bluuebunny/crossref_metadata_2025 huggingface dataset:
Searching for Kardashev Type III civilisations from high q-value sources in the LoTSS-DR1 value-added catalogue
Authors: Chen H , Garrett M A
Published: August 2021

Kardashev Type III civilisations have by definition energy requirements that are likely to generate strong excess emission in the mid-infrared (MIR) that is associated with the waste heat they generate. For those civilisations that capture starlight via Dyson sphere like constructions, the Optical to MIR flux ratio of the host galaxies is also expected to be unusually low. Since a wide range of galaxy types adhere to the infrared-radio correlation (IRC), galaxies hosting Type III civilisations should also strongly deviate from this relation. Radio data can therefore play a crucial role in breaking the degeneracy between the effects of dust obscuration in a galaxy and the signature of an energy-intensive civilisation. We have used the newly released LoTSS-DR1 value-added catalogue to create a sample of 16 367 z < 0.2 sources with radio and MIR flux densities, optical photometry and (photometric) redshifts. We calculated the IRC parameter $q^{{\rm 22~\mu m}}_{{\rm 150~MHz}}$ = log(S150 MHz/$S_{22~{\rm \mu m}}$) and identified 21 sources with exceptionally high values of $q^{{\rm 22~\mu m}}_{{\rm 150~MHz}}$, an indication of MIR emission enhanced by a factor of ∼10. Out of the 21 high q-value sources, 4 sources have very red MIR colours, and appear to have relatively low optical/MIR ratios. Two of the four sources are not well known in the literature, they are considered as potential hosts of Type III civilisations. These sources deserve further study and investigation. Finally, we note that extending our analysis to the full LoTSS survey area can place very strong constraints on the incidence of Type III civilisations in the Universe.
De-dimerization of PTB is catalyzed by PDI and is involved in the regulation of p53 translation
Authors: Gong Fu-Xing , Zhan Guoqin , Han Rong , Yang Zhigang , Fu Xin , Xiao Ran
Published: July 2021

Polypyrimidine tract-binding protein (PTB) is an RNA binding protein existing both as dimer and monomer and shuttling between nucleus and cytoplasm. However, the regulation of PTB dimerization and the relationship between their functions and subcellular localization are unknown. Here we find that PTB presents as dimer and monomer in nucleus and cytoplasm respectively, and a disulfide bond involving Cysteine 23 is critical for the dimerization of PTB. Additionally, protein disulfide isomerase (PDI) is identified to be the enzyme that catalyzes the de-dimerization of PTB, which is dependent on the CGHC active site of the a’ domain of PDI. Furthermore, upon DNA damage induced by topoisomerase inhibitors, PTB is demonstrated to be de-dimerized with cytoplasmic accumulation. Finally, cytoplasmic PTB is found to associate with the ribosome and enhances the translation of p53. Collectively, these findings uncover a previously unrecognized mechanism of PTB dimerization, and shed light on the de-dimerization of PTB functionally linking to cytoplasmic localization and translational regulation.
Generation, characterization, and drug sensitivities of 12 patient-derived IDH1-mutant glioma cell cultures
Authors: Verheul Cassandra , Ntafoulis Ioannis , Kers Trisha V , Hoogstrate Youri , Mastroberardino Pier G , Barnhoorn Sander , Payán-Gómez César , Tching Chi Yen Romain , Struys Eduard A , Koolen Stijn L W , Dirven Clemens M F , Leenstra Sieger , French Pim J , Lamfers Martine L M
Published: August 2021

Background

Mutations of the isocitrate dehydrogenase (IDH) gene occur in over 80% of low-grade gliomas and secondary glioblastomas. Despite considerable efforts, endogenous in vitro IDH-mutated glioma models remain scarce. Availability of these models is key for the development of new therapeutic interventions.

Methods

Cell cultures were established from fresh tumor material and expanded in serum-free culture media. D-2-Hydroxyglutarate levels were determined by mass spectrometry. Genomic and transcriptomic profiling were carried out on the Illumina Novaseq platform, methylation profiling was performed with the Infinium MethylationEpic BeadChip array. Mitochondrial respiration was measured with the Seahorse XF24 Analyzer. Drug screens were performed with an NIH FDA-approved anti-cancer drug set and two IDH-mutant specific inhibitors.

Results

A set of twelve patient-derived IDHmt cell cultures was established. We confirmed high concordance in driver mutations, copy numbers and methylation profiles between the tumors and derived cultures. Homozygous deletion of CDKN2A/B was observed in all cultures. IDH-mutant cultures had lower mitochondrial reserve capacity. IDH-mutant specific inhibitors did not affect cell viability or global gene expression. Screening of 107 FDA-approved anti-cancer drugs identified nine compounds with potent activity against IDHmt gliomas, including three compounds with favorable pharmacokinetic characteristics for CNS penetration: teniposide, omacetaxine mepesuccinate, and marizomib.

