bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Predictors of Long‐term Response to Antitumor Necrosis Factor Agents in Pediatric Inflammatory Bowel Disease
Authors: Salvador‐Martín Sara , Bossacoma Ferrán , Pujol‐Muncunill Gemma , Navas‐López Víctor Manuel , Gallego‐Fernández Carmen , Viada Javier , Muñoz‐Codoceo Rosana , Magallares Lorena , Martínez‐Ojinaga Eva , Moreno‐Álvarez Ana , Solar‐Boga Alfonso , Segarra Oscar , Clemente Susana , Rodriguez‐Martinez Alejandro , Alvarez‐Vayo Concepción , Loverdos Inés , Merino‐Bohórquez Vicente , Balboa‐Vega María J. , Blanca‐García José A. , Fobelo María J. , Millán‐Jiménez Antonio , García‐Romero Ruth , Sanchez Cesar , Tolín Mar , de Caldas Rafael Gonzalez , Eizaguirre Francisco J. , Sánchez‐Hernandez José G. , Torres‐Peral Ricardo , Aznal Elena , García‐González Xandra , Sanjurjo‐Sáez María , López‐Fernández Luis A.
Published: July 2020

Objectives:

Inflammatory bowel disease (IBD) is more complex in children and they will have to live with the disease for much longer. For this reason, it is necessary to optimize treatment. The polymorphisms associated with the response to anti‐tumor necrosis factor (TNF) drugs in adults with IBD have not been analyzed in children. The aim of the study was to identify genetic variants associated with the long‐term response to anti‐TNF drugs in children with IBD.

Methods:

An observational, longitudinal, ambispective cohort's study was conducted. We recruited 209 anti‐TNF‐treated children diagnosed with IBD and genotyped 21 polymorphisms previously studied in adults with Crohn disease (CD) using real‐time PCR. The association between single‐nucleotide polymorphisms (SNPs) and time‐to‐failure was analyzed using the log‐rank test.

Results:

After multivariate analysis, 3 SNPs in IL10, IL17A and IL6 were significantly associated with response to anti‐TNF treatment among patients diagnosed with CD (rs1800872‐HR, 4.749 (95% confidence interval [CI] 1.156–19.517), P value < 0.05; rs2275913‐HR, 0.320 [95% CI 0.111–0.920], P value < 0.05; and rs10499563‐HR, 0.210 [95% CI 0.047–0.947], P value 0.05, respectively). None of these SNPs were associated with response to infliximab in adults diagnosed with CD. Among patients diagnosed with ulcerative colitis (UC), 1 SNP in LY96 was significantly associated with response to anti‐TNF treatment (rs‐11465996‐HR, 10.220 [95% CI 1.849–56.504] P value < 0.05).

Conclusions:

Genotyping of these DNA variants before starting treatment may help to identify children who are long‐term responders to anti‐TNF drugs, and thus tailor treatment of pediatric IBD.
Parent Perspectives on Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn Disease
Authors: Mehta Pooja , Pan Zhaoxing , Furuta Glenn T. , Kim David Yonghyuk , de Zoeten Edwin F.
Published: July 2020

Objectives:

Exclusive enteral nutrition (EEN) is infrequently used in the United States but is an effective treatment for pediatric Crohn disease (CD). Limited data exists regarding patient and parent perspectives on this treatment modality. The aim of this study was to determine parent and provider perspectives regarding EEN and understand parent‐cited barriers to its use.

Methods:

We surveyed the parents/guardians of children ages 1 through 17 with CD in our institution regarding EEN. Healthcare provider perspectives regarding reason for stopping EEN and those cited by survey respondents were compared using retrospective chart review.

Results:

One hundred fifteen (62.5%) out of 184 recipients responded to the survey. Ninety percentage of respondents had heard of EEN but of these, 26% had not discussed it with their gastroenterologist. Thirty‐eight patients (33%) were treated in the past and 15 (13%) were currently on EEN. Common barriers cited by current EEN users were cost/finances and difficult social situations. Of the children who stopped EEN, most did so as parents felt it was not working (n = 14, 37%). In these cases, their primary gastroenterologist cited treatment failure for 4 cases and nonadherence for 6.

Conclusions:

Despite the efficacy of EEN and interest in dietary treatments by patients with CD, there are many barriers surrounding effective communication and successful implementation of dietary therapies. Future research is needed regarding patient‐physician communication, cost mitigation, and coping with the social limitations of dietary therapies.
Gut Microenvironment and Bacterial Invasion in Paediatric Inflammatory Bowel Diseases
Authors: Zaidi Deenaz , Huynh Hien Q. , Carroll Matthew W. , Mandal Rupasri , Wishart David S. , Wine Eytan
Published: July 2020

Objectives:

Host-microbial relationship is disrupted in inflammatory bowel diseases (IBD). We hypothesized that altered gut luminal microenvironment can impact microbial virulence in IBD, leading to disruption of homeostasis and disease. We investigated the relationship between gut microenvironment and microbial virulence.

Methods:

Intestinal aspirates were collected from 10 non-IBD controls, 9 Crohn disease, and 10 ulcerative colitis paediatric patients during endoscopy. In vitro invasion of bacteria isolated from the duodenum and terminal ileum (TI) was quantified using gentamicin protection assays. Intestinal epithelial cells were infected in vitro by known Escherichia coli strains with patient intestinal aspirates added. Nuclear magnetic resonance spectroscopy (NMR) analysis was conducted on intestinal aspirates to identify metabolites associated with invasion; these metabolites were then introduced to the infection model.

