bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Breast Aesthetic Revision Procedures after Unilateral Abdominal-based Free-flap Breast Reconstruction: A Single-center Experience with 1251 Patients
Authors: Smith J. Michael , Boukovalas Stefanos , Chang Edward I. , Liu Jun , Selber Jesse C. , Hanson Summer E. , Reece Gregory P.
Published: March 2023

Background:

Although autologous free-flap breast reconstruction is the most durable means of reconstruction, it is unclear how many additional operations are needed to optimize the aesthetic outcome of the reconstructed breast. The present study aimed to determine the average number of elective breast revision procedures performed for aesthetic reasons in patients undergoing unilateral autologous breast reconstruction and to analyze variables associated with undergoing additional procedures.

Methods:

A retrospective review of all unilateral abdominal-based free-flap breast reconstructions performed from 2000 to 2014 was undertaken at a tertiary academic center.

Results:

Overall, 1251 patients were included in the analysis. The average number of breast revision procedures was 1.1 ± 0.9, and 903 patients (72.2%) underwent at least one revision procedure. Multiple logistic regression analysis demonstrated that younger age, higher body mass index, and prior oncologic surgery on the reconstructed breast were factors associated with increased likelihood of undergoing a revision procedure. The probability of undergoing at least one revision increased by 4% with every 1-unit (kg/m2) increase in a patient’s body mass index. Multiple Poisson regression modeling demonstrated that younger age, prior oncologic surgery on the reconstructed breast, and bipedicle flap reconstruction were significant factors associated with undergoing a greater number of revision procedures.

Conclusions:

Most patients who undergo unilateral autologous breast reconstruction require at least one additional operation to optimize their breast aesthetic results. Young age and obesity increase the likelihood of undergoing additional operations. These findings can aid reconstructive microsurgeons in counseling patients and establishing patient expectations prior to their undergoing microvascular breast reconstruction.
Effects of continuous positive airway pressure on very short-term blood pressure variability associated with sleep-disordered breathing by pulse transit time-based blood pressure measurements
Authors: Misaka Tomofumi , Yoshihisa Akiomi , Yokokawa Tetsuro , Takeishi Yasuchika
Published: March 2023

Background:

Blood pressure (BP) variability (BPV) is a predictor of cardiovascular outcomes independently of BP absolute values. We previously reported that pulse transit time (PTT) enables monitoring beat-to-beat BP, identifying a strong relationship between the extent of very short-term BPV and the severity of sleep-disordered breathing (SDB). Here, we investigated the effects of continuous positive airway pressure (CPAP) on very short-term BPV.

Methods:

We studied 66 patients (mean age 62 years old, 73% male) with newly diagnosed SDB who underwent full polysomnography on two consecutive days for diagnosis (baseline) and CPAP, together with PTT-driven BP continuous recording. PTT index was defined as the average number of acute transient rises in BP (≥12 mmHg) within 30 s/h.

Results:

CPAP treatment effectively improved SDB parameters, and attenuated PTT-based BP absolute values during the night-time. Very short-term BPV that includes PTT index and standard deviation (SD) of systolic PTT-BP was significantly reduced by CPAP therapy. The changes in PTT index from baseline to CPAP were positively correlated with the changes in apnea-hypopnea index, obstructive apnea index (OAI), oxygen desaturation index, minimal SpO2, and mean SpO2. Multivariate regression analysis revealed that changes in OAI and minimal SpO2, as well as heart failure, were the independent factors in determining the reduction of PTT index following CPAP.

Conclusion:

PTT-driven BP monitoring discovered the favorable effects of CPAP on very short-term BPV associated with SDB events. Targeting very short-term BPV may be a novel approach to identifying individuals who experience greater benefits from CPAP.
Interferon regulatory factor 4 deletion protects against kidney inflammation and fibrosis in deoxycorticosterone acetate/salt hypertension
Authors: Gao Ying , Liu Benquan , Guo Xiaoqing , Nie Jiayi , Zou Hao , Wen Shihong , Yu Wenqiang , Liang Hua
Published: March 2023

Background:

Inflammation and renal interstitial fibrosis are the main pathological features of hypertensive nephropathy. Interferon regulatory factor 4 (IRF-4) has an important role in the pathogenesis of inflammatory and fibrotic diseases. However, its role in hypertension-induced renal inflammation and fibrosis remains unexplored.

Method and results:

We showed that deoxycorticosterone acetate (DOCA)-salt resulted in an elevation of blood pressure and that there was no difference between wild-type and IRF-4 knockout mice. IRF-4−/− mice presented less severe renal dysfunction, albuminuria, and fibrotic response after DOCA-salt stress compared with wild-type mice. Loss of IRF-4 inhibited extracellular matrix protein deposition and suppressed fibroblasts activation in the kidneys of mice subjected to DOCA-salt treatment. IRF-4 disruption impaired bone marrow-derived fibroblasts activation and macrophages to myofibroblasts transition in the kidneys in response to DOCA-salt treatment. IRF-4 deletion impeded the infiltration of inflammatory cells and decreased the production of proinflammatory molecules in injured kidneys. IRF-4 deficiency activated phosphatase and tensin homolog and weakened phosphoinositide-3 kinase/AKT signaling pathway in vivo or in vitro. In cultured monocytes, TGFβ1 also induced expression of fibronectin and α-smooth muscle actin and stimulated the transition of macrophages to myofibroblasts, which was blocked in the absence of IRF-4. Finally, macrophages depletion blunted macrophages to myofibroblasts transition, inhibited myofibroblasts accumulation, and ameliorated kidney injury and fibrosis.

