bluuebunny/crossref_metadata_2025 huggingface dataset:
Catheter ablation for atrial fibrillation in left ventricular assist device
Authors: Chung Yu Jin , Choi Jin-Oh , Park Kyoung-Min
Published: June 2021

Introduction:

Mechanical circulatory support such as the left ventricular assist device (LVAD) has become widely implemented in the treatment of end-stage heart failure, whether as bridge-to-transplant or as destination therapy. The hemodynamic effects of arrhythmia on LVADs and its management are significant in determining the long-term outcome of these patients. Both atrial arrhythmia and ventricular arrhythmia are commonly seen after implantation of the device. There are no strict guidelines, however, on the need for intensive management of arrhythmias in LVAD. In this case report, we present a patient with new onset atrial fibrillation after LVAD implantation which leads to acute decompensating heart failure. The patient was treated with catheter ablation. The intervention demonstrated positive outcomes for this patient.

Patient concerns:

The patient was a Korean male, who presented with dyspnea, fatigue and generalized edema after persistent atrial fibrillation precipitated by implantation of the left ventricular assist device.

Diagnosis:

The patient was diagnosed with acute decompensating heart failure that was aggravated by recurrent atrial arrhythmia.

Intervention:

We attempted to relieve symptoms of right ventricular dysfunction by method of strict rhythm control in this patient. The patient underwent radiofrequency catheter ablation for recurrent atrial fibrillation.

Outcome:

The patient showed improved clinical symptoms, BNP levels, and echocardiogram parameters immediately after the procedure as well as during long term outpatient follow up.

Conclusion:

In this case report, we present the first successful case in Korea of atrial fibrillation in LVAD treated with catheter ablation. This case suggests setting catheter ablation as a routine first-line treatment for atrial arrhythmia in LVAD patients, especially when the arrhythmia predisposes the patient at risk for decompensating heart failure.
Molecular diagnosis of sex chromosome mosaics in fetal amniotic cells
Authors: Fan Zuqian , Weng Xunjin , Pan Zhijian , Fan Qiongying , Long Ju , Lin Guixian , Yang Qian , Sun Lei
Published: June 2021

Mosaicism can be observed in karyotype analyses of amniotic fluid cells. Differentiating between true mosaicism and pseudomosaicism and determining mosaic proportions can help avoid misjudgments by doctors and effectively reduce mental and physical harm to pregnant women. However, the detection of mosaicism and mosaic proportions via karyotype analysis and fluorescence in situ hybridization (FISH) is extremely complex. We have developed a novel approach, “segmental duplication quantitative fluorescent PCR” (SD-QF-PCR), to detect mosaicism and mosaic proportions.

In this study, twenty control samples and fourteen mosaic samples were tested by first-line karyotype analysis; by second-line karyotype analysis, SD-QF-PCR and FISH were used to reassess fetal sex chromosome mosaicism and mosaic proportions.

Detection of the 20 control samples by second-line karyotype analysis via FISH and SD-QF-PCR showed normal and consistent results. Among the 14 mosaic samples, the numbers of samples showing true mosaicism and pseudomosaicism detected by the three methods were 6 and 8, respectively.

Our study demonstrates that SD-QF-PCR can be used as a complementary method to traditional cytogenetic analysis of amniotic fluid mosaics and has clinical application value.
Total endoscopic sublay mesh repair for umbilical hernias
Authors: Cai Xiao-yan , Chen Ke , Pan Yu , Yang Xiao-yan , Huang Di-yu , Wang Xian-fa , Chen Qi-long
Published: June 2021

Umbilical hernias constitute some of the most common surgical diseases addressed by surgeons. Endoscopic techniques have become standard of care together with the conventional open techniques for the treatment of umbilical hernias. Several different approaches were described to achieve laparoscopic sublay repair.

We prospectively collected and reviewed the medical records of 10 patients with umbilical hernias underwent total endoscopic sublay repair (TES) at our institution from November 2017 to November 2019. All operations were performed by a same surgical team. The demographics, intraoperative details, and postoperative complications were evaluated.

All TES procedures were successfully performed without conversion to an open operation. No intraoperative morbidity was encountered. The average operative time was 109.5 minutes (range, 80–140 minutes). All the patients resumed an oral diet within 6 hours after the intervention. The mean time to ambulation was 7.5 hours (range, 4–14 hours), and mean postoperative hospital stay was 2.2 day (range, 1–4 days). One patient developed postoperative seroma. No wound complications, chronic pain, or recurrence were registered during the follow-up.

Initial experiences with this technique show that the TES is a safe, and effective procedure for the treatment of umbilical hernias.
Treatments of unruptured brain arteriovenous malformations
Authors: Liu Renjie , Zhan Yongle , Piao Jianmin , Yang Zhongxi , Wei Yun , Liu Pengcheng , Chen Xuan , Jiang Yu
Published: June 2021

Background:

The best therapeutic option for unruptured brain arteriovenous malformations (bAVMs) patients is disputed.

Objective:

To assess the occurrence of obliteration and complications of patients with unruptured bAVMs after various treatments.

Methods:

A systematic literature search was performed in PubMed, EMBASE, Web of Science, and so on to identify studies fulfilling predefined inclusion criteria. Baseline, treatment, and outcomes data were extracted for statistical analysis.

