bluuebunny/crossref_metadata_2025 huggingface dataset:
Noncognitive Factors of Grit and Mindset Do Not Predict Performance on the National Physical Therapy Exam
Authors: Huebner Bethany , Mattocks Alma , Pitt Jason
Published: February 2023

Introduction.

National Physical Therapy Exam (NPTE) performance is predicted to some degree by cognitive measures, such as grade point average (GPA) and the Graduate Record Exam scores. Researchers have begun to explore noncognitive measures, for example, grit and mindset, which could account for other potential determinants of student success in physical therapist (PT) education programs and the NPTE.

Review of Literature.

There is a paucity of evidence that has explored non‐cognitive factors related to academic performance compared to cognitive factors. Constructs such as grit and mindset have been identified as reliable measures; however, mixed results occur in the literature as how these scales predict NPTE performance. Cognitive factors continue to demonstrate stronger correlations to NPTE performance.

Subjects.

Four PT student cohorts (n = 43, 45, 50, and 49) were enrolled in a prospective cohort study.

Methods.

Grit and mindset were measured by self-reported questionnaires. Cognitive measures were obtained, including undergraduate cumulative GPA (cGPA), undergraduate science GPA (sGPA), graduate GPA (gGPA), Academic Practice Exam and Assessment Tool (Academic PEAT) scores, and NPTE scores. Pairwise Pearson’s correlation coefficients were calculated for each cohort. National Physical Therapy Exam scores from 2 graduating cohorts were analyzed using multiple linear regression to identify variables that predicted successful outcomes.

Results.

Neither grit nor mindset correlated with any cognitive measures. Furthermore, neither grit nor mindset were significantly associated with NPTE scores or outcomes in multivariate regression models. National Physical Therapy Exam scores were significantly associated with gGPA (β = 148.4, 95% confidence interval [CI] = 93.4–203.5) and Academic PEAT scores (β = 0.28, 95% CI = 0.08–0.49).

Discussion and Conclusion.

Among PT students at a small liberal arts institution in the midwest, grit and mindset were not associated with any indicators of academic success (e.g., cGPA, sGPA, gGPA, Academic PEAT, or NPTE scores). NPTE outcomes were best predicted by gGPA and Academic PEAT scores. These findings conflict with previous reports that grit and mindset are potential markers for academic success and support monitoring gGPA and Academic PEAT scores to identify students who may require additional preparation before sitting for the NPTE.
Health Maintenance and Preventative Care in Inflammatory Bowel Disease
Authors: Weissman Simcha , Systrom Hannah K. , Bangolo Ayrton , Elias Daniel , Awasi Marcel , Zahdeh Tamer , Ogbu Chukwuemeka E. , Kim Mishka Hoo , Kalra Meenal , Khota Kavya , Kasarapu Ritu B. , Mutabi Erasmus , Makrani Moinulhaq , Nemalikanti Sanskrita , Thomas Jim , Jijo Joseph P. , Thwe Hla M. , Salib Yousstina , Narayan Kiran L. , Ahmed Kareem , Aziz Muhammad , Elias Sameh , Feuerstein Joseph D.
Published: February 2023

Background & Aims:

Preventative care plays an important role in maintaining health in patients with inflammatory bowel disease (IBD). We aimed to assess the overall quality, strength, and transparency of conflicts among guidelines on preventative care in IBD.

Methods:

A systematic literature search was performed in multiple databases to identify all guidelines pertaining to preventative care in IBD in April 2021. All guidelines were reviewed for the transparency of conflicts of interest and funding, recommendation quality and strength, external guideline review, patient voice inclusion, and plan for update—as per Institute of Medicine standards. In addition, recommendations and their quality were compared between societies.

Results:

Fifteen distinct societies and a total of 89 recommendations were included. Not all guidelines provided recommendations on the key aspects of preventative care in IBD—such as vaccinations, cancer prevention, stress reduction, and diet/exercise. Sixty-seven percent of guidelines reported on conflicts of interest, 20% underwent external review, and 27% included patient representation. In all, 6.7%, 21.3%, and 71.9% of recommendations were based on high, moderate, and low-quality evidence, respectively. Twenty-seven percent, 23.6%, and 49.4% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence (P=0.28) and strong recommendations (P=0.41) did not significantly differ across societies.

Conclusions:

Many guidelines do not provide recommendations on key aspects of preventative care in IBD. As over 70% of recommendations are based on low-quality evidence, further studies on preventative care in IBD are warranted to improve the overall quality of evidence.
Predictors and Etiologies of Clinical Relapse Among Patients With Ulcerative Colitis in Deep Remission
Authors: Zeina Tanya , Gandhi Shiv , Mittal Akaash , Levy Alexander N. , Weinstock Joel , Singh Siddharth , Jangi Sushrut
Published: February 2023

Goal:

The objective of this study was to evaluate for potential predictors and etiologies of clinical relapse among patients with ulcerative colitis in deep remission.

Background:

Patients displaying deep (endoscopic and histologic) remission have a decreased cumulative risk of relapse in ulcerative colitis of <10% per year, but predictors and etiologies of relapse in this population are poorly understood.

