bluuebunny/crossref_metadata_2025 huggingface dataset:
IT System Management: A Service Provider Perspective
Authors: Madhavan Naveen
Published: August 2021

The adoption of digitisation has transformed organisations to become entirely reliant on information systems to function, writes Naveen Madhavan PhD MBCS, Senior Product Specialist (pathology) at Digital Health and Care Wales.
Integration of Formal Proof into Unified Assurance Cases - With Isabelle/SACM
Authors: Foster Simon , Nemouchi Yakoub , Gleirscher Mario , Wei Ran , Kelly Tim
Published: August 2021

The paper, by Simon Foster, Yakoub Nemouchi, Mario Gleirscher, Ran Wei and Tim Kelly, published in The Formal Aspects of Computing—Applicable Formal Methods (June 2021), explores the introduction of Isabelle/SACM into formal methods of assurance.
Whose Right Is It Anyway? The Duties Owed to a Deceased and to Surviving Family Members When Dealing with a Corpse: Brennan v City of Bradford Metropolitan District Council and Leeds Teaching Hospitals NHS Trust [2021] 1 WLUK 429
Authors: Davey Tina , Mead David
Published: August 2021

This commentary considers the case of Brennan, in which surviving family members successfully brought a Human Rights Act 1998 (HRA) claim against a hospital and a council for the way in which they both treated a body post-mortem. Their failure to freeze it led to such a state of decomposition that it was unfit for viewing. The family argued this constituted an unjustified interference with their rights to family and private life. After a review of Strasbourg case law, the Leeds County Court found for them and awarded them damages under section 8 of the HRA. This commentary evaluates both the Strasbourg law and the way it was utilised and interpreted domestically. While agreeing with the outcome, the authors conclude that the Strasbourg case law does not line up four square—and instead they suggest that a different approach, accepting the legitimacy of a claim based on ‘memory-securing’, is warranted on the facts. The commentary also questions whether the court was correct in seeing the rights reposed in the surviving family, and offers the view that greater coherence to the law might be achieved if we conceive of the survivors as the vehicle for the exercise of rights by the deceased.
A case of shiitake dermatitis in the United States
Authors: Gomez Jesus , Sharma Krishna , Huho Albert , Gregory Neal
Published: August 2021

A 65-year-old male presented to our dermatology clinic with a two-day intensely pruritic rash covering his back. The lesions were predominantly on his chest, upper extremity, and back. He denied any prior history of similar rashes and his past medical history was non-contributory. A detailed exposure history revealed the patient had eaten Shiitake mushrooms for dinner 48 hours previously.

Physical examination showed a truncal dominant rash. Close-up examination confirmed the papulovesicular nature of the rash with multiple small vesicles grouped both along the breadth and length of each linear streak on an erythematous background. Biopsies showed spongiosis with micro-vesiculation. Blood work showed a nominal CBC and CRP/ESR and serum IgE. The patient was put on topical steroid and the rash resolved in one week.

With increasing mushroom consumption [1], cognizance of this etiology avoids a diagnostic ‘odyssey’ and prevents recurrence of this very characteristic rash.
p53 regulation by MDM2 contributes to self‐renewal and differentiation of basal stem cells in mouse and human airway epithelium
Authors: Garrido‐Jimenez Sergio , Barrera‐Lopez Juan Francisco , Diaz‐Chamorro Selene , Mateos‐Quiros Clara Maria , Rodriguez‐Blanco Ignacio , Marquez‐Perez Francisca Lourdes , Lorenzo Maria Jesus , Centeno Francisco , Roman Angel Carlos , Carvajal‐Gonzalez Jose Maria
Published: August 2021

Proper physiological function of mammalian airways requires the differentiation of basal stem cells into secretory or multiciliated cells, among others. In addition, the self‐renewal ability of these basal stem cells is crucial for developing a quick response to toxic agents in order to re‐establish the epithelial barrier function of the airways. Although these epithelial missions are vital, little is known about those mechanism controlling airway epithelial regeneration in health and disease. p53 has been recently proposed as the guardian of homeostasis, promoting differentiation programs, and antagonizing a de‐differentiation program. Here, we exploit mouse and human tracheal epithelial cell culture models to study the role of MDM2‐p53 signaling in self‐renewal and differentiation in the airway epithelium. We show that p53 protein regulation by MDM2 is crucial for basal stem cell differentiation and to keep proper cell proliferation. Therefore, we suggest that MDM2/p53 interaction modulation is a potential target to control regeneration of the mammalian airway epithelia without massively affecting the epithelium integrity and differentiation potential.
Comparison of sequential feeding and continuous feeding on the blood glucose of critically ill patients: a non-inferiority randomized controlled trial
Authors: Ren Chang-Jie , Yao Bo , Tuo Miao , Lin Hui , Wan Xiang-Yu , Pang Xu-Feng
Published: August 2021

Background:

Glucose control is an important aspect in managing critically ill patients. The goal of this study was to compare the effects of sequential feeding (SF) and continuous feeding (CF) on the blood glucose of critically ill patients.

