bluuebunny/crossref_metadata_2025 huggingface dataset:
A Propensity-Matched Cohort Study of Tocilizumab in Patients With Coronavirus Disease 2019
Authors: Lewis Tyler C. , Adhikari Samrachana , Tatapudi Vasishta , Holub Meredith , Kunichoff Dennis , Troxel Andrea B. , Montgomery Robert A. , Sterman Daniel H.
Published: November 2020

Objectives:

To determine the impact of tocilizumab, a monoclonal antibody against the interleukin 6 receptor, on survival in patients with coronavirus disease 2019.

Design:

Observational cohort study of patients hospitalized with coronavirus disease 2019 between March 1, 2020, and April 24, 2020. A propensity-matched (1:1) analysis was used to compare patients who received tocilizumab to controls who did not. Competing risk survival analysis was used to determine the primary outcome of time to mortality, and adjusted log-linear and logistic regression for secondary outcomes.

Setting:

Three hospitals within the NYU Langone Health system in New York.

Patients:

Consecutive adult patients hospitalized with coronavirus disease 2019.

Intervention:

Tocilizumab 400-mg IV once in addition to standard of care or standard of care alone.

Measurements and Main Results:

Data from 3,580 severe acute respiratory syndrome coronavirus 2 positive qualifying hospitalized patients were included, of whom 497 (13.9%) were treated with tocilizumab. In the analysis of tocilizumab-treated patients and matched controls, fewer tocilizumab-treated patients died (145/497, 29.2%) than did controls (211/497, 42.4%). In the adjusted competing risk regression model, tocilizumab therapy was associated with improved survival relative to controls (hazard ratio = 0.24, 95% CI = 0.18–0.33, p < 0.001). Tocilizumab-treated patients and controls had similar adjusted time to discharge from hospital (hazard ratio = 0.96, 95% CI = 0.78–1.17, p = 0.67). However, they had longer adjusted ICU length of stay (rate ratio = 3.1, 95% CI = 2.5–3.7, p < 0.001) and a higher adjusted infection rate (odds ratio = 4.18, 95% CI = 2.72–6.52, p < 0.001) than controls.

Conclusions:

Tocilizumab therapy was associated with significantly improved survival in coronavirus disease 2019 patients. This survival benefit was associated with increased ICU length of stay and increased infection rate, even as more patients in the tocilizumab group were rescued from rapid death. A prospective, randomized, placebo-controlled trial is needed to confirm these findings.
Procalcitonin Exerts a Mediator Role in Septic Shock Through the Calcitonin Gene-Related Peptide Receptor
Authors: Baranowsky Anke , Appelt Jessika , Kleber Christian , Lange Tobias , Ludewig Peter , Jahn Denise , Pandey Puja , Keller Daniela , Rose Thomas , Schetler Daniela , Braumüller Sonja , Huber-Lang Markus , Tsitsilonis Serafeim , Yorgan Timur , Frosch Karl-Heinz , Amling Michael , Schinke Thorsten , Keller Johannes
Published: November 2020

OBJECTIVES:

Clinically, procalcitonin represents the most widely used biomarker of sepsis worldwide with unclear pathophysiologic significance to date. Pharmacologically, procalcitonin was shown to signal through both calcitonin receptor and calcitonin gene-related peptide receptor in vitro, yet the identity of its biologically relevant receptor remains unknown.

DESIGN:

Prospective randomized animal investigations and in vitro human blood studies.

SETTING:

Research laboratory of a university hospital.

SUBJECTS:

C57BL/6J mice and patients with post-traumatic sepsis.

INTERVENTIONS:

Procalcitonin-deficient mice were used to decipher a potential mediator role in experimental septic shock and identify the relevant receptor for procalcitonin. Cecal ligation and puncture and endotoxemia models were employed to investigate septic shock. Disease progression was evaluated through survival analysis, histology, proteome profiling, gene expression, and flow cytometry. Mechanistic studies were performed with cultured macrophages, dendritic cells, and gamma delta T cells. Main findings were confirmed in serum samples of patients with post-traumatic sepsis.

MEASUREMENTS AND MAIN RESULTS:

Procalcitonin-deficient mice are protected from septic shock and show decreased pulmonary inflammation. Mechanistically, procalcitonin potentiates proinflammatory cytokine expression in innate immune cells, required for interleukin-17A expression in gamma delta T cells. In patients with post-traumatic sepsis, procalcitonin positively correlates with systemic interleukin-17A levels. In mice with endotoxemia, immunoneutralization of interleukin-17A inhibits the deleterious effect of procalcitonin on disease outcome. Although calcitonin receptor expression is irrelevant for disease progression, the nonpeptide calcitonin gene-related peptide receptor antagonist olcegepant, a prototype of currently introduced antimigraine drugs, inhibits procalcitonin signaling and increases survival time in septic shock.

