bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of a new triple-row circular stapler in reducing the risk of colorectal anastomotic leakage: A historical control and propensity score–matched study
Authors: Mazaki Junichi , Katsumata Kenji , Ishizaki Tetsuo , Fukushima Noritoshi , Udo Ryutaro , Tago Tomoya , Kasahara Kenta , Kuwabara Hiroshi , Enomoto Masanobu , Nagakawa Yuichi , Tsuchida Akihiko
Published: July 2022

Anastomotic leakage (AL) after colorectal surgery is a serious complication. This study aimed to evaluate the effectiveness of the EEA™ circular stapler, a new triple-row circular stapler (TCS), relative to a conventional, double-row circular stapler (DCS).

A total of 285 patients who underwent anastomosis with the double stapling technique at the Tokyo Medical University Hospital between 2017 and 2021 were included in this nonrandomized clinical trial with historical controls using a propensity score (PS) analysis. The primary endpoint was the risk of AL.

We performed a 1:2 PS matching analysis. Before case matching, AL occurred in 15 (7.4%) and 2 (2.4%) patients in the DCS and TCS groups, respectively, with no significant difference (P = .17). After case matching, AL occurred in 13 patients (11.6%) and 1 patient (1.8%) in the DCS and TCS groups, respectively, revealing a significant difference (P = .04). Cox models were created by applying PS to adjust for group differences via regression adjustment. Odds ratios for AL in the DCS group versus the TCS group were 0.31 (95% confidence interval [CI]: 0.07–1.38) in the entire cohort, 0.15 (95% CI: 0.02–0.64) in the regression adjustment cohort, and 0.14 (95% CI: 0.02–1.09) in the 1:2 PS-matched cohort.

PS analysis of clinical data suggested that the use of TCS contributes to a reduced risk of AL after colorectal anastomosis CTwith the double stapling technique.
COVID-19 and male infertility: An overview of the disease
Authors: Malki Mohammed Imad
Published: July 2022

Since SARS-CoV-2 infection was first discovered in December 2019 in Wuhan City in China, it spread rapidly and a global pandemic of COVID-19 has occurred. According to several recent studies on SARS-CoV-2, the virus primarily infects the respiratory system but may cause damage to other systems. ACE-2, the main receptor for entry into the target cells by SARS-CoV-2, was reported to abundantly express in testes, including spermatogonia, Leydig and Sertoli cells. Nevertheless, there is no clinical evidence in the literature about whether SARS-CoV-2 infection has an impact on male reproductive health. Therefore, this review highlights the effect of SARA-CoV-2 infection on male reproductive health, including the reproductive system and its functioning, as well as gamete and male gonadal function that might be affected by the virus itself or secondary to immunological and inflammatory response, as well as drug treatments and the psychological stress related to panic during the COVID-19 outbreak.
Use of high-flow nasal oxygen in spontaneously breathing pediatric patients undergoing tubeless airway surgery: A prospective observational study
Authors: Kim Eun-Hee , Ji Sang-Hwan , Lee Ji-Hyun , Kim Jin-Tae , Jang Young-Eun , Kwon Seong-Keun , Kim Hee-Soo
Published: July 2022

The use of high-flow nasal oxygen is gaining popularity in apneic and spontaneously breathing adult patients during anesthesia. This prospective observational study evaluated the effect of high-flow nasal oxygen in maintaining adequate oxygenation and ventilation in spontaneously breathing pediatric patients with dynamic airway obstruction, undergoing tubeless airway surgery.

Oxygenation was provided via an age-appropriate, high-flow nasal cannula at a flow rate of 2 L kg−1 min−1. Propofol and remifentanil were used to maintain anesthesia while preserving spontaneous respiration. We sought to determine the incidence and risk factors of rescue ventilation. Rescue ventilation with a face mask was performed when the pulse oximetry oxygen saturation was <90% or transcutaneous carbon dioxide was >80 mm Hg.

In total, 27 patients were included in the final analysis. Median (interquartile range) of pulse oximetry and transcutaneous carbon dioxide were 100% (99%–100%) and 58.4 mm Hg (51.4–70.3 mm Hg), respectively. Altogether, 9 (33.3%) patients needed rescue ventilation during anesthesia. Of these, 7 patients (25.9%) developed oxygen desaturation (<90%) and 2 patients (7.4%) developed hypercarbia. Patients who required rescue ventilation were significantly younger (8.2 vs 28.8 months, P = .02) and required a longer anesthesia time (55.7 vs 41.0 minutes, P = .04) than those who did not.

In conclusion, High-flow nasal oxygen is an alternative technique to maintain oxygenation in children undergoing airway surgeries. However, younger age and longer anesthesia time are significant risk factors leading to the requirement of rescue ventilation in these patients. Further studies with large sample size are required for clinical application of these techniques.
A WeChat-based caregiver education program improves satisfaction of stroke patients and caregivers, also alleviates poststroke cognitive impairment and depression: A randomized, controlled study
Authors: Kang Kaining , Li Shurui
Published: July 2022

Caregiver education program has been applied to stroke patients, while its effect on mental health in stroke patients is still obscure. This study aimed to assess the impact of the WeChat-based caregiver education (WBCE) program on cognition, anxiety, and depression in stroke patients.

Totally, 170 patients with ischemic stroke were included. They were randomized at a 1:1 ratio to the WBCE group (N = 86) and control care (CC) group (N = 84), and their caregivers received WBCE or CC for 12 months, respectively.

