bluuebunny/crossref_metadata_2025 huggingface dataset:
The clinical and imaging features of cerebrotendinous xanthomatosis
Authors: Ma Chi , Ren Yan-De , Wang Jia-Chen , Wang Cheng-Jian , Zhao Ji-Ping , Zhou Tong , Su Hua-Wei
Published: March 2021

Rationale:

Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid deposition disorder characterized by systemic signs and neurological dysfunction. The radiological features of CTX are infrequently summarized in the literature.

Patient concerns:

We described a 40-year-old male patient who repeatedly engaged in wrestling matches and presented with progressive difficulty in walking and reduced balance with egg-sized, hard, smooth, and painless masses in both ankles.

Diagnosis:

Neuroimaging examination showed abnormalities both supra- and infratentorially. Bilateral ankle joint magnetic resonance imaging showed bilateral xanthomata of the Achilles tendon. The diagnosis was confirmed by the detection of a sterol 27-hydroxylase gene mutation.

Interventions:

The patient was treated with chenodeoxycholic acid (250 mg 3 times per day).

Outcomes:

To date, the patient's bilateral xanthomas of the Achilles tendon have begun to diminish, and his neurological impairment has not deteriorated further but has not yet improved.

Lessons:

We report a rare case of CTX and summarize the clinical and imaging features of this disease. Our findings suggest that the abnormal signals in the dentate nucleus or a long spinal cord lesion involving the central and posterior cord, combined with tendon xanthoma, are important clues for the diagnosis of CTX.
Bilateral optic neuropathy following vincristine chemotherapy
Authors: Lee Woo Hyuk , You Sun Kyoung , Lee Yeon-Hee
Published: March 2021

Rationale:

A few cases of optic neuropathy presumed to be caused by vincristine have been reported. However, none described multimodal imaging findings. Here, we report abnormal magnetic resonance imaging (MRI) and optical coherence tomography (OCT) findings in a putative case of vincristine-induced optic neuropathy.

Patient concerns:

A 9-year-old boy with Burkett lymphoma who had had no visual problems noticed blurred vision in both eyes 22 days after the first maintenance therapy for lymphoma; the blurred gradually worsened. At that time, the best-corrected visual acuity was 20/200 and 20/100 in the right and left eyes, respectively.

Diagnoses:

Blood and imaging workup, and cerebrospinal fluid and genetic analyses, were performed; these included fundus photography, OCT, and MRI. We found no plausible cause of the optic neuropathy other than vincristine.

Interventions:

The scheduled chemotherapy was stopped, and the patient was managed with high-dose corticosteroids. However, as there was no improvement, plasma exchange was then performed.

Outcomes:

Three days after the initial examination, the visual acuity in both eyes was only light perception and projection. Signal intensity was abnormally high on 3-dimensional T2-weighted turbo spin echo and T2-weighted MRI images. Optic disc atrophy progressed to “total pallor”; thinning of the ganglion cell-inner plexiform and retinal nerve fiber layers also progressed. The patient was followed up for 7 months but showed no improvement in vision. There were no treatment-related complications.

Lessons:

We conclude that vincristine can cause optic neuropathy, and clinicians need to be alert to the possibility of optic neuropathy in any patient prescribed this agent.

OCT and MRI may help to diagnose optic neuropathy in pediatric patients. Periodic ophthalmologic examinations, including an OCT scan, may be useful.
Multiple myeloma with Echinococcus granulosus infection diagnosed by detection of oligoclonal bands
Authors: Li Jinghong , Zhang Xiaoyun , Hao Hongjun , Fan Shiheng , Xu Yuming
Published: March 2021

Rationale:

Isoelectric focusing electrophoresis (IFE) is currently recognized as the gold standard for detecting oligoclonal bands (OCBs) in cerebrospinal fluid (CSF). To the best of our knowledge, however, no study has reported on type III OCBs using IFE. In this paper, we report on a rare case of multiple myeloma (MM) with Echinococcus granulosus infection diagnosed by IFE.

Patient concerns:

A 71-year-old man complained of weakness of the right lower extremity accompanied with fever (temperature range 37.8°C–38.2°C) for more than 6 months.

Diagnoses:

MM with E granulosus infection.

Interventions:

The IFE results identified a unique monoclonal band, indicating that the patient may have MM in conjunction with a distinct pathogen infection. He received anthelmintic treatment and bortezomib-thalidomide-dexamethasone therapy.

Outcomes:

The patient was followed up for 15 months. During that time, his temperature returned to normal, his Medical Research Council Grading of Muscle Power scale became 5, and his vital signs stabilized.

Lessons:

Detection of OCB type III indicated that the patient was diagnosed with MM accompanied by E granulosus infection. Thus, IFE of CSF may be an auxiliary diagnostic method for MM in the future.
Comparison of polyurethane tracheal tube cuffs and conventional polyvinyl chloride tube cuff for prevention of ventilator-associated pneumonia
Authors: Saito Minami , Maruyama Koichi , Mihara Takahiro , Hoshijima Hiroshi , Hirabayashi Go , Andoh Tomio
Published: March 2021

Background:

The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the effect of a polyurethane (PU) tracheal tube cuff on the prevention of ventilator-associated pneumonia (VAP).

Methods:

We performed a systematic search using the MEDLINE database through PubMed, Cochrane Central Register of Controlled Trial, SCOPUS, and Web of Science.

