bluuebunny/crossref_metadata_2025 huggingface dataset:
How to inhibit transforming growth factor beta safely in diabetic kidney disease
Authors: Yang Yuxin , Shi Kexin , Patel Devang M. , Liu Fang , Wu Tieqiao , Chai Zhonglin
Published: November 2020

Purpose of review

Diabetic kidney disease (DKD) is a leading cause of mortality and morbidity in diabetes. This review aims to discuss the major features of DKD, to identify the difficult barrier encountered in developing a therapeutic strategy and to provide a potentially superior novel approach to retard DKD.

Recent findings

Renal inflammation and fibrosis are prominent features of DKD. Transforming growth factor beta (TGFβ) with its activity enhanced in DKD plays a key pathological profibrotic role in promoting renal fibrosis. However, TGFβ is a difficult drug target because it has multiple important physiological functions, such as immunomodulation. These physiological functions of TGFβ can be interrupted as a result of complete blockade of the TGFβ pathway if TGFβ is directly targeted, leading to catastrophic side-effects, such as fulminant inflammation. Cell division autoantigen 1 (CDA1) is recently identified as an enhancer of profibrotic TGFβ signaling and inhibitor of anti-inflammatory SIRT1. Renal CDA1 expression is elevated in human DKD as well as in rodent models of DKD. Targeting CDA1, by either genetic approach or pharmacological approach in mice, leads to concurrent attenuation of renal fibrosis and inflammation without any deleterious effects observed.

Targeting CDA1, instead of directly targeting TGFβ, represents a superior approach to retard DKD.
Recent developments in antimicrobial therapy for gastrointestinal infections
Authors: Carlson Travis J. , Gonzales-Luna Anne J. , Garey Kevin W.
Published: November 2020

Purpose of review

This focused, narrative review summarizes human clinical trial data for direct-acting antimicrobials in development for the treatment of gastrointestinal infections that were published in the past 18 months (1 January 2019 to 30 June 2020).

Recent findings

Antimicrobial agents for Clostridioides difficile infection (n = 6), cryptosporidiosis (n = 1), cytomegalovirus infection (n = 3) and Helicobacter pylori infection (n = 1) have completed and/or are undergoing human clinical trials.

Although this review highlights significant advances in four disease states, many common gastrointestinal pathogens have no antimicrobials in human clinical trials, emphasizing the need for continued prioritization in this field of study.
Religiosity and Spirituality in the Stages of Recovery From Persistent Mental Disorders
Authors: Saiz Jesús , Chen-Chen Xin , Mills Paul J.
Published: November 2020

The impact of religiosity and spirituality (R/S) on mental health and the importance of incorporating R/S in mental health treatment have been previously explored. However, clarification is needed regarding the effects of R/S in the process of recovery from persistent mental disorders (PMDs). This study identifies how different R/S factors correlate with the stages of recovery, while considering individual psychological well-being and perceived social support. Seventy-five individuals who use Madrid's public services for people with PMD completed questionnaires assessing those factors. We found that during the recovery process, R/S correlated with psychological well-being and perceived social support, and that these variables were associated with the five stages of recovery differently. We further identified the importance of gratitude, compassion, inner peace, and connection with life in the recovery process. Overall, our findings highlight the importance of these R/S variables in particular recovery stages for individuals with PMD.
Perceived Adverse Parenting in Childhood and Psychological Distress Among Psychotherapy Patients
Authors: Aafjes-van Doorn Katie , McCollum James , Silberschatz George , Kealy David , Snyder John
Published: November 2020

The way people derive inferences from actual adverse experiences plays an important role in the development of psychopathology. This study aims to examine the mediating role of pathogenic beliefs (i.e., emotion-laden, powerful, painful convictions about self and others) on the relation between perceived adverse parenting behaviors in childhood and subsequent adult psychopathology. Participants (mostly Caucasian and heterosexual) were 204 consecutively admitted patients with a range of psychological difficulties, including depression, anxiety, and interpersonal problems, at a low-fee outpatient clinic. Participants completed standard self-report assessments of perceived parental style, depressive and anxiety symptoms, and a clinically derived measure of pathogenic beliefs. We examined the indirect effects of adverse parenting on anxiety and depressive symptom severity through pathogenic beliefs. Pathogenic beliefs reflecting the unreliability of others significantly mediated the relationship between adverse parenting and anxiety symptoms. The other mediation model is consistent with the theory that perceived adverse parenting contributes to the severity of depressive symptoms through beliefs about not being deserving and other people being unreliable. Within the limitations of the cross-sectional, retrospective, and self-report nature of the data, our results seem to suggest that attending to intermediary subjective beliefs might be important in understanding psychopathology development in the context of childhood adversity. Aiming to modify the beliefs in therapy might modify the symptoms. However, this would remain to be demonstrated through formal intervention research.
An Interprofessional Course on Trauma-Informed Care
Authors: Fiske Elizabeth , Reed Ashcraft Kellie , Hege Adam , Harmon Kristin
Published: November 2020

Background

Health care professionals need to recognize trauma exposure and provide trauma-informed care. There is a concomitant need to develop resilience when working in this context.

Problem

We recognized the need to educate future health care professionals to provide trauma-informed care, develop resilience skills, and collaborate with other disciplines to provide this care.

