bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular repair of descending thoracic aortic aneurysms—a mid-term report from the Global Registry for Endovascular Aortic Treatment (GREAT)
Authors: Grassi Viviana , Trimarchi Santi , Weaver Fred , de Beaufort Hector W L , Azzizzadeh Ali , Upchurch Jr Gilbert R , Piffaretti Gabriele , Lomazzi Chiara ,   the GREAT participants
Published: July 2021

OBJECTIVES

The aim of this study was to evaluate the short- to mid-term outcomes of descending thoracic aortic aneurysm (DTAA) repair from the Gore Global Registry for Endovascular Aortic Treatment (GREAT).

METHODS

This is a multicentre sponsored prospective observational cohort registry. The study population comprised those treated for DTAA receiving GORE thoracic aortic devices for DTAA repair between August 2010 and October 2016. Major primary outcomes were early and late survival, freedom from aorta-related mortality and freedom from aorta-related reintervention.

RESULTS

There were 180 (58.1%) males and 130 (41.9%) females: the mean age was 70 ± 11 years (range 18–92). The median maximum DTAA diameter was 60 mm (interquartile range 54–68.8). Technical success was achieved in all patients. Operative mortality, as well as immediate conversion to open repair, was never observed. At the 30-day window, mortality occurred in 4 (1.3%) patients, neurological events occurred in 4 (1.3%) patients (transient ischaemic attacks/stroke n = 3, paraplegia n = 1) and the reintervention rate was 4.5% (n = 14). Estimated survival was 95.6% [95% confidence interval (CI) 92.6–97.4] at 6 months, 92.7% (95% CI 89.1–95.2) at 1 year and 57.3% (95% CI 48.5–65.1) at 5 years. Freedom from aorta-related mortality was 98.3% (95% CI 96.1–99.3) at 6 months, 98.3% (95% CI 96.1–99.3) at 1 year and 92.2% (95% CI 83.4–96.4) at 5 years. Freedom from thoracic endovascular aortic repair (TEVAR)-related reintervention at 5 years was 87.2% (95% CI 81.2–91.4).

CONCLUSIONS

TEVAR for DTAAs using GORE thoracic aortic devices is associated with a low rate of device-related reinterventions and is effective at preventing aorta-related mortality for up to 5 years of follow-up.

Clinical registration number

NCT number: NCT01658787.

Subject collection

161, 164.
How to minimize the circulatory arrest time by using the Thoraflex Hybrid prosthesis: the ‘release and perfuse’ technique
Authors: Piperata Antonio , d’Ostrevy Nicola , Busuttil Olivier , Pernot Mathieu
Published: July 2021

Although the frozen elephant trunk technique permits a complete single-stage treatment in patients with extended thoracic aortic disease, the problem of circulatory arrest time remains unsolved. We propose a simplified use of the Thoraflex Hybrid prosthesis to minimize the circulatory arrest time.
Next-generation sequencing to confirm clinical familial hypercholesterolemia
Authors: Reeskamp Laurens F , Tromp Tycho R , Defesche Joep C , Grefhorst Aldo , Stroes Erik S G , Hovingh G Kees , Zuurbier Linda
Published: July 2021

Background

Familial hypercholesterolemia is characterised by high low-density lipoprotein-cholesterol levels and is caused by a pathogenic variant in LDLR, APOB or PCSK9. We investigated which proportion of suspected familial hypercholesterolemia patients was genetically confirmed, and whether this has changed over the past 20 years in The Netherlands.

Methods

Targeted next-generation sequencing of 27 genes involved in lipid metabolism was performed in patients with low-density lipoprotein-cholesterol levels greater than 5 mmol/L who were referred to our centre between May 2016 and July 2018. The proportion of patients carrying likely pathogenic or pathogenic variants in LDLR, APOB or PCSK9, or the minor familial hypercholesterolemia genes LDLRAP1, ABCG5, ABCG8, LIPA and APOE were investigated. This was compared with the yield of Sanger sequencing between 1999 and 2016.

Results

A total of 227 out of the 1528 referred patients (14.9%) were heterozygous carriers of a pathogenic variant in LDLR (80.2%), APOB (14.5%) or PCSK9 (5.3%). More than 50% of patients with a Dutch Lipid Clinic Network score of ‘probable’ or ‘definite’ familial hypercholesterolemia were familial hypercholesterolemia mutation-positive; 4.8% of the familial hypercholesterolemia mutation-negative patients carried a variant in one of the minor familial hypercholesterolemia genes. The mutation detection rate has decreased over the past two decades, especially in younger patients in which it dropped from 45% in 1999 to 30% in 2018.

Conclusions

A rare pathogenic variant in LDLR, APOB or PCSK9 was identified in 14.9% of suspected familial hypercholesterolemia patients and this rate has decreased in the past two decades. Stringent use of clinical criteria algorithms is warranted to increase this yield. Variants in the minor familial hypercholesterolemia genes provide a possible explanation for the familial hypercholesterolemia phenotype in a minority of patients.
The Scattering: a Family History for a Floating World
Authors: Moran Joe
Published: July 2021

This essay is an experiment in family history, inspired by a journey to scatter my father’s ashes on Scattery – the island in the Shannon estuary where my grandmother was born and raised. It explores how my family’s story illuminates the history of small Irish islands and of two much bigger islands, Ireland and Britain. Island stories replay in microcosm, and with great intensity, broader narratives of Irish and British history since the famine. But they also muddy these narratives with the idiosyncratic, granular experiences of a precise and bounded place. They put human flesh and bones on abstract nouns like family, community, modernity, emigration and exile. In every island story – Scattery as my father’s idyllic land of endless summer, Ireland as the home of sturdy children and happy maidens, Britain as proud island nation taking back control of its borders – lies a fantasy of homogeneity and readability. Even the smallest islands have multilayered histories; and then, as they disperse their peoples across the world as small islands do, those histories keep multiplying. Our journey back to the island may have begun as a search for origins but it ended up revealing the heterogeneity and unrecoverability of the past.
Inhibition of d-alanylation of teichoic acids overcomes resistance of methicillin-resistant Staphylococcus aureus
Authors: Coupri Delphine , Verneuil Nicolas , Hartke Axel , Liebaut Axelle , Lequeux Thierry , Pfund Emmanuel , Budin-Verneuil Aurélie
Published: July 2021

Background

MRSA are high-priority multidrug-resistant pathogens. Although there are still some antibiotics active against MRSA, continuous efforts to discover new antibiotics and treatment strategies are needed because resistance to these new drugs has already been reported.

