bluuebunny/crossref_metadata_2025 huggingface dataset:
FoundationOne CDx testing accurately determines whole arm 1p19q codeletion status in gliomas
Authors: Sharaf Radwa , Pavlick Dean C , Frampton Garrett M , Cooper Maureen , Jenkins Jacqueline , Danziger Natalie , Haberberger James , Alexander Brian M , Cloughesy Timothy , Yong William H , Liau Linda M , Nghiemphu Phioanh L , Ji Matthew , Lai Albert , Ramkissoon Shakti H , Albacker Lee A
Published: February 2021

Background

Molecular profiling of gliomas is vital to ensure diagnostic accuracy, inform prognosis, and identify clinical trial options for primary and recurrent tumors. This study aimed to determine the accuracy of reporting the whole arm 1p19q codeletion status from the FoundationOne platform.

Methods

Testing was performed on glioma samples as part of clinical care and analyzed up to 395 cancer-associated genes (including IDH1/2). The whole arm 1p19q codeletion status was predicted from the same assay using a custom research-use only algorithm, which was validated using 463 glioma samples with available fluorescence in-situ hybridization (FISH) data. For 519 patients with available outcomes data, progression-free and overall survival were assessed based on whole arm 1p19q codeletion status derived from sequencing data.

Results

Concordance between 1p19q status based on FISH and our algorithm was 96.7% (449/463) with a positive predictive value (PPV) of 100% and a positive percent agreement (PPA) of 91.0%. All discordant samples were positive for codeletion by FISH and harbored genomic alterations inconsistent with oligodendrogliomas. Median overall survival was 168 months for the IDH1/2 mutant, codeleted group, and 122 months for IDH1/2 mutant-only (hazard ratio (HR): 0.42; P < .05).

Conclusions

1p19q codeletion status derived from FoundationOne testing is highly concordant with FISH results. Genomic profiling may be a reliable substitute for traditional FISH testing while also providing IDH1/2 status.
Caregiver perceptions of end-of-life care in patients with high-grade glioma
Authors: Fortunato John T , Van Harn Meredith , Haider Sameah A , Phillips Joel , Walbert Tobias
Published: February 2021

Background

Patients dying from high-grade gliomas (HGG) suffer from high symptom burden in the end-of-life (EoL) phase. Family caregivers are most informed about the patient’s symptoms and disease course. The aim of this study is to assess caregiver perception on quality of EoL care of HGG patients.

Methods

Caregivers prospectively participated in the Toolkit After-Death Bereaved Family Member Interview, part of the Toolkit of Instruments to Measure End-of-Life Care (TIME survey). This validated survey assesses EoL care in areas such as physical comfort and emotional support, advance care planning, focus on the individual, attention to family, and coordination of care. The quality of EoL care was measured by domain scores (0 = care was always optimal, 1 = care was always suboptimal) or with a 0-10 scale.

Results

Of the 55 enrolled family caregivers, 44 completed the interview and rated the overall care high (8.90 ± 1.36/10), perceived that patients’ wishes were respected (9.46 ± 0.95) and that they died in dignity (9.65 ± 0.98). Caregivers perceived high satisfaction with information and decision-making (0.18), advance care planning (0.19), focus on the individual (0.16), and care coordination (0.11). Attention to family (0.25) needed improvement. Only 41% of caregivers were confident that they knew what to do at the time of death and 46% felt that the healthcare team did not provide them with someone to turn to in distress.

Conclusions

Caregivers reported high overall satisfaction with EoL HGG care, though attention to family and communication needed improvement. Focus should therefore be on improved caregiver communication to improve EoL care, caregiver burnout, and bereavement in HGG populations.
Atomically dispersed Ir/α-MoC catalyst with high metal loading and thermal stability for water-promoted hydrogenation reaction
Authors: Li Siwei , Cao Ruochen , Xu Mingquan , Deng Yuchen , Lin Lili , Yao Siyu , Liang Xuan , Peng Mi , Gao Zirui , Ge Yuzhen , Liu Jin-Xun , Li Wei-Xue , Zhou Wu , Ma Ding
Published: February 2021

Synthesis of atomically dispersed catalysts with high metal loading and thermal stability is challenging but particularly valuable for industrial application in heterogeneous catalysis. Here, we report a facile synthesis of a thermally stable atomically dispersed Ir/α-MoC catalyst with metal loading as high as 4 wt%, an unusually high value for carbide supported metal catalysts. The strong interaction between Ir and the α-MoC substrate enables high dispersion of Ir on the α-MoC surface, and modulates the electronic structure of the supported Ir species. Using quinoline hydrogenation as a model reaction, we demonstrate that this atomically dispersed Ir/α-MoC catalyst exhibits remarkable reactivity, selectivity and stability, for which the presence of high-density isolated Ir atoms is the key to achieving high metal-normalized activity and mass-specific activity. We also show that the water-promoted quinoline hydrogenation mechanism is preferred over the Ir/α-MoC, and contributes to high selectivity towards 1,2,3,4-tetrahydroquinoline. The present work demonstrates a new strategy in constructing a high-loading atomically dispersed catalyst for the hydrogenation reaction.
Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature
Authors: Czech Mary M , Nayak Ashwin K , Subramanian Kavitha , Suarez Jose F , Ferguson Jessica , Jacobson Karen Blake , Montgomery Susan P , Chang Michael , Bae Gordon H , Raghavan Shyam S , Wang Hannah , Miranti Eugenia , Budvytiene Indre , Shoor Stanford Mervyn , Banaei Niaz , Rieger Kerri , Deresinski Stan , Holubar Marisa , Blackburn Brian G
Published: February 2021

Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.
Alternating Current Is More Fatigable Than Pulsed Current in People Who Are Healthy: A Double-Blind, Randomized Crossover Trial
Authors: Paz Isabel de Almeida , Rigo Graciane Taglian , Sgarioni Amanda , Baroni Bruno Manfredini , Frasson Viviane Bortoluzzi , Vaz Marco Aurélio
Published: February 2021

Objective

Tolerance level and rapid fatigue onset are limitations in the use of neuromuscular electrical stimulation (NMES) as an electrotherapeutic resource in rehabilitation and training protocols; however, it is unclear if pulsed current (PC) and alternating current (AC) produce different fatigue levels when applied at submaximal contraction level. The purpose of this study was to compare fatigue and discomfort levels between PC and AC during a submaximal contraction protocol in people who are healthy.

Methods

In this double-blind, randomized crossover trial conducted in a laboratory setting, 30 male volunteers [23.23 years of age (SD = 4.59)] performed 2 submaximal fatigue protocols (with a 7-day interval) in a randomized order: PC (pulse duration = 2 milliseconds, pulse frequency = 100 Hz) and AC (2.5 kHz, pulse duration = 0.4 milliseconds, burst frequency = 100 Hz). NMES currents were applied to the knee extensor motor point of the dominant limb. The NMES protocol consisted of 80 evoked contractions (time on:off = 5:10 seconds) and lasted 20 minutes. The current was maintained at a constant intensity throughout the NMES protocol. The primary outcome measures were maximal voluntary isometric contraction, fatigue index (evoked torque decline), fatigability (number of contractions for a 50% drop in evoked-torque from the protocol start), total evoked torque-time integral (TTI), decline in TTI, and discomfort level.

Results

AC at 2.5 kHz demonstrated higher maximal voluntary isometric contraction decline post-fatigue, higher fatigue index, higher fatigability (ie, fewer contractions to reach the 50% evoked torque decline from the protocol start), smaller total TTI, and higher TTI decline compared with PC. No between-currents difference was observed in discomfort level.

Conclusion

PC is less fatigable than AC at 2.5 kHz.

Impact

Based on this study, PC is the preferred current choice when the NMES goal is to generate higher muscle work, higher mechanical load, and smaller fatigability during training both for athletes who are healthy and for rehabilitation programs for people with disease or injury.
Nutrition in Physical Therapist Practice: Setting the Stage for Taking Action
Authors: Berner Patrick , Bezner Janet R , Morris David , Lein Donald H
Published: February 2021

Diet and nutrition are critical components of health, recovery from disease and illness, performance, and normal growth across the lifespan. Thus, it is important for physical therapists to be knowledgeable about nutrition and to have competency in providing information and guidance to patients/clients. Yet, there is an overwhelming amount of diet and nutrition information available from numerous sources, which makes it difficult to reach conclusions and determine the importance and relevance to patient care. The purpose of this perspective paper is to increase the knowledge and skills of physical therapists by providing guidelines for healthy eating and outlining diet and nutrition information most relevant for physical therapist practice and to clarify professional scope of practice related to diet and nutrition, including boundaries created by law, and the connection between healthy eating and health outcomes, muscle strength, bone health, and wound healing.
Blood-Flow–Restricted Strength Training Combined With High-Load Strength and Endurance Training in Pulmonary Rehabilitation for COPD: A Case Report
Authors: Kohlbrenner Dario , Aregger Céline , Osswald Martin , Sievi Noriane A , Clarenbach Christian F
Published: February 2021

Objective

The purpose of this report is to describe the case of a patient with chronic obstructive pulmonary disease (COPD) who was load compromised and being referred for outpatient pulmonary rehabilitation. Low-load blood flow restriction strength training (LL-BFRT) was applied to prepare for and increase tolerability of subsequently applied high-load strength training.

Methods (Case Description)

A 62-year-old woman with COPD GOLD 2 B presented with severe breathlessness. Lower limb strength was severely reduced while functional exercise capacity was preserved. The patient was severely load compromised and had high risk to be intolerant of the high training loads required to trigger the desired adaptations. LL-BFRT was applied during the first 12 training sessions and high-load strength training in the subsequent 12 training sessions of the rehabilitation program. Endurance training on a cycle ergometer was performed throughout the program.

Results

Symptom burden in the COPD assessment test was reduced by 6 points (40%). Lower limb strength improved by 95.3 Nm (521%) and 88.4 Nm (433%) for the knee extensors and by 33.8 Nm (95%) and 56 Nm (184%) for the knee flexors, respectively. Functional exercise capacity improved by 44 m (11%) in the 6-minute walk test and 14 repetitions (108%) in the 1-minute sit-to stand test. The patient did not experience any adverse events related to the exercise training.

Conclusion

Clinically relevant changes were observed in both strength-related functional and self-reported outcomes. The achievements translated well into daily living and enabled functioning according to the patients’ desires. LL-BFRT was reported to be well tolerated and implementable into an outpatient pulmonary rehabilitation program.

