bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensorimotor Performance and Reference Values for Fall Risk Assessment in Community-Dwelling Adults: The Yishun Study
Authors: Pang Benedict Wei Jun , Wee Shiou-Liang , Lau Lay Khoon , Jabbar Khalid Abdul , Seah Wei Ting , Ng Daniella Hui Min , Tan Queenie Lin Ling , Chen Kenneth Kexun , Jagadish Mallya Ullal , Ng Tze Pin
Published: January 2021

Objective

This study sought to answer the following questions: What are the reference values of sensorimotor performance for fall risk in community-dwelling adults? How do population norms compare with that of other populations? Are younger adults at risk of falls?

Methods

In a cross-sectional study design, sensorimotor functions and fall risk scores of community-dwelling adults were assessed and calculated to derive corresponding fall risk categories. Reference values were determined using the average scores by age group. A total of 542 community-dwelling adults were recruited (21–90 years old) across 10-year (21–60 years) and 5-year age groups (>60 years) to obtain a representative sample of community-dwelling adults in Singapore. Five physiological domains were assessed: vision, proprioception, muscle strength, reaction time, and postural balance according to the Physiological Profile Assessment (PPA). Fall risk scores and the corresponding fall risk profiles were generated from an online calculator.

Results

Sensorimotor performance and PPA fall risk scores were significantly worse for increasing age categories. Females had significantly slower reaction time, lower muscle strength, and higher fall risk. The representative sample of older adults (≥65 years) performed poorer in postural sway (z = −0.50) and reaction time (z = −0.55), but better in proprioception (z = 0.29) and vision (z = 0.23) compared with Caucasian norms. Among younger adults (21–59 years), 36.8% appeared to exhibit higher fall risk.

Conclusion

This study presents important reference data and compared sensorimotor functions and physiological fall risk across age groups of community-dwelling adults in a Southeast Asian population. Poor sensorimotor performance and fall risk appear already pertinent in younger adults. Further studies are warranted to improve understanding of fall risk among younger adults.

Impact

In physical therapist practice, PPA reference values can aid clinicians in the development of targeted interventions tailored towards an individual’s physiological risk profile, addressing specific physiological systems that require particular attention.
Ralstonia solanacearumDepends on Catabolism of Myo-Inositol, Sucrose, and Trehalose for Virulence in an Infection Stage–Dependent Manner
Authors: Hamilton Corri D. , Steidl Olivia R. , MacIntyre April M. , Hendrich Connor G. , Allen Caitilyn
Published: January 2021

The soilborne pathogen Ralstonia solanacearum causes a lethal bacterial wilt disease of tomato and many other crops by infecting host roots, then colonizing the water-transporting xylem vessels. Tomato xylem sap is nutritionally limiting but it does contain some carbon sources, including sucrose, trehalose, and myo-inositol. Transcriptomic analyses revealed that R. solanacearum expresses distinct catabolic pathways at low cell density (LCD) and high cell density (HCD). To investigate the links between bacterial catabolism, infection stage, and virulence, we measured in planta fitness of bacterial mutants lacking specific carbon catabolic pathways expressed at either LCD or HCD. We hypothesized that early in disease, during root infection, the bacterium depends on carbon sources catabolized at LCD, while HCD carbon sources are only required later in disease during stem colonization. A R. solanacearum ΔiolG mutant unable to use the LCD-catabolized nutrient myo-inositol was defective in tomato root colonization, but after it reached the stem this strain colonized and caused symptoms as well as wild type. In contrast, R. solanacearum mutants unable to use the HCD-catabolized nutrients sucrose (ΔscrA), trehalose (ΔtreA), or both (ΔscrA/treA), infected roots as well as wild-type R. solanacearum but were defective in colonization and competitive fitness in midstems and had reduced virulence. Further, xylem sap from tomato plants colonized by ΔscrA, ΔtreA, or ΔscrA/treA R. solanacearum mutants contained twice as much sucrose as sap from plants colonized by wild-type R. solanacearum. Together, these findings suggest that quorum sensing specifically adapts R. solanacearum metabolism for success in the different nutritional environments of plant roots and xylem sap.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Progression of Symptoms Caused byBotryosphaeria dothideaon Apple Branches
Authors: Dong Xiang-li , Cheng Zi-zhen , Leng Wei-feng , Li Bao-hua , Xu Xiang-ming , Lian Sen , Wang Cai-xia
Published: January 2021

Until recently, the causal agent of Botryosphaeria canker was assumed to differ from that causing ring rot on fruit and warts on branches on apple trees in China and East Asia. However, recent research documented that Botryosphaeria dothidea caused both disease symptoms on apple. Inoculations with strains isolated from cankers and warts on branches were conducted to investigate symptom progression caused by B. dothidea and conditions inducing the two symptom types. The results confirmed that both cankers and warts are caused by B. dothidea. Warts are the results of hyperplasia and suberization of bark tissues induced by fungal infection, whereas cankers result from the rapid growth of hyphae from inside warts, lenticels, or wounds. Resistance to B. dothidea exists in living apple branches. When a living branch is infected via lenticels, the pathogen induces proliferation and suberization of cortical cells that restricts the growth and expansion of the hyphae, leading to warts. However, under certain stress conditions such as drought, the hyphae inside host tissues expand rapidly and kill cortical cells, leading to canker development. Host resistance may recover during active growth periods, which suppresses or even stops rapid expansion of the hyphae, leading to the intermediate symptom of canker warts. Abiotic factors, such as drought or high temperature in early spring, can result in rapid extension of colonized hyphae in branches and conversion of warts to cankers. Preventing this transition can be an important measure in managing Botryosphaeria canker on apple.
Using the Postoperative Morbidity Survey to Measure Morbidity After Cranial Neurosurgery
Authors: Luoma Astri M.V. , Douglas Deborah R. , D’Antona Linda , Toma Ahmed K. , Smith Martin
Published: January 2021

Background:

The incidence of morbidity after cranial neurosurgery is significant, reported in up to a quarter of patients depending on methodology used. The Postoperative Morbidity Survey (POMS) is a reliable method for identifying clinically relevant postsurgical morbidity using 9 organ system domains. The primary aim of this study was to quantify early morbidity after cranial neurosurgery using POMS. The secondary aims were to identify non-POMS-defined morbidity and association of POMS with postoperative hospital length of stay (LOS).

