bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of a Surgical Microscope for Subperichondrial–Subperiosteal Dissection in Preservation Rhinoplasty: Ergonomic Considerations
Authors: Hattori Yoshitsugu , Uda Hirokazu , Sugawara Yasushi
Published: March 2022

Preservation of anatomical components in rhinoplasty has gained increasing popularity over recent years. Given that elevation of the soft tissue envelope in a continuous subperiochondrial–subperiosteal dissection preserves soft tissues, vessels, nerves, and lymphatics, this procedure may result in faster healing time and less swelling and scarring. However, the technique requires a learning phase and can be challenging to perform because it typically requires meticulous dissection under surgical loupes. The dissection may thus be time-consuming and a burden for surgeons, especially in secondary rhinoplasty cases. Further, the potential risk of musculoskeletal discomfort and injury to the surgeon should not be overlooked; consideration for surgical ergonomics is needed to prevent injuries and enhance surgical performance. To address these issues, we propose the use of a surgical microscope for subperiochondrial–subperiosteal dissection in preservation rhinoplasty. A microscope enables clear visualization of the surgical field and allows surgeons to make precise and delicate manipulation maneuvers. Moreover, it may also enable surgeons to maintain an ideal ergonomic posture and neutral positioning of their joints, thereby reducing physical strain. A surgical microscope may thus be a useful tool for subperiochondrial–subperiosteal dissection by providing clear visualization of the surgical field and improved surgical ergonomics for surgeons.
Bilateral Chronic Expanding Hematoma 20 Years after Silicone Breast Implant Removal
Authors: Hosoyamada Hiroto , Yamamoto Naoto , Kuwabara Masahiro , Kawai Keita
Published: March 2022

We encountered a case of a chronic expanding hematoma (CEH) that occurred bilaterally in the breast regions of a 42-year-old woman approximately 20 years after SBI removal. There have been no other reports of CEH occurring after implant removal. Furthermore, this is also the first case of a CEH that developed bilaterally in the breasts; most reported cases are of a unilaterally developed CEH. A CEH reportedly develops after a long period of time following trauma or surgery. If surgeons encounter an expanding tumor emerging from regions with such a history, they must consider the presence of a CEH even after implant removal, as in the present case. Hematomas caused by trauma or surgery are usually absorbed or are replaced with fibrous tissue. In rare cases, they can chronically increase as CEHs. Herein, we report a case of a CEH that occurred in both breasts approximately 20 years after silicone breast implant removal.
Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols
Authors: Baker Nusaiba F. , Brown Owen , Hart Alexandra M. , Danko Dora , Stewart Christopher M. , Thompson Peter W.
Published: March 2022

Background:

Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence regarding “best practices” in the prevention of implant infections. In the absence of strong data, standardizing procedures based on available evidence can reduce error and improve efficacy and outcomes.

Methods:

We performed a focused literature review of the available evidence supporting specific interventions for infection prevention in the preoperative, intraoperative, and postoperative phases of care that are applicable to IBBR. In addition, we examined previously published standardized perioperative protocols for implant reconstruction.

Results:

Preoperative, intraoperative, and postoperative planning and organization is crucial in IBBR. Preoperative planning involves skin decolonization in advance of surgery with either chlorhexidine gluconate or mupirocin. Intraoperative methods that have shown potential benefit include double-gloving, breast pocket irrigation, separate closing instruments, and the utilization of “no-touch” techniques. In the postoperative period, the duration of drain removal and postoperative antibiotic administration play an important role in the prevention of surgical site infection.

Conclusions:

There is a crucial need to establish an evidence-based set of “best practices” for IBBR, and there exists a paucity of evidence in the breast literature. These data can be utilized to develop a standardized protocol as part of a rigorous quality improvement methodology.
The Importance of Scar Cosmesis across the Surgical Specialties: Factors, Perceptions, and Predispositions
Authors: Lari Ali , Alherz Mohammad , Hussain Salman , Burhamah Waleed , Alabbad Fahad , Jarragh Ali , Lari Aqeel
Published: March 2022

Background:

Existing disparities in the perception of scars between patients and practitioners can translate into undesirable physical and psychological outcomes. An understanding of the determinants of surgeons’ perceptions on the importance of scar cosmesis is a first step toward bridging this gap.

Methods:

In an online survey, surgeons were asked about the extent to which various patient and technical factors affect the importance of scar cosmesis. Additional data were obtained on surgeon characteristics, including their specialty, gender, years of experience, and work sector to investigate potential relationships.

Results:

A total of 303 responses were obtained from surgeons across six specialties. Based on the survey, the importance of scar cosmesis was rated highest among plastic surgeons and obstetricians and gynecologists, and lowest among orthopedic and vascular surgeons. Compared with surgeons in private practice, publicly employed surgeons’ rating of the importance of cosmesis was lower. The patient’s request for a cosmetic outcome was the most highly rated factor. Regarding the influence of patient demographics on surgeons’ attitudes, scar cosmesis in young and female patients was favored in comparison with older and male patients. Factors that reduced the importance of cosmesis were emergency and late-night surgeries followed by lengthy procedures, large incisions, and busy operative lists.

