bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison adductor canal block combined with local infiltration analgesia and adductor canal block alone for pain management after total knee arthroplasty
Authors: Zhang Qingchun , Fan Limei
Published: August 2020

Background:

Pain control after total knee arthroplasty has shown many advances; however, the optimal method remains controversial. The purpose of this present study is to assess the efficacy and safety of the addition of local infiltration analgesia to adductor canal block for pain control after primary total knee arthroplasty.

Methods:

This prospective randomized controlled research was conducted from January 2018 to June 2019. All the patients and their family members signed the informed consent forms, and this work was authorized via the ethics committee of Jinxiang Hospital Affiliated to Jining Medical College (JXHP0024578). Inclusion criteria were 55 years old or older, who possess the physical status I–III of American Society of Anesthesiologists, and the body mass index in the range of 18to 30 kg/m2. Exclusion criteria were regional and/or neuroaxial anesthesia contraindications, the history of drug allergy involved in the research, neuropathic pain, as well as the chronic pain requiring opioid therapy. Seventy-two patients were divided into 2 groups randomly. Study group (n = 36) received both adductor canal block and local infiltration analgesia. Control group (n = 36) received adductor canal block alone. Primary outcome included postoperative pain score (visual analog scale 0 to 10 cm, in which 0 represents no pain and 10 represents the most severe imaginable pain). The measures of secondary outcome included the knee range of motion, opioid consumption, the hospital stay length as well as the postoperative complications (for instance, pulmonary embolism, deep vein thrombosis, and the wound infection). All the analyses were conducted through utilizing the SPSS for Windows Version 20.0.

Results:

The results will be shown in Table 1 JOURNAL/medi/04.03/00005792-202008280-00060/table1/v/2023-09-15T184550Z/r/image-tiff .

Conclusion:

The study will provide more evidence on the combination use of adductor canal block and local infiltration analgesia in the treatment of pain after the total knee arthroplasty.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5832).
Effects of shuxuetong injection for cerebral infarction
Authors: Fang Hua , Zhou Honglong , Zhang Jicai , Li Ziyi , Chen Zhen , Yuan RaoRao , Huang Xiangqun , Yang Junyong , Zhang Jianqiang , Wang Shuo , Huang Yong , Hu Shangwei
Published: August 2020

Background:

Cerebral infarction (CI) is a common disease with high morbidity and disability. Shuxuetong (SXT) injection is a Chinese Materia Medica standardized product used in the treatment of CI. Currently, there is a lack of high-quality evidence to support the effectiveness and safety of SXT on patients with CI. This systematic review protocol aims at describing a meta-analysis to evaluate the efficacy of SXT for the treatment of CI.

Methods:

We will search the databases of PubMed, MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database (CNKI), Wan fang database, Chongqing VIP information, and SinoMed from their inception to Jun 2020. Two reviewers will independently screen Randomized controlled trials of SXT for the treatment of CI. The meta-analysis will be conducted using RevMan V.5.3 software.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

The conclusion of our systematic review will provide evidence to judge whether SXT is an effective intervention for patients with CI.

Trial registration number:

10.17605/OSF.IO/3F6ZH.
Application of optimized digital surgical guides in mandibular resection and reconstruction with vascularized fibula flaps
Authors: Han Lu , Zhang Xiaojie , Guo Zeyou , Long Jie
Published: August 2020

Rationale:

Currently, digital surgical techniques have been widely used in the precise treatment of mandibular resection and reconstruction with fibula flaps. Utilizing these innovative techniques in surgical planning and hardware fabrication before surgery has shown to provide great help. However, it is difficult for even experienced surgeons to place the preformed reconstruction plate in the same position as its preoperative design, causing surgical results to differ from preoperative planning. This study aims to solve these acknowledged challenges by creating newly designed equipment.

Patient concerns:

Two patients suffering from long-term expansion of the mandible were admitted to our department. Case I was a 39-year-old female patient who was concerned about the disease in the middle of the mandible, Case II was a 45-year-old female patient who was concerned about the disease at the left mandibular angle and ramus region.

Diagnoses:

Two patients were diagnosed with the mandibular ameloblastoma based on computed tomography (CT) scan and pathological results.

Interventions:

Personalized 3-dimensional (3D) surgical guides were applied to 2 patients with mandibular ameloblastoma who underwent mandibular resection and reconstruction with vascularized fibula flaps using a specially optimized and designed reconstruction guide plate.

Outcomes:

We achieved precise mandibular repair with such a guide in full accordance with the preoperative plan and ensured the restoration of patient facial symmetry.

Lessons:

Optimized reconstruction guide template could accurately locate the preformed reconstruction plate. This component had the ability to ensure that the location of the actual reconstruction plates were highly consistent with preoperative designed models.
Effectiveness of walking versus mind-body therapies in chronic low back pain
Authors: Nduwimana Ildephonse , Nindorera Félix , Thonnard Jean Louis , Kossi Oyene
Published: August 2020

Purpose:

Walking and mind-body therapies (MBTs) are commonly recommended to relieve pain and improve function in patients with chronic low back pain (CLBP). The purpose of this study was to compare the effectiveness of walking and MBTs in CLBP.

