bluuebunny/crossref_metadata_2025 huggingface dataset:
Analgesic dorsal root ganglionic field stimulation blocks conduction of afferent impulse trains selectively in nociceptive sensory afferents
Authors: Chao Dongman , Zhang Zhiyong , Mecca Christina M. , Hogan Quinn H. , Pan Bin
Published: July 2020

Increased excitability of primary sensory neurons after peripheral nerve injury may cause hyperalgesia and allodynia. Dorsal root ganglion field stimulation (GFS) is effective in relieving clinical pain associated with nerve injury and neuropathic pain in animal models. However, its mechanism has not been determined. We examined effects of GFS on transmission of action potentials (APs) from the peripheral to central processes by in vivo single-unit recording from lumbar dorsal roots in sham injured rats and rats with tibial nerve injury (TNI) in fiber types defined by conduction velocity. Transmission of APs directly generated by GFS (20 Hz) in C-type units progressively abated over 20 seconds, whereas GFS-induced Aβ activity persisted unabated, while Aδ showed an intermediate pattern. Activity generated peripherally by electrical stimulation of the sciatic nerve and punctate mechanical stimulation of the receptive field (glabrous skin) was likewise fully blocked by GFS within 20 seconds in C-type units, whereas Aβ units were minimally affected and a subpopulation of Aδ units was blocked. After TNI, the threshold to induce AP firing by punctate mechanical stimulation (von Frey) was reduced, which was reversed to normal during GFS. These results also suggest that C-type fibers, not Aβ, mainly contribute to mechanical and thermal hypersensitivity (von Frey, brush, acetone) after injury. Ganglion field stimulation produces use-dependent blocking of afferent AP trains, consistent with enhanced filtering of APs at the sensory neuron T-junction, particularly in nociceptive units.
Extracorporeal Life Support in Hemorrhagic Conditions: A Systematic Review
Authors: Willers Anne , Swol Justyna , Kowalewski Mariusz , Raffa Giuseppe Maria , Meani Paolo , Jiritano Federica , Matteucci Matteo , Fina Dario , Heuts Samuel , Bidar Elham , Natour Ehsan , Sels Jan Willem , Delnoij Thijs , Lorusso Roberto
Published: July 2020

Extracorporeal life support (ECLS) is indicated in refractory acute respiratory or cardiac failure. According to the need for anticoagulation, bleeding conditions (e.g., in trauma, pulmonary bleeding) have been considered a contraindication for the use of ECLS. However, there is increasing evidence for improved outcomes after ECLS support in hemorrhagic patients based on the benefits of hemodynamic support outweighing the increased risk of bleeding. We conducted a systematic literature search according to the PRISMA guidelines and reviewed publications describing ECLS support in hemorrhagic conditions. Seventy-four case reports, four case series, seven retrospective database observational studies, and one preliminary result of an ongoing study were reviewed. In total, 181 patients were identified in total of 86 manuscripts. The reports included patients suffering from bleeding caused by pulmonary hemorrhage (n = 53), trauma (n = 96), postpulmonary endarterectomy (n = 13), tracheal bleeding (n = 1), postpartum or cesarean delivery (n = 11), and intracranial hemorrhage (n = 7). Lower targeted titration of heparin infusion, heparin-free ECLS until coagulation is normalized, clamping of the endotracheal tube, and other ad hoc possibilities represent potential beneficial maneuvers in such conditions. Once the patient is cannulated and circulation restored, bleeding control surgery is performed for stabilization if indicated. The use of ECLS for temporary circulatory or respiratory support in critical patients with refractory hemorrhagic shock appears feasible considering tailored ECMO management strategies. Further investigation is needed to better elucidate the patient selection and ECLS management approaches.
Nocturnal Gastroesophageal Reflux Disease (GERD) and Sleep
Authors: Shibli Fahmi , Skeans Jacob , Yamasaki Takahisa , Fass Ronnie
Published: July 2020

Gastroesophageal reflux disease (GERD) is a prevalent, chronic medical condition that affects 13% of the adult population globally at least once a week. Sleep disturbances are frequently encountered in up to 25% of the GERD patients, likely due to nocturnal gastroesophageal reflux (GER). With advance in diagnostic techniques allowing for an improved understanding of involved physiological mechanisms of nocturnal reflux, there is growing evidence of a bidirectional relationship between GERD and sleep disturbances. Furthermore, nocturnal GER is associated with more complicated GERD. Obstructive sleep apnea (OSA) and GERD also have been linked, but to what degree remains controversial. Treatment of nocturnal GER has been shown to improve both subjective and objective sleep measures. The therapeutic approach includes lifestyle modifications and medication individualization and optimization with proton-pump inhibitors serving as the mainstay of treatment. Antireflux surgery and newer endoscopic procedures have been demonstrated to control nocturnal GER.
Assessment of muscle mass in critically ill patients: role of the sarcopenia index and images studies
Authors: Lopez-Ruiz Arnaldo , Kashani Kianoush
Published: July 2020

Purpose of review

Sarcopenia is a progressive generalized decline in skeletal muscle mass, strength, and function. This condition is highly prevalent in critically ill patients and is associated with poor outcomes in the ICU. In this review, we describe the use, evidence, and limitations of the most common validated imaging studies used to assess muscle mass in ICU, and we provide an overview of the benefits of using the sarcopenia index [(serum creatinine/serum cystatin C) × 100]) in the ICU.