Results:

We identified 28 eligible studies totaling 5852 patients. The obliteration rates were 98% in microsurgery group (95% confidence interval (CI): 96%–99%, I
2 = 74.5%), 97% in surgery group (95%CI: 95%–99%, I
2 = 18.3%), 87% in endovascular treatment group (95%CI: 80%–93%, I
2 = 0.0%), and 68% in radiosurgery group (95%CI: 66%–69%, I
2 = 92.0%). The stroke or death rates were 1% in microsurgery group (95%CI: 0%–2%, I
2 = 0.0%), 0% in surgery group (95%CI: 0%–1%, I
2 = 0.0%), 4% in endovascular treatment group (95%CI: 0%–8%, I
2 = 85.8%), and 3% in radiosurgery group (95%CI: 3%–4%, I
2 = 82.9%). In addition, the proportions of hemorrhage were 2% in microsurgery group (95%CI: 1%–4%, I
2 = 0.0%), 23% in endovascular treatment group (95%CI: 7%–39%), and 12% in radiosurgery group (95%CI: 12%–13%, I
2 = 99.2%). As to neurological deficit, the occurrence was 9% in microsurgery group (95%CI: 6%–11%, I
2 = 94.1%), 20% in surgery group (95%CI: 13%–27%, I
2 = 0.0%), 14% in endovascular treatment group (95%CI: 10%–18%, I
2 = 64.0%), and 8% in radiosurgery group (95%CI: 7%–9%, I
2 = 66.6%).

Conclusions:

We found that microsurgery might provide lasting clinical benefits in some unruptured bAVMs patients for its high obliteration rates and low hemorrhage. These findings are helpful to provide a reference basis for neurosurgeons to choose the treatment of patients with unruptured bAVMs.
The effects of core stability training in nurses with nonspecific low back pain
Authors: Zou Chao-Jun , Li Jian-Hua , Wu Fang-Chao , Li Yang-Zhen , Pan Hong-Ying , Wu Tao
Published: June 2021

To investigate the effect of core stability training on nonspecific low back pain (NSLBP) in nurses.

The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. A total of 40 nurses with NSLBP were included and divided into observation group and control group. Each group were given routine health education for NSLBP. Core stability training was performed in observation group for 4 weeks. Surface electromyography (sEMG) evaluation of erector spine and multifidus muscle, pain Numeric Rating Scale (NRS) and Japanese Orthopaedic Association (JOA) scores were evaluated and analyzed before and 4 weeks after intervention.

There was no significant difference of NRS score and JOA score between two groups before intervention (P > .05, respectively). The NRS and JOA scores were significantly improved in both two groups after 4 weeks of intervention (P < .05, respectively). Moreover, the improvement of NRS and JOA scores in the observation group were better than those of the control group (P < .05, respectively). No significant difference of average electromyography (AEMG) or median frequency (MF) were noted between the healthy side and the affected side in both groups before or after intervention (P > .05, respectively). After 4 weeks of intervention, the AEMG of the healthy and the affected side of the two groups showed an improved trend without significant difference (P > .05, respectively). The MF of affected side was significantly higher 4 weeks after intervention than those before treatment in the observation and control group (P < .05, respectively).

Core stability training can alleviate pain, improve the fatigue resistance of the core muscles and the balance of the functions of bilateral multifidus muscles in nurses with NSLBP.
PHoral: Effects of carnosine supplementation on quantity/quality of oral salivae in healthy volunteer and in subjects affected by common oral pathologies
Authors: Ciulla Michele M. , Re Dino , Gilardoni Ettore , D’Amato Alfonsina , Altomare Alessandra , Baron Giovanna , Carugo Stefano , Aldini Giancarlo
Published: June 2021

Background:

Diseases of the oral cavity (OC) with an infectious trigger such as caries and periodontal disease are extremely common in the general population and can also have effects at the cardiovascular level. The oral salivary flow, with its buffering capacity, is able to regulate the pH of the OC and, therefore, significantly contribute to the ecological balance of the microenvironment in which the oral microbiome (OM) develops. On the other side, when the quality/quantity of salivary flow is altered it is supposed the disruption of this balance with the potential increase in oral pathogens and triggered diseases. Among the endogenous substances able to exert a significant effect on the salivary flow and its characteristics, carnosine (Car), a dipeptide originally isolated in skeletal muscle, represents, thanks to the known buffering properties, a promising principle.

Methods:

We aimed this protocol to evaluate the quantitative/qualitative characteristics of the salivary flow in healthy volunteer subjects (n = 20) and in subjects suffering from common OC pathologies (n = 40), before and after 7 days of supplementation with SaliflussTM (Metis Healthcare srl, Milan, Italy), a Class I medical device on the market as 400 mg mucoadhesive oral tablets that has Car as the main ingredient.

Discussion:

Combining the characteristics of saliva with the OM and comparing them with OC pathologies, we expect to clarify their reciprocal relationship and, using quantitative proteomics techniques, to help clarify the mechanism of action of Car.
A germline c.1546dupC MEN1 mutation in an MEN1 family
Authors: Cho Yoon Young , Chung Yun Jae
Published: June 2021

Rationale:

Multiple endocrine neoplasia type 1 (MEN1) is a rare tumor syndrome with an autosomal dominant inheritance, and genetic testing for MEN1 gene is important for both affected individuals and their relatives. We present a 2-person family affected by a germline c.1546dupC MEN1 mutation, and one of them had a full-spectrum of MEN-related endocrine tumors.