Materials and Methods:

A retrospective electronic health care record review was conducted for all patients who underwent elective or expedited major cranial surgery over a 3-month period. Postsurgical morbidity was quantified on postoperative days (D) 1, 3, 5, 8, and 15 using POMS. A Poisson regression model was used to test the correlation between LOS and total POMS scores on D1, 3 and 5. A further regression model was used to test the association of LOS with specific POMS domains.

Results:

A total of 246 patients were included. POMS-defined morbidity was 40%, 30%, and 33% on D1, D3, and D8, respectively. The presence of POMS morbidity on these days was associated with longer median (range) LOS: D1 6 (1 to 49) versus 4 (2 to 45) days; D3 8 (4 to 89) versus 6 (4 to 35) days; D5 14 (5 to 49) versus 8.5 (6 to 32) days; D8 18 (9 to 49) versus 12.5 (9 to 32) days (P<0.05). Total POMS score correlated with overall LOS on D1 (P<0.001), D3 (P<0.001), and D5 (P<0.001). A positive response to the “infectious” (D1, 3), “pulmonary” (D1), and “renal” POMS items (D1) were associated with longer LOS.

Conclusion:

Although our data suggests that POMS is a useful tool for measuring morbidity after cranial neurosurgery, some important morbidity items that impact on LOS are missed. A neurosurgery specific tool would be of value.
Midterm Outcomes After Open Arthrolysis for Posttraumatic Elbow Stiffness in Children and Adolescents
Authors: Ruan Ji-hao , Cui Hao-min , Sun Zi-yang , Chen Shuai , Wang Wei , Fan Cun-yi
Published: January 2021

Background:

Open arthrolysis is used for treating elbow stiffness in adults. This study evaluated the midterm outcomes after open arthrolysis in children and adolescents with posttraumatic elbow stiffness.

Methods:

Data of 31 children and adolescents with posttraumatic elbow stiffness following open arthrolysis with or without hinged external fixation from 2010 to 2014 were retrospectively analyzed. Their mean age was 15 (range: 6 to 19) years. At baseline and the follow-up (>4 y), we evaluated the outcomes (range of motion and Mayo Elbow Performance Index) and postoperative complications (pain, ulnar nerve symptoms, infections, and instability) and analyzed the association between outcomes and clinical variables.

Results:

The Mayo Elbow Performance Index improved from 67.9 (range: 35 to 95 points) to 93.7 points (range: 65 to 100 points; P<0.001). The elbow active flexion/extension arc increased significantly from 49 degrees (range: 0 to 120 degrees) to 108 degrees (range: 0 to 120 degrees; P<0.001), with a mean flexion of 123 degrees (range: 70 to 140 degrees; P<0.001) and mean extension of 15 degrees (range: 0 to 85 degrees; P<0.001) postoperatively. The increasing age at surgery was associated with improved elbow motions (P=0.004). Patients with increased preoperative serum alkaline phosphatase level demonstrated decreased arc of motion (P=0.015). Patients with extra-articular fractures had better outcomes than the other patients. At the final follow-up, 8 patients experienced recurrent contracture in the flexion arc with heterotopic ossification. Two patients had postoperative pain, 1 elbow instability, and 1 ulnar neuropathy.

Conclusions:

Most patients showed satisfactory functional outcomes after arthrolysis, indicating that open release with or without hinged external fixation is an effective and maintained technique for children and adolescents with posttraumatic elbow stiffness. The age at surgery, preoperative alkaline phosphatase level, and injury type should be considered to achieve good outcomes.

Level of Evidence:

Therapeutic level III.
Clinical Outcomes of Metastatic Renal Carcinoma Following Disease Progression to Programmed Death (PD)-1 or PD-L1 Inhibitors (IO)
Authors: Santini Daniele , Stellato Marco , De Giorgi Ugo , Pantano Francesco , De Lisi Delia , Casadei Chiara , Maruzzo Marco , Bimbatti Davide , Naglieri Emanuele , Buti Sebastiano , Bersanelli Melissa , De Vivo Rocco , Di Lorenzo Giuseppe , Sbrana Andrea , Verzoni Elena , Soraru’ Mariella , Fornarini Giuseppe , Mucciarini Claudia , Grillone Francesco , Mini Enrico , Vignani Francesca , Attademo Laura , Pignata Sandro , Procopio Giuseppe
Published: January 2021

Objectives:

The aim of our study was to collect data about of the outcome of metastatic renal cell carcinoma patients who progressed after immune checkpoint inhibitors in order to enhance data about efficacy and safety of treatment beyond immune-oncology (IO).

Materials and Methods:

A total of 162 eligible patients, progressing to IO, were enrolled from 16 Italian referral centers adhering to the Meet-Uro association. Baseline characteristics, outcome data and toxicities were retrospectively collected. Descriptive analysis was made using median values and ranges. Kaplan-Meier method and Mantel-Haenszel log-rank test were performed to compare differences between groups.