Conclusions

Our twelve IDH-mutant cell cultures show high similarity to the parental tissues and offer a unique tool to study the biology and drug sensitivities of high-grade IDHmt gliomas in vitro. Our drug screening studies reveal lack of sensitivity to IDHmt inhibitors, but sensitivity to a set of nine available anti-cancer agents.
Live-imaging provides an atlas of cellular growth dynamics in the stamen
Authors: Silveira Sylvia R , Le Gloanec Constance , Gómez-Felipe Andrea , Routier-Kierzkowska Anne-Lise , Kierzkowski Daniel
Published: July 2021

Development of multicellular organisms is a complex process involving precise coordination of growth among individual cells. Understanding organogenesis requires measurements of cellular behaviors over space and time. In plants, such a quantitative approach has been successfully used to dissect organ development in both leaves and external floral organs, such as sepals. However, the observation of floral reproductive organs is hampered as they develop inside tightly closed floral buds, and are therefore difficult to access for imaging. We developed a confocal time-lapse imaging method, applied here to Arabidopsis (Arabidopsis thaliana), which allows full quantitative characterization of the development of stamens, the male reproductive organs. Our lineage tracing reveals the early specification of the filament and the anther. Formation of the anther lobes is associated with a temporal increase of growth at the lobe surface that correlates with intensive growth of the developing locule. Filament development is very dynamic and passes through three distinct phases: (1) initial intense, anisotropic growth, and high cell proliferation; (2) restriction of growth and proliferation to the filament proximal region; and (3) resumption of intense and anisotropic growth, displaced to the distal portion of the filament, without cell proliferation. This quantitative atlas of cellular growth dynamics provides a solid framework for future studies into stamen development.
Percutaneous Interventional Strategies for Migraine Prevention: A Systematic Review and Practice Guideline
Authors: Barad Meredith , Ailani Jessica , Hakim Sameh M , Kissoon Narayan R , Schuster Nathaniel M
Published: August 2021

Objective

To systematically evaluate the efficacy and effectiveness of percutaneous interventional treatments for prevention of migraine through a qualitative and (when possible) quantitative analysis.

Methods

An expert panel was asked to develop recommendations for the multidisciplinary preventive treatment of migraine, including interventional strategies. The committee conducted a systematic review and (when evidence was sufficient) a meta-analytic review by using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria and the modified Cochrane Risk of Bias analysis available in the Covidence data management program. Clinical questions addressed adults with migraine who should be offered prevention. Examined outcomes included headache days, acute medication use, and functional impairment. Acute management of migraine was outside the scope of this guideline.

Results

The committee screened 1,195 studies and assessed 352 by full text, yielding 16 randomized controlled trials that met the inclusion criteria.

Recommendations and Conclusions

As informed by evidence related to the preselected outcomes, adverse event profile, cost, and values and preferences of patients, onabotulinumtoxinA received a strong recommendation for its use for chronic migraine prevention and a weak recommendation against its use for episodic migraine prevention. Greater occipital nerve blocks received a weak recommendation for their use for chronic migraine prevention. For greater occipital nerve block, steroid received a weak recommendation against its use vs the use of local anesthetic alone. Occipital nerve with supraorbital nerve blocks, sphenopalatine ganglion blocks, cervical spine percutaneous interventions, and implantable stimulation all received weak recommendations for their use for chronic migraine prevention. The committee found insufficient evidence to assess trigger point injections in migraine prevention and highly discouraged the use of intrathecal medication.
Patient-Reported Opioid Analgesic Use After Discharge from Surgical Procedures: A Systematic Review
Authors: Mallama Celeste A , Greene Christina , Alexandridis Apostolos A , McAninch Jana K , Dal Pan Gerald , Meyer Tamra
Published: August 2021

Objective

This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use after surgery.

Methods

We searched PubMed (February 2019) and Web of Science and Embase (June 2019) for U.S. studies describing patient-reported outpatient opioid analgesic use. Two reviewers extracted data on opioid analgesic use, standardized the data on use , and performed independent quality appraisals based on the Cochrane Risk of Bias Tool and an adapted Newcastle-Ottawa scale.

Results

Ninety-six studies met the eligibility criteria; 56 had sufficient information to standardize use in oxycodone 5-mg tablets. Patient-reported opioid analgesic use varied widely by procedure type; knee and hip arthroplasty had the highest postoperative opioid use, and use after many procedures was reported as <5 tablets. In studies that examined excess tablets, 25–98% of the total tablets prescribed were reported to be excess, with most studies reporting that 50–70% of tablets went unused. Factors commonly associated with higher opioid analgesic use included preoperative opioid analgesic use, higher inpatient opioid analgesic use, higher postoperative pain scores, and chronic medical conditions, among others. Estimates also varied across studies because of heterogeneity in study design, including length of follow-up and inclusion/exclusion criteria.

Conclusion

Self-reported postsurgery outpatient opioid analgesic use varies widely both across procedures and within a given procedure type. Contributors to within-procedure variation included patient characteristics, prior opioid use, intraoperative and perioperative factors, and differences in the timing of opioid use data collection. We provide recommendations to help minimize variation caused by study design factors and maximize interpretability of forthcoming studies for use in clinical guidelines and decision-making.
Oral Cannabinoid Preparations for the Treatment of Chronic Migraine: A Retrospective Study
Authors: Baraldi Carlo , Lo Castro Flavia , Negro Andrea , Ferrari Anna , Cainazzo Maria Michela , Pani Luca , Guerzoni Simona
Published: August 2021

Objective

To explore the effectiveness and safety of three oral cannabinoid preparations (FM2®, Istituto farmaceutico militare, Firenze, Italy; Bedrocan®, Bedrocan International, Vandaam, Netherlands; and Bediol®, Bedrocan International, Vandaam, Netherlands) in the treatment of chronic migraine.

