bluuebunny/crossref_metadata_2025 huggingface dataset:
Macular Hole Closure Without Endotamponade Application
Authors: Stopa Marcin , Ciesielski Maksym , Rakowicz Piotr
Published: May 2020

Purpose:

We describe an alternative vitreoretinal technique that allows for the macular hole closure without filling the vitreous cavity with gas.

Methods:

A prospective interventional one-center case series from March 2019 to January 2020. The patients underwent the formation of viscoelastic-assisted temporal internal limiting membrane flap without any gas endotamponade. Preoperative and postoperative visual acuity and foveal structure in optical coherence tomography images were evaluated.

Results:

Macular hole closure was achieved with a single procedure in 11 of 12 eyes with no endotamponade application. Preoperative, mean best-corrected visual acuity was 1.11 (Snellen equivalent 20/258) ± 0.28 logarithm of the minimal angle of resolution (range 1.398–0.523). We were able to assess visual acuity as early as on the first postoperative day in all patients. It ranged from 1.398 to 0.523 logarithm of the minimal angle of resolution (Snellen equivalent 20/500–20/67) with a mean of 0.97 (20/186) ± 0.29. Final best-corrected visual acuity was 0.31 (Snellen equivalent 20/40) ± 0.18 (range 0.699–0.1) at the end of the 3-month follow-up.

Conclusion:

This technique avoids the application of any tamponade, does not require positioning, and seems to provide macular hole closure rates similar to those of traditional vitrectomy with gas.
A Systematic Review of Emerging Therapeutic Strategies in the Management of Chemical Injuries of the Ocular Surface
Authors: Poon Stephanie Hiu Ling , Wong William Ho Lam , Bu Yashan , Lo Amy Cheuk Yin , Jhanji Vishal , Chan Yau Kei , Shih Kendrick Co
Published: May 2020

Objectives:

To evaluate recent in vivo studies on emerging therapies for managing corneal epithelial injuries.

Methods:

The search was conducted on PubMed for articles published between January 2015 and September 2019 and in English language.

Results:

Thirty studies were identified for evaluation, including those on mesenchymal stem cells, amniotic membrane-derived therapies, endogenous peptides and their inhibitors, as well as hydrogel therapies. Intermediate to strong levels of evidence are presented regarding the use of these strategies on chemically injured cornea, including their effects on healing of corneal epithelial defect, anti-inflammatory properties, prevention of corneal neovascularization, as well as restoration of anatomy and functions of the anterior eye, although clinical trials are needed to determine the safety and efficacy of these strategies on humans.

Conclusion:

Recent advances and understanding in various novel therapeutic methods for corneal epithelial chemical injuries should provide potential alternatives to current standard treatment regimens and help reduce risks of complications, hence improve patient outcomes.
Acanthamoeba Keratitis Versus Mixed Acanthamoeba and Bacterial Keratitis: Comparison of Clinical and Microbiological Profiles
Authors: Singh Arshi , Sahu Srikant K. , Sharma Savitri , Das Sujata
Published: May 2020

Purpose:

To compare the clinical profiles and outcomes of patients with Acanthamoeba keratitis with or without mixed bacterial infection.

Methods:

A retrospective analysis of microbiologically confirmed AK cases presenting to a tertiary care center over a 9-year period was conducted. Fourteen eyes in the coinfected group (group 1) and 24 eyes in the AK group (group 2) were analyzed to study the differences in these 2 groups of patients. The cases were diagnosed using a conventional microscopic analysis with staining techniques confirmed by cultural methods and were treated, which tailored to the microbiology report.

Results:

There was no difference in the demographic profile and presenting features in the 2 groups. Duration of symptoms and history of ocular trauma, contact lens wear, and previous steroid usage were also similar for both the groups. Dense central corneal infiltrate was the common presentation for both groups (7/14 vs. 16/24 in group 1 vs. group 2). Epithelial defect without dense stromal infiltrate was significantly more common in group 1 (42.9% vs. 4.2%, P = 0.003) as a presenting clinical feature. Hypopyon was present in 8/14 of group 1 versus 9/24 of group 2 eyes (P = 0.25). No significant difference was found in the final visual acuity in pure and mixed AK cases, and the need for surgical intervention was comparable. The most common bacterial pathogen isolated in the mixed group was the Staphylococcus species.

Conclusions:

Bacterial coinfection is common in patients with Acanthamoeba keratitis. Coinfection did not point toward a worse clinical disease at presentation or outcome.
Isolation and Characterization of a New Human Corneal Epithelial Cell Line: HCE-F
Authors: Cristaldi Martina , Olivieri Melania , Spampinato Giorgia , Anfuso Carmelina Daniela , Scalia Marina , Lupo Gabriella , Rusciano Dario
Published: May 2020

Purpose:

To isolate and characterize an epithelial cell (EC) line from a human donor cornea, which may serve as a reliable test cell line to address biomolecular issues and study the response of corneal epithelium to stressing events and therapeutic treatments.