Impact

The description of this case encourages the systematic investigation of LL-BFRT in COPD. LL-BFRT has the potential to increase benefits as well as tolerability of strength training in pulmonary rehabilitation. Consideration of the physiological changes achieved through LL-BFRT highlights potential in targeting peripheral muscle dysfunction in COPD.
Dynamic Asset Pricing with Interactions between Short-Sale and Borrowing Constraints
Authors: Shi Lei , Xiao Yajun
Published: February 2021

This paper studies the joint effect of borrowing and short-sale constraints under heterogeneous beliefs and risk aversions. Although the constraints never simultaneously bind in equilibrium, interesting economics emerge in the anticipatory effects of potentially future binding constraints. In particular, the risk-free rate and Sharpe ratio experience endogenous jumps at a critical state, where two equilibria coexist. Moreover, a short-sale ban can lead to a lower stock price and higher volatility depending on the relative tightness between the constraints, and tightening the borrowing constraint during a short-sale ban can also make returns more volatile. (JEL G11, G12)
Parts of Speech: The Grammar of Redemption in De Worde’s Printed Interludes
Authors: Ridley Jacob
Published: February 2021

This essay proposes that Hyckescorner and The Worlde and the Chylde, playbooks printed by Wynkyn De Worde in 1515–1522, were made to resemble his Latin schoolbooks, or grammars, in order to function like textbooks of virtue and vice. Using De Worde’s output as a linchpin, the essay considers the plays’ personified abstractions (such as Contemplation, Manhood, and Free Will) in ‘grammatical’ terms and refers to standard school-texts of the day—from the so-called Auctores octo to the contemporary grammars of Robert Whittington—which might have helped lay readers to mine the plays for moral teaching. The teaching of elementary Latin provides a surprisingly apt metaphor throughout. I also suggest that The Worlde and the Chylde was published because it transposed the recent pedagogical controversy of the Grammarians’ War of 1519–1521 into the sphere of spiritual education, depicting the dangers of blind imitation and the fruits of preceptive instruction. The essay challenges the prevailing scholarly view that dramatic dialogue was the foremost feature which printers sought to emphasize when they first began publishing English plays. It also posits ‘pedagogical’ reading, shaped explicitly by schoolroom practice, as one tool which printers and book designers anticipated in publishing didactic works, and demonstrates how interpretatively fruitful De Worde’s sometimes confusing, and often maligned, blackletter quartos can be.
The relationship between chronotype and sleep behavior during rotating shift work: a field study
Authors: Kervezee Laura , Gonzales-Aste Fernando , Boudreau Phillipe , Boivin Diane B
Published: February 2021

Shift work, an essential part of our 24/7 society, inevitably leads to displacement of the habitual sleep period and thereby to misalignment of the internal circadian timing system with the rest–activity cycle and the environment. How interindividual differences in circadian organization affect sleep duration and timing during rotating shift work is not fully understood. The objective of this study was to assess the effect of chronotype, shift type, and their interaction on actigraphy-based sleep behavior in 74 police officers (20 women and 54 men; age [mean ± SD]: 32.1 ± 5.4 years) involved in rotating shift work throughout a 28- to 35-day work cycle consisting of morning, evening, and night shifts. Using linear mixed modeling, we found that chronotype was associated with sleep duration depending on the shift type: increasing morningness was correlated with longer sleep duration during series of consecutive morning shifts, while increasing eveningness was correlated with longer sleep duration during series of evening shifts. During series of night shifts, increasing eveningness was associated with a longer duration of the main sleep episode, but this relationship was attenuated and no longer significant when naps were taken into account due to increased napping in morning chronotypes during series of night shifts. Providing a detailed within-subject characterization of sleep behavior across a complete work cycle consisting of morning, evening, and night shifts, this study advances the understanding of the relationship between chronotype and sleep in rotating shift workers and supports the implementation of work schedules that take into account chronobiological principles.
The Contexts of Spiritual Seeking: How Ghanaians in the United States Navigate Changing Normative Conditions of Religious Belief and Practice
Authors: Manglos-Weber Nicolette D
Published: February 2021

Two concurrent agendas in the sociology of religion explore how conditions of secularism in the United States result in widespread norms of “spiritual seeking”, and how religion functions as a basis of belonging for U.S. immigrants. This study brings these subfields together by asking whether new immigrants from Ghana, West Africa, also exhibit an orientation of spiritual seeking in their religious trajectories, and how they engage with normative conditions of spiritual seeking within institutional contexts. I find strong evidence of spiritual seeking in their narratives, and I identify processes within the social institutions of family and coethnic networks, higher education, and African Evangelical Christianity that support a seeking orientation. I argue for more focus on the counter-impulses of seeking versus dwelling in immigrant religion, and that more studies of religion and culture should explicitly analyze the institutional contexts that mediate between normative culture and trajectories of social practice.
Effects of narasin or virginiamycin on growth performance and carcass characteristics of growing and finishing pigs
Authors: Linneen Sara K , Arentson Roger A , Chewning J Jeffrey , Carr Scott N
Published: February 2021

