bluuebunny/crossref_metadata_2025 huggingface dataset:
External Fixation Characteristics Drive Cost of Care for High-Energy Tibial Plateau Fractures
Authors: Albright Patrick , Only Arthur , Parikh Harsh R. , McCreary Dylan L. , Hayek Kevin , Siljander Breana , Kibble Kendra , Cunningham Brian P.
Published: August 2021

Objective:

To determine the total cost for a 30-day episode of care for high-energy tibial plateau fractures and the aspects of care associated with total cost.

Design:

Time-driven activity-based costing analysis.

Setting:

One Level 1 adult trauma center.

Patients:

One hundred twenty-one patients with isolated, bicondylar tibial plateau fractures undergoing staged treatment were reviewed.

Primary Outcome:

Total cost.

Results:

A total of 85 patients were included and most sustained Schatzker VI fractures (n = 66, 77%). All patients were treated with biplanar external fixation before definitive fixation. A total of 26 patients (31%) were discharged to skilled nursing facilities, and 37 patients (43%) were not discharged between procedures. Total cost for a 30-day episode of care was $22,113 ± 4056. External fixation components ($5952, 26.9%), length of hospital stay ($5606, 25.4%), discharge to skilled nursing facility (SNF) ($3061, 13.8%), and definitive fixation implants ($2968, 13.4%) contributed to the total cost. The following were associated with total cost: patient discharged to SNFs (P < 0.001), patient remaining inpatient after external fixation (P < 0.001), days of admission for open reduction internal fixation (ORIF) (P = 0.005), days spent with external fixation (P < 0.001), days in a SNF after ORIF (P < 0.001), and external fixation component cost (P < 0.001).

Conclusions:

External fixation component selection is the largest contributor to cost of a 30-day episode of care for high-energy bicondylar tibial plateau fractures. Reduction in cost variability may be possible through thoughtful use of external fixation components and care pathways.

Level of Evidence:

Economic analyses Level IV. See Instructions for Authors for a complete description of levels of evidence.
Can we still use X-rays to predict contralateral slip in primary unilateral slipped capital femoral epiphysis?
Authors: Kwiatkowska Magdalena , Kwiatkowski Marcin , Czubak-Wrzosek Maria , Czubak Jarosław , Tyrakowski Marcin
Published: August 2021

The objective of this study was to assess subsequent contralateral slip (SCS) in the unaffected hip in patients with primary unilateral slipped capital femoral epiphysis (SCFE) using three radiographic parameters: posterior sloping angle (PSA), center-edge angle (CEA) and triradiate cartilage (TC) appearance. A total of 152 patients admitted to two pediatric units between 2001 and 2015 were divided into three groups: A - underwent prophylactic fixation of the unaffected hip at the time of index surgery- high clinical risk of SCS; B - no clinical risk factors but SCS occurred; C - no issues regarding the contralateral hip during follow-up. The mean PSA for groups A, B and C were 22°(6–49), 17°(9–24) and 13°(0–27), respectively. PSA was significantly higher in Group A than in Group C (P < 0.0001). The differences in PSA between groups A and B, but also B and C were insignificant (P = 0.12 and p=0.21, respectively). The mean CEA in groups A, B and C was 33(25–43), 35(26–42) and 37(17–53), respectively. CEA did not differ significantly between groups A, B and C (P = 0.25). Assessment of TC did not differ significantly between the groups (P = 0.66). Observation of TC in groups B and C combined revealed that the cartilage was open in 65% of 77 patients and 14% of them developed SCS; whereas among the 35% of patients with ossified TC only 7% developed SCS (OR=2.0). PSA and CEA alone have no predictive value in determining the risk of contralateral slip. The absence of TC results in a two-fold decrease in the likelihood of developing an SCS. The decision of prophylactic surgical treatment of the contralateral hip in primary unilateral SCFE should not be based solely on radiographic findings.
Circular RNA circ_0000592 elevates ANXA4 expression via sponging miR-1179 to facilitate tumor progression in gastric cancer
Authors: Ji Zhiwu , Diao Weiying , Shang Jincai
Published: August 2021

Increasing evidence indicated that dysregulated circular RNAs were implicated in the progression of multiple malignancies. However, the function of circ_0000592 in gastric cancer (GC) progression and its associated mechanism remain poorly understood. Quantitative real-time PCR and Western blot assay were performed to detect RNA and protein expression. Cell proliferation, migration and invasion were analyzed by 5-Ethynyl-2′-deoxyuridine staining assay, Transwell migration assay and Transwell invasion assay, respectively. The glucose/lactate assay kit was used to assess the rates of glucose consumption and lactate production. The interaction between microRNA-1179 (miR-1179) and circ_0000592 or Annexin A4 (ANXA4) was confirmed by dual-luciferase reporter assay and RNA pull-down assay. Xenograft tumor model was established to investigate the effect of circ_0000592 on tumor growth in vivo. Circ_0000592 expression was elevated in GC tissues and cells. Circ_0000592 knockdown hampered cell proliferation, migration, invasion and glycolysis of GC cells. MiR-1179 was a direct target of circ_0000592, and circ_0000592 silencing-mediated effects in GC cells were partly reversed by the knockdown of miR-1179. MiR-1179 interacted with the 3′ untranslated region (3′UTR) of ANXA4. Circ_0000592 silencing reduced ANXA4 expression partly by upregulating miR-1179 in GC cells. ANXA4 overexpression partly overturned circ_0000592 knockdown-induced effects in GC cells. Circ_0000592 depletion markedly suppressed xenograft tumor growth in vivo. Circ_0000592 contributed to GC progression through regulating miR-1179/ANXA4 axis, which provided novel potential biomarkers and therapeutic targets for GC treatment.
Tumor-mutation burden as a marker for immunotherapy of pancreatic cancer: the case report and literature review
Authors: Zhu Peng-Fei , Chen Yun-Wang , Wang Ming-Xing , Deng Ya-Ya , Pan Shuang-Yue , Chen Zhe-Ling , Yang Liu
Published: August 2021

