bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated Pest Management for Stored Grain: Potential Natural Biological Control by a Parasitoid Wasp Community
Authors: Harush Avichai , Quinn Elazar , Trostanetsky Anatoly , Rapaport Aviv , Kostyukovsky Moshe , Gottlieb Daphna
Published: November 2021

Insect contamination of stored grain is a major concern for the grain industry. Phosphine is currently the standard fumigant used to control insect pests in stored grain. However, some species and populations of insects that infest stored grain exhibit resistance to this fumigant and consumers are concerned about pesticide residues. Therefore, alternative methods of effective pest control are needed to partially or completely replace the use of phosphine. There is growing interest in biological control via parasitoid wasps. However, there is evidence that biological control will succeed only if used alongside other pest-management measures. Integrating biological control with the use of chemical insecticide is challenging and may lead to severe reductions in parasitoid survival and success. The main aim of the current study is to shed light on a greatly overlooked issue: the parasitoid community found in stored grain before and after phosphine treatment. The current study results indicate that there is a high level of parasitoid biodiversity within grain stores. We found common parasitoids at both semi-arid and Mediterranean sites, suggesting that those parasitoids can be active across a wide range of abiotic conditions. This research indicates that the community may recover even though phosphine has an immediate negative effect on a parasitoid community. Nevertheless, the parasitoid wasps seem to reduce the host population insufficiently. In light of the findings presented here, those interested in implementing pest-management strategies that include both phosphine treatment and biological control should consider conservation and augmentation of the naturally occurring parasitoid population. These studies should take into account interactions between and within parasitoid populations and phosphine distribution within the grain storage. To limit the effect of phosphine on the parasitoids, pest-management strategies should also reflect careful consideration of the timing of phosphine treatment and the need for sufficient refuge for the parasitoids.
Expert Consensus on the Contraindications and Cautions of Foam Rolling—An International Delphi Study
Authors: Bartsch Katja Martina , Baumgart Christian , Freiwald Jürgen , Wilke Jan , Slomka Gunda , Turnhöfer Sascha , Egner Christoph , Hoppe Matthias W. , Klingler Werner , Schleip Robert
Published: November 2021

Background: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts’ consensus on contraindications and cautions of foam rolling by means of a Delphi process. Methods: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. Results: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. Discussion: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds.
Does Additive Pressurized Carbon Dioxide Lavage Improve Cement Penetration and Bond Strength in Cemented Arthroplasty?
Authors: Knappe Kevin , Stadler Christian , Innmann Moritz M. , Schonhoff Mareike , Gotterbarm Tobias , Renkawitz Tobias , Jaeger Sebastian
Published: November 2021

The modern cementing technique in cemented arthroplasty is a highly standardized and, therefore, safe procedure. Nevertheless, aseptic loosening is still the main reason for revision after cemented total knee or cemented total hip arthroplasty. To investigate whether an additional carbon dioxide lavage after a high-pressure pulsatile saline lavage has a positive effect on the bone–cement interface or cement penetration, we set up a standardized laboratory experiment with 28 human femoral heads. After a standardized cleaning procedure, the test implants were cemented onto the cancellous bone. Subsequently, the maximum failure load of the bone–cement interface was determined using a material testing machine to pull off the implant, and the cement penetration was determined using computed tomography. Neither the maximum failure load nor cement penetration into the cancellous bone revealed significant differences between the groups. In conclusion, according to our experiments, the additive use of the carbon dioxide lavage after the high-pressure pulsatile lavage has no additional benefit for the cleaning of the cancellous bone and, therefore, cannot be recommended without restrictions.
Immunogenicity of BNT162b2 Vaccine in Patients with Inflammatory Bowel Disease on Infliximab Combination Therapy: A Multicenter Prospective Study
Authors: Shehab Mohammad , Abu-Farha Mohamed , Alrashed Fatema , Alfadhli Ahmad , Alotaibi Khazna , Alsahli Abdullah , Alphonse Thanaraj Thangavel , Channanath Arshad , Ali Hamad , Abubaker Jehad , Almulla Fahd
Published: November 2021

