bluuebunny/crossref_metadata_2025 huggingface dataset:
P166 Measures of overnight sleep stability in patients with hypersomnolence
Authors: Woods S , Frenkel S , Lopez C , Murnane C , Southcott A
Published: October 2021

Introduction

Hypersomnolence causes significant impairment of daytime functioning. The multiple sleep latency test (MSLT) measures objective hypersomnolence (OH). Patients with hypersomnolence with a normal MSLT are said to have subjective hypersomnolence (SH). The mechanisms of hypersomnolence in such patients is uncertain. This study describes differences in measures of sleep stability derived from the overnight polysomnography (PSG) in patients with OH and SH.

Methods

A retrospective analysis of 100 patients undergoing PSG/MSLT for investigation of hypersomnolence was performed. Patients were classified as OH (MSLT≤8 min) or SH (MSLT>8min). Sleep stage distribution and PSG-derived markers of sleep stability including cardiopulmonary coupling (CPC), cyclic alternating pattern (CAP) and sleep stage shifts were compared between the two groups.

Results

When compared to OH patients (N=50), SH patients (N=50) had significantly more sleep stage shifts, more shifts to stage N1 and longer PSG sleep latency. Small but significantly lower sleep efficiency, higher stage N1 and N3 proportions were also observed in SH patients. OH patients had a small but significantly higher CAP rate and CAP index compared to SH patients. There were no significant differences in CPC metrics between the two groups.

Conclusion

Several PSG-derived markers of sleep stability indicated that patients with SH experienced more unstable sleep than OH patients. This may provide insight into the underlying pathophysiological mechanisms which differentiate these patient groups and may serve as a future therapeutic target.
The roles of photochemical and non-photochemical quenching in regulating photosynthesis depend on the phases of fluctuating light conditions
Authors: Han Jimei , Gu Lianhong , Warren Jeffrey M , Guha Anirban , Mclennan David A , Zhang Wangfeng , Zhang Yali
Published: October 2021

The induction and relaxation of photochemistry and non-photochemical quenching (NPQ) are not instantaneous and require time to respond to fluctuating environments. There is a lack of integrated understanding on how photochemistry and NPQ influence photosynthesis in fluctuating environments. We measured the induction and relaxation of chlorophyll a fluorescence and gas exchange in poplar and cotton at varying temperatures under saturating and fluctuating lights. When the light shifted from dark to high, the fraction of open reaction centers in photosystem II (qL) gradually increased while NPQ increased suddenly and then remained stable. Temperature significantly changed the response of qL but not that of NPQ during the dark to high light transition. Increased qL led to higher photosynthesis but their precise relationship was affected by NPQ and temperature. qL was significantly related to biochemical capacity. Thus, qL appears to be a strong indicator of the activation of carboxylase, leading to the similar dynamics between qL and photosynthesis. When the light shifted from high to low intensity, NPQ is still engaged at a high level, causing a stronger decline in photosynthesis. Our finding suggests that the dynamic effects of photochemistry and NPQ on photosynthesis depend on the phases of environmental fluctuations and interactive effects of light and temperature. Across the full spectra of light fluctuation, the slow induction of qL is a more important limiting factor than the slow relaxation of NPQ for photosynthesis in typical ranges of temperature for photosynthesis. The findings provided a new perspective to improve photosynthetic productivity with molecular biology under natural fluctuating environments.
Age-Diverse Workplace Friendship: A Systematic Literature Review and Recommendations for Future Research
Authors: Dietz Laura , Fasbender Ulrike
Published: October 2021

Friendship may help to bridge differences between people, such as between age-diverse employees. Oftentimes, age diversity in employee interactions cultivates interpersonal tensions. Age-diverse workplace friendship—a relationship between coworkers of different ages, who like each other and who are engaged in a balanced social exchange—may help to overcome these interpersonal tensions because having something in common can de-escalate age-related difficulties and reduce negative feelings between diverse individuals. Despite the relevance of the topic, literature focusing on age-diverse workplace friendship is rare. To address this gap and direct future research, we aim to integrate research on related topics such as workplace friendship and (age) diversity at work into a systematic literature review. Concentrating primarily on the formation and maintenance of age-diverse workplace friendship, we identified similarity-attraction theory, social identity theory, and socioemotional selectivity theory as the three dominant theories referenced in the literature and utilize them to embed and connect our findings into existing theory. More specifically, we review and summarize the findings of our systematic literature review into an integrated framework depicting the antecedents, formation and maintenance processes, and outcomes of age-diverse workplace friendship. We discuss the theoretical and practical implications of our findings and point out directions for future research.
Long bone shape variation in the forelimb of Rhinocerotoidea: relation with size, body mass and body proportions
Authors: Mallet Christophe , Houssaye Alexandra , Cornette Raphaël , Billet Guillaume
Published: October 2021

In quadrupeds, limb bones are strongly affected by functional constraints linked to weight support, but few studies have addressed the complementary effects of mass, size and body proportions on limb bone shape. During their history, Rhinocerotoidea have displayed a great diversity of body masses and relative size and proportions of limb bones, from small tapir-like forms to giant species. Here, we explore the evolutionary variation of shapes in forelimb bones and its relationship with body mass in Rhinocerotoidea. Our results indicate a general increase in robustness and greater development of muscular insertions in heavier species, counteracting the higher weight loadings induced by an increased body mass. The shape of the humerus changes allometrically and exhibits a strong phylogenetic signal. Shapes of the radius and ulna display a stronger link with body mass repartition than with the absolute mass itself. Congruent shape variation between the humerus and the proximal part of the ulna suggests that the elbow joint is comprised of two strongly covariant structures. In addition, our work confirms the uniqueness of giant Paraceratheriidae among Rhinocerotoidea, whose shape variation is related to both a high body mass and a cursorial forelimb construction.
Composition of the Microbiomes from Spinach Seeds Infested or Noninfested with Peronospora effusa or Verticillium dahliae
Authors: Kandel Shyam L. , Henry Peter M. , Goldman Polly H. , Mou Beiquan , Klosterman Steven J.
Published: October 2021