The objective of this experiment was to determine the effects of narasin (NAR; Skycis®; Elanco Animal Health, Greenfield, IN) or virginiamycin (VIR; Stafac®; Phibro Animal Health Corporation, Teaneck, NJ) on finishing pig growth performance and carcass characteristics. Two separate experiments were conducted at the same site in 2013 and 2014. A total of 576 pigs (initial BW = 23.2 ± 0.19 kg) were housed in 24 pens with 8 pigs per pen in Exp. 1. In Exp. 2, a total of 888 pigs (initial BW = 26.2 ± 0.12 kg) were housed in 39 pens with 8 pigs per pen. Treatments consisted of a series of unmedicated corn–soybean meal diets (CON), CON + NAR (15 mg/kg), or CON + VIR (11 mg/kg) fed for 108 d (Exp. 1) or 109 d (Exp. 2). Pen was the experimental unit in both studies. Data were analyzed as a randomized complete block design with the main effects of block and treatment (Exp. 1) and as an incomplete block design with the fixed effect of treatment and the random effects of barn and barn within block (Exp. 2). In Exp.1, NAR and VIR increased (P < 0.05) ADG and ADFI from days 0 to 28, and BW on days 28, 56, 76, and 97 as compared to pigs fed CON. During days 0–28, pigs fed NAR had a greater (P < 0.05) G:F than those fed CON or VIR. Also, during days 28–56 pigs fed VIR had a greater (P < 0.05) ADFI than pigs fed CON. Pigs fed NAR or VIR had greater (P < 0.05) carcass yield than those fed CON. In Exp.2, feeding NAR increased (P < 0.05) pig BW from days 54 through 96 compared to pigs fed CON or VIR. No differences (P > 0.05) in ADG were detected between pigs fed VIR and CON through the first 74 day, but ADG of pigs fed VIR was similar to (P > 0.05) those fed NAR from days 26 to 54. From day 0 to 109, NAR improved ADG compared to pigs fed VIR, which also had similar gain to those consuming CON (P = 0.04). Feed efficiency was similar between pigs fed NAR and VIR with pigs fed CON intermediate (P = 0.05). Pigs fed NAR had a greater (P < 0.05) HCW and loin depth than those fed CON or VIR. A subtherapeutic dose of VIR showed improvements in growth performance that were similar to NAR in one experiment. Although there were differences in the magnitude of growth and carcass effects of NAR between the two studies, pigs fed NAR showed at least a tendency to have greater G:F and in some cases increased carcass weight and yield compared to pigs consuming nonmedicated feed.
Unraveling hydrogen sulfide-promoted lateral root development and growth in mangrove plant Kandelia obovata: insight into regulatory mechanism by TMT-based quantitative proteomic approaches
Authors: Li Huan , Ghoto Kabir , Wei Ming-Yue , Gao Chang-Hao , Liu Yi-Ling , Ma Dong-Na , Zheng Hai-Lei
Published: February 2021

Mangroves are the main intertidal ecosystems with varieties of root types along the tropical and subtropical coastlines around the world. The typical characteristics of mangrove habitats, including the abundant organic matter and nutrients, as well as the strong reductive environment, are favor for the production of hydrogen sulfide (H2S). H2S, as a pivotal signaling molecule, has been evidenced in a wide variety of plant physiological and developmental processes. However, whether H2S functions in the mangrove root system establishment is not clear yet. Here, we reported the possible role of H2S in regulation of Kandelia obovata root development and growth by tandem mass tag (TMT)-based quantitative proteomic approaches coupled with bioinformatic methods. The results showed that H2S could induce the root morphogenesis of K. obovata in a dose-dependent manner. The proteomic results successfully identified 8075 proteins, and 697 were determined as differentially expressed proteins. Based on the functional enrichment analysis, we demonstrated that H2S could promote the lateral root development and growth by predominantly regulating the proteins associated with carbohydrate metabolism, sulfur metabolism, glutathione metabolism and other antioxidant associated proteins. In addition, transcriptional regulation and brassinosteroid signal transduction associated proteins also act as important roles in lateral root development. The protein–protein interaction analysis further unravels a complicated regulation network of carbohydrate metabolism, cellular redox homeostasis, protein metabolism, secondary metabolism, and amino acid metabolism in H2S-promoted root development and growth of K. obovata. Overall, our results revealed that H2S could contribute to the morphogenesis of the unique root system of mangrove plant K. obovata, and play a positive role in the adaption of mangrove plants to intertidal habitats.
Is asthma a risk factor for coronavirus disease-2019 worse outcomes? The answer is no, but …
Authors: Franco Priscila A. , Jezler Sergio , Cruz Alvaro A.
Published: February 2021

Purpose of review

To search for evidence on whether having asthma increases the risk of poor outcomes of COVID-19 and report on recommendations on optimal asthma management in times of COVID-19.

Recent findings

Patients with asthma are neither at greater risk of becoming infected by SARS-CoV-2 nor they are at risk of complications of COVID-19 but those requiring frequent use of oral corticosteroid may be at greater risk.

In general, patients with asthma are not at risk of COVID-19 morbidity or mortality. On the contrary, patients with asthma may be at lower risk of hospitalizations during the COVID-19 pandemic. This may be related to asthma and its treatment, to patient's behavior, to the health system, and to collective changes in activities. It is likely that reduction in respiratory infections because of social distancing, face masks, and hand washing have a role in the reduction in asthma hospitalizations. Management of asthma in times of COVID-19 must be optimized, medication have to be used regularly and exacerbations detected early. Systemic corticosteroids may be used for control of severe asthma or severe exacerbations. Patient education on an action plan is crucial, as well as facilitating communications with the healthcare team.
Low Back Pain in Young Sports Players
Authors: Yabe Yutaka , Hagiwara Yoshihiro , Sekiguchi Takuya , Momma Haruki , Tsuchiya Masahiro , Kanazawa Kenji , Yoshida Shinichirou , Sogi Yasuhito , Onoki Takahiro , Suzuki Kazuaki , Takahashi Tadahisa , Itoi Eiji , Nagatomi Ryoichi
Published: February 2021

Study Design.

