bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Care Nurses' Experiences With Patient Safety Incident Management
Authors: Serre Nicole , Espin Sherry , Indar Alyssa , Bookey-Bassett Sue , LeGrow Karen
Published: July 2021

Background:

Global trends in the aging population will increase the demands for long-term care (LTC) resources. Due to recent pressures to deliver more complex care, there is further risk to resident safety in LTC. Emphasis on the management and the delivery in safe and quality resident care in LTC is required.

Purpose:

The purpose of this study was to describe nurses' experiences with patient safety incident (PSI) management involving residents living in LTC.

Methods:

Using a qualitative descriptive approach, 9 nurses were recruited in 3 LTC homes. Semistructured interviews were conducted, and data were analyzed using inductive content analysis.

Results:

Three main categories emerged: commitment to resident safety, workplace culture, and emotional reaction.

Conclusions:

Providing nurses with an opportunity to share their PSI management experiences highlights the current factors influencing frontline resident safety in LTC. Study results can inform nursing practice and policy development to support PSI identification and management.
Automating Case Reporting of Chlamydia and Gonorrhea to Public Health Authorities in Oregon Clinics
Authors: Todd Jonathan V. , Collins Natalie Viator , Oakley Jee , Menza Timothy , Barber Michelle , Kasarskis Irina , Weresch Andrew , Morgan Shane , Jellison Jim , Mishra Ninad , Pérez Alejandro , Karki Saugat
Published: July 2021

Background

Optimizing sexually transmitted disease (STD) reporting to state public health authorities is important to reduce incidence and manage outbreaks of STDs. Electronic laboratory reporting (ELR) is the standard through which local clinics report STDs to state public health authority. Electronic case reporting (eCR) is an alternative approach which automates transmission of case reports to public health jurisdictions using electronic health record (EHR) data.

Methods

Working with 3 community health centers in Oregon between February 3, 2020 and May 15, 2020, we piloted an automated eCR approach for gonorrhea (GC) and chlamydia (CT) from these clinics to the Oregon Health Authority. We compared the eCR approach to the existing ELR approach to determine completeness of case reporting for GC/CT.

Results

A total of 365 eCRs from 206 unique patients were generated. Among 154 instances where the case detection logic was satisfied for CT, 37% (54 instances) were based on the presence of a diagnosis and 63% (97 instances) were based on laboratory data. Among 232 instances where logic was satisfied for GC, 44% (102 instances) reflected a diagnosis and 56% (130 instances) reflected laboratory results. Data completeness was uniformly equal or higher for eCRs versus ELRs.

Conclusions

The eCR approach was successful in identifying CT and GC cases and provided a more complete set of information to assist public health authorities when compared with ELRs. Electronic case reporting has the potential to automate and relieve staff burden on an important reporting requirement for clinical providers.
Direct and Indirect Cost Savings From Sexually Transmitted Infection Testing, Treatment, and Counseling Among Foster Youth
Authors: Kennedy Andrea K. , Kaushik Gaurav , Dubinsky Emma L. , Huseynli Aytakin , Jonson-Reid Melissa , Plax Katie
Published: July 2021

Background

Sexually transmitted infection (STI) prevention programs can decrease the economic burden of STIs. Foster youth have higher rates of STIs compared with their peers; however, information on direct costs and indirect costs averted by STI testing, treatment, and counseling among foster youth is lacking.

Methods

This study used data from a comprehensive medical center for foster youth over a 3-year study period from July 2017 to June 2020. Direct and indirect costs averted by testing and treatment of chlamydia, gonorrhea, and syphilis, as well as HIV testing and counseling, were calculated based on formulas developed by the Centers for Disease Control and Prevention and adjusted for inflation.

Results

Among the 316 youth who received medical services during this time, 206 were sexually active and tested for STIs and/or HIV. Among 121 positive STI test results, 64.5% (n = 78) were positive for chlamydia, 30.6% (n = 37) were positive for gonorrhea, and 5.0% (n = 6) were positive for syphilis. Treatment was provided to all. Overall, $60,049.68 in direct medical costs and $73,956.36 in indirect costs were averted.

Conclusions

Given the rates of STIs among this population and the economic benefit of STI treatment, it is imperative to continue to provide intensive and comprehensive, individualized sexual health care for foster youth. Traditional care management may miss the opportunity to prevent, identify, and treat STIs that comprehensive wraparound care can achieve. This study suggests that comprehensive wraparound care is a cost-effective way to identify, treat, and prevent STIs among foster youth.
Characteristics and Physiologic Changes After 4% Albumin Fluid Boluses in a PICU
Authors: Gelbart Ben , Fulkoski Nick , Stephens David , Bellomo Rinaldo
Published: July 2021

OBJECTIVES:

To describe the characteristics, hemodynamic, and physiologic changes after 4% albumin fluid boluses in critically ill children.

DESIGN:

Retrospective observational study.

SETTING:

Single-center PICU.

