bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeated occurrence of surface-sediment remobilization along the landward slope of the Japan Trench by great earthquakes
Authors: Ikehara Ken , Usami Kazuko , Kanamatsu Toshiya
Published: August 2020

Deep-sea turbidites have been utilized to understand the history of past large earthquakes. Surface-sediment remobilization is considered to be a mechanism for the initiation of earthquake-induced turbidity currents, based on the studies on the event deposits formed by recent great earthquakes, such as the 2011 Tohoku-oki earthquake, although submarine slope failure has been considered to be a major contributor. However, it is still unclear that the surface-sediment remobilization has actually occurred in past great earthquakes. We examined a sediment core recovered from the mid-slope terrace (MST) along the Japan Trench to find evidence of past earthquake-induced surface-sediment remobilization. Coupled radiocarbon dates for turbidite and hemipelagic muds in the core show small age differences (less than a few 100 years) and suggest that initiation of turbidity currents caused by the earthquake-induced surface-sediment remobilization has occurred repeatedly during the last 2300 years. On the other hand, two turbidites among the examined 11 turbidites show relatively large age differences (~ 5000 years) that indicate the occurrence of large sea-floor disturbances such as submarine slope failures. The sedimentological (i.e., of diatomaceous nature and high sedimentation rates) and tectonic (i.e., continuous subsidence and isolated small basins) settings of the MST sedimentary basins provide favorable conditions for the repeated initiation of turbidity currents and for deposition and preservation of fine-grained turbidites. The MST small basin is a suitable site for examining deep-sea turbidite paleoseismology.
It is not ‘business as usual’ for orthopaedic surgeons in May 2020– the Austrian-German-Swiss experience
Authors: Liebensteiner M. C. , Khosravi I. , Hirschmann M. T. , Heuberer P. R. ,   The Board of the AGA - Society of Arthroscopy and Joint-Surgery, HEUBERER Philipp , NIEMEYER Philipp , LILL Helmut , LAMPERT Christoph , DIRISAMER Florian , BRAUN Sepp , BUCHHORN Tomas , ATTAL René E. L. , JUNG Christian , MÜLLER Andreas Marc , SCHEFFLER Sven , ZELLNER Johannes , ANGELE Peter , Saffarini M. , Thaler M.
Published: August 2020

Purpose

To document the status-quo of orthopaedic health-care services as the COVID-19 pandemic recedes, and to determine the rate of resumption of orthopaedic surgery in the German-speaking countries in May 2020.

Methods

A prospective online survey was sent out to 4234 surgeons of the AGA - Society of Arthroscopy and Joint-Surgery (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey was created using SurveyMonkey software and consisted of 23 questions relating to the reduction of orthopaedic services at the participating centres and the impact that the pandemic is having on each surgeon.

Results

A total of 890 orthopaedic surgeons responded to the online survey. Approximately 90% of them experienced a reduction in their surgical caseload and patient contact. 38.7% stated that their institutions returned to providing diagnostic arthroscopies. 54.5% reported that they went back to performing anterior cruciate ligament reconstructions (ACLR), 62.6% were performing arthroscopic meniscus procedures, and 55.8% had resumed performing shoulder arthroscopy. Only 31.9% of the surgeons were able to perform elective total joint arthroplasty. 60% of the participants stated that they had suffered substantial financial loss due to the pandemic.

Conclusion

A gradual resumption of orthopaedic health-care services was observed in May 2020. Typical orthopaedic surgical procedures like ACLR, shoulder arthroscopy and elective total joint arthroplasty were reported to be currently performed by 54%, 56% and 32% of surgeons, respectively. Despite signs of improvement, it appears that there is a prolonged curtailment of orthopaedic health-care at present in the middle of Europe.
A functional observational battery for evaluation of neurological outcomes in a rat model of acute bacterial meningitis
Authors: Fisher Jane , Pavan Chiara , Ohlmeier Luisa S. , Nilson Bo , Lundgaard Iben , Linder Adam , Bentzer Peter
Published: August 2020

Background

Acute bacterial meningitis is a disease with a high mortality and a high incidence of neurological sequelae in survivors. There is an acute need to develop new adjuvant therapies. To ensure that new therapies evaluated in animal models are translatable to humans, studies must evaluate clinically relevant and patient-important outcomes, including neurological symptoms and sequelae.

Methods

We developed and tested a functional observational battery to quantify the severity of a variety of relevant neurological and clinical symptoms in a rat model of bacterial meningitis. The functional observational battery included symptoms relating to general clinical signs, gait and posture abnormalities, involuntary motor movements, focal neurological signs, and neuromotor abnormalities which were scored according to severity and summed to obtain a combined clinical and neurological score. To test the functional observational battery, adult Sprague-Dawley rats were infected by intracisternal injection of a clinical isolate ofStreptococcus pneumoniae. Rats were evaluated for 6 days following the infection.

