bluuebunny/crossref_metadata_2025 huggingface dataset:
A major outbreak of the COVID-19 on the Diamond Princess cruise ship: Estimation of the basic reproduction number
Authors: Chou Yu-Ching , Lin Yu-Ju , Shie Shian-Sen , Tsai Hung-Bin , Sheng Wang-Huei
Published: October 2022

Background:

The COVID-19 pandemic, which broke out in Wuhan, China, in 2019, was declared an international public health emergency by the World Health Organization on January 31, 2020. The outbreak on the Diamond Princess cruise ship had appeared first as a cluster infection outside China during the early pandemic. The incident occurred on February 1, 2020, involved an 80-year-old Hong Kong man who was diagnosed with COVID-19. The cruise ship docked in Yokohama, Japan, for 14 days of onboard quarantine; however, cluster infection outbroke rapidly.

Methods:

We constructed a SIR mathematical model and conducted an epidemiological study of the COVID-19 outbreak on the Diamond Princess cruise ship, covering the period from February 5 (start of quarantine) to February 20 (completion of 14-day quarantine). We estimated the basic reproduction number (R0) using a novel method of nonlinear least-squares curve fitting under Microsoft Excel Solver. The 95% confidence interval (CI) values were estimated by the jackknife procedures.

Results:

Six hundred thirty-four (17.1%) cases were diagnosed in a total population of 3711 cruise passengers, and 328 (51.7%) cases were asymptomatic. As of April 24, 2020, 712 cases had been diagnosed and 14 (1.96%) deaths had occurred. The R0 with 95% CI of the COVID-19 outbreak was 3.04 (2.72–3.36). Without an evacuation plan for passengers and crew, we estimated the total number of cumulative cases would reach 3498 (CI, 3464–3541). If the R0 value was reduced by 25% and 50%, the cumulative cases would be reduced to 3161 (CI, 3087-3254) and 967 (CI, 729-1379), respectively. The abovementioned R0 value was estimated from the original Wuhan strain.

Conclusion:

Cruise conditions would accelerate the spread of infectious diseases and were not suitable for onboard quarantine. Early evacuation and isolation of all passengers and crew members would reduce the R0 value and avoid further infections.
Justice Denied: A Call to Action for Forensic Nurses
Authors: Glover Hilary Ashton
Published: October 2022

Sexual violence is a major public health problem that negatively affects millions of Americans. Persons who have experienced sexual violence may choose to undergo a medical forensic examination and complete a sexual assault kit to collect and preserve evidence. DNA evidence is an impactful tool that has the potential to confirm an assailant's identity, reveal previously unknown offenders, connect serial predators to other crime scenes, exonerate the wrongly convicted, and prevent future acts of sexual violence. However, many of these kits have become “backlogged,” meaning that evidence was not submitted by law enforcement for testing or DNA analysis was not completed by the crime laboratory, thereby denying justice and closure for victims. The purpose of this article is to illustrate the backlog of untested sexual assault kits in the United States and describe a case in which a serial offender was apprehended because of the testing of backlogged kits. In addition, this call to action aims to raise awareness regarding kit processing and promote advocacy among forensic nurses.
Association Between Human Leukocyte Antigen Polymorphism and Human Papillomavirus Infection in Brazilian Women
Authors: de Araujo-Souza Patricia Savio , El-Zein Mariam , Bolpetti Aline do N. , Maciag Paulo Cesar , Rabachini Tatiana , Franco Eduardo L. , Villa Luisa L.
Published: October 2022

Background

Human papillomavirus (HPV) infection is a necessary cause for cervical cancer, but a majority of genital HPV infections clear spontaneously. Human leukocyte antigen (HLA) polymorphism influences immune response and genetic susceptibility, and its association with cervical cancer was extensively investigated, but few reports focused on HPV infection.

Methods

We performed molecular typing of HLA-A, HLA-B, HLA-DQB1, and HLA-DRB1 genes as well as of HPV in 1226 women enrolled in the Ludwig-McGill cohort study and investigated the influence on cumulative HPV positivity. HPV types were grouped according to Alphapapillomavirus subgenera that exhibit similar tissue tropism and biological behavior concerning cancer risk. The associations between HLA polymorphisms and HPV infections were estimated using unconditional logistic regression analysis adjusted for age and race.

Results

HLA-B*08 and HLA-DRB1*15:01 were negatively associated with HPV positivity, and similar effects were observed for HPV subgenus 2 only, which includes HPV16. HLA-DRB1*08:07 was associated with overall HPV infection and subgenus 2 positivity. The haplotypes HLA-B*08-DRB1*03:01-DQB1*02:01 and HLA-DRB1*08:07-DQB1*04:02 were negatively and positively associated with cumulative HPV positivity, respectively.