PATIENTS:

Children in a cardiac and general PICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Between January 2017 and May 2019, there were 1,003 fluid boluses of 4% albumin during 420 of 5,731 admissions (7.8%), most commonly in children with congenital/acquired heart disease (71.2%) and sepsis (7.9%). The median fluid bolus dose was 10 mL/kg (interquartile range, 5.8–14.6 mL/kg), and its duration 30 minutes (interquartile range, 14.0–40.0 min; n = 223). After the fluid bolus, a significant change in mean arterial pressure (2.3 mm Hg [5.1%], 2.7 mm Hg [5.8%], 2.9 mm Hg [6.1%], and 3.8 mm Hg [8.0%] at 1, 2, 3, and 4 hr, respectively [p ≤ 0.001]) only occurred in children less than or equal to 12 months old. A mean arterial pressure response, defined by an increase greater than or equal to 10% from baseline, occurred in 290 of 887 patients (33%) with maximal response at 1 hour. Hypotension at baseline predicted the magnitude of mean arterial pressure increase at 60 (coefficient 24.3 [95% CI, 0.79–7.87]; p = 0.04) and 120 minutes (coefficient 26.1 [95% CI, 2.75–48.2]; p = 0.02). There were no biochemical or hematocrit changes within 4 hours of the fluid bolus. Urine output for the entire cohort was 2 mL/kg/hr at baseline and did not change with the fluid bolus.

CONCLUSIONS:

Fluid boluses of 4% albumin were common and predominantly in children with cardiac disease and sepsis with a median dose of 10 mL/kg given over half an hour. Such treatment was associated with significant hemodynamic changes only in children less than 12 months old, and we failed to identify an association with urine output.
Physical Medicine and Rehabilitation Consultation for Stroke Patients in Acute Care Setting May Be Associated With an Increased Rate of Discharge to the Community From the Inpatient Rehabilitation Facility
Authors: Ikramuddin Farha S. , Guarino A.J. , Siedel Erica , Vonderhor Kathleen , Larson Elizabeth , Battaglino Ricardo , Morse Leslie
Published: July 2021

Objective

The aim of the study was to determine whether stroke patients who receive physical medicine and rehabilitation consultation in acute care setting are more likely to discharge from inpatient rehabilitation facility to a community setting compared with those who do not.

Design

This was a retrospective analysis of consecutive patients admitted with stroke to inpatient rehabilitation facility between June and October 2018. The primary outcome measure was discharge disposition. Other variables measured included functional independence measures and length of stay. Analysis of baseline covariates was conducted with t tests and analysis of primary outcome measured with Fisher exact test.

Results

We identified 184 consecutive patients, with 62 (33.7%) having and 122 (66.3%) not having a physical medicine and rehabilitation consult; 35 (56.5%) patients versus 51 (41.8%) in physical medicine and rehabilitation consult versus non–physical medicine and rehabilitation group were discharged home (P = 0.042). Between both groups, there were no differences in baseline admission/discharge cognitive or motor functional independence measure scores, total admission/discharge functional independence measure scores, functional independence measure efficiency, or length of stay. However, in both the groups, admission versus discharge overall functional independence measure scores were significantly improved, 71.34 vs. 94.76 and 66.52 vs. 89.94 (P < 0.0001).

Conclusions

Despite no difference in baseline functional scores or length of stay, physical medicine and rehabilitation consultation of poststroke patients in hospital may be associated with discharge home after inpatient rehabilitation facility.
A Systematic Review and Meta-analysis on the Effectiveness of Transcranial Direct Current Stimulation on Swallowing Function of Poststroke Patients
Authors: Lin Qian , Lin Shu-Fang , Ke Xiao-Hua , Jia Xiao-Fei , Huang Dun-Bing
Published: July 2021

Objective

The purpose of this study was to investigate the therapeutic effects of transcranial direct current stimulation on swallowing function in poststroke patients.

Design

We searched for potentially eligible randomized controlled trials from electronic databases, including the PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Chinese Science and Technology Periodical (VIP) databases, from their inception to January 15, 2021. All statistical analyses were performed using RevMan 5.4, and the standardized mean difference with 95% confidence intervals was estimated for the swallowing function outcomes and to understand the mean effect size.

Results

Ten studies involving 343 participants were included in this meta-analysis. The overall analyses demonstrated a significant effect size for swallowing function. Subgroup analyses suggested that both acute and chronic stroke patients showed significant effects on swallowing function after transcranial direct current stimulation. Furthermore, compared with sham stimulation, transcranial direct current stimulation anodal to the affected, unaffected, and bilateral hemispheres can produce a significant effect size for swallowing function in stroke patients.

Conclusions

This meta-analysis showed that transcranial direct current stimulation is likely to be effective for the recovery of dysphagia in poststroke patients, in the acute or chronic phase, and that the effect of anodal transcranial direct current stimulation to unaffected hemispheres is larger.
Let’s Write a Manuscript
Authors: Özçakar Levent , Rizzo John-Ross , Franchignoni Franco , Negrini Stefano , Frontera Walter R.
Published: July 2021

A group of international researchers and editors summarize how (promptly and easily) an original manuscript can be written using certain tips and tricks. The authors guide novice colleagues with minimal experience using simple hints and straightforward advice in scholarly publishing. The main body of an original article is composed of four parts: Introduction, Methods, Results, and Discussion (the IMRaD format). We make recommendations about how to write these sections. We also make suggestions regarding the title, abstract, key words, and references. In addition, we underline the importance of carefully reading and following general recommendations for the conduct, reporting, editing, and publication of scholarly papers. Specific guidelines are reviewed for improving clarity, accuracy, and transparency, from protocol registration and ethical approval to submission issues, inclusive of rehabilitation specificities. A thorough review of the mission and instructions of the journals under consideration is also critical, inclusive of manuscript preparation guidelines such as word limits of main text, limits in number and style of references, tables and figures, format, checklist, and other specific instructions. Finally, each and every sentence should be iteratively revised for grammar, style, and clarity.
The predicted risk of adverse pregnancy outcomes as a result of treatment-associated obesity in a hypothetical population receiving tenofovir alafenamide/emtricitabine/dolutegravir, tenofovir disoproxil fumarate/emtricitabine/dolutegravir or tenofovir disoproxil fumarate/emtricitabine/efavirenz
Authors: Asif Sumbul , Baxevanidi Evangelia , Hill Andrew , Venter Willem Daniel Francois , Fairlie Lee , Masenya Masebole , Serenata Celicia , Sokhela Simiso , Chandiwana Nomathemba
Published: July 2021