Results

Pneumococcal meningitis was not lethal in this model; however, it induced severe neurological symptoms. Most common symptoms were hearing loss (75% of infected vs 0% of control rats;p= 0.0003), involuntary motor movements (75% of infected vs 0% of control rats;p= 0.0003), and gait and posture abnormality (67% of infected vs 0% of control rats;p= 0.0013). Infected rats had a higher combined score when determined by the functional observational battery than control rats at all time points (24 h 12.7 ± 4.0 vs 4.0 ± 2.0; 48 h 17.3 ± 7.1 vs 3.4 ± 1.8; 6 days 17.8 ± 7.4 vs 1.7 ± 2.4;p< 0.0001 for all).

Conclusions

The functional observational battery described here detects clinically relevant neurological sequelae of bacterial meningitis and could be a useful tool when testing new therapeutics in rat models of meningitis.
Diffusion-Weighted Imaging (DWI) derived from PET/MRI for lymph node assessment in patients with Head and Neck Squamous Cell Carcinoma (HNSCC)
Authors: Freihat Omar , Pinter Tamas , Kedves András , Sipos Dávid , Cselik Zsolt , Repa Imre , Kovács Árpád
Published: August 2020

Background

To determine the usefulness of Diffusion Weighted Imaging (DWI) derived from PET/MRI in discriminating normal from metastatic lymph nodes and the correlation between the metastatic lymph nodes with the grade and the localization of the primary tumor.

Methods

Retrospective study of 90 lymph nodes from 90 subjects; 65 patients who had proven histopathological metastatic lymph nodes from (HNSCC) who had undergone18F- PET/MRI for clinical staging and assessment and twenty-five lymph nodes were chosen from 25 healthy subjects. Apparent Diffusion Coefficient (ADC) map was generated from DWI withbvalues (0 and 800 s/mm2). ADC values of the metastatic lymph nodes were calculated and compared to the normal lymph nodes ADC values, ROC was used to determine the best cut-off values to differentiate between the two group. Metastatic lymph nodes ADC mean values were compared to primary tumor grade and localization.

Results

ADCmean value of the metastatic lymph nodes in the overall sample (0.899 ± 0.98*10− 3 mm2/sec) was significantly lower than the normal lymph nodes’ ADCmean value (1.267 ± 0.88*10− 3 mm2/sec); (P = 0.001). The area under the curve (AUC) was 98.3%, sensitivity and specificity were 92.3 and 98.6%, respectively, when using a threshold value of (1.138 ± 0.75*10− 3 mm2/sec) to differentiate between both groups. Significant difference was found between metastatic lymph nodes (short-axis diameter < 10 mm), ADCmean (0.898 ± 0.72*10− 3 mm2/sec), and the benign lymph nodes ADCmean, (P = 0.001). No significant difference was found between ADCmean of the metastatic lymph nodes < 10 mm and the metastatic lymph nodes > 10 mm, ADCmean (0.899 ± 0.89*10− 3 mm2/sec), (P = 0.967). No significant differences were found between metastatic lymph nodes ADCmean values and different primary tumor grades or different primary tumor localization, (P > 0.05).

Conclusion

DWI-ADC is an effective and efficient imaging technique in differentiating between normal and malignant lymph nodes, and might be helpful to discriminate sub-centimeters lymph nodes.

Trial registration

The trial is registered in clinical trials underID:NCT04360993, registration date: 17/04/2020.
Potential impact and challenges associated with Parkinson’s disease patient care amidst the COVID-19 global pandemic
Authors: Elbeddini Ali , To Anthony , Tayefehchamani Yasamin , Wen Cindy
Published: August 2020

Background

COVID-19 has made itself known to health care providers and families across the world in a matter of months. While primarily a respiratory disorder, it has also been shown to cause neurological symptoms, which can be a concern for Parkinson’s disease (PD) patients. Although PD is not as common as other conditions such as cardiovascular diseases, it affects millions of patients around the world whose care has been affected by the global pandemic.

Objectives

The aim of this review is to provide insight into the direct and indirect associations between COVID-19 and PD patient care.

Results

Potential direct effects of COVID-19 include possible neurodegeneration, concerns of symptom self-management with over-the-counter (OTC) products and ICU challenges that can arise in PD patients. In addition, a subset of PD patients may be at higher risk of severe COVID-19 infection. The indirect effects of the pandemic are associated with the social distancing measures and disruptions in health care systems and PD clinical trials, which may negatively affect PD patients’ mental wellbeing and create barriers in controlling their PD symptoms. On a more positive note, telemedical care is quickly emerging as a primary communication tool for virtual patient care. However, further research should be conducted to examine the applicability of telemedicine across the entire PD population, such as those with more severe symptoms living in less developed areas. With all the uncertainty during this time, it is hopeful to hear many promising COVID-19 treatments being researched, one of them being a PD drug therapy, amantadine.