Methods:

A corneal button from a donor patient was treated with enzymes to separate the epithelial sheet and to free EC, which were put in tissue culture. ECs were characterized by optic and electronic microscopies, cytokeratins and PAX6 were detected by SDS-PAGE and western immunoblotting, the barrier function was evaluated by transepithelial electric resistance and by the immune detection of membrane junction proteins, and the karyotype was characterized according to the classical methods.

Results:

Morphological analyses returned the picture of classical homogeneous polygonal morphology as expecetd by EC that was maintained over time and several in vitro passages. Transepithelial electric resistance values were characteristic of a typical barrier-forming cell line. The cytokeratin expression pattern was the one expected for corneal EC with a predominance of CK3 and CK5 and different from a human keratocyte cell line. The male karyotype showed 2 trisomies, of chromosomes 8 and 11.

Conclusions:

All the data so far obtained with the HCE-F cells concur to certify this cell line as a stable, true primary human corneal EC line, which could then be used as a test cell line to study and address the questions concerning the biological response of human corneal epithelium to stressing and/or therapeutic treatments and as a term of comparison for EC derived from pathological corneas.
In Vitro Antimicrobial Activity of a New Ophthalmic Solution Containing Hexamidine Diisethionate 0.05% (Keratosept)
Authors: Pinna Antonio , Donadu Matthew Gavino , Usai Donatella , Dore Stefano , Boscia Francesco , Zanetti Stefania
Published: May 2020

Purpose:

To assess the in vitro antimicrobial activity of a new commercial ophthalmic solution containing hexamidine diisethionate 0.05% (Keratosept).

Methods:

Staphylococcus aureus American Type Culture Collection (ATCC 43300), Pseudomonas aeruginosa ATCC 27853, 3 ocular bacterial isolates (1 Staphylococcus epidermidis, 1 S. aureus, and 1 P. aeruginosa), and 5 Candida species were used. The bacterial and fungal isolates were cultured on Columbia blood agar base and Sabouraud-dextrose agar plates, respectively, and incubated overnight at 37°C. Suspensions were prepared in a sterile saline solution with optical density equal to 0.5 McFarland standard (∼108 CFU/mL). Isolate suspensions were made in Keratosept solution to obtain a concentration of 106 CFU/mL. The suspensions were then distributed in conical tubes with a final volume of 1 mL and incubated at 37°C. After 1, 5, 10, 15, 20, 25, 30 minutes, and 24 hours, 10 μL of each suspension was removed, seeded on Columbia blood agar base and Sabouraud-dextrose agar plates and then incubated for 24 hours at 37°C.

Results:

After 1-minute incubation, there was no growth on the plates seeded with S. aureus ATCC 43300, S. aureus clinical isolate, S. epidermidis clinical isolate, and all 5 Candida species tested. Conversely, Keratosept solution failed to kill the Pseudomonas isolates after 30 minutes exposure and needed 24 hours to eradicate the organisms.

Conclusions:

Keratosept ophthalmic solution showed in vitro antimicrobial activity against S. epidermidis, S. aureus, and Candida species. Results suggest that it may be a potential candidate for the treatment of staphylococcal and Candida infections of the ocular surface and have some role in antimicrobial prophylaxis before intravitreal injections.
A New Surgical Approach for the Management of Acute Corneal Hydrops Complicated With Corneal Perforation
Authors: Petrelli Myrsini , Cohen Judith , Hashemi Kattayoon , Grentzelos Michael A. , Kymionis George D.
Published: May 2020

Purpose:

To report an unusual case of a patient with keratoconus and acute hydrops complicated with corneal perforation and describe its management using a new surgical approach.

Methods:

A case report and new surgical approach description.

Results:

A 47-year-old female patient with a history of keratoconus and implantable contact lens surgery presented at our institute with symptoms of acute corneal hydrops in her right eye. On examination, best corrected visual acuity was of counting fingers in the involved eye. Slit-lamp examination revealed a small inferotemporal corneal perforation, surrounded by marked corneal edema and a positive Seidel test. Initial attempts of conservative treatment with cyanoacrylate tissue adhesive application and bandage soft contact lens placement were ineffective. We decided to proceed with an inferior, lamellar wedge resection of the diseased corneal tissue. One month postoperatively, the cornea remained clear, whereas best corrected visual acuity was 0.1.

Conclusions:

Lamellar wedge resection could represent an alternative surgical approach for keratoconic patients, with eccentric acute hydrops and subsequent corneal perforation that provides rapid visual rehabilitation.
Steep Declines in Pediatric AIDS Mortality in South Africa, Despite Poor Progress Toward Pediatric Diagnosis and Treatment Targets
Authors: Johnson Leigh F. , Patrick Mark , Stephen Cindy , Patten Gabriela , Dorrington Rob E. , Maskew Mhairi , Jamieson Lise , Davies Mary-Ann
Published: May 2020

Background:

Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality.

Methods:

A multiparameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT.

Results:

By mid-2018, the model estimated that 75.2% (95% CI: 73.9%–76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4%–52.7%) was also lower than that in adults (62.0%). In 2017–2018, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94%, respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT.

