bluuebunny/crossref_metadata_2025 huggingface dataset:
CENTRAL SEROUS CHORIORETINOPATHY MIMICKING IDIOPATHIC UVEAL EFFUSION SYNDROME
Authors: Boulanger Etienne , Bonnin Sophie , Delahaye-Mazza Corinne , Tadayoni Ramin , Gaudric Alain
Published: June 2021

Purpose:

To describe central serous chorioretinopathy cases presenting as uveal effusion syndrome, providing new insights into “pachychoroid spectrum” diseases.

Methods:

Clinical charts, color fundus photographs, fluorescein angiography, indocyanine green angiography, optical coherence tomography, ultrasound imaging, cerebral magnetic resonance imaging, and biometry of four eyes of three patients were assessed. A literature review was conducted.

Results:

The three patients had peripheral choroidal detachment and inferior bullous retinal detachment associated with central serous chorioretinopathy features detected using multimodal imaging, including fluorescein and indocyanine green angiography. The choroid was thick in the three patients, and uveal effusion occurred after steroid treatment in all cases. Subretinal fluid drainage and deep sclerectomy with flaps of 4 × 4 mm in both inferior quadrants were performed in three eyes of two patients with good outcomes. One patient was treated with photodynamic therapy. All three patients developed a typical leopard-spot pigmentary pattern in the fundus.

Conclusion:

A severe presentation of highly exudative central serous chorioretinopathy may occur in rare cases with a peripheral choroidal detachment mimicking uveal effusion syndrome. These severe cases highlighted the role of choroidal thickening and hyperpermeability, choroidal vein dilation, and possible scleral thickening in both entities.
Imaging Fuchs Endothelial Corneal Dystrophy in Clinical Practice and Clinical Trials
Authors: Patel Sanjay V.
Published: June 2021

Corneal tomography has an emerging role in the assessment of Fuchs endothelial corneal dystrophy (FECD) in clinical practice and potentially for future clinical trials. Posterior elevation and pachymetry maps derived from elevation based Scheimpflug tomography can detect early corneal edema, even at a subclinical stage, enabling clinicians to better counsel patients about their vision and the risk of disease progression with and without cataract surgery. Tomographic imaging provides a functional assessment of corneal endothelial health, and could enable objective assessment of FECD progression, or regression, in response to novel therapeutic interventions. Clinicians and investigators should adopt Scheimpflug imaging for the assessment of FECD over traditional morphologic imaging modalities.
Cutaneous mechanisms of itch signaling
Authors: Cheng Hunter , Kim Brian S. , Hu Hongzhen
Published: June 2021

Itch is defined as an unpleasant sensation that stimulates the scratch reflex. While acute itch, such as from an insect bite, is protective and serves as a warning signal for potential tissue damage, chronic itch significantly impairs quality of life. This condition is still poorly understood and lacks universally effective treatments. Uncovering the cellular and molecular mechanisms of chronic itch is crucial for the development of anti-itch therapies. Skin is the largest sensory organ in which itch sensation is initiated. Currently, knowledge of itch signaling pathways in the skin has focused on (1) neuroimmune crosstalk in itch and inflammation in the skin; (2) skin-expressed ion channels that regulate itch signaling; and (3) skin-derived antimicrobial peptides that act as endogenous pruritogens.
Time-efficiency assessment of guided toric intraocular lens cataract surgery: pilot study
Authors: Barberá-Loustaunau Emanuel , Basanta Iván , Vázquez José , Durán Pablo , Costa María , Couñago Felipe , Garzón Nuria , Ángel Sánchez-Tena Miguel
Published: June 2021

Purpose:

To compare the time spent on toric intraocular lens (IOL) implantation during cataract surgery using a manual-marking vs a digital image–guided system (t Verion) for toric IOL alignment.

Setting:

Instituto Oftalmológico Quirónsalud ophthalmology clinic, A Coruña, Spain.

Design:

Experimental and longitudinal study.

Methods:

A total of 98 eyes of 65 participants (68.2 ± 12.2 years) were divided into 2 groups: 49 eyes operated with toric IOL alignment using a manual-marking technique (manual group) and another 49 eyes operated using image-guided marking (Verion group). The primary variable for comparison between both groups was cataract surgery time. Other outcomes such as toric IOL misalignment, spherical equivalent, astigmatism, uncorrected distance visual acuity, and corrected distance visual acuity were also measured.

Results:

The total cataract surgery time was 2:09 minutes shorter (P < .001) with the Verion system (12:12 ± 2:20 in 49 eyes operated) compared with the surgical procedure performed using manual marking (15:27 ± 3:04 in 49 eyes operated). One month after surgery, there were no statistical differences in terms of toric IOL misalignment between the Verion (3.38 ± 2.95 degrees) and the manual group (4.66 ± 3.95 degrees). No statistical differences were observed between groups for refractive and visual outcomes (P ≥ .05).