Results:

A total of 111 patients (68.5%) were treated after IO progression. In all, 51 patients (31.5%) did not receive further treatment for clinical deterioration. Median IO progression free survival (PFS) was 4 months (95% confidence interval [CI]: 3.1-4.8). IO-PFS tends to be longer in patients reporting adverse events (AE) of any grade (5.03 [95% CI: 3.8-6.1] vs. 2.99 [95% CI: 2.4-3.5] months P=0.004). Subsequent therapies included cabozantinib (n=79, 48%), everolimus (n=11, 6.7%), and others (n=21, 12.9%).

Median PFS post-IO was 6.5 months (95% CI: 5.1-7.8). Cabozantinib showed longer PFS compared with everolimus (7.6 mo [95% CI: 5.2-10.1] vs. 3.2 mo [95% CI: 1.8-4.5]) (hazard ratio: 0.2; 95% CI: 0.1026-0.7968) and other drugs (4.3 mo [95% CI: 1.3-7.4]) (hazard ratio: 0.6; 95% CI: 0.35-1.23). All grade AE were reported in 83 patients (74%) and G3 to G4 AE in 39 patients (35%). Target therapies post-IO showed median overall survival of 14.7 months (95% CI: 0.3-21.4).

Conclusions:

In our real world experience after progression to IO, vascular endotelial groth factor-tyrosine kinase inhibitors, given to patients, proved to be active and safe choices. Cabozantinib was associated with a better outcome in terms of median PFS.
High flow nasal oxygen during procedural sedation for cardiac implantable electronic device procedures
Authors: Conway Aaron , Collins Peter , Chang Kristina , Kamboj Navpreet , Filici Ana Lopez , Lam Phoebe , Parotto Matteo
Published: January 2021

BACKGROUND

High flow nasal oxygen may better support the vulnerable respiratory state of patients during procedural sedation.

OBJECTIVE

The objective of this study was to investigate the effects of high flow nasal oxygen in comparison to facemask oxygen on ventilation during cardiac implantable electronic device procedures performed with procedural sedation.

DESIGN

A randomised controlled trial.

SETTING

The study was conducted at one academic hospital in Canada.

PARTICIPANTS

Adults undergoing elective cardiac implantable electronic device procedures with sedation administered by an anaesthesia assistant, supervised by an anaesthesiologist from August 2019 to March 2020.

INTERVENTIONS

Participants were randomised 1 : 1 to facemask (≥ 8 l · min−1) or high flow nasal oxygen (50 l · min−1 and a 50 : 50 oxygen to air ratio).

MAIN OUTCOME MEASURES

The primary outcome was peak transcutaneous carbon dioxide. Outcomes were analysed using Bayesian statistics.

RESULTS

The 129 participants who were randomised and received sedation were included. The difference in peak transcutaneous carbon dioxide was 0.0 kPa (95% CI -0.17 to 0.18). Minor adverse sedation events were 6.4 times more likely to occur in the high flow nasal oxygen group. This estimate is imprecise (95% CI 1.34 to 42.99). The odds ratio for oxygen desaturation for the high flow nasal oxygen group compared with the facemask group was 1.2 (95% CI 0.37 to 3.75). The difference in satisfaction with sedation scores between groups was 0.0 (95% CI -0.33 to 0.23).

CONCLUSIONS

Ventilation, as measured by TcCO2, is highly unlikely to differ by a clinically important amount between high flow nasal oxygen at 50 l min−1 or facemask oxygen at 8 l min−1. Further research with a larger sample size would be required to determine the optimal oxygen:air ratio when using high flow nasal oxygen during cardiac implantable electronic device procedures performed with sedation.

TRIAL REGISTRATION NUMBER

NCT03858257
Selection of candidates for foetal intervention in congenital lower urinary tract obstruction
Authors: Nassr Ahmed A. , Fisher James E. , Belfort Michael A.
Published: January 2021

Purpose of review

Congenital lower urinary tract obstruction (LUTO) is a rare group of conditions characterized by high perinatal morbidity and mortality if associated with oligohydramnios or anhydramnios in early pregnancy. Although foetal intervention has the potential to improve perinatal survival in a select group of foetuses with LUTO, the actual selection of those candidates most likely to benefit from intervention remains challenging.

Recent findings

Foetuses with LUTO who are potential candidates for prenatal intervention should undergo detailed multidisciplinary evaluation to ensure proper assessment and counselling. Using a combination of multiple ultrasound-based renal parameters, including measurement of foetal bladder volumes before and after vesicocentesis and kidney size and morphology, combined with repeated foetal urine biochemistry may allow for better selection than any single test.

Foetal intervention should be offered to women carrying a foetus with LUTO only after appropriate evaluation and counselling. A combined approach utilizing ultrasound and biochemical measurements of foetal renal function appears best. Research focusing on the development of more accurate markers is needed.
CHANGES IN THE CHOROIDAL THICKNESS AFTER MACULAR BUCKLING IN HIGHLY MYOPIC EYES
Authors: Tang Ningning , Zhao Xiujuan , Chen Jing , Liu Bingqian , Lu Lin
Published: January 2021

Purpose:

To assess changes in the choroidal thickness (CT) after macular buckling in eyes with high myopia.

Methods:

Highly myopic eyes that underwent macular buckling surgery were retrospectively analyzed. Data of swept-source optical coherence tomography scanning at baseline and at 1, 3, 6, 12, and 18 months after macular buckling were collected. Subfoveal CT and CT at 750 µm superior, inferior, nasal, and temporal to the fovea were measured. The total choroidal area, vascular area, and stromal area were measured by the binarization method. The choroidal vascularity index was calculated by dividing the vascular area by the total choroidal area.

