bluuebunny/crossref_metadata_2025 huggingface dataset:
Anticorrelated lags in a neutron star Z source GX 5-1: AstroSat’s View
Authors: P Chiranjeevi , Sriram K
Published: August 2022

We report the cross-correlation function studies of a neutron star low-mass X-ray binary, a Z source GX 5-1, using Soft X-ray Telescope (SXT) and Large Area X-ray Proportional Counter (LAXPC) energy bands onboard AstroSat. For the first time, we report the lag between soft (0.8–2.0 keV, SXT) and hard X-ray energy bands (10–20 and 16–40 keV, LAXPC) in GX 5-1 and detected lags of the order of a few tens to hundreds of seconds in the horizontal branch. We interpreted them as the readjustment time-scale of the inner region of the accretion disc. We used various two components and three-component spectral models to unfold the spectra and observed the changes in soft and hard component fluxes that were exhibiting horizontal branch oscillation variations. It was observed that the bbody component assumed to be originating from the boundary layer over the NS and was also found to vary along with the HBO variation where lags were detected. We constrained the size of the comptonizing region of the order 15–55 km, assuming that lags were due to variation in the size of the corona. We noticed a similar size of the comptonizing region after employing other models and suggest that the overall size of corona must be of the order of a few tens of km to explain the lags, HBO variation, and respective spectral variations. In a case study, it was noted that the BL size increases as GX 5-1 vary from the top of the HB to the upper vertex.
Tacrolimus use and renal function in pregnancy with lupus nephritis: Analysis of post-marketing surveillance data in Japan
Authors: Suzuki Kazuko , Uno Satoshi , Wakasugi Naoko
Published: August 2022

Objectives

Tacrolimus may be administered to pregnant women with lupus nephritis in Japan if considered therapeutically beneficial, but supporting data are limited. We assessed the safety and effectiveness of tacrolimus before, during, and after pregnancy in women with lupus nephritis receiving tacrolimus.

Methods

This was an ad hoc analysis of data from a post-marketing surveillance study of tacrolimus in patients with lupus nephritis in Japan. Pregnancy outcomes, nephritis status, and adverse events were assessed for up to 2 years postpartum.

Results

Data were available for 23 births in 21 patients (two patients had two births each). Tacrolimus for lupus nephritis was continued during 11 births in nine patients (during and after pregnancy) and discontinued in 12 patients (when pregnancy was known or when approaching delivery). Renal function was generally maintained in patients who gave birth while receiving tacrolimus; however, there were cases of increased urine protein and decreased renal function over 2 years. There were no unexpected adverse events/safety concerns.

Conclusions

These data from clinical practice suggest that tacrolimus is a valid treatment option for lupus nephritis in fertile women in Japan and, with careful monitoring, pregnant women with lupus nephritis may continue their tacrolimus treatment.
Development of targeted therapies in IgG4-related disease
Authors: Nakayamada Shingo , Tanaka Yoshiya
Published: August 2022

IgG4-related disease (IgG4-RD) is a systemic disease characterized by high serum IgG4 levels, infiltration of lymphocytes and IgG4-positive plasma cells into affected tissues, and subsequent fibrosis, forming mass, nodular, and thickened lesions in organs. Although glucocorticoids (GCs) are the first-line treatment for IgG4-RD, the disease often relapses during dose reduction or after discontinuation of GC. Long-term treatment with GC is associated with adverse effects such as infection, osteoporosis, and atherosclerosis. Therefore, there is an urgent need to develop a treatment strategy that specifically addresses the pathogenesis of IgG4-RD. As immunocompetent cells and immune-related molecules involved in the pathogenesis of IgG4-RD are increasingly being identified, there is a growing demand for new molecular-targeted drugs that target them. In particular, favourable results have been reported for drugs that target B cells, such as anti-cluster of differentiation (CD)20 and anti-CD19 antibodies. In addition, clinical trials are underway for new therapeutic agents, such as anti-signalling lymphocytic activation molecule family 7 antibodies that target T cells and other cells.
Availability of Results of Trials Studying Pancreatic Adenocarcinoma over the Past 10 Years
Authors: Pellat Anna , Boutron Isabelle , Ravaud Philippe
Published: August 2022

Background

Pancreatic adenocarcinoma (PDAC) is a lethal cancer with few therapeutic options. Availability of results is a crucial step in interventional research. Our aim was to evaluate results availability for trials in patients with PDAC and explore associated factors.

Materials and Methods

We performed a retrospective cohort study and searched the ClinicalTrials.gov registry for trials evaluating PDAC management with a primary completion date between 1 January 2010 and 1 June 2020. Then, we searched for results submitted on ClinicalTrials.gov and/or published. Our primary outcome was the proportion of PDAC trials with available results: submitted on ClinicalTrials.gov (either publicly available or undergoing quality control check) and/or published in a full-text article. The association of predefined trial characteristics with results availability was assessed.

Results

We identified 551 trials of which 386 (70%) had available results. The cumulative percentage of trials with available results was 21% (95% CI, 18-25%) at 12 months after the primary completion date, 44% (95% CI, 30-48%) at 24 months and 57% (95% CI, 53-61%) at 36 months. Applicable clinical trials, required to comply with the 2007 Food and Drug Administration Amendments Act 801 and its final rule on reporting of results on ClinicalTrials.gov, were more likely to have available results over time (HR 2.1 [95% CI 1.72-2.63], P < .001). Industry-funded, small sample size, and terminated trials were less likely to have available results. Other trial characteristics showed no association with results availability.