Background: Vaccination is a promising strategy to protect vulnerable groups like inflammatory bowel disease (IBD) patients against COVID-19 and associated severe outcomes. COVID-19 vaccine clinical trials excluded IBD patients taking infliximab with azathioprine or 6-mercaptopurine (infliximab combination). Therefore, we sought to evaluate serologic responses to COVID-19 vaccination with the mRNA vaccine, BNT162b2, in patients with IBD receiving infliximab combination therapy compared with healthy participants. Method: This was a multicenter prospective study. Patients with IBD were recruited at the time of attendance at infusion center between 1 August 2021, and 15 September 2021. Our primary outcome were the concentrations of SARS-CoV-2 antibodies 4–10 weeks after vaccination with two doses of BNT162b2 vaccine in patients with IBD taking infliximab combination therapy (study group) compared with a healthy participants group (control group). Both study and control groups were matched for age, sex, and time-since-last-vaccine-dose using optimal pair-matching method. Results: In total, 116 participants were recruited in the study, 58 patients in the study group and 58 in the control group. Median (IQR) IgG concentrations were lower in the study group (99 BAU/mL (40, 177)) than the control group (139 BAU/mL (120, 188)) following vaccination (p = 0.0032). Neutralizing antibodies were also lower in the study group compared with the control group (64% (23, 94) vs. 91% (85, 94), p < 0.001). The median IgA levels in the study group were also significantly lower when compared with the control group (6 U/mL (3, 34) vs. 13 U/mL (7, 30), p = 0.0097). In the study group, the percentages of patients who achieved positive IgG, neutralizing antibody and IgA levels were 81%, 75%, and 40%, respectively. In the control group, all participants (100%) had positive IgG and neutralizing antibody levels while 62% had positive IgA levels. Conclusion: In patients with IBD receiving infliximab combination therapy, SARS-CoV2 IgG, IgA, and neutralizing antibody levels after BNT162b2 vaccination were lower compared with healthy participants. However, most patients treated with infliximab combination therapy seroconverted after two doses of the vaccine.
Myocardial Involvement Detected Using Cardiac Magnetic Resonance Imaging in Patients with Systemic Sclerosis: A Prospective Observational Study
Authors: Hromadka Milan , Baxa Jan , Seidlerova Jitka , Miklik Roman , Rajdl Dan , Sudova Vendula , Suchy David , Rokyta Richard
Published: November 2021

Introduction and objectives: Cardiac involvement in systemic sclerosis (SSc) patients affects mortality. Cardiac magnetic resonance (CMR) is capable of detecting structural changes, including diffuse myocardial fibrosis that may develop over time. Our aim was to evaluate myocardial structure and function changes using CMR in patients with SSc without known cardiac disease during a 5-year follow-up and find possible correlations with selected biomarkers. Methods: A total of 25 patients underwent baseline and follow-up CMR examinations according to a pre-specified protocol. Standard biochemistry, five biomarkers (hsTnI, NT-proBNP, galectin-3, sST2, and GDF-15), and disease-specific functional parameters enabling the classification of disease severity were also measured. Results: After five years, no patient suffered from manifest heart disease. Mean extracellular volume (ECV) and T1 mapping values did not change significantly (p ≥ 0.073). However, individual increases in native T1 time and ECV correlated with increased galectin-3 serum levels (r = 0.56; p = 0.0050, and r = 0.71; p = 0.0001, respectively). The progression of skin involvement assessed using the Rodnan skin score and a decrease in the diffusing capacity of the lungs were associated with increased GDF-15 values (r = 0.63; p = 0.0009, and r = −0.51; p = 0.011, respectively). Conclusions: During the 5-year follow-up, there was no new onset of heart disease observed in patients with SSc. However, in some patients, CMR detected progression of sub-clinical myocardial fibrosis that significantly correlated with elevated galectin-3 levels. GDF-15 values were found to be associated with disease severity progression.
Immunomodulation and Reduction of Thromboembolic Risk in Hospitalized COVID-19 Patients: Systematic Review and Meta-Analysis of Randomized Trials
Authors: Sagris Dimitrios , Florentin Matilda , Tasoudis Panagiotis , Korompoki Eleni , Gatselis Nikolaos , Giamarellos-Bourboulis Evangelos J. , Milionis Haralampos , Douketis James , Spyropoulos Alex C. , Dalekos George , Ntaios George
Published: November 2021

Background: We aimed to investigate the potential beneficial effect of immunomodulation therapy on the thromboembolic risk in hospitalized COVID-19 patients. Methods: We searched PubMed and Scopus for randomized trials reporting the outcomes of venous thromboembolism (VTE), ischemic stroke or systemic embolism, myocardial infarction, any thromboembolic event, and all-cause mortality in COVID-19 patients treated with immunomodulatory agents. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using the Mantel–Haenszel random effects method. Results: Among 8499 patients hospitalized with COVID-19, 4638 were treated with an immunomodulatory agent, 3861—with usual care only. Among the patients prescribed immunomodulatory agents, there were 1.77 VTEs per 100 patient-months compared to 2.30 among those treated with usual care (OR: 0.84, 95% CI: 0.61–1.16; I2: 0%). Among the patients who received an interleukin 6 (IL-6) antagonist, VTEs were reported in 12 among the 1075 patients compared to 20 among the 848 receiving the usual care (OR: 0.52, 95% CI: 0.22–1.20; I2: 6%). Immunomodulators as an add-on to usual care did not reduce the risk of stroke or systemic embolism (OR: 1.10, 95% CI: 0.50–2.40; I2: 0%) or of myocardial infarction (OR: 1.06, 95% CI: 0.47–2.39; I2: 0%) and there was a nonsignificant reduction in any thromboembolic event (OR: 0.86, 95% CI: 0.65–1.14; I2: 0%). Conclusions: We did not identify a statistically significant effect of immunomodulation on prevention of thromboembolic events in COVID-19. However, given the large effect estimate for VTE prevention, especially in the patients treated with IL-6 antagonists, we cannot exclude a potential effect of immunomodulation.
Rupture of the Pleomorphic Adenoma of the Parotid Gland: What to Know before, during and after Surgery
Authors: Grasso Michele , Fusconi Massimo , Cialente Fabrizio , de Soccio Giulia , Ralli Massimo , Minni Antonio , Agolli Griselda , de Vincentiis Marco , Remacle Marc , Petrone Paolo , Di Maria Domenico , D’Andrea Vito , Greco Antonio
Published: November 2021