Conclusion

Hopefully, we can consider this pandemic an opportunity to strengthen the PD community and learn more about the impact of the SARS-COV-2 virus. This review provides an overview of the interaction between COVID-19 and PD patients and future investigational retrospective studies are suggested to validate the observations.
Development of an invasive ductal carcinoma in a contralateral composite nipple graft after an autologous breast reconstruction: a case report
Authors: Kimura Mariko , Narui Kazutaka , Shima Hidetaka , Ikejima Shizune , Muto Mayu , Satake Toshihiko , Tanabe Mikiko , Inayama Yoshiaki , Adachi Shoko , Yamada Akimitsu , Shimada Kazuhiro , Sugae Sadatoshi , Ichikawa Yasushi , Ishikawa Takashi , Endo Itaru
Published: August 2020

Background

Nipple-areola complex (NAC) reconstruction is a technique used in breast reconstructive surgery, which is performed during the final stage of breast reconstruction after total mastectomy of primary breast cancer. Composite nipple grafts utilizing the contralateral NAC are common; however, to our knowledge, there are no reports of new primary invasive ductal carcinoma development within the graft. Here, we describe one such case for the first time.

Case presentation

A 54-year-old woman was referred to us by the Department of Plastic and Reconstructive Surgery in our medical center for further evaluation of right nipple erosion. She had undergone total mastectomy of the right breast following a breast cancer diagnosis 15 years ago, at which time tumor biological profiling revealed the following: estrogen receptor (ER), positive; progesterone receptor (PgR), negative; and human epidermal growth factor receptor 2 (HER2), undetermined. She received adjuvant chemotherapy and endocrine therapy. She defaulted endocrine therapy for a few years, and 7 years after surgery, she underwent autologous breast reconstruction with a deep inferior epigastric perforator (DIEP) flap. In the following year, NAC reconstruction was performed using a composite graft technique. Seven years after the NAC reconstruction, erosion appeared on the nipple grafted from its contralateral counterpart; scrape cytology revealed malignancy. The skin on the right side of her chest around the NAC and subcutaneous fat tissue consisted of transferred tissue from the abdomen, as the DIEP flap and grafted nipple were located on the graft skin. The right nipple carcinoma arose from the tissue taken from the left nipple. Magnetic resonance imaging (MRI) or computed tomography showed no malignant findings in the left breast. As the malignant lesion seemed limited to the area around the grafted right nipple on MRI, surgical resection with sufficient lateral and deep margins was performed around the right nipple. Pathological findings revealed invasive ductal carcinoma with comedo ductal components infiltrating the graft skin and underlying adipose tissue. Immunohistochemistry revealed positive for ER, PgR, and HER2.

Conclusions

To our knowledge, this is the first case involving the development of invasive ductal carcinoma in a nipple graft constructed on the skin of a DIEP flap, with the origin from the contralateral breast’s nipple.
Potential assessment and experimental analysis of solar vegetable dryer: in case of northern Ethiopia
Authors: Sintie Yihun Tefera , Aduye Gebrie Teshome
Published: August 2020

The traditional vegetable drying (open-air/sun drying) method of harvesting of tomato, potato and onion in the Fogera District in Amhara regional state, Ethiopia, leads to loss of product, reduction in the quality of product and economic loss for the poor farmers. So, this experiment aimed to show the effectiveness of solar dryer technology by increasing the quality of the product in tomato, potato, and onion in Fogera district Northwest Ethiopia, 2018. A simple solar vegetable dryer is experimentally analyzed to alleviate the problem associated with vegetable processing in Woreta city. The first law of thermodynamics energy analysis was carried out to estimate the amount of useful energy gained from solar air dryer and energy utilization ratio of the drying chamber and the energy through drying box. The magnitude of the exergy inflow, outflow and exergy losses in the drying chamber during the drying process was determined by applying the second law of thermodynamics. The average solar drying efficiency was found to be 75.01% to 86.70% for tomato, 75.70% to 87.90% for potato and 58.7% to 85.5% for onion. Regrading the drying period, it took 33 h for tomato, 27 h for potato and 44 h for onion during the experimental test.
Study protocol: a lifestyle intervention for African American and Hispanic prostate cancer survivors on active surveillance and their partners
Authors: Cho Dalnim , Basen-Engquist Karen , Acquati Chiara , Ma Hilary , Pettaway Curtis , Li Yisheng , Diep Cassandra S. , McNeill Lorna H.
Published: August 2020

Background

Prostate cancer is the most commonly diagnosed cancer in both African American and Hispanic men. Active surveillance is a treatment option for low- or very low-risk prostate cancer survivors, and lifestyle interventions have been found to reduce the disease progression and improve the quality of life for both survivors and their partners. To date, no lifestyle interventions that specifically target African American or Hispanic men and their partners exist. This protocol describes a study that tests the feasibility of a randomized controlled trial, a lifestyle intervention developed to enhance healthy lifestyle and quality of life among African American and Hispanic men on active surveillance and their partners.

Methods

A mixed-method study, including a two-arm randomized controlled trial (n = 30 dyads in the intervention arm and n = 10 dyads in the control arm) and in-depth interviews, will be conducted. Intervention arm participants will receive bi-weekly health coaching calls (a total of 12 calls based on Motivational Interviewing), as well as physical activity-specific (e.g., power point slides, print materials about physical activity, and activity trackers for self-monitoring) and nutrition-specific education (e.g., two nutrition counseling sessions from a registered dietitian, print materials about nutrition, and food intake recording for self-monitoring) over 6 months. All participants will be assessed at baseline, month 3, and month 6. Blood will be collected at baseline and month 6 from the prostate cancer survivors. Finally, in-depth interviews will be conducted with subsamples (up to n = 15 dyads in the intervention arm and up to n = 5 dyads in the control arm) at baseline and months 3 and 6 to conduct a process evaluation and further refine the intervention.

