bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Differences in Lifetime Prevalence and Onset Timing of Suicidal Ideation and Suicide Attempt Among Post-9/11 Veterans and Nonveterans
Authors: Hoffmire Claire A. , Monteith Lindsey L. , Forster Jeri E. , Bernhard Paul A. , Blosnich John R. , Vogt Dawne , Maguen Shira , Smith Alexandra A. , Schneiderman Aaron I.
Published: January 2021

Background:

Rising US suicide rates are particularly notable among military veterans, especially women. It is unknown whether these differences extend to suicidal ideation (SI) and suicide attempts (SA), which are major predictors of suicide. Literature comparing SI and SA prevalence and timing of onset between veterans and nonveterans is limited.

Objective:

The objective of this study was to estimate and compare SI and SA prevalence and onset timing relative to age and military service between veterans and nonveterans, by gender.

Research Design:

Gender-stratified analysis of cross-sectional data from the Comparative Health Assessment Interview Study. Generalized estimating equations logistic regression was used to compare prevalence and onset of SI and SA between time periods and across groups, controlling for years at risk in each time period.

Subjects:

National sample of 15,082 post-9/11 veterans (36.7% women) and 4638 nonveterans (30.5% women).

Measures:

Columbia-Suicide Severity Rating Scale adapted to assess SI and SA relative to age (less than 18 y, 18 y and above) and military service (pre-, during, and post-military).

Results:

Veteran men experienced significantly higher odds of lifetime SI compared with nonveteran men (odds ratio=1.13), whereas veteran women experienced significantly higher odds of lifetime SA compared with nonveteran women (odds ratio=1.35). SI and SA onset varied considerably for veterans and nonveterans and by gender within veteran groups.

Conclusions:

Veterans and nonveterans appear to differ in periods of risk for SI and SA. Furthermore, gender differences in SI and SA onset for veterans highlight the need for gender-informed veteran suicide prevention strategies that target periods of highest risk.
Latent Class Analysis of Self-directed Violence and Indirect Self-harm Behaviors
Authors: Zelkowitz Rachel L. , Mitchell Karen S. , Grossman Stephanie L. , Nillni Yael I. , Gradus Jaimie L. , Galovski Tara E.
Published: January 2021

Objective:

This study aimed to (1) examine whether the latent class structure of individuals engaging in self-directed violence and indirect self-harm behaviors (eg, substance use, disordered eating) varied by gender in a sample of US veterans, and (2) test the associations of posttraumatic stress disorder (PTSD) and depressive symptoms with the resulting classes.

Study Design:

Cross-sectional data from 3581 veterans, ages 18–50 (51.9% identified as women) were analyzed. Veterans self-reported histories of self-directed violence, substance use, and disordered eating. Latent class analysis and latent class regression were used to explore class structure by gender and examine association of class membership with PTSD and depressive symptoms.

Results:

A 4-class model was supported in the sample. Class 1 (20.0%) was characterized by substance use and self-directed violent thoughts and behaviors. Class 2 (8.3%) was characterized by substance use, disordered eating, and self-directed violent thoughts and behaviors. Class 3 (12.6%) was distinguished by indirect self-harm behaviors (substance use and disordered eating). Class 4 (59.6%) reflected low likelihood of behavioral dysregulation. Classes were partially invariant across gender; endorsement of substance use behaviors was generally higher for men in each class. Comorbid clinically significant depressive and PTSD symptoms were associated with the class characterized by highest behavioral dysregulation.

Conclusions:

Self-directed violent thoughts and behaviors present comorbidly with indirect self-harm in men and women veterans, although patterns of indirect self-harm behaviors differ slightly by gender. Such comorbidity may be associated with more severe presentations of psychiatric concerns.
Circumstances Associated With Suicides Among Females—16 States, United States, 2005–2016
Authors: Crosby Alex E. , Ertl Allison , Lyons Bridget H. , Ivey-Stephenson Asha Z. , Jack Shane P.D.
Published: January 2021

Background:

Suicide rates in the United States have been consistently increasing since 2005 and increasing faster among females than among males. Understanding circumstances related to the changes in suicide may help inform prevention programs. This study describes the circumstances associated with suicides among females in the United States using the National Violent Death Reporting System.

Methods:

We analyzed the circumstances of suicides occurring from 2005 to 2016 in 16 states (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin) among females aged 10 years and above. We compared the percentages of circumstances reported for the entire sample, by age group, and by race/ethnicity. Trends in changes in the leading circumstances were analyzed using Joinpoint regression.

Results:

From 2005 to 2016, there were 27,809 suicides among females 10 years and older in the 16 states. Overall, the 2 leading precipitating circumstances were current mental health problem and ever treated for mental health problem. The leading circumstances differed by demographics. Joinpoint analysis showed inflection points in reports of job problems, financial problems, and non–intimate partner relationship problems during 2005–2009. During 2010–2016, downward inflections were seen in reports of job problems and financial problems and upward inflections in substance abuse problems and a recent or impending crisis.

Conclusions:

These findings show changes by age group and race/ethnicity in the circumstances associated with suicides among females in the 16 states have occurred. Studying these shifts and identifying the most salient circumstances among female suicide decedents may help prevention programs adapt to different needs.
Understanding Existential Anxiety and the Soothing Nature of Nostalgia in Life With Incurable Esophageal Cancer
Authors: Missel Malene , Bergenholtz Heidi , Beck Malene , Donsel Pernille Orloff , Simonÿ Charlotte
Published: January 2021

Background

Research has identified how people living with incurable esophageal cancer experience existential concerns.

