bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent Advances and New Challenges in Cisgender Women’s Gynecologic and Obstetric Health in the Context of HIV
Authors: DEESE JENNIFER , HEFFRON RENEE , JASPAN HEATHER , MASSON LINDI , SMIT JENNIFER A. , SIBEKO SENGEZIWE
Published: May 2021

Although rates of human immunodeficiency virus (HIV) have declined globally over the past 10 years, United Nations Programme on HIV/AIDS estimates 1.7 million new infections occurred in 2019, with cisgender women (cis women) and girls accounting for 48%. Acquired immune deficiency syndrome-related illnesses are the leading global cause of mortality in cis women aged 15 to 49, and in many sub-Saharan Africa countries, young women face substantially higher HIV risk than their male counterparts. Drivers of this increased risk include sexual and reproductive health characteristics unique to cis women. This review discusses the role of sexually transmitted infections, contraception and pregnancy in HIV risk, and biomedical HIV prevention technologies available and in development.
Impact of Graves Disease on Ocular Surface and Corneal Epithelial Thickness in Patients With and Without Graves Orbitopathy
Authors: Carreira Ana Rita , Rodrigues-Barros Sandra , Moraes Filipe , Loureiro Tomás , Machado Inês , Campos Paul , Nobre Cardoso João , Campos Nuno
Published: May 2021

Purpose:

Our aim was to assess ocular surface and tear film stability and corneal epithelial thickness (CET) in patients with Graves disease (GD) with and without Graves orbitopathy (GO).

Methods:

This study included healthy age-matched controls and patients with GD. Symptoms (Ocular Surface Disease Index questionnaire) and signs (schirmer test and tear breakup time test) of dry eye disease were determined, according to the International Dry Eye Workshop II criteria of DED. CET map was also assessed.

Results:

Twenty-four eyes were included in the control group, with a mean age of 41.00 ± 13.65 years, and 34 in the GD group, 18 with GO and 16 without GO, with a mean age of 44.44 ± 13.95 and 45.75 ± 10.59 years, respectively. All patients with GO had inactive disease (mean clinical activity score: 1.33 ± 0.69). Patients with GD had higher proportion of clinical diagnosis of dry eye disease (GO vs. GD without GO vs. controls: 77.77% vs. 75.00% vs. 4.17%), with higher Ocular Surface Disease Index (GO vs. GD without GO vs. controls: 15.44 vs. 15.06 vs. 9.88) and lower tear breakup time test (GO vs. GD without GO vs. controls: 6.33 s vs. 7.25 s vs. 11.63 s). Superior CET was lower in patients with GD (P < 0.05). No differences were found between patients with and without GO (P > 0.05).

Conclusions:

GD negatively influenced ocular surface and CET, with a higher level of eye dryness and corneal thinning regardless of GO status, suggesting that subclinical chronic inflammation may play a role in the pathogenesis of tear film and ocular surface stability.
Late Corneal Stromal Deposits After COVID-19
Authors: Pareja-Ríos Alicia , Bonaque-González Sergio
Published: May 2021

We present 2 cases of striking stromal corneal infiltrates months after COVID-19 infection. While we cannot prove that these infiltrates are caused by or directly related to COVID-19, we did not find any other plausible cause that could explain these ophthalmic signs. In these cases, the ongoing process was detected in relatively early stages due to scheduled visits with patients and responded positively to prednisolone acetate 1% ophthalmic suspension. However, we do not know the response to treatment in more advanced cases.
The Intersection of Gross Motor Abilities and Participation in Children With Autism Spectrum Disorder
Authors: Holloway Jamie M. , Long Toby M. , Biasini Fred J.
Published: May 2021

Many children with autism spectrum disorder (ASD) demonstrate movement difficulties in addition to problems with social communication and interactions, and repetitive or restrictive behaviors. The goal of early intervention for children with disabilities is to promote participation in routines and activities, but little is known about the role gross motor abilities contribute to participation for young children with ASD. The purpose of this study was to examine relationships between gross motor abilities and participation in preschool-aged children with ASD. Twenty-two children with ASD participated in the study. Gross motor skills were measured using the Peabody Developmental Motor Scales, Second Edition. Participation was measured using the Preschool Activity Card Sort. Children who had greater gross motor skills also demonstrated greater participation in self-care, high-demand leisure, and social interaction activities. Results also identified activities that may be difficult for preschoolers with ASD. Findings suggest that early childhood intervention providers consider the impact of gross motor deficits within the context of participation in daily routines and activities.
Family and Coach Responses to a Program for Fostering Infant Language
Authors: Hollingsworth Heidi L. , Knight-McKenna Mary , Esposito Judy , Redd Caroline
Published: May 2021

This study investigated family and coach responses to a two-year community-based research program, Strong Beginnings for Babies (SBB), designed to support families in fostering infant language development. The study focused on families of infants from low-income backgrounds, as these children may be at risk for delayed language development. The majority of participants self-identified as Hispanic, Latino, or of Spanish origin. Three coaches were hired to work closely with participating families during a series of group sessions where they modeled language promotion practices, provided feedback on families' implementation of practices, and reviewed measures of infants' home language environments with families. Analyses of surveys, interviews, and documents indicated that SBB proffered a number of benefits for both families and coaches. Benefits for families included increased knowledge about the importance of and practices for engaging in language interactions with their infants, as well as a sense of community with other families. Benefits for coaches included personal and professional opportunities for growth and positive relationships with participating families. Challenges and areas for improvement were also noted. Although families expressed a desire for more frequent and longer coaching sessions, coaches reported concerns about inconsistent program attendance and acknowledged the complexities of families' lives.
From Emotional Crisis to Empowerment
Authors: Cain Melissa , Fanshawe Melissa
Published: May 2021

