bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence of nodular regenerative hyperplasia of the liver in long-term thiopurine-treated inflammatory bowel disease patients
Authors: Gilissen Lennard P.L. , Tajzai Rudaba , Romberg Marielle , Pierik Marieke , Stronkhorst Arnold , Steenhuisen Karin , Van Bodegraven Ad , Daniels Alette , Wong Dennis
Published: November 2020

Introduction

Nodular regenerative hyperplasia (NRH) has been associated with thiopurine therapy in patients with inflammatory bowel disease (IBD), but prevalence and prognosis of NRH remain unclear. This study is a cross-sectional search for NRH in IBD patients with long-term azathioprine or 6-mercaptopurine treatment.

Material and methods

Thirty-three IBD patients with continuous azathioprine/6-mercaptopurine treatment for at least 5 years were included. Laboratory tests, thiopurine metabolite levels, liver histology, MRI were examined for NRH and signs of portal hypertension.

Results

NRH was not observed in this cohort of 33 patients. Nevertheless, some possibly related signs of vascular changes were found by MRI in three patients. Also, splenomegaly, which may be associated with portal hypertension, was found in one patient. No high thiopurine dose neither high metabolite levels were found in these patients.

Conclusion

No NRH was found in this group of IBD patients with long-term azathioprine/6-mercaptopurine treatment. Larger multicenter studies are needed to determine the prevalence of NRH in thiopurine-treated IBD patients.
Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry
Authors: Boger Philip , Rahman Imdadur , Hu Maxworth , Ayaru Laksh , Bhandari Pradeep , Chedgy Fergus , Green Susi , Hayat Mumtaz , Hopper Andrew D. , Ishaq Sauid , Martin John , McCallum Iain , Phull Perminder , Pugh Stirling , Russo Evangelos , Suzuki Noriko , Thomas-Gibson Siwan , Zeino Zeino , Patel Praful
Published: November 2020

Background

Endoscopic full-thickness resection (eFTR) of the colon using the full-thickness resection device (FTRD) is a novel method for removing lesions involving, or tethered to, deeper layers of the colonic wall. The UK FTRD Registry collected data from multiple centres performing this procedure. We describe the technical feasibility, safety and early outcomes of this technique in the UK.

Methods

Data were collected and analysed on 68 patients who underwent eFTR at 11 UK centres from April 2015 to June 2019. Outcome measures were technical success, procedural time, specimen size, R0 resection, endoscopic clearance, and adverse events. Reported technical difficulties were collated.

Results

Indications for eFTR included non-lifting polyps (29 cases), T1 tumour resection (13), subepithelial tumour (9), and polyps at the appendix base or diverticulum (17). Target lesion resection was achieved in 60/68 (88.2%). Median specimen size was 21.7 mm (10–35 mm). Histologically confirmed R0 resection was achieved in 43/56 (76.8%) with full-thickness resection in 52/56 (92.9%). Technical difficulties occurred in 17/68 (25%) and complications in 3/68 (5.9%) patients.

Conclusion

eFTR is a useful technique with a high success rate in treating lesions not previously amenable to endoscopic therapy. Whilst technical difficulties may arise, complication rates are low and outcomes are acceptable, making eFTR a viable alternative to surgery for some specific lesions.
Very Late Relapse in Pediatric Acute Myeloid Leukemia: A Case Report and Brief Literature Review
Authors: Unis Graham D. , VanderVeen Nathan , Fletcher Matthew , Vasquez Robert J.
Published: November 2020

Acute myeloid leukemia (AML) is a heterogenous group of diseases affecting ~500 children in the United States annually. With current therapy, 90% of these children will obtain complete remission. However, 30% to 40% of these patients will relapse, most commonly within the first 3 years. Very late relapses, defined as relapse occurring >5 years after complete remission, are rare, accounting for 1% to 3% of relapses. We describe a patient with AML harboring an AFDN/KMT2A translocation who relapsed 12 years after matched sibling stem cell transplant, provide a brief review of the relevant literature, and describe proposed mechanisms to explain very late relapse AML.
Making the Most of Midlines
Authors: Meyer Britt M.
Published: November 2020

Decision-making for vascular access device selection is becoming increasingly complex as new technologies come to market and efforts to reduce central line-associated bloodstream infections increase. This retrospective review of 165 midline catheter outcomes was undertaken after a cluster of unexpected failures occurred in a large academic medical center in the southeastern United States. Mean dwell time for midline catheters was 8.5 days; 62.8% lasted to therapy completion, and complications occurred in 15.8%. A quality improvement initiative including implementation of a blood return algorithm and standard education for unit staff reduced infiltration and thrombosis complications.
End-of-Life Interventions for African Americans With Serious Illness
Authors: Hart Alysha S. , Matthews Alicia K.
Published: November 2020

