bluuebunny/crossref_metadata_2025 huggingface dataset:
P587 Utility of intestinal ultrasound in Inflammatory Bowel Disease patients on management decisions
Authors: Abraham B , Saleh A , Perry C
Published: May 2021

Background

Intestinal Ultrasound (IUS) has been gaining momentum in the management of patients with inflammatory bowel disease (IBD). Underutilized in the United States(U.S.), we present the impact of IUS in management decisions in a cohort of IBD patients seen at a tertiary center.

Methods

This retrospective study analyzed all IBD patients seen at our institution undergoing IUS as part of routine clinical evaluation. Patient demographics, disease type, clinical activity, laboratory markers, and therapy was obtained. Patients with evidence of inflammation based on IUS characteristics of bowel wall thickening, with additional parameters of mural stratification, mesenteric fat, doppler flow, lymph nodes, dilated bowel, free fluid used as adjunct measures were compared to those without IUS features of activity. Subsequent management plan based on findings were evaluated.

Results

Of 148 patients seen for IUS (median age 41 (range 18–81), 67% female), 108(73%) had Crohn’s disease (CD), 39(26.4%) had ulcerative colitis (UC), 1(0.7%) had IBD-undetermined (IBD-U) with 111(75%) Caucasians, 9.5% Blacks, 8.8% Asians, and 6.8% Hispanics. Median disease duration was 8 years, range (0–43) with 113(94.1%) on biologic/small molecule therapy and 7(5.8%) on mesalamines. No differences in BMI were noted in those with active disease vs. those in remission. However, we noted 29(19.3%) had fatty liver on ultrasound, which correlated highly with high BMI (31 vs. 24) in those with normal liver (p<0.05).

On IUS, 110(66%) of our patients had evidence of disease activity and 56(34%) were in remission. Inflammatory markers ESR and CRP did not correlate to IUS activity. In our UC patients Mayo score correlated to IUS findings but not Harvey Bradshaw Index (HBI) for CD. For those with positive findings on IUS, 29.5% escalated therapy for their IBD, and 13.3% required change in drug mechanism. For those in remission, the majority of patients 43(84.3%) continued their therapy while 3(5.9%) successfully de-escalated therapy.

Conclusion

In our study, IUS was useful in providing management decisions in those with active disease especially as there was a lack of correlation to inflammatory markers and HBI scores.
P657 Acceptability of a COVID-19 vaccine among cohort of Croatian IBD patients treated in tertiary IBD centre
Authors: Tomasic V , Bišćanin A , Ćaćić P , Kralj D , Dorosulić Z , Ogresta D , Hrabar D
Published: May 2021

Background

Several different types of COVID-19 vaccines are currently available in the EU. Although the massive prophylactic vaccination campaign is the best global solution that may bring an end to the pandemic, a certain proportion of the population seems to remain reluctant to it. No specific data for IBD patients is yet available. We aimed to assess prevalence and characteristics of IBD patients with COVID-19 vaccine hesitancy.

Methods

Adult IBD patients treated in our centre were invited to fulfil anonymous online survey from January 17th to February 25th, 2021. Participants’ characteristics were assessed using descriptive statistics. Normal distribution was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were compared with independent t-test and Mann–Whitney test when appropriate. Categorical variables were analyzed using the Chi-square test.

Results

A total of 120 subjects (43.3% female, mean age 34.5±12.3 years, 56.7% Crohn’s disease) completed the survey with a response rate of 96%. Median of disease duration was 8 years (IQR 3–12 years) and 65.8% of participants were on biologics. Overall, only 51.7% were willing to get a COVID-19 vaccine. Mean age of subjects who were inclined to vaccination was higher compared to those who are not (38.1 vs 30.4 years), t(118)=3.43, p=.001. There wasn’t statistically significant difference in median of disease duration between these two groups U=1551, N1=58, N2=62, p=.194, two-tailed. Mean BMI was higher in group of patients who were willing to get vaccinated (25.4 vs 23.2 kg/m2) t(111.67)=2.94, p=.004. There was no difference in vaccine acceptance between IBD patients who identified themselves as a high-risk group and the other which didn’t. Also, acceptability of a COVID-19 vaccine in IBD patients with or without comorbidities didn’t differ significantly (χ 2 (1, N = 120) = .52, p < .47). Connection between biologic use and willingness to vaccination wasn’t observed (χ 2 (1, N = 120) = 2.06, p < .15). Reported reasons for COVID-19 vaccine unacceptability were belief that vaccine can’t be safe because of its rapid development (55%), fear from possible interaction between IBD therapy and vaccine (44%), and fear that vaccine may lead to disease flare (36%).

Conclusion

A high proportion of Croatian IBD patients are unwilling to get vaccinated against COVID-19. Further patient education, motivation strategies and positive vaccination campaign by gastroenterologists are warranted. Those could be the most significant factors in driving the compliance to COVID-19 vaccination and in reducing IBD patient’s hesitancy to get vaccinated.
P661 Radon exposure and inflammatory bowel disease in a radon prone area
Authors: Mauriz Barreiro M V , Ruano-Raviña A , Baston-Rey I , Ferreiro-Iglesias R , Calviño-Suarez C , Barros-Dios J M , Dominguez-Muñoz J E , Barreiro-de Acosta M
Published: May 2021

Background

Inflammatory Bowel Disease (IBD) is a multifactorial pathology with an increasing incidence. There are environmental factors, many unknown, that participate in its development. There is no study having assessed a possible relationship with residential radon exposure, which is very high in the study area. The aim of this study was to analyze if residential radon concentration measured at a municipal level is associated with a higher incidence of IBD and its characteristics (clinical or demographic).