This article presents the experiences of 2 mothers whose children were born blind. It relates their journey moving from the grief experienced when presented with the unexpected challenges of supporting a child with special needs to a position of empowerment after gaining the necessary knowledge and skills to integrate into their new and reimagined lives. This research addresses the following question: “What is the role of Early Intervention Specialists (EISs) in supporting parents of children with unexpected congenital blindness?” Using case study methodology, the authors interviewed 2 mothers in Australia, when their children were aged 5 years and again 5 years later to gather a longitudinal understanding of their interactions with EISs. These narratives underscore the critical importance of the specialized knowledge EISs provide in empowering caregivers to take control of their child's therapy needs and advocate for their full participation within educational contexts and the community.
Caregiver Navigation Through Early Hearing Detection and Intervention Programs in South Africa
Authors: Kanji Amisha , Noorbhai Wasifah
Published: May 2021

This research study aimed to explore the experiences of caregivers of children through the early hearing detection and intervention (EHDI) process in the public health care sector in South Africa. A qualitative research design was employed. Semistructured interviews were conducted with 8 caregivers from 3 different levels of service delivery in the public health care sector who had children aged 5 months and 3 years. Data were analyzed using inductive thematic analysis, which resulted in 6 interrelated themes. Most participants reported a positive experience in terms of service provision with professionals. Accessibility to services and long waiting periods, however, remain challenges within the EHDI process. Continuity of care and care coordination was found to need attention in South Africa, particularly for high-risk infants who require ongoing follow-up.
Social Validity of an Early Intervention Online Professional Development Program
Authors: Sexton Sarah J. , Yang Lihua , Hamby Deborah
Published: May 2021

This article presents findings from an online early intervention orientation program developed to provide one state with an economical and systematic means for onboarding new early intervention providers, administrators, and service coordinators. The quantitative findings suggest the courses were a successful method of delivering training to participants, the courses were perceived to achieve their intended objectives, and the courses had high social validity in terms of ease of use and content of the courses. The qualitative findings revealed participants' plans for putting course content into practice. Findings suggest that online course delivery could be a viable and efficient means of providing early intervention orientation to a statewide network. The design of the courses and alignment with adult learning characteristics is discussed. Potential limitations and contributions to the field of early intervention are included.
Clinical relevance of attentional biases in pediatric chronic pain: an eye-tracking study
Authors: Soltani Sabine , van Ryckeghem Dimitri M.L. , Vervoort Tine , Heathcote Lauren C. , Yeates Keith O. , Sears Christopher , Noel Melanie
Published: May 2021

Attentional biases have been posited as one of the key mechanisms underlying the development and maintenance of chronic pain and co-occurring internalizing mental health symptoms. Despite this theoretical prominence, a comprehensive understanding of the nature of biased attentional processing in chronic pain and its relationship to theorized antecedents and clinical outcomes is lacking, particularly in youth. This study used eye-tracking to assess attentional bias for painful facial expressions and its relationship to theorized antecedents of chronic pain and clinical outcomes. Youth with chronic pain (n = 125) and without chronic pain (n = 52) viewed face images of varying levels of pain expressiveness while their eye gaze was tracked and recorded. At baseline, youth completed questionnaires to assess pain characteristics, theorized antecedents (pain catastrophizing, fear of pain, and anxiety sensitivity), and clinical outcomes (pain intensity, interference, anxiety, depression, and posttraumatic stress). For youth with chronic pain, clinical outcomes were reassessed at 3 months to assess for relationships with attentional bias while controlling for baseline symptoms. In both groups, youth exhibited an attentional bias for painful facial expressions. For youth with chronic pain, attentional bias was not significantly associated with theorized antecedents or clinical outcomes at baseline or 3-month follow-up. These findings call into question the posited relationships between attentional bias and clinical outcomes. Additional studies using more comprehensive and contextual paradigms for the assessment of attentional bias are required to clarify the ways in which such biases may manifest and relate to clinical outcomes.
Physical Activity Participation After a 16-Week Supervised Workplace Exercise RCT With a 15-Month Follow-Up
Authors: Hunter Jayden R. , Gordon Brett A. , Huynh Minh , Benson Amanda C.
Published: May 2021

Objective:

To investigate the effects of exercise supervision on short- and longer-term moderate-vigorous physical activity (MVPA) participation.

Methods:

Fifty-six Australian university employees completed a 16-week moderate-to-high intensity aerobic and resistance exercise intervention, and the international physical activity questionnaire (IPAQ) 15 months later. Participants received either personal (SUP; n = 21) or non-personal (NPS; n = 19) exercise supervision at an onsite facility or exercised offsite with no supervision (CON; n = 16).

