bluuebunny/crossref_metadata_2025 huggingface dataset:
Opening up science for a sustainable world: An expansive normative structure of open science in the digital era
Authors: Vicente-Saez Ruben , Gustafsson Robin , Martinez-Fuentes Clara
Published: July 2021

New digital technologies and tools, together with evolving open physical and digital infrastructures, are remodelling science and innovation practices at universities and challenging their existing cultures, cognitive norms, missions, and policies. The purpose of this empirical study was to understand how existing and recently adopted open science practices and the underlying principles and attitudes of research teams support the advancement of knowledge and the development of actions, solutions, and technologies for sustainable development. The results of this study provide novel insights and important suggestions to guide the advancement of open science and innovation policies at universities for a sustainable economy, society, and environment—in sum, for a sustainable world. We infer a new expansive normative structure—practices, norms, and institutional goal—for open science and a new role of researchers in the digital era. Based on our findings, we propose an expansive model of university research and innovation to guide the renewal of university governance in the digital era.
Comprehensive phenotypic phylogenetic analysis supports the monophyly of stromateiform fishes (Teleostei: Percomorphacea)
Authors: Pastana Murilo N L , Johnson G David , Datovo Aléssio
Published: July 2021

More than half the ray-finned fishes and about one-quarter of all living vertebrates belong to Percomorphacea. Among its 30 orders, Stromateiformes encompass 77 species in 16 genera and six families. Stromateiform monophyly has never been tested using morphology, and it has been rejected by molecular analyses. This comprehensive revision of Stromateiformes includes all its valid genera of all percomorph families previously aligned with the order. We sampled 207 phenotypic characters in 66 terminal taxa representing 14 orders and 46 acanthopterygian families. This dataset significantly surpasses all previous phenotype-based phylogenies of Stromateiformes, which analysed only a fraction of these characters. Stromateiformes is recovered as monophyletic, supported by eight unequivocal synapomorphies. Amarsipidae is the sister group of all other Stromateiformes (= Stromateoidei). Centrolophidae is paraphyletic, with three of its genera allocated into an early-diverging clade and the other four appearing as successive sister groups to a lineage containing the remaining stromateiforms. All other stromateoid families are monophyletic, with the following cladistic arrangement: (Nomeidae (Stromateidae (Tetragonuridae, Ariommatidae))). Our analysis convincingly refutes recent molecular phylogenetic interpretations that fail to recover a monophyletic Stromateiformes. These findings call into question large-scale conclusions of percomorph relationships and trait evolution based solely on molecular data.
Ultrastructural Observations of Botrytis cinerea and Physical Changes in Resistant and Susceptible Grapevines
Authors: Hou Xiaoqing , Zhang Guoyun , Han Rui , Wan Ran , Li Zhi , Wang Xiping
Published: July 2021

The necrotrophic fungus Botrytis cinerea is a major threat to grapevine cultivation worldwide. Here, a highly resistant Chinese wild grapevine, Vitis amurensis ‘Shuangyou’ (SY), and the susceptible V. vinifera ‘Red Globe’ (RG) were selected for study, and their pathogenic infection and biochemical responses to B. cinerea were evaluated. The results revealed more trichomes on and a thicker cuticle for leaves of SY than RG under scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Both SEM and TEM also showed that conidial germination, appressorium formation, and hyphal development of B. cinerea were delayed on the leaves of resistant SY. Fewer infected hyphae were also observed in leaves of resistant SY when compared with susceptible RG. The infected leaves of resistant SY harbored higher levels of cellulase and pectinase activity during the early infection stages of B. cinerea at 4 h postinoculation (hpi), and higher glucanase and chitinase activity were maintained in the inoculated leaves of SY from 4 through 18 hpi. Lignin was deposited in the infected leaves of susceptible RG but not in resistant SY. Taken together, these results provide insights into the ultrastructural characterizations and physical changes in resistant and susceptible grapevines.
Women Representation as First and Corresponding Authors in Neuroanesthesiology and Neurocritical Care Journals: A Retrospective Analysis
Authors: Gupta Nidhi , Banerjee Shraya , Choudhury Kalyanpury J. , Prabhakar Hemanshu
Published: July 2021

Introduction:

There is limited literature on the representation of women in leading roles in neuroanesthesiology and neurocritical care academia. We aimed to determine the representation of women as first and corresponding authors in articles published in 3 dedicated journals of neuroanesthesiology and neurocritical care during last 5 years.

Methods:

Articles published in the Journal of Neurosurgical Anesthesiology, Neurocritical Care, and Journal of Neuroanaesthesiology and Critical Care between July 1, 2015 and June 30, 2020 were included in this study. The primary outcome was the proportion of women first authors, and secondary outcomes were the percentage of women corresponding authors, and representation of women as first and corresponding author by article type and country of affiliation.

Results:

Of the 1164 articles included in the study, 403 (34.6%) had a woman first author. Women first authorship was highest for Special Articles (5/11; 45.5%), Clinical Reports (44/113; 38.9%) and Narrative Review Articles (58/151; 38.4%) and lowest for Original Research Articles (198/597; 33.2%). Women accounted for 29.6% (344/1164) of corresponding authors across all article types. Overall, the United States and India had the highest representation of women first authors (159/403; 39.0% and 107/344; 31.0%, respectively), and India also had highest proportion of women corresponding authors (107/272; 39.3%).

