bluuebunny/crossref_metadata_2025 huggingface dataset:
Citizenship Status and Restrictive Policies Affect Participation in Temporary Assistance for Needy Families (TANF)
Authors: Cheng Tyrone C , Lo Celia C
Published: April 2022

This study examined relationships between participation in Temporary Assistance for Needy Families (TANF) programs and citizenship status, and between TANF participation and restrictive TANF policies. Its sample of 8,657 adults (yielding 66,680 person-years, the units of analysis) was extracted from a 2001–2009 national longitudinal data set. Generalized estimating equations showed TANF participation to be associated in a positive direction with prior TANF receipt and with poverty, single motherhood, number of dependent children, and race/ethnicity (specifically African American, Hispanic, and other racial/ethnic minority groups). Negative associations were found between participation and the following: citizen status, being less educated, being unemployed, being younger, and availability of state funds for noncitizens. The variables birth outside United States and policy of rendering noncitizens ineligible were not significantly associated with participation. This study’s main finding was that noncitizens were less likely than citizens to participate in TANF, regardless of nativity or restrictiveness of TANF policies. This debunks the notion that immigrants should be barred from the United States because they burden its welfare system. Other implications for policy are discussed as well.
Advancing forward—narrowing the divide between powers of advancement and powers of appointment
Authors: Embley Oliver
Published: April 2022

Oliver Embley explains the differences between powers of advancement and powers of appointment, including how such powers can be exercised to benefit non-objects of a trust. The article discusses the differences between powers of advancement and appointment and how modern trust deeds have blurred the lines between the two. The article considers PQ and another v RS and others [2019] EWHC 1643 (Ch) and how a power of appointment can be exercised to benefit a non-object of a trust.
Postdischarge outcomes of COVID-19 patients from South Asia: a prospective study
Authors: Abeysuriya Visula , Seneviratne Suranjith L , De Silva Arjuna P , Mowjood Riaz , Mowjood Shazli , de Silva Thushara , de Mel Primesh , de Mel Chandima , Wijesinha R S , Fernando Amitha , de Mel Sanjay , Chandrasena Lal
Published: April 2022

Background

Coronavirus disease 2019 (COVID-19) may cause clinical manifestations that last for weeks or months after hospital discharge. The manifestations are heterogeneous and vary in their frequency. Their multisystem nature requires a holistic approach to management. There are sparse data from the South Asian region on the outcomes of hospital-discharged COVID-19 patients. We assessed the posthospital discharge outcomes of a cohort of Sri Lankan COVID-19 patients and explored the factors that influenced these outcomes.

Methods

Data were prospectively collected from patients who were discharged following an admission to the Nawaloka Hospital, Sri Lanka with COVID-19 from March to June 2021. At discharge, their demographic, clinical and laboratory findings were recorded. The patients were categorised as having mild, moderate and severe COVID-19, based on the Sri Lanka Ministry of Health COVID-19 guidelines. Following discharge, information on health status, complications and outcomes was collected through clinic visits and preplanned telephone interviews. A validated (in Sri Lanka) version of the Short Form 36 health survey questionnaire (SF-36) was used to assess multi-item dimensions health status of the patients at 1, 2 and 3 mo postdischarge.

Results

We collected data on 203 patients (male, n=111 [54.7%]). The level of vaccination was significantly associated with disease severity (p<0.001). Early recovery was seen in the mild group compared with the moderate and severe groups. At 3 mo, on average 98% of mild and 90% of moderate/severe patients had recovered. Based on the SF-36, physical functioning dimensions, role limitation due to physical and emotional health, energy/ fatigue, emotional well-being, social functioning, pain and general health were significantly different in the moderate/severe vs mild COVID-19 groups at 1, 2 and 3 mo postdischarge (p<0.05). Twenty-three patients developed complications, of which the most common were myocardial infarction with heart failure (n=6/23; 26.1%), cerebrovascular accident (n=6/23; 26.1%) and respiratory tract infections (n=3/23; 13.01%) and there were six deaths.

Conclusions

In our cohort, receiving two doses of the COVID-19 vaccine was associated with reduced disease severity. Those with mild disease recovered faster than those with moderate/severe disease. At 3 mo posthospital discharge, >90% had recovered.
The use of cholera oral vaccine for containment of the 2019 disease outbreak in Sudan
Authors: Mohamed Nouh S , Ali Yousif , Abdalrahman Sanaa , Ahmed Ayman , Siddig Emmanuel Edwar
Published: April 2022

A cholera outbreak in Blue Nile and Sennar states, south-eastern and southern Sudan, took place during September–December 2019. An outbreak surveillance sample collection was made. Vibrio cholerae O1 Ogawa was isolated from clinical samples of all confirmed 200 and 132 cases in Blue Nile state and Sennar state, respectively. The case fatality rate was higher in Blue Nile state, 4% compared with only 2.3% in Sennar state. The Euvichol-Plus oral cholera vaccine was rapidly deployed for the first time in Sudan to the most at-risk populations in the two affected states, 1 471 188 and 1 546 542 individuals in Sennar and Blue Nile states, respectively. The rapid deployment of cholera vaccines as the major prevention and control strategy was successful and helped greatly with the containment of this epidemic. In-depth genomics studies are crucial for understanding the disease dynamics in Sudan by identifying locally circulating strains of the bacteria and further improving prevention and control strategy by characterising the susceptibility and resistance of these locally circulating strains to currently used antibiotics.
Systematic affinities of Zygophylacidae (Cnidaria: Hydrozoa: Macrocolonia) with descriptions of 15 deep-sea species
Authors: Gu Zhangjie , Ruthensteiner Bernhard , Moura Carlos J , Liu Lihua , Zhang Rui , Song Xikun
Published: April 2022

