bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of sustained virological response on metabolic disorders in diabetic chronic hepatitis C virus patients after treatment with generic sofosbuvir and daclatasvir
Authors: Abdo Mahmoud , Rabiee Ahmed , Abdellatif Zeinab , Abdel Alem Shereen , Moustafa Ahmed
Published: August 2020

Objectives

To evaluate the effect of generic sofosbuvir and daclatasvir (SOF/DCV) treatment on the glycemic state and insulin resistance as well as lipid profiles of those who achieved sustained virological response (SVR) in diabetic chronic hepatitis C virus (CHC) patients.

Methods

We retrospectively reviewed 114 CHC patients with evidence of type 2 diabetes that were treated with generic SOF/DCV between May 2016 and August 2017. Baseline demographic and laboratory data were recorded. At 12-week post end of therapy (SVR12), glycemic state and insulin resistance as well as lipid profiles were re-evaluated and compared with baseline.

Results

A total of 98 diabetic CHC patients were finally included and were responders. A significant decline in the glycemic state as well as Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values (P ≤ 0.0001) was observed, but HOMA-S showed a statistically significant increase (P ≤ 0.0001) at SVR12 in comparison to baseline values. Also, a significant increase in serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol levels was observed at SVR12 compared to baseline, but serum triglycerides levels showed a significant decrease. Logistic regression showed that the higher baseline HOMA-IR was a significant predictive variable of a decrease ≥20% of HOMA-IR, while higher baseline HOMA-IR and baseline triglycerides emerged as the only significant predictors of the Δ increase LDL-C level at SVR12.

Conclusion

SOF/DCV-based therapy led to an improvement of glycemic state associated with a global worsening of lipid profile. Further studies are strongly warranted to evaluate the cardiovascular balance between amelioration of insulin resistance and negative changes of the lipid profile.
Fluoroquinolone-resistant strains in cirrhotic patients with spontaneous bacterial peritonitis: microbiological and molecular aspects
Authors: Ghweil Ali A. , Bazeed Shamardan Ezzeldin S. , Al Rawy M.H. , Khodeary Ashraf , El-Amir Mostafa I.
Published: August 2020

Objectives

This study aimed to determine the causative bacterial agents of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and to define antibiotic-resistance patterns in addition to identifying the genetic mutations in the quinolone resistance determining regions (QRDRs).

Patients and methods

Twenty milliliters of ascetic fluid was obtained from 51 patients with SBP. The antibiotic-sensitivity patterns of different strains were determined by the Kirby–Bauer method. Extracted bacterial DNA was used to determine the mutations in four different genes in QRDRs (gyrA, gyrB, parC, and parE) by sequencing after gene amplification by PCR.

Results

Gram-negative bacilli were detected in 60.7% of the patients. Escherichia coli was detected in 33.3% of the patients, and Staphylococcus aureus was detected in 21.6%. Gram-negative bacilli showed the best sensitivity to meropenem (90.3%), followed by amikacin (83.9%). Gram-positive cocci were sensitive to vancomycin and oxacillin at 90 and 80%, respectively. Fluoroquinolone resistance was detected in 27% of the bacterial strains. Mutations in the gyrA and parC genes were detected in quinolone-resistant strains (64.3 and 35.7%, respectively). Several mutations were found in the gyrA gene (Ser83Leu, Ser81Phe, and Ser-84Leu). Ser80Ile and Ser79Tyr mutations were detected in the parC gene. No mutation was detected in the parE gene.

Conclusion

Frequent use of antibiotics as prophylaxis against SBP leads to an increase in antibiotic resistance and changes the microbial pattern of causative agents. The gyrA gene mutation was the most common mutation detected in fluoroquinolone-resistant strains.
Impact of a Prior Nonpancreatic Malignancy on Survival Outcomes of Patients With Stage IV Pancreatic Neuroendocrine Tumor
Authors: Li Gang , Tian Mao-Lin , Bing Yun-Tao , Yuan Chun-Hui , Xiu Dian-Rong
Published: August 2020

Objective

The aim of the study was to investigate the impact of a previous nonpancreatic malignancy on the survival outcomes in patients with a stage IV pancreatic neuroendocrine tumor (PanNET).

Methods

The Surveillance, Epidemiology, and End Results database was reviewed, and patients diagnosed with a stage IV PanNET between 2004 and 2015 were selected. Patients were divided into 2 groups according to the presence or absence of a previous nonpancreatic malignancy. Clinicopathological characteristics and survival outcomes were compared.

Results

A total of 1582 patients with stage IV PanNET were identified, of whom 116 (7.3%) had a prior malignancy. Prostate (33.62%), breast (17.24%), and gastrointestinal (12.07%) malignancies were the most common. Most prior malignancies (84.48%) were localized and regional. Patients with intervals of 36 months or less, 36 to 60 months, 60 to 120 months, and more than 120 months account for 25.86%, 14.66%, 31.03%, and 28.45% of all cases, respectively. Before and after propensity score matching, there was no significant difference detected regarding survival outcomes.