The worldwide distribution of plant seeds can disseminate beneficial and plant-pathogenic microorganisms. This phenomenon is of particular concern where seed production is geographically isolated from crop production, as is the case with spinach in the United States. We aimed to characterize the structure and function of spinach seed microbiomes in commercial spinach seed lots originating from Europe and New Zealand. The seed lots we analyzed were infested with Peronospora effusa and Verticillium dahliae, only infested with V. dahliae, or not infested with either of these pathogens. The microbial taxonomic composition and gene function (assessed by gene ontology [GO] terms) of spinach seeds were highly influenced by geographic origin and the status of pathogen infestation. Through taxonomic profiling, we found that potentially plant-beneficial bacterial genera such as Pseudomonas and Pantoea were the most abundant taxa both in infested and noninfested seeds, and Stenotrophomonas was observed in seed lots infested with P. effusa and V. dahliae. Many potential plant pathogens that are not known to be associated with spinach seed were also discovered by metagenomic analysis, including Sclerotinia sclerotiorum, Botrytis cinerea, Bipolaris sorokiniana, Fusarium pseudograminearum, Alternaria brassicae, A. solani, Parastagonospora nodorum, and Pyrenophora teres f. teres. Our analysis of the function of prokaryotic genes in de novo assembled metagenomes revealed distinct GO terms associated with the geographic origin of seed lots. This work provides an important first step toward identifying spinach seedborne microorganisms that could be utilized to improve plant health and plant pathogens that could be inadvertently carried to new locations.
First Job Workplace Stressors for New Nurse Graduates in Their Own Words: A Secondary Analysis
Authors: Feeg Veronica D. , Mancino Diane J. , Kret Diane D.
Published: October 2021

AIM

The purpose of this study was to have a better understanding of the experiences of new nurse graduates in their work environment and the perceived stressors during their transition into the role of registered nurse.

BACKGROUND

The National Student Nurses’ Association conducts an annual survey of all its members who are new graduates in the months following graduation.

METHOD

The study used a qualitative design on a sample of 1,456 responses. Participants provided typed-in responses. Responses were sorted and coded using constant comparison method. Three independent judges aggregated interpretations through consensus.

RESULTS

The themes that emerged were related to respondents’ attempts to find balance and reflected the stress of the environment, expectations on self, and interactions with others that affected them.

CONCLUSION

New graduates describe their transitions to the role of new nurse in words that suggest that their workplace environments are extremely stressful.
The Role of Standardized Patient Programs in Promoting Equity, Diversity, and Inclusion: A Narrative Review
Authors: Uzelli Yilmaz Derya , Azim Arden , Sibbald Matthew
Published: October 2021

Purpose

Integrating equity, diversity, and inclusion (EDI) in curricula for training health professionals is a frequent institutional goal. The use of standardized (or simulated) patient programs (SPPs) to support EDI in health sciences training is not well described. Here the authors present a theoretical model based on a synthesis of the literature for using SPPs in EDI training, along with a narrative review of the available literature.

Method

The authors searched PubMed, Scopus, Science Direct, and Google Scholar databases for studies published between January 2000 and October 2019 describing the use of SPPs to support EDI in health sciences education. Studies were included if they described standardized patient (SP) education involving EDI and reported empiric data about its design, delivery, or effectiveness. The authors conducted a narrative review and provided a synthesis of the available literature, identifying key themes.

Results

Out of 117 studies identified, 17 met the inclusion criteria. Most studies (53%; n = 9) focused on cultural competence; many focused on communication with diverse patients (29%; n = 5) or health inequity (18%; n = 3). Studies employed portrayal of diversity (71%; n = 12) or learning objectives supported by diversity (29%; n = 5) as approaches to EDI relevant to SP training. Three primary themes emerged: improving cultural competence, effective communication with diverse patients, and highlighting health inequalities.

Conclusions

This review outlines approaches to EDI-based SPPs, with the perspectives and priorities of institutional approaches in mind. SP education around specific EDI issues is reported; however, programmatic approaches to EDI by SPPs are lacking. More research is needed to provide further evidence for the challenges, effectiveness, and outcomes of developing and implementing EDI-based SPPs in health sciences education.
Risk of Hernia Mesh Explantation following Early Versus Late Onset Skin and Soft Tissue Infection
Authors: O’Brien William J. , Dipp Ramos Radwan , Gupta Kalpana , Itani Kamal M. F.
Published: October 2021

Objective:

To estimate the relative risk of explantation in patients with skin and soft tissue infection onset within 90 days of hernia surgery, compared with days 91–365 and after 1 year.

Background:

Infectious complications occurring after hernia repair with synthetic mesh require prolonged treatment, and eventual mesh explantation. Little is known whether early versus late onset infection is associated with differential risk of mesh removal, and whether treatment with long-term antibiotics or debridement are associated with mesh salvage.

