bluuebunny/crossref_metadata_2025 huggingface dataset:
Trichomonas vaginalis in Pregnancy
Authors: Kim Tesia G. , Young Marisa R. , Goggins Emily R. , Williams Rachel E. , HogenEsch Elena , Workowski Kimberly A. , Jamieson Denise J. , Haddad Lisa B.
Published: April 2020

OBJECTIVE:

To identify factors associated with testing for and diagnosis of trichomoniasis in pregnancy and to describe patterns of treatment and tests of reinfection or persistence.

METHODS:

We conducted a retrospective cohort study of women who delivered from July 2016 to June 2018 at one institution. Testing for Trichomonas vaginalis infection was done by wet mount microscopy or by nucleic acid amplification testing for routine prenatal testing or symptomatic visits. Poisson regression was used to identify factors associated with testing for trichomoniasis and testing positive in pregnancy. Treatment and re-testing patterns also were assessed.

RESULTS:

Among 3,265 pregnant women, 2,489 (76%) were tested for T vaginalis infection. Of the total sample, 1,808 (55%) were tested by wet mount microscopy, 1,661 (51%) by nucleic acid amplification testing, and 980 (30%) by both modalities. The sensitivity for microscopy compared with nucleic acid amplification testing was 26%, with a specificity of 99%. Factors associated with increased likelihood of being tested included younger age (adjusted risk ratio [aRR] 0.99, 95% CI 0.99–1.00) and bacterial vaginosis (aRR 1.17, 95% CI 1.01–1.37). Prevalence of trichomoniasis was 15% among those tested by any modality (wet mount or nucleic acid amplification testing). Risk factors for trichomoniasis included younger age (aRR 0.97, P<.01), being of black race (aRR 2.62, P<.01), abnormal vaginal discharge (aRR 1.45, P<.01), and chlamydia during the current pregnancy (aRR 1.70, P<.01). Women diagnosed by microscopy had a shorter time to treatment compared with those diagnosed by nucleic acid amplification testing. Most (75%) women with positive infections had a test of reinfection; 29% of these were positive. Bacterial vaginosis was associated with decreased risk of a positive test of reinfection.

CONCLUSION:

Although testing for and treatment of trichomoniasis during pregnancy is not routinely recommended, the high burden of infection among some pregnant women demonstrates a need to further understand patterns of T vaginalis testing and infection. Opportunities exist for improving timely treatment of trichomoniasis and test of reinfection.
First Twin in Breech Presentation and Neonatal Mortality and Morbidity According to Planned Mode of Delivery
Authors: Korb Diane , Goffinet François , Bretelle Florence , Parant Olivier , Riethmuller Didier , Sentilhes Loïc , Verspyck Eric , Schmitz Thomas ,   for the JUmeaux MODe d'Accouchement (JUMODA) Study Group* and the Groupe de Recherche en Obstétrique et Gynécologie (GROG)
Published: April 2020

OBJECTIVE:

To compare neonatal mortality and morbidity of first twins according to the planned mode of delivery when the first twin is in breech presentation, in a country where planned vaginal delivery is an option.

METHODS:

This is a planned secondary analysis of the JUMODA (JUmeaux MODe d'Accouchement) cohort, a national prospective population-based study of twin deliveries conducted in 176 French hospitals. We analyzed pregnancies with first twins in breech presentation and applied the inclusion criteria of the Twin Birth Study (except the criterion for first-twin presentation): both fetuses alive, with a birth weight between 1,500 g and 4,000 g, at or after 32 0/7 weeks of gestation. The primary outcome was a composite of neonatal mortality and morbidity. We used multivariate Poisson regression models to control for potential confounders and propensity score analyses, that is, matching and inverse probability of treatment weighting to control for indication bias.

RESULTS:

Among the 1,467 women with a breech-presenting first twin included in this analysis, 1,169 (79.7%) had planned cesarean and 298 (20.3%) planned vaginal births, of whom 185 (62.1%) delivered both twins vaginally. The neonatal mortality and severe morbidity rate for first twins was 1.7% (5/298) in the planned vaginal and 1.9% (22/1,169) in the planned cesarean delivery groups (crude relative risk [RR] 0.90, 95% CI 0.34–2.34). Planned vaginal delivery was not associated with higher neonatal mortality and morbidity than planned cesarean delivery, regardless of the statistical method used: adjusted RR 0.71, 95% CI 0.27–1.86; RR 0.61, 95% CI 0.20–1.83 after matching for propensity score; RR 0.63, 95% CI 0.23–1.74 with inverse probability of treatment weighting. Analyses of neonatal mortality and morbidity of second twins yielded similar results.

CONCLUSION:

Although our sample size precluded a robust assessment for small differences in outcomes between planned cesarean and planned vaginal delivery in twin pregnancies in which the first twin was in breech presentation, in our cohort planned vaginal delivery was not associated with higher neonatal mortality and morbidity for either twin.
Pregnancy Prevalence and Outcomes in U.S. Jails
Authors: Sufrin Carolyn , Jones Rachel K. , Mosher William D. , Beal Lauren
Published: April 2020

OBJECTIVE:

To describe the number of admissions of pregnant people to U.S. jails and the outcomes of pregnancies that end in custody.

