bluuebunny/crossref_metadata_2025 huggingface dataset:
Greenscreen: A simple method to remove artifactual signals and enrich for true peaks in genomic datasets including ChIP-seq data
Authors: Klasfeld Samantha , Roulé Thomas , Wagner Doris
Published: September 2022

Chromatin immunoprecipitation followed by sequencing (ChIP-seq) is widely used to identify factor binding to genomic DNA and chromatin modifications. ChIP-seq data analysis is affected by genomic regions that generate ultra-high artifactual signals. To remove these signals from ChIP-seq data, the Encyclopedia of DNA Elements (ENCODE) project developed comprehensive sets of regions defined by low mappability and ultra-high signals called blacklists for human, mouse (Mus musculus), nematode (Caenorhabditis elegans), and fruit fly (Drosophila melanogaster). However, blacklists are not currently available for many model and nonmodel species. Here, we describe an alternative approach for removing false-positive peaks called greenscreen. Greenscreen is easy to implement, requires few input samples, and uses analysis tools frequently employed for ChIP-seq. Greenscreen removes artifactual signals as effectively as blacklists in Arabidopsis thaliana and human ChIP-seq dataset while covering less of the genome and dramatically improves ChIP-seq peak calling and downstream analyses. Greenscreen filtering reveals true factor binding overlap and occupancy changes in different genetic backgrounds or tissues. Because it is effective with as few as two inputs, greenscreen is readily adaptable for use in any species or genome build. Although developed for ChIP-seq, greenscreen also identifies artifactual signals from other genomic datasets including Cleavage Under Targets and Release Using Nuclease. We present an improved ChIP-seq pipeline incorporating greenscreen that detects more true peaks than other methods.
An explanation of how mutant and wild-type mitochondria might stably co-exist in inherited mitochondrial diseases
Authors: Kowald Axel , Kemeth Felix P , Kirkwood Tom B L
Published: September 2022

Mitochondria are cellular organelles of crucial relevance for the survival of metazoan organisms. Damage to the mitochondrial DNA can give rise to a variety of mitochondrial diseases and is thought also to be involved in the aging process. The fate of mtDNA mutants is controlled by their synthesis as well as degradation and mathematical models can help to better understand this complex interplay. We present here a model that combines a replicative advantage for mtDNA mutants with selective degradation enabled by mitochondrial fission and fusion processes. The model not only shows that the cell has efficient means to deal with (many) types of mutants but, surprisingly, also predicts that under certain conditions a stable co-existence of mutant and wild-type mtDNAs is possible. We discuss how this new finding might explain how mitochondria can be at the heart of processes with such different phenotypes as mitochondrial diseases and aging.
How the Easter Egg Weevils Got Their Spots: Phylogenomics Reveals Müllerian Mimicry in Pachyrhynchus (Coleoptera, Curculionidae).
Authors: Van Dam Matthew H , Anzano Cabras Analyn , Lam Athena W
Published: September 2022

The evolutionary origins of mimicry in the Easter egg weevil, Pachyrhynchus, have fascinated researchers since first noted more than a century ago by Alfred Russel Wallace. Müllerian mimicry, or mimicry in which 2 or more distasteful species look similar, is widespread throughout the animal kingdom. Given the varied but discrete color patterns in Pachyrhynchus, this genus presents one of the best opportunities to study the evolution of both perfect and imperfect mimicry. We analyzed more than 10,000 UCE loci using a novel partitioning strategy to resolve the relationships of closely related species in the genus. Our results indicate that many of the mimetic color patterns observed in sympatric species are due to convergent evolution. We suggest that this convergence is driven by positive frequency-dependent selection. [Biogeography, discrete traits, frequency-dependent selection, mimicry, partitioning, Philippines, polymorphic, UCE.]
Returning complex genetic risk information to promote better health-related behaviors: a commentary of the literature and suggested next steps
Authors: Driver Morgan N , Kuo Sally I-Chun , Dick Danielle M
Published: September 2022

Genome-wide association studies aim to identify genetic variants that are associated with a disease phenotype in order to enhance precision medicine efforts. Despite the excitement surrounding the promise of precision medicine and interest among the public in accessing personalized genetic information, there has been little effort dedicated to understanding how complex genetic risk information could be incorporated into clinical practice to inform prevention, screening, and treatment. In this article, we briefly summarize the literature on the impact of receiving genetic risk information on health-related behavior, discuss the limitations of these studies, and outline the challenges that will need to be overcome, along with suggested next steps for future studies, to understand the true promise of precision medicine. The current literature demonstrates that there is no consistent or strong evidence that receiving complex genetic risk information, such as polygenic risk scores, has an impact on behavior; however, there are a number of limitations that may impact the failure to find significant effects associated with receiving genetic feedback. Behavior change is a complex process and simply providing genetic risk information without incorporating a theoretical perspective on behavior change diminishes the potential impact of receiving genetic risk information on actual behavior change. Future studies and interventions which return genetic feedback should be designed using theoretical frameworks of behavior change models to improve the impact of receiving personalized genetic information.
Association of dengue virus non-structural-1 protein with disease severity: a brief review
Authors: Ghetia Charmi , Bhatt Puneet , Mukhopadhyay Chiranjay
Published: September 2022

