bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-Hop Relay Deployment Based on User Trajectory in Wireless Networks
Authors: Li Zhiyao , Ouyang Siru , Gao Xiaofeng , Chen Guihai
Published: August 2021

The traditional relay deployment problem typically assumes that the locations of users are known and stationary, which is not realistic in practice. The prevalence of mobile devices has made it possible to collect user trajectory and account for user movement while deploying relays. Under this background, a novel problem trajectory-based relay deployment (TBRD) is put forward. This problem considers communication-related metrics and is aimed at maximizing user connection time as users roam through the target area under relay resource constraints, which is more reasonable than the goal of expanding the relay coverage. To figure out the TBRD, we first propose the concept demand nodes (DNs), which are virtual weighted nodes representing the locations where users frequently pass or stay for a long period. Next, we design a Demand Node Generation algorithm that can transform the continuous historical user trajectory into a number of discrete DNs. By generating DNs, we convert the TBRD problem into a demand node coverage (DNC) problem, which is proved to be NP-complete. Followed by that, we introduce an approximation algorithm, named Submodular Iterative Deployment Algorithm, which solves the DNC problem with the approximation factor $1-\frac{1}{\sqrt{e\cdot (1-1/k)}}$, where $e$ is the mathematical constant, and $k$ is the relay number constraint. Finally, five real trajectory datasets are used to evaluate our proposed algorithm, and the simulation results demonstrate that our algorithm can obtain high coverage for users in motion, which can lead to better user experience. In addition, we also analyze the impact of different parameters on the coverage performance, and under this circumstance, we may safely come to the conclusion that our work is at the leading edge to utilize user trajectories for relay deployment in wireless networks.
Exploring the evolutionary process of alkannin/shikonin O-acyltransferases by a reliable Lithospermum erythrorhizon genome
Authors: Tang Chengyi
Published: August 2021

Increasing genome data are coming out. Genome size estimation plays an essential role in guiding genome assembly. Several months ago, other researchers were the first to publish a draft genome of the red gromwell (i.e. Lithospermum erythrorhizon). However, we considered that the genome size they estimated and assembled was incorrect. This study meticulously estimated the L. erythrorhizon genome size to should be ∼708.74 Mb and further provided a reliable genome version (size ≈ 693.34 Mb; contigN50 length ≈ 238.08 Kb) to support our objection. Furthermore, according to our genome, we identified a gene family of the alkannin/shikonin O-acyltransferases (i.e. AAT/SAT) that catalysed enantiomer-specific acylations in the alkannin/shikonin biosynthesis (a characteristic metabolic pathway in L. erythrorhizon’s roots) and further explored its evolutionary process. The results indicated that the existing AAT/SAT were not generated from only one round of gene duplication but three rounds; after different rounds of gene duplication, the existing AAT/SAT and their recent ancestors were under positive selection at different amino acid sites. These suggested that a combined power from gene duplication plus positive selection plausibly propelled AAT/SAT’s functional differentiation in evolution.
All Options Are on the Table? Time Horizons and the Decision-Making Process in Conflict
Authors: Dvir Rotem
Published: August 2021

This study explores how time horizons shape the decision-making process in international conflicts. I posit that leaders assess only a subset of the available policy options. The proposed decision-making model suggests that time horizons serve as a screening mechanism. Only policies that fit the actor's time horizon enter the choice set and can be eventually selected. Thus, variations in actors’ time horizons generate different choice sets in terms of size and composition. These different choice sets affect the identity of the selected policy. Using a two-phase experiment, I demonstrate that short time horizons reduce the choice set size and the type of options that are considered. The selection of the final policy is sensitive to the inherent trade-off in policy implications and to the composition of the choice set. These findings clarify the influence of time horizons on conflict choices within a two-phase decision process. It also explains why, facing international conflicts, political leaders are not likely to place all policy options “on the table.”
Circulating soluble receptor of advanced glycation end product is associated with bicuspid aortic aneurysm progression via NF-κB pathway
Authors: Jia Hao , Kang Le , Lu Shuyang , Chen Zhenhang , Shen Jinqiang , Huang Ben , Zou Yunzeng , Sun Yongxin
Published: August 2021

OBJECTIVES

Patients with bicuspid aortic valve (BAV) have a high risk of aortic dilation and adverse vascular events. Previous studies had reported soluble receptor for advanced glycation end products (sRAGE) to compete with receptor of advanced glycation end products (RAGE) for ligand binding and inhibit the activation of nuclear-factor kappa-B (NF-κB) pathway and matrix metalloproteinases (MMP) transcription. Thus, sRAGE serum levels may contribute to the clinical diagnosis and monitoring of ascending aorta aneurysm in patients with BAV.

METHODS

To eliminate the confounding factors, 44 patients with BAV were divided into 3 subgroups according to the diameter of ascending aorta, and 20 patients with tricuspid aortic valve and normal-sized ascending aorta were selected as a control group. Protein levels and gene transcription of several variates were evaluated in the tissue and serum samples from these patients. Human aortic smooth muscle cells were treated with AGE-BSA in gradient concentrations, and changes in phenotype and protein and mRNA levels were detected.

RESULTS

Serum levels of sRAGE in the 3 BAV groups were obviously higher than those in the tricuspid aortic valve group, although there was negative correlation between the serum sRAGE levels and ascending aortic diameters among patients with BAV. Transcript expression levels of RAGE and NF-κBp65 mRNA were increased in the 3 BAV groups and RAGE/NF-κB pathway was activated with the progression of ascending aortic aneurysm. Abnormal activation of RAGE/NF-κB pathway was observed in AGE-BSA-treated human aortic smooth muscle cells.