METHODS:

We prospectively collected pregnancy data from six U.S. jails, including the five largest jails, on a monthly basis for 12 months. Jails reported de-identified, aggregate numbers of pregnant people admitted, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, and maternal and newborn deaths.

RESULTS:

There were 1,622 admissions of pregnant people in 12 months in the selected jails. The highest 1-day count of pregnant people at a single jail was 65. The majority of these admissions involved the release of a pregnant person. Of the 224 pregnancies that ended in jail, 144 (64%) were live births, 41 (18%) were miscarriages, 33 (15%) were induced abortions, and four were ectopic (1.8%). One third of the births were cesarean deliveries and 8% were preterm. There were two stillbirths, one newborn death, and no maternal deaths.

CONCLUSION:

About 3% of admissions of females to U.S. jails are of pregnant people; extrapolating study results to national female jail admission rates suggests nearly 55,000 pregnancy admissions in 1 year. It is feasible to track pregnancy statistics about this overlooked group.
Implant Sonication versus Tissue Culture for the Diagnosis of Spinal Implant Infection
Authors: Carlson Bayard C. , Hines Jeremy T. , Robinson William A. , Sebastian Arjun S. , Greenwood-Quaintance Kerryl E. , Patel Robin , Huddleston Paul M.
Published: April 2020

Mini

We compared the sensitivity and specificity of peri-implant tissue culture to the vortexing–sonication technique for the diagnosis of spinal implant infection (SII). Lower thresholds of sonicate fluid culture positivity showed increased sensitivity with maintained specificity. We recommend a threshold of 20 CFU/10 mL for sonicate culture positivity for the diagnosis of SII.

Study Design.

This is a retrospective study comparing the diagnosis of spinal implant infection (SII) by peri-implant tissue culture to vortexing–sonication of retrieved spinal implants.

Objective.

We hypothesized that vortexing–sonication would be more sensitive than peri-implant tissue culture.

Summary of Background Data.

We previously showed implant vortexing–sonication followed by culture to be more sensitive than standard peri-implant tissue culture for diagnosing of SII. In this follow-up study, we analyzed the largest sample size available in the literature to compare these two culture methods and evaluated thresholds for positivity for sonicate fluid for SII diagnosis.

Methods.

We compared peri-implant tissue culture to the vortexing–sonication technique which samples bacterial biofilm on the surface of retrieved spinal implants. We evaluated different thresholds for sonicate fluid positivity and assessed the sensitivity and specificity of the two culture methods for the diagnosis of SII.

Results.

A total of 152 patients were studied. With more than 100 colony forming units (CFU)/10 mL as a threshold for sonicate fluid culture positivity, there were 46 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 65.2% and 79.6%; the specificities were 88.7% and 93.4%, respectively. With more than 50 CFU/10 mL as a threshold, there were 50 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 68.0% and 76.0%; the specificities were 92.2% for both methods. Finally, with more than or equal to 20 CFU/10 mL as a threshold, there were 52 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 69.2% and 82.7%; the specificities were 94.0% and 92.0%, respectively.

Conclusion.

Implant sonication followed by culture is a sensitive and specific method for the diagnosis of SII. Lower thresholds for defining sonicate fluid culture positivity allow for increased sensitivity with a minimal decrease in specificity, enhancing the clinical utility of implant sonication.

Level of Evidence: 4
Misinformation During the Coronavirus Disease 2019 Outbreak: How Knowledge Emerges From Noise
Authors: Rochwerg Bram , Parke Rachael , Murthy Srinivas , Fernando Shannon M. , Leigh Jeanna Parsons , Marshall John , Adhikari Neill K. J. , Fiest Kirsten , Fowler Rob , Lamontagne François , Sevransky Jonathan E.
Published: April 2020

Objectives:

Although the amount of information generated during this most recent coronavirus disease 2019 pandemic is enormous, much is of uncertain trustworthiness. This review summaries the many potential sources of information that clinicians turn to during pandemic illness, the challenges associated with performing methodologically sound research in this setting and potential approaching to conducting well done research during a health crisis.

Data Sources:

Not applicable.

Study Selection:

Not applicable.

Data Extraction:

Not applicable.

Data Synthesis:

Not applicable.

Conclusions:

Pandemics and healthcare crises provide extraordinary opportunities for the rapid generation of reliable scientific information but also for misinformation, especially in the early phases, which may contribute to public hysteria. The best way to combat misinformation is with trustworthy data produced by healthcare researchers. Although challenging, research can occur during pandemics and crises and is facilitated by advance planning, governmental support, targeted funding opportunities, and collaboration with industry partners. The coronavirus disease 2019 research response has highlighted both the dangers of misinformation as well as the benefits and possibilities of performing rigorous research during challenging times.
Perspectives on Sleep from Multiethnic Community Parents, Pediatric Providers, and Childcare Providers
Authors: Sadler Lois S. , Banasiak Nancy , Canapari Craig , Crowley Angela A. , Fenick Ada , O'Connell Meghan , Ordway Monica R. , Sude Leslie , Trevino Sandra , Redeker Nancy S.
Published: April 2020

Objective:

To describe the perceptions of (1) parents, childcare, and health care providers regarding sleep health among multiethnic infants and toddlers living with socioeconomic adversity, (2) factors that contribute to sleep health and its consequences, and (3) best ways to promote sleep health in these children.

