bluuebunny/crossref_metadata_2025 huggingface dataset:
Collateral Damage: Maternal Obesity During Pregnancy Continues to Rise
Authors: Davis Anne M.
Published: January 2020

Importance

The pandemic of obesity during pregnancy now afflicts 1 out of every 2 pregnant women in the United States. Even though unintended pregnancy has decreased to 45% of all pregnancies, 50% of those unintended pregnancies occur in obese women.

Objective

This study aims to identify why current lifestyle interventions for obese pregnancy are not effective and what the newer complications are for obesity during pregnancy.

Evidence Acquisition

Available literatures on current treatments for maternal obesity were reviewed for effectiveness. Emerging maternal and infant complications from obesity during pregnancy were examined for significance.

Results

Limitations in successful interventions fell into 3 basic categories to include the following: (1) preconception weight loss; (2) bariatric surgery before pregnancy; and (3) prevention of excessive gestational weight gain during pregnancy. Emerging significant physiological changes from maternal obesity is composed of inflammation (placenta and human milk), metabolism (hormones, microbiome, fatty acids), and offspring outcomes (body composition, congenital malformations, chronic kidney disease, asthma, neurodevelopment, and behavior).

Conclusions and Relevance

Are current prepregnancy lifestyle and behavioral interventions feasible to prevent maternal obesity complications? Epigenetic and metabolomic research will be critical to determine what is needed to blunt the effects of maternal obesity and to discover successful treatment.

Target Audience

Obstetricians, gynecologists, family physicians, midwives, nurse practitioners, and dietitians

Learning Objectives

After participating in this activity, the learner should be better able to identify lifestyle interventions used to prevent complications from an obese pregnancy; describe emerging maternal obesity complications; classify the severity of maternal obesity in the United States; and explain barriers to lifestyle intervention success in obese pregnancy.
High Interest in Syphilis Pre-exposure and Post-exposure Prophylaxis Among Gay, Bisexual and Other Men Who Have Sex With Men in Vancouver and Toronto
Authors: Fusca Laura , Hull Mark , Ross Patrick , Grennan Troy , Burchell Ann N. , Bayoumi Ahmed M. , Tan Darrell H. S.
Published: January 2020

Background

We assessed the acceptability of doxycycline-based syphilis pre-exposure and post-exposure prophylaxis (PrEP/PEP) as well as human immunodeficiency virus (HIV) PrEP/PEP in gay, bisexual, and other men who have sex with men (gbMSM).

Methods

We recruited gbMSM from Toronto and Vancouver sexually transmitted infection (STI) clinics during routine visits from June 2018 to August 2018. We analyzed data using descriptive statistics and constructed multivariable logistic regression models for willingness to use syphilis and HIV PrEP and PEP respectively.

Results

Among 424 participants (56.4% Toronto, 43.6% Vancouver), median (interquartile range [IQR]) age was 31.0 years (26.0–39.0 years), 61.7% had completed postsecondary education and 54.4% were white. Median (IQR) number of male partners in the past 6 months was 6.0 (3.0–13.0), and 18.2% had 1 or more prior syphilis diagnosis. 60.1%/44.1% indicated willingness to use syphilis PEP/PrEP; 36.6% were unwilling to use either. Among HIV-negative participants, 74.0% and 75.2% were willing to use HIV PrEP and PEP, respectively. Most participants were familiar with antibiotic resistance (89.0%) and agreed that syphilis rates are rising in Canada (68.2%), but only 55.4% believed they were at risk for syphilis. Agreement with the latter statement was associated with willingness to use syphilis PrEP (adjusted odds ratio [aOR], 1.6; 95% confidence interval [95%CI], 1.0–2.5), as was previous/existing HIV PrEP use (aOR, 2.2; 95% CI, 1.1–4.3) and being “very concerned” about STI acquisition (aOR, 1.9; 95% CI, 1.0–3.4). Odds of being willing to use syphilis PEP were higher in Toronto versus Vancouver (aOR, 2.0; 95% CI, 1.2–3.4) and increased with the number of different STIs previously diagnosed (aOR, 1.4; 95% CI, 1.2,1.7).

Conclusions

There is considerable interest in syphilis PrEP/PEP in gbMSM attending Toronto/Vancouver STI clinics.
Lateral Condyle Fracture of the Humerus Among Children Attending a Pediatric Emergency Department
Authors: James Vigil , Chng Abigail Chin Chii , Ting Francesca Lim May , Chan Yiong Huak , Ganapathy Sashikumar
Published: January 2020

Background

The lateral humeral condyle fractures in children accounts for one fifth of all elbow fractures. These fractures have a propensity to displace because of the pull of the extensor muscles on the condyle.

Objectives

The aim of this study was to examine the epidemiology, injury patterns, complications, and predictors for conservative/surgical management in patients with lateral condyle humeral fractures between 0 and 18 years of age.

Methods

This was a single-center retrospective study conducted between January 2006 and December 2016.

Results

There were 268 patients identified with lateral condyle elbow fracture. Majority of the patients (81.4%) with lateral condyle humeral fractures presented with either undisplaced or minimally displaced (<2 mm) fractures. The initial management in majority (90.7%) of the patients was conservative. Of the patients, 26.8% had secondary displacement at follow-up. The overall proportion of patients who required surgical intervention was 36.2%. Varus deformity of elbow (2.2%) and malunion (0.4%) were the complications noticed on long-term follow-up. Increased age and undisplaced fracture were statistically significant positive predictors for conservative management. The presence of concurrent elbow injuries and type of fracture (displaced >2 mm) were statistically significant positive predictors for surgical management.

