bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of degree of translation or rotation of acetabular fragment of periacetabular osteotomy procedure on pelvic X-ray parameters
Authors: Hapa Onur , Aydemir Selahattin , Husemoglu R Bugra , Yanik Berkay , Gursan Onur , Balci Ali , Havitcioglu Hasan
Published: June 2022

The present study aims to investigate the effect of amount of lateralization and/or anteversion of the point where the iliac cut meets with the posterior column cut of periacetabular osteotomy (PAO), on X-ray parameters such as Center of edge (CE) angle, retroversion index (RVI) and sharp angle. Fourteen patients with symptomatic hip dysplasia (CE° < 20°) were included. Pelvis Computerized tomography (CT) sections were used for 3D printing. PAO was then performed on these models. The point (A), 1 cm lateral to the pelvic brim, is marked where the iliac cut intersects the posterior column cut. In Group I (1.5–0), point A is lateralized parallel to the osteotomy line for 1.5 cm. In Group II (1.5–0.5), it is additionally anteverted for 0.5 cm. In Group III (3–0), point A is lateralized for 3 cm and then additionally anteverted for 1 cm (Group IV: 3–1). Radiographs were taken in each stage. The lateral CE angle, RVI and sharp angle were measured. All had an increase in the CE angle and RVI and a decrease in the sharp angle compared to the control group (P < 0.05). The amount of CE angle (ΔCE) or RVI increase (ΔRV) was as follows: 3–1(38°, 0.3) > 3–0(27°, 0.2) and 1.5–0.5(25°, 0.1) > 1.5–0(17°, 0.07) (P < 0.05) (with no difference between groups 1.5–0.5 and 3–0, P = 0.7). The amount of sharp angle decrease was as follows: 3–1(20°), 3–0(18°) < 1.5–0.5(11°) < 1.5–0(8°) (P < 0.05). The lateralization of the intersection point where the iliac wing cut meets with the posterior column cut along the cut surface led to an increase of lateral cover and focal retroversion. Additional anteversion leads to further increases in those parameters, while groups 1.5–0.5 and 3–0 did not differ between.
Glutaraldehyde and uranyl acetate dual fixation combined sputtering/unroofing enables intracellular fatty acids TOF-SIMS imaging with organelle-corresponding subcellular distribution
Authors: Zhang Chi , Horikawa Makoto , Kahyo Tomoaki , Matsudaira Takaomi , Tanaka Tatsuya , Xu Lili , Takei Shiro , Setou Mitsutoshi
Published: June 2022

Fatty acids (FAs) have diverse functions in cellular activities. The intracellular distribution of FAs is critical for their functions. Imaging of FAs by time-of-flight secondary ion mass spectrometry (TOF-SIMS) has been achieved. However, TOF-SIMS images of FAs so far do not have subcellular distribution due to inadequate sample preparation methods. In this study, we developed a chemical fixation method using glutaraldehyde (GA) with uranyl acetate (UA), which preserved cellular structure and intracellular FA distribution well. Combining GA+UA fixation with sputtering-based methods and unroofing-based methods, respectively, we successfully imaged intracellular lipids with the subcellular distribution.
Analyzing gender clues in war-time letters
Authors: Keskustalo Heikki , Korkeamäki Laura , Vanamo Selja , Kettunen Kimmo , Kumpulainen Sanna
Published: June 2022

Many historians struggle with their information needs which cannot be directly served by the information access systems. Satisfying these needs often requires reasoning and interpretation of pieces of information in context, from user-specific viewpoints. One common need in studying historical phenomena is what indicates gender in historical text. We call such textual indicators ‘gender clues’ because they help satisfy information needs regarding the concept of gender. In this article, we analyze gender clues qualitatively and present a typology of them based on a set of private letters from the Second World War in Finland. We also discuss the general need to create metadata to support the historian’s explorations from specific viewpoints, especially in small and noisy collections that are common in the historical domain.
Addressing Persistent Vaccine Hesitancy in a Military Community Through a Physician-Led Intervention
Authors: Glendening Joseph , Bickford Brant , Markert Ronald , Yuhas Joseph , Berglund Andrew , Kelly Devin , Scott Joshua , Burtson Kathryn
Published: June 2022

Introduction

Following the identification of coronavirus disease 2019 (COVID-19) in China, the virus has spread rapidly around the world causing severe illness and death. Several vaccines were found to be safe and effective and made available first to those most at risk and then to the general public. Despite the safety and efficacy profiles, vaccine hesitancy remains a significant barrier to widespread immunity. Within the military community at Wright-Patterson Air Force Base, we provided multiple physician-led educational seminars to address vaccination concerns and decrease vaccine hesitancy.

Materials and Methods

The authors presented a PowerPoint presentation of the available vaccinations, their safety data, and efficacy, followed by a town hall-style question-and-answer period where questions were presented from the previous submission, as well as real-time submissions through Facebook Live. The questions were fielded by specialists in Internal Medicine, Infectious Disease, Pulmonary-Critical Care, Obstetrics and Gynecology, and Rheumatology. The entire presentation was streamed through Facebook Live and was freely available. Following the presentation, an online survey was provided for willing participants to complete which included demographic data and addressed their previous and current attitudes toward COVID-19 vaccinations and their opinions on the presentation. Data from the survey were then analyzed through IBM SPSS Statistics 25.0 to find any associations or risk factors for hesitancy.