Methods:

This was a retrospective observational cohort study. We obtained data on all inguinal, umbilical, and ventral hernia repairs with implanted synthetic mesh performed in Veterans Affairs hospitals during 2008–2015. Participants without a 5-year infection after hernia surgery were excluded. Logistic regression estimated the association of mesh explantation with exposure to mesh-related infection during postoperative days 0–90, versus days 91–365 versus after 1 year. Additional covariates included any subsequent abdominal operation, antibiotic administration, and incision and drainage (I&D) or debridement procedures.

Results:

One thousand eight hundred eighty-five patients underwent index hernia repair and developed a skin and soft tissue infection within 5 years. Infection onset during days 91–365 was associated with increased explantation risk (OR, 1.62; 95% CI, 1.04–2.48), as was increased antibiotic use (OR, 1.04; 95% CI, 1.03–1.05) and surgical treatments (OR, 3.74; 95% CI, 3.02–4.67). Subsequent abdominal operation was associated with lower explantation risk (OR, 0.46; 95% CI, 0.33–0.61).

Conclusions:

Early infections may be more suitable for conservative management. Later-onset infections have lower probability of mesh salvage and should be considered for earlier explantation to save the patients prolonged courses of antibiotics and surgical interventions.
Using Narrow Band CE-Chirps to Elicit Cervical Vestibular Evoked Myogenic Potentials
Authors: Mat Quentin , Deggouj Naïma , Duterme Jean-Pierre , Tainmont Sophie , Lelubre Christophe , Manto Mario
Published: October 2021

Objectives:

To compare the effects of Narrow band CE-Chirps (NB CE-Chirps) and tone bursts (TBs) at 500 Hz and 1000 Hz on the amplitudes and latencies in cervical vestibular evoked myogenic potentials (cVEMPs).

Design:

Thirty-one healthy adult volunteers of varying ages were tested by air conduction at 95 dB nHL. Recording conditions were randomized for each participant and each modality was tested twice.

Results:

NB CE-Chirps showed larger corrected amplitudes than TBs at 500 Hz (p < 0.001) which were themselves larger than NB CE-Chirps and TBs at 1000 Hz (p < 0.001). In older volunteers, NB CE-Chirps 500 and 1000 Hz had significantly higher response rates than TBs 500 Hz (p = 0.039). A negative correlation was observed between the corrected amplitudes and the age of the participants regardless of the stimulus and the frequency studied. The p13 and n23 latencies were not correlated with the age of the subjects.

Conclusions:

NB CE-Chirps at 500 Hz improved the corrected amplitudes of waveforms in cVEMPs as a result of a better frequency specificity compared with TBs. In the elderly, eliciting cVEMPs at a frequency of 1000 Hz might not be necessary to improve response rates with NB CE-Chirps. Additional studies including a higher number of healthy participants and patients with vestibular disorders are required to confirm these observations.
Selective Thoracic Fusion for Idiopathic Scoliosis
Authors: Ruiz John N.M. , Kandwal Pankaj , Lau Leok Lim , Liu Gabriel Ka Po , Thambiah Joseph , Wong Hee-Kit
Published: October 2021

Study Design.

Single-center retrospective review of outcomes among three surgical techniques in the treatment of thoracic idiopathic scoliosis (T-AIS) with a follow-up of at least 5 years.

Objective.

To investigate how outcomes compare in video-assisted anterior thoracic instrumentation (VATS), all hooks/hook-pedicle screw hybrid instrumentation (HHF), and all pedicle screw instrumentation (PSF) techniques for T-AIS.

Summary of Background Data.

Studies comparing outcomes for anterior versus posterior fusion for T-AIS are few and with short follow-up.

Methods.

Three groups of patients with T-AIS who underwent thoracic fusion were included in this study: 98 patients with mean curve of 49.0° ± 9.5° underwent VATS (Group 1); 44 patients with mean curve of 51.1° ± 7.4° underwent HHF (Group 2); and 47 patients with mean curve of 47.6° ± 9.9° underwent PSF (Group 3). Radiological outcomes were compared at preoperative, and up to 5 years. Surgical outcomes were noted until latest follow-up.

Results.

Group 1 had less blood loss, less fusion levels, longer surgical time, and longer hospital stay compared with the other groups (P < 0.01). Groups 1 and 3 were comparable in all time periods with 78.8% and 78.2% immediate curve correction, and 72.9% and 72.1% at 5 years, respectively. Group 2 had lower correction in all time periods (P < 0.0001). Thoracic kyphosis and lumbar lordosis decreased in Group 3, but improved in both Groups 1 and 2 (P < 0.0001). Group 1 had more respiratory complications. The posterior groups had more deep wound infections. Two patients in Group 1 and one patient in Group 2 required revision surgery for implant-related complications. Reoperations for deep wound infections were noted only in the posterior groups.

Conclusion.

This is the first report comparing 5 year outcomes between anterior and posterior surgery for T-AIS. All three surgical methods resulted in significant and durable scoliosis correction; however, curve correction using HHF was inferior to both VATS and PSF with the latter two groups achieving similar coronal correction. However, VATS involved fewer segments, kyphosis improvement, and no deep wound infection, whereas PSF has less surgical time, shorter hospital stays, and no revision surgery from implant-related complications.