Dengue virus (DENV) was discovered by P. M. Ashburn and Charles F. Craig in 1907. Evidence of dengue-like illness was observed before 1907 and DENV epidemics have been reported from different parts of the world since then, with increased morbidity rates every year. DENV typically causes a febrile illness that ranges from mild asymptomatic infection to fatal dengue haemorrhagic fever (DHF) and/or dengue shock syndrome (DSS). Host mechanisms through which mild infection progresses to the fatal forms are still unknown. Few factors have been associated to aid severe disease acquisition, DENV non-structural 1 (NS1) protein being one of them. NS1 is a highly conserved glycoprotein among the Flavivirus and is often used as a biomarker for dengue diagnosis. This review focuses on assessing the role of NS1 in severe dengue. In this review, hospital-based studies on the association of dengue NS1 with severe dengue from all over the world have been assessed and analysed and the majority of the studies positively correlate high NS1 levels with DHF/DSS acquisition. The review also discusses a few experimental studies on NS1 that have shown it contributes to dengue pathogenesis. This review assesses the role of NS1 and disease severity from hospital-based studies and aims to provide better insights on the kinetics and dynamics of DENV infection with respect to NS1 for a better understanding of the role of NS1 in dengue.
Infectious Diseases Management in Wound Care Settings: Common Causative Organisms and Frequently Prescribed Antibiotics
Authors: Fukuta Yuriko , Chua Hubert , Phe Kady , Poythress E. Lee , Brown Cameron August
Published: September 2022

Although all chronic wounds are colonized by microbes and not all wounds are infected, antibiotics are widely prescribed in wound care settings. Antibiotic misuse in wound care occurs for many reasons, including diagnostic uncertainty regarding the presence of a bacterial infection, insufficient clinician knowledge about when antibiotics are necessary, clinicians’ fear of achieving unfavorable patient outcomes, and patient demand. Understanding wound infection stages and proper wound assessment are essential to differentiate infected wounds from colonized wounds. Adequate knowledge of microbiology and commonly prescribed antibiotics in wound care settings is critical to optimize antimicrobial management. In this article, the authors review wound infection stages, host resistant factors, and microbial virulence factors that affect the progression of wound infection, specimen collection, common causative organisms, and commonly prescribed antibiotics in wound care settings.

GENERAL PURPOSE

To provide information about the management of infected wounds in wound care settings.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Identify a host factor that may predispose a patient to a wound infection as well as characteristics of each stage of wound infection.

2. Distinguish a common organism that causes early, acute wound infections and explain the preferred method for obtaining a wound specimen for culture.

3. Apply knowledge of commonly prescribed antibiotics in wound care settings.
Successful use of rituximab for refractory hemophagocytic lymphohistiocytosis in a melanoma patient treated with targeted therapy
Authors: Tejedor Ines , Tedbirt Billal , Carvalho Priscille , Duval-Modeste Anne Bénédicte , Joly Pascal , Hébert Vivien
Published: September 2022

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease characterized by aberrant immune hyperactivation of T CD8 lymphocytes and macrophages driven by cytokine dysfunction. We report a 64-year-old man, with advanced BRAF-mutant melanoma treated by combined targeted therapies who had a recalcitrant and cortico-dependent Epstein–Barr virus (EBV)-induced HLH. One rituximab cycle led to a rapid and prolonged HLH remission which allowed to switch the targeted therapy for immunotherapy rituximab thus makes it possible to limit the use of corticosteroids, which limits the effectiveness of immunotherapy. The patient finally died of a cerebral tumoral progression 2 years later. Despite secondary hypogammaglobulinemia, we did not observe any severe infections during this period. This case suggests that rituximab can be a valuable option for EBV-induced HLH to avoid the T-suppressive effects of high-dose of corticosteroids in immunotherapy-treated patients.
Melanoma cell plasticity poses diagnostic challenges: a case series
Authors: Mennens Fer , Van Herck Yannick , Sciot Raf , Vanden Bempt Isabelle , Boecxstaens Veerle , Garmyn Maria , Bechter Oliver
Published: September 2022

Phenotype switching is an emerging concept in melanoma research and deals with the cancer cell plasticity. In this paper, we present five cases of patients with metastatic malignant melanoma where the tumor underwent dramatic morphological and immunohistochemical changes thereby mimicking other types of malignancies. The diagnosis of melanoma in all these cases was based on the mutational profile of the tumor assessed by next-generation sequencing compared to the primary lesion or local regional lymph nodes. These cases highlight the importance of thorough diagnostic measures in patients with metastatic melanoma who show progressive disease and where basic pathological assessment shows a diagnostic discrepancy.
Spine trabecular bone scores and bone mineral density of postmenopausal Taiwanese women
Authors: Huang Mei-Lan , Hsieh Tsyh-Jyi , Lin Song-Shei , Huang Wen-Chuan
Published: September 2022

Objectives

The aims of the study were to determine the mean trabecular bone score (TBS) of postmenopausal Taiwanese women and to analyze the value of TBS in predicting osteoporosis.