Conclusions:

Although levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress toward the 90-90-90 targets appears relatively poor when compared with that in adults.
Implementation of Australia's National Disability Insurance Scheme
Authors: Gavidia-Payne Susana
Published: May 2020

The National Disability Insurance Scheme (NDIS) was introduced in Australia in 2013 to address the inadequacies of a fragmented and underfunded service system for people with disabilities. For young children with developmental disabilities, NDIS services fall under the early childhood early intervention (ECEI) approach, the impact of which is yet to be documented. Considering the critical role of families in supporting their children with a disability, the aim of the present study was therefore to examine their experiences of the ECEI approach in the State of Victoria. Seventeen parents participated in interviews and focus groups, which generated information clustered around five themes: (1) accessing the NDIS and the ECEI; (2) plan development and implementation; (3) choice and control; (4) family and community life; and (5) parental distress. While highlighting the potential of the NDIS funding and its long-term benefits, participating parents reported numerous challenges in their pursuit of supports under the ECEI. It is concluded that for the NDIS to fulfil its promise and potential, substantive revisions of its systems, policies and practices will be required to be relevant and sensitive to the needs of young children with developmental disabilities and their families.
Persistent pain and cognitive decline in older adults: a systematic review and meta-analysis from longitudinal studies
Authors: de Aguiar Gabriella Pequeno Costa Gomes , Saraiva Marcos Daniel , Khazaal Eugênia Jatene Bou , de Andrade Daniel Ciampi , Jacob-Filho Wilson , Suemoto Claudia Kimie
Published: May 2020

Both persistent pain and cognitive decline prevalence increase with advancing age and are associated with functional decline. However, the association of pain and cognitive decline has not been evaluated yet by a systematic assessment of longitudinal studies. We aimed to assess the association of persistent pain as a risk factor for cognitive decline in community older adults, using data from longitudinal studies in a systematic review and meta-analysis. Publications were identified using a systematic search on PubMed, EMBASE, and Cochrane Library databases from inception to June 2019. Because heterogeneity across studies was high, we used random-effects meta-analysis to calculate the pooled relative risk (RR) for the association between persistent pain and cognitive decline incidence. We investigated sources of heterogeneity among studies using meta-regression and stratified analyses. We included 10 prospective longitudinal studies with 57,495 participants with a mean age at the baseline ranging from 61.8 to 88.4 years and mean follow-up times ranging from 2.75 to 11.8 years. Persistent pain at baseline was not associated with the development of cognitive decline during the follow-up (pooled RR = 1.05, 95% confidence interval = 0.92-1.21). In sensitivity analyses, only length of follow-up time ≤4.5 years was associated with a higher risk of cognitive impairment (pooled RR = 1.19, 95% confidence interval = 1.10-1.28). Persistent pain was not associated with the incidence of cognitive decline.
Patterns of prescription opioid utilization among adolescents and adults with comorbid chronic pain and mental health diagnosis
Authors: Olopoenia Abisola , Onukwugha Eberechukwu , Simoni-Wastila Linda , Camelo-Castillo Wendy , Villalonga-Olives Ester , Gandhi Aakash Bipin , Slejko Julia
Published: May 2020

Our goal was to examine the association between mental health disorders (MHD) and subsequent risk of opioid use among commercially insured youth and adults (aged 14-64 years) with comorbid chronic noncancer pain (CNCP) conditions. We conducted a retrospective cohort study using IQVIA Health Plan Claims database from January 1, 2006, to December 31, 2015. Chronic noncancer pain was defined as any diagnosis of back, head, neck, arthritis, or chronic pain (index date). Mental health disorders were assessed in the 12 months before the index pain diagnosis. Based on days supply (none, acute, and chronic) and average daily dose (none, low, medium, and high), we constructed a 7-level categorical dependent measure of opioid use. We estimated the overall prevalence of MHD and opioid receipt. Among those with CNCP, multinomial logistic regression (AOR; 95 confidence interval) was used to estimate the association of MHD with opioid receipt. Among 879,815 individuals diagnosed with CNCP, 143,923 (16.4%) had comorbid MHD. Chronic/high-dose use of opioids was more common among those with CNCP and MHD compared to those with only CNCP. After adjusting for demographic and clinical factors, individuals with comorbid CNCP and MHD were significantly more likely to be prescribed opioids compared to those with only CNCP conditions. This effect varied by average daily dose and days supply: acute/low dose (1.08; 1.07-1.08); chronic/low dose (1.49; 1.49-1.50); acute/medium dose (1.07; 1.07-1.08); chronic/medium dose (1.61; 1.61-1.62); acute/high dose (1.03; 1.02-1.03); and chronic/high dose (1.53; 1.53-1.54). In individuals with CNCP, having a MHD was a strong predictor of prescription opioid use, particularly chronic use.
COVID-19 Crisis Creates Opportunities for Community-Centered Population Health
Authors: Goldfield Norbert I. , Crittenden Robert , Fox Durrell , McDonough John , Nichols Len , Lee Rosenthal Elizabeth
Published: May 2020