Results:

A linear mixed model identified a significant group × time interaction effect for MVPA, with increases at 15-month follow-up for CON only. Pooled data suggested more participants completed ≥500 MET-minutes of weekly MVPA at 16 weeks (66%) and 15-month follow-up (68%) compared to baseline (54%).

Conclusions:

A comprehensive health and fitness assessment and individually tailored exercise without personal supervision may promote ongoing MVPA.
The Correlation of Clinical Corticosteroid Responsiveness With Expression of IL-6 in Peripheral Blood Immune Cells (PBMC) in Patients With Autoimmune Inner Ear Disease (AIED)
Authors: Gorthey Scott W. , Pathak Shresh , Vambutas Andrea
Published: May 2021

Hypothesis:

Autoimmune inner ear disease (AIED) patients will differentially express interleukin (IL)-6 based on corticosteroid responsiveness.

Background:

AIED is characterized by periods of acute sensorineural hearing loss (SNHL). In a majority of patients corticosteroid responsiveness is lost over time. The mechanisms that control corticosteroid responsiveness have not been fully elucidated.

Methods:

Thirty-five AIED patients and 13 age-matched control subjects were enrolled in this study. Steroid responsive (n = 15) and steroid nonresponsive AIED patients (n = 20) were characterized based on audiometry before and after treatment for acute SNHL. Plasma and peripheral blood mononuclear cells (PBMC) were obtained at the time of acute SNHL to quantify plasma IL-6, soluble IL-6 receptor (sIL-6R), and C-C Motif Chemokine Ligand 3 (CCL3). PBMCs were stimulated with dexamethasone and release of soluble IL-6, sIL-6R, and CCL3 protein into conditioned supernatants was measured. Plasma IL-6 was also correlated to serum c-reactive protein (CRP), cardiac CRP, erythrocyte sedimentation rate.

Results:

Statistically significant differences were observed in the plasma IL-6 between AIED patients and controls (2.37 versus 2.03 pg/ml, p < 0.01), plasma IL-6, and CCL3 between responders and nonresponders (0.136 versus 3.84 pg/ml, p < 0.005; 30.5 versus 32.4, p < 0.05) and released IL-6 from dexamethasone stimulated PBMC in AIED patients compared with controls (0.54 versus 1.12 pg/ml, p < 0.001). There was a correlation between plasma IL-6 levels of AIED patients to both serum CRP and cardiac CRP (R2 = 0.83, R2 = 0.88).

Conclusions:

We observed AIED patients, specifically nonresponders expressed greater levels of IL-6. Elevated IL-6 levels in AIED patients correlated with CRP levels, providing a commonly available laboratory test that may aid in rapid clinical decision-making in these patients.
An Open-label, Multicenter Study to Assess the Efficacy and Safety of a Novel Probiotic Blend in Patients With Functional Gastrointestinal Symptoms
Authors: Harris Lucinda A. , Cash Brooks D. , Moftah Karim , Franklin Howard
Published: May 2021

Goal:

A novel 5-strain (Bl-04, Bi-07, HN019, NCFM, and Lpc-37) probiotic blend was developed and its safety and efficacy were evaluated in patients with functional gastrointestinal (GI) symptoms.

Background:

These strains administered together have not previously been investigated.

Study:

Patients aged 18 to 75 years with functional GI symptoms were eligible for inclusion in a single-arm, open-label, multicenter study (NCT04155801). An oral capsule containing the novel probiotic blend was administered once daily for 30 days. The primary efficacy endpoint was patient-reported improvement in overall GI well-being at day 30. Secondary efficacy endpoints included changes in GI symptoms assessed using the GI Health Symptom Questionnaire. Incidence of treatment-emergent adverse events was recorded at all visits.

Results:

Of 188 enrolled patients, 72.3% were female and mean (SD) age was 44.1 (13.4) years. At day 30, 85.1% of patients achieved the primary endpoint, a positive response signifying improvement in overall GI well-being. Improvements from baseline were reported at day 30 in diarrhea frequency (baseline frequency≥3 to 4 d/wk) and severity (baseline severity≥5/10) for 75.8% and 87.3% of patients, respectively. Over the same time period, constipation frequency (baseline frequency≥3 to 4 d/wk) and severity (baseline severity≥5/10) improved in 73.6% and 80.4% of patients, respectively. Most patients reported improvements at day 30 in frequency and severity of straining, urgency, abdominal pain/discomfort, bloating, and distention. Improvements reported at day 30 were generally observable at day 14. No safety signals were identified.

Conclusion:

A novel 5-strain probiotic blend improved functional GI symptoms and was safe.
Gut microbiome, parathyroid hormone, and bone
Authors: Kermgard Elizabeth , Chawla Nadine Khouzam , Wesseling-Perry Katherine
Published: May 2021

Purpose of review

Microorganisms in the gut (the ‘microbiome’) and the metabolites they produce (the ‘metabolome’) regulate bone mass through interactions between parathyroid hormone (PTH), the immune system, and bone. This review summarizes these data and details how this physiology may relate to CKD-mediated bone disease.

