bluuebunny/crossref_metadata_2025 huggingface dataset:
Current status of the assessment of sarcopenia, frailty, physical performance and functional status in chronic kidney disease patients
Authors: Otobe Yuhei , Rhee Connie M. , Nguyen Matthew , Kalantar-Zadeh Kamyar , Kopple Joel D.
Published: November 2021

Purpose of review

Low physical function, frailty, and sarcopenia are common complications of chronic kidney disease (CKD). In this article, we review the epidemiology and pathogenesis of low physical function, as well as its associations with adverse outcomes in CKD patients. Additionally, we present various traditional and novel methods for assessment of physical function in CKD patients.

Recent findings

In nondialysis dependent (NDD) and dialysis-dependent CKD patients, the prevalence of low physical function, frailty, and sarcopenia are substantially higher than in the general population. The potential mechanisms of low physical function, frailty, and sarcopenia in CKD patients are due to various factors including underlying kidney disease, co-existing comorbidities, and certain therapeutic interventions utilized in CKD. Increasing evidence has also uncovered the ill effects of impaired physical function on clinical outcomes in CKD patients.

Routine assessment of physical function is an under-utilized yet important component in the management of CKD patients. Future studies are needed to determine how prescription of exercise and increased daily physical activity can be tailored to optimize the health and well-being of NDD and dialysis-dependent CKD patients in pursuit of successful aging.
Novel monitoring of renal function and medication levels in saliva and capillary blood of patients with kidney disease
Authors: Beshay Manal , Rhee Connie M. , Kalantar-Zadeh Kamyar
Published: November 2021

Purpose of review

Serum creatinine, urea, and cystatin C are the main biomarkers used to estimate glomerular filtration rates in persons with and without chronic kidney disease (CKD). Frequent measurements of these assays are needed to identify patients with earlier stages of CKD, detect episodes of acute kidney injury (AKI), and monitor for CKD progression. However, the cumbersome, time-consuming nature of conventional laboratory-based kidney function assays limit more frequent monitoring and greater patient self-management.

Recent findings

Noninvasive salivary assessments of creatinine, cystatin C, and urea make it feasible to conduct frequent monitoring of kidney function in point-of-care settings, as well as in nonclinical-care settings such as at home. Additionally, fingerstick sampling can offer an alternative route of blood testing that is suitable for home-based assessments. In this review, we provide an overview of emerging data on various salivary vs. fingerstick blood assessment methods for kidney function; their accuracy in comparison to ‘gold-standard’ laboratory-based methods; and their respective strengths and limitations in the clinical setting.

A practical, cost-effective, minimally invasive, multimarker assessment platform has the potential to circumvent the limitation of conventional laboratory blood-based testing approaches, and thereby address a major unmet need in the management of CKD patients.
Management of stage I testicular cancer
Authors: Padayachee Jerusha , Clark Roderick , Warde Padraig , Hamilton Robert J.
Published: November 2021

Purpose of review

Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications.

Recent findings

At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into minimizing toxicities of treatments for relapse, and in particular, retroperitoneal lymph node dissection (RPLND) presents an attractive alternative. This, though, remains investigational in the setting of seminoma.

Testicular cancer is a highly curable malignancy. In stage I disease, an active surveillance approach following radical orchiectomy is preferred, irrespective of risk-profile. This approach serves to limit the toxicity of adjuvant treatment in a significant proportion of patients, while maintaining excellent survival outcomes.
Dietary Guidelines for Americans, 2020–2025
Authors: Snetselaar Linda G. , de Jesus Janet M. , DeSilva Dana M. , Stoody Eve E.
Published: November 2021

The Dietary Guidelines for Americans, 2020–2025 was issued jointly by the US Departments of Agriculture and of Health and Human Services in December 2020. It is the ninth edition of the Dietary Guidelines and is the first to provide recommendations by life stage, from birth to older adulthood. The Dietary Guidelines is grounded in the current body of scientific evidence on diet and health outcomes and aims to promote health and prevent chronic diseases. The process to develop the Dietary Guidelines involved 4 steps: (1) identifying the topics and supporting scientific questions, (2) appointing a Dietary Guidelines Advisory Committee (Committee) to review current scientific evidence, (3) developing the new edition of the Dietary Guidelines, and (4) implementing the Dietary Guidelines. The 2020-2025 edition provides 4 overarching guidelines and supporting key recommendations that encourage healthy dietary patterns across the life span. The foods and beverages that people consume have a profound impact on health, and it is never too late or too early to eat healthfully.
Non-Alcoholic Fatty Liver Disease (NAFLD) and Nutrition
Authors: Craven Kay , Clement Donna , Brewster Caroline T. , Messenger Jamie , Kolasa Kathryn M.
Published: November 2021

