bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Quality of PrEP Counseling for Adolescent Girls and Young Women in Kenya With Standardized Patient Actors: A Dose–Response Analysis
Authors: Larsen Anna , Abuna Felix , Owiti George , Kemunto Valarie , Sila Joseph , Wilson Kate S. , Owens Tamara , Pintye Jillian , Richardson Barbra A. , Kinuthia John , John-Stewart Grace , Kohler Pamela
Published: September 2021

Background:

Health care worker (HCW) training using standardized patient actors (SPs) is an evidence-based approach for improving patient–provider interactions. We evaluated whether SP training among HCWs in Western Kenya improved the quality of pre-exposure prophylaxis (PrEP) counseling for adolescent girls and young women (AGYW).

Methods:

We conducted a 2-day SP training intervention among HCWs providing PrEP counseling for AGYW. Six trained SPs role played one encounter each with HCWs following scripts depicting common PrEP-seeking scenarios. SPs used checklists to report and discuss domains of adherence to national PrEP guidelines, communication, and interpersonal skills using validated scales after each encounter. HCWs presented to each case in a random order. Overall and domain-specific mean score percentages were compared between the first and subsequent case encounters using generalized linear models, clustering by HCWs.

Results:

During 564 training cases among 94 HCWs, the overall mean quality of PrEP counseling score was 83.1 (SD: 10.1); scores improved over the course of the 6 encounters (P < 0.001). Compared with the first case encounter, the mean scores for the fourth were significantly higher (79.1 vs. 85.9, P < 0.001). The mean scores plateaued from the fourth to the sixth case (85.2). Although HCWs demonstrated high baseline communication (95.3) and interpersonal skills (83.7), adherence to PrEP guidelines at baseline was suboptimal (57.6). By the fourth case, scores increased significantly (P < 0.001) for all domains.

Conclusions:

SP training improved PrEP counseling overall and in domains of interpersonal skills, use of guidelines, and communication with AGYW and could be useful in efforts to improve the quality of PrEP counseling for AGYW.
Seroadaptive Strategy Patterns of Young Black Gay, Bisexual, and Other Men Who Have Sex With Men in Atlanta, Georgia
Authors: Mann Laura M. , Kelley Colleen F. , Siegler Aaron J. , Stephenson Rob , Sullivan Patrick S.
Published: September 2021

Background:

Young Black gay, bisexual, and other men who have sex with men (YBMSM) are disproportionally affected by HIV. Seroadaptive strategies—modification of sexual behavior based on an individual's perceived serostatus, the perceived status of the partner, and/or HIV transmission risk by the type of sex act—are often used to reduce the risk of HIV transmission or acquisition.

Methods:

We used demographic, behavioral, and clinical data from Ele[MEN]t, a prospective cohort study of YBMSM aged 18–29 years in Atlanta, GA, conducted during 2015–2019. The prevalence of seroadaptive strategies at baseline was reported, and latent class analysis was used to identify the latent classes of strategies for both YBMSM known and not known to be living with HIV. Latent classes were compared by key behavioral and clinical characteristics to validate our findings.

Results:

In a 4-class model, the most common latent class of YBMSM not known to be living with HIV (32.4%) was characterized by all individuals reporting only having sex with men not perceived to be living with HIV. The most common latent class of YBMSM known to be living with HIV (48.2%) was characterized by a combination of serosorting strategies, including using condoms for anal sex with partners not known to be living with HIV and avoiding sex with men not known to be living with HIV.

Conclusions:

YBMSM use various patterns of strategies to reduce their HIV transmission or acquisition risk. Our study highlights the need for targeted HIV prevention recommendations based on individual behaviors.
Brief Report: HIV Is Associated With Impaired Pulmonary Diffusing Capacity Independent of Emphysema
Authors: Raju Sarath , Astemborski Jacquie , Drummond Michael Bradley , Ramamurthi Hema C. , Sun Jing , Brown Robert H. , Kirk Gregory D. , McCormack Meredith C.
Published: September 2021

Background:

HIV is associated with accelerated decline in lung function and increased risk for chronic obstructive pulmonary disease (COPD). Recently, there has been growing attention toward the impairment in the diffusing capacity of the lungs for carbon monoxide (DLCO), a marker of pulmonary gas exchange, observed among persons living with HIV. Although increased emphysema can contribute to the DLCO impairment observed, other factors may drive this association.

Methods:

Using cross-sectional data from the Study of HIV in the Etiology of Lung Disease, we studied the association between HIV and DLCO independent of emphysema. We also analyzed the joint influence of HIV and COPD on DLCO impairment. An analysis was conducted among 339 participants (229 with HIV) with lung function and chest CT imaging data. Multivariable regression models were generated with percent predicted DLCO and odds of DLCO impairment as outcomes.

Results:

After adjusting for confounders, including emphysema severity, HIV was associated with lower DLCO (β −4.02%; P = 0.020) and higher odds of DLCO impairment (odds ratio 1.93; P = 0.017). Even among those without COPD, HIV was independently associated with lower DLCO (β −3.89%; P = 0.049). Compared with HIV-uninfected participants without COPD, those with both HIV and COPD experienced the greatest impairment in DLCO (β −14.81; P < 0.001).

