bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual dream and family relationships in frequent sexual dreamers and healthy volunteers
Authors: Shao Xu , Wang Chu , Jia Yanli , Wang Wei
Published: September 2020

Early life family relationships affect the sexuality in adulthood, and these influences might be reflected in sexual dreams. The present study was designed to investigate the exact associations between family relationships and sexual dream experience. We therefore invited 62 frequent sexual dreamers (dreamers) and 104 healthy volunteers (controls) to answer the Sexual Dream Experience Questionnaire (SDEQ) and the Family Relationship Questionnaire (FRQ). Compared to controls, dreamers scored higher on all SDEQ factors and sexual dream frequency, higher on FRQ Paternal Abuse, and lower on FRQ General Attachment and Maternal Freedom Release. In controls, Paternal Abuse was associated with Joyfulness, Maternal Dominance with Aversion, and Maternal Abuse with dream frequency (–). In dreamers, Paternal Abuse was associated with Aversion, Bizarreness and dream frequency, and Maternal Freedom Release with Aversion (–). In conclusion, there were pronounced associations between sexual dreams and family relationships in frequent sexual dreamers. Paternal Abuse in particular was associated with sexual dream experience. Adverse family relationships might induce frequent sexual dream occurrence, and family therapy or early intervention of Paternal Abuse might alleviate the negative sexual dream experience.
Home enteral nutrition after esophagectomy for esophageal cancer
Authors: Liu Li , Wang Yu-cui , Liu Qian-wen , Zhong Jiu-di , Li Jin-bo , Wu Xiao-dan , Qin Hui-ying
Published: September 2020

Background:

Not only has the placement rate of enteral feeding tubes during operations for esophageal cancer increased, but also has number of patients who choose to continue enteral feeding at home instead of removing the feeding tube at discharge. The impacts of home enteral nutrition (HEN) after esophagectomy in esophageal cancer patients are analyzed.

Methods:

A systematic review was conducted in accordance with PRISMA and Cochrane guidelines. English and Chinese databases, including PubMed, Embase, Web of Science, The Cochrane Library, Scopus, CBM, CNKI, and Wan Fang were searched from inception to December 7, 2019. Randomized controlled trials evaluating the short-term outcomes of HEN following esophagectomy in cancer patients were included. The risk of bias of the included studies was appraised according to the Cochrane risk of bias tool. The summary of relative risk/weighted mean difference (WMD) estimates and corresponding 95% confidence interval (95% CI) were calculated using fixed- and random-effects models.

Results:

Nine randomized controlled trials involving 757 patients were included in the meta-analysis. Compared with oral diet, HEN was associated with significantly increased body weight (WMD 3 kg, 95% CI 2.36–3.63, P < .001), body mass index (WMD 0.97 kg/m2, 95% CI 0.74–1.21, P < .001), albumin (WMD 3.43 g/L, 95% CI 2.35–4.52, P < .001), hemoglobin (WMD 7.23 g/L, 95% CI 5.87–8.59, P < .001), and total protein (WMD 5.13 g/L, 95% CI 3.7–6.56, P < .001). No significant differences were observed in prealbumin and gastrointestinal adverse reactions. Physical (WMD 8.82, 95% CI 6.69–10.95, P < .001) and role function (WMD 12.23, 95% CI 2.72–21.74, P = .01) were also significantly better in the HEN group. The nausea/vomiting (WMD −5.43, 95% CI −8.29 to −2.57, P = .002) and fatigue symptoms (WMD −11.76, 95% CI −16.21 to −7.32, P < .001) were significantly reduced. Appetite loss (WMD −8.48, 95% CI −14.27 to −4.88, P = .001), diarrhea (WMD −3.9, 95% CI −7.37 to −0.43, P = .03), and sleep disturbance (WMD −7.64, 95% CI −12.79 to −2.5, P = .004) in the HEN group were also significantly less than the control group.

Conclusions:

HEN improved nutrition status, physical and role function, and reduced nausea/vomiting, fatigue, appetite loss, diarrhea, and sleep disturbance compared with an oral diet in esophageal cancer patients postsurgery. HEN did not increase adverse reactions.
The effectiveness and safety of moxibustion for treating benign prostatic hyperplasia
Authors: Chen Hui , Li Qi , Fang Ting , Liao Anting , Xiang Shanshan , Guo Zheng , Chen Mei , Guo Yongqiang , Liu Fushui , Yang Fengyun
Published: September 2020

Background:

Benign prostatic hyperplasia (BPH) is a disease of the urinary system. It is common in middle-aged and elderly men. Moxibustion is widely used to manage BPH and the associated lower urinary tract symptoms, but there is still lack of systematic review of moxibusiton for BPH. So the aim of this review is to comprehensively evaluate the effectiveness and safety of moxibustion in the treatment of BPH.