Conclusions

Our study demonstrated that majority of the patients with lateral condyle humeral fractures had presented with either undisplaced or minimally displaced (<2 mm) fractures. The positive predictors for conservative management of fractures were increased age and undisplaced fracture. The positive predictors for surgical management of lateral condyle humerus fractures were concurrent injuries in elbow and type of fracture (displaced >2 mm). Physician vigilance to the possibility of additional migration of lateral condyle fractures initially managed conservatively, and the need for subsequent surgical stabilization plays an important role in the management of these fractures.
Brief Report: Temporal Changes in HIV Transmission Patterns Among Young Men Who Have Sex With Men, United States, 2009–2016
Authors: Panneer Nivedha , France Anne Marie , Whiteside Y. Omar , Zhang Tianchi , Wertheim Joel O. , Oster Alexandra M.
Published: January 2020

Background:

In the United States, young men (aged 13–24 years) who have sex with men (MSM) bear a disproportionate burden of HIV. Transmission among MSM has been found to be disassortative by age.

Methods:

We analyzed HIV-1 pol sequences reported to the US National HIV Surveillance System from MSM with HIV diagnosed during 2009–2016. Using an HIV genetic transmission network, we identified persons with closely related viruses (ie, genetic distance ≤1.5%) and used multivariable logistic regression to examine changes from 2009–2012 to 2013–2016 in proportions of MSM linked to young MSM who were >5 years older or of the same race/ethnicity.

Results:

Among 9510 young MSM linked to another MSM with a closely related virus, 37% linked to an older MSM and 62% linked to an MSM of the same race/ethnicity. Comparing 2013–2016 with 2009–2012, we found increases in linkage of older MSM to young MSM, with the most substantial increases seen in Hispanic/Latinos aged 13–19 [adjusted prevalence ratio (APR) = 1.31, 95% confidence interval (CI) = 1.11 to 1.56] and blacks aged 13–19 (APR = 1.23, CI = 1.06 to 1.41) and 20–24 years (APR = 1.14, CI = 1.02 to 1.28). By contrast, change in linkage patterns among racial/ethnic groups was unremarkable.

Conclusions:

We found evidence of increased age mixing among MSM with respect to HIV transmission over time, which coincides temporally with changes in partner-seeking behavior such as increased use of mobile applications. These findings indicate the importance of social factors on HIV sexual and transmission networks and suggest that prevention efforts need to effectively reach MSM of all ages.
Temperature-Sensitive Frozen-Tissue Imaging for Cryoablation Monitoring Using STIR-UTE MRI
Authors: Tokuda Junichi , Wang Qun , Tuncali Kemal , Seethamraju Ravi T. , Tempany Clare M. , Schmidt Ehud J.
Published: January 2020

Purpose

The aim of this study was to develop a method to delineate the lethally frozen-tissue region (temperature less than −40°C) arising from interventional cryoablation procedures using a short tau inversion-recovery ultrashort echo-time (STIR-UTE) magnetic resonance (MR) imaging sequence. This method could serve as an intraprocedural validation of the completion of tumor ablation, reducing the number of local recurrences after cryoablation procedures.

Materials and Methods

The method relies on the short T
1 and T
2* relaxation times of frozen soft tissue. Pointwise Encoding Time with Radial Acquisition, a 3-dimensional UTE sequence with TE = 70 microseconds, was optimized with STIR to null tissues with a T
1 of approximately 271 milliseconds, the threshold T
1. Because the T
1 relaxation time of frozen tissue in the temperature range of −40°C < temperature < −8°C is shorter than the threshold T
1 at the 3-tesla magnetic field, tissues in this range should appear hyperintense. The sequence was evaluated in ex vivo frozen tissue, where image intensity and actual tissue temperatures, measured by thermocouples, were correlated. Thereafter, the sequence was evaluated clinically in 12 MR-guided prostate cancer cryoablations, where MR-compatible cryoprobes were used to destroy cancerous tissue and preserve surrounding normal tissue.

Results

The ex vivo experiment using a bovine muscle demonstrated that STIR-UTE images showed regions approximately between −40°C and −8°C as hyperintense, with tissues at lower and higher temperatures appearing dark, making it possible to identify the region likely to be above the lethal temperature inside the frozen tissue. In the clinical cases, the STIR-UTE images showed a dark volume centered on the cryoprobe shaft, V
inner, where the temperature is likely below −40°C, surrounded by a doughnut-shaped hyperintense volume, where the temperature is likely between −40°C and −8°C. The hyperintense region was itself surrounded by a dark volume, where the temperature is likely above −8°C, permitting calculation of V
outer. The STIR-UTE frozen-tissue volumes, V
inner and V
outer, appeared significantly smaller than signal voids on turbo spin echo images (P < 1.0 × 10−6), which are currently used to quantify the frozen-tissue volume (“the iceball”). The ratios of the V
inner and V
outer volumes to the iceball were 0.92 ± 0.08 and 0.29 ± 0.07, respectively. In a single postablation follow-up case, a strong correlation was seen between V
inner and the necrotic volume.