Objective:

Integrase inhibitors, including dolutegravir (DTG), are associated with weight gain and obesity, especially when combined with tenofovir alafenamide (TAF). Obesity increases the risk of adverse pregnancy outcomes (APOs). This study aimed to predict the risk of APOs caused by treatment-associated obesity, using a hypothetical sample based on the ADVANCE trial.

Design:

Risk prediction.

Methods:

Firstly, a meta-analysis was performed to determine the relative risk (RR) for APOs in women with obese (≥30) versus normal prepregnancy BMIs (18.5–24.9). For the hypothetical sample, 3000 nonpregnant women with normal BMIs at Week 0 of treatment were evenly allocated across the following treatment arms: TAF/FTC+DTG, TDF/FTC+DTG, TDF/FTC/EFV. The treatment-associated obesity rates from ADVANCE were used to calculate the number of women with obese and normal BMIs expected at Week 96 in our sample. This was combined with the APO RRs to predict the number of women at risk of APOs, in each treatment arm, assuming they conceived at Week 96.

Results:

At Week 96, the percentage of women predicted to be obese was 14.1% with TAF/FTC+DTG, 7.9% with TDF/FTC+DTG and 1.5% with TDF/FTC/EFV. The RR in women with obese versus normal BMIs was significantly higher for most APOs. Therefore, the number of women at risk of APOs was higher with TAF/FTC+DTG than TDF/FTC+DTG and TDF/FTC/EFV. For example, 11/1000 additional gestational hypertension cases were predicted with TAF/FTC+DTG, 6/1000 with TDF/FTC+DTG and 1/1000 with TDF/FTC/EFV.

Conclusion:

Treatment-associated obesity increased the APO risk in women. This risk is likely to increase, as preliminary data from ADVANCE demonstrates ongoing weight gain beyond Week 96.
Hepatitis delta in patients hospitalized in Spain (1997–2018)
Authors: Ramos-Rincon José-Manuel , Pinargote Héctor , Ramos-Belinchón Clara , de Mendoza Carmen , Aguilera Antonio , Soriano Vicente
Published: July 2021

Background:

Hepatitis delta is the most aggressive form of chronic viral hepatitis. We examined the clinical burden, epidemiological features and time trends for hepatitis delta patients hospitalized in Spain during the last two decades.

Methods:

Retrospective, observational study using the Spanish National Registry of Hospital Discharges. Information was retrieved since 1997 to 2018.

Results:

From a total of 79 647 783 nationwide hospital admissions recorded during the study period, 5179 included hepatitis delta as diagnosis. The overall hospitalization rate because of hepatitis delta was 6.5/105, without significant yearly changes. In-hospital death occurred in 335 (6.6%) patients. Acute hepatitis and cirrhosis were recorded in 46.5 and 33.5% of hepatitis delta hospitalizations, respectively. Acute hepatitis delta predominated until 2007 (55.9%) whereas cirrhosis increased since then (39.4%). Hepatic decompensation events and liver cancer accounted on average for 16 and 8% of hospitalizations, increasing significantly over time. Coinfection with HIV and hepatitis C virus (HCV) were recognized in 24 and 31.2% of hepatitis delta patients, respectively. All hepatitis C, HIV and injection drug use declined significantly since 2008.

Conclusion:

The rate of hepatitis delta in patients hospitalized in Spain is low and has remained stable over two decades. However, hepatitis delta-related decompensation events and liver cancer are on the rise. The association of hepatitis delta with injection drug use, HIV and HCV has declined among recently hospitalized hepatitis delta patients.
Duration of antibiotic therapy for Enterobacterales and Pseudomonas aeruginosa: a review of recent evidence
Authors: Reyes Sergio , Morel Maria del Pilar , Kostka Julia , Nicolau David P.
Published: July 2021

Purpose of review

Emergence of multidrug-resistant organisms, impact on intestinal microbiome, side effects and hospital costs are some of the factors that have encouraged multiple studies over the past two decades to evaluate different duration of antibiotic therapy with the goal of shorter but effective regimens. Here, we reviewed the most recent relevant data on the duration of therapy focused on two of the most common Gram-negative organisms in clinical practice, Pseudomonas aeruginosa and Enterobacterales.

Recent findings

Recent studies including meta-analysis confirm that short antibiotic courses for both Enterobacterales and P. aeruginosa infections have comparable clinical outcomes to longer courses of therapy. Despite the advocacy for short-course therapy in contemporary guidelines, recent evidence in the USA has revealed a high prevalence of inappropriate antibiotic usage due to excessive duration of therapy.

Although the decision process regarding the optimal duration of antibiotic therapy is multifactorial, the vast majority of infections other than endocardial or bone and joint, can be treated with short-course antibiotic therapy (i.e., ≤7 days). The combination of biomarkers, clinical response to therapy, and microbiologic clearance help determine the optimal duration in patients with infections caused by P. aeruginosa and Enterobacterales.
Neonatal bloodstream infections
Authors: Hadfield Brandon R. , Cantey Joseph B.
Published: July 2021

Purpose of review

Neonatal bloodstream infections (BSI) are a major contributor to morbidity and mortality within neonatal intensive care units. BSI, including central line-associated BSI, have decreased over the past 15 years but remain common in extremely preterm infants. The purpose of this review is to highlight recent advances in the causes, diagnosis, management, and prevention of neonatal BSI.

