bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Near-Infrared Fluorescence-Guided Hepatectomy for the Detection of Colorectal Liver Metastases: A Randomized Controlled Trial
Authors: He Kunshan , Hong Xiaopeng , Chi Chongwei , Cai Chaonong , An Yu , Li Peiping , Liu Xialei , Shan Hong , Tian Jie , Li Jian
Published: April 2022

BACKGROUND:

The application of indocyanine green fluorescence–guided hepatectomy for liver metastases from colorectal cancer is in the preliminary stage of clinical practice; thus, its efficacy needs to be determined. This study compared the number of intrahepatic colorectal liver metastases detected intraoperatively and postoperative recovery data between patients who underwent traditional hepatectomy (nonindocyanine green group) and traditional hepatectomy plus intraoperative indocyanine green fluorescence imaging (indocyanine green group).

STUDY DESIGN:

Between January 2018 and March 2020, patients with potentially resectable colorectal liver metastases were randomly assigned to the nonindocyanine green or indocyanine green group. The number of intrahepatic colorectal liver metastases identified intraoperatively and based on postoperative recovery data were compared between both groups.

RESULTS:

Overall, we recruited 80 patients, among whom 72 eligible patients were randomly assigned. After allocation, 64 patients, comprising 32 in each group, underwent the allocated intervention and follow-up. Compared with the nonindocyanine green group, the mean number of intrahepatic colorectal liver metastases identified intraoperatively in the indocyanine green group was significantly greater (mean [standard deviation], 3.03 [1.58] vs 2.28 [1.35]; p = 0.045), the postoperative hospital stay was shorter (p = 0.012) and the 1-year recurrence rate was also lower (p = 0.017). Postoperative complications and 90-day mortality were comparable, with no statistical differences.

CONCLUSIONS:

Indocyanine green fluorescence imaging significantly increases the number of intrahepatic colorectal liver metastases identified and reduces postoperative hospital stay and 1-year recurrence rate without increasing hepatectomy-related complications and mortality rates.
Intraoperative Cytologic Sampling for Resected Pancreatic and Periampullary Adenocarcinoma with Implications for Locoregional Recurrence-Free Survival
Authors: Papai Emily , Nevler Avinoam , Solomides Charalambos , Shergill Mandeep S , Yeo Theresa P , Cannaday Shawnna , Yeo Charles J , Winter Jordan M , Lavu Harish
Published: April 2022

BACKGROUND:

We hypothesized that pancreatic and periampullary adenocarcinoma recurrence after surgical resection may be affected by the shedding of malignant epithelial cells during surgical dissection and that this may have implications for disease recurrence and survival.

STUDY DESIGN:

In this ongoing, investigator-initiated prospective randomized controlled trial, patients with pancreatic and periampullary adenocarcinoma were randomized intraoperatively, postresection into 3 study arms: peritoneal lavage using 10 L normal saline or distilled water, or control group with no lavage. Peritoneal fluid was sampled for cytologic analysis (cytospin, cellblock, immunohistochemistry-Ber-EP4 antibody) at 4 stages: (1) abdominal entry pre-dissection, (2) resection bed after tumor extirpation, (3) ex vivo resected specimen, and (4) resection bed postlavage.

RESULTS:

Between April 2016 and May 2018, 193 patients who underwent randomization for the study also underwent the described cytologic sampling. Of these, 167 patients (86.5%) were ultimately found to have pancreatic or periampullary adenocarcinoma. Before dissection (1) on cytospin analysis, 4.9% were positive, which rose to 10.2% intraoperatively (2), 16.7% ex vivo (3), and decreased to 4.3% (4) after lavage. Lymph node metastasis, margin involvement, and perineural invasion did not correlate with locoregional recurrence (LR). Tumor cells in the ex vivo cytospin (3) correlated with LR (odds ratio 3.8 [95% CI 1.6 to 9.2], p = 0.005) and LR disease-free survival (p = 0.007). Cox regression analysis revealed ex vivo cytospin positivity to be strongly associated with poorer LR disease-free survival (hazard ratio 2.26 [95% CI 1.16 to 4.42], p = 0.017).

CONCLUSIONS:

Cytologic sampling from ex vivo specimen irrigation after surgical resection of pancreatic and periampullary adenocarcinoma may have implications for LR, survival, and treatment, suggesting a possible cancer cell shedding phenotype.
Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders
Authors: Bulger Eileen M , Johnson Peyton , Parker Lea , Moloney Kathleen E , Roberts Michelle K , Vaziri Natalie , Seo Sara , Nehra Deepika , Thomas Peter , Zatzick Douglas
Published: April 2022

BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms, firearm violence events, alcohol and drug use problems, and major depression and suicidal ideation are endemic among patients admitted to US trauma centers. Despite increasing policy importance, the current availability of screening and intervention services for this constellation of conditions in US trauma centers is unknown.

STUDY DESIGN

Trauma program staff at all Level I and Level II trauma centers in the US. (N = 627) were contacted to complete a survey describing screening and intervention procedures for alcohol and drug use problems, PTSD symptoms, depression and suicidality, and firearm violence. Additional questions asked trauma centers about the delivery of peer interventions and information technology capacity for screening and intervention procedures.