Design

Retrospective, cohort study.

Subjects

Patients with chronic migraine who received FM2, Bedrocan, or Bediol daily for the off-label treatment of their headache, for up to 6 months.

Methods

The number of migraine days per month, pain intensity, the number of acute medications taken per month, the number of days per month on which the patient took at least one acute medication, and adverse events were recorded at baseline and at 3 months and 6 months after the start of treatment with oral cannabinoid preparations.

Results

The number of migraine days did not change significantly after the third month or the sixth month when compared with baseline (P = 0.1182). The pain intensity (P = 0.0004), the acute medication consumption (P = 0.0006), and the number of days per month in which patients took at least one acute medication significantly decreased when compared with baseline (P = 0.0004). No significant differences were found between patients who were still taking a preventive treatment for chronic migraine and those who were not (all P > 0.05). Different oral cannabinoid preparations displayed similar levels of effectiveness (all P > 0.05). The adverse events were mostly mild and occurred in 43.75% of patients.

Conclusions

Oral cannabinoid preparations may have a role in reducing pain intensity and acute medication intake in patients with chronic migraine, but the magnitude of the effect seems modest; further studies are needed.
The Effect of Preoperative Serratus Anterior Muscle Plane Block on Persistent Postsurgical Pain After Video-assisted Thoracic Surgery
Authors: Zhao Hong , Wu Yaqing , Zhang Xizhe , Feng Yi
Published: August 2021

Objectives:

Acute pain intensity is a strong indicator for the occurrence of persistent postsurgical pain (PPP) after video-assisted thoracic surgery (VATS). The effect of preoperative serratus anterior muscle plane block (SAPB) on PPP was investigated.

Materials and Methods:

In this retrospective cohort study, data of 148 patients who underwent VATS for lung nodules in 2019 were collected. Seventy-four patients received a single-shot of SAPB with 0.33% ropivacaine 30 mL after anesthesia induction and another 74 patients received intercostal blocks using 1% ropivacaine 10 mL at the fifth to seventh intercostal spaces after surgery. Postoperative analgesia was accomplished by continuous infusion of flurbiprofen (8 mg/h), and intravenous oxycodone rescue (1 mg) given on demand. Pain intensity was recorded at 24 and 48 hours after surgery and all patients were followed up 3 months after surgery investigating the occurrence of PPP.

Results:

Intraoperative sufentanil in the SAPB group was significantly decreased in comparison with Control group (0.34±0.09 vs. 0.43±0.14 ug/kg, P<0.001). The incidence of PPP was comparable between 2 groups (20.2% [15/74] vs. 14.8% [11/74], P=0.078). All patients who experienced PPP rated their PPP as mild, except 1 patient in Control group rated her pain as moderate. Multivariate logistic regression showed that pain score at 24 hours (odds ratio 1.646, 95% confidence interval [1.058, 2.560], P=0.027) and female (odds ratio 3.711, 95% confidence interval [1.274, 10.810], P=0.026) were independent risk factors for the development of PPP.

Discussion:

When SAPB was combined with continuous infusion of nonsteroidal anti-inflammatory drugs, no patient had moderate chronic pain. Pain score at 24 hours after surgery and female were risk factors for PPP after VATS.
Pulse Oximetry Saturation (Spo 2) Monitoring in the Neonatal Intensive Care Unit (NICU): The Challenge for Providers
Authors: Falsaperla Raffaele , Giacchi Valentina , Saporito Marco Andrea Nicola , Pavone Piero , Puglisi Federica , Ruggieri Martino
Published: August 2021

Background:

In the neonatal intensive care unit (NICU), maintaining an oxygenation level that avoids both hypoxemia and hyperoxemia is challenging. Pulse oximetry has become fundamental for noninvasive monitoring of saturation of peripheral oxygen (Spo
2) in preterm newborns.

Purpose:

The aim of this systematic review is to determine Spo
2 target values in order to avoid hypoxemia or hyperoxemia and complications arising from these.

Method and Search Strategy:

For this systematic review, articles were audited from 2010 to 2020 using the PRISMA guidelines. PubMed, MEDLINE, Google Scholar, and Scopus databases were used, and search terms were related to use of pulse oximetry in the NICU.

Results:

The result showed that 12 of 20 (60%) studies focused on target values but without a unanimous agreement on values, although 5 of 12 studies (41.66%) suggested a lower value target of 85% and 4 of 12 studies (33.33%) recommended 95% as the higher target value. Other authors showed no difference in the incidence of adverse events comparing different target values and focused the importance more on the fluctuation of the value than on the target value itself.

Implication for Practice:

Reaching a balance in the oxygen administration so as to avoid potential complications associated with hypoxemia or hyperoxemia is a challenge for the clinicians.

Implication for Research:

Further studies on fluctuation of Spo
2 comparing different starting targets could better clarify the role of fluctuations and the absolute target values.