Older African Americans (AAs) with serious illness experience disparities in advance care planning, access to palliative care and hospice, and decision-making at end of life. While culturally specific drivers of care outcomes have been identified, little has been done to standardize integration and application of targeted elements of end-of-life (EOL) interventions for AA populations. A scoping review was conducted to describe and evaluate the benefit of culturally targeted EOL interventions for AAs. A computerized search of empirical and gray literature was completed. Twelve full-text articles, 1 brief report, and 1 abstract describing a total of 14 EOL interventions for AAs with a range of serious illness were reviewed. Interventions were described relative to culturally targeted adaptations and resulting cognitive, emotional, and behavioral outcomes. Most interventions were theory-based and used psychoeducational approaches and interactive discussion and interviews. Significant improvements in psychological and behavioral outcomes were reported including knowledge and self-efficacy (n = 8); self-reported anxiety, depression, and/or well-being (n = 5); and advance care plan completion (n = 3). Few culturally tailored randomized controlled trials (n = 9) have been conducted. Preliminary results show promise for interventions using cultural adaptations. Culturally targeted intervention approaches are feasible to address EOL outcomes for AA patients and families experiencing serious illness.
Supporting Interprofessional Engagement in Serious Illness Conversations
Authors: Beddard-Huber Elizabeth , Strachan Patricia , Brown Susan , Kennedy Vicki , Marles Maria Mia , Park Sungyou , Roberts Della
Published: November 2020

Communication is vital to quality palliative care nursing particularly when caring for someone with a chronic life-limiting illness and their family. Conversations about future decline and preferred care are considered challenging and difficult and are often avoided, resulting in missed opportunities for improving care. To support more, earlier, better conversations, health care organizations in British Columbia, Canada, adopted the Serious Illness Care Program inclusive of the Serious Illness Conversation Guide developed by Ariadne Labs. Workshops for interprofessional team members have been held throughout the province. Nurses and allied health identified the need for more guidance in using the guide in the contexts of their clinical practice. Specifically challenging has been prognosis communication that falls within the scope of practice for each profession. Informed by workshop feedback, an expert team of nurse clinicians and educators tailored an interprofessional clinician reference guide to optimize the guide's use across health care settings. In this article, we present the adaptations focusing on (1) the role of nurses and allied health in serious illness communication, (2) prognosis communication, and (3) a range of role-play scenarios specific to nonphysician practice for serious illness conversations that may arise within the process of care.
Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti–CD20-based Biological Therapy
Authors: Sohani Aliyah R. , Maurer Matthew J. , Giri Sharmila , Pitcher Brandelyn , Chadburn Amy , Said Jonathan W. , Bartlett Nancy L. , Czuczman Myron S. , Martin Peter , Rosenbaum Cara A. , Jung Sin-Ho , Leonard John P. , Cheson Bruce D. , Hsi Eric D.
Published: November 2020

Follicular lymphoma (FL) is an indolent B-cell neoplasm of germinal center origin. Standard treatment regimens consist of anti-CD20 therapy with or without chemotherapy. While high response rates to initial therapy are common, patients ultimately relapse or have progressive disease. Clinical risk factors such as the Follicular Lymphoma International Prognostic Index (FLIPI) have been identified, but there is a need for prognostic and predictive biomarkers. We studied markers of lymphoma cells and tumor microenvironment by immunohistochemistry in tissue samples from patients enrolled in 1 of 4 phase 2 trials of anti–CD20-based biological therapy for previously untreated grades 1 to 2 or 3A FL. Results were correlated with progression-free survival (PFS) and PFS status at 24 months. The 4 trials included 238 patients (51.1% male, median age: 55 y) with stage III, IV, or bulky stage II disease. By FLIPI, 24.6% had low-risk, 56.8% had intermediate-risk, and 18.6% had high-risk disease. The outcome differed significantly for patients treated with lenalidomide and rituximab (CALGB 50803) compared with the other 3 trials (median: PFS not reached vs. 3.0 y, hazard ratio=3.47, 95% confidence interval: 2.11-5.72); therefore, data were stratified by clinical trial (CALGB 50803 vs. all others) and adjusted for FLIPI risk group. Among 154 patients with available tissue, interfollicular BCL6 positivity, interfollicular CD10 positivity, and elevated Ki67 proliferation index ≥30% within neoplastic follicles were each associated with inferior PFS and a high risk of the early event by PFS status at 24 months. We identify promising biomarkers for FL risk stratification that warrant further validation in phase 3 trials.
Decreased Human Leukocyte Antigen DR on Circulating Monocytes Expression After Severe Pediatric Trauma: An Exploratory Report
Authors: Cour-Andlauer Fleur , Morrow Brenda M. , McCulloch Mignon , Javouhey Etienne , Lecour Sandrine , van As Sebastian , Remy Solenn , Monneret Guillaume , Argent Andrew C.
Published: November 2020

OBJECTIVES:

Major trauma in adults induces immune dysfunction, with diminished expression of human leukocyte antigen-DR on circulating monocytes. No pediatric data are available. This study described the kinetics of human leukocyte antigen-DR on circulating monocytes following major pediatric trauma and relationships between human leukocyte antigen-DR on circulating monocytes and outcomes.

DESIGN:

Prospective observational study.

SETTING:

PICU and trauma unit at a tertiary-care university hospital in South Africa.