Methods:

A non-inferiority randomized controlled trial was adopted in this study. A total of 62 patients who were fed enteral nutritional suspension through gastric tubes were enrolled. After achieving 80% of the nutrition target calories (25 kcal·kg−1·day−1) through CF, the patients were then randomly assigned into SF and CF groups. In the SF group, the feeding/fasting time was reasonably determined according to the circadian rhythm of the human body as laid out in traditional Chinese medicine theory. The total daily dosage of the enteral nutritional suspension was equally distributed among three time periods of 7 to 9 o’clock, 11 to 13 o’clock, and 17 to 19 o’clock. The enteral nutritional suspension in each time period was pumped at a uniform rate within 2 h by an enteral feeding pump. In the CF group, patients received CF at a constant velocity by an enteral feeding pump throughout the study. Blood glucose values at five points (6:00/11:00/15:00/21:00/1:00) were monitored and recorded for seven consecutive days after randomization. Enteral feeding intolerance was also recorded. Non-inferiority testing was adopted in this study, the chi-square test or Fisher test was used for qualitative data, and the Mann-Whitney U test was used for quantitative data to determine differences between groups. In particular, a repeated measure one-way analysis of variance was used to identify whether changes in glucose value variables across the time points were different between the two groups.

Results:

There were no significant demographic or physiological differences between the SF and CF groups (P > 0.050). The average glucose level in SF was not higher than that in CF (8.8 [7.3–10.3] vs. 10.7 [9.1–12.1] mmol/L, Z = −2.079, P for non-inferiority = 0.019). Hyperglycemia incidence of each patient was more common in the CF group than that in the SF group (38.4 [19.1–63.7]% vs. 11.8 [3.0–36.7]%, Z = −2.213, P = 0.027). Hypoglycemia was not found in either group. Moreover, there was no significant difference during the 7 days in the incidence of feeding intolerance (P > 0.050).

Conclusions:

In this non-inferiority study, the average blood glucose in SF was not inferior to that in CF. The feeding intolerance in SF was similar to that in CF. SF may be as safe as CF for critically ill patients.

Trial Registration

ClinicalTrials.gov, NCT03439618; https://clinicaltrials.gov/ct2/show/record/NCT03439618
Opioids
Authors: Hines Cheryl B. , Owings Clara R.
Published: August 2021

In the last decade, critical-care nurses have seen a surge in acute opioid overdose admissions to intensive care units; there have also been significant increases in intensive care unit admissions due to opioid-related illness such as dependence, tolerance, and hyperalgesia. Despite these issues, opioids continue to be the criterion standard of pain management, and the search for opioid alternatives has not produced a clear replacement. A contributor to this problem has been the prevailing opinion that once bound to a receptor, all opioids engaged in the same types of intracellular signaling, which resulted in the same types of responses, only differing in the magnitude of those responses. Contemporary research with G-protein–coupled receptor models (eg, opioids) has demonstrated that this oversimplification is incorrect or incomplete. Understanding the complexity of opioid pharmacodynamics and pharmacokinetics helps us to grasp the intricacies of opioid-related adverse effects. Although there are many potential adverse effects related to opioids, this review focuses on the major adverse effects commonly seen in critical care, namely, respiratory depression, tolerance, hyperalgesia, and central sensitization. In addition, a case study has been incorporated to aid in understanding of strategies nurses can incorporate into their practices: that help mitigate the development of these effects.
Moral Distress Among Interdisciplinary Critical Care Team Members at a Comprehensive Cancer Center
Authors: Sandberg Angela D. , Beuer Genevieve , Reich Richard R. , Mason Tina M.
Published: August 2021

Background

Moral distress (MD) has been linked to health care professional burnout, intent to leave, and decreased quality of care.

Objectives

The aim of this study was to describe the perceptions of MD among critical care interdisciplinary team members and assess the association of MD with team member characteristics.

Methods

A descriptive cross-sectional design was used with interdisciplinary team members in an intensive care unit setting at an NCI-designated Comprehensive Cancer Center in the southeastern United States. The Measure of Moral Distress for Healthcare Professionals was provided to registered nurses, oncology technicians, providers, respiratory therapists, and ancillary team members (social workers, pharmacists, dietitians).

Results

A total of 67 team members completed the survey. Mean responses for 3 items were higher than 8 (halfway point of scale): “Follow family's insistence to continue aggressive treatment even though I believe it is not in the best interest of patient” (mean [SD], 11.4 [4.8]); “Continue to provide aggressive treatment for a patient most likely to die regardless of this treatment when no one will make a decision to withdraw it” (mean [SD], 10.5 [5.3]); and “Witness providers giving ‘false hope’ to patient/family” (mean [SD], 9.0 [5.3]). Higher responses on the “Continuing to provide aggressive treatment” item was associated with having “considered leaving due to MD” (P = .027) and “considering leaving now due to MD” (P = .016). Higher total scores were related to having left or considered leaving a job (P = .04). When examining education level, registered nurses with a master's degree (n = 5) exhibited the most MD (P = .04).