Conclusions

Our data suggest that HLA class I and II polymorphism can influence HPV natural infection.
Dysplastic Pulmonary Valve Infective Endocarditis With an Atrial Septal Defect—A Black Swan Event
Authors: Desai Heena M. , Tapadia Ritika , Amonkar Gayathri P.
Published: October 2022

A case of infective endocarditis of a dysplastic pulmonic valve along with atrial septal defect has been described. Right-sided endocarditis has now increased in frequency because of cardiac invasive procedures and intravenous drug abuse. Although the tricuspid valve usually bears the brunt of right-sided endocarditis, there have now been increasing reports of pulmonary valve infective endocarditis.
Facilitating Overdose Risk Mitigation Among Patients Following a Clinician Office Closure: A Connecticut Case Study of the Opioid Rapid Response Program
Authors: Rubel Stephanie K. , Neubert Patrick , Navarretta Nancy , Logan Susan
Published: October 2022

The Opioid Rapid Response Program (ORRP) is a federal program designed to support states in mitigating risks to patients who lose access to a prescriber of opioids or other controlled substances. Displaced patients might face risks of withdrawal, overdose, or other harms. Rapid response efforts to mitigate risks require coordination across multiple parts of the health care system. This case study describes an ORRP-coordinated event, including notification from law enforcement, information sharing with state health officials, state-coordinated response efforts, key observations, and lessons learned. Timely risk mitigation and care continuity required coordination between law enforcement and public health in advance of the disruption and throughout the state-led response. Patients' acute and prolonged health care needs were complex and highlight the importance of investing time and resources in coordinated, multisector state and local preparedness for these types of disruptions.
Pilot Case Study: A Framework for Multisector Public Health and Safety Teams Addressing the Overdose Epidemic
Authors: Roe S. Sarisa , Cordelli Roseann , Shutz Brittany , Rubel Stephanie
Published: October 2022

The Public Health and Safety Team (PHAST) Framework and Toolkit were developed by the CDC Foundation in collaboration with the Centers for Disease Control and Prevention to guide local jurisdictions in strengthening coordination among public health, public safety, and other sectors to address the overdose crisis. The PHAST Framework uses guiding principles, strategies, and tools to help improve multisector engagement, data sharing, and coordinated overdose prevention. To assess its utility and inform its refinement, the initial version of the Toolkit was piloted in York County, Pennsylvania. A follow-up assessment was conducted 1 year after the pilot concluded. Application of the PHAST Framework appeared to have contributed to positive and sustained changes to meeting activities, structure, and attendance, supporting the potential utility of PHAST for advancing local-level multisector overdose prevention efforts. This article describes the basic tenets of PHAST, the pilot process, and findings from the 1-year follow-up assessment.
Compliance Is Doable! A Framework for Navigating Privacy Regulations in Public Health and Public Safety Partnerships
Authors: Worobiec Michele , Firesheets Kelly C.
Published: October 2022

The past decade witnessed an explosion of public health/public safety collaborations. Many emerged as pragmatic responses to the opioid epidemic, where communities struggled to help individuals at risk of fatal and nonfatal overdoses. Multidisciplinary programs formed to actively engage people with services, including harm reduction, treatment, and peer support, instead of arrest. These initiatives blur traditional lines between public safety, health, treatment, and services. Novel applications of HIPAA and 42 CFR Part 2 created confusion, sometimes discouraging new ways of doing business and other times leading to a disregard for individual privacy protections in the interest of “doing the right thing.” Neither is ideal. In this article, the authors present a framework for collaborations to navigate issues related to privacy, review relevant laws, provide a practical application to public health/public safety partnerships, and offer practice pointers. With this resource, stakeholders are empowered to create effective and compliant overdose response programs.
Designed to Do Good: Key Findings on the Development and Operation of First Responder Deflection Programs
Authors: Ross Jon , Taylor Bruce
Published: October 2022

Opioids and drug overdoses have claimed more than 750 000 American lives since the late 1990s. Overdoses since the mid-2010s have risen dramatically, due to synthetic opioids such as fentanyl whose lethality is disproportionately greater than street drugs of earlier decades. Until recently, most police and other first responders lacked resources beyond arrest to respond to overdoses and other nonviolent crimes. Largely in response to the opioid crisis and synthetic opioid-related overdoses, first responder deflection (FRD) has emerged as an alternative. First responder deflection has enabled first responders across the United States to save lives by training them to administer naloxone, a medication that blocks opioid receptors after overdose, then linking these individuals to community-based treatment and services. Consequently, FRD has helped keep many citizens out of the justice system entirely, giving them a chance to rebuild their lives and become productive members of their communities. To this end, TASC's Center for Health and Justice and National Opinion Research Center at The University of Chicago collaborated on a national FRD survey encompassing a comprehensive overview of the field and its role in responding to the opioid crisis. The findings reveal how FRD offers alternatives to traditional policing, including its role in advancing racial and social equity by aligning public health and public safety for those who otherwise might enter the justice system. This article will discuss the methodology, key findings, and policy implications of this national survey (encompassing more than 300 active FRD programs). We will present results on the development of FRDs and how they operate. Results will cover the extensive involvement of law enforcement agencies in initiating FRD initiatives; the role of non–first responder partners in providing treatment and services through FRD; and the scope of Medication-Assisted Treatment in these programs, among other important findings.
Legal Needs, Health, and Health Care Utilization Among Patients Participating in the Delaware Medical Legal Partnership
Authors: Mapp Alexandra M. , Moore Christopher , Booker Erin , Santiago Cindy , Baker Dawn , Salvatore Alicia L.
Published: October 2022

Context:

Unmet legal needs can exacerbate health disparities and contribute to a lack of adherence to treatment plans and medical recommendations for care. Medical legal partnerships (MLPs) are integrated health care and legal aid interventions offered by many health systems in the United States. Although much research has been published regarding the success of MLPs with specific patient groups, there is a gap in literature regarding the nature of MLPs in a more general, at-risk patient population.