RESULTS:

Fifty-one percent of trauma centers (n = 322) responded to the survey. More than 95% of responding sites endorsed routinely screening and/or intervening for alcohol use problems. Routine services addressing PTSD were less common, with 28% of centers reporting routine screening. More than 50% of sites that screened for PTSD used previously established trauma center alcohol use services. Programmatic screening and intervention for firearm injury sequelae was occurring at 30% of sites.

CONCLUSION

Alcohol screening and intervention is occurring frequently at US trauma centers and appears to be responsive to American College of Surgeons Committee on Trauma verification requirements. Routine screening and intervention services for PTSD and firearm injury were occurring less frequently. Regular national surveys may be a key element of tracking progress in national mental health and substance use screening, intervention, and referral policy.
Re-Sighting the Gun Debate: Defining Patterns of Firearm-Related Death to Help Focus Prevention Efforts
Authors: Huang Dih-Dih , Manley Nathan R , Lewis Richard H , Fischer Peter E , Magnotti Arianna , Davis Samantha , Croce Martin A , Magnotti Louis J
Published: April 2022

BACKGROUND:

Gun violence remains a significant public health problem. Although gun violence prevention efforts mostly target homicides, nationally, two-thirds of all firearm deaths are suicides. The purpose of this study was to define patterns of firearm-related deaths and examine the effect of population size.

STUDY DESIGN:

All firearm-related deaths in the US between 1999 and 2016 were analyzed. Homicides and suicides were obtained from the Federal Bureau of Investigation and the Centers for Disease Control and Prevention, respectively, comprising the database. For each state, the largest metropolitan city by population and a corresponding small urban city were selected. Firearm-related deaths were stratified by type and city size and compared. Rates of firearm-related homicides and suicides per 1 million population were stratified by year and compared over time using simple linear regression.

RESULTS:

544,749 firearm-related deaths occurred across the US over the study period (38% homicides, 62% suicides). The median rate of firearm-related suicides was significantly greater than firearm-related homicides regardless of city size and across the US. Linear regression analysis failed to identify a significant change in the rate of firearm-related homicides over the study period. However, the rate of firearm-related suicides increased significantly regardless of city size between 1999 and 2016.

CONCLUSION:

Although homicides account for the majority of firearm-related deaths in metropolitan areas, suicides constitute a disproportionate number in smaller urban areas. Although the rate of homicides has stabilized, the rate of firearm-related suicides continues to increase significantly, underscoring the need for better direct prevention efforts and public health policy.
Bowel Dysfunction after Low Anterior Resection for Colorectal Cancer: A Frequent Late Effect of Surgery Infrequently Treated
Authors: McKenna Nicholas P , Bews Katherine A , Yost Kathleen J , Cima Robert R , Habermann Elizabeth B
Published: April 2022

BACKGROUND:

The development of major low anterior resection syndrome (LARS) after low anterior resection is severely detrimental to quality of life, yet awareness of it by clinicians and patients and the frequency of treatment of LARS is unclear.

STUDY DESIGN:

Patients who underwent low anterior resection for sigmoid or rectal cancer at a tertiary center between 2007 and 2017 (n = 798) were surveyed in 2019 to assess LARS symptoms and report medications or treatment received for LARS. LARS scores were calculated (score range 0–42) and normalized to published data on LARS prevalence in the general population in Europe, stratified by age (<50 or ≥50) and sex.

RESULTS:

Of the 594 patients (74%) who returned the survey, 255 (43%) were identified as having major LARS (LARS score ≥30). This prevalence was significantly higher than published normative data from Denmark and Amsterdam when stratified by age greater than or less than 50 and sex. Patients with major LARS infrequently reported current use of first-line therapies (antidiarrheal medications 32%, fiber supplements 16%, and both 13%). Only 3% reported receiving second-line therapy of transanal irrigations and/or pelvic floor rehabilitation, and only 1% had undergone third-line therapy of sacral nerve stimulator implantation.

CONCLUSION:

Major LARS is common yet seemingly underrecognized by clinicians because less than half of patients are on first-line therapy and practically none are on second- and third-line therapies. Long-term follow-up of patients after low anterior resection, improved preoperative and postoperative education, and continued symptom assessment is necessary to improve treatment of major LARS.
Treat Now or Treat Later: Comparative Effectiveness of Adjuvant Therapy in Resected Stage IIIA Melanoma
Authors: Ma Emily Z , Terhune Julia H , Zafari Zafar , Blackburn Kyle W , Olson John A , Mullins C Daniel , Hu Yinin
Published: April 2022

BACKGROUND:

Adjuvant therapy for most sentinel-node–positive (stage IIIA) melanoma may have limited clinical benefit for older patients given the competing risk of non-cancer death. The objective of this study is to model the clinical effect and cost of adjuvant therapy in stage IIIA melanoma across age groups.

STUDY DESIGN:

A Markov decision analysis model simulated the overall survival of patients with resected stage IIIA melanoma treated with adjuvant therapy vs observation. In the adjuvant approach, patients are modeled to receive adjuvant pembrolizumab (BRAF wild type) or dabrafenib/trametinib (BRAF mutant). In the observation approach, treatment is deferred until recurrence. Transition variables were derived from landmark randomized trials in adjuvant and salvage therapy. The model was analyzed for age groups spanning 40 to 89 years. The primary outcome was the number needed to treat (NNT) to prevent one melanoma-related death at 10 years. Cost per mortality avoided was estimated using Medicare reimbursement rates.

