bluuebunny/crossref_metadata_2025 huggingface dataset:
Occupational and physical therapy for pain in pediatric clients
Authors: Tupper Susan M. , Engel Joyce M. , Swiggum Mary , Holsti Liisa
Published: June 2021

Occupational therapists (OTs) and physical therapists (PTs) are rehabilitation therapists with distinct but complementary roles who contribute to pain assessment and management in young people either as solo providers, or as a critical component of the interdisciplinary treatment team. Pain in infants, children, and adolescents interferes with their ability to engage in essential interactions with caregivers, acquisition of developmental milestones, and with participation in activities related to self-care, leisure, play, school, and work. OTs and PTs use specific treatment strategies, such as positioning, splinting, adaptive equipment, exercise, manual therapy, electrophysical agents, education on energy conservation, joint protection strategies, and pain self-management training to facilitate participation in valued life activities and occupations. This chapter provides an overview of important theoretical frameworks for rehabilitation therapists, reviews evidence for OT and PT interventions, and describes a framework for planning procedural pain management for rehabilitation therapists when working with pediatric clients.
Impact of a Multidisciplinary Long-Term Opioid Therapy Safety Program at a Military Tertiary Academic Medical Center
Authors: Jaskiewicz Jennifer L , Garry Conor B , Ernst Andrew J , Cole Jacob H , Allen Miranda L , Fox Catherine C , Gendron Richard T , Gentry Shari L , Hughey Scott B , Stedje-Larsen Eric T
Published: June 2021

Objective

In light of the ongoing opioid crisis, Naval Medical Center Portsmouth (NMCP) created the Long-Term Opioid Therapy Safety (LOTS) program to reduce risks and improve long-term opioid therapy outcomes. Our primary outcome was change in compliance with the recommended safety metrics.

Design

This is a retrospective cohort study performed at NMCP, a large military academic medical center providing comprehensive medical care to DoD beneficiaries. The NMCP LOTS program provides both patient and provider narcotic education as well as medical record auditing. The NMCP LOTS program promotes adherence to published CDC, the DVA, and DoD guidelines.

Methods

Anonymized data were compiled each fiscal quarter and were analyzed retrospectively. Adult patients prescribed opioids for at least 90 days without a gap of 30 days between prescriptions were included in this study. The investigators recorded and reported provider compliance with LOTS metrics over the same period.

Results

Compliance with the recommended safety metrics improved. We noted a decrease in the number of long-term opioid patients, concurrent benzodiazepine prescriptions, and patients prescribed greater than 90 morphine equivalents per day during the observation period. The number of naloxone prescriptions for LOTS patients also increased, reflecting improved guideline adherence.

Conclusion

Systematic education and feedback to providers are effective in creating a system and culture of opioid reduction, safe opioid prescribing, and system accountability. This article presents a comprehensive approach to modifying prescribing patterns of long-term opioids in a large healthcare system.
‘Conversion Therapy’ As Degrading Treatment
Authors: Trispiotis Ilias , Purshouse Craig
Published: June 2021

Abstract—

This article responds to the widespread uncertainty in UK and international human rights law over the legality of ‘conversion therapy’, a set of practices that aim to eradicate LGBTIQ+ sexualities and gender identities. The article pursues two main arguments. First, it is argued that all forms of ‘conversion therapy’ are disrespectful of the equal moral value of LGBTIQ+ people and violate specific protected areas of liberty and equality that are inherent in the idea of human dignity. Secondly, the article develops a theoretical account of degrading treatment under article 3 of the European Convention on Human Rights that illuminates the relationship between the prohibition of degrading treatment, human dignity and antidiscrimination. It is then argued that ‘conversion therapy’, in all its different forms, spawns the specific kind of degradation that UK and international human rights law prohibit. The article ends by analysing the positive state obligations that arise in this context.
The UV sensitivity of the Higgs potential in Gauge–Higgs Unification
Authors: Yamada Atsuyuki
Published: June 2021

In this paper, we discuss the UV sensitivity of the Higgs effective potential in a Gauge--Higgs Unification (GHU) model. We consider an $SU(\mathcal N)$ GHU on $\mathbf M^4\times S^1$ spacetime with a massless Dirac fermion. In this model, we evaluate the four-Fermi diagrams at the two-loop level and find them to be logarithmically divergent in the dimensional regularization scheme. Moreover, we confirm that their counter-terms contribute to the Higgs effective potential at the four-loop level. This result means that the Higgs effective potential in the GHU depends on UV theories as well as in other non-renormalizable theories.
Legal landscape of trust law in Thailand: the fading twilight of common law trusts and the sunrise of statutory trusts
Authors: Reekie Adam , Reekie Surutchada , Ruengsrichaiya Kaipichit
Published: June 2021

The creation of trusts in Thailand was strictly prohibited by the adoption of the Civil and Commercial Code in 1935. However, this civil law jurisdiction is currently home to a number of trusts: those created prior to 1935 in accordance with English law and trusts for use in capital markets, a statutory exception introduced in 2008. With a bill introducing trusts for personal asset management in the legislative pipeline, this article presents a timely overview of this little-known but evolving trust law landscape.
Functional Imaging of the Cerebellum during Action Execution and Observation
Authors: Raos Vassilis , Savaki Helen E
Published: June 2021

