bluuebunny/crossref_metadata_2025 huggingface dataset:
How to produce sound predictions of incidence at a district level using either health care or mortality data in the absence of a national registry: the example of cancer in France
Authors: Chatignoux Edouard , Uhry Zoé , Grosclaude Pascale , Colonna Marc , Remontet Laurent
Published: October 2020

Background

In many countries, epidemiological surveillance of chronic diseases is monitored by local registries (LR) which do not necessarily cover the whole national territory. This gap has fostered interest in using non-registry databases (e.g., health care or mortality databases) available for the whole territory as proxies for incidence at the local level. However, direct counts from these databases do not provide reliable incidence measures. Accordingly, specific methods are needed to correct proxies and assess their epidemiological usefulness.

Methods

This study’s objective was to implement a three-stage turnkey methodology using national non-registry data to predict incidence in geographical areas without an LR as follows: constructing a calibration model to make predictions including accurate prediction intervals; accuracy assessment of predictions and rationale for the criteria to assess which predictions were epidemiologically useful; mapping after spatial smoothing of the latter predictions. The methodology was applied to a real-world setting, whereby we aimed to predict cancer incidence, by gender, at the district level in France over the 2007–15 period for 24 different cancer sites, using several health care indicators and mortality. In the present paper, the spatial smoothing performed on predicted incidence of epidemiological interest is illustrated for two examples.

Results

Predicted incidence of epidemiological interest was possible for 27/34 solid site-gender combinations and for only 2/8 haematological malignancies-gender combinations. Mapping of smoothed predicted incidence provided a clear picture of the main contrasts in incidence between districts.

Conclusions

The methodology implemented provides a comprehensive framework to produce valuable predictions of incidence at a district level, using proxy measures and existing LR.
Structure-preserving discretization and control of a two-dimensional vibro-acoustic tube
Authors: Liu Ning , Wu Yongxin , Le Gorrec Yann , Ramirez Hector , Lefèvre Laurent
Published: October 2020

This paper deals with the structure-preserving discretization and control of a two-dimensional vibro-acoustic tube using the port-Hamiltonian framework. A discretization scheme is proposed, and a set of precise basis functions are given in order to obtain a structure-preserving finite-dimensional port- Hamiltonian approximation of the two-dimensional vibro-acoustic system. Using the closed-loop structural invariants of the approximated system an energy-Casimir controller is derived. The performance of the proposed discretization scheme and the controller is shown by means of numerical simulations.
White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks
Authors: Pezzani Maria Diletta , Carrara Elena , Sibani Marcella , Presterl Elisabeth , Gastmeier Petra , Renk Hanna , Kanj Souha S , Velavan Thirumalaisamy P , Song Le Huu , Leibovici Leonard , Torumkuney Didem , Kostyanev Tomislav , Mendelson Marc , Tacconelli Evelina ,   the ARCH working group
Published: October 2020

Background

Antimicrobial surveillance and antimicrobial stewardship (AMS) are essential pillars in the fight against antimicrobial resistance (AMR), but practical guidance on how surveillance data should be linked to AMS activities is lacking. This issue is particularly complex in the hospital setting due to structural heterogeneity of hospital facilities and services. The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions for linking surveillance data with AMS activities.

Methods

A scoping review of the literature was carried out addressing research questions on three areas: (i) AMS leadership and accountability; (ii) antimicrobial usage and AMS; (iii) AMR and AMS. Consensus on the target actions was reached through a RAND-modified Delphi process involving over 40 experts in different fields from 18 countries.

Results

Evidence was retrieved from 51 documents. Initially 38 targets were proposed, differentiated as essential or desirable according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for 32 targets. Following a second consultation, 27 targets were approved, 11 were deleted and 4 were suggested for rephrasing, leading to a final approved list of 34 target actions in the form of a practical checklist.

Conclusions

This White Paper provides a pragmatic and flexible tool to guide the development of calibrated hospital-surveillance-based AMS interventions. The strength of this tool is that it is a comprehensive perspective that takes into account the hospital patient case-mix and the related epidemiology, which ultimately drives antimicrobial usage, and the feasibility in low-resource settings.
Severe Neurological Sequelae after a Recreational Dose of LSD
Authors: Aakerøy Rachel , Brede Wenche Rødseth , Stølen Stian Bergseng , Krabseth Hege-Merete , Michelsen Lisbeth Solem , Andreassen Trine Naalsund , Ader Tiina , Frost Joachim , Slettom Grete , Steihaug Ole Martin , Slørdal Lars
Published: October 2020

A young man with an unremarkable medical history suffered a seizure with subsequent cardiorespiratory arrest and severe neurological sequelae after ingesting a blotter. Analysis of a similar blotter and a serum sample obtained 3 h after the event detected lysergic acid diethylamide (LSD) at an amount of 300 µg in the blotter and at a concentration of 4.0 ng/mL (12.4 nmol/L) in the serum. No other drugs were present in concentrations which may confer significant effects. In addition, no individual traits which would make the patient particularly susceptible to adverse LSD effects have subsequently been identified. This suggests that LSD may confer toxic effects in previously healthy individuals.
Multi-stemming strategies of Quercus glauca in an evergreen broad-leaved forest: when and where
Authors: Rao Mide , Ye Duo , Chen Jianhua , Ni Jian , Mi Xiangcheng , Yu Mingjian , Ma Keping , Cornelissen Johannes H C
Published: October 2020

Aims

Multi-stemming supports plants’ resilience to disturbances and then contributes to soil stabilization and forest function, especially in mountain habitats. Many questions remain about (i) the ontogenetic phase at which multiple stems can occur, (ii) how habitat drivers affect multi-stemming and (iii) whether ontogenetic phase and habitat drivers interact. We asked these questions for Quercus glauca (ring-cupped oak), the dominant species and sprouter across large warm-temperate areas of Asia; its multi-stemmed trees reflect individual survival, population regeneration and forest ecosystem stability.

