bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced remote care for heart failure in times of COVID-19 using an implantable pulmonary artery pressure sensor: the new normal
Authors: Bayes-Genis Antoni , Codina Pau , Abdul-Jawad Altisent Omar , Santiago Evelyn , Domingo Mar , Cediel Germán , Spitaleri Giosafat , Lupón Josep
Published: December 2020

Heart failure (HF) is a major public health problem and a leading cause of hospitalization in western countries. Over the past decades, the goal has been to find the best method for monitoring congestive symptoms to prevent hospitalizations. Addressing this task through regular physician visits, blood tests, and imaging has proven insufficient for optimal control and has not decreased enough HF-related hospitalization rates. In recent years, new devices have been developed for this reason and CardioMEMS is one of the therapeutic monitoring options. CardioMEMS has shown to be effective in preventing and reducing HF hospitalizations in patients both with HF with reduced ejection fraction and HF with preserved ejection fraction. CardioMEMS’ versatility has made it a great option for pulmonary artery pressure monitoring, both during the coronavirus disease-19 (COVID-19) pandemic and when the clinic visits have (partially) resumed. CardioMEMS is the remote haemodynamic monitoring system with the most evidence-driven efficacy, and COVID-19 has put it in the spot as a centre-stage technology for HF monitoring. In a few months of the COVID-19 epidemic, CardioMEMS has grown to maturity, making it the new normal for high-quality, high-value remote HF care.
Patient with heart failure: importance to treat valvular diseases
Authors: Adamo Marianna , Alos Benjamin , Metra Marco , Lefèvre Thierry , Swaans Martins J , Gheorghe Livia , Tschöpe Carsten , Krackhardt Florian , Alfieri Ottavio , Bouleti Claire
Published: December 2020

COVID-19 pandemic is causing an unprecedented burden on healthcare resources and this includes treatment of heart failure and valvular heart diseases (VHD). Percutaneous procedures have broadened the number of patients with VHD who could be treated. However, COVID-19 pandemic has challenged their implementation. The risk of in-hospital infection, resources reallocation, reduced access to hospital caused a substantial delay of VHD treatment with an increased risk of clinical worsening and mortality. Now, the pandemic is not ended and subsequent waves are likely. Reorganization of our healthcare resources is needed, including a proper algorithm for patients’ prioritization, based on the severity of their valve disease, their life expectancy, complexity of the intervention, and the resources available. A wider use of telemedicine for patients’ selection and follow-up and any measurement that can shorten the duration of the hospital stay must be adopted. Patients’ and healthcare staff screening for COVID-19 and all needed procedures to prevent infection will continue to be mandatory. Percutaneous procedures, compared to surgery, are associated with a lower risk of infection and a lower need for in-hospital resources, including a shorter duration of hospital stay. This may favour their adoption when the risk of viral infection is high.
One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index
Authors: Maguire Fiachra , Romero-Ortuno Roman , O’Connor John D , Reilly Richard B , Knight Silvin P , Kenny Rose-Anne
Published: December 2020

Background

Orthostasis is a potent physiological stressor which adapts with age. The age-related accumulation of health deficits in multiple physiological systems may impair the physiological response to orthostasis and lead to negative health outcomes such as falls, depression, and cognitive decline. Research to date has focused on changes with orthostasis at prespecified intervals of time, without consideration for whole signal approaches.

Methods

One-dimensional statistical parametric mapping identified regions in time of significant association between variables of interest using a general linear model. Frailty index operationalized accumulated health and social deficits using 32-items from a computer-assisted interview. This study examined the association of frailty index on blood pressure, heart rate, and cerebral oxygenation during an orthostatic test in a sample of 2742 adults aged 50 or older from The Irish Longitudinal Study on Ageing.

Results

Frailty index was seen to be negatively associated with cerebral oxygenation changes from baseline over a period of 7 seconds (p = .036). Heart rate and systolic blood pressure were positively and negatively associated with frailty index over periods of 17 seconds (p = .001) and 10 seconds (p = .015), respectively.

Conclusions

Statistical parametric mapping demonstrated these significant regions of cerebral oxygenation during orthostasis provide indirect evidence of impaired autoregulation associated with frailty. Statistical parametric mapping also replicated prior relationships in heart rate and systolic blood pressure associated with a higher frailty index. These findings highlight the utility of 1-dimensional statistical parametric modeling in identifying significant regions of interest in physiological recordings.
Association of Paraspinal Muscle Measurements on Chest Computed Tomography With Clinical Outcomes in Patients With Severe Coronavirus Disease 2019
Authors: Feng Zhichao , Zhao Huafei , Kang Wendi , Liu Qin , Wu Jianzhen , Bragazzi Nicola Luigi , Ma Xiaoqian , Wang Wei , Rong Pengfei
Published: December 2020

Background

Skeletal muscle depletion is common in old adults and individuals with chronic comorbidities, who have an increased risk of developing severe coronavirus disease 2019 (COVID-19), which is defined by hypoxia requiring supplemental oxygen. This study aimed to determine the association between skeletal muscle depletion and clinical outcomes in patients with severe COVID-19.