Recent findings

Continued quality improvement efforts and bundles have reduced BSI incidence, and novel approaches are highlighted. An update of emerging pathogens as well as traditional pathogens with novel antimicrobial resistance, which are an increasingly common cause of neonatal BSI, is included. Finally, current and future investigations into serum or noninvasive biomarkers for neonatal BSI are reviewed.

Neonatal BSIs continue to decrease due to enhanced infection control and prevention techniques. However, many challenges remain, including emerging bacterial and fungal resistance and the continued need for novel diagnostics that hasten time to pathogen identification and effective treatment. This review of the past 18 months highlights the rapid changes in this area. Ongoing efforts to reduce the morbidity and mortality caused by neonatal BSI must remain a priority.
Characterization of Patients With Dermatomyositis According to Anti–Melanoma Differentiation-Associated Gene-5 Autoantibodies in Centers from 3 Latin American Countries
Authors: Olivo Pallo Pablo Arturo , Hoff Leonardo Santos , Borges Isabela Bruna Pires , Torres-Ruiz Jiram , Cassiano-Quezada Fabiola , Granel Amelia , Gomez Graciela , Pisoni Cecilia , Gomez Ramiro , Shinjo Samuel Katsuyuki
Published: July 2021

Background/Objective

The anti–melanoma differentiation-associated protein 5 (MDA5) autoantibodies have been associated with a high frequency of interstitial lung disease (ILD) and rapidly progressive ILD (RP-ILD) in dermatomyositis (DM) patients, mainly in Asian subjects. However, there is scarce information about these parameters in Latin American patients.

Method

This was a medical records review cohort study that included classic DM (CDM) and clinically amyopathic DM (CADM) patients from 3 Latin American countries (Argentina, Brazil, and Mexico).

Results

A total of 270 DM patients were evaluated: 25.9% with CADM and 74.1% with CDM. The overall prevalence of ILD and RP-ILD, respectively, was 70 (25.9%) and 4 (1.5%) of the 270 patients, and the distributions were comparable between patients with CDM and CADM. The anti-MDA5 was present in 31 (25.4%) of 122 CDM patients and in 17 (48.6%) of 35 CADM patients; it was not associated with presence of ILD and RP-ILD. However, anti-MDA5–positive CDM patients had significantly high frequency of “mechanic's hands,” arthralgia, arthritis, and lower serum levels of creatine phosphokinase, whereas anti-MDA5–positive CADM patients had significantly high frequency of arthritis. Pulmonary infection and ILD are main causes of death in DM patients.

Conclusions

In the present study, the prevalence of ILD in DM patients is comparable to that described in the literature, in contrast to the very low frequency of RP-ILD. In addition, the anti-MDA5 is not associated with ILD and RP-ILD, but anti-MDA5–positive DM patients present conditions that mimic antisynthetase syndrome. Pulmonary infection and ILD were the main causes of death in our sample.
Impact of Fibromyalgia Syndrome on Female Sexual Function
Authors: Ricoy-Cano Adrián Jesús , Cortés-Pérez Irene , del Carmen Martín-Cano María , De La Fuente-Robles Yolanda María
Published: July 2021

Background

Women with fibromyalgia syndrome (FMS) experience generalized and chronic musculoskeletal pain and other disabling symptoms such as female sexual difficulties that reduce the quality and the frequency of their sexual relationships.

Objective

The aim of this study was to examine sexual dysfuntion in women diagnosed with FMS compared with healthy controls.

Methods

A systematic review with meta-analysis was performed. The literature search was conducted using PubMed Medline, Scopus, Web of Science, CINAHL, SciELO, and PsycINFO PROQUEST until February 2021. Observational studies with 2 groups (women with FMS and healthy controls) that assessed sexual function were included. Pooled effect was calculated using Cohen standardized mean difference (SMD) and its 95% confidence interval (CI) in a random-effects model.

Results

Twelve studies were included comprising 1367 women (766 diagnosed with FMS and 601 healthy controls). The methodological quality of the included studies was moderate, according to the Newcastle-Ottawa Scale. Our findings showed a significant sexual dysfunction in women diagnosed with FMS (SMD = 1.72; 95% CI, 1.18–2.26; p < 0.001). In addition, the secondary outcomes more affected in women with FMS were sexual satisfaction (SMD = −2.09; 95% CI, −2.83 to −1.36; p < 0.001) and the pain during sexual relations (SMD = −1.97; 95% CI, −2.81 to −1.12; p < 0.001).

Conclusions

Women with FMS showed a significant sexual dysfunction and other related sexual difficulties, such as increase in sexual pain and a decreased sexual desire or sexual satisfaction, compared with healthy women.
The Role of Early Subspeciality Consultation in the Timing of Hemophagocytic Lymphohistiocytosis Diagnosis and Management
Authors: Patel Sneha , Bibi Ayesha , Eisenberg Ruth , Gendlina Inessa , Murakhovskaya Irina , Ramesh Manish , Balagula Yevgeniy , Kumthekar Anand
Published: July 2021

Objective

The aim of this study was to investigate the relation between timing of subspeciality consult and hemophagocytic lymphohistiocytosis (HLH) consideration, immunosuppression initiation, and in-hospital mortality in patients with HLH.

