bluuebunny/crossref_metadata_2025 huggingface dataset:
Head and Neck Acinic Cell Carcinoma
Authors: Xu Bin , Saliba Maelle , Ho Alan , Viswanathan Kartik , Alzumaili Bayan , Dogan Snjezana , Ghossein Ronald , Katabi Nora
Published: January 2022

Acinic cell carcinoma (AciCC) is traditionally considered as a low-grade salivary gland carcinoma. However, a subset demonstrates high-grade features with a higher mortality rate and distant metastasis. In this large retrospective study of 117 cases, we aimed to establish a histologic grading scheme for AciCC. Adverse independent prognostic factors identified on the multivariate analysis included older age, tumor necrosis, nuclear anaplasia, lymphovascular invasion, absence of tumor-associated lymphoid stroma, and high American Joint Committee on Cancer (AJCC) pT and pN stages. A 3-tiered grading scheme using 4 pathologic parameters (mitotic index, necrosis, tumor border, and fibrosis at the frankly invasive front) was subsequently applied. Compared with low/intermediate-grade, high-grade AciCC defined as a mitotic index ≥5/10 HPFs and/or necrosis was an independently adverse prognostic factor. The 5-year overall survival was 50% in high-grade AciCCs, and 100% in low-grade or intermediate-grade AciCCs. Compared with low-grade or intermediate-grade AciCC, high-grade tumors were associated with older age, larger tumor size, focal rather than diffuse zymogen granules, solid architecture, infiltrative tumor border, fibrosis at the frankly invasive front, lymphovascular invasion, perineural invasion, positive margin, high pT, and pN stages. NR4A3 was a highly sensitive and specific immunohistochemical stain for diagnosing AciCC with a sensitivity and specificity of 96% and 93%, respectively. In conclusion, although we proposed a 2-tiered grading system for AciCC with high-grade tumors defined by a mitotic count ≥5/10 HPFs and/or necrosis, more studies are needed to assess the prognostic value of intermediate grade. NR4A3 immunohistochemical stain is a useful diagnostic marker for AciCC.
Relative Sit-to-Stand Muscle Power Predicts an Older Adult’s Physical Independence at Age of 90 Yrs Beyond That of Relative Handgrip Strength, Physical Activity, and Sedentary Time
Authors: Hetherington-Rauth Megan , Magalhães João P. , Alcazar Julian , Rosa Gil B. , Correia Inês R. , Ara Ignacio , Sardinha Luís B.
Published: January 2022

Objectives

Muscle power is important for an older adult’s physical independence and can be easily estimated using the sit-to-stand test. This investigation aimed to assess whether muscle power estimated using the sit-to-stand test could identify older adults at risk of losing physical independence beyond handgrip strength, physical activity, and sedentary time and to develop minimal sit-to-stand power thresholds.

Design

Physical independence was assessed cross-sectionally in older adults using a composite physical function questionnaire. Muscle power was calculated using the 30-sec sit-to-stand test. Muscle strength was determined using a handgrip dynamometer. Physical activity and sedentary time were assessed by accelerometry. Multiple logistic regression was used to assess the independent association between sit-to-stand power and projected physical independence (n = 737). Receiver operator characteristic curves were used to develop sit-to-stand power cut points (N = 1748).

Results

Sit-to-stand power proved to be the best predictor of physical independence in later life regardless of handgrip strength, physical activity, and sedentary time (standardized B = 0.45, −0.02, 0.12, −0.28, respectively). Sex- and age-specific cutoffs for sit-to-stand power had good discriminatory ability (area under the curve = 0.75–0.78 [women], 0.76–0.82 [men]).

Conclusions

Sit-to-stand power can be used as a simple and practical screening tool to assess an older adult’s future physical independence.
Effects of Exercise Mode on Improving Cardiovascular Function and Cardiorespiratory Fitness After Bariatric Surgery
Authors: Mahmoud Abeer M. , Gonçalves da Silva Andréa Lúcia , André Larissa Delgado , Hwang Chueh-Lung , Severin Richard , Sanchez-Johnsen Lisa , Borghi-Silva Audrey , Elokda Ahmed , Arena Ross , Phillips Shane A.
Published: January 2022

Obesity affects 600 million people globally and increases the risk of developing cardiovascular disease, stroke, diabetes, and cancer. Bariatric surgery is an increasingly popular therapeutic intervention for morbid obesity to induce rapid weight loss and reduce obesity-related comorbidities. However, some bariatric surgery patients, after what is considered a successful surgical procedure, continue to manifest obesity-related health issues, including weight gain, reduced physical function, persistent elevations in blood pressure, and reduced cardiorespiratory fitness. Cardiorespiratory fitness is a strong predictor of mortality and several health outcomes and could be improved by an appropriate exercise prescription after bariatric surgery. This review provides a broad overview of exercise training for patients after bariatric surgery and discusses cardiorespiratory fitness and other potential physiological adaptations in response to exercise training.
Evaluation of the Association of Academic Physiatrists Medical Student Summer Clinical Externship
Authors: Grewal Harmandeep , Kim Soojin , Katz Nicole B. , Case Christina M. , Pingenot Edward , Chung Yelim K. , Chukwuma Valentine , Mayer R. Samuel
Published: January 2022

