bluuebunny/crossref_metadata_2025 huggingface dataset:
The psychological impact of COVID-19 among primary care physicians in the province of Verona, Italy: a cross-sectional study during the first pandemic wave
Authors: Lasalvia Antonio , Rigon Giulio , Rugiu Carlo , Negri Claudia , Del Zotti Franco , Amaddeo Francesco , Bonetto Chiara
Published: August 2021

Background

Among healthcare professionals working with COVID-19 patients, general practitioners (GPs) are under considerable pressure and may develop adverse mental health outcomes.

Objectives

To assess mental health outcomes on GPs working during the COVID-19 pandemic and to explore their associations with personal characteristics and features of GP practices.

Methods

Observational cross-sectional study conducted on a sample of GPs working in Verona province (Italy) during the first pandemic wave. Participants were invited to complete a web-based form addressing socio-demographic and work-related information, previous practice organization, practice re-organization during the COVID-19 pandemic, and a set of measures for post-traumatic stress (IES-R), anxiety (SAS), depression (PHQ-9), and burnout (MBI-GS).

Results

A total of 215 GPs (38.3% of the eligible population) participated. Overall, 44.7% reported COVID-19-related traumatic events; among these, 35.9% (95% CI, 26%‒46%) developed symptoms of post-traumatic distress. Furthermore, 36% (95% CI, 29%‒43%) reported symptoms of anxiety, 17.9% (95% CI, 12%‒23%) symptoms of at least moderate depression, and 25.4% (95% CI, 19%‒32%) symptoms of burnout. Multivariate regressions showed that being quarantined or admitted for COVID-19 was associated with all the mental health outcomes considered. Being female, working in rural settings, and having less professional experience were associated with higher anxiety and depression. The ability to diagnose COVID-19 increased self-perceived professional efficacy, thus contributing to burnout reduction.

Conclusion

The high prevalence of adverse mental health outcomes among GPs during the pandemic highlights the importance of timely interventions in this population and promoting targeted preventive actions in the event of future healthcare crises.
Phylogenetic relationships and codon usage bias amongst cluster K mycobacteriophages
Authors: Crane Adele , Versoza Cyril J , Hua Tiana , Kapoor Rohan , Lloyd Lillian , Mehta Rithik , Menolascino Jueliet , Morais Abraham , Munig Saige , Patel Zeel , Sackett Daniel , Schmit Brandon , Sy Makena , Pfeifer Susanne P
Published: August 2021

Bacteriophages infecting pathogenic hosts play an important role in medical research, not only as potential treatments for antibiotic-resistant infections but also offering novel insights into pathogen genetics and evolution. A prominent example is cluster K mycobacteriophages infecting Mycobacterium tuberculosis, a causative agent of tuberculosis in humans. However, as handling M. tuberculosis as well as other pathogens in a laboratory remains challenging, alternative nonpathogenic relatives, such as Mycobacterium smegmatis, are frequently used as surrogates to discover therapeutically relevant bacteriophages in a safer environment. Consequently, the individual host ranges of the majority of cluster K mycobacteriophages identified to date remain poorly understood. Here, we characterized the complete genome of Stinson, a temperate subcluster K1 mycobacteriophage with a siphoviral morphology. A series of comparative genomic analyses revealed strong similarities with other cluster K mycobacteriophages, including the conservation of an immunity repressor gene and a toxin/antitoxin gene pair. Patterns of codon usage bias across the cluster offered important insights into putative host ranges in nature, highlighting that although all cluster K mycobacteriophages are able to infect M. tuberculosis, they are less likely to have shared an evolutionary infection history with Mycobacterium leprae (underlying leprosy) compared to the rest of the genus’ host species. Moreover, subcluster K1 mycobacteriophages are able to integrate into the genomes of Mycobacterium abscessus and Mycobacterium marinum—two bacteria causing pulmonary and cutaneous infections which are often difficult to treat due to their drug resistance.
Desaturation effects of pyrite–sand mixtures on induced polarization signals
Authors: Martin Tina , Weller Andreas , Behling Laura
Published: August 2021

