bluuebunny/crossref_metadata_2025 huggingface dataset:
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion
Authors: Olsen Margaret A. , Greenberg Jacob K. , Peacock Kate , Nickel Katelin B. , Fraser Victoria J. , Warren David K.
Published: December 2021

Objectives

To determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI).

Methods

Persons aged 10–64 years undergoing spinal fusion between 1 January 2010 and 30 June 2015 were identified in the MarketScan Commercial Database. Complicated patients and those coded for infection from 30 days before to 2 days after the surgical admission were excluded. Outpatient oral antibiotics were identified within 2 days of surgical discharge. SSI was defined using ICD-9-CM diagnosis codes within 90 days of surgery. Generalized linear models were used to determine factors associated with post-discharge prophylactic antibiotic use and with SSI.

Results

The cohort included 156 446 fusion procedures, with post-discharge prophylactic antibiotics used in 9223 (5.9%) surgeries. SSIs occurred after 2557 (1.6%) procedures. Factors significantly associated with post-discharge prophylactic antibiotics included history of lymphoma, diabetes, 3–7 versus 1–2 vertebral levels fused, and non-infectious postoperative complications. In multivariable analysis, post-discharge prophylactic antibiotic use was not associated with SSI risk after spinal fusion (relative risk 0.98; 95% CI 0.84–1.14).

Conclusions

Post-discharge prophylactic oral antibiotics after spinal fusion were used more commonly in patients with major medical comorbidities, more complex surgeries and those with postoperative complications during the surgical admission. After adjusting for surgical complexity and infection risk factors, post-discharge prophylactic antibiotic use was not associated with decreased SSI risk. These results suggest that prolonged prophylactic antibiotic use should be avoided after spine surgery, given the lack of benefit and potential for harm.
Indication alerts to improve problem list documentation
Authors: Grauer Anne , Kneifati-Hayek Jerard , Reuland Brian , Applebaum Jo R , Adelman Jason S , Green Robert A , Lisak-Phillips Jeanette , Liebovitz David , Byrd Thomas F , Kansal Preeti , Wilkes Cheryl , Falck Suzanne , Larson Connie , Shilka John , VanDril Elizabeth , Schiff Gordon D , Galanter William L , Lambert Bruce L
Published: December 2021

Background

Problem lists represent an integral component of high-quality care. However, they are often inaccurate and incomplete. We studied the effects of alerts integrated into the inpatient and outpatient computerized provider order entry systems to assist in adding problems to the problem list when ordering medications that lacked a corresponding indication.

Methods

We analyzed medication orders from 2 healthcare systems that used an innovative indication alert. We collected data at site 1 between December 2018 and January 2020, and at site 2 between May and June 2021. We reviewed random samples of 100 charts from each site that had problems added in response to the alert. Outcomes were: (1) alert yield, the proportion of triggered alerts that led to a problem added and (2) problem accuracy, the proportion of problems placed that were accurate by chart review.

Results

Alerts were triggered 131 134, and 6178 times at sites 1 and 2, respectively, resulting in a yield of 109 055 (83.2%) and 2874 (46.5%), P< .001. Orders were abandoned, for example, not completed, in 11.1% and 9.6% of orders, respectively, P<.001. Of the 100 sample problems, reviewers deemed 88% ± 3% and 91% ± 3% to be accurate, respectively, P = .65, with a mean of 90% ± 2%.

Conclusions

Indication alerts triggered by medication orders initiated in the absence of a justifying diagnosis were useful for populating problem lists, with yields of 83.2% and 46.5% at 2 healthcare systems. Problems were placed with a reasonable level of accuracy, with 90% ± 2% of problems deemed accurate based on chart review.
Lemmel syndrome: an extraordinary cause of obstructive jaundice—a case report
Authors: Goroztieta-Rosales L M , Gómez-Farías J , López-García K D , Davila-Rodriguez D O
Published: December 2021

Lemmel syndrome is created by a periampullary duodenal diverticulum. It is identified incidentally in 22% of the population, <10% present with jaundice, pain in the right flank and alteration of bilirubins, transaminases and/or pancreatic enzymes. Its diagnosis and therapeutic management can be carried out successfully with endoscopic retrograde cholangiopancreatography (ERCP), although some cases will require surgical management. We present the case of a 72-year-old male with recurrent obstructive jaundice and suspected choledocholithiasis managed with ERCP, identifying Lemmel syndrome. We recognize the importance of considering this extraordinary cause of obstructive jaundice in order to be able to make a diagnosis and offer timely treatment.
Thermal instability in the presence of the cosmic ray and ambipolar diffusion
Authors: Gholipour Mahmoud , Davoudifar Pantea , Eslami Shafigh Amir Abbas
Published: December 2021

