bluuebunny/crossref_metadata_2025 huggingface dataset:
A digitally enhanced home-based physical activity intervention for high-risk middle school youth during COVID-19
Authors: Tripicchio Gina L , Jones Gareth J , Hart Chantelle N , Hyun Moonsup , DeSabato Emily , Giddings Amy , Ehrhardt Amanda , Rosenberg Emily
Published: December 2021

COVID-19 significantly impacted physical activity among high-risk youth. Camp from Home, a digitally enhanced home-based intervention, was developed to address physical activity disparities among middle school youth during COVID-19. Camp from Home enrolled 62 youth in 54 families from five schools in Philadelphia during the summer of 2020. The 6-week intervention comprised of (1) three home deliveries of “activity kits” including exercise equipment and activity booklets, (2) asynchronous sport and exercise videos posted to a private YouTube channel, and (3) supportive text-messages from health coaches. YouTube analytics and self-report surveys completed by parents and youth at baseline and at the end of programming were used to assess engagement, acceptability, and preliminary efficacy. Youth participants were 12.4 (1.2) years, 38.7% female and 90.3% Black/African American. At follow-up, 41 parents (75.9%) and 34 youth (54.8%) completed measures. Youth self-reported increases in self-efficacy (ΔM(sd) = 0.4(1.0), p = .03) and physical activity (ΔM(sd) = 4.2(7.9), p = .004), despite suboptimal engagement in digital program components. Overall, participants highly rated the program. Activity kits and text-messages from health coaches were rated as most helpful. Most parents (95.1%) and youth (83.8%) expressed interested in participating again in the future. A 6-week digitally enhanced, home-based physical activity intervention was acceptable and feasible among parents and youth during the summer of 2020, with youth reporting improvements in self-efficacy and physical activity. Summer programs are critical for reducing disparities in physical activity and hold potential for addressing key barriers for high-risk youth even outside the context of COVID-19.
SeedborneCercospora beticolaCan Initiate Cercospora Leaf Spot from Sugar Beet (Beta vulgaris) Fruit Tissue
Authors: Spanner Rebecca , Neubauer Jonathan , Heick Thies M. , Grusak Michael A. , Hamilton Olivia , Rivera-Varas Viviana , de Jonge Ronnie , Pethybridge Sarah , Webb Kimberley M. , Leubner-Metzger Gerhard , Secor Gary A. , Bolton Melvin D.
Published: November 2021

Cercospora leaf spot (CLS) is a globally important disease of sugar beet (Beta vulgaris) caused by the fungus Cercospora beticola. Long-distance movement of C. beticola has been indirectly evidenced in recent population genetic studies, suggesting potential dispersal via seed. Commercial sugar beet “seed” consists of the reproductive fruit (true seed surrounded by maternal pericarp tissue) coated in artificial pellet material. In this study, we confirmed the presence of viable C. beticola in sugar beet fruit for 10 of 37 tested seed lots. All isolates harbored the G143A mutation associated with quinone outside inhibitor resistance, and 32 of 38 isolates had reduced demethylation inhibitor sensitivity (EC50> 1 µg/ml). Planting of commercial sugar beet seed demonstrated the ability of seedborne inoculum to initiate CLS in sugar beet. C. beticola DNA was detected in DNA isolated from xylem sap, suggesting the vascular system is used to systemically colonize the host. We established nuclear ribosomal internal transcribed spacer region amplicon sequencing using the MinION platform to detect fungi in sugar beet fruit. Fungal sequences from 19 different genera were identified from 11 different sugar beet seed lots, but Fusarium, Alternaria, and Cercospora were consistently the three most dominant taxa, comprising an average of 93% relative read abundance over 11 seed lots. We also present evidence that C. beticola resides in the pericarp of sugar beet fruit rather than the true seed. The presence of seedborne inoculum should be considered when implementing integrated disease management strategies for CLS of sugar beet in the future.
An MYB Transcription Factor Modulates Panax notoginseng Resistance Against the Root Rot Pathogen Fusarium solani by Regulating the Jasmonate Acid Signaling Pathway and Photosynthesis
Authors: Qiu Bingling , Chen Hongjun , Zheng Lilei , Su Linlin , Cui Xiuming , Ge Feng , Liu Diqiu
Published: November 2021

Root rot of Panax notoginseng, a precious Chinese medicinal plant, seriously impacts its sustainable production. However, the molecular regulatory mechanisms employed by P. notoginseng against root rot pathogens, including Fusarium solani, are still unclear. In this study, the PnMYB2 gene was isolated, and its expression was affected by independent treatments with four signaling molecules (methyl jasmonate, ethephon, salicylic acid, and hydrogen peroxide) as assessed by quantitative real-time PCR. Moreover, the PnMYB2 expression level was induced by F. solani infection. The PnMYB2 protein localized to the nucleus and may function as a transcription factor. When overexpressed in transgenic tobacco, the PnMYB2 gene conferred resistance to F. solani. Jasmonic acid (JA) metabolism and disease resistance-related genes were induced in the transgenic tobacco, and the JA content significantly increased compared with in the wild type. Additionally, transcriptome sequencing, Kyoto Encyclopedia of Genes and Genomes annotation enrichment, and metabolic pathway analyses of the differentially expressed genes in the transgenic tobacco revealed that JA metabolic, photosynthetic, and defense response-related pathways were activated. In summary, PnMYB2 is an important transcription factor in the defense responses of P. notoginseng against root rot pathogens that acts by regulating JA signaling, photosynthesis, and disease-resistance genes.
Phylo-Taxonogenomics Supports Revision of Taxonomic Status of 20 Xanthomonas Pathovars to Xanthomonas citri
Authors: Bansal Kanika , Kumar Sanjeet , Patil Prabhu B.
Published: November 2021

