bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound of Optic Nerve Sheath Diameter and Stroke Outcomes
Authors: Patel Rohit , Chowdhury Muhammad A. B. , Gul Sarah , Fahy Brenda G. , Gonzalez Andres , Fitzpatrick Desmond , DePortu Giuliano , Weeks Emily , Elie-Turenne Marie-Carmelle , Ocampo Samirah , Ponnaluri Sameer , Pizzi Michael A.
Published: November 2021

OBJECTIVES:

We aimed at utilizing ocular ultrasound to determine its utility in predicting outcomes among stroke patients.

DESIGN:

Single-center prospective observational study.

SETTING:

Emergency department and ICUs.

PATIENTS:

Patients suspected of stroke.

INTERVENTIONS:

None.

MEASURES AND MAIN RESULTS:

Bilateral optic nerve sheath diameter was measured on arrival and within the first 2 days of admission. Outcomes were inpatient survival, Cerebral Performance Category, and modified Rankin Scale at 3 and 6 months. Analysis was conducted using descriptive statistics, paired t test, chi-square test. Eighty-six patients were enrolled with ischemic or hemorrhagic stroke. Mean age was 67.2 years (± 15 yr), and 54.7% of patients were male. There was no difference between left and right eye measurements (p = 0.467 and p = 0.903, respectively) or between longitudinal and transverse measurements (transverse p = 0.163 and longitudinal p = 0.270). Mean optic nerve sheath diameter differed in patients who survived versus died prior to discharge in both ischemic (0.53 vs 0.58 cm; p = 0.009) or hemorrhagic stroke (0.57 vs 0.62 cm; p = 0.019). For every 0.1 cm increase in optic nerve sheath diameter, odds ratio for death were 4.2 among ischemic stroke (95% CI, 1.32–13.64; p = 0.015), and odds ratio 6.2 among ischemic or hemorrhagic patients (95% CI, 1.160–33.382; p = 0.033). Increased optic nerve sheath diameter correlated (r = 0.44; p < 0.0001) with poor functional outcomes measured as modified Rankin Scale scores of 3–6 at 6 months.

CONCLUSIONS:

Elevations in optic nerve sheath diameter were associated with increased inhospital mortality and poor functional outcome at 6 months. Optic nerve sheath diameter may serve as a noninvasive marker of inhospital mortality and functional outcome. Further multicenter prospective trials for evaluating and treating optic nerve sheath diameter in ischemic and hemorrhagic strokes are warranted.
Peri-prosthetic Fat Grafting Decreases Collagen Content, Density, and Fiber Alignment of Implant Capsules
Authors: Komorowska-Timek Ewa , Jaźwiec Anna , Adams Nicholas S. , Fahrenkopf Matthew P. , Davis Alan T.
Published: November 2021

Background:

Lower capsular contracture rates have been observed with peri-prosthetic fat grafting. We investigated the effect of fat grafting on capsular characteristics and peri-prosthetic collagen density, content, and fiber alignment.

Methods:

Forty miniature tissue expanders were placed on the backs of 20 rats. After four weeks, both inguinal fat pads were harvested, homogenized, and injected into peri-prosthetic tissue of the right tissue expander (fat graft) while the left served as control. The animals were killed at three (10 rats) and 12 weeks (10 rats), and full thickness peri-prosthetic samples were histologically processed for morphology (H&E) and collagen type and content (picrosirius red).

Results:

An 8.1% increase in adipose peri-prosthetic thickness was associated with a 10% decrease in collagen content at any time point (P = 0.004). Fat-grafted capsules displayed a 59% reduction in % total collagen when compared with controls (P < 0.001). There were no differences in capsular thickness. Fat-grafted samples were 54 times more likely to have a higher inflammation score and 69 times more likely to have a lower capsular density score than their nongrafted counterparts (P < 0.001 and P = 0.001, respectively). The extent of inflammation decreased over time in all samples (P = 0.002). Additionally, fat-grafted samples were 67 times more likely to have a lower fiber alignment score than the controls (P < 0.001).

Conclusions:

Enhancement of peri-prosthetic tissue with fat grafting decreases collagen content, density, and fiber alignment of implant capsules. These findings support clinical application of fat grafting in prosthetic breast surgery to potentially decrease capsular contracture.
A New Extraperitoneal Method for Entero-atmospheric Fistula Closure Using a Free Muscle Flap
Authors: de Weerd Louis , Bakkehaug Bård , Gosciewska Malgorzata , Norderval Stig
Published: November 2021

Treatment of an entero-atmospheric fistula (EAF) is challenging and associated with significant morbidity and mortality. For an EAF with protrusion of mucosa, chances for spontaneous closure are minimal. Standard surgical procedures may be associated with a high risk for complications in patients with a hostile abdomen. This article describes a new method for extraperitoneal closure of an EAF in a patient with a hostile abdomen. A free segmental latissimus dorsi musculocutaneous flap was harvested on its thoracodorsal pedicle, leaving the remaining muscle innervated. The flap was anastomosed to the internal mammary vessels. The muscle was sutured into the fistula opening using a parachute technique and temporarily immobilized with a negative wound pressure device. The skin of the flap was used for monitoring and later replaced by a skin graft. The postoperative course was uneventful. At 24 months follow-up, there were no signs of recurrences. The patient had no pain and had no defecation problems. Extraperitoneal closure of an EAF with a segmental free latissimus dorsi muscle flap sutured into the fistula opening with a parachute technique may be a new promising technique in patients where standard surgical procedures are associated with too high a risk for complications and where a local pedicled muscle flap is not available. The advantages of this method are that no laparotomy is required, the intestinal lumen is not reduced in diameter, and that no bowel resection is performed, which is a particular advantage in cases with a short bowel syndrome.
Effectiveness of Skin Graft in the Chest for Postburn Cervical Contractures
Authors: Maitani Kosuke , Tomita Koichi , Taminato Mifue , Kubo Tateki
Published: November 2021

