bluuebunny/crossref_metadata_2025 huggingface dataset:
From strongyloidiasis to disseminated mucormycosis: the story of an HTLV-1-infected migrant
Authors: Autier Brice , Chesnay Adélaïde , Mayence Claire , Houcke Stéphanie , Guégan Hélène , Demar Magalie , Blanchet Denis
Published: December 2020

Strongyloidiasis manifestations range from asymptomatic cases to the life-threatening disseminated strongyloidiasis in case of immune deficiency: larvae migrate throughout the body, disseminating germs from the digestive flora to various organs. Here, we described a case of disseminated mucormycosis consecutive to Strongyloides stercoralis hyperinfestation in a Surinamese migrant infected with HTLV-1.
Determining the Hubble constant without the sound horizon scale: measurements from CMB lensing
Authors: Baxter Eric J , Sherwin Blake D
Published: December 2020

Measurements of the Hubble constant, H0, from the cosmic distance ladder are currently in tension with the value inferred from Planck observations of the cosmic microwave background (CMB) and other high-redshift data sets if a flat Λ cold dark matter (ΛCDM) cosmological model is assumed. One of the few promising theoretical resolutions of this tension is to invoke new physics that changes the sound horizon scale in the early Universe; this can bring CMB and baryon acoustic oscillations (BAO) constraints on H0 into better agreement with local measurements. In this paper, we discuss how a measurement of the Hubble constant can be made from the CMB without using information from the sound horizon scale, rs. In particular, we show how measurements of the CMB lensing power spectrum can place interesting constraints on H0 when combined with measurements of either supernovae or galaxy weak lensing, which constrain the matter density parameter. The constraints arise from the sensitivity of the CMB lensing power spectrum to the horizon scale at matter–radiation equality (in projection); this scale could have a different dependence on new physics than the sound horizon. From an analysis of current CMB lensing data from Planck and Pantheon supernovae with conservative external priors, we derive an rs-independent constraint of $H_0 = 73.5\pm 5.3\, {\rm km}\,{\rm s}^{-1}\,{\rm Mpc}^{-1}$. Forecasts for future CMB surveys indicate that improving constraints beyond an error of $\sigma (H_0) = 3\, {\rm km}\,{\rm s}^{-1}\,{\rm Mpc}^{-1}$ will be difficult with CMB lensing, although applying similar methods to the galaxy power spectrum may allow for further improvements.
Active galactic nucleus feedback in an elliptical galaxy with the most updated AGN physics: Parameter explorations
Authors: Yao Zhiyuan , Yuan Feng , Ostriker Jeremiah P
Published: December 2020

In a previous work, we have proposed a sub-grid model of active galactic nucleus (AGN) feedback by taking into account the state-of-the-art AGN physics, and used that model to study the effect of AGN feedback on the evolution of an isolated elliptical galaxy by performing 2D high-resolution (i.e. the Bondi radius is well resolved) simulations. In that work, typical values of model parameters were adopted. In this work, we extend that study by exploring the effects of uncertainties of parameter values. Such a study is also useful for us to understand the respective roles of various components of the model. These parameters include the mass flux and velocity of AGN wind and radiative efficiency in both the hot and cold feedback modes, and the initial black hole (BH) mass. We find that the velocity of AGN wind in the hot mode is the most important quantity to control the typical accretion rate and luminosity of AGN, and the mass growth of the BH. The effect of the wind on star formation is less sensitive. Within the limited parameter range explored in this work, a stronger AGN wind suppresses star formation within ∼100 pc but enhances star formation beyond this radius, while the star formation integrated over the evolution time and the whole galaxy roughly remain unchanged. AGN radiation suppresses the BH accretion in a mild way, but dust is not considered here. Finally, a smaller initial BH mass results in a more violent evolution of the BH accretion rate. The corresponding AGN spends more time in the high-luminosity state and the percentage of BH mass growth is higher. Our results indicate the robustness of AGN feedback in keeping the galaxy quenched.
From hydrodynamics to N-body simulations of star clusters: mergers and rotation
Authors: Ballone Alessandro , Torniamenti Stefano , Mapelli Michela , Di Carlo Ugo N , Spera Mario , Rastello Sara , Gaspari Nicola , Iorio Giuliano
Published: December 2020

We present a new method to obtain more realistic initial conditions for N-body simulations of young star clusters. We start from the outputs of hydrodynamical simulations of molecular cloud collapse, in which star formation is modelled with sink particles. In our approach, we instantaneously remove gas from these hydrodynamical simulation outputs to mock the end of the gas-embedded phase, induced by stellar feedback. We then enforce a realistic initial mass function by splitting or joining the sink particles based on their mass and position. Such initial conditions contain more consistent information on the spatial distribution and the kinematical and dynamical states of young star clusters, which are fundamental to properly study these systems. For example, by applying our method to a set of previously run hydrodynamical simulations, we found that the early evolution of young star clusters is affected by gas removal and by the early dry merging of sub-structures. This early evolution can either quickly erase the rotation acquired by our (sub-)clusters in their embedded phase or ‘fuel’ it by feeding of angular momentum by sub-structure mergers, before two-body relaxation acts on longer time-scales
A deafness-associated tRNA mutation caused pleiotropic effects on the m1G37 modification, processing, stability and aminoacylation of tRNAIle and mitochondrial translation
Authors: Meng Feilong , Zhou Mi , Xiao Yun , Mao Xiaoting , Zheng Jing , Lin Jiaxi , Lin Tianxiang , Ye Zhenzhen , Cang Xiaohui , Fu Yong , Wang Meng , Guan Min-Xin
Published: December 2020