Background: We assessed the cases of intraoperative spillage of primary pleomorphic adenomas (PPAs) of the parotid gland in the literature, comparing them with our own cases. We aim to explain how the surgeon should manage a spillage during surgery (i.e., how to avoid spreading the contents that are coming out of the tumor). We also aim to investigate whether or not spillage is linked to a higher rate of PPA recurrence. Methods: We collected surgical and pathological reports, taking data on capsular ruptures and the spillage of tumors. Results: Intraoperative tumor spillage and tumor rupture occurred in 34/202 cases. There were three recurrences after a mean of 3.7 years (mean follow-up duration: 10.3 years). One recurrence happened to a patient who had an intraoperative tumor spillage, and two more recurrences happened to patients who did not have spillage. Conclusion: We believe that the real number of the events of spillage is underestimated and underreported by surgeons. Capsular rupture must always be avoided, and secure resection margins must always be pursued, independent of the type of parotidectomy being performed. Features that increase the risk of recurrence are an intraoperative rupture and the presence of satellite nodules (as recorded in the pathologist’s report). In these cases, patients need a longer follow-up period.
Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding
Authors: Neuenfeldt Friederike S. , Weigand Markus A. , Fischer Dania
Published: November 2021

Patient Blood Management advocates an individualized treatment approach, tailored to each patient’s needs, in order to reduce unnecessary exposure to allogeneic blood products. The optimization of hemostasis and minimization of blood loss is of high importance when it comes to critical care patients, as coagulopathies are a common phenomenon among them and may significantly impact morbidity and mortality. Treating coagulopathies is complex as thrombotic and hemorrhagic conditions may coexist and the medications at hand to modulate hemostasis can be powerful. The cornerstones of coagulation management are an appropriate patient evaluation, including the individual risk of bleeding weighed against the risk of thrombosis, a proper diagnostic work-up of the coagulopathy’s etiology, treatment with targeted therapies, and transfusion of blood product components when clinically indicated in a goal-directed manner. In this article, we will outline various reasons for coagulopathy in critical care patients to highlight the aspects that need special consideration. The treatment options outlined in this article include anticoagulation, anticoagulant reversal, clotting factor concentrates, antifibrinolytic agents, desmopressin, fresh frozen plasma, and platelets. This article outlines concepts with the aim of the minimization of complications associated with coagulopathies in critically ill patients. Hereditary coagulopathies will be omitted in this review.
Early Surgery with Neuraxial Anaesthesia in Patients on Chronic Antiplatelet Therapy with a Proximal Femur Fracture: Multicentric Randomised Clinical Trial
Authors: Anaya Rafael , Rodriguez Mireia , Millan Angélica , Reguant Francesca , Llorca Jordi , Guilabert Patricia , Ruiz Ana , Pantoja Percy-Efrain , Gil José María , Moral Victoria , Merchán-Galvis Angela , Martinez-Zapata Maria Jose ,   on behalf of the AFFEcT Study Group
Published: November 2021

Background: Patients with proximal femur fracture on antiplatelet treatment benefit from early surgery. Our goal was to perform early surgery under neuraxial anaesthesia when indicated by the platelet function test. Methods: We conducted a multicentre randomised open-label parallel clinical trial. Patients were randomised to either early platelet function-guided surgery (experimental group) or delayed surgery (control group). Early surgery was programmed when the functional platelet count (as measured by Plateletworks) was >80 × 109/L. The primary outcome was the emergency admission-to-surgery interval. Secondary outcomes were platelet function, postoperative bleeding, medical and surgical complications, and mortality. Results: A total of 156 patients were randomised, with 78 in each group, with a mean (SD) age of 85.96 (7.9) years, and 67.8% being female. The median (IQR) time to surgery was 2.3 (1.5–3.7) days for the experimental group and 4.9 (4.4–5.6) days for the control group. One-third of patients did not achieve the threshold functional platelet count on the first day of admission, requiring more than one test. There was no difference in clinical outcomes between groups. Conclusions: A strategy individualised according to the platelet function test shortens the time to proximal femur fracture surgery under neuraxial anaesthesia in patients on chronic antiplatelet treatment. Better powered randomised clinical trials are needed to further evaluate the clinical impact and safety of this strategy.
Suppression of Electrographic Seizures Is Associated with Amelioration of QTc Interval Prolongation in Patients with Traumatic Brain Injury
Authors: Dabrowski Wojciech , Siwicka-Gieroba Dorota , Schlegel Todd T. , Robba Chiara , Zaid Sami , Bielacz Magdalena , Jaroszyński Andrzej , Badenes Rafael
Published: November 2021