RESULTS:

Projections for NNT among BRAF wild type patients increased by age from 14.71 (age 40 to 44) to 142.86 (age 85 to 89), with patients in cohorts over the age of 75 having an NNT over 25. The cost per mortality avoided ranged from $2.75 million (M) (age 40 to 44) to $27.57M (age 85 to 89). Corresponding values for BRAF mutant patients were as follows: NNT 18.18 to 333.33; cost per mortality avoided ranged from $2.75M to $54.70M.

CONCLUSION:

Universal adjuvant therapy for stage IIIA melanoma is costly and provides limited clinical benefit in patients older than 75 years.
Effect of Co-mutation of RAS and TP53 on Postoperative ctDNA Detection and Early Recurrence after Hepatectomy for Colorectal Liver Metastases
Authors: Nishioka Yujiro , Chun Yun Shin , Overman Michael J , Cao Hop S Tran , Tzeng Ching-Wei D , Mason Meredith C , Kopetz Scott W , Bauer Todd W , Vauthey Jean-Nicolas , Newhook Timothy E ,   for the MD Anderson Cancer Center INTERCEPT Program
Published: April 2022

BACKGROUND:

Circulating tumor DNA (ctDNA) is a promising biomarker for patients undergoing hepatectomy for colorectal liver metastases (CLM). We hypothesized that post-hepatectomy ctDNA detection would identify patients at highest risk for early recurrence of CLM.

STUDY DESIGN:

Patients with CLM who underwent curative-intent hepatectomy with ctDNA analysis within 180 days postoperatively (1/2013 and 6/2020) were included. Tissue somatic mutations and ctDNA analyses were performed by next-generation sequencing panels. Survival analyses determined factors associated with clinical recurrence 1 year or earlier after hepatectomy. Patients with primary tumors in situ and without 1-year follow-up were excluded. Median follow-up was 28.3 months.

RESULTS:

Of 105 patients, 32 (30%) were ctDNA positive (ctDNA+) after curative-intent hepatectomy. Compared with ctDNA-negative patients, ctDNA+ patients had multiple CLM (84% vs 55%, p = 0.002) and co-mutated RAS/TP53 (47% vs 23%, p = 0.018). Multiple CLM (odds ration (OR), 5.43; p = 0.005) and co-mutated RAS/TP53 (OR, 3.30; p = 0.019) were independently associated with post-hepatectomy ctDNA. Although perioperative carcinoembryonic antigen levels were not prognostic, postoperative ctDNA+ (hazard ratio (HR), 2.04; p = 0.011) and extrahepatic disease (HR, 2.45, p = 0.004) were independently associated with worse recurrence-free survival. After adjusting for extrahepatic disease, preoperative chemotherapy, multiple CLM, tumor viability of 50% or greater, and co-mutated RAS/TP53, ctDNA+ within 180 days was the only independent risk factor for recurrence 1 year or earlier after hepatectomy (94% vs 49%; HR, 11.8; p = 0.003).

CONCLUSION:

Postoperative ctDNA detection is associated with early recurrence 1 year or earlier after curative-intent hepatectomy for CLM, and RAS/TP53 co-mutations result in a more than 3-fold increased risk for postoperative ctDNA positivity. This highlights the complementary effect of tumor tissue and circulating mutational profiling for patients with CLM.
Examination of Racial and Socioeconomic Disparity in Use of Nondirected Kidney Donation in the US
Authors: Herbst Leyla R , Zeiser Laura Bowles , Mitchell Jonathan , Nijhar Kieranjeet , Perincherry Vijay , López Julia I , Segev Dorry L , Massie Allan B , King Elizabeth , Cameron Andrew M
Published: April 2022

BACKGROUND:

Nondirected donor (NDD) kidney transplant (NDDKT) continues to improve organ access for waitlisted candidates. Although NDDs are becoming increasingly common, there has been no contemporary evaluation of NDD allograft use, and it is vital to understand sociodemographic, as well as center-level, use across the US.

STUDY DESIGN:

Using national data from the Scientific Registry for Transplant Recipients, this study characterized NDDs, NDDKT recipients, and center-level distribution of NDDKT. Directed donor and NDD characteristics were compared using Fisher’s exact and Wilcoxon rank-sum tests for categorical and continuous variables, respectively. Multivariable logistic regression was used to identify characteristics associated with receiving NDDKT, and center distribution of NDDKT was assessed using the Gini coefficient.

RESULTS:

NDDKT increased from 1.4% (n = 154) of all living donor kidney transplants in 2010 to 6.5% (n = 338) in 2020. Compared with directed living donors, NDDs were older (median [IQR], 44 [33 to 54] vs 43 [33 to 52], p < 0.01), more often male (40.2% vs 36.7%, p < 0.001), and White (91.4% vs 69.5%, p < 0.001). White adult candidates were more likely to receive NDDKT compared with Black (adjusted odds ratio [aOR], 0.300.340.39, p < 0.001), Hispanic/Latino (aOR, 0.360.420.48, p < 0.001), and Other (aOR, 0.410.470.55, p < 0.001) candidates. Black pediatric candidates had lower odds of receiving NDDKT (aOR, 0.090.220.54, p = 0.02). The proportion of centers performing NDDKT has increased from 2010 to 2020 (Gini = 0.77 vs 0.68).