The Medical Student Summer Clinical Externship is an 8-wk program hosted by the Association of Academic Physiatrists and offered to first year medical students. Various institutions sponsor participants and provide clinical exposure and mentorship opportunities to promote interest in the field. The program has had more than 100 medical student participants. Students were asked to complete a preparticipation and postparticipation survey. Results revealed a statistically significant increase in interest in physiatry and participants’ scores for comfort and experience level in obtaining a history of present illness, general physical examination, and managing developmental, musculoskeletal, and neurologic disabilities. The Medical Student Summer Clinical Externship program provides an opportunity for mentorship and exposure to various subspecialties that likely reinforces student interest in those who are predisposed to physiatry. Students’ increased comfort level in treating patients with developmental, musculoskeletal, and neurologic disabilities may lead to improvements in the quality of and access to care received by these populations. All participants gain an increased awareness of the scope of practice of physiatry that will hopefully lead to the increased integration of physical medicine and rehabilitation into the care plans and as a standard of care for patients who might greatly benefit.
Pregnancy After Amputation
Authors: Bateman Emma A. , Frengopoulos Courtney , Viana Ricardo , Payne Michael W.C.
Published: January 2022

Pregnancy could affect the mobility of women with lower extremity limb loss, deficiency, or amputations. The aim of this systematic review was to characterize the pregnancy-related experiences, including prosthesis, gait aid, and mobility outcomes, of women with lower extremity limb loss, deficiency, or amputations. MEDLINE, CINAHL, and Embase databases were searched for all relevant English-language articles describing pregnancy experiences of women with lower extremity limb loss, deficiency, or amputations. Data extracted were age, amputation level and etiology, obstetrical history, prosthesis and/or gait aid use before, during, and after pregnancy, and pregnancy-related complications. Risk of bias was assessed using applicable CLARITY tools. Data were analyzed with descriptive statistics. Among 399 retrieved studies, 24 met inclusion criteria describing 31 pregnancies in 25 women. All were case series/reports with high risk of bias. All women had acquired lower extremity limb loss, deficiency, or amputations. Sixteen women had hemipelvectomy (64%) and 4 had transfemoral amputations (16%). Three women used a prosthesis, 5 did not, and use was not described for 17 (68%). Prosthesis or gait aid use changed in 2 pregnancies, did not change in 6, and was not specified in 23 (74%). Available cases are likely not representative; additional research is required to characterize the impact of pregnancy on women with lower extremity limb loss, deficiency, or amputations.
Effect of Adding a Wheelchair Immersion Program to a Physical Medicine and Rehabilitation Clerkship on Emotions, Behavior, and Attitude
Authors: Hsieh Shelly , Donovan Jayne , Fyffe Denise , McKay Ondrea , Kirshblum Steven
Published: January 2022

People with disabilities encounter significant barriers in health care and report that healthcare providers often lack an understanding in caring for them. Currently, there is limited disability awareness training in medical school curricula. This mixed-methods pilot study examined the effects of integrating a short wheelchair immersion program in a physical medicine and rehabilitation clerkship, versus the clerkship alone, on attitudes toward people with disabilities, comfort in treating people with disabilities, knowledge of wheelchair etiquette, and understanding of wheelchair-associated challenges. The standard training group underwent the physical medicine and rehabilitation clerkship, consisting of a 2-wk clinical rotation and didactic program. The intervention group additionally underwent a newly developed 1-hr wheelchair program where they simulated mobility and some activities of daily living as a “wheelchair user” and “caregiver.” Quantitative analysis demonstrated that all students who completed the clerkship had significantly improved attitudes toward and comfort in treating people with disabilities, knowledge of wheelchair etiquette, and understanding of wheelchair-associated challenges, whereas students in the wheelchair immersion program had a greater change in understanding wheelchair-associated challenges. Qualitative analysis revealed that the intervention resulted in positive attitudinal changes. These findings suggest that integrating a brief wheelchair immersion program with a physical medicine and rehabilitation clerkship may enhance disability awareness training in medical school curricula.
Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation in Migraine
Authors: Saltychev Mikhail , Juhola Juhani
Published: January 2022

Objective

The aim of the study was to evaluate the effectiveness of repetitive transcranial magnetic stimulation in migraine measured by decrease in pain severity or attack frequency.

Methods

A search at the Cochrane Controlled Trials Register (CENTRAL), MEDLINE (via PubMed), Embase, CINAHL, Web of Science, and Scopus. The risk of systematic bias was rated by using the Cochrane domain-based quality assessment tool. A random-effects model was used.

Results

Of 434 identified records, 8 randomized control studies were included in the meta-synthesis. All have used a high-frequency repetitive transcranial magnetic stimulation targeting the left dorsolateral prefrontal cortex. The risk of systematic bias was low. The difference between repetitive transcranial magnetic stimulation and control groups in frequency of migraine days per month was 8.1 (95% confidence interval = 4.8–11.4) days in favor of repetitive transcranial magnetic stimulation. Respectively, for intensity of migraine pain (scaled from 0 to 100), this difference was 13.6 (95% confidence interval = 5.3–21.8) points in favor of repetitive transcranial magnetic stimulation. The heterogeneity was substantial with I
2 = 86%.

Conclusions

In chronic migraine, repetitive transcranial magnetic stimulation seems to have positive effects on both migraine pain severity and attack frequency compared with sham stimulation. Although the effect on pain intensity was probably clinically insignificant, repetitive transcranial magnetic stimulation reduced pain frequency by 8 days per month on average.
A Countermovement Jump for the Midterm Assessment of Force and Power Exertion After Anterior Cruciate Ligament Reconstruction
Authors: Labanca Luciana , Budini Francesco , Cardinali Ludovica , Concilio Giulia , Rocchi Jacopo Emanuele , Mariani Pier Paolo , Laudani Luca , Macaluso Andrea
Published: January 2022

Objective

The aim of this study was to assess force and power exertion during a countermovement jump after anterior cruciate ligament reconstruction using either semitendinosus and gracilis or bone-patellar tendon-bone graft.