Introduction: Disorders in electroencephalography (EEG) are commonly noted in patients with traumatic brain injury (TBI) and may be associated with electrocardiographic disturbances. Electrographic seizures (ESz) are the most common features in these patients. This study aimed to explore the relationship between ESz and possible changes in QTc interval and spatial QRS-T angle both during ESz and after ESz resolution. Methods: Adult patients with TBI were studied. Surface 12-lead ECGs were recorded using a Cardiax device during ESz events and 15 min after their effective suppression using barbiturate infusion. The ESz events were diagnosed using Masimo Root or bispectral index (BIS) devices. Results: Of the 348 patients considered for possible inclusion, ESz were noted in 72, with ECG being recorded in 21. Prolonged QTc was noted during ESz but significantly ameliorated after ESz suppression (540.19 ± 60.68 ms vs. 478.67 ± 38.52 ms, p < 0.001). The spatial QRS-T angle was comparable during ESz and after treatment. Regional cerebral oximetry increased following ESz suppression (from 58.4% ± 6.2 to 60.5% ± 4.2 (p < 0.01) and from 58.2% ± 7.2 to 60.8% ± 4.8 (p < 0.05) in the left and right hemispheres, respectively). Conclusion: QTc interval prolongation occurs during ESz events in TBI patients but both it and regional cerebral oximetry are improved after suppression of seizures.
Preliminary Report: Rapid Intraoperative Detection of Residual Glioma Cell in Resection Cavity Walls Using a Compact Fluorescence Microscope
Authors: Akimoto Jiro , Fukami Shinjiro , Ichikawa Megumi , Nagai Kenta , Kohno Michihiro
Published: November 2021

Objective: The surgical eradication of malignant glioma cells is theoretically impossible. Therefore, reducing the number of remaining tumor cells around the brain–tumor interface (BTI) is crucial for achieving satisfactory clinical results. The usefulness of fluorescence–guided resection for the treatment of malignant glioma was recently reported, but the detection of infiltrating tumor cells in the BTI using a surgical microscope is not realistic. Therefore, we have developed an intraoperative rapid fluorescence cytology system, and exploratorily evaluated its clinical feasibility for the management of malignant glioma. Materials and methods: A total of 25 selected patients with malignant glioma (newly diagnosed: 17; recurrent: 8) underwent surgical resection under photodiagnosis using photosensitizer Talaporfin sodium and a semiconductor laser. Intraoperatively, a crush smear preparation was made from a tiny amount of tumor tissue, and the fluorescence emitted upon 620/660 nm excitation was evaluated rapidly using a compact fluorescence microscope in the operating theater. Results: Fluorescence intensities of tumor tissues measured using a surgical microscope correlated with the tumor cell densities of tissues evaluated by measuring the red fluorescence emitted from the cytoplasm of tumor cells using a fluorescence microscope. A “weak fluorescence” indicated a reduction in the tumor cell density, whereas “no fluorescence” did not indicate the complete eradication of the tumor cells, but indicated that few tumor cells were emitting fluorescence. Conclusion: The rapid intraoperative detection of fluorescence from glioma cells using a compact fluorescence microscope was probably useful to evaluate the presence of tumor cells in the resection cavity walls, and could provide surgical implications for the more complete resection of malignant gliomas.
Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) Could Provide Better Accuracy Than Creatinine in Predicting Acute Kidney Injury Development in Critically Ill Patients
Authors: Jahaj Edison , Vassiliou Alice G. , Pratikaki Maria , Gallos Parisis , Mastora Zafeiria , Dimopoulou Ioanna , Orfanos Stylianos E. , Orfanos Philippos , Lagiou Pagona , Kotanidou Anastasia
Published: November 2021

