bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Paternal Skin-to-Skin Care
Authors: Kuo Shu-Fen , Chen I-Hui , Chen Su-Ru , Chen Kee-Hsin , Fernandez Ritin S.
Published: May 2021

Background:

Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants.

Purpose:

The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants.

Methods:

The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790].

Results:

Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: −0.35 pg/mL; 95% CI: −0.75, 0.05), salivary cortisol levels (MD: 0.25 μg/dL; 95% CI: −0.82, 1.33), or anxiety scores (MD: −0.17; 95% CI: −0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: −0.11 μg/dL; 95% CI: −0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups.

Implications for Practice and Research:

P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.
Complete response of brainstem metastasis in BRAF-mutated melanoma without stereotactic radiosurgery after initiation of encorafenib and binimetinib
Authors: Khullar Karishma , Hanft Simon , Mehnert Janice M. , Weiner Joseph P.
Published: May 2021

Metastatic melanoma is often accompanied by the development of brain metastases, at presentation or during the course of therapy. Local therapies such as surgery and radiation have been considered standard treatments for intracranial disease. However, the emergence of systemic therapies has been changing the treatment paradigm for the management of brain metastases. In patients with BRAF-mutated melanoma, combined BRAF and MEK inhibition has been found to elicit significant clinical responses. Patients who develop resistance to MAP kinase (MAPK) targeted therapy can achieve significant responses upon rechallenge. In this case, a 68-year-old woman with metastatic melanoma who had received multiple treatment courses including combination immunotherapy and combination MAPK-targeted therapy presented with a brainstem metastasis and demonstrated a complete response upon initiation of encorafenib and binimetinib, thereby obviating the need for stereotactic radiosurgery.
Innovating patient care and gynecologic surgery instruction through tele-education
Authors: Siedhoff Matthew T. , Truong Mireille D. , Wright Kelly N.
Published: May 2021

Purpose of review

Effects of the coronavirus disease 2019 pandemic prompted the need for rapid, flexible change in the delivery of care, education, and commitment to the well-being of obstetrics and gynecology (OB/GYN) residents.

Recent findings

Published literature shows multiple models for surge scheduling for residency programs in other specialties. We describe our experience creating a surge schedule for OB/GYN residents that allowed for sufficient coverage of inpatient care while minimizing resident exposure and limited hospital resources, respecting work hour requirements, and plans for coverage due to illness or need for home quarantine. We also report innovative approaches to trainee education through the use of remote-learning technology and gynecologic surgery skills training in absence of normal clinical exposure.

Our approach serves as a model for adapting to unprecedented challenges and offers suggestions for creative transformations of traditional teaching that can be continued beyond the immediate crisis.
Common pediatric gynecological issues: a review
Authors: Kudze Tambu , Wheeler Carol
Published: May 2021

Purpose of review

To provide clinicians with a review of recent research and methods for evaluation of common pediatric gynecology complaints and problems.

Recent findings

The examination and history of a pediatric gynecologic patient involve information gathering in order to limit anxiety for the child and optimize the ability to diagnose and treat her. Child abuse recognition is increasing, and its management requires special expertise. The early management of disorders of sexual development (DSDs) has changed with a focus towards early identification and consideration of delayed surgical management. The multidisciplinary evaluation and management of the pelvic mass in the child involves careful preoperative evaluation to allow for conservative management.

Reproductive endocrinology and infertility (REI) providers are often called upon to evaluate children when a pediatric gynecologist is not immediately available. This review highlights valuable information for adult gynecologic providers who may encounter young girls with gynecologic issues in a variety of settings. Having some basic knowledge of the evaluation and management will allow the provider to either manage the child themselves or triage her to the appropriate consultant.
Evaluation of endometrial progesterone receptor expression after 12 weeks of exposure to a low-dose vaginal estradiol insert
Authors: Mirkin Sebastian , Simon James A. , Liu James H. , Archer David F. , Castro Patricia D. , Graham Shelli , Bernick Brian , Komm Barry
Published: May 2021

Objective:

To evaluate endometrial progesterone receptor (PGR) expression in menopausal women who used vaginal 4-μg and 10-μg estradiol (E2) inserts or placebo.

Methods:

REJOICE was a randomized, placebo-controlled trial investigating vaginal E2 inserts in women with moderate to severe dyspareunia due to menopause. In this post hoc analysis, 25 eligible women with endometrial biopsies were randomly selected from each treatment group (4-μg and 10-μg E2 vaginal inserts and placebo). Endometrial biopsy sections were immunostained using an anti-PR (A and B) monoclonal antibody. Cell staining was quantified using an artificial intelligence feature-recognition algorithm. Mean PGR expression levels were analyzed between baseline and week 12.

Results:

PGR expression results were available for 22 women in the 4-μg E2 group, and 25 women each for the 10-μg E2 and placebo groups. Similar PGR expression levels were observed at baseline (0.301-0.470 pmol/mg) and after 12 weeks of treatment (0.312-0.432 pmol/mg) for all treatment groups, with no significant differences between baseline and week 12.

