bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial intelligence in ophthalmology during COVID-19 and in the post COVID-19 era
Authors: Hallak Joelle A. , Scanzera Angelica C. , Azar Dimitri T. , Chan R.V. Paul
Published: July 2020

Purpose of review

To highlight artificial intelligence applications in ophthalmology during the COVID-19 pandemic that can be used to: describe ocular findings and changes correlated with COVID-19; extract information from scholarly articles on SARS-CoV-2 and COVID-19 specific to ophthalmology; and implement efficient patient triage and telemedicine care.

Recent findings

Ophthalmology has been leading in artificial intelligence and technology applications. With medical imaging analysis, pixel-annotated distinguishable features on COVID-19 patients may help with noninvasive diagnosis and severity outcome predictions. Using natural language processing (NLP) and data integration methods, topic modeling on more than 200 ophthalmology-related articles on COVID-19 can summarize ocular manifestations, viral transmission, treatment strategies, and patient care and practice management. Artificial intelligence for telemedicine applications can address the high demand, prioritize and triage patients, as well as improve at home-monitoring devices and secure data transfers.

COVID-19 is significantly impacting the way we are delivering healthcare. Given the already successful implementation of artificial intelligence applications and telemedicine in ophthalmology, we expect that these systems will be embraced more as tools for research, education, and patient care.
Mapping the network underpinnings of central poststroke pain and analgesic neuromodulation
Authors: Elias Gavin J.B. , De Vloo Philippe , Germann Jürgen , Boutet Alexandre , Gramer Robert M. , Joel Suresh E. , Morlion Bart , Nuttin Bart , Lozano Andres M.
Published: July 2020

Central poststroke pain (CPSP) is a debilitating and often treatment-refractory condition that affects numerous stroke patients. The location of lesions most likely to cause pain and the identity of the functional brain networks that they impinge upon remain incompletely understood. We aimed to (1) elucidate which lesion locations are most frequently accompanied by pain; (2) explore CPSP-associated functional networks; and (3) examine how neuromodulation interacts with these networks. This multisite study investigated 17 CPSP patients who received deep brain stimulation (DBS; n = 12) or motor cortex stimulation (MCS; n = 5). Pain-causing lesions were manually segmented and normalized to standard space. To identify areas linked to high risk of pain, the locations of CPSP lesions and 220 control lesions were compared using voxelwise odds ratio mapping. The functional connectivity of pain-causing lesions was obtained using a large (n = 1000) normative resting-state functional MRI connectome and compared to that of control lesions and therapeutic DBS activation volumes. Brain regions most associated with CPSP risk (highest value = 63 times) were located along the ascending somatosensory pathways. These areas and the majority of individual CPSP lesions were functionally connected to anterior/middle cingulate cortex, insula, thalamus, and inferior parietal lobule (P
Bonferroni < 0.05). The extent of connectivity to the thalamus, inferior parietal lobule, and precuneus also differed between CPSP and control lesions (P
Bonferroni < 0.05). Posterior insula and thalamus shared connectivity with both CPSP lesions and pain-alleviating DBS activation volumes (P
Bonferroni < 0.05). These findings further clarify the topography and functional connectivity of pain-causing brain lesions, and provide new insights into the network-level mechanism of CPSP neuromodulation.
Association between obesity indicators and cardiovascular risk factors among adults in low-income Han Chinese from southwest China
Authors: Wang Ke , Pan Li , Wang Dingming , Dong Fen , Yu Yangwen , Wang Li , Li Ling , Liu Tao , Sun Liangxian , Zhu Guangjin , Feng Kui , Xu Ke , Pang Xinglong , Chen Ting , Pan Hui , Ma Jin , Zhong Yong , Shan Guangliang
Published: July 2020

There may be differences in optimal anthropometric cut-offs for diagnosing obesity among different regions of China. However, there has been little studies about choosing effective obesity indicators in Han People of low-income Chinese adults in southwest China. The purpose of this study was to compare and evaluate the associations between different obesity indicators and cardiovascular disease risk factors (CVDRF) and choose the optimal cut-off values.

A cross-sectional study was carried out in southwest of China, with multi-stage sampling enrolling 2112 subjects aged 20 to 80 years old. Anthropometric measurements included Body mass index (BMI), waist circumference (WC), Hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). We measured the percentage of body fat (PBF) by bioelectrical impedance analyzer to assess the body composition. The validity of different obesity indicators in assessing CVDRF risk were assessed through comparison area under curve of different indicators in assessing CVDRF risk in different gender. Logistic regression models were used to evaluate the association between the obesity indicators and CVDRF.

When both male and female were considered, the optimal indicators were WHtR and percentage of body fat PBF for hypertension, WHR and WHtR for dyslipidemia. Both WC and WHtR were optimal indicators in assessing metabolic syndrome risk for both genders. When both disease and gender were considered, WHtR was the best associated indicators with various CVDRF. The cut-off of BMI and WC were consistent to the definition of obesity in Working Group of China. The WHtR positively correlated with the CVDRF. The cut-off of WHtR to do what was approximately 0.50 for adults in both genders in southwest of China.

WHtR may be the best associated indicators for obesity-related CVDRF among the others (BMI, WC, Hip circumference, PBF, and WHR) in southwest of China. The cut-off of WHtR was approximately 0.50 for adults in both genders in southwest of China.
Prognostic value of CD44v9 expression in human cancers: Retraction
Authors: Zeng Li , Chen Yitian , Chen Ligang , Tang Chengwei
Published: July 2020

Background:

The prognostic significance of CD44 variant-9 (CD44v9) expression in human cancers has been investigated in several studies, however, definite conclusion has not be reached. The aim of this systematic review and meta-analysis was to evaluate the prognostic significance of CD44v9 expression in various cancers.