Skin grafts (SGs) offer a simple and reliable means of correcting postburn cervical contractures. However, their use has a high risk of contracture recurrence, as proper postoperative care is often difficult to perform. Splinting and pressure therapy are challenging in the neck, which has complex multidirectional mobility and contains critical structures. In contrast, the upper chest area, which also contributes to neck extension, has a relatively plane surface and rigid subcutaneous tissue, and is likely to be a more reliable site for pressure application. Here we report a case with good restoration of neck extension after using a split-thickness SG (STSG) only in the upper chest. A 22-year-old man with third-degree burns survived with the use of multiple SGs. Nine years later, he lacked a healthy donor site for a full-thickness SG or flap surgery. Although a split-thickness SG on the neck was performed for restricted cervical extension, severe contracture of the skin graft developed due to failure to continue postoperative pressure therapy. As a last resort, further surgery with a split-thickness SG was performed in the upper chest after releasing the contracture. With continued, successful postoperative pressure therapy, contracture of the skin graft was minimized. According to our survey of healthy volunteers, chest skin mobilization contributes to about 30% of cervical extension. This suggests that SG use in the chest is a reasonable option to reliability and effectively address restricted neck motility due to postburn contracture when a healthy donor site for a full-thickness SG or flap surgery is unavailable.
Topical Nerve Growth Factor for the Treatment of Neurotrophic Keratopathy Caused by Wallenberg Syndrome
Authors: Mandarà Erika , Brocca Daniele , Pellegrini Francesco , Interlandi Emanuela
Published: November 2021

Purpose:

The aim of this study was to report a case of central neurotrophic keratopathy (NK) in Wallenberg syndrome (WS) and its successful management with topical recombinant nerve growth factor (rNGF).

Methods:

A 47-year-old man with WS caused by a stroke in the territory of the left vertebrobasilar artery complained of progressive visual loss in his left eye (OS). Examination showed corneal anesthesia associated with a corneal epithelial ulceration consistent with a diagnosis of NK grade 3 of central origin. Topical treatment with rNGF, 1 drop 6 times daily, was started for 8 weeks, and the patient was followed up for 1 year.

Results:

Topical treatment with rNGF was successful in promoting complete epithelial corneal healing. No recurrence was seen at 1-year follow-up.

Conclusions:

Clinicians should be aware that visual loss can also occur from NK of central origin. To the best of our knowledge, this is the first case report of NK caused by WS successfully treated with rNGF reported in the literature.
Incremental Health Care Expenditures Associated With Glaucoma in the United States: A Propensity Score–matched Analysis
Authors: Rasendran Chandruganesh , Li Ang , Singh Rishi P.
Published: November 2021

Précis:

Adjusting for sociodemographics and comorbidities, patients with glaucoma incur an annual incremental economic burden of $1863.17, translating to $9.2 billion nationally. When analyzed by the health care service sector, prescription medication expenditures were higher for glaucoma patients.

Purpose:

The purpose of this study was to estimate the incremental health care burden, defined as attributable costs solely due to a diagnosis, of patients with diagnosed glaucoma, controlling for comorbidities, and sociodemographics.

Design:

A retrospective cross-sectional analysis of Medical Expenditure Panel Survey (MEPS) participants (age above 18 y) between 2016 and 2018.

Methods:

A cross-validated 2-part generalized linear regression model estimated the incremental glaucoma expenditures in aggregate and by sociodemographic subgroups and health care service sector [inpatient, outpatient (including surgical procedures), emergency room, home health, and medications] after 1:3 propensity matching.

Results:

After 1:3 propensity matching for sociodemographics and the Charlson Comorbidity Index, this study analyzed 1521 glaucoma patients (mean expenditures: $13,585.68±1367.03) and 4563 patients without glaucoma (mean expenditures: $12,048.92±782.49). A higher proportion of glaucoma patients are female, elderly, publicly insured (Medicare/Medicaid), college educated, identify ethnically as non-Hispanic, reside in the Northeast, and have more comorbidities (P<0.001). There were no differences in health care burden based on sex, income, insurance status, education, and year of care received for patients with glaucoma. Controlling for comorbidities and socioeconomic factors, propensity-matched glaucoma patients incur an annual incremental health care burden of $1863.17 (95% confidence interval, 393.44-3117.23, P=0.013), translating into an additional $9.2 billion in population-level US health care expenditures. By health care service sector, the expenditure ratio for health care expenditures was higher for prescription medications (expenditure ratio=1.20, 95% confidence interval, 1.02-1.42, P=0.031).