Acute kidney injury (AKI) is one of the most common complications in critically ill patients. In recent years, studies have focused on exploring new biomarkers for the early diagnosis and prognosis of AKI. The aim of this study was to investigate serum prognostic biomarkers (neutrophil gelatinase-associated lipocalin, NGAL, and creatinine) of AKI in critically ill patients. The study included 266 critically ill, initially nonseptic, patients admitted to a multidisciplinary ICU. Serum levels of NGAL and creatinine were measured at ICU admission. ROC curves were generated to estimate the prognostic value of the biomarkers, while a logistic regression analysis was performed to assess their association with an increased AKI risk. Patients were divided in two groups based on the development (n = 98) or not (n = 168) of AKI during their ICU stay. Serum NGAL levels at ICU admission were significantly higher in those who subsequently developed AKI compared to those who did not (p < 0.0001). NGAL was shown to be more accurate in predicting AKI development than creatinine; furthermore, NGAL levels were associated with an increased risk of AKI development (1.005 (1.002–1.008), p < 0.0001). In the present study, we were able to demonstrate that increased serum NGAL levels at ICU admission might be predictive of AKI development during ICU hospitalization. Further studies are needed to support NGAL as a prognostic marker of acute kidney injury.
Lateralization in Reverse Shoulder Arthroplasty
Authors: Bauer Stefan , Corbaz Jocelyn , Athwal George S. , Walch Gilles , Blakeney William G.
Published: November 2021

Indications for Reverse Shoulder Arthroplasty (RSA) have been extended over the last 25 years, and RSA has become the most frequently implanted shoulder arthroplasty worldwide. The initial Grammont design with medialization of the joint center of rotation (JCOR), placement of the JCOR at the bone–implant interface, distalization and semi-constrained configuration has been associated with drawbacks such as reduced rotation and range of motion (ROM), notching, instability and loss of shoulder contour. This review summarizes new strategies to overcome these drawbacks and analyzes the use of glenoid-sided, humeral-sided or global bipolar lateralization, which are applied differently by surgeons and current implant manufacturers. Advantages and drawbacks are discussed. There is evidence that lateralization addresses the initial drawbacks of the Grammont design, improving stability, rates of notching, ROM and shoulder contour, but the ideal extent of lateralization of the glenoid and humerus remains unclear, as well as the maximal acceptable joint reaction force after reduction. Overstuffing and spine of scapula fractures are potential risks. CT-based 3D planning as well as artificial intelligence will help surgeons with planning and execution of appropriate lateralization in RSA. Long-term follow-up of lateralization with new implant designs and implantation strategies is needed.
TEG®, Microclot and Platelet Mapping for Guiding Early Management of Severe COVID-19 Coagulopathy
Authors: Laubscher Gert Jacobus , Lourens Petrus Johannes , Venter Chantelle , Kell Douglas B , Pretorius Etheresia
Published: November 2021

An important component of severe COVID-19 disease is virus-induced endothelilitis. This leads to disruption of normal endothelial function, initiating a state of failing normal clotting physiology. Massively increased levels of von Willebrand Factor (VWF) lead to overwhelming platelet activation, as well as activation of the enzymatic (intrinsic) clotting pathway. In addition, there is an impaired fibrinolysis, caused by, amongst others, increased levels of alpha-(2) antiplasmin. The end result is hypercoagulation (proven by thromboelastography® (TEG®)) and reduced fibrinolysis, inevitably leading to a difficult-to-overcome hypercoagulated physiological state. Platelets in circulation also plays a significant role in clot formation, but they themselves may also drive hypercoagulation when they are overactivated due to the interactions of their receptors with the endothelium, immune cells or circulating inflammatory molecules. From the literature it is clear that the role of platelets in severely ill COVID-19 patients has been markedly underestimated or even ignored. We here highlight the value of early management of severe COVID-19 coagulopathy as guided by TEG®, microclot and platelet mapping. We also argue that the failure of clinical trials, where the efficacy of prophylactic versus therapeutic clexane (low molecular weight heparin (LMWH)) were not always successful, which may be because the significant role of platelet activation was not taken into account during the planning of the trial. We conclude that, because of the overwhelming alteration of clotting, the outcome of any trial evaluating an any single anticoagulant, including thrombolytic, would be negative. Here we suggest the use of the degree of platelet dysfunction and presence of microclots in circulation, together with TEG®, might be used as a guideline for disease severity. A multi-pronged approach, guided by TEG® and platelet mapping, would be required to maintain normal clotting physiology in severe COVID-19 disease.
MRI Staging in Locally Advanced Vulvar Cancer: From Anatomy to Clinico-Radiological Findings. A Multidisciplinary VulCan Team Point of View
Authors: Gui Benedetta , Persiani Salvatore , Miccò Maura , Pignatelli Vincenza , Rodolfino Elena , Avesani Giacomo , Di Paola Valerio , Panico Camilla , Russo Luca , Fragomeni Simona , Garganese Giorgia , Tagliaferri Luca , Scambia Giovanni , Manfredi Riccardo
Published: November 2021