Approach

We used a systematic instructional design process and an interprofessional approach to design and deliver the course. We utilized a range of resources and approached the course from micro, meso, and macro perspectives.

Outcomes

Through purposeful design, we developed a course that was well-aligned with our objectives. Assessments provided documentation that students achieved the learning outcomes.

Conclusions

The course educated future health care professionals on trauma-informed care. Students gained valuable experience that will help them contribute to interprofessional teams in the future. Students also practiced resilience techniques essential for health care professionals.
Nursing Students in Crisis Mode
Authors: Savitsky Bella , Findling Yifat , Ereli Anat , Hendel Tova
Published: November 2020

Background

The COVID-19 pandemic initiated a period of new and difficult challenges for nursing students.

Purpose

The aim of this study was to assess the change in levels of anxiety and ways of coping when the lockdown was being lifted compared with the period of the most severe lockdown restrictions.

Methods

First- to fourth-year nursing students in Israel (N = 244) completed 2 surveys conducted during the initial lockdown and 5 weeks later.

Results

When the restrictions were lightened, the mean anxiety score decreased from 9.3 to 7.5 (P < .0001). Among Muslims students, the trend was the opposite, and anxiety levels increased. Stronger resilience was associated with lower odds for anxiety. Mental disengagement and information seeking were associated with higher anxiety levels.

Conclusions

The pandemic created unparalleled stressful situations for nursing students. Faculty should have heightened awareness of these stressors and act to implement innovative resolutions for the problems that arise.
Creating a Blueprint for the Future: Lessons Learned From Public Health Laboratories in the COVID-19 Response
Authors: Toney Denise , Pentella Michael , Blank Eric , Becker Scott
Published: November 2020

Public health laboratories have played a central role in the US response to COVID-19. Since the earliest days, myriad issues have impeded the laboratory community's ability to keep pace with the overwhelming demand for effective tests. In this article, the Association of Public Health Laboratories and a subset of its members examine the response to date and evaluate lessons learned from 4 main categories: testing surges, supplies, staffing, and regulations and policy. Within these categories, the authors offer recommendations intended both to improve the ongoing COVID-19 response and to strengthen planning for future outbreaks.
Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis
Authors: Makar Katelyn G. , Waljee Jennifer F. , Kasten Steven J. , Buchman Steven R. , Vercler Christian J.
Published: November 2020

Background:

Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data.

Methods:

The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatal

procedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications.

Results:

In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment.

Conclusions:

Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time.

Clinical Question/Level of Evidence:

Therapeutic, III.
The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review
Authors: Faulkner Heather R. , Shikowitz-Behr Lauren , McLeod Matthew , Wright Eric , Hulsen John , Austen William G.
Published: November 2020

Background:

Breast reconstruction is most frequently performed using implants or expanders. Adjunctive materials such as acellular dermal matrix and synthetic meshes are used to support the implant or expander. A paucity of large studies exist on the use of synthetic mesh for breast reconstruction.

Methods:

A retrospective chart review of all patients over the past 7 years who had implant reconstruction with synthetic absorbable mesh at the Massachusetts General Hospital was performed. Data were collected on demographic and surgical outcomes. Statistical analysis was performed.

Results:

A total of 227 patients (376 mastectomies) were treated with direct-to-implant subpectoral reconstruction with absorbable mesh from 2011 to 2017. The infection rate was 2.1 percent. The rate of capsular contracture was 4.8 percent. Patients who had radiation therapy either preoperatively or postoperatively had a higher rate of complications, including capsular contracture. Cost savings for using mesh instead of acellular dermal matrix surpassed $1.2 million.

Conclusion:

Synthetic absorbable mesh is a safe alternative to acellular dermal matrix in prosthetic breast reconstruction and provides stable results along with significant cost savings.

Clinical Question/Level of Evidence:

Therapeutic, IV.
Sexual Behavior and Its Determinants During COVID-19 Restrictions Among Men Who Have Sex With Men in Amsterdam
Authors: van Bilsen Ward P. H. , Zimmermann Hanne M. L. , Boyd Anders , Coyer Liza , van der Hoek Lia , Kootstra Neeltje A. , Hoornenborg Elske , Prins Maria , Schim van der Loeff Maarten F. , Davidovich Udi , Matser Amy
Published: November 2020

Objective:

To investigate the impact of Dutch COVID-19 restrictions on sexual behavior and HIV/sexually transmitted infection (STI) acquisition among men who have sex with men (MSM) participating in the Amsterdam Cohort Studies (ACS) on HIV in Amsterdam.

Methods:

ACS participants complete a questionnaire on sexual behavior and are tested for HIV/STI biannually. They may also be tested at the STI clinic in-between study visits. On May 29, 2020, ACS participants were invited to complete an online questionnaire on health, COVID-19 risk perceptions, and sexual behavior. Determinants of reporting casual sex partners (CSP) during COVID-19 restrictions were examined using logistic regression.

Results:

Of 683 MSM, 353 (52%; median age, 47 years; interquartile range, 38–53 years) completed the questionnaire. Since COVID-19, 73% reported a reduction in the number of CSP. CSP during COVID-19 restrictions were reported by 133 MSM (38%) and, in multivariable analysis, was associated with not having a college/university degree, being single, lower perceived importance of avoiding COVID-19, number of CSP before COVID-19, and current preexposure prophylaxis use (P < 0.05 for all). During COVID-19 restrictions, no HIV infections were diagnosed, and the STI positivity rate was 8%.