We employed the 14C-deoxyglucose autoradiographic method to map the activity in the cerebellar cortex of rhesus monkeys that performed forelimb movements either in the light or in the dark and of monkeys that observed forelimb movements executed by a human experimenter. The execution of forelimb movements, both in the light and in the dark, activated the forelimb representations in the cerebellar hemispheric extensions of 1) vermian lobules IV–VI and 2) vermian lobule VIIIB, ipsilaterally to the moving forelimb. Activations in the former forelimb representation involved both a paravermal and a lateral hemispheric region. Also, Crus II posterior in the ansiform lobule (the hemispheric expansion of lobule VIIB) was activated bilaterally by execution of movements in the light but not in the dark. Action observation activated the lateral-most region of the forelimb representation in the lateral hemispheric extension of vermian lobules IV–VI, as well as the crus II posterior, bilaterally. Our results demonstrate that the cerebellar cortex, in addition to its involvement in the generation of movement, is also recruited in the perception of observed movements. Moreover, our findings suggest a modularity gradient in the primate cerebellar cortex, which progresses from unimodal (medially) to multimodal (laterally) functional areas.
Mechanism Exploration of 3-Hinge Gyral Formation and Pattern Recognition
Authors: Razavi Mir Jalil , Liu Tianming , Wang Xianqiao
Published: June 2021

The 3-hinge gyral folding is the conjunction of gyrus crest lines from three different orientations. Previous studies have not explored the possible mechanisms of formation of such 3-hinge gyri, which are preserved across species in primate brains. We develop a biomechanical model to mimic the formation of 3-hinge patterns on a real brain and determine how special types of 3-hinge patterns form in certain areas of the model. Our computational and experimental imaging results show that most tertiary convolutions and exact locations of 3-hinge patterns after growth and folding are unpredictable, but they help explain the consistency of locations and patterns of certain 3-hinge patterns. Growing fibers within the white matter is posited as a determining factor to affect the location and shape of these 3-hinge patterns. Even if the growing fibers do not exert strong enough forces to guide gyrification directly, they still may seed a heterogeneous growth profile that leads to the formation of 3-hinge patterns in specific locations. A minor difference in initial morphology between two growing model brains can lead to distinct numbers and locations of 3-hinge patterns after folding.
Characterization of Pyrenophora tritici-repentis in Tunisia and Comparison with a Global Pathogen Population
Authors: Laribi Marwa , Akhavan Alireza , Ben M’Barek Sarrah , Yahyaoui Amor H. , Strelkov Stephen E. , Sassi Khaled
Published: June 2021

Pyrenophora tritici-repentis causes tan spot, an important foliar disease of wheat. A collection of P. tritici-repentis isolates from Tunisia, located in one of the main secondary centers of diversification of durum wheat, was tested for phenotypic race classification based on virulence on a host differential set and for the presence of the necrotrophic effector (NE) genes ToxA, ToxB, and toxb by PCR analysis. While races 2, 4, 5, 6, 7, and 8 were identified according to their virulence phenotypes, PCR testing indicated the presence of “atypical” isolates that induced necrosis on the wheat differential ‘Glenlea,’ but lacked the expected ToxA gene, suggesting the involvement of other NEs in the P. tritici-repentis/wheat interaction. Genetic diversity and the P. tritici-repentis population structure were explored further by examining 59 Tunisian isolates and 35 isolates from Algeria, Azerbaijan, Canada, Iran, and Syria using 24 simple sequence repeat markers. Average genetic diversity, overall gene flow, and percentage polymorphic loci were estimated as 0.58, 2.09, and 87%, respectively. Analysis of molecular variance showed that 81% of the genetic variance occurred within populations and 19% occurred between populations. Cluster analysis by the unweighted pair group method indicated that ToxB– isolates grouped together and were distantly related to ToxB+ isolates. Based on Nei’s analysis, the global collection clustered into two distinct groups according to their region of origin. The results suggest that geographic origin and the host specificity imposed by different NEs can lead to differentiation among P. tritici-repentis populations.
Numbers Encapsulate, Words Elaborate: Toward the Best Use of Comments for Assessment and Feedback on Entrustment Ratings
Authors: Ginsburg Shiphra , Watling Christopher J. , Schumacher Daniel J. , Gingerich Andrea , Hatala Rose
Published: June 2021

The adoption of entrustment ratings in medical education is based on a seemingly simple premise: to align workplace-based supervision with resident assessment. Yet it has been difficult to operationalize this concept. Entrustment rating forms combine numeric scales with comments and are embedded in a programmatic assessment framework, which encourages the collection of a large quantity of data. The implicit assumption that more is better has led to an untamable volume of data that competency committees must grapple with. In this article, the authors explore the roles of numbers and words on entrustment rating forms, focusing on the intended and optimal use(s) of each, with a focus on the words. They also unpack the problematic issue of dual-purposing words for both assessment and feedback. Words have enormous potential to elaborate, to contextualize, and to instruct; to realize this potential, educators must be crystal clear about their use. The authors set forth a number of possible ways to reconcile these tensions by more explicitly aligning words to purpose. For example, educators could focus written comments solely on assessment; create assessment encounters distinct from feedback encounters; or use different words collected from the same encounter to serve distinct feedback and assessment purposes. Finally, the authors address the tyranny of documentation created by programmatic assessment and urge caution in yielding to the temptation to reduce words to numbers to make them manageable. Instead, they encourage educators to preserve some educational encounters purely for feedback, and to consider that not all words need to become data.
A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States
Authors: Lindeman Brenessa , Brasel Karen , Minter Rebecca M. , Buyske Jo , Grambau Marni , Sarosi George
Published: June 2021