CONCLUSIONS:

Although more centers are performing NDDKT, racial disparities persist among NDDs and NDDKT recipients. Continued effort is needed to recruit living kidney donors and improve access to living donation for minority groups in the US. (J Am Coll Surg 2022;234:000-00. © 2022 by the American College of Surgeons)
Outcomes of Breast-Conserving Surgery Plus Radiation vs Mastectomy for All Subtypes of Early-Stage Breast Cancer: Analysis of More Than 200,000 Women
Authors: Chu Quyen D , Hsieh Mei-Chin , Yi Yong , Lyons John M , Wu Xiao-Cheng
Published: April 2022

BACKGROUND:

Recent large retrospective studies suggest that breast-conserving therapy (BCT) plus radiation yielded better outcomes than mastectomy (MST) for women with early-stage breast cancer (ESBC). Whether this is applicable to the different subtypes is unknown. We hypothesize that BCT yielded better outcomes than MST, regardless of subtypes of ESBC.

STUDY DESIGN:

Data on women diagnosed with first primary stage I to II breast cancer between 2010 and 2017 who underwent either BCT or MST were from the population-based 18 Surveillance, Epidemiology, and End Results cancer registries. The Kaplan-Meier method was used to estimate unadjusted 5-year overall survival and cause-specific survival. Univariable and multivariable Cox proportional regression models were used to determine the impact of surgical approaches on the hazard ratios adjusted for relevant demographic and clinical variables for molecular subtype (luminal A, luminal B, triple-negative, and HER2 enriched).

RESULTS:

Of the 214,128 patients with breast cancer, 41.6% received MST. For the different subtypes, BCT yielded better 5-year overall survival and cause-specific survival than MST. After adjusting for demographic and clinical factors, the risk of overall survival and cause-specific survival was still statistically significantly higher among MST recipients than BCT recipients for all subtypes.

CONCLUSIONS:

BCT yielded better survival rates than mastectomy for women with all subtypes of ESBC. The role of mastectomy for women with ESBC should be reassessed in future clinical trials.
Are We Undertreating Black Patients with Nonfunctional Pancreatic Neuroendocrine Tumors? Critical Analysis of Current Surveillance Guidelines by Race
Authors: Zheng-Pywell Rui , Lopez-Aguiar Alexandra , Fields Ryan C , Vickers Selwyn , Yates Clayton , Dudeja Vikas , Chen Herbert , Reddy Sushanth , Maithel Shishir K , Rose J Bart
Published: April 2022

BACKGROUND:

Pancreatic neuroendocrine tumor (PNET) survival outcomes differ by race. Current recommendations for surveillance of PNETs less than 2 cm in size are based on low malignant potential and low rates of lymph node metastases (LNM). We investigated whether these guidelines are universally applicable regardless of race.

STUDY DESIGN:

A multi-institutional analysis of patients with resected, nonfunctional, sporadic PNETs was performed initially using the US Neuroendocrine Study Group dataset with the National Cancer Database as a validation dataset. Patients with distant metastatic disease were excluded from analysis.

RESULTS:

A total of 453 (388 White and 65 Black) and 5,532 patients (4,772 White and 760 Black) were analyzed in the initial and validation datasets, respectively. White patients had a low incidence of LNM in tumors of less than 2 cm in both datasets (5% and 12%, respectively), which increased with tumor size. However, the incidence of LNM in Black patients was similar in the initial and validation datasets for tumors sized less than 2 cm (23% and 21%) and 2 to 3 cm (21% and 29%). Black patients had a significantly higher incidence of LNM in tumors less than 2 cm in size in the initial and validation datasets (p < 0.01) compared with White patients.

CONCLUSIONS:

The current recommendation for surveillance of PNETs of less than 2 cm in size is likely based on a low rate of LNM seen in a predominantly White population. The incidence of LNM in Black patients with tumors less than 2 cm in size is clinically relevant and concerning. Current guidelines may not be universally applicable, and a more aggressive approach to resection in Black patients with small PNETs may be warranted.
State Gun Law Grades and Impact on Mass Shooting Event Incidence: An 8-Year Analysis
Authors: Duchesne Juan , Taghavi Sharven , Toraih Eman , Simpson John T , Tatum Danielle
Published: April 2022

BACKGROUND:

Gun violence, particularly in the form of mass shooting events (MSE), is a growing, significant public health crisis in the US. Whether stricter gun laws decrease MSE is not known. We hypothesized that stronger state gun laws would be associated with lower MSE incidence.

STUDY DESIGN:

Mass shooting events, defined as at least 4 people injured in a single event, and state gun law grade data for years 2014 through 2021 were obtained from the Gun Violence Archive and Giffords Law Center, respectively. An A grade indicated strictest gun control laws, and F indicated the weakest. US 2020 Census data were used to estimate MSE per million per state. The number of MSE per million was examined for association with gun law grades.

RESULTS:

From 2014 through 2020, there were a total of 2,736 recorded MSE, with at least a 2-fold increase in incidence from 272 in 2014 to 626 in 2020. Concomitantly, the number of F grade states decreased from 27 to 21 (22%). The MSE mean (SD) per F state increased from 4.0 (5.1) in 2014 to 9.7 (10.3) in 2020 (p = 0.03). No differences were found in unadjusted number of MSE per year by gun law grade for any study year examined (p = 0.67). After adjusting for population, this finding of no difference persisted.