Methods:

We included randomized controlled trials (RCTs) comparing walking or MBTs to any other intervention or control in adults with CLBP. Studies were identified through PubMed, Cochrane Library, PsycINFO, Scopus, and ScienceDirect databases. The research was limited to studies published in English and French between January 2008 and December 2018. Two reviewers independently selected the studies, extracted data, and assessed studies quality using the Physiotherapy Evidence Database (PEDro) scale. Statistical analyses were performed under a random-effects model. We analyzed pain and activity limitation, with the calculation of standardized mean differences and 95% confidence intervals for the different treatment effects.

Results:

Thirty one randomized controlled trials involving 3193 participants were analyzed. Walking was as effective as control interventions in the short-term and slightly superior in the intermediate term with respect to pain (Standardized mean differences (SMD)  = –0.34; 95% CI, –0.65 to –0.03; P = .03) and activity limitation (SMD = –0.30; 95% CI, –0.50 to –0.10; P = .003). In contrast, yoga was more effective than control interventions in the short term in terms of pain (SMD = –1.47; 95% CI, –2.26 to –0.68; P = .0003) and activity limitation (SMD = –1.17; 95% CI, –1.80 to –0.55; P = .0002). Yoga was no longer superior to the control interventions for pain at the 6-month follow-up.

Conclusion:

MBTs, especially yoga, seem to be more effective in the short term, and walking seems to be more effective in the intermediate term, for the relief of pain and activity limitation in patients with CLBP. A combination of walking and MBTs fits the biopsychosocial model and might be valuable therapy for CLBP throughout follow-up due to combined effects.
A miRNA-clinicopathological nomogram for the prediction of central lymph node metastasis in papillary thyroid carcinoma-analysis from TCGA database
Authors: Wang Mingjun , Li Rongjing , Zou Xiuhe , Wei Tao , Gong Rixiang , Zhu Jingqiang , Li Zhihui
Published: August 2020

It is of significance to evaluate central lymph node status in patients with papillary thyroid carcinoma (PTC), because it can decrease postoperative complications resulting from unnecessary prophylactic central lymph node dissection (CLND). Due to the low sensitivity and specificity of neck ultrasonography in the evaluation of central lymph node metastasis (CLNM), it is urgently required to find alternative biomarkers to predict CLNM in PTC patients, which is the main purpose of this study.

RNA-sequencing datasets and clinical data of 506 patients with thyroid carcinoma from the Cancer Genome Atlas (TCGA) database were downloaded and analyzed to identify differentially expressed miRNAs (DEMs), which can independently predict CLNM in PTC. A nomogram predictive of CLNM was developed based on clinical characteristics and the identified miRNAs. Receiver operating characteristics curves were drawn to evaluate the predictive performance of the nomogram. Bioinformatics analyses, including target genes identification, functional enrichment analysis, and protein–protein interaction network, were performed to explore the potential roles of the identified DEMs related to CLNM in PTC.

A total of 316 PTC patients were included to identify DEMs. Two hundred thirty-seven (75%) PTC patients were randomly selected from the 316 patients as a training set, while the remaining 79 (25%) patients were regarded as a testing set for validation. Two DEMs, miRNA-146b-3p (HR: 1.327, 95% CI = 1.135–1.551, P = .000) and miRNA-363–3p (HR: 0.714, 95% CI = 0.528–0.966, P = .029), were significantly associated with CLNM. A risk score based on these 2 DEMs and calculating from multivariate logistic regression analysis, was significantly lower in N0 group over N1a group in both training (N0 vs N1a: 2.04 ± 1.01 vs 2.73 ± 0.61, P = .000) and testing (N0 vs N1a: 2.20 ± 0.93 vs 2.79 ± 0.68, P = .003) sets. The nomogram including risk score, age, and extrathyroidal extension (ETE) was constructed in the training set and was then validated in the testing set, which showed better prediction value than the other three predictors (risk score, age, and ETE) in terms of CLNM identification. Bioinformatics analyses revealed that 5 hub genes, SLC6A1, SYT1, COL19A1, RIMS2, and COL1A2, might involve in pathways including extracellular matrix organization, ion transmembrane transporter activity, axon guidance, and ABC transporters.

On the basis of this study, the nomogram including risk score, age, and ETE showed good prediction of CLNM in PTC, which has a potential to facilitate individualized decision for surgical plans.
The efficacy and safety of moxibustion for chemotherapy-induced gastrointestinal adverse reaction
Authors: Zhang Han-Xiao , Zhang Cheng-Shun , Dai Xiao-Qin , Zuo Chuan-Yi , Lv Peng , Huang Rui-Zhen , Mo Qian-Ning , Bai Yi-Feng , Zhou Yi
Published: August 2020

Background:

Many cancer patients experience gastrointestinal adverse reaction during chemotherapy. Pharmacological interventions are commonly used to treat chemotherapy-induced gastrointestinal side effects but have various limitations. Clinical trials have indicated that moxibustion may alleviate gastrointestinal dysfunction and improve quality of life (QoL) after chemotherapy. This study aims to assess the efficacy and safety of moxibustion for chemotherapy-induced gastrointestinal adverse reaction through a systematic review and meta-analysis.