Mini-mental state examination (MMSE) score was increased in the WBCE group compared with that in the CC group at the 9th month (M9) (27.2 ± 1.9 vs 26.6 ± 1.6, P = 0.017) and M12 (27.1 ± 1.8 vs 26.5 ± 1.5, P = 0.015), while cognitive impairment rate was decreased in WBCE group compared with that in CC group at 12th month (M12) (30.2% vs 45.2%, P=0.043). In the meantime, the Hospital Anxiety and Depression Scale (HADS) for Anxiety score (6.5 ± 3.1 vs 7.5 ± 2.8, P = 0.020), HADS for depression score (6.7 ± 3.1 vs 7.7 ± 3.3, P = 0.040) and depression rate (33.7% vs 48.8%, P = 0.046) in WBCE group were reduced compared with those in CC group at M12. Besides, an elevation in the satisfaction score of patients at M12 (8.0 ± 1.2 vs 7.4 ± 1.2, P = 0.002) and that of caregivers at 6th months (M6) (6.6 ± 1.1 vs 6.2 ± 1.3, P = 0.038) and M12 (7.2 ± 1.1 vs 6.8 ± 1.4, P=0.042) were found in WBCE group compared with CC group.

WBCE program not only improves the satisfaction of stroke patients and caregivers but also attenuates cognitive impairment and depression in stroke patients.
A bibliometric analysis of global publications on graft-versus-host disease research
Authors: Huang Xuemiao , Wang Taiwei , Zu Wanting , Xu Tianxin , Du Lin , Wang Yiming , Nie Wenbo , Wang Lisheng
Published: July 2022

Background:

Graft-versus-host disease (GVHD) is a fatal complication of hematopoietic stem cell transplantation and is an enormous burden on the patient economy and related health systems. Nevertheless, only a few bibliometric studies have examined the direction of research and the major findings within the field.

Methods:

Statistical and visualization bibliometric analysis was performed in April 2021. Our research data were retrieved from the Web of Science using an advanced search strategy. We then used bibliometric analysis to determine the current general research direction and trend of publications and established the most prolific and distinguished authors, institutions, countries, funding agencies, and keywords in GVHD research. We employed VOSviewer (Leiden University, Leiden, Netherlands), Microsoft Excel (Microsoft, Redmond, State of Washington), and GunnMap (https://lert.co.nz/map/) to retrieve, integrate, and visualize the results.

Results:

Overall, 15,378 publications from 500 journals were extracted from the Institute for Scientific Information (ISI) Web of Science Core Collection database based on our analysis, of which the United States and the Fred Hutchinson Cancer Research Center were the most prolific countries and institutions, respectively. Moreover, we identified future research trends and the current status of GVHD research based on the top 10 most cited articles. Finally, influential authors’ analysis demonstrated that Blazar, BR were both the most productive and most cited among all authors.

Conclusion:

Our study provides an exhaustive and objective overview of the current status of GVHD research. This information would be highly beneficial to anyone seeking information on GVHD and would serve as a reference guide for researchers aiming to conduct further GVHD research.
Acquisition of new medical devices among the persistently critically ill: A retrospective cohort study in the Veterans Affairs
Authors: Viglianti Elizabeth M. , Carlton Erin F. , McPeake Joanne , Wang Xiao Qing , Seelye Sarah , Iwashyna Theodore J.
Published: July 2022

Patients who develop persistent critical illness remain in the ICU predominately because they develop new late-onset organ failure(s), which may render them at risk of acquiring a new medical device. The epidemiology and short-term outcomes of patients with persistent critical illness who acquire a new medical device are unknown.

We retrospectively studied a cohort admitted to the Veterans Affairs (VA) ICUs from 2014 to 2019. Persistent critical illness was defined as an ICU length of stay of at least 14 days. Receipt of new devices was defined as acquisition of a new tracheostomy, feeding tube (including gastrostomy and jejunostomy tubes), implantable cardiac device, or ostomy. Logistic regression models were fit to identify patient factors associated with the acquisition of each new medical device. Among hospitalized survivors, 90-day posthospitalization discharge location and mortality were identified.

From 2014 to 2019, there were 13,184 ICU hospitalizations in the VA which developed persistent critical illness. In total, 30.4% of patients (N = 3998/13,184) acquired at least 1 medical device during their persistent critical illness period. Patients with an initial higher severity of illness and prolonged hospital stay preICU admission had higher odds of acquiring each medical device. Among patients who survived their hospitalization, discharge location and mortality did not significantly differ among those who acquired a new medical device as compared to those who did not.

Less than one-third of patients with persistent critical illness acquire a new medical device and no significant difference in short-term outcomes was identified. Future work is needed to understand if the acquisition of new medical devices is contributing to the development of persistent critical illness.
Diagnostic value of 18F-FDG PET/CT in discriminating between benign and malignant lesions of the ribs
Authors: Choi Sunju , Kim Yong-il , Lee Geun Dong , Choi Sehoon , Kim Hyeong Ryul , Kim Yong-Hee , Kim Dong Kwan , Park Seung-Il , Ryu Jin-Sook
Published: July 2022

Purpose:

Imaging biomarkers for rib mass are needed to optimize treatment plan. We investigated the diagnostic value of metabolic and volumetric parameters from 18F-fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) in discriminating between benign and malignant lesions of the ribs.