Patient concerns:

A female patient aged 32 years presented with jejunal ulcer perforation due to gastrinoma.

Diagnoses:

We conducted genetic analysis and extensive biochemical/radiological evaluation for detecting other endocrine tumors. Multiple pancreatic neuroendocrine tumors (NETs), prolactinoma and primary hyperparathyroidism were diagnosed, and a frame-shift mutation, NM_130799.1:c.1546dupC (p.Arg516Profs∗15), was detected. One daughter of the proband, aged 12 years, had the same mutation for MEN1.

Intervention:

She underwent pancreatic surgery for pancreatic NETs and total parathyroidectomy for primary hyperparathyroidism.

Outcomes:

After pancreatic surgery, long-term symptoms of epigastric soreness, acid belching, sweating, and palpitation in fasting were improved. Hypercalcemia was improved after parathyroidectomy and she was supplemented with oral calcium and vitamin D. Her daughter showed normal biochemical surveillance until 15 years of age.

Lessons:

We report 2 people in a family affected by MEN1 with the heterozygous germline c.1546dupC mutation, a variant that should be surveilled for early development of full-blown MEN1-associated endocrine tumors.
Clinical outcome and toxicity of radiotherapy for inferior vena cava tumor thrombus in HCC patients
Authors: Lee So Jung , Jang Hong Seok , Choi Yoo Kyung
Published: June 2021

Hepatocellular carcinoma (HCC) involving the inferior vena cava rarely occurs, but its prognosis is extremely poor, with no established treatment to date. This study aimed to analyze the clinical outcome and toxicity of radiotherapy (RT) targeting inferior vena cava tumor thrombus (IVCTT) in HCC patients.

From November 2011 to July 2020, medical record of 19 HCC patients who were treated with RT for IVCTT was retrospectively reviewed. RT was delivered using 3-dimensional conformal radiation therapy, intensity-modulated radiation therapy, and stereotactic body radiation therapy. The median radiation dose was 50 Gy (range, 45–55.8 Gy) for intensity-modulated radiation therapy and three-dimensional conformal radiotherapy. Stereotactic body radiation therapy was performed in 5 patients, for a total of 32 Gy in 4 fractions.

The median follow-up duration was 8.1 months (range, 3.3–26.5 months). The median overall survival was 9.4 months (range, 3.7–26.5 months), and the 1-year overall survival rate was 37.1%. Eight of 19 patients (42.1%) had extrahepatic metastasis at the start of RT. Six of 11 patients (54.5%) who did not have extrahepatic metastasis at the start of RT showed extrahepatic metastasis after RT. The major cause of death was progression of extrahepatic metastasis (11 patients, 57.9%). The overall response rate of IVCTT for RT was 84.2%, and the local control rate at the time of the last follow-up was 89.4%. After RT, the most common first progression site was the lungs (9 patients, 47.4%). Most toxicities were grade 1 to 2 gastrointestinal (26.3%) and liver enzyme elevation (68.4%). Three patients occurred pulmonary embolism after RT later than 5 months after.

RT is a feasible and safe local therapy for IVCTT, with favorable tumor control and acceptable toxicity. Extrahepatic metastasis is the major progression pattern and a leading cause of death in patients treated with RT. The combination of effective systemic therapy with RT may have to be considered.
Extent of resection and survival in patients with glioblastoma multiforme
Authors: Revilla-Pacheco Francisco , Rodríguez-Salgado Pamela , Barrera-Ramírez Mónica , Morales-Ruiz María Paula , Loyo-Varela Mauro , Rubalcava-Ortega Johnatan , Herrada-Pineda Tenoch
Published: June 2021

Background:

Glioblastoma multiforme (GBM) owes an ominous prognosis: its mean overall survival is 14 months. The extent of surgical resection (ESR) highlights among factors in which an association has been found to a somewhat better prognosis. However, the association between greater ESR and prolonged overall (OS) survival is not a constant finding nor a proven cause-and-effect phenomenon. To our objective is to establish the strength of association between ESR and OS in patients with GBM through a systematic review and meta-analysis.

Methods:

In accordance with PRISMA-P recommendations, we conducted a systematic literature search; we included studies with adult patients who had undergone craniotomy for GBM. Our primary outcome is overall postoperative survival at 12 and 24 months. We reviewed 180 studies, excluded 158, and eliminated 8; 14 studies that suited our requirements were analyzed.

Results:

The initial level of evidence of all studies is low, and it may be degraded to very low according to GRADE criteria because of design issues. The definition of different levels of the extent of resection is heterogeneous and poorly defined. We found a great amount of variation in the methodology of the operation and the adjuvant treatment protocol. The combined result for relative risk (RR) for OS for 12 months analysis is 1.25 [95% confidence interval (95% CI) 1.14–1.36, P < .01], absolute risk reduction (ARR) of 15.7% (95% CI 11.9–19.4), relative risk reduction (RRR) of 0.24 (95% CI 0.18–0.31), number needed to treat (NNT) 6; for 24-month analysis RR is 1.59 (95% CI 1.11–2.26, P < .01) ARR of 11.5% (95% CI 7.7–15.1), relative risk reduction (RRR) of 0.53 (95% CI 0.33–0.76), (NNT) 9. In each term analysis, the proportion of alive patients who underwent more extensive resection is significantly higher than those who underwent subtotal resection.