Results:

There was no difference in in vitro invasion of bacteria obtained from intestinal aspirates of non-IBD and IBD patients. Incubation of laboratory E coli strains with TI aspirates from IBD patients increased their invasion into epithelial cells in vitro. NMR analysis revealed intestinal metabolites that correlated with bacterial invasion; succinate present in the intestinal aspirates correlated positively, whereas acetate and formate related negatively with invasion. Addition of exogenous succinate increased invasion of E coli in vitro.

Conclusions:

Alterations in the gut microenvironment in IBD can affect bacterial invasion. Succinate is associated with increased bacterial invasion and can alter bacterial virulence in IBD. This highlights the interaction between specific metabolites and bacteria that could be instrumental in propagating or suppressing inflammation in paediatric IBD patients.
Factors Associated With 5- and 10-Year Survival After Intestinal Transplantation in Infants and Children
Authors: Kara Balla Abdalla , Elsabbagh Ahmed , Khan Khalid M. , Kroemer Alexander H.K. , Hawksworth Jason S. , Yazigi Nada A. , Fishbein Thomas M. , Matsumoto Cal S. , Kaufman Stuart S.
Published: July 2020

Objectives:

Intestinal transplantation is an option for permanent intestinal failure with parenteral nutrition intolerance. We sought to determine long-term intestinal graft survival in pediatric patients at our center and to identify factors influencing survival.

Methods:

Retrospective chart review of 86 patients transplanted between 2003 and 2013, targeting potential explanatory variables related to demographics, perioperative factors, and postoperative complications.

Results:

Intestinal graft survival was 71% and 65% after 5 and 10 years, respectively. Five-year graft survival was attained in 79% of patients with a history of anatomic intestinal failure compared with 45% with functional intestinal failure (P = 0.0055). Compared with nonsurvival, 5-year graft survival was also associated with reduced incidences of graft-versus-host disease (2% vs 16%, P = 0.0237), post-transplant lymphoproliferative disorder (3% vs 24%, P = 0.0067), and de novo donor-specific antibodies (19% vs 57%, P = 0.0451) plus a lower donor-recipient weight ratio (median 0.727 vs 0.923, P = 0.0316). Factors not associated with 5-year intestinal graft survival included graft rejection of any severity and inclusion of a liver graft. Factors associated with graft survival at 10 years were similar to those at 5 years.

Conclusions:

In our experience, outcomes in pediatric intestinal transplantation have improved substantially for anatomic but not functional intestinal failure. Graft survival depends on avoidance of severe infectious and immunological complications including GVHD, whereas inclusion of a liver graft provides no obvious survival benefit. Reduced success with functional intestinal failure may reflect inherently increased susceptibility to complications in this group.
Reduced Intestinal Inflammation With Lumacaftor/Ivacaftor in Adolescents With Cystic Fibrosis
Authors: Tétard Candice , Mittaine Marie , Bui Stéphanie , Beaufils Fabien , Maumus Pascale , Fayon Michael , Burgel Pierre‐Regis , Lamireau Thierry , Delhaes Laurence , Mas Emmanuel , Enaud Raphaël
Published: July 2020

A chronic intestinal inflammation may occur in patients with cystic fibrosis (CF), while no therapeutic management is proposed. Although Lumacaftor/Ivacaftor is well‐known to modulate the defective cystic fibrosis transmembrane conductance regulator (CFTR) protein in lungs, no data are available on the impact of this treatment on CF intestinal disorders. We, therefore, investigated the evolution of intestinal inflammation after initiation of Lumacaftor/Ivacaftor in CF adolescents (median of follow‐up: 336 days [IQR: 278;435]). Median fecal calprotectin concentrations decreased significantly after Lumacaftor/Ivacaftor initiation (102 μg/g [IQR: 69–210]) compared with the baseline (713 μg/g (IQR:148–852), P = 0.001). To our knowledge, this study showed for the first time that CF‐related intestinal inflammation is improved by Lumacaftor/Ivacaftor treatment.
Cystic Fibrosis‐related Liver Disease
Authors: Baker Robert D. , Baker Susan S.
Published: July 2020

Up to 40% of individuals with cystic fibrosis have cystic fibrosis‐related liver disease (CFLD); however, only 5% to 10% will have clinically evident disease. With the introduction of powerful cystic fibrosis transmembrane conductance regulator (CFTR) enhancers, effective treatment for cystic fibrosis is available. The role of CFTR enhancers in liver disease is unknown at this time. The traditionally accepted theory of the pathogenesis of CFLD is being questioned. A different pathogenesis may lead to new ways to treat CFLD. The way that CFLD is diagnosed and monitored is evolving as new imaging technology become available.
A Case of Lysosomal Acid Lipase Deficiency Confirmed by Response to Sebelipase Alfa Therapy
Authors: Shen Joseph J. , Davis Jessica L. , Hong Xinying , Laningham Fred H. , Gelb Michael H. , Kim Grace E.
Published: July 2020

Lysosomal acid lipase (LAL) deficiency, or cholesterol ester storage disease, is a disorder affecting the breakdown of cholesterol esters and triglycerides within lysosomes. Clinical findings include hepatomegaly, hepatic dysfunction, and dyslipidemia with a wide range of phenotypic variability and age of onset. The available clinical and molecular information of the patient presented herein was consistent with a diagnosis of LAL deficiency, but her LAL activity assay repeatedly showed normal or borderline low results. Her response to enzyme replacement therapy and demonstrable deficiency on a newer specific enzymatic assay ultimately confirmed her diagnosis of LAL deficiency.
Lipidomics in Nonalcoholic Fatty Liver Disease
Authors: Draijer Laura G. , Froon‐Torenstra Denise , van Weeghel Michel , Vaz Frédéric M. , Bohte Anneloes E. , Holleboom Adriaan G. , Benninga Marc A. , Koot Bart G.P.
Published: July 2020

Objectives:

Disturbances in lipid metabolism play an important role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). Using lipidomics, an analytical technique that is used to broadly survey lipid metabolism, we searched for biomarkers in plasma that are correlated with the presence of hepatic steatosis in children with obesity.

