bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection rates of urogenital cancers and benign pathology in men presenting with hematospermia
Authors: Satchi Maria , Katelaris Athos , Smekal Martina , Alnajjar Hussain M. , Muneer Asif
Published: January 2022

Background:

Hematospermia, although often found to be a benign condition, can be an alarming sign. Consequently, patients can undergo multiple investigations with no current standardized pathway based on data from large series. The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with hematospermia.

Materials and methods:

A retrospective review of 393 consecutive men who underwent investigations for hematospermia was performed in a single tertiary center. Patient demographics, radiological and microbiological results were recorded together with symptoms of concomitant hematuria and clinical outcomes.

Results:

In this cohort, the overall prostate cancer detection rate was 5.3% and 7.2% in the ≥40 years group. One patient was diagnosed with testicular seminoma detected on scrotal ultrasound scan and one with G1pTa urothelial carcinoma of the bladder detected on flexible cystoscopy. In addition, 5.6% of patients were found to have a significant benign pathology for which intervention was proposed. A total of 288 patients underwent a transrectal ultrasound scan and 58.7% (n = 169) of these patients were found to have a positive finding. One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6% (n = 81) had a positive finding.

Conclusions:

Apart from transrectal ultrasound and multiparametric magnetic resonance imaging, the remaining investigations have a low diagnostic yield. Prostate cancer detection was 5.3%; 7.2% in the ≥40 years group, and two further patients were diagnosed with testicular and bladder malignancy. Based on our results, we propose an algorithm for the management of hematospermia to limit unnecessary investigations with the majority requiring reassurance.
Treatment of Horizontal Wrinkles of the Neck Using a Hyaluronic Acid Filler: Results From a Prospective Study
Authors: Renga Monica , Ryder Timothy J.
Published: January 2022

BACKGROUND

VYC-12 is a hyaluronic acid filler with low cohesivity.

OBJECTIVE

To evaluate the safety and effectiveness of VYC-12 for aesthetic improvement of horizontal neck lines.

METHODS

This was a prospective study of consecutive women undergoing neck treatment using VYC-12. All had a baseline score of 1 to 4 on the Allergan Transverse Neck Lines Scale (ATNLS). Individuals with an ATNLS score of 1 to 3 were treated with VYC-12 alone; those with a score of 4 received filler combined with high-intensity focused ultrasound (HIFU). Total VYC-12 volumes were ∼1 mL per patient. Follow-up lasted ≤30 months.

RESULTS

Fifty women were enrolled (mean age: 55.0 ± 5.7 years; n = 42 VYC-12 alone, n = 8 VYC-12 + HIFU). Forty-six patients (92%) achieved a ≥ 1-grade improvement on ATNLS 1 month post-treatment; the mean ATNLS score decreased from 2.64 ± 0.83 to 1.44 ± 0.81 (p < .0001). Rasch-transformed scores on the FACE-Q “Appraisal of the Neck” questionnaire improved from 31.0 ± 14.2 at baseline to 49.7 ± 14.4 at 1 month (p < .0001). Repeat injections at 9- to 12-month intervals led to progressive improvements. There were no treatment-related adverse events.

CONCLUSION

Treatment of the neck using VYC-12 was safe and effective in reducing the appearance of horizontal lines.
Hyaluronic Acid Filler Incidentally Found During Mohs Micrographic Surgery: Observations in 36 Patients Regarding Skin Depth, Degradation Size, and Estimated Persistence Time
Authors: Chow Kingsley V. , Urman Danielle S. , Cabral Erik S. , Shim Elisabeth K. , Bennett Richard G.
Published: January 2022

BACKGROUND

Although its clinical effect is reported to last up to 2 years, how long hyaluronic acid filler (HAF) histologically persists in the skin is unknown.

OBJECTIVE

To determine the approximate persistence time of HAF in the skin and to correlate persistence time with HAF histological appearance, size, depth, and location.

METHODS

Retrospective review of patient data and available frozen sections from 2003 to 2021 in which HAF was identified in 36 Mohs micrographic surgery patients.

RESULTS

Incidental HAF histologically persisted in the skin for as long as 10.75 years in 1 patient and 3 years or more in 36.8% (7/19) of the patients who remembered the time of implantation. HAF is more apparent in frozen sections stained with toluidine blue than those stained with hematoxylin and eosin. Although HAF volume tended to be less with time, fragmentation was present both early at 3 months and at 3 years or more. There was no correlation of persistence time with anatomic location or depth. In 90.3% of the cases (28/31), HAF was located in the subcutaneous fat. There was no granulomatous or giant cell response at any time period.

CONCLUSION

Hyaluronic acid filler may be seen histopathologically in the skin, usually in the subcutaneous fat, up to 10.75 years after implantation.
Clinical Implication of the Regional Thickness of the Lower Facial Skin, Superficial Fat, and Superficial Musculoaponeurotic System on High-Intensity Focused Ultrasound Treatment
Authors: Kwon Soon-Hyo , Ahn Gun Young , Lew Bark-Lynn , Shin Jung-Won , Na Jung-Im , Huh Chang-Hun
Published: January 2022

BACKGROUND

Knowledge of the topographic thickness of the skin and soft tissues is necessary when performing a high-intensity focused ultrasound (HIFU) procedure. Thermal tissue injury to the superficial musculoaponeurotic system (SMAS) or deeper can injure the facial nerve and its branches.

OBJECTIVE

To demonstrate the topographic thickness of the lower facial skin, superficial fat, and SMAS.

