bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Technique That Percutaneous Endoscopic Decompression and Vertebroplasty in a Patient With Osteoporotic Vertebral Fracture
Authors: Senturk Salim , Unsal Ulkun Unlu
Published: March 2020

Study Design.

Technique note.

Objective.

To evaluate the feasibility of endoscopy in various spinal pathologies.

Summary of Background Data.

Osteoporotic vertebral fractures are a common pathology in the elderly. These fractures are often accompanied by serious complications such as neurological deficits due to the compression of the spinal cord or nerve roots.

Methods.

A 78-year-old female patient presented to our hospital with a severe pain in her left leg and back. Lumbar magnetic resonance imaging and computed tomography scan revealed an osteoporotic L3 burst fracture compressing the left L3 nerve root. A minimally invasive translaminar endoscopic approach was used to remove the fractured fragment and cement was injected into the L3 vertebra. The patient was mobilized the same evening and was relieved of her pain.

Conclusion.

Minimally invasive endoscopy is a safe and effective alternative to conventional major decompression with or without posterior stabilization, particularly in elderly patients with serious comorbidities.

Level of Evidence: 4
Functional Outcomes Associated With Adjacent-level Ossification Disease 10 Years After Cervical Disc Arthroplasty or ACDF
Authors: Boody Barrett S. , Lee Evan N. , Sasso Willa R. , Vinayek Sheetal , Demeter Jaclyn M. , Sasso Rick C. , Smucker Joseph D.
Published: March 2020

Study Design:

A retrospective review of a prospective, randomized control Food and Drug Administration (FDA) investigational device exemption trial comparing anterior cervical discectomy and fusion (ACDF) with Bryan cervical disc arthroplasty.

Objective:

Determine the clinical significance of adjacent-level ossification disease (ALOD) on long-term functional outcomes after ACDF or arthroplasty.

Summary of Background Data:

ALOD occurs when the anterior longitudinal ligament and annulus adjacent to the index surgical level calcifies. As previously reported, ALOD happens more commonly after an arthrodesis than an arthroplasty. No investigation has previously examined 10-year clinical outcomes associated with ALOD.

Materials and Methods:

Forty patients were included in the 10-year follow-up. The index level was radiographically blinded and the cephalad-adjacent level was evaluated for ALOD. These scores underwent statistical analysis to compare the 2 surgical groups (ACDF and arthroplasty) for differences in the development of ALOD at a decade follow-up. Two investigational groups, on the basis of a high or low ALOD score, then proceeded through statistical analysis to compare the functional outcomes of patients in each group.

Results:

Statistical evaluation of ALOD findings in patients from each surgical group found a significantly higher rate of high-grade ALOD in patients who underwent cervical arthrodesis with plate fixation compared with cervical arthroplasty (68.2% vs. 11.1%, P=0.0003). Functional outcomes of patients were also assessed at the 10-year mark and outcomes in patients with either high-grade or low-grade ALOD were compared. When stratified by high versus low-grade ALOD, no significant difference was found for Neck Disability Index (NDI) (P=0.6431), VAS-arm (P=0.4497), or VAS-neck (P=0.8700) scores between groups.

Conclusions:

The present study suggests that there are no significant long-term functional outcome differences between patients with and without significant ALOD. Our findings suggest ALOD may be a radiographic finding that does not alter patient-reported outcomes.

Level of Evidence:

Level III—therapeutic.
Current Treatments of Tibial Surgical Site Infection and Osteomyelitis After Fracture Surgery
Authors: Costales Timothy , Shannon Steven F. , Gage Mark J. , Manson Theodore T.
Published: March 2020

Infections after tibia fracture are one of the most challenging areas of orthopedic care. Specialized techniques are required to achieve resolution of the infection and bony union. We detail here our strategies for infection debridement, temporary skeletal stabilization, antibiotic administration, and definitive reconstruction. Special emphasis is on the treatment of osteomyelitis of the tibial shaft; however, these same techniques can be applied to other areas of the skeleton as well.
The Use of Immersive and Virtual Reality Technologies to Enable Nursing Students to Experience Scenario-Based, Basic Life Support Training—Exploring the Impact on Confidence and Skills
Authors: Rushton Melanie Ann , Drumm Ian Anthony , Campion Simon Peter , O'Hare John Joseph
Published: March 2020

The link between effective basic life support and survival following cardiac arrest is well known. Nurses are often first responders at in-hospital cardiac arrests and receive annual basic life support training to ensure they have the adequate skills, and student nurses are taught this in preparation for their clinical practice. However, it is clear that some nurses still lack confidence and skills to perform basic life support in an emergency situation. This innovative study included 209 participants, used a mixed-methods approach, and examined three environments to compare confidence and skills in basic life support training. The environments were nonimmersive (basic skills room), immersive (immersive room with video technology), and the Octave (mixed reality facility). The skills were measured using a Laerdal training manikin (QCPR manikin), with data recorded on a wireless Laerdal Simpad, and confidence levels before and after training were measured using a questionnaire. The nonimmersive and the immersive rooms were familiar environments, and the students felt more comfortable, relaxed, and, thus, more confident. The Octave offered the higher level of simulation utilizing virtual reality technology. Students felt less comfortable and less confident in the Octave; we assert that this was because the environment was unfamiliar. The study identified that placing students in an unfamiliar environment influences the confidence and skills associated with basic life support; this could be used as a way of preparing student nurses with the necessary emotional resilience to cope in stressful situations.
Gut hormones in microbiota-gut-brain cross-talk
Authors: Sun Li-Juan , Li Jing-Nan , Nie Yong-Zhan
Published: March 2020