CONCLUSIONS:

Our experimental data suggest that procalcitonin exerts a moderate but harmful effect on disease progression in experimental septic shock. In addition, the study points towards the calcitonin gene-related peptide receptor as relevant for procalcitonin signaling and suggests a potential therapeutic application for calcitonin gene-related peptide receptor inhibitors in sepsis, which warrants further clinical investigation.
An Appraisal of Electrodiagnostic Studies in Stiff Person Syndrome
Authors: Li Yuebing , Thakore Nimish
Published: November 2020

A literature review was performed on the use of electrodiagnostic (EDX) tests including nerve conduction study, electromyography, exteroceptive reflex, blink reflex, and late response in the evaluation of patients with stiff person syndrome (SPS). A web survey was conducted to report the extent of EDX testing usage in the evaluation of SPS among laboratories accredited by the American Academy of Neuromuscular and Electrodiagnostic Medicine. Coactivation of selected agonist and antagonist muscles was performed in 5 healthy subjects to determine its specificity for SPS. Observation of continuous motor unit activity on electromyography and elicitation of exteroceptive reflexes by electric stimulation are informative in assisting a diagnosis of SPS, but further studies focusing on their sensitivities in diagnosing SPS and specificities in differentiating SPS from other movement disorders are needed. The value of EDX testing in SPS lies in ruling out other neuromuscular disorders.
A Pharmacoepidemiologic Approach to Evaluate Real-world Effectiveness of Hormonal Contraceptives in the Presence of Drug–drug Interactions
Authors: Sarayani Amir , Brown Joshua D. , Goodin Amie J. , Squires Patrick , Pham Phuong , Cicali Brian , Henriksen Carl , Schmidt Stephan , Winterstein Almut G.
Published: November 2020

Background:

Accurate estimation of conception is critical in the assessment of the effects of drugs used during pregnancy or to prevent pregnancy. In a novel application, we studied the effectiveness of oral contraceptives (OCs), where misclassification of conception relative to OC exposure may obscure effect estimates.

Methods:

We studied OC failure, in a large claims database, among women who used antiepileptic drugs with metabolizing enzyme-inducing properties (carbamazepine or oxcarbazepine), which reduce OC’s effectiveness or enzyme-neutral properties (lamotrigine or levetiracetam), with no expected impact on OC effectiveness. We compared conception rates in women 12–48 years of age concomitantly using OCs and enzyme-inducing drugs with rates in concomitant users of OCs and enzyme-neutral drugs. We measured conception with a validated algorithm that estimates gestational age based on pregnancy endpoints. We estimated relative and attributable risk using generalized estimating equation models after standardized mortality ratio weighting.

Results:

We identified 89,777 concomitant use episodes with adjusted contraceptive failure rates of 1.6 (95% confidence interval (CI) = 1.4, 1.8) per 100 person–years among users of enzyme-neutral drugs and 18,964 episodes with a rate of 2.3 (1.9, 2.8) among users of enzyme-inducing drugs. The relative risk of conception for enzyme-inducing group was 1.4 (1.1, 1.8), and the rate difference was 0.7 (0.2, 1.2).

Conclusions:

OCs in combination with antiepileptic drugs that interact with metabolic enzymes were associated with increased contraceptive failure rates. Measurement of conception in claims data had adequate accuracy to uncover a strong drug–drug interaction, offering promise for broader application in comparative effectiveness studies on hormonal contraceptives to inform clinical and regulatory decisionmaking.
Eighty-micron flap femtosecond-assisted LASIK for the correction of myopia and myopic astigmatism
Authors: Bages-Rousselon Yunuen , Pinkus Denisse , Rivas Miguel , Butron Karla , Robledo Nora , Chayet Arturo
Published: November 2020

Purpose:

To evaluate the safety and efficacy of 80-μm flap femtosecond laser–assisted LASIK and the early clinical and refractive outcomes in the correction of myopia and myopic astigmatism.

Setting:

Private practice, outpatient.

Design:

Prospective study.

Methods:

Patients who underwent femtosecond-assisted LASIK between February and April 2018 were included. Inclusion criteria were myopia from −1.00 to −8.00 diopters (D) and astigmatism up to −3.00 D and no previous surgeries. All patients were tested preoperatively and on day 1 and month 3 for uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), slitlamp and dilated fundus examination, Schirmer I test with anesthesia, and ocular surface disease index questionnaire. The FEMTO LDV Z8 was used for flap construction and the Wavelight Allegretto 400 excimer for refractive treatment. Flap thickness was measured at week 1 with anterior segment optical coherence tomography (AS-OCT).

Results:

Eighty-two eyes were included. Logarithm of the minimum angle of resolution UDVA was 1.28 ± 0.53 preoperatively, 0.02 ± 0.05 at day 1, and 0.14 ± 0.127 at month 3. There was no loss of CDVA lines. The mean flap thickness measured at 1 week with AS-OCT was 73 ± 6.7 µm.

Conclusions:

The use of ultrathin flaps, just below Bowman's layer, with the Ziemer LDV Z8 femtosecond laser was possible, safe, reliable, and reproducible. Eighty-micron flaps allowed for excellent vision on 1 day post-LASIK and might be a good alternative to maintain an appropriate percentage of tissue altered, especially when attempting greater corrections or larger treatment zones.
Isovolemic filter-based therapeutic plasma-exchange with fresh frozen plasma is associated with minimal thromboelastometric changes in noncoagulopathic patients
Authors: Popescu Mihai , Marcu Alexandra , Dinca Alexandru , Tanase Andreea , Tomescu Dana
Published: November 2020