Methods

We performed an ecological study where we included all incident cases of IBD in the area of Santiago de Compostela between January and December 2017 in order to estimate municipal incidence rates. Radon levels at a municipal level were obtained from the Galician Radon Map and correlated with demographic factors and type of IBD. We used the Spearman’s correlation coefficient to test the existence of any association.

Results

96 patients were included, 63 (65.6%) with Ulcerative Colitis, 29 (30.25) with Crohn’s Disease and 4 (4.2%) with indeterminate colitis. Median age was 41 (IQR: 33.5 to 56 years), and 50.0% were women. The incidence rate per 100.000 inhabitants-year in the study area was 21.6 cases. The median radon concentration was 104.9Bq/m3 (IQR: 91.0 to 154.6), without statistically significant differences in function of the location of the house (rural vs. urban) nor the type of edification (flat vs house), p >0.05. There were no statistically significant differences on the type of IBD developed (ulcerative colitis, Crohn’s disease or indeterminate colitis) regarding radon levels either (p>0.05). There were no statistically significant differences (p>0.05) between radon and sex of IBD cases. No correlation between radon levels and age of the individuals was observed (Spearman’s rho = -0.13, p-value 0.2), nor radon levels variation by age groups (p>0.05). There was no correlation between radon concentration and cumulative incidence of IBD at municipal level (Spearman’s rho = 0.13, p-value 0.5), as it is shown in figure 1.

Conclusion

In the area of Santiago de Compostela there is a higher incidence of IBD in comparison with previous studies taking western countries as reference. It is possible that some environmental risk factors, could be responsible of this difference. In this study we have not found any correlation with municipal average radon concentration and incidence of IBD or any of its types.
Humanitarian Intervention and the Law of State Responsibility
Authors: Paddeu Federica I
Published: May 2021

The primary rules of international law do not permit states to resort to force for humanitarian purposes. Some scholars have thus attempted to rely on the secondary rules of state responsibility to find a legal basis for forcible humanitarian intervention. In particular, three claims can be identified: that humanitarian intervention is justified; that the state intervening for humanitarian purposes is excused; and that the consequences arising from the intervention for the state acting for humanitarian purposes ought to be mitigated. All three arguments rely either on the defence of necessity, cast as a justification or as an excuse, or on necessity-like reasoning, as the basis for mitigation. This article takes these three claims and draws out the implications of each both within and beyond the law of responsibility. In so doing, this article shows how each of the three arguments is more problematic and less straightforward than it appears at first and that, ultimately, none can provide an adequate legal basis for humanitarian intervention. The legality of humanitarian intervention must be found in the primary rules regulating the use of force in international relations and not in the secondary rules of state responsibility.
Strong, Non-specific Adhesion Using C-Lectin Heterotrimers in a Molluscan Defensive Secretion
Authors: Smith A M , Huynh P , Griffin S , Baughn M , Monka P
Published: May 2021

Synopsis

The defensive mucus produced by the slug Arion subfuscus is tough and remarkably sticky. It spreads rapidly and adheres strongly to a wide range of surfaces. The adhesion is equally strong on wettable (glass) and non-wettable (plastic) surfaces. The adhesion appears to depend on a group of proteins that adsorb equally well to a wide range of different natural and artificial surfaces. Prominent among these proteins were those that distinguish the adhesive secretion from the non-adhesive mucus. The adhesive proteins were not washed off by non-ionic detergent. Similarly, the adhesion of the glue as a whole was not affected by this treatment. In contrast, high salt concentrations washed the most abundant adhesive proteins off the surfaces, and correspondingly weakened the glue’s attachment. The most abundant of the adhesive proteins were C-lectins, which appear to form heterotrimers. These and other lectin-like proteins in slug glue have a high proportion of aromatic amino acids at conserved locations, and are relatively small and often basic. The aromatic and cationic side chains may provide a powerful combination promoting and maintaining surface adhesion.
Genetics and animal models of familial pulmonary fibrosis
Authors: Yasutomo Koji
Published: May 2021

Pulmonary fibrosis is caused by the interplay between genetic and environmental factors. Recent studies have revealed various genes associated with idiopathic pulmonary fibrosis, as well as the causative genes for familial pulmonary fibrosis. Although increased death or dysfunction of type 2 alveolar epithelial (AT2) cells has been detected in lung specimens from pulmonary fibrosis patients, it remains unclear whether and how AT2 cell death or dysfunction is responsible for the progression of pulmonary fibrosis. A recent study showed that increased AT2 cell necroptosis is the initial event in pulmonary fibrosis by analyzing patients with familial pulmonary fibrosis and an animal model that harbors the same mutation as patients. The contribution of AT2 cell necroptosis to the pathogenesis of pulmonary fibrosis has not been identified in animal model studies, which validates the effectiveness of genetic analysis of familial diseases to uncover unknown pathogeneses. Thus, further extensive genetic studies of pulmonary fibrosis along with functional studies based on genetic analysis will be crucial not only in elucidating the precise disease process but also, ultimately, in identifying novel treatment strategies for both familial and non-familial pulmonary fibrosis.
Prognostic significance of the controlling nutritional status score in patients with metastatic renal cell carcinoma diagnosed before an era of first-line immune-oncology combination therapies
Authors: Sekiya Ken , Ito Masaya , Takemura Kosuke , Suzuki Hiroaki , Kobayashi Shuichiro , Koga Fumitaka
Published: May 2021

Objective

To explore the prognostic role of the controlling nutritional status score in patients with metastatic renal cell carcinoma.