Objective

The aim of this study was to examine the phenomenon of existential anxiety when living with esophageal cancer in the context of receiving general palliative care in a hospital setting.

Methods

This qualitative study is inspired by phenomenological and hermeneutical aspects of the philosophies of Ricoeur and Heidegger. Applying Heidegger's theory of existential anxiety and nostalgia, we interpreted the narratives of 18 patients receiving palliative care due to incurable esophageal cancer.

Results

The patients experienced existential anxiety at the loss of a future and homeliness when receiving palliative care. Their existence was reduced to the present, with a break in temporal continuity. An anxious mood permeated their entire being-in-the-world in an unhomelike way. Despite this, patients initiated a restoration of home and meaning expressed as a soothing sense of nostalgia that served as an atmospheric, safe space allowing them to inhabit the borderline between past, present, and future.

Conclusions

The study suggests an empirical interpretation of the existential anxiety patients experience when receiving palliation for incurable esophageal cancer. It sheds light on how these patients would benefit from healthcare professionals inviting them to narrate significant aspects of their life stories in which the soothing presence of nostalgia can be supported.

Implication for Practice

Providing care conditions for a life heading toward death, where the patient can live alongside anxiety, involves focusing on “being with” the patient and on incorporating a nostalgic dimension to facilitate soothing restoration of home for patients.
Prevalence of Chlamydia trachomatis Infection in Young Women and Associated Predictors
Authors: Gupta Kanupriya , Harrison Sally A. , Davis Nkele A. , Culp Matilda L. , Hand Samuel C. , Simpson Tina , Van Der Pol Barbara , Galbraith James W. , Van Wagoner Nicholas J. , Morrison Sandra G. , Morrison Richard P. , Geisler William M.
Published: January 2021

Background

Chlamydia trachomatis (CT) infection remains highly prevalent, and young women are disproportionately affected. Most CT-infected women are asymptomatic, and their infection often goes unrecognized and untreated. We hypothesized that testing for active CT infection with molecular diagnostics and obtaining a reported history of CT infection underestimate the prevalence of current and past CT infection, and incorporating serum CT antibody testing in addition to these other prevalence measures would generate more accurate estimates of the prevalence of CT infection in asymptomatic young women.

Methods

We enrolled 362 asymptomatic women aged 16 to 29 years at 4 different clinical settings in Birmingham, AL, between August 2016 and January 2020 and determined the prevalence of CT infection based on having 1 or more of the following prevalence measures: an active urogenital CT infection based on molecular testing, reported prior CT infection, and/or being CT seropositive. Multivariable regression analysis was used to determine predictors of the prevalence of CT infection after adjustment for participant characteristics.

Results

The prevalence of CT infection was 67.7% (95% confidence interval, 62.6%–72.5%). Addition of CT antibody testing to the other individual prevalence measures more than doubled the CT infection prevalence. Non-Hispanic Black race, reported prior gonorrhea, and reported prior trichomoniasis predicted a higher prevalence of CT infection.

Conclusions

More than half of women were unaware of ever having CT infection, suggesting many were at risk for CT-associated reproductive complications. These data reinforce the need to adhere to chlamydia screening guidelines and to increase screening coverage in those at risk.
Determinants of HIV Preexposure Prophylaxis Adherence Among Female Sex Workers in a Demonstration Study in Cotonou, Benin: A Study of Behavioral and Demographic Factors
Authors: Mboup Aminata , Diabaté Souleymane , Béhanzin Luc , Guédou Fernand Aimé , Zannou Djimon Marcel , Kêkê René K. , Bachabi Moussa , Gangbo Flore , Marzinke Mark A. , Hendrix Craig , Gagnon Marie-Pierre , Alary Michel
Published: January 2021

Background

HIV preexposure prophylaxis (PrEP) efficacy is closely linked to adherence, and factors associated with PrEP adherence are not well understood and may differ across populations. As PrEP demonstration projects and implementation are ongoing, it is essential to understand factors associated with adherence to oral PrEP to design effective adherence interventions and maximize the public health impact of PrEP. We thus aimed to assess demographic and behavioral factors associated with optimal PrEP adherence (100%) among female sex workers (FSWs) participating in a demonstration project in Cotonou, Benin.

Methods

Female sex workers were provided with daily Truvada and followed quarterly for 1 to 2 years. Sociodemographics, partners, and behaviors were collected through face-to-face questionnaires. Another questionnaire based on sexual the theory of planned behavior and the theory of interpersonal behavior was also administered. Generalized estimating equations were used to identify factors associated with optimal daily adherence.

Results

At baseline, 255 FSWs were followed up. One-year increase in age of FSWs was associated with a 3% increase in optimal adherence (prevalence ratio, 1.03; 95% confidence interval, 1.01–1.05; P for trend = 0.0003), and optimal adherence decreased by 31% for every 6 months of follow-up (prevalence ratio, 0.69; 95% confidence interval, 0.59–0.79; P for trend < 0.0001). For the participants who have completed the behavioral questionnaires, high intention to adhere to the treatment was also a predictor of optimal adherence.