Conclusions:

Glaucoma patients have a substantial incremental economic health care burden after accounting for demographics and comorbidities, largely secondary to prescription medications. There is a need to continue identifying and studying treatment options for patients with glaucoma to maintain vision while minimizing health care expenditures.
The Inferior, Superior, Temporal Rim Width Pattern (IST Rule) Detects Glaucoma in a Japanese Population
Authors: Iwase Aiko , Sawaguchi Shoichi , Tanaka Kenji , Tsutsumi Tae , Araie Makoto
Published: November 2021

Précis:

The inferior>superior>temporal rim width rate (IST pattern) rather than inferior≥superior≥nasal≥temporal (ISNT) pattern was suited for screening glaucoma in Japanese subjects. Failure of the IST pattern was associated with several important risk factors for glaucoma.

Purpose:

The purpose of this study was to find a rim width rate pattern to yield the highest positive likelihood ratio (LR+) in detecting glaucoma eyes and to identify risk factors for glaucoma correlating with its failure in a population-based setting.

Methods:

Disc stereophotographs of 2474 eyes of 2474 normal subjects and 237 eyes of 237 glaucoma subjects found in the Kumejima Study were analyzed using computer-assisted planimetry. Among all combinations of the inferior (I), superior (S), nasal (N) and/or temporal (T) rim width rate, a pattern showing the highest LR+ was selected and risk factors for glaucoma correlating with its failure were determined using multiple logistic regression analysis.

Results:

The average I, S, N, and T rim widths (SD) were 0.45 (0.10), 0.39 (0.09), 0.47 (0.11), and 0.27 (0.07) mm. Among all combinations, the I>S>T rim width rate pattern (IST pattern) disregarding the N rim width showed the highest LR+ of 2.002 (95% confidence interval, 1.778–2.253). Failure of the IST pattern in normal eyes correlated with a smaller disc area (P<0.001) and disc ovality (P=0.005) and larger β-peripapillary area (P<0.001) and compliance with in glaucoma eyes with a smaller β-PPA area (P=0.027), thicker central corneal thickness (P=0.017), lower intraocular pressure (P=0.019), and higher body mass index (P=0.037).

Conclusion:

Among all combinations, the I>S>T rim width pattern, the IST pattern, yielded the highest LR+ in detecting glaucoma in Japanese glaucoma eyes and its failure of or compliance with the pattern significantly correlated with several known risk factors for glaucoma.
Appositional Choroidal Detachment Following XEN45 Gel Stent Requiring Surgical Drainage
Authors: Shah Yash S. , Oydanich Marko , Desai Rajen U. , Chinskey Nicholas , Khouri Albert S.
Published: November 2021

An 82-year-old man with severe primary open-angle glaucoma on maximal medical therapy underwent an ab externo closed conjunctival Xen45 device insertion with mitomycin C. The surgery was uncomplicated, with a first postoperative day intraocular pressure of 4 mm Hg and visual acuity of 20/40 OD. Ten days later, the patient presented with an intraocular pressure of 5 mm Hg and a visual acuity of counting fingers at 5 feet. Examination showed Seidel negative bleb, shallow anterior chamber, and large nonappositional choroidal detachments. Medical therapy with steroids and cycloplegia was initiated. One week later, the serous choroidal detachments became appositional, and Xen explantation and surgical drainage of the choroidal detachment was performed. Postoperatively, the vision improved to 20/60. Significant choroidal detachments can occur after XEN45 implantation requiring surgical intervention.
Impact of COVID-19 on Outpatient Antimicrobial Prescribing Patterns in New York City
Authors: Douglas Monica , Moy Stanley , Hernandez Nubriel
Published: November 2021

Background

Antibiotic and antiviral agents may be prescribed in patients with suspected or confirmed coronavirus disease 2019 (COVID-19) infections because of in vitro evidence of cessation of viral replication, potential bacterial secondary or coinfection, and inability to distinguish COVID-19 infections from common bacterial infections. The objective of this study was to evaluate antimicrobial prescribing patterns in the outpatient setting during the initial peak of COVID-19 in New York City.

Methods

This single-center, retrospective chart review included patients at least 18 years old who were prescribed oral antimicrobial agents in outpatient primary care clinics between March and May 2020. Data were compared with prescribing patterns from March to May 2019. The primary outcome was the number of antimicrobial prescriptions per 1000 patient visits. Secondary outcomes included documented indication, incidence of confirmed infections, mortality, and/or hospital admission within 90 days. Descriptive statistics were used.

Results

The overall antimicrobial prescribing rate increased from 31.94 prescriptions per 1000 visits in 2019 to 57.48 prescriptions per 1000 visits in 2020. Agents that were more commonly prescribed during the initial peak of COVID-19 include cefpodoxime, hydroxychloroquine, doxycycline, and sulfamethoxazole-trimethoprim. COVID-19 represented 7 (6%) documented antimicrobial indications in 2020, with agents such as azithromycin, hydroxychloroquine, doxycycline, cefpodoxime, and oseltamivir prescribed.

