bluuebunny/crossref_metadata_2025 huggingface dataset:
Second-generation mother-to-child HIV transmission in South Africa is characterized by poor outcomes
Authors: Millar Jane R. , Fatti Isabella , Mchunu Noxolo , Bengu Nomonde , Grayson Nicholas E. , Adland Emily , Bonsall David , Archary Moherndran , Matthews Philippa C. , Ndung’u Thumbi , Goulder Philip
Published: April 2021

Objective:

The worldwide incidence of pregnancy for women living with perinatal HIV infection is increasing. Subsequently, there is growing risk of second-generation mother-to-child HIV transmission. The infant clinical outcomes for such a phenomenon have yet to be described.

Design:

As part of a wider observational study in KwaZulu-Natal, South Africa, six infants with in-utero HIV infection were identified as being born to mothers with perinatal HIV infection.

Methods:

Blood results and clinical data were collected in the first 3 years of life. In two cases, sample availability allowed confirmation by phylogenetic analysis of grandmother-to-mother-to-child HIV transmission.

Results:

Outcomes were poor in all six cases. All six mothers had difficulty administering twice daily combination antiretroviral therapy to their infants due to difficulties with acceptance, disclosure, poor health and being themselves long-term nonprogressors. Nonnucleoside reverse transcriptase inhibitor-resistant virus was detected in all mothers tested. None of the infants maintained suppression of viraemia on combination antiretroviral therapy. One infant died, and another was lost to follow-up.

Conclusion:

As the numbers of second-generation mother-to-child transmissions increase, it is important to highlight that this mother–infant dyad represents an extremely vulnerable group. In order for them to survive and thrive, these infants’ mothers require their specific needs to be addressed and given intensive support.
The impact of viraemia on inflammatory biomarkers and CD4+ cell subpopulations in HIV-infected children in sub-Saharan Africa
Authors: Prendergast Andrew J. , Szubert Alexander J. , Pimundu Godfrey , Berejena Chipo , Pala Pietro , Shonhai Annie , Hunter Patricia , Arrigoni Francesca I.F. , Musiime Victor , Bwakura-Dangarembizi Mutsa , Musoke Philippa , Poulsom Hannah , Kihembo Macklyn , Munderi Paula , Gibb Diana M. , Spyer Moira J. , Walker A. Sarah , Klein Nigel
Published: April 2021

Objective:

To determine the impact of virological control on inflammation and cluster of differentiation 4 depletion among HIV-infected children initiating antiretroviral therapy (ART) in sub-Saharan Africa.

Design:

Longitudinal cohort study.

Methods:

In a sub-study of the ARROW trial (ISRCTN24791884), we measured longitudinal HIV viral loads, inflammatory biomarkers (C-reactive protein, tumour necrosis factor alpha, interleukin 6 (IL-6), soluble CD14) and (Uganda only) whole blood immunophenotype by flow cytometry in 311 Zimbabwean and Ugandan children followed for median 3.5 years on first-line ART. We classified each viral load measurement as consistent suppression, blip/post-blip, persistent low-level viral load or rebound. We used multi-level models to estimate rates of increase or decrease in laboratory markers, and Poisson regression to estimate the incidence of clinical events.

Results:

Overall, 42% children experienced viral blips, but these had no significant impact on immune reconstitution or inflammation. Persistent detectable viraemia occurred in one-third of children and prevented further immune reconstitution, but had little impact on inflammatory biomarkers. Virological rebound to ≥5000 copies/ml was associated with arrested immune reconstitution, rising IL-6 and increased risk of clinical disease progression.

Conclusions:

As viral load testing becomes more available in sub-Saharan Africa, repeat testing algorithms will be required to identify those with virological rebound, who need switching to prevent disease progression, whilst preventing unnecessary second-line regimen initiation in the majority of children with detectable viraemia who remain at low risk of disease progression.
Black men who have sex with men living in states with HIV criminalization laws report high stigma, 23 U.S. cities, 2017
Authors: Baugher Amy R. , Whiteman Ari , Jeffries William L. , Finlayson Teresa , Lewis Rashunda , Wejnert Cyprian
Published: April 2021

Objectives:

To examine the association between HIV laws, perceived community stigma, and behaviors and to compare differences between and within Black and White men who have sex with men (MSM).

Design/Methods:

National HIV Behavioral Surveillance conducted interviews and HIV testing with MSM in 23 U.S. cities in 2017 using venue-based sampling methods. We used weighted cross-sectional data to compare MSM living in states with versus without HIV laws using Rao–Scott chi-square tests. We modeled the association between stigma and state HIV laws within racial groups to obtain adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs).

Results:

Among 7392 MSM, 56% lived in a state with HIV laws. In law states, Black MSM were more likely than White MSM to report their community would discriminate against persons with HIV (PWH) (59 versus 34%), not support the rights of PWH (20 versus 9%), not be friends with PWH (19 versus 10%), believe PWH ‘got what they deserved’ (27 versus 16%), and be intolerant of MSM (14 versus 5%). Adjusted for confounders, Black MSM in HIV law states were more likely to think their community would discriminate against PWH (aPR, 1.14; 95% CI, 1.02–1.29; P = 0.02) and be intolerant toward MSM (aPR, 2.02; 95% CI, 1.43–2.86; P < 0.001) than Black MSM in states without such laws.