Conclusions

Efforts should be geared toward FSWs intending to use PrEP to help them reach adequate adherence levels for effective HIV protection.
MHC Class I Loss in Triple-negative Breast Cancer
Authors: Dusenbery Anna C. , Maniaci Joseph L. , Hillerson Natalie D. , Dill Erik A. , Bullock Timothy N. , Mills Anne M.
Published: January 2021

Suppression of the immune system is intimately linked to the development and progression of malignancy, and immune modulating treatment options have shown promise in a variety of tumor types, including some triple-negative breast cancers (TNBC). The most dramatic therapeutic success has been seen with immune checkpoint inhibitors targeting programmed cell death protein 1 (PD-1) and its ligand, PD-L1. Difficulty remains, however, in appropriate patient selection for treatment, as many PD-L1-positive cancers fail to show durable responses to PD-1/PD-L1 inhibition. Checkpoint inhibitor targeting of the adaptive immune response relies on the presence of major histocompatibility complex (MHC) class I molecules on the tumor cell surface for tumor antigen presentation. MHC class I loss has been previously described in breast cancer and represents a putative mechanism of immunotherapeutic resistance in this tumor type. One hundred seventeen invasive primary breast carcinomas with a range of histologic subtypes were evaluated on tissue microarrays containing formalin-fixed paraffin-embedded tissue. Loss of MHC class I expression was common among breast cancers, with greater than half of cases demonstrating either subclonal or diffuse loss. Fifty-nine percent of TNBC demonstrated loss of MHC class I, including 46% of those meeting the Food and Drug Administration-approved threshold of 1% for tumor-associated immune cell PD-L1 expression. MHC class I loss was particularly common in the apocrine subtype of TNBC (78%). MHC class I’s employment as a predictive biomarker should be considered, as its loss may represent a barrier to successful enhancement of the antitumor adaptive immune response by PD-1/PD-L1 inhibition.
Evaluation of an Integrated Psychology Service in a Pediatric Emergency Department and Urgent Care
Authors: Casher Gabriel A. , Sutton Brianne , Roosevelt Genie , Simpson Scott A.
Published: January 2021

Objectives

Children visiting emergency departments (EDs) are disproportionately affected by mental health disorders. Integrated behavioral health models hold promise for improving care among ED patients. We implemented and evaluated a novel behavioral health service integrated psychology trainees in a safety net hospital's pediatric ED and urgent care.

Methods

Consultations and interventions provided were identified from the service's patient registry. Patients treated by the service were matched based on age, sex, day, and month of presentation to control patients who received a brief assessment by a specialized psychiatric nurse or patients receiving comprehensive management in a psychiatric emergency service. Rates of ED return visits were obtained from local hospital records, and insurance claims were used to identify rates of psychiatric hospitalization and outpatient follow-up care.

Results

The most commonly provided interventions among 71 intervention patients were assistance with connection to follow-up behavioral health treatment (65%), relaxation training (41%), and motivational interviewing (31%). These patients were matched with 142 comparison patients. There was no difference among groups in return rates within 90 days among intervention versus nurse assessment or psychiatric emergency service patients (25% vs 23% vs 13%, P = 0.14). Insurance claims data were available for 115 patients (54%): within 90 days, integrated care patients were less likely to have at least 1 outpatient claim (52% vs 78% vs 84%, P < 0.01), and there was no difference in rates of psychiatric hospital admission (18% vs 20% vs 24%, P = 0.83).

Conclusions

Although this psychology-led integrated behavioral health service delivered a range of brief psychotherapeutic interventions, its impact on outpatient, inpatient, and emergency care was mixed. This lower follow-up rate among intervention patients may reflect the success of active psychological treatment in the ED, lower acuity among intervention patients, or implications of the study's safety net setting. The authors discuss this model's potential for enhancing mental health care in pediatric EDs.
Aromatherapy for Procedural Anxiety in Pain Management and Interventional Spine Procedures
Authors: Singh Jaspal R. , Rand Ethan B. , Erosa Samantha C. , Cho Rosa S. , Sein Michael
Published: January 2021

Objective

The aim of this study was to evaluate a nonsedating agent, lavender aromatherapy, to reduce anxiety before interventional spinal procedures.

Design

In this prospective, single-blind study performed at a tertiary care center for an academic institution, 144 patients undergoing spinal procedures (epidural steroid injection, medial branch block, or radiofrequency ablation) were randomized into two groups of 72 patients. The experimental group was exposed to a tablet formulation of lavender aromatherapy, while the control group was exposed to tablets devoid of any scent. The exposure duration for each group was 5 mins. The primary outcome measurement was patients’ anxiety state before the spinal procedure using the six-item State-Trait Anxiety Inventory. Secondary outcomes quantified the rate of vasovagal events and aborted procedures because of patient intolerance.

Results

Compared with the control group, the posttreatment anxiety score of those exposed to lavender aromatherapy revealed a statistically significant difference as measured by the six-item State-Trait Anxiety Inventory (12.15 ± 2.67 and 10.67 ± 2.81,P< 0.05). Within group, the experimental group’s anxiety level decreased from 12.26 ± 2.75 to 10.67 ± 2.81 (P< 0.05). There were two vasovagal episodes and one aborted procedure in the control group, whereas there was one vasovagal episode and no aborted procedures in the aromatherapy group.