Recent findings

The actions of PTH on bone require microbial metabolite activation of immune cells. Butyrate is necessary for CD4+ T-cell differentiation, T-reg cell expansion and CD8+ T-cell secretion of the bone-forming factor Wnt10b ligand. By contrast, mice colonized with segmented filamentous bacteria exhibit an expansion of gut Th17 cells and continuous PTH infusion increases the migration of Th17 cells to the bone marrow, contributing to bone resorption. In the context of CKD, a modified diet, frequent antibiotic therapy, altered intestinal mobility, and exposure to multiple medications together contribute to dysbiosis; the implications for an altered microbiome and metabolome on the pathogenesis of renal osteodystrophy and its treatment have not been explored.

As dysregulated interactions between PTH and bone ('skeletal resistance’) characterize CKD, the time is ripe for detailed, mechanistic studies into the role that gut metabolites may play in the pathogenesis of CKD-mediated bone disease.
Coronavirus disease 2019 and kidney injury
Authors: Punj Shweta , Eng Eudora , Shetty Aneesha A.
Published: May 2021

Purpose of review

In this paper, we seek to review coronavirus disease 2019 (COVID-19) associated kidney injury with a focus on what is known about pathophysiology.

Recent findings

Kidney injury is a common complication of SARS-CoV-2 infection and is associated with increased morbidity and mortality. Acute tubular necrosis and glomerular injury are two common findings. Direct viral effect, endothelial dysfunction, and podocyte and tubular epithelial injury have been described. COVID-19-related glomerular injury may also be associated with high-risk APOL1 genotype.

Data on COVID-19 renal involvement have suggested novel mechanisms of kidney injury that need to be further elucidated. More data are needed on renal involvement in milder disease, renal-specific therapeutic interventions, and long-term sequelae.
Cystic fibrosis in the kidney: new lessons from impaired renal HCO3− excretion
Authors: Berg Peder , Jeppesen Majbritt , Leipziger Jens
Published: May 2021

Purpose of review

A key role of cystic fibrosis transmembrane conductance regulator (CFTR) in the kidney has recently been uncovered. This needs to be integrated into the understanding of the developed phenotypes in cystic fibrosis (CF) patients.

Recent findings

In the beta-intercalated cells of the collecting duct , CFTR functions in very similar terms as established in the exocrine pancreatic duct and both CFTR and SLC26A4 (pendrin) orchestrate regulated HCO3
− secretion. Like in the pancreas, the hormone secretin is a key agonist to activate renal HCO3
− secretion. In mice lacking CFTR or pendrin, acute and chronic base challenges trigger marked metabolic alkalosis because collecting duct base secretion is defective. Also in CF patients, the ability to acutely increase renal HCO3
− excretion is markedly reduced.

The now much enlarged understanding of CFTR in the kidney may permit the measurement of challenged urine HCO3
− excretion as a new biomarker for CF. We suggest a new explanation for the electrolyte disorder in CF termed Pseudo-Bartter Syndrome. The hallmark electrolyte disturbance features of this can be well explained by a reduced function of collecting duct Cl−/HCO3
− exchange. Eventually, we suggest the diagnostic term distal renal tubular alkalosis to cover those disturbances that causes metabolic alkalosis by a reduced collecting duct base secretion.
Low PDCD4 Expression Is Associated With Poor Prognosis of Colorectal Carcinoma
Authors: Kim Joo Young , Lee Hojung , Kim Eun Kyung , Lee Won Mi , Hong Young Ok , Hong Soon Auck
Published: May 2021

Programmed cell death 4 (PDCD4) is a tumor suppressor gene that inhibits tumor progression, invasion, and metastasis. Decreased PDCD4 expression is associated with poor prognosis in various types of cancers. We evaluated PDCD4 expression and its clinicopathologic correlation, including patient survival, in 289 surgically resected colorectal cancers. Low nuclear PDCD4 expression was identified in 177 (61.2%) cases and was associated with large tumor size, high pT classification, and the presence of lymphovascular and perineural invasion. The 5-year survival rate of patients with low nuclear PDCD4 expression was significantly lower than that of patients with high expression (72.2% vs. 93.3%, P<0.001). American Joint Committee on Cancer stage II and III colorectal cancer patients with low nuclear PDCD4 expression (76.9% and 67.2%, respectively) showed significantly worse overall survival than those with high expression (100% and 92.9%, P=0.002 and 0.032, respectively). Low nuclear PDCD4 expression was an independent poor prognostic factor in colorectal cancer patients (hazard ratio=3.556; 95% confidence interval, 1.739-7.271; P=0.001). Our study suggests that low PDCD4 expression is associated with aggressive behavior and can be used as a prognostic indicator of colorectal cancer patients.
Prolonged Mechanical Ventilation in Children: Review of the Definition
Authors: Colleti José , Azevedo Rafael Teixeira , de Oliveira Caino Felipe Rezende , de Araujo Orlei Ribeiro
Published: May 2021

OBJECTIVES:

To review existing definitions of prolonged mechanical ventilation in children.

DESIGN:

Review of the literature.

SETTING:

Not applicable.

PATIENTS:

Pediatric patients under mechanical ventilation.

INTERVENTIONS:

Not applicable.

MEASUREMENTS AND MAIN RESULTS:

We searched the literature for original research on prolonged mechanical ventilation in children using the PubMed, Embase, and Cochrane Library databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and we extracted patient characteristics, duration of mechanical ventilation, outcomes, and associated complications. We identified 30 articles for qualitative analysis and found a wide variety of definitions, varying from 48 hours to 6 months. The most frequently used definitions of prolonged mechanical ventilation were greater than 7 days, greater than 14 days, and greater than 21 days. There was no high-quality evidence of a definition for prolonged mechanical ventilation in children.