Conclusions:

HIV laws were related to higher stigma, but only for Black MSM. Future research regarding HIV-related laws should account for racial/ethnic disparities. Modernizing laws can delegitimize stigma and promote focusing on effective HIV prevention strategies.
Unique Techniques Utilizing Rib Grafts for Mandibular Reconstruction in the Pediatric Population
Authors: Liu Alice , Odono Lauren T. , Wlodarczyk Jordan R. , Garg Ravi K. , Hammoudeh Jeffrey A.
Published: April 2021

Introduction:

Pediatric mandibular reconstruction requires a grafted segment of sufficient height and stability to support dental implant placement. Double barreling and mandibular distraction osteogenesis (MDO) after reconstruction are two techniques to achieve this, but they have only been reported with fibular grafts. Rib grafts not only have a lower donor site morbidity than fibular grafts, but they also provide adequate defect coverage in children. As such, we propose their use with either a double barrel technique or with MDO.

Methods:

Three pediatric patients underwent mandibular resection and reconstruction using rib grafting. One patient underwent single rib graft placement with subsequent vertical rib distraction. In the remaining two patients, a double-barreled rib technique was used, stacked horizontally in one patient and vertically in the other.

Results:

From March 2018 to May 2019, three patients with an average age of 11 underwent resection of mandibular tumors or tumor-like lesions followed by immediate reconstruction with rib graft. Due to postoperative wound complications, the graft was completely removed in one patient. The remaining two patients had an uneventful recovery with dental implants planned for one and fully osseointegrated in the other. None of the patients experienced donor-site complications.

Conclusion:

This case series supports the utility and versatility of autogenous rib grafts as a reconstructive option in children. Not only is rib an excellent bone source with low donor site morbidity, but its height can be augmented through MDO or double barreling, facilitating the successful placement of implants and oral rehabilitation in pediatric patients.
The Impact of Hydrocephalus Shunt Devices on Quality of Life
Authors: Mitchell Kerry-Ann S. , Zelko Ian , Shay Tamir , Horen Sydney , Williams Ally , Luciano Mark , Huang Judy , Brem Henry , Gordon Chad R.
Published: April 2021

Background:

Despite advances in hydrocephalus shunt technology and improvement in hydrocephalus management, many patients have chronic disability and require multiple surgeries throughout their lifetime. There is limited data from patients’ perspective regarding the impact of shunt devices on quality-of-life.

Methods:

A cross-sectional survey was developed to evaluate the impact of shunt devices on patient quality-of-life. The survey was distributed via social media platforms of the Hydrocephalus Association, and patients self-selected to anonymously complete the online questionnaire. A literature review was performed to contextualize the findings from the survey.

Results:

A total of 562 survey responses were obtained from a network encompassing 35,000 members. The mean age was 30 years old (0.5–87), and 65% identified as female. Eighty one percent underwent at least 1 shunt revision surgery, with a reported average of 10 shunt revision surgeries per patient (1–200 surgeries). Occlusion, shunt migration and infection were the leading causes for revision at 60%, 47%, and 35%, respectively. In addition, 72% of patients reported pain and discomfort from the device, and 68% expressed avoidance of certain activities due to “fear of bumping shunt.” Despite numerous articles discussing shunt technology, a review of the literature indicated a paucity of studies specifically evaluating the burden of shunt devices from a patient/caregiver perspective.

Conclusions:

The findings from this study suggest long-term physical and psychosocial burden associated with shunt devices. Importantly, this study highlights the need for concerted efforts to develop validated tools to study patient reported outcomes as it relates to neurocranial implanted devices.
Inferior Turbinate Mucocele
Authors: Lee Dong Hoon , Lim Sang Chul
Published: April 2021

Objective:

In what follows, it is extremely rare for the inferior turbinate to occur with a mucocele. The authors aim to evaluate the characteristics, clinical features, and treatment outcome of the inferior turbinate mucocele in our hospital.

Patients and Methods:

Five patients with radiologically confirmed inferior turbinate mucocele between January 2006 and December 2017 were enrolled in this study.

Results:

Out of the 5 patients with inferior turbinate mucocele reviewed, 2 out of the 5 patients had symptoms of nasal obstruction and headache respectively, whereas the other 3 remaining patients were found incidentally by radiological examinations without any nasal symptoms. Four patients were performed the surgery by the transnasal endoscopic marsupialization. One patient had a very small size of an inferior turbinate mucocele and had no symptoms, and in that case the authors decided to do a periodic observation without a surgical intervention. There were no major complications resulting from this surgical intervention, and no recurrence of the inferior turbinate mucocele.

Conclusions:

The inferior turbinate mucocele is an extremely rare disease and can be diagnosed accurately by the use of radiologic examinations. The prevailing discipline is that endoscopic marsupialization is the best treatment for the inferior turbinate mucocele, which is known for showing very good results without recurrence of the condition.
Are Vowels Normalized After Maxillary Osteotomy? An Acoustic Study in Cleft Lip and Palate
Authors: Ho Choco H.Y. , Yu Wilson S. , Tuomainen Jryki , Sell Debbie , Lee Kathy Y.-S. , Tong Michael C.-F. , Pereira Valerie Jane
Published: April 2021

Background:

Maxillary hypoplasia is a common skeletal condition in cleft lip and palate (CLP). Maxillary osteotomy is typically used to reposition the maxilla in CLP with maxillary hypoplasia. Previous studies have suggested that vowel articulations are adjusted postsurgically due to altered vocal tract configuration and articulatory reorganization. This acoustic study aims to investigate whether vowels are normalized postoperatively and to explore the nature of articulatory reorganization.