PATIENTS:

Children between 1 month and 13 years hospitalized for severe brain trauma or trauma with an Injury Severity Score greater than or equal to 16, from November 2016 to March 2017.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We included 36 children. Median (interquartile range) age and Injury Severity Score were 7 years (4.9–10.5 yr) and 25 years (22.7–30 yr), respectively. Blood samples (n = 83) for standardized human leukocyte antigen-DR on circulating monocytes measurement were collected at days 1–2, 3–4, and 8–9 after injury (D1, D3, and D8, respectively). On D1, median (interquartile range) human leukocyte antigen-DR on circulating monocytes was markedly reduced relative to normal values (7,031 [5,204–11,201] antibodies per cell). There was a significant increase in human leukocyte antigen-DR on circulating monocytes from D1 to D8. Although all patients with secondary infections (n = 8; 22%) had human leukocyte antigen-DR on circulating monocytes less than 15,000 antibodies per cell at D3, human leukocyte antigen-DR on circulating monocytes levels were not associated with the occurrence of secondary infections (p = 0.22). At D3, human leukocyte antigen-DR on circulating monocytes was significantly higher in patients discharged home (n = 21) by Day 30 after trauma compared with those who died or were still hospitalized (n = 14) (p = 0.02).

CONCLUSIONS:

Pediatric severe trauma induced an early and dramatic decrease in human leukocyte antigen-DR on circulating monocytes expression. This alteration of innate immunity was not associated with the occurrence of secondary infection, possibly due to a lack of statistical power. However, human leukocyte antigen-DR on circulating monocytes at Day 3 is a potential indicator of those at high risk of secondary infection and worse outcomes.
National Survey to Describe the Current Patterns of Procedural Sedation Practices Among Pediatric Emergency Medicine Practitioners in the United States
Authors: Choudhary Deepak , Dhillon Reshvinder , Chadha Kunal , Cross Keith , Carnevale Frank P.
Published: November 2020

Objective

Pediatric procedural sedation (PPS) is used to maintain children's safety, comfort, and cooperation during emergency department procedures. Our objective was to gather data describing PPS practice across the United States to highlight the variations in practice and adherence to National Guidelines.

Methods

We performed a nationwide survey of PPS practitioners using a secure web-based software program. A link to the survey was sent to all subscribers of a pediatric emergency medicine listserv. We collected participant demographics, their PPS approach for personnel, monitoring, equipment, postsedation observation, and side effects, as well as providers' medication preferences for 3 common PPS scenarios.

Results

We received 211 completed surveys from 34 States. There were 20.6% respondents that were based in New York, 83.4% were pediatric emergency medicine attendings, and 91.7% were based in the United States teaching hospitals. Our participants learned PPS by various methods, most commonly: observation of at least 10 PPS (29.9%); self-study (24.8%); and classroom lectures (24.5%). Seventy-seven percent of our participants reported no body mass index cutoff to do PPS. There were 31.5% of our participants that observe children after PPS up to 1 hour, 30.1% up to 2 hours. There were 67.7% of the PPS providers that were a separate person from the practitioner doing the procedure, and 98.2% required a separate trained nurse to be present for monitoring. There were 92.6% of PPS providers that measure end-tidal carbon dioxide (ETCO2) during the sedation. Most PPS providers reported having no reversal agents (71.4%) and no defibrillator (65.9%) at bedside. For the abscess drainage scenario, 22% of participants preferred local anesthetic alone, and 22.5% preferred utilizing local anesthetic in combination with intravenous ketamine. For a forearm fracture reduction scenario, 62.8% of participants would choose intravenous ketamine alone. For the laceration repair scenario, the most favored drug combination was local anesthesia + intranasal midazolam by 39.8% of participants.

Conclusions

Our study demonstrates a wide variability in several aspects of PPS and low adherence to national PPS guidelines.
A Pragmatic Randomized Controlled Trial to Increase PrEP Uptake for HIV Prevention: 55-Week Results From PrEPChicago
Authors: Schneider John A. , Young Lindsay , Ramachandran Arthi , Michaels Stuart , Cohen Hildie , Robinson Ishida , Alon Leigh , Hill Brandon , Nakasone Sarah , Balenciaga Mario , Motley Darnell , Bouris Alida , Khanna Aditya , Ferreira Matthew , Valente Thomas , Schumm Phillip ,   for the PrEP Chicago Network Intervention Team
Published: November 2020

Objectives:

We tested preliminary efficacy of a peer change agent type I network intervention to increase pre-exposure prophylaxis (PrEP) linkage to care among network members connected to young Black men who have sex with men.

Design:

Parent study is a pragmatic randomized controlled trial with 110 weeks of total follow-up. Interim midpoint analyses are performed here using participant data before crossover assignment at 55 weeks.

Methods:

We randomly assigned 423 participants in Chicago to receive the network intervention, an opinion leader workshop with telephonic booster sessions, versus a time-matched control from 2016 to 2018. The consolidated surrogate outcome was PrEP referral and linkage to clinical care among network members connected to study participants and was collected from independent administrative data.

Results:

Each study participant in the trial (n = 423) had on average 1822 network contacts who could be eligible for PrEP referral and linkage. During the 55-week observation period, PrEP referral was most likely to occur within 3 days of an intervention session compared to control [odds ratio (OR) 0.07 (0.02–0.013); P = 0.007] resulting in 1–2 referrals of network members per session. Network members with referral or linkage were more likely to be connected to study participants in the intervention arm than the control condition [aOR 1.50 (1.09–2.06); P = 0.012].

