bluuebunny/crossref_metadata_2025 huggingface dataset:
Personalized Estimates of Brain Structural Variability in Individuals With Early Psychosis
Authors: Antoniades Mathilde , Haas Shalaila S , Modabbernia Amirhossein , Bykowsky Oleg , Frangou Sophia , Borgwardt Stefan , Schmidt André
Published: January 2021

Background

Early psychosis in first-episode psychosis (FEP) and clinical high-risk (CHR) individuals has been associated with alterations in mean regional measures of brain morphology. Examination of variability in brain morphology could assist in quantifying the degree of brain structural heterogeneity in clinical relative to healthy control (HC) samples.

Methods

Structural magnetic resonance imaging data were obtained from CHR (n = 71), FEP (n = 72), and HC individuals (n = 55). Regional brain variability in cortical thickness (CT), surface area (SA), and subcortical volume (SV) was assessed with the coefficient of variation (CV). Furthermore, the person-based similarity index (PBSI) was employed to quantify the similarity of CT, SA, and SV profile of each individual to others within the same diagnostic group. Normative modeling of the PBSI-CT, PBSI-SA, and PBSI-SV was used to identify CHR and FEP individuals whose scores deviated markedly from those of the healthy individuals.

Results

There was no effect of diagnosis on the CV for any regional measure (P > .38). CHR and FEP individuals differed significantly from the HC group in terms of PBSI-CT (P < .0001), PBSI-SA (P < .0001), and PBSI-SV (P = .01). In the clinical groups, normative modeling identified 32 (22%) individuals with deviant PBSI-CT, 12 (8.4%) with deviant PBSI-SA, and 21 (15%) with deviant PBSI-SV; differences of small effect size indicated that individuals with deviant PBSI scores had lower IQ and higher psychopathology.

Conclusions

Examination of brain structural variability in early psychosis indicated heterogeneity at the level of individual profiles and encourages further large-scale examination to identify individuals that deviate markedly from normative reference data.
Integrative Computational Approaches to Inform Relative Bioaccumulation Potential of Per- and Polyfluoroalkyl Substances Across Species
Authors: Cheng Weixiao , Doering Jon A , LaLone Carlie , Ng Carla
Published: January 2021

Predictive toxicology is increasingly reliant on innovative computational methods to address pressing questions in chemicals assessment. Of importance is the evaluation of contaminant impact differences across species to inform ecosystem protection and identify appropriate model species for human toxicity studies. Here we evaluated 2 complementary tools to predict cross-species differences in binding affinity between per- and polyfluoroalkyl substances (PFAS) and the liver fatty acid-binding protein (LFABP): the Sequence Alignment to Predict Across Species Susceptibility (SeqAPASS) tool and molecular dynamics (MD). SeqAPASS determined that the structure of human LFABP, a key determinant of PFAS bioaccumulation, was conserved in the majority of vertebrate species, indicating these species would have similar PFAS bioaccumulation potentials. Level 3 SeqAPASS evaluation identified several potentially destabilizing amino acid differences across species, which were generally supported by DUET stability change predictions. Nine single-residue mutations and 7 whole species sequences were selected for MD evaluation. One mutation (F50V for PFNA) showed a statistically significant difference with stronger affinity than wild-type human LFABP. Predicted binding affinities for 9 different PFAS across 7 species showed human, rat, chicken, and rainbow trout had similar binding affinities to one another for each PFAS, whereas Japanese medaka and fathead minnow had significantly weaker LFABP-binding affinity for some PFAS. Based on these analyses, the combined use of SeqAPASS and MD provides rapid screening for potential species differences with deeper structural insight. This approach can be easily extended to other important biological receptors and potential ligands.
Rapid ethical appraisal of stakeholder views on research prior to undertaking immunopathogenesis studies on podoconiosis in northeast Ethiopia during a period of social instability
Authors: Negash Mikias , Chanyalew Menberework , T Gebresilase Tewodros , Sintayehu Bizunesh , Anteye Temesgen , Aseffa Abraham , Newport Melanie J
Published: January 2021

Background

Undertaking research and attaining informed consent can be challenging when there is political unrest and community mistrust. Rapid ethical appraisal (REA) is a tool that uses qualitative methods to explore sociocultural issues that may affect the ethical conduct of research.

Methods

We used REA in northeast Ethiopia shortly following a period of unrest, during which violence against researchers occurred, to assess stakeholder perceptions of research, researchers and the informed consent process. We held 32 in-depth interviews and 2 focus group discussions.

Results

Most community members had little awareness about podoconiosis or healthcare research. Convincing the community to donate blood for research is challenging due to association with HIV testing. The attack on researchers was mainly motivated by the community's mistrust of their intentions against the background of a volatile political situation. Social media contributed to the spread of misinformation. Lack of community engagement was also a key contributing factor.

