bluuebunny/crossref_metadata_2025 huggingface dataset:
Should Nations With Surplus Donated Corneal Tissue Export to Those Without? A Review of Sector Opinion Through the Example of One Nation—Australia
Authors: Machin Heather , Sutton Gerard , Baird Paul N.
Published: June 2020

Purpose:

There is a global demand for corneal tissue (CT) for transplantation, with some nations potentially able to export donations to those nations without. Unfortunately, there remains a global paucity of information that explains the process of exportation and importation (transnational activity), supports or defines practice, or informs those seeking to engage. Without knowledge, inclusive of the pros and cons, participating nations and decision makers are unable to make effective and informed decisions.

Methods:

Through the example of our own nation, Australia, which may be entering a surplus-to-domestic demand phase and able to export, we conducted qualitative grounded-theory semistructured interviews with sector experts. Our approach ascertained whether Australia should export and under what arrangements. Through saturation and sentiment methods, we capture for the first time, global opinion on CT transnational activity (although primarily exportation), key themes, and finally determine whether Australia should engage.

Results:

Eighty-four (91%) of 92 participants directly commented on our question “should Australia export corneal tissue?” Of 84, n = 67 (80%) stated yes, n = 17 (20%) indicated mixed opinions. No participant categorically stated that there should be no export.

Conclusions:

Eye tissue and eye care experts whom we interviewed, supported the concept of Australia exporting CT; however, they advise several safeguards to protect both import and export nations. Principally, they recommended practice be transparent with donors, nationally coordinated, part of a wider humanitarian program, nonprofit, short term for the importing nations as they move toward self-sufficiency and that Australia must define and confirm domestic need and ensure that demand is met before routine exportation.
Sutureless Femtosecond Laser–Assisted Anterior Lamellar Keratoplasty Using a Bioengineered Cornea as a Viable Alternative to Human Donor Transplantation for Superficial Corneal Opacities
Authors: Khodaparast Mehdi , Shahraki Kianoush , Jabbarvand Mahmoud , Shahraki Kourosh , Rafat Mehrdad , Moravvej Zahra
Published: June 2020

Purpose:

To evaluate the safety and efficacy of a bioengineered corneal implant using femtosecond laser–assisted anterior lamellar keratoplasty for superficial corneal opacities.

Methods:

Six eyes of 6 consecutive patients with superficial corneal stromal opacities involving <220 μm owing to various pathologies were included in the study. Preoperatively, all patients underwent anterior segment optical coherence tomography (Visante; Carl Zeiss Meditec AG) to evaluate the depth of the corneal opacity. All patients underwent sutureless femtosecond laser–assisted anterior lamellar keratoplasty using a bioengineered collagen corneal implant (linkcor). Visual indices, refraction, and keratometry were evaluated preoperatively and 12 months postoperatively.

Results:

Corrected distance visual acuity improved significantly in all patients (P = 0.02). A significant decrease was seen in refractive astigmatism postoperatively (P = 0.04). Flat keratometry reduced significantly 12 months after the intervention (P = 0.04). No intraoperative or early postoperative complications were noticed. All implants were fully covered by healthy epithelium within a month after the surgery and remained clear at follow-up visits. The results of this procedure remained stable throughout the follow-up period. In 1 patient, mild inferior collagen melting and epithelial defect formation occurred at 1-year follow-up. Despite frequent topical corticosteroid therapy the melting progressed, the collagen tissue was removed and the patient was treated accordingly with good visual outcomes.

Conclusions:

Femtosecond laser–assisted anterior lamellar keratoplasty with bioengineered corneal (linkcor) implantation is an effective treatment for improving vision quality in anterior stromal opacities. This procedure reduces the need for human donor tissue and avoids human donor-related and suturing complications.
Inhibitory Effect of Valsartan on Pterygium Fibroblasts
Authors: Küçük Erkut , Aydemir Işıl , Zor Kürsad Ramazan , Özkan Oktay
Published: June 2020

Purpose:

Angiotensin receptor blockers (ARBs) were shown to have antifibrotic properties in ocular and systemic diseases. In this study, our aim was to investigate the effect of an angiotensin receptor blocker, valsartan, on pterygium fibroblasts and compare this effect with that of mitomycin C (MMC).

Methods:

Pterygium tissue samples were obtained from 3 patients during surgical excision. Primary cultured pterygium fibroblasts and L929 cell cultures were treated with different concentrations of MMC and valsartan.

Results:

The cell viability decreased with increasing concentrations of valsartan at 48 hours for both cell types. MMC inhibited the proliferation of both cell types at 48 hours. Both agents significantly decreased the cell migration of the 2 cell types, although it was more prominent in the MMC-treated group.