Conclusion

Our results highlight a waste in interventional research studying PDAC.
Dissemination of Fusarium Wilt of Banana in Mozambique Caused by Fusarium odoratissimum Tropical Race 4
Authors: van Westerhoven Anouk C. , Meijer Harold J. G. , Houdijk Joost , Martínez de la Parte Einar , Matabuana Elie Luntadila , Seidl Michael F. , Kema Gert H. J.
Published: August 2022

Fusarium wilt of banana (FWB) is a serious soil-borne fungal disease. In the previous century, FWB already destroyed Gros Michel-based banana cultures in Central America, and currently, the disease threatens all major banana-producing regions of the world. The causal agents of these epidemics, however, are diverse. Gros Michel was infected by a wide range of Fusarium species, the so-called Race 1 strains, whereas the contemporary Cavendish-based cultures are affected by Fusarium odoratissimum, colloquially called Tropical Race 4 (TR4). TR4 was reported in Mozambique on two commercial banana farms in 2013, but no incursions were found outside the farm boundaries in 2015, suggesting that the disease was under control. Here we report the presence of TR4 outside of these farm boundaries. We obtained fungal samples from 13 banana plants in smallholder and roadside plantings at various locations throughout northern Mozambique. These samples tested positive for TR4 by molecular diagnostics and in greenhouse pathogenicity assays. The results were confirmed with reisolations, thereby completing Koch’s postulates. To study the diversity of TR4 isolates in Mozambique, we selected five samples for whole-genome sequencing. Comparison with a global collection of TR4 samples revealed very little genetic variation, indicating that the fungus is clonally spreading in Mozambique. Furthermore, isolates from Mozambique are clearly genetically separated from other geographic incursions, and thus we cannot trace the origin of TR4 in Mozambique. Nevertheless, our data demonstrates the dissemination of TR4 in Mozambique, underscoring the failure of disease management strategies. This threatens African banana production.
Current status, trends, and predictions in the burden of gallbladder and biliary tract cancer in China from 1990 to 2019
Authors: Chen Shimin , Han Ke , Song Yang , Liu Shaohua , Li Xuehang , Wang Shengshu , Li Haowei , Li Rongrong , Wang Jianhua , He Yao , Liu Miao
Published: August 2022

Background:

Gallbladder and biliary tract cancer (GBTC) has greatly damaged the health of patients and is accompanied by a dismal prognosis. The worldwide distribution of GBTC shows extensive variance and the updated data in China is lacking. This study was to determine the current status, trends, and predictions in the burden of GBTC over the past 30 years in China.

Methods:

This was a descriptive, epidemiological, secondary analysis of the Global Burden of Disease, Injuries, and Risk Factor Study 2019 data. Data including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of GBTC in China by year, age, and sex were assessed. Joinpoint regression analysis was conducted to evaluate trends of disease burden due to GBTC from 1990 to 2019. Nordpred age-period-cohort analysis was applied for the projection of mortality and incidence due to GBTC from 2019 to 2044.

Results:

Nationally, there were 38,634 (95% uncertainty interval [UI]: 27,350–46,512) new cases and 47,278 (95% UI: 32,889–57,229) patients due to GBTC, causing 34,462 (95% UI: 25,220–41,231) deaths, and 763,584 (95% UI: 566,755–920,493) DALYs in 2019. Both cases and rates of burden owing to GBTC were heavier among males and at old age. From 1990 to 2019, the age-standardized rates of incidence, prevalence, mortality, and DALYs of GBTC generally increased from 1990 to 2019, with average annual percentage change at 0.8% (95% confidential interval [CI]: 0.6–1.0%), 1.3% (95% CI: 1.1–1.5%), 0.4% (95% CI: 0.2–0.6%), and 0.2% (95% CI: 0.1–0.4%), respectively. Even though the age-standardized incidence rate and age-standardized mortality rate in both sexes were predicted to decline gradually from 2019 to 2044, the number of new cases and deaths were expected to grow steadily.

Conclusions:

GBTC is becoming a major health burden in China, particularly among males and older individuals. Given the aging population and increasing burden, effective strategies and measurements are urged to prevent or reduce the number of new cases and deaths of GBTC.
The Early Impact of the COVID-19 Pandemic on Lung, Colorectal, and Breast Cancer Screening and Treatment at a Tertiary Cancer Center
Authors: Lou Johanna , Kooragayala Keshav , Williams Jennifer P. , Sandilos Georgianna , Butchy Margaret V. , Yoon-Flannery Kahyun , Kwiatt Michael , Hong Young Ki , Shersher David D. , Burg Jennifer M.
Published: August 2022

Objectives:

During the coronavirus-19 pandemic, experts recommended delaying routine cancer screening and modifying treatment strategies. We sought to understand the sequalae of these recommendations.

Materials and Methods:

We performed a retrospective single-center analysis of screening, diagnosis, and treatment of lung, colorectal, and breast cancer. Data was collected from our institutional cancer registry. Prepandemic (2016-2019) was compared with pandemic (2020) data.

