bluuebunny/crossref_metadata_2025 huggingface dataset:
First detection of X-ray line emission from Type IIn supernova 1978K with XMM-Newton’s RGS
Authors: Chiba Yuki , Katsuda Satoru , Yoshida Takashi , Takahashi Koh , Umeda Hideyuki
Published: February 2020

We report on robust measurements of elemental abundances of the Type IIn supernova SN 1978K, based on the high-resolution X-ray spectrum obtained with the Reflection Grating Spectrometer (RGS) onboard XMM-Newton. The RGS clearly resolves a number of emission lines, including N Ly$\alpha$, O Ly$\alpha$, O Ly$\beta$, Fe xvii, Fe xviii, Ne He$\alpha$, and Ne Ly$\alpha$ for the first time from SN 1978K. The X-ray spectrum can be represented by an absorbed, two-temperature thermal emission model, with temperatures of $kT \sim 0.6$ keV and 2.7 keV. The elemental abundances are obtained to be N $=$$2.36_{{-0.80}}^{{+0.88}}$, O $=$$0.20 \pm {0.05}$, Ne $=$$0.47 \pm {0.12}$, Fe $=$$0.15_{{-0.02}}^{{+0.01}}$ times the solar values. The low metal abundances except for N show that the X-ray emitting plasma originates from the circumstellar medium blown by the progenitor star. The abundances of N and O are far from the CNO-equilibrium abundances expected for the surface composition of a luminous blue variable, and resemble the H-rich envelope of less massive stars with masses of 10–25$\, M_{\odot }$. Together with other peculiar properties of SN 1978K, i.e., a low expansion velocity of 500–1000 km s$^{-1}$ and SN IIn-like optical spectra, we propose that SN 1978K is a result of either an electron-capture SN from a super asymptotic giant branch star, or a weak Fe core-collapse explosion of a relatively low-mass ($\sim \! \! 10\, M_{\odot }$) or high-mass ($\sim$20–25$\, M_{\odot }$) red supergiant star. However, these scenarios cannot naturally explain the high mass-loss rate of the order of $\dot{M} \sim 10^{-3}\, M_{\odot }\:{\rm yr^{-1}}$ over $\gtrsim$1000 yr before the explosion, which is inferred by this work as well as many other earlier studies. Further theoretical studies are required to explain the high mass-loss rates at the final evolutionary stages of massive stars.
Zircon Microstructures Record Deformation History of Shock- and Tectonically-generated Pseudotachylites: a Case Study from the Vredefort Impact Structure, South Africa
Authors: Kovaleva E , Huber M S , Habler G , Zamyatin D A
Published: February 2020

High-strain rate deformation can cause in situ melting of rocks, resulting in the formation of dark, micro- to nanocrystalline pseudotachylite veins. On Earth, pseudotachylite veins form during meteorite impacts, large landslides, and earthquakes. Within the Vredefort impact structure, both impact-generated and (pre-impact) tectonically-generated pseudotachylite veins have been described, but are challenging to distinguish. Here, we demonstrate a genetic distinction between two pseudotachylite veins from Vredefort by studying their petrography, degree of recrystallization and deformation, cross-cutting relationships and the deformation microstructures in associated zircon. We conclude that Vein 1 is pre-impact and tectonically-generated, and Vein 2 is impact-generated. In agreement, zircon microstructures in Vein 1 contain planar deformation bands (PDBs), attributed to tectonic deformation, whereas zircon microstructures in Vein 2 reveal microtwin lamellae, indisputable evidence of shock metamorphism. Thus, deformation microstructures in zircon may provide a new criterion for distinguishing the genetic origin of pseudotachylite veins. Zircons that have been removed from their context (i.e., alluvial or detrital zircon, zircon from Lunar breccia) should be interpreted with caution in terms of their deformation history. For example, zircon with PDBs cannot reliably be used as a marker for shock deformation, because this feature has been shown to form in purely tectonic settings.
Retention of physicians and surgeons in rural areas—what works?
Authors: Kumar Shireen , Clancy Bridget
Published: February 2020

Background

Causes for health inequity among rural populations globally are multifactorial, and include poorer access to healthcare professionals. This study summarizes the recent literature identifying factors that influence rural doctor retention and analyses strategies implemented to increase retention. Uniquely, this study addresses the importance of context in the planning, implementation and success of these strategies, drawing on literature from high-, middle- and low-income countries.

Methods

A systematic review of the English literature was conducted in two parts. The first identified factors contributing to rural doctor retention, yielding 28 studies (2015–2019). The second identified 19 studies up to 2019 that assessed the outcomes of implemented rural retention strategies.

Results

Universal retention factors for health professionals in a rural environment include rural background, positive rural exposure in training or in the early postgraduate years and personal and professional support. Financial incentives were less influential on retention, but results were inconsistent between studies and differed between high-, middle- and low-income nations. Successful strategies included student selection from rural backgrounds into medical school and undergraduate education programs and early postgraduate training in a rural environment. Bundled or multifaceted interventions may be more effective than single factor interventions.