CONCLUSIONS

Our study has shown a trend in serum levels of sRAGE among patients with BAV, and that the cellular and extracellular pathological processes are quite serious even in the normal-sized or slightly dilated aorta. Together, the findings indicated that sRAGE may be used as a biomarker to predict aneurysm expansion rates and the risk of adverse vascular events.
African Countries’ Debt: A Tale of Acceleration at Multiple Speeds and Shades
Authors: Songwe Vera , Awiti Christine
Published: August 2021

Over 50% of African countries had debt to GDP ratios above 50% in 2019 with at least 48% of countries having debt to GDP ratios above 70%. The rise in debt levels is a recent phenomenon, with most countries’ debt increasing between 2014 and 2019. In this paper, we propose a new approach to debt monitoring. We argue that the speed of debt accumulation matters and that monitoring the speed of debt could alter the path of debt to more sustainable debt levels. We carry out an empirical analysis for all African countries in the 10 years to 2018 and group countries into seven categories based on their speed of growth of debt and their debt levels. We find that there is heterogeneity in country debt acquisition and that ensuing policies to ensure sustainable debt will need to be country specific.
Open notes sounds great, but will a provider’s documentation change? An exploratory study of the effect of open notes on oncology documentation
Authors: Rahimian Maryam , Warner Jeremy L , Salmi Liz , Rosenbloom S Trent , Davis Roger B , Joyce Robin M
Published: August 2021

Objective

The effects of shared clinical notes on patients, care partners, and clinicians (“open notes”) were first studied as a demonstration project in 2010. Since then, multiple studies have shown clinicians agree shared progress notes are beneficial to patients, and patients and care partners report benefits from reading notes. To determine if implementing open notes at a hematology/oncology practice changed providers’ documentation style, we assessed the length and readability of clinicians’ notes before and after open notes implementation at an academic medical center in Boston, MA, USA.

Materials and Methods

We analyzed 143 888 notes from 60 hematology/oncology clinicians before and after the open notes debut at Beth Israel Deaconess Medical Center, from January 1, 2012 to September 1, 2016. We measured the providers’ (medical doctor/nurse practitioner) documentation styles by analyzing character length, the number of addenda, note entry mode (dictated vs typed), and note readability. Measurements used 5 different readability formulas and were assessed on notes written before and after the introduction of open notes on November 25, 2013.

Results

After the introduction of open notes, the mean length of progress notes increased from 6174 characters to 6648 characters (P < .001), and the mean character length of the “assessment and plan” (A&P) increased from 1435 characters to 1597 characters (P < .001). The Average Grade Level Readability of progress notes decreased from 11.50 to 11.33, and overall readability improved by 0.17 (P = .01). There were no statistically significant changes in the length or readability of “Initial Notes” or Letters, inter-doctor communication, nor in the modality of the recording of any kind of note.

Conclusions

After the implementation of open notes, progress notes and A&P sections became both longer and easier to read. This suggests clinician documenters may be responding to the perceived pressures of a transparent medical records environment.
Cannabinoid Cancer Biology and Prevention
Authors: McAllister Sean D , Abood Mary E , Califano Joseph , Guzmán Manuel
Published: August 2021

Plant-based, synthetic, and endogenous cannabinoids have been shown to control a diverse array of biological processes, including regulation of cell fate across cancers. Their promise as broad-based antitumor agents in preclinical models has led to the initiation of pilot clinical trials. Session 5 of the National Cancer Institute’s Cannabis, Cannabinoids and Cancer Research Symposium provides an overview of this research topic. Overall, the presentations highlight cannabinoid signal transduction and specific molecular mechanisms underlying cannabinoid antitumor activity. They also demonstrate the broad-based antitumor activity of the plant-based, synthetic, and endogenous cannabinoid compounds. Importantly, evidence is presented demonstrating when cannabinoids may be contraindicated as a treatment for cancer, as in the case of human papilloma virus–meditated oropharynx cancer or potentially other p38 MAPK pathway–driven cancers. Finally, it is discussed that a key to advancing cannabinoids into the clinic is to conduct well-designed, large-scale clinical trials to determine whether cannabinoids are effective antitumor agents in cancer patients.
Oral Appliances for OSA Treatment: Meeting the Quadruple Aim
Authors: Knowles S , Dekow Matthew , Williamson Michele L
Published: August 2021

Introduction

In order to better treat obstructive sleep apnea (OSA) in a more efficient and cost-effective way, a joint program between dental clinics and the sleep medicine clinic was piloted at Fort Hood, Texas. Obstructive sleep apnea negatively affects soldier readiness and deployability, leading to the need to establish a successful and proven workflow to treat these patients with oral appliance therapy (OAT).

Materials and Methods

We performed a retrospective review of a de-identified data set which included 288 patients from July 2016 to July 2020. Projected cost data were obtained from routinely collected sleep clinic positive airway pressure (PAP) data. Data were analyzed to determine treatment success and potential cost savings using OAT versus continuous positive airway pressure (CPAP). Patient workflow including successes and challenges with the program is summarized.