A cross-sectional study.

Objective.

The purpose of this large cohort study was to assess the prevalence of low back pain (LBP) among young players participating in several types of sports.

Summary of Background Data.

LBP is a significant problem among young sports players. Sport discipline among young players is thought to be associated with LBP. However, similar previous studies did not specifically analyze LBP by age and sex.

Methods.

A cross-sectional study was conducted with young sports players (ages 6–15 years, n = 7277) using a self-reported questionnaire. The prevalence of LBP was assessed using the variables of age, sex, and sport discipline.

Results.

The point prevalence of LBP among young sports players was 5.0%. The participants between 6 and 8 years’ old had the lowest prevalence of LBP (0.4%–1.3%), which increased with aging and reached the highest proportion of 13.5% to 14.8% at 13 to 14 years. Furthermore, female players had significantly higher proportions of LBP than male players (8.1% vs. 3.7%). Regarding sport discipline, the prevalence of LBP was higher in basketball, handball, and volleyball.

Conclusion.

The prevalence of LBP among young sports players was different for age, sex, and sport discipline. Further studies are needed to clarify the association of sport-specific movements to LBP in each sport discipline. This may assist in developing programs or strategies for preventing LBP among young sports players.

Level of Evidence: 3
Comparison of videolaryngoscopy alone with video-assisted fibreoptic intubation in a difficult cadaver airway model
Authors: Koopman Erik M. , van Emden Michael W. , Geurts Jeroen J.G. , Schwarte Lothar A. , Schober Patrick
Published: February 2021

No Abstract.
State of Gender Diversity and Equity Policies within Plastic and Reconstructive Surgery in Canada
Authors: Retrouvey Helene , Jakubowski Josephine , Lipa Joan E. , Forrest Christopher , Snell Laura
Published: February 2021

Background:

Given the growing number of women in plastic and reconstructive surgery (PRS), it is imperative to evaluate the extent of gender diversity and equity policies among Canadian PRS programs to support female trainees and staff surgeons.

Methods:

A modified version of the United Nations Women’s Empowerment Principles (WEPs) Gender Gap Analysis tool was delivered to Canadian PRS Division Chairs (n = 11) and Residency Program Directors (n = 11). The survey assessed gender discrimination and equity policies, paid parental leave policies, and support for work/life balance.

Results:

Six Program Directors (55% response rate) and ten Division Chairs (91% response rate) completed the survey. Fifty percent of respondents reported having a formal gender non-discrimination and equal opportunity policy in their program or division. Eighty-three percent of PRS residency programs offered paid maternity/paternity/caregiver leave; however, only 29% offered financial or non-financial support to its staff surgeons. Only 33% of programs had approaches to support residents as parents and/or caregivers upon return to work. Work/life balance was supported for most trainees (67%) but only few faculty members (14%).

Conclusions:

The majority of Canadian PRS programs have approaches rather than formal policies to ensure gender non-discrimination and equal opportunity among residents and faculty. Although residency programs support wellness, few have approaches for trainees as parents and/or caregivers upon return to work. At the faculty level, approaches and policies lack support for maternity/paternity/caregiver leave or work/life balance. This information can be used to develop policy for support of plastic surgery trainees and faculty.
The Internal Oblique Muscle Flap with Synthetic Mesh Reinforcement for a Large, Contaminated Abdominal Wall Defect
Authors: Watanabe Shiho , Sakuma Hisashi , Kono Hikaru , Shimono Ayano , Matsuura Naoki
Published: February 2021

We report a case of a large mediocaudal abdominal defect in contaminated circumstances with no residual rectus abdominis muscle that was reconstructed using an internal oblique muscle flap with large-pore polypropylene mesh reinforcement. The internal oblique muscle flap can reconstruct the lower abdominal midline without leaving any additional conspicuous scar. Previous studies showed that large-pore polypropylene mesh in contaminated wounds has a minimal difference in terms of infection rate, and less frequent occurrence of hernia, compared even with biological meshes. We believe that this method could be a strong and cosmetically satisfying option for large mediocaudal abdominal wall reconstruction.
Innovative CAD/CAM Guide for Mandibular Reconstruction with Metallic Condylar Head and Free Fibular Flap
Authors: Yamochi Ryo , Numajiri Toshiaki , Nakamura Hiroko , Morita Daiki , Sowa Yoshihiro
Published: February 2021

In reconstructions of mandibles and condyles, free fibular flaps and metallic condylar heads (CH) are often used after resection. However, in conventional reconstructions, it is difficult to fix the metallic CH on the same preoperative position because the position is determined visually. Therefore, we have made an original computer-aided design and manufacture (CAD/CAM) guide for mandibular condyle reconstruction, combining a metallic CH with a free fibular flap. A 71-year-old woman with gingival carcinoma underwent hemimandibulectomy. We reconstructed the mandible and condyle with a metallic CH and a free fibular flap. We placed a mark on the CAD/CAM guide showing the correct position for fixing the CH to the fibular blocks. We also designed a surface for attaching to the healthy edge of the mandible. The fibular blocks and metallic CH were fixed as 1 unit before separating the flap from the leg and replacing the diseased tissue. Reconstruction was completed by fixing the attachment surface to the healthy side of the mandible. The guide marks solved the difficulty of conventional reconstruction; during surgery, we fixed the metallic CH to the same position as the original bone using these marks. The postoperative deviation of the condyle from the virtual plan was 4.3 mm, whereas the reported deviation of such prostheses was 3.8 mm (range 1.3–6.7); so our guide was acceptably accurate. Furthermore, it appears that the CAD/CAM guide is more useful for reconstruction after hemimandibulectomy including the condyle than after segmental resection without including condyle.
Second Generation Radiofrequency Body Contouring Device: Safety and Efficacy in 300 Local Anesthesia Liposuction Cases
Authors: Chia Christopher T. , Marte Joseph A. , Ulvila Derek D. , Theodorou Spero J.
Published: February 2021