MATERIALS AND METHODS

The ultrasound data of 200 healthy patients who underwent lower facial rejuvenation were retrospectively reviewed.

RESULTS

The mean age was 41.1 ± 13.7 years (range, 19–76 years). The jowl had thinner skin, thicker superficial fat, and deeper superficial and deep margins of the SMAS than the preauricle or lower cheek. The thickness of the superficial fat decreased with age, especially on the preauricle, lower cheek, and jowl. Women had thicker superficial fat than men on the preauricle and lower cheek. The superficial and deep margins of the SMAS were located more superficially in old and male patients with a slim facial figure than in young and female patients with a chubby facial figure.

CONCLUSION

The present findings provide anatomical information regarding the superficial fat and SMAS, which is useful in determining the focal penetration depth of HIFU treatment for lower face rejuvenation.
Computerized Analysis of Antepartum Cardiotocography: A Review
Authors: Jones Gabriel Davis , Cooke William R. , Vatish Manu , Redman Christopher W.G.
Published: February 2022

Cardiotocography measures the human fetal heart rate and uterine activity using ultrasound. While it has been a mainstay in antepartum care since the 1960s, cardiotocograms consist of complex signals that have proven difficult for clinicians to interpret accurately and as such clinical inference is often difficult and unreliable. Previous attempts at codifying approaches to analyzing the features within these signals have failed to demonstrate reliability or gain sufficient traction. Since the early 1990s, the Dawes-Redman system of automated computer analysis of cardiotocography signals has enabled robust analysis of cardiotocographic signal features, employing empirically-derived criteria for assessing fetal wellbeing in the antepartum. Over the past 30 years, the Dawes-Redman system has been iteratively updated, now incorporating analyses from over 100,000 pregnancies. In this review, we examine the history of cardiotocography, signal processing methodologies and feature identification, the development of the Dawes-Redman system, and its clinical applications.
Everolimus Concentration in Saliva to Predict Stomatitis: A Feasibility Study in Patients with Cancer
Authors: Molenaar-Kuijsten Laura , Verheijen Remy B. , Jacobs Bart A. W. , Thijssen Bas , Rosing Hilde , Dorlo Thomas P. C. , Beijnen Jos H. , Steeghs Neeltje , Huitema Alwin D. R.
Published: January 2022

Background:

Most patients with cancer treated with everolimus experience stomatitis, which seriously affects the quality of life. The salivary concentrations of everolimus may predict the incidence and severity of stomatitis. The authors aimed to examine whether it was feasible to quantify the everolimus concentration in saliva and subsequently use it to predict stomatitis.

Methods:

Saliva and whole blood samples were taken from patients with cancer, who were treated with everolimus in the dosage of either 10 mg once a day or 5 mg twice a day. Everolimus concentrations in saliva samples were measured by liquid chromatography–tandem mass spectrometry. A published population pharmacokinetic model was extended with the everolimus concentration in saliva to assess any association between everolimus in the blood and saliva. Subsequently, the association between the occurrence of stomatitis and the everolimus concentration in saliva was studied.

Results:

Eleven patients were included in this study; saliva samples were available from 10 patients, including 3 patients with low-grade stomatitis. Everolimus concentrations were more than 100-fold lower in saliva than in whole blood (accumulation ratio 0.00801 and relative standard error 32.5%). Interindividual variability (67.7%) and residual unexplained variability (84.0%) were high. The salivary concentration of everolimus tended to be higher in patients with stomatitis, 1 hour postdose (P = 0.14).

Conclusions:

Quantification of the everolimus concentration in saliva was feasible and revealed a nonsignificant correlation between everolimus concentration in the saliva and the occurrence of stomatitis. If future research proves this relationship to be significant, the everolimus concentration in the saliva may be used as an early predictor of stomatitis without invasive sampling. Thereby, in patients with high salivary everolimus concentrations, precautions can be taken to decrease the incidence and severity of stomatitis.
Development and Validation of a Liquid Chromatography–Tandem Mass Spectrometry (LC-MS/MS) Assay for the Determination of Total and Unbound Ciprofloxacin Concentrations in Human Plasma
Authors: de Vroom Suzanne L. , Pistorius Marcel C. M. , Bijleveld Yuma A. , Geerlings Suzanne E. , Mathôt Ron A. A. , van Hest Reinier M. , Jager Nynke G. L.
Published: January 2022

Background:

Although unbound ciprofloxacin is responsible for antibacterial effects, assays measuring the unbound drug plasma concentrations are scarce. This study aimed to develop and validate a rapid, reproducible, and sensitive liquid chromatography–tandem mass spectrometry assay for the determination of total and unbound ciprofloxacin plasma concentrations.

Methods:

The determination of total ciprofloxacin concentrations required a 10 μL sample, while for unbound ciprofloxacin concentrations, it was 100 μL. Unbound ciprofloxacin was separated from protein-bound ciprofloxacin through ultrafiltration. A deuterated internal standard was used, and the sample preparation involved protein precipitation. The method was fully validated over a concentration range of 0.02–5.0 mg/L, according to the US Food and Drug Administration guidelines. In addition, its clinical application was demonstrated.

Results:

The total run time was 1.5 minutes. For total ciprofloxacin plasma concentrations, the mean accuracy ranged from 94.5% to 105.0% across the validated range, the intraday imprecision was ≤7.6%, and the interday imprecision was ≤9.8%. For unbound ciprofloxacin plasma concentrations, the mean accuracy ranged from 92.8% to 102.1% across the validated range, the intraday imprecision was ≤7.0%, and the interday imprecision was ≤9.6%. Ciprofloxacin in plasma and ultrafiltrate remained stable for at least 96 hours at room temperature, at least 4 years at −80°C, and at least 3 freeze/thaw cycles (−80°C), with a minimum interval of 24 hours.