Methods:

Lipidomics was performed in plasma samples of 21 children with obesity in whom steatosis was detected using proton magnetic resonance spectroscopy (1H‐MRS) and were compared with the lipidome of 21 samples of nonsteatotic subjects with obesity.

Results:

Forty‐two samples were analyzed (57% boys; median age 15 years). A total of 18 lipid classes constituting 839 different lipid species were identified. A statistically significant increase in alkyldiacylglycerol (TG[O]) and phosphatidylethanolamine (PE) species and a significant decrease in alkyl/alkenyl‐phosphatidylethanolamine (PE[O]), alkyl/alkenyl‐lysophosphatidylethanolamine (LPE[O]) and alkyl/alkenyl‐phosphatidylcholine (PC[O]) was observed in children with hepatic steatosis compared with controls. Twelve individual lipid species of 3 lipid classes were significantly increased in steatotic subjects compared with controls.

Conclusions:

In this pilot study, we found statistically significant alterations in 5 major lipid classes and 12 individual lipid species in children with steatosis. These might be potential biomarkers for pediatric NAFLD. Lipidomic studies in larger cohorts of children are needed to determine the diagnostic value of these lipids and determine whether results can be generalized for different age groups and ethnic backgrounds.
Fall Prevention Practices and Implementation Strategies: Examining Consistency Across Hospital Units
Authors: Turner Kea , Staggs Vincent S. , Potter Catima , Cramer Emily , Shorr Ronald I. , Mion Lorraine C.
Published: July 2020

Objective

Our study examines how consistently fall prevention practices and implementation strategies are used by U.S. hospitals.

Methods

We conducted a cross-sectional, descriptive study of 60 general adult hospital units.

We administered a survey measuring 5 domains of fall prevention practices: visibility and identification, bed modification, patient monitoring, patient safety, and education. We measured 4 domains of implementation strategies including quality management (e.g., providing data and support for quality improvement), planning (e.g., designating leadership), education (e.g., providing consultation and training), and restructuring (e.g., revising staff roles and modifying equipment).

Results

Of 60 units, 43% were medical units and 57% were medical-surgical units. The hospital units varied in fall prevention practices, with practices such as keeping a patient’s bed in a locked position (73% strongly agree) being used more consistently than other practices, such as scheduled toileting (15% strongly agree). Our study observed variation in fall prevention implementation strategies. For example, publicly posting fall rates (60% strongly agree) was more consistently used than having a multidisciplinary huddle after a fall event (12% strongly agree).

Conclusions

There is substantial variation in the implementation of fall prevention practices and implementation strategies across inpatient units. Our study found that resource-intensive practices (e.g., scheduled toileting) are less consistently used than less resource-intensive practices and that interdisciplinary approaches to fall prevention are limited. Future studies should examine how units tailor fall prevention practices based on patient risk factors and how units decide, based on their available resources, which implementation strategies should be used.
Influence of Human Immunodeficiency Virus Infection on the Management and Outcomes of Acute Myocardial Infarction With Cardiogenic Shock
Authors: Vallabhajosyula Saraschandra , Subramaniam Anna V. , Sundaragiri Pranathi R. , Cheungpasitporn Wisit , Temesgen Zelalem , O'Horo John C , Jaffe Allan S. , Barsness Gregory W.
Published: July 2020

Background:

There are limited data on the outcomes of acute myocardial infarction–cardiogenic shock (AMI-CS) in patients with HIV infection and AIDS.

Setting:

Twenty percent sample of all US hospitals.

Methods:

A retrospective cohort of AMI-CS during 2000–2017 from the National Inpatient Sample was evaluated for concomitant HIV and AIDS. Outcomes of interest included in-hospital mortality and use of cardiac procedures. A subgroup analysis was performed for those with and without AIDS within the HIV cohort.

Results:

A total 557,974 AMI-CS admissions were included, with HIV and AIDS in 1321 (0.2%) and 985 (0.2%), respectively. The HIV cohort was younger (54.1 vs. 69.0 years), more often men, of non-White race, uninsured, from a lower socioeconomic status, and with higher comorbidity (allP< 0.001). The HIV cohort had comparable multiorgan failure (37.8% vs. 39.0%) and cardiac arrest (28.7% vs. 27.4%) (P> 0.05). The cohorts with and without HIV had comparable rates of coronary angiography (70.2% vs. 69.0%;P= 0.37) but less frequent early coronary angiography (hospital day zero) (39.1% vs. 42.5%;P< 0.001). The cohort with HIV had higher unadjusted but comparable adjusted in-hospital mortality compared with those without [26.9% vs. 37.4%; adjusted odds ratio 1.04 (95% confidence interval: 0.90 to 1.21);P= 0.61]. In the HIV cohort, AIDS was associated with higher in-hospital mortality [28.8% vs. 21.1%; adjusted odds ratio 4.12 (95% confidence interval: 1.89 to 9.00);P< 0.001].