Conclusions:

Women were underrepresented compared with men as first author of articles published in 3 dedicated neuroanesthesiology and neurocritical care journals over the last 5 years. Women had the lowest representation as authors of Original Research Articles.
Injury risk among athletes on artificial turf: a review of current literature
Authors: Sivasundaram Lakshmanan , Mengers Sunita , Paliobeis Andrew , Trivedi Nikunj N. , Karns Michael R. , Salata Michael J. , Voos James E.
Published: July 2021

Artificial turf is used commonly as an alternative to natural grass for athletic playing surfaces, primarily for its ease of maintenance, multi-use capability year-round, and cost. Prior studies have demonstrated increased biomechanical stresses at the shoe-surface interface on artificial turf when compared to natural grass. However, there is debate whether the altered shoe-surface interface confers additional risk for injury to athletes. The purpose of this study was to review the current literature on injury risk associated with artificial turf among various sports played on turf. The present study was a clinical review of the current literature regarding injury risk on artificial and natural turf. While playing surface generally does not appear to impact overall injury risk in soccer and rugby players, data is inconclusive among American football athletes. Lower-extremity injuries, in particular knee and ankle injuries, more commonly occur on artificial turf in comparison to natural grass. Surface and sport-specific shoes, third-generation artificial turf, and routine monitoring and maintenance have all been shown to reduce the risk of injury on artificial turf. When athletes must play on artificial turf, surface-specific strategies may be implemented to reduce their risk of injury. Future studies should be conducted to evaluate further these risk reduction strategies.

Level of Evidence:

Level V.
Retrospective matched case-control study evaluating cementless total knee replacements in patients with BMI over 30 kg/m2 or in patients aged 65 yr and younger
Authors: Silverstein Rachel Sanislo , Owashi Eric Toshio , Rawicki Nathaniel Levi , Patel Neel R. , Shatkin Michael Stephen , Zelicof Steven B.
Published: July 2021

Background:

This study’s goal was to compare outcomes in cemented and cementless total knee arthroplasty (TKA) in patients with a body mass index of 30 kg/m2 or greater or patients aged 65 yr or younger.

Methods:

A retrospective matched case-control study was performed on 400 consecutive primary TKAs at the same community-based teaching institution by a single fellowship-trained arthroplasty surgeon. One hundred and eighty-six patients met the inclusion criteria for the obese cohort (93 cementless, 93 cemented). One hundred and seventy-one patients met the inclusion criteria of 65 yr of age or younger cohort (85 cementless, 86 cemented). Charts were reviewed for demographics, TKA revisions, Knee Society Score-Knee (KSS-Knee), Knee Society Score-Function (KSS-Function), Knee Injury and Osteoarthritis Outcomes Scores for Joint Replacement outcome scores, and perioperative complications.

Results:

The average follow-up was 4 years (range 2.5 to 7 yr). Patients demonstrated improved change for minimal clinically important differences values in both the cementless and cemented TKA groups for KSS-Knee and KSS-Function in each cohort. Substantial clinical benefit had improved change for cementless TKAs in both KSS-Knee and KSS-Function scores; however, only the cementless TKA group achieved an improved change in substantial clinical benefit with KSS-Function. Knee Injury and Osteoarthritis Outcomes Scores for Joint Replacement scores were equivalent between both the cementless and cemented cohorts.

Conclusions:

This study was clinically significant as outcome data remained positive for longer term follow-up in patients with a body mass index of 30 kg/m2 or greater or those aged 65 yr or younger with cementless total knees.

Level of Evidence:

Level III.
Factors that influence patients’ recommendations of orthopaedic surgeons: a cross-sectional study of a popular online rating website
Authors: Hanna Gabriel , Luis Justin , Para Ashok , Ezzat Bishoy , Batko Brian D. , Edobor-Osula Folorunsho
Published: July 2021

Background:

In the modern digital age, patients have increased the use of online physician reviews prior to making healthcare decisions. The authors sought to investigate trends in online physician reviews.

Methods:

Healthgrades.com was queried for “orthopaedic surgery” in the state of New Jersey. Data points were collected including demographic information, fellowship training status, and the likelihood to recommend score (LTRS). Quantitative analysis was conducted using descriptive statistics, Student’s t-test, one-way analysis of variance (ANOVA), Pearson correlation, and multiple linear regression. Qualitative analysis of randomly selected positive comments and all negative comments was conducted. Common themes were identified using a frequency-based word cloud generator.

Results:

In total 834 board certified orthopaedic surgeons (800 men, 34 women) were identified. Fellowship-trained surgeons were more likely to be recommended. The LTRS increased with total number of reviews (r=0.205, P=0.01). Compared with waiting time more than 10 min, those with waiting time less than 10 min were more likely to be recommended. The LTRS decreased with increasing number of negative comments (r=−0.317, P=0.01). Qualitative analysis of a randomly selected sample of 4,151 out of a total of 12,168 positive comments and 1,113 total negative comments revealed that although positive comments centered on surgeon competence and professionalism, negative comments centered on surgeon personality and waiting time.