Conclusions:

The presented method is precise and accurate. It has been implemented in clinical care and research projects at a university hospital, permitting rapid determination of total and unbound ciprofloxacin.
The Dorsal Scapular Artery Perforator Flap: A Complete Muscle-sparing Technique
Authors: Marr Kirsten L. , Varga Aaron , Dumestre Danielle O.
Published: February 2022

Cervical and thoracic spine reconstruction can be a difficult area to provide stable soft tissue coverage. Historically, trapezius myocutaneous flaps and trapezius muscle turnover flaps have proven to be reliable and versatile methods for the reconstruction of these areas. However, sequelae such as restriction of shoulder movement have been reported, as well as unsightly “humpback” contour deformities from turnover flap bulk. The use of the trapezius muscle for coverage has evolved to include descriptions of a trapezius perforator flap to address some of the issues of donor site morbidity, as it is described as a muscle-sparing technique. Although described as “muscle-sparing,” these approaches nonetheless involve sacrifice of trapezius muscle overlying the pedicle as that musculature is “deroofed” and divided off the pedicle during dissection. In this article, we present a detailed technical description of our novel technique to the trapezius perforator flap using a dorsal scapular artery flap for spinal reconstruction that is truly, completely muscle-sparing. This technique may prove useful for those patients in which even minimal disruption of trapezius muscle fibers is undesirable.
Public Awareness of Breast Implant-associated Anaplastic Large Cell Lymphoma in Saudi Arabia
Authors: Mrad Mohamed Amir , Alharthi Sawsan A. , Alyousef Loujain A. , Kattan Abdullah E. , Shah Mardan Qutaiba N.M.
Published: February 2022

Background:

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was first reported in 1997. Since then, the number of reported cases has been increasing, and patients’ knowledge and perceptions about this condition are unclear. This study aimed to evaluate the public knowledge and perceptions toward BIA-ALCL and its association with cosmetic/reconstructive breast implants in Saudi Arabia.

Methods:

In this cross-sectional, online survey–based study, women aged 18–60 years in Saudi Arabia were the target population on social media platforms. Questions included data on demographics, experience of implants, and knowledge and concerns regarding BIA-ALCL.

Results:

A total of 543 women participated in this study, with a mean age of 34 years. Only 1.9% had breast implants due to cosmetic or reconstructive reasons, whereas 9.8% expressed their desire of having implants in the future. More than half (57.3%) of the respondents had never heard of BIA-ALCL in comparison with 21.7% who had an established background. After reading the highlights on BIA-ALCL, 60% of the women with breast implants still wanted to keep their implants and 42.5% of the ones who desired breast implants would still aim to have them. Almost all the sample stated that BIA-ALCL should be included in the written consent.

Conclusions:

Nearly half of Saudi women have not heard of BIA-ALCL, and report that it is an important part of the surgical consultation and informed consent. Our role as plastic surgeons is to raise the awareness of BIA-ALCL through social media and health care settings to maximize the safety of women with breast implants.
Performance of Targeted Congenital Cytomegalovirus Screening in Newborns Failing Universal Hearing Screening: A Multicenter Study
Authors: Fourgeaud Jacques , Boithias Claire , Walter-Nicolet Elisabeth , Kermorvant Elsa , Couderc Sophie , Parat Sophie , Pol Christine , Mousset Carole , Bussières Laurence , Guilleminot Tiffany , Ville Yves , Nkam Lionelle , Grimaldi Lamiae , Parodi Marine , Leruez-Ville Marianne
Published: January 2022

Background:

Cytomegalovirus (CMV) is the most frequent cause of congenital infection and ≈20% of all infected neonates present or will develop sensorineural hearing loss. Targeted congenital CMV (cCMV) screening in newborns who failed universal newborn hearing screening has been proposed as a strategy to identify neonates with both hearing loss and cCMV infection who could benefit from antiviral treatment implemented within the first month of life.

Objectives:

To evaluate the feasibility and performance of cCMV targeted screening in a French setting.

Methods:

Neonates were recruited in 5 maternity centers in greater Paris. A saliva sample for CMV polymerase chain reaction (PCR) testing was collected in neonates who failed newborn hearing screening. Outcomes including CMV PCR result and confirmation of hearing loss by an otorhinolaryngologist specialist were documented.

Results:

Two-hundred thirty-six newborns were included and a saliva sample was collected in 98% (231/236) of them. The result of CMV PCR was available at a median of 9 days (7–10 days) of life and in 96% of cases within the first month of life. Two neonates were infected with CMV. The result of the otorhinolaryngologist assessment was available in 75% (178/236) of cases at a median of 16 days (9–26 days). Hearing loss was confirmed in 2.8% (5/178). The 2 infected neonates had hearing loss confirmed at 5 and 8 days of life and were treated with valganciclovir at days 9 and 16, respectively.

Conclusions:

The result of this study confirms that targeted cCMV screening is feasible in these French settings.
An Immunohistochemical Study of Epidermal Growth Factor Receptor in Sebaceous Carcinoma of the Eyelid: A Potential Therapeutic Target
Authors: Zhang Ping , Tang Lijuan , Gao Huanhuan , Xu Hua , Zhang Wenxin , Lin Jianxian , Chen Shuxia
Published: January 2022

Purpose:

To investigate the relationship between epidermal growth factor receptor (EGFR) expression and clinicopathological characteristics in sebaceous carcinoma (SbC) of the eyelid.