Conclusion

This study suggests that the Measure of Moral Distress for Healthcare Professionals is useful in identifying areas for focused efforts at reducing MD for interdisciplinary teams.
Understanding the genetics of chronic obstructive pulmonary disease, α1-antitrypsin deficiency, and implications for clinical practice
Authors: Mammen Jennifer R. , Lee Jung Eun
Published: August 2021

Cigarette smoking and poor air quality are the greatest risk factors for developing chronic obstructive pulmonary disease (COPD), but growing evidence indicates that genetic factors also affect predisposition to and clinical expression of disease. With the exception of α1-antitrypsin deficiency (AATD), a rare autosomal recessive disorder that is present in 1–3% of individuals with COPD, no single gene is associated with the development of obstructive lung disease. Instead, a complex interplay of genetic, epigenetic, and environmental factors is the basis for persistent inflammatory responses, accelerated cell aging, cell death, and fibrosis, leading to the clinical symptoms of COPD and different phenotypic presentations. In this brief review, we discuss current understanding of the genetics of COPD, pathogenetics of AATD, epigenetic influences on the development of obstructive lung disease, and how classifying COPD by phenotype can influence clinical treatment and patient outcomes.
Salivary peptest for laryngopharyngeal reflux and gastroesophageal reflux disease
Authors: Guo Zihao , Jiang Jiali , Wu Hao , Zhu Jinxia , Zhang Shutian , Zhang Chuan
Published: August 2021

Background:

A rapid lateral flow test (Peptest) to detect pepsin in saliva/sputum has been considered as a valuable method for diagnosing laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD). The aim of this meta-analysis is to analyze the utility of Peptest for diagnosis of LPR and GERD.

Methods:

PubMed, EMBASE, and the Cochran Library (from January 1980 to 26 January 2020) were searched for pepsin in saliva for LPR/GERD diagnosis. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve data were summarized to examine the accuracy.

Results:

A total of 16 articles that included 2401 patients and 897 controls were analyzed. The pooled sensitivity and specificity for the diagnosis of GERD/LPR with Peptest were 62% (95% confidence interval [CI] 49%–73%) and 74% (95% CI 50%–90%), respectively. The summarized diagnostic odds ratio and area under the curve were 5.0 (95% CI 2–19) and 0.70 (95% CI 0.66–0.74), respectively.

Conclusion:

Peptest shows moderate diagnostic value for LPR and GERD. More studies with standard protocols should be done to verify its usefulness.
Gastroenterologists attitude in various clinical settings in the era of COVID-19 pandemic
Authors: Sbeit Wisam , Mari Amir , Khoury Tawfik
Published: August 2021

Coronavirus disease 2019 (COVID-19) pandemic has impacted our clinical practice. Many gastroenterologists have changed their attitudes toward various gastroenterological clinical settings. The aim of the present study is to explore the gastroenterologist's attitudes in several clinical settings encountered in the clinical practice.

An online based survey was completed by 101 of 250 Israeli gastroenterologists (40.5%).

Most of the participants were males (76.2%), and most of them were in the age range of 40 to 50 (37.6%). For all questionnaire components, the 2 most common chosen options were “I perform endoscopy with N95 mask, gloves and gown protection in a standard endoscopy room without preendoscopy severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing” and “Tend to postpone endoscopy until SARS-CoV-2 test is performed because of fear from being infected, or virus spreading in the endoscopy suite.” Notably, 12 (11.9%) gastroenterologists were infected by Coronavirus disease 2019 during their work. Classifying the clinical settings to either elective and non-elective, most gastroenterologists (77.4%) chose the attitude of “I perform endoscopy with N95 mask, gloves and gown protection in a standard endoscopy room without SARS-COV-2 testing” in the nonelective settings as compared to 54.2% for the elective settings, (P < .00001), whereas 32.9% of the responders chose the attitude of “Tend to postpone endoscopy until SARS-COV-2 test is performed because of fear from being infected, or virus spreading in the endoscopy suite” in the elective settings (P < .00001).

Gastroenterologists’ attitude in various gastroenterological settings was based on the clinical indication. Further studies are needed to assess the long-term consequences of the different attitudes.
Brain abscess due to listeria monocytogenes
Authors: Zhang Junliang , Huang Shuangfeng , Xu Luyao , Tao Manli , Zhao Yujun , Liang Zhigang
Published: August 2021

Rationale:

Listeria monocytogenes infective encephalitis is a rare phenomenon, which is more common in people with changed eating habits and immunodeficiency. To the best of our knowledge, listeria brain abscess is even more rare. In this case report, we summarized the clinical characteristics of listeria brain abscess, in order to explore the diagnosis and treatment of Listeria brain abscess, and raise awareness and attention to the disease.

Patient concerns:

A 64-years-old female patient presented to our institution with 4 days of right arm and leg weakness, the salient past history of the patient was nephrotic syndrome, membranous nephropathy diagnosed 6 months prior, for which she was prescribed glucocorticoids and cyclophosphamide.

Diagnosis:

Listeria monocytogenes was cultured in the blood of the patient. Comprehensive medical history and imaging features, she was diagnosed as listeria brain abscess.

Interventions:

The patient underwent ampicillin combined with meropenem but not surgery.

Outcomes:

The patient recovered without complications. At a 3-month follow-up visit, the condition was better than that before treatment.