Conclusions:

HIV is associated with impaired pulmonary gas exchange independent of emphysema severity. Our data also suggest a potentially additive influence between HIV and COPD on DLCO impairment. Further studies should investigate the other factors, including pulmonary vascular disease, which may contribute to DLCO impairment among persons living with HIV.
68Ga-DOTA-FAPI-04 PET/CT Imaging in a Case of SAPHO Syndrome
Authors: Xu Tingting , Huang Yilin , Zhao Yan , Wang Peng , Chen Yue
Published: September 2021

A 66-year-old woman presented with anterior chest wall and knee joints pain and multiple skin lesions. 99mTc-MDP bone scintigraphy showed increased bone density in the sternal angle with abnormal bone metabolism. The patient was enrolled in a 68Ga-DOTA-FAPI-04 PET/CT tumor clinical trial, and it showed increased tracer uptake in the sternum and right knee joint. Subsequently, ultrasound of the right knee joint confirmed the existence of synovitis, and no malignant components were found in sternal biopsy. The patient’s final diagnosis was synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. The case confirmed that 68Ga-DOTA-FAPI-04 imaging is helpful for evaluating the involved sites of SAPHO syndrome.
Clinical Findings and Management of Punctal Apposition Syndrome: Rare Cause of Epiphora
Authors: Lee Hyunkyu , Cha Eunhyang , Baek Sehyun
Published: September 2021

The purpose of this study is to evaluate the diagnosis and treatment of punctal apposition syndrome. We retrospectively reviewed the medical records of 2 patients diagnosed with punctal apposition syndrome who underwent lateral tarsal strip procedure. The patients included 1 male and 1 female, with an average age of 76.5 years. Before surgery, both patients had epiphora symptoms with a Munk score of 4 in both eyes. in the primary gaze, it was noted that the upper and lower puncta were appose with each other in both eyes throughout the blinking cycle. On slit lamp examination, there were no keratoconjunctival diseases, and the shape of the puncta were normal. On fluorescein dye disappearance test, grade 3 findings were observed in both eyes of both patients. in dacryos-cintigraphy of the 2 patients, both eyes showed complete obstruction, However, no obstruction of the lacrimal duct system was found in probing and syringing tests. The patient's subjective symptoms improved after patching test. A lateral tarsal strip procedure was performed as a treatment and we obtain satisfactory results. Therefore, punctal apposition syndrome could be 1 of the causes of epiphora.
Psychosocial Impact of Coronal Access Scars in Craniosynostosis Procedures on Patients and Their Families
Authors: Shaw Abigail V. , Kennedy–Williams Patrick , Care Helen , Dalton Louise , Wall Steven , Johnson David
Published: September 2021

The coronal incision is the mainstay for access in craniosynostosis surgery. Scarring is a common concern of parents whose children are offered an open procedure. To the author's knowledge, there are no previous studies looking at the psychosocial impact of scarring from coronal access incisions for craniosynostosis procedures. The author's study focused on patients undergoing procedures for nonsyndromic single-suture craniosynostosis.

This study comprised 3 parts: worldwide survey regarding coronal access incisions for craniosynostosis surgery, questionnaire to determine the psychosocial impact of the scars on patients and their parents, and measurement of postoperative scars in craniosynostosis patients.

Survey responses from 46 craniofacial centers worldwide revealed a zig-zag was the most commonly utilized incision. Seventy-two percent of survey responses reported problems with postoperative stretching of the scar; only 20% of centers reported formal data collection of whether families were affected by this.

Psychology questionnaires revealed that the majority of patients and their parents were not bothered by the zig-zag coronal scars. Patient felt the scars were less noticeable than the parents. Parent perceptions improved with age and time postsurgery.

Coronal access scars following craniosynostosis surgery appear to stretch more in the supra-auricular region compared with the midline.

These findings are useful for the craniofacial multidisciplinary team to inform parents contemplating surgery and who may be concerned about the impact of the scar in the future.
Effect of Early Spheno-Occipital Synchondrosis Fusion in Preadolescent Patients With Syndromic Craniosynostosis on Craniofacial Skeletal Patterns: A Preliminary Study Using Cephalometric Analysis
Authors: Yang Il-Hyung , Chung Jee Hyeok , Cho Il-Sik , Kim Sukwha , Baek Seung-Hak
Published: September 2021

The purpose of this study was to investigate the effects of early spheno-occipital synchondrosis (SOS) fusion in preadolescent patients with syndromic craniosynostosis (SC) on the craniofacial skeletal patterns. Twenty preadolescent SC patients were divided into the fused SOS (FS, n = 10; 8 Crouzon and 2 Apert) and not-fused SOS groups (NFS, n = 10; 9 Crouzon and 1 Apert). Lateral cephalograms (mean age: 9.60 years, cervical vertebral maturation index: stage I and II) were used to investigate the skeletal sagittal (ANB) and vertical patterns (SN-GoMe), upward inclination of the anterior cranial base (ACB; SN-FH), degree of midface hypoplasia (MH, SNA), retrusive position of orbitale (SNO), and forward position of the condyle in relation to sella (saddle angle). Using the ordinal values calculated by ethnic norm (criteria: moderate, over ±1 standard deviation, severe, over ±2 standard deviation), statistical analysis was performed. The FS group showed a higher percentage of severe MH than the NFS group (70% versus 10%,P < 0.05). Although the 2 groups did not differ in the distribution of ANB, SN-GoMe, saddle angle, and SN-FH (allP > 0.05), the FS group showed relatively higher percentages of severe Class III (100% versus 70%), severe hyper-divergent pattern (40% versus 10%), severely forward condyle position (30% versus 0%), and moderate and severe upward anterior cranial base inclination (90% versus 50%) than the NFS group. However, the 2 groups exhibited the same distribution of moderately and severely retrusive orbitale position ([50%, 20%],P > 0.05). Early SOS fusion in preadolescent SC patients might not be related to retrusive orbitale position, but to severe MH.
Legal Liability of a Dentist: Inferior Alveolar Nerve Damage After Calcium Hydroxide Extrusion
Authors: Sodnom-Ish Buyanbileg , Seo Mi Hyun , Yang Hoon Joo , Kim Soung Min
Published: September 2021