Conclusions:

A peer change agent type I network intervention is preliminarily effective at diffusing PrEP through a network of individuals highly susceptible to HIV over 55 weeks. This low-intensity intervention demonstrated network-level impact among populations that have experienced limited PrEP care engagement in the United States.
Expanding the Vision for Differentiated Service Delivery: A Call for More Inclusive and Truly Patient-Centered Care for People Living With HIV
Authors: Ehrenkranz Peter , Grimsrud Anna , Holmes Charles B. , Preko Peter , Rabkin Miriam
Published: November 2020

Background:

Simplifying antiretroviral therapy for clinically stable people living with HIV (PLHIV) is important but insufficient to meet their health care needs, including prevention and treatment of tuberculosis and noncommunicable diseases, routine primary care, and family planning. Integrating these services into differentiated service delivery (DSD) platforms is a promising avenue to achieve such coverage. We propose a transition from an HIV-focused “DSD 1.0” to a patient-centered “DSD 2.0” that is inclusive of additional chronic care services for PLHIV.

Discussion:

The lack of coordination between HIV programs and these critical services puts a burden on both PLHIV and health systems. For individual patients, fractionated services increase cost and time, diminish the actual and perceived quality of care, and increase the risk that they will disengage from health care altogether. The burden on the health system is one of inefficiency and suboptimal outcomes resulting from the parallel systems required to manage multiple vertical programs.

Conclusions:

DSD 2.0 provides an opportunity for the HIV and Universal Health Coverage agendas—which can seem to be at odds—to achieve greater collective impact for patients and health systems by integrating strong vertical HIV, tuberculosis and family planning programs, and relatively weaker noncommunicable disease programs. Increasing coordination of care for PLHIV will increase the likelihood of achieving and sustaining UNAIDS′ goals of retention on antiretroviral therapy and viral suppression. Eventually, this shift to DSD 2.0 for PLHIV could evolve to a more person-centered vision of chronic care services that would also serve the general population.
Brief Report: Modeling the Impact of Voluntary Medical Male Circumcision on Cervical Cancer in Uganda
Authors: Davis Stephanie M. , Habel Melissa A. , Pretorius Carel , Yu Teng , Toledo Carlos , Farley Timothy , Kabuye Geoffrey , Samuelson Julia
Published: November 2020

Background:

In addition to providing millions of men with lifelong lower risk for HIV infection, voluntary medical male circumcision (VMMC) also provides female partners with health benefits including decreased risk for human papillomavirus (HPV) and resultant cervical cancer (CC).

Setting:

We modeled potential impacts of VMMC on CC incidence and mortality in Uganda as an additional benefit beyond HIV prevention.

Methods:

HPV and CC outcomes were modeled using the CC model from the Spectrum policy tool suite, calibrated for Uganda, to estimate HPV infection incidence and progression to CC, using a 50-year (2018–2067) time horizon. 2016 Demographic Health Survey data provided baseline VMMC coverage. The baseline (no VMMC scale-up beyond current coverage, minimal HPV vaccination coverage) was compared with multiple scenarios to assess the varying impact of VMMC according to different implementations of HPV vaccination and HPV screening programs.

Results:

Without further intervention, annual CC incidence was projected to rise from 16.9 to 31.2 per 100,000 women in 2067. VMMC scale-up alone decreased 2067 annual CC incidence to 25.3, averting 13,000 deaths between 2018 and 2067. With rapidly-achieved 90% HPV9 vaccination coverage for adolescent girls and young women, 2067 incidence dropped below 10 per 100,000 with or without a VMMC program. With 45% vaccine coverage, the addition of VMMC scaleup decreased incidence by 2.9 per 100,000 and averted 8000 additional deaths. Similarly, with HPV screen-and-treat without vaccination, the addition of VMMC scaleup decreased incidence by 5.1 per 100,000 and averted 10,000 additional deaths.

Conclusions:

Planned VMMC scale-up to 90% coverage from current levels could prevent a substantial number of CC cases and deaths in the absence of rapid scale-up of HPV vaccination to 90% coverage.
A Health Care Value Framework for Physical Therapy Primary Health Care Organizations
Authors: IJntema Rutger Friso , Barten Di-Janne , Duits Hans B. , Tjemkes Brian V. , Veenhof Cindy
Published: November 2020

Background and Objective:

To develop a health care value framework for physical therapy primary health care organizations including a definition.

Method:

A scoping review was performed. First, relevant studies were identified in 4 databases (n = 74). Independent reviewers selected eligible studies. Numerical and thematic analyses were performed to draft a preliminary framework including a definition. Next, the feasibility of the framework and definition was explored by physical therapy primary health care organization experts.

Results:

Numerical and thematic data on health care quality and context-specific performance resulted in a health care value framework for physical therapy primary health care organizations—including a definition of health care value, namely “to continuously attain physical therapy primary health care organization-centered outcomes in coherence with patient- and stakeholder-centered outcomes, leveraged by an organization's capacity for change.”