Entrustable professional activities (EPAs) have been increasingly used as an assessment framework to formally capture the myriad ad hoc entrustment decisions that occur on a daily basis in clinical settings with learners present. Following the definition of Core EPAs for Entering Residency by the Association of American Medical Colleges in 2014, the American Board of Surgery (ABS) began to explore the utility of EPAs as a framework to support competency-based resident education within general surgery in 2016. As the complement of EPAs drafted for a specialty serve to define the core tasks of a professional within that discipline, initial efforts to define the entire scope of general surgery were fraught with difficulty as no commonly accepted definition of a general surgeon currently exists. Opting to prioritize a pilot of the EPA conceptual framework within surgical training rather than defining the entirety of the specialty, ABS leaders identified 5 EPAs that represent a core of general surgery with which to begin. This article details the process of choosing the initial set of EPAs and provides a roadmap for other disciplines interested in testing the feasibility of this assessment framework while garnering buy-in among the community of educators. Future steps, including implementation of the existing 5 EPAs beyond the initial pilot sites and drafting and implementation of the additional complement of EPAs, are also described.
Lessons from the COVID-19 Pandemic: The Case for Virtual Residency Interviews
Authors: Dey Pranam , Havlik John L. , Kurup Viji , Ahuja Nita
Published: June 2021

This perspective from a variety of stakeholders including aspiring surgeons, a current department chair for education, and a current chair of surgery advocates for making virtual residency interviews a permanent part of the match process. We delineate how a shift to virtual residency interviews can save applicants time and money, enhance equity in the match, and ultimately strengthen a program’s ability to assess applicants.
Clinical Results of Corrective Cast and Brace Treatment for Early-onset Scoliosis: The Effectiveness of Long-term Cast Treatment That Extends into Children’s Schooldays
Authors: Sugawara Ryo , Kikkawa Ichiro , Watanabe Hideaki , Taki Naoya , Tomisawa Hiroko , Takeshita Katsushi
Published: June 2021

Background:

Cast and brace treatment is a conservative treatment for early-onset scoliosis (EOS). We analyzed the clinical results of this treatment when extended into patients’ schooldays.

Methods:

Twenty-two children with EOS underwent alternatively repetitive cast and brace treatment (ARCBT). Cast was applied under general anesthesia and remained for some weeks, and the brace was continuously worn, which was repeatedly applied when scoliosis progressed. The change in the major curve angle, requirement for surgical intervention, and complications of ARCBT were analyzed.

Results:

Six patients had idiopathic scoliosis (IS), 9 had syndromic scoliosis (SS), and 7 had neuromuscular scoliosis. Cast treatment started at 4.9±2.1 years of age, and the patients were followed up for 8.3 years. The average total number of cast applications was 5.5 per patient. The mean major scoliosis angle was 45.4±12.5 degrees at the first visit; this was corrected to 26.5±8.7 degrees at the first cast application and progressed to 75.4±22.1 degrees at the final visit. Nine patients whose scoliosis progressed finally underwent surgery. The mean age at surgery was 11.0 years (range, 8.8 to 13.1 y), and the mean period from first cast application to surgery was 6.1 years (range, 5.0 to 8.9 y). Four patients’ IS rapidly progressed after 9 years of age, and all of them underwent final fusion surgery with a correction rate of 56.9%. Among patients with SS, 1 final fusion, and 2 growth-friendly surgeries were performed at a mean age of 9.2 years; the correction rate was 21.5%. Among patients with neuromuscular scoliosis, 2 final fusion surgeries were performed at a mean age of 11.3 years; the correction rate was 30.7%. The cast-related complication rate was 5.0%, and most complications were skin problems.

Conclusions:

Long-term ARCBT extended into schooldays might be effective for IS. This should be considered as a time-saving treatment option for EOS.

Level of Evidence:

Level IV—case series.
A CASE OF HIGH-RISK CILIARY BODY MELANOMA ARISING IN AN EYE AFTER RESECTION OF AN IRIDOCILIARY MELANOCYTOMA
Authors: Lee Terry , Semenova Ekaterina , Proia Alan D. , Materin Miguel A.
Published: June 2021

Purpose:

To report a case of a benign iridociliary melanocytoma recurring as malignant melanoma after excision.

Methods:

Observational case report with clinical data, slit-lamp examination findings, ultrasound biomicroscopy results, and histopathological and genetic analyses.

Results:

A 40-year-old African American woman initially presented with a superonasal iridociliary mass with a maximal thickness of 2.5 mm. Visual acuity of the involved eye was 20/25, intraocular pressure was 52 mmHg on maximal pressure-lowering medications, and Humphrey visual field testing revealed an inferior altitudinal defect. Fine-needle aspiration biopsy and incisional biopsy followed by tumor excision confirmed a benign melanocytoma. After 5 years of stability, possible recurrence was detected on ultrasound biomicroscopy as an increase in ciliary body thickness. The new lesion grew to a thickness of 5.1 mm over the next 18 months of observation. Fine-needle aspiration biopsy and gene expression profile of the recurrent lesion diagnosed a malignant melanoma with high metastatic potential (Class 2). The patient underwent plaque brachytherapy and has ongoing regression of the tumor.