Objectives

Here we explore if d-alanylation of teichoic acids (TAs) mediated by the dlt operon gene products might be a druggable target to overcome β-lactam-resistance of MRSA.

Methods

MICs and bactericidal effects of several β-lactam antibiotics were monitored in a panel of clinical MRSA strains with genetic or chemically induced deficiency in d-alanylation of TAs. Efficiency of the chemical inhibitor to rescue MRSA-infected larvae of Galleria mellonella as well as its ability to prevent or eradicate biofilms of S. aureus were analysed.

Results

Genetic inactivation of the Dlt system or its chemical inhibition re-sensitizes MRSA to β-lactams. Among the 13 strains, the most pronounced effect was obtained using the inhibitor with imipenem, reducing the median MIC from 16 to 0.25 mg/L. This combination was also bactericidal in some strains and significantly protected G. mellonella larvae from lethal MRSA infections. Finally, inactivation of d-alanylation potentiated the effect of imipenem on inhibition and/or eradication of biofilm.

Conclusions

Our combined results show that highly efficient inhibitors of d-alanylation of TAs targeting enzymes of the Dlt system should be promising therapeutic adjuvants, especially in combination with carbapenems, for restoring the therapeutic efficacy of this class of antibiotics against MRSA.
Fentanyl, Acetylfentanyl and Carfentanil in Impaired Driving Cases: A Review of 270 Cases
Authors: Kiely Elizabeth , Juhascik Matthew
Published: July 2021

The detection of fentanyl (FEN) and FEN analogs has been widely communicated throughout the scientific community. While most of the reporting has been in relation to overdose deaths, these drugs are commonly detected in impaired driving cases. A retrospective study of impaired driving cases analyzed between 2017 and 2019 produced 270 cases positive for FEN, carfentanil (CFEN) and/or acetylfentanyl (AFEN). FEN was the predominant drug found in these 270 cases (65.5%) with concentrations ranging from less than 1.0 to 64 ng/mL. CFEN was found alone in 6.6% cases with three concentrations above 1.0 ng/mL. AFEN was always found when FEN was positive with concentrations ranging from <1.0 to 9.2 ng/mL. Detailed case histories are provided with corresponding toxicology results. Toxicology results show impaired drivers using multiple drugs with a wide range of observed behaviors. The inclusion of these drugs in routine impaired driver toxicology testing is extremely important when attempting to determine their overall prevalence.
Novel approach to removing a steel bar extending from the scrotum to anterior abdominal wall: a case report
Authors: Wen Chen-Yueh , Ho Kai-Hung , Wu Meng-Yu , Lin Jen-Tai , Yu Chia-Cheng , Chen Yin-Shen
Published: July 2021

Foreign body penetration from the scrotum is not rare. If a large and sharp foreign body pierces through an existing wound, it likely must be extended to improve exposure. Therefore, many traumatologists attempt to minimize the surgical wound caused by the removal of the foreign body. We describe a case of a foreign object penetrating from the scrotum to anterior abdominal wall. Our novel surgical approach is safe and feasible to use and provides minimal scarring, thereby allowing rapid recovery.
Enhancing Partner Nation Security: A Mixed-Methods Evaluation of A Peacekeeping Public Health Capacity Building Initiative
Authors: Snowden Bobbi S , Licina Derek , Crowley Kathleen , Migliaccio Gene , Ramsey Sueann
Published: July 2021

Introduction

One way the U.S. Department of Defense (DoD) works to achieve national security is through security cooperation, by way of building and enhancing partner nation capacity. This study evaluated a health-related security cooperation training initiative delivered by the DoD to military peacekeepers. The study specifically examined outcomes of change, including the beginning phase of sustainability.

Materials and Methods

The U.S. DoD employed a train-the-trainer model in Ghana, Rwanda, Senegal, and Uganda to support the African Peacekeeping Rapid Response Partnership program. U.S. instructors trained 192 peacekeepers through 11 training iterations between December 2016 and March 2020. A mixed-method explanatory sequential design was used to explore training outcomes. Quantitatively, three hypotheses were tested using nonparametric statistical analysis. Qualitative analysis of documents was used to inform and contextually understand the quantitative results. This study was submitted to the George Washington University Institutional Review Board and was fully approved (NCR202918).

Results

Quantitative and qualitative results indicated improved short-term public health knowledge and upskill among partner nation participants. There was the beginning of a cascade effect of the partner nations’ ability to autonomously teach tasks and skills to their military to sustain the initiative. Differences in achieving and maintaining change outcomes were related to student characteristics, the training course, and the partner nation.