Results

About 85.5% of patients met criteria for successful control of their OSA using OAT as treatment. Five patients did not tolerate OAT and switched back to CPAP. A higher (less severe) O2 nadir on diagnostic polysomnography is moderately correlated with OAT success. Diagnostic Apnea–Hypopnea Index was inversely and weakly correlated with success. Two of the major challenges noted in the program were (1) loss of follow-up and (2) the length of time from oral appliance referral to fitting the oral appliance. If this program was successfully implemented at other Defense Health Agency (DHA) medical treatment facility (MTF) markets nationwide, a potential cost savings of over $500,000/year/MTF could be achieved.

Conclusions

Oral appliance therapy has the potential to increase both readiness and deployability for active duty soldiers. Using baseline O2 nadir can help predict success with OAT patients, determining which patients will benefit from this joint program between the dental and medical sleep clinics. Future studies can aim to establish an evidence-based pathway for clinic testing and follow-up. If this patient workflow is implemented properly, there can be significant cost savings army-wide. This all helps The United States Medical Command (MEDCOM) align with the DHA’s Quadruple Aim of increased readiness, better health, better care, and lower cost.
Ten-Step Minimally Invasive Treatment of Lumbar Giant Disc Herniation via Unilateral Tubular Laminotomy for Bilateral Decompression: 2-Dimensional Operative Video
Authors: Kirnaz Sertac , Kocharian Gary , Sommer Fabian , McGrath Lynn B , Goldberg Jacob L , Härtl Roger
Published: August 2021

Giant disc herniation (GDH) is generally defined as a lumbar disc herniation that obstructs 50% or more of the space in the spinal canal.
1-3
Common treatment options for GDH include unilateral interlaminar approach, bilateral approach, or open full laminectomy.
4,5
Surgical treatment of GDH may be challenging because severe bilateral compression of neural elements in the spinal canal increases the risk of iatrogenic injury to nerve roots and dura. The surgical approach can be further complicated by calcification, hardening, and dehydration of the GDH tissue. The prevailing opinion in the literature is that giant disc herniations cannot safely be treated via tubular minimally invasive approaches.
5-7
In this video, we present a case of a 52-yr-old male patient with a history of progressive low back pain that radiates bilaterally from the buttocks toward the posterior legs and knees for 2 yr because of a GDH at the L4-5 level. The patient was treated via a tubular “over-the-top” minimally invasive decompression in order to first provide generous bilateral decompression of neural elements and dura.
8,9
After sufficient decompression at the surgical level, the discectomy was performed via an ipsilateral piecemeal resection of the GDH. The “over-the-top” contralateral mobilization of disc herniation was also achieved with this approach, which facilitated the removal of the entire disc fragment. Patient consent was obtained prior to performing the procedure. Therefore, GDH should not be considered as a contraindication for tubular decompression when this modified technique is performed.
Cancer and Portfolio Choice: Evidence from Norwegian Register Data
Authors: Døskeland Trond , Kvaerner Jens Soerlie
Published: August 2021

We examine the personal investment decisions of 60,000 households following a cancer diagnosis. To create a control group that minimizes the likelihood that the results are confounded by lifestyle factors, we rely on households diagnosed with the same diagnosis but a few years later. Our estimates show that a cancer diagnosis reduces households’ willingness to take risks with their financial wealth. We use the vast heterogeneity among cancers regarding its impact on life expectancy (LE) and income to analyze through which channels cancer impact risk-taking. We find that cancers that have a greater impact on LE and income cause a larger reduction in risk-taking. These two channels account for about 40–90% of the estimated effects of cancer on personal investment decisions. We do not find any association between having dealt with cancer many years ago and current portfolio choices.
Intermittent hypoxia and respiratory patterns during sleep of preterm infants aged 3 to 18 months residing at high altitude
Authors: Duenas-Meza Elida , Escamilla-Gil María Isabel , Bazurto-Zapata María Angelica , Caparo Elizabeth , Suarez Cuartas Miguel , Rincón Martínez Laura , Pernett Buenaver Lizbeth , Rojas Ortega Ariana , Torres Jorge , Restrepo-Gualteros Sonia , Parra Buitrago Andrea , Gonzalez-Garcia Mauricio
Published: August 2021

Study Objectives

The aim of this study was to determine the impact of apneas on oxygen saturation and the presence of intermittent hypoxia, during sleep of preterm infants (PTIs) born at high altitudes and compare with full-term infants (FTIs) at the same altitude.

Methods

PTIs and FTIs from 3 to 18 months were included. They were divided into three age groups: 3–4 months (Group 1); 6–7 months (Group 2), and 10–18 months (Group 3). Polysomnography parameters and oxygenation indices were evaluated. Intermittent hypoxia was defined as brief, repetitive cycles of decreased oxygen saturation. Kruskal-Wallis test for multiple comparisons, t-test or Mann–Whitney U-test were used.

Results

127 PTI and 175 FTI were included. Total apnea-hypopnea index (AHI) was higher in PTI that FTI in all age groups (Group 1: 33.5/h vs. 12.8/h, p = 0.042; Group 2: 27.0/h vs. 7.4/h, p < 0.001; and Group 3: 11.6/h vs. 3.1/h, p < 0.001). In Group 3, central-AHI (8.0/h vs. 2.3/h, p < 0.001) and obstructive-AHI (1.8/h vs. 0.6/h, p < 0.008) were higher in PTI than FTI. T90 (7.0% vs. 0.5, p < 0.001), oxygen desaturation index (39.8/h vs. 11.3, p < 0.001) were higher in PTI than FTI, nadir SpO2 (70.0% vs. 80.0, p<0.001) was lower in PTI.