Methods:

Clinical records and microscopic slides of 102 cases of SbC in the eyelid were reviewed. An immunohistochemical antibody for EGFR was employed. Differentiation, pagetoid spread, and mitosis were evaluated.

Results:

Of the 102 patients, 46 (45.1%) cases were male and 56 (54.9%) cases were female (male:female, 1:1.2). The mean age of the patients was 57.32 ± 13.23 years (range, 26–85 years). Fifty-two (51%) cases occurred in the right eye and 50 (49%) cases in the left eye. The stage T1 and stage T2 cases were 71 (69.6%) and 31 (30.4%), respectively. There were 69 (67.6%) cases with pagetoid spread and 33 (32.4%) cases without pagetoid spread. There were 15 (14.7%) well-differentiated cases, 33 (32.4%) moderately differentiated cases, and 54 (52.9%) poorly differentiated cases. There was 1 (1%) case of 0 to 1/ high power field (HPF) mitosis, 46 (45.1%) cases of 2 to 5/HPF mitoses, and 55 (53.9%) cases of >5/HPF mitoses, respectively. The EGFR positivity of SbCs was 97.1% (99 cases) with 2% (2 cases) weak expression, 46.1% (47 cases) moderate expression, and 49% (50 cases) strong expression. While EGFR was weakly positive only in a few conjunctival epithelial cells and basal cells of the sebaceous glands. The EGFR expression of SbCs was related to the clinic T category statistically (P = 0.048) but not related to age, gender, differentiation, nuclear mitosis, and pagetoid spread of these tumors statistically (P > 0.05). And the differentiation of these SbCs was related to the mitosis of these tumors statistically (P < 0.001).

Conclusions:

The EGFR expression of SbCs was related to the tumor stage statistically, which implied that EGFR might be used as a prognostic marker of SbCs. EGFR is expressed in most SbC cases, which implied that it might act in the tumorigenesis mechanisms of SbC and could be a therapeutic target in the treatment of SbC for some metastatic cases.
Unsafe and Unsettling
Authors: Keller Elizabeth , Boch Samantha , Hittle Beverly M.
Published: January 2022

Background

Stress remains a major occupational hazard among nurses. As the United States maintains the largest correctional system in the world, little is understood regarding the occupational stress of correctional nurses and how that stress impacts their overall health and well-being.

Question Addressed

What are the occupational/environmental stressors and professional burnout factors experienced by correctional nurses?

Review Methods

Guided by Whittemore and Knafl's methodology, an integrative review was conducted using online databases of Scopus, CINAHL, NIOSH-tic, and PubMed in July of 2021 for peer-reviewed articles ever published internationally. Key concepts of “correctional health nursing” and “occupational stress” were used in our search.

Review Results

One hundred fifty-two articles were identified. Eleven articles met eligibility criteria and were included in this review. Three key themes emerged: conflict, fear, and demands.

Discussion

Conflict arose from ethical and relational issues among coworkers, management, and incarcerated patients. Fear stemmed from physical safety concerns and workplace violence, whereas demands involved high workloads paired with a lack of organizational support. Findings revealed evidence on the unique occupational environment of correctional nursing professionals that impacted levels of stress and burnout across all types of correctional settings (e.g., jails and prisons).

Implications

Better assessment and consistent evaluation of the health and well-being of correctional nurses and their correctional nursing environments are needed. Additional resources to reduce stress, along with ensuring policies that mitigate ethical challenges, workplace violence, and bullying, may promote professional and safe workspaces.
Higher Sexually Transmissible Infection Test Yield Among Men Who Have Sex With Men Attending a Community-Based Testing Site Compared With a Clinical Service In Sydney, Australia
Authors: Rees Heulwen , Callander Denton , Goddard Sian Louise , Griggs Elizabeth , Prott Gary , Clifton Brent , Templeton David James
Published: January 2022

From January 2014 to December 2015, the overall yield of sexually transmitted infections testing among asymptomatic MSM was two-fold higher at a community-based versus clinic-based service. Compared with the clinic-based service, yield of chlamydia (9.0% vs 4.9%; P = 0.010), gonorrhea (6.5% vs 3.1%; P < 0.001), and infectious syphilis (0.9% vs 0.1%; P = 0.024) were all higher at the community-based service.
Retrospective Cohort Study of the Incidence and Outcomes of Jarisch-Herxheimer Reactions After Treatment of Infectious Syphilis in Late Pregnancy
Authors: Macumber Stephen , Singh Ameeta E. , Gratrix Jennifer , Robinson Joan L. , Smyczek Petra , Rathjen Lindsay , Sklar Cameron
Published: January 2022

Of 39 pregnant women at ≥20 weeks' gestation treated with benzathine penicillin G for infectious syphilis, we identified only 2 mild Jarisch-Herxheimer reactions. There were no immediate fetal sequelae. Data from our study do not support the recommendation for routine admission for the treatment of infectious syphilis in late pregnancy.
Feasibility, Acceptability, and Potential Cost-Effectiveness of a Novel Mobile Phone Intervention to Promote Human Immunodeficiency Virus Testing Within Social Networks in Tanzania
Authors: Ostermann Jan , Njau Bernard , Masaki Martha , Mtuy Tara , Itemba Dafrosa , Hobbie Amy , Yelverton Valerie , Moore Spencer , Yamanis Thespina , Thielman Nathan M.
Published: January 2022