Conclusion

Rural health workforce retention strategies need to be multifaceted and context specific, and cannot be effective without considering the practitioner’s social context and the influence of their family in their decision making. Adequate rural health facilities, living conditions, work-life balance and family, community and professional support systems will maximize the success of implemented strategies and ensure sustainability and continuity of healthcare workforce in rural environments.
Evaluation of a Cognitive Behavioral Model of Tinnitus Distress: A Cross-Sectional Study Using Structural Equation Modeling
Authors: Handscomb Lucy , Shorter Gillian W. , Hoare Derek J. , Hall Deborah A.
Published: February 2020

Objectives:

There is a great deal of variation in the extent to which people with tinnitus find it distressing, which cannot be explained solely by differences in perceived loudness. The Cognitive Behavioral Model of Tinnitus Distress proposes that tinnitus becomes and is maintained as a distressing problem due to a process of interaction between negative thoughts, negative emotions, attention and monitoring, safety behavior, and beliefs. This study used path analysis to assess how well different configurations of this model fit using questionnaire data obtained from people with tinnitus.

Design:

This was a cross-sectional study. Three hundred forty-two members of the public with tinnitus volunteered to complete a survey comprising a series of questionnaires and subscales of questionnaires measuring each of the constructs contained within the Cognitive Behavioral Model of Tinnitus Distress. The optimum factor structure of each measure for the study population was established, and the resulting factors were used to construct a series of path models based on the theoretical model. Path analysis was conducted for each of these, and the goodness of fit of the models was assessed using established fit criteria.

Results:

Five of the six path models tested reached the threshold for adequate fit, and further modifications improved the fit of the three most parsimonious of these. The two best-fitting models had comparable fit indices which approached the criteria for good fit (Root Mean Square Error of Approximation = 0.061, Comparative Fit Index = 0.984, Tucker Lewis Index = 0.970 and Root Mean Square Error of Approximation = 0.055, Comparative Fit Index = 0.993, Tucker Lewis Index = 0.982). They differed principally in the placement of tinnitus magnitude and the inclusion/noninclusion of control beliefs.

Conclusions:

There are theoretical arguments to support both a beliefs-driven and a loudness-driven model, and it may be that different configurations of the Cognitive Behavioral Model of Tinnitus Distress are more appropriate to different groups of people with tinnitus. Further investigation of this is needed. This notwithstanding, the present study provides empirical support for a model of tinnitus distress which provides a clinical framework for the development of more effective psychological therapy.
Spectral-Temporal Trade-Off in Vocoded Sentence Recognition: Effects of Age, Hearing Thresholds, and Working Memory
Authors: Shader Maureen J. , Yancey Calli M. , Gordon-Salant Sandra , Goupell Matthew J.
Published: February 2020

Objectives:

Cochlear implant (CI) signal processing degrades the spectral components of speech. This requires CI users to rely primarily on temporal cues, specifically, amplitude modulations within the temporal envelope, to recognize speech. Auditory temporal processing ability for envelope modulations worsens with advancing age, which may put older CI users at a disadvantage compared with younger users. To evaluate how potential age-related limitations for processing temporal envelope modulations impact spectrally degraded sentence recognition, noise-vocoded sentences were presented to younger and older normal-hearing listeners in quiet. Envelope modulation rates were varied from 10 to 500 Hz by adjusting the low-pass filter cutoff frequency (LPF). The goal of this study was to evaluate if age impacts recognition of noise-vocoded speech and if this age-related limitation existed for a specific range of envelope modulation rates.

Design:

Noise-vocoded sentence recognition in quiet was measured as a function of number of spectral channels (4, 6, 8, and 12 channels) and LPF (10, 20, 50, 75, 150, 375, and 500 Hz) in 15 younger normal-hearing listeners and 15 older near-normal-hearing listeners. Hearing thresholds and working memory were assessed to determine the extent to which these factors were related to recognition of noise-vocoded sentences.

Results:

Younger listeners achieved significantly higher sentence recognition scores than older listeners overall. Performance improved in both groups as the number of spectral channels and LPF increased. As the number of spectral channels increased, the differences in sentence recognition scores between groups decreased. A spectral-temporal trade-off was observed in both groups in which performance in the 8- and 12-channel conditions plateaued with lower-frequency amplitude modulations compared with the 4- and 6-channel conditions. There was no interaction between age group and LPF, suggesting that both groups obtained similar improvements in performance with increasing LPF. The lack of an interaction between age and LPF may be due to the nature of the task of recognizing sentences in quiet. Audiometric thresholds were the only significant predictor of vocoded sentence recognition. Although performance on the working memory task declined with advancing age, working memory scores did not predict sentence recognition.

Conclusions:

Younger listeners outperformed older listeners for recognizing noise-vocoded sentences in quiet. The negative impact of age was reduced when ample spectral information was available. Age-related limitations for recognizing vocoded sentences were not affected by the temporal envelope modulation rate of the signal, but instead, appear to be related to a generalized task limitation or to reduced audibility of the signal.
Prognostic value of tumor-infiltrating lymphocyte subtypes in residual tumors of patients with triple-negative breast cancer after neoadjuvant chemotherapy
Authors: Bai Yu-Ge , Gao Guo-Xuan , Zhang Hong , Zhang Shuang , Liu Yin-Hua , Duan Xue-Ning , Xu Ling
Published: February 2020

Background:

After neoadjuvant chemotherapy (NAC), non-pathological complete response of breast cancer patients can benefit from tailored adjuvant chemotherapy. However, it is difficult to select patients with poorer prognosis for additional adjuvant chemotherapy to maximize the benefits. Our study aimed to explore whether the subtypes of tumor-infiltrating lymphocytes (TILs) in residual tumors (RT) is related to the prognosis of triple-negative breast cancer (TNBC) after NAC.