Nonalcoholic fatty liver disease is defined as an excess accumulation of fat in the liver in patients with little or no history of alcohol consumption. It is considered difficult to identify and treat in this early, reversible stage and is strongly associated with obesity, insulin resistance (including type 2 diabetes mellitus), metabolic syndrome, and dyslipidemia. The prevalence in both adults and children is increasing. Treatment guidelines from around the world agree that weight loss is the first line of treatment. We discuss diet-related therapies including weight loss and with a special focus on the Mediterranean diet. We present a case from our family medicine practice to demonstrate how evidence-based medical nutrition therapy, along with prescription medication to assist in weight management, can be used to help adult patients with nonalcoholic fatty liver disease. We also comment on recommended treatment for pediatric patients.
Gentamicin Susceptibility in Neisseria gonorrhoeae and Treatment Outcomes for Urogenital Gonorrhea After 25 Years of Sustained Gentamicin Use in Malawi
Authors: Matoga Mitch , Chen Jane S. , Krysiak Robert , Ndalama Beatrice , Massa Cecilia , Bonongwe Naomi , Mathiya Esther , Kamtambe Blessing , Jere Edward , Chikaonda Tarsizio , Golparian Daniel , Unemo Magnus , Cohen Myron S. , Hobbs Marcia M. , Hoffman Irving F.
Published: November 2021

Background

Gentamicin has been used for the treatment of gonorrhea in Malawi since 1993. However, declining clinical cure rates have been suspected. We evaluated current Neisseria gonorrhoeae susceptibility to gentamicin in vitro and clinically.

Methods

Men with acute urethritis were recruited at the Bwaila District Hospital STI Clinic in Lilongwe, Malawi, between January 2017 and August 2019. All men provided urethral swabs for etiological testing at enrollment and test of cure (TOC), 1 week later, using Gram-stained microscopy and culture. We used Etest to determine minimum inhibitory concentrations (MICs) of gentamicin, azithromycin, cefixime, ceftriaxone, ciprofloxacin, and spectinomycin; disc diffusion for tetracycline susceptibility; and whole-genome sequencing (WGS) to verify/refute treatment failure.

Results

Among 183 N. gonorrhoeae culture-positive men enrolled, 151 (82.5%) had a swab taken for TOC. Of these 151 men, 16 (10.6%) had a positive culture at TOC. One hundred forty-one baseline isolates were tested for gentamicin susceptibility using Etest: 2 (1.4%), MIC = 2 μg/mL; 111 (78.7%), MIC = 4 μg/mL; and 28 (19.9%), MIC = 8 μg/mL. All isolates were susceptible to azithromycin, cefixime, ceftriaxone, and spectinomycin, whereas 63.1% had intermediate susceptibility or resistance to ciprofloxacin. Almost all (96.1%) isolates were resistant to tetracycline. All examined isolates cultured at TOC (n = 13) had gentamicin MICs ≤8 μg/mL. Ten men had pretreatment and posttreatment isolates examined by whole-genome sequencing; 2 (20%) were verified new infections (4119 and 1272 single-nucleotide polymorphisms), whereas 8 (80%) were confirmed treatment failures (0–1 single-nucleotide polymorphism).

Conclusions

Gentamicin MICs poorly predict gonorrhea treatment outcome with gentamicin, and treatment failures are verified with gonococcal strains with in vitro susceptibility to gentamicin. The first-line treatment of gonorrhea in Malawi should be reassessed.
Digital Scarlet Letters: Sexually Transmitted Infections in the Electronic Medical Record
Authors: Bennett Sarah , Newman-Griffis Denis R. , Beach Mary Catherine , Gross Marielle
Published: November 2021

The harms of implicit bias in clinical settings are acknowledged but poorly understood and difficult to overcome. We discuss how structural components of electronic medical record (EMR) user interfaces may contribute to sex and gender-based discrimination against patients via constant, duplicative presentation of stigmatizing sexually transmitted infection (STI) data irrespective of clinical significance. Via comparison with symbolism and representative quotes in Hawthorne's 1850 novel The Scarlet Letter, we propose a metaphor to examine how EMRs function as a platform for moral judgment, which may display an indelible “scarlet letter” for pregnant patients with STI history. We consider whether current depictions of STIs in EMRs are structurally unjust and may contribute to biased treatment by directing attention to violations of hegemonic sex/gender norms regarding sexual behavior and thus triggering moral judgments of maternal fitness. We conclude with recommendations for how to address these challenges to improve ethical stewardship of sensitive sexual/reproductive health data.
Partner Seeking and Sexual Behavior in the United States During the COVID-19 Pandemic, March 2020 to March 2021
Authors: Rushmore Julie , Copen Casey E. , Schneider John , Lamuda Phoebe S.M. , Taylor Bruce G. , Kirkcaldy Robert D. , Bernstein Kyle T.
Published: November 2021

We examined partner seeking and sexual behaviors among a representative sample of US adults (n = 1161) during the first year of the COVID-19 pandemic. Approximately 10% of survey respondents sought a new partner, with age and sexual identity being associated with partner seeking behavior. Approximately 7% of respondents had sex with a new partner, which marks a decrease as compared with a prepandemic estimate from 2015 to 2016 in which 16% of US adults reported having sex with a new partner during the past year. Among respondents who had in-person sex with a new partner during the first year of the pandemic, public health guidelines for in-person sexual activity were infrequently followed.
The Association Between Initial Serum Bicarbonate Levels and the Management of Dehydrated Children in the Emergency Department
Authors: Moustafa Moustafa , Sawaya Rasha D. , Lakissian Zavi , Sharara-Chami Rana
Published: November 2021

Objectives

There is no consensus in the current literature on the relevance of serum bicarbonate levels, cutoff benchmarks and the management of dehydration; therefore, this study aims to explore whether an association can be established between initial serum bicarbonate levels and the subsequent management of children between the ages of 0 to 36 months presenting to the emergency department (ED) with dehydration.