Conclusions

Stage IV PanNET patients with a history of a prior cancer had comparable survival outcomes with patients without such history. These patients could be candidates for clinical trials if otherwise appropriate, and aggressive and potentially curative therapies should be offered.
Proteomic Analysis of Cell Lines and Primary Tumors in Pancreatic Cancer Identifies Proteins Expressed Only In Vitro and Only In Vivo
Authors: Coleman Orla , Henry Michael , O'Neill Fiona , Roche Sandra , Swan Niall , Geoghegan Justin , Conlon Kevin , McVey Gerard , Moriarty Michael , Meleady Paula , Clynes Martin
Published: August 2020

Objectives

A limited repertoire of good pancreatic ductal adenocarcinoma (PDAC) models is one of the main barriers in developing effective new PDAC treatments. We aimed to characterize 6 commonly used PDAC cell lines and compare them with PDAC patient tumor samples using proteomics.

Methods

Proteomic methods were used to generate an extensive catalog of proteins from 10 PDAC surgical specimens, 9 biopsies of adjacent normal tissue, and 6 PDAC cell lines. Protein lists were interrogated to determine what extent the proteome of the cell lines reflects the proteome of primary pancreatic tumors.

Results

We identified 7973 proteins from the cell lines, 5680 proteins from the tumor tissues, and 4943 proteins from the adjacent normal tissues. We identified 324 proteins unique to the cell lines, some of which may play a role in survival of cells in culture. Conversely, a list of 63 proteins expressed only in the patient samples, whose expression is lost in culture, may place limitations on the degree to which these model systems reflect tumor biology in vivo.

Conclusions

Our work offers a catalog of proteins detected in each of the PDAC cell lines, providing a useful guide for researchers seeking model systems for PDAC functional studies.
Clinical features and physical performance in multiple sclerosis patients with and without cognitive impairment: a cross-sectional study
Authors: Ozkul Cagla , Guclu-Gunduz Arzu , Eldemir Kader , Apaydin Yasemin , Yazici Gokhan , Irkec Ceyla
Published: August 2020

The factors associated with cognitive functions in patients with multiple sclerosis (PwMS) are not yet clear. The aims of this study were (1) to compare clinical features and physical performance in healthy controls, and PwMS with and without cognitive impairment, and (2) to determine the relationship between cognitive domains and demographics characteristics, clinical features and physical performance in PwMS. A total of 112 PwMS and 25 healthy controls participated in this study. Cognitive functions were evaluated by Brief Repeatable Battery of Neuropsychological Tests (BRB-N). Based on cognitive performances by BRB-N, PwMS were divided into two groups as MS patients with impaired (MS-I, n: 57) and with normal (MS-N, n: 55) cognitive functions. For clinical features, fatigue, mood and sleep quality were evaluated by the Fatigue Impact Scale, Beck’s Depression Inventory, Pittsburgh Sleep Quality Index, respectively. For physical performances, balance and walking capacity were evaluated by posturography and Six-Minute Walking Test, respectively. The results showed that the education years, postural stability and walking capacity in MS-N and healthy controls were higher than in MS-I (P < 0.05). In addition, visuospatial memory was correlated with both postural stability under all sensory conditions and walking capacity; verbal memory was correlated with education years, postural stability on eyes closed-foam surface and walking capacity; verbal fluency was correlated with only walking capacity; information processing speed was correlated with education years, postural stability under all sensory conditions and walking capacity (P < 0.001). This study suggests that the interventions that aim to improve physical performance might protect and even improve cognitive functions in PwMS.
The Impact of Delays in Low-Income Women’s Breast Cancer Experiences
Authors: Jerome-D’Emilia Bonnie , Suplee Patricia D. , Robles-Rodriguez Evelyn , D’Emilia Wyatt
Published: August 2020

Background

Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment

Objective

The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays.

Methods

A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis.

Results

Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease.

Conclusions

While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment.

Implications for Practice

Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.
Using Magnet Model Components at a COVID-19–Positive Field Hospital
Authors: Erickson Jeanette Ives , Johnson Stacy Hutton , Blanchfield Bonnie B.
Published: August 2020

In this column, the authors who were part of a leadership team at 1000-bed field hospitals for patients with COVID-19 provide background and guidance on the development of a nurse staffing and training model.
Managing Care Transitions to the Community During a Pandemic
Authors: Landor Misty , Schroeder Karla , Thompson Tina-Ann Kerr
Published: August 2020

This column discusses the establishment of a multidisciplinary model for care transition of COVID-19-positive patients from hospital to community. The pandemic has presented challenging issues for discharge transition. A tiered patient identification and clinical messaging referral system was developed. The use of the COVID-19 transition model provided support to patients and physicians during the 30-day discharge period and can serve as a model for emerging public health issues in the future.
Variable Mechanisms of Dog-Related Deaths
Authors: Byard Roger W. , Langlois Neil E.I.
Published: August 2020