Conclusions

Using REA, we identified potential barriers to the informed consent process, participant recruitment for data and specimen collection and the smooth conduct of research. Researchers should assess existing conditions in the study area and engage with the community to increase awareness prior to commencing their research activities.
Delays in lymphatic filariasis elimination programmes due to COVID-19, and possible mitigation strategies
Authors: Prada Joaquín M , Stolk Wilma A , Davis Emma L , Touloupou Panayiota , Sharma Swarnali , Muñoz Johanna , Caja Rivera Rocio M , Reimer Lisa J , Michael Edwin , de Vlas Sake J , Hollingsworth T Déirdre
Published: January 2021

Background

In view of the current global coronavirus disease 2019 pandemic, mass drug administration interventions for neglected tropical diseases, including lymphatic filariasis (LF), have been halted. We used mathematical modelling to estimate the impact of delaying or cancelling treatment rounds and explore possible mitigation strategies.

Methods

We used three established LF transmission models to simulate infection trends in settings with annual treatment rounds and programme delays in 2020 of 6, 12, 18 or 24 months. We then evaluated the impact of various mitigation strategies upon resuming activities.

Results

The delay in achieving the elimination goals is on average similar to the number of years the treatment rounds are missed. Enhanced interventions implemented for as little as 1 y can allow catch-up on the progress lost and, if maintained throughout the programme, can lead to acceleration of up to 3 y.

Conclusions

In general, a short delay in the programme does not cause a major delay in achieving the goals. Impact is strongest in high-endemicity areas. Mitigation strategies such as biannual treatment or increased coverage are key to minimizing the impact of the disruption once the programme resumes and lead to potential acceleration should these enhanced strategies be maintained.
Preconditioning with Foam-mediated External Suction on Flap Microvasculature and Perfusion in a Rodent Model
Authors: Mohan Anita T. , Zhu Lin , Michalak Gregory J. , Laungani Alexis T. , Vercnocke Andrew J. , Moran Steven L. , Saint-Cyr Michel
Published: January 2021

Background:

Foam-mediated external suction (FMES) has previously shown to improve tissue microcirculation. We hypothesized that preconditioning fasciocutaneous perforator flaps with FMES would augment perfusion and demonstrate greater capillary recruitment.

Methods:

Gluteal perforator flaps were designed on sixteen 400 g rats. Continuous FMES at −125 mm Hg was applied on one side (intervention) to precondition tissue for 5 days, with the contralateral side as a paired control. In group A, we assessed changes following pretreatment, after surgery, and 7 days postprocedure, and in group B, we evaluated changes during preconditioning alone. In group A (N = 8), control and intervention flaps were assessed using laser-assisted indocyanine green fluorescence angiography. In group B, flap regions were assessed using 4-dimensional computed tomographic angiography. All flaps were analyzed for microvessel density using micro–computed tomography and histological assessment using hematoxylin and eosin and CD3 immunohistochemistry.

Results:

Thirty-two flaps were included in this study (N = 16 intervention and matched controls). Four-dimensional computed tomographic angiography demonstrated 17% greater tissue perfusion in preconditioned flaps (mean, 78.7 HU; SD, 8.8) versus controls (mean, 67.3 HU; SD, 15.7; P < 0.01). Laser-assisted indocyanine green fluorescence angiography showed a 30% higher mean absolute intensity in preconditioned flaps versus controls (P < 0.01). Postsurgery mean absolute intensity in preconditioned flaps remained 21% higher than in controls (P = 0.03). Preconditioned flaps demonstrated a 2-fold increase in mean vessel volume of 9.1 mm3 (SD, 7) versus 4.5 mm3 (SD, 3) in controls (P = 0.04); there was a 33% higher mean area fraction of CD31 in preconditioned flaps, 3.9% (SD, 3) versus 2.9% (SD, 3) in controls (P = 0.03).

Conclusion:

FMES preconditioning has the potential to augment vascularity of tissue for flap harvest; however, further experimental studies are required to optimize strategies and evaluate long-term effects for clinical applications.
Combined Horizontal Split Gluteus Maximus Muscle and Fasciocutaneous Limberg Flaps for Reconstruction of Recurrent Sacrococcygeal Pilonidal Sinus
Authors: Ahmad Mahfouz S. I. , Eltayeb Hazem
Published: January 2021

Background:

Pilonidal sinus is a chronic recurrent medical disease. The exact etiology of the disease is still unknown, but the most accepted theory is an acquired condition characterized by infected sinus in the natal cleft area containing a lifeless hair tuft. Multiple techniques were prescribed for its treatment; however, the ideal method is not yet defined.

Methods:

The study population includes 58 male patients who underwent excision of their recurrent pilonidal sinus, and the resulting defects were reconstructed using combined horizontal split gluteus maximus flaps and rhomboid flaps. Outcomes were revised from patient case files and followed up in our outpatient clinic and via questionnaires.

Results:

The mean hospital stay was 3 days. The mean time to return to work was 16 days. Partial wound dehiscences occurred in 2 patients. Distal end flap necrosis occurred in 1 patient. There were no flap losses, no recurrences, no infections, no loss of function, and no seromas during a mean follow-up period of 24 months. All patients were satisfied with the results.

Conclusions:

This technique has an operative time and hospital stays comparable to those of other techniques. It has minimal and acceptable complication rates and no recurrences. We can conclude that this procedure of combined split gluteus maximus muscle flap and rhomboid flap provides an excellent, effective, easy, and feasible method of choice for reconstructing defects of recurrent pilonidal sinus disease.
Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study
Authors: Buitrago Giancarlo , Caballero Felipe , Montealegre Giovanni E.
Published: January 2021

Background:

The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated.