Randomized controlled trials comparing the incidence of VAP and clinically relevant outcomes between PU cuff tubes and polyvinyl chloride (PVC) cuff tubes in adult patients. Two authors independently extracted study details, patient characteristics, and clinical outcomes such as incidence of VAP, bacterial colonization of tracheal aspirate, duration of mechanical ventilation, ICU stay, and ICU mortality.

Results:

From 309 studies identified as potentially eligible, six studies with 1226 patients were included in this meta-analysis. All studies compared the incidence of VAP between PU cuffs and PVC cuffs. Use of a PU cuff was not associated with a reduction in VAP incidence (RR = 0.68; 95% CI, 0.45–1.03) with significant statistical heterogeneity (I
2 = 65%). The quality of evidence was “very low.” According to the TSA, the actual sample size was only 15.8% of the target sample size, and the cumulative Z score did not cross the trial sequential monitoring boundary for benefit. No positive impact was reported for the other relevant outcomes for PU cuffs.

Conclusions:

The use of a PU cuff for mechanical ventilation did not prevent VAP. Further trials with a low risk of bias need to be performed.
Does the presence of neuropathic pain affect the outcomes of the interlaminar epidural steroid injection for cervical disc herniation?
Authors: Sanal-Toprak Canan , Ozturk Ekim Can , Yucel Feyza Nur , Sencan Savas , Gunduz Osman Hakan
Published: March 2021

Epidural steroid injections (ESI) are commonly performed for the treatment of chronic cervical disc herniation (CDH). Although they are considered to be effective for both nociceptive and neuropathic types of pain, there is a lack of data regarding the impact of neuropathic pain (NP) and nociceptive pain components on treatment outcomes. The aim of this study is to compare the effectiveness of interlaminar epidural steroid injection (ILESI) between patients with predominantly NP and nociceptive pain due to CDH.

Sixty five participants were initially included in the study and assessed by numeric rating scale (NRS), neck pain and disability scale (NPDS), short form-12 (SF-12), and self-reported Leeds assessment of neuropathic symptoms and signs (S-LANSS) pain scale at baseline and 1 month, 3 months, 6 months after ILESI.

All patients were evaluated at 1st month and 3rd month follow-up periods while 54 of patients achieved to complete 6th month follow-up. There were significant improvements in all outcome measures for all time periods when compared with the pre-intervention scores. At baseline 24 (36.9%) of patients had predominantly NP in accordance with S-LANSS pain scale. The ratio of NP predominant patients reduced to 7.6% at 1st month, 12.3% at 3rd month, and 12.9% at 6th month with a significant difference for each follow-up period when compared with the baseline. Although all NRS and NPDS scores at baseline were significantly higher in patients with NP, improvement was significant at all follow-up periods in both groups. Minimal clinically important change in NRS was observed in >75% of patients at 1st, 3rd, and 6th month in both groups.

The results of this study showed that NP is present in one-third of the patients suffering from neck and radiating arm pain due to CDH and cervical ILESI is an effective treatment approach for both neuropathic and nociceptive components of pain.

Clinical Trials Registration Number: NCT04235478
The number of previous failed embryo transfer cycles is an independent factor affecting implantation rate in women undergoing IVF/ICSI treatment
Authors: Wang Yangyang , Tian Yichao , Liu Liu , Li Tin-Chiu , Tong Xiaomei , Zhu Haiyan , Zhang Songying
Published: March 2021

The implantation rate (IR) in assisted reproductive technologies such as in vitro fertilization (IVF) and intracytoplasmic sperm injection is affected by many different factors such as age, quality of embryo, and stage of embryo development. This study aimed to investigate to what extent the number of previous failed embryo transfer cycles is an independent factor affecting IR.

This was a single-center, retrospective cohort study of a consecutive series of 6376 day-3 embryo transfer (ET) cycles following IVF between January 2012 and August 2018. None of the subjects underwent endometrial scratch/injury prior to the treatment cycle, or received intravenous immunoglobulin, steroid, dehydroepiandrosterone, intralipid or heparin during the treatment with the aim of improving implantation rates.

Multiple regression analysis showed that the 3 most important independent factors affecting the IR, in decreasing of importance: age, frozen or fresh embryo transfer and the number of previous ET cycles. Having controlled for 2 of the more important confounding variables including maternal age and the type of embryo, the IR in women who had 0, 1, 2, and 3 or more previous failed ET cycles were 45.8%, 35.9%, 31.2%, 21.0%, respectively (P < .001).

Repeated implantation failure is a significant independent factor affecting the IR. The number of previous failed ET cycles should be considered in counselling women regarding the prognosis of a further IVF-ET treatment cycle.
Effects of mind-body exercise on cardiopulmonary function, blood pressure, and quality of life in CHD patients
Authors: Duan Fei-xing , Wu Qi , Zuo Yi-fan , Yang Hui-xin , Dai Fei , Wang Lin
Published: March 2021

Background:

Coronary heart disease (CHD) is one of the highest mortality diseases in the world, which seriously threatens human health and quality of life (QOL). The purpose of this study is to systematically analyze the effects of mind-body exercise on cardiopulmonary function, blood pressure and QOL in CHD patients, and to provide scientific evidence-based exercise prescription for patients with coronary heart disease.

Methods:

This research review will include the following electronic databases from its establishment to December 2020: PubMed, EMBASE, Web of Science, Cochrane Library, the Chinese National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, and Wanfang. Objective to search randomized controlled trials (RCTs) about the effects of mind-body exercise on cardiopulmonary function, blood pressure and QOL in patients with coronary heart disease.