Level of Evidence: 3
Prognostic and Predictive Biomarkers in Patients With Coronavirus Disease 2019 Treated With Tocilizumab in a Randomized Controlled Trial*
Authors: Tom Jennifer , Bao Min , Tsai Larry , Qamra Aditi , Summers David , Carrasco-Triguero Montserrat , McBride Jacqueline , Rosenberger Carrie M. , Lin Celia J. F. , Stubbings William , Blyth Kevin G. , Carratalà Jordi , François Bruno , Benfield Thomas , Haslem Derrick , Bonfanti Paolo , van der Leest Cor H. , Rohatgi Nidhi , Wiese Lothar , Luyt Charles Edouard , Kheradmand Farrah , Rosas Ivan O. , Cai Fang
Published: October 2021

OBJECTIVES:

To explore candidate prognostic and predictive biomarkers identified in retrospective observational studies (interleukin-6, C-reactive protein, lactate dehydrogenase, ferritin, lymphocytes, monocytes, neutrophils, d-dimer, and platelets) in patients with coronavirus disease 2019 pneumonia after treatment with tocilizumab, an anti–interleukin-6 receptor antibody, using data from the COVACTA trial in patients hospitalized with severe coronavirus disease 2019 pneumonia.

DESIGN:

Exploratory analysis from a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial.

SETTING:

Hospitals in North America and Europe.

PATIENTS:

Adults hospitalized with severe coronavirus disease 2019 pneumonia receiving standard care.

INTERVENTION:

Randomly assigned 2:1 to IV tocilizumab 8 mg/kg or placebo.

MEASUREMENTS AND MAIN RESULTS:

Candidate biomarkers were measured in 295 patients in the tocilizumab arm and 142 patients in the placebo arm. Efficacy outcomes assessed were clinical status on a seven-category ordinal scale (1, discharge; 7, death), mortality, time to hospital discharge, and mechanical ventilation (if not receiving it at randomization) through day 28. Prognostic and predictive biomarkers were evaluated continuously with proportional odds, binomial or Fine-Gray models, and additional sensitivity analyses. Modeling in the placebo arm showed all candidate biomarkers except lactate dehydrogenase and d-dimer were strongly prognostic for day 28 clinical outcomes of mortality, mechanical ventilation, clinical status, and time to hospital discharge. Modeling in the tocilizumab arm showed a predictive value of ferritin for day 28 clinical outcomes of mortality (predictive interaction, p = 0.03), mechanical ventilation (predictive interaction, p = 0.01), and clinical status (predictive interaction, p = 0.02) compared with placebo.

CONCLUSIONS:

Multiple biomarkers prognostic for clinical outcomes were confirmed in COVACTA. Ferritin was identified as a predictive biomarker for the effects of tocilizumab in the COVACTA patient population; high ferritin levels were associated with better clinical outcomes for tocilizumab compared with placebo at day 28.
Prevalence of pre-sarcopenia among postmenopausal women younger than 65 years
Authors: Orprayoon Nalina , Wainipitapong Peerapraut , Champaiboon Jirapa , Wattanachanya Lalita , Jaisamrarn Unnop , Chaikittisilpa Sukanya
Published: October 2021

Objective:

Sarcopenia is associated with high morbidity and mortality in older women. Early detection and intervention during the postmenopausal period were hypothesized to help maintain muscle mass and performance. Although the Asian Working Group has developed guidelines for sarcopenia management, the condition has not been sufficiently investigated in the middle-aged cohort of the Asian population. This study aimed to measure the prevalence of pre-sarcopenia and sarcopenia in middle-aged postmenopausal women and to determine the factors associated with low muscle mass.

Methods:

In this cross-sectional study conducted in the Menopause Clinic, King Chulalongkorn Memorial Hospital, we used the bioelectrical impedance analysis method to determine the appendicular muscle mass using a body composition analyzer (TANITA MC980 Plus). Appendicular muscle mass index, handgrip strength, and 6-m gait speed were measured in 340 women aged 45 to 65 years. Hormonal profiles, anthropometric data, and relevant history were recorded.

Results:

The mean age of the study participants and time since menopause were 57.8 ± 4.5 years and 9.4 ± 5.5 years, respectively. The proportion of pre-sarcopenic, sarcopenic, and nonsarcopenic women were 11.8%, 2.7%, and 85.6%, respectively. A body mass index ≤ 20 kg/m2 had the strongest correlation with low muscle mass (odds ratio 7.1; 95% confidence interval 3.0-16.8, P < 0.001).

Conclusion:

Nearly 12% of Thai middle-aged postmenopausal women were pre-sarcopenic. Early detection of symptoms of pre-sarcopenia and maintenance of a healthy body mass index may reduce the burden of this condition for middle-aged and older women.
Sex-specific associations of brachial–ankle pulse wave velocity with adverse cardiac remodeling and long-term cardiovascular outcome
Authors: Kwak Soongu , Kim Hack-Lyoung , Lim Woo-Hyun , Seo Jae-Bin , Kim Sang-Hyun , Zo Joo-Hee , Kim Myung-A
Published: October 2021

Background:

It remains unclear whether the cardiovascular consequences of arterial stiffness differ by sex. This study aimed to investigate the sex-specific association of brachial–ankle pulse wave velocity (baPWV) with adverse cardiac remodeling and cardiovascular outcome.

Method:

We studied 11 767 patients (57.6% men) with cardiovascular risk factors, whose baPWV was measured. The primary endpoint was composite cardiovascular events. Restricted cubic spline (RCS) analyses were performed to delineate the association of baPWV with echocardiography parameters and risks of cardiovascular events.

Results:

RCS curves showed that structural/functional echocardiography parameters gradually worsened with increasing baPWV more prominently in women than in men. The prevalence of left ventricular hypertrophy and diastolic dysfunction increases with baPWV increase more steeply in women (P-for-interaction by sex <0.001). During the median follow-up of 3.64 years (interquartile interval, 1.56–5.38 years), 350 cardiovascular events (3.0%) and 155 deaths (1.3%) occurred. Cumulative cardiovascular events and deaths were significantly higher in patients with elevated baPWV in both sexes (P < 0.001). Cox analyses showed that the increase in baPWV was associated with the higher risks of cardiovascular events and deaths more strongly in women [cardiovascular events: men, adjusted hazard ratio 1.10, 95% confidence interval (1.08–1.13), P < 0.001; women, adjusted hazard ratio 1.18, 95% confidence interval (1.13–1.24), P < 0.001 by 100 cm/s increase in baPWV; P-for-interaction by sex = 0.022].