Methods

One hundred and sixteen patients with severe COVID-19 who underwent chest computed tomography scan on admission were included in this multicenter, retrospective study. Paraspinal muscle index (PMI) and radiodensity (PMD) were measured using computed tomography images. The primary composite outcome was the occurrence of critical illness (respiratory failure requiring mechanical ventilation, shock, or intensive care unit admission) or death, and the secondary outcomes were the duration of viral shedding and pulmonary fibrosis in the early rehabilitation phase. Logistic regression and Cox proportional hazards models were employed to evaluate the associations.

Results

The primary composite outcome occurred in 48 (41.4%) patients, who were older and had lower PMD (both p < .05). Higher PMD was associated with reduced risk of critical illness or death in a fully adjusted model overall (odds ratio [OR] per standard deviation [SD] increment: 0.87, 95% confidence interval [CI]: 0.80–0.95; p = .002) and in female patients (OR per SD increment: 0.71, 95% CI: 0.56–0.91; p = .006), although the effect was not statistically significant in male patients (p = .202). Higher PMD (hazard ratio [HR] per SD increment: 1.08, 95% CI: 1.02–1.14; p = .008) was associated with shorter duration of viral shedding among female survivors. However, no significant association was found between PMD and pulmonary fibrosis in the early rehabilitation phase, or between PMI and any outcome in both men and women.

Conclusions

Higher PMD, a proxy measure of lower muscle fat deposition, was associated with a reduced risk of disease deterioration and decreased likelihood of prolonged viral shedding among female patients with severe COVID-19.
A mobile-based educational intervention on STI-related preventive behavior among Iranian women
Authors: Kazemi Sara , Tavousi Mahmoud , Zarei Fatemeh
Published: December 2020

While rates of sexually transmitted infections (STIs) in Iran are alarming, little is known about preventive sexual behaviors. The purpose of this article was to assess the effect of a mobile-based educational program to promote preventive behaviors regarding STIs in Iranian women. Using Roger’s protection motivation theory, the following measures were developed as the study’s conceptual framework: STI knowledge, STI vulnerability, STI prevention self-efficacy and STI prevention intentions. These variables were measured by the Persian version of a valid Korean four-scale tool. Data from 76 women were analyzed: 37 women in the smartphone application (Experimental) group and 39 in the control group. Health Education Sexually Transmitted Infections Application was developed as a smartphone application training program. Participants were tested at three-time points: pre-test (baseline), post-test 1 (immediately after the program’s completion) and post-test 2 (16 weeks after the program’s completion). Significant group differences were found at different times in STI knowledge, vulnerability, prevention self-efficacy and prevention intentions. The smartphone application was effective in sustaining the effects of the educational program in the experimental group. The development of appropriate teaching materials on sensitive public health issues, such as STIs to promote individual self-learning skills is suggested.
Sensitivity of sand lance to shifting prey and hydrography indicates forthcoming change to the northeast US shelf forage fish complex
Authors: Suca Justin J , Wiley David N , Silva Tammy L , Robuck Anna R , Richardson David E , Glancy Sarah G , Clancey Emily , Giandonato Teresa , Solow Andrew R , Thompson Michael A , Hong Peter , Baumann Hannes , Kaufman Les , Llopiz Joel K
Published: December 2020

Northern sand lance (Ammodytes dubius) and Atlantic herring (Clupea harengus) represent the dominant lipid-rich forage fish species throughout the Northeast US shelf and are critical prey for numerous top predators. However, unlike Atlantic herring, there is little research on sand lance or information about drivers of their abundance. We use intra-annual measurements of sand lance diet, growth, and condition to explain annual variability in sand lance abundance on the Northeast US Shelf. Our observations indicate that northern sand lance feed, grow, and accumulate lipids in the late winter through summer, predominantly consuming the copepod Calanus finmarchicus. Sand lance then cease feeding, utilize lipids, and begin gonad development in the fall. We show that the abundance of C. finmarchicus influences sand lance parental condition and recruitment. Atlantic herring can mute this effect through intra-guild predation. Hydrography further impacts sand lance abundance as increases in warm slope water decrease overwinter survival of reproductive adults. The predicted changes to these drivers indicate that sand lance will no longer be able to fill the role of lipid-rich forage during times of low Atlantic herring abundance—changing the Northeast US shelf forage fish complex by the end of the century.
Burns and COVID-19—Initial Experience and Challenges
Authors: Kumar Shalabh , Kain Rakesh , More Amrita , Sheth Srushti , Arumugam Praveen Kumar
Published: December 2020