Conclusions:

The cohort with HIV had comparable rates of cardiac procedures and in-hospital mortality; however, those with AIDS had higher in-hospital mortality.
Brief Report: Retrospective Evaluation on the Efficacy of Lopinavir/Ritonavir and Chloroquine to Treat Nonsevere COVID-19 Patients
Authors: Gao Guiju , Wang Aibin , Wang Sa , Qian Fang , Chen Meiling , Yu Fengting , Zhang Ju , Wang Xudong , Ma Xiaoyang , Zhao Tianwei , Zhang Fujie , Chen Zhihai
Published: July 2020

Background:

The effectiveness of lopinavir/ritonavir (LPV/r) and chloroquine treatment for COVID-19 has not been verified.

Methods:

We conducted a retrospective study to summarize the clinical practices of nonsevere patients with COVID-19 receiving the standard care, LPV/r or chloroquine in Beijing Ditan Hospital from January 20 to March 26, 2020. The main outcome measurements include the changes of cycle threshold values of open reading frame 1 ab (ORF1ab) and nucleocapsid (N) genes by reverse transcriptase–polymerase chain reaction assay from day 1 to 7 after admission for patients receiving standard care or after treatment being initiated for patients receiving either LPV/r or chloroquine. The proportion of developing severe illness, fever duration and the time from symptom onset to chest computer tomography improvement, and negative conversion of nucleic acid were compared.

Results:

Of the 129 patients included in the study, 59 received the standard care, 51 received LPV/r, and 19 received chloroquine. The demographics and baseline characteristics were comparable among the 3 groups. The median duration of fever, median time from symptom onset to chest computer tomography improvement, and negative conversion of the nucleic acid were similar among the 3 groups. The median increase in cycle threshold values of N and ORF1ab gene for patients receiving LPV/r or chloroquine or the standard care during the treatment course was 7.0 and 8.5, 8.0, and 7.6, 5.0, and 4.0, respectively. These figures were not found significantly different among the 3 groups.

Conclusions:

Antiviral therapy using LPV/r or chloroquine seemed not to improve the prognosis or shorten the clinical course of COVID-19.
Costs and Cost-Effectiveness of the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers
Authors: Shrestha Ram K. , Schommer Jon C. , Taitel Michael S. , Garza Oscar W. , Camp Nasima M. , Akinbosoye Osayi E. , Clay Patrick G. , Byrd Kathy K. ,   for the Patient-centered HIV Care Model Team
Published: July 2020

Background:

The patient-centered HIV care model (PCHCM) is an evidence-informed structural intervention that integrates community-based pharmacists with primary medical providers to improve rates of HIV viral suppression. This report assesses the costs and cost-effectiveness of the PCHCM.

Setting:

Patient-centered HIV care model.

Methods:

Three project sites, each composed of a medical clinic and 1 or 2 community-based HIV-specialized pharmacies, were included in the analyses. PCHCM required patient data sharing between medical providers and pharmacists and collaborative therapy-related decision making. Intervention effectiveness was measured as the incremental number of patients virally suppressed (HIV RNA <200 copies/mL at the last test in a 12-month measurement period). Microcosting direct measurement methods were used to estimate intervention costs. The cost per patient, cost per patient visit, and incremental cost per patient virally suppressed were calculated from the health care providers' perspective. Additionally, the number of HIV transmissions averted, lifetime HIV treatment cost saved, quality-adjusted life years (QALYs) saved, and cost per QALY saved were calculated from the societal perspective, using standard methods and reported values from the published literature.

Results:

Overall, the PCHCM annual intervention cost for the 3 project sites was $226,741. The average cost per patient, cost per patient visit, and incremental cost per patient virally suppressed were $813, $48, and $5,039, respectively. The intervention averted 2.75 HIV transmissions and saved 12.22 QALYs and nearly $1.28 million in lifetime HIV treatment costs. The intervention was cost saving overall and at each project site.

Conclusions:

The PCHCM can be delivered at a relatively low cost and is a cost-saving intervention to assist patients in achieving viral suppression and preventing HIV transmission.
Lower Cumulative Antiretroviral Exposure in People Living With HIV and Diabetes Mellitus
Authors: Mann Sarah C. , Morrow Mary , Coyle Ryan P. , Coleman Stacey S. , Saderup Austin , Zheng Jia-Hua , Ellison Lucas , Bushman Lane R. , Kiser Jennifer J. , MaWhinney Samantha , Anderson Peter L. , Castillo-Mancilla Jose R.
Published: July 2020

Objective:

People living with HIV (PLWH) are living longer and developing more non-AIDS comorbidities, which negatively impact antiretroviral therapy (ART) adherence. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a novel pharmacologic measure of cumulative ART adherence that is predictive of viral suppression and future viremia. However, the relationship between non-AIDS comorbidities and this adherence measure is unknown. We aimed to evaluate the association between 3 non-AIDS comorbidities (diabetes mellitus (DM), hypertension, and hyperlipidemia) and TFV-DP in DBS in PLWH.

Methods:

Blood for TFV-DP in DBS and HIV viral load was prospectively collected from PLWH on tenofovir disoproxil fumarate for up to 3 times over 48 weeks. Non-AIDS comorbidities were recorded. Mixed effect multivariable linear regression models were used to estimate the changes in TFV-DP concentrations in DBS according to the presence of comorbidities and to estimate the percent differences in TFV-DP concentrations between these groups.

