PPTs than controls at the symptomatic area (affected side: MD = −175.89 kPa [95% CI = −220.30 to −131.48 kPa]; nonaffected side: MD = −104.50 kPa [95% CI = −142.72 to −66.28 kPa]) and the segment-related area (affected side: MD = −150.63 kPa [95% CI = −212.05 to −89.21 kPa]; nonaffected side: MD = −170.34 kPa [95% CI = − 248.43 to −92.25]) than controls. No significant differences in PPTs over distant pain-free areas were observed.

Conclusion

Low to moderate quality evidence suggests bilateral hypersensitivity to pressure pain at the symptomatic and contralateral/mirror areas in patients with upper extremity tendinopathies/overuse injury. Moderate quality of evidence supports bilateral pressure pain sensitivity in the segment-related area (neck) in lateral epicondylalgia, but not in subacromial impingement syndrome. No evidence of widespread pressure pain hyperalgesia was reported.

Impact

Early identification of people with altered pain modulation could guide clinicians in treatment strategies. This review shows that there is a complex interplay between peripheral and central pain mechanisms in upper extremity tendinopathies/overuse injuries and that there likely are different subgroups of patients with upper extremity conditions.
Spatial Reconstruction of the Early Hepatic Transcriptomic Landscape After an Acetaminophen Overdose Using Single-Cell RNA-Sequencing
Authors: Umbaugh David S , Ramachandran Anup , Jaeschke Hartmut
Published: May 2021

An acetaminophen (APAP) overdose is the most common cause of acute liver failure in the United States. A hallmark characteristic of APAP hepatotoxicity is centrilobular necrosis. General, innate mechanisms such as lower amounts of GSH and higher cytochrome P450 2e1 expression in pericentral (PC) hepatocytes are known to contribute to the differences in susceptibility to cell injury between periportal (PP) hepatocytes and PC hepatocytes. Although a sequence of molecular events involving formation of the reactive metabolite N-acetyl-p-benzoquinone imine, GSH depletion, oxidative stress, and c-Jun N-terminal kinase activation define the early cell stress trajectory following APAP exposure, their activation in PC versus PP hepatocytes is not well characterized. By using single-cell RNA-sequencing, we provide the first reconstruction of the early transcriptomic APAP liver lobule after validation of our methodology using human liver single-cell RNA-sequencing data. Two hours after APAP treatment, we find that PP hepatocytes progress along the APAP stress axis to oxidative stress, before resolving injury due to innate and adaptive mechanisms. However, PC hepatocytes continue along this stress axis as indicated by activation of mitogen-activated protein kinase genes, which is absent in PP hepatocytes. We also identify a population of glutamine synthetase enriched PC hepatocytes in close proximity to the central vein, where a stepwise induction of a stress program culminated in cell death. Collectively, these findings elucidate a molecular sequence of events distinguishing the differential response to APAP exposure between PP and PC hepatocytes and identify a subset of uniquely susceptible PC hepatocytes.
Genomic and Hormonal Biomarkers of Phthalate-Induced Male Rat Reproductive Developmental Toxicity Part II: A Targeted RT-qPCR Array Approach That Defines a Unique Adverse Outcome Pathway
Authors: Gray Leon Earl , Lambright Christy S , Conley Justin M , Evans Nicola , Furr Johnathan R , Hannas Bethany R , Wilson Vickie S , Sampson Hunter , Foster Paul M D
Published: May 2021

Previously, we demonstrated that exposure to some diortho-phthalate esters during sexual differentiation disrupts male reproductive development by reducing fetal rat testis testosterone production (T Prod) and gene expression in a dose-related manner. The objectives of the current project were to expand the number of test compounds that might reduce fetal T Prod, including phthalates, phthalate alternatives, pesticides, and drugs, and to compare reductions in T Prod with altered testis mRNA expression. We found that PEs that disrupt T Prod also reduced expression of a unique “cluster” of mRNAs for about 35 genes related to sterol transport, testosterone and insulin-like hormone 3 hormone syntheses, and lipoprotein signaling and cholesterol synthesis. However, phthalates had little or no effect on mRNA expression of genes in peroxisome proliferator-activated receptor (PPAR) pathways in the fetal liver, whereas the 3 PPAR agonists induced the expression of mRNA for multiple fetal liver PPAR pathway genes without reducing testis T Prod. In summary, phthalates that disrupt T Prod act via a novel adverse outcome pathway including down regulation of mRNA for genes involved in fetal endocrine function and cholesterol synthesis and metabolism. This profile was not displayed by PEs that did not reduce T Prod, PPAR agonists or the other chemicals. Reductions in fetal testis gene expression and T Prod in utero can be used to establish relative potency factors that can be used quantitatively to predict the doses of individual PEs and mixtures of phthalates that produce adverse reproductive tract effects in male offspring.
Measure for Measure: Comparing Survey Based Estimates of Income and Consumption for Rural Households
Authors: Carletto Gero , Tiberti Marco , Zezza Alberto
Published: May 2021