Hydrozoans (Cnidaria) are distributed worldwide and exhibit alternating benthic polyp (hydroid) and pelagic medusan life-history forms. Zygophylacidae are a hydrozoan family with an exclusive hydroid stage throughout their life cycle. Within Hydrozoa, they are unusual in that a relatively large proportion (50%) of species occur in deep waters, but their validity and systematic affinities have been controversial for more than a century. Here, 97 deep-sea specimens, collected by manned submersible or bottom dredging, were investigated using an integrative taxonomical approach. Molecular data concatenating the 16S, 18S and 28S rRNA genes support the validity of Zygophylacidae and their placement within Macrocolonia, instead of Lafoeida. Fourteen zygophylacids and one relevant lafoeid are described or re-described, including three newly proposed species: Zygophylax lighti sp. nov. and Z. tankahkeei sp. nov. from the South China Sea, Z. pseudosibogae sp. nov. from Portugal and five species introduced by Eberhard Stechow (1883–1959) through the re-examination of type material. Four candidate generic diagnoses are discussed for future Zygophylacidae fine systematics by integrating a taxonomic review of all 74 zygophylacids. Morphological characters such as long hydrothecae and complex protective gonothecal structures mostly present in the deep-sea zygophylacids are heuristic for future functional morphology and evolutionary studies.
Perianastomotic Irrigation With Passive Drainage Dramatically Decreases POPF Rate After High-risk Pancreaticoduodenectomy
Authors: Adamenko Olga , Ferrari Carlo , Porreca Annamaria , Seewald Stefan , Groth Stefan , Gutzwiller Jean-Pierre , Kulaksiz Hasan , Schmidt Jan
Published: April 2022

Objective:

To assess whether prophylactic irrigation and passive drainage of pancreatico-jejunal anastomosis could reduce leak and mortality rates after high-risk pancreaticoduodenectomies.

Background:

Postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreaticoduodenectomy. Several risk factors have been proposed likewise potential mitigation strategies. Regarding the latter, surgical drain policy remains a “hot topic.” We propose an innovative approach to mitigate POPF and POPF-related mortality following high-risk pancreaticoduodenectomies.

Methods:

One hundred fifty-seven patients undergoing pancreaticoduodenectomy between January 2012 and November 2021 were included in the study. Subjects with main pancreatic duct ≤ 3 mm and soft parenchyma were classified as high-risk for POPF development. Since August 2015, high-risk patients received prophylactic irrigation and drainage of the perianastomotic area. These patients were compared with risk-matched historical controls.

Results:

We identified 73 high-risk patients. Of these, the 47 subjects receiving prophylactic perianastomotic irrigation showed significantly lower POPF rates (12.7% vs 69.2%, P < 0.001). Multivariate regression analysis confirmed the significant association between irrigation drainages and POPF (odds ratio 0.014, P = 0.01). Although not significant, mortality was lower in the irrigation group (4.2% vs 13.0%, P = 0.340). However, none of the fatalities in the irrigation-drainage group were POPF-related. No significant difference in length of hospital stay was observed between the 2 groups (18.0 vs 21.0 days, P = 0.091).

Conclusions:

Irrigation and drainage of the perianastomotic area represents a powerful approach to reduce POPF and, potentially, mortality after high-risk pancreaticoduodenectomies.
From Churg–Strauss Syndrome to Eosinophilic Granulomatosis With Polyangiitis: A Historical Review of Nomenclature and Diagnostic Criteria
Authors: Tabb Elisabeth S. , Duncan Lyn M. , Nazarian Rosalynn M.
Published: April 2022

Eosinophilic granulomatosis with polyangiitis (EGPA) is rare vasculitis syndrome that involves the skin and other organ systems manifesting as asthma, eosinophilia, and pulmonary infiltrates. The understanding of EGPA, previously known as Churg–Strauss Syndrome, has continued to evolve from its earliest documentation in the literature in 1951. Herein, we review key historical advances in the diagnosis, classification, and nomenclature of EGPA that have shaped our understanding of this protean disorder over time.
Correlation Between Ultrasonographic Response and Anti–Tumor Necrosis Factor Drug Levels in Crohn's disease
Authors: Han Ze-Min , Elodie Welera Haissou , Yan Li-Hua , Xu Pei-Chun , Zhao Xin-Mei , Zhi Fa-Chao
Published: April 2022

Background:

Ultrasound is valuable in tight control algorithms for Crohn's disease (CD). However, the correlation between ultrasonographic response and anti–tumor necrosis factor (TNF) drug levels remains unknown. Elucidating this correlation would be helpful in optimizing the use of anti-TNF drugs. Thus, the authors aimed to investigate this correlation.

Methods:

Between June 2020 and June 2021, all patients with CD who completed anti-TNF induction therapy were retrospectively included. Ultrasound was performed at week 0 and week 14, and proactive therapeutic drug monitoring of anti-TNF drugs was performed at week 14. The receiver operating characteristic (ROC) curve was used in the correlation analysis.