Conclusions:

Orthopaedic surgeons have generally favorable ratings and mostly positive comments. Knowledge of which surgeon-specific attributes are important to patients may provide valuable insight to orthopaedic surgeons on how to improve patient care and patient satisfaction as well as improve online review websites as reliable sources for evaluating physicians.

Level of Evidence:

Level IV.
Nationwide Ethnic/Racial Differences in Surgical Treatment of Discoid Meniscus in Children: A PHIS Database Study
Authors: Milewski Matthew D. , Coene Ryan P. , McFarlane Kelly H. , Williams Kathryn A. , Feldman Lanna , Beck Jennifer J.
Published: July 2021

Background:

Discoid meniscus, a congenital meniscus variant, may have greater incidence in Asian populations. No US population-based studies have examined the discoid meniscus ethnic/racial distribution. In pediatric patients undergoing meniscus surgery, it is hypothesized that ethnic/racial variability exists in patients with discoid meniscus and this variability is different than in patients with medial meniscus tears.

Methods:

The Pediatric Health Information System was queried from 48 hospitals to examine patients 18 years of age and younger between 2015 and 2019, using International Classification of Diseases, 10th Revision, Clinical Modification codes. A cohort of patients treated surgically for discoid meniscus was compared with a cohort of patients treated surgically for medial meniscal tear. These 2 populations were compared based on age, sex, ethnicity/race, Current Procedural Terminology code, insurance, urban versus rural, and region of country. Univariate testing and multivariable logistic modeling were used to test for associations.

Results:

A discoid meniscus cohort of 399 children (median age, 13.0 y) was compared with a medial meniscus tear cohort of 3157 children (median age, 16.0 y) (P<0.001). Hispanic/Latino children accounted for 36.8% of the discoid lateral meniscus and 22.7% of the medial meniscus populations (P<0.001). Among pediatric patients that had surgery for discoid lateral meniscus or medial meniscus, Hispanic/Latino children had 2.36 times the odds of surgery for discoid meniscus compared with White patients after adjusting for age and insurance (P<0.001). Asian children also had 2.41 times the odds of surgery for discoid meniscus compared with White patients (P=0.017).

Conclusions:

This study shows a significant association of ethnicity/race with discoid versus medial meniscus surgical treatment in children. Among pediatric patients undergoing surgery for discoid meniscus, Hispanic/Latino and Asian patients were a significantly larger percentage of the population than White patients. Hispanic/Latino children made up a greater percentage of the population having surgery for a torn discoid meniscus versus a torn medial mensicus. When evaluating pediatric patients, younger age and Asian or Hispanic/Latino ethnicity should increase attention to the possibility of a discoid meniscus.

Level of Evidence:

Level IV.
Measuring Nurses' Experiences With Unintended Adverse Consequences in EMR Use in Acute Care Settings
Authors: Lee Seonah
Published: July 2021

Adverse effects of EMR use have been rarely reported in South Korea. This study examined nurses' experiences with unintended adverse consequences associated with EMR implementation. The participants were 155 nurses using the EMR for patient care in three public hospitals. The statistically tested 21-item instrument and the same 21 open-ended questions were used for data collection. The data collected were analyzed using descriptive statistics and two-way analysis of variance, and the descriptions were grouped by meaning. The participants frequently experienced unintended adverse consequences that resulted from EMR use, and their experiences were organized into 11 subgroups under four dimensions of the unintended consequences instrument including the malfunction and inefficient design of EMR screens dimension (two groups), extra work from EMR implementation dimension (three groups), EMR incompatibility and changes in the prescription pattern dimension (three groups), and patient safety and EMR dependence (three groups). Successful implementation of EMRs is possible when unintended adverse consequences identified by the users are corrected and EMRs are tailored to user needs. Healthcare organizations should provide administrative support, timely technical remedy, and user training to increase user acceptance on a system.
Transcranial sonography in differential diagnosis of Parkinson disease and other movement disorders
Authors: Wang Li-Shu , Yu Teng-Fei , Chai Bin , He Wen
Published: July 2021

Background:

Reports evaluating the efficacy of transcranial sonography (TCS) for the differential diagnosis of Parkinson disease (PD) and other movement disorders in China are scarce. Therefore, this study aimed to assess the application of TCS for the differential diagnosis of PD, multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and essential tremor (ET) in Chinese individuals.

Methods:

From 2017 to 2019, 500 inpatients treated at the Department of Dyskinesia, Beijing Tiantan Hospital, Capital Medical University underwent routine transcranial ultrasound examination. The cross-sections at the midbrain and thalamus levels were scanned, and the incidence rates of substantia nigra (SN) positivity and the incidence rates of lenticular hyperechoic area were recorded. The echo of the SN was manually measured.