Results:

A total of 1144 person-visits derived from 523 participants with available concentrations of TFV-DP in DBS were included in this analysis. In univariate analysis, no significant association between non-AIDS comorbidities (categorized as having 0, 1, 2, or 3 comorbidities) and the concentrations of TFV-DP in DBS was observed (P= 0.40). Participants who had DM had 25% lower (95% confidence interval: −36% to −12%;P< 0.001) TFV-DP in DBS than participants without DM after adjusting for age, gender, race, body mass index, estimated glomerular filtration rate, CD4+T-cell count, hematocrit, ART class, patient-level medication regimen complexity index, and 3-month self-reported adherence.

Conclusions:

Diabetic PLWH have lower concentrations of TFV-DP in DBS compared with those without DM. Further research is required to identify the clinical implications and biological mechanisms underlying these findings.
The Crisis We Are Not Talking About: One-in-Three Annual HIV Seroconversions Among Sexual and Gender Minorities Were Persistent Methamphetamine Users
Authors: Grov Christian , Westmoreland Drew , Morrison Corey , Carrico Adam W. , Nash Denis
Published: July 2020

Introduction:

Methamphetamine use is once again on the rise among sexual and gender minorities who have sex with men (SGMSM).

Methods:

Baseline and 12-month data are taken from an ongoing cohort study of n = 4786 SGMSM aged 16–49 at risk for HIV from across the United States. Participants completed annual online surveys and at-home HIV testing (oral fluid samples returned through mail).

Results:

Overall, 2.47 per 100 persons seroconverted over 12 months. In addition, 13.8% of participants reported any methamphetamine use over the 12-month study period. Nearly three-fourths (74.7%; 422 of 565) of those who reported using methamphetamine at baseline were persistent users at 12 months. In adjusted analyses, compared with those who did not use methamphetamine, incident methamphetamine users (ie, those who indicated use between baseline and follow-up) and persistent methamphetamine users had significantly higher odds of HIV seroconverting (adjusted odds ratio = 3.95, 95% confidence interval: 1.64 to 9.47; and 7.11, 4.53 to 11.17, respectively). Persistent methamphetamine users accounted for one-third of all observed HIV seroconversions (41 of 115).

Discussion:

Among SGMSM at elevated risk for HIV, persistent methamphetamine use was prevalent and associated with substantially amplified risk for HIV seroconversion. Expanded efforts are needed to test implementation strategies for scalable, evidence-based interventions to reduce HIV risk in SGMSM who use methamphetamine.
Prevention, Partners, and Power Imbalances: Women's Views on How Male Partners Affected Their Adherence to Vaginal Microbicide Gels During HIV Prevention Trials in Africa
Authors: Miller Lori , Morar Neetha , Kapiga Saidi , Ramjee Gita , Hayes Richard
Published: July 2020

Background:

Low adherence has contributed to disappointing results for trials testing vaginal microbicides for HIV prevention. This study engaged former gel trial participants to understand the reasons behind low adherence and seek suggestions on how to improve products and adherence to microbicides. This analysis examines the impact of participant perceptions of male partners on participant adherence and suggestions on how to address those issues.

Methods:

Eight focus group discussion workshops were conducted with 46 former microbicide trial participants in South Africa and Tanzania. Participants provided feedback on why women join trials, barriers to using gels and reporting adherence accurately, and how adherence and adherence reporting can be improved.

Results:

Participants reported that male partners can affect women's ability to use gels. For some, the lubricating effects caused relationship conflicts due to suspicion of male partners about infidelity. Needing to provide sex to partners on demand was a barrier to gel use. Participants suggested a gel formulation which was thicker and less noticeable, and explicit male partner engagement to enhance understanding of the purpose of the gels.

Conclusions:

The imbalance of power in intimate relationships affects the ability of women to use microbicides as directed. To improve adherence to HIV prevention methods within trials and for successful rollout of proven HIV prevention methods in populations, it is important that the complicated dynamics of sex and relationships be taken into greater consideration and that women receive targeted support to navigate product use and communication within the context of these gender dynamics.
Pharmacological Management of Osteoarthritis With a Focus on Symptomatic Slow-Acting Drugs
Authors: Alexander Lila A. M. , LN Denisov , EG Zotkin , IS Dydykina , AY Kochish , SS Rodionova , EA Trofimov , SP Yakupova , EZ Yakupov , L Gallelli
Published: July 2020

Background

This article describes an updated stepwise algorithm for the pharmacological management of osteoarthritis (OA) to establish a treatment method for patients with OA.

In step 1, background maintenance therapy includes symptomatic slow-acting drugs for OA, especially prescription crystalline glucosamine sulfate product, for which the high-quality evidence base of efficacy is unequivocal, or prescription chondroitin sulfate. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol only as rescue analgesia is given on top of the background therapy. Step 2: For patients with persistent OA symptoms, the use of oral NSAIDs is mandatory for maintaining supportive therapy with symptomatic slow-acting drugs for OA. It is recommended to properly stratify patients and carefully select oral NSAID therapy to maximize the benefit-to-risk ratio. Intra-articular hyaluronic acid and intra-articular corticosteroids are recommended as well in step 2 of the algorithm, especially for patients who do not respond to the previous therapies. Step 3: Duloxetine is considered along with the previous procedures, especially in patients with pain from central sensitization. Step 4: Total joint replacement is recommended for patients with severe symptoms and poor quality of life.

Major Conclusions

The current guidelines and literature review provide evidence-based recommendations supported by clinical experience on how to organize the treatment process in patients with knee OA applicable in the Russian clinical practice.