CONCLUSIONS:

Strength of state gun law grades does not affect MSE incidence, even after correction for population size. This suggests that legislation by itself is not an effective prevention measure and other broader and meaningful primary gun violence interventions are needed.
Microbe Profile: Salinispora tropica: natural products and the evolution of a unique marine bacterium
Authors: Jensen Paul R.
Published: April 2022

Salinispora tropica

was originally cultured from tropical marine sediments and described as the first obligate marine actinomycete genus. Soon after its discovery, it yielded the potent proteasome inhibitor salinosporamide A, a structurally novel natural product that is currently in phase III clinical trials for the treatment of cancer. If approved, it will be the first natural product derived from a cultured marine microbe to achieve clinical relevance.

S. tropica

produces many other biologically active natural products, including some linked to chemical defence, thus providing ecological context for their production. However, genomic analyses reveal that most natural product biosynthetic gene clusters remain orphan, suggesting that more compounds await discovery. The abundance of biosynthetic gene clusters in

S. tropica

supports the concept that the small molecules they encode serve important ecological functions, while their evolutionary histories suggest a potential role in promoting diversification. Better insights into the ecological functions of microbial natural products will help inform future discovery efforts.
Using Geographically Weighted Linear Regression for County-Level Breast Cancer Modeling in the United States
Authors: Banerjee Srikanta , Jones Matt
Published: April 2022

Due to the continued disparities in breast cancer, improved models are being needed to inform policy related to existing social disparities related to cancer. First ordinal least squares regression was used to determine the relationship of sociodemographic measures (i.e. poverty rate and social inequity) on breast cancer incidence in the United States. Gini coefficient was used as a measure of income inequality. Next, Geographically Weighted Regression (GWR), a local spatial model, was used to explore the impact location has on the relationship between sociodemographic measures and breast cancer. Mappings of the results are presented, which can assist policymakers to address inequities and social determinants when funding cancer interventions. The GWR model is then compared to linear regression models that do not take into consideration location, highlighting the benefits of spatial models in cancer policy research. More studies applying spatial regression techniques are needed in order to accurately inform policy.
Managing bed capacity and timing of interventions: a COVID-19 model considering behavior and underreporting
Authors: Mendoza Victoria May P. , Mendoza Renier , Ko Youngsuk , Lee Jongmin , Jung Eunok
Published: April 2022

Introduction

At the start of the pandemic, the Philippine capital Metro Manila was placed under a strict lockdown termed Enhanced Community Quarantine (ECQ). When ECQ was eased to General Community Quarantine (GCQ) after three months, healthcare systems were soon faced with a surge of COVID-19 cases, putting most facilities at high or critical risk and prompting a return to a stricter policy.

Methods

We developed a mathematical model considering behavior changes and underreporting to represent the first major epidemic wave in Metro Manila. Key parameters were fitted to the cumulative cases in the capital from March to September 2020. A bi-objective optimization problem was formulated that allows easing of restrictions at an earlier time and minimizes the necessary additional beds to ensure sufficient capacity in healthcare facilities once ECQ was lifted.

Results

If behavior was changed one to four weeks earlier before GCQ, then the cumulative number of cases can be reduced by up to 55% and the peak delayed by up to four weeks. Increasing the reporting ratio during ECQ threefold may increase the reported cases by 23% but can reduce the total cases, including the unreported, by 61% on June 2020. If GCQ began on May 28, 2020, 48 beds should have been added per day to keep the capacity only at high-risk (75% occupancy). Among the optimal solutions, the peak of cases is lowest if ECQ was lifted on May 20, 2020 and with at least 56 additional beds per day.

Conclusion

Since infectious diseases are likely to reemerge, the formulated model can be used as a decision support tool to improve existing policies and plan effective strategies that can minimize the socioeconomic impact of strict lockdown measures and ensure adequate healthcare capacity.
Formative usability assessment of a new connector design for peritoneal dialysis
Authors: Yekinni Ibrahim , Viker Tom , Hartsig Bill , Erdman Arthur
Published: April 2022

Background

This paper presents a first, formative study to explore the usability of a new peritoneal dialysis connector design intended for use by patients. The study was conducted with a user population of both naive users and experienced peritoneal dialysis patients across a range of ages. The goals of the study were to evaluate the usability of the key user interfaces of this connector design by test participants representative of new and experienced peritoneal dialysis patients, as well as to evaluate the use of the connector as it interacts with other components of the peritoneal dialysis system including peritoneal dialysis fluid bags and tubing. Further objectives were to capture any usability issues and obtain participants’ feedback on the design.

Methods

A total of 7 patient and non-patient participants received brief training and performed simulated connection and disconnection of peritoneal catheter extension sets for therapy with the new design.

Results

All 7 participants completed the simulated connection and disconnection tasks successfully, with only one use error (0.22%), 18 close calls (4.0%), 6 use difficulties (1.3%) observed from the total of 449 use steps performed by all participants. Other findings include usability improvement with repeated use, participants feedback and suggestions for the ‘protective enclosure’, a novel feature of the touchless connector design.