Methods:

Nested within a larger community-engaged mixed methods study, we used a descriptive qualitative design to describe the experience of multiethnic young parents who were raising 6- to 36-month-old children, pediatric health care providers, and childcare providers living and working in an urban under-resourced community. Semistructured interviews with 25 parents and 16 providers were conducted, transcribed, coded, and analyzed using thematic analysis by a 6-member research team. Interviews continued until themes were saturated.

Results:

Parent responses and provider responses resulted in overlapping and divergent findings. Common themes among all respondents were the importance of sleep, interest and desire for more sleep health information, and common environmental/social impediments to healthy family sleep. Divergent themes included the importance of bedtime routines and timing, views on the family bed, importance of naps, and healthy sleep aids. Childcare centers were suggested as good sites for sleep health promotion programs.

Conclusion:

Sleep is a topic of interest and importance for young families. There are unique family challenges to be considered in any sleep health promotion program tailored to the needs of the community. The voices of parents and community providers are valuable assets informing the development of novel family-friendly approaches for decreasing sleep disparities and improving the health of young children and families.
Prevalence of High-risk Nonavalent Vaccine-type Human Papillomavirus Infection Among Unvaccinated, Sexually Active Asian Female Adolescents With and Without Perinatally Acquired HIV Infection
Authors: Sricharoenchai Sirintip , Kerr Stephen J. , Gatechompol Sivaporn , Hansudewechakul Rawiwan , Dang Hanh Le Dung , Tran Dan Ngoc Hanh , Teeratakulpisarn Nipat , Chalermchockcharoenkit Amphan , Achalapong Jullapong , Teeraananchai Sirinya , Singtoroj Thida , Phanuphak Nittaya , Sohn Annette H. , Chokephaibulkit Kulkanya ,   on behalf of Steering Committee of the HPV in Adolescents Study
Published: April 2020

Background:

We studied the prevalence of 7, high-risk human papillomavirus (HPV) types in the nonavalent vaccine (HRVT-7: HPV 16, 18, 31, 33, 45, 52, 58) among vaccine-naïve, sexually active Asian female adolescents with and without perinatally acquired HIV infection (PHIV).

Methods:

PHIV female adolescents 12–24 years of age and HIV-uninfected controls matched by age and number of lifetime sex partners were enrolled in a 3-year observational cohort study in Thailand and Vietnam. Samples from the oral cavity, anus, cervix and vagina were collected for HRVT-7 HPV genotyping, and serum collected for HPV 16 and 18 antibody testing. Baseline data were analyzed using multivariable logistic regression.

Results:

We included 93 PHIV (median CD4 593 cells/mm3, 62% with HIV RNA suppression) and 99 HIV-uninfected adolescents (median lifetime sex partners 2). The overall prevalence of HRVT-7 infection was 53% in PHIV and 49% in HIV-uninfected adolescents (P = 0.66). Cervical HRVT-7 DNA was detected more frequently in PHIV than HIV-uninfected adolescents (37% vs. 23%, P = 0.04). Overall, more lifetime partners [≥3 vs. 1; odds ratio (OR) 2.99 (1.38–6.51), P = 0.02] and having other sexually transmitted infections [OR 3.30 (1.51–7.21), P = 0.003] increased the risk of HRVT-7 infection and/or positive HPV 16/18 antibodies; while detectable HIV RNA [OR 2.78 (1.05–7.36), P = 0.04] increased the risk among PHIV adolescents.

Conclusions:

Half of sexually active Asian female adolescents, regardless of HIV infection, had already acquired HRVT-7 infection. This underscores the need for earlier access to HPV vaccine in the region.
Simultaneous surgery of mandibular reduction and impacted mandibular third molar extraction
Authors: Song Guodong , Yu Panxi , Huang Guoqian , Zong Xianlei , Du Le , Yang Xiaonan , Qi Zuoliang , Jin Xiaolei
Published: April 2020

A considerable number of patients with prominent mandibular angle have mandibular third molar impaction that needs surgical removal. Mandibular reduction is a popular and effective surgery to correct prominent mandibular angle, but it has been rarely performed simultaneously with impacted third molar extraction. In order to decrease the number of operations and suffering of patients, safely performing these 2 operations together is necessary and important. From January 2016 to June 2018, patients received mandibular reduction and impacted mandibular third molar extraction together were retrospectively reviewed. Forty-seven patients receiving long-curve mandibular reduction (n = 12) or simple mandibular reduction (n = 35) were included in this study. A total of 65 impacted mandibular third molars were extracted during mandibular reduction. One patient had hematoma within facial soft tissue which reabsorbed spontaneously. Seven patients who underwent long-curve mandibular reduction reported transient inferior lip numbness for several weeks. No infection or poor wound healing was reported. No immediate or delayed mandibular fracture occurred. All the patients were satisfied with both the aesthetic result of mandibular reduction and the unnecessity of receiving a secondary surgery to extract the impacted third molar. Simultaneously performing mandibular reduction and impacted mandibular third molar extraction can effectively reduce the number of operations and patients’ suffering. It is also safe with adequate pre-op assessment, professional surgical knowledge, proper use of surgical instruments, meticulous surgical procedures, and correct post-op care.
Management of paradoxical embolism in a patient with coexisting patent foramen ovale and masked pulmonary arteriovenous fistula
Authors: Liu Xiao-hua , Yang Jian-min
Published: April 2020

Rationale:

Paradoxical embolism (PE) is an important cause of cryptogenic stroke, particularly in young patients, which usually have a relation with an unexpected route in circulation. Here we report a rare case of cryptogenic stroke carried 2 uncommon malformations.