Results:

Forty-one eyes were included in the final analysis. The subfoveal CT increased from 49.85 ± 31.23 µm preoperatively to 75.74 ± 37.89 µm 1 month after macular buckling (P < 0.001), then decreased over time, coinciding with the trends of parafoveal CT, total choroidal area, vascular area, and stromal area. The subfoveal CT was restored to the preoperative level six months postoperatively (P = 0.202) and remained stable until the end of follow-up. The choroidal vascularity index increased at 1 and 3 months postoperatively (P = 0.001 and 0.005, respectively).

Conclusion:

The choroid thickened in the early postoperative period. The compression force of the buckle implant might disturb microcirculatory drainage and contribute to the thickening. The choroid spontaneously recovered to the preoperative level over time.
Impact of an Extended Nursing Shift Schedule in a Rural and Urban Primary Care Setting
Authors: Kingston Eileen , Hale Suzanne , Siemsen Stephanie , Benzel Heather , Makowski Kimberly , Woods Sandra Schlup , Struwe Leeza , Cohen Marlene Z.
Published: January 2021

Two primary care clinics in rural and urban settings implemented a 9-hour nursing shift schedule. The purpose of this project was to use a quasiexperimental mixed-methods research design to assess outcomes for a 1-year implementation of nursing staff maintaining 9-hour shifts. Pre- and postdata were collected before and after implementation. The rural clinic demonstrated significant improvements in nurse satisfaction, overtime, compensatory time, and postacute follow-up. The urban facility showed significant decreases in sick leave. Patient satisfaction scores did not show significant changes for either clinic.
Arterial stiffness in regards to kidney function in middle-aged subjects with metabolic syndrome: Lithuanian high-risk cohort
Authors: Laucyte-Cibulskiene Agne , Ryliskyte Ligita , Badaras Ignas , Navickas Petras , Badariene Jolita , Laucevicius Aleksandras
Published: January 2021

Objective

The current study aimed to check whether early vascular aging, measured as carotid-femoral pulse wave velocity (cfPWV), is related to kidney function, measured as creatinine-based estimated glomerular filtration (eGFR) and urinary albumin-to-creatinine ratio (UACR), in middle-aged subjects with metabolic syndrome.

Methods

Participants were recruited from Lithuanian high-risk cohort (LitHiR). The cohort consists of middle-aged individuals with high cardiovascular risk but without overt cardiovascular disease. Participants underwent baseline and second visit hemodynamics measurement, including aortic mean arterial pressure (MAP), cfPWV, crPWV, carotid-intima media thickness measurement (CIMT) and biochemical analysis and all fulfilled NCEP/ATPIII criteria for metabolic syndrome diagnosis. First of all, we had determined correlations among hemodynamic measurement and eGFR together with albuminuria, expressed as UACR. Then we compared subjects who experienced significant eGFR decline with the remaining population and determining factors influencing this.

Results

A total of 689 subject data were eligible for analysis. We observed relationship between cfPWV and MAP, crPWV, glucose, BMI, C-reactive protein, waist circumference except kidney function measured as eGFR at the baseline and at the second visit. eGFR was not associated with MAP or albuminuria. Baseline but not second visit UACR significantly positively correlated with cfPWV (r-spearman = 0.146, P = 0.003) and MAP (r-spearman = 0.142, P = 0.005). eGFR decline was mainly observed in subjects with higher baseline eGFR and was independently influenced by increase in cfPWV.

Conclusion

In middle-aged subjects with prevalent metabolic syndrome eGFR decline is related to aortic and not peripheral arterial stiffening. Better baseline kidney function could be possibly an effect of glomerular hyperfiltration, and it allows us to conclude that this phenomenon indicates early vascular damage and it should be addressed seriously in metabolic syndrome patients with normal kidney function.
Distal arthrogryposis type 5D in a South Indian family caused by novel deletion in ECEL1 gene
Authors: Gowda Mamatha , Mohan Shruthi , Ramesh Devika , Chinta Navya
Published: January 2021

Distal arthrogryposis (DA) is a heterogeneous group of disorders with congenital, nonprogressive contractures affecting the joints of distal extremities. About 13 distinct subtypes have been defined based on phenotypic features and the different genes known to be causative typically encode for sarcomeric proteins of the contractile apparatus. Although most subtypes are inherited in autosomal dominant manner, distal arthrogryposis type 5D (DA5D) is the only type inherited as an autosomal recessive disorder with a prevalence of <1/1 000 000. We are reporting the phenotype of three members of a family affected by DA5D caused by a novel deletion in the
ECEL1
gene. All of them exhibited the distal arthogryposis involving hands and feet, scoliosis, unilateral drooping shoulder, ptosis, central furrow over tip of the tongue and typical facial features.
Nutritional Therapy in Children With Spinal Muscular Atrophy in the Era of Nusinersen
Authors: Yerushalmy‐Feler Anat , Levy Dina , Sagi Liora , Fattal‐Valevski Aviva , Shiff Yaffa Elbaum , Brener Avivit , Cohen Shlomi
Published: January 2021

Objectives:

Spinal muscular atrophy (SMA) is a genetic motor neuron disorder characterized by progressive muscle atrophy. Our aims were to evaluate the impact of nutritional intervention and nusinersen therapy on the nutritional status of SMA patients.

Study design:

This prospective study included all children and young adults (<24 years of age) with SMA who attended our multidisciplinary SMA clinic, during January 2017–July 2019. We documented demographic, clinical, anthropometric, and nutritional data at baseline and follow‐up. A nutritional intervention was implemented according to standards of the 2018 Consensus Statement of SMA Management.