CONCLUSIONS:

There is limited evidence to determine the definition of prolonged mechanical ventilation in children. The variety of definitions is a sign of the need for a consensus definition of pediatric prolonged mechanical ventilation.
Creating a Dedicated Pandemic Ambulatory Clinic: Lessons Learned From COVID-19
Authors: Kwon Joshua , Hedges Mary , Jackson K. Dawson , Keimig Andrew , Francis Dawn
Published: May 2021

Background and Objectives:

COVID-19 is highly infectious and the pandemic requires many adaptations to how we deliver medical care. Early in the pandemic, much of this focus was on hospital and emergency department care delivery models to ensure the safety of non–COVID-19 patients and health care workers. However, providing much needed outpatient assessments for COVID-19 patients during a pandemic is also fraught with challenges. From our review of the literature, best practices for a dedicated pandemic ambulatory outpatient clinic have not previously been described. We present a model for creating a dedicated ambulatory pandemic clinic at our institution for the acute care needs of COVID-19 patients.

Methods:

To address the current pandemic, the Mayo Acute Symptoms of COVID-19 Clinic was implemented on April 13, 2020, with the aims of providing a stand-alone location for COVID-19 patients to have acute outpatient evaluations as well as diagnostics.

Results:

Recognized challenges addressed included consideration of airflow recirculation patterns in standard medical office buildings, optimization of protocols to conserve personal protective equipment (PPE), limiting total exposure time during patient flow, and reducing surfaces and spaces that patients would physically contact. To this end, unique methods of patient scheduling, patient flow process, staff training, and PPE protocols were developed and are explained in detail in this article.

Conclusion:

In the COVID-19 pandemic, as well as inevitably in future pandemics, outpatient medical facilities need to be prepared to care for nonhospitalized and nonemergent pandemic patients. We offer a practical approach that has been successful at our institution, with opportunity for local adaptation based on need and resources.
Hyperthyroidism Incidentally Noted on Lymphoscintigraphy
Authors: Liu Yong , Tong Guansheng , Wen Zhe , Zhuang Hongming
Published: May 2021

A 43-year-old woman with edema in both left upper limb and lower limb underwent lymphoscintigraphy to evaluate possible lymphedema. Two separate lymphoscintigraphies, one for the lower and the other for the upper limbs, were performed with interval of 3 days. Incidentally, an activity in the region of the thyroid glands was noted in the delayed images of both studies. Subsequently, Graves disease was diagnosed based on the patient’s symptoms and the results of laboratory examinations.
Neuroblastoma Shown on 18F-DOPA PET/CT Performed to Evaluate Congenital Hyperinsulinism
Authors: O’Brien Sophia R. , States Lisa J. , Zhuang Hongming
Published: May 2021

18F-DOPA PET/CT was performed to evaluate congenital hyperinsulinism in a 55-day-old boy with hypoglycemia. The images revealed not only a focal 18F-DOPA–avid lesion in the pancreas but also in a left thoracic paraspinal neuroblastoma.
Prospective Evaluation of the First Integrated Positron Emission Tomography/Dual-Energy Computed Tomography System in Patients With Lung Cancer
Authors: Martin Simon S. , van Assen Marly , Burchett Philip , Monti Caterina B. , Schoepf U. Joseph , Ravenel James , Rieter William J. , Vogl Thomas J. , Costello Philip , Gordon Leonie , De Cecco Carlo N.
Published: May 2021

Purpose:

The aim of this pilot study was to prospectively evaluate the first integrated positron emission tomography (PET)/dual-energy computed tomography (DECT) system performance in patients with non–small cell lung cancer (NSCLC).

Materials and Methods:

In this single-center, prospective trial, consecutive patients with NSCLC referred for a PET study between May 2017 and June 2018 were enrolled. All patients received contrast-enhanced imaging on a clinical PET/DECT system. Data analysis included PET-based standard uptake values (SUVmax) and DECT-based iodine densities of tumor masses, lymph nodes, and distant metastases. Results were analyzed using correlation tests and receiver operating characteristics curves.

Results:

The study population was composed of 21 patients (median age 62 y, 14 male patients). A moderate positive correlation was found between iodine density values (2.2 mg/mL) and SUVmax (10.5) in tumor masses (ρ=0.53, P<0.01). Iodine density values (2.3 mg/mL) and SUVmax (5.4) of lymph node metastases showed a weak positive correlation (ρ=0.23, P=0.14). In addition, iodine quantification analysis provided no added value in differentiating between pathologic and nonpathologic lymph nodes with an area under the curve (AUC) of 0.55 using PET-based SUVmax as the reference standard. A weak positive correlation was observed between iodine density (2.2 mg/mL) and SUVmax in distant metastases (14.9, ρ=0.23, P=0.52).

Conclusions:

The application of an integrated PET/DECT system in lung cancer might provide additional insights in the assessment of tumor masses. However, the added value of iodine density quantification for the evaluation of lymph nodes and distant metastases seems limited.
The Edmonton Obesity Staging System Predicts Postoperative Complications After Abdominoplasty
Authors: Simunovic Filip , Bonaventura Bastian , Schneider Laura , Horner Verena K. , Weber Janick , Stark G. Björn , Kalash Ziad
Published: May 2021

Background

This study investigates the relationship between Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after abdominoplasty in massive weight loss patients.