Lessons:

Listeria brain abscess is an unusual form of listeriosis, its clinical manifestations lack specificity. Early accurate diagnosis and standardized treatment can effectively promote the recovery of neurological function as well as reduce the morbidity and mortality and improve the prognosis.
Biologic therapy for amyloid A amyloidosis secondary to rheumatoid arthritis treated with interleukin 6 therapy
Authors: Jung Ju-Yang , Kim Young-Bae , Kim Ji-won , Suh Chang-Hee , Kim Hyoun-Ah
Published: August 2021

Introduction:

Secondary amyloidosis is a rare complication of rheumatoid arthritis (RA) that is histologically characterized by the deposition of amyloid fibrils in target organs, such as the kidneys and gastrointestinal tract. Controlling the inflammatory response is essential to prevent organ dysfunction in amyloid A (AA) amyloidosis secondary to RA, and no clear treatment strategy exists.

Patient Concerns and Diagnosis:

A 66-year-old woman with RA, who had been treated with disease-modifying anti-rheumatic drugs for 1 year, presented with recurrent abdominal pain and prolonged diarrhea. Endoscopy showed chronic inflammation, and colon tissue histology confirmed AA amyloidosis.

Interventions and Outcomes:

After tocilizumab therapy was begun, her diarrhea and abdominal pain subsided, and articular symptoms improved. Biologic drugs for RA have been used in patients with secondary AA amyloidosis, including tumor necrosis factor and Janus kinase inhibitors, interleukin 6 blockers, and a T cell modulator. Here, we systematically review existing case reports and compare the outcomes of RA-related AA amyloidosis after treatment with various drugs.

Conclusion:

The data indicate that biologic drugs like tocilizumab might be treatments of choice for AA amyloidosis secondary to RA.
Shear wave elastography of the scalene muscles in healthy adults
Authors: Bedewi Mohamed A. , Alhariqi Bader Abdullah , Aldossary Nasser M. , Gaballah Ayman H. , Sandougah Kholoud J.
Published: August 2021

The aim of the study is to evaluate the reliability of shear wave elastography to assess the anterior and middle scalene muscles in healthy adult subjects.

The study included 60 scalene muscles in 15 healthy subjects. High-resolution ultrasound and shear wave elastography were used to evaluate the anterior scalene and the middle scalene muscles. Stiffness values were measured.

The mean shear elastic modulus showed the following values, right anterior scalene muscle 18.83 ± 5.32 kPa, left anterior scalene muscle 21.71 ± 4.8 kPa, right middle scalene muscle 12.84 ± 5.2 kPa, left middle scalene muscle 19.76 ± 5.30 kPa. Positive correlation was noted between the left middle scalene muscle and body mass index (P = .004). No difference in elasticity was noted between the right and left anterior scalene muscles; however, significant difference was noted between the right and left middle scalene muscles (P = .002).

The results obtained in our study could be a reference point for future research considering different scalene muscle pathologies.
Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life
Authors: Murali Komal P. , Yu Gary , Merriman John D. , Vorderstrasse Allison , Kelley Amy S. , Brody Abraham A.
Published: August 2021

Background

Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). Although palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with noncancer serious illness and multiple chronic conditions has been understudied. Latent class analysis is a statistical method that can be used to better understand the relationship between severity of symptom burden and covariates, such as the presence of multiple chronic conditions. Although latent class analysis has been used to highlight subgroups of seriously ill adults with cancer based on symptom clusters, none have incorporated multiple chronic conditions.

Objectives

The objectives of this study were to (a) describe the demographic and baseline characteristics of seriously ill adults at the end of life in a palliative care cohort, (b) identify latent subgroups of seriously ill individuals based on severity of symptom burden, and (c) examine variables associated with latent subgroup membership, such as QOL, functional status, and the presence of multiple chronic conditions.

Methods

A secondary data analysis of a palliative care clinical trial was conducted. The latent class analysis was based on the Edmonton Symptom Assessment System, which measures nine symptoms on a scale of 0–10 (e.g., pain, fatigue, nausea, depression, anxiousness, drowsiness, appetite, well-being, and shortness of breath). Clinically significant cut-points for symptom severity were used to categorize each symptom item in addition to a categorized total score.

Results

Three latent subgroups were identified (e.g., low, moderate, and high symptom burden). Lower overall QOL was associated with membership in the moderate and high symptom burden subgroups. Multiple chronic conditions were associated with statistically significant membership in the high symptom burden latent subgroup. Older adults between 65 and 74 years had a lower likelihood of moderate or high symptom burden subgroup membership compared to the low symptom burden class.

Discussion

Lower QOL was associated with high symptom burden. Multiple chronic conditions were associated with high symptom burden, which underlines the clinical complexity of serious illness. Palliative care at the end of life for seriously ill adults with high symptom burden must account for the presence of multiple chronic conditions.
Postoperative Cardiovascular Surgery Delirium
Authors: Colwill Jennifer P. , Bena James F. , Morrison Shannon L. , Bakaeen Faisal , Albert Nancy M.
Published: August 2021

Purpose

The aims of this study were to examine interrater agreement of delirium between clinical nurses and a clinical nurse specialist, determine delirium subtype prevalence, and examine associated patient, procedure, and hospital factors.

Design

A descriptive cross-sectional design and a convenience sample of nurses and patients on progressive care units were used in this study.

Methods

Clinical nurse specialist data were collected on a case report form, and clinician and patient data were obtained from electronic databases. Interrater agreement of delirium prevalence was assessed by κ statistic, and logistic regression models were used to determine patient factors associated with delirium.