Conclusion

The studied connector design showed minimal use errors or difficulties and based on participant feedback, the usability can be significantly improved with minimal modifications in future prototypes.
AI-Driven Longitudinal Characterization of Neonatal Health and Morbidity
Authors: De Francesco Davide , Reiss Jonathan D. , Roger Jacquelyn , Tang Alice S. , Chang Alan L. , Becker Martin , Phongpreecha Thanaphong , Espinosa Camilo , Morin Susanna , Berson Eloïse , Thuraiappah Melan , Le Brian L. , Ravindra Neal G. , Payrovnaziri Seyedeh Neelufar , Mataraso Samson , Kim Yeasul , Xue Lei , Rosenstein Melissa , Oskotsky Tomiko , Marić Ivana , Gaudilliere Brice , Carvalho Brendan , Bateman Brian T. , Angst Martin S. , Prince Lawrence S. , Blumenfeld Yair J. , Benitz William E , Fuerch Janene H. , Shaw Gary M. , Sylvester Karl G. , Stevenson David K. , Sirota Marina , Aghaeepour Nima
Published: April 2022

While prematurity is the single largest cause of death in children under 5 years of age, the current definition of prematurity, based on gestational age, lacks the precision needed for guiding care decisions. Here we propose a longitudinal risk assessment for adverse neonatal outcomes in newborns based on a multi-task deep learning model that uses electronic health records (EHRs) to predict a wide range of outcomes over a period starting shortly after the time of conception and ending months after birth. By linking the EHRs of the Lucile Packard Children’s Hospital and the Stanford Healthcare Adult Hospital, we developed a cohort of 22,104 mother-newborn dyads delivered between 2014 and 2018. This enabled a unique linkage between long-term maternal information and newborn outcomes. Maternal and newborn EHRs were extracted and used to train a multi-input multi-task deep learning model, featuring a long short-term memory neural network, to predict 24 different neonatal outcomes. An additional set of 10,250 mother-newborn dyads delivered at the same Stanford Hospitals from 2019 to September 2020 was used to independently validate the model, followed by a separate analysis of 12,256 mothers-newborn dyads at the University of California, San Francisco. Moreover, comprehensive association analysis identified multiple known and new associations between various maternal and neonatal features and specific neonatal outcomes. To date, this is the largest study utilizing linked EHRs from mother-newborn dyads and would serve as an important resource for the investigation and prediction of neonatal outcomes. An interactive website is available for independent investigators to leverage this unique dataset:https://maternal-child-health-associations.shinyapps.io/shiny_app/.
Patient Perceptions by Race of Educational Animations About Living Kidney Donation Made for a Diverse Population
Authors: Keller Maria M. , Lucas Todd , Cadzow Renee , Feeley Thomas , Berhalter Laurene Tumiel , Kayler Liise
Published: April 2022

Introduction

This qualitative study sought to identify potential design and delivery alterations to inform cultural adaptation of educational animations about living donor kidney transplantation (LDKT) – previously developed for a diverse population – to better fit Black Americans’ needs.

Methods

We conducted a secondary analysis of 88 transcripts derived from interviews and focus groups conducted with diverse target users (62 kidney failure patients, 36 prior/potential donors, and 11 care partners) to develop 12 animations about LDKT, namedKidneyTIME. Statements were abstracted and coded pertaining to cognitive and communication barriers to LDKT, and the perceived value of using the videos to learn and share the information with social network members using content analysis. Incidence counts of each content code were also calculated to assess differences between Black and non-Black patients.

Results

Cognitive barrier codes included lack of knowledge, ambivalence, and concern for donor. Communication barrier codes included reluctance and difficulty talking about LDKT. Cognitive facilitating codes included attention-getting, efficient learning, manageable content, emotional impact, and new knowledge. Communication facilitating codes included delivery through many dissemination channels and broadly shareable. Compared to non-black patients (n=33) Black patients (n=29) more often stated concern for donor and reluctance/difficulty talking about LDKT as barriers, and less often stated efficient learning and manageable content as facilitators.

Conclusion

Findings highlight the value of LDKT informational content that is visually appealing, digestible, non-threatening, and highly shareable. Heterogeneity may exist when considering access and intervention preferences in usingKidneyTIMEvideos and highlight a potential for further cultural targeting or tailoring.
WikiProject Clinical Trials for Wikidata
Authors: Rasberry Lane , Tibbs Sheri , Hoos William , Westermann Amy , Keefer Jeffrey , Baskauf Steven James , Anderson Clifford , Walker Philip , Kwok Cherrie , Mietchen Daniel
Published: April 2022

WikiProject Clinical Trials is a Wikidata community project to integrate clinical trials metadata with the Wikipedia ecosystem. Using Wikidata methods for data modeling, import, querying, curating, and profiling, the project brought ClinicalTrials.gov records into Wikidata and enriched them. The motivation for the project was gaining the benefits of hosting in Wikidata, which include distribution to new audiences and staging the content for the Wikimedia editor community to develop it further. Project pages present options for engaging with the content in the Wikidata environment. Example applications include generation of web-based profiles of clinical trials by medical condition, research intervention, research site, principal investigator, and funder.