Methods

The study is a single center, retrospective review of 335 charts of children between 0 and 36 months of age presenting to the ED of an urban academic tertiary hospital between June 2014 and June 2016 with a medical history suggestive of dehydration and documented serum bicarbonate levels during their visits.

Results

A total of 310 charts were analyzed. No significant difference was found between mean serum bicarbonate levels of admitted and discharged patients (18.82 mmol/L vs 18.75 mmol/L; P = 0.89). Children with serum bicarbonate levels below 15 mmol/L were significantly more likely to receive a fluid bolus (P = 0.00) in the ED but neither the length of stay in the ED (P = 0.07) nor in the hospital (P = 0.41) was affected. Bounce backs within 7 days of discharge were not associated with serum bicarbonate levels at first presentation, but rather with a shorter duration of diarrhea (P = 0.013).

Conclusions

Initial serum bicarbonate level of dehydrated children does not appear to be associated with the severity of dehydration, vomiting, diarrhea and the patients' management in the ED or the hospital. Initial serum bicarbonate is associated with the decision to administer fluid boluses and potential bounce back.
Variability in Point-of-Care Lung Ultrasound Findings in Pediatric COVID-19 Patients
Authors: Lee Thomas , Goldberg Bradley , Pade Kathryn , Uya Atim , Cohen Stephanie , Bergmann Kelly , Abulfaraj Maher , Lam Samuel H. F. , Elkhunovich Marsha
Published: November 2021

Point-of-care ultrasound (POCUS) has been described as a useful tool for identification of coronavirus disease 2019 (COVID-19) in adults and children. Although several case reports describe POCUS findings in children with COVID-19, to our knowledge, there have been no published multicenter case series describing the large heterogeneity in lung POCUS findings in pediatric COVID-19. This series includes 7 symptomatic patients with COVID-19 who had a lung POCUS performed at 6 institutions by pediatric emergency attendings and fellows. The findings were variable, ranging from no findings to the appearance of B-lines, pleural abnormalities, consolidations, and a pleural effusion. Further studies are needed to improve our understanding, characterization, and prognostic correlation of POCUS findings in this novel disease in children.
HPV42-associated Seborrhoeic Keratosis-like Lesion of the Cervix: First Reported Case With High-grade Morphology
Authors: Talia Karen L. , Rahimi Siavash , Hawkes David , McCluggage W. Glenn
Published: November 2021

Seborrheic keratosis-like lesion (SKLL) is an extremely rare, morphologically distinct lesion occurring in the cervix and vagina that differs histologically from usual squamous intraepithelial lesions in these sites, by bearing close resemblance to cutaneous seborrheic keratosis and lacking koilocytosis. Like many vulvar seborrheic keratoses, which are associated with low-risk human papillomavirus (HPV), an association between SKLL and low-risk HPV is suggested based on the identification of HPV42, regarded as a low-risk genotype, in 4 of 8 reported cases. We report a further HPV42-associated SKLL of the cervix which differs from the previously reported cases by the presence of high-grade morphology and block-type p16 immunoreactivity. This novel finding challenges the classification of HPV42 as a low-risk genotype and expands the reported morphologic spectrum of SKLL, suggesting that they may not always be clinically indolent.
p53/CK17 Dual Stain Improves Accuracy of Distinction Between Differentiated Vulvar Intraepithelial Neoplasia and Its Mimics
Authors: McMullen-Tabry Emily R. , Schechter Shula A. , Wang Grace Y. , Sciallis Andrew P. , Hrycaj Steven M. , Chan May P. , Skala Stephanie L.
Published: November 2021

Accurate diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) is challenging, in part due to the sometimes subtle nature of its atypia. Many dVIN lesions demonstrate aberrant p53 staining; however, staining patterns overlap between dVIN and benign/reactive entities. We evaluate a p53/CK17 dual stain in an initial cohort of dVIN (n=30), benign vulvar skin (n=5), lichen sclerosus (LS, n=10), lichen simplex chronicus (LSC, n=10), and pseudoepitheliomatous hyperplasia (PEH, n=10). In the initial cohort, aberrant p53 staining was seen only in dVIN (50%, 15/30). Equivocal p53 staining patterns were seen in dVIN (37%, 11/30), LS (50%, 5/10), LSC (40%, 4/10), and PEH (40%, 4/10). All 30 dVIN cases were positive for CK17 (strong partial-thickness or full-thickness staining), but positive CK17 staining was also seen in LS (70%, 7/10), LSC (50%, 5/10), and PEH (100%, 10/10). In the initial cohort, the combination of aberrant p53 and positive CK17 was seen only for dVIN (50%, 15/30). Forty cases of LS with known follow-up (20 with progression to dVIN, 20 without) were stained to assess prognostic value. Three LS cases showed aberrant p53 staining with CK17 positivity; all progressed to dVIN. Equivocal p53 staining and CK17 positivity were seen in cases with and without progression. The p53/CK17 dual stain is more diagnostically useful than either stain alone. Negative/focal staining for CK17 argues against a diagnosis of dVIN, while aberrant p53 staining with CK17 positivity strongly supports the diagnosis.
Effects of a modified passive socket system on short-term changes in residuum volume and comfort: A preliminary study in transtibial amputees
Authors: Atallah Huthaifa , Kenney Laurence , Howard David , Liu Anmin , Head John
Published: November 2021

Background:

Changes in residuum volume are a common problem in lower-limb amputees during prosthesis usage, and can lead to poor suspension, impaired gait, and tissue damage. Residuum volume can be affected by the in-socket air pressure, which will influence fluid flow in and around the residuum. The use of “active” pumps to reduce air pressure has been shown to conserve the residuum volume, but these are expensive and unlikely to be widely available. An alternative, passive approach, based on Boyles' law, is to introduce a larger distal void volume at the end of the socket and hence reduce the change in pressure for a given change in volume.