Materials and Methods:

We performed a retrospective cohort study utilizing electronic medical records at Tufts Medical Center to identify patients in deep remission, classified as having both endoscopic remission (Mayo Endoscopic Score of 0 or 1) and histologic remission (Simplified Geboes Score

0.2). We evaluated the cumulative risk of clinical relapse following attainment of deep remission and examined predictors and etiologies of relapse.

Results:

Among 139 patients with ulcerative colitis in deep remission, the cumulative risk of relapse was <10% and <20% at 1 and 2 years. Patients with complete normalization of mucosa (Geboes=0) and normalization of C-reactive protein (<7.48 mg/dL) at the time of remission were associated with a lower risk of relapse. Discontinuation of therapy was the most commonly identified etiology of relapse.

Conclusions:

Patients in deep remission have a 1-year risk of clinical relapse of <10%, with those demonstrating a non-normalized mucosa or elevated C-reactive protein predictive of persistent relapse risk. Discontinuation of therapy or minor histologic changes may drive relapse among those in deep remission.
Providing a Clear Path to the Direct Admission Process
Authors: Johnson Sarah , Abraham Aney , Lopez Julie A.
Published: February 2023

OBJECTIVES

The aim of this study was to increase patient safety during care transitions through the development of a new process and electronic screening tool.

BACKGROUND

Direct hospital admissions that are not clinically triaged can put the patient at an increased safety risk.

METHODS

Utilizing the electronic medical record and mnemonic situation, background, assessment, and recommendation (SBAR), an admission module was created to intake direct admission requests by transfer center nurses to ensure clinical triage and accurate bed placement.

RESULTS

One hundred eighty-nine direct admissions met inclusion criteria. Thirteen patients were clinically screened, deemed not stable for the acute care setting, and sent to the emergency department. One direct admission safety event occurred involving a hypoglycemic patient upon arrival. Results indicate the new clinical screening program offered a safer way to directly admit patients to the inpatient setting.

CONCLUSION

Implementation of the electronic SBAR handoff tool meets the Joint Commission standard of care transitions compliance. The significant workflow changes increased patient safety and will be expanded in the future to all service lines.
Facial Fracture Patterns and Severity of Associated Injuries After Motorcycle Accidents
Authors: Chuang Kai-Ti , Chu Yu-Ying , Chen Chien-Tzung , Liao Han Tsung
Published: February 2023

Background

Motorcycle injuries remain a significant cause of motor vehicle-related morbidity and mortality in Taiwan. Besides, the facial region is a commonly fractured site under motorcycle accidents. To date, there are no trauma mechanism-based studies of facial fractures.

Aim and Objectives

This study aims to determine the facial fracture patterns, the severity of head trauma, and associated injuries by different motorcycle-related trauma mechanisms enabling a greater understanding of its distribution and magnitude.

Methods

This is a retrospective descriptive analysis conducted over a 2-year period at Linkou Chang Gung Memorial Hospital. We focused on the population of maxillofacial injury caused by motorcycle accidents. We divided the patient cohort into 3 main trauma mechanisms: single-motorcycle collision (SM group), motorcycle-to-motorcycle collision (MM group), motorcycle-to-vehicle collision (MV group). Data, including demographics, age, fracture patterns of facial bones, and other associated injuries, were collected.

Results

A total of 881 cases were identified that involved facial fractures. Most patients were male (71%), young adult (mean age, 32.49 years), and the most common fracture region is the midfacial fracture (79.5%, 700 victims). Among the 3 groups, the MM group was less likely to sustain severe injuries by trauma score system, less head injury and mortality rate. The MV group and SM group have similar mortality rates but different fracture pattern tendencies. Lower facial fractures were more likely in the MV group, but midface fractures in the SM group. Associated injuries were higher in the MV group.

Conclusions

Our study presents the different trends of fracture patterns and injury under 3 main mechanisms of motorcycle casualties. We document all these data in the hope of providing insights into trauma doctors dealing with motorcycle accidents.
A Comparison Study of Outcomes and Complications Between Marginal Mandibulectomy With or Without Additional Mandibulotomy in Tongue Cancers
Authors: Chiu Ting-Han , Marchi Filippo , Huang Shiang-Fu , Kang Chung-Jan , Liao Chun-Ta , Hung Shao-Yu , Cheong David Chon-Fok , Tsao Chung-Kan
Published: February 2023

Background

Marginal mandibulectomy with or without additional mandibulotomy could represent the alternatives to avoid segmental mandibulectomy in carefully selected tongue cancers.

Aim and Objectives

This study investigated a subgroup of tongue cancers with suspected involvement to the alveolar bone because of the shallow and deformed mouth floor. We aimed to compare the functional outcomes, postoperative complications, and disease control efficacy between the 2 different marginal mandibulectomy approaches, with or without additional mandibulotomy.

Materials and Methods

A retrospective study of 29 marginal mandibulectomies and 26 combined mandibulotomies for tongue cancer wide excisions and flap reconstruction at Chang Gung Memorial Hospital Linkou Branch during 2014 to 2019 was performed.