Methods:

All randomized controlled trials (RCTs) related to moxibution targeting chemotherapy-induced gastrointestinal adverse reaction will be searched in online databases, such as PubMed, EMBASE, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP Database) and WanFang Database from their inception to May 1, 2020. The primary outcome is the incidence and severity of chemotherapy-related gastrointestinal toxicities (nausea and vomiting, diarrhea and constipation). The secondary outcomes include the quality of life, biological parameters’ alteration, and adverse events. Study selection, data extraction, and assessment of risk of bias will be performed independently by 2 researchers. The Cochrane Collaboration's Review Manager (RevMan 5.3) software will be used to conduct the direct meta-analysis.

Results:

This study will provide a comprehensive review of the available evidence for the treatment of chemotherapy-induced gastrointestinal adverse reaction with moxibustion.

Conclusion:

The conclusion of this study will provide evidence to judge whether moxibustion is an effective and safety therapeutic intervention for chemotherapy-induced gastrointestinal adverse reaction.

PROSPERO registration number:

CRD42020182990.
Impact of mirna-21 on survival prognosis in patients with pancreatic cancer
Authors: Zhang Wei , Chen Jing , He Guoqian , Xu Wenming , He Guolin
Published: August 2020

Background:

Previous studies have reported that microRNA-21 (mRNA-21) has an effect on the prognosis of pancreatic cancer. However, the conclusion is still unclear. Therefore, this study will try to explore the effect of high expression of mRNA-21 on the prognosis of pancreatic cancer.

Methods:

Retrieved the database, including the China National Knowledge Infrastructure (CNKI), Chinese Biomedical literature Database (CBM), Chinese Scientific and Journal Database (VIP), Wan Fang database, PubMed, and EMBASE. Hazard ratios (HRs) and its 95% confidence intervals (CIs) to assess the prognostic effect of miRNA-21 on overall survival (OS) and disease-free survival (DFS). RevMan 5.3 and STATA 16.0 software were used to perform the meta-analysis.

Results:

This study will comprehensively review and evaluate the available evidence of high expression of miRNA-21 on the prognosis of patients with pancreatic cancer.

Conclusion:

Our findings will show the effect of high expression of miRNA-21 on the prognosis of patients with pancreatic cancer. Such studies may find a new prognostic marker for patients with pancreatic cancer and help clinicians and health professionals make clinical decisions.

Ethics and dissemination:

The private information from individuals will not publish. This systematic review also will not involve endangering participant rights. Ethical approval is not available. The results may be published in a peer- reviewed journal or disseminated in relevant conferences.

OSF Registration number:

DOI 10.17605/OSF.IO/2A6KJ.
Therapeutic Potentials of MicroRNAs for Curing Diabetes Through Pancreatic β-Cell Regeneration or Replacement
Authors: Ghani Muhammad Waseem , Li Ye , Ghani Hammad , Birmani Muhammad Waseem , Liu Bin , Lang Guan Cun , Zhang Wenqi , Xiao Mei
Published: August 2020

MicroRNAs are a type of noncoding RNAs that regulates the expression of target genes at posttranscriptional level. MicroRNAs play essential roles in regulating the expression of different genes involved in pancreatic development, β-cell mass maintenance, and β-cell function. Alteration in the level of miRNAs involved in β-cell function leads to the diabetes. Being an epidemic, diabetes threatens the life of millions of patients posing a pressing demand for its urgent resolve. However, the currently available therapies are not substantial to cure the diabetic epidemic. Thus, researchers are trying to find new ways to replenish the β-cell mass in patients with diabetes. One promising approach is the in vivo regeneration of β-cell mass or increasing the efficiency of β-cell function. Another clinical strategy is the transplantation of in vitro developed β-like cells. Owing to their role in pancreatic β-cell development, maintenance, functioning and their involvement in diabetes, overexpression or attenuation of different miRNAs can cause β-cell regeneration in vivo or can direct the differentiation of various kinds of stem/progenitor cells to β-like cells in vitro. Here, we will summarize different strategies used by researchers to investigate the therapeutic potentials of miRNAs, with focus on miR-375, for curing diabetes through β-cell regeneration or replacement.
Laterality and Patient-Reported Outcomes following Autologous Breast Reconstruction with Free Abdominal Tissue: An 8-Year Examination of BREAST-Q Data
Authors: Allen Robert J. , Sobti Nikhil , Patel Aadit R. , Matros Evan , McCarthy Colleen M. , Dayan Joseph H. , Disa Joseph J. , Mehrara Babak J. , Morrow Monica , Pusic Andrea L. , Nelson Jonas A.
Published: August 2020

Background:

Despite the rise in rates of contralateral prophylactic mastectomy, few studies have used patient-reported outcomes to assess satisfaction between unilateral and bilateral breast reconstruction with autologous tissue. The purpose of this study was to investigate patient satisfaction and quality of life following autologous reconstruction to determine whether differences exist between unilateral and bilateral reconstructions to better guide clinical decision-making.

Methods:

The current study examined prospectively collected BREAST-Q results following abdominal free flap breast reconstruction procedures performed at a tertiary academic medical center from 2009 to 2017. The reconstruction module of the BREAST-Q was used to assess outcomes between laterality groups (unilateral versus bilateral) at 1 year, 2 years, 3 years, and more than 3 years.