Conclusion:

Since COVID-19, the number of CSP decreased among MSM, and there may have been a temporary reduction in HIV/STI transmission. Some MSM were not fully compliant to social distancing regulations and reported CSP, which was related to prior sexual behavior and low perceived importance of avoiding COVID-19. For these men, it is important to maintain accessible HIV/STI-related testing and care during times of lockdown.
90Y Radiosynovectomy in Persistent Synovitis Caused by Knee Replacement
Authors: Liepe Knut , Baehr Marcel
Published: November 2020

Introduction

After knee replacement, therapy resistant, persistent synovitis is a common issue, which causes effusion and pain, and leads to loosing. It has been hypothesized that radiosynovectomy (RSO) is useful in these patients.

Materials and Methods

A cohort of 55 patients with 57 knee replacements and persistent synovitis underwent RSO using 4.9 ± 0.24 mCi (182 ± 9 MBq) of 90Y-citrate. The number of RSOs ranged from 1 to 4. Bone scans before and 3 months after every RSO were performed. Long-term follow-up ranged from 0.8 to 7.6 years with a mean of 23.2 months. For qualitative analysis, an established 4 steps scoring was used. For quantification, the uptake was determined within the 99mTc-MDP scintigraphy blood pool phase before and after therapy.

Results

Long-term response was in 27% with excellent, 24% good, 30% weak, and 20% no response. The duration of response was 12.0 ± 12.0 months (maximum, 54 months). In patients with repeated treatment, the effect after the first therapy was lesser than in patients who received a single treatment in total. However, 3 months after the last RSO, patients with repeated treatment showed a similar effectiveness than single treated patients. At the end of long-term follow-up, patients with repeated RSOs had a higher effectiveness at similar duration response. In bone scan, 65% of patients showed a reduction of uptake. When comparing subjective and objective response, 78% of patients showed a concordance in both symptoms and scintigraphy. Pilot histological analysis revealed that the synovitis is triggered by small plastic particles.

Conclusions

We concluded that RSO is an effective therapy in patients with knee replacement and persistent synovitis with high long-term response. Repeated treatment leads to a stronger long-time response.
Diffuse Subcutaneous Metabolic Activity in Post Bone Marrow Transplant Hodgkin Lymphoma
Authors: Doroudinia Abtin , Mehrian Payam , Rouhizadeh Alireza , Hosseini Mahsa
Published: November 2020

We present a 14-year-old adolescent boy with Hodgkin lymphoma. He had prior completed chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) regimen followed by bone marrow transplantation 6 months ago. Currently, he has neither specific clinical complaint nor receiving any specific medication. Follow-up FDG PET/CT scan demonstrated diffuse increased metabolic activity in the entire body subcutaneous tissue. This finding is rarely reported in the literature and may represent an underlying active inflammatory process, most likely attributed to the received treatments. This could impair the diagnostic quality of the scan, affecting the image interpretation, and should be recognized when present.
Quality and Safety in Healthcare, Part LXXXIII
Authors: Harolds Jay A.
Published: November 2020

A safety culture encourages the reporting of mistakes so that all can learn from them and remedy underlying system problems. However, errors will only be reported in a culture in which most types of common human errors are not punished because all humans make errors, and usually there are underlying system problems contributing to this. All healthcare errors must be viewed partly as opportunities to improve. A safety culture includes good leadership, communication, learning, collaboration, mindfulness, medicine that is based on evidence and best practice, and care that is centered on the patient.
Hypermetabolic Cerebral Metastases of Cardiac Myxoma on FDG PET/CT
Authors: Wang Peipei , Hou Guozhu , Li Fang , Cheng Xin
Published: November 2020

A 66-year-old woman with a history of surgical resection of left atrial myxoma 6 months ago presented with multiple brain lesions with MRI. An FDG PET/CT was performed for further evaluation. The images showed that cerebral tumors had variable and increased FDG uptake in general, and no other abnormal FDG-avid lesions were noted. The tumor of right occipital lobe was resected and confirmed as metastatic cardiac myxoma on histology.
Delayed 68Ga-PSMA PET/CT Image-Guided Biopsy for Low-Grade Adenocarcinoma in Benign Prostatic Hyperplasia
Authors: Santhosh Sampath , Jeeva Godwin
Published: November 2020

Image-guided biopsy of prostate with multiparametric MRI is being adopted in the workup of prostate adenocarcinoma (PAC). 68Ga-PSMA PET/CT-guided biopsy has also been shown to be equally sensitive in the evaluation of higher-grade tumors with increased PSMA expression. The sensitivity of 68Ga-PSMA PET/CT, however, reduces with lesser PSMA expression in low-grade PAC. Herein, we demonstrate a case where delayed 68Ga-PSMA PET/CT imaging helped in detecting low-grade PAC in BPH.
Aesthetic Consideration in a Patient With Lipomatosis
Authors: Nagano Hisato , Aoki Shimpo , Azuma Ryuichi , Kiyosawa Tomoharu
Published: November 2020

