bluuebunny/crossref_metadata_2025 huggingface dataset:
Concurrent Validity of the School Outcomes Measure and the School Function Assessment in Elementary Students
Authors: Klug Kimberly B. , Kolobe Thubi H. A. , James Shirley A. , Arnold Sandra H.
Published: January 2021

Purpose:

Examine the concurrent validity of the School Outcomes Measure (SOM) and the School Function Assessment (SFA) in students kindergarten through sixth grade.

Methods:

Twenty-four school-based therapists completed the SOM and the SFA for 42 students, representing Gross Motor Function Classification System (GMFCS) levels I to V.

Results:

Correlation coefficients between SOM Self-Care, Mobility, and Assuming Student's Role median total scores and the 21 SFA Activity Performance scale median criterion scores were statistically significant. There were significant correlation coefficients between SOM Expressing Learning and Behavior and SFA median criterion scores. The SOM differentiated between GMFCS groups for all physical tasks but not cognitive/behavioral tasks, and the SFA for half of the physical tasks.

Conclusions:

Overall, student performance on the SOM was consistent with participation on the SFA, which lends support to the preliminary validity of the SOM. The GMFCS analysis suggests that the SOM differentiates between the GMFCS levels for physical tasks.
Perceived Barriers Before and After a 3-Month Period of Modified Ride-On Car Use
Authors: Logan Samuel W. , Feldner Heather A. , Bogart Kathleen R. , Catena Michele A. , Hospodar Christina M. , Raja Vora Joseline , Smart William D. , Massey William V.
Published: January 2021

Purpose:

The purpose of the study is to examine how perceived barriers change before and after a 3-month period of modified ride-on car use.

Methods:

This study used a qualitative content analysis of perceived barriers. Fourteen caregivers (13 mothers; 1 grandmother) responded to a single-question, free-response survey before and after a 3-month period of modified ride-on car use.

Results:

A total of 11 and 20 perceived barriers were reported before and after the 3-month period. Environmental barriers were the most frequently reported before and after the 3-month period.

Conclusions:

Pediatric physical therapists need to be aware of the potential perceived barriers that families may experience in regard to young children with disabilities using modified ride-on cars and determine strategies to support families on an individual basis.
Stander Use in Spinal Muscular Atrophy: Results From a Large Natural History Database
Authors: Townsend Elise L. , Simeone Sarah D. , Krosschell Kristin J. , Zhang Ren Zhe , Swoboda Kathryn J.
Published: January 2021

Purpose:

The purpose of this study was to describe stander use in a natural history cohort of drug therapy-naïve children with spinal muscular atrophy (SMA) who are not walking and identify factors associated with consistent stander use.

Methods:

Data from 397 children with SMA types 1 and 2 characterized the prevalence and frequency of stander use. Predictors of consistent stander use explored were SMA type, survival motor neuron 2 gene (SMN2) copy number, respiratory support, and motor performance.

Results:

Prevalence of consistent stander use was 13% in type 1 and 68% in type 2. SMA type, SMN2 copy number, respiratory support, and head rotation control each predicted consistent stander use.

Conclusions:

Findings characterize stander use in children with SMA who are not walking, address important safety considerations, identify factors that may inform physical therapists' clinical decision-making related to standing program prescription, and provide guidance for future prospective studies.
Trends in Psychiatric Residency Education and Practice From 1944 to 2019: A Loving, Informal, and Highly Personal Review Served With Gently Roasted Sacred Cow
Authors: YAGER JOEL
Published: January 2021

In celebration of the American Psychiatric Association’s 175th anniversary, the author presents an overview of major trends in psychiatric residency education over the past 75 years, from 1944 to 2019, using narrative review and personal perspectives infused with occasional irreverence. In both 1944 and today in 2020, psychiatric educators have been challenged by having too many patients, too few clinicians, too few teachers, and too little knowledge. Over the course of these years, psychiatric residency training has adapted and evolved in response to major ongoing shifts in psychiatric practice patterns shaped by economic, social, and cultural forces, academic regulations and processes, roles for psychiatry vis-à-vis other health and mental health professions, diagnostic and scientific models, psychotherapeutic, psychosocial, and biological treatment paradigms, methods of education, and methods of educational evaluation. Trends in psychiatric education have moved from loosely and irregularly structured clinical and didactic curricula to much more highly regulated and bureaucratized program requirements and processes, from faith-based beliefs and practices to increasing reliance on evidence-based faith, from the availability of Federal funds directly supporting stipends and teachers to the disappearance of those funds, from few to increasing numbers of women entering psychiatry (and all of medicine), and persistent concerns about recruiting excellent and diverse US medical school graduates into residency. Psychiatric educators will continue to help generate, synthesize, sustain, and disseminate meaningful narratives and to prepare future generations of psychiatric residents armed with iteratively better myths and conceptualizations about human nature, purpose, and our place in the universe—and about how to better confront and reduce psychiatric suffering through psychotherapeutic, psychosocial, and biological treatment strategies. Trends are onward and upward.
Application of Next Generation Quality/Statistical Process Control and Expert-Led Case Review to Increase the Consistency of Diagnostic Rates in Precancerous Colorectal Polyps
Authors: Bonert Michael , Collins Andrew , Xenodemetropoulos Ted , Dmetrichuk Jennifer M. , Al-Haddad Sahar , Major Pierre , Naqvi Asghar
Published: January 2021

Background:

Prior work suggests high interrater variability in the pathologist diagnostic rate (PDR) of the precancerous polyp sessile serrated adenoma (SSA).