Conclusions:

These initial findings highlight a need to investigate means of fostering a more holistic, impartial approach toward scar cosmesis, as well as addressing potential workplace barriers that may prevent surgeons from seeking a more cosmetic result. Greater alignment between the priorities of surgeons and patients may manifest in objective and subjective improvements in patient’s scars and well-being.
Venous Flap Reconstruction following Wide Local Excision for Primary Cutaneous Malignancies in Extremities
Authors: Deguchi Ayaka , Motomura Hisashi , Hatano Takaharu , Fujikawa Heishiro , Maeda Shusaku
Published: March 2022

Background:

Cutaneous malignancies in the extremities are relatively common, and radical treatment such as ray amputation was performed for certain advanced skin cancer cases in the past. The concept of surgical treatment of primary cutaneous malignant tumor has gradually changed, and preservation of the extremity by performing the appropriate excision and reconstruction became possible. Various reconstructive methods after the resection of malignant tumors such as skin grafts, local flaps, and free flaps, including perforator flaps have been noted. Due to limitations and some disadvantages of these reconstructive materials for extremities, the arterialized venous flap arose as an alternative method. The arterialized venous flap, which has arterial inflow through an afferent vein perfusing the flap and venous outflow through the efferent veins, is considered to function as a great reconstructive material for distal extremities. Although efficacy of this flap has been noted in the past, usage of the flap considering the oncological aspects and application of the flap to the toes and feet have never been reported.

Methods:

Thirteen reconstructive cases from October 2005 to October 2016 using venous flaps after excision of primary cutaneous malignancy in the distal extremities were performed in our institution.

Results:

For all cases, satisfactory functional and cosmetic outcomes were observed.

Conclusions:

Reconstruction using the arterialized venous flap is considered a reliable and versatile method. Careful application of this flap satisfies functional, cosmetic, and oncological aspects of all distal extremities with cutaneous malignancy.
Frontalis Suspension in Muscular Dystrophy: 16-years Follow-up
Authors: Abdulrauf Badr M. I.
Published: March 2022

Acquired eyelid ptosis in adults, with complete loss of levator palpebrae superiosis function, can be a challenging problem to diagnose and treat. A 48-year-old woman with chronic bilateral severe blepharoptosis of 10 years duration is presented, whose neurological investigations excluded myasthenia gravis. The patient was preliminarily diagnosed with chronic progressive external ophthalmoplegia. The levator excursion was negligible, and a frontalis suspension procedure was considered using a conventional autogenous fascia lata graft. An optimal outcome was achieved with over 16-years follow-up. Although the patient was healthy otherwise upon first presentation, 10 years later, she developed other neurologic manifestations, including dysphagia and oral dryness. The fact that blepharoptosis did not recur over the years in this case differentiates an oculo-pharyngeal type of muscular dystrophy in this patient from other types and from the more frequent condition of chronic progressive external ophthalmoplegia.
COMPARISON BETWEEN SCLERAL BUCKLING AND VITRECTOMY IN THE ONSET OF CYSTOID MACULAR EDEMA AND EPIRETINAL MEMBRANE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR
Authors: Gharbiya Magda , Visioli Giacomo , Iannetti Ludovico , Iannaccone Andrea , Tamburrelli Anna Clara , Marenco Marco , Albanese Giuseppe Maria
Published: March 2022

Purpose:

To investigate the incidence and risk factors for the main complications in patients with rhegmatogenous retinal detachment treated with scleral buckling (SB) or pars plana vitrectomy (PPV).

Methods:

A retrospective, comparative, observational study was conducted. The medical records of 107 patients with primary rhegmatogenous retinal detachment who were managed with SB (n = 57) or PPV (n = 50) were reviewed. Scleral buckling was performed using scleral encircling solid silicone band and circumferential solid silicone exoplant to support the break. Pars plana vitrectomy was combined with phacoemulsification in phakic eyes and with scleral encircling in inferior detachments. Follow-ups, including spectral-domain optical coherence tomography examination, were scheduled at 1, 3, and 12 months after surgery. Propensity score matching was used to adjust for potential preoperative selection bias.

Results:

The overall incidence of postoperative cystoid macular edema (CME) and epiretinal membrane was 14.95% and 30.84%, respectively. Compared with SB, CME was more frequent in the PPV (P = 0.021) and in the PPV pseudophakic eyes (P = 0.027). Postoperative CME was an early, predominantly transient complication and regressed in 67% of SB and in 77% of PPV eyes within 12 months after surgery. No differences were observed regarding epiretinal membrane development. Except for the surgical technique, no preoperative factors associated with CME were identified. A correlation between epiretinal membrane and patients' age was found (P = 0.028).

Conclusion:

The incidence of CME after rhegmatogenous retinal detachment repair was higher in patients who underwent PPV, either alone or combined with phacoemulsification, than in those treated with SB. Epiretinal membrane development was correlated to older age, regardless of the surgical procedure.
Delayed intracapsular hematoma after use of iris retractor hooks
Authors: Wagner Isabella V. , Dorairaj Syril K. , Miller Darby D. , Ten Hulzen Richard D. , Stewart Michael W.
Published: March 2022

Introduction:

To the author's knowledge, this is the first reported case of a delayed intracapsular hematoma after complex femtosecond laser–assisted cataract surgery (FLACS) and the use of iris retractor hooks for intraoperative floppy-iris syndrome. It is important that cataract surgeons be aware of this association.