Dealing with the COVID-19 coronavirus requires a coordinated transnational effort. We propose a 2-stage state-led effort that utilizes community health workers (CHWs). We spell out what is beginning to occur in states to control and suppress COVID-19. In the second stage, we suggest working with these CHWs as a key element in the next evolution of our health care system: community-centered population health.
Planning for Reactivation of Ambulatory Care Settings Post–COVID-19 Pandemic Restrictions
Authors: Murphy James
Published: May 2020

In response to COVID-19 pandemic social distancing restrictions, ambulatory care settings have largely transitioned to virtual health care delivery. As local, state, and federal officials discuss timelines for these restrictions to be lifted, ambulatory leadership is tasked with the responsibility of developing reactivation plans for its clinics to resume in-person care. This article discusses a method in which ambulatory leadership can determine the clinic's deficit in patient encounters, set a time period to return to normal operations, planning for space and scheduling changes, balancing in-person virtual visits, and thoughtfully communicating these plans to clinic staff and providers.
TAS2R38 Haplotype Predicts 24-Hour Urinary Sodium Excretion in Patients With Heart Failure and Their Family Caregivers
Authors: Smith Jennifer L. , Mudd-Martin Gia , Estus Steven , Lennie Terry A. , Chung Misook L.
Published: May 2020

Background

Adherence to a low-sodium diet is essential to self-care of heart failure (HF). Genetic determinants of preference for high-sodium foods may impede adherence but have not been well-studied.

Objective

Our purpose was to examine if TAS2R38 haplotype predicted salt taste sensitivity and dietary sodium intake among patients with HF.

Method

This pilot study used baseline data from a large interventional randomized control trial to support adherence to a low-sodium diet in patients with HF and their family caregivers. Participants were tested for salt taste sensitivity and provided a 24-hour urinary sodium sample and a blood sample for DNA analysis at baseline. Fungiform papillae were counted. χ
2 Test and 1-way analysis of variance were used to compare haplotype groups. Linear regression was performed to examine predictors of salt taste sensitivity and 24-hour urinary sodium excretion, controlling for age, gender, ethnicity, smoking status, and fungiform papillae density.

Results

There were 42 patients with HF and their family caregivers (age, 64.6 ± 13.4 years, 46.5% male, 97.7% white, and 90.7% nonsmoker). Pronine-alanine-valine homozygous haplotype predicted lower urinary sodium excretion (b = −1780.59, t
41 = −2.18, P = .036), but genotype was not a significant predictor of salt taste sensitivity.

Conclusions

The results of our study partially supported our hypothesis that PAV homozygous haplotype predicts 24-hour urinary sodium excretion. With our small sample size, more research is needed. Understanding genetic influences on taste can lead to development of educational interventions tailored to patients with HF and their family caregivers to better support dietary adherence.
Pneumonitis associated with immune checkpoint inhibitors among patients with non-small cell lung cancer
Authors: Shannon Vickie R.
Published: May 2020

Purpose of review

Patients with lung cancer are particularly vulnerable to lung injury associated with immune checkpoint inhibition and often present with more frequent and more severe manifestations of lung disease compared to patients with other tumor types. The present review explores the reasons for increased susceptibility to immune checkpoint-related lung injury among this group of patients and focuses on the current knowledge of the clinical and radiologic manifestations of lung injury associated with immune checkpoint blockade and current treatment strategies.

Recent findings

Recent investigations have shown that pneumonitis risk associated with immune checkpoint blockade may be stratified according to the tumor type that is being targeted. Patients with lung cancer have the highest rates of pneumonitis associated with this class of agents.

Pneumonitis associated with immune checkpoint blockade among patients with lung cancer has the highest prevalence of all cancer types. In this patient population, the additional insult to the lungs imposed by immune-checkpoint therapies is often poorly tolerated because of tumor burden within the lung, sequelae from prior treatment and frequent comorbid lung diseases, such as chronic obstructive pulmonary disease. Thus, early recognition and treatment is critical in this patient population to successful outcome.
Hypoxia-inducible factor prolyl hydroxylase inhibitor in the treatment of anemia in chronic kidney disease
Authors: Kurata Yu , Tanaka Tetsuhiro , Nangaku Masaomi
Published: May 2020

Purpose of review

Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are orally active small molecules and are launched as novel therapeutic agents for anemia in chronic kidney disease (CKD). In contrast to conventional exogenous erythropoietin (EPO) administration, HIF-PHIs stimulate endogenous EPO production and improve iron metabolism via stabilization of hypoxia-inducible factor (HIF). This review summarizes the mechanism of action, the results of clinical trials, and future perspectives of HIF-PHIs.

Recent findings

Six HIF-PHIs are currently under phase III studies, some of which have been already completed. According to the results of clinical trials, HIF-PHIs increased and maintained hemoglobin levels in both nondialysis-dependent and dialysis-dependent CKD patients with physiological EPO concentrations. HIF-PHIs also improved iron utilization and were comparably effective regardless of underlying inflammation and iron status.