This paper uses a large database of surveys of household incomes to characterize income underreporting in household surveys in low- and middle-income countries. The objective is to document (a) the extent of this underreporting, and (b) whether and how it varies systematically with respondent, household, income, and survey design features. Drawing on rural household data from 20 developing and transition countries, and using consumption expenditure as a benchmark, results indicate that the observed income/consumption ratios are very small, being on average around 0.76. Results suggest that income underreporting is systematically associated with household and survey characteristics. In particular, the degree of underreporting is strongly associated with the income source, with agricultural income being the component suffering more than any other components from underreporting. The analysis also provides evidence supporting the well-established proposition that underreporting tends to increase with household welfare: richer households appear to underreport income more. Implications for survey design and for future research are drawn.
Educational needs and challenges in axial spondyloarthritis
Authors: Kumthekar Anand , Bittar Mohamad , Dubreuil Maureen
Published: May 2021

Purpose of review

Axial spondyloarthritis (axSpA) affects 0.5–1% of the population in many regions of the world. This review summarizes the challenges in medical education around axSpA with attention to evidence around delayed diagnosis, clinician familiarity with typical axSpA features, such as inflammatory back pain and adherence to accepted management principles.

Recent findings

Clinicians who commonly manage patients with chronic back pain or other typical axSpA features are not consistently aware of the concept of inflammatory back pain and common extra-spinal manifestations. Further, clinicians may not be familiar with the nonradiographic spectrum of axSpA. Management of patients with possible axSpA does not consistently follow principles that would establish an axSpA diagnosis, and diagnosis of axSpA remains delayed by 6–7 years on average, with evidence suggesting management disparities on the basis of sex and race in some cases. Referral recommendations have increased the probability of axSpA diagnosis up to about 40% and, may complement educational efforts in axSpA.

Educational efforts in axSpA should focus on providing front-line clinicians with a better understanding of inflammatory back pain, the nonradiographic form of axSpA, and accepted principles in axSpA management.
State of the art and future directions in the systemic treatment of neuroendocrine neoplasms
Authors: Jungels Christiane , Deleporte Amélie
Published: May 2021

Purpose of review

Neuroendocrine neoplasms (NENs) are rare and heterogeneous malignancies whose natural evolution may be defined according to various prognostic factors, including localization of the primitive tumour, hormone secretory status, histological grade, tumour burden, tumour growth rate, expression of somatostatin receptors and fluorodeoxyglucose-avidity. The treatment of these tumours in an advanced setting is based on relatively little robust data.

Recent findings

A recent pathological classification introduced a new category of high-grade but well differentiated neuroendocrine tumours (NET G3), with markedly different behaviour from neuroendocrine carcinomas (NECs). Yet, the optimal treatment of those tumours is still uncertain. Advances are needed in molecular subtyping of NENs to understand better their heterogeneity and inform personalized therapies.

The current review summarizes the current knowledge, indicates some exciting future directions and outlines the most interesting ongoing clinical trials likely to impact current practice.
Antiplatelet therapy in percutaneous coronary intervention: latest evidence from randomized controlled trials
Authors: Galli Mattia , Angiolillo Dominick J.
Published: May 2021

Purpose of review

Antiplatelet therapy is key to reduce systemic and local thrombotic events among patients undergoing percutaneous coronary interventions (PCI). Antiplatelet treatment regimens have been subject to continuous changes over the years, with a dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor representing the cornerstone of treatment in these patients.

Recent findings

The need for less aggressive antithrombotic drugs to prevent local ischemic events with newer generation drug-eluting stent together with the increased understanding of the prognostic relevance of bleeding events in PCI patients, have prompted investigations aimed at identifying antiplatelet treatment regimens associated with a more favorable balance between ischemic and bleeding risks. Several key randomized controlled trials (RCTs) on antiplatelet regimens in patients undergoing PCI have been recently reported resulting in updates in practice guidelines.

This manuscript provides an overview of the advancements in the field deriving from key RCTs on antiplatelet regimens in patients undergoing PCI.
Compression Factor and Visual Performance in Adults Treated With Orthokeratology
Authors: He Yuanhao , Liu Longqian , Vincent Stephen J.
Published: May 2021

Objectives:

To investigate the effect of compression factor on visual performance in orthokeratology (ortho-k).