Patient and Clinical Findings:

An 83-year-old man underwent FLACS with astigmatic keratotomy and intraocular lens implantation. Iris retractor hooks were used to counter intraoperative miosis. Hyphema, corneal edema, and subconjunctival hemorrhage were observed on postoperative day (POD) 1. The patient returned on POD 3 with further decrease in vision due to Descemet folds, advanced corneal edema, layered hyphema, and a dense intracapsular hematoma.

Diagnosis, Intervention, and Outcomes:

Minimal improvement of the hematoma occurred through 4 weeks, at which time the hematoma was drained with Nd:YAG laser posterior capsulotomy. The hematoma reabsorbed within 1 month with full recovery of vision.

Conclusions:

The iris retractor hooks in the setting of complex FLACS likely caused postoperative bleeding with accumulation of blood within the capsule. Nd:YAG laser posterior capsulotomy is an effective treatment option for nonclearing intracapsular hematoma.
Effect of prolonged experimental neck pain on exercise-induced hypoalgesia
Authors: Christensen Steffan Wittrup McPhee , Elgueta-Cancino Edith , Simonsen Morten Bilde , Silva Priscila de Brito , Sørensen Line Bay , Graven-Nielsen Thomas , Hirata Rogerio Pessoto
Published: March 2022

Neck pain is a common musculoskeletal problem often accompanied by reduced exercise-induced hypoalgesia (EIH) or hyperalgesia compared with an asymptomatic population. This study investigated EIH in a healthy population during experimental neck pain. Forty participants were randomized into this double-blinded parallel-group study. On 4 separate test days (day 0, day 2, day 4, and day 15), participants completed the Neck Disability Index and scored neck pain intensity during head movements on a numerical rating scale. At the end of day 0 and day 2, nerve growth factor (NGF) or isotonic saline (control) was injected into the right splenius capitis muscle. Pressure pain thresholds (PPTs) were recorded bilaterally over splenius capitis (neck), temporalis (head), and tibialis anterior (leg) muscles on all days. On day 0, day 4, and day 15, PPTs were recorded before and after a hand-bike exercise. Exercise-induced hypoalgesia was defined as the PPT increase caused by the exercise. Compared with the control group, the NGF group demonstrated higher Neck Disability Index scores at day 2 and day 4 (P < 0.001, η2 > 0.557) and higher numerical rating scale scores (P < 0.03, η2 > 0.09) along with reduced neck PPTs (P < 0.01, d > 0.44) at day 2 (right: 95% confidence interval [CI] [26.0-54.0]; left: 95% CI [6.8-26.9]), day 4 (right: 95% CI [40.5-67.9]; left: 95% CI [6.9-28.2]), and day 15 (right: 95% CI [5.6-37.2]; left: 95% CI [6.9-34.8]). Across days, the EIH effect was reduced at the neck site in the NGF group compared with the control group (P < 0.001,

= 0.367, 95% CI [−34.5 to −13.7]). At the head and leg sites, the NGF group showed reduced EIH effect compared with the control group (P < 0.05, d > 0.43) on day 4 (head: 95% CI [−61.4 to −22.9]; leg: 95% CI [−154.7 to −72.4]) and day 15 (head: 95% CI [−54.3 to −7.6]; leg: 95% CI [−122.7 to −34.4]). These results indicate that a few days of clinically comparable neck pain and hyperalgesia might have a negative impact on EIH responses and may help explain why some patients with neck pain do not experience immediate positive effects of exercise.
Pharmacological consideration of COVID-19 infection and vaccines in pregnancy
Authors: Mohapatra Satyajit , Ananda Preethika , Tripathy Saswati
Published: March 2022

COVID-19 is a pandemic of the 21st century that recorded 234 809 103 confirmed cases and more than 4 800 375 deaths. Many studies report the effect of COVID-19 in the overall population; nevertheless, there is information scarceness related to pharmacological management and pregnancy and fetal outcomes during the epidemic. Pregnancy is a state of change in immune physiology and anatomy modulation in preference to immune suppression. Additionally, manifold interactions with the health care system during pregnancy increases the chance of infection, and managing, pregnant population poses a more significant challenge. This review will summarize the available data on pharmacological considerations and vaccines in pregnancy and their adverse effects on fetal outcomes. Several drug choices include but are not limited to antivirals and antimalarial and combinations, corticosteroids, nonsteroidal anti-inflammatory drugs, and antipyretics. Approved vaccines for pregnancy include Pfizer/BioNTech and mRNA-1273 Moderna/National Institutes of Health. COVID-19 treatment approaches vary across different countries; the WHO and the Centers for Disease Control and Prevention guidelines and country regulators advise managing adverse effects on pregnancy and fetal outcome. But the efficacy of these drugs is questionable. There is no adequate literature to demonstrate the safety of these drugs in pregnant and lactating women. Hence, well-conducted studies that assess the safety of anti-COVID-19 medications and vaccines in pregnancy and lactating women are needed.
Diagnostic values of supine and erect abdominal radiographs for patients with acute abdomen: which is better for decision making?
Authors: Lee Chia-Ying , Chen Jen-Dar
Published: March 2022

Background:

Plain abdominal radiography including supine and erect abdominal radiographs (SAR and EAR) is a frequently used image modality for preliminary evaluation of acute abdomen. We aimed to explore which one of the SAR or EAR has a higher diagnostic value in overall diagnosis of acute abdomen, including their respective advantages over each other for the various underlying diseases.