Patient concerns:

A 48-year-old female experienced double neurological events in just 2 months.

Diagnosis:

Patent foramen ovale was diagnosed with transesophageal echocardiography and successfully occluded in the first admission due to stroke. In the second admission, chest tomographic angiography found a chordae shadow in the right middle lobe, was the first clue for pulmonary arteriovenous fistula (PAVF), thereafter further confirmed by the enhanced pulmonary computed tomographic angiography.

Interventions:

This patient then received intervention occlusion therapy with coils for PAVF under the help of microcatheter. Given the possible native origin of the thrombus in PAVF due to the spiral morphology, dual antiplatelet therapy was prescribed for this patient for the first 3 months to prevent device-related embolism after discharge, and the following single antiplatelet therapy was mandated.

Outcomes:

No recanalization was detected on the follow-up enhanced pulmonary computed tomographic angiography (PCTA), no neurological defect event recurred in the 16 months of follow-up.

Lessons:

Computed tomograph (CT) deserved more value in screening and depicting the morphology of the PAVF, particular in young adults with no apparent arteriosclerotic risk factor. Microcatheter would be helpful for intervention treatment. Antiplatelet therapy might be adequate in specific patients, yet definitely need more evidence to verify.
The role of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase-3 in esophageal squamous cell carcinoma
Authors: Bao Junhui , Wu Ya , Wang Limei , Zhu Yaqun
Published: April 2020

6-phosphofructo-kinase-2/fructose diphosphatase-2 isoenzyme 3 (PFKFB3) is closely related to the growth of many types of cancer cells. Glycolysis not only provides Adenosine triphosphate for the growth of tumor cells, but also protects them from acid products, which is beneficial to the invasion and metastasis of tumors. However, PFKFB3 expression in esophageal squamous cell carcinoma (ESCC) has been scarcely reported. In this study, the role of PFKFB3 was studied in 120 ESCC samples using immunohistochemistry technique (IHC), western blotting, and reverse transcriptase-polymerase chain reaction (RT-PCR). Both PFKFB3 protein and gene expression in ESCC tissues were significantly higher than in adjacent non-tumor tissues (P < .05). Single factor analysis showed that both PFKFB3 protein and gene expression are related to infiltration depth, stage, tumor metastasis, and the degree of tumor differentiation in ESCC. Multifactor Cox survival analysis revealed that PFKFB3 protein expression, tumor location, tumor metastasis, tumor differentiation degree, and tumor stage were independent factors affecting the overall survival of postoperative patients. Multivariate Cox survival analysis showed that PFKFB3 mRNA has a good performance for predicting 3-year survival of patients with ESCC 0.89 (0.79–0.99), with a sensitivity of 0.85 and specificity of 0.77. Encouragingly, the sensitivity and specificity of PFKFB3 in the diagnosis of early ESCC (stage I and stage II) can reach 87.8% and 91.5%. In conclusion, high PFKFB3 protein and gene expression may be associated with the occurrence, development, and prognosis of ESCC. PFKFB3 could be used to help develop new therapeutic and diagnostic strategies for ESCC patients.
A comparison of sociobehavioral impact on cognitive preservation in Alzheimer's disease between Taiwan and Korea
Authors: Hsieh Sun-Wung , Kim Sang-Yun , Shim Yong-Soo , Huang Ling-Chun , Yang Yuan-Han
Published: April 2020

Both Taiwan and Korea are developed countries with different cultures. When encountering the issue of dementia, such sociobehavioral factors have various and different impacts on dementia. We aim to assess the cross-national difference of sociobehavioral impact on cognitive preservation in Alzheimer's disease (AD) between Taiwan and Korea.

A uniformed data set was administered regarding AD. We evaluated annual cognitive function using the Mini-Mental State Examination (MMSE), Clinical Dementia Rating sum of box (CDR-SB), and CDR for 2 continuous years. Annual change of scores compared with the baseline indicated cognitive change as preservation or decline. We recorded the sociodemographic variables of interest, including education duration, level of independence, living situation, and marital status. Step-wise regression analyses were performed to determine the independent factors for cognitive preservation.

In total, 503 participants in Taiwan and 77 participants in Korea were recruited from 2011 to 2014. The baseline demographic characteristics were different in levels of education, living situation, level of independence, and dementia severity between the 2 countries. With follow-up for 2 years, cognitive preservation was associated with CDR staging at baseline and independence [adjusted odds ratio (OR) = 1.657, 95% confidence interval (95% CI) = 1.109–2.477, P = .014] in the Taiwanese population, whereas cognitive preservation was related to living alone (adjusted OR = 3.316, 95% CI = 1.135–9.687, P = .028) in the Korean population. The levels of education showed inconsistency in cognitive preservation in both countries.

