bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Investigation and Bracing in DDH Impacts Maternal Wellbeing and Breastfeeding
Authors: Hoffer Alexander , Chhina Harpreet , Mulpuri Kishore , Cooper Anthony P.
Published: October 2022

Background:

The outcomes of Pavlik Harness (PH) management for Developmental Dysplasia of the Hip (DDH) are equivalent regardless of the initiation timing, if it is within the first 6 weeks of life. A PH may be a physical barrier to breastfeeding, which is important for nutrition, immunity, and normal child development. The diagnosis of DDH and early management with a PH may also negatively affect the maternal psychosocial wellbeing and the infant-maternal relationship. The purpose of this study is to investigate the impact of the diagnosis of DDH and the management with a PH has on maternal wellbeing and maintenance of breastfeeding, compared with being screened for but not diagnosed with DDH.

Methods:

A retrospective cohort of the mothers of infants who were diagnosed with DDH and treated with a PH brace was compared with the mothers of infants who were screened for DDH only. The Hip Worries Inventory and Edinburgh Postnatal Depression Scale were completed by the mothers in both groups. The PH group also completed an in-house questionnaire specific to PH and breastfeeding.

Results:

Eighty completed surveys were included, 50 from the treatment group. The mean age of the PH initiation was 6.2 weeks. The modified Hip Worries Inventory score was higher in the treatment group, with a mean difference (MD) of 9.7 out of 50 (95% confidence interval, CI, 6.8, 12.5). The MD of the Edinburgh Postnatal Depression Scale was 2.0 out of 30 (CI −0.5, 4.5). Although there was no difference in the breastfeeding ease before and after the PH initiation (MD−0.2, CI−0.7, 0.2), 83% of mothers found breastfeeding more difficult with a PH and 11% of mothers stopped breastfeeding earlier than planned because of the PH.

Conclusions:

Mothers of infants with DDH worry more about their child’s hips and the PH. Screening alone may contribute to maternal psychological dejection and negative thoughts. The presence of a PH makes breastfeeding more difficult.

Level of Evidence:

Retrospective comparative study, level III.
A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis
Authors: Pinter Zachariah W. , Freedman Brett A. , Nassr Ahmad , Sebastian Arjun S. , Coric Domagoj , Welch William C. , Steinmetz Michael P. , Robbins Stephen E. , Ament Jared , Anand Neel , Arnold Paul , Baron Eli , Huang Jason , Whitmore Robert , Whiting Donald , Tahernia David , Sandhu Faheem , Chahlavi Ali , Cheng Joseph , Chi John , Pirris Stephen , Groff Michael , Fabi Alain , Meyer Scott , Kushwaha Vivek , Kent Roland , DeLuca Steven , Smorgick Yossi , Anekstein Yoram ,   TOPS Study Group
Published: October 2022

Study Design:

Prospective randomized Food and Drug Administration investigational device exemption clinical trial.

Objective:

The purpose of the present study is to report the 1-year clinical and radiographic outcomes and safety profile of patients who underwent lumbar facet arthroplasty through implantation of the Total Posterior Spine System (TOPS) device.

Summary of Background Data:

Lumbar facet arthroplasty is one proposed method of dynamic stabilization to treat grade-1 spondylolisthesis with stenosis; however, there are currently no Food and Drug Administration-approved devices for facet arthroplasty.

Methods:

Standard demographic information was collected for each patient. Radiographic parameters and patient-reported outcome measures were assessed preoperatively and at regular postoperative intervals. Complication and reoperation data were also collected for each patient.

Results:

At the time of this study, 153 patients had undergone implantation of the TOPS device. The mean surgical time was 187.8 minutes and the mean estimated blood loss was 205.7cc. The mean length of hospital stay was 3.0 days. Mean Oswestry Disability Index, Visual Analog Score leg and back, and Zurich Claudication Questionnaire scores improved significantly at all postoperative time points (P>0.001). There were no clinically significant changes in radiographic parameters, and all operative segments remained mobile at 1-year follow-up. Postoperative complications occurred in 11 patients out of the 153 patients (7.2%) who underwent implantation of the TOPS device. Nine patients (5.9%) underwent a total of 13 reoperations, 1 (0.6%) of which was for device-related failure owing to bilateral L5 pedicle screw loosening.

Conclusions:

Lumbar facet arthroplasty with the TOPS device demonstrated a statistically significant improvement in all patient-reported outcome measures and the ability to maintain motion at the index level while limiting sagittal translation with a low complication rate.
The Starfish Procedure for Independent Digital Control of a Myoelectric Prosthesis
Authors: Denduluri Sahitya K. , Rees Andrew , Nord Keith M. , Loeffler Bryan J. , Gaston R. Glenn
Published: October 2022