The COVID-19 pandemic has brought with it many challenges in the field of healthcare around the world. Managing burn patients has its own challenges as they require a long duration of care and are more susceptible to infection. We conducted a retrospective observational study from January 30 to July 15, 2020 at our center to study the epidemiology of burns treated & patients and healthcare workers affected by COVID-19 during this period. The number of burn admissions showed a 42.6% reduction as compared to last year. A total of 17 patients (3.67%) and 29 health care workers (8.68%) tested positive for COVID-19 in the burns department. Our strategy underwent changes based on the changing dynamics of COVID-19 and changes in government and institutional policies. We have described the various challenges we faced in managing burns during this time. We found that effective screening of patients and healthcare workers, proper segregation of negative and positive/ suspect population and a low threshold for COVID-19 testing were essential to mitigate transmission of infection.
Early Selective Vulnerability of the CA2 Hippocampal Subfield in Primary Age-Related Tauopathy
Authors: Walker Jamie M , Richardson Timothy E , Farrell Kurt , Iida Megan A , Foong Chan , Shang Ping , Attems Johannes , Ayalon Gai , Beach Thomas G , Bigio Eileen H , Budson Andrew , Cairns Nigel J , Corrada María , Cortes Etty , Dickson Dennis W , Fischer Peter , Flanagan Margaret E , Franklin Erin , Gearing Marla , Glass Jonathan , Hansen Lawrence A , Haroutunian Vahram , Hof Patrick R , Honig Lawrence , Kawas Claudia , Keene C Dirk , Kofler Julia , Kovacs Gabor G , Lee Edward B , Lutz Mirjam I , Mao Qinwen , Masliah Eliezer , McKee Ann C , McMillan Corey T , Mesulam M Marsel , Murray Melissa , Nelson Peter T , Perrin Richard , Pham Thao , Poon Wayne , Purohit Dushyant P , Rissman Robert A , Sakai Kenji , Sano Mary , Schneider Julie A , Stein Thor D , Teich Andrew F , Trojanowski John Q , Troncoso Juan C , Vonsattel Jean-Paul , Weintraub Sandra , Wolk David A , Woltjer Randall L , Yamada Masahito , Yu Lei , White Charles L , Crary John F
Published: December 2020

Primary age-related tauopathy (PART) is a neurodegenerative entity defined as Alzheimer-type neurofibrillary degeneration primarily affecting the medial temporal lobe with minimal to absent amyloid-β (Aβ) plaque deposition. The extent to which PART can be differentiated pathoanatomically from Alzheimer disease (AD) is unclear. Here, we examined the regional distribution of tau pathology in a large cohort of postmortem brains (n = 914). We found an early vulnerability of the CA2 subregion of the hippocampus to neurofibrillary degeneration in PART, and semiquantitative assessment of neurofibrillary degeneration in CA2 was significantly greater than in CA1 in PART. In contrast, subjects harboring intermediate-to-high AD neuropathologic change (ADNC) displayed relative sparing of CA2 until later stages of their disease course. In addition, the CA2/CA1 ratio of neurofibrillary degeneration in PART was significantly higher than in subjects with intermediate-to-high ADNC burden. Furthermore, the distribution of tau pathology in PART diverges from the Braak NFT staging system and Braak stage does not correlate with cognitive function in PART as it does in individuals with intermediate-to-high ADNC. These findings highlight the need for a better understanding of the contribution of PART to cognitive impairment and how neurofibrillary degeneration interacts with Aβ pathology in AD and PART.
Antibiotic-Associated Adverse Events in Hospitalized Children
Authors: Same Rebecca G , Hsu Alice J , Cosgrove Sara E , Klein Eili Y , Amoah Joe , Hersh Adam L , Kronman Matthew P , Tamma Pranita D
Published: December 2020

Background

Antibiotic-associated adverse events (AEs) in hospitalized children have not been comprehensively characterized.

Methods

We conducted a retrospective observational study of children hospitalized at The Johns Hopkins Hospital receiving ≥24 hours of systemic antibiotics. Consensus regarding antibiotic-associated AE definitions was established by 5 infectious diseases specialists prior to data collection. Two physicians reviewed potential AEs and determined whether they were more likely than not related to antibiotics after comprehensive manual chart review. Inpatient and post-discharge AEs were identified using the Epic Care Everywhere network. AEs evaluated from the initiation of antibiotics until 30 days after antibiotic completion included gastrointestinal, hematologic, hepatobiliary, renal, neurologic, dermatologic, cardiac, myositis, vascular access device-related events, and systemic reactions. Ninety-day AEs included Clostridioides difficile infections, multidrug-resistant organism infections, and clinically significant candidal infections. The impact of AEs was categorized as necessitating additional diagnostic testing, changes in medications, unplanned medical encounters, prolonged or new hospitalizations, or death.

Results

Among 400 antibiotic courses, 21% were complicated by at least one AE and 30% occurred post-discharge. Each additional day of antibiotics was associated with a 7% increased odds of an AE. Of courses complicated by an AE, 66% required further intervention. Hematologic, gastrointestinal, and renal AEs were the most common, accounting for 31%, 15%, and 11% of AEs, respectively. AEs complicated 35%, 35%, 19%, and 18% of courses of piperacillin-tazobactam, tobramycin, ceftazidime, and vancomycin, respectively.

Conclusions

More than 1 in 5 courses of antibiotics administered to hospitalized children are complicated by AEs. Clinicians should weigh the risk of harm against expected benefit when prescribing antibiotics.
The governmentality of nursing professionalization in advanced liberal societies
Authors: Hoff Jan-Luuk , Kuiper Marlot
Published: December 2020