Methods:

The following 8 electronic databases including PubMed (1966–2020), EMbase (1980–2020), the Cochrane Library, Web of Science (1900–2020), China National Knowledge Infrastructure Database (1979–2020), WanFang Database (1998–2020), Chinese Scientific Journal Database (1989–2020), and Chinese Biomedical Literature Database (1979–2020) will be searched. No language restrictions will be used. Researchers will retrieve databases, identify trials, extract data, and evaluate the quality of eligible randomized controlled trials, independently. The outcomes will include: total effective rate, the American Urologic Association Symptom Score, International Prostate Symptom Score, urinary flow rate (measured in mL/s), changes in prostate size (measured in cc), quality of life, side effects and adverse events. The quality of methodology and evidence will be rated by using the Cochrane risk-of-bias assessment tool and grading of recommendations, assessment, development, and evaluation tool, respectively. Data synthesis will be presented by the manager of the Cochrane Collaboration's RevMan 5.3.0.

Results:

We will show the results of this study in a peer-reviewed journal.

Conclusions:

The findings will provide credible clinical evidence of moxibustion treatment for BPH.

PROSPERO Registration number:

CRD42020190630.
The efficacy and safety of Huangqi Guizhi Wuwu decoction for rheumatoid arthritis
Authors: Wang Lei , Fan Yihua , Xin Ping , Zhao Yuetong , Deng Huaihan , Jia Bo
Published: September 2020

Background:

Rheumatoid arthritis has the characteristics of slow progression, long course, and repeated attacks. At present, western medicine commonly used in clinical practice not only reduces pain and improves symptoms, but also has more adverse reactions, affecting the health, and life of patients. In ancient China, Huangqi Guizhi Wuwu decoction was used by doctors to treat rheumatoid arthritis, with remarkable effect. In recent years, many clinical studies have also shown that Huangqi Guizhi Wuwu decoction has reliable effect in treating rheumatoid arthritis, but there is no evidence of evidence-based medicine. Therefore, this study aims to systematically evaluate the clinical efficacy and safety of Huangqi Guizhi Wuwu decoction in the treatment of rheumatoid arthritis.

Methods:

Using computer to retrieve PubMed, The Cochrance Library, Embase, Web of Science, CNKI, VIP and Wanfang database, in addition manually retrieve Google academic and Baidu academic to collect all randomized controlled trials for Huangqi Guizhi Wuwu decoction in the treatment of rheumatoid arthritis, including relevant academic journal and conference papers, dissertations, from the establishment of the database to July 2020. After 2 evaluators independently screened the literature, extracted the data, and evaluated the risk of bias included in the study, RevMan5.3 software was used to analyze the data.

Results:

This research evaluate the efficacy and safety of Huangqi Guizhi Wuwu decoction in treating Rheumatoid arthritis from the aspects of clinical efficacy rate, visual analog scale (VAS), swollen joint count (SJC), morning stiffness time, Rrythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and adverse reaction incidence.

Conclusion:

This study will provide reliable evidence for the clinical application of Huangqi Guizhi Wuwu decoction in the treatment of rheumatoid arthritis.

Ethics and dissemination:

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

OSF Registration number:

DOI 10.17605/OSF.IO/RZY3V.
Clinical analysis of reversible splenial lesion syndrome in Chinese adults
Authors: Gao Xiaoyu , Feng Qiaochan , Arif Saeed , Liaqat Jahanzeb , Li Bing , Jiang Kun
Published: September 2020

Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults.

Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al.

Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ± 11.47 years. Seven cases occurred in the months of winter and spring (December–March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution.

We found 5 (45.45%) patients had a CSF opening pressure >180 mmH2O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients.

When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.
Case report: a nonfunctioning juxtaglomerular cell tumor mimicking renal cell carcinoma
Authors: Dong Jie , Xu Weifeng , Ji Zhigang
Published: September 2020

Introduction:

Based on existing literature, the juxtaglomerular cell tumor (JGCT) is a rare renal tumor, typically present with hypertension and hypokalemia. Nonfunctioning JGCT, without hypertension or hypokalemia, is extremely rare.

Patient Concerns:

Herein, we report a case of nonfunctioning JGCT mimicking renal cell carcinoma. The 29-year-old woman with an unremarkable past medical history presented with a left renal tumor without hypertension or hypokalemia.

Diagnosis:

Both CT and 18F-FDG-PET/CT suggested a malignancy, possibly renal cell carcinoma.

Interventions:

The tumor was then removed completely via robotic assistant laparoscopic partial nephrectomy; and pathology result was JGCT. Since the patient had no hypertension or hypokalemia, a nonfunctional JGCT was diagnosed.

Outcomes:

The patient recovered uneventfully, and was in good health in 6-months’ follow-up period.

Conclusion:

Preoperative identification of JGCT is very difficult due to the lack of specific clinical manifestations. This case teaches us that for young patients with renal tumors whose CT enhancement is not obvious at the early phase, JGCT should be considered as a differential diagnosis. Radical nephrectomy should be avoided for JGCT in consideration of its relatively good prognosis.
What is the optimal regimen for intravenous dexamethasone administration in primary total hip arthroplasty?
Authors: Liang Dongliang , Xue Chao , Liu Weibo , Wang Yang
Published: September 2020

Background:

A number of recent studies have investigated the optimal dosage and timing of dexamethasone in total hip arthroplasty (THA) but have inconsistent findings. Therefore, we designed the randomized controlled research to look for the optimal intravenous dexamethasone dose for the treatment of early postoperative pain after the THA.