Methods:

Data from patients with primary TNBC consecutively diagnosed at the Breast Disease Center of Peking University First Hospital from 2008 to 2014 were retrieved, and the cases with RT in the breast after NAC were enrolled. TILs subtypes in RT were observed by double-staining immunohistochemistry, and counted with the median TILs value per square millimeter as the cut-off to define high versus low TILs density in each subtype. The relationships between the TIL density of each subgroup and the clinicopathological characteristics of the RT after NAC patients were analyzed by Fisher exact test. Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method and log-rank statistics.

Results:

A total of 37 eligible patients were included in this study, and the median follow-up period was 50 months (range 17–106 months). There was no significant correlation between the infiltrate density of CD4+, CD8+, CD20+, and CD68+ lymphocytes and clinic-pathological characteristics. Significantly better prognosis was observed in patients with high CD4+-TILs (DFS: P = 0.005, OS: P = 0.021) and high CD8+-TILs (DFS: P = 0.018) and low CD20+-TILs (OS: P = 0.042). Further analysis showed that patients with CD4+/CD20+ ratio greater than 1 (DFS: P = 0.001, OS: P = 0.002) or CD8+/CD20+ ratio greater than 1 (DFS: P = 0.009, OS: P = 0.022) had a better prognosis.

Conclusions:

Subtypes of TILs in RT is a potential predictive biomarker of survival in TNBC patients after NAC.
Myocardial Depression in Sepsis: Beneficial Adaptation or Sequelae that Requires Treatment?
Authors: Rumery Kyle , Yunus Fahd , Frishman William H.
Published: February 2020

Myocardial depression is a common yet reversible phenomenon that occurs in patients in septic shock. Initially, it was unclear whether this provided an adaptive survival benefit, as early studies showed decreased mortality in septic patients with myocardial depression. However, subsequent larger studies have debunked this myth. Given that no benefit exists, cardiac dysfunction in septic patients may be monitored via echocardiography and may be treated with inotropic agents. Beta-blockers provide a novel avenue of treatment as they aid in reducing adrenergic overstimulation and cytokine production, which may drive the pathogenesis of septic shock. This review chronicles how the understanding of myocardial depression in sepsis has evolved and how it should be clinically managed.
Cardiac cGMP Signaling in Health and Disease: Location, Location, Location
Authors: Cuello Friederike , Nikolaev Viacheslav O.
Published: February 2020

3′,5′-Cyclic guanosine monophosphate (cGMP) is a ubiquitous second messenger, which critically regulates cardiac pump function and protects from the development of cardiac hypertrophy by acting in various subcellular microdomains. Although clinical studies testing the potential of cGMP elevating drugs in patients suffering from cardiac disease showed promising results, deeper insight into the local actions of these drugs at the subcellular level are indispensable to inspire novel therapeutic strategies. Detailed information on the spatio-temporal dynamics of cGMP production and degradation can be provided by the use of fluorescent biosensors that are capable of monitoring this second messenger at different locations inside the cell with high temporal and spatial resolution. In this review, we will summarize how these emerging new tools have improved our understanding of cardiac cGMP signaling in health and disease, and attempt to anticipate future challenges in the field.
Successful Resolution of Recurrent Vaginal Pinworm Infection With Intermittent Albendazole Administration
Authors: Shimizu Hiroyuki , Ito Shuichi
Published: February 2020

We describe the case of a 7-year-old girl with repeated vaginal Enterobius vermicularis infection, never detected as a digestive tract infection. Two-dose pyrantel pamoate or 2-dose albendazole could not suppress recurrence. Finally, 3-dose albendazole after 2-week intervals was successful in preventing relapse.
Impact of Infectious Diseases Consultation on the Treatment of Staphylococcus aureus Bacteremia
Authors: Lewis Paul O. , Brewster Aaryn M. , Ibrahim Lamis W. , Youssef Dima A. , Kullab Susan M. , Patel Paras D.
Published: February 2020

Background

This study assessed the impact of infectious diseases consultation (IDC) on 30-day readmission rates in patients with Staphylococcus aureus bacteremia (SAB). Furthermore, this study also evaluated the effect of IDC on adherence to guideline-directed therapy.

Methods

This retrospective cohort study enrolled 149 adult patients with SAB. Cohort 1 included 28 patients without IDC. Cohort 2 included 121 patients with IDC. Primary end point was all-cause 30-day readmission rates. Secondary outcomes included adherence to guideline-directed therapy and hospital length of stay (LOS). Guideline-directed therapy included repeat blood cultures until blood sterility, assessment for an echocardiogram, and appropriateness of antimicrobial therapy (including antibiotic, dose, and duration).

Results

Readmission rates were 46.4% (13/28) without IDC and 19% (23/121) with IDC (P = 0.006). Guideline-directed therapy occurred in 21.4% (6/28) without IDC versus 96.7% (117/121) with IDC (P = 0.0001). The average LOS was shorter without IDC than with IDC (5.6 vs 7.8 days, respectively; P = 0.01). The most common reasons for lack of guideline adherence in the control group were lack of echocardiogram (72.4%) and lack of repeat blood cultures (51.7%). Multivariate analysis demonstrated that only lack of IDC significantly affected readmission rates (odds ratio, 3.51; 95% confidence interval, 1.48–8.52; P = 0.0048).