Defects in the posttranscriptional modifications of mitochondrial tRNAs have been linked to human diseases, but their pathophysiology remains elusive. In this report, we investigated the molecular mechanism underlying a deafness-associated tRNAIle 4295A>G mutation affecting a highly conserved adenosine at position 37, 3′ adjacent to the tRNA’s anticodon. Primer extension and methylation activity assays revealed that the m.4295A>G mutation introduced a tRNA methyltransferase 5 (TRMT5)-catalyzed m1G37 modification of tRNAIle. Molecular dynamics simulations suggested that the m.4295A>G mutation affected tRNAIle structure and function, supported by increased melting temperature, conformational changes and instability of mutated tRNA. An in vitro processing experiment revealed that the m.4295A>G mutation reduced the 5′ end processing efficiency of tRNAIle precursors, catalyzed by RNase P. We demonstrated that cybrid cell lines carrying the m.4295A>G mutation exhibited significant alterations in aminoacylation and steady-state levels of tRNAIle. The aberrant tRNA metabolism resulted in the impairment of mitochondrial translation, respiratory deficiency, decreasing membrane potentials and ATP production, increasing production of reactive oxygen species and promoting autophagy. These demonstrated the pleiotropic effects of m.4295A>G mutation on tRNAIle and mitochondrial functions. Our findings highlighted the essential role of deficient posttranscriptional modifications in the structure and function of tRNA and their pathogenic consequence of deafness.
Neurophysiologic Mapping of Thalamocortical Tract in Asleep Craniotomies: Promising Results From an Early Experience
Authors: Simon Mirela V , Lee Daniel K , Choi Bryan D , Talati Pratik A , Yang Jimmy C , Koch Matthew J , Jones Pamela S , Curry William T
Published: December 2020

BACKGROUND

Subcortical mapping of the corticospinal tract has been extensively used during craniotomies under general anesthesia to achieve maximal resection while avoiding postoperative motor deficits. To our knowledge, similar methods to map the thalamocortical tract (TCT) have not yet been developed.

OBJECTIVE

To describe a neurophysiologic technique for TCT identification in 2 patients who underwent resection of frontoparietal lesions.

METHODS

The central sulcus (CS) was identified using the somatosensory evoked potentials (SSEP) phase reversal technique. Furthermore, monitoring of the cortical postcentral N20 and precentral P22 potentials was performed during resection. Subcortical electrical stimulation in the resection cavity was done using the multipulse train (case #1) and Penfield (case #2) techniques.

RESULTS

Subcortical stimulation within the postcentral gyrus (case #1) and in depth of the CS (case #2), resulted in a sudden drop in amplitudes in N20 (case #1) and P22 (case #2), respectively. In both patients, the potentials promptly recovered once the stimulation was stopped. These results led to redirection of the surgical plane with avoidance of damage of thalamocortical input to the primary somatosensory (case #1) and motor regions (case #2). At the end of the resection, there were no significant changes in the median SSEP. Both patients had no new long-term postoperative sensory or motor deficit.

CONCLUSION

This method allows identification of TCT in craniotomies under general anesthesia. Such input is essential not only for preservation of sensory function but also for feedback modulation of motor activity.
Biodegradable metals for bone fracture repair in animal models: a systematic review
Authors: Zhang Jiazhen , Shang Zhizhong , Jiang Yanbiao , Zhang Kui , Li Xinggang , Ma Minglong , Li Yongjun , Ma Bin
Published: December 2020

Biodegradable metals hold promises for bone fracture repair. Their clinical translation requires pre-clinical evaluations including animal studies, which demonstrate the safety and performance of such materials prior to clinical trials. This evidence-based study investigates and analyzes the performance of bone fractures repair as well as degradation properties of biodegradable metals in animal models. Data were carefully collected after identification of population, interventions, comparisons, outcomes and study design, as well as inclusion criteria combining biodegradable metals and animal study. Twelve publications on pure Mg, Mg alloys and Zn alloys were finally included and reviewed after extraction from a collected database of 2122 publications. Compared to controls of traditional non-degradable metals or resorbable polymers, biodegradable metals showed mixed or contradictory outcomes of fracture repair and degradation in animal models. Although quantitative meta-analysis cannot be conducted because of the data heterogeneity, this systematic review revealed that the quality of evidence for biodegradable metals to repair bone fractures in animal models is ‘very low’. Recommendations to standardize the animal studies of biodegradable metals were proposed. Evidence-based biomaterials research could help to both identify reliable scientific evidence and ensure future clinical translation of biodegradable metals for bone fracture repair.
Enhancing the mechanical properties and cytocompatibility of magnesium potassium phosphate cement by incorporating oxygen-carboxymethyl chitosan
Authors: Gong Changtian , Fang Shuo , Xia Kezhou , Chen Jingteng , Guo Liangyu , Guo Weichun
Published: December 2020