Results:

The cohort included 51 SMA patients with a median age of 7.2 (interquartile range 2.1–15.3) years. Among them, 24 (47%) were SMA type 1, 16 (31.4%) SMA type 2, and 11 (21.6%) SMA type 3 patients. At baseline, 28 (54.9%) patients presented with malnutrition, 20 (71.4%) of whom with severe malnutrition. A decline in the frequency of severe malnutrition of SMA type 1 patients was observed at follow‐up. The body mass index of patients who started nusinersen therapy after the nutritional intervention increased significantly compared with patients that started nusinersen therapy before the nutritional intervention (P = 0.042). There was also a significant increase in total energy and protein consumption in the former group (P = 0.043).

Conclusions:

Malnutrition is frequent among children with SMA, and the nutritional status of patients that started nusinersen therapy after implementation of a nutritional intervention underwent a more significant improvement. The importance of combining adequate nutritional management with disease‐modifying treatment is highlighted.
Muscular Hemorrhages Around the Scapula Provide Insight on the Manner of Asphyxia
Authors: Oshima Toru , Ohtani Maki , Mimasaka Sohtaro
Published: January 2021

Muscular hemorrhages around the scapula that are caused by upper extremity motion are rarely reported in cases other than drowning. We examined differences in the frequency of muscular hemorrhages around the scapula and stratified them by the cause of death. Muscular hemorrhages were mostly noted in cases of drowning (118/185, 63.8%), followed by cases of asphyxia (23/44, 52.3%). In addition, muscular hemorrhages around the scapula were found in cases of ligature strangulation (8/11, 72.7%), manual strangulation (2/3, 66.7%), choking (11/14, 78.6%), and traumatic asphyxia (2/2, 100%). Muscular hemorrhages were not found in cases of hanging or environmental suffocation, possibly because of the short time interval preceding the loss of consciousness. The distribution of muscular hemorrhages was similar in choking and drowning cases. Muscular hemorrhages due to strangulation were mainly unilateral, whereas those due to choking and drowning were mainly bilateral. During all types of asphyxia, muscular hemorrhages around the scapula were considered to be the result of conscious, active upper extremity motion. Because the frequency and laterality of muscular hemorrhages around the scapula differed based on the type of asphyxia, our findings provide insights into the manner of asphyxia that could be used to aid in the identification of homicidal hangings.
Glyphosate and Polyoxyethyleneamine Ingestion Leading to Renal, Hepatic, and Pulmonary Failure
Authors: Bigner Jessica A. , Fiester Steven E. , Fulcher James W. , Schammel Christine M.G. , Ward Michael E. , Burney Harmonie E. , Wheeler John F. , Wheeler Sandy K. , Teuber Julie M.
Published: January 2021

Glyphosate is an organophosphorus compound and the active ingredient in commonly used herbicides, whereas polyoxyethyleneamine (POEA) is a nonionic surfactant often coupled with glyphosate in these herbicides to increase their efficacy. Cases of glyphosate-POEA ingestion have shown a variety of outcomes, ranging from skin and mucosal surface irritation to death. Here, we report mortality after ingestion of at least 237 mL of an herbicide confirmed to contain both glyphosate and POEA. The decedent's electronic medical record indicates presentation to the emergency department shortly after ingestion and rapid decompensation, with death occurring on the fourth day of admission. The autopsy report showed extensive pulmonary edema and congestion with no alimentary tract abnormalities. Microscopically, airway inflammation, edema, and hemorrhage were shown as well as pericentral necrosis and macrovascular hepatic steatosis. This case is unusual for several reasons including the fatal outcome in a young 30-year-old patient, the large volume of the herbicide consumed, the associated large volume aspirated, and the lung pathology associated with exposure to glyphosate-POEA since inhalation, and in this case, aspiration is an uncommon route of glyphosate-POEA exposure. This report therefore offers rare respiratory tract pathological findings and the clinical course after aspiration of a large volume of glyphosate-POEA.
“I Just Decided to Stop:” Understanding PrEP Discontinuation Among Individuals Initiating PrEP in HIV Care Centers in Kenya
Authors: Ongolly Fernandos K. , Dolla Annabel , Ngure Kenneth , Irungu Elizabeth M. , Odoyo Josephine , Wamoni Elizabeth , Peebles Kathryn , Mugwanya Kenneth , Mugo Nelly R. , Bukusi Elizabeth A. , Morton Jennifer , Baeten Jared M. , O'Malley Gabrielle
Published: January 2021

Background:

Preexposure prophylaxis (PrEP) discontinuation rates in clinical trials and demonstration projects have been well characterized; however, little is known about discontinuation in routine public health settings in sub-Saharan Africa. Understanding discontinuation in nonstudy settings is important for establishing expectations for PrEP continuation in national programs and for facilitating effective PrEP scale-up.

Methods:

We conducted in-depth interviews with 46 individuals who had initiated PrEP at 25 HIV comprehensive care clinics (CCCs) in central and western Kenya and whose clinic records indicated they had discontinued.

Results:

Many of our study participants discontinued PrEP when their perceived risk decreased (eg, hiatus or end of a sexual relationship or partner known to be living with HIV became virally suppressed). Others reported discontinuation due to side effects, daily pill burden, preference for condoms, or their partner's insistence. Participant narratives frequently described facility level factors such as stigma-related discomforts with accessing PrEP at CCCs, inconvenient clinic location or operating hours, long wait times, and short refill dates as discouraging factors, suggesting actionable areas for improving PrEP access and continuation.