Methods and Procedures:

A prospective study was conducted to examine the vowel production of a group of individuals with CLP (N = 17) undergoing maxillary osteotomy and a group of normal controls (N = 20), using speech acoustic data. The data were collected at 0 to 3 months presurgery (T1), 3-months (T2), and 12-months (T3) postsurgery. General linear model repeated measures and independentt-tests were undertaken on F1, F2, and vowel space area.

Results:

General linear model repeated measures revealed no main effects of time forF1 (F[2, 22] = 1.094,P = 0.352),F2 (F[2, 22] = 1.269,P = 0.301), and vowel space area (F[2, 28] = 0.059,P = 0.943). Independentt-tests showed statistically significant differences (P < 0.05) for all acoustic parameters and all vowels between the CLP and the normal groups at all time points.

Conclusions:

Vowels were not normalized after maxillary osteotomy despite positive anatomical changes within the oral cavity. Individuals with CLP tended to adjust their vowel articulatory gestures to match presurgical patterns. The nature of articulatory reorganization appears to be prompt, sensory-driven, complete, and permanent.
Augmentation of Supratemporal Hollowing With Silicone Block During Autologous Cranioplasty After Decompressive Craniectomy With Additional Temporalis Resection
Authors: Park Kwang Hyon , Park Bumsoo , Byoun Hyoung Soo , Lim Jeongwook
Published: April 2021

Decompressive craniectomy is a potentially life-saving neurosurgical procedure. In cases of insufficient decompression, uncontrolled intracranial pressure even after sufficient decompression, or when the intracranial pressure is increased due to external factors such as intramuscular hematoma in the temporal muscle, additional temporalis resection may be necessary. However, the hollowing of the supratemporal fossa that occurs after additional temporalis resection can create a major cosmetic problem. Several alternatives are available to fill the hollowing of the supratemporal fossa during cranial reconstruction, but each has a disadvantage, whether it is expensive or difficult to shape for bilateral symmetry. The author solved the cosmetic problem by using a properly carved silicone block to fill the supratemporal fossa while conducting cranioplasty, and here reports it with a literature review.
Craniofacial and Upper Airway Development in Patients With Treacher Collins Syndrome
Authors: Lin Yanxian , Ma Xiaoyang , Huang Yuanliang , Mu Lin , Yang Liya , Zhao Minghao , Xie Fang , Zhang Chao , Xu Jiajie , Lu Jianjian , Teng Li
Published: April 2021

This study evaluated age-associated morphology changes in the cranial base, facial development, and upper airway of patients with Treacher Collins syndrome (TCS). A total of 33 preoperative computed tomographic images (TCS, n = 14; control, n = 19) were included in the study and divided into three age-related subgroups (2–6 years, 7–18 years, and older than 18 years). Linear, angular cephalometric measurements and upper airway volumes were collected. All measurements were analyzed using ProPlan CMF software (version 3.0; Materialize, Leuven, Belgium). The association between aging and upper airway morphology was analyzed. Compared to control subjects, TCS patients had a smaller cranial base, maxilla, and nose; they also had reduced upper airway volume compared to control subjects. The observed differences were most significant in patients between the ages of 7 and 18 years. This study used computed tomography-based three-dimensional analyses to provide a detailed description of age-related changes that occur in craniofacial measurements and upper airway volumes in children, adolescents, and young adult patients with TCS in China. These data can be used to evaluate individual patients with TCS and to select treatment to improve the growth of the craniofacial region.
An Orbital Venous Varix Presenting as a Strain-Induced Lower Eyelid Mass
Authors: Jun Daiwon , Kim Jin Kwan , Kim Jeana , Lee Jung Ho
Published: April 2021

Orbital varix is uncommon disease entity, accounting for less than 1% of orbital tumor. Authors report a case of tumor mimicking lower eyelid varix of inferior palpebral vein induced by forced closure of the patient's eyelids. A 21-year-old female visited our institution with a complaint of eyelid mass that only appeared on frowning. A 0.5 × 1.0 cm2 sized soft, nontender and nonpulsating mass was observed at her left lower eyelid when she frowned. Preoperative ultrasound imaging revealed a hypoechoic cystic lesion above orbicularis oculi muscle. A surgical resection through transconjunctival approach was performed. Congestion of perforating inferior palpebral vein caused by contraction of orbicularis oculi muscle was observed intraoperatively. Histopathology has confirmed dilated venous structures. The symptom was immediately resolved after surgery. No sign of recurrence was detected after two years of follow-up.
Long-Term Complications of Coronavirus Disease 2019; What the Oral Surgeon Needs To Know
Authors: Abu-Hammad Osama , Dar-Odeh Najla , Abu-Hammad Abdalla , Althagafi Nebras , Eshky Rawah , Abu-Hammad Shaden
Published: April 2021

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 manifests mainly as respiratory symptoms. Extrapulmonary manifestations have also been detected and several vital organs may sustain irreversible or long-standing damage. These extrapulmonary manifestations can be detected in cardiovascular, hepatic, renal, and hematologic systems. Maxillofacial surgeons may encounter patients who have recovered from COVID-19 but are still suffering long-term morbidities as a result of this incompletely understood infection. Consequently, they have to be aware of the various systemic complications that may be encountered in these patients as they may interfere with their treatment plan or may necessitate certain modifications and precautions.