Results

The combined mandibulotomy group had more advanced T-status (P < 0.001) and greater tumor diameters (P < 0.001) but not increased preexisting trismus, bone invasions, or positive margins. The additional mandibulotomy increased flap necrosis (P = 0.044), late infections (P = 0.004), and tongue movement limitations (P = 0.044) but not osteoradionecrosis. Osteoradionecrosis was unrelated to the resected mandibular length or the mandibulotomy sites. Feeding tube dependence was greater in the combined group at discharge (P = 0.014), but no long-term differences were noted. Kaplan-Meier overall survival (P = 0.052) and disease-free survival (P = 0.670) were both comparable between the 2 groups.

Conclusions

The combined procedure of mandibulotomy and marginal mandibulectomy in large tongue cancers without bone invasions is associated with increased soft tissue–related complications but not bone-related complications. However, comparable disease control, survival, and long-term tube feeding outcomes were noted.
Reimbursement Trends in Reduction Mammoplasty
Authors: Radparvar Jacob , Dorante Miguel I. , Youssef George , Ganeshbabu Nishanth , Pandya Sonal N. , Guo Lifei
Published: February 2023

Background

Medicare reimbursement for plastic surgery procedures increased by 2% while inflation increased by 19% in the past decade. Given increasing national breast reduction case volume and the negative impact decreased reimbursements have on surgeon well-being, we sought to evaluate actual surgeon reimbursements for bilateral breast reduction over a decade.

Methods

A retrospective review was performed including all identifiable breast reduction procedures (Current Procedure Terminology 19318) performed at a tertiary academic hospital between October 2011 and September 2021 (fiscal year 2012–2021). The annual number of patients undergoing breast reduction, the payor, and average yearly amounts reimbursed were evaluated and trended over time. Percent change from Medicare average yearly reimbursements was evaluated and trended over time. All values were adjusted to 2021 US dollars.

Results

During our study period, there were 486 bilateral breast reduction procedures with 36 outlier payments; therefore, 450 reimbursements were included in the study. There were 5 payors, and the average adjusted reimbursement amount was $2418.74 ± $1123.83. All private payors had significantly higher average reimbursement than Medicare (P < 0.0001), and Medicare was the only payor with significant decrease in reimbursement over time (−$58.58 per year, 95% confidence interval, −$110.80 to −$6.33, P = 0.033).

Conclusions

Our data demonstrate that a difference exists between public and private payors for bilateral breast reduction procedures. Private payor reimbursements outpaced inflation. Medicare is an unreliable benchmark that may indirectly lead to declining reimbursements over time.
Utilization Fraction of Reduction Mammoplasty Instrument Sets
Authors: Dorante Miguel I. , Barron Sivana L. , Jones Lloyd , Freniere Brian B. , Guo Lifei
Published: February 2023

Purpose

Healthcare spending will account for 20% of US gross domestic product by 2028. One strategy to address rising costs is evaluating the utilization fraction (UF) of surgical trays. Utilization fraction averages between 13% and 27% among surgical specialties, yet data from plastic surgery are lacking.

Methods

This prospective observational study assessed UF of surgical instruments in all reduction mammoplasty performed at 2 sites in the same healthcare system over a 6-month period. Site 1 is a tertiary hospital and site 2, an outpatient surgical center. Utilization fraction was calculated as percent fraction of used, or if operating surgeons touched them, to opened instruments. A new surgical tray was created by removing instruments not used in 20% of cases. Reprocessing costs and savings were calculated using published reprocessing figures of $0.10 to $0.51 per instrument. Descriptive statistics and parametric variables reported as mean ± standard deviation. Unpaired Student t test was performed to determine statistical significance of findings (P < 0.05).

Results

Four plastic surgeons performed 37 procedures, 11 at site 1 and 26 at site 2. At site 1, 112 instruments are opened in one tray with 53 unique and 59 duplicates. At site 2, 155 instruments are opened in 2 trays with 58 unique, 20 shared, and 77 duplicates. Instrument user did not vary by site (P = 0.446), with 19 ± 3 instruments and 17 ± 3 instruments used per case; however, UF varied significantly (P < 0.0001) with average UF of 16.6% ± 2.8% and 11.5% ± 1.7% at sites 1 and 2, respectively. Estimated reprocessing costs per case are currently $11.20 to $57.12 at site 1 and $15.50 to $79.05 at site 2, with unused instruments accounting for $9.34 to 47.64 and $13.72 to $69.96, respectively. The new surgical tray includes 32 instruments, 18 unique and 14 duplicates, with estimated reprocessing cost of $3.20 to $16.32 per case. Adoption would reduce reprocessing costs by approximately $8.00 to $40.80 and $12.30 to $62.73 per case at sites 1 and 2, respectively.

Conclusions

Despite studying a single, but common, plastic surgery procedure, our findings reveal consistency in excessive appropriation of instruments between sites with values similar to those in the literature. These findings exemplify a cost-saving opportunity at our institution and chance to optimize UF for other high-volume plastic surgery procedures.
Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training
Authors: Oberoi Michelle K. , Reghunathan Meera , Aref Youssef , Dinis Jacob J. , Balumuka Darius , Gosman Amanda
Published: February 2023

Background

Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows.