HIF-PHIs have several advantages including oral administration, physiological EPO secretion, and improved iron utilization. Undoubtedly, HIF-PHIs will pave the new way in the field of treatment of anemia in CKD, but it should be noted that HIFs have pleiotropic effects on a plethora of cellular functions, which might lead to either beneficial or undesirable off-target effects. Intensive postmarketing surveillance is crucially important to identify unexpected consequences.
Spinal Accessory and Suprascapular Nerve Injury After Human Bite
Authors: Dididze Marine , Jimsheleishvili Sopiko , Ward William B. , Ramos-Vargas Kathya E.
Published: May 2020

This is a unique clinical case of spinal accessory and suprascapular nerve injury related to a human bite not yet described elsewhere. The case emphasizes the importance of considering local trauma of the posterior triangle of the neck in case of shoulder weakness with electrophysiologic evidence of combined spinal accessory and suprascapular nerve injury.
Comparing Operative Performance between Independent and Integrated Plastic Surgery Residents
Authors: Cooney Carisa M. , Meyer Meredith L. , Aravind Pathik , Bello Ricardo J. , Rosson Gedge D. , Lifchez Scott D. , Cooney Damon S.
Published: May 2020

Background:

Anecdotally, faculty report that independent residents’ operative skills differ from those of their integrated peers. This study compared operative competency between integrated (postgraduate years 4 to 6) and independent plastic surgery residents.

Methods:

The authors compared independent (postgraduate years 1 to 3) and integrated (postgraduate years 4 to 6) plastic surgery residents at their institution using operative performance data from the Operative Entrustability Assessment, a validated five-point assessment tool that provides residents with real-time feedback about their operative performance, documenting performance at the point of care. Independent postgraduate year 1, 2, and 3 residents were categorized as postgraduate year 4, 5, and 6 residents, respectively, for comparison. The authors analyzed attending physician (evaluator) Operative Entrustability Assessment scores over time using the independent t test.

Results:

From July 1, 2013, to June 30, 2018, Operative Entrustability Assessments were completed at one training program for residents in postgraduate years 4 to 6: 1886 (47.4 percent) by independent [n = 12 (37.5 percent)] and 2094 (52.6 percent) by integrated [n = 20 (62.5 percent)] residents. Evaluator scores were lower for independent track residents throughout the first two quarters of postgraduate year 4 (quarter 1 delta, −0.49 point, p < 0.001; quarter 2 delta, −0.36 point, p < 0.001). However, this difference was no longer statistically significant during the third and fourth quarters of postgraduate year 4 (p = 0.192 and p = 0.228, respectively). No difference was detectable at postgraduate year 5 (p = 0.095) or postgraduate year 6 (p = 0.877).

Conclusions:

Operative Entrustability Assessment data demonstrate that differences between independent and integrated plastic surgery residents regarding operative skills (0.49 of 5 points) and amount of time needed for independent residents to catch up (6 months) is minimal and resolves during the third quarter of independent postgraduate year 1. Programs can design curricula to facilitate independent residents’ plastic surgery skill acquisition during their first two quarters.
Performance of Male Condoms When Used With and Without a Silicone Placebo Vaginal Ring—A Randomized, Crossover Trial
Authors: Nel Annalene , Malherbe Mariëtte , van Niekerk Neliëtte , Beksinska Mags , Greener Ross , Smit Jennifer , Frezieres Ron , Walsh Terri
Published: May 2020

Background:

The dapivirine vaginal ring reduced the risk of HIV infection by approximately 30% in Phase III trials. To ensure higher levels of protection against HIV and sexually transmitted infections, women should be counseled to use condoms when using the vaginal ring. This article evaluates the compatibility of male condoms with a placebo vaginal ring.

Methods:

This was a 2-period crossover, randomized, noninferiority trial. Couples in 2 sites in the United States were randomized to male condom use, with and without a placebo silicone vaginal ring, and asked to use 4 male condoms in each period. The primary noninferiority end points were total clinical failure and their component failure events (clinical breakage or slippage). Frequencies and percentages were calculated for each failure mode and differences in performance of the 2 periods using the male condom without the ring as reference. Noninferiority was defined using a 3% margin at the 5% significance level. Safety and acceptability were also assessed.

Results:

Seventy couples were enrolled, and 68 completed the trial with a total of 275 male condoms used in each period. Total condom clinical failure rates were 2.2% and 4.0% in the presence and absence of the vaginal ring, respectively, with a difference of −1.9% (95% confidence interval: −5.3% to 1.5%), thereby demonstrating noninferiority when used with the ring. There was no difference in safety between the 2 periods.

Discussion:

Concurrent use of the placebo silicone vaginal ring had no significant effect on male condom functionality or safety outcomes.
A Dose Simulation X-Ray Software
Authors: Meunier Benjamin , Boënnec Ronan , Dujardin Paul-Armand , Rafin Jean M. , Sirinelli Dominique , Chassagnon Guillaume , Morel Baptiste
Published: May 2020

Purpose:

Chest radiography is one of the most frequent x-ray examinations performed on children. Reducing the delivered dose is always a major task. The objective of our study was to determine the minimum dose to be delivered while maintaining the image quality of chest radiographs, using dose reduction simulation software.