Conclusion:

The detrimental effects of baPWV on adverse cardiac remodeling and cardiovascular outcome were stronger in women than in men. The prognostic information provided by baPWV may be particularly crucial for women.
Three-year clinical outcomes of accelerated epithelium-off corneal crosslinking for a case of superior keratoconus
Authors: Mounir Amr , Mostafa Engy Mohamed
Published: October 2021

In this case report, we presented the long-term outcome of accelerated epithelium-off corneal crosslinking (CXL) for a case of superior keratoconus, which is a rare type of keratoconus. A 26-year-old man presented with progressive loss of vision in both eyes. The uncorrected distance visual acuity (UDVA) in the right eye was 0.1 in decimal corrected to 0.4 by a refraction of −1.00 diopter sphere (DS) −3.50 diopter cylinder (DC) @ 107, whereas the UDVA in the left eye was 0.01 corrected to 0.3 by a refraction of +2.00 DS −5.50 DC @ 31. Slitlamp examination of both eyes revealed a superior corneal protrusion without associated scarring or vascularization. Both eyes were diagnosed as grade 1 keratoconus with superior cone by Scheimpflug corneal tomography. Accelerated epithelium-off CXL was done for each eye separately in 2 consecutive sessions. The patient was followed up for 3 years with the improvement of the visual acuity as regards UDVA and corrected distance visual acuity and the improvement of the corneal topographic parameters, including keratometry, corneal elevation, and pachymetry. Accelerated epithelium-off CXL stabilized and halted the progression of superior keratoconus after long-term follow-up.
Corneal topographic changes after sequential suture removal in a corneal wound burn after phacoemulsification
Authors: Pereira Savio , Dorennavar Laxmi , R.P. Nikhil , Ganesh Sri
Published: October 2021

This case describes the timing of suture removal and stabilization of refraction in a case of corneal wound burn associated with phacoemulsification. A 70-year-old woman presented with diminution of visio in both eyes for 1 year. O/E lens opacification classification system grade NC4C3P2 cataract was present in both eyes with normal fundus. Primary diagnosis was cataract in both eyes. The left eye was planned for microincision cataract surgery by a trainee under local anesthesia. Corneal wound burn and iris chaffing were noted at the end of surgery, and 3 sutures were placed at the main port. At 15 days and 1 month postoperatively, the uncorrected distance visual acuity (UDVA) was 20/80 with high regular astigmatism showing over cylinder on autorefractometer. Sequential suture removal was done 1 month postoperatively with an interval of 15 minutes between each suture and corneal topography performed after each suture removal. Topography exhibited reduction in astigmatism from 10.6 to 1.2 diopters after suture removal. The UDVA and corrected distance visual acuity after 1-hour postsuture removal was 20/32 and 20/20, respectively, with a refraction of −0.50 diopter sphere/−0.50 diopter cylinder @ 95 degrees, which was stable even at 1-month and 6-month follow-up. We conclude that suture removal can be planned as early as 4 weeks with refraction and keratometric readings being stable even after 6 months.
The impact of bystander cardiopulmonary resuscitation on patients with out-of-hospital cardiac arrests
Authors: Liou Fang-Yu , Lin Kun-Chang , Chien Chian-Shiu , Hung Wan-Ting , Lin Yi-Ying , Yang Yi-Ping , Lai Wei-Yi , Lin Tzu-Wei , Kuo Shu-Hung , Huang Wei-Chun
Published: October 2021

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death around the world. Bystander cardiopulmonary resuscitation (CPR) is an independent factor to improve OHCA survival. However, the prevalence of bystander CPR remains low worldwide. Community interventions such as mandatory school CPR training or targeting CPR training to family members of high-risk cardiac patients are possible strategies to improve bystander CPR rate. Real-time feedback, hands-on practice with a manikin, and metronome assistance may increase the quality of CPR. Dispatcher-assistance and compression-only CPR for untrained bystanders have shown to increase bystander CPR rate and increase survival to hospital discharge. After return of spontaneous circulation, targeted temperature management should be performed to improve neurological function. This review focuses on the impact of bystander CPR on clinical outcomes and strategies to optimize the prevalence and quality of bystander CPR.
Transforming the Degradation Rate of β-tricalcium Phosphate Bone Replacement Using 3-Dimensional Printing
Authors: Shen Chen , Wang Maxime M. , Witek Lukasz , Tovar Nick , Cronstein Bruce N. , Torroni Andrea , Flores Roberto L. , Coelho Paulo G.
Published: October 2021

Background

β-Tricalcium phosphate (β-TCP) is one of the most common synthetic bone grafting materials utilized in craniofacial reconstruction; however, it is limited by a slow degradation rate. The aim of this study was to leverage 3-dimensional (3D) printing in an effort to accelerate the degradation kinetics of β-TCP.

Methods

Twenty-two 1-month-old New Zealand white rabbits underwent creation of calvarial and alveolar defects, repaired with 3D-printed β-TCP scaffolds coated with 1000 μM of osteogenic agent dipyridamole. Rabbits were euthanized after 2, 6, and 18 months after surgical intervention. Bone regeneration, scaffold degradation, and bone mechanical properties were quantified.