Management of partial hand amputations is a notable clinical challenge. Historically, myoelectric prostheses have not allowed for independent digital control, resulting in unsatisfactory function and high rejection rates among upper extremity amputees. The Starfish Procedure was developed for patients who sustained loss of multiple digits through the level of the base of the proximal phalanx or distal metacarpal. The procedure involves the pedicled transfer of 1 or more dorsal interosseous muscles to a subcutaneous location. This allows for a myoelectric sensor to capture the signals generated by these transferred muscles, thereby enabling intuitive, independent, digital prosthetic flexion and extension. In this article, we detail the relevant anatomy, indications, and technique for performing the Starfish Procedure. Given our patients’ promising outcomes to date, we hope this technique paper will encourage upper extremity surgeons of all training backgrounds to perform this relatively straightforward procedure, thereby allowing patients with life-altering finger amputations to regain meaningful function by enhancing control of digital prostheses.
Effect of Intermittent Pneumatic Compression in Addition to Pharmacologic Prophylaxis for Thromboprophylaxis in Hospitalized Adult Patients: A Systematic Review and Meta-Analysis
Authors: Duval Cécile , Sirois Caroline , Savoie-White Félix H. , Tardif Pier-Alexandre , Bérubé Mélanie , Turgeon Alexis F. , Cook Deborah J. , Lauzier François , Moore Lynne
Published: October 2022

OBJECTIVES:

Venous thromboembolic events (VTE) are frequent complications in hospitalized patients and a leading cause of preventable death in hospital. Pharmacologic prophylaxis is a standard of care to prevent VTE in patients at risk, the additional value of intermittent pneumatic compression (IPC) is uncertain. We aimed to evaluate the efficacy of adding IPC to pharmacologic prophylaxis to prevent VTE in hospitalized adults.

DATA SOURCES:

We searched the Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the International Clinical Trials Registry Platform from inception to July 2022.

STUDY SELECTION:

We included randomized controlled trials comparing the use of IPC in addition to pharmacological thromboprophylaxis to pharmacological thromboprophylaxis alone in hospitalized adults.

DATA EXTRACTION:

Meta-analyses were performed to calculate risk ratio (RR) of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). We assessed the risk of bias using the Cochrane Risk of Bias Tool for Randomized Trials, Version 2 and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.

DATA SYNTHESIS:

We included 17 trials enrolling 8,796 participants. The IPC was mostly applied up to the thigh and pharmacological thromboprophylaxis was primarily low-molecular-weight heparin. Adjunctive IPC was associated with a decreased risk of VTE (15 trials, RR = 0.53; 95% CI [0.35–0.81]) and DVT (14 trials, RR = 0.52; 95% CI [0.33–0.81]) but not PE (seven trials, RR = 0.73; 95% CI [0.32–1.68]). The quality of evidence was graded low, downgraded by risk of bias and inconsistency. Moderate and very low-quality evidence, respectively, suggests that adjunctive IPC is unlikely to change the risk of all-cause mortality or adverse events. Subgroup analyses indicate a more evident apparent benefit in industry-funded trials.

CONCLUSIONS:

Results indicate low-quality evidence underpinning the additional use of IPC to pharmacological thromboprophylaxis for prevention of VTE and DVT. Further large high-quality randomized trials are warranted to support its use and to identify patient subgroups for whom it could be beneficial.
Contrasts of Initial and Gain Scores in Obesity Treatment–Targeted Psychosocial Variables by Women Participants' Weight Change Patterns Over 2 Years
Authors: Annesi James J. , Stewart Francine A.
Published: October 2022

The typical pattern of weight change associated with behavioral obesity treatments has been some loss in weight through approximately 6 months, followed by near complete regain. However, patterns vary widely across individuals. The objectives are to determine whether recent prediction model–based indications of relations among changes in psychosocial correlates of the weight loss behaviors of physical activity and controlled eating vary by patterns of weight change. Women with obesity enrolled in a community-based behavioral obesity treatment who failed to lose at least 5% of their baseline weight (Minimal Effect group, n = 44), lost 5% or greater and then regained most during months 6 to 24 (Loss/Regain group, n = 42), or lost 5% or greater and then maintained/continued loss (Loss/Loss group n = 42) were evaluated. Improvements in physical activity– and eating-related self-regulation and self-efficacy, mood, and emotional eating over 6 months were significant overall and generally most favorable in the Loss/Loss group and least favorable in the Minimal Effect group. Expected model–based relationships between 6-month changes in the aforementioned psychosocial variables were significant and generally not significantly affected by weight change group. However, group substantially affected the prediction of self-regulation of eating at month 24—a key correlate of long-term weight loss. Findings suggested community-based obesity treatment targets and emphases.
Globe Compression by Bone Fragments in Orbital Blow-in Fractures: A Case Series and Systematic Review
Authors: Park Royce B. , North Victoria S. , Rebhun Carl L. , Belinsky Irina , Godfrey Kyle J. , Tran Ann Q.
Published: October 2022

Purpose:

The purpose of this study was to describe the clinical characteristics, management, and outcomes of orbital blow-in fractures involving compression of the globe by bone fragments.

Methods:

A retrospective case series and systematic literature review were performed.

Results:

Three male patients (mean age 29 years) with orbital blow-in fractures causing globe indentation presented with extraocular movement restriction, choroidal folds, and B-scan ultrasonography demonstrating deformation of the globe contour by a hyperechoic bone fragment. All underwent surgical repair within 1 day of presentation resulting in improved visual outcomes. An additional 10 cases were identified in the literature review. The majority of patients were male (80%) with a mean age of 29 years. Fractures originated primarily from the lateral orbital wall (50%) or the orbital roof (40%). Globe compression was evident on CT of the orbit (100%) and ultrasonography (30%). Common presenting signs included decreased visual acuity (70%), restriction of supraduction (40%) or abduction (40%), choroidal folds (30%), brow laceration (40%), periorbital edema (40%), and hypoglobus (40%). Most patients underwent surgical intervention (80%) involving fracture reduction (50%) or fragment removal (38%). Reported postsurgical outcomes were excellent with resolution of diplopia, motility, and visual acuity.