This is the first report of multiple parosteal lipomas as a late complication of aesthetic procedures. A 70-year-old woman presented with multiple frontal nodules that had grown slowly over 5 years. She underwent forehead-lifting surgery 30 years ago and botulinum toxin injection 3 years ago. Computed tomography showed six low-density nodules measuring 10 to 20 mm just above the frontal bone. The tumors were resected via a parietal coronal incision. Histopathological findings revealed parosteal lipoma with foreign bodies. At 1 year postoperatively, there has been no recurrence or complications. The multiple lesions corresponded to the sites of the aesthetic procedures. The mesenchymal cells in the periosteum seemed to be stimulated by cytokines released from a postoperative hematoma or damaged periosteum, resulting in tumorigenesis. When performing aesthetic procedures in the face, care should be taken to avoid unnecessary injury to the periosteum, given the possibility of tumor development.

Level of evidence: Level V, case report
Sellar Floor Bone Flap With a Pedicled Nasoseptal Flap in Endoscopic Transnasal Pituitary Adenoma Surgery
Authors: Xing Mengyang , Lv Wenming , Wang Jing , Liu Sheng , Liu Pengfei , Wang Bo , Gao Wenbo , Zhang Liangwen
Published: November 2020

Objective:

To explore the clinical effect of sellar floor bone flap with a pedicled nasoseptal flap in endoscopic transnasal pituitary adenoma surgery for skull base reconstruction.

Method: This was a retrospective clinical analysis of 30 patients with pituitary adenoma operated by the same neurosurgical team from June 2015 to June 2018. All patients were diagnosed with pituitary adenoma by pituitary magnetic resonance imaging, and the authors confirmed that the sellar floor bone was intact using sphenoid sinus computed tomography. All patients underwent an endoscopic transnasal approach, and the authors created a pedicled nasoseptal flap and sellar floor bone flap intraoperatively and reconstructed the skull base at the end of the surgery. Postoperative complications constituted cerebrospinal fluid leakage, brain tissue herniation, nasal discomfort, decreased sense of smell, and epistaxis.

Results:

Cerebrospinal fluid leakage occurred in 13 patients (43.3%) intraoperatively; small amounts in 6 patients (20.0%), moderate amounts in 3 patients (10.0%), and large amounts in 4 patients (13.3%). Only 1 patient (3.3%) with large-volume cerebrospinal fluid leakage intraoperatively experienced cerebrospinal fluid leakage postoperatively, and this resolved with lumbar catheter drainage and bed rest. The 6-month postoperative follow-up brain computed tomography findings revealed brain tissue herniation in no patients, nasal discomfort in 3 patients (10.0%), decreased sense of smell in 5 patients (16.7%), and epistaxis in 2 patients (6.7%).

Conclusion:

Reconstructing the skull base with a sellar floor bone flap and a pedicled nasoseptal flap played an important role in preventing cerebrospinal fluid leakage and brain tissue herniation in endoscopic transnasal pituitary adenoma surgery and did not increase the incidence of postoperative nasal discomfort, decreased sense of smell, or epistaxis.
Analysis of Cranial Base Suture Fusion Patterns
Authors: Rodriguez Jose J. , McLaughlin Caroline , Thompson James T.
Published: November 2020

Purpose:

It is known from both anatomic and radiographic studies that the majority of cranial sutures begin fusing in early adulthood and are fused by late adulthood. However, most of the studies focus on the cranial vault rather than the cranial base. Most clinicians treating patients with craniosynostosis are interpreting the behavior of cranial sutures on CT imaging. Therefore, the purpose of this study was to further clarify the radiographic appearance of cranial base sutures over the natural human life span.

Methods:

Thirty CT scans of the head and face were reviewed for each decade starting at 1 year of life up to age 90. Scans were evaluated for the appearance of the occipitomastoid, petrosoocciptial, sphenosquamous, sphenopetrosal, frontosphenoidal, sphenozygomatic, petrososquamosal, frontoethmoidal, sphenoethmoidal and sphenoccipital sutures. Sutures were categorized as obliterated, present with fusion, present without fusion and unable to visualize.

Results:

The majority of cranial base sutures are visible up through the eighth decade, although evidence of ossification across the suture starts as early as the second decade. Some sutures such as the occipitomastoid appeared > 90% open even as late as the ninth decade. Other sutures such as the sphenosquamosal and frontozygomatic are mostly fused by that age.

Conclusion:

Cranial base sutures appear to behave radiographically similar, to the cranial vault sutures in that they largely remain visible throughout adulthood but show varying amounts of ossification. There are some cranial base sutures which appear to remain open throughout life although the significance of this has yet to be determined.
Facial Animation With Free Functional Gracilis Transfer Innervated by the Cross-Facial Nerve Graft
Authors: Liang Hongyu , Chen Sen , Yang Zhe , Ma Ning , Wang Weixin , Liu Qiyu , Wu Qi , Ji Xiuzhen , Li Yangqun
Published: November 2020

Background:

The treatment of long-standing facial paralysis has always been a challenge for plastic surgery. The purpose of this study was to demonstrate that the free functional gracilis transfer innervated by the cross-facial nerve graft (CFNG) is still an ideal option, even though there are many new surgical options available.

