bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymorphisms of stress pathway genes and emergence of suicidal ideation at antidepressant treatment onset
Authors: Nobile B. , Ramoz N. , Jaussent I. , Dubois J. , Guillaume S. , Gorwood Ph , Courtet Ph
Published: September 2020

The prescription of antidepressant drugs is one of the most frequently used strategies to prevent suicide and suicidal behavior. However, some patients develop suicidal ideation at antidepressant treatment onset, a phenomenon known as treatment-emergent suicidal ideation (TESI). Few studies have explored TESI pharmacogenomics. As the Hypothalamic-Pituitary-Adrenal (HPA) axis might be implicated in suicidal behavior, we assessed the relationship between TESI and single nucleotide polymorphisms (SNPs) in the HPA axis-implicated NR3C1 (n = 7 SNPs), FKBP5 (n = 5 SNPs), AVPR1B (n = 1 SNPs), CRHR1 (n = 1 SNPs), and SKA2 (n = 1 SNPs) genes, in a sample of 3566 adult outpatients with depression for whom an antidepressant treatment was introduced. General practitioners and psychiatrists throughout France followed participants for 6 weeks after the initial prescription of tianeptine, an antidepressant molecule showing mu agonism. Suicidal ideation was assessed with item 10 of the Montgomery-Åsberg Depression Rating Scale (item dedicated to suicidal ideation) at baseline, and at week 2, 4, and 6 of treatment. Within the informative sample, 112 patients reported TESI and 384 did not. TESI was significantly associated with the TT genotype of the SNP rs6902321 in FKBP5 (OR = 1.76, 95% CI = [1.07; 2.90]; p-value = 0.03) and the GG/AG genotype of the SNP rs7208505 in SKA2 (OR = 1.85, 95% CI = [1.03;3.33]; p-value = 0.04). These associations were not significant after multiple test correction. Nevertheless, our results suggest a possible involvement of HPA axis elements in treatment-emergent suicidal ideation (TESI).
Use of a Novel Device in Reconstructive Venous Surgery: Preliminary Results
Authors: Camilli Daniele , Platone Alessandro , Ruggeri Massimo , Furgiuele Sergio
Published: September 2020

Evaluation of the outcomes of OSES (oval-shaped external support), a novel device for external valvuloplasty of the great saphenous vein (GSV) for the conservative treatment of superficial venous insufficiency. Between 2012 and 2015, 30 patients underwent external valvuloplasty of the GSV for a total of 32 limbs. Patients were subjected to clinical and instrumental follow-up by a half-year ultrasound for a minimum of 36 months. The main endpoints were the recurrence of varicose disease, persistent or recurrent venous reflux, and venous thrombosis. Varicose recurrence was verified in six limbs on 32 (18.75%). Four limbs (12.5%) presented a recurrence of the reflux even in the absence of varicose veins. Two limbs (6.25%) underwent saphenectomy after the valvuloplasty intervention at 12 and 18 months, respectively, because of the presence of saphenofemoral reflux and varicose recurrences. No case of venous thrombosis of the saphenous trunk was observed. The external valvuloplasty of the GSV is a well-known technique that used to treat the superficial venous insufficiency. The newly introduced OSES device seems to show better midterm results, due to a better alignment of the valve flaps. In our experience, the use of this device gives better long-term results and allowed to extend the indication to patients with saphenic diameters that were considered not eligible for repair. In conclusion, although our data needs further confirmation, OSES device might represents a new interesting opportunity for reconstructive venous surgery.
Resting Brain Fluctuations Are Intrinsically Coupled to Visual Response Dynamics
Authors: Belloy Michaël E , Billings Jacob , Abbas Anzar , Kashyap Amrit , Pan Wen-Ju , Hinz Rukun , Vanreusel Verdi , Van Audekerke Johan , Van der Linden Annemie , Keilholz Shella D , Verhoye Marleen , Keliris Georgios A
Published: September 2020

How do intrinsic brain dynamics interact with processing of external sensory stimuli? We sought new insights using functional magnetic resonance imaging to track spatiotemporal activity patterns at the whole brain level in lightly anesthetized mice, during both resting conditions and visual stimulation trials. Our results provide evidence that quasiperiodic patterns (QPPs) are the most prominent component of mouse resting brain dynamics. These QPPs captured the temporal alignment of anticorrelation between the default mode (DMN)- and task-positive (TPN)-like networks, with global brain fluctuations, and activity in neuromodulatory nuclei of the reticular formation. Specifically, the phase of QPPs prior to stimulation could significantly stratify subsequent visual response magnitude, suggesting QPPs relate to brain state fluctuations. This is the first observation in mice that dynamics of the DMN- and TPN-like networks, and particularly their anticorrelation, capture a brain state dynamic that affects sensory processing. Interestingly, QPPs also displayed transient onset response properties during visual stimulation, which covaried with deactivations in the reticular formation. We conclude that QPPs appear to capture a brain state fluctuation that may be orchestrated through neuromodulation. Our findings provide new frontiers to understand the neural processes that shape functional brain states and modulate sensory input processing.
Implications of taxon-level variation in climate change response for interpreting plankton lifeform biodiversity indicators
Authors: Bedford Jacob , Johns David G , McQuatters-Gollop Abigail
Published: September 2020