Incorporating bioactive substances into synthetic bioceramic scaffolds is challenging. In this work, oxygen-carboxymethyl chitosan (O-CMC), a natural biopolymer that is nontoxic, biodegradable and biocompatible, was introduced into magnesium potassium phosphate cement (K-struvite) to enhance its mechanical properties and cytocompatibility. This study aimed to develop O-CMC/magnesium potassium phosphate composite bone cement (OMPC), thereby combining the optimum bioactivity of O-CMC with the extraordinary self-setting properties and mechanical intensity of the K-struvite. Our results indicated that O-CMC incorporation increased the compressive strength and setting time of K-struvite and decreased its porosity and pH value. Furthermore, OMPC scaffolds remarkably improved the proliferation, adhesion and osteogenesis related differentiation of MC3T3-E1 cells. Therefore, O-CMC introduced suitable physicochemical properties to K-struvite and enhanced its cytocompatibility for use in bone regeneration.
Adverse Selection in the Marriage Market: HIV Testing and Marriage in Rural Malawi
Authors: Angelucci Manuela , Bennett Daniel
Published: December 2020

Asymmetric information in the marriage market may cause adverse selection and delay marriage if partner quality is revealed over time. Sexual safety is an important but hidden partner attribute, especially in areas where HIV is endemic. A model of positive assortative matching with both observable (attractiveness) and hidden (sexual safety) attributes predicts that removing the asymmetric information about sexual safety accelerates marriage and pregnancy for safe respondents, and more so if they are also attractive. Frequent HIV testing may enable safe people to signal and screen. Consistent with these predictions, we show that a high-frequency, “opt-out” HIV testing intervention changed beliefs about partner’s safety and accelerated marriage and pregnancy, increasing the probabilities of marriage and pregnancy by 26 and 27$\%$ for baseline-unmarried women over 28 months. Estimates are larger for safe and attractive respondents. Conversely, a single-test intervention lacks these effects, consistent with other HIV testing evaluations in the literature. Our findings suggest that an endogenous response to HIV risk may explain why the HIV/AIDS epidemic has coincided with systematic marriage and pregnancy delays.
A Triple Threat: Parents in Recovery During COVID-19
Authors: Clark Maria Carolina , Buswell Jessica , Gold Claudia , Peacock-Chambers Elizabeth
Published: December 2020

In this commentary, we describe the triple threat that parents in recovery face during the COVID-19 pandemic due to the loss of social support. We explore how the absence of human connection during the pandemic can be detrimental to parents in recovery as well as the parent-child relationship. We conclude by proposing strategies to offer critical support for families as this period of social isolation extends and the effects become increasingly apparent.
Risk of Clinically Significant Chromosomal Microarray Analysis Findings in Fetuses With Nuchal Translucency From 3.0 mm Through 3.4 mm
Authors: Sagi-Dain Lena , Singer Amihood , Ben Shachar Shay , Josefsberg Ben Yehoshua Sagi , Feingold-Zadok Michal , Greenbaum Lior , Maya Idit
Published: December 2020

OBJECTIVE:

To examine the risk of clinically significant chromosomal microarray analysis findings in fetuses with nuchal translucency from 3.0–3.4 mm. In addition, we aimed to define the yield of noninvasive prenatal testing (NIPT) in such pregnancies.

METHODS:

This retrospective cohort study included results of all chromosomal microarray analysis tests performed owing to a nuchal translucency measurement from 3.0–3.4 mm, without ultrasonographic anomalies, retrieved from the Israeli Ministry of Health computerized database. Rates of clinically significant (pathogenic and likely pathogenic) microarray findings were compared with a previously published local control population, encompassing 2,752 fetuses with normal ultrasound findings and nuchal translucency less than 3.0 mm.

RESULTS:

Overall, 619 chromosomal microarray analyses were performed owing to isolated nuchal translucency from 3.0–3.4 mm. Of these, 29 (4.7%) cases had clinically significant copy number variants, a significantly higher risk compared with control-group pregnancies (relative risk 3.3, 95% CI 2.6–7.2). Divided by tenths of millimeters, the risk for abnormal chromosomal microarray analysis findings remained significantly increased, except for the subgroup of 198 fetuses with nuchal translucency measurements of 3.0 mm. Noninvasive prenatal testing for the five common chromosome aneuploidies would have missed 41.4% of the abnormal copy number variants—1.9% of overall cases, or 1 in 52 fetuses with nuchal translucency from 3–3.4 mm. Genome-wide NIPT, as well as traditional karyotyping, could have missed an abnormal finding in 9 of 619 (1.5%), or 1 in 69 fetuses.

CONCLUSION:

Our outcomes show that the rate of abnormal chromosomal microarray analysis findings in fetuses with nuchal translucency from 3.1–3.4 mm is significantly higher compared with fetuses with normal ultrasound findings.
Placenta Accreta Spectrum Among Women With Twin Gestations
Authors: Miller Hayley E. , Leonard Stephanie A. , Fox Karin A. , Carusi Daniela A. , Lyell Deirdre J.
Published: December 2020

OBJECTIVE:

To assess whether placenta accreta spectrum occurs more frequently among women with twin gestations compared with singleton gestations.