Conclusion:

Our results sustain a weak but statistically significant association between the ESR and OS in patients with GBM obtained from observational studies with a very low level of evidence according to GRADE criteria. As a consequence, any estimate of effect is very uncertain. Current information cannot sustain a cause-and-effect relationship between these variables.
Erlotinib as a salvage treatment after gefitinib failure for advanced non-small-cell lung cancer patients with brain metastasis
Authors: Dong Yong , Li Qijun , Miao Qian , Li Da
Published: June 2021

Rationale:

The guidelines recommended gefitinib as a first-line targeted treatment for stage IV non-small-cell lung cancer (NSCLC) patients with EGFR mutations. However, resistance to gefitinib ensues invariably and there is little evidence as for the effectiveness of subsequent salvage treatment for patients without T790m mutation. The case is to evaluate the efficacy of erlotinib, another EGFR-TKI, after failed first-line use of gefitinib.

Patient concerns:

We described a 55-year-old man with good performance status (PS).

Diagnoses:

He was histopathologically diagnosed stage IV lung adenocarcinoma with EGFR mutations in November 2018.

Interventions:

He was administrated with gefitinib daily (250 mg) for activating epidermal growth factor receptor (EGFR) mutations (exon 19 deletions,19del), and combined with platinum-based dual-drug chemotherapy. During the target treatments, the optimal efficacy evaluation was partial remission (PR) with a 12-month progression-free survival (PFS) time. Later, the intracranial progression of the patient rendered the treatment change to erlotinib.

Outcomes:

It is surprising that the tumor lesion in brain as well as lung relieved obviously. His progression-free survival (PFS)was nearly 11 months, and the overall survival (OS)was>36 months up to now. The adverse events were tolerable.

Lessions:

This case manifests that re-biopsy of advanced or recurrent NSCLC is beneficial to make a better therapeutic regimen, and erlotinib can be used as a salvage treatment after gefitinib failure.
Successful defibrotide treatment of a patient with veno-occlusive disease after living-donor liver transplantation
Authors: Lee Tae Beom , Yang Kwangho , Ko Hyo Jung , Shim Jae Ryong , Choi Byung Hyun , Lee Jung Hee , Ryu Je Ho
Published: June 2021

Rationale:

Veno-occlusive disease (VOD) is characterized by painful hepatomegaly, ascites, weight gain, and jaundice with nonthrombotic, fibrous obliteration of the centrilobular hepatic veins. VOD after liver transplantation is a rare complication, with an incidence of approximately 2%; however, it can be life-threatening in severe cases. The precise etiology and mechanism of VOD after liver transplantation remains unclear. Acute cellular rejection, antibody-mediated rejection, and treatment with tacrolimus or azathioprine may be associated with the development of VOD after liver transplantation. Additionally, the optimal treatment of VOD after liver transplantation has not yet been established and focuses on supportive care. Defibrotide is an anti-ischemic and antithrombotic drug with no systemic anticoagulant effects. Moreover, only a few reports have investigated the use of defibrotide for VOD after liver transplantation, which has shown promising results.

Patient concerns:

A 39-year-old woman with primary biliary cholangitis underwent living-donor liver transplantation at our center. She experienced right upper quadrant pain with increased ascites, pleural effusion, and weight gain on postoperative day 14.

Diagnoses:

Imaging and pathological tests showed no evidence of rejection or vessel complications. VOD was diagnosed clinically based on the findings of weight gain, ascites, jaundice, and pathological biopsy.

Interventions:

Defibrotid, 25 mg/kg/day, was administered intravenously for 21 days.

Outcomes:

She showed complete clinical resolution of the VOD.

Lessons:

Herein, we report a case of successful defibrotide treatment of VOD after living-donor liver transplantation.
Evaluation of the emergency medical system in an area following lifting of the mandatory evacuation order after the Fukushima Daiichi Nuclear Power Plant accident
Authors: Yamamoto Chika , Sawano Toyoaki , Nishikawa Yoshitaka , Ozaki Akihiko , Shimada Yuki , Morita Tomohiro , Zhao Tianchen , Hasegawa Arifumi , Oikawa Tomoyoshi , Tsubokura Masaharu
Published: June 2021

Following the lifting of the evacuation order due to the Fukushima Daiichi Nuclear Power Plant accident, the medical demand and emergency medical system (EMS) in the area where the evacuation orders were lifted have not been well-investigated. This study aimed to evaluate the emergency transportation in such areas and compare the differences with areas that had minimal impact.

Using the local EMS transport records, the characteristics of patients who were transferred by an EMS vehicle in Minamisoma City were collected between July 12, 2016 and July 31, 2018, and were compared between former evacuation zones and outside the evacuation zones in the city.

The number of emergency transports in the study period in Minamisoma City were 325 cases in the area where the evacuation orders were lifted and 4307 cases in the other areas. The total EMS time was significantly longer in the area where the evacuation order was lifted (48 ± 16 minutes) than in the other areas (40 ± 15 minutes) (P < .001). In the analysis of each component of EMS times, the transport time, which is the time from departure from the patient's location to arrival at a hospital, was significantly longer in the former evacuation zone than in the other areas (16 ± 9 vs 9 ± 9 minutes, P < .001), suggesting that transport time contributed to the longer EMS response times.

