bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-time monitoring of subcellular H2O2 distribution in Chlamydomonas reinhardtii
Authors: Niemeyer Justus , Scheuring David , Oestreicher Julian , Morgan Bruce , Schroda Michael
Published: June 2021

Hydrogen peroxide (H2O2) is recognized as an important signaling molecule in plants. We sought to establish a genetically encoded, fluorescent H2O2 sensor that allows H2O2 monitoring in all major subcompartments of a Chlamydomonas cell. To this end, we used the Chlamydomonas Modular Cloning toolbox to target the hypersensitive H2O2 sensor reduction–oxidation sensitive green fluorescent protein2-Tsa2ΔCR to the cytosol, nucleus, mitochondrial matrix, chloroplast stroma, thylakoid lumen, and endoplasmic reticulum (ER). The sensor was functional in all compartments, except for the ER where it was fully oxidized. Employing our novel sensors, we show that H2O2 produced by photosynthetic linear electron transport (PET) in the stroma leaks into the cytosol but only reaches other subcellular compartments if produced under nonphysiological conditions. Furthermore, in heat-stressed cells, we show that cytosolic H2O2 levels closely mirror temperature up- and downshifts and are independent from PET. Heat stress led to similar up- and downshifts of H2O2 levels in the nucleus and, more mildly, in mitochondria but not in the chloroplast. Our results thus suggest the establishment of steep intracellular H2O2 gradients under normal physiological conditions with limited diffusion into other compartments. We anticipate that these sensors will greatly facilitate future investigations of H2O2 biology in plant cells.
TIR signal promotes interactions between lipase-like proteins and ADR1-L1 receptor and ADR1-L1 oligomerization
Authors: Wu Zhongshou , Tian Lei , Liu Xueru , Zhang Yuelin , Li Xin
Published: June 2021

TIR signaling promotes the interactions between lipase-like proteins EDS1/PAD4 and ADR1-L1 immune receptor, and oligomerization of ADR1-L1.
A Note on the Concordance Invariant Epsilon
Authors: Wang Shida
Published: June 2021

We compare the smooth concordance invariants Upsilon, phi and epsilon. Previous work gave examples of knots with one of the Upsilon and phi invariants zero but the epsilon invariant nonzero. We build an infinite family of linearly independent knots with both the Upsilon and phi invariants zero but the epsilon invariant nonzero. This provides examples of knots with arbitrarily large concordance genus but vanishing bounds from the Upsilon and phi invariants.
Novel Integrative Modeling of Molecules and Morphology across Evolutionary Timescales
Authors: Ogilvie Huw A , Mendes Fábio K , Vaughan Timothy G , Matzke Nicholas J , Stadler Tanja , Welch David , Drummond Alexei J
Published: June 2021

Evolutionary models account for either population- or species-level processes but usually not both. We introduce a new model, the FBD-MSC, which makes it possible for the first time to integrate both the genealogical and fossilization phenomena, by means of the multispecies coalescent (MSC) and the fossilized birth–death (FBD) processes. Using this model, we reconstruct the phylogeny representing all extant and many fossil Caninae, recovering both the relative and absolute time of speciation events. We quantify known inaccuracy issues with divergence time estimates using the popular strategy of concatenating molecular alignments and show that the FBD-MSC solves them. Our new integrative method and empirical results advance the paradigm and practice of probabilistic total evidence analyses in evolutionary biology.[Caninae; fossilized birth–death; molecular clock; multispecies coalescent; phylogenetics; species trees.]
Fast and Accurate Estimation of Species-Specific Diversification Rates Using Data Augmentation
Authors: Maliet Odile , Morlon Hélène
Published: June 2021

Diversification rates vary across species as a response to various factors, including environmental conditions and species-specific features. Phylogenetic models that allow accounting for and quantifying this heterogeneity in diversification rates have proven particularly useful for understanding clades diversification. Recently, we introduced the cladogenetic diversification rate shift model, which allows inferring multiple rate changes of small magnitude across lineages. Here, we present a new inference technique for this model that considerably reduces computation time through the use of data augmentation and provide an implementation of this method in Julia. In addition to drastically reducing computation time, this new inference approach provides a posterior distribution of the augmented data, that is the tree with extinct and unsampled lineages as well as associated diversification rates. In particular, this allows extracting the distribution through time of both the mean rate and the number of lineages. We assess the statistical performances of our approach using simulations and illustrate its application on the entire bird radiation.[Birth–death model; data augmentation; diversification; macroevolution.]
Ultrasound-based evaluation of the prevalence of abdominal cystic echinococcosis in the Turkestan region of Kazakhstan
Authors: Mustapayeva Aigerim , Luca D'Alessandro Gian , Doszhanova Gaukhar , Colpani Agnese , Sadybekov Nurbol , Baimakhanov Zhasulan , Assanov Ernar , Salybekov Samat , Kaniyev Shokan , Serikuly Erbol , Tagabayeva Lyazzat , Budke Christine M , Vola Ambra , Mariconti Mara , De Silvestri Annalisa , Yalisheva Sofyia , Sadykova Ainur , Zholdybay Zhamilya , Katarbayev Adil , Zhakenova Zhanar , Brunetti Enrico , Juszkiewicz Konrad , Duisenova Amangul , Manciulli Tommaso
Published: June 2021

Background

Human cystic echinococcosis (CE) is a zoonotic disease caused by Echinococcus granulosus sensu lato. CE is known to be endemic in some parts of Central Asia. We present findings from an ultrasound-based survey to estimate the prevalence of CE in the Turkestan oblast of Kazakhstan.