The aim of this study is to investigate the impact of the cosmic ray (CR) and ambipolar diffusion (AD) on the thermal instability in a weakly ionized gas. The CR propagates along the magnetic-field line, where the AD is present. The weakly ionized gas and the CR are considered as two different interacting fluids. Using the linear perturbation analysis, we consider the occurrence of the thermal instability to obtain a dispersion relation in the presence of both phenomena. This equation describes the stable and unstable modes in the terms of some parameters, which depend on the CR and AD. The results show that the angle between the direction of the perturbation propagation and the magnetic-field lines plays an important role on the domains of stability and instability. Furthermore, we found that there is a characteristic wavelength related to the ambipolar diffusivity that explains whether the AD increases the magnetic support of the cloud against the collapse, or decreases it against the collapse. Finally, the results address some new points in the study of the structure formation within the clumpy molecular clouds, as well as the formation of the low-mass stars in the interstellar medium.
Enhanced phase mixing of torsional Alfvén waves in stratified and divergent solar coronal structures – II. Non-linear simulations
Authors: Boocock C , Tsiklauri D
Published: December 2021

We use magnetohydrodynamic (MHD) simulations to detect the non-linear effects of torsional Alfvén wave propagation in a potential magnetic field with exponentially divergent field lines, embedded in a stratified solar corona. In Paper I, we considered solutions to the linearized governing equations for torsional Alfvén wave propagation and showed, using a finite difference solver we developed named WiggleWave, that in certain scenarios wave damping is stronger than what would be predicted by our analytical solutions. In this paper, we consider whether damping would be further enhanced by the presence of non-linear effects. We begin by deriving the non-linear governing equations for torsional Alfvén wave propagation and identifying the terms that cause coupling to magnetosonic perturbations. We then compare simulation outputs from an MHD solver called Lare3d, which solves the full set of non-linear MHD equations, to the outputs from WiggleWave to detect non-linear effects such as: the excitation of magnetosonic waves by the Alfvén wave, self-interaction of the Alfvén wave through coupling to the induced magnetosonic waves, and the formation of shock waves higher in the atmosphere caused by the steepening of these compressive perturbations. We suggest that the presence of these non-linear effects in the solar corona would lead to Alfvén wave heating that exceeds the expectation from the phase mixing alone.
Identification, functional characterization, assembly and structure of ToxIN type III toxin–antitoxin complex from E. coli
Authors: Manikandan Parthasarathy , Sandhya Sankaran , Nadig Kavyashree , Paul Souradip , Srinivasan Narayanaswamy , Rothweiler Ulli , Singh Mahavir
Published: December 2021

Toxin–antitoxin (TA) systems are proposed to play crucial roles in bacterial growth under stress conditions such as phage infection. The type III TA systems consist of a protein toxin whose activity is inhibited by a noncoding RNA antitoxin. The toxin is an endoribonuclease, while the antitoxin consists of multiple repeats of RNA. The toxin assembles with the individual antitoxin repeats into a cyclic complex in which the antitoxin forms a pseudoknot structure. While structure and functions of some type III TA systems are characterized, the complex assembly process is not well understood. Using bioinformatics analysis, we have identified type III TA systems belonging to the ToxIN family across different Escherichia coli strains and found them to be clustered into at least five distinct clusters. Furthermore, we report a 2.097 Å resolution crystal structure of the first E. coli ToxIN complex that revealed the overall assembly of the protein-RNA complex. Isothermal titration calorimetry experiments showed that toxin forms a high-affinity complex with antitoxin RNA resulting from two independent (5′ and 3′ sides of RNA) RNA binding sites on the protein. These results further our understanding of the assembly of type III TA complexes in bacteria.
Effects of nutrition and gestational alcohol consumption on fetal growth and development
Authors: Naik Vishal D , Lee Jehoon , Wu Guoyao , Washburn Shannon , Ramadoss Jayanth
Published: December 2021

Fetal alcohol exposure can lead to a range of developmental disorders, including impaired fetal growth and development of multiple organ systems. These disorders are grouped under the term fetal alcohol spectrum disorders (FASDs). Adequate nutrition and a conducive intrauterine environment are essential for healthy fetal development. Nutrient deficiencies resulting from inadequate maternal nutrient ingestion may be compounded by alcohol-induced altered nutrient metabolism, placental clearance, and malabsorption. Alcohol-induced alteration of the intrauterine environment is the main source of developmental deficits and nutritional insufficiencies can worsen the effects on fetal development. In this review, we discuss studies examining the collective and interactive effects of nutrition (specifically iron, selenium, vitamin A, thiamine, zinc, folate, vitamin B12, choline, and amino acids) relative to gestational alcohol consumption and its effects on fetal growth and development. We also summarize scientific reports that tested potential benefits of micronutrient supplementation in animal models of fetal alcohol spectrum disorders and in humans. In summary, the deleterious effects of alcohol exposure in relation to nutrient homeostasis further validate that avoidance of alcohol consumption during pregnancy is the most effective way to mitigate the teratogenic effects of alcohol.
Bridging Boundaries? The Effect of Genetic Ancestry Testing on Ties across Racial Groups
Authors: Roth Wendy D , Côté Rochelle , Eastmond Jasmyne
Published: December 2021