Methods:

Three common databases were searched and retrieved studies were assessed using the inclusion and exclusion criteria. The further analyses for overall survival (OS), recurrence-free survival (RFS), and clinicopathological parameters were performed.

Results:

Fifteen studies containing 1633 cancer patients were included into this research. Patients with positive CD44v9 expression tended to have shorter OS (hazard ratio [HR] = 1.93, 95% confidence interval [CI] = 1.48–2.52, P < .01) and RFS (HR = 3.60, 95% CI = 1.52–8.53, P < .01) when compared with patients with negative CD44v9 expression. Positive CD44v9 expression was associated with larger tumor size (P = .04), deeper tumor invasion (P < .01), earlier lymph node metastasis (P < .01), and more advanced clinical stage (P < .01) when compared with negative CD44v9 expression.

Conclusion:

Positive CD44v9 expression predicted worse prognosis in human cancers compared with negative CD44v9 expression. CD44v9 expression could serve as a prognostic factor of human cancers.
Controversies in the application of corticosteroids for pediatric septic shock treatment: a preferred reporting items for systematic reviews and meta-analysis-compliant updated meta-analysis
Authors: Yang Jing , Sun Shaobo
Published: July 2020

Objectives:

Septic shock is the major cause of childhood mortality. However, the application of corticosteroids remains controversial. This work aimed to analyze the source of controversy based on existing data and recent randomized controlled trials by meta-analysis and to assess whether it can avoid these factors to guide clinical treatment.

Methods:

We searched the public databases up to 8 June 2019 and included only randomized controlled trials. The primary outcome was mortality. Sensitivity analysis, subgroup analysis, and dose-response meta-analysis were performed in this work.

Results:

We included twelve studies consisting of 701 children in the meta-analysis. For primary outcome, the fixed-effect model showed steroids could significantly reduce the mortality compared to the control (Odds Ratio: 0.67; 95% confidence interval: 0.46–0.98; P = .041). However, the random-effect model showed a negative result (Odds Ratio: 0.69; 95% confidence interval: 0.32–1.51; P = .252). None of the subgroup results rejected the null hypothesis that the overall effect equaled zero. Dose-response effect analysis showed that increased dosage at a low dosage might reduce the mortality, while at a high dosage, increasing the dose might increase the mortality. Moreover, the grading of recommendations assessment, development, and evaluation level of evidence is low for mortality.

Conclusions:

Corticosteroid application is not recommended for septic shock children under current medical conditions.
A hybrid therapeutic approach for decreasing postoperative complications in patients with adult lumbar degenerative scoliosis
Authors: Zhao Yongfei , Liang Yan , Wang Tianhao , Wang Zheng , Lu Ning
Published: July 2020

To decrease postoperative complications in patients with adult lumbar degenerative scoliosis (ALDS), short-segment fusion surgery was used in this study. However, the incidence of adjacent segment disease was found to be remarkable. Therefore, we applied the hybrid treatment (short-segment fusion for responsibility levels plus nonfusion stabilization of lumbar segments, which was called the Wallis system, for the proximal level) to patients enrolled into this study. The purpose of this study was to investigate the feasibility of a novel hybrid therapeutic approach for treating patients with ALDS.

From January 2011 to January 2017, a retrospective study was conducted consisting of 16 patients with ALDS who were treated with hybrid treatment. All patients were treated with short-segment decompression and fusion for responsibility levels and nonfusion stabilization of lumbar segments for the proximal levels. The imaging outcomes were evaluated preoperatively and at the time of follow-up.

The mean visual analog score for back pain decreased from 6.1 ± 2.0 preoperatively to 2.1 ± 0.7 at 2-year follow-up (P < .05), and the mean visual analog score for leg pain reduced from 8.1 ± 0.6 preoperatively to 1.3 ± 0.8 at 2-year follow-up (P < .05). The Oswestry disability index scores improved from 65.4 ± 16.3% preoperatively to 18.3 ± 5.6% at 2-year follow-up (P < .05). The mean Cobb angle was 22.1 ± 6.2° preoperatively, and 13.8 ± 6.8° at 2-year follow-up (P < .05). The lumbar lordosis changed from −40.4 ± 14.8° to −43.5 ± 11.2° at 2-year follow-up (P < .05). Solid fusion was achieved in all the patients, and no incidence of adjacent segment disease was noted as well.

The proposed hybrid treatment for patients with ALDS can achieve favorable clinical outcomes and a lower incidence of ALDS. However, the correction of deformity is still limited that highlights the necessity of further study.
Relationship between arterial stiffness and variability of home blood pressure monitoring
Authors: Park Jin-Sun , Shin Joon-Han , Park Jeong-Bae , Choi Dong-Ju , Youn Ho-Joong , Park Chang-Gyu , Kwan Jun , Ahn Youngkeun , Kim Dong-Woon , Rim Se-Joong , Park Seung-Woo , Sung Jidong , Bae Jang-Ho
Published: July 2020

Variability of blood pressure (BP) is known as a prognostic value for the subsequent target organ damage in hypertensive patients. Arterial stiffness is a risk factor for cardiovascular morbidity and mortality. The relationship between the arterial stiffness and the BP variability has been controversial. The objective of the present study was to investigate the relationship between arterial stiffness and home BP variability in patients with high normal BP and new onset hypertension (HTN).