Discussion

If effective, the intervention may have a higher health impact compared with a typical lifestyle intervention targeting only survivors (or partners), as it improves both survivors’ (tertiary prevention) and partners’ health (primary prevention). Results from this study will provide important information regarding recruiting racial/ethnic minority cancer survivors and their partners. Lessons learned from this study will be used to apply for a large-scale grant to test the impact of the dyadic intervention in a fully powered sample.

Trial registration

ClinicalTrials.gov (NCT No. 03575832) registered on 3 July 2018.
Pediatric size phlebotomy tubes and transfusions in adult critically ill patients: a pilot randomized controlled trial
Authors: Barreda Garcia Javier , Xian Jonathan Z. , Pedroza Claudia , Salahuddin Moiz , Mak Garbo , Keene Anabelle , Cherian Sujith V. , Young Alisha Y. , Vijhani Praveen , Doshi Pratik B.
Published: August 2020

Background

Transfusion of red blood cells (RBC) is common, can have adverse effects, and is a costly and limited resource. Interventions that reduce iatrogenic blood losses could reduce transfusions. The objectives of this pilot trial were to assess the feasibility (acceptability of the intervention and suitability of eligibility criteria) and potential effectiveness of pediatric size phlebotomy tubes in adult critically ill patients.

Methods

We conducted a pilot, randomized controlled trial in the medical intensive care unit (ICU) of a university-affiliated, tertiary care referral hospital from November 2017 to September 2018. A total of 200 patients with hemoglobin of at least 7 g/dL and without bleeding were randomized to pediatric or adult size phlebotomy tubes. Stratification was according to baseline hemoglobin (7–9.49 g/dL, 9.5–11.99 g/dL, and 12 g/dL or greater). Acceptability was measured via the number of blood test recollections and the number of patients that discontinued the use of pediatric tubes. The suitability of patient eligibility criteria was determined by identifying baseline characteristics associated with RBC transfusions. Potential effectiveness was estimated from the time to RBC transfusion or to hemoglobin level below 7 g/dL.

Results

The use of pediatric tubes was acceptable as patients experienced a low number of tests recollections (on average 1 every 57 days), and none of the participants discontinued their use. The baseline hemoglobin category was the only factor that appeared to be independently associated with RBC transfusions. A total of 6 patients (6%) in the pediatric tube group and 11 patients (11%) in the adult tube group (hazard ratio, 0.69; 95% CI, 0.25 to 1.9) received an RBC transfusion or reached hemoglobin below 7 g/dL. Almost all of these patients (16 of 17 participants) had baseline hemoglobin of 7–9.49 g/dL.

Conclusions

This pilot study suggests that pediatric phlebotomy tubes are acceptable to patients and can therefore be used in adult ICU patients. A future study should focus on patients with hemoglobin levels below 9.5 g/dL, as these patients have a high risk of transfusions. This intervention has the potential of being successful in selected patients. A definitive trial is warranted.

Trial registration

ClinicalTrials.gov, NCT03286465. Retrospectively registered on September 18, 2017.
Assessment of the correlation between various risk factors and orofacial cleft disorder spectrum: a retrospective case-control study
Authors: Cheshmi Behzad , Jafari Zahra , Naseri Mohammad Ali , Davari Heidar Ali
Published: August 2020

Background

Orofacial clefts (OFCs) comprise a wide range of malformations, including cleft lip, cleft palate, and cleft lip with cleft palate, which can vary in terms of etiology, severity, and disease burden.

Objective(s)

This study aimed to evaluate the correlation between various risk factors and orofacial cleft disorder spectrum in newborns.

Study design

A total of 323 cases and 400 controls were enrolled in this study and evaluated in terms of the maternal history of abortion or miscarriage, child’s sex, maternal and paternal age, maternal history of systemic disease, history of medication therapy during pregnancy, birth order, consanguineous marriage, and complications during pregnancy.

Results

Analysis of the results suggested that consanguineous marriage, a maternal history of abortion/miscarriage, and complications during pregnancy could potentially increase the risk of OFCs in children (P < 0.05). However, the analyses revealed that the other variables could not potentially increase the risk of OFCs (P > 0.05).

Conclusion(s)

Multiple cofactors may simultaneously contribute to the formation of such abnormalities; therefore, a comprehensive, multidisciplinary care program is necessary to ensure a successful pregnancy period and the birth of a healthy newborn.
Atlas-based measures of left ventricular shape may improve characterization of adverse remodeling in anthracycline-exposed childhood cancer survivors: a cross-sectional imaging study
Authors: Narayan Hari K. , Xu Ronghui , Forsch Nickolas , Govil Sachin , Iukuridze David , Lindenfeld Lanie , Adler Eric , Hegde Sanjeet , Tremoulet Adriana , Ky Bonnie , Armenian Saro , Omens Jeffrey , McCulloch Andrew D.
Published: August 2020

Background

Adverse cardiac remodeling is an important precursor to anthracycline-related cardiac dysfunction, however conventional remodeling indices are limited. We sought to examine the utility of statistical atlas-derived measures of ventricular shape to improve the identification of adverse anthracycline-related remodeling in childhood cancer survivors.