Results:

Of the 500 patients, 125 were excluded due to poor signal in temporal window sound transmission. Among the 375 individuals with good temporal window sound transmission, 200 were diagnosed with PD, 90 with ET, 50 with MSA, and 35 with PSP. The incidence rates of SN positivity differed significantly among the four patient groups (χ
2 = 121.061, P < 0.001). Between-group comparisons were performed, and the PD group showed a higher SN positivity rate than the ET (χ
2 = 94.898, P < 0.017), MSA (χ
2 = 57.619, P < 0.017), and PSP (χ
2 = 37.687, P < 0.017) groups. SN positivity showed a good diagnostic value for differentiating PD from the other three movement diseases, collectively or individually. The incidences of lenticular hyperechoic area significantly differed among the four patient groups (χ
2 = 38.904, P < 0.001). Next, between-group comparisons were performed. The lenticular hyperechoic area was higher in the PD group than in the ET (χ
2 = 6.714, P < 0.017) and MSA (χ
2 = 18.680, P < 0.017) groups but lower than that in the PSP group (χ
2 = 0.679, P > 0.017).

Conclusion:

SN positivity could effectively differentiate PD from ET, PSP, and MSA in a Chinese population.
Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000–2019
Authors: Lu Bin , Li Na , Luo Chen-Yu , Cai Jie , Lu Ming , Zhang Yu-Han , Chen Hong-Da , Dai Min
Published: July 2021

Background:

Globally, colorectal cancer (CRC) imposes a substantial burden on healthcare systems and confers considerable medical expenditures. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC.

Methods:

We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index (HDI). Trends of age-standardized rates of incidence and mortality in 60 countries (2000–2019) were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019. The association between exposure to country-level lifestyle, metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression.

Results:

CRC incidence and mortality varied greatly in the 60 selected countries, and much higher incidence and mortality were observed in countries with higher HDIs, and vice versa. From 2000 to 2019, significant increases of incidence and mortality were observed for 33 countries (average annual percent changes [AAPCs], 0.24–3.82) and 18 countries (AAPCs, 0.41–2.22), respectively. A stronger increase in incidence was observed among males (AAPCs, 0.36–4.54) and individuals <50 years (AAPCs, 0.56–3.86). Notably, 15 countries showed significant decreases in both incidence (AAPCs, −0.24 to −2.19) and mortality (AAPCs, −0.84 to −2.74). A significant increase of incidence among individuals <50 years was observed in 30 countries (AAPCs, 0.28–3.62). Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking, higher level of cholesterol level, higher level of unemployment, and a poorer healthcare system.

Conclusions:

Some high-HDI countries showed decreasing trends in CRC incidence and mortality, whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends, especially in males and populations ≥50 years, which require targeted preventive health programs.
Promoting Cardiac Rehabilitation in Acute Coronary Syndrome Patients: Quality Initiative Based on Education, Automated Referral, and Multidisciplinary Rounds
Authors: Matthia Eldon L. , Mohadjer Ashley , Randall Morgan H. , Canha Catarina , Warren Elizabeth , Ashraf Hassan M. , Plasschaert Jeffrey M. , Winchester David E. , Keeley Ellen C.
Published: July 2021

Cardiac rehabilitation is a class 1 recommendation for acute coronary syndrome (ACS) patients according to the American College of Cardiology/American Heart Association. However, only 1 in 5 ACS patients are referred for cardiac rehabilitation nationally, and even fewer at our institution. We sought to improve the number of referrals to cardiac rehabilitation for post-ACS patients admitted to our inpatient cardiology service, and ultimately their participation in the program. We designed a quality improvement initiative that included education of patients and house staff, automated referral order, and participation of cardiac rehabilitation staff members on multidisciplinary rounds. We compared the number of patients who received a referral to cardiac rehabilitation, had the first appointment scheduled before hospital discharge, and attended the program before and after our intervention. Six months after initiation of the project, the proportion of ACS patients referred to cardiac rehabilitation before hospital discharge increased from 10% to 43% (P < 0.001). The mean number of patients with a cardiac rehabilitation appointment scheduled before discharge was 2 before and 5 after the intervention (P < 0.001), and the mean number of patients who attended their scheduled appointment was 1 before and 3 after the intervention (P = 0.001). Run charts demonstrated that the number of referrals and the number of scheduled appointments remained above the median following the intervention. In conclusion, an initiative that included education, automated referrals, and direct one-on-one contact with cardiac rehabilitation staff before discharge increased the number of cardiac rehabilitation referrals, and appointments scheduled and attended in post-ACS patients.
Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries
Authors: Greene M. Claire , Huang Terry T. K. , Giusto Ali , Lovero Kathryn L. , Stockton Melissa A. , Shelton Rachel C. , dos Santos Palmira , Saúte Francisco , Wainberg Milton L.
Published: July 2021