Conclusions:

The cataract surgery time was reduced when the procedure was assisted using the Verion system to align the IOL compared with manual marking, maintaining the same efficacy in terms of toric IOL misalignment, residual refraction, and visual acuity.
The association between hepatitis C virus infection and renal function
Authors: Gantumur Gantsetseg , Batsaikhan Batbold , Huang Ching-I , Yeh Ming-Lun , Huang Chung-Feng , Lin Yi-Hung , Lin Tzu-Chun , Liang Po-Cheng , Liu Ta-Wei , Lee Jia-Jung , Lin Yi-Ching , Lin I-Ling , Huang Jee-Fu , Chuang Wan-Long , Yu Ming-Lung , Tu Hung-Pin , Dai Chia-Yen
Published: June 2021

Background:

The association between hepatitis C virus (HCV) infection and chronic kidney disease (CKD) still remains controversial. We aimed to investigate whether HCV really affects renal function, and to analyze the association between clinical effects of CHC and decreased kidney function (assessed by glomerular filtration rate (eGFR) level).

Methods:

An estimated 3360 patients with HCV infection and 3360 age- and sex-matched community-based control individuals without HCV were enrolled (1:1, case and control ratio) in this study between 2004 and 2016. We used the modification of diet in renal diseases to calculate eGFR. Demographic and laboratory parameters were assessed, and appropriate statistical methods were performed for the analysis.

Results:

Multivariate logistic regression analysis revealed that serum alanine aminotransferase level (odds ratio [OR] 0.998; 95% confidence interval [CI] 0.997–0.999; P = 0.001), platelet count (OR 0.997; 95% CI 0.995-0.999; p = 0.002), and hypertension (OR 1.31; 95% CI 1.03-1.66; P = 0.027) were significantly associated with HCV infection and serum triglyceride levels (OR 1.001; 95% CI 1.00-1.002; p = 0.005), platelet count (OR 0.996; 95% CI 0.995-0.997; p < 0.001), body mass index (BMI) >25 (OR 1.43; 95% CI 1.23-1.67; p < 0.001), hypertension (OR 1.69; 95% CI 1.42-1.99; p < 0.001), hyperlipidemia (OR 1.32; 95% CI 1.02-1.71; p = 0.035), and diabetes (OR 1.33; 95% CI 1.03-1.71; p = 0.032) were significantly associated with a low eGFR (<90 mL/min/m3) in control subjects. The BMI >25 kg/m2, hypertension, and diabetes were found to be associated with low eGFR interaction with the HCV infection, via a multivariate analysis.

Conclusion:

Our study found that the patients with HCV infection are associated with a low eGFR compared with non-HCV–infected patients. This association is consistent in obese, diabetic, and hypertensive patients.
Practice scholarship engagement as reported by nurses holding a doctor of nursing practice degree
Authors: Kesten Karen , Moran Katherine , Beebe Sarah L. , Conrad Dianne , Burson Rosanne , Corrigan Catherine , Manderscheid Amy , Pohl Elizabeth
Published: June 2021

Background:

Nearly 15 years after the introduction of the doctor of nursing practice (DNP) degree, stakeholders anticipate practice scholarship outcomes from graduates.

Purpose:

To examine the frequency of engagement in practice scholarship, the relationship between the knowledge gained in DNP programs and the frequency of engagement in practice scholarship and the relationship between engagement in practice scholarship, work role, and years since graduation with a DNP degree, as reported by practicing nurses.

Methodology:

This cross-sectional study recruited 306 practicing DNP graduates via a national organization and employed an electronic survey. Descriptive and inferential statistics, correlational analysis, and a one-way analysis of variance were conducted on demographics and outcome variables for 269 completed surveys.

Results:

The practice scholarship activity reported most frequently was evaluation of current clinical evidence and least frequently was dissemination of policy papers. Reported knowledge gained from DNP programs and frequency of engagement in practice scholarship indicate a weak positive correlation. There was a significant difference in the direct care work role and practice scholarship engagement compared with other roles, and between those practicing greater than 10 years and those with less experience.

Conclusions:

Results highlight the underutilization of knowledge gained in DNP programs and engagement in practice scholarship. The study emphasizes the complexity of realizing practice scholarship outcomes of DNP-prepared nurses to influence patients, populations, systems, and policy as well as the advancement of the nursing profession.

Implications:

This is a call to action for DNP graduates, academia, practice, and the nursing profession to support and value practice scholarship.
Biodegradable polymer drug-eluting stents versus durable polymer drug-eluting stents for percutaneous coronary intervention: a contemporary registry-based analysis
Authors: Levi Amos , Kheifets Mark , Bental Tamir , Perl Leor , Codner Pablo , Witberg Guy , Talmor-Barkan Yeela , Landes Uri , Samara Abed , Greenberg Gabriel , Erez Aharon , Vaknin-Assa Hanna , Kornowski Ran
Published: June 2021

Aims

We aimed to compare the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with biodegradable polymer drug-eluting stents (BP-DES) versus durable polymer drug-eluting stents (DP-DES).

Methods and results

Among 11 517 PCIs with second-generation DES performed in our institution between 2007 and 2019, we identified 8042 procedures performed using DP-DES and 3475 using BP-DES. The primary outcome was target lesion failure, the composite target lesion revascularization (TLR), target vessel myocardial infarction and death. Propensity score matching was used to create a well-balanced cohort. Mean follow-up was 4.8 years. Of the 3413 matched pairs, 21% were females, and the mean age was 66 years. At 1 year, the primary outcome occurred in 8.3% patients versus 7.1% (P = 0.07), and TLR rate was 3% versus 2% (P = 0.006) in patients with DP-DES and BP-DES respectively. Within 5 years, the primary outcome occurred in 23.1% versus 23.4% (P = 0.44), and the rate of TLR was 7.2% versus 6.5% (P = 0.07) in patients with DP-DES and BP-DES, respectively.