Conclusions

Overall antimicrobial prescribing rates in outpatient primary care clinics increased during the first peak of COVID-19 in an area with high infection burden. This increase may have been influenced by restricted patient evaluation, changes in patient management, and a decrease in overall patient visits.
Network meta-analysis and trial sequential analysis for atrial fibrillation patients receiving PCI or with ACS
Authors: Yang Shu-Mei , Huang Chi-Jung , Chen Chen-Huan , Yu Wen-Chung , Sung Shih-Hsien , Guo Chao-Yu , Chuang Shao-Yuan , Cheng Hao-Min , Chiang Chern-En
Published: November 2021

Background:

In patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI), choosing the most appropriate antithrombotic treatment remains a dilemma. We aimed to compare the relative efficacy and safety outcomes of antithrombotic drugs in patients with AF after undergoing PCI or ACS.

Methods:

Randomized controlled trials were systematically searched on PubMed, EMBASE, and the Cochrane Library. Five studies (11,532 patients) were included in the network meta-analysis. Trial sequential analysis (TSA) was performed to assess the reliability and conclusiveness of the meta-analysis comparing the dual antithrombotic therapy strategies with the triple antithrombotic therapy strategy.

Results:

Compared with vitamin K antagonist + dual antiplatelet therapy, novel oral anticoagulant (NOAC) + P2Y12 inhibitor was associated with a significantly better trial-defined primary safety outcome (odds ratio: 0.53; 95% CI, 0.31-0.90) and the lowest probability of thrombolysis in myocardial infarction major bleeding and intracranial hemorrhage using the cumulative ranking technique. In patients omitting aspirin, TSA demonstrated conclusive evidence with significant decreases in all safety outcomes and inconclusive evidence with a nonsignificant increase in in-stent thrombosis (risk ratio: 1.32; TSA-adjusted 95% CI, 0.54-3.24) and myocardial infarction (risk ratio: 1.19; TSA-adjusted 95% CI, 0.84-1.68).

Conclusions:

In patients with AF receiving PCI or with ACS, NOAC + P2Y12 inhibitor was associated with the lowest bleeding risk but resulted in a statistically nonsignificant, numerically greater risk for stent thrombosis and myocardial infarction, suggesting that triple antithrombotic therapy should still be an option for certain patients at a high risk of stent thrombosis or myocardial infarction.
Pulmonary arterial hypertension in the elderly population
Authors: Chen Chang-Ying , Hung Cheng-Chung , Chiang Cheng-Hung , Tsa Yi-Ching , Fu Yun-Ju , Wang Chia-Lin , Tsai Fu-Ting , Tai Hsiao-Yun , Lin Kun-Chang , Hung Wan-Ting , Kuo Shu-Hung , Huang Wei-Chun
Published: November 2021

Pulmonary arterial hypertension (PAH) was a disease predominantly affecting young females about 40 years ago; however, it has been increasingly diagnosed in elderly individuals. Few studies have investigated the features of elderly patients with PAH. This review provides an overview of the characteristics of elderly patients with PAH compared to young patients. The examination of the changing demographics of the population with PAH revealed that the mean age has increased over the years. In addition, the investigation into the diagnostic challenges in elderly patients with PAH revealed the difficulty in differentiating PAH from pulmonary hypertension secondary to diastolic heart failure. Moreover, it was noted that elderly patients underwent combination drug regimens less frequently and exhibited poorer treatment responses than young patients. Finally, it was found that elderly PAH patients experienced poorer survival than young patients. The differences among five survival prediction models and their applicability in predicting the prognosis of PAH patients are discussed.
The Mediating Role of Social Support and Resilience Between HIV-Related Stigmas and Patient Activation Among Young Black Women Living With HIV in the Southern United States: A Cross-sectional Study
Authors: Chapman Lambert Crystal , Fazeli Pariya L. , Yigit Ibrahim , Elopre Latesha , King Kiko , Kempf Mirjam-Colette , Guthrie Barbara , Mugavero Michael J.
Published: November 2021

Little is known about the construct of patient activation for engaging in favorable self-management behaviors in people with HIV. We conducted a cross-sectional study among young Black women with HIV (n = 84) to examine the association between stigma and patient activation and the mediating role of social support and resilience. Social support mediated the relationship between the following dimensions of stigma and patient activation: internalized (β = −0.20, SE = 0.08, CI [−0.369 to −0.071]) and anticipated in health care settings (β = −0.06, SE = 0.04, CI [−0.177 to −0.001]). Resilience mediated the relationship between the following dimensions of stigma and patient activation: anticipated in health care (β = −0.20, SE = 0.08, CI [−0.387 to −0.057]) and community settings (β = −0.15, SE = 0.08, CI [−0.318 to −0.017]), and enacted in community settings (β = −0.14, SE = 0.09, CI [−0.332 to −0.001]). Our findings suggest intrapersonal and interpersonal mechanisms by which various dimensions of stigma contribute to patient activation, thus identifying social support, resilience, and patient activation as potential intervention targets.
“You Don't Want Your Parents Knowing That You're Taking Pre-exposure Prophylaxis”: Pre-exposure Prophylaxis Stigma Among Black and Latinx Adolescents
Authors: Rao Sharanya , Albritton Tashuna , Pina Paulo , Liang Yilin , Taggart Tamara
Published: November 2021