Design

One hundred-nineteen semitendinosus and gracilis and 146 bone-patellar tendon-bone participants performed a countermovement jump on two force platforms after 3 (T1) and 6–9 mos (T2) from surgery. Twenty-four healthy participants served as control group. Peak force of eccentric and concentric phases and peak power were obtained from the analysis of vertical components of the ground reaction forces. Asymmetry was quantified by means of limb symmetry index.

Results

Eccentric peak force was significantly (P < 0.05) lower than concentric peak force in both bone-patellar tendon-bone and semitendinosus and gracilis at T1 and T2. At T1, bone-patellar tendon-bone showed higher peak power, but lower limb symmetry index in eccentric and concentric compared with semitendinosus and gracilis. At T2, bone-patellar tendon-bone showed higher peak power than semitendinosus and gracilis, although there were no differences in limb symmetry index between the two groups, which however was significantly (P < 0.05) lower in both groups when compared with control group.

Conclusions

Bone-patellar tendon-bone and semitendinosus and gracilis participants showed asymmetries in eccentric and concentric force during a countermovement jump. Bone-patellar tendon-bone showed greater asymmetries and a higher peak power respect to semitendinosus and gracilis participants.
Cervical Spinal Lesion, Completeness of Injury, Stress, and Depression Reduce the Efficiency of Mental Imagery in People With Spinal Cord Injury
Authors: Kaur Jaskirat , Ghosh Shampa , Singh Prabhakar , Dwivedi Alok Kumar , Sahani Asish Kumar , Sinha Jitendra Kumar
Published: January 2022

Objectives

The aims of this study were to assess the relationships of (1) clinical variables (age, level of injury, time since injury [TSI], and completeness of injury) and (2) psychological variables (stress and depression) with mental imagery ability in individuals with spinal cord injury.

Study Design

This was a cross-sectional study. Participants with spinal cord injury (N = 130) were requested to fill the Kinesthetic and Visual Imagery Questionnaire and Vividness of Motor Imagery Questionnaire. They also completed the Perceived Stress Scale and Patient Health Questionnaire 9 for the assessment of stress and depression, respectively.

Results

Mental imagery scores were found to be significantly low in cervical injuries (P < 0.001) as compared with thoracic injuries (P < 0.001). Furthermore, higher levels of spinal injuries resulted in lower mental imagery scores. Completeness of injury (according to Asia Impairment Scale) also had a significant relationship (P < 0.001) with the mental imagery ability among spinal cord injury participants. Presence of stress (P < 0.001) and depression (P < 0.001) also associated with reduced efficiency of mental imagery in these individuals.

Conclusions

Injury type and psychological factors were associated with mental imagery in SCI patients. Imagery-based interventions should be designed after consideration of identified factors yielding effect on their outcomes.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Determine the impact of clinical variables such as level of injury, completeness and chronicity of injury on mental imagery ability in spinal cord injury; (2) Discuss the role of stress and depression on mental imagery ability in spinal cord injury; and (3) Describe the various dimensions of mental imagery ability and its variability among individuals who have spinal cord injury.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Ultrasonographic Evaluation of the Metacarpal Cartilage Thicknesses in Weightlifters and Volleyball Players
Authors: İskender Öner , Kaymak Bayram , Kara Murat , Akıncı Ayşen , Ülkar Bülent , Özçakar Levent
Published: January 2022

Objective

The aim of the study was to evaluate the possible effects of impact and loading on the metacarpal cartilage and hand functions in young elite athletes.

Design

In this cross-sectional study athletes with at least 3 yrs of sport background and who have been under a scheduled training program were enrolled. The second to fifth fingers’ metacarpal head cartilage thicknesses were measured bilaterally by using ultrasonography. Handgrip and pinch strengths were measured. Michigan Hand Outcomes Questionnaire was also completed for every participant.

Results

A total of 42 male athletes (19 weightlifters, 23 volleyball players) and 46 healthy control subjects were enrolled. Metacarpal cartilage thicknesses of the athletes were thicker than those of the healthy controls (all P < 0.001). There were no differences between the dominant and nondominant hands (all P > 0.05). In the weightlifting group, Michigan Hand Outcomes Questionnaire work performance and pain scores were worse than the other groups (both P < 0.001).

Conclusions

The presence of increased cartilage thickness measurements in the athletes suggests that sports activities might affect the metacarpal articular cartilage. Highest pain scores and lowest work performance scores in the weightlifters with highest metacarpal cartilage thickness might suggest that impact and loading during their sports play could lead to cartilage edema.
Examining a Fatigue Management Model in Older Individuals
Authors: Torossian Maral R. , Chung Joohyun , Mamo Sara K. , Jacelon Cynthia S.
Published: January 2022

Purpose

The aim of this study was to examine a fatigue model for older individuals based on the theory of unpleasant symptoms.

Research Design

The research design used was a secondary data analysis of the “Patient-Reported Outcomes Measurement Information System Profiles–Health Utilities Index” data set.

Methods

Multiple regression analysis and path analyses were used to examine hypothesized model paths.