Conclusions:

No meaningful differences in endometrial PGR expression were observed with the vaginal E2 (4- and 10-μg) inserts at week 12 from baseline, supporting the hypothesis that local exposure to E2 from a low-dose, vaginal insert placed near the vaginal introitus will not be sufficient to upregulate endometrial PGR expression. Coupled with the lack of histologic changes and systemic absorption, our data suggest that these softgel vaginal E2 inserts would not be expected to stimulate endometrial hyperplasia leading to a potential endometrial safety issue in postmenopausal women with moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy. Further study on the endometrial safety of softgel vaginal E2 inserts is under way.
Waist circumference change and risk of high carotid intima-media thickness in a cohort of Chinese children
Authors: Wang Huan , Sun Jiahong , Zhang Zhenwei , Yang Liu , Zhao Min , Bovet Pascal , Xi Bo
Published: May 2021

Objective:

Previous cross-sectional studies showed a positive association between waist circumference (WC) and carotid intima-media thickness (cIMT) among children and adolescents. We examined the association between change in WC and cIMT in a cohort study of Chinese children with 2-year follow-up.

Methods:

A school-based cohort study named ‘Huantai Childhood Cardiovascular Health Cohort Study’ was conducted in Zibo City, Shandong Province, China. WC and cIMT were measured in 2017 and 2019. Change in WC was categorized into four groups: persistently low WC, WC loss, WC gain and persistently high WC. We examined the association between WC change and cIMT during a 2-year follow-up.

Results:

A total of 1183 children aged 6–11 years at baseline were included in this study. After adjustment for potential covariates, WC change was associated positively with cIMT change (linear regression coefficient = 5.92 μm/cm per 2 years, 95% confidence interval [CI]: 4.55–7.30). Among the 1072 children (out of 1183 children) with normal cIMT at baseline, compared with persistently low WC, WC gain (odds ratio [OR] = 3.23, 95% CI: 1.14–9.17) and persistently high WC (OR = 7.94, 95% CI: 3.81–16.51) were associated with high cIMT at the end of the follow-up period. In contrast, WC loss during follow-up was not associated with high cIMT (OR = 1.33, 95% CI:0.35–5.11).

Conclusion:

In this cohort of children, WC gain and persistently high WC were associated with increased cIMT whereas WC loss was not. These findings emphasize the importance of maintaining a normal WC in childhood to promote vascular health.
Comparative analysis of visual outcomes of multifocal and monofocal intraocular lenses in congenital cataract surgery
Authors: Buzzonetti Luca , Petroni Sergio , De Sanctis Carlo Maria , Valente Paola , Federici Matteo , Benassi Claudia , Iarossi Giancarlo
Published: May 2021

Purpose:

To assess the impact on visual development of multifocal vs monofocal intraocular lenses (IOLs) implantation in children after congenital cataract surgery.

Setting:

Ophthalmology Department, Bambino Gesù Children’s Hospital, Rome, Italy.

Design:

Retrospective interventional consecutive case series.

Methods:

Records of 56 eyes of 43 pediatric patients who underwent congenital cataract surgery with phacoaspiration and simultaneous implantation of the IOL younger than 1 year were reviewed. Corrected distance visual acuity (CDVA), refractive error, and ocular motility disorders were evaluated at follow-up of greater than 4 years.

Results:

32 multifocal (18 unilateral, Group A and 14 bilateral, Group B) and 24 monofocal (12 unilateral, Group C and 12 bilateral, Group D) IOLs were implanted. Mean follow-up was 6.67 years. Mean CDVA of the eyes with multifocal IOLs was 0.75 ± 0.46 logMAR in unilateral cataract surgery and 0.34 ± 0.25 logMAR in bilateral ones; with monofocal IOLs was 0.71 ± 0.52 logMAR in unilateral and 0.53 ± 0.43 logMAR in bilateral ones. No statistically significant difference in the CDVA between Groups A and B and Groups C and D were recorded. Final mean spherical equivalent was −3.88 ± 4.73 diopters (D); in Group A, it was −2.74 ± 4.22 D, in Group C was −1.08 ± 1.45 D, in Group B was −4.82 ± 4.64 D, and in Group D was −6.81 ± 4.61 D. The difference was statistically significant between Groups B and D (P = .01), but not between Groups A and C (P = .14). 26 patients (60.4%) showed postoperative strabismus. Surgical correction occurred more in patients with multifocal IOLs implanted (P = .038).

Conclusions:

Multifocal IOLs did not show significant advantages in visual development in children after congenital cataract extraction younger than 1 year when compared with monofocal IOLs.
Pre-existing Disparities and Potential Implications for the Rapid Expansion of Telemedicine in Response to the Coronavirus Disease 2019 Pandemic
Authors: Poeran Jashvant , Cho Logan D. , Wilson Lauren , Zhong Haoyan , Mazumdar Madhu , Liu Jiabin , Memtsoudis Stavros G.
Published: May 2021

Background:

Concerns exist regarding exacerbation of existing disparities in health care access with the rapid implementation of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. However, data on pre-existing disparities in telemedicine utilization is currently lacking.