Video Abstract available at:
https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=49
The Effect of Vibration on Pain During Heel Lance Procedures in Newborns
Authors: Avan Antepli Nihal , Bilsin Kocamaz Elif , Güngörmüş Zeynep
Published: August 2021

Background/Significance:

The pain-reducing effect of applying vibration, which is used as a nonpharmacological method in pain management, is explained by the gate control theory developed by Melzack and Wall. Studies that are based on this theory have shown similar results to those of Melzack and Wall, indicating that pain-transmitting nerves are suppressed by vibrations, leading to higher pain thresholds.

Purpose:

The study aimed to evaluate the effect of applying vibration to manage pain during heel lance procedures in newborns.

Methods:

This is a randomized, controlled experimental study. The study sample included 56 newborns determined using power analysis (vibration group = 28; control group = 28). For those in the vibration group, a vibrating device was used for approximately 30 seconds before the heel lance procedure and then continued throughout the procedure. No interventions were provided to the newborns in the control group. Pain in the newborns was evaluated by the nurse who performed the heel lance procedures, before the procedures and 15 to 20 seconds and 5 minutes after procedures, and by 2 specialists who viewed the video footage and conducted the Neonatal Infant Pain Scale examination.

Results:

The pain scores were significantly lower at 15 to 20 seconds and 5 minutes after the heel lance procedures in the group that received vibrations than in the control group (P< .05).

Implications for Practice:

The application of vibration, which is effective, nonpharmacological, and noninvasive, could help nurses manage pain in newborns as a nonpharmacological method.

Implications for Research:

The number of studies that examine the effect that vibration has on pain associated with heel lance procedures in newborns is very limited, and it is recommended that further studies be conducted with larger sample sizes.
Using a Bundle Approach to Prevent Bronchopulmonary Dysplasia in Very Premature Infants
Authors: Ratliff-Crain Devon , Wallingford Brenda , Jorgenson Lisa
Published: August 2021

Background:

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects about 20% to 30% of infants born at less than 32 weeks of gestation. Diagnosis is made if an infant requires oxygen therapy at 36 weeks' corrected age or discharge home. BPD increases healthcare costs, mortality rates, and risk of long-term respiratory complications and neurosensory impairments.

Purpose:

The purpose of this project was to improve rates and severity of BPD in very premature infants without increasing length of hospitalization.

Methods:

A multidisciplinary care bundle involving respiratory support and medication use guidelines was created and implemented along with a noninvasive ventilation algorithm for the delivery room. This bundle was utilized for infants born in a Midwest hospital in 2019 at less than 32 weeks of gestation and the outcomes were compared to infants born in 2017.

Results:

Implementation of this BPD prevention bundle contributed to a decrease in the use of oxygen at discharge for very premature infants without increasing length of hospitalization. Use of invasive mechanical ventilation and the severity of BPD also decreased.

Implications for Practice and Research:

A multidisciplinary bundle approach can be successful in decreasing the rates of BPD for very premature infants. Future quality improvement projects should focus on improving delivery room management of extremely premature infants, with an emphasis on optimizing noninvasive ventilation strategies. More research is still needed to determine the best method of ventilation for premature infants and the best utilization of surfactant and corticosteroids.
Incidence and Risk Factors of Ocular Hypertension and Glaucoma in Patients With Acanthamoeba Keratitis
Authors: Al Owaifeer Adi Mohammed , Al-Omair Sarah , Alrefaie Shaimaa , Alenezi Saad H. , Al-Shahwan Sami
Published: August 2021

Objectives:

To determine the incidence of ocular hypertension (OHT) and glaucoma in patients with acanthamoeba keratitis (AK) and to outline the risk factors for the development of glaucoma.

Methods:

A retrospective review of patients diagnosed with AK at our institute during the period from 2000 to 2018. The main outcome measures were the incidence of OHT and glaucoma, and risk factors for the development of glaucoma.

Results:

Fifty-two eyes diagnosed with AK were included. The incidence of OHT and glaucoma was 51.9% and 32.7%, respectively. The mean duration from disease onset to the first attack of elevated intraocular pressure was 8.4±16.6 months. The use of corticosteroids in the treatment regimen was significantly associated with the development of glaucoma (odds ratio, 3.93; 95% confidence interval, 0.96–16.15; P=0.049). At the last follow-up visit, both patients with glaucoma and nonglaucoma patients had improved visual acuity without a difference in the mean amount of logarithm of the minimum angle of resolution acuity improvement among them (0.56±0.91 vs. 0.67±0.87, P=0.686).

Conclusion:

Our findings confirm that OHT and glaucoma are frequent complications in AK. Patients treated with a regimen containing corticosteroids are at a higher risk; thus, they should receive close intraocular pressure monitoring.
Botanical Medicines With Activity Against Stationary Phase Bartonella henselae
Authors: Ma Xiao , Leone Jacob , Schweig Sunjya , Zhang Ying
Published: August 2021