MR imaging provides excellent spatial and contrast resolution to stage locally advanced vulvar cancer (LAVC) for tumor and nodal evaluation in order to facilitate the planning of treatment. Although there are no standard indications for how to estimate the clinical stage of International Federation of Gynecology and Obstetrics at diagnosis, MR imaging can depict the tumor and its extension to the vulvar region and adjacent organs, such as the vagina, urethra, and anus. Optimizing the MR imaging protocol and technique is fundamental for correct staging. The aim of this overview was to focus on the role of MR imaging in LAVC staging. We define vulvar anatomy and corresponding MR imaging findings, MR imaging protocol, and technique. Moreover, we describe the MR imaging findings of LAVC with example cases stage by stage. Key imaging findings based on signal intensity, diffusion restriction, and enhancement are portrayed to correctly identify and stage vulvar cancer. A structured report for LAVC staging is reported in order to give all necessary information to the clinicians and to facilitate MR imaging comprehension.
The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries
Authors: Lin Chen-Hua , Ling Xiao Chun , Wu Wei-Chi , Chen Kuan-Jen , Hsieh Chi-Hsun , Liao Chien-Hung , Fu Chih-Yuan
Published: November 2021

Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.
Coping, Anxiety, and Pain Intensity in Patients Requiring Thoracic Surgery
Authors: Hasan Elisei Moise , Calma Crenguta Livia , Tudor Anca , Oancea Cristian , Tudorache Voicu , Petrache Ioan Adrian , Tudorache Emanuela , Papava Ion
Published: November 2021

Stress, anxiety, and post-surgical chest pain are common problems among patients with thoracic surgical pathology. The way in which psychological distress is managed—the coping style—can influence the postsurgical evolution and quality of life of patients. In our study, we monitored the influence of coping style on patients’ anxiety and the intensity of post-operative chest pain. We conducted a cross-sectional study on 90 subjects with thoracic surgical pathology. One month after their surgeries, patients completed the following scales and questionnaires, translated, adapted, and validated for the Romanian population: COPE scale inventory, Generalized Anxiety Disorder-7 Questionnaire, McGill Pain Questionnaire, and Numeric Pain Rating Scale. Anxiety (evaluated using the Generalized Anxiety Disorder-7 Questionnaire) and postoperative thoracic pain intensity (evaluated by means of the Numeric Pain Rating Scale, Number of Words Chosen, and McGill Pain Questionnaire) were significantly higher in patients exhibiting social-focused coping than in patients presenting emotion-focused or problem-focused coping as their main coping style (Kruskal–Wallis, p = 0.028, p = 0.022, p = 0.042, p = 0.007). In our study, there were no differences observed in pain intensity relative to level of anxiety. Coping style is an important concept in the management of anxiety and pain experienced by patients undergoing chest surgery. Therefore, a multidisciplinary approach should be considered in clinical practice.
Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
Authors: Jakuscheit Axel , Schaefer Nina , Roedig Johannes , Luedemann Martin , von Hertzberg-Boelch Sebastian Philipp , Weissenberger Manuel , Schmidt Karsten , Holzapfel Boris Michael , Rudert Maximilian
Published: November 2021

Background: The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds. Methods: We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors. Results: 3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8% and 6.4%, respectively. Haemoglobin concentration (Hb, p < 0.001), low body mass index (BMI, p < 0.001) and estimated glomerular filtration rate (eGFR, p = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (p = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m2, and eGFR = 54 min/mL were associated, respectively, with a 10% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10% risk of a complication. Conclusion: The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.
Race and Drug Toxicity: A Study of Three Cardiovascular Drugs with Strong Pharmacogenetic Recommendations
Authors: O’Brien Travis J. , Fenton Kevin , Sidahmed Alfateh , Barbour April , Harralson Arthur F.
Published: November 2021

The Clinical Pharmacogenetics Implementation Consortium (CPIC®) establishes evidence-based guidelines for utilizing pharmacogenetic information for certain priority drugs. Warfarin, clopidogrel and simvastatin are cardiovascular drugs that carry strong prescribing guidance by CPIC. The respective pharmacogenes for each of these drugs exhibit considerable variability amongst different ethnic/ancestral/racial populations. Race and ethnicity are commonly employed as surrogate biomarkers in clinical practice and can be found in many prescribing guidelines. This is controversial due to the large variability that exists amongst different racial/ethnic groups, lack of detailed ethnic information and the broad geographic categorization of racial groups. Using a retrospective analysis of electronic health records (EHR), we sought to determine the degree to which self-reported race/ethnicity contributed to the probability of adverse drug reactions for these drugs. All models used individuals self-reporting as White as the comparison group. The majority of apparent associations between different racial groups and drug toxicity observed in the “race only” model failed to remain significant when we corrected for covariates. We did observe self-identified Asian race as a significant predictor (p = 0.016) for warfarin hemorrhagic events in all models. In addition, patients identifying as either Black/African-American (p = 0.001) or Other/Multiple race (p = 0.019) had a lower probability of reporting an adverse reaction than White individuals while on simvastatin even after correcting for other covariates. In both instances where race/ethnicity was predictive of drug toxicity (i.e., warfarin, simvastatin), the findings are consistent with the known global variability in the pharmacogenes described in the CPIC guidelines for these medications. These results confirm that the reliability of using self-identified race/ethnic information extracted from EHRs as a predictor of adverse drug reactions is likely limited to situations where the genes influencing drug toxicity display large, distinct ethnogeographic variability.
Making Agriculture Carbon Neutral Amid a Changing Climate: The Case of South-Western Australia
Authors: Kingwell Ross
Published: November 2021