Methods:

We retrospectively analyzed the imaging findings of plain abdominal radiography of patients with acute abdomen who received abdominal computed tomography (CT) within 24 hours at the emergency department of a medical center in northern Taiwan between October 2019 and February 2020. Final diagnosis was made by CT reports and clinical data. The relevance between the imaging findings and clinical diagnosis in the groups of SAR and EAR were compared.

Results:

A total of 1009 cases with acute abdomen were included, of which 341 (33.8%) underwent EAR and 668 (66.2%) underwent SAR. Among them, 820 cases had final diagnosis confirmed by CT and clinical data. In comparison of the diagnostic relevance of SAR and EAR, there were no significant difference in the overall acute abdomen, but EAR showed a better diagnostic relevance in cases with bowel obstruction than SAR did (100% vs 87.2%, p < 0.05). No statistical difference in other abdominal diseases.

Conclusion:

There is no significant difference between SAR and EAR in evaluation of overall acute abdomen. However, EARs has a diagnostic advantage over SAR for evaluation of suspected bowel obstruction.
Sexual Function and Fertility in Males With Vascular Malformations of the Genitourinary Tract and Pelvis
Authors: Stewart Jessica K. , Hartman Terry , Adams Denise M. , Fishman Steven J. , Blatt Julie
Published: March 2022

Objectives:

A subset of males with vascular malformations (VM) have involvement of their genitourinary (GU) tract. The purpose of this study was to survey males with VM to investigate whether patients with GU involvement experience problems with sexual function and fertility.

Methods:

An anonymous survey was designed based on modifications of Patient-Reported Outcomes Measurement Information System and International Index of Erectile Function surveys to examine sexual interest, function, satisfaction, and fertility. Surveys were sent electronically to 709 males 18 years or older (or parents of minor males under age 18) with VM through the Klippel-Trenaunay Support Group, the CLOVES Syndrome Community, and the Lymphangiomatosis & Gorham’s Disease Alliance.

Results:

Evaluable responses were received from 42 surveys (5.9%). Thirty-three of the 42 responses (79%) were from males with VM involving the GU tract (4.6% of surveys sent). Of the 33 with GU VM, 17 (52%) reported one or more problems including pain with masturbation and/or intercourse, bleeding with masturbation and/or intercourse, lack of interest in sex, and erectile dysfunction. Fourteen of 33 reported that they had fathered children. There was no statistically significant difference in these symptoms compared with responses from men with VM not involving the pelvis.

Conclusion:

Males with VM involving or not involving the GU system may experience problems with sexual function and satisfaction. While prospective studies are needed to clarify the prevalence and extent of these symptoms, providers should be aware that such symptoms can occur in this patient population.
Rural Hospital Closures
Authors: Andreyeva Elena , Kash Bita , Averhart Preston Veronica , Vu Lan , Dickey Nancy
Published: March 2022

Background:

Access to health care continues to be a challenge, especially in remote areas. Since 2013, 70 rural hospitals have closed in the United States further exacerbating barriers to health care access in rural areas.

Objective:

The objective of this study is to identify the impact of rural hospital closures on total medical spending and utilization among the commercially insured rural population.

Research Design:

We use a pre-post study design with a comparison group. Individual‐level Texas commercial claims data in 2014–2019 were linked to the Centers for Medicare & Medicaid Services (CMS) Provider of Services Current Files, Area Health Resource File, and Census American Community Survey. We performed an event study to test for pre-trends.

Subjects:

Analysis sample included commercially insured individuals 19–64 years of age residing in Texas.

Measures:

Total medical spending and counts of health care encounters.

Results:

Individuals residing in rural Texas areas affected by a hospital closure experienced decreases in outpatient and emergency department (ED) utilization and no statistically significant changes in total medical spending relative to the unaffected individuals. Outpatient and ED utilization decreased by 0.133 (<0.1) and 0.015 (7<0.05) visits, respectively. Heterogeneity analysis showed that individuals residing in urban Texas experienced increases in total medical spending by $12.2 per month (<0.01) as well as individual spending subcategories.

Conclusions:

Rural hospital closures led to significant decreases in outpatient and ED utilization while having no effect on health care spending. Close attention must be paid to rural hospital closures to ensure equitable health care access, especially for underserved populations.
Autoerotic Death by Electrocution
Authors: McLeod Elizabeth V. , Loughney Elizabeth K. , Baker Andrew M. , Berg Eric W. , Warren Wendy S.
Published: March 2022