Methods

We retrospectively analyzed 107 patients with metastatic renal cell carcinoma who received their diagnosis between 2007 and 2018 and were treated with or without a first-line interferon or tyrosine kinase inhibitor at a single cancer center. The controlling nutritional status score was based on values for albumin, lymphocyte count and total cholesterol at the metastatic renal cell carcinoma diagnosis. Association of the controlling nutritional status score and clinical variables, including the Memorial Sloan-Kettering Cancer Center and the International Metastatic Renal Cell Carcinoma Database Consortium risk classifications, with overall survival was examined using the Cox proportional hazard model. Predictive accuracy of the prognostic factors was assessed using Harrell’s concordance index.

Results

First-line interferon and tyrosine kinase inhibitor were given to 48 (45%) and 41 (38%) patients, respectively, and 28 (26%) and 33 (31%) patients underwent cytoreductive nephrectomy and metastasectomy, respectively. During follow-up (median: 36.3 months), 64 patients died. The median controlling nutritional status score was 2 (range: 0–8). A controlling nutritional status score ≥ 2 was significantly associated with shorter overall survival (P < 0.01) independently of the Memorial Sloan-Kettering Cancer Center and International Metastatic Renal Cell Carcinoma Database Consortium risk classifications. Integration of the controlling nutritional status score into the Memorial Sloan-Kettering Cancer Center and International Metastatic Renal Cell Carcinoma Database Consortium risk classifications improved concordance index from 0.702 to 0.770 and from 0.698 to 0.749, respectively.

Conclusion

The controlling nutritional status score may serve as a prognostic biomarker objectively reflecting the general physical condition of patients with metastatic renal cell carcinoma treated with or without first-line interferon or tyrosine kinase inhibitor in terms of nutritional and immuno-inflammatory status.
Development of a gas environmental heating specimen holder system using differential pumping
Authors: Hashimoto Ayako , Han Yutain , Akimoto Hajime , Hozumi Ryo , Takeguchi Masaki
Published: May 2021

We developed a gas environmental heating specimen holder system by applying differential pumping effect to a specimen holder for the insitu transmission electron microscopy observation and electron energy loss spectroscopy (EELS) analysis of catalytic materials. In the insitu experiments, using two small orifices and O-rings, the maximum formed gas pressure was ∼20 Pa. Also, using a heater membrane, the maximum obtained heating temperature was ∼1000°C. We could actually observe/analyze the Pt and Ni nanoparticles with an atomic scale using a double-aberration-corrected microscope and an EELS instrument in the reaction gases at high temperatures.
Comparison of Mid-Turbinate and Nasopharyngeal Specimens for Molecular Detection of SARS-CoV-2 Among Symptomatic Outpatients at a Pediatric Drive-Through Testing Site
Authors: Sahni Leila C , Avadhanula Vasanthi , Ortiz Camerin S , Feliz Karen E , John Rebekah E , Brown Cameron A , Lively Joana Y , Rha Brian , Munoz Flor M , Piedra Pedro A , Dunn James J , Boom Julie A
Published: May 2021

Background

Nasopharyngeal (NP) specimen testing by reverse transcriptase polymerase chain reaction (RT-PCR) is the standard of care for detecting SARS-CoV-2. Data comparing the sensitivity and specificity of the NP specimen to the less invasive, mid-turbinate (MT) nasal specimen in children are limited.

Methods

Paired clinical NP and research MT specimens were collected from children <18 years with respiratory symptoms and tested by molecular assays to detect SARS-CoV-2 RNA. Sensitivity, specificity, and agreement (Cohen’s kappa [κ]) were calculated for research MT specimens compared to the clinical NP specimens.

Results

Out of 907 children, 569 (62.7%) had parental consent and child assent when appropriate to participate and provided paired MT and NP specimens a median of 4 days after symptom onset (range 1-14 days). 16.5% (n = 94) of MT specimens were positive for SARS-CoV-2 compared with 20.0% (n = 114) of NP specimens. The sensitivity of research MT compared to clinical NP specimens was 82.5% (95% CI: 74.2%, 88.9%), specificity was 100.0% (95% CI: 99.2%, 100.0%), and overall agreement was 96.1% (κ = 0.87). The sensitivity of MT specimens decreased with time from 100% (95% CI: 59.0%, 100.0%) on day 1 of illness to 82.1% (95% CI: 73.8%, 88.7%) within 14 days of illness onset; sensitivity was generally >90% when specimens were collected within the first week of illness.