Methods

In October 2019, six villages were chosen based on records from a national surveillance dataset. Inhabitants aged 5–90 y were invited to undergo a free abdominal ultrasound to screen for CE cysts. All identified cysts were staged according to the WHO-endorsed classification for CE cysts.

Results

A total of 2252 individuals underwent ultrasound screening. Twenty-two (0.98%) individuals had CE, with a combined total of 33 cysts: 25 (75.7%) inactive (14 CE4, 11 CE5) and 8 (24.3%) active/transitional (2 CE1, 1 CE2, 3 CE3a, 2 CE3b). One patient had a postsurgical cavity. Sixty-eight patients (3.0%) reported CE prior to surgical treatment. In 25 (36.8%) previously diagnosed patients, albendazole prophylaxis was not used.

Conclusions

CE is endemic in the study region, with ongoing transmission. The number of surgically treated CE patients suggests an underestimation of the disease burden by the current surveillance system. Further studies on local CE epidemiology and the implementation of expert treatment recommendations are needed.
Phylogenetic assessment and systematic revision of the acoel family Isodiametridae
Authors: Atherton Sarah , Jondelius Ulf
Published: June 2021

Isodiametridae is a large family of Acoela with 22 nominal genera and nearly 100 species. Unfortunately, systematics of Isodiametridae, as it stands, is highly problematic. Genera frequently have been proposed without reference to an explicit phylogenetic hypothesis, such that the current classification system holds little or no predictive power. Many taxa do not fit with the family diagnosis, and it is increasingly difficult to determine in which taxon a new species should be described. Herein, we reconstruct the phylogenetic relationships of Acoela with a focus on Isodiametridae using both previously published and new ribosomal and mitochondrial sequence data. Our dataset comprises sequences from 45 species representing 16 of the 22 isodiametrid genera. Our results recovered a well-supported Isodiametridae, but provided further evidence that the family and several genera within require revision. We have updated the classification system of Isodiametridae to be consistent with its phylogeny, including the transference of Otocelis to Otocelididae, Postaphanostoma and Faerlea to Mecynostomidae and Alluna to Actinoposthiidae. Six other genera are placed in synonymy. We review the morphological taxonomy and provide an identification key of the genera in the revised family.
Workplace-Based Entrustment Scales for the Core EPAs: A Multisite Comparison of Validity Evidence for Two Proposed Instruments Using Structured Vignettes and Trained Raters
Authors: Ryan Michael S. , Khan Asra R. , Park Yoon Soo , Chastain Cody , Phillipi Carrie , Santen Sally A. , Barron Beth A. , Obeso Vivian , Yingling Sandra L. ,   for the Core Entrustable Professional Activities for Entering Residency Pilot Program
Published: June 2021

Purpose

In undergraduate medical education (UME), competency-based medical education has been operationalized through the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs). Direct observation in the workplace using rigorous, valid, reliable measures is required to inform summative decisions about graduates’ readiness for residency. The purpose of this study is to investigate the validity evidence of 2 proposed workplace-based entrustment scales.

Method

The authors of this multisite, randomized, experimental study used structured vignettes and experienced raters to examine validity evidence of the Ottawa scale and the UME supervisory tool (Chen scale) in 2019. The authors used a series of 8 cases (6 developed de novo) depicting learners at preentrustable (less-developed) and entrustable (more-developed) skill levels across 5 Core EPAs. Participants from Core EPA pilot institutions rated learner performance using either the Ottawa or Chen scale. The authors used descriptive statistics and analysis of variance to examine data trends and compare ratings, conducted interrater reliability and generalizability studies to evaluate consistency among participants, and performed a content analysis of narrative comments.

Results

Fifty clinician-educators from 10 institutions participated, yielding 579 discrete EPA assessments. Both Ottawa and Chen scales differentiated between less- and more-developed skill levels (P < .001). The interclass correlation was good to excellent for all EPAs using Ottawa (range, 0.68–0.91) and fair to excellent using Chen (range, 0.54–0.83). Generalizability analysis revealed substantial variance in ratings attributable to the learner–EPA interaction (59.6% for Ottawa; 48.9% for Chen) suggesting variability for ratings was appropriately associated with performance on individual EPAs.

Conclusions

In a structured setting, both the Ottawa and Chen scales distinguished between preentrustable and entrustable learners; however, the Ottawa scale demonstrated more desirable characteristics. These findings represent a critical step forward in developing valid, reliable instruments to measure learner progression toward entrustment for the Core EPAs.
Does Quantitative Sensory Testing Improve Prediction of Chronic Pain Trajectories? A Longitudinal Study of Youth With Functional Abdominal Pain Participating in a Randomized Controlled Trial of Cognitive Behavioral Treatment
Authors: Morris Matthew C. , Bruehl Stephen , Stone Amanda L. , Garber Judy , Smith Craig , Palermo Tonya M. , Walker Lynn S.
Published: June 2021

Objectives:

Youth with functional abdominal pain (FAP) experience significant pain-related distress and functional impairment. Although quantitative sensory testing protocols have identified alterations in pain modulatory systems that distinguish youth with FAP from healthy controls, the extent to which evoked pain responses predict subsequent trajectories of pain symptoms and disability over and above established psychosocial risk factors is unclear.