Pancreatic cancer is digestive cancer with limited therapeutic options and a poor outcome. Pancreatic cancer has a high mortality rate, with a 5-year survival rate of less than 5%. The median survival after metastasis of the disease is less than 6 months. Studies have revealed that the standard treatment, including palliative chemotherapy or immunotherapy, is not significantly effective for pancreatic cancer. Herein, we report a case of pancreatic cancer who benefited from a combination of anti-PD-1 immunotherapy and chemotherapy.
Lifestyle and quality of life in patients with early-stage breast cancer receiving adjuvant endocrine therapy
Authors: Di Meglio Antonio , Soldato Davide , Presti Daniele , Vaz-Luis Ines
Published: August 2021

Purpose of review

A comprehensive approach to survivorship care for women with early-stage, hormone-receptor positive breast cancer should systematically include the proactive assessment and adequate management of endocrine therapy-associated symptoms, in order to assure optimal balance between preserving quality of life (QOL) and maximizing treatment adherence. We reviewed the recent literature focused on lifestyle factors, including physical activity, diet and nutrition, weight management, smoke, and alcohol behavior, and their link with symptomatology and QOL among women receiving adjuvant endocrine therapy.

Recent findings

Recent studies confirm the safety, feasibility, and effectiveness of lifestyle interventions in mitigating several common endocrine therapy-related effects, including musculoskeletal pain, fatigue, and insomnia, and in improving physical and emotional wellbeing as well as overall health-related QOL among women with early-stage breast cancer.

Healthy lifestyle behaviors have the potential to modulate the downstream impact of endocrine therapy and improve QOL among women with early-stage breast cancer. Considerations for real-world clinical care implementation emerged, including a need to evaluate the long-term uptake of healthy behaviors and facilitate the postintervention maintenance of an improved lifestyle. Some facilitators to health promotion in breast cancer survivors were also suggested, such as individualized and one-to-one supervised programs, and digital solutions providing real-time feedback, building on personalized, direct patient engagement.
Impact of Mentorship, by Gender, on Career Trajectory in an Academic Anesthesiology Department: A Survey Study
Authors: Warner Lindsay L. , Gali Bhargavi , Oxentenko Amy S. , Schroeder Darrell R. , Arendt Katherine W. , Moeschler Susan M.
Published: August 2021

Introduction:

Mentorship has been identified as a key component of success in business and in academic medicine.

Methods:

After institutional review board approval of the study, an email survey was sent to anesthesiologists in one anesthesiology department to assess mentorship status. A survey link was sent to nonrespondents at 2 weeks and 4 weeks. All participants were deidentified. The identification of a mentor was compared by gender, academic rank, and years of practice.

Results:

Among 233 anesthesiologists, 103 (44.2%) responded to the survey. More than 90% of survey respondents agreed or strongly agreed that having a mentor is important to career success. Of the 103 respondents, 31 (30%) indicated they had a mentor. Overall, 84% of the identified mentors were men; however, this percentage differed significantly between men and women respondents (95% versus 60%; P = .03). Characteristics associated with having a mentor included younger age (P = .007), fewer years since finishing training (P = .004), and working full time (P = .02). For respondent age and years since finishing training, there was some evidence that the association was dependent on the gender of the respondent (age-by-gender interaction, P = .08; experience-by-gender interaction, P = .08).

Discussion:

Anesthesiologists in this department believed that mentorship led to more academic success. Few women mentors were reported, and women were unlikely to identify a mentor once advanced past an assistant professor rank. Most respondents believed that mentorship was important for overall career success, but only approximately one-third identified a mentor at the time of the survey.
Expanding Access to Medications for Opioid Use Disorder Treatment Through Incentivized Continuing Education
Authors: Salisbury-Afshar Elizabeth , Smithenry Dennis , Boley Randy A. , Hill Kristin , Karnik Niranjan S.
Published: August 2021

Introduction:

Buprenorphine treatment for opioid use disorder (OUD) has positive outcomes including reducing opioid-related morbidity and mortality. In March 2018, 58 of 102 counties in Illinois lacked access to medication for OUD.

Methods:

Rush University created a fellowship training program with financial incentives to help expand buprenorphine treatment in Illinois. Fellows first completed an online waiver course, then attended an in-person intensive training weekend, and finally participated in a 9-month webinar series. Demographic and prescribing data were collected from fellows, as well as a comparison group of providers outside the fellowship who only completed a waiver training.

Results:

At the fellowship's end, 31 of 37 fellows (84%) reported they were actively prescribing buprenorphine. Of the 23 fellows who were not prescribing at the fellowship's beginning, 17 (74%) initiated prescribing by the end. Among the 16 nonfellowship subjects who only completed a waiver training, just two (13%) reported they were prescribing buprenorphine at the study period's end.