Conclusion:

Clients frequently make intentional decisions to discontinue PrEP as they weigh different prevention options within the context of complex lives. Many clients will decide to discontinue PrEP when perceiving themselves to be at reduced risk and PrEP counseling must include provisions for addressing seasons of risk. PrEP will not be the right prevention method for everyone, or forever. Expanding PrEP access points and increasing sex-positive messaging may facilitate PrEP being a better option for many.
Secular Trends in Breast Cancer Risk Among Women With HIV Initiating ART in North America
Authors: Coburn Sally B. , Shiels Meredith S. , Silverberg Michael J. , Horberg Michael A. , Gill M. John , Brown Todd T. , Visvanathan Kala , Connor Avonne E. , Napravnik Sonia , Marcus Julia L. , Moore Richard D. , Mathews W. Chris , Mayor Angel M. , Sterling Timothy R. , Li Jun , Rabkin Charles S. , D'Souza Gyspyamber , Lau Bryan , Althoff Keri N. ,   for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiology Databases to Evaluate AIDS
Published: January 2021

Background:

Studies suggest lower risk of breast cancer in women with HIV versus without HIV. These estimates may be biased by lower life expectancy and younger age distribution of women with HIV. Our analysis evaluated this bias and characterized secular trends in breast cancer among women with HIV initiating antiretroviral therapy. We hypothesized breast cancer risk would increase over time as mortality decreased.

Setting:

Women with HIV prescribed antiretroviral therapy in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 1997 through 2016.

Methods:

We estimated breast cancer hazard (cause-specific hazard ratios) and cumulative incidence accounting for competing risks (subdistribution hazard ratios) to assess changes in breast cancer risk over time. This was assessed overall (1997–2016) and within/across calendar periods. Analyses were adjusted for race/ethnicity and inverse probability weighted for cohort. Cumulative incidence was graphically assessed by calendar period and race/ethnicity.

Results:

We observed 11,587 women during 1997–2016, contributing 63 incident breast cancer diagnoses and 1,353 deaths [73,445 person-years (median follow-up = 4.5 years)]. Breast cancer cumulative incidence was 3.2% for 1997–2016. We observed no secular trends in breast cancer hazard or cumulative incidence. There were annual declines in the hazard and cumulative incidence of death (cause-specific hazard ratios and subdistribution hazard ratios: 0.89, 95% confidence interval: 0.87 to 0.91) which remained within and across calendar periods.

Conclusions:

These findings contradict the hypothesis of increasing breast cancer risk with declining mortality over time among women with HIV, suggesting limited impact of changing mortality on breast cancer risk. Additional inquiry is merited as survival improves among women with HIV.
Skin manifestations of Pseudomonas aeruginosa infections
Authors: Spernovasilis Nikolaos , Psichogiou Mina , Poulakou Garyfallia
Published: January 2021

Purpose of review

Pseudomonas aeruginosa is an opportunistic pathogen with considerable morbidity and mortality, particularly in vulnerable hosts. Skin manifestations are common, either representing local inoculation or secondary skin seeding following bloodstream infections. As patients with various predisposing conditions are expanding, we sought to review the most recent published evidence regarding epidemiology, risk factors and diagnosis of skin manifestations of P. aeruginosa.

Recent findings

New data exist on epidemiology and diagnosis of skin infections; systemic infections are impacted by multidrug-resistance issues and host immune status.

Green nail syndrome, toe web infection, hot tub folliculitis, hot hand-foot infection and external otitis are the most common infections originating from the skin per se. Local treatments are the cornerstone and prognosis is favorable in immunocompetent hosts. Ecthyma gangrenosum and P. aeruginosa subcutaneous nodules are usually associated with bloodstream infections and occur primarily in immunocompromised hosts. Necrotizing skin and soft tissue infections occur in diabetic, alcoholic and immunocompromised patients; management requires a multidisciplinary team with surgical approach. Burn wound infections may also be challenging, requiring a specialized team. In all the four latter types of P. aeruginosa skin infections portending significant morbidity and mortality, systemic antibiotics are an integral part of the treatment.
Anorectal Transplantation
Authors: Araki Jun , Nishizawa Yuji , Fujita Naoki , Sato Tomoyuki , lizuka Tomoya , Komata Masatoshi , Hatayama Naoyuki , Yakura Tomiko , Hirai Shuichi , Tashiro Kensuke , Galvão Flavio H. F. , Nakamura Tatsuo , Nakagawa Masahiro , Naito Munekazu
Published: January 2021

Objective:

Anorectal transplantation is a challenging procedure but a promising option for patients with weakened or completely absent anorectal function.

Summary Background Data:

We constructed a canine model of anorectal transplantation, evaluated the long-term outcomes, and controlled rejection and infection in allotransplantation.

Methods:

In the pudendal nerve function study, 6 dogs were randomly divided into 2 groups, transection and anastomosis, and were compared with a control using anorectal manometry, electromyography, and histological examination. In the anorectal transplantation model, 4 dogs were assigned to 4 groups: autotransplant, allotransplant with immunosuppression, allotransplant without immunosuppression, and normal control. Long-term function was evaluated by defecography, videography, and histological examination.

Results:

In the pudendal nerve function study, anorectal manometry indicated that the anastomosis group recovered partial function 6 months postoperatively. Microscopically, the pudendal nerve and the sphincter muscle regenerated in the anastomosis group. Anorectal transplantation was technically successful with a 3-stage operation: colostomy preparation, anorectal transplantation, and stoma closure. The dog who underwent allotransplantation and immunosuppression had 2 episodes of mild rejection, which were reversed with methylprednisolone and tacrolimus. The dog who underwent allotransplantation without immunosuppression had a severe acute rejection that resulted in graft necrosis. Successful dogs had full defecation control at the end of the study.