Conclusion:

This systematic review and meta-analysis will provide strong evidence for the efficacy and safety of mind-body exercise in patients with coronary heart disease.

Systematic review registration:

INPLASY202120016.

Ethics and dissemination:

Ethical approval will not be necessary since this systematic review and meta-analysis will not contain any private information of participants or violate their human rights.
Ultrasonographic characteristics of thyroid nodule rupture after microwave ablation
Authors: Tian Peng , Du Wenyan , Liu Xiaoxi , Ding Yiwen , Zhang Zekai , Li Jing , Wang Yanzhen
Published: March 2021

Rationale:

Thyroid nodule rupture is a rare complication after microwave ablation (MWA). The ultrasonographic characteristics, clinical course, treatment, or prognosis of thyroid nodule rupture after ablation have not been systematically summarized. Three cases with thyroid nodule rupture after MWA were reported in this study, including the characteristic ultrasound images before ablation and after rupture. Meanwhile, we investigated the etiology, diagnosis, treatment and prevention of the rupture. These findings can provide references for the future clinical practice.

Patients concerns:

All 3 patients were pathologically diagnosed as benign thyroid nodules by core needle biopsy and then received 1 session of MWA.

Diagnoses:

Fourteen days to 1 month after MWA later, all 3 patients presented with abrupt neck pain and swelling, and 1 of them had a fever. Ultrasound examinations shared common features that the rupture of thyroid capsule and a soft-tissue mass with unclear margin in front of the thyroid gland, which connected with the post-ablation nodule. Three patients were diagnosed as thyroid nodule ruptures.

Interventions:

All 3 patients received conservative management after the ruptures. With the treatment of intravenous antibiotics for 1 week, the neck swelling of patients 1 and 2 both disappeared. The aggravation of neck swelling was found in patient 3. Ultrasonography of the neck revealed irregular fluid echo in the soft-tissue mass, suggesting abscess formation. Aspiration and irrigation were performed. The neck swelling regressed gradually over another 2 weeks with the treatment of antibiotics. Two months after ablation, ultrasound examination showed that the mass had completely disappeared.

Outcomes:

None of the 3 patients underwent open surgery due to thyroid nodule rupture. At 1-year follow-up, the volume reduction rate of thyroid nodules in 3 patients were as follows: 100%, 98.1% and 90.7%.

Lessons:

Nodule rupture is a rare but severe complication after MWA of the thyroid nodules. The diagnosis can be confirmed by clinical symptoms and ultrasound examination, and most nodule ruptures could be cured with conservative treatment. Grasping the characteristics of ultrasound imaging during the course of disease, and dynamically assessing course of disease progression by ultrasonography could avoid unnecessary imaging examinations or invasive procedures.
Working in Peru: A 25-Year Experience With Voluntary Cleft Missions, and a Technique for the Primary Repair of the Unilateral Cleft Lip and Nasal Deformity
Authors: Navarro Carlos E.
Published: March 2021

Background:

CIRPLAST is a nonprofit volunteer plastic surgery program that has provided free surgery for patients with cleft lip and palate deformities in different parts of Peru since 1995. In 2015, the author reported 6,108 patients that had been successfully operated on by the CIRPLAST team over a 20-year period. A technique, developed by the author, for the straight-line vertical cleft lip closure without skin flaps of the unilateral cleft lip, was mentioned in that publication but it was not described. 1 The purpose of this article is to present the technique, which has been successfully employed in all the CIRPLAST cleft missions in Peru, for the past 25 years.

Methods:

The straight-line vertical cleft closure does not rely on measurements or skin flaps, and it can be used to close any degree of unilateral cleft lip cleft. The procedure is simple and dependable. After incising the cleft borders on both sides of the cleft, the orbicularis oris muscle is liberated from the surrounding tissues, segmented, and then moved down toward the free border of the lip, so that the cupid's bows can be placed in its normal horizontal position, together with the philtrum on the medial lip, providing normal fullness and pouting of the lower part of the upper lip. Lip length results from the orbicularis oris muscle repair and not from skin flaps. The associated nasal deformity is addressed at the same time as the lip repair, by freeing on the cleft side, the lower lateral cartilage (alar cartilage) from the external nasal skin through a rim incision, and then elevating the cartilage together with its vestibular skin, to place it in its normal position at the tip of the nose, and fixing it there with sutures.

Results:

The anatomic, functional, and esthetic results of the lip closure together with the correction of the associated nasal deformity have been satisfactory, when comparing the repaired cleft side with the normal side, for symmetry.

Conclusions:

The straight-line vertical cleft lip closure, based on the orbicularis oris muscle repair, can be used to close any degree of lip clefting, including very wide clefts, without skin flaps. The associated cleft nasal deformity is corrected before the lip closure. The procedure has been used in all the CIRPLAST cleft missions in Peru for the past 25 years, and the outcomes of the repair over time have been satisfactory and stable.
Craniofacial Injuries in Lacrosse: A Novel Algorithm for Injury Assessment
Authors: Plotsker Ethan L. , Mathew Prakash , Wolfe Erin M. , Thaller Seth
Published: March 2021

Introduction:

Lacrosse is played widely across the United States, as evidenced by growing participation in the sport. The rapid increase in participation suggests that many of the new players are inexperienced. Many coaches might be ill-equipped to deal with player trauma. There are several crucial differences in the way the sports are played between males and females, altering the experience of the game and the injury profiles that may arise.