Future Research Directions

International evidence-based guidelines lack consensus on different treatments, including the use of prescription crystalline glucosamine sulfate, NSAIDs, and intra-articular hyaluronic acid. The content of this article needs a further discussion about the clinical evidence and harmonization of recommendations for knee OA management.
Clinical Significance of Oncoplastic Breast-Conserving Surgery and Application of Volume-Displacement Technique
Authors: Jin Shiyang , Xu Bingqi , Shan Ming , Liu Yang , Han Jiguang , Zhang Guoqiang
Published: July 2020

Oncoplastic breast-conserving surgery for breast cancer has been continuously developing in recent years, and it has become an important part of breast cancer surgery. Its safety and aesthetics have been widely recognized by domestic and foreign experts. However, due to the complexity and diversity of individuals and diseases, and the need for integrating the thinking of breast surgery and plastic surgery, it is still a challenge for breast surgeons. This review summarizes the pros and cons of its clinical application through a comprehensive discussion of hot issues in oncoplastic breast-conserving surgery and introduces common volume-displacement techniques in the clinic for reference by doctors in daily work.
Hepatic Artery Microvascular Anastomosis in Liver Transplantation: A Systematic Review of the Literature
Authors: Kantar Rami S. , Berman Zoe P. , Diep Gustave K. , Ramly Elie P. , Alfonso Allyson R. , Sosin Michael , Lee Z-Hye , Rifkin William J. , Kaoutzanis Christodoulos , Yu Jason W. , Ceradini Daniel J. , Dagher Nabil N. , Levine Jamie P.
Published: July 2020

Background

The operating microscope is used in many centers for microvascular hepatic arterial reconstruction in living as well as deceased donor liver transplantation in adult and pediatric recipients. To date, a systematic review of the literature examining this topic is lacking.

Methods

This systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Three different electronic databases (PubMed, Embase OVID, and Cochrane CENTRAL) were queried.

Results

A total of 34 studies were included. The rate of hepatic artery thrombosis (HAT) in noncomparative studies (28) ranged from 0% to 10%, with 8 studies reporting patient deaths resulting from HAT. Within comparative studies, the rate of HAT in patients who underwent arterial reconstruction using the operating microscope ranged from 0% to 5.3%, whereas the rate of HAT in patients who underwent arterial reconstruction using loupe magnification ranged from 0% up to 28.6%, and 2 studies reported patient deaths resulting from HAT. Two comparative studies did not find statistically significant differences between the 2 groups.

Conclusions

Our comprehensive systematic review of the literature seems to suggest that overall, rates of HAT may be lower when the operating microscope is used for hepatic arterial reconstruction in liver transplantation. However, matched comparisons are lacking and surgical teams need to be mindful of the learning curve associated with the use of the operating microscope as compared with loupe magnification, as well as the logistical and time constraints associated with setup of the operating microscope.
The Anatomic Feasibility of a Functional Chimeric Flap in Complex Abdominal Wall Reconstruction
Authors: Scomacao Isis , Vijayasekaran Aparna , Fahradyan Vahe , Aliotta Rachel , Drake Richard , Gurunian Raffi , Djohan Risal
Published: July 2020

Background

Dynamic and functional abdominal wall reconstruction (FAWR) remains a complex challenge. The ideal flap should have a minimal donor-site morbidity and cover a large surface area with motor and sensory capabilities. The goal was to investigate the feasibility of using a free chimeric flap with anterolateral thigh (ALT) and rectus femoris (RF) components pedicled only on the motor nerve branch.

Methods

Ten fresh cadavers were dissected with a designed chimeric thigh flap including ALT and RF flaps. Anterolateral thigh was designed and raised with the lateral femoral cutaneous nerve integrated, and the descending branch of the lateral circumflex femoral artery was preserved. Rectus femoris was elevated and the common pedicle was dissected up to the femoral origin. Accompanying motor nerve branches were carefully dissected to their femoral origin.

Results

Twenty RF flaps were dissected and 9 were harvested as a true chimeric flap with ALT. The mean number of neurovascular bundles associated with RF flap was 2.11 ± 0.47, and the mean primary motor nerve average length was 9.40 ± 2.42 cm. The common vascular bundle in all 9 chimeric flaps was ligated, and the flap was rotated toward the abdomen pedicled only by primary motor nerve of the RF muscle. Nerve length was adequate for reach up to xiphoid area in all 20 flaps.

Conclusions

This study demonstrates the feasibility of the chimeric ALT/RF muscle free flap pedicled only by the motor nerve branch, with adequate flap rotation. Even with the limitations in a live patient, this flap would be an excellent option for FAWR in the right patient.
Postconditioning With Red-Blue Light Therapy Improves Survival of Random Skin Flaps in a Rat Model
Authors: Hamushan Musha , Cai Weijie , Lou Tengfei , Cheng Pengfei , Zhang Yubo , Tan Moyan , Chai Yimin , Zhang Feng , Lineaweaver William C. , Han Pei , Ju Jiaqi
Published: July 2020

Background

Random skin flap ischemic necrosis is a serious challenge in reconstructive surgery. Photobiomodulation is a noninvasive effective technique to improve microcirculation and neovascularization. Photobiomodulation with red or blue light has been separately proven to partially prevent skin flap necrosis, but the synergistic effect of red and blue light not been elucidated. Our experiment evaluated the impact of postconditioning with red-blue light therapy on the viability of random flaps.

Methods

Thirty Sprague-Dawley male rats (male, 12 weeks) with a cranially based random pattern skin flap (3 × 8 cm) were divided into 3 groups: control group, red light group, and red-blue light group. On postoperative day 7, flap survival was observed and recorded using transparent graph paper, flaps were obtained and stained with hematoxylin and eosin, and microvessel density was measured. Micro-computed tomography was used to measure vascular volume and vascular length. On days 0, 3, and 7 after surgery, blood flow was measured by laser Doppler. To investigate the underlying mechanisms, the amount of nitric oxide (NO) metabolites in the flap tissue was assessed on days 3, 5, and 7 after surgery.