Conclusion:

Transformation of benign iridociliary melanocytoma to melanoma is rare. To the best of the authors' knowledge, this is the first documented case of a melanoma arising in an eye after initial excision of a melanocytoma. Close monitoring of these patients is warranted even years after the initial excision.
Evaluating the Utility of Routine Computed Tomography Scans after Cranial Vault Reconstruction for Children with Craniosynostosis
Authors: Ahammout Chaima , Perez Francisco A. , Birgfeld Craig B. , Koudstaal Maarten J. , Ellenbogen Richard G. , Lee Amy , Heike Carrie L.
Published: June 2021

Background:

Postoperative computed tomography scans allow for evaluation of the structural results of cranial vault reconstruction and potential surgical concerns. The authors evaluated the clinical utility of routine postoperative scans to identify relevant surgical findings in children treated for craniosynostosis.

Methods:

The authors conducted a retrospective study of postoperative computed tomography reports for patients with craniosynostosis following cranial vault reconstruction during a 9-year period at their tertiary care pediatric hospital. They categorized postoperative computed tomography findings as typical, atypical, or indeterminate. Images with reported indeterminate or atypical findings were reviewed and verified by a pediatric neuroradiologist and a pediatric neurological surgeon. Clinical outcomes of patients with abnormal postoperative images were assessed with chart review for clinical relevance.

Results:

Postoperative computed tomography radiology reports for 548 operations in 506 participants were included. Most participants had single-suture craniosynostosis (89 percent), were male (64 percent), and under 1 year of age (78 percent). Surgically concerning scans were described in 52 reports (<9.5 percent), and the research team’s pediatric neuroradiologist confirmed abnormal findings in 36 (6.5 percent). Potentially relevant abnormal findings included subdural blood (n = 18), subarachnoid blood (n = 4), intraparenchymal findings (n = 6), bone abnormalities (n = 5), vascular injury (n = 3), and increased ventricular size (n = 2). Most cases with abnormal findings did not require additional observation nor intervention. Only three cases (of 548; 0.55 percent) required further intervention, which included additional medical management (n = 2) and return to the operating room (n = 1).

Conclusion:

Abnormal findings on routine computed tomography scans after cranial vault reconstruction are uncommon and rarely result in an urgent surgical or medical intervention.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
A Novel Treatment for Giant Congenital Melanocytic Nevi Combining Inactivated Autologous Nevus Tissue by High Hydrostatic Pressure and a Cultured Epidermal Autograft: First-in-Human, Open, Prospective Clinical Trial
Authors: Morimoto Naoki , Mitsui Toshihito , Sakamoto Michiharu , Mahara Atsushi , Yoshimura Kenichi , Arata Jun , Jinno Chizuru , Kakudo Natsuko , Kusumoto Kenji , Yamaoka Tetsuji
Published: June 2021

Background:

Giant congenital melanocytic nevi are large skin lesions associated with a risk of malignant transformation. The authors developed a novel treatment to reconstruct full-thickness skin defects by combining an inactivated nevus as the autologous dermis and a cultured epidermal autograft. The first-in-human trial of this treatment was performed.

Methods:

Patients with melanocytic nevi that were not expected to be closed by primary closure were recruited. The full-thickness nevus of the target was removed and inactivated by high hydrostatic pressurization at 200 MPa for 10 minutes. The inactivated nevus was sutured to the original site, and a cultured epidermal autograft was grafted onto it 4 weeks later. Patients were followed for up to 52 weeks.

Results:

Ten patients underwent reimplantation of the pressurized nevus, and one patient dropped out. The recurrence of nevus at 52 weeks was not detected by pathological diagnosis in any patients. The L* value at 52 weeks was significantly higher than that of the target nevus. One patient received skin grafting due to contracture of the reconstructed skin. The epithelized area of the reconstructed skin, as the percentage of the original target nevus, was 55.5 ± 19.4 percent at 12 weeks and 85.0 ± 32.4 percent at 52 weeks.

Conclusions:

The inactivated nevus caused inflammation and contracture for several months. However, no recurrence was observed, and combination therapy using an inactivated nevus with a cultured epidermal autograft may therefore be a novel treatment of giant congenital melanocytic nevi.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Intraoperative Scintigraphy With Portable Gamma Camera for the Localization of Interaortocaval Paraganglioma
Authors: Pérez-Santiago Leticia , Cassinello-Fernández Norberto , Alfonso-Ballester Raquel , Díaz-Expósito Rafael , Moscardó-Navarro Anaïs , Ortega-Serrano Joaquín
Published: June 2021

A 15-year-old adolescent girl diagnosed of interaortocaval paraganglioma with a positive 123I-MIGB SPECT/CT and 1 unsuccessful prior surgery was operated on with the assistance of a handheld gamma camera. Once the lesion was located and removed, 2 images were taken, one of the surgical field (without 123I-MIGB uptake) and another of the tumor ex vivo (with high 123I-MIGB uptake), confirming that the lesion had been satisfactorily excised. This case highlights the use of a portable gamma camera as a useful tool to locate this rare tumor, with a SPECT/CT positive for 123I-MIGB and a difficult anatomical location suspected.
Mandibular Distraction Osteogenesis for Tongue-Based Airway Obstruction Without Micrognathia
Authors: Kosyk Mychajlo S. , Carlson Anna R. , Zapatero Zachary D. , Kalmar Christopher L. , Cielo Christopher M. , Lioy Janet , Bartlett Scott P. , Taylor Jesse A. , Swanson Jordan W.
Published: June 2021

Purpose

Mandibular distraction osteogenesis (MDO) effectively treats tongue-based airway obstruction (TBAO) in micrognathic patients with Robin Sequence. Mandibular distraction osteogenesis may also address TBAO in certain nonmicrognathic patients who have severe obstructive apnea, although there is no current literature to guide MDO use in these atypical patients. This study describes outcomes of MDO in a series of patients with TBAO without micrognathia.