Methods

We conducted a medical records review study of patients 18 years or older with definite or probable HLH at Montefiore Medical Center between 2006 and 2019. Earlier subspeciality consultation (rheumatology, hematology, and infectious disease) was defined as consultation in less than or equal to 18 hours from time of admission. Demographic, clinical characteristics, and outcomes were compared between patients with early and later subspecialty consultation.

Results

A total of 28 patients were included. The median age was 40 years, and 61% of patients were male. Infection was identified as a cause of HLH in 13 patients (46%). Fifteen patients (54%) were classified as having an earlier subspeciality consultation with a median time (interquartile range) to HLH consideration of 1.0 day (0.3–4.2 days) compared with 7.9 days (3.1–9.9 days) for the later consultation group (p = 0.002). The median time (interquartile range) to immunosuppression initiation was 4.6 days (1.7–7.8 days) versus 10.9 days (5.1–13.4 days) (p = 0.01), respectively. Five patients (33%) had in-hospital deaths in the early consultation group compared with 7 patients (54%) in later consultation group (p = 0.27). Among the subset of patients who survived to discharge, the 90-day readmission rate was higher in the later consultation group (83% vs 30%, p = 0.12).

Conclusions

In patients with HLH, earlier subspeciality consultation may play a role in earlier HLH consideration and treatment initiation.
Coronary Artery Calcium Scoring
Authors: van Praagh Gijs D. , Wang Jia , van der Werf Niels R. , Greuter Marcel J.W. , Mastrodicasa Domenico , Nieman Koen , van Hamersvelt Robbert W. , Oostveen Luuk J. , de Lange Frank , Slart Riemer H.J.A. , Leiner Tim , Fleischmann Dominik , Willemink Martin J.
Published: July 2021

Objectives

Although the Agatston score is a commonly used quantification method, rescan reproducibility is suboptimal, and different CT scanners result in different scores. In 2007, McCollough et al (Radiology 2007;243:527–538) proposed a standard for coronary artery calcium quantification. Advancements in CT technology over the last decade, however, allow for improved acquisition and reconstruction methods. This study aims to investigate the feasibility of a reproducible reduced dose alternative of the standardized approach for coronary artery calcium quantification on state-of-the-art CT systems from 4 major vendors.

Materials and Methods

An anthropomorphic phantom containing 9 calcifications and 2 extension rings were used. Images were acquired with 4 state-of-the-art CT systems using routine protocols and a variety of tube voltages (80–120 kV), tube currents (100% to 25% dose levels), slice thicknesses (3/2.5 and 1/1.25 mm), and reconstruction techniques (filtered back projection and iterative reconstruction). Every protocol was scanned 5 times after repositioning the phantom to assess reproducibility. Calcifications were quantified as Agatston scores.

Results

Reducing tube voltage to 100 kV, dose to 75%, and slice thickness to 1 or 1.25 mm combined with higher iterative reconstruction levels resulted in an on average 36% lower intrascanner variability (interquartile range) compared with the standard 120 kV protocol. Interscanner variability per phantom size decreased by 34% on average. With the standard protocol, on average, 6.2 ± 0.4 calcifications were detected, whereas 7.0 ± 0.4 were detected with the proposed protocol. Pairwise comparisons of Agatston scores between scanners within the same phantom size demonstrated 3 significantly different comparisons at the standard protocol (P < 0.05), whereas no significantly different comparisons arose at the proposed protocol (P > 0.05).

Conclusions

On state-of-the-art CT systems of 4 different vendors, a 25% reduced dose, thin-slice calcium scoring protocol led to improved intrascanner and interscanner reproducibility and increased detectability of small and low-density calcifications in this phantom. The protocol should be extensively validated before clinical use, but it could potentially improve clinical interscanner/interinstitutional reproducibility and enable more consistent risk assessment and treatment strategies.
Changes in Eyelid Position Following Silicone Tube Insertion and Removal in Dacryocystorhinostomy
Authors: Vu Que Anh , Youn Ji Min , Baek Sehyun
Published: July 2021

Aims:

The authors sought to assess the changes in eyelid position after silicone tube insertion and removal in endoscopic dacryocys-torhinostomy.

Methods:

The authors retrospectively reviewed 60 eyes of 48 consecutive patients who underwent endoscopic dacryocystorhinostomy operation at Korea University Guro Hospital, Seoul, Republic of Korea, between April 2019 and November 2019. All cases were evaluated to discern eyelid positioning, focusing on the marginal reflex distance 1, medial palpebral fissure, central palpebral fissure (PF-2), lateral palpebral fissure (PF-3), and medial canthal angle (MCA) before surgery and at 1 week and 1, 2, 3, and 4 months postoperatively.

Results:

Twelve patients (25%) were operated on bilaterally and 36 patients (75%) were operated on unilaterally. The average patient age was 56.5years and 9 men (18.8%) and 39 women (81.3%) were included in this study. At 2 months postoperatively, all values of interest (marginal reflex distance 1, medial palpebral fissure, PF-2, PF-3, and MCA) had decreased significantly (p < 0.05, Friedman test), but the changes in PF-3 immediately after surgery were not significant (P = 0.062, Wilcoxon rank-sum test). From 2 to 3 months after surgery, all 5 indicators of interest increased significantly. After silicone tube removal, whereas there was no statistically significant difference in medial palpebral fissure, PF-3, and marginal reflex distance 1 values; the changes in PF-2 and MCA values as compared with before surgery was 0.47 mm (p = 0.02, Wilcoxon test) and 3.25° (p = 0.000, Wilcoxon test), respectively, which was significantly different. However, with these small gaps, it will be difficult to notice the changes in PF-2 and MCA values during clinical examination.