Methods

Names and photos of graduated fellows for the past 10 years (2012–2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population.

Results

Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons.

Conclusion

This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.
Public Perception of Ideal Areola Proportions
Authors: Kuruvilla Annet S. , Kumar Anish , Ibelli Taylor J. , Mandelbaum Max , Greer Madison , Henderson Peter W.
Published: February 2023

Background

In breast reconstruction, mastopexy, and breast reduction procedures, surgeons make decisions about the resulting areola size, and this significantly impacts the overall aesthetic result. Despite the importance of these decisions, little is known about the general population's preferences for areola size. The objective of this study was to survey the global population to better understand the public's perceptions of ideal areola dimensions.

Methods

A survey was developed with 9 different composite diagrams of a female torso (every combination of 3 breast widths and 3 waist widths). In each composite diagram, 6 different areola sizes were shown (areola-to-breast diameter ranging from 1:12 to 6:12). The survey was distributed via the Amazon Mechanical Turk digital platform, and respondents' demographics (sex, age, race/ethnicity, country, and state if located in the United States) and preferences for the most aesthetically pleasing size in each composite diagram were recorded.

Results

Among 2259 participants, with 1283 male (56.8%) and 976 female (43.2%), most participants were between 25 and 34 years old (1012, 44.8%), were from the United States (1669, 73.9%), and identified as White (1430, 63.3%). With 9 breast width and waist width combinations, the respondents were most likely to prefer the 2:12 (32.9%) areola-to-breast ratio (P < 0.0001). The second most commonly preferred ratio was 3:12 (30.6%) (P < 0.0001). Gender subgroup analysis showed that women preferred middle-range ratios, such as 2:12, 3:12, and 4:12 (P < 0.0001). Meanwhile, men were more likely to prefer extreme ratios of 1:12 or 6:12 (P < 0.0001). Across almost all races/ethnicities, 2:12 was significantly the most popular, except among American Indian/Alaskan Native and Middle Eastern where 3:12 was the most preferred (P < 0.0001). Within the top 6 countries (United States, India, Brazil, Italy, Canada, United Kingdom), the United States, India, and Italy preferred 2:12, and Brazil, Canada, and the United Kingdom preferred 3:12 (P < 0.0001).

Conclusions

This study provides the first objective data on public impressions of the ideal areola proportions and can serve as a guide for surgical decision making in breast reconstruction and reshaping procedures.
Aesthetic Sideburn Reconstruction Using an Expanded Hair Bearing Skin Flap With Natural Hairline
Authors: Zhang Tiran , Fan Jincai , Tian Jia , Gan Cheng , Yang Zengjie , Jiao Hu , Han Bing , Liu Liqiang
Published: February 2023

Background

Hairline is the marginal line of hair growth on the scalp. Patients with sideburn defects, caused by tumor resection, severe infection, or burns, might have low self-esteem and mental stress. The purpose of this article was to explore a surgical method of applying the expanded scalp flap with natural hairline for cosmetic reconstruction of hairline, so as to provide reference for future clinical work.

Methods

In this study, a retrospective analysis was conducted on 23 patients in the plastic surgery ward of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2015 to December 2018, who underwent expanded scalp flap cosmetic reconstruction of the sideburns with natural hairline (14 males and 9 females; average age, 18.7 ± 13.7 years). The follow-up time was 8 to 44 months.

Results

Patient satisfaction rate (scored 4 or more) was 95.7%, with an average score of 4.59. A total of 16 patients were very satisfied, and 6 were satisfied. There were 21 patients who had good flap survival, and 2 patients who had venous congestion at the distal end of the flap. One case relieved voluntarily 3 days postsurgery, and the other case had partial skin necrosis at the distal end, healing phase II. These 2 cases were classified as grade I according to the Clavien-Dindo classification. In 9 of the patients, the reconstructed sideburn presented a natural look with good hair angle and great size and shape, with average scores of 4.61, 4.52, and 4.48. The scars at the donor site were inconspicuous, and there were no complaints (average score, 4.61). The rest of the patients received satisfactory appearances after surgery.

Conclusion

In conclusion, the technique described above presented a fine method for sideburn reconstruction. Based on the achieved aesthetic scores of our study, as well as the high patient satisfaction rate (95.7%), the aforementioned technique is acceptable for both surgeons and patients.
A spontaneous gravity prior: newborn chicks prefer stimuli that move against gravity
Authors: Bliss Larry , Vasas Vera , Freeland Laura , Roach Robyn , Ferrè Elisa Raffaella , Versace Elisabetta
Published: February 2023

At the beginning of life, inexperienced animals use evolutionary-given preferences (predispositions) to decide what stimuli to attend and approach. Stimuli that contain cues of animacy, such as face-like stimuli, biological motion and changes in speed, are particularly attractive across vertebrate taxa. A strong cue of animacy is upward movement against terrestrial gravity, because only animate objects consistently move upward. To test whether upward movement is spontaneously considered attractive already at birth, we tested the early preferences of dark-hatched chicks (
Gallus gallus
) for upward- versus downward-moving visual stimuli. We found that, without any previous visual experience, chicks consistently exhibited a preference to approach stimuli that move upward, against gravity. A control experiment showed that these preferences are not driven by avoidance of downward stimuli. These results show that newborn animals have a gravity prior that attracts them toward upward movement. Movement against gravity can be used as a cue of animacy to orient early approach responses in the absence of previous visual experience.
The origins and development of free-electron lasers in the UK
Authors: Seddon Elaine A. , Poole Michael W.
Published: February 2023