Methods:

Myopic adults were fitted with ortho-k lenses with either a 0.75 diopter (D) or 1.75 D compression factor. Higher-order aberrations (HOAs), corneal topography, and responses to the National Eye Institute/Refractive Error Quality of Life Instrument-42 questionnaire were measured at baseline and 6-month and 12-month follow-up along with a satisfaction questionnaire. Subjective refraction, high-contrast, and low-contrast visual acuity were measured at baseline and 1-day, 1-week, 6-month, and 12-month follow-up.

Results:

Forty-four myopic (mean spherical equivalent refraction: −3.66±0.84 D) adults (median age 25 years) completed the 12-month follow-up. After ortho-k lens wear, levels of satisfaction of vision after waking were significantly higher than vision before sleep for both compression factors (both P<0.01). The increased compression factor (ICF) resulted in less myopia at the 1-week visit (P=0.04) and better high-contrast unaided visual acuity at the 1-day visit (P=0.03) compared with the conventional compression factor (CCF). No other significant differences were observed for the compression factor for treatment zone diameter, lens decentration, or any subjective measurements. Individual HOA terms

,

,

, and

were significantly higher in the CCF group (0.75 D) (all P<0.05). The HOA visual Strehl ratio decreased significantly after lens wear (P<0.001) but did not vary with the compression factor.

Conclusions:

An ICF did not result in clinically significant differences in subjective refraction, visual acuity, unaided vision, or the total ocular HOA profile compared with a CCF (0.75 D) in myopic adults after long-term ortho-k lens wear.
Viscoelastic testing to assess the effects of rapid fibrinogen concentrate administration after cardiopulmonary bypass: insights from the REPLACE study
Authors: Rahe-Meyer Niels , Levy Jerrold H. , Ueda Yuichi , Schmidt Dirk Steffen , Gill Ravi
Published: May 2021

Haemorrhage during and following surgery results in increased morbidity and mortality. Low plasma fibrinogen levels have been associated with increased blood loss and transfusion requirements. Fibrinogen supplementation has been shown to reduce bleeding in coagulopathic patients. This post hoc study evaluated fibrinogen repletion and pharmacokinetic data from the REPLACE study. One hundred and fifty-two adult patients undergoing elective aortic surgery requiring cardiopulmonary bypass (CPB) with defined bleeding of 60–250 g at first 5 min bleeding mass were included in the phase III trial. Patients were randomized to receive either fibrinogen concentrate (FCH) or placebo following CPB removal. Plasma fibrinogen levels and viscoelastic testing parameters (ROTEM-based FIBTEM and EXTEM assays) were measured before, during, and after study treatment administration. A mean dose of 6.3 g FCH was administered in the FCH group, with a median infusion duration of 2 min. Immediately following completion of FCH administration, a rapid increase in plasma fibrinogen levels to near baseline (median change from baseline −0.10 g/l) was seen in the FCH group but not in the placebo group (median change from baseline −1.29 g/l). FCH administration also caused an immediate increase in FIBTEM maximum clot firmness (MCF) to 23 mm and improvements in EXTEM coagulation time and clot formation time by the end of infusion. There was a strong correlation between the plasma fibrinogen level and FIBTEM MCF. Treatment with high doses of FCH with a rapid infusion time resulted in immediate recovery to baseline levels of plasma fibrinogen and viscoelastic testing parameters.
Novel methods to identify and measure catabolism
Authors: Page Alexandria , Flower Luke , Prowle John , Puthucheary Zudin
Published: May 2021

Purpose of review

Assess current potential catabolism-biomarkers to characterize patients developing prolonged critical illness.

Recent findings

A raised urea-to-creatinine ratio (UCR) during critical illness is negatively associated with muscle mass with greater increases in UCR seen patients developing persistent critical illness. Similarly, sarcopenia index (a ratio of creatinine to cystatin-c concentrations) correlates well to muscle mass in intensive care populations. Elevated growth/differentiation factor-15 (GDF-15) has been inconsistently associated with muscle loss. Although GDF-15 was a poor marker of feeding tolerance, it has been associated with worse prognosis in intensive care.

UCR is an available and clinically applicable biomarker of catabolism. Similarly, sarcopenia index can be used to assess muscle mass and indirectly measure catabolism based on readily available biochemical measurements. The utility of novel biomarkers, such as GDF-15 is less established.
Modified Glasgow coma scale for predicting outcome after subarachnoid hemorrhage surgery
Authors: Bae In-Suk , Chun Hyoung-Joon , Choi Kyu-Sun , Yi Hyeong-Joong
Published: May 2021

There are many grading scales that attempt to predict outcome following aneurysmal subarachnoid hemorrhage (aSAH). Most scales used to assess outcome are based on the neurological status of the patient. Here, we propose a new scale for aSAH patients that combines the Glasgow Coma Scale (GCS) and the modified Fisher scale (mFS).