Discussion:

Our study indicates that providers need more training beyond the waiver to initiate buprenorphine prescribing. When resources are available to address a health crisis such as OUD, this model offers an innovative mechanism for delivering continuing medical education that produces outcomes quickly.
Documenting Educational Impact in the Promotion Dossier with an Enhanced Curriculum Vitae
Authors: Hobson Wendy L. , Gordon Rachel J. , Cabaniss Deborah L. , Richards Boyd F.
Published: August 2021

Faculty with a career focus on education in the health professions often have difficulty representing their academic accomplishments for due consideration in promotion decisions at their respective institutions. This problem occurs because the traditional curriculum vitae (CV) format which is most often used tends to focus on peer-reviewed accomplishments easily presented in lists, such as grants and publications. In some institutions, an educator portfolio is required in place of or in addition to the CV. However, creating or reviewing such a narrative-oriented document takes large amounts of time—time that most faculty or reviewers do not have. Having to use an educator portfolio also calls out the educator as different from the traditional research faculty member. To address this problem, we propose the solution of an Enhanced CV. The Enhanced CV includes much of what is presented in an educator portfolio but in a format closer to the traditional CV. Unlike a traditional CV, the Enhanced CV includes categories inclusive of educational contributions (eg, teaching, mentoring, and course leadership) and includes brief descriptions and/or impact statements to clarify the significance of the listed accomplishments. The Enhanced CV has been adopted at two very different institutions, where evidence is accumulating regarding the viability of the Enhanced CV as a solution to educators' problem of presenting their accomplishments for promotions. The lessons learned from these institutions illustrate how the Enhanced CV can increase the ability of educators to present their accomplishments and advance in rank in their academic careers.
Progress in cancer epidemiology: avoided deaths in Europe over the last three decades
Authors: La Vecchia Carlo , Negri Eva , Carioli Greta
Published: August 2021

Progress in cancer epidemiology and prevention has been a key determinant of the fall in cancer mortality in Europe. Using mortality and population figures from the WHO and Eurostat databases, we estimated the number of averted cancer deaths in the EU27 over the period 1989–2021, for both sexes, for all cancers, and nine major cancer sites. We also computed the avoided deaths for all cancers in five major European countries and the UK. We estimated a total of 4 958 000 (3 339 000 men and 1 619 000 women) avoided deaths for all neoplasms over the period 1989–2021 and 348 000 (246 000 men and 102 000 women) in 2021 alone in the EU27. For both sexes, we estimated 1 679 000 avoided deaths for stomach cancer, 747 000 for colorectum, 227 000 for bladder, 102 000 for leukemias. Avoided deaths for lung cancer accounted for 1 156 000 in men, while no reduction was estimated for women. For breast and uterine cancer, avoided deaths were about 300 000, for ovary 105 000 and for prostate 352 000. In the UK, a total of 1 061 000 (721 000 men and 340 000 women) deaths was avoided. Elimination of tobacco may avoid a further 20% of cancer mortality by 2050. Control of alcohol, overweight and obesity, and occupational and environmental carcinogens may avoid an additional 10% of cancer deaths. A similar reduction may be due to optimal adoption of cervical, colorectal, breast, and probably, lung and prostate cancer screening. Thus, primary and secondary cancer prevention can avoid an additional third of cancer deaths in Europe up to 2050.
Local Control and Use of External Beam Parametrial Boost in the Era of Image-Guided Brachytherapy for Locally Advanced Cervical Cancer
Authors: Arya Ritu , Giurcanu Mihai , Jutzy Jessica M. , Peters Pamela , Daily Ellen W. , Golden Daniel W. , McCall Anne R. , Howard Andrew R. , Hasan Yasmin , Son Christina H.
Published: August 2021

Objective:

Historically, external beam parametrial boost (EBPB) has been used in locally advanced cervical cancers to supplement radiation dose. However, it has become controversial in the era of image-guided brachytherapy. Modern 3D imaging and brachytherapy techniques have improved delineation and coverage of tumor. Outcomes with and without parametrial boost were analyzed.

Methods:

Women with cervical cancer involving the parametria (clinically or radiographically) diagnosed between 2001 and 2017 were identified. Clinicopathologic and treatment features, survival and patterns of failure data were collected. Univariate and multivariable data analysis was performed to evaluate association of these variables, including parametrial boost, with local failure-free survival and overall survival. Competing risks analysis was performed for cumulative incidence of local failure, with death and other failures treated as competing events.

Results:

A total of 100 women were identified (median follow-up 26.8 mo). Forty-one (41%) received EBPB; these patients were less likely to have received magnetic resonance imaging, positron emission tomography, interstitial, or high-dose rate brachytherapy. Magnetic resonance imaging, positron emission tomography, dose rate, and treatment era were highly correlated (Cramer’s V: 0.43 to 0.68, P<0.01). Two-year overall survival and local failure were 78% and 12% for the entire cohort. While the use of EBPB was not associated with any outcome on multivariable analysis, treatment year after 2009 was highly associated with improved outcomes in all models.