Methods

A single-institution retrospective review of patients undergoing abdominoplasty between 2009 and 2019 after massive weight loss. Demographic data, laboratory findings, known risk factors for postoperative complications, as well as data on major and minor complications were extracted from the patient charts. Logistic regression models were used to investigate the relationship between the variables.

Results

Four hundred and five patients were included in the study. The prevalence of EOSS stages was: 0 (no comorbidities, N = 151, 37%), 1 (mild conditions, N = 40, 10%), 2 (moderate conditions, N = 149, 36%) and 3 (severe conditions, N = 70, 17%). Regression analysis showed that, controlling for body mass index (BMI), BMI Δ (maximal BMI − BMI at presentation), bariatric surgery, volume of resected tissue, and duration of surgery, EOSS stage significantly associated with the occurrence of postoperative complications. Compared with EOSS stage 0, EOSS stages 2 and 3 patients were associated with significantly more minor and major complications, respectively. The volume of resected tissue, BMI Δ, and age were associated with the occurrence of major complications. A regression model of comorbidities comprising the EOSS revealed a significant association of variables diabetes mellitus and hypertension with the occurrence of postoperative complications.

Conclusions

Edmonton Obesity Staging System is a robust predictor of postoperative complications in abdominoplasty.
Qualitative Analysis of Single-Site Headache Surgery
Authors: Israel Jacqueline S. , Gutierrez-Meza Diana , Albano Nicholas J. , Smith Jeremy P. , Abd-Elsayed Alaa , Schwarze Margaret L. , Macdonald Cameron L. , Afifi Ahmed M.
Published: May 2021

Background

Migraine surgery has been shown to be efficacious, but nuanced effects of surgery on pain and individuals' lives remain incompletely understood. Surgery may be performed at a single or multiple “primary” sites. The aims of this study were to investigate patient perceptions following single-site surgery and compare themes in patients undergoing single-site surgery with those from a previously published conceptual framework generated with patients undergoing multisite surgery.

Methods

Patients who underwent single-site headache surgery participated in open-ended interviews at least 1 year after surgery. Participants (n = 14) had undergone either occipital, temporal, or nasoseptal site surgery. A multidisciplinary team analyzed transcripts. Recurring themes were identified and compared and contrasted to those observed in patients who underwent multiple-site surgery (n = 15) in a previous study (Plast Reconstr Surg 2019;144(4):956–964).

Results

Similar recurring themes emerged from the single-site cohort, and the conceptual framework was applicable to all participants. Two new themes emerged from the single-site analysis. First, 5 of 14 participants described being “migraine-free” postoperatively, a finding not observed in the multisite group. Second, several individuals described financial benefits after surgery, via decreased prescription medication requirements, raises at work, and improved productivity.

Conclusions

Single-site headache surgery appears to positively impact patients' lives in ways that support and expand upon previously published outcomes. Patients undergoing surgery at a single site may be more likely to experience a “pain-free” state, which may relate to the underlying pathophysiology of chronic headache. The effect of surgery on finances appears to be an outcome of interest to patients, which should be explored further.
Hemangioma Endothelial Cells and Hemangioma Stem Cells in Infantile Hemangioma
Authors: Sun Yuming , Qiu Fengzhen , Hu Chengjun , Guo Yu , Lei Shaorong
Published: May 2021

Background

Hemangioma is one of the most common benign tumors in infants and young children. The 2 most important cells in the course of infantile hemangioma (IH) are hemangioma stem cells (HemSCs) and hemangioma endothelial cells (HemECs). Infantile hemangioma is characterized by massive proliferation of HemECs, but current studies indicate that HemSCs play an important role in pathogenesis of IH.

Objective

This review aimed to identify molecules that influence HemSC differentiation and HemEC proliferation and apoptosis to help clarify the pathogenesis of IH and provide novel drug targets for the treatment of IH.

Methods

Relevant basic science studies related to IH were identified by searching Google Scholar, Embase, PubMed, MEDLINE, and peer-reviewed journal articles.

Result

Hemangioma stem cells can differentiate into HemECs, pericytes, and adipocytes. In the proliferating phase of IH, HemSCs mainly differentiate into HemECs and pericytes to promote angiogenesis. In the regressive phase, they mainly differentiate into adipocytes. Therefore, increasing the proportion of HemSCs differentiating into adipocytes, inhibiting the proliferation of HemECs, and promoting the apoptosis of HemECs can facilitate the regression of IH.
Facial Injections and Blindness
Authors: Li Dan , Zhang Hengshu
Published: May 2021

With the sudden emergence of new medical aesthetic fillers, the number of fillers injected worldwide has exploded, but there are also worrying risks in the pursuit of beauty. At present, many cases of blindness caused by injection of aesthetic fillers have been reported. Most of the cases are caused by irreversible vascular embolism. This is a rare yet greatly feared complication of using facial cosmetic fillers. This article reviewed and analyzed the literature and summarized the changes in the anatomical structure of facial blood vessels related to blindness during facial injection.
Adipose Grafting for Volume and Scar Release
Authors: Le John M. , Bosworth Jeremy W. , Honeywell Brandon , Ananthasekar Shivani , Collawn Sherry S.
Published: May 2021

Adipose fat grafting (AFG) is a popular technique used to add volume in the face, breasts, and other tissue deficient areas of the body. In terms of scar release, not only has fat provided additional soft tissue coverage but also the relief of pain in scars in those patients suffering from disease processes, such as complex regional pain syndrome with steroid-induced atrophy, burn scars, morphea, and lupus. The purpose of this article is to demonstrate the senior author's technique and outcomes of using AFG in the face and body for treating volume deficiency, atrophic scarring, and deformities.