Methods

Patients who underwent MDO for TBAO from 2013–20 were reviewed, and patients with micrognathia were excluded. Study subjects received baseline/follow up polysomnography. Polysomnography variables, including Obstructive Apnea Hypopnea Index, oxyhemoglobin saturation nadir (SpO2 nadir), percent sleep time end tidal CO2 greater than 50 mm Hg (%ETCO2 > 50), and respiratory-related arousals were compared before and after MDO. Demographics, syndromic/cleft palate status, airway anomalies, respiratory support, and feeding outcomes were collected.

Results

One hundred and twenty-four patients underwent MDO during this study period; 5 were nonmicrognathic and included in analysis. Sixty percent (n = 3) of the cohort was syndromic: 1 patient each had Trisomy 9, Beckwith Wiedemann syndrome, and duplicated pituitary gland plus syndrome. Forty percent (n = 2) of patients had a cleft palate, 60% (n = 3) had laryngomalacia, and 40% had tracheomalacia. Median (range) age at MDO was 53 days (47–167 days), and median length of distraction was 16 mm (14–20 mm). After MDO, median Obstructive Apnea Hypopnea Index decreased from x̃ = 60.7/h (11.6–109.4) to x̃ = 5.3/h (3.5–19.3) (P = 0.034). SpO2 nadir increased (69% [58–74] to 85% [80–88], P = 0.011), and median %ETCO2 > 50 mm Hg decreased (5.8% [5.2–30.1] to 0.0% [0.0–1.3], P ≤ 0.043). Continuous positive airway pressure was used by all patients immediately after MDO, and at 6 months postoperatively, 1 patient remained on continuous positive airway pressure and 1 patient required supplemental oxygen. At last follow up, no patients had significant residual airway obstruction or required a tracheostomy.

Conclusions

Mandibular distraction osteogenesis can effectively treat severe TBAO in some patients without micrognathia that would otherwise be candidates for tracheostomy. When used in select patients, MDO significantly improves obstructive sleep apnea and reduces need for ventilatory support, although feeding support is still needed in most patients at 6 months. Further study in a larger cohort will help identify appropriate candidates for MDO and characterize outcomes of unique patient populations.
Customized Two-Dimensional Computed Tomography-Guided Preoperative Pectus Bar Shaping
Authors: Ho Christopher Wei Guang , Tan Bien-Keem , Ong Boon Hean , Nakao Masakazu , Lim Chong-Hee
Published: June 2021

Introduction

Successful minimally invasive repair of pectus excavatum relies on a pectus bar that closely conforms to the desired shape of the sternum and ribs to produce optimal elevation and remodeling. However, the present method of empirical intraoperative bar shaping is tedious and risks trauma to surrounding structures. To overcome this, we devised a technique using a life-sized computed tomography (CT) printout of the patient's chest wall to guide preoperative bar bending.

Methods

A 5-cm-wide polymethylmethacrylate block placed on the sternum as the patient underwent chest CT was used as a marker to guide scaling of an axial screenshot of the patient's chest to life-size. This life-size image was printed and the planned correction of the patient's chest wall was traced onto it. The pectus bar was bent according to this template. Patient demographics, Haller index, surgical indications, operative technique, complications, aesthetic and functional improvements, and overall satisfaction were assessed.

Results

Thirty patients (4 women) underwent primary minimally invasive repair of pectus excavatum with a single pectus bar shaped preoperatively over an 8-year period. The average age and Haller index was 20.6 years and 5.4, respectively. The mean operative time was 66.4 minutes. Satisfactory sternal elevation was attained with a single attempt at bar insertion in all cases. Two patients had pneumothoraxes that resolved without intervention. The mean follow-up period was 50.1 months. There were no cases of bar migration or recurrence of deformity after bar removal. On a 5-point Likert scale, all patients indicated an improvement in aesthetic appearance (4.6), and patients with physical symptoms (10) reported an improvement in function (4.4). The overall satisfaction score was 4.7.

Conclusions

This technique of CT-guided preoperative pectus bar shaping is straightforward, eliminates the need for intraoperative revisions to bar shape, and achieves effective correction of the pectus excavatum deformity. All patients were satisfied with the aesthetic, functional, and overall outcomes.
The “Arrow Flap” Technique in Reduction Mammaplasty
Authors: Torresetti Matteo , Scalise Alessandro , Di Benedetto Giovanni
Published: June 2021

Introduction

Breast reduction is one of the most common procedures performed by plastic surgeons worldwide. Despite that several techniques have been proposed for management of ptotic or hypertrophic breasts, most of them often deal with too large breast bases, poor breast projection, persistent “dog ears,” and a certain percentage of bottoming out. Lower-pole shaping of the breast remains one of the challenge of vertical mammoplasty.

Materials and Methods

The authors report their 5-year-long experience with a modification of the vertical scar technique, the “arrow flap,” in which they harvest a double lateral glandular and cutaneous flap, to tighten and better shape the base of the breast and to improve the breast projection with a “double-bra” effect. From April 2015 to February 2019, 75 patients with moderate to severe macromastia/breast ptosis underwent bilateral reduction mammoplasty.