Conclusions:

In this study, omission of EBPB did not compromise local control or survival in the modern era, supporting a decreased need for standardized use of parametrial boost.
Review of Cardiac Malpractice Cases Involving a Trainee
Authors: McElhinny Megan M. , Pappas Dominic K. , Lindor Rachel A.
Published: August 2021

Lawsuits involving medical trainees are underappreciated and poorly documented, including within cardiology-related fields. The purpose of this review was to characterize clinical characteristics and legal outcomes of cardiology- and cardiac surgery-related lawsuits involving trainees. Westlaw, an online legal research database containing legal records from around the United States, was retrospectively reviewed for malpractice cases involving medical students, residents, or fellows through November 2020. Cases included both cardiac and cardiac surgery cases. A total of 28 cases were identified, with 16 involving female patients (57%). In the 17 cases in which patient age was included, the median age was 51 years. A total of 22 (79%) cases resulted in death or permanent disability. The most common alleged errors included procedural issues (n = 14, 50%) and failure to diagnose (n = 7, 25%). A total of 14 cases (50%) ended in favor of the physicians, 9 (32%) ended in a settlement or verdict against the physician, and 5 cases had an unknown outcome. Of the 8 cases in which the settlement or verdict amount was reported, the median payment was $1,291,992 with a range of $220,507–$30,000,000. This review of cardiac and cardiac surgery malpractice cases involving a trainee suggests trainee involvement in procedures and diagnosis may confer relatively high liability risks for both trainees and their supervisors.
Maternal Stress and Early Neurodevelopment: Exploring the Protective Role of Maternal Growth Mindset
Authors: Elansary Mei , Pierce Lara J. , Wei Wendy S. , McCoy Dana Charles , Zuckerman Barry , Nelson Charles A.
Published: August 2021

Objective:

The purpose of this study was to test associations between maternal stress, maternal mindset, and infant neurodevelopment at 12 months of age. Specifically, we sought to examine the extent to which maternal growth mindsets may serve to attenuate the negative associations between maternal stress and infants' neurodevelopment.

Methods:

The current exploratory study leverages data from a longitudinal cohort study following mother-infant dyads. Maternal-perceived stress, maternal mindset, and infant electroencephalography (EEG) recordings were collected when infants were 12 months of age. The final analytic sample included 33 dyads.

Results:

Results revealed no statistically significant main effects of maternal stress or maternal mindset for any of the infant EEG frequency band outcomes. After including interactions between maternal stress and mindset, statistically significant positive interactions were detected for all EEG frequency bands. Simple slope tests revealed significant negative associations between maternal stress and each of the 6 EEG frequency bands for mothers with more fixed-oriented mindsets. Associations between maternal stress and infant EEG outcomes for mothers with more growth-oriented mindsets did not differ from 0.

Conclusion:

These findings suggest that infants raised by mothers with growth mindsets may be protected against the neurodevelopmental consequences of higher maternal stress.
The predominant role of glucose as a building block and precursor of reducing equivalents
Authors: Sobotka Lubos , Sobotka Ondrej
Published: August 2021

Purpose of review

Stores of glucose (Glc) in our body are small compared with protein and lipid. Therefore, at times of famines or trauma/disease-related starvation, glucose utilization must be limited only to pathways that can only run with glucose carbon as substrate. We will try to outline how insulin resistance drives these pathways and inhibits glucose oxidation in the stressed organism.

Recent findings

Glc is a basic substrate for a variety of other biomolecules like nucleic acids, amino acids, proteoglycans, mucopolysaccharides and lipids. It is essential for the formation of reducing equivalents, indispensable for anabolic, antioxidative, regulatory and immune processes. As a result, a continuous Glc turnover/cycle is essential to secure at all times the Glc requirements for nonoxidative pathways mentioned above but then requires introduction of extra glucose or other intermediates into the cycle. The production of ATP through complete Glc oxidation occurs only when Glc intake is higher than required for its nonoxidative metabolism. Insulin resistance and decreased Glc oxidation indicate that requirements of Glc for anabolic pathways are high.

Glc is an important building block for anabolic reactions and substrate for reducing equivalents formation. Insulin resistance prevents irreversible Glc oxidation and stimulates Glc production during stress or growth. Glc is only oxidized when intake is in excess of its anabolic requirements.
Celiac disease: clinical update
Authors: Uche-Anya Eugenia , Lebwohl Benjamin
Published: August 2021

Purpose of review

This review highlights literature from the past year and explores the impact on current understanding of celiac disease pathogenesis, diagnosis, and management.

Recent findings

In contrast to earlier clinical trials, recent data suggests that early gluten introduction may protect against the development of celiac disease. Celiac disease is underdiagnosed, associated with high burden of disease and linked to excess mortality risk, yet, there remains considerable uncertainty regarding the utility of mass screening in asymptomatic individuals. The gut microbiome is increasingly implicated in celiac disease pathogenesis, although the exact mechanism is undefined. Probiotics have been proposed as a disease-modifying option for celiac disease but most studies assessing efficacy are of low-quality. Patients with celiac disease do not appear to be at increased risk of contracting or developing adverse outcomes from COVID-19. Little is known about the pathogenesis of nonceliac gluten sensitivity; however, recent findings suggest an autoimmune basis for the condition.

Current understanding of celiac disease continues to advance, though significant knowledge gaps remain. Large, rigorous, prospectively designed studies are needed to further characterize celiac disease pathogenesis, management and therapeutic options.
Improved Patient Safety and Quality Outcomes With Amiodarone Infusions
Authors: Woods Carri , Hughes Penny , Wood Michelle , Ryan Susan , Powers Jan
Published: August 2021

Background:

Amiodarone is a common intravenous medication and a known irritant to the vessel wall when administered peripherally.