Conclusions:

Valsartan inhibited the proliferation and migration of pterygium fibroblasts. The known favorable safety profile of these drugs and the results of this study showing inhibitory effect on pterygium fibroblasts make valsartan a potential therapeutic agent for pterygium treatment.
Loss of SLC9A6/NHE6 impairs nociception in a mouse model of Christianson syndrome
Authors: Petitjean Hugues , Fatima Tarheen , Mouchbahani-Constance Stephanie , Davidova Albena , Ferland Catherine E. , Orlowski John , Sharif-Naeini Reza
Published: June 2020

Children diagnosed with Christianson syndrome (CS), a rare X-linked neurodevelopmental disorder characterized by intellectual disability, epilepsy, ataxia, and mutism, also suffer from hyposensitivity to pain. This places them at risk of sustaining serious injuries that often go unattended. Christianson syndrome is caused by mutations in the alkali cation/proton exchangerSLC9A6/NHE6that regulates recycling endosomal pH homeostasis and trafficking. Yet, it remains unclear how defects in this transporter lead to altered somatosensory functions. In this study, we validated aNhe6knockout (KO) mouse as a model of CS and used it to identify the cellular mechanisms underlying the elevated pain tolerance observed in CS patients. Within the central nervous system, NHE6 immunolabelling is detected in a small percentage of cortical neurons involved in pain processing, including those within the primary somatosensory and the anterior cingulate cortices as well as the periaqueductal gray. Interestingly, it is expressed in a larger percentage of nociceptors. Behaviourally,Nhe6KO mice have decreased nocifensive responses to acute noxious thermal, mechanical, and chemical (ie, capsaicin) stimuli. The reduced capsaicin sensitivity in the KO mice correlates with a decreased expression of the transient receptor potential channel TRPV1 at the plasma membrane and capsaicin-induced Ca2+influx in primary cultures of nociceptors. These data indicate that NHE6 is a significant determinant of nociceptor function and pain behaviours, vital sensory processes that are impaired in CS.
Factors Influencing Aberrant Facial Nerve Stimulation Following Cochlear Implantation: A Systematic Review and Meta-analysis
Authors: Van Horn Adam , Hayden Chistopher , Mahairas Anthony D. , Leader Preston , Bush Matthew L.
Published: June 2020

Objective:

The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS) following cochlear implantation. Additionally, management strategies for AFNS were assessed.

Data Sources:

A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, and Web of Science to identify peer reviewed research.

Study Selection:

Eligible studies were those containing peer-reviewed research in English addressing AFNS following cochlear implantation. Studies with paired data were included in the meta-analysis.

Data Extraction:

Three investigators independently reviewed all articles and extracted data. Bias was assessed using the National Institutes of Health Study Quality Assessment Tool.

Data Synthesis:

Thirty-seven articles were included, representing 5,694 patients. The overall reported AFNS rate was 5.6% (range, 0.68–43%). Array type demonstrated a significant association with AFNS with lateral wall electrodes having a higher odds ratio than perimodiolar electrodes (odds ratio [OR] = 3.92, 95% confidence interval [CI] 1.46–10.47, p = 0.01). CI recipients with otosclerosis were also more likely to experience AFNS compared with non-otosclerosis pathology (OR = 13.73, 95% CI 3.57–52.78, p < 0.01). Patients with cochlear malformations had an overall AFNS rate of 28% (range, 5.3–43%) and those with otosclerosis had an overall rate of 26% (range, 6.25–75%). Reprogramming with or without electrode deactivation was successful for AFNS elimination. Four patients of 3,015 required explantation.

Conclusion:

Array type and underlying cochlear pathology are associated with AFNS and implant reprogramming is an overall successful management strategy. Further research is needed to elucidate mechanism of AFNS and develop management strategies that limit impact on hearing outcomes.
Clinical Characteristics and Prognosis of Sudden Sensorineural Hearing Loss in Post-irradiated Nasopharyngeal Carcinoma Survivors
Authors: Jiang Weihong , Xie Shaobing , Wu Xuewen , Gao Kelei , Feng Yong , Mei Lingyun , Xie Zhihai
Published: June 2020

Objectives:

Sudden sensorineural hearing loss (SSNHL) may occur in post-irradiated nasopharyngeal carcinoma (NPC) survivors with a rare rate. This study was conducted to evaluate the clinical characteristics and prognosis of this population.

Study Design:

Retrospective cohort study.

Setting:

Tertiary otology referral center.

Patients:

Five hundred ninety nine SSNHL patients were recruited between January 2010 and January 2019. Patients were divided into two groups: NPC group (n = 24) and non-NPC group (n = 575).

Interventions:

All SSNHL patients were diagnosed by pure tone audiometry and treated with steroids, blood flow promoting agents, and hyperbaric oxygen therapy.

Main Outcome Measures:

We evaluated the clinical characteristics and prognosis of post-irradiated SSNHL and identified prognostic factors by logistic regression analysis.

Results:

In the NPC group, the initial hearing threshold, contralateral hearing threshold, rate of vertigo, rate of profound hearing loss were all higher than in the non-NPC group (p < 0.05). Hearing gains and the rate of good recovery (both complete recovery and partial recovery) were lower in the NPC group than in the non-NPC group (p < 0.05). Logistic regression analysis revealed that NPC was significantly associated with poor hearing recovery (OR = 3.499, p = 0.040), and that a higher initial hearing threshold and longer treatment delay time were related to a poor prognosis (p < 0.05).

Conclusions:

SSNHL occurred in post-irradiated NPC survivors often suffered a severe hearing loss with a high rate of accompanying vertigo. NPC may have an adverse impact on the prognosis of SSNHL, and higher initial hearing threshold and longer treatment delay time were indicators of poor hearing recovery.
Audiological Findings in Children Suspected to Have Been Exposed to the Zika Virus in the Intrauterine Period
Authors: Faria Armanda de Oliveira Pache de , Miterhof Maria Elisa Vieira da Cunha Ramos , Vianna Renata Artimos de Oliveira , Carvalho Fabiana Rabe , Dalcastel Luis Antonio Bataglin , Oliveira Solange Artimos de , Fonseca Sandra Costa , Riley Lee Woodland , Velarde Luis Guillermo Coca , Cardoso Claudete Aparecida Araújo
Published: June 2020

Objective:

To evaluate auditory manifestations in children born to mothers who had exanthema during pregnancy, suspected to have been exposed to the Zika virus (ZIKV).

