bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Salivary Busulfan the Cause of Oral Mucositis and the Changes in Salivary Antioxidant Enzymes After Hematopoietic Cell Transplantation?
Authors: de Paula Eduardo Fernanda , Bezinelli Letícia Mello , Carvalho Danielle L. C. , Ferreira Mariana Henriques , Gobbi Marcella , Rosin Flavia C. P. , dos Santos Ferreira Carlos Eduardo , Sodre da Costa Lidiane Soares , Hamerschlak Nelson , Corrêa Luciana
Published: March 2020

Background:

To determine whether the busulfan (Bu) present in saliva during hematopoietic cell transplantation (HCT) conditioning correlates with oral mucositis and the changes in salivary antioxidant enzymes.

Methods:

Bu levels in the plasma and saliva of 19 patients who received HCTs were quantified. Salivary flow and salivary superoxide dismutase and catalase activities were measured during HCT. For the toxicity analysis of salivary Bu, an in vitro assay was conducted by exposing human keratinocytes to artificial saliva containing Bu.

Results:

Plasma and salivary Bu concentrations were very similar (rho = 0.92, P < 0.001). Salivary Bu concentration correlated with the degree of oral mucositis severity (rho = 0.391, P = 0.029) and was inversely proportional to salivary superoxide dismutase and catalase activities (rho = −0.458, P = 0.036; rho = −0.424, P = 0.043, respectively). Cells exposed to Bu-containing saliva had fewer viable cells (P < 0.01) and more apoptotic cells (P = 0.001) than those exposed to non–Bu-containing saliva.

Conclusions:

Bu found in saliva during HCT conditioning was correlated with severe oral mucositis and the reduction in salivary antioxidative activity. Furthermore, Bu can be toxic to keratinocytes.
Increased dipeptidyl peptidase-4 accelerates chronic stress-related thrombosis in a mouse carotid artery model
Authors: Jin Xianglan , Jin Chunzi , Nakamura Kae , Jin Tiefeng , Xin Minglong , Wan Ying , Yue Xueling , Jin Shengyu , Wang Hailong , Inoue Aiko , Nan Yongshan , Lin Zhenhua , Kuzuya Masafumi , Cheng Xian Wu
Published: March 2020

Objective:

Exposure to chronic psychosocial stress is a risk factor for metabolic cardiovascular disorders. Given that dipeptidyl peptidase-4 (DPP-4) has an important role in human pathobiology, we investigated the role of DPP-4 in stress-related thrombosis in mice, focusing on oxidative stress and the von Willebrand factor (vWF)-cleaving protease ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13).

Methods and results:

Male mice randomly assigned to nonstress and 2-week immobilized-stress groups underwent iron chloride3 (FeCl3)-induced carotid artery thrombosis surgery for morphological and biochemical studies at specific times. On day 14 post-stress/surgery, stress had enhanced the lengths and weights of arterial thrombi, with alterations of plasma DPP-4, plasminogen activation inhibitor-1 and ADAMTS13. The stressed mice had increased levels of vascular cell adhesion molecule-1, intracellular adhesion molecule-1, monocyte chemoattractant protein-1, gp91phox, p22phox, matrix metalloproteinase-2 (MMP-2), MMP-9, cathepsins S and K mRNAs and/or proteins, and reduced levels of endothelial nitric oxide synthase, catalase and superoxide dismutase-1 mRNAs and/or proteins. Stress also accelerated arterial endothelial cell damage. The DPP-4 inhibitor anagliptin ameliorated the stress-induced targeted molecular and morphological changes and thrombosis. In vitro, DPP-4 inhibition also mitigated the alterations in the targeted ADAMTS13 and other oxidative and inflammatory molecules in human umbilical vein endothelial cells in response to H2O2.

Conclusion:

DPP-4 inhibition appeared to improve the FeCl3-induced thrombosis in mice that received stress, possibly via the improvement of ADAMTS13 and oxidative stress, suggesting that DPP-4 could become a novel therapeutic target for chronic psychological stress-related thrombotic events in metabolic cardiovascular disorders.
Retinal arterial remodeling in patients with pheochromocytoma or paraganglioma and its reversibility following surgical treatment
Authors: Gosk-Przybyłek Maria , Doroszko Adrian , Dobrowolski Piotr , Warchoł-Celińska Ewa , Harazny Joanna , Bińczyk Ewelina , Szymanek Katarzyna , Pęczkowska Mariola , Kabat Marek , Toutounchi Sadegh , Gałązka Zbigniew , Górnicka Barbara , Szaflik Jerzy , Januszewicz Magdalena , Klisiewicz Anna , Hoffman Piotr , Lenders Jacques W.M. , Eisenhofer Graeme , Szaflik Jacek P. , Schmieder Roland E. , Prejbisz Aleksander , Januszewicz Andrzej
Published: March 2020

Objective:

Structural abnormalities in resistance arteries are a hallmark of patients with hypertension. In hypertensive patients with pheochromocytoma or paraganglioma (PPGL), it is still a matter of debate whether structural vascular changes are because of elevated blood pressure (BP) or to toxic effects of elevated circulating catecholamines. Hence, the aim of our study was to assess whether catecholamine excess and/or elevated BP affect the structure of small retinal arteries in patients with catecholamine-producing tumors.

Methods:

The study included 27 patients with PPGL and 27 hypertensive patients. All patients underwent biochemical tests for catecholamine excess, echocardiography and analyses of scanning-laser-Doppler-flowmetry (SLDF) both at baseline and 12 months following surgical resection of PPGL.