Results

A number of comorbidities, pain, sleep, depression, anxiety, education, and sensory impairment were significant predictors of fatigue. Higher fatigue scores predicted lower physical, social, and cognitive performances, as well as worse perceived health and quality of life (QOL). In addition, the identified fatigue outcomes mediated the relationship between fatigue and QOL.

Conclusions

Future research should be directed toward exploring other risk factors of fatigue and examining feedback loops depicted in the theory of unpleasant symptoms.

Clinical Relevance to the Practice of Rehabilitation Nursing

Rehabilitation nurses should closely monitor and manage the identified fatigue-influencing factors to improve older individuals’ performance, perceived health, and QOL.
Investigation of the Effectiveness of Microvascular Doppler Ultrasound and Q-Pack in the Discrimination of Malign Thyroid Nodules From Benign
Authors: Karagülle Mehmet , Arslan Fatma Zeynep , Şimşek Samet , Öncü Süleyman , Pamuk Gül Gizem , Öncü Mehmet , Tan Cimilli Ahmet
Published: January 2022

In this prospective study, the diagnostic performance of MicroV Doppler ultrasonography (US) and Q-pack application in distinguishing malignant thyroid nodules from benign nodules will be examined. Given the emerging irregular vascular structures in malignant nodules, it is thought that MicroV Doppler US and Q-pack application can help in diagnosis. One hundred sixteen nodules that were suggested a biopsy by a clinician were examined with B-mode US, color, X-flow, and MicroV Doppler US, respectively. In addition, during MicroV Doppler US examination, thyroid nodule and its adjacent thyroid parenchyma were evaluated with Q-pack application. After US examinations, biopsy was performed on the nodules and histopathological results were obtained. Eighty-nine nodules were histopathologically proven as benign, and the rest of them were malignant. In Doppler types, the thyroid findings in score 1, 2, and 3 nodule blood supply type were benign, whereas the thyroid findings in the score 4 have a possibility of malignancy between 63% and 66.7%. It was found that MicroV Doppler was significantly superior to X-flow and color Doppler (P = 0.037 and P = 0.042, respectively). Nodule/parenchyma Q-pack mean values were statistically significantly higher in malignant findings compared with benign findings (P < 0.001). Nodule/parenchyma Q-pack peak values were also statistically significantly higher in malignant findings compared with benign findings (P < 0.001).

As a result, although Q-pack application enables us to obtain quantitative values about vascularity, due to its ability to demonstrate slow blood flow, microvascular vessel structure, and distribution, MicroV Doppler US has promises to detect malignant thyroid nodules.
Arrival-Time Parametric Imaging in Contrast-Enhanced Ultrasound for Diagnosing Fibrosis in Primary Biliary Cholangitis
Authors: Yoshimine Naoyuki , Wakui Noritaka , Nagai Hidenari , Igarashi Yoshinori
Published: January 2022

Liver biopsy is usually required for diagnosing fibrosis in primary biliary cholangitis (PBC), but contrast-enhanced ultrasonography (CEUS) is a possible alternative. The aim of this study was to investigate arrival-time parametric imaging (At-PI) in for diagnosing fibrosis in PBC. Forty-eight patients (male/female, 8/40; mean age, 60 ± 13 years) with PBC diagnosed by liver biopsy underwent CEUS during 2009–2019. Of these, 27 who also underwent shear wave elastography (SWE) were further analyzed. Perflubutane was intravenously injected and CEUS performed. Contrast dynamics of hepatic segment V and the right kidney were recorded and At-PI generated. The ratio of red indicating contrast arrival time <5 seconds to the entire liver contrast-enhanced area was calculated and compared with shear wave velocity (Vs) measured by SWE by fibrosis stage (F0–F3), bile duct loss score, cholangitis activity, hepatitis activity (HA0–HA3), and disease stage, as determined by liver biopsy. Ratio of red significantly differed between F0 and F2–F3 and between F1 and F2–F3. Using ratio of red to diagnose ≥F1 (≥F2), area under the receiver operating characteristic curve was 0.77 (0.92) (cutoff, 36.7% [47.1%]; sensitivity, 0.75 [0.92]; specificity, 0.82 [0.81]). At-PI was useful for diagnosing fibrosis, especially F2 or worse, in PBC, suggesting that At-PI can correctly diagnose fibrosis regardless of hepatic inflammation.
Thoracic Outlet Syndrome—An Uncommon Cause of Acute Upper-Limb Ischemia
Authors: Sudheer Gokhale , Naman Gaur , Gupta Akshya , Dogra Vikram
Published: January 2022

Acute upper-limb ischemia is usually secondary to thromboembolic occlusion. The heart is the usual source of emboli in the majority of patients. In a small percentage of cases, the thromboembolic process may start in a proximal large-sized artery, such as the subclavian artery, resulting in thromboembolic occlusion of the upper extremity's small peripheral arteries. In patients with acute upper-limb ischemia, a systematic color flow Doppler ultrasound of the upper extremity arteries may reveal thoracic outlet syndrome as the underlying cause. This pictorial review presents a systemic color flow Doppler approach to evaluate upper extremity arteries in patients with thoracic outlet syndrome presenting as acute ischemia.
Trigeminal Trophic Syndrome: A Comprehensive Review of a Surgical Approach
Authors: Khan Kamran , Chuadhry Arif , Schafer Charles , Pogson Kaylyn , Wood Jeyhan
Published: January 2022

Trigeminal trophic syndrome (TTS) is an exceedingly rare disease that causes facial ulceration, most commonly at the nasal ala. The overall incidence of TTS is not known, with less than 150 cases published in the literature.