Results

There were 73 respondents to the assessment, most of which were nonmedical. Of the 73, the majority (45) had already received a vaccine for COVID-19. Of those unvaccinated, 17 did not want a vaccination before or after the seminar. Two did change their mind about being receptive to vaccination, and one changed from receptive to hesitant. The only statistically significant risk factors for vaccine hesitancy were those with a moderate to great amount of trust in their health care provider compared to those with little to no trust (73% vs. 4%, P < .001).

Conclusions

Our intervention was limited in its effectiveness to address vaccine hesitancy late in the pandemic, with our study limited by our small sample size. Regardless, it identified a peculiar discrepancy with those with the most trust in health care providers being the most likely to be vaccine-hesitant. This highlights the importance of the information that trusted health care providers are providing to their patients and may identify more effective routes to address vaccine hesitancy in the future.
Duplication of Horizontally Acquired GH5_2 Enzymes Played a Central Role in the Evolution of Longhorned Beetles
Authors: Shin Na Ra , Doucet Daniel , Pauchet Yannick
Published: June 2022

The rise of functional diversity through gene duplication contributed to the adaption of organisms to various environments. Here we investigate the evolution of putative cellulases of the subfamily 2 of glycoside hydrolase family 5 (GH5_2) in the Cerambycidae (longhorned beetles), a megadiverse assemblage of mostly xylophagous beetles. Cerambycidae originally acquired GH5_2 from a bacterial donor through horizontal gene transfer (HGT), and extant species harbor multiple copies that arose from gene duplication. We ask how these digestive enzymes contributed to the ability of these beetles to feed on wood. We analyzed 113 GH5_2, including the functional characterization of 52 of them, derived from 25 species covering most subfamilies of Cerambycidae. Ancestral gene duplications led to five well-defined groups with distinct substrate specificity, allowing these beetles to break down, in addition to cellulose, polysaccharides that are abundant in plant cell walls (PCWs), namely, xyloglucan, xylan, and mannans. Resurrecting the ancestral enzyme originally acquired by HGT, we show it was a cellulase that was able to break down glucomannan and xylan. Finally, recent gene duplications further expanded the catalytic repertoire of cerambycid GH5_2, giving rise to enzymes that favor transglycosylation over hydrolysis. We suggest that HGT and gene duplication, which shaped the evolution of GH5_2, played a central role in the ability of cerambycid beetles to use a PCW-rich diet and may have contributed to their successful radiation.
An Analysis of SARS-CoV-2 Vaccine Reactogenicity: Variation by Type, Dose, and History, Severity, and Recency of Prior SARS-CoV-2 Infection
Authors: Scher Ann I , Berjohn Catherine M , Byrne Celia , Colombo Rhonda E , Colombo Christopher J , Edwards Margaret Sanchez , Ewers Evan C , Ganesan Anuradha , Jones Milissa , Larson Derek T , Libraty Daniel , Lindholm David A , Madar Cristian S , Maldonado Carlos J , Maves Ryan C , Mende Katrin , Richard Stephanie A , Rozman Julia S , Rusiecki Jennifer , Smith Alfred , Simons Mark , Tribble David , Agan Brian , Burgess Timothy H , Pollett Simon D ,   EPICC COVID-19 Cohort Study Group, Merritt S , Merritt T , Lewis McChord Joint Base , Chambers S , Faestel COL P , Mount COL C , Stein M , Uyehara C , Broder C , Chung COL (Ret.) K , Epsi N , Hickey COL P , Livezey LTC J , Parmelee E , Samuels E , Wayman M , Chao TSgt T , Lanter K , Meyer J , Reynolds K , Starr C , Iskander CAPT J , Kamara CDR I , Hostler LTC D , Huprikar MAJ N
Published: June 2022

Background

There is limited information on the functional consequences of coronavirus disease 2019 (COVID-19) vaccine side effects. To support patient counseling and public health messaging, we describe the risk and correlates of COVID-19 vaccine side effects sufficient to prevent work or usual activities and/or lead to medical care (“severe” side effects).

Methods

The EPICC study is a longitudinal cohort study of Military Healthcare System beneficiaries including active duty service members, dependents, and retirees. We studied 2789 adults who were vaccinated between December 2020 and December 2021.

Results

Severe side effects were most common with the Ad26.COV2.S (Janssen/Johnson and Johnson) vaccine, followed by mRNA-1273 (Moderna) then BNT162b2 (Pfizer/BioNTech). Severe side effects were more common after the second than first dose (11% vs 4%; P < .001). First (but not second) dose side effects were more common in those with vs without prior severe acute respiratory syndrome coronavirus 2 infection (9% vs 2%; adjusted odds ratio [aOR], 5.84; 95% CI, 3.8–9.1), particularly if the prior illness was severe or critical (13% vs 2%; aOR, 10.57; 95% CI, 5.5–20.1) or resulted in inpatient care (17% vs 2%; aOR, 19.3; 95% CI, 5.1–72.5). Side effects were more common in women than men but not otherwise related to demographic factors.