Conclusion:

Globe indentation from blow-in fractures are rare. Clinicians should be suspicious in cases of high-velocity trauma to the superolateral orbit with hypoglobus, motility limitation, and indentation of the globe upon dilated exam. Prompt diagnosis and early surgical removal of the compressive orbital bone fragments in a multidisciplinary fashion can lead to good visual, functional, and cosmetic outcomes.
Pimavanserin Exposure-Response Analyses in Patients With Schizophrenia
Authors: Darwish Mona , Bugarski-Kirola Dragana , Passarell Julie , Owen Joel , Jaworowicz David , DeKarske Daryl , Stankovic Srdjan
Published: October 2022

Purpose/Background

Pimavanserin is a selective serotonin 5-HT2A receptor inverse agonist/antagonist being investigated in patients with negative symptoms of schizophrenia. This analysis aimed to characterize exposure-response relationships of pimavanserin in this population.

Methods/Procedures

Exposure-response models were developed using data from ADVANCE. Patients with negative symptoms of schizophrenia receiving background antipsychotics were randomized to pimavanserin 20 mg (adjusted to 34 or 10 mg between weeks 2–8 based on efficacy or tolerability) or placebo for 26 weeks. Time-varying pimavanserin exposure measures were predicted for each patient using a population pharmacokinetic model and individual empiric Bayesian parameter estimates. Response measures were the Negative Symptom Assessment 16 (NSA-16, primary end point), Personal and Social Performance scale, negative symptoms component of the Clinical Global Impression of Schizophrenia–Severity Scale, and adverse events.

Findings/Results

A higher pimavanserin exposure was associated with greater improvement in NSA-16 score. For a median area under the pimavanserin plasma concentration-time curve from time 0 to 24 hours of 1465 ng × h/mL for the 34-mg dose, the model predicted a 10.5-point reduction in NSA-16 score. This exposure-response relationship with NSA-16 scores was not influenced by covariates. Similar results were observed with Personal and Social Performance and Clinical Global Impression of Schizophrenia–Severity, but not to the extent as NSA-16. There was no significant exposure-response relationship with anxiety, headache, insomnia, or somnolence.

Implications/Conclusions

Increasing pimavanserin plasma concentration was associated with improved NSA-16 scores (primary end point) in patients with negative symptoms of schizophrenia. No exposure-response relationship with select adverse events was observed.
Forgotten Heroes
Authors: Valera-Hernández María Fernanda , Arenas-Pérez Luisa , Fernandez-Capriles Isabella , Omaña-Paipilla Felipe , Palencia-Sánchez Francisco , Cadena-Camargo Yazmin
Published: October 2022

Objectives

Health care support workers have been facing several challenges due to the stressful environment in COVID-19 pandemic. Because of the gap in literature, it is mandatory to explore their experiences to identify burnout, predisposing factors, and possible interventions.

Methods

We conducted qualitative research with a hermeneutic phenomenological method. Participants belonged to cleaning services, security, and hospital administration areas at a hospital in Bogotá. We used semistructured individual interviews. The analysis approaches were deductive and inductive.

Results

As main concepts, we found the following: fear of infection and coping mechanisms, dealing with COVID-19 and being part of the health care support system, overwhelming workload and motivation to keep going and socioeconomic conditions.

Conclusions

We found burnout predisposing factors; however, the participants did not express symptoms of burnout syndrome. We believe protective factors such as resilience are influential concerning this outcome.
Triggering goals of care conversations in heart failure patients
Authors: Fang Yichun M. , de Peralta Shelly S.
Published: October 2022

Background:

Goals of care conversations (GoCCs) are essential discussions, for those with chronic diseases, to identify a health care surrogate, initiate and review advance directives, and refer for palliative care. Prognosis with pulmonary hypertension (PH) related to heart failure (HF) remains challenging due to variation in trajectory of disease progression. The Gagne Combined Comorbidity score, an electronic prognostication score (E-Gagne), can be used to identify patients with high (>10%) 1-year mortality.

Local Problem:

Implementation of E-Gagne tool to identify HF patients with high 1-year mortality risk and trigger GoCCs.

Methods:

Plan-Do-Study-Act cycles were used throughout nine-week pre- and postintervention in an outpatient setting. Descriptive statistics and Chi-square analysis were used to compare GoCCs pre and post intervention.

Intervention:

Using the E-Gagne tool, PH patients with high mortality risk were identified, within 1 week of their scheduled appointments. GoCCs education was provided to all stakeholders. Medical records were reviewed for four aspects of GoCCs: presence and review of advanced directive, documented health care surrogates, and referral for palliative care.

Results:

Documentation of GoCCs was greater postintervention compared with preintervention (0%, n = 0/47 and 88%, n = 35/40 respectively, p < .001). Documentation of each of the four aspects of GoCCs was variable with the greatest improvement in documentation of health care surrogate and review of advance directives. There were no referrals for palliative care (0%, n = 0/47 and 0%, n = 0/40).