Methods

We analyzed cardiac magnetic resonance imaging from a cross-sectional cohort of 20 childhood cancer survivors who were treated with low (< 250 mg/m2[N = 10]) or high (≥250 mg/m2[N = 10]) dose anthracyclines, matched 1:1 by sex and age between dose groups. We reconstructed 3D computational models of left ventricular end-diastolic shape for each subject and assessed the ability of conventional remodeling indices (volume, mass, and mass to volume ratio) vs. shape modes derived from a statistical shape atlas of an asymptomatic reference population to stratify anthracycline-related remodeling. We compared conventional parameters and five atlas-based shape modes: 1) between survivors and the reference population (N = 1991) using multivariable linear regression, and 2) within survivors by anthracycline dose (low versus high) using two-sided T-tests, multivariable logistic regression, and receiver operating characteristic curves.

Results

Compared with the reference population, survivors had differences in conventional measures (lower volume and mass) and shape modes (corresponding to lower overall size and lower sphericity; allp < 0.001). Among survivors, differences in a shape mode corresponding to increased basal cavity size and altered mitral annular orientation in the high-dose group were observed (p = 0.039). Collectively, atlas-based shape modes in conjunction with conventional measures discriminated survivors who received low vs. high anthracycline dosage (area under the curve [AUC] 0.930, 95% confidence interval 0.816, 1.00) significantly better than conventional measures alone (AUC 0.710, 95% confidence interval 0.473, 0.947; AUC comparisonp = 0.0498).

Conclusions

Compared with a reference population, heart size is smaller in anthracycline-exposed childhood cancer survivors. Atlas-based measures of left ventricular shape may improve the detection of anthracycline dose-related remodeling differences.
Multisensory inclusive design with sensory substitution
Authors: Lloyd-Esenkaya Tayfun , Lloyd-Esenkaya Vanessa , O’Neill Eamonn , Proulx Michael J.
Published: August 2020

Sensory substitution techniques are perceptual and cognitive phenomena used to represent one sensory form with an alternative. Current applications of sensory substitution techniques are typically focused on the development of assistive technologies whereby visually impaired users can acquire visual information via auditory and tactile cross-modal feedback. But despite their evident success in scientific research and furthering theory development in cognition, sensory substitution techniques have not yet gained widespread adoption within sensory-impaired populations. Here we argue that shifting the focus from assistive to mainstream applications may resolve some of the current issues regarding the use of sensory substitution devices to improve outcomes for those with disabilities. This article provides a tutorial guide on how to use research into multisensory processing and sensory substitution techniques from the cognitive sciences to design new inclusive cross-modal displays. A greater focus on developing inclusive mainstream applications could lead to innovative technologies that could be enjoyed by every person.
Patient-reported outcome measures for retinoblastoma: a scoping review
Authors: Janic Ana , Bowden Sylvie , Levy Sarah , Stinson Jennifer , Dimaras Helen
Published: August 2020

Background

Retinoblastoma is a childhood retinal cancer with lifelong consequences such as vision loss and increased risk of second cancer. Patient-reported outcome measures (PROMs) are instruments that measure outcomes related to health directly reported by patients. The purpose of this study was to determine the scope, characteristics and quality of PROMs used in retinoblastoma and related fields of pediatric ophthalmology and pediatric oncology.

Methods

Databases MEDLINE and Embase were searched for studies in the English language that reported on PROMs used in retinoblastoma, pediatric oncology, or pediatric ophthalmology; grey literature and studies reporting on developmental PROM phases were excluded. PROMs were grouped by the construct measured and domains assessed, and classified as condition-specific or generic. A subsequent search was then conducted in MEDLINE and Embase for studies assessing measurement properties of the identified PROMs. PROMs with associated studies were assessed for their methodologic quality using the COnsensus-based standard for the Selection of health Measurement INstruments (COSMIN) strategy.

Results

Among 110 eligible studies uncovered by the database searches, 143 PROMs were identified: one retinoblastoma-specific, 56 ophthalmology- and 86 oncology-related. The most common construct measured was ‘health-related quality of life’ and the most common domain assessed was emotional well-being. Of the 143 PROMs, 100 had associated validation studies; the one retinoblastoma-specific PROM was not validated. Quality assessment revealed 34/100 PROMs received a score of sufficient quality in both subcategories of ‘overall content validity’; 3/100 received a score of sufficient quality in both subcategories of ‘internal structure’; 0/100 received a score of sufficient quality in all three subcategories of ‘remaining measurement properties’. The Patient-Reported Outcome Measure Information System (PROMIS) Pediatric Profile-25 was the highest-scoring PROM identified, meeting COSMIN standards for 2/3 measurement property categories (and 5/7 subcategories). Eleven additional PROMs were identified which had sufficient scores in 1/3 measurement property categories (and 5/7 subcategories).