We searched the United States National Library of Medicine National Institutes of Health (PubMed) using the terms “Trigeminal Trophic Syndrome” and “TTS” as keywords. Publications in all languages were included if an English abstract was available. We reviewed 111 cases of TTS described in 75 publications from 1979 to 2021.

Fourteen cases involved surgical reconstruction. Of these, the lesions completely healed in 7 cases (50%), recurred in 5 (36%), and were unspecified in 2 (14%). Reconstruction was completed in a 2 to 3-stage approach in 6 cases; of these, healing without recurrence was observed in 5 cases (83%). When donor tissue from the affected side was used as a basis for reconstruction, healing without recurrence was observed in 2 cases (50%). This is in comparison to the use of contralateral, sensate tissue in which there was healing without recurrence in all 3 cases (100%).

The surgical management of TTS remains a topic of controversy. The rates of success remain comparable despite the use of various flap types. However, the use of contralateral, sensate flaps and a staged surgical approach appears to be effective based upon the best available evidence in the literature. Further prospective orretrospective controlled studies are necessary to make more reliable recommendations, though may be challenging given the rarity of TTS.
What is the Role of Midfacial Sutures in the Development of Maxillary Hypoplasia in Children With Cleft Palate?
Authors: Zapatero Zachary D. , Carlson Anna R. , Kosyk Mychajlo S. , Kalmar Christopher L. , Swanson Jordan W. , Bartlett Scott P. , Vossough Arastoo , Taylor Jesse A.
Published: January 2022

Maxillary hypoplasia is common in patients with cleft lip and palate (CL/P), and its etiology is incompletely understood. The purpose of this study is to evaluate facial suture patency in patients with CL/P and maxillary hypoplasia. The authors hypothesize that patients with CL/P will demonstrate higher rates of premature midfacial suture fusion in comparison to unaffected controls. Skeletally mature patients with CL/P and midface hypoplasia were identified, along with a cohort of unaffected age- and sex-matched controls. High-resolution facial computed tomography scans were evaluated for the presence of facial suture fusion. Utilizing a previously published suture fusion grading scale, the facial sutures were classified as open, partially open, closed, or pathologically absent. Thirty-one CL/P patients with midface hypoplasia were identified, with age and sex-matched controls. The frequency of intermaxillary suture fusion did not differ between patients with CL/P and unaffected controls (P 
> 0.05.) Pathologic absence of the midpalatal suture was more commonly present in patients with CL/ P and midface hypoplasia in comparison to unaffected controls (P < 0.05.) The role of midfacial sutures in the development of midfacial hypoplasia seen in CLP has not previously been studied or described. Our data show that the midpalatal suture is frequently pathologically absent in patients with CL/P and maxillary hypoplasia. The authors did not identify statistically significant differences in other midfacial sutures between patients with CL/P and controls, leading us to conclude that midfacial sutures may not play a key role in the development of midfacial hypoplasia.
The Use of Scapular Bone Flaps During Head-and-Neck Reconstruction: Functional, Orthopedic, and Quality of Life Analyses of Flap-Harvest-Related Deficits
Authors: Valentini Valentino , Di Giacomo Giovanni , Di Giorgio Danilo , Monaca Marco Delia , Priore Paolo , Piscitelli Luigi , Battisti Andrea
Published: January 2022

The authors sought correlations between harvesting of the scapular bone tip free flap used for head-and-neck reconstruction and any shoulder function deficit, particularly at the level of the rotator cuff. The flap permits reconstruction of large and diverse regions of the head and neck, but long-term harvest morbidity has not been investigated extensively. The authors analyzed the clinical records of all patients who underwent head-and-neck reconstructions using free scapular tip flaps in our department over the past 5 years. The inclusion criteria were complete clinical and radiological documentation and follow-up for at least 12 months. Two populations, a surgical and control population, were analyzed. All patients in both populations underwent the simple shoulder test, an internationally validated self-administered test that highlights functional shoulder deficits, and 3 additional tests at orthopedic visits: the external rotation test, Patte test, and external rotation lag sign test. A head-and-neck cancer-specific questionnaire (University of Washington Quality of Life, version 4) was completed by the surgical patients. All statistical analyses were performed using Software IBM SPSS Statistics (IBM Corp., Armonk, NY).

A total of 19 patients met the inclusion criteria: 11 males (57.8%) and 8 females (42.2%) of mean age 60.9 years (range 23–75 years). In addition, 20 age-and sex-matched volunteers with no history of shoulder pathology were evaluated in terms of shoulder functionality. The average score on the simple shoulder test was 10.55 in the healthy population versus 8.31 in the study population (P < 0.001); in particular, shoulder strength differed between the groups. Similarly, the orthopedic examinations revealed clinically significant differences between the controls and patients on the Patte test and external rotation lag sign test (both P < 0.001), but not the external rotation test (P > 0.001). The mean University of Washington Quality of Life was 73.39; most patients reported good quality of life (52.6%), followed by very good (15.7%).

The free scapular bone tip flap is valuable for reconstruction of head-and-neck defects; the long and reliable vascularpedicle allows rapid patient mobilization. Morbidity was confined to small reductions in shoulder strength and external rotation, which do not affect quality of life.
A Novel Strategy for Transmural Stent Removal in Necrotizing Pancreatitis Undergoing Endoscopic Transmural Necrosectomy
Authors: Zhu Yong , Ding Ling , Xia Liang , He Wenhua , Xiong Huifang , Liu Pi , Shu Xu , Liu Zhijian , Zhu Yin , Chen Youxiang , Lu Nonghua
Published: January 2022

Background:

Although metal stents have been widely used in the endoscopic step-up approach for necrotizing pancreatitis, the exact timing of transmural stent removal has not been well studied. Here, we report a novel strategy for stent removal and compare it with the conventional strategy.