Objective:

We aimed to study: (1) the prevalence of outpatient telemedicine visits before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income; and (2) associated diagnosis categories.

Research Design:

This was a retrospective cohort study.

Subject:

Commercial claims data from the Truven MarketScan database (2014−2018) representing n=846,461,609 outpatient visits.

Measures:

We studied characteristics and utilization of outpatient telemedicine services before the COVID-19 pandemic by patient subgroups based on age, comorbidity burden, residence rurality, and median household income. Disparities were assessed in unadjusted and adjusted (regression) analyses.

Results:

With overall telemedicine uptake of 0.12% (n=1,018,092/846,461,609 outpatient visits) we found that pre-COVID-19 disparities in telemedicine use became more pronounced over time with lower use in patients who were older, had more comorbidities, were in rural areas, and had lower median household incomes (all trends and effect estimates P<0.001).

Conclusion:

These results contextualize pre-existing disparities in telemedicine use and are crucial in the monitoring of potential disparities in telemedicine access and subsequent outcomes after the rapid expansion of telemedicine during the COVID-19 pandemic.
Progress in hepatitis C virus management in chronic kidney disease
Authors: Cohen-Bucay Abraham , Francis Jean M. , Gordon Craig E.
Published: May 2021

Purpose of review

The current review highlights advances in the use of direct-acting antiviral (DAA) agents in the treatment of hepatitis C virus (HCV) in chronic kidney disease (CKD) stages G4-5, end-stage renal disease, and kidney transplantation. The use of DAA to facilitate kidney transplantation of HCV negative recipients with kidneys from HCV-infected donors and in the management of HCV-related cryoglobulinemia are also reviewed.

Recent findings

DAA treatment results in rates of viral clearance (sustained virological response or SVR) of 90–100% in all studied CKD populations, comparable to SVR rates in the general population. DAA treatment allows safe and effective transplantation of HCV viremic kidneys into uninfected recipients.

The high SVR results achieved with DAA allow successful treatment of previously under-treated CKD populations, and encouraged innovative interventions such as the use of HCV-infected donor kidneys to uninfected kidney transplant recipients.
A 17-Month-old Boy With Pancytopenia Caused by a Rare Genetic Defect of Vitamin B12 Malabsorption
Authors: Baker Keturah M. , Parikh Nirzar S. , Salsbery Kyle T. , Shaw Gene R. , Steiner Robert D. , Oelstrom Matthew J. , Manalang Michelle A.
Published: May 2021

Imerslund-Gräsbeck syndrome is an autosomal recessive disorder of vitamin B12 malabsorption presenting with megaloblastic anemia and mild proteinuria in childhood. The disorder is caused by biallelic pathogenic variants in the CUBN or AMN genes, which encode proteins involved in B12 absorption. We present the case of a 17-month-old boy with failure to thrive, pancytopenia, and fevers. His megaloblastic anemia was overlooked leading to unnecessary invasive testing. Findings on bone marrow biopsy prompted investigation for genetic disorders of B12 metabolism. Exome sequencing uncovered 1 known pathogenic variant and 1 novel likely pathogenic variant in CUBN, confirming the diagnosis of Imerslund-Gräsbeck syndrome.
Spontaneous Retrobulbar Hemorrhage in a Previously Healthy Infant
Authors: Irawati Yunia , Pratama Avisena , Paramita Carennia , Bani Anna P. , Primacakti Fitri
Published: May 2021

Spontaneous retrobulbar hemorrhage is a rare yet vision-threatening condition. We reported a 5-month-old male infant with sudden onset of left eye proptosis with no prior history of getting vitamin K injection after birth. Head computed tomography scan revealed retrobulbar and intracranial hemorrhages. Laboratory results showed anemia, prolonged prothrombin and activated partial thromboplastin time, supporting the diagnosis of vitamin K deficiency bleeding. After the bleeding and clotting profile were stabilized, lateral canthotomy and cantholysis; and drainage following orbital decompression were successfully performed, yielded in a completely resolved proptosis. The right timing for surgery with the goal of releasing intraorbital pressure represent the merit of this paper. Our case also led to a crucial emphasis on vitamin K prophylaxis at birth.
The Effectiveness of Sarcopenia Interventions for Cancer Patients Receiving Chemotherapy
Authors: Jang Min Kyeong , Park Chang , Tussing-Humphreys Lisa , Fernhall Bo , Phillips Shane , Doorenbos Ardith Z.
Published: May 2021

Background

Among people with cancer undergoing chemotherapy, generalized loss of muscle mass, termed secondary sarcopenia, is associated with treatment toxicities and physical disability.

Objective

This systematic review and meta-analysis aimed to provide an overview of current interventions for sarcopenia in cancer patients receiving chemotherapy and to assess potentially effective interventions.

Methods

We searched PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and EMBASE for primary original research of exercise and nutrition interventions for sarcopenia published in English. The review used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Standardized mean difference and 95% confidence interval (CI) were calculated as effect measures by applying the random-effects model.