Conclusions

Lavender-based aromatherapy is effective in reducing preprocedural anxiety before interventional spine procedures for pain management.
The Prevalence and Impact of Back and Neck Pain in Veterans With Upper Limb Amputation
Authors: Resnik Linda , Borgia Matthew , Clark Melissa A.
Published: January 2021

Objective

The aims of the study were (1) to describe frequency of back pain only, neck pain only, and co-occurring pain in veterans with upper limb amputation, (2) to examine changes in pain over 1 yr, and (3) to quantify the association of pain and health-related quality of life and disability.

Design

This is an observational cohort study with a survey of a sample of 792 veterans with upper limb amputation, with 1-yr reassessment of 585 (85.3%) of 777 eligible participants. Pain prevalence and intensity were examined. Logistic and linear regressions identified variables associated with pain and examined associations between intensity and veterans RAND-12 mental component score and physical component score and QuickDASH.

Results

At baseline, 52.3% had co-occurring pain, 20.0% had back pain, and 8.3% had neck pain. Persistent back and neck pain is present in 60.8% and 48.1% respondents, respectively. Pain intensity was unchanged for 59.1% with back pain and 61.3% with neck pain. Mental component score and QuickDASH were significantly worse with severe and moderate back and neck pain, compared with no pain. Severe/moderate back pain intensity was associated with lower physical component score.

Conclusions

Back and neck pain is highly prevalent and persistent in veterans with upper limb amputation. Pain intensity is negatively associated with health-related quality of life and disability. Pain prevention and intervention are needed in this population.
Using longitudinal genetic-network study to understand HIV treatment-as-prevention
Authors: Kang Ruihua , Li Jianjun , Chen Huanhuan , Tang Zhenzhu , Pan Stephen W. , Luo Liuhong , Zhu Qiuying , Lan Guanghua , Liang Shujia , Lu Huaxiang , Zhu Jinhui , Feng Yi , Liao Lingjie , Xing Hui , Shao Yiming , Ruan Yuhua , Shen Zhiyong
Published: January 2021

Objective:

The WHO has recommended that antiretroviral therapy be provided to all HIV patients to reduce future HIV transmission rates. However, few studies have examined this public health strategy at the population level in a real-world setting.

Methods:

In this longitudinal genetic-network study in Guangxi, China, the baseline and follow-up data were collected from HIV patients in 2014 and newly diagnosed HIV patients from 2015 to 2018, respectively. The prevention efficacy was used to estimate the effect of treatment-as-prevention in reducing HIV secondary transmission.

Results:

Among 804 newly diagnosed HIV patients during 2015–2018, 399 (49.6%) of them genetically linked to HIV patients at baseline during 2014–2017. The overall proportion of genetic linkage between newly diagnosed HIV patients during 2015–2018 with untreated and treated HIV patients at baseline during 2014–2017 was 6.2 and 2.9%, respectively. The prevention efficacy in HIV transmission for treated HIV patients was 53.6% [95% confidence interval (95% CI): 42.1–65.1]. Subgroup analyses indicated an 80.3% (95% CI: 74.8–85.8) reduction in HIV transmission among HIV patients who were treated for 4 years or more and had viral loads less than 50 copies/ml. There was no significant reduction in HIV transmission among treated HIV patients who dropped out or who had missing viral load measures.

Conclusion:

Our study results support the feasibility of treating all HIV patients for future reductions in HIV transmission at the population level in real-world settings. Comprehensive intervention prevention programmes are urgently needed.
Clinical Outcomes and Inflammatory Markers by HIV Serostatus and Viral Suppression in a Large Cohort of Patients Hospitalized With COVID-19
Authors: Patel Viraj V. , Felsen Uriel R. , Fisher Molly , Fazzari Melissa J. , Ginsberg Mindy S. , Beil Robert , Akiyama Matthew J. , Anastos Kathryn , Hanna David B.
Published: January 2021

Background:

Limited data exist about clinical outcomes and levels of inflammatory and immune markers among people hospitalized with COVID-19 by HIV serostatus and by HIV viral suppression.

Setting:

Large tertiary care health system in the Bronx, NY, USA.

Methods:

We conducted a retrospective cohort study of 4613 SARS-CoV-2 PCR-positive patients admitted between March 10, 2020, and May 11, 2020. We examined in-hospital intubation, acute kidney injury (AKI), hospitalization length, and in-hospital mortality by HIV serostatus, and by HIV-viral suppression and CD4 counts among people living with HIV (PLWH) using adjusted competing risks regression. We also compared immune and inflammatory marker levels by HIV serostatus and viral suppression.

Results:

Most patients were either non-Hispanic Black (36%) or Hispanic (37%); 100/4613 (2.2%) were PLWH, among whom 15 had detectable HIV viral load. PLWH compared to patients without HIV had increased intubation rates (adjusted hazard ratio 1.73 [95% CI: 1.12 to 2.67], P = 0.01). Both groups had similar rates of AKI, length of hospitalization, and death. No (0%) virally unsuppressed PLWH were intubated or died, versus 21/81 (26%, P = 0.04) and 22/81 (27%, P = 0.02) of virally suppressed PLWH, respectively. Among PLWH, higher CD4 T-cell counts were associated with increased intubation rates. C-reactive protein, IL-6, neutrophil counts, and ferritin levels were similar between virally suppressed PLWH and patients without HIV, but significantly lower for unsuppressed PLWH (all P < 0.05).