As the literature has tended to focus on injuries and deaths due to active dog attacks, the following review was undertaken to examine the range of circumstances and mechanisms that may be associated with all types of fatal encounters with dogs. A search was undertaken of the literature and the Forensic Science SA, Australia, autopsy database for cases where deaths had been caused by dog-related activity. Only 2 cases were found in the autopsy database over a 15-year period from 2005 to 2019. The first was a 55-year-old man who bled to death from a large degloving dog bite to his forehead exacerbating underlying cardiovascular disease. The second was a 40-year-old previously splenectomized man who died ofCapnocytophaga canimorsussepsis shortly after being bitten by his dog. Dogs may be involved in vehicle crashes if drivers swerve to avoid them or if pedestrians attempt to rescue dogs that have strayed onto roads. In the literature, trauma has also occurred from “non-bite dog-related injuries” where individuals have been pulled over by, or tripped on, dogs. Dogs may also be responsible for specific types of infections such as echinococcosis andC. canimorsus, which may have potentially lethal consequences. Thus, the types of cases of injuries, illnesses, and deaths associated with dogs encountered by pathologists in a forensic context may be extremely diverse and not always straightforward.
DNA Mismatch Repair–deficient Endometrial Carcinosarcomas Portend Distinct Clinical, Morphologic, and Molecular Features Compared With Traditional Carcinosarcomas
Authors: Segura Sheila E. , Pedra Nobre Silvana , Hussein Yaser R. , Abu-Rustum Nadeem R. , Weigelt Britta , Soslow Robert A. , DeLair Deborah F.
Published: August 2020

Uterine carcinosarcomas (UCSs) are aggressive neoplasms composed of high-grade malignant epithelial and mesenchymal elements with most (∼90%) showingTP53abnormalities. A subset, however, shows mismatch repair deficiency (MMR-D). We sought to describe their clinical, morphologic, and molecular features. Clinicopathologic data of MMR-D UCSs were recorded including age, stage, follow-up, mismatch repair and p53 immunohistochemistry (IHC),MLH1promoter methylation status, and germline alterations,TP53mutation status, microsatellite instability and mutational burden by massively parallel sequencing. Seventeen (6.2%) MMR-D were identified among 276 UCSs. Of MMR-D UCSs, the median age was 60 years. mismatch repair IHC loss is as follows: MLH1/PMS2 65%, MSH2/MSH6 18%, MSH6 12%, and PMS2 6%.MLH1promoter methylation and Lynch syndrome was identified in 47% and 12% of cases, respectively. Cases with p53 IHC showed the following patterns: wild-type 70%, aberrant 20%, and equivocal 10%. Of cases with sequencing, 88% were hypermutated and microsatellite instability high. High-grade endometrioid, undifferentiated, and clear cell carcinoma was present in 53%, 41%, and 6% of cases, respectively and 47% also showed a low-grade endometrioid component. Most patients presented at an early stage (67%) and upon follow-up, 18% died of disease, 65% showed no evidence of disease, while 18% are alive with disease. Patients with MMR-D UCS are younger than the reported median age (70 y) for traditional UCS and most do not show p53 abnormalities. Low-grade endometrioid and undifferentiated carcinoma were seen in approximately half of all cases. Although UCSs have a high tendency for early extrauterine spread, most patients in our cohort presented at an early stage and at follow-up were no evidence of disease. MMR-D UCSs display distinct clinical, morphologic, and molecular features compared with traditional UCSs.
Primary Palate Reconstruction Combined With Cranio-Maxillo-Facial Fixation After Self-Inflicted Gunshot Wound Injury: Critical Incision Planning for Regional Flap Reconstruction
Authors: Brennan Tara E. , Nicholas Robert G.
Published: August 2020

Self-inflicted gunshot wounds (GSW) to the palate result in complex bony and soft tissue trauma to the mid and upper face. Patients who survive these injuries are faced with significant speech and feeding difficulties. Upper and midface fractures open reduction and internal fixation (ORIF) is required for many of these patients, and consideration to incision planning is critical in order to preserve a primary option for oroantral fistula repair. The temporoparietal fascia (TPF) flap is an excellent option for primary palate repair as it is often exposed in the operative field during facial fracture ORIF and can be readily used for this purpose if its blood supply and width is not inadvertently compromised while making a temporal incision. This flap is easy to elevate, does not require any microvascular expertise, and using the TPF to reconstruct the palate injury primarily may save the patient years of wearing an obturator and/or subsequent trips to the OR for operative fistula management. In contrast to the temporalis muscle flap, this flap does not create temporal hollowing after elevation, which is a significant aesthetic complaint among patients. Proper incision planning is critical to preserve this flap as an option for palate fistula repair as the fascial layer is often incised when making coronal incisions. Primary repair of palate injuries using the TPF flap at the same time as upper facial ORIF has very little morbidity in this setting, and greatly augments patients’ quality of life.
Artists With Anatomical Knowledge After Anathomia (1316) and Before Fabrica (1543)
Authors: Hwang Kun
Published: August 2020

In the Renaissance, anatomical science was a major source of inspiration for artists. By the 15th century, interest had emerged in anatomy, and the artists of the period dissected cadavers. The aim of this paper was to analyze the works of 15th century artists who had a good knowledge of human anatomy.

In PubMed and Google, "Renaissance" and "artist" and ("anatomy" or "cadaver" or "corpse") were searched. In the book Lives of the Painters, Sculptors, and Architects by Vasari, the terms "cadaver" or "dissect" or "corps" or "anatomy" were searched. Fourteen artists (Donato di Niccolò di Betto Bardi, Piero della Francesca Andrea del Castagno, Antonio del Pollaiuolo, Andrea del Verrocchio, Leonardo da Vinci, Michelangelo di Lodovico Buonarroti Simoni, Domenico di Pace Beccafumi, Baccio Bandinelli, Giovanni Antonio Lappoli, Rosso Fiorentino, Silvio Cosini of Fiesole, Jan van Calcar, and Taddeo Zucchero) who learned anatomy or performed dissections were identified, and artworks representing their knowledge of human anatomical structures were analyzed.