Conclusions

This research serves as the first published study to empirically examine health-related security cooperation train-the-trainer initiative change outcomes. This research is an essential building block to empirically evaluate and capture change outcomes from security cooperation capacity building training initiatives. The findings and recommendations inform security cooperation policy and associated investments.
Army Urban Augmentation Medical Task Forces for COVID-19: Part 1—Development
Authors: Dire Daniel J , Suter Robert E , Robinson Joe D , Lynn W Scott
Published: July 2021

This article describes how the U.S. Army developed a new ad hoc medical formation, named Urban Augmentation Medical Task Force for the Department of Defense (DoD) in response to the Coronavirus Disease 2019 pandemic in the Continental United States during the spring of 2020. We review the role of the DoD support of the Federal Emergency Management Agency as a part of Defense Support of Civilian Authorities.
Generating neutron-star magnetic fields: three dynamo phases
Authors: Lander S K
Published: July 2021

Young neutron stars (NSs) have magnetic fields in the range 1012–1015 G, believed to be generated by dynamo action at birth. We argue that such a dynamo is actually too inefficient to explain the strongest of these fields. Dynamo action in the mature star is also unlikely. Instead we propose a promising new precession-driven dynamo and examine its basic properties, as well as arguing for a revised mean-field approach to NS dynamos. The precession-driven dynamo could also play a role in field generation in main-sequence stars.
Midterm Outcomes After Low-Profile Visualization Endoluminal Support or Atlas Stent-Assisted Coiling of Intracranial Aneurysms: A Propensity Score Matching Analysis
Authors: Yeon Eung Koo , Cho Young Dae , Yoo Dong Hyun , Kim Jeong Eun , Kim Kang Min , Lee Sung Ho , Cho Won-Sang , Kang Hyun-Seung
Published: July 2021

BACKGROUND

The interplay of various commercially available stents during coil embolization of intracranial aneurysms and their ultimate impact are subject to debate.

OBJECTIVE

To compare midterm outcomes of Low-Profile Visualization Endoluminal Support (LVIS) (MicroVention Inc) and Atlas (Stryker) stent-assisted coiling procedures.

METHODS

A total of 459 intracranial aneurysms subjected to coil embolization using LVIS (n = 318) or Atlas stents (n = 141) between April 2015 and December 2019 were eligible for study. To assess occlusive status postembolization, magnetic resonance angiography and/or conventional angiography were used. The Raymond classification was applied to categorize recanalization. Our analysis was propensity score matched according to probability of stent type deployed.

RESULTS

Eventually, 41 aneurysms (8.9%) displayed recanalization (minor, 28; major, 13) 6 mo after coiling. Patient age (P = .018), sex (P = .015), aneurysmal location (P < .001), and type of aneurysm (P < .001) differed significantly by group. Overall and major recanalization rates at midterm were similar in both groups (9.1% and 8.5% vs 3.1% and 2.1%, respectively), and there was no significant difference even after 1:1 propensity score matching (odds ratio [OR] = 0.75 [P = .514] and OR = 0.75 [P = .706], respectively).

CONCLUSION

In stent-assisted coil embolization of intracranial aneurysms, midterm outcomes of LVIS and Atlas device groups were similar, despite theoretic LVIS superiority. Further randomized comparative studies are needed to confirm our findings.
Monetary policy expectations and sovereign risk dynamics in the Eurozone
Authors: Bratis Theodoros , Laopodis Nikiforos T , Kouretas Georgios P
Published: July 2021

We empirically assess the dynamic linkages among sovereign bond yield spreads (both short- and long-term) and monetary policy rates/spreads during the Eurozone’s sovereign and banking crises in the post-2008 period when unconventional monetary policy replaced conventional policy. Our focus is on two subperiods, the crisis period (30 November 2009 to 25 July 2012) and the tranquil period (26 July 2012 to 30 April 2014). For the first subperiod, we noted significant spillovers from the overnight interest spreads spread to almost all sovereign bond yield spreads, at both the mean and volatility levels. Thus, during that period expectations on monetary surprises led bond spreads and their corresponding volatilities compared to the tranquil period, regardless of the bond yields maturities. Overall, we infer that monetary policy and sovereign risk were highly linked during the crisis period and thus, the interest-rate monetary policy transmission mechanism was effective in reducing these yield spreads.
Mechanisms of far-red light-mediated dampening of defense against Botrytis cinerea in tomato leaves
Authors: Courbier Sarah , Snoek Basten L , Kajala Kaisa , Li Linge , van Wees Saskia C M , Pierik Ronald
Published: July 2021

Plants detect neighboring competitors through a decrease in the ratio between red and far-red light (R:FR). This decreased R:FR is perceived by phytochrome photoreceptors and triggers shade avoidance responses such as shoot elongation and upward leaf movement (hyponasty). In addition to promoting elongation growth, low R:FR perception enhances plant susceptibility to pathogens: the growth–defense tradeoff. Although increased susceptibility in low R:FR has been studied for over a decade, the associated timing of molecular events is still unknown. Here, we studied the chronology of FR-induced susceptibility events in tomato (Solanum lycopersicum) plants pre-exposed to either white light (WL) or WL supplemented with FR light (WL+FR) prior to inoculation with the necrotrophic fungus Botrytis cinerea (B.c.). We monitored the leaf transcriptional changes over a 30-h time course upon infection and followed up with functional studies to identify mechanisms. We found that FR-induced susceptibility in tomato is linked to a general dampening of B.c.-responsive gene expression, and a delay in both pathogen recognition and jasmonic acid-mediated defense gene expression. In addition, we found that the supplemental FR-induced ethylene emissions affected plant immune responses under the WL+FR condition. This study improves our understanding of the growth–immunity tradeoff, while simultaneously providing leads to improve tomato resistance against pathogens in dense cropping systems.
Operational challenges in the implementation of an anti-stigma campaign in rural Andhra Pradesh, India
Authors: Kallakuri Sudha , Kaur Amanpreet , Hackett Maree L , Maulik Pallab K
Published: July 2021

Background

Despite of literature available on mental health-related stigma interventions, little is reported about the operational challenges faced during the planning, implementation and evaluation phases.