In areas where the evacuation orders were lifted, the EMS transport time was significantly longer than that in the area outside the former evacuation zone; correspondingly, the total EMS time significantly increased in the former evacuation zone. A plausible reason for this may be the closure of local medical facilities following the evacuation order after the nuclear accident.
Anesthetic management of lung transplantation in a patient with end-stage COVID-19 pneumonia
Authors: Guo Shao-Hui , Li Ang , Yin Peng-Fei , Zhu Sheng-Mei , Yao Yong-Xing
Published: June 2021

Rationale:

The COVID-19 pandemic is spreading around the world and the leading cause of death is rapidly progressive respiratory failure because of lung damage and consolidation. Lung transplantation is the last line of treatment for chronic end-stage lung diseases. There were several cases of lung transplantation reported in patients with COVID-19 pneumonia. However, anesthetic management of lung transplantation in this subpopulation is rare. We report the anesthetic and perioperative management of lung transplantation in a patient with COVID-19 pneumonia.

Patient concerns:

A 70-year-old man with a 7-day history of fever was diagnosed with COVID-19 pneumonia. His throat swab was positive for COVID-19, but negative for other common viruses. Chest radiography showed multiple inflammatory foci in both lungs. By day 5, he presented respiratory distress. Computed tomography (CT) scan showed progressive deterioration of both lungs. Starting on day 7, SARS-CoV-2 RNA in bronchoalveolar lavage samples were continuously negative. However, his lung condition deteriorated. By day 17, a veno-venous extracorporeal membrane oxygenation (ECMO) was initiated. After 10 days of ECMO support, the patient's lung condition did not improve. CT scan revealed bilateral parenchymal consolidation with pulmonary fibrosis and hydrothorax.

Diagnosis:

Irreversible lung function loss induced by COVID-19 pneumonia.

Interventions:

Bilateral transplantation was performed because the patient's lung condition did not improve and CT scan revealed parenchymal consolidation with pulmonary fibrosis after 10 days of ECMO support. Thirty-six hours after the surgery, ECMO was discontinued. A percutaneous transluminal coronary angioplasty and a stent implantation were performed because of acute coronary syndrome and myocardial ischemia 4 days postoperatively.

Outcomes:

The patient remained hospitalized because of requirements for intermittent assisted ventilation via tracheostomy.

Lessons:

This case further supports the consideration that lung transplantation can potentially be the successful therapy for these patients who have developed irreversible lung function lose due to COVID-19 pneumonia. However, most critical patients with COVID-19 are older individuals with various comorbidities, which present new anesthetic challenges.
Diagnostic yields of endoscopic ultrasound-guided fine-needle tissue acquisition according to the gastric location
Authors: Kim Dong Hyun , Park Chang-Hwan , Park Seon-Young , Cho Eunae , Kim Hyun Soo , Choi Sung Kyu
Published: June 2021

The diagnostic accuracy of endoscopic ultrasound-guided fine-needle tissue acquisition (EUS-FNTA) according to the gastric location of subepithelial tumors (SETs) has not been well established. We aimed to evaluate the efficacy of EUS-FNTA for the diagnosis of gastric SETs according to tumor location.

Thirty-three patients diagnosed with gastric SETs via EUS-FNTA from January 2016 to May 2018 were analyzed retrospectively. Patient demographics, diagnostic yields, and complications were evaluated.

Nineteen patients (57.6%) were female, with a mean age of 57.7 years. Endoscopic ultrasound revealed a mean longitudinal diameter of 25.6 mm. The most common location of SETs was in the gastric body (n = 18, 54.5%), followed by cardia and fundus (n = 10, 30.3%), and antrum (n = 5, 15.2%). A 20-gauge biopsy needle was most frequently used (90.9%). The diagnostic yield was obtained in 23 patients (69.7%). The most common diagnosis was gastrointestinal stromal tumor (73.9%), followed by leiomyoma (17.4%). The diagnostic yield of SETs in gastric antrum (0/5, 0%) was significantly lower than that in the gastric body and cardia (23/28, 82.1%, P = .001). A case of immediate bleeding after EUS-FNTA occurred in 1 patient (3.0%) who recovered uneventfully. According to related literature, the overall diagnostic yield of SETs in gastric antrum was significantly lower than that in the gastric body, fundus, and cardia (29.7% vs 71.4%, P < .001, n = 191).

EUS-FNTA is ineffective in the diagnosis of SETs in the gastric antrum. Although EUS-FNTA is an advanced diagnostic tool for gastric SETs, it is essential to develop more effective methods for the diagnosis of antral SETs.
Long-term stable efficacy of botulinum toxin A in facial movement disorders with no need for increasing dose
Authors: Badarny Samih , Ibrahim Raphiq , Susel Zvi , Zaina Adnan , Nasar Rema , Badarny Yazid
Published: June 2021

Botulinum toxin A is considered an effective treatment for involuntary facial movements. We examined whether treatment efficacy maintained or changed over time with two products, Botox and Dysport, in patients with hemifacial spasm, facial synkinesis and benign essential blepharospasm.

We retrospectively investigated 87 consecutive patients (51 women, 36 men) who had undergone treatment for ≥6 years. Long-term effects, as well as side effects of Botox or Dysport local injections were evaluated. The first three treatments were considered the titration period and not taken into account when testing for dose changes.

