bluuebunny/crossref_metadata_2025 huggingface dataset:
SpeciesRax: A Tool for Maximum Likelihood Species Tree Inference from Gene Family Trees under Duplication, Transfer, and Loss
Authors: Morel Benoit , Schade Paul , Lutteropp Sarah , Williams Tom A , Szöllősi Gergely J , Stamatakis Alexandros
Published: December 2021

Species tree inference from gene family trees is becoming increasingly popular because it can account for discordance between the species tree and the corresponding gene family trees. In particular, methods that can account for multiple-copy gene families exhibit potential to leverage paralogy as informative signal. At present, there does not exist any widely adopted inference method for this purpose. Here, we present SpeciesRax, the first maximum likelihood method that can infer a rooted species tree from a set of gene family trees and can account for gene duplication, loss, and transfer events. By explicitly modeling events by which gene trees can depart from the species tree, SpeciesRax leverages the phylogenetic rooting signal in gene trees. SpeciesRax infers species tree branch lengths in units of expected substitutions per site and branch support values via paralogy-aware quartets extracted from the gene family trees. Using both empirical and simulated data sets we show that SpeciesRax is at least as accurate as the best competing methods while being one order of magnitude faster on large data sets at the same time. We used SpeciesRax to infer a biologically plausible rooted phylogeny of the vertebrates comprising 188 species from 31,612 gene families in 1 h using 40 cores. SpeciesRax is available under GNU GPL at https://github.com/BenoitMorel/GeneRax and on BioConda.
Characterization of the SARS-CoV-2 ExoN (nsp14ExoN–nsp10) complex: implications for its role in viral genome stability and inhibitor identification
Authors: Baddock Hannah T , Brolih Sanja , Yosaatmadja Yuliana , Ratnaweera Malitha , Bielinski Marcin , Swift Lonnie P , Cruz-Migoni Abimael , Fan Haitian , Keown Jeremy R , Walker Alexander P , Morris Garrett M , Grimes Jonathan M , Fodor Ervin , Schofield Christopher J , Gileadi Opher , McHugh Peter J
Published: December 2021

The SARS-CoV-2 coronavirus is the causal agent of the current global pandemic. SARS-CoV-2 belongs to an order, Nidovirales, with very large RNA genomes. It is proposed that the fidelity of coronavirus (CoV) genome replication is aided by an RNA nuclease complex, comprising the non-structural proteins 14 and 10 (nsp14–nsp10), an attractive target for antiviral inhibition. Our results validate reports that the SARS-CoV-2 nsp14–nsp10 complex has RNase activity. Detailed functional characterization reveals nsp14–nsp10 is a versatile nuclease capable of digesting a wide variety of RNA structures, including those with a blocked 3′-terminus. Consistent with a role in maintaining viral genome integrity during replication, we find that nsp14–nsp10 activity is enhanced by the viral RNA-dependent RNA polymerase complex (RdRp) consisting of nsp12–nsp7–nsp8 (nsp12–7–8) and demonstrate that this stimulation is mediated by nsp8. We propose that the role of nsp14–nsp10 in maintaining replication fidelity goes beyond classical proofreading by purging the nascent replicating RNA strand of a range of potentially replication-terminating aberrations. Using our developed assays, we identify drug and drug-like molecules that inhibit nsp14–nsp10, including the known SARS-CoV-2 major protease (Mpro) inhibitor ebselen and the HIV integrase inhibitor raltegravir, revealing the potential for multifunctional inhibitors in COVID-19 treatment.
Prospective biomarker study in newly diagnosed glioblastoma: Cyto-C clinical trial
Authors: Griguer Corinne E , Oliva Claudia R , Coffey Christopher S , Cudkowicz Merit E , Conwit Robin A , Gudjonsdottir Anna L , Ecklund Dixie J , Fedler Janel K , Neill-Hudson Tina M , Nabors Louis B , Benge Melanie , Hackney James R , Chase Marianne , Leonard Timothy P , Patel Toral , Colman Howard , de la Fuente Macarena , Chaudhary Rekha , Marder Karen , Kreisl Teri , Mohile Nimish , Chheda Milan G , McNeill Katharine , Kumthekar Priya , Dogan Aclan , Drappatz Jan , Puduvalli Vinay , Kowalska Agnes , Graber Jerome , Gerstner Elizabeth , Clark Stephen , Salacz Michael , Markert James
Published: December 2021

Background

Glioblastoma (GBM) has a 5-year survival rate of 3%-5%. GBM treatment includes maximal resection followed by radiotherapy with concomitant and adjuvant temozolomide (TMZ). Cytochrome C oxidase (CcO) is a mitochondrial enzyme involved in the mechanism of resistance to TMZ. In a prior retrospective trial, CcO activity in GBMs inversely correlated with clinical outcome. The current Cyto-C study was designed to prospectively evaluate and validate the prognostic value of tumor CcO activity in patients with newly diagnosed primary GBM, and compared to the known prognostic value of MGMT promoter methylation status.

Methods

This multi-institutional, blinded, prospective biomarker study enrolled 152 patients with newly diagnosed GBM who were to undergo surgical resection and would be candidates for standard of care. The primary end point was overall survival (OS) time, and the secondary end point was progression-free survival (PFS) time. Tumor CcO activity and MGMT promoter methylation status were assayed in a centralized laboratory.