Methods

The Systematic Medical Appraisal, Referral and Treatment Mental Health Project was implemented in 42 villages of the West Godavari district in India. Andersen’s Behavioural Model for Health Services Use was adopted to understand the factors influencing anti-stigma campaign delivery and the strategies identified to overcome these challenges.

Results

The challenges faced during the planning and implementation phase included distance and time taken for travel by the field staff, inadequate mental health services and infrastructure within communities, engagement of community with the field staff and community’s poor mental health literacy and knowledge. Strategies used to overcome these challenges were regular engagement with community stakeholders, understanding mental health literacy levels and seeking inputs from the community regarding campaign design, organizing live drama shows at community’s preferred time and place and screening of recorded drama video clips where lives shows were difficult. The evaluation phase posed challenges such as non-availability of key stakeholders and inadequate time and funding to evaluate the entire study population.

Conclusion

The reported findings can help in planning and scaling up of the anti-stigma campaign in large trials in similar settings.
Predictors of poor function in RA based on two prospective UK inception cohorts. Do comorbidities matter?
Authors: Busby Amanda D , Wason James , Pratt Arthur G , Young Adam , Isaacs John D , Nikiphorou Elena
Published: July 2021

Objectives

Evidence suggests that factors beyond disease activity associate with functional disability in RA. The primary study objective was to explore associations between comorbidities, sociodemographic factors and functional outcomes at five and 10 years.

Methods

RA patients from two UK prospective cohorts were grouped into low (<1.5) and high (≥1.5) five- and 10-year health assessment questionnaire (HAQ) score. Clinical variables (e.g. disease activity, rheumatoid nodules, erosions) and sociodemographic factors (e.g. ethnicity, deprivation) were recorded at baseline and yearly thereafter. Comorbidity was measured using the Rheumatic Diseases Comorbidity Index (RDCI). Binary logistic regression models were fitted using multiple imputation.

Results

In total, 2701 RA patients were recruited (mean age 56.1 years, 66.9% female). A total of 1718 (63.4%) had five-year and 820 (30.4%) 10-year follow-up data. In multivariable analysis, no association was found between RDCI and HAQ ≥ 1.5 at five or 10 years. Sociodemographic factors (increased age at disease onset, female gender, minority ethnicity) were associated with higher odds of HAQ ≥ 1.5 at five and 10 years, with worse deprivation additionally associated with HAQ ≥ 1.5 at 10 years (OR 0.79, 95% CI: 0.69, 0.90).

Conclusion

Comorbidities at baseline have not been found to be associated with worse RA functional outcome in the long-term. On the other hand, sociodemographic factors, independently of disease measures, are associated with worse functional outcome in RA at five and 10 years, in models adjusting for comorbidity burden. Tailoring management interventions according to not only clinical disease parameters but also patient sociodemographic factors may improve long-term outcomes including functional disability.
A 5-YEAR RETROSPECTIVE ANALYSIS OF IONIZING RADIATION DOSE TO HYBRID OPERATING ROOM PERSONNEL IN SAUDI ARABIA
Authors: Almalki Musaed , Alashban Yazeed , Shubayr Nasser
Published: July 2021

The annual average effective dose (ED) for operating room personnel (ORP) in Saudi Arabia was estimated from the period of 2015–2019 using thermoluminescent dosemeters. A retrospective analysis was conducted on annual EDs for 7530 ORP working across 52 hospitals. These workers were only exposed to radiation in the operating room. The annual average ED over the period of 5 years was found to be 0.59 mSv with no incidence of a dose above the annual dose limit of 20 mSv. The maximum annual ED reported was 15 mSv for an operating room worker in 2019. More than 88% of the workers received an annual ED of <1 mSv. The study concluded that the work environment in hybrid operating rooms across Saudi Arabia is safe. However, it is always recommended that workers take every protective measure when dealing with ionization radiation.
Overexpression ofMdVQ37reduces drought tolerance by altering leaf anatomy and SA homeostasis in transgenic apple
Authors: Dong Qinglong , Duan Dingyue , Zheng Wenqian , Huang Dong , Wang Qian , Yang Jie , Liu Changhai , Li Chao , Gong Xiaoqing , Li Cuiying , Ma Fengwang , Mao Ke
Published: July 2021

Drought stress is an environmental factor that seriously threatens plant growth, development and yield. VQ proteins are transcriptional regulators that have been reported to be involved in plant growth, development and the responses to biotic and abiotic stressors. However, the relationship between VQ proteins and drought stress has not been well documented in plants. In this study, overexpressing the apple VQ motif-containing protein (MdVQ37) gene in apple plants markedly reduced the tolerance to drought. Physiological and biochemical studies further demonstrated lower enzymatic activities and decreased photosynthetic capacity in transgenic lines compared with wild-type (WT) plants under drought stress. Ultrastructural analysis of leaves showed that the leaves and palisade tissues from the transgenic lines were significantly thinner than those from WT plants. Salicylic acid (SA) analysis indicated that overexpression of MdVQ37 increased the accumulation of 2,5-DHBA by up-regulating the expression of the SA catabolic gene, which ultimately resulted to a significant reduction in endogenous SA content and the disruption of the SA-dependent signaling pathway under drought stress. Applying SA partially increased the survival rate of the transgenic lines under drought stress. These results demonstrate that the regulatory function of apple MdVQ37 is implicated in drought stress, through a change in leaf development and SA homeostasis. This study provides novel insight into understanding the multiple functions of VQ proteins.
Rabies and the pandemic: lessons for One Health
Authors: Nadal Deborah , Beeching Sarah , Cleaveland Sarah , Cronin Katy , Hampson Katie , Steenson Rachel , Abela-Ridder Bernadette
Published: July 2021