Making Australian agriculture carbon neutral by 2050 is a goal espoused by several agricultural organisations in Australia. How costly might it be to attain that goal, especially when adverse climate change projections apply to agriculture in southern Australia? This study uses scenario analysis to examine agricultural emissions and their abatement via reforestation in south-western Australia under projected climate change. Most scenarios include the likelihood of agricultural emissions being reduced in the coming decades. However, the impact of projected adverse climate change on tree growth and tree survival means that the cost of achieving agricultural carbon neutrality via reforestation is forecast to increase in south-western Australia. Agricultural R&D and innovation that enable agricultural emissions to diminish in the coming decades will be crucial to lessen the cost of achieving carbon neutrality. On balance, the more likely scenarios reveal the real cost of achieving carbon neutrality will not greatly increase. The cost of achieving carbon neutrality under the various scenarios is raised by an additional AUD22 million to AUD100 million per annum in constant 2020 dollar terms. This magnitude of cost increase is very small relative to the region’s gross value of agricultural production that is regularly greater than AUD10 billion.
Promoter Demethylation Upregulates STEAP1 Gene Expression in Human Prostate Cancer: In Vitro and In Silico Analysis
Authors: Rocha Sandra M. , Sousa Inês , Gomes Inês M. , Arinto Patrícia , Costa-Pinheiro Pedro , Coutinho Eduarda , Santos Cecília R. , Jerónimo Carmen , Lemos Manuel C. , Passarinha Luís A. , Socorro Sílvia , Maia Cláudio J.
Published: November 2021

The Six Transmembrane Epithelial Antigen of the Prostate (STEAP1) is an oncogene overexpressed in several human tumors, particularly in prostate cancer (PCa). However, the mechanisms involved in its overexpression remain unknown. It is well known that epigenetic modifications may result in abnormal gene expression patterns, contributing to tumor initiation and progression. Therefore, this study aimed to analyze the methylation pattern of the STEAP1 gene in PCa versus non-neoplastic cells. Bisulfite amplicon sequencing of the CpG island at the STEAP1 gene promoter showed a higher methylation level in non-neoplastic PNT1A prostate cells than in human PCa samples. Bioinformatic analysis of the GEO datasets also showed the STEAP1 gene promoter as being demethylated in human PCa, and a negative association with STEAP1 mRNA expression was observed. These results are supported by the treatment of non-neoplastic PNT1A cells with DNMT and HDAC inhibitors, which induced a significant increase in STEAP1 mRNA expression. In addition, the involvement of HDAC in the regulation of STEAP1 mRNA expression was corroborated by a negative association between STEAP1 mRNA expression and HDAC4,5,7 and 9 in human PCa. In conclusion, our work indicates that STEAP1 overexpression in PCa can be driven by the hypomethylation of STEAP1 gene promoter.
Selective Inhibition of IL-6 Trans-Signaling Has No Beneficial Effect on the Posttraumatic Cytokine Release after Multiple Trauma in Mice
Authors: Homeier Jil-Madeline , Bundkirchen Katrin , Winkelmann Marcel , Graulich Tilman , Relja Borna , Neunaber Claudia , Macke Christian
Published: November 2021

While improvements in pre-hospital and in-hospital care allow more multiple trauma patients to advance to intensive care, the incidence of posttraumatic multiple organ dysfunction syndrome (MODS) is on the rise. Herein, the influence of a selective IL-6 trans-signaling inhibition on posttraumatic cytokine levels was investigated as an approach to prevent MODS caused by a dysbalanced posttraumatic immune reaction. Therefore, the artificial IL-6 trans-signaling inhibitor sgp130Fc was deployed in a murine multiple trauma model (femoral fracture plus bilateral chest trauma). The traumatized mice were treated with sgp130Fc (FP) and compared to untreated mice (WT) and IL-6 receptor knockout mice (RKO), which received the same traumas. The overall trauma mortality was 4.4%. Microscopic pulmonary changes were apparent after multiple trauma and after isolated bilateral chest trauma. Elevated IL-6, MCP-3 and RANTES plasma levels were measured after trauma, indicating a successful induction of a systemic inflammatory reaction. Significantly reduced IL-6 and RANTES plasma levels were visible in RKO compared to WT. Only a little effect was visible in FP compared to WT. Comparable cytokine levels in WT and FP indicate neither a protective nor an adverse effect of sgp130Fc on the cytokine release after femoral fracture and bilateral chest trauma.
Master Protocols for Precision Medicine in Oncology: Overcoming Methodology of Randomized Clinical Trials
Authors: Di Liello Raimondo , Piccirillo Maria Carmela , Arenare Laura , Gargiulo Piera , Schettino Clorinda , Gravina Adriano , Perrone Francesco
Published: November 2021