Methods:

A retrospective cohort study was performed using administrative data from patients of all ages diagnosed with head and neck cancer who underwent FTT between 2013 and 2016 in Colombia’s contributory health system. Postoperative mortality rates were estimated at 30, 90, and 180 days, as well as reintervention rates at 30 and 90 days. Total healthcare costs were calculated. Generalized linear models were generated to determine prognostic factors associated with outcomes.

Results:

A total of 485 patients were included, 215 (44.33%) of which were women. Mean age was 61.4 years. Mortality rate was 3.09 at 30 days, 9.28 at 90 days, and 15.26 at 180 days, per 100 surgeries. Reintervention rate was 5.77 at 30 days and 8.25 at 90 days, per 100 surgeries. The 30-day reintervention rate was lower for 40- to 59-year-old group and for a Charlson Index ≤ 3. The median total healthcare cost of an episode was USD 12,403.68 (interquartile range, 5754–16,736). The bivariate and multivariate models determined that age, the Charlson Index, and geographic region were associated with outcomes.

Conclusion:

For patients undergoing FTT in Colombia, differences in reintervention and total costs incurred by the national health system exist, and these differences are associated with age, the Charlson Index, and the geographic region.
Pediatric Malignancies in Plastic Surgery: Case Report of Facial Leukemia Cutis
Authors: Gargya Vipul , Hoogendoorn Joris , Kahn Alissa R. , Bascone Corey , Podda Silvio
Published: January 2021

Skin and soft tissue lesion removal contributes significantly to both academic and private plastic surgery practices. When encountering various types of dermatologic diseases, it is crucial for a plastic surgeon to exercise caution and consider further medical evaluation before proceeding with local excision of any abnormal skin growth, especially those that involve the face in the pediatric or adolescent population. In this case report, we discuss the case of a child who presented with a primary cutaneous skin lesion involving the left nasal ala, which was ultimately diagnosed as B-cell acute lymphoblastic leukemia. This case is reported to highlight B-cell acute lymphoblastic leukemia for plastic and reconstructive surgeons so that it can be included in the differential when encountering fast growing cutaneous lesions of the face in children.
Late Bleed after Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Authors: Pferdehirt Rachel E. , Nahabedian Maurice Y.
Published: January 2021

Late bleed following deep inferior epigastric perforator (DIEP) flap breast reconstruction is an uncommon event. In this case report, the authors describe a case of late bleed 7 months following the index operation. This occurred in the setting of strenuous exercise. No specific etiology was determined and the condition resolved without treatment.
Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp
Authors: Baldelli Ilaria , Mangialardi Maria Lucia , Salgarello Marzia , Raposio Edoardo
Published: January 2021

Background:

Scalp reconstruction in cases of melanoma excision can be challenging due to specific functional and aesthetic outcome requirements. Reconstructive techniques reported in the literature were reviewed to establish whether a surgical algorithm for the management of melanoma of the scalp may be deduced.

Methods:

A literature search was conducted to evaluate reconstructive strategies after melanoma wide local excision of the scalp according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were English language, diagnosis of melanoma of the scalp, and the presence of the following data: characteristics of the residual defect (width and depth), type of reconstruction, follow-up, and surgical outcome.

Results:

Six hundred twenty-five records were identified after excluding the duplicates; 48 full-text articles were assessed for eligibility, and 17 records were selected for inclusion. A total of 39 patients were included in the review. The majority of patients (n = 20) underwent skin grafting subsequent to dermal regeneration template positioning. Local flaps (n = 10), free flaps (n = 7), skin grafting alone (n = 1), and dermal regeneration template positioning alone (n = 1) were less frequent.

Conclusions:

Numerous reconstructive strategies for the scalp are described in the literature. Melanoma patients present a greater variability in terms of general health conditions and social needs that must be taken into account while choosing the most suitable procedure.
Current Trends in Prepectoral Breast Reconstruction: A Survey of American Society of Plastic Surgeons Members
Authors: Marks Jacob M. , Farmer Rebecca L. , Afifi Ahmed M.
Published: January 2021

Background:

Prepectoral implant-based breast reconstruction has recently gained increasing popularity, but there are limited data regarding national trends in the use of this technique. Our aim was to determine practice patterns related to prepectoral breast reconstruction among plastic surgeons, as well as to identify perceived advantages and disadvantages of this technique.

Methods:

A 16-question electronic survey tool was distributed to 2535 members of the American Society of Plastic Surgeons. Survey items focused on surgeon practices related to prepectoral reconstruction, in addition to their motivations for and concerns with performing the procedure.

Results:

A total of 274 responses were received (10.8% response rate). Nearly half of respondents (48.4%) reported using prepectoral techniques in all or most of their procedures. Decreased animation deformity was identified as the most significant advantage by 76.3% of respondents. Increased rippling and potential wound healing complications were identified as the most significant disadvantages to the procedure by 49.1% and 40.4% of respondents, respectively. The majority of surgeons reported using acellular dermal matrices in their procedures, with most surgeons demonstrating preferences for cohesive and shaped devices.