Indicators based on broad functional characteristics, which group plankton taxa into “lifeforms”, summarize changes across a high number of taxa in a way that reflects changes in community functioning and are used to inform policy assessments. Key questions remain, however, as to what extent plankton taxa within these lifeforms share responses to environmental change. Addressing this knowledge gap can provide additional information on the influence of environmental drivers, including climate change, on plankton communities. Here, we use a multi-decadal plankton time series to examine the extent to which taxa within lifeforms share responses to sea surface temperature (SST) change. At the North Sea scale, the individual taxa responses within the dinoflagellate lifeform are skewed towards a negative response to increasing SST, consolidating previous findings that dinoflagellate abundance is decreasing with ocean warming. The individual taxa responses within the zooplankton lifeforms, however, varied, suggesting that lifeform traits are less of a factor determining response to SST for zooplankton than for phytoplankton. The lifeform level of grouping taxa, therefore, is useful for communicating change in the state and functioning of ecosystems, but finer taxonomically resolved data are essential for determining the drivers of plankton community change, including climate influences, during formal assessments.
Genetic Variant of TBX1 Gene Is Functionally Associated With Adolescent Idiopathic Scoliosis in the Chinese Population
Authors: Li Yang , Wu Zhichong , Xu LeiLei , Feng Zhenhua , Wang Yuwen , Dai Zhicheng , Liu Zhen , Sun Xu , Qiu Yong , Zhu Zezhang
Published: September 2020

Study Design.

A genetic association study.

Objective.

The aim of this study was to investigate whether rs1978060 of TBX1 gene was a susceptible locus of adolescent idiopathic scoliosis (AIS) in the Chinese Han population and to better define the functional role of TBX1 in the development and progression of AIS.

Summary of Background Data.

A recent genome-wide association study reported a novel susceptible locus in TBX1 gene, which was associated with the development of AIS in the Japanese population. However, there is a paucity of knowledge concerning the functional role of TBX1 in the Chinese AIS population.

Methods.

The SNP rs1978060 was genotyped in 1725 female AIS patients and 2600 healthy controls. Paraspinal muscle samples were collected from 30 AIS patients and 26 age-matched congenital scoliosis (CS) patients for the analysis of tissue expression. The differences of genotype and allele distributions between the patients and the controls were calculated using the χ
2 test. The Pearson correlation analysis was carried out to investigate the relation between the expression of the PAX1 gene and the curve severity.

Results.

SNP rs1978060 was significantly associated with the susceptibility of AIS. Allele G of rs1978060 could significantly add to the risk of AIS with an odds ratio of 1.12. The tissue expression of TBX1 was obviously decreased in AIS patients. There was a remarkable correlation between the curve magnitude and the TBX1 expression (r = −0.519, P = 0.003).

Conclusion.

The association between TBX1 and the susceptibility of AIS was successfully replicated in the Chinese population. Moreover, rs1978060 may be a functional variant regulating the expression of TBX1. More studies were warranted to explore the functional role of TBX1 in the onset and progression of AIS.

Level of Evidence: 3
Limited Cost Benefit of Lateral Interbody Fusion for Adult Spinal Deformity Surgery
Authors: Yamamoto Tatsuya , Yagi Mitsuru , Suzuki Satoshi , Nori Satoshi , Tsuji Osahiko , Nagoshi Narihito , Okada Eijiro , Fujita Nobuyuki , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: September 2020

Study Design.

Retrospective case series.

Objective.

The aim of this study was to compare the utility and cost-effectiveness of multilevel lateral interbody fusion (LIF) combined with posterior spinal fusion (PSF) (L group) and conventional PSF (with transforaminal lumbar interbody fusion) (P group) in adult spinal deformity (ASD) surgery.

Summary of Background Data.

The clinical and radiographic outcomes of multilevel LIF for ASD have been reported favorable; however, the cost benefit of LIF in conjunction with PSF is still controversial.

Methods.

Retrospective comparisons of 88 surgically treated ASD patients with minimum 2-year follow-up from a multicenter database (L group [n = 39] and P group [n = 49]) were performed. Demographic and radiographic data, health-related quality of life (HRQoL), and the direct hospitalization cost for the initial surgery and 2-year total hospitalization cost were analyzed.

Results.