Conclusions

Short tau inversion-recovery ultrashort echo-time MR imaging successfully delineated the area approximately between −40°C and −8°C isotherms in the frozen tissue, demonstrating its potential to monitor the lethal ablation volume during MR-guided cryoablation.
Advanced Case of Achalasia That Appeared on 68Ga–Prostate-Specific Membrane Antigen PET/CT
Authors: Shakeri Sara , Farahmandfar Fatemeh , Gholami Golnaz , Norouzbeigi Nasim , Sadeghi Ramin
Published: January 2020

We report a known case of severe achalasia that appeared on 68Ga–prostate-specific membrane antigen (PSMA) PET/CT. The patient was a known case of high-grade transitional cell carcinoma and suspicious diagnosis of prostate cancer referred for 68Ga-PSMA PET/CT. 68Ga-PSMA PET/CT showed linear increased activity in the esophageal wall as well as a distended esophagus.
Recurrent Immunoglobulin G4–Related Disease Shown on 18F-FDG and 68Ga-FAPI PET/CT
Authors: Pan Qingqing , Luo Yaping , Zhang Wen
Published: January 2020

A 21-year-old man had been diagnosed with immunoglobulin G4–related disease (IgG4-RD) for 5 years, and the disease recurred 1 month ago. 18F-FDG PET/CT revealed intense FDG activity in the pituitary stalk, submandibular gland, pleura, pericardium, pancreas, liver, prostate, and multiple lymph nodes, which were considered the involvements of IgG4-RD. 68Ga-FAPI PET/CT also showed intense 68Ga-FAPI uptake in the above FDG-avid lesions except the lymph node involvement. Additionally, involvement in the lacrimal glands was detected by 68Ga-FAPI. The positive findings of 68Ga-FAPI in the current case highlighted that 68Ga-FAPI may have value in the evaluation of IgG4-RD.
Comparison of 18F-FDG PET/CT Criteria for the Prediction of Therapy Response and Clinical Outcome in Patients With Metastatic Melanoma Treated With Ipilimumab and PD-1 Inhibitors
Authors: Annovazzi Alessio , Vari Sabrina , Giannarelli Diana , Pasqualoni Rosella , Sciuto Rosa , Carpano Silvia , Cognetti Francesco , Ferraresi Virginia
Published: January 2020

Immunotherapy currently represents one of the most effective therapies in metastatic melanoma. However, its indirect antineoplastic activity through the immune system has raised relevant challenges for diagnostic imaging in the evaluation of the response to treatment.

Purpose

The aim of this retrospective study was to compare the diagnostic accuracy of different 18F-FDG PET/CT criteria to predict therapy response and clinical outcome in melanoma patients treated with immune checkpoint inhibitors.

Patients and Methods

Fifty-seven patients with metastatic melanoma treated with ipilimumab (n = 25; group 1) or with PD-1 inhibitors (n = 32; group 2) who performed an 18F-FDG PET/CT scan before treatment (PET0) and 12 to 18 weeks later (PET1) were retrospectively evaluated. Response at PET1 was evaluated according to RECIST 1.1, EORTC, PERCIMT (PET Response Evaluation Criteria for Immunotherapy), and by percentage change of metabolic tumor volume (MTV) and total lesion glycolysis of up to 5 target lesions. Performance of each criterion at PET1 to predict clinical benefit at 6 months since starting immunotherapy was assessed and correlated to progression-free survival.

Results

In group 1, the best predictor of therapy response was MTV combined with PERCIMT criteria (accuracy, 0.96). In group 2, overlapping results were found for EORTC, MTV, and total lesion glycolysis (accuracy, 0.97). The reliability of the above parameters was also confirmed in the progression-free survival analysis.

Conclusions

18F-FDG PET/CT performed after 3 to 4 months since starting immunotherapy can correctly evaluate response to treatment and can also able to predict long-term clinical outcome. Performance of 18F-FDG PET/CT and criteria for response assessment is influenced by the class of treatment.
The Complementary Role of 68Ga-DOTATATE PET/CT in Neuroblastoma
Authors: Telli Tuğçe , Lay Ergün Eser , Volkan Salanci Bilge , Özgen Kiratli Pinar
Published: January 2020

A girl diagnosed with neuroblastoma at 33 months underwent 123I-MIBG scan after surgery and chemoradiotherapy. Although MIBG scan showed complete response, the bone marrow biopsy showed refractory disease. Therefore, she underwent 68Ga-DOTATATE PET/CT, which revealed bone marrow involvement and 68Ga-DOTATATE–avid brain metastasis. Rare physiological pineal gland uptake was also depicted. 68Ga-DOTATATE PET/CT showed active progressive disease earlier, before it was detectable with MIBG scan. For patients with MIBG-negative relapsed/refractory disease, 68Ga-DOTATATE may have an important role in restaging, detecting unsuspected metastasis, therapy planning.
Early Initiation of Renal Replacement Therapy Among Burned Patients With Acute Kidney Injury
Authors: Tan Bien-Keem , Liew Zhong Hong , Kaushik Manish , Cheah Andrew Kim Wee , Tan Han Khim
Published: January 2020

Background

Burned patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have exceedingly high mortality rates of 73% to 100%. Since January 2011, we have been adopting an early RRT approach in managing burned patients with AKI. Our hypothesis was that early initiation of RRT leads to improved outcome and survival among burned patients with AKI.

Methodology

We conducted a retrospective analysis of Burns Database in Singapore General Hospital from January 2011 to February 2016. Indications for dialysis included serum creatinine of greater than 1.5 times baseline or urine output of less than 0.5 mL/kg per hour for at least 6 consecutive hours. Patients with similar condition from January 2006 to December 2010 were recruited for comparison.