Induced polarization (IP) is an acknowledged method in ore exploration and can be applied to evaluate the metal content in dumps containing the residues of ore processing facilities. Existing models explain the relationships between ore content and grain size of the ore particles with IP parameters. However, the models assume full water saturation of the ore containing samples, which is often not the case in field conditions at dump sites. Hence, our study investigates the effect of desaturation on the resulting IP signal. We used six different sand–pyrite mixtures with varying amount and grain sizes of the pyrite particles. Evaporative drying desaturated the samples. Complex conductivity spectra were recorded in the frequency range between 0.02 and 1000 Hz at certain saturation levels. The resulting spectra indicate an decrease of the conductivity amplitude with progressing desaturation. This effect agrees with the second empirical Archie equation. The saturation exponent of the conductivity amplitude shows values slightly larger than one. The measured spectra were processed by a Debye decomposition. We observe a nearly constant total chargeability during desaturation. This finding is in agreement with existing models that relate the total chargeability to the metal content in the sample. However, the mean relaxation time decreases remarkably during the drying process, whereas the normalized relaxation time, which considers the ratio between the mean relaxation time and the resistivity of the embedding material, does not indicate any dependence on water saturation. This behaviour contradicts existing models that predict a decreasing relaxation time with increasing water salinity, which results from evaporative drying. In order to explain the observed effects, we propose a conceptional model that compares a mixture of pyrite particles in an embedding material (sand, water and air) with an electrical RC circuit. The pyrite grains behave as small condensers that are charged and discharged via the conductive background material. According to this simple physical model, the relaxation time is proportional to the resistivity of the embedding material. A resistivity increase while desaturation causes an increase of relaxation time as observed in our experiments. This conceptional model is in good agreement with other experiments that change the resistivity in the background material by varying water salinity or clay content. The capacitive behaviour of the dispersed particles is characterized by the normalized relaxation time that depends on the grain size and the volume content of the pyrite particles.
Determining reservoir intervals in the Bowland Shale using petrophysics and rock physics models
Authors: de Jonge-Anderson Iain , Ma Jingsheng , Wu Xiaoyang , Stow Dorrik
Published: August 2021

An evaluation of prospective shale gas reservoir intervals in the Bowland Shale is presented using a wireline log data set from the UK's first shale gas exploration well. Accurate identification of such intervals is crucial in determining ideal landing zones for drilling horizontal production wells, but the task is challenging due to the heterogeneous nature of mudrocks. This heterogeneity leads to stratigraphic variations in reservoir quality and mechanical properties, and leads to complex geophysical behaviour, including seismic anisotropy. We generate petrophysical logs such as mineralogy, porosity, and organic content and calibrate these to the results of core studies. If ‘reservoir quality’ is defined by combined cut-offs relating to these parameters, we find that over 100 m of reservoir quality shale is present in the well, located primarily within the upper section. To examine the link between geophysical signature and rock properties, an isotropic rock physics model is developed, using effective medium theories, to recreate the elastic properties of the shale and produce forward-looking templates for subsequent seismic inversion studies. We find that the mineralogical heterogeneity in the shale has a profound impact on modelled elastic properties, obscuring more discrete changes due to porosity, organic content and water saturation and that the best reservoir quality intervals of the shale bear a distinctive response on rock physics cross-plots. Finally, we consider the density of natural fractures in the shale by developing an anisotropic rock physics model to reflect high-angle fractures observed on micro-imagery logs. We invert crack density using shear wave splitting well log data and find a crack density of up to 4 per cent which correlates well with micro-imagery observations. Our work further supports previous authors’ core-based studies in concluding that the Bowland Shale holds good reservoir characteristics, and we propose that there are multiple intervals within the shale that could be targeted with stacked horizontal wells, should those intervals’ mechanical properties also be suitable and there be adequate stress barriers between to restrict vertical hydraulic fracture growth. Finally, our rock physics templates may provide useful tools in interpreting pre-stack seismic data sets in prospective areas of the Bowland Shale and picking the best locations for drilling wells.
Blockchain: A Data Metamorphosis?
Authors: Day Anthony
Published: August 2021

Do you believe the hype? Anthony Day, Blockchain Partner for IBM UK & Ireland, talks to Johanna Hamilton AMBCS about whether blockchain is a transformative tool or just a new way to do something we were already doing.
Diversity Report 2021: Slow Progress is Some Progress
Authors: Runciman Brian
Published: August 2021

BCS has produced four reports analysing the ONS Labour Force survey, looking at diversity issues in the IT space. For IT, the picture is mixed but with some encouraging trends. From an employer point of view, it is perhaps a tale of opportunities missed, but with implied potential. Brian Runciman MBCS writes.
Architecting an Equal Future
Authors: Arnold Gillian
Published: August 2021

Why is the number of women who occupy some of the most senior technical roles in our profession so small? Gillian Arnold FBCS, MD at Tectre, explores the issue.
Making Workshops Work… Despite Complications
Authors: Pullan Penny
Published: August 2021

Workshops are a great way to collaborate with others, or at least they can be when things run smoothly, writes Penny Pullan MBCS.
Agile Sourcing: Find the Right Technology Partner Faster
Authors: Brook David
Published: August 2021

If going out to tender fills you with dread, you’re not alone — suppliers feel the same. David Brook, IT Sourcing Specialist at Turnstone Services talks tenders and agile sourcing.
Long-term multiband monitoring of blazar 3C 66A: Evidence of the two distinct states with different baseline flux
Authors: Mohana A Krishna , Bhattacharya Debbijoy , Misra Ranjeev , Bhattacharyya Subir , Bhatt Nilay
Published: August 2021