Study Design:

Prospective observational.

Setting:

Tertiary referral center.

Patients:

Children born in Rio de Janeiro, Brazil, between April 2016 and September 2017, who were referred for newborn hearing screening (NHS).

Intervention:

The NHS was performed by the automated brainstem auditory-evoked potential test at an intensity of 30 dBHL (decibels Hearing Level) with the result presented as “PASS/FAIL.” A follow-up test was performed 6 months after the first examination.

Main Outcome Measures:

Hearing outcomes by audiological assessment.

Results:

Ninety-eight children were recruited and 78 underwent the NHS test. In the first evaluation, the FAIL NHS result was observed in 4 of the 78 children. Three were diagnosed with sensorineural hearing loss and one had conductive loss. Including the first and second evaluation, the frequency of audiological alterations was 5.1%. Of the four children diagnosed with hearing loss, two were carriers of ZIKV, one had suspected ZIKV infection, and one was asymptomatic with confirmed exposure to the virus. There was no progression of hearing loss or other hearing abnormality in the children by the time of the second evaluation. The group of nonexposed children (negative quantitative reverse transcription polymerase chain reaction for ZIKV) showed no hearing loss.

Conclusion:

Uni or bilateral sensorineural hearing loss was diagnosed in asymptomatic children at birth. These observations highlight the importance of periodic follow-up of patients with congenital Zika syndrome to better understand their long-term auditory clinical outcome.
T-tubes Through Cartilage Tympanoplasty: Is It Worth the Perforation Risk?
Authors: Gibson Anna Celeste , Page Joshua Cody , Jervis-Bardy Joshua , King DeAnne , Dornhoffer John L.
Published: June 2020

Objective:

To review a single surgeon's experience with T-tube placement through cartilage tympanoplasty versus native tympanic membrane for long-term ventilation of the chronic ear and residual perforation rates following tube removal.

Study Design:

Retrospective chart review.

Setting:

Two tertiary referral centers.

Patients:

One hundred sixteen patients (4–71 yr of age) who underwent either total island cartilage tympanoplasty or posterior palisade cartilage tympanoplasty with T-tube placement primarily or secondarily from 1998 to 2016.

Main Outcome Measures:

Long-term outcome of each T-tube was recorded with respect to retention and patency, and tympanic membrane status following either tube removal or extrusion. Audiometric data, age, sex, diagnosis, and procedure(s) performed were considered.

Results:

There were 116 patients (122 total ears and 139 total T-tubes) included: 57 ears underwent total island cartilage tympanoplasty with tube placed through cartilage and 65 ears underwent posterior island graft with tube placed through native tympanic membrane. Sixty-eight T-tubes were placed in the total island cartilage group with three (4.4%) residual perforations following removal. Seventy-one T-tubes were placed in the posterior palisade graft group with six residual perforations (8.5%) following removal or extrusion. The mean retention rate for the T-tubes was 3.93 years for the total island tympanoplasty group and 3.58 years for the posterior palisade tympanoplasty group. The mean follow-up for total island tympanoplasty and posterior palisade tympanoplasty was 5.36 and 5.66 years, respectively.

Conclusion:

Our data suggest that T-tube placement through cartilage tympanoplasty is worthwhile providing long-term ventilation to the middle ear and portends no higher risk for residual perforation than T-tube placement through native tympanic membrane.
Trends in Opioid Usage Following Tympanoplasty and Mastoidectomy
Authors: Mahairas Anthony D. , Neff Ryan , Craker Nikki , McNulty Beth N. , Shinn Jennifer B. , Bush Matthew L.
Published: June 2020

Objective:

Evaluate opioid prescribing patterns following tympanoplasty/mastoidectomy and assess factors associated to recurrent opioid use.

Study Design:

Retrospective cohort study.

Setting:

National pharmaceutical database recording opioid fulfillment (Truven Health Marketscan Commercial Claims/Encounters and Medicare Claims/Encounters database).

Participants:

Patients who 1) underwent tympanoplasty and/or mastoidectomy, 2) filled postoperative opioid prescriptions between 2011 and 2016, and 3) had no opioid prescriptions filled 60 days before surgery. Cohort 1 filled only one prescription and cohort 2 filled more than one prescription in the 12 months following surgery. Univariate/multivariate analysis was performed to assess for associations with recurrent opioid use.

Main Outcome Measure(s):

Opioid prescription details and recurrent opioid use.

Results:

The study included 398 patients (cohort 1 = 233, cohort 2 [recurrent opioid user] = 165). Hydrocodone 5 mg was most frequently used. The average duration opioids were prescribed was 5.8 days with an average quantity of tablets of 36.51. Recurrent opioid use in cohort 2 was associated with total morphine milligram equivalents prescribed/d in the first postoperative week (odds ratio [OR] = 1.02, p < 0.001), post-op chronic pain disorder (OR = 2.00, p = 0.04), post-op substance abuse (OR = 2.12, p = 0.05), and post-op anxiety (OR = 1.96, p = 0.02).