Materials and Methods:

This retrospective, nested, case-control study analyzed all adult necrotizing pancreatitis patients who underwent endoscopic transmural necrosectomy (ETN). Clinical outcomes were compared between case group (a novel strategy in which the stents were removed during the last necrosectomy when the ETN endpoint was achieved) and 1:1 necrosis extent matched control group (the conventional strategy).

Results:

Baseline characteristics was comparable between case group (n=37) and control group (n=37). Three (8.1%) patients in case group and 1 (2.7%) patient in control group needed additional ETN after stent removal (P>0.05). Nearly all patients (case: 97.3%; control: 94.6%) achieved clinical success. There was no difference in disease-related (case: 40.5%; control: 37.8%) or stent-related (case: 27.0%; control: 16.2%) complications. Case group had a trend of shorter length of stent placement (median: 20.0 vs. 29.5 d, P>0.05).

Conclusions:

The novel strategy of transmural stent removal during last necrosectomy might be feasible which needed further validation. Compared with the convention strategy, the novel strategy avoids one endoscopy procedure and should be considered in clinical practice.
Proposal of a Novel Index of Abdominal Compliance and the Association With Postoperative Pain After Laparoscopic Inguinal Hernia Repair
Authors: Kinoshita Shoichi , Kawaguchi Chihiro , Takagi Tadataka , Ohyama Takao
Published: January 2022

Background:

In laparoscopic surgery, low pneumoperitoneum pressure is reported to reduce pain, which suggests that easing abdominal expansion is crucial for less postoperative pain. However, although abdominal compliance (AC) is associated with the degree of abdominal expansion, the role of AC in pain by pneumoperitoneum is unknown. In this study, we devised a novel index as a surrogate of AC to evaluate the association between AC and postoperative pain in laparoscopic inguinal hernia repair.

Materials and Methods:

We reviewed 83 patients who underwent elective transabdominal preperitoneal repair from 2019 to 2021 at Heisei Memorial Hospital. Insufflation pressure was set to low pressure (8 mm Hg). The abdominal compliance index [ACI; insufflated intra-abdominal volume (L)/body surface area (m2)] was utilized to evaluate the association between AC and postoperative pain.

Results:

ACI was evaluated in 30 patients. Median ACI was 1.53 (1.00 to 2.48) L/m2. Although there was no difference in the average body constitution, the high ACI group (n=15) had significantly higher intra-abdominal volume at 8 mm Hg pressure, compared with the low ACI group (n=15) (3.1 vs. 2.1 L, P<0.0001). The high ACI group had significantly higher pain than the low ACI group on the day of surgery (2.0 vs. 1.0, P=0.006) and the day after (0.8 vs. 0.3, P=0.007). In addition, 46.7% of the patients in the high ACI group experienced pneumoperitoneum-associated pain, whereas patients in the low ACI group experienced incision pain only. Additional analgesics were administered in 53.3% of the high ACI group, compared with 33.3% in the low ACI group.

Conclusions:

AC was suggested to be a vital factor of postoperative pain after laparoscopic inguinal hernia repair. Patients with high AC may be susceptible to higher pain by pneumoperitoneum, even in low-pressure settings.
A Computational Framework for Identifying Age Risks in Drug-Adverse Event Pairs
Authors: Zhao Zhizhen , Liu Ruoqi , Wang Lei , Li Lang , Song Chi , Zhang Ping
Published: January 2022

The identification of associations between drugs and adverse drug events (ADEs) is crucial for drug safety surveil-lance. An increasing number of studies have revealed that children and seniors are susceptible to ADEs at the population level. However, the comprehensive explorations of age risks in drug-ADE pairs are still limited. The FDA Adverse Event Reporting System (FAERS) provides individual case reports, which can be used for quantifying different age risks. In this study, we developed a statistical computational framework to detect age group of patients who are susceptible to some ADEs after taking specific drugs. We adopted different Chi-squared tests and conducted disproportionality analysis to detect drug-ADE pairs with age differences. We analyzed 4,580,113 drug-ADE pairs in FAERS (2004 to 2018Q3) and identified 2,523 pairs with the highest age risk. Furthermore, we conducted a case study on statin-induced ADE in children and youth. The code and results are available at https://github.com/Zhizhen-Zhao/Age-Risk-Identification
TEX13B is important for germ cell development and male fertility
Authors: Kumar Umesh , Sudhakar Digumarthi V S , Kumar Nithyapriya , Kale Hanuman T , Jha Rajan Kumar , Gupta Nalini J , Chakravarthy B N , Deenadayal Mamata , Tolani Aarti Deenadayal , Raychaudhuri Swasti , Shekar P Chandra , Thangaraj Kumarasamy
Published: January 2022