Bartonella henselae is a Gram-negative bacterium and is the causative agent of cat scratch disease. In humans, infections with B. henselae can result in acute or chronic systemic infections with diverse clinical symptoms. The current treatment for Bartonella infections with antibiotics such as doxycycline and rifampin is not always effective, presumably due in part to bacterial persistence. There are various anecdotal reports of herbal extracts used for treating patients with persistent Bartonella infections but their activity on B. henselae is unknown. In order to identify more effective therapies for persistent Bartonella infections, in this study, we tested the antimicrobial activity of botanical and herbal medicines and screened an herbal product collection against stationary phase B. henselae in vitro using a SYBR Green I/propidium iodide viability assay. We identified five herbal product extracts (at 1.67 mg/mL or 2.5 mg/mL), including Cryptolepis sanguinolenta, Juglans nigra, Polygonum cuspidatum, Scutellaria baicalensis, and Scutellaria barbata, that had high activity against stationary phase B. henselae. Among them, C. sanguinolenta, J. nigra, and P. cuspidatum could eradicate all stationary phase B. henselae cells within 7 days at 0.83 mg/mL or 1.25 mg/mL in drug exposure time-kill assays, whereas S. baicalensis and S. barbata showed relatively poor activity. These top hits were active against both stationary phase non-growing B. henselae and log phase growing B. henselae in minimum inhibitory concentration testing. These findings may have implications for improved treatment of persistent Bartonella infections.
Exclusive Breastfeeding for 6 Months Postpartum and Factors Associated With Success in a Tertiary Care Baby-Friendly Hospital
Authors: Balcı Yangın Hatice , Akpınar Arzu , Çakmak Havva , Çalışkan Özdöl Fatma , Akçakuş Mustafa
Published: July 2021

It is very important that infants are exclusively breastfed for the first 6 months of life and then that breastfeeding is continued until 2 years of age. In this study, we aimed to determine the rate of exclusive breastfeeding for the first 6 months of life following birth and the factors associated with continuation of exclusive breastfeeding. The study was a retrospective cohort study. The study population consists of infants born in Akdeniz University Hospital. Infants born between June 1, 2016, and June 1, 2017 (n = 1402) were included in the sample. For analysis of data, descriptive statistics, χ2 test, t test, and logistic regression test were employed. The rate of exclusive breastfeeding for the first 6 months was 29.8%. Further analysis revealed that chances of breastfeeding exclusivity for the first 6 months were increased by 1.6-fold if the father had higher education, by 1.4-fold if the infant was not given formula in the hospital, by approximately 4-fold if feeding bottle was not used, and by 1.7-fold in the absence of problems related to breastfeeding. The study results showed that success in exclusive breastfeeding was influenced by several factors. We recommended that modifiable factors associated with the success of exclusive breastfeeding be well managed.
Is there a role for immune-enhancing therapies for acutely ill patients with coronavirus disease 2019?
Authors: Wittebole Xavier , Montiel Virginie , Mesland Jean-Baptiste
Published: August 2021

Purpose of review

Although the so-called cytokine storm has been early described and related to a dramatic evolution in severe COVID-19 patients, it soon became clear that those patients display clinical and biological evidence of an immunosuppressive state characterized, among other, by a profound lymphopenia. The negative role of this immune suppression on the outcome raises the question on immune therapies that might improve patient's condition.

Recent findings

Important positive effects of active immune therapies, such as IL-7 or thymosin-α are already described and warrant confirmation in larger prospective trials. For other therapies, such as interferons, firm conclusions for critically ill COVID-19 patients are lacking as those patients were often excluded from the published trials. Treatment with immunoglobulins or convalescent plasma is a passive strategy to provide specific immunity. Unfortunately, results from large RCTs do not support their use presently.

In this article, we provide a review on active and passive immune boosting strategies that might help treating the most severe COVID-19 patients. We mainly focus on active strategies that include IL-7, thymosin-α, interferons, and vitamin D. Although some positive effects are described, they certainly warrant confirmation in large randomized controlled trials.
Rectal Evacuation Disorders are Associated With Poor Bowel Preparation in Patients With Chronic Constipation
Authors: Pathipati Mythili P. , Silvernale Casey J. , Barshop Kenneth G. , Ha Jasmine B. , Richter James M. , Staller Kyle D.
Published: August 2021

Introduction:

We evaluated factors that can predict the adequacy of bowel preparation in patients with chronic constipation undergoing colonoscopy.

Materials and Methods:

We identified patients with chronic constipation who underwent anorectal manometry and at least 1 colonoscopy at 2 tertiary referral centers from 2003 to 2019. We also identified a subgroup of patients who underwent colonic transit testing through radiopaque marker testing. We determined demographic, medical, and constipation-related factors associated with poor bowel preparation and their effect on standardized quality metrics using univariate and multivariate analyses.

Results:

We identified 274 patients with chronic constipation who underwent anorectal manometry testing. Both outlet dysfunction (prolonged balloon expulsion) and slow-transit constipation were associated with suboptimal bowel preparation. Outlet dysfunction was also associated with decreased cecal intubation rates, adenoma detection rates, and sessile serrated polyp detection rates. In multivariable analyses controlling for demographics and known factors associated with poor bowel preparation, outlet dysfunction was associated with an almost 3-fold odds of suboptimal bowel preparation [odds ratio (OR): 2.9; 95% confidence interval (CI): 1.6-5.1] and a 3-fold reduction in cecal intubation rates (OR: 0.3; 95% CI: 0.1-0.8). Among those with radiopaque marker colonic transit testing available, slow-transit constipation was associated with a >2-fold odds of suboptimal bowel preparation (OR: 2.2; 95% CI: 1.1-4.4).