A retrospective chart review of 127 AFG procedures of the face and body from September 2006 to September 2019 was performed. Of these, 14 patients had scar releases performed with fat grafting of areas of scar contracture. Fat was harvested from the abdomen, thighs, and flanks using Toomey syringes or an enclosed power-assisted system with 3.7- or 3.0-mm cannulas. Grafting in small areas, such as the face, was performed with the 0.9-mm blunt cannula.

The majority of AFG was completed in the face (45%), followed by breasts (22%), and scar contracture (16%). The mean volume of fat grafted in procedures involving the breasts, buttocks, and face was 102, 182, and 21 mL, respectively. For scar contracture, the mean volume was 38 mL and for deformations, 27 mL. Sixteen percent of the cohort required at least 1 additional AFG procedure to achieve satisfactory results. There were no major complications, such as skin loss, vascular injury, embolization, or blindness. Minor complications, such as erythema, edema, and hematoma at the fat harvest or graft site, did occur and were managed with local measures.

Autologous fat grafting has consistently resulted in volume correction. In addition, in patients with autoimmune disorders, burn scars, and retracted scars, not only has there been volume correction but also decreased pain in the area of treatment. In our series of patients, we described our technique of AFG for the face, body, and scar contracture. Our results demonstrate that AFG remains an inexpensive, safe, and effective treatment option to achieve volume.
Nationwide Analysis of the Distribution of Level 1 and Level 2 Trauma Centers Per Population Growth and Motor Vehicle Collision Injuries/Fatalities Utilizing Geographic Information Systems Mapping Technology
Authors: Sen-Crowe Brendon , Sutherland Mason , McKenney Mark , Elkbuli Adel
Published: May 2021

Background:

Trauma centers (TCs) improve patient outcomes. Few investigations detail the US geographical distribution of Level 1 and 2 TCs (L1TCs, L2TCs) regarding motor vehicle collision (MVC) injuries/fatalities.

Objective:

We utilized Geographic Information Systems mapping to investigate the distribution of L1TCs and L2TCs in relation to population growth, MVC injuries, and MVC fatalities at the county and regional level to identify any disparities in access to trauma care.

Methods:

A cross-sectional analysis of L1TC and L2TC distribution, MVC injuries/fatalities, and population growth from 2010 to 2018. Information was gathered at the county and region level for young adults (aged 15–44), middle-aged adults (45–64), and elderly (≥65).

Results:

A total of 263 L1TCs across 46 states and 156 counties and 357 L2TCs across 44 states and 255 counties were identified. The mean distance between L1TCs and L2TCs is 28.3 miles and 31.1 miles, respectively. Seven counties were identified as being at-risk, all in the Western and Southern US regions that experienced ≥10% increase in population size, upward trends in MVC injuries, and upward trends MVC fatalities across all age groups.

Conclusions:

Seven US counties containing ≤2 ACSCOT-verified and/or state-designated L1TCs or L2TCs experienced a 10% increase in population, MVC injuries, and MVC fatalities across young, middle-aged and elderly adults from 2010 to 2018. This study highlights chronic disparities in access to trauma care for MVC patients. Evaluation of state limitations regarding the distribution of L1TCs and L2TCs, frequent evaluation of local and regional trauma care needs, and strategic interventions to improve access to trauma care may improve patient outcomes for heavily burdened counties.
Tracheostomy for COVID-19 Respiratory Failure
Authors: Mahmood Kamran , Cheng George Z. , Van Nostrand Keriann , Shojaee Samira , Wayne Max T. , Abbott Matthew , Nettlow Darrell , Parish Alice , Green Cynthia L. , Safi Javeryah , Brenner Michael J. , De Cardenas Jose
Published: May 2021

Objective:

The aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure.

Summary Background Data:

Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID-19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices.

Methods:

It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at 7 hospitals in 5 tertiary academic medical systems from February 1, 2020 to September 4, 2020.

Result:

Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1–Q3: 18–25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days (Q1–Q3) among patients weaned from the ventilator in the early, middle and late groups were 21 (21–31), 34 (26.5–42), and 37 (32–41) days, respectively with P = 0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator [median (Q1–Q3): 34 (29–39) vs 39 (34–51) days, P = 0.038]; decreased ventilator-associated pneumonia (58.7% vs 80.8%, P = 0.039); and among patients who were discharged, shorter intensive care unit duration [median (Q1–Q3): 33 (27–42) vs 47 (33–64) days, P = 0.009]; and shorter hospital length of stay [median (Q1–Q3): 46 (33–59) vs 59.5 (48–80) days, P = 0.001].

