bluuebunny/crossref_metadata_2025 huggingface dataset:
A260 ACUTE PANCREATITIS IN JORDANIAN CHILDREN
Authors: Altamimi E M , Droubi B
Published: February 2022

Background

Acute pancreatitis is a uncommon disease in children. The difference between pediatric and adult pancreatitis limit the ability of extrapolating the adults data and magnify the need for further pediatric research.

Aims

We aimed to describe the demographics, clinical presentation and findings of acute pancreatitis in Jordanian children. In addition, we discuss the diagnostic criteria of AP and compare the role of various labratory and radiological investigations in the diagnostic process in our cohort.

Methods

This is a retrospective study involving children below 18 years of age, diagnosed with acute pancreatitis at King Abdullah University Hospital, a tertiary healthcare center in Irbid, Jordan.

Patient electronic records from 2011 to 2020 were manually reviewed and data collected into an excel sheet. The data included their demographics (Age, sex, age at first recurrence in case of recurrent pancreatitis) and clinical data (presentation, physical findings, laboratory and radiological investigations, interventions and outcomes). Those with insufficient data were excluded.

Results

A total of 22 patients with 59 episodes of AP were identified. Of those patients, 11 (50%) were males, and 11 (50%) had only a single AP episode. The mean age during the first attack of AP was 10 years (SD = 3.6 y, N = 21) and the youngest was 3.45 years.

Of the 22 patients who had the first AP episode, 11 (50%) had at least one more episode of AP later on. In those who did have recurrence; The median duration between the first and second episodes was 2.7 months, IQR = 11 mo. The median length of hospital stay was 3 days, IQR = 4 days.

Abdominal pain was the most common presenting symptom of AP (96%). Nausea and vomiting were less common (67% and 50%, respectively).

The cause of pancreatitis was identified in 18 (82%) children, while 4 (18%) were labelled as idiopathic. The most common known cause in our cohort was congenital biliary-pancreatic abnormalities; namely choledochal cyst and pancreatic divisum (6, 27%) followed by genetic cause (4, 18%) and biliary pancreatitis (4,18%).

Abdominal ultrasound (US) was the most used diagnostic imaging (33 exams). The most common finding was bulky and enlarged pancreas in 9 exams. MRCP evaluation was available for 10 episodes; 3 exams showed a normal pancreas, while 2 confirmed the suspicion of pancreatic divisum, 1 suggested cholangitis. 1 visualized a small choledochal cyst that was undetected with neither US nor CT.

Development of peripancreatic fluid collection (pseudocyst) was seen in 4 patients, two of which underwent intervention, one was treated with endoscopic gastro-cystic drainage and the other was treated with surgical drainage. Of the 22 children and 59 AP episodes, only 1 died.

Conclusions

Acute pancreatitis is uncommon in Jordanian children. Although the small number in our cohort, we reported different etiological spectrum compared to reported literture.

Funding Agencies

None
Could Europe Apply a Suitable Control Method for the Small Hive Beetle (Coleoptera: Nitidulidae)?
Authors: Sabella Giorgio , Mulè Rosaria , Robba Lavinia , Agrò Alfonso , Manachini Barbara
Published: February 2022

The European bee, Apis mellifera L. (Hymenoptera: Apidae), is a fundamental resource for the pollination of a great variety of botanical species used by humans for sustenance. Over the last few decades, bee colonies have become vulnerable to a new pest that has advanced beyond its native sub-Saharan territory: the small hive beetle, Aethina tumida Murray (Coleoptera: Nitidulidae). This currently presents a pressing problem in the United States and Australia, but it has also been recorded in Portugal and Italy and it is likely to spread in the rest of Europe too. This study represents a systematic review, based on EFSA guidelines, of the various control treatments for small hive beetles in order to identify the most effective methods as well as, those with no effects on bee colonies. The results show that the bulk of these studies were performed in the United States and that a number of treatments are suitable for the control of A. tumida, though some have negative effects on bees while others have low effectiveness or are ineffective. The best results are those with the entomopathogenic nematodes of the genus Steinernema and Heterorhabditis, but also with formic acid or diatomaceous earth. Various products containing insecticides have been effective, for example, Perizin (Bayer), GardStar (Y-Tex), CheckMite+ strips (Bayer), but Apithor (Apithor ) cannot be used in Europe because it contains Fipronil, which has been banned since 2013. Some common products like bleach and detergent have also been effective.
International Criminal Liability for Spreading Disinformation in the Context of Mass Atrocity
Authors: Holvoet Mathias
Published: February 2022

In the context of international crimes, falsehoods — ranging from selective reporting of facts, deliberate mischaracterization of events and adversaries, or even plain fabrication and lies — constitute a breeding ground in which incitement to commit violence can thrive. While disseminating such falsehoods does not constitute a direct call to commit physical violence, it nevertheless sows the seeds for mass atrocities. This article considers the outer limits of International Criminal Law (ICL) — defined by the principle of culpability — by enquiring whether campaigns of disinformation in the context of mass atrocities could ever give rise to individual responsibility. On the basis of the Fritzsche, Gvero and Mbarushimana cases, liability for disseminating disinformation might in principle be engaged before, during and even after the commission of such crimes. Recent concerns about the role of Facebook in Myanmar also pose the question whether social media companies or their personnel may be liable for amplifying disinformation campaigns. Yet, overall, these cases show the unease of ICL in criminalizing disinformation contributing to atrocity crimes.
Sterilization of Lucilia sericata (Diptera: Calliphoridae) Eggs for Maggot Debridement Therapy
Authors: Bavani Mulood Mohammadi , Seyyedzadeh Seyyed Jaavad , Radi Ehsan , Malekian Azam , Hoseinpour Mahdiyeh , Gholizadeh Saber
Published: February 2022