Conclusion:

Recurrent opioid use following tympanoplasty/mastoidectomy is associated with the amount prescribed per day but not opioid type or duration of treatment. Postoperative diagnoses such as chronic pain disorder, substance abuse, or anxiety could be predictive of or coexistent with recurrent opioid use. Limiting opioids prescribed per day and use of anti-inflammatory medications could decrease the risk of recurrent opioid use.
Predicting Postoperative Cochlear Implant Performance Using Supervised Machine Learning
Authors: Crowson Matthew G. , Dixon Peter , Mahmood Rafid , Lee Jong Wook , Shipp David , Le Trung , Lin Vincent , Chen Joseph , Chan Timothy C. Y.
Published: June 2020

Objectives:

To predict postoperative cochlear implant performance with heterogeneous text and numerical variables using supervised machine learning techniques.

Study Design:

A supervised machine learning approach comprising neural networks and decision tree-based ensemble algorithms were used to predict 1-year postoperative cochlear implant performance based on retrospective data.

Setting:

Tertiary referral center.

Patients:

One thousand six hundred four adults who received one cochlear implant from 1989 to 2019. Two hundred eighty two text and numerical objective demographic, audiometric, and patient-reported outcome survey instrument variables were included.

Outcome Measures:

Outcomes for postoperative cochlear implant performance were discrete Hearing in Noise Test (HINT; %) performance and binned HINT performance classification (“High,” “Mid,” and “Low” performers). Algorithm performance was assessed using hold-out validation datasets and were compared using root mean square error (RMSE) in the units of the target variable and classification accuracy.

Results:

The neural network 1-year HINT prediction RMSE and classification accuracy were 0.57 and 95.4%, respectively, with only numerical variable inputs. Using both text and numerical variables, neural networks predicted postoperative HINT with a RMSE of 25.0%, and classification accuracy of 73.3%. When applied to numerical variables only, the XGBoost algorithm produced a 1-year HINT score prediction performance RMSE of 25.3%. We identified over 20 influential variables including preoperative sentence-test performance, age at surgery, as well as specific tinnitus handicap inventory (THI), Short Form 36 (SF-36), and health utilities index (HUI) question responses as the highest influencers of postoperative HINT.

Conclusion:

Our results suggest that supervised machine learning can predict postoperative cochlear implant performance and identify preoperative factors that significantly influence that performance. These algorithms can help improve the understanding of the diverse factors that impact functional performance from heterogeneous data sources.
Effect of Vestibular Schwannoma Size and Nerve of Origin on Posterior External Auditory Canal Sensation: A Prospective Observational Study
Authors: Mehta Gautam U. , Lekovic Gregory P. , Maxwell Anne K. , Brackmann Derald E. , Slattery William H.
Published: June 2020

Objective:

Posterior external auditory canal (EAC) hypesthesia (Hitselberger's sign) has been previously described to occur in all vestibular schwannomas (1966) but has not been studied since. We hypothesized that sensory loss may be related to tumor size and sought to determine if this clinical sign could predict preoperative characteristics of vestibular schwannomas, intraoperative findings, and/or surgical outcomes.

Study Design:

Prospective observational study.

Setting:

Tertiary referral center.

Patients:

Twenty-five consecutive patients who underwent surgery for vestibular schwannoma.

Intervention:

Patients were tested for the presence of EAC hypesthesia or anesthesia.

Main Outcome Measures:

Preoperative, intraoperative, and postoperative findings were recorded, including facial nerve function, hearing function, tumor size, tumor nerve of origin, and extent of resection.

Results:

Twelve patients (48%) demonstrated either posterior EAC hypesthesia (11 patients) or anesthesia (1 patient). Sensory loss was a significant predictor of size (tumor maximal diameter) (p = 0.004). Median tumor diameter was 1.7 cm in the cohort with intact sensation versus 2.9 cm in the cohort with sensory loss. Patients with sensory loss were also significantly more likely to be associated with a superior vestibular nerve origin tumor (p = 0.01). Preoperative sensory loss did not significantly predict postoperative facial outcome (p = 0.10).

Conclusion:

Neurological exam findings may be overlooked in the workup of brain tumors. Posterior EAC hypesthesia is a predictor of tumor size and superior vestibular nerve origin. These findings may have implications for patient selection, particularly with the middle cranial fossa approach. Furthermore, given this relationship with tumor size, this clinical biomarker should be studied as a potential predictor of tumor growth.
Safety and efficacy of intracoronary thrombolytic therapy via a new infusion catheter in patients with ST-segment elevation myocardial infarction with large thrombus burden: a pilot study
Authors: Chen Tao , Wang Qi , Liu Ge , Jin Qinhua , Liu Changfu , Gao Lei , Chen Yundai , Guo Jun
Published: June 2020

Background

A large intracoronary thrombus burden is associated with adverse clinical results. The optimal management of this scenario remains unknown. We aimed to determine the efficacy and safety of a new rapid infusion catheter combined with low-dose intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) with a large thrombus burden.

Methods and results

This pilot study included 22 patients with STEMI with a large thrombus burden. A large thrombus burden was defined as a definite thrombus with the largest dimension of at least two vessel diameters [thrombolysis in myocardial infarction (TIMI) thrombus grades 4 and 5]. All patients received primary percutaneous coronary intervention guided by the presence of recurrent chest pain or clinical myocardial ischemia evidences. All patients regained myocardial perfusion immediately after the infusion catheter crossed the thrombus. Local fibrinolysis with low-dose recombinant human prourokinase was administered continuously via the infusion catheter for 30 min. Repeat coronary angiography revealed marked thrombus resolution, with an improvement in TIMI flow from 0.14 ± 0.35 at baseline to 2.82 ± 0.40. Only one patient with postlysis thrombus grades 4–5 was observed. No major bleeding events were observed.