Objectives:

To improve the diagnostic consistency in the pathological evaluation of colorectal polyp specimens with diagnostic rate awareness, using funnel plots (FPs)/control charts (CCs), and a focused group case review.

Methods:

All colorectal polyp specimen (CRPS) reports September 2015 to August 2017 were analyzed at one institution. PDRs were extracted using a hierarchical free-text string matching algorithm and visualized using FPs, showing pathologist specimen volume versus PDR, and CCs, showing pathologist versus normed PDR. The FPs/CCs were centered on the group median diagnostic rate (GMDR). Pathologists were shown their baseline SSA diagnostic rate in relation to the practice, and in January 2017, there was a focused group case review/open discussion of approximately 40 sequential cases signed as SSA with a gastrointestinal pathology expert.

Results:

Nine pathologists interpreted more than 250 CRPSs per year. FPs/CCs for the first and second years showed 6/4 and 3/1 P < .05/P < .001 pathologist outliers, respectively, in relation to the GMDR for SSA and 0/0 and 0/0 P < .05/P < .001 pathologist outliers, respectively, in relation to the GMDR for tubular adenoma (TA). An in silico kappa (ISK) for SSA improved from 0.52 to 0.62.

Conclusion:

Diagnostic rate awareness facilitated by FPs/CCs coupled with focused expert-led reviews may help calibrate PDR. Variation in SSA PDRs still remains high in relation to TA. ISK represents an intuitive, useful metric and Next Generation Quality/Statistical Process Control a promising approach for objectively increasing diagnostic consistency.
Evaluation of the Relationship Between Midpalatal Suture Maturation Indicators as Predictors for Surgically-Assisted and Conventional Rapid Maxillary Expansion
Authors: Acar Yasemin Bahar , Abuhan Ece
Published: January 2021

Rapid maxillary expansion (RME) is an effective orthopedic procedure to correct maxillary transversal deficiency in young patients. In cases of sutural closure, surgically assisted RME is used to reduce the resistance to sutural disjunction. Foundation of a diagnostic relationship between maturation indices and the expected skeletal response to expansion can enable clinicians to identify the need for surgically assisted RME prospectively. The primary aim of this study was to assess the correlation between the amount of achieved skeletal expansion with midpalatal suture density on computed tomography images, and the secondary aim was to assess the correlation between the amount of achieved skeletal expansion with the recently suggested midpalatal suture maturation indicators: cervical vertebral maturation (CVS), midpalatal suture maturation stage (MPSM) and midpalatal suture density ratio. Forty Digital Imaging and Communications in Medicine data from the archived computed tomography scans of 20 patients (mean age: 15.55 years) before RME (T1) and after 3-month retention period (T2) were analyzed. The tested maturity indicators did not show statistically significant correlation between the skeletal effect proportions. However, clinically and radiologically effective RME was seen in MPSMs A, B, and C and also cervical vertebra stages CVS5 and CVS6. More research is needed to determine a diagnostic predictor for the skeletal effects of maxillary expansion treatment modalities.
Three-Dimensional Stereophotogrammetry in the Evaluation of Craniosynostosis: Current and Potential Use Cases
Authors: Abdel-Alim Tareq , Iping Rik , Wolvius Eppo B. , Mathijssen Irene M.J. , Dirven Clemens M.F. , Niessen Wiro J. , van Veelen Marie-Lise. C. , Roshchupkin Gennady V.
Published: January 2021

Three-dimensional (3D) stereophotogrammetry is a novel imaging technique that has gained popularity in the medical field as a reliable, non-invasive, and radiation-free imaging modality. It uses optical sensors to acquire multiple 2D images from different angles which are reconstructed into a 3D digital model of the subject's surface. The technique proved to be especially useful in craniofacial applications, where it serves as a tool to overcome the limitations imposed by conventional imaging modalities and subjective evaluation methods. The capability to acquire high-dimensional data in a quick and safe manner and archive them for retrospective longitudinal analyses, provides the field with a methodology to increase the understanding of the morphological development of the cranium, its growth patterns and the effect of different treatments over time.

This review describes the role of 3D stereophotogrammetry in the evaluation of craniosynostosis, including reliability studies, current and potential clinical use cases, and practical challenges. Finally, developments within the research field are analyzed by means of bibliometric networks, depicting prominent research topics, authors, and institutions, to stimulate new ideas and collaborations in the field of craniofacial 3D stereophotogrammetry.