Blazar variability can be described as flaring activities on a wide range of time-scales over a baseline flux level. It is important to detect and distinguish baseline flux changes from long-term flare variations, since the former may reflect state transitions caused by a secular change in bulk properties such as the bulk Lorentz factor or the viewing angle. We report such a transition observed in the 11 yr Fermi γ-ray light curve of the blazar 3C 66A, where the baseline flux of ∼1.8 × 10−7 ph cm−2 s−1 persisted for three years and then changed over a month time-scale to ∼0.8 × 10−7 ph cm−2 s−1 and remained in that level for the next eight years. Moreover, there is evidence for a similar shift in baseline flux in the optical band. Broad-band spectral energy distribution modelling for the two activity states reveals that the baseline flux change is consistent with an overall decrease in the Doppler factor, which in turn implies an increase in the jet inclination angle by ∼1° or a decrease in the bulk Lorentz factor by ∼25 per cent. We discuss the implication of such a variation occurring on a month time-scale.
The KBSS–KCWI survey: the connection between extended Ly α haloes and galaxy azimuthal angle at z ∼ 2–3
Authors: Chen Yuguang , Steidel Charles C , Erb Dawn K , Law David R , Trainor Ryan F , Reddy Naveen A , Shapley Alice E , Pahl Anthony J , Strom Allison L , Lamb Noah R , Li Zhihui , Rudie Gwen C
Published: August 2021

We present the first statistical analysis of kinematically resolved, spatially extended $\rm Ly\alpha$ emission around z = 2–3 galaxies in the Keck Baryonic Structure Survey (KBSS) using the Keck Cosmic Web Imager (KCWI). Our sample of 59 star-forming galaxies (zmed = 2.29) comprises the subset with typical KCWI integration times of ∼5 h and with existing imaging data from the Hubble Space Telescope and/or adaptive optics-assisted integral field spectroscopy. The high-resolution images were used to evaluate the azimuthal dependence of the diffuse $\rm Ly\alpha$ emission with respect to the stellar continuum within projected galactocentric distances of ≲30 proper kpc. We introduce cylindrically projected 2D spectra (CP2D) that map the averaged $\rm Ly\alpha$ spectral profile over a specified range of azimuthal angle, as a function of impact parameter around galaxies. The averaged CP2D spectrum of all galaxies shows clear signatures of $\rm Ly\alpha$ resonant scattering by outflowing gas. We stacked the CP2D spectra of individual galaxies over ranges of azimuthal angle with respect to their major axes. The extended $\rm Ly\alpha$ emission along the galaxy principal axes is statistically indistinguishable, with residual asymmetry of ≤2 per cent (∼2σ) of the integrated $\rm Ly\alpha$ emission. The symmetry implies that the $\rm Ly\alpha$ scattering medium is dominated by outflows in all directions within 30 kpc. Meanwhile, we find that the blueshifted component of $\rm Ly\alpha$ emission is marginally stronger along galaxy minor axes for galaxies with relatively weak $\rm Ly\alpha$ emission. We speculate that this weak directional dependence of $\rm Ly\alpha$ emission becomes discernible only when the $\rm Ly\alpha$ escape fraction is low. These discoveries highlight the need for similar analyses in simulations with $\rm Ly\alpha$ radiative transfer modelling.
YB-1 unwinds mRNA secondary structures in vitro and negatively regulates stress granule assembly in HeLa cells
Authors: Budkina Karina , El Hage Krystel , Clément Marie-Jeanne , Desforges Bénédicte , Bouhss Ahmed , Joshi Vandana , Maucuer Alexandre , Hamon Loic , Ovchinnikov Lev P , Lyabin Dmitry N , Pastré David
Published: August 2021

In the absence of the scanning ribosomes that unwind mRNA coding sequences and 5′UTRs, mRNAs are likely to form secondary structures and intermolecular bridges. Intermolecular base pairing of non polysomal mRNAs is involved in stress granule (SG) assembly when the pool of mRNAs freed from ribosomes increases during cellular stress. Here, we unravel the structural mechanisms by which a major partner of dormant mRNAs, YB-1 (YBX1), unwinds mRNA secondary structures without ATP consumption by using its conserved cold-shock domain to destabilize RNA stem/loops and its unstructured C-terminal domain to secure RNA unwinding. At endogenous levels, YB-1 facilitates SG disassembly during arsenite stress recovery. In addition, overexpression of wild-type YB-1 and to a lesser extent unwinding-defective mutants inhibit SG assembly in HeLa cells. Through its mRNA-unwinding activity, YB-1 may thus inhibit SG assembly in cancer cells and package dormant mRNA in an unfolded state, thus preparing mRNAs for translation initiation.
Axis fracture due to giant cranial AVM
Authors: Karamani Lydia , Dürr Nikola Reinhard , Suchorska Bogdana , Scholz Martin , Brassel Friedhelm
Published: August 2021

Cerebral arteriovenous malformations (AVMs) are a vascular anomaly consisting of a bundle of direct connection of arteries and veins. AVMs clinical expression ranges from complete asymptomatic, and thus incidentally found, to life threatening with rupturing and bleeding. In this wide spectrum, osteolysis is considered as a rare complication of interosseous AVMs, and only few cases of mandible and maxilla osteolysis have been reported. We present, herein, a case of an intracranial AVM, which has caused in the course of the time an osteolysis of the dens and axis.
To Assess the Technical Feasibility of Ultrasound Lumbar Sympathetic Block with Electrical Stimulation Needle in Out-of-Plane Needle Orientation: A Prospective Interventional Study
Authors: Marada Snehitha , Punj Jyotsna , Dhar Anita , Bhoi Debesh , Mohan Virender , Trikha Anjan , Pandey Ravindra Kumar , Darlong Vanlal
Published: August 2021

Objective

We describe the technical feasibility of a new technique of ultrasound lumbar sympathectomy validated by fluoroscopy.