Patients and methods:

Fifty-seven patients with pathologically proven diagnosis of rib lesions were retrospectively enrolled. The size of rib lesions, the maximum, mean, and peak standardized uptake value (SUVmax, SUVmean, SUVpeak), tumor-to-background ratio (TBR), metabolic tumor volume (MTV), and total lesions glycolysis (TLG) were measured. The FDG uptake patterns (segmental and discrete) and CT findings (soft tissue involvement and fracture) were also reviewed.

Results:

Among the multiple parameters extracted from PET/CT, the MTV of malignant lesions was significantly higher than that of benign lesions (median; 4.7 vs 0.2, respectively, P = .041). In receiver operating characteristics curve analysis, MTV had the largest area under curve of 0.672 for differentiating malignant from benign lesions. For identifying malignant lesions, an MTV threshold of 0.5 had a sensitivity of 85.0%, specificity of 47.1%, positive predictive value of 79.1%, negative predictive value of 57.1%, and accuracy of 73.7%. The presence of adjacent soft tissue involvement around rib lesions showed a significant association with malignancy (odds ratio = 6.750; 95% CI, 1.837–24.802, P = .003).

Conclusions:

The MTV is a useful PET/CT parameter for assisting in the differential diagnosis of suspected malignant lesions of the ribs. CT finding of adjacent soft tissue involvement around rib was significantly associated with malignant lesions of the ribs.
Matched-pair analysis of survival in patients with poorly differentiated versus well and moderately differentiated hypopharyngeal squamous cell carcinoma
Authors: Xia Xin , Liang Ya , Zhu Yingying , Zhu Xiaoli , Diao Wenwen , Chen Xingming
Published: July 2022

Hypopharyngeal squamous cell carcinoma (HPSCC) is among the most common malignances of the head and neck and is associated with a poor prognosis. Although both differentiation and tumor-node-metastasis stage affect tumor aggressiveness, the effect of differentiation on the prognosis of HPSCC at different stages is unclear. The aim of this study was to compare survival outcomes between patients with poorly differentiated versus well-differentiated and moderately differentiated HPSCC.

Patients with well/moderately differentiated and poorly differentiated HPSCC were matched based on age, sex, smoking status, alcohol use, comorbidity score, tumor stage, and therapeutic strategies. The Kaplan-Meier curve and Cox proportional hazards model were used to analyze survival. A total of 204 patients with newly diagnosed HPSCC were included after matching 102 well/moderately differentiated cases and 102 poorly differentiated cases from Peking Union Medical College Hospital.

Patients with well/moderately differentiated HPSCC had significantly better disease-specific survival (P = .003) and overall survival (P = .006) than patients with poorly differentiated HPSCC. Additionally, multivariable analysis indicated that increased differentiation was associated with a significantly reduced risk of overall death (adjusted hazard ratio, 0.51; 95% confidence interval, 0.34–0.78, P = .002), and death due to disease (adjusted hazard ratio, 0.44; 95% confidence interval, 0.28–0.69, P < .001).

Survival outcomes differed significantly between the well/moderately differentiated and poorly differentiated HPSCC patients. Treatment strategies based on the level of pathological differentiation might be necessary to improve survival outcomes in patients with HPSCC.
Is the incidence of sandwich vertebral fracture higher than that of ordinary adjacent vertebral fracture after PKP?
Authors: Yang Bo , Zhao Yu , Zhao Yangxue
Published: July 2022

Objective:

To compare the incidence of fracture between sandwich vertebra and ordinary adjacent vertebra after percutaneous kyphoplasty (PKP).

Method:

We analyzed 225 consecutive patients with osteoporotic vertebral compression fractures who underwent PKP between January 2016 and December 2020 at our medical institution. The sandwich vertebrae was located between 2 cement-augmented vertebra and was followed for at least 12 months. The clinical data of patients with sandwich vertebra and ordinary adjacent vertebra were recorded, and the incidence of postoperative fracture between sandwich vertebra and ordinary adjacent vertebra was compared.

Results:

The mean continuous follow-up time was 31.30 ± 18.04 months in patients with sandwich vertebra and 25.85 ± 7.96 months in patients with ordinary adjacent vertebra. It should be noted that the incidence of sandwich vertebral fractures was 10.00%, which was not statistically higher than 3.26% for ordinary adjacent vertebral fractures. However, a significant difference was observed in the cement volume of single vertebral body, procedure time, and bleeding.

Conclusion:

Although the volume of cement in a single vertebral body is less and the procedure time and bleeding are more, the incidence of sandwich vertebral fracture is not higher than that of ordinary adjacent vertebral body.
Preventing type 1 diabetes development and preserving beta-cell function
Authors: Mastrandrea Lucy D. , Quattrin Teresa
Published: July 2022

Purpose of review

Type 1 diabetes (T1D) is the most common chronic disease of childhood presenting a significant burden, both in terms of day-to-day medical management and lifelong care. Studies aligned with diverse strategies to prevent or modify the course of T1D are reviewed.

Recent findings

The diagnosis of T1D precedes the classic clinical presentation when insulin dependence develops. With an increased understanding of the pathophysiology of the autoimmune process leading to T1D, treatment strategies to prevent the development of autoimmunity and/or modify the immune response have been trialed in persons at risk for developing the disease. Interventions prior to insulin dependence or very early after clinical diagnosis show some promise both in preventing disease onset and prolonging beta-cell insulin production.