Conclusion:

Collectively, IRF-4 plays a critical role in the pathogenesis of kidney inflammation and fibrosis in DOCA-salt hypertension.
Accuracy of automated cuff blood pressure monitors in special populations: International Organization for Standardization (ISO) Task Group report and call for research
Authors: Stergiou George S. , Menti Ariadni , Asayama Kei , De La Sierra Alejandro , Wang Jiguang , Kinoshita Hiroyuki , Sawanoi Yukiya , Yamashita Shingo , Kollias Anastasios , Wu Colin O. , Ichikawa Tsutomu , Alpert Bruce
Published: March 2023

Objective:

Automated cuff blood pressure (BP) devices are widely used for ambulatory, home, and office BP measurement. However, an automated device, which is accurate in the general adult population may be inaccurate in some special populations. A 2018 Collaborative Statement by the US Association for the Advancement of Medical Instrumentation, the European Society of Hypertension, and the International Organization for Standardization (ISO) considered three special populations requiring separate validation (children, pregnancy, and atrial fibrillation). An ISO Task Group was appointed to identify evidence for additional special populations.

Method:

Evidence on potential special populations was identified from the STRIDE BP database, which performs systematic PubMed searches for published validation studies of automated cuff BP monitors. Devices that passed in a general population, but failed in potential special populations were identified.

Results:

Of 338 publications (549 validations, 348 devices) in the STRIDE BP database, 29 publications (38 validations, 25 devices) involved four potential special populations: (i) age 12–18 years: three of seven devices failed but passed in a general population; (ii) age more than 65 years: one of 11 devices failed but passed in a general population; (iii) diabetes type-2: four devices (all passed); (iv) chronic kidney disease: two of seven devices failed but passed in a general population.

Conclusion:

Some evidence suggest that the automated cuff BP devices may have different accuracy in adolescents and in patients with chronic kidney disease than in the general population. More research is needed to confirm these findings and investigate other potential special populations.
Central arterial stiffness, brain white matter hyperintensity and total brain volume across the adult lifespan
Authors: Tomoto Tsubasa , Tarumi Takashi , Zhang Rong
Published: March 2023

Objectives:

Mounting evidence suggests that central arterial stiffening is associated with brain ageing in older adults. The purpose of this study was to determine the associations of age with carotid arterial stiffness and carotid-femoral pulse wave velocity (cfPWV), both measurements of central arterial stiffness, the relationship between age-related arterial stiffness, brain white matter hyperintensity (WMH) and total brain volume (TBV), and whether effects of central arterial stiffness on WMH volume and TBV are mediated by pulsatile cerebral blood flow (CBF).

Methods:

One hundred and seventy-eight healthy adults (21–80 years) underwent measurements of central arterial stiffness using tonometry and ultrasonography, WMH and TBV via MRI, and pulsatile CBF at the middle cerebral artery via transcranial Doppler.

Results:

Advanced age was associated with increases in both carotid arterial stiffness and cfPWV, increases in WMH volume and decreases in TBV (all P < 0.01). Multiple linear regression analysis showed that carotid β-stiffness was positively associated with WMH volume (B = 0.015, P = 0.017) and cfPWV negatively with TBV (B = −0.558, P < 0.001) after adjustment for age, sex and arterial pressure. Pulsatile CBF mediates the associations between carotid β-stiffness and WMH (95% confidence interval: 0.0001–0.0079).

Conclusion:

These findings suggest that age-related central arterial stiffness is associated with increased WMH volume and decreased TBV, which is likely mediated by increased arterial pulsation.
Cutibacterium (Formerly Propionibacterium) acnes Keratitis: A Review
Authors: Ashby Nathaniel S. , Johnson Taylor J. , Castillo-Ronquillo Yasmyne , Payne Carter J. , Davenport Connor , Hoopes Phillip C. , Moshirfar Majid
Published: March 2023

Infectious keratitis is a devastating cause of vision loss worldwide. Cutibacterium acnes (C. acnes), a commensal bacterium of the skin and ocular surface, is an underrecognized but important cause of bacterial keratitis. This review presents the most comprehensive and up-to-date information for clinicians regarding the risk factors, incidence, diagnosis, management, and prognosis of C. acnes keratitis (CAK). Risk factors are similar to those of general bacterial keratitis and include contact lens use, past ocular surgery, and trauma. The incidence of CAK may be approximately 10%, ranging from 5% to 25% in growth-positive cultures. Accurate diagnosis requires anaerobic blood agar and a long incubation period (≥7 days). Typical clinical presentation includes small (<2 mm) ulcerations with deep stromal infiltrate causing an anterior chamber cell reaction. Small, peripheral lesions are usually resolved, and patients recover a high visual acuity. Severe infections causing VA of 20/200 or worse are common and often do not significantly improve even after treatment. Vancomycin is considered the most potent antibiotic against CAK, although other antibiotics such as moxifloxacin and ceftazidime are more commonly used as first-line treatment.
Long-term results of a new posterior chamber phakic intraocular lens in patients with high myopia: 5-year results
Authors: Cakir Ihsan , Sonmez Orcun , Pehlivanoglu Seren , Cakir Gulay Yalcinkaya , Yildiz Burcin Kepez , Yildirim Yusuf , Agca Alper
Published: March 2023

Purpose:

To evaluate the long-term refractive outcomes of Eyecryl posterior chamber spherical phakic intraocular lens (pIOL) implantation in high myopia and endothelial cell density (ECD) change.

Setting:

Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

Design:

Retrospective.