Based on phylo-taxonogenomics criteria, we present amended descriptions for 20 pathovars to Xanthomonas citri. Incidentally, 18 were first reported from India. Seven out of twenty are classified as X. axonopodis, 12 out of 20 as X. campestris, and one as X. cissicola. In this study, we have generated genome sequence data of four pathovars, and the genomes of the remaining 16 were used from the published data. Comprehensive genome-based phylogenomic and taxonogenomic analyses reveal that all these pathovars belong to X. citri and need to reconcile their taxonomic status. This proposal will aid in systematic studies of a major species and its constitutent members that infect economically important plants.
Cervical Sagittal Alignment in Patients with Cervical Spondylotic Myelopathy
Authors: Evaniew Nathan , Charest-Morin Raphaële , Jacobs W. Bradley , Johnson Michael , Bailey Christopher S. , Christie Sean , Paquet Jérôme , Nataraj Andrew , Cadotte David W. , Wilson Jefferson R. , Craig Michael , Xu Mark , Manson Neil , Hall Hamilton , Thomas Ken C. , Rampersaud Y. Raja , McIntosh Greg , Fisher Charles G. , Dea Nicolas
Published: November 2021

Study Design.

Prospective cohort study.

Objective.

Among patients with CSM, we aimed to evaluate the extent to which: (1) Preoperative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms; (2) Surgery leads to changes in cervical sagittal alignment; and (3) Postoperative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms at 12 months of follow-up.

Summary of Background Data.

The importance of maintaining or improving cervical sagittal alignment in the surgical management of patients with CSM has not been established.

Methods.

We measured C2–C7 Cobb angle, T1 slope, and C2–C7 cervical sagittal vertical axis (cSVA). We tested for associations with Neck Disability Index, Pain Scales for neck and arm pain, EuroQol 5D, Short Form 12 Physical and Mental Component Summaries, and modified Japanese Orthopaedic Association scores. We adjusted for potential confounders using multiple linear regression, and we performed various prespecified subgroup (cSVA > 40 mm, surgical approach) and sensitivity analyses.

Results.

Among 250 patients, adjusted analyses yielded significant inverse associations prior to surgery between each of cSVA and T1 slope with SF12 Physical Component Summaries (T1 slope: −0.14, 95% CI −0.26 to −0.01, P = 0.03; C2–C7 cSVA: −0.13, 95% CI -−0.21 to −0.05 P < 0.01). Surgery was associated with a small but statistically significant increase in cSVA across the cohort (+5.8 mm [SD 11.7], P < 0.01) but no change in Cobb angle or T1 slope. At 12-months after surgery, there were no significant associations between alignment parameters or change in alignment and any measures of health-related quality of life, function, or symptoms. Results were consistent across subgroup and sensitivity analyses.

Conclusion.

Increased cSVA and T1 slope were associated with inferior health-related quality of life at presentation among patients with CSM, but no significant associations were observed following surgical treatment.

Level of Evidence: 3
CircATXN7 contributes to the progression and doxorubicin resistance of breast cancer via modulating miR-149-5p/HOXA11 pathway
Authors: Wang Hualong , Shan Shisheng , Wang Hongbo , Wang Xinmin
Published: November 2021

Breast cancer is a frequent tumor threatening the health of women. Circular RNAs (circRNAs) play vital roles in cancer progression and chemoresistance. Herein, we mainly investigate the role and potential mechanism of circRNA ataxin 7 (circATXN7; circ_0066436) in breast cancer. RNA expression levels were detected via quantitative real-time PCR (qPCR), western blot and immunohistochemistry. Cell viability and half inhibitory concentration (IC50) of doxorubicin were assessed by cell counting kit-8 (CCK-8) method. Cell proliferation, migration and invasion were determined by CCK-8, 5-ethynyl-2’-deoxyuridine, colony formation and transwell assays. The binding relationship between microRNA-149-5p (miR-149-5p) and circATXN7 or homeobox A11 (HOXA11) was validated via dual-luciferase reporter assay and RNA immunoprecipitation assay. Xenograft assay was conducted to analyze the effect of circATXN7 on doxorubicin resistance of breast cancer. CircATXN7 and HOXA11 levels were enhanced, whereas miR-149-5p level was declined in breast cancer tissues and cells. CircATXN7 silencing suppressed breast cancer development and doxorubicin resistance. Additionally, circATXN7 upregulated HOXA11 via absorbing miR-149-5p, thereby inducing breast cancer cell progression and reducing doxorubicin sensitivity. Besides, depletion of circATXN7 enhanced doxorubicin sensitivity in vivo. Interference of circATXN7 inhibited breast cancer progression and doxorubicin resistance via mediating miR-149-5p/HOXA11 axis, which might provide a possible biomarker for breast cancer therapy.
Pleiotrophin affects the susceptibility of prostate cancer cells to cisplatin
Authors: Che Qiuru , You Liwei , Dai Yumeng , Sun Wei , Wang Tao , Ding Ke , Li Yunfei , Zhang Yuqiang , Ding Linlin , Wang Xingxing , Zhang Zhuoqi , Li Zhiwei , Yang Liquan
Published: November 2021