Conclusions

Vaccine side effects sufficient to prevent usual activities were more common after the second than first dose and varied by vaccine type. First dose side effects were more likely in those with a history of COVID-19—particularly if that prior illness was severe or associated with inpatient care. These findings may assist clinicians and patients by providing a real-world evaluation of the likelihood of experiencing impactful postvaccine symptoms.
Abscisic acid influences ammonium transport via regulation of kinase CIPK23 and ammonium transporters
Authors: Ganz Pascal , Porras-Murillo Romano , Ijato Toyosi , Menz Jochen , Straub Tatsiana , Stührwohldt Nils , Moradtalab Narges , Ludewig Uwe , Neuhäuser Benjamin
Published: June 2022

Ammonium uptake at plant roots is regulated at the transcriptional, posttranscriptional, and posttranslational levels. Phosphorylation by the protein kinase calcineurin B-like protein (CBL)-interacting protein kinase 23 (CIPK23) transiently inactivates ammonium transporters (AMT1s), but the phosphatases activating AMT1s remain unknown. Here, we identified the PP2C phosphatase abscisic acid (ABA) insensitive 1 (ABI1) as an activator of AMT1s in Arabidopsis (Arabidopsis thaliana). We showed that high external ammonium concentrations elevate the level of the stress phytohormone ABA, possibly by de-glycosylation. Active ABA was sensed by ABI1-PYR1-like () complexes followed by the inactivation of ABI1, in turn activating CIPK23. Under favorable growth conditions, ABI1 reduced AMT1;1 and AMT1;2 phosphorylation, both by binding and inactivating CIPK23. ABI1 further directly interacted with AMT1;1 and AMT1;2, which would be a prerequisite for dephosphorylation of the transporter by ABI1. Thus, ABI1 is a positive regulator of ammonium uptake, coupling nutrient acquisition to abiotic stress signaling. Elevated ABA reduces ammonium uptake during stress situations, such as ammonium toxicity, whereas ABI1 reactivates AMT1s under favorable growth conditions.
Rescaling Resettlement: Local Welcoming Policies and the Shaping of Refugee Belonging
Authors: Watson Jake
Published: June 2022

This paper brings together scholarship on race, place, and legal status to examine how local context mediates the outcomes of federal refugee resettlement policy. Over the past several decades, local actors across the United States have developed initiatives to “welcome refugees” that interact with and extend beyond the formal federal program to shape refugee incorporation. Drawing on a comparative study of Pittsburgh, Pennsylvania, and Atlanta, Georgia, I show that these initiatives construct different aspects of refugee identity as socially valuable. Refugees learn about these valuations as they seek access to resources and recognition, in turn amplifying desirable aspects of their identity to claim belonging and to distance themselves from racialized and stigmatized others. In Pittsburgh, refugees emphasize their ethnic identity and membership to ethnic groups, while refugees in Atlanta claim belonging by emphasizing their legal and humanitarian status as refugees. This paper contributes to scholarly understandings of refugee resettlement as a racialized process mediated by the institutional and socio-cultural dynamics of local context. Moreover, this paper extends calls to rethink the immigrant/refugee distinction by revealing the variable salience of the refugee status across subnational space.
Diagnosing and treating Mycobacterium kansasii
Authors: Moore Randy R. , Holder Douglas , Earnest Sarah
Published: June 2022

This article describes an 18-year-old immunocompetent patient who developed Mycobacterium kansasii, manifested with shortness of breath and a cavitary lung lesion seen on radiograph. Initial sputum smears were negative; however, after 2 weeks, the cultures grew M. kansasii and the patient was started on an antimycobacterial regimen.
Nonsteroidal anti-inflammatory drugs and cardiovascular disease risk in spondyloarthritis-spectrum diseases
Authors: So Ho , Tam Lai-Shan
Published: June 2022

Purpose of review

Increased cardiovascular (CV) risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) is well recognized in the general population. This may limit the use of this effective therapy in patients with spondyloarthritis (SpA), a population already at high CV risk.

Recent findings

Increased CV diseases and their risk factors in patients with SpA were consistently shown in recent population-level data. NSAIDs remained commonly prescribed in SpA, though their structural benefit remained controversial and the dispensing practice was variable in different regions in the world. A previous observation study suggested NSAIDs in SpA might be cardio-protective, possibly via their modulation of the chronic inflammatory state. A recent meta-analysis of nonrandomized studies also revealed no increased risk of a CV event. Interestingly, there is growing evidence that different NSAIDs might impose differential CV risk on patients with SpA.

Recent evidence suggested NSAIDs were associated with a neutral and possibly lower CV risk in patients with SpA, which provided some reassurance for their use.
Achilles Tendon-Bone Allograft is Advantageous for Chronic Patellar Tendon Ruptures Using a Modified Fixation Technique
Authors: Keyhani Sohrab , Movahedinia Mohammad , Amouzadeh Farzad , Ghanbari Naser
Published: June 2022

Objectives:

A patellar tendon rupture is an extremely disabling extensor mechanism injury. This follow-up study describes the clinical and radiologic outcomes of a new modified technique for reconstructing chronic patellar tendon ruptures.

Materials and Methods:

From 2014 to 2018, we reconstructed 15 chronic patellar tendon ruptures using Achilles tendon-bone allograft. Clinical and radiologic outcomes were evaluated preoperatively and during the final follow-up, 2 to 7 years after reconstruction. Assessments involved the International Knee Documentation Committee (IKDC), Lysholm, and Kujala scores, as well as quadriceps muscle strength and extension lag. Radiologic results were evaluated using the Insall-Salvati index on plain radiography and allograft integration through magnetic resonance imaging.