Conclusion:

Implementation of the E-Gagne tool, an electronic prognostication tool, identified high-risk PH HF patients and was effective in increasing documentation of GoCCs.
A new cardiovascular disease risk factor for young adults: Preterm birth
Authors: Brewer Pamela L. , D'Agata Amy L. , Sullivan Mary C.
Published: October 2022

Adults born preterm (birth <37 weeks' gestation) have a two-fold increased risk of early cardiovascular mortality. With 10% of the U.S. population born prematurely and perinatal advancements dramatically improving survival rates, millions of survivors are now reaching adulthood. This phenomenon has introduced a whole new population of individuals with a history of preterm birth. Although the prevailing notion has been that preterm birth is a condition confined only to infancy and early childhood, we now know preterm birth is a risk for lifelong chronic health conditions. Despite almost a decade of epidemiological evidence showing increased cardiovascular risk for those born preterm, this has not yet been translated into clinical practice. As a result, clinicians are caring for adults born prematurely without screening and treatment guidelines for this at-risk population and few inquire about birth history during clinical encounters. This brief report presents growing evidence about disrupted cardiogenesis and consequential structural and functional modifications. By asking the question “Were you born preterm?,” nurse practitioners can take the first step of increasing their awareness of this at-risk population and mitigate adverse cardiovascular outcomes by using preterm birth as a risk factor when determining health promotion and treatment decisions.
Standardization of Outcome Measures for Intratympanic Steroid Treatment for Idiopathic Sudden Sensorineural Hearing Loss
Authors: Osafo Neil K. , Friedland David R. , Harris Michael S. , Adams Jazzmyne , Davis Chasity , Osinski Kristen , Tong Ling , Luo Jake
Published: October 2022

Objective

To identify variability in reported hearing outcomes for intratympanic (IT) steroid treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) by comparing outcomes using the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) guideline with other published criteria.

Study Design

Retrospective chart review.

Setting

Tertiary otology practice.

Patients

Patients with ISSNHL treated with IT steroid between April 2003 and December 2020.

Interventions

IT steroid injection and audiometric evaluation.

Main Outcome Measures

1) Rates of full, partial, or no recovery using the AAO-HNS guideline versus other reported criteria, and 2) correlation analyses of demographic and clinical variables with response to IT steroid.

Results

Using AAO-HNS reporting criteria, full recovery of the pure-tone average was noted in 25.68% of patients. Applying eight other published outcomes criteria to this patient cohort classified full recovery in 14.87 to 40.54% of patients. Similarly, AAO-HNS criteria classified “no recovery” in 51.35% of our patients, whereas applying the other reported criteria showed an average rate of 62.16% no recovery and as high as 82.43% of patients without recovery. Younger age (p = 0.003; effect size, 0.924) and IT injection within a week of onset (p < 0.001; effect size, 1.099) positively correlated with full recovery. There was no impact of prior or concurrent oral steroids, or number of steroid injections on outcome.

Conclusion

Great variability exists in the literature for assessment of IT steroid outcomes in ISSNHL. Standard reporting of outcomes as per the AAO-HNS SSNHL guideline is recommended to consistently characterize IT steroid efficacy and allow comparison across studies.
Brief Report: Dapivirine Ring HIV-1 Prevention Effectiveness for Women Engaged in Vaginal and Anal Intercourse: Insights From Mathematical Modeling
Authors: Peebles Kathryn , Brown Elizabeth R. , Hendrix Craig W. , Palanee-Phillips Thesla , van der Straten Ariane , Harkoo Ishana , Reddy Krishnaveni , Mirembe Brenda G. , Jeenarain Nitesha , Hillier Sharon L. , Baeten Jared M. , Barnabas Ruanne V. ,   for the MTN-020/ASPIRE study team
Published: October 2022

Background:

The dapivirine vaginal ring reduces the risk of HIV-1 acquisition in acts of vaginal intercourse (VI), and although it does not offer HIV-1 protection in acts of anal intercourse (AI), it may provide some overall risk reduction for women for whom most sex acts are vaginal. We estimated the protective effect of the ring among women with high ring adherence engaged in both VI and AI.

Methods:

We developed a microsimulation model using data from the MTN-020/ASPIRE trial. Among women who reported any AI, we estimated the proportion of all sex acts that were AI. Model scenarios varied this proportion among women engaged in both VI and AI from 5% to 30%, including the trial-observed median proportion of 6.3% of all acts being AI. In primary analyses, dapivirine ring efficacy was model-calibrated at 70% for vaginal exposures and assumed to be 0% for anal exposures.

Results:

Among highly adherent women for whom 6.3% of sex acts were AI, the ring reduced HIV-1 risk by 53% (interquartile range: 44, 60), with a decline to 26% (interquartile range: 16, 36) among women for whom 30% of acts were AI. Ring effectiveness was less than 40% among women for whom AI accounted for greater than 16% of all sex acts, although this represented less than 5% of all women in the ASPIRE trial.

Conclusions:

For most women, including those who engage in AI, because most HIV-1 risk occurs in acts of vaginal sex, the dapivirine vaginal ring can provide important HIV-1 protection.
Rest/Stress Intradermal Lymphoscintigraphy for the Functional Imaging of the Lymphatic System
Authors: Tartaglione Girolamo , Ieria Francesco Pio , Visconti Giuseppe , Bartoletti Roberto , Tarantino Giulio , Aloisi Daniele , Gentileschi Stefano , Salgarello Marzia
Published: October 2022

Purpose

Lymphoscintigraphy is the criterion-standard method for diagnosing lymphedema, and there is no universally standardized imaging modality. In our center, we use a new approach: rest/stress intradermal lymphoscintigraphy.