Maggot debridement therapy (MDT) is a therapy with the medical use of sterile fly larvae of certain species, particularly those within the Calliphoridae family including green bottle fly, Lucilia sericata (Meigan, Diptera: Calliphoridae), for treating chronically infected wounds and ulcers. Lucilia sericata flies were maintained under insectary conditions, and the eggs were sterilized using three treatments: hydrogen peroxide solutions, used as a hand disinfectant (Treatment 1—T1), hydrogen peroxide, surface disinfectant (Treatment 2—T2), and SaniHigene (Treatment 3—T3) and the control (without treatment). All three treatment caused the complete sterilization of eggs, and no bacterial colonies were found on the blood agar culture. The egg hatching rate after 72 h was much higher than after 24 h. Egg mortality in hydrogen peroxide solutions, T1 and T2, was 3–4% and less than in solution T3 (13%). Owing to less mortality and more sterility of the eggs, the aforementioned solutions are suggested to be appropriate for sterility in maggot therapy.
European traditional tomatoes galore: a result of farmers’ selection of a few diversity-rich loci
Authors: Blanca Jose , Pons Clara , Montero-Pau Javier , Sanchez-Matarredona David , Ziarsolo Peio , Fontanet Lilian , Fisher Josef , Plazas Mariola , Casals Joan , Rambla Jose Luis , Riccini Alessandro , Palombieri Samuela , Ruggiero Alessandra , Sulli Maria , Grillo Stephania , Kanellis Angelos , Giuliano Giovanni , Finkers Richard , Cammareri Maria , Grandillo Silvana , Mazzucato Andrea , Causse Mathilde , Díez Maria José , Prohens Jaime , Zamir Dani , Cañizares Joaquin , Monforte Antonio Jose , Granell Antonio
Published: February 2022

A comprehensive collection of 1254 tomato accessions, corresponding to European traditional and modern varieties, early domesticated varieties, and wild relatives, was analyzed by genotyping by sequencing. A continuous genetic gradient between the traditional and modern varieties was observed. European traditional tomatoes displayed very low genetic diversity, with only 298 polymorphic loci (95% threshold) out of 64 943 total variants. European traditional tomatoes could be classified into several genetic groups. Two main clusters consisting of Spanish and Italian accessions showed higher genetic diversity than the remaining varieties, suggesting that these regions might be independent secondary centers of diversity with a different history. Other varieties seem to be the result of a more recent complex pattern of migrations and hybridizations among the European regions. Several polymorphic loci were associated in a genome-wide association study with fruit morphological traits in the European traditional collection. The corresponding alleles were found to contribute to the distinctive phenotypic characteristic of the genetic varietal groups. The few highly polymorphic loci associated with morphological traits in an otherwise a low-diversity population suggests a history of balancing selection, in which tomato farmers likely maintained the morphological variation by inadvertently applying a high selective pressure within different varietal types.
Quantifying the cool ISM in radio AGNs: evidence for late-time retriggering by galaxy mergers and interactions
Authors: Bernhard E , Tadhunter C N , Pierce J C S , Dicken D , Mullaney J R , Morganti R , Ramos Almeida C , Daddi E
Published: February 2022

We use deep Herschel observations of the complete 2Jy sample of powerful radio active galactic nuclei (AGNs) in the local Universe (0.05 < z < 0.7) to probe their cool interstellar medium (ISM) contents and star-forming properties, comparing them against other samples of nearby luminous AGNs and quiescent galaxies. This allows us to investigate triggering and feedback mechanisms. We find that the dust masses of the strong-line radio galaxies (SLRGs) in our sample are similar to those of radio-quiet quasars, and that their median dust mass (Mdust = 2 × 107 M⊙) is enhanced by a factor of ∼200 compared to that of non-AGN ellipticals, but lower by a factor of ∼16 relative to that of local ultraluminous infrared galaxies (ULIRGs). Along with compelling evidence for merger signatures in optical images, the SLRGs in our sample also show relatively high star formation efficiencies, despite the fact that many of them fall below the main sequence for star-forming galaxies. Together, these results suggest that most of our SLRGs have been retriggered by late-time mergers that are relatively minor in terms of their gas contents. In comparison with the SLRGs, the radio AGNs with weak optical emission lines (weak-line radio galaxies – WLRGs) and edge-darkened radio jets (Fanaroff–Riley Class I radio sources – FRIs) have both lower cool ISM masses and star formation rates (by a factor of >30), consistent with being fuelled by a different mechanism (e.g. the direct accretion of hot gas).
Interaction-induced particle-hole symmetry breaking and fractional exclusion statistics
Authors: Zhang Xibo , Chen Yang-Yang , Liu Longxiang , Deng Youjin , Guan Xiwen
Published: February 2022