The phenomenon of widespread genetic ancestry testing has raised questions about its social impact, particularly on issues of race. Some accounts suggest testing can promote bridging social capital – connections between racial groups. In this multi-method paper, we ask whether (1) taking genetic ancestry tests (GATs) and (2) receiving results of African, Asian, or Native American ancestry increases network racial diversity for White Americans. We use a randomized controlled trial of 802 White, non-Hispanic Americans, half of whom received GATs. Unexpected findings show that test-takers’ network racial diversity decreases after testing. Using 58 follow-up interviews, we develop and test a possible theory, finding initial evidence that test-takers’ network racial diversity declines because they reconsider their racial appraisals of others in their networks.
Response of Different Grapevine Cultivars to Infection byLasiodiplodia theobromaeandLasiodiplodia mediterranea
Authors: Reis Pedro , Gaspar Ana , Alves Artur , Fontaine Florence , Rego Cecília
Published: December 2021

Botryosphaeria dieback is a grapevine trunk disease that affects all viticulture regions of the world. Species of the genus Lasiodiplodia have been reported as pathogenic toward grapevine in several growing regions and have also been previously reported from Portuguese vineyards. Species in this genus, particularly Lasiodiplodia theobromae, have been reported in previous studies to be more aggressive than other Botryosphaeriaceae species most commonly associated with Botryosphaeria dieback. The aim of this study was to assess the response of some of the more representative cultivars planted throughout Portuguese vineyards, ‘Touriga Nacional,’ ‘Touriga Franca,’ ‘Alvarinho,’ ‘Aragonez’ (= ‘Tempranillo’), and ‘Cabernet Sauvignon,’ by performing artificial inoculations with Lasiodiplodia spp. collected in different geographic locations worldwide. Two experiments, one that involved inoculating 2-year-old grapevines kept in greenhouse-controlled conditions with six isolates of L. theobromae and one isolate of L. mediterranea and one that involved inoculating 7-year-old field-grown grapevines with two isolates of L. theobromae, were conducted twice. We assessed the response of the cultivars by evaluating the length of lesions caused by the isolates 5 months after inoculation. The results showed that all isolates studied were able to infect the annual shoots because they were always reisolated and produced internal wood discoloration. Significant differences were found for all isolate–cultivar combinations. In both experiments, Touriga Nacional showed the largest lesions and while Aragonez recorded the smallest lesions of the cultivars inoculated with Lasiodiplodia spp. In general, Portuguese isolates were more aggressive than those from Peru, which were mildly aggressive. These results are a first insight into the response of selected Portuguese cultivars to Lasiodiplodia species, which are present in Portugal but not commonly associated with Botryosphaeria dieback. This research contributes to our knowledge of the impact that Botryosphaeria dieback causal agents have on crucial national cultivars, which may help winegrowers not only manage current cultural practices but also optimize decision making when planning new vineyards.
Comparative Performance of Fungicides and Biocontrol Products in the Management of Fusarium Wilt of Blackberry
Authors: Acosta-González Uriel , Silva-Rojas Hilda V. , Fuentes-Aragón Dionicio , Hernández-Castrejón Jesús , Romero-Bautista Alejandro , Rebollar-Alviter Angel
Published: December 2021

Fusarium wilt of blackberry (FWB) is an emerging disease caused by a Fusarium oxysporum species complex. More than 3,000 ha of blackberry (Rubus spp.) crops have been lost in Mexico since 2011. The objectives of this research were: to evaluate the sensitivity of pathogenic F. oxysporum isolates recovered from symptomatic blackberry plants to fungicides with different modes of action; to assess the potential of these fungicides and plant resistance inducers against FWB in the greenhouse; and to determine the effects of commercial biofungicides and two indigenous strains of Trichoderma spp. on the incidence of FWB. The EC50 values of the fungicides prochloraz, thiabendazole, azoxystrobin, thiophanate-methyl, difenoconazole, triflumizole, and potassium phosphite for six pathogenic F. oxysporum isolates were determined. In a separate experiment, the fungicides acibenzolar-s-methyl (ASM), potassium phosphite, and commercial biofungicides, as well as two soil microbial inoculants and two indigenous Trichoderma strains, were tested for protection against wilt development in blackberry plants in the greenhouse. Prochloraz showed an average sensitivity for EC50 of 0.01 μg ml−1 for the tested F. oxysporum isolates, followed by difenoconazole and thiabendazole. Prochloraz and ASM proved to be the most effective treatments in the greenhouse. In contrast, potassium phosphite was ineffective in both the in vitro and in vivo experiments. The soil bioinoculants MicroSoil, Baktillis, T. koningiopsis, and T. asperellum significantly reduced the incidence of disease in the greenhouse. These results provide evidence for the potential of the various tools as useful components of integrated FWB management in the field.
The Dark Side of Shade: How Microclimates Drive the Epidemiological Mechanisms of Coffee Berry Disease
Authors: Motisi Natacha , Papaïx Julien , Poggi Sylvain
Published: December 2021