Methods:

The Declaration of Helsinki principles was followed and the Consolidated Standards of Reporting Trials guidelines for randomized controlled trials was adhered in this study. The First Medical Center in People's Liberation Army General Hospital approved the study (2020-089). After written informed consent was obtained, patients aged between 18 and 80 years with Physical Status I to III of American Society of Anesthesiologists, scheduled for primary unilateral THA, were included in this present work. Randomization is the use of a computer-formed list via a secretary, at a ratio of 1:1:1. The major end points were pain scores at 24 hours, 48 hours, and 72 hours after surgery, with visual analog scale (VAS) utilized at rest, and at 45 degrees passive hip flexion. The secondary outcomes involved the total consumption of morphine, opioid-related side effects, hip range of motion, inflammation markers, and the length of hospital stay.

Results:

We assumed that the patients who received 3 doses of dexamethasone intravenously possessed the best postoperative results compared to those who received 1 or 2 doses of the dexamethasone.

Trial registration: This study protocol was registered in Research Registry (researchregistry5864).
Long sleep duration and risk of increased arterial stiffness in a Chinese population
Authors: Liu Xiaoxue , Song Qiaofeng , Wu Shouling , Wang Xizhu
Published: September 2020

To examine the relationship between self-reported sleep duration and arterial stiffness in a large Chinese population from Kailuan.

From July 2010 to December 2015, a total of 17,018 participants aged 18 to 98 years were enrolled after excluding those with a history of cerebrovascular events and coronary artery disease. Participants were divided into 5 categories according to self-reported night sleep duration: ≤5.0, 6.0, 7 (ref), 8, and ≥9.0 hours. A brachial-ankle pulse wave velocity ≥1400 cm/s was considered to represent arterial stiffness. Multivariate logistic regression models were used to calculate the odds ratio (OR) and confidence interval (CI) for arterial stiffness according to the sleep duration.

Using 7 hours of sleep as the reference group, the multivariable adjusted ORs (95% CI) for arterial stiffness were 1.00 (0.87–1.16), 1.00 (0.90–1.11), 1.0 (ref), 1.03 (0.93–1.14), and 1.48 (1.05–2.08) from the lowest to highest category of sleep duration, respectively. Secondary analysis showed no evidence of interactions between sleep duration and age/sex on the risk of arterial stiffness (P-interaction = .390/.198).

A long night sleep duration was associated with increased arterial stiffness.
Bilateral posterior fracture-dislocation of the shoulders
Authors: Wu Junwei , Li Lianxin , Wang Fengrui , Lu Shun , Liu Fanxiao , Jia Honglei , Yang Yongliang , Wang Fu , Hao Zhenhai , Xu Shihong , Wang Bomin
Published: September 2020

Rationale:

Bilateral posterior fracture-dislocation of the shoulders occurs rarely and the diagnosis is often challenging. This injury is often missed or delayed on initial presentation, leading to continuous pain, disability, and rising medical costs. Timely diagnosis and proper treatment are very important to restore shoulder function.

Patient concerns:

Here we report 2 rare cases. Case 1 was a 53-year-old physical worker with severe pain and limited shoulder movement after an unexpected fall. Case 2 was a 55-year-old man with pain in upper limbs and shoulders after an electric shock.

Diagnosis:

Both of them were diagnosed as bilateral posterior fracture-dislocation of the shoulders by computed tomography (CT) scan.

Intervention:

After systematic preoperative evaluation, both of them were treated with open reduction and internal fixation.

Outcomes:

After 16 months follow-up, case 1 was pain-free in both shoulders. He had returned to full activity and was satisfied with his level of function. At 24 months follow-up, both shoulders of case 2 were painless and stable with acceptable range of motion and he was able to carry out daily activities.

Lessons:

Our case reports highlight that bilateral posterior fracture-dislocation of the shoulders is easy to be missed; one way to prevent missing diagnosis is to suspect cases with pain and limited external rotation, especially those with a history of seizures, electric shock, or severe trauma; appropriate history inquiry, physical examination, proper shoulder images are the key to correct diagnosis.
Laparoscopic advanced intraoperative restaging for radiographic non-metastasis pancreatic cancer
Authors: Zheng Zhi , Li Ang , Cao Feng , Li Fei
Published: September 2020

Background:

Although surgical resection holds promise for curing pancreatic cancer, <20% of patients are suitable; however, early postoperative recurrence is common. Currently, radiographic examination is the primary method to determine whether pancreatic cancer has metastasized and to inform clinical staging before surgery. However, the method has a limited detection rate for micro-metastasis within the abdominal cavity; therefore, patients with advanced pancreatic cancer and existing micro-metastasis may receive unnecessary surgical treatment, delaying the timing of adjuvant chemotherapy and resulting in poor prognosis. Laparoscopic staging might be used as a supplement to detect micro-metastasis in patients with pancreatic cancer; however, there is no consistent standard to guide the use of this procedure. Therefore, it is necessary to conduct a trial to further explore the consistency and short-term and long-term efficacy of an intraoperative staging strategy for patients with radiographic non-metastasis.

