bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective Androgen Receptor Modulator–Induced Liver Injury in Active Duty Male
Authors: Lee Byung K , Park Brian B , Bower Richard J
Published: March 2022

Selective androgenic receptor modulators (SARMs) are extensively advertised as safer and more effective analogues to traditional androgenic anabolic steroids, yet there are increasing cases of hepatotoxicity secondary to their use. We present the case of a previously healthy young active duty Marine who presented with cholestatic liver injury secondary to SARM use. This is the first reported case in a service member and contributes to the growing amount of evidence regarding the potential detrimental effects of SARMs. It also illustrates the impact of SARMs on military members and overall mission readiness as his treatment course included hospitalization and placement in a non-deployable status until recovery from his liver injury. Additional steps should be taken to increase awareness in order to protect service members and sustain readiness.
Nuclear receptor activation shapes spatial genome organization essential for gene expression control: lessons learned from the vitamin D receptor
Authors: Warwick Timothy , Schulz Marcel H , Gilsbach Ralf , Brandes Ralf P , Seuter Sabine
Published: March 2022

Spatial genome organization is tightly controlled by several regulatory mechanisms and is essential for gene expression control. Nuclear receptors are ligand-activated transcription factors that modulate physiological and pathophysiological processes and are primary pharmacological targets. DNA binding of the important loop-forming insulator protein CCCTC-binding factor (CTCF) was modulated by 1α,25-dihydroxyvitamin D3 (1,25(OH)2D3). We performed CTCF HiChIP assays to produce the first genome-wide dataset of CTCF long-range interactions in 1,25(OH)2D3-treated cells, and to determine whether dynamic changes of spatial chromatin interactions are essential for fine-tuning of nuclear receptor signaling. We detected changes in 3D chromatin organization upon vitamin D receptor (VDR) activation at 3.1% of all observed CTCF interactions. VDR binding was enriched at both differential loop anchors and within differential loops. Differential loops were observed in several putative functional roles including TAD border formation, promoter-enhancer looping, and establishment of VDR-responsive insulated neighborhoods. Vitamin D target genes were enriched in differential loops and at their anchors. Secondary vitamin D effects related to dynamic chromatin domain changes were linked to location of downstream transcription factors in differential loops. CRISPR interference and loop anchor deletion experiments confirmed the functional relevance of nuclear receptor ligand-induced adjustments of the chromatin 3D structure for gene expression regulation.
OMARU: a robust and multifaceted pipeline for metagenome-wide association study
Authors: Kishikawa Toshihiro , Tomofuji Yoshihiko , Inohara Hidenori , Okada Yukinori
Published: March 2022

Microbiome is an essential omics layer to elucidate disease pathophysiology. However, we face a challenge of low reproducibility in microbiome studies, partly due to a lack of standard analytical pipelines. Here, we developed OMARU (Omnibus metagenome-wide association study with robustness), a new end-to-end analysis workflow that covers a wide range of microbiome analysis from phylogenetic and functional profiling to case–control metagenome-wide association studies (MWAS). OMARU rigorously controls the statistical significance of the analysis results, including correction of hidden confounding factors and application of multiple testing comparisons. Furthermore, OMARU can evaluate pathway-level links between the metagenome and the germline genome-wide association study (i.e. MWAS-GWAS pathway interaction), as well as links between taxa and genes in the metagenome. OMARU is publicly available (https://github.com/toshi-kishikawa/OMARU), with a flexible workflow that can be customized by users. We applied OMARU to publicly available type 2 diabetes (T2D) and schizophrenia (SCZ) metagenomic data (n = 171 and 344, respectively), identifying disease biomarkers through comprehensive, multilateral, and unbiased case–control comparisons of metagenome (e.g. increased Streptococcus vestibularis in SCZ and disrupted diversity in T2D). OMARU improves accessibility and reproducibility in the microbiome research community. Robust and multifaceted results of OMARU reflect the dynamics of the microbiome authentically relevant to disease pathophysiology.
Management of the patent ductus arteriosus in preterm infants
Authors: Mitra Souvik , Weisz Dany , Jain Amish , Jong Geert ‘t
Published: March 2022

Management of the patent ductus arteriosus (PDA) is one of the most contentious topics in the care of preterm infants. PDA management can be broadly divided into prophylactic and symptomatic therapy. Prophylaxis with intravenous indomethacin in extremely low birth weight infants may reduce severe intraventricular hemorrhage. Echocardiography should be routinely used to confirm the presence of a PDA before considering symptomatic therapy. A symptomatic PDA can be managed conservatively, using pharmacotherapy or with procedural closure. Ibuprofen should be considered as the pharmacotherapy of choice for a symptomatic PDA. High-dose ibuprofen may be preferable, especially for preterm infants beyond the first 3 to 5 days of age. If pharmacotherapy fails (after two courses) or is contraindicated, procedural closure may be considered for infants with a persistent PDA with significant clinical symptoms in addition to echocardiographic signs of a large PDA shunt volume and pulmonary over-circulation.
Partitioning Behaviors of Cobalt and Manganese along Diverse Melting Paths of Peridotitic and MORB-Like Pyroxenitic Mantle
Authors: Chen Chen , Yao Zhuo-Sen , Wang Christina Yan
Published: March 2022