Analyses of sagittal spinal alignment showed no significant difference between the two groups at baseline and 2 years post-operation. Surgical time was longer in the L group (L vs. P: 354 vs. 268 minutes, P < 0.01), whereas the amount of blood loss was greater in the P group (494 vs. 678 mL, P = 0.03). The HRQoL was improved similarly at 2 years post-operation (L vs. P: SRS-22 total score, 3.86 vs. 3.80, P = 0.54), with comparable revision rates (L vs. P: 18% vs. 10%, P = 0.29). The total direct cost of index surgery was significantly higher in the L group (65,937 vs. 49,849 USD, P < 0.01), which was mainly due to the operating room cost, including implant cost (54,466 vs. 41,328 USD, P < 0.01). In addition, the 2-year total hospitalization cost, including revision surgery, was also significantly higher in the L group (70,847 vs. 52,560 USD, P < 0.01).

Conclusion.

LIF with PSF is a similarly effective surgery for ASD when compared with conventional PSF. However, due to the significantly higher cost, additional studies on the cost-effectiveness of LIF in different ASD patient cohorts are warranted.

Level of Evidence: 3
The Prevalence of Sexual Dysfunction in Patients With Multiple Sclerosis in Cyprus: A Cross-sectional Study
Authors: Hadjimichail Kyriakos , Asimakopoulou Evanthia , Charalambous Demetra , Pantzaris Marios , Theodosis-Nobelos Panagiotis , Triantis Charalampos
Published: September 2020

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory and degenerative disorder of the central nervous system with significant immune participation. It can cause a variety of symptoms that may impact quality of life. This study investigates sexual dysfunction (SD) in patients with MS in Cyprus and compares it with a sample of the general population. METHODS: The sample includes 107 patients with MS and 104 healthy controls. Recruitment was based on simple random sampling during their follow-up at a neurology clinic. Data collection for this study was carried out from May to September 2019. RESULTS: Among patients with MS, 29.9% experienced SD symptoms (40.0% men and 23.9% women), whereas in the healthy population, the percentage with SD was 12.5%. Although 10 women with MS expressed SD symptoms, they did not categorize themselves as having sexual problems. Almost 90% of all patients reported that they have never been tested for SD. CONCLUSION: Patients with MS have a higher rate of SD than the healthy control population, especially for the female population. There is a growing need for clinical advice on the issue of SD.
Postcraniotomy Patients' Readiness for Discharge and Predictors of Their Readiness for Discharge
Authors: Baksi Altun , Arda Sürücü Hamdiye , I˙nal Gülşah
Published: September 2020

BACKGROUND: Postcraniotomy individuals should be monitored because of the direct influence on brain function as well as constraints caused by underlying illness. The relationship between demographic and clinical characteristics of postcraniotomy individuals and their readiness for discharge was examined. METHODS: A descriptive correlational study included 150 individuals. The Readiness for Hospital Discharge Scale and demographic variables were examined using descriptive statistics, correlation, and stepwise multiple linear regression. RESULTS: The mean postcraniotomy score for the subdimension of knowledge related to readiness for discharge was 5.13 ± 3.04, and mean score for the whole scale was 7.76 ± 1.48. The individuals' age, employment status, presence of a person to provide care at home, poor financial status, and first hospitalization during the lifetime of the patient were statistically significant predictors of their readiness for discharge. This model was statistically significant (F = 25.572, P < .001) and accounted for 57% of the variance in discharge readiness. CONCLUSION: Patients had moderate levels of readiness for discharge and low levels of discharge-related knowledge. The findings point to the importance of individual approach to the discharge planning.
Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials
Authors: WANG Chia-Hui , YANG Shu-Hui , JEN Hsiu-Ju , TSAI Jui-Chen , LIN Hsi-Kuei , LOH El-Wui
Published: September 2020

Background

Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature.

Purpose

A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO.

Methods

PubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model.

Results

The RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]).

Conclusions/Implications for Practice

The results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.
Treatment of hepatitis B virus infection in chronic infection with HBeAg-positive adult patients (immunotolerant patients): a systematic review
Authors: Tovo Cristiane V. , Ahlert Marcelo , Panke Carine , de Mattos Ângelo Z. , de Mattos Angelo A.
Published: September 2020