Conclusion

MT specimens, particularly those collected within the first week of illness, have moderately reduced sensitivity and equivalent specificity to less-tolerated NP specimens in pediatric outpatients. MT specimen use in children may represent a viable alternative to NP specimen collection.
Effects of dietary live yeast supplementation on growth performance and biomarkers of metabolism and inflammation in heat-stressed and nutrient-restricted pigs
Authors: Mayorga Edith J , Kvidera Sara K , Horst Erin A , Al-Qaisi Mohmmad , McCarthy Carrie S , Abeyta Megan A , Lei Samantha , Elsasser Theodore H , Kahl Stanislaw , Kiros Tadele G , Baumgard Lance H
Published: May 2021

Study objectives were to determine the effects of dietary live yeast (Saccharomyces cerevisiae strain CNCM I-4407; ActisafHR+; 0.25g/kg of feed; Phileo by Lesaffre, Milwaukee, WI) on growth performance and biomarkers of metabolism and inflammation in heat-stressed and nutrient-restricted pigs. Crossbred barrows (n = 96; 79 ± 1 kg body weight [BW]) were blocked by initial BW and randomly assigned to one of six dietary-environmental treatments: 1) thermoneutral (TN) and fed ad libitum the control diet (TNCon), 2) TN and fed ad libitum a yeast containing diet (TNYeast), 3) TN and pair-fed (PF) the control diet (PFCon), 4) TN and PF the yeast containing diet (PFYeast), 5) heat stress (HS) and fed ad libitum the control diet (HSCon), or 6) HS and fed ad libitum the yeast diet (HSYeast). Following 5 d of acclimation to individual pens, pigs were enrolled in two experimental periods (P). During P1 (7 d), pigs were housed in TN conditions (20 °C) and fed their respective dietary treatments ad libitum. During P2 (28 d), HSCon and HSYeast pigs were fed ad libitum and exposed to progressive cyclical HS (28–33 °C) while TN and PF pigs remained in TN conditions and were fed ad libitum or PF to their HSCon and HSYeast counterparts. Pigs exposed to HS had an overall increase in rectal temperature, skin temperature, and respiration rate compared to TN pigs (0.3 °C, 5.5 °C, and 23 breaths per minute, respectively; P < 0.01). During P2, average daily feed intake (ADFI) decreased in HS compared to TN pigs (30%; P < 0.01). Average daily gain and final BW decreased in HS relative to TN pigs (P < 0.01); however, no differences in feed efficiency (G:F) were observed between HS and TN treatments (P > 0.16). A tendency for decreased ADFI and increased G:F was observed in TNYeast relative to TNCon pigs (P < 0.10). Circulating insulin was similar between HS and TN pigs (P > 0.42). Triiodothyronine and thyroxine levels decreased in HS compared to TN treatments (~19% and 20%, respectively; P < 0.05). Plasma tumor necrosis factor-alpha (TNF-α) did not differ across treatments (P > 0.57) but tended to decrease in HSYeast relative to HSCon pigs (P = 0.09). In summary, dietary live yeast did not affect body temperature indices or growth performance and had minimal effects on biomarkers of metabolism; however, it tended to improve G:F under TN conditions and tended to reduce the proinflammatory mediator TNF-α during HS. Further research on the potential role of dietary live yeast in pigs during HS or nutrient restriction scenarios is warranted.
Stories in the Time of COVID-19
Authors: Kumagai Arno K. , Baruch Jay
Published: May 2021

The time of COVID-19 is the time of storytelling—stories of chaos, loss, and despair, but also of victories large and small, acts of kindness, and deep connections. Stories are a way to pass on meaning from one person to another, among communities, and across generations. COVID-19 stories are being used in the education of physicians, but for whose benefit and to what end? What if the “heroic” frontline worker is experiencing burnout or working out of necessity rather than by choice? What if the battle against an invisible enemy does not end triumphantly but becomes an interminable war of attrition? It is important not only to propose new questions but also to create spaces for stories that do not fit conveniently into standard narratives. Stories help foster the energy and drive to write about what is next and to act as physicians in the service of human beings and their lives.
Implementing Clinic First Guiding Actions Across 4 Family Medicine Residency Clinics
Authors: Adam Patricia , Hersch Derek , Peek C.J.
Published: May 2021

Problem

Family medicine faculty and residents have observed that continuity clinic is often unsatisfying, attributed to a lack of patient and team continuity and erratic clinic schedules pieced together after the prioritization of hospital service and rotation schedules.

Approach

In 2019, a 3-year Clinic First project, called Clinic as Curriculum (CaC), was launched across the 4 family medicine residencies of the Department of Family Medicine and Community Health, University of Minnesota Medical School. The department began publishing quarterly CaC dashboard data. Each clinic completed a baseline assessment of their performance on the 13 Building Blocks of High-Performing Primary Care. Using their baseline data, each clinic identified which block or blocks, in addition to the blocks on continuity of care and resident scheduling, to focus on. The plan is to collaboratively implement the overall and local goals using dashboard data and iterative process improvement over 3 years.

Outcomes

At baseline, clinics functioned quite well with respect to the 13 building blocks, but CaC dashboard data varied across the 4 clinics, with large variation between clinics on how frequently faculty were scheduled in the clinic and the proportion of total clinic visits seen by faculty. Resident continuity rates were low (range, 38%–47%). Level loading (consistent physician availability to meet patient demand) rates ranged from 1 to 11 days a month. Regarding resident schedules, 2 programs are moving from 4-week to 2-week inpatient blocks, and 2 programs are exploring longitudinal scheduling. One clinic will assign faculty and residents to specific clinic days. Two clinics are implementing microteams of 1 faculty and 3–4 residents.