We anticipate that utilization of this modality's full potential requires a global effort in terms of collaborations, data sharing, standardization, and harmonization. Such developments can facilitate larger studies and novel deep learning methods that can aid in reaching an objective consensus regarding the most effective treatments for patients with craniosynostosis and other craniofacial anomalies, and to increase our understanding of these complex dysmorphologies and associated phenotypes.
Reconstruction of Combined Orbital Floor and Medial Wall Fractures Using Custom-Made Titanium Alloy Implant
Authors: Kitabata Reina , Uno Kayoko , Sakamoto Yoshiaki
Published: January 2021

The reconstruction of combined orbital floor and medial wall fractures is challenging due to the surgical approach and implant stability. A 0.5 mm thickness rigidity custom made titanium alley implant was created by 3-dimensional printing with electron-beam additive manufacturing. The implant was designed to cover the entire surface of the inferomedial orbit based on the flipped the contralateral orbit images. Although the cost was expensive, the use of three-dimensional printed implants for extensive orbital wall fractures was useful for decreasing operative time, and can be accessed with a limited surgical approach with a precise fit.
Olfactory and Gustatory Dysfunctions in COVID-19 Patients: From a Different Perspective
Authors: Polat Burcu , Yilmaz Nesrin Helvaci , Altin Gökhan , Atakcan Zeynep , Mert Ali
Published: January 2021

Purpose:

The prevalence of sensory disorders (smell and/or taste) in affected patients has shown a high variability of 5% to 98% during the COVID-19 outbreak, depending on the methodology, country, and study. Loss of smell and taste occurring in COVID-19 cases are now recognized by the international scientific community as being among the main symptoms of the disease. This study investigates loss of smell and taste in outpatients and hospitalized patients with laboratory-confirmed COVID-19 infection.

Methods:

Enrolled in the study were patients with a positive PCR test for COVID-19. Excluded were patients with chronic rhinosinusitis, nasal polyposis, common cold, influenza, and olfactory/gustatory dysfunction predating the pandemic. Patients were asked about changes in their sense of smell and taste by structured questionnaire. Their status was classified according to severity of the symptoms.

Results:

A total of 217 patients were included in the study, of whom 129 received outpatient treatment, whereas 88 were hospitalized; mean age was 41.74 years (range18–76), 59.4% were male. At evaluation for olfactory dysfunction, 53.9% of the patients were found to be normal, whereas 33.2% were anosmic. No gustatory dysfunction was found in 49.8% of patients, whereas in those with loss of taste, the most commonly recorded symptom was ageusia. Anosmia was significantly more common in outpatients (P = 0.038). Presentation of chemosensorial symptoms in women was higher than in men (P = 0.009). No correlation was found between olfactory and gustatory dysfunction and age (P = 0.178).

Conclusions:

About one-half of our patients presented olfactory and/or gustatory deficits, and loss of smell was more common in mild cases. It should be considered; a sudden, severe, and isolated loss of smell and/or taste may also be present in COVID-19 patients who are otherwise asymptomatic. We suggest that identification of persons with these signs and early isolation could prevent spread of the disease in the community.
Outcomes in Orbital Floor Trauma: A Comparison of Isolated and Zygomaticomaxillary-Associated Fractures
Authors: Prabhu Shamit S. , Hemal Kshipra , Runyan Christopher M.
Published: January 2021

Orbital floor fractures are common sequalae of trauma to the orbit. These fractures present as an isolated orbital floor (I-OF) fracture or with other midface fractures, typically the zygomaticomaxillary complex. The authors sought to better understand the differences in patient presentation, surgical decision-making, and outcomes in I-OF fractures compared with those associated with zygomaticomaxillary complex fractures (Z-OF). A retrospective review of patients with orbital floor fractures was conducted to generate an I-OF fracture group and a Z-OF fracture group. Demographics, preoperative symptoms, surgical choices, and postoperative complications were assessed. Complications were assessed individually and as 2 composite groups consisting of orbital complications and eyelid complications. There were 156 patients that met inclusion criteria with 75 I-OF fractures and 81 Z-OF fractures. The most common mechanism of injury for I-OF fractures was assault (34.7%) and motor vehicle accidents (39.5%) for Z-OF fractures. The I-OF group presented more often with diplopia (P = 0.01) whereas the Z-OF group had more trauma symptoms (P = 0.01), which included subconjunctival hemorrhages, retrobulbar hemorrhages, and relative afferent pupillary defects. I-OF fractures had longer preoperative observational periods (P < 0.001). Postoperatively, I-OF fractures had more motility restrictions (P = 0.002) but Z-OF fractures had higher risk for eyelid complications (P = 0.03). There was no significant difference in reoperation rates (P = 0.93). Multivariate analysis showed Z-OF fractures had reduced a rate of postoperative motility defects by 72% (P = 0.03) but had 2.6 times higher risk of eyelid complications (P = 0.04). Z-OF fractures present differently, vary in surgical management, and have complications that differ from an I-OF fracture.
A Complication of Mycobacterium chelonae Infection Following Orbital Floor Fracture Repair
Authors: Ghodke Ameer , Mims Mark M. , Shah Rupali N. , Clark J. Madison
Published: January 2021