Conclusion:

Prior literature mainly discussed health care quality and context-specific performance for primary health care organizations separately. The current study met the need for a value-based framework, feasible for physical therapy primary health care organizations, which are for a large part micro or small. It also solves the omissions of incoherent literature and existing frameworks on continuous health care quality and context-specific performance. Future research is recommended on longitudinal exploration of the HV (health care value) framework.
Gel Rounds
Authors: Nauka Peter C. , Pellerito John S. , Ohngemach Daniel J. , Persaud Radha , Rennie William , D'Agostino Catherine
Published: November 2020

Despite formal ultrasound training becoming prevalent in preclinical medical student education, significant barriers remain to the continuation of this training during clinical years. We sought to develop a program for third-year medical students to continue ultrasound training after an already robust preclinical ultrasound curriculum and evaluate their scanning confidence after participation. We developed a program to facilitate bedside ultrasound scanning of patients being cared for by third-year students. Students identified appropriate patients to be scanned, obtained consent for scanning, and determined which scans were most appropriate given the patient's clinical problems. Trained facilitators met with students at the bedside in 1-hour sessions called Gel Rounds to observe and direct the students' scans of their patients. Fifty-one students were surveyed after completing Gel Rounds. Students were significantly more likely to feel comfortable with independently acquiring and interpreting images after Gel Rounds than before completing the activity. Approximately 67% of students felt that ultrasound had utility in assisting bedside clinical reasoning, and this proportion did not change significantly after completing Gel Rounds. Gel Rounds was a positive continuation of the ultrasound curriculum into the third-year clerkship environment. A minority of students reported prior ultrasound exposure in their third year, reflecting difficulty with developing a longitudinal curriculum. The activity helped students to independently acquire and interpret images in patients. Because Gel Rounds can be performed at the discretion of students and faculty, it fits naturally in a variety of existing longitudinal curricula.
The Performance of a 2-Dimensional Shear-Wave Elastography Technique for Predicting Different Stages of Liver Fibrosis Using Transient Elastography as the Control Method
Authors: Bende Felix , Sporea Ioan , Şirli Roxana , Nistorescu Silviu , Fofiu Renata , Bâldea Victor , Popescu Alina
Published: November 2020

The aim was to evaluate the performance of 2-dimensional (2D) shear-wave elastography from general electric (2D SWE-GE), implemented on the new LOGIQ S8 system, for the noninvasive assessment of liver fibrosis, and to identify liver stiffness (LS) cutoff values for predicting different stages of fibrosis using transient elastography (TE) as the control method. We included 179 consecutive subjects, with or without chronic hepatopathies, in whom LS was evaluated in the same session using 2 elastographic techniques: TE (FibroScan, EchoSens) and 2D SWE-GE (LOGIQ S8; GE Healthcare, Chalfont St Giles, United Kingdom). Reliable LS measurements were defined for TE: the median value of 10 measurements with a success rate of 60% or greater and an interquartile range/median ratio (IQR/M) < 0.30; for 2D SWE-GE: the median value of 10 measurements acquired in a homogenous area and IQR/M < 0.30. To discriminate between fibrosis stages by TE, we used the following cutoffs: F2–7; F3–9.5 and F4–12 kPa. Reliable LS measurements were obtained in 97.2% subjects by 2D SWE-GE and in 98.3% by TE (P = 0.72), so that 171 subjects were included for the final analysis. A good correlation was found between the LS values obtained by the 2 methods (r = 0.72, P < 0.0001). The best 2D SWE-GE cutoff value for F ≥ 2 was 6.9 kPa (areas under receiver operating characteristic [AUROC], 0.93; sensitivity, 85.8%; specificity, 90.2%), for F of 3 or greater, it was 8.2 kPa (AUROC, 0.93; sensitivity, 87.5%; specificity, 86.8%) and for F value of 4, it was 9.3 kPa (AUROC, 0.91; sensitivity, 85.7%; specificity, 81.2%). In conclusion, the best 2D SWE-GE (S8) cutoff values for predicting F2, F ≥ 3 and F = 4 were 6.9, 8.2, and 9.3 kPa.
The Borderline-Size Appendix
Authors: Madhuripan Nikhil , Jawahar Anugayathri , Jeffrey R. Brooke , Olcott Eric W.
Published: November 2020

Diagnostic criteria for acute appendicitis using graded compression sonography have been well established based on the maximum outer diameter (MOD) of the appendix, with MOD values of <6 mm nearly always indicating normal appendices and MOD values of >8 mm nearly always indicating appendicitis. However, the “borderline-size” appendix, meaning one whose MOD lies between these ranges (ie, an appendix with MOD of 6–8 mm), presents a diagnostic dilemma because appendices in this size range are neither clearly normal nor abnormal when diagnosis is based on the MOD alone; accordingly, such borderline MOD values are diagnostically equivocal, and sonographic diagnosis must rely on sonographic findings other than the MOD. The goal of this review was to examine the additional sonographic findings that can add specificity and help enable an accurate diagnosis to be made in patients with borderline-size appendices.
Midface Morphology and Growth in Syndromic Craniosynostosis Patients Following Frontofacial Monobloc Distraction
Authors: Tonello Cristiano , Cevidanes Lucia H.S. , Ruellas Antonio C.O. , Alonso Nivaldo
Published: November 2020

Background:

Facial advancement represents the essence of the surgical treatment of syndromic craniosynostosis. Frontofacial monobloc distraction is an effective surgical approach to correct midface retrusion although someone consider it very hazardous procedure. The authors evaluated a group of patients who underwent frontofacial monobloc distraction with the aim to identify the advancement results performed in immature skeletal regarding the midface morphologic characteristics and its effects on growth.

Methods:

Sixteen patients who underwent frontofacial monobloc distraction with pre- and postsurgical computed tomography (CT) scans were evaluated and compared to a control group of 9 nonsyndromic children with CT scans at 1-year intervals during craniofacial growth. Three-dimensional measurements and superimposition of the CT scans were used to evaluate midface morphologic features and longitudinal changes during the craniofacial growth and following the advancement. Presurgical growth was evaluated in 4 patients and postsurgical growth was evaluated in 9 patients.