Methods

A total of 1,915 postmenopausal women with lumbar spine and hip bone mineral density (BMD) and spine TBS were enrolled from a single medical center into this study. The women's BMD and TBS were measured using dual x-ray absorptiometry (Discovery Wi; Hologic, Bedford, Mass) and iNsight software (Med-Imaps SASU, Merignac, France), respectively. The women's demographic characteristics; lumbar spine, total hip, and femoral neck BMD; and lumbar spine TBS were recorded, and correlations among the parameters were identified using a 2-tailed Pearson test, in which a P value less than 0.05 was considered statistically significant. We developed simple linear regression models to represent changes related to TBS and performed an analysis of variance on the selected variables.

Results

The average age of the women was 62.5 ± 9.1 years (range, 25.7–93.7 years). The mean TBS was 1.300 ± 0.086 (range, 1.015‐1.596). The TBS was weakly and negatively correlated with body mass index (r = −0.078) and moderately and positively correlated with the lumbar spine BMD (r = 0.619). The patients' lowest BMD values among those measured at multiple sites revealed a higher rate of osteoporosis (32.5%) than those measured at individual sites. Degraded TBS were noted in 21.2% of the participants, and a combination of BMD and TBS results predicted more individuals (7.8%) at a high risk of fracture than did the BMD result only. The rates of both osteoporosis and degraded TBS increased with age.

Conclusions

Bone mineral density and TBS can be used in combination to predict osteoporosis in a greater number of postmenopausal Taiwanese women. Because the incidence of osteoporosis is the highest among older women, clinicians should pay careful attention to TBS degradation among older patients without low BMD.
Acquiring and Implementing High-Cost and Complex Imaging Modalities
Authors: Contreras Joemart Ian
Published: September 2022

Large medical centers go through an extensive process for several key service departments to acquire imaging modalities. One such project involved the evaluation, planning, implementation, and go-live of a new mobile magnetic resonance imaging (MRI) for a newly built outpatient clinic. My role in this project was to lead the full procurement and installation process of the mobile MRI. The customer for this project was the radiology service at the new outpatient clinic. The radiology staff hopes to use the new mobile MRI to increase their overall patient caseload over the next several years and provide a much-needed service to a highly populated patient area. This should increase overall patient satisfaction while decreasing community-of-care costs for the hospital. The technology of an MRI is quite complicated, which made the acquisition of one that would meet the needs of the clinical staff that are more imperative for the biomedical engineering department to handle. The overall timeline for this project was about year and a half, and it had been planned extensively while also dealing with a few obstacles along the way. The technology assessment and procurement phases of this project brought new levels of education on the technology and the intense process that the medical center goes through to acquire imaging modalities. The medical center is currently waiting on the final vendor selection to proceed with the implementation of the mobile MRI. In the meantime, leading a separate fixed MRI replacement project at another outpatient facility has prepared me well for the mobile MRI project. Some of the challenges faced during this project included managing a team of different stakeholders, dealing with timeline issues, and understanding the different processes and procedures to accomplish certain tasks. The biggest learning opportunity was leading and managing both the procurement of the modality and its eventual installation. This project looks to improve the patient care and safety of the unique patient population at the new outpatient center.
Computed Tomography Diagnostic Reference Levels for Brain, Chest, and Abdominal/Pelvis Examinations
Authors: Abdullah Mohammed H. , Hamza Alnazier O. , Barakat Hana M. , Khider Mohamed O.
Published: September 2022

Radiation dosage variance is one of the topics that arise when dealing with computed tomography (CT) devices within medical imaging centers. In this article, a review was done to enlighten the causes of such dosage variance and the degree of variation for pediatric patients. The article focuses on the diagnostic reference levels (DRLs) for the brain, chest, and abdomen CT images. The reviewed studies were categorized depending on the type of the cases of pediatric patients, which include head, chest, and abdominal examinations. There were 9 studies using human data, 1 with phantom data, and 2 with combined human and phantom data. The dosage indices used in the studies were the DRLs, which were used as a key comparison between studies. The classification was likewise done at the expense of the radiation dose, with a secondary classification based on the patients' age, weight, and size. The type of scanner, differences in protocols, variations in patients, and variations in research design are all considered sources of variation. The following dosage indices were found in different combinations: volume CT dose index (CTDIvol), dose length product (DLP), and size-specific dose estimate (SSDE). The use of different dose indices limited the dose comparison between 11 studies.
Weight strategy in older adults with obesity: calorie restriction or not?
Authors: Colleluori Georgia , Villareal Dennis T.
Published: September 2022

Purpose of review

Along with the marked increase in the population of older adults with obesity is the need for effective strategies to treat aging- and obesity-related complications. This review highlights recent progress in obesity management in older adults.