Coffee berry disease (CBD) can cause significant coffee yield losses along with major income losses for African smallholders. Although these farmers cannot afford to purchase pesticides to control the disease, agroecological solutions have rarely been investigated, and how epidemiological mechanisms are linked to the environment of the coffee tree and the plot remains unclear. Agroforestry systems are a promising agroecological option, but the effect of shade on CBD regulation is the subject of debate, and the use of plant species diversity remains uncertain. Here, we address how shade affects epidemiological mechanisms by modifying the microclimate. For this purpose, we developed a mechanistic susceptible-exposed-infectious-removed model and used a Bayesian framework to infer the epidemiological parameters against microclimatic covariates. We show that shade has opposing effects on different epidemiological mechanisms. Specifically, shade can limit disease dynamics by reducing disease transmission while simultaneously promoting disease dynamics by reducing the latent period of the pathogen. However, in full sun, efficient disease transmission compensates for long latent periods. As a result, the balances between microclimatic variables can counterbalance the epidemiological rates, which can dramatically alter the fate of epidemics in shade versus full sun conditions. We propose research avenues to help design cost- and environmentally effective management strategies for CBD that are notably based on the functional traits of shade trees that could hamper CBD dispersal.
Breeding a Soybean Cultivar Heinong 531 with Peking-Type Cyst Nematode Resistance, Enhanced Yield, and High Seed-Oil Contents
Authors: Wang Jiajun , Kong Lingan , Zhang Liuping , Shi Xue , Yu Baishuang , Li Jinrong , Zhang Bixian , Gao Mingjie , Liu Xiulin , Li Xiaobai , Gao Yuan , Peng Deliang , Liu Shiming
Published: December 2021

Soybean cyst nematode (SCN) is a destructive threat to soybean production. It is economically important to develop a new SCN-resistant soybean cultivar with high yield and other good agronomic traits. In this study, a yellow-seed-coated and yellow-hilum-pigmented cultivar Heinong 531 belonging to maturity group I was developed by a pedigree breeding method through a test-cross between a female parental SCN-resistant soybean cultivar Pengdou 158 and a male parental line F1 (high-yield but SCN-susceptible Hefeng 55 × SCN-resistant Kangxian 12). Heinong 531 was evaluated for SCN resistance in both SCN-infested field and autoclaved soil inoculated with hatched second-stage juveniles of SCN HG Type 0. The results indicated that SCN development at all stages in Heinong 531 was suppressed and the female index was only 1.6 to 5.6%. Heinong 531 as well as Pengdou 158 and Kangxian 12 were identified as carrying the Peking-type resistance with both rhg1-a GmSNAP18 and Rhg4 GmSHMT08 genes. In the 2-year regional trials, the average yield of Heinong 531 reached 2805.0 kg/ha, and the 1-year production trial demonstrated an average yield of 2,751.5 kg/ha with yield increase of >12.0% when compared with the local cultivars. The average seed-fat (oil) contents of Heinong 531 reached up to 22.3%. The Peking-type SCN-resistant Heilong 531 with enhanced yield and high seed-oil contents was released in China in June 2021 with the certified number of ‘Heishendou 20210004’. These agronomic traits make Heinong 531 a good prospect in a wide attempt to control SCN in the main soybean-producing areas of Northeast China.
Field Studies on the Effect of Rye Cover Crop on Soybean Root Disease and Productivity
Authors: Araldi-Da-Silva Grazieli , Kandel Yuba R. , Han Gang , Mueller Daren S. , Helmers Matthew J. , Kaspar Thomas C. , Leandro Leonor F. S.
Published: December 2021

Cover crops improve soil and water quality in annual cropping systems, but knowledge of their impact on soybean ( Glycine max L.) seedling and root diseases is limited. The effects of winter rye cover crops ( Secale cereale L.) on soybean population, biomass, root morphology, seedling and root diseases, pathogen incidence, canopy reflectance, and yield were assessed over 2 years in Iowa and Missouri, U.S.A. Plots without a rye cover crop were compared with plots with early-kill rye and late-kill rye cover crops, which were terminated 34 to 49 days or 5 to 17 days before soybean planting, respectively. Soybean shoot dry weight, root rot severity, and incidence of Fusarium spp. and Pythium spp. on roots were not influenced by the treatments. Soybean grain yield and plant population were reduced in the presence of rye in 2 site years, increased in 1 site year, and unchanged in the remaining site years. Soybean canopy reflectance was measured at 810 nm, and measurements were first made at 70 to 80 days after planting (DAP). At least five measurements were obtained at 7- to 15-day intervals, ending at 120 to 125 DAP. Measurements at approximately 120 to 125 DAP differed by treatments but were not consistently associated with the presence or absence of a rye cover crop. Our field studies suggest that Iowa and Missouri soybean farmers can use winter rye as a cover crop in soybean fields with low seedling disease pressure without increasing the risk of seedling and root diseases or suppressing yield.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Early Life Influences on Hearing in Adulthood: a Systematic Review and Two-Step Individual Patient Data Meta-Analysis
Authors: Dawes Piers , Newall John , Graham Petra L. , Osmond Clive , von Bonsdorff Mikaela B. , Gunnar Eriksson Johan
Published: December 2021

Objectives:

Adverse prenatal and early childhood development may increase susceptibility of hearing loss in adulthood. The objective was to assess whether indices of early development are associated with adult-onset hearing loss in adults ≥18 years.

Design:

In a systematic review and meta-analysis, four electronic databases were searched for studies reporting associations between indices of early development (birth weight and adult height) and adult-onset hearing loss in adults ≥18 years. We screened studies, extracted data, and assessed risk of bias. Authors were contacted to provide adjusted odds ratios from a logistic regression model for relationships between birth weight/adult height and normal/impaired hearing enabling a two-step individual patient data random-effects meta-analysis to be carried out. The study is registered with PROSPERO, CRD42020152214.