Results:

At the final follow-up, the Lysholm, IKDC, and Kujala scores improved by 57, 58, and 54 points, respectively (P<0.001). The average quadriceps muscle strength improved from 2.6 (2 to 3) before the operation to 4.6 (4 to 5) at the final follow-up (P<0.001). The extension lag also improved significantly from 31.7 degrees (25 to 40) to 0.6 degrees (0 to 10). The preoperative Insall-Salvati index was 1.6 (1.5 to 1.9), which improved significantly to 1.2 (1 to 1.3) postoperatively (P<0.001). Two years after the operation, magnetic resonance imaging showed good allograft integration in all pateints.

Conclusion:

Combining an Achilles tendon-bone allograft with a robust fixation method led to favorable clinical and radiologic outcomes.

Level of Evidence:

Level IV.
How could HIV-1 drug resistance impact preexposure prophylaxis for HIV prevention?
Authors: Parikh Urvi M. , Mellors John W.
Published: June 2022

Purpose of review

To review current laboratory and clinical data on the frequency and relative risk of drug resistance and range of mutations selected from approved and investigational antiretroviral agents used for preexposure prophylaxis (PrEP) of HIV-1 infection, including tenofovir disproxil fumarate (TDF)-based oral PrEP, dapivirine ring, injectable cabotegravir (CAB), islatravir, lenacapavir and broadly neutralizing antibodies (bNAbs).

Recent findings

The greatest risk of HIV-1 resistance from PrEP with oral TDF/emtricitabine (FTC) or injectable CAB is from starting or continuing PrEP after undiagnosed acute HIV infection. By contrast, the dapivirine intravaginal ring does not appear to select nonnucleoside reverse transcriptase inhibitor resistance in clinical trial settings. Investigational inhibitors including islatravir, lenacapavir, and bNAbs are promising for use as PrEP due to their potential for sustained delivery and low risk of cross-resistance to currently used antiretrovirals, but surveillance for emergence of resistance mutations in more HIV-1 gene regions (gag, env) will be important as the same drugs are being developed for HIV therapy.

PrEP is highly effective in preventing HIV infection. Although HIV drug resistance from PrEP use could impact future options in individuals who seroconvert on PrEP, the current risk is low and continued monitoring for the emergence of resistance and cross-resistance during product development, clinical studies, and product roll-out is advised to preserve antiretroviral efficacy for both treatment and prevention.
Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study
Authors: Cavagna Pauline , Kramoh Kouadio Euloge , Diop Ibrahima Bara , Kouam Kouam Charles , Ikama Meo Stéphane , Takombe Jean Laurent , Damorou Jean Marie , Ali Toure Ibrahim , Balde Dadhi M. , Dzudie Anastase , Khoury Stéphanie , Perier Marie Cécile , Asselin Anouk , Azizi Michel , Houenassi Martin Dèdonougbo , Kane Abdoul , Kimbally-Kaki Suzy Gisèle , Kingue Samuel , Limbole Emmanuel , Mfeukeu Kuate Liliane , Mipinda Jean Bruno , Ferreira Beatriz , Nhavoto Carol , Sidy Ali Abdallahi , Empana Jean Philippe , N’guetta Roland , Jouven Xavier , Antignac Marie
Published: June 2022

Background:

Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa.

Methods:

We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies.

Results:

The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11–1.77)], complication of hypertension [OR 2.4 (1.89–3.03)], former hypertension [OR 3.12 (2.3–4.26)], good adherence [OR 1.98 (1.47–2.66)], from MIC [OR 1.38 (1.10–1.74)] and living in urban areas [OR 1.52 (1.16–1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC.

Conclusion:

In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.
Remote Video Monitoring of Simultaneous Visual Field Testing
Authors: Meshkin Ryan S. , Zhao Yan , Elze Tobias , Boland Michael V. , Friedman David S.
Published: June 2022

Précis:

In this prospective interventional case series that included 474 patients, there were no significant differences in visual field (VF) parameters between fields from patients tested one-at-a-time and simultaneously, except for fixation losses.

Purpose:

To test for differences in reliability and performance parameters of patients taking VF tests while using a remote patient monitoring system to supervise 1 or 2 test sessions simultaneously.

Methods:

In a prospective interventional case series, 861 eyes of 474 consecutive patients undergoing automated perimetry during a 6-month period were monitored during the test using an audio/video-enabled remote monitoring system. Two patients were simultaneously tested (simultaneous test) by a single technician if they were ready for testing at the same time. Patients were otherwise tested individually (single test). Performance and reliability parameters including false negatives, false positives, fixation losses, mean deviation, pattern standard deviation, VF index, and test duration were compared between patients undergoing simultaneous tests and single tests. Patients undergoing remotely monitored testing, for whom a prior VF could be found, had performance and reliability parameters compared with those prior tests. VFs were analyzed separately for 2 test strategies: SITA Standard 24-2 and SITA Faster 24-2C.

Results:

No significant parameter differences were observed among SITA Standard 24-2 VFs between single and simultaneous tests, except for fixation losses (single: 16.8±19.7%, simultaneous: 22.5±25.0%, P=0.01). Similarly, there were no significant differences observed among SITA Faster 24-2C tests. Paired analyses comparing remotely monitored VFs with prior traditionally monitored VFs showed no significant differences for any parameters, except for fewer fixation losses with remote monitoring (traditional: 23.6±27.5%, remote 17.7±20.8%, P=0.003).