The Co, Mn, Fe, and Ni contents of olivine phenocrysts and host basalts are sensitive to source mantle lithology, which suggests they may be used to constrain the processes of mantle melting and identify basalts formed from non-peridotitic (i.e. pyroxenitic) mantle sources. Here, we use a new comprehensive, forward model involving multiple parameters to simulate partitioning of Co and Mn during partial melting of the mantle in different tectonic settings: (1) polybaric continuous melting of peridotite mantle in mid-ocean ridges can generate melts that show decreasing Co and Mn with increasing degrees of melting so that the mid-ocean ridge basalts (MORBs) contain ~39–84 μg/g Co and ~900–1600 μg/g Mn; (2) flux-melting of the mantle wedge in subduction zones tends to produce a melt that has Co increasing from ~24 to 55 μg/g and Mn from ~500 to 1110 μg/g with increasing temperature; (3) melts produced by isobaric melting of the subcontinental lithospheric mantle are also sensitive to increasing temperature and have ~35–160 μg/g Co and ~800–2600 μg/g Mn; (4) decompression melting of peridotite related to the mantle plume generates melts containing ~45–140 μg/g Co and ~1000–2000 μg/g Mn, and the abundances of these metals decrease with increasing degrees of melting; and (5) partitioning behaviors of Co, Mn, and Ni during decompression melting of MORB-like pyroxenite contrast with those during decompression melting of peridotite due to the different mineralogy and compositions in mantle lithologies, and the MORB-like pyroxenite-derived melt is metal-poor with ~25–60 μg/g Co, ~290–1600 μg/g Mn, and ~160–340 μg/g Ni. Although high-Ni, low-Mn forsteritic olivine phenocrysts and high melt Fe/Mn ratio have been proposed as diagnostic indicators of pyroxenitic components in the mantle, our models show that these features can be also generated by melting of peridotite at greater depth (i.e. a high pressure and temperature). To quantify the effect of high-pressure melting of peridotite on these diagnostic indicators, we modeled the correlations of melt Fe/Mn and olivine Co, Mn, and Ni contents with melting depth along the decompression melting path of a thermal plume. When Fe/Mn ratios of basalts and/or compositions of olivine phenocrysts deviate significantly from our modeled correlation lines, high-pressure melting of peridotite cannot explain these data, and the existence of pyroxenitic component in the mantle source is likely required. The pyroxenite-derived melt is modeled to be Ni-poor, but mixing with a peridotite-derived melt can strongly increase the partition coefficient of Ni between olivine and mixed melt, resulting in the generation of high-Ni olivine phenocrysts in plume-associated magmatic suites.
Emergence of Lie group symmetric classical spacetimes in the canonical tensor model
Authors: Kawano Taigen , Sasakura Naoki
Published: March 2022

We analyze a wave function of a tensor model in the canonical formalism, when the argument of the wave function takes Lie group invariant or nearby values. Numerical computations show that there are two phases, which we call the quantum and the classical phases. In the classical phase fluctuations are suppressed, and configurations emerge which are discretizations of classical geometric spaces invariant under Lie group symmetries. This is explicitly demonstrated for emergence of Sn (n = 1, 2, 3) for SO(n + 1) symmetries by checking the topological and geometric (Laplacian) properties of the emerging configurations. The transition between the two phases has the form of splitting/merging of distributions of variables, resembling a matrix model counterpart, namely the transition between one-cut and two-cut solutions. However, this resemblance is obscured by a difference in the mechanism of distribution in our setup from that in the matrix model. We also discuss this transition as a replica symmetry breaking. We perform various preliminary studies of the properties of the phases and the transition for such values of the argument.
One-particle irreducible Wilson action in the gradient flow exact renormalization group formalism
Authors: Sonoda Hidenori , Suzuki Hiroshi
Published: March 2022

We define a one-particle irreducible (1PI) Wilson action in the gradient flow exact renormalization group (GFERG) formalism as the Legendre transform of a Wilson action. We consider quantum electrodynamics in particular, and show that the GFERG flow equation preserves the invariance of the 1PI Wilson action (excluding the gauge-fixing term) under the conventionalU(1) gauge transformation. This is in contrast to the invariance of the original Wilson action under a modified U(1) gauge transformation. The global chiral transformation also takes the conventional form for the 1PI Wilson action. Despite the complexity of the GFERG flow equation, the conventional form of the gauge and global chiral transformations may allow us to introduce a non-perturbative Ansatz for gauge and chiral invariant 1PI Wilson actions.
Drought Stress Exacerbates Fungal Colonization and Endodermal Invasion and Dampens Defense Responses to Increase Dry Root Rot in Chickpea
Authors: Irulappan Vadivelmurugan , Kandpal Manu , Saini Kumud , Rai Avanish , Ranjan Aashish , Sinharoy Senjuti , Senthil-Kumar Muthappa
Published: March 2022

Drought plays a central role in increasing the incidence and severity of dry root rot (DRR) disease in chickpea. This is an economically devastating disease, compromising chickpea yields particularly severely in recent years due to erratic rainfall patterns. Macrophomina phaseolina (formerly Rhizoctonia bataticola) is the causal agent of DRR disease in the chickpea plant. The infection pattern in chickpea roots under well-watered conditions and drought stress are poorly understood at present. This study provides detailed disease symptomatology and the characteristics of DRR fungus at morphological and molecular levels. Using microscopy techniques, the infection pattern of DRR fungus in susceptible chickpea roots was investigated under well-watered and drought-stress conditions. Our observations suggested that drought stress intensifies the progression of already ongoing infection by weakening the endodermal barrier and overall defense. Transcriptomic analysis suggested that the plant’s innate immune defense program is downregulated in infected roots when subjected to drought stress. Furthermore, genes involved in hormonal regulation are differentially expressed under drought stress. These findings provide hints in terms of potential chickpea genes to target in crop improvement programs to develop climate-change-resilient cultivars.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
The Development of a Measuring Instrument for Substance Abuse Media Literacy Scale in Students
Authors: Jormand Hanieh , Bashirian Saeed , Barati Majid , Babamiri Mohammad , Rezapur-Shahkolai Forouzan
Published: March 2022