Conclusion

Similar rates of the composite outcome were observed throughout the entire follow-up. Target lesion revascularization rates were lower in the BP-DES group at 1-year but equalized within 5 years.
Comparison of bone SPECT/CT and MRI in detection of pain generator in ankle and foot pain: a retrospective diagnostic study
Authors: Agrawal Kanhaiyalal , Swaroop Shakti , Patro P. Sai Sradha , Tripathy Sujit Kumar , Naik Suprava , Velagada Sandeep
Published: June 2021

Objective

To study the sensitivity and specificity of MRI and bone SPECT-CT in detecting the pain generator in ankle and foot pain with diagnostic dilemma.

Methods

Retrospectively data of patients with ankle or foot pain who underwent both MRI and Bone SPECT-CT were analyzed. The lesions and probable pain generator sites were reported as per MRI and bone SPECT-CT findings. These lesions were correlated clinically, managed accordingly and followed up. The patients who had significant improvement in response to the treatment provided were considered to have been diagnosed accurately. The foot and ankle disability index (FADI) was used to evaluate the patient’s pre- and postintervention condition.

Results

The study included 37 patients retrospectively (18 women and 19 men). The lesions were classified into soft tissue lesions (ligaments/tendons), joint lesions (arthritis) and bony lesions (fractures/osteomyelitis/osteochondral lesions). Overall, MRI had sensitivity, specificity, positive predictive value and negative predictive value of 82, 31, 74 and 42%, respectively, and SPECT-CT had sensitivity, specificity, positive predictive value and negative predictive value of 84, 60, 84 and 60%, respectively. The mean FADI score pretreatment for all patients was 61.5 (SD = 13.8) and posttreatment 88.4 (SD = 13.01) showing significant improvement in the score (P < 0.05), suggesting that the final diagnosis of these patients was accurate. Overall, management change due to bone SPECT-CT over MRI was seen in 26% of patients.

Conclusion

Bone SPECT-CT has incremental value over MRI in the diagnosis of pain generator in foot and ankle pain. The overall specificity of bone SPECT-CT is higher than MRI in detection of pain generators. Bone SPECT-CT performed better than MRI in detection of culprit pathology in the bone, whereas MRI is better in soft tissue lesions.

Advances in knowledge

There are only a few published literature with direct comparison of bone SPECT-CT scintigraphy and MRI in detection of foot and ankle pain generator. This study directly compares diagnostic utility of bone SPECT-CT scintigraphy and MRI in foot and ankle pain. In the present study, the bone SPECT-CT performed better than MRI in detection of culprit pathology in the bone, whereas MRI is better in soft tissue lesions.
Protective Factors to Promote Health and Flourishing in Black Youth Exposed to Parental Incarceration
Authors: Boch Samantha J. , Ford Jodi L.
Published: June 2021

Background

Mass incarceration of Black fathers and mothers in the United States has had an undeniably negative effect on the health and well-being of their children, families, and communities. Nearly 1 in every 9 Black youth in the United States has had an incarcerated parent compared to 1 in every 17 White youth. To mitigate the consequences of such historical and structural racism, family and community protective factors that promote health and flourishing in Black youth need exploration.

Objectives

The aim of this study was to understand the associations of protective family, school, and neighborhood factors of overall health and flourishing in Black youth ever exposed to parental incarceration.

Methods

Using the 2016–2019 National Survey of Children’s Health, secondary data analyses were conducted of Black youth ages 6–17 years exposed to parental incarceration (n = 839). Multivariable logistic regression models predicted the associations among protective family and community factors and two child outcomes of interest: overall good health status and flourishing. Overall good health status was measured dichotomously comparing children in “good, very good, or excellent” health to children in “fair or poor” health. Flourishing was measured as a count score using three survey questions designed to assess the child’s curiosity and discovery about learning, resilience, and self-regulation. Protective factors of interest included family resilience and connectedness, neighborhood support and safety, and school safety. Other child and caregiver demographics and health characteristics were also included as covariates.

Results

Across all models, higher levels of family connectedness were associated with greater odds of having overall good health and flourishing in Black youth exposed to parental incarceration after adjusting for covariates and neighborhood and school protective characteristics. No significant associations were found between neighborhood or school protective factors and either outcome.

Discussion

To achieve health equity and maximize opportunities for all youth, we must remove the obstacles and consequences of mass incarceration. Improving the health and flourishing of Black youth who have had incarcerated parents requires greater investment in structural supports to bolster family connectedness and better evidence on how to support families affected by mass incarceration and structural racism.
The Association Between Neighborhood Social Vulnerability and Cardiovascular Health Risk Among Black/African American Women in the InterGEN Study
Authors: Basile Ibrahim Bridget , Barcelona Veronica , Condon Eileen M. , Crusto Cindy A. , Taylor Jacquelyn Y.
Published: June 2021

Background

Black/African American women in the United States are more likely to live in neighborhoods with higher social vulnerability than other racial/ethnic groups, even when adjusting for personal income. Social vulnerability, defined as the degree to which the social conditions of a community affect its ability to prevent loss and suffering in the event of disaster, has been used in research as an objective measure of neighborhood social vulnerability. Black/African American women also have the highest rates of hypertension and obesity in the United States.