Conclusions:

Remote patient monitoring of VF testing enabled technicians to supervise testing of 2 patients simultaneously with preserved performance and reliability.
The Impact of Childhood and Parental Vaccination on SARS-CoV-2 Infection Rates in Children
Authors: Yigit Metin , Ince Yunus Emre , Kalayci Furkan , Santaflioglu Beytullah , Kurt Funda , Ozkaya-Parlakay Aslinur , Dibek Misirlioglu Emine , Senel Emrah
Published: June 2022

Background:

The data on the indirect protection of children via the coronavirus disease 2019 (COVID-19) vaccination of household members are insufficient, and analyses to evaluate the efficacy of COVID-19 vaccines are limited.

Methods:

We gathered data on 12,442 patients under the age of 18 regarding the vaccination status of their household members, their vaccine preferences and doses, and their previous history of COVID-19 infection immediately before the patients were administered a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between September 1, 2021 and December 5, 2021.

Results:

A total of 18.4% (2289) were vaccinated, 91.4% with BNT162b2mRNA vaccine, 8.6% with inactivated COVID-19 vaccine; 48.7% received a single dose, and 51.3% had 2 doses. Real-time RT-PCR positivity proportions were much higher in older children (P < 0.001) and were higher in children 12 years of age and older [odds ratio (OR), 1.34; 95% confidence interval (CI): 1.21–1.47] compared with others. SARS-CoV-2 infection was significantly lower in the vaccinated group (fully and incompletely) (P < 0.001). Unvaccinated (OR, 4.88; 95% CI: 3.77–6.13) and incompletely vaccinated children (OR, 1.83; 95% CI: 1.52–2.12) had a higher risk of COVID-19 infection compared with fully vaccinated patients No significant association was found between the COVID-19 real-time RT-PCR positivity rates of patients and the vaccination status or vaccine preferences of household members (P > 0.05 each).

Conclusions:

SARS-CoV-2 infection rates were significantly lower in vaccinated children, especially with mRNA vaccines. The indirect protection of unvaccinated children via the vaccination of household members against COVID-19 seems inadequate. The individual vaccination of children remains crucial.
Management of corneal haze and edema post-PRK
Authors: Awidi Abdelhalim , Ahmed Ishrat , Daoud Yassine J.
Published: June 2022

Introduction:

To present the potential use of serum tears, corneal crosslinking, and phototherapeutic keratectomy in the management of corneal haze and edema post-photorefractive keratectomy (PRK).

Patient and Clinical Findings:

A patient who underwent PRK and subsequently developed corneal haze and edema was treated using conservative management to achieve moderate improvement.

Diagnosis, Intervention, and Outcomes:

The combination of serum tears, corneal crosslinking, and phototherapeutic keratectomy was used to treat corneal haze and edema, helping the patient achieve an uncorrected visual acuity of 20/20 in the last follow-up.

Conclusions:

The use of serum tears, corneal crosslinking, and phototherapeutic keratectomy may provide an additional therapeutic option in the treatment of corneal haze and edema that develops post-PRK.
Extracellular vesicles in human milk
Authors: Golan-Gerstl Regina , Reif Shimon
Published: June 2022

Purpose of review

Milk-derived extracellular vesicles (MDEVs) are nanovesicles that carry microRNA (miRNA) DNA, RNA, proteins and lipids. MDEVs have a potential of therapeutic targets, based on their properties and cargo profile. The present review summarizes recent studies on MDEVs, their cargo and potential role in mammalian development.

Recent findings

The detailed characterization of their miRNA cargo leads to the conclusion of their potential importance in the regulation of gene expression, immune function, development and infant growth.

While their miRNAs are important regulatory elements and their profile expression was characterized in various mammalian milk sources, little is known about their effect on infant health and development. MiRNA activity in breast milk is likely influenced by the overall ecosystem of the early environment, including maternal characteristics, behaviors, and health.

MDEVs may have an important role in early child development and infant future health. Understanding benefits of MDEVs characteristics have potential role on gut maturation, immune system development and the prevention of metabolic disorders.
3D printed foods-carbs from the lab for better health
Authors: Singh Jyoti , Kaur Jaspreet , Rasane Prasad , Kaur Sawinder
Published: June 2022

Purpose of review

The purpose of the review is to describe carbohydrate based 3D food printing technology in light of how it is affected by the use of various ingredients of ink and the properties associated with carbohydrate inks used for printing. Special focus is diverted to evaluate its effect on texture and corresponding health implications associated with carbohydrate based printed foods.

Recent findings

The focus of 3D food printed products has revolved around texture modulation and carbohydrates are the best possible additives to achieve this modification. Carbohydrate based inks are used to design healthy texturized printed foods to provide various health benefits to consumer in addition to satisfy their aesthetic requirements. Other ingredients such as prebiotics and probiotics are major adjuncts that add value to these carbohydrates based 3D food printed foods and may have synergistic effects.