Design

Prospective interventional study.

Setting

Pain block area.

Subjects

Thirty patients with peripheral arterial disease with pain at rest (numerical rating score [NRS] ≥3) were recruited.

Methods

In the lateral position, a curved probe (FUJIFILM SonoSite Edge, Bothell, WA, USA, 2–5 MHz) was placed transversely at the iliac crest. An electrical stimulation needle was inserted out of plane, below the lower pole of the kidneys, directed anterior to the vertebral body below. When the needle tip was not visualized, a current of 2.0 A was applied. Patients’ quadriceps contractions, ultrasound psoas contractions, and bone contact guided needle placement, which was confirmed on fluoroscopy. Other parameters noted were the number of needle insertions, vertebral level, pain NRS at baseline and at 4 hours, 24 hours, 1 week, and 2 weeks after block, temperature rise, and any other complications.

Results

In all patients, the needle tip was correctly placed in one to three attempts. In 73% of patients, the needle tip was at L3. Baseline pain NRS was 8 (interquartile range 7–8), which decreased to 2 (interquartile range 2–3) at 1 week after the procedure, and it was maintained in this range until 2 weeks later. A temperature rise of >2ºC was noted in all patients.

Conclusion

Ultrasound lumbar sympathectomy can be performed safely in patients with peripheral arterial disease by an out-of-plane approach in the lateral patient position with an electrical stimulation needle. Before injection of the drug, aspiration of blood should be ruled out in view of the possibility of aortocaval injection.
Seizures in Iatrogenic Cerebral Arterial Gas Embolism
Authors: Muller Fenna F. , van Hulst Robert A. , Coutinho Jonathan M. , Weenink Robert P.
Published: August 2021

Objectives:

Iatrogenic cerebral arterial gas embolism occurs when gas enters the cerebral arterial circulation during a medical procedure and is considered a severe complication. Seizures have been described in these patients, but information on clinical characteristics, treatment, and outcome is lacking in current literature. The aim of the study was to explore seizures in patients with iatrogenic cerebral arterial gas embolism and to evaluate management strategies.

Design:

Retrospective single-center observational study.

Setting:

The only university hospital in the Netherlands with a hyperbaric oxygen therapy facility.

Patients:

All patients presenting at or referred to our center with iatrogenic cerebral arterial gas embolism between May 2016 and December 2020.

Interventions:

Not applicable.

Measurements and Main Results:

Fifteen patients with iatrogenic cerebral arterial gas embolism were identified, of whom 11 (73%) developed seizures. Five patients developed their first seizure prior to hyperbaric oxygen therapy, three during hyperbaric oxygen therapy, and three after hyperbaric oxygen therapy. Of the 11 patients with seizures, all but one were treated with anti-epileptic drugs. With a median follow-up time of 5 months (range, 1–54 mo), five patients showed complete neurologic recovery, five had minor neurologic deficit, two had moderate to severe neurologic deficit, and three had died. Four patients still used anti-epileptic drugs at follow-up. No patients had recurrent seizures after hospital discharge.

Conclusions:

`Seizures are a common symptom in iatrogenic cerebral arterial gas embolism. They are often treated with anti-epileptic drugs and do not seem to lead to chronic epilepsy.
Amyloid and tau positive mild cognitive impairment: clinical and biomarker characteristics of dementia progression
Authors: Wei Hong-Chun , Li Bing , Ng Kok Pin , Fu Qing-Xi , Dong Sheng-Jie , Ba Mao-Wen , Kong Min
Published: August 2021

Background:

According to the amyloid, tau, neurodegeneration research framework classification, amyloid and tau positive (A+T+) mild cognitive impairment (MCI) individuals are defined as prodromal Alzheimer disease. This study was designed to compare the clinical and biomarker features between A+T+MCI individuals who progressed to progressive MCI (pMCI) and those who remained stable MCI (sMCI), and to identify relevant baseline clinical biomarker and features that could be used to predict progression to dementia within 2 years.

Methods:

We stratified 197 A+T+MCI individuals into pMCI (n = 64) and sMCI (n = 133) over 2 years. Demographics and cognitive assessment scores, cerebrospinal fluid (CSF), and neuroimaging biomarkers (18F-florbetapir positron emission tomography mean standardized uptake value ratios [SUVR] and structural magnetic resonance imaging [MRI]) were compared between pMCI and sMCI at baseline, 12- and 24-month follow-up. Logistic regression models then were used to evaluate clinical baseline and biomarker features that predicted dementia progression in A+T+MCI.