Results

OS and PFS did not differ by high or low tumor CcO activity, and the prognostic validity of MGMT promoter methylation was confirmed. Notably, a planned exploratory analysis suggested that the combination of low CcO activity and MGMT promoter methylation in tumors may be predictive of long-term survival.

Conclusions

Tumor CcO activity alone was not confirmed as a prognostic marker in GBM patients. However, the combination of low CcO activity and methylated MGMT promoter may reveal a subgroup of GBM patients with improved long-term survival that warrants further evaluation. Our work also demonstrates the importance of performing large, multi-institutional, prospective studies to validate biomarkers. We also discuss lessons learned in assembling such studies.
Unambiguous evidence of brilliant iridescent feather color from hollow melanosomes in an Early Cretaceous bird
Authors: Pan Yanhong , Li Zhiheng , Wang Min , Zhao Tao , Wang Xiaoli , Zheng Xiaoting
Published: December 2021

A unique form of melanosomes contributing to brilliant iridescent colors in modern bird feathers, previously unknown in fossil birds, is identified in the Early Cretaceous bird Eoconfuciusornis. The discovery highlights the complexity of plumage color nanostructures utilized early in bird evolution as far back as 130 million years ago.
Long working hours, depression and suicidality among OB/GYNs in Japan
Authors: Ishikawa M
Published: December 2021

Background

There is abundant evidence linking long working hours among physicians with adverse health effects; however, most studies have focused on medical residents. In Japan, obstetrician/gynaecologists (OB/GYNs) work the longest hours, yet no studies have investigated potential relationships between excessive overtime and depression and suicidal ideation within this population.

Aims

To investigate the relationship between long working hours and depression and suicidal ideation among OB/GYNs in Japan.

Methods

We administered a survey questionnaire to OB/GYNs and received 919 valid responses. Multivariate logistic regression was performed with depression and suicidal ideation as the outcome variables and number of working hours per week, gender, age, marital status, hospital type and geographical area type as the explanatory variables.

Results

Sixteen per cent of the participants were depressed, and 3% reported suicidal ideation. Working 100 or more hours per week increased the odds for both depression and suicidal ideation [odds ratio (OR): 2.08 (95% confidence interval {CI}: 1.07–4.05, P = 0.03); and OR: 7.03 (95% CI: 1.95–25.38, P < 0.001), respectively].

Conclusions

The results suggest that the Japanese Government should vigorously promote physicians’ work-style reform, so that a lowered upper limit of overtime hours will be enforced from 2024 to improve physicians’ health and patients’ safety.
Depression prevention in healthcare workers during the COVID-19 pandemic
Authors: Takada H , Ae R , Ogawa M , Kagomoto T
Published: December 2021

Background

Few studies have assessed depression in healthcare workers (HCWs) in Japan owing to the coronavirus disease 2019 (COVID-19) pandemic, and no studies have proposed effective interventions to help support their mental health.

Aims

To test the hypothesis that enhancing access to mental healthcare professionals helps to improve HCWs’ mental health.

Methods

This cross-sectional study assessed depressive symptoms in HCWs at three hospitals in Osaka prefecture between May and July, 2020. The survey obtained information on HCWs’ mental state and related situations/perceptions. Multivariable logistic regression analysis was performed to identify factors associated with depressive symptoms.

Results

Of the 3291 eligible HCWs, 1269 (39%) completed the survey. Of all HCWs, 87 (7%) were physicians, and 700 (55%) were nurses. A total of 181 (14%) HCWs had moderate-to-severe symptoms of depression. Being a frontline worker was not significantly associated with depressive symptoms (odds ratio: 0.86 [95% confidence intervals: 0.54–1.37], P = 0.50). The unwillingness to consult with anyone was significantly associated with more severe depressive symptoms (1.70 [1.10–2.63], P < 0.01). HCWs who had no opportunity to confide in family/friends (1.66 [1.10–2.52], P < 0.01) or colleagues/supervisors (3.19 [2.22–4.58], P < 0.001) were significantly more likely to have depressive symptoms.

Conclusions

Being a frontline HCW in a Japanese hospital treating patients with COVID-19 was not significantly associated with having depressive symptoms. The study highlights that encouraging daily communication with close persons (family, friends, colleagues and supervisors), rather than improving access to mental health professionals, might help to prevent depression in HCWs during the COVID-19 pandemic.
Multicenter Cohort Study of Ceftaroline Versus Daptomycin for Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection
Authors: Zasowski Evan J , Trinh Trang D , Claeys Kimberly C , Lagnf Abdalhamid M , Bhatia Sahil , Klinker Kenneth P , Veve Michael P , Estrada Sandy J , Johns Scott T , Sawyer Adam J , Huang Vanthida , LaFrance Brandi , Levine Donald P , Kaye Keith S , Davis Susan L , Rybak Michael J
Published: December 2021

Background

Observational data suggest ceftaroline may be effective for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI), but comparative data with standard of care are limited. This analysis compares the outcomes of MRSA BSI treated with ceftaroline or daptomycin.