Conclusion

The study identified several PROMs from the pediatric ophthalmology and pediatric oncology literature that could be relevant to the retinoblastoma population, but many have limits to their validation. Future development of a retinoblastoma-specific PROM, performed in partnership with retinoblastoma patients to support optimal content validity, could first focus on the selection and definition of the optimal construct to measure, followed potentially by adaptation and further validation of the relevant PROMs with strong methodologic quality identified in this study.
An observational field study of the cloacal microbiota in adult laying hens with and without access to an outdoor range
Authors: Schreuder Janneke , Velkers Francisca C. , Bouwstra Ruth J. , Beerens Nancy , Stegeman J. Arjan , de Boer Willem F. , van Hooft P. , Elbers Armin R. W. , Bossers Alex , Jurburg Stephanie D.
Published: August 2020

Background

Laying hens with access to outdoor ranges are exposed to additional environmental factors and microorganisms, including potential pathogens. Differences in composition of the cloacal microbial community between indoor- and outdoor-housed layers may serve as an indicator for exposure to the outdoor environment, including its pathogens, and may yield insights into factors affecting the chickens’ microbiota community dynamics. However, little is known about the influence of outdoor housing on microbiota community composition in commercial layer flocks. We performed a cross-sectional field study to evaluate differences in the cloacal microbiota of indoor- vs outdoor-layers across farms.

Eight layer flocks (four indoor, four outdoor) from five commercial poultry farms were sampled. Indoor and outdoor flocks with the same rearing flock of origin, age, and breed were selected. In each flock, cloacal swabs were taken from ten layers, and microbiota were analysed with 16S rRNA gene amplicon sequencing.

Results

Housing type (indoor vs outdoor), rearing farm, farm and poultry house within the farm all significantly contributed to bacterial community composition. Poultry house explained most of the variation (20.9%), while housing type only explained 0.2% of the variation in community composition. Bacterial diversity was higher in indoor-layers than in outdoor-layers, and indoor-layers also had more variation in their bacterial community composition. No phyla or genera were found to be differentially abundant between indoor and outdoor poultry houses. One amplicon sequence variant was exclusively present in outdoor-layers across all outdoor poultry houses, and was identified as Dietzia maris.

Conclusions

This study shows that exposure to an outdoor environment is responsible for a relatively small proportion of the community variation in the microbiota of layers. The poultry house, farm, and rearing flock play a much greater role in determining the cloacal microbiota composition of adult laying hens. Overall, measuring differences in cloacal microbiota of layers as an indicator for the level of exposure to potential pathogens and biosecurity seems of limited practical use. To gain more insight into environmental drivers of the gut microbiota, future research should aim at investigating community composition of commercial layer flocks over time.
Opioids and the Hypothalamic-Pituitary-Gonadal (HPG) Axis
Authors: Wehbeh Leen , Dobs Adrian S
Published: August 2020

Context

Hypogonadism is a well-established consequence of opioid use. It has been reported in both men and women, although more widely studied in men.

Evidence Acquisition

PubMed was searched for articles in English until December 2019 for opioids and hypogonadism. Bibliography of retrieved articles was searched for relevant articles.

Evidence Synthesis

The prevalence of opioid-induced hypogonadism (OIH) varies between studies but was reported to be 69% in a recent systematic review. There is large heterogeneity in the studies, with different factors shown to have stronger association with hypogonadism such as specific types of opioids, higher doses, and longer durations of use. The consequences of OIH include sexual dysfunction, depression, decreased quality of life, and low bone density. There is paucity of randomized controlled trials assessing the efficacy of testosterone replacement therapy (TRT) for OIH in men, and even less studies on treating OIH in women. TRT studies in men reported varying outcomes with some studies favoring and others showing no clear benefit of TRT on different measures.

Conclusions

Despite the high prevalence of OIH, it remains underrecognized and undertreated with multiple endocrine and metabolic consequences. A reasonable approach in patients using opioids includes informing them of this complication and its potential consequences, screening for signs and symptoms of hypogonadism then sex hormone levels if prolonged opioid use > 3 months, and treating patients diagnosed with hypogonadism, if and when clinically indicated, with sex hormones if chronic opioids are planned to be continued for ≥ 6 months.
Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function
Authors: Moolhuijsen Loes M E , Visser Jenny A
Published: August 2020

Context

Anti-müllerian hormone (AMH) is produced by granulosa cells of small, growing follicles in the ovary. Serum AMH levels strongly correlate with the number of growing follicles, and therefore AMH has received increasing attention as a marker for ovarian reserve. This review summarizes recent findings and limitations in the application of serum AMH in ovarian reserve assessment.

Evidence Acquisition

A PubMed search was conducted to find recent literature on the measurements and use of serum AMH as a marker for ovarian reserve.

Evidence Synthesis

Serum AMH levels are measured to assess the “functional ovarian reserve,” a term that is preferred over “ovarian reserve,” since AMH levels reflect the pool of growing follicles that potentially can ovulate. Serum AMH levels are used in individualized follicle-stimulating hormone dosing protocols and may predict the risk of poor response or ovarian hyperstimulation syndrome but has limited value in predicting ongoing pregnancy. Serum AMH levels are studied to predict natural or disease-related age of menopause. Studies show that the age-dependent decline rates of AMH vary among women. The generalized implementation of serum AMH measurement has also led to an increase in diagnostic assays, including automated assays. However, direct comparison of results remains problematic.