Objectives

The purpose of this study was to examine the relationship between neighborhood social vulnerability and cardiovascular risk (hypertension and obesity) among Black/African American women.

Methods

We conducted a secondary analysis of data from the InterGEN Study that enrolled Black/African American women in the Northeast United States. Participants’ addresses were geocoded to ascertain neighborhood vulnerability using the Centers for Disease Control and Prevention’s Social Vulnerability Index at the census tract level. We used multivariable regression models to examine associations between objective measures of neighborhood quality and indicators of structural racism and systolic and diastolic blood pressure and obesity (body mass index > 24.9) and to test psychological stress, coping, and depression as potential moderators of these relationships.

Results

Seventy-four percent of participating Black/African American women lived in neighborhoods in the top quartile for social vulnerability nationally. Women living in the top 10% of most socially vulnerable neighborhoods in our sample had more than a threefold greater likelihood of hypertension when compared to those living in less vulnerable neighborhoods. Objective neighborhood measures of structural racism (percentage of poverty, percentage of unemployment, percentage of residents >25 years old without a high school diploma, and percentage of residents without access to a vehicle) were significantly associated with elevated diastolic blood pressure and obesity in adjusted models. Psychological stress had a significant moderating effect on the associations between neighborhood vulnerability and cardiovascular risk.

Discussion

We identified important associations between structural racism, the neighborhood environment, and cardiovascular health among Black/African American women. These findings add to a critical body of evidence documenting the role of structural racism in perpetuating health inequities and highlight the need for a multifaceted approach to policy, research, and interventions to address racial health inequities.
Detection of Lymphogranuloma Venereum–Associated Chlamydia trachomatis L2 Serovars in Remnant Rectal Specimens Collected from 7 US Public Health Laboratories
Authors: Chi Kai H. , de Voux Alex , Morris Monica , Katz Samantha S. , Pillay Allan , Danavall Damien , Bowden Katherine E. , Gaynor Anne M. , Kersh Ellen N.
Published: June 2021

The frequency of lymphogranuloma venereum or invasive Chlamydia trachomatis infection with serovar L1, L2, or L3 is unknown in the United States. While no diagnostic test is commercially available, we used a laboratory-developed test and detected lymphogranuloma venereum–associated serovar L2 in 14% of 132 remnant C. trachomatis–positive rectal swabs.
Patient Falls, Nurse Communication, and Nurse Hourly Rounding in Acute Care: Linking Patient Experience and Outcomes
Authors: Gliner Melissa , Dorris Joe , Aiyelawo Kimberley , Morris Erica , Hurdle-Rabb Danielle , Frazier Chantell
Published: June 2021

Research has consistently found a link between hourly nurse rounding and patient outcomes, including reduced falls, reduced pressure ulcers, reduced call light usage, and improved patient experience; however, little research exists specific to patient falls and nurse rounding in acute care settings. This study adds to the body of knowledge by statistically quantifying and providing linkages between nurse rounding frequency and patient fall rates using data from 31 military treatment facilities comprehensively over a period from fiscal year (FY) 2017 through FY2019. Poisson regression results indicated that hourly nurse rounding was associated with a reduction of more than 21% in fall rates (incidence rate ratio = 0.79, P < .01) relative to infrequent rounding, and poorly rated nurse communication was associated with an 8.6-fold increase in patient fall rates relative to highly rated nurse communication (incidence rate ratio = 8.6, P < .01).
Assessing Public Health Workforce Informatics Competencies: A Study of 3 District Health Departments in Georgia
Authors: Adewale Olatanwa , Apenteng Bettye A. , Shah Gulzar H. , Mase William A.
Published: June 2021

Context:

Despite the increased recognition of the importance of having informatics-competent public health professionals, the competency level of the public health workforce in public health informatics (PHI) has not been examined extensively in the literature.

Objective:

The purpose of this study was to assess public health workforce informatics competencies in select Georgia health districts and determine the correlates of PHI proficiency.

Methods:

This study is based on a cross-sectional quantitative study design. We conducted an online self-administered survey of employees from 3 selected district health departments to assess proficiency in foundational PHI competency domains. Three hundred thirty-three respondents completed the survey, with a response rate of 32.5%. A gap score was calculated as a proxy to identify informatics training needs. A path analysis was conducted to assess the relationships among contextual factors and foundational PHI competency domains.

Results:

The public health employees participating in this study reported relatively high proficiency in foundational PHI competency. Psychometric testing of the competency assessment instrument revealed 2 foundational informatics competency domains—effective information technology (IT) use and effective use of information. The effective use of IT mediated the relationship between employee-level factors of age and past informatics training and the effective use of information.