Recent findings

Although calorie restriction is needed to significantly reduce fat mass, an exercise protocol is crucial to ameliorate functional outcomes. The addition of a resistance exercise protocol improves the response of muscle protein synthesis to anabolic stimuli, preventing the calorie restriction-induced reduction in muscle and bone mass. The addition of an aerobic exercise protocol improves cardiorespiratory fitness and cognitive function. However, the addition of both aerobic and resistance exercise protocols to calorie restriction provides the greatest improvements in myocellular quality, frailty, and cardiometabolic and cognitive outcomes, translating into the greatest improvement in quality of life. Such comprehensive lifestyle intervention effectively improves glucometabolic control and age-relevant outcomes in older adults with diabetes. When combined with testosterone therapy, such lifestyle intervention also preserves muscle and bone mass in older, men with obesity and hypogonadism.

We conclude that calorie restriction among older adults with obesity should be prescribed in combination with both aerobic and resistance exercise to maximize benefits on overall health.
Digital Therapeutic Self‐Management Intervention in Adolescents With Inflammatory Bowel Disease
Authors: Hommel Kevin A. , Ramsey Rachelle R. , Gray Wendy N. , Denson Lee A.
Published: September 2022

The objective of this study was to design, code, and test the feasibility, acceptability, and preliminary efficacy of a digital therapeutic self‐management tool for pediatric inflammatory bowel disease (IBD). The Self‐Management Assistance for Recommended Treatment (SMART) portal development involved an iterative co‐design process with a series of focus group/interview sessions with key stakeholders. Subsequently, a pilot, single‐arm, open‐label trial was conducted with 22 patients; medication adherence was the primary outcome. Usage data for the SMART portal were good, with patients demonstrating better engagement than parents. Results from the trial demonstrated improvement in medication adherence (M = 24%–31%; t = 7.94, P < 0.05) and self‐management barriers as well as trends in health‐related quality of life and symptoms. The SMART portal is a feasible digital therapeutic self‐management tool for pediatric IBD that demonstrated preliminary efficacy in this pilot trial. Large, controlled trials are needed to definitively determine the clinical efficacy of this tool.
Inclusion of Disability Content in Simulation
Authors: Ozkara San Eda , Marx Katherine A. , Robertiello Gina , Latimer Beth , Nahum Jennifer L. , Pasklinsky Natalya
Published: September 2022

Background:

Despite recommendations to include disability content in nursing education, nursing students have little exposure to disability education, which would help to develop necessary knowledge, skills, and attitudes in learning to care for patients with disabilities.

Purpose:

This study evaluated learners' perceptions of the effectiveness of a tabletop simulation in meeting their learning needs related to nursing care for children with disabilities and their families.

Methods:

The research design was a descriptive educational intervention study. Nursing students (n = 234) enrolled in the pediatric nursing course attended the simulation as a required part of their coursework.

Results:

The majority of the students found the tabletop simulation with disability content to be an effective educational intervention.

Conclusions:

The results obtained from this study indicated that the tabletop simulation was an effective educational strategy for nursing students' learning to provide care for children with disabilities and their families.
Embolic Stroke Associated With a Pulmonary Arteriovenous Fistula
Authors: Chen Lizhang , Yang Yujia , Tang Li , Zhou Muke , He Li
Published: September 2022

Introduction:

Here, we described a patient with ischemic stroke due to embolism, through an isolated pulmonary arteriovenous fistula (PAVF). Our case could be a paradigm of embolic stroke of undetermined source (ESUS) with an uncommon cause, providing an etiologic investigation process in addition to diagnostic pitfalls and pearls, eventually raising neurologists’ ability to treat ESUS.

Case Report:

A 37-year-old right-handed woman presented to our emergency department with sudden onset left upper limb and lower limb weakness. She denied a past medical history of hypertension, diabetes, heart diseases, and other cerebrovascular disease risk factors, and she is without a family history of stroke, previous trauma, toxic exposure, or drug use. On admission, her physical and neurological examinations were negative, except for left-sided hemiparesis. Her routine evaluations, serum autoantibody testing, and digital subtraction angiography were negative. Subsequent diffusion-weighted brain magnetic resonance imaging demonstrated acute infarction in the right frontoparietal lobe. To find the etiology of this case, more detailed examinations were performed. Finally, she was diagnosed with ESUS, which was caused by the PAVF.

Conclusions:

This case raises the awareness of a potential important emboligenic mechanism, the existence of an isolated PAVF as a right-to-left shunt in patients with a stroke of unknown origin should not be overlooked, even if a PAVF is not suggested by the initial physical findings or chest x-ray.
Preliminary Findings of the Birmingham Policy Surveillance Initiative
Authors: Fifolt Matthew , Graham Tessa , McMahon Sean , McCormick Lisa C.
Published: September 2022