Objective:

Substance Abuse Media Literacy (SAML) is a scale for assessing substance abuse media literacy among students. This tool can examine the effect of media exposure on substance abuse in youth. Presently, no validated, comprehensive instrument exists to measure media literacy for substance abuse. The current study aimed at assessing the psychometric features of the SAML scale in students.

Methods:

In this cross-sectional validation work, 436 students from Hamadan, Iran, were sampled via the stratified random sampling procedure, and their media literacy regarding substance abuse was investigated. Reliability was assessed by the intraclass correlation coefficient and internal consistency. Moreover, exploratory factor analysis and confirmatory factor analysis were conducted to examine the construct validity. Content Validity Index and Content Validity Ratio were used to examine the content validity.

Results:

Based on the results of factor analysis, the SAML included 13 items that measure 4 components, explaining 63.99% of the usual variance. The means scores for the Content Validity Index and Content Validity Ratio were 0.93 and 0.82, respectively. Further analyses revealed the acceptability of the results for internal consistency reliability values with a Cronbach α of 0.80.

Conclusion:

Based on factor analysis results, the SAML included 13 items is a valid and reliable tool and is now suitable and acceptable for present and future studies.
Practice Variation Within a Single Institution in Management of Degenerative Spondylolisthesis
Authors: Ogink Paul T. , Groot Olivier Q. , van Steijn Nicole , Im Gi Hye , Cha Thomas D. , Hershman Stuart H. , Bono Christopher M. , Schwab Joseph H.
Published: March 2022

Study Design:

This was a retrospective cohort study.

Objective:

The objective of this study was to assess variation in care for degenerative spondylolisthesis (DS) among surgeons at the same institution, to establish diagnostic and therapeutic variables contributing to this variation, and to determine whether variation in care changed over time.

Summary of Background Data:

Like other degenerative spinal disorders, DS is prone to practice variation due to the wide array of treatment options. Focusing on a single institution can identify more individualized drivers of practice variation by omitting geographic variability of demographics and socioeconomic factors.

Materials and Methods:

We collected number of office visits, imaging procedures, injections, electromyography (EMG), and surgical procedures within 1 year after diagnosis. Multivariable logistic regression was used to determine predictors of surgery. The coefficient of variation (CV) was calculated to compare the variation in practice over time.

Results:

Patients had a mean 2.5 (±0.6) visits, 1.8 (±0.7) imaging procedures, and 0.16 (±0.09) injections in the first year after diagnosis. Thirty-six percent (1937/5091) of patients had physical therapy in the 3 months after diagnosis. CV was highest for EMG (95%) and lowest for office visits (22%). An additional spinal diagnosis [odds ratio (OR)=3.99, P<0.001], visiting a neurosurgery clinic (OR=1.81, P=0.016), and diagnosis post-2007 (OR=1.21, P=0.010) were independently associated with increased surgery rates. The CVs for all variables decreased after 2007, with the largest decrease seen for EMG (132% vs. 56%).

Conclusions:

While there is variation in the management of patients diagnosed with DS between surgeons of a single institution, this variation seems to have gone down in recent years. All practice variables showed diminished variation. The largest variation and subsequent decrease of variation was seen in the use of EMG. Despite the smaller amount of variation, the rate of surgery has gone up since 2007.
Understanding Nonsuicidal Self-Injury
Authors: Moore Jill , Bauer Renee
Published: March 2022

Nonsuicidal self-injury has existed since biblical times. It is increasing and gaining acceptance particularly among adolescents. Spiritual discontent or doubt is often a component. Therapeutic interventions include cognitive and behavior practices and developing strong, sustained relationships with patients to encourage healthy transformation.
Child Abuse
Authors: Overton Julia
Published: March 2022

Because child abuse occurs across all genders, ethnicities, and socioeconomic groups, nurses working with pediatric patients and their families need keen observation and assessment skills. The purpose of this article is to discuss the recognition, reporting, and appropriate response to child abuse. Caring for children who have been abused and their families is challenging yet presents the opportunity to demonstrate Christ's compassion. Awareness of one's own emotional responses requires meaningful self-care strategies that are also discussed.
Camp Nursing
Authors: Schmidt Karen
Published: March 2022

Camp nursing offers a unique opportunity for nurses to invest their skills in a novel setting. Nurses fill an essential role in the camp environment and have opportunities to practice a wide variety of tasks with diverse populations of children and teens. The purpose of this article is to inform potential camp nurses of the skill set and aptitudes most inclined to ensure a successful and satisfying camp nursing experience. Serving at a Christian camp also allows nurses to reflect Christ and invest in the faith journey of campers and staff.
Faith Community Nursing
Authors: Reid Roxanne
Published: March 2022