Conclusions

Consultation with infectious diseases reduces 30-day readmission rates in patients with SAB and increases adherence to guideline-directed therapy; however, LOS was increased. Infectious diseases consultation should be considered for all patients with SAB.
Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic
Authors: Smith Ralph , Baldock James , FitzPatrick Michael , Jones Natasha , Newton Julia L.
Published: February 2020

Objective:

To evaluate the incidence of undiagnosed celiac disease (CD) in patients presenting with bone stress injuries (BSI) to a NHS Sport and Exercise Medicine (SEM) clinic.

Design:

Retrospective cohort study.

Setting:

Single tertiary-level SEM clinic.

Patient/Participants:

One hundred consecutive patients with radiologically proven BSIs.

Interventions:

Laboratory blood tests (LBT) can unmask underlying metabolic bone disorders. Anti-tissue transglutaminase antibody (TTG) testing has a high sensitivity and specificity for CD. In this SEM clinic, clinicians were encouraged to perform LBT including TTG, at time of diagnosis of BSI. A retrospective analysis of age, sex, fracture site, co-morbidities, TTG result, and subsequent investigations was performed.

Main Outcome Measures:

The primary outcome was the number and percentage of patients with BSIs and either positive TTG (CD seropositivity) or a diagnosis of CD.

Results:

Of the 100 patients with radiologically proven BSIs, 70% were female, and the mean age was 37 years (range 16-69). Eighty-five percent had the appropriate LBTs, of which 70% (60/85) were female, and the mean age was 37(16-69). Metatarsal (35%) and tibial (21%) were the most common BSIs. Anti-tissue transglutaminase antibody was performed in 85 patients. Two patients (2/85) had pre-existing CD and were excluded from incidence calculations. Five patients [5/83 (6%), mean age 38 years (28-57), 80% female] had a positive TTG, of whom 3 have subsequently had CD confirmed by endoscopic biopsy. Four patients with a positive TTG underwent dual-energy X-ray absorptiometry with osteopenia found in 3 (75%) cases.

Conclusions:

In this cohort, the incidence of CD seropositivity was 6%, and the prevalence of biopsy-confirmed CD was 5%, approximately 5-fold higher than UK population estimates. Anti-tissue transglutaminase antibody screening for CD should be considered in all patients presenting with BSIs.
Developing the Next Generation in Electronic Clinical Auditing
Authors: Kidd Heather , Rankin Samantha , Gillman Lucia
Published: February 2020

Background:

Although auditing is embedded into clinical culture, data collection tends to be retrospective, requires expertise, and is time consuming.

Local Problem:

Clinical audit data are needed in real time to manage patient safety issues.

Methods:

An iterative approach was undertaken to develop the electronic audit tool with a cross-sectional survey used for evaluation.

Interventions:

The Combined Bedside and Risk Assessment (CoBRA) audit tool captures patient safety risk and compliance such as falls, pressure injuries, and infections.

Results:

More than 17 956 safety audits were collected on randomly selected inpatients. Monthly audits completion average is 96% (n = 614). Patient safety risk mitigation is available in real time. Stakeholders stated that the CoBRA tool was useful in educating patients on risks (n = 141; 78.3%), improved patient care (n = 120; 67.4%), and prompted staff to modify patient care based on CoBRA findings (n = 98; 54%).

Conclusions:

The electronic CoBRA process facilitates patient safety risk mitigation and data transparency.
Subarticular Inflammatory Pseudoabscesses
Authors: Zhang Lingxin , Mirza Serene Z. , DiCarlo Edward F.
Published: February 2020

Abnormal accumulation of neutrophils in a subarticular bone usually raises the concern for osteomyelitis or septic arthritis, a disabling and potentially life-threatening medical condition. At the pathology department of a specialized orthopedic institute, we observed a distinct pattern of subarticular inflammation mimicking infection characterized by collections of neutrophils, macrophages, and fibrin in pseudocystic spaces of variable size and extent in the superficial subarticular bone not accompanied by granulation tissue or necrosis. We coined the term “inflammatory pseudoabscess” to describe these accumulations. From 1997-2015, we reported inflammatory pseudoabscesses in 157 primary arthroplasty/osteotomy specimens from 143 patients without penetrating trauma or hardware in the affected joint. The predominant gross and histologic features were those of destructive/inflammatory joint disease, including lymphoplasmacytic synovitis (95.3%), subchondral osseous chronic inflammation (80.3%), exudative synovitis (58.0%), synovial pannus (52.0%), and marginal erosions of articular cartilage and/or subarticular bone (43.3%). Clinical information was available in 137 (95.8%) patients, 107 (overall: 74.8%) of whom had preoperatively or postoperatively diagnosed inflammatory arthropathy, most commonly rheumatoid arthritis. The remaining 30 (overall: 21.0%) patients had no documented inflammatory disorders, but some had bilateral or multijoint arthropathy, hands/feet involvement, lymphoplasmacytic synovitis, ulcerative colitis, or family history of inflammatory arthropathy. There was no documented infection-associated implant failure. We believe that inflammatory pseudoabscess represents an intraosseous manifestation of noninfectious inflammatory disorders of joints. This feature should be recognized by pathologists and used to suggest further clinical evaluation for undiagnosed inflammatory joint diseases.
Ultrasound Imaging of the Superficial Fascial System Can Predict the Subcutaneous Strength of Abdominal Tissue Using Mean Gray Value Quantification
Authors: Guidry Richard F. , McCarthy Michelle E. , Straughan David M. , St. Hilaire Hugo , Schuster Jason D. , Dancisak Michael , Lindsey John T.
Published: February 2020

Background:

This study is the first to correlate sonographic findings of subcutaneous tissue to structural and biomechanical properties.