Result

A total of 27 patients with burns and AKI were recruited from January 2011 to February 2016. The mean age was 45.4 years and 88.9% were male. The mean total burn surface area (TBSA) was 54.8%. The total volume of fluid resuscitation was 2.7 mL/kg per TBSA. The time from onset of burn to RRT was 6.4 days. Most patients presented with stage 1 AKI (51.9%), whereas 22.2% and 25.9% had stage 2 and stage 3 AKI, respectively. Most patients (74.1%) received CRRT and 18.5% received SLED. The mortality rate was 37.0% with majority of death (70%) due to sepsis/multiorgan failure. Only 1 patient required long-term RRT after discharge, and there was no occurrence of abdominal compartment syndrome. The mean age of 15 patients from 2006 to 2010 was 47.8 years. The mean TBSA was 49.5%. Only 26.7% of patients were started on RRT. The mortality rate was 66.7%, which was higher than that of subjects from 2011 to 2016 (37.0%) (P = 0.039).

Conclusions

Optimal timing of RRT for burned patients with AKI has not been established and data on early RRT approach are scarce. The findings of our study suggested that early RRT was associated with lower mortality rates among burned victims with AKI.
Application of Self-Made Connection Device in Intractable Intramedullary Device
Authors: Lei Pengfei , Cui Juncheng , Wang Wu , Liu Hao , Luo Zhenhua , Yang Xucheng
Published: January 2020

Background:

Intramedullary fixation a standard surgical technique for long bone meta/diaphyseal fractures. There were many difficulties in removal of the intractable intramedullary device. The authors reported a new technique to remove the intractable intramedullary nail by using a self-made connecting device.

Methods:

The subject underwent removal of the intramedullary nail using a self-made connecting device, the core components of which were a caudal connecting rod and a sliding hammer in the common intramedullary nail removal device, and the auxiliary device was mainly a clinically commonly used Kirschner wire (K-wire; diameter 1.5–2.5 mm). In technical procedure, the key point was the connection between the k-wire and the intramedullary device, according to the specific conditions of the intramedullary device.

Results:

From 2012 to 2017, a total of 10 cases of intractable intramedullary devices were taken out using this self-made connection device, including 7 cases of tibial intramedullary nails, 1 case of femoral nail, and 1 case of tibial elastic nail. The technique provided satisfactory results, no infection or re-fracture occurred after the.

Conclusion:

The self-made connecting device may provide new technique for more surgeons in the face of intractable intramedullary device.
SAPHO Syndrome Involving the Mandible Treated With 99Tc-MDP
Authors: Shao Shengjie , Wang Weihong , Qian Yemei
Published: January 2020

SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome is a chronic inflammatory disease involving multiple organs such as skin and bones. At present, its etiology and pathogenesis are still unclear. Due to the variety of clinical manifestations and the small number of SAPHO syndrome involving the mandible, accurate diagnosis is difficult for oral and maxillofacial surgeons. Here, the authors report that a male patient with SAPHO syndrome involving the maxillofacial skin and mandible, followed for 3 years. We used99Tc-MDP (technetium-99 conjugated with methylene disphosphonate) (commercially known as Yunke) to treat this disease and achieved significant clinical treatment. This suggests that99Tc-MDP can be used as a bisphosphonate to treat SAPHO syndrome.
Recurrent Orbital Trauma Following Repaired Orbital Floor Fracture
Authors: Homer Benjamin , Homer Alexander , Sullivan Stephen R. , Taylor Helena O.
Published: January 2020

A study of a 22-year-old male who was assaulted and sustained a left orbital floor blowout fracture was presented in this study. The orbital floor was repaired with a titanium-reinforced porous polyethylene implant. Two years postoperatively, the patient sustained repeated left orbital trauma. The orbital floor implant remained stable while the medial wall blew out.
Maxillofacial Manifestation of a Giant Dimension Cranial Osteoma
Authors: Guerra Raphael Capelli , Carvalho Pedro Henrique de Azambuja , Pulino Bianca de Fátima Borim , Passetto Marcelo Teixeira , Junior José Carlos Rodrigues , Hochuli-Vieira Eduardo
Published: January 2020

Osteoma is the most frequent benign tumor in the craniomaxillofacial region. The most common initial manifestation is facial pressure or headache.

The clinical examination showed increased volume in the right supraorbital region, asymmetry of the orbital contour, exophthalmia, dystopia, proptosis and clinical restraint of ocular movement for supraversion. The lesion measured approximately 4 cm in diameter with irregular contour. Osteotomy was performed with saw surrounding the tumor, with aid of a surgical piezo on the orbital medial wall.

The result of histopathological examination was osteoma. The patient is 2.5 years postoperatively and so far without complications.
Macrocystic Lymphangioma in Children Treated by Sclerotherapy With Bleomycin
Authors: Sonmez Kaan , Karabulut Ramazan , Turkyilmaz Zafer
Published: January 2020

Although surgical operation is a commonly preferred method in lymphangiomas (LAs), there is a risk of vascular or nerve injury especially in macrocystic LA. Therefore, sclerotherapy would be more appropriate as the first treatment. The authors wanted to share the excellent results of intralesional bleomycin treatment in 3 patients with cervical macrocystic LA.
Application of Superficial Temporal Artery Flap in Wound Repairing After the Resection of Craniofacial Malignant Tumors
Authors: Ni Xiao-Dong , Xu Yuan , Wang Min , Cang Zheng-Qiang , Wang Qian , Yuan Si-Ming
Published: January 2020

Background and Objective:

Craniofacial malignant tumors require not only extended resection but also appropriate reconstruction to restore appearance, which remains a major challenge. Here the authors introduced the application of superficial temporal artery (STA) flap in wound repairing after the resection of craniofacial malignant tumors.