This review article covers close to 45 years of free-electron laser (FEL) activity in the UK from the mid 1970s until 2022. Technical details of the projects are given together with personal insights provided by those who worked on specific projects. Both funded and unfunded projects are included to highlight the breadth of ideas generated over the years; this approach also clearly reveals the evolution in FEL activities from the early imperative to reproduce and understand first results at long wavelength towards the development of ever-higher-quality FEL output at very short wavelengths. Also included are the longer-term and broader benefits of the early projects. One aspect of this is the many years of UK experience in the design, operation and use of FEL facilities (in the UK and abroad) which reveal the wider value, financial and intellectual, of much of the work that has been undertaken and that is often not apparent. Continuous development of the UK technological base in this area has led to innovative contributions on a global scale and considerable financial return.
Bulk-interface correspondences for one-dimensional topological materials with inversion symmetry
Authors: Thiang Guo Chuan , Zhang Hai
Published: February 2023

The interface between two materials described by spectrally gapped Hamiltonians is expected to host an in-gap interface mode, whenever a certain topological invariant changes across the interface. We provide a precise statement of this bulk-interface correspondence and its rigorous justification. The correspondence applies to continuum and lattice models of interfaces between one-dimensional materials with inversion symmetry, with dislocation models being of particular interest. For continuum models, the analysis of the parity of the ‘edge’ Bloch modes is the key component in our argument, while for the lattice models, the relative Zak phase and index theory are.
JMM Profile: Usutu virus
Authors: Golding Megan , Seechurn Nicola , Baylis Matthew , Johnson Nicholas
Published: February 2023

Usutu virus (USUV) is an emerging arbovirus belonging to the family Flaviviridae, genus Flavivirus. It is maintained in an enzootic cycle, with mosquitos as the vector and birds as the main amplifying host. Humans, and other mammals such as horses, are dead-end hosts. The virus was originally detected in sub-Saharan Africa, but in the past two decades has spread across Europe. In certain bird species, such as the Eurasian blackbird (Turdus merula), USUV is extremely virulent and can be fatal. Human infection is rare and often asymptomatic, but multiple short-term neurological diseases have been reported, highlighting its public-health risk.
Antimicrobial susceptibility study and molecular epidemiology of ceftazidime/avibactam against Pseudomonas aeruginosa collected from clinical patients in PR China (2004–2021)
Authors: Hu Yanyan , Chen Jiawei , Huang Ling , Liu Congcong , Zhou Hongwei , Zhang Rong
Published: February 2023

Introduction. The increasing prevalence of multidrug-resistant (MDR)

Pseudomonas aeruginosa

worldwide is a significant global public health concern. Ceftazidime/avibactam (CZA) has been considered a novel promising β-lactam/β-lactamase inhibitor combination antibiotic against difficult-to-treat

P. aeruginosa

isolates. Big data studies on CZA susceptibility against

P. aeruginosa

have been limited.

Gap statement. Production of metallo-β-lactamases was the most prevalent resistance mechanism for

P. aeruginosa

against CZA.

Aim. To assess the in vitro activity of CZA against

P. aeruginosa

strains and the relevant resistance mechanisms.

Methodology. One thousand three hundred and sixty-three

P. aeruginosa

isolates were collected from 2004 to 2021. Antimicrobial susceptibility testing was carried out for commonly used antipseudomonal drugs via the broth microdilution method. Polymerase chain reaction (PCR) or whole-genome sequencing were performed to analyse the most common carbapenemase genes. Molecular epidemiology was analysed by uploading the sequencing data to the Center for Genomic Epidemiology website.

Results. Antimicrobial susceptibility testing showed that CZA and lipopeptides are the most active antibiotics against

P. aeruginosa

isolates. PCR and genome sequencing revealed that the most prevalent resistance mechanism for

P. aeruginosa

against CZA was the production of metallo-β-lactamases. None of the bla
PDC mutations were found to be associated with avibactam resistance.

Conclusion. Our findings revealed that CZA and lipopeptides are the most active antibiotics against

P. aeruginosa

isolates. The most prevalent resistance mechanism for

P. aeruginosa

against CZA was the production of metallo-β-lactamases, and none of the bla
PDC mutations were found to be associated with avibactam resistance.
Nanopore-only assemblies for genomic surveillance of the global priority drug-resistant pathogen, Klebsiella pneumoniae
Authors: Foster-Nyarko Ebenezer , Cottingham Hugh , Wick Ryan R. , Judd Louise M. , Lam Margaret M. C. , Wyres Kelly L. , Stanton Thomas D. , Tsang Kara K. , David Sophia , Aanensen David M. , Brisse Sylvain , Holt Kathryn E.
Published: February 2023