In Western countries, the occupational discipline of nursing is undergoing processes of professionalization. Although professionalization offers an appealing perspective on occupational advancement, it is an ambiguous process, especially in the context of ongoing reforms of advanced liberal states. More specifically, there is a confusing relationship between the professionalization of nursing and the state. This relation is underexamined in theories of nursing professionalization. Instead of seeing the state and professions as two distinct spheres, this article highlights their interconnectedness. It argues that nursing professionalization can be understood as a strategy of advanced liberal governmentality. Through an empirical analysis of the professionalization of Dutch nursing from a Foucauldian perspective, it shows how the appeal to ‘professionalism’ functions as a disciplinary mechanism that produces forms of advanced liberal ‘(bio)power’. This generates academic and practical questions, since nurses—the largest group of healthcare professionals—have distinctive relations with their patients, who regard them as ‘independent’ and ‘caring experts’. Furthermore, it sheds light on the academic debate about the reconfiguration of professionalism by showing how certain ‘professional’ reconfigurations are not only unavoidable but unavoidably (bio)political as well.
Observation Sentences Revisited
Authors: Kemp Gary
Published: December 2020

I argue for an alternative to Quine’s conception of observation sentences, one that better satisfies the roles Quine envisages for them, and that otherwise respects Quinean constraints. After reviewing a certain predicament Quine got into in balancing the needs of the intersubjectivity of observation sentences with his notion of the stimulus meaning of an observation sentence, I push for replacing the latter with what I call the ‘stimulus field’ of an observation sentence, a notion that remains ‘proximate’ but is shared between different language users. Throughout, I emphasize the epistemological role of observation sentences.
First insights into the structural features of Ebola virus methyltransferase activities
Authors: Valle Coralie , Martin Baptiste , Ferron François , Roig-Zamboni Véronique , Desmyter Aline , Debart Françoise , Vasseur Jean-Jacques , Canard Bruno , Coutard Bruno , Decroly Etienne
Published: December 2020

The Ebola virus is a deadly human pathogen responsible for several outbreaks in Africa. Its genome encodes the ‘large’ L protein, an essential enzyme that has polymerase, capping and methyltransferase activities. The methyltransferase activity leads to RNA co-transcriptional modifications at the N7 position of the cap structure and at the 2′-O position of the first transcribed nucleotide. Unlike other Mononegavirales viruses, the Ebola virus methyltransferase also catalyses 2′-O-methylation of adenosines located within the RNA sequences. Herein, we report the crystal structure at 1.8 Å resolution of the Ebola virus methyltransferase domain bound to a fragment of a camelid single-chain antibody. We identified structural determinants and key amino acids specifically involved in the internal adenosine-2′-O-methylation from cap-related methylations. These results provide the first high resolution structure of an ebolavirus L protein domain, and the framework to investigate the effects of epitranscriptomic modifications and to design possible antiviral drugs against the Filoviridae family.
Modeling human brain tumors in flies, worms, and zebrafish: From proof of principle to novel therapeutic targets
Authors: Shahzad Uswa , Taccone Michael S , Kumar Sachin A , Okura Hidehiro , Krumholtz Stacey , Ishida Joji , Mine Coco , Gouveia Kyle , Edgar Julia , Smith Christian , Hayes Madeline , Huang Xi , Derry W Brent , Taylor Michael D , Rutka James T
Published: December 2020

For decades, cell biologists and cancer researchers have taken advantage of non-murine species to increase our understanding of the molecular processes that drive normal cell and tissue development, and when perturbed, cause cancer. The advent of whole-genome sequencing has revealed the high genetic homology of these organisms to humans. Seminal studies in non-murine organisms such as Drosophila melanogaster, Caenorhabditis elegans, and Danio rerio identified many of the signaling pathways involved in cancer. Studies in these organisms offer distinct advantages over mammalian cell or murine systems. Compared to murine models, these three species have shorter lifespans, are less resource intense, and are amenable to high-throughput drug and RNA interference screening to test a myriad of promising drugs against novel targets. In this review, we introduce species-specific breeding strategies, highlight the advantages of modeling brain tumors in each non-mammalian species, and underscore the successes attributed to scientific investigation using these models. We conclude with an optimistic proposal that discoveries in the fields of cancer research, and in particular neuro-oncology, may be expedited using these powerful screening tools and strategies.
Total bone mineral density is inversely associated with stroke: a family osteoporosis cohort study in rural China
Authors: Zhu B , Yang J , Zhou Z , Ling X , Cheng N , Wang Z , Liu L , Huang X , Song Y , Wang B , Qin X , Zalloua P , Xu X P , Yang L , Zhao Z
Published: December 2020

Background

The relationship of osteoporosis and stroke is still not fully clarified. Apart from the well-known risk factors for stroke, bone mineral density (BMD) has gained more interest in recent years.

Aim

To further elucidate the relationship between BMD and stroke risk, a prospective cohort study in the Chinese rural population was conducted.

Design

Retrospective analysis of a family osteoporosis cohort.

Methods

Our subjects were selected from an osteoporosis cohort conducted in Anqing, China. All participants underwent a questionnaire assessment, clinical examinations and laboratory assessments. During the follow-up period, the number of people who had a stroke was recorded. Generalized estimating equation regression analysis was performed to determine the significance of the association between BMD and stroke.

Results

A total of 17868 people were included. A two-way interaction test of sex and BMD on stroke was significant (P = 0.002). There was a significant difference in BMD and stroke morbidity in the male group (P = 0.003). When BMD was assessed as quartiles and the lowest quartile was used as reference, a significantly lower risk for stroke was observed in Q2–4. Notably, no significant difference was observed in female participants with adjusted odds ratio (P > 0.05). The P-value for interaction was calculated. The body mass index (P = 0.014) and waist-to-hip ratio (P = 0.027) were found to be significantly associated with BMD and stroke risk in female participants.