Conclusions:

Prepectoral breast reconstruction is being widely adopted by plastic surgeons, with the majority of surgeons in our sample using prepectoral techniques in their practices. Responses demonstrate that this technique offers several perceived advantages, most notably the avoidance of animation deformity. However, our data also highlight that there are still many unanswered questions in the community about the complication profile and technical aspects of prepectoral techniques that warrant further investigation.
Quantifying Inequitable Access to Rapid Burn and Reconstructive Care through Geospatial Mapping
Authors: Lo Steven , Ampomah Opoku , Ankrah Levi , Darko Kwame , Bertozzi-Villa Amelia
Published: January 2021

Time-critical pathologies, such as the care of burn-injured patients, rely on accurate travel time data to plan high-quality service provision. Geospatial modeling, using data from the Malaria Atlas Project, together with census data, permits quantification of the huge global discrepancies in temporal access to burn care between high-income and low-resource settings. In this study, focusing on the United Kingdom and Ghana, we found that a 3-fold population difference exists with, respectively, 95.6% and 29.9% of the population that could access specialist burn care within 1-hour travel time. Solutions to such inequalities include upscaling of infrastructure and specialist personnel, but this is aspirational rather than feasible in most low- to middle-income countries. Mixed models of decentralization of care that leverage eHealth strategies, such as telemedicine, may enhance quality of local burns and reconstructive surgical care through skills transfer, capacity building, and expediting of urgent transfers, while empowering local healthcare communities. By extending specialist burn care coverage through eHealth to 8 district hospitals in rural Ghana, we demonstrate the potential to increase specialist population coverage within 1-hour travel time from 29.9% to 45.3%—equivalent to an additional 5.1 million people.
Entrapment Neuropathy Causing Persistent Headache Symptoms after Nonsurgical Rhinoplasty
Authors: Benjamin Martin , McGregor Andrew , Yousif Sarah , Shaikh Dooniya , Reish Richard G.
Published: January 2021

Background:

The frequency of nonsurgical rhinoplasty has increased in recent years. The occurrence of headaches or migraine symptoms, and their treatment following nonsurgical rhinoplasty, have been scarcely described in the literature. Here, we present a patient who presented with subjective complaints of a new onset headache immediately after nonsurgical rhinoplasty, with subsequent reversal of her symptoms using hylauronidase. Furthermore, a literature review was conducted to establish a possible anatomical pathophysiologic mechanism of these symptoms seen in this patient.

Methods:

A case report of a patient who developed persistent headache symptoms after nonsurgical rhinoplasty, with reversal of symptoms using hylaronidase, is described. A literature review of studies on patients developing headaches or migraine-like symptoms after nonsurgical rhinoplasty was conducted, along with a review of the anatomic causes of migraines.

Results:

Of the 147 relevant citations identified in our search, only 1 individual case report describes a patient who developed a migraine headache after undergoing a nonsurgical rhinoplasty via an injection of hyaluronic acid filler. This was promptly resolved with the utilization of a hyaluronidase injection. The majority of the relevant articles in our search focused on the alarming and most feared complication of vascular compromise of the nasal tissue and intravascular embolization. Within the literature, there was no case series of nonsurgical-rhinoplasty-induced migraines taking into account our inclusion criteria.

Conclusions:

This article demonstrates the paucity of literature regarding nonsurgical-rhinoplasty-induced headaches. Although a causation effect cannot be linked, our study highlights a rare phenomenon associated with this ever-increasing aesthetic procedure.
Pediatric Ectopic Nail Formation following Fingertip Trauma: A Case Report and Literature Review
Authors: Fleury Christopher M. , Nasser Jacob S. , Aivaz Marudeen , Mantilla-Rivas Esperanza , Manrique Monica , Oh Albert K. , Boyajian Michael J. , Rogers Gary F.
Published: January 2021

Post-traumatic ectopic nail is an uncommon entity that is occasionally observed after trauma to the fingertip and nail, resulting in aesthetic and functional morbidity. We report a case of post-traumatic ectopic nail in a 3-year-old girl following trauma to her index finger and subsequent surgical intervention to remove an inclusion cyst. The unusual clinical sequence is presented to highlight the etiology and treatment of this rare lesion.
Associations of the nocturnal blood pressure fall and morning surge with cardiovascular events and mortality in individuals with resistant hypertension
Authors: Cardoso Claudia R.L. , Salles Gil F.
Published: January 2021

Objective:

The prognostic importance of the nocturnal blood pressure (BP) fall and early-morning surge were scarcely investigated in patients with resistant hypertension (RHT). We investigated them in a prospective cohort of 1726 RHT individuals.

Methods:

The nocturnal fall and morning surge were calculated from the baseline ambulatory BP monitoring (ABPM) and also as mean cumulative values using all ABPMs performed during follow-up. Dipping patterns (normal, extreme, reduced, and reverse) were defined by classic cut-off values of the night-to-day ratio, while MS (difference between early-morning and night-time BP) was categorized into quartiles and at the extremes of its distribution (5th, 10th, 90th, and 95th percentiles). The primary outcomes were total cardiovascular events (CVEs), major adverse cardiovascular events (MACEs), all-cause and cardiovascular mortalities. Multivariate Cox analyses examined the associations between nocturnal BP fall and morning surge and outcomes.