Conclusions:

Among a cohort of patients with chronic constipation undergoing colonoscopy, outlet dysfunction was associated with suboptimal bowel preparation and other quality metrics. Constipated patients with a rectal evacuation disorder may represent a subgroup of patients that could benefit from individualized strategies for better bowel preparation.
Effects of coronavirus disease 2019 on the digestive system and its nutritional implications
Authors: Aguila Enrik John T. , Cua Ian Homer Y. , Singh Rajvinder
Published: August 2021

Purpose of review

There has been a deluge of scientific data since coronavirus disease 2019 (COVID-19) was first reported. The effects of COVID-19 on the digestive system are now increasingly well understood. This article aims to review the current data on the effects of COVID-19 on the digestive system with particular emphasis on preexisting digestive diseases and its implications on nutrition practices.

Recent findings

Evidence has shown that Severe acute respiratory syndrome coronavirus 2 virus affects the gastrointestinal (GI) tract, pancreas and hepatobiliary system resulting in different GI manifestations. Several preexisting digestive diseases have been investigated. These studies have revealed that these special patient population groups are generally not at an increased risk to contract COVID-19, but are susceptible to develop increasing severity of disease. Aside from medical therapy, optimizing nutritional care has a beneficial role in this group of patients.

GI manifestations of COVID-19 in addition to preexisting digestive diseases have an impact on patient's nutrition. Digestion, absorption and transport of nutrients may be impaired. To date, there are no existing guidelines on the nutritional management of patients for this particular at-risk group. Most nutrition practices are based only on observations and clinical experience. Basic prepandemic nutrition care principles are primarily followed but often individualized based on clinical judgment.
The cepstral spectral index of dysphonia, the acoustic voice quality index and the acoustic breathiness index as novel multiparametric indices for acoustic assessment of voice quality
Authors: Barsties v. Latoszek Ben , Mathmann Philipp , Neumann Katrin
Published: August 2021

Purpose of review

The objective assessment of voice quality using acoustic measures is an important pillar of voice diagnostics. This article reviews three recent acoustic measures and their clinical use in phoniatrics and laryngology.

Recent findings

Two acoustic parameters, the cepstral spectral index of dysphonia (CSID) and the acoustic voice quality index (AVQI), have gained importance as validated multiparametric indices in the objective assessment of hoarseness because they include both continuous speech and sustained vowels. The acoustic breathiness index (ABI), another multiparametric index, assesses breathiness admixture during phonation and identifies it robustly, unaffected by other characteristics of dysphonia such as roughness.

Acoustic measurements are useful diagnostic tools when used correctly with an appropriate recording system, consideration of environment and use of software programs. CSID, AVQI and ABI objectively improve the detection of voice quality abnormalities. In addition to their proven validity, their application is simple and their usability for clinicians is high.
Somatic-type Malignancies in Testicular Germ Cell Tumors
Authors: Hwang Michael J. , Hamza Ameer , Zhang Miao , Tu Shi-Ming , Pisters Louis L. , Czerniak Bogdan , Guo Charles C.
Published: August 2021

The development of somatic-type malignancies (SMs) in testicular germ cell tumors (GCTs) is a rare but well-recognized phenomenon. We studied the pathologic features of 63 GCTs with SMs in the testis (n=22) or metastases (n=41) and correlated these features with clinical outcomes. The patients with SMs in the testis (median age, 26 y) were younger than those with metastatic SMs (median age, 38.5 y). The SMs consisted of carcinomas (n=21), sarcomas (n=21), primitive neuroectodermal tumors (n=15), nephroblastomas (n=3), and mixed tumors (n=3). Sarcoma was the most common SM in the testis (n=11), and most sarcomas were rhabdomyosarcomas (n=9). Carcinoma was the most common SM in metastases (n=20), and most carcinomas were adenocarcinomas (n=12). In metastases, carcinomatous SMs developed after a longer interval from the initial orchiectomy (median times, 213 mo) than sarcomatous SMs (median times, 68 mo). Patients with metastatic SMs had significantly poorer overall survival than those with SMs in the testis (5-y survival rate, 35% vs. 87%; P=0.011). Furthermore, patients with carcinomatous SMs had a significantly worse prognosis than those with sarcomatous or primitive neuroectodermal tumor SMs (5-y survival rates, 17%, 77%, and 73%, respectively; P=0.002), when the whole cohort, including testicular and metastatic SMs, were analyzed. Our results demonstrate that SMs in metastatic GCTs are associated with a significantly worse prognosis than those in the testis. Furthermore, the histologic subtype of SM has a significant effect on the clinical outcome, with the carcinomatous SM carrying the highest risk for mortality.
Global health security as it pertains to Zika, Ebola, and COVID-19
Authors: Pannu Jaspreet , Barry Michele
Published: August 2021

Purpose of review

Due to the impact of the COVID-19 pandemic this past year, we have witnessed a significant acceleration in the science, technology, and policy of global health security. This review highlights important progress made toward the mitigation of Zika, Ebola, and COVID-19 outbreaks. These epidemics and their shared features suggest a unified policy and technology agenda that could broadly improve global health security.