Conclusion:

Insertion of a silicone tube during endoscopic dacryo-cystorhinostomy leads to temporary deformation of the lid position. However, after silicone tube removal, all eyelids recovered to their original shape.
Unusual Gigantiform Angiomatosis of Jawbone
Authors: Kumar Niranjan , Anehosur Venkatesh , Desai Anil , Agrawal Sayli , Prabhu Avinash , Hallikeri Kaveri
Published: July 2021

The purpose of this paper is to highlight rare highly infiltrative massive Angiomatosis and depict surgical outcome of a rare case series of gigantic lesions in the maxillofacial region. Data were recorded from the medical records of patients. Predictor variables were drawn from demographics, age, gender, site, evaluation of surgical treatment. The outcome variables were the challenges encountered and related complications. Out of 6 patients, the youngest was 10 and the oldest was 26 years old. Soft tissue and jawbone involvement were seen in 3 patients each with a single massive lesion involving both maxilla and mandible. All 6 patients had wide excision of the lesion with one patient having 2 stage procedures. No complications or recurrence was seen at 1-year follow-up. Angiomatosis is a rare and benign lesion in the head and neck region. its diffuse infiltrating nature may give a false malignant picture. it clinically mimics Hemangioma or Arteriovenous (AV) malformation thus requires thorough evaluation and its surgical intervention is challenging as described in this case series because of its magnitude and infiltrative nature.
Spontaneous Fracture of the Maxillary Sinus as a Consequence of Nose-Blowing
Authors: Lee Dong Hoon , Lim Sang Chul
Published: July 2021

Spontaneous fracture of the maxillary sinus without preceding trauma or pathology is extremely rare. Our patient presented with a maxillary sinus fracture related to recurrent nose-blowing, in the absence of any other cause. Although rare, spontaneous fracture of maxillary sinus should be considered in the differential diagnosis of pain and swelling of the cheek and eye in elderly patients.
Preservation Rhinoplasty: Assessment of Anatomical Safe Boundaries on Computed Tomography
Authors: Demirel Oguzhan , Atesci Mustafa Serdar
Published: July 2021

Background:

Nasal dorsum reconstruction is a crucial step of the rhinoplasty. For avoiding complications, techniques that preserve natural dorsal anatomy becomes popular recently. In preservation techniques, ethmoidal bone surgery may take part in the vast majority of defined techniques. Therefore, detailed anatomical knowledge is essential to avoid severe complications, especially cerebrospinal fluid leakage. Based on these, this study aimed to investigate anatomical safe boundaries of preservation techniques based on the measurements on computed tomography.

Methods:

A total of 100 patients who underwent paranasal computed tomography were enrolled in this retrospective study. Five groups were selected based on the age distribution. The distance of the dorsal osteotomy line to cranial base, amount of cartilaginous/bony septum overlaps under nasal bones, cartilaginous/bony septum length anterior and posterior to the nasal hump starting point, and anteroposterior distance of perpendicular plate was measured.

Results:

The mean distance between the starting point of the nasal hump and the cribriform plate was 29.5 mm. The amount of bony overlap above the cartilaginous septum was 10.9 mm in females and 10.5 mm in males. The length of septal cartilage posterior to nasal hump was 0 mm in 39 of 100 patients (39%) and the mean value was 2.38 mm in all populations. The mean distance from the starting point of the perpendicular plate to the cribriform plate was 28.17 mm.

Conclusions:

Perpendicular plate may take part in the constitution of the nasal hump. Therefore, delicate surgery with appropriate tools needed for avoiding the risk of skull base injury.

Level of evidence:

Level of Evidence: 3 (Therapeutic)
Outcome in Elderly Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction
Authors: Ratcovich Hanna Louise , Josiassen Jakob , Helgestad Ole Kristian Lerche , Linde Louise , Jensen Lisette Okkels , Ravn Hanne Berg , Joshi Francis R. , Engstrøm Thomas , Schmidt Henrik , Hassager Christian , Møller Jacob E. , Holmvang Lene
Published: July 2021

Introduction:

Despite advances in treatment of patients with cardiogenic shock following acute myocardial infarction (AMICS) in-hospital mortality remains around 50%. Outcome varies among patient subsets and the elderly often have a poor a priori prognosis. We sought to investigate outcome among elderly AMICS patients referred to evaluation and treatment at a tertiary university hospital.

Methods:

Current analysis was based on the RETROSHOCK registry comprising consecutive AMICS patients admitted to tertiary care. Patients in the registry were individually identified and validated.

Results:

Of 1,716 admitted patients, 496 (28.9%) patients were ≥75 years old. Older patients were less likely to be admitted directly to a tertiary centre (59.4% vs. 69.9%, P = 0.003), receive mechanical support devices (i.e., Impella® (8.9% vs. 15.0%, P = 0.003), and undergo revascularization attempt (76.8% vs. 90.2%, P < 0.001). Thirty-day survivors ≥75 years were characterized by having higher left ventricular ejection fraction (30.2% ± 12.5% vs. 26.5% ± 11.8%, P = 0.004) and lower arterial lactate (3.2[2.2–5.2] mmol/L vs. 5.5[3.3–8.2] mmol/L, P < 0.001) at admission. In a multivariable analysis of patients ≥75 years, higher age (HR 1.09, 95% CI 1.05–1.14, P < 0.001), higher heart rate (HR 1.01, 95% CI 1.001–1.014, P = 0.03), and higher lactate (HR 1.11, 95% CI 1.07–1.16, P < 0.001) at admission were associated with an increased risk of 30-day mortality.