Drug resistance is a major problem in cancer therapy with cisplatin. It has not been reported that pleiotrophin, which is anti-apoptotic in some cancer cells, is associated with cisplatin resistance. Pleiotrophin was exogenously expressed in 293 cells. Viability and apoptosis of PC3 cells treated with different concentrations of cisplatin in the presence or absence of purified pleiotrophin were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and flow cytometry, respectively. PC3 cells transfected with shRNAs were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and western blotting 24 h after transfection. MTT assay data indicated that the EC50 value of cisplatin for PC3 cells was significantly increased in the presence of pleiotrophin. Flow cytometry data demonstrated the pleiotrophin dose-dependent anti-apoptosis in PC3 cells treated with cisplatin. Knockdown of pleiotrophin with sh-RNA, as justified by RT-PCR and western blotting analysis, led to increased cisplatin induced-apoptosis in PC3 cells with an increased level of the cleaved poly ADP-ribose polymerase protein. Pleiotrophin may be a potential antiapoptotic protein associated with cisplatin susceptibility, which warrants further study on the role of pleiotrophin in cisplatin resistance.
Clinical Impact of Plasma Metagenomic Next-generation Sequencing in a Large Pediatric Cohort
Authors: Niles Denver T. , Revell Paula A. , Ruderfer Daniel , Marquez Lucila , McNeil J. Chase , Palazzi Debra L.
Published: November 2021

Background:

Plasma metagenomic next-generation sequencing (mNGS) has the potential to detect thousands of different organisms with a single test. There are limited data on the real-world impact of mNGS and even less guidance on the types of patients and clinical scenarios in which mNGS testing is beneficial.

Methods:

A retrospective review of patients who had mNGS testing as part of routine clinical care at Texas Children’s Hospital from June 2018–August 2019 was performed. Medical records were reviewed for pertinent data. An expert panel of infectious disease physicians adjudicated each unique organism identified by mNGS for clinical impact.

Results:

There were 169 patients with at least one mNGS test. mNGS identified a definitive, probable or possible infection in 49.7% of patients. mNGS led to no clinical impact in 139 patients (82.2%), a positive impact in 21 patients (12.4%), and a negative impact in 9 patients (5.3%). mNGS identified a plausible cause for infection more often in immunocompromised patients than in immunocompetent patients (55.8% vs. 30.0%, P = 0.006). Positive clinical impact was highest in patients with multiple indications for testing (37.5%, P = 0.006) with deep-seated infections, overall, being most often associated with a positive impact.

Conclusion:

mNGS testing has a limited real-world clinical impact when ordered indiscriminately. Immunocompromised patients with well-defined deep-seated infections are likely to benefit most from testing. Further studies are needed to evaluate the full spectrum of clinical scenarios for which mNGS testing is impactful.
Variable neurological phenotypes of homocystinuria caused by biallelic methylenetetrahydrofolate reductase variants
Authors: Moirangthem Amita , Saxena Deepti , Masih Suzena , Shambhavi Arya , Nilay Mayank , Phadke Shubha R.
Published: November 2021

Inherited methylenetetrahydrofolate reductase (MTHFR) deficiency is associated with a wide spectrum of disorders including homocystinuria. This study aims to describe the neurological phenotypes and molecular profiles of patients with homocystinuria caused by biallelic variants in MTHFR. We report six subjects with MTHFR deficiency who presented with variable neurological phenotypes which could be viewed as a continuous spectrum. Fatal infantile encephalopathy was observed in one family, whereas another patient presented at 27 years with acute leukoencephalopathy and recovered within 3 months. Intermediate forms presenting as complicated hereditary spastic paraparesis of variable severity were observed in four subjects. Clinical and molecular information of the 207 cases reported in literature were also retrieved and analyzed. We categorized all subjects into three categories - severe, intermediate and mild forms according to the clinical presentation. In addition, a total of 286 disease-causing variations reported to date were analyzed. These included seven disease-causing variants reported in this study of which one is novel. Some genotype-phenotype correlation could be seen which corroborated with previous observations. However, inter- and intrafamilial variability was also noted. Treatment with betaine, B12 and folic acid was started in four subjects with variable outcomes.
Continuous glucose monitoring in primary care – are we there?
Authors: Martens Thomas W.
Published: November 2021

Purpose of review

In this review, we examine the expanding role of continuous glucose monitoring in glycaemic management in primary care.

Recent findings

Improving technology and decreasing cost have increased the uptake of use of continuous glucose monitoring (CGM) for glycaemic management in primary care, wherein most diabetes is managed. Optimized use of this technology, however, will require a convergence of several factors. Availability of devices for people with diabetes, availability of data at the time of clinical interactions, and expertise in interpretation of CGM and ambulatory glucose profile (AGP) data, as well as optimization of therapies, will be required. Significant progress has been made in all three areas in recent years, yet creating systems of support for widespread use of CGM in primary care remains an area of active investigation.