In this review, we identified artists who had a good knowledge of anatomy and applied anatomical knowledge of features such as muscle shape and volume in their works.

The artists sought to accurately portray facial expressions, positions, reflexive motions, and draped clothing. Observation of living subjects is the primary source of artists’ expertise. Dissection provides fixed model without flowing blood, which cannot be used as an animated model. It is thought that these artists learned about the origins of vivid expressions from the anatomy of the muscles lying beneath the skin.
Advanced Robotic Surgery of the Parapharyngeal Space: Transoral Robotic Styloidectomy in Eagle Syndrome
Authors: Rizzo-Riera Elena , Rubi-Oña Carlos , García-Wagner Miguel , Costa Ana Araujo-Da , Miralles Joan , Enchev Enrik , Rama-López Julio
Published: August 2020

Eagle syndrome (ES) is characterized by symptomatic elongation of the styloid process or ossification of the stylohyoid ligament causing irritation and inflammation of the trigeminal, facial, glossopharyngeal, and vagus nerves. The use of robotic surgery has been accepted as a first-line treatment for some head and neck squamous cell carcinomas but not for styloidectomy. The aim of this article is to document our experience with a transoral robotic approach to treat ES and to present the outcomes of 6 patients.

The author present the transoral robotic surgery as a successful alternative for the surgical management of ES. Our experience with this approach has been excellent, granting an optimal vision of the surgical field with the consequent safe manipulation of the instruments avoiding injuries to healthy tissue.
Surgical Ciliated Cysts in Orthognathic Surgery
Authors: Soares José Castro , Villalba Natalia Casañas , Sanromán Jacinto Fernández , Ferro Martin Fernández , Fernández Pablo López , Betancourt Annahys López , López Alberto Costas
Published: August 2020

Surgical ciliated cysts (SCC) are rare entities that were first described in the Japanese literature after treatment for chronic maxillary sinusitis. Classically associated with surgery to the maxillary sinus, they have also been reported in association with orthognathic surgery, bone grafting, and trauma. These lesions can develop from a few months up to several years after the surgical procedure. The authors report 2 new cases of SCC after a LeFort I osteotomy for class III dentofacial deformity correction. One of them presented with bilateral lesions and suffered from a recurrence after 5 years, 2 rare events associated with SCC.

A review of the literature of the past 5 years was undertaken, in order to ascertain the reported time of follow-up and recurrence. A PubMed search retrieved a total of 15 articles with 17 cases reported. Nine cases were associated with orthognathic surgery, 4 with Caldwell-Luc procedures, 2 with sinus lift and 2 with trauma. The mean follow-up after removal of the SCC was of 8.6 months. Four cases did not specify the follow up time; 1 case was lost to follow-up. No relapses were reported.

Like what happens with the primary lesion, a recurrence can take place several years after removal. It is the authors’ opinion that adequate long-term follow-up must be granted for a timely diagnosis and treatment of relapsed SCC.
Cell Models for Birth Defects Caused by Chloroethyl Nitrosourea-Induced DNA Lesions
Authors: Cao Jiankun , Liu Zongjian , Wang Congxiao , Wang Jie , Pan Bo , Qie Shuyan
Published: August 2020

Birth defects have been linked to administration of alkylating agents during pregnancy. The anti-tumor efficacy of alkylating agents correlate with their ability to induce DNA lesions, especially interstrand crosslinks (ICLs). Yet the role of DNA damages in birth defects remains to be clarified, owing, in part, to a lack of cell models. Here we generate DNA lesions in NIH/3T3 cells to mimic defects in fetus triggered by 3-Bis(2-chloroethyl)-1-nitrosourea (BCNU, carmustine). CCK-8 assay suggests that BCNU-induced cell death was dose-dependent. Alkaline comet tests and γ-H2AX staining confirm DNA ICLs and other forms of DNA damages caused by BCNUs. The cell cycle analysis shows cells arrest in G2/M phase until crosslinks repair is complete. Taken together, all these experiments demonstrate we have successfully established normal cell models for birth defects caused by BCNU-mediated DNA damages. The model can not only guide the development of effective and low-toxicity anticancer drugs, but also be of great significance for the study of neonatal malformation triggered by BCNUs.
Orbital Floor Fractures Comparing Different Kinds of Reconstruction: A Proposal for Restoration of Physiological Anatomy
Authors: Spinzia Alessia , Renzetti Paolo , Bongiorno Antonella , Laganà Francesco
Published: August 2020