Results:

Overall, 405 patients who underwent autologous breast reconstruction completed the BREAST-Q. Cross-sectional analysis at 1 year, 2 years, and 3 years revealed similar satisfaction scores between groups; however, bilateral reconstruction patients demonstrated higher satisfaction scores at more than 3 years (p = 0.04). Bilateral reconstruction patients reported lower scores of abdominal well-being at 1 year, 2 years, and more than 3 years (p = 0.01, p = 0.03, and p = 0.01, respectively).

Conclusions:

These results suggest that satisfaction with breasts does not differ with the laterality of the autologous reconstruction up to 3 years postoperatively but may diverge thereafter. Bilateral reconstruction patients, however, have lower satisfaction with the abdominal donor site. These data can be used in preoperative counseling, informed consent, and expectations management in patients considering contralateral prophylactic mastectomy.
The Crucial Role of Surgical Treatment in BIA-ALCL Prognosis in Early- and Advanced-Stage Patients
Authors: Campanale Antonella , Spagnoli Alessandra , Lispi Lucia , Boldrini Rosaria , Marletta Marcella
Published: August 2020

Background:

Studies on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) are trying to optimize medical and surgical treatments for early and advanced stages of this disease. The aim of this article is to share the experience gathered on the authors’ prospectively collected 46 well-documented cases.

Methods:

Italian physicians are obliged to report BIA-ALCL cases to the Italian Ministry of Health. Because of this cooperation with health care professionals, the competent authority has coordinated and centralized the collection of information for each patient in 46 cases of BIA-ALCL. Statistical analyses with cumulative incidence and corresponding 95 percent confidence interval are provided for each year, dividing the number of new cases that occurred in a defined year and the population at risk of experiencing BIA-ALCL during the same year.

Results:

The mean time to the onset of symptoms is reduced to 6.4 ± 3.77 years (range, 1 to 22 years). Increased knowledge has also shortened the average time to diagnosis, at 7.2 ± 3.71 years (range, 2 to 22 years). A late seroma appears in 91 percent of cases. The patient who died underwent limited surgery. The Italian incidence has been estimated as 2.8 per 100,000 patients receiving implants (95 percent CI, 0.88 to 4.84) in 2015; 2.1 (95 percent CI, 0.43 to 3.86) in 2016; 3.2 (95 percent CI, 1.11 to 5.31) in 2017; and 3.5 (95 percent CI, 1.36 to 5.78) in 2018.

Conclusion:

Although the number of cases has risen slightly, BIA-ALCL is still a rare disease with a stable incidence, easily recognized and with a favorable prognosis also in advanced stages if complete surgical excision is performed.
Long-Term Outcomes of Successful Fingertip Replantation: A Follow-Up of at Least 10 Years
Authors: Hayashi Kota , Hattori Yasunori , Chia Dawn Sinn Yii , Sakamoto Sotetsu , Doi Kazuteru
Published: August 2020

Background:

The purpose of this study was to evaluate the long-term outcome of successful fingertip replantations with more than 10 years of follow-up after surgery.

Methods:

A total of 34 successfully replanted digits in 31 patients with a mean period to follow-up of 16.5 years were included in this study. The main outcome measures were time to return to work, pain, cold intolerance, sensory recovery, nail deformity, grip strength, range of motion of the thumb interphalangeal or finger distal interphalangeal joint, fingertip atrophy, nonunion, bone shortening, use in activities of daily living, and patient satisfaction.

Results:

None of the patients reported chronic pain. No cold intolerance was experienced in 32 digits. Semmes-Weinstein monofilament testing showed recovery of protective sensation in 27 digits. The moving two-point discrimination test showed excellent or good recovery in 91 percent of the patients. Sensory recovery was satisfactory, and there was no significant difference regardless of nerve repair or injury type. Moderate to severe nail deformity was found in six digits. Fingertip atrophy was evaluated by comparing the volume of the replanted fingertip with the contralateral digit. The volume was 82 ± 17 percent of the contralateral normal side. There was no significant difference in the volume comparing the level of amputation, injury type, or incidence of postoperative vascular complication. Ninety-seven percent of the patients were satisfied with the results.

Conclusion:

Long-term outcome of fingertip replantation more than 10 years after surgery was found to be favorable.
Five Essential Principles for First Web Space Reconstruction in the Burned Hand
Authors: Greyson Mark A. , Wilkens Suzanne C. , Sood Ravi F. , Winograd Jonathan M. , Eberlin Kyle R. , Donelan Matthias B.
Published: August 2020

Background:

Burn injuries commonly affect the hand, and the development of adduction contractures of the first web space is frequent and deleterious, both functionally and aesthetically. Many corrective techniques and algorithmic approaches have been described to treat this problem, but there is no consensus on the optimal management.

Methods:

A retrospective review at a single high-volume pediatric burn center was undertaken to evaluate the clinical course of these patients. All pediatric patients undergoing initial release of burn scar contracture of the first web space from 2005 through 2015 were included in a retrospective cohort study.

Results:

The authors identified 40 patients with 57 burned hands. The initial approach to management was variable. Z-plasty or other local flap was the first technique used in 28 hands (49 percent), split-thickness skin graft in 19 hands (33 percent), full-thickness skin graft in seven hands (12 percent), groin flaps in two hands (4 percent), and a reverse radial forearm flap in one hand (2 percent). The mean numbers of total reconstructive procedures per hand including the initial procedure were as follows: groin flap, 4.0; full-thickness skin graft, 3.1; split-thickness skin graft, 2.1; Z-plasty, 1.4; and reverse radial forearm flap, 1.0.