METHODS:

All live births in California from 2016 to 2017 were identified from previously linked records of birth certificates and birth hospitalization discharges. The primary outcome was placenta accreta spectrum (which includes placenta accreta, increta, and percreta), identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes (O43.2x) for placenta accreta, increta, and percreta. We analyzed the association between twin gestation and placenta accreta spectrum by using multivariable logistic regression and assessed whether our findings were replicated by using a previously validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)–based approach.

RESULTS:

Among 918,452 live births, 1,126 were diagnosed with placenta accreta spectrum. The prevalence of placenta accreta spectrum was 11.8 per 10,000 among singleton pregnancies and 41.6 per 10,000 among twin pregnancies. In the unadjusted regression analysis, twin pregnancy was associated with higher relative risk of placenta accreta spectrum (RR 3.41, 95% CI 2.57–4.52). After adjusting the regression model for maternal age, previous cesarean birth, and sociodemographic factors, the association held with higher relative risk of placenta accreta spectrum (aRR 2.96, 95% CI 2.23–3.93). Women with twin compared with singleton gestations with placenta accreta spectrum were less likely to have placenta previa. When assessed using ICD-9-CM codes, placenta accreta spectrum was similarly more prevalent among twins than singletons, with an increase in the relative risk of placenta accreta spectrum (aRR 2.45, 95% CI 2.33–3.25).

CONCLUSION:

Twin gestation conferred an increased risk for placenta accreta spectrum independent of measured risk factors, which may contribute to increased maternal morbidity in twin gestation compared with singleton gestation. Clinicians should be aware of the increased risk for placenta accreta spectrum in twin gestation and should consider it during ultrasonographic screening.
Transcutaneous Electrical Nerve Stimulation to Reduce Pain With Medication Abortion
Authors: Goldman Ariella R. , Porsch Lauren , Hintermeister Abigail , Dragoman Monica
Published: December 2020

OBJECTIVE:

To evaluate whether high-frequency transcutaneous electrical nerve stimulation (hfTENS) reduces pain during medication abortion.

METHODS:

We conducted a randomized, placebo-controlled trial. Participants who were undergoing medication abortion with mifepristone and misoprostol through 70 days of gestation either received active 80 Hz hfTENS or sham to use for a minimum of 60 minutes within 8 hours of misoprostol. Maximum pain on an 11-point numerical rating scale at 8 hours after misoprostol was the primary outcome. We estimated 20 per group for 80% power to detect a 2-point difference and up to 10% attrition. Secondary outcomes included a maximum pain score at 24 hours, additional analgesia use, the difference in score before and after treatment, the experience of side effects, abortion outcomes, and acceptability. We collected data at baseline, time of misoprostol (0-hour), 8-hour and 24 hours using real-time electronic surveys, and at follow-up.

RESULTS:

Between June 2019 and March 2020, we screened 251 patients and randomized 40—20 each to hfTENS or sham—with one postrandomization exclusion and two patients lost to follow-up. Baseline characteristics were similar. Median maximum pain scores at 8 hours were 7.0 (interquartile range 3.0) and 10.0 (interquartile range 3.0) for hfTENS and sham, respectively. The distribution of these scores was lower among hfTENS users compared with sham (mean rank 15.17 vs 22.63, P=.036). High-frequency TENS users also experienced a significant reduction in posttreatment pain score (−2.0 [interquartile range 2.5] vs 0 [interquartile range 1.5], P=.008). We found no statistically significant differences in use of additional analgesia, distribution of maximum pain scores at 24 hours, side effects, or measures of acceptability.

CONCLUSION:

High-frequency TENS reduced maximum pain scores within 8 hours of misoprostol and reduced pain scores immediately after treatment compared with placebo. High-frequency TENS offers an effective nonpharmacologic option for pain management during medication abortion.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03925129.
Thoracolumbar Burst Fracture: McCormack Load-sharing Classification
Authors: Filgueira Ériko Gonçalves , Imoto Aline Mizusaki , da Silva Helbert Eustáquio Cardoso , Meves Robert
Published: December 2020

Study Design.

A systematic review and single-arm meta-analysis of randomized clinical trials.

Objective.

The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF).

Summary of Background Data.

There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures.

Methods.

On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I
2 and τ2 statistics.

Results.

The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I
2 = 77%, τ2 < 0.0015, P < 0.01).

Conclusion.

Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.

Level of Evidence: 1
Vertebral Artery Variation in Patients With Congenital Cervical Scoliosis
Authors: Xia Tian , Sun Yu , Wang Shaobo , Zhang Fengshan , Zhang Li , Pan Shengfa , Diao Yinze , Chen Xin , Zhou Feifei , Zhao Yanbin
Published: December 2020

Study Design.

Observational, anatomical, radiological study.

Objective.

The aim of this study was to explore the incidence and type of vertebral artery (VA) variation in patients with congenital cervical scoliosis and approach their clinical importance during surgery.

Summary of Background Data.

Congenital scoliosis of the cervical spine is usually sporadic and caused by a variety of bone structural anomalies. Most of the cases remain asymptomatic. Surgical intervention is the main management for patients with neurological compromise or with cosmetic demands. The operation involved more screw insertion and osteotomy than the regular degenerative cases. The incidence and pattern of VA variants in these patients have not been reported.