Methods:

From January 2015 to December 2018, 16 patients with craniofacial malignant tumors were enrolled into the study, including squamous cell carcinoma (n = 6), basal cell carcinoma (n = 3), melanoma (n = 4), neuroendocrine carcinoma (n = 2), and dermatofibrosarcoma protuberance (n = 1). All of the tumors underwent extended resection. The defects formed were repaired by flaps pedicled with superior or frontal branch of STA. Donor sites were repaired with skin grafts. Patients were followed up for 6 months to 3 years to monitor the recurrence of tumor.

Results:

All the flaps survived well. Venous congestion occurred in two cases but resolved after blood-letting and application of drugs promoting venous draining. During the follow-up, no recurrence of tumors was observed and the appearance of flaps was satisfying. But flap donor sites suffered from relatively poor appearance or alopecia deformity.

Conclusions:

The STA flap is reliable for wound repairing after resection of craniofacial malignant tumors. The STA parietal branch flap is preferred for repairing scalp defects, while the STA frontal branch flap is preferred for repairing facial defects. However, the STA flap should be used prudently due to its disadvantage of the deformity in scalp donor sites.
Parry-Romberg Syndrome With Hemimasticatory Spasm: A Rare Combination
Authors: Chen Guang-can , Chen Min-jie , Wei Wen-bin , Hao Yun-bo
Published: January 2020

Parry-Romberg syndrome is a rare craniofacial disorder characterized by progressive hemifacial atrophy with systematic manifestations. The combination with hemimasticatory spasm is rare, with only 9 patients reported before. In this study, a study of a young male patient with Parry-Romberg syndrome and hemimasticatory spasm on his left side was presented. Radiologic examinations showed severe atrophy limited to subcutaneous tissue and electromyography demonstrated as hemimasticatory spasm. Injection of botulinum toxin type A was applied for the treatment of hemimasticatory spasm and after 2 separated injections, the patient was significantly relieved from symptom. The theory of focal demyelination of the trigeminal nerve peripheral brunches is the possible link between hemifacial atrophy and hemimasticatory spasm, although the pathogenesis of both diseases requires further study and current therapeutic methods are still limited to symptomatic treatments. Injection of botulinum toxin type A is an effective way to treat hemimasticatory spasm and autologous fat transplant is a promising solution to correct facial asymmetry.
Therapeutic Effects of Hyaluronic Acid in Peritonitis-Induced Sepsis in Mice
Authors: Lee Jae Hoon , Liu Airan , Park Jeong-Hyun , Kato Hideya , Hao Qi , Zhang Xiwen , Zhou Li , Lee Jae-Woo
Published: January 2020

Intra-abdominal infection is the second most common cause of sepsis, and the mortality rate from abdominal sepsis remains high. High molecular weight (HMW) hyaluronic acid (HA) has been studied in sterile injury models as an anti-inflammatory and anti-permeability agent. This study evaluated the therapeutic effects of intraperitoneal HMW HA administration in mice with peritonitis-induced sepsis. Sepsis was induced in C57BL/6 mice by cecal ligation and puncture (CLP), followed 4 h later by an intraperitoneal injection of HMW HA (20 mg/kg) solution or phosphate buffered saline (PBS). Survival, physiological data, organ injury, bacterial burden, and inflammatory cytokine levels were assessed in the CLP mice. To assess the effect of HA on macrophage phagocytosis activity, RAW264.7 cells, primed with lipopolysaccharide, were exposed with either PBS or HMW HA (500 μg/mL) prior to exposure to 107 CFU of E coli bacteria. HMW HA instillation significantly improved blood oxygenation, lung histology, and survival in CLP mice. Inflammatory cytokine levels in the plasma and bacterial burdens in the lung and spleen were significantly decreased by HA administration at 24 h after CLP. At 6 h after CLP, HA significantly decreased bacterial burden in the peritoneal lavage fluid. HMW HA administration significantly increased E coli bacterial phagocytosis by RAW264.7 cells in part through increased phosphorylation of ezrin/radixin/moesin, a known downstream target of CD44 (a HA receptor); ezrin inhibition abolished the enhanced phagocytosis by RAW264.7 cells induced by HA. Intraperitoneal administration of HMW HA had therapeutic effects against CLP-induced sepsis in terms of suppressing inflammation and increasing antimicrobial activity.
Abdominal Drainage at Appendectomy for Complicated Appendicitis in Children
Authors: Fujishiro Jun , Fujiogi Michimasa , Hirahara Norimichi , Terui Keita , Okamoto Tatsuya , Watanabe Eiichiro , Ishimaru Tetsuya , Miyata Hiroaki
Published: January 2020

Objective:

The aim of the study was to investigate the effect of abdominal drainage at appendectomy for complicated appendicitis in children.

Summary of Background Data:

Although an abdominal drain placement at appendectomy is an option for reducing or preventing postoperative infectious complication, there is controversy regarding its effect for complicated appendicitis.

Method:

The study used the data on appendectomies for complicated appendicitis in children (≤15 years old) that were operated in 2015 and registered in the National Clinical Database, a nationwide surgical database in Japan. One-to-two propensity score matching was performed to compare postoperative outcomes between patients with and without drainage at appendectomy.

Result:

The study included 1762 pediatric appendectomies for complicated appendicitis, 458 of which underwent abdominal drainage at appendectomy. In the propensity-matched analysis, the drainage group showed a significant increase in wound dehiscence [drain (−) vs drain (+); 0.3% vs 2.4%, P = 0.001], and postoperative hospital stay (median: 7 days vs 9 days, P < 0.001). There were no significant differences in the incidence of any complications, organ space surgical site infection, re-admission, and reoperation.