Methods:

The present study included 183 adolescents with FAP who were enrolled in a randomized controlled trial comparing an 8-week, internet-delivered program of cognitive behavior therapy (n=90) or pain education (n=93). Participants completed a quantitative sensory testing protocol before the intervention and were followed for 12-month posttreatment.

Results:

Whereas adolescents with FAP who exhibited stronger baseline conditioned pain modulation (CPM) reported decreases in pain-related interference over follow-up (b=−0.858, SE=0.396,P=0.032), those with weaker CPM exhibited high, relatively stable levels of pain-related interference over time (b=−0.642, SE=0.400,P=0.110). CPM status predicted changes in pain-related interference after controlling for the effects of treatment condition and psychosocial risk factors. Static measures of pain sensitivity (ie, pain threshold, pain tolerance) and temporal summation of second pain were not associated with changes in measures of abdominal pain, gastrointestinal symptom severity, or pain-related interference over follow-up.

Discussion:

The present findings contribute to a growing literature on the predictive utility of quantitative sensory testing indices and suggest that CPM may complement existing psychosocial risk measures in determining individualized pain-related risk profiles.
Use of External Tissue Expanders to Assist in Reverse Sural Flap Donor Site Closure
Authors: Cox Cameron , Gaschen Paul D. , Foley David , MacKay Brendan
Published: June 2021

Background:

Complex lower extremity injuries can cause large soft tissue defects that require reconstruction. In the distal third of the lower leg, the reverse sural artery fasciocutaneous flap is a viable coverage option due to its versatility, vascular supply, and ability to cover larger defects than other local pedicled flaps. Although advances in techniques have improved reliability of reverse sural flaps, complications such as donor site morbidity remain a challenge for surgeons. Donor wounds may be difficult to close, and delayed closure can increase the risk for infection and other postoperative complications. In these cases, donor site skin grafting can cause additional morbidity and/or mobility restrictions.

Methods:

In this case series, 16 patients underwent reconstruction with large reverse sural artery fasciocutaneous flaps and a continuous external tissue expander to assist in donor site closure.

Results:

One patient was lost to follow-up. All donor sites healed without complication with an average time to healing of 9.2 weeks (n = 15, range: 3–18). At the most recent follow-up, all flaps survived without complication.

Conclusions:

Given our success in 100% of patients, we purport that this system of enhanced closure may be a valuable adjunctive therapy in closing reverse sural artery fasciocutaneous flaps. We believe that this method may be useful in closing other difficult donor wounds.
ACUTE IDIOPATHIC MACULOPATHY
Authors: Pajtler Rosar Ana , Casalino Giuseppe , Cozzi Mariano , Pellegrini Marco , Bottoni Ferdinando , Dell'Arti Laura , Lavric Alenka , Umek Lan , Globocnik Petrovic Mojca , Pavesio Carlos , Vidovič Valentinčič Nataša , Staurenghi Giovanni
Published: June 2021

Purpose:

To describe the clinical course and the multimodal imaging of acute idiopathic maculopathy.

Methods:

Medical records and multimodal imaging including color fundus photography, optical coherence tomography, and fundus autofluorescence were retrospectively reviewed. Recognition of the fundus autofluorescence patterns and their relationship with the disease duration, best-corrected visual acuity, and optical coherence tomography features represented the main outcome measures.

Results:

Seventeen eyes of 16 patients (7 women; mean age 29.9 years) with a mean follow-up of 23.9 months were included. The mean best-corrected visual acuity at presentation was 0.63 ± 0.54 logarithm of the minimum angle of resolution (Snellen equivalent, 20/85). All but one patient had the best-corrected visual acuity recovery to 20/20. Four sequential patterns of fundus autofluorescence corresponding to 4 proposed stages of disease were observed. Patterns 1 (central hypoautofluorescence with surrounding hyperautofluorescence) and 2 (stippled hyperautofluorescence and hypoautofluorescence) were found at presentation. Patterns 3 (central hyperautofluorescence surrounded by hypoautofluorescence) and 4 (hypoautofluorescence) were observed during the disease course and/or at the last follow-up visit. Duration of the disease was significantly different between patterns at baseline and last visit. Pattern 1 significantly related to the presence of subretinal detachment (Fisher's exact test; P =0.003) on optical coherence tomography in comparison with Pattern 2. Pattern 4 showed unique homogeneously decreased autofluorescence with corresponding attenuation of retinal pigment epithelium and restored outer retinal layers on optical coherence tomography.