Results:

Three thousand three sixty one screening chest computed tomography scans (CTs), 35,917 colonoscopies, and 48,093 screening mammograms were performed. There was no difference in CTs [81.0 (SEM10.0) vs. 65.6 (SEM3.29), P=0.067] or mammograms [1017.0 (SEM171.8) vs. 809.4 (SEM56.41), P=0.177] in 2020 versus prepandemic. There were fewer colonoscopies in 2020 [651.4 (SEM103.5) vs. 758.91 (SEM11.79), P=0.043]. There was a decrease in cancer diagnoses per month in 2020 of lung [22.70 (SEM1.469) vs. 28.75 (SEM0.8216), P=0.003] and breast [38.56 (SEM6.133) vs. 51.82 (SEM1.257), P=0.001], but not colorectal [13.11 (SEM1.467) vs. 15.88 (SEM0.585), P=0.074] cancer. There was no change in stage at presentation for lung (P=0.717), breast (P=0.115), or colorectal cancer (P=0.180). Lung had a shorter time-to-treatment in 2020 [38.92 days (SEM 2.48) vs. 66 (SEM1.46), P=0.002].

Conclusions:

In 2020, there was no difference in screening studies for lung and breast cancer but there was a decrease in new diagnoses. Although there were fewer colonoscopies performed in 2020, there was no change in new colorectal cancer diagnoses. Despite changes in guidelines during the pandemic, the time-to-treatment for lung cancer was shorter and was unchanged for colorectal and breast cancer. These findings highlight the importance of continuing care for a vulnerable patient population despite a pandemic.
Child Mental Health and Sleep Disturbances During the Early Months of the COVID-19 Pandemic in the United States
Authors: Dayton Lauren , Kong Xiangrong , Powell Terrinieka W. , Bowie Janice , Rebok George , Strickland Justin C. , Latkin Carl
Published: August 2022

Many children have experienced unprecedented levels of stress as a result of the COVID-19 pandemic due to school closures, strained resources, and excess morbidity and mortality. The current study examines change in children's mental health and sleep during the early months of the US pandemic and identifies risk and protective factors. In May 2020, a total of 225 parents reported on the mental health and sleep of each child (N = 392 children) living in their household prior to the onset of the COVID-19 pandemic and about their functioning in the past month. McNemar's test examined change in mental health and sleep disturbance across developmental stage. Bivariate and multivariate generalized estimating equations examined predictors of change in mental health and sleep. Each age group showed a significant change in mental health and sleep outcomes, but the development of mental health problems was greater for older children. Parental caregiving strain (adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI], 1.11-5.27) was identified as a risk factor associated with children developing anxiety, and income loss was associated with developing sleep disturbances (aOR = 2.34; 95% CI, 1.06-5.17). Parental receipt of emotional support was identified as a protective factor for all child health outcomes. Policies and interventions that promote access to mental health services, provide financial safety nets, and strengthen social support networks for families are needed.
Behind Closed Doors
Authors: McClellan Sean P. , Boyd Tyler W. , Hendrix Jacqueline , Peña Kryztal , Swider Susan M. , Martin Molly A. , Rothschild Steven K.
Published: August 2022

The present work studies how community health workers (CHWs) perform the role of educator and how this relates to the implementation of other CHW roles, skills, and qualities. Prior studies on this topic have relied on interviews or focus groups rather than analysis of CHW interactions. We conducted a thematic analysis of 24 transcripts of conversations occurring between CHWs and participants during home visits as part of the Mexican American Trial of Community Health Workers, a randomized controlled trial that improved clinical outcomes among low-income Mexican American adults with type 2 diabetes. Three themes describing interactions related to diabetes self-management education accounted for about half of encounter content. The other half of encounter content was dedicated to interactions not explicitly related to diabetes described by 4 subthemes. In a successful CHW intervention, focused educational content was balanced with other interactions. Interactions not explicitly related to diabetes may have provided space for the implementation of core CHW roles, skills, and qualities other than educator, particularly those related to relationship building. It is important that interventions provide CHWs with sufficient time and flexibility to develop strong relationships with participants.
#TheUglyTruth? A Qualitative Evaluation of Outcomes Photography on Instagram: Introducing the SEPIA Scoring System
Authors: Soares Danny J. , von Haven Haley N. , Yi Christina H.
Published: August 2022

Background:

Photographs of cosmetic treatment outcomes on social media are prone to bias and misrepresentation from nonadherence to established photographic standards. However, there is currently insufficient information regarding which norms are most-commonly violated, precluding quality improvement efforts.

Methods:

A qualitative study of cosmetic treatment photographs published on Instagram was undertaken in accordance with the Guidelines for Reporting Reliability and Agreement Studies using a newly proposed Standards for the Evaluation of Photographs In Aesthetics (SEPIA) nine-point photograph scoring system and grading scale.

Results:

A total of 510 posts encompassing 2020 clinical photographs published by 102 practitioner accounts on Instagram were audited for photographic quality. The average score was 4 out of 9 (medium quality), with approximately 40% of posts scoring in the low-quality range. Zoom, lighting, timing, and presentation of multiple views were the standards most-commonly disregarded. Plastic and Reconstructive Surgery specialty and subspecialty (PRSS) practitioners scored higher (4.5/9 versus 3.1/9, P = 0.002) and had fewer low-quality posts (22% versus 54%, P = 0.001) than non-PRSS providers. Low-quality photographs were most often seen with rhinoplasty (30% versus 7%, P < 0.00001) and lip filler (60% versus 33%, P = 0.0001) compared with surgical and nonsurgical treatments, respectively, due to a higher incidence of immediate photographs and selfies.