Recent findings

Currently, the determination of muscle mass using anthropometric measurements and serum biomarkers is unreliable. Several new techniques, including a dual-energy X-ray absorptiometry, computed tomography scan, ultrasonography, and bioimpedance analysis, have been studied and validated for the diagnosis and prognosis of sarcopenia in the ICU. However, these techniques are often not accessible for the majority of critically ill patients. The sarcopenia index constitutes an accurate method to diagnose sarcopenia, predict ICU outcomes, and nutritional status in critically ill patients.

Diagnosis of sarcopenia has substantial implications in ICU patients. Choosing the correct test to identify patients who may need preventive or therapeutic support for this condition will favorably impact ICU outcomes.
Clinical trials in group 3 pulmonary hypertension
Authors: Harder Eileen M. , Waxman Aaron B.
Published: July 2020

Purpose of review

Despite worse outcomes associated with the development of pulmonary hypertension in chronic lung disease, there are no approved treatments for this population. The present review summarizes the recent clinical trials in World Symposium on Pulmonary Hypertension (WSPH) Group 3 pulmonary hypertension, with a particular focus on the study of pulmonary arterial hypertension (PAH)-targeted therapy.

Recent findings

Multiple recent randomized controlled trials have studied a host of PAH-specific medications in the treatment of WSPH Group 3 pulmonary hypertension, including endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclins. In pulmonary hypertension associated with chronic obstructive lung disease (PH-COPD) and with interstitial lung disease (PH-ILD), most trials have shown conflicting or negative results, although they have been limited by variable patient populations and small sample sizes. Recent large-scale trial data demonstrate that inhaled treprostinil is associated with improved outcomes in the PH-ILD population.

Although most PAH medications have not shown consistent benefit in the WSPH Group 3 population, recent work suggests that inhaled treprostinil has an important role in the treatment of PH-ILD. Efforts are ongoing to evaluate the efficacy of other medications, identify optimal treatment candidates, and define clinically meaningful endpoints in WSPH Group 3 pulmonary hypertension.
Therapeutic options for chronic kidney disease-associated pulmonary hypertension
Authors: Edmonston Daniel L. , Sparks Matthew A.
Published: July 2020

Purpose of review

Pulmonary hypertension is a common and devastating complication of chronic kidney disease (CKD). Traditionally considered a consequence of volume overload, recent findings now expand this paradigm. These novel mechanisms herald new treatment options. This review summarizes the current evidence to provide a theoretical model of the contributing factors for CKD-associated pulmonary hypertension. Along this framework, we highlight current and emerging therapeutic strategies for each putative factor.

Recent findings

A series of retrospective studies of right heart catheterization data provide insights into the potential hemodynamic profile of CKD-associated pulmonary hypertension. These studies suggest that elevated pulmonary vascular resistance may commonly contribute to pulmonary hypertension. In addition, preclinical models implicate an increasing array of CKD-associated factors which influence pulmonary vascular biology. Many of these factors also adversely affect kidney function and CKD progression. Clinical trial and other prospective data for treatments of CKD-associated pulmonary hypertension remain limited.

Volume overload and left-ventricular dysfunction are the predominant focus of CKD-associated pulmonary hypertension treatment for most patients. However, new findings suggest that treatments targeting pulmonary vascular vasoconstriction and remodeling may be promising treatment options for select patients. Clinical trials are needed for all therapeutic strategies for CKD-associated pulmonary hypertension.
Efficacy and Toxicity of 5-Fluorouracil–Oxaliplatin in Gastroenteropancreatic Neuroendocrine Neoplasms
Authors: Merola Elettra , Dal Buono Arianna , Denecke Timm , Arsenic Ruza , Pape Ulrich-Frank , Jann Henning , Wiedenmann Bertram , Pavel Marianne E.
Published: July 2020

Objectives

The objective of this study was to investigate the efficacy and tolerability of 5-fluorouracil–oxaliplatin (FOLFOX) in advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs).

Methods

Retrospective analysis of consecutive 72 advanced GEP-NENs treated with FOLFOX between 2005 and 2016 at a single German referral center for NENs was performed. We assessed treatment response by response evaluation criteria in solid tumors 1.0 criteria, progression-free survival by Kaplan-Meyer method, and risk factor analysis by Cox-regression model.

Results

Patients were 44.5% G1/G2, 55.5% G3, receiving a median of 7 treatment cycles (range, 2–21), and had a median of 18 months of follow-up (range, 3–111 months). Disease control was achieved in 75.0% of cases but 91.3% in the 23 patients receiving FOLFOX as first line (P = 0.04). Median progression-free survival of the overall population was 8 months. A better outcome was significantly related to treatment duration (P = 0.02) and grade of histological differentiation for G3 patients (well differentiated vs poorly differentiated, P = 0.03). Adverse events occurred in 88.8% of patients, mostly grade 1 and 2 hematotoxicity and chemotherapy-induced peripheral sensory neuropathy (84.1% and 50.0% of patients, respectively).