Five hundred ninety-seven patients with aSAH who were treated at our institution between January 2008 and December 2017 were retrospectively analyzed. Initial GCS score, Hunt and Hess scale, World Federation of Neurosurgical Societies scale, mFS, and modified Rankin Scale were obtained by reviewing data. Incidence of vasospasm was investigated. Factors found to be significant on a multivariable regression analysis were used to develop a scale that was compared with other grading systems using the area under the curve (AUC) calculated from receiver operating characteristic curve.

The GCS score and mFS were related to outcomes in patients with aSAH. A simple score, which we call the GCS-F score, was calculated using these initial data. The GCS-F score had an AUC of 90.5% for unfavorable outcome prediction, and 88.4% for in-hospital mortality prediction. On the receiver operating characteristic curve analysis for vasospasm, the AUC for World Federation of Neurosurgical Societies, mFS and GCS-F scores were 0.912, 0.704, and 0.936, respectively.

A simple arithmetic combination of the GCS score and mFS, the GCS-F score, includes the radiographic status as well as the clinical status of the patient, so that the state of the patient can be known in more detail than other single scales. The GCS-F score may be a useful scale for predicting outcome and the occurrence of vasospasm in patients with aSAH.
Differences in clinical characteristics and liver injury between suspected and confirmed COVID-19 patients in Jingzhou, Hubei Province of China
Authors: Zhang Qing , Li Jie , Zhang Yan , Gao Jie , Wang Peixue , Ai Minghua , Ding Wen , Tan Xiaoping
Published: May 2021

To evaluate the clinical characteristics and liver injury in coronavirus disease 2019 (COVID-19) patients, and analyze the differences between suspected and confirmed COVID-19 patients, this retrospective study was performed on 157 COVID-19 patients and 93 suspected patients who were ultimately excluded from COVID-19 (control patients). Differences in clinical characteristics and liver injury between suspected and confirmed COVID-19 patients were analyzed. Age, male sex, fever, chest tightness and dyspnea were related to the severity of COVID-19. C-reactive protein (CRP) and D-dimer may be predictors of the severity of COVID-19. Computed tomography (CT) played an important role in the screening of COVID-19 and the evaluation of disease severity. Multiple factors may cause liver injury in COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be more likely to cause liver injury than common respiratory infectious diseases. Age, temperature (T), white blood cell (WBC), lymphocytes (LY), hematocrit (HCT), CRP, and finger pulse oxygen saturation (SpO2) may correlate with liver function impairment and may predict the occurrence and severity of liver function impairment. Some therapeutic drugs (like glucocorticoid) may be involved in the liver function impairment of COVID-19 patients. Most liver function indices improved significantly after active treatment. Although COVID-19 and other common respiratory infectious diseases share some clinical characteristics, COVID-19 has its own characteristics.
Measuring Multimorbidity
Authors: Suls Jerry , Bayliss Elizabeth A. , Berry Jay , Bierman Arlene S. , Chrischilles Elizabeth A. , Farhat Tilda , Fortin Martin , Koroukian Siran M. , Quinones Ana , Silber Jeffrey H. , Ward Brian W. , Wei Melissa , Young-Hyman Deborah , Klabunde Carrie N.
Published: May 2021

Background:

Adults have a higher prevalence of multimorbidity—or having multiple chronic health conditions—than having a single condition in isolation. Researchers, health care providers, and health policymakers find it challenging to decide upon the most appropriate assessment tool from the many available multimorbidity measures.

Objective:

The objective of this study was to describe a broad range of instruments and data sources available to assess multimorbidity and offer guidance about selecting appropriate measures.

Design:

Instruments were reviewed and guidance developed during a special expert workshop sponsored by the National Institutes of Health on September 25–26, 2018.

Results:

Workshop participants identified 4 common purposes for multimorbidity measurement as well as the advantages and disadvantages of 5 major data sources: medical records/clinical assessments, administrative claims, public health surveys, patient reports, and electronic health records. Participants surveyed 15 instruments and 2 public health data systems and described characteristics of the measures, validity, and other features that inform tool selection. Guidance on instrument selection includes recommendations to match the purpose of multimorbidity measurement to the measurement approach and instrument, review available data sources, and consider contextual and other related constructs to enhance the overall measurement of multimorbidity.

Conclusions:

The accuracy of multimorbidity measurement can be enhanced with appropriate measurement selection, combining data sources and special considerations for fully capturing multimorbidity burden in underrepresented racial/ethnic populations, children, individuals with multiple Adverse Childhood Events and older adults experiencing functional limitations, and other geriatric syndromes. The increased availability of comprehensive electronic health record systems offers new opportunities not available through other data sources.
Novel transurethral resection technologies and training modalities in the management of nonmuscle invasive bladder cancer: a comprehensive review
Authors: Schuettfort Victor M. , Pradere Benjamin , Compérat Eva , Abufaraj Mohammad , Shariat Shahrokh F.
Published: May 2021

Purpose of review

Conventional transurethral resection (TURBT) with tumor fragmentation is the primary step in the surgical treatment of nonmuscle invasive bladder cancer. Recently, new surgical techniques and training modalities have emerged with the aim to overcome short-comings of TURBT and improve oncologic outcomes. In this review, we provide a comprehensive update of recent techniques/techniques that aim to improve upon conventional TURBT and beyond.