Autoerotic death is defined as an accidental death that occurs when some type of apparatus is used to enhance sexual stimulation and causes an unintended death. We present the case of an atypical autoerotic death of a 23-year-old man found deceased in a bathroom. An electrical cord with a standard wall plug on one end and exposed wires twisted into loops on the other end was on the floor near his body. Minute black burns were present on each nipple. The outlet was protected by a ground fault circuit interrupter that was demonstrated to be in working order. An electrical consultant concluded that the cause of death could not be electrocution. Ground fault circuit interrupters work by detecting differences in current within a circuit. If a ground fault occurs, the circuit is broken to prevent a fatal electrocution. In the present case, the ground fault circuit interrupter did not shut off because the decedent had wired himself in parallel with the circuit. This, with the other scene findings, indicated this to be a case of atypical autoerotic death. Autoerotic deaths by means other than asphyxiation are rare. This case serves to illustrate the circumstances of an atypical autoerotic death by means of electrocution.
Low back pain definitions: effect on patient inclusion and clinical profiles
Authors: Massé-Alarie Hugo , Angarita-Fonseca Adriana , Lacasse Anaïs , Pagé M. Gabrielle , Tétreault Pascal , Fortin Maryse , Léonard Guillaume , Stone Laura S. , Roy Jean-Sébastien ,   on behalf of the Quebec Low Back Pain Consortium
Published: March 2022

Introduction:

Numerous definitions of acute low back pain (aLBP) exist. The use of different definitions results in variability in reported prevalence or incidence, conflicting data regarding factors associated with the transition to chronic LBP (cLBP), and hampers comparability among studies.

Objective:

Here, we compare the impact of 3 aLBP definitions on the number of aLBP cases and participants' characteristics and explore the distribution of participants across definitions.

Methods:

A sample of 1264 participants from the Quebec Low Back Pain Study was included. Three definitions of aLBP were used: (1) not meeting the National Institutes of Health (NIH) cLBP definition (“nonchronic”), (2) pain beginning <3 months ago (“acute”), and (3) pain beginning <3 months with a preceding LBP-free period (“new episode”).

Results:

There were 847, 842, and 489 aLBP cases meeting the criteria for the 3 definitions, respectively. Participants included in the “nonchronic” had lower pain interference, greater physical function scores, and fewer participants reporting >5 years of pain than in the other definitions. Half the participants meeting the “acute” definition and one-third of participants meeting the “new episode” definition were also classified as cLBP based on the NIH definition.

Conclusions:

Our results highlight the importance of the definition used for aLBP. Different definitions influence the sample size and clinical profiles (group's characteristics). We recommended that cohort studies examining the transition from aLBP to cLBP ensure that the definitions selected are mutually exclusive (ie, participants included [aLBP] differ from the expected outcome [cLBP]).
Custom-made foot orthoses with and without heel plugs and their effect on plantar pressures during treadmill walking
Authors: Balsdon Megan E. R. , Dombroski Colin E.
Published: March 2022

Background:

Foot orthoses have consistently demonstrated an improvement in pain scores for plantar fasciitis. The fabrication of custom-made foot orthoses (CFOs) can vary between clinicians and may include the use of different materials and casting techniques. This cross-sectional study's objective was to quantify plantar pressure for two CFOs, one with a heel plug (HP) and one without.

Methods:

Fourteen healthy participants (8 men and 6 women; 35.4 ± 7.7 years) were cast by the same practitioner. Both CFOs were made with the same materials and specifications, except for the HP orthosis, which replaced hard material under the heel with a softer blue PORON ® plug for added cushioning. Plantar pressures were recorded during treadmill walking for both devices in a running shoe. Average pressure, peak pressure, and pressure contact area were determined for three regions of the foot: hindfoot, midfoot, and forefoot. A paired samples t-test determined differences in each region (P < 0.05).

Results:

The HP orthosis reduced the overall means of average pressure, peak pressure, and pressure contact area in the hindfoot while tending to increase these measures in the midfoot and forefoot. The three measures showed statistically significant decreases in the hindfoot, whereas a statistically significant increase was seen in average and peak pressures in the midfoot (P < 0.05).

Conclusions:

CFOs with HPs are more effective than regular CFOs in offloading plantar pressures in the hindfoot while increasing pressures in the midfoot. This is an important finding because offloading the hindfoot is critical in pathologies such as plantar fasciitis to decrease pain and increase function.
Prevalence and Risk Factors of Low Bone Mineral Density in HIV/AIDS Patients: A Chinese Cross-Sectional Study
Authors: Meng Weiqing , Chen Meiling , Song Yangzi , Zhang Huan , Xie Ruming , Zhang Fujie
Published: March 2022

Introduction:

Our study aimed to investigate the prevalence and risk factors of low bone mineral density (BMD) among HIV/AIDS patients in China.

Methods:

We performed a cross-sectional analysis of HIV-infected patients from October 2017 to August 2020. Demographic information, clinical data, and serum parameters were obtained. Univariable and multiple logistic regression analyses were performed.

Results:

A total of 1143 patients were included. In the ART-naive group, low BMD was diagnosed in 19.2% (117/608), including osteoporosis in 1.0% (6/608) and osteopenia in 18.3% (111/608). In the ART group, low BMD was diagnosed in 32.2% (231/717), including osteoporosis in 2.4% (17/717) and osteopenia in 29.8% (214/717). Using multivariate analysis, we identified age older than 50 years, body mass index < 18.5 kg/m2, and treatment based on tenofovir disoproxil fumarate as independent risk factors for low BMD. Low high-density lipoprotein cholesterol was a protective factor for low BMD. Among low BMD participants, the most common number of low BMD sites for a patient to have was 4 (33.6%, 117/348).

