bluuebunny/crossref_metadata_2025 huggingface dataset:
The diagnostic performance of magnetic resonance imaging for differentiating the nature of cardiac masses
Authors: Ni Jin-Rong , Hu Yuan , Shao Li-Ping , Song Bing , Li Yuan-Min , Lei Jun-Qiang
Published: January 2020

Background:

Cardiac masses are rare, but lead to high risk of stroke and death. Because of the different treatment methods, it is significant for clinicians to differentiate the nature of masses. Cardiac magnetic resonance (CMR) imaging has high intrinsic soft-tissue contrast and high spatial and temporal resolution and can provide evidence for differential diagnosis of cardiac masses. However, there is no evidence-based conclusion as to its accuracy. Therefore, the purpose of our study is to perform a systematic review on this issue and provide useful information for clinical diagnosis and treatment.

Methods:

We will perform a systematic search in EMBASE, Cochrane Library, PubMed and Web of Science for diagnostic studies using CMR to detect cardiac masses from inception to October, 2019. Two authors will independently screen titles and abstracts for relevance, review full texts for inclusion and conduct detail data extraction. The methodological quality will be assessed using the QUADAS-2 tool. If pooling is possible, we will use bivariate model for diagnostic meta-analysis to estimate summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CMR, as well as different sequences of CMR. Estimates of sensitivity and specificity from each study will be plotted in summary receive operating curve space and forest plots will be constructed for visual examination of variation in test accuracy. If enough studies are available, we will conduct sensitivity analysis and subgroup analysis.

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

To our knowledge, this will be the first systematic review on the accuracy of CMR in the differential diagnosis of cardiac masses. This study will provide evidence and data to form a comprehensive understanding of the clinical value of CMR for cardiac masses patients.

Ethics and dissemination:

Ethics approval and patient consent are not required, as this study is a systematic review.

PROSPERO registration number:

CRD42019137800.
Health-related quality of life and costs of switching originator infliximab to biosimilar one in treatment of inflammatory bowel disease
Authors: Huoponen Saara , Eberl Anja , Räsänen Pirjo , Roine Risto P. , Sipponen Taina , Arkkila Perttu , Blom Marja
Published: January 2020

Effectiveness, efficacy and safety of biosimilar infliximab (CT-P13) in inflammatory bowel disease (IBD) patients has been shown in previous studies. Limited data exist on health-related quality of life (HRQoL) of switching originator to biosimilar infliximab (IFX) in IBD patients. The objective of this study was to evaluate impact of switching originator to biosimilar IFX on HRQoL, disease activity, and health care costs in IBD maintenance treatment.

In this single-center prospective observational study, all IBD patients receiving maintenance IFX therapy were switched to biosimilar IFX. HRQoL was measured using the generic 15D health-related quality of life instrument (15D) utility measurement and the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ). Crohn Disease Activity Index (CDAI) or Partial Mayo Score (pMayo), and fecal calprotectin (FC) served for evaluation of disease activity. Data were collected at time of switching and 3 and 12 months after switching. Patients’ characteristics, clinical background information and costs were collected from patient records and the hospital's electronic database.

Fifty-four patients were included in the analysis. No statistically significant changes were observed in 15D, CDAI, pMayo, and FC during 1-year follow-up. IBDQ scores were higher (P = .018) in Crohn disease 3 months after switching than at time of switching. Costs of biosimilar IFX were one-third of costs of originator one. Total costs related to secondary health care (excluding costs of IFX), were similar before and after the onset of biosimilar IFX.

HRQoL and disease activity were after switching from originator to biosimilar IFX comparable, but the costs of biosimilar IFX were only one-third of those of the originator one.
Carbapenems vs alternative antibiotics for the treatment of complicated urinary tract infection
Authors: Tan Xinmei , Pan Qiwen , Mo Changgan , Li Xianshu , Liang Xueyan , Li Yan , Lan Yingnian , Chen Lingyuan
Published: January 2020

Background:

Complicated urinary tract infections (cUTI) are universal reasons for hospitalization, and highly likely to develop into sepsis or septic shock. Carbapenem antibiotics with potentially higher efficacy or with fewer and milder side effects have increased in popularity, but evidence is limited by a scarcity of randomized controlled trials (RCTs) comparing different carbapenem antibiotics for cUTI. Network meta-analysis is a useful tool to compare multiple treatments when there is limited or no direct evidence available.

Objective:

The aim of this study is to compare the efficacy and safety of different carbapenems with alternative antibiotics for the treatment of cUTI.

Methods:

Pubmed, Medline, CENTRAL, and Embase were searched in November 2018. Studies of cUTI patients receiving carbapenem were included. We performed network meta-analysis to estimate the risk ratio (RR) and 95% credible interval (CrI) from both direct and indirect evidence; traditional meta-analysis was also performed. Primary outcomes were clinical and microbiological treatment success.

Results:

A total of 19 studies and 7380 patients were included in the analysis. Doripenem (DOPM) was associated with lower clinical treatment success rates than other carbapenems. Although the efficacy of other carbapenems by RRs with 95% CrIs did not show statistical differences, the cumulative rank probability indicated that meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) had higher clinical and microbiological treatment success rates; imipenem/cilastatin (IC) and MV showed higher risk of adverse events (AEs).