Conclusions

In Chinese rural areas, total BMD may negatively correlated with stroke, especially in men.
Variability of Phytoplasma Infection Density in Poinsettia and Evaluation of its Association with the Level of Branching in Host Plants
Authors: Lee Shin , Chu Chien-Young , Chu Chia-Ching
Published: December 2020

It has long been established that phytoplasma infection is the cause of the free-branching phenotype in poinsettia. However, relatively little is known about the ecology of the pathogen in planta. The present study evaluated the infection pattern of poinsettia branch-inducing phytoplasma (PoiBI) and its association with the poinsettia phenotype during cutting propagation. The presence of this pathogen in the poinsettia variety Luv U Pink was determined using PCR and sequence analysis. The infection density of PoiBI in distinct tissue types of different plant segments were then determined using quantitative PCR coupled with plasmid-based standard curves. Both vegetative-stage and flowering-stage plants were tested. The results showed that, despite being considerably variable among plants, the infection densities of PoiBI tend to be higher in source leaves located in the lower parts of the plant. The densities were consistently lower in tissues located at the top of the plants, regardless of the tissue type. Analysis of the infection densities among samples collected from six stock plants used in commercial production also revealed significantly different levels of PoiBI load. An association between PoiBI infection density in the stock plants and the level of branching in cutting-propagated plants (derived from the stock plants) was also observed; stock plants with low infection densities tended to produce smaller proportions of plants exhibiting higher degrees of branching both before and after pinching. These data suggest that uneven distribution of PoiBI within and among stock plants may lead to the production of cuttings with variable phytoplasma densities which may, in turn, affect the phenotypic uniformity of the plants produced. Overall, findings from the present work add to the understanding of PoiBI’s ecology and could provide implications to commercial poinsettia production.
Versatile Applications of the CRISPR/Cas Toolkit in Plant Pathology and Disease Management
Authors: Wheatley Matthew S. , Yang Yinong
Published: December 2020

New tools and advanced technologies have played key roles in facilitating basic research in plant pathology and practical approaches for disease management and crop health. Recently, the CRISPR/Cas (clustered regularly interspersed short palindromic repeats/CRISPR-associated) system has emerged as a powerful and versatile tool for genome editing and other molecular applications. This review aims to introduce and highlight the CRISPR/Cas toolkit and its current and future impact on plant pathology and disease management. We will cover the rapidly expanding horizon of various CRISPR/Cas applications in the basic study of plant–pathogen interactions, genome engineering of plant disease resistance, and molecular diagnosis of diverse pathogens. Using the citrus greening disease as an example, various CRISPR/Cas-enabled strategies are presented to precisely edit the host genome for disease resistance, to rapidly detect the pathogen for disease management, and to potentially use gene drive for insect population control. At the cutting edge of nucleic acid manipulation and detection, the CRISPR/Cas toolkit will accelerate plant breeding and reshape crop production and disease management as we face the challenges of 21st century agriculture.
Frontiers in HER2-positive breast cancer in 2020
Authors: Peddi Parvin F. , Slamon Dennis J.
Published: December 2020

Purpose of review

The field of HER2-positive breast cancer has seen tremendous advances in the last 2 years with largest number of new drugs in decades. The present review aims to summarize the cutting-edge research of the past 2 years and future directions.

Recent findings

This review will go over four new drugs, three of which have gained FDA approval within the past 18 months, in the treatment of HER2-positive breast cancer. We will go over early and mature clinical data on these therapeutics and ongoing clinical trials further exploring their role in the treatment of patients with advanced HER2-positive breast cancer and HER2 low breast cancer. Will also discuss ongoing trials using immunotherapy and CDK4/6 inhibitors in the advanced HER2-positive setting.

: The therapies described in this review have quickly become standard of care for patients with HER2-positive breast cancer. Furthermore, they have the potential to change the landscape of breast cancer therapy further to include even patients with HER2 low breast cancer.
Pregnancy and type 1 diabetes: updates on technology and treatment
Authors: Kennedy-Grant Abigail , Golden Lauren
Published: December 2020

Purpose of review

The goal of this article is to review recent research of technology use, including insulin pumps, continuous glucose monitors, and smartpens, for pregnant women with preexisting type 1 diabetes.

Recent findings

Recent research shows that there may be benefits from technology use in type 1 diabetes pregnancies given the changes in insulin sensitivity throughout the span of pregnancy as well as allowing for more monitoring to allow for sooner titration of insulin doses.