Results:

Over a median follow-up of 8.3 years, 417 CVEs occurred (358 MACEs), and 391 individuals died (233 cardiovascular deaths). Reduced and reverse dipping patterns were significant predictors of CVEs and MACEs, with hazard ratios between 1.6 and 2.5, whereas extreme dipping was a protective factor in younger individuals (hazard ratios 0.3--0.4) but a hazardous factor in elderly (hazard ratios 3.7--5.0) and in individuals with previous cardiovascular diseases (hazard ratios 2.6--4.4). No morning surge parameter was predictive of any outcome in fully adjusted analyses.

Conclusion:

Abnormal dipping patterns but not the early-morning BP surge, were important prognostic markers for future cardiovascular morbidity in RHT patients. The prognosis of extreme dippers depended on age and the presence of cardiovascular diseases.
COMPARISON OF SINGLE DRUSEN SIZE ON COLOR FUNDUS PHOTOGRAPHY AND SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Authors: Kim Dong Yoon , Loo Jessica , Farsiu Sina , Jaffe Glenn J.
Published: January 2021

Purpose:

To determine the relationship of drusen size as determined by spectral-domain optical coherence tomography (SD-OCT) with that measured on registered color fundus photography (CFP) images and to derive an OCT-based classification system that was comparable with that determined by CFP.

Methods:

Custom software was developed to register CFP images to the scanning laser ophthalmoscopy fundus images obtained simultaneously with the corresponding SD-OCT images, so that individual drusen observed on CFP could be matched with those seen on SD-OCT. Single druse size (diameter, area, volume, and height) on CFP and SD-OCT images from a phase two clinical trial was determined with the Duke OCT Retinal Analysis Program.

Results:

The sizes of 213 individual drusen were measured on CFP and SD-OCT. The drusen diameter measured on CFP was significantly correlated with those determined on SD-OCT (R: 0.879, P < 0.001). Based on the corresponding formula: drusen diameter on SD-OCT = 0.77 × (drusen diameter on CFP) + 50.67 µm, large drusen defined as ≥125 µm on CFP had a diameter ≥145 µm on OCT, medium drusen defined as 63 µm to 124 µm on CFP had diameters 100 µm to 144 µm on OCT, and small drusen defined as <63 µm on CFP had diameters <100 µm on OCT.

Conclusion:

With our registration software and imaging processing algorithms, we were able to correlate individual druse sizes measured on CFP with those determined on SD-OCT. These data can be used to develop an SD-OCT-based grading scale, analogous to the CFP Age-Related Eye Disease Study drusen scale that may be useful in the clinic and in clinical trials.
Subretinal Injection Under Perfluorocarbon Liquids to Avoid Foveal Dehiscence
Authors: Steel David H. , Geraghty Brendan , Kearns Victoria , Stanzel Boris , Wong David
Published: January 2021

summary:

We describe a novel technique modification of subretinal injection to reduce the risk of foveal dehiscence during subretinal tissue plasminogen activator delivery for submacular haemorrhage, using a perfluorocarbon liquid filled vitreous cavity and an eccentric injection point, with a viscous fluid injector system controlled injection.

Purpose:

To describe a novel method of subretinal injection to reduce the risk of foveal dehiscence during subretinal tissue plasminogen activator delivery for submacular hemorrhage.

Method:

Description of technique with illustrative case description and details of four cases treated. The subretinal injection is delivered under a perfluorocarbon liquid bubble filling 80% of the vitreous cavity. An eccentric injection point is used and the tissue plasminogen activator injected under a pneumatically controlled viscous fluid injection system with a 38-g polyimide cannula and low injection pressure.

Results:

Four cases have been treated with controlled subretinal injection extending under the fovea without dehiscence, including one case with apparent preexisting foveal dehiscence and a preretinal clot.

Conclusion:

The technique allows the creation of a low more diffuse subretinal bleb compared with without perfluorocarbon liquid, minimizing hydraulic stress on the fovea during injection and could be applied to other subretinal injection scenarios where the fovea is at risk of hydraulic blowout. Further experience of the technique is needed to validate this initial report.
Corneal Edema Visualization With Optical Coherence Tomography Using Deep Learning: Proof of Concept
Authors: Zéboulon Pierre , Ghazal Wassim , Gatinel Damien
Published: January 2021

Purpose:

Optical coherence tomography (OCT) is essential for the diagnosis and follow-up of corneal edema, but assessment can be challenging in minimal or localized edema. The objective was to develop and validate a novel automated tool to detect and visualize corneal edema with OCT.

Methods:

We trained a convolutional neural network to classify each pixel in the corneal OCT images as “normal” or “edema” and to generate colored heat maps of the result. The development set included 199 OCT images of normal and edematous corneas. We validated the model's performance on 607 images of normal and edematous corneas of various conditions. The main outcome measure was the edema fraction (EF), defined as the ratio between the number of pixels labeled as edema and those representing the cornea for each scan. Overall accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve were determined to evaluate the model's performance.