Results:

Baseline retinal arterial diameter, arterial wall thickness and wall cross sectional area (WCSA) were higher in patients with PPGL as compared with subjects without PPGL (arterial diameter: 110 ± 16.5 vs. 99.5 ± 10.8 μm, wall thickness: 16.3 ± 6.0 vs. 13.5 ± 4.0 μm, WCSA: 4953.9 ± 2472.8 vs. 3784.1 ± 1446.3 μm2, P < 0.05). Significant correlations were noted between wall thickness and WCSA and echocardiographic parameters assessing diastolic and systolic function of left ventricle. No correlations between retinal parameters, BP level and plasma concentrations of metanephrines were observed. In patients with PPGL, there were postoperative decreases in wall thickness (16.4 ± 15.8 vs. 14.8 ± 4.7 μm; P = 0.011) and WLR (0.42 ± 0.13 vs. 0.37 ± 0.10; P = 0.003) at 12 months after surgical removal of tumors.

Conclusion:

This is the first study to demonstrate that catecholamine excess is related to thickening of retinal arteries independent of BP and reversible after surgical cure. These data support a role of catecholamines in vascular remodeling in PPGL patients.
Deep-layer Microvasculature Dropout in Preperimetric Glaucoma Patients
Authors: Suh Min Hee , Na Jeong Ho , Zangwill Linda M. , Weinreb Robert N.
Published: March 2020

Purpose:

To compare disease severity between preperimetric primary open-angle glaucoma (POAG) patients with and without deep-layer microvasculature dropout.

Materials and Methods:

Ninety-four eyes of 94 preperimetric POAG patients with β-zone parapapillary atrophy (βPPA) were categorized according to the presence of deep-layer microvasculature dropout defined as a complete loss of microvasculature within the choroid or scleral flange on optical coherence tomography angiography. Parameters representing disease severity, that is, visual field (VF) mean deviation (MD), global and sectoral (6-sector) retinal nerve fiber layer (RNFL) thickness, and other factors including age, focal lamina cribrosa (LC) defect, width of βPPA with and without Bruch membrane (BM) (βPPA+BM and βPPA−BM), and optic disc hemorrhage were compared between eyes with and without dropout.

Results:

Deep-layer microvasculature dropout was observed in 33 preperimetric POAG eyes (35.1%). Eyes with dropout had significantly thinner RNFL in all areas except the inferonasal sector, worse VF MD, and higher prevalence of focal LC defect, and larger βPPA−BM (P<0.05), whereas the 2 groups did not differ in age, disc hemorrhage, or βPPA+BM width (P>0.05). In the multivariable logistic regression, worse VF MD [odds ratio (OR), 1.485; P=0.045], thinner RNFL (OR, 1.141; P<0.001), and higher prevalence of focal LC defect (OR, 6.673; P<0.001) were significantly associated with dropout.

Conclusions:

Deep-layer microvasculature dropout was observed in a considerable number of preperimetric POAG eyes, and worse disease severity was associated with dropout. Future studies elucidating the pathogenic role of deep-layer microvasculature dropout in the development and progression of glaucoma are warranted.
Foveal Avascular Zone Measurement Via Optical Coherence Tomography Angiography and its Relationship With the Visual Field in Eyes With Open-angle Glaucoma
Authors: Igarashi Ryoko , Ochiai Shun , Togano Tetsuya , Sakaue Yuta , Suetake Aki , Iikawa Ryu , Honma Yurie , Miyamoto Daiki , Fukuchi Takeo
Published: March 2020

Precis:

The foveal avascular zone (FAZ) in optical coherence tomography angiography is significantly correlated with retinal inner layer thickness, Humphrey field analyzer (HFA) 10-2 sensitivity threshold, and mean deviation (MD) value in open-angle glaucoma patients.

Purpose:

The purpose of this study was to measure the FAZ area using optical coherence tomography angiography and investigate its relationship with retinal inner layer thickness and visual field defects in eyes with open-angle glaucoma.

Participants and Methods:

A total of 52 eyes with open-angle glaucoma from 52 patients. FAZ area was measured using optical coherence tomography angiography in angio-macula mode. Thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer plus inner plexiform layer (GCL+IPL), and ganglion cell complex (GCC) were determined using a 7 mm×7 mm macular (V) map via 3D-OCT. Correlations of FAZ area with sensitivity threshold measurements, foveal threshold (FT), and MD value in the HFA10-2 visual field were analyzed for each inner retinal layer.

Results:

FAZ area was 0.26±0.07 mm2; overall mean thicknesses were 19.14±6.55 μm (RNFL), 57.34±5.93 µm (GCL+IPL), and 75.87±10.96 μm (GCC); mean FT was 35.23±3.15 dB, and sensitivity threshold was 20.81±7.22 dB in the HFA10-2 visual field. FAZ area was significantly correlated with the thickness of individual retinal layers in the entire field (RNFL, P<0.001; GCL+IPL, P<0.001; GCC, P<0.001), sensitivity threshold (P=0.01), FT (P<0.001), and MD value (P=0.011).

Conclusion:

FAZ area was significantly negatively correlated with retinal inner layer thickness, sensitivity threshold, FT, and MD value in the HFA10-2 visual field.
Accuracy of intraocular lens power calculation methods when targeting low myopia in monovision
Authors: Turnbull Andrew M.J. , Hill Warren E. , Barrett Graham D.
Published: March 2020

Purpose:

To investigate the accuracy of IOL power calculation methods for refractive targets of myopia compared with emmetropia.

Setting:

Lions Eye Institute, Perth, Australia.

Design:

Retrospective analysis.