Results:

pMCI individuals had higher mean 18F-florbetapir SUVR, CSF total-tau (t-tau), and p-tau181P than those in sMCI individuals. pMCI individuals performed poorer in cognitive assessments, both global and domain specific (memory, executive, language, attention, and visuospatial skills) than sMCI. At baseline, there were significant differences in regions of interest of structural MRI between the two groups, including bilateral amygdala, hippocampus and entorhinal, bilateral inferior lateral ventricle, left superior and middle temporal, left posterior and caudal anterior cingulate (P < 0.05). Baseline CSF t-tau levels and cognitive scores of Montreal cognitive assessment, functional assessment questionnaire, and everyday cognition by the patient's study partner language domain could predict progression to dementia in A+T+MCI within 2 years.

Conclusions:

In future clinical trials, specific CSF and cognitive measures that predict dementia progression in A+T+MCI might be useful risk factors for assessing the risk of dementia progression.
Infantile Hemangiomas Cleared by Combined Therapy With Pulsed Dye Laser and Propranolol
Authors: Sugimoto Atsuko , Aoki Ritsu , Toyohara Eri , Ogawa Rei
Published: August 2021

BACKGROUND

Oral propranolol is the first-line therapy for infantile hemangioma. Combining it with pulse dye laser (PDL) (595nm-long PDL) could reduce treatment duration and sequelae incidence and severity.

OBJECTIVE

To determine the effect of PDL-propranolol treatment on duration to cure and sequelae.

METHODS

All consecutive patients with infantile hemangioma who were cured by PDL-propranolol treatment were identified.

RESULTS

In the 27 cases, average age at treatment start was 4.3 ± 3.8 months, mean tumor diameter was 11.1 ± 14.0 cm2, and tumor-type was most common (72.4% of lesions). The patients received 9.8 ± 10.5 PDL sessions. After ensuring patients had no physical contraindications, including heart disease, oral propranolol was started at 1 mg/kg/d, increased up to 3 mg/kg/d as a maintenance dose. Mean propranolol treatment duration was 11.1 ± 4.9 months. Total treatment duration was 15.3 ± 10.8 months.

CONCLUSION

Our data in the context of recent literature suggest combining propranolol with PDL may reduce propranolol duration without increasing harms.
Effect of De-epithelialization on Graft Survival Rate After Follicular Unit Extraction
Authors: Fan Zhe-Xiang , Liu Fang , Li Kai-Tao , Hu Zhi-Qi , Miao Yong
Published: August 2021

BACKGROUND

To achieve a natural postoperative appearance, hair grafts are often de-epithelialized from the epidermis during follicular unit extraction (FUE). However, the effect of de-epithelialization on the survival rate of transplanted hair follicles (HFs) has not been investigated.

OBJECTIVE

To investigate the effect of de-epithelialization on the survival rate of transplanted HFs.

METHODS

A total of 64 male patients with androgenetic alopecia were included in this study. They were randomly divided into de-epithelialization and control groups. Organ culture was performed to assess the elongation of hair shaft and the percentage of anagen HFs in both groups. Patients were followed up postoperatively to evaluate complications, postoperative shedding, survival rates, and satisfaction.

RESULTS

No significant difference in hair shaft elongation and percentage of anagen HFs was observed between both groups. The immediate postoperative satisfaction in the control group was much lower than that in the de-epithelialization group (71.25% and 100%, respectively). No significant differences in shedding rate, graft survival rate, and complications were noticed between both groups.

CONCLUSION

Follicular de-epithelialization does not affect the survival rate of graft in FUE. Based on these data, de-epithelialization may improve immediate postoperative appearance and lead to a more pleasing cosmetic outcome.
Change of plasma amylin after bariatric surgery challenged by oral glucose is associated with remission of type 2 diabetes mellitus
Authors: Wang Jiunn-Wei , Chen Pei-Yu , Huang Hsien-Hao , Yeh Chun , Chen Shu-Chun , Lee Wei-Jei , Chen Chih-Yen
Published: August 2021

Background:

Gastric bypass (GB) and sleeve gastrectomy (SG) were found to achieve different remission rates in the treatment of type 2 diabetes (T2DM). The alteration in several gut hormones after bariatric surgery has been demonstrated to play a key role for T2DM remission. Nevertheless, amylin, one of the diabetes-associated peptides, so far has an undetermined position on T2DM remission after bariatric surgery.

Methods:

Sixty eligible patients with T2DM (GB, 30; SG, 30) were initially enrolled in the hospital-based randomized trial. Twenty patients (GB, 10; SG, 10) who met the inclusion criteria and agreed to undergo 75-g oral glucose tolerance test (OGTT) were recruited. The recruited subjects underwent anthropometric measurements, routine laboratory tests, and 75-g OGTT before and 1 year after bariatric surgery. Enzyme immunoassays for plasma amylin were analyzed.