In this report the authors present the long-standing systemic complications of COVID-19 reported so far, and discuss their implications within the context of maxillofacial surgery with regards to the modifications and precautions in the process of treatment planning.

Graphical abstract shows the long-term complications of COVID-19 that may complicate maxillofacial surgical procedures.
The Propeller Myocutaneous Flap of the Upper Eyelid: Anatomical Study and its Clinical Implication
Authors: Delia Gabriele , Fazio Antonina , Parafioriti Andrea , Meduri Alessandro , Inferrera Leandro , Stagno d’Alcontres Francesco
Published: April 2021

Background:

The reconstruction of the upper eyelid and the periorbital region is a challenge for the surgeon. The aims of this reconstruction are to guarantee protection to the eyeball, maintain the visual field, and restore the function of the eyelid without damaging other anatomical structures. In this study, the authors describe the use of a propeller myocutaneous flap based on the small vertical branches of marginal, peripheral ed superficial arcade, for the reconstruction of the upper eyelid or periorbital region.

Materials and Methods:

The authors enrolled 3 patients (Caucasian), between 2018 and 2019, and subjected to reconstructive surgery with the propeller myocutaneous flap of the periorbital region at the Plastic Surgery Unit of the University of Messina. The vascularization of the flap was demonstrated through an anatomical study conducted on cadavers at the dissection laboratories of the University of Bordeaux 2.

Results:

The authors have shown that the myocutaneous flap represents a valid alternative for loss of substance coverage and reconstruction of the upper eyelid or periorbital region, allowing the achievement of a good aesthetic and functional result.

Follow up:

Patients were followed up at 3–6–12 months. No complications were reported (flap retraction, periocular region deformity, donor site morbidity). Furthermore, at the last visit, the scars were almost invisible.

Conclusions:

The use of the propeller myocutaneous flap of the upper eyelid is a valid reconstructive alternative to the standard techniques described so far for the reconstruction of the periorbital region.
Intraoperative Celiac Plexus Block With Preperitoneal Infusion Reduces Opioid Usage in Major Hepato-pancreato-biliary Surgery
Authors: Teo Zhe Hao T. , Tey Boon Lim J. , Foo Chek Wun , Wong Wan Yi , Low Jee Keem
Published: April 2021

Objective:

Given the role of celiac plexus block (CPB) in the management of chronic pain, we sought to investigate the utility of CPB in the control of postoperative pain in major hepato-pancreato-biliary surgeries.

Summary Background Data:

CPB has been in practice for decades for the management of upper abdominal visceral pain, especially in cancer patients. Typically, in this group of patients with chronic pain, a neurolytic agent is injected to cause irreversible neural damage to achieve pain control. We apply this concept to postoperative pain control by injecting bupivacaine to the celiac plexus instead of a neurolytic agent. We aim to investigate if this novel technique decreases postoperative opioid usage, offers better pain relief and leads to earlier ambulation

Methods:

A retrospective, single institution study comparing consecutive patients who received intraoperative CPB and preperitoneal infusion with patients who received only preperitoneal infusion in open hepato-pancreato-biliary surgery between the years 2016 and 2019 by a single surgeon. Patients with incomplete data on patient-controlled analgesia usage and postoperative ambulation information were excluded.

Results:

Patients with CPB used 31% less morphine on postoperative day 1 compared to patient without CPB and 42% less morphine on postoperative day 2. Overall average morphine usage was significantly lower in patients with CPB. Duration of patient-controlled analgesia was shorter for patient with CPB compared with patient without CPB. The dynamic visual analogue score was marginally better in patients with CPB. Time to ambulation was similar in both groups.

Conclusions:

CPB can be considered as part of a multimodal approach for postoperative pain management in open hepato-pancreato-biliary surgeries.
Laparoscopic Pancreaticoduodenectomy With Transanal Specimen Extraction for Periampullary Tumors
Authors: Meng Haipeng , Wang Song , Liu Jinchao , Zhao Xu , Rong Zhen , Xu Yanling , Yu Gang
Published: April 2021

Objective:

To explore the possibility of LPD with transanal specimen extraction for periampullary tumors.

Background:

Natural orifice specimen extraction has been widely performed in colorectal surgery. But so far there is no report regarding natural orifice specimen extraction in LPD.

Methods:

Data of 3 patients who underwent LPD with transanal specimen extraction by the same surgeon between July 2018 and March 2019 due to periampullary tumors were evaluated retrospectively.

Results:

All patients underwent LPD with no conversion to open surgery. Specimens were all extracted transanally. No complications occurred except for delayed gastric emptying in 1 patient. The patients’ anorectal function was intact and no opioids were required postoperatively. After a follow-up of 17–25 months, all patients were alive with no tumor recurrence.

Conclusion:

Treatment of periampullary tumors by LPD with transanal specimen extraction is feasible and safe.
Nonintubated Robotic-assisted Thoracic Surgery for Tracheal/Airway Resection and Reconstruction
Authors: Li Shuben , Ai Qing , Liang Hengrui , Liu Hui , Yang Chao , Deng Hongsheng , Zhong Yunpeng , Zhang Jie , He Jianxing
Published: April 2021

Objective:

We aim to report a novel surgical technique that RATS combined with nonintubated spontaneous ventilation to perform tracheal/airway surgery.