Conclusions:

MV was associated with higher treatment success rates for cUTI, especially for cUTI caused by carbapenem-resistant uropathogens, but also with higher risk of AEs. Our findings suggest MV as a first-choice treatment of carbapenem-resistant cUTI. ETPM, BAPM, and meropenem (MEPM) is another reasonable choice for cUTI empiric therapy.
Immunotherapy for stone disease
Authors: Dominguez-Gutierrez Paul R. , Kwenda Elizabeth P. , Khan Saeed R. , Canales Benjamin K.
Published: January 2020

Purpose of review

In addition to traditional risk factors such as low urine volume or hypercalciuria, emerging data suggest that calcium oxalate (CaOx), one of the most common mineral complexes in the urine, elicits a strong immunologic response. This review highlights those studies and projects how future therapies may be directed for kidney stone prevention.

Recent findings

Over the last 2 years, several groups have studied the response of the immune system to CaOx crystals using cell culture and animal models. Dominguez et al. found that CaOx crystals were recognized by monocytes through an lipopolysaccharide-mediated mechanism, leading to M1 ‘inflammatory’ macrophage phenotype. Patel et al. proposed excessive oxalate-mediated reactive oxygen species within macrophage mitochondria may impair their ability to properly clear stones. Two other groups developed mouse models (an androgen receptor knock-out and an overexpression of Sirtuin 3 protein) and demonstrated increased renal anti-inflammatory macrophage differentiation and decreased CaOx deposition in experimental compared with controls. Anders et al. fed hyperoxaluric mice 1,3-butanediol, which blocks an inflammatory form of cell death called NLRP3 inflammasome and found less intrarenal oxidative damage and higher anti-inflammatory renal infiltrates in experimentals. Finally, monocytes exposed to CaOx crystals followed by hydroxyapatite had reduced inflammatory cytokine and chemokine production compared with those without hydroxyapatite, suggesting that Randall's plaque may play a role in dampening M1-mediatiated CaOx inflammation.

By modulating the immune response, immunotherapy could provide the means to prevent stone recurrences in certain individuals. The promotion of M2 over M1 macrophages and inhibition of inflammation could prevent the cascade that leads to CaOx nucleation. Future therapies may target the ability of macrophages to degrade CaOx crystals to prevent stones.
Epidemiology of Functional Abdominal Pain Disorders and Functional Defecation Disorders in Adolescents in Curacao
Authors: Zeevenhooven Judith , van der Heijden Sanne , Devanarayana Niranga M. , Rajindrajith Shaman , Benninga Marc A.
Published: January 2020

Objectives:

Functional abdominal pain disorders (FAPDs) and functional defecation disorders (FDDs) are common in children and adolescents, but prevalence rates from the Caribbean are lacking. Therefore, our aim was to determine the prevalence of FAPDs and FDDs in adolescents in Curacao and to assess the influence of psychosocial factors on the prevalence of FAPDs and FDDs.

Methods:

The prevalence of FAPDs and FDDs in children and adolescents living in Curacao, ages 11 to 18 years, was assessed using the Rome IV Questionnaire on Pediatric Gastrointestinal Disorders (RIV‐QPGD). FAPDs and FDDs were diagnosed according to the Rome IV criteria. Sociodemographic characteristics, somatic symptoms, early adverse life events, stressful life events, and physical and emotional abuse were evaluated as associated factors.

Results:

Out of 946 questionnaires distributed, 783 were included for further analysis. The mean age of adolescents was 14.7 years (±1.6) with 61.7% being girls. A total of 266 adolescents (34%, 95% confidence interval [CI] 30.7–37.5) met Rome IV criteria for at least 1 FAPD or FDD. Twenty‐nine adolescents (3.7%) qualified for 2 functional gastrointestinal disorders. Functional constipation (18.6%) and irritable bowel syndrome (12.3%) were the most prevalent disorders. After multivariate logistic regression analyses, dizziness (odds ratio [OR] 1.84, 95% CI 1.28–2.64) was significantly associated with having a FAPD or FDD.

Conclusions:

FAPDs and FDDs are common in adolescents in Curacao. Dizziness is associated with the presence of a FAPD or FDD.
Very Low Birth Weight Preterm Infants have Decreased Celiac Disease Autoimmunity During Childhood and Adolescence
Authors: Ben Tov Amir , Cohen Shlomi , Shamir Raanan , Chodick Gabriel , Melzer‐Cohen Cheli , Shalev Varda , Fayngor Rochelle , Weintraub Yael , Yerushalmy‐Feler Anat , Kuint Jacob
Published: January 2020

Little is known about the effect of prematurity on later development of celiac disease (CD). We conducted a retrospective analysis of real‐world data examining the association between very low birth weight (VLBW) prematurity and later development of CD autoimmunity (CDA) in 3580 infants born between years 2000 and 2012 and their matched controls. At a median of 12 years, VLBW prematurity was negatively associated with later development of CDA with a cumulative prevalence of 5.9 per 1000 versus 10.3 per 1000 (P = 0.02), though more former VLBW premature infants were ever tested for CDA (48.5% vs 37.4%, P < 0.001). The odds ratio for developing CDA among children born preterm at VLBW was 0.57 (95% confidence interval (CI) 0.35–0.92) as compared with matched controls. There was no difference in clinical characteristics of CDA between both groups. In conclusion, VLBW preterm infants present a decreased risk for the development of CDA during childhood and adolescence.
Total Oesophagogastric Dissociation in Neurologically Impaired Children
Authors: Battaglia Sonia , Orizio Paolo , Boroni Giovanni , Cheli Maurizio , Colusso Mara Marcella , Parolini Filippo , Bianchi Adrian , Alberti Daniele
Published: January 2020

Objectives:

Total oesophagogastric dissociation (TOGD) is an alternative antireflux surgery for neurologically impaired children because of a 16% to 38% fundoplication failure rate. This study evaluates TOGD's feasibility and its long‐term efficacy both as a Primary and as a “Rescue” procedure after failed fundoplication.