Conclusions:

PLWH had increased risk of intubation but similarly frequent rates of AKI and in-hospital death as those without HIV. Findings of no intubations or deaths among PLWH with unsuppressed HIV viral load warrant further investigation.
Brain 18F-FDG and 18F-Flumetamol PET Imaging of Fragile X-Associated Tremor Ataxia Syndrome
Authors: Bacchin Ruggero , Salgarello Matteo , Trentin Michela , Zanette Giampietro , Tamburin Stefano
Published: January 2021

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a rare movement disorder caused by a 55-to-200 CGG-trinucleotide expansion premutation in the FMR1 gene. Core diagnostic criteria are tremor, ataxia, and T2-weighted hyperintensity of the middle cerebellar peduncles on MRI, but FXTAS encompass a broad spectrum of neurological symptoms. FXTAS pathophysiology is largely unknown, and some animal models and neuropathology findings suggest possible overlap with Alzheimer disease. We report the combined PET imaging of a genetically confirmed FXTAS patient, presenting reduced temporal-frontal 18F-FDG uptake, and pathological cortical deposition of amyloid to 18F-flumetamol PET scan. This report may offer clues to FXTAS pathophysiology.
Compromised Flap Salvage With Closed Incision Negative Pressure Therapy Under Real-Time Indocyanine Green Fluorescence Assessment
Authors: Chien Yi-Chun , Lin Yu-Hsien , Chen Cha-Chun , Lin Huwang-Chi
Published: January 2021

Background

Skin flap transfer is a commonly used technique by surgeons; however, compromised blood flow may result in flap ischemia and necrosis. We describe the use of closed incision negative pressure therapy (ciNPT) to help manage skin flap reconstructions with indocyanine green fluorescence angiography (ICG-FA) to assess perfusion of the flaps before and after ciNPT.

Methods

Three female and 5 male patients underwent various skin flap reconstructions, including local flaps, pedicled flaps, and propeller flaps, for wound defects related to trauma, infection, or cancer. After flap setting and suturing, ciNPT (−125 mm Hg) was applied to the closed incision for 7 days. Perfusion was assessed using ICG-FA before applying ciNPT and again at 24 hours later. The Shapiro-Wilk test and Wilcoxon signed rank test were used in statistical analysis.

Results

Initial postoperative survival was observed for all skin flaps; however, 1 flap failed after 2 weeks due to uncontrolled infection. The remaining 7 flaps healed well without any surgical revision. All patients were initially determined to have impaired flap perfusion; however, skin flap perfusion was significantly higher after ciNPT than before ciNPT in each case (P = 0.012).

Conclusions

This study showed good healing outcomes for skin flap reconstructions without complications, despite the fact that each flap had compromised flap perfusion to some extent during the surgery. This case series is novel in that it used laser-assisted ICG-FA to provide a real-time assessment of skin flap perfusion before and after ciNPT.
Diced Cartilage Rhinoplasty for Cleft Nose Deformities
Authors: Lonic Daniel , Hsiao Yen-Chang , Huang Jung-Ju , Chang Chun-Shin , Chen Jyh-Ping , Denadai Rafael , Bosselmann Talia , Kehrer Andreas , Prantl Lukas , Lo Lun-Jou , Chen Yu-Ray
Published: January 2021

Background

The objective of this trial is to evaluate the flexibility of the cartilaginous component of the cleft nose after diced cartilage rhinoplasty by determining the degree of possible bending in relation to the vertical nasal dorsum axis and to compare with to a control group of the unaffected population.

Patients and Methods

Fifteen cleft nose patients with diced cartilage rhinoplasty were included in this study, as well as a control group of 15 unaffected individuals. The angle of maximum nasal bending is measured between the basic and maximum bending axis and performed by the same rater twice at least 2 weeks apart to account for intrarater reliability. Study groups were compared with Fisher and independent t test.

Results

The maximum bending to the left side was 16.10 ± 5.03 degrees for the study group and 23.95 ± 6.54 degrees for the control group (P = 0.001). The maximum bending to the right side were 16.54 ± 6.73 degrees for the study group and 23.00 ± 8.88 degrees for the control group (P = 0.034).

Conclusion

Diced cartilage graft injection for dorsal augmentation yields reproducible and esthetically pleasing outcomes with good flexibility and natural feel of the nasal tip. Although there is a significant difference compared with a nonaffected control group in maximum bending capacity, all patients in this study were satisfied with the results.
Neutrophil Gelatinase-Associated Lipocalin (NGAL) Measured at Admission is Associated With Development of Late Cardiogenic Shock and Mortality in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Frydland Martin , Møgelvang Rasmus , Møller Jacob Eifer , Helgestad Ole K. L. , Holmvang Lene , Mark Peter D. , Jensen Lisette Okkels , Hassager Christian
Published: January 2021

In patients with ST-elevation myocardial infarction (STEMI) the immune system is activated with an inflammatory response to follow. In STEMI patients with a severe inflammatory response, risk of development of cardiogenic shock (CS) seems increased. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a glycoprotein released from mature neutrophils and plasma concentration may increase immediately after STEMI. We therefore aimed to assess whether admission NGAL plasma concentration in patients with STEMI was associated with CS development after leaving the catheterization laboratory (late CS) and 30-day all-cause mortality.