Materials and Methods:

We included 60 children who had had a chest radiography in 5 groups established according to the diagnostic reference levels equitably represented by weight ranges. The software simulated for each radiograph 6 additional simulated photonic noise images corresponding to 100%, 80%, 64%, 50%, 40%, and 32% of the initial dose. The 360 radiographs were blindly scored by 2 radiologists, according to the 7 European quality criteria and a subjective criterion of interpretability, using a semiquantitative visual Lickert scale.

Results:

There was no significant difference in scoring between the reference radiograph (100%) and simulated radiographs at 80% of the dose in children between 5 and 20 kg, 50% of the dose in children between 20 and 30 kg, and between simulated radiographs at 40% of the dose in children over 30 kg. Interobserver reproducibility was moderate to excellent.

Conclusion:

Chest radiography dose might be reduced by 20% in children between 5 and 20 kg, 50% in children between 20 and 30 kg, and 60% in children over 30 kg, without any difference in the image quality appreciation. Software that produced simulated x-ray with decreasing delivered dose is an innovating tool for an optimization process.
Delta Systolic Blood Pressure (SBP) Can be a Stronger Predictor of Mortality Than Pre-Aortic Occlusion SBP in Non-Compressible Torso Hemorrhage: An Abotrauma and Aorta Analysis
Authors: Duchesne Juan , McGreevy David , Nilsson Kristofer , DuBose Joseph , Rasmussen Todd E. , Brenner Megan , Jacome Tomas , Hörer Tal , Tatum Danielle
Published: May 2020

Background:

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct for the management in patients with severe non-compressible torso hemorrhage (NCTH). Although guidelines have been developed to help with the best indications for REBOA utilization, no studies have addressed the significance of change in systolic blood pressure (ΔSBP) after REBOA insufflation. We hypothesized that ΔSBP would predict mortality in patients with NCTH and have utility as a surrogate marker for hemorrhage status.

Study Design:

This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. ΔSBP was defined as the difference between pre- and post-REBOA insertion SBP. Based on post-insertion SBP, patient hemorrhage status was categorized as responder or non-responder. A non-responder was defined as a hypotensive patient with systolic blood pressure < 90 mm Hg after REBOA placement with full aortic occlusion. Significance was set at P < 0.05.

Results:

A total of 524 patients with NCTH were included. Most (74%) were male, 77% blunt injured with a median age of 40 (27–58) years and Injury Severity Score 34 (25–45). Overall mortality was 51.0%. Twenty percent of patients were classified as non-responders. Demographic and injury descriptors did not differ between groups. Mortality was significantly higher in non-responders versus responders (64% versus 46%, respectively; P = 0.001). Non-responders had lower median pre-insertion SBP (50 mm Hg vs. 67 mm Hg; P < 0.001) and lower ΔSBP (20 mm Hg vs. 48 mm Hg; P < 0.001).

Conclusion:

REBOA non-responders present and remain persistently hypotensive and are more likely to die than responders, indicating a potential direct correlation between ΔSBP as a surrogate marker of hemorrhage volume status and mortality. Future prospective studies will need to further elucidate the impact of Damage Control Resuscitation efforts on ΔSBP and mortality.
A Snapshot of Elective Oncological Surgery in Italy During COVID-19 Emergency
Authors: Torzilli Guido , Viganò Luca , Galvanin Jacopo , Castoro Carlo , Quagliuolo Vittorio , Spinelli Antonino , Zerbi Alessandro , Donadon Matteo , Montorsi Marco
Published: May 2020

Objective:

To analyze the impact of COVID-19 emergency on elective oncological surgical activity in Italy.

Summary of Background Data:

COVID-19 emergency shocked national health systems, subtracting resources from treatment of other diseases. Its impact on surgical oncology is still to elucidate.

Methods:

A 56-question survey regarding the oncological surgical activity in Italy during the COVID-19 emergency was sent to referral centers for hepato-bilio-pancreatic, colorectal, esophago-gastric, and sarcoma/soft-tissue tumors. The survey portrays the situation 5 weeks after the first case of secondary transmission in Italy.

Results:

In total, 54 surgical Units in 36 Hospitals completed the survey (95%). After COVID-19 emergency, 70% of Units had reduction of hospital beds (median −50%) and 76% of surgical activity (median −50%). The number of surgical procedures decreased: 3.8 (interquartile range 2.7–5.4) per week before the emergency versus 2.6 (22–4.4) after (P = 0.036). In Lombardy, the most involved district, the number decreased from 3.9 to 2 procedures per week. The time interval between multidisciplinary discussion and surgery more than doubled: 7 (6–10) versus 3 (3–4) weeks (P < 0.001). Two-third (n = 34) of departments had repeated multidisciplinary discussion of patients. The commonest criteria to prioritize surgery were tumor biology (80%), time interval from neoadjuvant therapy (61%), risk of becoming unresectable (57%), and tumor-related symptoms (52%). Oncological hub-and-spoke program was planned in 29 departments, but was active only in 10 (19%).