Recently, a controversial approach suggesting the early treatment of chronic infection with hepatitis B “e” antigen-positive patients with hepatitis B virus (HBV) infection, has been proposed. The objective of this study is to systematically review medical literature regarding treatment of HBV infection in adult chronic infection with HBeAg-positive patients. A systematic review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Original studies that evaluated the effect of antivirals in adult chronic infection with HBeAg-positive patients were included. The outcomes of interest were viral load suppression, the loss/seroconversion of HBeAg, the loss/seroconversion of hepatitis B surface antigen, and the development of cirrhosis or hepatocellular carcinoma. The search for eligible studies was performed in Excerpta Medica dataBASE, PubMed and Cochrane databases until January 2020, without language or date restriction. The risk of bias was evaluated using the Newcastle–Ottawa Scale for observational studies and the Revised Cochrane Risk-of-Bias Tool for randomized controlled trials. Two hundred ninety-six articles were retrieved. After analyzing titles and abstracts, 287 articles were excluded and nine were considered potentially eligible. From these, five were excluded after full-text analysis. Finally, four articles were included. Only two were randomized controlled trials. All studies were carried out in Asian patients. Results were variable with regard to viral load, negativation/seroconversion of HBeAg and HBsAg. One study demonstrated that treated patients developed cirrhosis or hepatocellular carcinoma less frequently than untreated individuals. Overall, the studies were of poor quality. In conclusion, the present systematic review demonstrated that, at present, there is not enough evidence to recommend treating this population of patients.
The dietary practices and beliefs of people living with inactive ulcerative colitis
Authors: Crooks Benjamin , McLaughlin John , Matsuoka Katsuyoshi , Kobayashi Taku , Yamazaki Hajime , Limdi Jimmy K.
Published: September 2020

Objective

Diet is implicated in the aetiopathogenesis of inflammatory bowel disease (IBD) and in generating symptoms. Few studies have explored dietary practices in people with IBD, in which participants perceived strong links between diet in triggering flares and maintaining remission. Fewer studies have explored dietary habits in self-reported remission. Our aim was to describe dietary practices and beliefs in those with inactive ulcerative colitis.

Methods

A questionnaire was developed and prospectively administered to 208 participants with inactive ulcerative colitis attending IBD clinics.

Results

Thirty-one percent believed diet was the initiating factor for ulcerative colitis with 37% believing diet could trigger relapse. Fifty-nine percent avoided dietary items to prevent relapse. Most frequently avoided were spicy (43%) and fatty (38%) foods, alcohol (27%), carbonated drinks (26%), coffee (24%) and milk products (21%). Females were more likely to practice dietary avoidance (P = 0.007). Twenty-three percent had used exclusion diets, most commonly gluten- or lactose-free. Those reporting relapse in the previous year were more likely to avoid the same menu as their family (P = 0.01) and females were less likely to eat out in order to prevent relapse (P = 0.004). Information resources guiding food avoidance included participants’ own experiences (90%), healthcare professionals’ advice (19%) and the internet (11%).

Conclusion

People with inactive ulcerative colitis hold dietary beliefs and display practices with a high level of consistency around perceived triggers. Food avoidance whilst in remission raises the possibility of visceral hypersensitivity or altered physiology alongside psychosocial, neurocognitive or co-existing functional factors.
ESPGHAN ‘biopsy-sparing’ guidelines for celiac disease in children with low antitransglutaminase during COVID-19
Authors: Trovato Chiara Maria , Montuori Monica , Cucchiara Salvatore , Oliva Salvatore
Published: September 2020

Objectives

Recent guidelines for celiac disease have allowed a biopsy-free approach in endomysial antibodies (EMAs) positive children with high antitransglutaminase (TGA-IgA) titer [>10 time upper limit of normal (ULN)]. Esophagogastroduodenoscopy is still necessary for diagnosis in children with lower title. Because elective pediatric endoscopy has been substantially shouted down during coronavirus disease (COVID-19) pandemic, many children remained undiagnosed – and therefore untreated – for a long time. We aimed to analyze the feasibility and accuracy of a biopsy-free approach in suspected celiac disease children with TGA-IgA values <10 ULN to facilitate the diagnostic process by avoiding endoscopy.

Methods

In this study cohort, we retrospectively analyzed all biopsy-confirmed diagnosis of celiac disease in our center (between 2014 and 2019). The positive predictive value (PPV) of TGA-IgA titers between 5 and 10 ULN and positive EMA in diagnosing celiac disease were determined. Mucosal atrophy and resolution of symptoms after gluten-free diet (GFD) were considered to confirm initial diagnosis.

Results

Of 430 celiac disease patients (F: 274; mean age 7.54 years) diagnosed by endoscopy, 84 (F: 46; mean age 8 years) with TGA-IgA between 5 and 10 ULN and positive EMA were identified. The PPV of TGA-IgA between 5 and 10 ULN and positive EMA was 0.93 (95% confidence interval 0.90–0.96). All these children had a symptom resolution and antibodies normalization after GFD.