Background:

Suction-assisted lipectomy has undergone significant improvements in technique, outcomes, and safety. The local anesthetic option has an excellent safety profile, and energy-based modalities such as radiofrequency-assisted liposuction (RFAL) devices were developed to enhance soft-tissue contraction. The purpose of this study was to report a single center’s experience with two surgeons using the second-generation RFAL device compared with the first-generation device in terms of safety and efficacy.

Methods:

In total, 300 consecutive operations were performed under local anesthesia. Following tumescent injection, the RFAL device was used to heat the skin and underlying collagen network. Subsequently, areas to be contoured were followed with suction-assisted lipectomy to remove excess fat and fluid.

Results:

An estimated 300 operations were performed on 240 patients in 421 anatomic areas. Treated areas included the face, trunk, and extremities. The average maximum temperatures were 38.6°C externally and 65.6°C internally. The average total and fat aspirate volumes were 1264 and 648 mL. There were no major complications or mortalities, and 3 minor complications treated locally.

Conclusions:

The data indicated statistically significant lower proportions of major, minor, or cumulative complications compared with the patients who received first-generation RFAL treatment. Major complications were exhibited for 6.25% of the first-generation group and 0% for the second-generation group. The first-generation group exhibited 8.3% minor complications, with 0.7% in the second-generation group. In sum, the data from the second-generation series of RFAL device operations indicate a statistically, as well as clinically, significant reduction in the overall complication rates compared with the first-generation device.
Accuracy of Soft Tissue Prediction of 2 Virtual Planning Systems in Patients Undergoing Intraoral Quadrangular Le Fort II Osteotomy
Authors: Willinger Katrin , Guevara-Rojas Godoberto , Cede Julia , Schicho Kurt , Stamm Tanja , Klug Clemens
Published: February 2021

Background:

Virtual surgical planning (VSP) is state of the art in routine clinical work. Visualization of soft tissue changes adds important information for surgical planning. The aim of this study was to evaluate accuracy of soft tissue prediction of 2 VSP systems in patients undergoing an intraoral quadrangular Le Fort II osteotomy.

Methods:

VSP was performed with the software application IPS Case Designer (IPS) and Dolphin Imaging 11.95 (DOL) in bone and soft tissue structure. Distances were measured at the 3 levels of the face at the infraorbital rim, the sinus floor, and the lateral incisor level with 2 VSP systems (DOL and IPS).

Results:

A convenience sample of 19 patients was included in the study with a mean age of 21.9 years. From cranial to caudal, mean differences between simulation and postintervention data were as follows: infraorbital rim level: DOL and ST0: mean difference: 2.90 mm; IPS and ST0: 1.70 mm; sinus floor level: DOL and ST0: mean difference: 3.57 mm; IPS and ST0: 1.34 mm; and lateral incisor level: DOL and ST0: mean difference: 2.48 mm; IPS and ST0: 2.25 mm.

Conclusions:

Generally, both VSP systems are suitable for planning an intraoral quadrangular Le Fort II osteotomy. Especially in the infraorbital region, improvement of the algorithm is required for trustworthy prediction of soft tissue changes.
Associations of biogeographic ancestry with hypertension traits
Authors: Keaton Jacob M. , Hellwege Jacklyn N. , Giri Ayush , Torstenson Eric S. , Kovesdy Csaba P. , Sun Yan V. , Wilson Peter W.F. , O’Donnell Christopher J. , Edwards Todd L. , Hung Adriana M. , Velez Edwards Digna R.
Published: February 2021

Objectives:

Ethnic disparities in hypertension prevalence are well documented, though the influence of genetic ancestry is unclear. The aim of this study was to evaluate associations of geographic genetic ancestry with hypertension and underlying blood pressure traits.

Methods:

We tested genetically inferred ancestry proportions from five 1000 Genomes reference populations (GBR, PEL, YRI, CHB, and LWK) for association with four continuous blood pressure (BP) traits (SBP, DBP, PP, MAP) and the dichotomous outcomes hypertension and apparent treatment-resistant hypertension in 220 495 European American, 59 927 African American, and 21 273 Hispanic American individuals from the Million Veteran Program. Ethnicity stratified results were meta-analyzed to report effect estimates per 10% difference for a given ancestry proportion in all samples.

Results:

Percentage GBR was negatively associated with BP (P = 2.13 × 10−19, 7.92 × 10−8, 4.41 × 10−11, and 3.57 × 10−13 for SBP, DBP, PP, and MAP, respectively; coefficient range −0.10 to −0.21 mmHg per 10% increase in ancestry proportion) and was protective against hypertension [P = 2.59 × 10−5, odds ratio (OR) = 0.98] relative to other ancestries. YRI percentage was positively associated with BP (P = 1.63 × 10−23, 1.94 × 10−26, 0.012, and 3.26 × 10−29 for SBP, DBP, PP, and MAP, respectively; coefficient range 0.06–0.32 mmHg per 10% increase in ancestry proportion) and was positively associated with hypertension risk (P = 3.10 × 10−11, OR = 1.04) and apparent treatment-resistant hypertension risk (P = 1.86 × 10−4, OR = 1.04) compared with other ancestries. Percentage PEL was inversely associated with DBP (P = 2.84 × 10−5, beta = −0.11 mmHg per 10% increase in ancestry proportion).