There may be utility in incorporation of technology during pregnancy with appropriate medical guidance. Additional research would be helpful to further assess the ability of newer automated insulin systems to aid in tight glucose management goals during pregnancy and show value in receiving FDA approval.
Cellular and Molecular Mechanisms of Breast Implant–Associated Anaplastic Large Cell Lymphoma
Authors: DeCoster Ryan C. , Clemens Mark W. , Di Napoli Arianna , Lynch Evan B. , Bonaroti Alisha R. , Rinker Brian D. , Butterfield Timothy A. , Vasconez Henry C.
Published: December 2020

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and highly treatable cancer of the immune system that can form around textured-surface breast implants. Although the underlying cause has yet to be elucidated, an emerging theme—linking pathogenesis to a chronic inflammatory state—continues to dominate the current literature. Specifically, the combination of increasing mutation burden and chronic inflammation leads to aberrant T-cell clonal expansion. However, the impetus remains largely unknown. Proposed mechanisms include a lipopolysaccharide endotoxin response, oncogenic transformation related to viral infection, associated trauma to the breast pocket, particulate matter digestion by capsular macrophages, chronic allergic inflammation, and genetic susceptibility. The Janus kinase–signal transducer and activator of transcription 3 (JAK-STAT3) pathway is a major signaling pathway that regulates a variety of intracellular growth and survival processes. Constitutive activation of JAK-STAT3 has been implicated in several malignancies, including lymphomas, and has recently been identified as a potential key mediator in BIA-ALCL. The purpose of this article is to review the cellular and molecular mechanisms of BIA-ALCL with a focus on the role of oncogenic JAK-STAT3 signaling in BIA-ALCL tumorigenesis and progression. Selected experimental work from the authors’ group on aberrant JAK-STAT3 signaling in BIA-ALCL is also included. The authors discuss how an inflammatory microenvironment may facilitate malignant transformation through the JAK-STAT3 pathway—highlighting its potential mechanistic role. The authors’ hope is that further investigation of this signaling pathway will reveal avenues for using JAK-STAT3 signaling as a prognostic indicator and novel therapeutic target in the case of advanced disease.
Incidence of Cancer and Premalignant Lesions in Surgical Specimens of Transgender Patients
Authors: Jacoby Adam , Rifkin William , Zhao Lee C. , Bluebond-Langner Rachel
Published: December 2020

Background:

Gender-affirming surgery is becoming increasingly more common. Procedures including chest masculinization, breast augmentation, vaginoplasty, metoidioplasty, and phalloplasty routinely generate discarded tissue. The incidence of finding an occult malignancy or premalignant lesion in specimens from gender-affirming surgery is unknown. The authors therefore conducted a retrospective review of all transgender patients at their institution who underwent gender-affirming surgery to determine the incidence of precancerous and malignant lesions found incidentally.

Methods:

A retrospective review of transgender patients who underwent gender-affirming surgery at the authors’ institution between 2017 and 2018 performed by a single plastic surgeon and a single reconstructive urologic surgeon was conducted. Only transgender patients who underwent gender-affirming surgery that led to routine pathologic review of discarded tissue (mastectomy, vaginoplasty, vaginectomy as part of phalloplasty) were included. Charts were reviewed and patient demographics, duration of hormonal therapy, medical comorbidities, genetic risk factors for cancer, medications (including steroids or other immunosuppressants), pathology reports, and cancer management were recorded.

Results:

Between 2017 and 2018, 295 transgender patients underwent gender-affirming surgery that generated discarded tissue sent for pathologic evaluation. During this period, 193 bilateral mastectomies, 94 vaginoplasties with orchiectomies, and eight vaginectomies were performed; 6.4 percent of all patients had an atypical lesion found on routine pathologic evaluation.

Conclusions:

Gender-affirming surgery is increasingly more common given the increase in access to care. The authors’ review of routine pathologic specimens generated from gender-affirming surgery yielded a 6.4 percent rate of finding atypical lesions requiring further evaluation. The authors advocate that all specimens be sent for pathologic evaluation.
Improving Results in Oncoplastic Surgery
Authors: Losken Albert , Chatterjee Abhishek
Published: December 2020

Learning Objectives:

After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of oncoplastic procedures for partial breast reconstruction, and how they compare to breast conservation-therapy alone. 2. Have a working knowledge of oncoplastic techniques and how they are addressed from the multidisciplinary perspective. 3. Understand the limitations of oncoplastic techniques and how to avoid unfavorable results.

Oncoplastic surgical techniques have expanded indications for breast conservation and have improved both oncologic and reconstructive outcomes. This article will focus on some of the barriers to adoption and discuss ways to improve safety through streamlining the process, understanding the oncologic concerns, and evaluating unfavorable outcomes that might interfere with the appropriate delivery of breast cancer care.
Low-Cost, Three-Dimensionally–Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction
Authors: Dvoracek Lucas A. , Lee Jonathan Y. , Unadkat Jignesh V. , Lee Yan H. , Thakrar Darshit , Losee Joseph E. , Goldstein Jesse A.
Published: December 2020

Background:

Orbital blowout fracture reconstruction often requires an implant, which must be shaped at the time of surgical intervention. This process is time-consuming and requires multiple placement trials, possibly risking complications. Three-dimensional printing technology has enabled health care facilities to generate custom anatomical models to which implants can be molded to precisely match orbital anatomy. The authors present their early experience with these models and their use in optimizing orbital fracture fixation.

Methods:

Maxillofacial computed tomographic scans from patients with orbital floor or wall fractures were prospectively obtained and digitally reconstructed. Both injured-side and mirrored unaffected-side models were produced in-house by stereolithography printing technique. Models were used as templates for molding titanium reconstruction plates, and plates were implanted to reconstruct the patients’ orbital walls.