Four hundred sixty three patients (252 males, 49 ± 12 year-old) with high normal BP or HTN were enrolled. Using radial applanation tonometry, pulse wave analysis (PWA) was performed for evaluation of systemic arterial stiffness. All patients underwent both home BP monitoring (HBPM) and PWA. Home BP variability was calculated as the standard deviation (SD) of 7 measurements of HBPM. Multiple linear regression analysis was performed to estimate and test the independent effects of home BP variability on the arterial stiffness.

Mutivariate analysis showed that both systolic and diastolic morning BP variabilities were correlated with arterial stiffness expressed as augmentation pressure (AP, β-coefficient = 1.622, P = .01 and β-coefficient = 1.07, P = .035). The SDs of systolic and diastolic BP of evening were also associated with AP (β-coefficient = 1.843, P = .001 and β-coefficient = 1.088, P = .036). The SDs of morning and evening systolic BP were associated with augmentation index (AI, β-coefficient = 1.583, P = .02 and β-coefficient = 1.792, P = .001) and heart rate (75 bpm) adjusted AI (β-coefficient = 1.592, P = .001 and β-coefficient = 1.792, P = .001).

In present study, the variability of systolic BP was closely related with arterial stiffness. The home BP variability might be important indicator of arterial stiffness.
A nationwide analysis of desmoplastic small round cell tumor
Authors: Xiang Tao , Zhang Shu-Yang , Wang Sai-Sai , Fei Ru-Shan , Li Hui
Published: July 2020

This study aim is to enhance the understanding, diagnosis and treatment of desmoplastic small round cell tumor (DSRCT) and to determine what factors can affect survival of the disease in China.

We report here 8 patients with DSRCT in our center who received a variety of treatment methods. By reviewing the literature published from Chinese database (CNKI, WANGFAN, VIP, CBM, CMCC) in 2000 to 2015 with the terms of “dsrct”, “desmoplastic” and “small round-cell tumor”,104 eligible cases of DSRCT(including 8 cases in our hospital) were retrospectively analyzed.

Among the 104 patients, Median age was 24 years with a range of 15 to 54 years. The main primary tumor site was the abdomen and/or pelvis in 92/104 patients (88.5%). Only 25% of patients had localized disease. Most of the patients had received adjuvant chemotherapy (87.5%) and 76.9% patients had not experienced adjuvant radiotherapy. One-fourth of the patients underwent grossly complete surgical resection, and 33.7% and 41.3% patients received no surgery and incomplete surgical resection, respectively. Median overall survival for all patients was 26 months (95% CI: 20.29–31.71). Multivariate analysis revealed that Metastatic status (HR: 2.327, 95% CI: 1.136–4.768, P = .021), Surgical patterns (HR: 0.673, 95% CI: 0.487–0.928, P = .016), and Adjuvant chemotherapy (HR: 0.337, 95% CI: 0.167–0.678, P = .002) were significant independent prognostic factors for longer overall survival. It was noteworthy that CD99 were significantly associated with OS (P = .002).

Here, we identified the prognostic factors which may facilitate risk-adapted treatments for this rare DSRCT group, which should be further investigated.
Focal nodular hyperplasia on an accessory liver lobe
Authors: Su Na , Chen Cheng , Dai Qing , Wang Liang , Yang Meng , Xia Yu , Jiang Yuxin , Lv Ke
Published: July 2020

Introduction:

Accessory liver lobe (ALL), an autonomous island of normal liver parenchyma, is a rare congenital anomaly that is difficult for preoperative diagnosis and often identified incidentally. It can also be accompanied with benign or malignant diseases, which is extremely rare. There are only 3 cases of focal nodular hyperplasia (FNH) detected on ALL reported by previous literature.

Patient concerns:

A 33-year-old woman was incidentally diagnosed with a mass in left upper quadrant abdomen by a routine ultrasound examination. Doppler ultrasound revealed that the mass was attached to left liver lobe with a vascular pedicle. A spoke-wheel artery with diffuse enhancement during hepatic arterial phase was visualized on contrast-enhanced ultrasound, and the mass was continuously hyper-enhanced with a hypo-enhanced intralesional scar during the portal and delayed phase. And contrast-enhanced computed tomography showed a similar enhancement mode of the mass.

Diagnosis:

The mass was resected and postoperative histopathologic result of the lesion revealed a nodular hyperplastic parenchyma with a central fibrous scar, without tumor cells. And a final diagnosis of FNH on ALL was determined accordingly.

Interventions:

Mass resection was conducted according to patient's demand.

Outcome:

After general postoperative administration, the patient was discharged. Then, she had been undergoing regular serological tests and imaging examinations in our hospital for 24 months.

Conclusion:

The finding of a mass connecting with liver by a stalk should alert the clinician of the possibility of ALL, as well as benign or malignancies on an ALL. This is the first case of FNH on ALL preoperatively confirmed by contrast-enhanced ultrasound. We suggest that an integrated radiologic approach is crucial to evaluate an incidentally detected, asymptomatic abdominal focal mass.
Patients with spontaneous pneumothorax have a higher risk of developing lung cancer
Authors: Chen Chien-Kuang , Chang Yen-Jung , Fang Hsin-Yuan
Published: July 2020

Lung cancer is a common malignancy worldwide, and risk factors include bronchitis, asthma, tuberculosis, smoking, and air pollution. These are also risk factors for spontaneous pneumothorax, a benign disease. We hypothesized that patients who experience a spontaneous pneumothorax have a greater risk to develop lung cancer, and designed a study to determine if this is so.