Results:

Ninety-two patients (60 treated with infliximab and 32 with adalimumab) were included. At week 14, an ultrasonographic response was detected in 43 patients. Patients with ultrasonographic response had significantly higher median drug levels (5.9 mcg/mL for infliximab; 18.2 mcg/mL for adalimumab) than those without (0.9 mcg/mL for infliximab, P < 0.001; 4.8 mcg/mL for adalimumab, P < 0.001). The ROC curve showed a significant correlation between ultrasonographic response and anti-TNF drug levels (area under the curve = 0.79 for infliximab, P < 0.001; area under the curve = 0.86 for adalimumab, P < 0.001). The optimal cut-off values for infliximab and adalimumab correlated with ultrasonographic response were 5.0 and 10.5 mcg/mL, respectively. An incremental increase was observed in ultrasonographic response with higher anti-TNF drug levels.

Conclusions:

Higher anti-TNF drug levels are associated with an increased likelihood of ultrasonographic response in patients with CD.
Single-agent Bevacizumab in the Treatment of Symptomatic Newly Diagnosed and Recurrent/Refractory Pediatric Cervicomedullary Brainstem Low-grade Gliomas: A Single Institutional Experience
Authors: Sridhar Sunita , Paul Megan Rose , Yeh-Nayre Lanipua , Khanna Paritosh C. , Elster Jennifer , Aristizabal Paula , Crawford John R.
Published: April 2022

Bevacizumab-based therapies have been utilized as single or combination therapy of refractory/recurrent pediatric low-grade gliomas. Its efficacy for symptomatic cervicomedullary low-grade gliomas (cmLGGs) in the upfront and the recurrent setting is less known. We report our retrospective single institutional experience from 2015 to 2021 with single-agent bevacizumab for symptomatic cmLGG. Six consecutive patients (4 female, ages 2 to 12 y) with newly diagnosed (n=3) and recurrent/refractory (n=3) symptomatic nondisseminated cmLGG (5/6 biopsy-proven, 2 BRAFV600E, 2 BRAF-KIAA1549) were treated with single-agent bevacizumab. All demonstrated radiographic response most pronounced on post-gadolinium T1-weighted magnetic resonance imaging (2 complete, 4 partial) at a median of 8 weeks (range: 2 to 12 wk). Clinical response was seen in all patients with improvement in cranial nerve abnormalities (3 recurrent/refractory, 1 newly diagnosed), strength (2 recurrent/refractory, 2 newly diagnosed), pain (2 recurrent/refractory), and anorexia (1 newly diagnosed). Four patients (2 recurrent/refractory, 2 newly diagnosed) experienced disease progression on subsequent adjunct therapies, 2 of which (the 2 newly diagnosed patients) are currently being rechallenged. At a mean follow-up of 7 months, all patients are clinically stable without disease progression. Single-agent bevacizumab may be effective in the management of symptomatic newly diagnosed and recurrent/refractory cmLGG and warrants further evaluation in a clinical trial setting.
Suboptimal Beta-Lactam Therapy in Critically Ill Children: Risk Factors and Outcome*
Authors: Van Der Heggen Tatjana , Dhont Evelyn , Willems Jef , Herck Ingrid , Delanghe Joris R. , Stove Veronique , Verstraete Alain G. , Vanhaesebrouck Sophie , De Paepe Peter , De Cock Pieter A. J. G.
Published: April 2022

OBJECTIVES:

In critically ill children, severely altered pharmacokinetics may result in subtherapeutic β-lactam antibiotic concentrations when standard pediatric dosing regimens are applied. However, it remains unclear how to recognize patients most at risk for suboptimal exposure and their outcome. This study aimed to: 1) describe target attainment for β-lactam antibiotics in critically ill children, 2) identify risk factors for suboptimal exposure, and 3) study the association between target nonattainment and clinical outcome.

DESIGN:

Post hoc analysis of the “Antibiotic Dosing in Pediatric Intensive Care” study (NCT02456974, 2012–2019). Steady-state trough plasma concentrations were classified as therapeutic if greater than or equal to the minimum inhibitory concentration of the (suspected) pathogen. Factors associated with subtherapeutic concentrations and clinical outcome were identified by logistic regression analysis.

SETTING:

The pediatric and cardiac surgery ICU of a Belgian tertiary-care hospital.

PATIENTS:

One hundred fifty-seven patients (aged 1 mo to 15 yr) treated intravenously with amoxicillin-clavulanic acid, piperacillin-tazobactam, or meropenem.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Three hundred eighty-two trough concentrations were obtained from 157 patients (median age, 1.25 yr; interquartile range, 0.4–4.2 yr). Subtherapeutic concentrations were measured in 39 of 60 (65%), 43 of 48 (90%), and 35 of 49 (71%) of patients treated with amoxicillin-clavulanic acid, piperacillin-tazobactam, and meropenem, respectively. Estimates of glomerular filtration rate (eGFR; 54% increase in odds for each sd increase in value, 95% CI, 0.287–0.736; p = 0.001) and the absence of vasopressor treatment (2.8-fold greater odds, 95% CI, 1.079–7.253; p = 0.034) were independently associated with target nonattainment. We failed to identify an association between antibiotic concentrations and clinical failure.