Pre-exposure prophylaxis (PrEP) stigma is an understudied barrier to PrEP uptake among Black and Latinx adolescents. U.S. Black and Latinx adolescents (13–17 years) completed an online survey or participated in focus groups/interviews. Associations between PrEP stigma, PrEP disclosure, and provider-initiated PrEP discussion preferences were examined using logistic-regression models. Qualitative data provided further context to quantitative findings. The survey sample included 208 adolescents (53% female; 58% Latinx; M = 15 years), with 98% endorsing PrEP stigma. The qualitative sample included 26 adolescents (54% female; 34% Latinx; M = 15 years). PrEP stigma was associated with lower odds of PrEP disclosure to parents/guardians, and preference for health care providers to initiate PrEP-related discussions only with patients the provider judged to be at high risk for HIV. Qualitative data supported quantitative results: Adolescents endorsed multiple negative stereotypes about PrEP users. Mitigating PrEP stigma among Black and Latinx adolescents is an important step in overcoming challenges related to PrEP uptake.
Injuries and Concussions in Female High School Rugby: Prevention is Worth a Try
Authors: Shill Isla J. , West Stephen W. , Sick Stacy , Schneider Kathryn , Hagel Brent E. , Pasanen Kati , Wiley James Preston , Emery Carolyn A. , Black Amanda M.
Published: November 2021

Objectives:

To describe injury and concussion rates and mechanisms in female high school rugby players.

Design:

Two-year prospective cohort study.

Setting:

High school rugby.

Participants:

Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition.

Intervention:

None.

Main Outcome Measures:

Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates.

Results:

A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6).

Conclusions:

Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.
Combination of Autologous Fat Grafting and Negative-Pressure Wound Therapy for the Treatment of Scalp Linear Scleroderma
Authors: Chicco Maria , Ahmadi Ali R. , Lin Fu-Yu , Cheng Hsu-Tang , Lee Min-Min
Published: November 2021

Scalp linear scleroderma (LSc) is a subtype of localized scleroderma which typically affects young patients and which can be severely disfiguring. Traditional treatment options include bone grafting or tissue expansion. in this report, we present the case of a patient with scalp LSc successfully treated with scar release, autologous fat grafting, and negative-pressure wound therapy (NPWT). A 55-year-old female, with a history of craniectomy for a benign sellar tumor 10 years previously, developed LSc over the frontal scalp with exposure of titanium plates and screws. She was treated with removal of metalwork, scar release, autologous fat grafting from the abdominal wall and immediate application of NPWT. At 3-month postoperative follow-up, the appearance of the depressed lesion and of its margins had significantly improved. Our experience suggests that the combination of autologous fat grafting and NPWT is an effective treatment modality for scalp LSc.
Antifibrinolytics Are Not Associated With Reduced Blood Loss in Minimally-Invasive Endoscopic-Assisted Craniectomy for Repair of Single-Suture Craniosynostosis
Authors: Sobey Jenna H. , Menser Carrie C. , Hartzog Anna J. , Hocking Kyle M. , Niconchuk Jonathan A. , Bonfield Christopher M. , Stricker Paul A. , Reddy Srijaya K.
Published: November 2021

Minimally-invasive endoscopic-assisted craniectomy (EAC) achieves similar functional and cosmetic outcomes, whereas reducing morbidity risk that is often associated with complex cranial vault reconstruction. Antifibrinolytics (AF) usage to limit blood loss and transfusion requirements during complex cranial vault reconstruction has been studied extensively; however, studies are limited for AF therapy in EAC. The aim of this single-center retrospective observational cohort pilot study was to evaluate whether the use of AF was associated with reduced blood loss in infants undergoing EAC. The authors hypothesized that there would be no difference in blood loss between patients who received AF and those that did not receive AF during EAC. Non-syndromic patients who underwent single-suture EAC were retrospectively evaluated. Primary outcome measure was intraoperative calculated blood loss (mL/kg). Secondary outcome measures included perioperative red blood cells transfusion volumes, number of blood donor exposures, and pediatric intensive care unit and total hospital length of stay. Study cohort demographic and outcome data were analyzed; Fisher exact test was used for categorical data, Student t test was used for continuous data. A P value of <0.05 was considered statistically significant. Forty-nine EAC patients were included in the study with 34 patients in the AF cohort and 15 patients in the non-AF cohort. There were no significant differences in demographics between the 2 groups. Additionally, there was no significant difference in intraoperative calculated blood loss or any secondary outcome measure. In our single-suture EAC study cohorts, AF administration was not associated with a decrease in blood loss when compared to those that did not receive AF therapy.
A comparative study of pan-genome methods for microbial organisms: Acinetobacter baumannii pan-genome reveals structural variation in antimicrobial resistance-carrying plasmids
Authors: Urhan Aysun , Abeel Thomas
Published: November 2021

Microbial organisms have diverse populations, where using a single linear reference sequence in comparative studies introduces reference-bias in downstream analyses, and leads to a failure to account for variability in the population. Recently, pan-genome graphs have emerged as an alternative to the traditional linear reference with many successful applications and a rapid increase in the number of methods available in the literature. Despite this enthusiasm, there has been no attempt at exploring these graph construction methods in depth, demonstrating their practical use. In this study, we aim to develop a general guide to help researchers who may want to incorporate pan-genomes in their analyses of microbial organisms. We evaluated the state-of-the art pan-genome construction tools to model a collection of 70