The homeostasis of the gut-brain axis has been shown to exert several effects on physiological and psychological health. The gut hormones released by enteroendocrine cells scattered throughout the gastrointestinal tract are important signaling molecules within the gut-brain axis. The interaction between gut microbiota and gut hormones has been greatly appreciated in gut-brain cross-talk. The microbiota plays an essential role in modulating many gut-brain axis-related diseases, ranging from gastrointestinal disorders to psychiatric diseases. Similarly, gut hormones also play pleiotropic and important roles in maintaining health, and are key signals involved in gut-brain axis. More importantly, gut microbiota can affect the release and functions of gut hormones. This review highlights the role of gut microbiota in the gut-brain axis and focuses on how microbiota-related gut hormones modulate various physiological functions. Future studies could target the microbiota-hormones-gut brain axis to develop novel therapeutics for different psychiatric and gastrointestinal disorders, such as obesity, anxiety, and depression.
Desflurane anesthesia compared with total intravenous anesthesia on anesthesia-controlled operating room time in ambulatory surgery following strabotomy: a randomized controlled study
Authors: Zhu Yan-Ling , Shen Wei-Hua , Chen Qian-Ru , Ye Hui-Jin , Huang Jing-Xia , Kang Ying , Chi Wei , Gan Xiao-Liang
Published: March 2020

Background

Ophthalmic ambulatory surgery is preferred to be performed under general anesthesia either by total intravenous anesthesia (TIVA) or by inhalational anesthesia to increase the patient comfort. However, anesthesia-controlled time (ACT) can cause increased non-operative operating room (OR) time which may adversely affect the ORs efficiency. This study was aimed to compare the ACT of desflurane with that of propofol-remifentanil in strabismus ambulatory surgery.

Methods

From November 2016 to December 2017, a total of 200 strabismus patients (aged 18–60 years old, and scheduled for elective ambulatory surgery at Zhongshan Ophthalmic Center) were randomly assigned to receive either propofol-based TIVA (group TIVA) or desflurane anesthesia (group DES) for maintenance of anesthesia. The primary outcome was the extubation time. Secondary outcomes included surgical time, anesthetic time, OR exit time, and Phase I and II recovery time. The intraoperative incidences of hypotension, bradycardia and oculocardiac reflex (OCR), and the incidences of any post-operative complications were recorded. Mann-Whitney U test and Chi-square or Fisher exact tests were used to compare the two groups.

Results

We found that the extubation time (5.5 [3.9–7.0] vs. 9.7 [8.5–11.4] min, P < 0.001) and the incidence of prolonged time to extubation (0 vs. 6%, P = 0.029) in the DES group were significantly decreased compared with those in the TIVA group. The patients in the DES group displayed shorter OR exit time as compared with that in the TIVA group (7.3 [5.5–8.7] vs. 10.8 [9.3–12.3] min, P < 0.001). The patients using desflurane exhibited more stable hemodynamics during surgery than the patients using propofol-based TIVA, as demonstrated by lower incidences of hypotension (1% vs. 22%, P < 0.001), bradycardia (2% vs. 13%, P = 0.002), and OCR (17% vs. 44%, P < 0.001).

Conclusion

DES enhanced the ophthalmic OR efficiency by reducing the extubation time and OR exit time, and provided more stable hemodynamics intra-operatively than TIVA in patients undergoing strabismus ambulatory surgery.

Trial registration: ClinicalTrials.gov, No. NCT02922660; https://clinicaltrials.gov/ct2/show/NCT02922660?id=NCT02922660&draw=2&rank=1
Simultaneous Cochlear and Auditory Brainstem Implantation in Children With Severe Inner Ear Malformations: Initial Surgical and Audiological Results
Authors: Sennaroğlu Levent , Yarali Mehmet , Sennaroğlu Gonca , Çinar Betül Çiçek , Batuk Merve Özbal , Yücel Esra , Bilginer Burçak , Bajin Münir Demir , Winter Margaret , Wilkinson Eric P.
Published: March 2020

Objective:

To report the initial surgical and audiological outcomes of three pediatric patients with severe inner ear malformations who were simultaneously implanted with cochlear and brainstem implants in the same surgical session.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Three pediatric patients with severe inner ear malformations between ages of 1.9 to 2.5 years, who were simultaneously implanted with cochlear implant in one ear and auditory brainstem implant in the other ear.

Intervention(s):

Simultaneous application of cochlar implant in one ear, auditory brainstem implant in the other ear.

Main Outcome Measures:

Free field thresholds with cochlear and brainstem implants. Surgical issues are also discussed.

Results:

The study is descriptive in nature. Free field thresholds with each device alone and together showed good progress. One of the patients had slower progress possibly due to comorbid CHARGE syndrome.