Next Steps

The authors plan to analyze the dashboard data longitudinally; explore microteams, team continuity, and team scheduling adherence; and develop and implement resident scheduling changes over the next 3 years.
Anterior Canal Reconstruction and Fusion for Myelopathy Caused by Degenerative Cervical Kyphosis and Stenosis With or Without Ossification of the Posterior Longitudinal Ligament
Authors: Yang Haisong , Sun Yuling , Wang Liang , Guo Qunfeng , Jiang Jingjing , Lu Xuhua
Published: May 2021

Study Design:

This was a retrospective study.

Objective:

To introduce an anterior surgical technique for myelopathy caused by degenerative cervical kyphosis and stenosis (DCKS) with or without ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data:

The optimal approach in the treatment of DCKS remains a controversy because each anterior or posterior route surgery has advantages and disadvantages.

Materials and Methods:

In the period from June 2017 through June 2019, a consecutive cohort of adults diagnosed with DCKS underwent anterior canal reconstruction and fusion (ACRF). All patients underwent x-ray, computed tomography, and magnetic resonance imaging of the cervical spine. Radiologic assessment included kyphosis, canal area, canal reconstruction, OPLL, and spinal cord curvature and morphology. The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological status. Surgery-related and implant-related complications were all recorded. Follow-up was carried out at 3, 6, 12, 24, and 36 months postoperation.

Results:

Fourty-one patients were included in the study, of which 19 presented with OPLL. Postoperatively, the canal area were significantly greater at last follow-up compared with preoperation (208.4 vs. 123.2 mm2; P=0.001). There was significant kyphosis correction (−17.6 vs. 8.5 degrees, P=0.001) at last follow-up. Ninety-six segmental canal reconstruction were performed, 89 (92.7%) reached bone fusion at both grooves with a mean time of 7.9 months. On sagittal magnetic resonance imaging, 33 (80.5%) patients presented with lordosis in the spinal cord curvature, 8 (19.5%) with straight. The mean JOA score at last follow-up was significantly better than preoperation (15.0 vs. 9.3 points; P<0.01). One patient presented with cerebrospinal fluid leakage, 1 with screw displacement and 2 with dysphagia.

Conclusion:

ACRF, receiving good correction of kyphosis, amplified canal area, solid instrumented fusion and circumferential decompression, is an effective and safe surgical technique for cervical myelopathy caused by DCKS with or without OPLL.

Level of Evidence:

Level III—a retrospective analysis.
The Effects of Surgery on Postural Instability in Patients With Cervical Compressive Myelopathy
Authors: Yano Toma , Fujishiro Takashi , Obo Takuya , Nakano Atsushi , Nakaya Yoshiharu , Hayama Sachio , Mori Katsunori , Baba Ichiro , Neo Masashi
Published: May 2021

Study Design:

A retrospective study.

Objective:

To investigate the effects of surgery on the subjective perception of bodily unsteadiness and the objective measurements of postural instability in patients with cervical compressive myelopathy (CCM).

Summary of Background Data:

Several studies have demonstrated that CCM patients have impaired postural stability and investigated its surgical outcomes. However, these studies have only objectively measured postural stability by using a stabilometer or three-dimensional motion capture system. There have been no studies examining the subjective perception of postural instability in CCM patients.

Materials and Methods:

We retrospectively reviewed patients who underwent decompressive surgery for CCM. The Fall Efficacy Scale-International (FES-I) and a self-prepared questionnaire were used to evaluate subjective perception of bodily unsteadiness. To objectively assess postural instability, a stabilometric analysis was performed with the following parameters: sway area (SwA, cm2), sway velocity (SwV, cm/s), and sway density (SwD, /cm). The evaluations were performed preoperatively, during the early postoperative period (3–6 mo postoperatively), and at 1-year postoperatively in patients with CCM. The evaluation results were compared with age-matched, sex-matched, and body mass index-matched healthy subjects.

Results:

We included 70 CCM patients and 36 healthy subjects in this study. In both the FES-I and self-prepared questionnaire, CCM patients reported significantly milder postoperative bodily unsteadiness. The stabilometric parameters were significantly improved during the postoperative period when compared with preoperative values. Nevertheless, neither the self-reported outcome measures nor stabilometric parameters of CCM patients reached the levels of those in healthy controls in the postoperative period.

Conclusion:

This was the first study to examine CCM surgical outcomes in terms of both subjective perception and objective postural instability. While both objective postural stability and subjective perception improved following decompressive surgery, they did not reach the levels seen in healthy participants.

Level of Evidence:

Level III.
Surgery of small bowel melanoma metastases in the era of efficient medical therapies: a retrospective cohort study
Authors: Malissen Nausicaa , Farvacque Georges , Duconseil Pauline , Birnbaum David Jérémie , Falque Claire , Macagno Nicolas , Grob Jean-Jacques , Gaudy-Marqueste Caroline , Moutardier Vincent
Published: May 2021