Conclusion:

We confirmed a high prevalence of low BMD and osteoporosis in HIV/AIDS patients, and we identified age older than 50 years, low body mass index, and a treatment based on tenofovir disoproxil fumarate as risk factors for low BMD. Low high-density lipoprotein cholesterol had a protective effect against low BMD. Among low BMD patients, patients most commonly had 4 sites with low BMD, which has been associated with fracture risk. In addition, bone changes to L1 can present before low BMD diagnosis and may be a potentially useful indicator that low BMD is developing.
How bacteria utilize sialic acid during interactions with the host: snip, snatch, dispatch, match and attach
Authors: Jennings Michael P. , Day Christopher J. , Atack John M.
Published: March 2022

N -glycolylneuraminic acid (Neu5Gc), and its precursor N-acetylneuraminic acid (Neu5Ac), commonly referred to as sialic acids, are two of the most common glycans found in mammals. Humans carry a mutation in the enzyme that converts Neu5Ac into Neu5Gc, and as such, expression of Neu5Ac can be thought of as a ‘human specific’ trait. Bacteria can utilize sialic acids as a carbon and energy source and have evolved multiple ways to take up sialic acids. In order to generate free sialic acid, many bacteria produce sialidases that cleave sialic acid residues from complex glycan structures. In addition, sialidases allow escape from innate immune mechanisms, and can synergize with other virulence factors such as toxins. Human-adapted pathogens have evolved a preference for Neu5Ac, with many bacterial adhesins, and major classes of toxin, specifically recognizing Neu5Ac containing glycans as receptors. The preference of human-adapted pathogens for Neu5Ac also occurs during biosynthesis of surface structures such as lipo-oligosaccharide (LOS), lipo-polysaccharide (LPS) and polysaccharide capsules, subverting the human host immune system by mimicking the host. This review aims to provide an update on the advances made in understanding the role of sialic acid in bacteria-host interactions made in the last 5–10 years, and put these findings into context by highlighting key historical discoveries. We provide a particular focus on ‘molecular mimicry’ and incorporation of sialic acid onto the bacterial outer-surface, and the role of sialic acid as a receptor for bacterial adhesins and toxins.
Prevalence, Clinical Implication, and Cause of Spine Hip Discordance in Elderly Patients with Fragility Hip Fracture
Authors: Lee Kyung-Hag , Park Jung-Wee , Kim Sujin , Lee Guen Young , Park Sung Bin , Yang Du-Bin , Ha Yong-Chan
Published: March 2022

Background: Spine-hip discordance (SHD) increases fracture risk. However, its prevalence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and investigated the cause of SHD in patients with hip fractures.Methods: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients underwent dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Society of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to determine the cause of discordance.Results: Among 1,220 eligible patients, 130 were excluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes.Conclusions: Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.
Cervical Fusion-Requiring Mineral and Bone Disorder Disguised as Osteoporosis in a Chronic Kidney Disease Patient on Hemodialysis: A Case Report
Authors: Lee Jong Weon , Cho Suhyun , Kim Kyung-Min , Park Jung Hyun
Published: March 2022

Bony deformities and fragility fractures in end-stage renal disease (ESRD) patients on long-term hemodialysis can be caused by either osteoporosis or chronic kidney disease-mineral and bone disorder (CKD-MBD). Correct identification of the underlying mechanism is critical since the treatment methods differ, and one treatment approach could negatively affect the other. Cervical kyphosis, severe enough to require immediate surgical treatment, can be caused by uncontrolled CKD-MBD, albeit in limited cases. This report presents the case of a 61-year-old female with an 11-year history of hemodialysis treatment and severe cervical kyphosis with myelopathy, which required 2-stage spinal surgeries. Our report calls for a careful diagnostic approach in ESRD patients with skeletal disorders, the points to consider before calcium replacement, and early detection of fragility fractures in them. Moreover, early mobilization and weight-bearing after the surgical procedure may lead to better neurological and functional improvements.
The tryptophan catabolite or kynurenine pathway in Alzheimer’s disease: a systematic review and meta-analysis
Authors: Almulla Abbas F. , Supasitthumrong Thitiporn , Amrapala Arisara , Tunvirachaisakul Chavit , Abdul Jaleel Al-Karrar Kais , Oxenkrug Gregory , Al-Hakeim Hussein K. , Maes Michael
Published: March 2022

Background

Alzheimer’s disease (AD), characterized by gradual brain dysfunction and memory loss, is one of the major elderly health issues worldwide. Neuroinflammation and increased oxidative stress contribute to the pathophysiology of AD, thereby presumably inducing tryptophan (TRP) degradation through the TRP catabolite (TRYCAT) pathway.

Objectives

To delineate the activity of the TRYCAT pathway along with levels of TRP and tryptophan catabolites (TRYCATs) in AD patients.

Methods

We employed PubMed, Google Scholar, Web of Science, and SciFinder to obtain the relevant articles through a search process lasting the entire February 2022. We found 19 eligible articles which involved 738 patients and 665 healthy controls.