The recent epidemiological studies suggest that nearly one out of every 7 reproductive age couples face problem to conceive a child after trying for at least one year. Impaired fertility of the male partner is causative in approximately 50% of the infertile couples. However, the etiologies of large proportion of male infertility are still unclear. Our unpublished exome sequencing data identified several novel genes including TEX13B, which motivated us to further explore the role of TEX13B in male infertility in large infertile case control cohort. Hence in this study, we have examined the role of TEX13B in male infertility by whole gene sequencing 628 infertile and 427 control men and have demonstrated the functional role of Tex13b in spermatogonia GC1spg (GC1) cells. We identified 2 variants on TEX13B which are tightly associated with male infertility. TEX13B gene exclusively expressed in germ cells, but its molecular functions in germ cells are still unknown. Hence, we demonstrated the functional importance of Tex13b in GC1 cell line by genomic manipulation via CRISPR-Cas9 and mass spectrometry-based whole cell proteomics. The gene knock out in GC1 cell line clearly shows that Tex13b play an important role in germ cell growth and morphology. We demonstrate that Tex13b knockout or conditional overexpression in GC1 cells reprograms the metabolic status from an oxidative phosphorylation to glycolysis state and vice versa. In conclusion, our study clearly showed the importance of Tex13b in germ cells development and Its association with male infertility.
The Chinese Assessment of physical literacy:Based on Grounded Theory Paradigm for children in grades 3-6
Authors: YongKang Wang , QianQian Fu
Published: January 2022

The aim of this study is to construct and validate “physical literacy self-assessment questionnaire”(PLAQ)for Chinese students in grades 3-6. This study uses qualitative and quantitative methods to construct evaluation indicators of PL and determine the weights of each indicator. The 60 items of original PLAQ was based on literature review and interviews,and administered to 1179 primary students graded 3-6 in China. Exploratory factor analysis(EFA)and confirmatory factor analysis(CFA) are used to optimize the structure and verify the reliability and validity of the questionnaire. The model of PLAQ is composed of 4 first-level indicators, 10 second-level indicators and 35 third-level indicators. The results of EFA and CFA resulted in a 44-items, 4-factor questionnaire. EFA item loadings ranged from 0.558 to 0.896,and Cronbach’s alpha ranged from 0.818 to 0.892. The results of CFA show that the constructed model fits well, and PLAQ has good convergent validity and discriminative validity. The PLAQ appeared to be reliable and valid that can be used as an assessment tool for students in grades 3-6. PLAQ can be used as a guide for the development of PL. Additionally, PLAQ gives us a shared understanding about what PL is and how it can be developed by Chinese children. However, studies on the accuracy and generalizability of the PLAQ should be conducted to improve it in the future.
COVID MED – An Early Pandemic Randomized Clinical Trial of Losartan for Hospitalized COVID-19 Patients
Authors: Freilich Daniel , Victory Jennifer , Jenkins Paul , Wheeler James , Vail G. Matthew , Riesenfeld Erik , Cross Peggy , Gilmore Catherine , Huckabone Melissa , Schworm Anna , Boregowda Umesha , Deshmukh Farah , Choi Yuri , Khan Azkia , Gadomski Anne
Published: January 2022

Background

ACEi/ARB medications have been hypothesized to have potential benefit in COVID-19. Despite concern for increased ACE-2 expression in some animal models, preclinical and observational-retrospective and uncontrolled trials suggested possible benefit. Two RCTs of the ARB losartan from University of Minnesota showed no benefit yet safety signals for losartan in outpatient and hospitalized COVID-19 patients. COVID MED, started early in the pandemic, also assessed losartan in a RCT in hospitalized patients with COVID-19.

Methods

COVID MED was a double-blinded, placebo-controlled, multicenter, platform randomized clinical trial (RCT). Hospitalized COVID-19 patients were randomized to receive standard care and hydroxychloroquine, lopinavir/ritonavir, losartan, or placebo. Hydroxychloroquine and lopinavir/ritonavir arms were discontinued after RCTs showed no benefit. We report data from the losartan arm compared to combined (lopinavir-ritonavir and placebo) and prespecified placebo-only controls. The primary endpoint, the mean COVID-19 Ordinal Severity Score (COSS) slope of change, was compared with the Student’s t-test. Slow enrollment prompted early termination.

Results

Of 448 screened patients, 15 (3.5%) were randomized/enrolled, 9 to receive losartan and 6 to receive control (lopinavir/ritonavir [N=2], placebo [N=4]); 1 patient who withdrew prior to study drug was excluded yielding 14 patients for analysis (losartan [N=9] vs. control [N=5] [lopinavir/ritonavir [N=2], placebo [N=3]]). Most baseline parameters were balanced. Treatment with losartan was not associated with a difference in mean COSS slope of change in comparison with combined control (p=0.4) or placebo-only control (p=0.05) (trend favoring placebo). 60-day mortality and overall AE and SAE rates were numerically but not significantly higher with losartan.

Conclusions

In this small blinded RCT in hospitalized COVID-19 patients, losartan did not improve outcome vs. control comparisons and was associated with adverse safety signals.
Cell-type-specific transcriptome architecture underlying the establishment and exacerbation of systemic lupus erythematosus
Authors: Nakano Masahiro , Ota Mineto , Takeshima Yusuke , Iwasaki Yukiko , Hatano Hiroaki , Nagafuchi Yasuo , Itamiya Takahiro , Maeda Junko , Yoshida Ryochi , Yamada Saeko , Nishiwaki Aya , Takahashi Haruka , Takahashi Hideyuki , Akutsu Yuko , Kusuda Takeshi , Suetsugu Hiroyuki , Liu Lu , Kim Kwangwoo , Yin Xianyong , Bang So-Young , Cui Yong , Lee Hye-Soon , Shoda Hirofumi , Zhang Xuejun , Bae Sang-Cheol , Terao Chikashi , Yamamoto Kazuhiko , Okamura Tomohisa , Ishigaki Kazuyoshi , Fujio Keishi
Published: January 2022