Mycobacterium chelonae is a rare, atypical nontuberculous bacterium that has been reported to be an underlying cause of persistent wound infections. Although there are several studies highlighting the role of M chelonae as the putative cause of other postoperative wound infections, to our knowledge there are no reports of infection following implant placement for repair of an orbital floor fracture. The authors present a unique case describing the management of a persistent postoperative infection in a young, immunocompetent patient with an orbital floor fracture repaired with a Stryker Medpor Titan implant. The patient was initially treated with broad-spectrum antibiotics with minimal clinical improvement. Following culture-proven M chelonae, a second surgical intervention was undertaken to remove the implant and later, a third intervention for scar revision. The patient has remained free of infection utilizing a long-term tailored 2-drug antibiotic regimen. This case emphasizes the need for recognition of M chelonae as a potential pathogen in certain clinical situations and the difficulty in eradicating M chelonae in the context of infected implantable devices. The comprehensive treatment protocol required to ensure adequate therapy is reviewed.
Lacrimal Duct Obstruction Caused by Nasomaxillary Fracture: A Retrospective Analysis of Consecutive 12 Patients by Computed Tomographic Dacryocystography
Authors: Hasegawa Yuki , Niimi Yosuke , Kamei Wataru , Ikeda Karin , Sakurai Hiroyuki
Published: January 2021

Nasomaxillary fracture is a characteristic mid-facial fracture, and there are no reports showing the fracture damaging the nasolacrimal system (NLS). This report described nasomaxillary fracture cases with NLS damages, which were assessed by computed tomographic dacryocystography (CT-DCG). A retrospective cohort study of nasomaxillary fractures diagnosed by CT was conducted from 2007 to 2015. Twelve patients (mean age: 27.5 years) were found, and their clinical symptoms were as follows: nasal deformity in 10 patients, infra-orbital hypoesthesia in 7, epiphora in 5, and diplopia in one. CT-DCG was performed for 2 patients who complained epiphora, and obstruction was found in 1 patient. All patients underwent open reduction and internal fixation (ORIF), and epiphora in 5 patients was improved. One patient, however, complained epiphora postoperatively, which was supposed to be due to the unsuitable screw insertion. Since nasomaxillary fracture could give NLS obstruction, CT-DCG is useful for diagnosis. Although ORIF is an optimal treatment, attention is needed to avoid the lacrimal canal in screwing on the nasomaxillary buttress.
Rates of Anastomotic Complications and Their Management Following Esophagectomy
Authors:   Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative
Published: January 2021

Objective:

This study aimed to characterize rates and management of anastomotic leak (AL) and conduit necrosis (CN) after esophagectomy in an international cohort.

Background:

Outcomes in patients with anastomotic complications of esophagectomy are currently uncertain. Optimum strategies to manage AL/CN are unknown, and have not been assessed in an international cohort.

Methods:

This prospective multicenter cohort study included patients undergoing esophagectomy for esophageal cancer between April 2018 and December 2018 (with 90 days of follow-up). The primary outcomes were AL and CN, as defined by the Esophageal Complications Consensus Group. The secondary outcomes included 90-day mortality and successful AL/CN management, defined as patients being alive at 90 day postoperatively, and requiring no further AL/CN treatment.

Results:

This study included 2247 esophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% (n = 319) and CN rate was 2.7% (n = 60). The overall 90-day mortality rate for patients with AL was 11.3%, and increased significantly with severity of AL (Type 1: 3.2% vs. Type 2: 13.2% vs. Type 3: 24.7%, P < 0.001); a similar trend was observed for CN. Of the 329 patients with AL/CN, primary management was successful in 69.6% of cases. Subsequent rounds of management lead to an increase in the rate of successful treatment, with cumulative success rates of 85.4% and 88.1% after secondary and tertiary management, respectively.

Conclusion:

Patient outcomes worsen significantly with increasing AL and CN severity. Reintervention after failed primary anastomotic complication management can be successful, hence surgeons should not be deterred from trying alternative management strategies.
Cognitive impairment in older adults with cancer
Authors: Lloyd-Williams Mari , Mogan Caroline , Harrison Dening Karen
Published: January 2021

Purpose of review

Cognitive impairment is increasing in an ageing population and as people live longer, they are more likely to develop cancer therefore cognitive impairment and cancer are frequently co-occurring. We reviewed articles published since 2018 on cognitive impairment and cancer.

Recent findings

The current review has focused on diagnosis, treatment and palliative and end of life care. A comprehensive systematic review reported joint cancer and cognitive impairment prevalence from 0.2 to 45.6%. The review reported there was reduced likelihood of patients with co-occurring cognitive and cancer receiving information regarding cancer stage, reduced cancer treatment with curative intent and limited pain and symptom management. Further studies emphasized the role of family carers in supporting patients with cognitive impairment through cancer treatment.

Disappointingly in an area where the numbers of patients with cognitive impairment and cancer are increasing, there appears to be little recently published research in this area. We conclude that further research is required to determine how best to support patients with cognitive impairment and cancer and families during diagnosis of cancer, treatment and continuing care and most importantly the findings of all studies are implemented within clinical practice.
How to Preserve Liver Grafts From Circulatory Death With Long Warm Ischemia? A Retrospective Italian Cohort Study With Normothermic Regional Perfusion and Hypothermic Oxygenated Perfusion
Authors: De Carlis Riccardo , Schlegel Andrea , Frassoni Samuele , Olivieri Tiziana , Ravaioli Matteo , Camagni Stefania , Patrono Damiano , Bassi Domenico , Pagano Duilio , Di Sandro Stefano , Lauterio Andrea , Bagnardi Vincenzo , Gruttadauria Salvatore , Cillo Umberto , Romagnoli Renato , Colledan Michele , Cescon Matteo , Di Benedetto Fabrizio , Muiesan Paolo , De Carlis Luciano
Published: January 2021

Background.

Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE).

Methods.

We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program.

Results.

In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001).

Conclusions.

These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.
Immunological Determinants of Liver Transplant Outcomes Uncovered by the Rat Model
Authors: Wang Xinle , MacParland Sonya A. , Perciani Catia T.
Published: January 2021

For many individuals with end-stage liver disease, the only treatment option is liver transplantation. However, liver transplant rejection is observed in 24%–80% of transplant patients and lifelong drug regimens that follow the transplant procedure lead to serious side effects. Furthermore, the pool of donor livers available for transplantation is far less than the demand. Well-characterized and physiologically relevant models of liver transplantation are crucial to a deeper understanding of the cellular processes governing the outcomes of liver transplantation and serve as a platform for testing new therapeutic strategies to enhance graft acceptance. Such a model has been found in the rat transplant model, which has an advantageous size for surgical procedures, similar postoperative immunological progression, and high genome match to the human liver. From rat liver transplant studies published in the last 5 years, it is clear that the rat model serves as a strong platform to elucidate transplant immunological mechanisms. Using the model, we have begun to uncover potential players and possible therapeutic targets to restore liver tolerance and preserve host immunocompetence. Here, we present an overview of recent literature for rat liver transplant models, with an aim to highlight the value of the models and to provide future perspectives on how these models could be further characterized to enhance the overall value of rat models to the field of liver transplantation.
Improvements in Functional Status Among Survivors of Orthotopic Heart Transplantation Following High-risk Bridging Modalities
Authors: Huckaby Lauren V. , Hickey Gavin , Sultan Ibrahim , Kilic Arman
Published: January 2021

Background.

The 2018 heart allocation change has resulted in greater frequency of high-risk bridging to orthotopic heart transplantation (OHT). Although survival has been studied in these patients, functional status outcomes are less established. This study evaluated changes in functional status of OHT survivors based on bridging strategy.

Methods.

Adults (≥18 y) undergoing OHT between January 2015 and March 2020 were stratified by bridging modality: no bridging, inotropes only, intra-aortic balloon pump (IABP), temporary ventricular assist device (VAD), durable VAD, and extracorporeal membrane oxygenation (ECMO). Using paired analysis, the Karnofsky performance scale (0–100) was utilized to compare differences in function at listing, transplant, and follow-up.

Results.

In total, 13 142 patients underwent OHT. At the time of both listing and transplant, patients requiring IABP, temporary VAD, and ECMO displayed the lowest functional status (each median 20) compared with other groups (P < 0.001). Among survivors, the median performance status at follow-up was ≥80 for all groups, indicating total functional independence with no assistance required. Substantial improvement in Karnofsky score occurred from transplant to follow-up in survivors bridged with IABP (40), temporary VADs (60), and ECMO (50) (each P < 0.001). Among survivors with at least 90-day follow-up, the median Karnofsky score was 90 regardless of bridging modality.

Conclusions.

Despite a higher mortality risk, critically ill patients who survive OHT after bridging with high-risk modalities experience acceptable functional status outcomes. These findings are important to place in the context of the impact that the 2018 allocation change has had on the landscape of OHT in the United States.
Controls of Hyperglycemia Improves Dysregulated Microbiota in Diabetic Mice
Authors: Cao Mengtao , Peng Yuanzheng , Lu Ying , Zou Zhicheng , Chen Jiao , Bottino Rita , Knoll Michael , Zhang Hanchen , Lin Shan , Pu Zuhui , Sun Liang , Fang Zhoubin , Qiu Chuanghua , Dai Yifan , Cai Zhiming , Mou Lisha
Published: January 2021

Background.

Type 1 diabetes (T1DM) is a chronic autoimmune disease characterized by T-cell–mediated destruction of insulin-producing beta cells. Evidence shows that patients with T1DM and mice used in specific diabetic models both exhibit changes in their intestinal microbiota and dysregulated microbiota contributes to the pathogenesis of T1DM. Islet transplantation (Tx) is poised to play an important role in the treatment of T1DM. However, whether treatment of T1DM with islet Tx can rescue dysregulated microbiota remains unclear.

Methods.

In this study, we induced diabetic C57BL/6 mice with streptozotocin. Then treatment with either insulin administration, or homogenic or allogenic islet Tx was performed to the diabetic mice. Total DNA was isolated from fecal pellets and high-throughput 16S rRNA sequencing was used to investigate intestinal microbiota composition.

Results.

The overall microbial diversity was comparable between control (nonstreptozotocin treated) and diabetic mice. Our results showed the ratio of the Bacteroidetes: Firmicutes between nondiabetic and diabetic mice was significant different. Treatment with islet Tx or insulin partially corrects the dysregulated bacterial composition. At the genus level, Bacteroides, Odoribacter, and Alistipes were associated with the progression and treatment efficacy of the disease, which may be used as a biomarker to predict curative effect of treatment for patients with T1DM.

Conclusions.