The most effective treatment for orbital fractures is still under debate and different strategies are proposed in the literature. All such strategies focus on reconstruction of the orbital structure, neglecting the main function of the medial and inferior walls, these latter being constructed so as to break during high energy trauma. The aim of the authors is to highlight the difference between different reconstructive techniques in an orbital fracture restoration, being inclined to favor repair over reconstruction of the orbital floor, assuming that a second trauma could happen and reconstructive material left in the orbit may damage the visual apparatus in such a scenario. Following this theme, the authors propose a reconstruction strategy using a custom made stereolithographic model and resorbable plate made of polylactic acid mesh molded onto it. The mesh is used alone or in combination with bone graft, to obtain a better reparative result. At present, this approach is best suited to sports people and the young. Even if a deeper evaluation of the method would be useful, the series of case studies presented could be of stimulus for future discussion.
Forehead Widening in Nonsyndromic Scaphocephaly Operated After 12 Months of Age
Authors: Paternoster Giovanna , Jing X.L. , Haber Samer E. , James Syril , Legros Christophe , Liu X.X. , Khonsari Hossein Roman , Zerah Michel , Meyer Philippe , Arnaud Eric
Published: August 2020

Aim and Scope:

Our standard management is to operate isolated sagittal synostosis around 4 months of age because of morphological and cognitive outcomes. However, some patients present late and the likelihood of spontaneous remodeling is low in isolated sagittal craniosynostosis operated on after 12 months of age with a limited technique. The preliminary result of a modified technique for forehead remodeling and subtotal calvarial remodeling in nonsyndromic scaphocephalic children with late presentation is presented.

Patients and Methods:

All patients older than 1 with isolated sagittal synostosis assessed between 2011 and 2015, over 1 year of age at the time of surgery, with available pre and postoperative computed tomography-scans, were retrospectively included into the study. The following parameters were collected: (1) age at surgery, (2) duration of the procedure, (3) surgical technique, (4) fronto-nasal angle before and after surgery and (5) forehead width before and after surgery.

Results:

Ten patients aged between 15 months and 6 years were retrospectively included. Delayed surgery was due to late presentation or initial parental reluctance. All patients presented with a transversal narrowing of the forehead and an anterior bulge. Mean age at surgery was 28 months and mean follow up was 23 months (1–4 years). Measurements showed significant improvement of both the fronto-nasal angle and the width of the forehead.

Conclusions:

Late-presenting scaphocephalic patients operated on after 12 months of age require forehead remodeling to achieve satisfactory aesthetic results. Modified forehead remodeling by splitting the forehead sagittally into 2 symmetrical halves and adding a midline bone strip is a safe and feasible way to widen the forehead. Long term follow-up is needed to assess this modified technique.
Three-Dimensional Calvarial Growth in Spring-Assisted Cranioplasty for Correction of Sagittal Synostosis
Authors: Rodriguez-Florez Naiara , Borghi Alessandro , Yauwan Daniel D. , Heuntinck Pam , Bruse Jan L. , Tenhagen Maik , Göktekin Özge K. , Angullia Freida , Schievano Silvia , Dunaway David J. , Jeelani Noor Ul Owase , James Greg
Published: August 2020

Spring-assisted cranioplasty (SAC) is a minimally invasive technique for treating sagittal synostosis in young infants. Yet, follow-up data on cranial growth in patients who have undergone SAC are lacking. This project aimed to understand how the cranial shape develops during the postoperative period, from spring insertion to removal. 3D head scans of 30 consecutive infants undergoing SAC for sagittal synostosis were acquired using a handheld scanner pre-operatively, immediately postoperatively, at follow-up and at spring removal; 3D scans of 41 age-matched control subjects were also acquired. Measurements of head length, width, height, circumference, and volume were taken for all subjects; cephalic index (CI) was calculated. Statistical shape modeling was used to compute 3D average head models of sagittal patients at the different time points. SAC was performed at a mean age of 5.2 months (range 3.3–8.0) and springs were removed 4.3 months later. CI increased significantly (P < 0.001) from pre-op (69.5% ± 2.8%) to spring removal (74.4% ± 3.9%), mainly due to the widening of head width, which became as wide as for age-matched controls; however, the CI of controls was not reached (82.3% ± 6.8%). The springs did not constrain volume changes and allowed for natural growth. Population mean shapes showed that the bony prominences seen at the sites of spring engagement settle over time, and that springs affect the overall 3D head shape of the skull. In conclusion, results reaffirmed the effectiveness of SAC as a treatment method for nonsyndromic single suture sagittal synostosis.
The Science Behind the Springs: Using Biomechanics and Finite Element Modeling to Predict Outcomes in Spring-Assisted Sagittal Synostosis Surgery
Authors: Jeelani Noor ul Owase , Borghi Alessandro , Florez Naiara Rodriguez , Bozkurt Selim , Dunaway David , Schievano Silvia
Published: August 2020

Spring-assisted surgery for the correction of scaphocephaly has gained popularity over the past 2 decades. Our unit utilizes standardized torsional springs with a central helix for spring-assisted surgery. This design allows a high degree of accuracy and reproducibility of the force vectors and force distance curves. In this manuscript, we expand on the biomechanical testing and properties of these springs. Standardization of design has enabled us to study the springs on bench and in vivo and a comprehensive repository of calvarial remodeling and spring dynamics has been acquired and analyzed.

Finite element modeling is a technique utilized to predict the outcomes of spring-assisted surgery. We have found this to be a useful tool, in planning our surgical strategy and improving outcomes. This technique has also contributed significantly to the process of informed consent preoperatively. In this article, we expand on our spring design and dynamics as well as the finite element modeling used to predict and improve outcomes.