During root canal treatments, calcium hydroxide can extrude through the apex causing chemical, mechanical, and/or thermal injuries to the inferior alveolar nerve, which can lead to neurological disorders. unfortunately, dental practitioner negligence can produce this potentially life-changing injury that can compromise the patient's life. The aim of this study is present a case of dental negligence by calcium hydroxide extrusion causing inferior alveolar nerve damage, discuss the methods of prevention, and characterize the medico-legal aspects of complication.
Pediatric Dog Bites: A Review of 1422 Cases Treated at a Level One Regional Pediatric Trauma Center
Authors: Boyd Louisa C. , Chang Jeremy , Ajmera Sonia , Wallace Robert D. , Alvarez Sonia M. , Konofaos Petros
Published: September 2021

Background:

Children under the age of 14 account for over 40% of the almost 900,000 annual hospital visits associated with dog bites. Care for dog bites ranges from simple wound irrigation to complex surgical reconstruction. Due to a number of factors, children frequently sustain dog bites to highly vulnerable regions, often necessitating intervention by plastic surgeons.

Methods:

This retrospective study analyzed data from the 1422 pediatric patients who sustained dog bites and presented to the Le Bonheur Children's Hospital Emergency Room from January 2011 to May 2017.

Results:

The typical pediatric dog bite case was male (63.5%), African-American (57.4%), and less than 10 years old (69.4%). The head and neck were the most commonly affected areas (64.7%). Of the head and neck regions, the cheeks and lips were the most frequently injured structures (34.5%). Hospital admission was required for 188 patients (13.2%) and operative repair was deemed necessary in 16.9% of all cases. Of the patients requiring inpatient operative repair, most (78.3%) were discharged in less than 24 hours. Operative complications occurred in 5.8% of all cases, with infections accounting for the majority (92.9%). No fatal dog bites occurred in this study.

Conclusions:

Age, bite location, and number of bites sustained are several factors of significance, which may aid the novice plastic surgeon in identifying, which pediatric dog bite cases will require surgical intervention.
Reconstruction of an Extensive Maxillofacial Avulsion Injury Caused by Bear Attack With a Double-Island Anterolateral Thigh Free Flap
Authors: Yang Ting , Xu Guikun , Long Yifei , Tian Weidong , Xie Huixu , Long Jie
Published: September 2021

Bear attack, a relatively rare cause of maxillofacial trauma, could lead to severe facial deformity as well as functional impairment. A 45-year-old male ranger was attacked by a bear and suffered an extensive maxillofacial avulsion injury, resulting in massive soft tissue loss (17.5 × 10 cm2) on his left temporal-facial region with an intraoral defect (3 × 2 cm2), surrounded by pus and necrotic tissue. Computed tomography revealed a comminuted fracture of the mandible, as well as bone defects in the left zygomatic bone, zygomatic arch, and part of the lateral orbital wall. in contrast with tumor resection, this large defect wound resulting from trauma was an infected wound with extensive loss of soft tissue and bone, which presented many operational challenges. The initial goal was to control local infection and then repair the maxillofacial and intraoral defects simultaneously. The left oral mucosal lining and maxillofacial skin after infection control were repaired by transposition of a double-island anterolateral thigh flap, and the fractured mandible was fixed, achieving primary closure for the reconstruction of large soft and hard tissue injuries in the oral and maxillofacial region. Five months postoperatively, the flap had healed and the patient was satisfied with the profile. This patient demonstrated how a rare severe injury caused by a bear attack was treated by preliminary closure of an extremely large post-traumatic oral and maxillofacial defect. The authors recommend the 1 pedi- cled double-island free anterolateral thigh flap as a worthwhile choice for the reconstruction of complicated oral and maxillofacial tissue defects combined with an intraoral defect. To our knowledge, this is the largest clinical application reported to date of an anterolateral thigh flap (approximately 200 cm2) for a post-traumatic oral and maxillofacial defect.
The Onlay Rotated Flap (ORF): An Original Technique for Nasal Tip Plasty
Authors: Yilmaz H. Baki , Çakan Doğan , Yilmaz Asli Şahin
Published: September 2021

Objective:

The reshaping of the nasal tip in rhinoplasty according to the expectations of the patient and the surgeon is called tip plasty. in this article, the onlay rotated flap (ORF) is presented as a new technique for reshaping, supporting, and projecting the nasal tip without any resection or grafting.

Methods:

Thirty-two patients (26 female and 6 male) were included in the study retrospectively. Primary rhinoplasty with ORF was performed to all patients. The follow-up period was between 9 and 12months. The nasal tip projection (NTP) with Goode method and nasal tip rotation (NTR) according to nasolabial angle were calculated in standardized preoperative and postoperative(6th month) photographs with image J. SPSS Version 21.0 was used for statistical analysis.

Results:

There were no complications resulting from our procedure. There were no visible tip flaps, no distortion, no asymmetry, and no alar retraction. Revision surgery was not required in any patient. The preoperative and postoperative means of nasolabial angle (Mean ± SD) were 92.06 ± 7.73° and 99.71 ± 6.06°, respectively. The preoperative and postoperative means of NTP (Mean ± SD) were 0.535 ± 0.041 and 0.57 ± 0.386, respectively. The postoperative nasal tip rotation and NTP values of the ORF procedure were found to be statistically significantly higher than the preoperative values (P < 0.05).