Methods

We tested 231 consecutive patients with suspected lymphedema. All patients were studied after a complex physical therapy program to reduce edema. Two doses of 99mTc-nanocolloid were injected intradermally. Two static planar scans were taken at rest following tracer injection. Next, patients performed an isotonic muscular exercise for 2 minutes followed by postexercise scans. Subsequently, a prolonged exercise was performed for 30 to 40 minutes, after which delayed scans were taken. Abnormal patterns were distinguished into minor or major findings, according to severity.

Results

We identified superficial lymphatic vessels and regional lymph nodes in approximately 80% of limbs. Deep vessels were visualized in 26% of limbs. Minor findings were reported in 22.7% of limbs examined, whereas major findings were reported in 53.2% of limbs.

Conclusion

We observed major findings including lymph stagnation, extravasation, or dermal backflow in a significantly higher percentage of limbs with secondary lymphedema than in primary. We also observed the deep lymphatic pathways in a significantly higher percentage of limbs with primary lymphedema. Intradermal radiotracer injection, combined with isotonic muscular exercise, may offer a better and faster imaging of lymphatic pathways, evaluating the effects of muscular exercise on lymphatic drainage. Based on the in-depth information of the lymphatic pathways provided by rest/stress intradermal lymphoscintigraphy, microsurgeons can obtain important functional information to perform supermicrosurgical lymphatic-venous anastomosis or vascularized lymph node transfer.
Facial Defects With Infraorbital and Zygomatic Area Reconstruction Using an Expanded Flap Based on the Orbicularis Oculi Muscle: A Long-Term Follow-up
Authors: Luo Si-Si , Yang Zhe , Ma Ning , Wang Wei-Xin , Chen Sen , Wu Qi , Qu Si-Wei , Li Yang-Qun
Published: October 2022

Objective:

Reconstruction of facial soft-tissue defects may pose a dilemma for plastic surgeons, as the flaps must be reliable to obtain a natural appearance while minimizing donor site morbidities. This clinical study describes a reconstructive method for infraorbital and zygomatic defects using a pre-expanded rotation flap based on the orbicularis oculi muscle (OOM).

Methods:

The surgeries were subdivided into 2 stages. In the first stage of the operation, a 100 to 200 mL expander was placed underneath the temporal area through a hairline incision. In the second stage, after adequate inflation of the expander, the pre-expanded rotation flap based on the OOM of the lower eyelid was raised from lateral to medial to cover the facial defects.

Results:

In this single-center study from February 2010 to February 2017, 16 patients underwent facial defect reconstruction using the pre-expanded flap based on the OOM. All of the defects were located at the infraorbital and zygomatic regions, and their sizes ranged from 3.0 

 4.0 to 7.0 

 14.0 cm. The causes of these defects included postburn scars (37.5%), melanocytic nevus (50%), and hemangiomas (12.5%). In all cases, good coverage was provided for the defects that were in the medial cheek or lower eyelids. There were no flap losses of any kind. There were no major complications, and all minor incidences were treated by minimal procedures. The patients were followed up after surgery, with the follow up ranging from 6 months to 108 months. The follow-up data included postoperative consultations, the defect size, the need for further procedures and the degree of satisfaction.

Conclusion:

The pre-expanded rotation flaps in the lateral facial area based on the OOM can ideally and safely be applied for facial defect reconstruction owing to their reliable blood supply and excellent texture match.
Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis
Authors: Habarth-Morales Theodore E. , Rios-Diaz Arturo J. , Isch Emily , Ni Roselind L. , Hamou Samara J. , Caterson Edward J.
Published: October 2022

The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission. The authors sought to evaluate the incidence of TTMR according to external injury cause and evaluate the association of skull fracture patterns with TTMR using a national trauma database. A cross-sectional analysis of trauma encounters was conducted using the National Trauma Data Bank (NTDB) from 2008 to 2015. Demographic and injury data were abstracted. Poisson regression was used to determine the incidence rate ratios of tympanic membrane rupture by external injury cause and logistic regression was used to estimate odds ratios (OR) of TTMR by skull fracture type. A total of 8214 patients were identified with TTMR during acute admission. The majority were on average 30 years old, 76% male, 71% White, had a mean Injury Severity Score of 14, and 42% were admitted to level I centers. The incidence rate ratio was only higher in lightning related injuries [5.262; 95% confidence interval (CI): 4.194–6.602] when using those caused by explosives as a reference. Basilar skull (OR: 12.95; 95% CI: 12.095–12.866) and cranial vault (OR: 2.938; 95% CI: 2.647–3.260) fractures were most associated with TTMR. The high incidence TTMR in association with certain external causes of injury and types of skull fractures should drive screening in the acute setting in order to increase detection and reduce morbidity from missed injuries.
Application of 3D-printed Surgical Cutting Guide in Anterior Mandibular Body Ostectomy
Authors: Xie Kungpeng , Wang Lin , Chen Kai , Hu Xiangjin , Wu Guomin
Published: October 2022