The aim of this study was to assess the effects of isovolemic therapeutic plasma-exchange using fresh frozen plasma on coagulations parameters assessed by standard coagulation tests and rotational thromboelastometry in noncoagulopathic patients. Twenty patients who underwent isovolemic filter-based therapeutic plasma-exchange of approximately 1.5 plasma volume per session were included in the current study. Standard coagulation tests and rotational thromboelastometry (ExTEM, InTEM, FibTEM and ApTEM) were performed 30 min before and after the procedure. Isovolemic therapeutic plasma-exchange was associated with decreased fibrinogen levels (P = 0.01). Thromboelastometric assay demonstrated an increased clotting time in both ExTEM (P = 0.03) and InTEM (P = 0.01) and a decreased thrombodynamic potential index in ExTEM (P = 0.03). No significant difference in FibTEM maximum clot firmness was recorded (P = 0.41). Therapeutic plasma-exchange in noncoagulopathic patients is associated with minimal changes in thromboelastometric parameters, mainly by an increase in clotting time in both intrinsic and extrinsic pathways.
Human hematopoiesis: aging and leukemogenic risk
Authors: Adelman Emmalee R. , Figueroa Maria E.
Published: November 2020

Purpose of review

Our understanding of the effects of aging on human hematopoiesis has advanced significantly in recent years, yet the full ramifications of these findings are not fully understood. This review summarizes these findings and discusses their implication as they relate to malignant hematopoiesis.

Recent findings

With human aging there is an impaired immune response, loss of hematopoietic stem cell (HSC) function, increase in clonal hematopoiesis, and higher frequency of myeloid malignancies. Although murine models have implicated abnormalities in DNA damage repair, autophagy, metabolism, and epigenetics, studies in primary human specimens are more limited. The development of age-related clonal hematopoiesis and the risk associated with this is one of the major findings in the field of recent years. This is accompanied by changes in bone marrow stem and progenitor composition, changes in the epigenetic program of stem cells and an inflammatory milieu in the bone marrow. The precise consequences of these changes for the development of age-related malignancies are still unclear.

Advances in the field have begun to reveal the mechanisms driving human HSC loss of function with age. It will be critical to delineate between normal and malignant aging in order to better prevent age-associated myeloid malignancies.
Current understanding of human megakaryocytic-erythroid progenitors and their fate determinants
Authors: Kwon Nayoung , Thompson Evrett N. , Mayday Madeline Y. , Scanlon Vanessa , Lu Yi-Chien , Krause Diane S.
Published: November 2020

Purpose of review

This review focuses on our current understanding of fate decisions in bipotent megakaryocyte-erythroid progenitors (MEPs). Although extensive research has been carried out over decades, our understanding of how MEP commit to the erythroid versus megakaryocyte fate remains unclear.

Recent findings

We discuss the isolation of primary human MEP, and focus on gene expression patterns, epigenetics, transcription factors and extrinsic factors that have been implicated in MEP fate determination. We conclude with an overview of the open debates in the field of MEP biology.

Understanding MEP fate is important because defects in megakaryocyte and erythrocyte development lead to disease states such as anaemia, thrombocytopenia and leukaemia. MEP also represent a model system for studying fundamental principles underlying cell fate decisions of bipotent and pluripotent progenitors, such that discoveries in MEP are broadly applicable to stem/progenitor cell biology.
Current evidence for focal therapy and partial gland ablation for organ-confined prostate cancer: systematic review of literature published in the last 2 years
Authors: Kayano Paulo Priante , Klotz Laurence
Published: November 2020

Purpose of review

The shift in the diagnostic algorithm for prostate cancer to early imaging with mpMRI has resulted in many patients being diagnosed with small volume, apparently unilateral, clinically significant cancers. In these patients, a minimally invasive, nonmorbid intervention is appealing. The aim of this study was to review data reported within the last 2 years on focal therapy and partial gland ablation for organ-confined prostate cancer.

Recent findings

High-intensity focal ultrasound, focal cryotherapy, photodynamic therapy, irreversible electroporation and focal laser ablation, have been used as treatment modalities for localized prostate cancer treatment. The reported oncologic outcomes vary widely and makes comparisons challenging. All the focal therapies report low rates of complications, and high rates of continence and erectile function preservation. The most common adverse events are hematuria, urinary retention and urinary tract infections. During this period, the initial results of several new technologies including MRI-guided transurethral ultrasound ablation were published.

Focal therapy and partial gland ablation for organ-confined prostate cancer is an option for patients with intermediate-risk disease because of its low complication profile and preservation of QOL. Trials comparing the outcome of different focal therapy technologies have not been carried out, and the existing evidence does not point to one approach being clearly superior to others. Long-term oncologic outcome is lacking. Despite this, for men with unilateral intermediate-risk prostate cancer whose disease is often relatively indolent, focal therapy is an appealing option.
An Exploratory Study of Bullying Directed Toward Clinical Nursing Faculty
Authors: El Ghaziri Mazen , Simons Shellie , Taylor Rosemary
Published: November 2020

Background

Clinical education is an integral component of nursing education and relies heavily on clinical nursing faculty (CNF). However, there are not enough nurses seeking CNF positions to meet the current demand of the nursing workforce.

Purpose

The purpose of this study was to examine the prevalence and impact of workplace bullying directed toward CNF.

Methods

For this exploratory cross-sectional study, a web-based survey was distributed to CNF working in New England states.

Results

A total of 76 participant responses were analyzed. Eighteen percent of the participants met the criteria for being either occasionally or frequently bullied. Nursing staff in the clinical agencies and colleagues and administrators in the nursing program where CNF teach were identified as the most frequent perpetrators.