Methods.

Patients with congenital cervical scoliosis treated in our department were reviewed. We measured Cobb angle of cervical spine. We observed bilateral VAs and recorded variants. We measured their diameter in each segment through CT angiography. The bilateral diameter in each patient was then compared respectively.

Result.

There is a total of 44 patients enrolled. The incidence of VA variation was 41% (18/44). Fifty percent (22/44) of patients had the dominant VA with no difference between concave side and convex side. Patients with a dominant VA had a larger Cobb angle than those who had not (30.25° vs. 23.24°, P < 0.05). The courses of VA were abnormal in 18 patients. Two patients had unilateral variant in V1 segment. Twelve patients had variants in V2 segment. Eight patients had variants in V3 segment. Three patients had VA variants in multiple sites.

Conclusion.

In patients with congenital cervical scoliosis, the dominance of VA is not related to the convex side or concave side, but patients with a dominance of VA have a larger Cobb angle. The incidence of variant in V2 and V3 segment is higher. A thorough evaluation of bilateral VAs is required before surgery. Extra cautions must be taken during surgery.

Level of Evidence: 5
Predictive Value of the Spinal Instability Neoplastic Score for Survival and Ambulatory Function After Surgery for Metastatic Spinal Cord Compression in 110 Patients with Prostate Cancer
Authors: Wänman Johan , Jernberg Johannes , Gustafsson Patrik , Abul-Kasim Kasim , Grabowski Pawel , Bobinski Lukas , Crnalic Sead
Published: December 2020

Study Design..

We retrospectively analyzed Spinal Instability Neoplastic Score (SINS) in 110 patients with prostate cancer operated for metastatic spinal cord compression (MSCC).

Objective..

We aimed to investigate the association between SINS and clinical outcomes after surgery for MSCC in patients with prostate cancer.

Summary of Background Data..

The SINS is a useful tool for assessing tumor-related spinal instability, but its prognostic value regarding survival and neurological outcome is still controversial.

Methods..

We analyzed 110 consecutive patients with prostate cancer who underwent surgery for MSCC. The patients were categorized according to their SINS. Patients with castration-resistant prostate cancer (CRPC, n = 84) and those with hormone-naïve disease (n = 26) were analyzed separately.

Results..

In total, 106 of 110 patients met the SINS criteria for potential instability or instability (scores 7–18). The median SINS was 10 (range 6–15) for patients with CRPC and 9 (7–16) for hormone-naïve patients. In the CRPC group, the SINS was classified as stable (score 0–6) in 4 patients, as potentially unstable (score 7–12) in 70 patients, and as unstable (score 13–18) in 10 patients. In the hormone-naïve group, 22 patients met the SINS criteria for potential instability and 4 patients for instability. There was no statistically significant difference in the overall risk for death between the SINS potentially unstable and unstable categories (adjusted hazard ratio 1.3, P = 0.4), or in the risk of loss of ambulation 1 month after surgery (adjusted odds ratio 1.4, P = 0.6).

Conclusion..

The SINS is helpful in assessing spinal instability when selecting patients for surgery, but it does not predict survival or neurological outcomes. Patients with a potential spinal instability benefit equally from surgery for MSCC as do patients with spinal instability.

Level of Evidence: 3
Cancer mortality and predictions for 2020 in selected Australasian countries, Russia and Ukraine
Authors: Pizzato Margherita , Carioli Greta , Bertuccio Paola , Malvezzi Matteo , Levi Fabio , Boffetta Paolo , Negri Eva , La Vecchia Carlo
Published: December 2020

Objectives

Predicted cancer mortality figures are useful for public health planning. We predicted cancer mortality rates in Israel, Hong Kong, Japan, the Philippines, Korea, Australia, Russia and Ukraine for the year 2020 using the most recent available data. We focused on breast cancer.

Methods

We obtained cancer death certification and population data from the WHO and the United Nations Population Division databases. We derived figures for 10 major cancer sites and total cancers over 1970–2017. We predicted numbers of deaths and age-standardized mortality rates for 2020 through joinpoint regression models. We calculated the number of avoided deaths from 1994–2020.

Results

Overall, total cancer mortality is predicted to decline. Russia had the highest all cancers rates in 2020, 151.9/100 000 men and 79.6 women; the Philippines had the lowest rate in men, 78.0/100 000, Korea in women, 47.5. Stomach cancer rates declined over the whole period in all countries considered, colorectal cancer since the late 1990s. Trends for pancreas were inconsistent. Predicted rates for lung and breast cancer were favourable; women from Hong Kong, Korea and Australia had lung cancer death rates higher than breast ones. Predicted rates for uterine, ovarian, prostate and bladder cancers and leukaemias were downward for most countries. Between 1994 and 2020, over 3.3 million cancer deaths were avoided in the considered countries, except for the Philippines where no reduction was observed.