Conclusions

Our results support FOLFOX as therapeutic option in advanced GEP-NENs with poor prognosis, either at first or further therapy line. Longer duration of therapy was associated with a more durable benefit.
Functional β-Cell Differentiation of Small-Tail Han Sheep Pancreatic Mesenchymal Stem Cells and the Therapeutic Potential in Type 1 Diabetic Mice
Authors: Zhang Shuang , Yin Jiahui , Ji Hongbing , Wang Qi , Yang Qin , Lai Junhui , Sun Yuchen , Guan Weijun , Chen Peijie
Published: July 2020

Objectives

This study aims to investigate the characteristics of sheep pancreatic mesenchymal stem cells (PSCs) and therapeutic potential of differentiated β-like cells in streptozotocin-induced diabetic mice.

Methods

Pancreatic mesenchymal stem cells were isolated from 3- to 4-month-old sheep embryos, and their biological characteristics were explored. The function and therapeutic potential of differentiated β-like insulin-producing cells were also investigated in vitro and in vivo. Differentiated cells were identified through dithizone staining and immunofluorescence staining. Insulin secretion was analyzed using an enzyme-linked immunosorbent assay kit. The preliminary therapeutic potential of induced β-like cells in diabetic mice was detected by blood glucose and body weight.

Results

Primary PSCs were isolated and subcultured up to passage 36. Immunofluorescence staining presented PSC-expressed important markers such as Pdx1, Nkx6-1, Ngn3, and Nestin. Primary PSCs could be induced into functional pancreatic β-like islet cells with a 3-step protocol. The induced β-like islet cells could ameliorate blood glucose in diabetic mice.

Conclusions

The method proposed for generating pancreatic islet β cells provided a preliminary phenotypic investigation of induced cell treatment in diabetic mice, and also laid a foundation in the identification of pharmaceutical targets to treat insulin-dependent diabetes.
Diagnostic Value of Serum Amylase Levels Indicating Computed Tomography–Defined Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Authors: Inatomi Osamu , Bamba Shigeki , Nakai Yoshitaka , Kusumoto Kiyonori , Kawakami Takumi , Suzuki Takahiro , Suzuki Azumi , Endoh Bunji , Ota Shinichi , Inoue Akitoshi , Itokawa Yoshio , Chikugo Koki , Andoh Akira , Mizumoto Yoshinori , Tanaka Kiyohito
Published: July 2020

Objective

Post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis involves persistent serum amylase levels of 3 times or more the standard upper limit. However, these criteria were mostly based on retrospective studies and not necessarily supported by diagnostic imaging. Our prospective study aimed to investigate cutoff serum amylase levels suggesting post-ERCP pancreatitis using computed tomography as the criterion standard.

Methods

We prospectively followed 2078 cases. Computed tomography was performed in patients whose serum amylase levels exceeded the institutional upper limit 12 to 24 hours after ERCP. Two expert radiologists blindly assessed the images and judged the presence or absence of pancreatitis. Correlations between serum amylase levels with pancreatitis were investigated using receiver operating characteristic analysis.

Results

Amylase levels increased in 416 (23.2%) of 1789 cases included, and 350 cases were analyzed using computed tomography. Post–endoscopic retrograde cholangiopancreatography pancreatitis was diagnosed in 12.0% (214/1789). The cutoff amylase levels for judging pancreatitis after 12 to 24 hours was 2.75 times higher than the institutional upper limit, with an area under the curve of 0.77.

Conclusions

The appropriate cutoff serum amylase level for judging post-ERCP pancreatitis at 12 to 24 hours after ERCP was 2.75 times higher than the institutional upper limit. These results may clarify the definition of post-ERCP pancreatitis.
Angiotensin-(1–7) Treatment Restores Pancreatic Microcirculation Profiles
Authors: Wang Xueyan , Liu Mingming , Hu Weikai , Cui Tianyu , Yu Xiaozheng , Liu Ruixia , Yin Chenghong
Published: July 2020

Objectives

The aim of this study was to investigate the changes of pancreatic microvascular vasomotion and blood distribution pattern in acute pancreatitis (AP), and whether Angiotensin (Ang)-(1–7) treatment could restore pancreatic microcirculation profiles.

Methods

Mice were randomly separated into control, AP, and Ang-(1–7)-treated AP (A-AP) group. Acute pancreatitis was induced in mice by intraperitoneal injection of cerulein and lipopolysaccharide. Pancreatitis was confirmed by histopathology, serum amylase, and high-sensitive C-reactive protein. Pancreatic microvascular vasomotion and blood distribution pattern in AP progression were assessed by laser Doppler. Meanwhile, ultrastructural changes of pancreatic microcirculation, including microvascular cavity and wall and endothelial mitochondria, were evaluated by transmission electron microscopy.

Results

Acute pancreatitis mice exhibited pathological pancreatic injuries with lower blood distribution pattern and decreased average blood perfusion, relative velocity, effective frequency, and amplitude of microvascular vasomotion. The pancreatic pathological injuries in Ang-(1–7)-treated mice were significantly alleviated. Consistently, Ang-(1–7) treatment led to a restoration in pancreatic microcirculation profiles. Furthermore, non–Ang-(1–7)-treated mice showed an irregular microvascular wall, narrow cavity, and swelling mitochondria, and these ultrastructural impairments were reversed by Ang-(1–7) administration.