Results:

Syndromic maxillary width and length were reduced and the most obtuse facial angles showed a lack in forward projection of the central portion in these patients. Three-dimensional distances and images superimposition demonstrated the age did not influence the course of abnormal midface growth.

Conclusion:

The syndromic midface is hypoplastic and the sagittal deficiency is associated to axial facial concavity. The advancement performed in mixed dentition stages allowed the normalization of facial position comparable to nonsyndromic group. However, the procedure was not able to change the abnormal midface architecture and craniofacial growth.
Rotation of the Ipsilateral Supraorbital Rim Around the Horizontal Axis in Unilateral Coronal Synostosis: A Craniometric Analysis of the Emergence Profile
Authors: Margulies Ilana G. , Sanati-Mehrizy Paymon , Goel Pedram , Graziano Francis , Bui Anthony H. , Som Peter M. , Urata Mark M. , Taub Peter J.
Published: November 2020

Introduction:

Unilateral coronal synostosis (UCS) results in well-defined dysmorphic changes including sphenoid malposition yielding posterior displacement of the supraorbital rim. Although variation in the ipsilateral supraorbital rim emergence profile has been suggested, it has not been previously investigated. The authors sought to characterize the emergence profile of the ipsilateral supraorbital rim in UCS through craniometric analysis.

Methods:

Thirty-five nonsyndromic UCS patients (0–18 months) with CT images obtained before operative intervention and 16 control patients (0–24 months, 32 orbits) were included. Craniometric measurements were performed to quantify the emergence profile of the ipsilateral supraorbital rim and locate the likely apex of rotation.

Results:

The ipsilateral supraorbital rim was significantly rotated around the horizontal axis when measured in reference to the 0° vertical in UCS versus control patients by an average difference of 7.3° to 11.3° across age groups (P < 0.05). No significant effect modification was detected between age and UCS on ipsilateral supraorbital rim emergence profile (P > 0.05). Additional angles with vertices around the superior orbital circumference were then measured to locate the likely apex of rotation and revealed a significant decrease in the posterior orbital roof to 0° horizontal in UCS patients by an average of 9.3° to 22.1° in children under 1 year old (P < 0.01).

Conclusion:

Variation in the emergence profile of the ipsilateral supraorbital rim in UCS is quantified, and the apex of this rotation likely lies at the posterior orbital roof. The novel quantification and characterization of this deformity will better direct the operative approach and enable a more accurate correction.
Optic Disc Cupping Due to Dolichoectatic Internal Carotid Artery Optic Nerve Compression
Authors: Micieli Jonathan A. , Margolin Edward A.
Published: November 2020

Background:

To determine whether significant compression of the optic nerve by the internal carotid artery (ICA) can produce an optic neuropathy with optic disc cupping that resembles glaucoma in patients without elevated intraocular pressure (IOP).

Methods:

This was a retrospective case series of patients referred to neuro-ophthalmology for a possible nonglaucomatous optic neuropathy. Patients were included in the study if they had preserved visual acuity, optic disc-related visual field defects, optic nerve cupping, IOP less than 21 mm Hg, open angles, and unequivocal radiological compression of the ipsilateral optic nerve by an intracranial blood vessel.

Results:

Three patients were included with a mean age of 56.3 (range 29–82) years. Patient 1 was a 58-year-old man incidentally noted to have left optic nerve cupping on a routine examination. He had an inferior arcuate defect and the left prechiasmatic optic nerve was elevated and compressed by a tortuous left ICA. Patient 2 was a 29-year-old man with a normal-tension glaucoma (NTG) diagnosis for 7 years in the right eye treated with latanoprost. He had a superior greater than inferior arcuate defect and there was vascular compression of the optic nerve between the supraclinoid ICA and A1 segment of the anterior cerebral artery. Patient 3 was an 82-year-old woman with an NTG diagnosis for 10 years who had progression of her visual field defects despite low IOPs. MRI showed mass effect on the right optic nerve by a dolichoectatic right supraclinoid ICA.

Conclusions:

Significant compression of the optic nerve by a normal, tortuous, or dolichoectatic ICA may result in an optic neuropathy with optic disc cupping that resembles glaucoma.
Pituitary Macroadenoma Presenting With Monocular Temporal Hemianopia
Authors: Gupta Ankur , Deshmukh Mira , Palexas George
Published: November 2020

A 35-year-old primigravida woman presented to the eye emergency department with reduced visual acuity in the right eye. Humphrey visual field testing showed a monocular right eye temporal hemianopia before delivery. An MRI after delivery revealed a largely symmetrical pituitary macroadenoma with chiasmal compression. This is a rare presentation of a pituitary macroadenoma especially when the tumor is largely symmetrical.
Horizontal Gaze Palsy, Scoliosis, and Split Pons Sign in a 6-Year-Old Girl
Authors: Singanamalla Bhanudeep , Chaurasia Shweta , Jain Chirag , Bhatia Vikas , Sharma Neeraj , Madaan Priyanka , Gopinathan Nirmal Raj , Saini Lokesh
Published: November 2020