In our unit, this practice has led to a significant improvement in patient outcomes and parental satisfaction and we hope to make our techniques available to a wider audience.
Posterior Distraction Using Springs in Syndromic and Multisuture Craniosynostosis: Improving the Technique
Authors: Mathijssen Irene M.J. , Driessen Caroline , Versnel Sarah L. , Dremmen Marjolein H.G. , van Veelen Marie-Lise C.
Published: August 2020

Introduction:

Posterior distraction is the preferred surgical treatment for particularly Apert and Crouzon syndrome in most craniofacial centers, using either external distractors or springs. The authors prefer the use of springs and have adapted their technique to further improve outcomes.

Methods:

All patients who were treated with the adapted technique for occipital expansion using springs were included. The most significant adaption that the authors introduced in 2017 is using a bony hinge at the top of the vault instead of at the caudal edge of the occiput.

Results:

A total of 8 posterior expansions with springs were performed. No complications occurred and the springs were also successfully applied in cases with extremely thin bone. If indicated, a simultaneous foramen magnum decompression was performed and this was easier to combine with a hinge at the top of the vault.

Conclusions:

Posterior distraction with springs is a safe and effective procedure and allows a simultaneous foramen magnum decompression. Planning the hinge at the vault allows intracranial volume gain at the site of the posterior skull base.
Open Reduction, Internal Fixation of Isolated Mandible Angle Fractures in Growing Children
Authors: Yesantharao Pooja S. , Lopez Joseph , Reategui Alvaro , Najjar Omar , Yu Jason W. , Pourtaheri Navid , Redett Richard J. , Manson Paul N. , Dorafshar Amir
Published: August 2020

Background:

Mandible angle fractures can result in significant, long-term morbidity in children. However, management of this particular mandibular fracture type is not well-characterized in the pediatric population. This study investigated isolated mandibular angle fractures in the pediatric patients.

Methods:

This was a 30-year retrospective, longitudinal cohort study of pediatric patients presenting to a single institution with mandibular angle fractures. Patient data were abstracted from electronic medical records. Subgroup analyses were completed by dentition stage.

Results:

Seventeen patients met inclusion criteria, of whom 6 (35.3%) had deciduous, 4 (23.5%) had mixed, and 7 (41.2%) had permanent dentition. Deciduous/mixed dentition patients with mobile, displaced fractures underwent ORIF, whereas those with nondisplaced fractures underwent treatment with soft diet. Among permanent dentition patients, most patients (71.4%) underwent ORIF regardless of fracture severity. The post-ORIF complication rate was 55.6%; no complications were reported after soft diet or closed treatment (Fischer exact: P 
= 0.05). The most common post-ORIF complication was alveolar nerve paresthesia (17.6%) and post-ORIF complication rates did not vary by age (deciduous: 16.7%, mixed: 25.0%, permanent: 42.9%, Fischer exact: P 
= 0.80). ORIF patients who received a single upper border miniplate had a lower complication rate (42.9%) than other plating methods (upper and lower miniplates—100%). Fracture severity was predictive of post-ORIF complications (odds ratio: 2.23, 95% confidence interval: 2.22–2.24, P < 0.0001).

Conclusions:

Isolated mandible angle fractures were relatively rare in children, and treatment requirements varied by injury severity and dentition stage. Although isolated angle fractures had substantial associated morbidity, this fracture pattern did not result in notable growth limitations/deformity.
Endoscopic Spring-Mediated Distraction for Unilambdoid Craniosynostosis
Authors: Mittermiller Paul A. , Rochlin Danielle H. , Menard Robert M.
Published: August 2020

Background:

Craniosynostosis treatment modalities have changed over time. These have included open calvarial remodeling, suturectomy with helmet molding, hand-powered distraction devices, and spring-mediated distraction. Implantable springs were first described for their use in treatment of craniosynostosis in 1998 (Lauritzen et al, Plast Reconstr Surg 121;2008:545-554). They have been used for the correction of craniosynostosis involving single and multiple sutures and have been placed through both endoscopic and open approaches. Their use for correction of lambdoid synostosis has been previously only described using an open approach (Arnaud et al, Child Nerv Syst 28;2012:1545-1549). The senior author has performed spring-mediated distraction for treating unilambdoid craniosynostosis using an endoscopic approach, which is described below and has not previously been reported by other authors.

Methods:

A retrospective analysis of our series of endoscopic unilambdoid synostosis repairs is included in this article. Patients were analyzed based on patient characteristics, operative details, and outcomes. The operation commences by approaching the lambdoid suture endoscopically through a 2- to 3-cm incision lateral to the lambdoid suture. Burr holes are placed on either side of the suture and a suturectomy is performed. Springs are bent preoperatively to a predetermined force. Two springs are placed across the suturectomy defect and the skin is closed. The patient is monitored for improvement in head shape and cranial X-rays are performed to measure the degree of distraction.

Results:

Seven patients underwent endoscopic spring-mediated distraction for unilambdoid craniosynostosis. The average age at the time of operation was 9.4 months. The median force of each spring placed was 7.0 N. The median length of hospital stay after spring placement was 2 days. Springs were removed at 5.6 months on average. Five patients had X-rays immediately after placement and prior to removal. Each spring expanded an average distance of 15.3 mm. There were no surgical complications. Three patients had both preoperative and postoperative computed tomography scans available. The angle of the cranial base, calculated by comparing foramen magnum to cribriform plate angles, improved 5.8° (12.3 preoperatively to 6.6 postoperatively).