Methods:

A query of the National Electronic Injury Surveillance System database was performed to study the types of craniofacial injuries incurred from lacrosse.

Results:

Concussions were the most common injury type, and players between 10 and 14 years old were found to be at greater risk of contusions relative to older players. Players between 15 and 19 years old were at a greater risk of sustaining lacerations. In terms of gender, females were more likely to experience concussions than males, and were at increased risk of head injuries relative to face injuries.

Discussion:

The finding that females are at increased risk of concussion might be subsequent to a lack of adequate training by coaches. Female athletes tend to experience worse outcomes following concussions incurred secondary to playing sports. Recent work has suggested that this may be a consequence of female anatomy; women tend to have shorter neck dimensions, which predisposes them to more deleterious head-neck accelerations, and thus concussions. These results may inform a layperson-friendly algorithm for the workup of craniofacial injuries sustained from lacrosse.
Utilization Trends and Volume-outcomes Relationship of Endoscopic Resection for Early Stage Esophageal Cancer
Authors: Jawitz Nicole G. , Raman Vignesh , Jawitz Oliver K. , Shimpi Rahul A. , Wood Richard K. , Hartwig Matthew G. , D’Amico Thomas A.
Published: March 2021

Objectives:

We describe utilization trends and center volume-outcomes relationship of ER of early stage esophageal cancer using a large hospitalbased registry.

Summary of Background Data:

ER is increasingly accepted as the preferred treatment for early stage esophageal cancer, however its utilization and the center volume-outcomes relationship in the United States is unknown.

Methods:

The National Cancer Database was used to identify patients with cT1N0M0 esophageal cancer treated with ER or esophagectomy between 2004 and 2015. Relative frequencies were plotted over time. Restricted cubic splines and maximally selected rank statistics were used to identify an inflection point of center volume and survival.

Results:

A total of 1136 patients underwent ER and 2829 patients underwent esophagectomy during the study period. Overall utilization of ER, and relative use compared to esophagectomy, increased throughout the study period. Median annualized center ER volume was 1.9 cases per year (interquartile range 0.5–5.8). Multivariable Cox regression showed increasing annualized center volume by 1 case per year was associated with improved survival. Postoperative 30- or 90-day mortality, 30-day readmission, and pathologic T upstaging rates were similar irrespective of center volume.

Conclusions:

Utilization of ER compared to esophagectomy for stage I esophageal cancer has increased over the past decade, though many individual centers perform fewer than 1 case annually. increasing annualized center volume by one procedure per year was associated with improved survival. increased volume beyond this was not associated with survival benefit. Referral to higher volume centers for treatment of superficial esophageal cancer should be considered.
Patient-reported Comorbidity Assessment After Bariatric Surgery
Authors: Chao Grace F. , Bonham Aaron J. , Ross Rachel , Stricklen Amanda , Ghaferi Amir A.
Published: March 2021

Objective:

To determine the accuracy of postoperative patient-reported comorbidity assessment, as it may be an important mechanism for long-term follow-up in surgical patients.

Summary of Background Data:

Less than 1% of patients who qualify actually undergo bariatric surgery which may be due to concerns surrounding long-term efficacy. Longitudinal follow-up of patients’ comorbidities remains a challenge.

Methods:

Retrospective, cross-sectional study of bariatric surgery patients from 38 sites within a state-wide collaborative from 2017 to 2018. A minimum of 10 and maximum of 20 responses to a 1-year postoperative questionnaire from each site were randomly sampled. We examined percent agreement between patient-reported and medical chart audit comorbidity assessment and further evaluated agreement by intraclass correlation or κ statistic. Postoperative comorbidities assessed include weight, hyperlipidemia, hypertension, diabetes, depression, obstructive sleep apnea, gastroesophageal reflux disease (GERD), anxiety, and pain.

Results:

Five hundred eighty-five patients completed postoperative questionnaires after laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass. The response rate was 64% during the study period. Patients reported weight with a mean difference of 2.7 lbs from chart weight (intraclass correlation = 0.964). Agreement between patient report and audit for all comorbidities was above 80% except for GERD (71%). κ statistics were greater than 0.6 (good agreement) for hyperlipidemia, hypertension, diabetes, and depression. Anxiety (κ = 0.45) and obstructive sleep apnea (κ = 0.53) had moderate agreement. Concordance for GERD and pain were fair (both κ = 0.38).

Conclusions:

Patient-reported comorbidity assessment has high levels of agreement with medical chart audit for many comorbidities and can improve understanding of long-term outcomes. This will better inform patients and providers with hopes of 1 day moving beyond the 1%.
Bariatric Surgery and Risk of Death in Persons With Chronic Kidney Disease
Authors: Coleman Karen J. , Shu Yu-Hsiang , Fischer Heidi , Johnson Eric , Yoon Tae K. , Taylor Brianna , Imam Talha , DeRose Stephen , Haneuse Sebastien , Herrinton Lisa J. , Fisher David , Li Robert A. , Theis Mary Kay , Liu Liyan , Courcoulas Anita P. , Smith David H. , Arterburn David E. , Friedman Allon N.
Published: March 2021

Objective:

A retrospective cohort study investigated the association between having surgery and risk of mortality for up to 5 years and if this association was modified by incident ESRD during the follow-up period. Summary of Background Data: Mortality risk in individuals with pre-dialysis CKD is high and few effective treatment options are available. Whether bariatric surgery can improve survival in people with CKD is unclear.