Methods

In a 5-ha permanent plot of subtropical evergreen broad-leaved forest in eastern China, we examined the temporal patterns and spatial distribution of multi-stemmed trees of Q. glauca within 99 quadrats of 20 m × 20 m.

Important Findings

There were three temporal modes for multi-stemming among the Q. glauca trees and most of them appeared to produce multiple stems from an early stage. Environmental disturbances related to slope convexity appear to be the main drivers of multi-stemming of Q. glauca. Moreover, the closer to the ridge, the earlier the multi-stemming occurs. Thus, also for other woody species in other forests and climate zones, ontogeny and environmental drivers promoting disturbance (not only geomorphology, but also extreme weather events, soil drought, fire), as well as soil fertility, need to be considered in combination to better understand multi-stemming and its consequences for community structure.
Rising summer temperatures do not reduce the reproduction number of COVID-19
Authors: Sahafizadeh Ebrahim , Sartoli Samaneh
Published: October 2020

Data analysis on the spread of COVID-19 in Bushehr, one of the warmest provinces of Iran, indicates that rising summer temperatures do not reduce the reproduction number and the spread of COVID-19.
Gender inequality and female body language in children’s literature
Authors: Čermáková Anna , Mahlberg Michaela
Published: October 2020

In this paper, we aim to situate corpus linguistic approaches to literary texts within the wider context of digital humanities. With an exploratory case study of gendered body language in children’s literature, we illustrate the relationship between quantitative and qualitative analysis. The case study is focused on female body language descriptions and how the presentation of body language has changed over time. We work with two corpora of children’s literature: 19th century and contemporary fiction. Our analysis confirms the substantial imbalance in the representation of female and male characters that has been identified by earlier studies and also shows a more nuanced picture of emerging subtle changes.
E-Cigarette Use and Perceptions Among Veterans Receiving Outpatient Treatment in Veterans Affairs Substance Use and Mental Health Clinics
Authors: Dixit Devika , Herbst Ellen , Das Smita
Published: October 2020

Introduction

Individuals with substance use disorders and/or mental health (MH) conditions have higher rates of cigarette smoking than the general population. Electronic nicotine delivery systems (ENDS) while gaining popularity pose health risks. Herein we investigate risk perceptions and attitudes toward e-cigarettes in military Veterans with MH conditions.

Materials and Methods

Participants included U.S. Veterans receiving services from Veterans Administration MH/substance use disorder clinics in the San Francisco Bay Area (N = 98; 95% male, 44% White, 34% Black/African American), who completed a survey on smoking and health. Results compare attitudes and perceptions regarding e-cigarette use between ever and never e-cigarette users. The study was reviewed by the Institutional Review Board at both the Veterans Administration and University.

Results

Most respondents reported being current/past cigarette smokers (91%) and over a third reported having ever used an e-cigarette (38%). Most believed that e-cigarettes are not safe, are potentially dangerous, are potentially addictive if they use every day and are tempting and appealing to youth. Fifty-one percent of ever-users agreed with a statement that e-cigarettes can help people quit smoking regular cigarettes completely, and there was a significant difference in this belief when comparing them with never-users (23% agreed); χ2 = 9.259, P = 0.010.

Conclusions

Proportion of e-cigarette use in this Veteran sample is greater than the general population. We observed high risk perception about e-cigarettes among all respondents and differences in perceived helpfulness of e-cigarettes for quitting in ever-users versus never-users in this sample. More consistent assessment of tobacco use among Veterans, with inclusion of ENDS use, would help inform prevention and treatment priorities, especially as information on health impacts of ENDS surfaces.
E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) in an Active Duty Service Member
Authors: Colesar Michael T , McCollum Daniel J
Published: October 2020

E-cigarette or vaping product use-associated lung injury (EVALI) is a developing serious pulmonary disease associated with the increasing use of vaping products in both civilian and active duty populations. This case study describes an active duty trainee using unbranded vaping products who developed acute respiratory distress syndrome necessitating intubation and multiday intensive care unit hospitalization. Diffuse ground glass opacities in imaging, lipid-laden macrophages found on bronchoalveolar lavage, negative infectious disease workup, and recent vaping indicate EVALI. This case demonstrates more work needs to be done within the Armed Forces to reduce use of vaping products given the danger of EVALI.
TPR is required for the efficient nuclear export of mRNAs and lncRNAs from short and intron-poor genes
Authors: Lee Eliza S , Wolf Eric J , Ihn Sean S J , Smith Harrison W , Emili Andrew , Palazzo Alexander F
Published: October 2020