Advancements in global mental health implementation research have revealed promising strategies for improving access to evidence-based mental health care. These advancements have not translated, however, into a reduced prevalence of mental disorders. In this review we examine the relationships between determinants (i.e., barriers and facilitators) and outcomes of mental health services in low- and middle-income countries to identify opportunities for improving the population-level impact and sustainability of innovations in global mental health. We identified three key implementation and services outcomes that influenced the prevalence of mental disorders in the 56 included review articles: supply (access, implementation), demand (help seeking, utilization), and quality (effectiveness, quality of care) of mental health services. Determinants of these outcomes revealed seven themes: community stakeholder engagement; cultural relevance; stigma; human resource capacity; organization of services; governance, policy, and financing; and sociopolitical and community context. We developed a causal loop diagram to illustrate the relationships among these determinants and outcomes. The causal loop diagram revealed the central role of community stakeholder engagement in bridging implementation and patient outcomes, the importance of addressing stigma and social determinants of mental health, and the need to complement supply-side implementation strategies with approaches to equilibrate demand and improve the quality of services. Applying systems science methodologies to global mental health research presents an opportunity to examine the complex relationships among community and health system factors that influence implementation of evidence-based interventions in order to identify sustainable approaches to improve the population-level impact of mental health services in low- and middle-income countries.
Physical Activity Surveillance in the United States for Work and Commuting
Authors: Whitsel Laurie P. , Huneycutt Frederique , Anderson David R. , Beck Alan M. , Bryant Cedric , Bucklin Rebecca S. , Carson Russell L. , Escaron Anne L. , Hopkins Jammie M. , Imboden Mary T. , McDonough Christina , Pronk Nicolaas P. , Wojcik Janet R. , Zendell Anna , Ablah Elizabeth
Published: July 2021

Objective:

To summarize and describe the current US surveillance systems that assess physical activity (PA) for work and commuting.

Methods:

An expert group conducted an environmental scan, generating a list (n = 18) which was ultimately reduced to 12, based on the inclusion of PA and/or sedentary behavior data.

Results:

The 12 surveys or surveillance systems summarized provide nationally representative data on occupational-level PA or individual-level PA at work, data on active commuting, some are scorecards that summarize workplace health best practices and allow benchmarking, and one is a comprehensive nationally representative survey of employers assessing programs and practices in different worksites.

Conclusions:

The various surveillance systems and surveys/scorecards are disparate and need to be better analyzed and summarized to understand the impact of occupational-level PA and commuting on population health and well-being, life expectancy, and workforce productivity.
Dual Targeted Therapy for the Management of Inflammatory Bowel Disease
Authors: Haider Mahnur , Lashner Bret
Published: July 2021

The burden of inflammatory bowel disease (IBD) is increasing globally and imposes a high morbidity in patients with IBD. Advances have been made in medical management of IBD with the advent of novel therapies such as the biologics and small molecule drugs (SMDs). However, response to these medications is limited; with only 40% of patients achieving clinical remission at 1 year with a biologic. Hence, medical management of IBD is a rapidly evolving paradigm in which not only are new medications being developed but understanding how, when and in whom to use them is evolving. Dual targeted therapy (DTT), which is the combination of biologics and/or SMDs is an attractive concept as it is theoretically a potent and multidimensional anti-inflammatory treatment strategy. In this review, we present the published literature on the use of DTT and highlight its utility in clinical practice. The majority of studies on DTT are case reports and case series on the combination of dual biologic therapy. From the limited evidence available in patients with IBD, dual biologic therapy may be a safe option for patients with refractory IBD who have failed multiple biologic therapies and to manage extraintestinal manifestation of IBD. There are a handful of reports of combination therapy with a biologic and a SMD in patients with IBD. Further studies and randomized control trials are required to comprehensivretain hereely evaluate the safety and efficacy of DTT in IBD.
Pediatric Patients with a Dual Diagnosis of Inflammatory Bowel Disease and Chronic Recurrent Multifocal Osteomyelitis
Authors: Dushnicky Molly J. , Beattie Karen A. , Cellucci Tania , Heale Liane , Zachos Mary , Sherlock Mary , Batthish Michelle
Published: July 2021

There is a paucity of information about the epidemiology, pathophysiology, and treatment of patients with a dual diagnosis of inflammatory bowel disease (IBD) and chronic recurrent multifocal osteomyelitis (CRMO). A retrospective chart review was performed of patients at McMaster Children's Hospital with a diagnosis of either IBD or CRMO, to identify those with the dual diagnosis over a 10‐year period. A dual diagnosis was identified in seven patients. Most patients (6/7) had a diagnosis of IBD first and were subsequently diagnosed with CRMO. At the time of CRMO diagnosis, IBD treatment regimens included one or more of, sulfasalazine (1/6), infliximab (3/6), adalimumab (1/6), or no treatment (1/6). Although the etiology of the link remains unknown, there does not seem to be an association to a specific IBD subtype, age, or treatment. Our patient population demonstrated a response to biologic agents, specifically tumor necrosis factor‐α inhibitors, as treatment for both conditions.
Updates and Challenges in Fecal Microbiota Transplantation for Clostridioides difficile Infection in Children
Authors: Hourigan Suchitra K. , Nicholson Maribeth R. , Kahn Stacy A. , Kellermayer Richard
Published: July 2021