Policy surveillance is becoming an increasingly powerful tool in public health to identify policies and programs that influence individual and community health. However, not many systems exist to track or facilitate greater understanding of policies at a city or county level. Furthermore, relatively little is known about which policies are being implemented and how they relate to population health goals. In 2019, the University of Alabama at Birmingham School of Public Health joined a consortium of universities to specifically track municipal policies in Birmingham, Alabama. Since its inception, the Birmingham Policy Surveillance Initiative has identified 443 policies and program initiatives related to 6 key areas of focus. The purpose of this article is to describe a policy surveillance system in Birmingham, Alabama. Results are intended to raise the profile of policy surveillance and inform policy makers of opportunities and gaps in policies that influence individual and community health.
Evaluating the Effectiveness of State-Level Policies on Childhood Blood Lead Testing Rates
Authors: Ruckart Perri Zeitz , Bove Frank J. , Dallas Cham
Published: September 2022

Context:

Lead exposure can harm nearly every organ in the human body. Millions of US children are exposed to lead hazards. Identifying lead-exposed children using blood lead testing is essential for connecting them to appropriate follow-up services. However, blood lead testing is not consistently conducted for at-risk children. Thus, determining which policies help improve blood lead testing rates is essential.

Objective:

This analysis provides critical evidence to better understand which state-level policies are more effective at increasing childhood blood lead testing rates. These include metrics, incentives, other managed care organization guidance, provider guidelines, mandatory reporting of results to state health departments, data sharing between Medicaid and other state agencies, and proof of testing for school enrollment.

Design:

This analysis included 33 states with complete data on the number of children tested for blood lead in 2017-2018 as reported to the Centers for Disease Control and Prevention. Linear regression modeling was conducted to examine associations between testing rates and the aforementioned policies. Fully adjusted models included percentages of the population living in pre-1980 housing, younger than 6 years with Medicaid coverage, and foreign-born.

Results:

Strongest unadjusted and adjusted regression coefficients were observed for requiring proof of testing for school enrollment (β = .12, P = .03) and metrics (β = .06, P = .01), respectively.

Conclusion:

Policies associated with higher childhood blood lead testing rates can be used by policy makers; local, state, and federal public health agencies; professional organizations; nonprofit organizations; and others to inform development and implementation of additional policies to increase childhood blood lead testing.
One Decade Later: The Generalizability, Diversity, and Inclusion of Community Health Needs Assessments
Authors: Summers-Gabr Nicole Marie , Cantrall Jessica
Published: September 2022

Context:

The 2010 Patient Protection and Affordable Care Act aimed to reduce health disparities and change medicine to be more community-driven. To maintain tax-exempt status, hospitals must complete a Community Health Needs Assessment (CHNA) every 3 years. This assessment must (a) integrate input from individuals the community serves, (b) make the report publicly assessable, and (c) adopt an implementation strategy based on community health needs identified in the assessment. However, there is little information on how representative CHNAs are of the community.

Design:

A content analysis was performed on a random sample of CHNA reports.

Setting:

This investigation examined nonprofit hospitals across the United States.

Objectives:

This investigation analyzed the quality of CHNAs and described existing CHNA practices through 4 means: (1) identified the type of data included; (2) examined the frequency in the methods of data collection; (3) understood how representative those data are of the hospital's service region; and (4) explored to what extent the hospital addressed diversity and inclusion such as through recruitment.

Methods:

A stratified random sample was drawn of CHNAs published in the past 3 years (n = 450 reports). The sample was stratified by the US Department of Agriculture's Rural-Urban Continuum codes to balance hospital representation from metro and nonmetro areas.

Results:

A series of dependent t tests revealed that these hospitals' reports represented a significantly more female, White, college-educated, and older population than the service area. In addition, only 3.12% of hospitals collected primary youth data. Finally, results also found that survey recruitment was not inclusive of individuals who did not have Internet access, could not read, or did not speak English fluently.
Long-Term Outcomes of Arthroscopic-Assisted Bone-Ligament-Bone Reconstruction for non-static Scapholunate Ligament Injury.
Authors: Della Rosa Norman , Bertozzi Nicolò , Annoscia Paolo , Adani Roberto
Published: September 2022

Purpose:

Scapho-lunate (SL) ligament injury is the most common cause of carpal instability. This retrospective case-series study aimed to assess the effectiveness and the maintenance of the results obtained by reconstructing the SL ligament with a bone–ligament–bone autograft through an arthroscopic-assisted minimally invasive approach.

Methods:

Thirty-six patients were initially enrolled but only 31 constituted the final population study (23 male, 8 females; median age was 38 years; range, 18-55). Radiographic (postero-anterior and true lateral radiographs to assess the SL gap, radio-lunate, capito-lunate angles; CT scan and MR images) functional (grip strength: Jamar test and Pinch test; active range of motion), and subjective (patient-rated wrist evaluation test) outcome measurements were collected. Minimum follow-up was 50 months.

Results:

Grip strength and wrist mobility were significantly improved from the preoperative values and improved in time. No SL synostosis, nor any carpal bone necrosis was observed. No wrist showed any sign of arthrosis or progression towards wrist instability. Only four patients had SL gap > 3 mm.