Conclusions:

Before and after photographs of surgical and nonsurgical cosmetic treatment outcomes on social media are frequently of substandard quality. This study outlines specific items frequently neglected in outcomes photography to assist practitioners in maximizing adherence to established standards of photography online.
Autologous Fat Grafting in the Upper Extremity: Defining New Indications
Authors: Deptula Peter , Block Tennyson , Tanabe Kylie , Kulber David
Published: August 2022

Background:

Autologous fat grafting is a commonly used technique in plastic surgery that can also be applied broadly in hand surgery. We present a case series to demonstrate the diverse indications for fat grafting in hand surgery.

Methods:

We retrospectively reviewed cases of fat grafting in the upper extremity in 2020. Cases representing a unique application of fat grafting were identified. Patient data, including demographics, diagnoses, preoperative and postoperative assessments, complications, patient satisfaction, and surgical operative reports, were recorded.

Results:

Five patients representing distinct indications for autologous fat grafting in the upper extremity were identified. Indications included hand rejuvenation (20.0%), burn/scar management (20.0%), tenolysis (20.0%), revision nerve decompression (20.0%), and carpometacarpal joint arthritis (20.0%). Average patient age was 60.4 years (range, 42–71). Average volume of fat injected was 15.2 ml (range, 1–37 ml). No major complications were noted (0.0%). All patients expressed satisfaction with their overall result with good functional outcomes (100%).

Conclusions:

Autologous fat grafting can be applied broadly in hand surgery. Indications for fat grafting in hand surgery include hand rejuvenation, burn/scar management, tenolysis, revision nerve decompression, and thumb carpometacarpal arthritis. Hand surgeons can easily incorporate fat grafting into their daily practice. Current literature supports fat grafting as a viable technique in hand surgery with lower-level studies.
Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication
Authors: Bulgarelli Luana Lima , Goldenberg Dov Charles , Loureiro Rafael Maffei , Gentil Andre Felix , Morgulis Roberto Franco , Ribas Eduardo Carvalhal
Published: August 2022

Le Fort I osteotomy is a frequent surgical procedure used in orthognathic surgeries to treat severe malocclusions and is associated with relatively rare surgical complications. Here, the authors report a case of thrombotic ischemic stroke as a result of this procedure, a complication still not described in the literature. A 19-year-old man with class II malocclusion and retrognathia underwent orthognathic surgery for aesthetic purposes. The surgery included a Le Fort I maxillary osteotomy with vertical impaction, bilateral sagittal split ramus osteotomy for mandibular advancement, and genioplasty. Postoperatively, the patient developed left eye blindness, headache, somnolence, aphasia, and right hemiplegia. Medical imaging showed the Le Fort I line of fracture extending from the maxillary osteotomy to the left optic canal and to the left carotid canal, with osseous fragments impinging the petrous segment of the internal carotid artery, left carotid artery occlusion and associated to an ischemic stroke at the left middle cerebral artery territory. Treatment required decompressive craniectomy and later focused on clinical stabilization, infection management, orthognathic care, neurorehabilitation, and cranioplasty. The hemiplegia and aphasia partially recovered during 12 months, and final dental occlusion was appropriate. Our report demonstrates that an unfavorable Le Fort I fracture trajectory can lead to ischemic stroke and severe neurological deficits.
PMMA-collagen Gel in Nonsurgical Rhinoplasty Defects: A Methodological Overview and 15-year Experience
Authors: Rivkin Alexander
Published: August 2022

Background:

Nonsurgical rhinoplasty (NSR) is an alternative to surgical rhinoplasty for patients who desire correction of mild-to-moderate aesthetic nasal defects but do not wish to undergo surgery due to concern about risks, recovery time, or cost. Although not a surrogate, NSR can be a more accessible and more precise modality for achieving aesthetic goals. Furthermore, for certain types of defects, the precision possible with filler injection versus surgery can make NSR the preferred procedure. In these instances, polymethylmethacrylate (PMMA)-collagen gel is a valuable tool for appropriate candidates due to its permanence and its favorable safety profile when injected appropriately.

Methods:

Optimal use of PMMA-collagen gel for NSR is predicated on expert-level injector experience and careful patient selection and education. The author draws on over 15 years of experience treating more than 1000 NSR patients with PMMA-collagen gel to provide a discussion of relevant anatomy; methodological overview, including patient selection; and a video describing injection technique of NSR with PMMA-collagen gel.

Results:

To our knowledge, this is the first published guidance on NSR with permanent filler. In addition to the clinical experience provided, patient images with 10 years of follow-up are included to illustrate the durability of the results and the continued natural appearance of the correction as the treated patients continue to age.