Methods:

Thirty patients (18 boys) who underwent TOGD between 2000 and 2018 in 2 Italian Centres were retrospectively reviewed. Twenty‐three were Primary procedures and 7 were “Rescue” ones. Inclusion criteria were severe neurodisability, intractable gastroesophageal reflux, and dysphagia.

Results:

Preoperatively, all children had regurgitation, vomiting or retching, and 93% had unsafe swallowing and aspiration, with recurrent chest infections/aspiration pneumonia. Median relative weight was 77% (48%‐‐118%). All patients were taking antireflux medication before surgery. Median age at TOGD was 6.48 years (0.69‐‐22.18). Median follow‐up was 3.5 years (0.6–17.7). No recurrence of gastroesophageal reflux (GER) and vomiting was recorded. The number of chest infections and length of hospital stay showed a significative decrease (P value <0.0001 for both), whereas median relative weight reached 101% (P value 0.002). Parents’/caregivers’ perception of outcome showed a significative improvement. Six patients (20%) experienced early complications and 3 required surgical intervention. Three late complications (10%) also required surgery. There was no surgery‐related mortality.

Conclusion:

TOGD is an effective procedure with an acceptably low complication rate for children with severe neurological impairment and is followed by a major improvement in general health and quality of life for children and families. There was no substantial difference in outcome between Primary and “Rescue” procedures.
Primary Gastric Synovial Sarcoma in a Child: A Case Report and Review of the Literature
Authors: Manohar Archana , Gopal Champaka , Premalata Chennagiri S. , Kumar Rekha V. , Patil Okaly Geeta V. , Somashekhar S.P. , Padma M.
Published: January 2020

Synovial sarcoma is a mesenchymal neoplasm that shows a specific t(X;18) translocation that leads to the formation of SS18-SSX gene fusions and is most commonly seen in soft tissues of the extremity. The gastrointestinal tract is a very rare site of involvement. We report a case of primary gastric synovial sarcoma in a 13-year-old male child. Synovial sarcoma should be included in the differential diagnosis when spindle cell neoplasms are encountered in the stomach. A high degree of suspicion, followed by the necessary immunohistochemistry and molecular studies, is required to make an accurate diagnosis.
Safety and Efficacy of Saffron (Crocus sativus L.) for Treating Mild to Moderate Depression
Authors: Dai Lili , Chen Lingyan , Wang Wenjing
Published: January 2020

Background

Herbal remedies are becoming increasingly popular for the treatment of depression. Recently, accumulating evidences reveal a positive effect of saffron (Crocus sativusL.) in relieving depressive symptoms. The objective of this meta-analysis was to assess the safety and efficacy of saffron in treating mild to moderate depression by synthesizing all available data.

Materials and Methods

Relevant studies were retrieved from electronic databases and cross-checking of reference lists. Eligible trials were carefully reviewed, and necessary data were extracted. The Hamilton Rating Scale for Depression or Beck Depression Inventory scores, response rate, remission rate, and adverse effects were compared between saffron and placebo or saffron and antidepressants to assess the efficacy of saffron for depression.

Results

Twelve studies were included in the meta-analysis. Overall results showed that saffron possessed better efficacy in the improvement of depressive symptoms when compared with placebo, whereas saffron was as effective as synthetic antidepressants. No significant difference was detected in the incidence of adverse effects between saffron and placebo or between saffron and antidepressants.

Conclusions

Saffron could be considered as an alternative to synthetic antidepressants in the treatment of mild to moderate depression. However, multicenter trials with larger sample size, longer treatment duration, and different ethnic groups are required to verify our results.
Practical Approach to the Histologic Diagnosis of Gastrointestinal Lymphomas Through the First-line Marker Battery of CD20, CD3, CD30, and Epstein-Barr Virus–encoded RNAs
Authors: Kim Eun Kyung , Yang Woo Ick , Ryu Hyang Joo , Ji Hee Lee , Yoon Sun Och
Published: January 2020