Conclusion:

The study highlights the importance of improving the ability of public health professionals to leverage IT and information to advance population health. Periodic assessment of staff PHI competencies can help proactively identify competency gaps and address needs for additional training. Short assessment tools, such as presented in this study, can be validated and used for such assessments.
Combined Symphyseal and Condylar Fractures: Considerations for Treatment in Growing Pediatric Patients
Authors: Yesantharao Pooja S. , Lopez Joseph , Reategui Alvaro , Jenny Hillary , Najjar Omar , Yu Jason W. , Yang Robin , Manson Paul N. , Dorafshar Amir , Redett Richard J.
Published: June 2021

Background:

Combined symphyseal-condylar mandible fractures are relatively common but difficult to manage in children. This study investigated the cause and management of symphyseal-condylar fractures in pediatric patients.

Methods:

This study presents a retrospective review and expert opinion of pediatric symphyseal-condylar mandibular fracture management at the authors’ institution between 1990 and 2019. National data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database (2000 to 2016) were used to determine whether institutional data had national applicability.

Results:

Twenty-one patients at the authors’ institution met inclusion criteria. Of these patients, 26.7 percent of deciduous dentition patients underwent open reduction and internal fixation, 40 percent underwent closed treatment (maxillomandibular fixation), and 33.3 percent received a soft diet. All mixed dentition patients underwent open reduction and internal fixation or closed treatment; all permanent dentition patients underwent open reduction and internal fixation. The national database (n = 1708) demonstrated similar treatment patterns: most permanent dentition patients (88.7 percent) underwent open reduction and internal fixation, most mixed dentition patients (79.2 percent) underwent closed treatment, and among deciduous dentition patients, 53.5 percent patients received a soft diet; 38 percent received closed treatment. In this study, the overall posttreatment complication rate was 62.5 percent among open reduction and internal fixation patients, 14.3 percent among closed treatment patients, and 16.7 percent among patients treated with a soft diet.

Conclusions:

Symphyseal-condylar mandibular fractures were associated with substantial morbidity in children. The authors created a treatment algorithm to maximize outcomes in children who suffer from this challenging fracture pattern.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Assessment of Plastic Surgery Residency Applications without United States Medical Licensing Examination Step 1 Scores
Authors: Irwin Timothy J. , Friedrich Jeffrey B. , Nguyen Vu T. , Ko Jason H. , Phillips Brett T. , Eberlin Kyle R.
Published: June 2021

The United States Medical Licensing Examination announced the changing of Step 1 score reporting from a three-digit number to pass/fail beginning on January 1, 2022. Plastic surgery residency programs have traditionally used United States Medical Licensing Examination Step 1 scores to compare plastic surgery residency applicants. Without a numerical score, the plastic surgery residency application review process will likely change. This article discusses advantages, disadvantages, and steps forward for residency programs related to the upcoming change. The authors encourage programs to continue to seek innovative methods of objectively and holistically evaluating applications.
Computer-Aided Design and Manufacturing versus Conventional Surgical Planning for Head and Neck Reconstruction: A Systematic Review and Meta-Analysis
Authors: Padilla Pablo L. , Mericli Alexander F. , Largo Rene D. , Garvey Patrick B.
Published: June 2021

Background:

Virtual surgical planning and computer-aided design/computer-aided manufacturing (CAD/CAM) for complex head and neck reconstruction has a number of cited advantages over conventional surgical planning, such as increased operative efficiency, fewer complications, improved osseous flap union, immediate osseointegrated dental implant placement, and superior functional and aesthetic outcomes. The authors performed a systematic review and meta-analysis of the available evidence on CAD/CAM maxillofacial reconstruction with the primary purpose of determining which approach is more efficacious.

Methods:

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a PubMed and Embase database search was performed to identify English-language, human-subject studies of CAD/CAM–assisted head and neck reconstruction. All comparative studies were included in a meta-analysis to identify differences in operative time, ischemia time, surgical-site occurrence, microvascular complication, and partial or total flap loss between the two groups. All included studies (comparative and noncomparative) were used in the systematic review, summarizing the various flap characteristics, technical nuances, and functional and aesthetic outcomes.

Results:

Twelve articles were included in the meta-analysis, representing 277 patients in the CAD/CAM group and 419 patients in the conventional group. CAD/CAM was associated with 65.3 fewer minutes of operating room time (95 percent CI, −72.7 to −57.9 minutes; p < 0.0001) and 34.8 fewer minutes of ischemia time (95 percent CI, −38 to −31.5 minutes; p < 0.0001). There were no significant differences in surgical-site occurrence, nonunion, flap loss, microvascular complications, or hardware-related complications.

Conclusions:

CAD/CAM is associated with shorter operating room and ischemia times. There are no significant differences in flap or hardware-related complications between CAD/CAM and conventional surgical planning.
Using Black Bone Magnetic Resonance Imaging for Fibula Free Flap Surgical Planning: A Means to Reduce Radiation Exposure with Accurate Surgical Outcomes
Authors: Suchyta Marissa A. , Gibreel Waleed , Sabbagh M. Diya , Hunt Christopher H. , Gorny Krzysztof R. , Lu Aiming , Mardini Samir
Published: June 2021