Significant progress has been made in the treatment of T1D. However, suboptimal glycemic control remains a challenge impacting overall health and quality of life for patients with this chronic disease. Although physicians and basic sciences investigators continue to pursue the prevention of the autoimmune process, the advent of disease-modifying agents is a promising strategy. Further studies are needed to ensure that insulin preservation can be achieved longer term.
The 1 mg overnight dexamethasone suppression test: a danger to the adrenal gland?
Authors: Vanek Chaim , Loriaux Lynn
Published: July 2022

Purpose of review

The 1 mg overnight dexamethasone suppression test (ONDST) with a cutoff cortisol value of 1.8 mcg/dl (50 nmol/l) is routinely used for the assessment of incidental, benign adrenal nodules. Patients with an abnormal test are diagnosed with mild autonomous cortisol secretion (MACS). This timely commentary reviews the origins of the ONDST, its relationship to the diagnoses of MACS, and whether this is clinically relevant for clinical care.

Recent findings

Millions of incidental adrenal nodules are found on CT scans annually. Several papers in the last three years discuss and advocate for the diagnose of MACS via the ONDST.

An ONDST cutoff of 1.8 mcg/dl (50 nmol/l) in patients with no clinical features of Cushing's syndrome will produce false positive results and a diagnosis of MACS that could result in unnecessary adrenalectomy.
Agreement and accuracy of shear-wave techniques (point shear-wave elastography and 2D-shear-wave elastography) using transient elastography as reference
Authors: Fernandes Flavia , Piedade Juliana , Freitas Gabriela , Area Philippe , Santos Ricardo , Grinsztejn Beatriz , Veloso Valdilea , Pereira Gustavo , Perazzo Hugo
Published: July 2022

Objective

We aimed to evaluate the agreement/accuracy of point shear-wave elastography (p-SWE) and 2D-shear-wave elastography (2D-SWE) for liver fibrosis staging using transient elastography (TE) as the reference.

Methods

This retrospective study analyzed data from people with chronic liver diseases submitted to TE, p-SWE, and 2D-SWE. Liver fibrosis stages were defined using the TE’s ‘rule of five’: normal (<5 kPa); suggestive of compensated-advanced chronic liver disease (cACLD) (10–15 kPa); highly suggestive of cACLD (15–20 kPa); suggestive of clinically significant portal hypertension (>20 kPa). Agreement and accuracy of p-SWE and 2D-SWE were assessed. Optimal cutoffs for p-SWE and 2D-SWE were identified using the point nearest to the upper left corner of the ROC curves.

Results

A total of 289 participants were included. The correlation between TE and 2D-SWE (rho = 0.59; P < 0.001) or p-SWE (rho = 0.69; P < 0.001) was satisfactory. The AUROCs (95% CI) of 2D-SWE and p-SWE for TE ≥ 5 kPa; TE ≥ 10 kPa; TE ≥ 15 kPa and TE ≥ 20 kPa were 0.757 (0.685–0.829) and 0.741 (0.676–0.806); 0.819 (0.770–0.868) and 0.870 (0.825–0.915); 0.848 (0.803–0.893) and 0.952 (0.927–0.978); 0.851 (0.806–0.896) and 0.951 (0.920–0.982), respectively. AUROCs of 2D-SWE were significantly lower compared with p-SWE for detecting cACLD. Optimal thresholds of 2D-SWE and p-SWE for TE ≥ 15 kPa were 8.82 kPa (sensitivity = 86% and specificity = 79%) and 8.86 kPa (sensitivity = 90% and specificity = 92%), respectively.

Conclusion

LSM by p-SWE and 2D-SWE techniques were correlated with TE. LSM by p-SWE seems to be more accurate than 2D-SWE to identify patients with more advanced fibrosis.
Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments
Authors: Fustiñana Ana , Yock-Corrales Adriana , Casson Nils , Galvis Laura , Iramain Ricardo , Lago Patricia , Da Silva Ana Paula Pereira , Paredes Fátima , Zamarbide María Pia , Aprea Valeria , Kohn-Loncarica Guillermo ,   on behalf of the Sepsis Working Group of the Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA)
Published: July 2022

Objective

Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour.

Methods

A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated.

Results

We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of “cold shock,” and 13% of “warm shock,” 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20–60 minutes) and 40 minutes (IQR, 20–60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30–135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59–278 minutes] vs 42 minutes [30–70 minutes], respectively [P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001).

Conclusions

We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.
Transcription factors dysregulated in three complex birth defects datasets
Authors: Chen Zhong-Zhong , Gao Yun-Qian , Xie Hua , Huang Yi-Chen , Chen Fang , Lei Yun-Ping
Published: July 2022

Objective:

To investigate the roles of transcription factors (TFs) in the etiology of complex human birth defects, including neural tube defects (NTDs), congenital heart diseases (CHDs), and hypospadias.

Methods:

We examined the overlap of genetically associated genes among NTDs, CHDs, and hypospadias. We then compared the expression profiles of these diseases based on all the detected genes and disease-associated TFs. The differentially expressed TFs that we obtained were further subjected to functional enrichment analysis to elucidate their role in the development of these birth defects.

Results:

TF genes were significantly enriched in complex birth defects (P = 5.95 × 10−24). NTDs, CHDs, and hypospadias showed distinct gene expression profiles compared with the controls. Although TFs could not efficiently separate CHDs from normal subjects, distinct gene expression profiles of TFs could distinguish NTDs and hypospadias from controls. Differentially expressed TFs can be used to characterize NTDs, hypospadias, and controls. The enriched TFs in biological processes (BPs) reflected the different morphological processes of NTDs, CHDs, and hypospadias.