The gastrointestinal (GI) tract is a prevalent site for extranodal lymphomas. Some subtypes of GI tract lymphomas are aggressive and have dismal clinical outcomes. Therefore, prompt histopathologic detection of such types can be very important. We thus introduce a practical approach in the histopathologic diagnosis of GI lymphomas according to the revised World Health Organization (WHO) classification. When lymphocyte proliferation is found in the GI tract, a stepwise approach can help narrow down the differential diagnoses. When considering subtype incidence, macroscopic findings, and microscopic patterns, applying a first-line marker battery of CD20, CD3, CD30, and Epstein-Barr virus–encoded RNAs can effectively narrow down the top differential diagnoses at the initial step. Generally, the most common subtype among GI tract lymphomas is B-cell non-Hodgkin lymphoma identified by CD20 expression, followed by T-cell and NK-cell non-Hodgkin lymphomas identified by the CD3 expression, and some subtypes are defined by Epstein-Barr virus infection or CD30 expression. Macroscopically, lymphomas present as various gross types, such as large masses, small lesions, superficial and shallow lesions, polyp-like or polyposis-like features, or ulcer/necrosis/perforation. Microscopically, large pleomorphic cells or small to medium-sized tumor cells grow with various architectures and tumor microenvironments. Incorporation of macroscopic and microscopic features and the stepwise immunophenotyping may be a practical approach to the differential diagnosis of aggressive lymphoma, indolent/low-grade lymphoma, or benign to indolent lymphoproliferative disease. Exceptions always exist; this approach focuses on the relatively prevalent circumstances of lymphomatous lesions initially encountered in the GI tract.
Recurrent Fusions Between YAP1 and KMT2A in Morphologically Distinct Neoplasms Within the Spectrum of Low-grade Fibromyxoid Sarcoma and Sclerosing Epithelioid Fibrosarcoma
Authors: Puls Florian , Agaimy Abbas , Flucke Uta , Mentzel Thomas , Sumathi Vaiyapuri P. , Ploegmakers Marieke , Stoehr Robert , Kindblom Lars-Gunnar , Hansson Magnus , Sydow Saskia , Arbajian Elsa , Mertens Fredrik
Published: January 2020

Sclerosing epithelioid fibrosarcoma (SEF) is an aggressive soft tissue sarcoma. In the majority of cases, there is overexpression of MUC4, and most cases show EWSR1-CREB3L1 gene fusions. A subset of SEF displays composite histologic features of SEF and low-grade fibromyxoid sarcoma (LGFMS). These “hybrid” tumors are more likely to harbor the FUS-CREB3L2 fusion, which is also seen in most LGFMS. We, here, characterize a series of 8 soft tissue neoplasms with morphologic features highly overlapping with LGFMS and SEF but lacking MUC4 expression and EWSR1/FUS-CREB3L gene fusions. Seven tumors showed fusions of the YAP1 and KMT2A genes, and 1 had a fusion of PRRX1 and KMT2D; all but 1 case displayed reciprocal gene fusions. At gene expression profiling, YAP1 and KMT2A/PRRX1 and KMT2D tumors were distinct from LGFMS/SEF. The patients were 4 female individuals and 4 male individuals aged 11 to 91 years. Tumors with known locations were in the lower extremity (5), trunk (2), and upper extremity (1); 3 originated in acral locations. Tumor size ranged from 2.5 to 13 cm. Proportions of SEF-like and LGFMS-like areas varied considerably among tumors. All tumors that showed infiltrative growth and mitotic figures per 10 HPFs ranged from 0 to 18. Tumor necrosis was present in 1 case. Follow-up was available for 5 patients (11 to 321 mo), 2 of whom developed local recurrences, and 1 died of metastatic disease. The clinical behavior of these soft tissue sarcomas remains to be further delineated in larger series with extended follow-up; however, our limited clinical data indicate that they are potentially aggressive.
Teaching Infant Cardiopulmonary Resuscitation to Caregivers in the Emergency Department
Authors: Song Joo Lee , Chang Todd P. , Schmidt Anita R. , Stavroudis Theodora A. , Pham Phung K. , Nager Alan L.
Published: January 2020

Objectives

Infant cardiopulmonary resuscitation (CPR) has been taught to caregivers of infants in inpatient settings. There are no studies to date that look at teaching infant CPR in the emergency department (ED). Using a framework of cognitive load theory, we compared teaching infant CPR to caregivers in a pediatric ED versus an inpatient setting.

Methods

Knowledge tests, 1-minute infant CPR performances on a Resusci Baby QCPR (Laerdal) manikin, and self-reported questionnaires were completed before and after caregivers were self-taught infant CPR using Infant CPR Anytime kits. The proportions of chest compression depth and rate that met quality standards from the American Heart Association's Basic Life Support program were measured.

Results

Seventy-four caregivers participated. Mean knowledge scores (out of a total score of 15) increased in both settings (ED preintervention: Mean (M) = 4.53 [SD = 1.97]; ED postintervention: M = 10.47 [SD = 2.90],P< 0.001; inpatient preintervention: M = 4.83 (SD = 2.08); inpatient postintervention: M = 10.61 [SD = 2.79],P< 0.001). Improvement in the proportion of chest compression that met high quality standards for depth increased in the inpatient group only. Neither groups had improvements in compression rates. There were no statistically significant differences in the difficulty of learning CPR, frequency of interruptions/distractions, or difficulty staying concentrated in learning CPR between the 2 settings.

Conclusions

Caregivers in the ED and inpatient settings after a self-instructional infant CPR kit did not demonstrate adequate infant CPR performance. However, both groups gained infant CPR knowledge. Differences in cognitive loads between the 2 settings were not significant.
Does Point-of-Care Gastric Ultrasound Correlate With Reported Fasting Time?
Authors: Miller Andrew F. , Levy Jason A. , Krauss Baruch S. , Gravel Cynthia A. , Vieira Rebecca L. , Neuman Mark I. , Monuteaux Michael C. , Rempell Rachel G.
Published: January 2020

Objective

Traditionally, patient-reported fasting time has been the primary objective presedation measure of aspiration risk. Recently, gastric ultrasound has been used to assess gastric volume for the determination of aspiration risk in patients undergoing anesthesia in the operative setting. We sought to determine the correlation of gastric volume estimated by point-of-care ultrasound (POCUS) to reported fasting time.