Conclusions:

The results showed good progress in terms of audition with both devices. Simultaneous cochlear and brainstem application serves as a remedy for pediatric patients who are candidates for cochlear implant on one side and brainstem implant on the other side. With this simultaneous application precious time for auditory development is not lost.
The influence of educational measures and low-level laser phototherapy on temporomandibular disorders
Authors: Dantas Caroline Maria Gomes , Vivan Carolina Lapaz , de Fantini Solange Mongelli , de Freitas Costa e Silva Patrícia Moreira , Pannuti Claudio Mendes , Witzel Andrea Lusvarghi , Dominguez Gladys Cristina
Published: March 2020

Photobiomodulation therapy (PBMT) with low-power laser is used for pain relief in several clinical conditions, including temporomandibular disorders (TMD). As musculoskeletal pain often produces changes in motor behavior, it is common for patients with TMD to present limited mandibular movements. To the date, there is no consensus about the optimal dosimetric parameters of PMBT for TMD. This randomized, controlled, double-blind clinical trial aims to evaluate pain relief and mandibular mobility in patients with TMD following treatments with 2 laser wavelengths, red (660 nm) and infrared (808 nm) individually and in combination as compared to a placebo treatment. One-hundred participants presenting myalgia and arthralgia, with disk displacement or not, will be selected based on the Research Diagnostic Criteria for Temporomandibular Disorders. All participants will be instructed about the etiology, prognosis, and self-care techniques for pain control on TMD, and followed up for 2 weeks. After this period, those who still present pain score over 4 in a visual analog scale (VAS) will be included in the study. Participants will be randomly assigned to 4 treatment groups: G1 = placebo (SHAM); G2 = PBMT with red laser (660 nm, 0.034 cm2, 88 J/cm2, 100 mW, 3 J/point); G3 = PBMT with infrared laser (808 nm, 0.034 cm2, 88 J/cm2, 100 mW, 3 J/point); and G4 = PBMT with red and infrared laser alternated between sessions. The treatment consists of 8 sessions, 2 times a week. The effect of the proposed therapies will be measured by: pain reduction in VAS; pressure pain threshold on TMJ, masseter and temporal muscles; and the amplitude of mandibular movements (opening, protrusion, and right and left lateral movements). The data will be collected at the following times: initial (T1), after the 1st treatment session (T2), at the end of treatment (T3), and 30 days after the last PBMT session (T4). For statistical analysis will be used 2-way repeated measures analysis of variance test, complemented by a post hoc Tukey test (P < .05).
Adding radiotherapy to androgen deprivation therapy in men with node-positive prostate cancer after radical prostatectomy
Authors: Guo Lijuan , Zhu Zhaowei , Zhang Xuepei
Published: March 2020

Background:

Several studies have tested the addition of adjuvant radiotherapy (RT) to androgen deprivation therapy (ADT) in node-positive prostate cancer (PCa) after radical prostatectomy (RP). This meta-analysis aims to assess the effects of adding RT to ADT in the treatment of PCa patients with lymph node invasion.

Methods:

We systematically searched PubMed and Embase through June 2018 for human studies comparing RT plus ADT versus ADT in men with node-positive PCa after RP. The primary end point was overall survival (OS). Secondary end point was cancer-specific survival (CSS). Hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of RT plus ADT on OS and CSS were combined across studies using meta-analysis.

Results:

Five studies were selected for inclusion. Overall, 15,524 patients were enrolled in the 5 studies. This included 6309 (40.6%) patients receiving ADT, 4389 (28.3%) patients receiving adjuvant RT plus ADT, and 4826 (31.1%) patients receiving observation. In lymph node-positive PCa patients, the addition of adjuvant RT was associated with improved OS (HR: 0.74; 95% CI, 0.59–0.92; P = .008). Moreover, the addition of adjuvant RT was also associated with a dramatic CSS improvement (HR: 0.40; 95% CI, 0.27–0.59; P = .000).

Conclusions:

Adding RT to ADT may be a clinically effective treatment option for men with lymph node-positive PCa after RP.
Non-HIV talaromycosis
Authors: Li Xinchun , Hu Wenqing , Wan Qi , Lei Qiang , Sun Chongpeng , Hou Zhongjun , Shrestha Nitesh
Published: March 2020

To investigate the characteristics of spiral computed tomography (CT), positron emission tomography–computed tomography (PET/CT) and clinical manifestations of talaromycosis to improve the diagnostic level and deepen its recognition in radiology.

Radiological, clinical, and pathological manifestations of 15 patients of non-HIV talaromycosis confirmed by bronchofiberscope lung biopsy and/or abscess puncture fluid culture and/or blood culture and/or sputum culture were analyzed retrospectively. All patients underwent chest CT, among them, six had a brain MRI, and six had a PET/CT scan before treatment.

On plain CT scan, there were multiple patches and massive consolidation in 6 patients, multiple patchy consolidations and patchy ground-glass opacities in 3 patients, solitary or multiple nodules and masses in 3 patients, multiple cavities and small nodules in 3 patients. Multiple lymphadenectasis appeared in bilateral hila, mediastinum, and neck in 10 patients. In contrast CT scan, the parenchyma of the lesions had a slight enhancement in 10 patients, moderate enhancement in 3 patients, obvious enhancement in 2 patients. Seven cases had bone destruction and hyperplasia, cranial involvement in 1 patient and liver involvement in 3 patients, respectively. On PET/CT, five patients showed elevated standard uptake value (SUV).