Conclusions

Pancreatic microcirculation profiles are abnormal in the progression of AP. Angiotensin-(1–7) administration could restore functional status of pancreatic microcirculation.
Intimate Partner Violence Among Patients Diagnosed With Severe Mental Disorder
Authors: Tasa-Vinyals Elisabet , Álvarez María-José , Puigoriol-Juvanteny Emma , Roura-Poch Pere , García-Eslava Jairo Santiago , Escoté-Llobet Santiago
Published: July 2020

Intimate partner violence (IPV) has a remarkable impact on mental health and is common in people diagnosed with severe mental disorders (SMDs). Data of 102 outpatients were collected from clinical records and the Traumatic Life Events Questionnaire (TLEQ). Global estimation of lifetime IPV exposure was obtained by combining answers to selected TLEQ questions about physical, psychological, and sexual IPV. Overall, 24.5% of the participants reported at least one lifetime episode of IPV victimization. Female gender (odds ratio [OR] = 3.15, p = 0.016) and childhood trauma (OR = 4.7, p = 0.002) significantly increased the likelihood of IPV victimization. Conversely, posttraumatic stress disorder was not significantly increased in IPV victims. These findings are in line with current literature and suggest a remarkable and transdiagnostic prevalence of lifetime IPV victimization in SMD. Gender, childhood trauma, and SMD are relevant factors in IPV analysis and prevention. Diathesis of trauma, psychosocial vulnerability to revictimization and intersectional feminist theory help explain our results.
Increasing Confidence Through the Development of a Transition-to-Practice Orientation Program for the Experienced Nurse
Authors: Montgomery Tiffany , Harshman Jenny , Kennedy Sarah , Richards Kendel , Shaw Martha
Published: July 2020

A formalized orientation program for experienced nurses was modeled after a program for new graduate nurses. Within a year, experienced nurses rotated through teaching stations, including simulations of shock and respiratory failure. Participants completed pre- and postsurveys and scored self-confidence on a Likert scale. Surveys showed a significant increase in participants’ confidence related to elements in their new role. Future plans include a retention rate comparison of participants in this program versus nonparticipants.
HPV-independent Precursors Mimicking High-grade Squamous Intraepithelial Lesions (HSIL) of the Vulva
Authors: Rakislova Natalia , Alemany Laia , Clavero Omar , del Pino Marta , Saco Adela , Marimon Lorena , Quirós Beatriz , Lloveras Belen , Ribera-Cortada Inmaculada , Alejo Maria , Pawlita Michael , Quint Wim , de Sanjose Silvia , Ordi Jaume
Published: July 2020

Two etiopathogenic types of vulvar squamous cell carcinoma (VSCC) have been described: human papillomavirus (HPV)-associated and HPV-independent. Precursor lesions, frequently identified in the adjacent skin, are also distinct in the 2 types of VSCC: high-grade squamous intraepithelial lesions (HSILs) in HPV-associated VSCC and differentiated vulvar intraepithelial neoplasia (dVIN) or vulvar acanthosis with altered differentiation in HPV-independent VSCC. Although HPV-independent precursors mimicking HSIL have been described in the vulva, their frequency and morphologic spectrum have not been completely characterized. We explored, in a large series of HPV-independent VSSC, the frequency and the histologic features of precursors mimicking HSIL. We included 779 DNA HPV-negative/p16-negative VSCC with at least 1 cm of adjacent skin. We evaluated the histologic and immunohistochemical (p16 and p53) characteristics of the intraepithelial lesions, focusing on precursors mimicking HPV-associated vulvar HSIL. A total of 254 tumors (33%) had adjacent premalignant lesions. Of them, 186 (73%) had dVIN, 22 (9%) had vulvar acanthosis with altered differentiation, and 46 (18%) had lesions that mimicked HSIL. The mean age of the patients with these HSIL-like lesions was 72±15 years. Twenty-six of these HSIL-like lesions had basaloid morphology, 13 warty, and 7 mixed basaloid/warty features. All the HSIL-like precursors were DNA HPV-negative/p16-negative; 74% of them showed p53 abnormal staining and 35% of them had areas of conventional dVIN. In conclusion, about one fifth of the HPV-independent precursors mimic HSIL, showing either basaloid or warty features. Older age and the presence of areas of typical HPV-independent intraepithelial lesions, together with p16 negativity, should raise suspicion of an HPV-independent etiology.
Reliance on Acute Care Settings for Health Care Utilization
Authors: Goyal Monika K. , Richardson Troy , Masonbrink Abbey , Reed Jennifer L. , Alpern Elizabeth R. , Hall Matt , Neuman Mark I.
Published: July 2020

Objective

Because a goal of the Affordable Care Act was to increase preventive care and reduce high-cost care, the objective of this study was to evaluate current health care use and reliance on acute care settings among Medicaid-enrolled children.

Methods

This was a retrospective cohort study of the 2015 Truven Marketscan Medicaid claims database among children 0 to 21 years old with at least 11 months of continuous enrollment. We calculated adjusted probabilities of health care use (any health care use and ≥1 health maintenance visit) and high acute care reliance (ratio of emergency department or urgent care visits to all health care visits >0.33) by age and compared use between adolescents and younger children using multivariable logistic regression.

Results

Of the 5,182,540 Medicaid-enrolled children, 18.9% had no health care visits and 47.3% had 1 or more health maintenance visit in 2015. Both health care use and health maintenance visits decreased with increasing age (P < 0.001). Compared with younger children (0–10 years old), adolescents were more likely to have no interaction with the health care system [adjusted odds ratio (aOR), 2.20; 95% confidence interval (CI), 2.19–2.21] and less likely to have health maintenance visits (aOR, 0.40; 0.39–0.40). High acute care reliance was associated with increasing age, with adolescents having greater odds of high acute care reliance (aOR, 1.08; 1.08–1.09).