Patients and Methods:

From 1,892 consecutive patients with STEMI 1,626 (86%) had plasma NGAL concentration measured upon hospital admission before angiography throughout a 1-year period at two tertiary heart centers in Denmark. Patients were stratified according to NGAL quartiles (Q1–4). To assess late CS development, we adjusted for the Observatoire Régional Breton sur l’Infarctus risk score for late CS. For mortality assessment, we adjusted for gender, age, post-PCI culprit Thrombolysis in myocardial infarction flow, left ventricular ejection fraction (LVEF), kidney dysfunction, and being comatose after cardiac arrest.

Results:

Increasing NGAL concentration was associated with higher age, more comorbidities, and more critical patient conditions including lower blood pressure and LVEF. When adjusted for factors associated with poor outcome, NGAL remained independently associated with both late CS development (Q4 vs. Q1–3) (OR (95% CI) 3.64 (1.79–7.41) and 30-day mortality (HR (95% CI) 3.18 (1.73–5.84)).

Conclusion:

Admission plasma concentration of NGAL in STEMI patients is independently associated with 30-day all-cause mortality and predictive of late CS development.
Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial
Authors: Berkel Annefleur E. M. , Bongers Bart C. , Kotte Hayke , Weltevreden Paul , de Jongh Frans H. C. , Eijsvogel Michiel M. M. , Wymenga Machteld , Bigirwamungu-Bargeman Marloes , van der Palen Job , van Det Marc J. , van Meeteren Nico L. U. , Klaase Joost M.
Published: January 2021

Objective:

To assess the effects of a 3-week community-based exercise program on 30-day postoperative complications in high-risk patients scheduled for elective colorectal resection for (pre)malignancy.

Summary Background Data:

Patients with a low preoperative aerobic fitness undergoing colorectal surgery have an increased risk of postoperative complications. It remains, however, to be demonstrated whether prehabilitation in these patients reduces postoperative complications.

Methods:

This 2-center, prospective, single-blinded randomized clinical trial was carried out in 2 large teaching hospitals in the Netherlands. Patients (≥60 years) with colorectal (pre)malignancy scheduled for elective colorectal resection and with a score ≤7 metabolic equivalents on the veterans-specific activity questionnaire were randomly assigned to the prehabilitation group or the usual care group by using block-stratified randomization. An oxygen uptake at the ventilatory anaerobic threshold <11 mL/kg/min at the baseline cardiopulmonary exercise test was the final inclusion criterion. Inclusion was based on a power analysis. Patients in the prehabilitation group participated in a personalized 3-week (3 sessions per week, nine sessions in total) supervised exercise program given in community physical therapy practices before colorectal resection. Patients in the reference group received usual care. The primary outcome was the number of patients with one or more complications within 30 days of surgery, graded according to the Clavien-Dindo classification. Data were analyzed on an intention-to-treat basis.

Results:

Between February 2014 and December 2018, 57 patients [30 males and 27 females; mean age 73.6 years (standard deviation 6.1), range 61–88 years] were randomized to either prehabilitation (n = 28) or usual care (n = 29). The rate of postoperative complications was lower in the prehabilitation group (n = 12, 42.9%) than in the usual care group (n = 21, 72.4%, relative risk 0.59, 95% confidence interval 0.37–0.96, P = 0.024).

Conclusions:

Exercise prehabilitation reduced postoperative complications in high-risk patients scheduled to undergo elective colon resection for (pre)malignancy. Prehabilitation should be considered as usual care in high-risk patients scheduled for elective colon, and probably also rectal, surgery.
A Structured, Hybrid Cystoscopy Simulation Curriculum for Obstetrics/Gynecology Residents
Authors: Do Linh , Pasha Kainat , Sanchez Sheralyn , Montoya T. Ignacio , Maldonado Pedro A.
Published: January 2021

Objectives

This study aimed to assess the subjective and objective cystoscopy skills of gynecology residents before and after implementation of a comprehensive simulation curriculum.

Methods

Residents in an obstetrics/gynecology program at a single academic institution participated in a 6-week cystoscopy simulation course. Residents attended an initial orientation and didactic presentation, and then weekly 20- to 30-minute training sessions using a water balloon model and a virtual reality simulator. Pretesting and posttesting were performed, including (1) subjective self-assessments, (2) a written quiz, and (3) objective structured assessment of technical skills. Paired t test was used to assess the differences in residents’ objective assessment scores before and after simulation training.

Results

A total of 16 residents were recruited. Residents reported significant subjective improvements in comfort, confidence, and proficiency in performing cystoscopy after completing the curriculum. Their overall objective assessment improved, including written quiz scores (mean score, 49% vs 78%; P < 0.001), efficiency in cystoscope assembly (means score, 0 vs 4; P < 0.001), overall bladder survey score (56% vs 86%, P < 0.001), and global rating score (mean score, 15 vs 24; P < 0.001). Residents tended to prefer the water-balloon model compared with the virtual reality simulator (75% vs 25%).