The radiological manifestations of non-HIV talaromycosis show multiple consolidations, ground-glass opacities, multiple nodules or masses in bilateral lungs, deep-seated enlarged lymph nodes and bone destruction in multiple systems. The final diagnosis should be based on the culture of talaromycosis.
Peer support for discharge from inpatient to community mental health services
Authors: Gillard Steve , Bremner Stephen , Foster Rhiannon , Gibson Sarah Louise , Goldsmith Lucy , Healey Andrew , Lucock Mike , Marks Jacqueline , Morshead Rosaleen , Patel Akshay , Priebe Stefan , Repper Julie , Rinaldi Miles , Roberts Sarah , Simpson Alan , White Sarah
Published: March 2020

Introduction:

In the period shortly after discharge from inpatient to community mental health care, people are at increased risk of self-harm, suicide, and readmission to hospital. Discharge interventions including peer support have shown potential, and there is some evidence that community-based peer support reduces readmissions. However, systematic reviews of peer support in mental health services indicate poor trial quality and a lack of reporting of how peer support is distinctive from other mental health support. This study is designed to establish the clinical and cost effectiveness of a peer worker intervention to support discharge from inpatient to community mental health care, and to address issues of trial quality and clarity of reporting of peer support interventions.

Methods:

This protocol describes an individually randomized controlled superiority trial, hypothesizing that people offered a peer worker discharge intervention in addition to usual follow-up care in the community are less likely to be readmitted in the 12 months post discharge than people receiving usual care alone. A total of 590 people will be recruited shortly before discharge from hospital and randomly allocated to care as usual plus the peer worker intervention or care as usual alone. Manualized peer support provided by trained peer workers begins in hospital and continues for 4 months in the community post discharge. Secondary psychosocial outcomes are assessed at 4 months post discharge, and service use and cost outcomes at 12 months post discharge, alongside a mixed methods process evaluation.

Discussion:

Clearly specified procedures for sequencing participant allocation and for blinding assessors to allocation, plus full reporting of outcomes, should reduce risk of bias in trial findings and contribute to improved quality in the peer support evidence base. The involvement of members of the study team with direct experience of peer support, mental distress, and using mental health services, in coproducing the intervention and designing the trial, ensures that we theorize and clearly describe the peer worker intervention, and evaluate how peer support is related to any change in outcome. This is an important methodological contribution to the evidence base.

Trial registration:

This study was prospectively registered as ISRCTN 10043328 on November 28, 2016.
Meditation treatment of Alzheimer disease and mild cognitive impairment
Authors: Chen Yunhui , Zhang Jiayuan , Zhang Tiane , Cao Liu , You Yanyan , Zhang Chunjiang , Liu Xinglong , Zhang Qi
Published: March 2020

Background:

Growing body of scientific researches in recent years have suggested the promising effect of meditation on improving cognitive impairment of Alzheimer disease (AD) and mild cognitive impairment (MCI). This paper aims to provide a protocol for systematic review to evaluate the efficacy of meditation on cognition performance of patient with AD and MCI.

Methods:

The Cochrane Library, PubMed, EMBASE, Web of Science, the Chinese Biological Medicine Database, China National Knowledge Infrastructure, Wanfang database, and VIP information database will be searched systematically and electronically from establishment to March 2020. All published randomized controlled trials related will be included. Assessment of bias risk and data analyses will be implemented by Review Manager (V.5.3.5). The strength of the evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluation system.

Results:

A high-quality synthesis of current evidence of meditation for patient with AD and mild cognitive impairment will be provided in this study.

Conclusion:

This protocol of systematic review will be helpful for providing evidence of whether meditation is an effective and safe intervention for cognitive impairment of patient with AD and MCI.

Ethics and dissemination:

Ethical approval is unnecessary since this protocol is only for systematic review and does not involve privacy data or conduct an animal experiment. This protocol will be disseminated by a peer-review journal or conference presentation.

Systematic review registration:

PROSPERO CRD42019145932.
The efficacy and safety of acupuncture for perimenopause symptom compared with different sham acupuncture control groups
Authors: He Qiujun , Ren Yajing , Wang Yanqiu , Zhang Feng , Zhang Sanyin
Published: March 2020

Background:

Perimenopause is a period that every woman must go through, most people are more or less affected by perimenopausal symptoms, it to affect women's health, work, life, and economy. As acupuncture treatment is more and more increasing in perimenopausal symptoms, there have also been many clinical trials about it. But the results of the trials are inconsistent. Therefore, we will conduct a systematic review and meta-analysis of the safety and efficacy of perimenopausal symptoms treated with acupuncture.

Methods:

The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. RCT study on different acupuncture interventions for perimenopausal symptoms will be searched in 8 databases (PubMed, EMBASE, the Cochrane Library, the web of science, CBM, CNKI, WAN FANG, and VIP). Besides, the search will also be performed on the clinical trial research platform if necessary. The primary outcome that will be extracted: the Flushes per 24 hours, the Frequency of hot flashes, the severity of hot flashes, the menopause-related symptom score, the treatment efficacy, the adverse event. Endnote software X8 will be used for study selection, STATA 13.0 and Review Manager software 5.3 will be used for analysis and synthesis. These studies selection, data extraction, and risk of bias assessment will be conducted by 2 independent reviewers.

Results:

This study will provide the results: 1. the primary and secondary outcome indicators of different acupuncture intervention measures (traditional hand acupuncture, moxibustion, ear acupuncture, laser, acupressure points) for perimenopausal symptoms. 2. The effects of different control groups (medicine control, routine care, waiting, and sham acupuncture control) on the analysis results will be reported, especially the effects of different sham acupuncture control (invasive/noninvasive) on the analysis results.