Methods:

A retrospective survey was made on 12 patients who received free functional gracilis transfer innervated by the CFNG. A modified version of the House-Brackmann scale was used to evaluate the movement of the corners of mouth after surgery. Patients were also asked about their satisfaction with the operation. In addition, an objective test was performed to assess the postoperative angle improvement by measuring the angle formed between the horizontal line of both corners of the lips and the vertical midline.

Results:

All grafts survived well. No severe complication occurred. Three patients received further surgical operations for aesthetic reasons. The movement of the corners of mouth was classified as excellent in 8 cases, good in three cases, and fair in one cases. The static angle and dynamic angle of postoperation improved and the range of dynamic angle improvement was larger than that of static angle.

Conclusion:

Free functional gracilis transfer innervated by the CFNG is an ideal technique for facial paralysis. It can effectively improve the facial dynamic of the affected side.
Adenomatous Neuroendocrine Tumors of the Middle Ear in a Young Man With Conductive Hearing Loss
Authors: Zagaria Annamaria , Nicastro Viviana , Abita Pietro , Freni Francesco , Galletti Francesco
Published: November 2020

Neuroendocrine neoplasms of the ear pose a diagnostic challenge because clinical symptoms are no specific. Definite diagnosis is made by histopathological analysis with immunohystochemical evalutation. Therapy consists in a complete surgical resection. Controversial terminology of the neoplasm arises from the differentiation of these tumors composed of both endocrine and exocrine glands. Middle ear localization is an extremely rare presentation but less aggressive than gastrointestinal tract or lung localizations which are the most frequent. Radio-diagnostic analyses are necessary follow-up for preventing or detecting recurrence or metastasis. The authors present a case of neuroendocrine tumor of the middle ear in a young male of 37 years old who presented unilateral right hearing loss and tinnitus. A transcanal tympanoplasty was performed. There were no intraoperative complications and the postoperative period was uneventful.
The Likelihood of Orthognathic Surgery After Orofacial Cleft Repair
Authors: Choi Katherine J. , Wlodarczyk Jordan R. , Nagengast Eric S. , Wolfswinkel Erik , Munabi Naikhoba C.O. , Yao Caroline , Magee William P.
Published: November 2020

Midface hypoplasia is one of the most significant sequelae of cleft lip and/or palate surgery. A complete understanding of the rate of orthognathic surgery across varying cleft phenotypes is a powerful tool for educating patients and families as to the treatment course that the patient will incur during their lifetime. Understanding the average rates of orthognathic intervention also can act to develop metrics for outcome evaluation with different treatment protocols. Attempting to identify the average rates of orthognathic intervention, the authors conducted a systematic review and meta-analysis by combining studies from 1987 to 2016 describing the frequency of orthognathic intervention on the different cleft phenotypes as the primary outcome. Secondary outcomes included identification of surgical protocol, age of patient at orthognathic intervention, and the method by which patients were evaluated for orthognathic intervention. The rate of orthognathic surgery was 38.1% for bilateral cleft lip and palate (BCLP), 30.2% for unilateral cleft lip and palate (UCLP), 4.4% for isolated cleft palate (ICP), and 1.8% for patients with isolated cleft lip (ICL). 71% (n = 10) reported using lateral cephalograms for orthognathic surgery evaluation and only one of those studies reported specific objective cephalometric measurements for orthognathic intervention. Our findings demonstrated that BCLP possessed the highest rate of orthognathic intervention followed by UCLP, ICP, and ICL. ICP and ICL both possessed low rates of orthognathic intervention. By sharing our findings, the authors hope to provide a useful tool for informing patients’ families as to their risk of needing orthognathic intervention.
Repair of Donor Site Defects After Forearm Free Flap Harvest With Dual Triangular Flaps and in Situ Small Full-thickness Skin Flaps
Authors: Yao Lin , Deng Zhang , Guo Mengmeng , Zeng Wei , Yao Lin
Published: November 2020

Purposes:

The aim of this study was to introduce a method for repairing donor site defects after harvesting forearm free flaps with dual triangular flaps combined with in situ small full-thickness skin flaps.

Methods:

Free forearm skin flaps were applied to repair defects after tumor resection in 25 patients with oral squamous cell carcinoma. Although forearm free flaps were prepared, dual triangular flaps and adjacent full-thickness skin flaps were designed and fabricated to repair donor site defects in situ.

Results:

Twenty-five cases of forearm donor site defects were successfully repaired with dual triangular flaps combined with in situ small full-thickness skin grafts. All adjacent full-thickness skin grafts used to close the donor site defect of the forearm survived, and the wound healed well without delayed wound rupture or serious complications at the donor site. The movement of the elbow and wrist joint on the side of the flap was normal, the blood supply in the palm was normal, and the skin color at the donor site of the forearm skin flap was similar to that of the surrounding tissue. There was no dent deformity or contracture deformity. Moreover, there was no significant difference in swelling and wrist movement between the adjacent forearm skin grafting group and the abdominal skin grafting group, but the former technique reduced the risk of scar infection and tendon exposure and greatly improved the esthetics of the surgical site on the forearm.