Mean treatment duration was 10 years (range 6–11, SD 1.0), 2441 treatments were administered, 1162 with Botox and 1279 with Dysport, the two brands were interchanged as needed. Good to full improvement was seen in 90% of patients both with both brands. Injection doses and treatment responses were consistent during the study with both drugs. No major side effects were reported, and relatively few minor adverse events were reported, with clear reduction from the titration period (6.1%), to the remainder of the study (3.9%).

Botulinum toxin (BTX-A) is a satisfactory long-term treatment without need for dose increase over. Both Botox and Dysport were effective when used interchangeably.
Calculus-related functional protein expression in ureteral calculus-adhered polyp
Authors: Li Mingjie , Zhang Heng , Jiang Deqi , Li Lihua , Liu Xia , Zhao Xiaoxiao , Ye Dandan , Ni Yongliang
Published: June 2021

To explore the expressions of calculus-related functional proteins in the ureteral calculus-adhered polyp tissues and investigate the role of these proteins in the formation of adhesions between the calculus and polyp.

Patients with ureteral calculi and polyps who underwent ureteroscopic lithotripsy for the excision of polyps between January 2019 and June 2019 were enrolled. Polyps obtained from each patient were divided into 2 groups using a matched pairs design: observation group (polyps adhered to calculus) and control group (polyps not adhered to calculus). Histopathological examination of polyps was performed using hematoxylin and eosin staining. Polyp tissues were immunohistochemically stained to assess the expressions of calculus-related functional proteins, that is, annexin A1, calcium-binding protein S100A9 (S100A9), uromodulin, and osteopontin. Furthermore, quantitative analysis was performed using the H-score of tissue staining; Pearson correlation analysis was performed for proteins with high expression.

Overall, 40 polyp specimens were collected from 20 patients with ureteral calculi combined with polyps (observation group, 20 specimens; control group, 20 specimens). Hematoxylin and eosin staining revealed obvious epithelial cell proliferation in polyps of both groups; crystals were observed in the epithelial cells of the polyp tissue in the observation group. The expression levels of annexin A1 and S100A9 in the observation group were significantly greater than those in the control group (P < .05). However, no obvious expression of osteopontin or uromodulin was observed in the polyp tissues of both groups. There was a strong correlation between the increased expressions of annexin A1 and S100A9 in the observation group (R = 0.741, P = .022).

We documented increased expressions of annexin A1 and S100A9 in the ureteral calculus-adhered polyp tissues. Annexin A1 and S100A9 may play an essential role in the adhesion of calculus and polyp and the growth of calculi.
Improving Screening for Social Determinants of Health in a Pediatric Resident Clinic: A Quality Improvement Initiative
Authors: Friedman Suzanne , Caddle Steve , Motelow Joshua E. , Meyer Dodi , Lane Mariellen
Published: June 2021

Introduction:

Social determinants of health (SDOH) account for 80% of modifiable factors in a population’s health. Addressing SDOH in a healthcare setting can improve care, patient experience, health outcomes, and decrease cost. Therefore, screening for SODH in the pediatric setting has become an essential and evidence-based component of pediatric preventative care. Multiple barriers exist for its implementation, particularly for trainees.

Methods:

Using resident-driven quality improvement (QI) methodology, we aimed to increase SDOH screening to >90% for 9 individual questions at newborn and 1-year well visits and completely screen for all 9 questions at more than 40% of visits. Parents were provided with a paper screening form upon arrival to be completed before visits. We performed tests of change to improve distribution, documentation, and quality of interventions.

Results:

The primary outcome of complete screening for all 9 questions increased from 24% to 43% at newborn visits and 28% to 83% at 1-year visits. Screenings that identified at least 1 need increased from 8% to 19%, with provider response to an identified need increasing from 20% to 40%. These metrics were the secondary outcome measures.

Conclusions:

The use of parent completed paper screening forms improved SDOH screening, documentation, and interventions by residents and faculty.
Better Etiquette for Effective Paging (B.E.E.P.)—Improving Daily In-hospital Communications in the Pediatric ICU
Authors: Chandnani Harsha K. , Fujimoto Shana , Wilson Michele , Fluitt Julie , Jones Janae , Dehom Salem , Tinsley Cynthia , Lopez Merrick
Published: June 2021

Introduction:

Paging is a vital part of patient care that allows quick contact between physicians and other hospital personnel. There was no structured way to send a page to physicians at our institution. We hypothesized that by standardizing paging format, scheduling laboratory draw times, and using order clean-up sheets, through a bundle of interventions called Better Etiquette for Effective Paging, we would decrease the number of pages received on the pediatric intensive care unit (PICU) resident pager by 15%.

Methods:

This project was a quality improvement initiative in a 25-bed multidisciplinary PICU in a tertiary children’s hospital. Baseline data collection was performed in December 2015, categorized by time of day received and type of page. Interventions were paging standards to include relevant information, scheduling laboratory draw times, and order clean-up sheets. We collected postintervention data over 3 years to monitor for sustained change.

Results:

The average number of pages decreased from a baseline of 4.71 pages/patient/d in 2015 to 3.70 in 2016 (21% decrease), 3.32 in 2017 (30% decrease), and 2.74 in 2018 (42% decrease). The average PRISM 3 score remained similar in all sets (2.52, 2.50, 2.10, and 2.35). The standardized mortality ratio was not adversely affected by the decrease in pages (0.58, 1.07, 1.19, and 0).