There has been significant uptake in the use of CGM in the management of diabetes in primary care. Optimized use, however, requires both access to CGM data and the expertise to use the data. Although promising strategies have emerged, the task of generalizing these strategies to the broad population of primary care in America is ongoing. CGM technology holds significant potential for improving glycaemic management in primary care, yet important work remains to leverage the full potential of this promising technology.
Continuous glucose monitoring in the hospital: an update in the era of COVID-19
Authors: Gothong Chikara , Singh Lakshmi G. , Satyarengga Medha , Spanakis Elias K.
Published: November 2021

Purpose of review

Continuous glucose monitoring (CGM) systems are Food and Drug Administration approved devices for the ambulatory setting; however, they remain investigational systems for inpatient use. This review summarizes the most recent and relevant literature on the use of continuous glucose monitoring in the hospital setting.

Recent findings

CGM provides real-time glucose data that enable healthcare professionals to make proactive and timelier clinical decisions with regards to diabetes management. CGM devices appear to be safe and accurate systems for glucose monitoring in the hospital setting. Real-time CGM systems and glucose telemetry can decrease hypoglycemia and reduce hyperglycemia in hospitalized patients with diabetes. Remote glucose monitoring decreases the need of frequent Point-of-care checks and personal protective equipment use while also mitigating staff exposure risk which is timely in the advent of the COVID-19 pandemic. Although most nursing staff have limited exposure and training on CGM technology, early studies show that CGM use in the hospital is well received by nurses.

Given the evidence in the current literature regarding CGM use in the hospital, CGM devices may be incorporated in the inpatient setting.
Breaking the Cycle
Authors: Edge Naph'tali B.
Published: November 2021

Purpose/Objectives:

Approximately 100,000 people in the United States are affected by sickle cell disease (SCD). Sickle cell disease represents one of the highest readmitting diagnoses at this organization. The purpose of this study is to determine the impact of implementing care coordination interventions to reduce hospital readmissions of patients with SCD.

Primary Practice Setting:

The setting for conducting the interventions took place at the flagship hospital of a seven hospital system in Houston, TX. The hospital is a not-for-profit, faith-based, 907-bed academic facility that provides highly specialized health services to the community and the world. The population of focus was adult patients (18 years of age and older) admitted to the hospital with a primary diagnosis of SCD.

Findings/Conclusion:

Two interventions were implemented: Disease-specific discharge education and scheduling postdischarge follow-up appointments prior to discharge. These interventions were conducted by bedside nurses, case managers, and SCD champions over a 6-month period. The 30-day readmission rate for SCD was reduced by 22%. There was also a 0.9-day reduction in length of stay and a 17% reduction in emergency, observation, and inpatient encounters of patients with SCD.

Implications for Case Management Practices:

This project found that implementing evidence-based care coordination interventions can reduce the 30-day readmission rate for patients with SCD. Implementation of effective evidence-based care coordination is a key aspect to reducing hospital readmissions of patients with SCD. Partnering with community networks is also important in addressing readmission risk factors including management of social determinants of health that increase hospital visits. Consistent, patient-centered education using simple and convenient tools helps improve understanding, applicability, and self-care management.
Unmet Prenatal Expectations During the COVID-19 Pandemic
Authors: Goyal Deepika , Rosa Liana De La , Mittal Leena , Erdei Carmina , Liu Cindy H.
Published: November 2021

Purpose:

To explore the experiences of pregnant women who were living in the United States during the COVID-19 pandemic.

Study Design and Methods:

Using a qualitative design, we used data obtained from women in their second or third trimester of pregnancy who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study from May 21 to December 22, 2020.

Results:

361 of 408 pregnant women (88%) who participated in the PEACE study during that timeframe provided narrative comments. Participants had a mean age of 33.2 years (SD = 3.7) with a high percentage of White women (91.4%). At the time of participation, women were between 2.4 and 8.6 months into the COVID-19 pandemic. Just under half were pregnant for the first time (n = 177). Content analysis of responses revealed an overall sense of “unmet expectations” within two themes involving the role of relationships: 1) losing the experience of going through pregnancy together and 2) loss of social support and expected relationship building. Differences were noted between participants giving birth for the first time and participants with other children at home.

Clinical Implications:

This study offers insight for nurses and other clinicians taking care of pregnant women during times of public health crises and provides implications for the care of women as the pandemic continues. Nurses can help women plan for future health care changes that may disrupt their support needs as seen during the COVID-19 pandemic. Nurses should also be aware of possible enduring effects of prenatal unmet needs on later outcomes.
Child Temperament as a Predictor of Parents' Potential for Emotional Abuse
Authors: Pekdoğan Serpil , Kanak Mehmet
Published: November 2021