Conclusion

During the COVID-19 outbreak, a temporarily reduction of the TGA-IgA threshold for biopsy-sparing approach seems feasible in EMA positive children with TGA-IgA between 5 and 10 ULN.
Estimation of glomerular filtration rate in patients with cirrhosis: evaluation of equations currently used in clinical practice and validation of Royal Free Hospital cirrhosis glomerular filtration rate
Authors: Protopapas Adonis A. , Papagiouvanni Ioanna , Fragkou Nikolaos , Alevroudis Emmanouil , Sinakos Emmanouil , Goulis Ioannis
Published: September 2020

Objective

Conventional creatinine-based glomerular filtration rate (GFR) equations have been reported to overestimate renal function in patients with cirrhosis. The Royal Free Hospital (RFH) cirrhosis GFR equation was developed to accurately estimate GFR in this population. The aim of this study was to evaluate the ability of widely available equations [Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI), Modification of Diet in Renal Disease equations (MDRD-4, MDRD-6)] and the RFH equation to correctly estimate the GFR of patients with cirrhosis.

Methods

We retrospectively analyzed data from patients with cirrhosis who underwent measurement of GFR with the use of 51Cr-EDTA (GFR-M). The CKD-EPI, MDRD-4, MDRD-6 and RFH equations were calculated, while bias, precision and accuracy were estimated for each one of them and then compared with paired t-tests. Bias was defined as the mean difference between the GFR-M and the result of each equation; precision was defined as the SD of the differences and accuracy was defined as the square root of the mean squared error (mean of the squared differences). Higher values are associated with worse bias and better precision/accuracy.

Results

One-hundred and thirty-four cirrhotic patients were included. Bias was estimated for CKD-EPI, MDRD-4, MDRD-6 and RFH at −5.91, −3.13, 0.92 and 18.24, respectively. Significant differences were observed between all equations (P < 0.001). Regarding precision, only the comparison between MDRD-4 (20.81) and RFH (16.6) yielded a statistically significant result (P = 0.037). Finally, CKD-EPI (19.32) and MDRD-6 (18.81) exhibited better accuracy than GFR-RFH (24.61) (P = 0.006 and 0.001).

Conclusion

RFH demonstrates inferior accuracy in predicting renal function in patients with cirrhosis, in comparison to conventional equations.
A Call Light Responsiveness Program
Authors: Shamailov Maya , Neal Suzanne , Bena James F. , Morrison Shannon L. , Albert Nancy M.
Published: September 2020

Background:

Purposeful hourly rounding and information on whiteboards in patients' rooms have been known to reduce use of call lights.

Problem:

Call light activation was higher than desired.

Methods:

This continuous improvement initiative used retrospective data collection (pre-, early- and maintenance postintervention) to assess call light responsiveness.

Intervention:

A bundled purposeful hourly rounding approach was used.

Results:

Call light frequency was higher in the early postintervention period than in the preintervention; however, there was no change in the frequency of call lights that extended beyond 5 minutes. In the maintenance postintervention period, compared with the pre- and early postintervention periods, call lights per patient/unit day and call lights extending beyond 5 minutes per patient/unit day decreased (all P < .001).

Conclusions:

Activation of a bundled purposeful hourly rounding approach was associated with a decrease in all call lights and call lights extending beyond 5 minutes per patient/unit day.
Expanding Public Health Practice to Address Older Adult Health and Well-being
Authors: Wolfe Megan , De Biasi Anne , Carmody Jane , Fulmer Terry , Auerbach John
Published: September 2020

Context:

The older adult population in the United States is experiencing unprecedented growth and is accompanied by a parallel increase in the health challenges of these individuals. Public health has, historically, not played a large role in older adult health, but given its contributions to longevity, it makes sense for public health to now prioritize the health of this population.

Program:

With the goal of public health prioritization of healthy aging, Trust for America's Health, with support from The John A. Hartford Foundation, launched an initiative to demonstrate the crucial roles public health departments can play to improve the health of older adults.

Implementation:

An Age-Friendly Public Health Systems (AFPHS) Learning and Action Network was created to provide local health departments in Florida with training and technical assistance through in-person and virtual activities, as well as access to events, opportunities, and resources to increase expertise and capacity to address healthy aging. AFPHS Network participants attended monthly learning activities to enhance their capacity around data analysis, health equity, partnerships and collaboration, social determinants of health, and other age-friendly initiatives.

Evaluation:

Network participants are being tracked on 13 key indicators to improve the health and well-being of older adults, including data collection and dissemination; ensuring emergency preparedness plans target older adults; and targeting older adult health needs in community health assessments.

Discussion:

Trust for America's Health's AFPHS initiative demonstrates that state and local public health departments have crucial roles to play to improve the health and well-being of older adults through data collection and analysis, collaboration with aging sector stakeholders, and adapting policies and programs to become age-friendly.
Making Injustice Visible: How a Health Department Can Demonstrate the Connection Between Structural Racism and the Health of Whole Neighborhoods
Authors: Shiman Lauren J. , Freeman Kim , Bedell Jane , Bassett Mary T.
Published: September 2020

Context:

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has built a presence in Tremont, a historically redlined neighborhood located in Bronx, NYC. As part of an agency-wide commitment to explicitly name racism as a threat to healthy communities, DOHMH has sought opportunities to educate and engage in discussion about historical and current structural racism.