Methods

Multicenter, retrospective, observational cohort study of adult patients with MRSA BSI from 2010 to 2017. Patients treated with ≥72 hours of ceftaroline or daptomycin were included. Those clearing BSI before study drug and those with a pneumonia source were excluded. The primary outcome was composite treatment failure, defined as 30-day mortality, BSI duration ≥7 days on study drug, and 60-day MRSA BSI recurrence. Inverse probability of treatment weighted risk difference in composite failure between daptomycin and ceftaroline groups was computed and 15% noninferiority margin applied.

Results

Two hundred seventy patients were included; 83 ceftaroline and 187 daptomycin. Ceftaroline was noninferior to daptomycin with respect to composite failure (39% daptomycin, 32.5% ceftaroline; weighted risk difference, 7.0% [95% confidence interval, –5.0% to 19.0%]). No differences between treatment groups was observed for 30-day mortality or other secondary efficacy outcomes. Creatine phosphokinase elevation was significantly more common among daptomycin patients (5.3% vs 0%, P = .034). Rash was significantly more common among ceftaroline patients (10.8 vs 1.1%, P = .001).

Conclusions

No difference in treatment failure or mortality was observed between MRSA BSI treated with ceftaroline or daptomycin. These data support future study of ceftaroline as a primary MRSA BSI treatment and current use of ceftaroline when an alternative to vancomycin and daptomycin is required.
Fosfomycin vs Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study
Authors: Wald-Dickler Noah , Lee Todd C , Tangpraphaphorn Soodtida , Butler-Wu Susan M , Wang Nina , Degener Tyler , Kan Carolyn , Phillips Matthew C , Cho Edward , Canamar Catherine , Holtom Paul , Spellberg Brad
Published: December 2021

Background

We sought to determine the comparative efficacy of fosfomycin vs ertapenem for outpatient treatment of complicated urinary tract infections (cUTIs).

Methods

We conducted a multicenter, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs intravenous ertapenem at 3 public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis.

Results

We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. The study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase–producing E. coli and Klebsiella pneumoniae, 80%–90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow-up, and relapse were 1.21 (95% CI, 0.68–2.16), 0.84 (95% CI, 0.46–1.52), and 0.94 (95% CI, 0.52–1.70) for fosfomycin vs ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy and fewer adverse events (1 vs 10). Fosfomycin outcomes were similar irrespective of duration of lead-in intravenous (IV) therapy or fosfomycin dosing interval (daily, every other day, every third day).

Conclusions

These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest that fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.
Association Between Foot Surgery Type and Subsequent Healing in Veterans With Moderate-to-Severe Diabetic Foot Infections
Authors: Kim Justin J , Littman Alyson J , Sorkin John D , Roghmann Mary-Claire
Published: December 2021

Background

Diabetic foot infections are a common precursor to lower extremity amputations. The treatment of diabetic foot infections involves both medical and surgical management, of which limb-sparing surgeries are increasingly preferred over amputations at or above the ankle to preserve mobility and quality of life. The outcomes following these limb-sparing surgeries are not well described.

Methods

This was a single-center, retrospective cohort study of 90 Veterans with moderate-to-severe diabetic foot infections between 2017 and 2019 from the Veterans Affairs Maryland Health Care System. The exposure was foot surgery with bone resection (ie, toe amputation, metatarsal resection, transmetatarsal amputation) vs debridement alone. The outcome was healing within 1 year. We used log-binomial regression to assess the association between foot surgery type and healing, stratify by infection location, and evaluate potential confounding variables.

Results

The cumulative incidence of healing after foot surgery with bone resection was greater than that following debridement (risk ratio [RR], 1.80 [95% confidence interval {CI}, 1.17–2.77]). This association was modified by infection location and greater for toe infections (RR, 4.52 [95% CI, 1.30–15.7]) than other foot infections (RR, 1.19 [95% CI, .69–2.02]). We found no evidence of confounding by comorbidities or infection severity.

Conclusions

For patients with toe infections, foot surgery with bone resection was associated with better healing than debridement alone. The multiple specialties caring for patients with diabetic foot infections need a stronger common knowledge base—from studies like this and future studies—to better counsel patients about their treatment and prognosis.
A dominant mutation in β-AMYLASE1 disrupts nighttime control of starch degradation in Arabidopsis leaves
Authors: Feike Doreen , Pike Marilyn , Gurrieri Libero , Graf Alexander , Smith Alison M
Published: December 2021

Arabidopsis (Arabidopsis thaliana) leaves possess a mechanism that couples the rate of nighttime starch degradation to the anticipated time of dawn, thus preventing premature exhaustion of starch and nighttime starvation. To shed light on the mechanism, we screened a mutagenized population of a starvation reporter line and isolated a mutant that starved prior to dawn. The mutant had accelerated starch degradation, and the rate was not adjusted to time of dawn. The mutation responsible led to a single amino acid change (S132N) in the starch degradation enzyme BETA-AMYLASE1 (BAM1; mutant allele named bam1-2D), resulting in a dominant, gain-of-function phenotype. Complete loss of BAM1 (in bam1-1) did not affect rates of starch degradation, while expression of BAM1(S132N) in bam1-1 recapitulated the accelerated starch degradation phenotype of bam1-2D. In vitro analysis of recombinant BAM1 and BAM1(S132N) proteins revealed no differences in kinetic or stability properties, but in leaf extracts, BAM1(S132N) apparently had a higher affinity than BAM1 for an established binding partner required for normal rates of starch degradation, LIKE SEX FOUR1 (LSF1). Genetic approaches showed that BAM1(S132N) itself is likely responsible for accelerated starch degradation in bam1-2D and that this activity requires LSF1. Analysis of plants expressing BAM1 with alanine or aspartate rather than serine at position 132 indicated that the gain-of-function phenotype is not related to phosphorylation status at this position. Our results strengthen the view that control of starch degradation in wild-type plants involves dynamic physical interactions of degradative enzymes and related proteins with a central role for complexes containing LSF1.
Coordinated Capacity Reductions and Public Communication in the Airline Industry
Authors: Aryal Gaurab , Ciliberto Federico , Leyden Benjamin T
Published: December 2021