Recent findings

A systemic approach during conventional TURBT that features the use of a surgical checklist has been shown to improve recurrence-free survival. Several simulators have been developed and validated to provide additional training opportunities. However, transfer of improved simulator performance into real world surgery still requires validation. While there is no convincing data that demonstrate superior outcomes with bipolar TURBT, en-bloc resection already promises to offer lower rates of complications as well as potentially lower recurrence probabilities in select patients.

TURBT remains the quintessential procedure for the diagnosis and treatment of bladder cancer. Urologists need to be aware of the importance and challenges of this procedure. Aside of embracing new resection techniques and a conceptual-systematic approach, training opportunities should be expanded upon to improve patient outcomes.
Maintenance of a High Influenza Vaccination Rate and Improvement in Health Outcomes in a Pediatric Sickle Cell Disease Clinic
Authors: Lo Zachary C. , Sobota Amy E.
Published: May 2021

Background:

Children with sickle cell disease (SCD) are at high-risk of complications from influenza and should receive an influenza vaccination seasonally. Despite this recommendation, vaccination rates remain suboptimal. Boston Medical Center (BMC) previously achieved high influenza vaccination rates among its pediatric patients with SCD. The purpose of this study was to determine whether this high vaccination rate has been maintained and whether it has influenced outcome measures.

Patients and Methods:

A retrospective chart review was conducted in the hematology clinic at an urban, academic medical center. Fisher’s exact test and the independent samples t test were used to determine if there were any significant differences in characteristics between patients with influenza and patients without influenza, as well as between vaccinated and unvaccinated patients. Influenza vaccination rate, influenza-related hospitalization rate, and influenza-positive rate were collected and compared with reported rates.

Results:

Data from 124 pediatric patients with SCD were examined. The influenza vaccination rate for pediatric patients with SCD at BMC (90.32%) was higher than previous studies that were not conducted at BMC, while BMC’s influenza-related hospitalization rate (0) and influenza-positive rate (4.84%) were lower than other studies. Subjects who contracted influenza were younger than those who did not (4.67 vs. 10.03 y, P=0.005).

Conclusions:

BMC has maintained a high influenza vaccination rate among pediatric patients with SCD. BMC’s vaccination strategy has been successful at improving outcome measures including rates of influenza and influenza hospitalizations without requiring additional staff. Such efforts should be replicated at other centers.
Association between Paravertebral Block and Pain Score at the Time of Hospital Discharge in Oncoplastic Breast Surgery: A Retrospective Cohort Study
Authors: Buzney Catherine D. , Lin Liz Z. , Chatterjee Abhishek , Gallagher Sean W. , Quraishi Sadeq A. , Drzymalski Dan M.
Published: May 2021

Background:

Using nonopioid analgesics may decrease the risk of patients chronically using opioids postoperatively. The authors evaluated the relationship between paravertebral block and pain score at the time of hospital discharge.

Methods:

The authors performed a retrospective cohort study of 89 women with American Society of Anesthesiologists Physical Status I to III undergoing oncoplastic breast surgery with 20 to 50 percent breast tissue removal and immediate contralateral reconstruction between August of 2015 and August of 2018. The primary outcome was pain score at hospital discharge with or without paravertebral block. The secondary outcome was postoperative length of stay. Data were analyzed using the Wilcoxon rank sum test,ttest, Fisher’s exact test, univariable and multivariable regression, Kaplan-Meier analyses, and Cox regression.

Results:

Median pain score at hospital discharge was lower with paravertebral block [2 (interquartile range, 0 to 2) compared to 4 (interquartile range, 3 to 5);p< 0.001]. Multivariable regression revealed that pain score at the time of hospital discharge was inversely associated with paravertebral block after adjusting for age, body mass index, American Society of Anesthesiologists class, extent of lymph node surgery, and duration of surgery (p< 0.001). Pain score at hospital discharge was also associated with total opioid consumption during the first 24 hours after surgery (p= 0.001). Patients who received paravertebral blocks had median total 24-hour postoperative opioid consumption in morphine equivalents of 7 mg (interquartile range, 3 to 10 mg) compared with 13 mg (interquartile range, 7 to 18 mg) (p< 0.001), and median length of stay of 18 hours (interquartile range, 16 to 20 hours) compared with 22 hours (interquartile range, 21 to 27 hours) (p< 0.001).