Conclusions

Medicaid-enrolled adolescents have low rates of health care use and have high reliance on acute care settings. Further investigation into adolescent-specific barriers to health maintenance care and drivers for acute care is warranted.
Starvation Ketosis in the Pediatric Emergency Department
Authors: Millar Robert , Chiappazzo Amelia , Palmer Bethany
Published: July 2020

Objectives

Starvation ketosis may occur in children during intercurrent illnesses due to metabolic adaptation to fasting, resulting in significant ketonemia and sometimes ketoacidosis. Also known as accelerated starvation, common symptoms are vomiting, lethargy, and seizures. Previous studies found the prevalence of ketotic hypoglycemia to be 4 per 100,000 presentations to the emergency department (ED). We hypothesized that the prevalence had been underestimated due to the retrospective nature and restricted definitions of previous studies. Our aim was to determine if a prospective study would confirm a higher prevalence of starvation ketosis in pediatric patients presenting to the ED.

Methods

A prospective observational study of consecutive patients was performed in an urban pediatric ED utilizing point-of-care testing of capillary blood glucose and ketones in symptomatic children.

Results

This study found the prevalence of clinically significant ketosis (defined as beta-hydroxybutyrate 2.5 mmol/L or more) to be approximately 1800 per 100,000 ED presentations, with more than 170 per 100,000 also being hypoglycemic. Affected patients were 3 months to 9 years of age. Fifty-five percent of the presentations were boys, and 56% were under the 50th centile for weight.

Conclusions

This prospective observational study using a targeted testing regimen found the prevalence of both starvation ketosis and hypoglycemia to be much greater than previous studies which used retrospective analyses. A simple capillary test for ketones should be considered in unwell children younger than 10 years who present with vomiting or lethargy, as this may identify the need for specific therapy to resolve ketosis.
Making the Most of Big Data in Plastic Surgery
Authors: Gibson John A. G. , Dobbs Thomas D. , Kouzaris Loukas , Lacey Arron , Thompson Simon , Akbari Ashley , Hutchings Hayley A. , Lineaweaver William C. , Lyons Ronan A. , Whitaker Iain S.
Published: July 2020

In medicine, “big data” refers to the interdisciplinary analysis of high-volume, diverse clinical and lifestyle information on large patient populations. Recent advancements in data storage and electronic record keeping have enabled the expansion of research in this field. In the United Kingdom, Big data has been highlighted as one of the government's “8 Great Technologies,” and the Medical Research Council has invested more than £100 million since 2012 in developing the Health Data Research UK infrastructure. The recent Royal College of Surgeons Commission of the Future of Surgery concluded that analysis of big data is one of the 4 most likely avenues to bring some of the most innovative changes to surgical practice in the 21st century.

In this article, we provide an overview of the nascent field of big data analytics in plastic and highlight how it has the potential to improve outcomes, increase safety, and aid service planning.

We outline the current resources available, the emerging role of big data within the subspecialties of burns, microsurgery, skin and breast cancer, and how these data can be used. We critically review the limitations and considerations raised with big data, offer suggestions regarding database optimization, and suggest future directions for research in this exciting field.
Characterization of Face Transplant Candidates Evaluated at Cleveland Clinic and Algorithm to Maximize Efficacy of Screening Process
Authors: Knackstedt Rebecca , Siemionow Maria , Papay Frank , Djohan Risal , Priebe Debra , Gastman Brian
Published: July 2020

Introduction

As a high-volume referral center for facial transplantation, we have learned significantly from the screening, evaluation, and enrollment process. This report analyzes our algorithm for the assessment of potential face transplant candidates referred to our institution.

Methods

After institutional review board approval in 2004, a prospectively maintained database was created for patients who were referred face transplant. Records were reviewed for the nature of tissue defect, functional deficit, surgical and medical history, and expert recommendations.

Our algorithm begins with a review of a patient's file with a focus on institutional review board criteria. After screening, a phone interview is conducted, and transplantation is discussed. Patients are presented to the team to analyze the medical, psychiatric, and surgical history; support network; and geographic location. Eligible patients are invited for an in-person evaluation, and the case is reviewed again with the team. If approved, the patient can provide consent for transplantation.

Results

More than 200 patients were referred for transplant evaluation at the Cleveland Clinic from 2004 to 2016. Sixty were eligible for further evaluation for face transplantation based on preliminary screening. Thirteen (6.5% of original cohort) were invited for in-person evaluation and physical examination. Five (2.5% of original cohort, 38.4% invited cohort) of these 13 patients underwent face transplantation, of whom, 3 (1.5% of original cohort, 23.1% invited cohort) underwent face transplantation at our institution. All 3 patients who were ultimately transplanted were referred by a physician.

Discussion

As the availability of public information on face transplant increases, it is likely that an increase in self-referral for face transplantation will occur. Thus, it is critical that institutions adopt a systematic approach to triage in order to identify appropriate patients. Our algorithm allowed for a high enrollment and transplantation ratio to save patient and institution time and resources. This could be easily adopted by other institutions to save time, money, and resources.
New Solutions to Improve the Accuracy of the Navigation-Guided Foreign Body Removal in Craniomaxillofacial Deep Space
Authors: Zhang Chuxi , Wu Jinyang , Yang Chengshuai , Liu Nian , Hui Wenyu , Zhang Yong , Zhang Shilei
Published: July 2020

Objective:

Surgical navigation-guided removal of foreign bodies in the craniomaxillofacial region has been proven to be an effective method. However, there have been some unsuccessful patients due to reduced navigation accuracy or complicated and undetectable anatomy. This article summarizes the experience and proposes some solutions to achieve better results.