We investigate the allegation that legacy US airlines communicated via earnings calls to coordinate with other legacy airlines in offering fewer seats on competitive routes. To this end, we first use text analytics to build a novel dataset on communication among airlines about their capacity choices. Estimates from our preferred specification show that the number of offered seats is 2$\%$ lower when all legacy airlines in a market discuss the concept of “capacity discipline.” We verify that this reduction materializes only when legacy airlines communicate concurrently, and that it cannot be explained by other possibilities, including that airlines are simply announcing to investors their unilateral plans to reduce capacity, and then following through on those announcements.
Obinutuzumab as treatment for ANCA-associated vasculitis
Authors: Amudala Naomi A , Boukhlal Sara , Sheridan Brittany , Langford Carol A , Geara Abdallah , Merkel Peter A , Cornec Divi
Published: December 2021

Objectives

Rituximab is a standard of care therapy for patients with ANCA-associated vasculitis. When rituximab is contraindicated, or in the case of refractory disease, other treatments are needed. Obinutuzumab is another anti-CD20 antibody for the treatment of haematological malignancies that may induce a deeper B cell depletion compared with rituximab. This article reviews three cases of patients with ANCA-associated vasculitis who were treated with obinutuzumab due to their history of anaphylactic reactions to rituximab.

Methods

Case series of three patients with ANCA-associated vasculitis treated with obinutuzumab.

Results

One female patient with microscopic polyangiitis and two male patients with granulomatosis with polyangiitis received obinutuzumab. The treatment was well-tolerated in all patients despite previous anaphylactic reaction to rituximab. Treatment with obinutuzumab was effective in (i) inducing disease remission, (ii) inducing total B cell depletion, and (iii) resulting in undetectable serum titres of ANCA. All three patients were re-treated with obinutuzumab for maintenance of remission.

Conclusion

Obinutuzumab appears to be a safe and efficacious therapy for patients with ANCA-associated vasculitis who have had refractory disease or a history of anaphylaxis to rituximab. Prospective studies comparing rituximab to obinutuzumab in ANCA-associated vasculitis patients are warranted.
Factors Associated with Healing Outcomes in Primary Care Patients with Diabetic Foot Ulcers: A Retrospective Study in a Multiethnic Sample
Authors: Zhu Xiaoli , Olsson Maja M. , Bajpai Ram , Lim Voon Hooi , Goh Ling Jia
Published: December 2021

OBJECTIVE

To identify and determine patient- and ulcer-related factors associated with healing outcomes within 3 months for patients with diabetic foot ulcer (DFU) in a multiethnic primary care sample.

METHODS

Retrospective data were collected over 3 months from 520 primary care patients with a DFU between April 1, 2016 and March 31, 2017. Multivariable prevalence ratios (PRs) were calculated using Poisson regression to find associations between patient- and ulcer-related factors and healing outcomes.

RESULTS

Most patients were male (66%) and Chinese (49.8%) and had a diabetes mellitus duration longer than 5 years (81.8%). Toe ulcers (64%) were most common. Healing occurred for 33.9% of participants; 19.1% and 1.5% underwent minor and major amputation, respectively. Wound sizes between 1 and 10 cm2 (PR, 0.61; 95% confidence interval [CI], 0.46–0.76; P < .001) and over 10 cm2 (PR, 0.55; 95% CI, 0.33–0.76; P = .003), ulcer duration 6 months or longer (PR, 0.36; 95% CI, 0.19–0.53; P < .001), ischemic ulcers (PR, 0.54; 95% CI, 0.22–0.86; P = .044), and neuroischemic ulcers (PR, 0.73; 95% CI, 0.53–0.93; P = .027) were negatively associated with healing outcomes. Women were more likely to experience healing (PR, 1.18; 95% CI, 0.91–1.45; P = .157).