Quantum statistics plays a fundamental role in the laws of nature. Haldane fractional exclusion statistics (FES) generalizes the Pauli exclusion statistics, and can emerge in the properties of elementary particles and hole excitations of a quantum system consisting of conventional bosons or fermions. FES has a long history of intensive studies, but its simple realization in interacting physical systems is rare. Here we report a simple non-mutual FES that depicts the particle-hole symmetry breaking in interacting Bose gases at a quantum critical point. We show that the FES distribution directly comes from particle-hole symmetry breaking. Based on exact solutions, quantum Monte Carlo simulations and experiments, we find that, over a wide range of interaction strengths, the macroscopic physical properties of these gases are determined by non-interacting quasi-particles that obey non-mutual FES of the same form in one and two dimensions. Whereas strongly interacting Bose gases reach full fermionization in one dimension, they exhibit incomplete fermionization in two dimensions. Our results provide a generic connection between interaction-induced particle-hole symmetry breaking (depicted by FES) and macroscopic properties of many-body systems in arbitrary dimensions. Our work lays the groundwork for using FES to explore quantum criticality and other novel many-body phenomena in strongly correlated quantum systems.
How Not to Analyse Number Sentences
Authors: Schwartzkopff Robert
Published: February 2022

Number and Count Sentences like ‘The number of Martian moons is two’ and ‘Mars has two moons’ give rise to a puzzle. How can they be equivalent if only the truth of Number but not that of Count Sentences requires the existence of numbers? Proponents of Linguistic Deflationism seek to resolve this puzzle by arguing that on their correct linguistic analysis the truth of Number Sentences does not require the existence of numbers. In this paper, I argue that Katharina Felka’s recent attempt to vindicate this strategy by analysing Number Sentences as so-called specificational sentences is philosophically dissatisfying and sketch a promising alternative.
Efficient gene targeting in soybean using Ochrobactrum haywardense-mediated delivery of a marker-free donor template
Authors: Kumar Sandeep , Liu Zhan-Bin , Sanyour-Doyel Nathalie , Lenderts Brian , Worden Andrew , Anand Ajith , Cho Hyeon-Je , Bolar Joy , Harris Charlotte , Huang Lingxia , Xing Aiqiu , Richardson Alexandra
Published: February 2022

Gene targeting (GT) for precise gene insertion or swap into pre-defined genomic location has been a bottleneck for expedited soybean precision breeding. We report a robust selectable marker-free GT system in soybean, one of the most economically important crops. An efficient Oh H1-8 (Ochrobactrum haywardense H1-8)-mediated embryonic axis transformation method was used for the delivery of CRISPR-Cas9 components and donor template to regenerate T0 plants 6–8 weeks after transformation. This approach generated up to 3.4% targeted insertion of the donor sequence into the target locus in T0 plants, with ∼ 90% mutation rate observed at the genomic target site. The GT was demonstrated in two genomic sites using two different donor DNA templates without the need for a selectable marker within the template. High-resolution Southern-by-Sequencing analysis identified T1 plants with precise targeted insertion and without unintended plasmid DNA. Unlike previous low-frequency GT reports in soybean that involved particle bombardment–mediated delivery and extensive selection, the method described here is fast, efficient, reproducible, does not require a selectable marker within the donor DNA, and generates nonchimeric plants with heritable GT.
Rethinking Parkinson Disease: Exploring Gut-Brain Interactions and the Potential Role of Exercise
Authors: Zapanta Kaylie , Schroeder E Todd , Fisher Beth E
Published: February 2022

Although Parkinson disease (PD) has traditionally been considered a disease of the central nervous system, a bidirectional communication system known as the gut-brain axis can influence PD pathogenesis. The dual-hit hypothesis proposed that PD is due to peripheral dysregulations to the gut microbiota, known as dysbiosis. Since then, further investigation has shown that there are multiple pathological sources associated with PD. However, dysbiosis plays a critical role in the disease process. Substantial evidence has identified that cardinal motor symptoms of PD and disease progression are associated with dysbiosis. In other neurodegenerative disorders, dysbiosis has been linked to cognition. Non-PD research has shown that exercise can effectively restore the gut microbiota. Likewise, exercise has become a well-established strategy to improve cognitive and motor function in PD. However, despite the interaction between the gut and brain, and the exercise benefits on gut health, no research to date has considered the effects of exercise on the gut microbiota in PD. Therefore, the purpose of this Perspective is to explore whether exercise benefits observed in PD could partly be due to restorations to the gut microbiota. First, we will review the gut-brain axis and its influence on motor and cognitive function. Next, we will outline evidence regarding exercise-induced restoration of the gut microbiota in non-PD populations. Finally, we will summarize benefits of exercise on motor-cognitive function in PD, proposing that benefits of exercise seen in PD might actually be due to restorations to the gut microbiota. By positing the gut microbiota as a moderator of exercise improvements to motor and cognitive function, we aim to provide a new perspective for physical therapists to prioritize exercise regimens for individuals with PD that can specifically restore the gut microbiota to better improve PD symptoms and prognosis.

Impact

This Perspective raises awareness that dysregulations to the gut microbiota have recently been attributed to PD symptoms and pathology and that exercise can be an effective therapeutic strategy to improve gut health in individuals with PD.