A 6-year-old girl presented with complaints of absent horizontal eye movements since birth. There was also associated progressive scoliosis for past 1 year. Neuroimaging revealed split pons sign, butterfly-shaped medulla, and prominent inferior olivary nuclei. The presence of congenital horizontal gaze palsy, childhood onset progressive scoliosis, and abnormal neuroimaging findings confirmed the diagnosis of horizontal gaze palsy with progressive scoliosis. This case highlights the importance of neuroimaging in a child presenting with horizontal gaze palsy and scoliosis that helped for starting early rehabilitation of the child, prevention of permanent vision loss, and parental counseling for future pregnancies.
Facial Nerve Involvement Accompanying Optic Neuritis Secondary to Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disorder
Authors: Chen Zhiyong , Saini Monica , Loo Jing Liang
Published: November 2020

We present the first reported case of facial nerve involvement accompanying an optic neuritis in myelin oligodendrocyte glycoprotein antibody–associated disorder.
Resurrecting the discussion on neurotoxicity of lithium at therapeutic levels
Authors: Jha Aishwariya , Pai Naveen Manohar , Ganjekar Sundarnag , Desai Geetha , Chaturvedi Santosh K.
Published: November 2020

Lithium is widely used in the treatment of bipolar disorder. Here we describe the syndrome of irreversible lithium-effectuated neurotoxicity in a patient within therapeutic doses and levels, which persisted after discontinuation of Lithium. A 50-year-old gentleman with Bipolar disorder presented with symptoms of Mania following drug default. Lithium was initiated as a mood stabilizer. On day 4, the patient developed abdominal pain, itching, and sore throat. On day 5, lithium levels were 0.9 mEq/L. Subsequently, the patient was noted to have slurring of speech, dysarthria, past pointing, and dysdiadochokinesis. Lithium was withdrawn on day 7. When lithium was re-introduced at a lower dose, the neurological symptoms re-appeared after 2 days and lithium was discontinued. Mild degree of slurring of speech persisted at 2-month follow-up. The patient had no history of side effects with antipsychotics in the past or current episode. In the absence of predisposing factors, Lithium has resulted in neurotoxicity at therapeutic doses and levels. Slurring of speech persisted despite adequate dose of anticholinergics. In addition to presumed neuroprotective effects of lithium, it can produce neurotoxic symptoms at therapeutic doses and levels.
Consumer regulation of the carbon cycle in coastal wetland ecosystems
Authors: He Qiang , Li Haoran , Xu Changlin , Sun Qingyan , Bertness Mark D. , Fang Changming , Li Bo , Silliman Brian R.
Published: November 2020

Despite escalating anthropogenic alteration of food webs, how the carbon cycle in ecosystems is regulated by food web processes remains poorly understood. We quantitatively synthesize the effects of consumers (herbivores, omnivores and carnivores) on the carbon cycle of coastal wetland ecosystems, ‘blue carbon’ ecosystems that store the greatest amount of carbon per unit area among all ecosystems. Our results reveal that consumers strongly affect many processes of the carbon cycle. Herbivores, for example, generally reduce carbon absorption and carbon stocks (e.g. aboveground plant carbon by 53% and aboveground net primary production by 23%) but may promote some carbon emission processes (e.g. litter decomposition by 32%). The average strengths of these effects are comparable with, or even times higher than, changes driven by temperature, precipitation, nitrogen input, CO
2
concentration, and plant invasions. Furthermore, consumer effects appear to be stronger on aboveground than belowground carbon processes and vary markedly with trophic level, body size, thermal regulation strategy and feeding type. Despite important knowledge gaps, our results highlight the powerful impacts of consumers on the carbon cycle and call for the incorporation of consumer control into Earth system models that predict anthropogenic climate change and into management strategies of Earth's carbon stocks.

This article is part of the theme issue ‘Integrative research perspectives on marine conservation’.
Temperature variability alters the stability and thresholds for collapse of interacting species
Authors: Dee Laura E. , Okamtoto Daniel , Gårdmark Anna , Montoya Jose M. , Miller Steve J.
Published: November 2020

Temperature variability and extremes can have profound impacts on populations and ecological communities. Predicting impacts of thermal variability poses a challenge, because it has both direct physiological effects and indirect effects through species interactions. In addition, differences in thermal performance between predators and prey and nonlinear averaging of temperature-dependent performance can result in complex and counterintuitive population dynamics in response to climate change. Yet the combined consequences of these effects remain underexplored. Here, modelling temperature-dependent predator–prey dynamics, we study how changes in temperature variability affect population size, collapse and stable coexistence of both predator and prey, relative to under constant environments or warming alone. We find that the effects of temperature variation on interacting species can lead to a diversity of outcomes, from predator collapse to stable coexistence, depending on interaction strengths and differences in species' thermal performance. Temperature variability also alters predictions about population collapse—in some cases allowing predators to persist for longer than predicted when considering warming alone, and in others accelerating collapse. To inform management responses that are robust to future climates with increasing temperature variability and extremes, we need to incorporate the consequences of temperature variation in complex ecosystems.