Results:

Mean EF was 0.0087 ± 0.01 in the normal scans and 0.805 ± 0.26 in the edema scans (P < 0.0001). Area under the receiver operating characteristic curve for EF in the diagnosis of corneal edema in individual scans was 0.994. The optimal threshold for distinguishing normal from edematous corneas was 6.8%, with an accuracy of 98.7%, sensitivity of 96.4%, and specificity of 100%.

Conclusions:

The model accurately detected corneal edema and distinguished between normal and edematous cornea OCT scans while providing colored heat maps of edema presence.
Immunogenicity of Vero Cell Culture-derived Japanese Encephalitis Vaccine in Pediatric and Young Hematopoietic Stem Cell Transplantation Recipients
Authors: Assawawiroonhakarn Surapat , Apiwattanakul Nopporn , Pakakasama Samart , Hongeng Suradej , Anurathapan Usanarat , Yoksan Sutee , Klinmalai Chompunuch , Sae-Chew Pattarana , Techasaensiri Chonnamet
Published: January 2021

Background:

Children and young adults undergoing hematopoietic stem cell transplantation (HSCT) typically lose their immunity to vaccine-preventable diseases, including Japanese encephalitis (JE). Revaccination against JE in this population has not been well characterized.

Methods:

This prospective study evaluated the immunogenicity of inactivated Vero cell culture-derived JE vaccine in children and young adults (<25 years of age) who had completed HSCT >1 year prior. Each patient received inactivated Vero cell culture-derived JE vaccine at enrollment and 1 month after enrollment, as well as a booster dose 13 months after enrollment. Serum JE plaque reduction neutralization test and JE-specific T lymphocyte count assay were performed at baseline, 1 month after the second dose, on the day of the booster dose, and 1 month after the booster dose.

Results:

Thirty-seven patients were enrolled. At baseline, 15 patients (40.5%) had plaque reduction neutralization titer >10, which is considered protective. Among 22 seronegative patients, 15 (68.2%) and 19 (86.4%) exhibited seroconversion after revaccination and booster dose, respectively. Median JE-specific T lymphocyte counts also increased. Twenty of 111 (18.0%) vaccination doses resulted in self-limiting side effects.

Conclusions:

The inactivated Vero cell culture-derived JE vaccine may be safe and effective for immunization against JE virus in children and young adults who have undergone HSCT.
Acute Pancreatitis in a Teenager With SARS-CoV-2 Infection
Authors: Paz Liborio , Eslava Edgar , Ribes María , Mayer Erick F.
Published: January 2021

The clinical manifestations of SARS-CoV-2 infection, the causative agent of COVID-19, mainly involve the respiratory system. However, there is increasing evidence that this virus can affect other organs causing a wide arrange of clinical symptoms. In this report, we present the case of 14-year-old boy with acute abdominal pain, with laboratory and radiologic findings consistent with acute pancreatitis, without any risk factors except for a SARS-CoV-2 infection.
Just4Us: Development of a Counselor-Navigator and Text Message Intervention to Promote PrEP Uptake Among Cisgender Women at Elevated Risk for HIV
Authors: Teitelman Anne M. , Koblin Beryl A. , Brawner Bridgette M. , Davis Annet , Darlington Caroline , Lipsky Rachele K. , Iwu Emilia , Bond Keosha T. , Westover Julie , Fiore Danielle , Tieu Hong-Van
Published: January 2021

In the United States, pre-exposure prophylaxis (PrEP) uptake among eligible cisgender women has been slow, despite the availability of oral PrEP since 2012. Although women make up nearly 20% of those living with HIV, there are currently few PrEP uptake interventions for cisgender women at elevated risk for acquiring HIV. Here we describe the process used to design and pre-pilot test Just4Us, a theory-based behavioral intervention to promote PrEP initiation and adherence among PrEP-eligible cisgender women. This work was part of a multiphase study conducted in New York City and Philadelphia, two locations with HIV rates higher than the national average. The counselor-navigator component of the intervention was designed to be delivered in a 60- to 90-min in-person session in the community, followed by several phone calls to support linkage to care. An automated text messaging program was also designed for adherence support. Just4Us addressed personal and structural barriers to PrEP uptake using an empowerment framework by building on women's insights and resources to overcome barriers along the PrEP cascade. Usability pre-pilot testing results were favorable and provided valuable feedback used to refine the intervention.
Depressive Symptoms Predict Delayed Ambulation After Traumatic Injury
Authors: Higgins Jacob T. , Lennie Terry A. , Frazier Susan K.
Published: January 2021

Background:

Impaired psychological state, such as anxiety and depressive symptoms, occurs in up to 40% of patients hospitalized for traumatic injury. These symptoms, in the acute period, may delay engagement in activity, such as ambulation, following injury. The purpose of this study was to determine whether baseline anxiety and depressive symptoms predicted delayed (>48 hr from admission) ambulation in patients hospitalized for major traumatic injury.