The project’s curation workflows including entity disambiguation and language translation could be expanded when there is a need to make subsets of clinical trial information more accessible to a given community. This project’s methods could be adapted for other clinical trial registries, or as a model for using Wikidata to enrich other metadata collections.
Rheology of Growing Axons
Authors: Oliveri Hadrien , de Rooij Rijk , Kuhl Ellen , Goriely Alain
Published: April 2022

The growth of axons is a key process in neural system development, which relies upon a subtle balance between external mechanical forces and remodeling of cellular constituents. A key problem in the biophysics of axons is therefore to understand the overall response of the axon under stretch, which is often modeled phenomenologically using morphoelastic or viscoelastic models. Here, we develop a microscopic mixture model of growth and remodeling based on protein turnover and damage to obtain the macroscopic rheology of axonal shafts. First, we provide an estimate for the instantaneous elastic response of axons. Second, we demonstrate that under moderate traction velocities, axons behave like a viscoelastic Maxwell material. Third, for larger velocities, we show that failure takes place due to extensive damage.
A playback paradox? Nathusius’ bats, Pipistrellus nathusii, bypass mating and fueling opportunities on migratory transit flights
Authors: Marggraf Lara C. , Lindecke Oliver , Voigt Christian C. , Pētersons Gunārs , Voigt-Heucke Silke L.
Published: April 2022

In late summer, migratory bats of the temperate zone face the challenge of accomplishing two energy-demanding tasks almost at the same time: migration and mating. Both require information and involve search efforts, such as localizing prey or finding potential mates. In non-migrating bat species, playback studies showed that listening to vocalizations of other bats, both con-and heterospecifics, may help a recipient bat to find foraging patches and mating sites. However, we are still unaware of the degree to which migrating bats depend on con- or heterospecific vocalizations for identifying potential feeding or mating opportunities during nightly transit flights. Here, we investigated the vocal responses of Nathusius’ pipistrelle bats, Pipistrellus nathusii, to simulated feeding and courtship aggregations at a coastal migration corridor. We presented migrating bats either feeding buzzes or courtship calls of their own or a heterospecific migratory species, the common noctule, Nyctalus noctula. We expected that during migratory transit flights, simulated feeding opportunities would be particularly attractive to bats, as well as simulated mating opportunities which at the same time indicate suitable roosts for a stopover. However, we found that the echolocation call activity of P. nathusii decreased during the playback of conspecific feeding buzzes and courtship calls, yet the call activity remained unaffected when heterospecific call types were broadcast. Our results therefore suggest that while on migratory transits, P. nathusii circumnavigate conspecific feeding and mating aggregations, possibly to save time or to reduce the risks associated with social interactions. This avoidance behavior could be a result of optimization strategies by P. nathusii when performing long-distance migratory flights.
Real World Evidence of the Neutralizing Monoclonal Antibody Sotrovimab for Preventing Hospitalization and Mortality in COVID-19 Outpatients
Authors: Aggarwal Neil R. , Beaty Laurel E. , Bennett Tellen D. , Carlson Nichole E. , Davis Christopher B. , Kwan Bethany M. , Mayer David A. , Ong Toan C. , Russell Seth , Steele Jeffrey , Wogu Adane F. , Wynia Matthew K. , Zane Richard D. , Ginde Adit A.
Published: April 2022

Background

It is not known whether sotrovimab, a neutralizing monoclonal antibody (mAb) treatment authorized for early symptomatic COVID-19 patients, is effective against the SARS-CoV-2 Delta variant to prevent progression to severe disease and mortality.

Methods

Observational cohort study of non-hospitalized adult patients with SARS-CoV-2 infection from October 1st2021 - December 11th2021, using electronic health records from a statewide health system plus state-level vaccine and mortality data. We used propensity matching to select 3 patients not receiving mAbs for each patient who received outpatient sotrovimab treatment. The primary outcome was 28-day hospitalization; secondary outcomes included mortality and severity of hospitalization.

Results

Of 10,036 patients with SARS-CoV-2 infection, 522 receiving sotrovimab were matched to 1,563 not receiving mAbs. Compared to mAb-untreated patients, sotrovimab treatment was associated with a 63% decrease in the odds of all-cause hospitalization (raw rate 2.1% versus 5.7%; adjusted OR 0.37, 95% CI 0.19-0.66) and an 89% decrease in the odds of all-cause 28-day mortality (raw rate 0% versus 1.0%; adjusted OR 0.11, 95% CI 0.0-0.79), and may reduce respiratory disease severity among those hospitalized.

Conclusion

Real-world evidence demonstrated sotrovimab effectiveness in reducing hospitalization and all-cause 28-day mortality among COVID-19 outpatients during the Delta variant phase.
Firing behavior of single motor neurons of the tibialis anterior in human walking as non-invasively revealed by HDsEMG decomposition
Authors: Yokoyama Hikaru , Kaneko Naotsugu , Sasaki Atsushi , Saito Akira , Nakazawa Kimitaka
Published: April 2022

Investigation of the firing behavior of spinal motor neurons (MNs) provides essential neuromuscular control information because MNs form the “final common pathway” in motor control. The MNs activated during human infants’ leg movements and rodent locomotion, mainly controlled by the spinal central pattern generator (CPG), show highly synchronous firing. In addition to spinal CPGs, the cerebral cortex is involved in neuromuscular control during walking in human adults. Thus, MN firing behavior during adult walking is expected to be similar to that of infants and rodents and has some unique features. Recent technical advances allow non-invasive investigation of MN firing by high-density surface electromyogram (HDsEMG) decomposition. Therefore, we investigated the MN firing behavior of the tibialis anterior muscle during walking by HDsEMG decomposition. We found motor unit recruitment modulation compared with steady isometric contractions, doublet firings, and gait phase-specific firings during walking. We also found high MN synchronization during walking over a wide range of frequencies, probably including cortical and spinal CPG-related components. The amount of MN synchronization was modulated between the gait phases and motor tasks. These results suggest that the central nervous system, including the spinal CPG and cerebral cortex, flexibly controls MN firing to generate appropriate muscle force during human walking. In addition to revealing the neural control mechanisms of walking, our data demonstrate the feasibility of non-invasive investigation of MNs during walking, which will open new frontiers for the study of neuromuscular function in medical and exercise sciences.
Workplace ventilation improvement to address coronavirus disease 2019 cluster occurrence in a manufacturing factory
Authors: Kitamura Hiroko , Ishigaki Yo , Ohashi Hideaki , Yokogawa Shinji
Published: April 2022

Aim and Methods

A coronavirus disease 2019 (COVID-19) cluster emerged in a manufacturing factory in early August 2021. In November 2021, a ventilation survey using tracer gas and data analysis was performed to reproduce the situation at the time of cluster emergence and verify that ventilation in the office increased the risk of aerosol transmission; verify the effectiveness of measures implemented immediately in August; and verify the effectiveness of additional measures when previously enforced measures proved inadequate.