Methods:

Eyes that were not suitable for corneal refractive surgery, had high myopia between −6.00 diopters (D) and −20.00 D, had Eyecryl posterior chamber spherical pIOL implantation, and had at least 5 years of follow-up were included. Preoperative ECD was ≥2300 cells/mm2 and cylindrical value was ≤2.0 D in all cases. Preoperative and postoperative first, third, and fifth years of refraction, uncorrected and corrected distance visual acuity (UDVA/CDVA), and ECD were recorded.

Results:

36 eyes of 18 patients were examined. The mean UDVA and CDVA in postoperative fifth years were 0.24 ± 0.19 logMAR and 0.12 ± 0.18 logMAR, respectively. The safety and efficacy indices were 1.52 ± 0.54 and 1.14 ± 0.38, respectively. At 5 years, the spherical equivalent was ±0.50 D in 75% of eyes and ±1.00 D in 92% of eyes. After 5 years, the mean cumulative ECD loss was 6.91% (P = .07). The annual ECD loss was 1.57% in the first year, 0.26% between 1 year and 3 years, and 2.38% between 3 years and 5 years. Asymptomatic anterior capsule opacity developed in 1 eye 4 years after surgery. Rhegmatogenous retinal detachment developed in 1, and myopic choroidal neovascular membrane occurred in 1 eye.

Conclusions:

Eyecryl posterior chamber spherical pIOL implantation is one of the effective and safe refractive surgical methods in correcting high myopia with predictable and stable refractive results over a 5-year period. Longer-term studies are needed for complications such as decreased ECD, retinal complications, and lens opacity.
Comparison of the Barrett toric calculator using measured and predicted posterior corneal astigmatism and the Kane and Abulafia-Koch calculators
Authors: Reitblat Olga , Barnir Megiddo , Qassoom Ayat , Levy Adi , Assia Ehud I. , Kleinmann Guy
Published: March 2023

Purpose:

To compare the accuracy of the Barrett toric calculator with measured and predicted posterior corneal astigmatism (MPCA and PPCA, respectively), the Abulafia-Koch (AK) formula, and the toric Kane formula.

Setting:

Ein-Tal Eye Center, Tel-Aviv, Israel.

Design:

Retrospective cohort.

Methods:

Consecutive cases of patients who underwent uneventful cataract extraction surgery with implantation of a toric intraocular lens between March 2015 and July 2019 were retrospectively reviewed. 1 eligible eye from each patient was included. The predicted postoperative refractive astigmatism was calculated using each method and compared with the postoperative refractive astigmatism to give the prediction error.

Results:

80 eyes of 80 patients were included in this study. The mean centroid and the mean and median absolute prediction errors using Kane (0.25 diopters [D] ± 0.54 @ 6 degrees, 0.50 D ± 0.31 and 0.45 D, respectively) were significantly different compared with MPCA (0.12 D ± 0.52 @ 16 degrees, P < .001, .44 D ± 0.28 and 0.36 D, P = .027, respectively), PPCA (0.09 D ± 0.49 @ 12 degrees, P < .001, .41 D ± 0.27 and 0.35 D, P < .001, respectively), and AK (0.11 D ± 0.49 @ 11 degrees, P < .001, .42 D ± 0.27 and 0.35 D, P = .004, respectively). No significant differences were found between the calculators in the predictability rates within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D.

Conclusions:

The measured posterior corneal curvature in the Barrett calculator yielded comparable outcomes to its prediction by the Barrett and AK formulas. The Kane calculator showed a slight against-the-rule prediction error compared with the other methods, resulting in a small higher median absolute error with marginal clinical importance.
Monitoring of Serum TWEAK Level Guides Glucocorticoid Dosages in the Treatment of Systemic Lupus Erythematosus
Authors: Chen Jing-Yun , Zhang Yu-Fei , Wu Yi , Wu Xiao-Kang , Wang Li , Luo Mai , Xiao Sheng-Xiang , Wang Hui-Xia , Xia Yu-Min
Published: March 2023

Objective:

Accurate assessment of systemic lupus erythematosus (SLE) disease activity is critical. This study explored the relationship between the serum level of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score as well as the role of TWEAK in guiding the glucocorticoid dosage in SLE treatment.

Methods:

This study involved 131 patients with SLE, 34 with subacute cutaneous lupus erythematosus (SCLE), 22 with discoid lupus erythematosus (DLE), and 32 healthy volunteers. The serum and urinary TWEAK levels were determined. Monomeric C-reactive protein (mCRP), anti-dsDNA IgG, antinuclear antibody (ANA), complements in serum and urinary albumin level were measured. The SLEDAI 2000 (SLEDAI-2K) was used to evaluate disease activity. The correlation of the SLEDAI-2K score with all biomarkers was determined. Methylprednisolone was orally administered to patients with SLE depending on the serum level of TWEAK.

Results:

TWEAK levels were higher in patients with SLE or SCLE than in patients with DLE or healthy controls. The serum TWEAK level was positively correlated with the SLEDAI-2K score in patients with SLE (P < 0.001), and was more strongly correlated with the SLEDAI-2K score than other parameters (P < 0.001). Moreover, TWEAK-based glucocorticoid therapy was associated with lower SLEDAI-2K scores, better tapering of glucocorticoid doses, and fewer lupus flares in patients with SLE.