We used the population-based Taiwan Health Insurance Research Database to perform a retrospective cohort study. The database includes more than 99% of the population of Taiwan. We established a 27,405-person pneumothorax cohort and a 109,620 person comparison cohort with data from 2000 to 2009 to evaluate the relationship between spontaneous pneumothorax and lung cancer.

Multivariable analysis showed that patients who have had a spontaneous pneumothorax have a greater relative risk to develop lung cancer. The overall hazard ratio was 2.09 (95% confidence interval 1.69-2.58) adjusted by age, gender, hypertension, diabetes mellitus, and chronic lung diseases such as chronic obstructive pulmonary disease, tuberculosis, asthma, bronchitis, and emphysema. A dose effect was present; a high frequency of spontaneous pneumothorax was associated with a greater relative risk to develop lung cancer. If the spontaneous pneumothorax frequency was greater than 2 times per year, the hazard ratio was 34.09 (95% confidence interval 22.74-51.10)

Patients with spontaneous pneumothorax have an increased relative risk to develop lung cancer, especially among patients 35 to 49 years of age. The more frequent the occurrence of spontaneous pneumothorax, the greater the relative risk of lung cancer. If the spontaneous pneumothorax frequency was greater than 2 times per year, the increase in risk of lung cancer was more than 30-fold.
Evaluation of the efficacy of Chinese herbal medicine and acupuncture for the prevention of mental disorders in interstitial cystitis patients
Authors: Hung Hao-Hsiu , Chen Wen-Chi , Chen Yung-Hsiang , Chiu Lu-Ting , Chen Huey-Yi
Published: July 2020

Traditional Chinese medicine (TCM) is commonly used for urinary symptoms in Eastern countries. Since there are few effective treatments available for patients with interstitial cystitis/bladder pain syndrome (IC/BPS), the psychological burden leads to increased healthcare-seeking behavior. Some patients may therefore seek TCM treatment for related urinary symptoms. Due to limited clinical research evaluating the effects of TCM on IC/BPS, we conducted a nationwide population-based cohort study to investigate the relationship between TCM and mental disorders among these patients. The IC/BPS cohort and its matched non-IC/BPS comparison cohort were recruited from the National Health Insurance (NHI) Research Database between 2000 and 2011. Patients with the use of Chinese herbal medicine (CHM) granules or acupuncture over 90 days per year were enrolled as the TCM users. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of mental disorders related to interstitial cystitis. The incidence of mental disorders in the 2 cohorts was assessed with Kaplan–Meier curves. A total of 1123 patients with IC/BPS and 4492 matched non-IC/BPS subjects were included in this study. The IC/BPS cohort demonstrated higher incidence rate of mental disorders than the cohort without IC/BPS (adjusted HR: 2.21, 95% confidence interval [CI]: 1.73–2.81). There was no statistically significant difference in the risk of mental disorders between IC/BPS patients with and without CHM granules or acupuncture treatment (adjusted HR: 0.99, 95% CI: 0.58–1.68). Our results indicated that CHM and acupuncture showed insignificant efficacy in the prevention of mental disorders in IC/BPS patients.
Body Composition of Infants With Biliary Atresia
Authors: Grutters L. Agnes , Pennings Jan Pieter , Bruggink Janneke L.M. , Viddeleer Alain R. , Verkade Henkjan J. , de Kleine Ruben H.J. , de Haas Robbert J.
Published: July 2020

Objectives:

Biliary atresia (BA) causes neonatal cholestasis that requires hepatoportoenterostomy or liver transplantation (LT) for long‐term survival. Nutritional optimization is necessary as sarcopenia and sarcopenic obesity have been associated with adverse clinical outcome. Currently, mid upper arm circumference (MUAC) is considered the most accurate indicator. The aim of the study was to determine computed tomography (CT)‐based body metrics in infants with BA and to evaluate its correlation with MUAC.

Methods:

We retrospectively analyzed all BA infants below 2 years of age who underwent CT as part of LT screening at our hospital between 2006 and 2019. Measured variables were indexed with length and included: MUAC, total psoas muscle surface area (tPMSA), cross‐sectional skeletal muscle area (CSMA), and total abdominal fat area. Intraclass correlation coefficients and Pearson coefficients were calculated. CSMA‐to‐abdominal fat area ratio was divided in quartiles, the lowest quartile group was considered sarcopenic obese.

Results:

Eighty infants with a median age of 4.6 months at LT screening were included. Intraclass correlation coefficients were: tPMSA = 0.94, CSMA = 0.92, and total abdominal fat area = 0.99. Correlation between MUAC z‐score and indices of tPMSA, CSMA, and total abdominal fat area were r = 0.02, r = 0.06, and r = 0.43, respectively. The cut‐off for sarcopenic obesity was CSMA‐to‐abdominal fat area ratio below 0.93.

Conclusions:

In BA infants, it is possible to determine CT‐based body metrics during LT screening with very strong interobserver agreement. Poor correlation between CT‐based body metrics and MUAC suggests that CT‐based body metrics provide additional information on body composition in BA infants, such as relative muscle mass.
“I’m Not From Another Planet”
Authors: Kerr Lucille , Fisher Christopher M. , Jones Tiffany
Published: July 2020

Background

There is little research that addresses the needs of trans and gender diverse people with cancer. Emerging evidence shows unique concerns, particularly in relation to gendered cancers such as breast and gynecological.