Conclusion

Predicted cancer rates were lower than in the European Union and the USA, even though falls started later and were less marked.
Generation of Filler Emboli as a Mechanism for Filler-Related Blindness
Authors: Ugradar Shoaib , Diniz Stefania , Hoenig Jonathan , Goldberg Robert A.
Published: December 2020

BACKGROUND

Intra-arterial injection of fillers can lead to occlusion of the ophthalmic artery or its branches supplying the retina or the optic nerve. The mechanism through which this occurs is incompletely understood. We investigated the possibility of generating microparticles after injecting commercially available fillers into a flowing system in vitro.

METHODS

Three hyaluronic acid fillers and one calcium hydroxylapatite filler were injected into an artificial saline flow system mimicking arterial systolic blood pressure and corresponding to the diameter of the facial artery. All the saline at the end of the tube was collected, centrifuged, and inspected for filler particles.

RESULTS

After injection into the system, all fillers immediately disintegrated into small particles that were carried downstream with the flow of the saline. The saline at the end of the tube contained collections of filler.

CONCLUSION

Hyaluronic acid and hydroxylapatite fillers break up into small particles immediately after injection into a flowing system, generating emboli rather than a column of filler. The results of this study lead us to hypothesize another potential mechanism leading to filler-related blindness.
Virtual learning in global surgery: current strategies and adaptation for the COVID-19 pandemic
Authors: Joos Emilie , Zivkovic Irena , Shariff Farhana
Published: December 2020

Modern surgical education has shifted to include technology as an integral component of training programs. The onset of the COVID-19 pandemic highlights the need to identify currently training modalities in global surgery and to delineate how these can be best used given the shift of global surgical training to the virtual setting. Here, we conducted a rapid review of the MEDLINE database examining the current status of training modalities in global surgical training programs and presented a case study of a virtual learning course on providing safe surgical care in the time of a pandemic. Our rapid review identified 285 publications, of which 101 were included in our analysis. Most articles describe training in high income country environments (87%, 88/101). The principal training modality described is apprenticeship (46%, 46/101), followed by simulation training (37%, 37/101), and virtual learning strategies (14%, 14/101). Our focused case study describes a virtual course entitled “Safe Surgical Care: Strategies During Pandemics,” created at the University of British Columbia by E.J., published 1-month postdeclaration of the pandemic. This multimodal course was rolled-out over a 5-week period and had significant engagement on an international level, with 1944 participants from 105 countries. With in-person training decreased as a result of the pandemic, virtual reality, virtual simulation, and telementoring may serve to bridge this gap. We propose that virtual learning strategies be integrated into global surgical training through the pursuit of increased accessibility, incorporation of telementoring, and inclusion in national health policy.
Home-Based Versus Outpatient-Based Cardiac Rehabilitation Post–Coronary Artery Bypass Graft Surgery
Authors: Takroni Mohammed A. , Thow Morag , Ellis Brian , Seenan Christopher
Published: December 2020

Background

The prevalence of coronary heart disease continues to increase in the Kingdom of Saudi Arabia (KSA). Despite advances in cardiac surgery, there are no established outpatient cardiac rehabilitation programs in the KSA.

Objective

The aim of this study was to investigate the effectiveness of home-based cardiac rehabilitation compared with outpatient-based cardiac rehabilitation and usual care for patients who are post–coronary artery bypass graft surgery.

Method

This 3-arm, single-blind, randomized controlled trial was carried out at the King Faisal Specialist Hospital, Riyadh, KSA. A total of 82 patients post–coronary artery bypass graft surgery were randomized and 73 patients completed the study. Recruited patients were distributed to home-based cardiac rehabilitation (n = 24), outpatient-based cardiac rehabilitation (n = 25), or usual care (control group) (n = 24). Participants in the intervention groups completed an individualized exercise program for 2 hours, 3 times a week for 8 weeks. The control group followed usual care (no intervention). The incremental shuttle walk test (ISWT), metabolic equivalence task, Short Form-36, and Hospital Anxiety and Depression Scale (HADS) were measured at baseline, postintervention, and after a 4-week follow-up period.

Results

Postintervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P < .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures.

Conclusion

Home-based cardiac rehabilitation is as effective as outpatient-based cardiac rehabilitation. Home-based cardiac rehabilitation appears to be more effective at maintaining improvements follow the end of the intervention.
Persistent Heart Failure Symptoms at Hospital Discharge Predicts 30-Day Clinical Events
Authors: Senecal Laura E. , Jurgens Corrine Y.
Published: December 2020

Background

The relationship between heart failure (HF) symptoms at hospital discharge and 30-day clinical events is unknown. Variability in HF symptom assessment may affect ability to predict readmission risk.

Objective

The aim of this study was to describe HF symptom profiles and burden at hospital discharge. A secondary aim was to examine the relationship between symptom burden at discharge and 30-day clinical events.

Methods

An exploratory descriptive design was used. Patients with HF (n = 186) were enrolled 24 to 48 hours pre hospital discharge. The HF Somatic Perception Scale quantified 18 HF physical signs and symptoms. Scores were divided into tertiles (0–10, 11–19, and 20 and higher). The Patient Health Questionnaire-9 quantified depressive symptoms. Self-assessed health, comorbid illnesses, and 30-day clinical events were documented. Chi-square and logistic regression were used to examine clinical events.