Results

Of 216 patients, 23 had delirium; clinical nurses identified fewer cases than the clinical nurse specialist: 1.8% versus 10.7%; κ agreement, 0.27 (0.06, 0.49). By delirium subtype, hypoactive delirium was more frequent (n = 10). Factors associated with delirium were history of cerebrovascular disease (odds ratio [95% confidence interval], 2.8 [1.01–7.7]; P = .044), history of mitral valve disease (odds ratio [95% confidence interval], 0.31 [0.09–0.90]; P = .041), and longer perfusion time (odds ratio [95% confidence interval], 1.7 [1.1–2.7]; P = .016). One factor was associated with hypoactive delirium, longer perfusion time (odds ratio [95% confidence interval], 2.2 [1.3–4.2]; P = .008).

Conclusions

Because clinician–clinical nurse specialist delirium agreement was low and hypoactive delirium was common, clinical interventions are needed.
Point-of-Care Ultrasound-Guided Versus Conventional Bladder Catheterization for Urine Sampling in Children Aged 0 to 24 Months
Authors: Akca Caglar Ayla , Tekeli Aysun , Karacan Can Demir , Tuygun Nilden
Published: August 2021

Objectives

It can be difficult to obtain urine samples, especially in children aged 0 to 24 months who have not yet completed toilet training. Bladder catheterization is a common method for urine sampling in this age group. However, if the bladder is not adequately filled, this process fails and repeat catheterization is necessary. Point-of-care ultrasonography (POCUS) is often used to assist invasive procedures in the pediatric emergency department. This study aimed to compare success rates of bladder catheterization in patients with and without POCUS to guide the timing of the procedure.

Methods

This was a prospective cohort study of children 0 to 24 months presenting to a pediatric emergency department in a tertiary center hospital. Patients were divided into 2 groups; the one group received conventional catheterization (CC group) without POCUS and the other group had catheterization after POCUS (POCUS group). The transverse and anterior-posterior diameter measurements of the bladder were obtained from one view in the transverse orientation using the (6–3 MHz) convex probe. Successful catheterization was defined by obtaining 3 mL or more of urine.

Results

A total of 110 patients were included in the study, with 56 in the POCUS group and 54 in the CC group. There was no difference between the mean age and sex of the groups. The success rates of obtaining urine samples were 93% and 78% in the POCUS group and CC group, respectively. This difference was statistically significant (P = 0.03). No significant difference was found between measurements of bladder catheterizations with and without obtaining 3 mL or greater urine volumes in the ultrasound group (P > 0.05).

Conclusions

The use of POCUS during bladder catheterization in children was found to be effective and successful. In addition, the detection of any amount of urine in the bladder using POCUS increases the success rate of bladder catheterization.
Rehabilitation After Single-Event Multilevel Surgery for Children and Young Adults With Cerebral Palsy
Authors: Guinet Anne-Laure , Khouri Néjib , Desailly Eric
Published: August 2021

This review sought to describe and analyze published protocols for rehabilitation after single-event multilevel surgery for people with cerebral palsy, to identify their differences and limits, and to introduce a common step-by-step framework for future descriptions and assessments of postoperative rehabilitation protocols.

The MEDLINE, Embase, CINAHL, and the Cochrane Library databases were searched. Inclusion criteria were as follows: (1) single-event multilevel surgery, (2) full-text reports published after 1985, and (3) articles with a method section describing the rehabilitation protocol. Interventions were coded using the Oxford Levels of Evidence and the Methodological Index for Non-Randomized Studies Index.

Twenty-four articles were included in the review. Studies included patients aged 4–30 yrs with spastic cerebral palsy (hemiplegia, diplegia, and quadriplegia). The mean postoperative rehabilitation duration was 4.5 mos, with 4 sessions per week, and rehabilitation took place in a rehabilitation center. This review provides relevant information about the modalities, contents, limits, and difficulties associated with the post-SEMS rehabilitation protocol reported in the literature. Pain was identified as a major problem.

A more precise and comprehensive description of post-SEMS rehabilitation protocols would be useful. The proposed five-step framework could be used by future studies to standardize their protocol description in terms of objective, content, and intensity.
COVID-19 and Chronic Lymphocytic Leukemia
Authors: Chatzikonstantinou Thomas , Herishanu Yair , Montserrat Emili , Ghia Paolo , Cuneo Antonio , Foà Robin , Scarfò Lydia
Published: August 2021

Coronavirus disease 2019 (COVID-19) has markedly impacted on the management of patients with chronic lymphocytic leukemia (CLL) and their outcome in the last year. The cumulative incidence of COVID-19 in patients with CLL in 1 year was approximately 3% in the recent Italian CAMPUS CLL survey; large retrospective studies have documented a higher mortality in patients with CLL hospitalized for severe COVID-19 compared with the general population. Controversial results for CLL-directed treatment have been reported, with some studies suggesting a potential benefit for BTK inhibitors. Reducing the number of hospital visits, delaying treatment whenever possible, and using oral therapy have become the mainstay of management in these patients. Available results with severe acute respiratory syndrome coronavirus 2 vaccines indicate an immune serological response in 40% of patients only, with a detrimental effect of recent therapy with or without anti-CD20 therapy, older age, and hypogammaglobulinemia. Further studies are needed to determine the best strategies in patients with CLL regarding (i) management of concomitant COVID-19, (ii) identification of patients in whom CLL therapy can be safely postponed, (iii) CLL treatment algorithms, and (iv) optimal severe acute respiratory syndrome coronavirus 2 vaccination strategies.
Mining the Microenvironment for Therapeutic Targets in Chronic Lymphocytic Leukemia
Authors: Kipps Thomas J.
Published: August 2021