Conclusions:

The ORF technique is another alternative for achieving adequate nasal tip definition and projection and has many advantages and very successful postoperative results. The alar retraction was not encountered in our technique and this is the superior aspect of our technique over similar methods described in the literature.
A Life-Saving Early Diagnosis of Burkitt Lymphoma: The Role of a Dentist
Authors: Sodnom-Ish Buyanbileg , Seo Mi Hyun , Huh Kyung-Hoe , Myoung Hoon , Kim Soung Min
Published: September 2021

Burkitt lymphoma (BL) is a subtype of Non-Hodgkin lymphoma, considered one of the fastest growing human tumors. Due to the highly aggressive nature of BL, a prompt diagnosis and aggressive chemotherapeutic treatment are essential. However, the clinical features of BL often can mimic periodontal disease or dentoalveolar abscess. The aim of this study is to present a case of a 31-year-old male patient who was referred to the department of oral and maxillofacial surgery for severe neurosensory disturbance and pain in the lower jaw. He was misdiagnosed with periodontitis and dental abscess at the local clinic. Based on radiographic findings, he was suspected of hematopoietic malignancy. He was referred to the department of hemato-oncology and diagnosed with BL. This case highlights the essential life-saving role of a maxillofacial surgeon in the early diagnosis of a rare malignancy.
A Comparison of Outcomes of Proximal and Distal Anastomosis Sites of the Facial Artery in Head and Neck Reconstruction
Authors: Stoehr Jenna R. , Curran Nicholas R. , Micallef Christopher J. , Ellis Marco F.
Published: September 2021

Recipient vessel selection in head and neck reconstruction is based on multiple factors, including defect size and location, patient history, and vessel location, diameter, and length. The authors present a comparison of proximal and distal anastomotic sites of the facial artery. A chart review of head and neck reconstructions using the facial artery as a recipient vessel over a 7-year period was conducted. The anastomosis site was identified as distal (at the inferior mandible border) or proximal (at the origin of the artery). The distal site was utilized for both defects of the midface/ scalp and of the mandible/neck, while the proximal site was exclusively used for mandible/neck defects. The following complications were included in the analysis: facial nerve injury, surgical site infection, thrombosis, flap congestion, flap loss, hardware failure, malunion/nonunion, osteomyelitis, sinus/fistula, hematoma, seroma, reoperation, and 90-day mortality. Fifty-four free tissue transfers were performed. The overall complication rate (including major and minor complications) was 53.7%. Anastomosis level did not have a significant impact on complication rate. In addition, there were no significant differences in complication rates for the distal anastomosis site when stratified by defect location. However, obese patients were more likely to have a complication than nonobese patients. This conclusion may reassure surgeons that factors related to anastomosis level, such as vessel diameter and proximity to the zone of injury, have less impact on outcomes than factors like obesity, which may inform preoperative planning, intraoperative decision-making, and postoperative monitoring.
Extranasopharyngeal Angiofibroma of the Natural Ostium of Maxillary Sinus
Authors: Yeon Eung Rok , Park Chanhyeon , Jeong Soo Jin , Park Seong Kook
Published: September 2021

Extranasopharyngeal angiofibroma which occurs in all head and neck regions is extremely rare. Unlike most angiofibromas which show nasal congestion and recurrent epistaxis as their symptoms, extranasopharyngeal angiofibromas (ENAF) may lead to various symptoms depending on their location. Nasal septum is the most frequent site of origin of ENAF. No study of ENAF originating in natural ostium of maxillary sinus has been reported. We present a case of 27-year-old male who has extranasophar- yngeal angiofibroma arising from the natural ostium of maxillary sinus in an adult patient whose symptom was right sided nasal obstruction. With this study, although uncommon, angiofibroma should be considered as a differential diagnosis in patient with mass lesion in the middle nasal meatus.
Acute Invasive Fungal Rhinosinusitis and Coronavirus Disease 2019
Authors: Abdel-Aziz Mosaad , Azab Noha
Published: September 2021

Acute invasive fungal rhinosinusitis (mucormycosis) is a rare, highly fatal disease. This opportunistic fungal infection causes angioinvasion and ischemic tissue necrosis. It mainly affects immunocompromised patients. Since the coronavirus disease 2019 (COVID-19) outbreak, many case reports have described the rhino-orbital-cerebral mucormycosis associated with COVID-19. However, the underlying predisposing factors are unknown. Several factors, other than diabetes, which is the most well-known contributing factor, may be involved in causing this severe fungal infection in COVID-19 patients. These factors may include steroid therapy, which is being used in severely dyspneic patients, the use of broad-spectrum antibiotics that may cause fungal flare-ups, and hospitalization with possible nosocomial infections. In addition, increased serum ferritin levels, possible endothelial damage, and pancreatic islets affection among COVID-19 patients may be implicated. Head and neck surgeons should be aware of the increasing prevalence of craniofacial mucormycosis among COVID-19 patients, as early diagnosis and prompt treatment are essential to improve the outcomes.
Energy-Dispersive X-Ray Spectroscopic Analysis of an Extraorally Installed Implant in a Silicone Facial Prosthesis Patient
Authors: Nguyen Truc Thi Hoang , Sodnom-Ish Buyanbileg , Eo Mi Young , Cho Yun Ju , Kim Soung Min
Published: September 2021