Methods

We included children 4 to 18 years of age who presented with an acute traumatic injury. Enrolled children underwent POCUS to calculate gastric volume, which was calculated using a validated formula: Volume (mL) = −7.8 + (3.5 × Cross-sectional Area [CSA]) + (0.127 × Age in months). The CSA was measured (CSA = (anterior-posterior diameter × craniocaudal diameter × π)/4). We analyzed the relationship between time since last reported oral intake and measured gastric volume using Spearman rank correlation (ρ).

Results

A total of 103 patients with a median age of 10.5 years (interquartile range, 7.3–13.7 years) were enrolled. The gastric antrum was identified and measured in 88 (85%) patients; air obstructing the posterior surface of the gastric antrum prevented measurement in 14 of the 15 remaining patients. We observed a weak inverse correlation between fasting time (either liquid or solid) and estimated gastric volume (ρ = −0.33), with no significant difference based on type of intake (solids, ρ = 0.28; liquids, ρ = 0.22).

Conclusion

Gastric volume can be estimated by POCUS and is not strongly correlated with fasting time in children in the emergency department setting.
Blinding in Rehabilitation Research
Authors: Armijo-Olivo Susan , Dennett Liz , Arienti Chiara , Dahchi Mustafa , Arokoski Jari , Heinemann Allen W. , Malmivaara Antti
Published: January 2020

Objective

The aim of the study was to assess the association between different types of blinding on treatment effects estimates in the area of rehabilitation.

Methods

Evidence synthesis was used for the design of the study. This study included any systematic review or meta-epidemiological study that investigated associations between any blinding component and treatment effects estimates in randomized control trials in the area of rehabilitation. The information obtained from the included studies was organized by type of blinding and summarized using a narrative and/or quantitative approach when possible. If there were enough data of estimates for any type of blinding, we decided to pool them in an exploratory fashion.

Results

The literature search identified a total of 1015 citations, of which 7 studies fulfilled the inclusion criteria. Studies show overestimation, underestimation, or neutral associations for different types of blinding on treatment effects.

Conclusions

Associations were mixed and did not follow a consistent pattern. Lack/poor reporting of blinding, small sample sizes, and heterogeneity of data sets could have led to nonsignificant and inconsistent results obtained by the included studies. Although the evidence regarding the association between blinding and treatment effect estimates is still inconclusive in the rehabilitation field, based on the available literature, researchers should select creative solutions to avoid performance and detection bias.
High levels of genetically intact HIV in HLA-DR+ memory T cells indicates their value for reservoir studies
Authors: Horsburgh Bethany A. , Lee Eunok , Hiener Bonnie , Eden John-Sebastian , Schlub Timothy E. , von Stockenstrom Susanne , Odevall Lina , Milush Jeffrey M. , Liegler Teri , Sinclair Elizabeth , Hoh Rebecca , Boritz Eli A. , Douek Daniel C. , Fromentin Remi , Chomont Nicolas , Deeks Steven G. , Hecht Frederick M. , Palmer Sarah
Published: January 2020

Objective:

The contribution of HLA-DR+ memory CD4+ T cells to the HIV reservoir during prolonged antiretroviral therapy is unclear as these cells are commonly excluded when assessing for replication-competent HIV. To address this issue, we examined the distribution of genetically intact HIV DNA within HLA-DR− and HLA-DR+ memory CD4+ T cells and the RNA transcriptional profile of these cells during antiretroviral therapy.

Design/methods:

Full-length DNA sequencing was used to examine the HIV DNA landscape within HLA-DR+ and HLA-DR− memory CD4+ T cells. RNA quantification and sequencing was used to interrogate the relationship between HLA-DR status and HIV RNA transcription.

Results:

HLA-DR+ CD4+ T cells contained a high frequency of genetically intact HIV genomes, contributing over half of the genetically intact viral sequences to the reservoir. Expansions of genetically identical sequences were identified in all T-cell subsets, indicating that cellular proliferation maintains genetically intact and defective viral DNA during therapy. Intracellular HIV RNA levels in HLA-DR+ and HLA-DR− T cells were not statistically different by either long terminal repeat quantitative PCR quantification or single-genome RNA sequencing of the p6-RT region.

Conclusion:

The high proportion of intact viral DNA sequences in the proliferative HLA-DR+ subset suggests they are critical in maintaining HIV infection during effective therapy. As such, these cells should be included in any immune intervention targeting HIV during effective therapy.
Assessing Cognitive Functioning in People Living With HIV (PLWH): Factor Analytic Results From CHARTER and NNTC Cohorts
Authors: May Pamela E. , Heithoff Abigail J. , Wichman Christopher S. , Phatak Vaishali S. , Moore David J. , Heaton Robert K. , Fox Howard S.
Published: January 2020

Background:

Single summary scores, such as the Global Deficit Score, are often used to classify overall performance on neuropsychological batteries. The factor structure of test scores that underlie Global Deficit Score in studies of people living with HIV (PLWH) was assessed to determine whether individual test scores loaded onto a unitary factor to summarize performance.

Setting:

Secondary data analysis on baseline data of PLWH from National NeuroAIDS Tissue Consortium and CNS HIV Antiretroviral Therapy Effects Research (CHARTER) Study.

Method:

Primary analyses included testing model structure and fit of neuropsychological test scores with confirmatory and exploratory factor analyses. Secondary analyses involved receiver operating characteristic curves, and associations with psychosocial and medical variables.