Results

Postoperative outcomes showed an overall satisfactory results and low incidence of complications. Two patients presented with an asymmetry between the 2 breasts, and no nipple-areola complex necrosis occurred. One patient reported a wider vertical scar, whereas no bottoming out was observed.

Conclusions

All patients reported a stable and durable projection of the breast, with pleasant cosmetic results. By combining short scars and narrow base, we can obtain a pleasant lower pole reshaping of the breast, even in that challenging cases of large and squared breast. The authors believe that this technique provides a useful surgical option, increasing the versatility of the superior pedicle vertical mammaplasty both for mastopexy and breast reduction, even in cases of severe macromastia.
Controlling biomolecular condensates via chemical reactions
Authors: Kirschbaum Jan , Zwicker David
Published: June 2021

Biomolecular condensates are small droplets forming spontaneously in biological cells through phase separation. They play a role in many cellular processes, but it is unclear how cells control them. Cellular regulation often relies on post-translational modifications of proteins. For biomolecular condensates, such chemical modifications could alter the molecular interaction of key condensate components. Here, we test this idea using a theoretical model based on non-equilibrium thermodynamics. In particular, we describe the chemical reactions using transition-state theory, which accounts for the non-ideality of phase separation. We identify that fast control, as in cell signalling, is only possible when external energy input drives the reaction out of equilibrium. If this reaction differs inside and outside the droplet, it is even possible to control droplet sizes. Such an imbalance in the reaction could be created by enzymes localizing to the droplet. Since this situation is typical inside cells, we speculate that our proposed mechanism is used to stabilize multiple droplets with independently controlled size and count. Our model provides a novel and thermodynamically consistent framework for describing droplets subject to non-equilibrium chemical reactions.
Assessment and clinical utility of a non-Next-Generation Sequencing based Non-Invasive Prenatal Testing technology
Authors: Gormus U , Chaubey A , Shenoy S , Wong YW , Chan LY , Choo BP , Oraha L , Gousseva A , Persson F , Prensky L , Chin E , Hegde M
Published: June 2021

Background

Rolling circle replication (RCR) is a novel technology that has not been applied to cell-free DNA (cfDNA) testing until recently. Given the cost and simplicity advantages of this technology compared to other platforms currently used in cfDNA analysis, an assessment of RCR in clinical laboratories was performed. Here, we present the first validation study from clinical laboratories utilizing RCR technology.

Methods

831 samples from spontaneously pregnant women carrying a singleton fetus and 25 synthetic samples were analyzed for the fetal risk of Trisomy 21, Trisomy 18 and Trisomy 13 by three laboratories on three continents. All women who provided the samples were followed to birth, where evaluation for fetal aneuploidies was performed using newborn examinations and any suspected aneuploidies were confirmed with karyotyping.

Results

The study found rolling circle replication to be a highly viable technology for clinical assessment of fetal aneuploidies with 100% sensitivity for T21 (95% CI:82.35% - 100.00%); 100.00% sensitivity for T18 (71.51% - 100.00%) and 100.00% sensitivity for T13 analyses (66.37% - 100.00%). The specificities were >99% for each trisomies [99.7% (99.01% - 99.97%) for T21; 99.5% (98.62% - 99.85%) for T18; 99.7% (99.03% - 99.97%) for T13], along with a first pass no-call rate of 0.93%.

Conclusions

The study showed that using a rolling circle replication-based cfDNA system for the evaluation of the common aneuploidies would provide greater accuracy and clinical utility compared to conventional biochemical screening and comparable results to other reported cfDNA methodologies.
Changes in mobility pre and post first SARS-CoV-2 vaccination: findings from a prospective community cohort study including GPS movement tracking in England and Wales (Virus Watch)
Authors: Nguyen Vincent , Liu Yunzhe , Mumford Richard , Flanagan Ben , Patel Parth , Braithwaite Isobel , Shrotri Madhumita , Byrne Thomas , Beale Sarah , Aryee Anna , Erica Fong Wing Lam , Fragaszy Ellen , Geismar Cyril , Navaratnam Annalan M D , Hardelid Pia , Kovar Jana , Pope Addy , Cheng Tao , Hayward Andrew , Aldridge Robert W
Published: June 2021

Background

Some evidence suggests that individuals may change adherence to public health policies aimed at reducing contact, transmission and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination. In this study, we aim to estimate the rate of change in average daily travel distance from a participant’s registered address before and after SARS-CoV-2 vaccination.

Method

Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants and vaccination status was collected from January 2021 onwards. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute towards our tracker sub-cohort which uses the Global Positioning System (GPS) to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose.

Results

We analysed the daily travel distance of 228 vaccinated adults. Between 157 days prior to vaccination until the day before vaccination, the median daily travel distance travelled was 8.9km (IQR: 3.50km, 24.17km). Between the day of vaccination and 100 days after vaccination, the median daily travel distance travelled was 10.30km (IQR: 4.11, 27.53km). Between 157 days prior to vaccination and the vaccination date, there was a daily median decrease in mobility of 40m (95%CI: −51m, −31m, p-value <0.001) per day. After the removal of outlier data, and between the vaccination date and 99 days after vaccination, there was a median daily increase in movement of 45.0m (95%CI: 25m, 65m, p-value = <0.001). Restricting the analysis to the 3rd national lockdown (4th of January 2021 to the 5th of April 2021), we found a median daily movement increase of 9m (95%CI: −25m, 45m, p = 0.57) in the 30 days prior to vaccination and the vaccination date, and a median daily movement increase of 10m (95%CI: −60m, 94m, p-value = 0.69) in the 30 days after vaccination.