Objective

The aim of this study was to explore the intersubjective experiences in cancer care of trans and gender-diverse people to inform a microethical approach to improving care for this community.

Methods

Qualitative interviews (n = 12) were conducted with trans and gender-diverse people who had a diagnosis of cancer. Analysis was phenomenologically inspired and used Braun and Clarke’s inductive thematic methods.

Results

The intersubjective experiences revealed that interactions were often characterized by a sense of alienation and invisibility. Six intertwined themes demonstrate the emergence of these feelings for the participants, these included Gender Stereotypes and Assumptions, Negation of Identity, Dismissed Concerns, Invisibility in the System, Alienation in Waiting Rooms and Support Groups, and Uniquely Gendered Bodies and Interactions. Conversely, 1 theme showed how participants could be made to feel connected and recognized—Affirming Experiences.

Conclusions

The unique experiences of trans and gender-diverse people in cancer care shed light on the effect of gender biases and barriers to empathic care. Findings provide professionals with insights that can enhance their clinical practice through informing the ways they provide care to people with diverse genders.

Implications for Practice

Cancer care nurses should be reflecting on their own assumptions related to gender and engaging their patients in genuinely empathic communication.
Social Distancing Metrics and Estimates of SARS-CoV-2 Transmission Rates: Associations Between Mobile Telephone Data Tracking and R
Authors: Morley Christopher P. , Anderson Kathryn B. , Shaw Jana , Stewart Telisa , Thomas Stephen J. , Wang Dongliang
Published: July 2020

Background:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In the absence of robust preventive or curative strategies, the implementation of social distancing has been a key component of limiting the spread of the virus.

Methods:

Daily estimates of R(t) were calculated and compared with measures of social distancing made publicly available by Unacast. Daily generated variables representing an overall grade for distancing, changes in distances traveled, encounters between individuals, and daily visitation, were modeled as predictors of average R value for the following week, using linear regression techniques for 8 counties surrounding the city of Syracuse, New York. Supplementary analysis examined differences between counties.

Results:

A total of 225 observations were available across the 8 counties, with 166 meeting the mean R(t) < 3 outlier criterion for the regression models. Measurements for distance (β = 1.002, P = .012), visitation (β = .887, P = .017), and encounters (β = 1.070, P = .001) were each predictors of R(t) for the following week. Mean R(t) drops when overall distancing grades move from D+ to C−. These trends were significant (P < .001 for each).

Conclusions:

Social distancing, when assessed by free and publicly available measures such as those shared by Unacast, has an impact on viral transmission rates. The scorecard may also be useful for public messaging about social distance, in hospital planning, and in the interpretation of epidemiological models.
Public Perceptions of Cross-Sex Vascularized Composite Allotransplantation
Authors: Mills Emily C. , Alfonso Allyson R. , Wolfe Erin M. , Park Jenn J. , Sweeney Guillermo Najera , Hoffman Alexandra F. , Felsenheld Julia H. , Sosin Michael , Ramly Elie P. , Rodriguez Eduardo D.
Published: July 2020

Background

Cross-sex vascularized composite allotransplantation has been performed in cadaveric facial transplantation and clinical extremity transplantation. Understanding the challenge of appropriate donor-recipient matching, this study sought to characterize the public's perception of cross-sex vascularized composite allotransplantation.

Methods

Participants were surveyed in New York City. Data collected included demographics and willingness to donate vascularized composite allografts (VCAs) of various types. Similar questions were asked in the context of same-sex and cross-sex donation.

Results

A total of 101 participants (male: 56.4%; age ≤35 years: 62.4%) were surveyed. The majority expressed willingness to donate to recipients of a different sex (hand: 78.2%, face: 56.4%, penis or uterus: 69.3%, lower limb: 81.2%, abdominal wall: 80.2%, larynx: 81.2%, and solid organs: 85.2%). Among VCAs, willingness to donate facial allografts was significantly different in same-sex versus cross-sex contexts (64.4% vs 56.4%; P = 0.008). Participants were also significantly more likely to donate VCAs to same-sex recipients on behalf of themselves versus loved ones (P < 0.05). There was significantly lower willingness to receive cross-sex versus same-sex facial (P = 0.022) and genital allografts (P = 0.022). Education on the preservation of recipient masculinity or femininity in cross-sex facial transplantation increased participants' willingness to receive a cross-sex face transplant from 56.4% to 71.3% (P = 0.001).

Conclusions

This study highlights the urban public's acceptance of VCA donation or reception regardless of sex mismatch. There is increased willingness to receive a cross-sex face transplant after education, highlighting opportunities for future focused interventions to increase public awareness and ultimately the donor pool.
Eustachian Tube: Computed Tomography Analysis
Authors: El-Anwar Mohammad Waheed , Eldib Diaa Bakry , Nofal Ahmed Abdel Fattah , Khazbak Alaa Omar
Published: July 2020

Background:

Eustachian tube has a major role in ventilation, drainage, and protection of the middle ear. High resolution computed tomography magnifies the role of preoperative imaging for detailed inner and middle ear anatomical information. The aim of this study was to find an applicable way by computed tomography imaging for assessment of Eustachian tube. The goal was to provide improved understanding of the Eustachian tube measurements and the relationship with middle ear in Egyptian population. Computed tomography measurements for Eustachian tube were done including; length of the bony and cartilaginous portions, Total length of Eustachian tube, as well as the width and height of the tympanic orifice of the Eustachian tube. Also, tubotympanic and Reid plane- Eustachian tube angles were measured.