Conclusions:

Successful reconstruction of the first web space must be addressed in the context of the entire hand. It is the authors’ preference to use split-thickness skin grafting whenever a skin deficiency is present—only then should leading edge contractures be addressed with Z-plasty. Based on their experience, the authors recommend five principles that are essential to successfully treat postburn contractures of the first web space.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Analysis of Alternative Metrics of Research Impact: A Correlation Comparison between Altmetric Attention Scores and Traditional Bibliometrics among Plastic Surgery Research
Authors: Shiah Eric , Heiman Adee J. , Ricci Joseph A.
Published: August 2020

Background:

Scholarly output has typically been measured by citation-based metrics such as the Hirsch index (h-index). The Altmetric Attention Score has emerged as a substitute to measure digital attention given to a project. This study aims to determine whether there is any correlation between h-index and the Altmetric score in the plastic surgery literature.

Methods:

Article metrics (full-text views, abstract views, PDF downloads, times e-mailed, Altmetric Attention Score, times tweeted, and number of citations by posts) were extracted from articles published in Plastic and Reconstructive Surgery over a 2-year period. Author metrics, including h5-index, were also collected. Pairwise correlations were performed using Spearman’s rank correlation coefficient (r).

Results:

A total of 1668 articles were published, with 971 included. Altmetric Attention Scores showed strong correlation with other article metrics (r = 0.48 to 0.97; p < 0.001) but weak correlation with h5-index (r = 0.14; p < 0.001) and sum of times cited without self-citation (r = 0.14; p < 0.001). It did not correlate with total publications, average citations per item, or sum of times cited. The h5-indexes showed strong positive correlation with other author bibliometrics (r = 0.66 to 0.97; p < 0.001); moderate correlation with times e-mailed (r = 0.41; p < 0.001); weak correlation with number of citations by posts (r = 0.10; p = 0.002); and no correlation with full-text views, abstract views, PDF downloads, and times tweeted.

Conclusion:

The Altmetric Attention Score and conventional senior author bibliometrics have weak positive correlation at best and appear to have distinct but complementary roles in measuring scholarly output.
The State of Plastic Surgery Education Outside of the Operating Room
Authors: Fisher Mark , Alba Brandon , Duvvuri Priya , Kasabian Armen K. , Thorne Charles , Janis Jeffrey E. , Gosain Arun K. , Bradley James P. , Tanna Neil
Published: August 2020

Background:

Plastic surgery education consists of technical skills, surgical decision-making, and the knowledge necessary to provide safe patient care. Competency in these modalities is ensured by requiring case minimums and oral and written examinations. However, there is a paucity of information detailing what teaching modalities residency programs use outside of the operating room.

Methods:

A 16-question survey was sent to all integrated and independent program directors. Information regarding nonsurgical resident education was collected and analyzed.

Results:

There were 44 responses (46 percent). Most programs had six to 10 faculty (43 percent), and a majority (85 percent) required faculty to participate in resident education outside of the operating room. Residents most commonly had 3 to 4 hours (43 percent) of protected educational time 1 day per week (53 percent). Nonsurgical education consisted of weekly lectures by attending physicians (44 percent) and residents (54 percent), in addition to weekly CoreQuest (48 percent), teaching rounds (38 percent), and Plastic Surgery Education Network lectures (55 percent). Monthly activities included morbidity and mortality conference (81 percent) and journal club (86 percent). Indications conference was either monthly (41 percent) or weekly (39 percent). Cadaver laboratories, visiting professors, board preparation, in-service review, and meetings with the program director occurred yearly or several times per year. Forty-nine percent of programs sponsor one educational course per resident. In addition, most programs (65 percent) do not receive outside funding for education.

Conclusions:

These findings improve understanding of the current state of nonsurgical resident education in plastic surgery. They illustrate that residents participate in a diverse number of nonsurgical educational activities without any significant standardization.
Sleep Outcomes in Neonates with Pierre Robin Sequence Undergoing External Mandibular Distraction: A Longitudinal Analysis
Authors: Ehsan Zarmina , Weaver K. Nicole , Pan Brian S. , Huang Guixia , Hossain Md M. , Simakajornboon Narong
Published: August 2020

Background:

Robin sequence is a common cause of upper airway obstruction in newborns. Herein, we report sleep outcomes in neonates undergoing external mandibular distraction osteogenesis.

Methods:

In this retrospective, 14-year, single-institution study of neonates with Robin sequence undergoing mandibular distraction osteogenesis, we compare respiratory parameters and sleep architecture before versus after surgery.

Results:

Thirty-one neonates were included; age was 13 days (interquartile range, 5 to 34 days) at preoperative polysomnography and 80 days (interquartile range, 50 to 98 days) at postoperative polysomnography. All neonates had severe obstructive sleep apnea at baseline (defined as pre-operative obstructive apnea hypopnea index ≥ 10). Postoperatively, there was a significant reduction in obstructive apnea hypopnea index [38.3 (interquartile range, 23.4 to 61.8) preoperatively versus 9.4 (interquartile range, 5.3 to 17.1) postoperatively; p < 0.0001], and a significant improvement in sleep efficiency and oxygen saturation nadir. Although 26 neonates (84 percent) had a 50 percent reduction in obstructive apnea hypopnea index postoperatively, all neonates had obstructive sleep apnea, and 15 neonates (48 percent) had persistent severe obstructive sleep apnea following surgery.