Conclusion:

This systematic review and meta-analysis study hopes to provide useful evidence for better use of different types of acupuncture in treat perimenopausal symptoms and better design of control groups in related clinical trials. In addition, the research conclusion will be published in peer journals.

OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/VZCKU Ethics and dissemination This conclusion of the study will be published in peer journals. The ethical approval is not required because there is no direct involvement of human.
An investigation and validation of CT scan in detection of spinal epidural adipose tissue
Authors: Chen Yilei , Hu Ziang , Li Zhaozhi , Fan Shunwu , Zhao Xing , Song Lijiang , Wang Lili
Published: March 2020

To investigate the accuracy of computed tomography (CT) in evaluating spinal epidural adipose tissue compared to magnetic resonance imaging (MRI).

CT scan images and matched magnetic resonance images of total 368 patients between July 2014 and July 2016 were evaluated. Hounsfield units (HU) of epidural fat (EF), dural sac (DuS), ligamentum flavum, bone of facet joints, and paraspinal muscles were measured for comparison. Anteroposterior diameter of the EF, anteroposterior diameter of the DuS, transverse diameter of the DuS, cross-sectional area of the EF, and cross-sectional area of the DuS were measured at each disc level from L1–2 to L5–S1.

Fat tissue showed exclusive negative HU significantly different from all other periphery tissues. Pearson correlation coefficient analyses showed significant positive correlations between CT and MRI measurements; Bland–Altman plots also depicted satisfied agreement. Overgrowth of spinal EF was more commonly found at L2–3 and L3–4 levels in present study, and body weight, age, and gender were significantly associated with amounts of EF both on CT and MRI.

The CT scan is a satisfied alternative of MRI for the evaluation of spinal epidural adipose tissue.
No Pathogen-Specific Sign or Symptom Predicts the Etiology of Monomicrobial Nongonococcal Urethritis in Men
Authors: Jordan Stephen J. , Toh Evelyn , Williams James A. , Fortenberry Lora J. , LaPradd Michelle , Ryan John D. , Nelson David E. , Batteiger Teresa A.
Published: March 2020

Identifying pathogen-specific signs or symptoms of nongonococcal urethritis could improve syndromic management accuracy. We evaluated nongonococcal urethritis signs and symptoms in 220 men with single-pathogen infections (Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, or Ureaplasma urealyticum) or idiopathic urethritis. No individual sign or symptom accurately predicted the infectious etiology.
Prediction of the Development of Severe Sepsis Among Children With Intestinal Failure and Fever Presenting to the Emergency Department
Authors: Eisenberg Matthew , Puder Mark , Hudgins Joel
Published: March 2020

Objectives

Children with intestinal failure (IF) and fever are frequently bacteremic, but risk factors for development of sepsis in this population are not well delineated. Our objective was to determine what clinical factors available on arrival to the emergency department (ED), including commonly used vital sign thresholds, predicted the subsequent development of severe sepsis in children with IF and fever.

Study Design

This was a retrospective cohort study of children younger than 21 years with IF presenting to a tertiary care ED between 2010 and 2016 with fever who did not have hypotensive septic shock on arrival. The primary outcome was development of severe sepsis within 24 hours of ED arrival, as defined by consensus criteria. We identified predictors of severe sepsis using both univariate and multivariate models and calculated the test characteristics of 3 different sets of vital sign criteria in determining risk of severe sepsis.

Results

In 26 (9.4%) of 278 encounters, the patient developed severe sepsis within 24 hours of arrival to the ED; 3 were excluded due to hypotensive shock on arrival. Predictors of severe sepsis included history of intestinal pseudo-obstruction (odds ratio, 8.2; 95% confidence interval, 2.3–30.2) and higher initial temperature (odds ratio, 1.7; 95% confidence interval, 1.2–2.3). The 3 sets of vital sign criteria had widely varying sensitivity and specificity in identifying development of severe sepsis.

Conclusions

History of intestinal pseudo-obstruction and higher fever predicted increased risk of severe sepsis among children with IF and fever presenting to an ED. No single set of vital sign criteria had both high sensitivity and specificity for this diagnosis.
Brief Report: Sexual Debut Among 14- to 17-year-old Sexual Minority Males: A Preliminary Investigation of Early HIV Risk and Sexual Health Needs
Authors: Nelson Kimberly M. , Perry Nicholas S. , Stout Claire D. , Carey Michael P.
Published: March 2020

Background:

Adolescent sexual minority males (ASMM) are disproportionately at risk of HIV.

Purpose:

This study documents the sexual debut behaviors of ASMM, tests whether sexual debut and sexual behavior differed by race/ethnicity, and explores the association between early anal sex debut and engaging in condomless anal sex.

Methods:

Sexually active ASMM (N = 118; ages 14–17) in the United States completed an online sexual health survey. We used Fisher exact tests to explore differences by race/ethnicity in sexual debut characteristics and hypothesized relationships between sexual debut and risk behavior.

Results:

The average age of sexual debut with a male partner was 14 years (SD = 2.4). Approximately one-third (31%) reported anal sex at their sexual debut, with non-Latino black/African American ASMM more likely to report anal sex at debut (63%) compared with non-Latino white (28%), Latino (21%), or mixed race/other identified youth (19%; χ2 = 12.1, P = 0.01). All participants (100%) who reported an anal sex debut before the age of 14 years reported engaging in condomless anal sex in their lifetime, compared to 60% of those who reported an anal sex debut when they were 14 years old or older (χ2 = 5.6, P = 0.03). Participants wanted information about how to safely and comfortably have anal sex (59%) and skills around partner communication (>50%) before debut.