Study design:

Two solutions were proposed to optimize the surgical navigation procedure: using a 3-dimensionally printed customized mandible retainer to indirectly maintain the consistency of the foreign body's visual images of preoperative planning and intraoperative navigation and importing real-time endoscopic imaging during surgery to provide vision under complex anatomy. Two patients were selected for each method.

Results:

The foreign bodies were successfully and minimally invasively removed in all patients assisted by optimized surgical navigation. During follow-up at 3 to 6 months postoperatively, no complications were found.

Conclusion:

Improving navigation accuracy and providing real vision might be effective at compensating for insufficient navigation due to navigation positioning errors or the interference of imperceptible and complicated anatomy.
Combination Laser Treatment With Real-Time Ultrasound Navigation for Oral Venous Malformations
Authors: Noguchi Tadahide , Konno Yu , Sugiura Yasushi , Dohi Akihiro , Okada Naruo , Sasaguri Ken-ichi , Oyatsu Yukio , Fujita Akifumi , Miyazaki Hidetaka , Mori Yoshiyuki
Published: July 2020

Vascular lesions, including hemangiomas and vascular malformations, are common benign diseases. More than 50% originate from blood vessels or vascular structures and are locate in the head and neck region. This study aimed to evaluate the efficiency and safety of a combination of laser treatments for oral venous malformations using ultrasound navigation. This study reports 3 cases of massive vascular malformation in the oral cavity, which were treated by a combination of a multiple spotted transmucosal irradiation technique (the so-called leopard technique) for the superficial layer, and intralesional photocoagulation for the deep layer using a neodymium-doped yttrium aluminum garnet laser, under real-time ultrasound navigation. All cases presented with a venous malformation with multiple blue swellings on the dorsum of the tongue, which had a maximum dimension of over 30 mm. The percent reduction in the size of the lesions was determined by magnetic resonance imaging. All cases showed a decrease in lesion volume of over 80%, without extensive tissue necrosis, 6 to 12 months after the laser treatment. None of the patients experienced any complications, and all were satisfied with the treatment outcome after one irradiation session.

The results of this study suggest that laser treatment using ultrasound navigation is a promising approach for the safe and minimally invasive resolution of oral vascular lesions without scarring and loss of normal tissue architecture, sensation, oral function.
Comparison of Glenoid Fossa Morphology Between Different Sagittal Skeletal Pattern Using Cone Beam Computed Tomography
Authors: Khademi Bahar , Karandish Maryam , Paknahad Maryam , Farmani Somaye
Published: July 2020

Morphology of glenoid fossa might help the clinician in the diagnosis, establishing more biological treatment modalities and treatment response between patients with different skeletal malocclusions. This study aimed to assess the glenoid fossa morphology in different sagittal facial types using CBCT. The CBCT images of 64 patients with normal vertical growth patterns were classified into class I, class II, and class III based on the skeletal sagittal analysis. Depth, width, and angle of glenoid fossa were measured and assessed on CBCT images. One-way analysis of variance (ANOVA) and Tukey post-hoc test were used to compare mean values among the groups. There was a significant statistical difference in means of glenoid fossa’ width between groups with skeletal class III and skeletal class I (P value: 0.038). However, no significant statistical differences were found in angle(P value = 0.18) and depth (P value = 0.40) of glenoid fossa among 3 groups. This study showed the glenoid fossa in class I patients was wider than class III patients. There were no statistically significant differences in the angle and depth of glenoid fossa in patients with a different sagittal skeletal pattern.
β-amyloid-induced gonadotropin-releasing hormone decline involving Forkhead transcription factor FOXO3a and nuclear factor-κB
Authors: Shi Chun , Shi Rongjie , Guo Han , Shi Yuchen , Liu Xintong
Published: July 2020

Previously, it has been demonstrated that aging is controlled by the hypothalamus, and that hypothalamus-driven programmatic aging is associated with nuclear factor-κB (NF-κB)-mediated gonadotropin-releasing hormone (GnRH) decrease. Abundant accumulation of β-amyloid (Aβ) has been observed in brains of cognitively normal elderly. However, it is unclear whether Aβ neurotoxicity is involved in aging-associated hypothalamic GnRH decline. GT1-7 cells, which are a cell line of hypothalamic GnRH neurons, were used in the current study to investigate whether and how Aβ decreased GnRH release. The results of the current study demonstrated that Aβ impaired the release of GnRH through activation of NF-κB. Mechanistic studies revealed that Aβ activated NF-κB via Forkhead box protein O3a, thereby inhibitinggnrh1gene. The results of the present study provided novel insights into the mechanisms underlying aging-dependent hypothalamic GnRH decline.
Lichenicoccus roseus gen. nov., sp. nov., the first bacteriochlorophyll a-containing, psychrophilic and acidophilic Acetobacteraceae bacteriobiont of lichen Cladonia species
Authors: Pankratov Timofey A. , Grouzdev Denis S. , Patutina Ekaterina O. , Kolganova Tatiana V. , Berestovskaya Julia J. , Ashikhmin Aleksandr A.
Published: July 2020