Conclusion:

A sequential disease staging based on multimodal imaging for acute idiopathic maculopathy is proposed. The recognition of the observed imaging patterns may help clinicians in the correct diagnosis and patient counseling.
Pleurodesis After Bronchial Occlusion for Inoperable Secondary Spontaneous Pneumothorax
Authors: Kida Hirotaka , Muraoka Hiromi , Morikawa Kei , Inoue Takeo , Mineshita Masamichi
Published: June 2021

Background:

In many cases of secondary spontaneous pneumothorax (SSP), surgery is not feasible. Furthermore, in cases with a collapsed lung or numerous air leaks, pleurodesis is ineffective, and treatment options are severely limited. For these cases, bronchial occlusion might be the only effective treatment, despite the low success rate. If, however, bronchial occlusion can expand the lung and reduce air leakage, it can positively amplify later effects on pleurodesis, resulting in a powerful treatment. We reviewed the clinical data of patients who underwent bronchial occlusion with endobronchial Watanabe spigot (BO-EWS) and pleurodesis to investigate the usefulness of bronchial occlusion therapy in inoperable SSP patients.

Materials and Methods:

This single-center, retrospective study reviewed 36 cases of inoperable SSP patients who underwent pleurodesis after BO-EWS from April 2007 to October 2018. Twenty cases were allocated to the air leak analysis group, and 16 cases were included in the pneumothorax volume analysis group. The Robert David Cerfolio classification and the Collins method were used to evaluate air leak and pneumothorax volume, respectively.

Results:

Pneumothorax volumes decreased significantly after BO-EWS from 29.1%±17.3% to 12.1%±8.8%, while the air leak score decreased from 2.9±1.4 to 1.2±1.0. The success rate for chest tube removals in cases that underwent pleurodesis after BO-EWS was 85.0% (17/20).

Conclusions:

This study demonstrated the synergistic effectiveness of BO-EWS and the usefulness of pleurodesis treatment in inoperable SSP patients with lung collapse or numerous air leaks. We believe that this treatment will benefit patients with inoperable SSP which, until now, has had few treatment options.
Laparoscopic spleen-preserving distal pancreatectomy for epidermoid cyst in an intrapancreatic accessory spleen
Authors: Zheng Xiang , Zhou Bo , Sun Jing-Qing , Jin Ming , Yan Sheng
Published: June 2021

Rationale:

Pancreatic tail cystic lesions are increasingly encountered in clinical practice, however, it is difficult to make a correct diagnosis preoperatively because there are many types of pancreatic neoplastic and non-neoplastic cysts. Epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) is a rare non-neoplastic cyst locating in the pancreatic tail, and it is commonly misdiagnosed as another cystic neoplasm.

Patient concerns:

A 51-year-old man was admitted for investigation of abdominal pain. The physical examination and laboratory tests found no abnormalities, except for an elevation of carbohydrate antigen (CA)19-9. Imaging revealed a cystic lesion within the pancreatic tail, and the solid component surrounding the cyst was enhanced similarly to those of the splenic tissue.

Diagnosis:

ECIPAS was diagnosed based on the pathology after surgery. The mass was composed of a cyst and brown solid spleen-like tissue. The microscopic analysis demonstrated that the solid component was accessory splenic tissue, and the cyst wall was lined with a thin stratified squamous epithelium.

Interventions:

Laparoscopic spleen-preserving distal pancreatectomy was performed.

Outcomes:

The patient was discharged on day 5 postoperatively after an uneventful recovery. CA19-9 returned to normal after surgery. During a 2-years follow-up, there was no evidence of tumor recurrence.

Lessons:

Although rare ECIPAS should be considered in the differential diagnosis of pancreatic tail cystic lesions, and the typical imaging features might facilitate the preoperative diagnosis. Laparoscopic distal pancreatectomy is a safe and effective approach for treating ECIPAS.
Effects and safety of acne vulgaris with external application of herbal medicines
Authors: Zhou Jin , Li Xiaoxiao , Chen Haimin , Qi Zirong , Shao Shujun , Tang Yinshan , Jiang Chenglong
Published: June 2021

Background

Acne vulgaris (AV) is a common dermatologic disease. The morbidity is increasing annually. External application of herbal medicines (EAHM) has been pervasively used in the therapy of AV. EAHM , as the traditional Chinese therapy, is widely applied in clinical trials for AV. The aim of this review is to systematically evaluate the efficacy and safety of EAHM in the therapy for AV.

Methods

We will conduct an electronic search of 13 databases from their inception to May, 2020, including PubMed, EMBASE, MEDLINE, Web of Science, Cochrane Library, SpringerLink, WHO International Clinical Trials Registry Platform, Wanfang China database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, as well as China's Conference Papers Database and China Dissertation database. Other valid search strategies will also be retrieved to complete this review. All randomized controlled trials in which EAHM was used for the treatment of AV will be adopted. Two researchers will select eligible studies respectively according to a predefined protocol. Methodological quality will be assessed with Cochrane risk of bias by means of RevMan V.5.3.5 software.

Results

This systematic view will present a high-quality synthesis based on current evidence of EAHM intervention for AV patients.