Program:

Between January and September 2018, DOHMH exhibited Undesign the Redline, a pictorial timeline and historical analysis of redlining, in its Tremont office. The exhibit exposed neglected history, making concrete the concept of structural racism.

Implementation:

DOHMH staff led 101 tours for 950 visitors, including employees, community partners, and residents. Tours were given in English and Spanish in three 2-month cycles over 8 months. Tour guides also facilitated interactive workshops with youth groups, community-based organizations, and teams from city agencies to engage participants in the design and ownership of new systems intended to “undesign” the consequences of redlining.

Evaluation:

Immediate feedback was requested from all participants at the conclusion of each tour and was collected on a bulletin board. Longer-term impact was assessed through an electronic survey sent to all participants who provided valid contact information to better understand ways that the exhibit impacted personal and professional actions. Participants reported talking with family, friends, and coworkers, seeking more information, and applying an equity lens to professional projects after experiencing the exhibit.

Discussion:

Hosting the exhibit in a local health department building offered a concrete opportunity to learn about and discuss structural racism. Exhibit tours had immediate- and long-term impacts on participants and contributed to sustainable changes internal to DOHMH work. This work presents a concrete practice to make injustice visible and engage in open conversation about structural racism to build community trust.
The Influence of Fat Grafting on Breast Imaging after Postmastectomy Reconstruction: A Matched Cohort Analysis
Authors: Cason Roger W. , Shammas Ronnie L. , Broadwater Gloria , Glener Adam D. , Sergesketter Amanda R. , Vernon Rebecca , Le Elliot , Wickenheisser Victoria A. , Marks Caitlin E. , Orr Jonah , Pyfer Bryan J. , Hollenbeck Scott T.
Published: September 2020

Background:

Fat grafting to the reconstructed breast may result in the development of benign lesions on physical examination, prompting further investigation with imaging and biopsy. The aim of this study was to assess the influence of fat grafting on the incidence of imaging and biopsies after postmastectomy reconstruction.

Methods:

Patients who underwent autologous or implant-based reconstruction following mastectomy from 2010 to 2018 were identified. Those receiving fat grafting as part of their reconstructive course were propensity matched 1:1 to those that did not with body mass index, reconstruction timing, and reconstruction type as covariates in a multivariable logistic regression model.

Results:

A total of 186 patients were identified, yielding 93 propensity-matched pairs. Fat-grafted patients had higher incidences of palpable masses (38.0 percent versus 18.3 percent; p = 0.003) and postreconstruction imaging (47.3 percent versus 29.0 percent; p = 0.01), but no significant difference in the number of biopsies performed (11.8 percent versus 7.5 percent; p = 0.32). Imaging was predominately interpreted as normal (Breast Imaging-Reporting and Data System 1, 27.9 percent) or benign (Breast Imaging-Reporting and Data System 2, 48.8 percent), with fat necrosis being the most common finding [n = 20 (45.5 percent)]. No demographic, oncologic, reconstructive, or fat grafting–specific variables were predictive of receiving postreconstruction imaging on multivariate analysis. Fat grafting was not associated with decreased 5-year overall survival or locoregional recurrence-free survival.

Conclusions:

Fat grafting to the reconstructed breast is associated with increased incidences of palpable masses and subsequent postreconstruction imaging with benign radiographic findings. Although the procedure is oncologically safe, both patients and providers should be aware that concerning physical examination findings can be benign sequelae of fat grafting and may lead to increased imaging after breast reconstruction.

Clinical Question/Level of Evidence:

Therapeutic, III.
Human Stromal Cell Aggregates Concentrate Adipose Tissue Constitutive Cell Population by In Vitro DNA Quantification Analysis
Authors: Sesé Borja , Sanmartín Javier M. , Ortega Bernat , Llull Ramon
Published: September 2020

Background:

Regenerative cell strategies rely on stromal cell implants to attain an observable clinical outcome. However, the effective cell dose to ensure a therapeutic response remains unknown. To achieve a higher cell dose, the authors hypothesized that reducing the volume occupied by mature adipocytes in lipoaspirate will concentrate the stromal vascular fraction present in the original tissue.

Methods:

Human standardized lipoaspirate (n = 6) was centrifuged (1200 g for 3 minutes) and the water phase was discarded. Mechanical disaggregation was achieved by shearing tissue through 2.4- and 1.2-mm Luer-to-Luer transfers. After a second centrifugation (800 g for 10 minutes), stromal cell aggregates were separated from the supernatant oil phase. Lipoaspirate percentage composition was determined by its constituent weights. Cell content was measured by total DNA quantification, and partial cell viability was determined by image cytometry. Tissue sections were evaluated histologically (hematoxylin and eosin and Masson trichrome stains).