Conclusion:

These results demonstrate that risk for BP traits varies significantly by genetic ancestry. Our findings provide insight into the geographic origin of genetic factors underlying hypertension risk and establish that a portion of BP trait ethnic disparities are because of genetic differences between ancestries.
Salivary Duct Carcinoma With Rhabdoid Features—No or Aberrant Expression of E-cadherin and Genetic Changes in CDH1
Authors: Kusafuka Kimihide , Yamada Hidetaka , Ishino Keiko , Maeda Matsuyoshi , Yamanegi Koji , Baba Satoshi , Ohuchi Tomoyuki , Inagaki Hiroshi , Yamamoto Hidetaka , Iwasaki Tomohiro , Tsuchiya Chinatsu , Sugimura Haruhiko , Suzuki Makoto
Published: February 2021

Salivary duct carcinoma is a relatively uncommon malignancy of the salivary glands; however, it frequently occurs as a carcinomatous component of carcinoma ex pleomorphic adenoma. We previously reported salivary duct carcinoma with rhabdoid features (SDCRF) as an extremely rare subtype of salivary duct carcinoma, and that it occurred as a salivary counterpart of pleomorphic lobular carcinoma of the breast (PLCB). We collected new cases of SDCRF for this study, in which we examined a total of 17 cases immunohistochemically and genetically. As it is known that PLCB exhibits loss of or aberrant E-cadherin expression and carries nonsense/missense mutations in or deletion of the CDH1 gene, we examined the CDH1 gene status of our SDCRF cases. All of the examined SDCRF cases involved the diffuse proliferation of large ovoid cells with eosinophilic cytoplasm and eccentric nuclei, which displayed reduced cell-cell adhesion. Most cases were positive for pan-cytokeratin, androgen receptor, gross cystic disease fluid protein-15, SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1, and WI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily A member 4, whereas they were negative for vimentin. No and decreased/cytoplasmic E-cadherin expression was observed in 11 and 4 of 17 cases, respectively, whereas no and decreased/cytoplasmic β-catenin expression were observed in 10 and 5 of 17 cases, respectively. Among the 11 cases that could be genetically analyzed, a nonsense mutation (1 case), missense mutations (6 cases), and insertions (1 case) were detected in the CDH1 gene. In conclusion, we propose that SDCRF is the salivary counterpart of PLCB due to its morphology and immunophenotype, and the genetic status of CDH1.
HER-2 Amplification in Uterine Serous Carcinoma and Serous Endometrial Intraepithelial Carcinoma
Authors: Banet Natalie , Shahi Maryam , Batista Denise , Yonescu Raluca , Tanner Edward J. , Fader Amanda N. , Cimino-Mathews Ashley
Published: February 2021

Human epidermal growth factor receptor 2 (HER-2) targeted therapy shows promising results in HER-2-positive uterine serous carcinoma (USC). HER-2 scoring criteria for USC and its associated noninvasive lesion, serous endometrial intraepithelial carcinoma (SEIC), are not well-established. Here, we compare the breast and gastric (GI) HER-2 immunohistochemistry (IHC) scoring criteria for HER-2 with HER-2/neu fluorescence in situ hybridization (FISH) in 68 tumors (17 USC with SEIC, 30 USC, 18 SEIC, 3 metastatic USC). The majority (97%) of lesions displayed intratumoral HER-2 IHC heterogeneity. Breast or GI IHC scoring criteria were performed equivalently. The breast and GI IHC criteria classified 51% and 47% USC as HER-2 negative (IHC 0/1+), 40% and 45% as equivocal (IHC 2+), and 9% each as HER-2 positive (IHC 3+). A quarter of USC classified as HER-2 negative or positive with the breast (25%, n=7/28) or GI IHC criteria (23%, n=6/26) was discordant by FISH. Specifically, 13% to 14% of IHC 0/1+ USC were FISH amplified; 50% of IHC 3+ USC were FISH negative. The majority (77% to 83%) of SEIC were HER-2 IHC 0/1+, and no SEIC was HER-2 IHC 3+. A minority (4% to 7%) of IHC 0/1+ SEIC were FISH positive. Discordant HER-2 status was observed between half (47%,bn=7/15) of synchronous SEIC and USC. In conclusion, USC displays HER-2 intratumoral heterogeneity, a high IHC/FISH discordance rate, and variation in HER-2 status between the SEIC and invasive components. Caution is required when evaluating HER-2 in small biopsies, which should be repeated on excisions. Both IHC and FISH should be performed on USC until clinical trials correlate HER-2 status with clinical response to HER-2-targeted therapy.
An Inpatient Psychiatric Program Targeting Opioid Overdoses
Authors: MAHGOUB NAHLA , O’CONNELL KATIE , GEVINT KIMBERLY , DEDONATIS ANTHONY , VELASCO JOEFFEL , THAM ANNA , CANGEMI SONIA , TAI FEN-JU , STELLMAN MICHAEL , RADOSTA MICHAEL , ANTHONY DONNA
Published: February 2021