Methods/design:

This is a single-center cross-sectional and follow-up study. Patients diagnosed with pancreatic cancer without metastasis by radiographic examination and histopathological biopsy, who received intraoperative restaging, will be enrolled. The total sample size required for the trial is approximately 125 patients from May 2020 to December 2022. First, radiographic examination staging will be used. Then, laparoscopic exploration will be performed for patients without definite metastatic lesions. Data collection will include preoperative blood examination, radiographic examination, surgical information, and postoperative recovery. The patients will undergo follow-up every 3 months after surgery until death. The primary endpoint is the metastasis-positive rate via laparoscopic exploration. The secondary endpoints are the consistency, sensitivity, and specificity of the intraoperative restaging strategy and radiographic examination, the incidence of postoperative complications within 30 days, the 6-month relapse-free survival rate, and perioperative indicators (total cost, hospital stay, length of surgery, and intraoperative blood loss).

Discussion:

We are conducting the trial to explore the metastasis-positive rate of intraoperative restaging strategy for diagnosing pancreatic cancer micro-metastasis. This new intraoperative restaging strategy would help pancreatic cancer patients with potential micro-metastasis avoid receiving unnecessary resection, allow systemic treatment as early as possible, and improve the prognosis of patients.
Association between neurodegenerative dementia and chronic rhinosinusitis
Authors: Wee Jee Hye , Yoo Dae Myoung , Byun Soo Hwan , Hong Seok Jin , Park Min Woo , Choi Hyo Geun
Published: September 2020

The aim of this case-control study was to evaluate the association between chronic rhinosinusitis (CRS) and neurodegenerative dementia in a large representative Korean population. The ≥ 50-year-old population was selected from the Korean Health Insurance Review and Assessment Service – National Sample Cohort from 2002 to 2015. A total of 17,634 neurodegenerative dementia patients were matched in a 1:4 ratio with 70,536 control participants for age, sex, income, and region of residence. Neurodegenerative dementia was defined using the ICD-10 codes G30 and F00. CRS was identified based on the ICD-10 code J32. Among the cohort, we selected participants who were treated ≥ 2 times and those who underwent head and neck computed tomography. The odds ratio (OR) for CRS in patients with dementia was analyzed using a conditional logistic regression model. Subgroup analyses were conducted according to age and sex. There was no difference in the prevalence of CRS with/without nasal polyps between the dementia (1.1%) and control (1.2%) groups (P = .825). CRS with/without nasal polyps was not significantly associated with dementia (adjusted OR = 0.96, 95% CI = 0.82–1.13, P = .653). In the subgroup analyses according to age and sex, the adjusted ORs for CRS with/without nasal polyps were not higher in the dementia group than in the control group. Previous CRS was not associated with neurodegenerative dementia in the Korean population.
Contribution of aging oral microbiota in getting neurodegenerative diseases
Authors: Karbalaei Mohsen , Keikha Masoud , Yousefi Bahman , Ali-Hassanzadeh Mohammad , Eslami Majid
Published: September 2020

Nowadays aging-related neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease are as important as infectious diseases for human communities. 60–80% of dementia cases are related to Alzheimer's disease while only 2–3% of cases are associated with Parkinson's disease. Oral bacteria produce some chemical compounds such as volatile sulfur compounds and therefore are responsible for halitosis (malodor). This is while most of the cases (80–90%) of halitosis caused following the production of volatile sulfur compounds in the oral cavity. Some periodontal pathogens such as Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Prevotella gingivalis are detectable in Alzheimer's patients. On the other hand, Prevotella genus members, (e.g., P. intermedia, P. nigrescens, and P. melaninogenica) increase in Parkinson's disease patients, and most likely, it is associated with a reduction in hygiene oral care. Although many aspects of these diseases are still unknown, we have studied the Alzheimer's disease and Parkinson's disease diseases and also the role of oral microbiota infections in these diseases in older persons.
Pathophysiology of COVID-19 infection: what is the novel coronavirus (SARS-CoV-2) doing to body? A comprehensive systematic review
Authors: Hashemi Aghdam Mohammadreza , Hosseinzadeh Ramin , Motallebizadeh Behzad , Rezaeimehr Mohammadreza , Khedmat Leila , Soleimani Zahra , Heiat Mohammad , Moosazadeh Moghaddam Mehrdad , Abyazi Mohammadali , Karbasi Ashraf
Published: September 2020

Since December 2019, an emerging outbreak of a novel coronavirus (SARS-CoV-2) has begun from Wuhan, China, and spread rapidly throughout the world. This systematic review aimed to discuss the involvement of the body's systems during COVID-19 infection comprehensively. PubMed database was used to identify relative studies to be included in this review. Four authors searched PubMed independently using determined search terms. Then, the results were merged and duplicates were removed. The inclusion and exclusion criteria were specified and at least two review authors assessed the eligibility of the studies. The full texts of included studies were reviewed in detail by the authors and the relevant content was extracted and summarized. The pulmonary tract is the most frequent system involved with a wide range of involvement from no pneumonia to white lung and acute respiratory distress syndrome. Computed tomography is the best imaging modality to diagnose COVID-19 infection. Cardiac and renal system injuries are seen during COVID-19 infection and must be taken seriously. Gastrointestinal manifestations are frequently observed during the infection and are probably associated with more severe disease. The placenta acts as an important physiological and immunological barrier that prevents transplacental vertical transmission. COVID-19 infection is a multiorgan involving infection which needs a team of different expertise to diagnose and manage the disease. Although there are many studies available about COVID-19 infection, most of them are focused on pulmonary involvement and the effects of the virus on many other organs and systems remain unclear that shows the necessity of further investigations about the disease.
Point-of-Care Ultrasound Diagnosis of Ureteropelvic Junction Obstruction in a Child With Recurrent Abdominal Pain and Vomiting
Authors: Fox Evan M. , Kasmire Kathryn E.
Published: September 2020