Although much of the current attention is on texture modulation, health aspects of the foods naturally drive the future course of research associated with the carbohydrate based 3D food printed foods.
Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency
Authors: Claessens Yann-Erick , Berthier Frédéric , Baqué-Juston Marie , Perrin Christophe , Faraggi Marc , Keita-Perse Olivia , Duval Xavier
Published: June 2022

Chest CT-scan (CT) exceeds chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) but actual use and results remain unclear. We examine whether CT performed at ED visit improved ED diagnosis of CAP as compared to a final diagnosis of CAP at hospital discharge (gold standard diagnosis for the study), and how it impacts relevant clinical outcomes. This retrospective monocenter observational study was based on the analysis of the hospital database. Patients with a diagnosis of CAP in the ED (ICD-10 codes: J110, J111, from J12- to J18-, J440, J690, U0710, and U0711) were included. We compared ED patients who were diagnosed with CAP using CXR and CT. We measured diagnostic consistency, duration of ED visit, percentage of CXR and CT during hospital stay, hospital length-of-stay, ICU admission, and in-hospital mortality. Multivariate analysis was adjusted for CRB65 score by multiple logistic regression analysis for binary outcomes and by multivariate analysis of variance for continuous outcomes. We included 994 ED patients with an initial diagnosis of CAP (751 receiving CXR, 243 receiving CT). CT prescription in the ED increased over time (P < 0.001). In patients admitted after ED, CT improved diagnosis consistency for CAP [88.2% vs. 80.9%; difference 7.3% (95% confidence interval 1.2–13.3%)] with a trend for lower hospital length-of-stay [10.2 vs. 12.2 days; difference −2.0 (95% confidence interval −3.9 to −0.1)], but not ICU admission (P = 0.09) and in-hospital mortality (P = 0.056). Diagnosis of patients admitted with CAP improved when CT was obtained at ED visit. These results should be reproduced at a larger scale to test whether early CT conserves healthcare resources.
Assessment of the Wisconsin Criteria at a Level I Trauma Center
Authors: Gray Megan C. , Kollu Tejas , Uppal Priya A. , Hanos Christina , Heiman Adee , Ricci Joseph A. , Patel Ashit
Published: June 2022

The Wisconsin Criteria was developed for physicians evaluating facial trauma to determine the likelihood of facial fractures. Subsequent studies have not consistently validated these criteria. This study seeks to validate the Wisconsin Criteria and determine its utility in predicting operative facial fractures.

Retrospective chart review of the trauma database registry at a Level I Trauma Center was conducted from September 2011 to May 2019. Adult patients who had a complete facial examination by otolaryngology or plastic surgery as well as a head computed tomography scan completed, were included. Fisher exact test was utilized for statistical analysis (P < 0.05) and positive predictive value, and negative predictive value (NPV) were calculated with a 95% confidence interval.

After screening, 546 patients met eligibility, 448 had at least 1 finding of the Wisconsin Criteria, and 472 patients had facial fractures. The sensitivity of the Wisconsin Criteria for determining the presence of a facial fracture was 86.23%, the specificity was 44.59%, and the NPV was 33.67% (P < .0001). Malocclusion was the criterion most specific in determining if a facial fracture was present (98.65%), and Glasgow Coma Score < 14 was the least specific (67.57%).

The Wisconsin Criteria did aid in the identification of facial fractures in trauma patients with a comparable sensitivity, higher specificity, and much lower NPV than originally described. Further investigation should be done to validate the criteria in other large trauma centers.
Extracranial Craniopharyngioma Confined to the Sphenoid Sinus
Authors: Ko Min Chul , Kim Jung Soo , Kim Mee-Seon , Heo Sung Jae
Published: June 2022

Craniopharyngioma is rare epithelial tumor that develops along the craniopharyngeal duct, and most of these tumors occur in the sellar and suprasellar regions. Although it rarely occurs in the extracranial region, sphenoid solitary lesions were not reported in previous literature. In this study, we report a case of infrasellar craniopharyngioma within the sphenoid sinus without intracranial lesion. A patient with intermittent headache visited a private clinic and presented with sphenoid lesions based on the Magnetic resonance imaging scan results. The mass was completely removed using endoscopic endonasal transsphenoidal approach without any complications and showed characteristic pathologic findings, which lead to the diagnosis of craniopharyngioma.
Giant Skull Tumor: A Benign Meningioma
Authors: Abuzayed Bashar , Rawagah Feras , Bataineh Lama , Al Mohtaseb Alia
Published: June 2022

A 37-year-old male patient was complaining from painless forehead swelling, which started 5 years ago. Brain computed tomography scan and magnetic resonance imaging showed a large extradural mass compressing the both frontal lobes with skull bone infiltration, hyperostosis and enlargement. The patient was operated in 2 stages. In the first stage, the authors achieved separation for the tumor from the scalp and skull. In the second stage after 1 week, the authors continued with circumferential dural opening around the tumor and separation of the tumor from brain tissue. Duroplasty was performed by autologous fascia latta and skin flap was closed primarily. The specimen was received grossly as huge mass weighing 1530 g and measuring 39 × 16 × 12 cm. Histopathologic examination showed grade I meningioma extending beyond the skull to the surrounding soft tissue.
Births After Bariatric Surgery in the United States
Authors: Chao Grace F. , Yang Jie , Peahl Alex , Thumma Jyothi R. , Dimick Justin B. , Arterburn David E. , Telem Dana A.
Published: June 2022

Objective:

To characterize incidence and outcomes for bariatric surgery patients who give birth.

Background:

Patients of childbearing age comprise 65% of bariatric surgery patients in the United States, yet data on how often patients conceive and obstetric outcomes are limited.