Results:

All subjects that underwent GB and half of those who underwent SG achieved T2DM remission. Plasma amylin levels significantly decreased 60–90 min after OGTT in the GB group (p < 0.05) and 30–60 minutes after OGTT in the SG group (p < 0.05). Significantly decreased plasma amylin levels were observed at 30–90 minutes after OGTT in the noncomplete remitters of the GB group (p < 0.05). Plasma amylin levels initially increased (p < 0.05) within 30 minutes after OGTT and then decreased (p < 0.05) in the next 30-minute interval in the nonremitters of the SG group.

Conclusion:

Postoral glucose challenge amylin levels could be as one of the parameters to evaluate T2DM remission after bariatric surgery, especially in those after SG.
Meniscal Injuries: Mechanism and Classification
Authors: Wells Matthew E. , Scanaliato John P. , Dunn John C. , Garcia E’Stephan J.
Published: August 2021

Meniscal tears may be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention. Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time. Surgical advances in operative techniques, modern instrumentation and biological enhancements collectively improve healing rates of meniscal repair. However, failed repair is not without consequences and can negative impact patient outcomes. Therefore, it is imperative for surgeons to have a thorough understanding of the vascular zones and biomechanical classifications of meniscal tears in order to best determine the most appropriate treatment.
What intensive care registries can teach us about outcomes
Authors: Beane Abi , Salluh Jorge I.F. , Haniffa Rashan
Published: August 2021

Purpose of review

Critical care registries are synonymous with measurement of outcomes following critical illness. Their ability to provide longitudinal data to enable benchmarking of outcomes for comparison within units over time, and between units, both regionally and nationally is a key part of the evaluation of quality of care and ICU performance as well as a better understanding of case-mix. This review aims to summarize literature on outcome measures currently being reported in registries internationally, describe the current strengths and challenges with interpreting existing outcomes and highlight areas where registries may help improve implementation and interpretation of both existing and new outcome measures.

Recent findings

Outcomes being widely reported through ICU registries include measures of survival, events of interest, patient-reported outcomes and measures of resource utilization (including cost). Despite its increasing adoption, challenges with quality of reporting of outcomes measures remain. Measures of short-term survival are feasible but those requiring longer follow-ups are increasingly difficult to interpret given the evolving nature of critical care in the context of acute and chronic disease management. Furthermore, heterogeneity in patient populations and in healthcare organisations in different settings makes use of outcome measures for international benchmarking at best complex, requiring substantial advances in their definitions and implementation to support those seeking to improve patient care.

Digital registries could help overcome some of the current challenges with implementing and interpreting ICU outcome data through standardization of reporting and harmonization of data. In addition, ICU registries could be instrumental in enabling data for feedback as part of improvement in both patient-centred outcomes and in service outcomes; notably resource utilization and efficiency.
Prognostic value of SUVmax in breast cancer and comparative analyses of molecular subtypes
Authors: Lee Moon il , Jung Youn Joo , Kim Dong Il , Lee Seungju , Jung Chang Shin , Kang Seok Kyung , Pak Kyoungjune , Kim Seong Jang , Kim Hyun Yul
Published: August 2021

Background:

To assess the prognostic capability of the maximum standardized uptake values (SUVmax) measured in the primary tumor and axillary lymph nodes (ALNs) by pretreatment fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography and analyze outcomes according to the molecular breast cancer subtypes.

Methods:

The databases were systematically searched using keywords for breast cancer, positron emission tomography/computed tomography, and SUVmax; the extracted studies reported at least 1 form of survival data, event-free survival (EFS) and overall survival. Comparative analyses of the pooled hazard ratios (HRs) for EFS and overall survival were performed to assess their correlations with SUVmax. The pooled HR was estimated using random-effects model according to the results of heterogeneity.

Results:

Thirteen eligible studies comprising 3040 patients with breast cancer were included. The pooled HRs of high SUVmax in the primary tumor and ALN were 3.01 (95% CI 1.83–4.97, P < .00001; I2 = 82%) and 3.72 (95% CI 1.15–12.01; I2 = 92%; P = .03), respectively. Patients with higher SUVmax demonstrated a poorer survival prognosis. Furthermore, comparative analyses according to the molecular subtypes demonstrated that the SUVmax in the primary tumor or ALN can be a predictive parameter in patients with the luminal subtype disease. Subtype analysis results indicated a significant association of the luminal group, with a HR of 2.65 (95% CI 1.31–5.37; I2 = 27%; P = .007).

Conclusions:

SUVmax from pretreatment is a significant prognostic factor for EFS in patients with breast cancer. Despite several limitations, correlation with molecular subtype (luminal type) was demonstrated. Further large-scale studies are required to investigate the precise prognostic capability of SUVmax.
Analysis and forecasting of confirmed, death, and recovered cases of COVID-19 infections in Nigeria
Authors: Chigbu Baptista C. , Edikpa Edith C. , Onu Eucharia A. , Nwabueze Akachukwu I. , Aneke Mary C. , Vita-Agundu Uche C. , Adepoju Esther B.
Published: August 2021

The coronavirus (COVID-19) disease outbreak was a public health emergency of international concern which eventually evolved into a pandemic. Nigeria was locked down in March, 2020 as the country battled to contain the spread of the disease. By August 2020, phase-by-phase easing of the lockdown was commenced and university students will soon return for academic activities. This study undertakes some epidemiological analysis of the Nigerian COVID-19 data to help the government and university administrators make informed decisions on the safety of personnel and students.