Surgery of small bowel melanoma metastases has to be reconsidered in the era of targeted treatments and immunotherapy. To retrospectively assess context and outcomes of small bowel melanoma metastases resections. All consecutive melanoma patients who underwent resection of small bowel metastases between 2011 and 2017, in a single referral center, were retrospectively analyzed through melanoma-specific survival (MSS). A total of 20 patients were included with a 47.8 months median follow-up. Before small bowel surgery, eight patients (40%) were asymptomatic while seven had anemia and five patients had abdominal pain. All resections were decided on tumor boards except for three surgeries performed in the emergency setting. In the whole cohort, MSS was 89.5 months with 50% of patients alive at the study endpoint. We classified surgical indications in three groups: (1) surgery as a pivotal treatment for mono- or oligo-metastases limited to the small bowel (n = 6); (2) salvage surgery for symptomatic patients in order to preserve their chances to switch to an active line of medical treatment (n = 8); and (3) surgery of small bowel dissociated metastatic progression for patients otherwise controlled (n = 6), aiming at keeping patients with the same treatment or active follow-up. In these three situations, the objective of surgery was usually met, and most patients had a long median MSS after surgery: 70.3 months, 89.5 months and 72.4 months, respectively. Although medical treatments have dramatically improved survival in metastatic melanoma, surgical control of life-threatening localization like small bowel metastases is often a condition for long survival.
A Direct Estimate of the Impact of PM2.5, NO2, and O3 Exposure on Life Expectancy Using Propensity Scores
Authors: Schwartz Joel D. , Di Qian , Requia Weeberb J. , Dominici Francesca , Zanobetti Antonella
Published: May 2021

Background:

Many studies have reported associations of air pollutants and death, but fewer examined multiple pollutants, or used causal methods. We present a method for directly estimating changes in the distribution of age at death using propensity scores.

Methods:

We included all participants in Medicare from 2000 to 2016 (637,207,589 person-years of follow-up). We fit separate logistic regressions modeling the probability of death at each year of age from 65 to 98 or older as a function of exposure to particulate matter less tha 2.5 µM in diameter (PM2.5), NO2, and O3, using separate propensity scores for each age. We estimated the propensity score using gradient boosting. We estimated the distribution of life expectancy at three counterfactual exposures for each pollutant.

Results:

The estimated increase in mean life expectancy had the population been exposed to 7 versus 12 µg/m3 PM2.5 was 0.29 years (95% CI = 0.28, 0.30). The change in life expectancy had the population been exposed to 10 versus 20 ppb of NO2 was −0.01 years (95% CI = −0.015, −0.006). The increase in mean life expectancy had the population been exposed to 35 versus 45 ppb of O3 was 0.15 years (95% CI = 0.14, 0.16). Each of these effects was independent and additive.

Conclusions:

We estimated that reducing PM2.5 and O3 concentrations to levels below current standards would increase life expectancy by substantial amounts compared with the recent increase of life expectancy at age 65 of 0.7 years in a decade. Our results are not consistent with the hypothesis that exposure to NO2 decreases life expectancy.
Leveraging Pathogen Sequence and Contact Tracing Data to Enhance Vaccine Trials in Emerging Epidemics
Authors: Kahn Rebecca , Wang Rui , Leavitt Sarah V. , Hanage William P. , Lipsitch Marc
Published: May 2021

Introduction:

Advance planning of vaccine trials conducted during outbreaks increases our ability to rapidly define the efficacy and potential impact of a vaccine. Vaccine efficacy against infectiousness (VEI) is an important measure for understanding a vaccine’s full impact, yet it is currently not identifiable in many trial designs because it requires knowledge of infectors’ vaccination status. Recent advances in genomics have improved our ability to reconstruct transmission networks. We aim to assess if augmenting trials with pathogen sequence and contact tracing data can permit them to estimate VEI.

Methods:

We develop a transmission model with a vaccine trial in an outbreak setting, incorporate pathogen sequence data and contact tracing data, and assign probabilities to likely infectors. We then propose and evaluate the performance of an estimator of VEI.

Results:

We find that under perfect knowledge of infector-infectee pairs, we are able to accurately estimate VEI. Use of sequence data results in imperfect reconstruction of transmission networks, biasing estimates of VEI towards the null, with approaches using deep sequence data performing better than approaches using consensus sequence data. Inclusion of contact tracing data reduces the bias.

Conclusion:

Pathogen genomics enhance identifiability of VEI, but imperfect transmission network reconstruction biases estimate toward the null and limits our ability to detect VEI. Given the consistent direction of the bias, estimates obtained from trials using these methods will provide lower bounds on the true VEI. A combination of sequence and epidemiologic data results in the most accurate estimates, underscoring the importance of contact tracing.
Early-life Farm Exposure and Ovarian Reserve in a US Cohort of Women
Authors: Upson Kristen , Weinberg Clarice R. , Nichols Hazel B. , Dinse Gregg E. , D’Aloisio Aimee A. , Sandler Dale P. , Baird Donna D.
Published: May 2021

Background:

In a previous exploratory study, we reported lower concentrations of the ovarian reserve biomarker anti-Müllerian hormone (AMH) in adulthood with prenatal farm exposure. We now examine this association as well as childhood farm exposure using enrollment data from the Sister Study, a large US cohort of women.

Methods:

We collected prenatal and childhood farm exposure data by questionnaire and telephone interview. However, serum AMH data were available only for a nested subset: premenopausal women ages 35–54 subsequently diagnosed with breast cancer (n = 418 cases) and their matched controls (n = 866). To avoid potential bias from restricting analyses to only premenopausal controls, we leveraged the available cohort data. We used data from both premenopausal cases and controls as well as postmenopausal women ages 35–54 (n = 3,526) (all presumed to have undetectable AMH concentrations) and applied weights to produce a sample representative of the cohort ages 35–54 (n = 17,799). The high proportion of undetectable AMH concentrations (41%) was addressed using reverse-scale Cox regression. An adjusted hazard ratio (HR) <1.0 indicates that exposed individuals had lower AMH concentrations than unexposed individuals.