Oxford Nanopore Technologies (ONT) sequencing has rich potential for genomic epidemiology and public health investigations of bacterial pathogens, particularly in low-resource settings and at the point of care, due to its portability and affordability. However, low base-call accuracy has limited the reliability of ONT data for critical tasks such as antimicrobial resistance (AMR) and virulence gene detection and typing, serotype prediction, and cluster identification. Thus, Illumina sequencing remains the standard for genomic surveillance despite higher capital and running costs. We tested the accuracy of ONT-only assemblies for common applied bacterial genomics tasks (genotyping and cluster detection, implemented via Kleborate, Kaptive and Pathogenwatch), using data from 54 unique

Klebsiella pneumoniae

isolates. ONT reads generated via MinION with R9.4.1 flowcells were basecalled using three alternative models [Fast, High-accuracy (HAC) and Super-accuracy (SUP), available within ONT’s Guppy software], assembled with Flye and polished using Medaka. Accuracy of typing using ONT-only assemblies was compared with that of Illumina-only and hybrid ONT+Illumina assemblies, constructed from the same isolates as reference standards. The most resource-intensive ONT-assembly approach (SUP basecalling, with or without Medaka polishing) performed best, yielding reliable capsule (K) type calls for all strains (100 % exact or best matching locus), reliable multi-locus sequence type (MLST) assignment (98.3 % exact match or single-locus variants), and good detection of acquired AMR genes and mutations (88–100 % correct identification across the various drug classes). Distance-based trees generated from SUP+Medaka assemblies accurately reflected overall genetic relationships between isolates. The definition of outbreak clusters from ONT-only assemblies was problematic due to inflation of SNP counts by high base-call errors. However, ONT data could be reliably used to ‘rule out’ isolates of distinct lineages from suspected transmission clusters. HAC basecalling + Medaka polishing performed similarly to SUP basecalling without polishing. Therefore, we recommend investing compute resources into basecalling (SUP model), wherever compute resources and time allow, and note that polishing is also worthwhile for improved performance. Overall, our results show that MLST, K type and AMR determinants can be reliably identified with ONT-only R9.4.1 flowcell data. However, cluster detection remains challenging with this technology.
Role of demographic factors and vascular anatomy in successful trans-radial Tiger catheterization in coronary angiography
Authors: Farsavian Ali Asghar , Ghadirzadeh Erfan , Daghestani Maryam , Golshani Samad , Nadi Ghara Ali Asghar
Published: February 2023

Objective

The use of a single catheter in the trans-radial angiography approach (TRA) is associated with fewer complications. However, there are some discrepancies regarding the effectiveness of these catheters. Catheter selection is crucial in reducing the risk of trauma to the coronary arteries in angiography, so the main objective of the present study was to investigate the success rate of the Tiger single catheter in the right and left coronary angiography in the TRA, in addition to characterizing the role of demographic factors, underlying conditions and vascular anatomy in its success.

Methods

This observational study was conducted on 127 patients with suspected CAD. Demographic data and risk factors were recorded in a checklist. The root diameter of the aortic artery at different sections ejection fraction was measured by transthoracic echocardiography before performing TRA. Coronary anomaly, tortuosity of the radial artery pathway to the aorta, as well as coronary artery take-off and procedure indication, were also recorded during the TRA.

Results

In this study, 127 patients with a mean age of 59 ± 10.3 were enrolled. Sixty-seven patients (51.5%) were female, and 63 patients (48.5%) were male. Failure was reported only in 5 patients (3.85%). Age, gender, BMI, height, aortic diameter, coronary anomalies, tortuosity, hypertension, dyslipidemia, and smoking had not a significant relationship with successful Tiger catheterization (P > 0.05) but high coronary take-off had (P= 0.004).

Conclusion

In cases of high coronary take-off and coronary abnormality, a Tiger catheter can probably benefit the patient with a trans-radial approach.
A longitudinal evaluation of personalized intrinsic network topography and cognitive decline in Parkinson’s disease
Authors: Li Renxi , Pozorski Vincent , Dabbs Kevin , Haebig Maureen , Birn Rasmus , Pletcher Colleen , Wey Alexandra , Barzgari Amy , Theisen Frances , Cox Christopher , Okonkwo Ozioma , Gallagher Catherine
Published: February 2023

Resting state functional MRI (R-fMRI) offers insight into how synchrony within and between brain networks is altered in disease states. Individual and disease-related variability in intrinsic connectivity networks may influence our interpretation of R-fMRI data.

Methods

We used a personalized approach designed to account for individual variation in the spatial location of correlation maxima to evaluate R-fMRI differences between Parkinson’s disease (PD) patients who showed cognitive decline, those who remained cognitively stable, and cognitively stable controls. We compared fMRI data from these participant groups, studied at baseline and 18 months later, using both Network-based Statistics (NBS) and calculations of mean inter- and intra-network connectivity within pre-defined functional networks.

Results

The NBS analysis showed that PD participants who remained cognitively stable showed exclusively (at baseline) or predominantly (at follow-up) increased intra-network connectivity, whereas decliners showed exclusively reduced intra-network and inter-(ventral attention and default mode) connectivity, in comparison to the control group. Evaluation of mean connectivity between all ROIs within a priori networks showed that decliners had consistently reduced inter-network connectivity for ventral attention, somatomotor, visual, and striatal networks, and reduced intra-network connectivity for ventral attention network to striatum and cerebellum.