Advances in virtual surgical planning and three-dimensionally–printed guides have enabled increased precision in vascularized free fibula flap reconstruction of the mandible and valuable preoperative planning. However, virtual surgical planning currently requires high-resolution computed tomographic scans, exposing patients to ionizing radiation. The aim of this study was to determine whether black bone magnetic resonance imaging can be used for accurate surgical planning and three-dimensionally–printed guide creation, thus reducing patient radiation exposure. This study included 10 cadaver heads and 10 cadaver lower extremities. A mock fibula free flap for mandible reconstruction was performed. Five operations were planned with guides created using black bone magnetic resonance imaging, whereas the other five were planned and performed using guides created with computed tomographic scan data. All specimens underwent a postoperative computed tomographic scan, and three-dimensional reconstruction of scans was performed and surgical accuracy to the planned surgery was assessed. Guides created from black bone magnetic resonance imaging demonstrated high accuracy to the surgical plan. There was no statistically significant difference in postoperative deviation from the plan when black bone magnetic resonance imaging versus computed tomographic scanning was used for virtual surgical planning and guide creation. Both modalities led to a postoperative positive or negative deviation from the virtual plan within 0.8 mm. This study demonstrates that virtual surgical planning and three-dimensionally–printed guide creation for free fibula flaps for mandible reconstruction can be performed using black bone magnetic resonance imaging with comparable accuracy to computed tomographic scanning. This could reduce radiation exposure for patients and enable a more streamlined imaging process for head and neck cancer patients.
Coronavirus disease 2019 vaccination in transplant recipients
Authors: Eberhardt Christiane S. , Balletto Elisa , Cornberg Markus , Mikulska Malgorzata
Published: June 2021

Purpose of review

Coronavirus disease 2019 (COVID-19) vaccination is considered one of the most promising and socioeconomically sustainable strategy to help control the pandemic and several vaccines are currently being distributed in nationwide mass immunization campaigns. Very limited data are available on benefits and risks of COVID-19 vaccination in immunocompromised patients and in particular in solid organ or hematopoietic stem cell transplant recipients as they were excluded from phase III trials. This review summarizes current knowledge, international guidelines and controversies regarding COVID-19 vaccination in these vulnerable populations.

Recent findings

Various COVID-19 vaccine platforms showed good efficacy in phase III trials in the immunocompetent and there are data arising on the safety and immunogenicity of these vaccines in the immunocompromised population.

Transplant recipients could benefit significantly from COVID-19 vaccination, both through active immunization provided they elicit protective vaccine responses, and probably through cocooning by immunization of caregivers and healthcare personnel and thus reducing the risk of SARS-coronavirus-2 exposure. Although awaiting more data on the safety and efficacy of COVID-19 vaccines to inform potential adaptations of vaccine regimens, we strongly recommend prioritizing COVID-19 vaccination of solid and hematopoietic stem cell transplant recipients to decrease COVID-19-related morbidity and mortality.
Endemic parasitic infections in donors and recipients of stem cell and solid organ transplants: focus on strongyloidiasis and Chagas disease
Authors: Galeano Sebastian , Prieto Jimena
Published: June 2021

Purpose of review

The aim of the article is to review recent recommendations on the management of Strongyloidiasis and Chagas disease (ChD) in the context of stem-cell or solid-organ transplantation.

Recent findings

An update on laboratory screening, detection of acute disease or reactivation and recommended preventive or therapeutic options in the transplant recipients and donors is presented. Recent epidemiological data showing new estimates on the worldwide burden of both diseases and changes in the classical distribution around the globe should increase awareness and will impact the evaluation and management of transplant recipients and donors in endemic and nonendemic regions.

Strongyloidiasis and ChD are potentially life threatening if unnoticed in the context of stem-cell or solid-organ transplantation and should be considered in endemic and nonendemic areas. Effective strategies for detection, monitoring, prevention and management are available for both diseases.
Magnetic Resonance Imaging Around Metal at 1.5 Tesla
Authors: Germann Christoph , Nanz Daniel , Sutter Reto
Published: June 2021

During the last decade, metal artifact reduction in magnetic resonance imaging (MRI) has been an area of intensive research and substantial improvement. The demand for an excellent diagnostic MRI scan quality of tissues around metal implants is closely linked to the steadily increasing number of joint arthroplasty (especially knee and hip arthroplasties) and spinal stabilization procedures. Its unmatched soft tissue contrast and cross-sectional nature make MRI a valuable tool in early detection of frequently encountered postoperative complications, such as periprosthetic infection, material wear–induced synovitis, osteolysis, or damage of the soft tissues. However, metal-induced artifacts remain a constant challenge. Successful artifact reduction plays an important role in the diagnostic workup of patients with painful/dysfunctional arthroplasties and helps to improve patient outcome. The artifact severity depends both on the implant and the acquisition technique. The implant's material, in particular its magnetic susceptibility and electrical conductivity, its size, geometry, and orientation in the MRI magnet are critical. On the acquisition side, the magnetic field strength, the employed imaging pulse sequence, and several acquisition parameters can be optimized. As a rule of thumb, the choice of a 1.5-T over a 3.0-T magnet, a fast spin-echo sequence over a spin-echo or gradient-echo sequence, a high receive bandwidth, a small voxel size, and short tau inversion recovery–based fat suppression can mitigate the impact of metal artifacts on diagnostic image quality. However, successful imaging of large orthopedic implants (eg, arthroplasties) often requires further optimized artifact reduction methods, such as slice encoding for metal artifact correction or multiacquisition variable–resonance image combination. With these tools, MRI at 1.5 T is now widely considered the modality of choice for the clinical evaluation of patients with metal implants.
Whole-body Composition Profiling Using a Deep Learning Algorithm
Authors: Huber Florian A. , Chaitanya Krishna , Gross Nico , Chinnareddy Sunand Reddy , Gross Felix , Konukoglu Ender , Guggenberger Roman
Published: June 2021

Objectives

To develop, test, and validate a body composition profiling algorithm for automated segmentation of body compartments in whole-body magnetic resonance imaging (wbMRI) and to investigate the influence of different acquisition parameters on performance and robustness.