Conclusions

In patients with STEMI presenting with a large thrombus burden, all patients regained myocardial perfusion immediately after the infusion catheter crossed over the thrombus, and low doses of intracoronary thrombolysis could significantly reduce the thrombus burden and improve the coronary flow without major bleeding.
Effect of intervention timing on one-year mortality in elderly non–ST-segment elevation myocardial infarction patients
Authors: Shen Lan , Xian Ying , Chen Anita Y. , Thomas Laine , Roe Matthew T. , Peterson Eric D. , He Ben
Published: June 2020

Background

The best timing for early invasive therapy in non–ST-segment elevation myocardial infarction (NSTEMI) patients remains controversial. We sought to determine the optimal timing of early catheterization in order to improve long-term outcomes in elderly (>65  years old) patients with NSTEMI.

Methods

Using data from the CRUSADE registry linked to Medicare claims, we evaluated the association of early catheterization within the first 24  h or earlier time cut-points of NSTEMI presentation with long-term mortality among older Medicare beneficiaries.

Results

Of 15  575 NSTEMI patients from 398 CRUSADE hospitals (2003–2006), 3880 (24.9%) received early (≤12  h) catheterization. Compared with those undergoing later catheterization, patients treated early were younger and had less comorbid illness. Relative to those treated later, patients receiving early catheterization had similar 1-year all-cause mortality (11.8% vs 11.9%, P  =  0.90). Using on- vs off-hour presentation as an instrumental variable, balancing potential measured and unmeasured confounders, early and later catheterization patients had nonsignificant differences in 1-year mortality (+5.6% [−11.5%, +22.7%]). Similar results were observed in clinically relevant subgroups, such as age (< or ≥75  years), gender, diabetes status, Global Registry of Acute Coronary Events score (< or ≥140), presence of heart failure, and sensitivity analyses of alternative definitions of early catheterization (≤6 and ≤24  h).

Conclusions

Among older NSTEMI patients, we found that <24  h or earlier (neither <6 nor 12  h) of catheterization timing were not significantly associated with differences in long-term mortality.
Effect of chest ultrasound on diagnostic workup in elderly patients with acute respiratory failure in the emergency department: a prospective study
Authors: De Carvalho Hugo , Javaudin François , Le Bastard Quentin , Boureau Anne-Sophie , Montassier Emmanuel , Le Conte Philippe
Published: June 2020

Diagnostic assessment of acute respiratory failure in elderly patients is often challenging, and initial misdiagnosis is associated with poorer outcomes. Chest ultrasound could help to improve diagnostic performance in this population. The objective of our study was to assess chest ultrasound (i.e. combined cardiac and lung ultrasound) add-on investigation to standard diagnosis approach in elderly patients presenting to the emergency department (ED) with acute respiratory failure.

Methods

We carried out a prospective study performed in our ED, included patients older than 75 years presenting with acute respiratory failure. Noninclusion criteria were documented palliative care or the need for immediate intensive care. After informed consent approval and routine diagnostic procedure (clinical, radiological and laboratory tests), the ED physician established the first diagnosis. Chest ultrasound was then performed, and a second diagnosis was established. An adjudication committee also established a diagnosis. The unweighted Cohen’s kappa (κ) coefficient was used to measure the strength of agreement between routine diagnostic approach, chest ultrasound and adjudication committee diagnosis.

Results

A total of 89 patients were included, mean age 86 ± 5 years old. Concordance was very good (κ = 0.82) between chest ultrasound and adjudication committee diagnostic and moderate (κ = 0.52) between routine diagnostic approach and adjudication committee diagnostic. Cardiogenic pulmonary edema and community-acquired pneumonia were the most frequent diagnoses (48.5 and 27%, respectively). Chest ultrasound had higher sensitivity and specificity for both diagnoses.

Conclusion

In our study, chest ultrasound add-on investigation to standard approach improved diagnosis performance in elderly patients presenting to the ED with acute respiratory failure. Further multicenter randomized trials are warranted to confirm this finding.
Assessment of Tamoxifen-Related Endometrial Changes in Premenopausal Female Patients With Diffusion-Weighted Magnetic Resonance Imaging
Authors: Abdel Razek Ahmed Abdel Khalek , Elkalla Hend M. Hamdey Rashed , Refky Basel , Elsergany Aliaa , Sakrana Amal Abdelsattar , Saleh Gehad , Gadelhak Basma N.
Published: June 2020

Purpose

To evaluate tamoxifen-related endometrial changes in premenopausal female patients with diffusion-weighted magnetic resonance imaging (DWI).

Methods

This prospective study was performed on 71 premenopausal female patients (mean age, 41 years) who were receiving tamoxifen therapy. All patients underwent magnetic resonance imaging with DWI of the pelvis and hysteroscopic-guided endometrial biopsy. The apparent diffusion coefficient (ADC) values of the endometrial plate were calculated and correlated with pathological results.