Results

The 6 included studies showed a trend toward significantly increasing skeletal muscle mass after intervention (mean difference, 0.168; 95% CI, −0.015 to 0.352; P = .072), with no significant changes in lean body mass loss after intervention (mean difference, −0.014; 95% CI, −1.291 to 1.264; P = .983). Resistance exercise and combined exercise and nutrition intervention were more effective at preserving or increasing muscle mass.

Conclusions

Early implementation of a resistance exercise intervention or a combined exercise and nutrition intervention is a promising strategy for avoiding muscle mass loss during chemotherapy. Additional evidence-based assessments of interventions for secondary sarcopenia are needed to identify the most effective approach.

Implications for Practice

In clinical practice, oncology nurses should frequently assess cancer patients’ muscle mass and when warranted should implement the most feasible early sarcopenia intervention to minimize the adverse outcomes of this condition.
The Causes of Death and Pathological Findings of Kratom Users
Authors: Jittasopa Worrapat , Srisont Smith
Published: May 2021

Kratom is a psychoactive substance in Thailand. The major psychoactive chemical component of Kratom is mitragynine. This study aims to elucidate the characteristics and pathologies of autopsied cases where mitragynine was present and quantify the amounts of mitragynine. The autopsy reports in which the blood samples were positive for mitragynine were selected in Ramathibodi Hospital between January 2015 and December 2019. Data from autopsy reports comprised sex, age, circumstances of death, pathological findings, other substances, causes of death, and mitragynine concentrations. Mitragynine was quantitatively analyzed using liquid chromatography-mass spectrometry/mass spectrometry. Twenty-four cases from 2160 autopsy cases were found to be positive for mitragynine. The most commonly observed pathological findings were pulmonary edema (7 cases) and coronary atherosclerosis (6 cases). Antihistamine (8 cases), ethanol (4 cases), and amphetamine (4 cases) were commonly found. The mitragynine concentrations were 0.0035 to 3.6 mg/L (median 0.069). One interesting case involved a 43-year-old man whose pathological findings showed chronic asthma with a high concentration of mitragynine in the blood (3.6 mg/L), although no other substances were detected. In conclusion, the use of mitragynine may be a direct or indirect cause of death, whereas the lethal concentration has yet to be clearly determined.
Renal Tubular Epithelial Subnuclear Vacuolization in Hypothermia and Diabetic Ketoacidosis—A Retrospective Autopsy Study
Authors: Tekin Burak , Righi Fabiola , Quinton Reade
Published: May 2021

Subnuclear vacuolization of the renal tubular epithelium refers to discrete lipid vacuoles displacing the nuclei toward the lumen. This phenomenon has been associated with conditions sharing fatal ketoacidosis as a common denominator. This retrospective study aimed to investigate renal tubular epithelial subnuclear vacuolization and other postmortem examination findings in fatal hypothermia and diabetic ketoacidosis (DKA) cases.

Fourteen cases with hypothermia and 19 cases with DKA were included. More cases with DKA had focal or diffuse subnuclear vacuolization compared with hypothermia cases (89% vs 43%; P = 0.007). In 6 cases with DKA, formalin pigment was detected within subnuclear vacuoles, whereas no case with hypothermia had formalin pigment deposition. Comparative analyses of hypothermia and DKA cases revealed further differences: Vitreous beta-hydroxybutyrate was higher in the DKA group compared with the hypothermia group (P = 0.044), whereas blood ethanol concentrations were higher in the latter (P = 0.008). Hypothermia cases were older compared with the DKA cases (P = 0.022).

When all cases were included in the statistical analysis, cases with subnuclear vacuolization had higher vitreous beta-hydroxybutyrate and blood ethanol concentrations (P = 0.029 and 0.023, respectively). The findings corroborate the results of previous studies suggesting a link between subnuclear vacuolization and increased levels of ketoacidosis.
Quantitative Ultrasound Elastography Methods in Focal Liver Lesions Including Hepatocellular Carcinoma
Authors: Gu Jiong-hui , Zhu Lu , Jiang Tian-an
Published: May 2021

The ability of ultrasound elastography to diagnose focal liver lesions and determine their prognoses including hepatocellular carcinoma (HCC) is unclear. At present, radiofrequency ablation and liver resection are the most common treatments for HCC. However, the survival rate remains disappointing because of recurrences and postoperative liver failure, necessitating the development of noninvasive approaches. There is currently no systematic definition of an elastic technique for measuring liver stiffness to predict the recurrence of HCC after radiofrequency ablation and postoperative liver failure. In this review, recent advances in ultrasound elastography for the diagnosis and prognosis of focal liver lesions are discussed including HCC.
The 25 Most Cited Articles in The Journal of Craniofacial Surgery: A Study Based on the Web of Science From 1995 to 2020
Authors: Bahşi Ayşe , Tekin Ahmet Mahmut , Bahşi Ilhan
Published: May 2021