Children who are constantly criticized and humiliated by their parents and whose needs for affection and attention are not sufficiently addressed are defined as people with personality traits, low self-confidence, and antisocial behaviors. These personality traits have a significant influence on the shaping of the child's temperament. Therefore, emotional abuse negatively affects both the personality and success of the child. In line with this, child temperament was analyzed as a predictor of the emotional abuse potential of parents who have children between the ages of 4 and 6. The experimental group of the study consisted of 237 parents. Data were collected using The Scale for Emotional Abuse Potential of Parents with Children Aged 3 to 6 and Temperament Assessment Battery for Children–Revised: Parent Form. In the data analysis, the intervariable relationship was determined by the Pearson correlation coefficient, and the predictors of emotional abuse potentials were determined by multiple regression analysis. As a result of the analysis, a significant negative correlation was found between shyness and parents' emotionally abusive behaviors, a significant positive correlation between those behaviors and surgency, and negative affectivity. A positive correlation was found between persistence and the parents' emotional abuse preventive behaviors. In terms of predictive variables, it was found that the causality subdimension of the emotional abuse potentials of parents was significantly predicted by the negative affectivity subdimension of temperament, and emotional abuse preventive potentials of parents were significantly predicted by the persistence subdimension of temperament.
Expression of CHL1 in Clear Cell Renal Cell Carcinoma and its Association With Prognosis
Authors: Qin Minchao , Gao Xie , Luo Weiping , Ou Kongbo , Lu Hao , Liu Hui , Zhuang Qianfeng
Published: November 2021

As a member of the L1 family of neural cell molecules, close homologue of L1 (CHL1) has been proved to be downregulated in several human cancers. In the present study, we aimed to assess the expression and prognostic value of CHL1 in clear cell renal cell carcinoma (CCRCC). Immunohistochemistry was performed to detect the expression of CHL1 in tissue microarray chips. Then we compared specific clinicopathologic features in patients with different CHL1 expressions. The correlation between CHL1 expression and overall survival (OS) was evaluated by the Kaplan-Meier method and Cox regression analysis. We found that the expression of CHL1 was significantly lower in CCRCC tissues compared with adjacent normal tissues, which was correlated with TNM stage (P<0.001), Fuhrman grade (P=0.006), and LVI (P=0.004). The Kaplan-Meier survival analysis indicated that CCRCC patients with low CHL1 expression had a poorer OS rate than those with high CHL1 expression (P<0.001). Univariate and multivariate Cox regression analyses suggested that CHL1 was an independent and unfavorable prognostic factor for the OS rate of CCRCC patients. Collectively, low expression of CHL1 might predict poor OS rate of CCRCC.
Utilization of Monitored Beds for Children Admitted With Unintentional Poisonings
Authors: Smola Cassi , Wu Chang L. , Narayanan Sridaran , Nichols Michele H. , Pruitt Chris
Published: November 2021

Objectives

Children with unintentional poisonings (UPs) are frequently admitted to monitored beds (MBs), though most require minimal interventions. We aimed to (1) describe clinical factors and outcomes for children admitted for UPs and (2) identify clinical factors associated with MB placement.

Methods

In this single-center retrospective cohort study, we studied patients younger than 6 years admitted from the emergency department (ED) for UPs over a 5-year period to a quaternary-care children's hospital. Primary outcome was disposition (MB vs non-MB). Secondary outcomes included length of stay, escalation of inpatient care, 7-day readmission, and death. Covariates included age, certainty of ingestion, altered mental status, and ED provider training level. Subanalysis of drug class effect on disposition was also studied. Associations of clinical factors with MB placement were tested with multivariable logistic regression.

Results

Of 401 patients screened, 345 subjects met inclusion criteria. Most subjects (308 of 345 [89%]) were admitted to MBs. Children with high certainty of ingestion (adjusted odds ratio [aOR], 4.2; 95% confidence interval [CI], 1.52–11.58), altered mental status (aOR, 5.82; 95% CI, 2.45–13.79), and a fellow (vs faculty) ED provider (aOR, 2.34; 95% CI, 1.04–5.24) were more likely to be admitted to MBs. No escalations of care, readmissions, or deaths occurred. Exposures to cardiac drugs had increased MB placement (aOR, 6.74; 95% CI, 1.93–23.59).

Conclusions

The majority of children admitted for UPs were placed in MBs. Regardless of inpatient placement, no adverse events were observed, suggesting opportunities for optimized resource utilization. Future research may focus on direct costs, inpatient interventions, or prospective outcomes to validate these findings.
Direct-to-Implant Prepectoral Breast Reconstruction: Patient-Reported Outcomes
Authors: Safran Tyler , Al-Halabi Becher , Viezel-Mathieu Alex , Hazan Jessica , Dionisopoulos Tassos
Published: November 2021

Background:

Direct-to-implant prepectoral breast reconstruction has recently experienced a resurgence in popularity because of its lower levels of postoperative pain and animation deformity. BREAST-Q, a well-validated patient-reported outcomes tool, was used to assess patient satisfaction and quality of life. The goal of this study was to assess patient-reported outcomes at 6-month and 1-year follow-up after direct-to-implant prepectoral breast reconstruction.

Methods:

Sixty-nine consented adult patients undergoing a total of 110 direct-to-implant, prepectoral, postmastectomy breast reconstructions completed BREAST-Q questionnaires immediately preoperatively, and at 6 and 12 months thereafter.

Results:

Mean breast satisfaction decreased nonsignificantly from 61.3 preoperatively to 58.6 at 12 months after reconstruction (p = 0.32). Psychosocial well-being improved nonsignificantly from 67.1 preoperatively to 71.1 at 12-month follow-up (p = 0.26). Physical well-being of the chest was insignificantly different, from 74.4 to 73.3 at 12-month follow-up (p = 0.62). Finally, sexual well-being similarly remained nonsignificantly changed from 60.2 preoperatively, to 59.1 at 12 months (p = 0.80). The use of acellular dermal matrix and postmastectomy radiotherapy did not have any significant effects on patient-reported outcomes. Through regression analysis, neoadjuvant chemotherapy, increased age, and incidence of rippling were found to negatively influence BREAST-Q results.