Conclusion

The summary of our systematic view will provide evidence to judge whether EAHM is an effective and safe intervention for AV patients.
A nomogram incorporated lifestyle indicators for predicting nonalcoholic fatty liver disease
Authors: Peng Kaili , Wang Shuofan , Gao Linjiao , You Huaqiang
Published: June 2021

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, and its pathogenesis is complicated and triggered by unbalanced diet, sedentary lifestyle, and genetic background. The aim of this study was to construct and validate a nomogram incorporated lifestyle habits for predicting NAFLD incidence.

The overall cohort was divided into training set and test set as using computer-generated random numbers. We constructed the nomogram by multivariate logistic regression analysis in the training set. Thereafter, we validated this model by concordance index, the area under the receiver operating characteristic curve (ROC), net reclassification index, and a calibration curve in the test set. Additionally, we also evaluated the clinical usefulness of the nomogram by decision curve analysis.

There were no statistically significant differences about characteristics between training cohort (n = 748) and test cohort (n = 320). Eleven features (age, sex, body mass index, drinking tea, physical exercise, energy, monounsaturated fatty acids, polyunsaturated fatty acids, hypertension, hyperlipidemia, diabetes) were incorporated to construct the nomogram, concordance index, the area under the ROC curve, net reclassification index were 0.801, 0.801, and 0.084, respectively, indicating the nomogram have good discrimination of predicting NAFLD incidence. Also, the calibration curve showed good consistency between nomogram prediction and actual probability. Moreover, the decision curve showed that when the threshold probability of an individual is within a range from approximately 0.5 to 0.8, this model provided more net benefit to predict NAFLD incidence risk than the current strategies.

This nomogram can be regarded as a user-friendly tool for assessing the risk of NAFLD incidence, and thus help to facilitate management of NAFLD including lifestyle and medical interventions.
The efficacy of probiotic preparations on inflammatory cytokines in patients with chronic kidney disease
Authors: Wang Peidong , Peng Yanyan , Guo Yueqin , Zhao Yongqiang
Published: June 2021

Background:

Probiotics supplementation has emerged as adjuvant therapy for chronic kidney disease (CKD) in recent years. However, the effects of probiotic preparations on serum inflammatory cytokine levels are still highly controversial and poorly documented. Therefore, we performed the protocol for systematic review and meta-analysis to further clarify the effects of probiotic preparations in CKD patients.

Methods:

This review will develop following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. We searched literature published until May, 2021 thoroughly in PUBMED, Scopus, EMBASE, Web of Science, and Cochrane Library databases on May, 2021. The risk of bias of included studies was estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting, and other bias by Cochrane Collaboration's tool for assessing the risk of bias. Data synthesis and analyses were performed using Stata version 10.0 software.

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

We hypothesized that probiotic preparations may decrease the serum levels of inflammatory cytokines and protect the intestinal epithelial barrier of patients with CKD.
Vitamin C and D supplementation and the severity of COVID-19
Authors: Toscano Gislani Acásia da Silva , de Araújo Ivani Iasmin , de Souza Talita Araújo , Barbosa Mirabal Isabelle Ribeiro , de Vasconcelos Torres Gilson
Published: June 2021

Background:

The COVID-19 pandemic has rapidly spread to other countries, causing numerous deaths and challenges for organizations and health professionals. Diet and nutrition invariably influence the competence of the immune system and determine the risk and severity of infections. Studies have already been published on the relationships through which vitamins C and D can mitigate the severity of infections such as COVID-19. In this context, this protocol describes a systematic review intended to analyze if vitamin C and D supplementation can reduce the severity of Covid-19.

Methods:

This protocol was developed based on the recommendations of PRISMA-P. In order to accomplish the systematic review, we will carry out searches in the PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect databases in the quest for control case studies that analyze the supplementation and evolution of patients with COVID-19. There will be no limitations related to language or publication time. The searches will be carried out by 2 independent researchers who will select the articles, and then the duplicate studies will be removed, while the suitable ones will be selected using the Rayyan QCRI application. In order to assess the risk of bias, we will use the instrument proposed by the National Heart, Lung and Blood Institute. Moreover, we will carry out metaanalyses and subgroup analyses according to the conditions of the included data.

Results:

This review will assess the association between vitamin C and D supplementation and the reduction in the severity of COVID-19.

Conclusion:

The findings of this systematic review will summarize the latest evidence for the association between vitamin C and D supplementation and COVID-19 through a systematic review and meta-analysis.

Record of systematic review:

CRD42021255763.
Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016
Authors: Ang Li Wei , Toh Matthias Paul Han Sim , Wong Chen Seong , Boudville Irving Charles , Archuleta Sophia , Lee Vernon Jian Ming , Leo Yee Sin , Chow Angela
Published: June 2021

We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.

Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.

Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82–2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15–4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46–1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.

The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.
Irisin is a predictor of sarcopenic obesity in type 2 diabetes mellitus
Authors: Oguz Ayten , Sahin Murat , Tuzun Dilek , Kurutas Ergul B. , Ulgen Cansu , Bozkus Ozlem , Gul Kamile
Published: June 2021

We aimed to evaluate sarcopenia and sarcopenic obesity (SO) in patients with type 2 diabetes mellitus (T2DM), possible relationships with serum irisin and myostatin levels, and the effect of glycemic control on SO.