While splicing has been shown to enhance nuclear export, it has remained unclear whether mRNAs generated from intronless genes use specific machinery to promote their export. Here, we investigate the role of the major nuclear pore basket protein, TPR, in regulating mRNA and lncRNA nuclear export in human cells. By sequencing mRNA from the nucleus and cytosol of control and TPR-depleted cells, we provide evidence that TPR is required for the efficient nuclear export of mRNAs and lncRNAs that are generated from short transcripts that tend to have few introns, and we validate this with reporter constructs. Moreover, in TPR-depleted cells reporter mRNAs generated from short transcripts accumulate in nuclear speckles and are bound to Nxf1. These observations suggest that TPR acts downstream of Nxf1 recruitment and may allow mRNAs to leave nuclear speckles and properly dock with the nuclear pore. In summary, our study provides one of the first examples of a factor that is specifically required for the nuclear export of intronless and intron-poor mRNAs and lncRNAs.
Bidirectional associations between sleep quality or quantity, and dietary intakes or eating behaviors in children 6–12 years old: a systematic review with evidence mapping
Authors: Ward Aimee L , Jospe Michelle , Morrison Silke , Reynolds Andrew N , Kuroko Sarahmarie , Fangupo Louise J , Smith Claire , Galland Barbara C , Taylor Rachael W
Published: October 2020

Context

Although dietary advice has long been a cornerstone of a healthy lifestyle, how sleep quality and quantity may interact with dietary intake or eating behaviors remains unclear.

Objective

To consider a bidirectional relationship between sleep and diet in children aged 6–12 years via a systematic review following PRISMA guidelines.

Data Sources

Relevant trials and observational studies were identified by searching the PubMed, Medline, Embase, and CENTRAL databases up to June 1, 2019, without language or date restrictions and supplemented with hand searching. Recognized procedures and reporting standards were applied.

Data Extraction

Data on participant characteristics, study parameters, diet measures, sleep measures, and findings of study quality assessment criteria were collected.

Data Analysis

Forty-five articles involving 308 332 participants on a diverse range of topics were included. Meta-analyses were planned but were impossible to perform due to high study heterogeneity. Most studies (82%) were cross-sectional, which prevented examining directionality of the observed associations. Risk of bias was assessed for trial, cohort studies, and cross-sectional studies, using the Cochrane Risk of Bias Tool or Newcastle Ottawa Scale.

Results

Of 16 studies in which the effect of sleep on dietary intake was investigated, 81% (n = 13) reported a significant association. All studies (n = 8) of sugar-sweetened or caffeinated beverages reported a negative association with sleep, and in 6 of 7 studies in which eating behaviors were investigated, associations with sleep were reported. The use of objective measures of sleep and diet were scarce, with most trials and studies relying on subjective measures of sleep (68%) or diet (93%).

Conclusion

Because most studies investigating the relationship between sleep and diet in this age group are cross-sectional, temporality could not be determined. Additional randomized controlled trials and long-term cohort studies in middle childhood, particularly those using objective rather than questionnaire measures of sleep, are required to better understand interactions between diet and sleep.

Systematic Review Registration

Prospectively registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42018091647).
The Molecular Function of Plant mTERFs as Key Regulators of Organellar Gene Expression
Authors: Wobbe Lutz
Published: October 2020

The protein family of mTERFs (mitochondrial transcription termination factors) was initially studied in mammalian and insect mitochondria before the first Arabidopsis mTERF mutant was characterized. More than 10 years of research on the function of plant mTERFs in the flowering plants Arabidopsis thaliana, Zea mays and the green microalga Chlamydomonas reinhardtii has since highlighted that mTERFs are key regulators of organellar gene expression (OGE) in mitochondria and in chloroplasts. Additional functions to be fulfilled by plant mTERFs (e.g. splicing) and the fact that the expression of two organellar genomes had to be facilitated have led to a massive expansion of the plant mTERF portfolio compared to that found in mammals. Plant mTERFs are implicated in all steps of OGE ranging from the modulation of transcription to the maturation of tRNAs and hence translation. Furthermore, being regulators of OGE, mTERFs are required for a successful long-term acclimation to abiotic stress, retrograde signaling and interorganellar communication. Here, I review the recent progress in the elucidation of molecular mTERF functions.
Asset-Level Risk and Return in Real Estate Investments
Authors: Sagi Jacob S
Published: October 2020

In stark contrast with liquid asset returns, commercial real estate idiosyncratic return means and variances do not scale with the holding period, even after accounting for all cash flow-relevant events. This puzzling phenomenon survives controlling for vintage effects, systematic risk heterogeneity, and a host of other explanations. To explain the findings, I derive an equilibrium search-based asset-pricing model that, when calibrated, provides an excellent fit to transactions data. A structural model of transaction risk seems crucial to understanding real estate price dynamics. These insights extend to other highly illiquid asset classes, such as private equity and residential real estate.
Early Childhood General Anesthesia and Neurodevelopmental Outcomes in the Avon Longitudinal Study of Parents and Children Birth Cohort
Authors: Walkden Graham J. , Gill Hannah , Davies Neil M. , Peters Alethea E. , Wright Ingram , Pickering Anthony E.
Published: October 2020

Background

Most common anesthetic agents have been implicated in causing neurodegeneration in the developing animal brain, leading to warnings regarding their use in children. The hypothesis of this study was that exposure to general anesthesia and surgery before 4 yr would associate with adverse neurodevelopmental outcomes at age 7 to 16 yr.