Conclusion

Serum AMH remains the preferred ovarian reserve marker. However, the lack of an international standard for AMH limits comparison between AMH assays. Furthermore, little is known about endogenous and exogenous factors that influence serum AMH levels, which limits proper interpretation of AMH values in a clinical setting.
Intraoperative Data Enhance the Detection of High-Risk Acute Kidney Injury Patients When Added to a Baseline Prediction Model
Authors: Kim Minjae , Li Gen , Mohan Sumit , Turnbull Zachary A. , Kiran Ravi P. , Li Guohua
Published: August 2020

BACKGROUND:

Aspects of intraoperative management (eg, hypotension) are associated with acute kidney injury (AKI) in noncardiac surgery patients. However, it is unclear if and how the addition of intraoperative data affects a baseline risk prediction model for postoperative AKI.

METHODS:

With institutional review board (IRB) approval, an institutional cohort (2005–2015) of inpatient intra-abdominal surgery patients without preoperative AKI was identified. Data from the American College of Surgeons National Surgical Quality Improvement Program (preoperative and procedure data), Anesthesia Information Management System (intraoperative data), and electronic health record (postoperative laboratory data) were linked. The sample was split into derivation/validation (70%/30%) cohorts. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL within 48 hours or >50% within 7 days of surgery. Forward logistic regression fit a baseline model incorporating preoperative variables and surgical procedure. Forward logistic regression fit a second model incorporating the previously selected baseline variables, as well as additional intraoperative variables. Intraoperative variables reflected the following aspects of intraoperative management: anesthetics, beta-blockers, blood pressure, diuretics, fluids, operative time, opioids, and vasopressors. The baseline and intraoperative models were evaluated based on statistical significance and discriminative ability (c-statistic). The risk threshold equalizing sensitivity and specificity in the intraoperative model was identified.

RESULTS:

Of 2691 patients in the derivation cohort, 234 (8.7%) developed AKI. The baseline model had c-statistic 0.77 (95% confidence interval [CI], 0.74–0.80). The additional variables added to the intraoperative model were significantly associated with AKI (P < .0001) and the intraoperative model had c-statistic 0.81 (95% CI, 0.78–0.83). Sensitivity and specificity were equalized at a risk threshold of 9.0% in the intraoperative model. At this threshold, the baseline model had sensitivity and specificity of 71% (95% CI, 65–76) and 69% (95% CI, 67–70), respectively, and the intraoperative model had sensitivity and specificity of 74% (95% CI, 69–80) and 74% (95% CI, 73–76), respectively. The high-risk group had an AKI risk of 18% (95% CI, 15–20) in the baseline model and 22% (95% CI, 19–25) in the intraoperative model.

CONCLUSIONS:

Intraoperative data, when added to a baseline risk prediction model for postoperative AKI in intra-abdominal surgery patients, improves the performance of the model.
An Update on One-Lung Ventilation in Children
Authors: Templeton T. Wesley , Piccioni Federico , Chatterjee Debnath
Published: August 2020

One-lung ventilation in children continues to present technical and sometimes physiologic challenges to the clinician. The rarity of these cases at any single institution, however, has led to very few prospective trials to guide best practices. As a result, most clinicians continue to be guided by local tradition and preference. That said, the development of new bronchial blockers such as the EZ-Blocker or blocking devices such as the Univent tube have continued to evolve the practice of lung isolation in children. Further, the development of a variety of extraluminal blocker techniques has led to innovations in practice through a relatively diverse landscape of published case series offering different approaches to one-lung ventilation during the past 15 years. The Arndt bronchial blocker continues to represent the most well documented of these devices. Additionally, recent advances have occurred in our understanding of the relevant anatomic constraints of the lower pediatric airway. This review is intended to provide a comprehensive and practical update to practicing pediatric anesthesiologists to further their understanding of the modern practice of one-lung ventilation for thoracic surgery in children.
A Methyltransferase Inhibitor (Decitabine) Alleviates Intergenerational Effects of Paternal Neonatal Exposure to Anesthesia With Sevoflurane
Authors: Xu Ning , Lei Lei , Lin Yunan , Ju Ling-Sha , Morey Timothy E. , Gravenstein Nikolaus , Yang Jianjun , Martynyuk Anatoly E.
Published: August 2020

BACKGROUND:

Neonatal exposure to sevoflurane induces neurobehavioral and neuroendocrine abnormalities in exposed male rats (generation F0) and neurobehavioral, but not neuroendocrine, abnormalities in their male, but not female, offspring (generation F1). These effects of sevoflurane are accompanied by a hypermethylated neuron-specific K+-2Cl− (Kcc2) Cl− exporter gene in the F0 spermatozoa and the F1 male hypothalamus, while the gene’s expression is reduced in the F0 and F1 hypothalamus. We investigated whether inhibition of deoxyribonucleic acid methyltransferases (DNMTs) before paternal sevoflurane exposure could alleviate the anesthetic’s F0 and F1 effects.