Objective:

We aimed to better understand specific patient characteristics and health outcomes associated with different iHELP legal needs.

Design:

This is a cross-sectional study of patients who were enrolled in the Delaware MLP (DMLP) from November 2018 to June 2020 (N = 212).

Setting:

The DMLP is a collaboration between ChristianaCare, a Mid-Atlantic health system, and the Community Legal Aid Society, Inc (CLASI).

Participants:

Patients must be adults (ie, 18 years or older), below 200% of the federal poverty level (eg, ≤$53 000 for a household of 4 as of 2021), have at least one qualifying legal need, and live in the state.

Intervention:

The DMLP is designed to address unmet legal needs that fall under a framework called iHELP. iHELP legal domains are income and insurance (i), housing and utilities (H), education and employment (E), legal status (L), and personal and family stability (P).

Main Outcome Measures:

Outcomes of interest were iHELP legal needs, patient demographics, perceived stress and mental and physical health–related quality of life, comorbidities, and health care utilization.

Results:

Housing and utilities (46.2%) and income support (41.5%) were the highest reported legal needs. Perceived stress scores were significantly higher for those with income needs (P = .01) as well as those with housing and utilities needs (P = .01).

Conclusions:

MLP programs offer a value-added service that can address unmet legal needs in vulnerable, at-risk patients.
Maine's Overdose Prevention Through Intensive Outreach, Naloxone and Safety (OPTIONS) Initiative
Authors: Carter Amy , Soucier Daniel S. , Haram Eric , Mazerolle Sybil , Sauschuck Michael , Coutu-Farrell Katherine
Published: October 2022

This article outlines the successes, barriers, and lessons learned in implementing the Overdose Prevention Through Intensive Outreach, Naloxone and Safety (OPTIONS) initiative in Maine during its first year. With leadership from the Governor's Office, the Department of Health and Human Services, and the Department of Public Safety, the Office of Behavioral Health contracted with behavioral health organizations to hire and provide supervision for 16 clinicians. These behavioral health clinicians, known as OPTIONS liaisons, were each assigned to provide services for one county in the state and were embedded within a public safety agency. A technical assistance team was also assembled to assist in guiding implementation and improving this public health and public safety partnership.
Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes
Authors: Penna Austin R. , Hunter Jennifer C. , Sanchez Guillermo V. , Mohelsky Romy , Barnes Laura E. A. , Benowitz Isaac , Crist Matthew B. , Dozier Tiffany R. , Elbadawi Lina I. , Glowicz Janet B. , Jones Heather , Keaton Amelia A. , Ogundimu Abimbola , Perkins Kiran M. , Perz Joseph F. , Powell Krista M. , Cochran Ronda L. , Stone Nimalie D. , White Katelyn A. , Weil Lauren M.
Published: October 2022

Context:

Between April 2020 and May 2021, the Centers for Disease Control and Prevention (CDC) awarded more than $40 billion to health departments nationwide for COVID-19 prevention and response activities. One of the identified priorities for this investment was improving infection prevention and control (IPC) in nursing homes.

Program:

CDC developed a virtual course to train new and less experienced public health staff in core healthcare IPC principles and in the application of CDC COVID-19 healthcare IPC guidance for nursing homes.

Implementation:

From October 2020 to August 2021, the CDC led training sessions for 12 cohorts of public health staff using pretraining reading materials, case-based scenarios, didactic presentations, peer-learning opportunities, and subject matter expert–led discussions. Multiple electronic assessments were distributed to learners over time to measure changes in self-reported knowledge and confidence and to collect feedback on the course. Participating public health programs were also assessed to measure overall course impact.

Evaluation:

Among 182 enrolled learners, 94% completed the training. Most learners were infection preventionists (42%) or epidemiologists (38%), had less than 1 year of experience in their health department role (75%), and had less than 1 year of subject matter experience (54%). After training, learners reported increased knowledge and confidence in applying the CDC COVID-19 healthcare IPC guidance for nursing homes (≥81%) with the greatest increase in performing COVID-19 IPC consultations and assessments (87%). The majority of participating programs agreed that the course provided an overall benefit (88%) and reduced training burden (72%).

Discussion:

The CDC's virtual course was effective in increasing public health capacity for COVID-19 healthcare IPC in nursing homes and provides a possible model to increase IPC capacity for other infectious diseases and other healthcare settings. Future virtual healthcare IPC courses could be enhanced by tailoring materials to health department needs, reinforcing training through applied learning experiences, and supporting mechanisms to retain trained staff.
Improving Partnerships Between Public Health and Public Safety to Reduce Overdose Deaths: An Inventory From the CDC Overdose Data to Action Funding Initiative
Authors: Mital Sasha , Wisdom April C. , Wolff Jessica G.
Published: October 2022