Summary of Background Data:

Our team has demonstrated video-assisted transthoracic surgery can be used for thoracic tracheal diseases with satisfactory outcomes. Our team has also demonstrated that tracheal/airway resection and reconstruction under spontaneous ventilation can improve the anastomosis and operating time. Recently, RATS emerged as an available alternative minimally invasive approach for lung cancer, with lower perioperative mortality and conversion rate to open.

Methods:

Five patients fulfilling the criteria for nonintubated approach underwent RATS tracheal/airway surgery. Patient 1 has a tumor in the thoracic trachea; patient 2 had involving secondary carina; patient 3 had involving trachea carina, and patient 4 had involving left main bronchus. Patient 5 had involving mid-tracheal.

Results:

All patients had an uneventful procedure. The total operative time ranged from 5 hours 5 minutes to 9 hours 55 minutes. The postoperative hospital stays ranged from 4 days to 14 days. Fiber-optic bronchoscopy performed 1 month after the procedure showed good anastomotic healing with no stricture.

Conclusion:

This is the first report on RATS use in tracheal/airway surgery, in combination with nonintubation spontaneous ventilation. In selected patients, this novel combined approach is feasible and safe. A patient can potentially benefit from the combined advantages of both techniques. More cases and longer-term data are required to establish its role in tracheal/airway surgery.
Bound Together: Allyship in the Art of Medicine
Authors: Ellis Danielle
Published: April 2021

In the setting of the immense social, political, medical, and cultural challenges of last year, medicine has been made acutely aware of its participation in inequity and in response offers allyship as a framework for clinicians to pursue change, using tools already apart of the practice of medicine.

Allyship in the workplace can be summarized as a strategic mechanism used by individuals to become collaborators who fight injustice and promote equity through supportive personal relationships and public acts of sponsorship and advocacy. The idea of allyship may be intimidating, particularly for practitioners and leaders who do not belong to the communities they endeavor to support. But as the article unpacks, practitioners need not look any further for how to be allies than what they practice every day: lifelong learning; humility in complications; an expectation of imperfection; and, bound together with those who suffer, persistence in the pursuit of healing.
From Listening to Action
Authors: Korndorffer James R. , Wren Sherry M. , Pugh Carla M. , Hawn Mary T.
Published: April 2021

Objective:

The aim of this study was to describe the development and evaluation of a structured department wide cultural competency curriculum.

Summary Background Data:

Despite numerous organizational policies and statements, social injustice and bias still exist. Our department committed to assist individuals of the entire department to develop foundational knowledge and skills to combat implicit bias and systemic racism through the creation of a cultural competency curriculum. The purpose of this manuscript is to detail our curriculum and the evaluation of its effectiveness.

Methods:

Using a well-established curriculum development framework, a cultural competency curriculum was developed focusing on knowledge, skills and attitudes at the individual level, for all members of the department. The curriculum was implemented through 6-hour-long sessions over a 9-week period. Effectiveness was assessed through a post curriculum survey.

Results:

Twenty percent of the respondents had experienced bias based on race, ethnicity, or sexual orientation in the past 12 months, whereas 30% had experienced bias based on sex. Seventy-one percent independently explored related topics. The curriculum was overall well received and generally achieved the goals and objectives.

Conclusion:

Using a standard curriculum development framework, an effective department-wide cultural competency curriculum can be developed and implemented.
Gender Differences in Entrustable Professional Activity Evaluations of General Surgery Residents
Authors: Padilla Elena P. , Stahl Christopher C. , Jung Sarah A. , Rosser Alexandra A. , Schwartz Patrick B. , Aiken Taylor , Acher Alexandra W. , Abbott Daniel E. , Greenberg Jacob A. , Minter Rebecca M.
Published: April 2021

Objective:

To determine differences in entrustable professional activity (EPA) assessments between male and female general surgery residents.

Summary Background Data:

Evaluations play a critical role in career advancement for physicians. However, female physicians in training receive lower evaluations and underrate their own performance. Competency-based assessment frameworks, such as EPAs, may help address gender bias in surgery by linking evaluations to specific, observable behaviors.

Methods:

In this cohort study, EPA assessments were collected from July 2018 to May 2020. The effect of resident sex on EPA entrustment levels was analyzed using multiple linear and ordered logistic regressions. Narrative comments were analyzed using latent dirichlet allocation to identify topics correlated with resident sex.

Results:

Of the 2480 EPAs, 1230 EPAs were submitted by faculty and 1250 were submitted by residents. After controlling for confounding factors, faculty evaluations of residents were not impacted by resident sex (estimate = 0.09, P = 0.08). However, female residents rated themselves lower by 0.29 (on a 0–4 scale) compared to their male counterparts (P < 0.001). Within narrative assessments, topics associated with resident sex demonstrated that female residents focus on the “guidance” and “supervision” they received while performing an EPA, while male residents were more likely to report “independent” action.