Acinetobacter baumannii

strains. Our results suggest that all tools produced pan-genome graphs conforming to our expectations based on previous literature, and that their approach to homologue detection is likely to be the most influential in determining the final size and complexity of the pan-genome. The graphs overlapped most in the core pan-genome content while the cloud genes varied significantly among tools. We propose an alternative approach for pan-genome construction by combining two of the tools, Panaroo and Ptolemy, to further exploit them in downstream analyses, and demonstrate the effectiveness of our pipeline for structural variant calling in beta-lactam resistance genes in the same set of

A. baumannii

isolates, identifying various transposon structures for carbapenem resistance in chromosome, as well as plasmids. We identify a novel plasmid structure in two multidrug-resistant clinical isolates that had previously been studied, and which could be important for their resistance phenotypes.
The impact of chemosensory dysfunctions on weight loss
Authors: Daskalou Dimitrios , Hsieh Julien W. , Hugentobler Marianne , Landis Basile N.
Published: November 2021

Background

The role of chemosensory senses (olfaction, taste, and trigeminal) is crucial, and their dysfunctions profoundly affect the quality of life, potentially impacting eating behaviors. However, it is unclear which chemosensory symptoms could lead to undernutrition. This study aims to investigate which findings in patients’ smell and taste workup are predictors of weight loss.

Methods

This is a retrospective study based on a validated questionnaire consecutively given to adult patients presented in smell and taste consultations during a 10-year period. Psychophysical tests were used to measure chemosensory function (Sniffin’ Sticks, taste powder, and Taste Strips tests).

Results

We included 554 patients (307 females) with a median age of 51 years (IQR 23). Among them, 76 (13.7%) reported involuntary weight loss due to chemosensory disorders occurred over periods ranging from 3 to 36 months. We found that the odds of losing weight were 2.1 times higher when patients reported changes in aroma perception (p-value=0.012; 95% CI 1.15 - 3.83). Parosmia, but not phantosmia nor smell loss, was a significant predictor of weight loss (OR 2.22; p-value=0.015; 95% CI 1.17 - 4.2). Furthermore, the duration of symptoms for more than two years was protective for weight loss (OR 0.44; p-value=0.014; 95% CI 0.23 - 0.85). Regarding putative etiologies, post-traumatic chemosensory dysfunction was also a significant predictor (OR 2.08; p-value=0.039; 95% CI 1.04 - 4.16). Concerning psychophysical tests, we found that the probability of a patient to present weight loss increased by 8% for every 1-unit reduction in Taste Strips score (p-value=0.006; 95% CI 0.87 - 0.98).

Conclusion

We recommend investigating weight loss in smell and taste consultations, especially when patients report changes in aroma perception, parosmia, duration of symptoms for less than two years, head injury, and when low Taste Strips score is measured.
Early neurodevelopmental problems and risk for avoidant/restrictive food intake disorder (ARFID) in the general child population: a Japanese birth cohort study
Authors: Dinkler Lisa , Yasumitsu-Lovell Kahoko , Eitoku Masamitsu , Fujieda Mikiya , Suganuma Narufumi , Hatakenaka Yuhei , Hadjikhani Nouchine , Bryant-Waugh Rachel , Råstam Maria , Gillberg Christopher
Published: November 2021

Background

An overrepresentation of neurodevelopmental disorders (NDDs) has been observed in individuals with avoidant/restrictive food intake disorder (ARFID). Previous studies on the association between ARFID and NDDs are limited to cross-sectional data from clinical samples of small size. This study aimed to extend previous research by using prospectively collected data in children from a general population sample. We examined the occurrence and predictive power of early neurodevelopmental problems in 4–7-year-old children with suspected ARFID.

Methods

Data were collected via parent-report in 3,728 children born between 2011 and 2014 in Kochi prefecture, a sub-sample of the Japan Environment and Children’s Study (JECS). Neurodevelopmental problems were assessed with several instruments at different time points between 0.5 and 3 years of age as part of the JECS. In an add-on study, ARFID was identified cross-sectionally (between 4 and 7 years of age) using a newly developed screening tool.

Results

Circa 3% of children at high risk for NDDs in preschool age screened positive for ARFID between age 4 and 7 years, reflecting a three times increased risk of suspected ARFID. A fifth (20.8%) of children with suspected ARFID had likely NDDs, compared to 8.6% of children without suspected ARFID. Developmental delay trajectories of children with and without suspected ARFID started to divert after the age of 6 months. Only 2.2% of children with early feeding problems later screened positive for ARFID. The inclusion of neurodevelopmental problems improved the prediction of later ARFID.