Systemic lupus erythematosus (SLE) is a complex and heterogeneous autoimmune disease involving multiple immune cells. A major hurdle to the elucidation of SLE pathogenesis is our limited understanding of dysregulated gene expression linked to various clinical statuses with a high cellular resolution. Here, we conducted a large-scale transcriptome study with 6,386 RNA sequencing data covering 27 immune cell types from 159 SLE and 89 healthy donors. We first profiled two distinct cell-type-specific transcriptomic signatures: disease-state and disease-activity signatures, reflecting disease establishment and exacerbation, respectively. We next identified candidate biological processes unique to each signature. This study suggested the clinical value of disease-activity signatures, which were associated with organ involvement and responses to therapeutic agents such as belimumab. However, disease-activity signatures were less enriched around SLE risk variants than disease-state signatures, suggesting that the genetic studies to date may not well capture clinically vital biology in SLE. Together, we identified comprehensive gene signatures of SLE, which will provide essential foundations for future genomic, genetic, and clinical studies.
Background incidence rates of adverse events of special interest related to COVID-19 vaccines in Ontario, Canada, 2015 to 2020, to inform COVID-19 vaccine safety surveillance
Authors: Nasreen Sharifa , Calzavara Andrew , Buchan Sarah A. , Thampi Nisha , Johnson Caitlin , Wilson Sarah E. , Kwong Jeffrey C.
Published: January 2022

Background

Background incidence rates are critical in pharmacovigilance to facilitate identification of vaccine safety signals. We estimated background incidence rates of nine adverse events of special interest related to COVID-19 vaccines in Ontario, Canada.

Methods

We conducted a population-based retrospective observational study using linked health administrative databases for hospitalizations and emergency department visits among Ontario residents. We estimated incidence rates of Bell’s palsy, idiopathic thrombocytopenia, febrile convulsions, acute disseminated encephalomyelitis, myocarditis, pericarditis, Kawasaki disease, Guillain-Barré syndrome, and transverse myelitis during five pre-pandemic years (2015– 2019) and 2020.

Results

The average annual population was 14 million across all age groups with 51% female. The pre-pandemic mean annual rates per 100,000 population during 2015–2019 were 43.9 for idiopathic thrombocytopenia, 27.8 for Bell’s palsy, 25.0 for febrile convulsions, 22.8 for acute disseminated encephalomyelitis, 11.3 for myocarditis/pericarditis, 8.6 for pericarditis, 2.9 for myocarditis, 1.9 for Guillain-Barré syndrome, 1.7 for transverse myelitis, and 1.6 for Kawasaki disease. Females had higher rates of acute disseminated encephalomyelitis and transverse myelitis while males had higher rates of myocarditis, pericarditis, and Guillain-Barré syndrome. Bell’s palsy, acute disseminated encephalomyelitis, and Guillain-Barré syndrome increased with age. The mean rates of myocarditis and/or pericarditis increased with age up to 79 years; males had higher rates than females: from 12–59 years for myocarditis and ≥12 years for pericarditis. Febrile convulsions and Kawasaki disease were predominantly childhood diseases and generally decreased with age.

Conclusions

Our estimated background rates will permit estimating numbers of expected events for these conditions and facilitate detection of potential safety signals following COVID-19 vaccination.
Machine Learning for Sudden Cardiac Death Prediction in the Atherosclerosis Risk in Communities Study
Authors: Yu Zhi , Wongvibulsin Shannon , Daya Natalie R. , Zhou Linda , Matsushita Kunihiro , Natarajan Pradeep , Coresh Josef , Zeger Scott L.
Published: January 2022

Introduction

Sudden cardiac death (SCD) is a devastating consequence often without antecedent expectation. Current risk stratification methods derived from baseline independently modeled risk factors are insufficient. Novel random forest machine learning (ML) approach incorporating time-dependent variables and complex interactions may improve SCD risk prediction.

Methods

Atherosclerosis Risk in Communities (ARIC) study participants were followed for adjudicated SCD. ML models were compared to standard Poisson regression models for interval data, an approximation to Cox regression, with stepwise variable selection. Eighty-two time-varying variables (demographics, lifestyle factors, clinical characteristics, biomarkers, etc.) collected at four visits over 12 years (1987-98) were used as candidate predictors. Predictive accuracy was assessed by area under the receiver operating characteristic curve (AUC) through out-of-bag prediction for ML models and 5-fold cross validation for the Poisson regression models.

Results

Over a median follow-up time of 23.5 years, 583 SCD events occurred among 15,661 ARIC participants (mean age 54 years and 55% women). Compared to different Poisson regression models (AUC at 6-year ranges from 0.77-0.83), the ML model improved prediction (AUC at 6-year 0.89). Top predictors identified by ML model included prior coronary heart disease, which explained 47.9% of the total phenotypic variance, diabetes mellitus, hypertension, and T wave abnormality in any of leads I, aVL, or V6. Using the top ML predictors to select variables, the Poisson regression model AUC at 6-year was 0.77 suggesting that the non-linear dependencies and interactions captured by ML, are the main reasons for its improved prediction performance.

Conclusions

Applying novel ML approach with time-varying predictors improves the prediction of SCD. Interactions of dynamic clinical characteristics are important for risk-stratifying SCD in the general population.