Results

The mean percentage of skin flap survival was 59 ± 10% for the control group, 69 ± 7% for the red light group, and 79 ± 9% for the red-blue light group (P < 0.01). The microvessel density was 12.3 ± 1.2/mm2 for the control group, 31.3 ± 1.3/mm2 for the red light group, and 36.5 ± 1.4/mm2 for the red-blue light group (P < 0.01). Both vascular volume and total length in the red-blue light group showed significantly increased compared with the red light and control group (P < 0.01). Blood flow in the red-blue light treated flap showed significantly increased at postsurgery days 3 and 7 compared with the red light and control group (P < 0.01). The level of the NO metabolites was significantly increased in flap tissues belonging to the red-blue light group compared with the other 2 groups (P < 0.01).

Conclusions

This study showed that postconditioning with red-blue light therapy can enhance the survival of random skin flap by improving angiogenesis and NO releasing.
Causally linking neural dominance to perceptual dominance in a multisensory conflict
Authors: Yun Kyongsik , Bhattacharya Joydeep , Sandkühler Simone , Lin Yong-Jun , Iwaki Sunao , Shimojo Shinsuke
Published: July 2020

When different senses are in conflict, one sense may dominate the perception of other sense, but it is not known whether the sensory cortex associated with the dominant modality exerts directional influence, at the functional brain level, over the sensory cortex associated with the dominated modality; in short, the link between sensory dominance and neuronal dominance is not established. In a task involving audio-visual conflict, using magnetoencephalography recordings in humans, we first demonstrated that the neuronal dominance – auditory cortex functionally influencing visual cortex – was associated with the sensory dominance – sound qualitatively altering visual perception. Further, we found that prestimulus auditory-to-visual connectivity could predict the perceptual outcome on a trial-by-trial basis. Subsequently, we performed an effective connectivity-guided neurofeedback electroencephalography experiment and showed that participants who were briefly trained to increase the neuronal dominance from auditory to visual cortex showed higher sensory, that is auditory, dominance during the conflict task immediately after the training. These results shed new light into the interactive neuronal nature of multisensory integration and open up exciting opportunities by enhancing or suppressing targeted mental functions subserved by effective connectivity.
Hymenobacter polaris sp. nov., a psychrotolerant bacterium isolated from an Arctic station
Authors: Dahal Ram Hari , Chaudhary Dhiraj Kumar , Kim Dong-Uk , Kim Jaisoo
Published: July 2020

A pink-pigmented, non-motile, Gram-stain-negative, rod-shaped bacterium, designated RP-2-7T, was obtained from soil sampled at the Arctic station, Spitsbergen, Svalbard, Norway. Cells were strictly aerobic, psychrotolerant, grew optimally at 15–20 °C and hydrolysed CM-cellulose. Phylogenetic analysis based on its 16S rRNA gene sequence revealed that strain RP-2-7T formed a lineage within the family

Hymenobacteraceae

and clustered with members of the genus

Hymenobacter

. Its closest relative was

Hymenobacter marinus

KJ035T (97.6 % sequence similarity). The sequence similarities to other strains were ≤96.9 %. The principal respiratory quinone was MK-7 and the major polar lipids were phosphatidylethanolamine and an unidentified aminophospholipid. The predominant cellular fatty acids were summed feature 3 (C16 : 1
 ω7c and/or C16 : 1
 ω6c), anteiso-C15 : 0, iso-C15 : 0, C16 : 1
 ω5c and summed featured 4 (iso-C17 : 1 I and/or anteiso-C17 : 1 B). The DNA G+C content was 62.8 mol%. In addition, the average nucleotide identity and in silico DNA–DNA hybridization relatedness values between strain RP-2-7T and closely related strains were lower than species demarcation thresholds. Based on the resuls of genomic, chemotaxonomic, phenotypic and phylogenetic analyses, strain RP-2-7T represents novel species in the genus

Hymenobacter

, for which the name Hymenobacter polaris sp. nov. is proposed. The type strain is RP-2-7T (=KACC 21670T=NBRC 114391T).
The epidemiology and molecular characteristics of linezolid-resistant Staphylococcus capitis in Huashan Hospital, Shanghai
Authors: Ding Li , Li Pei , Yang Yang , Lin Dongfang , Xu Xiaogang
Published: July 2020

Introduction. Linezolid-resistant (LZR)

Staphylococcus capitis

has recently emerged in our hospital, and its potential resistance mechanisms are still not clear.

Aim. This study aimed to investigate the epidemiology, clinical and genetic characteristics, resistance mechanisms and biofilm formation capacity of LZR

S. capiti

s isolated from patients at Huashan Hospital, Shanghai, PR China between 2012 and 2018.

Methodology. Strains were subjected to antimicrobial susceptibility testing (AST) with antibiotics using the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of cfr, optrA and poxtA, as well as mutations in the 23S ribosomal (r)RNA and ribosomal proteins, was investigated using PCR and sequencing techniques. The genetic relationship between isolates was analysed using pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS). Biofilm biomasses were detected by using crystal violet staining.