CONCLUSIONS:

Subtherapeutic β-lactam concentrations are common in critically ill children and correlate with renal function. eGFR equations may be helpful in identifying patients who may require higher dosing. Future studies should focus on the impact of subtherapeutic concentrations on clinical outcome.
Effect of lower limb orthoses on cartilage in patients with knee osteoarthritis: A narrative review
Authors: Fernandes Nuno , Silva Filipe , Carvalho Óscar , Leal Ana
Published: April 2022

The objective of this review was to infer how the use of an orthosis affects cartilage in patients with knee osteoarthritis. A search was performed in four different databases (Web of Science, Scopus, EMBASE, and PubMed) up to the 21st of November of 2020 to evaluate how the patient’s condition was monitored. The parameters chosen for this review were medial tibial cartilage volume, x-ray evaluation, Lequesne Index, pain visual analog scale score, Western Ontario and McMaster Universities Arthritis Index pain score, and Knee Injury and Osteoarthritis Outcome Score pain subscale score. The initial search yielded a total of 12,622 documents. After thoroughly screening them, 38 were selected for analysis. Of the resulting data, only two objectively evaluated the cartilage (medial tibial cartilage volume, n = 1; x-ray evaluation, n = 1), with the remainder evaluating subjective symptoms (Lequesne Index, n = 8; pain visual analog scale score, n = 18; Western Ontario and McMaster Universities Arthritis Index pain score, n = 10; Knee Injury and Osteoarthritis Outcome Score pain subscale score, n = 10). The data did not converge toward any general outcome. The articles read demonstrated a great tendency to evaluate qualitative parameters pertinent to the symptoms of this condition or quantitative parameters related to the biomechanics of the knee. However, these parameters are not ideal because they are ambiguous. As such, a shift toward more objective quantitative parameters that directly assess the cartilage volume of the knee should be considered in future clinical trials.
Cost-effectiveness analysis of prosthesis provision for patients with transfemoral amputation in Tanzania
Authors: Donnelley Claire A. , von Kaeppler Ericka P. , Hetherington Alexander , Shirley Corin , Haonga Billy T. , Challa Sravya T. , Andrysek Jan , Lutyens Emily Mochizuki , Mamseri Leah , Mwakasungula Geofrey , Morshed Saam , Shearer David W.
Published: April 2022

Background:

Limb loss leads to significant disability. Prostheses may mitigate this disability but are not readily accessible in low- and middle-income countries (LMICs). Cost-effectiveness data related to prosthesis provision in resource-constrained environments such as Tanzania is greatly limited.

Objectives:

This study aimed to compare the cost-effectiveness of a prosthesis intervention compared with that of no prosthesis for persons with transfemoral amputations in an LMIC.

Study design:

This is a prospective cohort study.

Methods:

Thirty-eight patients were prospectively followed up. Clinical improvement with prosthesis provision was measured using EuroQuol-5D, represented as quality-adjusted life years gained. Direct and indirect costs were measured. The primary outcome was incremental cost per quality-adjusted life year, measured at 1 year and projected over a lifetime using a Markov model. Reference case was set as a single prosthesis provided without replacement from a payer perspective. Additional scenarios included the societal perspective and replacement of the prosthesis. Uncertainty was measured with one-way probabilistic sensitivity analysis.

Results:

From the payer perspective, the incremental cost-effectiveness ratio (ICER) was $242 for those without prosthetic replacement over a lifetime, and the ICER was $390 for those with prosthetic replacement over a lifeime. From the societal perspective, prosthesis provision was both less expensive and more effective. One-way sensitivity analysis demonstrated the ICER remained below the willingness to pay threshold up to prosthesis costs of $763.

Conclusions:

These findings suggest prosthesis provision in an LMIC may be cost-effective, but further studies with long-term follow up are needed to validate the results.
Imaging Aldosterone-Producing Adrenocortical Carcinoma With 68Ga-Pentixafor PET/CT
Authors: Shu QiaoQiao , Deng Maoxue , Chen Yue , Liu Nan , Cai Liang
Published: April 2022

Chemokine receptor 4 (CXCR4) is a 7-transmembrane G protein–coupled receptor, and pentixafor is considered to be a potent ligand for the CXCR4 receptor. Recently, 68Ga-pentixafor has been reported as a potential PET imaging agent for CXCR4-positive tumors and inflammatory lesions, including adrenocortical lesions. We report a case of primary aldosteronism due to adrenocortical carcinoma with intense 68Ga-pentixafor activity on PET/CT.
Magnetic Resonance Imaging for Guidance and Follow-up of Thoracic Needle Biopsies and Thermal Ablations
Authors: Abrishami Kashani Maya , Campbell-Washburn Adrienne E. , Murphy Mark C. , Catalano Onofrio A. , McDermott Shaunagh , Fintelmann Florian J.
Published: April 2022

Magnetic resonance imaging (MRI) is used for the guidance and follow-up of percutaneous minimally invasive interventions in many body parts. In the thorax, computed tomography (CT) is currently the most used imaging modality for the guidance and follow-up of needle biopsies and thermal ablations. Compared with CT, MRI provides excellent soft tissue contrast, lacks ionizing radiation, and allows functional imaging. The role of MRI is limited in the thorax due to the low hydrogen proton density and many air-tissue interfaces of the lung, as well as respiratory and cardiac motion. Here, we review the current experience of MR-guided thoracic needle biopsies and of MR-guided thermal ablations targeting lesions in the lung, mediastinum, and the chest wall. We provide an overview of MR-compatible biopsy needles and ablation devices. We detail relevant MRI sequences and their relative advantages and disadvantages for procedural guidance, assessment of complications, and long-term follow-up. We compare the advantages and disadvantages of CT and MR for thoracic interventions and identify areas in need of improvement and additional research.
Retained Morbidly Adherent Placenta Presenting as a Myometrial Mass in Patients With Vaginal Bleeding
Authors: Noblett Dylan , Sekhon Simran , Corwin Michael T. , Lamba Ramit , McGahan John P.
Published: April 2022