Conclusions

Understanding the prevalence and impact of bullying of CNF helps inform the development of strategies to support and retain these essential members of the nursing education workforce.
Comparison of Virtual Simulation to Clinical Practice for Prelicensure Nursing Students in Pediatrics
Authors: Weston Jeannie , Zauche Lauren Head
Published: November 2020

Background

The COVID-19 (coronavirus disease) pandemic has required a transition from in-person clinical practice to virtual learning.

Purpose

This study compares the standardized assessment test scores of prelicensure nursing students who completed their pediatric clinical practicum in person for both the clinical and simulation practice settings versus virtually.

Methods

This study included 186 students in a pediatric clinical course. Half the students completed in-person pediatric clinical practice and simulation, and half the students used i-Human to complete their pediatric clinical practicum virtually. Scores on the Assessment Technologies Institute (ATI) Nursing Care of Children examination were compared using independent-samples t tests.

Results

There were no significant differences in ATI scores between students who completed their pediatric clinical practicum in the clinical setting compared with virtually (P = .485; 95% confidence interval, −2.24 to 4.71).

Conclusions

Using the i-Human platform, along with prebriefing and debriefing, is an effective pedagogical approach to simulating a pediatric clinical practicum.
Comparison of MRI, PSMA PET/CT, and Fusion PSMA PET/MRI for Detection of Clinically Significant Prostate Cancer
Authors: Arslan Aydan , Karaarslan Ercan , Güner A. Levent , Sağlıcan Yeşim , Tuna Mustafa Bilal , Özışık Ozan , Kural Ali Rıza
Published: November 2020

Purpose

The aim of our study is to compare the efficacy of positron emission tomography (PET) and magnetic resonance imaging (MRI) for detecting intraprostatic lesions in patients with clinically significant prostate cancer who underwent radical prostatectomy; additionally, investigate the benefits of rostate-specific membrane antigen (PSMA) PET-MR software fusion images to the diagnosis.

Methods

Thirty patients, who underwent radical prostatectomy between June 2015 and April 2018, were included in the study. Subjects with gallium PSMA PET-CT and multiparametric prostate MRI performed according to Prostate Imaging Reporting and Data System v2 criteria in our clinic were included in the study. 68Ga-PSMA PET-CT images were fused with MR sequences for analysis.

Results

The mean age of cases was 63.2 years (ranged from 45 to 79 years). Index lesions of 29 cases were detected by MRI and 22 of them by PET CT. Both modalities were found to be less sensitive for detection of bilaterality and multifocality (42.85% and 20% for MRI, 28.57% and 20% for PET CT, respectively). There was no statistically significant difference between modalities. It was observed that if a clinically significant tumor focus was not detected by MRI, it was small (6 mm or less) in diameter or had a low Gleason score.

Conclusions

Software fusion PSMA PET-MRI increased the sensitivity of the index lesion identification compared with PSMA PET-CT and also increased the sensitivity of real lesion size identification compared with multiparametric prostate MRI.
Posterior Based Triangular Mucosal Advancement Flap for Surgical Correction of Scleroderma-Induced Microstomia
Authors: Kao Tuan-Yu , Kim Tae-Seup , Alqussair Ali , Choi Jin-Young
Published: November 2020

Systemic sclerosis is a complex autoimmune connective tissue disease of unknown cause that causes sclerosis and inflammation of the skin and subcutaneous tissue. Sclerosis involving the face can lead to microstomia, leading to difficulties with mastication, phonation, and oral hygiene. Although many agents have been used to treat internal organ involvement, they often have compromised efficacy on cutaneous manifestation including facial dermal sclerosis. In this case presentation, we will introduce a surgical technique to correct scleroderma-induced microstomia.
Implant-Supported Maxillary and Mandibular Rehabilitation in a Patient With Hallermann-Streiff Syndrome
Authors: von Marttens Alfredo , Perilla Andres , Wen Schilin , Acuña Pablo , Beltrán Víctor
Published: November 2020

Hallermann-Streiff syndrome is a rare congenital abnormality involving multiple craniofacial malformations, such as micrognathia, prominent frontal and nasal bones, vision defects, and dental anomalies. In most patients, patients affected with this disease have multiple dental problems involving a severe loss of teeth and maxillary atrophy. Specialized individual and multidisciplinary treatments are often required in these patients. The objective of this report was to demonstrate the rehabilitation approach of a patient with Hallermann-Streiff syndrome using total implant-support prostheses, with optimal aesthetic and functional results, which significantly improved the patient's quality of life.
Chimeric Anterolateral Thigh and Rectus Femoris Flaps for Reconstruction of Complex Oral and Maxillofacial Defects
Authors: Li Panchun , Zhang Shanshan , Liu Jiang , Xu Yuming , Wu Hanjiang , Gong Zhaojian
Published: November 2020

Purpose:

Complex oral and maxillofacial defects are continuously a challenge for reconstructive surgeons. This study evaluates the effects of chimeric anterolateral thigh (ALT) and rectus femoris flaps for the reconstruction of such defects.

Patients and Methods:

A retrospective review was performed of 10 patients who underwent reconstruction of oral and maxillofacial defects with chimeric ALT and rectus femoris flaps from October 2014 through August 2016 at the Second Xiangya Hospital.