Results

The sample (n = 186) was predominantly White (87.6%), male (59.1%), elderly (mean [SD], 74.2 [12.5]), and symptomatic (92.5%) at discharge. Heart Failure Somatic Perception Scale scores ranged from 0 to 53, with a mean (SD) of 13.7 (10.1). Symptoms reported most frequently were fatigue (67%), nocturia (62%), need to rest (53%), and inability to do usual activities due to shortness of breath (52%). Thirty-day event rate was 28%, with significant differences between Heart Failure Somatic Perception Scale tertiles (9.4% vs 37.7% in the second and third tertiles, respectively; χ2(N = 186) = 16.73, P < .001). Heart Failure Somatic Perception Scale tertile 2 or 3 (odds ratio [OR], 5.7; P = .003; and OR, 4.3; P = .021), self-assessed health (OR, 2.6; P = .029), and being in a relationship predicted clinical events.

Conclusions

Heart failure symptom burden at discharge predicted 30-day clinical events. Comprehensive symptom assessment is important when determining readmission risk.
Anxiety and Depression
Authors: di Giacomo Ester , Colmegna Fabrizia , Biagi Enrico , Zappa Luigi , Caslini Manuela , Dakanalis Antonios ,   UnimibPsychiatricResearch-Group (Martina Tremolada,‡ Giulia Gamba,‡ Francesca Pescatore,‡ Rodolfo Pessina,‡ Valeria Placenti,∗ Jacopo Santambrogio,‡ Francesca Costantini‡), Clerici Massimo
Published: December 2020

Anxiety and depressive disorders affect one fourth of the population. Personality disorders often present comorbid with anxiety and depressive disorders during the lifetime course of the illness. To fully explore the interplay between personality disorders and anxiety or depression, 179 patients, consecutively admitted to the Anxiety and Depression Outpatient Department, were clinically evaluated and tested with the Mini-International Neuropsychiatric Interview and the Iowa Personality Disorder Screening. Twenty-six percent of the total sample was affected only by personality disorders (PDs), and 21% had a comorbidity between a personality, anxiety, and/or depressive disorder (Comorbidity). Compared with PDs, Comorbidity used more antipsychotics and benzodiazepines (4.3% vs. 9.6%, χ
2 = 0.267; 43.4 vs. 72.6, p = 0.004), showing a worse clinical picture, and expressed more personality traits even without statistical significance (6.863 ± 2.328 vs. 7.609 ± 1.674, p = 0.105). The different impact of personality disorders compared with anxiety and/or depression has to be further analyzed in terms of economic load and resource allocation.
An Implementation Science Approach to Promote Optimal Implementation, Adoption, Use, and Spread of Continuous Clinical Monitoring System Technology
Authors: Dykes Patricia C. , Lowenthal Graham , Faris Ann , Leonard Michelle Waters , Hack Robin , Harding Deborah , Huffman WHNP Carolyn , Hurley Ann , An Perry
Published: December 2020

Objectives

This study aimed to apply implementation science tenets to guide the deployment and use of in-hospital Clinical Monitoring System Technology (CMST) and to develop a toolkit to promote optimal implementation, adoption, use, and spread of CMST.

Methods

Six steps were carried out to (1) establish leadership support; (2) identify, educate, and sustain champions; (3) enlist clinical staff users to learn barriers and facilitators; (4) examine initial qualitative data from 11 clinician group interviews; (5) validate barriers/facilitators to CMST use and toolkit content; and (6) propose a toolkit to promote utilization. Clinical Monitoring System Technology output before and after implementation were compared.

Results

The top 3 barriers to effective CMST use were as follows: (1) inadequate education/training/support, (2) clinical workflow challenges, and (3) lack of communication. Facilitators to CMST implementation and adoption included the following: (1) providing comprehensive and consistent CMST education, (2) presenting evidence early and often, (3) tailoring device and usage expectations to individual environments, and (4) providing regular feedback about progress. Empirical data drove the development of a CMST implementation toolkit covering 6 areas: (1) why, (2) readiness, (3) readiness and implementation, (4) patient/family introduction, (5) champions, (6) care team saves, and (7) troubleshooting. Clinical Monitoring System Technology positively impacted failure to rescue events. Monthly median cardiac alert responses decreased from 30 to 3.64 minutes (87.9%), and respiratory alert responses decreased from 26 to 4.85 minutes (81.4%).

Conclusions

Using implementation science tenets to concurrently guide deployment and study performance of 2 CMST devices and impact on workload was effective for both learning CMST efficacy at 2 hospital systems and developing a toolkit to promote optimal implementation, adoption, use, and spread.
Accelerated Isotropic Multiparametric Imaging by High Spatial Resolution 3D-QALAS With Compressed Sensing
Authors: Fujita Shohei , Hagiwara Akifumi , Takei Naoyuki , Hwang Ken-Pin , Fukunaga Issei , Kato Shimpei , Andica Christina , Kamagata Koji , Yokoyama Kazumasa , Hattori Nobutaka , Abe Osamu , Aoki Shigeki
Published: December 2020

Objectives

The aims of this study were to develop an accelerated multiparametric magnetic resonance imaging method based on 3D-quantification using an interleaved Look-Locker acquisition sequence with a T2 preparation pulse (3D-QALAS) combined with compressed sensing (CS) and to evaluate the effect of CS on the quantitative mapping, tissue segmentation, and quality of synthetic images.