This article examines the impact of coronavirus disease 2019 (COVID-19) on dog-mediated rabies, a neglected tropical disease that remains endemic in >65 countries. A globally agreed strategy for rabies elimination is underpinned by a One Health approach, coordinating human and animal health sectors and engaging communities. We present data on the scale and nature of COVID-19 disruption to rabies control programmes and the wider learning for One Health implementation. We argue that the global shift in health priorities caused by the pandemic, and consequent side-lining of animal health, will have broader ramifications for One Health implementation and preparedness for future emergent zoonoses.
Biocontrol Activity ofBacillusspp. andPseudomonasspp. AgainstBotrytis cinereaand Other Cannabis Fungal Pathogens
Authors: Balthazar Carole , Novinscak Amy , Cantin Gabrielle , Joly David L. , Filion Martin
Published: July 2021

Gray mold caused by Botrytis cinerea is one of the most widespread and damaging diseases in cannabis crops worldwide. With challenging restrictions on pesticide use and few effective control measures, biocontrol agents are needed to manage this disease. The aim of this study was to identify bacterial biocontrol agents with wide-spectrum activity against B. cinerea and other cannabis fungal pathogens. Twelve Bacillus and Pseudomonas strains were first screened with in vitro confrontational assays against 10 culturable cannabis pathogens, namely B. cinerea, Sclerotinia sclerotiorum, Fusarium culmorum, F. sporotrichoides, F. oxysporum, Nigrospora sphaerica, N. oryzae, Alternaria alternata, Phoma sp., and Cercospora sp. Six strains displaying the highest inhibitory activity, namely Bacillus velezensis LBUM279, FZB42, LBUM1082, Bacillus subtilis LBUM979, P. synxantha LBUM223, and P. protegens Pf-5, were further assessed in planta where all, except LBUM223, significantly controlled gray mold development on cannabis leaves. Notably, LBUM279 and FZB42 reduced disease severity by at least half compared with water-treated plants and prevented lesion development and/or sporulation up to 9 days after pathogen inoculation. Genomes of LBUM279, LBUM1082, and LBUM979 were sequenced de novo and taxonomic affiliations were determined to ensure nonrelatedness with pathogenic strains. Moreover, the genomes were exempt of detrimental genes encoding major toxins and virulence factors that could otherwise pose a biosafety risk when used on crops. Eighteen gene clusters of potential biocontrol interest were also identified. To our knowledge, this is the first reported attempt to control cannabis fungal diseases in planta by direct antagonism with beneficial bacteria.
Mini-invasive Osteotomy for Pediatric Distal Radius Malunion
Authors: Pääkkönen Markus
Published: July 2021

Although most malunions after pediatric distal radius fractures will remodel as the child grows, adolescent patients with severe malunion and limited growth require reduction to restore alignment. The authors technique for a mini-invasive osteotomy is presented. The apex of the malunion is approached from a single 2 cm volar incision through the flexor carpi radialis sheath. Open wedge osteotomy is performed. The osteosynthesis is secured with an individually contoured T-plate. The procedure was used to correct a severe visible malunion in a 12-year-old girl. Normal alignment was achieved with no nerve or tendon injury or irritation, infection, refracture, or any other complication. Mini-invasive osteotomy with a volar plate is a feasible method for experienced hand surgeons for the treatment of distal radius malunion in adolescents.
Correlation of Measures From the OCULUS Keratograph and Clinical Assessments of Dry Eye Disease in the Dry Eye Assessment and Management Study
Authors: Sutphin John E. , Ying Gui-shuang , Bunya Vatinee Y. , Yu Yinxi , Lin Meng C. , McWilliams Kathleen , Schmucker Elizabeth , Kuklinski Eric J. , Asbell Penny A. , Maguire Maureen G. ,   for the Dry Eye Assessment and Management (DREAM) Study Research Group
Published: July 2021

Purpose:

The purpose of this study was to compare objective, noninvasive assessments of tear function using the OCULUS Keratograph with the corresponding clinical assessments [tear break-up time (TBUT), Schirmer test, and bulbar erythema] among patients with moderate-to-severe dry eye disease.

Methods:

Participants in the Dry Eye Assessment and Management study at centers having an OCULUS Keratograph were assessed using standardized procedures. Associations between the assessments from the Keratograph [noninvasive keratograph break-up time (NIKBUT), tear meniscus height (TMH), and bulbar redness (BR)] and clinical examination (TBUT, Schirmer test, and bulbar erythema) and between these test results and Ocular Surface Disease Index (OSDI) scores were summarized with Spearman correlation coefficients (rs); 95% confidence intervals (95% CI) accounted for intereye correlation.

Results:

Among 288 patients (576 eyes), the mean (standard deviation) age was 56.6 (13.8) years, 78.1% were female, and the mean baseline OSDI score was 44.3 (14.0). The mean was 2.9 (1.5) seconds for TBUT and 8.2 (5.7) seconds for NIKBUT (their correlation rs= 0.18, 95% CI = 0.09–0.28). The mean was 10.6 (7.6) mm for the Schirmer test and 0.3 (0.2) mm for TMH (rs= 0.15, 95% CI = 0.04–0.25). The median clinical grade redness was mild, and the mean BR score was 1.1 (0.5) (rs= 0.25, 95% CI = 0.15–0.35). Correlation between results of each of the 6 tests and OSDI scores was low (rsfrom −0.07 to 0.05).