Titanium implants are considered to be highly biocompatible relative to other metals, and the use of this metal is increasing more and more. However, studies on its possible toxic effects are rare. A patient who had a large midface defect was treated with an implant-supported magnet-retained silicone prosthesis; however, the extraoral implant failed. Scanning electron microscopy and energy dispersive X-ray spectroscopy was used to analyze the surface characteristics and the chemical compositions of the failed implant fixture and attached bone tissue. The contamination of the implant and bone tissue with aluminum (Al), iron (Fe), and mercury (Hg) potentially had an influence on the integration of bone tissue and the health of peri-implant tissue. The exposure of the facial prosthesis and its implant to the external environment may have caused the contamination. Careful clinical examination during the follow-up period and adequate hygiene is essential for the longterm success of implant-supported prostheses.
Patterns of Mandibular Fractures in South Australia: Epidemiology, Treatment, and Clinical Outcomes
Authors: Diab Jason , Flapper Walter J. , Anderson Peter J. , Moore Mark H.
Published: September 2021

Introduction:

The mandible is one of the most common facial bones to be injured with great clinical variability across countries caused by assaults, road traffic accidents, and falls.

Methods:

A retrospective review was conducted for adult mandibular fractures from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. Our aim was to describe epidemiological trends of mandibular fractures, differences for sex and age, and clinical outcomes.

Results:

Five hundred sixty five adult patients presented with a mandibular fracture with a male predominance (4.5:1). The mean age was 34.2 years with men 11.9 years younger than females (32.0 versus 44.1 years, P 
< 0.001). Assaults represented 58.2% of cases. A quarter of the cohort reported alcohol use. Assaults commonly resulted in angle and symphyseal fractures, whereas almost all falls and road traffic accident resulted in condylar or coronoid fractures. Young men were 1.9 times more likely to have mandibular fractures compared to women, whereas elderly men were 11.8% less likely (P < 0.001). The most common fracture was the angle (33.6%) and the angle/symphyseal (14.2%). Men were 2.5 times more likely to have surgery. The complication rate was 10.8% and the re-operative rate was 5.0%. Women had a significantly longer admission of 1.6 days compared to men (4.4 versus 2.8 days, P = 0.003).

Conclusions:

Young men are more likely to have mandibular fractures from assaults and have surgery. Young women and elderly females are more likely to have animal and fall-related injuries resulting including in condylar fractures with associated injuries and extended length of stay.
Could the Pittsburgh Severity Score guide the treatment of esophageal perforation? Experience of a single referral center
Authors: Moletta Lucia , Pierobon Elisa Sefora , Capovilla Giovanni , Valotto Giovanni , Gavagna Laura , Provenzano Luca , Zanchettin Gianpietro , Salvador Renato , Costantini Mario , Merigliano Stefano , Valmasoni Michele
Published: September 2021

BACKGROUND

Esophageal perforation (EP) is characterized by high morbidity and mortality. The Pittsburgh Severity Score (PSS) is a scoring system based on clinical factors at the time of EP presentation, intended to guide treatment. The aim of the study is to verify PSS usefulness in stratifying EP severity and in guiding clinical decisions.

METHODS

All patients referred to our unit for EP between January 2005 and January 2020 were enrolled. Patients were stratified according to their PSS into three groups (PSS ≤ 2, 3–5, and >5): the postoperative outcomes were compared. The predictive value of the PSS was evaluated by simple linear and logistic regression for the following outcomes: need for surgery, complications, in-hospital mortality, intensive care unit (ICU) and hospital stay, time to refeeding, and need for reintervention.

RESULTS

Seventy-three patients were referred for EP (male/female, 46/27). Perforations were more frequently iatrogenic (41.1%) or spontaneous (38.3%). The median PSS was 4 (interquartile range, 2–6). Surgery was required in 60.3% of cases. Pittsburgh Severity Score was associated with ICU admission, hospital stay, need for surgery and reintervention, postperforation complications and mortality. After regression analysis, PSS was significantly predictive of postperforation complications (p < 0.01), in-hospital mortality (p = 0.01), ICU admission (p < 0.01), need for surgical treatment (p < 0.01), and need for reintervention (p = 0.02).

CONCLUSION

Pittsburgh Severity Score is useful in stratifying patients in risk groups with different morbidity and mortality. It is also useful in guiding the therapeutic conduct, selecting patients for nonoperative management. Prospective studies are needed to confirm the role of the PSS in the treatment of esophageal perforation.

LEVEL OF EVIDENCE

Management, Therapeutic/Care; level IV.
Visual Function and Brief Cognitive Assessment for Multiple Sclerosis in Optic Neuritis Clinically Isolated Syndrome Patients
Authors: Collorone Sara , Kanber Baris , Hashem Leen , Cawley Niamh , Prados Ferran , Davagnanam Indran , Barkhof Frederik , Ciccarelli Olga , Toosy Ahmed
Published: September 2021

Background:

In this study, we hypothesized that clinically isolated syndrome–optic neuritis patients may have disturbances in neuropsychological functions related to visual processes.

Methods:

Forty-two patients with optic neuritis within 3 months from onset and 13 healthy controls were assessed at baseline and 6 months with MRI (brain volumes, lesion load, and optic radiation lesion volume) and optical coherence tomography (OCT) (peripapillary retinal nerve fiber layer [RNFL], ganglion cell and inner plexiform layers [GCIPLs], and inner nuclear layer). Patients underwent the brief cognitive assessment for multiple sclerosis, high-contrast and low-contrast letter acuity, and color vision.