Methods

This cohort study comprised 13,433 children enrolled in the Avon Longitudinal Study of Parents and Children, a prospective, population-based birth cohort born between 1991 and 1993 in southwest England. Children were grouped by none, single, or multiple exposures to general anesthesia and surgery by 4 yr. Motor, cognitive, linguistic, educational, social, and behavioral developmental outcomes were evaluated at 7 to 16 yr using school examination results, validated parent/teacher questionnaires, or clinic assessments. Continuous outcomes were z-scored. P-value thresholds were corrected using false discovery rate procedures.

Results

This study compared 46 neurodevelopmental outcomes in 13,433 children: 8.3% (1,110) exposed singly and 1.6% (212) exposed multiply to general anesthesia and surgery. Of these, the following reached predefined levels of statistical significance (corrected P < 0.00652): dynamic balance scores were 0.3 SD (95% CI, 0.1, 0.5; P < 0.001) lower in multiply exposed children; manual dexterity performance was 0.1 SD (95% CI, 0.0, 0.2; P = 0.006) lower in singly and 0.3 SD (95% CI, 0.1, 0.4; P < 0.001) lower in multiply exposed children; and social communication scores were 0.1 SD (95% CI, 0.0, 0.2; P = 0.001) and 0.4 SD (95% CI, 0.3, 0.5; P < 0.001) lower in singly and multiply exposed children, respectively. General anesthesia and surgery were not associated with impairments in the remaining neurodevelopmental measures including: general cognitive ability; attention; working memory; reading, spelling, verbal comprehension and expression; behavioral difficulties; or national English, mathematics, and science assessments (all ≤0.1 SD; corrected P ≥ 0.00652).

Conclusions

Early childhood general anesthesia and surgery were not associated with a global picture of clinically and statistically significant neurodegenerative effects, providing reassurance about the neurotoxic potential of general anesthesia. Exposure to anesthesia and surgery was associated with significantly lower motor and social linguistic performance.

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Hypotension Prediction Index for Prevention of Hypotension during Moderate- to High-risk Noncardiac Surgery
Authors: Maheshwari Kamal , Shimada Tetsuya , Yang Dongsheng , Khanna Sandeep , Cywinski Jacek B. , Irefin Samuel A. , Ayad Sabry , Turan Alparslan , Ruetzler Kurt , Qiu Yuwei , Saha Partha , Mascha Edward J. , Sessler Daniel I.
Published: October 2020

Background

The Hypotension Prediction Index is a commercially available algorithm, based on arterial waveform features, that predicts hypotension defined as mean arterial pressure less than 65 mmHg for at least 1 min. We therefore tested the primary hypothesis that index guidance reduces the duration and severity of hypotension during noncardiac surgery.

Methods

We enrolled adults having moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring. Participating patients were randomized to hemodynamic management with or without index guidance. Clinicians caring for patients assigned to guidance were alerted when the index exceeded 85 (range, 0 to 100) and a treatment algorithm based on advanced hemodynamic parameters suggested vasopressor administration, fluid administration, inotrope administration, or observation. Primary outcome was the amount of hypotension, defined as time-weighted average mean arterial pressure less than 65 mmHg. Secondary outcomes were time-weighted mean pressures less than 60 and 55 mmHg.

Results

Among 214 enrolled patients, guidance was provided for 105 (49%) patients randomly assigned to the index guidance group. The median (first quartile, third quartile) time-weighted average mean arterial pressure less than 65 mmHg was 0.14 (0.03, 0.37) in guided patients versus 0.14 (0.03, 0.39) mmHg in unguided patients: median difference (95% CI) of 0 (–0.03 to 0.04), P = 0.757. Index guidance therefore did not reduce amount of hypotension less than 65 mmHg, nor did it reduce hypotension less than 60 or 55 mmHg. Post hoc, guidance was associated with less hypotension when analysis was restricted to episodes during which clinicians intervened.

Conclusions

In this pilot trial, index guidance did not reduce the amount of intraoperative hypotension. Half of the alerts were not followed by treatment, presumably due to short warning time, complex treatment algorithm, or clinicians ignoring the alert. In the future we plan to use a lower index alert threshold and a simpler treatment algorithm that emphasizes prompt treatment.

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Oral Dexmedetomidine Promotes Non-rapid Eye Movement Stage 2 Sleep in Humans
Authors: Chamadia Shubham , Hobbs Lauren , Marota Sophia , Ibala Reine , Hahm Eunice , Gitlin Jacob , Mekonnen Jennifer , Ethridge Breanna , Colon Katia M. , Sheppard Kimberly S. , Manoach Dara S. , DiBiasio Alan , Nguyen Sarah , Pedemonte Juan C. , Akeju Oluwaseun
Published: October 2020

Background

The administration of dexmedetomidine is limited to highly monitored care settings because it is only available for use in humans as intravenous medication. An oral formulation of dexmedetomidine may broaden its use to all care settings. The authors investigated the effect of a capsule-based solid oral dosage formulation of dexmedetomidine on sleep polysomnography.

Methods

The authors performed a single-site, placebo-controlled, randomized, crossover, double-blind phase II study of a solid oral dosage formulation of dexmedetomidine (700 mcg; n = 15). The primary outcome was polysomnography sleep quality. Secondary outcomes included performance on the motor sequence task and psychomotor vigilance task administered to each subject at night and in the morning to assess motor memory consolidation and psychomotor function, respectively. Sleep questionnaires were also administered.