Conclusion:

Endoscopic spring-mediated distraction is a safe and effective method of treatment for unilambdoid craniosynostosis. The series represents the largest experience with this technique. The approach can be considered in all patients with unilambdoid synostosis given the efficacious improvement in vault remodeling, low patient morbidity, short operating time, and minimal inpatient stay.
Respiratory and Gastrointestinal COVID-19 Phenotypes in Kidney Transplant Recipients
Authors: Crespo Marta , Mazuecos Auxiliadora , Rodrigo Emilio , Gavela Eva , Villanego Florentino , Sánchez-Alvarez Emilio , González-Monte Esther , Jiménez-Martín Carlos , Melilli Edoardo , Diekman Fritz , Zárraga Sofía , Hernández Domingo , Pascual Julio
Published: August 2020

Background.

Coronavirus infectious disease 2019 (COVID-19) pandemic has posed at risk the kidney transplant (KT) population. We describe clinical pictures, risk factors for death, and chances to recovery in a large cohort of KT recipients with COVID-19.

Methods.

Inclusion in a Spanish prospectively filled registry was allowed for KT cases with confirmed COVID-19. Outcomes were assessed as in-hospital mortality or recovery.

Results.

The study population comprised of 414 patients. Fever, respiratory symptoms, and dyspnea were the most frequent COVID-19-related symptoms, and 81.4% of them had pneumonia. More than one-third of patients showed digestive symptoms at diagnosis, combinations of nausea, vomiting, and diarrhea. Most patients were hospitalized, 12.1% in intensive care units, and 17.6% needed ventilator support. Treatment for COVID-19 included frequently hydroxychloroquine, azithromycin, high-dose steroids, lopinavir/ritonavir, and tocilizumab. After a mean follow-up of 44 days, the fatality rate was 26.3%. Pneumonia without gastrointestinal symptoms was associated with a 36.3% mortality (respiratory phenotype), and gastrointestinal symptoms without pneumonia with a 5.3% mortality (gastrointestinal phenotype). The mixed pneumonia and gastrointestinal phenotype showed an intermediate mortality of 19.5% (mixed phenotype). Multivariate Cox regression analysis showed that age and pneumonia were independently associated with death, whereas the gastrointestinal phenotype was associated with recovery.

Conclusions.

COVID-19 is frequent among the KT population. Advanced age and pneumonia are the main clinical features associated with a high-mortality rate. Gastrointestinal disease is associated with a more benign course and lower mortality.
Extracorporeal Membrane Oxygenation in Pediatric Liver Transplantation: A Multicenter Linked Database Analysis and Systematic Review of the Literature
Authors: Ziogas Ioannis A. , Johnson Wali R. , Matsuoka Lea K. , Rauf Muhammad A. , Thurm Cary , Hall Matt , Bacchetta Matthew , Godown Justin , Alexopoulos Sophoclis P.
Published: August 2020

Background.

Extracorporeal membrane oxygenation (ECMO) can be used to maintain oxygen delivery and provide hemodynamic support in case of circulatory and respiratory failure. Although the role of ECMO has emerged in the setting of adult liver transplantation (LT), data in children are limited. We aimed to describe the characteristics and outcomes of children receiving ECMO support at the time of or following LT.

Methods.

All pediatric LT recipients (≤20 y) requiring ECMO support peri-/post-LT were identified from a linked Pediatric Health Information System/Scientific Registry of Transplant Recipients dataset (2002–2018). The Kaplan-Meier method and Cox regression analysis were used to assess post-ECMO survival. A systematic literature review was conducted in accordance with the PRISMA statement.

Results.

Thirty-four children required ECMO peri-/post-LT. The median time from LT to ECMO was 5 d (interquartile range, 0.0–12.3), and the median ECMO duration was 1 d (interquartile range, 1.0–6.3). Children started on ECMO within 1 d of LT exhibited superior survival compared with those started on ECMO later (P = 0.03). When adjusting for recipient weight, increasing time from LT to ECMO initiation was associated with increased risk of mortality (hazard ratio, 1.03; 95% confidence interval, 1.00-1.06; P = 0.049). Overall, 55.9% (n = 19 of 34) of the patients survived. Twenty-two children receiving ECMO in the peri-/post-LT period were systematically reviewed, and 15 of them survived (68.2%).

Conclusions.

With an encouraging >55% patient survival at 6 mo, ECMO should be considered as a viable option in pediatric LT recipients with potentially reversible severe respiratory or cardiovascular failure refractory to conventional treatment.
Trinational Study Exploring the Early Impact of the COVID-19 Pandemic on Organ Donation and Liver Transplantation at National and Unit Levels
Authors: Reddy Mettu S. , Hakeem Abdul R. , Klair Tarunjeet , Marcon Francesca , Mathur Abhishek , Samstein Benjamin , Mohanka Ravi , Mathur Surendra K. , Prachalias Andreas , Menon Krishna V. , Muiesan Paolo , Rela Mohamed , Emond Jean C.
Published: August 2020

Background.

The coronavirus disease (COVID-19) pandemic is stressing healthcare services to an unprecedented extent. There is anecdotal evidence of reduction in organ donation and transplantation activity across the world.