Results:

All 10 patients were male, with a mean age of 53.6 years. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. Salivary fistula occurred in 1 patient, and wound effusion of the thigh occurred in another patient. Gradual wound healing was observed after repeated dressing changes. The patients were followed for approximately 3 to 46 months, the appearance and oral functions were recovered well, and no thigh motor dysfunctions were observed.

Conclusions:

Because of the convenient flap design, effective avoidance of recipient site complications, lower donor site morbidity, and acceptable functional and esthetic results, chimeric ALT and rectus femoris flaps are a good choice for the reconstruction of complex oral and maxillofacial defects.
An Innovative Biological Model for Ultrasound-Guided Central Venous Access Simulation
Authors: Grillet Guillaume R. , Bouju Pierre M. , Le Pabic Estelle M. , Guinier David J. , Norwood James D. , La Combe Béatrice S.
Published: November 2020

Introduction

Simulation training is an increasingly used method to train medical students in the use of ultrasound guidance for vascular access positioning. Although very efficient for basic training, commercial simulators for vascular access do not reproduce real-life conditions. We developed a biological training model, using porcine liver, and compared it with an existing commercial model.

Methods

Whole porcine livers were used by perfusing the portal vein system after inferior vena cava clamping. Thirty-three practitioners accustomed to ultrasound-guided procedure were enrolled to perform an ultrasound-guided vascular procedure on both biological and commercial models. Procedure duration was recorded and 10-point scales were used to compare the 2 models regarding image quality, procedure feeling, and similarity with the real-life procedure.

Results

Participants reported a better image quality with the biological model (8.8 ± 1 vs. 7.7 ± 2, P = 0.007) as well as a significant difference in the procedure feeling (8.0 ± 1 vs. 6.9 ± 1.9, P = 0.002). Real-life likeness was significantly better for the biological model (8.4 ± 1.1 vs. 4.5 ± 6, P < 0.0001). Procedure duration was almost 3 times longer using the biological model than the commercial model (209.6 ± 189.0 vs. 59.8 ± 50.1, P < 0.0001).

Conclusions

This study validates our biological model of porcine's liver as an interesting training model, allowing closer real-life perception than its commercial counterpart. This model could complement and enhance simulation learning.
Management of Gastroschisis
Authors: Allin Benjamin S. R. , Opondo Charles , Kurinczuk Jennifer J. , Baird Rob , Puligandla P. , Skarsgard Erik , Knight Marian
Published: November 2020

Objective:

In infants with gastroschisis, outcomes were compared between those where operative reduction and fascial closure were attempted ≤24 hours of age (PC), and those who underwent planned closure of their defect >24 hours of age following reduction with a pre-formed silo (SR).

Summary of Background Data:

Inadequate evidence exists to determine how best to treat infants with gastroschisis.

Methods:

A secondary analysis was conducted of data collected 2006–2008 using the British Association of Pediatric Surgeons Congenital Anomalies Surveillance System, and 2005–2016 using the Canadian Pediatric Surgery Network.

28-day outcomes were compared between infants undergoing PC and SR. Primary outcome was number of gastrointestinal complications. Interactions were investigated between infant characteristics and treatment to determine whether intervention effect varied in sub-groups of infants.

Results:

Data from 341 British and Irish infants (27%) and 927 Canadian infants (73%) were used. 671 infants (42%) underwent PC and 597 (37%) underwent SR. The effect of SR on outcome varied according to the presence/absence of intestinal perforation, intestinal matting and intestinal necrosis. In infants without these features, SR was associated with fewer gastrointestinal complications [aIRR 0.25 (95% CI 0.09–0.67, P = 0.006)], more operations [aIRR 1.40 (95% CI 1.22–1.60, P < 0.001)], more days PN [aIRR 1.08 (95% CI 1.03–1.13, P < 0.001)], and a higher infection risk [aOR 2.06 (95% CI 1.10–3.87, P = 0.025)]. In infants with these features, SR was associated with a greater number of operations [aIRR 1.30 (95% CI 1.17–1.45, P < 0.001)], and more days PN [aIRR 1.06 (95% CI 1.02–1.10, P = 0.003)].

Conclusions:

In infants without intestinal perforation, matting, or necrosis, the benefits of SR outweigh its drawbacks. In infants with these features, the opposite is true. Treatment choice should be based upon these features.
Comparing Diabetes Outcomes
Authors: Yang Phillip , Bonham Aaron J. , Ghaferi Amir A. , Varhan Oliver A.
Published: November 2020

Objective:

To determine if sleeve gastrectomy has weight-independent benefits on diabetes outcomes.

Summary Background Data:

Weight loss is recommended when treating conditions such as diabetes, hypertension, and hyperlipidemia. Bariatric surgery has been shown to improve or resolve metabolic conditions, but weight loss outcomes vary by procedure type.

Methods:

Using data from a statewide bariatric surgery registry, a total of 988 patients with a preoperative diagnosis of diabetes who underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic adjustable gastric banding (LAGB) were included in the study. The patients were matched based on age, race, sex, preoperative body mass index (BMi) and weight loss at 1 year after surgery. Chi-square comparisons were conducted for medication discontinuation for diabetes. Secondary outcome measures included discontinuation of medications for hypertension and hyperlipidemia.