Conclusion:

Sexually active ASMM begin engaging in sexual behavior with other males early and with incomplete knowledge and skills regarding sexual health and safety.
Public Perception of a Normal Head Shape in Children With Sagittal Craniosynostosis
Authors: Al-Shaqsi Sultan Z. , Rai Ahsan , Forrest Christopher , Phillips John
Published: March 2020

A question that remains unanswered is at what level of surgical correction does the public perceive a head shape to be “normal” or “acceptable?” For most cases of non-syndromic asymptomatic craniosynostosis, the parents desire for surgical correction is to improve the cosmetic appearance of head shape. At the time of this writing, the intraoperative surgeons’ perspective of what constitutes an acceptable head shape is the target for surgical correction. In introducing an improved objectively cosmetic goal, an appropriate outcome measure would be to assess what the general public considers a normal or acceptable head shape in children with craniosynostosis.

Method:

Twenty-two unique images were presented via an online crowdsourcing survey of a severe case of non-syndromic sagittal craniosynosis gradually corrected to an age and gender matched normalized head shape. Participants were recruited via the Sick Kids Twitter account. Participants were invited to rate the head shapes as “normal” or “abnormal.”

Results:

The 538 participants completed the online survey. Participants were able to reliably and consistently identify normal and abnormal head shapes with a Kappa Score >0.775. Furthermore, participants indicated that a correction of 70% is required in order for the cranial deformity to be regarded as “normal.” This threshold closely reflects a normal Cranial Index, which is a widely used morphometric outcome in craniosynostosis.

Conclusion:

Crowdsourcing provides an ideal method for capturing the general population's perspective on what constitutes a normal and acceptable head shape in children with sagittal craniosynostosis. Laypersons are able to reliably and consistently distinguish cranial deformities from a “normal” head shape. The public indicates a threshold correction of 70% in sagittal craniosynosis to regard it as a “normal” head shape.
Aging of the Adult Bony Orbit
Authors: Ching Jessica A. , Ford Jonathan M. , Decker Summer J.
Published: March 2020

Background:

Accurate quantitative data of the adult bony orbital volume and dimension are needed for treatment optimization. In the present study, the authors aim to evaluate adult orbital volume and corresponding linear dimensions according to age, volume, and individual symmetry.

Methods:

Seventy computerized tomography facial scans of adults were randomly chosen from an institutional database and 3-dimensionally reconstructed. Studies were excluded for orbital pathology or incomplete radiographic data. Anatomic landmarks were marked. Interval linear distances and orbital volumes were calculated. Data were analyzed using paired T-tests, independent T-tests, linear regression analysis, and 1-way analysis of variance.

Results:

A total of 140 orbits from 70 patients were analyzed (female = 35, male = 35), ranging from 20 to 88 years of age. Orbital volume was similar between an individual's left and right side; however, a difference was observed in vertical orbital height, orbital width, inferior orbital rim position, orbital roof length, orbital width, and medial orbital wall length (0.45, 0.64, 0.4, 0.77, 0.97, and 5.1 mm, respectively; P < 0.05). In comparison to females, males averaged larger orbital volume by 3.07 cm3 (29.58 cm3 versus 26.51 cm3, P = 0.0002), medial wall length by 2.66 mm (P < 0.05), and orbital width by 2.66 mm (P < 0.05). Orbital volume did not correlate with patient age, while lateral wall length was correlative.

Conclusion:

This accurate normative data of the adult bony orbit impacts key aspects of patient diagnosis and treatment and also suggest clinical signs of periorbital aging are not due to bony orbital changes.
A Case-matched Comparative Study of Laparoscopic Versus Open Pancreaticoduodenectomy
Authors: Ammori Basil J. , Omari Balqees , Al Najjar Hani , Abdullah Niveen , Dabous Ali , Daoud Faiez , Almasri Mahmoud
Published: March 2020

Background:

The laparoscopic approach to pancreaticoduodenectomy (LPD) is technically demanding, but may offer benefits over open surgery [open pancreaticoduodenectomy (OPD)]. The aim of this study was to compare the outcomes of these 2 approaches at a tertiary cancer center from the Middle East.

Materials and Methods:

Fifty consecutive patients who underwent LPD (n=12) and OPD (n=38) between 2015 and 2018 were considered. One surgeon performed LPD for “all comers,” while 3 other surgeons performed open surgery. Patients were randomly matched on a 1:2 basis for pathology (benign vs. malignant), malignancy size (±1 cm), and whether the pancreatic duct was dilated (>3 mm).

Results:

Six patients were excluded, leaving 44 patients, of whom 33 were matched (LPD n=11, OPD n=22). The groups were comparable for age (57 vs. 63 y, P=0.123) and sex distribution (female; 55% vs. 45%, P=0.721), tumor size (3 cm in each group), frequency of pancreatic duct dilatation (45% in each group), and malignant pathology (82% in each group). There were no conversions to open surgery. Although the operating time for LPD was significantly longer (680 vs. 313 min, P<0.0001), LPD was associated with significantly shorter primary (4.7 vs. 7.8 d, P<0.0001) and total hospital stay that included readmissions (4.7 vs. 8.9 d, P<0.0001). There were no significant differences in blood loss (200 vs. 325 mL, P=0.082), overall complication rate (36.4% vs. 59.1%, P=0.282), or clinically significant complications (9.1% vs. 22.2%, P=0.643) and readmissions (0 vs. 4 patients). In patients with malignant disease, there were no differences with regard to the number of lymph nodes retrieved (18 vs. 12, P=0.095) and frequency of R0 resections (77.8% in each group).