Conclusions:

This study indicates that abnormal expression patterns of specific TFs may disrupt the normal requirements for developmental equilibrium through the related BPs. The investigation of genetically associated genes and gene expression profiles for the three different complex birth defects provides new insights into how the dysregulation of TFs influences their developmental process.
Measuring Quality of Life in Chronic Limb-threatening Ischemia Patients and Informal Carers: A Scoping Review
Authors: Shan Leonard L. , Shi Margaret D.Y. , Tew Michelle , Westcott Mark J. , Davies Alun H. , Choong Peter F.
Published: July 2022

Objective:

To review quality of life (QOL) instruments for chronic limb-threatening ischemia (CLTI) patients and informal carers, and their use in QOL and cost-utility analysis (CUA) studies.

Background:

CLTI is a global health problem with significant morbidity affecting patients and informal carers. QOL is increasingly measured for holistic outcomes assessment and CUA. However, measurement instruments in CLTI are poorly understood.

Methods:

MEDLINE, EMBASE, PsycINFO, CINAHL, COSMIN, PROQOLID, CEA registry, and NHS EED databases were searched for all English language studies up to May 2021. Features of instruments, evidence of measurement property appraisal, and trends in use were assessed. Prospective protocol registration (Open Science Framework: https://doi.org/10.17605/OSF.IO/KNG9U).

Results:

A total of 146 studies on QOL instruments (n=43), QOL outcomes (n=97), and CUA (n=9) were included. Four disease-specific QOL instruments are available for lower extremity arterial disease (intermittent claudication or CLTI). VascuQoL-25 and VascuQoL-6 have been used in CLTI. There is no CLTI-specific instrument. Of 14 generic instruments, SF-36, EQ-5D-3L, NHP, and WHOQOL-BREF were most common. Studies reporting partial measurement property appraisal favored VascuQoL-25, VascuQoL-6, and SF-36. Feasibility considerations include mode of administration and responder burden. None of 4 available carer-specific instruments have been used in CLTI. Since 1992, the number of QOL studies has increased considerably, but CUA studies are scarce. Informal carers have not been assessed.

Conclusions:

This review provides a comprehensive reference for QOL measurement in CLTI that helps end-users with instrument selection, use, and interpretation. However, a CLTI-specific instrument is needed. There is an opportunity to benefit society through future CUA studies and evaluation of QOL in informal carers.
Improved Re-estimation of Perioperative Cardiac Risk Using the Surgical Apgar Score: A Retrospective Cohort Study
Authors: Daza Julian F. , Bartoszko Justyna , Van Klei Wilton , Ladha Karim S. , McCluskey Stuart A. , Wijeysundera Duminda N.
Published: July 2022

Objective:

To assess whether the Surgical Apgar Score (SAS) improves re-estimation of perioperative cardiac risk.

Background:

The SAS is a novel risk index that integrates three relevant and easily measurable intraoperative parameters (blood loss, heart rate, mean arterial pressure) to predict outcomes. The incremental prognostic value of the SAS when used in combination with standard preoperative risk indices is unclear.

Methods:

We conducted a retrospective cohort study of adults (18 years and older) who underwent elective noncardiac surgery at a quaternary care hospital in Canada (2009–2014). The primary outcome was postoperative acute myocardial injury. The SAS (range 0–10) was calculated based on intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate documented in electronic medical records. Incremental prognostic value of the SAS when combined with the Revised Cardiac Risk Index was assessed based on discrimination (c-statistic), reclassification (integrated discrimination improvement, net reclassification index), and clinical utility (decision curve analysis).

Results:

The cohort included 16,835 patients, of whom 607 (3.6%) patients had acute postoperative myocardial injury. Addition of the SAS to the Revised Cardiac Risk Index improved risk estimation based on the integrated discrimination improvement [2.0%; 95% confidence interval (CI): 1.5%–2.4%], continuous net reclassification index (54%; 95% CI: 46%–62%), and c-index, which increased from 0.68 (95% CI: 0.65–0.70) to 0.75 (95% CI: 0.73–0.77). On decision curve analysis, addition of the SAS to the Revised Cardiac Risk Index resulted in a higher net benefit at all decision thresholds.

Conclusions:

When combined with a validated preoperative risk index, the SAS improved the accuracy of cardiac risk assessment for noncardiac surgery. Further research is needed to delineate how intraoperative data can better guide postoperative decision-making.
The Long-term Value of Bariatric Surgery Interventions for American Adults With Type 2 Diabetes Mellitus
Authors: Chaturvedi Ritika , Gracner Tadeja , Tysinger Bryan , Narain Kimberly , Goldman Dana , Sturm Roland
Published: July 2022

Background:

Bariatric surgery can cause type 2 diabetes (diabetes) remission for individuals with comorbid obesity, yet utilization is <1%. Surgery eligibility is currently limited to body mass index (BMI) ≥35 kg/m2, though the American Diabetes Association recommends expansion to BMI ≥30 kg/m2.

Objective:

We estimate the individual-level net social value benefits of diabetes remission through bariatric surgery and compare the population-level effects of expanding eligibility alone versus improving utilization for currently eligible individuals.

Methods:

Using microsimulation, we quantified the net social value (difference in lifetime health/economic benefits and costs) of bariatric surgery-related diabetes remission for Americans with obesity and diabetes. We compared projected lifetime surgical outcomes to conventional management at individual and population levels for current utilization (1%) and eligibility (BMI ≥35 kg/m2) and expansions of both (>1%, and BMI ≥30 kg/m2).