Conclusion:

Among patients ≥75 years with AMICS referred for tertiary specialized treatment, 30-day mortality was 73.4%. Survivors were characterized by lower arterial lactate and heart rate at admission.
Outcomes of Subtotal Parathyroidectomy Versus Total Parathyroidectomy With Autotransplantation for Tertiary Hyperparathyroidism
Authors: Choi Hye Ryeon , Aboueisha Mohamed A. , Attia Abdallah S. , Omar Mahmoud , ELnahla Ahmad , Toraih Eman A. , Shama Mohamed , Chung Woong Youn , Jeong Jong Ju , Kandil Emad
Published: July 2021

Objectives:

Due to the paucity of data and controversy regarding the preferred surgical approach for managing tertiary HPT, we sought to investigate the outcomes of different surgical approaches in managing this challenging disease.

Methods:

We performed a multi-center retrospective study to include patients with tertiary HPT who underwent STPX or total parathyroidectomy with autotransplantation (TPX-A).

Results:

One hundred five patients had kidney transplant, and 43 were on dialysis. In the kidney transplant group, 61 patients underwent STPX, and 44 for TPX-A. Patients’ demographics were not significantly different (48.61 ± 9.31 vs 47.95 ± 12.73 years, P = 0.759. The postoperative follow-up showed that the TPX-A cohort had a higher rate of hypoparathyroidism (N = 20, 45.45%) versus (N = 14, 22.95%) with the STPX cohort (P = 0.013). The cure among the TPX-A cohorts (84.09%) over the STPX cohort (73.77%) (P = 0.153). The long-term follow-up showed that the rate of developing temporary (N = 16, 41.03%) or permanent (N = 8, 20.51%) hypoparathyroidism was significantly higher among patients who underwent TPX-A over the patients who underwent STPX (N = 7, 17.95%), and (N = 4, 10.26%), respectively (P = 0.012). There was no statistical difference between the persistence (N = 3, 7.69%) or the recurrence (N = 2, 5.13%) of the HPT in the TPX-A cohort and the STPX cohort (N = 2, 5.13%). (N = 4, 10.26%), respectively, P = 0.644.

Conclusions:

To our knowledge, this is the largest multi-center study that compared different approaches for managing tertiary HPT. Showing that STPX is the better modality in patients diagnosed with tertiary HPT and had kidney transplants avoiding the risk of hypoparathyroidism.
Effect of Thoracic Surgery Regionalization on 1- and 3-Year Survival after Cancer Esophagectomy
Authors: Ely Sora , Alabaster Amy , Dominguez Dana A. , Maxim Clara , Ashiku Simon K. , Patel Ashish R. , Velotta Jeffrey B.
Published: July 2021

Objective:

The aim of this study was to investigate whether our previously reported improvements in short-term cancer esophagectomy outcomes after large-scale regionalization in the United States translated to longer-term survival benefit.

Background:

Regionalization is associated with better early postoperative outcomes following cancer esophagectomy; however, data regarding its effect on long-term survival are mixed.

Methods:

We retrospectively reviewed 461 patients undergoing cancer esophagectomy before (2009-2013, N = 272) and after (2014-2016, N = 189) regionalization. Kaplan-Meier curves and chi-square tests were used to describe 1- and 3-year survival in each era. Hierarchical logistic regression models examined the adjusted effect of regionalization on mortality.

Results:

Compared to pre-regionalization patients, post-regionalization patients had significantly higher 1-year survival (83.1% vs 73.9%, P = 0.02) but not 3-year survival (52.9% vs 58.2%, P = 0.26).

Subgroup analysis by cancer stage revealed that 1-year survival benefit was only significant among mid-stage (IIB-IIIB) patients, whereas differences in 3-year survival only approached significance among early-stage (IA-IIA) patients.

In multivariable analysis, only regionalization was a predictor of lower mortality at 1 year [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.29-1.00], and only thoracic specialty at 3years (OR 0.62, 95% CI 0.38-0.99). Older age, more advanced stage, and complications were associated with higher 1- and 3-year mortality. Comorbidity, minimally invasive approach, surgeon volume, facility volume, and neoadjuvant treatment were not significant in this model.

Conclusions:

Regionalization was associated with improved 1-year survival after cancer esophagectomy, independent of factors such as morbidity or volume in our adjusted models. This survival benefit did not persist at 3 years, likely due to the aggressive nature of the disease.
Oxicam-type NSAIDs enhanceAgrobacterium-mediated transformation in plants
Authors: Choi Seung-won , Kumaishi Kie , Motohashi Reiko , Enoki Harumi , Chacuttayapong Wiluk , Takamizo Tadashi , Saika Hiroaki , Endo Masaki , Yamada Tetsuya , Hirose Aya , Koizuka Nobuya , Kimura Seisuke , Kawakatsu Yaichi , Koga Hiroyuki , Ito Emi , Shirasu Ken , Ichihashi Yasunori
Published: July 2021