A case is described of a 4 year-old girl who presented with chronic episodic abdominal pain with vomiting. Physical examination was unremarkable aside from hypertension. Point-of-care renal ultrasound showed hydronephrosis, leading to a diagnosis of ureteropelvic junction obstruction presenting with Dietl crisis (episodic abdominal pain secondary to urinary tract obstruction). The clinical utility of point-of-care renal ultrasound in the evaluation of abdominal pain and ultrasound findings of ureteropelvic junction obstruction are highlighted.
Inappropriate Transfer of Burn Patients
Authors: Slavin Benjamin , Shoucair Sami , Klifto Kevin , Grzelak Michael , Shetty Pragna , Cox Carrie , Javia Vidhi , Asif Mohammed , Hultman C. Scott
Published: September 2020

Objective

Burn injuries have an annual incidence exceeding 40,000. The Burn Center Referral Criteria published by the American Burn Association (ABA) serve to guide health centers in determining appropriateness of patient transfer to a specialized center. With inappropriate transfer rates reaching up to 77%, reliance on the ABA criteria is critical as the decision to transfer a patient can impose significant costs to both the patient and healthcare system. The aim of this study is to evaluate the appropriateness of all burn patient transfers to a single burn center over a 5-year period and assess the potential role of telemedicine to optimize the assessment and care of this patient population.

Methods

A 5-year retrospective review was conducted to all burn patients transferred or consulted for transfer to our burn center between January 2013 and January 2017. After application of inclusion and exclusion criteria, 767 cases were analyzed, with 612 ultimately being transferred. Outcome measures included basic clinical and demographic information, as well as logistical burn and transfer data such as percent total body surface area and transfer distance. After data collection, 5-year descriptive trends were analyzed, and the ABA criteria were applied to each patient case to evaluate appropriateness of transfer. Patients transferred despite not meeting at least one of the ABA criteria were classified as inappropriately transferred.

Results

A total of 25 patients (3.2%) were found to be inappropriate transfers. Statistical analysis compared appropriately transferred patients (n = 587) with those inappropriately transferred. Overall, inappropriately transferred patients were more likely to have superficial partial thickness burns (76% vs 46%, P = 0.05), were less likely to need surgery (4% vs 22%, P < 0.05), and had a higher incidence of upper extremity burns (32% vs 4%, P < 0.01).

Conclusions

Our study increases awareness of the most commonly seen presentation of inappropriately transferred burn patients over a 5-year period at our center. Given the advent of telemedicine, the ability of institutions to pinpoint a subset of patients most vulnerable to inappropriate transfer will allow for a streamlining of resources that will serve to benefit both patients and the health system.
Academic Productivity Among Plastic Surgery Subspecialty Fellowship Applicants
Authors: McGlone Katie L. , Ngaage Ledibabari M. , Steinberg Jordan P. , Lifchez Scott D. , Slezak Sheri , Rasko Yvonne M.
Published: September 2020

Introduction

Plastic surgery subspecialty fellowships are highly competitive. Academic productivity is an objective metric that can be used to compare candidates. This study aims to evaluate intersubspecialty differences in academic profiles of plastic surgery fellows.

Methods

We performed a cross-sectional analysis of the plastic surgery fellows in the United States from 2015 to 2019. We used the San Francisco Match website and individual program websites to obtain details of fellowship programs (microsurgery, aesthetic, hand, and craniofacial) and plastic surgery fellows. Bibliometric data at the time of fellowship application were obtained for each fellow.

Results

A total of 235 fellows were included. There was a significant difference in the median number of publications (P = 0.0067) and h-index (P = 0.0229) across subspecialties. Multivariate analysis demonstrated that dedicated research time was predictive for a high publication count (odds ratio [OR], 3.59; P = 0.0007) and h-index (OR, 4.88; P < 0.0001) at the time of fellowship application. Although international residency and aesthetic fellowship application were predictive of a reduced number of publications (OR, 0.17; P < 0.0001, and OR, 0.43; P = 0.0190, respectively), H-index was increased by possession of an advanced degree (OR, 2.00; P = 0.0291) and decreased with international residency (OR, 0.26, P = 0.0021).

Conclusions

All plastic surgery fellows have highly qualified academic profiles at the time of fellowship application. Academic productivity differs between subspecialty fellowships. Those wishing to match into competitive subspecialties should consider taking dedicated time for research or attaining an advanced degree.
Quantitative Augmented Reality-Assisted Free-Hand Orthognathic Surgery Using Electromagnetic Tracking and Skin-Attached Dynamic Reference
Authors: Kim Seong-Ha , Lee Sang-Jeong , Choi Min-Hyuk , Yang Hoon Joo , Kim Jo-Eun , Huh Kyung-Hoe , Lee Sam-Sun , Heo Min-Suk , Hwang Soon Jung , Yi Won-Jin
Published: September 2020