Conclusion

At high altitude, compared to FTI, PTI have a higher rate of respiratory events, greater desaturation, and a delayed resolution of these conditions, suggesting the persistence of intermittent hypoxia during the first 18 months of life. This indicates the need for follow-up of these infants for timely diagnosis and treatment of respiratory disturbances during sleep.
Pea seed-borne mosaic virus (PSbMV) Risk Analysis of Field Pea Based on Susceptibility, Yield Loss, and Seed Transmission
Authors: Beck-Okins Amanda L. , del Río Mendoza Luis E. , Burrows Mary , Simons Kristin J. , Pasche Julie S.
Published: August 2021

Pea seed-borne mosaic virus (PSbMV), a nonpersistently aphid-transmitted potyvirus, has been reported in field pea (Pisum sativum L.)-growing regions worldwide. In 2014, PSbMV was first identified in field peas in North Dakota, U.S.A. Susceptibility and yield losses attributed to PSbMV infection are influenced by viral pathotype and host genotype. Isolate ND14-1, recovered from North Dakota infected seed and identified as pathotype 4 (P4), was mechanically inoculated onto 20 field pea cultivars under greenhouse conditions. PSbMV susceptibility, number of seeds and pods per plant, yield, symptom expression, and PSbMV seed transmission rates were assessed by cultivar. A risk assessment was developed based on cultivar susceptibility, yield reduction, and PSbMV seed transmission. Risk factors were weighted based on perceived importance to commercial field pea producers. Three cultivars were classified as low risk, seven cultivars were classified as intermediate risk, and 10 cultivars were classified as high risk. Two of the low-risk cultivars, Aragorn and Cruiser, were confirmed to be resistant to this isolate of PSbMV. Cultivar Arcadia was susceptible to PSbMV infection with mild expression of symptoms, but was classified as low risk based on a low seed transmission rate and diminished yield losses. This risk assessment could prove a useful tool for growers in field pea cultivar selection where PSbMV is prevalent.
The Importance of Meaningful Faculty Recognition in Creating a Healthy Academic Work Environment: A Mixed-Methods Study
Authors: Hollinger-Smith Linda M. , O’Lynn Chad , Groenwald Susan
Published: August 2021

AIM

The purpose of this study was to understand nursing faculty’s perceptions of meaningful recognition and how it contributes to a caring academic climate.

BACKGROUND

A supportive, healthy work environment is critical in recruiting and retaining nursing faculty. Research on caring for faculty through meaningful recognition and the impact on the workplace climate is limited.

METHOD

The study employed a parallel mixed-methods design in which quantitative and qualitative findings were integrated into synthesized conclusions. A total of 193 full-time faculty participated in the survey portion of the study; 15 full- and part-time faculty participated in video-conferenced focus groups.

RESULTS

Results of this study demonstrated that meaningful recognition contributes to a caring workplace, motivates faculty work performance, and impacts faculty roles in positive ways.

CONCLUSION

For recognition to be meaningful, it must be genuine, aligned with faculty’s perceptions of performance, commensurate with level of effort, and relevant to individuals.
Stability in Pelvic Triple Osteotomies in Children Using Resorbable PLGA Screws for Fixation
Authors: Hedelin Henrik , Larnert Per , Antonsson Pavel , Lagerstrand Kerstin , Brisby Helena , Hebelka Hanna , Laine Tero
Published: August 2021

Background:

The triple pelvic osteotomy (TPO) is a major redirectional osteotomy used to improve the acetabular coverage of the femoral head in selected pediatric patients with hip disorders. Traditionally the iliac osteotomy is stabilized by metal screws that require a second surgery for removal. Despite favorable results for both adults and children in related pelvic osteotomies, resorbable implants have not previously been used for TPOs.

This study aims to suggest a novel modified TPO surgical method in children using resorbable poly lactic-co-glycolic acid (PLGA) screws for fixation and to radiographically evaluate the postoperative stability achieved by these implants in a case series.

Methods:

All patients (n=11) with dysplasia of the hip (2), Perthe disease (5), or Down syndrome (4), who underwent primary TPO surgery during 2013 to 2019, using resorbable PLGA screws for fixation were included. The stability of the osteotomy was evaluated in the postoperative radiograph series using the acetabular index, migration percentage, Sharp’s angle and the center-edge angle. The osteotomy angle was introduced as a parameter to confirm the postoperative integrity of the achieved correction. All cases were evaluated until radiographic healing of the iliac osteotomy. Hospital notes were analyzed for complications or local reactions in relation to the implants.

Results:

In all studied hips, the overall achieved correction was well maintained. The mean (SD) correction achieved, from the preoperative images to the last measurable postoperative image, was a 16.7 degrees decrease for Sharp angle, a 20.9 degrees decrease in acetabular index and a 24.7 degrees increase for the center-edge angle, respectively. There were no complications related to the bioabsorption of the implants.

Conclusion:

The present findings suggest that the modified TPO method, using resorbable PLGA screws, provides sufficient stability and appears to be a promising alternative to traditional TPO. Avoiding implant removal is a major benefit in a pediatric population. Resorbable screws enable the surgeon to place implants with more degrees of freedom since later implant removal is not a limiting factor.