Results

Our result revealed a significant difference (p= 0.008) in the kynurenine (KYN)/TRP ratio (standardized mean difference, SMD = 0.216, 95% confidence interval, CI: 0.057; 0.376), and a significant decrease in TRP in AD patients (SMD = -0.520, 95% CI: -0.738; -0.302, p < 0.0001). Moreover, we also found a significant increase in the central nervous system (CNS, brain and cerebrospinal fluid, CSF) kynurenic acid (KA)/KYN ratio but not in peripheral blood, as well as a significant decrease in plasma KA and xanthurenic acid (XA) in the CNS and blood.

Conclusions

AD is characterized by TRP depletion but not by an overactivity of the TRYCAT pathway. IDO-induced production of neurotoxic TRYCATs is not a key factor in the pathophysiology of AD.
Humoral and cellular immune memory to four COVID-19 vaccines
Authors: Zhang Zeli , Mateus Jose , Coelho Camila H. , Dan Jennifer M. , Moderbacher Carolyn Rydyznski , Gálvez Rosa Isela , Cortes Fernanda H. , Grifoni Alba , Tarke Alison , Chang James , Escarrega E. Alexandar , Kim Christina , Goodwin Benjamin , Bloom Nathaniel I. , Frazier April , Weiskopf Daniela , Sette Alessandro , Crotty Shane
Published: March 2022

Multiple COVID-19 vaccines, representing diverse vaccine platforms, successfully protect against symptomatic COVID-19 cases and deaths. Head-to-head comparisons of T cell, B cell, and antibody responses to diverse vaccines in humans are likely to be informative for understanding protective immunity against COVID-19, with particular interest in immune memory. Here, SARS-CoV-2-spike—specific immune responses to Moderna mRNA-1273, Pfizer/BioNTech BNT162b2, Janssen Ad26.COV2.S and Novavax NVX-CoV2373 were examined longitudinally for 6 months. 100% of individuals made memory CD4+ T cells, with cTfh and CD4-CTL highly represented after mRNA or NVX-CoV2373 vaccination. mRNA vaccines and Ad26.COV2.S induced comparable CD8+ T cell frequencies, though memory CD8+ T cells were only detectable in 60-67% of subjects at 6 months. Ad26.COV2.S was not the strongest immunogen by any measurement, though the Ad26.COV2.S T cell, B cell, and antibody responses were relatively stable over 6 months. A differentiating feature of Ad26.COV2.S immunization was a high frequency of CXCR3+ memory B cells. mRNA vaccinees had substantial declines in neutralizing antibodies, while memory T cells and B cells were comparatively stable over 6 months. These results of these detailed immunological evaluations may also be relevant for vaccine design insights against other pathogens.
The motivational determinants of human action, their neural bases and functional impact in adolescents with OCD
Authors: Perkes Iain E. , Morris Richard W. , Griffiths Kristi R. , Quail Stephanie , Waters Felicity , O’Brien Margo , Hazell Philip L. , Balleine Bernard W.
Published: March 2022

Background

Establishing the motivational influences on human action is essential for understanding choice and decision-making in health and disease. Here we used tests of value-based decision-making, manipulating both predicted and experienced reward values to assess the motivational control of goal-directed action in adolescents and the functional impact of OCD.

Methods

After instrumental training on a two action-two outcome probabilistic task, participants underwent Pavlovian conditioning using stimuli predicting either the instrumental outcomes, a third outcome or nothing. We then assessed fMRI during choice tests in which we varied predicted value, using specific and general Pavlovian-instrumental transfer (PIT), and experienced value, using outcome devaluation.

Results

Both predicted and experienced values influenced the performance of goal-directed actions in healthy adolescent participants, mediated by distinct orbitofrontal (OFC)-striatal circuits involving the lateral-OFC and medial-OFC respectively. To establish their functional significance, we tested a matched cohort of adolescents with obsessive-compulsive disorder (OCD). We found that choice between actions in OCD was insensitive to changes in both predicted and experienced values and that these impairments corresponded to hypoactivity activity in the lateral OFC and hyperactivity in medial OFC during specific PIT and hypoactivity in anterior prefrontal cortex, caudate nucleus and their connectivity in the devaluation test.

Discussion

We found, therefore, that predicted and experienced values exerted a potent influence on the performance of goal-directed actions in adolescents via distinct orbitofrontal- and prefrontal-striatal circuits. The influence of these motivational processes was severely blunted in OCD resulting in dysregulated action control associated with the intrusion of competing actions.
WITHDRAWN: Retinal Microvasculature Alteration in Patients with Rheumatoid Arthritis
Authors: Lee Hsuan-Yi
Published: March 2022

Withdrawal Statement

The authors have withdrawn this manuscript because they have identified areas that require significant modification to ensure the accuracy and reliability of our findings. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
Unified Predictive Model for Endometriosis: Merging Clinical, Self-reporting and Genetic Information
Authors: Blass Ido , Sahar Tali , Shraibman Adi , Ofer Dan , Rappoport Nadav , Linial Michal
Published: March 2022