Local Problem:

Nurses identified an increase in phlebitis associated with peripheral amiodarone leading to multiple catheter replacements and interruptions in drug therapy. Central venous access is recommended by the manufacturer but not practical for a short-term infusion based on the risk to the patient, time, and cost.

Methods:

A 4-phased approach was used to identify a more suitable peripheral intravenous catheter.

Interventions:

A collaborative effort between bedside nurses and the vascular access team evolved to look at alternative products for peripheral intravenous catheters.

Results:

The extended dwell peripheral catheter decreased phlebitis from 54% to 5%. It also decreased interruptions in drug therapy and improved patient comfort and satisfaction.

Conclusions:

A practice change was implemented utilizing extended dwell peripheral catheters for intravenous amiodarone and disseminated to other units.
Lived Experience of Medicine Nurses Caring for COVID-19 Patients
Authors: Mohammed Natasha , Lelièvre Hannah
Published: August 2021

Background:

The COVID-19 pandemic has overwhelmed health care systems globally. To understand how health care systems can best support frontline health care providers caring for patients in similar situations, it is necessary to gain insights into their experience.

Purpose:

This quality improvement study explored the lived experience of Canadian frontline medicine nurses caring for COVID-19 patients during the first wave of the pandemic.

Method:

A qualitative interpretive phenomenological approach was conducted. Forty-three eligible nurses participated in semistructured interviews and online surveys. Full transcription and thematic content analysis were performed.

Results:

Three overarching themes were deduced: (1) a traumatic experience, (2) living through the experience, and (3) achieving transcendence.

Conclusion:

Several recommendations were identified. These recommendations aim to aid health care systems in emergency preparation planning and future pandemic responses while supporting frontline health care providers' resilience and well-being.
Seated postural control measure: Italian translation and validation in children with cerebral palsy
Authors: Tofani Marco , Blasetti G Giulia , Lucibello Luca , Sabbadini Maurizio , Berardi Anna , Galeoto Giovanni , Field Debra , Castelli Enrico
Published: August 2021

Background:

Seating interventions are part of the postural management program recommended for children with Cerebral Palsy (CP) who are nonambulatory or have difficulty in walking. The lack of validated outcome measures for assessing seating interventions limits access to obtain valid and comparable data internationally.

Objective:

To translate the Seated Postural Control Measure (SPCM) into Italian and assess reliability and validity of the translated measure in a population of children with CP.

Study design:

Cross-sectional and repeated measures study.

Methods:

The original version of the SPCM was translated and culturally adapted by a multidisciplinary team according to international guidelines. Internal consistency was examined with Cronbach's alpha. Both inter- and intrarater reliabilities were estimated using intraclass correlation coefficients with 95% confidence intervals. Intrarater reliability was estimated over a 1-week period. Convergent construct validity was investigated by comparing SPCM values with the Level of Sitting Scale, the Gross Motor Function Classification System, and the Manual Ability Classification System using Pearson's correlation coefficients.

Results:

The Italian version of the SPCM (IT-SPCM) was evaluated on 72 children with CP aged 4–18 years. Cronbach's alpha was 0.83, 0.95, and 0.93 for IT-SPCM alignment subscale, IT-SPCM functioning subscale, and total score, respectively. Reliability for IT-SPCM total score was high for both inter- and intrarater reliabilities (0.95 and 0.93). The IT-SPCM total score was moderately correlated with the Level of Sitting Scale (0.37), Gross Motor Function Classification System (−0.41), and Manual Ability Classification System (−0.56).

Conclusion:

Preliminary evidence supports the reliability and validity of using IT-SPCM with a population of children with CP.
The Effects of Local Alendronate With or Without Recombinant Human Bone Morphogenetic Protein 2 on Dental Implant Stability and Marginal Bone Level: A Randomized Controlled Study
Authors: Al-Assaf Dhuha A. , Bede Salwan Y.
Published: August 2021

The aim of this study was to evaluate the effects of local application of bisphosphonate gel and recombinant human bone morphogenic protein 2 gel, on titanium dental implant stability and marginal bone level. Twenty-seven patients with upper and lower missing posterior tooth/teeth were included in the study with a total of 71 implants that were used for rehabilitation. The implants were randomly divided into 4 groups: 3 study groups and 1 control. Group1; local application of bisphosphonate gel, group 2; local application of recombinant human bone morphogenic protein 2 gel, group 3; local application of a mixed formula of both gels. The gel application was immediately preimplant insertion, group 4; implant insertion without application of any medication. Using resonance frequency analyzer, implant stability was measured 4 times; primary, 8 weeks (second stage surgery), 12 weeks, and at least 14 weeks post functional loading. The level of the marginal bone around each implant were assessed using cone beam computed tomography. Four implants failed. Generally, there was a similar pattern of changes in implant stability over the study period in all groups and the stability was dependent on the healing time with no significant difference between groups. There was no significant treatment effect regarding marginal bone level differences of study groups against control, although there were significant differences on palatal and mesiodistal surfaces among the study (test) groups.
The Opportunity Cost of Resident Involvement in Adult Craniofacial Surgery: An Analysis of Relative Value Units
Authors: Khetpal Sumun , Phillips Sarah , Parsaei Yassmin , Peck Connor , Lopez Joseph , Prsic Adnan
Published: August 2021

Purpose:

Within the academic surgical setting resident involvement may confer longer operative times. The increasing pressures to maximize clinical productivity and decreasing reimbursement rates, however, may conflict with these principles. This study calculates the opportunity cost of resident involvement in craniofacial surgery.