Methods:

Using the IBM MarketScan database, we performed a retrospective cohort study of female patients ages 18 to 52 undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass from 2011 to 2017. We determined the incidence of births in the first 2 years after bariatric surgery using Kaplan-Meier estimates. We then restricted the cohort to those with a full 2-year follow-up to examine obstetric outcomes and bariatric-related reinterventions. We reported event rates of adverse obstetric outcomes and delivery type. Adverse obstetric outcomes include pregnancy complications, severe maternal morbidity, and delivery complications. We performed multivariable logistic regression to examine associations between birth and risk of reinterventions.

Results:

Of 69,503 patients who underwent bariatric surgery, 1464 gave birth. The incidence rate was 2.5 births per 100 patients in the 2 years after surgery. Overall, 85% of births occurred within 21 months after surgery. For 38,922 patients with full 2-year follow-up, adverse obstetric event rates were 4.5% for gestational diabetes and 14.2% for hypertensive disorders. In all, 48.5% were first-time cesarean deliveries. Almost all reinterventions during pregnancy were biliary. Multivariable logistic regression analysis showed no association between postbariatric birth and reintervention rate (odds ratio: 0.93, 95% confidence interval: 0.78–1.12).

Conclusions:

In this first national US cohort, we find giving birth was common in the first 2 years after bariatric surgery and was not associated with an increased risk of reinterventions. Clinicians should consider shifting the dialogue surrounding pregnancy after surgery to shared decision-making with maternal safety as one component.
Impact of Red Blood Cell Transfusion on In-hospital Mortality of Isolated Coronary Artery Bypass Graft Surgery
Authors: Colson Pascal H. , Gaudard Philippe , Meunier Charles , Seguret Fabienne
Published: June 2022

Objective:

To assess the relationship between red blood cell (RBC) transfusion exposure and in-hospital mortality after isolated coronary artery bypass graft (CABG) surgery.

Background:

RBC transfusion was commonly used to treat anemia in isolated CABG surgery, but transfusion was found an independent risk factor of postoperative mortality; recent guidelines on patient blood management strategy issued in the last decade may have changed transfusion incidence and related mortality.

Methods:

A retrospective cohort study was conducted from the National database on patients’ hospital discharge reports. Consecutive adult patients who underwent isolated CABG surgery in France from January 1, 2016, to December 31, 2018, were included. The primary outcome was the in-hospital mortality rate. RBC transfusion during the hospital stay was identified by specific codes and ordered as categorical variables (no, moderate, or massive transfusion).

Results:

A total of 37,498 participants were studied [mean (SD) age, 66.5 (9.6) years, 31,587 (84.2%) were men]. In-hospital mortality rate was 1.45% (n=541) and RBC transfusion rate was 9.4% (n=3521). In-hospital deaths were more frequent among transfused patients [1.06% (361) if no transfusion up to 10.2% (n=113) if massive transfusion]. After adjustment for confounding variables, RBC transfusion remained a significant independent factor of in-hospital mortality: odds ratio=1.66 (95% confidence interval: 1.27–2.19, P<0.001) for moderate transfusion, 6.40 (95% confidence interval: 5.07–8.09, P<0.001) if massive.

Conclusions and Relevance:

Despite a modest patients’ exposure to transfusion, this study suggests that RBC administration is an independent factor of in-hospital mortality in isolated CABG surgery.
Racial Disparities in the 30-Day Outcomes of Gender-affirming Chest Surgeries
Authors: Jolly Divya , Boskey Elizabeth R. , Ganor Oren
Published: June 2022

Objective:

To determine if and how race impacts the 30-day outcomes of gender-affirming chest surgeries.

Background:

Little is currently known about how race may affect the outcomes of gender-affirming surgeries.

Methods:

We analyzed data from the National Surgical Quality Improvement Program (NSQIP) database of 30-day complications of gender-affirming chest surgeries from 2005 to 2019. All participants had a postoperative diagnosis code for gender dysphoria and at least one procedure code for bilateral mastectomy, bilateral breast reduction, or bilateral augmentation mammoplasty. Differences by racial group were analyzed through Pearson χ2 and multivariate logistic regression.

Results:

There were no racial differences in the all-complication rates for both transmasculine and transfeminine individuals undergoing gender-affirming chest surgeries. Black patients undergoing masculinizing procedures were significantly more likely to experience mild systemic [adjusted odds ratio (aOR): 2.17, 95% confidence interval (CI): 1.02–4.65] and severe complications (aOR: 5.63, 95% CI: 1.99–15.98) when compared with White patients. Patients of unknown race had increased odds of experiencing severe complications for masculinizing procedures compared with White patients (aOR: 3.77, 95% CI: 1.39–10.24). Transmasculine individuals whose race was unknown were 1.98 times more likely (95% CI: 1.03–3.81) to experience an unplanned reoperation compared with White individuals. Black transfeminine individuals were 10.50 times more likely to experience an unplanned reoperation (95% CI: 1.15–95.51) than their White peers.

Conclusions:

Although overall complications are uncommon, there is evidence to suggest that there are racial disparities in certain 30-day outcomes of gender-affirming chest surgeries.
Defining Benchmark Outcomes for Distal Pancreatectomy
Authors: Durin Thibault , Marchese Ugo , Sauvanet Alain , Dokmak Safi , Cherkaoui Zineb , Fuks David , Laurent Christophe , André Marie , Ayav Ahmet , Magallon Cloe , Turrini Olivier , Sulpice Laurent , Robin Fabien , Bachellier Philippe , Addeo Pietro , Souche François-Régis , Bardol Thomas , Perinel Julie , Adham Mustapha , Tzedakis Stylianos , Birnbaum David J. , Facy Olivier , Gagniere Johan , Gaujoux Sébastien , Tribillon Ecoline , Roussel Edouard , Schwarz Lilian , Barbier Louise , Doussot Alexandre , Regenet Nicolas , Iannelli Antonio , Regimbeau Jean-Marc , Piessen Guillaume , Lenne Xavier , Truant Stéphanie , El Amrani Mehdi
Published: June 2022

Objective:

Defining robust and standardized outcome references for distal pancreatectomy (DP) by using Benchmark analysis.