Randomized clinical trials are considered the milestones of clinical research in oncology, and guided the development and approval of new compounds so far. In the last few years, however, molecular and genomic profiling led to a change of paradigm in therapeutic algorithms of many cancer types, with the spread of different biomarker-driven therapies (or targeted therapies). This scenario of “personalized medicine” revolutionized therapeutic strategies and the methodology of the supporting clinical research. New clinical trial designs are emerging to answer to the unmet clinical needs related to the development of these targeted therapies, overcoming the “classical” structure of randomized studies. Innovative trial designs able to evaluate more than one treatment in the same group of patients or many groups of patients with the same treatment (or both) are emerging as a possible future standard in clinical trial methodology. These are identified as “master protocols”, and include umbrella, basket and platform trials. In this review, we described the main characteristics of these new trial designs, focusing on the opportunities and limitations of their use in the era of personalized medicine.
Genome-Wide Investigation and Analysis of Microsatellites and Compound Microsatellites in Leptolyngbya-like Species, Cyanobacteria
Authors: Yao Dan , Cheng Lei , Du Lianming , Li Meijin , Daroch Maurycy , Tang Jie
Published: November 2021

Microsatellites (simple sequence repeats, SSRs) are ubiquitously distributed in almost all known genomes. Here, the first investigation was designed to examine the SSRs and compound microsatellites (CSSRs) in genomes of Leptolyngbya-like strains. The results disclosed diversified patterns of distribution, abundance, density, and diversity of SSRs and CSSRs in genomes, indicating that they may be subject to rapid evolutionary change. The numbers of SSRs and CSSRs were extremely unevenly distributed among genomes, ranging from 11,086 to 24,000 and from 580 to 1865, respectively. Dinucleotide SSRs were the most abundant category in 31 genomes, while the other 15 genomes followed the pattern: mono- > di- > trinucleotide SSRs. The patterns related to SSRs and CSSRs showed differences among phylogenetic groups. Both SSRs and CSSRs were overwhelmingly distributed in coding regions. The numbers of SSRs and CSSRs were significantly positively correlated with genome size (p < 0.01) and negatively correlated with GC content (p < 0.05). Moreover, the motif (A/C)n and (AG)n was predominant in mononucleotide and dinucleotide SSRs, and unique motifs of CSSRs were identified in 39 genomes. This study provides the first insight into SSRs and CSSRs in genomes of Leptolyngbya-like strains and will be useful to understanding their distribution, predicting their function, and tracking their evolution. Additionally, the identified SSRs may provide an evolutionary advantage of fast adaptation to environmental changes and may play an important role in the cosmopolitan distribution of Leptolyngbya strains to globally diverse niches.
Emerging Mutations Potentially Related to SARS-CoV-2 Immune Escape: The Case of a Long-Term Patient
Authors: Capozzi Loredana , Simone Domenico , Bianco Angelica , Del Sambro Laura , Rondinone Valeria , Pace Lorenzo , Manzulli Viviana , Iacobellis Michela , Parisi Antonio
Published: November 2021

SARS-CoV-2 isolates from long-term COVID-19 patients play a significant role in understanding the mechanisms of infection and virus persistence. This study describes a SARS-CoV-2 isolate from a 53-year-old woman from Apulia (Italy), who was COVID-19 positive for approximately four months. In this paper we aimed to investigate any potential correlation between genetic mutations and clinical features of this case of infection. The viral isolate was assigned to lineage B.1.177.51 through whole-genome sequencing (WGS) and harbored a novel set of mutations on the Spike protein (V143D, del144/145 and E484K); furthermore, seroneutralization assays showed impaired response of the surveyed strain to BNT162b2 (Comirnaty) Pfizer/BioNTech vaccine-induced (average reduction of 70%) and convalescent sera (average reduction of 19.04%), when compared to VOC P.1. This study highlights the importance of genomic surveillance for the management of the COVID-19 pandemic, the relevance of monitoring of emerging SARS-CoV-2 mutations in all lineages, and the necessity of testing the response of emerging variants to available therapies and vaccines.
Welcome to Liquids: An Open Access Journal
Authors: Bodo Enrico
Published: November 2021

We are thrilled to launch “Liquids” as a peer-reviewed open access journal [...]