Level of Evidence:

Level IV—case series.
Minimally Invasive Fusionless Surgery for Scoliosis in Spinal Muscular Atrophy: Long-term Follow-up Results in a Series of 59 Patients
Authors: Gaume Mathilde , Saudeau Etienne , Gomez-Garcia de la Banda Marta , Azzi-Salameh Viviane , Mbieleu Blaise , Verollet Delphine , Benezit Audrey , Bergounioux Jean , Essid Aben , Doehring Isabelle , Dabaj Ivana , Desguerre Isabelle , Barnerias Christine , Topouchian Vicken , Glorion Christophe , Quijano-Roy Susana , Miladi Lotfi
Published: August 2021

Background:

Treatment of spinal muscular atrophy (SMA) scoliosis has evolved in the last decade, with the emergence of fusionless surgical techniques that allow correction of the deformity before the end of growth spurt. These techniques are expected to delay definitive spine fusion and preserve trunk growth.

Purpose:

The aim was to evaluate long-term clinical, radiologic, and respiratory outcomes of a minimally invasive fusionless surgery (MIFLS) in SMA scoliosis.

Methods:

All children affected with SMA scoliosis who underwent MIFLS in our department from 2011 to 2019 were included. The instrumentation consisted in a bilateral sliding rod construct from T1 to the sacrum, anchored proximally by double-hook claws and distally by iliosacral screws. Clinical, genetic, respiratory and radiographic data were retrospectively reviewed. A patient’s satisfaction survey was performed.

Results:

A total of 59 children with genetic confirmation of SMA (9SMA1c, 47SMA2, and 3SMA3) underwent MIFLS at a mean age of 11±1.9 years. All of them were nonwalker at the time of surgery. Twenty-six were treated with intrathecal Nusinersen. Mean follow-up was 5.2 years (2 to 9.6 y). Mean major coronal curve improved from 79±15 to 41±16 degrees and pelvic obliquity decreased from 24±11 to 5.9±4 degrees. Mean space available for lung improved from 77% to 93%. Mechanical or infectious complications occurred in 9 patients, with removal of the implant in 1. 6 children required unplanned surgeries. Postoperative bracing was needed in 13 children. Mean gain weight 3 years after the first surgery was 6 kg. 91.5% of patients had a positive satisfaction of the surgery. There was no significant impact in respiratory function postoperatively. Only 30 children required rod lengthening procedures, with a mean interval between procedures of 1.9 years (0.5 to 3.7 y). No arthrodesis was required at last follow-up in any patient.

Conclusion:

Bipolar MIFLS in SMA preserves spinal and thoracic growth without interference with respiratory function. It provides a significant correction of spinal deformity and pelvic obliquity, having a reduced rate of complications. The correction of spinal deformity was maintained at long term, not requiring definitive fusion at the end of growth.

Level of Evidence:

Level IV.
Double Vascularized Fibula Proximal Growth Plate Transplantation: Novel Technique for the Radial Longitudinal Deficiency (RLD) Grade IV Reconstruction
Authors: Ozols Dzintars , Butnere Marisa M. , Kalnina Linda , Mokanu Arturs , Ozola Santa , Mikitins Aleksandrs , Petersons Aigars
Published: August 2021

Radial absence or severe hypoplasia in radial longitudinal deficiency (RLD) is most commonly treated through stabilization of the carpus on the ulna (centralization or radialization) with or without preliminary distraction. Alternative methods include bone transfer to replace the absent or deficient radius using the proximal fibula, vascularized or nonvascularized, and more recently the transfer of a vascularized second metatarsophalangeal joint. There is paucity of articles suggesting vascularized fibula growth plate transfer for RLD grade III where proximal part of radius can be found and none about double fibular growth plate transplantation. We developed new technique a bilateral growth plate transplantation for the pediatric patient with unilateral RLD stage IV (Bayne and Klug). Totally 2 patients were operated using new technique. No vascular problems occurred and no peroneal nerve damage were observed at the follow-ups. Annual growth was determined on x-rays at the 1 and 2-year follow-ups measuring 0.75 to 0.9 cm with open growth plates. The x-rays also show no changes that can harm the long-term growth potential in the forearm, demonstrating this technique’s capacity to achieve better results for forearm length and functionality in comparison to the Vilkki procedure or radialization operation and there is no need to sacrifice second toe. Thumb reconstruction can be done at age 3 or 4 years using pollicization or toe-to hand transplantation techniques. The patients and parents are satisfied with functional and esthetic outcomes. We believe the double fibular growth plate transplantation is a promising method to use to reconstruct unilateral RLD grade IV.
Biomarker-Based Classification of Patients With Acute Respiratory Failure Into Inflammatory Subphenotypes: A Single-Center Exploratory Study
Authors: Drohan Callie M. , Nouraie S. Mehdi , Bain William , Shah Faraaz A. , Evankovich John , Zhang Yingze , Morris Alison , McVerry Bryan J. , Kitsios Georgios D.
Published: August 2021

OBJECTIVES:

Hyper- and hypoinflammatory subphenotypes discovered in patients with acute respiratory distress syndrome predict clinical outcomes and therapeutic responses. These subphenotypes may be important in broader critically ill patient populations with acute respiratory failure regardless of clinical diagnosis. We investigated subphenotyping with latent class analysis in an inclusive population of acute respiratory failure, derived a parsimonious model for subphenotypic predictions based on a small set of variables, and examined associations with clinical outcomes.

DESIGN:

Prospective, observational cohort study.

SETTING:

Single-center, academic medical ICU.

PATIENTS:

Mechanically ventilated patients with acute respiratory failure.