Objectives:

To compare the performance across three test conditions (passive—conventional, with standard distal void; passive—with increased distal void; and active system) in terms of residuum volume changes and comfort.

Study design:

Repeated-measures experiment under three test conditions.

Methods:

Five transtibial amputee participants (three males and two females), aged between 27 and 67 years, and of mobility grade K2 or K3, were fitted with a bespoke test prosthesis that was adapted to include the three test conditions. Residuum volume was measured before and after walking under each test condition (presented in a random order). Comfort was also assessed after walking with each test condition.

Results:

The reduction in residuum volume, relative to the baseline volume, was higher for the conventional passive system (4.2% ± 2.8%) compared with the modified passive (1.4% ± 1.4%) and active (1.6% ± 1.1%) systems.

Conclusion:

The use of a passive suspension system with an increased distal void within the socket may help to stabilize the residuum volume during prosthesis usage.
3D-printed prostheses in developing countries: A systematic review
Authors: Abbady Hnady E.M.A. , Klinkenberg Edwin T.M. , de Moel Lisanne , Nicolai Noa , van der Stelt Merel , Verhulst Arico C. , Maal Thomas J.J. , Brouwers Lars
Published: November 2021

Background:

According to the World Health Organization, only 5%–15% of people in lower-income countries have access to prostheses. This is largely due to low availability of materials and high costs of prostheses. 3D-printing techniques have become easily accessible and can offer functional patient-specific components at relatively low costs, reducing or bypassing the current manufacturing and postprocessing steps. However, it is not yet clear how 3D-printing can provide a sustainable solution to the low availability of limb prostheses for patients with amputations in lower-income countries.

Objective:

To evaluate 3D-printing for the production of limb prostheses in lower-income countries and lower–middle-income countries (LLMICs).

Study design:

Systematic Review.

Methods:

Literature searches, completed in April 2020, were performed in PubMed, Embase, Web of Science, and Cochrane Library. The search results were independently screened and reviewed by four reviewers. Only studies that examined interventions using prostheses in LLMICs for patients with limb amputations were selected for data extraction and synthesis. The web was also searched using Google for projects that did not publish in a scientific journal.

Results:

Eighteen studies were included. Results were reported regarding country of use, cost and weight, 3D-printing technology, satisfaction, and failure rate.

Conclusion:

Low material costs, aesthetic appearance, and the possibility of personalized fitting make 3D-printed prostheses a potential solution for patients with limb amputations in LLMICs. However, the lack of (homogeneous) data shows the need for more published (scientific) research to enable a broader availability of knowledge about 3D-printed prostheses for LLMICs.
Integrating a Transdiagnostic Psychological Intervention Into Routine HIV Care: A Mixed-Methods Evaluation of the Common Elements Treatment Approach in Mozambique
Authors: Fabian Katrin E. , Muanido Alberto , Cumbe Vasco F. J. , Mukunta Chombalelo , Manaca Nelia , Dorsey Shannon , Hammett Wilson H. , Wagenaar Bradley H.
Published: November 2021

Introduction:

We integrated a transdiagnostic psychological intervention (Common Elements Treatment Approach [CETA]) into routine HIV care in Sofala, Mozambique. This task-shared program screens and treats newly diagnosed HIV+ patients with comorbid mental health symptoms.

Methods:

A mixed-methods evaluation included demographics, intake screening scores, mental health symptoms, and barriers/facilitators to implementation examined through interviews. Multilevel models were used to analyze factors associated with symptom improvement and loss to follow-up (LTFU).

Results:

From March 2019 to June 2020, 820 individuals were screened for CETA treatment; 382 (46.6%) showed clinically significant mental health symptoms and attended 1484 CETA sessions. Of CETA patients, 71.5% (n = 273/382) had general mental distress, 7.3% (n = 28) had alcohol abuse/dependence, 12.0% (n = 46) had suicidal ideation, and 3.7% (n = 14) had other violent ideation; 66.2% (n = 253) had experienced at least 1 traumatic event at intake. Mental health symptoms decreased by 74.1% (17.0 to 4.4) after 5 CETA sessions, and 37.4% of patients (n = 143) achieved a ≥50% symptom reduction from intake. LTFU was 29.1% (n = 111), but 59.5% of LTFU patients (n = 66) achieved a ≥50% symptom reduction before LTFU. Facilitators for CETA implementation included readiness for change given the unaddressed burden of mental illness. Barriers included complexity of the intervention and stigma.