Conclusions:

In the Dry Eye Assessment and Management study, NIKBUT, TMH, and BR were weakly correlated with their clinical counterparts. No measurements were correlated with the OSDI score.
Ocular Surface Squamous Neoplasia With Coexistent Microbial Keratitis: Incidence, Risk Factors, Clinical Features, Microbiological Profile, and Treatment Outcome
Authors: Kapoor Anasua G. , Vempuluru Vijitha S. , Laghimshetty Srujana , Roy Aravind , Sharma Savitri , Mishra Dilip K. , Mohamed Ashik , Kaliki Swathi
Published: July 2021

Purpose:

The purpose of this study was to evaluate the incidence, clinical features, microbiology, risk factors, and treatment outcomes in cases of ocular surface squamous neoplasia (OSSN) with coexisting microbial keratitis (MK).

Methods:

This was a retrospective case–control study from a cohort of 939 cases with OSSN.

Results:

Twenty eyes (2%) with OSSN and MK were included in the study group and 100 age-matched eyes with only OSSN as controls. Most common presentation was a combination of pain, redness, watering, and decreased vision (50%) over a median duration of 14 days. Mean corneal surface involvement by MK was 48% with corneal perforation in 6 cases (30%). Microbiology showed 10 culture positive cases for Gram-positive organisms (n = 5), fungus (n = 4), or mixed infection (n = 1). In the salvaged eyes, MK resolved in 9 eyes (90%) on medical treatment at a mean duration of 30 days and keratoplasty was performed in 1 eye. OSSN treatment included wide excisional biopsy (n = 9/18; 50%), extended enucleation (n = 7/18; 39%), and orbital exenteration in 1. Over a mean follow-up of 12 months, vision salvage was achieved in 7 of 18 (39%) and globe salvage in 10 of 18 (55%). Logistic regression analysis showed the following significant risk factors for MK in OSSN: male sex, human immunodeficiency virus seropositivity, increasing tumor diameter, limbal epicenter, temporal quadrant, noduloulcerative morphology, pigmentation, scleral invasion, keratin, and corneal component of the OSSN lesion.

Conclusions:

Rarely, MK can coexist with OSSN leading to a poor treatment outcome. Male sex, human immunodeficiency virus seropositivity, large limbal pigmented OSSN lesion with keratin and corneal component, noduloulcerative morphology, and scleral invasion were risk factors for this association.
Chronic Ocular Sequelae and Subsequent Surgical Interventions in Stevens–Johnson Syndrome After Amniotic Membrane Transplantation
Authors: Sharma Supriya , Singh Swati , Basu Sayan , Shanbhag Swapna S.
Published: July 2021

Purpose:

The purpose of this study was to describe the chronic ocular sequelae and subsequent surgical interventions after amniotic membrane transplantation (AMT) in a patient with Stevens–Johnson syndrome (SJS).

Methods:

A 30-year-old woman was diagnosed with SJS after taking phenytoin prescribed for generalized tonic–clonic seizures. Bedside AMT covering the eyelid margins, the conjunctiva, and the cornea was performed in both eyes during the acute phase during hospitalization. A repeat AMT was necessary after 5 days. After AMT, she was prescribed topical steroids, antibiotics, and artificial tears. She was asked to follow up every 2 weeks in the first 3 months after AMT.

Results:

Eyelid-related complications such as trichiasis, distichiasis, eyelid margin keratinization (LMK), and cicatricial entropion developed during the follow-up period within the first year after AMT. Eyelid margin mucous membrane graft (MMG) of all eyelids was performed at the earliest clinical sign of lid-related keratopathy due to LMK. The right eye developed upper eyelid and lower eyelid cicatricial entropion, for which anterior lamellar repositioning with eyelid margin MMG was performed. Electroepilation of the trichiatic eyelashes in all 4 eyelids was performed more than once to maintain a healthy ocular surface.

Conclusions:

Successful AMT was performed twice within the first week of ocular involvement in the acute phase of SJS. Chronic ocular sequelae affecting the eyelid margin were identified during the chronic phase and were successfully treated with eyelid margin MMG. Necessity for the close follow-up and the need for subsequent interventions to maintain visual acuity should be explained to patients after acute SJS with ocular involvement.
Impact of COVID-19 Pandemic on Infectious Keratitis Outcomes: A Retrospective Multicenter Study in Tertiary Eye Hospitals of South India
Authors: Christy Josephine S. , Mathews Priya , Rhagavan Anita , Venugopal Anitha , Manohar Divya , Janakiraman Anuja , Gandhi Preethika , Nallobolu Srujana , Akpek Esen K.
Published: July 2021

Purpose:

The purpose of this study was to report the adverse effects of the COVID-19 pandemic on the clinical outcomes of infectious keratitis in South India.

Methods:

Two hundred fifty-eight patients presented with infectious keratitis at 6 tertiary care centers when strict travel restrictions were in place from March 24 to May 31, 2020. Case records were collected retrospectively and analyzed for demographics, type of initial treatment, length of delay in presentation, microbiological diagnosis, clinical course, and final treatment outcome.

Results:

The mean age of the patients was 49.2 years, with most of them (61.2%) being male. Forty-one patients (15.9%) did not receive any treatment for at least a week after the onset of symptoms. One hundred eight patients (41.9%) presented with severe ulcer (32 had a frank perforation). Resolution of the infection was achieved only in 103 patients (45.6%). A total of 90 patients (39.8%) with ulcers had a perforation, yet only 29 patients (32.2%) could receive keratoplasty because of the unavailability of donor tissues. At the end of 6-month follow-up, 47 patients had anatomical failure (loss of globe) and 12 additional patients had functional failure (total permanent vision loss).