Methods:

Precisely sized tissue specimens (59 samples) were collected from five abdominoplasty procedures. A Philips Lumify L12-4 linear array probe, connected to an Android tablet, was used to obtain ultrasound images of the superficial fascial system. A no. 1 Vicryl suture on a CTX needle placed though a needle guide within a three-dimensionally printed template ensured equal bites of subcutaneous tissue across specimens. Suture pull-out strength was measured until failure at a displacement rate of 2.12 mm/second using an Admet MTEST Quattro. Mean gray value for the superficial fascial system in associated ultrasonographic images was quantified by CellProfiler.

Results:

Superficial fascial system visualization can be accomplished using high-resolution portable ultrasound. Comparing multiple specimens’ imaging, interpatient and intrapatient variability of superficial fascial system quantity and structural characteristics are apparent. The superficial fascial system is highly abundant in some patients, but has limited presence in others. Individual-specimen mean gray value and whole-patient mean gray value positively correlated with tissue tensile strength (p = 0.006) and patient-average tissue tensile strength (p = 0.036), respectively. Whole-patient mean gray value accounted for 98.5 percent of the variance seen in patient-average tensile strength, making it a strong predictor for tensile strength.

Conclusions:

Portable ultrasound and image-processing technology can visualize, quantify, and predict subcutaneous tissue strength of the superficial fascial system. The superficial fascial system quantity correlates with suture tensile strength. Clinically, preoperative superficial fascial system quantification may aid in outcome predictions, manage patient expectations, and potentially lower complication rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, V.
The Bidirectional Movement of the Frontalis Muscle: Introducing the Line of Convergence and Its Potential Clinical Relevance
Authors: Cotofana Sebastian , Freytag David L. , Frank Konstantin , Sattler Sonja , Landau Marina , Pavicic Tatjana , Fabi Sabrina , Lachman Nirusha , Hernandez Claudia A. , Green Jeremy B.
Published: February 2020

Background:

Cosmetic treatment of the forehead using neuromodulators is challenging. To avoid adverse events, the underlying anatomy has to be understood and thoughtfully targeted. Clinical observations indicate that eyebrow ptosis can be avoided if neuromodulators are injected in the upper forehead, despite the frontalis muscle being the primary elevator.

Methods:

Twenty-seven healthy volunteers (11 men and 16 women) with a mean age of 37.5 ± 13.7 years (range, 22 to 73 years) and of diverse ethnicity (14 Caucasians, four African Americans, three Asians, and six of Middle Eastern descent) were enrolled. Skin displacement vector analyses were conducted on maximal frontalis muscle contraction to calculate magnitude and direction of forehead skin movement.

Results:

In 100 percent of investigated volunteers, a bidirectional movement of the forehead skin was observed: the skin of the lower forehead moved cranially, whereas the skin of the upper forehead moved caudally. Both movements converged at a horizontal forehead line termed the line of convergence, or C-line. The position of the C-line relative to the total height of the forehead was 60.9 ± 10.2 percent in men and 60.6 ± 9.6 percent in women (p = 0.941). Independent of sex, the C-line was located at the second horizontal forehead line when counting from superior to inferior (men, n = 2; women, n = 2). No difference across ethnicities was detected.

Conclusions:

The identification of the C-line may potentially guide practitioners toward more predictable outcomes for forehead neuromodulator injections. Injections above the C-line could mitigate the risk of neuromodulator-induced brow ptosis.
Utility of the International HIV Dementia Scale for HIV-Associated Neurocognitive Disorder
Authors: Molinaro Maria , Sacktor Ned , Nakigozi Gertrude , Anok Aggrey , Batte James , Kisakye Alice , Myanja Richard , Nakasujja Noeline , Robertson Kevin R. , Gray Ronald H. , Wawer Maria J. , Saylor Deanna
Published: February 2020

Background:

We assessed the utility of the International HIV Dementia Scale (IHDS) in detecting HIV-associated neurocognitive disorder (HAND) in Uganda in antiretroviral (ART)-naïve and ART-experienced adults.

Setting:

A longitudinal observational cohort study in Rakai, Uganda.

Methods:

Three hundred ninety-nine HIV+ ART-naïve adults underwent neurological, functional status, and neuropsychological assessments including the IHDS. Three hundred twelve participants who initiated ART were re-evaluated after 2 years. HAND stages [asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD)] were determined based on Frascati criteria using local normative data. Sensitivity, specificity, and area under the ROC curve were determined for various IHDS thresholds (≤9, ≤ 9.5, and ≤10).

Results:

At baseline, the participants' mean age was 35 years (SD ± 8), 53% were men, and 84% had less than a high school education. At baseline, sensitivity for detecting any HAND stage, symptomatic HAND [mild neurocognitive disorder, HAD], and HAD alone were maximized at IHDS ≤10 (81%, 83%, 92%, respectively). Among 312 individuals who returned for the 2-year follow-up and had initiated ART, a score of ≤10 provided a lower or equal sensitivity for detecting different stages of HAND (all HAND: 70%; symptomatic HAND: 75%; HAD: 94%). The area under the ROC curve was higher for ART-experienced versus ART-naïve individuals.