Methods:

Patients with class II and III obesity and pre-dialysis CKD stages 3–5 who underwent bariatric surgery between January 1, 2006 and September 30, 2015 (n = 802) were matched to patients who did not have surgery (n = 4933). Mortality was obtained from state death records and ESRD was identified through state-based or healthcare system-based registries. Cox regression models were used to investigate the association between bariatric surgery and risk of mortality and if this was moderated by incident ESRD during the follow-up period.

Results:

Patients were primarily women (79%), non-Hispanic White (72%), under 65 years old (64%), who had a body mass index >40kg/m2 (59%), diabetes (67%), and hypertension (89%). After adjusting for incident ESRD, bariatric surgery was associated with a 79% lower 5-year risk of mortality compared to matched controls (hazard ratio = 0.21; 95% confidence interval: 0.14–0.32; P < 0.001). Incident ESRD did not moderate the observed association between surgery and mortality (hazard ratio = 1.59; 95% confidence interval: 0.31–8.23; P =0.58).

Conclusions:

Bariatric surgery is associated with a reduction in mortality in pre-dialysis patients regardless of developing ESRD. These findings are significant because patients with CKD are at relatively high risk for death with few efficacious interventions available to improve survival.
Sex Difference in the Tolerance of Hepatic Ischemia-reperfusion Injury and Hepatic Estrogen Receptor Expression According to Age and Macrosteatosis in Healthy Living Liver Donors
Authors: Han Sangbin , Cho Junhun , Wi Wongook , Won Lee Kyo , Hwa Cha Hyun , Lee Sanghoon , Hyun Ahn Joong , Kim Seonwoo , Sung Choi Gyu , Man Kim Jong , Ha Sang Yun , Soo Kim Gaab , Joh Jae-Won
Published: March 2021

Background.

Hepatic estrogen signaling, which is important in liver injury/recovery, is determined by the level of systemic estrogen and hepatic estrogen receptor. We aimed to evaluate whether females’ advantage in the tolerance of hepatic ischemia-reperfusion injury decreases according to the age of 40 y (systemic estrogen decrease) and macrosteatosis (hepatic estrogen receptor decrease).

Methods.

We included 358 living liver donors (128 female and 230 male individuals). The tolerance of hepatic ischemia-reperfusion injury was determined by the slope of the linear regression line modeling the relationship between the duration of intraoperative hepatic ischemia and the peak postoperative transaminase level. Estrogen receptor content was measured in the biopsied liver samples using immunohistochemistry.

Results.

In the whole cohort, the regression slope for aspartate transaminase was comparable between female and male individuals (P = 0.940). Within the subgroup of donors aged ≤40 y, the regression slope was significantly smaller in female individuals (P = 0.031), whereas it was comparable within donors aged >40 y (P = 0.867). Within the subgroup of nonmacrosteatotic donors aged ≤40 y, the regression slope was significantly smaller in female individuals in univariable (P = 0.002) and multivariable analysis (P = 0.006), whereas the sex difference was not found within macrosteatotic donors aged ≤40 y (P = 0.685). Estrogen receptor content was significantly greater in female individuals within nonmacrosteatotic donors aged ≤40 y (P = 0.021), whereas it was not different in others of age >40 y or with macrosteatosis (P = 0.450).

Conclusions.

The tolerance of hepatic ischemia-reperfusion injury was greater in female individuals than in male individuals only when they were <40 y and without macrosteatosis. The results were in agreement with the hepatic estrogen receptor immunohistochemistry study.
Range and Consistency of Infection Outcomes Reported in Trials Conducted in Kidney Transplant Recipients: A Systematic Review
Authors: Chan Samuel , Au Eric , Johnson David W. , Hawley Carmel M. , Tong Allison , Pascoe Elaine M. , Craig Jonathan C. , Sautenet Benedicte , Blumberg Emily A. , Brennan Daniel , Campbell Scott B. , Cao Christopher , Francis Ross S. , Huuskes Brooke , Isbel Nicole M. , Knoll Greg , Kotton Camille N. , Mamode Nizam , Muller Elmi , An Ha Phan Hai , Tedesco-Silva Helio , White David M. , Wolley Martin J. , Viecelli Andrea K.
Published: March 2021

Background.

Infection remains a leading cause of death in kidney transplant recipients. This study aimed to assess the scope and consistency of infection outcomes reported in contemporary trials conducted in kidney transplant recipients.

Methods.

A literature review of all randomized trials and trial protocols reporting infection outcomes in adult kidney transplant recipients was identified in the Cochrane Kidney and Transplant Specialized Register from January 2014 to July 2019. Characteristics and infection outcomes from the trials were analyzed.

Results.

From 102 included trials, 772 outcome measures were extracted and categorized into 216 unique measures with a median of 3.2 outcome measures per trial (range: 1–9). Measures were further grouped into 32 outcomes based on site of infection (14 outcomes) and organism (18 outcomes). The most commonly reported site-specific outcome and organism-specific outcome were systemic infection (71% trials) and cytomegalovirus infection (62% trials), respectively. Outcome metric and methods of aggregation included mean, median, proportion, proportional change, and number of patients with at least 1 episode. Across all trials, measures were assessed at 55 different time points with a range of 1–11 time points per trial.

Conclusions.