The leukemia cells of patients with chronic lymphocytic leukemia (CLL) are highly fastidious, requiring stimulation by soluble factors and interactions with accessory cells within the supportive niches of lymphoid tissue that comprise the leukemia microenvironment. The advent of therapies that can disrupt some of the stimulatory signaling afforded by the microenvironment has ushered in a new era of targeted therapy, which has dramatically improved clinical outcome and patient survival. Future advances are required for patients who develop intolerance or resistance to current targeted therapies. These may be found by investigating novel drugs that can inhibit identified targets, such as the pathways involved in B-cell receptor signaling, or by developing agents that inhibit additional targets of the leukemia microenvironment. This review describes some of the molecules involved in promoting the growth and/or survival of CLL cells and discusses targeting strategies that may become tomorrow’s therapy for patients with CLL.
Genetics of Chronic Lymphocytic Leukemia
Authors: Bosch Francesc , Dalla-Favera Riccardo
Published: August 2021

During the past 10 years, relevant advances have been made in the understanding of the pathogenesis of chronic lymphocytic leukemia via the integrated analysis of its genome and related epigenome, and transcriptome. These analyses also had an impact on our understanding of the initiation, as well as of the evolution of chronic lymphocytic leukemia, including resistance to chemotherapy and sensitivity and resistance to novel targeted therapies. This chapter will review the current state of the art in this field, with emphasis on the genetic heterogeneity of the disease and the biological pathways that are altered by the genetic lesions.
Update in Unilateral Cleft Lip Surgery
Authors: Xue Amy S. , Buchanan Edward P. , Hollier Larry H.
Published: August 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Describe the unilateral cleft lip and nasal deformity and associated anatomical variations. 2. Understand the history and evolution of the unilateral cleft lip repair. 3. List different presurgical treatment options. 4. Differentiate between surgical techniques.

This article describes characteristics of the unilateral cleft lip and nasal deformity and its management, including presurgical orthopedics, operative techniques, and postsurgical care. The rotation-advancement and straight-line repairs are discussed in detail, as are the current concepts in primary cleft nose repair.
Component Restoration in the Bilateral Intermediate Cleft Tip Rhinoplasty
Authors: Dang Brian N. , Pfaff Miles J. , Jain Nirbhay S. , Hu Allison C. , Bertrand Anthony A. , Chan Candace H. , Kang Vicky , Lee James C. , Bradley James P. , Lee Justine C.
Published: August 2021

The intermediate cleft tip rhinoplasty is frequently performed during childhood to address nasal tip anomalies in cleft patients before the most critical period of psychosocial development. The authors previously described the component restoration intermediate cleft tip rhinoplasty technique for the unilateral cleft nose, which was developed to systematically address the lining deficiency, cleft lower lateral cartilage malpositioning, and cleft lateral cartilage weakness using a combination of lower lateral cartilage release, lateral cartilage repositioning, and placement of an auricular composite chondrocutaneous graft. In this work, the authors evaluate the utility of this technique to the bilateral cleft nose. Preoperative and postoperative (mean ± SD, 18.6 ± 10.8 months) photographs of bilateral cleft patients treated with the component restoration intermediate cleft tip rhinoplasty (n = 7) were evaluated using photogrammetric measurements and aesthetic assessments. From preoperatively to postoperatively, the columella length–to–alar width ratio on basal photographs increased (0.19 ± 0.05 versus 0.28 ± 0.05; p = 0.001). On lateral view, the columella-labial angle decreased from preoperatively to postoperatively [138 degrees (interquartile range, 132 to 144 degrees) versus 123 degrees (interquartile range, 122 to 139 degrees); p = 0.04]. Aesthetic ratings performed by four blinded observers also improved from preoperatively to postoperatively (1.6 ± 0.8 versus 2.4 ± 0.7; p = 0.004). As a comparison, bilateral cleft nose patients who did not undergo intermediate cleft tip rhinoplasty (n = 3) of similar ages were subjected to the same photogrammetric and aesthetic analyses, which showed no differences from preoperatively to postoperatively. In combination, the current work suggests that the component restoration technique in the bilateral intermediate cleft tip rhinoplasty improves nasal tip support and aesthetic outcomes.
A National Review of Insurance Coverage of Noncancerous Breast Reconstruction
Authors: Klein Marissa , Ha Michael , Yang Annie , Ngaage Ledibabari M. , Slezak Sheri , Rasko Yvonne
Published: August 2021

Background

Breast reconstruction is commonly performed for a multitude of noncancerous indications, such as correction of congenital deformities, acquired tissue disease, burns, and trauma. However, breast reconstruction for noncancerous indications is often considered cosmetic or not explicitly mentioned in insurance policies. The goal of this study was to assess variability in insurance coverage of breast reconstruction for noncancerous indications.