Spirituality and faith, which are cornerstones of African American churches, also create a receptive setting for health improvement activities. This article presents participant responses to a health improvement intervention to promote church members' self-care. Using the Body & Soul program, the faith community nurse involved laypersons as health ministry team members to support urban African American churchgoers in learning and practicing healthier eating and self-care practices. The health intervention used the Patient Activation Measure (PAM) and incorporated Scripture into weekly sessions, revealing an increase in participants' self-care activation activities.
Telomeres, aging and reproduction
Authors: Córdova-Oriz Isabel , Chico-Sordo Lucía , Varela Elisa
Published: March 2022

Purpose of review

Women's fertility decay starts at the mid 30 s. However, the current delay of childbearing leads to ovarian aging and the need of assisted reproduction technologies (ART). Telomere biology is one of the main pathways involved in organismal aging. Thus, this review will focus on the knowledge acquired during the last 2 years about the telomere pathway and its influence on female fertility and the consequences for the newborn.

Recent findings

New research on telomere biology reaffirms the relationship of telomere attrition and female infertility. Shorter maternal telomeres, which could be aggravated by external factors, underly premature ovarian aging and other complications including preeclampsia, preterm birth and idiopathic pregnancy loss. Finally, the telomere length of the fetus or the newborn is also affected by external factors, such as stress and nutrition.

Recent evidence shows that telomeres are implicated in most processes related to female fertility, embryo development and the newborn's health. Thus, telomere length and telomerase activity may be good biomarkers for early detection of ovarian and pregnancy failures, opening the possibility to use telomere therapies to try to solve the infertility situation.
Incidence and Outcomes of Completion Mastectomy following Oncoplastic Reduction: A Case Series
Authors: Baker Nusaiba F. , Brown Ciara A. , Styblo Toncred M. , Carlson Grant W. , Losken Albert
Published: March 2022

Background:

Patients occasionally need completion mastectomy (CM) following oncoplastic reduction for various reasons necessitating definitive reconstructive techniques. The purpose of this study was to evaluate those patients who required CM following oncoplastic reduction and evaluate indications, technique, and outcomes.

Methods:

Patients who underwent a completion mastectomy at some time point following the oncoplastic reduction were identified. Factors that influenced CM and additional reconstruction were analyzed. All statistical analysis was conducted using the IBM SPSS Statistics 27.0 (IBM Corp.).

Results:

A total of 29 patients (5.3%) underwent CM during the study period with an average follow-up of 3 years since the original procedure. The most common reasons were positive margins (20/29, 69.0%) and recurrence (8/29, 27.6%). Twenty-two had reconstructive procedures (75.9%) and seven did not (24.1%). The patients who underwent CM and reconstruction were significantly younger (49.2 years) than those who had no reconstruction (64.3 years, P = 0.004). The most common type of reconstruction was transverse rectus abdominis myocutaneous (TRAM)/deep inferior epigastric perforator (DIEP) flap (12/22, 54.5%), followed by latissimus (6/22, 27.3%) and tissue expander (3/22, 13.6%). The complication rate in the CM group was 24% (N = 7/29), which included two seromas (6.9%), followed by infection, fat necrosis, mastectomy skin necrosis, and donor site necrosis (3.4% each).

Conclusions:

Completion mastectomy is indicated typically for positive margins or recurrence. Reconstruction is performed more frequently in younger patients, with the TRAM/DIEP flap and latissimus dorsi reconstruction being the most common technique.
Transumbilical Single-incision Laparoscopic Surgery for Harvesting Rib and Costal Cartilage
Authors: Zhang Lu , Huo Haizhong , Li Hongjie , Luo Meng , Wang Feng , Zhou Yixiong , Li Qingfeng , Zhang Yuguang
Published: March 2022

Background:

The study aimed to introduce a rib and costal cartilage harvesting surgery by transumbilical single-incision laparoscopy and evaluate its efficiency and safety.

Methods:

Patients who underwent rib and costal cartilage harvest under different approaches (direct open approach and transumbilical) were collected in this retrospective study. The differences in the pain scores [visual analog scale (VAS)], postoperative appearance, and complications were compared between the two groups at 1, 2, 3, and 7 days after surgery. In addition, based on the minimal clinically important difference and the generalized estimating equation, the differences were compared between the two groups in terms of the VAS score.

Results:

On postoperative day 1, the VAS scores of the direct open approach group and the transumbilical group were significantly different, that is, 7.29 and 6.10, respectively (P < 0.001). Also, the generalized estimating equation results were different (P < 0.001). An interaction was observed between different groups and days, that is, a statistical difference was observed in the VAS score between the two groups (P < 0.001). In terms of aesthetics and complications, patients from the transumbilical group had no scars on the chest wall and no obvious postoperative complications.