CONCLUSIONS

Ulcer healing varied by sex and was affected by wound size, wound duration, and ischemic etiology, regardless of ethnicity. Prompt attention to these risk factors may reduce healing time. Further studies are warranted to elucidate the mechanism underlying sex differences in association with DFU healing.
Reducing Hospital-Acquired Pressure Injuries through Measure-vention
Authors: Wyatt Rachel
Published: December 2021

Evidence has shown that Braden subscale scores are independent predictors of the development of pressure injuries. However, current practice is to implement preventive measures for pressure injuries based on the total Braden Scale score. Applying evidence from the literature on Braden subscales and using “Measure-vention,” a quality improvement project using Braden subscales, was implemented in a 30-bed ICU in a Northern California level II trauma acute care hospital. The pilot study's purpose was to test whether tailoring interventions specific to the patient’s subscale risk would decrease the incidence of hospital-acquired pressure injuries (HAPIs). A 6-month pilot was launched for all patients in the ICU, regardless of Braden total score. Frontline staff collected data in real time, measuring adherence to the “Interventions by Braden Subscale” protocol, and event reports were aggregated to measure the incidence of HAPIs before and after the pilot. At the end of the pilot, the ICU noted a decrease in HAPIs by 63.5%. The results demonstrated the efficacy of using the Braden subscales to guide preventive HAPI care, preventing both HAPIs and the overutilization of resources.
Pediatric Fluoroscopic Follies: A Journey Through the GI Tract With Twists and Turns
Authors: Rich Natalie , Sharma Priya G.
Published: December 2021

Fluoroscopy is a key imaging modality in the pediatric population and can be used to diagnose emergent conditions in the neonatal period, including malrotation with midgut volvulus, and atresias of the small intestine. This activity is designed to teach radiologists about critical portions of the pediatric upper gastrointestinal fluoroscopic examination and to provide an overview of pediatric upper gastrointestinal fluoroscopy for general practitioners to improve confidence and accuracy with diagnosing common and emergent conditions.
How Clinical Supervisors Conceptualize Procedural Entrustment: An Interview-Based Study of Entrustment Decision Making in Endoscopic Training
Authors: Jeyalingam Thurarshen , Brydges Ryan , Ginsburg Shiphra , McCreath Graham A. , Walsh Catharine M.
Published: December 2021

Purpose

Entrustment is central to assessment in competency-based medical education (CBME). To date, little research has addressed how clinical supervisors conceptualize entrustment, including factors they consider in making entrustment decisions. The aim of this study was to characterize supervisors’ decision making related to procedural entrustment, using gastrointestinal endoscopy as a test case.

Method

Using methods from constructivist grounded theory, the authors interviewed 29 endoscopy supervisors in the United States and Canada across multiple specialties (adult and pediatric gastroenterology, surgery, and family medicine). Semistructured interviews, conducted between April and November 2019, focused on how supervisors conceptualize procedural entrustment, how they make entrustment decisions, and what factors they consider. Transcripts were analyzed using constant comparison to generate an explanatory framework and themes.

Results

Three themes were identified from the analysis of interview transcripts: (1) entrustment occurs in varying degrees and fluctuates over time; (2) entrustment decisions can transfer within and across procedural and nonprocedural contexts; (3a) persistent static factors (e.g., supervisor competence, institutional culture, legal considerations) influence entrustment decisions, as do (3b) fluctuating, situated dynamic factors (e.g., trainee skills, patient acuity, time constraints), which tend to change from one training encounter to the next.

Conclusions

In the process of making procedural entrustment decisions, clinical supervisors appear to synthesize multiple dynamic factors against a background of static factors, culminating in a decision of whether to entrust. Entrustment decisions appear to fluctuate over time, and assessors may transfer decisions about specific trainees across settings. Understanding which factors supervisors perceive as influencing their decision making has the potential to inform faculty development, as well as competency committees seeking to aggregate faculty judgments about trainee unsupervised practice. Those leading CBME programs may wish to invest in optimizing the observed static factors, such that these foundational factors are tuned to facilitate trainee learning and achievement of entrustment.
No Recurrence in Primary Invasive Stage 1a and 1b Melanoma and Melanoma in Situ Treated With Serial Disk Staged Excision
Authors: Ahn Grace Sora , Pousti Bobak , Singh Gaurav , Elsensohn Ashley , Jiang Shang I Brian
Published: December 2021

BACKGROUND

Optimal surgical treatment modality for invasive melanoma (IM) and melanoma in situ (MIS) has been debated with proponents for standard wide local excision (WLE), serial disk staged excision, and Mohs micrographic surgery.

OBJECTIVE

The purpose of this study is to identify the recurrence rates and surgical margins of invasive stage 1 melanoma and MIS lesions using serial disk staged excision technique with rush permanent processing and “bread loafing” microscopic analysis.

MATERIALS AND METHODS

Recurrence rates and surgical margins of 63 IM and 207 MIS at the University of California Dermatology Surgery Unit were retrospectively reviewed.

RESULTS

No recurrences were observed with average follow-up of 34 and 36 months for IM and MIS, respectively (range, 10–92 months). Average surgical margins were 19.8 mm (SD 9.7) for IM and 12.1 mm (SD 12.2) for MIS.

CONCLUSION

This SSE technique for the treatment of IM and MIS is comparable in efficacy to other SSE techniques, and it offers physicians a simple and accessible alternative to WLE and MMS.
Early Endothelialization of Ab Interno Stromal Tectonic Patch in the Management of Corneal Perforation Secondary to Bacterial Keratitis
Authors: Roberts Harry W. , Davidson Max , Thaung Caroline , Myerscough James
Published: December 2021

Purpose:

The purpose of this study was to describe a novel surgical technique using an ab interno stromal patch to treat corneal perforation and to present the histological findings of the patch after its removal during definitive mushroom keratoplasty.