METHODS:

Sprague-Dawley male rats were anesthetized with 2.1% sevoflurane for 5 hours on postnatal day (P) 5 and mated with control females on P90 to generate offspring. The nonselective DNMT inhibitor decitabine (0.5 mg/kg, intraperitoneally) was administered 30 minutes before sevoflurane exposure. The F0 and F1 male rats were evaluated in in vivo and in vitro tests in adulthood.

RESULTS:

Paternal exposure to sevoflurane induced impaired prepulse inhibition of the acoustic startle response and exacerbated corticosterone responses to stress in F0 males and impaired prepulse inhibition of the startle responses in F1 males. These effects were accompanied in both generations by reduced and increased expressions of hypothalamic Kcc2 and Dnmt3a/b, respectively. Decitabine deterred the effects of paternal exposure to sevoflurane in F0 and F1 males.

CONCLUSIONS:

These results suggest that similar decitabine-sensitive mechanisms regulating expression of multiple genes are involved in the mediation of neurobehavioral abnormalities in sires neonatally exposed to sevoflurane and in their future unexposed male offspring.
Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic
Authors: Bowdle Andrew , Jelacic Srdjan , Shishido Sonia , Munoz-Price L. Silvia
Published: August 2020

Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2–infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2–infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance.
A 30-Min Rest Protocol Does Not Affect W′, Critical Power, and Systemic Response
Authors: TRISKA CHRISTOPH , HOPKER JAMES , WESSNER BARBARA , REIF ASTRID , TSCHAN HARALD , KARSTEN BETTINA
Published: August 2020

Purpose

This study aimed to assess and compare the systemic response of oxygen uptake kinetics and muscle deoxygenation between a 30-min rest protocol and a multivisit protocol on the parameters of the power–duration relationship (i.e., critical power [CP] and W′).

Methods

Nine endurance-trained triathletes reported to the laboratory on five occasions: a preliminary graded exercise test and a familiarization, a 30-min single-visit protocol (time trials of 10, 5, and 2 min in that order interspersed with 30 min rest), and a multivisit protocol (time trials of 10, 5, and 2 min in randomized order interspersed by >24 h rest). Heart rate (HR) was recorded continuously, respiratory gases were measured breath by breath, and deoxygenation was recorded at 10 Hz using near-infrared spectroscopy (NIRS) during all tests. Blood lactate (BLa−) concentration was measured before all time trials. Maximal HR (HRmax), oxygen uptake (V˙O2) during the first 2 min (V˙O2onset), mean response time, end-exercise V˙O2 (V˙O2peak), V˙O2 amplitude (amplV˙O2), O2 deficit, NIRS τ, amplitude (amplNIRS), and time delay were assessed. To compare the two protocols and to assess the differences in W′ and CP, a paired sample t-test was used as well as a two-way ANOVA to assess the differences between trials and/or protocols, including trial–protocol interactions.

Results

No significant differences, and trivial effect sizes, were found for W′ and CP between protocols (P = 0.106–0.114, d < 0.01–0.08). Furthermore, no significant differences between protocols were found for all parameters, except for [BLa−]. Significant differences between trials were found for V˙O2ampl, V˙O2onset, NIRS τ, amplNIRS, [BLa−], and HRmax.

Conclusion

Results suggest that W′ and CP can be determined using the 30-min rest protocol without confounding effects of previous severe exercise compared with the multivisit protocol.
Mortality Effects of Hypothetical Interventions on Physical Activity and TV Viewing
Authors: YANG YI , HODGE ALLISON M. , DUGUÉ PIERRE-ANTOINE , WILLIAMSON ELIZABETH J. , GARDINER PAUL A. , BARR ELIZABETH L. M. , OWEN NEVILLE , DUNSTAN DAVID W. , LYNCH BRIGID M. , ENGLISH DALLAS R.
Published: August 2020

Introduction

Long-term effects of physical activity and television (TV) viewing on mortality have been inferred from observational studies. The associations observed do not allow for inferences about the effects of population interventions and could be subject to bias due to time-varying confounding.

Methods

Using data from the Australian Diabetes, Obesity and Lifestyle Study, collected in 1999–2000 (T0), 2004–2005 (T1), and 2011–2012 (T2), we applied the parametric g-formula to estimate cumulative risks of death under hypothetical interventions on physical activity and/or TV viewing determined from self-report while adjusting for time-varying confounding.

Results

In the 6377 participants followed up for 13 yr from 2004 to 2005 to death or censoring in 2017, 781 participants died. The observed cumulative risk of death was 12.2%. The most effective hypothetical intervention was to increase weekly physical activity to >300 min (risk ratio (RR), 0.66 (0.46–0.86) compared with a “worst-case” scenario; RR, 0.83 (0.73–0.94) compared with no intervention). Reducing daily TV viewing to <2 h in addition to physical activity interventions did not show added survival benefits. Reducing TV viewing alone was least effective in reducing mortality (RR, 0.85 (0.60–1.10) compared with the worst-case scenario; RR, 1.06 (0.93–1.20) compared with no intervention).

Conclusions

Our findings suggested that sustained interventions to increase physical activity could lower all-cause mortality over a 13-yr period, and there might be limited gain from intervening to reduce TV viewing time in a relatively healthy population.