Results

Oral dexmedetomidine increased the duration of non-rapid eye movement (non-REM) stage 2 sleep by 63 (95% CI, 19 to 107) min (P = 0.010) and decreased the duration of rapid eye movement (REM) sleep by 42 (5 to 78) min (P = 0.031). Overnight motor sequence task performance improved after placebo sleep (7.9%; P = 0.003) but not after oral dexmedetomidine–induced sleep (–0.8%; P = 0.900). In exploratory analyses, we found a positive correlation between spindle density during non-REM stage 2 sleep and improvement in the overnight test performance (Spearman rho = 0.57; P = 0.028; n = 15) for placebo but not oral dexmedetomidine (Spearman rho = 0.04; P = 0.899; n = 15). Group differences in overnight motor sequence task performance, psychomotor vigilance task metrics, and sleep questionnaires did not meet the threshold for statistical significance.

Conclusions

These results demonstrate that the nighttime administration of a solid oral dosage formulation of dexmedetomidine is associated with increased non-REM 2 sleep and decreased REM sleep. Spindle density during dexmedetomidine sleep was not associated with overnight improvement in the motor sequence task.

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A Pharmacokinetic and Pharmacodynamic Study of Oral Dexmedetomidine
Authors: Chamadia Shubham , Pedemonte Juan C. , Hobbs Lauren E. , Deng Hao , Nguyen Sarah , Cortinez Luis I. , Akeju Oluwaseun
Published: October 2020

Background

Dexmedetomidine is only approved for use in humans as an intravenous medication. An oral formulation may broaden the use and benefits of dexmedetomidine to numerous care settings. The authors hypothesized that oral dexmedetomidine (300 mcg to 700 mcg) would result in plasma concentrations consistent with sedation while maintaining hemodynamic stability.

Methods

The authors performed a single-site, open-label, phase I dose-escalation study of a solid oral dosage formulation of dexmedetomidine in healthy volunteers (n = 5, 300 mcg; followed by n = 5, 500 mcg; followed by n = 5, 700 mcg). The primary study outcome was hemodynamic stability defined as lack of hypertension, hypotension, or bradycardia. The authors assessed this outcome by analyzing raw hemodynamic data. Plasma dexmedetomidine concentrations were determined by liquid chromatograph–tandem mass spectrometry. Nonlinear mixed effect models were used for pharmacokinetic and pharmacodynamic analyses.

Results

Oral dexmedetomidine was associated with plasma concentration–dependent decreases in heart rate and mean arterial pressure. All but one subject in the 500-mcg group met our criteria for hemodynamic stability. The plasma concentration profile was adequately described by a 2-compartment, weight allometric, first-order absorption, first-order elimination pharmacokinetic model. The standardized estimated parameters for an individual of 70 kg was V1 = 35.6 [95% CI, 23.8 to 52.8] l; V2 = 54.7 [34.2 to 81.7] l; CL = 0.56 [0.49 to 0.64] l/min; and F = 7.2 [4.7 to 14.4]%. Linear models with effect sites adequately described the decreases in mean arterial pressure and heart rate associated with oral dexmedetomidine administration. However, only the 700-mcg group reached plasma concentrations that have previously been associated with sedation (>0.2 ng/ml).

Conclusions

Oral administration of dexmedetomidine in doses between 300 and 700 mcg was associated with decreases in heart rate and mean arterial pressure. Despite low oral absorption, the 700-mcg dose scheme reached clinically relevant concentrations for possible use as a sleep-enhancing medication.

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Component breakage after total knee arthroplasty: a narrative review
Authors: Biggi Stefano , Capuzzo Andrea , Tedino Riccardo , Cattaneo Gabriele , Tornago Stefano , Camera Andrea
Published: October 2020

Component breakage is a rare complication after total knee arthroplasty (TKA). Fracture can occur in the metallic components or the polyethylene liner. Polyethylene liner fractures are the most frequent and usually belong to the tibial post because of trauma or excessive rotational forces in malaligned implants. In metallic components, the most frequent pattern is stress-fatigue fracture in the thinner areas, when exposed to greater loads. Specifically, these occur in the junction between the distal and medial surfaces of the medial condyle of the femur or the area between the stem and the medial plateau in the tibial tray. Common clinical findings are swelling, loss of motion, varus collapse, and patellar clunk syndrome. Diagnosis is relatively easy and includes clinical examinations and standard radiographs. The treatment is surgical and can hide pitfalls, especially if the surgical timing is incorrect. In addition to the revision of one or more components, surgeons must address any issues for the management of bone defects and ligamentous stability.
Does participation in a multicenter study group affect physician treatment preference? A survey of participants
Authors: Martin Benjamin D. , Kelly Derek M. , Nolan Vikki G. , Matthews Allison , Flournory Jolecia , Kim Harry K.W.
Published: October 2020

Background:

Our purpose was to determine if participation in a prospective, multicenter study group will influence surgeons’ treatment preferences despite no new evidence reported by the group.