Results:

At baseline, patients had impaired visual function, had GCIPL thinning in both eyes, and performed below the normative average in the visual-related tests: Symbol Digit Modalities Test and Brief Visuospatial Memory Test-Revised (BVMT-R). Over time, improvement in visual function in the affected eye was predicted by baseline GCIPL (P = 0.015), RNFL decreased, and the BVMT-R improved (P = 0.001). Improvement in BVMT-R was associated with improvement in the high-contrast letter acuity of the affected eye (P = 0.03), independently of OCT and MRI metrics.

Conclusion:

Cognitive testing, assessed binocularly, of visuospatial processing is affected after unilateral optic neuritis and improves over time with visual recovery. This is not related to structural markers of the visual or central nervous system.
Three month FVC change: a trial endpoint for IPF based on individual participant data meta-analysis
Authors: Khan Fasihul A , Stewart Iain , Moss Samuel , Fabbri Laura , Robinson Karen A. , Johnson Simon , Jenkins R Gisli
Published: September 2021

Rationale

Novel therapies for idiopathic pulmonary fibrosis (IPF) are in development, but there remains uncertainty about the optimal trial endpoint. An earlier endpoint would enable assessment of a greater number of therapies in adaptive trial designs.

Objectives

Individual participant data (IPD) from placebo arms of interventional trials were sought to determine whether short-term changes in forced vital capacity (FVC), gas transfer for carbon monoxide (DLCO) and six-minute walk distance (6MWD) could act as surrogate endpoints to accelerate early-phase trials in IPF.

Methods

Electronic databases were searched on 1st December 2020, and IPD were sought and meta-analysed. The primary outcome was overall mortality according to baseline and/or three-month change in either FVC, DLCO or 6MWD, with a secondary outcome of disease progression at 12 months, adjusted for age, sex, smoking status and baseline physiology.

Measurements and main results

IPD was available for 10/23 eligible studies totalling 1819 participants. Baseline and three-month change in all physiological variables were independently associated with disease outcomes. A 2.5% relative decline in FVC over three months was associated with mortality (adjusted hazard ratio 1.14, 95%CI 1.06;1.24, I2 = 59.9%) and disease progression (adjusted odds ratio 1.29; 95%CI 1.18;1.40, I2=67%). Optimal thresholds for three-month change in FVC for distinguishing disease outcomes were identified.

Conclusions

IPD meta-analysis of trial placebo arms demonstrated three-month change in physiological variables, particularly FVC, were associated with mortality and disease progression among individuals with untreated IPF. FVC change over three months may hold potential as a surrogate endpoint in IPF interventional adaptive trials.
Covid-19 Per Capita Fatality Rate: A Path Analysis Model
Authors: Penuliar Michael , Clark Candice , Curti Debra , Carrasco Miguel , Hudson Catherine , Philips Billy
Published: September 2021

Objectives

Various individual factors have been shown to influence Covid-19 mortalities, but these factors do not exist in isolation. Unique to this study is a multivariate approach that has yet to be fully explored by previous research. Using an interconnected multifactor model, this work investigated social determinant, geographic, prior health, and political behavioral factors likely to influence Covid-19 per capita fatalities in Texas.

Methods

County-level income, rurality, insurance, health status, 2020 presidential vote percentage, and fatality rate data were collected and analyzed in a path analysis model with Covid-19 per capita fatalities as the key variable of interest.

Results

The analysis found strong support for the proposed model structure (R2 = 37.6%). The strongest overall effects on the Covid-19 per capita fatality rate came from income levels and voting behaviors.

Conclusion

The model explained a substantial amount of variability in mortalities attributed to Covid-19. Socioeconomic and political factors provided the strongest contribution to the per-capita Covid-19 death rate, controlling for the other variables studied. The Covid-19 pandemic was highly politicized by various leaders and media outlets. The current analysis showed that political trends were one of the key overall factors related to Covid-19 mortality. The strongest overall factor was median income. Income is used to enhance one’s current health or acquire adequate treatment which may safeguard people from the most severe effects of Covid-19. Counties with lower income levels had higher rates of Covid-19 per capita fatalities.
Systemic impact of the expression of the mitochondrial alternative oxidase onDrosophiladevelopment
Authors: Camargo André F. , Saari Sina , Garcia Geovana S. , Chioda Marina M. , Othonicar Murilo F. , Martins Ailton A. , Hayashi Gabriel , ten Hoeve Johanna , Jacobs Howard T. , Pinheiro Daniel G. , Dufour Eric , Oliveira Marcos T.
Published: September 2021