Methods:

Retrospective analysis was conducted with patients who underwent craniofacial procedures from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012. Patients were selected based on relevant Current Procedural Terminology codes for craniofacial pathologies (ie, trauma, head and neck reconstruction, orthognathic surgery, and facial reanimation). Variables included patient demographics, operative time, and presence or absence of resident trainee. Average relative value units were calculated to determine the opportunity cost of resident involvement for each craniofacial procedure.

Results:

In total, 2096 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012. Resident involvement was associated with a statistically significant higher operative time (P < 0.001) for facial reanimation, facial trauma, orthognathic surgery, and head and neck reconstruction. The opportunity costs per case associated with resident involvement were the highest for head and neck reconstruction ($1468.04), followed by orthognathic surgery ($1247.03), facial trauma ($533.03), and facial reanimation ($358.32). Resident involvement was associated with higher rate of complications for head and neck reconstruction (P < 0.043).

Conclusions:

Resident involvement is associated with longer operative times, higher complications, and higher re-operations, compared to attending exclusive surgical care. Future studies may consider how reimbursements should align incentives to promote resident education and training.
Short-Term Stability After Segmental Le Fort I Maxillary Impaction Surgery With Mandibular Autorotation in Seven High-Angle Class II Patients: A Case Series
Authors: Takahara Namiaki , Tomomatsu Nobuyoshi , Hsieh Diana , Kurasawa Yasuhiro , Morita Kei-ichi , Yoda Tetsuya
Published: August 2021

Purpose:

To retrospectively evaluate skeletal stability after Le Fort I maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy (BSSO) in high-angle class II patients.

Materials and Methods:

Seven female high-angle class II patients who underwent maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy were included in this study. Surgical changes and relapse were measured on lateral cephalograms taken preoperatively and at 1 month, 6 months and 1 year postoperatively.

Results:

The horizontal movement of the maxilla at point A was 5.8 ± 3.3 mm backward, and the upward movement at the posterior nasal spine was 3.3 ± 1.4 mm. The mean horizontal change at point A during the 1-year follow-up period was 0.1 ± 0.2 mm, and the vertical change at posterior nasal spine was 0.2 ± 1.3 mm, which were not statistically significant. The horizontal surgical change at point B was 4.0 ± 1.8 mm forward and the vertical surgical change at point B was 4.7 ± 1.8 mm upward. Postoperative relapse was 10.9% and 13.7% in the horizontal and vertical directions, respectively.

Conclusions:

Le Fort I maxillary impaction surgery with mandibular autorotation may be 1 of the suitable procedures for high-angle class II patients.
Randomized trials on non-pharmaceutical interventions for COVID-19 as of August 2021: a meta-epidemiological analysis
Authors: Hirt Julian , Janiaud Perrine , Hemkens Lars G.
Published: August 2021

Background

Numerous non-pharmaceutical interventions (NPIs) were taken worldwide to contain the spread of the COVID-19 pandemic. We aimed at providing an overview of randomized trials assessing NPIs to prevent COVID-19.

Methods

We included all randomized trials assessing NPIs to prevent COVID-19 in any country and setting registered in ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform using the COVID-evidence platform (until 17 August 2021). We searched for corresponding publications in MEDLINE/PubMed, Google Scholar, the Living Overview of Evidence platform (L-OVE), and the Cochrane COVID-19 registry as well as for results posted in registries.

Results

We identified 41 randomized trials. Of them, 11 were completed (26.8%) including 7 with published results. The 41 trials planned to recruit a median of 1,700 participants (IQR, 588 to 9,500, range 30 to 35,256,399) with a median planned duration of 8 months (IQR, 3 to 14, range 1 to 24). Most came from the United States (n=11, 26.8%). The trials mostly assessed protective equipment (n=11, 26.8%), COVID-19-related information and education programs (n=9, 22.0%), access to mass events under specific safety measures (n=5, 12.2%), testing and screening strategies (n=5, 12.2%), and hygiene management (n=5, 12.2%).

Conclusions

Worldwide, 41 randomized trials assessing NPIs have been initiated with published results available to inform policy decisions for only 7 of them. A long-term research agenda including behavioral, environmental, social, and systems level interventions is urgently needed to guide policies and practices in the current and future public health emergencies.
Localized and Whole-Room Effects of Portable Air Filtration Units on Aerosol Particle Deposition and Concentration in a Classroom Environment
Authors: Kong Meng , Li Linhao , Eilts Stephanie M. , Li Li , Hogan Christopher J. , Pope Zachary C.
Published: August 2021

In indoor environments with limited ventilation, recirculating portable air filtration (PAF) units may reduce COVID-19 infection risk via not only the direct aerosol route (i.e., inhalation) but also via an indirect aerosol route (i.e., contact with the surface where particles deposited). We systematically investigated the impact of PAF units in a mock classroom, as a supplement to background ventilation, on localized and whole-room surface deposition and particle concentration. Fluorescently tagged particles with a volumetric mean diameter near two micrometers were continuously introduced into the classroom environment via a breathing simulator with a prescibed inhalation-exhalation waveform. Deposition velocities were inferred on >50 horizontal and vertical surfaces throughout the classroom, while aerosol concentrations were spatially monitored via optical particle spectrometry. Results revealed a particle decay rate consistent with expectations based upon the reported clean air delivery rates of the PAF units. Additionally, the PAF units reduced peak concentrations by a factor of around 2.5 compared to the highest concentrations observed and led to a statistically significant reduction in deposition velocities for horizontal surfaces >2.5 m from the aerosol source. Our results not only confirm PAF units can reduce particle concentrations but also demonstrate that they may lead to reduced particle deposition throughout an indoor environment when properly positioned.