Methods:

Patients undergoing bilateral, sequential cataract surgery with a plan of modest monovision were analyzed. Target refraction was plano (distance eye) and −1.25 diopters (D) (near eye). Prediction error was determined by comparing the actual postoperative refraction with the predicted postoperative refraction, calculated by the Barrett Universal II (BUII), Hill-RBF version 2.0 (Hill-RBF 2.0), Haigis, Holladay 1, SRK/T, and Hoffer Q formulas. The dataset was divided into distance and near eye subgroups. Mean and median absolute error and percentage of eyes within ±0.25, ±0.50, ±0.75, and ±1.00 D of refractive target were compared.

Results:

The study included 88 consecutive patients. There was a consistent trend for lower refractive accuracy in the near eyes. BUII and Hill-RBF 2.0 were the most accurate overall and least affected by this phenomenon, with 1 (1.1%) and 4 (4.6%) fewer eyes, respectively, in the near subgroup achieving ±0.50 D of target. Haigis and SRK/T were most affected, with 14 (15.9%) and 11 (12.5%) fewer near eyes achieving ±0.50 D of target (P < .05). Holladay 1 and Hoffer Q occupied the middle ground, with 6 (6.8%) and 9 (10.2%) fewer near eyes achieving ±0.50 D of target.

Conclusions:

IOL-power calculation formulas appear to be less accurate when targeting myopia compared with emmetropia. BUII and Hill-RBF 2.0 represented good options when planning pseudophakic monovision as they were least affected by this phenomenon and can be used for both distance and near eyes.
Management of Malignant Vulval Melanoma: A Retrospective Case Series and Review of the Literature
Authors: Platt Sarah , Coleridge Sarah , Hughes Geoff , Donkers Hannah , Wiggans Alison , Frost Jonathan , Rolland Phil , Julian Sophia , Morrison Jo , Pawade Joya , Patel Amit , Newton Claire
Published: March 2020

Objectives

The aims of the study were to evaluate clinicopathologic features, management, and outcomes in vulval melanoma and to review the literature.

Materials and Methods

Data were collected retrospectively on patients with vulval melanoma from 2001 to 2017 in 5 gynecological oncology cancer centers (Bristol, Taunton, Truro, Plymouth, and Cheltenham). SPSS software was used for univariate and multivariate statistical analysis. Disease-specific median survival was calculated using Kaplan-Meier curves.

Results

Forty-four patients with vulval melanoma were included, with a median age of 71 years. Forty-three of 44 had wide local excision with full inguinal lymphadenectomy if abnormal lymph nodes. Seven patients had sentinel lymph nodes. However, 2 patients with negative sentinel lymph nodes had distant recurrences within 16 months.

On univariate analysis, presence of ulceration (p = .012), perineural invasion (p = .03), and area of lesion (p = .016) were associated with risk of recurrence but only presence of microsatellites (p = .01) was associated with risk of death.

There were 31 deaths (70%): 29 (94%) of 31 from melanoma and 28 (64%) of 44 recurrences: 17 local (10 groin, 7 vulval) and 9 distant. Overall median survival was 32.5 months (95% CI, 17.8–46.5 months) and median recurrence-free survival 12.6 months (95% CI, 7.7–17.4 months).

Conclusions

This retrospective multicenter study highlights the high recurrence rate and poor prognosis of vulval melanoma. Lymph node surgery did not make any difference to recurrence-free survival or overall survival. The presence of microsatellites was associated with a statistically increased risk of death.
Left Ventricular Thinning and Distension in Pig Hearts as a Reproducible Ex Vivo Model of Functional Mitral Regurgitation
Authors: Agra Elorm J. , Suresh Kirthana Sreerangathama , He Qi , Onohara Daisuke , Guyton Robert A. , Padala Muralidhar
Published: March 2020

Functional mitral regurgitation in the setting of an enlarged heart is challenging to repair surgically with an annular approach, and the need to develop subannular and ventricular approaches is recognized yet unrealized because of the lack of models for investigations. In this study, we report a novel model of functional mitral regurgitation induced by left ventricular thinning and distension in pig hearts. Seven pig hearts were explanted at a local slaughterhouse, and left ventricular distension induced by thinning the ventricular myocardium by 60–65% of its original thickness. Distension of the thinned hearts with a 120 mmHg column confirmed significant left ventricular dilatation and mitral valve tethering. These hearts were then mounted into a pulsatile flow model and animated at 120 mmHg left ventricular pressure, 5 L/min cardiac output at 70 beats/min. Echocardiography was used to assess valvular kinematics and hemodynamics. Left ventricular wall thickness reduced by 60.5% ± 10.1% at the basal plane, 64.8% ± 11.3% at the equatorial plane, and 64.0% ± 11.4% at the apical plane after thinning. Upon distension, ventricular volumes increased by 852.4% ± 639.8% after left ventricular thinning, with an 89.5% ± 33.9% increase in sphericity index. Mitral valve systolic tenting height increased from 7.92 ± 2.06 to 15.02 ± 3.89 mm, systolic tethering area increased from 130.7 ± 38.2 to 409.9 ± 124.6 mm2 and an average mitral regurgitation fraction of 24.4% ± 16.6% was measured. In a case study, use of multimodality imaging to test the efficacy of transcatheter mitral devices was confirmed. Ventricular wall thinning leading to passive left ventricular distension and dilatation is a reproducible ex vivo model of mitral valve tethering and functional mitral regurgitation, which in combination with multimodality imaging provides a good simulation model.
Intracorporeal Biventricular Assist Devices Using the Heartware Ventricular Assist Device in Children
Authors: Schweiger Martin , E. Mascio Christoph , Kanter Kirk R. , Marasco Silvana , Eghtesady Pirooz , Miera Oliver , Hübler Michael , Kavarana Minoo N.
Published: March 2020