Conclusions:

The IHDS is a potentially useful screening tool for neurocognitive impairment in rural Uganda for both ART-naïve and ART-experienced adults. A cutoff ≤10 demonstrates higher sensitivity for more severe HAND stages compared with less severe HAND. Future studies should focus on potential modifications to the IHDS to improve its specificity.
Dynamic Brow Restoration Using a Soft Tissue Expander in Adult Patients With Arteriovenous Malformation
Authors: Ding Wei , Chen Hui , Lin Xiaoxi , Hu Xiaojie
Published: February 2020

Background

Impaired brow function in adult patients with arteriovenous malformation is a serious disability that can even influence the field of vision. Brow reanimation techniques are used to recover a more natural appearance and brow function. Many static procedures have been set to augment brow elevation, but only dynamic procedures can lead to better functional results. In this study, the experience of a single surgeon addressing the challenge of brow restoration with dynamic procedures is presented.

Methods

A retrospective review was performed using the records of 4 adult patients who underwent dynamic procedures using a soft tissue expander for brow restoration after arteriovenous malformation excision in the unilateral site of the forehead with the expander on the contralateral side. Movement and electrodiagnostic examinations were performed postoperatively at 2 months.

Results

The patients included 3 males and 1 female (mean age, 20.5 ± 4.04 years). Brow improvement was noted in all patients. The results of the electrodiagnostic examination showed synchronous and spontaneous motor unit potentials and compound muscle action potentials with the contralateral forehead.

Conclusions

Dynamic procedures using a soft tissue expander can provide both static and dynamic functional brow elevation of the contralateral frontalis and skin.
Management and Outcome of Local Regrowths in a Watch-and-wait Prospective Cohort for Complete Responses in Rectal Cancer
Authors: van der Sande Marit E , Figueiredo Nuno , Beets Geerard L.
Published: February 2020

Objective:

To evaluate the management and oncological outcomes of rectal cancer patients with local regrowth in a watch-and-wait (W&W) program.

Background:

Approximately 15%–30% of patients with a clinical complete response after (chemo) radiotherapy who undergo a W&W policy will experience a local regrowth. The risks of these local regrowths have not yet been fully established and main concerns include high postoperative morbidity, requirement of advanced surgery, and pelvic recurrence after regrowth treatment.

Methods:

All patients with a local regrowth after an initial W&W approach between January 2005 and March 2018 were retrospectively identified from 2 cohorts of rectal cancer patients with a clinical complete response after (chemo) radiotherapy. Type and outcome of regrowth treatment were assessed. Oncological outcome was assessed using Kaplan-Meier estimates.

Results:

Eighty-nine out of 385 patients developed a local regrowth after a median of 9 (interquartile range 7–14) months. Median follow-up time was 28 (interquartile range 19–41) months. Eighty-four (94%) patients underwent surgical treatment of the local regrowth: total mesorectal excision was performed in 58 out of 84 (69%) patients and local excision was performed in 26 (31%) patients. The 2-year local recurrence-free rate, distant metastasis-free rate, disease-free survival, and overall survival in the patients undergoing surgical treatment were 97.8%, 91.8%, 90.3%, and 98.4%, respectively.

Conclusion:

The vast majority (97%) of patients with regrowth after a W&W policy were able to undergo treatment with curative intent for local regrowth. Uncontrolled pelvic disease was very rare.
Transoral Endoscopic Thyroidectomy Vestibular Approach: An Initial Experience in Vietnam
Authors: Le Quang V. , Ngo Duy Q. , Tran Toan D. , Ngo Quy X.
Published: February 2020

Background:

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be applied to many health facilities worldwide, even in places whose medical facilities have not developed yet. To that end, our hospital is the first hospital to deploy this novel technique in Vietnam. In the study, the authors will evaluate the safety and efficacy of TOETVA, which was initially performed on patients in Vietnam.

Materials and Methods:

A TOETVA research was conducted on 28 patients in hospital K from January 1, 2018 to May 31, 2019. The surgical outcomes, cosmetic results, and complications were evaluated.

Results:

The mean operative time was 91 minutes (70 to 130 min). There were no cases with temporary and permanent hypoparathyroidism in the patients. One patient had temporary mental nerve injury recovered completely after 14-day surgery. No case used drains in patients. All patients were highly satisfied with the surgical outcome, especially, cosmetic results.

Conclusions:

TOETVA is a safe and feasible technique with acceptable complication rates and good outcomes. The authors will carry on this procedure for selected patients. TOETVA should not only be performed in some countries with well-developed health care systems but also be done in other developing countries worldwide.
Low Postoperative Levels of C-Reactive Protein Are an Early Predictor for an Uncomplicated Course After Bariatric Surgery: A Retrospective, Validated Cohort Study
Authors: Pochhammer Julius , Drozdzynski Jonas , Bernsmeier Alexander , Kersebaum Jan-Niclas , Laudes Matthias , Mehdorn Anne-Sophie , Richter Florian , Schafmayer Clemens , Becker Thomas , Beckmann Jan H.
Published: February 2020

Background:

Bariatric surgery is popularly used to treat or prevent morbidity in severely obese patients. Severe complications are rare, but their early detection has a significant impact on clinical outcomes. We aimed to determine whether blood tests in the first few postoperative days are reliable predictors for complications.

Methods:

We retrospectively analyzed 1073 patients who underwent laparoscopic bariatric surgery between 2009 and 2018 at our center. Clinical outcome was correlated with postoperative serum C-reactive protein (CRP), white blood cell count, and vital signs, analyzed using a receiver operating characteristic (ROC) curve. A total of 570 procedures between 2009 and 2015 were used to calculate the best cutoff values (calculation group), which were validated with 330 different patients operated upon between 2016 and 2018 (validation group).