Conclusions:

Patients who underwent direct-to-implant prepectoral breast reconstruction demonstrated an overall satisfaction with their outcomes. As prepectoral breast reconstruction continues to advance and grow in popularity, patient-reported outcomes such as those presented in this study become of paramount importance in practice.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Current Management of Sternal Wounds
Authors: Hamaguchi Ryoko , Shekar Prem S. , Johnson Jennifer A. , Orgill Dennis P.
Published: November 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Describe the pathogenesis, classification, and risk factors of sternal wound infection. 2. Discuss options for sternal stabilization for the prevention of sternal wound infection, including wiring and plating techniques. 3. Discuss primary surgical reconstructive options for deep sternal wound infection and the use of adjunctive methods, such as negative-pressure wound therapy.

Poststernotomy sternal wound infection remains a life-threatening complication of open cardiac surgery. Successful treatment relies on timely diagnosis and initiation of multidisciplinary, multimodal therapy.
A Correlation between Upper Extremity Compressive Neuropathy and Nerve Compression Headache
Authors: Gfrerer Lisa , Chartier Christian , Lans Jonathan , Eberlin Kyle R. , Austen William Gerald
Published: November 2021

Background:

Compressive neuropathies of the head/neck that trigger headaches and entrapment neuropathies of the extremities have traditionally been perceived as separate clinical entities. Given significant overlap in clinical presentation, treatment, and anatomical abnormality, the authors aimed to elucidate the relationship between nerve compression headaches and carpal tunnel syndrome, and other upper extremity compression neuropathies.

Methods:

One hundred thirty-seven patients with nerve compression headaches who underwent surgical nerve deactivation were included. A retrospective chart review was conducted and the prevalence of carpal tunnel syndrome, thoracic outlet syndrome, and cubital tunnel syndrome was recorded. Patients with carpal tunnel syndrome, cubital tunnel syndrome, and thoracic outlet syndrome who had a history of surgery and/or positive imaging findings in addition to confirmed diagnosis were included. Patients with subjective report of carpal tunnel syndrome/thoracic outlet syndrome/cubital tunnel syndrome were excluded. Prevalence was compared to general population data.

Results:

The cumulative prevalence of upper extremity neuropathies in patients undergoing surgery for nerve compression headaches was 16.7 percent. The prevalence of carpal tunnel syndrome was 10.2 percent, which is 1.8- to 3.8-fold more common than in the general population. Thoracic outlet syndrome prevalence was 3.6 percent, with no available general population data for comparison. Cubital tunnel syndrome prevalence was comparable between groups.

Conclusions:

The degree of overlap between nerve compression syndromes of the head/neck and upper extremity suggests that peripheral nerve surgeons should be aware of this correlation and screen affected patients comprehensively. Similar patient presentation, treatment, and anatomical basis of nerve compression make either amenable to treatment by nerve surgeons, and treatment of both entities should be an integral part of a formal peripheral nerve surgery curriculum.
Representation of African American Patients in Social Media for Breast Reconstruction
Authors: Hassan Abbas M. , Chappell Ava G. , Ketheeswaran Suvethavarshini , Joshi Chitang , Boyd Riley M. , Wan Rou , Carabaño Miguel , Koko Deima , Perez Laura C. , Ellis Marco F. , Galiano Robert D.
Published: November 2021

Background:

Social media use by plastic surgeons may contribute to the overall increase in breast reconstruction in the United States. However, recent data show a concerning decrease in breast reconstruction in African American women. The purpose of this study was to analyze the inclusion of African American women in social media posts for breast reconstruction, with the premise that this may be a possible contributing factor to decreasing rates of breast reconstruction in this population.

Methods:

Data from several social media platforms were obtained manually on December 1, 2019. Each image was analyzed using the Fitzpatrick scale as a guide.

Results:

A total of 2580 photographs were included that met the authors’ criteria. Only 172 photographs (6.7 percent) were nonwhite. This study surveyed 543 surgeons, 5 percent of whom were nonwhite. The analysis of the results from the random sample of the top plastic surgery social media influencers showed that only 22 (5 percent) of the photographs uploaded were nonwhite patients. Furthermore, 30 percent of surgeons did not have any photographs of nonwhite patients uploaded.

Conclusions:

Numerous factors can contribute to the disparity between the growing trend of white patients seeking reconstructive surgery compared to the decreasing trend of African American patients, one of which may be the disparity in their representation in social media, particularly among common platforms and social media influencers. This study highlights the evolving factors that may impair African American breast cancer patients’ access to safe, effective breast reconstruction, which must be identified and resolved.
Robotic Rectus Abdominis Muscle Flap following Robotic Extirpative Surgery
Authors: Asaad Malke , Pisters Louis L. , Klein Geraldine T. , Adelman David M. , Oates Scott D. , Butler Charles E. , Selber Jesse C.
Published: November 2021