Conclusions:

Transumbilical single-incision laparoscopic surgery is an innovative surgical approach for harvesting ribs and costal cartilage, which leaves no scars on the skin of the chest wall and has the advantages of slight postoperative pain, quick recovery, and fewer complications. This novel surgery is beneficial to patients with higher aesthetic requirements.
Negative Pressure Wound Therapy as an Artificial Leech to Save a Congestive Flap: Case Report
Authors: Ardila Maria Paula , Gómez-Ortega Viviana
Published: March 2022

Historically, patients with lower limb defects have represented a challenge for plastic surgeons because of their higher rate of complications. One of the main complications is venous congestion. Recently, various studies have suggested the use of negative pressure wound therapy as a salvage flap therapy, showing promising results. In this case report, we will outline the case of an elderly patient with different comorbidities in whom we used negative pressure wound therapy (as an artificial leech) to reverse venous congestion in the flap, with a satisfactory clinical outcome and without any more surgical procedures.
A1 Pulley Tenderness as a Modification to Tenderness along the Flexor Sheath in Diagnosing Pyogenic Flexor Tenosynovitis
Authors: Siska Robert C. , Davidson Amelia L. , Driscoll Cassandra R. , Browne Donald T. , Maus Jacob C. , Prabhu Shamit S. , Rudolph Megan A. , Schneider Michael A. , Runyan Christopher M. , Reynolds Michael
Published: March 2022

Background:

Pyogenic flexor tenosynovitis (PFT) is frequently diagnosed by physical examination according to the Kanavel signs. This study proposes a modification of the Kanavel sign “tenderness over the course of the flexor sheath” by including palpation of the A1 pulley to increase specificity for diagnosis.

Methods:

A retrospective review was performed over 8 months for patients in the emergency department who received a consult to hand surgery to rule out PFT. Two cohorts, nonPFT infections and PFT infections, were studied for the presence or absence of the four Kanavel signs, as well as tenderness specifically over the A1 pulley on the affected digit(s) or T1 pulley of the thumb.

Results:

There were a total of 33 patients in the two cohorts (21 nonPFT, 12 PFT) with statistically significant differences with regard to the presence of all the Kanavel signs. A1 pulley tenderness had the greatest odds ratio, positive predictive value, specificity, and accuracy when compared with all Kanavel signs. When used in conjunction with each Kanavel sign, there was an increase in specificity in all four signs. Receiver operating characteristic analysis revealed increased area under the curve with A1 pulley tenderness added, indicating improved ability to classify hand infections as PFT versus nonPFT.

Conclusion:

Although the classic Kanavel signs have shown reliable clinical utility, this study finds that tenderness at the A1 pulley can be a useful specification of “tenderness over the course of the flexor sheath” to help with the diagnosis of PFT.
Free Nipple Graft Breast Reduction without a Vertical Incision
Authors: Vazquez Oscar Adrian , Yerke Hansen Payton , Komberg Jacob , Slutsky Hanna L. , Becker Hilton
Published: March 2022

Background:

A technique of a free nipple graft with an inframammary incision and no vertical incision offers promising postoperative results as a safe and aesthetic alternative.

Methods:

This was a retrospective chart review of patients who presented to a single surgeon for breast reduction surgery using a free nipple graft with an inframammary incision from June 1999 to March 2021. Baseline patient demographics and clinical information along with postoperative complications were recorded and compared between patients who presented for concomitant reconstruction or just reduction. A narrative literature review on surgical techniques and outcomes was also conducted.

Results:

From the literature search, there have been minimal prior mentions of breast reductions using a free nipple graft with an inframammary incision and no vertical incision. Fifty-five cases were identified for breast reduction surgery in the author’s 22-year study period, of which 46 had adequate clinical documentation and follow-up. An estimated 22 patients had either both or one breast reconstructed with opposite side breast reduction, and 24 patients underwent breast reduction alone with free nipple grafting. No implants were used in any of the patients.

Conclusions:

The free nipple graft technique with an inframammary incision can be performed on patients with excessively large or ptotic breasts. It is possible to reduce the volume of the breast and obtain good projection with this method. Furthermore, avoidance of the vertical incision reduces breakdown at the T-junction and is aesthetically beneficial.
Achieving Functional Outcomes after Surgical Management of Catastrophic Vasopressor-induced Limb Ischemia
Authors: Deldar Romina , Abu El Hawa Areeg A. , Haffner Zoe K. , Higgins James P. , Katz Ryan D. , Attinger Christopher E. , Evans Karen K.
Published: March 2022

Background:

Vasopressor-induced limb ischemia is an unfortunate complication that can occur in patients treated for septic shock. Current literature lacks surgical treatment recommendations for this condition, besides amputation. We describe various reconstructive surgeries and functional outcomes in patients treated surgically for vasopressor-induced limb ischemia.

Methods:

We retrospectively reviewed patients who were treated for septic shock and developed vasopressor-induced limb ischemia at our tertiary referral academic medical center. We reviewed presentation, treatment, surgical outcomes, and long-term functional outcomes.

Results:

We present three previously healthy patients who developed gangrene of multiple limbs following the use of vasopressors to treat septic shock. Each patient underwent amputations or limb salvage procedures.

Conclusions:

Limb ischemia is a devastating complication that can occur after prolonged vasopressor use. The decision to proceed with limb salvage versus amputation of ischemic extremities should be tailored to the individual patient. The main objective should be for the patient to obtain optimal function and quality of life, regardless of the type of surgery.
Surgical Management of Intraocular Pressure With Ab Interno Canaloplasty in Postkeratoplasty Patients: 12-Month Results
Authors: Riaz Kamran M. , Gill Mohsain S. , Murphy David A. , Ding Kai , Khaimi Mahmoud A.
Published: March 2022

Purpose:

The purpose of this study was to report clinical outcomes of ab interno canaloplasty (ABiC) with the iTrack microcatheter (Nova Eye Medical, Fremont, CA) for surgical management of intraocular pressure (IOP) in postkeratoplasty patients.