Lay Summary

People with PD have been found to have reduced microbial diversity in their gut, which can play an important role in the progression of the disease. Physical therapists can design therapeutic exercises that might help improve gut health in people with PD.
Imports, Exports, and Earnings Inequality: Measures of Exposure and Estimates of Incidence
Authors: Adão Rodrigo , Carrillo Paul , Costinot Arnaud , Donaldson Dave , Pomeranz Dina
Published: February 2022

The earnings of individuals depend on the demand for the factor services they supply. International trade may therefore affect earnings inequality because either (i) foreign consumers and firms demand domestic factor services in different proportions than domestic consumers and firms do, an export channel; or (ii) domestic consumers and firms change their demand for domestic factor services in response to the availability of foreign goods, an import channel. Building on this idea, we develop new measures of export and import exposure at the individual level and provide estimates of their incidence across the earnings distribution. The key input fed into our empirical analysis is a unique administrative data set from Ecuador that merges firm-to-firm transaction data, employer-employee matched data, owner-firm matched data, and firm-level customs transaction records. We find that export exposure is pro-middle class, import exposure is pro-rich, and in terms of overall incidence, the import channel is the dominant force. As a result, earnings inequality in Ecuador is higher than it would be in the absence of trade.
SEARCH FOR EXPERIMENTAL EVIDENCE OF DOSE-RATE AND WALL SCATTERING EFFECTS IN THE THERMOLUMINESCENCE RESPONSE OF LIF:MG,TI (TLD-100)
Authors: Ginzburg Dimitry , Eliyahu Ilan , Spooner Nigel , Sterenberg Matan , Reshes Galina , Shapiro Alex , Biderman Shlomo , Herman Beny , Assor Yossi , Nemirovsky Dimitry , Oster Leonid , Horowitz Yigal Shalom , Hershkovich David
Published: February 2022

An experimental investigation into the possibility of dose-rate effects and wall scatter in the thermoluminescent response of LiF:Mg,Ti (TLD-100) was carried out. The investigation was motivated by theoretical simulations predicting the possible presence of dose-rate effects coupled with the lack of detailed experimental studies. The dose rate was varied by changing the source to sample distance, by the use of attenuators, sources of 137Cs of various activities, filtration and the construction of identical geometrical irradiators of Teflon and stainless steel. Four levels of dose in the linear dose response region were studied at 10−2 Gy, 1.5 × 10−2 Gy, 0.1 Gy and 0.5 Gy to avoid complications in interpretation due to supralinearity above 1 Gy. At the dose of 1.5 × 10−2 Gy, the dose rate was varied by five orders of magnitude from 4.9 × 10−3 Gy s−1 to 4.9 × 10−8 Gy s−1. At the other levels of dose, a one to two orders of magnitude in dose rate was achieved. Within the measurement uncertainty of 5–10%, no dose-rate effects were observed in any of the experimental measurements and no changes in the shape of the glow curve were observed. The maximum wall scatter effect (Teflon to stainless steel) was measured at ~8% within the experimental uncertainty and well below expectations. The results are encouraging with respect to the accurate and reproducible use of LiF:Mg,Ti under various experimental conditions of irradiation.
Advancing engineering students’ conceptual understanding through puzzle-based learning: a case study with exact differential equations
Authors: Rezvanifard Faezeh , Radmehr Farzad , Rogovchenko Yuriy
Published: February 2022

Current views on the teaching of differential equations (DEs) are shifting towards the use of graphical and numerical methods. Motivated by recent research suggesting that puzzle-based learning (PzBL) can improve the teaching and learning of STEM subjects and by the lack of relevant studies for DEs, we designed two tasks—sophism and paradox—to explore undergraduate engineering students’ conceptual understanding of a classical topic—exact DEs—and to analyse the process of meaning-making during collaborative learning in small groups. One hundred and thirty-five undergraduate engineering students from a public university in Iran participated. In response to recent research signalling the tendency of the students to procedural learning of DEs, we analyse how the students in our study engaged in small group work on puzzle tasks, gaining a more conceptual understanding of exact DEs and acknowledging the efficiency of PzBL in their responses to a questionnaire and in interviews.
Survey for Virus Diversity in Common Bean (Phaseolus vulgaris) Fields and the Detection of a Novel Strain ofCowpea polerovirus 1in Zambia
Authors: Mulenga Rabson M. , Miano Douglas W. , Al Rwahnih Maher , Kaimoyo Evans , Akello Juliet , Nzuve Felister M. , Simulundu Edgar , Alabi Tunrayo , Chikoti Patrick C. , Alabi Olufemi J.
Published: February 2022

The production of common bean (Phaseolus vulgaris L.) is adversely affected by virus-like diseases globally, but little is known about the occurrence, distribution, and diversity of common bean-infecting viruses in Zambia. Consequently, field surveys were conducted during the 2018 season in 128 fields across six provinces of Zambia and 640 common bean leaf tissue samples were collected with (n = 585) or without (n = 55) symptoms. The prevalence of symptomatic fields was 100%, but incidence of symptomatic plants ranged from 32 to 67.5%. Metagenomic analyses of nine composite samples and a single plant sample of interest revealed the occurrence of isolates of Bean common mosaic necrosis virus, Bean common mosaic virus, Cowpea aphid-borne mosaic virus, Peanut mottle virus, Southern bean mosaic virus (SBMV), Cucumber mosaic virus, Phaseolus vulgaris alphaendornavirus 1 (PvEV-1), PvEV-2, Ethiopian tobacco bushy top virus (ETBTV), and a novel strain of Cowpea polerovirus 1 (CPPV1-Pv) of 5,902 nt in length. While CPPV1-Pv was consistently detected in mixed infection with ETBTV and its satellite RNA molecule, based on results of mechanical transmission assays it does not appear to be involved in disease etiology, suggesting that its role may be limited to being a helper virus for the umbravirus. Screening of the survey samples by real-time PCR for the viruses detected by high-throughput sequencing revealed the prevalence of single (65.2% or 417/640) over mixed (1.9% or 12/640) infections in the samples. SBMV was the most frequently detected virus, occurring in ∼29.4% (188/640) of the samples and at a prevalence rate of 58.6% (75/128) across fields. The results showed that diverse virus species are present in Zambian common bean fields and the information will be useful for the management of common bean viral diseases.
A Novel Wheat-Rye 2R (2D) Disomic Substitution Line Pyramids Two Types of Resistance to Powdery Mildew
Authors: Han Guohao , Li Hongwei , Cao Lijun , Liu Shiyu , Yan Hanwen , Wang Jing , Zhou Yilin , An Diaoguo
Published: February 2022