Ninety T2DM patients were included in this a cross-sectional study. Sarcopenia was determined by evaluating muscle mass (bioelectrical impedance analysis), muscle strength (HGS), and gait speed (GS). Patients with muscle mass loss with functionally reduced muscle strength and/or performance were considered sarcopenic. In addition, participants were divided into 3 groups according to the FM (fat mass)/FFM (fat-free mass) ratio [group 1:5th-50th percentiles; group 2:50th-95th percentiles and group 3: ≥95 percentiles (sarcopenic obese)]. Irisin, myostatin levels and metabolic parameters were measured in all patients.

The prevalence of sarcopenia and SO was 25.6% and 35.6%, respectively. Irisin levels were lower in sarcopenic patients, while glycosylated hemoglobin (A1c), body mass index (BMI), FM, and FM index were higher (P < .05). From group 1 to group 3, BMI, FM, FM index, GS, myostatin, and A1c increased, and muscle mass percentage, HGS, and irisin decreased (P < .05). A positive correlation was found between FM/FFM and myostatin and a negative correlation between FM/FFM and irisin (r = 0.303, P = .004 vs. r = −0.491, P < .001). Irisin remained an important predictor of SO, even after adjusting for confounding variables (OR:1.105; 95% CI:0.965–1.338, P = .002). The optimal cut-off value for irisin to predict SO was 9.49 ng/mL (specificity = 78.1%, sensitivity = 75.8%). In addition, A1c was an independent risk factor for SO development (OR:1.358, P = .055).

This study showed that low irisin levels (<9.49ng/mL) and poor glycemic control in T2DM patients were an independent risk factor, especially for SO.
Comparison of the sensitivity of mammography, ultrasound, magnetic resonance imaging and combinations of these imaging modalities for the detection of small (≤2 cm) breast cancer
Authors: Chen Hai-long , Zhou Jiao-qun , Chen Qiang , Deng Yong-chuan
Published: June 2021

The aim of this study was to compare the sensitivity of mammography (MG), ultrasound (US), magnetic resonance imaging (MRI), and combinations of these imaging modalities for the detection of small (≤2 cm) breast cancer and to evaluate the benefit of preoperative breast MRI after performing conventional imaging techniques for small breast cancer.

This was an observational retrospective review of 475 patients with pathologically confirmed breast cancer. We reviewed the medical records; assessed the preoperative reports of MG, US, and MRI; and categorized them as benign features (BI-RADS 1–3) or malignant features (BI-RADS 4 or 5). The criterion standard for detection was the pathologic assessment of the surgical specimen. The sensitivities of the different techniques were compared using the McNemar test.

Among the 475 women, the sensitivity of MG was significantly greater in patients with low breast density than in those with high breast density (84.5% vs 65.8%, P < .001). US had higher sensitivity than MG (P < .001), and the combination of MG + US showed better sensitivity than MG or US alone (P < .001). Further addition of MRI to the combination of MG and US statistically contributed to the sensitivity yield (from 93.3% to 98.2%; P < .001) but did not significantly increase the mastectomy rate (from 48.2% to 49.3%; P = .177).

MG has limited diagnostic sensitivity in patients with small breast cancer, especially in those with dense breast tissue. US is better than MG at detecting small breast cancer, regardless of breast density. The addition of MRI to MG and US could increase sensitivity without increasing the mastectomy rate. This study suggests performing MRI routinely on the basis of MG and US for small (≤2 cm) breast cancer.
Longer length of post-acute care stay causes greater functional improvements in poststroke patients
Authors: Tung Yu-Ju , Huang Chin-Tsan , Lin Wen-Chih , Cheng Hsin-Han , Chow Julie Chi , Ho Chung-Han , Chou Willy
Published: June 2021

Post-acute care (PAC) is a type of transitional care for poststroke patients after the acute medical stage; it offers a relatively intensive rehabilitative program. Under Taiwan's National Health Insurance guidelines, the only patients who can transfer to PAC institutions are those who have had an acute stroke in the previous month, are in a relatively stable medical condition, and have the potential for improvement after aggressive rehabilitation. Poststroke patients receive physical, occupational, and speech therapy in PAC facility. However, few studies have evaluated the effects of PAC in poststroke patients since PAC's initiation in Taiwan. Thus, this study aims to investigate whether the length of stay in a PAC institution correlates with patients’ improvements.

This retrospective and single-center study in Taiwan enrolled 193 poststroke patients who had received acute care at Chi-Mei Medical Center, Taiwan, at any period between 2014 and 2017. Data on their length of stay in the PAC institution were collected. Poststroke patients’ functional ability—such as activities of daily living (ADL) function and swallowing ability—as well as their corresponding scales were assessed on the first and last day of PAC stay. Statistical analysis was conducted by SPSS version 21.0 .

The average duration of PAC stay was 35.01 ± 16.373 days. Duration of PAC stay was significantly positively correlated with the Barthel index (P < .001), Berg balance test score (P < .001), gait speed (P = .002), and upper sensory function and upper motor function within the Fugl–Meyer Assessment (both P < .001).