Recent findings

Molecular epidemiology is not yet in widespread use, but shows promise toward informing on-the-ground decision-making during outbreaks. Point-of-care (POC) diagnostics have been achieved for each of these threats; however, deployment of Zika and Ebola diagnostics lags behind those for COVID-19. POC metagenomics offers the possibility of identifying novel viruses. Vaccines have been successfully approved for Ebola and COVID-19, due in large part to public-private partnerships and advance purchase commitments. Therapeutics trials conducted during ongoing epidemics have identified effective antibody therapeutics for Ebola, as well as steroids (both inhaled and oral) and a broad-spectrum antiviral for COVID-19.

Achieving global health security remains a challenge, though headway has been made over the past years. Promising policy and technology strategies that would increase resilience across emerging viral pathogens should be pursued.
Prospective Trial of Near-Infrared Spectroscopy for Continuous Noninvasive Monitoring of Free Fibular Flaps
Authors: Ouyang Si-Yuan , Cai Zhi-Gang , Shan Xiao Feng , Li Yue
Published: August 2021

Introduction

Some free flaps develop postoperative vessel thrombosis, which influences the flap survival rate. Early discovery and identification of vascular crisis are critical to the success rate of flap salvage. The primary aims of this study were to determine the features of postoperative blood supply changes in fibular flaps with normal and abnormal blood flow, using near-infrared spectroscopy (NIRS), to monitor oxygenation and blood flow, and to characterize the probable risk factors for vascular crisis.

Methods

Sixty-three consecutive patients undergoing reconstruction of unilateral mandibular defects with free fibular flaps at the Peking University School of Stomatology were included. Patients were divided into 2 groups, A (n = 38) and B (n = 25); fibular flaps in group A underwent continuous NIRS monitoring from immediately postoperatively until 7 days postoperatively (approximately 150 hours), whereas fibular flaps and opposite mandibles in group B underwent intermittent monitoring: once every 4 hours during the first 24 hours postoperatively and once every 12 hours from 24 to 168 hours postoperatively.

Results

Six fibular flaps developed vascular thromboses: 4 were venous thromboses and 2 were arterial thromboses; 5 were rescued after exploration. Of 6 regional oxygen saturation (rSO2) values in the continuous monitoring group, 4 showed no significant differences at any time point compared with the intermittent monitoring group (P > 0.05). The rSO2 of the fibular flap was significantly different from that in the opposite mandible in the first 36 hours postoperatively (P < 0.05). This difference decreased over time. During the initial period of venous thrombosis, rSO2, deoxyhemoglobin, and oxygenated hemoglobin all rose slightly, then showed simultaneous rapid reduction. However, the magnitude of reduction was smaller for deoxyhemoglobin than for oxygenated hemoglobin.

Conclusions

Near-infrared spectroscopy can be used for noninvasive and reliable assessment of oxygenation and blood flow in free flaps through continuous, real-time monitoring. It is also portable, inexpensive, and simple to operate. In addition, the detection depth of NIRS is up to 2.0 cm, so it can be used to monitor buried flaps with depths <2.0 cm.
Mechanical Embolectomy for Superior Cerebellar Artery Embolism
Authors: Yin Chun , Ding Yasuo , Sun Bing , Zhang Bo , Chang Hao
Published: August 2021

Acute embolism of the superior cerebellar artery is rarely reported. The treatment is mainly medication, decompressive craniectomy is performed when necessary, and mechanical thrombus removal is not recommended. This article describes the admission of a 69-year-old man with acute superior cerebellar artery embolization. Compared with the imaging data of the patient 2 weeks before the onset of the disease, cerebral angiography revealed that there was a mural thrombus covering the opening of the superior cerebellar artery. it is also a bold attempt for this patient to undergo mechanical thrombectomy. The patient finally recovered well from neurological symptoms. This case report details the causes of the rare mural thrombosis leading to superior cerebellar artery embolism, and also has a new understanding of arterial embolism in acute stroke.
Long-term Normothermic Machine Preservation of Partial Livers: First Experience With 21 Human Hemi-livers
Authors: Mueller Matteo , Hefti Max , Eshmuminov Dilmurodjon , Schuler Martin J. , Sousa Da Silva Richard X. , Petrowsky Henrik , De Oliveira Michelle L. , Oberkofler Christian E. , Hagedorn Catherine , Mancina Leandro , Weber Achim , Burg Brian , Tibbitt Mark W. , Rudolf von Rohr Philipp , Dutkowski Philipp , Becker Dustin , Bautista Borrego Lucia , Clavien Pierre-Alain
Published: August 2021

Objective:

The aim of this study was to maintain long-term full function and viability of partial livers perfused ex situ for sufficient duration to enable ex situ treatment, repair, and regeneration.

Background:

Organ shortage remains the single most important factor limiting the success of transplantation. Autotransplantation in patients with nonresectable liver tumors is rarely feasible due to insufficient tumor-free remnant tissue. This limitation could be solved by the availability of long-term preservation of partial livers that enables functional regeneration and subsequent transplantation.

Methods:

Partial swine livers were perfused with autologous blood after being procured from healthy pigs following 70% in-vivo resection, leaving only the right lateral lobe. Partial human livers were recovered from patients undergoing anatomic right or left hepatectomies and perfused with a blood based perfusate together with various medical additives. Assessment of physiologic function during perfusion was based on markers of hepatocyte, cholangiocyte, vascular and immune compartments, as well as histology.