Conclusion:

Paravertebral blocks are associated with decreased pain score at the time of hospital discharge.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Flap Reconstruction of Perineal Defects after Pelvic Exenteration: A Systematic Description of Four Choices of Surgical Reconstruction Methods
Authors: Witte Donna Y. S. , van Ramshorst Gabrielle H. , Lapid Oren , Bouman Mark-Bram , Tuynman Jurriaan B.
Published: May 2021

Background:

The treatment of locally advanced or recurrent anorectal cancer requires radical surgery such as extralevator abdominoperineal resection and pelvic exenteration. Larger defects require flap reconstruction. The authors evaluated outcomes of different perineal reconstruction techniques.

Methods:

A systematic search was performed in the PubMed, Embase, and Cochrane databases. Studies reporting outcomes on perineal flap reconstruction in patients with anal or colorectal cancer were included. Data on patient characteristics, surgical details, perineal and donor-site complications, revision surgery, mortality, and quality of life were extracted. Articles were assessed using the Group Reading Assessment and Diagnostic Evaluation approach.

Results:

The authors included 58 mainly observational studies comprising 1988 patients. Seventy-three percent of patients had rectal cancer. The majority of 910 abdominoperineal resection patients underwent reconstruction with rectus abdominis flaps (91 percent). Dehiscence (15 to 32 percent) and wound infection (8 to 16 percent) were the most common complications. Partial flap necrosis occurred in 2 to 4 percent and flap loss occurred in 0 to 2 percent. Perineal herniation was seen in 6 percent after gluteal flap reconstruction and in 0 to 1 percent after other types of reconstruction. Donor-site complications were substantial but were reported inconsistently.

Conclusions:

Clinical outcome data on perineal reconstruction after exenterative surgery are mostly of very low quality. Perineal reconstruction after pelvic exenteration is complex and requires a patient-tailored approach. Primary defect size, reconstruction aims, donor-site availability, and long-term morbidity should be taken into account. This review describes the clinical outcomes of four flap reconstruction techniques. Shared clinical decision-making on perineal reconstruction should be based on these present comprehensive data.
Does Pandemic Crisis Mean Education Crisis? The Chicago Academic Plastic Surgery Collaborative Response to COVID-19
Authors: Siotos Charalampos , Reid Russell R. , Corcoran Julia F. , Ko Jason , Agnew Sonya P. , Dorafshar Amir H.
Published: May 2021

The health care crisis related to the spread of novel coronavirus (severe acute respiratory syndrome coronavirus 2) has created new challenges to plastic surgery education, mostly because of the decreased volume of procedures. The plastic surgery program directors in Chicago decided to act and identify ways to promote surgical education through citywide, multi-institutional, systematic clinical case discussions. Although the initiative has no impact on the surgical skill of the trainees, it was welcomed by residents and faculty and promoted clinical core knowledge in plastic surgery and collaboration among the institutions.
Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery
Authors: Ahuja Shalini , Peiffer-Smadja Nathan , Peven Kimberly , White Michelle , Leather Andrew J. M. , Singh Sanjeev , Mendelson Marc , Holmes Alison , Birgand Gabriel , Sevdalis Nick
Published: May 2021

Objective:

Surgical site infection (SSI) prevention remains significant, particularly in the era of antimicrobial resistance. Feedback on practices and outcomes is known to be key to reduce SSI rates and optimize antibiotic usage. However, the optimal method, format and frequency of feedback for surgical teams remains unclear. The objective of the study is to understand how data from surveillance and audit are fed back in routine surgical practice.

Methods:

A systematic scoping review was conducted, using well-established implementation science frameworks to code the data. Two electronic health-oriented databases (MEDLINE, EMBASE) were searched to September 2019. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively.

Results:

We identified 21 studies: 17 focused on SSI rates and outcomes and 10 studies described antimicrobial stewardship for SSI (with some overlap in focus). Several interventions were reported, mostly multimodal with feedback as a component. Feedback was often provided in written format (62%), either individualized (38%) or in group (48%). Only 25% of the studies reported that feedback cascaded down to the frontline perioperative staff. In 65% of the studies, 1 to 5 implementation strategies were used while only 5% of the studies reported to have utilized more than 15 implementation strategies. Among studies reporting antibiotic usage in surgery, most (71%) discussed compliance with surgical antibiotic prophylaxis.

Conclusions:

Our findings highlight the need to provide feedback to all levels of perioperative care providers involved in patient care. Future research in this area should report implementation parameters in more detail.
Unveiling the neuroimaging-genetic intersections in the human brain
Authors: Diez Ibai , Sepulcre Jorge
Published: May 2021

Purpose of review

The prevalence of new public datasets of brain-wide and single-cell transcriptome data has created new opportunities to link neuroimaging findings with genetic data. The aim of this study is to present the different methodological approaches that have been used to combine this data.