Powdery mildew, caused by Blumeria graminis f. sp. tritici, is a devastating disease of wheat that seriously affects yield and quality worldwide. Because of the extensive growth of wheat cultivars with homogeneous genetic background, exploring novel resistant resources from wheat relatives has become important for increasing the genetic diversity of wheat. Rye (Secale cereale) is a wheat relative possessing abundant resistance genes because of its high variation. Wheat line AL69, resistant to powdery mildew, was developed by crossing, backcrossing, and self-pollination for multiple generations between hexaploid triticale Zhongsi 237 and common wheat cultivar Zimai 17. Through genomic in situ hybridization (GISH) and multicolor fluorescence in situ hybridization (FISH), nondenaturing FISH, multicolor GISH, and selection with specific molecular markers, AL69 was determined to be a wheat-rye 2R (2D) disomic substitution line. Testing with different B. graminis f. sp. tritici isolates and genetic analysis showed that the all-stage resistance (also called seedling resistance) of AL69 was conferred by the cataloged powdery mildew resistance gene Pm4b derived from Zimai 17, and its adult-plant resistance was derived from the alien chromosome 2R of Zhongsi 237, which was found to be different from the previously reported rye-derived Pm genes, including Pm7 on 2RL. In addition, AL69 showed improved spike number per plant, spike length, fertile spikelet number per spike, kernel number per spike, and grain yield per plant compared with its wheat parent Zimai 17. An elite line S251 combining powdery mildew resistance with excellent agronomic performance was selected from the progenies of AL69 and wheat cultivar Jimai 22. Therefore, AL69 has two types of resistance genes to powdery mildew and improved agronomic traits through pyramiding and thus can be used as a promising genetic stock for wheat breeding.
Neck Flexion Strength as a Predictor of Need for Intubation in Guillain–Barre Syndrome
Authors: Arnold Lisa M. , Hehir Michael K. , Tandan Rup , Kolb Noah , Waheed Waqar
Published: February 2022

Objectives:

Respiratory failure in Guillain–Barre syndrome (GBS) is common. Forced vital capacity (FVC) is the gold standard for monitoring respiratory muscle strength in GBS. In some clinical situations, FVC testing could be delayed or unavailable, thus there is a need for accurate, fast, and device-free bedside respiratory evaluation.

Methods:

We examined neck flexion strength in 23 GBS patients as a possible predictor of the need for subsequent intubation and as a predictor of FVC change.

Results:

Intubation was required by 100% of patients with neck flexion strength of Medical Research Council grade ≤3. A correlation between neck flexion strength and FVC could not be determined.

Conclusions:

Significant weakness of neck flexion (Medical Research Council grade ≤3) at the time of admission correlates with poor respiratory status as measured by the need for intubation in patients with GBS.
Satisfaction of Saudi Board Plastic Surgery Residents with the Training Program: A National Survey
Authors: Al Qurashi Abdullah A. , Mortada Hatan , Alrobaiea Saad , Abuthiyab Noorah , Al Zaid Nura , Betar Manar , Malibari Lama , Al Turkistani Talah , Arab Khalid
Published: February 2022

Background:

It is well established in the literature that the satisfaction of trainees correlates with higher productivity and efficiency during training years. The satisfaction rate of Saudi Board of Plastic Surgery trainees has not been investigated since its establishment in 2001. Therefore, we aimed to measure the satisfaction rate of local trainees and detail the predictors of satisfaction.

Methods:

This study was conducted on September 9–13, 2021. The study is a cross-sectional, nation-wide study utilizing a self-structured questionnaire targeting all plastic surgery residents in Saudi Arabia. IRB approval and approval from the governing body of residency programs in Saudi Arabia were obtained.

Results:

The study included 100% of western region residents (N = 9) and 72.7% of central region residents (N = 24), yielding a total of 33 participants with 78.6% response rate. Of all the residents, only 39.4% were satisfied with their training in the Saudi Board of Plastic Surgery program, 45.5% were neutral regarding their opinion, and 15.2% expressed their dissatisfaction with the program. The area most in need of improvement was mentorship (30.3%), followed by the quality of teaching (12.1%) and workplace climate (12.1%), whereas the least was administrative components (6.1%).