Results:

Four studies of birth weight and seven of adult height were identified. Three studies reported smaller birth weight associated with poorer adult hearing. Six studies reported shorter height associated with poorer hearing. Risk of bias was low to moderate. Four studies provided data for two-step individual patient data random-effects meta-analysis. Odds of hearing impairment were 13.5% lower for every 1 kg increase in birth weight [OR: 0.865 (95% confidence interval: 0.824 to 0.909)] in adulthood over two studies (N=81,289). Every 1 cm increase in height was associated with a 3% reduction in the odds of hearing impairment [OR: 0.970 (95% confidence interval: 0.968 to 0.971)] over four studies (N=156,740).

Conclusions:

Emerging evidence suggests that adverse early development increases the likelihood of hearing impairment in adulthood. Research and public health attention should focus on the potential for prevention of hearing impairment by optimizing development in early life.
High Ankle Syndesmosis Disruption: All-Inside Arthroscopic Reduction and Internal Fixation
Authors: Martin Kevin D. , Callender Nathan W. , Luplow Craig , Groth Adam T.
Published: December 2021

Ankle syndesmotic injury, or high ankle sprain, has been shown to lead to chronic injury and long-term debilitation when undertreated or malreduced. Arthroscopic repair of ankle syndesmosis injury provides a novel therapeutic avenue to achieve adequate reduction and fixation of ankle syndesmosis injury while preventing unnecessary soft tissue trauma and shortening time to return to sport. We describe and illustrate one academic institution’s technique of arthroscopic repair of ankle syndesmosis injury as well as the benefits and pitfalls of such an approach. Syndesmosis arthroscopic reduction and internal fixation is a novel strategy addressing diagnosis and fixation while minimizing soft tissue disruption and allowing early return to activity. It allows direct visualization of a dynamic exam, enhancing the surgeon’s ability to accurately identify the injury pattern. Following diagnosis, the syndesmosis reduction maneuver and fixation are directly monitored arthroscopically helping to prevent iatrogenic malreduction, as the syndesmosis remains visible throughout. The addition of an all-inside anterior-inferior talofibular ligament reconstruction can augment syndesmosis stability if necessary.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Teleguidance Technology for Endotracheal Intubation: A Scoping Review
Authors: Levin Benjamin S. , Chang Marvin G. , Bittner Edward A.
Published: December 2021

OBJECTIVES:

Teleguidance facilitated intubation has recently reemerged during the coronavirus disease 2019 pandemic as a strategy to provide expert airway management guidance and consultation to practitioners in settings where such expertise is not readily available onsite or in-person. We conducted a scoping review to provide a synthesis of the available literature on teleguidance facilitated intubation. Specifically, we aimed to evaluate the feasibility, safety, and efficacy of teleguidance facilitated intubation given existing technology.

DATA SOURCES:

A librarian-assisted search was performed using three primary electronic medical databases from January 2000 to November 2020.

STUDY SELECTION:

Articles that reported outcomes focused on implementing or evaluating the performance of teleguidance facilitated intubation were included.

DATA EXTRACTION:

Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system.

DATA SYNTHESIS:

Of 255 citations identified, 17 met eligibility criteria. Studies included prospective investigations and proof of technology reports. These studies were performed in clinical and simulation environments. Five of the prospective investigations that examined time to intubation and intubation success rates. Multiple different commercially available and noncommercial teleconference software systems were used in these studies.

CONCLUSIONS:

There is a limited body of literature evaluating the feasibility, safety, and efficacy of teleguidance facilitated intubation. Based on the studies available that examined a variety of technologies within simulation and clinical environments, teleguidance facilitated intubation appears to be feasible, safe, and efficacious. Given the exponential growth in the use of telemedicine technology during the coronavirus disease 2019 pandemic and the evidence supporting teleguidance facilitated intubation, there is a need to critically evaluate the most effective mechanisms to integrate and optimize these technologies across diverse practice settings.
The role of FGF21 in the pathogenesis of cardiovascular disease
Authors: Zhang Ying , Liu Dan , Long Xiao-Xue , Fang Qi-Chen , Jia Wei-Ping , Li Hua-Ting
Published: December 2021

The morbidity and mortality of cardiovascular diseases (CVDs) are increasing worldwide and seriously threaten human life and health. Fibroblast growth factor 21 (FGF21), a metabolic regulator, regulates glucose and lipid metabolism and may exert beneficial effects on the cardiovascular system. In recent years, FGF21 has been found to act directly on the cardiovascular system and may be used as an early biomarker of CVDs. The present review highlights the recent progress in understanding the relationship between FGF21 and CVDs including coronary heart disease, myocardial ischemia, cardiomyopathy, and heart failure and also explores the related mechanism of the cardioprotective effect of FGF21. FGF21 plays an important role in the prediction, treatment, and improvement of prognosis in CVDs. This cardioprotective effect of FGF21 may be achieved by preventing endothelial dysfunction and lipid accumulating, inhibiting cardiomyocyte apoptosis and regulating the associated oxidative stress, inflammation and autophagy. In conclusion, FGF21 is a promising target for the treatment of CVDs, however, its clinical application requires further clarification of the precise role of FGF21 in CVDs.
The “Phillips” Ileostomy Correction Technique for Prolapsed Stoma
Authors: Bellato Vittoria , Tanis Pieter J. , Hompes Roel , Buskens Christianna J. , Sica Giuseppe S. , Bemelman Willem A.
Published: December 2021

INTRODUCTION:

Stoma prolapse is a common complication associated with ostomy creation, causing leakage, obstruction, and sometimes incarceration. Sometimes ileostomy prolapse cannot be treated with resection and alternative methods must be applied. We propose a new surgical revisional technique for ileostomy prolapse.