We describe the experience with biventricular HeartWare VAD (HVAD) support in the pediatric population. As of May 2017, using the Heartware database, 11 centers were identified. Seven centers participated providing information for 10 patients (four females, six males). Median age at the time of implantation was 12.7 ± 4.6years (5.3–6.9), median body surface area was 1.56. The indications for biventricular assist device (BiVAD) support included: myocarditis (n = 1), cardiomyopathy (n = 8), and one posttransplant heart failure. Six patients had a primary BiVAD implantation. Out of 10 patients with BiVAD, five were transplanted, one is ongoing (postoperatively day 207), and none were weaned from the device. Two patients (20%) were discharged from hospital on BiVAD support. Median support time was 52 days (16–235). The overall success rate was 60% surviving to transplant (median support time: 51 days) or are ongoing. Reasons for death included bleeding (n = 2), intracerebral hemorrhage (n = 1), and multisystem organ failure (n = 1). Eight out of 10 patients had at least one major complication, that is, major bleeding requiring re-operation (n = 6), severe neurologic injury (n = 1), and pump thrombosis in two patients requiring device exchange (n = 1) or thrombolysis therapy (n = 1). BiVAD HVAD implantation in children is a rare procedure, with high mortality and low discharge rates. Bleeding requiring re-operation was the most common postoperative complication, despite fresh sternotomies in the majority of patients. The risk and benefit ratio of such an approach should be carefully reviewed, and compared with the standard strategy using the Berlin EXCOR.
Hemophilia A and von Willebrand deficiency: therapeutic implications
Authors: Basso Maria , Lazzareschi Ilaria , Curatola Antonietta , Di Gennaro Leonardo , Buonsenso Danilo , Gatto Antonio , De Candia Erica , De Cristofaro Raimondo
Published: March 2020

Hemophilia A is an X-linked bleeding disorder caused by a deficiency of factor VIII. Depending on the factor VIII activity in patient's plasma, we can have three different forms of hemophilia A: mild (5–40 IU/dl), moderate (1–5 IU/dl) and severe (<1 IU/dl). The most common symptoms include recurrent bleeding episodes of soft tissues and joints. The treatment is based on the prophylactic use of clotting factor concentrates to prevent bleeding episodes. We describe three cases of patients with initially diagnosis of hemophilia A that show different clinical severity, undergoing prophylactic therapies with low benefit. In these patients, the dosage of von Willebrand antigen revealed either low level or absence of this factor, which in one case was caused by the occurrence of a type III form of von Willebrand disease.
Food allergy prevention: current evidence
Authors: Baker Mary Grace , Nowak-Wegrzyn Anna
Published: March 2020

Purpose of review

The aim of the article is to critically appraise the most relevant studies in the rapidly advancing field of food allergy prevention.

Recent findings

Epidemiologic studies identified atopic dermatitis as a strong risk factor for food allergy, with mounting evidence for impaired skin barrier and cutaneous inflammation in the pathogenesis. Additional risk factors include a family history of atopy, the timing of allergenic food introduction into the infant's diet, dietary diversity, vitamin D, and environmental factors, such as dog ownership. Early introduction of allergenic foods (such as peanut) into the infant diet was shown to significantly reduce the risk of food allergy in infants with risk factors, whereas studies targeting skin barrier function have produced conflicting results. Cumulative evidence supports dietary diversity during pregnancy, breastfeeding, infancy, and early childhood.

A variety of interventions have been evaluated for the prevention of atopic dermatitis and food allergy, often producing conflicting results. At present, official guidelines encourage breastfeeding and early allergenic food introduction for infants at risk for food allergy, with an emphasis on dietary diversity, fruits, vegetables, fish, and food sources of vitamin D during pregnancy, lactation, and early life for all infants.
Comparing open-radical cystectomy and robot-assisted radical cystectomy: current status and analysis of the evidence
Authors: Khetrapal Pramit , Conroy Samantha , Kelly John D. , Catto James W.F.
Published: March 2020

Purpose of review

Radical cystectomy is the definitive surgical treatment for aggressive bladder cancer. The robotic platform offers a new approach to radical cystectomy, but the benefits are unclear. This review examines the latest evidence, with a particular focus on developments in the last two years.

Recent findings

Prospective evaluations of open (ORC) and robot-assisted radical cystectomy (RARC) are emerging. The radical cystectomy in patients with bladder cancer trial reported in 2018 and demonstrated oncological noninferiority for both approaches and marginal shorter length of stays with RARC using an extracorporeal reconstruction. The trial confirmed prospective randomized comparisons are possible, and replicates observations from two earlier, smaller randomised controlled trials with longer follow-up. Although there has been significant traction to the intracorporeal approach to RARC, randomized trial evidence is awaited to show any benefit over ORC.

New evidence alludes to the noninferiority of the robotic platform in radical cystectomy in comparison to open surgery. There is minimal evidence of a clinically meaningful benefit. Until this is addressed, ORC remains the gold standard for the definitive surgical management of bladder cancer.
Climate Change and Risk of Completed Suicide
Authors: Dumont Caroline , Haase Elizabeth , Dolber Trygve , Lewis Janet , Coverdale John
Published: March 2020

Climate change is increasingly recognized as having multiple adverse mental health effects, many of which are just beginning to be understood. The elevated rates of suicides observed in some communities affected by climate change and rising rates of suicide in the United States as climate change intensifies have suggested the two may be associated. We searched PubMed and PsycInfo using the terms climate change and suicide, and provide here a review of the current literature on climate change and suicide that explores possible associations and methodological issues and challenges in this research.
Building a Research Data Repository for Chronic Condition Self-Management Using Harmonized Data
Authors: Moore Shirley M. , Musil Carol M. , Alder Megan L. , Pignatiello Grant , Higgins Patricia , Webel Allison , Wright Kathy D.
Published: March 2020

Background

Building nursing research data repositories with the goal of comparing and synthesizing results across numerous studies and public sharing of data is still in early stages of development.