Conclusion:

In patients with aesthetic nasal deficits treated with filler, where permanent correction is desired, the appropriate use of PMMA-collagen gel is an effective treatment option.
Periventricular rather than deep white matter hyperintensities mediate effects of hypertension on cognitive performance in the population-based 1000BRAINS study
Authors: Gronewold Janine , Jokisch Martha , Schramm Sara , Himpfen Heiko , Ginster Theresa , Tenhagen Isabell , Doeppner Thorsten R. , Jockwitz Christiane , Miller Tatiana , Lehmann Nils , Moebus Susanne , Jöckel Karl-Heinz , Erbel Raimund , Caspers Svenja , Hermann Dirk M.
Published: August 2022

Objectives:

White matter hyperintensities (WMH) of presumed vascular origin are frequent in cerebral MRI of older people. They represent a sign of small vessel disease, are promoted by arterial hypertension, and relate to cognitive deficits. The interdependence of blood pressure and its treatment, WMH, and cognitive performance has not systematically been studied in population-based studies.

Methods:

Consequently, we analysed the interdependence of SBP, DBP, and antihypertensive medications, as well as BP/treatment category, with WMH and cognitive performance in 560 participants of the population-based 1000BRAINS study.

Results:

BP, its treatment, and BP/treatment category were moderately associated with cognitive performance (e.g. unadjusted β = −0.10, 95%CI = −0.19 to −0.02 for the association of SBP (per standard deviation of 17.2 mmHg) with global cognition (per standard deviation of 0.5 z score)]. The harmful effect of BP on cognition was strongly mediated by periventricular hyperintensities (PVH), which were significantly associated with both SBP [β = 0.24, 95% CI = 0.14–0.34 (per 1-point-increase in Fazekas score)] and global cognition (β = −0.22, 95%CI =  −0.32 to −0.13). Thus, PVH mediated as much as 52% of the effects of SBP on cognitive performance. Mediation was less strong for deep white matter hyperintensities (DWMH, 16%), which showed less association with SBP (β = 0.14, 95% CI = 0.05–0.24) and global cognition (β = −0.12, 95%CI = −0.21 to −0.03). Regarding different cognitive domains, PVH most strongly mediated effects of SBP on nonverbal memory (94%) and executive function (81%).

Conclusion:

Our results indicate that PVH may predispose to cognitive impairment associated with hypertension, especially in the domains of nonverbal memory and executive function.
A qualitative exploration of dentists' opioid prescribing decisions within U.S. veterans affairs facilities
Authors: Sharp Lisa K. , Solanki Pooja , Boyer Taylor , Vivo Amanda , Kale Ibuola , Hughes Ashley M. , Gibson Gretchen , Jurasic M. Marianne , Evans Charlesnika T. , Suda Katie J.
Published: August 2022

The U.S. Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States and provides dental care to approximately one-half million veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. Although opioid prescribing by VA dentists has decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that affect opioid decision making for management of acute dental pain among VA dentists. Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semistructured guide designed around the Capability (C), Opportunity (O), Motivation (M), and Behaviour (B) model. Audio recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (eg, electronic medical records), clinical judgement (eg, evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. The results can offer intervention targets for continued opioid risk mitigation efforts.
Lower brachial artery flow-mediated dilation is associated with a worse prognosis and more lung parenchymal involvement in Covid-19: Prospective observational study
Authors: Güz Göksel , Demirgan Serdar
Published: August 2022

Severe acute respiratory syndrome coronavirus-2 is a highly infectious pathogenic coronavirus, which has appeared toward the end of 2019. The virus seen all over the world caused a pandemic of an acute respiratory disease named coronavirus disease 2019 (Covid-19). It has been shown that the virus that uses angiotensin-converting enzyme 2 receptors is causing endothelial dysfunction resulting in vascular inflammation and coagulopathy. It is possible to assess endothelial dysfunction by the flow-mediated dilatation (FMD) technique. Our study aimed to demonstrate the effect of endothelial dysfunction assessed using the FMD on prognosis and mortality in the patients hospitalized with the diagnosis of Covid-19.

In this prospective observational study, endothelial functions of 94 patients hospitalized due to the Covid-19 in the ward or intensive care unit (ICU) were evaluated by FMD. The relationship among endothelial dysfunction and prognosis of disease, biochemical parameters, lung involvement, and mortality was investigated.

We found that the FMD% values of the Covid-19 ICU patients compared to those followed up in the ward (2.66 ± 0.62 vs. 5.23 ± 1.46/P < .001) and those who died due to Covid-19 compared to those who were discharged alive (2.57 ± 0.22 vs. 4.66 ± 1.7/P < .001) were significantly lower. There were moderate negative correlation between FMD% and peak values of D-dimer (r = −0.52, P < .001), troponin (r = −0.45, P < .001), ferritin (r = −0.47, P < .001), lactate dehydrogenase (r = −0.49, P < .001), and white blood cells count (r = −0.23, P = .024). Lower FMD% was associated with higher lung parenchymal involvement (P < .001). The optimum cutoff point of FMD in predicting mortality was found to be 3.135% (sensitivity: 1, selectivity: 0.70).