Fecal microbiota transplantation (FMT) is currently the most effective but loosely regulated therapy, for recurrent Clostridioides difficile infection (rCDI) in pediatrics. Over the last 2 years, there have been mounting challenges in the ability to provide FMT to pediatric patients. Firstly, an Food and Drug Administration (FDA) safety alert in 2019 reported transmission of a multidrug resistant organism from FMT donor to recipient resulting in the death of 1 patient. Secondly, the coronavirus disease 2019 (COVID-19) pandemic induced further safety and regulatory challenges. Biotherapeutics are promising and more readily regulated treatment options for rCDI, which may replace FMT in the near future for adults upon regulatory agency approvals. Such approvals, however, are expected to be significantly delayed for children, raising concerns for limited access to effective treatment for children with rCDI. In this commentary, we discuss the recent challenges and future directions of FMT and microbial therapeutics in children with rCDI.
Implicit and Explicit Beliefs About the Effectiveness of Psychotherapy vs. Medication
Authors: Silverman Alexandra L. , Werntz Alexandra , Ko Tomohiro M. , Teachman Bethany A.
Published: July 2021

One exploratory study (N = 10,335) and one preregistered replication and extension study (N = 6648) evaluated implicit and explicit beliefs in the effectiveness of psychotherapy versus medication, and whether these beliefs vary as a function of demographics, mental health difficulties, and treatment experiences. Data were collected from a sample of visitors to a mental health research website who completed the Therapy vs. Medication Effectiveness Implicit Association Test (IAT). The IAT demonstrated evidence of convergent validity with two measures of explicit therapy versus medication effectiveness beliefs. Across both studies, individuals held greater implicit and explicit beliefs that therapy is more effective than medication, and individuals who were Black (versus all other races, excluding “other/unknown”) and who had experienced past (versus current) mental health difficulties had stronger implicit and explicit beliefs in the effectiveness of therapy versus medication. More work is needed to understand how these differences in beliefs arise, as well as to evaluate the clinical utility of this novel measure.
HIV Infection Prevalence Significantly Intersects With COVID-19 Infection At the Area Level: A US County-Level Analysis
Authors: Luan Hui , Song Insang , Fiellin David A. , Ransome Yusuf
Published: July 2021

Background:

Limited empirical evidence exists about the extent to which the current HIV epidemic intersects with COVID-19 infections at the area/geographic level. Moreover, little is known about how demographic, social, economic, behavioral, and clinical determinants are jointly associated with these infectious diseases.

Setting:

Contiguous US counties (N = 3108).

Methods:

We conducted a cross-sectional analysis and investigated the joint association between new HIV infection prevalence in 2018 and COVID-19 infections (January 22, 2020 and October 7, 2020) and explore the contribution of factors such as income inequality, binge drinking, and socioeconomic deprivation. We used Bayesian multivariate spatial models to estimate the cross-disease correlations between these diseases and identified hotspots, which we defined as a county with a posterior probability greater than 80% of being in the top decile of that disease.

Results:

New HIV infection prevalence and COVID-19 infection moderately and significantly intersect [spatial correlation = 0.37, 95% credible interval (CrI) = 0.36–0.37]. Seventy-five counties, mostly in the south, were at elevated burden for HIV and COVID-19 infections. Higher income inequality was positively associated with both COVID-19 (relative risk 1.05, 95% CrI = 1.03–1.07) and HIV infection (relative risk = 1.12, 95% CrI = 1.09–1.15).

Conclusions:

We found that there is a considerable intersection between the current distribution of HIV burden with COVID-19 infections at the area level. We identified areas that federal funding and vaccination campaigns should prioritize for prevention and care efforts.
Performance of Multiparametric Functional Imaging to Assess Peritoneal Tumor Burden in Ovarian Cancer
Authors: Mallet Estelle , Angeles Martina Aida , Cabarrou Bastien , Chardin David , Viau Philippe , Frigenza Mélanie , Navarro Anne Sophie , Ducassou Anne , Betrian Sarah , Martínez-Gómez Carlos , Tanguy Le Gac Yann , Chantalat Elodie , Motton Stéphanie , Ferron Gwénaël , Barranger Emanuel , Gabiache Erwan , Martinez Alejandra
Published: July 2021

Purpose

The aim of the study was to evaluate the clinical utility of pretreatment 18F-FDG PET/CT with quantitative evaluation of peritoneal metabolic cartography in relation to staging laparoscopy for ovarian carcinomatosis.

Patients and Methods

A retrospective review of prospectively collected data from 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IIIC to IV ovarian cancer was carried out. All patients had a double-blinded 18F-FDG PET/CT review. Discriminant capacity of metabolic parameters to identify peritoneal carcinomatosis in the 13 abdominal regions according to the peritoneal cancer index was estimated with area under the receiver operating characteristic curve (AUC).

Results

The metabolic parameter showing the best trade-off between sensitivity and specificity to predict peritoneal extension compared with peritoneal cancer index score was the metabolic tumor volume (MTV), with a Spearman ρ equal to 0.380 (P < 0.001). The AUC of MTV to diagnose peritoneal involvement in the upper abdomen (regions 1, 2, and 3) ranged from 0.740 to 0.765. MTV AUC values were lower in the small bowel regions (9–12), ranging from 0.591 to 0.681, and decreased to 0.487 in the pelvic region 6. 18F-FDG PET/CT also improved the detection of extra-abdominal disease, upstaging 35 patients (41.6%) from stage IIIC to IV compared with CT alone and leading to treatment modification in more than one third of patients.