Conclusions:

We report the largest cohort of sleep outcomes in neonates with Robin sequence and severe obstructive sleep apnea undergoing external mandibular distraction osteogenesis. Although the severity of obstructive sleep apnea improves postoperatively, the disease persists in all neonates. We propose that neonates undergo polysomnography before and soon after mandibular distraction osteogenesis to objectively assess improvement in obstructive sleep apnea, as they may require additional evaluation for sites of multilevel airway obstruction and treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Age-Related Changes in Relaxation Times, Proton Density, Myelin, and Tissue Volumes in Adult Brain Analyzed by 2-Dimensional Quantitative Synthetic Magnetic Resonance Imaging
Authors: Hagiwara Akifumi , Fujimoto Kotaro , Kamagata Koji , Murata Syo , Irie Ryusuke , Kaga Hideyoshi , Someya Yuki , Andica Christina , Fujita Shohei , Kato Shimpei , Fukunaga Issei , Wada Akihiko , Hori Masaaki , Tamura Yoshifumi , Kawamori Ryuzo , Watada Hirotaka , Aoki Shigeki
Published: August 2020

Objectives

Quantitative synthetic magnetic resonance imaging (MRI) enables the determination of fundamental tissue properties, namely, T1 and T2 relaxation times and proton density (PD), in a single scan. Myelin estimation and brain segmentation based on these quantitative values can also be performed automatically. This study aimed to reveal the changes in tissue characteristics and volumes of the brain according to age and provide age-specific reference values obtained by quantitative synthetic MRI.

Materials and Methods

This was a prospective study of healthy subjects with no history of brain diseases scanned with a multidynamic multiecho sequence for simultaneous measurement of relaxometry of T1, T2, and PD. We performed myelin estimation and brain volumetry based on these values. We performed volume-of-interest analysis on both gray matter (GM) and white matter (WM) regions for T1, T2, PD, and myelin volume fraction maps. Tissue volumes were calculated in the whole brain, producing brain parenchymal volume, GM volume, WM volume, and myelin volume. These volumes were normalized by intracranial volume to a brain parenchymal fraction, GM fraction, WM fraction, and myelin fraction (MyF). We examined the changes in the mean regional quantitative values and segmented tissue volumes according to age.

Results

We analyzed data of 114 adults (53 men and 61 women; median age, 66.5 years; range, 21–86 years). T1, T2, and PD values showed quadratic changes according to age and stayed stable or decreased until around 60 years of age and increased thereafter. Myelin volume fraction showed a reversed trend. Brain parenchymal fraction and GM fraction decreased throughout all ages. The approximation curves showed that WM fraction and MyF gradually increased until around the 40s to 50s and decreased thereafter. A significant decline in MyF was first noted in the 60s age group (Tukey test, P < 0.001).

Conclusions

Our study showed changes according to age in tissue characteristic values and brain volumes using quantitative synthetic MRI. The reference values for age demonstrated in this study may be useful to discriminate brain disorders from healthy brains.
Imaging of Cardiac Infections
Authors: Kirkbride Rachael R. , Rawal Bhavin , Mirsadraee Saeed , Galperin-Aizenberg Maya , Wechalekar Kshama , Ridge Carole A. , Litmanovich Diana E.
Published: August 2020

Infections of the cardiovascular system may present with nonspecific symptoms, and it is common for patients to undergo multiple investigations to arrive at the diagnosis. Echocardiography is central to the diagnosis of endocarditis and pericarditis. However, cardiac computed tomography (CT) and magnetic resonance imaging also play an additive role in these diagnoses; in fact, magnetic resonance imaging is central to the diagnosis of myocarditis. Functional imaging (fluorine-18 fluorodeoxyglucose-positron emission tomography/CT and radiolabeled white blood cell single-photon emission computed tomography/CT) is useful in the diagnosis in prosthesis-related and disseminated infection. This pictorial review will detail the most commonly encountered cardiovascular bacterial and viral infections, including coronavirus disease-2019, in clinical practice and provide an evidence basis for the selection of each imaging modality in the investigation of native tissues and common prostheses.
Perfusion MRI using endogenous deoxyhemoglobin as a contrast agent: preliminary data
Authors: Poublanc J. , Sobczyk O. , Shafi R. , Duffin J. , Uludag K. , Wood J. , Vu C. , Dharmakumar R. , Fisher J.A. , Mikulis D.J.
Published: August 2020

Background

The paramagnetic properties of deoxyhemoglobin shorten T2* as do gadolinium based contrast agents. Induction of abrupt changes in arterial deoxyhemoglobin concentration ([dOHb]) can simulate intra-vascular injections of gadolinium for perfusion imaging.

Aim

To demonstrate the feasibility of making rapid changes in pulmonary venous hemoglobin saturation and employing the resulting changes in T2* to calculate flow metrics in the brain.

Methods

A gas blender with a sequential gas delivery breathing circuit and software enabling prospective arterial blood gas targeting was used to implement rapid isocapnic lung changes in the partial pressure of blood oxygen (PaO2). Lung PO2was initially lowered to induce a low baseline [dOHb]. PaO2 was then rapidly raised to PaO2∼ 100 mmHg for 10 seconds and then rapidly returned to baseline. Blood oxygenation level dependent (BOLD) MRI signal changes were measured over time.