Results:

Prenatal exposure to maternal residence or work on a farm was associated with lower AMH concentrations (HR 0.66; 95% confidence intervals [CI] = 0.48 to 0.90). Associations between childhood farm residence exposures and AMH were null or weak, except childhood contact with pesticide-treated livestock or buildings (HR 0.69; 95% CI = 0.40 to 1.2).

Conclusions:

Replication of the prenatal farm exposure and lower adult AMH association raises concern that aspects of prenatal farm exposure may result in reduced adult ovarian reserve.
Immediate Tendon Transfer with Nerve Repair in Low Combined Ulnar and Median Nerve Injury
Authors: Reyad Khaled A. , Behiri Ahmed M. , El Lamie Karim K. , Sayed Mohamed A. , Abd Elsabour Sabah Hala M.
Published: May 2021

Background:

Combined median-ulnar nerve injury at the level of distal forearm (below the musculotendinous junction) causes a detrimental effect on hand functions, which have a great impact on patients’ hands as well as a financial burden. Many previous authors advocated early or immediate tendon transfer in solitary median or ulnar nerve injuries.

Methods:

This study included 20 patients with combined distal ulnar-median nerve injury, who were divided into 2 groups. Group I (control) included 10 patients who underwent primary (group fascicular) repair of both nerves only. Group II (study) included 10 patients underwent primary (group fascicular) repair with immediate tendon transfer simultaneously: opponenplasty using extensor indicies and adductoplasty extensor carpi radialis brevis with appropriate splinting, postoperative rehabilitation, and biofeedback facilities.

Results:

Twenty patients (age: 18–38 years) were affected. The response of median and ulnar nerves showed invariable results in both groups, whilst the hand grip, hand pinch, and opposition showed marked improvements in group II. Moreover, inter-phalangeal and metacarpophalangeal joints of thumb showed no deformities in group II in comparison with high level of deformities in group I, owing to early regain of thumb movements.

Conclusions:

Immediate (during neurorrhaphy) tendon transfer may offer additional merits over nerve repair only for distal combined ulnar and median injury, as it offers scarless field, no adhesion, and no joint edema, leading to very early return to normal hand functions with a consequent decrease of thumb deformities, better hand grip, and key pinch.
The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH): A Research Protocol
Authors: Oliveira Vitor H. F. , Erlandson Kristine M. , Cook Paul F. , Jankowski Catherine , MaWhinney Samantha , Dirajlal-Fargo Sahera , Knaub Leslie , Hsiao Chao-Pin , Horvat Davey Christine , Webel Allison R.
Published: May 2021

The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH), which incorporates an exercise and biobehavioral coaching intervention, has the following overall goals: (a) to determine whether high-intensity interval training (HIIT) mitigates physical function impairments, fatigue, and impairments in mitochondrial bioenergetics of older people living with HIV (PLWH) to a greater extent than continuous moderate exercise (CME); and (b) to determine whether a biobehavioral coaching and mobile health text messaging intervention after HIIT or CME can promote long-term adherence to physical activity. The HEALTH study is a randomized trial of 100 older PLWH (≥50 years of age) who self-report fatigue and have a sedentary lifestyle. Enrolled participants will be randomized to 16 weeks of supervised HIIT or CME training, followed by a 12-week maintenance phase, involving a mobile health coaching intervention. Outcomes of the HEALTH study will inform the development of scalable, effective exercise recommendations tailored to the unique needs of aging PLWH.
The national institutes of health's approach to address research gaps in pancreatitis, diabetes and early detection of pancreatic cancer
Authors: Serrano Jose , Rinaudo Jo Ann , Srivastava Sudhir , Ghosh Sharmistha , Unalp-Arida Aynur , Andersen Dana K.
Published: May 2021

Purpose of review

Diseases of the pancreas are a broad spectrum of conditions resulting from metabolic, inflammatory, and neoplastic processes (pancreatitis, pancreatogenic diabetes, and pancreatic cancers). Pancreatic diseases cause significant morbidity, mortality, and cost.

Recent findings

Research progress in diseases of the exocrine pancreas (chronic pancreatitis [CP], pancreatogenic diabetes mellitus, and pancreatic cancer) has been hampered by the disorders’ heterogeneity, the limitations of previous small cross-sectional studies, the inability to safely obtain pancreatic tissue for study, and the lack of structured epidemiology tools, genetic testing, and biomarker development.

Given the increasing incidence and prevalence of CP and its complications, high mortality rate, and associated healthcare cost, the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute funded the Consortium for the study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer (CPDPC) to identify research gaps and foster multidisciplinary collaborations to better diagnose, characterize and manage CP and its sequelae and to understand the diabetes/pancreatic cancer association.