Materials and Methods

A segmentation algorithm for subcutaneous and visceral adipose tissue (SCAT and VAT) and total muscle mass (TMM) was designed using a deep learning U-net architecture convolutional neuronal network. Twenty clinical wbMRI scans were manually segmented and used as training, validation, and test datasets. Segmentation performance was then tested on different data, including different magnetic resonance imaging protocols and scanners with and without use of contrast media. Test-retest reliability on 2 consecutive scans of 16 healthy volunteers each as well as impact of parameters slice thickness, matrix resolution, and different coil settings were investigated. Sorensen-Dice coefficient (DSC) was used to measure the algorithms' performance with manual segmentations as reference standards. Test-retest reliability and parameter effects were investigated comparing respective compartment volumes. Abdominal volumes were compared with published normative values.

Results

Algorithm performance measured by DSC was 0.93 (SCAT) to 0.77 (VAT) using the test dataset. Dependent from the respective compartment, similar or slightly reduced performance was seen for other scanners and scan protocols (DSC ranging from 0.69–0.72 for VAT to 0.83–0.91 for SCAT). No significant differences in body composition profiling was seen on repetitive volunteer scans (P = 0.88–1) or after variation of protocol parameters (P = 0.07–1).

Conclusions

Body composition profiling from wbMRI by using a deep learning–based convolutional neuronal network algorithm for automated segmentation of body compartments is generally possible. First results indicate that robust and reproducible segmentations equally accurate to a manual expert may be expected also for a range of different acquisition parameters.
Assessment of Lung Reaeration at 2 Levels of Positive End-expiratory Pressure in Patients With Early and Late COVID-19-related Acute Respiratory Distress Syndrome
Authors: Smit Marry R. , Beenen Ludo F.M. , Valk Christel M.A. , de Boer Milou M. , Scheerder Maeke J. , Annema Jouke T. , Paulus Frederique , Horn Janneke , Vlaar Alexander P.J. , Kooij Fabian O. , Hollmann Markus W. , Schultz Marcus J. , Bos Lieuwe D.J.
Published: June 2021

Purpose:

Patients with novel coronavirus disease (COVID-19) frequently develop acute respiratory distress syndrome (ARDS) and need invasive ventilation. The potential to reaerate consolidated lung tissue in COVID-19-related ARDS is heavily debated. This study assessed the potential to reaerate lung consolidations in patients with COVID-19-related ARDS under invasive ventilation.

Materials and Methods:

This was a retrospective analysis of patients with COVID-19-related ARDS who underwent chest computed tomography (CT) at low positive end-expiratory pressure (PEEP) and after a recruitment maneuver at high PEEP of 20 cm H2O. Lung reaeration, volume, and weight were calculated using both CT scans. CT scans were performed after intubation and start of ventilation (early CT), or after several days of intensive care unit admission (late CT).

Results:

Twenty-eight patients were analyzed. The median percentages of reaerated and nonaerated lung tissue were 19% [interquartile range, IQR: 10 to 33] and 11% [IQR: 4 to 15] for patients with early and late CT scans, respectively (P=0.049). End-expiratory lung volume showed a median increase of 663 mL [IQR: 483 to 865] and 574 mL [IQR: 292 to 670] after recruitment for patients with early and late CT scans, respectively (P=0.43). The median decrease in lung weight attributed to nonaerated lung tissue was 229 g [IQR: 165 to 376] and 171 g [IQR: 81 to 229] after recruitment for patients with early and late CT scans, respectively (P=0.16).

Conclusions:

The majority of patients with COVID-19-related ARDS undergoing invasive ventilation had substantial reaeration of lung consolidations after recruitment and ventilation at high PEEP. Higher PEEP can be considered in patients with reaerated lung consolidations when accompanied by improvement in compliance and gas exchange.
The Role for Simulation in Professional Identity Formation in Medical Students
Authors: Feldman Moshe , Edwards Cherie , Wong Alice , Randolph Jessica , Woleben Christopher , Nguyen Andrew , Grossman Catherine
Published: June 2021

Introduction

Authentic clinical experiences and reflection are critical for medical student professional identity formation (PIF). Individualized learning plans and competency-based education accelerate time to graduation, thus creating more demand for students to gain PIF experiences early in medical education. This pilot study investigated student professional identity experiences related to participation in a clinical simulation during the first week of medical school.

Methods

All first-year medical students at an academic health center participated in a clinically relevant simulation-based orientation to medical school (SOMS). Participants completed evaluation surveys measuring PIF-related experiences during the SOMS.