MEASUREMENTS AND MAIN RESULTS:

We included 498 patients with acute respiratory failure (acute respiratory distress syndrome: 143, at-risk for acute respiratory distress syndrome: 198, congestive heart failure: 37, acute on chronic respiratory failure: 23, airway protection: 61, and multifactorial: 35) in our derivation cohort and measured 10 baseline plasma biomarkers. Latent class analysis considering clinical variables and biomarkers determined that a two-class model offered optimal fit (23% hyperinflammatory subphenotype). Distribution of hyperinflammatory subphenotype varied among acute respiratory failure etiologies (acute respiratory distress syndrome: 31%, at-risk for acute respiratory distress syndrome: 27%, congestive heart failure: 22%, acute on chronic respiratory failure 0%, airway protection: 5%, and multifactorial: 14%). Hyperinflammatory patients had higher Sequential Organ Failure Assessment scores, fewer ventilator-free days, and higher 30- and 90-day mortality (all p < 0.001). We derived a parsimonious model consisting of angiopoietin-2, soluble tumor necrosis factor receptor-1, procalcitonin, and bicarbonate and classified subphenotypes in a validation cohort (n = 139). Hyperinflammatory patients (19%) demonstrated higher levels of inflammatory biomarkers not included in the model (p < 0.01) and worse outcomes.

CONCLUSIONS:

Host-response subphenotypes are observable in a heterogeneous population with acute respiratory failure and predict clinical outcomes. Simple, biomarker-based models can offer prognostic enrichment in patients with acute respiratory failure. The differential distribution of subphenotypes by specific etiologies of acute respiratory failure indicates that subphenotyping may be more relevant in patients with hypoxemic causes of acute respiratory failure and not in patients intubated for airway protection or acute on chronic decompensation.
Hepatosplenic T-cell lymphoma: treatment challenges
Authors: Bron Dominique , De Leval Laurence , Michiels Sandra , Wittnebel Sebastian
Published: August 2021

Purpose of review

Hepatosplenic lymphoma (HSTCL) is a rare T-cell malignancy occurring in young males, associated with immune deficiency in 20% of the cases which, despite aggressive treatments, has a poor survival. Specific recommendations for first-line treatment remain debatable.

Recent findings

Published data covering case reports or series of HSTCL concur that allogeneic stem cell transplant should be proposed as a consolidation after response to chemotherapy in all patients eligible for transplant. In the light of two recent clinical examples, we also confirm that specific chemotherapy and a first-line consolidation with allogeneic transplantation when a donor is available to represent a treatment of choice these rare and distinctive lymphomas. Recent molecular studies are summarized in this review and suggest potential targets for new therapeutic strategies.

Major progresses have been achieved in improving the outcome of HSTCL l patients using intensive chemotherapy and allogeneic transplantation.
The Use of Hemostatic Agents to Decrease Bleeding Complications in General Plastic Surgery Procedures
Authors: Bloom Joshua A. , Erlichman Zachary , Foroutanjazi Sina , Beqiraj Zhaneta , Jonczyk Michael M. , Persing Sarah M. , Chatterjee Abhishek
Published: August 2021

Background:

Within plastic surgery, hematomas and seromas are frequently reported complications that can negatively impact wound healing and result in significant morbidity in patients. As a result, there has been considerable interest in hemostatic agents to complement traditional methods of hemostasis. The purpose of this study was to evaluate postoperative bleeding complications and duration of Jackson-Pratt (JP) drain use in general plastic surgery procedures with and without hemostatic agents.

Methods:

After obtaining institutional review board approval, a retrospective chart review was performed. Patients who underwent bilateral breast reduction, panniculectomy, or abdominoplasty were included. Data collected included indication for surgery, type of operation, use of hemostatic agent, specifically fibrin sealant (FS, EVICEL, Ethicon, USA) or combination powder (CP, HEMOBLAST Bellows, Biom’up, France), length of follow-up, time to JP drain removal, postoperative complications, and specimen weight. This was a consecutive experience where initially no hemostatic agent was used, followed by use of FS, and then CP.

Results:

The use of a hemostatic agent resulted in reduced time duration for JP drain use and overall fewer recorded complications in the hemostatic agent groups. Although not significant, the hemostatic agent group (FS and CP) experienced fewer hematomas and seromas compared with the nonhemostatic agent group. JP drain duration was significantly less among breast reduction (3.46 versus 6.92 days, P < 0.01) for CP when compared with FS.

Conclusion:

The use of hemostatic agents in general plastic surgery procedures may result in decreased postoperative complications and significantly reduce time to JP drain removal.
Split Skin Grafting the Heart: A Simple Solution for a Complex Reconstructive Challenge
Authors: Cochrane Elliott , Morritt Andrew
Published: August 2021

We present the interesting case of an 87-year-old woman who underwent debridement of chest wall osteoradionecrosis (ORN) that arose following radiotherapy for breast cancer. Debridement left a complex defect with exposed myocardium and parietal pleura. An extensive surgical history, compromised physiological reserve, and the patient’s desire not to undergo major reconstructive surgery limited the reconstructive options. Ultimately, a split skin graft (SSG) was applied directly to the heart and pleura to obtain wound closure. We believe this is the first report of an SSG being applied directly onto the myocardium to achieve stable soft tissue cover
Microsurgery Arena: A New Device to Develop Microsurgical Skills
Authors: Costa Francesco , di Summa Pietro G. , Srinivasan Jeyaram
Published: August 2021