Complications in mandibular surgeries involve nerve and root injuries. Due to the variation of the intraosseous pattern of the inferior alveolar nerve and roots among patients, the risk of injury remains high in complex cases of mandibular body surgeries. This technical note aims to introduce a novel design of surgical cutting guide used in anterior mandibular body ostectomy. Roots of neighboring teeth and the inferior alveolar nerve are segmented and visualized in 3-dimension. Osteotomy planes designed in virtual surgical planning provide an accurate safety distance to the nerve and roots. These planes are translated to a bone-based cutting guide to ensure the osteotomy is conducted as planned. Application of the cutting guide offers protection to the neighboring structures and the simplified structure requires limited preoperative design time of the cutting guide. Therefore, the authors believe this surgical cutting guide would bring accuracy and efficiency to mandibular surgeries.
Systematic Review of the Clinical and Experimental Research Assessing the Effects of Craniosynostosis on the Brain
Authors: Furtado Leopoldo M. F. , Teles Lucas R. , Martins da Costa Sara Alois de Abreu , de Souza Matos Victor U. , Teixeira Natália M. , Gonçalves Carlos A. , Filho José Aloysio da Costa Val
Published: October 2022

Although neurocognitive impairment has been considered as the main argument for the surgical treatment of craniosynostosis (CS), recent studies reported subtle deficits in neurological function even in operated patients. However, the cause of these deficits remains poorly understood. This systematic review sought to examine the impact of CS on the brain microstructure, mainly on functional connectivity, and comprehensively summarize the clinical and experimental research available on this topic. A systematic review was performed considering the publications of the last 20 years in PubMed and Web of Science, including relevant human and animal studies of the types of brain-microstructure disturbances in CS. Among the 560 papers identified, 11 were selected for analysis. Seven of those were conducted in humans and 4 in animal models. Resting-state functional magnetic resonance imaging, task-based magnetic resonance imaging, and diffusion tensor imaging were the main instruments used to investigate brain connectivity in humans. The main findings were increased connectivity of the posterior segment of cingulum gyri, reduced interconnectivity of the frontal lobes, and reduced diffusivity on diffusion tensor imaging, which were associated with hyperactivity behaviors and poorer performance on neurocognitive tests. Conversely, despite the lack of evidence of brain dysfunction in animal studies, they reported a tendency toward the development of hyperactive behaviors and impairment of neurocognitive function. Skull restriction caused by CS apparently chronically increases the intracranial pressure and produces white matter injuries. The current evidence supports the contention that an early surgical approach could minimize brain-connectivity impairment in this context.
CSF α-Synuclein and Tau as Biomarkers for Dementia With Lewy Bodies
Authors: Zhang Qinghui , Li Jia , Quan Wei , Liu Li , Qin Yidan , Pei Xiaochen , Su Hang , Xu Jing , Chen Jiajun
Published: October 2022

Objective:

This study investigated whether α-synuclein and tau in cerebrospinal fluid (CSF) can be used as biomarkers to diagnose dementia with Lewy bodies (DLB).

Materials and Methods:

We retrieved 3303 studies with “Dementia with Lewy bodies,” “α-synuclein,” and “tau” as keywords. We formulated screening criteria, and 2 researchers completed the screening, quality evaluation, and data extraction tasks. Finally, 35 studies related to tau, and 14 studies related to α-synuclein were included. Review Manager 5.4 and Stata16 were used for meta-analysis. Subgroup, sensitivity, and meta-regression analyses were performed to identify sources of heterogeneity and strengthen the results.

Results:

Compared with the control group, DLB patients showed significantly higher CSF levels of tau [weighted mean difference=81.36 (59.82, 102.91); Z=7.40; P<0.00001], and lower CSF levels of α-synuclein [weighted mean difference=−95.25 (−162.02, −28.48); Z=2.80; P=0.005]. Mini-Mental State Examination (MMSE) score, male ratio, and disease duration were not sources of heterogeneity on subgroup and meta-regression analyses. Sensitivity analysis revealed no significant differences.

Conclusions:

Higher levels of tau and lower levels of α-synuclein were found in the CSF of patients with DLB compared with the control group. Therefore, CSF tau and α-synuclein levels may be diagnostic biomarkers for DLB.
Can the American College of Surgeons NSQIP Surgical Risk Calculator Accurately Predict Adverse Postoperative Outcomes in Emergency Abdominal Surgery? An Italian Multicenter Analysis
Authors: Scotton Giovanni , La Greca Antonio , Lirusso Chiara , Mariani Diego , Zago Mauro , Chiarugi Massimo , Tartaglia Dario , de Manzini Nicolò , Biloslavo Alan ,   for the Emergency Surgery Collaborative
Published: October 2022

Background:

The ACS-NSQIP Surgical Risk Calculator (SRC) provides an estimation of 30-day post-operative adverse outcomes. It is useful in the identification of high risk patients needing clinical optimization and supports the informed consent process. The purpose of this study is to validate its predictive value in the Italian emergency setting.

Methods:

Six Italian institutions were included. Inclusion diagnosis were acute cholecystitis, appendicitis, gastrointestinal perforation or obstruction. Areas under the ROC curves (AUC), Brier score, Hosmer-Lemershow index (H-L), and observed to expected event ratio (O/E) were measured to assess both discrimination and calibration. Effect of the Surgeon Adjustment Score (SAS) on calibration was then tested. A patient’s personal Risk Ratio (RR) was obtained and a cut-off was chosen to predict mortality with a high NPV.