The purpose of this study was to develop a quantitative AR-assisted free-hand orthognathic surgery method using electromagnetic (EM) tracking and skin-attached dynamic reference. The authors proposed a novel, simplified, and convenient workflow for augmented reality (AR)-assisted orthognathic surgery based on optical marker-less tracking, a comfortable display, and a non-invasive, skin-attached dynamic reference frame. The 2 registrations between the physical (EM tracking) and CT image spaces and between the physical and AR camera spaces, essential processes in AR-assisted surgery, were pre-operatively performed using the registration body complex and 3D depth camera. The intraoperative model of the maxillary bone segment (MBS) was superimposed on the real patient image with the simulated goal model on a flat-panel display, and the MBS was freely handled for repositioning with respect to the skin-attached dynamic reference tool (SRT) with quantitative visualization of landmarks of interest using only EM tracking. To evaluate the accuracy of AR-assisted Le Fort I surgery, the MBS of the phantom was simulated and repositioned by 6 translational and three rotational movements. The mean absolute deviations (MADs) between the simulation and post-operative positions of MBS landmarks by the SRT were 0.20, 0.34, 0.29, and 0.55 mm in x- (left lateral, right lateral), y- (setback, advance), and z- (impaction, elongation) directions, and RMS, respectively, while those by the BRT were 0.23, 0.37, 0.30, and 0.60 mm. There were no significant differences between the translation and rotation surgeries or among surgeries in the x-, y-, and z-axes for the SRT. The MADs in the x-, y-, and z-axes exhibited no significant differences between the SRT and BRT. The developed method showed high accuracy and reliability in free-hand orthognathic surgery using EM tracking and skin-attached dynamic reference.
Lip Shapes Over the Last Century (1948–2012)
Authors: Hwang Kun , Yun Seon Mi
Published: September 2020

The aim of this study was to analyze lip shapes as represented in the British edition of Vogue over the last century (1916–2015). Photographs containing distinguishable lips were selected from a book entitled Vogue 100: A Century of Style. A total of 98 frontal pictures (20 males, 78 females) in which the lips and mouth were identifiable were included and analyzed in terms of 4 lip-related ratios (lip thickness-to-width ratio [LTW]; upper-to-lower vermillion ratio [ULR]; upper vermillion thickness-to-upper lip height ratio [VUL]; and lip-to-nose width ratio [LNW]). The LTW was 0.39 ± 0.07, and did not vary significantly over time (P = 0.261 [linear regression analysis]). The LTW of women (0.41 ± 0.07) was significantly greater than that of men (0.34 ± 0.05) (P < 0.001 [independent 2-samples t-test]). The ULR was 0.74 ± 0.16, and did not vary significantly over time (P = 0.647). There was no significant difference in the ULR between men (0.75 ± 0.10) and women (0.74 ± 0.17) (P = 0.769). The VUL was 0.43 ± 0.09, and did not vary significantly over time (P = 0.550). The VUL of women (0.44 ± 0.09) was significantly greater than that of men (0.37 ± 0.06) (P = 0.001). The LNW was 1.49 ± 0.19, and did not vary significantly over time (P = 0.619). There was no significant difference in the LNW between men (1.43 ± 0.16) and women (1.51 ± 0.19) (P = 0.082). The results of this study may be useful for planning facial rejuvenation operations, as well as for clinical practitioners dealing with brow esthetics or lip tattooing.
Novel Surgical Approach to Acalvaria
Authors: Caycedo Diego J. , Castillo-Huila Juan P. , Zapata-Copete James A. , Santacruz Luis Fernando
Published: September 2020

Acalvaria, also known as acrania, is a rare congenital anomaly which is characterized by a complete or partial defect of the calvarium. Due to the low number of patients reported, there is no a standard for the treatment of this condition; thereby, the objective is to present a new surviving patient with acalvaria and a novel surgical approach to treat it, giving craniofacial surgeons and neurosurgeons more tools to face it. In this article, the authors present a reproducible surgical approach in patients with partial acalvaria, which consist in use the present bone as a graft to cover the defect, giving a temporal but stable coverture. No other calvaria graft has been published along the available literature, since only around 4 patients are acalvaria survivors worldwide. However, the authors need to make a longer follow-up to establish the usefulness of the technique in long term. Other limitation is the future procedures needed to a better function and aesthetic.
Walter Heinrich Munk. 19 October 1917—8 February 2019
Authors: Garrett Chris , Wunsch Carl
Published: September 2020

Born in Vienna, Austria, shortly before the Austro-Hungarian Empire lost its access to the sea, Walter Munk became a leading geophysicist and physical oceanographer after being sent to school in New York State and later moving west to California. He and Harald Sverdrup developed wave prediction schemes that were used by the Allies in World War II to evaluate whether amphibious landings would be feasible. His post-war research included further major contributions to the understanding of ocean waves, as well as ocean circulation, tides, internal waves, mixing processes and many other phenomena. He showed how variations in the Earth's rotation contained a wealth of valuable geophysical information and was an instigator of the ‘Mohole’ project that failed for political reasons but paved the way for the Deep Sea Drilling Project. Although primarily a theoretician, throughout his career he was an enthusiastic adopter of new technologies and data analysis techniques. He showed how acoustic transmissions could be used to map ocean eddies and currents as well as to monitor temperature changes of whole ocean basins. He was a key adviser to the US Navy and a dedicated member of the science advisory group, JASON, that focuses on national security. As well as his scientific contributions, his legacy includes the La Jolla Institute of Geophysics and Planetary Physics. He was liberal in his political outlook, gregarious, hospitable and treated everyone, from undergraduate to admiral, with the same interest and respect.
A multivariate geostatistical framework for combining multiple indices of abundance for disease vectors and reservoirs: a case study ofrattinessin a low-income urban Brazilian community
Authors: Eyre Max T. , Carvalho-Pereira Ticiana S. A. , Souza Fábio N. , Khalil Hussein , Hacker Kathryn P. , Serrano Soledad , Taylor Joshua P. , Reis Mitermayer G. , Ko Albert I. , Begon Mike , Diggle Peter J. , Costa Federico , Giorgi Emanuele
Published: September 2020