According to our results, lower FMD% was associated with higher lung parenchyma involvement, ICU admission, and mortality rate in Covid-19 patients. The best cutoff point for predicting mortality of FMD was 3.135%. Nevertheless, largescale, multicenter studies are needed to evaluate lower FMD values as a risk factor for mortality in Covid-19.
Cross-sectional and prospective association between internet addiction and risk of fatigue among Chinese college students
Authors: Liang Siyu , Ren Zhongyu , Yang Guang
Published: August 2022

Severe internet addiction (IA) is associated with a higher risk of musculoskeletal pain, but whether there is a significant prospective association between IA and fatigue is unclear. This study aimed to examine the association between IA and fatigue level among Chinese college students. A cross-sectional (n = 1011) and prospective study (n = 653) was conducted to examine the association between IA and risk of fatigue. IA was measured using Young internet addiction test. Fatigue level was evaluated using the Chalder fatigue scale. Multivariate logistic regression analyses showed a cross-sectional association between IA and the risk of fatigue. The odds ratios (95% CIs) of fatigue for normal, mild, and moderate to severe groups were 1.00 (reference), 1.88 (1.20, 2.95), and 5.60 (3.33, 9.42), respectively (P for trend: <0.001). Similarly, multivariate logistic regression analyses also revealed a significant prospective relationship between IA and the risk of fatigue during the 1-year follow-up period. The odds ratios (95% CIs) of fatigue for normal, mild, and moderate to severe groups were 1.00 (reference), 1.56 (0.67, 3.67), and 3.29 (1.08, 10.04), respectively (P for trend: 0.046). Our findings indicate that IA is positively related to risk of fatigue among Chinese college students. Further interventional studies are needed to explore the causality underlying the effects of IA on fatigue.
Effect of circuit training with low-carbohydrate diet on body composition, cardiometabolic indices, and exercise capacity in adults with mild to moderate obesity in Saudi Arabia: A randomized control trial
Authors: Seyam Mohamed K. , Alqahtani Mazen , Sirajudeen Mohamed Sherif , Muthusamy Hariraja , Kashoo Faizan Z. , Salah Mukhtar M.
Published: August 2022

Background:

Circuit training that combines aerobic and resisted training is reported to reduce body fat, weight, and improve exercise capacity than performing either type of exercise independently. There is no study evaluating the combined effect of circuit training exercise (CTE) and dietary intervention (low-carbohydrate [LC] diet) among young males with obesity.

Methods:

A randomized control trial was conducted to explore the effects of a combined program of CTE and a LC diet for adults with mild or moderate obesity. Seventy adults with obesity were allocated randomly into 2 groups. The experimental group (group 1) received circuit training with LC diet intervention, whereas the control (group 2) received only circuit training. The study variables such as exercise capacity, body composition, and cardiometabolic indices were measured at the baseline and the end of 60 days of intervention.

Results:

The participants of group 1 showed significant improvements in body composition (body weight, body mass index, waist circumference, waist hip circumference, and body fat percentage), exercise capacity (maximal oxygen consumption), and cardiometabolic indices (high-density lipoprotein, low-density lipoprotein, triglycerides, and total cholesterol) with a P < .05 for all the variables, when compared with group 2.

Conclusions:

The combined structured CTE with controlled LC diet intervention in obese adults caused significant reduction in body composition and cardiometabolic indices variables and an increase in exercise capacity.
Exceptional response of skin symptoms to secukinumab treatment in a patient with SAPHO syndrome: Case report and literature review
Authors: Ji Qiang , Wang Qing , Pan Wenping , Hou Yanfeng , Wang Xiuhua , Bian Lin , Wang Zhankui
Published: August 2022

Rationale:

SAPHO syndrome is a rare clinical entity characterized by a wide range of dermatological and musculoskeletal manifestations. Treatment strategies are not standardized. Palmoplantar pustulosis (PPP) is the most common rash in patients with SAPHO syndrome.

Patient concerns:

A 24-year-old Chinese woman with no relevant medical or familial history had a 1-year history of cutaneous lesions with PPP and pain in the sternoclavicular joint.

Diagnosis:

Based on the diagnostic criteria for SAPHO syndrome proposed by Nguyen et al in 2012, we diagnosed SAPHO syndrome with severe PPP as the predominant manifestation.

Interventions:

Due to the limited therapeutic efficacy of methotrexate and cyclosporin, we started therapy with subcutaneous secukinumab 150 mg weekly for the first month, then 150 mg monthly thereafter.

Outcomes:

After 4 weeks of secukinumab administration, the patient showed significant remission of pustular skin lesions, with almost no joint pain and no adverse reaction. Complete remission of skin symptoms was achieved after 3 months. Joint pain and adverse events have not reoccurred in follow-up thus far.

Conclusions:

In patients with SAPHO syndrome, we recommend personalized treatment, which may have excellent therapeutic efficacy in those with PPP or severe skin symptoms. Although data related to the use of IL-17 blockers for SAPHO syndrome are very limited, secukinumab provides a novel therapeutic option, especially for patients with PPP and severe skin lesions. Further prospective studies are needed to support our findings.
Influencing a Culture of Quality and Safety Through Huddles
Authors: McCain Natalia , Ferguson Tysa , Barry Hultquist Teresa , Wahl Carol , Struwe Leeza
Published: August 2022

Background:

Literature shows that interdisciplinary huddles help promote clear communication and proactive reporting of potential errors.

Local Problem:

High reliability organization (HRO) and just culture models were implemented, yet fragmented team communication about patient safety remained. Huddles were implemented to identify and address patient safety issues.

Methods:

A pre/postintervention design was used. Near-miss and actual event safety metrics, patient satisfaction, and employee satisfaction/work group perceptions were measured at 3 time points over 1 year.