Methods:

Adults (n = 19) admitted for major trauma (Injury Severity Score [ISS] = 15) provided a baseline measure of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]). Logistic regression was used to determine the predictive power of baseline HADS Anxiety and HADS Depression subscale scores for delayed ambulation while controlling for ISS.

Results:

At baseline, anxiety was present in 32% of patients; 21% reported depressive symptoms. Baseline HADS Anxiety score did not predict the ambulation group. However, for each 1 point increase in baseline HADS Depression score, the likelihood of patients ambulating after 48 hr from admission increased by 67% (odds ratio = 1.67; 95% CI [1.02, 2.72]; p = .041).

Conclusion:

Worsening depressive symptoms were associated with delayed ambulation in the acute period following injury. Future, larger scale investigations are needed to further elucidate the relationship between psychological symptoms and the acute recovery period from trauma to better inform clinicians and guide development of interventions to improve patient outcomes.
Desmopressin for Antiplatelet-Associated Intracranial Hemorrhage: A Concise Review
Authors: Geiger Haden , Samai Kathryn
Published: January 2021

Objective

To provide a concise review of the literature on desmopressin use for antiplatelet reversal in patients with intracranial hemorrhage.

Data Sources

Source data were obtained from a PubMed literature review.

Study Selection:

Studies addressing desmopressin for antiplatelet reversal.

Data Extraction:

Relevant studies were reviewed and included through consensus of the authors. The following aspects of each study were identified, abstracted, and analyzed: study population, study design, methods, results, and relevant implications for practice.

Data Synthesis

A growing body of evidence continues to provide mixed results for the use of desmopressin in patients presenting with antiplatelet-associated intracranial hemorrhage. The potential benefit outweighs the possible risks associated with a one-time dose. In addition to desmopressin, platelets should only be considered in patients undergoing a neurosurgical procedure until further and superior evidence is available. Guidelines recommend a weight-based approach for desmopressin dosing at 0.4 mcg/kg over 30 min.

Conclusions

The available evidence supports desmopressin as potentially beneficial with minimal risk for use in patients with antiplatelet-associated intracranial hemorrhage.
Genomics of aging: Genes, adducts, and telomeres
Authors: Wysocki Kenneth , Seibert Diane
Published: January 2021

Genomics influences the aging process in many different ways. This 10-part series of articles describes what is known about genetics and aging, including genes, adducts, and telomeres, decreased immune defenses, oxidation and inefficient mitochondria, toxins and radiation, glycosylation, caloric intake and sirtuin production, neurotransmitter imbalance, hormone mechanisms, reduced nitric oxide, and stem cell slowdown. This first article explores gene adducts as an epigenetic “sludge,” the influence of telomeres and other mutations that contribute to DNA dysfunction, cell stress, and premature aging. Factors that contribute to adduct formation and reduced telomere length are presented along with some changes in behavior, environmental exposure, food/supplement use, weight, sleep, and exercise that have been found to reduce damage, potentially increasing longevity. Adherence to a Mediterranean diet that contains fruits and whole grains along with fiber, antioxidants (e.g., beta-carotene, vitamins C and E), omega-3 fatty acids, and soy protein may reduce DNA adducts and protect telomeres. So providers may want to recommend these simple but key clinical and individual changes to enhance DNA health, wellness, and longevity.
Assessment and management of agitation, sleep, and mental illness in the surgical ICU
Authors: Ortiz Damaris
Published: January 2021

Purpose of review

Increased focus on patient-centered outcomes, mental health, and delirium prevention makes this review timely and relevant for critical care.

Recent findings

This review focuses on patient-centered outcomes in the ICU, highlighting the latest research to promote brain health and psychological recovery during and after perioperative critical illness. Topics include sedation in the obese patient, delirium severity assessments, the role of the Psychiatry Consultation-Liaison in the ICU, Post-intensive care syndrome, and the importance of family engagement in the COVID era.

Highlighting new research, such as novel implementation strategies in addition to a lack of research in certain areas like sleep in the ICU may lead to innovation and establishment of evidence-based practices in critical care. Perioperative brain health is multifaceted, and an increase in multidisciplinary interventions may help improve outcomes and decrease morbidity in ICU survivors.
The limitations of evidence: increasing data and increasing doubt in the treatment of cardiac arrest
Authors: Berg Katherine M.
Published: January 2021

Purpose of review

Cardiac arrest is one of the most challenging disease processes to study with clinical trials due to the emergent and unpredictable nature of these events and complexity of the patient population. In recent years, there has been a major push to complete more large, multicentre trials. In many cases, however, there remains little certainty on what treatments are most efficacious, in spite of the recent increase in evidence. This review was undertaken to address some of the unique barriers to address answering research questions in cardiac arrest with clinical trials.

Recent findings

Multiple examples of trials that have failed to reach definitive conclusions, and potential reasons for this, are discussed.