Conclusions:

Modified donor dual triangular flaps combined with adjacent full-thickness skin grafts can reduce the recovery time during and after surgery and avoid trauma at a third surgical site. This method is worthy of practical application in the preparation of forearm skin flaps for oral and maxillofacial surgery.
The Impact of Racial Residential Segregation on Colorectal Cancer Outcomes and Treatment
Authors: Poulson Michael , Cornell Ella , Madiedo Andrea , Kenzik Kelly , Allee Lisa , Dechert Tracey , Hall Jason
Published: November 2020

Objective:

We sought to examine the impact of racial residential segregation on Black-White disparities in colorectal cancer diagnosis, surgical resection, and cancer-specific survival.

Summary Background Data:

There are clear Black-White disparities in colorectal cancer diagnosis and treatment with equally disparate explanations for these findings, including genetics, socioeconomic factors, and health behaviors.

Methods:

Data on Black and White patients with colorectal cancer were obtained from SEER between 2005 and 2015. The exposure of interest was the index of dissimilarity (IoD), a validated measure of segregation derived from 2010 Census data. Outcomes included advanced stage at diagnosis (AJCC stage IV), resection of localized disease (AJCC stage I-II), and cancer-specific survival. We used Poisson regression with robust error variance for the outcomes of interest and Cox proportional hazards were used to assess cancer-specific 5-year survival.

Results:

Black patients had a 41% increased risk of presenting at advanced stage per IoD [risk ratio (RR) 1.41, 95% confidence intervals (CI) 1.18, 1.69] and White patients saw a 17% increase (RR 1.17, 95%CI 1.04, 1.31). Black patients were 5% less likely to undergo surgical resection (RR 0.95, 95%CI 0.90, 0.99), whereas Whites were 5% more likely (RR 1.05, 95%CI 1.03, 1.07). Black patients had 43% increased hazards of cancer-specific mortality with increasing IoD (hazard ratio (HR) 1.43, 95%CI 1.17, 1.74).

Conclusions:

Black patients with colorectal cancer living in more segregated counties are significantly more likely to present at advanced stage and have worse cancer-specific survival. Enduring structural racism in the form of residential segregation has strong impacts on the colorectal cancer outcomes.
Maintaining high thrombectomy rates during pandemics
Authors: Dobrocky Tomas , Kaesmacher Johannes , Pereira Vitor Mendes , Gralla Jan , Fischer Urs
Published: November 2020

Purpose of review

The aim of this article is to review the current literature on endovascular treatment of acute ischemic stroke in the aftermath of the coronavirus disease 2019 (COVID-19) lockdown.

Recent findings

The outbreak of the COVID-19 has had effect of unprecedented magnitude on the social, economic and personal aspects around the globe. Healthcare providers were forced to expand capacity to provide care to the surging number of symptomatic COVID-19 patients, while maintaining a fully operating service for all non-COVID patients. The recent literature suggesting an overall decrease in acute ischemic stroke admissions as well as total number of endovascular treatments will be reviewed. Although the underlying reasons therefore remain the matter of debate, it seems that the imposed restrictions, requiring social distancing, and stopping all nonessential services, have led to a higher threshold for patients to seek medical attention, in particular in those with less severe symptoms. Thus, raising public awareness on the importance of strokes and transient ischemic attacks is even more important in the light of the current situation to avoid serious healthcare, economic consequences, and limit long term morbidity.

The priority remains maintaining a fast and efficient pre and in-hospital work-flow while mitigating nosocomial transmission and protecting the patient and the healthcare workers with appropriate personal protective equipment.
Addressing psychological resilience during the coronavirus disease 2019 pandemic: a rapid review
Authors: Blanc Judite , Briggs Anthony Q. , Seixas Azizi A. , Reid Marvin , Jean-Louis Girardin , Pandi-Perumal Seithikurippu R.
Published: November 2020

Purpose of review

The mental health toll on populations exposed to COVID-19 is alarming, and there is a need to address this with urgency. This current review provides insights on how individuals, communities, and specific populations, such as healthcare workers and patients are leveraging pre-COVID-19 and peri-COVID-19 factors to reinforce their psychological resilience during the global public health crisis.

Recent findings

Examination of the extant literature indicated that populations around the world rely often on support from their loved-ones, closed significant others, outdoor and physical activities, and spirituality to cope with the COVID-19-related distress. Increased sense of meaning/purpose since the COVID-19 pandemic was also reported.

A portion of publications provided intervention models to reinforce resilience among specific populations during the COVID-19 pandemic. Nevertheless, it is not convincing that some of these models can be applied universally. Additionally, it is important to note that in this category, translational data was scarce.
SARS-CoV-2 Reinfection in Patients Negative for Immunoglobulin G Following Recovery from COVID-19
Authors: Ali Ayad M. , Ali Kameran Mohammed , Fatah Mohammed Hassan , Tawfeeq Hassan Mohammad , Rostam Hassan Muhammad
Published: November 2020