Results

The mean ADCs of tamoxifen-related benign endometrial lesions (1.35 ± 0.19 and 1.32 ± 0.13 × 10−3 mm2/s) were significantly higher (P = 0.001) than those of normal endometrial plate (0.95 ± 0.11 and 0.93 ± 0.11 × 10−3 mm2/s) by both reviewers, respectively. The cutoff ADC values used to differentiate tamoxifen-related benign endometrial lesions from normal endometrium were 1.07 and 1.02 × 10−3 mm2/s with areas under the curve of 0.94 and 0.93 and accuracy of 94.4 and 95.8 by both reviewers, respectively. The mean ADC values of endometrial polyp (EP) (1.44 ± 0.19 and 1.42 ± 0.22 × 10−3 mm2/s) were significantly higher (P = 0.001) than those of endometrial hyperplasia (EH) (1.25 ± 0.19 and 1.23 ± 0.19 × 10−3 mm2/s) by both reviewers, respectively. The cutoff ADC values used to differentiate EP from EH were 1.38 × 10−3 and 1.36 × 10−3 mm2/s with areas under the curve of 0.81 and 0.77 and accuracy of 80% and 70% by both reviewers, respectively. There was an insignificant difference in ADC value between typical and atypical EH. The ADC values of endometrial cancer (0.80 and 0.78 × 10−3 mm2/s) were lower than those of tamoxifen-related benign endometrial lesions. The final diagnosis was normal endometrium (n = 36), benign endometrial lesions either EH (n = 17), or EP (n = 16), and endometrial cancer in only 2 patients.

Conclusions

We concluded that DWI helps in detection and characterization of different tamoxifen-related endometrial changes in the premenopausal female patients.
Comparative Study Between Integrated Positron Emission Tomography/Magnetic Resonance and Positron Emission Tomography/Computed Tomography in the T and N Staging of Hypopharyngeal Cancer: An Initial Result
Authors: Huang Caiyun , Song Tianbin , Mukherji Suresh Kumar , Zhang Lingyu , Lu Jie , Chen Xiaohong , Xian Junfang
Published: June 2020

Objective

To compare the diagnostic accuracy of positron emission tomography/magnetic resonance (PET/MR) versus PET/computed tomography (PET/CT) for T and N staging of hypopharyngeal cancer.

Methods

Integrated PET/MR and PET/CT examinations were performed in 20 patients with hypopharyngeal cancer after same-day single injection. Eleven of 20 patients underwent surgery with histologic findings directly compared with imaging findings. Statistical analysis included Spearman correlation and McNemar test.

Results

Accuracy of PET/MR, PET/CT, and MRI for T staging was 81.8%, 63.6%, and 72.7%, respectively. Sensitivity and specificity for detecting metastatic lymph nodes was 88.2% and 98.2% on PET/MR, 76.5% and 98.3% on PET/CT, and 64.7% and 94.7% on MRI.

Conclusions

The PET/MR and PET/CT provide comparable results for assessing hypopharyngeal carcinoma and detecting metastatic lymph nodes.
Access to Lung Transplantation in the United States: The Potential Impact of Access to a High-volume Center
Authors: Chan Ernest G. , Hayanga J.W. Awori , Tuft Marie , Morrell Matthew R. , Sanchez Pablo G.
Published: June 2020

Background.

Health disparities plague our healthcare system. Utilizing a novel approach, we sought to assess the effects of geographic disparities on access to lung transplantation (LT) in the United States.

Methods.

A total of 13 743 LT adult recipients in the United Network for Organ Sharing Database were identified between May 2005 and December 2014 with a zip code status. Geographic access was defined by global spherical distance from patient zip code centroid to transplant center. Measures analyzed included the association among socioeconomic status (SES), distance to a transplant center, and center switching behavior.

Results.

Median distance traveled was 62.9 miles. There was an inverse relationship between Diez Roux SES and median distance traveled (90 versus 80.1 versus 60.5 versus 30, P < 0.001). There was no association found between 5-y survival and distance traveled (P = 0.099). However, traveling >158.7 miles was associated with worse survival (hazard ration 1.1; 95% confidence interval, 1.0-1.2; P = 0.005). Over 80% of patients exhibiting center switching were transplanted at a high-volume center than their home institution. Those more likely to switch to a high-volume center were those with an associates/bachelor (P < 0.005) or graduate-level degree (P < 0.05). Recipients with high-volume home institutions had the lowest probability of switching to an alternative center (odds ratio, 0.009; P < 0.001). There was no difference in survival when comparing those transplanted at their home institution versus those who sought transplantation at an alternative institution (55.3% versus 55.0%, P = 0.41).

Conclusions.

Although there was no association among SES, distance traveled, and survival, access to LT services varies among populations in the United States.
Peroxisome proliferator-activated receptor-γ mediates the antihypertensive effects of acupuncture in spontaneously hypertensive rats
Authors: Fan Hao , Yang Jing-Wen , Huang Jin , Wang Lu , Yang Na-Na , Tu Jian-Feng , Liu Cun-Zhi
Published: June 2020

We investigated a central antihypertensive effect of acupuncture in rostral ventrolateral medulla (RVLM) in spontaneously hypertensive rats (SHRs). In total, 56 rats were randomly divided into seven groups as follows: the SHR group, SHR+acupuncture (SHR+Acu) group, SHR+nonacupuncture (SHR+Non-acu) group, GW9662+acupuncture (GW9662+Acu) group, GW9662+GW1929 group, GW9662 group, and 2% DMSO group (n = 8 per group). The whole eight Wistar–Kyoto rats were assigned to the WKY group. The acupuncture treatment lasting for 14 days was performed at the Taichong acupoint (LR3) or at a nonacupoint (non-acu) once daily. The peroxisome proliferator-activated receptor (PPAR)-γ agonist GW1929 and the PPAR-γ inhibitor GW9662 were microinjected by the brain stereotactic technique. Blood pressure was measured by the tail-cuff method. Sympathetic vasomotor activity was determined by implanting in a telemetry electrocardiogram radio transmitter. The expression of PPARs in the RVLM of the rats was detected using Western blot. We demonstrated that acupuncture attenuated blood pressure, heart rate, and sympathetic vasomotor activity in SHRs. The protein expression of PPAR-γ was significantly increased in SHRs treated with acupuncture. The antihypertensive effects of acupuncture in SHRs were abrogated by microinjection bilaterally into RVLM of GW9662. Microinjection of GW1929 mimicked the antihypertensive effect of acupuncture. PPAR-γ expression was negatively correlated with blood pressure and sympathetic vasomotor activity in SHRs treated with acupuncture. These results suggested that acupuncture promoted a central antihypertensive effect by increasing the expression of PPAR-γ in RVLM of SHRs.
Association between methylenetetrahydrofolate reductase gene C677T polymorphism and susceptibility to polycystic ovary syndrome
Authors: Rai Vandana , Kumar Pradeep
Published: June 2020