The aim of this study was to identified and analyzed the top 25 most cited articles among the articles published in The Journal of Craniofacial Surgery (J Craniofac Surg) from 1995 to 2020 in the Web of Science database. Using the advanced search section in the Web of Science, all articles published in the J Craniofac Surg were listed. The distribution of the numbers of publications by years was determined. It was determined that a total of 11,888 articles were published in the J Craniofac Surg between 1995 and 2020. A total of 84,218 citations were made to these articles, and the h-index of these articles was 73. The top 25 most cited articles were determined. The top three countries that made the most cited to these 25 articles were the USA (n: 1112), China (n: 292), and Germany (n: 251), respectively. The top three journals that made the most cited to these 25 articles were the J Craniofac Surg (n: 378), Plast Reconstr Surg (n: 179), and J Oral Maxillofac Surg (n: 120), respectively. The authors think that this study may benefit researchers in this field by identifying the most cited articles in the J Craniofac Surg.
A Cohort Study of Strabismus Rates Following Correction of the Unicoronal Craniosynostosis Deformity: Conventional Bilateral Fronto-Orbital Advancement Versus Fronto-Orbital Distraction Osteogenesis
Authors: Hoppe Ian C. , Taylor Jesse A.
Published: May 2021

Background:

The purpose of this prospective study is to compare perioperative morbidity and strabismus rates between traditional fronto-orbital advancement reconstruction (FOAR) and fronto-orbital distraction osteogenesis (FODO) in unicoronal craniosynostosis (UCS).

Method:

A consecutive group of 15 patients undergoing FODO for isolated UCS were compared to a contemporaneous group of 15 patients undergoing traditional FOAR for UCS. Patient age, operative time, blood loss, blood replacement, technical details of the surgery, length of stay, complications, and strabismus rates were documented and compared statistically using chi-square and Student t test with a significance value of 0.05.

Results:

The 15 patients undergoing FODO were younger (6.3 and 9.8 months, P < 0.05), experienced less operative time for the initial procedure (111 versus 190 minutes, P < 0.01), less blood loss (26% versus 50% of total blood volume, P < 0.01), and less blood replacement (40% versus 60% of total blood volume, P < 0.05). One patient in the FODO group experienced a new-onset strabismus postoperatively compared with 5 in the FOAR group (P < 0.05). There were no complications requiring a return to the operating room in either group.

Conclusions:

Fronto-orbital distraction osteogenesis for the treatment of isolated UCS is associated with a favorable perioperative morbidity profile and a decreased incidence of postoperative strabismus compared with traditional FOAR. These positive factors are tempered by the need for an additional procedure for removal of the device and lack of long-term outcomes data on the technique.
A Case of Complex Facial Reconstruction Illuminates Paul Tessier's Surgical State of Mind
Authors: Segna Eleonora , Khonsari Roman Hossein
Published: May 2021

Successful head and neck reconstructions tackle both morphological and functional issues within treatment plans involving multiple coordinated steps. Nowadays, biomaterials, computer-assisted surgery, and free tissue transfers have greatly increased the potentialities of craniofacial surgeons. In the 1970s, when Paul Tessier, one of the founders of modern plastic surgery, was at the peak of his career, complex reconstructions had little technology to rely on. Here we report a case of facial reconstruction after gunshot trauma performed by Paul Tessier based on his “craniofacial autarchy” principle, that is using solely local flaps and grafts harvested in the head and neck area. This case involved 30 procedures on the mandible, maxilla, chin, lips, and nose. Based on data from the archives from the “Association Française des Chirurgiens de la Face” (Amiens, France) we provide details on Tessier's approach to surgical planning and on his global conception of treatment plans in reconstructive surgery.
Current Trends in Facial Feminization Surgery: An Assessment of Safety and Style
Authors: Chaya Bachar F. , Berman Zoe P. , Boczar Daniel , Siringo Nicolette , Rodriguez Colon Ricardo , Trilles Jorge , Diep Gustave K. , Rodriguez Eduardo D.
Published: May 2021

Background:

Facial feminization surgery (FFS) plays an instrumental role in the process of gender affirmation. These procedures are becoming increasingly appreciated for their ability to improve patient satisfaction and gender identity in a way that alleviates gender dysphoria and improves the quality of life. Despite the recent surge in popularity across the US, the current literature lacks evidence on the safety profile of combined facial feminization procedures. Our goal was to determine the safety profile of facial feminization procedures registered on a national surgical database.

Methods:

Patients with a primary diagnosis of gender dysphoria undergoing facial surgical procedures were identified from the National Surgical Quality Improvement Program database between the years 2013 and 2018. Demographic characteristics along with 30-day postoperative complications were recorded. Logistic regression models adjusted for confounders were used to determine the independent predictors of postoperative complications.