Subgroup analyses in perforated appendicitis and perforated appendicitis with abscess, and open and laparoscopic appendectomy all demonstrated that drain placement was not associated with a reduction in any complication or organ space surgical site infection. However, it was significantly associated with longer hospital stays.

Conclusion:

This study suggested that an abdominal drain placement at appendectomy for complicated appendicitis among children has no advantage and can be harmful for preventing postoperative complications.
Effectiveness of the combat application tourniquet for arterial occlusion in young children
Authors: Kelly Joseph R. , Levy Matthew J. , Reyes Jose , Anders Jennifer
Published: January 2020

BACKGROUND

Tourniquet use for extremity hemorrhage has become a mainstay in adult trauma care in last 15 years. The efforts of the Stop the Bleed campaign have increased the distribution and use of tourniquets in civilian settings in response to mass shootings and as part of disaster preparedness. Little research or published experience exists regarding the use of tourniquets in the pediatric population. This study sought to determine the minimum patient age on which the combat application tourniquet (CAT) is able to control extremity hemorrhage.

METHODS

A convenience sample of pediatric patients, ages 1 year to 8 years, scheduled for elective orthopedic surgery at an academic hospital, were eligible for enrollment. Subject age, weight, height, blood pressure, and arm and leg circumferences were obtained. Once under general anesthesia, the pulse of an upper and a lower limb were obtained by Doppler, a CAT was then placed at the most proximal practical location of the limb until the corresponding pulse was either no longer obtainable by Doppler or until the tourniquet was as tight as its design allows. The tourniquet was removed after 30 seconds of arterial occlusion.

RESULTS

Thirteen children, ages 2 years to 7 years were enrolled. Weights ranged from 12.8 kg to 23.9 kg, with a mean of 16.7 kg. Leg circumferences were 24.5 cm to 34.5 cm, with a mean of 27.9 cm and arm circumferences were 13 cm to 24 cm, with a mean of 16.3 cm. Subject heights were 87 cm to 122 cm, with a mean of 103.4 cm. Twenty-four total extremities were tested, 11 arms and 13 legs. Arterial occlusion was obtained on 100% of limbs tested (95% confidence interval, 85.8–100%).

CONCLUSION

This study is similar to previous adult tourniquet efficacy studies in design, size and outcomes. It is the first to show successful arterial occlusion on preschool-aged children with a commercial tourniquet in a controlled setting. The results suggest that the CAT can be used in school-aged children with severe extremity hemorrhage with a high likelihood of success.

LEVEL OF EVIDENCE

Therapeutic, level II.
Muscle Quality Index as a Predictor of Hip Osteoarthritis
Authors: Machado-Payer Ramón , Latorre-Román Pedro Ángel , Jerez-Mayorga Daniel , Chirosa Luis Javier , Ábalos-Medina Gracia
Published: January 2020

Objective:

To determine the utility of the muscle quality index (MQI) as a predictor of osteoarthritis (OA) and to assess the influence of strength and body composition manifestations in subjects with hip OA.

Methods:

Fifty subjects (21 men and 29 women, 66.4 ± 5.3 years) participated in this study. Of them, 25 subjects had unilateral hip OA, and 25 healthy subjects. The 2 groups were matched by age and sex. We evaluated muscle perimeter, length of the upper limb, body mass, and administered the sit-to-stand test, which measures the time it takes to rise and sit 10 times, and the MQI, in addition to the maximum voluntary isometric contraction in hip flexion and extension movements.

Results:

The OA group presented significantly (P < .05) higher body mass index, but lower fat mass and greater leg length. In turn, significant differences were observed between the groups for the sit-to-stand test (P = .002) and, as a consequence, in the MQI (P = .003). The binary logistic regression analysis shows that a higher MQI is a protective factor against OA, with the cut-off point being 144.20.

Conclusion:

The MQI is a complementary tool for the diagnosis and monitoring of OA in elderly people.
Integrating Working Memory Exercises With Nursing Home Rehabilitation to Achieve “Better, Faster” Functional Outcomes
Authors: Mansbach William E. , Mace Ryan A. , Tanner Melissa A. , Knoepfel Erin M. , Maxwell Robert , Chew Felicia
Published: January 2020

Targets:

We examined the efficacy of working memory exercises (WME), applied concurrently with rehabilitation services provided in skilled nursing facilities, for improving activities of daily living (ADLs) among older skilled nursing facilities residents with cognitive impairment.

Intervention Description:

Participants (N = 63) were randomized to the WME or treatment-as-usual control group. The WME was a 3-week, 9-session course (30 minutes each) of a rehabilitation program for therapists in post–acute settings.

Mechanisms of Action:

Working memory exercises aim to improve ADLs by targeting attention and working memory, based on the link between executive function and everyday functional skills. By developing cognitive communication skills and strengthening strategies for learning and memory, WME may give patients an added boost to traditional ADLs remediation therapies.

Outcomes:

Working memory exercises participants' ADL performance increased by 1.59 points on average (95% confidence interval = 0.69-2.49, P < .001) on the Katz Index of ADL scale compared with a 0.05 decrease for the control group (95% confidence interval = −1.09 to 0.99, P = .92). A greater proportion of WME participants than controls progressed from ADL dependent to independent for continence, dressing, feeding, functional transfers, and toileting. Simultaneously targeting cognitive and functional skills was associated with greater improvements in ADLs than targeting functional deficits alone.
Injury Pathways That Lead to AKI in a Mouse Kidney Transplant Model
Authors: Jain Swati , Plenter Robert , Nydam Trevor , Jani Alkesh
Published: January 2020

Background.