Polycystic ovary syndrome (PCOS) is the most common form of endocrinopathy of women. Several studies have investigated the association of methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism with PCOS risk but the results are contradictory. So, the aim of the present study was to carry out a meta-analysis of a published case control studies to find out exact association between MTHFR gene C677T polymorphism and PCOS susceptibility. Pubmed, Springer link, Science Direct and Google Scholar databases were searched for case-control studies. Odds ratios (ORs) with 95% confidence intervals (CIs) was used as association measure and meta-analysis was performed using MIX and MetaAnalyst programs.

Meta-analysis of 24 studies showed strong significant association between C677T polymorphism and PCOS risk (for T vs. C: OR= 1.18, 95% CI=1.01-1.38, p=0.03; for TT vs. CC: OR= 1.37, 95% CI=1.0-1.89, p= 0.045; for TT + CT vs. CC: OR= 1.31, 95% CI= 1.07-1.62, p= 0.008; for CT vs. CC: OR= 1.31, 95% CI= 1.04-1.62, p= 0.01 and for TT vs. CT + CC: OR= 1.10, 95% CI= 0.82-1.47, p= 0.04). In subgroup analysis, MTHFR C677T polymorphism is significantly associated with PCOS risk with Asian individuallas but in Caucasian population MTHFR C677T polymorphism was not significantly associated with PCOS risk. In conclusion, C677T polymorphism is a risk factor for PCOS.
Adaptation of bacteria to glyphosate: a microevolutionary perspective of the enzyme 5-enolpyruvylshikimate-3-phosphate (EPSP) synthase
Authors: Rainio Miia J. , Ruuskanen Suvi , Helander Marjo , Saikkonen Kari , Saloniemi Irma , Puigbò Pere
Published: June 2020

Glyphosate is the leading herbicide worldwide, but it also affects prokaryotes because it targets the central enzyme (EPSPS) of the shikimate pathway in the synthesis of the three essential aromatic amino acids in autotrophs. Our results reveal that bacteria easily become resistant to glyphosate through changes in the EPSPS active site. This indicates the importance of examining how glyphosate affects microbe-mediated ecosystem functions and human microbiomes.
Engaging Community Leaders to Identify Community Assets for Emergency Preparedness
Authors: Piltch-Loeb Rachael , Bernard Dottie , Quinones Beatriz , Harriman Nigel , Savoia Elena
Published: June 2020

Introduction

Public health and emergency management agencies play a critical role in addressing the needs of vulnerable populations in preparation for and in response to emergencies. Identifying and leveraging community assets is a way to address such needs. Local knowledge about community assets is a valuable and untapped resource that can be leveraged for disaster response and recovery efforts. This study focuses on the development of a process and tools to engage community leaders in sharing their knowledge about their community characteristics and assets useful for emergency planning.

Methods

We conducted interviews with community leaders across five study sites with the goal of understanding what type of local knowledge community leaders are able to share in regards to emergency preparedness. Interview questions focused on community challenges and assets that could be useful to plan for emergencies. Based on the interviews’ results we developed and tested a mobile application to generate a directory and map of community assets. Subsequently, we hosted five community meetings and two tabletop exercises to gather feedback, from community leaders and preparedness planners, on the utility of the local knowledge data produced and on the use of the mobile application to gather and share such knowledge.

Results

Based on the interviews’ results we identified two main types of local knowledge about community assets for emergency preparedness: communication-based and trust-based local knowledge. Interviews’ data were used to develop a directory of community assets embedded into a mobile application to be used by community leaders to share the location and/or point of access of specific community assets based on their knowledge. Preparedness planners, who tested the application during a tabletop exercise, found it a useful tool to raise awareness about community assets and enhance planning efforts for vulnerable populations.

Conclusion

Community leaders’ engagement in preparedness efforts is important to identify community assets that can be leveraged to address the needs of the most vulnerable segments of a community. The use of a directory of community assets, embedded in a mobile application, can enhance information sharing between community leaders and preparedness planners and facilitate the integration of community assets into preparedness efforts.
SARS-CoV-2 qRT-PCR Ct value distribution in Japan and possible utility of rapid antigen testing kit
Authors: Takeda Yuta , Mori Masatoshi , Omi Kazuya
Published: June 2020