Methods:

This study was a single-center retrospective case series of postkeratoplasty eyes undergoing ABiC. Efficacy was evaluated based on graft survivability and mean reduction in IOP at 12 months postoperatively. Secondary end points consisted of visual acuity outcomes, number of topical hypotensive medications, and rate of complications.

Results:

ABiC was successfully performed in 17 eyes after keratoplasty (8 penetrating keratoplasty, 6 DSAEK, 2 penetrating keratoplasty + DSAEK, and 1 DMEK) with elevated IOP refractory to topical hypotensive medications. The baseline mean IOP was 26.2 ± 8.4 mm Hg and reduced significantly to 15.0 ± 4.21 mm Hg at 6 months and 13.0 ± 2.99 mm Hg at 12 months (P < 0.005). The best-corrected visual acuity improved from 0.61 ± 0.55 logMAR at baseline to 0.47 ± 0.59 and 0.49 ± 0.64 at 6 and 12 months, respectively, following ABiC (not statistically significant: P = 0.6769). The baseline mean number of topical hypotensive medications was 3.7 ± 1.8 and reduced to 2.7 ± 1.4 and 2.9 ± 1.3 at 6 and 12 months, respectively (P = 0.096). One patient developed a hyphema which required anterior chamber washout. One patient required additional glaucoma surgery 19 months after ABiC. No patients experienced graft failure.

Conclusions:

ABiC is a clinically safe and effective treatment that can be performed in postkeratoplasty patients to reduce IOP for at least 1 year without any significant complications.
Clinical Outcomes of Ahmed ClearPath Implantation in Glaucomatous Eyes: A Novel Valveless Glaucoma Drainage Device
Authors: Grover Davinder S. , Kahook Malik Y. , Seibold Leonard K. , Singh Inder Paul , Ansari Husam , Butler Michelle R. , Smith Oluwatosin U. , Sawhney Gagan K. , Van Tassel Sarah H. , Dorairaj Syril
Published: March 2022

Précis:

Designed with novel features to facilitate implantation and improve safety, the Ahmed ClearPath (ACP) glaucoma drainage device (GDD) provided intraocular pressure (IOP) reduction comparable with other GDDs in eyes with refractory glaucoma in a multicenter retrospective study.

Purpose:

To present clinical outcomes with a novel valveless GDD (ACP, New World Medical). The 250 and 350 mm2 models feature a contoured plate for optimal globe apposition, anteriorized suture points to facilitate suturing to the globe, and a prethreaded 4-0 polypropylene ripcord suture.

Methods:

This was a multicenter retrospective analysis of eyes with medically and/or surgically uncontrolled glaucoma implanted with the 250 or 350 mm2 ACP either as a standalone procedure or in combination with other procedures. Pre-, intra-, and postoperative data through 6 months were collected.

Results:

A total of 104 eyes (100 subjects) received the ACP by 10 US surgeons, 63.5% of which had primary open-angle glaucoma and 62.5% had severe glaucoma. Mean baseline IOP was 26.3 (9.0) mm Hg and mean medication use was 3.9 (1.3). Through 6 months’ follow-up, mean IOP ranged from 13.6 to 16.7 mm Hg and mean medication use from 0.9 to 1.9 medications (P<0.0001 at all timepoints for each outcome measure). At 6 months, mean IOP was 13.7 mm Hg (−13.0 mm Hg, 43.0%, P<0.0001) and mean medication use was 1.9 medications per eye (−2.1, 47.7%, P<0.0001). Common adverse events included anterior chamber inflammation (16.3%), hyphema (15.4%), and hypotony (6.7%).

Conclusion:

The new ACP appears to be safe and efficacious as a standalone procedure or in combination with other procedures for uncontrolled glaucoma, and may be considered as a GDD option for patients in whom its unique design may facilitate the implantation process.
Impact of Firefighting Aqueous Film-Forming Foams on Human Cell Proliferation and Cellular Mortality
Authors: Kafkoutsou Alexia L. , Yang Yu-Ping , Zeynaloo Elnaz , Deo Sapna K. , Solle Natasha Schaefer , Kobetz Erin N. , Daunert Sylvia , Caban-Martinez Alberto J.
Published: March 2022

Objective(s):

Evaluate the toxic effects of Aqueous Film-Forming Foams used by firefighters for Class B fire suppression in human-derived kidney cells (HEK-293).

Methods:

Three widely used AFFFs were collected from fire departments and were added to HEK-293 cells in various concentrations. Seventy-two hours post-treatment, cellular proliferation and toxicity were examined using commercially available kits.

Results:

All AFFFs evaluated induced cellular toxicity and significantly decreased cell proliferation, even when cells were treated with concentrations 10-fold lower than the working concentration used for fire suppression.

Conclusions:

Despite the reduced usage of PFAS-containing AFFFs in the firefighter work environment, the evaluated AFFFs demonstrated significantly altered cellular proliferation, while also inducing toxicity, indicating the presence of toxic compounds. Both stronger implementation of PFAS-containing AFFFs restrictions and robust evaluation of fluorine-free and next-generation AFFFs are warranted.
Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus–Positive Screening Test Results
Authors: Demarco Maria , Egemen Didem , Hyun Noorie , Chen Xiaojian , Moscicki Anna-Barbara , Cheung Li , Carter-Pokras Olivia , Hammer Anne , Gage Julia C. , Clarke Megan A. , Castle Philip E. , Befano Brian , Chen Jie , Dallal Cher , He Xin , Desai Kanan , Lorey Thomas , Poitras Nancy , Raine-Bennett Tina R. , Perkins Rebecca B. , Wentzensen Nicolas , Schiffman Mark
Published: March 2022

Objective

The US screening and management guidelines for cervical cancer are based on the absolute risk of precancer estimated from large clinical cohorts and trials. Given the widespread transition toward screening with human papillomavirus (HPV) testing, it is important to assess which additional factors to include in clinical risk assessment to optimize management of HPV-infected women.