Infection outcomes in kidney transplant recipients were frequently reported by site and organism but varied widely in terms of outcome, metrics, method of aggregation, and time point of measurement. Establishment of core outcomes for infection based on the shared priorities of patients/caregivers and health professionals may improve the consistency, comparability, and usefulness of trial evidence
Verbal Adynamia and Conceptualization in Partial Rhombencephalosynapsis and Corpus Callosum Dysgenesis
Authors: Barker Megan S. , Knight Jacquelyn L. , Dean Ryan J. , Mandelstam Simone , Richards Linda J. , Robinson Gail A.
Published: March 2021

Verbal adynamia is characterized by markedly reduced spontaneous speech that is not attributable to a core language deficit such as impaired naming, reading, repetition, or comprehension. In some cases, verbal adynamia is severe enough to be considered dynamic aphasia. We report the case of a 40-year-old, left-handed, male native English speaker who presented with partial rhombencephalosynapsis, corpus callosum dysgenesis, and a language profile that is consistent with verbal adynamia, or subclinical dynamic aphasia, possibly underpinned by difficulties selecting and generating ideas for expression. This case is only the second investigation of dynamic aphasia in an individual with a congenital brain malformation. It is also the first detailed neuropsychological report of an adult with partial rhombencephalosynapsis and corpus callosum dysgenesis, and the only known case of superior intellectual abilities in this context.
Neuropsychological Assessment Should Always be Considered in Myotonic Dystrophy Type 2
Authors: Theodosiou Thomas , Christidi Foteini , Xirou Sofia , Bede Peter , Karavasilis Efstratios , Papadopoulos Constantinos , Kourtesis Panagiotis , Pantoleon Varvara , Kararizou Evangelia , Papadimas George , Zalonis Ioannis
Published: March 2021

Myotonic dystrophies (DMs) are hereditary, multisystem, slowly progressive myopathies. One of the systems they affect is the CNS. In contrast to the well-established cognitive profile of myotonic dystrophy type 1 (DM1), only a few studies have investigated cognitive dysfunction in individuals with myotonic dystrophy type 2 (DM2), and their findings have been inconsistent. To identify the most commonly affected cognitive domains in individuals with DM2, we performed a formal comprehensive review of published DM2 studies. Using the terms “myotonic dystrophy type 2” AND “cognitive deficits,” “cognitive,” “cognition,” “neuropsychological,” “neurocognitive,” and “neurobehavioral” in all fields, we conducted an advanced search on PubMed. We read and evaluated all of the available original research articles (13) and one case study, 14 in total, and included them in our review. Most of the research studies of DM2 reported primary cognitive deficits in executive functions (dysexecutive syndrome), memory (short-term nonverbal, verbal episodic memory), visuospatial/constructive-motor functions, and attention and processing speed; language was rarely reported to be affected. Based on the few neuroimaging and/or multimodal DM2 studies we could find, the cognitive profile of DM2 is associated with brain abnormalities in several secondary and high-order cortical and subcortical regions and associative white matter tracts. The limited sample size of individuals with DM2 was the most prominent limitation of these studies. The multifaceted profile of cognitive deficits found in individuals with DM2 highlights the need for routine neuropsychological assessment at both baseline and follow-up, which could unveil these individuals’ cognitive strengths and deficits.
A single dose of SARS-CoV-2 FINLAY-FR-1A dimeric-RBD recombinant vaccine enhances neutralization response in COVID-19 convalescents, with excellent safety profile. A preliminary report of an open-label phase 1 clinical trial
Authors: Chang-Monteagudo Arturo , Ochoa-Azze Rolando , Climent-Ruiz Yanet , Macías-Abraham Consuelo , Rodríguez-Noda Laura , Valenzuela-Silva Carmen , Sánchez-Ramírez Belinda , Perez-Nicado Rocmira , González-Mugica Raúl , Hernández-García Tays , Orosa-Vázquez Ivette , Díaz-Hernández Marianniz , de los A. García-García María , Jerez-Barceló Yanet , Triana-Marrero Yenisey , Ruiz-Villegas Laura , Rodríguez-Prieto Luis , Puga-Gómez Rinaldo , Guerra-Chaviano Pedro Pablo , Zúñiga-Rosales Yaíma , Marcheco-Teruel Beatriz , Rodríguez-Acosta Mireida , Noa-Romero Enrique , Enríquez-Puertas Juliet , Porto-González Delia , Leon-Monzon Kalet , Chen Guan-Wu , Martinez Luis Herrera , Valdés-Balbín Yury , García-Rivera Dagmar , Vérez-Bencomo Vicente ,   The Soberana 01B Clinical Trial team
Published: March 2021

We evaluated response to a single dose of the FINLAY-FR-1A recombinant dimeric-RBD base vaccine during a phase I clinical trial with 30 COVID-19 convalescents, to test its capacity for boosting natural immunity. This short report shows: a) an excellent safety profile one month after vaccination for all participants, similar to that previously found during vaccination of naïve individuals; b) a single dose of vaccine induces a >20 fold increase in antibody response one week after vaccination and remarkably 4-fold higher virus neutralization compared to the median obtained for Cuban convalescent serum panel. These preliminary results prompt initiation of a phase II trial in order to establish a general vaccination protocol for convalescents.
Application of 23 novel serological markers for identifying recent exposure to Plasmodium vivax parasites in an endemic population of western Thailand
Authors: Chotirat Sadudee , Nekkab Narimane , Kumpitak Chalermpon , Hietanen Jenni , White Michael T , Kiattibutr Kirakorn , Sa-angchai Patiwat , Brewster Jessica , Takashima Eizo , Tsuboi Takafumi , Harbers Matthias , Chitnis Chetan , Healer Julie , Tham Wai-Hong , Nguitragool Wang , Mueller Ivo , Sattabongkot Jetsumon , Longley Rhea J
Published: March 2021