Results:

A cohort of 77 patients who underwent a total of 220 procedures was identified. The number of patients undergoing surgery per year increased from three (3.9%) in 2013 to 41 (53.2%) in 2018, a 13.6-fold increase. The most commonly performed procedure was forehead contouring/frontal sinus setback, performed on 52 patients (67.5%), followed by orbital contouring (n = 37, 48%), rhinoplasty (n = 34, 44%), mandibuloplasty (n = 34, 44%), chondrolaryngoplasty (n = 27, 35.1%), genioplasty (n = 11, 14%), brow lift (n = 9, 11.7%), cheek augmentation (n = 9, 11.7%), and lip lift (n = 7, 9.1%). The number of patients who underwent 5 or more procedures in a single anesthetic event was 41 (53.2%). The complication rate was 3.9%. Univariate analysis suggested an association between older age and postoperative morbidity (P 
< 0.02). However, this was not found to be an independent predictor on multivariate analysis adjusted for confounders (P < 0.083). Additionally, an increase in operative time and the number of procedures performed during a single anesthetic were not independent predictors of 30-day postoperative complications (P < 0.317 and P 
< 0.19, respectively).

Conclusions:

FFS can be safely performed and has a low risk of postoperative morbidity. The number of patients seeking FFS surgery has risen exponentially, with the highest demand seen for the reconstruction of the upper facial third. These findings should guide expectations for patients seeking FFS, as well as for plastic surgeons looking to perform multiple procedures per anesthetic event.
Data-driven approaches to neuroimaging biomarkers for neurological and psychiatric disorders: emerging approaches and examples
Authors: Calhoun Vince D. , Pearlson Godfrey D. , Sui Jing
Published: May 2021

Purpose of review

The ‘holy grail’ of clinical applications of neuroimaging to neurological and psychiatric disorders via personalized biomarkers has remained mostly elusive, despite considerable effort. However, there are many reasons to continue to be hopeful, as the field has made remarkable advances over the past few years, fueled by a variety of converging technical and data developments.

Recent findings

We discuss a number of advances that are accelerating the push for neuroimaging biomarkers including the advent of the ‘neuroscience big data’ era, biomarker data competitions, the development of more sophisticated algorithms including ‘guided’ data-driven approaches that facilitate automation of network-based analyses, dynamic connectivity, and deep learning. Another key advance includes multimodal data fusion approaches which can provide convergent and complementary evidence pointing to possible mechanisms as well as increase predictive accuracy.

The search for clinically relevant neuroimaging biomarkers for neurological and psychiatric disorders is rapidly accelerating. Here, we highlight some of these aspects, provide recent examples from studies in our group, and link to other ongoing work in the field. It is critical that access and use of these advanced approaches becomes mainstream, this will help propel the community forward and facilitate the production of robust and replicable neuroimaging biomarkers.
The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals
Authors: Evans Stephanie , Agnew Emily , Vynnycky Emilia , Stimson James , Bhattacharya Alex , Rooney Christopher , Warne Ben , Robotham Julie
Published: May 2021

Nosocomial transmission of SARS-CoV-2 is a key concern, and evaluating the effect of testing and infection prevention and control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical English hospital, we estimate that between 9 March 2020 and 17 July 2020 approximately 20% of infections in inpatients, and 73% of infections in healthcare workers (HCWs) were due to nosocomial transmission. Model results suggest that placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 35%. Periodic testing of HCWs has a smaller effect on the number of hospital-acquired COVID-19 cases in patients, but reduces infection in HCWs by as much as 37% and results in only a small proportion of staff absences (approx. 0.3% per day). This is considerably less than the 20–25% of staff that have been reported to be absent from work owing to suspected COVID-19 and self-isolation. Model-based evaluations of interventions, informed by data collected so far, can help to inform policy as the pandemic progresses and help prevent transmission in the vulnerable hospital population.

This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
The population attributable fraction of cases due to gatherings and groups with relevance to COVID-19 mitigation strategies
Authors: Brooks-Pollock Ellen , Read Jonathan M. , House Thomas , Medley Graham F. , Keeling Matt J. , Danon Leon
Published: May 2021

Many countries have banned groups and gatherings as part of their response to the pandemic caused by the coronavirus, SARS-CoV-2. Although there are outbreak reports involving mass gatherings, the contribution to overall transmission is unknown. We used data from a survey of social contact behaviour that specifically asked about contact with groups to estimate the population attributable fraction (PAF) due to groups as the relative change in the basic reproduction number when groups are prevented. Groups of 50+ individuals accounted for 0.5% of reported contact events, and we estimate that the PAF due to groups of 50+ people is 5.4% (95% confidence interval 1.4%, 11.5%). The PAF due to groups of 20+ people is 18.9% (12.7%, 25.7%) and the PAF due to groups of 10+ is 25.2% (19.4%, 31.4%). Under normal circumstances with pre-COVID-19 contact patterns, large groups of individuals have a relatively small epidemiological impact; small- and medium-sized groups between 10 and 50 people have a larger impact on an epidemic.