The United States is currently experiencing an opioid epidemic, as drug overdose deaths have become a leading cause of death. According to the Centers for Disease Control, in 2017, opioids were responsible for 47,000 deaths, which involved both illicit and prescription opioids. A multifaceted public health approach that utilizes public health authorities, health care providers, local hospitals, and affected communities is required to effectively reduce opioid-related morbidity and mortality. The authors of this paper developed an inpatient program on the dual-diagnosis unit at Gracie Square Psychiatric Hospital in New York to target the opioid crisis. The purpose of this program was to train patients and their families on how to respond to an opioid overdose and administer naloxone spray. The paper describes the implementation of this program.
Gadolinium Concentrations in Biological Matrices From Patients Exposed to Gadolinium-Based Contrast Agents
Authors: Layne Kerry A. , Raja Kishor , Dargan Paul I. , Wood David M.
Published: February 2021

Objectives

There is increasing evidence that Gd may be retained within the skin, bones, and solid organs in patients with normal renal function after exposure to Gd-based contrast agents (GBCAs). Here we present clinical data from 19 patients who requested referral to our clinical toxicology service for assessment of potential “Gd toxicity.”

Materials and Methods

Patients had undergone a median of 2 (interquartile range [IQR], 1–5) exposures to GBCAs and were reviewed at a median of 5 months (IQR, 2–8 months) after the last GBCA exposure. Patients had a clinical assessment by a clinical toxicologist, and biological samples were taken in 17 patients (89.5%). Gd concentrations were measured in these samples using inductively coupled plasma mass spectrometry.

Results

All patients had significant comorbidities, and after an extensive clinical review, none of the reported symptoms were considered likely to be related to “Gd toxicity.” Whole blood, plasma, and urine samples had detectable Gd concentrations in 69.2%, 78.6%, and 95.2% of samples, respectively. Median (IQR) concentrations of Gd were as follows: whole blood, 0.013 ng/mL (IQR, limit of detection [LOD]–0.884 ng/mL); plasma, 0.012 ng/mL (IQR, LOD–0.046 ng/mL); and spot urine, 0.304 μg/g creatinine (IQR, 0.070–3.702 μg/g creatinine). There were positive correlations between whole blood and plasma (P = 0.0024, r = 0.84), whole blood and urine (P = 0.0018, r = 0.82), and plasma and urine (P = 0.0001, r = 0.89) Gd concentrations. There was a negative correlation between Gd concentrations and the period after exposure for whole blood (P = 0.0028, r = −0.80), plasma (P = 0.0004, r = −0.86), and urine (P < 0.0001, r = −0.91).

Conclusions

We identified detectable Gd concentrations in biological matrices from all patients reporting exposure to GBCAs who were reviewed in our clinical toxicology outpatient clinic with concerns regarding potential “Gd toxicity”; however, there were no clinical features of toxicity present in this cohort. Further research is required to explore the pharmacokinetics and pharmacodynamics of GBCAs in patients with normal renal function and to determine the clinical significance of these detectable Gd concentrations.
Tolosa–Hunt Syndrome Misdiagnosed as Surgical Complication After Frontal Balloon Sinuplasty
Authors: Lee Ki-Il , Park Joong Su , Lee Seon-Min , In Seung Min
Published: February 2021

Tolosa–Hunt syndrome (THS) is a rare benign disease caused by granulomatous inflammation in the craniofacial region. It is mostly idiopathic and generally presents with painful ophthalmoplegia, ipsilateral oculomotor paresis, and steroid responsiveness. There are few reports of THS after sinus surgery. Here, we present a case of THS in an adult immunocompetent patient with severe ophthalmic pain and diplopia after frontal balloon sinuplasty. The patient was initially misdiagnosed as having a surgical complication. The patient was treated with massive corticosteroid pulse therapy, and the symptoms resolved dramatically. There were no complications or recurrence in the 7-month follow-up period.
Simplified Postoperative Care After Spring-assisted Strip Craniotomy for Sagittal Synostosis: A Prospective Before-and-After Study
Authors: Malmqvist Carina , Paganini Anna , Johansson Lotta , Maltese Giovanni , Tarnow Peter , Olsson Robert , Kölby Lars , Rylander Christian
Published: February 2021

Since the development of spring-assisted techniques for corrective craniofacial surgery, routine postoperative admission to intensive care units (ICUs) has been questioned. However, close monitoring is necessary if the continuous infusion of morphine is used as recommended for better pain relief. In this study, the authors evaluated a simplified postoperative protocol without continuous morphine infusion and no indwelling urinary catheter following spring-assisted surgery (SAS) for sagittal synostosis. Ten children were cared for according to a standard protocol with postoperative intravenous (i.v.) infusion of morphine and an indwelling urinary catheter, and 11 consecutive children were treated according to a simplified protocol with pain relief based on intermittent injections of morphine and clonidine [according to Face, Legs, Activity, Cry, Consolability (FLACC) scores >4] without the indwelling catheter. A Mann−Whitney U test was used for comparison of distributions between the two groups. The results revealed no differences between groups regarding the proportion of FLACC scores >4, total amount of administered i.v. morphine and clonidine, total volume of buffered glucose infused, time to first feeding on breast milk or substitute, or the length of stay. Despite the inherent limitations of our small observational study, the authors concluded that at our institution, it was possible to exclude a standard continuous i.v. infusion of morphine and an indwelling urinary catheter from our postoperative care protocol without decreasing the quality of pain relief in children submitted to SAS for sagittal synostosis. This finding supports downgrading the level of care from the ICU to a regular ward after limited immediate postoperative observation.