A key requirement in studies of endemic vector-borne or zoonotic disease is an estimate of the spatial variation in vector or reservoir host abundance. For many vector species, multiple indices of abundance are available, but current approaches to choosing between or combining these indices do not fully exploit the potential inferential benefits that might accrue from modelling their joint spatial distribution. Here, we develop a class of multivariate generalized linear geostatistical models for multiple indices of abundance. We illustrate this novel methodology with a case study on Norway rats in a low-income urban Brazilian community, where rat abundance is a likely risk factor for human leptospirosis. We combine three indices of rat abundance to draw predictive inferences on a spatially continuous latent process,rattiness, that acts as a proxy for abundance. We show how to explore the association betweenrattinessand spatially varying environmental factors, evaluate the relative importance of each of the three contributing indices and assess the presence of residual, unexplained spatial variation, and identifyrattinesshotspots. The proposed methodology is applicable more generally as a tool for understanding the role of vector or reservoir host abundance in predicting spatial variation in the risk of human disease.
Altered DNA methylation profiles in blood from patients with sporadic Creutzfeldt-Jakob disease
Authors: Dabin Luke , Guntoro Fernando , Campbell Tracy , Bélicard Tony , Smith Adam R. , Smith Rebecca G. , Raybould Rachel , Schott Jonathan M. , Lunnon Katie , Sarkies Peter , Collinge John , Mead Simon , Viré Emmanuelle
Published: September 2020

Prion diseases are fatal and transmissible neurodegenerative disorders caused by the misfolding and aggregation of prion protein. Although recent studies have implicated epigenetic variation in common neurodegenerative disorders, no study has yet explored their role in human prion diseases. Here we profiled genome-wide blood DNA methylation in the most common human prion disease, sporadic Creutzfeldt-Jakob disease (sCJD). Our case-control study (n=219), when accounting for differences in cell type composition between individuals, identified 38 probes at genome-wide significance (p < 1.24×0-7). Nine of these sites were taken forward in a replication study, performed in an independent case-control (n=186) cohort using pyrosequencing. Sites in or close to FKBP5, AIM2 (2 probes), UHRF1, KCNAB2, PRNP, ANK1 successfully replicated. The blood-based DNA methylation signal was tissue- and disease-specific, in that the replicated probe signals were unchanged in case-control studies using sCJD frontal-cortex (n=84), blood samples from patients with Alzheimer’s disease, and from inherited and acquired prion diseases. Machine learning algorithms using blood DNA methylation array profiles accurately distinguished sCJD patients and controls. Finally, we identified sites whose methylation levels associated with prolonged survival in sCJD patients. Altogether, this study has identified a peripheral DNA methylation signature of sCJD with a variety of potential biomarker applications.
CD38+CD27− on Mtb-specific CD4+ T cells distinguishes latent from active tuberculosis
Authors: Acharya Muthya Pragun , Pradeep Sai Pallavi , Murthy Venkataramappa Srinivasa , Chikkannaiah Panduranga , Kambar Vivekanand , Narayanashetty Satyanarayana , Nagaraja Sharath Burugina , Niveditha  , Yoganand Raksha , Satchidanandam Vijaya
Published: September 2020

RATIONALE

Early and accurate diagnosis followed by timely treatment are the key prerequisites to fight tuberculosis (TB) and reduce its global burden. Despite scientific advances, the rapid and correct diagnosis of both pulmonary and extrapulmonary tuberculosis remains a challenge due to traditional reliance on detection of the elusive bacilli. Mycobacterium tuberculosis (Mtb)-specific host immune activation and cytokine production has shown significant promise as an alternative means of detecting and distinguishing active disease from latent infection.

OBJECTIVE

Phenotypic characteristics of Mtb-specific cytokine-producing immune cell subsets were investigated and queried for their diagnostic ability in identifying active tuberculosis.

METHODS

Subjects belonging to the following groups were recruited – pulmonary, extrapulmonary, latent TB, cured TB, sick controls and healthy controls. Polychromatic flow cytometry was used to identify host immune biomarkers in an exploratory cohort comprising 56 subjects using peripheral blood mononuclear cells. Clinical performance of the identified biomarker was evaluated using whole blood in a blinded validation cohort comprising 165 individuals.