Prolonged cold ischemia (CI) is a risk factor for acute kidney injury after kidney transplantation. We endeavored to determine the pathways involved in the development of tubular cell injury and death before and after transplantation. We hypothesized that ex vivo cold storage before transplant would produce a different injury phenotype to that seen after engraftment in kidney transplants with or without CI.

Methods.

Four groups of mouse donor kidneys were studied: (1) nontransplanted control kidneys; (2) donor kidneys subjected to ex vivo cold ischemia (CI); (3) donor kidneys subjected to kidney transplant without CI (Txp); and (4) donor kidneys subjected to CI followed by transplantation (CI+Txp).

Results.

Acute kidney injury only occurred in the CI+Txp group, which had significantly increased sCr versus the Txp group and the control mice. Histologically, the CI group demonstrated significantly increased tubular cell apoptosis and caspase-9 expression, whereas the Txp group demonstrated only mild brush border injury without apoptosis or necrosis. In contrast, the CI+Txp group had tubular cell apoptosis associated with expression of caspase-8, TNFR1, and increased serum TNF-α. CI+Txp also led to significantly higher ATN scores in association with increased RIP1, RIP3, pMLKL, and TLR4 expression.

Conclusions.

Our results suggest distinct therapies are needed at different times during organ preservation and transplantation. Prevention of apoptosis during cold storage is best achieved by inhibiting intrinsic pathways. In contrast, prevention of cell death and innate immunity after CI+Txp requires inhibition of both the extrinsic death receptor pathway via TNFR1 and caspase-8 and inhibition of programmed necrosis via TLR4 and TNFR1.
Correlation of Visual Quality of Life With Clinical and Visual Status in Friedreich Ataxia
Authors: Afsharian Parisa , Nolan-Kenney Rachel , Lynch Abigail E. , Balcer Laura J. , Lynch David R.
Published: January 2020

Background:

The primary objective was to determine the association of patient-reported vision-specific quality of life to disease status and visual function in patients with Friedreich's ataxia (FRDA).

Methods:

Patients with FRDA were assessed with the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) along with measures of disease status (ataxia stage) and visual function (low- and high-contrast letter acuity scores). The relations of NEI-VFQ-25 scores to those for disease status and visual function were examined.

Results:

Scores for the NEI-VFQ-25 were lower in patients with FRDA (n = 99) compared with published disease-free controls, particularly reduced in a subgroup of FRDA patients with features of early onset, older age, and abnormal visual function.

Conclusions:

The NEI-VFQ-25 captures the subjective component of visual function in patients with FRDA.
Retinal Vascular Signs and Cerebrovascular Diseases
Authors: Rim Tyler Hyungtaek , Teo Alvin Wei Jun , Yang Henrik Hee Seung , Cheung Carol Y. , Wong Tien Yin
Published: January 2020

Background:

Cerebrovascular disease (CeVD), including stroke, is a leading cause of death globally. The retina is an extension of the cerebrum, sharing embryological and vascular pathways. The association between different retinal signs and CeVD has been extensively evaluated. In this review, we summarize recent studies which have examined this association.

Evidence Acquisition:

We searched 6 databases through July 2019 for studies evaluating the link between retinal vascular signs and diseases with CeVD. CeVD was classified into 2 groups: clinical CeVD (including clinical stroke, silent cerebral infarction, cerebral hemorrhage, and stroke mortality), and sub-clinical CeVD (including MRI-defined lacunar infarct and white matter lesions [WMLs]). Retinal vascular signs were classified into 3 groups: classic hypertensive retinopathy (including retinal microaneurysms, retinal microhemorrhage, focal/generalized arteriolar narrowing, cotton-wool spots, and arteriovenous nicking), clinical retinal diseases (including diabetic retinopathy [DR], age-related macular degeneration [AMD], retinal vein occlusion, retinal artery occlusion [RAO], and retinal emboli), and retinal vascular imaging measures (including retinal vessel diameter and geometry). We also examined emerging retinal vascular imaging measures and the use of artificial intelligence (AI) deep learning (DL) techniques.

Results:

Hypertensive retinopathy signs were consistently associated with clinical CeVD and subclinical CeVD subtypes including subclinical cerebral large artery infarction, lacunar infarction, and WMLs. Some clinical retinal diseases such as DR, retinal arterial and venous occlusion, and transient monocular vision loss are consistently associated with clinical CeVD. There is an increased risk of recurrent stroke immediately after RAO. Less consistent associations are seen with AMD. Retinal vascular imaging using computer assisted, semi-automated software to measure retinal vascular caliber and other parameters (tortuosity, fractal dimension, and branching angle) has shown strong associations to clinical and subclinical CeVD. Other new retinal vascular imaging techniques (dynamic retinal vessel analysis, adaptive optics, and optical coherence tomography angiography) are emerging technologies in this field. Application of AI-DL is expected to detect subclinical retinal changes and discrete retinal features in predicting systemic conditions including CeVD.