Methods:

Surveys of treatment preferences in patients with Legg-Calve-Perthes (LCPD) disease and four cases with radiographs were sent to the International Perthes Study Group participants just before the inaugural meeting in 2012 and after the fifth annual meeting in 2016, and results were compared. A treatment change was a move from operative to nonoperative treatment or vice versa, surgeon experience was number of years in practice; the number of annual meetings attended served as a proxy study group participation.

Results:

Survey responses from 47 surgeons were analyzed. Participation in the study group ranged from one to five meetings, and the average clinical experience was 15 yr. On each survey question, some surgeons changed their response, highlighting changes in treatment preferences over time; however, no association was noted between treatment changes and number of meetings attended or length of surgeon experience. The more meetings attended, the more likely the surgeon used lateral extrusion on radiograph, lateral pillar or Catterall classification, or perfusion MRI as an indication to operate on certain age groups. For one of the four clinical cases, surgeons were 1.8 times more likely to change treatment preference with each meeting attended, and surgeons with less than 15 yr of experience were 8.5 times more likely to change.

Conclusions:

Although treatment preferences varied, study group participation did not impact decisions for operative versus nonoperative treatment, except in one case.

Level of Evidence:

Level IV.
Convalescent Plasma Therapy in Four Critically Ill Pediatric Patients With Coronavirus Disease 2019: A Case Series
Authors: Schwartz Stephanie P. , Thompson Peyton , Smith Melissa , Lercher Daniel M. , Rimland Casey A. , Bartelt Luther , Park Yara A. , Weiss Susan , Markmann Alena Janda , Raut Rajendra , Premkumar Lakshmanane , Kuruc JoAnn , Willis Zachary
Published: October 2020

Background:

Coronavirus disease 2019 is a pandemic with no specific therapeutic agents or vaccination. Small published case series on critically ill adults suggest improvements in clinical status with minimal adverse events when patients receive coronavirus disease 2019 convalescent plasma, but data on critically ill pediatric patients are lacking. We report a series of four critically ill pediatric patients with acute respiratory failure who received coronavirus disease 2019 convalescent plasma as a treatment strategy for severe disease.

Case Summary:

Patients ranged in age from 5 to 16 years old. All patients received coronavirus disease 2019 convalescent plasma within the first 26 hours of hospitalization. Additional disease modifying agents were also used. All patients made a full recovery and were discharged home off of oxygen support. No adverse events occurred from the coronavirus disease 2019 convalescent plasma transfusions.

Conclusion:

Coronavirus disease 2019 convalescent plasma is a feasible therapy for critically ill pediatric patients infected with severe acute respiratory syndrome coronavirus 2. Well-designed clinical trials are necessary to determine overall safety and efficacy of coronavirus disease 2019 convalescent plasma and additional treatment modalities in pediatric patients.
Antiviral Dosing Modification for Coronavirus Disease 2019–Infected Patients Receiving Extracorporeal Therapy
Authors: Chaijamorn Weerachai , Rungkitwattanakul Dhakrit , Nuchtavorn Nantana , Charoensareerat Taniya , Pattharachayakul Sutthiporn , Sirikun Wiriyaporn , Srisawat Nattachai
Published: October 2020

Previous literature regarding coronavirus disease 2019 outlined a presence of organ dysfunction including acute respiratory distress syndrome and acute kidney injury that are linked to mortality. Several patients require extracorporeal therapy. This review aims to gather available published resources including physicochemical and pharmacokinetic properties and suggests antiviral drug dosing adaptation for coronavirus disease 2019–infected critically ill patients receiving extracorporeal therapy. A literature search was performed using PubMed, clinical trial registries, and bibliographic review of textbooks and review articles. Unfortunately, no standard of pharmacologic management and recommendations of drug dosing for coronavirus disease 2019 infection for critically ill patients receiving extracorporeal therapy exist due to the limited data on pharmacokinetic and clinical studies. All available extracted data were analyzed to suggest the appropriate drug dosing adjustment. Antiviral drug dosing adjustments for critically ill patients receiving extracorporeal membrane oxygenation and continuous renal replacement therapy are presented in this review. Considering pathophysiologic changes, drug properties, and extracorporeal modalities, applying our suggestions is recommended.
Prevention of atelectasis by continuous positive airway pressure in anaesthetised children
Authors: Acosta Cecilia M. , Lopez Vargas María Paz , Oropel Facundo , Valente Lisandro , Ricci Lila , Natal Marcela , Suarez Sipmann Fernando , Tusman Gerardo
Published: October 2020

BACKGROUND

Continuous positive airway pressure (CPAP) prevents peri-operative atelectasis in adults, but its effect in children has not been quantified.

OBJECTIVE

The aim of this study was to evaluate the role of CPAP in preventing postinduction and postoperative atelectasis in children under general anaesthesia.

DESIGN

A randomised controlled study.

SETTING

Single-institution study, community hospital, Mar del Plata. Argentina.

PATIENTS

We studied 42 children, aged 6 months to 7 years, American Society of Anesthesiologists physical status class I, under standardised general anaesthesia.

INTERVENTIONS

Patients were randomised into two groups: Control group (n = 21): induction and emergence of anaesthesia without CPAP; and CPAP group (n = 21): 5 cmH2O of CPAP during induction and emergence of anaesthesia. Lung ultrasound (LUS) imaging was performed before and 5 min after anaesthesia induction. Children without atelectasis were ventilated in the same manner as the Control group with standard ventilatory settings including 5 cmH2O of PEEP. Children with atelectasis received a recruitment manoeuvre followed by standard ventilation with 8 cmH2O of PEEP. Then, at the end of surgery, LUS images were repeated before tracheal extubation and 60 min after awakening.