Conclusions:

Providing a biologic reconstruction of both volar and dorsal portion of the SL ligament, while avoiding extensive capsulotomy, the proposed technique for SL reconstruction obtained significant functional outcomes improvement which were maintained over time, while preventing degenerative changes to the articular surfaces.
Sirenomelia: Review of a rare syndrome with case report, review of anatomy, and thoughts on management
Authors: Pederson William C , Phillips William A. , Jalalabadi Faryan , White Lindsey , Reece Edward , Pederson William C
Published: September 2022

Background:

Sirenomelia is a very rare syndrome in which the infant is born with the legs fused from the pelvis down to the feet. It is often fatal in the neonatal period due to multiple other anomalies. The feet, if present, are often splayed outward or face backwards, and may be absent. There are no case reports of any patient with this syndrome who have successfully ambulated after separation of the legs.

Methods:

We report here on a patient we treated with sirenomelia who was born with the feet facing backwards, but otherwise normal-appearing hips and thighs. She had no other anomalies which would lead to fatality in the near future. After preop tissue expansion, we performed separation of the legs with through-knee amputations, utilizing a vascularized flap from the lower part of the legs based on the sciatic vessels for coverage of the perineum. There was no need for skin grafts or dermal matrices, and she healed primarily. She was referred to physical therapy in an attempt to allow her to ambulate.

Results:

She began to ambulate on her stumps early on, and is now walking with stubby prostheses. Her other medical issues have remained stable and non-problematic.

Conclusions:

Selected patients with sirenomelia may be able to ambulate after separation of the legs. This will depend on the status of other congenital differences as well as the status of the legs when separated. Careful workup with multidisciplinary planning of overall care as well as surgical care is essential.
Does Presurgical Taping Change Nose and Lip Esthetics in Infants with Unilateral Cleft Lip and Palate After Surgical Lip Repair? A Randomized Controlled Trial
Authors: Abd El-Ghafour Mohamed , Aboulhassan Mamdouh A. , El-Beialy Amr Ragab , Fayed Mona M. Salah , Eid Faten Hussein Kamel , Emara Dawlat , El-Gendi Mahmoud
Published: September 2022

Background:

The aim of the current randomized controlled trial (RCT) was to assess the effectiveness of taping alone in changing nose and lip (N&L) esthetics in infants with unilateral complete cleft lip and palate (UCLP) before and after surgical lip repair.

Methods:

The followed study design was prospective, balanced, randomized, parallel-groups, single-blinded, controlled-trial. All the steps were carried out in the Department of Orthodontics, Cairo university in Egypt. Thirty-one, non-syndromic UCLP infants were randomly assigned to either no-treatment (control) or taping groups. In taping group, all infants received horizontal tape between the 2 labial segments aiming to decrease the cleft gap. No other interventions were performed to infants included in this group. Standardized photographs and videos were captured to the included infants in both groups at the beginning of the treatment (T1), directly before surgical lip repair (T2) and 2 weeks after surgical lip repair (T3). Photos and shots from videos were calibrated and used for outcome assessment. Blinded-assessors carried out all the measurements digitally on the standardized photos at T1, T2 and T3 using Adobe Systems, Photoshop CS3 software.

Results:

Significant changes in all the measurements were recorded in the taping group at T2 before surgical lip repair in comparison to control group. At T3, no differences were found between the 2 groups.

Conclusions:

Taping is a successful intervention in changing nose and lip esthetics before surgical lip repair. After surgical lip repair, both groups had matching esthetics.
Real-World Experience of Tixagevimab and Cilgavimab (Evusheld) in Rheumatologic Patients on Rituximab
Authors: Ocon Anthony J. , Mustafa S. Shahzad
Published: September 2022

Background/Objective

Although vaccination is the primary strategy against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), rheumatologic patients on B-cell depleting agent rituximab may have a suboptimal response. Tixagevimab and cilgavimab (Evusheld) could be administered under Food and Drug Administration emergency use authorization as pre-exposure prophylaxis.

Methods

A cohort study of rheumatologic patients on rituximab therapy who received Evusheld was followed longitudinally. Adverse events were monitored.

Results

Forty-three patients received Evusheld, with diagnoses including rheumatoid arthritis, ANCA vasculitis, immune-mediated myositis, Sjögren disease, and systemic lupus erythematosus. Average time to follow-up was 100 ± 33 days. One patient experienced symptomatic infection with SARS-CoV-2 confirmed by home antigen test twice. A total of 97.8% of patients during follow-up did not contract acute SARS-CoV-2 infection. At the same time, 32,074 new local cases were reported with a local cumulative SARS-CoV-2 incidence rate of 4.32%. Adverse events included myalgia, flu-like symptoms, fevers, injection site pain, or headache. No serious adverse events, anaphylaxis, or cardiac events occurred.

Conclusions

Evusheld demonstrated effectiveness in preventing symptomatic SARS-CoV-2 infection in a real-world cohort of rheumatologic patients on rituximab therapy. Administration of Evusheld may be considered as part of a multilayered approach to risk mitigation in this high-risk population as pre-exposure prophylaxis.
Clinical Analysis of Primary Malignant Lacrimal Sac Tumors: A Case Series Study With a Comparison to the Previously Published Literature
Authors: Zhao Hong-shu , Shi Ji-tong , Wei Wen-bin
Published: September 2022

Purpose:

To report management of a series of patients with primary malignant lacrimal sac tumors and to compare these results to the previously published literature.