Methods:

The endothelium had already been removed with the submerged cornea using backgrounds away (SCUBA) technique.

Results:

The patient was managed successfully with a sutureless ab interno stromal tectonic patch. Two months later, definitive mushroom keratoplasty was performed and the patch was sent for histological examination. Immunohistochemistry revealed a reactive endothelium covering the posterior surface of the graft. Nine months later, her best-corrected visual acuity was 6/9.

Conclusions:

This is the first case to our knowledge demonstrating that stromal tectonic grafts without the endothelium can successfully attach to the host tissue and seal a perforation. The stroma may undergo reendothelialization and begin to restore vision, even before penetrating keratoplasty.
Effects of Carbapenem Restriction on the Prevalence of Carbapenem-Resistant Acinetobacter baumannii Infection in Adult General Wards
Authors: Alotaibi Meshal Saud , Alzayed Mohammed Saud , Alhabeeb Yasser Mohammed , Tawfic Nader Ahmad , Rakha Ehab Badran
Published: December 2021

Background

Recently, there has been a significant increase in the number of nosocomial infections caused by the carbapenem-resistant Acinetobacter baumannii (CRAB) pathogen, subsequently increasing mortality and morbidity. This infection is usually observed in intensive care units. However, in our hospital, we have experienced an increasing number of CRAB infection cases in adult general wards. Carbapenem use is considered a contributing factor. Therefore, we examined the restriction of carbapenem use in adult general wards as a strategy to decrease the prevalence of CRAB infection.

Methods

The study was divided into 2 periods: carbapenem-nonrestricted period and carbapenem-restricted period. During the carbapenem-nonrestricted period, data of CRAB infection cases and carbapenem consumption were collected retrospectively between February 1, 2016, and January 31, 2017. During the carbapenem-restricted period, the same data were collected prospectively from February 1, 2017, to January 31, 2018. The amount of carbapenem consumed was measured as daily defined doses per 1000 patient days.

Results

The numbers of admitted patients during the carbapenem-nonrestricted and carbapenem-restricted periods were 7501 and 8062, respectively. The average amount of carbapenem consumption reduced from 1.35 defined daily doses/1000 to 0.125 defined daily doses/1000 patient days. During the carbapenem-nonrestricted period, 31 CRAB infection cases exhibited isolated CRAB. After the carbapenem-restricted period, only 14 CRAB infection cases were reported (P = 0.005).

Conclusions

Implementing carbapenem restriction can be an effective strategy to decrease the prevalence of CRAB infection, subsequently decreasing mortality. However, the stewardship of other groups of antibiotics, which can be used as alternatives to carbapenems, is important to avoid the emergence of other bacterial strains.
Subcutaneous Dirofilariasis in the United States
Authors: Houston Peter M. , Parks Amanda L.
Published: December 2021

Dirofilariasis is a filarial infection of domestic and sylvatic vertebrates such as canines, felines, raccoons, and bears (the definitive hosts) and is transmitted mostly by mosquitoes (the vector) with the exception being Dirofilaria ursi that is transmitted by the black fly. At least 60 cases of subcutaneous dirofilariasis in humans have been reported; however, the overall incidence of dirofilarial infection has increased, and dirofilariasis is considered an emerging zoonosis. Here, we present a case of subcutaneous Dirofilaria in an otherwise healthy woman in her sixth decade who presented with a painless, mobile, nonerythematous pea-sized nodule of the right upper extremity of 1 month's duration. Evaluation regarding possible disseminated infection, microfilaremia, filarial serology, pulmonary, and central nervous system involvement was negative. She reported no travel outside of South Carolina. Her only risk factor was exposure to mosquitoes 5 months prior in her backyard, composed primarily of wetlands, a common habitat in coastal southeastern United States. No antihelminthics were given. She had complete resolution of the lesion after surgical excision, with no sequelae. This is the second case reported in Charleston, South Carolina.
Positive, Mildly Positive, and Uncertain Nasopharyngeal Swab and Outcome in COVID-19 Patients
Authors: Malerba Paolo , Boari Gianluca E. M. , Nardin Matteo , Tomasi Cesare , Chiarini Giulia , Bonetti Silvia , Bianco Gianluca , Faustini Cristina , Braglia-Orlandini Federico , De Ciuceis Carolina , Rizzoni Damiano
Published: December 2021

Introduction and Aim

Diagnosis of SARS-CoV-2 infection is mainly based on gene detection through polymerase chain reaction analysis on nasopharyngeal swab. The Allplex TM 2019-nCoV assay targets 3 different viral genes: RNA-dependent RNA polymerase, envelope, and nucleocapside. A coding system was developed based on different number of genes expressed: a nasopharyngeal swab was considered “positive” if all 3 genes tested underwent amplification, “mildly positive” if only 2 out of 3 genes were detected, “uncertain” if only 1 gene and “negative” if none resulted amplified from the test. Our aim was to assess whether this classification correlates with clinical outcome in a cohort of COVID-19 patients.

Methods

This is a retrospective study including patients admitted with diagnosis of SARS-CoV-2 infection to a medical ward at the Montichiari Hospital, Brescia, Italy, from February 28 to April 30, 2020. All patients underwent the nasopharyngeal swab upon admission.