Methods

The authors conducted a cross-sectional analysis of 102 US insurance companies, including Medicare and Medicaid, for coverage of breast reconstruction for noncancerous indications (Poland syndrome, fibrocystic breast disease, burns and trauma). Insurance companies were selected based on their state enrollment data and market share. A Web-based search and individual telephone interviews were conducted to identify the policy. Medical necessity criteria were abstracted from publicly available policies.

Results

Half of the insurers (49%, n = 50) had no policy for Poland syndrome, 46% (n = 47) had no policy for burns and trauma, and 82% (n = 84) had no policy for fibrocystic breast disease. Fifty-two percent (n = 22) of policies providing coverage for Poland syndrome, 24% (n = 13) of policies providing coverage for burns and trauma, and 58% (n = 7) of policies providing coverage for fibrocystic breast disease had specific, stringent criteria for medical necessity. Thirty-six percent (n = 15) of policies covering Poland syndrome, 47% (n = 26) of policies covering burns and trauma, and 33% (n = 4) of policies covering fibrocystic breast disease include coverage of the contralateral breast.

Conclusions

There is a paucity of publicly available information on insurance coverage of breast reconstruction for noncancerous indications and a lack of consensus between top US insurance companies on what constitutes medical necessity for surgical correction.
Improving Metacarpophalangeal Joint Instability by Joint Implantation in Parallel From a Supernumerary Thumb in Severely Hypoplastic Duplicated Thumbs
Authors: Iwasawa Motonao , Mishima Yoshito , Nakajima Yuta , Tsunekawa Kazuhiro , Yuzuriha Shunsuke
Published: August 2021

Here, we present 2 cases of a severely hypoplastic duplicated thumb classified as Wassel types 5 and 6 and discuss whole-joint implantation from a supernumerary thumb as an alternative to stabilize the hypoplastic metacarpophalangeal (MCP) joint. The aim of the surgical treatment of thumb polydactyly is to reconstruct a functional and aesthetically pleasing thumb. Hypoplasia of joint components and abnormal tendon alignment lead to unpleasing results with angular deformity of the reconstructed thumb. In 2 cases, the MCP joint of the dominant digit was hypoplastic and unstable in all directions. The main problem was underdevelopment of the affected MCP joint, and it was reasonable to attempt to stabilize the unstable joint by adding another redundant joint in parallel. Whole-joint implantation with a flap on a vascular pedicle is useful to repair both joint instability and soft tissue hypoplasia, as in case 1. The vascularized joint can maintain balanced growth potential. However, nonvascularized interphalangeal (IP) joint implantation is a simple solution for repairing MCP joint instability, as in case 2. These joints have no tendon insertions, so we believe they are acting as a splint supporting the hypoplastic joint for a long period. The transfer of composite tissues from the foot has been reported for reconstruction of finger and thumb hypoplasia. Duplicated thumb operation is usually recommended at 1 year old. Similarly, nonvascularized joint implantation in parallel may be a promising choice to overcome MCP joint instability and to maintain range of motion in hypoplastic cases with a duplicated thumb.

In conclusion, joint implantation in parallel from a supernumerary thumb could prevent angular deformity and is an alternative to overcome MCP joint instability in cases of a severely hypoplastic duplicated thumb without any donor morbidity.
Isolated Medial Maxillary Buttress Displacement in Naso-Orbito-Ethmoid Fractures
Authors: Barkho Jouseph O. , Cooper Michael J. , McRae Mark H. , Choi Matthew
Published: August 2021

Purpose

The aim of this study was to present a case series emphasizing low medial maxillary (pyriform) buttress displacement in naso-orbito-ethmoid (NOE) fractures as an operative indication, in the absence of the typical NOE surgical indications (medial canthus displacement, midface bony comminution, nasal bone collapse, and orbital indications), to prevent nasal airway obstruction.

Methods

Five cases of minor NOE fractures are reviewed, where only the low medial maxillary buttress was displaced. The typical surgical indications for NOE repair were absent.

Results

In each case, the pyriform buttress was medially and posteriorly displaced, creating nasal airway obstruction in each patient. The medial canthal tendons were all nondisplaced, there was no diplopia, and the other 2 cardinal buttresses (infraorbital rim and nasofrontal junction) were minimally displaced or greensticked. In the acute setting, patients were treated with open reduction and internal fixation. With delayed presentation, septorhinoplasty or osteotomy and fixation were used. Among the patients who had adequate follow-up, nasal airway obstruction was resolved.

Conclusions

This series suggests that, in NOE fractures with isolated displacement at the medial maxillary buttress, nasal airway obstruction should be considered an operative indication (independent of the classical indications) in order to prevent or resolve nasal airway obstruction.
Artificial intelligence explainability: the technical and ethical dimensions
Authors: McDermid John A. , Jia Yan , Porter Zoe , Habli Ibrahim
Published: August 2021

In recent years, several new technical methods have been developed to make AI-models more transparent and interpretable. These techniques are often referred to collectively as ‘AI explainability’ or ‘XAI’ methods. This paper presents an overview of XAI methods, and links them to stakeholder purposes for seeking an explanation. Because the underlying stakeholder purposes are broadly ethical in nature, we see this analysis as a contribution towards bringing together the technical and ethical dimensions of XAI. We emphasize that use of XAI methods must be linked to explanations of human decisions made during the development life cycle. Situated within that wider accountability framework, our analysis may offer a helpful starting point for designers, safety engineers, service providers and regulators who need to make practical judgements about which XAI methods to employ or to require.