Recent findings

Drawing from various sources of open access data, several studies have been able to correlate neuroimaging maps with spatial distribution of brain expression. These efforts have enabled researchers to identify functional annotations of related genes, identify specific cell types related to brain phenotypes, study the expression of genes across life span and highlight the importance of selected brain genes in disease genetic networks.

New transcriptome datasets and methodological approaches complement current neuroimaging work and will be crucial to improve our understanding of the biological mechanism that underlies many neurological conditions.
Mycobacterium vicinigordonae sp. nov., a slow-growing scotochromogenic species isolated from sputum
Authors: Liu Guan , Yu Xia , Luo Jingjing , Hu Yanjie , Dong Lingling , Jiang Guanglu , Huo Fengmin , Wang Fen , Liang Qian , Huang Hairong
Published: May 2021

A slow-growing, scotochromogenic mycobacterial strain (24T) was isolated from the sputum of a Chinese male human. Phylogenetic analysis using the 16S rRNA gene assigned strain 24T to the

Mycobacterium gordonae

complex, which includes

Mycobacterium gordonae

and

Mycobacterium paragordonae

. The phenotypic characteristics, unique mycolic acid profile and the results of phylogenetic analysis based on hsp65 and rpoB sequences strongly supported the taxonomic status of strain 24T as a representative of a species distinct from the other members of the

M. gordonae

complex. The genomic G+C content of strain 24T was 65.40mol%. Genomic comparisons showed that strain 24T and

M. gordonae

ATCC 14470T had an average nucleotide identity (ANI) value of 81.00 % and a DNA–DNA hybridization (DDH) value of 22.80 %, while the ANI and DDH values between strain 24Tand

M. paragordonae

49 061T were 80.98 and 22.80 %, respectively. In terms of phylogenetic, phenotypic and chemotaxonomic features, strain 24T is distinguishable from its closest phylogenetic relatives and represents a novel species of the genus

Mycobacterium

, therefore the name Mycobacterium vicinigordonae sp. nov. is proposed. The type strain is 24T (=CMCC 93559T=DSM 105979T).
Quality characteristics of soft persimmon spread prepared with
different functional saccharides
Authors: Choi Ji-Young , Cho Mun-Gyeong , Moon Kwang-Deog
Published: May 2021

Soft persimmon spreads with four different functional saccharides were prepared
for reducing the amount of excess sugar, and their quality characteristics were
analyzed. CON1 had 40% sucrose added in weight, while CON2, XLT, IMO, FTO and
MTD had 20% of sucrose, xylitol, isomalto-oligosaccharide,
fructo-oligosaccharide, and maltodextrin added in weight, respectively. The
proximate composition, soluble solid content, pH, total acidity, color,
viscosity, tannin content, lycopene content, and glucose dialysis retardation
index of the spreads with different saccharides were analyzed and compared. The
proximate composition of the spreads was summarized as follows: 49-58% moisture,
0.29-0.58% crude protein, 0.02-0.10% crude fat, 0.32-0.37% crude ash, 40-50%
carbohydrates, and 0.26-0.49% crude fiber. The total soluble solid of the spread
containing IMO was 41.00 °Brix, which was significantly lower than that
of the control spread (CON1) of 59.33 °Brix. The viscosity of the spread
containing MTD was the highest, that is, 43,733 cp, while the spread with IMO
had the lowest value of 17,600 cP. The content of lycopene in the spread with
IMO was the highest as 58.99 mg/kg. The spread containing MTD indicated the most
efficient glucose dialysis retardation index. There were no significant
differences in the pH, total acidity, tannin content, color value, and sensory
evaluation between the samples(p>0.05). Therefore, in terms of reducing
sugar content in the spread, IMO exhibited the optimum result.
Comparison of ginsenoside (Rg1, Rb1) content and radical-scavenging
activities of wild-simulated ginseng extract with respect to the
solvent
Authors: Kim Su Cheol , Hwang Chung Eun , Kim Ba O Lo , Lee Ki Hyun , Lee Jin Hwan , Cho Kye Man , Joo Ok Soo
Published: May 2021