Conclusions

These findings suggest that specific functional connectivity covariance patterns differentiate PD cognitive subtypes and may predict cognitive decline. Further, increased intra and internetwork synchrony may support cognitive function in the face of PD-related network disruptions.

Key Points

Resting state functional MRI (R-fMRI) can be used to probe changes in brain networks related to disease. Personalized approaches can be used to address spatial variations in R-fMRI correlation maxima influenced by individual variation or brain plasticity in response to disease.

Longitudinal R-fMRI from cognitively stable Parkinson’s patients were compared with those who experienced decline as well as controls using a personalized approach.

Cognitively stable patients showed increased inter and intra-network synchrony while decliners showed decreases that may have preceded cognitive decline.
Deletion ofMEC1suppresses replicative senescence of thecdc13-2mutant inSaccharomyces cerevisiae
Authors: Yao Yue , Fekete-Szücs Enikő , Rosas Bringas Fernando R. , Chang Michael
Published: February 2023

InSaccharomyces cerevisiae, telomerase recruitment to telomeres depends on a direct interaction between Cdc13, a protein that binds single-stranded telomeric DNA, and the Est1 subunit of telomerase. Thecdc13-2allele disrupts telomerase association with telomeres, resulting in progressive telomere shortening and replicative senescence. The Mec1/ATR kinase is both a positive and negative regulator of telomerase activity, and is required for the cell cycle arrest in telomerase-deficient senescent cells. In this study, we find that deletion ofMEC1suppresses the replicative senescence ofcdc13-2. This suppression is dependent on telomerase, indicating that Mec1 antagonizes telomerase-mediated telomere extension incdc13-2cells to promote senescence.
Dissemination of IncI plasmid encodingblaCTX-M-1is not hampered by its fitness cost in the pig’s gut
Authors: Allain Margaux , Mahérault Anne Claire , Gachet Benoit , Martinez Caroline , Condamine Bénédicte , Magnan Mélanie , Kempf Isabelle , Denamur Erick , Landraud Luce
Published: February 2023

Multiresistance plasmids belonging to the IncI incompatibility group have become one of the most pervasive plasmid types in extended-spectrum beta-lactamase producingEscherichia coliof animal origin. The extent of the burden imposed on the bacterial cell by these plasmids seems to contribute to the emergence of “epidemic” plasmids. However,in vivodata in the natural environment of the strain are scarce. Here, we investigated the cost of ablaCTX-M-1-IncI1 epidemic plasmid in a commensalE. colianimal strain, UB12-RC, before and after oral inoculation of fifteen 6-to 8-week-old specific pathogen-free pigs. Growth rate in rich medium was determined on (i) UB12-RC and derivatives, with or without plasmid,in vivoand/orin vitroevolved, and (ii) strains that acquired the plasmid in the gut during the experiment. AlthoughblaCTX-M-1-IncI1 plasmid imposed no measurable burden on the recipient strain after conjugation and during the longitudinal carriage in the pig’s gut, we observed a significant difference in the bacterial growth rate between IncI1 plasmid-carrying and plasmid-free isolates collected duringin vivocarriage. Only a few mutations on the chromosome of the UB12-RC derivatives were detected by whole-genome sequencing. RNA-Seq analysis of a selected set of these strains showed that transcriptional responses to theblaCTX-M-1-IncI1 acquisition were limited, affecting metabolism, stress response, and motility functions. Our data suggest that the effect of IncI plasmid on host cells is limited, fitness cost being insufficient to act as a barrier to IncI plasmid spread among natural population ofE. coliin the gut niche.
The Hidden Footprints of Platelets in IgG4-Related Disease Pathogenesis
Authors: Oguz Ali Kemal , Oygur Cagdas Sahap , Dedeoglu Bala Gur , Turacli Irem Dogan , Kilicoglu Sibel Serin , Ergun Ihsan
Published: February 2023

Platelets have grabbed great attention as immune cells and principal modulators of tissue remodeling besides their well-known hemostatic and vascular wall safeguarding functions. In line with this knowledge, findings indicating an excessive platelet activation have been reported in systemic sclerosis, which is an autoimmune, multisystem, fibrotic disorder. By borrowing the transcriptomic data of Nakajima et al. (GEO data repository, GSE66465) we sought a platelet contribution in immunoglobulin G4-related disease (IgG4-RD) pathogenesis, another immune-mediated, fibroinflammatory, multiorgan disease. GEO2R for class comparisons and WebGestalt for functional enrichment analyses were used. When treatment naïve IgG4-RD patients were compared with healthy controls, 268 differentially expressed genes (204 with increased and 64 with decreased expression) were detected. Enrichment analyses performed using gene ontology (Biological Process), pathway (Panther), and disease (GLAD4U) functional databases documented many significantly enriched terms relating to platelets, coagulation, and thrombosis, including “ Thrombasthenia”, “ Low on-treatment platelet reactivity”, “ High on-treatment platelet reactivity”, “ Platelet reactivity”, “ Platelet aggregation inhibition”, “ Blood platelet disorders”, “ Platelet degranulation”, “ Platelet aggregation”, and “ Platelet activation”. The enrichment ratios of these terms were found to be between 6.4 and 83.2. Together with the limited data in the relevant literature, it seems imperative to plan meticulously designed research specifically focusing on platelets’ contribution to IgG4-RD pathogenesis.
Mortality Predictions for Men and Women Diagnosed with Anal Canal Squamous Cell Carcinoma in the United States
Authors: Ahmmad Roungu , Hosseini-Carroll Pegah , Hossain Sanwar , Muthukumaru Raina
Published: February 2023