Conclusion:

In experienced hands, the laparoscopic approach to pancreaticoduodenectomy seems to offer advantages over open surgery in terms of reduction in hospital stay while maintaining an equivalent oncologic resection.
Long noncoding RNA small nucleolar RNA host gene 1 contributes to sevoflurane-induced neurotoxicity through negatively modulating microRNA-181b
Authors: Zhang Nannan , Wang Dan , Yang Xianglong , Hou Dongnan
Published: March 2020

Sevoflurane has been reported to promote learning and memory disabilities by promoting neuroinflammation and neuroapoptosis. However, the precise mechanism by which sevoflurane mediating neurotoxicity remains to be determined. Cell viability, reactive oxygen species (ROS) generation, inflammation and apoptosis were measured by cell counting kit-8 assay, ROS kit, ELISA, flow cytometry and western blot assay. The abundance of small nucleolar RNA host gene 1 (SNHG1) and microRNA-181b (miR-181b) was measured by quantitative real-time PCR in HT22 cells. The binding sites between miR-181b and SNHG1 were predicted by Starbase, and this combination was verified by dual-luciferase reporter assay, RNA immunoprecipitation and RNA-pull down assays. Sevoflurane treatment promoted ROS generation, inflammation and apoptosis while impeded the viability of HT22 cells via upregulating long noncoding RNA (lncRNA) SNHG1. MiR-181b was a direct target of SNHG1, and it was inversely regulated by SNHG1 in HT22 cells. The overexpression of miR-181b counteracted the neurotoxicity of sevoflurane treatment in HT22 cells. MiR-181b depletion abolished the inhibitory effects of SNHG1 intervention on the ROS generation, inflammation and apoptosis and the promoting impact on the viability of HT22 cells. LncRNA SNHG1 contributed neurotoxicity in sevoflurane-stimulated HT22 cells via downregulating miR-181b. The SNHG1/miR-181b axis was a target for the prevention of sevoflurane-induced neurotoxicity.
Universal rules for the interaction of selection and transmission in evolution
Authors: Rice Sean H.
Published: March 2020

The Price equation shows that evolutionary change can be written in terms of two fundamental variables: the fitness of parents (or ancestors) and the phenotypes of their offspring (descendants). Its power lies in the fact that it requires no simplifying assumptions other than a closed population, but realizing the full potential of Price’s result requires that we flesh out the mathematical representation of both fitness and offspring phenotype. Specifically, both need to be treated as stochastic variables that are themselves functions of parental phenotype. Here, I show how new mathematical tools allow us to do this without introducing any simplifying assumptions. Combining this representation of fitness and phenotype with the stochastic Price equation reveals fundamental rules underlying multivariate evolution and the evolution of inheritance. Finally, I show how the change in the entire phenotype distribution of a population, not simply the mean phenotype, can be written as a single compact equation from which the Price equation and related results can be derived as special cases.

This article is part of the theme issue ‘Fifty years of the Price equation’.
Selection, adaptation, inheritance and design in human culture: the view from the Price equation
Authors: Nettle Daniel
Published: March 2020

For decades, parts of the literature on human culture have been gripped by an analogy: culture changes in a way that is substantially isomorphic to genetic evolution. This leads to a number of sub-claims: that design-like properties in cultural traditions should be explained in a parallel way to the design-like features of organisms, namely with reference to selection; that culture is a system of inheritance; and that cultural evolutionary processes can produce adaptation in the genetic sense. The Price equation provides a minimal description of any evolutionary system, and a method for identifying the action of selection. As such, it helps clarify some of these claims about culture conceptually. Looking closely through the lens of the Price equation, the differences between genes and culture come into sharp relief. Culture is only a system of inheritance metaphorically, or as an idealization, and the idealization may lead us to overlook causally important features of how cultural influence works. Design-like properties in cultural systems may owe more to transmission biases than to cultural selection. Where culture enhances genetic fitness, it is ambiguous whether what is doing the work is cultural transmission, or just the genetically evolved properties of the mind. I conclude that there are costs to trying to press culture into a template based on Darwinian evolution, even if one broadens the definition of ‘Darwinian’.

This article is part of the theme issue ‘Fifty years of the Price equation’.
Exploring diseases/traits and blood proteins causally related to expression of ACE2, the putative receptor of SARS-CoV-2: A Mendelian Randomization analysis highlights tentative relevance of diabetes-related traits
Authors: Rao Shitao , Lau Alexandria , So Hon-Cheong
Published: March 2020

Objectives

COVID-19 has become a major public health problem. There is good evidence that ACE2 is a receptor for SARS-CoV-2, and high expression ofACE2may increase susceptibility to infection. We aimed to explore risk factors affecting susceptibility to infection and prioritize drug repositioning candidates, based on Mendelian randomization (MR) studies onACE2lung expression.