Among 145 individuals surveyed in Tanzania, 42% indicated willingness to test for human immunodeficiency virus in response to a confidential, phone-based text message. On average, participants were likely to provide contact information for 1.5 members of their social networks, suggesting high feasibility and moderate acceptability of a novel mHealth human immunodeficiency virus testing intervention.
Uterine Leiomyosarcoma Associated With Leiomyoma With Bizarre Nuclei: Histology and Genomic Analysis of 2 Cases
Authors: Fischer Jean V. , Mejia-Bautista Melissa , Vadasz Brian , Yin Ping , Bulun Serdar , Tanner Edward J. , Lu Xinyan , Wei Jian-Jun
Published: January 2022

Leiomyoma with bizarre nuclei (LM-BN) is a rare variant of leiomyoma with overall benign clinical course. It has histologic features showing focal or diffuse nuclear atypia surrounded by usual type leiomyoma. Uterine leiomyosarcomas (LMS) are a group of rare and aggressive malignancies with limited treatment options available. The potential association between LM-BN with LMS is largely unknown. In this study, we report 2 cases of uterine smooth muscle tumor with typical histologic and molecular evidence of LM-BN, which are associated with its progression to the malignant counterpart of LMS. We summarize the detailed histologic, morphologic, and genomic characteristics of these 2 sets of cases. Our findings suggest that LMS progressing from preexisting LM-BN can be one of the tumor pathogenesis pathways in uterine leiomyosarcomas.
Training Effectiveness and Impact on Safety, Treatment Quality, and Communication in Prehospital Emergency Care: The Prospective Longitudinal Mixed-Methods EPPTC Trial
Authors: Häske David , Beckers Stefan K. , Dieroff Marc , Gliwitzky Bernhard , Hofmann Marzellus , Lefering Rolf , Münzberg Matthias
Published: January 2022

Background

Emergency training is designed to improve medical care teams’ knowledge, practical skills, and treatment procedures in patient care to increase patient safety. This requires effective training, but the multifactorial effects of training are difficult to measure.

Methods

We assessed the impact of emergency team training on treatment procedures and quality, processes, technical skills, and nontechnical skills in simulated trauma emergencies in a longitudinal analysis, using videos that were recorded before (t
0), immediately after (t
1), and 1 year after the training (t
2). The training was evaluated with the validated PERFECT checklist, which includes 7 scales: primary assessment, secondary assessment, procedures, technical skills, trauma communication, nontechnical skills, and a global performance scale.

The primary end point was the change from before a training intervention (t
0) to 1 year after training (t
2), measured by a metric point score. The second end point was the impact of the intervention from before training to after and from immediately after training to 1 year later.

Results

A total of 146 trainings were evaluated. In simulated traumatological emergencies, training participants showed significantly better treatment capacity after 1 year (t
0: 28.8 ± 5.6 points versus t
2: 59.6 ± 6.6 points, P < 0.001), with greater improvement from t
0 to t
1 (28.8 ± 5.6 points versus 65.1 ± 7.9 points, P < 0.001). The most significant change from t
0 to t
2 was seen in the primary assessment, with a mean change of 11.1 ± 5.1, followed by the scale of the procedure (6.1 ± 3.0) and nontechnical skills (6.0 ± 3.0).

Conclusions

Team trainings with intensive scenario training and short theoretical inputs lead to a significant improvement in simulated care of severely injured patients, especially in identifying and intervening in life-threatening symptoms, processes, and nontechnical skills, even 1 year after the course. Positive, longitudinally positive effects were also in communication and subjective safety of prehospital health care personnel.
Assessing Impact: Implementing an Opioid Prescription Protocol in Otolaryngology
Authors: Thal Arielle G. , Ahmed Sadia , Kim Stanley , Yang Christina J. , Gao Qi , Gangar Mona , Mehta Vikas
Published: January 2022

Objective

A lack of guidance for pain control after otolaryngology surgery can lead to overprescription of opioids. We implemented a postoperative site-specific opioid prescription protocol and analyzed the impact on opioid prescriptions.

Methods

This is a retrospective cohort study. A postoperative opioid prescription protocol was implemented within our otolaryngology department at a tertiary academic medical center on January 1, 2020. Retrospective chart review was completed for all patients undergoing otolaryngology surgery from November 1, 2019, to February 29, 2020 (2 months before and after initiation of intervention; n = 1070). The primary outcome was change in the amount of opioid prescribed for the preintervention and postintervention cohorts. Unplanned contact related to pain and opioid refills were tracked to assess pain control.

Results

A total of 940 cases were included; adult and pediatric data were analyzed separately. There were 489 pediatric cases, 250 preintervention and 239 postintervention. There was a significant decrease in the amount of opioid prescribed per pediatric patient in the postintervention cohort (2.7 versus 0.32 morphine milligram equivalents, P = 0.02), and 99% of patients were not prescribed opioids at all. There was no significant change in unplanned contact, and no refills were required. There were 451 adult cases, 200 preintervention and 251 postintervention. There was no statistically significant decrease in the amount of opioid prescribed per adult patient (56.8 versus 51.7 morphine milligram equivalents, P = 0.23). There was no significant increase in unplanned contact or refills.