Conclusions:

Faculty assessments showed no difference in EPA levels between male and female residents. Female residents rate themselves lower by nearly an entire post graduate year (PGY) level compared to male residents. Latent dirichlet allocation -identified topics suggest this difference in self-assessment is related to differences in perception of autonomy.
Impact of Age on Obesity-related Comorbidity After Gastric Bypass
Authors: Gerber Peter , Anderin Claes , Gustafsson Ulf O. , Thorell Anders
Published: April 2021

Objective:

To evaluate the resolution of obesity-related comorbidities after gastric bypass in relation to age.

Summary Background Data:

Previous studies have shown that age >60 years is associated with a significant, but small, increased risk of complications after gastric bypass. The effect in terms of improvement of obesity-related comorbidities in this group of patients is not studied.

Methods:

Data on 57,215 patients operated with primary gastric bypass between May 2007 and December 2018 was extracted from the Scandinavian Obesity Surgery Registry. Odds ratio and 95% confidence interval for resolution of comorbidities in 5-years age groups at 1, 2, and 5 years postoperatively was calculated by logistic regression with the entire cohort of patients as reference. Resolution was defined as no longer in need for pharmacological (or continuous positive airway pressure) treatment.

Results:

Follow-up rates in all eligible patients were 89%, 69%, and 59% at 1, 2, and 5 years, respectively, and 64% in patients >60 years at 5 years. At baseline, the prevalence of most comorbidities was higher in patients above 60 years. In this group of patients, the preoperative prevalence of diabetes, hypertension, dyslipidemia and obstructive sleep apnea syndrome was reduced at 5years by 45%, 10%, 24%, and 62%, respectively. Compared to all patients, the odds ratio (95% confidence interval) for resolution of these comorbidities in patients above 60 years at five years were 0.70 (0.57–0.86) 0.45 (0.37–0.53), 0.80 (0.63–1.01), and 0.54 (0.40–0.72).

Conclusions:

Although to somewhat lower rates compared to younger patients, marked and sustained improvements in obesity-related comorbidities are seen after gastric bypass in patients >60 years. This, together with the finding that bariatric surgery is safe in this group of patients, suggests that age should not be considered an exclusion criterion by itself.
Pancreatic Enucleation Patients Share the Same Quality of Life as the General Population at Long-Term Follow-Up
Authors: Giuliani Tommaso , De Pastena Matteo , Paiella Salvatore , Marchegiani Giovanni , Landoni Luca , Festini Michele , Ramera Marco , Marinelli Veronica , Casetti Luca , Esposito Alessandro , Bassi Claudio , Salvia Roberto
Published: April 2021

Objective:

The aim of this study was to assess short- and long-term outcomes including quality of life (QoL) following pancreatic enucleation (PE).

Background:

PE is deemed to preserve both the endocrine and the exocrine function while ensuring radicality. However, to assess whether this reflects an actual benefit perceived by patients, QoL has to be considered.

Methods:

Data from all consecutive patients undergoing PE from January 2010 to December 2019 were retrospectively analyzed. Surgical outcomes were graded according to the Clavien-Dindo classification, and EORTC-C30 and the EORTC-Pan26 were administered as a cross-sectional assessment of QoL. A control group consisting of healthy individuals from the general population was obtained and matched using the propensity score matching method.

Results:

Eighty-one patients underwent PE using the open (59.3%), laparoscopic (27.2%), or robot-assisted (13.5%) approach. Sixty-five (80.2%) patients exhibited functioning/nonfunctioning pancreatic neuroendocrine tumors at final pathology.

Surgical morbidity and complications of a Clavien-Dindo grade ≥3 were 48.1% and 16.0%, respectively. In-hospital mortality was 0%. Postoperative pancreatic fistula, post-pancreatectomy hemorrhage, and delayed gastric emptying rates were 21.0%, 9.9%, and 4.9%, respectively.

Patients returned the questionnaires after a median of 74.2 months from the index surgery. Postoperative new onset of diabetes mellitus (NODM) was observed in 5 subjects (7.1%), with age being an independent predictor. Seven patients (10.0%) developed postoperative exocrine insufficiency. At the analysis of QoL, all function and symptom scales were comparable between the 2 groups, except for 2 of the EORTC-Pan 26 symptom scales, (“worries for the future” and “body image”, P < 0.05).

Conclusions:

Despite being associated with significant postoperative morbidity, PE provides excellent long-term outcomes. The risk of NODM is low and related to patient age, with QoL being comparable to the general population. Such information should drive surgeons to pursue PE whenever properly indicated.
Navajo
Authors: Henderson Davis E.
Published: April 2021

Standardized norm-referenced language assessments are used to identify developmental language disorder (DLD) in bicultural Navajo children. However, these assessments do not include normative data for Navajo children, the majority of whom are exposed to both Navajo and English, and consequently the assessments may not reflect their true language abilities. The purpose of this clinical tutorial is to provide background and alternative assessment information to help practitioners accurately identify Navajo children with and without DLD. In particular, the use of dynamic assessment, a test–teach–retest method, has shown promising results in differentiating Navajo children with and without DLD.
Safety and Reactogenicity of 2 Doses of SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients
Authors: Ou Michael T. , Boyarsky Brian J. , Motter Jennifer D. , Greenberg Ross S. , Teles Aura T. , Ruddy Jake A. , Krach Michelle R. , Jain Vedant S. , Werbel William A. , Avery Robin K. , Massie Allan B. , Segev Dorry L. , Garonzik-Wang Jacqueline M.
Published: April 2021

Background.