Conclusions:

The mild level of dissatisfaction toward the local training in plastic surgery should alarm the governing body in the Saudi Commission for Health Specialties and the program directors to take certain interventions toward the improvement of local training. Considering the areas most in need of improvement is necessary to achieve a suitable training environment for the residents.
Repairing Facial Fractures with Interrupted Maxillary-mandibular Arches by Computer-assisted Reverse Planning Model Surgery
Authors: Chen Chien-Chung , Yang Ching-Hsiang , Chang Yu-Jen , Wu Cheng-Chun , Chang Li-Ren , Lai Jui-Pin
Published: February 2022

Background:

Management of comminuted facial fractures with maxillary-mandibular arch interruption is difficult, resulting in inadequate bone reduction and malocclusion. Traditionally, a good quality dental splint is helpful, but difficult to obtain in acute trauma. We apply a computer-assisted design and three-dimensional printing technology to improve splint fabrication and utilization, thus facilitating restoration of dental occlusion and facial fracture.

Methods:

We retrospectively reviewed patients who suffered from facial fractures with interruption of the maxillary-mandibular arches. We developed the “computer-assisted reverse planning and three-dimensional printing model surgery” algorithm and applied it in selected patients. An occlusal splint was created as a surgical guide to enhance the maxilla-mandibular unit repair by taking care of the bone reduction and occlusion. All included patients were followed up to assess the functional outcome and patients suitable for this method.

Results:

From Jan 2015 to Aug 2020, 10 patients (eight men and two women) with comminuted facial fractures were included. The average time of surgery was 9.2 days. The average follow-up time was 8.6 months. There was no patient who needed major revision to correct malocclusion or facial asymmetry.

Conclusions:

A computer-assisted design splint decreases intraoperative inaccuracies and difficulty in comminuted maxillo-mandibular fractures. It is a useful and reliable alternative. Collaboration with an experienced engineer and patient selection are indispensable in delivering successful outcomes. Patients who have more than three bone fragments in a single dental arch or more than four bone fragments in the entire maxillary-mandibular unit appear to be excellent candidates for this method.
INNER AND OUTER CHOROIDAL CHANGES IN THE FELLOW EYE OF PATIENTS WITH UNILATERAL CENTRAL SEROUS CHORIORETINOPATHY
Authors: Borrelli Enrico , Battista Marco , Barresi Costanza , Grosso Domenico , Gabela Maria Cristina , Quarta Alberto , Saladino Andrea , Sacconi Riccardo , Querques Lea , Bandello Francesco , Querques Giuseppe
Published: February 2022

Purpose:

To quantitatively evaluate the inner and outer choroidal changes in the fellow eyes of patients with unilateral central serous chorioretinopathy (CSC).

Methods:

We analyzed data from patients with a diagnosis of unilateral CSC who had structural optical coherence tomography (OCT) and swept-source OCT angiography obtained. An additional group of age-matched healthy patients was included for comparison. The main outcome measures were: (1) choriocapillaris flow deficits' quantitative metrics; (2) choroidal luminal (LCA) and stromal (SCA) areas; and (3) choroidal vascularity index.

Results:

Fellow unaffected eyes from 60 patients with unilateral CSC and 30 healthy subjects were included in the analysis. Mean ± SD age was 47.5 ± 9.9 years in the unilateral CSC group and 50.7 ± 10.8 years in the control group (P = 0.410). In the structural OCT assessment, both the LCA and SCA were increased in the unilateral CSC group (0.33 ± 0.11 and 0.29 ± 0.10 mm2) compared with healthy controls (0.28 ± 0.08 and 0.27 ± 0.05 mm2), although only differences in LCA reached a statistical significance (P = 0.041 and P = 0.286 for LCA and SCA, respectively). The choroidal vascularity index was higher in CSC patients (53.7 ± 3.6 and 50.9 ± 5.5%, P = 0.045). In the OCT angiography evaluation, the choriocapillaris flow deficits' percentage and number were increased in those patients affected by unilateral CSC. In multiple regressions, the strongest association with choriocapillaris percentage of flow deficits was with the presence of pachychoroid pigment epitheliopathy signs in the study eye (P < 0.0001).

Conclusion:

Our results corroborate the hypothesis that inner and outer choroidal changes affect both eyes of patients with unilateral disease.
MACULAR NEUROVASCULAR ABNORMALITIES IN A CHILD WITH INCONTINENTIA PIGMENTI ON HANDHELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Patel Pujan R. , Tai Vincent , Imperio Ryan , Viehland Christian , Izatt Joseph A. , Toth Cynthia A. , Chen Xi
Published: February 2022

Purpose:

To report macular neurovascular abnormalities in a child with incontinentia pigmenti using handheld optical coherence tomography (OCT) and OCT angiography (OCT-A).

Methods:

An eye of a child with incontinentia pigmenti enrolled in BabySTEPS was imaged using an investigational noncontact, handheld swept-source OCT device during examination under anesthesia. Custom MATLAB scripts were used to generate depth-resolved vascular slabs, B-scans with flow overlay, and retinal thickness maps.

Results:

Depth-resolved OCT and OCT-A imaging demonstrated focal areas of decreased capillary flow that corresponded to areas of both inner retinal and outer retinal thinning on retinal thickness maps. Atypical diving of superficial retinal vessels occurred as they traversed from thin retina to normal-thickness retina.