Background:

Outcomes after DP are recorded in medium or small-sized studies without standardized analysis. Therefore, the best results remain uncertain.

Methods:

This multicenter study included all patients undergoing DP for resectable benign or malignant tumors in 21 French expert centers in pancreas surgery from 2014 to 2018. A low-risk cohort defined by no significant comorbidities was analyzed to establish 18 outcome benchmarks for DP. These values were tested in high risk, minimally invasive and benign tumor cohorts.

Results:

A total of 1188 patients were identified and 749 low-risk patients were screened to establish Benchmark cut-offs. Therefore, Benchmark rate for mini-invasive approach was ≥36.8%. Benchmark cut-offs for postoperative mortality, major morbidity grade ≥3a and clinically significant pancreatic fistula rates were 0%, ≤27%, and ≤28%, respectively. The benchmark rate for readmission was ≤16%. For patients with pancreatic adenocarcinoma, cut-offs were ≥75%, ≥69.5%, and ≥66% for free resection margins (R0), 1-year disease-free survival and 3-year overall survival, respectively. The rate of mini-invasive approach in high-risk cohort was lower than the Benchmark cut-off (34.1% vs ≥36.8%). All Benchmark cut-offs were respected for benign tumor group. The proportion of benchmark cases was correlated to outcomes of DP. Centers with a majority of low-risk patients had worse results than those operating complex cases.

Conclusion:

This large-scale study is the first benchmark analysis of DP outcomes and provides robust and standardized data. This may allow for comparisons between surgeons, centers, studies, and surgical techniques.
Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment
Authors: Dewulf Maxime , Muysoms Filip , Vierendeels Tijl , Huyghe Marc , Miserez Marc , Ruppert Martin , Tollens Tim , van Bergen Liesbeth , Berrevoet Frederik , Detry Olivier
Published: June 2022

Introduction:

The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis, we report on the results of the 60-month follow-up of the PRIMAAT trial.

Methods:

In a prospective, multicenter, open-label, randomized design, patients were randomized between prophylactic retrorectus mesh reinforcement (mesh group), and primary closure of their midline laparotomy after open AAA repair (no-mesh group). This article reports on the results of clinical follow-up after 60 months. If performed, ultrasonography or computed tomography were used for the diagnosis of IHs.

Results:

Of the 120 randomized patients, 114 were included in the intention-to-treat analysis. Thirty-three patients in the no-mesh group (33/58—56.9%) and 34 patients in the mesh group (34/56—60.7%) were evaluated after 5 years. In each treatment arm, 10 patients died between the 24-month and 60-month follow-up. The cumulative incidence of IHs in the no-mesh group was 32.9% after 24 months and 49.2% after 60 months. No IHs were diagnosed in the mesh group. In the no-mesh group, 21.7% (5/23) underwent reoperation within 5 years due to an IH.

Conclusions:

Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs.
Genetic background of Cambodian pneumococcal carriage isolates following pneumococcal conjugate vaccine 13
Authors: Belman Sophie , Soeng Sona , Soputhy Chansovannara , Gladstone Rebecca , Hawkins Paulina A. , Breiman Robert F. , McGee Lesley , Bentley Stephen D. , Lo Stephanie W. , Turner Paul
Published: June 2022

Streptococcus pneumoniae

(the pneumococcus) is a leading cause of childhood mortality globally and in Cambodia. It is commensal in the human nasopharynx, occasionally resulting in invasive disease. Monitoring population genetic shifts, characterized by lineage and serotype expansions, as well as antimicrobial-resistance (AMR) patterns is crucial for assessing and predicting the impact of vaccination campaigns. We sought to elucidate the genetic background (global pneumococcal sequence clusters; GPSCs) of pneumococci carried by Cambodian children following perturbation by pneumococcal conjugate vaccine (PCV) 13. We sequenced pre-PCV13 (01/2013–12/2015, N=258) and post-PCV13 carriage isolates (01/2016–02/2017, N=428) and used PopPUNK and SeroBA to determine lineage prevalence and serotype composition. Following PCV13 implementation in Cambodia, we saw expansions of non-vaccine type (NVT) serotypes 23A (GPSC626), 34 (GPSC45) and 6D (GPSC16). We predicted antimicrobial susceptibility using the CDC-AMR pipeline and determined concordance with phenotypic data. The CDC-AMR pipeline had >90 % concordance with the phenotypic antimicrobial-susceptibility testing. We detected a high prevalence of AMR in both expanding non-vaccine serotypes and residual vaccine serotype 6B. Persistently high levels of AMR, specifically persisting multidrug-resistant lineages, warrant concern. The implementation of PCV13 in Cambodia has resulted in NVT serotype expansion reflected in the carriage population and driven by specific genetic backgrounds. Continued monitoring of these GPSCs during the ongoing collection of additional carriage isolates in this population is necessary.