Conclusions

The results mirror the previously observed overrepresentation of NDDs in ARFID populations, although to a weaker extent. In non-clinical populations, early feeding problems are common and rarely develop into ARFID, however, our findings imply that they should be monitored closely in children with high neurodevelopmental risk in order to prevent ARFID.
Once-daily feeding is associated with better health in companion dogs: Results from the Dog Aging Project
Authors: Bray Emily E. , Zheng Zihan , Tolbert M. Katherine , McCoy Brianah M. ,   Dog Aging Project Consortium, Kaeberlein Matt , Kerr Kathleen F.
Published: November 2021

A variety of diets have been studied for possible anti-aging effects. In particular, studies of intermittent fasting and time-restricted feeding in laboratory rodents have found evidence of beneficial health outcomes. Companion dogs represent a unique opportunity to study diet in a large mammal that shares human environments. The Dog Aging Project has been collecting data on thousands of companion dogs of all different ages, sizes, and breeds since 2019. We leveraged this diverse cross-sectional dataset to investigate associations between feeding frequency and cognitive function (n = 10,474) as well as nine broad categories of health conditions (n = 24,238). Controlling for sex, age, breed, and other potential confounders, we found that dogs fed once daily rather than more frequently had lower mean scores on a cognitive dysfunction scale, and lower odds of having gastrointestinal, dental, orthopedic, kidney/urinary, and liver/pancreas disorders. Therefore, we find that once-daily feeding is associated with better health in multiple domains. Future research with longitudinal data can provide stronger evidence for a possible causal effect of feeding frequency on health in companion dogs.
Evaluation of methods for whole genome sequencing of Enterococcus faecium in a diagnostic laboratory
Authors: Raven Kathy E. , Leek Danielle , Blane Beth , Girgis Sophia T. , Akram Asha , Brown Nicholas , Peacock Sharon J.
Published: November 2021

Enterococcus faecium is an important nosocomial pathogen associated with hospital transmission and outbreaks. Based on growing evidence that bacterial whole genome sequencing enhances hospital outbreak investigation of other bacterial species, our aim was to develop and evaluate methods for low volume clinical sequencing of E. faecium. Using a test panel of 22 E. faecium isolates associated previously with hospital transmission, we developed laboratory protocols for DNA extraction and library preparation, which in combination with the Illumina MiniSeq can generate sequence data within 24 hours. The final laboratory protocol took 3.5 hours and showed 98% reproducibility in producing sufficient DNA for sequencing. Repeatability and reproducibility assays based on the laboratory protocol and sequencing demonstrated 100% accuracy in assigning species, sequence type (ST) and (when present) detecting vanA or vanB, with all isolates passing the quality control metrics. Minor variation was detected in base calling of the same isolate genome when tested repeatedly due to variations in mapping and base calling, but application of a SNP cut-off (≤15 SNPs) to assign isolates to outbreak clusters showed 100% reproducibility. An evaluation of contamination showed that controls and test E. faecium sequence files contained <0.34% and <2.12% of fragments matching another species, respectively. Deliberate contamination experiments confirmed that this was insufficient to impact on data interpretation. Further work is required to develop informatic tools prior to implementation into clinical practice.

Importance

Enterococcus faecium is a leading cause of hospital infections, particularly in the immunocompromised, and has been shown to be associated with hospital transmissions. Whole-genome sequencing is a highly discriminatory technique that has been shown to be capable of identifying transmissions that may otherwise go undetected by conventional infection control methods. This could be a powerful adjunct to infection control, since previous studies have shown that there are numerous hospital outbreaks of E. faecium, which can extend over multiple wards and years. In this study, we developed and evaluated laboratory methods for low volume clinical sequencing of E. faecium, to allow uptake in smaller local diagnostic laboratories. We demonstrated that sequencing could be performed within 24-48 hours of the sample flagging positive. This would allow a more rapid turnaround time, compared to sending isolates to the reference laboratory, providing an opportunity for infection control to act earlier to prevent further transmission.
Comparing the performance of risk stratification scores in Brugada syndrome: a multi-centre study
Authors: Lee Sharen , Zhou Jiandong , Bazoukis George , Letsas Konstantinos P , Liu Tong , Wong Wing Tak , Wong Ian Chi Kei , Mok Ngai Shing , Mak Chloe , Zhang Qingpeng , Tse Gary
Published: November 2021

Introduction

The management of Brugada Syndrome (BrS) patients at intermediate risk of arrhythmic events remains controversial. The present study evaluated the predictive performance of different risk scores in an Asian BrS population and its intermediate risk subgroup.

Methods

This is a retrospective territory-wide cohort study of consecutive patients diagnosed with BrS from January 1st, 1997 to June 20th, 2020 in Hong Kong. The primary outcome is sustained ventricular tachyarrhythmias. A novel predictive score was developed. Machine learning-based nearest neighbor and Gaussian Naïve Bayes models were also developed. The area under the receiver operator characteristic (ROC) curve (AUC) was compared between the different scores.

Results

The cohort consists of 548 consecutive BrS patients (7% female, age at diagnosis: 50±16 years old, follow-up duration: 84±55 months). For risk stratification in the whole BrS cohort, the score developed by Sieira et al. showed the best performance with an AUC of 0.805, followed by the Shanghai score (0.698), and the scores by Okamura et al. (0.667), Delise et al. (0.661), Letsas et al. (0.656) and Honarbakhsh et al. (0.592). A novel risk score was developed based on variables and weighting from the best performing score (the Sieira score), with the inclusion of additional variables significant on univariable Cox regression (arrhythmias other than ventricular tachyarrhythmias, early repolarization pattern in the peripheral leads, aVR sign, S-wave in lead I and QTc ≥436 ms). This score has the highest AUC of 0.855 (95% CI: 0.808-0.901). The Gaussian Naïve Bayes model demonstrated the best performance (AUC: 0.97) compared to logistic regression and nearest neighbor models.