Conclusions:

Approximately 45% of newly diagnosed HIV+ individuals in Mozambique have clinically significant mental health symptoms at diagnosis. Integrating CETA into routine HIV platforms has in-context feasibility. Future implementation studies can optimize strategies for patient retention and scale-up.
Human Trafficking in Rehabilitation: What Nurses Need to Know
Authors: Franklin Melissa I. , Koszalinski Rebecca S.
Published: November 2021

Violence and human trafficking are frequently paired and violate human rights. Human trafficking is a complex, global health issue. Trafficking survivors report seeking medical care for women’s services, physical abuse, mental health, and gastrointestinal issues while being held in captivity. However, the majority of healthcare providers are unaware or unprepared to intervene, thus missing the chance to identify victims during these encounters. Rehabilitation nurses are no exception. Trafficking victims may come in contact with rehabilitation nurses because of injuries or chronic diseases caused by trafficking abuse. This article shares human trafficking red flags, victims’ access to services, barriers to identification, and nursing interventions and implications.
Trends in Distal Esophageal and Gastroesophageal Junction Cancer Care
Authors: Kalff Marianne C. , van Berge Henegouwen Mark I. , Baas Peter C. , Bahadoer Renu R. , Belt Eric J. T. , Brattinga Baukje , Claassen Linda , Ćosović Admira , Crull David , Daams Freek , van Dalsen Annette D. , Dekker Jan Willem T. , van Det Marc J. , Drost Manon , van Duijvendijk Peter , Eshuis Wietse J. , van Esser Stijn , Gaspersz Marcia P. , Görgec Burak , Groenendijk Richard P. R. , Hartgrink Henk H. , van der Harst Erwin , Haveman Jan Willem , Heisterkamp Joos , van Hillegersberg Richard , Kelder Wendy , Kingma B. Feike , Koemans Willem J. , Kouwenhoven Ewout A. , Lagarde Sjoerd M. , Lecot Frederik , van der Linden Philip P. , Luyer Misha D. P. , Nieuwenhuijzen Grard A. P. , Olthof Pim B. , van der Peet Donald L. , Pierie Jean-Pierre E. N. , Pierik E. G. J. M. Robert , Plat Victor D. , Polat Fatih , Rosman Camiel , Ruurda Jelle P. , van Sandick Johanna W. , Scheer Rene , Slootmans Cettela A. M. , Sosef Meindert N. , Sosef Odin V. , de Steur Wobbe O. , Stockmann Hein B. A. C. , Stoop Fanny J. , Voeten Daan M. , Vugts Guusje , Vijgen Guy H. E. J. , Weeda Víola B. , Wiezer Marinus J. , van Oijen Martijn G. H. , Gisbertz Suzanne S.
Published: November 2021

Objective:

This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer.

Summary of Background Data:

The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer.

Methods:

Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007–2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods.

Results:

Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% (P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 (P <0.001), and median survival increased from 35 to 41 months (P = 0.027).

Conclusion:

In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival.
Pelvic Organ Prolapse Takes Up Space in the Bedroom: A Mixed Method Exploration of the Circular Sexual Response Cycle in Women With Pelvic Organ Prolapse
Authors: Shah Fatima I. , Ramage Kaylee , Scime Natalie V. , Brennand Erin A. , Walker Lauren M.
Published: November 2021

Objective

Pelvic organ prolapse (POP) is a multidimensional reproductive health issue, which negatively affects women’s sexual well-being. Using the circular sexual response cycle as a framework, we sought to evaluate women’s sexual experiences living with POP.

Methods

Measures of genital self-image, sexual distress, sexual satisfaction, and sexual function were administered before conducting semistructured interviews. Participants were 16 heterosexual partnered women seeking surgical and nonsurgical treatment for symptomatic POP.

Results

Standardized questionnaires indicated normal genital self-image, sexual satisfaction, and sexual function; however, sexual distress scores exceeded normal cutoffs. Eight themes emerged, including reasons for having sex, willingness to initiate and sexual receptivity, contextual factors, sexual stimuli, sexual arousal, responsive desire, outcomes, and spontaneous sexual desire. In contrast to quantitative findings, themes demonstrated sexual difficulty. Women with POP mainly engage in sex out of obligation and report reduced sexual initiation and receptiveness, as well as a negative impact on genital self-image. Pelvic organ prolapse was perceived to adversely affect subjective arousal, responsive desire, and spontaneous desire, despite intact physiological arousal. Difficulty experiencing subjective arousal was profound and seemed to be limited by preoccupation with POP. Sexual satisfaction and rewards were diminished after POP, including orgasmic capacity. Rewarding motivators to engage in sex were seldom discussed and often overshadowed by experiencing guilt and obligation related to sex.

Conclusions

The circular sexual response cycle largely fit participants’ experiences; however, POP inhibits subjective arousal, which prevents responsive desire for many. Patients may need better support to cope with preoccupation with POP, indicating that addressing the psychosocial symptoms of POP should be prioritized.
The unequal impact of interhospital transfers on emergency general surgery patients: Procedure risk and time to surgery matter
Authors: Coimbra Raul , Barrientos Robert , Allison-Aipa Timothy , Zakhary Bishoy , Firek Matthew
Published: November 2021

BACKGROUND

The impact of interhospital transfer on outcomes of patients undergoing emergency general surgery (EGS) procedures is incompletely studied. We set out to determine if transfer before definitive surgical care leads to worse outcomes in EGS patients.