The COVID-19 data on confirmed cases, deaths, and recovered were obtained from the website of the Nigerian Centre for Disease Control (NCDC) from April 2, 2020 to August 24, 2020. The infection rate, prevalence, ratio, cause-specific death rate, and case recovery rate were used to evaluate the epidemiological characteristics of the pandemic in Nigeria. Exponential smoothing was adopted in modeling the time series data and forecasting the pandemic in Nigeria up to January 31, 2021.

The results indicated that the pandemic had infection rate of at most 3 infections per 1 million per day from April to August 2020. The death rate was 5 persons per 1 million during the period of study while recovery rate was 747 persons per 1000 infections. Analysis of forecast data showed steady but gradual decrease in the daily infection rate and death rate and substantial increase in the recovery rate, 975 recoveries per 1000 infections.

In general, the epidemiological attributes of the pandemic from the original data and the forecast data indicated optimism in the decrease in the rate of infection and death in the future. Moreover, the infection rate, prevalence and death rate in January 2021 coincided with the predictions based on the analysis. Therefore, the Nigerian government is encouraged to allow universities in the country to reopen while university administrators set up the necessary protocols for strict adherence to safety measures.
Efficacy and safety of HDACIs in the treatment of metastatic or unresectable renal cell carcinoma with a clear cell phenotype
Authors: Chen Juan , Ren Jia-Ju , Cai Jiangxia , Wang Xiaoli
Published: August 2021

Background:

In this study, we evaluated the efficacy and safety of histone deacetylase inhibitors (HDACIs) in the treatment of renal cell carcinoma (RCC).

Methods:

PubMed, EMBASE, the Cochrane Library, CNKI, and the Wanfang database were searched to retrieve studies describing the use of HDACIs for the treatment of RCC published between January 1, 2009, and January 1, 2021. Relevant studies were selected, and data were extracted. Then, a meta-analysis was performed using R 3.5.2 software.

Results:

The results showed that the objective response rate (ORR) of HDACIs used to treat RCC was 26% [95% confidence interval (95% CI): 0.19∼0.34] and that the 1-year progression-free survival (PFS) rate was 29% (95% CI: 0.14∼0.59). The ORR and PFS rate of the combination group were better than those of the monotherapy group, and the ORR and PFS rate of the selective HDACI group were better than those of the pan-HDACI group. The incidences of neutropenia and thrombocytopenia were higher and the incidence of fatigue was lower in the selective HDACI group than in the pan-HDACI group.

Conclusion:

This study initially confirmed the efficacy and safety of HDACIs for the treatment of RCC. Due to the limitations of the included studies, more high-quality studies are needed to validate the conclusions.
Adnexal Masses in Pregnancy
Authors: Montes de Oca Mary Katherine , Dotters-Katz Sarah K. , Kuller Jeffrey A. , Previs Rebecca A.
Published: August 2021

Importance

Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.

Objective

The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy.

Evidence Acquisition

This was a literature review using primarily PubMed and Google Scholar.

Results

Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy.

Conclusions and Relevance

Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, learners should be better able to compare different types of adnexal masses found in pregnancy, including incidence, clinical features, and imaging characteristics; evaluate an adnexal mass with imaging and laboratory tests; describe complications related to an adnexal mass in pregnancy; and determine management and/or surgical approaches for removal.
Vaginal Hysterectomy Rates Before and After Implementation of a Multiple-Tier Intervention
Authors: Crouss Tess , Sharma Shefali , Smith Devon , Hunter Krystal , Perry Robin , Lipetskaia Lioudmila
Published: August 2021

(Abstracted from Obstet Gynecol 2021;137:641–647)

The American College of Obstetricians and Gynecologists recommend vaginal hysterectomy (VH) as the optimal route of hysterectomy when feasible. Compared with a laparoscopic route, the vaginal route is associated with lower overall costs, a decreased length of hospital stays, less postoperative pain, and quicker return to activity with no difference in adverse complications.
Fertility-Sparing Treatment for Early-Stage Cervical, Ovarian, and Endometrial Malignancies
Authors: Nitecki Roni , Woodard Terri , Rauh-Hain J. Alejandro
Published: August 2021

(Abstracted from Obstet Gynecol 2020;136:1157–1169)

Approximately 21% of gynecologic malignancies are diagnosed in women younger than 40 years, raising the importance of future fertility in discussions of informed consent before cancer therapy. Fertility-preserving procedures in patients diagnosed with cancer remain relatively rare.
A Randomized Controlled Trial Assessing the Impact of Opioid-Specific Patient Counseling on Opioid Consumption and Disposal After Reconstructive Pelvic Surgery
Authors: Buono Kristen , Whitcomb Emily , Guaderrama Noelani , Lee Elizabeth , Ihara Jun , Sudol Neha , Lane Felicia , Lee Jennifer , Heliker Bhumy Davé , Brueseke Taylor
Published: August 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:151–158)