Materials and Methods:

A total of 27 patients with pathologically confirmed primary malignant lacrimal sac lesions were enrolled into this study. Pathological classifications, clinical characteristics, various treatment modalities and follow-up time, including tumor recurrence, were documented. The outcome measures included overall survival, progression-free survival, and median survival time.

Results:

Among 27 eligible cases, 33.33% (9/27) of the tumor was non-Hodgkin B-cell lymphoma, and 33.33% (9/27) was squamous cell carcinoma; both were the most common tumor in this series, followed by adenocarcinoma 18.52% (5/27), then melanoma 7.41% (2/27). Treatment modalities included surgery, radiotherapy, and/or chemotherapy, the overall survival rate of 27 patients was 70.37%, with a median follow-up of 45 months (range: 7 mo–16 y), 8 patients had died from metastatic disease, but 13 patients remained without evidence of recurrent tumor. The 5-year overall survival and progression-free survival for all cases were 73.33% and 66.67%, respectively. The median survival time for 5 deceased patients with interstitial brachytherapy was 98 months, and 5-year survival rate was 60%.

Conclusions:

In this series, among primary malignant lacrimal sac tumors, the proportion of lymphoma had increased when compared with the previously published literature, and multidisciplinary therapy may lead to a good prognosis in the majority of patients with the tumors and patients may benefit more from interstitial brachytherapy than external beam radiotherapy.
A 29-MRNA HOST RESPONSE WHOLE-BLOOD SIGNATURE IMPROVES PREDICTION OF 28-DAY MORTALITY AND 7-DAY INTENSIVE CARE UNIT CARE IN ADULTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH SUSPECTED ACUTE INFECTION AND/OR SEPSIS
Authors: Kostaki Antigone , Wacker James W. , Safarika Asimina , Solomonidi Nicky , Katsaros Konstantinos , Giannikopoulos George , Koutelidakis Ioannis M. , Hogan Catherine A. , Uhle Florian , Liesenfeld Oliver , Sweeney Timothy E. , Giamarellos-Bourboulis Evangelos J.
Published: September 2022

Background: Risk stratification of emergency department patients with suspected acute infections and/or suspected sepsis remains challenging. We prospectively validated a 29–messenger RNA host response classifier for predicting severity in these patients. Methods: We enrolled adults presenting with suspected acute infections and at least one vital sign abnormality to six emergency departments in Greece. Twenty-nine target host RNAs were quantified on NanoString nCounter and analyzed with the Inflammatix Severity 2 (IMX-SEV-2) classifier to determine risk scores as low, moderate, and high severity. Performance of IMX-SEV-2 for prediction of 28-day mortality was compared with that of lactate, procalcitonin, and quick sequential organ failure assessment (qSOFA). Results: A total of 397 individuals were enrolled; 38 individuals (9.6%) died within 28 days. Inflammatix Severity 2 classifier predicted 28-day mortality with an area under the receiver operator characteristics curve of 0.82 (95% confidence interval [CI], 0.74–0.90) compared with lactate, 0.66 (95% CI, 0.54–0.77); procalcitonin, 0.67 (95% CI, 0.57–0.78); and qSOFA, 0.81 (95% CI, 0.72–0.89). Combining qSOFA with IMX-SEV-2 improved prognostic accuracy from 0.81 to 0.89 (95% CI, 0.82–0.96). The high-severity (rule-in) interpretation band of IMX-SEV-2 demonstrated 96.9% specificity for predicting 28-day mortality, whereas the low-severity (rule-out) band had a sensitivity of 78.9%. Similarly, IMX-SEV-2 alone accurately predicted the need for day-7 intensive care unit care and further boosted overall accuracy when combined with qSOFA. Conclusions: Inflammatix Severity 2 classifier predicted 28-day mortality and 7-day intensive care unit care with high accuracy and boosted the accuracy of clinical scores when used in combination.
Making the Financial Case for Surgical Resident Well-being: A Scoping Review
Authors: Greenberg Anya L. , Doherty Devon V. , Cevallos Jenny R. , Tahir Peggy , Lebares Carter C.
Published: September 2022

Objective:

To conduct a scoping review of literature on financial implications of surgical resident well-being.

Background:

Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited.

Methods:

Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis.

Results:

Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective.