Results

Arrival delay, signal amplitude and change in BOLD discriminated between large arteries, tissue and veins. The median half-time of BOLD signal in the middle cerebral artery was 1.7 s, indicating minimal dispersion confirming effective rapid modulation of pulmonary venous PO2. The contrast-to-noise ratio in the cortex was 3. Calculations of arrival delay, cerebral blood volume, mean transit time and cerebral blood flow were within normal ranges from published literature values.

Conclusion

Non-invasive induction of abrupt changes in [OHb] may function as a novel non-invasive vascular contrast agent for use in perfusion imaging.
Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis
Authors: Emmerson Chris , Adamson James P , Turner Drew , Gravenor Mike B , Salmon Jane , Cottrell Simon , Middleton Victoria , Thomas Buffy , Mason Brendan W , Williams Chris J
Published: August 2020

Background

Adult residential and nursing care homes are settings in which older and often vulnerable people live in close proximity. This population experiences a higher proportion of respiratory and gastrointestinal illnesses than the general population and has been shown to have a high morbidity and mortality in relation to COVID-19.

Methods

We examined 3,115 hospital discharges to 1,068 Welsh adult care homes and the subsequent outbreaks of COVID-19 occurring over an 18 week period between 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time-dependent exposure to hospital discharge on the incidence of the first known outbreak, over a window of 7-21 days after discharge, and adjusted for care home characteristics, including size, type of provision and health board.

Results

A total of 330 homes experienced an outbreak of COVID-19, and 544 homes received a discharge from hospital over the study period. The exposure to discharge from hospital was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1·15, 95% CI 0·89, 1·47, p = 0·29) after adjusting for care home characteristics. Care home size was by far the most significant predictor. Hazard ratios (95% CI) in comparison to homes of <10 residents were: 3·40 (1·99, 5·80) for 10-24 residents; 8·25 (4·93, 13·81) for 25-49 residents; and 17·35 (9·65, 31·19) for homes of 50+ residents. When stratified for care home size, the outbreak rates were similar for periods when homes were exposed to a hospital discharge, in comparison to periods when homes were unexposed.

Conclusion

Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk.

Research in context

What is already known on this subject

Care home populations experience more respiratory outbreaks than the general population1 and older people have been more severely affected by COVID-19, with a case fatality proportion of 2·3% overall but 8% in those aged 70-79 and 14·8% in those aged over 802

Evidence and modelling suggested that up to half of all COVID-19 fatalities could come from the care home population3 and that testing prior to hospital discharge was not always available or undertaken9

Type and use of PPE6 and the number of staff employed can have an impact on care home outbreaks of COVID-196,7

What this study adds

Our analysis found no effect of hospital discharges on care home outbreaks once care home size had been adjusted for. In line with previous studies, larger care homes were much more likely to experience an outbreak
The effectiveness of a FY-1 doctor preparation course for final year medical students
Authors: Beedham William , Wanigasooriya Kasun , Layton Georgia R. , Chan Ley Taing , Darr Adnan , Mittapalli Devender
Published: August 2020

Background

Starting work as a junior doctor can be daunting for any medical student. There are numerous aspects of the hidden or informal curriculum which many students fail to acquire during their training.

Objectives

To evaluate the effectiveness of a novel foundation year one (FY1) doctor preparation course focusing on certain core topics, practical tips and components of the hidden curriculum. The primary objective was to improve the confidence level and knowledge of final year medical student transition to FY1 doctors.

Method

A two-day, practical course titled “Preparation 2 Practice” delivering hands-on, small-group and lecture-based teaching, covering core medical student undergraduate curriculum topics in medicine and surgery. The course content spanned therapeutics, documentation skills and managing acute clinical tasks encountered by FY1 doctors during an on-call shift. A pre- and post-course survey and knowledge assessment were carried out to assess the effectiveness of the course. The assessment was MCQ-based, derived from topics covered within our course. The 20-question test and a short survey were administered electronically.

Results

Twenty students from a single UK medical school attended the course. 100% participation was observed in the pre- and post-course test and survey. The median post-course test result was 22 (IQR 20.25 –23.75) which was higher than the median pre course test score of 18.75 (IQR 17–21.75). A Wilcoxon sign rank test revealed a statistically significant difference between the pre- and post-course test results (p=0.0003). The self-reported confidence score of delegates on starting work as a junior doctor was also significantly higher following the course (p=0.004).