MAIN OUTCOME MEASURES

Lung aeration score and atelectasis assessed by LUS.

RESULTS

Before anaesthesia, all children were free of atelectasis. After induction, 95% in the Control group developed atelectasis compared with 52% of patients in the CPAP group (P < 0.0001). LUS aeration scores were higher (impaired aeration) in the Control group than the CPAP group (8.8 ± 3.8 vs. 3.5 ± 3.3 points; P < 0.0001). At the end of surgery, before tracheal extubation, atelectasis was observed in 100% of children in the Control and 29% of the CPAP group (P < 0.0001) with a corresponding aeration score of 9.6 ± 3.2 and 1.8 ± 2.3, respectively (P < 0.0001). After surgery, 30% of children in the Control group and 10% in the CPAP group presented with residual atelectasis (P < 0.0001) also corresponding to a higher aeration score in the Control group (2.5 ± 3.1) when compared with the CPAP group (0.5 ± 1.5; P < 0.01).

CONCLUSION

The use of 5 cmH2O of CPAP in healthy children of the studied age span during induction and emergence of anaesthesia effectively prevents atelectasis, with benefits maintained during the first postoperative hour.

TRIAL REGISTRY

Clinicaltrials.gov NCT03461770.
Diplopia Following the Insertion of a Canalicular Bypass Tube: Etiology, Risk Factors, Management, and Outcomes
Authors: Bladen John C. , Mombaerts Ilse , Kakizaki Hirohiko , McNab Alan A. , Norris Jonathan H. , Verity David , DeAngelis Dan D. , Ataullah Sajid M. , McCormick Austin G. , Parkin Ben , Patel Bhupendra C. K. , Morley Ana M. S. , Rose Geoffrey E. , Malhotra Raman
Published: October 2020

Purpose:

To report the etiology, management, and possible risk factors for diplopia after canalicular bypass surgery.

Methods:

A multicenter retrospective, noncomparative case series of patients who developed diplopia following canalicular bypass surgery were assessed.

Results:

Twenty-four cases of diplopia were identified across 12 institutions. Tubes were inserted as a primary procedure with external dacryocystorhinostomy (DCR) (1; 4%) or without DCR (10; 42%) or as a secondary procedure after external (8; 33%) or endonasal (5; 21%) DCR. Factors predisposing to local damage were noted in 17 (71%): these factors included preexisting autoimmune/inflammatory condition (7 cases), medial canthal tumor resection (5 cases), preoperative radiotherapy (2 cases), 2 drug treatments (topical and systemic), and 1 local surgery. Horizontal diplopia was due to restriction of abduction and first noted at a median of 3.5 months (mean: 17.8 months, range: 1 day to 112 months) and persisted in 23 (96%) cases with a mean restriction of −2, affecting primary gaze in 4 patients and activities of daily living in 13 (42%). Seventeen patients received various treatments: 10 were operated on resulting in cure in 1 and improvement in 9. A stable degree of diplopia persisted in all but one patient.

Conclusions:

Restriction of abduction causing horizontal diplopia is a rare complication with canalicular bypass surgery and a notably high proportion occurred after tube placement without DCR; carunculectomy was not ubiquitous. Although in some the diplopia may be improved with intervention, the chance of cure is low. This complication should probably be included during informed consent for canalicular bypass tubes.
Primary Lacrimal Gland Oncocytoma Associated With Hypervascularity: A Case Report With Imaging and Immunohistochemical Characterization
Authors: Sweeney Adam R. , Allen Richard C.
Published: October 2020

Oncocytoma is a rare benign neoplasm with few cases reported to involve the orbit. When affecting the orbit, oncocytomas have very slow growth and often evade early diagnosis. The diagnostic evaluation of these orbital tumors is not fully understood. The authors present a case of a benign oncocytoma arising in the lacrimal gland associated with significant vascularity and intraoperative bleeding. The authors provide immunohistochemical analysis of this rare orbital tumor and insights in surgical planning.
Prognostic Factors for Orbital Exenteration, Local Recurrence, Metastasis, and Death From Disease in Conjunctival Squamous Cell Carcinoma
Authors: El-Hadad Christian , Rubin Maria Laura , Nagarajan Priya , Ford Joshua Richard , Xu Shiqiong , Ning Jing , Esmaeli Bita
Published: October 2020

Purpose:

Information regarding risk of metastasis and disease-related death (DD) from conjunctival squamous cell carcinoma (SCC) is relatively scarce. We explored prognostic factors for orbital exenteration, local recurrence, nodal metastasis, and DD in patients with conjunctival SCC.

Design:

Retrospective cross-sectional study.

Methods:

All consecutive patients with conjunctival SCC treated by the senior author at MD Anderson Cancer Center during1999–2018 were included. Survival curves were estimated using the Kaplan–Meier method, and survival differences were assessed using 2-sided log-rank tests.