Endometriosis is a condition characterized by implants of endometrial tissues into extrauterine sites, mostly within the pelvic peritoneum. The prevalence of endometriosis is under-diagnosed, and estimated to account for 5–10% of all women of reproductive age. The goal of this study is to develop a model for endometriosis based on the UK-biobank (UKBB). We partitioned the data into those diagnosed with endometriosis (5,924; ICD-10: N80) and a control group (142,576). We included over 1000 variables from UKBB covering personal information about female health, lifestyle, self-reported data, genetic variants, and medical history prior to endometriosis diagnosis. We applied machine learning algorithms to train an endometriosis prediction model. The optimal prediction was achieved with the gradient boosting algorithms of CatBoost for the data-combined model, with an area under the ROC curve (roc-AUC) of 0.78. We discovered that, prior to being diagnosed with endometriosis, women had significantly more ICD-10 diagnoses than the average unaffected woman. Informative features, ranked by SHAP values included irritable bowel syndrome (IBS) and the length of the menstrual cycle. We conclude that the rich population-based retrospective data from the UKBB is valuable for developing predictive models despite the limitations of missing data and noisy medical input. The informative features of the model may improve clinical utility for endometriosis diagnosis.
Targeting phenotypic plasticity prevents metastasis and the development of chemotherapy-resistant disease
Authors: San Juan Beatriz P , Hediyeh-Zadeh Soroor , Rangel Laura , Milioli Heloisa H , Rodriguez Vanina , Bunkum Abigail , Kohane Felix V , Purcell Carley A , Bhuva Dharmesh D , Kurumlian Anie , Castillo Lesley , Lim Elgene , Gill Anthony J , Ganju Vinod , Dear Rachel , O’Toole Sandra , Vargas A. Cristina , Hickey Theresa E , Goldstein Leonard D , Lock John G , Davis Melissa J , Chaffer Christine L
Published: March 2022

Cancer cells invoke phenotypic plasticity programs to drive disease progression and evade chemotherapeutic insults, yet until now there have been no validated clinical therapies targeting this process. Here, we identify a phenotypic plasticity signature associated with poor survival in basal/triple-negative breast cancer, in which androgen signalling is prominent. We establish that anti-androgen therapies block cancer stem cell function and prevent chemotherapy-induced emergence of new cancer stem cells. In particular, the anti-androgen agent seviteronel synergizes with chemotherapy to improve chemotherapeutic inhibition of primary and metastatic tumour growth and prevent the emergence of chemotherapy-resistant disease. We validate cytoplasmic AR expression as a clinical phenotypic plasticity biomarker that predicts poor survival and poor response to chemotherapy, and positive response to seviteronel plus chemotherapy. This new targeted combination therapy validates modulating phenotypic plasticity as an effective strategy to prevent and treat chemotherapy-resistant cancers with transformative clinical potential.

STATEMENT OF SIGNIFICANCE

There are currently no curative therapies for patients with chemotherapy-resistant cancer. We demonstrate that modulating phenotypic plasticity prevents the emergence of chemotherapy-resistant disease in triple-negative breast cancer. This represents the first known validated clinical therapy leveraging phenotypic plasticity. Moreover, we identify a highly effective anti-androgen drug and a biomarker to select and treat patients best-suited to this new therapy. A clinical trial is underway (NCT04947189).

SUMMARY SENTENCE

Blocking phenotypic plasticity is an effective targeted therapeutic strategy to treat cance
Traumatic Experience and Self-Control in Old Age
Authors: Choung Youngjoo , Pak Tae-Young
Published: March 2022

The behavioral economics literature suggests that exposure to traumatic events shifts preference features like risk aversion and time preference. Drawing on this literature, this study explored the relationship between early life exposure to traumatic events and self-control at older ages. The data were obtained from the Health and Retirement Study, which offers retrospective data on trauma exposure and a measure of self-control. The results showed that the experience of serious physical attacks or assaults was associated with a 3.1% reduction in self-control, above and beyond the influence of demographic characteristics and childhood socioeconomic disadvantages. The mean number of years elapsed since the physical attack was about 30, conditional on exposure, indicating that traumatic experiences early in life exert a lasting influence on self-control. Our findings were consistent with evidence that experiences of natural disasters and armed conflicts increased impatience among survivors.

JEL classification code

D12, D14, D91
Towards Formal Computable Representation of Clinical Trial Eligibility Criteria for Alzheimer's Disease
Authors: Yin Pengfei , Zhang Hansi , HE XING , Diller Matthew , Li Qian , Tian Shubo , Erdengasileng Arslan , He Zhe , Tao Cui , Bian Jiang
Published: March 2022

Ambiguity and misunderstanding of free-text clinical trial eligibility can affect the accuracy of translating trial investigators' mental model of the study population to the correct cohort identification queries. In this pilot study, to eliminate the ambiguity when parsing eligibility criteria, we built ontology-based representations to standardize clinical trial eligibility criteria. We analyzed 10 Alzheimer's disease (AD) trials' eligibility criteria and categorized them into general query patterns using an annotation schema borrowed from the literature on constructing knowledge graphs. Then, for each pattern, we built the corresponding ontological representations, linked them to real-word electronic health record (EHR) data, and constructed cohort identification queries using the neo4j graph database. Our evaluation results of these cohort queries verified the accuracy of our ontology representation; and interestingly, we found that graph-queries achieved better runtime performance for complex study traits. These results indicated that our approach is feasible and potentially beneficial; nevertheless, more systematic and comprehensive investigations are warranted.