Conclusion:

Depth-resolved OCT and OCT-A identified retinal vascular abnormalities that were not evident on fundus photography or fluorescein angiography. This case depicted concurrent, localized abnormalities in retinal thickness and microvasculature in an eye with incontinentia pigmenti.
NOVEL RETINAL IMAGING ABNORMALITIES IN ALPORT SYNDROME
Authors: Jadon Trishla , Sadda Srinivas , Singh Geetika , Narayan Parvathy , Chhablani Jay , Venkatesh Pradeep
Published: February 2022

Purpose:

The purpose of this study was to report a novel observation during retinal screening of a child with Alport syndrome.

Methods:

This was a review of case record and imaging files.

Results:

Clinical examination of the retina and standard color fundus photography revealed no abnormality. However, distinct and identical wrinkling of the temporal macula (fingerprint sign) in both eyes was noted on Optos pseudocolor images of the retina. On optical coherence tomography, there were corresponding “saw-tooth” corrugations in the middle layers of the retina. En face images further highlighted the characteristic nature of this unusual observation.

Conclusion:

Fingerprint sign in the retina, a heretofore undescribed feature, is reported in a child with biopsy confirmed Alport syndrome.
The Effect of COVID-19 on Corneal Donor Volumes and Eye Bank Processes: An Analysis From the Eye Bank of Canada (Ontario Division)
Authors: AlShaker Sara M. , Humphreys Christine , Smigielski Natalie , Chan Clara C.
Published: February 2022

Purpose:

With the rise in COVID-19 cases, the Eye Bank of Canada (Ontario Division), the largest eye bank in Canada, was faced with challenges related to ocular donor suitability which resulted in tissue shortages after the first wave of COVID-19 cases in Ontario, Canada. This article aims to analyze the impact of COVID-19 on ocular tissue donation and transplant surgeries.

Methods:

Trends in ocular donations in 2020 and the transplant rates were compared with the data from the previous year, as a benchmark of normal eye bank activity.

Results:

Ocular donor volumes decreased during the first wave of the COVID-19 pandemic (March–June 2020) by 65% as compared to the same period in 2019. By the end of the year 2020, this had resulted in a total reduction of 29% of ocular donor volumes as compared to 2019. The ocular transplant surgery volumes in the year 2020 decreased by 32% compared to the previous year, mostly secondary to elective surgery shutdown during the first wave. Because of tissue shortages, the Eye Bank of Canada (Ontario Division) had to import 24 corneas from the United States and cancel 7 surgeries in the year 2020.

Conclusions:

The decline in ocular tissue donor volumes and transplant surgery was a result of an interplay of causes related to the COVID-19 pandemic. Most importantly, ruling out of COVID-19 carriers, lockdown measures affecting tissue retrieval processes, and shutdown of elective surgery were the 3 major factors accounting for tissue shortages and surgical volume reductions.
Establishing a Biomarker for the Prediction of Short-Term Graft Detachment After Descemet Membrane Endothelial Keratoplasty
Authors: Muijzer Marc B. , Noordmans Herke-Jan , Delbeke Heleen , Dickman Mor M. , Nuijts Rudy M. M. A. , Dunker Suryan , Imhof Saskia M. , Wisse Robert P. L.
Published: February 2022

Purpose:

The purpose of this study was to investigate the predictive value of pachymetry mapping 1 day after Descemet membrane endothelial keratoplasty (DMEK) as a biomarker for early graft detachment.

Methods:

This was a post hoc analysis of 65 pseudophakic subjects with Fuchs endothelial dystrophy who underwent DMEK surgery between December 2018 and April 2021 as part of the Advanced Visualization In Corneal Surgery Evaluation international multicenter randomized controlled trial. One eye per patient was included. Preoperatively and 1 day postoperatively, patients underwent anterior segment optical coherence tomography imaging. Using a grid consisting of 25 zones (ie, pachymetry map), corneal thickness and presence of a graft detachment were mapped for each patient. Detachments of any size were considered, regardless of subsequent clinical interventions. Missing data were imputed and subsequently divided into a training and test set. Two prediction methods were evaluated: one model based on absolute corneal thickness and a regression model.

Results:

A total of 65 eyes were included for analysis of which 33 developed any form of graft detachment. Preoperatively, no significant differences were observed between the groups (P = 0.221). Corneal thickness in the corneal zones with a detached graft was significantly increased compared with corneal zones with an attached graft (P < 0.001). The regression prediction model had an area under the curve of 0.87 (sensitivity: 0.79 and specificity: 0.75), whereas the absolute thickness cutoff model only reached 0.65.

Conclusions:

Pachymetry mapping 1 day after DMEK was predictive for early graft detachment, and the prediction model had a good to excellent performance. This aids in identifying patients at risk for graft detachment and subsequent tailored postoperative care.
Hypothermic machine perfusion for liver graft preservation
Authors: Amin Arpit , Panayotova Guergana , Guarrera James V.
Published: February 2022

Purpose of review

Ex-vivo machine perfusion has emerged as a promising alternative to static cold storage (SCS) for preservation of liver grafts over the last decade. This review describes the mechanistic benefits associated with hypothermic machine perfusion (HMP) for preservation of liver grafts and highlights clinical outcomes of liver transplantation using HMP technology.

Recent findings

Over the last decade, several single-centre studies have shown decreased biliary complications, decreased early allograft dysfunction (EAD) rates and improved patient survival in liver transplant recipients after application of HMP for liver graft preservation. This has led to initiation of prospective, multicentre, randomized controlled trials (RCTs) in both Europe and North America focused on clinical outcomes in liver transplant recipients using HMP-preserved liver grafts. In addition, recent single-centre studies have shown the utility of perfusate biomarker analysis during HMP in predicting EAD after liver transplantation.