Conclusions

A postoperative opioid prescribing protocol can reduce the amount of opioid prescribed without increasing unplanned contact or opioid refills.
A Deep Learning Approach to Predicting Disease Progression in Multiple Sclerosis Using Magnetic Resonance Imaging
Authors: Storelli Loredana , Azzimonti Matteo , Gueye Mor , Vizzino Carmen , Preziosa Paolo , Tedeschi Gioachino , De Stefano Nicola , Pantano Patrizia , Filippi Massimo , Rocca Maria A.
Published: January 2022

Objectives

Magnetic resonance imaging (MRI) is an important tool for diagnosis and monitoring of disease course in multiple sclerosis (MS). However, its prognostic value for predicting disease worsening is still being debated. The aim of this study was to propose a deep learning algorithm to predict disease worsening at 2 years of follow-up on a multicenter cohort of MS patients collected from the Italian Neuroimaging Network Initiative using baseline MRI, and compare it with 2 expert physicians.

Materials and Methods

For 373 MS patients, baseline T2-weighted and T1-weighted brain MRI scans, as well as baseline and 2-year clinical and cognitive assessments, were collected from the Italian Neuroimaging Network Initiative repository. A deep learning architecture based on convolutional neural networks was implemented to predict: (1) clinical worsening (Expanded Disability Status Scale [EDSS]–based model), (2) cognitive deterioration (Symbol Digit Modalities Test [SDMT]–based model), or (3) both (EDSS + SDMT–based model). The method was tested on an independent data set and compared with the performance of 2 expert physicians.

Results

For the test set, the convolutional neural network model showed high predictive accuracy for clinical (83.3%) and cognitive (67.7%) worsening, although the highest accuracy was reached when training the algorithm using both EDSS and SDMT information (85.7%). Artificial intelligence classification performance exceeded that of 2 expert physicians (70% of accuracy for the human raters).

Conclusions

We developed a robust and accurate model for predicting clinical and cognitive worsening of MS patients after 2 years, based on conventional T2-weighted and T1-weighted brain MRI scans obtained at baseline. This algorithm may be valuable for supporting physicians in their clinical practice for the earlier identification of MS patients at risk of disease worsening.
An Ethical Framework for Conducting Active-Shooter Simulation in the Healthcare Environment
Authors: Ketterer Andrew R. , Austin Andrea L.
Published: January 2022

Summary Statement

Active shooter events, although rare, are increasing in frequency in the United States, and healthcare settings are not immune to such events. Of the 277 active shooter events that took place in the United States between 2000 and 2019, 15 (4.5%) took place in healthcare facilities. Healthcare workers (HCWs) must be (1) well trained to respond to an active shooter event and (2) trained to respond to active shooter casualties. Educational activities related to active shooter events require a clear focus on goals and objectives, balanced to assure the physical and psychological safety of all participants. This article outlines how the recommendations of the National Association of School Psychologists might be adapted to conduct active shooter drills in the healthcare setting. This approach provides a framework for managing some of the ethical considerations in active shooter simulations.
Assessing Usability of Untethered Head-Mounted Displays for Medical Education
Authors: Bailey Shannon K. T. , Lewis Joanna E. , Ciccone Brendan A. , Friedland Richard L. , Reiner Colleen C.
Published: January 2022

Introduction

Recent meta-analyses have found immersive technology to be effective for training, yet there is limited research on user experience with head-mounted displays (HMDs) in the medical domain. If emerging immersive displays do not meet usability standards in the context of healthcare simulation, the technology may cause frustration or hinder learning outcomes. This is the first experimental comparison of usability in commercial untethered, “all-in-one” HMDs for healthcare simulation.

Methods

The usability and comfort of three commercial untethered HMDs (Oculus Go, Oculus Quest, and Lenovo Mirage Solo) were tested using a randomized within-person design such that each headset was evaluated by all participants in a random sequence. During the experiment, participants (n = 9) interacted with a simulated healthcare environment in each headset and then responded to usability and comfort surveys.

Results

All of the HMDs were rated as having higher than average usability compared with an industry benchmark scale, the System Usability Scale. Only one of the headsets had a usability rating in the highest range, which was significantly higher than the lowest rated headset (P = 0.047, Cohen d = 0.901). In addition, feelings of discomfort with the headsets were low, and comfort ratings did not differ significantly between headsets (P > 0.05).

Conclusions

Untethered HMDs had acceptable user experience ratings during a healthcare simulation task, but some headsets were rated higher on usability. Because usability is important for learner engagement and training outcomes, educators should confirm that immersive displays meet usability standards before implementation.
Tardive Seizures After Electroconvulsive Therapy
Authors: Warren Nicola , Eyre-Watt Brenton , Pearson Ella , O'Gorman Cullen , Watson Emily , Lie David , Siskind Dan
Published: January 2022

Objectives

Seizures that occur spontaneously after termination of an electroconvulsive therapy (ECT) seizure are termed tardive seizures. They are thought to be a rare complication of ECT, influenced by risk factors that affect seizure threshold. However, there has been limited review of tardive seizures with modified ECT. We aimed to review the literature to provide clinical guidance for the use of ECT after tardive seizures.

Methods

PubMed, EMBASE, PsycInfo, and CINAHL databases were searched from inception to May 2021 to identify cases of modified ECT, with evidence of a seizure occurring within 7 days of a terminated ECT seizure. Data for demographic, medical, pharmacological, anesthetic, and ECT variables as well as management strategies were collected.

Results

There have been 39 episodes of modified ECT-related tardive seizures published over a period of 40 years. In 97.4% of cases, there was at least 1 identified potential risk factor for seizures, including use of a seizure-lowering medication and/or preexisting neurological injury. Major complications were uncommon (<15% of cases); however, 1 fetal death and 1 subsequent suicide were reported. No case was diagnosed with epilepsy, although around 20% continued on antiepileptic medications. More than half of the included patients were retrialed on ECT, with only 15% developing further tardive seizures.