Conclusions:

Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area’s importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.
Chronic multiple mild stress induces sustained adverse psychological states in rats
Authors: Yu Tianze , Chen Yi , Lu Jiani , Gong Luyun , Mao Yuechen , Liu Xinya , Zhou Yiying , Guo Lei , Wu Xiang , Zhang Junfang , Wang Chuang , Shen Haowei , Zhou Wenhua , Mei Disen , Cui Wei
Published: September 2022

Adverse psychological states are stimulated by multiple types of environmental factors in human being. However, only few animal models of adverse psychological states were established by applying multiple types of stressors to mimic real conditions. A multisensory stress simulation device was designed to apply a combination of stressors to animals. Selected types and intensity of stressors were stimulated by this multisensory stress simulation device to induce chronic multiple mild stress (CMMS) in rats, modeling sustained adverse psychological states caused by long-term exposure in relative extreme environments with limited social interaction in human being. Fourteen-day treatment of CMMS-induced anhedonia, anxiety, and the loss of body weight in rats, which were similar to those in human being with adverse psychological states. Moreover, CMMS treatment leads to decreased production of serotonin and increased expression of corticotropin-releasing factor receptor 1, adrenocorticotropic hormone, and glucocorticoid in the brain, which were prevented by paroxetine and sertraline, two clinical-used antidepressants. Furthermore, these antidepressants prevented the CMMS-induced inhibition of brain-derived neurotrophic factor/cAMP-response element binding protein pathway, reduction of synaptic protein expression, and the activation of microglia and astrocytes in the hippocampus and the prefrontal cortex of rats. In addition, 14-day CMMS-induced long-term depressive-like behaviors, even after 14 days of CMMS treatment. And sertraline reversed CMMS-induced behavioral and biochemical changes in rats. All these results suggested that CMMS protocol induced sustained adverse psychological states in rats. By adjusting the intensity and the type of stressors in the multisensory stress simulation device, it might be practicable to establish animal models with complicated and changeable environmental factors.
Molecular evolution and genetic characteristics of G3P[3] group A canine rotavirus isolated in Wuhan, China
Authors: Chen Yue , Wu Renwei , Mi Wenqin , Ghonaim Ahmed H. , Ren Wenhui , Yang Lijun , Ruan Shennan , He Qigai , Chen Huanchun , Jiang Yunbo
Published: September 2022

Rotaviruses can infect multiple animal species and have the potential for cross-recombination based on the segmented genome characteristics. To study the intra-host recombination and zoonotic potential of group A canine rotavirus (CRV), 438 samples were collected from domestic dogs in six animal hospitals and from stray dogs from October 2019 to May 2021 in Wuhan, China. Seven of the samples were positive (7/438) for group A CRV from which a CRV strain was successfully isolated in MA-104 cells. The genotype of the isolated strain was characterized by whole-genome sequencing showing that the genotype was group A CRV G3P[3]. According to the Rotavirus Classification Working Group (RCWG), the genomic constellation of the isolated CRV was G3-P[3]-I3-R3-C3-M3-A9-N2-T3-E3-H6, which belongs to the AU-1-like group with gene segments of AU-1-like and Cat 97-like strains. Based on the phylogenetic analysis of the 11 gene segments, we found that the different segments of the isolated group A CRV were closely related to several reassortment rotaviruses from different animal sources and bat strains. Based on the analysis of the molecular evolution and genetic characteristics, we concluded that the isolated strain might be a reassortment strain. These data further enrich our understanding of rotavirus molecular evolution and genetic characteristics in China.
Continuous Hypoxia Reduces Retinal Ganglion Cell Degeneration in a Mouse Model of Mitochondrial Optic Neuropathy
Authors: Warwick Alexander M. , Bomze Howard M. , Wang Luyu , Klingeborn Mikael , Hao Ying , Stinnett Sandra S. , Gospe Sidney M.
Published: September 2022

Purpose

To test whether continuous hypoxia is neuroprotective to retinal ganglion cells (RGCs) in a mouse model of mitochondrial optic neuropathy.

Methods

RGC degeneration was assessed in genetically modified mice in which the floxed gene for the complex I subunit NDUFS4 is deleted from RGCs using Vlgut2-driven Cre recombinase. Beginning at postnatal day 25 (P25), Vglut2-Cre;ndufs4loxP/loxP mice and control littermates were housed under hypoxia (11% oxygen) or were kept under normoxia (21% oxygen). Survival of RGC somas and axons was assessed at P60 and P90 via histological analysis of retinal flat mounts and optic nerve cross sections, respectively. Retinal tissue was also assessed for neuroinflammation using Western blot and confocal microscopy.

Results

Consistent with our previous characterization of this model, at least one-third of RGCs had degenerated by P60 in Vglut2-Cre;ndufs4loxP/loxP mice remaining under normoxia. However, continuous hypoxia resulted in complete rescue of RGC somas and axons at this time point, with normal axonal myelination observed on electron microscopy. Though only partial, hypoxia-mediated rescue of complex I-deficient RGC somas and axons remained significant at P90. Hypoxia prevented reactive gliosis at P60, while the retinal accumulation of Iba1-positive mononuclear inflammatory cells was not substantially reduced.

Conclusions

Continuous hypoxia achieved dramatic rescue of early RGC degeneration in mice with severe mitochondrial dysfunction. Although complete rescue was not durable to P90, our observations suggest that investigating the mechanisms underlying hypoxia-mediated neuroprotection of RGCs may identify useful therapeutic strategies for optic neuropathies resulting from less profound mitochondrial impairment, such as Leber Hereditary Optic Neuropathy.