Results:

Stromal cell aggregates reduced the standardized lipoaspirate mass to 28.6 ± 4.2 percent. Accordingly, the cell density increased by 222.6 ± 63.3 percent (from 9.9 ± 1.4 million cells/g to 31.3 ± 6.6 million cells/g; p < 0.05). Cell viability was unaffected in stromal cell aggregates (71.3 ± 2.5 percent) compared to standardized lipoaspirate (72.2 ± 2.3 percent), and histologic analysis revealed high-density areas enriched with stromal cells (622.9 ± 145.6 percent) and extracellular matrix (871.2 ± 80.3 percent).

Conclusion:

Stromal cell aggregates represent a biological agent that triplicates the cell density versus unprocessed lipoaspirate, low on oil and water fluids, and enriched extracellular matrix components.
Contrast-enhanced Ultrasound—State of the Art in North America
Authors: Barr Richard G. , Wilson Stephanie R. , Lyshchik Andrej , McCarville Beth , Darge Kassa , Grant Edward , Robbin Michelle , Wilmann Juergen Karl , Chong Wui K. , Fleischer Arthur , Paltiel Harriet J.
Published: September 2020

On October 24, 2017, in Chicago, the Society of Radiologists in Ultrasound convened a panel of specialists in contrast-enhanced ultrasound (CEUS) to arrive at a white paper regarding the use of CEUS in noncardiac applications in North America. Recommendations are based on analysis of the current literature and common practice strategies. They represent a reasonable approach to introduce the advantages of this safe and noninvasive technique for the benefit of our patients. Characterization of liver nodules with CEUS, as the approval indication worldwide, is the major focus of this endeavor. In addition, many off label uses are reviewed and literature supporting these indications provided.

Key Points

(1) Contrast-enhanced ultrasound (CEUS) allows cross-sectional imaging of the liver, kidneys and multiple other solid and hollow viscera, providing excellent characterization of identified focal mass lesions.

(2) Performed with the injection of a microbubble contrast agent, CEUS provides a safe and readily available imaging technique which requires no ionizing radiation, making it appropriate for use in all ages, in those with renal insufficiency and when a portable examination is needed.

(3) The CEUS can be considered in abdominal imaging whenever blood flow information is of value to diagnosis.

(4) Dynamic real-time acquisition and the use of a purely intravascular contrast agent are the 2 most essential technical aspects of CEUS imaging which distinguish it from both computed tomography and magnetic resonance scan.
Treatment of Hepatic Hydatid Disease: Role of Surgery, ERCP, and Percutaneous Drainage: A Retrospective Study
Authors: Muhammedoğlu Bahtiyar , Pircanoğlu Eyüp Mehmet , Pişkin Erol , Torun Serkan , Karadağ Mehmet , Topuz Sezgin , Köktaş Süleyman
Published: September 2020

Introduction:

Failure to follow the World Health Organization’s Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures.

Materials and Methods:

Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed.

Results:

Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography.

Conclusions:

ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. İn some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.
Patient Case Report: Memantine for the Treatment of Occipital Neuralgia
Authors: Hayes William J. , Hoffmann Chelsea , Jacobson Philip , Kotschevar Christopher , Kappes John A. , Berendse Joseph
Published: September 2020

Occipital neuralgia (ON) is described as a shooting, stabbing pain in the posterior part of the scalp that involves the occipital nerve. The epidemiology and pathophysiology are uncertain, but ON is considered distinct from other headache types. At the time of this writing, memantine for the treatment of ON has not been described in the literature. The following details a case report of successful treatment of ON with memantine. A 64-year-old, 91-kg, White man presented with severe headache associated with ON. Previous trials of oral medications, acupuncture, or physical therapy did not provide relief. The patient reported 15 ON headache days per month, use of 18 sumatriptan tablets per month, and daily use of as-needed ibuprofen. Because of inadequate relief of ON from other treatments, memantine was started. After titration to memantine 10 mg by mouth twice daily, the patient reported he was “100% headache free” from his ON pain. The patient tolerated memantine well without adverse effects. This case report displays safe, effective, and novel treatment of ON with memantine 10 mg by mouth daily, twice daily. The known safety, tolerability, and pharmacodynamics of memantine may warrant its off-label use in future studies exploring efficacy in ON.
Video Ambulatory EEG in Children: A Quality Improvement Study
Authors: DiGiovine Marissa P. , Massey Shavonne L. , LaFalce Denise , Vala Lisa , Allen-Napoli Linda , Banwell Brenda L. , Abend Nicholas S.
Published: September 2020

Purpose:

We implemented a video ambulatory EEG (VA-EEG) Program as an alternative to inpatient video EEG monitoring for some patients given potential benefits related to quicker access, greater convenience, and lower cost. To evaluate the newly initiated program, we performed a quality improvement study to assess whether VA-EEG yielded studies with interpretable EEG and video quality that generated clinically beneficial data.