FINDINGS

Frequencies of Mtb-specific CD4+ T cells of the phenotype CD38+CD27− clearly distinguished patients with active tuberculosis from individuals without the disease. CD38+CD27−CD4+ T cells secreting TNF-α upon stimulation with ESAT6/CFP10 peptides had the best diagnostic accuracy at a cut-off of 9.91% [exploratory: 96.67% specificity, 88.46% sensitivity; validation: 96.15% specificity, 90.16% sensitivity]. Additionally, this subset differentiated treatment-naive TB patients from individuals cured of TB following completion of anti-tuberculosis therapy.

INTERPRETATION

Mtb-specific CD38+CD27−TNF-α+CD4+ T cell subset is a robust biomarker for TB diagnosis and can determine cure.

IMPACT OF THIS RESEARCH

We identified and validated CD38+CD27−TNF-α+ as a robust biomarker with diagnostic accuracies >90% in both PBMCs and whole blood that can be translated into a reliable and cost-effective in vitro diagnostic test with ease. By not removing samples with insignificant immune response and instead classifying them as negative, our study represents a truly realistic assessment of the diagnostic accuracy of the identified biomarker in a clinical setting.
Racial and workplace disparities in seroprevalence of SARS-CoV-2 in Baton Rouge, Louisiana, July 15-31, 2020
Authors: Feehan Amy K. , Velasco Cruz , Fort Daniel , Burton Jeffrey H. , Price-Haywood Eboni , Katzmarzyk Peter T. , Garcia-Diaz Julia , Seoane Leonardo
Published: September 2020

Using paired molecular and antibody testing for SARS-CoV-2 infection, we determined point prevalence and seroprevalence in a municipality in Louisiana, USA during the second phase of reopening. Infections were highly variable by race, work environment, and ZIP code. Census-weighted seroprevalence and point prevalence were 3.6% and 3.0%, respectively.
Gradient Boosting Decision Tree Algorithm for the Prediction of Postoperative Intraocular Lens Position in Cataract Surgery
Authors: Li Tingyang , Yang Kevin , Stein Joshua D. , Nallasamy Nambi
Published: September 2020

Purpose

To develop a method for predicting postoperative anterior chamber depth (ACD) in cataract surgery patients based on preoperative biometry, demographics, and intraocular lens (IOL) power.

Methods

Patients who underwent cataract surgery and had both preoperative and postoperative biometry measurements were included. Patient demographics and IOL power were collected from the Sight Outcomes Research Collaborative (SOURCE) database. A gradient boosting decision tree model was developed to predict the postoperative ACD. The mean absolute error (MAE) and median absolute error (MedAE) were used as evaluation metrics. The performance of the proposed method was compared to five existing formulas.

Results

847 patients were assigned randomly in a 4:1 ratio to a training/validation set (678 patients) and a testing set (169 patients). Using preoperative biometry and patient sex as predictors, the presented method achieved an MAE of 0.106 ± 0.098 (SD) on the testing set, and a MedAE of 0.082. MAE was significantly lower than that of the five existing methods (p < 0.01). When keratometry was excluded, our method attained an MAE of 0.123 ± 0.109, and a MedAE of 0.093. When IOL power was used as an additional predictor, our method achieved an MAE of 0.105 ± 0.091 and a MedAE of 0.080.

Conclusions

The presented machine learning method achieved accuracy surpassing that of previously reported methods in the prediction of postoperative ACD.

Translational Relevance

Increasing accuracy of postoperative ACD prediction with the presented algorithm has the potential to improve refractive outcomes in cataract surgery.
Willingness to pay tuition and risk-taking proclivities among students: A fundamental conundrum for universities
Authors: Zafari Zafar , Goldman Lee , Kovrizhkin Katia , Muennig Peter
Published: September 2020

Importance

As universities around the world decide whether to remain open or to close their campuses because of the COVID-19 pandemic, they often are doing so without objective information on the preferences and risk tolerance of their students.

Objectives

To quantify students’: 1) risk tolerance for in-person instruction; 2) willingness to pay for in-person instruction versus online-only instruction; and 3) risk-tolerance for social activities held off campus.

Design, Setting, and Participants

We developed an automated survey tool that administered a “standard gamble” exercise grounded in game theory to 46 Columbia University public health graduate students who were knowledgeable about COVID-19 and who had experience with both online and offline coursework. Students were asked to trade between the risk of becoming infected with COVID-19 and: 1) attending classes in-person versus online and 2) attending parties in the greater New York City area. We also assessed their willingness to pay for online only tuition, and plans to travel off campus.

Main Outcome Measures

The decision point in iterative trade-offs between risk of infection with COVID-19 and a desired goal (taking classes in-person or attending social events).

Results

On average, students were willing to accept a 23% (standard error [SE]: 4%) risk of infection on campus over the semester in exchange for the opportunity to attend classes in-person. Students were willing-to-pay only 48% (SE: 3%) of typical in-person tuition were courses held exclusively online, and no students were willing to pay full price for online-only instruction. Students planned to leave campus an average of 3.6 times per week (SE: 0.54), and 15% of the students would be willing to attend a party in the community surrounding the university even if the prevalence of circulating COVID-19 were high.

Conclusions and Relevance

Students with a strong knowledge of COVID-19 transmission and risks are an enigma: they are willing to pay only around 50% for online classes but likely to engage in activities that present significant barriers to holding in-person classes This enigma underscores the conundrum facing universities.