Results:

Nine patients (mean age, 15.5 years) were included. Enophthalmos was present in seven patients preoperatively and resolved in six patients with surgery. All patients had excellent conformation of the implant to the fracture site on postoperative computed tomographic scan. Postoperative fracture-side orbital volumes were significantly less than preoperative, and not significantly different from unfractured-side orbital volumes. Total model preparation time was approximately 10 hours. Materials cost was at most $21. Plate bending time was approximately 60 seconds.

Conclusions:

Patient-specific orbital models can speed the shaping of orbital reconstruction implants and potentially improve surgical correction of orbital fractures. Production of these models with consumer-grade technology confers the same advantages as commercial production at a fraction of the cost and time.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Platelet-Rich Plasma: Evolving Role in Plastic Surgery
Authors: Chamata Edward S. , Bartlett Erica L. , Weir David , Rohrich Rod J.
Published: December 2020

Background:

The use of platelet-rich plasma has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. It has grown to encompass a wide variety of applications within the field of plastic surgery, including its use in combination with microneedling, laser, and fat-grafting procedures.

Methods:

In this article, the authors aim to (1) describe the preparation process of platelet-rich plasma; (2) discuss the proposed science behind platelet-rich plasma with regard to its evolving role in hair restoration and facial rejuvenation; and (3) highlight the recent literature examining its widespread use.

Results:

Based on the available literature, there is a therapeutic advantage to the use of platelet-rich plasma as a single treatment modality for alopecia and skin rejuvenation and in combination with laser skin treatment and fat grafting. There is, however, a considerable amount of variability in the processing, preparation, and treatment modalities.

Conclusions:

Despite a lack of standardized protocols for platelet-rich plasma preparation and a scarcity of large-scale studies with long-term follow-up, there is convincing evidence with objective measurement modalities that display positive outcomes after treatment for skin rejuvenation, hair regrowth, wound healing, and fat graft take.
Mentorship Experiences and Perceptions of Didactic Program in Dietetics Students
Authors: Patten Emily Vaterlaus , Bellini Sarah Gunnell , Meier Amanda , Earl Kaitlin
Published: December 2020

This study explored dietetics students' experiences and perceptions of mentoring. A survey was developed, piloted, and then distributed to dietetics students in the United States. Descriptive statistics were calculated, and open-ended data were analyzed using a conventional line-by-line content analysis approach. Students (n = 611) representing 69 dietetics programs completed the survey. Most (58%) cited a “professor or instructor” as their mentor, and only 20% reported no mentor. Themes that emerged from open-ended responses are the mentor, the process, and relationship expectations. Mentoring perceptions and experiences of students can guide educators and practitioners in supporting the pipeline of professionals.
Prevalence of Disease-Related Undernutrition on Hospital Admission and Its Association With Functionality and Length of Hospital Stay in Multiethnic Suriname
Authors: van der Held-Horinga Geertrui A. , Stuber Josine M. , MacDonald-Ottevanger Meerte-Sigrid , van Kanten Armand R. , Nahar-van Venrooij Lenny M. W.
Published: December 2020

Our aim was to describe the prevalence of disease-related undernutrition (DRU) on admission to a department of surgery in Suriname and to explore its association with ethnicity and adverse outcomes. All patients 18 years or older who were not pregnant were invited to participate. Data were collected on weight (history), length, fat-free mass index (FFMI) using bioimpedance analysis, and ethnicity. Age, sex, and diagnosis data were extracted from the medical files. Associations between DRU and ethnicity, functionality, and length of hospital stay were assessed using logistic and Cox regression analyses adjusting for age, sex, diagnosis, and disease severity. The study population of 351 participants revealed 46% were undernourished, 31% had unintended weight loss (UWL), and 27% had a low FFMI. DRU and low FFMI were associated with low handgrip strength, but UWL was not. DRU, UWL, and low FFMI were associated with length of stay. Determinants of DRU seemed to vary between ethnic groups. The prevalence of DRU was high, and nutrition protocols should be implemented to increase awareness and limit adverse outcomes. Further research is needed to reveal whether ethnicity should be part of the DRU risk assessment.
Innovative Partnerships
Authors: Cummings Joanna , Bergquist Erin , Boateng Laurene , Phoxay Chandavone , Stadler Diane
Published: December 2020

Nearly every country in the world faces a dual burden of nutrition-related diseases. Increased prevalence of these conditions is especially concerning in least developed countries. Training local health care professionals to administer medical nutrition therapy and apply behavior change counseling in hospital and community settings will reduce nutrition-related disease burden. We describe strategies used by Iowa State University and Oregon Health & Science University and their partners in Ghana, Africa, and Lao People's Democratic Republic, Southeast Asia, to build professional capacity in clinical and community nutrition interventions and provide US-based dietetic interns and graduate students experience in the international nutrition sector.
Donor-derived Cell-free DNA Combined With Histology Improves Prediction of Estimated Glomerular Filtration Rate Over Time in Kidney Transplant Recipients Compared With Histology Alone
Authors: Huang Edmund , Gillespie Matthew , Ammerman Noriko , Vo Ashley , Lim Kathlyn , Peng Alice , Najjar Reiad , Sethi Supreet , Jordan Stanley C. , Mirocha James , Haas Mark
Published: December 2020

Background.

Higher Banff inflammation and chronicity scores on kidney transplant biopsies are associated with poorer graft survival, although histology alone has limitations in predicting outcomes. We investigated if integrating donor-derived cell-free DNA (dd-cfDNA, Allosure; CareDx, Inc.) with Banff biopsy scores into a predictive model for estimated glomerular filtration rate over time can improve prognostic assessment versus histology alone.