Results:

The per capita net social value of bariatric surgery-related diabetes remission was $264,670 (95% confidence interval: $234,527–294,814) under current and $227,114 (95% confidence interval: $205,300–248,928) under expanded eligibility, an 11.1% and 9.16% improvement over conventional management. Quality-adjusted life expectancy represented the largest gains (current: $194,706; expanded: $169,002); followed by earnings ($51,395 and $46,466), and medical savings ($41,769 and $34,866) balanced against the surgery cost ($23,200). Doubling surgical utilization for currently eligible patients provides higher population gains ($34.9B) than only expanding eligibility at current utilization ($29.0B).

Conclusions:

Diabetes remission following bariatric surgery improves healthy life expectancy and provides net social benefit despite high procedural costs. Per capita benefits appear greater among currently eligible individuals. Therefore, policies that increase utilization may produce larger societal value than expanding eligibility criteria alone.
Bilateral Simultaneous Nonarteritic Anterior Ischemic Optic Neuropathy: Demographics, Risk Factors, and Visual Outcomes
Authors: Chung Jennifer E. , Singaravelu Janani , Wilson Bradley S. , Baykal Annah P. , Lee Michael S. , McClelland Collin M. , Chen John J. , Bhatti M. Tariq , Melson Andrew T. , Van Stavern Gregory P.
Published: July 2022

Background:

Although nonarteritic anterior ischemic optic neuropathy is a well-known cause of vision loss, it typically presents unilaterally. Simultaneous, bilateral nonarteritic anterior ischemic optic neuropathy (sNAION) is rare and poorly studied in comparison. This study seeks to characterize the clinical features and risk factors of patients with sNAION compared with unilateral NAION (uNAION).

Methods:

In this retrospective case–control study, we reviewed 76 eyes (38 patients) with sNAION and 38 eyes (38 patients) with uNAION (controls) from 4 academic institutions examined between 2009 and 2020. Demographic information, medical history, medication use, symptom course, paraclinical evaluation, and visual outcomes were collected for all patients.

Results:

No significant differences were observed in demographics, comorbidities and their treatments, and medication usage between sNAION and uNAION patients. sNAION patients were more likely to undergo an investigative work-up with erythrocyte sedimentation rate measurement (P = 0.0061), temporal artery biopsy (P = 0.013), lumbar puncture (P = 0.013), and MRI (P < 0.0001). There were no significant differences between the 2 groups for visual acuity, mean visual field deviation, peripapillary retinal nerve fiber layer thickness, or ganglion cell-inner plexiform layer thickness at presentation, nor at final visit for those with ≥3 months of follow-up. The sNAION eyes with ≥3 months of follow-up had a smaller cup-to-disc ratio (CDR) at final visit (P = 0.033). Ten patients presented with incipient NAION, of which 9 suffered vision loss by final visit.

Conclusion:

Aside from CDR differences, the risk factor profile and visual outcomes of sNAION patients seem similar to those of uNAION patients, suggesting similar pathophysiology.
Quantitative genetic analysis of attractiveness of yeast products to Drosophila
Authors: Yan Weiru , Li Yishen , Louis Ed , Kyriacou Charalambos , Xie Xiaodong
Published: July 2022

The interaction between two model organisms, the fruit fly Drosophila melanogaster, and the budding yeast Saccharomyces cerevisiae, is widely perceived as mutually beneficial. The bridge of this biological connection is the volatile compounds from yeast fermentation, which can be attractive to the flies. The generation of volatile molecules derives from complex metabolism and different yeast will generate different combinations of volatiles. The attractiveness to fruit flies can therefore be considered a complex trait. In this study, six strains from SGRP were selected for fermenting commercial grape juice. The attractiveness of these ferments to a wild fruit fly line was then tested. Flies prefer the ferments of the Wine European (WE) strain over the North America (NA) strain. The preference assay was then applied to ferments of genotyped F1 progeny of WE crossed to NA for QTL mapping of genetic variation in attractiveness. GC-MS profiling of all ferments demonstrated that NA could be easily distinguished from other strains. 15 compounds were further quantified and the concentrations in F1 progeny ferments were correlated with genotypes using our r/QTL pipeline. Candidate genes from QTL mapping were tested by reciprocal hemizygosity analysis, validating the impact of two genes, PTC6 and YFL040W. The alleles of these validated genes from NA has better effect on the preference assay than the allele from WE, which is can be considered as antagonistic QTLs. The identification variation in these two genes underpinning metabolic differences, demonstrates how WE and NA have different attraction to one wild fruit fly line.
YML003w, a gene of unknown function, is required for spontaneous and UV-induced mutations
Authors: Li Yishen , Yan Weiru , Louis Ed
Published: July 2022

YML003w. a gene of unknown function is defined on a truncated gene in S288C. The next annotated ORF, YML002w, is therefore not expressed in S288C. Previous studies suggest that these two genes is a large ORF in wild type strains named VRL1. Based on our previous study, we speculate YML003w might be involved in a DNA repair process and its null mutant is sensitive to DNA damage agents. No spontaneous or UV induced mutations are seen in the deletion of YML003w, while overexpression of YML003w results in an increase in spontaneous and UV-induced mutations compared to the wild type frequencies. We then created a series of double deletion strains with yml003w- and other DNA repair related genes. The deletion of YML003w results in loss of spontaneous mutations in most deletions, with the exception of rad5- and mms2-. UV sensitivity of many of these mutants is reversed in the absence of YML003w. Our findings suggest that YML003w plays an important role in mutagenesis and UV sensitivity and potentially interacts with Rad5 mediated pathways.
Modifying Pavlovian-To-Instrumental Transfer By Approach Avoidance Training In Healthy Subjects – A Proof of Concept Study
Authors: Rosenthal Annika , Chen Ke , Beck Anne , Romanczuk-Seiferth Nina
Published: July 2022