This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
Segmentation and shielding of the most vulnerable members of the population as elements of an exit strategy from COVID-19 lockdown
Authors: van Bunnik Bram A. D. , Morgan Alex L. K. , Bessell Paul R. , Calder-Gerver Giles , Zhang Feifei , Haynes Samuel , Ashworth Jordan , Zhao Shengyuan , Cave Roo Nicola Rose , Perry Meghan R. , Lepper Hannah C. , Lu Lu , Kellam Paul , Sheikh Aziz , Medley Graham F. , Woolhouse Mark E. J.
Published: May 2021

This study demonstrates that an adoption of a segmenting and shielding strategy could increase the scope to partially exit COVID-19 lockdown while limiting the risk of an overwhelming second wave of infection. We illustrate this using a mathematical model that segments the vulnerable population and their closest contacts, the ‘shielders’. Effects of extending the duration of lockdown and faster or slower transition to post-lockdown conditions and, most importantly, the trade-off between increased protection of the vulnerable segment and fewer restrictions on the general population are explored. Our study shows that the most important determinants of outcome are: (i) post-lockdown transmission rates within the general and between the general and vulnerable segments; (ii) fractions of the population in the vulnerable and shielder segments; (iii) adherence to protective measures; and (iv) build-up of population immunity. Additionally, we found that effective measures in the shielder segment, e.g. intensive routine screening, allow further relaxations in the general population. We find that the outcome of any future policy is strongly influenced by the contact matrix between segments and the relationships between physical distancing measures and transmission rates. This strategy has potential applications for any infectious disease for which there are defined proportions of the population who cannot be treated or who are at risk of severe outcomes.

This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
Mapping social distancing measures to the reproduction number for COVID-19
Authors: Brooks-Pollock Ellen , Read Jonathan M. , McLean Angela R. , Keeling Matt J. , Danon Leon
Published: May 2021

In the absence of a vaccine, severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) transmission has been controlled by preventing person-to-person interactions via social distancing measures. In order to re-open parts of society, policy-makers need to consider how combinations of measures will affect transmission and understand the trade-offs between them. We use age-specific social contact data, together with epidemiological data, to quantify the components of the COVID-19 reproduction number. We estimate the impact of social distancing policies on the reproduction number by turning contacts on and off based on context and age. We focus on the impact of re-opening schools against a background of wider social distancing measures. We demonstrate that pre-collected social contact data can be used to provide a time-varying estimate of the reproduction number (
R
). We find that following lockdown (when
R
=
0.7, 95% CI 0.6, 0.8), opening primary schools has a modest impact on transmission (
R
= 0.89, 95% CI 0.82−0.97) as long as other social interactions are not increased. Opening secondary and primary schools is predicted to have a larger impact (
R
= 1.22, 95% CI 1.02−1.53). Contact tracing and COVID security can be used to mitigate the impact of increased social mixing to some extent; however, social distancing measures are still required to control transmission. Our approach has been widely used by policy-makers to project the impact of social distancing measures and assess the trade-offs between them. Effective social distancing, contact tracing and COVID security are required if all age groups are to return to school while controlling transmission.

This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
Real-time nowcasting and forecasting of COVID-19 dynamics in England: the first wave
Authors: Birrell Paul , Blake Joshua , van Leeuwen Edwin , Gent Nick , De Angelis Daniela
Published: May 2021

England has been heavily affected by the SARS-CoV-2 pandemic, with severe ‘lockdown’ mitigation measures now gradually being lifted. The real-time pandemic monitoring presented here has contributed to the evidence informing this pandemic management throughout the first wave. Estimates on the 10 May showed lockdown had reduced transmission by 75%, the reproduction number falling from 2.6 to 0.61. This regionally varying impact was largest in London with a reduction of 81% (95% credible interval: 77–84%). Reproduction numbers have since then slowly increased, and on 19 June the probability of the epidemic growing was greater than 5% in two regions, South West and London. By this date, an estimated 8% of the population had been infected, with a higher proportion in London (17%). The infection-to-fatality ratio is 1.1% (0.9–1.4%) overall but 17% (14–22%) among the over-75s. This ongoing work continues to be key to quantifying any widespread resurgence, should accrued immunity and effective contact tracing be insufficient to preclude a second wave.

This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
Exploring surveillance data biases when estimating the reproduction number: with insights into subpopulation transmission of COVID-19 in England
Authors: Sherratt Katharine , Abbott Sam , Meakin Sophie R. , Hellewell Joel , Munday James D. , Bosse Nikos ,   CMMID COVID-19 Working Group, Jit Mark , Funk Sebastian
Published: May 2021

The time-varying reproduction number (

R
t

: the average number of secondary infections caused by each infected person) may be used to assess changes in transmission potential during an epidemic. While new infections are not usually observed directly, they can be estimated from data. However, data may be delayed and potentially biased. We investigated the sensitivity of

R
t

estimates to different data sources representing COVID-19 in England, and we explored how this sensitivity could track epidemic dynamics in population sub-groups. We sourced public data on test-positive cases, hospital admissions and deaths with confirmed COVID-19 in seven regions of England over March through August 2020. We estimated

R
t

using a model that mapped unobserved infections to each data source. We then compared differences in

R
t

with the demographic and social context of surveillance data over time. Our estimates of transmission potential varied for each data source, with the relative inconsistency of estimates varying across regions and over time.