Interventions:

Daily interdisciplinary huddles were implemented to improve communication, reduce errors, and improve patient and employee satisfaction.

Results:

Near-miss reporting increased across time points. Patient satisfaction with how the staff worked together to provide care significantly increased over time. Employee satisfaction and perception of work group communication, collaboration, and psychological safety scores improved, however, were not statistically significant.

Conclusion:

Implementing huddles demonstrated improved outcomes in patient safety, patient satisfaction, and employee satisfaction/work group perceptions.
Typhoid fever control in the 21st century: where are we now?
Authors: Carey Megan E. , McCann Naina S. , Gibani Malick M.
Published: August 2022

Purpose of review

Momentum for achieving widespread control of typhoid fever has been growing over the past decade. Typhoid conjugate vaccines represent a potentially effective tool to reduce the burden of disease in the foreseeable future and new data have recently emerged to better frame their use-case.

Recent findings

We describe how antibiotic resistance continues to pose a major challenge in the treatment of typhoid fever, as exemplified by the emergence of azithromycin resistance and the spread of Salmonella Typhi strains resistant to third-generation cephalosporins. We review efficacy and effectiveness data for TCVs, which have been shown to have high-level efficacy (≥80%) against typhoid fever in diverse field settings. Data from randomized controlled trials and observational studies of TCVs are reviewed herein. Finally, we review data from multicountry blood culture surveillance studies that have provided granular insights into typhoid fever epidemiology. These data are becoming increasingly important as countries decide how best to introduce TCVs into routine immunization schedules and determine the optimal delivery strategy.

Continued advocacy is needed to address the ongoing challenge of typhoid fever to improve child health and tackle the rising challenge of antimicrobial resistance.
Analysis of the High Submandibular Approach: A Critical Reapprasail of a Transfacial Access to the Mandibular Skeleton
Authors: Laganà Francesco , Arcuri Francesco , Spinzia Alessia , Bianchi Bernardo
Published: August 2022

Aim:

In 2006 following the development of dedicated osteosynthesis plates, Meyer and colleagues reported a successful clinical study of condylar fractures treated by a modified submandibular approach; it was called high submandibular approach or “Strasbourg approach.” The aim of this study is to describe the high submandibular approach step by step.

Case Series:

Between January 2010 and December 2015 at the Maxillofacial Unit of the Hospital “Policlinico San Martino” 13 patients affected by subcondylar fracture underwent open reduction and internal with high submandibular approach. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 89 minutes, ranging from 66 to 125 minutes. The mean hospital stay was 2.9 days, ranging from 2 to 6 days. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible.

Conclusions:

The morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and aesthetic deformity. The authors think that further prospective clinical trials are necessary to assess and eventually develop this approach.
Microvascular Reconstruction of the Anterior Skull Base
Authors: Nwaba Adaure , Ho Alisha , Ellis Marco F.
Published: August 2022

Anterior skull base defects present a unique reconstructive challenge. Risk factors such as previous operation, radiation and infection require a multidisciplinary approach to create a stable wound. Reconstructive microsurgery serves an important role when attempts with pericranial flap placement and nonvascularized graft obliteration fail. Our series analyzes the outcomes of 5 patients who underwent vascularized reconstruction of craniofacial defects at Northwestern Memorial Hospital from 2014-2021. Each patient presented with a complex, hostile scalp and bony wound. Common risk factors included previous craniotomy, failed obliteration, chemoradiation, osteomyelitis and epidural abscess. Patients underwent multi-stage procedures to obtain wound source control, reconstruct the frontal sinus and skull base, and frontal bone cranioplasty. Each patient underwent successful free flap reconstruction without flap loss or donor site complications. No patients suffered ongoing symptomatic CSF leak or pneumocephalus. However, only two patients have had sustained success with their alloplastic cranioplasty. A perfect, watertight seal is required to prevent seeding the implant and avoiding infection. Overall, free flap reconstruction of the skull base and frontal sinus is a necessary solution when patients fail more conservative locoregional options. Close collaboration with neurosurgery can help with diagnosis and establish the optimal timing for surgical care.
MECHANISM OF MIR-25-3P CARRIED BY EXTRACELLULAR VESICLES DERIVED FROM PLATELET-RICH PLASMA IN IL-1β–INDUCED NUCLEUS PULPOSUS CELL DEGENERATION VIA THE SOX4/CXCR7 AXIS
Authors: Hu Baoshan , Wang Lianxin , Sun Naikun , Lin Shengrong , Rui Gang
Published: August 2022