Conclusions:

Serum TWEAK is a useful biomarker reflecting SLE disease activity. Monitoring of the serum TWEAK level can improve the outcomes of glucocorticoid therapy in patients with SLE.
Deficiency of Autophagy-Related Gene 5 in Keratinocytes Leads to Aggravation of Epidermal Damage in 2,4-dinitrochlorobenzene-induced Allergic Contact Dermatitis
Authors: Zhang Yi-Qun , Xiao Ta , Song Chang-Jun , Ke Yang-Ying , Gao Xiang , Li Min , Gu Heng , Chen Xu
Published: March 2023

Objective:

To determine whether keratinocyte-specific autophagy-related gene 5 (ATG5) deficiency can regulate apoptosis to inhibit skin damage in mice with 2,4-dinitrochlorobenzene (DNCB)-induced allergic contact dermatitis (ACD).

Methods:

This study involved keratinocyte-specific Atg5 conditional knockout (cKO) mice (Krt14cre/+-Atg5
flox/flox) and control mice (Krt14+/+-Atg5
flox/flox). We painted DNCB on the right ear of each mouse to induce ACD. Dermatitis scoring and measurements of ear weight and thickness were performed to evaluate inflammation levels. An immunohistochemical assay was performed to analyze immune cell infiltration. Histological study and TUNEL staining were performed to compare the differences in skin lesions between Atg5 cKO mice and control mice. Immunofluorescence and western blotting were used to examine the levels of ATG5 and apoptosis-related protein. The results were statistically analyzed by t test.

Results:

After DNCB stimulation of mice ears, we observed a more severe phenotype in Atg5 cKO mice than in control mice (dermatitis score: 7.5 ± 2.5884 vs. 3.25 ± 0.8216, P = 0.0033). Further analysis of ATG5 protein confirmed keratinocyte-specific ablation of Atg5 in cKO mice and showed that DNCB did not influence ATG5 expression. Immunohistochemistry assay revealed that the infiltrated immune cells were not involved in aggravation of the phenotype of DNCB-stimulated Atg5 cKO mice. However, the histological study (P = 0.0238), TUNEL staining (P = 0.0238), immunofluorescence (P = 0.0357), and western blotting showed that the increase in keratinocyte death, especially apoptosis, contributed to aggravation of the phenotype of DNCB-stimulated Atg5 cKO mice.

Conclusion:

Deficiency of Atg5 in keratinocytes increases apoptosis, aggravating skin damage in DNCB-induced ACD mice. This has no relationship with the involvement of immune cells.
Early Syphilis Presenting as Thickened Penile Plaques With an Embedded Recurrent Ulcer (Chancre Redux): A Case Report
Authors: Davies Stephen C. , Hannaford Rodney , Cotter Joseph
Published: March 2023

Introduction:

The manifestations of syphilis are varied, and serology can establish the diagnosis early, especially in rare cases.

We report a case of chancre redux (a rare recurrence of primary syphilis), which was embedded within a secondary syphilitic penile skin plaque. There were missed opportunities at earlier diagnosis as serology for syphilis was not ordered.

Case presentation:

A 56-year-old man presented with thickened penile plaques for five months. He reported a small penile ulcer approximately one month prior. There was no history of other skin lesions or rash. However, clinically there was an asymptomatic, indurated ulcer embedded within a plaque which was swab-positive for syphilis by PCR. A punch biopsy of a plaque was spirochaete-positive using an immunoperoxidase stain. The patient’s lesions resolved three weeks after treatment with intramuscular benzathine penicillin.

Discussion:

Uncommonly reported even in the preantibiotic era, chancre redux is now rare. The ulcer usually recurs at or near the site of the original chancre, and has similar morphological features. The skin lesions of secondary syphilis can exhibit remarkable morphological variety. The most common skin manifestation, a generalized macular rash, was not present at any time in this case. Rather, there were only a couple of nonspecific penile plaques. If biopsy is performed, histologic findings are variable, though typically the inflammatory infiltrate includes plasma cells. A special immunoperoxidase stain can highlight spirochaetes in biopsy sections.

Conclusion:

This case highlights the importance of considering syphilis in the differential diagnosis of persistent, atypical penile lesions and underscores the need for appropriate serological testing in such instances.
Expert consensus on the treat-to-target strategy for psoriasis with biological agents in China
Authors: Chen Ai-Jun , Cai Da-Xing , Chen Xiang , Cui Yong , Ding Yan , Gu Heng , Gao Xing-Hua , Ji Chao , Kang Xiao-Jing , Kuang Ye-Hong , Lyu Cheng-Zhi , Li Min , Li Wei , Li Xia , Li Yu-Zhen , Man Xiao-Yong , Qiao Jian-Jun , Su Juan , Sun Liang-Dan , Shi Yu-Ling , Tao Juan , Xia Jian-Xin , Xiao Rong , Yang Bin , Zhu Wu , Zhang Xue-Jun ,   Committee on Psoriasis, Dermatology and Venereology Branch of the Chinese Medical Association
Published: March 2023

Psoriasis is a chronic, recurrent, inflammatory systemic disease that is not only characterized by skin manifestations but may also be accompanied by various comorbidities, imposing a heavy burden on patients’ physical and mental health and affecting their quality of life. Although the continuous approval of various biological agents for clinical use has provided more effective treatment options to patients with psoriasis, no consensus on the evaluation of comprehensive treatment goals has yet been established. The treat-to-target (T2T) strategy requires consideration of multiple dimensions of treatment outcomes, the development of long-term management goals, and regular assessments of treatment conditions, which are often used in the management of chronic diseases. Therefore, based on the latest consensuses and guidelines, research data, and clinical experience as well as the combination of survey results and expert group discussions, the present consensus focuses on four dimensions of short- and long-term integrated management goals for biological agents: alleviating skin lesions, improving quality of life, screening and managing psoriasis comorbidities, and ensuring drug safety. The implementation methods, evaluation time, treatment monitoring, and program adjustments are also herein described to achieve comprehensive management of psoriasis to the maximum extent. This consensus provides a reference for clinical practice.
More or Less Job Performance in an Insecure Job? A Study on the Relationship between Job Insecurity and In-Role and Extra-Role Performance
Authors: Roodbol Janine , Stynen Dave
Published: March 2023

Objective

To gain insight into the complex relationship between job insecurity and in-role and extra-role performance. Autonomous work motivation is investigated as a mediator in this relationship. The quality of the employee-supervisor relationship (LMX) is investigated as a moderator between job insecurity and autonomous work motivation.