Conclusion

The results show a significant improvement in perceived confidence and knowledge on core curriculum topics amongst final year medical students having attended our FY1 doctor preparation course. We conclude that there is scope for similar supplementary courses as an adjunct to the undergraduate medical curriculum.
Parameter Estimation of COVID-19 Pandemic Model with Self Protection Behavior Changes
Authors: Mekonen Kassahun Getnet , H/Michael Tatek Getachew , Feyissa Shiferaw
Published: August 2020

A mathematical model for the transmission dynamics of Coronavirus diseases (COVID-19) is proposed by incorporating self-protection behavior changes in the population. The disease-free equilibrium point is computed and its stability analysis is studied. The basic reproduction number(R0) of the model is computed and the disease-free equilibrium point is locally and globally stable forR0< 1 and unstable forR0>1. Based on the available data the unknown model parameters are estimated using a combination of least square and Bayesian estimation methods for different countries. Using forward sensitivity index the model parameters is carried out to determine and identify the key factors for the spread of disease dynamics. From country to country the sensitive parameters for the spread of the virus varies. It is found out that the reproduction number depends mostly on the infection rates, the threshold value of the force of infection for a population, the recovery rates, and the virus decay rate in the environment. It is also demonstrated that control of the effective transmission rate (recommended human behavioral change towards self-protective measures) is essential to stop the spreading of the virus. Numerical simulations also show that the virus’s transmission dynamics depend mostly on those sensitive parameters.
Sociodemographic disparities in knowledge, practices, and ability to comply with COVID-19 public health measures in Canada
Authors: Brankston Gabrielle , Merkley Eric , Fisman David N. , Tuite Ashleigh R. , Poljak Zvonimir , Loewen Peter J. , Greer Amy L.
Published: August 2020

The effectiveness of public health interventions for mitigation of the coronavirus (COVID-19) pandemic depends on individual attitudes and the level of compliance toward these measures. We surveyed a representative sample of the Canadian population about risk perceptions, attitudes, and behaviours towards the Canadian COVID-19 public health response. Our analysis demonstrates that these risk perceptions, attitudes, and behaviours varied by several demographic variables identifying a number of areas in which policies could help address issues of public adherence. Examples include targeted messaging for men and younger age groups, social supports for those who need to self-isolate but may not have the means to do so, changes in workplace policies to discourage presenteeism, and provincially co-ordinated masking and safe school reopening policies. Taken together such measures are likely to mitigate the impact of the next pandemic wave in Canada.
SARS-CoV-2 phylodynamics differentiates the effectiveness of non-pharmaceutical interventions
Authors: Rasigade Jean-Philippe , Barray Anaïs , Shapiro Julie Teresa , Coquisart Charlène , Vigouroux Yoann , Bal Antonin , Destras Grégory , Vanhems Philippe , Lina Bruno , Josset Laurence , Wirth Thierry
Published: August 2020

Quantifying the effectiveness of large-scale non-pharmaceutical interventions against COVID-19 is critical to adapting responses against future waves of the pandemic. By combining phylogenetic data of 5,198 SARS-CoV-2 genomes with the chronology of non-pharmaceutical interventions in 57 countries, we examine how interventions and combinations thereof alter the divergence rate of viral lineages, which is directly related to the epidemic reproduction number. Home containment and education lockdown had the largest independent impacts and were predicted to reduce the reproduction number by 35% and 26%, respectively. However, we find that in contexts with a reproduction number >2, no individual intervention is sufficient to stop the epidemic and increasingly stringent intervention combinations may be required. Our phylodynamic approach can complement epidemiological models to inform public health strategies against COVID-19.
SARS-CoV-2 3CLpro whole human proteome cleavage prediction and enrichment/depletion analysis
Authors: Prescott Lucas
Published: August 2020

A novel coronavirus (SARS-CoV-2) has devastated the globe as a pandemic that has killed more than 1,600,000 people. Widespread vaccination is still uncertain, so many scientific efforts have been directed toward discovering antiviral treatments. Many drugs are being investigated to inhibit the coronavirus main protease, 3CLpro, from cleaving its viral polyprotein, but few publications have addressed this protease’s interactions with the host proteome or their probable contribution to virulence. Too few host protein cleavages have been experimentally verified to fully understand 3CLpro’s global effects on relevant cellular pathways and tissues. Here, I set out to determine this protease’s targets and corresponding potential drug targets. Using a neural network trained on cleavages from 388 coronavirus proteomes with a Matthews correlation coefficient of 0.983, I predict that a large proportion of the human proteome is vulnerable to 3CLpro, with 4,460 out of approximately 20,000 human proteins containing at least one putative cleavage site. These cleavages are nonrandomly distributed and are enriched in the epithelium along the respiratory tract, brain, testis, plasma, and immune tissues and depleted in olfactory and gustatory receptors despite the prevalence of anosmia and ageusia in COVID-19 patients. Affected cellular pathways include cytoskeleton/motor/cell adhesion proteins, nuclear condensation and other epigenetics, host transcription and RNAi, ribosomal stoichiometry and nascent-chain detection and degradation, coagulation, pattern recognition receptors, growth factors, lipoproteins, redox, ubiquitination, and apoptosis. This whole proteome cleavage prediction demonstrates the importance of 3CLpro in expected and nontrivial pathways affecting virulence, lead me to propose more than a dozen potential therapeutic targets against coronaviruses, and should therefore be applied to all viral proteases and subsequently experimentally verified.
Experimental infection of cattle with SARS-CoV-2
Authors: Ulrich Lorenz , Wernike Kerstin , Hoffmann Donata , Mettenleiter Thomas C. , Beer Martin
Published: August 2020

Six cattle (Bos taurus) were intranasally inoculated with SARS-CoV-2 and kept together with three naïve in-contact animals. Low-level virus replication and a specific sero-reactivity were observed in two inoculated animals, despite the presence of high antibody titers against a bovine betacoronavirus. The in-contact animals did not become infected.