Conclusions:

We describe the critical role of the pudendal nerve in anorectal function and the first long-term success with anorectal transplantation in a canine model. This report is a proof-of-concept study for anorectal transplantation as a treatment for patients with an ostomy because of anorectal dysfunction.
Learning From England's Best Practice Tariff
Authors: Zogg Cheryl K. , Metcalfe David , Judge Andrew , Perry Daniel C. , Costa Matthew L. , Gabbe Belinda J. , Schoenfeld Andrew J. , Davis Kimberly A. , Cooper Zara , Lichtman Judith H.
Published: January 2021

Objective:

The objective of this study was to evaluate England's Best Practice Tariff (BPT) and consider potential implications for Medicare patients should the US adopt a similar plan.

Summary Background Data:

Since the beginning of the Affordable Care Act, Medicare has renewed efforts to improve the outcomes of older adults through introduction of an expanding set of alternative-payment models. Among trauma patients, recommended arrangements met with mixed success given concerns about the heterogeneous nature of trauma patients and resulting outcome variation. A novel approach taken for hip fractures in England could offer a viable alternative.

Methods:

Linear regression, interrupted time-series, difference-in-difference, and counterfactual models of 2000 to 2016 Medicare (US), HES-APC (England) death certificate-linked claims (≥65 years) were used to: track US hip fracture trends, look at changes in English hip fracture trends before-and-after BPT implementation, compare changes in US-versus-English mortality, and estimate total/theoretical lives saved.

Results:

A total of 806,036 English and 3,221,109 US hospitalizations were included. After BPT implementation, England's 30-day mortality decreased by 2.6 percentage-points (95%CI: 1.7–3.5) from a baseline of 9.9% (relative reduction 26.3%). 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000 to 2016, US outcomes were stagnant (P > 0.05), resulting in an inversion of the countries’ mortality and >38,000 potential annual US lives saved.

Conclusions:

Process measure pay-for-performance led to significant improvements in English hip fracture outcomes. As efforts to improve US older adult health continue to increase, there are important lessons to be learned from a successful initiative like the BPT.
The Cost of Quarantine
Authors: Bose Sourav K. , Dasani Serena , Roberts Sanford E. , Wirtalla Chris , DeMatteo Ronald P. , Doherty Gerard M. , Kelz Rachel R.
Published: January 2021

Objective:

We sought to quantify the financial impact of elective surgery cancellations in the US during COVID-19 and simulate hospitals’ recovery times from a single period of surgery cessation.

Background:

COVID-19 in the US resulted in cessation of elective surgery—a substantial driver of hospital revenue—and placed patients at risk and hospitals under financial stress. We sought to quantify the financial impact of elective surgery cancellations during the pandemic and simulate hospitals’ recovery times.

Methods:

Elective surgical cases were abstracted from the Nationwide Inpatient Sample (2016–2017). Time series were utilized to forecast March–May 2020 revenues and demand. Sensitivity analyses were conducted to calculate the time to clear backlog cases and match expected ongoing demand in the post-COVID period. Subset analyses were performed by hospital region and teaching status.

Results:

National revenue loss due to major elective surgery cessation was estimated to be $22.3 billion (B). Recovery to market equilibrium was conserved across strata and influenced by pre- and post-COVID capacity utilization. Median recovery time was 12–22 months across all strata. Lower pre-COVID utilization was associated with fewer months to recovery.

Conclusions:

Strategies to mitigate the predicted revenue loss of $22.3B due to major elective surgery cessation will vary with hospital-specific supply-demand equilibrium. If patient demand is slow to return, hospitals should focus on marketing of services; if hospital capacity is constrained, efficient capacity expansion may be beneficial. Finally, rural and urban nonteaching hospitals may face increased financial risk which may exacerbate care disparities.
Outpatient Opioid Prescriptions are Associated With Future Substance Use Disorders and Overdose Following Adolescent Trauma
Authors: Bell Teresa M. , Raymond Jodi L. , Mongalo Alejandro C. , Adams Zachary W. , Rouse Thomas M. , Hatcher LeRanna , Russell Katie , Carroll Aaron E.
Published: January 2021

Objective:

This study aims to determine if outpatient opioid prescriptions are associated with future SUD diagnoses and overdose in injured adolescents 5 years following hospital discharge.

Summary of Background Data:

Approximately, 1 in 8 adolescents are diagnosed with an SUD and 1 in 10 experience an overdose in the 5 years following injury. State laws have become more restrictive on opioid prescribing by acute care providers for treating pain, however, prescriptions from other outpatient providers are still often obtained.

Methods:

This was a retrospective cohort study of patients ages 12–18 admitted to 2 level I trauma centers. Demographic and clinical data contained in trauma registries were linked to a regional database containing 5 years of electronic health records and prescription data. Regression models assessed whether number of outpatient opioid prescription fills after discharge at different time points in recovery were associated with a new SUD diagnosis or overdose, while controlling for demographic and injury characteristics, and depression and posttraumatic stress disorder diagnoses.

Results:

We linked 669 patients (90.9%) from trauma registries to a regional health information exchange database. Each prescription opioid refill in the first 3 months after discharge increased the likelihood of new SUD diagnoses by 55% (odds ratio: 1.55, confidence interval: 1.04–2.32). Odds of overdose increased with ongoing opioid use over 2–4 years post-discharge (P = 0.016–0.025).