Objectives

We describe the process of using common data elements (CDEs) to build a data repository for research addressing self-management of chronic conditions. Issues in the development of CDEs, lessons learned in the creation of a combined data set across seven studies of different chronic condition populations, and recommendations for creating and sharing harmonized nursing research data sets are provided.

Methods

In 2014, at initiation of a National Institutes of Health-funded Centers of Excellence in Self-Management Research, our center investigators defined a set of CDEs for use in future center-funded pilot studies consisting of populations having different chronic conditions with the intent to combine the study data sets. Over the next 4 years, center investigators were provided with standardized codebooks and data collection protocols for applying the CDEs and data storage. Data from seven pilot studies were subsequently combined.

Results

Although each pilot study was small—with sample sizes ranging from 18 to 31 participants—our combined data set of 179 participants provides us with a sample size sufficient to conduct analyses that could not be done with the individual small samples alone. The research data repository addressing self-management of chronic conditions will soon be available for public sharing.

Discussion

Our experience demonstrates that, with careful, upfront planning and ongoing vigilant oversight, CDEs can be applied across studies consisting of different chronic condition populations to combine data sets to create research data repositories for public sharing.
Imaging and Image-Guided Thermal Ablation for Oligometastatic Colorectal Cancer Liver Disease
Authors: Vasiniotis Kamarinos Nikiforos , Sofocleous Constantinos Thasos
Published: March 2020

Colorectal cancer affects more than 1 million people worldwide, and half of this population develops liver metastases. Image-guided thermal ablation is an acceptable local therapy for the management of oligometastatic colorectal cancer liver disease, in patients who are noneligible for surgery, or present with recurrence after hepatectomy. Continuous technological evolutions, understanding of tumor variability through disease biology and genetics, and optimization of ablation parameters with ablation margin assessment have allowed patients with resectable small-volume disease to be treated by thermal ablation with curative intent. The growing role of imaging and image guidance in thermal ablation for patient selection, procedure planning, tumor targeting, and assessment of technical success is discussed in this article.
Near point-of-care, point-mutation test to detect drug resistance in HIV-1: a validation study in a Mexican cohort
Authors: Panpradist Nuttada , Beck Ingrid A. , Ruth Parker S. , Ávila-Ríos Santiago , García-Morales Claudia , Soto-Nava Maribel , Tapia-Trejo Daniela , Matías-Florentino Margarita , Paz-Juarez Hector E. , del Arenal-Sanchez Silvia , Reyes-Terán Gustavo , Lutz Barry R. , Frenkel Lisa M.
Published: March 2020

Objective:

Pretreatment HIV-drug resistance (PDR, HIVDR) to non-nucleoside reverse transcriptase inhibitors (NNRTIs) is increasing globally. NNRTIs continue to be used as first-line antiretroviral therapy (ART) in some communities due to the cost of dolutegravir-based ART or dolutegravir-associated adverse events. A simplified version of the oligonucleotide ligation assay (OLA) – ‘OLA-Simple’ – is a low-cost, near point-of-care assay that provides ready-to-use lyophilized reagents and reports HIVDR mutations as colored lines on lateral flow strips. Our objective was to design and validate OLA-Simple for a Mexican cohort.

Design:

OLA-Simple probes to detect K65R, K103N/S, Y181C, M184V, and G190A were optimized for HIV Mexican sequences. Sixty clinical plasma specimens were analyzed by OLA-Simple by technicians blinded to Illumina-MiSeq sequences, and HIVDR results were compared.

Methods:

Plasma RNA was tested using OLA-Simple kits. OLA-Simple lateral flow strips were read by in-house software, and were classified as mutant or wild-type at each codon. The comparison of results by OLA-Simple and Miseq was used to generate receiver-operating characteristic curves.

Results:

OLA-Simple PCR amplified 59 of 60 specimens and successfully genotyped 287 of 295 codons, with eight of 295 (2.7%) indeterminate results. Compared to MiSeq, OLA-Simple gave five of 295 (1.7%) false-positive and four of 295 (1.4%) false-negative results. Excluding indeterminate results, OLA-Simple classified mutant with an accuracy of 97.4 and 98.8% when using thresholds at 10 and 25% mutant within an individual's HIV quasispecies, respectively.

Conclusions:

Compared to MiSeq, OLA-Simple detected HIVDR with high sensitivity and accuracy. OLA-Simple could expand access to affordable and rapid HIVDR testing to guide appropriate ART choices in populations using NNRTI-based ART.
Imaging of Cardiopulmonary Involvement in Systemic Immune-mediated Diseases
Authors: Bordonaro Veronica , Larici Anna Rita , Franchi Paola , Paciolla Fabiano , Giubbolini Francesca , Meduri Agostino , Marano Riccardo , Manfredi Riccardo , Natale Luigi
Published: March 2020