R
t

estimates based on hospital admissions and deaths were more spatio-temporally synchronous than when compared to estimates from all test positives. We found these differences may be linked to biased representations of subpopulations in each data source. These included spatially clustered testing, and where outbreaks in hospitals, care homes, and young age groups reflected the link between age and severity of the disease. We highlight that policy makers could better target interventions by considering the source populations of

R
t

estimates. Further work should clarify the best way to combine and interpret

R
t

estimates from different data sources based on the desired use.

This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
Use of medicinal plants for COVID-19 prevention and respiratory symptom treatment during the pandemic in Cusco, Peru: A cross-sectional survey
Authors: Villena-Tejada Magaly , Vera-Ferchau Ingrid , Cardona-Rivero Anahí , Zamalloa-Cornejo Rina , Quispe-Florez Maritza , Frisancho-Triveño Zany , Abarca-Melendez Rosario C. , Alvarez-Sucari Susan G. , Mejia Christian R. , Yañez Jaime A.
Published: May 2021

Background

The burden of the COVID-19 pandemic in Peru has led to people seeking alternative treatments as preventives and treatment options such as medicinal plants. This study aimed to assess factors associated with the use of medicinal plants as preventive or treatment of respiratory symptom related to COVID-19 during the pandemic in Cusco, Peru.

Method

A web-based cross-sectional study was conducted on general public (20- to 70-year-old) from August 31 to September 20, 2020. Data were collected using a structured questionnaire via Google Forms, it consisted of an 11-item questionnaire that was developed and validated by expert judgment using Aiken’s V (Aiken’s V > 0.9). Both descriptive statistics and bivariate followed by multivariable logistic regression analyses were conducted to assess factors associated with the use of medicinal plants for COVID-19 prevention and respiratory symptom treatment during the pandemic. Prevalence ratios (PR) with 95% Confidence Interval (CI), and a P-value of 0.05 was used to determine statistical significance.

Results

A total of 1,747 respondents participated in the study, 80.2% reported that they used medicinal plants as preventives, while 71% reported that they used them to treat respiratory symptoms. At least, 24% of respondents used medicinal plants when presenting with two or more respiratory symptoms, while at least 11% used plants for malaise. For treatment or prevention, the multivariate analysis showed that most respondents used eucalyptus (p < 0.001 for both), ginger (p < 0.022 for both), spiked pepper (p < 0.003 for both), garlic (p = 0.023 for prevention), and chamomile (p = 0.011 for treatment). The respondents with COVID-19 (p < 0.001), at older ages (p = 0.046), and with a family member or friend who had COVID-19 (p < 0.001) used more plants for prevention. However, the respondents with technical or higher education used less plants for treatment (p < 0.001).

Conclusion

There was a significant use of medicinal plants for both prevention and treatment, which was associated with several population characteristics and whether respondents had COVID-19.
Medical brain drain from Western Balkan and Croatia to Germany and Austria – an approach to the digital demography
Authors: Jurić Tado
Published: May 2021

Background

In this paper, we show that the tools of digital demography, such as the Google Trends (GT) can be very useful for determining, estimating, and predicting the migration of healthcare workers as well as for further predictions of the general interest in emigration.

Objective

This paper analyses recent trends in the mobility of health workers in Europe and focuses specifically on the patterns of mobility among medical doctors and nurses from Western Balkans and Croatia to Germany and Austria. It identifies the drivers of this mobility and shows how to predict further migration of this stuff. In the last 10 years, every fourth nurse has emigrated from the Croatian health system -to Germany, while according to projections Croatia will lose as much as 1/3 of all doctors in the next five years.

Methods

A special problem in the analysis of the emigration of healthcare workers from the Western Balkans and Croatia is the fact that there is no system for monitoring this process. Official data up to three years late, and exist only for persons who have deregistered from the state system. The basic methodological concept of our approach is to monitor the digital trace of language searches with the Google Trends analytical tool (trends.google.com). Initially, keywords were chosen by brainstorming possible words that we believed to be predictive, specific, and common enough for use in the forecasting of migration of healthcare professionals. To standardize the data, we requested the data for the period from Dec. 2015 to Dec. 2020 and divided the keyword frequency for each word giving us a search frequency index. Then we have compared searches with official statistics to prove the significations of results and correlations.

Results

In Croatia search activities using GT for terms such as ‘‘Bewerbung” (job application), “Arbeit” (work), “Krankenschwester, Bewerbung” (nurses, job application) correlate strongly with officially Germans data for emigrants from Croatia. The data collected by this method correlate with official data, which allows reliable forecasts for the future. Austria will soon become one of the most desirable emigration destinations for Croats, especially for healthcare workers. Simultaneously, the emigration of Croatian citizens to Germany will continue.

Conclusion

Understanding why health care personnel emigrate from Western Balkans and Croatia and which are the consequences of this process are key to enable state agencies and government to develop optimal intervention strategies to retain medical staff. The benefit of this method is reliable estimates that can enable state agencies and the government to prepare and better respond to a possible shortage of healthcare workers and to protect the functioning of the health system.