Conclusion

The inclusion of investigation results and more complex models are needed to improve the predictive performance of risk scores in the intermediate risk BrS population.
Genome wide association study of human bacteremia Escherichia coli isolates identifies genetic determinants for the portal of entry but not fatal outcome
Authors: Denamur Erick , Condamine Bénédicte , Esposito-Farèse Marina , Royer Guilhem , Clermont Olivier , Laouenan Cédric , Lefort Agnès , de Lastours Victoire , Galardini Marco ,   the COLIBAFI,   SEPTICOLI groups
Published: November 2021

Escherichia coli is an important cause of bloodstream infections (BSI), which is of concern given its high mortality and increasing worldwide prevalence. Finding bacterial genetic variants that might contribute to patient death is of interest to better understand its mechanism and implement diagnostic methods that specifically look for those factors. E. coli samples isolated from patients with BSI are an ideal dataset to systematically search for those variants, as long as the influence of host factors such as comorbidities are taken into account. Here we performed a genome-wide association study (GWAS) using data from 910 patients with E. coli BSI from hospitals in Paris, France; we looked for associations between bacterial genetic variants and three patient outcomes (death at 28 days, septic shock and admission to intensive care unit), as well as two portals of entry (urinary and digestive tract), using various clinical variables from each patient to account for host factors. We did not find any associations between genetic variants and patient outcomes, potentially confirming the strong influence of host factors in influencing the course of BSI; we however found a strong association between the papGII/papGIII operon and entrance of E. coli through the urinary tract, which demonstrates the power of bacterial GWAS even when applied to actual clinical data. Despite the lack of associations between E. coli genetic variants and patient outcomes, we estimate that increasing the sample size by one order of magnitude could lead to the discovery of some putative causal variants. The adoption of bacterial genome sequencing of clinical isolates might eventually lead to the elucidation of the mechanisms behind BSI progression and the development of sequence-based diagnostics.
Physiological and life history changes associated with seasonal adaptation in the cactophilic Drosophila mojavensis
Authors: Shaible Tierney M. , Matzkin Luciano M.
Published: November 2021

Many insects inhabiting temperate climates are faced with changing environmental conditions throughout the year. Depending on the species, these environmental fluctuations can be experienced within a single generation or across multiple generations. Strategies for dealing with these seasonal changes vary across populations. Drosophila mojavensis is a cactophilic Drosophila species endemic to the Sonoran Desert. The Sonoran Desert regularly reaches temperatures of 50°C in the summer months. As individuals of this population are rare to collect in the summer months, we therefore simulated in a temperature and light controlled chamber the cycling temperatures experienced by D. mojavensis in the Sonoran Desert from April to July (four generations) to understand the physiological and life history changes that allow this population to withstand these conditions. In contrast to our hypothesis of a summer aestivation, we found that D. mojavensis continue to reproduce during the summer months, albeit with lower viability, but the longevity of the population is highly reduced during this period. As expected, stress resistance increased during the summer months in both the adult and the larval stages. This study examines several strategies for withstanding the Sonoran Desert summer conditions which may be informative in the study of other desert endemic species.
A single cell atlas of human and mouse white adipose tissue
Authors: Emont Margo P. , Jacobs Christopher , Essene Adam L. , Pant Deepti , Tenen Danielle , Colleluori Georgia , Di Vincenzo Angelica , Jørgensen Anja M. , Dashti Hesam , Stefek Adam , McGonagle Elizabeth , Strobel Sophie , Laber Samantha , Agrawal Saaket , Westcott Gregory P. , Kar Amrita , Veregge Molly L. , Gulko Anton , Srinivasan Harini , Kramer Zachary , De Filippis Eleanna , Merkel Erin , Ducie Jennifer , Boyd Christopher G. , Gourash William , Courcoulas Anita , Lin Samuel J. , Lee Bernard T. , Morris Donald , Tobias Adam , Khera Amit V. , Claussnitzer Melina , Pers Tune H. , Giordano Antonio , Ashenberg Orr , Regev Aviv , Tsai Linus T. , Rosen Evan D.
Published: November 2021

White adipose tissue (WAT), once regarded as morphologically and functionally bland, is now recognized to be dynamic, plastic, heterogenous, and involved in a wide array of biological processes including energy homeostasis, glucose and lipid handling, blood pressure control, and host defense1. High fat feeding and other metabolic stressors cause dramatic changes in adipose morphology, physiology, and cellular composition1, and alterations in adiposity are associated with insulin resistance, dyslipidemia, and type 2 diabetes (T2D)2. Here, we provide detailed cellular atlases of human and murine subcutaneous and visceral white fat at single cell resolution across a range of body weight. We identify subpopulations of adipocytes, adipose stem and progenitor cells (ASPCs), vascular, and immune cells and demonstrate commonalities and differences across species and dietary conditions. We link specific cell types to increased risk of metabolic disease, and we provide an initial blueprint for a comprehensive set of interactions between individual cell types in the adipose niche in leanness and obesity. These data comprise an extensive resource for the exploration of genes, traits, and cell types in the function of WAT across species, depots, and nutritional conditions.