METHODS

Using the National Surgical Quality Improvement Project database (2013–2019), a retrospective cohort study was conducted including nine surgical procedures encompassing 80% of the burden of EGS diseases, performed on an urgent/emergent basis. The procedures were classified as low risk (open and laparoscopic appendectomy and laparoscopic cholecystectomy) and high risk (open cholecystectomy, laparoscopic and open colectomy, lysis of adhesions, perforated ulcer repair, small bowel resection, and exploratory laparotomy). Time to surgery was recorded in days. The impact of interhospital transfer on outcomes (mortality, major complications, 30-day reoperations, and 30-day readmissions) and length of stay, according to procedure risk and time to surgery, were analyzed by multivariate logistic regression and inverse probability treatment of the weighting with treatment effect in the treated.

RESULTS

A total of 329,613 patients were included in the study (284,783 direct admission and 44,830 transfers). Adjusted mortality (3.1% vs. 10.4%; adjusted odds ratio [AOR], 1.28; p < 0.001), major complications (6.7% vs. 18.9%; AOR, 1.39; p < 0.001), 30-day reoperations (3.1% vs. 6.4%; AOR, 1.22; p < 0.001), and length of stay (2 vs. 5) were higher in transferred patients. Transfer had no effect on 30-day readmissions (6% vs. 8.5%; AOR, 1.04; p = 0.063). These results were also observed in high-risk surgery patients and in the late surgery group. The results were further confirmed after robust propensity score weighting was performed.

CONCLUSION

We have demonstrated that delays to surgical intervention affect outcomes and that interhospital transfer of EGS patients for definitive surgical care has a negative impact on mortality, development of postoperative complications, and reoperations in patients undergoing high-risk EGS procedures. These findings may have important implications for regionalization of EGS care.

LEVEL OF EVIDENCE

Prognostic/epidemiological, level III.
States should use Medicaid to support violence intervention efforts
Authors: Zavala Claudia , Buggs Shani A. , Fischer Kyle R.
Published: November 2021

In recent years, calls to address gun violence through public health approaches have increased. However, securing funding for health-based community violence intervention models has remained a challenge. New actions suggest that this may be shifting. Upon taking office, the Biden administration announced a series of funding opportunities for these programs, which ranged from competitive grant programs to a proposed 8-year, $5 billion plan. Less publicized, but just as important, is the administration's announcement that Medicaid can be used to reimburse this work, specifically noting the eligibility of hospital-based violence intervention and prevention programs. For these programs, this creates a predictable and reliable funding source that has not existed to date. This integration of violence prevention programming in the traditional health care and financing systems represents a critical inflection point in the United States' shifting response to community violence. However, the decision to use this optional benefit lies with each state. States should strongly consider harnessing Medicaid as a wise investment to address the United States' gun violence epidemic.

LEVEL OF EVIDENCE

Economic and value-based evaluation, level IV.
Experimental study to assess the impact of vasopressors administered during maintenance of the brain-dead donation in the quality of the intestinal graft
Authors: Vecchio Dezillio Leandro Emmanuel , Romanin David Emmanuel , Ivanoff Marinoff Ivana Mariel , Vernengo Julieta , Abate Zárate Juan Cruz , Machuca Mariana Alejandra , Gondolesi Gabriel Eduardo , Lausada Natalia Raquel , Stringa Pablo Luis , Rumbo Martín
Published: November 2021

BACKGROUND

The hemodynamic maintenance of brain-dead donors will influence the quality of the organs procured for transplantation, including the intestine. Although norepinephrine (NE) and dopamine (DA) are commonly used to sustain mean arterial pressure in humans, there are no standardized protocols for their use during maintenance of brain-dead donors. Our aim was to compare the effects of each drug, in the intestinal graft quality using a rat brain-dead donation model.

METHODS

Wistar rats (N = 17) underwent brain death (BD) for 2 hours with NE (NE group) or with DA (DA group) administration; the control group was mechanically ventilated for 2 hours without BD. Jejunum biopsies were obtained at the end of the maintenance period. Histological damage was evaluated using Park-Chiu scale. Villi/crypt ratio, mucosal thickness, Goblet cell count, and villi density were evaluated using ImageJ software (US National Institutes of Health, Bethesda, MD). Barrier damage was assessed by bacterial translocation culture counting on liver samples. The inflammatory status of the intestine was evaluated by CD3+ counting by immunohistochemistry and gene expression analysis of interleukin (IL)-6, IL-22, and CXCL10.

RESULTS

Norepinephrine-treated donors had higher focal ischemic injury in the intestinal mucosa without a substantial modification of morphometrical parameters compared with DA-treated donors. CD3+ mucosal infiltration was greater in intestines procured from brain-dead donors, being highest in NE (p ˂ 0.001). Local inflammatory mediators were affected in BD: DA and NE groups showed a trend to lower expression of IL-22, whereas CXCL10 expression was higher in NE versus control group. Brain death promoted intestinal bacterial translocation, but the use of NE resulted in the highest bacterial counting in the liver (p ˂ 0.01).