The exact pathology of COVID-19 remains mostly unclear, and accurate epidemiological understanding and rapid testing are crucial to overcome this disease. Several types of nucleic acid tests (NAT) have been used in Japan, but information about the viral RNA load, determined by Ct values, of the patients is limited due to the small number of patients tested in each clinical institution and lack of standardization of the testing kits. We have been performing the qRT-PCR tests established by NIID, and the mean Ct value distribution of 62 cases, which are deemed “first-visit” patients, among the total of 88 positive cases tested in a 4-day window of early April, was 24.9 with SD=5.45. Recently approved antigen testing kits were also used in the same samples (62 positives) along with 100 negative cases, and it revealed the positive predictive value of 80.6% and negative predictive value of 100%, with an overall agreement rate of 92.6%. These results indicate that a certain number of patients with lower Ct values, existed in Japan when SARS-CoV-2 virus started to spread. The newly approved rapid antigen testing kit will be a useful tool to identify such populations rapidly.
Seroprevalence and epidemiological characteristics of immunoglobulin M and G antibodies against SARS-CoV-2 in asymptomatic people in Wuhan, China: a cross-sectional study
Authors: Ling Ruijie , Yu Yihan , He Jiayu , Zhang Jixian , Xu Sha , Sun Renrong , Zhu Wangcai , Chen Mingfeng , Li Tao , Ji Honglong , Wang Huanqiang
Published: June 2020

Objectives

Population screening for IgG and IgM against SARS-CoV-2 was initiated on March 25 and was open to all residents of Wuhan who were symptom-free. All ages with no fever, headache or other symptoms of COVID-19 among residents in Wuhan were included.

Methods

This study adopted a cross-sectional study. Pearson Chi-square test, T-test, and Mann-Whitney test were used in comparison between different groups. To correct the effects of gender and age, the seroprevalence of IgM positivity, IgG positivity, and IgM and/or IgG positivity were standardized according to the gender and age-specific population of Wuhan in 2017.

Results

The seroprevalence of IgG and IgM standardized for age and gender in Wuhan showed a downward trend. No significant correlation was observed between the seroprevalence of IgG and the different age groups. The seroprevalence was significantly higher for females than males (x2 =35.702, p < 0.001), with an odds ratio of 1.36 (95% CI: 1.24–1.48). A significant difference was seen in the seroprevalence of IgG among people from different geographic areas and different types of workplaces (respectively, x2 = 42.871, p < 0.001 and x2 = 202.43, p < 0.001). The IgG antibody-positive cases had a greater number of abnormalities in CT imaging than IgG-negative cases (30.7% vs 19.7%).

Conclusions

Our work found the reported number of confirmed patients in Wuhan only represents a small proportion of the total number of infections. There was a significant aggregation of asymptomatic infections in individuals from some occupations, and based on CT and laboratory findings, some damage may have occurred in asymptomatic individuals positive for IgG antibody.

Strengths and limitations of this study

This study has the important feature of having been designed as repeated five-day serosurveys, which allowed for the monitoring of seroprevalence progression.

This study applied scientific statistical methods accounting for the demographic structure of the general population and imperfect diagnostic tests to estimate seroprevalence in the overall population.

This study had selection bias since the analyzed medical records were based on examinees directed by their work units.

People under the age of 19 and over age 65 were too few to be fully covered in analyses.
VEGFC induced cell cycle arrest mediates sprouting and differentiation of venous and lymphatic endothelial cells
Authors: Jerafi-Vider Ayelet , Moshe Noga , Hen Gideon , Splittstoesser Daniel , Shin Masahiro , Lawson Nathan , Yaniv Karina
Published: June 2020

The emergence and growth of new vessels requires a tight synchronization between proliferation, differentiation and sprouting, traditionally thought to be controlled by mitogenic signals, especially of the VEGF family. However, how these cues are differentially transduced, by sometimes even neighboring endothelial cells (ECs), remains unclear. Here we identify cell-cycle progression as a new regulator of EC sprouting and differentiation. Using transgenic zebrafish illuminating cell-cycle stages, we show that venous and lymphatic precursors sprout from the Cardinal Vein (CV) exclusively in G0/G1, and reveal that cell-cycle arrest is induced in these ECs by p53 and the CDK-inhibitors p27 and p21. Moreover, we demonstrate thatin vivo, chemical and genetic cell-cycle inhibition, results in massive vascular growth. Mechanistically, we identify the mitogenic VEGFC/VEGFR3/ERK axis as direct inducer of cell-cycle arrest in angiogenic ECs and characterize the cascade of events governing venous vs. lymphatic segregation and sprouting. Overall, our results uncover an unexpected mechanism whereby mitogen-controlled cell-cycle arrest boosts sprouting, raising important questions about the use of cell-cycle inhibitors in pathological angiogenesis and lymphangiogenesis.
Embryonic Tissues as Active Foams
Authors: Kim Sangwoo , Pochitaloff Marie , Georgina-Stooke-Vaughan  , Campàs Otger
Published: June 2020

The physical state of embryonic tissues emerges from non-equilibrium, collective interactions among constituent cells. Cellular jamming, rigidity transitions and characteristics of glassy dynamics have all been observed in multicellular systems, but there is no unifying framework to describe all these behaviors. Here we develop a general computational framework that enables the description of embryonic tissue dynamics, accounting for the presence of extracellular spaces, complex cell shapes and tension fluctuations. In addition to previously reported rigidity transitions, we find a distinct rigidity transition governed by the magnitude of tension fluctuations. Our results indicate that tissues are maximally rigid at the structural transition between confluent and non-confluent states, with actively-generated tension fluctuations controlling stress relaxation and tissue fluidization. Comparing simulation results to experimental data, we show that tension fluctuations do control rigidity transitions in embryonic tissues, highlighting a key role of non-equilibrium tension dynamics in developmental processes.