Results

All participants completed the survey (N = 186). Students agreed that the SOMS helped them feel what it is like to be a doctor (90%) and transition to the role of student-physician (91%). Student comments about the SOMS-reflected PIF-related processes, such as building a sense of a community of practice among their peers in their roles as a healthcare team. Students also valued the opportunity to engage in reflection about their roles as student-physicians.

Conclusions

Simulation experiences can be used as a trigger for self-reflection to assist in medical student professional identity development as early as the first weeks of medical school. Simulation exercises may improve PIF and could further enhance medical student PIF by adding them longitudinally into the curriculum.
Cross-reactive antibodies after SARS-CoV-2 infection and vaccination
Authors: Grobben Marloes , van der Straten Karlijn , Brouwer Philip J.M. , Brinkkemper Mitch , Maisonnasse Pauline , Dereuddre-Bosquet Nathalie , Burger Judith A. , Poniman Meliawati , Oomen Melissa , Eggink Dirk , Bijl Tom P.L. , van Willigen Hugo D.G. , Wynberg Elke , Verkaik Bas J. , Figaroa Orlane J.A. , de Vries Peter J. , Boertien Tessel M. , Grand Roger Le , de Jong Menno D. , Prins Maria , Chung Amy W. , de Bree Godelieve J. , Sanders Rogier W. , van Gils Marit J.
Published: June 2021

Current SARS-CoV-2 vaccines are losing efficacy against emerging variants and may not protect against future novel coronavirus outbreaks, emphasizing the need for more broadly protective vaccines. To inform the development of a pan-coronavirus vaccine, we investigated the presence and specificity of cross-reactive antibodies against the spike (S) proteins of human coronaviruses (hCoV) after SARS-CoV-2 infection and vaccination. We found an 11 to 123-fold increase in antibodies binding to SARS-CoV and MERS-CoV as well as a 2 to 4-fold difference in antibodies binding to seasonal hCoVs in COVID-19 convalescent sera compared to pre-pandemic healthy donors, with the S2 subdomain of the S protein being the main target for cross-reactivity. In addition, we detected cross-reactive antibodies to all hCoV S proteins after SARS-CoV-2 S protein immunization in macaques, with higher responses for hCoV more closely related to SARS-CoV-2. These findings support the feasibility of and provide guidance for development of a pan-coronavirus vaccine.
Evaluation of the INDICAID™ COVID-19 Rapid Antigen Test in symptomatic populations and asymptomatic community testing
Authors: Chiu Ricky Y. T. , Kojima Noah , Mosley Garrett Lee , Cheng Kwok Kin , Pereira David Y. , Brobeck Matthew , Chan Tsun Leung , Zee Jonpaul Sze-Tsing , Kittur Harsha , Chung Tenny Cheuk-Yiu , Tsang Eric , Maran Kajal , Yung Raymond Wai-Hung , Leung Alex Chin-Pang , Siu Ryan Ho-Ping , Ng Jessica Pui-Ling , Choi Tsz Hei , Fung Mei Wai , Chan Wai Sing , Lam Ho Yin , Lee Koon Hung , Parkin Sean , Chao Felix C. , Ho Stephen Ka-Nung , Marshak Daniel R. , Ma Edmond Shiu-Kwan , Klausner Jeffrey D.
Published: June 2021

Background

As the COVID-19 pandemic continues to cause substantial morbidity and mortality, there is an increased need for rapid, accessible assays for SARS-CoV-2 detection.

Methods

Here we present a clinical evaluation and real-world implementation of the INDICAID™ COVID-19 Rapid Antigen Test (INDICAID™ Rapid Test). A multi-site clinical evaluation of the INDICAID™ Rapid Test using prospectively collected samples from symptomatic subjects was performed. The INDICAID™ Rapid Test was then implemented at COVID-19 outbreak screening centers in Hong Kong to screen individuals for COVID-19 to prioritize confirmatory RT-PCR testing among asymptomatic populations.

Results

The clinical evaluation in symptomatic patient populations demonstrated a positive percent agreement and negative percent agreement of 85.3% (95% confidence interval [95% CI]: 75.6% - 91.6%) and 94.9% (95% CI: 91.6% - 96.9%), respectively, when compared to laboratory-based RT-PCR testing. When used during outbreak testing of 22,994 asymptomatic patients, the INDICAID™ Rapid Test demonstrated a positive percent agreement of 84.2% (95% CI: 69.6% - 92.6%) and a negative percent agreement of 99.9% (95% CI: 99.9% - 100%) compared to laboratory-based RT-PCR testing. When incorporated in a testing algorithm, the INDICAID™ Rapid Test reduced time to confirmatory positive result from an average 10.85 hours (standard RT-PCR only) to 0.84 hours, depending on the algorithm.

Conclusion

The INDICAID™ Rapid Test has excellent performance when compared to laboratory-based RT-PCR testing, and when used in tandem with RT-PCR, reduces the time to confirmatory positive result.

In clinical evaluations, the INDICAID™ COVID-19 Rapid Antigen Test demonstrated high sensitivity and specificity in symptomatic and asymptomatic patient populations. When used in tandem with RT-PCR testing, the INDICAID™ Rapid Test expedited confirmatory results and may help reduce SARS-CoV-2 outbreaks.