Collectively, our results indicate that diabetic mice show changed microbiota composition and that treatment with insulin and islet Tx can partially correct the dysregulated microbiota.
Ex Vivo Expanded Donor Alloreactive Regulatory T Cells Lose Immunoregulatory, Proliferation, and Antiapoptotic Markers After Infusion Into ATG-lymphodepleted, Nonhuman Primate Heart Allograft Recipients
Authors: Ezzelarab Mohamed B. , Zhang Hong , Sasaki Kazuki , Lu Lien , Zahorchak Alan F. , van der Windt Dirk J. , Dai Helong , Perez-Gutierrez Angelica , Bhama Jay K. , Thomson Angus W.
Published: January 2021

Background.

Regulatory T cell (Treg) therapy is a promising approach to amelioration of allograft rejection and promotion of organ transplant tolerance. However, the fate of infused Treg, and how this relates to their therapeutic efficacy using different immunosuppressive regimens is poorly understood. Our aim was to analyze the tissue distribution, persistence, replicative activity and phenotypic stability of autologous, donor antigen alloreactive Treg (darTreg) in anti-thymocyte globulin (ATG)-lymphodepleted, heart-allografted cynomolgus monkeys.

Methods.

darTreg were expanded ex vivo from flow-sorted, circulating Treg using activated donor B cells and infused posttransplant into recipients of major histocompatibility complex-mismatched heart allografts. Fluorochrome-labeled darTreg were identified and characterized in peripheral blood, lymphoid, and nonlymphoid tissues and the graft by flow cytometric analysis.

Results.

darTreg selectively suppressed autologous T cell responses to donor antigens in vitro. However, following their adoptive transfer after transplantation, graft survival was not prolonged. Early (within 2 wk posttransplant; under ATG, tacrolimus, and anti-IL-6R) or delayed (6–8 wk posttransplant; under rapamycin) darTreg infusion resulted in a rapid decline in transferred darTreg in peripheral blood. Following their early or delayed infusion, labeled cells were evident in lymphoid and nonlymphoid organs and the graft at low percentages (<4% CD4+ T cells). Notably, infused darTreg showed reduced expression of immunoregulatory molecules (Foxp3 and CTLA4), Helios, the proliferative marker Ki67 and antiapoptotic Bcl2, compared with preinfusion darTreg and endogenous CD4+CD25hi Treg.

Conclusions.

Lack of therapeutic efficacy of infused darTreg in lymphodepleted heart graft recipients appears to reflect loss of a regulatory signature and proliferative and survival capacity shortly after infusion.
The Frequency of Carotid Intraplaque Hemorrhage on Vessel Wall Imaging in Patients With Retinal Artery Occlusion: A Cross-Sectional Prevalence Study
Authors: Larson Anthony S. , Chen John J. , Bhatti M. Tariq , Klaas James P. , Lanzino Giuseppe , Huston John , Brinjikji Waleed
Published: January 2021

Background:

Intraplaque hemorrhage (IPH) in a carotid artery plaque viewed on vessel wall imaging has been shown to be associated with ischemic stroke. Whether such an association between carotid IPH and retinal artery occlusion (RAO) exists remains unknown.

Methods:

This was a cross-sectional prevalence study. Medical and imaging records of all patients who underwent neck MRA with plaque imaging sequences at our institution from 2015 to 2020 were retrospectively reviewed. Fourteen patients with confirmed RAO and plaque imaging performed within 6 weeks of presentation were included. A group of 211 patients without a prior ischemic event (RAO, stroke, etc.) with plaque imaging were used as controls. A single artery from control patients was randomly selected. The prevalence of IPH and degree of ipsilateral carotid stenosis were compared between RAO and control patients. Multiple regression analysis was performed to determine independent associations between variables and RAO.

Results:

Five patients (35.7%) with RAO had imaging evidence of ipsilateral IPH in contrast to 7 of 211 (3.3%) patients in the control group (odds ratio [OR]: 16.2, 95% confidence interval [95% CI]: 4.3–61.1, P = 0.0002). Of the 5 patients with RAO and ipsilateral IPH, only one (20.0%) was found to ipsilateral carotid stenosis greater than 70%. Carotid IPH was the only variable that was independently associated with RAO (OR: 12.6, 95% CI = 2.2–73.6, P = 0.005).

Conclusions:

Carotid IPH is independently associated with RAO. The use of plaque imaging in the evaluation of patients with acute RAO is therefore supported.
Successful Treatment of a Venous Leg Ulcer With Manuka Honey
Authors: Mosteiro-Miguéns Diego Gabriel , Herrera-Jiménez Cristina , Lorenzo-Ruiz Héctor , Domínguez-Martís Eva María , Novío Silvia
Published: January 2021

BACKGROUND:

Refractory venous leg ulcers (VLUs) often require extended time to heal, and they carry a high risk of recurrence. This case study describes our experiences with a patient with a VLU refractory to multiple treatment strategies who was successfully treated with Manuka honey.

CASE:

Mr S. was a 76-year-old man with multiple comorbid conditions and hypersensitivity to silver-based compounds, who developed 3 VLUs of his right lower extremity. He experienced 90 days of unsuccessful treatments using an iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, and antibiotic treatment without progression toward wound healing. We then initiated treatment with Manuka honey and continued compression therapy. His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing. Mr S. reported clinically relevant improvement in wound-related pain at 17 days.