Results:

Within 200 studied ears in 100 subjects, the mean total Eustachian tube length was 40.19 ± 3.05 mm, mean length of the bony Eustachian tube was 11.69 ± 1.8 mm with significant longer Eustachian tube on left side, The mean length of the cartilaginous Eustachian tube was 28.5 ± 2.95 mm with significantly longer cartilaginous and total length in male (P < 0.0001). The mean width and height of the tympanic orifice of the Eustachian tube was 5.4 ± 0.79 and 4.85 ± 0.75 mm, respectively. The mean tubotympanic angle of the Eustachian tube was 148.11 ± 2.82°. The mean Reid plane- Eustachian tube angle was 27.69 ± 2.08° with significantly wider angle in males (P < 0.022).

Conclusion:

The Eustachian tube measurements can easily be obtained on computed tomography images, and are representative for the Eustachian tube anatomy. There is importance of extending computed tomography examinations beyond the middle ear cavity and the mastoids to the Eustachian tube in order to have more data on its condition and relations with different pathological conditions. Computed tomography provides improved understanding of the Eustachian tube measurements and relationship with middle ear structures.
Cell–Cell Interaction Mechanisms in Acute Lung Injury
Authors: Zhou Huiting , Fan Erica K. , Fan Jie
Published: July 2020

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are caused by an exaggerated inflammatory response arising from a wide variety of pulmonary and systemic insults. Lung tissue is composed of a variety of cell populations, including parenchymal and immune cells. Emerging evidence has revealed that multiple cell populations in the lung work in concert to regulate lung inflammation in response to both direct and indirect stimulations. To date, the question of how different types of pulmonary cells communicate with each other and subsequently regulate or modulate inflammatory cascades remains to be fully addressed. In this review, we provide an overview of current advancements in understanding the role of cell–cell interaction in the development of ALI and depict molecular mechanisms by which cell–cell interactions regulate lung inflammation, focusing on inter-cellular activities and signaling pathways that point to possible therapeutic opportunities for ALI/ARDS.
Platelet–Monocyte Aggregates: Understanding Mechanisms and Functions in Sepsis
Authors: Fu Guang , Deng Meihong , Neal Matthew D. , Billiar Timothy R. , Scott Melanie J.
Published: July 2020

Platelets have been shown to play an important immunomodulatory role in the pathogenesis of various diseases through their interactions with other immune and nonimmune cells. Sepsis is a major cause of death in the United States, and many of the mechanisms driving sepsis pathology are still unresolved. Monocytes have recently received increasing attention in sepsis pathogenesis, and multiple studies have associated increased levels of platelet–monocyte aggregates observed early in sepsis with clinical outcomes in sepsis patients. These findings suggest platelet–monocyte aggregates may be an important prognostic indicator. However, the mechanisms leading to platelet interaction and aggregation with monocytes, and the effects of aggregation during sepsis are still poorly defined. There are few studies that have really investigated functions of platelets and monocytes together, despite a large body of research showing separate functions of platelets and monocytes in inflammation and immune responses during sepsis. The goal of this review is to provide insights into what we do know about mechanisms and biological meanings of platelet–monocyte interactions, as well as some of the technical challenges and limitations involved in studying this important potential mechanism in sepsis pathogenesis. Improving our understanding of platelet and monocyte biology in sepsis may result in identification of novel targets that can be used to positively affect outcomes in sepsis.
Making Every Liver Count
Authors: MacConmara Malcolm , Hanish Steven I. , Hwang Christine S. , De Gregorio Lucia , Desai Dev M. , Feizpour Cyrus A. , Tanriover Bekir , Markmann James F. , Zeh Herbert , Vagefi Parsia A.
Published: July 2020

Objective:

Normothermic machine perfusion (NMP) enables optimized ex-vivo preservation of a donor liver in a normal physiologic state. The impact of this emerging technology on donor liver utilization has yet to be assessed.

Summary Background Data:

NMP of the donor liver and ex-vivo enhancement of its function has been envisioned for decades, however only with recent technological advances have devices been suitable for transition to clinical practice. The present study examines the effect NMP on liver utilization in the United States.

Methods:

The United Network for Organ Sharing database was queried to identify deceased donor livers procured from 2016 to 2019 (n = 30596). Donor livers were divided by preservation method: standard cold-static preservation (COLD, n = 30,368) versus NMP (n = 228). Donor and recipient risk factors, liver disposition, and discard reasons were analyzed. The primary outcome was liver discard rate between 2 groups.

Results:

A total of 4037 livers were discarded. The NMP group had a 3.5% discard rate versus 13.3% in the COLD group (P< 0.001), and this was despite NMP donors being older (47.7 vs 39.5 years,P< 0.0001), more frequently donation after cardiac death (DCD) (18% vs 7%,P< 0.001), and having a greater donor risk index (1.6 vs 1.5,P< 0.05). The most common reasons for liver discard in the COLD group were biopsy findings (38%), DCD warm ischemic time (11%), and prolonged preservation time (10%). Survival analysis, following propensity score matching, found no significant difference in 1-year overall survival between recipients of NMP versus COLD livers.