Materials and Methods

We analyzed data from HPV-infected women, ages 30–65 years, in the National Cancer Institute–Kaiser Permanente Northern California Persistence and Progression study. We estimated the influence of HPV risk group, cytology result, and selected cofactors on immediate risk of cervical intraepithelial neoplasia grade 3 or higher (CIN 3+) among 16,094 HPV-positive women. Cofactors considered included, age, race/ethnicity, income, smoking, and hormonal contraceptive use.

Results

Human papillomavirus risk group and cytology test result were strongly correlated with CIN 3+ risk. After considering cytology and HPV risk group, other cofactors (age, race/ethnicity, income, smoking, and hormonal contraceptive use) had minimal impact on CIN 3+ risk and did not change recommended management based on accepted risk thresholds. We had insufficient data to assess the impact of long-duration heavy smoking, parity, history of sexually transmitted infection, or immunosuppression.

Conclusions

In our study at the Kaiser Permanente Northern California, the risk of CIN 3+ was determined mainly by HPV risk group and cytology results, with other cofactors having limited impact in adjusted analyses. This supports the use of HPV and cytology results in risk-based management guidelines.
Secondary Infection Risk in Patients With Severe COVID-19 Pneumonia Treated With Tocilizumab
Authors: Sandhu Gagangeet , Piraino Samuel T. , Piticaru Joshua
Published: March 2022

Background:

Severe SARS-CoV-2 (COVID) pneumonia is characterized by marked inflammation. Current guidelines recommend the addition of the tocilizumab to dexamethasone in critically ill patients. In randomized trials, the use of tocilizumab was not associated with a statistically significant increased risk of secondary infections but concerns remain.

Study Question:

Do patients with severe COVID pneumonia treated with tocilizumab experienced high rates of secondary infection.

Study Design:

We performed a retrospective electronic chart review of patients with COVID pneumonia who received tocilizumab and dexamethasone (n = 62) from January 2021 to October 2021 and compared them with a cohort of patients (n = 49) who received only dexamethasone and admitted from July 2020 to December 2020 (before institutional use of tocilizumab). Patients received tocilizumab only if they had acute hypoxic respiratory failure and were felt to be clinically worsening. Patients were deemed to have a secondary infection only if a diagnosis of infection was confirmed via positive cultures.

Results:

Sixty-six patients received tocilizumab; of which, 30 (45.5%) subsequently had culture-positive secondary infections compared with 24.5% of controls. Thirty-one patients (47.0%) who received tocilizumab died by the time of analysis, 14 (45.2%) of whom had a secondary infection. Gram-negative bacterial infections predominated, followed by fungal infections. Patients who received tocilizumab had over twice as many gram-negative pneumonias (30.3% vs. 14.3%).

Conclusions:

Patients with severe COVID pneumonia treated with tocilizumab experienced high rates of secondary infection. Although the benefit of tocilizumab in reducing mortality is well-established and almost certainly outweighs secondary infection risks, we question if the “real-world” infection rates are much higher than those reported in trials or if the infection risk could be mitigated with dose reductions in tocilizumab without losing the mortality benefit. Further study into the infection risk, and risk–benefit analysis of dose adjustments, of tocilizumab in the critical care setting is warranted.
Methamphetamine Injection Into Face Causing Fatal Cavernous Sinus Thrombosis
Authors: Podduturi Varsha , Guileyardo Joseph M.
Published: March 2022

Cavernous sinus thrombosis is a rare and often fatal condition, usually associated with infections in the head and neck region. Clinical presentation includes fever, headache, and periorbital swelling. Mortality can be high; however, prompt treatment can reduce the probability of death. We present a case of a cavernous sinus thrombosis associated with methamphetamine injection into the face.
Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease
Authors: Kozyak Benjamin W. , Fraga María V. , Juliano Courtney E. , Bhombal Shazia , Munson David A. , Brandsma Erik , Stoller Jason Z. , Jain Ankit , Kesman Russell , Meshkati Malorie , Noh Caroline Y. , Dewitt Aaron G. , Costarino Andrew T. , Hehir David A. , Groves Alan M.
Published: March 2022

OBJECTIVES:

Umbilical venous cannulation is the favored approach to perinatal central access worldwide but has a failure rate of 25–50% and the insertion technique has not evolved in decades. Improving the success of this procedure would have broad implications, particularly where peripherally inserted central catheters are not easily obtained and in neonates with congenital heart disease, in whom umbilical access facilitates administration of inotropes and blood products while sparing vessels essential for later cardiac interventions. We sought to use real-time, point-of-care ultrasound to achieve central umbilical venous access in patients for whom conventional, blind placement techniques had failed.

DESIGN:

Multicenter case series, March 2019–May 2021.

SETTING:

Cardiac and neonatal ICUs at three tertiary care children’s hospitals.

PATIENTS:

We identified 32 neonates with congenital heart disease, who had failed umbilical venous cannulation using traditional, blind techniques.