The differential diagnosis for a uterine mass and vaginal bleeding after abortion or delivery is broad and includes both benign and malignant causes. A rare etiology for this condition is retained morbidly adherent placenta. Few cases of retained morbidly adherent placenta presenting as a myometrial mass in the setting of vaginal bleeding have been described in the medical literature. In this case series and review of the current literature, we describe the ultrasound features of 3 retained morbidly adherent placentae, along with correlative magnetic resonance imaging findings.
A Randomized Trial of Social Media Versus Search Engine Advertising to Increase Awareness of Treatments for Female Stress Urinary Incontinence
Authors: Bennett Alaina T. , Boniface Emily R. , Spiers Alaina , Gregory W. Thomas , Cichowski Sara B.
Published: April 2022

Importance

Outreach based on user characteristics through social media advertising is significantly more effective than outreach based on user interests with search engine advertising for female stress urinary incontinence.

Objective

The aim of the study was to compare the effectiveness of 2 online outreach platforms to engage women at risk of stress urinary incontinence with a high-quality patient education website.

Study Design

A geographic randomized trial was performed comparing online advertising on Facebook, a social media site, versus Google Ads, a search engine, to direct viewers to VoicesForPFD.org. Advertisements were developed using health communication theory and pretested before the randomized trial. Counties in the Pacific Northwest were grouped into approximately equal populations, called “supercounties,” and randomized to advertisement platforms. Educational website views resulting from each campaign, called sessions, were measured using Google Analytics; the primary outcome was the number of sessions per supercounty. County characteristics were obtained from national survey data. Effectiveness of the advertising platforms was compared between randomization arms using Welch’s unequal variances t test, and crude and adjusted linear regression models.

Results

Mean user sessions were significantly higher in areas randomized to Facebook advertising (470 sessions) compared with areas randomized to Google Ads advertising [44 sessions; mean, 426 session difference (95% confidence interval, 199–653 sessions); P = 0.001]. After accounting for adult female population and rurality, randomization to Facebook instead of Google Ads still resulted in 409 additional sessions (95% confidence interval, 317–501 sessions; P < 0.001).

Conclusions

Social media was 10 times more effective (470 versus 44 mean sessions per supercounty) than search engine outreach advertising and should be prioritized in outreach efforts. Future work is needed on engagement and behavior change with online outreach.
Economic Evaluation of Screening for Polyomavirus Infection in Kidney Transplant Recipients: A Cost-Utility Analysis
Authors: Wong Germaine , Myint Thida Maung , Lee Yoon Jae , Craig Jonathan C. , Axelrod David , Kiberd Bryce
Published: April 2022

Background:

Screening for polyomavirus infection after kidney transplantation is recommended by clinical practice guidelines, but cost-effectiveness of this strategy is uncertain. The aim of this study was to estimate the incremental costs and benefits of routine screening for polyomavirus infection compared with no screening in kidney transplant recipients.

Methods:

Probabilistic Markov models were constructed to compare the health and economic benefits of routine screening for polyomavirus infection using real-time polymerase chain reaction assay. A series of 1-way and probabilistic sensitivity analyses were conducted to define the most influential variables in the model.

Results:

Monthly screening for 6 mo followed by 3 monthly screenings until 12 mo after transplant was dominant (lower costs and improved outcomes). Compared with no screening, the incremental benefits of screening were 0.294 life-years saved and 0.232 quality-adjusted life-years saved. Total savings from screening were $6986 Australian dollars ($5057 US dollars). The cost-effectiveness ratios were most sensitive to the costs of transplantation and dialysis, age of transplantation, prevalence of viremia, and probability of death in patients with a history of polyomavirus-associated nephropathy. Probabilistic sensitivity analysis indicated that screening (compared with no screening) was the dominant strategy across all plausible ranges of transition probabilities.

Conclusions:

Screening for polyomavirus infections 1 year following transplantation appears to save money, improves survival, and improves quality of life in kidney transplant recipients.
The Unmet Challenge of Diagnosing and Treating Photophobia
Authors: Buchanan Thomas M. , Digre Kathleen B. , Warner Judith E. A. , Katz Bradley J.
Published: April 2022

Background:

Although patients with abnormal light sensitivity may present to an ophthalmologist or optometrist for the evaluation of photophobia, there are no previous reviews of the most common causes of this symptom.

Methods:

We conducted a retrospective chart review of patients who presented to our eye center between 2001 and 2009 primarily for the evaluation of photophobia. We recorded demographics, ocular examination findings, and diagnoses of these patients.

Results:

Our population included 58 women and 53 men. The mean age at presentation to the clinic was 37 years (range 6 months–94 years). The most frequent cause of photophobia was migraine headache (53.7%), followed by dry eye syndrome (36.1), ocular trauma (8.2%), progressive supranuclear palsy (6.8%), and traumatic brain injury (4.1%). A significant proportion of patients (25.9%) left the clinic without a cause for their photophobia documented by the examining physician (11.7% of adults and 69.4% of children).