Results

A total of 204 patients were included in this study. Patients with full positive nasopharyngeal swab showed higher values of C-reactive protein and neutrophiles/lymphocytes ratio compared with patients with mildly positive or uncertain nasopharyngeal swab. Mortality did not differ between the 2 groups. A Cox multivariate analysis showed that age, male sex, and CRP values are independent predictors of in-hospital mortality.

Conclusions

Our study demonstrated that patients with a complete SARS-CoV-2 gene detection nasopharyngeal swab show a higher inflammatory profile, and this can be an indirect measurement of viral load in COVID-19 patients.
Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients
Authors: Yang Zhen , Chen Ping , Hou Bailing , Zhang Huijun
Published: December 2021

Complications arising from human immunodeficiency virus may affect the ability of elderly AIDS patients to communicate and make decisions about future medical care. It is important for elderly AIDS patients to be able to express effectively their preferences for future treatments and care. This study explored preferences and influencing factors of advance care planning among elderly AIDS patients. A semistructured interview outline was developed based on the theory of planned behavior. A qualitative preference interview was conducted among 16 eligible elderly AIDS patients. Using thematic analysis, the data were analyzed and categorized into 3 themes and 9 subthemes that were classified under the theory of planned behavior framework. The 3 themes were as follows: a positive attitude toward advance care planning, a strong desire for family and social support, and some obstacles to discussing advance care planning in the current environment. These themes provided valuable insights to advance care planning educators and practitioners from different work environments and units to aid them in constructing future ACP intervention models for elderly AIDS patients.
Supporting Family Members in Palliative Phases of Cancer
Authors: Stadelmaier Nena , Assemat Laura , Paternostre Bernard , Bartholome Cécile , Duguey-Cachet Odile , Quintard Bruno
Published: December 2021

This comparative and exploratory multicenter study explored the experiences of 2 groups of family members caring for relatives in palliative phases of cancer: caregivers practicing health care professionals (doctors/nurses) and caregivers who were not health care professionals. The ill family members of the 2 groups were also interviewed. Twenty-seven volunteer caregiving relatives (including 16 health professionals) and 18 cancer patients participated in psychologist-conducted semistructured interviews exploring psychological experiences of the support (including daily, personal, and medical care) and, for caregivers, of the interactions with medical teams. Interviews were recorded and transcribed for inductive thematic analysis. Caregiving relatives, irrespective of their profession, all reported developing closer bonds with their relative since the cancer diagnosis and being highly involved in the palliative care. They also all reported psychological stress with additional stress linked to health care professionals' acute knowledge of the disease and treatments often experienced as a burden. Whereas non–health care professional caregivers reported hope for favorable disease progression, health professional caregivers did not. Interactions with the health care team were generally described as satisfactory. A minority of health care professional caregivers reported difficulties when the health care team perceived their investment in the patient's care as negative. Patients' perceptions were consistent with caregiver perceptions.
Continuation of Hemodialysis in a Patient With Global Hypoxic Brain Injury
Authors: Vickey Terri , Frechman Erica
Published: December 2021

Survivors of an out-of-hospital cardiac arrest are at a high risk of mortality and morbidity especially when there is resultant global hypoxic brain injury. In these situations, the patient's degree of neurologic recovery may be uncertain and family decision making is often difficult. Decision making may also be complicated by the age of the patient and one's underlying cultural and spiritual beliefs stressing the importance of patient- and family-centered care. In this article, this clinical case demonstrates the challenges in decision making and highlights the importance of communication among the health care team and the family to align the patient's goals, values, and preferences in light of a poor neurological prognosis.
Analysis of the Main Groups Victimized by Familiar Violence and by Violence by a Known Person in Brazil
Authors: Rodrigues Nádia Cristina Pinheiro , Andrade Mônica Kramer de Noronha , O'Dwyer Gisele , Monteiro Denise Leite Maia , Reis Inês do Nascimento , Lino Valéria Teresa Saraiva
Published: December 2021

This study aims to evaluate the ratio of the number of cases of family violence and violence by a known person, over the four surveys that took place in 2006, 2007, 2009, and 2011, within the population treated in the Brazilian health services, according to demographic and socioeconomic characteristics. Data from the Vigilância de Violências e Acidentes survey was used. The variables age, victim sex, aggressor sex, race, and schooling level were considered in the analysis. This study pointed out decreasing trend in the number of violence-related care within the older age group. The number of familial violence-related care per victim sex was higher for male victims when the aggressor was female, and conversely, it was higher for female victims when the aggressor was male. The number of violence-related care was mostly higher in non-White people than in White. People with low schooling levels showed the highest ratio of the number of violence-related care.
Thirty-Minute Psychiatric Management Visits in Academic Medical Centers
Authors: Yager Joel , MacPhee Edward R. , Ritvo Alexis D. , Salamander Rakel M.
Published: December 2021