Cognitive preservation was associated with independence in the Taiwanese population, whereas cognitive preservation was related to living alone in the Korean population. By practicing relevant socioeconomic support, this might contribute to lessening the negative impact of dementia and preserving cognition in different countries.
Clinicopathologic characteristics and outcomes of papillary thyroid carcinoma in younger patients
Authors: Lu Yi , Jiang Lin , Chen Chao , Chen Haitao , Yao Qinghua
Published: April 2020

In the 7th edition of AJCC staging system, cervical lymph node metastases (LNM) in papillary thyroid carcinoma (PTC) is considered as a poorer prognostic indicator only in patients aged 45 years or older, but as a low-risk factor in patients younger than 45 years. The objective of this study is to investigate the influence of cervical LNM on prognostic outcomes of young patients (<45 years’ old) with PTC.

We carried out a retrospective analysis of 1896 PTC patients younger than 45 years’ old at diagnosis, who were firstly treated in our department between January 2005 and December 2014. Clinicopathologic features, recurrences, disease-free survival (DFS) were recorded and analyzed.

A total of 1896 consecutive patients were identified, comprising of 426 males and 1470 females after a median follow-up period of 40 months (3–129 months) from initial surgery to disease recurrence or to the end of follow-up. The rate of recurrence was 2.16% (n = 41). The DFS rates for a 1-year, 3-year, or 5-year team were 99.1%, 97.8%, or 97.4%, respectively. Univariate analysis showed that diagnosed age ≤30 years, tumor size >1.0 cm, extrathyroidal extension, multifocal lesions, lesions in bilateral lobes, central neck LNM, and lateral neck LNM were associated with a worse DFS. Multivariate analysis showed that only central neck LNM and lateral neck LNM were significant independent prognostic factors for DFS (P < .001). For patients with papillary thyroid microcarcinoma, cervical LNM were also identified as independent risk factors for DFS (P < .001).

LNM have prognostic significance for DFS in PTC patients younger than 45 years. It indicated that PTC patients (<45 years old) with LNM, especially lateral neck LNM, were understaged by the 7th edition of AJCC staging system. Thus, radical resection of primary tumor and metastatic lymph nodes, frequent follow-up, and strict TSH suppression should be taken for young patients with PTC.
Psychometric properties and domains of postural control tests for individuals with knee osteoarthritis: a systematic review
Authors: French Helen P. , Hager Charlotte K. , Venience Anne , Fagan Ryan , Meldrum Dara
Published: April 2020

Individuals with knee osteoarthritis (OA) commonly demonstrate impaired postural control. We aimed to systematically review psychometric properties of tests that assess postural control in people with knee OA and secondly, to determine domains of postural control measured by these tests. PubMed, CINAHL, Embase and Web of Science databases were searched to January 2019. Two independent review authors screened references according to eligibility criteria. The Consensus-based Standards for the selection of health Measurement Instruments were used to evaluate study methodological quality. Postural control tests identified from included studies were assessed to determine postural control constructs using the Systems Framework for Postural Control identifying nine domains. Following the screening of 2643 references, five cross-sectional studies and one longitudinal study (n = 408) were included. Four studies evaluated reliability, validity or responsiveness of three clinical measures: Community Balance and Mobility Scale, Star Excursion Balance Test and Tinetti Performance Oriented Mobility Assessment. Two assessed reliability or validity of a force platform. Results showed that evidence for reliability, validity and responsiveness of all these postural measures is limited. The most common domain of postural control assessed was ‘static stability’. No study used measures that evaluated all nine postural control domains. Our results highlight limited investigation of psychometric properties specific to postural control in knee OA. The few existing ones have limitations regarding psychometric robustness and completeness regarding different domains of postural control. Future research should focus on verifying the quality of existing tools to evaluate postural control in knee OA for research and clinical purposes.
Maintaining Muscle Function Across the Lifespan
Authors: Arnold W. David , Padilla Colón Carlos J.
Published: April 2020

Sarcopenia is a geriatric syndrome currently defined as pathological loss of muscle mass and function. Sarcopenia is not only a major contributor to loss of physical function in older adults but is also associated with increased risk of morbidity, mortality, and increased healthcare costs. As a complex and multifactorial syndrome, sarcopenia has been associated with numerous degenerative changes during the aging process, but there is building evidence for significant contributions to the development of sarcopenia from neurodegenerative changes in the peripheral nervous system. A variety of interventions have been investigated for the treatment of sarcopenia, but current management is primarily focused on nutrition and therapeutic exercise interventions. Great strides have been made to improve screening procedures and diagnostic criteria for sarcopenia, but continued optimization of diagnostic and screening strategies is needed to better identify individuals with sarcopenia or at risk of developing sarcopenia. Understanding and addressing the major drivers of sarcopenia pathogenesis will help develop therapeutics that can reduce the impact of sarcopenia on affected individuals and society.
Comparison of Success Rate of Dental Implants Placed in Autogenous Bone Graft Regenerated Areas and Pristine Bone
Authors: Altiparmak Nur , Akdeniz Sidika Sinem , Diker Nurettin , Bayram Burak , Uckan Sina
Published: April 2020