Conclusions

18F-FDG PET/CT metrics are highly accurate to reflect peritoneal tumor burden, with variable diagnostic value depending on the anatomic region. MTV is the most representative metabolic parameter to assess peritoneal tumor extension.
Fully Automated Gross Tumor Volume Delineation From PET in Head and Neck Cancer Using Deep Learning Algorithms
Authors: Shiri Isaac , Arabi Hossein , Sanaat Amirhossein , Jenabi Elnaz , Becker Minerva , Zaidi Habib
Published: July 2021

Purpose

The availability of automated, accurate, and robust gross tumor volume (GTV) segmentation algorithms is critical for the management of head and neck cancer (HNC) patients. In this work, we evaluated 3 state-of-the-art deep learning algorithms combined with 8 different loss functions for PET image segmentation using a comprehensive training set and evaluated its performance on an external validation set of HNC patients.

Patients and Methods

18F-FDG PET/CT images of 470 patients presenting with HNC on which manually defined GTVs serving as standard of reference were used for training (340 patients), evaluation (30 patients), and testing (100 patients from different centers) of these algorithms. PET image intensity was converted to SUVs and normalized in the range (0–1) using the SUVmax of the whole data set. PET images were cropped to 12 × 12 × 12 cm3 subvolumes using isotropic voxel spacing of 3 × 3 × 3 mm3 containing the whole tumor and neighboring background including lymph nodes. We used different approaches for data augmentation, including rotation (−15 degrees, +15 degrees), scaling (−20%, 20%), random flipping (3 axes), and elastic deformation (sigma = 1 and proportion to deform = 0.7) to increase the number of training sets. Three state-of-the-art networks, including Dense-VNet, NN-UNet, and Res-Net, with 8 different loss functions, including Dice, generalized Wasserstein Dice loss, Dice plus XEnt loss, generalized Dice loss, cross-entropy, sensitivity-specificity, and Tversky, were used. Overall, 28 different networks were built. Standard image segmentation metrics, including Dice similarity, image-derived PET metrics, first-order, and shape radiomic features, were used for performance assessment of these algorithms.

Results

The best results in terms of Dice coefficient (mean ± SD) were achieved by cross-entropy for Res-Net (0.86 ± 0.05; 95% confidence interval [CI], 0.85–0.87), Dense-VNet (0.85 ± 0.058; 95% CI, 0.84–0.86), and Dice plus XEnt for NN-UNet (0.87 ± 0.05; 95% CI, 0.86–0.88). The difference between the 3 networks was not statistically significant (P > 0.05). The percent relative error (RE%) of SUVmax quantification was less than 5% in networks with a Dice coefficient more than 0.84, whereas a lower RE% (0.41%) was achieved by Res-Net with cross-entropy loss. For maximum 3-dimensional diameter and sphericity shape features, all networks achieved a RE ≤ 5% and ≤10%, respectively, reflecting a small variability.

Conclusions

Deep learning algorithms exhibited promising performance for automated GTV delineation on HNC PET images. Different loss functions performed competitively when using different networks and cross-entropy for Res-Net, Dense-VNet, and Dice plus XEnt for NN-UNet emerged as reliable networks for GTV delineation. Caution should be exercised for clinical deployment owing to the occurrence of outliers in deep learning–based algorithms.
Chronic Colitis Mimicking Malignancy on 68Ga-FAPI PET/CT
Authors: Yang Xiao , Huang Yilin , Mou Chunru , Liu Huipan , Chen Yue
Published: July 2021

A 40-year-old man presented with abdominal pain and diarrhea for 2 months. Abdominal CT showed thickening of the cecal wall, which was considered likely malignant. The patient was subsequently enrolled in a clinical trial of 68Ga-FAPI PET/CT study in tumors. Intense 68Ga-FAPI activity was noted in the thickened cecum, also suggestive of malignancy. However, pathological examination from biopsy rendered a diagnosis of chronic colitis.
Assessment of Apparent Diffusion Coefficients and SUVs as Predicators of Histological Differentiation in Anal Squamous Cell Carcinoma
Authors: Parsai Arman , Zerizer Imene , Jan Hikmat , Kastler Adrian , Subhan Sana , Balogh Petra , Nowosinska Ewa , Thaha Mohammed , Miquel Marc. E.
Published: July 2021

Aim

The study aims to assess minimal apparent diffusion coefficient (ADCmin) and SUVmax as predictors of histological differentiation in patients with anal squamous cell carcinoma (ASCC) and to determine cutoff values for each histopathological tumor grade.

Patients and Methods

A retrospective study of 41 ASCC patients (14 males, 27 females; mean age, 65 ± 13 years) staged with FDG PET/CT and MRI (mean scan time interval, 21 ± 11 days). SUVmax and ADCmin values were measured and compared with histopathological tumor grading obtained from biopsy.