Methods

Cross-sectional data were collected by online surveys among 206 Dutch and Belgian employees. Multiple regression analyses were performed to test the hypotheses.

Results

Job insecurity was negatively associated with both in-role and extra-role performance. Autonomous work motivation mediated the negative relationship between job insecurity and in-role and extra-role performance. LMX did not moderate the negative relationship between job insecurity and autonomous work motivation.

Conclusions

Organizations need to prevent job insecurity and limit the negative consequences of job insecurity for sustaining employees' autonomous work motivation and job performance.
Conjunctivitis: A Primer on Conjunctival Biopsy and Approach to Histopathologic Diagnosis
Authors: Margo Curtis E. , Harman Lynn E.
Published: March 2023

Conjunctivitis, or inflammation of the mucosal covering the anterior third of sclera and inner eyelid, is a common clinical condition of varied causation. Most cases are self-limited due to infection or allergy and rarely necessitate biopsy. Inflammation of the conjunctiva, however, is one of the most common principal histopathologic diagnoses rendered when the tissue is biopsied. In the context of conjunctivitis, biopsy is usually performed when inflammation is chronic and recalcitrant to therapy, has clinically atypical features, or requires an etiologic diagnosis when one cannot be reached through other laboratory methods. The exclusion of ocular surface neoplasia in a chronically inflamed conjunctiva is a common justification for biopsy. When inflammation is the principal histopathology finding, it is desirable—whenever feasible—to establish the cause. This brief review provides a guide in how histologic findings of an inflamed conjunctiva can direct the clinical evaluation towards an etiologic diagnosis.
Elevated Diaphragmatic Tonic Activity in PICU Patients: Age-Specific Definitions, Prevalence, and Associations*
Authors: Plante Virginie , Poirier Clarice , Guay Hélène , Said Carla , Sauthier Michael , Al-Omar Sally , Harrington Karen , Emeriaud Guillaume
Published: March 2023

OBJECTIVES:

Tonic diaphragmatic activity (tonic Edi, i.e., sustained diaphragm activation throughout expiration) reflects diaphragmatic effort to defend end-expiratory lung volumes. Detection of such elevated tonic Edi may be useful in identifying patients who need increased positive end-expiratory pressure. We aimed to: 1) identify age-specific definitions for elevated tonic Edi in ventilated PICU patients and 2) describe the prevalence and factors associated with sustained episodes of high tonic Edi.

DESIGN:

Retrospective study using a high-resolution database.

SETTING:

Single-center tertiary PICU.

PATIENTS:

Four hundred thirty-one children admitted between 2015 and 2020 with continuous Edi monitoring.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We characterized our definition of tonic Edi using data from the recovery phase of respiratory illness (i.e., final 3 hr of Edi monitoring, excluding patients with significant persistent disease or with diaphragm pathology). High tonic Edi was defined as population data exceeding the 97.5th percentile, which for infants younger than 1 year was greater than 3.2 μV and for older children as greater than 1.9 μV. These thresholds were then used to identify patients with episodes of sustained elevated tonic Edi in the first 48 hours of ventilation (acute phase). Overall, 62 of 200 (31%) of intubated patients and 138 of 222 (62%) of patients on noninvasive ventilation (NIV) had at least one episode of high tonic Edi. These episodes were independently associated with the diagnosis of bronchiolitis (intubated patients: adjusted odds [aOR], 2.79 [95% CI, 1.12–7.11]); NIV patients: aOR, 2.71 [1.24–6.0]). There was also an association with tachypnea and, in NIV patients, more severe hypoxemia.

CONCLUSIONS:

Our proposed definition of elevated tonic Edi quantifies abnormal diaphragmatic activity during expiration. Such a definition may help clinicians to identify those patients using abnormal effort to defend end-expiratory lung volume. In our experience, high tonic Edi episodes are frequent, especially during NIV and in patients with bronchiolitis.
Anticoagulation-Free Pediatric Extracorporeal Membrane Oxygenation: Single-Center Retrospective Study*
Authors: Rabinowitz Edon J. , Danzo Megan T. , Anderson Mark J. , Wallendorf Michael , Eghtesady Pirooz , Said Ahmed S.
Published: March 2023

Objectives:

To analyze hemorrhage and thrombosis data related to anticoagulation-free pediatric extracorporeal membrane oxygenation (ECMO).

Design:

Retrospective cohort study.

Settings:

High-volume ECMO single institution data.

Patients:

Children (0–18 yr) supported with ECMO (>24 hr) with initial anticoagulation-free period of greater than or equal to 6 hours.

Interventions:

None.