Conclusions:

Short-term outpatient opioid prescribing over the first few months of recovery had the largest effect on developing an SUD, while long-term prescription use over multiple years was associated with a future overdose.
Antioxidative and angiotensin I-converting enzyme inhibitory
activities of Eastern eel (Anguilla japonica)
Authors: Abebe Bethelehem , Park Jun Ho , Pyo Sang-Eun , Gibtan Ashagrie , Park Sun-Mee , Choi Jae-Suk , Kim Mi-Ryung
Published: January 2021

This study was designed to investigate the antioxidative and angiotensin
I-converting enzyme (ACE) inhibitory activities of Eastern eel (Anguilla
japonica). Hot water extracts were prepared over a period of 25 h
at 100°C from the meat and whole body of the Eastern eel. Protein
hydrolysates of Eastern eel were prepared over a period of 10 h using different
hydrolytic enzymes, such as Alcalase®,
Protamex®, and Alcalase® +
Protamex®. The antioxidative and ACE inhibitory activities
of the eel hydrolysates were higher than those of the extracts, and showed
similar trends for hydrolysis time on each assay system due to similar enzyme
specificity. The hydrolysates produced using Alcalase®
exhibited the highest DPPH scavenging activity (IC50=3.02 mg/mL),
while the Protamex® hydrolysates exhibited the highest ABTS
(IC50=1.13 mg/mL), hydroxyl radical (IC50=1.30 mg/mL),
and hydrogen peroxide (IC50=1.11 mg/mL) scavenging activities and ACE
inhibitory activity (IC50=110.37 μg/mL). These results
revealed that the Eastern eel hydrolysates exhibited strong radicals (DPPH,
ABTS, superoxide, hydroxyl, and hydrogen peroxide) scavenging properties and ACE
inhibitory activity, indicating that they can be potentially used as functional
food ingredients with potential to prevent oxidation and reduce blood
pressure.
Assessing the drivers of syphilis among men who have sex with men in Switzerland reveals a key impact of testing frequency: A modelling study
Authors: Balakrishna Suraj , Salazar-Vizcaya Luisa , Schmidt Axel J. , Kachalov Viacheslav , Kusejko Katharina , Thurnheer Maria Christine , Roth Jan A. , Nicca Dunja , Cavassini Matthias , Battegay Manuel , Schmid Patrick , Bernasconi Enos , Günthard Huldrych F. , Rauch Andri , Kouyos Roger D. ,   the Swiss HIV Cohort Study (SHCS)
Published: January 2021

Background

Over the last decade, syphilis diagnoses among men-who-have-sex-with-men (MSM) have strongly increased in Europe. Understanding the drivers of the ongoing epidemic may aid to curb transmissions.

Methods and Findings

We set up an epidemiological model to assess the drivers of syphilis in MSM in Switzerland between 2006 and 2017. We stratified the model by syphilis stage, HIV-diagnosis, and behavioral factors to account for syphilis infectiousness and risk for transmission. In the main model, we used ‘reported non-steady partners’ (nsP) as the main proxy for sexual risk. We parameterized the model using data from the Swiss HIV Cohort Study, Swiss Voluntary Counselling and Testing center, cross-sectional surveys among the Swiss MSM population, and published syphilis notifications from the Federal Office of Public Health.

The main model reproduced the increase in syphilis diagnoses from 168 cases in 2006 to 418 cases in 2017. It estimated that between 2006 and 2017, MSM with HIV diagnosis had 45.9 times the median syphilis incidence of MSM without HIV diagnosis. Defining risk as condomless anal intercourse with nsP decreased model accuracy (sum of squared weighted residuals, 378.8 vs 148.3). Counterfactual scenarios suggested that increasing screening of MSM without HIV diagnosis and with nsP from once every two-years to twice per year may reduce syphilis incidence (at most 12.8% reduction by 2017). Whereas, increasing screening among MSM with HIV diagnosis and with nsP from once per year to twice per year may substantially reduce syphilis incidence over time (at least 63.5% reduction by 2017).

Conclusions

The model suggests that reporting nsP regardless of condom use is suitable for risk stratification when modelling syphilis transmission. More frequent screening of MSM with HIV diagnosis, particularly those with nsP may aid to curb syphilis transmission.
Network-based modeling of herb combinations in Traditional Chinese Medicine
Authors: Wang Yinyin , Yang Hongbin , Chen Linxiao , Jafari Mohieddin , Tang Jing
Published: January 2021

Traditional Chinese Medicine (TCM) has been practiced for thousands of years for treating human diseases. In comparison to modern medicine, one of the advantages of TCM is the principle of herb compatibility, known as TCM formulae. A TCM formula usually consists of multiple herbs to achieve the maximum treatment effects, where their interactions are believed to elicit the therapeutic effects. Despite being a fundamental component of TCM, the rationale of combining specific herb combinations remains unclear. In this study, we proposed a network-based method to quantify the interactions in herb pairs. We constructed a protein-protein interaction network for a given herb pair by retrieving the associated ingredients and protein targets, and determined multiple network-based distances including the closest, shortest, center, kernel, and separation, both at the ingredient and at the target levels. We found that the frequently used herb pairs tend to have shorter distances compared to random herb pairs, suggesting that a therapeutic herb pair is more likely to affect neighboring proteins in the human interactome. Furthermore, we found that the center distance determined at the ingredient level improves the discrimination of top-frequent herb pairs from random herb pairs, suggesting the rationale of considering the topologically important ingredients for inferring the mechanisms of action of TCM. Taken together, we have provided a network pharmacology framework to quantify the degree of herb interactions, which shall help explore the space of herb combinations more effectively to identify the synergistic compound interactions based on network topology.