Autogenous bone grafting still has been considered as the “gold standard” and wildly used in the case of alveolar bone reconstruction. The aim of the present study is to evaluate the success rate of implants placed in autogenous block augmented ridges and implants placed in pristine bone (PB). This study included 113 patients. Fifty-three patients were treated with autogenous block grafts and particulate bone, after 6 months of healing implant placements were performed in autogenous bone augmented (ABA) areas. In 60 patients implant placement was performed, with no need for grafting and implants were placed into the PB. Follow-up data (pain, mobility, exudation from peri-implant space, success rate, marginal bone resorption) were collected after 5 years of prosthetic loading. The cumulative implant success rate at the 5-year examination was 92.45% for the ABA group and 85% for PB group. There were 3 failed implants in the ABA group and 3 in PB group. Average marginal bone loss was 1.47 mm on ABA group and 1.58 mm on PB group. No statistically significant differences for pain, exudation from peri-implant space, implant mobility, implant success, peri-implant bone loss parameters, and patient satisfaction level were found between groups. The obtained data demonstrated that the success rate of implants placed in regenerated areas are very similar to the success rate of implants those placed in PB.
Three-Dimensional Volumetric Changes in Posterior Vault Distraction With Distraction Osteogenesis
Authors: Thatikunta Meena , Pearson Luke , Nguyen Candice , John Kevin , Abolfotoh Mohammad , Mutchnick Ian , Gump William , Chariker Mark , Moriarty Thomas , Rapp Scott J.
Published: April 2020

Object:

Distraction osteogenesis (DO) may allow for maximal volumetric expansion in the posterior vault (PV) by overcoming viscoelastic forces of overlying soft tissues. Little evidence exists regarding surgical planning and anticipated 3D volumetric changes pre- and post-operatively. We aim to study the volumetric changes occurring in PV distraction in lambdoid craniosynostosis.

Methods:

From 2007 to 2019, a single institution retrospective review revealed 232 craniosynostosis patients. Fourteen demonstrated lambdoid synostosis (6%), and of those, 11 patients were included in the study due to treatment with PVDO or representative sample. Six patients had unilateral synostosis and 5 had bilateral synostosis. Imaging protocol for PVDO patients included preoperative head CT within 1 month of surgery and 8 weeks following distraction cessation with weekly skull plain films. 3D volumetric analyses were performed on pre and postoperative head CT using 3D Slicer software.

Results:

Posterior fossa volume (PFV) increased by 38.7% and foramen magnum area increased by 26.9% postoperatively. Unilateral lambdoid craniosynostosis patients had greater increases in PFV versus bilateral lambdoid craniosynostosis patients (63.5% versus 8.9%, P = 0.007). Osteotomy to the asterion was more effective in increasing PFV versus osteotomy to foramen magnum (P = 0.050). Placement of distractor in the inferior third of the lambdoid suture is more effective in increasing PFV versus placement in the middle or top third of the suture (P = 0.041).

Conclusions:

Highest volumetric increases are seen in unilateral lambdoid synostosis. Extending osteotomy beyond the asterion is not necessary for maximal PV volumetric gain. Placement of distractor in the inferior third of the suture leads to maximal PV volumetric gains.
Infraorbital Foramen Decompression Surgery for the Infraorbital Nerve Hypoesthesia in Patients With Isolated Fracture of Maxillary Sinus Anterior Wall
Authors: Shin Jongweon , Jung Ee Room , Cho Jin Tae , Yoo Gyeol
Published: April 2020

Isolated fracture of maxillary sinus anterior wall is relatively uncommon. If the extent of fracture is minimal, only conservative care is amenable, however, there is no agreement on whether infraorbital nerve dysfunction can be used as an indication for surgical intervention. This study was conducted to verify the effect of decompression surgery of infraorbital foramen for recovery of hypoesthesia. A total of 26 patients with unilateral fracture of maxillary sinus anterior wall were enrolled. Ten who received only conservative therapy were allocated in the control group, while sixteen patients were assigned to the decompression group. Pre- and post-treatment sensory assessment using visual analogue scale (VAS) was recorded. Overall treatment satisfaction was also evaluated by means of global assessment scale (GAS). Both absolute VAS value and score increment showed statistical difference only at 4 weeks (P = 0.010 and P = 0.021, respectively), but no significant difference at 1, 12, and 24 weeks. GAS score also showed no statistical significance (P = 0.386). Decompression surgery of infraorbital foramen does not have a significant effect on hypoesthesia recovery in isolated fracture of maxillary sinus anterior wall. Therefore, it is not recommended to perform the operation when the infraorbital nerve hypoesthesia is the only indication for the open reduction.
Anatomic injury patterns in combat casualties treated by forward surgical teams
Authors: Suresh Mithun R. , Valdez-Delgado Krystal K. , VanFosson Christopher A. , Trevino Jennifer D. , Mann-Salinas Elizabeth A. , Shackelford Stacy A. , Staudt Amanda M.
Published: April 2020

BACKGROUND

Role 2 forward surgical teams provide damage-control resuscitation and surgery for life- and limb-threatening injuries. These teams have limited resources and personnel, so understanding the anatomic injury patterns seen by these teams is vital for providing adequate training and preparation prior to deployment. The objective of this study was to describe the spectrum of injuries treated at Role 2 facilities in Afghanistan.

METHODS

Using Department of Defense Trauma Registry data, a retrospective, secondary data analysis was conducted. Eligible patients were all battle or non–battle-injured casualties treated by Role 2 forward surgical teams in Afghanistan from October 2005 to June 2018. Abbreviated Injury Scale (AIS) 2005 codes were used to classify each injury and Injury Severity Score (ISS) was calculated for each patient. Patients with multiple trauma were defined as patients with an AIS severity code >2 in at least two ISS body regions.