Gram-negative, aerobic, chemo-organotrophic and bacteriochlorophyll a-containing bacterial strains, KEBCLARHB70RT, KAMCLST3051 and KAMCLST3152, were isolated from the thalli of Cladonia arbuscula and Cladonia stellaris lichens. Cells from the strains were coccoid and reproduced by binary division. They were motile at the early stages of growth and utilized sugars and alcohols. All strains were psychrophilic and acidophilic, capable of growth between pH 3.5 and 7.5 (optimum, pH 5.5), and at 4–30 °C (optimum, 10–15 °C). The major fatty acids were C18 : 1
 ω7c and C18 : 0; the lipids were phosphatidylcholines, phosphatidylethanolamines, phosphatidic acids, phosphatidylglycerol, glycolipids, diphosphatidylglycerol and polar lipids with an unknown structure. The quinone was Q-10. The DNA G+C content was 67.8 mol%. Comparative 16S rRNA gene analysis together with other data, supported that the strains, KEBCLARHB70RT, KAMCLST3051 and KAMCLST3152 belonged to the same species. Whole genome analysis of the strain KEBCLARHB70RT and average amino acid identity values confirmed its distinctive phylogenetic position within the family

Acetobacteraceae

. Phenotypic, ecological and genomic characteristics distinguished strains KEBCLARHB70RT, KAMCLST3051 and KAMCLST3152 from all genera in the family

Acetobacteraceae

. Therefore, we propose a novel genus and a novel species, Lichenicoccus roseus gen. nov., sp. nov., for these novel

Acetobacteraceae

members. Strain KEBCLARHB70RT (=KCTC 72321T=VKM B-3305T) has been designated as the type strain.
Empirical non-linear modeling & forecast of global daily deaths of COVID-19 pandemic & evidence that a “third wave” is beginning to decay
Authors: Sánchez-Sesma Jorge
Published: July 2020

Objectives

The present COVID-19 pandemic (C19P) is challenging our socities all over the world. In this work, based on massive health information daily updated, the C19P daily death numbers at a global level, are modelled, analyzed and forecasted.

Methods

Two empirical models are proposed to explain daily death (DD) records: a) self-similar (SS) recurrences of the global responses, and b) geometric averaging of two independent SS models for global DD records.

Findings

The detected self-similar recurrences in the global response suggest three global “self-similar waves” that support multi-month forecasts of the DD numbers. However, there are upper and lower-limit SS forecast DD scenarios that were jointly integrated with a geometrical average (GA) model, that support the existence of a moderated “third wave”, with a decaying stage for the next months (July-September 2020). It appears that the “third world” (South America [SAM]+Asia [ASI] +Africa [AFR]), is the actual “big player”, (following China, and Europe [EUR]+North America [NAM]) with its biggest contribution to a global “third wave” (W3) of C19P.

Conclusion

The empirical global modeling of the C19P has suggested us a possible moderated W3 scenario, with contributions mainly coming from the third world people. This moderated W3 scenario, after to be calibrated with the last weeks, has provided to stakeholders of significant data and criteria to define, sustain and support plans for the next months, based on data and self-similarities. These scenarios provide a well-based perspective on non-linear dynamics of C19P, that will complement the standard health and economic models.
Genome-wide identification of novel long non-coding RNAs and their possible roles in hypoxic zebrafish brain
Authors: Banerjee Bodhisattwa , Koner Debaprasad , Karasik David , Saha Nirmalendu
Published: July 2020

Long non-coding RNAs (lncRNAs) are the master regulators of numerous biological processes. Hypoxia causes oxidative stress with severe and detrimental effects on brain function and acts as a critical initiating factor in the pathogenesis of Alzheimer’s disease (AD). From the RNA-Seq in the forebrain (Fb), midbrain (Mb), and hindbrain (Hb) regions of hypoxic and normoxic zebrafish, we identified novel lncRNAs, whose potentialcistargets showed involvement in neuronal development and differentiation pathways. Under hypoxia, several lncRNAs and mRNAs were differentially expressed. Co-expression studies indicated that the Fb and Hb regions’ potential lncRNA target genes were involved in the AD pathogenesis. In contrast, those in Mb (cry1b, per1a, cipca) were responsible for regulating circadian rhythm. We identified specific lncRNAs present in the syntenic regions between zebrafish and humans, possibly functionally conserved. We thus identified several conserved lncRNAs as the probable regulators of AD genes (adrb3b, cav1, stat3, bace2, apoeb, psen1, s100b).
Intraspecies diversity reveals a subset of highly variable plant immune receptors and predicts their binding sites
Authors: Prigozhin Daniil M , Krasileva Ksenia V
Published: July 2020