Simulation in microsurgery is an important pillar of training and maintenance of surgical skills. Between learning microsurgical skills and mastering them in clinical practice, the usefulness of low-fidelity simulators for improving microsurgery skills has been well documented. Nowadays the in vivo models represent the gold standard of microsurgical training; however, their use implies difficulties and limitations. We developed a portable, low-cost, and modern device to help trainees to practice at their convenience to maintain their microsurgical suturing skills. By using CAD and 3D printer designs, we developed a “microsurgery trainer” that contains a middle section with eight projections with holes, arranged as a circle. The idea is to pass the microsuture—preferably 7/0 or 8/0 sutures—in a clockwise manner—with the needle passing from “out to in” and “in to out” through each hole. This allows the trainee to use his/her wrist to be flexible and achieve better control over the micro needle. Studies evaluating the potential of such a device in shortening the learning curve are needed and will be crucial to define whether the “microsurgery arena” will help trainees to obtain better outcomes in microsurgical practice.
OPTICAL COHERENCE TOMOGRAPHY FEATURES OF POLYPOIDAL LESION CLOSURE IN POLYPOIDAL CHOROIDAL VASCULOPATHY TREATED WITH AFLIBERCEPT
Authors: Tan Anna C. S. , Jordan-Yu Janice Marie , Vyas Chinmayi Himanshuroy , Gan Alfred Tau Liang , Teo Kelvin Yi Chong , Chan ChoI Mun , Mathur Ranjana , Wong Tien Yin , Chakravarthy Usha , Cheung Gemmy Chui Ming
Published: August 2021

Purpose:

To evaluate whether optical coherence tomography (OCT) can determine polypoidal lesion (PL) perfusion in polypoidal choroidal vasculopathy eyes after 12 months of aflibercept monotherapy. Polypoidal lesion perfusion status, assessed by indocyanine green angiography, is an important anatomical outcome in polypoidal choroidal vasculopathy management.

Methods:

Post hoc data from a prospective randomized, open-label, study in eyes with polypoidal choroidal vasculopathy undergoing monotherapy with aflibercept evaluated PL perfusion status based on indocyanine green angiography (gold standard) and OCT features from baseline to 12 months.

Results:

Individual PLs (110 in total) from 48 eyes (48 patients) showed at 12 months; 57/110 PLs (51.8%) were closed on indocyanine green angiography. At 12 months, eyes with closed PLs were more likely to have the following OCT features: 1) no subretinal fluid (67.1% vs. 32.9%), 2) smaller pigment epithelial detachment height (67.2 [±43.8] vs. 189.2 [±104.9] μm), 3) densely hyperreflective pigment epithelial detachment contents (84.0% vs. 16.0%), 4) an absence of a hyperreflective ring(64.0% vs. 36.0%), and a 5) indistinct overlying retinal pigment epithelial (71.4% vs. 28.6%) (all P < 0.05). The three highest performing OCT features that differentiated perfused from closed PLs were (1), (3), and (4) (area under the receiver operating characteristic curve 0.85, 0.73, and 0.70, respectively). A combination of these three features achieved an area under the receiver operating characteristic curve of 0.90.

Conclusion:

Polypoidal lesion closure, an important anatomical treatment outcome in polypoidal choroidal vasculopathy typically defined by indocyanine green angiography, can be accurately detected by specific OCT features.
Use of Suvorexant and Antipsychotics in the Treatment of Delirium After Infectious Diseases
Authors: Okino Kazumaro , Yamada Hiroki , Tomioka Hiroi , Nozaki Shinji , Iwanami Akira , Inamoto Atsuko
Published: August 2021

Background

Delirium is often treated on a subjective basis and per the discretion of the attending physician because of a lack of pharmacological evidence in the literature. To address this knowledge gap, we aimed to examine the efficacy of a hypnotic drug, suvorexant, as a therapeutic agent for the treatment of delirium.

Methods

Fifty-seven patients were targeted. Of the 57 patients, 39 were in the subolexant group, 17 in the antipsychotic group, and 1 was taking antidepressants. The Delirium Rating Scale–Revised 98 was used to evaluate the symptoms of delirium before and 3 and 7 days after drug administration. In addition, the medical history, occurrence of adverse effects, white blood cell count, and C-reactive protein level of participants were examined.

Results

Both drugs exhibited therapeutic effects on delirium, but suvorexant had a more pronounced effect. Furthermore, the suvorexant group exhibited decreased levels of C-reactive protein, suggesting an anti-inflammatory effect. Suvorexant seems to improve the symptoms of inflammation-related delirium without any serious adverse effects, suggesting that it can be explored as a safe treatment option for clinical use in future studies.

Conclusions

Our findings will be relevant for physicians interested in learning about new pharmacological treatment options and researchers interested in validating our results.
Switching to Intranasal Esketamine Maintains the Antidepressant Response to Intravenous Racemic Ketamine Administration
Authors: Banov Michael D. , Landrum Rachel E. , Moore Michelle B. , Szabo Steven T.
Published: August 2021

Purpose

This study aims to assess the efficacy and safety of intranasal (IN) esketamine as maintenance antidepressant therapy in patients who have demonstrated clinical improvement with off-label intravenous (IV) racemic ketamine for treatment-resistant depression (TRD).

Methods

This is a retrospective case series of 10 consecutive outpatients with TRD who all had a clinically meaningful response when treated with IV racemic ketamine and were then switched to IN esketamine for maintenance therapy. Patient outcomes were assessed with the Montgomery-Åsberg Depression Rating Scale, Patient Health Questionnaire 9, and Clinical Global Impression of Improvement scale at each visit. Adverse effects were assessed at each treatment.