Conclusion:

Standardizing the format of pages and using scheduled laboratory times with order clean-up sheets has decreased the number of pages/patient/d in the PICU by 42% without adversely affecting patient care. We can continue to improve communication among the patient care team by emphasizing efficient, standardized communication using Better Etiquette for Effective Paging.
Healthcare Worker Serious Safety Events: Applying Concepts from Patient Safety to Improve Healthcare Worker Safety
Authors: Foster Christine , Doud Lauren , Palangyo Tua , Wood Matthew , Majzun Rick , Bargmann-Losche Jessey , Donnelly Lane F.
Published: June 2021

Introduction:

Patient safety has improved pediatric healthcare by defining when patient safety events meet criteria as serious safety events (SSEs). Similar concepts apply to healthcare worker (HCW) safety. We describe the newly designed process for HCW injury reporting, the process for evaluating HCW SSEs, and early experience with the new systems.

Methods:

The work to redesign our approach to HCW safety included 2 parts: (1) process flow mapping and redesigning the work for HCW injury reporting; and (2) creating a process to categorize HCW injuries and determine when such injuries rise to a HCW SSE level. We evaluated the mean time per month from HCW injury to reporting and compared those values during the postimplementation time. We also evaluated the team’s experience with the first 4 potential HCW SSEs.

Results:

By improving the process flow, the mean time to reporting decreased significantly from 28 days implementation time-period (September–October 2019) to 9 days during the postimplementation time-period (November 2019–May 2020) (P = 0.0002). Of the first 4 HCW events identified and reviewed as possible HCW SSE events, there were 2 defined as HCW SSE level 4, one defined as a precursor event, and one defined as a nonsafety event.

Conclusion:

Adapting infrastructure and definitions used previously to improve patient safety can improve HCW safety.
Gene duplication and subsequent diversification strongly affect phenotypic evolvability and robustness
Authors: Jouffrey V. , Leonard A. S. , Ahnert S. E.
Published: June 2021

We study the effects of non-determinism and gene duplication on the structure of genotype–phenotype (GP) maps by introducing a non-deterministic version of the Polyomino self-assembly model. This model has previously been used in a variety of contexts to model the assembly and evolution of protein quaternary structure. Firstly, we show the limit of the current deterministic paradigm which leads to built-in anti-correlation between evolvability and robustness at the genotypic level. We develop a set of metrics to measure structural properties of GP maps in a non-deterministic setting and use them to evaluate the effects of gene duplication and subsequent diversification. Our generalized versions of evolvability and robustness exhibit positive correlation for a subset of genotypes. This positive correlation is only possible because non-deterministic phenotypes can contribute to both robustness and evolvability. Secondly, we show that duplication increases robustness and reduces evolvability initially, but that the subsequent diversification that duplication enables has a stronger, inverse effect, greatly increasing evolvability and reducing robustness relative to their original values.
Topological analysis of differential effects of ketamine and propofol anaesthesia on brain dynamics
Authors: Varley Thomas F. , Denny Vanessa , Sporns Olaf , Patania Alice
Published: June 2021

Research has found that the vividness of conscious experience is related to brain dynamics. Despite both being anaesthetics, propofol and ketamine produce different subjective states: we explore the different effects of these two anaesthetics on the structure of dynamic attractors reconstructed from electrophysiological activity recorded from cerebral cortex of two macaques. We used two methods: the first embeds the recordings in a continuous high-dimensional manifold on which we use topological data analysis to infer the presence of higher-order dynamics. The second reconstruction, an ordinal partition network embedding, allows us to create a discrete state-transition network, which is amenable to information-theoretic analysis and contains rich information about state-transition dynamics. We find that the awake condition generally had the ‘richest’ structure, visiting the most states, the presence of pronounced higher-order structures, and the least deterministic dynamics. By contrast, the propofol condition had the most dissimilar dynamics, transitioning to a more impoverished, constrained, low-structure regime. The ketamine condition, interestingly, seemed to combine aspects of both: while it was generally less complex than the awake condition, it remained well above propofol in almost all measures. These results provide deeper and more comprehensive insights than what is typically gained by using point-measures of complexity.
Differential invariant method for seeking nonlocally related systems and nonlocal symmetries. II: Connections with the conservation law method
Authors: Bluman George W. , de la Rosa Rafael , Santos Bruzón María , Luz Gandarias María
Published: June 2021

In this paper, we show direct connections between the conservation law (CL)-based method and the differential invariant (DI)-based method for obtaining nonlocally related systems and nonlocal symmetries for a given partial differential equation (PDE) system. For a PDE system with two independent variables, we show that the CL method is a special case for the DI method. For a PDE system with at least three independent variables, we show that the CL method, for a curl-type CL, is a special case for the DI method. We also consider the situation for a self-adjoint, i.e. variational, linear PDE system. Here, a solution of the linear PDE system yields a nonlocally related system for both approaches. In particular, the resulting nonlocally related systems need not be invertibly equivalent. Through an example, we show that three distinct nonlocally related systems can be obtained from an admitted point symmetry.
Doublesexmediates species-, sex-, environment- and trait-specific exaggeration of size and shape
Authors: Rohner Patrick T. , Linz David M. , Moczek Armin P.
Published: June 2021