Materials and Methods

A magnetic resonance imaging system phantom, containing multiple compartments with standardized T1, T2, and proton density (PD) values; 10 healthy volunteers; and 12 patients with multiple sclerosis were scanned using the 3D-QALAS sequence with and without CS and conventional contrast-weighted imaging. The scan times of 3D-QALAS with and without CS were 5:56 and 11:11, respectively. For healthy volunteers, brain volumetry and myelin estimation were performed based on the measured T1, T2, and PD. For patients with multiple sclerosis, the mean T1, T2, PD, and the amount of myelin in plaques and contralateral normal-appearing white matter (NAWM) were measured. Simple linear regression analysis and Bland-Altman analysis were performed for each metric obtained from the datasets with and without CS. To compare overall image quality and structural delineations on synthetic and conventional contrast-weighted images, case-control randomized reading sessions were performed by 2 neuroradiologists in a blinded manner.

Results

The linearity of both phantom and volunteer measurements in T1, T2, and PD values obtained with and without CS was very strong (R
2 = 0.9901–1.000). The tissue segmentation obtained with and without CS also had high linearity (R
2 = 0.987–0.999). The quantitative tissue values of the plaques and NAWM obtained with CS showed high linearity with those without CS (R
2 = 0.967–1.000). There were no significant differences in overall image quality between synthetic contrast-weighted images obtained with and without CS (P = 0.17–0.99).

Conclusions

Multiparametric imaging of the whole brain based on 3D-QALAS can be accelerated using CS while preserving tissue quantitative values, tissue segmentation, and quality of synthetic images.
Is Technology Enhanced Learning Cost-effective to Improve Skills?
Authors: Lim Angelina S. , Lee Shaun Wen Huey
Published: December 2020

Introduction

Objective Structured Clinical Examinations (OSCEs) are an accepted technique for evaluation of clinical competence in healthcare. However, the economic imperative requires faculty to control cost, using innovative educational strategies such as virtual simulation. The objective of this study was to evaluate the cost implications of implementing an online interactive learning module [Monash OSCE Virtual Experience (MOVE)].

Methods

All fourth-year pharmacy students enrolled in Monash University in 2017 were provided access to MOVE. Cost-minimization analyses were performed to evaluate the cost of introducing MOVE in the pharmacy course using the smallest cohort size (Malaysia campus) of 40 students as the base case. We also determined under what circumstances MOVE would be more cost-effective, considering the different operational situations such as when student numbers increased or when the number of simulation modules created were increased.

Results

The overall cost of setup and implementation of MOVE in the first year of implementation among 40 students was US $94.38 per student. In comparison, the face-to-face workshop cost was US $64.14 per student. On the second year of implementation, the ongoing cost of operation of MOVE was US $32.86 per student compared with US $58.97 per student using face-to-face workshop. A net benefit using MOVE was observed after the third year of implementation. Larger savings were noted when the cohort size extends larger than 100 students.

Conclusions

Monash OSCE Virtual Experience was a flexible and cost-effective approach to aid students in preparation for an OSCE and enhanced students' learning experience. The wider applicability of these findings will need to be explored in other settings.
External Validity of the Multicenter Randomized PREOPANC Trial on Neoadjuvant Chemoradiotherapy in Pancreatic Cancer
Authors: Versteijne Eva , Suker Mustafa , Groen Jesse V. , Besselink Marc G. , Bonsing Bert A. , Bosscha Koop , Busch Olivier R. , de Hingh Ignace H. J. T. , de Jong Koert P. , Molenaar I. Quintus , van Santvoort Hjalmar C. , Verkooijen Helena M. , Van Eijck Casper H. , van Tienhoven Geertjan
Published: December 2020

Objectives:

To investigate the accrual proportion and patients’ reasons for not participating in the PREOPANC trial on neoadjuvant chemoradiotherapy versus immediate surgery in resectable and borderline resectable pancreatic cancer, and to compare these patients’ outcomes with those of patients who had been randomized in the trial.

Summary of Background Data:

The external validity of multicenter randomized trials in cancer treatment has been criticized for suboptimal non-representative inclusion. In trials, it is unclear how outcomes compare between randomized and nonrandomized patients.

Methods:

At 8 of 16 participant centers, this multicenter observational study identified validation patients, who had been eligible but not randomized during recruitment for the PREOPANC trial. We assessed the accrual proportion, investigated their most common reasons for not participating in the trial, and compared resection rates, radical (R0) resection rates, and overall survival between the validation patients and PREOPANC patients, who had been randomized in the trial to immediate surgery.

Results:

In total, 455 patients had been eligible during the recruitment period, 151 of whom (33%) had been randomized. Fifty-five percent of the 304 validation patients had refused to participate. Median overall survival in the validation group was 15.2 months, against 15.5 months in the PREOPANC group (P = 1.00). The respective resection rates (76% vs 73%) and R0 resection rates (51% vs 46%) did not differ between the groups.

Conclusions:

The PREOPANC trial included a reasonable percentage of 33% of eligible patients. In terms of the outcomes survival, resection rate, and R0 resection rate, this appeared to be a representative group.