CONCLUSION

Our results favor the use of DA instead of NE as main vasoactive drug to manage BD-associated hemodynamic instability. Dopamine may contribute to improve the quality of the intestinal graft, by better preserving barrier function and lowering immune cell infiltration.
Clinical assessment and screening of stroke patients with aphasia: a best practice implementation project
Authors: Wang Run , Wei Wei , Zhou Jungui , Yu Mei , Zhang Xiaomei , Luo Yansi , Yang Lixiao , Ye Xiaoling , Wu Yanni , Zhou Chunlan
Published: November 2021

Introduction and aims:

As a critical form of stroke damage, aphasia negatively impacts stroke patients’ return to society. Speech and language intervention has been found to assist in optimizing poststroke aphasia patient outcomes; consequently, early identification and diagnosis are vital for poststroke aphasia to ensure that patients receive the rehabilitation they require. This project aimed to promote evidence-based practice (EBP) in the assessment and screening of stroke patients with aphasia and to improve the clinical outcomes of patients who suffer from poststroke aphasia in a large tertiary hospital.

Methods:

The current evidence implementation project was conducted in the neurology and rehabilitation departments of a tertiary hospital in China. Six audit criteria were developed for the baseline and follow-up audits. The project used the JBI PACES software, as well as JBI's Getting Research into Practice audit and feedback tool, to foster evidence-based healthcare in practice.

Results:

Although the performance of all evidence-based criteria during the baseline audit was poor, barriers were identified through baseline, and the project team carried out and implemented developed strategies following Getting Research into Practice resources. All the criteria improved from baseline after the follow-up cycle, with four out of six criteria achieving a compliance rate of 100%, and two evidence-based criteria recorded at 73 and 80% compliance, respectively.

Conclusion:

The current project successfully increased EBP for the assessment and screening of stroke patients with aphasia. Further studies are needed to ensure the project's long-term sustainability.
Gattaca: Base pair resolution mutation tracking for somatic evolution studies using agent-based models
Authors: Schenck Ryan O , Brosula Gabriel , West Jeffrey , Leedham Simon , Shibata Darryl , Anderson Alexander RA
Published: November 2021

Gattaca provides the first base-pair resolution artificial genomes for tracking somatic mutations within agent based modeling. Through the incorporation of human reference genomes, mutational context, sequence coverage/error information Gattaca is able to realistically provide comparable sequence data for in-silico comparative evolution studies with human somatic evolution studies. This user-friendly method, incorporated into each in-silico cell, allows us to fully capture somatic mutation spectra and evolution.
Altered brain criticality in Schizophrenia: New insights from MEG
Authors: Alamian Golnoush , Lajnef Tarek , Pascarella Annalisa , Lina Jean-Marc , Knight Laura , Walters James , Singh Krish D , Jerbi Karim
Published: November 2021

Schizophrenia has a complex etiology and symptomatology that is difficult to untangle. After decades of research, important advancements towards a central biomarker are still lacking. One of the missing pieces is a better understanding of how non-linear neural dynamics are altered in this patient population. In this study, the resting-state neuromagnetic signals of schizophrenia patients and healthy controls were analyzed in the framework of criticality. When biological systems like the brain are in a state of criticality, they are thought to be functioning at maximum efficiency (e.g., optimal communication and storage of information) and with maximum adaptability to incoming information. Here, we assessed the self-similarity and multifractality of resting-state brain signals recorded with magnetoencephalography in patients with schizophrenia patients and in matched controls. Our analysis showed a clear ascending, rostral to caudal gradient of self-similarity values in healthy controls, and an opposite gradient for multifractality (descending values, rostral to caudal). Schizophrenia patients had similar, although attenuated, gradients of self-similarity and multifractality values. Statistical tests showed that patients had higher values of self-similarity than controls in fronto-temporal regions, indicative of more regularity and memory in the signal. In contrast, patients had less multifractality than controls in the parietal and occipital regions, indicative of less diverse singularities and reduced variability in the signal. In addition, supervised machine-learning, based on logistic regression, successfully discriminated the two groups using measures of self-similarity and multifractality as features. Our results provide new insights into the baseline cognitive functioning of schizophrenia patients by identifying key alterations of criticality properties in their resting-state brain data.
Regulatory T cells suppress the formation of potent KLRK1 and IL-7R expressing effector CD8 T cells by limiting IL-2
Authors: Tsyklauri Oksana , Chadimova Tereza , Niederlova Veronika , Kovarova Jirina , Michalik Juraj , Malatova Iva , Janusova Sarka , Ivashchenko Olha , Rossez Helene , Drobek Ales , Vecerova Hana , Galati Virginie , Kovar Marek , Stepanek Ondrej
Published: November 2021

Regulatory T cells (Tregs) are indispensable for maintaining self-tolerance by suppressing conventional T cells. On the other hand, Tregs promote tumor growth by inhibiting anti-cancer immunity. In this study, we identified that Tregs increase the quorum of self-reactive CD8+T cells required for the induction of experimental autoimmune diabetes. Their major suppression mechanism is limiting available IL-2, an essential T-cell cytokine. Specifically, Tregs inhibit the formation of a previously uncharacterized subset of antigen-stimulated KLRK1+IL7R+(KILR) CD8+effector T cells, which are distinct from conventional effector CD8+T cells. KILR CD8+T cells show a superior cell killing abilities in vivo. The administration of agonistic IL-2 immunocomplexes phenocopies the absence of Tregs, i.e., it induces KILR CD8+T cells, promotes autoimmunity, and enhances anti-tumor responses. Counterparts of KILR CD8+T cells were found in the human blood, revealing them as a potential target for immunotherapy.
Three-dimensional Shear Wave Elastography Using a 2D Row Column Addressing (RCA) Array
Authors: Dong Zhijie , Kim Jihun , Huang Chengwu , Lowerison Matthew R. , Chen Shigao , Song Pengfei
Published: November 2021

Objective

To develop a 3D shear wave elastography (SWE) technique using a 2D row column addressing (RCA) array, with either external vibration or acoustic radiation force (ARF) as the shear wave source.