Results:

Twenty-four patients (4.2%) developed anastomotic or staple-line leakages in the calculation group. The ROC curve showed a good reliability for CRP levels on day 2 (area under the ROC curve=0.86); the highest Youden index existed for a cutoff of 119 mg/L. White blood cell count and heart rate were poor predictors. Even though several characteristics differed in the validation cohort, test quality of the cutoff was high (sensitivity, 71.4%; specificity, 94.9%; positive predictive value, 23.8%; negative predictive value, 99.3%). The prediction was excellent especially for leakages appearing on days 2 to 9 (sensitivity 100.0%, negative predictive value 100%). Leakages from day 10 were rare and prediction poor (sensitivity 0%).

Conclusions:

A CRP level on day 2 <120 mg/L is a good predictor of a postoperative course without leakage, even though the predictive value goes down for late-appearing events. An earlier CRP measurement added no predictive benefit. The cutoff value was validated in an internal cohort and could be applied to different populations.
Benchmarking the value of care: Variability in hospital costs for common operations and its association with procedure volume
Authors: Zogg Cheryl K. , Bernard Andrew C. , Hirji Sameer A. , Minei Joseph P. , Staudenmayer Kristan L. , Davis Kimberly A.
Published: February 2020

BACKGROUND

Efforts to improve health care value (quality/cost) have become a priority in the United States. Although many seek to increase quality by reducing variability in adverse outcomes, less is known about variability in costs. In conjunction with the American Association for the Surgery of Trauma Healthcare Economics Committee, the objective of this study was to examine the extent of variability in total hospital costs for two common procedures: laparoscopic appendectomy (LA) and laparoscopic cholecystectomy (LC).

METHODS

Nationally weighted data for adults 18 years and older was obtained for patients undergoing each operation in the 2014 and 2016 National Inpatient Sample. Data were aggregated at the hospital-level to attain hospital-specific median index hospital costs in 2019 US dollars and corresponding annual procedure volumes. Cost variation was assessed using caterpillar plots and risk-standardized observed/expected cost ratios. Correlation analysis, variance decomposition, and regression analysis explored costs' association with volume.

RESULTS

In 2016, 1,563 hospitals representing 86,170 LA and 2,276 hospitals representing 230,120 LC met the inclusion criteria. In 2014, the numbers were similar (1,602 and 2,259 hospitals). Compared with a mean of US $10,202, LA median costs ranged from US $2,850 to US $33,381. Laparoscopic cholecystectomy median costs ranged from US $4,406 to US $40,585 with a mean of US $12,567. Differences in cost strongly associated with procedure volume. Volume accounted for 9.9% (LA) and 12.4% (LC) of variation between hospitals, after controlling for the influence of other hospital (8.2% and 5.0%) and patient (6.3% and 3.7%) characteristics and in-hospital complications (0.8% and 0.4%). Counterfactual modeling suggests that were all hospitals to have performed at or below their expected median cost, one would see a national cost savings of greater than US $301.9 million per year (95% confidence interval, US $280.6–325.5 million).

CONCLUSION

Marked variability of median hospital costs for common operations exists. Differences remained consistent across changing coding structures and database years and were strongly associated with volume. Taken together, the findings suggest room for improvement in emergency general surgery and a need to address large discrepancies in an often-overlooked aspect of value.

LEVEL OF EVIDENCE

Epidemiological, level III.
ACE2 expression by colonic epithelial cells is associated with viral infection, immunity and energy metabolism
Authors: Wang Jun , Zhao Shanmeizi , Liu Ming , Zhao Zhiyao , Xu Yiping , Wang Ping , Lin Meng , Xu Yanhui , Huang Bing , Zuo Xiaoyu , Chen Zhanghua , Bai Fan , Cui Jun , Lew Andrew M , Zhao Jincun , Zhang Yan , Luo Hai-Bin , Zhang Yuxia
Published: February 2020

Respiratory disease caused by the 2019 novel coronavirus (2019-nCoV) pneumonia first emerged in Wuhan, Hubei Province, China, in December 2019 and spread rapidly to other provinces and other countries. Angiotensin-converting enzyme 2 (ACE2) is the receptor for SARS-CoV and has been suggested to be also the receptor for 2019-nCoV. Paradoxically, ACE2 expression in the lung protects mice from SARS-CoV spike protein induced lung injury by attenuating the renin-angiotensin system. In the intestine, ACE2 also suppresses intestinal inflammation by maintaining amino acid homeostasis, antimicrobial peptide expression and ecology of the gut microbiome. Upon analysis of single cell-RNA sequencing data from control subjects and those with colitis or inflammatory bowel disease (IBD), we found thatACE2expression in the colonocytes was positively associated with genes regulating viral infection, innate and cellular immunity, but was negatively associated with viral transcription, protein translation, humoral immunity, phagocytosis and complement activation. In summary, we suggest that ACE2 may play dual roles in mediating the susceptibility and immunity of 2019-nCoV infection.
Irish Defence Forces graduate’s opinions and experiences of UCD’s Diploma in Military Medicine
Authors: Loughman S. , Berry C. , Hickey Paul , Ruddy Mark , Bruno Brian , Bury G.
Published: February 2020

Aims

This study explores the opinions and experiences of Irish Defences Forces graduates from UCD’s Diploma in Military Medicine. It aims to identify which aspects of medical education are relevant for the development of military graduates in future.