HMP technology has potential to increase the available donor liver organ pool for liver transplant recipients and improve clinical outcomes after liver transplantation. Broader clinical application of HMP in resuscitation and preservation of liver grafts is anticipated over the next decade once regulatory, logistical and financial challenges are overcome.
Cystic fibrosis: candidate selection and impact of the cystic fibrosis transmembrane conductance regulator therapy
Authors: Lehr Carli J. , Pilewski Joseph M.
Published: February 2022

Purpose of review

Over the past decade, the development of highly effective cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators has dramatically ameliorated the manifestations of CF for most patients. Perhaps most importantly, CFTR modulators impact the development and progression of advanced lung disease (ALD) and are changing the CF population accessing lung transplant.

Recent findings

A recent phase 3 trial of elexacaftor/tezacaftor/ivacaftor (ETI) demonstrated efficacy for individuals with at least one copy of the most common CF mutation, F508del. Studies of CFTR modulator therapy in patients with ALD have demonstrated similar improvements in lung function, nutrition, and pulmonary exacerbation frequency as seen in individuals with higher lung function. Due to improvements with ETI, rates of lung transplant for CF have declined and individuals are achieving stability in lung function. Nevertheless, the Cystic Fibrosis Foundation guidelines for lung transplant referral should be used to guide referral decisions for all individuals with CF, including those on CFTR modulator therapy, to allow remediation of modifiable barriers to transplant. ETI may be used in the posttransplant setting but for selected individuals and with close monitoring.

Increasing access to highly effective CFTR modulators has changed the trajectory of lung disease in CF for many, but not all, individuals and there remain individuals who cannot access therapy or whose mutations do not respond to modulators. Lung transplant remains an important treatment option for individuals with advanced CF lung disease. Increasing attention will be required to optimize decisions of when to list for transplant.
Comparison of the Lipidomic Signature of Fatty Liver in Children and Adults
Authors: Mann Jake P. , Jenkins Benjamin , Furse Samuel , Snowden Stuart G. , Alisi Anna , Draijer Laura G. , Karnebeek Kylie , Kelly Deirdre A. , Koot Bart G. , Mosca Antonella , Salvestrini Camilla , van Mourik Indra , Vreugdenhil Anita , Zilbauer Matthias , Koulman Albert ,   EU‐PNAFLD investigators^
Published: February 2022

Objective:

Non‐alcoholic fatty liver disease (NAFLD) is an increasingly common condition in children characterised by insulin resistance and altered lipid metabolism. Affected patients are at increased risk of cardiovascular disease (CVD) and children with NAFLD are likely to be at risk of premature cardiac events. Evaluation of the plasma lipid profile of children with NAFLD offers the opportunity to investigate these perturbations and understand how closely they mimic the changes seen in adults with cardiometabolic disease.

Methods:

We performed untargeted liquid chromatography—mass spectrometry (LC–MS) plasma lipidomics on 287 children: 19 lean controls, 146 from an obese cohort, and 122 NAFLD cases who had undergone liver biopsy. Associations between lipid species and liver histology were assessed using regression adjusted for age and sex. Results were then replicated using data from 9500 adults with metabolic phenotyping.

Results:

More severe paediatric NAFLD was associated with lower levels of long chain, polyunsaturated phosphatidylcholines (pC) and triglycerides (TG). Similar trends in pC and TG chain length and saturation were seen in adults with hepatic steatosis; however, many of the specific lipids associated with NAFLD differed between children and adults. Five lipids replicated in adults (including PC(36:4)) have been directly linked to death and cardiometabolic disease, as well as indirectly via genetic variants.

Conclusion:

These findings suggest that, whilst similar pathways of lipid metabolism are perturbed in paediatric NAFLD as in cardiometabolic disease in adults, the specific lipid signature in children is different.
C-Reactive Protein and the Outcome of a Pediatric Emergency Department 7 Days Revisit
Authors: Glatstein Miguel , Salamon Lotan , Soffer Gili Palnizky , Capua Tali , Scolnik Dennis , Rimon Ayelet
Published: February 2022

Background

Pediatric emergency department (PED) return visits represent an important quality of care metric and constitute a patient-centered outcome. C-reactive protein (CRP) is an inflammatory biomarker that is commonly used as screening tool in the PED. In this study, we assessed the clinical outcomes of children whose levels of CRP are 150 mg/L or higher at the initial PED visit and if such levels could be useful in predicting outcomes at a second PED visit.

Methods

A historical cohort study of all patients who visited the PED between July 2007 and June 2017 and had a CRP value of 150 mg/L or greater in the setting of a febrile illness. Data of patients with a return visit to the PED within 7 days were assessed for an association between laboratory values, diagnosis and clinical outcome.

Results

One hundred thirty-six index visits were included in this study. One hundred fifteen (84.6%) of the revisits were discharged after their second visit, and 21 (15.4%) were admitted to the inpatient unit. Admitted patients did not differ from patients who were discharged home in diagnosis and CRP levels, but a difference in white blood cell and absolute neutrophil counts was observed.

Conclusions

The intensity of the inflammatory response, as expressed by the high concentrations of CRP in children, does not seem to predict the outcome at a repeat PED visit within 7 days.