The modulation of instrumental action by conditioned Pavlovian cues is hypothesized to play a role in the emergence and maintenance of maladaptive behavior. The Pavlovian-to-instrumental transfer (PIT) task is designed to examine the magnitude of the influence of cues on behavior and we aim to manipulate the motivational value of Pavlovian cues to reduce their effect on instrumental responding. To this end, we utilized a joystick-based modification of approach and avoidance propensities that has shown success in clinical populations. In 35 healthy subjects, we examined changes in PIT after completion of either avoidance training or sham training. We found no effect of training on approach avoidance propensities but higher response rate towards negative stimuli during PIT after systematic avoidance training compared to sham training. On the other hand, we saw an increased PIT effect after sham training. These results imply that training can alter the strength of the influence of cues on instrumental behavior and suggest training to be beneficial in reducing environmental triggers of maladaptive behavior.
Mapping protein-DNA interactions with DiMeLo-seq
Authors: Maslan Annie , Altemose Nicolas , Mishra Reet , Marcus Jeremy , Brennan Lucy D. , Sundararajan Kousik , Karpen Gary , Straight Aaron F. , Streets Aaron
Published: July 2022

We recently developedDirectedMethylation withLong-readsequencing (DiMeLo-seq) to map protein-DNA interactions genome wide. DiMeLo-seq is capable of mapping multiple interaction sites on single DNA molecules, profiling protein binding in the context of endogenous DNA methylation, identifying haplotype specific protein-DNA interactions, and mapping protein-DNA interactions in repetitive regions of the genome that are difficult to study with short-read methods. With DiMeLo-seq, adenines in the vicinity of a protein of interest are methylated in situ by tethering the Hia5 methyltransferase to an antibody using protein A. Protein-DNA interactions are then detected by direct readout of adenine methylation with long-read, single-molecule, DNA sequencing platforms such as Nanopore sequencing. Here, we present a detailed protocol and practical guidance for performing DiMeLo-seq. This protocol can be run on nuclei from fresh, lightly fixed, or frozen cells. The protocol requires 1-2 days for performing in situ targeted methylation, 1-5 days for library preparation depending on desired fragment length, and 1-3 days for Nanopore sequencing depending on desired sequencing depth. The protocol requires basic molecular biology skills and equipment, as well as access to a Nanopore sequencer. We also provide a Python package,dimelo, for analysis of DiMeLo-seq data.

Key papers

Altemose, N., Maslan, A., Smith, O.K., Sundararajan, K., Brown, R.R., Mishra, R., Detweiler, A.M., Neff, N., Miga, K.H., Straight, A.F. and Streets, A., 2022. DiMeLo-seq: a long-read, single-molecule method for mapping protein–DNA interactions genome wide.Nature Methods, pp.1-13. (https://doi.org/10.1038/s41592-022-01475-6)
Sharp cell-type-identity changes differentiate the retrosplenial cortex from the neocortex
Authors: Sullivan Kaitlin E. , Kraus Larissa , Wang Lihua , Stach Tara R. , Lemire Andrew L. , Clements Jody , Cembrowski Mark S.
Published: July 2022

The laminae of the neocortex are fundamental processing layers of the mammalian brain. Notably, such laminae are believed to be relatively stereotyped across short spatial scales, such that shared laminae between nearby brain regions exhibit similar constituent cells. Here, we considered a potential exception to this rule by studying the retrosplenial cortex (RSC), a brain region known for sharp cytoarchitectonic differences across its granular-dysgranular border. Using a variety of transcriptomics techniques, we identified, spatially mapped, and interpreted the excitatory cell-type landscape of the mouse RSC. In doing so, we surprisingly uncovered that RSC gene expression and cell types change sharply at the granular-dysgranular border. Additionally, supposedly homologous laminae between the RSC and neocortex are effectively wholly distinct in their cell-type composition. In collection, the RSC exhibits a variety of intrinsic cell-type specializations, and embodies a new neocortical organizational principle wherein cell-type identities vary sharply within and between brain regions.
Age at separation, residential mobility, and depressive symptoms among twins in late adolescence and young adulthood: a FinnTwin12 cohort study
Authors: Wang Zhiyang , Whipp Alyce , Heinonen-Guzejev Marja , Kaprio Jaakko
Published: July 2022

Objectives

Leaving the parental home at an early age represents a major life event for an adolescent and may predispose them to poor mental health. This study aims to examine the effect of age at separation and residential mobility (from residential records) on depressive symptoms among twins in late adolescence and young adulthood. Age at separation of twins in a twin pair was used as a proxy indicator for the age of leaving the parental home

Methods

The participants (n=3055) are from the FinnTwin12 cohort. Residential mobility consisted of the number and total distance of moves before age 17. First, we used linear regression to assess the association of age at separation and residential mobility with log-transformed General Behavior Inventory (GBI) scores at age 17 and in young adulthood. Then, the mixed model for repeated measures (MMRM) was used to visualize the GBI scores’ trajectory and test the associations, controlling for “baseline” state.