Inappropriate overprescription of opioids, an important risk factor for the development of opioid abuse, has been demonstrated after benign hysterectomy and reconstructive surgery for pelvic organ prolapse. Several landmark studies have found that surgeons can prescribe fewer opioids in the postoperative setting without affecting patient distress or refill requests.
Preclinical Stem Cell Therapy in Fetuses With Myelomeningocele: A Systematic Review and Meta-Analysis
Authors: Kunpalin Yada , Subramaniam Sindhu , Perin Silvia , Gerli Mattia F. M. , Bosteels Jan , Ourselin Sebastien , Deprest Jan , De Coppi Paolo , David Anna L.
Published: August 2021

(Abstracted from Prenatal Diagnosis 2021;41:283–300)

Myelomeningocele (MMC) is a congenital malformation of the central nervous system that is caused by an incomplete closure of the neural tube during the third to fourth week of embryonic development. An MMC can be seen in some cases by prenatal ultrasound in the first trimester, although most cases are diagnosed during the second trimester.
A Multidisciplinary Approach and Review of Safety Recommendations for Plastic Surgeons during the COVID-19 Pandemic: Are N95 Masks Enough?
Authors: Jalisi Scharukh , Chen Austin D. , Gomez Ernest , Chigurupati Radhika , Cauley Ryan , Olbricht Suzanne , Lee Bernard T. , Lin Samuel J.
Published: August 2021

The novel coronavirus disease of 2019 pandemic presents a unique challenge to the field of plastic and reconstructive surgery. Although plastic surgeons may be postponing elective operations, there are still a number of emergent or urgent procedures that may need to be performed, and surgeons may be facing the reality of returning to a new normalcy of operating with coronavirus disease of 2019. These procedures, consisting of those such as head and neck reconstruction or maxillofacial trauma, largely require a multidisciplinary approach and may be considered of higher risk to health care workers because of the involvement of areas of the body identified as sources for viral transmission. Moreover, viral transmission may potentially extend beyond respiratory secretions, which has been the main focus of most safety precautions. The authors aim to present the scope of these procedures and the means of viral transmission, and to provide safety precaution recommendations for plastic surgery and its related disciplines.
Evaluation of Broadly Neutralizing Antibody Sensitivity by Genotyping and Phenotyping for Qualifying Participants to HIV Clinical Trials
Authors: Moldt Brian , Parvangada Aiyappa , Martin Ross , Pace Craig , Balakrishnan Mini , Thomsen Nathan D. , E. Collins Sean , Kuster Herbert , Braun Dominique L. , Günthard Huldrych F. , Geleziunas Romas , Callebaut Christian
Published: August 2021

Background:

HIV envelope (env) diversity represents a significant challenge for the use of broadly neutralizing antibodies (bNAbs) in HIV treatment and cure studies. Screening for viral sensitivity to bNAbs to select eligible trial participants will be important to improve clinical efficacy; however, no universal approach has been established.

Methods:

Pre-antiretroviral therapy plasma virus from participants in the Zurich Primary HIV Infection (ZPHI) study was genotyped and phenotyped for sensitivity to the bNAbs elipovimab (EVM, formerly GS-9722) and 3BNC117. The genotyping and phenotyping assessments were performed following the Clinical Laboratory Improvement Amendments of 1988 guidelines as required for entry into clinical trials. The genotypic-based prediction of bNAb sensitivity was based on HIV env amino acid signatures identified from a genotypic–phenotypic correlation algorithm using a subtype B database.

Results:

Genotyping the plasma virus and applying env sensitivity signatures, ZPHI study participants with viral sensitivity to EVM and 3BNC117 were identified. ZPHI study participants with virus sensitive to EVM and 3BNC117 were also identified by phenotyping the plasma virus. Comparison of the genotypic and phenotypic sensitivity assessments showed strong agreement between the 2 methodologies.

Conclusions:

The genotypic assessment was found to be as predictive as the direct measurement of bNAb sensitivity by phenotyping and may, therefore, be preferred because of more rapid turnaround time and assay simplicity. A significant number of the participants were predicted to have virus sensitive to EVM and 3BNC117 and could, thus, be potential participants for clinical trials involving these bNAbs.
Potential for combining semantics and data analysis in the context of digital twins
Authors: Vogel-Heuser Birgit , Ocker Felix , Weiß Iris , Mieth Robert , Mann Frederik
Published: August 2021

Modern production systems can benefit greatly from integrated and up-to-date digital representations. Their applications range from consistency checks during the design phase to smart manufacturing to maintenance support. Such digital twins not only require data, information and knowledge as inputs but can also be considered integrated models themselves. This paper provides an overview of data, information and knowledge typically available throughout the lifecycle of production systems and the variety of applications driven by data analysis, expert knowledge and knowledge-based systems. On this basis, we describe the potential for combining data analysis and knowledge-based systems in the context of production systems and describe two feasibility studies that demonstrate how knowledge-based systems can be created using data analysis.

This article is part of the theme issue ‘Towards symbiotic autonomous systems’.