Results:

Following the development phase with partial swine livers, 21 partial human livers (14 right and 7 left hemi-livers) were perfused, eventually reaching the targeted perfusion duration of 1 week with the final protocol. These partial livers disclosed a stable perfusion with normal hepatic function including bile production (5–10 mL/h), lactate clearance, and maintenance of energy exhibited by normal of adenosine triphosphate (ATP) and glycogen levels, and preserved liver architecture for up to 1 week.

Conclusion:

This pioneering research presents the inaugural evidence for long-term machine perfusion of partial livers and provides a pathway for innovative and relevant clinical applications to increase the availability of organs and provide novel approaches in hepatic oncology.
Effective Senior Surgical Residents as Defined by Their Peers
Authors: Coe Taylor M. , Jogerst Kristen M. , Petrusa Emil , Phitayakorn Roy , Lipman Jeremy
Published: August 2021

Objective:

This study aims to define an effective senior resident and understand the process of leadership and nontechnical skill development in the transition from junior to senior surgery resident.

Summary Background:

General surgery residents are responsible for patient care, technically demanding operations, and diverse care team management. However, leadership skill development for the transition from junior to senior resident roles is often overlooked.

Methods:

We conducted 15 semi-structured focus groups with surgery residents from an urban, academic institution. Focus group transcripts were inductively coded. Using content analysis and constant comparative methodology, primary codes were refined into categories and organized into higher-level themes.

Results:

Thirty-three general surgery residents completed fifteen focus groups. Six themes were identified. Three themes describe the process of becoming an effective senior resident: how to define a senior resident's scope of practice, the transition process, and the importance of personal investment. Three themes were identified regarding effective seniors: ideal traits, teachable skills, and the team and patient impact.

Conclusions:

Surgery residents define an effective senior resident as the team member with the highest level of experience who manages the big picture of patient care. The transition is improved by personal engagement and acknowledgement of the transition. Ideal traits of effective seniors, including emotional intelligence and inherent personality traits, allow a resident to more naturally assume this role; however, teachable skills, such as communication, expectation setting and competence, can be taught to improve one's effectiveness. The actions of a senior resident impact the team and patient care, underscoring the importance of understanding this role.
Risk Factors for Tumor Positive Resection Margins After Neoadjuvant Chemoradiotherapy for Esophageal Cancer: Results From the Dutch Upper GI Cancer Audit
Authors: Defize Ingmar L. , Goense Lucas , Borggreve Alicia S. , Mook Stella , Meijer Gert J. , Ruurda Jelle P. , van Hillegersberg Richard ,   on behalf of the Dutch Upper GI Cancer Audit Group
Published: August 2021

Objective:

To identify risk factors for tumor positive resection margins after neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy for esophageal cancer.

Summary Background Data:

Esophagectomy after nCRT is associated with tumor positive resection margins in 4% to 9% of patients. This study evaluates potential risk factors for positive resection margins after nCRT followed by esophagectomy.

Methods:

All patients who underwent an elective esophagectomy following nCRT in 2011 to 2017 in the Netherlands were included. A multivariable logistic regression was performed to assess the association between potential risk factors and tumor positive resection margins.

Results:

In total, 3900 patients were included. Tumor positive resection margins were observed in 150 (4%) patients. Risk factors for tumor positive resection margins included tumor length (in centimeters, OR: 1.1, 95% CI: 1.0–1.1), cT4-stage (OR: 3.0, 95% CI: 1.2–6.7), and an Ivor Lewis esophagectomy (OR: 1.6, 95% CI: 1.0–2.6). Predictors associated with a lower risk of tumor positive resection margins were squamous cell carcinoma (OR: 0.4, 95% CI: 0.2–0.7), distal tumors (OR: 0.5, 95% CI: 0.3–1.0), minimally invasive surgery (OR: 0.6, 95% CI: 0.4–0.9), and a hospital volume of >60 esophagectomies per year (OR: 0.6, 95% CI: 0.4–1.0).

Conclusions:

In this nationwide cohort study, tumor and surgical related factors (tumor length, histology, cT-stage, tumor location, surgical procedure, surgical approach, hospital volume) were identified as risk factors for tumor positive resection margins after nCRT for esophageal cancer. These results can be used to improve the radical resection rate by careful selection of patients and surgical approach and are a plea for centralization of esophageal cancer care.
Surgical Management of Retrorectal Tumors
Authors: Aubert Mathilde , Mege Diane , Parc Yann , Rullier Eric , Cotte Eddy , Meurette Guillaume , Zerbib Philippe , Trilling Bertrand , Lelong Bernard , Sabbagh Charles , Lakkis Zaher , Ouaissi Mehdi , Lebreton Gil , Rouanet Philippe , Manceau Gilles , Tuech Jean-Jacques , Piessen Guillaume , Bresler Laurent , Beyer-Berjot Laura , Denost Quentin , Lefèvre Jérémie H , Panis Yves
Published: August 2021

Objective:

To report the largest multicentric experience on surgical management of retrorectal tumors (RRT).

Background:

Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT.

Methods:

Patients operated for RRT in 18 academic French centers were retrospectively included (2000–2019).

Results:

A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 ± 24 (range, 13–107) vs 51 ± 26 (20–105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1–221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3).

Conclusions:

Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.