To address high clinical demand and manage workflow, some university-based practice settings are tending to replace traditional hour-long outpatient appointments with 30-minute psychiatric management visits, which must comply with multiple regulatory requirements for documentation and billing. This care model can significantly shape the culture of psychiatric treatment and education. Based on the limited published literature on this topic and pooled experiences of faculty, residents, and administrators, this article offers observations and raises questions concerning 1) clinical, educational and administrative benefits, limitations, and challenges for conducting 30-minute psychiatric visits in training contexts; 2) how administrative impositions affecting resident and faculty time and attention impact clinical encounters; 3) how various teaching settings manage regulatory requirements differently; and 4) considerations for education needs and opportunities, research gaps, and policy implications. Quality of care and education could be improved by judicious overhaul of administrative requirements to minimize burdens offering little clinical or educational value.
Cost-Effectiveness Analysis Between Sacral Neuromodulation and OnabotulinumtoxinA for the Treatment of Refractory Overactive Bladder in Women: A Systematic Review
Authors: Gerjevic Kristen A. , Ahmad Sophia , Strohbehn Kris , Riblet Natalie
Published: December 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:481–487)

Sacral neuromodulation (SNM) and onabotulinumtoxinA (BONT/A) are well-established treatments for refractory overactive bladder (OAB) syndrome. SNM inhibits urination by stimulating the sacral portion of the spinal court, and BONT/A inhibits acetylcholine by causing detrusor muscle paralysis.
Frontline Reporting from the Epicenter of a Global Pandemic: A Survey of the Impact of COVID-19 on Plastic Surgery Training in New York and New Jersey
Authors: Shah Jinesh , Zhao Ruya , Yi Joseph , Otterburn David , Patel Ashit , Szpalski Caroline , Tanna Neil , Taub Peter J. , Weichman Katie E. , Ricci Joseph A.
Published: December 2021

Background:

Since the first documented case of coronavirus disease of 2019 (COVID-19), the greater New York City area quickly became the epicenter of the global pandemic, with over 500,000 cases and 50,000 deaths. This unprecedented crisis affected all aspects of health care, including plastic surgery residency training. The purpose of this study was to understand the specific impact of the COVID-19 pandemic on plastic surgery residencies.

Methods:

A survey of all plastic surgery residency training programs in the greater New York City area was conducted. The impact to training during the peak months of infection (March and April of 2020) was evaluated using resident education as measured by case numbers, need for redeployment, and staff wellness as primary outcome variables.

Results:

A total of 11 programs were identified in the region, and seven programs completed the survey, with a response rate 63.6 percent. When comparing productivity in March and April of 2019 to March and April of 2020, a total decrease in surgical volume of 64.8 percent (range, 19.7 to 84.8 percent) and an average of 940 (range, 50 to 1287) cancelled clinic visits per month were observed. These decreases directly correlated with the local county’s COVID-19 incidence rates (p = 0.70). A total of 83 percent of programs required redeployment to areas of need, and correlation between local incidence of COVID-19 and the percentage of residents redeployed to non–plastic surgical clinical environments by a given program (ρ = 0.97) was observed.

Conclusion:

As the first COVID-19 wave passes the greater New York area and spreads to the rest of the country, the authors hope their experience will shed light on the effects of the ongoing COVID-19 pandemic, and inform other programs on what to expect and how they can try and prepare for future public health crises.
An Update on the Surgical Management of the Bulbous and Boxy Tip
Authors: Rohrich Rod J. , Avashia Yash J. , Savetsky Ira L.
Published: December 2021

The bulbous and box tips are two common morphologies encountered in rhinoplasty. Nasal tip reshaping is a challenging aspect of rhinoplasty. Understanding the classifications of nasal tip morphologies aids when performing a nasal-facial analysis. The management algorithm for both tip morphologies shares various techniques. These techniques include but are not limited to cephalic trim, transdomal sutures, and interdomal sutures. A graduated approach to managing the variations in bulbous and boxy tips will help in achieving consistent results. New concepts applied to the management include supporting alar rims with alar contour grafts, closing dead space through a series of techniques, and managing the soft-tissue envelope, which is often in excess.
Industry Payments to Plastic Surgeons, 2013 to 2018: Who’s Getting Paid?
Authors: Singerman Kyle W. , Moore Meredith G. , Kortlever Joost T. P. , Gobble Ryan M.
Published: December 2021

Background:

The Physician Payments Sunshine Act of 2010 mandated that all industry payments to physicians be publicly disclosed. To date, industry support of plastic surgeons has not been longitudinally characterized. The authors seek to evaluate payment trends from 2013 to 2018 and characteristics across plastic surgeon recipients of industry payments.

Methods:

The authors cross-referenced those in the 2019 American Society of Plastic Surgeons member database with Centers for Medicare & Medicaid Services Open Payments database physician profile identification number indicating industry funds received within the study period. We categorized surgeons by years since American Board of Plastic Surgery certification, practice region, and academic affiliation.

Results:

A sum of $89,436,100 (247,614 payments) was received by 3855 plastic surgeons. The top 1 percent of earners (n = 39) by dollar amount received 52 percent of industry dollars to plastic surgeons; of these, nine (23 percent) were academic. Overall, 428 surgeons (11 percent) were academic and received comparable dollar amounts from industry as their nonacademic counterparts. Neither geographic location nor years of experience were independent predictors of payments received. The majority of individual transactions were for food and beverage, whereas the majority of industry dollars were typically for royalties or license.

Conclusions:

Over half of all industry dollars transferred went to just 1 percent of American Society of Plastic Surgeons members receiving payments between 2013 and 2018. Considerable heterogeneity exists when accounting for payment subcategories.