Practical Implications

Portable air filtration units should be prioritized in classrooms as part of a multi-layed strategy to mitigate potentially infectious particle transmission by direct aerosol transmission via inhalation and indirect aerosol transmission via particle deposition to surfaces and later contact with said surfaces.

When placing portable air filtration unit(s) within a classrom space, one should consider the airflow field within the classroom, the characteristic operational mode (heating vs. cooling) of the heating, ventilation, and air conditioning system, the predominantly occupied areas of the classroom, and interference with the regular teaching and learning activities.
Predictive factors of response to 3rd dose of COVID-19 mRNA vaccine in kidney transplant recipients
Authors: Charmetant Xavier , Espi Maxime , Barba Thomas , Ovize Anne , Morelon Emmanuel , Thaunat Olivier
Published: August 2021

Only a minority of kidney transplant recipients (KTRs) develop protective neutralizing titers of anti-receptor binding domain of spike protein (RBD) IgG after two doses of mRNA COVID-19 vaccine. Administration of a third dose of mRNA vaccine to KTRs with sub-optimal response increase anti-RBD IgG titers but with high inter-individual variability. Patients with the higher response rate to the third dose of vaccine can be identified by the presence of low anti-RBD IgG titers and spike-specific CD4+ T cells in their circulation 14 days after the second dose.
CLINICAL OPPORTUNITIES FOR GERMLINE PHARMACOGENETICS AND MANAGEMENT OF DRUG-DRUG INTERACTIONS IN PATIENTS WITH ADVANCED SOLID CANCERS
Authors: Shugg Tyler , Ly Reynold C. , Rowe Elizabeth J. , Philips Santosh , Hyder Mustafa A. , Radovich Milan , Rosenman Marc B. , Pratt Victoria M. , Callaghan John T. , Desta Zeruesenay , Schneider Bryan P. , Skaar Todd C.
Published: August 2021

PURPOSE

Precision medicine approaches, including germline pharmacogenetics (PGx) and management of drug-drug interactions (DDIs), are likely to benefit advanced cancer patients who are frequently prescribed multiple concomitant medications to treat cancer and associated conditions. Our objective was to assess the potential opportunities for PGx and DDI management within a cohort of adults with advanced cancer.

PATIENTS AND METHODS

Medication data were collected from the electronic health records (EHRs) for 481 subjects since their first cancer diagnosis. All subjects were genotyped for variants with clinically actionable recommendations in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for 13 pharmacogenes. DDIs were defined as concomitant prescription of strong inhibitors or inducers with sensitive substrates of the same drug-metabolizing enzyme and were assessed for six major cytochrome P450 (CYP) enzymes.

RESULTS

Approximately 60% of subjects were prescribed at least one medication with CPIC recommendations, and ∼14% of subjects had an instance for actionable PGx, defined as prescription of a drug in a subject with an actionable genotype. The overall subject-level prevalence of DDIs and serious DDIs were 50.3% and 34.8%, respectively. Serious DDIs were most common for CYP3A, CYP2D6, and CYP2C19, occurring in 24.9%, 16.8%, and 11.7% of subjects, respectively. When assessing PGx and DDIs together, ∼40% of subjects had at least one opportunity for a precision medicine-based intervention and ∼98% of subjects had an actionable phenotype for at least one CYP enzyme.

CONCLUSION

Our findings demonstrate numerous clinical opportunities for germline PGx and DDI management in adults with advanced cancer.
Waning immunity of the BNT162b2 vaccine: A nationwide study from Israel
Authors: Goldberg Yair , Mandel Micha , Bar-On Yinon M. , Bodenheimer Omri , Freedman Laurence , Haas Eric J. , Milo Ron , Alroy-Preis Sharon , Ash Nachman , Huppert Amit
Published: August 2021

Background

Starting December 2020, Israel began a mass vaccination campaign against coronavirus administering the Pfizer BNT162b2 vaccine, which led to a sharp curtailing of the outbreak. After a period with almost no SARS-CoV-2 infections, a resurgent COVID-19 outbreak initiated mid June 2021. Possible reasons for the breakthrough were reduced vaccine effectiveness against the Delta variant, and waning immunity. The aim of this study was to quantify the extent of waning immunity using Israel’s national-database.

Methods

Data on all PCR positive test results between July 11-31, 2021 of Israeli residents who became fully vaccinated before June 2021 were used in this analysis. Infection rates and severe COVID-19 outcomes were compared between individuals who were vaccinated in different time periods using a Poisson regression, stratifying by age group and adjusting for possible confounding factors.