Results

In the adjusted linear regression, compared to twins separated before age 17, twins who separated in the later three groups all were significantly lower on log-transformed GBI scores at age 17. The two groups of twins who separated after age 19.5 scored lower GBIs in young adulthood. Compared to twins who never moved before age 17, moving twice led to a lower GBI score. In MMRM, twins who separated later all had lower GBI scores in young adulthood. Twins who moved twice or more had lower GBI scores in young adulthood.

Conclusion

The current study provides valid evidence of the family influence on depressive symptoms in later adolescence and young adulthood. A strong association between residential mobility and depressive symptoms was affirmed, although further research is still needed in the future.
Fractal-Thermodynamic System Analogy and Complexity of Plant Leaves
Authors: Vishnu M , Jaishanker R
Published: July 2022

More precise measurements of the complexity of leaf shapes can open new pathways to understanding plant adaptation and resilience in the face of changing environments. We present a method to measure the complexity of plant leaf shapes by relating their fractal dimensions to topological entropy. Our method relies on ‘segmental fractal complexity’ and stems from a fractal-thermodynamic system analogy. The complexity of plant leaf shapes is an algebraic combination of the fractal dimensions of the components of the leaf-image system. We applied this method to leaf forms of 30 tropical plant species. While topological entropy is positively correlated with the leaf dissection index, it is an improvement over the leaf dissection index because of its ability to capture the spatial positioning of the leaf lamina, the leaf edges, and the leaf background. The topological entropy method is also an advancement over conventional geometric and fractal dimension-based measures of leaf complexity because it does not entail information loss due to the pre-processing and is perceptibly simple.
Differential transport of a guild of mutualistic root aphids by the ant Lasius flavus
Authors: Parmentier Thomas
Published: July 2022

Mutually beneficial associations are widespread in ecological networks. They are typically assembled as multispecies guilds of symbionts that compete for one or more host species. The ant Lasius flavus engages in an intriguing and obligate mutualistic association with a community of aphids that are cultivated on plant roots in its nests. The ant displays a repertoire of amicable behaviours towards the aphids, including their transport. I examined whether L. flavus preferentially carried some of the root aphids. Using a no-choice and a choice experiment, I comparatively analysed the transport rate of five obligate and one loosely associated species back to the ant nest and used the transport rate of the ant larvae as a reference. All associated root aphids were carried back to the nest, but in a clear preferential hierarchy. Geoica utricularia, Forda Formicaria and Trama rara were rapidly transported, but slower than the own larvae. Tetraneura ulmi and Geoica setulosa were collected at a moderate rate and the loosely associated Aploneura lentisci was slowly retrieved. In contrast, different species of unassociated aphids were not transported and even provoked aggressive behaviour in L. flavus. This study revealed that co-occurring symbionts may induce different degrees of host attraction, which ultimately may affect the coexistence and assembly of ant-symbiont communities.
Beneficial Effects of Moderate Hepatic Activin A Expression on Metabolic pathways, Inflammation, and Atherosclerosis
Authors: Liu Huan , Hastings Margaret Hallauer , Kitchen Robert , Xiao Chunyang , Guerra Justin Ralph Baldovino , Kuznetsov Alexandra , Rosenzweig Anthony
Published: July 2022

BACKGROUND

Atherosclerosis is an inflammatory vascular disease marked by hyperlipidemia and hematopoietic stem cell (HSC) expansion. Activin A, a member of the Activin/GDF/TGFβ/BMP family is broadly expressed and increases in human atherosclerosis, but its functional effects in vivo in this context remain unclear.

METHODS

We studied LDLR-/- mice on a Western diet for 12 weeks and used adeno-associated viral vectors with a liver-specific thyroxine binding globulin (TBG) promoter to express Activin A or GFP (control). Atherosclerotic lesions were analyzed by oil red staining. Blood lipid profiling was performed by HPLC (High Performance Liquid Chromatography), and immune cells were evaluated by flow cytometry. Liver RNA-sequencing was performed to explore the underlying mechanisms.

RESULTS

Activin A expression decreased in both livers and aortae from LDLR-/- mice fed a Western diet compared with chow. AAV-TBG-Activin A increased Activin A hepatic expression (∼10-fold at 12-weeks, p<0.0001) and circulating Activin A levels (∼2000pg/ml vs ∼50pg/ml, p<0.001, compared with controls). Hepatic Activin A expression decreased plasma total and low-density lipoprotein (LDL) cholesterol (∼60% and ∼40%, respectively), reduced inflammatory cells in aortae and proliferating hematopoietic stem cells (HSC) in bone marrow, and reduced atherosclerotic lesion area in the aortic arch by ∼60%. Activin A also attenuated liver steatosis and expression of the lipogenesis genes, Srebp1 and Srebp2. RNA sequencing revealed Activin A not only blocked expression of genes involved in hepatic de novo lipogenesis but also fatty acid uptake, and liver inflammation. In addition, Activin A expressed in the liver also reduced white fat tissue accumulation, decreased adipocyte size, and improved glucose tolerance.

CONCLUSIONS

Our studies reveal hepatic Activin A expression reduces inflammation, HSC expansion, liver steatosis, circulating cholesterol, and fat accumulation, which likely all contribute to the observed protection against atherosclerosis. The reduced Activin A observed in LDLR-/- mice on a Western diet appears maladaptive and deleterious for atherogenesis.