Conclusions:

Delay in presentation and acute shortage of donor corneal tissues for emergency keratoplasty because of the COVID-19 pandemic had a grave impact, resulting in irreversible blindness in a significant number of patients.
Assessing Trends in Physician Assistant Student Depression Risk, Suicidal Ideation, and Mental Health Help-Seeking Behavior
Authors: Neary Stephanie , Ruggeri Mary , Roman Christopher
Published: July 2021

Purpose

The purpose of this study was to assess how physician assistant (PA) student depression risk, suicidal ideation, and mental health help-seeking behaviors change during didactic training and the relationship between depression risk and demographic factors.

Methods

Data were obtained through an anonymous online survey sent to didactic students in 7 PA programs during orientation and again at midpoint of the didactic year. Descriptive statistics, independent samples t-testing, and one-way ANOVA analyses were used to assess trends in patient health questionnaire (PHQ-9) scores over the 6-month time period. The PHQ-9 is the module of the PHQ that measures severity of depression risk.

Results

The orientation survey response rate was 82.7% (287/347) and the midpoint survey response rate was 62% (217/350). Analysis revealed that mean PHQ-9 scores increased significantly from 2.49 to 6.42 (p < 0.001) from orientation to midpoint of the didactic year, with 18.9% of students having scores of 10 or greater at midpoint compared to 4.5% at orientation. Thoughts of self-harm and/or suicidal ideation in the past 2 weeks also increased from 3.5% to 7.4% during the same time frame. Additionally, students' likelihood of seeking mental health help decreased between orientation and midpoint despite the concurrent increases in depression risk and suicidal ideation.

Conclusion

Rising PHQ-9 scores indicated an increased risk of major depression among didactic-year PA students. Further research on early screening methods and factors that encourage help-seeking behaviors may serve to inform programs about how to create learning environments that mitigate depression risk and promote wellbeing during professional training.
Does Hyperlipasemia Predict Worse Clinical Outcomes in COVID-19? A Multicenter Retrospective Cohort Study
Authors: Singh Ritu R. , Chhabra Puneet , Kumta Nikhil A.
Published: July 2021

Goal:

We aim to perform a multicenter retrospective cohort study to determine if elevated serum lipase determines clinical outcomes in patients with coronavirus disease 2019 (COVID-19).

Background:

Several cases of acute pancreatitis (AP) have recently been reported in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Most of the evidence is based on elevated serum lipase values without objective demonstration of pancreatic inflammation or necrosis.

Materials and Methods:

A population-based, multicenter, retrospective cohort study utilizing TriNetX was performed to obtain aggregated health records of ∼69 million patients from 49 health care organizations from January 1, 2020, to December 31, 2020. Adult patients (18 y and above) diagnosed with COVID-19 were identified using appropriate International Classification of Diseases, 10th Revision (ICD-10) codes and were stratified into 2 groups, with elevated (≥180 U/L) and with normal (≤80 U/L) serum lipase. The primary outcome was 30-day mortality; other outcomes were 30-day rehospitalization, need for mechanical ventilation, need for vasopressor use, acute kidney injury.

Results:

A total of 435,731 adult patients with COVID-19 were identified, and 1406 of them had elevated serum lipase which was associated with higher 30-day mortality [risk ratio (RR)=1.53, P<0.001], risk of acute kidney injury (RR=1.5, P=0.003), and vasopressor use (RR=1.69, P<0.001) without any difference in 30-day rehospitalization (RR=0.98, P=0.54), or need for mechanical ventilation (RR=1.20, P=0.26). The negative predictive value of normal serum lipase for 3-month mortality in patients with COVID-19 was 91%.

Conclusions:

Patients with COVID-19 who have elevated serum lipase experience worse clinical outcomes even in the absence of AP. If these findings can be replicated in prospective studies, serum lipase can be utilized as a marker of disease severity in patients with COVID-19.
Rhodococcus spongiicola sp. nov. and Rhodococcus xishaensis sp. nov., from marine sponges
Authors: Zhang Die , Su Zhi-you , Li Lei , Tang Wei-zhuo
Published: July 2021

Two novel

Rhodococcus

strains, LHW50502T and LHW51113T, were isolated from marine sponges obtained on Xisha Island, Hainan Province, PR China. Rods and cocci, typical characteristics of the genus

Rhodococcus

, were observed. The strains contained meso-diaminopimelic acid as the diagnostic diamino acid in the cell-wall hydrolysates and galactose, arabinose, ribose and glucose as the whole-cell sugars. The major fatty acid identified was C16 : 0. MK-8(H4) was the predominat menaquinone of both strains. Stains LHW50502T and LHW51113T had almost identical (99.6 %) 16S rRNA gene sequences but shared relatively low similarities with previously characterized

Rhodococcus

species (well below 98.7 %). The results of phylogenetic analysis supported their closest relationship; however, the average nucleotide identity and digital DNA–DNA hybridization values between these two strains indicated that they belonged to distinct species. Taken together, the results of this study indicate that strains LHW50502T and LHW51113T represent two novel species of the genus

Rhodococcus

, for which the names Rhodococcus spongiicola sp. nov. (type strain LHW50502T=DSM 106291T=CCTCC AA 2018033T) and Rhodococcus xishaensis sp. nov. (type strain LHW51113T=DSM 106204T=CCTCC AA 2018034T) are proposed.
Pedobacter endophyticus sp. nov., an endophytic bacterium isolated from Carex pumila
Authors: Peng Yuxin , Jiang Lingmin , Seo Jiyoon , Li Zhun , Choe Hanna , Jeong Jae Cheol , Kim Suk Weon , Kim Young-Min , Kim Cha Young , Lee Jiyoung
Published: July 2021

An aerobic, Gram-stain-negative, weak-motile, short-rod-shaped bacterial strain, designated JBR3-12T, was isolated from halophyte Carex pumila plants, and its taxonomic position was investigated by using a polyphasic taxonomic approach. The strain produced a pink pigment on tryptic soy agar and grew optimally at 25 °C, pH 8 and in the presence of 3 % (w/v) NaCl. Results of phylogenetic analysis based on 16S rRNA gene sequences showed that strain JBR3-12T formed a lineage within the genus