Despite the beneficial effects of xenotopically expressing the mitochondrial alternative oxidase AOX fromCiona intestinalisin mammalian and insect models, important detrimental outcomes have also been reported, raising concerns regarding its potential deployment as a therapeutic enzyme for human mitochondrial diseases. Because of its non-protonmotive terminal oxidase activity, AOX can bypass the cytochrome segment of the respiratory chain whilst not contributing to mitochondrial ATP synthesis. We have previously shown that pupal lethality occurs when AOX-expressingDrosophilalarvae are cultured on a low-nutrient diet, indicating that AOX can perturb normal metabolism during development. Here, combined omics analyses revealed multiple correlates of this diet-dependent lethality, including a general alteration of larval amino acid and lipid metabolism, functional and morphological changes to the larval digestive tract, and a drastic decrease in larval biomass accumulation. Pupae at the pre-lethality stage presented a general downregulation of mitochondrial metabolism and a signature of starvation and deregulated signaling. AOX-induced lethality was partially rescued when the low-nutrient diet was supplemented with tryptophan and/or methionine, but not with proline and/or glutamate, strongly suggesting perturbation of one-carbon metabolism. The developmental dependence on tryptophan and/or methionine, associated with elevated levels of lactate dehydrogenase, 2-hydroxyglutarate, choline-containing metabolites and breakdown products of membrane phospholipids, indicates that AOX expression promotes tissue proliferation and larval growth, but this is ultimately limited by energy dissipation due to partial mitochondrial uncoupling. We speculate that the combination of dietary interventions and AOX expression might, nevertheless, be useful for the metabolic regulation of proliferative tissues, such as tumors.
Genome annotation of Caenorhabditis briggsae by TEC-RED identifies new exons, paralogs, and conserved and novel operons
Authors: Jhaveri Nikita , van den Berg Wouter , Hwang Byung Joon , Muller Hans-Michael , Sternberg Paul W. , Gupta Bhagwati P.
Published: September 2021

The nematode Caenorhabditis briggsae is routinely used in comparative and evolutionary studies involving its well-known cousin C. elegans. The C. briggsae genome sequence has accelerated research by facilitating the generation of new resources, tools, and functional studies of genes. While substantial progress has been made in predicting genes and start sites, experimental evidence is still lacking in many cases. Here, we report an improved annotation of the C. briggsae genome using the Trans-spliced Exon Coupled RNA End Determination (TEC-RED) technique. In addition to identifying the 5’ ends of expressed genes, we have discovered operons and paralogs. In summary, our analysis yielded 10,243 unique 5’ end sequence tags with matches in the C. briggsae genome. Of these, 6,395 were found to represent 4,252 unique genes along with 362 paralogs and 52 previously unknown exons. These genes included 14 that are exclusively trans-spliced in C. briggsae when compared with C. elegans orthologs. A major contribution of this study is the identification of 493 operons, of which two-thirds are fully supported by tags. In addition, two SL1-type operons were discovered. Interestingly, comparisons with C. elegans showed that only 40% of operons are conserved. Of the remaining operons, 73 are novel, including 12 that entirely lack orthologs in C. elegans. Further analysis revealed that four of the 12 novel operons are conserved in C. nigoni. Altogether, the work described here has significantly advanced our understanding of the C. briggsae system and serves as a rich resource to aid biological studies involving this species.
Broad ultra-potent neutralization of SARS-CoV-2 variants by monoclonal antibodies specific to the tip of RBD
Authors: Ma Hang , Guo Yingying , Tang Haoneng , Tseng Chien-Te K. , Wang Lei , Zong Huifang , Wang Zhenyu , He Yang , Chang Yunsong , Wang Shusheng , Huang Haiqiu , Ke Yong , Yuan Yunsheng , Wu Mingyuan , Zhang Yuanyuan , Drelich Aleksandra , Kempaiah Kempaiah Rayavara , Peng Bi-Hung , Wang Ailin , Yang Kaiyong , Yin Haiyang , Liu Junjun , Yue Yali , Xu Wenbo , Zhu Shuangli , Ji Tianjiao , Zhang Xiaoju , Wang Ziqi , Li Gang , Liu Guangchun , Song Jingjing , Mu Lingling , Xiang ZongShang , Song Zhangyi , Chen Hua , Bian Yanlin , Zhang Baohong , Chen Hui , Zhang Jiawei , Liao Yunji , Zhang Li , Yang Li , Chen Yi , Gilly John , Xiao Xiaodong , Han Lei , Jiang Hua , Xie Yueqing , Zhou Qiang , Zhu Jianwei
Published: September 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) continue to wreak havoc across the globe. Higher transmissibility and immunologic resistance of VOCs bring unprecedented challenges to epidemic extinguishment. Here we describe a monoclonal antibody, 2G1, that neutralizes all current VOCs and has surprising tolerance to mutations adjacent to or within its interaction epitope. Cryo-electron microscopy structure showed that 2G1 bound to the tip of receptor binding domain (RBD) of spike protein with small contact interface but strong hydrophobic effect, which resulted in nanomolar to sub-nanomolar affinities to spike proteins. The epitope of 2G1 on RBD partially overlaps with ACE2 interface, which gives 2G1 ability to block interaction between RBD and ACE2. The narrow binding epitope but high affinity bestow outstanding therapeutic efficacy upon 2G1 that neutralized VOCs with sub-nanomolar IC50in vitro. In SARS-CoV-2 and Beta- and Delta-variant-challenged transgenic mice and rhesus macaque models, 2G1 protected animals from clinical illness and eliminated viral burden, without serious impact to animal safety. Mutagenesis experiments suggest that 2G1 could be potentially capable of dealing with emerging SARS-CoV-2 variants in future. This report characterized the therapeutic antibodies specific to the tip of spike against SARS-CoV-2 variants and highlights the potential clinical applications as well as for developing vaccine and cocktail therapy.
A neurocomputational model of the basal ganglia for the analysis of motor deficits after dopaminergic loss in Parkinson’s disease
Authors: Gigi Ilaria , Senatore Rosa , Marcelli Angelo
Published: September 2021

The basal ganglia (BG) is part of a basic feedback circuit, regulating cortical function, such as voluntary movement control, via their influence on thalamocortical projections. BG disorders, namely Parkinson’s disease (PD), characterized by the loss of neurons in the substantia nigra, involve the progressive loss of motor functions. At the present, PD is incurable. Converging evidence suggests the onset of PD-specific pathology prior to the appearance of classical motor signs. This latent phase of neurodegeneration in PD is of particular relevance in developing more effective therapies by intervening at the earliest stages of disease. Therefore, a key challenge in PD research is to identify and validate markers for the preclinical and prodromal stage of the illness.