We studied the safety and reactogenicity SARS-CoV-2 mRNA vaccines in transplant recipients because immunosuppressed patients were excluded from vaccine trials.

Methods.

US transplant recipients were recruited into this prospective cohort study through social media; those who completed the full vaccine series between December 9, 2020 and March 1, 2021 were included. We collected demographics, medical history, and safety information within 7 d after doses 1 and 2 (D1, D2). Associations between characteristics and reactions were evaluated using modified Poisson regression.

Results.

We studied 741 transplant recipients who underwent BNT162b2 (54%) or mRNA-1273 (46%) vaccination. Median (interquartile range) age was 60 (44–69) y, 57% were female, and 10% were non-White. Although local site reactions decreased after D2 (85% D1 versus 78% D2, P < 0.001), systemic reactions increased (49% D1 versus 69% D2, P < 0.001). Younger participants were more likely to develop systemic symptoms after D1 (adjusted incidence rate ratio [aIRR] per 10 y = 0.850.900.94, P < 0.001) and D2 (aIRR per 10 y = 0.910.930.96, P < 0.001). Participants who experienced pain (aIRR = 1.111.662.47, P = 0.01) or redness (aIRR = 1.833.928.41, P < 0.01) were more likely to develop an antibody response to D1 of mRNA vaccines. No anaphylaxis, neurologic diagnoses, or SARS-CoV-2 diagnoses were reported. Infections were minimal (3% after D1, <0.01% after D2). One patient reported incident acute rejection post-D2.

Conclusions.

In solid organ transplant recipients undergoing mRNA vaccination, reactogenicity was similar to that reported in the original trials. Severe reactions were rare. These early safety data may help address vaccine hesitancy in transplant recipients.
Innate (and Innate-like) Lymphoid Cells: Emerging Immune Subsets With Multiple Roles Along Transplant Life
Authors: Charmetant Xavier , Bachelet Thomas , Déchanet-Merville Julie , Walzer Thierry , Thaunat Olivier
Published: April 2021

Transplant immunology is currently largely focused on conventional adaptive immunity, particularly T and B lymphocytes, which have long been considered as the only cells capable of allorecognition. In this vision, except for the initial phase of ischemia/reperfusion, during which the role of innate immune effectors is well established, the latter are largely considered as “passive” players, recruited secondarily to amplify graft destruction processes during rejection. Challenging this prevalent dogma, the recent progresses in basic immunology have unraveled the complexity of the innate immune system and identified different subsets of innate (and innate-like) lymphoid cells. As most of these cells are tissue-resident, they are overrepresented among passenger leukocytes. Beyond their role in ischemia/reperfusion, some of these subsets have been shown to be capable of allorecognition and/or of regulating alloreactive adaptive responses, suggesting that these emerging immune players are actively involved in most of the life phases of the grafts and their recipients. Drawing upon the inventory of the literature, this review synthesizes the current state of knowledge of the role of the different innate (and innate-like) lymphoid cell subsets during ischemia/reperfusion, allorecognition, and graft rejection. How these subsets also contribute to graft tolerance and the protection of chronically immunosuppressed patients against infectious and cancerous complications is also examined.
Solid Organ Donation From Brain-dead Donors With Cardiorespiratory Arrest After Snow Avalanche Burial: A Retrospective Single-center Study
Authors: Gasteiger Lukas , Putzer Gabriel , Unterpertinger Regina , Cardini Benno , Schneeberger Stefan , Eschertzhuber Stephan , Mair Peter
Published: April 2021

Background.

Complete snow avalanche burial is associated with high mortality. The aim of this study was to assess the feasibility and incidence of organ retrieval in brain-dead donors following cardiorespiratory arrest due to avalanche burial and to evaluate the function of transplanted organs.

Methods.

The transplant registry of the Medical University of Innsbruck was searched for organ donors with a history of avalanche burial, and the function and survival of transplanted organs were assessed.

Results.

Thirty-three organs were procured from eight donors and 31 organs (13 kidneys, 6 livers, 3 pancreases, 5 hearts, and 4 lungs) were ultimately transplanted. Allograft and recipient 1-y survival were 100% and both initial and long-term graft function were good. Only one-third of all avalanche victims who died in the intensive care unit with signs of irreversible hypoxic brain injury became organ donors.

Conclusions.

Initial experience from this retrospective study suggests that organs from brain-dead avalanche victims can be transplanted with good results. Starting a Donation after Circulatory Determination of Death program might be an option for increasing the number of organ donations from avalanche victims with irreversible hypoxic brain injury.
Drug interactions and risks associated with the use of triptans, ditans and monoclonal antibodies in migraine
Authors: Al-Hassany Linda , MaassenVanDenBrink Antoinette
Published: April 2021

Purpose of review

The aim of this study was to review current evidence concerning potential risks and interactions associated with concomitant use of drugs indicated for the abortive treatment of migraine, namely triptans and ditans, and more recently developed drugs used for the preventive treatment. The latter drug class encompasses monoclonal antibodies (mAbs), which target either calcitonin gene-related peptide (CGRP) or its receptor.

Recent findings

To date, no pharmacokinetic interactions between these drug classes have been reported. However, patients who suffer from triptan- (or ditan-) induced medication overuse headache or those who are nonresponders to triptans might respond less effectively to mAbs. Caution is warranted when coadministrating these drugs in migraine patients with comorbid cardiovascular disease or with an increased cardiovascular risk profile.