Systemic immune-mediated diseases (SID) are a large group of disorders characterized by complex inflammatory and autoimmune damage to various organs and tissues. Among the possible manifestations, SIDs may potentially involve each structure of the cardiopulmonary system. Each disease is characterized by a specific clinical presentation. Coronary artery disease, myocarditis, pericarditis, valvular disease, pulmonary arterial hypertension, and interstitial lung disease represent characteristic findings of cardiopulmonary involvement in these disorders and their prompt recognition is crucial for the diagnosis of SIDs and the patient’s prognosis. In this setting, chest high-resolution computed tomography and cardiac magnetic resonance are the most important noninvasive techniques for the assessment of these diseases and their complications. The knowledge of various cardiac and pulmonary radiologic patterns increases the likelihood of diagnosing these disorders and can lead to improved understanding of the underlying pathophysiology to personalize the treatment for each patient.
The Feasibility, Tolerability, Safety, and Accuracy of Low-radiation Dynamic Computed Tomography Myocardial Perfusion Imaging With Regadenoson Compared With Single-photon Emission Computed Tomography
Authors: van Assen Marly , Duguay Taylor M. , Litwin Sheldon E. , Bayer Richard R. , Nance John W. , Suranyi Pal , De Cecco Carlo N. , Varga-Szemes Akos , Jacobs Brian E. , Johnson Addison A. , Tesche Christian , Schoepf U. Joseph
Published: March 2020

Objectives:

Computed tomography (CT) myocardial perfusion imaging (CT-MPI) with hyperemia induced by regadenoson was evaluated for the detection of myocardial ischemia, safety, relative radiation exposure, and patient experience compared with single-photon emission computed tomography (SPECT) imaging.

Materials and Methods:

Twenty-four patients (66.5 y, 29% male) who had undergone clinically indicated SPECT imaging and provided written informed consent were included in this phase II, IRB-approved, and FDA-approved clinical trial. All patients underwent coronary CT angiography and CT-MPI with hyperemia induced by the intravenous administration of regadenoson (0.4 mg/5 mL). Patient experience and findings on CT-MPI images were compared to SPECT imaging.

Results:

Patient experience and safety were similar between CT-MPI and SPECT procedures and no serious adverse events due to the administration of regadenoson occurred. SPECT resulted in a higher number of mild adverse events than CT-MPI. Patient radiation exposure was similar during the combined coronary computed tomography angiography and CT-MPI (4.4 [2.7] mSv) and SPECT imaging (5.6 [1.7]  mSv) (P-value 0.401) procedures. Using SPECT as the reference standard, CT-MPI analysis showed a sensitivity of 58.3% (95% confidence interval [CI]: 27.7-84.8), a specificity of 100% (95% CI: 73.5-100), and an accuracy of 79.1% (95% CI: 57.9-92.87). Low apparent sensitivity occurred when the SPECT defects were small and highly suspicious for artifacts.

Conclusions:

This study demonstrated that CT-MPI is safe, well tolerated, and can be performed with comparable radiation exposure to SPECT. CT-MPI has the benefit of providing both complete anatomic coronary evaluation and assessment of myocardial perfusion.
Interobserver Reliability of the Coronary Artery Disease Reporting and Data System in Clinical Practice
Authors: Hu Jiun-Yiing , Bergquist Peter J. , Hossain Rydhwana , Ropp Alan M. , Kligerman Seth , Amin Sagar B. , Sechrist Jacob W. , Patel Priya , Jeudy Jean , White Charles S.
Published: March 2020

Purpose:

This study aimed to evaluate interobserver reproducibility between cardiothoracic radiologists applying the Coronary Artery Disease Reporting and Data System (CAD-RADS) to describe atherosclerotic burden on coronary computed tomography angiography.

Methods:

Forty clinical computed tomography angiography cases were retrospectively and independently evaluated by 3 attending and 2 fellowship-trained cardiothoracic radiologists using the CAD-RADS lexicon. Radiologists were blinded to patient history and underwent initial training using a practice set of 10 subjects. Interobserver reproducibility was assessed using an intraclass correlation (ICC) on the basis of single-observer scores, absolute agreement, and a 2-way random-effects model. Nondiagnostic studies were excluded. ICC was also performed for CAD-RADS scores grouped by management recommendations for absent (0), nonobstructive (1 to 2), and potentially obstructive (3 to 5) CAD.

Results:

Interobserver reproducibility was moderate to good (ICC: 0.748, 95% confidence interval [CI]: 0.639-0.842, P<0.0001), with higher agreement among cardiothoracic radiology fellows (ICC: 0.853, 95% CI: 0.730-0.922, P<0.0001) than attending radiologists (ICC: 0.711, 95% CI: 0.568-0.824, P<0.0001). Interobserver reproducibility for clinical management categories was marginally decreased (ICC: 0.692, 95% CI: 0.570-0.802, P<0.0001). The average percent agreement between pairs of radiologists was 84.74%. Percent observer agreement was significantly reduced in the presence (M=62.22%, SD=15.17%) versus the absence (M=80.91%, SD=17.97%) of modifiers, t
(37.95)=3.566, P=0.001.

Conclusions:

Interobserver reliability and agreement with the CAD-RADS terminology are moderate to good in clinical practice. However, further investigations are needed to characterize the causes of interobserver disagreement that may lead to differences in management recommendations.
Incidence of Complications in Delayed Abdominal-Based Flap Breast Reconstruction Using a Drainless Recipient Site
Authors: Zolper Elizabeth G. , Bekeny Jenna C. , Fan Kenneth L. , Del Corral Gabriel A.
Published: March 2020

Background

Seroma is a common complication after breast surgery such as mastectomy and immediate reconstruction. However, there is a lack of evidence for the utility of drains in the recipient site in delayed autologous breast reconstruction. We reviewed our experience with delayed abdominal-based flap breast reconstruction with a drainless recipient site.

Methods

A single-surgeon retrospective case review was performed for delayed abdominal-based flap breast reconstruction using drainless recipient sites from May 2018 to June 2019. Primary outcomes were recipient-site complications.