Conclusions

Seizures that occurred spontaneously after the termination of an ECT seizure are a rare complication of modified ECT. Recommencing ECT after a tardive seizure may occur after review of modifiable seizure risk factors and with consideration of antiepileptic medication and extended post-ECT monitoring.
Historical Highlights on Electroconvulsive Therapy Practice in Iraq
Authors: Younis Maha Sulaiman , Arafat S.M. Yasir
Published: January 2022

Electroconvulsive therapy (ECT) is an established treatment option for severe psychiatric disorders. Electroconvulsive therapy practice began in Iraq in 1946, primarily to treat patients with schizophrenia. Since then, it has developed and expanded to treat mood disorders and major depression. Initially, both modified and unmodified ECT was administered to patients in Ibn Rushd and Al Rashad mental hospitals in Baghdad. The ongoing political turmoil from 3 wars, economic sanctions, and internal conflicts halted the development of mental health services across the country; ECT provision was not an exception. The practice of unmodified ECT—without general anesthesia—ceased in 2009, after the recommendations of the Royal College of Psychiatrists' Iraq Subcommittee. This closure reduced the availability and accessibility of ECT clinics nationwide because of limited access to general anesthesia. This article explores the nature of ECT services, in the context of Iraq's health care system, sociocultural norms, instability, and international codes of practice. This brief report uses the first author's work experience, few available data, and personal communication to describe the brief history of ECT practice in Iraq. This report is a baseline document for future ECT practice regulation in Iraq.
Virucidal activity and mechanism of action of cetylpyridinium chloride against SARS-CoV-2
Authors: Okamoto Nako , Saito Akatsuki , Okabayashi Tamaki , Komine Akihiko
Published: February 2022

Objective

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen causing the coronavirus disease 2019 (COVID-19) global pandemic. Recent studies have shown the importance of the throat and salivary glands as sites of virus replication and transmission. The viral host receptor, angiotensin-converting enzyme 2 (ACE2), is broadly enriched in epithelial cells of the salivary glands and oral mucosae. Oral care products containing cetylpyridinium chloride (CPC) as a bactericidal ingredient are known to exhibit antiviral activity against SARS-CoV-2 in vitro. However, the exact mechanism of action remains unknown.

Methods

This study examined the antiviral activity of CPC against SARS-CoV-2 and its inhibitory effect on the interaction between the viral spike (S) protein and ACE2 using an enzyme-linked immunosorbent assay.

Results

CPC (0.05%, 0.1% and 0.3%) effectively inactivated SARS-CoV-2 within the contact times (20 and 60 s) in directions for use of oral care products in vitro. The binding ability of both the S protein and ACE2 were reduced by CPC.

Conclusions

Our results suggest that CPC inhibits the interaction between S protein and ACE2, and thus, reduces infectivity of SARS-CoV-2 and suppresses viral adsorption.
Modelling non-local neural information processing in the brain
Authors: Balkenhol Johannes , Händel Barbara , Prada Juan , Bosman Conrado A. , Ehrenreich Hannelore , Grohmann Johannes , Kistowski Jóakim v. , Wojcik Sonja M. , Kounev Samuel , Blum Robert , Dandekar Thomas
Published: January 2022

The representation of the surrounding world emerges through integration of sensory information and actions. We present a novel neural model which implements non-local, parallel information processing on a neocolumnar architecture with lateral interconnections. Information is integrated into a holographic wave interference pattern. We compare the simulated in silico pattern with observed in vivo invasive and non-invasive electrophysiological data in human and non-human primates. Our model replicates the modulation of neural high-frequency activity during visual perception showing that phase-locked low and high-frequency oscillations self-organize efficiently and carry high information content. The simulation further models how criticality (high content) of information processing emerges given a sufficiently high number of correlated neurons. Non-local information processing, forming one holographic wave pattern, suggests a platform for emergence of conscious perception.

One sentence summary

Simulated non-local information processing on a neocolumnar architecture models well multiple electrophysiological observations of brain activity, including high-frequency activity during visual perception in primates.
PPRD: a comprehensive online database for expression analysis of ~45,000 plant public RNA-Seq libraries
Authors: Yu Yiming , Zhang Hong , Long Yanping , Shu Yi , Zhai Jixian
Published: February 2022

High-throughput RNA-sequencing (RNA-seq) has become the most popular technology for profiling gene expression in the last decade due to its low cost and high coverage. As a result, the number of RNA-seq libraries from the plant community has been increasing exponentially in recent years. For major crops, such as maize, rice, soybean, wheat, and cotton, the plant community has collected a total of ~45,000 libraries by 2021. To take full advantage of the bigdata of RNA-seq libraries, an effort to integrate all publicly available libraries via a uniformed processing pipeline and curate them into an easy-to-use searchable database is urgently needed. To address this challenge, here we present a comprehensive web-based platform, Plant Public RNA-seq Database (PPRD, http://ipf.sustech.edu.cn/pub/plantrna/). PPRD consists of a large number of RNA-seq libraries of maize (11,726), rice (19,664), soybean (4,085), wheat (5,816), and cotton (3,483) from Gene Expression Omnibus (GEO), Sequence Read Archive (SRA), European Nucleotide Archive (ENA), and DNA Data Bank of Japan (DDBJ) databases.
Feedback in the β-catenin destruction complex imparts bistability and cellular memory
Authors: Cantoria Mary Jo , Alizadeh Elaheh , Ravi Janani , Bunnag Nawat , Kettenbach Arminja N. , Ahmed Yashi , Paek Andrew L , Tyson John J. , Doubrovinski Konstantin , Lee Ethan , Thorne Curtis A.
Published: January 2022