While many patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eventually produce neutralising antibodies, the degree of susceptibility of previously infected individuals to reinfection by SARS-CoV-2 is currently unknown. To better understand the impact of the immunoglobulin (IgG) level on reinfection in recovered coronavirus disease 2019 (COVID-19) patients, IgG levels against SARS-CoV-2 were measured in 829 patients with previously confirmed infection just after their recovery. Notably, 87 of these patients had no detectable IgG concentration. While there was just one case of asymptomatic reinfection 4.5 months after the initial recovery amongst patients with detectable IgG levels, 25 of the 87 patients negative for IgG were reinfected within one to three months after their first infection. Therefore, patients who recover from COVID-19 with no detectable IgG concentration appear to remain more susceptible to reinfection by SARS-CoV-2, with no apparent immunity. Also, although our results suggest the chance is lower, the possibility for recovered patients with positive IgG findings to be reinfected similarly exists.
Association of axial length with retinal thickness and choroidal thickness in diabetic patients
Authors: Liu Sen , Wang Lanhua , Wang Wei , Gong Xia , Li Yuting , Li Wangting , Liang Xiaoling , Liu Yizhi , Huang Wenyong
Published: November 2020

Background

Understanding the associations of axial length (AL) with retinal thickness (RT) and choroidal thickness (CT) at different subgrids among diabetic participants are of great important in exploring potential protective mechanism and pathogenesis of diabetic retinopathy (DR) in myopic eyes. Therefore, this study aimed to investigate the associations of AL with RT and CT among participants with type-2 diabetes mellitus (T2DM).

Methods

Participants with T2DM and registered with the government-monitored diabetes communities near Zhongshan Ophthalmic Center, Guangzhou, China, were consecutively invited to participate in the current study from October 2017 to April 2019. High-definition retina and choroid images of the macular area were obtained using swept-source optical coherence tomography.AL and other ocular biometrics were measured using Lenstar900. Linear regression models were used to assess relationships between AL and RT as well as CT.

Results

A total of 1378 participants with a mean age of 63.8±7.75 years and mean AL of 23.6±1.15 mm were included in the current study. In the multivariate linear regression models, AL was positively associated with the central RT (β=4.11 per mm increased in AL, 95%confidence interval (CI)=2.66 to 5.56, P<0.001), but negatively associated with the RT of the outer ring (β=-3.37 per mm increased in AL, 95%CI=-4.19 to -2.56, P<0.001).Longer AL tended to have thinker CTs in the central (β=-27.4 per mm increased in AL, 95%CI=-31.2 to -23.7, P<0.001),outer ring (β=-20.8 per mm increased in AL, 95%CI=-23.8 to -17.7, P<0.001) and inner ring (β=-24.6 per mm increased in AL, 95%CI=-28.1 to -21.1, P<0.001).

Conclusions

Myopic ocular elongation is accompanied by retinal thinning of the outer ring and retinal thickening of the foveal area. The CT of the macular area tended to become thinner with elongated AL among the diabetic subjects.
Association between Renal Function and Retinal Neurodegeneration in Chinese Patients with Type 2 Diabetes Mellitus
Authors: Gong Xia , Wang Wei , Li Wangting , Jin Ling , Wang Lanhua , Meng Jie , Xiong Kun , Li Yuting , Han Xiao , Liang Xiaoling , Liu Yizhi , Huang Wenyong
Published: November 2020

Background

Chronic kidney disease (CKD) and diabetic retinopathy (DR) are two serious complications of diabetes. However, the association between retinal neurodegeneration in DR and renal function decline is still unclear. Our objective was to evaluate the association by measure estimated glomerular filtration rate (eGFR), macular ganglion cell–inner plexiform layer (GC–IPL) and ganglion cell complex (GCC) thickness in patients with type 2 diabetes mellitus (T2DM).

Methods

We analyzed the baseline data of the Guangzhou Diabetic Eye Study. T2DM patients from communities in Guangzhou were enrolled and all participants went through ophthalmic and general examinations. The thickness of the macular GC–IPL and GCC in their right eyes were measured by swept-source optical coherence tomography. CKD was defined as eGFR < 60 mL/min/1.73 m2.

Results

1,309 patients were included (mean age 64.4 ± 7.6 years, 59.1% female), and fifty-eight (4.4%) of them had CKD. Average macular GC-IPL thickness was significantly thinner in CKD patients (96.5 ± 9.1 μm) than non-CKD patients (101.3 ± 9.2 μm) (p < 0.01). Average macular GCC thickness was also significantly thinner in CKD patients (123.5 ± 13.2 μm) than non-CKD patients (129.9 ± 12.8 μm) (p < 0.01). The significant thinning of macular GC-IPL and GCC thickness presented in every gird in macula (all, p < 0.05) except for central grid (p ≥ 0.05). In the patients without DR, the eGFR was linearly correlated with the average macular GC–IPL thickness (β = 0.07 [95% CI 0.02–0.12], p < 0.01) and GCC thickness (β = 0.09 [95% CI 0.03–0.16], p < 0.01) after adjustment for age, sex, axial length, intraocular pressure and combination of hypertension. However, no linear correlation was found between eGFR and macular GC-IPL or GCC thickness in DR patients.