Results:

Participants with confounds were excluded, leading to 798 (National NeuroAIDS Tissue Consortium) and 1222 (CHARTER) cases. When confirmatory factor analysis models were structured to be consistent with theoretically-based cognitive domains, models did not fit adequately. Per exploratory factor analyses, tests assessing speeded information processing, working memory, and executive functions loaded onto a single factor and explained the most variance in both cohorts. This factor tended to be associated with age, estimated premorbid ability, and aspects of substance use history. Its relation to age, in context of demographically corrected neuropsychological scores, suggested accelerated aging.

Conclusion:

Results indicate that individual neuropsychological tests did not load exactly onto expected domains, suggesting another framework for future analyses of cognitive domains. The possibility of a new index, and its use to assess cognitive impairment in PLWH, is suggested for further diagnostic and prognostic purposes.
Endothelial Activation, Innate Immune Activation, and Inflammation Are Associated With Postbronchodilator Airflow Limitation and Obstruction Among Adolescents Living With HIV
Authors: Attia Engi F. , Bhatraju Pavan K. , Triplette Matthew , Kosamo Susanna , Maleche-Obimbo Elizabeth , West Timothy Eoin , Richardson Barbra A. , Zifodya Jerry S. , Eskander Sherry , Njiru Christine D. , Warui Danson , Kicska Gregory A. , Chung Michael H. , Crothers Kristina , Liles Wayne Conrad , Graham Susan M.
Published: January 2020

Background:

Chronic inflammation, innate immune activation, T-cell imbalance and endothelial activation have been linked with lung diseases. We sought to determine whether markers of these pathophysiologic pathways were associated with spirometry and chest computed tomography (CT) abnormalities among adolescents living with HIV (ALWH).

Setting:

Coptic Hope Center for Infectious Diseases in Nairobi, Kenya.

Methods:

We performed a cross-sectional study of ALWH (10–19 years old). Participants underwent chest CT, spirometry, and venipuncture for serum biomarkers. We also collected demographic, anthropometric, T-cell subset, antiretroviral therapy, and exposure data. We compared characteristics and biomarkers by airflow obstruction [postbronchodilator FEV1/FVC z-score (zFEV1/FVC) < −1.64]. We used multivariable linear regression to determine associations of log10-transformed biomarkers and chest CT abnormalities with lower postbronchodilator zFEV1/FVC (airflow limitation). We performed exploratory principal components analysis on biomarkers, and determined associations of factors with postbronchodilator zFEV1/FVC and chest CT abnormalities.

Results:

Of 47 participants with acceptable quality spirometry, 21 (45%) were female, median age was 13 years and 96% had perinatally-acquired HIV. Median CD4 was 672 cells/µL. Overall, 28% had airflow obstruction and 78% had a chest CT abnormality; airflow obstruction was associated with mosaic attenuation (P = 0.001). Higher endothelial activation (sVCAM-1, sICAM-1), inflammation and innate immune activation (serum amyloid-A, sTREM-1, sCD163), and T-cell imbalance (lower CD4/CD8) markers were associated with airflow limitation. Factors comprising endothelial and innate immune activation were associated with airflow limitation.

Conclusions:

Endothelial activation, innate immune activation, T-cell imbalance, and chronic inflammation are associated with airflow limitation and obstruction, providing insights into chronic lung disease pathophysiology among ALWH.
Sex Differences in People Aging With HIV
Authors: Brañas Fátima , Sánchez-Conde Matilde , Carli Federica , Menozzi Marianna , Raimondi Alessandro , Milic Jovana , Franconi Jacopo , Cuomo Gianluca , Mussini Cristina , Moreno Santiago , Guaraldi Giovanni
Published: January 2020

Background:

To evaluate differences between older women and men with HIV regarding HIV variables, comorbidity, physical function, and quality of life (QOL).

Setting:

The Modena HIV clinic.

Methods:

Prospective cohort study. Cross-sectional analysis. Patients >50 years were included, stratified by sex. We recorded sociodemographic data, comorbidities, variables related to HIV infection, frailty, data on body composition, physical function, physical activity, and QOL.

Results:

We evaluated 1126 older adults with HIV, of which 284 (25.2%) were women. Median age was 55 (IQR 6) years. There were significant differences between women and men in the median current CD4+ T-cell and the mean CD4/CD8 ratio. There were differences regarding alcohol consumption, cardiovascular (CV) disease, hypertension, diabetes mellitus, and renal failure. Sarcopenia and slower gait speed were found more prevalent among men, but without significant differences. Significant differences were found regarding lower extremity strength measured by the chair stand test and in the short physical performance battery score. Short physical performance battery <9 was detected for 11.1% women vs. 5.6% men (P = 0.002). EQ5D5L score was 0.87 in women vs. 0.89 in men (P = 0.002).

Conclusions:

In our cohort, older women represented one in 4 of the total patients. Despite the fact that women have better immunological recovery measured by CD4 T-cell count and CD4/CD8 ratio, and fewer CV disease and CV risk factors than men, their physical function and their QOL are worse. Therefore, older HIV-infected women have special characteristics, and the assessment of physical function in this group seems to be crucial.
Is It Feasible to Impact on Smoking Habits in HIV-Infected Patients? Mission Impossible From the STOPSHIV Project Cohort
Authors: De Socio Giuseppe Vittorio , Ricci Elena , Maggi Paolo , Orofino Giancarlo , Squillace Nicola , Menzaghi Barbara , Madeddu Giordano , Di Biagio Antonio , Francisci Daniela , Bonfanti Paolo , Vichi Francesca , dell'Omo Marco ,   for the CISAI study group
Published: January 2020

Objective:

Assessment of the feasibility and effectiveness of a brief intervention for smoking cessation in people living with HIV (PLWH).