Conclusions:

NMP reduces the discard rate of procured livers despite its use in donors traditionally considered of more marginal quality. NMP maintains excellent graft and patient survival. Broader application of NMP technology holds the potential to generate a significant number of additional liver grafts for transplantation every year, thus greatly reducing the nationwide disparity between supply and demand.
Is It Safe to Manage Acute Cholecystitis Nonoperatively During Pregnancy?
Authors: Rios-Diaz Arturo J. , Oliver Emily A. , Bevilacqua Lisa A. , Metcalfe David , Yeo Charles J. , Berghella Vincenzo , Palazzo Francesco
Published: July 2020

Objectives:

To compare cholecystectomy (CCY) and nonoperative treatment (no-CCY) for acute cholecystitis in pregnancy.

Summary of Background Data:

Current Society of Gastrointestinal and Endoscopic Surgery guidelines recommend CCY over nonoperative management of acute cholecystitis during pregnancy, and the American College of Obstetricians and Gynecologists recommend medically necessary surgery regardless of trimester. This approach has been recently questioned.

Methods:

Pregnant women admitted with acute cholecystitis were identified using the Nationwide Readmission Database 2010–2015. Propensity-score adjusted logistic regression models were used to compare CCY and no-CCY. The primary outcome was a composite measure of adverse maternal-fetal outcomes (intrauterine death/stillbirth, poor fetal growth, abortion, preterm delivery, C-section, obstetric bleeding, infection of the amniotic fluid, venous thromboembolism).

Results:

There were 6390 pregnant women with acute cholecystitis: 38.2% underwent CCY, of which 5.1% were open. Patients were more likely to be managed operatively in their second trimester (First 43.9%, Second 59.1%, Third 34.2%; P < 0.01). Patients managed with CCY did not differ in age, insurance, income, Charlson Comorbidity Index, diabetes or obesity when compared to no-CCY (all P > 0.05), but were less likely to have a previous C-section, gestational diabetes, preeclampsia/eclampsia or be in the third trimester (P ≤ 0.01). Risk-adjusted analyses showed that no-CCY was associated with significantly increased maternal-fetal complications during the index admission [odds ratio 3.0 (95% confidence interval 2.08–4.34), P < 0.01] and 30-day readmissions [odds ratio 1.61 (confidence interval % CI 1.12–2.32), P < 0.01].

Conclusions:

Contrary to current guidelines, most pregnant women admitted in the US with acute cholecystitis are managed nonoperatively. This is associated with over twice the odds of maternal-fetal complications in addition to increased readmissions.
Surgical Results With the ONSTEP Technique Using OnFlex Mesh for Inguinal Hernias: Case Series With Treating 986 Lesions
Authors: Yanagi Ken , Kashiwabara Moto
Published: July 2020

Background:

The ONSTEP technique is a surgical repair method that uses an anterior approach for inguinal hernias. It is a new surgical technique that spans layers in which the medial side of the mesh is inserted into the peritoneal cavity, and the lateral side is positioned over the internal oblique muscle. Previous reports on this technique have mentioned the use of PolySoft Hernia Patch mesh; however, there have been no reports of surgical outcomes using OnFlex Mesh with absorbent rings.

Materials and Methods:

The authors evaluate the results of the ONSTEP technique using OnFlex Mesh. In 2017, this technique was introduced as an outpatient surgical procedure at our institution. In the past 3 years, it has been performed in 941 patients to repair 986 lesions.

Results:

Recurrences were observed in only 1 patient (0.10%), and complications included subcutaneous hemorrhage in 21 patients, hematoma in 10, seroma in 9, wound infection in 4, and mesh infection in 1. No serious events, such as postoperative ileus, chronic pain, or bladder injury, were observed. Because this technique does not require a procedure to detach the lateral preperitoneal space, the duration of surgery was 27±8 min, which was shorter than other transinguinal preperitoneal repair techniques.

Conclusions:

The ONSTEP technique using OnFlex Mesh is a simple and safe repair method that can be performed as an outpatient surgical procedure. Although there is still a need to wait for long-term results, favorable short-term to medium-term results have been obtained.
Evaluation of Postoperative Serum MACC1 in the Prognosis of Laparoscopic Complete Mesocolic Excision for Colon Cancer
Authors: Zhang Ming , Wang Qinghua , Wang Weiping
Published: July 2020

Background:

To investigate the correlation between postoperative serum metastasis-associated in colon cancer-1 (MACC1) and prognosis of colon cancer patients after laparoscopic complete mesocolic excision (CME).

Materials and Methods:

A total of 280 colon cancer patients undergoing laparoscopic CME were included. The 40-month disease-free survival, progression-free survival, and overall survival were calculated.

Results:

Immunohistochemical staining, western blotting, and quantitative real-time polymerase chain reaction results showed that the MACC1 expression in cancer tissues was significantly higher than adjacent tissues (P<0.05). Compared with the small interfering RNA-negative control group, the tumor weight, tumor volume, and tumor number were all significantly decreased after treatment with small interfering RNA-MACC1 (P<0.05). Survival analysis showed that compared with the low MACC1 group, the disease-free survival (χ2=30.095, P<0.001), progression-free survival (χ2=50.027, P<0.001), and overall survival (χ2=53.861, P<0.001) in the high MACC1 group all decreased significantly.

Conclusion:

Postoperative serum MACC1 has a potential value for evaluating the prognosis of patients undergoing laparoscopic CME.
Deaths following withdrawal of life-sustaining therapy: Opportunities for quality improvement?
Authors: Guttman Matthew P. , Tillmann Bourke W. , Haas Barbara , Nathens Avery B.
Published: July 2020

BACKGROUND

Mortality is an important trauma center outcome. With many patients initially surviving catastrophic injuries and a growing proportion of geriatric patients, many deaths might occur following withdrawal of life-sustaining therapy (WLST). We utilized the American College of Surgeons Trauma Quality Improvement Program database to explore whether deaths following WLST might be preventable and to evaluate the impact of excluding patients who died following WLST on hospital performance.