Results:

The mean age of patients was 53.9 years, 75.5% were female, 89.3% were White. Mean preoperative BMi was 44.8 kg/m2 and 75.7% had noninsulin dependent diabetes, whereas 24.3% had insulin dependent diabetes. Mean % BMi loss at 1 year is similar between the 2 groups (8.3% vs 8.1%, P = 0.3811). LSG patients had significantly higher rates of discontinuation of oral diabetes medication (70.4% vs 46.0%, P < 0.0001), insulin (51.7% vs 38.3%, P = 0.0341), anti-hypertensive (41.1% vs 26.0%, P < 0.0001), and cholesterol-lowering medications (40.1% vs 27.8%, P = 0.0016) when compared to LAGB patients.

Conclusions:

Despite similar preoperative characteristics and postoperative weight loss, LSG patients experienced significantly higher rates of medication discontinuation for diabetes, hypertension, and hyperlipidemia than LAGB. These results suggest that LSG may have weight-independent effects on metabolic disease and should be considered in the treatment of diabetes, regardless of perceived weight loss outcomes.
Surgical Complications in a Multicenter Randomized Trial Comparing Preoperative Chemoradiotherapy and Immediate Surgery in Patients With Resectable and Borderline Resectable Pancreatic Cancer (PREOPANC Trial)
Authors: van Dongen Jelle C. , Suker Mustafa , Versteijne Eva , Bonsing Bert A. , Mieog J. Sven D. , de Vos-Geelen Judith , van der Harst Erwin , Patijn Gijs A. , de Hingh Ignace H. , Festen Sebastiaan , Ten Tije Albert J. , Busch Olivier R. , Besselink Marc G. , van Tienhoven Geertjan , Koerkamp Bas Groot , van Eijck Casper H. J.
Published: November 2020

Objectives:

To investigate the effect of preoperative chemoradiotherapy on surgical complications in patients after pancreatic resection for (borderline-)resectable pancreatic cancer.

Summary of Background Data:

Preoperative chemoradiotherapy is increasingly used in patients with (borderline-)resectable pancreatic cancer. concerns have been raised about the potential harmful effect of any preoperative therapy on the surgical complication rate after pancreatic resection.

Methods:

An observational analysis was performed within the multicenter randomized controlled PREOPANC trial (April 2013–July 2017). The trial randomly assigned (1:1) patients to preoperative chemoradiotherapy followed by surgery and the remaining adjuvant chemotherapy or to immediate surgery, followed by adjuvant chemotherapy. The main analysis consisted of a per-protocol approach. The endpoints of the present analyses were the rate of postoperative complications.

Results:

This study included 246 patients from 16 centers, of whom 66 patients underwent resection after preoperative therapy and 98 patients after immediate surgery. No differences were found regarding major complications (37.9% vs 30.6%, P=0.400), postpancreatectomy hemorrhage (9.1% vs 5.1%, P=0.352), delayed gastric emptying (21.2% vs 22.4%, P=0.930), bile leakage (4.5% vs 3.1%, P=0.686), intra-abdominal infections (12.1% vs 10.2%, P=0.800), and mortality (3.0% vs 4.1%, P=1.000). There was a significant lower incidence of postoperative pancreatic fistula in patients who received preoperative chemoradiotherapy (0% vs 9.2%, P=0.011).

Conclusions:

Preoperative chemoradiotherapy did not increase the incidence of surgical complications or mortality and reduced the rate of postoperative pancreatic fistula after resection in patients with (borderline-)resectable pancreatic cancer.
Hyperspectral Imaging (HSI) of Human Kidney Allografts
Authors: Sucher Robert , Wagner Tristan , Köhler Hannes , Sucher Elisabeth , Quice Hanna , Recknagel Sebastian , Lederer Andri , Hau Hans Michael , Rademacher Sebastian , Schneeberger Stefan , Brandacher Gerald , Gockel Ines , Seehofer Daniel
Published: November 2020

Objective:

Aim of our study was to test a noninvasive HSI technique as an intraoperative real time assessment tool for deceased donor kidney quality and function in human kidney allotransplantation.

Summary of Background Data:

HSI is capable to deliver quantitative diagnostic information about tissue pathology, morphology, and composition, based on the spectral characteristics of the investigated tissue. Because tools for objective intraoperative graft viability and performance assessment are lacking, we applied this novel technique to human kidney transplantation.

Methods:

Hyperspectral images of distinct components of kidney allografts (parenchyma, ureter) were acquired 15 and 45 minutes after reperfusion and subsequently analyzed using specialized HSI acquisition software capable to compute oxygen saturation levels (StO2), near infrared perfusion indices (NIR), organ hemoglobin indices, and tissue water indices of explored tissues.

Results:

Seventeen kidney transplants were analyzed. Median recipient and donor age were 55 years. Cold ischemia time was 10.8 ± 4.1 hours and anastomosis time was 35 ± 7 minutes (mean ± standard deviation). Two patients (11.8%) developed delayed graft function (DGF). cold ischemia time was significantly longer (18.6 ± 1.6) in patients with DGF (P < 0.01). Kidneys with DGF furthermore displayed significant lower StO2 (P = 0.02) and NIR perfusion indices, 15 minutes after reperfusion (P < 0.01). Transplant ureters displayed a significant decrease of NIR perfusion with increased distance to the renal pelvis, identifying well and poor perfused segments.