Measurements and Main Results:

Utilizing consensus American Thoracic Society definitions for hemorrhage and thrombosis on ECMO, we evaluated thrombosis and associated patient and ECMO characteristics during anticoagulation-free period. Thirty-five patients met inclusion criteria from 2018 to 2021 having a median age (interquartile range [IQR]) of 13.5 months (IQR, 3–91 mo), median ECMO duration of 135 hours (IQR, 64–217 hr), and 964 anticoagulation-free hours. Increased RBC transfusion needs were associated with longer anticoagulation-free periods (p = 0.03). We identified 20 thrombotic events: only four during the anticoagulation-free period and occurring in three of 35 (8%) patients. Compared with those without thrombotic events, anticoagulation-free clotting events were associated with younger age (i.e., 0.3 mo [IQR, 0.2–0.3 mo] vs 22.9 mo [IQR, 3.6–112.9 mo]; p = 0.02), lower weight (2.7 kg [IQR, 2.7–3.25 kg] vs 13.2 kg [5.9–36.4 kg]; p = 0.006), support with lower median ECMO flow rate (0.5 kg [IQR, 0.45–0.55 kg] vs 1.25 kg [IQR, 0.65–2.5 kg]; p = 0.04), and longer anticoagulation-free ECMO duration (44.5 hr [IQR, 40–85 hr] vs 17.6 hr [IQR, 13–24.1]; p = 0.008).

Conclusions:

In selected high-risk-for-bleeding patients, our experience is that we can use ECMO in our center for limited periods without systemic anticoagulation, with lower frequency of patient or circuit thrombosis. Larger multicentered studies are required to assess weight, age, ECMO flow, and anticoagulation-free time limitations that are likely to pose risk for thrombotic events.
Statistical and methodological considerations for randomized-controlled trial design in physical medicine and rehabilitation
Authors: Thakur Bhaskar , Ayers Gregory D. , Atem Folefac , DeClerq Josh , Jain Nitin B.
Published: March 2023

Well-designed randomized-controlled clinical trials assessing treatments in the field of physical medicine and rehabilitation (PM&R) are essential for evidence-based patient care. However, there are challenges unique to clinical trials in PM&R due to complex health interventions in this field. We highlight routinely encountered empirical challenges and provide evidence-based recommendations on statistical and methodological approaches for the design and conduct of randomized controlled trials. Some of the issues addressed include challenges with blinding treatment groups in a rehabilitation setting, heterogeneity in treatment therapy, heterogeneity of treatment effects, uniformity in patient-reported outcome measures, and effect on power with varying scales of information. Further, we discuss challenges with estimation of sample size and power, adaption to poor compliance with treatment and missing outcomes, and preferred statistical approaches for longitudinal data analysis.
High Level Spinal Cord Injury and the Failure of U.S. Acute Rehabilitation: An Analysis and Commentary
Authors: Bach John R. , Shih Tiffany
Published: March 2023

Acute and long-term morbidity and mortality rates have not changed in the United States for people with high level spinal cord injury in 40 years, neither has the conventional invasive respiratory management for these patients. This is despite a 2006 challenge to institutions for a paradigm shift to avoid or decannulate patients of tracheostomy tubes. Centers in Portugal, Japan, Mexico, and South Korea decannulate high level patients to up to continuous noninvasive ventilatory support and use mechanical insufflation exsufflation, as we have done and reported since 1990, but there has been no such paradigm shift in U.S. rehabilitation institutions. The quality of life and financial consequences of this are discussed. An example of decannulation of a relatively easy case, after failure to do so during 3 months of acute rehabilitation, is presented to encourage institutions to begin to learn and apply noninvasive management before decannulating more severe patients with little to no ventilator free breathing ability.
A computerized recognition system to assess breast asymmetry after augmentation mammaplasty
Authors: Xu Boyang , Chen Lin , Liu Chunjun , Luan Jie
Published: March 2023

Background

Breast augmentation patients are often unaware of their preexisted breast asymmetry before the surgery but discover it afterward, which leads to postoperative dissatisfaction and increases the reoperation rate. However, elaboration on how patients subjectively analyze breast asymmetry and the recognition thresholds was limited.

Methods

Two hundred female participants, including 100 six-months postoperative patients for primary augmentation mammaplasty, and 100 preoperative ones, were recruited as two study groups. Self-assessments of breast asymmetry and objective measurements were taken. A computerized recognition experiment was constructed based on standardized 3D models with different NAC and IMF asymmetry combinations. One hundred and twenty-one 3D models were generated and shown in random sequence. Participants responded whether they discovered breast asymmetry in each model. The recognition rate and 50% recognition thresholds of the asymmetry in NAC, IMF, lower pole length, volume and their interrelations were calculated.

Results

Self-assessment of the post-augmentation group showed a more precise distinguishment of NAC, IMF, and lower pole distance asymmetry than the pre-augmentation group. The 50% recognition thresholds of NAC and IMF level discrepancies were approximately 0.75cm, with the IMF asymmetry identified with higher accuracy. When the NAC level discrepancy ranged from 0.0cm to 1.25cm, adjusting the IMF level discrepancy from 0.0cm to 0.5cm in the same direction lowered participants' recognition rates of breast asymmetry.