Rates of drug overdose deaths are high and growing. Innovative strategies, such as partnerships between public health and public safety (PH/PS) agencies, are needed to curb these trends. Support for PH/PS partnerships as an overdose prevention strategy is growing; however, little information exists on the makeup of activities within this strategy. The US Centers for Disease Control and Prevention's (CDC's) Overdose Data to Action (OD2A) cooperative agreement supports innovative and comprehensive overdose surveillance and prevention activities across the United States. Within OD2A, funded states, counties/cities, and territories may implement PH/PS partnerships to reduce overdose deaths. An inventory of PH/PS activities described in OD2A recipients' year 2 annual progress reports was conducted. These activities were abstracted for PH/PS partners' roles, intended audience, deliverables, objectives, stage of overdose risk addressed, and type of strategy implemented. The inventory revealed that 49 of the 66 funded jurisdictions planned 109 PH/PS activities. Most aimed to bridge knowledge, data, and service gaps and intervened at higher levels of overdose risk. This analysis highlights opportunities to adapt and expand cross-sector overdose prevention efforts across the overdose risk continuum.
A novel approach to severe chronic neurogenic dysphagia using pharyngeal sensory electrical stimulation: a case report
Authors: Zhang Xue , Wang Xiaolu , Dou Zulin , Wen Hongmei
Published: October 2022

The treatment options for severe chronic neurogenic dysphagia are limited. A patient, after resection of medulla oblongata hemangioblastoma, who failed to respond to seven months of traditional dysphagia rehabilitation therapy, was treated with prolonged pharyngeal sensory electrical stimulation for 39 sessions over 57 days. For the first time, this case report showed improvement in hypopharyngeal peak pressure (9.1 mmHg vs. 90.8 mmHg) using high-resolution manometry. Reduction in the penetration and aspiration scale, secretion, and residue of the vallecular and pyriform sinus were verified by videofluoroscopic swallowing study and flexible endoscopic evaluation of swallowing. The Functional Oral Intake Scale score increased from 1 to 6. No adverse event was observed. This case report presented a potential therapeutic protocol for severe chronic neurogenic dysphagia, which might be instructive for clinical practice.
“Predicting Breast Reduction Resection Weights and Attainment of Insurance-Mandated Minimums: Sternal Notch-Nipple and Nipple-Inframammary Fold Distances Alone are Effective”
Authors: Zhu Xiao , Hall Jennifer A. , Gimbel Michael L. , Nguyen Vu T.
Published: October 2022

Background:

Despite evidence that reduction mammaplasty alleviates macromastia symptoms independent of resection weights, resection minimums are commonly used to grant insurance coverage. Multiple formulas have been published to predict resection weights, but very few have evaluated predictive performance relative to attaining common insurance minimums.

Methods:

This was a retrospective single-center review of 268 patients from 2007-2020. Multiple linear regression (MLR) and exponential model (EM) were created to predict resection weights and attainment of the Schnur, 350g, and 500g minimums. Accuracy was compared against published Appel, Descamps, and Galveston equations. BMI subgroup analyses were performed.

Results:

EM possessed the lowest resection weight prediction error overall (172.8 ± 211.5g). All equations performed significantly better than surgeons in predicting attainment of the 500g minimum. None performed better than the surgeons’ predictive accuracy in attaining a 350g minimum. MLR and EM performed significantly better than surgeons in predicting attainment of the Schnur minimum. Only the EM performed significantly better than surgeons for both the Schnur (82% vs. 71%, p<0.01) and the 500g minimums (89% vs. 68%, p<0.01). On BMI subgroup analyses, all three minimums were biased in favor of obese women – the least egregious of which was the 350g minimum.

Conclusion:

All minimums were biased against non-obese women. Our EM equation based on pre-operative sternal notch-nipple (SN-N) and nipple-inframammary fold (N-IMF) distances accurately predicts resection weights and improves on our surgeons’ predictive accuracy in attaining the Schnur or 500g minimums. This may prove useful in the preoperative setting to better counsel patients.
The BREASTrial Stage III: Acellular Dermal Matrix Breast Reconstruction Outcomes from Three Months to Two Years Postoperative
Authors: Mendenhall Shaun D. , Moss Whitney , Graham Emily M. , Carter Gentry , Agarwal Jayant P.
Published: October 2022

Background:

The Breast Reconstruction Evaluation of Acellular Dermal Matrix (ADM) as a Sling Trial is a blinded, randomized trial comparing the outcomes of tissue expander breast reconstruction using AlloDerm or DermaMatrix. In this final stage of the trial, outcomes three months to two years following definitive reconstruction are reported along with patient satisfaction data.

Methods:

A randomized trial was conducted to compare complication rates between groups reconstructed with AlloDerm and DermaMatrix. Regression models were used to analyze the impact of matrix type, age, chemotherapy, radiation therapy, and reconstructive type on complication rates. Pre- and postmastectomy questionnaires were used to assess patient satisfaction and were also analyzed using regression models.

Results:

Of the 128 patients (199 breasts) who were randomized in the trial, 108 patients (167 breasts) were available for analysis in stage III. There was no difference in the overall rates of complication between AlloDerm and DermaMatrix groups (6% vs. 13.2%, p=0.3) or the severity of those complications (p=0.7). Obesity was a positive predictor for complications, regardless of reconstruction group (p=0.02). Patient satisfaction was positive overall and did not grossly vary between AlloDerm and DermaMatrix groups.