Results

Histological analysis confirmed the generation of vascularized and organized bone. Microcomputed tomography analysis from 2 to 18 months demonstrated decreased scaffold volume within calvarial (23.6% ± 2.5%, 5.1% ± 2.2%;P< 0.001) and alveolar (21.5% ± 2.2%, 0.2% ± 1.9%;P< 0.001) defects, with degradation rates of 54.6%/year and 90.5%/year, respectively. Scaffold-inducted bone generation within the defect was volumetrically similar to native bone in the calvarium (55.7% ± 6.9% vs 46.7% ± 6.8%;P= 0.064) and alveolus (31.4% ± 7.1% vs 33.8% ± 3.7%;P= 0.337). Mechanical properties between regenerated and native bone were similar.

Conclusions

Our study demonstrates an improved degradation profile and replacement of absorbed β-TCP with vascularized, organized bone through 3D printing and addition of an osteogenic agent. This novel additive manufacturing and tissue engineering protocol has implications to the future of craniofacial skeletal reconstruction as a safe and efficacious bone tissue engineering method.
Current Evidence in Migraine Surgery
Authors: Henriques Sara , Almeida Alexandre , Peres Helena , Costa-Ferreira António
Published: October 2021

Introduction

Migraine headache is a widespread neurovascular disorder with an enormous social and economic impact. A subgroup of patients cannot be managed with pharmacological therapy. Although surgical decompression of extracranial sensory nerves has been proposed as a valid alternative treatment option, the medical community remains reluctant to accept it.

Materials and Methods

This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. An electronic search was performed in September 2020 on PubMed, ScienceDirect, CENTRAL, and Google Scholar databases for original articles reporting outcomes on migraine surgery.

Results

The search strategy revealed a total of 922 studies, of which 52 were included in the review. Significant improvement was reported in 58.3% to 100% and complete elimination in 8.3% to 86.8% of patients across studies. No major complications were reported.

Discussion

This systematic review demonstrates that migraine surgery is an effective and safe procedure, with a positive impact in patients' quality of life and a reduction in long-term costs.

Conclusion

There is considerable scientific evidence suggesting extracranial migraine surgery is an effective and safe procedure. This surgery should be considered in properly selected migraineurs refractory to medical treatment.
Free Flap Reconstruction of Oncologic Gluteal Defects
Authors: Arikawa Masaki , Akazawa Satoshi , Kagaya Yu , Kawai Akira , Miyamoto Shimpei
Published: October 2021

A number of studies have already examined gluteal reconstruction with free flaps. Thus, the aim of this study was to investigate the reliability of free flap reconstruction for oncologic gluteal defects. This retrospective cohort study included 23 patients who underwent immediate soft tissue reconstruction for an oncologic gluteal defect. Fifteen patients underwent reconstruction with a free flap and 8 with a regional flap. The postoperative results were compared between the free and regional flaps. In the free flap group, the latissimus dorsi musculocutaneous flap was used in 12 patients, the thoracodorsal artery perforator flap in 2 patients, and the anterolateral thigh flap in 1 patient. Recipient vessels were the inferior gluteal vessels or their branches in 8 patients and the superior gluteal vessels or their branches in 7 patients. All flaps have fully survived in both groups without vascular compromise. Dehiscence of the gluteal wound tended to be more common in the regional flap group; however, the difference between the groups was not statistically significant. The use of free flap reconstruction for large oncologic defects in the gluteal region is a feasible and reliable option. Tension-free wound closure and simplified suture lines can provide reliable wound coverage irrespective of the postoperative patient's position or movement. Because of the risk of postoperative compression on the vascular pedicle, selecting the appropriate recipient vessel and type of microvascular anastomosis is key for the success of free flap transfer in this region.
Characterizing the spatiotemporal heterogeneity of the COVID-19 vaccination landscape
Authors: Tiu Andrew , Susswein Zachary , Merritt Alexes , Bansal Shweta
Published: October 2021

It is critical that we maximize vaccination coverage across the United States so that SARS-CoV-2 transmission can be suppressed, and we can sustain the recent reopening of the nation. Maximizing vaccination requires that we track vaccination patterns to measure the progress of the vaccination campaign and target locations that may be undervaccinated. To improve efforts to track and characterize COVID-19 vaccination progress in the United States, we integrate CDC and state-provided vaccination data, identifying and rectifying discrepancies between these data sources. We find that COVID-19 vaccination coverage in the US exhibits significant spatial heterogeneity at the county level and statistically identify spatial clusters of undervaccination, all with foci in the southern US. Vaccination progress at the county level is also variable; many counties stalled in vaccination into June 2021 and few recovered by July, with transmission of the Delta variant rapidly rising. Using a comparison with a mechanistic growth model fitted to our integrated data, we classify vaccination dynamics across time at the county scale. Our findings underline the importance of curating accurate, fine-scale vaccination data and the continued need for widespread vaccination in the US, especially in the wake of the highly transmissible Delta variant.
Changes in ischemic stroke presentations and associated workflow during the first wave of the COVID-19 pandemic: A population study in Alberta, Canada
Authors: Ganesh Aravind , Stang Jillian M. , McAlister Finlay A. , Shlakhter Oleksandr , Holodinsky Jessalyn K. , Mann Balraj , Hill Michael D. , Smith Eric E.
Published: October 2021

Background

Pandemics may promote hospital avoidance among patients with emergencies, and added precautions may exacerbate treatment delays. There is a paucity of population-based data on these phenomena for stroke. We examined the effect of the COVID-19 pandemic on the presentation and treatment of ischemic stroke in an entire population.