CONCLUSION:

The use of Manuka honey proved effective in this patient with a VLU refractory to other treatment strategies.
Constipation in Hospitalized Patients
Authors: Junqueira Jaqueline Betteloni , Norton Christine , Santos Vera Lúcia Conceição de Gouveia
Published: January 2021

PURPOSE:

The purpose of this study was to identify the prevalence of constipation in hospitalized patients, along with sociodemographic and clinical variables associated with its occurrence.

DESIGN:

Observational, cross-sectional study.

SUBJECTS AND SETTINGS:

The study sample comprised 343 adult patients hospitalized at a University Hospital in Sao Paulo, Brazil.

METHODS:

Point-prevalence data were collected on the same day each month over a 4-month period. Data were collected via interviews, physical examination, medical record review, and completion of a data collection form that queried sociodemographic data and incorporated the Bowel Function in the Community instrument. Patients were classified as constipated if they met 2 or more of the Rome III criteria. Logistic regression analyses were used to identify clinical or sociodemographic factors associated with constipation.

RESULTS:

Fifty-one patients had constipation, reflecting a point-prevalence of 14.8% (95% CI, 11.49-19.02). The prevalence of constipation was 15% in females (n = 29) and 14.7% in males (n = 22). Multivariable logistic regression showed that use of laxatives (OR = 9.98; 95% CI, 3.539-29.666) was associated with a higher likelihood of constipation.

CONCLUSION:

The prevalence of constipation in hospitalized adult patients was lower than that in previous studies. Patients using laxatives were more likely to experience constipation.
Characteristics of Critically Ill Adults With Sacrococcygeal Unavoidable Hospital-Acquired Pressure Injuries
Authors: Solmos Susan , LaFond Cynthia , Pohlman Anne S. , Sala Jennifer , Mayampurath Anoop
Published: January 2021

PURPOSE:

To identify characteristics of critically ill adults with sacrococcygeal, unavoidable hospital-acquired pressure injuries (uHAPIs).

DESIGN:

Retrospective, matched, case-control design.

SUBJECTS/SETTING:

Patients admitted to adult intensive care units (ICUs) at an urban academic medical center from January 2014 through July 2016.

METHODS:

Thirty-four patients without uHAPI were matched to 34 patients with sacrococcygeal uHAPI. Time points of interest included admission to the ICU, the week preceding the definitive assessment date, and hospital discharge status. Variables of interest included length of stay, any diagnosis of sepsis, severity of illness, degree of organ dysfunction/failure, supportive therapies in use (eg, mechanical ventilation), and pressure injury risk (Braden Scale score).

RESULTS:

All 34 sacrococcygeal pressure injuries were classified as uHAPI using the pressure injury prevention inventory instrument. No statistically significant differences were noted between patients for severity of illness, degree of organ dysfunction/failure, or pressure injury risk at ICU admission. At 1 day prior to the definitive assessment date and at discharge, patients with uHAPI had significantly higher mean Sequential Organ Failure Assessment (SOFA) scores (greater organ dysfunction/failure) and lower mean Braden Scale scores (greater pressure injury risk) than patients without uHAPI. Patients with uHAPI had significantly longer lengths of stay, more supportive therapies in use, were more often diagnosed with sepsis, and were more likely to die during hospitalization.

CONCLUSION:

Sacrococcygeal uHAPI development was associated with progressive multiorgan dysfunction/failure, greater use of supportive therapies, sepsis diagnosis, and mortality. Additional research investigating the role of multiorgan dysfunction/failure and sepsis on uHAPI development is warranted.
The Use of a Stoma Rod/Bridge to Prevent Retraction
Authors: Gialamas Eleftherios , Meyer Jeremy , Abbassi Ziad , Popeskou Sotirios , Buchs Nicolas Christian , Ris Frédéric
Published: January 2021

PURPOSE

We evaluated evidence related to the use of a rod (bridge) to prevent stoma retraction during loop ostomy construction.

METHODS:

We completed a systematic review of the literature. We searched MEDLINE, EMBASE, and COCHRANE databases up to December 4, 2019. We posed the following question based on a PICO format. Do adult patients undergoing ostomy surgery experience less stomal retraction when compared to patients managed without placement of a stoma rod?

FINDINGS:

Our initial search returned 182 articles; after reading studies in full, 5 articles were identified that collectively enrolled 1058 participants. Four studies were randomized controlled trials and one was a prospective cohort study. Meta-analysis could not be performed because of the small number of studies and the heterogeneity of outcomes measurements. The incidence of stoma retraction ranged between 0%-8% in patients managed with a rod and 0.78%-8.2% in patients with no rod. The number of reported adverse events was low. Placement of a stoma rod was associated with more adverse outcomes than in patients managed without a rod. Adverse events included local edema, stoma necrosis, skin necrosis, peristomal moisture-associated skin damage (irritant dermatitis), peristomal abscess, bleeding, and mucocutaneous separation.

CONCLUSIONS:

Stoma rod does not seem to reduce the risk of stoma retraction and might result in other adverse events.