The studies undertaken by the CPDPC are described in other articles in this journal's issue.
Specific Probiotics for the Treatment of Pediatric Acute Gastroenteritis in India: A Systematic Review and Meta-Analysis
Authors: McFarland Lynne V. , Srinivasan Ramesh , Setty Rajendra P. , Ganapathy Sridhar , Bavdekar Ashish , Mitra Monjori , Raju Bhaskar , Mohan Neelam
Published: May 2021

Pediatric acute gastroenteritis (PAGE) is a significant cause of morbidity, mortality and healthcare costs in many countries, but differences in PAGE vary from country-to-country; thus, we limited our analysis to 1 country. Probiotics have been recommended as an adjunct to standard treatment, but the choice of probiotic is unclear. PubMed, Google Scholar, and reviews were searched from inception to May 2020 for randomized controlled trials (RCTs) in India using probiotics for a treatment for PAGE. Meta-analyses using subgroups of identical probiotic types (≥2 RCT/type) were conducted for primary outcomes (duration of diarrhea, cured by day 3, rapidity of response, and length of hospital stay). Twenty-two RCTs were included in the systematic review (N = 4059 participants) including 5 single-strained probiotics and 3 multi-strained mixtures. For the meta-analyses, 17 RCT (20 treatment arms) were included. Saccharomyces boulardii CNCM I-745 had the strongest effect on shortening the duration of diarrhea (standardized mean difference, –1.86 d; 95% confidence interval, –2.8 to –0.9), while both Lactobacillus rhamnosus GG and a mixture of 4 Bacillus clausii strains (O/C, SIN, N/R, T) significantly reduced the duration of diarrhea (–1.7 and –1.4 d, respectively). S. boulardii and L. rhamnosus GG significantly reduced hospital stays (−1.8 and −1.1 d, respectively), while B. clausii had no effect. The frequency of stools/day was significantly reduced by day 4 for S. boulardii and by day 5 for L. rhamnosus GG. In India, 2 types of probiotics (S. boulardii CNCM I-745 and L. rhamnosus GG) significantly shortened both the duration of diarrhea and hospitalization stays in pediatric patients with PAGE. While these 2 probiotic strains were safe and effective for children in India, further research is needed to confirm if other probiotic strains or mixtures may be effective.
Techniques in bacterial strain typing: past, present, and future
Authors: Simar Shelby R. , Hanson Blake M. , Arias Cesar A.
Published: May 2021

Purpose of review

The advancement of molecular techniques such as whole-genome sequencing (WGS) has revolutionized the field of bacterial strain typing, with important implications for epidemiological surveillance and outbreak investigations. This review summarizes state-of-the-art techniques in strain typing and examines barriers faced by clinical and public health laboratories in implementing these new methodologies.

Recent findings

WGS-based methodologies are on track to become the new ‘gold standards’ in bacterial strain typing, replacing traditional methods like pulsed-field gel electrophoresis and multilocus sequence typing. These new techniques have an improved ability to identify genetic relationships among organisms of interest. Further, advances in long-read sequencing approaches will likely provide a highly discriminatory tool to perform pangenome analyses and characterize relevant accessory genome elements, including mobile genetic elements carrying antibiotic resistance determinants in real time. Barriers to widespread integration of these approaches include a lack of standardized workflows and technical training.

Genomic bacterial strain typing has facilitated a paradigm shift in clinical and molecular epidemiology. The increased resolution that these new techniques provide, along with epidemiological data, will facilitate the rapid identification of transmission routes with high confidence, leading to timely and effective deployment of infection control and public health interventions in outbreak settings.
Needs Based Assessment of Trauma Systems 2, is it ready for primetime? A natural experiment testing its reliability
Authors: Ashley Dennis W. , Pracht Etienne E. , Tetzlaff-Bemiller Melissa J. , Medeiros Regina S. , Atkins Elizabeth V. ,   and the Georgia Research Institute for Trauma Study Group
Published: May 2021

INTRODUCTION

Needs Based Assessment of Trauma Systems 2 (NBATS-2) attempts to predict the impact on patient volume and travel time for patients when a new trauma center (TC) is added to the system. The purpose of this study was to examine NBATS-2 predictive accuracy regarding expected volume and travel times of trauma patients at a newly designated TC and nearby legacy TCs when compared with actual data.

METHODS

Needs Based Assessment of Trauma Systems predictive model for volume of trauma patients at the new TC was run based on 25th, 50th, and 75th percentiles of both state and National Trauma Data Bank (NTDB) patients per 100 TC beds. This was compared with the actual number of trauma patients from the State Discharge Data set before (2011–2012) and after (2016–2017) designation of the TC. Analysis was then augmented using the geographic information system (ArcGIS) spatial modeling to characterize median travel times for actual trauma patients, before and after designation of the TC.

RESULTS

Both state and NTDB 25th, 50th, and 75th percentiles resulted in significant overestimation of volume at the new TC in 2016. After another year of TC maturation (2017), overestimation decreased but was still present. The 25th percentile from state and NTDB data sets provided the most accurate predictions. For the legacy TCs, the model switched from under to overestimation as the state and NTDB percentiles increased. The geographic information system accurately showed patients traveling <40 minutes to a TC nearly doubled.

CONCLUSION

Needs Based Assessment of Trauma Systems 2 provides an excellent template for state strategic planning; however, it overestimates new TC volume and under/overestimates volumes for legacy TCs depending on the state and NTDB percentiles used. This study shows that population density of the county in which the new or legacy TC is located should be considered when choosing the appropriate state or NTDB percentile. The geographic information system appropriately showed a decrease in trauma patient travel times after TC designation.

LEVEL OF EVIDENCE

Care Management, level V.