Objective

Studies have concluded that treatments for patients with anal cancer vary based on their age, sex, and race. We examined gender-specific differences in mortality and overall survival for patients with squamous cell carcinoma (SCC) of the anal canal (AC), based on differences in treatment, stage and demographic factors.

Method

SEER’s retrospective cohort dataset was used to review all patients diagnosed with SCC of the AC between 2000 and 2018. We analyzed survival by sub-distributed Cox models and estimated overall survival probabilities through nomograms based on cancer treatments, tumor characteristics, and demographic data

Results

In the study, 24,892 patients with SCC in the AC had a median survival time of 43 months (IQR: 16-97). However, males (median 38.0 months, IQR: 13.0-92.0) had significantly shorter median survival times than females (median 46.0 months, IQR: 17-100). There were 12% of patients in metastatic stages, with females (70.3%) receiving more treatments than males (29.7%). The survival rate of patients with SCC of the AC who underwent radiation treatment was significantly higher (HR 0.72, 95% CI: 0.65-0.80, p<0.001). Moreover, compared to those without surgery on the primary site, those undergoing surgery on the primary site had a 49% lower mortality rate (HR 0.51; 95% CI: 0.45 to 0.56, p0.001). According to the study, the overall survival probability at 5 and 10 years for patients who received chemotherapy on primary sites was about 90%, compared to only 40% and 22% for those who did not receive chemotherapy. Surgical intervention yielded similar results, but radiation therapy did not significantly improve survival rates.

Conclusion

Compared with men, women with SCC of the AC have a higher survival rate, and younger patients tend to live longer. The factors negatively affecting survival were increasing age, non-whites, divorced / separated / widowed, and advanced stages of cancer. A significant increase in survival was seen after surgery and chemotherapy for SCC, while radiation had little effect on survival.
How Much of the Outcome Improvement after Successful Recanalization is Explained by Follow-up Infarct Volume Reduction?
Authors: Kniep Helge , Meyer Lukas , Broocks Gabriel , Bechstein Matthias , Austein Friederike , McDonough Rosalie , Brekenfeld Caspar , Flottmann Fabian , Deb-Chatterji Milani , Alegiani Anna , Hanning Uta , Thomalla Götz , Fiehler Jens , Gellißen Susanne ,   the German Stroke Registry – Endovascular Treatment (GSR – ET)
Published: February 2023

Background

Follow-up infarct volume (FIV) is used as surrogate for treatment efficiency in Mechanical Thrombectomy (MT). In contrast to these assumptions, previous works suggest that MT-related infarct volume reduction has only limited association with outcome comparing MT vs. medical care. It remains unclear to what extent the causal relationship between successful recanalization vs. persistent occlusion and functional outcome is explained by treatment-related reduction in FIV. Results might allow quantification of pathophysiological effects and could improve the understanding of the value of FIV as imaging endpoint in clinical trials.

Methods

All patients from our institution enrolled in the German Stroke Registry from 05/2015-12/2019 with anterior circulation stroke, availability of the relevant clinical data and follow-up CT were analyzed. A mediation analysis was conducted to investigate the effect of successful recanalization (Tici≥2b) on good functional outcome (90d mRS≤2) with mediation through final infarct volume.

Results

429 patients were included. 309(72 %) patients had a successful recanalization and 127(39%) achieved good functional outcome. Probability of good outcome was significantly associated with age (OR=0.89,p<0.001), pre-stroke mRS (OR=0.38,p<0.001), FIV (OR=0.98,p<0.001), hypertension (OR=2.08,p<0.05) and successful recanalization (OR=3.57,p<0.01). Using linear regression in the mediator pathway, FIV was significantly associated with ASPECTS (Coefficient(Co)=-26.13,p<0.001), NIHSS admission (Co=3.69,p<0.001), age (Co=-1.18,p<0.05) and successful recanalization (Co=-85.22,p<0.001). Mediation analysis suggest a 23 percentage points (pp) increase of probability of good functional outcome (95%CI:16pp-29pp) in patients with successful recanalization. 56% (95%CI:38%-78%) of the improvement in good outcome was explained FIV reduction.

Conclusions

56% of the improvement of functional outcome after successful recanalization is explained by FIV reduction. Results corroborate established pathophysiological assumptions and confirm the value of infarct volume as imaging endpoint in clinical trials. 44% of the improvement in outcome is not explained by FIV reduction and reflects the remaining mismatch between radiological and clinical outcome measures.

Trial Registration

https://clinicaltrials.gov/ct2/show/NCT03356392(NCT03356392)