Conclusions:

Photophobia affects patients of all ages, and many patients are left without a specific diagnosis, indicating a significant knowledge gap among ophthalmologists and optometrists evaluating these patients.
Horner Syndrome in Giant Cell Arteritis: Case Series and Review of the Literature
Authors: Sverdlichenko Irina , Lam Cindy , Donaldson Laura , Margolin Edward
Published: April 2022

Background:

Giant cell arteritis (GCA) is a systemic inflammatory vasculitis that affects medium- and large-sized arteries and can result in permanent vision loss. In rare instances, Horner syndrome has been noticed at the time of GCA diagnosis, although the mechanism of both diagnoses occurring at the same time is not entirely understood. We reviewed 53 charts of all patients diagnosed with biopsy-proven GCA in tertiary neuro-ophthalmology practice to find patients who presented with new onset of Horner syndrome at the time of GCA diagnosis.

Methods:

Two patients with biopsy-confirmed GCA who presented with concurrent Horner syndrome were found. Data on age, sex, and ophthalmic and neuroradiologic examination findings were collected.

Results:

Patient 1 was a 67-year-old man who presented with new onset of vertical binocular diplopia and was diagnosed with right fourth cranial nerve palsy. He then developed left ptosis and miosis, and was diagnosed with Horner syndrome by pharmacologic testing. He also had persistently elevated inflammatory markers. Patient 2 was a 71-year-old man who presented with new onset of binocular vertical diplopia, bitemporal headaches, and jaw ache. Both of his inflammatory markers were elevated. On examination, he had left ptosis and myosis, and small comitant left hypertropia. The diagnosis of left Horner syndrome was confirmed on pharmacologic testing and left hypertropia was attributed to skew deviation. Both patients underwent temporal artery biopsy, which confirmed the diagnosis of GCA. Treatment with high dose of oral corticosteroids commenced, and vertical diplopia has completely resolved in both patients. Horner syndrome persisted in Patient 1 and resolved in Patient 2. MRI and MR angiography of the brain and neck were unrevealing in both patients.

Conclusions:

This case series describes 2 patients with new diagnosis of GCA and concurrent Horner syndrome, with new diagnosis of likely nuclear/fascicular fourth nerve palsy in one patient and skew deviation in the other. In both patients, vasculitis presumptively affected vertebral arteries and their branches supplying the first-order sympathetic neurons in the brainstem. Considering the severe complication of permanent vision loss in GCA, this diagnosis should be considered in older patients presenting with concurrent new onset of Horner syndrome.
Kidney Disease: Improving Global Outcomes Classification of Chronic Kidney Disease and Short-Term Outcomes of Patients Undergoing Liver Resection
Authors: Bagante Fabio , Alaimo Laura , Tsilimigras Diamantis , Dalbeni Andrea , Ejaz Aslam , Ruzzenente Andrea , Donadello Katia , Spolverato Gaya , Guglielmi Alfredo , Pawlik Timothy M
Published: April 2022

BACKGROUND:

The impact of chronic kidney disease (CKD) on surgery is still not well defined. We sought to characterize the association of preoperative CKD with 30-day mortality after hepatic resection.

METHODS:

Patients included in the American College of Surgeons (ACS) NSQIP who underwent hepatectomy between 2014 and 2018 were identified. Kidney function was stratified according to the “Kidney Disease: Improving Global Outcomes” (KDIGO) Classification: G1, normal/high function (estimated glomerular-filtration-rate ≥ 90 ml/min/1.73m2); G2–3, mild/moderate CKD (89–30 ml/min/1.73m2); G4–5, severe CKD (≤ 29 ml/min/1.73m2).

RESULTS:

Overall, 18,321 patients were included. Older patients (ie more than 70 years old) and those with serious medical comorbidities (ie American Society of Anesthesiologists [ASA] class 3) had an increased incidence of severe CKD (both p < 0.001). Patients with G2–3 and G4–5 CKD were more likely to have a prolonged length of stay and to experience postoperative complications (both p < 0.001). Adjusted odds of 30-day mortality increased with the worsening CKD (p = 0.03). The degree of CKD was able to stratify patients within the NSQIP risk calculator. Among patients who underwent major hepatectomy for primary cancer, the rate of 30-day mortality was 2-fold higher with G2–3 and G4–5 CKD vs normal kidney function (p = 0.03).

CONCLUSIONS:

The degree of CKD was related to the risk of complications and 30-day mortality after hepatectomy. CKD classification should be strongly considered in the preoperative risk estimation of these patients.
Gene Expression Profiling: Identification of Novel Pathways and Potential Biomarkers in Severe Acute Pancreatitis
Authors: Nesvaderani Maryam , Dhillon Bhavjinder K , Chew Tracy , Tang Benjamin , Baghela Arjun , Hancock Robert EW , Eslick Guy D , Cox Michael
Published: April 2022

BACKGROUND:

Determining the risk of developing severe acute pancreatitis (AP) on presentation to hospital is difficult but vital to enable early management decisions that reduce morbidity and mortality. The objective of this study was to determine global gene expression profiles of patients with different acute pancreatitis severity to identify genes and molecular mechanisms involved in the pathogenesis of severe AP.

STUDY DESIGN:

AP patients (n = 87) were recruited within 24 hours of admission to the Emergency Department and were confirmed to exhibit at least 2 of the following features: (1) abdominal pain characteristic of AP, (2) serum amylase and/or lipase more than 3-fold the upper laboratory limit considered normal, and/or (3) radiographically demonstrated AP on CT scan. Severity was defined according to the Revised Atlanta classification. Thirty-two healthy volunteers were also recruited and peripheral venous blood was collected for performing RNA-Seq.