Methods.

The weekly organ donation and liver transplant numbers over a 3-month period (Feb 17, 2020, till May 17, 2020) for the United States, United Kingdom, and India were compared with their previous year’s activity. Liver transplant activity in 6 centers from these countries with varying local COVID-19 caseload was also compared.

Results.

The COVID-19 pandemic has led to a significant contraction in organ donation and liver transplantation in all 3 countries. Peak reduction ranged from 25% in the United States to over 80% in the United Kingdom and India. The reduction was different for deceased donor and living donor liver transplantation and varied between centers within a country. There was early evidence of recovery of deceased donation in the United States and United Kingdom and resumption of living donor liver transplantation activity in India toward the end of the study period. A number of policy changes were undertaken at national and transplant center levels to ensure safe transplantation despite significant redirection of resources to combat the pandemic.

Conclusions.

There was a substantial reduction in organ donation and liver transplantation activity across the 3 countries with signs of recovery toward the end of the study period. Multiple factors including COVID-19 severity, stress on resources and influence of regulatory agencies and local factors are responsible for the reduction and recovery.
Myocardial Vascular Function Assessed by Dynamic Oxygenation-sensitive Cardiac Magnetic Resonance Imaging Long-term Following Cardiac Transplantation
Authors: Iannino Nadia , Fischer Kady , Friedrich Matthias , Hafyane Tarik , Mongeon Francois-Pierre , White Michel
Published: August 2020

Background.

Coronary vascular function is related to adverse outcomes following cardiac transplantation (CTx) in patients with or without cardiac allograft vasculopathy (CAV). The noninvasive assessment of the myocardial vascular response using oxygenation-sensitive cardiac magnetic resonance (OS-CMR has not been investigated in stable long-term CTx recipients).

Methods.

CTx patients were prospectively recruited to complete a CMR study with a breathing maneuver of hyperventilation followed by a voluntary apnea. Changes in OS-sensitive signal intensity reflecting the myocardial oxygenation response were monitored and expressed as % change in response to these breathing maneuvers. Myocardial injury was further investigated with T2-weighted imaging, native and postcontrast T1 measurements, extracellular volume measurements, and late gadolinium enhancement.

Results.

Forty-six CTx patients with (n = 23) and without (n = 23) CAV, along with 25 healthy controls (HC), were enrolled. The OS response was significantly attenuated in CTx compared with HC at the 30-second time-point into the breath-hold (2.63% ± 4.16% versus 6.40% ± 5.96%; P = 0.010). Compared with HC, OS response was lower in CTx without CAV (2.62% ± 4.60%; P < 0.05), while this response was further attenuated in patients with severe CAV (grades 2–3, −2.24% ± 3.65%). An inverse correlation was observed between OS-CMR, ventricular volumes, and diffuse fibrosis measured by extracellular volume mapping.

Conclusions.

In heart transplant patients, myocardial oxygenation is impaired even in the absence of CAV suggesting microvascular dysfunction. These abnormalities can be identified by oxygenation-sensitive CMR using simple breathing maneuvers.
Association of serum leptin with angiographically proven cardiovascular disease and with components of the metabolic syndrome: a cross-sectional study in East Azerbaijan
Authors: Khanbabaei Nafiseh , Mozafar Saadati Hossein , Valizadeh Shahbazloo Shahnam , Hoseinpoor Reyhaneh , Naderi Seyed Hossein , Taghvamanesh Roya , Abolhasani Sakhavat
Published: August 2020

Background

Role of leptin is well documented in cardiometabolic diseases. The objective of this study was to investigate if the serum levels of leptin associates with the serum levels of markers related to cardiac and metabolic disorders in adults.

Materials and methods

One hundred eighty subjects [120 cardiovascular disease (CVD) and 60 healthy controls] were enrolled in the study, to determine the association of the serum leptin (in quartiles) and cardiometabolic diseases [metabolic syndrome (MetS) and CVD] adjusted for other biological and physical examination. MetS was according to the WHO Clinical Criteria for MetS definition and CVD by angiography outcomes. The serum levels of leptin and OX-LDL were measured by ELISA.

Results

Leptin levels were significantly higher in patients with MetS and those with positive angiography compared with controls. After controlling for potential confounders, a significant association of the leptin levels with cardiometabolic diseases was proven, albeit there was a higher rate of significance between CVD and leptin in comparison with MetS. Additionally, receiver operating characteristic analysis revealed that the serum levels of leptin were a valuable biomarker of the cardiometabolic diseases.

Conclusion

Our findings demonstrate that serum leptin levels are associated with components of the MetS and with CVD. Serum leptin may be a useful biomarker for CVD.
The periodic table and other wallcharts in the teaching of chemistry in St Andrews, 1884–1919
Authors: Aitken R. Alan , Gil M. Pilar
Published: August 2020

The teaching of the chemistry of the elements at the University of St Andrews by Professor Thomas Purdie FRS is examined with reference to selections from a collection of recently discovered historic wallcharts and extracts from his detailed hand-written lecture notes. Together these reveal a comprehensive and exciting programme of lectures incorporating numerous practical demonstrations which were continually updated to reflect the latest state of knowledge in what was a rapidly changing field.

This article is part of the theme issue ‘Mendeleev and the periodic table’.