TECHNIQUE:

Under general anesthesia, the prolapsed stoma is dissected and freed from the fascia and skin. The bowel is everted to create a nipple of 2-3 cm and subsequently fixed with a 3-row linear stapler, creating a “Phillips ileostomy.” The ileostomy is then sutured to the skin with 3-0 full thickness stitches.

RESULTS:

In our center, 3 patients were treated in a day surgery setting, and no complication occurred. One patient reported a prolapse recurrence after 6 months and was successfully treated with the same technique with no recurrence at 1 year.

CONCLUSIONS:

The 3-row stapler fixation of prolapsed ileostomy is simple to perform, preserves the bowel, and can be performed in the day surgery setting.
Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement From the Anti-infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology
Authors: Reuter Stephanie E. , Stocker Sophie L. , Alffenaar Jan-Willem C. , Baldelli Sara , Cattaneo Dario , Jones Graham , Koch Birgit C. P. , Kocic Danijela , Mathew Sumith K. , Molinaro Mariadelfina , Neely Michael , Sandaradura Indy , Marriott Deborah J. E.
Published: December 2021

Individualization of vancomycin dosing based on therapeutic drug monitoring (TDM) data is known to improve patient outcomes compared with fixed or empirical dosing strategies. There is increasing evidence to support area-under-the-curve (AUC24)–guided TDM to inform vancomycin dosing decisions for patients receiving therapy for more than 48 hours. It is acknowledged that there may be institutional barriers to the implementation of AUC24-guided dosing, and additional effort is required to enable the transition from trough-based to AUC24-based strategies. Adequate documentation of sampling, correct storage and transport, accurate laboratory analysis, and pertinent data reporting are required to ensure appropriate interpretation of TDM data to guide vancomycin dosing recommendations. Ultimately, TDM data in the clinical context of the patient and their response to treatment should guide vancomycin therapy. Endorsed by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology, the IATDMCT Anti-Infectives Committee, provides recommendations with respect to best clinical practice for vancomycin TDM.
Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect
Authors: Danker Sara J. , Mericli Alexander F. , Rice David C. , Santos David A. , Butler Charles E.
Published: December 2021

Background:

Three-dimensional (3D) printing of implantable materials is a recent technological advance that is available for clinical application. The most common medical application of 3D printing in plastic surgery is in the field of craniomaxillofacial surgery. There have been few applications of this technology in other areas.

Methods:

Here, we discuss a case of a large, symptomatic composite thoracic and abdominal defect resulting from the resection of a chondrosarcoma of the costal marginand sections of the abdominal wall, diaphragm, and sternum. The initial and second attempts at reconstruction failed, resulting in a massive hernia. Given the size of the defect, the contiguity with a large abdominal wall defect, and the high risk of recurrence, a rigid thoracic reconstruction was essential to durably repair the thoracic hernia and serve as a scaffold to which both the diaphragm and the abdominal mesh could be secured. A custom-made plate offered the most durable and anatomically accurate reconstruction in this particular clinical scenario. This technology was used in concert with a single section of coated mesh for reconstruction of the diaphragm, chest wall, and abdominal wall.

Results:

There were no post-operative complications. The patient has improvement of his symptoms and increased functional capacity. There is no evidence of hernia recurrence 1.5 years after repair.

Conclusions:

3D printing technology proved to be a useful and effective application for reconstruction of this large thoracic defect involving the costal margin. It is an available technology that should be considered for reconstruction of rigid structures with defect-specific precision.
Prurigo pigmentosa: a case with rapid response to doxycycline and the likely pathogenetic role of neutrophils
Authors: Hui Laura L.Y. , Lee Joyce S.S. , Tey Hong Liang
Published: December 2021

Prurigo pigmentosa is a rare pruritic dermatosis, characterized by the development of early papulo-pustules that subsequently evolves into reticulate pigmentation. It is commonly misdiagnosed or undiagnosed, as it presents as a dynamic process, with clinical and histologic presentations that vary according to the stages of development at different time points. To date, the underlying etiology is still unknown. It has been widely reported to be nonresponsive to antihistamine or topical corticosteroid therapy. We describe a patient with prurigo pigmentosa who demonstrated significant response to oral doxycycline therapy, with no subsequent recurrence. The rapid and marked response to treatment with antibiotics, especially tetracyclines, being antineutrophilic, suggests the important role of neutrophils in the underlying inflammatory process.
Associations of high anti-CMV IgG titer with renal function decline and allograft rejection in kidney transplant patients
Authors: Chen Tz-Heng , Ou Shuo-Ming , Tarng Der-Cherng
Published: December 2021

Background:

An anti-cytomegalovirus (CMV) immunoglobulin G (IgG) antibody is produced after primary CMV infection and generally persists after the primary infection. However, it is not well-known about the relationship between anti-CMV IgG titer and outcomes in kidney transplant recipients. We, therefore, aimed to explore the role of anti-CMV IgG titer on the risks of CMV disease development, allograft rejection, renal function decline, and mortality.