Conclusion:

Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.
Reducing Degrees of Freedom in Surgical Suturing: Implications for Minimally Invasive Device Development—A Prospective Experimental Study
Authors: Wilhelm Peter , Lambidis Lisa , Williams Jacob , Axt Steffen , Storz Pirmin , Kunert Wolfgang , Kirschniak Andreas , Rolinger Jens
Published: May 2021

Open surgery allows the use of all 6 degrees of freedom (DOF; x-y-z and roll-pitch-yaw), whereas laparoscopy requires working under limitation to 4 axes. We present a prospective experimental study evaluating translational and rotational DOF restriction in surgical suturing tasks. An experimental platform included a kinematic structure that limited the maneuverability of the surgical instruments. The subjects (n=20) worked in a randomized order using (1) 6DOF, (2) 4DOF with 3 translational and 1 rotational DOF (4TRANS), and (3) 4DOF with 1 translational and 3 rotational DOF (4ROT). The time required to perform each task was recorded. Suturing and knot tying were significantly faster under 6DOF compared with 4ROT (both P<0.001) and 4TRANS (both P<0.001). Assessment of subjective difficulty and impairment showed most favorable results for 6DOF. The advantage of rotational compared with translational DOF should be considered in the development of future surgical devices.
Effects of donepezil on the amplitude of low-frequency fluctuations in the brain of patients with Alzheimer’s disease: evidence from resting-state functional magnetic resonance imaging
Authors: Yang Hua , Zhang Jiangtao , Cheng Jianan
Published: May 2021

Objectives

To monitor the effects of donepezil on spontaneous neuronal activity (SNA), and the mechanisms underlying these effects in patients with mild-to-moderate Alzheimer’s disease, using the amplitude of low-frequency fluctuations (ALFFs), a metric of resting-state functional MRI (rs-fMRI).

Methods

Eleven patients with Alzheimer’s disease were treated with donepezil for 6 months. Before and after treatment, the Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Clinical Dementia Rating (CDR), Neuropsychiatric Inventory and Activities of Daily Living scores, along with rs-fMRI of patients were assessed. Eleven age-, sex-, and education-matched controls underwent MMSE and CDR assessments and rs-fMRI at enrollment. The ALFFs of the whole brain were obtained and compared between the groups.

Results

Following donepezil treatment, MMSE scores increased (P = 0.043) and ADAS-cog scores decreased (P = 0.010). Regarding SNA post-treatment, ALFF increased significantly in the right triangular part of the inferior frontal gyrus (IFGtriang; P = 0.030; d = −0.595) and the right orbital part of the inferior frontal gyrus (P = 0.044; d = −0.628) and decreased significantly in the left medial orbital part of the superior frontal gyrus (P = 0.039; d = 0.606) and the right gyrus rectus (P = 0.010; d = 0.609). Furthermore, the changes in ADAS-cog scores from before to after treatment were positively correlated with the changes in ALFF in the right IFGtriang (r = 0.645; P = 0.032).

Conclusions

Donepezil improved SNA in the frontal lobe of patients with Alzheimer’s disease. Therefore, ALFF was demonstrated to be a potential tool for assessing the effectiveness of Alzheimer’s disease treatment.
The N400 and late occipital positivity in processing dynamic facial expressions with natural emotional voice
Authors: Mori Kazuma , Tanaka Akihiro , Kawabata Hideaki , Arao Hiroshi
Published: May 2021

People require multimodal emotional interactions to live in a social environment. Several studies using dynamic facial expressions and emotional voices have reported that multimodal emotional incongruency evokes an early sensory component of event-related potentials (ERPs), while others have found a late cognitive component. The integration mechanism of two different results remains unclear. We speculate that it is semantic analysis in a multimodal integration framework that evokes the late ERP component. An electrophysiological experiment was conducted using emotionally congruent or incongruent dynamic faces and natural voices to promote semantic analysis. To investigate the top-down modulation of the ERP component, attention was manipulated via two tasks that directed participants to attend to facial versus vocal expressions. Our results revealed interactions between facial and vocal emotional expressions, manifested as modulations of the auditory N400 ERP amplitudes but not N1 and P2 amplitudes, for incongruent emotional face–voice combinations only in the face-attentive task. A late occipital positive potential amplitude emerged only during the voice-attentive task. Overall, these findings support the idea that semantic analysis is a key factor in evoking the late cognitive component. The task effect for these ERPs suggests that top-down attention alters not only the amplitude of ERP but also the ERP component per se. Our results implicate a principle of emotional face–voice processing in the brain that may underlie complex audiovisual interactions in everyday communication.
Doxazosin improved COVID-19 associated nightmare in a patient with major depressive disorder: a case report with a positive rechallenge
Authors: Hori Hikaru
Published: May 2021

This article reports on the treatment of a patient with nightmares who was treated with doxazosin of an alpha 1-adrenergic antagonists. A 71-year-old Japanese major depressive disorder (MDD) woman experienced nightmares after the coronavirus disease 2019 pandemic. She had nightmares about being chased by a coronavirus and catching the corona virus. After adding doxazosin 1 mg daily in the morning, her nightmares led to remission without side effects. We also had a rechallenge regimen with doxazosin. The nightmares ceased on the second night of the rechallenge and did not return with continued treatment. This case report suggests that doxazosin may be a useful therapeutic option to target nightmares in individuals with MDD.