Impact Statement

The proposed method paves the way for clinical translation of 3D-SWE based on the 2D RCA, providing a low-cost and high volume-rate solution that is compatible with existing clinical systems.

Introduction

SWE is an established ultrasound imaging modality that provides a direct and quantitative assessment of tissue stiffness, which is significant for a wide range of clinical applications including cancer and liver fibrosis. SWE requires high frame-rate imaging for robust shear wave tracking. Due to the technical challenges associated with high volume-rate imaging in 3D, current SWE techniques are typically confined to 2D. Advancing SWE from 2D to 3D is significant because of the heterogeneous nature of tissue, which demands 3D imaging for accurate and comprehensive evaluation.

Methods

A 3D SWE method using a 2D RCA array was developed with a volume-rate up to 2000 Hz. The performance of the proposed method was systematically evaluated on tissue-mimicking elasticity phantoms.

Results

3D shear wave motion induced by either external vibration or ARF was successfully detected with the proposed method. Robust 3D shear wave speed maps were reconstructed for both homogeneous and heterogeneous phantoms with inclusions.

Conclusion

The high volume-rate 3D imaging provided by the 2D RCA array provides a robust and practical solution for 3D SWE with a clear pathway for future clinical translation.
Cerebral blood flow predicts multiple demand network activity and fluid intelligence across the lifespan
Authors: Wu Shuyi , Tyler Lorraine K. , Henson Richard N.A. , Rowe James B. ,   Cam-Can, Tsvetanov Kamen A.
Published: November 2021

The preservation of cognitive function into old age is a public health priority. Cerebral hypoperfusion is a hallmark of dementia but its impact on maintaining cognitive ability across the lifespan is less clear. We investigated the relationship between baseline cerebral blood flow (CBF) and blood oxygenation level-dependent (BOLD) response during a fluid reasoning task in a population-based adult lifespan cohort (N=227, age 18-88 years). As age differences in baseline CBF could lead to non-neuronal contributions to the BOLD signal, we introduced commonality analysis to neuroimaging, in order to dissociate performance-related CBF effects from the physiological confounding effects of CBF on the BOLD response. Accounting for CBF, we confirmed that performance- and age-related differences in BOLD responses in the multiple-demand network (MDN) implicated in fluid reasoning. Differences in baseline CBF across the lifespan explained not only performance-related BOLD responses, but also performance-independent BOLD responses. Our results suggest that baseline CBF is important for maintaining cognitive function, while its non-neuronal contributions to BOLD signals reflect an age-related confound. Maintaining perfusion into old age may serve to support brain function with behavioural advantage, regulating brain health.
Real-time alerts from AI-enabled camera traps using the Iridium satellite network: a case-study in Gabon, Central Africa
Authors: Whytock Robin C. , Suijten Thijs , van Deursen Tim , Świeżewski Jędrzej , Mermiaghe Hervé , Madamba Nazaire , Moukoumou Narcys , Zwerts Joeri A. , Koumba Pambo Aurélie Flore , Bahaa-el-din Laila , Brittain Stephanie , Cardoso Anabelle W. , Henschel Philipp , Lehmann David , Momboua Brice Roxan , Makaga Loïc , Orbell Christopher , White Lee J.T. , Iponga Donald Midoko , Abernethy Katharine A.
Published: November 2021

Efforts to preserve, protect, and restore ecosystems are hindered by long delays between data collection and analysis. Threats to ecosystems can go undetected for years or decades as a result. Real-time data can help solve this issue but significant technical barriers exist. For example, automated camera traps are widely used for ecosystem monitoring but it is challenging to transmit images for real-time analysis where there is no reliable cellular or WiFi connectivity. Here, we present our design for a camera trap with integrated artificial intelligence that can send real-time information from anywhere in the world to end-users.

We modified an off-the-shelf camera trap (Bushnell™) and customised existing open-source hardware to rapidly create a ‘smart’ camera trap system. Images captured by the camera trap are instantly labelled by an artificial intelligence model and an ‘alert’ containing the image label and other metadata is then delivered to the end-user within minutes over the Iridium satellite network. We present results from testing in the Netherlands, Europe, and from a pilot test in a closed-canopy forest in Gabon, Central Africa.

Results show the system can operate for a minimum of three months without intervention when capturing a median of 17.23 images per day. The median time-difference between image capture and receiving an alert was 7.35 minutes. We show that simple approaches such as excluding ‘uncertain’ labels and labelling consecutive series of images with the most frequent class (vote counting) can be used to improve accuracy and interpretation of alerts.

We anticipate significant developments in this field over the next five years and hope that the solutions presented here, and the lessons learned, can be used to inform future advances. New artificial intelligence models and the addition of other sensors such as microphones will expand the system’s potential for other, real-time use cases. Potential applications include, but are not limited to, wildlife tourism, real-time biodiversity monitoring, wild resource management and detecting illegal human activities in protected areas.