Objectives: Nucleus pulposus (NP) cell degeneration promotes the progression of intervertebral disc (IVD) degeneration. MicroRNAs (miRs) are associated with IVD degeneration. This study expounded the mechanism of microRNA (miR)-25-3p carried by extracellular vesicles (EVs) derived from platelet-rich plasma (PRP) in interleukin (IL)-1β–induced NP cell degeneration. Methods: Platelet-rich plasma from mouse blood was obtained, and EVs were isolated from PRP (EVs derived from PRP [PRP-EVs]) and identified. Nucleus pulposus cells were isolated from the mouse lumbar IVD and treated with IL-1β to induce NP cell degeneration. Extracellular vesicles derived from PRP were added into NP cell culture medium. Afterward, intracellular miR-25-3p, sex determining region Y-related high-mobility-group box 4 (SOX4), and CXC chemokine receptor 7 (CXCR7) levels were examined. Nucleus pulposus cell viability, apoptosis, and inflammation were detected. Extracellular vesicles derived from PRP were labeled by PKH67 to obverse the uptake of EVs by NP cells. The binding relations between SOX4 and miR-25-3p and CXCR7 were predicted and examined. Functional rescue experiments were performed to investigate the roles of miR-25-3p, SOX4, and CXCR7 in NP cell degeneration. Results: miR-25-3p was downregulated, whereas SOX4 and CXCR7 were upregulated in IL-1β–induced NP cells. Extracellular vesicles derived from PRP increased the cell viability, and decreased apoptosis and inflammation. miR-25-3p carried by PRP-EVs into NP cells alleviated NP cell degeneration. miR-25-3p inhibited SOX4 expression and limited CXCR7 transcription. Silencing miR-25-3p or overexpressing SOX4 or CXCR7 reversed the alleviating role of PRP-EVs in NP cell degeneration. Conclusion: miR-25-3p carried by PRP-EVs into NP cells elevated intracellular miR-25-3p expression, which suppressed SOX4 expression and further limited CXCR7 transcription, thus alleviating IL-1β–induced NP cell degeneration. Extracellular vesicles derived from PRP containing miR-25-3p may be a new method for IVD treatment.
ACUTE AND SUSTAINED ALTERATIONS TO THE BONE MARROW IMMUNE MICROENVIRONMENT FOLLOWING POLYMICROBIAL INFECTION
Authors: Cho Dong Seong , Schmitt Rebecca E. , Dasgupta Aneesha , Ducharme Alexandra M. , Doles Jason D.
Published: August 2022

Sepsis is a highly prevalent cause of death in intensive care units. Characterized by severe immune cell derangements, sepsis is often associated with multiorgan dysfunction. For many sepsis survivors, these deficits can persist long after clinical resolution of the underlying infection. Although many studies report on the impact of sepsis on individual immune cell subtypes, a comprehensive analysis of sepsis-induced alterations within and across the immune cell landscape is lacking. In this study, we used single-cell RNA sequencing to assess sepsis-associated transcriptional changes in immune cells isolated from bone marrow at single-cell resolution. We used a high-survival fecal-induced peritonitis sepsis model using Friend leukemia virus B mice. Single-cell RNA sequencing classified 3402 single cells from control subjects into 14 clusters representing long-term hematopoietic stem cell (HSC), short-term HSC, basophil, dendritic cell, eosinophil, erythroblast, erythrocyte, macrophage, neutrophil, natural killer cell, plasma cell, plasmacytoid dendritic cell, pre-B cell, and T memory cell lineages. One day following experimentally induced sepsis, cell type compositions shifted significantly and included notable decreases in HSC and myeloid cell abundance. In addition to proportional cell composition changes, acute sepsis induced significant transcriptional alterations in most immune cell types analyzed—changes that failed to completely resolve 1 month after sepsis. Taken together, we report widespread and persistent transcriptional changes in diverse immune cells in response to polymicrobial infection. This study will serve as a valuable resource for future work investigating acute and/or long-term sepsis-associated immune cell derangements.
Quality control of loop-mediated isothermal amplification (LAMP) using external control: Detection of SARS-CoV-2 using nasopharyngeal specimens
Authors: Watanabe Naoki , Watari Tomohisa , Otsuka Yoshihito
Published: August 2022

We evaluated an external control for loop-mediated isothermal amplification (LAMP) for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using 100 nasopharyngeal specimens (20 positives and 80 negatives). We performed LAMP for the specimens and distilled water. We collected threshold time (Tt) and calculated the difference in Tt values between specimens and distilled water. All specimens showed amplification of the external control. Regarding the Tt values (median, min), no difference was found between the positive specimens (15.9) and the negative specimens (15.8) (p = 0.75). For the difference in Tt values, no difference was found between the positive specimens (1.4) and the negative specimens (1.3) (p = 0.78). No specimens were found with noticeable inhibitory reactions. These results indicate that the external control has the potential to monitor the inhibitory reactions in specimens. Future work will include the evaluation of specimens with inhibitory reactions.
Accurate support vector machine identification of limb-onset amyotrophic lateral sclerosis using resting-state activity of regions within executive control network
Authors: Meroiti James
Published: August 2022

Amyotrophic lateral sclerosis (ALS) is a motor neuron degenerative disorder facing diagnostic challenges due to its highly variable presentation and symptom overlap. In other neurodegenerative disorders, support vector machine (SVM) classifiers have utilized neuroimaging to address these challenges. Given functional alterations may be the earliest detectable in ALS, we aimed to uncover resting-state functional MRI (rs-fMRI) biomarkers for SVM classification. Resting-state networks derived from independent component analysis were compared between limb-onset ALS patients (n = 14) and controls (n = 12). A cluster within the executive control network (EXN) localizing predominantly to the anterior cingulate gyrus (ACG) was significantly decreased in limb-onset ALS. Activity of this cluster was able to develop a SVM with 86% sensitivity and 87% specificity on the validation dataset. These findings suggest the ACG and EXN may be important in classifying limb-onset ALS patients and could be incorporated into multi-modal SVM classifiers.