Results

The mean size and tumor volume were 3 ± 2 cm and 16.5 ± 27.3 cm3, respectively. The mean ADCmin values for well-, moderately, and poorly differentiated ASCC were 935 ± 179, 896 ± 123, and 637 ± 114, respectively. The mean SUVmax for well-, moderately, and poorly differentiated ASCC were 6.9 ± 1.8, 11.5 ± 4.1, and 13.4 ± 2.6, respectively. The difference in mean ADCmin values between poorly and moderately/well-differentiated tumors was statistically significant, whereas this was not significant between moderately and well-differentiated tumors. Differences in SUVmax values were statistically significant between poorly/moderately and well-differentiated tumors, whereas there was no statistical significance between poorly and moderately differentiated tumors. By combining the 2 modalities using cutoff values of 675 × 10−6 mm2·s−1 for ADCmin and 8.5 for SUVmax, it was possible to differentiate the tumor categories with a sensitivity, specificity, positive predictive value, and negative predictive value, respectively, of 84.6%, 96.4%, 91.7%, and 93.1% for well-differentiated ASCC, 76.5%, 87.5%, 81.3%, and 84% for moderately, and 90.9%, 89.3%, 76.9%, and 96.2% for poorly differentiated ASCC, respectively.

Conclusions

ADCmin and SUVmax values correlated with the degree of differentiation in ASCC and can be used as predictors of tumor grading and aggressiveness. Combined ADCmin and SUVmax cutoff values can therefore be used for early patient risk stratification and treatment decision making.
Benign Bone Cyst Mimicking Bone Metastasis Demonstrated on 68Ga-FAPI
Authors: Gungor Serkan , Selçuk Nalan Alan
Published: July 2021

A 59-year-old woman with lobular breast cancer was referred to nuclear medicine department for a 68Ga-FAPI PET/CT study after completion of treatment to rule out the possibility of metastatic disease. It revealed a lytic lesion showing increased FAPI accumulation in the right acetabulum, highly suspicious for bone metastasis. In comparison to an initial 18F-FDG PET/CT study done 2 years before, the lytic lesion showing no FDG uptake in the right acetabulum remained unchanged, and the findings were consistent with bone cyst. This case highlighted that benign bone cyst may demonstrate increased 68Ga-FAPI uptake mimicking bone metastasis on 68Ga-FAPI PET/CT.
A Staged Approach for Contouring of Temporal Deformities Using Porous Polyethylene and Lipofilling
Authors: Elgazzar Khaled , Elshahat Ahmed
Published: July 2021

Many studies evaluated the effectiveness of a single reconstructive material during temporal cranioplasty, or in comparison to the outcome of another material. To our knowledge, no previous study evaluated a staged combination of reconstruction modalities during temporal cranioplasty. In a prospective interventional study, the authors combined high-density porous polyethylene (HDPP) implant insertion (stage I) with a following lipofilling session (stage II) in 8 patients scheduled for temporal cranioplasties. This two-staged approach was evaluated 6 months after each stage independently. The patients’ satisfaction as regards the aesthetic outcome was evaluated through a 5-points Likert scale by the patients themselves. For every individual patient, this psychometric analysis was repeated by medical staff from other departments. Statistical analysis of the patients and medical staff satisfaction scores showed a statistically significant increase after the addition of lipofilling session (stage II) if compared to implant insertion only (stage I). Clinically, this outcome was maintained in a long-term follow-up ranged from 1 – 8 years. Nevertheless, 2 patients needed one more lipofilling session to obtain their satisfaction as regards the final aesthetic outcome. No other complications were recorded in this study. In conclusion, combining alloplastic and autogenous reconstruction modalities in a staged approach can suffice the reconstruction requirements for such temporal defects. After a long follow-up period, the insertion of high-density porous polyethylene implant with the addition of a following lipofilling session showed more evaluators’ satisfaction in terms of the final aesthetic outcome.
Bioabsorbable System-Related Subcutaneous Swelling After Craniofacial Surgery
Authors: Sakamoto Yoshiaki , Miwa Tomoru , Toda Masahiro , Kishi Kazuo
Published: July 2021

Background:

Bioabsorbable systems have been commonly used in pediatric patients for primary cranioplasty and other related surgeries. However, subcutaneous swelling, a unique complication related to bioabsorbable osteosynthesis, is a concern. Differences in the incidence of subcutaneous swelling, depending on the bioabsorbable material used to construct the plate, are still unknown.

Methods:

The authors retrospectively reviewed all incidences of subcutaneous swelling related to resorbable systems used during primary cranioplasty for patients with craniosynostosis at their hospital between 2014 and 2018 during a 12-month follow-up period. Furthermore, the authors reviewed all published English-language articles (since 1995) on subcutaneous swelling in bioabsorbable systems used for craniosynostosis.

Results:

The most common resorbable systems used in the literature were divided into 2 groups: mixtures of poly D-lactic acid and polyglycolic acid, and mixtures of poly D- and L-lactic acid. In patients for whom poly D-lactic acid and polyglycolic acid were used, the incidence of subcutaneous swelling during resorption was 0% to 4.2% between 3 and 9 months of follow-up. In patients for whom poly D- and L-lactic acid was used, subcutaneous swelling during resorption occurred in 5% to 16.7% of these patients between 6 and 12 months of follow-up. All cases resolved spontaneously after complete absorption of the plate.

Conclusions:

It was difficult to determine which system had the lowest incidence of subcutaneous swelling. The thickness of each resorbable system and the thickness of the infants’ scalps were different in each study. However, subcutaneous swelling occurred in every resorbable system. Therefore, preoperative counseling and careful follow-up are necessary.