Poststroke patients with longer stay in a PAC institution had superior ADL function, balance and coordination, walking speed, and upper-limb dexterity and sensory function.
Vertebral Artery Dissection in a Woman Due to Golf
Authors: Gallaer Alexander , Archambault Simon , Patel Smit D. , Mui Gracia
Published: June 2021

Introduction:

Traditionally, spontaneous cervical artery dissections have been associated with violent, sudden neck movements. These events are a significant cause of stroke related morbidity, particularly in young people. Only a handful of cases of golf-induced vertebral artery dissection (VAD) have been described, and the discussion has primarily focused on middle-aged men. Despite the discussion focused on this demographic, women are participating in golf at higher rates than ever before, and have a higher risk for developing VAD.

Case Report:

A 41-year-old woman presented to our hospital with sharp neck pain, dizziness, and ptosis after swinging a driver during a morning round of golf. Imaging demonstrated a right V3/V4 VAD and subsequent ischemic infarction. After administration of tissue plasminogen activator she had abrupt change in mental status with seizure-like activity. She underwent angiogram and mechanical thrombectomy, and was started in heparin 24 hours post-tissue plasminogen activator. This was subsequently changed to low-dose aspirin following thalamic petechial hemorrhage. She was discharged from the hospital after a few days with only minor deficits. We will discuss mechanism, treatment, and outcomes of VAD in context of this case.

Conclusion:

This patient is the first woman in the literature to suffer from VAD as a result of playing golf. The twisting motion of the head and neck in a golf swing may be a risk factor for dissection and subsequent development of stroke. As a result of increased female participation in golf, we expect to see increased incidence of women presenting with “golfer’s stroke” in coming years.
Chlamydia trachomatis and Neisseria gonorrhoeae in Pregnancy: Trends in United States, 2010 to 2018
Authors: Niles Justin K. , Kaufman Harvey W. , Peterman Thomas A. , Tao Guoyu , Gift Thomas L. , Alagia Damian P.
Published: June 2021

Background

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) case surveillance relies on reported positive laboratory results. Changes in reported cases may represent changes in testing practice or infection prevalence. This study evaluated changes over time for CT and NG positivity and testing rates of pregnant persons.

Methods

Prenatal testing results from persons aged 16 to 40 years tested by a national reference clinical laboratory were analyzed for CT and NG testing and positivity from 2010 to 2018 (n = 3,270,610).

Results

Testing rates increased among pregnant persons for CT (from 56.3% in 2010 to 64.1% in 2018, P < 0.001) and NG (from 55.6% to 63.2%, P < 0.001). Higher CT testing rates were found in Black non-Hispanic (adjusted odds ratio [AOR], 1.58; 95% confidence interval [CI], 1.57–1.60) and Hispanic (AOR, 1.19; 95% CI, 1.18–1.20) persons. NG and CT testing rates were virtually identical. Significant increasing trends in CT positivity were observed for each age group studied (P < 0.001 for all): 16–19 (from 11.7% to 13.0%), 20–24 (from 6.4% to 6.7%), 25–30 (from 1.9% to 2.4%), and 31–40 years (from 0.76% to 0.92%). Black non-Hispanic persons had the highest positivity for CT (AOR, 2.52; 95% CI, 2.46–2.57) and NG (AOR, 5.42; 95% CI, 5.05–5.82).

Conclusions

Testing and adjusted positivity for both CT and NG among pregnant persons increased from 2010 to 2018. Higher testing rates were observed in Black non-Hispanic and Hispanic persons (even in persons younger than 25 years), suggesting some testing decisions may have been based on perceived risk, in contrast to many guidelines recommending screening all pregnant persons younger than 25 years.
Recurred Sphenoethmoidal Mucocele After Treated With Simple Endoscopic Marsupialization
Authors: Lee Seon-Min , Lee Ki-Il
Published: June 2021

Paranasal sinus mucocele is a mostly benign disease but can cause irreversible complications depending on its location. A sphenoethmoidal mucocele (SEM) can cause compressive neuropathy due to its proximity to the optic nerve. Urgent endoscopic marsupialization is considered the treatment of choice for SEM. However, there is a scarcity regarding recurrence or operative size. Herein, the authors report a case of SEM that recurred after small endoscopic drainage. The patient was reoperated with wide cyst removal and nasal cavity ventilation expansion. Vision was partially resolved, and no recurrence was reported in the 6-month follow-up period.
Primary Repair of Bilateral Cleft Lip Deformity and Absent Prolabium With a Full-Thickness Skin Graft
Authors: Loh Ian , Chong David
Published: June 2021

Bilateral cleft lip deformities makeup 10% of orofacial clefts and are uncommon when compared to unilateral cleft lip.
1,2
These cleft deformities have significant physical and long-term psychosocial effects on not only the patient but their family. With bilateral cleft lip deformity, the cutaneous approximation of the lateral lip segments are dependent on a sufficient prolabium to reconstruct the philtrum.
3,4
Deficient skin equates to tight midline closure and subsequent unsightly scarring