Conclusions

Our study demonstrates the feasibility of collecting high volume geolocation data as part of research projects, and the utility of these for understanding public health issues. Our results are consistent with both an increase and decrease in movement after vaccination and suggest that, amongst Virus Watch participants, any changes in movement distances post-vaccination are small.
Meta-analytical evidence on mental disorder symptoms during the COVID-19 pandemic in Latin America
Authors: Zhang Stephen X. , Batra Kavita , Liu Tao , Dong Rebecca Kechen , Xu Wen , Yin Allen , Delios Andrew , Chen Bryan Z. , Chen Richard Z. , Miller Saylor , Wan Xue , Chen Jiyao
Published: June 2021

Objective

There is a lack of evidence related to the prevalence of mental disorder symptoms as well as their heterogeneities during the COVID-19 pandemic in Latin America, a continent across the equators. The current study aims to provide meta-analytical evidence on mental disorder symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population, and university students in Latin America.

Methods

Bibliographical databases, such as PubMed, Embase, Web of Sciences, PsycINFO, and medRxiv, were systematically searched to identify pertinent studies up to Februry 6, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimize data entry errors.

Results

A total of 33 studies with 101,772 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress, and insomnia was 32%, 27%, 32%, and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (33% vs. 27%, p <0.001). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers, and students in Latin America was 33%, 31%, 37%, and 36%, respectively.

Conclusion

The high yet heterogenous level of prevalence of mental disorder symptoms emphasizes the need for appropriate identification of psychological interventions in Latin America.
Strong immunogenicity of heterologous prime-boost immunizations with the experimental vaccine GRAd-COV2 and BNT162b2 or ChAdOx1-nCOV19
Authors: Agrati Chiara , Capone Stefania , Castilletti Concetta , Cimini Eleonora , Matusali Giulia , Meschi Silvia , Tartaglia Eleonora , Camerini Roberto , Lanini Simone , Milleri Stefano , Colloca Stefano , Vitelli Alessandra , Folgori Antonella
Published: June 2021

Here we report on the humoral and cellular immune response in eight volunteers who autonomously chose to adhere to the Italian national COVID-19 vaccination campaign more than 3 months after receiving a single administration GRAd-COV2 vaccine candidate in the context of the phase 1 clinical trial. We observed a clear boost of both binding/neutralizing antibodies as well as T cell responses upon receipt of the heterologous BNT162b2 or ChAdOx1-nCOV19 vaccines. These results, despite the limitation of the small sample size, support the concept that a single-dose of an adenoviral vaccine may represent an ideal tool to effectively prime a balanced immune response, which can be boosted to high levels by a single dose of a different vaccine platform.
Short-term Outcomes in Children Recovered from Multisystem Inflammatory Syndrome associated with SARS-CoV-2 infection
Authors: Patnaik Sibabratta , Jain Mukesh Kumar , Ahmed Sakir , Dash Arun Kumar , Ram Kumar P , Sahoo Bandya , Mishra Reshmi , Behera Manas Ranjan
Published: June 2021

Background

Multi System Inflammatory Syndrome in children (MIS-C) associated with COVID-19 is a recently recognised potentially life-threatening entity. There is limited data on post MIS-C sequelae.

Methods

21 children fulfilling the WHO criteria for MIS-C were included in our study. Data was collected at baseline and at 12-16 weeks post discharge to look for any persistent sequelae mainly relating to the lungs or heart including coronary arteries

Results

Fever was the most common presentation, found in 18 (85.7%) patients. All had marked hyper-inflammatory state. Low ejection fraction (EF) was found in 10 (47.6%), but none had any coronary artery abnormality. All received corticosteroids, while 7 (33.3%) children required additional treatment with intravenous Immunoglobulins. 20 children improved while 1 left against medical advice. At discharge, 3 children had impaired left ventricular function. At median 15 weeks’ follow-up, no persistent complications were found. EF had returned to normal and no coronary artery abnormalities were found during repeat echocardiography. Chest radiographs showed no fibrosis and all biochemical parameters had normalized.

Conclusion

The children with MIS-C are extremely sick during the acute stage. Timely and adequate management led to full recovery without any sequelae at a median follow-up of 15 weeks.
DEVELOPMENT AND VALIDATION OF AN ENZYME-LINKED IMMUNOASSAY KIT FOR DIAGNOSIS AND SURVEILLANCE OF COVID-19
Authors: Bagno Flávia F. , Sérgio Sarah A. R. , Figueiredo Maria Marta , Godoi Lara C. , Andrade Luis A. F. , Salazar Natália C. , Soares Camila P. , Aguiar Andressa , Almeida Flávia Jaqueline , da Silva Edimilson D. , Ferreira Antônio G. P. , Durigon Edison Luiz , Gazzinelli Ricardo T. , Teixeira Santuza M. R. , Fernandes Ana Paula S. M. , da Fonseca Flavio G.
Published: June 2021