Results. Twenty-one LZR

S. capitis

strains displayed MICs of 32–512 μg ml−1. All LZR strains showed G2576T and C2104T mutations in the 23S rRNA V region. Besides G2576T and C2104T, no base mutations were detected in the V region. The cfr was detected in 12 strains, while optrA and poxtA were not amplified in 21

S

.

capitis

strains. PFGE showed that the LZR

S. capitis

strains belonged to a single clone. The phylogenetic tree showed that 20 LZR

S. capitis

strains were highly similar to LNZR-1, isolated from Harbin (located in the north of China) in 2013, which showed resistance to linezolid.

Conclusions. In this research, cfr-negative strains displayed linezolid MICs of 32 μg ml−1. In comparison, cfr-positive strains exhibited linezolid MICs of 128–512 μg ml−1, indicating that high levels of linezolid resistance appear to be related to the presence of cfr. The outbreak of LZR

S. capitis

in our hospital needs to be monitored closely.
A Non-Adaptive Combinatorial Group Testing Strategy to Facilitate Healthcare Worker Screening During the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Outbreak
Authors: McDermott JH , Stoddard D , Woolf PJ , Ellingford JM , Gokhale D , Taylor A , Demain LAM , Newman WG , Black G
Published: July 2020

Background

Regular SARS-CoV-2 testing of healthcare workers (HCWs) has been proposed to prevent healthcare facilities becoming persistent reservoirs of infectivity. Using monoplex testing, widespread screening would be prohibitively expensive, and throughput may not meet demand. We propose a non-adaptive combinatorial (NAC) group-testing strategy to increase throughput and facilitate rapid turnaround via a single round of testing.

Methods

NAC matrices were constructed for sample sizes of 700, 350 and 250 with replicates of 2, 4 and 5, respectively. Matrix performance was tested by simulation under different SARS-CoV-2 prevalence scenarios of 0.1-10%, with each simulation ran for 10,000 iterations. Outcomes included the proportions of re-tests required and the proportion of true negatives identified. NAC matrices were compared to Dorfman Sequential (DS) approaches. A web application (www.samplepooling.com) was designed to decode results.

Findings

NAC matrices performed well at low prevalence levels with an average number of 585 tests saved per assay in the n=700 matrix at a 1% prevalence. As prevalence increased, matrix performance deteriorated with n=250 most tolerant. In simulations of low to medium (0.1%-3%) prevalence levels all NAC matrices were superior, as measured by fewer repeated tests required, to the DS approaches. At very high prevalence levels (10%) the DS matrix was marginally superior, however both group testing approaches performed poorly at high prevalence levels.

Interpretation

This testing strategy maximises the proportion of samples resolved after a single round of testing, allowing prompt return of results to staff members. Using the methodology described here, laboratories can adapt their testing scheme based on required throughput and the current population prevalence, facilitating a data-driven testing strategy.

Funding

None to Declare
Red blood cells injuries and hypersegmented neutrophils in COVID-19 peripheral blood film
Authors: Lakhdari Nordine , Tabet Boualem , Boudraham Lila , Laoussati Malha , Aissanou Sofiane , Beddou Lamia , Bensalem Sihem , Bellik Yuva , Bournine Lamine , Fatmi Sofiane , Iguer-Ouada Mokrane
Published: July 2020

In the current investigation, peripheral blood films of 15 COVID-19 patients (44.78±16.55 years), proven by computed tomographic imaging and RT-PCR for coronavirus SARS-CoV-2, were analyzed at the moment of hospital admission. Blood tests showed raised inflammatory markers (C-reactive protein 58.2±61.2 mg/L) with normal values for hemoglobin (126.2±2.6 g/L), WBC (6.8±18.74 109/L) RBC (4.55±0.99 1012/L) platelets (262.4±141.8, 109/L) MCV (79.84±8.2 fL) MCH (28±3.31 pg) and MCHC (350.3±1.15 g/L). The results revealed the presence of hypersegmented neutrophils in 66.66%% of the patients. The percentages of neutrophils with 4 and 5 lobes were 46.25 ± 4.83% and 31.5 ± 14.84%, respectively. Three major red blood cells morphological alteration were observed: (1) erythrocytes in “rouleaux” formation represented by linear erythrocytes aggregation, (2) spherocytes with the disappearance of the usual biconcave disk, and (3) echinocytes showing spiky projections. Apparent reorganization of hemoglobin is found in the majority of the analyzed erythrocytes. Rouleaux formation is observed in 33.33% of patients and spherocytes and echinocytes are present at variable levels in the all analyzed patients. The current results revealed erythrocytes injuries in COVID-19 peripheral blood, in association with hypersegmented neutrophils, alterations that could be involved in the respiratory syndrome.
The relationship between demographic, psychosocial and health-related parameters and the impact of COVID-19: a study of twenty-four Indian regions
Authors: Rajkumar Ravi Philip
Published: July 2020

Objectives: The impact of the COVID-19 pandemic has varied widely across nations and even in different regions of the same nation. Some of this variability may be due to the interplay of pre-existing demographic, psychological, social and health-related factors in a given population.
Methods: Data on the COVID-19 prevalence, crude mortality and case fatality rates were obtained from official government statistics for 24 regions of India. The relationship between these parameters and demographic, social, psychological and health-related indices in these states was examined using both bivariate and multivariate analyses.
Results: A variety of factors - state population, sex ratio, and burden of diarrhoeal disease and ischemic heart disease - were associated with measures of the impact of COVID-19 on bivariate analyses. On multivariate analyses, prevalence and crude mortality rate were both significantly and negatively associated with the sex ratio.
Conclusions: These results suggest that the transmission and impact of COVID-19 in a given population may be influenced by a number of variables, with demographic factors showing the most consistent association.