RESULTS:

In severe AP, 422 genes (185 upregulated, 237 downregulated) were significantly differentially expressed when compared with moderately severe and mild cases. Pathway analysis revealed changes in specific innate and adaptive immune, sepsis-related, and surface modification pathways in severe AP. Data-driven approaches revealed distinct gene expression groups (endotypes), which were not entirely overlapping with the clinical Atlanta classification. Importantly, severe and moderately severe AP patients clustered away from healthy controls, whereas mild AP patients did not exhibit any clear separation, suggesting distinct underlying mechanisms that may influence severity of AP.

CONCLUSION:

There were significant differences in gene expression affecting the severity of AP, revealing a central role of specific immunological pathways. Despite the existence of patient endotypes, a 4-gene transcriptomic signature (S100A8, S100A9, MMP25, and MT-ND4L) was determined that can predict severe AP with an accuracy of 64%.
Feasibility and Effectiveness of an Enhanced Recovery Program after Early Cholecystectomy for Acute Calculous Cholecystitis: A 2-Step Study
Authors: Demouron Marion , Selvy Marie , Dembinski Jeanne , Mauvais François , Cheynel Nicolas , Slim Karem , Sabbagh Charles , Regimbeau Jean-Marc
Published: April 2022

BACKGROUND:

Enhanced recovery programs (ERPs) are associated with a lower morbidity rate and a shorter length of stay. The present study’s objective was to determine whether an ERP is feasible and effective for patients undergoing early cholecystectomy for grade I or II acute calculous cholecystitis.

STUDY DESIGN:

A 2-step multicenter study was performed. In the first step (the feasibility study), patients were consecutively included in a dedicated, prospective database from March 2019 until January 2020. The primary endpoint was the ERP’s feasibility, evaluated in terms of the number and nature of the ERP components applied. During the second step, the ERP’s effectiveness in acute calculous cholecystitis was evaluated in a case-control study. The ERP+ group comprised consecutive patients who were prospectively included from March 2019 to November 2020 and compared with a control (ERP–) group of patients extracted from the ABCAL randomized controlled trial treated between May 2010 and August 2012 and who had not participated in a dedicated ERP.

RESULTS:

During the feasibility study, 101 consecutive patients entered the ERP with 17 of the 20 ERP components applied. During the effectiveness study, 209 patients (ERP+ group) were compared with 414 patients (ERP– group). The median length of stay was significantly shorter in the ERP+ group (3.1 vs 5 days; p < 0.001). There were no intergroup differences in the severe morbidity rate, mortality rate, readmission rate, and reoperation rate.

CONCLUSIONS:

Implementation of an ERP after early cholecystectomy for acute calculous cholecystitis appeared to be feasible, effective, and safe for patients. The ERP significantly decreased the length of stay and did not increase the morbidity rate.
Capturing and Improving Case Charge Accuracy in Robotic Surgery Programs
Authors: Gerull William D , Pierce Andrew , Mody Jessica , Awad Michael M , Martin Jackie , Wellen Jason R
Published: April 2022

The robotic platform offers many benefits to patients and surgeons; however, incorporating this new surgical tool has also introduced challenges in intraoperative documentation accuracy. In 2019, we began to investigate our institution’s robotic intraoperative supply documentation accuracy. We identified a 60% case error rate between the robotic items logged by the operating room staff in the electronic medical record and the true robotic items used for a case as logged on the Intuitive platform. This can be a widespread and unrecognized problem for other organizations as well. We then addressed this problem through patient safety and quality improvement-based interventions including error notification to operating room personnel, a barcode scanning system, peer-to-peer education, improving robotic item descriptions, and procedure receipt messaging. These interventions helped us decrease our institution’s case error rate from 60% to 16.9% during the past 2 years, which generated a cumulative 2.1% net increase in our billed robotic items, through the addition and/or subtraction of robotic items from each case. Through our multiple interventions, we have created a robust, flexible, and efficient item-capturing system for robotic surgery cases.
Principles, mechanisms and functions of entrainment in biological oscillators
Authors: Jiménez Alba , Lu Ying , Jambhekar Ashwini , Lahav Galit
Published: April 2022

Entrainment is a phenomenon in which two oscillators interact with each other, typically through physical or chemical means, to synchronize their oscillations. This phenomenon occurs in biology to coordinate processes from the molecular to organismal scale. Biological oscillators can be entrained within a single cell, between cells or to an external input. Using six illustrative examples of entrainable biological oscillators, we discuss the distinctions between entrainment and synchrony and explore features that contribute to a system's propensity to entrain. Entrainment can either enhance or reduce the heterogeneity of oscillations within a cell population, and we provide examples and mechanisms of each case. Finally, we discuss the known functions of entrainment and discuss potential functions from an evolutionary perspective.
Effectiveness of the BNT162b vaccine fourth dose in reducing SARS-CoV-2 infection among healthcare workers in Israel, a multi-center cohort study
Authors: Cohen Matan J , Oster Yonatan , Moses Allon E , Spitzer Avishay , Benenson Shmuel ,   the Israeli-hospitals 4th vaccine Working Group
Published: April 2022

During December 2021 the fifth COVID-19 wave started in Israel, caused mostly by the Omicron variant, affecting the unvaccinated and vaccinated population. Ninety percent of the Israeli adults, including most healthcare workers (HCWs), received three doses of the BNT162b2 vaccine until September 2021. Following the success and safety of the 3rd dose in preventing infection and severe disease, on December 30, 2021, the Israeli Ministry of Health recommended a voluntary 4th vaccine dose to adults above 60 years, immunocompromised, and HCWs. We compared breakthrough infections in HCWs, between 3 and 4-dose recipients.