Conclusions

Obstetrics/gynecology residents demonstrated significant improvements in subjective and objective measures of skill after completion of a 6-week cystoscopy simulation training course using a combination of low- and high-fidelity models. Although universal cystoscopy at the time of hysterectomy for benign indications remains controversial, cystoscopy simulation should remain an important part of resident training.
Association Between GlycA and Cognitive Function
Authors: Calice-Silva Viviane , Suemoto Claudia K. , Brunoni Andre R. , Bensenor Isabela M. , Lotufo Paulo A.
Published: January 2021

Inflammation is associated with poor cognitive performance. GlycA is a novel marker of systemic inflammation, but information on GlycA and cognition is scarce. We aimed to evaluate the association between GlycA and cognitive performance in a large sample from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). In this cross-sectional study, participants with GlycA measured at baseline were included. Cognitive function was evaluated using the word list test, the trail-making test, and the semantic and phonemic verbal fluency tests. The association of GlycA with cognitive performance was investigated using linear regression models adjusted for sociodemographic and clinical variables. A total of 4327 participants were analyzed (mean age=51.5±9.0 y old, 54% were female, 60% white). The mean GlycA was 414.9±69.8 µmol/L. Higher GlycA levels were associated with lower global cognitive performance, even after adjustments for confounders and C-reactive protein. Higher GlycA levels were associated with lower performance in language and executive function domains (language: β=−0.005, 95% confidence interval CI=−0.010, −0.001, P=0.01; and executive function: β=−0.005, 95% confidence interval=0.009, −0.001, P=0.02]. GlycA was associated with worse cognitive performance in the ELSA-Brasil study, independent of C-reactive protein levels. GlycA may be a potential biomarker for cognitive impairment.
Late Presentation of Linezolid-Induced Serotonin Syndrome After Maprotiline and Mirtazapine Therapy: A Case Report
Authors: Alotaibi Meshal Saud , Yousuf Abdalla Zarrouq , Khan Aslam , Alshammari Nwair Saad
Published: January 2021

Objective

This report describes a 45-year-old man who developed serotonin syndrome on day 13 of linezolid therapy. This is unusual as it typically appears within 24 hours of linezolid initiation.

Methods

The patient did not receive any serotonergic agents concurrently with linezolid; maprotiline and mirtazapine were stopped 17 days before the development of serotonin syndrome. On day 13 of linezolid administration, the patient exhibited diaphoresis, fever, confusion, agitation, disorientation, anxiety, and restlessness. His blood pressure was elevated with persistent tachycardia. He was then diagnosed with serotonin syndrome using the Hunter criteria.

Results

Linezolid was discontinued and supportive measures were initiated, which resulted in the complete resolution of the syndrome.

Conclusions

This case report highlights that linezolid-induced serotonin syndrome can occur late in the course of therapy and the importance of the serotonergic agent washout period before the introduction of linezolid. A multidisciplinary team is important for optimal diagnosis and management of such cases.
Reduced Occipital Cortex Excitability in Amyotrophic Lateral Sclerosis
Authors: Cengiz Bülent , Fidancı Halit , Baltacı Hande , Türksoy Ece , Kuruoğlu Reha
Published: January 2021

Purpose:

In addition to motor cortex involvement, sensory abnormalities have been demonstrated in amyotrophic lateral sclerosis (ALS), including structural and metabolic alterations in the occipital cortex. The aim of this study was to examine occipital excitability changes in ALS.

Methods:

Twenty-one patients with ALS and 16 healthy subjects were enrolled into the study. Phosphene experience and phosphene threshold were studied to assess occipital excitability. Cognitive function was evaluated in both groups by means of Montreal Cognitive Assessment and Addenbrooke's Cognitive Examination-Revised visuospatial score tests.

Results:

Phosphene was experienced in 13 (81.3%) healthy subjects and 9 (42.9%) patients with ALS (P = 0.04). The mean phosphene threshold was not significantly different between the two groups. No correlation existed between phosphene threshold and motor cortical excitability parameters, ALS Functional Rating Scale Revised, Montreal Cognitive Assessment, and Addenbrooke's Cognitive Examination-Revised scores.

Conclusions:

Visual cortex is affected, and the occipital excitability is reduced in ALS, without any relation to motor cortical excitability changes, providing another clue suggestive of sensory involvement in ALS.
Assessments of heavy lift UAV quadcopter drone to support COVID 19 vaccine cold chain delivery for indigenous people in remote areas in South East Asia
Authors: Adwibowo Andrio
Published: January 2021

Vaccine delivery is one important aspect need to be strengthened within health systems. One of the main challenges in COVID 19 vaccine delivery is how to cover indigenous population in remote and isolated forests in South East Asia. Another issue in COVID 19 cold chain delivery is requirement for a carrier that can maintain the suitable storage temperature. Related to this condition, COVID 19 vaccine should be delivered using heavy vaccine cooler box and this demand delivery system equipped with heavy lift capacity. In here, this study proposes and assess the potential used of heavy lift UAV quadcopter to expand the COVID 19 vaccine delivery to indigenous people living in village that impeded by rugged terrain. The landscape and terrain analysis show that access to the villages was dominated by 15%-45% slopes and the available access is only 1.5 m width trail. To transport 500 vials with 10 kg carrier along 2 km trail, it requires 2 persons to walk for 1 hour. By using drone, a straight line route with a length of 1.5 km can be developed. There were at least 3 drone types were available commercially to lift 10 kg load and several drones with payload capacity below 10 kg. For carrying 100 vials to village using drones, it is estimated the required delivery time was 1.23-1.38 minutes. Around 1.57-1.66 minute delivery times were required to transport 250 vials. For carrying the maximum and full loads of 500 vials or equals to 10 kg load, a drone requires in average of 3.13 minute delivery times. This required drone delivery time is significantly below the required time by walking that almost 1 hour. Drones were limited by flight operational times. Whereas all required delivery times for each drone assessed in this study were still below the drone operational time. The lowest drone operational time was 16 minutes and this is still higher than the time required for a drone to deliver the vaccine. Considering the effectiveness and anticipating vaccine vaccination, UAV quadcopter drone is a feasible option to support COVID 19 vaccine delivery to reach indigenous people in isolated areas.
Exploration of interethnic variation in the ibuprofen metabolizing enzyme CYP2C9: a genetic-based cautionary guide for treatment of COVID-19 symptoms
Authors: Almarzooq Ammar Ali
Published: January 2021