Methods:

In a hospital-based study, we identified 179 CMV-seropositive kidney transplant recipients between January 2013 and December 2017. These patients were divided into low and high anti-CMV IgG titer groups, respectively. The cutoff level of anti-CMV IgG titer was determined by receiver operating characteristic curve analysis. The outcomes evaluated included CMV disease, decrease of ≥15% in estimated glomerular filtration rate (eGFR), biopsy-proven allograft rejection, and all-cause mortality.

Results:

The high anti-CMV IgG titer group (≥846.2 AU/mL) exhibited a higher risk of CMV disease (adjusted hazard ratio [aHR], 3.77; 95% CI, 1.47–9.68; p = 0.006), eGFR decline ≥15% (aHR, 2.00; 95% CI, 1.19–3.35; p = 0.009), and renal allograft rejection (aHR, 2.95; 95% CI, 1.11–7.87; p = 0.030) than the low titer group (<846.2 AU/mL).

Conclusion:

In kidney transplant recipients, a high anti-CMV IgG titer was associated with higher risks for developing CMV disease, undergoing allograft rejection, and eGFR decline.
Pupil Light Reflex for the Assessment of Analgesia in Critically Ill Sedated Patients With Traumatic Brain Injury: A Preliminary Study
Authors: Martineau-Lessard Chloé , Arbour Caroline , Germélus Naïcha-Éveline , Williamson David , De Beaumont Louis , Bernard Francis
Published: December 2021

BACKGROUND: Analgesia monitoring is essential to preserve comfort in critically ill sedated patients with traumatic brain injury (TBI). Although pupil dilation (PD) and pain behaviors can be used to assess analgesia, these indicators require application of noxious stimulations for elicitation. Recently, the pupillary light reflex (PLR) has emerged as a nonnoxious parameter that may be used to predict analgesia requirements in non–brain-injured patients. Here, we explored whether PLR can be used for the purpose of analgesia monitoring in critically ill sedated TBI patients. METHODS: Fifteen mechanically ventilated TBI patients (11 men; 54 ± 20 years) under continuous analgesia and sedation infusions were assessed at predefined time within 72 hours of intensive care unit admission. Data collection was performed using video-pupillometry and the Behavioral Pain Scale. At each assessment, pupil size and PLR at rest were recorded followed immediately by the documentation of PD and pain behaviors elicited by a calibrated noxious stimulus. Blood concentrations of analgesics/sedatives were monitored. RESULTS: One hundred three assessments were completed. PLR resulted in an average decrease of 19% in pupil diameter, and PD resulted in an average increase of 10% in pupil diameter. Variations in PLR and PD were more pronounced in subjects who showed a Behavioral Pain Scale score greater than 3 (a recognized sign of subanalgesia) compared with those with no behavioral reaction. Multiple regression analyses suggest a significant overlap between fluctuations in pupillary reflexes and blood levels of fentanyl, not propofol. CONCLUSION: In our sample, percentages of variation in PLR and PD were found to be directly representative of TBI patients’ fentanyl blood concentration. Considering information about blood drug concentration is generally not available at bedside, PLR could be used as a proxy to assess analgesia requirements before a nociceptive procedure in critically ill sedated TBI patients who are vulnerable to stress.
Maternal health indicators in Brazil
Authors: Souza Dandara Rayssa Silva , de Morais Thiffany Nayara Bento , Costa Ketyllem Tayanne da Silva , de Andrade Fábia Barbosa
Published: December 2021

In addition to the maternal death indicator, Stork Network proposes the number of prenatal consultations, the gestational age of onset of prenatal care and the number of children breastfeeding.

The study aims to analyze maternal health indicators representative of the actions proposed by Stork Network in Brazil, after its implementation. Therefore, this is an ecological study of maternal health indicators in Brazil from 2012 to 2017.

Thus, it was found that the number of prenatal consultations per pregnant woman in Brazil from 2012 to 2017 increased >4 times between the first and the last year analyzed. The proportion of pregnant women who started prenatal care in the first trimester of pregnancy increased progressively each year in Brazil.

The breastfeeding coefficient also increased progressively between 2014 and 2017 in Brazil. It was found that maternal health indicators improved between 2012 and 2017 in the Brazilian territory.
Risk of bleeding with ticagrelor in elderly patients over 75 years old
Authors: Alaamri Shalan , Dalbhi Sultan Al
Published: December 2021

Background:

Bleeding is an untoward outcome in the management of elderly patients with acute coronary syndrome (ACS). Although the potent oral P2Y12 inhibitor, ticagrelor is clinically beneficial, its association with bleeding events in elderly ACS patients (≥75 years) is poorly understood.