Context-dependent trait exaggeration is a major contributor to phenotypic diversity. However, the genetic modifiers instructing development across multiple contexts remain largely unknown. We use the arthropod tibia, a hotspot for segmental differentiation, as a paradigm to assess the developmental mechanisms underlying the context-dependent structural exaggeration of size and shape through nutritional plasticity, sexual dimorphism and segmental differentiation. Using an RNAseq approach in the sexually dimorphic and male-polyphenic dung beetleDigitonthophagus gazella, we find that only a small portion (3.7%) of all transcripts covary positively in expression level with trait size across contexts. However, RNAi-mediated knockdown of the conserved sex-determination genedoublesexsuggests that it functions as a context-dependent master mediator of trait exaggeration inD. gazellaas well as the closely related dung beetleOnthophagus taurus. Taken together, our findings suggest (i) that the gene networks associated with trait exaggeration are highly dependent on the precise developmental context, (ii) thatdoublesexdifferentially shapes morphological exaggeration depending on developmental contexts and (iii) that this context-specificity ofdsx-mediated trait exaggeration may diversify rapidly. This mechanism may contribute to the resolution of conflict arising from environment-dependent antagonistic selection among sexes and divergent developmental contexts in a wide range of animals.
Hosts elevate either within-clutch consistency or between-clutch distinctiveness of egg phenotypes in defence against brood parasites
Authors: Caves Eleanor M. , Dixit Tanmay , Colebrook-Robjent John F. R. , Hamusikili Lazaro , Stevens Martin , Thorogood Rose , Spottiswoode Claire N.
Published: June 2021

In host–parasite arms races, hosts can evolve signatures of identity to enhance the detection of parasite mimics. In theory, signatures are most effective when within-individual variation is low (‘consistency’), and between-individual variation is high (‘distinctiveness’). However, empirical support for positive covariation in signature consistency and distinctiveness across species is mixed. Here, we attempt to resolve this puzzle by partitioning distinctiveness according to how it is achieved: (i) greater variation within each trait, contributing to elevated ‘absolutedistinctiveness’ or (ii) combining phenotypic traits in unpredictable combinations (‘combinatorialdistinctiveness’). We tested how consistency covaries with each type of distinctiveness by measuring variation in egg colour and pattern in two African bird families (Cisticolidae and Ploceidae) that experience mimetic brood parasitism. Contrary to predictions, parasitized species, but not unparasitized species, exhibited a negative relationship between consistency and combinatorial distinctiveness. Moreover, regardless of parasitism status, consistency was negatively correlated with absolute distinctiveness across species. Together, these results suggest that (i) selection from parasites acts on how traits combine rather than absolute variation in traits, (ii) consistency and distinctiveness are alternative rather than complementary elements of signatures and (iii) mechanistic constraints may explain the negative relationship between consistency and absolute distinctiveness across species.
Vertically migrating
Isoxys
and the early Cambrian biological pump
Authors: Pates Stephen , Daley Allison C. , Legg David A. , Rahman Imran A.
Published: June 2021

The biological pump is crucial for transporting nutrients fixed by surface-dwelling primary producers to demersal animal communities. Indeed, the establishment of an efficient biological pump was likely a key factor enabling the diversification of animals over 500 Myr ago during the Cambrian explosion. The modern biological pump operates through two main vectors: the passive sinking of aggregates of organic matter, and the active vertical migration of animals. The coevolution of eukaryotes and sinking aggregates is well understood for the Proterozoic and Cambrian; however, little attention has been paid to the establishment of the vertical migration of animals. Here we investigate the morphological variation and hydrodynamic performance of the Cambrian euarthropod
Isoxys
. We combine elliptical Fourier analysis of carapace shape with computational fluid dynamics simulations to demonstrate that
Isoxys
species likely occupied a variety of niches in Cambrian oceans, including vertical migrants, providing the first quantitative evidence that some Cambrian animals were adapted for vertical movement in the water column. Vertical migration was one of several early Cambrian metazoan innovations that led to the biological pump taking on a modern-style architecture over 500 Myr ago.
Wavelength-dependent effects of artificial light at night on phytoplankton growth and community structure
Authors: Diamantopoulou Christina , Christoforou Eleni , Dominoni Davide M. , Kaiserli Eirini , Czyzewski Jakub , Mirzai Nosrat , Spatharis Sofie
Published: June 2021

Artificial light at night (ALAN) is a disruptive form of pollution, impacting physiological and behavioural processes that may scale up to population and community levels. Evidence from terrestrial habitats show that the severity and type of impact depend on the wavelength and intensity of ALAN; however, research on marine organisms is still limited. Here, we experimentally investigated the effect of different ALAN colours on marine primary producers. We tested the effect of green (525 nm), red (624 nm) and broad-spectrum white LED ALAN, compared to a dark control, on the green microalgaeTetraselmis suecicaand a diatom assemblage. We show that green ALAN boosted chlorophyll production and abundance inT. suecica. All ALAN wavelengths affected assemblage biomass and diversity, with red and green ALAN having the strongest effects, leading to higher overall abundance and selective dominance of specific diatom species, some known to cause harmful algal blooms. Our findings show that green and red ALAN should be used with caution as alternative LED colours in coastal areas, where there might be a need to strike a balance between the effects of green and red light on marine primary producers with the benefit they appear to bring to other organisms.