Conclusion:

Findings from the BREASTrial conclude that AlloDerm and DermaMatrix exhibit similar histologic and clinical outcomes. Patient satisfaction is also similar between matrices. Obesity is a predictor of complications and acellular dermal matrices should be used with caution in these patients. As the largest head-to-head trial comparing two ADMs, the BREASTrial contributes to fund of knowledge regarding ADM supplementation in breast reconstruction.
Sensory restoration in abdominally-based free flap for breast reconstruction using nerve allograft
Authors: Djohan Risal , Scomacao Isis , Duraes Eliana FR , Knackstedt Rebecca , Mangan Rachel , Schwarz Graham
Published: October 2022

Background:

Neurotization of the breast reconstruction can be performed with the aid of nerve grafts and conduits to decrease the tedious dissection and overcome size mismatch. However, there has yet to be a formal analysis of this approach. The goal of this study is to evaluate sensory recovery after neurotized abdominally-based free flap for breast reconstruction using our novel technique and analyze factors that could affect sensory recovery.

Methods:

A novel technique employing processed nerve allograft in combination with a nerve conduit was utilized. Dynamic and static sensation recovery tests were performed in patients who underwent neurotized or non-neurotized abdominally-based free flap reconstructions. Demographics, surgical details, and complications were analyzed. Statistical analyses were performed using Chi-Square and Mann-Whitney tests.

Results:

Fifty patients (78 breasts) were analyzed; 60 with neurotized reconstruction and 18 without. For patients with more than twelve months of follow up, the neurotized cohort demonstrated improved dynamic tests compared to the non-neurotized cohort (38±21.69 vs. 56.17±20.8, p=0.014, respectively). Factors associated with decreased sensory return in patients who underwent neurotized reconstruction were diabetes, higher BMI, skin-sparing mastectomy, higher ASA class and history of radiation, or hormonal therapy.

Conclusion:

This is the first study to report on outcomes of neurotized autologous breast reconstruction utilizing a nerve graft and conduit technique. Our approach resulted in improved sensory outcomes compared to those in patients who did not undergo sensory reconstruction. Importantly, factors that can interfere with sensory recovery were identified.
Reconstructive Burnout After Mastectomy: Implications for Patient Selection
Authors: Halani Sameer H. , Jones Kaitlin , Liu Yulun , Teotia Sumeet S. , Haddock Nicholas T.
Published: October 2022

Background:

The reconstructive journey after mastectomy can be a long road with many hurdles to achieve an ideal aesthetic result. Cancer therapy, operative complications, and comorbidities impact patients, both physically and emotionally. Our study introduces the term ‘Reconstructive Burnout’ and aims to evaluate which factors predict and contribute to patients prematurely stopping reconstruction.

Methods:

We performed a retrospective review of patients undergoing breast reconstruction after skin-sparing mastectomy from 2014-2017 with two senior surgeons at a single institution. ‘Reconstructive Burnout’ is defined as either no breast mound creation or completion of the breast mound without completion of all major revisions

Results:

A total of 530 patients were included with 76.6% completing reconstruction. In patients undergoing delayed-immediate reconstruction, patients with wounds (p=0.004), infections (p=0.037), or a complication requiring operative intervention (p<0.001) were correlated with incomplete reconstruction; explantation of expanders were highly correlated with Reconstructive Burnout (p<0.001). Implant-based and autologous reconstruction had comparable burnout rates (17.1% vs 19.1%, p=0.58). Logistic regression models found high BMI, radiation therapy, any TE complication, and TE explantation to be significant predictors of burnout. Autologous reconstruction was the strongest predictor of completion of reconstruction in both univariable and multivariable models.

Conclusion:

Reconstructive Burnout in breast reconstruction is associated with TE complications, high BMIs, and radiation therapy. Overall rates of Burnout were comparable between autologous and implant-based reconstruction, with autologous reconstruction being the strongest predictor of completion of reconstruction. It is critical to tailor each patient’s reconstructive journey to meet both their emotional and physical needs to avoid Reconstructive Burnout.
Fold Flaps to the Rescue in Post-Mastectomy Breast Reconstruction
Authors: Brown Ciara A , Losken Albert
Published: October 2022

Background:

Ischemic complications following post-mastectomy breast reconstruction are not uncommon and can lead to reconstructive failure especially with implant reconstruction. We propose a simple local flap for management of such complications. This flap is easily raised from the upper abdomen or lateral chest as a medially or laterally based fasciocutaneous flap while the donor site is hidden in the infra or lateral mammary fold. We present a case series of these “fold flaps” which were used to manage complications following implant-based breast reconstruction.

Methods:

All patients between 2007 and 2021 who underwent a fold flap for breast reconstruction salvage were queried from a prospectively maintained data. Demographic variables, clinical factors and surgical details were analyzed. Outcomes assessed included complications, appropriate wound healing, and reconstructive salvage.

Results:

14 patients underwent thoracoepigastric or thoracoabdominal fold flaps following breast reconstruction for soft tissue coverage with an underlying prosthesis. The mean age was 54 years; BMI, 30; and follow-up duration, 18.5 months. Fold flap indications included mastectomy skin flap necrosis (n=9), infection (n=4) and chronic seroma (n=1). 11 (79%) reconstructions were salvaged while 3 (21%) required eventual prosthesis explantation secondary to infection or delayed wound healing.