We propose a mechanistic neurocomputational model of the BG at mesoscopic scale to investigate the behavior of the simulated neural system after several degrees of lesion of the substantia nigra, with the aim of possibly evaluating which is the smallest lesion compromising motor learning. In other words, we developed a working framework for the analysis of theoretical early-stage PD. While simulations in healthy conditions confirm the key role of dopamine in learning, in pathological conditions networks predict that there may exist abnormalities of motor learning process for physiological alterations in the BG which do not yet involve the presence of symptoms typical of the clinical diagnosis. Our model may account for the discovery of markers for an early diagnosis of the disease and give directions for developing novel noninvasive support systems.
The coordination of hip, knee and ankle joint angles during gait in soccer players and controls
Authors: Yaserifar Morteza , Mohammadi Ziya Fallah , Hosseininejad Sayed Esmaeil , Afrakoti Iman Esmaili Paeen , Meijer Kenneth , Boonstra Tjeerd W
Published: September 2021

Background

Clinical researchers are trying to unravel the impact of different training interventions on the kinematics of human gait. However, the effects of long-term training experience on the kinematics of a healthy gait pattern remains unclear. Here we assess the effect of long-term training experience on joint angle variability during walking.

Methods

Hip, knee, and ankle joint angles from fourteen soccer players and sixteen controls were acquired during treadmill and overground walking. Hip-knee coupling, knee-ankle coupling and coupling angle variability (CAV) of the right leg in the sagittal plane were assessed using a vector coding technique.

Results

Soccer players showed reduced hip-knee CAV during the mid-stance and terminal-stance phases and reduced knee-ankle CAV during the pre-swing phase of gait compared to the control group. In addition, soccer players less often used an ankle coordination pattern, in which only the ankle joint but not the knee joint rotates.

Interpretation

These findings show that soccer players had more stability in the ankle joint during the stance phase of the gait compared to the control group. Future studies can test whether these differences in the coordination of the ankle joint reflect the effects of long-term training on normal gait by comparing knee-ankle coupling and variability before and after exercise training interventions.
Complete sequences of epidermin and nukacin encoding plasmids from oral-derived Staphylococcus epidermidis and their antibacterial activity
Authors: Nakazono Kenta , Le Mi Nguyen-Tra , Kawada-Matsuo Miki , Kimheang Noy , Hisatsune Junzo , Oogai Yuichi , Nakata Masanobu , Nakamura Norifumi , Sugai Motoyuki , Komatsuzawa Hitoshi
Published: September 2021

Staphylococcus epidermidis is a commensal bacterium in humans. To persist in the bacterial flora of the host, some bacteria produce antibacterial factors such as the antimicrobial peptides known as bacteriocins. In this study, we tried to isolate bacteriocin-producing S. epidermidis strains. Among 150 S. epidermidis isolates from the oral cavities of 287 volunteers, we detected two bacteriocin-producing strains, KSE56 and KSE650. Complete genome sequences of the two strains confirmed that they carried the epidermin-harbouring plasmid pEpi56 and the nukacin IVK45-like- harbouring plasmid pNuk650. The amino acid sequence of epidermin from KSE56 was identical to the previously reported sequence, but the epidermin synthesis-related genes were partially different. The prepeptide amino acid sequences of nukacin KSE650 and nukacin IVK45 showed one mismatch, but both mature peptides were entirely similar. pNuk650 was larger and had an additional seven ORFs compared to pIVK45. We then investigated the antibacterial activity of the two strains against several skin and oral bacteria and found their different activity patterns. In conclusion, we report the complete sequences of 2 plasmids coding for bacteriocins from S. epidermidis, which were partially different from those previously reported. Furthermore, this is the first report to show the complete sequence of an epidermin-carrying plasmid, pEpi56.
Glycosylation-on-a-chip: a flow-based microfluidic system for cell-free glycoprotein biosynthesis
Authors: Aquino Alicia K. , Manzer Zachary A. , Daniel Susan , DeLisa Matthew P.
Published: September 2021

In recent years, cell-free synthetic glycobiology technologies have emerged that enable production and remodeling of glycoproteins outside the confines of the cell. However, many of these systems combine multiple synthesis steps into one pot where there can be competing reactions and side products that ultimately lead to low yield of the desired product. In this work, we describe a microfluidic platform that integrates cell-free protein synthesis, glycosylation, and purification of a model glycoprotein in separate compartments where each step can be individually optimized. Microfluidics offer advantages such as reaction compartmentalization, tunable residence time, the ability to tether enzymes for reuse, and the potential for continuous manufacturing. Moreover, it affords an opportunity for spatiotemporal control of glycosylation reactions that is difficult to achieve with existing cell-based and cell-free glycosylation systems. In this work, we demonstrate a flow-based glycoprotein synthesis system that promotes enhanced cell-free protein synthesis, efficient protein glycosylation with an immobilized oligosaccharyltransferase, and enrichment of the protein product from cell-free lysate. Overall, this work represents a first-in-kind glycosylation-on-a-chip prototype that could find use as a laboratory tool for mechanistic dissection of the protein glycosylation process as well as a biomanufacturing platform for small batch, decentralized glycoprotein production.