There is a massive demand to identify alternative methods to detect new cases of COVID-19 as well as to investigate the epidemiology of the disease. In many countries, importation of commercial kits poses a significant impact on their testing capacity and increases the costs for the public health system. We have developed an ELISA to detect IgG antibodies against SARS-CoV-2 using a recombinant viral nucleocapsid (rN) protein expressed in E. coli. Using a total of 894 clinical samples we showed that the rN-ELISA was able to detect IgG antibodies against SARS-CoV-2 with high sensitivity (97.5%) and specificity (96.3%) when compared to a commercial antibody test. After three external validation studies, we showed that the test accuracy was higher than 90%. The rN-ELISA IgG kit constitutes a convenient and specific method for the large-scale determination of SARS-Cov-2 antibodies in human sera with high reliability.
SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men
Authors: Stirrup Oliver T. , Boshier Florencia A. T. , Venturini Cristina , Guerra-Assunção José Afonso , Alcolea-Medina Adela , Becket Angela H , Charalampous Themoula , da Silva Filipe Ana , Glaysher Sharon , Khan Tabassum , Kulasegara-Shylini Raghavendran , Kele Beatrix , Monahan Irene M. , Mollett Guy , Parker Matthew , Pelosi Emanuela , Randell Paul , Roy Sunando , Taylor Joshua F. , Weller Sophie J. , Wilson-Davies Eleri , Wade Phillip , Williams Rachel ,   COG-UK HOCI Variant Substudy consortium,   The COVID-19 Genomics UK (COG-UK) consortium, Copas Andrew J. , Cutino-Moguel Teresa , Freemantle Nick , Hayward Andrew C. , Holmes Alison , Hughes Joseph , Mahungu Tabitha W. , Nebbia Gaia , Partridge David G. , Pope Cassie F. , Price James R. , Robson Samuel C. , Saeed Kordo , de Silva Thushan I. , Snell Luke B. , Thomson Emma C. , Witney Adam A. , Breuer Judith
Published: June 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage B.1.1.7 has been associated with an increased rate of transmission and disease severity among subjects testing positive in the community. Its impact on hospitalised patients is less well documented.

Methods

We collected viral sequences and clinical data of patients admitted with SARS-CoV-2 and hospital-onset COVID-19 infections (HOCIs), sampled 16/11/2020 - 10/01/2021, from eight hospitals participating in the COG-UK-HOCI study. Associations between the variant and the outcomes of all-cause mortality and intensive therapy unit (ITU) admission were evaluated using mixed effects Cox models adjusted by age, sex, comorbidities, care home residence, pregnancy and ethnicity.

Results

Sequences were obtained from 2341 inpatients (HOCI cases = 786) and analysis of clinical outcomes was carried out in 2147 inpatients with all data available. The hazard ratio (HR) for mortality of B.1.1.7 compared to other lineages was 1.01 (95% CI 0.79-1.28, P=0.94) and for ITU admission was 1.01 (95% CI 0.75-1.37, P=0.96). Analysis of sex-specific effects of B.1.1.7 identified increased risk of mortality (HR 1.30, 95% CI 0.95-1.78) and ITU admission (HR 1.82, 95% CI 1.15-2.90) in females infected with the variant but not males (mortality HR 0.82, 95% CI 0.61-1.10; ITU HR 0.74, 95% CI 0.52-1.04).

Conclusions

In common with smaller studies of patients hospitalised with SARS-CoV-2 we did not find an overall increase in mortality or ITU admission associated with B.1.1.7 compared to other lineages. However, women with B.1.1.7 may be at an increased risk of admission to intensive care and at modestly increased risk of mortality.
SARS-CoV-2 Vaccine Induced Atypical Immune Responses in Antibody Defects: everybody does their best
Authors: Salinas Ane Fernandez , Mortari Eva Piano , Terreri Sara , Quintarelli Concetta , Pulvirenti Federica , Cecca Stefano Di , Guercio Marika , Milito Cinzia , Bonanni Livia , Auria Stefania , Romaggioli Laura , Cusano Giuseppina , Albano Christian , Zaffina Salvatore , Perno Carlo Federico , Spadaro Giuseppe , Locatelli Franco , Carsetti Rita , Quinti Isabella
Published: June 2021

Background

Patients with Primary Antibody Deficiencies (PAD) represent a potential at-risk group in the current COVID-19 pandemic. However, unexpectedly low cumulative incidence, low infection-fatality rate, and mild COVID-19 or asymptomatic SARS-CoV-2 infections were frequently reported in PAD. The discrepancy between clinical evidence and impaired antibody production requires in-depth studies on patients’ immune responses.

Methods

Forty-one patients with Common Variable Immune Deficiencies (CVID), 6 patients with X-linked Agammaglobulinemia (XLA), and 28 healthy age-matched controls (HD) were analyzed for anti-Spike and anti-RBD antibody production, generation of low and high affinity Spike-specific memory B-cells, Spike-specific T-cells before and one week after the second dose of BNT162b2 vaccine.

Results

HD produced antibodies, and generated memory B-cells with high affinity for Trimeric Spike. In CVID, the vaccine induced poor Spike-specific antibodies, and atypical B-cells with low affinity for Trimeric Spike, possibly by extra-follicular reactions or incomplete germinal center reactions. In HD, among Spike positive memory B-cells, we identified receptor-binding-domain-specific cells that were undetectable in CVID, indicating the incapability to generate this new specificity. Specific T-cell responses toward Spike-protein were evident in HD and defective in CVID. Due to the absence of B-cells, patients with XLA responded to immunization by specific T-cell responses only.

Conclusions

We present detailed data on early non-canonical immune responses in PAD to a vaccine against an antigen never encountered before by humans. From our data, we expect that after BNT162b2 immunization, XLA patients might be protected by specific T-cells, while CVID patients might not be protected by immunization.