Hospitals collected data on personnel vaccinations and infections dates. The study cohort included all HCWs in eleven hospitals in Israel, who have been vaccinated with three doses up to September 30, 2021, and had not contracted COVID-19 before the vaccination campaign (January 2, 2022).

We calculated breakthrough infection rates in 4-dose recipients (more than six days after vaccination) vs. 3-dose recipients. Rate-ratios were calculated for the entire cohort and for subgroups (hospital, sex, age-groups, and profession). Additionally, we repeated the calculations on 4-dose and 3-dose recipients who received the 3rd dose on the same date and were matched for sex, age group, profession and hospital. We generated time-dependent Cox-regression models to account for 4th dose administration timing (Supplement).

There were 29,612 HCWs who received 3 vaccine doses between August and September 2021; of these, 5,331 (18.0%) received the 4th dose during January 2022 and were not infected by the first week after vaccination. Overall breakthrough infection rates in the 4-dose and 3-dose groups were 368/5331 (6.9%) and 4802/24280 (19.8%), respectively. The RR (95%CI) was 0.35 (0.32 to 0.39) for crude analysis, and 0.61 (0.54 to 0.71) in the matched analysis. The adjusted HR in the Cox-regression model was 0.56 (0.50 to 0.63). In both groups, severe disease and death were not reported.

Our data shows that the 4th BNT162b2 dose resulted in reduced breakthrough infection rates among HCWs. This reduction, similar to the findings in the Israeli elderly population, is lower than that observed after the 3rd dose.

Nevertheless, considering the high infectivity of the Omicron variant, which led to critical medical staff shortages, a 4th vaccine dose should be considered to mitigate the infection rate among HCWs.
Influence of immunosuppressive regimen on diffusivity and oxygenation of kidney transplants – analysis of functional MRI data from the randomized ZEUS trial
Authors: Mani Laila-Yasmin , Cotting Jasna , Vogt Bruno , Eisenberger Ute , Vermathen Peter
Published: April 2022

The ZEUS study was a multi-center randomized controlled trial investigating the effect of an early conversion from ciclosporin-based to an everolimus-based regimen on graft function twelve months post-transplantation. In this investigator-initiated sub-study, functional magnetic resonance imaging (fMRI) of kidney grafts was prospectively performed to non-invasively assess differences in graft oxygenation, diffusion and perfusion between groups and time-points using diffusion-weighted imaging (DWI) and blood oxygen level-dependent (BOLD)-MRI. Sixteen patients underwent DWI and BOLD-MRI at months 4.5 and 12 post-transplantation on a 3 Tesla and 1.5 Tesla (n=3) MR scanner. After exclusion due to image quality, outlier values or missing data, DWI was analyzed in ten, BOLD in eight subjects. The diffusion coefficient ADCD decreased in the CsA-group over time, whereas it increased in the EVE-group (p=0.046, medulla). The change in ADCD from month 4.5 to 12 significantly differed between groups in cortex (p=0.033) and medulla (p=0.019). In BOLD, cortico-medullary transverse relaxation rate R2* increased (decreased tissue oxygen) in the CsA-treated and decreased in the EVE-treated group over time. Similarly, R2* values at month 12 were higher in the CsA- vs. EVE-treated group. There was no significant difference for the perfusion fraction FP. In conclusion, this prospective sub-study of the ZEUS trial suggests an impact of immunosuppressive regimen on fMRI parameters of the kidney graft.
Germline sequencing of DNA-damage-repair genes in two hereditary prostate cancer cohorts reveals new disease risk-associated gene variants
Authors: Foley Georgea R. , Marthick James R. , Lucas Sionne E. , Raspin Kelsie , Banks Annette , Stanford Janet L. , Ostrander Elaine A. , FitzGerald Liesel M. , Dickinson Joanne L.
Published: April 2022

Background

Knowledge of rare, inherited variants in DNA damage repair (DDR) genes is informing clinical management in common cancers. However, defining the rare disease- associated variants in prostate cancer (PrCa) is challenging due to their low frequency.

Method

Here, whole-genome and -exome sequencing data from two independent, high- risk Australian and North American familial PrCa datasets were interrogated for novel, rare DDR variants. Segregating, high-risk, likely pathogenic DDR gene variants were identified and subsequently genotyped in 1,963 individuals (700 familial and 459 sporadic PrCa cases, 482 unaffected relatives, and 322 screened controls) and association analyses performed accounting for relatedness (MQLS).

Results

Rare variants significantly associated with PrCa risk were identified inERCC3(rs145201970, p=2.57×10−4) andBRIP1(rs4988345, p=0.025) in the combined datasets. APARP2(rs200603922, p=0.028) variant in the Australian dataset and aMUTYH(rs36053993, p=0.031) variant in the North American dataset were also associated with PrCa risk. No evidence for a younger age or higher-grade disease at diagnosis was evident in variant carriers.

Conclusions

Here, we provide new evidence for four novel germline DDR PrCa risk variants. Defining the full spectrum of PrCa associated DDR genes is important for effective clinical screening and disease management.