Vascularized tissue for obliteration of large pelvic dead spaces created by extirpative surgery has been shown to reduce complication rates. As more extensive resections are performed robotically, plastic surgeons have been challenged to reconstruct the resulting defects using a minimally invasive approach. The goal of this study was to report the authors’ experience with robotic harvest of the rectus abdominis muscle for reconstruction of pelvic defects. The authors conducted a retrospective case series of patients who underwent robotic flap harvest following robotic extirpative surgery at their institution. Patient demographics, surgical characteristics, and postoperative outcomes were collected. These were compared to a retrospective cohort of patients who underwent open rectus abdominis muscle harvest. The authors identified seven male patients who underwent robotic flap harvest for pelvic reconstruction between 2013 and 2019. Their mean age was 66 ± 6 years and mean body mass index was 31 ± 5 kg/m2. Six patients (86 percent) had a history of radiation therapy and five patients (71 percent) received hormone therapy or chemotherapy. Surgical-site complications occurred in two patients. One patient developed ventral hernia. The donor-site complication rate was 19 percent (n = 18) in patients who underwent open rectus abdominis muscle harvest (n = 95). This study demonstrates the safety, efficacy, and reproducibility of robotic harvest of the rectus abdominis muscle in complex, multidisciplinary, minimally invasive pelvic surgery. The technique avoids violation of the anterior rectus sheath and wound complications related to open flap harvest, and early experience suggests reduced donor-site morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Nasal Tip Shaping Finesse in Rhinoplasty
Authors: Savetsky Ira L. , Avashia Yash J. , Rohrich Rod J.
Published: November 2021

Anatomic subtleties of the nasal tip have a dramatic impact on the overall appearance of the nose. Mastery of normal nasal aesthetics and anatomy is a critical prerequisite to adeptly performing nasal tip refinement during open rhinoplasty. This article and series of videos aim to provide a focused review of nasal tip analysis, anatomy, and surgical technique, with particular emphasis on pertinent tip sutures and cartilage grafts.
Distinct Differences in Gastroesophageal Junction and Gastric Adenocarcinoma in 2194 Patients
Authors: Nakauchi Masaya , Vos Elvira L. , Carr Rebecca A. , Barbetta Arianna , Tang Laura H. , Gonen Mithat , Russo Ashley , Janjigian Yelena Y. , Yoon Sam S. , Sihag Smita , Rusch Valerie W. , Bains Manjit S. , Jones David R. , Coit Daniel G. , Molena Daniela , Strong Vivian E.
Published: November 2021

Objective:

We sought to compare gastroesophageal junction (GEJ) cancer and gastric cancer (GC) and identify clinicopathological and oncological differences.

Summary Background Data:

GEJ cancer and GC are frequently studied together. Although the treatment approach for each often differs, clinico-pathological and oncological differences between the 2 have not been fully evaluated.

Methods:

We retrospectively identified patients with GEJ cancer or GC who underwent R0 resection at our center between January 2000 and December 2016. Clinicopathological characteristics, disease-specific survival (DSS), and site of first recurrence were compared.

Results:

In total, 2194 patients were analyzed: 1060 (48.3%) with GEJ cancer and 1134 (51.7%) with GC. Patients with GEJ cancer were younger (64 vs 66 years; P < 0.001), more often received neoadjuvant treatment (70.9% vs 30.2%; P < 0.001), and had lower pathological T and N status. Five-year DSS was 62.2% in patients with GEJ cancer and 74.6% in patients with GC (P < 0.001). After adjustment for clinicopathological factors, DSS remained worse in patients with GEJ cancer (hazard ratio, 1.78; 95% confidence interval, 1.40–2.26; P < 0.001). The cumulative incidence of recurrence was approximately 10% higher in patients with GEJ cancer (P < 0.001). The site of first recurrence was more likely to be hematogenous in patients with GEJ cancer (60.1% vs 31.4%; P < 0.001) and peritoneal in patients with GC (52.9% vs 12.5%; P < 0.001).

Conclusions:

GEJ adenocarcinoma is more aggressive, with a higher incidence of recurrence and worse DSS, compared with gastric adenocarcinoma. Distinct differences between GEJ cancer and GC, especially in patterns of recurrence, may affect evaluation of optimal treatment strategies.
Crossroads between membrane trafficking machinery and copper homeostasis in the nerve system
Authors: Wen Meng-Hsuan , Xie Xihong , Huang Pei-San , Yang Karen , Chen Tai-Yen
Published: December 2021

Imbalanced copper homeostasis and perturbation of membrane trafficking are two common symptoms that have been associated with the pathogenesis of neurodegenerative and neurodevelopmental diseases. Accumulating evidence from biophysical, cellular andin vivostudies suggest that membrane trafficking orchestrates both copper homeostasis and neural functions—however, a systematic review of how copper homeostasis and membrane trafficking interplays in neurons remains lacking. Here, we summarize current knowledge of the general trafficking itineraries for copper transporters and highlight several critical membrane trafficking regulators in maintaining copper homeostasis. We discuss how membrane trafficking regulators may alter copper transporter distribution in different membrane compartments to regulate intracellular copper homeostasis. Using Parkinson's disease and MEDNIK as examples, we further elaborate how misregulated trafficking regulators may interplay parallelly or synergistically with copper dyshomeostasis in devastating pathogenesis in neurodegenerative diseases. Finally, we explore multiple unsolved questions and highlight the existing challenges to understand how copper homeostasis is modulated through membrane trafficking.
Cutaneous infection by non-diphtheria-toxin producing and penicillin-resistant Corynebacterium diphtheriae strain in a patient with diabetes mellitus
Authors: Batista Araújo Max Roberto , Bernardes Sousa Mireille Ângela , Seabra Luisa Ferreira , Caldeira Letícia Aparecida , Faria Carmem Dolores , Bokermann Sérgio , Sant’Anna Lincoln Oliveira , dos Santos Louisy Sanches , Mattos-Guaraldi Ana Luíza
Published: November 2021