Methods

We conducted a phenome-wide MR study to prioritize diseases/traits and blood proteins causally linked toACE2lung expression in GTEx. We also explored drug candidates whose targets overlapped with the top-ranked proteins in MR, as these drugs may alterACE2expression and may be clinically relevant.

Results

The most consistent finding was tentative evidence of an association between diabetes-related traits and increasedACE2expression. Based on one of the largest GWAS on type 2 diabetes (T2DM) to date (N=898,130), T2DM was causally linked to raisedACE2expression(p=2.91E-03;MR-IVW). Significant associations(at nominal level;p<0.05) withACE2expression was observed across multiple DM datasets and analytic methods, for type 1 and 2 diabetes and related traits including early start of insulin. Other diseases/traits having nominal significant associations with increased expression included inflammatory bowel disease, (ER+)breast and lung cancers, asthma, smoking and elevated ALT. We also identified drugs that may target the top-ranked proteins in MR, such as fostamatinib and zinc.

Conclusions

Our analysis suggested that diabetes and related traits may increaseACE2expression, which may influence susceptibility to infection (or more severe infection). However, none of these findings withstood rigorous multiple testing corrections (at FDR<0.05). Proteome-wide MR analyses might help uncover mechanisms underlyingACE2expression and guide drug repositioning. Further studies are required to verify our findings.
Comparative Impact of Individual Quarantine vs. Active Monitoring of Contacts for the Mitigation of COVID-19: a modelling study
Authors: Peak Corey M. , Kahn Rebecca , Grad Yonatan H. , Childs Lauren M. , Li Ruoran , Lipsitch Marc , Buckee Caroline O.
Published: March 2020

Background

Voluntary individual quarantine and voluntary active monitoring of contacts are core disease control strategies for emerging infectious diseases, such as COVID-19. Given the impact of quarantine on resources and individual liberty, it is vital to assess under what conditions individual quarantine can more effectively control COVID-19 than active monitoring. As an epidemic grows, it is also important to consider when these interventions are no longer feasible, and broader mitigation measures must be implemented.

Methods

To estimate the comparative efficacy of these case-based interventions to control COVID-19, we fit a stochastic branching model to reported parameters for the dynamics of the disease. Specifically, we fit to the incubation period distribution and each of two sets of the serial interval distribution: a shorter one with a mean serial interval of 4.8 days and a longer one with a mean of 7.5 days. To assess variable resource settings, we consider two feasibility settings: a high feasibility setting with 90% of contacts traced, a half-day average delay in tracing and symptom recognition, and 90% effective isolation; and low feasibility setting with 50% of contacts traced, a two-day average delay, and 50% effective isolation.

Findings

Our results suggest that individual quarantine in high feasibility settings where at least three-quarters of infected contacts are individually quarantined contains an outbreak of COVID-19 with a short serial interval (4.8 days) 84% of the time. However, in settings where this performance is unrealistically high and the outbreak continues to grow, so too will the burden of the number of contacts traced for active monitoring or quarantine. When resources are prioritized for scalable interventions such as social distancing, we show active monitoring or individual quarantine of high-risk contacts can contribute synergistically to mitigation efforts.

Interpretation

Our model highlights the urgent need for more data on the serial interval and the extent of presymptomatic transmission in order to make data-driven policy decisions regarding the cost-benefit comparisons of individual quarantine vs. active monitoring of contacts. To the extent these interventions can be implemented they can help mitigate the spread of COVID-19.

Funding

This work was supported in part by Award Number U54GM088558 from the US National Institute Of General Medical Sciences.
The Impact of Host-Based Early Warning on Disease Outbreaks
Authors: Hernandez Mark A. , Milechin Lauren E. , Davis Shakti K. , DeLaura Richard A. , Claypool Kajal T. , Swiston Albert J.
Published: March 2020

Objective

The detection of communicable pathogens responsible for major outbreaks relies on health care professionals’ recognition of symptoms manifesting in infectious individuals. Early warning of such communicable diseases before the onset of symptoms could improve both patient care and public health responses. However, the potential impact of such a host-based early warning system on containing the spread of an outbreak and in steering public health response is unknown.

Methods

We extend the deterministic SEIR (Susceptible, Exposed, Infectious, Recovered) model to simulate disease outbreak scenarios and to quantify the potential impact of a host-based early warning capability to mitigate pathogen transmission during an outbreak. In particular, we compare and contrast the performance of five different policies: Self-monitoring and reporting (baseline SEIR model), Quarantining the entire population, Quarantine-on-alert (with high sensitivity early warning), Quarantine-on-alert (with high specificity early warning), and Quarantine-on-alert (ideal early warning). We further evaluate these five policy options against four different outbreak scenarios with high or low disease transmission and high or low initial population exposures.

Results

For all scenarios, a quarantine-on-alert policy coupled with the near-ideal early warning capability reduces quarantine needs with only a small increase in the number of additional infections. The cost of a highly specific early detection system (i.e., a reduction in false alarms and thus quarantine costs) is an increase in additional infections relative to the near-ideal system. Conversely, a highly sensitive early detection system increases the percentage of the population in quarantine compared to both the ideal and high-specificity early detection system while also reducing the number of additional infections to nearly the numbers seen by quarantining the entire population a priori.

Conclusions

Our simulations demonstrate the utility of host-based early warning systems in controlling an outbreak under various outbreak conditions. Our tools also provide a simulation capability for evaluating public health policies enabling quantitative evaluation of their impacts prior to implementation.