Trials on multiple major cardiac arrest interventions, including temperature management, drugs during cardiopulmonary resuscitation (CPR) and airway management, now have high-quality randomized trials, but significant questions on efficacy and best practices remain. Common pitfalls and reasons for this are explored, including heterogeneity of patients and providers, variability in exact interventions studied, delay in starting research interventions and lack of consistency across systems in decision making around appropriateness for resuscitation.
Identification of acute kidney injury subphenotypes
Authors: Endre Zoltan H. , Mehta Ravindra L.
Published: January 2021

Purpose of review

AKI is a complex clinical syndrome with many causes and there is a broad range of clinical presentations that vary according to duration, severity and context. Established consensus definitions of AKI are nonspecific and limited to kidney function. This reduces treatment options to generic approaches rather than individualized, cause-based strategies that have limited both understanding and management of AKI.

Recent findings

The context and the temporal phase of kidney injury are critical features in the course of AKI and critical to timing-relevant intervention. These features are missing in generic definitions and terms used to describe AKI. Subphenotypes of AKI can be identified from novel damage biomarkers, from functional changes including creatinine trajectories, from the duration of change and from associated clinical characteristics and comorbidities. Subphenotype parameters can be combined in risk scores, or by association strategies ranging from a simple function-damage matrix to complex methods, such as machine learning. Examples of such strategies are reviewed along with tentative proposals for a revised nomenclature to facilitate description of AKI subphenotypes.

Appropriate intervention requires refinement of the nomenclature of AKI to identify subphenotypes that facilitate correctly timed and selectively targeted intervention.
Management of coeliac disease patients after the confirmation of diagnosis in Central Europe
Authors: Riznik Petra , De Leo Luigina , Dolinsek Jasmina , Gyimesi Judit , Klemenak Martina , Koletzko Berthold , Koletzko Sibylle , Koltai Tunde , Korponay-Szabó Ilma Rita , Krencnik Tomaz , Milinovic Marina , Not Tarcisio , Palcevski Goran , Sblattero Daniele , Werkstetter Katharina Julia , Dolinsek Jernej
Published: January 2021

Background

Recently published paediatric guidelines for diagnosing coeliac disease do not include recommendations on the follow-up of coeliac disease patients.

Goal

The aim of this study was to assess the management practices and experience of coeliac disease patients with their follow-up appointments in Central Europe.

Study

Gastroenterologists and coeliac disease patients in five Central European countries were asked to complete the web-based questionnaire focusing on coeliac disease management practices.

Results

Answers from 147 gastroenterologists and 2041 coeliac disease patients were available for the analysis. More than half of the gastroenterologists (58.5%) schedule the first follow-up visit within 3 months after the diagnosis. At follow-up, tissue transglutaminase antibodies are checked in almost all patients (95.9%). Approximately two-thirds (60.7%) of gastroenterologists refer all of their patients to the dietitian at diagnosis. Similarly, 42.8% of coeliac disease patients reported that they had not been appointed to a dietitian. Almost one-third of coeliac disease patients (30.8%) reported that they had no follow-up appointments with gastroenterologist at all.

Conclusions

Follow-up of coeliac disease patients is suboptimal in Central Europe. Many patients are not followed regularly. A lot of patients are not referred to a dietitian. The recommendations on the optimal follow-up of coeliac disease patients are needed in order to improve patient care.
Adjustment of Patient Experience Surveys for How People Respond
Authors: Cefalu Matthew , Elliott Marc N. , Hays Ron D.
Published: January 2021

Background:

Patient surveys are the primary tool to measure patient experiences of care. Caution must be taken when analyzing these data, as responses can be influenced by factors that do not reflect the quality of care received.

Objectives:

To provide a practical overview of adjusting patient experience survey results to address bias related to patient case-mix, extreme response tendency, and mode of survey administration.

Research Design:

We discuss options for adjustment for biases in how people respond to patient experience surveys.

Results:

Case-mix adjustment (CMA) aims to compare provider performance that would have been observed if all providers had treated the same set of patients by removing the effects of patient characteristics that vary across providers. Extreme response tendency can bias the measurement of the disparities in patient experiences even after typical CMAs, since differences in patients’ use of extreme response options may affect patient experience scores when they have a skewed distribution. Survey mode may affect scores for the provider entity being evaluated (eg, hospital) more than CMA if survey mode differs at the provider level.

Conclusions:

It is best practice to evaluate known source of bias when analyzing patient experience surveys. Failure to adjust for patient case-mix, extreme response tendency, and survey mode in patient experience surveys may lead to erroneous comparisons of providers.
Kamishibai Cards
Authors: Stewart Stephanie
Published: January 2021

Background:

Kamishibai (K) cards are a quality improvement process focused on improved bundle compliance and promotion of peer-to-peer feedback that the health system has used for a few years.

Problem:

Changing personnel structure and an emphasis on patient outcomes prompted a need to revamp the K Card process.

Approach:

A team approach was used to redesign the process resulting in a program that moved from utilization of champions to engaging all bedside nurses and having a standard completion requirement for all units. In 2 phases spanning 16 weeks, the nurse managers, point-of-care educators, and all bedside nurses were trained in the process using a computer-based training module and validated in the application of the process.

Outcomes:

By the end of the 16-week period, the completion compliance target was reached, and the system began to see a decrease in central line and Foley catheter device usage days.

Conclusion:

The result of the project design was a peer-to-peer feedback mechanism, which promotes evidence-based practices and system standards.