Setting:

Multicenter cohort prospective study involving PLWH from 10 Italian infectious disease centers.

Methods:

During routine HIV care, clinicians delivered the 5As brief intervention (Ask, Advise, Assess, Assist, Arrange) to each patient who enrolled in the study, following the European AIDS Clinical Society guidelines. At study end, participating clinicians evaluated their own adherence to intervention: “standard” if counseling was delivered in at least half of the follow-up visits, “soft” if less. The main outcome measure was smoking abstinence ≥6 months. Abstinence predictors were evaluated using a Cox-proportional hazard regression model.

Results:

One thousand eighty-seven PLWH-patients (age 47.9 ± 10.8, male 73.5%) were followed for a median of 23 months (interquartile range 21–25). At baseline, current smokers were 561 (51.6%). Standard intervention was performed in 4 of 10 centers and included 343 smokers; soft intervention was performed in 6 centers (218 smokers). At last visit, 35 patients in standard (10.8%) and 6 in soft intervention (2.8%) achieved self-reported tobacco abstinence ≥6 months (P = 0.0009). Overall, the 5As intervention led to 7.3% 6-month interruptions. In the multivariable analysis, significant predictors for 6-month smoking cessation were: lower Fagerström score, stage of change (preparation/contemplation vs. precontemplation), and standard intervention.

Conclusion:

Adherence to the 5As brief intervention emerged as a critical factor for success. In fact, compared with soft intervention, the standard intervention significantly increased abstinence, highlighting that clinicians need more time and supporting tools to encourage PLWH to quit smoking.
Impact of Perceived Cardiovascular Risk on Cardiovascular Disease Prevention Behaviors in People With and Without HIV Infection
Authors: Webel Allison , Horvat Davey Christine , Schexnayder Julie , Currie Jackson , Al Battashi Hamed , Chang Julia , Longenecker Chris T.
Published: January 2020

Background:

People living with HIV (PLHIV) are at elevated risk of developing atherosclerotic cardiovascular disease (ASCVD). PLHIV do not engage in recommended levels of ASCVD prevention behaviors, perhaps due to a reduced perception of risk for ASCVD. We examined how HIV status influences knowledge, beliefs, and perception of risk for ASCVD and ASCVD prevention behaviors.

Methods and Results:

We conducted a mixed-methods study of 191 PLHIV and demographically similar HIV-uninfected adults. Participants completed self-reported surveys on CVD risk perceptions, adherence to CVD medication (aspirin, antihypertensives, and lipid-lowering medication) and 3 dietary intake interviews. All wore an accelerometer to measure physical activity. A subset of PLHIV (n = 38) also completed qualitative focus groups to further examine the influence of HIV on knowledge, perception of risk for ASCVD, and behavior.

Participants:

They were approximately 54 (±10) years, mostly men (n = 111; 58%), and African American (n = 151, 83%) with an average 10-year risk of an ASCVD event of 10.4 (±8.2)%. PLHIV were less likely to engage in physical activity (44% vs 65%, P < 0.05), and HIV status was associated with 43 fewer minutes of physical activity per week (P = 0.004). Adherence to ASCVD medications was better among PLHIV (P < 0.001). Diet composition was similar between groups (P > 0.05). HIV status did not influence ASCVD risk perceptions (P > 0.05) and modestly influenced physical activity and smoking.

Conclusions:

Although perceptions of ASCVD risk modestly influence some behaviors, additional barriers and insufficient cues to action result in suboptimal physical activity, dietary intake, and smoking rates. However, PLHIV have high adherence to ASCVD medications, which can be harnessed to reduce their high burden of ASCVD.
Revisiting the Blood Supply of the Rectus Femoris
Authors: Zhan Yi , Zhu Hongzhang , Geng Pengfei , Zou Mengsha , Qi Jian , Zhu Qingtang
Published: January 2020

Background

Rectus femoris necrosis is a rare but severe complication after anterolateral thigh flap (ALTF) harvesting. It has been previously reported that the blood supply of the rectus femoris (RF) often arises from the same source artery as the ALTF; however, precise descriptions of the relationship remain limited. This article revisits the blood supply of the RF based on computed tomography angiography (CTA) and analyzes the possible influence of the blood supply on the RF during ALTF harvesting.

Methods

Between December 2017 and June 2018, CTA images of the bilateral lower extremities of 25 patients were studied. The RF length, number, and diameter of branches at the entry point into muscle, location, and overall branch vessel origins were recorded.

Results

The average ± SD RF length was 384.73 ± 19.28 mm. There were 170 branches (mean ± SD, 3.4 ± 0.96 branches per thigh), mainly arising from the lateral circumflex femoral artery. The average ± SD diameter was 1.90 ± 0.51 mm. The first branch was located at 1/5 of the proximal site of the RF, and 91% of all branches were located above the midpoint. The RF vascularity can be classified into 2 types: type 1 (36% of sides) has branches that arise from a single artery (descending lateral circumflex femoral artery or femoral artery), whereas type 2 (64% of sides) has branches at the 1/5 proximal and 4/5 distal parts, which arise from different arteries.