Conclusion:

Fold flaps are a reliable option to manage ischemic complications following post-mastectomy breast reconstruction. The benefits include improved soft tissue coverage with a high salvage rate. These flaps are simple to raise, and their donor site is concealed within the folds. Further, they provide a reliable early option to manage complications and potentially prevent reconstructive failure.
Frequency and Risk Factors for Air Embolism in Computed Tomography Fluoroscopy–Guided Biopsy of Lung Tumor With the Use of Noncoaxial Automatic Needle
Authors: Maehara Yosuke , Miura Hiroshi , Hirota Tatsuya , Asai Shunsuke , Okamoto Toshiyuki , Ohara Yu , Yamada Kei
Published: October 2022

Purpose

The aim of the study is to analyze incidence and risk factors for air embolism during computed tomography (CT) fluoroscopy–guided lung biopsies using noncoaxial automatic needle.

Materials and Methods

Between February 2014 and December 2019, 204 CT fluoroscopy–guided lung biopsies (127 men; mean age, 70.6 years) using noncoaxial automatic needle under inspiratory breath holding were performed. We retrospectively evaluated the incidence of air embolism as presence of air in the systemic circulation on whole-chest CT images obtained immediately after biopsy. Risk factors of the patient, tumor and procedural factors (size, location and type of nodule, distance from the pleura, the level of the lesion relative to the left atrium, emphysema, patient position, penetration of a pulmonary vein, etc) were analyzed.

Results

The technical success rate was 97.1%. Air embolism was radiologically identified in 8 cases (3.92%, 7 males; size, 21.6 ± 18.2 mm; distance to pleura, 11.9 ± 14.5 mm). Two patients showed overt symptoms and the others were asymptomatic. Independent risk factors were needle penetration of the pulmonary vein (P = 0.0478) and higher location relative to left atrium (P = 0.0353). Size, location and type of nodule, distance from the pleura, emphysema, patient position, and other variables were not significant risk factors. As other complications, pneumothorax and alveolar hemorrhage were observed in 57.4% and 77.5%, respectively.

Conclusions

In CT fluoroscopy–guided lung biopsy using the noncoaxial automatic needles, radiological incidence of air embolism was 3.92%. Given the frequency of air embolism, it is necessary to incorporate this into postprocedure imaging and clinical evaluation.
Advances in stress and depression research
Authors: LeMoult Joelle , Battaglini Ashley M. , Grocott Bronwen , Jopling Ellen , Rnic Katerina , Yang Lisa
Published: October 2022

Purpose of review

Stress plays a central role in the onset and course of depression. However, only a subset of people who encounter stressful life events go on to experience a depressive episode. The current review highlights recent advances in understanding when, why, and for whom the stress-depression link occurs, and we identify avenues for future research.

Recent findings

In the last 18 months, researchers have taken a more nuanced perspective on the biopsychosocial mechanisms critical to the stress–depression link. For example, examination of specific facets of emotion regulation, including emotion regulation flexibility and interpersonal emotion regulation, has been critical to understanding its role in depression. Similarly, refined investigations of social support allowed researchers to identify distinct – and occasionally opposite – outcomes depending on the context or manner in which the support was provided. Researchers also documented that the stress–depression link was enhanced by dysregulation of several stress-sensitive biological systems, such as the immune system, microbiome, endocrine system, and neuroanatomical substrates.

Recent studies highlight the importance of adopting a nuanced understanding of mechanisms and moderators that explain the stress–depression link. We also encourage continued engagement in collaborative, open science that uses multiple methods to study the full breadth of human diversity.
Deciphering Spatial Domains by Integrating Histopathological Image and Transcriptomics via Contrastive Learning
Authors: Zeng Yuansong , Yin Rui , Luo Mai , Chen Jianing , Pan Zixiang , Lu Yutong , Yu Weijiang , Yang Yuedong
Published: October 2022

Recent advances in spatial transcriptomics have enabled measurements of gene expression at cell/spot resolution meanwhile retaining both the spatial information and the histopathological images of the tissues. Deciphering the spatial domains of spots in the tissues is a vital step for various downstream tasks in spatial transcriptomics analysis. Existing methods have been developed for this purpose by combining gene expression and histopathological images to conquer noises in gene expression. However, current methods only use the histopathological images to construct spot relations without updating in the training stage, or simply concatenate the information from gene expression and images into one feature vector. Here, we propose a novel method ConGI to accurately decipher spatial domains by integrating gene expression and histopathological images, where the gene expression is adapted to image information through contrastive learning. We introduce three contrastive loss functions within and between modalities to learn the common semantic representations across all modalities while avoiding their meaningless modality-private noise information. The learned representations are then used for deciphering spatial domains through a clustering method. By comprehensive tests on tumor and normal spatial transcriptomics datasets, ConGI was shown to outperform existing methods in terms of spatial domain identification. More importantly, the learned representations from our model have also been used efficiently for various downstream tasks, including trajectory inference, clustering, and visualization.
A method to estimate contact regions between hands and objects during human multi-digit grasping
Authors: Hartmann Frieder , Maiello Guido , Rothkopf Constantin A. , Fleming Roland W.
Published: October 2022

In order to grasp an object successfully, we must select appropriate contact regions for our hands on the surface of the object. However, identifying such regions is challenging. Here, we describe a workflow to estimate contact regions from marker-based tracking data. Participants grasp real objects, while we track the 3D position of both the objects and the hand including the fingers’ joints. We first determine joint Euler angles from a selection of tracked markers positioned on the back of the hand. Then, we use state-of-the-art hand mesh reconstruction algorithms to generate a mesh model of the participant’s hand in the current pose and 3D position. Using objects that were either 3D printed, or 3D scanned—and are thus available as both real objects and mesh data—allows us to co-register the hand and object meshes. In turn, this allows us to estimate approximate contact regions by calculating intersections between the hand mesh and the co-registered 3D object mesh. The method may be used to estimate where and how humans grasp objects under a variety of conditions. Therefore, the method could be of interest to researchers studying visual and haptic perception, motor control, human-computer interaction in virtual and augmented reality, and robotics.