METHODS

A retrospective cohort study was conducted using data derived from American College of Surgeons Trauma Quality Improvement Program. Adult trauma patients treated at Levels I and II centers in 2016 were included. Three cohorts of deceased patients were created to assess differences in hospital performance. The first included all deaths, the second included only those who died without WLST, and the third included deaths without WLST and deaths with WLST where death was preceded by a major complication. Hospitals were ranked based on their observed-to-expected mortality ratio calculated using each of the three decedent cohorts. Outcomes included absolute change in hospital ranking and change in performance outlier status between cohorts.

RESULTS

We identified 275,939 patients treated at 447 centers who met inclusion criteria. Overall mortality was 6.9% (n = 19,145). Withdrawal of life-sustaining therapy preceded 43.6% (n = 8,343) of deaths and 23% (n = 1,920) of these patients experienced a major complication before death. The median absolute change in hospital performance rank between the first and second cohort was 58 (p < 0.001), between the first and third cohort was 44 (p < 0.001), and between the second and third cohort was 23 (p < 0.001). Hospital performance outlier status changed significantly between cohorts.

CONCLUSION

The exclusion of patients who die following WLST from benchmarking efforts leads to a major change in hospital ranks. Potentially preventable deaths, such as those following a major complication, should not be excluded.

LEVEL OF EVIDENCE

Epidemiological study, level III.
Kidney Dyads: Caregiver Burden and Relationship Strain Among Partners of Dialysis and Transplant Patients
Authors: Van Pilsum Rasmussen Sarah E. , Eno Ann , Bowring Mary G. , Lifshitz Romi , Garonzik-Wang Jacqueline M. , Al Ammary Fawaz , Brennan Daniel C. , Massie Allan B. , Segev Dorry L. , Henderson Macey L.
Published: July 2020

Background.

Caring for dialysis patients is difficult, and this burden often falls on a spouse or cohabiting partner (henceforth referred to as caregiver-partners). At the same time, these caregiver-partners often come forward as potential living kidney donors for their loved ones who are on dialysis (henceforth referred to as patient-partners). Caregiver-partners may experience tangible benefits to their well-being when their patient-partner undergoes transplantation, yet this is seldom formally considered when evaluating caregiver-partners as potential donors.

Methods.

To quantify these potential benefits, we surveyed caregiver-partners of dialysis patients and kidney transplant (KT) recipients (N = 99) at KT evaluation or post-KT. Using validated tools, we assessed relationship satisfaction and caregiver burden before or after their patient-partner’s dialysis initiation and before or after their patient-partner’s KT.

Results.

Caregiver-partners reported increases in specific measures of caregiver burden (P = 0.03) and stress (P = 0.01) and decreases in social life (P = 0.02) and sexual relations (P < 0.01) after their patient-partner initiated dialysis. However, after their patient-partner underwent KT, caregiver-partners reported improvements in specific measures of caregiver burden (P = 0.03), personal time (P < 0.01), social life (P = 0.01), stress (P = 0.02), sexual relations (P < 0.01), and overall quality of life (P = 0.03). These improvements were of sufficient impact that caregiver-partners reported similar levels of caregiver burden after their patient-partner’s KT as before their patient-partner initiated dialysis (P = 0.3).

Conclusions.

These benefits in caregiver burden and relationship quality support special consideration for spouses and partners in risk-assessment of potential kidney donors, particularly those with risk profiles slightly exceeding center thresholds.
Trends in Living Donation by Race and Ethnicity Among Children With End-stage Renal Disease in the United States, 1995–2015
Authors: Amaral Sandra , McCulloch Charles E. , Black Elizabeth , Winnicki Erica , Lee Brian , Roll Garret R. , Grimes Barbara , Ku Elaine
Published: July 2020

Background.

Living donor kidney transplants have declined among adults with end-stage renal disease (ESRD), with increases in racial/ethnic disparities over time. Secular trends in racial/ethnic disparities in living donor kidney transplantation have not been well studied in children.

Methods.

Using multivariable Cox modeling, we examined changes in living donor kidney transplant rates over time and probability of receiving living donor kidney transplantation within 2 years of incident ESRD by race/ethnicity among 19 772 children in the US Renal Data System, 1995–2015. We also examined racial/ethnic concordance between donors and recipients.

Results.

Overall, living donor kidney transplant rates declined by 3% annually since 1995 for all racial/ethnic groups except Asians for whom living donor kidney transplant rates remained stable; however, disparities persist. Compared with non-Hispanic white children, Hispanics were 42% less likely (adjusted hazard ratio: 0.58; 95% confidence interval: 0.49-0.67), Asians 39% less likely (0.61; 0.47-0.79), and blacks 66% less likely (0.34; 0.28-0.42) to receive living kidney donor transplantation within 2 years, even when accounting for deceased donor transplantation as a competing risk. Additionally, while 95% of non-Hispanic white children had non-Hispanic white donors, only 56% of Asian recipients had Asian donors (P < 0.001). Asian recipients were more likely to have nonrelated donors (P < 0.001).

Conclusions.

There are ongoing declines in living donation for children with ESRD for uncertain reasons, and minority populations experience significantly reduced access to timely living donor transplant, even when accounting for changes in deceased donation and donor-recipient relationships.