In this review, the main mechanisms of action of triptans, ditans and mAbs targeting CGRP or its receptor are summarized as well as the current evidence on their individual risks. Studies on risks and interactions in case of concomitant use of triptans, ditans and mAbs in migraine patients are relatively scarce. Therefore, these aspects have been considered from a theoretical and hypothetical point of view by taking both their overlapping target, CGRP, and contraindications into account.
Neuropathogenesis of acute coronavirus disease 2019
Authors: Farhadian Shelli F. , Seilhean Danielle , Spudich Serena
Published: April 2021

Purpose of review

Over the course of the coronavirus disease (COVID-19) pandemic, it has become increasingly clear that there is a high prevalence of neurological complications in people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Recent findings

Studies of central nervous system (CNS) tissue in brain model systems and from adults with acute SARS-CoV-2 infection have begun to uncover potential mechanisms for neurological damage during COVID-19. These studies suggest that direct viral invasion of the CNS occurs in a subset of cases but does not frequently cause overt viral meningoencephalitis. Vascular abnormalities including microvascular thrombi and endothelial activation, as well as parainfectious processes, including CNS specific immune responses, may contribute to neurological symptoms during acute SARS-CoV-2 infection.

Neuroimmune perturbations and vascular inflammation observed in people with COVID-19 may warrant investigation of immune-modulating interventions to ameliorate neurological complications associated with acute SARS-CoV-2 infection. These therapies may also impact the trajectory of potential long-term complications of COVID-19.
Off-label use of second-generation antipsychotics in borderline personality disorder: a comparative real-world study among oral and long-acting injectables in Spain
Authors: García-Carmona Juan Antonio , Simal-Aguado Jorge , Campos-Navarro María Pilar , Valdivia-Muñoz Francisco , Galindo-Tovar Alejandro
Published: April 2021

The aim of the present study was to evaluate the use of oral vs. long-acting injectables (LAIs) antipsychotics, as well as, to compare the effectiveness of different LAI antipsychotics [aripiprazole-1-month, paliperidone-1-month (PP1M), paliperidone-3-month (PP3M) and risperidone long-acting injectable (RLAI)] in patients diagnosed with borderline personality disorder (BPD), by evaluating the following clinical outcomes: (1) the number of hospital admissions; (2) the number of documented suicidal behaviour/attempts; and (3) the use of concomitant treatments, including benzodiazepines, oral antipsychotics and biperiden. We included a total of 116 patients diagnosed with BPD and treated with antipsychotic medication: 50 using a LAI antipsychotic formulation and 66 using the equivalent main oral antipsychotic. Patients treated with LAIs showed a decreased ratio of visits to emergency compared with the oral treatment group, and between LAIs, PP3M vs. aripiprazole-1-month group. Furthermore, patients treated with LAIs used lower number and dose of concomitant antipsychotics compared with patients treated with oral antipsychotics. Moreover, PP1M and PP3M used lower daily dose of diazepam equivalents compared with the aripiprazole-1-month and RLAI treatment groups. In conclusion, the use of LAIs may play a role in the management of BPD.
Psychiatric symptoms in an adolescent reveal a novel compound heterozygous mutation of the PANK2 gene in the atypical PKAN syndrome
Authors: González Huerta Luz María , Gómez González Sorina , Toral López Jaime
Published: April 2021

The proband in this study was a 16-year-old Mexican girl with psychotic and dyskinetic symptoms, and brain MRI showed at the basal ganglia the ‘eye-of-the-tiger’ sign. DNA direct sequencing identified a novel compound heterozygous mutation in the PANK2 gene. The diagnosis of pantothenate kinase-associated neurodegeneration (PKAN) disorder was made. This novel change increases the pool of PANK2 mutations. It supports the published data suggesting that PANK2 plays a significant role in patients expressing psychiatric phenotypes in the PKAN syndrome. When a patient presents with dyskinesia and psychiatric symptoms, PANK2 should be investigated as a possible diagnosis, and genetic consultation should be recommended.
Evolutionary consequences of environmental effects on gamete performance
Authors: Crean Angela J. , Immler Simone
Published: April 2021

Variation in pre- and post-release gamete environments can influence evolutionary processes by altering fertilization outcomes and offspring traits. It is now widely accepted that offspring inherit epigenetic information from both their mothers and fathers. Genetic and epigenetic alterations to eggs and sperm-acquired post-release may also persist post-fertilization with consequences for offspring developmental success and later-life fitness. In externally fertilizing species, gametes are directly exposed to anthropogenically induced environmental impacts including pollution, ocean acidification and climate change. When fertilization occurs within the female reproductive tract, although gametes are at least partially protected from external environmental variation, the selective environment is likely to vary among females. In both scenarios, gamete traits and selection on gametes can be influenced by environmental conditions such as temperature and pollution as well as intrinsic factors such as male and female reproductive fluids, which may be altered by changes in male and female health and physiology. Here, we highlight some of the pathways through which changes in gamete environments can affect fertilization dynamics, gamete interactions and ultimately offspring fitness. We hope that by drawing attention to this important yet often overlooked source of variation, we will inspire future research into the evolutionary implications of anthropogenic interference of gamete environments including the use of assisted reproductive technologies.

This article is part of the theme issue ‘How does epigenetics influence the course of evolution?’