Results

Thirty-one delayed abdominal-based flap breast reconstructions that did not use drains in the recipient site were identified in 22 patients. Mean age was 52.8 years (SD, 9.7 years). Mean body mass index was 30.1 kg/m2 (interquartile range [IQR], 28.2–35.0 kg/m2). Common comorbidities were obesity (45.4%), prior tobacco use (31.8%), and diabetes (10.0%). Median time to abdominal-based flap reconstruction was 27.5 months (IQR, 9.9–105.2 months). There were 22 muscle-sparing transverse rectus abdominis musculocutaneous flaps and 9 deep inferior epigastric artery perforator flaps performed. Ten patients (45.4%) underwent bilateral reconstruction. Mean operative time was 302 minutes (SD, 85 minutes). Flap take back occurred in 1 case (3.2%). Mean length of stay was 4 days (SD, 0.8 days). Recipient-site complications were healing complications (32.3%), seroma (3.2%), hematoma (3.2%), and fat necrosis (19.4%). Median follow-up was 4.2 months (IQR, 2.5–11.5).

Conclusions

In this case series, our data indicate that delayed autologous reconstruction without drain placement at the recipient site has been proven to be safe and successful and did not increase the rate of seroma or other complications. Adopting a drainless approach may also improve patient comfort and satisfaction.
Functional Outcomes of the Medial Sural Artery Perforator Flap in Oral Cavity Reconstruction
Authors: Mughal Maleeha , Gabuniya Natiya , Zoccali Giovanni , Roblin Paul , Townley William
Published: March 2020

Background

The medial sural artery perforator (MSAP) flap is an ideal option for reconstruction of oral cavity defects owing to its thin and pliable nature and favorable donor site. Our study presents an assessment of functional outcomes including speech and swallowing in patients with oral cavity tumors reconstructed with MSAP flaps.

Methods

Patients undergoing MSAP reconstruction for oral cavity tumors between January 2014 and January 2018 were identified from our prospective head and neck cancer database. Functional outcomes were assessed in conjunction with the Speech and Language Team with a minimum follow-up of 6 months. Function (speech and swallowing) was recorded as a performance status scale set up by the assessing health care professional.

Results

A total of 38 patients underwent reconstruction with the MSAP flap over the study period. The patient cohort included 10 female patients and 28 male patients. The age range was from 30 to 78 years, with a mean age of 56.8 years. Complications included 1 flap loss and 1 donor site wound dehiscence.

Most patients (84.2%) had intelligible speech at 6-month follow-up and further improvement at 1 year (92.1%). All patients resumed feeding on postoperative day 4, and only 7.8% (n = 3) of the patients required assistance with feeding at 1-year follow-up.

Conclusions

The MSAP flap provides adequate small-volume replacement for oral cavity reconstructions. Our results indicate that most patients achieve a full diet with no restrictions by 1 year after reconstruction. Most of our patients demonstrated excellent speech with little or no need for repetition in conversation. Over the past few years, this has become the flap of choice for oral cavity reconstruction in our unit.
Incidence of and Risk Factors for Postoperative Urinary Tract Infection After Abdominal and Vaginal Colpopexy
Authors: Soriano Alex , Hassani Daisy , Harvie Heidi , Sheyn David
Published: March 2020

Objective

The aims of the study were to determine the rate of urinary tract infection (UTI) in women undergoing colpopexy and to evaluate risk factors and timing for postoperative UTI.

Methods

This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2017. Patients were grouped into those with and without UTI. Pairwise analysis between groups was performed using χ2 and Fisher exact test. Multivariable logistic regression was used to identify independent predictors of UTI.

Results

Of 23,097 women who underwent colpopexy, 1079 (4.7%) experienced a postoperative UTI. Urinary tract infection was most frequently diagnosed in the second week after surgery (38.2%), compared with week 1 (19.9%), 3 (22.8%), and 4 (19.1%) (P < 0.001). Patients diagnosed with a UTI were more likely to have insulin-dependent diabetes (2.8% vs 1.7%, P = 0.006), coagulopathy (1.3% vs 0.7%, P = 0.04), and chronic steroid use (2.7% vs 1.8%, P = 0.004). Patients with a UTI versus those without a UTI were more likely to have undergone an intraperitoneal or extraperitoneal vaginal colpopexy (37.8% vs 30.5%, P < 0.001) and (29.8% vs 25.6%, P = 0.003), respectively, and more likely to undergo combined anterior and posterior colporrhaphy (17.1% vs 12.2%, P < 0.001). After logistic regression, intraoperative cystotomy repair (adjusted odds ratio = 2.93, 95% confidence interval = 1.54–5.59) was the most significant risk factor.

Conclusions

Postoperative UTI after colpopexy occurred less frequently than previously reported. Vaginal colpopexy is associated with a higher risk of UTI than abdominal or laparoscopic colpopexy.
Perineorrhaphy Outcomes Related to Body Imagery: A Randomized Trial of Body Image Perception
Authors: Ninivaggio Cara S. , Komesu Yuko M. , Jeppson Peter C. , Cichowski Sara B. , Qualls Clifford , Qeadan Fares , Rogers Rebecca G. , Dunivan Gena C.
Published: March 2020

Objectives

The aim of this study was to determine if a perineorrhaphy at the time of apical pelvic organ prolapse surgery positively affects women’s body image.

Methods

This is a randomized controlled trial of women undergoing apical suspension procedures in which women (GH ≥2 cm to ≤6 cm) received either perineorrhaphy or no perineorrhaphy. The primary aim compared body image between the groups postoperatively using the Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire. Secondary outcomes included prolapse stage, pain, pelvic floor muscle strength, pelvic floor symptoms, and sexual function. Between- and within-group differences were compared using Fisher exact test for categorical variables and t tests for continuous variables. When continuous variables were not normally distributed, the Welch-Satterthwaite test was used. Within-group analyses were performed via paired t tests for select continuous variables.