Thailand is aiming for malaria elimination by the year 2030. However, the high proportion of asymptomatic infections and the presence of the hidden hypnozoite stage of Plasmodium vivax are impeding these efforts. We hypothesized that a validated surveillance tool utilizing serological markers of recent exposure to P. vivax infection could help to identify areas of ongoing transmission. The objective of this exploratory study was to assess the ability of P. vivax serological exposure markers to detect residual transmission ‘hot-spots’ in Western Thailand. Total IgG levels were measured against a panel of 23 candidate P. vivax serological exposure markers using a multiplexed bead-based assay. A total of 4255 plasma samples from a cross-sectional survey conducted in 2012 of endemic areas in the Kanchanaburi and Ratchaburi provinces were assayed. We compared IgG levels with multiple epidemiological factors that are associated with an increased risk of P. vivax infection in Thailand, including age, gender and spatial location, as well as Plasmodium infection status itself. IgG levels to all proteins were significantly higher in the presence of a P. vivax infection (n=144) (t test, p<0.0001). Overall seropositivity rates varied from 2.5% (PVX_097625, merozoite surface protein 8) to 16.8% (PVX_082670, merozoite surface protein 7), with 43% of individuals seropositive to at least 1 protein. Higher IgG levels were associated with older age (>18 years, p<0.05) and males (17/23 proteins, p<0.05), supporting the paradigm that men have a higher risk of infection than females in this setting. We used a Random Forests algorithm to predict which individuals had exposure to P. vivax parasites in the last 9-months, based on their IgG antibody levels to a panel of 8 previously validated P. vivax proteins. Spatial clustering was observed at the village and regional level, with a moderate correlation between PCR prevalence and sero-prevalence as predicted by the algorithm. Our data provides proof-of-concept for application of such surrogate markers as evidence of recent exposure in low transmission areas. These data can be used to better identify geographical areas with asymptomatic infection burdens that can be targeted in elimination campaigns.
Investigation of ventilation conditions associated with CO2 concentration changes in ultrasonographic exam room from the perspective of COVID-19 infection control
Authors: Matsubayashi Roka N , Harada Shino , Tominaga Mitsuhiro
Published: March 2021

Objectives

Ventilation is an important factor in preventing COVID-19 infection. To clarify the state of ventilation in ultrasonic exam rooms, as an index of ventilation rate, the carbon dioxide (CO2) concentration in our exam rooms was measured.

Methods

We measured the CO2 concentration in each exam room before the examination and 0–15 minutes after end of the exam.

The subjects were 70 cases (abdomen: 24, breast: 16, neck: 16, and musculoskeletal: 14). In infant cases, one parent accompanied the patient during the examination.

Results

The highest CO2 concentration was 2261 ppm, observed after the breast examination. In all cases, the CO2 concentration in the exam room was highest immediately after the examination or two minutes after. Almost all cases had recovered to within 120% of the pre-examination CO2 concentrations within 15 minutes after the examination. The average CO2 concentration after ultrasonography was significantly higher for breast examinations than others.

Conclusions

Even in a hospital with modern ventilation equipment, the CO2 concentration in the ultrasound room was high after the exam and it takes 15 minutes to recover to the pre-exam state. Care must be taken to ensure adequate ventilation in ultrasonographic facilities.
IFNL4 genetic variant can predispose to COVID-19
Authors: Saponi-Cortes Jose Maria R , Rivas Maria Dolores , Calle Fernando , Sanchez Muñoz-Torrero Juan F , Costo Alberto , Martin Carlos , Zamorano Jose
Published: March 2021

Interferon lambda 4 (IFNλ4) has shown antiviral activity against RNA viruses, including some coronaviruses. Besides, genetic variants of IFNL4 can be predictive of clearance of RNA viruses. However, little is known about the effect of these genetic variants on SARS-CoV-2 infection. In this study, we investigated whether there was a relationship of the rs12979860 polymorphism of IFNL4 with COVID-19. We found that the T allele of rs12979860 was overrepresented in the COVID-19 patients with regard to the general population without this disease (36.16% vs. 26.40%, p=6.4×10−4; OR=0.633; 95% CI=0.487,0.824), suggesting this allele could be a risk factor to COVID-19. Accordingly, the CC genotype was significantly lower in COVID-19 patients compared to controls (37.85% vs. 55.51%, p=8×10−5; OR=0.488; 95% CI=0.342,0.698). These results were not affected by sex, age, and disease severity in patients with COVID-19. Our findings suggest that, like other infectious diseases caused by RNA viruses, genetic variants of IFNL4 may predispose to COVID-19. Confirmation of our results could have a substantial impact on the prognosis and treatment of this disease.
Long-term Exposures to Air Pollutants Affect FeNO in Children: A Longitudinal Study
Authors: Zhang Yue , Eckel Sandrah P. , Berhane Kiros , Garcia Erika , Muchmore Patrick , Molshatzki Noa Ben-Ari , Rappaport Edward B. , Linn William S. , Habre Rima , Gilliland Frank D.
Published: March 2021

Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation shown to be responsive to short-term air pollution exposures; however, effects of long-term exposures are uncertain. Using longitudinal assessments of FeNO and air pollutant exposures, we aimed to determine whether FeNO is a marker for chronic effects of air pollution exposures after accounting for short-term exposures effects.