In the subclinical phenotype of bilateral cleft lip and palate, where the patient has an absent or deficient prolabium, achieving tension free closure in the primary surgical setting is a reconstructive dilemma.
5
This clinical report describes the use of a full-thickness skin graft to reconstruct the philtrum in a 12-month-old boy with bilateral cleft lip deformity, absent prolabium, absent columella and absent nasal septum to provide an aesthetic subunit repair.
A Single-Center Retrospective Review of Perioperative Complications and Reoperation Rates Between Open Cranial Vault Remodeling and Distraction Osteogenesis for Unilateral Coronal Craniosynostosis
Authors: Kamel George N. , Wong Alvin , Segal Rachel M. , Carbulido Mary Kristine , Hornacek Michael , Ewing Emily , Lance Samuel H. , Gosman Amanda A.
Published: June 2021

Background:

Unilateral coronal craniosynostosis (UCS) is the third most prevalent form of craniosynostosis. Traditional treatment of UCS has been achieved with fronto-orbital advancement and cranial vault remodeling (FOAR), but utilization of cranial distraction osteogenesis (DO) techniques has increased. This study aims to compare perioperative complications and reoperation trends in FOAR versus DO techniques at a single institution.

Methods:

An Institutional Review Board-approved retrospective review was performed from January 1999 to November 2018 at a single institution. Patients were those that have undergone FOAR or DO with an anterior rotational flap technique as previously described. Indications for secondary procedures included: contour deformities, relapse, surgical site infection, and persistent cranial defects.

Results:

Eighty-one patients with UCS were identified, 64 patients underwent FOAR and 17 patients underwent DO. When perioperative characteristics were compared, patients who underwent DO were younger in age, however, there was no significant difference in transfusion requirement or length of stay between patient cohorts. Surgery time was increased in DO patients. When perioperative complications were compared, more intraoperative dural tears were observed in the FOAR cohort. When unplanned reoperation rates were compared, patients who had undergone FOAR had a statistically significant higher reoperation rates at 5 years of follow up. When including routine distractor removal as a reoperation, reoperative rate was increased in the DO cohort. No difference in reoperation rates was noted at 5 years following index operation.

Conclusions:

The safety profile of DO is similar to that of traditional FOAR techniques for treatment of UCS. Longer-term follow-up studies are needed to elucidate whether outcomes are durable, but the unplanned reoperation rate in DO is less than that of FOAR at 5 years and presents several advantages that warrants its use in patients with UCS.
Craniometric and Volumetric Analysis of Posterior Vault Distraction Osteogenesis: 10 Year Update
Authors: Zapatero Zachary D. , Kalmar Christopher L. , Kosyk Mychajlo S. , Carlson Anna R. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: June 2021

Purpose:

The purpose of this study is to quantitatively establish the volumetric changes observed with posterior vault distraction osteogenesis in the anterior, middle, and posterior thirds of the cranial vault; characterize change in cranial length, width, and height, correlating these changes to demographic variables that may help identify why younger kids gain more volume; and describe the short-term position of the transport segment.

Methods:

Multisuture craniosynostosis patients who underwent posterior vault distraction osteogenesis were retrospectively reviewed. Pediatric, dose-reduced, thin cut helically acquired head computed tomography scans were analyzed on Materialise Mimics v22 (Materialise, Ghent, Belgium). Pre and post-PVDO and “old” and “young” cohort were compared.

Results:

Twenty-one patients met inclusion criteria. The change in cranial length was significantly less at a median of 14.9 mm [Interquartile range (IQR) 11.8, 31.6] compared to the X-ray measured AP distraction distance (30 mm [IQR 24, 33]; P < 0.001) and significantly less than the theoretically calculated distance (23 mm [IQR 19, 31]; P = 0.012). Median anterior cranial height was shorter post PVDO (82.9 mm, [IQR 64.8, 92.6] versus 78.7 mm [IQR 57.0, 88.7]; P = 0.030). The younger cohort saw a greater increase in total intracranial volume (median 335.1 mL [IQR 163.2, 452.3, median 37.1%] versus 144.6 mL [IQR 119.0, 184.8, median 12.0%]; P = 0.011).

Conclusions:

This is the first study to quantify volumetric changes to the anterior, middle, and posterior cranial vaults and demonstrates benefits of preforming PVDO at a younger age to help control turricephaly and produce greater percentage volumetric increases.
Sir Leslie Fowden. 13 October 1925—16 December 2008
Authors: Fowden Abigail L. , Anderson John W. , Lea Peter J.
Published: June 2021

Professor Sir Leslie Fowden was an organic chemist and one of the most influential plant scientists of his generation. He pioneered the new field of phytochemistry and was the world authority on plant amino acids. He was distinguished for the identification, characterization and biological function of a new category of nitrogen containing molecules in plants, the non-protein amino acids. During his research career, he isolated at least 50 of these compounds from a wide range of different plant genera and established their structural diversity, metabolic and toxic functions, and their scientific significance. In achieving this, he developed novel techniques for the rapid, quantitative separation of compounds by chromatography and electrophoresis, which were widely adopted in other disciplines. As Director of Rothamsted Experimental Station, he opened up new areas of research in plant biochemistry and molecular biology, and became an effective voice for the importance of agricultural research in the UK. He provided strategic leadership in the translational application of plant biochemistry to the agrichemical industry and to global crop resistance and production. His discoveries established the complexity and central role of plant nitrogen metabolism in plant growth and laid the foundations for current research in plant sciences aimed at improving both food security and the nutritional value of plants.