INTERVENTIONS:

Real-time ultrasound guidance and liver pressure were used to replace malpositioned catheters and achieve successful placement at the inferior cavoatrial junction.

MEASUREMENTS AND MAIN RESULTS:

In 32 patients with failed prior umbilical venous catheter placement, real-time ultrasound guidance was used to successfully “rescue” the line and achieve central position in 23 (72%). Twenty of 25 attempts (80%) performed in the first 48 hours of life were successful, and three of seven attempts (43%) performed later. Twenty-four patients (75%) were on prostaglandin infusion at the time of the procedure. We did not identify an association between patient weight or gestational age and successful placement.

CONCLUSIONS:

Ultrasound guidance has become standard of care for percutaneous central venous access but is a new and emerging technique for umbilical vessel catheterization. In this early experience, we report that point-of-care ultrasound, together with liver pressure, can be used to markedly improve success of placement. This represents a significant advance in this core neonatal procedure.
Comparative Analysis of Subtalar Ligaments Between Patients With Talocalcaneal Coalition and Control Subjects Using 3-Dimensional Magnetic Resonance Imaging
Authors: Kang Ji Hee , Moon Sung Gyu , Jung Hong-Geun , Song Yeon Seon
Published: March 2022

Purpose

The purpose of this study was to find the differences in the subtalar ligaments between patients with talocalcaneal (TC) coalition and control subjects using 3-dimensional isotropic magnetic resonance imaging.

Methods

Magnetic resonance imaging of 27 ankles with TC coalition and 27 age- and sex-matched controls were retrospectively reviewed. Absence of cervical ligament, anterior capsular ligament (ACL), interosseous TC ligament (ITCL), and partial or complete absence of 3 roots of the inferior extensor retinaculum was analyzed. Thickness and width of ACL and ITCL were measured when possible.

Results

Absence of ACL and ITCL was significantly more frequent in TC coalition patients than in controls (59.2% vs 7.4%, P < 0.0001; 44.4% vs 7.4%, P = 0.004). Absence of cervical ligament and 3 roots of the inferior extensor retinaculum did not differ between the 2 groups. Thickness and width of ACL were significantly smaller in TC coalition patients than in control subjects (0.81 ± 0.23 vs 1.27 ± 0.41 mm, P < 0.0001; 5.26 ± 1.17 vs 7.07 ± 1.46 mm, P = 0.001). Thickness and width of ITCL did not differ between the 2 groups. In the TC coalition group, the absence of ACL and ITCL did not differ according to coalition type, patient demographics, and magnetic resonance imaging units.

Conclusions

Anterior capsular ligament and ITCL are frequently absent in TC coalition patients. Even when present, the ACL is attenuated in TC coalition patients compared with controls.
Performance of Multidetector Computed Tomography and Negative Versus Positive Enteric Contrast for Evaluation of Gastrointestinal Neuroendocrine Neoplasms
Authors: Morani Ajaykumar C. , Gupta Shiva , Elsayes Khaled M. , Mubarak Ahmad I. , Khalaf Ahmed M. , Bhosale Priya R. , Sun Jia , Jensen Corey T. , Kundra Vikas
Published: March 2022

Background

Routine computed tomography (CT) scans are thought to have poor performance for detection of gastrointestinal (GI) neuroendocrine neoplasms (NENs), which leads to delayed workup. Detection of even 1 bowel tumor can guide diagnostic workup and management. The purposes of this study were to assess the accuracy of multidetector computed tomography (MDCT) and to compare negative versus positive enteric contrast in detecting at least 1 GI tumor per patient with suspected or confirmed diagnosis of a NEN.

Methods

This retrospective study included 107 patients with intravenous and oral contrast (65 positive, 40 negative, and 2 no oral contrast) abdominopelvic MDCT. Two abdominal radiologists independently analyzed the CTs for detection and localization of bowel NENs. Surgical pathology was considered the reference standard. Analyses included κ and summary statistics, McNemar test, Pearson χ2 test, and Fisher exact test.

Results

Among the 107 CT scans, there were 30 pathology negative studies and 77 studies with positive pathology for GI NEN. Interreader agreement for CT evaluation was substantial (κ = 0.61). At least 1 GI NEN per patient was detected with 51% to 53% sensitivity, 87% to 93% specificity, 91% to 95% positive predictive value (PPV), 42% negative predictive value, and 63% accuracy for each reader, and 57% accuracy when only the concordant (ie, matching) results of the 2 readers were considered. Computed tomography scans with negative enteric contrast had significantly higher sensitivity for concordant results than CTs with positive enteric contrast (58% vs 30%, P = 0.01). Specificity (100% vs 95%, P = 0.5), PPV (100% vs 93%, P = 0.49), negative predictive value (39% vs 39%, P = 0.99), and accuracy (67% vs 51%, P = 0.10) were not significantly different for negative versus positive enteric contrast for the concordant results. There was no significant difference in GI NEN localization between the readers.

Conclusions

Routine MDCT with either positive or negative enteric contrast can detect at least 1 GI tumor per patient with more than 90% PPV and more than 50% accuracy in patients suspected of GI NEN. Using negative enteric contrast improves sensitivity for GI NEN versus positive enteric contrast. In addition, there is high accuracy in localizing the bowel tumor with positive or negative enteric contrast, which may guide surgery. Radiologists should have heightened awareness that evaluating such scans closely may lead to detection of primary bowel NENs at a higher rate than previously reported.