FeNO was assessed up to six times 2004-2012 in 3607 schoolchildren from 12 communities in the Southern California Children’s Health Study. Within-community long-term ambient air pollution exposures (PM2.5, PM10, NO2, O3) were represented by differences between community-specific annual averages and the eight-year average spanning the study period. Linear mixed-effect models estimated within-participant associations of annual average air pollution with current FeNO, controlling for previous FeNO, prior seven-day average pollution, potential confounders, and community-level random intercepts. We considered effect modification by sex, ethnicity, asthma, and allergy at baseline.

We found FeNO was positively associated with annual average air pollution, after accounting for short-term exposures. One standard deviation higher annual PM2.5 and NO2 exposures (PM2.5:2.0 μg/m3 ; NO2:2.7 ppb) were associated, respectively, with 4.6% (95%CI:2.3%-6.8%) and 6.5% (95%CI:4.1%-8.9%) higher FeNO. These associations were larger among females. We found little evidence supporting association with PM10 or O3.

Annual average PM2.5 and NO2 levels were associated with FeNO in schoolchildren, adding new evidence that long-term exposure affects FeNO beyond the well-documented short-term effects. Longitudinal FeNO measurements may be useful as an early marker of chronic respiratory effects of long-term PM2.5 and NO2 exposures in children.

Key messages

We show strong evidence that long-term exposures to air pollutants affect FeNO, independent of the well-documented associations with short-term exposures to air pollution

Longitudinal FeNO measurements may be useful as an early marker of chronic respiratory effects of long-term air pollution exposures in children.

Capsule summary

Annual average PM2.5 and NO2 were associated with FeNO in schoolchildren, adding new evidence that long-term exposure affects FeNO beyond the well-documented short-term effects.
Dynamic neurogenomic responses to social interactions and dominance outcomes in female paper wasps
Authors: Uy Floria M.K. , Jernigan Christopher M. , Zaba Natalie C. , Mehrotra Eshan , Miller Sara E. , Sheehan Michael J.
Published: March 2021

Social interactions have large effects on individual physiology and fitness. In the immediate sense, social stimuli are often highly salient and engaging. Over longer time scales, competitive interactions often lead to distinct social ranks and differences in physiology and behavior. Understanding how initial responses lead to longer-term effects of social interactions requires examining the changes in responses over time. Here we examined the effects of social interactions on transcriptomic signatures at two points, at the end of a 45-minute interaction and 4 hours later, in femalePolistes fuscatuspaper wasp foundresses. FemaleP. fuscatushave variable facial patterns that are used for visual individual recognition, so we separately examined the transcriptional dynamics in the optic lobe and the central brain. Results demonstrate much stronger transcriptional responses to social interactions in the central brain compared to the optic lobe. Differentially regulated genes in response to social interactions are enriched for memory-related transcripts. Comparisons between winners and losers of the encounters revealed similar overall transcriptional profiles at the end of an interaction, which significantly diverged over the course of 4 hours, with losers showing changes in expression levels of genes associated with aggression and reproduction in paper wasps. On nests, subordinate foundresses are less aggressive, do more foraging and lay fewer eggs compared to dominant foundresses and we find losers shift expression of many genes, including vitellogenin, related to aggression, worker behavior, and reproduction within hours of losing an encounter. These results highlight the early neurogenomic changes that likely contribute to behavioral and physiological effects of social status changes in a social insect.
Hypothalamic Overexpression of Neurosecretory Protein GL Leads to Obesity in Mice
Authors: Narimatsu Yuki , Fukumura Keisuke , Shikano Kenshiro , Iwakoshi-Ukena Eiko , Furumitsu Megumi , Bentley George E. , Kriegsfeld Lance J. , Ukena Kazuyoshi
Published: March 2021

Introduction

The mechanisms underlying obesity are not fully understood, necessitating the creation of novel animal models for investigation of metabolic disorders from the cellular-molecular to behavioral levels of analysis. We have previously found that neurosecretory protein GL (NPGL), a newly-identified hypothalamic neuropeptide, is involved in feeding behavior and fat accumulation in rats. Given the broad availability of genetic tools in mice, the present investigation sought to establish a mouse model of NPGL-induced obesity.

Methods

We overexpressed the NPGL-precursor gene (Npgl) in the hypothalamus using adeno-associated virus in C57BL/6J mice fed normal chow (NC) or a high-calorie diet (HCD). After 9 weeks ofNpgloverexpression, we measured adipose tissues, muscle, and several organ masses in addition to food intake and body mass. To assess the effects ofNpgloverexpression on peripheral tissues, we analyzed mRNA expression of lipid metabolism-related genes by quantitative RT-PCR.

Results

Npgloverexpression increased food intake, body mass, adipose tissues and liver masses, food efficiency, and circulating insulin levels under both NC and HCD, resulting in obesity observable within 8 weeks. Furthermore, we observed fat accumulation in adipose tissues and liver. Additionally, mRNA expression of lipid metabolism-related factors was increased in white adipose tissue and the liver afterNpgloverexpression.

Conclusion

Taken together, the present study suggests that NPGL is an endogenous obesogenic factor that acts within a short period of time in mice. As a result, this animal model can be widely applied to study the etiology of obesity from genes to behavior.