Coronavirus disease 2019 (COVID-19), is a rapidly spreading infectious illness that causes a debilitating respiratory syndrome. While non-steroidal anti-inflammatory drugs (NSAIDs), may be prescribed for the management of pain and fever, there was early controversy on the use of ibuprofen for symptomatic treatment of COVID-19. P450 enzyme CYP2C9 are known to be involved in the metabolism of NSAIDs. Although no study has been conducted in the setting of population genetics in patients with COVID-19 yet, there are plausible mechanisms by which genetic determinants may play a role in adverse drug reactions (ADRs). In this work, we adjusted expected phenotype frequencies based on racial demographic models dependent on population ancestry in drug responses and toxicity events associated with ibuprofen treatment. A cohort of 101 Jordanian Arab samples retrospectively were selected and genotyped using Affymetrix DMET Plus Premier Package, within the context of over 100,000 global subjects in 417 published reports. European populations are 7.2x more likely to show impaired ibuprofen metabolism than Sub-Saharan populations, and 4.5x more likely than East Asian ancestry populations. Hence, a proactive assessment of the most likely gene-drug candidates will lead to more effective treatments and a better understanding of the role of pharmacogenetics for COVID-19.
Unique brewing-relevant properties of a strain ofSaccharomyces jureiisolated from ash (Fraxinus excelsior)
Authors: Hutzler Mathias , Michel Maximilian , Kunz Oliver , Kuusisto Tiina , Magalhães Frederico , Krogerus Kristoffer , Gibson Brian
Published: January 2021

The successful application ofSaccharomyces eubayanusandSaccharomyces paradoxusin brewery fermentations has highlighted the potential of wild yeast for brewing, and prompted investigation into the application potential of other members of the genus. Here, we evaluate, for the first time, the brewing potential ofSaccharomyces jurei. The newly isolated strain from an ash tree (Fraxinus excelsior) in Upper Bavaria, Germany, close to the river Isar, was used to ferment a 12°P wort at 15°C. Performance was compared directly with that of a reference lager strain (TUM 34/70) and theS. eubayanustype strain. Both wild yeast rapidly depleted simple sugars and thereafter exhibited a lag phase before maltose utilization. This phase lasted for 4 and 10 days forS. eubayanusandS. jurei, respectively.S. eubayanusutilized fully the available maltose but, consistent with previous reports, did not use maltotriose.S. jurei, in contrast, utilized approx. 50% of the maltotriose available, making this the first report of maltotriose utilization in a wildSaccharomycesspecies. Maltotriose use was directly related to alcohol yield with 5.5, 4.9, and 4.5 % ABV produced byS. pastorianus, S. jureiandS. eubayanus. Beers also differed with respect to aroma volatiles, with a high level (0.4 mg/L) of the apple/aniseed aroma ethyl hexanoate inS. jureibeers, whileS. eubayanusbeers had a high level of phenylethanol (100 mg/L). A trained panel rated all beers as being of high quality, but noted clear differences. A phenolic spice/clove note was prominent inS. jureibeer. This was less pronounced in theS. eubayanusbeers, despite analytical levels of 4-vinylguaiacol being similar. Tropical fruit notes were pronounced inS. jureibeers, possibly resulting from the high level of ethyl hexanoate. Herein, we present the successful results of the first intentional application of S.jureias a yeast for beer fermentation known to us and compare its fermentation performance to other species of the genus. Results indicate considerable potential forS. jureiapplication in brewing, with clear advantages compared to other wildSaccharomycesspecies.
Pheromone binding protein shapes olfactory temporal resolution
Authors: Shiota Yusuke , Sakurai Takeshi , Ando Noriyasu , Haupt Stephan Shuichi , Mitsuno Hidefumi , Daimon Takaaki , Kanzaki Ryohei
Published: January 2021

Male moths are capable of orienting towards conspecific females using sex pheromones. Since pheromones are distributed as discontinuous plumes owing to air turbulence, tracking intermittent stimuli with high temporal resolution is suggested to be important for efficient localisation. Here, using a pheromone binding protein (BmPBP1) knockout silkmoth, we revealed that the loss of functional pheromone binding protein altered antennal response kinetics resulting in reduced temporal resolution to intermittent pheromone stimuli on the antennae. Behavioural analysis revealed thatBmPBP1-knockout males exhibited significantly less straight walking, which occurs when detecting pheromone stimuli, especially to high frequency stimuli. Accordingly,BmPBP1-knockout males took a significantly longer time to locate pheromone sources and females than did wild-type males. Together, BmPBP1 plays a critical role in determining temporal antennal response kinetics and that an appropriate range of temporal sensory and behavioural resolutions is essential for tracking pheromone plumes for efficient pheromone source localisation in the silkmoth.