Pedobacter

and was most closely related to

Pedobacter sandarakinus

DS-27T (98.0 %) and

Pedobacter agri

PB92T (97.6 %). The DNA G+C content of the genome was 41.3 mol%; the whole genome length was 5 426 070 bp. The major fatty acids of JBR3-12T were iso-C15 : 0, summed feature 3 (comprising C16 : 1
 ω6c and/or C16 : 1
 ω7c) and iso-C17 : 0 3-OH. The predominant polar lipid was phosphatidylethanolamine. The predominant quinone was menaquinone-7. Based on its phenotypic, phylogenetic and genotypic features, strain JBR3-12T is proposed to represent a novel species of the genus

Pedobacter

, for which the name is Pedobacter endophyticus sp. nov. The type strain is JBR3-12T (=KCTC 82363T=NBRC 114901T).
Validation and performance evaluation of a novel interferon-γ release assay for the detection of SARS-CoV-2 specific T-cell response
Authors: Huzly Daniela , Panning Marcus , Smely Franziska , Enders Martin , Komp Johanna , Steinmann Daniel
Published: July 2021

Background

The reliable detection of the T-cell mediated response to COVID-19 or COVID-19 vaccination is important for individual patient care and for monitoring the immune response e.g. in COVID-19 vaccine trials in a standardized fashion.

Methods

We used blood samples from health care workers (HCW) with or without history of COVID-19 to define test accuracy of a novel interferon-release assay. Usefulness of qualitative and quantitative results after COVID-19 vaccination was examined in HCW receiving homologous or heterologous vaccination regimens. For a real-life performance evaluation, we analysed interferon-response to complete vaccination in 149 patients receiving immunosuppressive or immune modulating therapies.

Results

Using a double-cut-off strategy integrating the result of background stimulation the assay had a specificity of 100%. Sensitivity of the IGRA was 83.5 and 100% in HCW after SARS-CoV-2 infection more or less than 6 months ago. Quantitative results showed significant differences between first and second vaccine dose, but no difference between homologous and heterologous vaccination regimen. The majority of immunocompromised patients showed no immune response or isolated T-cell or antibody response to complete vaccination.

Conclusions

The novel IGRA proved to be a highly specific and sensitive tool to detect the SARS-CoV-2 specific T-cell response to COVID-19 as well as COVID-19 vaccination. In perspective, it may serve as a standardized tool in COVID-19 vaccine trials and in clinical care of immunosuppressed patients.
Plasma cell-free DNA promise disease monitoring and tissue injury assessment of COVID-19
Authors: Jin Xin , Wang Yanqun , Xu Jinjin , Li Yimin , Cheng Fanjun , Luo Yuxue , Zhou Haibo , Lin Shanwen , Xiao Fei , Zhang Lu , Lin Yu , Zhang Zhaoyong , Jin Yan , Zheng Fang , Chen Wei , Zhu Airu , Tao Ye , Zhao Jingxian , Kuo Tingyou , Li Yuming , Li Lingguo , Wen Liyan , Ou Rijing , Li Fang , Lin Long , Zhang Yanjun , Sun Jing , Yuan Hao , Zhuang Zhen , Sun Haixi , Chen Zhao , Li Jie , Zhuo Jianfen , Chen Dongsheng , Zhang Shengnan , Sun Yuzhe , Wei Peilan , Yuan Jinwei , Xu Tian , Yang Huanming , Wang Jian , Xu Xun , Zhong Nanshan , Xu Yonghao , Sun Kun , Zhao Jincun
Published: July 2021

COVID-19 is a huge threat to global health. Due to the lack of definitive etiological therapeutics currently, effective disease monitoring is of high clinical value for better healthcare and management of the large number of COVID-19 patients. In this study, we recruited 37 COVID-19 patients, collected 176 blood samples upon diagnosis and during treatment, and analyzed cell-free DNA (cfDNA) in these samples. We report gross abnormalities in cfDNA of COVID-19 patients, including elevated GC content, altered molecule size and end motif patterns. More importantly, such cfDNA characteristics reflect patient-specific physiological conditions during treatment. Further analysis on tissue origin tracing of cfDNA reveals frequent tissue injuries in COVID-19 patients, which is supported by clinical diagnoses. Hence, we demonstrate the translational merit of cfDNA as valuable analyte for effective disease monitoring, as well as tissue injury assessment in COVID-19 patients.
Better individual-level risk models can improve the targeting and life-saving potential of early-mortality interventions
Authors: Hazlett Chad , Ramos Antonio P. , Smith Stephen
Published: July 2021

Infant mortality remains high and uneven in much of sub-Saharan Africa. Even low-cost, highly effective therapies can only save lives in proportion to how successfully they can be targeted to those children who, absent the treatment, would have died. This places great value on maximizing the accuracy of any targeting or means-testing algorithm. Yet, the interventions that countries deploy in hopes of reducing mortality are often targeted based on simple models of wealth or income or a few additional variables. Examining 22 countries in sub-Saharan Africa, we illustrate the use of flexible (machine learning) risk models employing up to 25 generally available pre-birth variables from the Demographic and Health Surveys. Using these models, we construct risk scores such that the 10 percent of the population at highest risk account for 15-30 percent of infant mortality, depending on the country. Successful targeting in these models turned on several variables other than wealth, while models that employ only wealth data perform little or no better than chance. Consequently, employing such data and models to predict high-risk births in the countries studied flexibly could substantially improve the targeting and thus the life-saving potential of existing interventions.