When we grasp an object, multiple regions of the fingers and hand typically make contact with the object’s surface. Reconstructing such contact regions is challenging. Here, we present a method for approximately estimating contact regions, by combining marker-based motion capture with existing deep learning-based hand mesh reconstruction.
Biological connectomes as a representation for the architecture of artificial neural networks
Authors: Schmidgall Samuel , Schuman Catherine , Parsa Maryam
Published: October 2022

Abstract

Grand efforts in neuroscience are working toward mapping the connectomes of many new species, including the near completion of theDrosophila melanogaster. It is important to ask whether these models could benefit artificial intelligence. In this work we ask two fundamental questions: (1) where and when biological connectomes can provide use in machine learning, (2) which design principles are necessary for extracting a good representation of the connectome. Toward this end, we translate the motor circuit of theC. Elegansnematode into artificial neu-ral networks at varying levels of biophysical realism and evaluate the outcome of training these networks on motor and non-motor behavioral tasks. We demonstrate that biophysical realism need not be upheld to attain the advantages of using biological circuits. We also establish that, even if the exact wiring diagram is not retained, the architectural statistics provide a valuable prior. Finally, we show that while theC. Eleganslocomotion circuit provides a powerful inductive bias on locomotion problems, its structure may hinder performance on tasks unrelated to locomotion such as visual classification problems.
A minimally-invasive method for serial cerebrospinal fluid collection and injection in rodents with high survival rates
Authors: Han Jingrong Regina , Yang Yu , Wu Tianshu William , Shi Tao-Tao , Li Wenlu , Zou Yilong
Published: October 2022

Cerebrospinal fluid (CSF) is a clear fluid surrounding and nourishing the brain and spinal cord. Molecular profiling of the CSF is a common diagnostic approach for central nervous system (CNS) diseases, including infectious diseases, autoimmune disorders, brain hemorrhage and traumatic brain injury, CNS tumors, and Alzheimer’s disease1–10. Rodent models are critical for investigating CNS disease mechanisms and therapeutics, however, both collecting CSF and injecting materials into CSF in small animals are technically challenging and often result in high rates of postoperative mortality. Here, we present an easy-to-practice and cost-effective protocol with minimum instrument requirements to access the CSF in live rodents for collection and infusion purposes. By introducing a metal needle tool bent at a unique angle and length, we could steadily reach the CSF via the foramen magnum. Compared with prior methods, this protocol requires neither the operator to discern the changes in resistance from solid tissues while puncturing the needle, nor surgical opening of the skin and muscle covering the rodent neck. Using this method, we frequently obtain 5-15 μL of CSF from mice and 70-120 μL from rats to enable diverse downstream analyses including mass spectrometry. Due to the minimal invasiveness, this procedure allows iterative CSF collection from the same animal every few days – a major improvement over prior protocols that require extensive surgical operations. Moreover, we demonstrate that this method could be used for injecting desired solutions including dyes into mouse CSF with high success rates. Our method shortens the time required for CSF collection or injection to 3-5 minutes. Notably, we could reach near 100% postoperative recovery rates in both mice and rats even with repetitive collections. Together, we establish an efficient and minimally-invasive protocol for collecting CSF and inoculating reagents into the CSF in live rodents to enable various longitudinal studies at the forefronts of CNS investigation.
Epigenetically distinct synaptic architecture in clonal compartments in the teleostean dorsal pallium
Authors: Isoe Yasuko , Nakamura Ryohei , Nonaka Shigenori , Kamei Yasuhiro , Okuyama Teruhiro , Yamamoto Naoyuki , Takeuchi Hideaki , Takeda Hiroyuki
Published: October 2022

The dorsal telencephalon (i.e. the pallium) exhibits high anatomical diversity across vertebrate classes. The mammalian dorsal pallium accommodates a six layered-structure, the neocortex, whereas the teleostean dorsal pallium possesses various compartmentalized structures among species. The development, function and evolution of the fish dorsal pallium remain unillustrated. Here, we analyzed the structure and epigenetic landscapes of cell lineages in the telencephalon of medaka fish (Oryzias latipes) which possesses a clearly delineated dorsal pallium (the Dd2 region). We found that different pallial regions, including Dd2, are formed by mutually exclusive clonal units, and that each pallium compartment exhibits a distinct epigenetic landscape. In particular, Dd2 possesses a unique open chromatin pattern that preferentially targets synapse-related genes. Indeed, Dd2 shows a high density of synapses, which might reflect strong plasticity. Finally, we identified several transcription factors as candidate regulators for the Dd2, which are partially shared with the human neocortex and hippocampus.
Decoupling of mRNA and protein expression in aging brains reveals the age-dependent adaptation of specific gene subsets
Authors: Khatir Ines , Brunet Marie A. , Meller Anna , Amiot Florent , Patel Tushar , Lapointe Xavier , Lopez Jessica Avila , Guilloy Noe , Castonguay Anne , Husain Mohammed Amir , St-Germain Joannie , Boisvert François-Michel , Plourde Mélanie , Roucou Xavier , Laurent Benoit
Published: October 2022