Conclusions:

There is extensive and increasing evidence that a range of retinal vascular signs and disease are closely linked to CeVD, including subclinical and clinical CeVD. New technology including AI-DL will allow further translation to clinical utilization.
Effects of metformin on lipopolysaccharide-induced depressive-like behavior in mice and its mechanisms
Authors: Yang Sheng , Chen Xiaohe , Xu Yuanyuan , Hao Yan , Meng Xianfang
Published: January 2020

Metformin, an AMPK activator, is a widely used medicine for type II diabetes, which has been considered to exert the anti-inflammatory effects. It has been reported that inflammation plays an important role in the pathogenesis of depression. Lipopolysaccharide (LPS) is often utilized to induce depressive-like behavior in mice with respect to recent studies. However, whether metformin alleviates the symptoms of depressive-like behaviors and its mechanisms remain unexplored. The present study investigates whether metformin alleviates LPS-induced depressive-like behavior in mice and aims to explore the mechanisms. We first treated adult mice with LPS (0.83  mg/kg, intraperitoneal) to induce depressive-like behavior model for 24  hours after treatment with or without metformin. Then, the effects of metformin on depressive-like behaviors were detected by tail suspension test and forced swim test. Moreover, quantitative RT-PCR was used to determine the mRNA expression levels of lipocalin 2 (Lcn-2) and inflammatory molecules including IL-1β, IL-6 and von Willebrand factor (vWF), which are concerned with inflammation and Lcn-2. It was shown that LPS-induced mouse depressive-like behaviors, as indicated by the increased time of immobility in tail suspension test and forced swim test, were reversed by metformin. It was also shown that LPS increased the mRNA expression levels of Lcn-2 and inflammation-related molecules such as IL-1β in the amygdala tissue, which could be alleviated by metformin. Taken together, metformin mitigates LPS-induced depressive-like behavior in mice by regulating the expression level of Lcn-2 and inflammation-related molecules, including IL-1β, IL-6 and vWF.

Video abstract: http://links.lww.com/WNR/A568
Accumulation of ammonium owing to the metabolic imbalance of carbon and nitrogen might inhibit the central metabolism inMethylomonassp. ZR1
Authors: Guo Wei , He Ronglin , Zhao Yujie , Li Demao
Published: January 2020

The metabolic intermediates of nitrogen source have been proved to have multiple functions on the metabolism of mehthanotrophs. In this study, accumulation and assimilation mechanism of the nitrate metabolic intermediate ammonium in the fast growingMethylomonassp. ZR1 was analyzed. Although, nitrate salt was the best nitrogen source supporting the growth of ZR1, its metabolic intermediate ammonium would accumulate and inhibit ZR1. Kinetic studies indicated that accumulation of NH4+was deduced from the imbalance of nitrogen and carbon metabolism. Compensation of carbon skeleton α-keto-glutaramate could effectively relieve the inhibition of NH4+to ZR1, which further approved the assumption. qPCR analysis indicated a third ammonium assimilation pathway Glycine synthesis system may function in ZR1 under high ammonium tension. In the presence of ammonium, ZR1 might employ two strategies to relieve the ammonium stress, one was assimilating the excess ammonium, and another one was cutting off the nitrogen reduction reactions. Investigation of the nitrogen metabolism and its influence to the carbon metabolism is meaningful to systematically understand and control the C1 feedstock bioconversion process in methanotrophs.

Importance

The nitrogen metabolism in methanotrophs has long been concerned. However, there are lots of research problems yet to be solved. In this study, the accumulation and assimilation mechanism of the nitrogen metabolic intermediate ammonium in the fast growingMethylomonassp. ZR1 was analyzed. Owing to the imbalance metabolism of carbon and nitrogen source, ammonium would accumulate to high concentrations to inhibit cell growth. Compensation of carbon skeleton was an effective strategy to relieve the inhibition of NH4+. A third ammonium assimilation pathway related genes were proved actively expressing in ZR1 when it confronted with high ammonium tension. When confronted with ammonium tension, ZR1 might employ different strategies to relieve the ammonium stress according to the edible carbon source. Revealing the endogenous ammonium accumulation mechanism and its metabolic adjustment effect on the central metabolism of methanotrophs, was meaningful to reveal the complex coordination metabolic mechanism of nitrogen and carbon in methanotrophs.
Deforestation in Belize-What, Where and Why
Authors: Folkard-Tapp Hollie
Published: January 2020

The tropical forests of Belize are a dynamic environment influenced by much disturbance throughout their natural history. In recent times, logging and agriculture have once more become the dominant drivers of land use change, yet the Belizean forests remain some of the most complete swathes of forest in the region. However, it is largely unknown how the abundance of specific forest types has changed. This study aims to critically assess whether valuable habitat types have been disproportionately affected by deforestation between 1986 and 2018. ENVI Classic 5.5 was used to calculate the NDVI values of Landsat imagery, with values over 0.6 deemed to indicate primary forest. ArcMap 10.6 was used for detecting change in forest cover between 1986 and 2018, in addition to digitising colonial maps. Results show variation in the percentage of forest lost between habitat types, with a bias towards forests fragmented by or replaced by agriculture, particularly in the north and along the Guatemalan border. The protected area network was found overall to have little influence on deforestation, though this varies between reserves. Of the three forest types experiencing the highest percentage of forest loss, only Ensino-Pixoy occurs exclusively outside protected areas. Cohune Santa-Maria and Sapote-Mahogany are found at least partially within protected areas and experience loss within them. Analysis of IUCN ratings of forest species revealed data deficiency, particularly concerning taxa indigenous to Mesoamerica, against which this study recommends further vegetation studies. to allow recommendations for protection of particularly threatened forest types. A review of management strategies in protected areas, especially the Caracol Archaeological Reserve, is necessary to avert the worrying deforestation trends this study has identified. The country-wide deforestation data can be used to advise future forest policy as well as calculation of national carbon stocks or determining integrity of ecosystem services.