Evolution of recognition specificities by the immune system depends on the generation of receptor diversity, and connecting binding of new antigens with initiation of downstream signalling. In plant immunity, these functions are enabled by the family of innate Nucleotide-Binding Leucine Rich Repeat (NLR) receptors. In this paper we surveyed the NLR complements of 62 ecotypes of Arabidopsis thaliana and 54 lines of Brachypodium distachyon and identified a limited number of NLR subfamilies responsible for generation of new receptor specificities. We show that the predicted specificity-determining residues cluster on the surfaces of Leucine Rich Repeat domains, but the location of the clusters varies between NLR subfamilies. By comparing NLR phylogeny, allelic diversity, and known functions of the Arabidopsis NLRs, we formulate a hypothesis for emergence of direct and indirect pathogen sensing receptors, and of the autoimmune NLRs. These findings reveal the recurring patterns of evolution of innate immunity and inform NLR engineering efforts.
Imaging Renal Ultrastructure using a Fast and Simple Optical Clearing and Swelling Protocol
Authors: Unnersjö-Jess David , Butt Linus , Höhne Martin , Witasp Anna , Kühne Lucas , Hoyer Peter F. , Patrakka Jaakko , Brinkkötter Paul T. , Wernerson Annika , Schermer Bernhard , Benzing Thomas , Scott Lena , Brismar Hjalmar , Blom Hans
Published: July 2020

Many light-microscopy protocols have in recent years been published for visualization of ultrastructure in the kidney. These protocols present researchers with new tools to evaluate both foot process anatomy and effacement, as well as protein distributions in foot processes, the slit diaphragm and in the GBM. However, these protocols either involve the application of different complicated super-resolution microscopes or lengthy sample preparation protocols. We here present a fast and simple, 5-hour long procedure for the full three-dimensional visualization of podocyte foot processes using conventional confocal microscopy. The protocol combines and optimizes different optical clearing and tissue expansion concepts to produce a mild swelling, sufficient for resolving foot processes using a diffraction-limited confocal microscope. We further show that the protocol can be used for common visualization of large-scale renal histology, pathology, and kidney protein distributions. Thus, we believe that our fast and simple protocol can be beneficial for routine conventional microscopic evaluation of kidney tissue integrity both in research and in the clinic.
Soil microbial composition varies in response to coffee agroecosystem management
Authors: Jurburg Stephanie D. , Shek Katherine L. , McGuire Krista
Published: July 2020

Soil microbes are essential to the continued productivity of sustainably-managed agroecosystems. In shade coffee plantations, the relationship between soil microbial composition, soil nutrient availability, and coffee productivity have been demonstrated, but the effect of management on the composition of the soil microbial communities remains relatively unexplored. To further understand how management modulates the soil microbiome, we surveyed the soil fungal and bacterial communities, as well as soil chemistry and canopy composition in a Nicaraguan coffee cooperative, across 19 individual farms. Using amplicon sequencing, we found that management (organic or conventional), stand age, and previous land use strongly affected the soil microbiome, albeit in different ways. Bacterial communities were most strongly associated with soil chemistry, while fungal communities were more strongly associated with the composition of the canopy and historical land use of the coffee plantation. Notably, both fungal and bacterial richness decreased with stand age. In addition to revealing the first in-depth characterization of the soil microbiome in coffee plantations in Nicaragua, our results highlight how fungal and bacterial communities are simultaneously modulated by long-term land use legacies (i.e., an agricultural plot’s previous land use) and short-term press disturbance (i.e., farm age).

One-sentence-summary

The composition of soil fungal and bacteria communities in shade coffee plantations depend on the combination of the farm’s management type, its previous land use, and the coffee plants’ stand age, but are differently influenced by each.
Enhanced metabolic potentials and functional gene interactions of microbial stress response towards high elevation in freshwater lakes
Authors: Li Huabing , Zeng Jin , Ren Lijuan , Yan Qingyun , Wu Qinglong L.
Published: July 2020

Elevation has strong influence on microbial community composition, but its influence on aquatic microbial functional genes remains unclear. Here, we compared the functional gene structure of microbial communities in surface water between two low-elevation lakes (LELs, with elevation of ca. 530 meters) and two high-elevation lakes (HELs, with elevation of ca. 4,600 meters) by using a metagenomic approach of Geo Chip-based functional gene arrays. We found significant differences in composition but not in richness of the microbial functional genes between the HELs and the LELs. In the HELs, the microbial communities had higher functional capacities in stress responses than those in LELs, which include cold shock, oxygen limitation, osmotic stress, nitrogen limitation, phosphate limitation, glucose limitation, radiation stress, heat shock, protein stress, and sigma factors genes. We also observed higher metabolic potentials in the degradation of aromatic, chitin, cellulose and hemicellulose in HELs than in LELs. By performing network analyses, we found enhanced interactions and complexity among the co-occurring functional genes in the HELs than those in the LELs in terms of network size, links, connectivity, and clustering coefficients. Notably, more functional genes of stress response played module-hub roles in the network of HELs. Overall, we observed contrasting patterns of microbial metabolic potentials and functional gene interactions in different elevational freshwater lakes, and found that the microbial communities developed functional strategies to cope with the harsh conditions at the high elevational lakes.

IMPORTANCE

Elevational patterns of biodiversity have attracted scientific interest in the fields of microbial ecology and biogeography. The influence of elevation on aquatic microbial functional gene structure and their metabolic potentials remains unclear. We compared the functional gene structure of microbial communities in surface water between two low-elevation lakes and two high-elevation lakes with a more than 4,000-meter difference in elevation along a mountainside by using GeoChip 5.0, which covered in total 144,000 gene sequences from 393 functional gene families. We found apparent differences in functional gene structures in lakes between the two different elevations. We also found enhanced metabolic potentials and functional gene interactions for microbial stress response with increasing elevation in freshwater lakes. These results highlighted that limnetic microbial communities could develop functional strategies to cope with harsh conditions towards high elevations.