RESULTS

The data set included 10,383 eligible patients with 45,225 diagnosis entries (range, 1–27 diagnoses per patient). The largest number of injuries occurred in the lower extremity/pelvis/buttocks (23.9%). Most injuries were categorized as minor (39.4%) or moderate (38.8%) in AIS severity, while the largest number of injuries categorized as severe or worse occurred in the head (13.5%). Among head injuries, 1,872 injuries were associated with a cerebral concussion or diffuse axonal injury, including 50.6% of those injuries being associated with a loss of consciousness. There were 1,224 patients with multiple trauma, and the majority had an injury to the extremities/pelvic girdle (58.2%). Additionally, 3.7% of all eligible patients and 10.5% of all patients with multiple trauma did not survive to Role 2 discharge.

CONCLUSION

The injury patterns seen in recent conflicts and demonstrated by this study may assist military medical leaders and planners to optimize forward surgical care in future environments, on a larger scale, and utilizing less resources.

LEVEL OF EVIDENCE

Epidemiological, Level III.
Diaphragm ultrasound: A novel approach to assessing pulmonary function in patients with traumatic rib fractures
Authors: O'Hara Danielle N. , Randazzo Sean , Ahmad Sahar , Taub Erin , Huang Emily , Vosswinkel James A. , Jawa Randeep S.
Published: April 2020

BACKGROUND

Rib fractures following blunt trauma are a major cause of morbidity. Various factors have been used for risk stratification for complications. Ultrasound (US) measurements of diaphragm thickness (T
di) and related measures such as thickening fraction (TF) have been verified for use in the evaluation of diaphragm function. In healthy individuals, Tdi by US is known to have a positive and direct relationship with lung volumes including inspiratory capacity (IC). However, TF has not been previously been described in, or used to assess, pulmonary function in rib fracture patients. We examined TF and IC to elucidate the association between acute rib fractures and respiratory function. We hypothesized that TF and IC were related. Secondarily, we examined the relationship of TF in rib fractures patients, in the context of values reported for healthy controls in the literature.

METHODS

We prospectively enrolled adults with acute blunt traumatic rib fractures within 48 hours of admission to a level 1 trauma center. Patients requiring a chest tube or mechanical ventilation at time of consent were excluded. Inspiratory capacity was determined via incentive spirometry. Thickening fraction was determined by bedside US measurements of minimum and maximum Tdi during tidal breathing (TFtidal) or deep breathing (TFDB) was calculated (TF = [T
dimax
Tdi − T
dimin
Tdi]/T
dimin
Tdi). TFDB values were also compared with previously reported mean ± SD values of 2.04 ± 0.62 in healthy males and 1.70 ± 0.89 in females. Univariate and multivariate analyses were performed.

RESULTS

A total of 41 subjects (58.5% male) with a median age of 64 years (interquartile range [IQR], 53–77 years) were enrolled. Diaphragm US demonstrated a median TFtidal of 0.30 (IQR, 0.24–0.46). Median IC was 1,750 mL (IQR, 1,250–2,000 mL). As compared with previously reported controls, our mean ± SD TFDB in males 0.90 ± 0.51 and 0.88 ± 0.89 in females were significantly lower. Multivariate analysis revealed a significant inverse correlation (−0.439, p = 0.004) between TFtidal and IC, and no relationship between TFDB and IC.

CONCLUSION

To our knowledge, this is the first report of TF in rib fracture patients. The significant inverse association between TFtidal and IC, along with lower than normal TFDB ranges, suggests that, in the setting of rib fractures, there are alterations in the diaphragm-chest cage mechanics, whereby other muscles may play more prominent roles.

LEVEL OF EVIDENCE

Diagnostic tests or criteria, Level III.
Bronchoalveolar Lavage-microRNAs Are Potential Novel Biomarkers of Outcome After Lung Transplantation
Authors: Palleschi Alessandro , Gaudioso Gabriella , Edefonti Valeria , Musso Valeria , Terrasi Andrea , Ambrogi Federico , Franzi Sara , Rosso Lorenzo , Tarsia Paolo , Morlacchi Letizia C. , Ferrero Stefano , Nosotti Mario , Vaira Valentina
Published: April 2020

Background.

Primary graft dysfunction, infections, and acute rejection (AR) worsen lung transplantation (LTx) outcome and patient survival. Despite significant efforts, reliable biomarkers of acute lung allograft dysfunction are lacking. To address this issue, we profiled the bronchoalveolar lavage (BAL) miRNome in LTx patients.

Methods.

BAL-microRNAs (miRNAs) from 16 patients were collected 7 days (T0), 15 days (T1), and 3 months (T2) after bilateral LTx and profiled on low-density array. Unsupervised and supervised analyses were used to identify miRNAs associated with clinical features, pneumonia, or AR. Prognostic markers were identified using the Cox model. Targeted signaling pathways were predicted in silico. A second series of 11 patients were used to validate AR-associated miRNAs.

Results.