This article is part of the theme issue ‘Towards symbiotic autonomous systems’.
Towards the realization of dynamically adaptable manufacturing automation systems
Authors: Harrison Robert , Vera Daniel , Ahmad Bilal
Published: August 2021

The transition from traditional to truly smart dynamically adaptable manufacturing demands the adoption of a high degree of autonomy within automation systems, with resultant changes in the role of the human, in both the manufacturing and logistics functions within the factory. In the context of smart manufacturing, this paper describes research towards the realization of adaptable autonomous automation systems from both the control and information perspectives. Key facets of the approach taken at WMG are described in relation to human–machine interaction, autonomous approaches to assembly and intra-logistics, integration and dynamic system-wide optimization. The progression from simple distributed behavioural components towards autonomous functional entities is described. Effective systems integration and the importance of interoperability in the realization of more distributed and autonomous automation systems are discussed, so that operational information can propagate seamlessly, eliminating the traditional boundary between operational technology and information technology systems, and as an enabler for global knowledge collection, analysis and optimization.

This article is part of the theme issue ‘Towards symbiotic autonomous systems'.
Development of an industrial cyber-physical platform for small series production using digital twins
Authors: Yablochnikov Eugeny I. , Chukichev Artemiy V. , Timofeeva Olga S. , Abyshev Oman A. , Abaev Grigory E. , Colombo Armando W.
Published: August 2021

The article describes an industrial cyber-physical platform for small series production using digital twins under development at ITMO University (Saint Petersburg, Russia). The platform is based on the following approaches: group technology, adaptive and selective assembling, and digital twin of production systems and processes. The article presents a mechanism for constructing a unified manufacturing process, and results of an integrated multiscale simulation of an injection moulding process. The issues of ensuring identification and monitoring of objects of the industrial cyber-physical platform are considered. Specific service applications required to implement the smart product concept are discussed. The combination of the considered technologies is used to create digital twins of production system objects. All humans that have different roles in the product value stream can interact with the industrial cyber-physical platform at the three levels, receiving support in performing their tasks.

This article is part of the theme issue ‘Towards symbiotic autonomous systems’.
Adaptive neural network control for nonlinear cyber-physical systems subject to false data injection attacks with prescribed performance
Authors: Liu Zhijie , Tang Jinglei , Zhao Zhijia , Zhang Shuang
Published: August 2021

Cyber-physical systems (CPSs), as emerging products of industry

4.0

, play a key role in the development of intelligent manufacturing. This paper proposes an observer-based adaptive neural network (NN) control for nonlinear strict-feedback CPSs subject to false data injection attacks. Since there may be strict constraints on the state or output signals of nonlinear cyber-physical systems (NCPSs), we propose a time-varying asymmetric barrier Lyapunov function to realize the specific output constraints of NCPSs under cyber-attacks. Besides, since false data injection attacks will corrupt the transmitted state variables, an observer is designed to obtain observations of the exact states, and NN is used to approximate the unknown nonlinearity of NCPSs. With the proposed control strategy, the constraint control problem of NCPSs subject to false data injection attacks is settled. Finally, a numerical simulation example verifies the effectiveness of the proposed controller.

This article is part of the theme issue ‘Towards symbiotic autonomous systems’.
Co-carrying an object by robot in cooperation with humans using visual and force sensing
Authors: Yu Xinbo , Zhang Shuang , Liu Yu , Li Bin , Ma Yinsong , Min Gaochen
Published: August 2021

Human–robot collaboration poses many challenges where humans and robots work inside a shared workspace. Robots collaborating with humans indirectly bring difficulties for accomplishing co-carrying tasks. In our work, we focus on co-carrying an object by robots in cooperation with humans using visual and force sensing. A framework using visual and force sensing is proposed for human–robot co-carrying tasks, enabling robots to
actively
cooperate with humans and reduce human efforts. Visual sensing for perceiving human motion is involved in admittance-based force control, and a hybrid controller combining visual servoing with force feedback is proposed which generates refined robot motion. The proposed framework is validated by a co-carrying task in experiments. There exist two phases in experimental processes: in
Phase 1
, the human hand holds one side of the box object, and the robot gripper of the Baxter robot automatically approaches to the other side of the box object and finally holds it; in
Phase 2
, the human and the Baxter robot co-carry the box object over a distance to different target positions.

This article is part of the theme issue ‘Towards symbiotic autonomous systems’.
Legal aspects related to digital twin
Authors: Teller Marina
Published: August 2021

The creation of digital replicas of individuals, based on their data, gives birth to what experts in medical field called the ‘personal digital twin’. This new ‘digital self’ raises many difficulties, in sociology, in science and in law. This article presents the main issues from a legal point of view. Most of the structuring concepts of the law are questioned by these special symbiotic systems: the concept of person, identity, entitlement to rights and obligations, legal capacity, liability, data processing, etc. All these notions, which are rooted in the legal tradition, are correlated to the human person and must therefore be profoundly adapted to apply to the digital twin. It is a new experience: the law must devise concepts to take account of an entity that is halfway between people and things. We see this as an opportunity to rethink the legal framework and to consider the advent of future digital human rights. This questioning, barely sketched here, aims to make the law evolve towards a better consideration of symbiotic systems.

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