The variation in the ginsenoside (Rg1, Rb1) content and antioxidant activities of
a wild-simulated ginseng extract with respect to the extraction solvent (water
and ethanol) were investigated. During water extraction, the Rg1 (17.85-18.31
mg/g) and Rb1 (12.22-13.64 mg/g) contents were high at an extraction temperature
of 80℃, and there was no significant difference upon varying the
extraction time. The ginsenoside content was higher in ethanol extracts than in
water, and the Rg1 and Rb1 contents increased with an increase in the ethanol
concentration. In particular, the average concentrations of Rg1 and Rb1 were
16.38 and 25.28 mg/g, when extracted for 2 h and 4 h, respectively in ethanol at
80 ℃. In the case of hot water extraction, the total phenolics content
(TPC) and total flavonoid content (TFC) gradually increased with an increase in
the extraction temperature; however, there was no difference between TPC and TFC
during ethanol extraction (p<0.05). In addition, the DPPH (70.91%) and
ABTS (69.17%) radical scavenging activities were the highest in the 70% ethanol
extract (extracted for 2 h). From present study the optimal extraction
conditions for ginsenosides Rg1 and Rb1 in wild-simulated ginseng were
determined as 2 h of extraction time, 70% ethanol, and 80℃ of extraction
temperature.
An Atomic Approach to the Design and Implementation of a Research Data Warehouse
Authors: Visweswaran Shyam , McLay Brian , Cappella Nickie , Morris Michele , Milnes John T. , Reis Steven E. , Silverstein Jonathan C. , Becich Michael J.
Published: May 2021

Objective

As a long-standing Clinical and Translational Science Awards (CTSA) Program hub, the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) developed and implemented a modern research data warehouse (RDW) to efficiently provision electronic patient data for clinical and translational research.

Methods

Because UPMC is one of the largest health care systems in the US with multiple vendors’ electronic health record (EHR) systems, we designed and implemented an RDW named Neptune to serve the specific needs of our CTSA. Neptune uses an atomic design where data is stored at a high level of granularity as represented in source systems. Neptune contains robust patient identity management tailored for research; integrates patient data from multiple sources, including EHRs, health plans, and research studies; and includes knowledge for mapping to standard terminologies. Neptune enables efficient provisioning of data to large analytics-oriented data models and to individual investigators.

Results

Neptune contains data for more than 5 million patients longitudinally organized as HIPAA Limited Data with dates and includes structured EHR data, clinical documents, health insurance claims, and research data. Neptune is used as a source for patient data for hundreds of IRB-approved research projects by local investigators and for national projects such as the Accrual to Clinical Trials (ACT) network, the All of Us Research Program, and the National Patient-Centered Clinical Research Network.

Discussion

The design of Neptune was heavily influenced by the large size of UPMC, the varied data sources, and the rich partnership between the University and the healthcare system. It features several desiderata of an RDW, including robust protected health information management, an extensible information storage model, and binding to standard terminologies at the time of data delivery. It also includes several unique aspects, including the physical warehouse straddling the University of Pittsburgh and UPMC networks and management under a HIPAA Business Associates Agreement.

Conclusion

We describe the design and implementation of an RDW at a large academic health care system that uses a distinctive atomic design where data is stored at a high level of granularity.
Cerebrovascular Response to an Acute Bout of Short Interval High Intensity Interval Exercise and Recovery in Healthy Adults
Authors: Whitaker Alicen A. , Aaron Stacey E. , Kaufman Carolyn S. , Kurtz Brady K. , Bai Stephen X. , Vidoni Eric D. , Billinger Sandra A.
Published: May 2021

Introduction

High intensity interval exercise (HIIE) is performed widely. However, the field possesses limited knowledge regarding the acute HIIE cerebrovascular response. Our objective was to characterize the middle cerebral artery blood velocity (MCAv) response during an acute bout of short interval HIIE in healthy adults. We hypothesized MCAv would decrease below BL 1) during HIIE, 2) following HIIE, 3) and 30-minutes after HIIE. As a secondary objective, we investigated sex differences in the MCAv response during HIIE.

Methods

Fourteen healthy adults (7 male) completed the HIIE session. The 10-minute HIIE session included alternating 1-minute bouts of high-intensity and low-intensity intervals. MCAv, mean arterial pressure (MAP), heart rate (HR), and expired end tidal carbon dioxide (PETCO2), were recorded at BL, during HIIE, following HIIE, and 30-minutes after HIIE.

Results

Contrary to our hypothesis, MCAv remained above BL for the HIIE duration. MCAv peaked at the third minute then decreased concomitantly with PETCO2. MCAv was lower than BL after HIIE (p=0.03). Thirty minutes after HIIE, MCAv returned to near BL values (p = 0.47). Women showed higher BL MCAv ( = 70.9 ± 8.1 cm·s-1) compared to men ( = 59.3 ± 5.8 cm·s-1, p = 0.01). A greater magnitude of MCAv response was observed in men resulting in non-significant differences during HIIE secondary to higher workload (p = 0.03).

Conclusions

Collectively, these findings show that in healthy adults, MCAv remained above BL during a 10-minute short-interval HIIE and returned to resting values 30 minutes after exercise.