Results

The rates of both documented SARS-CoV-2 infections and severe COVID-19 exhibit a statistically significant increase as time from second vaccine dose elapsed. Elderly individuals (60+) who received their second dose in March 2021 were 1.6 (CI: [1.3, 2]) times more protected against infection and 1.7 (CI: [1.0, 2.7]) times more protected against severe COVID-19 compared to those who received their second dose in January 2021. Similar results were found for different age groups.

Conclusions

These results indicate a strong effect of waning immunity in all age groups after six months. Quantifying the effect of waning immunity on vaccine effectiveness is critical for policy makers worldwide facing the dilemma of administering booster vaccinations.
Analysis of Mutational Profile of Hypopharyngeal and Laryngeal Head and Neck Cancers Identifies KMT2C as a Potential Tumor Suppressor
Authors: Machnicki Marcin M. , Rzepakowska Anna , Janowska Joanna I. , Pepek Monika , Krop Alicja , Pruszczyk Katarzyna , Stawinski Piotr , Rydzanicz Malgorzata , Grzybowski Jakub , Gornicka Barbara , Wnuk Maciej , Ploski Rafal , Osuch-Wojcikiewicz Ewa , Stoklosa Tomasz
Published: August 2021

Hypopharyngeal cancer represents one of worst types of head and neck tumors with only few studies focusing on the genomic profile of this type of cancer. Using targeted next-generation sequencing we analyzed 48 HPV-negative tumor samples including 23 originating from hypopharynx, and 25 from larynx. Among genes previously described as significantly mutated, TP53, FAT1, NOTCH1, KMT2C and CDKN2A were found to be most frequently mutated. We also found that more than three-fourths of our patients harbored candidate actionable or prognostic alterations in genes belonging to RTK/ERK/PI3K, cell-cycle and DNA-damage repair pathways. Using previously published data we compared 67 hypopharyngeal cancers to 595 head and neck cancers from other sites and found no prominent differences in mutational frequency except for CASP8 and HRAS genes. Since we observed relatively frequent mutations of KTM2C (MLL3) in our dataset, we analyzed their role in vitro by generating KMT2C-mutant hypopharyngeal cancer cell line FaDu with CRISPR-Cas9. We demonstrate that KMT2C loss-of-function results in increased colony formation and proliferation, in concordance with its previously published results. In summary, our results show that mutational profile of hypopharyngeal cancers might be similar to the one observed for other head and neck cancers with respect to minor differences and includes multiple candidate actionable and prognostic genetic alterations. We also demonstrate for the first time that KMT2C gene may play a role of tumor suppressor in head and neck cancer, which opens new possibilities in the search for new targeted treatment approaches.
Policy-relevant indicators for invasive alien species assessment and reporting
Authors: McGeoch Melodie A. , Arlé Eduardo , Belmaker Jonathan , Buba Yehezkel , Clarke David A. , Essl Franz , García-Berthou Emili , Groom Quentin , Henriksen Marie V. , Jetz Walter , Kühn Ingolf , Lenzner Bernd , Meyer Carsten , Pagad Shyama , Pili Arman , Roigé Mariona , Seebens Hanno , Tingley Reid , Vicente Joana R. , Wilson John R.U. , Winter Marten
Published: August 2021

Invasive alien species are repeatedly shown to be amongst the top threats to biodiversity globally. Robust indicators for measuring the status and trends of biological invasions are lacking, but essential for monitoring biological invasions and the effectiveness of interventions. Here, we formulate and demonstrate three such indicators that capture the key dimensions of species invasions, each a significant and necessary advance to inform invasive alien species policy targets: 1) Rate of Invasive Alien Species Spread, which provides modelled rates of ongoing introductions of species based on invasion discovery and reporting. 2) Impact Risk, that estimates invasive alien species impacts on the environment in space and time and provides a basis for nationally targeted prioritization of where best to invest in management efforts. 3) Status Information on invasive alien species, that tracks improvement in the essential dimensions of information needed to guide relevant policy and data collection and in support of assessing invasive alien species spread and impact. We show how proximal, model-informed status and trend indicators on invasive alien species can provide more effective global (and national) reporting on biological invasions, and how countries can contribute to supporting these indicators.
Evaluation of Residual Disinfectant Levels in Public Drinking Water Distribution Systems in Relation to anAcanthamoebaKeratitis Outbreak—Illinois 2002–2009
Authors: Holsinger Hannah , Blackstock Anna , Shaw Susan , Roy Sharon L.
Published: August 2021

Acanthamoebakeratitis (AK) is a painful, potentially blinding eye disease associated with contact lens use and corneal injury. AK, caused by the free-living amoebaAcanthamoeba, is ubiquitous in the environment and has been isolated from municipal water supplies. It can be tolerant of normal chlorine levels in drinking water. An AK outbreak investigated in 2003–2005 in five Illinois counties showed a lower AK age-standardized rate ratio in Cook County than in surrounding counties and was hypothesized to be due in part to reductions in residual disinfectant levels (RDLs) in drinking water. We evaluated RDLs in public water systems in the same five Illinois counties over eight years (2002–2009) using a multivariable model of water system RDL measurements. Fitted RDLs for each county were in the acceptable range by United States Environmental Protection Agency standards for the entire study period. After correcting for multiple testing, two of the surrounding counties had fitted RDLs that differed from Cook County for one year—this pattern differed from the epidemiologic pattern of cases observed in the AK outbreak. Our findings do not support the hypothesis that the development of AK was associated with changes in RDLs in the five Illinois counties.