Methods.

We identified 180 kidney transplant patients with dd-cfDNA assessed within 1 mo of biopsy. Using linear mixed–effects models, a prediction model of Banff histology scores and dd-cfDNA on estimated glomerular filtration rate over time was derived. Nested models were compared using the likelihood-ratio test, Akaike Information Criterion, and Bayesian Information Criterion to assess if inclusion of dd-cfDNA into a model consisting of Banff biopsy scores would improve model fit.

Results.

Univariate models identified significant covariate-by-time interactions for cg = 3 versus <3 (coefficient: −1.3 mL/min/1.73 m2/mo; 95% confidence interval [CI], −2.4 to −0.2; P = 0.02) and ci + ct ≥ 3 versus <3 (coefficient: −0.7 mL/min/1.73 m2/mo; 95% CI, −1.3 to −0.1; P = 0.03) and a trend toward significant covariate-by-time interaction for dd-cfDNA (coefficient: −0.5 mL/min/1.73 m2/mo; 95% CI, −1.0 to 0.1; P = 0.08). Addition of acute inflammation (i, t, and v), microvascular inflammation (g and ptc), and inflammation in area of interstitial fibrosis and tubular atrophy scores to chronicity scores (cg ≥ 3 and ci + ct ≥ 3) did not improve model fit. However, a model including dd-cfDNA with cg and ci + ct with covariate-by-time interactions had a better model fit compared with cg and ci + ct alone (likelihood-ratio test statistic = 21.1; df = 2; P < 0.001).

Conclusions.

Addition of dd-cfDNA to Banff biopsy scores provided better prognostic assessment over biopsy characteristics alone.
HIV Rev-isited
Authors: Truman Catherine Toni-Sue , Järvelin Aino , Davis Ilan , Castello Alfredo
Published: December 2020

The human immunodeficiency virus type 1 (HIV-1) proteome is expressed from alternatively spliced and unspliced genomic RNAs. However, HIV-1 RNAs that are not fully spliced are perceived by the host machinery as defective and are retained in the nucleus. During late infection, HIV-1 bypasses this regulatory mechanism by expression of the Rev protein from a fully spliced mRNA. Once imported into the nucleus, Rev mediates the export of unprocessed HIV-1 RNAs to the cytoplasm, leading to the production of the viral progeny. While regarded as a canonical RNA export factor, Rev has also been linked to HIV-1 RNA translation, stabilization, splicing and packaging. However, Rev's functions beyond RNA export have remained poorly understood. Here, we revisit this paradigmatic protein, reviewing recent data investigating its structure and function. We conclude by asking: what remains unknown about this enigmatic viral protein?
The evolutionary origins of the vertebrate olfactory system
Authors: Poncelet Guillaume , Shimeld Sebastian M.
Published: December 2020

Vertebrates develop an olfactory system that detects odorants and pheromones through their interaction with specialized cell surface receptors on olfactory sensory neurons. During development, the olfactory system forms from the olfactory placodes, specialized areas of the anterior ectoderm that share cellular and molecular properties with placodes involved in the development of other cranial senses. The early-diverging chordate lineages amphioxus, tunicates, lampreys and hagfishes give insight into how this system evolved. Here, we review olfactory system development and cell types in these lineages alongside chemosensory receptor gene evolution, integrating these data into a description of how the vertebrate olfactory system evolved. Some olfactory system cell types predate the vertebrates, as do some of the mechanisms specifying placodes, and it is likely these two were already connected in the common ancestor of vertebrates and tunicates. In stem vertebrates, this evolved into an organ system integrating additional tissues and morphogenetic processes defining distinct olfactory and adenohypophyseal components, followed by splitting of the ancestral placode to produce the characteristic paired olfactory organs of most modern vertebrates.
Comparative analysis of spontaneous blinking and the corneal reflex
Authors: Espinosa Julián , Pérez Jorge , Mas David
Published: December 2020

Ocular surface health, the cognitive status, psychological health or human neurological disorders, among others, can be assessed by studying eye blinking, which can be differentiated in spontaneous, reflex and voluntary. Its diagnostic potential has provided a great number of works that evaluate their characteristics and variations depending on the subject's condition (sex, tiredness, health, …). The objective of this study was to analyse the differences in blinking kinematics of spontaneous and reflex blinks, distinguishing between direct and consensual reflexes, using a self-developed, non-invasive and image processing-based method. A video-oculography system is proposed using an air jet driven by a syringe to induce reflex and a high-speed camera to record the blinking of both eyes. The light intensity diffused by the eye changes during blinking and peaks when the eyelid closes. Sixty-second sequences were recorded of 25 subjects blinking. Intensity curves were off-line fitted to an exponentially modified Gaussian (EMG) function, whose
σ
,
μ
and
τ
parameters were analysed. A two-way analysis of variance (ANOVA) of these parameters was conducted to test the influence of the subject, the eye and blink type. In the closing phase, direct and consensual corneal reflexes are faster than spontaneous blinking, but there was no significant difference between them, nor between right and left eyes. In the opening phase, the direct corneal reflex was the slowest and significant differences appeared between right and left eyes.