Agrobacterium-mediated transformation represents a key innovation for plant breeding and is routinely used in research and applied biology. However, for several species, the efficacy of transformation is limited. In this study, we discovered that oxicam-type nonsteroidal anti-inflammatory drugs (NSAIDs), including tenoxicam (TNX), enhance the efficiency ofAgrobacterium-mediated transient transformation in the model speciesArabidopsis thalianavia leaf infiltration and can be successfully applied in analyses of the subcellular localisation of fluorescent fusion proteins. TNX acts as an inhibitor of plant immune responses and lacks similar transient transformation efficiency in adde2/ein2/pad4/sid2quadruple mutant background, thereby indicating that TNX increases the efficiency ofAgrobacteriuminfection via a transient shutdown of the immune system mediated by jasmonic acid, ethylene, and salicylic acid signalling. In addition, we found that TNX enhances the efficiency of stable transformation in crops of agricultural and economic importance, such as Jatropha and maize, indicating that TNX can enhance the integration of exogenous DNA into the plant genome via an increased introduction of DNA into plant cells. Given that treatment with oxicam compounds is simple, cost effective, and has broad utility, we anticipate that this discovery will contribute to accelerating genome-editing technologies in plants.
Non-deletional CD8+T cell self-tolerance permits responsiveness but limits tissue damage
Authors: Truckenbrod Emily Nestor , Burrack Kristina S , Knutson Todd P , da Silva Henrique Borges , Block Katharine E , Stagliano Katie R , Hurwitz Arthur A , Fulton Ross B , Renkema Kristin R , Jameson Stephen C
Published: July 2021

Self-specific CD8+ T cells often escape clonal deletion, but the properties and capabilities of such cells in a physiological setting are unclear. We characterized polyclonal CD8+T cells specific for the melanocyte antigen tyrosinase-related protein 2 (Trp2) in mice that express or lack this enzyme due to deficiency inDct, which encodes Trp2. The size, phenotype, and gene expression profile of the pre-immune Trp2/Kb-specific pool were similar in wild-type (WT) andDct-deficient (Dct-/-) mice. Despite comparable initial responses to Trp2 immunization, WT Trp2/Kb-specific cells showed blunted expansion, and scRNAseq revealed WT cells less readily differentiated into a CD25+ proliferative population. Functional self-tolerance clearly emerged when assessing immunopathology: adoptively transferred WT Trp2/Kb-specific cells mediated vitiligo much less efficiently. Hence, CD8+T cell self-specificity is poorly predicted by precursor frequency, phenotype or even initial responsiveness, while deficient activation-induced CD25 expression and other gene expression characteristics may help to identify functionally tolerant cells.
Inhibition of protein N-myristoylation blocksPlasmodium falciparumintraerythrocytic development, egress, and invasion
Authors: Schlott Anja C. , Knuepfer Ellen , Green Judith L. , Hobson Philip , Borg Aaron J. , Morales-Sanfrutos Julia , Perrin Abigail J. , Snijders Ambrosius P. , Tate Edward W , Holder Anthony A.
Published: July 2021

We have combined chemical biology and genetic modification approaches to investigate the importance of protein myristoylation in the human malaria parasite,Plasmodium falciparum. Parasite treatment during schizogony in the last ten to fifteen hours of the erythrocytic cycle with IMP-1002, an inhibitor ofN-myristoyl transferase (NMT), led to a significant blockade in parasite egress from the infected erythrocyte. Two rhoptry proteins were mislocalized in the cell, suggesting that rhoptry function is disrupted. We identified sixteen NMT substrates for which myristoylation was significantly reduced by NMT inhibitor treatment, and of these, six proteins were substantially reduced in abundance. In a viability screen, we showed that for four of these proteins replacement of the N-terminal glycine with alanine to prevent myristoylation had a substantial effect on parasite fitness. In detailed studies of one NMT substrate, glideosome associated protein 45 (GAP45), loss of myristoylation had no impact on protein location or glideosome assembly, in contrast to the disruption caused by GAP45 gene deletion, but GAP45 myristoylation was essential for erythrocyte invasion. Therefore, there are at least three mechanisms by which inhibition of NMT can disrupt parasite development and growth: early in parasite development, leading to the inhibition of schizogony and formation of ‘pseudoschizonts’, which has been described previously; at the end of schizogony, with disruption of rhoptry formation, merozoite development and egress from the infected erythrocyte; and at invasion, when impairment of motor complex function prevents invasion of new erythrocytes. These results underline the importance ofP. falciparumNMT as a drug target because of the pleiotropic effect of its inhibition.
Aerial course stabilization is impaired in motion-blind flies
Authors: Leonte Maria-Bianca , Leonhardt Aljoscha , Borst Alexander , Mauss Alex S.
Published: July 2021

Visual motion detection is among the best understood neuronal computations. One assumed behavioural role is to detect self-motion and to counteract involuntary course deviations, extensively investigated in tethered walking or flying flies. In free flight, however, any deviation from a straight course is signalled by both the visual system as well as by proprioceptive mechanoreceptors called ‘halteres’, which are the equivalent of the vestibular system in vertebrates. Therefore, it is yet unclear to what extent motion vision contributes to course control, or whether straight flight is completely controlled by proprioceptive feedback from the halteres. To answer these questions, we genetically rendered flies motion-blind by blocking their primary motion-sensitive neurons and quantified their free-flight performance. We found that such flies have difficulties maintaining a straight flight trajectory, much like control flies in the dark. By unilateral wing clipping, we generated an asymmetry in propulsory force and tested the ability of flies to compensate for this perturbation. While wild-type flies showed a remarkable level of compensation, motion-blind animals exhibited pronounced circling behaviour. Our results therefore unequivocally demonstrate that motion vision is necessary to fly straight under realistic conditions.