Conclusions:

This survey showed how surgical oncology suffered remarkable reduction of the activity resulting in doubled waiting-list. The oncological hub-and-spoke program did not work adequately. The reassessment of healthcare systems to better protect the oncological path seems a priority.
Limbic-predominant Age-related TDP-43 Encephalopathy and Distinct Longitudinal Profiles of Domain-specific Literacy
Authors: Yu Lei , Schneider Julie A. , Kapasi Alifiya , Bennett David A. , Boyle Patricia A.
Published: May 2020

Purpose:

Emerging evidence suggests that limbic-predominant age-related TAR DNA-binding protein-43 (TDP-43) encephalopathy impacts domain-specific literacy, a complex ability not assessed in traditional cognitive evaluations. We examined longitudinal profiles of financial and health literacy in relation to limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC).

Participants:

A total of 275 community-dwelling older persons who had completed annual literacy assessments, died and undergone brain autopsy.

Methods:

Financial and health literacy was assessed using a 32-item instrument. Latent class mixed effects models identified groups of individuals with distinct longitudinal literacy profiles. Regression models examined group differences in 9 common age-related neuropathologies assessed via uniform structured neuropathologic evaluations.

Results:

Two distinct literacy profiles emerged. The first group (N=121, 44%) had higher level of literacy at baseline, slower decline and less variabilities over time. The second group (N=154, 56%) had lower level of literacy at baseline, faster decline, and greater variabilities. Individuals from the latter group were older, with fewer years of education and more female. They also had higher burdens of Alzheimer disease and LATE-NC. The group association with Alzheimer disease was attenuated and no longer significant after controlling for cognition. By contrast, the association with LATE-NC persisted.

Conclusion:

Limbic-predominant age-related TDP-43 encephalopathy is uniquely associated with distinct longitudinal profiles of financial and health literacy in old age.
Native expression of ASIC1a and ASIC1b human homologues in the HEK 293 cell line allows pharmacological evaluation of analgesics targeting acid sensation in humans
Authors: Yang Ya Lan , Lai Ted Weita
Published: May 2020

Nociceptors arising from the dorsal root ganglia (DRG) express acid-sensing ion channel-1 (ASIC1) subtypes to mediate the perception of inflammatory and neuropathic pain, and as such, these receptors are attractive targets for the development of analgesics for these painful conditions. Nevertheless, given that the human and rodent DRG differ considerably in subtype proportions of ASIC1 and that the pharmacological properties of rodent ASIC1 subtypes and their human homologues are distinct, ASIC1 inhibitors that demonstrate analgesic properties in rodents may not necessarily be effective in preventing pain in humans. In this study, we show that human embryonic kidney (HEK) 293 cells, which are routinely used as a cellular vehicle for the heterologous expression and pharmacological characterization of receptors and ion channels, natively transcribe the human homologues of ASIC1a and ASIC1b at similar proportions to those found in the human DRG. Importantly, HEK 293 ASIC1 is sensitive to inhibition by amiloride, ethylisopropyl amiloride, and the snake toxin mambalgin-1, but insensitive to inhibition by the ASIC1a inhibitor psalmotoxin-1 when applied at a physiological conditioning pH. Given that the human DRG transcribes the same set of ASIC1 subtypes as HEK 293 cells, our data support the notion that mambalgin-1 may be effective against acid pain sensation in humans. Moreover, our data suggest that the HEK 293 cell line may be a suitable tool for pharmacological screening and characterization of heteromeric human ASIC1.
Histone deacetylase-6 modulates amyloid beta-induced cognitive dysfunction rats by regulating PTK2B.
Authors: Liu Zhen , Hao Kai-Min , Wang Hao-Yu , Qi Wen-Xiu
Published: May 2020

The aim of this study was to investigate the effects of histone deacetylase-6 (HDAC6) on the functional and pathological changes of the amyloid beta (Aβ)-induced cognitive dysfunction rats by regulating protein tyrosine kinase 2 beta (PTK2B). Ninety Sprague Dawley rats were randomly divided into nine groups, consisting of five experimental groups and four control groups. In five experimental groups, Aβ1–42 was infused intracerebroventricularly and 3 days later, rats in each group were infused intracerebroventricularly with tubastatin A hydrochloride (TSA), the HDAC6-specific inhibitor (Aβ + TSA group), theophylline, the HDACs agonist (Aβ + Theo group), PF431396 (PF), the PTK2B inhibitor (Aβ + PF group), the combination of PF and theophylline (Aβ + PF + Theo group), and normal saline (Aβ + normal saline group), respectively. Rats in four control groups took normal saline that was equivalent to the volume of Aβ1–42, and 3 days later, TSA (TSA group), theophylline (Theo group), (PF group, or normal saline group) was given at a volume of 5 µL for rats in each group. Our results showed that HDAC6 may not only lead to the deterioration of learning and memory abilities but also elevate the levels of Aβo and Tau phosphorylation in Aβ-induced cognitive dysfunction rats via upregulating PTK2B.
The future of community psychiatry and community mental health services
Authors: Rosen Alan , Gill Neeraj S. , Salvador-Carulla Luis
Published: May 2020

Purpose of review

The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services.

Recent findings

Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities.