Results:

2,749 emergency procedures were considered for the analysis. The AUC was 0.932 for death (0.921-0.941, p<0.0001; Brier 0.041), 0.918 for discharge to nursing or rehab facility (0.907-0.929, p<0.0001; 0.070). Discrimination was also strong (AUC>0.8) for renal failure, cardiac complication, pneumonia, venous thromboembolism, serious complication and any complication. Brier score was informative (<0.25) for all the presented variables. The O/E ratios were 1.0 for death and 0.8 for discharge to facility. For almost all other variables, there was a general risk underestimation, but the use of the SAS permitted a better calibration of the model. An RR>3.00 predicted the onset of death with sensitivity=86%, specificity=77% and NPV=99%.

Conclusions:

The ACS-NSQIP SRC has proved to be a reliable predictor of adverse post-operative outcomes also in Italian emergency settings, with particular regard to mortality. We therefore recommend the use of the SRC in the multi-disciplinary care of patients undergoing emergency abdominal surgery.
Tubulator
: an automated approach to analysis of t-tubule and dyadic organization in cardiomyocytes
Authors: Frisk Michael , Norseng Per Andreas , Stenersen Espe Emil Knut , Louch William E.
Published: October 2022

During cardiac disease, t-tubules and dyads are remodelled and disrupted within cardiomyocytes, thereby reducing cardiac performance. Given the pathological implications of such dyadic remodelling, robust and versatile tools for characterizing these sub-cellular structures are needed. While analysis programs for continuous and regular structures such as rodent ventricular t-tubules are available, at least in two dimensions, these approaches are less appropriate for assessment of more irregular structures, such as dyadic proteins and non-rodent t-tubules. Here, we demonstrate versatile, easy-to-use software that performs such analyses. This software, called
Tubulator
, enables automated analysis of t-tubules and dyadic proteins alike, in both tissue sections and isolated myocytes. The program measures densities of subcellular structures and proteins in individual cells, quantifies their distribution into transversely and longitudinally oriented elements, and supports detailed co-localization analyses. Importantly,
Tubulator
provides tools for three-dimensional assessment and rendering of image stacks, extending examinations from the single plane to the whole-myocyte level. To provide insight into the consequences of dyadic organization for synchrony of Ca
2+
handling,
Tubulator
also creates ‘distance maps', by calculating the distance from all cytosolic positions to the nearest t-tubule and/or dyad. In conclusion, this freely accessible program provides detailed automated analysis of the three-dimensional nature of dyadic and t-tubular structures.

This article is part of the theme issue ‘The cardiomyocyte: new revelations on the interplay between architecture and function in growth, health, and disease’.
Genome dynamics mediated by repetitive and mobile elements in Xanthomonas citri pv. durantae
Authors: Rana Rekha , Bansal Kanika , Kaur Amandeep , Patil Prabhu B.
Published: October 2022

Xanthomonas

is a highly evolved group of phytopathogenic bacteria infecting nearly 400 host plants having vast genomic resources available with heterogenicity in representation from different species and pathovars. Unfortunately, the wealth of data is extremely biased and restricted to a few

Xanthomonas

pathogens that infect economically important plants, while those reported to infect the most diverse plants remain neglected. In the present study, we report the first complete genome sequence of

Xanthomonas citri

pv. durantae that was reported to infect Duranta repens L. or golden dewdrop, a hedge plant of ornamental importance native to the American region. Phylogenomic analysis with its closest relatives placed it amongst

X. citri

pv. citri A* pathotype strains and further comparative studies revealed various large unique genomic regions of chromosomal origin. The association of integrative and conjugative elements and prophages with unique genomic regions suggests the role of mobilome in genome dynamics. A large number of IS elements and transcription activator-like effectors encoding genes on each of the four plasmids indicate the further scope of diversification in

Xanthomonas

.
Case report: a genomics-guided reclassification of a blood culture isolate misassigned by MALDI-TOF as Yersinia pestis
Authors: Sim Eby M. , Koh Bryant , Ng Jimmy , Nguyen Trang , Wang Qinning , Ginn Andrew N. , Brown Mitchell , Pham David , Sintchenko Vitali
Published: October 2022

In this report, we describe a case where Gram-negative rods were isolated from a blood culture which subsequently presented a discordant

Yersinia

species result by MALDI-TOF. Rapid sequencing provided high-resolution identification of the isolate as

Yersinia pseudotuberculosis

, which was subsequently confirmed by biochemical tests.
Human parvovirus B19 infection in a pregnant patient resulting in severe hydrops, foetal death and persistent infection
Authors: Bertoldi Ariel , Colazo Salbetti María Belén , Rodríguez Gonzalo , Tenaglia Magdalena , Hernández Gabriela , Alfaro Jimena , Riberi María Inés , Olivera Nicolás Lionel , Pedranti Mauro , Isa María Beatriz , Adamo Maria Pilar
Published: October 2022

Human parvovirus B19 (B19V) is the aetiological agent of erythema infectiosum. Primary infection during pregnancy can be transmitted to the foetus and cause foetal abnormalities related to depletion of erythrocyte progenitor cells, including congenital anaemia, hydrops, and foetal death. In this paper we report the detection of B19V infection in a pregnant patient, which onset occurred without appreciable signs and symptoms until she developed inappropriate contractions for gestational age and fluid loss. B19V infection resulted in severe hydrops fetalis with a fatal course for the foetus, while persisted in the mother at least 12 months after foetal death. The objective of this report is to highlight the importance of optimizing B19V diagnosis through early suspicion and testing during pregnancy. Knowing the mother’s immune status before or at the beginning of gestation can contribute, together with early diagnosis, to improve the management of patients at risk.
Luminal and mucosa-associated caecal microbiota of chickens after experimental Campylobacter jejuni infection in the absence of Campylobacter-specific phages of group II and III
Authors: Hankel Julia , Kittler Sophie , Chuppava Bussarakam , Galvez Eric , Strowig Till , Becker André , von Köckritz-Blickwede Maren , Plötz Madeleine , Visscher Christian
Published: October 2022