Conclusion:

Intraoperative HSI is feasible and meaningful to predict DGF in renal allografts. Furthermore, it can be utilized for image guided surgery, providing information about tissue oxygenation, perfusion, hemoglobin concentration, and water concentration, hence allowing intraoperative viability assessment of the kidney parenchyma and the ureter.
A Proposed Blueprint for Operative Performance Training, Assessment, and Certification
Authors: Williams Reed G. , George Brian C. , Bohnen Jordan D. , Dunnington Gary L. , Fryer Jonathan P. , Klamen Debra L. , Meyerson Shari L. , Swanson David B. , Mellinger John D.
Published: November 2020

Objective:

The aim of this study was to propose an evidence-based blueprint for training, assessment, and certification of operative performance for surgical trainees.

Summary Background Data:

Operative skill is a critical aspect of surgical performance. High-quality assessment of operative skill therefore has profound implications for training, accreditation, certification, and the public trust of the profession. Current methods of operative skill assessment for surgeons rely heavily on global assessment strategies across a very broad domain of procedures. There is no mechanism to assure technical competence for individual procedures. The science and scalability of operative skill assessment has progressed significantly in recent decades, and can inform a much more meaningful strategy for competency-based assessment of operative skill than has been previously achieved.

Methods:

The present article reviews the current status and science of operative skill assessment and proposes a template for competency-based assessment which could be used to update training, accreditation, and certification processes. The proposal is made in reference to general surgery but is more generally applicable to other procedural specialties.

Results:

Streamlined, routine assessment of every procedure performed by surgical trainees is feasible and would enable a more competency-based educational paradigm. In light of the constraints imposed by both clinical volume and assessment bias, trainees should be expected to become proficient and be measured against a mastery learning standard only for the most important and highest-frequency procedures. For less frequently observed procedures, performance can be compared to a norm-referenced standard and, to provide an overall trajectory of performance, analyzed in aggregate. Key factors in implementing this approach are the number of evaluations, the number of raters, the timeliness of evaluation, and evaluation items.

Conclusions:

A competency-based operative skill assessment can be incorporated into surgical training, assessment, and certification. The time has come to develop a systematic approach to this issue as a means of demonstrating professional standards worthy of the public trust.
The Complexity of Defining Postoperative Pneumonia After Esophageal Cancer Surgery: A Spectrum of Lung Injury Rather Than a Simple Infective Complication?
Authors: Raftery Nicola B. , Murphy Conor F. , Donohoe Claire L. , O’Connell Brian , King Sinead , Ravi Narayanasamy , Reynolds John V.
Published: November 2020

Objective:

To analyze the spectrum of Centers for Disease Control and Prevention (CDC)-defined pneumonia after esophageal cancer surgery.

Summary Background Data:

Pneumonia is commonly documented after esophageal cancer surgery, and reducing its incidence is central to both ERAS development and to the evidence-base for minimally invasive approaches. The existing definitions of pneumonia based on hospital acquired pneumonia classifications may be suboptimal in this context and merits strict academic scrutiny.

Methods:

Patients (2013-2018) treated with curative intent by open surgery were studied. Pneumonia was defined per the CDC definition. Risk factors and associations were analyzed, as was the implications of positive cultures. Multivariable logistic regression examined independently predictive factors of pneumonia and oncologic outcomes.

Results:

Of 343 patients, 56 (16%) had defined pneumonia, 22 (39%) with positive cultures. Preoperative respiratory disease predicted pneumonia (P = 0.043). Neoadjuvant therapy was significantly (P = 0.004) associated with culture negative pneumonia, and age (P = 0.001) with culture positive pneumonia. In multivariable analysis, pneumonia was associated (P < 0.05) with respiratory comorbidity, tumor site, and neoadjuvant chemoradiation. Pneumonia did not impact on overall survival (P = 0.807).

Discussion:

CDC-defined pneumonia occurred in 16% of cases. Culture-negative pneumonia accounted for 61% of cases and was significantly associated with neoadjuvant chemoradiation. Pneumonia as currently defined seems to represent a spectrum of etiology and severity in the post-esoph-agectomy patient, with infection per se rarely proven, suggesting a need to reevaluate its definition, severity classification, and preventive and treatment strategies.
A Crucial Moment for Reflection on the Importance of Ethical Leadership in Academic Medicine
Authors: Angelos Peter , Devon Karen , Ferreres Alberto R. , McLeod Robin , Ellison Edwin Christopher
Published: November 2020

The extreme disturbances caused by the COVID -19 pandemic on our academic medical centers compounded by a recurrent surge of violence against people of color have reopened our wounds exposing fragility, inequality, and continued racial disparities in society and health. At the center of this severe institutional disruption, leaders will be compelled to take action to keep their constituents and patients safe and their hospitals and departments afloat during and after a pandemic, all while simultaneously addressing and implementing the cultural changes required to eliminate systemic racism and discrimination. Organizational disruptions of this magnitude will naturally test one's principles, loyalties and responsibilities while challenging the practical burdens of leadership. If the goal of responding to these upheavals is to bring them to resolution and ultimately to bring about organizational change for the better, ethical leadership is critical. Applying ethical principles allows leaders to chart clear paths to solutions both in the short and long term. We review the principles of ethical leadership exemplified by a case illustration and provide a novel resource to help ensure ethical leadership in academic medicine and beyond.
Applications of magnetic particle imaging in the dementias
Authors: Braidy Nady , Wen Wei , Bongers Andre , Sachdev Perminder S.
Published: November 2020

Purpose of review

This review discusses recent developments in the application of magnetic particle imaging (MPI) to dementia research.