Conclusion

Patients recognize their breast asymmetry issue more accurately after augmentation surgeries, despite improved parameters. In addition, adjusting the new IMF level aligning with NAC discrepancy within 0.5cm when treating mild NAC asymmetry improved symmetrical outcomes.
Modelling the control of bovine brucellosis in India
Authors: Holt H. R. , Walker M. , Beauvais W. , Kaur P. , Bedi J. S. , Mangtani P. , Sharma N. S. , Gill J. P. S. , Godfroid J. , McGiven J. , Guitian J.
Published: March 2023

Brucellosis imposes substantial impacts on livestock production and public health worldwide. A stochastic, age-structured model incorporating herd demographics was developed describing within- and between-herd transmission of
Brucella abortus
in dairy cattle herds. The model was fitted to data from a cross-sectional study conducted in Punjab State of India and used to evaluate the effectiveness of control strategies under consideration. Based on model results, stakeholder acceptance and constraints regarding vaccine supply, vaccination of replacement calves in large farms should be prioritized. Test and removal applied at early stages of the control programme where seroprevalence is high would not constitute an effective or acceptable use of resources because significant numbers of animals would be ‘removed’ (culled or not used for breeding) based on false positive results. To achieve sustained reductions in brucellosis, policymakers must commit to maintaining vaccination in the long term, which may eventually reduce frequency of infection in the livestock reservoir to a low enough level for elimination to be a realistic objective. This work provides key strategic insights into the control of brucellosis in India, which has the largest cattle population globally, and a general modelling framework for evaluating control strategies in endemic settings.
Synthesis and radiolabelling of PSMA-targeted derivatives containing GYK/MVK cleavable linkers
Authors: Murce Erika , de Blois Erik , van den Berg Sophie , de Jong Marion , Seimbille Yann
Published: March 2023

Targeted radionuclide therapy (TRT) is a promising strategy to treat different types of cancer. TRT relies on a targeting vector used to deliver a therapeutic radionuclide specifically to the tumour site. Several low molecular weight ligands targeting the prostate-specific membrane antigen (PSMA) have been synthesized, but their pharmacokinetic properties still need to be optimized. Hereby, we describe the synthesis of new conjugates, featuring the cleavable linkers Gly-Tyr-Lys (GYK) and Met-Val-Lys (MVK), to reduce the dose delivered to the kidneys. Compounds were synthesized by solid-phase peptide synthesis (SPPS) and obtained in greater than 95% chemical purity. Radiolabelling was performed with both In-111 and Lu-177 to validate potential use of the compounds as both imaging and therapeutic agents. Radiochemical purity greater than 80% was obtained for both nuclides, but significant radiolysis was observed for the methionine-containing analogue. The results obtained thus far with the GYK-PSMA conjugate could warrant further biological investigations.
Extreme value modelling of SARS-CoV-2 community transmission using discrete generalized Pareto distributions
Authors: Daouia Abdelaati , Stupfler Gilles , Usseglio-Carleve Antoine
Published: March 2023

Superspreading has been suggested to be a major driver of overall transmission in the case of SARS-CoV-2. It is, therefore, important to statistically investigate the tail features of superspreading events (SSEs) to better understand virus propagation and control. Our extreme value analysis of different sources of secondary case data indicates that case numbers of SSEs associated with SARS-CoV-2 may be fat-tailed, although substantially less so than predicted recently in the literature, but also less important relative to SSEs associated with SARS-CoV. The results caution against pooling data from both coronaviruses. This could provide policy- and decision-makers with a more reliable assessment of the tail exposure to SARS-CoV-2 contamination. Going further, we consider the broader problem of large community transmission. We study the tail behaviour of SARS-CoV-2 cluster cases documented both in official reports and in the media. Our results suggest that the observed cluster sizes have been fat-tailed in the vast majority of surveyed countries. We also give estimates and confidence intervals of the extreme potential risk for those countries. A key component of our methodology is up-to-date discrete generalized Pareto models which allow for maximum likelihood-based inference of data with a high degree of discreteness.
The dangerous of listen it but not understand it: The effect of interoceptive awareness as the underlying mechanism between anxiety and NSSI behaviors
Authors: Qu Diyang , Feng Yi , Chen Runsen
Published: March 2023

The underlying mechanism between anxiety and NSSI behaviors remains unclear. Interoceptive awareness has been suggested as a strong transdiagnostic risk factors for emotional disorders. Following the body-mind approach, we thus aimed to examine the potential indirect effect of three important dimensions of interoceptive awareness. The effect of study variables on the lifetime NSSI behaviors was first tested on 5281 Chinese participants, then the indirect effects were further clarified among individual with NSSI behaviors. We found that Emotional awareness and Body listening plays an indirect effect between anxiety symptoms and NSSI frequent, but in a opposite way. Future preventive intervention program in strength individual’s abilities of connection body and emotion has been strongly highlighted.
Dengue clinical features and predictors of severity in the diabetic patient: a retrospective cohort study on Reunion island, 2019
Authors: Issop Azizah , Bertolotti Antoine , Diarra Yves-Marie , Maïza Jean-christophe , Jarlet Éric , Cogne Muriel , Doussiet Éric , Magny Éric , Maillard Olivier ,   Epidengue Cohort Investigation Team, Nobécourt Estelle , Gérardin Patrick
Published: March 2023

Aim: Diabetes mellitus is associated with both the risks of severe dengue and dengue-related deaths, however the factors characterizing dengue in the diabetic patient are ill-recognized. The objective of this hospital-based cohort study was to identify the factors characterizing dengue and those able to predict dengue severity in the diabetic patient.

Methods

We retrospectively analysed demographic, clinical and biological parameters at admission in the cohort of patients who consulted at the university hospital between January and June 2019 with confirmed dengue. Bivariate and multivariate analyses were conducted.

Results

Of 936 patients, 184 patients (20%) were diabetic. One hundred and eighty-eight patients (20%) developed severe dengue according to the WHO 2009 definition. Diabetic patients were older and had more comorbidities than non-diabetics. In an age-adjusted logistic regression model, loss of appetite, altered mental status, high neutrophil to platelet ratios (>14.7), low haematocrit (≤ 38%), upper-range serum creatinine (>100 µmol/l) and high urea to creatinine ratio (>50) were indicative of dengue in the diabetic patient. In a modified Poisson regression model, four key independent variables were predictive of severe dengue in the diabetic patient: presence of diabetes complications, non-severe bleeding, altered mental status and cough. Among diabetes complications, diabetic retinopathy and neuropathy, but not diabetic nephropathy nor diabetic foot, were predictive of severe dengue.