Methods

We used linked provincial administrative data and data from the Quality Improvement and Clinical Research Alberta Stroke Program – a registry capturing stroke-related data on the entire population of Alberta(4.3 million)– to identify all patients presenting with stroke in the pre-pandemic(1-January-2016 to 27-February-2020, n=19,531) and pandemic(28-February-2020 to 30-August-2020, n=2,255) periods. We examined changes in thrombolysis and endovascular therapy(EVT) rates, workflow, and in-hospital outcomes.

Results

Hospitalizations/presentations for ischemic stroke dropped (weekly adjusted-incidence-rate-ratio[aIRR]:0.48, 95%CI:0.46-0.50, adjusted for age, sex, comorbidities, pre-admission care needs), as did population-level incidence of thrombolysis(aIRR:0.49,0.44-0.56) or EVT(aIRR:0.59,0.49-0.69). However, the proportions of presenting patients receiving acute therapies did not decline (e.g. thrombolysis:11.7% pre-pandemic vs 13.1% during-pandemic, aOR:1.02,0.75-1.38). Onset-to-door times were prolonged; EVT recipients experienced longer door-to-reperfusion times (median door-to-reperfusion:110-minutes, IQR:77-156 pre-pandemic vs 132.5-minutes, 99-179 during-pandemic; adjusted-coefficient:18.7-minutes, 95%CI:1.45-36.0). Hospitalizations were shorter but stroke severity and in-hospital mortality did not differ.

Interpretation

The first COVID-19 wave was associated with a halving of presentations and acute therapy utilization for ischemic stroke at a population level, and greater pre-hospital and in-hospital treatment delays. Our data can inform public health messaging and stroke care in current and future waves. Messaging should encourage attendance for emergencies and stroke systems should re-examine “code stroke” protocols to mitigate inefficiencies.
Model-based meta-analysis to optimise S. aureus-targeted therapies for atopic dermatitis
Authors: Miyano Takuya , Irvine Alan D , Tanaka Reiko J
Published: October 2021

Background

Several clinical trials of Staphylococcus aureus (S. aureus)-targeted therapies for atopic dermatitis (AD) have demonstrated conflicting results regarding whether they improve AD severity scores. This study performs a model-based meta-analysis to investigate possible causes of these conflicting results and suggests how to improve the efficacies of S. aureus-targeted therapies.

Methods

We developed a mathematical model that describes systems-level AD pathogenesis involving interactions between S. aureus and Coagulase Negative Staphylococcus (CoNS). The model was calibrated to reproduce time course data of S. aureus levels, EASI scores, and EASI-75 in response to dupilumab, S. hominis A9 (ShA9) and flucloxacillin from published clinical trials. We simulated efficacies of hypothetical S. aureus-targeted therapies on virtual patients using the model.

Results

Our model simulation reproduced the clinically observed detrimental effects that application of ShA9 and flucloxacillin had on AD severity and showed that these effects disappeared if the bactericidal activity against CoNS was removed. A hypothetical (modelled) eradication of S. aureus by 3.0 log10 CFU/cm2, without killing CoNS, achieved comparable EASI-75 to dupilumab. This efficacy was potentiated if dupilumab was administered in conjunction with S. aureus eradication (EASI-75 at week 16; S. aureus eradication: 66.7%, dupilumab 61.6% and combination: 87.8%). The improved efficacy was also seen for virtual dupilumab poor responders.

Conclusion

Our model simulation suggests that killing CoNS worsens AD severity and that S. aureus-specific eradication without killing CoNS could be effective for AD patients, including dupilumab poor responders. This study will contribute to design promising S. aureus-targeted therapy.
Prenatal maternal distress during the COVID-19 pandemic and its effects on the infant brain
Authors: Manning Kathryn Y. , Long Xiangyu , Watts Dana , Tomfohr-Madsen Lianne , Giesbrecht Gerald F. , Lebel Catherine
Published: October 2021

The COVID-19 pandemic has caused elevated distress in pregnant individuals, which has the potential to impact the developing infant. In this study, we examined anxiety and depression symptoms during the pandemic in a large sample of pregnant individuals (n=8602). For a sub-sample of participants, their infants underwent magnetic resonance imaging (MRI) at 3-months of age to examine whether this prenatal maternal distress was associated with infant brain changes. We found significantly elevated prenatal maternal distress compared to pre-pandemic rates, with 47% and 33% of participants reporting clinically significant symptoms of anxiety and depression, respectively. Importantly, we identified social support as a protective factor for clinically elevated prenatal maternal distress. We found significant relationships between prenatal maternal distress and infant amygdala-prefrontal microstructural and functional connectivity and demonstrate for the first time that social support moderates this relationship. Our findings suggest a potentially long-lasting impact of the COVID-19 pandemic on children and show that social support acts as a protective factor not just for pregnant individuals, but also for their developing infants. These findings provide timely evidence to inform clinical practice and policy surrounding the care of pregnant individuals and highlight the importance of social support.
A framework for reconstructing SARS-CoV-2 transmission dynamics using excess mortality data
Authors: Ghafari Mahan , Watson Oliver J , Karlinsky Ariel , Ferretti Luca , Katzourakis Aris
Published: October 2021