Results

At the time of cluster emergence, the average ventilation frequency was 0.73 times/h, less than the 2 times/h recommended by the Ministry of Health, Labour, and Welfare; as such, the factory’s situation was deemed to have increased the risk of aerosol transmission. Due to the measures already taken at the time of the survey, the ventilation frequency increased to 3.41 times/h on average. It was confirmed that ventilation frequency increased to 8.33 times/h on average, when additional measures were taken.

Conclusion

To prevent the re-emergence of COVID-19 clusters, it is necessary to continue the measures that have already been implemented. Additionally, introduction of real-time monitoring that visualizes CO2 concentrations is recommended. Furthermore, we believe it is helpful that external researchers in multiple fields and internal personnel in charge of health and safety department and occupational health work together to confirm the effectiveness of conducted measures, such as this case.
Equally low blood metal ion levels at 10-years follow up of total hip arthroplasties with Oxinium, CoCrMo and stainless steel femoral heads. Data from a randomized clinical trial
Authors: Høl Paul Johan , Hallan Geir , Furnes Ove , Fenstad Anne Marie , Indrekvam Kari , Kadar Thomas
Published: April 2022

Background and purpose

The use of inert head materials such as ceramic heads has been proposed as a method of reducing wear and corrosion products from the articulating surfaces in total hip arthroplasty (THA), as well as from the stem-head taper connection. In the present study, we wanted to evaluate the blood metal ion levels of Oxinium modular femoral heads at 10 years postoperatively and compare with the CoCrMo modular femoral head counterpart, and the monoblock stainless steel Charnley prosthesis.

Patients and methods

150 patients with osteoarthritis of the hip joint previously included in a randomized clinical trial that had the primary aim of examining polyethylene wear in cemented THAs were re-grouped according to femoral head material. One group (n=30) had received the Charnley monoblock stainless steel stem with 22.2 mm head (DePuy, UK). The other groups (n=120) received a Spectron EF CoCrMo stem with either a 28 mm CoCrMo or Oxinium modular head (Smith & Nephew, USA). After 10 years, 19 patients had died and 38 withdraw from the study. Five patients were revised due to infection in their hip and 7 were revised due to aseptic loosening of either the cup or stem or both. 81 patients with median age of 79 years (70-91) were available for whole blood metal ion analysis.

Results

The levels of Co, Cr, Ni and Zr in the blood were generally low with all head materials (medians <0.3 micrograms/L). We found no statistically significant difference in the concentration of metal ions between the group with Charnley prosthesis (n=17) and those with Spectron EF stems with either CoCrMo (n=32) or Oxinium heads (n=32) (p=0.18-0.81).

Interpretation

In this study of patients with non-revised THAs, no indication of severe trunnion corrosion was found. The blood ion levels with the use of ceramic Oxinium modular femoral heads were similar to CoCrMo or stainless steel heads at 10 years follow-up.
High-level motor planning allows flexible walking at different gait patterns in a neuromechanical model
Authors: Ramadan Rachid , Meischein Fabian , Reimann Hendrik
Published: April 2022

Humans are able to adopt almost any desired gait pattern on the fly when walking. We postulate that this flexibility in humans is partially due to the ability to control the whole body during walking as a volitional, goal-directed movement that can be planned and changed, rather than having to rely on habitual, reflexive control that is adapted over long time-scales. Here we present a neuromechanical model that accounts for this flexibility by combining movement goals and motor plans on a kinematic task level with low-level spinal feedback loops. We show that the model is able to walk at a wide range of different gait patterns by choosing a small number of high-level control parameters representing a movement goal. A larger number of parameters governing the low-level reflex loops in the spinal cord, on the other hand, remains fixed. We also show that the model is able to generalize the learned behavior by re-combining the high-level control parameters and walk with gait patterns it had not encountered before. Furthermore, the model can transition between different gaits without loss of balance by switching to a new set of control parameters in real time.
The influence of stereopsis on visual saliency in a proto-object based model of selective attention
Authors: Uejima Takeshi , Mancinelli Elena , Niebur Ernst , Etienne-Cummings Ralph
Published: April 2022

Some animals including humans use stereoscopic vision which reconstructs spatial information about the environment from the disparity between images captured by eyes in two separate adjacent locations. Like other sensory information, such stereoscopic information is expected to influence attentional selection. We develop a biologically plausible model of binocular vision to study its effect on bottom-up visual attention, i.e., visual saliency. In our model, the scene is organized in terms of proto-objects on which attention acts, rather than on unbound sets of elementary features. We show that taking into account the stereoscopic information improves the performance of the model in the prediction of human eye movements with statistically significant differences.