Campylobacteriosis is still the most commonly reported zoonosis in the European Union causing gastrointestinal disease in humans. One of the most common sources for these food-borne infections is broiler meat. Interactions between

Campylobacter

(C.) jejuni and the intestinal microbiota might influence

Campylobacter

colonization in chickens. The aim of the present study was to gain further knowledge about exclusive interactions of the host microbiota with

C. jejuni

in

Campylobacter

-specific phage-free chickens under standardized conditions and special biosafety precautions.

Therefore, 12 artificially infected (

C. jejuni

inoculum with a challenge dose of 7.64 log10 c.f.u.) and 12 control chickens of the breed Ross 308 were kept under special biosafety measures in an animal facility. At day 42 of life, microbiota studies were performed on samples of caecal digesta and mucus. No

Campylobacter

-specific phages were detected by real-time PCR analysis of caecal digesta of control or artificially infected chickens. Amplification of the 16S rRNA gene was performed within the hypervariable region V4 and subsequently sequenced with Illumina MiSeq platform. R (version 4.0.2) was used to compare the microbiota between

C. jejuni

-negative and

C. jejuni

-positive chickens. The factor chickens’ infection status contributed significantly to the differences in microbial composition of mucosal samples, explaining 10.6 % of the microbiota variation (P=0.007) and in digesta samples, explaining 9.69 % of the microbiota variation (P=0.015). The strongest difference between

C. jejuni

-non-infected and

C. jejuni

-infected birds was observed for the family

Peptococcaceae

whose presence in

C. jejuni

-infected birds could not be demonstrated. Further, several genera of the family

Ruminococcaceae

appeared to be depressed in its abundance due to

Campylobacter

infection. A negative correlation was found between

Christensenellaceae

R-7 group and

Campylobacter

in

C. jejuni

-colonised chickens, both genera potentially competing for substrate. This makes

Christensenellaceae

R-7 group highly interesting for further studies that aim to find control options for

Campylobacter

infections and assess the relevance of this finding for chicken health and

Campylobacter

colonization.
Orbitofrontal Cortex is necessary for the behavioural expression, but not learning, of Pavlovian conditioned inhibition
Authors: Panayi Marios C. , Killcross Simon
Published: October 2022

Orbitofrontal cortex (OFC) lesions cause deficits in flexible behavioural control, most notably response inhibition and has historically been linked to theories of response inhibition. This general inhibition hypothesis of OFC function has since been rejected by evidence that inhibitory behavioural control can be expressed following OFC damage, however the functional role of the OFC in the explicit learning of conditioned inhibition remains untested. Here we test whether muscimol disruption of OFC function during the learning stage of a Pavlovian conditioned inhibition procedure disrupted the learning of conditioned inhibitory associations. Muscimol abolished Inhibitory behavioural control during the learning phase, however learning about the conditioned inhibitor was intact when tested drug free in subsequent summation and retardation tests of conditioned inhibition. Muscimol also significantly impaired acquisition to control cues whose cue-outcome relationship did not change. In a second experiment, conditioned inhibition was found not to play a significant role in cue extinction (non-reinforcement), an effect that was disrupted by intra-OFC infusion of muscimol. These results confirm that the OFC is not functionally necessary for the learning of inhibitory associations but is critical to both the enhancement and suppression of responding when environmental contingencies change.
“Altered CD8+T cell associated aging gene signature in the peripheral blood of patients with Alzheimer’s disease”
Authors: Young Juan J. , Park Hong-Jai , Kim Minhyung , Par-Young Jennefer , Bartlett Hugh H. , Kim Hye Sun , Shin Min Sun , Unlu Serhan , Bucala Richard , Van Dyck Christopher H. , Allore Heather G. , Mecca Adam P. , You Sungyong , Kang Insoo
Published: October 2022

INTRODUCTION

Effector memory (EM) CD8+T cells have been associated with poor cognition in Alzheimer’s disease (AD). Our lab recently discovered an age-associated gene expression signature of IL-7 receptor alpha (IL-7Rα)lowEM CD8+T cells. We hypothesized that individuals with AD have altered levels of this IL-7Rαlowaging gene expression.

METHODS

Forty genes associated with IL-7RαlowEM CD8+T cells, AD, or memory, were analyzed in peripheral blood of participants with normal cognition, mild cognitive impairment, and dementia by qPCR.

RESULTS

Of the eight genes that were found to be differentially expressed based on clinical diagnosis, 5 genes (62.5%) were IL-7Rαlowaging genes. Principal component analysis revealed 3 clusters of participants with dementia which had distinct expression levels of IL-7Rαlowaging genes and cognitive function.

DISCUSSION

Our findings support the possible relationship of the IL-7RαlowEM CD8+T cell aging signature with cognition in individuals with dementia due to AD.