Detailed reconstruction of the SARS-CoV-2 transmission dynamics and assessment of its burden in several parts of the world has still remained largely unknown due to the scarcity of epidemiological analyses and limited testing capacities of different countries to identify cases and deaths attributable to COVID-19 [1-4]. Understanding the true burden of the Iranian COVID-19 epidemic is subject to similar challenges with limited clinical and epidemiological studies at the subnational level [5-9]. To address this, we develop a new quantitative framework that enables us to fully reconstruct the transmission dynamics across the country and assess the level of under-reporting in infections and deaths using province-level, age-stratified all-cause mortality data. We show that excess mortality aligns with seroprevalence estimates in each province and subsequently estimate that as of 2021-10-22, only 48% (95% confidence interval: 43-55%) of COVID-19 deaths in Iran have been reported. We find that in the most affected provinces such as East Azerbaijan, Qazvin, and Qom approximately 0.4% of the population have died of COVID-19 so far. We also find significant heterogeneity in the estimated attack rates across the country with 11 provinces reaching close to or higher than 100% attack rates. Despite a relatively young age structure in Iran, our analysis reveals that the infection fatality rate in most provinces is comparable to high-income countries with a larger percentage of older adults, suggesting that limited access to medical services, coupled with undercounting of COVID-19-related deaths, can have a significant impact on accurate estimation of COVID-19 fatalities. Our estimation of high attack rates in provinces with largely unmitigated epidemics whereby, on average, between 10% to 25% individuals have been infected with COVID-19 at least twice over the course of 20 months also suggests that, despite several waves of infection, herd immunity through natural infection has not been achieved in the population.
Postvaccination SARS-CoV-2 infection among healthcare workers – A Systematic Review and meta-analysis
Authors: Chandan Saurabh , Khan Shahab R. , Deliwala Smit , Mohan Babu P. , Ramai Daryl , Chandan Ojasvini C. , Facciorusso Antonio
Published: October 2021

INTRODUCTION

Healthcare workers (HCWs) remain on the front line of the battle against SARS-CoV-2 and COVID-19 infection, and are among the highest groups at risk of infection during this raging pandemic. We conducted a systematic review and meta-analysis to assess incidence of postvaccination SARS-CoV-2 infection among vaccinated HCWs.

METHODS

We searched multiple databases from inception through August 2021 to identify studies that reported on incidence of postvaccination SARS-CoV-2 infection among HCWs. Meta-analysis was performed to determine pooled proportions of COVID-19 infection in partially and fully vaccinated individuals.

RESULTS

Eighteen studies with 228,873 HCWs were included in the final analysis. Total number of partially vaccinated, fully vaccinated, and unvaccinated HCWs were 132,922, 155,673 and 17505, respectively. Overall pooled proportion of COVID-19 infections among partially/fully vaccinated and unvaccinated HCWs was 2.1% (95% CI 1.2-3.5). Among partially vaccinated, fully vaccinated and unvaccinated HCWs, pooled proportion of COVID-19 infections was 3.7% (95% CI 1.8-7.3), 1.3% (95% CI 0.6-2.9), and 10.1% (95% CI 4.5-19.5), respectively.

DISCUSSION

Our analysis shows the risk of COVID-19 infection in both partially and fully vaccinated HCWs remains exceedingly low when compared to unvaccinated individuals. There remains an urgent need for all frontline HCWs to be vaccinated against SARS-CoV-2 infection.
Correlation of long-term care facility vaccination practices between seasons and resident types
Authors: O’Neill Emily T , Bosco Elliott , Persico Erin , Silva Joe B , Riester Melissa R , Moyo Patience , van Aalst Robertus , Loiacono Matt M , Chit Ayman , Gravenstein Stefan , Zullo Andrew R
Published: October 2021

Objectives

Influenza vaccination varies widely across LTCFs due to staff behaviors, LTCF practices, and patient factors. It is unclear how seasonal LTCF vaccination varies between cohabitating but distinct short-stay and long-stay residents. Thus, we assessed the correlation of LTCF vaccination between these populations and across seasons.

Design

National retrospective cohort using Medicare and Minimum Data Set (MDS) data.

Setting and Participants

U.S. LTCFs. Short-stay and long-stay Medicare-enrolled residents age ≥65 in U.S. LTCFs from a source population of residents during October 1st-March 31stin 2013-2014 (3,042,881 residents; 15,683 LTCFs) and 2014-2015 (3,143,174, residents; 15,667 LTCFs).

Methods

MDS-assessed influenza vaccination was the outcome. Pearson correlation coefficients were estimated to assess seasonal correlations between short-stay and long-stay resident vaccination within LTCFs.

Results

The median proportion of short-stay residents vaccinated across LTCFs was 70.4% (IQR, 50.0-82.7%) in 2013-2014 and 69.6% (IQR, 50.0-81.6%) in 2014-2015. The median proportion of long-stay residents vaccinated across LTCFs was 85.5% (IQR, 78.0-90.9%) in 2013-2014 and 84.6% (IQR, 76.6-90.3%) in 2014-2015. Within LTCFs, there was a moderate correlation between short-stay and long-stay vaccination in 2013-2014 (r=0.50, 95%CI: 0.49-0.51) and 2014-2015 (r=0.53, 95%CI: 0.51-0.54). Across seasons, there was a moderate correlation for LTCFs with short-stay residents (r=0.54, 95%CI: 0.53-0.55) and a strong correlation for those with long-stay residents (r=0.68, 95%CI: 0.67-0.69).

Conclusion and Implications

In LTCFs with inconsistent influenza vaccination across seasons or between populations, targeted vaccination protocols for all residents, regardless of stay type, may improve successful vaccination in this vulnerable patient population.

Brief summary

In LTCFs, influenza vaccination was moderately correlated across all residents, but varied across seasons. Inconsistent vaccination among cohabitating residents may increase infection risk in LTCFs.