Methods

A validated Clinical Learning Environment Score (CLES) tool was adapted and incorporated into an online survey. This was sent electronically to 71 graduates. Responses were anonymous.

Results

38 (54%) of graduates responded. Just 16 (42%) use their new skills in their daily work. Of the 9 (24%) deployed overseas, all used their new skills. Emergency and Occupational Health skills were used more, while advanced skills were used rarely. Only 22 (40%) of DMMC graduates work in the Defence Forces Medical Unit.

Conclusion

Student feedback was positive regarding teaching and clinical placements at UCD. An emphasis on frequently used skills, and a change in how Defence Forces acknowledge qualifications, may support more graduates in entering the military medical workforce.

Key Messages

The Irish Defence Forces identified the need for an innovative training programme to equip its non-medical staff to address the role known as ‘Combat Medical Technician’(CMT).

This led to the development of the UCD Diploma in Military Medical Care (DMMC) programme.

The study shows that the skills used most frequently by graduates were those of the EMT and the Occupational Health aspects of the course.

Advanced skillsets were used rarely even when deployed overseas.

In developing future CMT courses it is recommended that the EMT and Occupational health skill sets are emphasised, with streamlining of the advanced skillset elements to focus the skills are most relevant in an overseas environment.

It would be advantageous to the Defence Forces for systems be put in place to recognise qualifications and support graduating students in practicing and using their new skills.
A database resource for Genome-wide dynamics analysis of Coronaviruses on a historical and global scale
Authors: Zhu Zhenglin , Meng Kaiwen , Meng Geng
Published: February 2020

The recent outbreak of a new zoonotic origin Coronavirus has ring the bell for the potential spread of epidemic Coronavirus crossing the species. With the urgent needs to assist the control of the Coronavirus spread and to provide valuable scientific information, we developed a coronavirus database (CoVdb), an online genomics and proteomics analysis platform. Based on public available coronavirus genomic information, the database annotates the genome of every strain and identifies 780 possible ORFs of all strains available in Genebank. In addition, the comprehensive evaluation of all the published genomes of Coronavirus strains, including population genetics analysis, functional analysis and structural analysis on a historical and global scale were presented in the CoVdb. In the database, the researcher can easily obtain the basic information of a Coronavirus gene with the distribution of the gene among strains, conserved or high mutation regions, possible subcellular location and topology of the gene. Moreover, sliding windows for population genetics analysis results is provided, thereby facilitating genetics and evolutional analysis at the genomic level. CoVdb can be accessed freely athttp://covdb.popgenetics.net.
Ultrastructural Visualization of 3D Chromatin Folding Using Serial Block-Face Scanning Electron Microscopy and In Situ Hybridization (3D-EMISH)
Authors: Trzaskoma Paweł , Ruszczycki Błażej , Lee Byoungkoo , Pels Katarzyna K. , Krawczyk Katarzyna , Bokota Grzegorz , Szczepankiewicz Andrzej A. , Aaron Jesse , Walczak Agnieszka , Śliwińska Małgorzata A. , Magalska Adriana , Kadlof Michal , Wolny Artur , Parteka Zofia , Arabasz Sebastian , Kiss-Arabasz Magdalena , Plewczynski Dariusz , Ruan Yijun , Wilczyński Grzegorz M.
Published: February 2020

The human genome is extensively folded into 3-dimensional organization, yet the detailed 3D chromatin folding structures have not been fully visualized due to the lack of robust and ultra- resolution imaging capability. Here, we report the development of a novel electron microscopy method that combines serial block-face scanning electron microscopy with in situ hybridization (3D-EMISH) to visualize 3D chromatin folding at targeted genomic regions with ultra-resolution (5×5×30 nm in xyz dimensions, respectively). We applied 3D-EMISH to human lymphoblastoid cells at a 1.7 Mb segment of the genome and visualized a large number of distinctive 3D chromatin folding structures in high ultra-resolution. We further quantitatively characterized the reconstituted chromatin folding structures by identifying sub-domains, and uncovered a high level of heterogeneity in chromatin folding ultrastructures, suggestive of extensive dynamic fluidity in 3D chromatin states.
Large-scalein silicomutagenesis experiments reveal optimization of genetic code and codon usage for protein mutational robustness
Authors: Schwersensky Martin , Rooman Marianne , Pucci Fabrizio
Published: February 2020

The question of how natural evolution acts on DNA and protein sequences to ensure mutational robustness and evolvability has been asked for decades without definitive answer. We tackled this issue through a structurome-scale computational investigation, in which we estimated the change in folding free energy upon all possible single-site mutations introduced in more than 20,000 protein structures. The validity of our results are supported by a very good agreement with experimental mutagenesis data. At the amino acid level, we found the protein surface to be more robust to mutations than the core, in a protein length-dependent manner. About 4% of all mutations were shown to be stabilizing, and a majority of mutations on the surface and in the core to be neutral and destabilizing, respectively. At the nucleobase level, single base substitutions were shown to yield on average less destabilizing amino acid mutations than multiple base substitutions. More precisely, the smallest average destabilization occurs for substitutions of base III in the codon, followed by base I, bases I+III, and base II. This ranking highly anticorrelates with the frequency of codon-anticodon mispairing, and suggests that the standard genetic code is optimized more to limit translation errors than the impact of random mutations. Moreover, the codon usage also appears to be optimized for minimizing the errors at the protein level, especially for surface residues that evolve faster and have therefore been under stronger selection, and for biased codons, suggesting that the codon usage bias also partly aims to optimize protein mutational robustness.