Findings

Results indicated that 9 patients either maintained the benefit or showed greater improvement when transitioned to IN esketamine for antidepressant maintenance therapy. One patient had worsening of depression due to an acute psychosocial stressor but still improved from baseline IV racemic ketamine treatment. Six patients returned to work or pursued employment, and 4 patients with suicidal ideation remitted during IV racemic ketamine treatment and had no recurrence of suicidality with IN esketamine. No serious adverse reactions or tolerability issues were observed.

Implications

This case series reports the outcomes of 10 severely ill patients with TRD who had a clinically meaningful response to IV racemic ketamine and demonstrated a maintenance of effect or continued improvement when transitioned to IN esketamine. Although this finding needs to be replicated in larger, controlled studies, this report provides promising results for patients who have safely and effectively switched to Food and Drug Administration–approved IN esketamine after receiving acute or maintenance depression treatment with off-label IV racemic ketamine.
Perineural Invasion of the Intratemporal Facial Nerve: How Far Proximally Do We Chase the Positive Margin?
Authors: Page Joshua Cody , Nader Marc-Elie , Knackstedt Mark , Roberts Dianna , Gidley Paul W.
Published: August 2021

Objective:

To determine recurrence patterns in patients with head and neck cancers requiring facial nerve sacrifice and to determine the optimal management of the positive proximal facial nerve margin.

Study design:

Case series with chart review.

Setting:

Tertiary care center.

Patients:

One hundred fifty-five patients with head and neck malignancies who underwent sacrifice of the facial nerve between March 1, 1999 and October 31, 2020. Demographics, preoperative facial nerve function, prior oncologic treatment, histologic type, operative details, adjuvant treatment, recurrence patterns, and overall survival were reviewed.

Main outcome measures:

Recurrence rates and recurrence location.

Results:

Thirteen patients (8%) had positive proximal margins on final pathologic evaluation. Six of 13 (46%) experienced disease recurrence. No disease recurred proximally along the facial nerve. The recurrence rate was 26% for negative proximal facial nerve margins. Segments of the facial nerve biopsied included: extratemporally (n = 78), at the stylomastoid foramen (36), mastoid segment (22), second genu (7), tympanic (6), geniculate (3), labyrinthine (1), and IAC (2). Median patient follow-up was 30.3 months.

Conclusions:

Our data suggest that a conservative approach to a positive proximal facial nerve margin is optimal with respect to operative planning, patient morbidity, and disease recurrence patterns. Recurrence proximally along the facial nerve is an exceedingly rare event and the necessity of biopsy proximal to the geniculate ganglion, and in some cases even to the second genu, is called into question.
Comparison of Cranioplasty Techniques Following Translabyrinthine Surgery: Implications for Postoperative Pain and Opioid Usage
Authors: Sioshansi Pedrom C. , Xiong Mulin , Tu Nathan C. , Bojrab Dennis I. , Schutt Christopher A. , Babu Seilesh C.
Published: August 2021

Objective:

To assess differences in postoperative pain, opioid usage, and surgical outcomes between cranioplasty using abdominal fat graft (AFG) versus hydroxyapatite cement (HAC) following translabyrinthine surgery.

Study Design:

Retrospective case control.

Setting:

Tertiary referral center.

Patients:

Sixty translabyrinthine procedures were evaluated, including 30 consecutive HAC patients and 30 matched AFG patients. Patients were matched by age, gender, body mass index, and tumor size.

Intervention:

Cranioplasty using HAC or AFG following translabyrinthine resection of vestibular schwannoma.

Main Outcome Measures:

Postoperative patient pain ratings, narcotic usage, inpatient length of stay, and complication rates.

Results:

Patients who underwent HAC cranioplasty had lower postoperative pain scores on several measures (p < 0.05) and less postoperative narcotic usage (mean difference of 36.7 morphine equivalents, p = 0.0025) when compared to those that underwent AFG closure. HAC cranioplasty patients had shorter average length of hospital stay (2.2 vs 3.4 days, p = 0.0441). Postoperative cerebrospinal fluid leaks (one in HAC group, two in AFG group) and skin reactions in AFG closure patients (n = 1) were infrequent.

Conclusion:

HAC cranioplasty is a safe technique comparable to AFG closure following translabyrinthine surgery which can decrease postoperative pain, narcotic usage, and hospital length of stay.
Arousal-based scoring of obstructive hypopneas
Authors: Malhotra Raman K.
Published: August 2021

Purpose of review

Obstructive sleep apnea in adults is diagnosed by an apnea–hypopnea index (AHI) above five (at least five apneas and/or hypopneas per hour of sleep). Though the definition of apneas has remained stable, the scoring criteria for hypopneas has varied throughout the years. There is even more evidence now that scoring respiratory events associated with arousals should be included in the diagnosis of obstructive sleep apnea, as these patients may benefit from treatment.

Recent findings

Recent studies, trials and meta-analyses have demonstrated that respiratory events associated with arousal are associated with symptoms, such as poor sleep quality and excessive daytime sleepiness. These arousal-based hypopneas have also been noted to carry a risk of hypertension and other adverse health consequences.

Requiring a 4% oxygen desaturation for hypopneas may miss patients that may benefit from treatment for obstructive sleep apnea. These patients are typically younger, nonobese, and women as they have been found to have respiratory events causing sleep fragmentation versus significant oxygen desaturation as compared with other populations.