Wnt ligands are considered classical morphogens, for which the strength of the cellular response is proportional to the concentration of the ligand. Herein, we show an emergent property of bistability arising from feedback among the Wnt destruction complex proteins that target the key transcriptional co-activator β-catenin for degradation. Using biochemical reconstitution, we identified positive feedback between the scaffold protein Axin and the kinase GSK3. Theoretical modeling of this feedback between Axin and GSK3 predicted that the activity of the destruction complex exhibits bistable behavior. We experimentally confirmed these predictions by demonstrating that cellular cytoplasmic β-catenin concentrations exhibit an “all-or-none” response with sustained memory (hysteresis) of the signaling input. This bistable behavior was transformed into a graded response and memory was lost through inhibition of GSK3. These findings provide a mechanism for establishing decisive, switch-like cellular response and memory upon Wnt pathway stimulation.

One Sentence Summary

Positive feedback within the β-catenin destruction complex gives rise to bistability and memory in response to Wnt stimulation, imparting signal transduction accuracy and insulation.
Modular and programmable RNA sensing using ADAR editing in living cells
Authors: Kaseniit K. Eerik , Katz Noa , Kolber Natalie S. , Call Connor C. , Wengier Diego L. , Cody Will B. , Sattely Elizabeth S. , Gao Xiaojing J.
Published: January 2022

With the increasing availability of single-cell transcriptomes, RNA signatures offer a promising basis for targeting living cells. Molecular RNA sensors would enable the study of and therapeutic interventions for specific cell types/stats in diverse contexts, particularly in human patients and non-model organisms. Here we describe a modular and programmable design for live RNA sensing using adenosine deaminases acting on RNA (RADAR). We validated and then expanded our basic design, characterized its performance, and thoroughly analyzed its compatibility with the human/mouse transcriptomes. We also identified strategies to further boost output levels and improve the dynamic range. We show that RADAR is programmable and modular, and uniquely enables compact AND logic. In addition to being quantitative, RADAR can distinguish disease-relevant point mutations. Finally, we demonstrate that RADAR is a self-contained system with the potential to function in diverse organisms.
GABABR agonist baclofen promotes central nervous system remyelination
Authors: Serrano-Regal Mari Paz , Bayón-Cordero Laura , Chara Juan Carlos , Tepavcevic Vanja , Ochoa-Bueno Blanca I. , Matute Carlos , Sánchez-Gómez María Victoria
Published: January 2022

Promoting remyelination - the endogenous response by which lost myelin sheaths are regenerated - is considered as a potential neuroprotective strategy to prevent/limit the development of permanent neurological disability in patients with multiple sclerosis (MS). To this end, a number of clinical trials are investigating the potential of existing drugs to enhance oligodendrocyte progenitor cell (OPC) differentiation, the process that fails in chronic MS lesions. As we previously reported that oligodendroglia lineage cells express GABABreceptors (GABABRs) bothin vitroandin vivo, and that GABABR-mediated signaling enhances OPC differentiation and myelination invitro, here we focused on the remyelinating potential of the best-known GABABR agonist baclofen (Bac), already approved to treat spasticity in MS. We demonstrated that Bac increases myelin protein production following lysolecithin (LPC)-induced demyelination in cerebellarex vivoslices. In addition, Bac administration enhanced OPC differentiation and remyelination in LPC-induced spinal cord lesions in adult mice. Thus, our results suggest that Bac should be considered as a potential therapeutic agent, not only to treat spasticity, but also to improve remyelination in patients with MS.
Transcriptome Analysis of the Nematode Caenorhabditis elegans and Litoditis marina in a Chemically Defined Food Environment
Authors: Sun Peiqi , Cao Xuwen , Zhang Liusuo
Published: January 2022

Diets regulate animal development, reproduction, and lifespan. However, the underlying molecular mechanisms remain elusive. A chemically defined CeMM diet attenuates development and promotes longevity of C. elegans, but whether it impact on other nematodes is unknown. Here, we studied the effect of the CeMM diet on the development and longevity of the marine nematode Litoditis marina, which belongs to the same family as C. elegans. We further investigated genome-wide transcriptional responses to CeMM and OP50 diet for both nematodes, respectively. We observed that the CeMM diet attenuated L. marina development but did not extend its lifespan. We found that many of the FOXO DAF-16 target genes, lysosome and xenobiotic metabolism related genes were significantly increased on the CeMM, which might contribute to the lifespan extension of C. elegans. Notably, we found that the expression of lysosome and xenobiotic metabolism pathway genes was significantly down regulated in L. marina on CeMM, which might explain why the CeMM diet could not promote the lifespan of L. marina compared to bacterial feeding. Additionally, down-regulation of several RNA transcription and protein generation and related processes genes might not only be involved in extending longevity but also contribute to attenuating development of C. elegans on CeMM, while down-regulation of unsaturated fatty acids synthesis genes might contribute to slow down the growth of L. marina on CeMM. Further genetic analysis of candidate gene(s) of longevity and development in C. elegans and L. marina will provide the molecular mechanisms underlying how diets regulate animal physiology and health in the context of global climate change with variable nutritional environments.