Conclusion

At hospital first presentation, dengue in the diabetic patient is characterized by deteriorations in appetite, mental and renal functioning, while severe dengue can be predicted by presence of diabetes complications, dengue-related non-severe haemorrhages, cough, and dengue-related encephalopathy.
Campus Sewage Water Surveillance based dynamics and infection trends of SARS-CoV-2 variants during third wave of COVID-19 in Pune, India
Authors: Malik Vinita , Rajput Vinay , Pramanik Rinka , Samson Rachel , Yadav Rakesh kumar , Kadam Pradnya , Shah Nikita , Sawant Rutuja , Bhalerao Unnati , Tupekar Manisha , Khan Soumen , Shah Priyanki , Shashidhara LS , Kamble Sanjay , Dastager Syed , Karmodiya Krishanpal , Dharne Mahesh
Published: March 2023

The wastewater-based epidemiology (WBE) of SARS-CoV-2 is a quick and cost-effective method of tracking virus transmission. However, few studies reported on campus or in academic or residential settings worldwide. In this study, we demonstrated the WBE approach to detect, monitor, and evaluate genomic variants of SARS-CoV-2 fragments in a sewage treatment plant (STP) located on the campus of CSIR National Chemical Laboratory, Pune, India. Herein we describe the early warning capability of WBE, with viral load rise in campus sewage water up to 14 days before its clinical detection. This was supported further by a significant correlation between SARS-CoV-2 RNA concentration and clinically reported COVID-19 cases on campus. Additionally, we comprehended the probable targets missed by the quantitative qRT-PCR using amplicon-based sequencing due to low viral load. The analysis revealed the presence of signature mutations of the Omicron (S:N679K, S:N764K, S:D796Y, N:P13L, ORF1a:T3255I, ORF1a:K856R, ORF1a:P3395H, and N:S413R) before the lineage was first detected globally. Further, we used Lineage decomposition (LCS) tool to detect the Variant of Concern (VOC)/Variant of Interest (VOI) signals upto a month earlier in sewage water samples. The analysis also indicated the transition of lineage from Delta to Omicron in late Decemeber,2021. This is the first study in India highlighting the use of on-campus STP to evaluate the local spread of SARS-CoV-2, which could aid in preventing COVID-19 in academic institutes/universities. This study proves the usefulness of WBE as an early warning system for detecting, tracking and tracing VOCs using the sequencing approach. The current study could aid in taking critical decisions to tackle the pandemic scenario on campus.

Highlights

The first study on campus sewage water for SARS-CoV-2 surveillance in India

Early detection of Omicron VOC signals during early November 2021

Sequencing revealed the presence of Omicron VOC fragments prior to clinical cases reported on campus

Genomic analysis indicated transition of Delta to Omicron lineage in late December 2021 and potentially led to the third wave

Combining qRT-PCR and sequencing could be useful for on-campus tracking of variants using wastewater surveillance
Artificial Intelligence Neural Network Consistently Interprets Lung Ultrasound Artifacts in Hospitalized Patients: A Prospective Observational Study
Authors: Fox Thomas H. , Gare Gautam R. , Hutchins Laura E. , Perez Victor S. , Rodriguez Ricardo , Smith David L. , Brito-Encarnacion Francisco X. , Danrad Raman , Tran Hai V. , Lowery Peter B. , Montgomery David J. , Zamorra Kevin A. , Krishnan Amita , Galeotti John M. , deBoisblanc Bennett P.
Published: March 2023

Background

Interpretation of lung ultrasound artifacts by clinicians can be inconsistent. Artificial intelligence (AI) may perform this task more consistently.

Research Question

Can AI characterize lung ultrasound artifacts similarly to humans, and can AI interpretation be corroborated by clinical data?

Study Design and Methods

Lung sonograms (n=665) from a convenience sample of 172 subjects were prospectively obtained using a pre-specified protocol and matched to clinical and radiographic data. Three investigators scored sonograms for A-lines and B-lines. AI was trained using 142 subjects and then tested on a separate dataset of 30 patients. Three radiologists scored similar anatomic regions of contemporary radiographs for interstitial and alveolar infiltrates to corroborate sonographic findings. The ratio of oxyhemoglobin saturation:fraction of inspired oxygen (S/F) was also used for comparison. The primary outcome was the intraclass correlation coefficient (ICC) between the median investigator scoring of artifacts and AI interpretation.

Results

In the test set, the correlation between the median investigator score and the AI score was moderate to good for A lines (ICC 0.73, 95% CI [0.53-0.89]), and moderate for B lines (ICC 0.66, 95% CI [0.55-0.75]). The degree of variability between the AI score and the median investigator score for each video was similar to the variability between each investigator’s score and the median score. The correlation among radiologists was moderate (ICC 0.59, 95% CI [0.52-0.82]) for interstitial infiltrates and poor for alveolar infiltrates (ICC 0.33, 95% CI [0.07-0.58]). There was a statistically significant correlation between AI scored B-lines and the degree of interstitial opacities for five of six lung zones. Neither AI nor human-scored artifacts were consistently associated with S/F.

Interpretation

Using a limited dataset, we showed that AI can interpret lung ultrasound A-lines and B-lines in a fashion that could be clinically useful.