This article is part of the theme issue ‘Integrative research perspectives on marine conservation’.
Citizen science and marine conservation: a global review
Authors: Kelly Rachel , Fleming Aysha , Pecl Gretta T. , von Gönner Julia , Bonn Aletta
Published: November 2020

Climate change, overfishing, marine pollution and other anthropogenic drivers threaten our global oceans. More effective efforts are urgently required to improve the capacity of marine conservation action worldwide, as highlighted by the United Nations Decade of Ocean Science for Sustainable Development 2021–2030. Marine citizen science presents a promising avenue to enhance engagement in marine conservation around the globe. Building on an expanding field of citizen science research and practice, we present a global overview of the current extent and potential of marine citizen science and its contribution to marine conservation. Employing an online global survey, we explore the geographical distribution, type and format of 74 marine citizen science projects. By assessing how the projects adhere to the Ten Principles of Citizen Science (as defined by the European Citizen Science Association), we investigate project development, identify challenges and outline future opportunities to contribute to marine science and conservation. Synthesizing the survey results and drawing on evidence from case studies of diverse projects, we assess whether and how citizen science can lead to new scientific knowledge and enhanced environmental stewardship. Overall, we explore how marine citizen science can inform current understanding of marine biodiversity and support the development and implementation of marine conservation initiatives worldwide.

This article is part of the theme issue ‘Integrative research perspectives on marine conservation’.
Mechanism of ligand recognition by human ACE2 receptor
Authors: Bhattarai Apurba , Pawnikar Shristi , Miao Yinglong
Published: November 2020

Angiotensin converting enzyme 2 (ACE2) plays a key role in renin-angiotensin system regulation and amino acid homeostasis. Human ACE2 acts as the receptor for severe acute respiratory syndrome coronaviruses SARS-CoV and SARS-CoV-2. ACE2 is also widely expressed in epithelial cells of lungs, heart, kidney and pancreas. It is considered an important drug target for treating SARS-CoV-2, as well as pulmonary diseases, heart failure, hypertension, renal diseases and diabetes. Despite the critical importance, the mechanism of ligand binding to the human ACE2 receptor remains unknown. Here, we address this challenge through all-atom simulations using a novel ligand Gaussian accelerated molecular dynamics (LiGaMD) method. Microsecond LiGaMD simulations have successfully captured both binding and unbinding of the MLN-4760 inhibitor in the ACE2 receptor. In the ligand unbound state, the ACE2 receptor samples distinct Open, Partially Open and Closed conformations. Ligand binding biases the receptor conformational ensemble towards the Closed state. The LiGaMD simulations thus suggest a conformational selection mechanism for ligand recognition by the ACE2 receptor. Our simulation findings are expected to facilitate rational drug design of ACE2 against coronaviruses and other related human diseases.
Understanding The Role of Magnetic and Magneto-Quasistatic Fields in Human Body Communication
Authors: Nath Mayukh , Ulvog Alfred Krister , Weigand Scott , Sen Shreyas
Published: November 2020

With the advent of wearable technologies, Human Body Communication (HBC) has emerged as a physically secure and power-efficient alternative to the otherwise ubiquitous Wireless Body Area Network (WBAN). Whereas the most investigated nodes of HBC have been Electric and Electro-quasistatic (EQS) Capacitive and Galvanic, recently Magnetic HBC (M-HBC) has been proposed as a viable alternative. Previous works have investigated M-HBC through an application point of view, without developing a fundamental working principle for the same. In this paper, for the first time, a ground up analysis has been performed to study the possible effects and contributions of the human body channel in M-HBC over a broad frequency range (1kHz to 10 GHz), by detailed electromagnetic simulations and supporting experiments. The results show that while M-HBC can be successfully operated as a body area network, the human body itself plays a minimal or negligible role in it’s functionality. For frequencies less than∼30 Hz, in the domain of operation of Magneto-quasistatic (MQS) HBC, the human body is transparent to the quasistatic magnetic field. Conversely for higher frequencies, the conductive nature of human tissues end up attenuating Magnetic HBC fields due to Eddy currents induced in body tissues, eliminating the possibility of the body to support efficient waveguide modes. With this better understanding at hand, different modes of operations of MQS HBC have been outlined for both high impedance capacitive and 50Ω termination cases, and their performances have been compared with EQS HBC for similar sized devices, over varying distance between TX and RX. The resulting report presents the first fundamental understanding towards M-HBC operation and its contrast with EQS HBC, aiding HBC device designers to make educated design decisions, depending on mode of applications.
Viral genome sequencing places White House COVID-19 outbreak into phylogenetic context
Authors: Bedford Trevor , Logue Jennifer K. , Han Peter D. , Wolf Caitlin R. , Frazar Chris D. , Pelle Benjamin , Ryke Erica , Hadfield James , Lee Jover , Rieder Mark J. , Nickerson Deborah A. , Lockwood Christina M. , Starita Lea M. , Chu Helen Y. , Shendure Jay
Published: November 2020

In October 2020, an outbreak of at least 50 COVID-19 cases was reported surrounding individuals employed at or visiting the White House. Here, we applied genomic epidemiology to investigate the origins of this outbreak. We enrolled two individuals with exposures linked to the White House COVID-19 outbreak into an IRB-approved research study and sequenced their SARS-CoV-2 infections. We find these viral sequences are identical to each other, but are distinct from over 190,000 publicly available SARS-CoV-2 genomes. These genomes fall as part of a lineage circulating in the USA since April or May 2020 and detected in Virginia and Michigan. Looking forwards, sequencing of additional community SARS-CoV-2 infections collected in the USA prior to October 2020 may shed further light on its geographic ancestry. In sequencing of SARS-CoV-2 infections collected after October 2020, it may be possible to identify infections that likely descend from the White House COVID-19 outbreak.