We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.
Demographics of Patients Receiving Electroconvulsive Therapy Based on State-Mandated Reporting Data
Authors: Luccarelli James , Henry Michael E. , McCoy Thomas H.
Published: May 2020

Objectives

Electroconvulsive therapy (ECT) is an effective treatment of depression and other psychiatric conditions. There are few comprehensive data on how many patients receive ECT in the United States or about the demographics of ECT recipients. This study characterizes the demographics of those receiving ECT and how these demographics may have changed with time.

Methods

Freedom of information requests for all data from record keeping inception to January 2019 were sent to the Department of Health or equivalent agency of states that mandate reporting of ECT. Information on demographics and the number of treating facilities was extracted.

Results

Data on 62,602 patients receiving treatment in 3 states (California, Illinois, Vermont) were obtained. Overall, 62.3% were women. Fewer than 1% of patients treated were younger than 18 years, whereas 30.3% were 65 years or older. White patients received a disproportionate proportion of treatments, with all other races underrepresented. The total number of facilities offering ECT in the 3 states declined over the study period.

Conclusions

Recipients of ECT are more likely to be female, more likely to be elderly, and more likely to be white than the average person in their state.
Stochastic modelling in fluid dynamics: Itô versus Stratonovich
Authors: Holm Darryl D.
Published: May 2020

Suppose the observations of Lagrangian trajectories for fluid flow in some physical situation can be modelled sufficiently accurately by a spatially correlated Itô stochastic process (with zero mean) obtained from data which is taken in fixed Eulerian space. Suppose we also want to apply Hamilton’s principle to derive the stochastic fluid equations for this situation. Now, the variational calculus for applying Hamilton’s principle requires the Stratonovich process, so we must transform from Itô noise in the
data frame
to the equivalent Stratonovich noise. However, the transformation from the Itô process in the data frame to the corresponding Stratonovich process shifts the drift velocity of the transformed Lagrangian fluid trajectory out of the data frame into a non-inertial frame obtained from the Itô correction. The issue is, ‘Will non-inertial forces arising from this transformation of reference frames make a difference in the interpretation of the solution behaviour of the resulting stochastic equations?’ This issue will be resolved by elementary considerations.
On rigid origami II: quadrilateral creased papers
Authors: He Zeyuan , Guest Simon D.
Published: May 2020

Miura-ori is well known for its capability of flatly folding a sheet of paper through a tessellated crease pattern made of repeating parallelograms. Many potential applications have been based on the Miura-ori and its primary variations. Here, we are considering how to generalize the Miura-ori: what is the collection of rigid-foldable creased papers with a similar quadrilateral crease pattern as the Miura-ori? This paper reports some progress. We find some new variations of Miura-ori with less symmetry than the known rigid-foldable quadrilateral meshes. They are not necessarily developable or flat-foldable, and still only have single degree of freedom in their rigid folding motion. This article presents a classification of the new variations we discovered and explains the methods in detail.
Shifts in plant community composition weaken the negative effect of nitrogen addition on community-level arbuscular mycorrhizal fungi colonization
Authors: Lu Yawen , Liu Xiang , Chen Fei , Zhou Shurong
Published: May 2020

Nitrogen addition affects plant–arbuscular mycorrhizal fungi (AMF) association greatly. However, although the direct effect of nitrogen addition on AMF colonization has received investigation, its indirect effect through shifts in plant community composition has never been quantified. Based on a 7-year nitrogen addition experiment in an alpine meadow of Qinghai–Tibet Plateau, we investigated the effects of nitrogen addition on plant community, AMF diversity and colonization, and disentangled the direct and indirect effects of nitrogen addition on community AMF colonization. At plant species level, nitrogen addition significantly decreased root colonization rate and altered AMF community composition, but with no significant effect on AMF richness. At plant community level, plant species richness and AMF colonization rate decreased with nitrogen addition. Plant species increasing in abundance after nitrogen addition were those with higher AMF colonization rates in natural conditions, resulting in an increased indirect effect induced by alternation in plant community composition with nitrogen addition, whereas the direct effect was negative and decreased with nitrogen addition. Overall, we illustrate the effect of nitrogen addition and plant species in influencing the AMF diversity, demonstrate how shifts in plant community composition (indirect effect) weaken the negative direct effect of nitrogen addition on community-level AMF colonization rate, and emphasize the importance of plant community-mediated mechanisms in regulating ecosystem functions.
The evolution of host resistance and parasite infectivity is highest in seasonal resource environments that oscillate at intermediate amplitudes
Authors: Ferris Charlotte , Wright Rosanna , Brockhurst Michael A. , Best Alex
Published: May 2020

Seasonal environments vary in their amplitude of oscillation but the effects of this temporal heterogeneity for host–parasite coevolution are poorly understood. Here, we combined mathematical modelling and experimental evolution of a coevolving bacteria–phage interaction to show that the intensity of host–parasite coevolution peaked in environments that oscillate in their resource supply with intermediate amplitude. Our experimentally parameterized mathematical model explains that this pattern is primarily driven by the ecological effects of resource oscillations on host growth rates. Our findings suggest that in host–parasite systems where the host's but not the parasite's population growth dynamics are subject to seasonal forcing, the intensity of coevolution will peak at intermediate amplitudes but be constrained at extreme amplitudes of environmental oscillation.