Results:

The study included 44 patients (24 men, 20 women); median age was 64 years (range, 40–90). T categories at presentation were as follows: Tis, 20 patients; T2, 8; T3, 9; and T4, 7. Eighteen patients (41%) had tumors exclusively in the bulbar conjunctiva; 26(59%) had nonbulbar conjunctival involvement. The median follow-up time was 29.2 months (95% CI: 21.8–44.3). Orbital exenteration was performed in 10 cases (23%) and was associated with T3 or more advanced disease at presentation (p < 0.001). Seven patients developed local recurrence during follow up. History of organ transplant correlated with local recurrence and orbital exenteration (p < 0.01). Nodal metastasis was present in 1 patient at presentation and occurred in 3 patients during follow up, for an overall nodal metastasis rate of 9% (4/44). By end of follow up, 2 patients had died of disease, 4 had died of other causes, and 38 were alive with no evidence of disease. The results suggest that both orbital exenteration and nodal metastasis are independent variables associated with DD.

Conclusions:

In patients with conjunctival SCC, orbital exenteration and nodal metastasis are associated with DD and organ transplantation is associated with orbital exenteration.
Air Bubble Test Versus Endoscopic Jones I Test in Assessment of Anatomical and Functional Success After Diode Laser Transcanalicular Dacryocystorhinostomy
Authors: Feijó Eduardo Damous , Alves Caixeta Juliana , Matayoshi Suzana
Published: October 2020

Purpose:

To compare the accuracy and positive predictive values of the air bubble test (ABT) and endoscopic Jones I test for assessment of anatomical and functional success after diode laser transcanalicular dacryocystorhinostomy (T-DCR).

Methods:

This cross-sectional study included 60 eyes of 56 patients who underwent T-DCR by a single surgical team from January 2016 to December 2018. All the 56 patients (60 eyes) underwent lacrimal syringing, endoscopic Jones I test, and ABT. Anatomical success was considered as a free passage of fluid with no reflux on the irrigation test. Functional success was defined as the resolution or improvement of epiphora (Munk score of 0 or 1). The results of irrigation test, endoscopic Jones I test, and ABT were used to calculate the accuracy and positive predictive values (PPVs) of ABT and endoscopic Jones I test for assessment of anatomical and functional success (Munk score of 0 or 1) after T-DCR. A value of p < 0.05 was considered statistically significant. All statistical evaluations were performed using SPSS software.

Results:

There were 60 T-DCR procedures in 56 patients (82.1% women; 46 patients) with a mean age of 56.4 years (standard deviation: 15.7; range from 29 to 92). The mean follow up was 8.1 months. Overall anatomical and functional success rates were 83.3% (50/60) and 73.3% (44/60), respectively. The PPV of endoscopic Jones I test in anatomical success and functional success was 100% and 88%, respectively. The accuracy of this test in anatomical and functional success was 100% and 81.25%, respectively. The PPV of ABT in anatomical success and functional success was 100% and 90.4%, respectively. The accuracy of this test in anatomical and functional success was 92% and 80.65%, respectively.

Conclusions:

In conclusion, both endoscopic Jones I test and ABT showed PPV of 100% to detect anatomical success after T-DCR; the endoscopic Jones I test and ABT had 88% and 90.4% of PPV on evaluation of functional success, respectively. Both tests showed good accuracy in the assessment of anatomical and functional success after T-DCR. These outcomes may indicate that ABT could substitute Jones I test on postoperative DCR assessment.
Nanodiamond-based microRNA delivery system promotes pluripotent stem cells toward myocardiogenic reprogramming
Authors: Liu Chao-Yu , Lee Ming-Cheng , Lin Heng-Fu , Lin Yi-Ying , Lai Wei-Yi , Chien Yueh , Huo Teh-Ia , Lo Wen-Liang , Lan Yuan-Tzu , Chen Yi-Wei , Huang Pin-I , Liu Yong-Yang , Yang Meng-Yin
Published: October 2020

Background:

Gene therapy is the advanced therapeutics for supplying or replacing the genetic material in patients with inherited disorders. Recent clinical studies have made some progress in a wide range of applications, including monogenic disorders, neurodegenerative diseases, malignant tumors, and congenital diseases. Heart diseases, especially myocardial ischemia, remain one of the leading causes of mortality worldwide and usually result in irreparable cardiomyocyte damage and severe heart failure.

Methods:

Most advances in induced pluripotent stem cell (iPSC) technologies for promoting regenerative medicine and stem cell research. However, the driver molecules of myocardial-lineage differentiation and the functional reconstruction capacity of iPSC-derived cardiomyocytes are still an open question. Nanomedicine-based gene delivery provided a crucial platform to carry on the biogenomic materials for equipping functionalities and engineering the living organ environment. Nanodiamond (ND), a carbon-based nanomaterial, has been discovered and shown the high biocompatible and less toxicity for transporting protein, drug, and genomic plasmids.

Results:

Here, we applied ND as a gene delivery vehicle to carry microRNA (miR-181a), and then transfected into iPS to promote cardiomyocyte-lineage differentiation. Notably, miR-181a plays a key role in iPS-derived cardiomyocyte differentiation which directly targets Hox-A11, leading to elevated MyoD expression and enhanced cardiomyocyte differentiation.

Conclusion:

Our study demonstrated that miR-181a promotes iPSC differentiation into functional cardiomyocytes. Delivery of NANO-DIAMOND-miR-181a may host clinical potential to enhance the differentiation and recovery of the cardiogenic function in injured cardiomyocytes.