Diphtheria is a potentially fatal infection, mostly caused by diphtheria toxin (DT)-producing

Corynebacterium diphtheriae

strains. During the last decades, the isolation of DT-producing

C. diphtheriae

strains has been decreasing worldwide. However, non-DT-producing

C. diphtheriae

strains emerged as causative agents of cutaneous and invasive infections. Although endemic in countries with warm climates, cutaneous diphtheria is rarely reported in Brazil. Presently, an unusual case of skin lesion in a Brazilian elderly diabetic patient infected by a penicillin-resistant non-DT-producing

C. diphtheriae

strain was reported. Laboratory diagnosis included mass spectrometry and multiplex PCR analyses. Since cutaneous diphtheria lesions are possible sources of secondary diphtheria cases and systemic diseases and considering that penicillin is the first line of antimicrobial agent for the treatment of these infections, the detection of penicillin-resistant strains of diphtheria bacilli should be a matter of concern. Thus, cases similar to the presently reported should be appropriately investigated and treated, particularly in patients with risk factor (s) for the development of

C. diphtheriae

invasive infections, such as diabetes. Moreover, health professionals must be aware of the presence of

C. diphtheriae

in cutaneous lesions of lower limbs, a common type of morbidity in diabetic patients, especially in tropical and subtropical countries.
A morphological and molecular reinvestigation of Janickina pigmentifera (Grassi, 1881) Chatton 1953 – an amoebozoan parasite of arrow-worms (Chaetognatha)
Authors: Volkova Ekaterina , Kudryavtsev Alexander
Published: November 2021

Amoebozoan parasites of arrow-worms (Chaetognatha) were isolated from their hosts living in plankton of the Bay of Villefranche (Mediterranean Sea). Based on the light microscopic characters, the amoebae were identified asJanickina pigmentifera(Grassi, 1881) by their limax locomotive form and due to the presence of the intracellular symbiont,Perkinsela amoebae, surrounded by a layer of pigment granules. Sequences of the 18S rRNA gene of bothJ. pigmentiferaand its symbiont were obtained for the first time. The molecular phylogenetic analyses of 18S rRNA gene placedJ. pigmentiferawithin the genusNeoparamoeba, a taxon also characterized by the presence of a symbiont, known asPerkinsela amoebae-like organism (PLO). The 18S rRNA gene sequence ofP. amoebaefromJ. pigmentiferagrouped with the sequences of 18S rRNA genes of PLOs fromNeoparamoeba branchiphilaandNeoparamoeba invadens. The first photo documentation of the light microscopic features ofJ. pigmentifera, such as locomotive form, the morphology of the nucleus andP. amoebaehave been provided. The new results support the affinity ofJ. pigmentiferawith the family Paramoebidae suggested previously based on the presence of PLO. In contrast toJanickina, typical members of Paramoebidae (NeoparamoebaandParamoeba) have a flattened, dactylopodial locomotive form. This discrepancy in morphology can be explained by the obligate parasitic lifestyle ofJanickina.
Genome-wide association study of gastric cancer- and duodenal ulcer-derived Helicobacter pylori strains reveals discriminatory genetic variations and novel oncoprotein candidates
Authors: Tuan Vo Phuoc , Yahara Koji , Dung Ho Dang Quy , Binh Tran Thanh , Huu Tung Pham , Tri Tran Dinh , Thuan Ngo Phuong Minh , Khien Vu Van , Trang Tran Thi Huyen , Phuc Bui Hoang , Tshibangu-Kabamba Evariste , Matsumoto Takashi , Akada Junko , Suzuki Rumiko , Okimoto Tadayoshi , Kodama Masaaki , Murakami Kazunari , Yano Hirokazu , Fukuyo Masaki , Takahashi Noriko , Kato Mototsugu , Nishiumi Shin , Azuma Takashi , Ogura Yoshitoshi , Hayashi Tetsuya , Toyoda Atsushi , Kobayashi Ichizo , Yamaoka Yoshio
Published: November 2021

Genome-wide association studies (GWASs) can reveal genetic variations associated with a phenotype in the absence of any hypothesis of candidate genes. The problem of false-positive sites linked with the responsible site might be bypassed in bacteria with a high homologous recombination rate, such as

Helicobacter pylori

, which causes gastric cancer. We conducted a small-sample GWAS (125 gastric cancer cases and 115 controls) followed by prediction of gastric cancer and control (duodenal ulcer)

H. pylori

strains. We identified 11 single nucleotide polymorphisms (eight amino acid changes) and three DNA motifs that, combined, allowed effective disease discrimination. They were often informative of the underlying molecular mechanisms, such as electric charge alteration at the ligand-binding pocket, alteration in subunit interaction, and mode-switching of DNA methylation. We also identified three novel virulence factors/oncoprotein candidates. These results provide both defined targets for further informatic and experimental analyses to gain insights into gastric cancer pathogenesis and a basis for identifying a set of biomarkers for distinguishing these

H. pylori

-related diseases.