Methods:

We conducted a systematic search of 7 databases up to May 20, 2020 to identify studies which examined the risk of bleeding (defined according to each study) among elderly ACS patients (≥75 years) receiving ticagrelor compared to clopidogrel. Summary risk ratios (RR) were estimated using the random effects model.

Results:

Eight studies consisting of 5 observational studies and 3 randomized controlled trials involving 7032 elderly patients met the eligibility criteria. The mean age of the patients was 77.8 years, and the mean follow-up duration was 12 months. Overall, the pooled RRs showed higher risk of a bleeding event with ticagrelor compared to clopidogrel (RR 1.20, 95% confidence interval [95% CI] 1.03–1.40; P = .017). No statistically significant heterogeneity was observed among the studies (Q = 6.93; P = .44; I2 = 0). Also, pooled RRs did not show a higher risk of major bleeding (RR 1.32, 95% CI 0.91–1.92; P = .15) or minor bleeding (RR 1.09, 95% CI 0.76–1.58; P = .64) when comparing the ticagrelor to the clopidogrel group.

Conclusions:

There is a 20% increased risk of a bleeding event in elderly ACS patients treated with ticagrelor compared to clopidogrel; for such patients, clopidogrel may be considered as an alternative agent to ticagrelor due to its lower risk of bleeding.
Clinical study on acupuncture treatment of gastrointestinal damp-heat acne
Authors: Duan Ping-Ping , Yan Chao-Qun , Feng Hui-Shang , Chen Yuan , Sun Ning , Yao Ya-Qi , Tian Kai-Bing , Wang Guang-An
Published: December 2021

Background:

Acne is a common inflammatory disease of sebaceous glands, which brings extensive emotional and psychological distress to patients. Although acupuncture has certain advantages in the treatment of acne, the curative effect is not exact. The purpose of this trial is to evaluate the feasibility, preliminary efficacy, and safety of the “Spleen and Stomach Guiyuan Acupuncture Method” (SSGA) in the treatment of gastrointestinal damp-heat acne.

Methods:

The proposed protocol is planned as a randomized, assessor-blind, conventional-treatment-controlled trial to evaluate the efficacy of SSGA on gastrointestinal damp-heat acne. Seventy six gastrointestinal damp-heat acne patients will be randomly divided into 2 groups and receive SSGA or conventional acupuncture treatment. The entire study period is 12 weeks, including an 8-week treatment period and a 4-week follow-up period. All patients will receive 16 sessions of acupuncture treatment over 8 weeks. The primary outcome is the investigation global assessment (IGA) at week 8, which is an overall assessment of the degree of the inflammatory and non-inflammatory lesion. The secondary outcomes include IGA, the total facial lesion count (Total Lesion Count), the acne-specific quality of life, etc at weeks 8 and 12. The Expectation and Credibility of treatment rating scale will be used to measure the patients’ attitudes to acupuncture after the first treatment. Adverse events will also be recorded.

Discussion:

This study is helpful to evaluate the feasibility, preliminary efficacy, and safety of SSGA in the treatment of gastrointestinal damp-heat acne. The results will be used in sample size calculations for subsequent large-scale studies.

Trial registration: Chinese Clinical Trial Registry ChiCTR2100047363. Registered on June 13, 2021.
Comparison of tracheal intubation between sitting position and standing position in COVID-19 patients
Authors: Wang Yong , Shi Yun , Li Yong-Xing , Zhong Ming , Zhuang Yue-Rong , Huang Wei , Ma Wu-Hua
Published: December 2021

It is recommended to use visual laryngoscope for tracheal intubation in a Corona Virus Disease 2019 patient to keep the operator farther from the patient. How the position of the operator affects the distance in this setting is not ascertained. This manikin study compares the distances between the operator and the model and the intubation conditions when the operator is in sitting position and standing position, respectively.

Thirty one anesthesiologists with minimum 3-years’ work experiences participated in the study. The participant's posture was photographed when he performed tracheal intubation using UE visual laryngoscope in standing and sitting position, respectively. The shortest distance between the model's upper central incisor and operator's face screen (UF), the horizontal distance between the model's upper central incisor and the operator's face screen, the angle between the UF line and the vertical line of the model's upper central incisor were measured. The success rate of intubation, the duration of intubation procedure, the first-attempt success rate, the Cormack–Lehane grade, and operator comfort score were also recorded.

When the operator performed the procedure in sitting position, the horizontal distance between the model's upper central incisor and the operator's face screen distance was significantly longer (9.5 [0.0–17.2] vs 24.3 [10.3–33.0], P ≤ .001) and the angle between the UF line and the vertical line of the model's upper central incisor angle was significantly larger (45.2 [16.3–75.5] vs 17.7 [0.0–38.9], P ≤ .001). There was no significant difference in UF distance when the operator changed the position. Cormack–Lehane grade was significantly improved when it was assessed using visual laryngoscope. Cormack–Lehane grade was not significantly different when the operator assessed it in sitting and standing position, respectively. No significant differences were found in the success rate, duration for intubation, first-attempt success rate, and operator comfort score.

The operator is kept farther from the patient when he performs intubation procedure in sitting position. Meanwhile, it does not make the procedure more difficult or uncomfortable for the operator, though all the participants prefer to standing position.