Methods:

This was a single-center prospective quality improvement study. We surveyed ordering clinicians, electroencephalographers, and caregivers regarding consecutive children who underwent clinically indicated VA-EEG. The primary outcome was the percentage of VA-EEG studies in which the ordering clinician reported that the study had answered the question of interest.

Results:

We evaluated 74 consecutive children selected to undergo clinically indicated VA-EEG by their clinicians and caregivers. Ordering clinicians reported that 77% of studies answered the question of interest. Electroencephalographers reported that the quality of the EEG and video was excellent or adequate in 100% and 92% of patients, respectively. Additionally, 84% of caregivers reported preferring VA-EEG if EEG data were needed in the future.

Conclusions:

Video ambulatory EEG may be an effective diagnostic modality among children selected by clinicians and caregivers to undergo long-term EEG monitoring. Given it is effective as well as convenient, accessible, and lower cost than inpatient EEG monitoring, all of which align with our institution's quality goals, we intend to expand our VA-EEG Program.
Establishing correlation of axial and vertical force of cardiac artificial tissue using a novel micromachined sensor
Authors: Gaitas Angelo , Stillitano Francesca , Turnbull Irene
Published: September 2020

Cardiomyocytes iPSC (iPSC-CMs) have great potential for cell therapy, drug assessment, and for understanding the pathophysiology and genetic underpinnings of cardiac diseases. Contraction forces are one of the most important characteristics of cardiac function and are predictors of healthy and diseased states. Cantilever techniques, such as atomic force microscopy, measure the vertical force of a single cell, while systems designed to more closely resemble the physical heart function, such as cardiac tissue on posts, measure the axial force. One important question is how do these two force measurements correlate? By establishing a correlation of the axial and vertical force we will be one step closer in being able to use single cell iPSC instead of more elaborate human engineered tissue or animal heart tissue as models. A novel micromachined sensor for measuring force contractions of artificial tissue has been developed. Using this novel sensor a correlation between axial force and vertical force is experimentally established. This finding supports the use of vertical measurements as an alternative to tissue measurements.
Long-term (1990-2019) monitoring of tropical moist forests dynamics
Authors: Vancutsem C. , Achard F. , Pekel J.-F. , Vieilledent G. , Carboni S. , Simonetti D. , Gallego J. , Aragao L. , Nasi R.
Published: September 2020

Accurate characterization of the tropical moist forests changes is needed to support conservation policies and to better quantify their contribution to global carbon fluxes. We document - at pantropical scale - the extent of these forests and their changes (degradation, deforestation and recovery) over the last three decades. We estimate that 17% of the tropical moist forests have disappeared since 1990 with a remaining area of 1060 million ha in 2019, from which 8.5% are degraded. Our study underlines the importance of the degradation process in such ecosystems, in particular as precursor of deforestation and in the recent increase of the tropical moist forest disturbances. Without reduction of the present disturbance rates, undisturbed forests will disappear entirely in large tropical humid regions by 2050. Our study suggests reinforcing actions to prevent the first disturbance scar that leads to forest clearance in 45% of the cases.
Applying Machine Learning Technology in the Prediction of Crop Infestation with Cotton Leafworm in Greenhouse
Authors: Tageldin Ahmed , Adly Dalia , Mostafa Hassan , Mohammed Haitham S
Published: September 2020

The use of technology in agriculture has grown in recent years with the era of data analytics affecting every industry. The main challenge in using technology in agriculture is identification of effectiveness of big data analytics algorithms and their application methods. Pest management is one of the most important problems facing farmers. The cotton leafworm,Spodoptera littoralis(Boisd.) (CLW) is one of the major polyphagous key pests attacking plants includes 73 species recorded at Egypt. In the present study, several machine learning algorithms have been implemented to predict plant infestation with CLW. The moth of CLW data was weekly collected for two years in a commercial hydroponic greenhouse. Furthermore, among other features temperature and relative humidity were recorded over the total period of the study. It was proven that the XGBoost algorithm is the most effective algorithm applied in this study. Prediction accuracy of 84 % has been achieved using this algorithm. The impact of environmental features on the prediction accuracy was compared with each other to ensure a complete dataset for future results. In conclusion, the present study provided a framework for applying machine learning in the prediction of plant infestation with the CLW in the greenhouses. Based on this framework, further studies with continuous measurements are warranted to achieve greater accuracy.