Conclusions

Preoperative CTA can provide anatomic information about the RF's nutrient vessel(s) and helps to optimize ALTF design.
Microsurgical Training Opportunities at the Queen Victoria Hospital
Authors: Henton John , Berner Juan Enrique , Blackburn Adam , Molina Alexandra
Published: January 2020

Becoming a competent microsurgeon requires training in a variety of skills and competences. However, instructing the next generation of microsurgeons seems to be a challenging task, considering the current trend to reduce training hours along with increased patient expectations. To evaluate the microsurgical training opportunities at the Queen Victoria Hospital, we conducted a retrospective review of the last 3 and a half years, to identify the opportunities given to trainees during breast reconstruction cases. We also surveyed the microsurgical fellows who worked in our unit during the same period. A total of 848 free flaps were performed between November 2015 and May 2019 for 699 patients undergoing breast reconstruction, with a flap failure rate of 0.47%. For unilateral cases, more than half of the flaps were raised by trainees: 39% by fellows and 12% by specialist registrars. For bilateral breast and bipedicled reconstructions, these figures were 44% and 2%, respectively. A total of 1835 microvascular anastomoses were performed, of which 33% were done by fellows and 17% by specialist registrars, with the remaining 50% being done by consultants. Six of 8 fellows who worked in our unit during the studied period replied to our survey. All of them were pleased with their training experience, and the majority of them progressed to a consultant post after their fellowship. We consider that a standardized surgical approach, along with a high-volume caseload, allows delivering an outstanding training experience while maintaining low complications rates.
Trainee Operative Autonomy in Plastic Surgery
Authors: Vargas Christina R. , Long Tobias C. , Kumar Anand R.
Published: January 2020

Background

Appropriate, progressive trainee autonomy is critical for training competent plastic surgeons who are adequately prepared to enter independent practice. Evaluation and reporting of meaningful operative autonomy among trainees in plastic surgery are understudied.

Methods

Parallel survey instruments were developed using the Zwisch metric for progressive operative autonomy and distributed electronically to trainees and faculties in all accredited training programs. Trainees were queried about their operative autonomy in 17 core plastic surgery procedures, associated approach to logging cases, and perceived readiness to enter practice. Faculties provided assessment of their final-year trainees using the same metrics.

Results

Trainees in 28 programs and faculties in 35 programs participated. Final-year trainees reported the most operative independence with breast tissue expander reconstruction and carpal tunnel release and the least with facelift and rhinoplasty. A mean of 40% of final-year trainees reached supervision only autonomy in the procedures queried; none achieved this with rhinoplasty. Faculties identified the highest final-year trainee operative autonomy with botulinum toxin injection and burn excision and grafting; the least trainee independence was reported with rhinoplasty, cleft lip repair, and facelift. Faculty perception of final-year trainee autonomy was higher than that of trainees for 82% of procedures queried.

Conclusions

Although plastic surgery trainees endorse gradual operative autonomy overall, a majority of final-year trainees do not perceive supervision only independence in the majority of core procedures queried. Faculties perceive higher trainee operative autonomy than trainees for most procedures. Discordant approaches to case logging were identified both among trainees and between trainees and faculties. Standardization may improve both progression and assessment of operative autonomy in plastic surgery training.
A Randomized Controlled Trial Comparing Short-term Outcomes of Self-Gripping (Progrip) Mesh Versus Fibrin Sealant in Laparoscopic Total Extraperitoneal Hernioplasty
Authors: Law Tsz Ting , Ng Ka Kin , Wei Rockson , Yip Jeremy , Ng Lily , Wong Kin Yuen , Foo Chi Chung
Published: January 2020

Background:

There are no data comparing the use of self-gripping mesh with standard mesh in total extraperitoneal repair (TEP). In this prospective study we aim to study the incidence of chronic pain between Progrip (PG) and standard mesh fixed by fibrin sealant (FS).

Materials and Methods:

Under Institutional Review Board approval, from April 2016 to May 2017, patients with primary unilateral or bilateral inguinal hernia eligible for TEP were recruited. Before mesh insertion they were randomized into PG or FS (Tisseel). Demographics, intraoperative, and postoperative data were recorded. Patients were followed up for at least 1 year. Visual Analog Scale was used to record pain scores. Primary outcome was the incidence of chronic pain at 3 months after surgery.

Results:

One hundred fifty patients were randomized. Of the 150 patients (193 hernias), 76 were randomized to PG and 74 randomized to FS. Demographic data such as age, presence of comorbidities, smoking history, mean body mass index was comparable in both groups. Bilateral hernias occurred in 25 (32.9%) and 18 (24.3%) patients in PG and FS group, respectively. Mean mesh deployment time was 283.7 seconds (range, 140 to 720 s) in PG group and 301.9 seconds (range, 67 to 1006 s) in FS group (P=0.30). A total of 5 patients were lost at follow-up and they were excluded from subsequent data analysis. Seroma occurred in 15 (20.3%) and 16 (22.5%) patients in PG and FS group, respectively (P=0.45). Mean Visual Analog Scale at 2 weeks (cough) was highest at 1.05 and 1.02 in PG and FS group, respectively (P=0.62). Eight (12.3%) and 15 (23.4%) patients in PG and FG group, respectively, reported pain at 3-month follow-up (P=0.1). Of those who experienced pain, majority was mild pain which did not affect activities of daily living. At a mean follow-up of 13.1±5.4 months, no recurrence was detected.

Conclusions:

There was no significant difference in terms of chronic pain between PG and FS group. The use of PG is effective in TEP.