During aging, changes in gene expression are associated with decline in physical and cognitive abilities. Here, we investigated the connection between changes of mRNA and protein expression in the brain by comparing the transcriptome and proteome of the mouse cortex during aging. Our transcriptomic analysis revealed that aging mainly triggers gene activation in the cortex. We showed that increase of mRNA expression correlates with protein expression, specifically in the anterior cingulate cortex where we also observed an increase of cortical thickness during aging. Genes exhibiting an aging-dependent increase of mRNA and protein levels are involved in sensory perception and immune functions. Our proteomic analysis also identified changes in protein abundance in the aging cortex and highlighted a subset of proteins that were differentially enriched but exhibited stable mRNA levels during aging, implying the contribution of aging-related post transcriptional and post-translational mechanisms. These specific genes were associated with general biological processes such as translation, ribosome assembly and protein degradation, but also important brain functions related to neuroplasticity. By decoupling mRNA and protein expression, we have thus characterized distinct subsets of genes that differentially adjust to cellular aging in the cerebral cortex.
A pathway to produce non-coding piRNAs from endogenous protein-coding regions supports Drosophila spermatogenesis
Authors: Iki Taichiro , Kawaguchi Shinichi , Kai Toshie
Published: October 2022

PIWI-interacting (pi)RNA pathways control transposable elements (TEs) and endogenous genes in animal gonads, playing important roles in gamete formation. Here, we report a mechanism by which endogenous protein-coding regions, that normally provide their sequences for translation, serve as origins of non-coding piRNA biogenesis in Drosophila melanogaster testes. The products, namely endo-piRNAs, formed silencing complexes with Aubergine (Aub) in germ cells. Proximity proteome combined to functional analyses revealed a testis-specialized chaperone, Cyclophilin 40 (Cyp40), selectively increases endo-piRNA occupancy inside Aub-RISCs aside from other TE-related piRNAs. Moreover, Argonaute 2 (Ago2) activities were found critical for endo-piRNA production. We provide evidence that Ago2-bound short interfering (si)RNAs and micro(mi)RNAs specify precursors and direct endo-piRNA biogenesis. Consistently, Aub and Ago2 cooperate in spermatid differentiation and regulate endogenous genes via endo-piRNA-directed mRNA cleavage. Collectively, our data highlight that Drosophila testes employ a unique strategy to expand the diversity of germline piRNAs supporting late spermatogenesis.

Headlines

Endogenous protein-coding regions derive non-coding endo-piRNAs

endo-piRNA and TE-piRNA are produced via distinct mechanisms

siRNA and miRNA activities direct secondary piRNA biogenesis

endo-piRNA pathway controls chromatin and sperm formation
Modelling membrane reshaping by staged polymerization of ESCRT-III filaments
Authors: Jiang Xiuyun , Harker-Kirschneck Lena , Vanhille-Campos Christian , Pfitzner Anna-Katharina , Lominadze Elene , Roux Aurélien , Baum Buzz , Šarić Anđela
Published: October 2022

ESCRT-III filaments are composite cytoskeletal polymers that can constrict and cut cell membranes from the inside of the membrane neck. Membrane-bound ESCRT-III filaments undergo a series of dramatic composition and geometry changes in the presence of an ATP-consuming Vps4 enzyme, which causes stepwise changes in the membrane morphology. We set out to understand the physical mechanisms involved in translating the changes in ESCRT-III polymer composition into membrane deformation. We have built a coarse-grained model in which ESCRT-III polymers of different geometries and mechanical properties are allowed to copolymerise and bind to a deformable membrane. By modelling ATP-driven stepwise depolymerisation of specific polymers, we identify mechanical regimes in which changes in filament composition trigger the associated membrane transition from a flat to a buckled state, and then to a tubule state that eventually undergoes scission to release a small cargo-loaded vesicle. We then characterise how the location and kinetics of polymer loss affects the extent of membrane deformation and the efficiency of membrane neck scission. Our results identify the near-minimal mechanical conditions for the operation of shape-shifting composite polymers that sever membrane necks.

Author summary

ESCRT-III proteins have the unique ability to cut membrane necks from within, which is needed for a vast number of cell remodelling events including the release of cargo-containing vesicles. ESCRT-III proteins exist in different forms, which can assemble into spiral and helical homopolymers of different curvatures, and they have been suggested to polymerize and depolymerize with each other in a staged manner to deform and cut membranes.

We developed a computer model to explore the physical mechanisms behind vesicle budding driven by the staged assembly and disassembly of multiple elastic filaments. We identified rules that determine the outcomes of membrane remodelling, which depend on the relative physical features of the distinct filaments, the dynamics of their disassembly, and on the presence of cargo; thereby providing experimentally testable predictions. Our study provides new physical insights into the ESCRT-III-mediated vesicle budding process, at a single subunit level, and identifies the general design principles of nanomachines built from shapeshifting copolymers, which might also be realized in synthetic systems.