Recent findings

MPI is a tracer method that is currently in the preclinical development stage. It provides high sensitivity for the detection and localization of magnetic nanoparticles with very high spatial and temporal resolution and a similar application spectrum as PET. Unlike MRI, the MPI signal is not contaminated by background signal from tissues and is highly quantifiable in terms of local tracer concentrations. These properties make the technology ideally suited for localization of specific targets or quantification of vascular parameters. MPI uses magnetic nanoparticles which can be modified by various coatings, and by adding ligands (i.e. peptides or antibodies) for specific targeting. This makes MPI an attractive tool for the potential detection of abnormal protein deposits, such as Aβ plaques, with greater specificity than MRI. Neural stem cells can also be labelled with these nanoparticles ex vivo to monitor their migration in vivo.

The capabilities of MPI opens the potential for several applications of MPI in neurocognitive disorders, including vascular imaging, detection of amyloid plaques and potentially other pathological hallmarks of Alzheimer's disease and stem-cell tracking.
Urban Vulnerability Assessment for Pandemic surveillance: The COVID-19 case in Bogotá, Colombia
Authors: Prieto Jeisson , Malagón Rafael , Gomez Jonatan , León Elizabeth
Published: November 2020

A Pandemic devastates the life of global citizens and causes significant economic, social, and political disruption. Evidence suggests that Pandemic’s likelihood has increased over the past century because of increased global travel and integration, urbanization, and changes in land use. Further, evidence concerning the urban character of the Pandemic has underlined the role of cities in disease transmission. An early assessment of the severity of infection and transmissibility can help quantify the Pandemic potential and prioritize surveillance to control of urban areas in Pandemics. In this paper, an Urban Vulnerability Assessment (UVA) methodology is proposed. UVA investigates the possible vulnerable factors related to Pandemics to assess the vulnerability in urban areas. A vulnerability index is constructed by the aggregation of multiple vulnerability factors computed on each urban area (i.e., urban density, poverty index, informal labor, transmission routes). UVA provides insights into early vulnerability assessment using publicly available data. The applicability of UVA is shown by the identification of high-vulnerable areas where surveillance should be prioritized in the COVID-19 Pandemic in Bogotá, Colombia.
How many COVID-19 PCR positive individuals do we expect to see on the Diamond Princess cruise ship?
Authors: Qin Jing , Chen Fang , Ma Huijuan , Liu Yukun , Follmann Dean , Zhou Yong
Published: November 2020

The coronavirus disease 2019 (COVID-19) has become a global epidemic crisis with tens of thousands confirmed cases surfacing everyday. The infection rates in households, offices and public places are quite different from those in encompassed spaces such as airplanes, trains and cruise ships.

Studying the behavior of COVID-19 in confined spaces like Diamond Princess cruise is of great importance to understand the disease progression and to manage the epidemic. We propose a novel mixture model to estimate the infection distribution and total infected number after 14 days of quarantine based on PCR test data performed on the Diamond Princess cruise.

Results

In contrast to the officially reported 634 individuals with PCR-positive results after the 14 day quarantine, which as of April 27, 2020 had increased to 712, we conclude that this number should be at least 1000. The discrepancy might be caused by the false-negative result of the PCR test or the occurrence of infection after the test.
Capability impacts of the Covid-19 lockdown in association with mental well-being, social connections and existing vulnerabilities: an Austrian survey study
Authors: Simon Judit , Helter Timea M. , White Ross G. , van der Boor Catharina , Łaszewska Agata
Published: November 2020

Background

Impacts of the Covid-19 pandemic and its public health measures go beyond physical and mental health and incorporate wider well-being impacts in terms of what people are free to do or be. We explored these capability impacts of the Covid-19 lockdown in association with people’s mental well-being, social support and existing vulnerabilities in Austria.

Methods

Adult Austrian residents (n=560) provided responses to a cross-sectional online survey about their experiences during Covid-19 lockdown (15 March-15 April 2020). Instruments measuring capabilities (OxCAP-MH), depression and anxiety (HADS), social support (MSPSS) and mental well-being (WHO-5) were used in association with six pre-defined vulnerabilities using multivariable linear regression.

Results

31% of the participants reported low mental well-being and only 30% of those with a history of mental health treatment received treatment during lockdown. Past mental health treatment had a significant negative effect across all outcome measures with an associated capability well-being score reduction of -6.54 (95%CI: -9.26,-3.82). Direct Covid-19 experience and being ‘at risk’ due to age and/or physical health conditions were also associated with significant capability deprivations. When adjusted for vulnerabilities, significant capability reductions were observed in association with increased levels of depression (−1.79) and anxiety (−1.50), and significantly higher capability levels (+3.77) were associated with higher levels of social support. Compared to the cohort average, individual capability impacts varied between -9% for those reporting past mental health treatment and +5% for those reporting one score higher on the social support scale.

Conclusions

Our study is the first to assess the capability limiting aspects of a lockdown in association with specific vulnerabilities. The negative impacts of the Covid-19 lockdown were strongest for people with a history of mental health treatment. In future public health policies, special attention should be also paid to improving social support levels to increase public resilience.