Variation in BAL-miRNAs was associated with acute lung allograft dysfunction. Increased levels of miR-23b-3p at T2 were detected in patients with pneumonia, whereas let-7f-5p, miR-146b-3p, miR-22-5p, miR-29c-5p, miR-362-5p, and miR-452-5p were upregulated at T2 in patients with AR. miR-148b-5p and miR-744-3p distinguished LTx patients with AR in both cohorts. Low miR-148b-5p and high miR-744-3p expression levels were significantly associated with a shorter time to AR either within the first year after LTx or during follow-up. Combination of the 2 miRNAs identified LTx patients with higher AR risk independently of clinical variables.

Conclusions.

Our data provide new insights into the roles of BAL-miRNAs in regulating the pulmonary environment after transplantation and suggest that these miRNAs could serve as biomarkers of early- or mid-stage events. If validated, these findings could pave the way to a personalized clinical approach in LTx patients.
Aliphatic Amines are Viable Pro-drug Moieties in Phosphonoamidate Drugs
Authors: Yan Victoria C. , Pham Cong-Dat , Arthur Kenisha , Muller Florian L.
Published: April 2020

Phosphate and phosphonates containing a single P-N bond are frequently used pro-drug motifs to improve cell permeability of these otherwise anionic moieties. Upon entry into the cell, the P-N bond is cleaved by phosphoramidases to release the active agent. Here, we apply a novel mono-amidation strategy to our laboratory’s phosphonate-containing glycolysis inhibitor and show that a diverse panel of phosphonoamidates may be rapidly generated for in vitro screening. We show that, in contrast to the canonical L-alanine or benzylamine moieties which have previously been reported as efficacious pro-drug moieties, small aliphatic amines demonstrate greater drug release efficacy for our phosphonate inhibitor. These results expand the scope of possible amine pro-drugs that can be used as second pro-drug leave groups for phosphate or phosphonate-containing drugs.

Abstract Figure
On Data-Driven Management of the COVID-19 Outbreak in South Africa
Authors: Mbuvha Rendani , Marwala Tshilidzi
Published: April 2020

The rapid spread of the novel coronavirus (SARS-CoV-2) has highlighted the need for the development of rapid mitigating responses under conditions of extreme uncertainty. While numerous works have provided projections of the progression of the pandemic, very little work has been focused on its progression in Africa and South Africa, in particular. In this work, we calibrate the susceptible-infected-recovered (SIR) compartmental model to South African data using initial conditions inferred from progression in Hubei, China and Lombardy, Italy. The results suggest two plausible hypotheses - either the COVID-19 pandemic is still at very early stages of progression in South Africa or a combination of prompt mitigating measures, demographics and social factors have resulted in a slowdown in its spread and severity. We further propose pandemic monitoring and health system capacity metrics for assisting decision-makers in evaluating which of the two hypotheses is most probable.
The Immediate Effect of COVID-19 Policies on Social Distancing Behavior in the United States
Authors: Abouk Rahi , Heydari Babak
Published: April 2020

Anecdotal evidence points to the effectiveness of COVID-19 social distancing policies, however, their effectiveness vis-a-vis what is driven by public awareness and voluntary actions have not been studied. Policy variations across US states create a natural experiment to study the causal impact of each policy. Using a difference-in-differences methodology, location-based mobility, and daily state-level data on COVID-19 tests and confirmed cases, we rank policies based on their effectiveness. We show that statewide stay-at-home orders had the strongest causal impact on reducing social interactions. In contrast, most of the expected impact of more lenient policies were already reaped from non-policy mechanisms. Moreover, stay-at-home policy results in a steady decline in confirmed cases, starting from ten days after implementation and reaching a 37% decrease after fifteen days, consistent with the testing practices and incubation period of the disease.
Predicting the number of reported and unreported cases for the COVID-19 epidemics in China, South Korea, Italy, France, Germany and United Kingdom
Authors: Liu Z. , Magal P. , Webb G.
Published: April 2020

We model the COVID-19 coronavirus epidemics in China, South Korea, Italy, France, Germany and United Kingdom. We use early reported case data to predict the cumulative number of reported cases to a final size in each country. The key features of our model are the timing of implementation of major public policies restricting social movement, the identification and isolation of unreported cases, and the impact of asymptomatic infectious cases.
Identification of the Likely Orthologues of RCD1 within the Plant Family Brassicaceae
Authors: Siddiqua Beena , Qamarunnisa Syeda , Azhar Abid
Published: April 2020

RCD1 is a signal transduction factor binding protein that gateways a myriad of developmental and stress-related pathways. It was first reported in the wild plantA. thaliana. Brassica napusis a cultivated member of the family Brassicaceae, in which the presence of this gene was reported. Using the homology data of these two family-related species, gene for this protein was mined within the genomes ofBrassica carinata, Brassica junceaandBrassica oleracea, using sets of degenerate primers designed on homologous portions of theA. thalianaandB. napusorthologues. The newly identified sequences were then compared and studied usingin-silicomeans and their 3D structures were modelled for having an estimate on their functions. Results demonstrate intergeneric conservation of this protein’s domains on structural and functional levels. The newly found orthologues show potential to be regulated under salinity and oxidative stresses apart from being involved in several developmental stages. These homologues are in-stablein-vivoand bear motifs for binding a wide-variety of transcription factors. The structure superimposition studies suggest that these Brassica orthologues bear the WWE domains having transferase activity, the fact that can dramatically increase the survival of these agriculturally important crop plants amid the adverse environmental conditions.