Conclusions

Renal function decreases is associated with the thinning of the macular GC–IPL and GCC in T2DM patients, suggesting the potential value of ganglion cell lose to detect early function decline in the kidney in diabetic patients, especially in patients without DR.
In-Silico analysis reveals lower transcription efficiency of C241T variant of SARS-CoV-2 with host replication factors MADP1 and HNRNP-1
Authors: Chaudhari Armi , Chaudhari Minal , Mahera Sapna , Saiyed Zuber , Nathani Neelam M. , Shukla Shantanu , Patel Chirag , Patel Dhaval , Joshi Madhvi , Joshi Chaitanya G.
Published: November 2020

Novel severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has claimed more than 1.5 million lives worldwide and counting. As per the GISAID database, the genomics of SARS-CoV2 is extensively studied with more than 500 genome submissions per day. Out of several hotspot mutations within the SARS-CoV-2 genome, researchers have focused a lot on missense variants but the least work is done on the UTRs. One of the most frequent 5’ UTR variants in the SARS-CoV-2 genome is the C241T with a global frequency of more than 0.9. In the present study, the effect of the C241T mutation has been studied with respect to change in RNA structure and its interaction with the host replication factors MADP1 Zinc finger CCHC-type and RNA-binding motif 1 (hnRNP1). The results obtained from molecular docking and molecular dynamics simulation indicated weaker interaction of C241T mutant stem loops with host transcription factor MADP1 indicating reduced replication efficiency. The results are also correlated with increased recovery rates and decreased death rates of global SARS-CoV-2 cases.
Maximizing statistical power to detect clinically associated cell states with scPOST
Authors: Millard Nghia , Korsunsky Ilya , Weinand Kathryn , Fonseka Chamith Y. , Nathan Aparna , Kang Joyce B. , Raychaudhuri Soumya
Published: November 2020

As advances in single-cell technologies enable the unbiased assay of thousands of cells simultaneously, human disease studies are able to identify clinically associated cell states using case-control study designs. These studies require precious clinical samples and costly technologies; therefore, it is critical to employ study design principles that maximize power to detect cell state frequency shifts between conditions, such as disease versus healthy. Here, we present single-cell Power Simulation Tool (scPOST), a method that enables users to estimate power under different study designs. To approximate the specific experimental and clinical scenarios being investigated, scPOST takes prototype (public or pilot) single-cell data as input and generates large numbers of single-cell datasetsin silico. We use scPOST to perform power analyses on three independent single-cell datasets that span diverse experimental conditions: a batch-corrected 21-sample rheumatoid arthritis dataset (5,265 cells) from synovial tissue, a 259-sample tuberculosis progression dataset (496,517 memory T cells) from peripheral blood mononuclear cells (PBMCs), and a 30-sample ulcerative colitis dataset (235,229 cells) from intestinal biopsies. Over thousands of simulations, we consistently observe that power to detect frequency shifts in cell states is maximized by larger numbers of independent clinical samples, reduced batch effects, and smaller variation in a cell state’s frequency across samples.
SREBP2 delivery to striatal astrocytes normalizes transcription of cholesterol biosynthesis genes and ameliorates pathological features in Huntington’s Disease
Authors: Birolini Giulia , Verlengia Gianluca , Talpo Francesca , Maniezzi Claudia , Zentilin Lorena , Giacca Mauro , Conforti Paola , Cordiglieri Chiara , Caccia Claudio , Leoni Valerio , Taroni Franco , Biella Gerardo , Simonato Michele , Cattaneo Elena , Valenza Marta
Published: November 2020

Brain cholesterol is produced mainly by astrocytes and is important for neuronal function. Its biosynthesis is severely reduced in mouse models of Huntington’s Disease (HD). One possible mechanism is a diminished nuclear translocation of the transcription factor sterol regulatory element binding protein 2 (SREBP2) and, consequently, reduced activation of SREBP-controlled genes in the cholesterol biosynthesis pathway.

Here we evaluated the efficacy of a gene therapy based on the unilateral intra-striatal injection of a recombinant adeno-associated virus 2/5 (AAV2/5) targeting astrocytes specifically and carrying the N-terminal fragment of human SREBP2 (hSREBP2).

Robust hSREBP2 expression in striatal glial cells in HD mice activated the transcription of cholesterol biosynthesis pathway genes, restored synaptic transmission, reversedDrd2transcript levels decline, cleared muHTT aggregates and attenuated behavioral deficits. We conclude that glial SREBP2 participates in HD brain pathogenesis in vivo and that AAV-based delivery of SREBP2 to astrocytes counteracts key features of HD.
Two Parallel Pathways Mediate Olfactory-Driven Backward Locomotion
Authors: Israel Shai , Rozenfeld Eyal , Weber Denise , Huetteroth Wolf , Parnas Moshe
Published: November 2020

Although animals switch to backward walking upon sensing an obstacle or danger in their path, the initiation and execution of backward locomotion is poorly understood. The discovery of Moonwalker Descending Neurons (MDNs), madeDrosophilauseful to study neural circuits underlying backward locomotion. MDNs were demonstrated to receive visual and mechanosensory inputs. However, whether other modalities converge onto MDNs and what are the neural circuits activating MDNs are unknown. We show that aversive but not appetitive olfactory input triggers MDN-mediated backward locomotion. We identify in each hemisphere, a single Moonwalker Subesophageal Zone neuron (MooSEZ), which triggers backward locomotion. MooSEZs act both upstream and in parallel to MDNs. Surprisingly, MooSEZs also respond mostly to aversive odor. Contrary to MDNs, blocking MooSEZs activity has little effect on odor-evoked backward locomotion. Thus, this work reveals another important modality input to MDNs in addition to a novel olfactory pathway and MDN-independent backward locomotion pathway.