Results

Forty-six women were enrolled; 45 (97.8%) completed the 6-week assessment and 38 (82.6%) completed the 3-month assessment. There were no differences in baseline characteristics. Although women within groups had an expected improvement in mean Body Image in Pelvic Organ Prolapse and subscale scores between baseline and 3 months (P < 0.05), there were no differences in the mean scores between groups. In addition, there were no differences between groups in any of the secondary outcomes.

Conclusions

Performance of apical prolapse surgery improved women’s body image, irrespective of performance of a perineorrhaphy. Other important outcomes, including pain, did not differ between women in the 2 groups. These findings demonstrate the need for further trials to investigate the utility of this procedure.
Effects of Electroconvulsive Therapy on Short-Term Suicide Mortality in a Risk-Matched Patient Population
Authors: Peltzman Talya , Shiner Brian , Watts Bradley V.
Published: March 2020

Objective

Although evidence has suggested that electroconvulsive therapy (ECT) is effective in reducing suicidal ideation, research establishing the effectiveness of ECT in reducing short-term risk of death by suicide is less conclusive. This study assessed whether receipt of ECT reduced suicide mortality among patients seeking healthcare in Veterans Health Administration hospitals.

Methods

Annual cohorts of patients who received ECT between 2006 and 2015 were propensity score matched with mental health patients who did not receive ECT. After matching, population averaged adjusted odds were calculated to assess the risk of suicide in the year after receipt of ECT, compared with a control group.

Results

The study population consisted of 14,810 patients in the ECT cohort and 58,369 matched controls. Matching successfully reduced clinical and demographic differences between cohorts of patients who received ECT and those who did not (asymptotic Kolmogorov-Smirnov statistic = 0.02, P > 0.99). After matching and controlling for remaining between-group differences in an adjusted logistic regression, the odds of suicide in the year after receipt of ECT were not statistically different from those of matched patients who did not receive the procedure (odds ratio = 1.31, 95% confidence interval = 0.94–1.96, P = 0.095).

Conclusions

Patients who received ECT were at a high risk for suicide. Electroconvulsive therapy did not seem to have a greater effect on decreasing short-term risk for suicide than other types of mental health treatment provided to patients with similar baseline risk.
Effects of aminoethoxyvinylglycine (AVG) and 1-methylcyclopropene (1-MCP) treatments on fruit quality attributes in cold-stored‘Jonathan’apples
Authors: Park Jun-yeun , Kim Kyoung-ook , Yoo Jingi , Win Nay Myo , Lee Jinwook , Choung Myoung-Gun , Jung Hee-Young , Kang In-Kyu
Published: March 2020

‘Jonathan’ apples are relatively small size which contributes to enhancing fruit consumption and gaining popularity. Thus, this study was carried out to evaluate the effects of AVG (aminoethoxyvinylglycine, ReTain®), sprayable 1-MCP (1-methylcyclopropene, HarvistaTM), and fumigation 1-MCP (SmartFreshTM) applications on fruit quality attributes and storability in ‘Jonathan’ apple fruits during cold-stored. The Jonathan fruits were dipped with either ReTain (75 mg/L) or Harvista (125 mg/L) solutions for 5 min, or fumigated with SmartFresh (1 mg/L) for 18 hr before storage at 0±1℃ for 75 days. Flesh firmness and titratable acidity remained higher in all pre-treated apples than control ones during cold storage period. Flesh firmness was higher for apples treated with ReTain and SmartFresh than samples treated with Harvista, while soluble solid content and respiration rate were not affected by sample pretreatment. Internal ethylene concentration (IEC) of all pretreated apples remained below about 4.5 μL/L during the entire storage period while that of control sample greatly increased to 10.29 μL/L. Ethylene production was much higher in control fruits than in treated ones during cold storage. These results indicated that ReTain and 1-MCP treatments would be considerably effective in retention of fruit quality attributes of ‘Jonathan’ apple during cold-stored.
Changes in quality characteristics of salted Kimchi cabbage and kimchi paste during storage
Authors: Song Hye-Yeon , Cheon Seon-Hwa , Yoo SeungRan , Chung Young Bae , Seo Hye-Young
Published: March 2020

This study was conducted to determine the potential use for salted Kimchi cabbage and kimchi paste by analyzing the quality characteristic of kimchi prepared with stored them. Salted Kimchi cabbages were packed with the 2% brine and kimchi paste were stored at 4℃ for 8 weeks, respectively. Kimchi prepared at 0 day and kimchi prepared with stored salted Kimchi cabbage and kimchi paste every week were stored at 4℃ for 8 weeks. The salinity and titratable acidity of salted Kimchi cabbage packed with the brine was lower than control. The results of salinity, pH and moisture contents of kimchi paste did not show any significant differences during storage, however, the titratable acidity was increased. In sensory evaluation, salted Kimchi cabbage packed with the brine showed higher score in overall preference than control. Kimchi paste showed 4.9~6.1 score in overall preference during storage. The titratable acidity of kimchi prepared with stored salted Kimchi cabbage and kimchi paste was lower than control. But, the results of sensory evaluation did not show significant difference among treatments. The study suggested that the use of 2% brine is an effective way for extending shelf-life of salted Kimchi cabbage and Kimchi prepared with stored salted Kimchi cabbage and kimchi paste every week is effective to delay the fermentation but no difference in sensory evaluation.