IMPLICATIONS:

We recommend avoidance of stoma rod/bridge placement during ostomy surgery.
Captive-bred populations of a partially migratory salmonid fish are unlikely to maintain migratory polymorphism in natural habitats
Authors: Tanaka Tatsuya , Ueda Rui , Sato Takuya
Published: January 2021

Variation in life history is fundamental to the long-term persistence of populations and species. Partial migration, in which both migratory and resident individuals are maintained in a population, is commonly found across animal taxa. However, human-induced habitat fragmentation continues to cause a rapid decline in the migratory phenotype in many natural populations. Using field and hatchery experiments, we demonstrated that despite both migrants and residents being maintained in captive environments, few individuals of the red-spotted masu salmon,Oncorhynchus masou ishikawae, became migrants in natural streams when released prior to the migration decision. Released fish rarely reached the threshold body size necessary to become migrants in natural streams, presumably owing to lower growth rates in natural than in captive environments. The decision to migrate is often considered a threshold trait in salmonids and other animal taxa. Our findings highlight the need for management programmes that acknowledge the effects of the environment on the determination of the migratory phenotypes of partially migratory species when releasing captive-bred individuals prior to their migratory decisions.
A review of clothing microbiology: the history of clothing and the role of microbes in textiles
Authors: Sanders Deaja , Grunden Amy , Dunn Robert R.
Published: January 2021

Humans have worn clothing for thousands of years, and since its invention, clothing has evolved from its simple utilitarian function for survival to become an integral part of society. While much consideration has been given to the broad environmental impacts of the textile and laundering industries, little is known about the impact wearing clothing has had on the human microbiome, particularly that of the skin, despite our long history with clothing. This review discusses the history of clothing and the evolution of textiles, what is and is not known about microbial persistence on and degradation of various fibres, and what opportunities for the industrial and environmental application of clothing microbiology exist for the future.
Duncan Joseph Greenwood. 16 October 1932—13 February 2010
Authors: Burns Ian G.
Published: January 2021

During his 55-year career as a highly distinguished scientist, Duncan Greenwood made a major contribution to the field of soil science and plant nutrition. His early studies on soil aeration revolutionized thinking on the mechanisms by which oxygen influences the activity of microorganisms and their metabolism of organic substances in structured soil. His ideas resulted in the ‘micro-site concept of soil aeration’, which is still widely accepted today. Later he turned his attention to the nutritional requirements of vegetable crops at a time when the horticultural industry was starting to introduce inorganic fertilizers. He developed a novel static model of N, P and K response, which he used to produce the first scientifically based inorganic fertilizer recommendations for 23 different vegetable crops. Not satisfied with this major development, Duncan started to create more sophisticated dynamic models using novel widely applicable relationships that took more account of the effects of weather on nutrient behaviour in the soil and plant. He not only used these to provide important insights into many of the complex interacting processes involved, but also incorporated them into some of the first computer-based decision support systems for practical site-specific fertilizer advice for the vegetable growing industry. The application of these advances had an important effect on the efficiency of crop production and the reduction of associated environmental impacts. Duncan continued to devise new models for nutrient and water use throughout the rest of his career and to explore ways of applying them in different areas of soil and crop science.
Revealing the unique features of each individual's muscle activation signatures
Authors: Aeles Jeroen , Horst Fabian , Lapuschkin Sebastian , Lacourpaille Lilian , Hug François
Published: January 2021

There is growing evidence that each individual has unique movement patterns, or signatures. The exact origin of these movement signatures, however, remains unknown. We developed an approach that can identify individual muscle activation signatures during two locomotor tasks (walking and pedalling). A linear support vector machine was used to classify 78 participants based on their electromyographic (EMG) patterns measured on eight lower limb muscles. To provide insight into decision-making by the machine learning classification model, a layer-wise relevance propagation (LRP) approach was implemented. This enabled the model predictions to be decomposed into relevance scores for each individual input value. In other words, it provided information regarding which features of the time-varying EMG profiles were unique to each individual. Through extensive testing, we have shown that the LRP results, and by extent the activation signatures, are highly consistent between conditions and across days. In addition, they are minimally influenced by the dataset used to train the model. Additionally, we proposed a method for visualizing each individual's muscle activation signature, which has several potential clinical and scientific applications. This is the first study to provide conclusive evidence of the existence of individual muscle activation signatures.
Endothelial cells do not align with the mean wall shear stress vector
Authors: Arshad Mehwish , Ghim Mean , Mohamied Yumnah , Sherwin Spencer J. , Weinberg Peter D.
Published: January 2021

The alignment of arterial endothelial cells (ECs) with the mean wall shear stress (WSS) vector is the prototypical example of their responsiveness to flow. However, evidence for this behaviour rests on experiments where many WSS metrics had the same orientation or where they were incompletely characterized. In the present study, we tested the phenomenon more rigorously. Aortic ECs were cultured in cylindrical wells on the platform of an orbital shaker. In this system, orientation would differ depending on the WSS metric to which the cells aligned. Variation in flow features and hence in possible orientations was further enhanced by altering the viscosity of the medium. Orientation of endothelial nuclei was compared with WSS characteristics obtained by computational fluid dynamics. At low mean WSS magnitudes, ECs aligned with the modal WSS vector, while at high mean WSS magnitudes they aligned so as to minimize the shear acting across their long axis (transverse WSS). Their failure to align with the mean WSS vector implies that other aspects of endothelial behaviour attributed to this metric require re-examination. The evolution of a mechanism for minimizing transverse WSS is consistent with it having detrimental effects on the cells and with its putative role in atherogenesis.