bluuebunny/crossref_metadata_2025 huggingface dataset:
#22: Clinical Significance of Human Herpes Virus 6 Positivity in Children
Authors: Kinler Zachary K , Inagaki Kengo , Galloway Regina , Palmer April L , Santos Roberto P
Published: June 2021

Background

Human Herpes Virus 6 (HHV6) is a common childhood disease that is typically mild, however, cases where it is the causative agent of meningitis/encephalitis (ME) have been reported. The treatment for HHV6 ME consists of ganciclovir, which is associated with bone marrow suppression and renal insufficiency. While the clinical significance of the presence of HHV6 in cerebrospinal fluid (CSF) in adults has been studied, there is a paucity of research on the clinical significance of HHV6 in the CSF of children with ME. We want to determine if there is clinical significance to HHV6 positivity in the CSF of children.

Methods

20 patients were included whose CSF tested positive for HHV6 on the CSF ME panel from Jan 1, 2017 to May 20, 2020. We obtained a sample of 80 patients whose CSF tested negative for every pathogen on the same CSF ME panel from the same period. Logistic regression was used based on age, sex, race/ethnicity, admission to neonatal intensive care unit (NICU)/pediatric intensive care unit (PICU), clinical presentation, and presence of abnormalities on neuroimaging to determine the propensity score matching (PSM) for each patient. (Table I) The HHV6 positive patients were matched with patients who tested negative for every pathogen on the panel at a 1:1 ratio and within a caliper size of 0.25. The odds ratio (OR) of neurological sequelae at discharge was determined by performing a logistic regression based on HHV6 status in both the group with PSM and without PSM. The length of stay between the HHV6 positive group and the control group were compared with and without PSM using Mann-Whitney U test with p<0.05 considered significant

Results

The OR for HHV6 positivity and experiencing neurological sequelae is 1.35 with a 95% confidence interval (CI) 0.133,13.721 (p=0.799) when compared to the control group without PSM. The OR for HHV6 positivity and experiencing neurological sequelae is 1 with a 95% CI 0.063, 15.988 (p=0.549) when compared to the control group with PSM. Table I shows the neurological sequelae between the HHV6 positive group, control group without PSM and the control group with PSM. It shows the Mann-Whitney U test comparing HHV6 status to the median length of hospital stay in both unmatched- and matched cohorts. We failed to reject the null hypothesis that there was a difference in the median length of hospital stay between HHV6 positive patients and all negative patients with and without PSM.

Conclusion

There is no clinical significance of HHV6 detection on the CSF ME panel in children as well as no statistical significance between the median length of hospital stay among HHV6 positive patients and all negative patients. Further, 10% of the HHV6 positive patients were inappropriately started on ganciclovir. Development of a consensus statement is in place regarding releasing the result of a positive HHV6 from the ME panel only among immunocompromised children to prevent inappropriate antiviral therapy.
#33: Single-cell RNA sequencing analysis of Zika virus infection in human stem cell-derived neuroprogenitor cells and cerebral organoids
Authors: Ocwieja K E , Hughes T K , Baker C C M , Stanton A C , Antonucci J M , Richards A L , Shalek A , Jaenisch R , Gehrke L
Published: June 2021

Background

The molecular mechanisms underpinning the neurologic and congenital pathologies caused by Zika virus (ZIKV) infection remain poorly understood. It is also unclear why congenital ZIKV disease was not reported prior to the recent epidemics in French Polynesia and the Americas, despite evidence that Zika virus has actively circulated in parts of Africa and Asia since 1947 and 1966, respectively.

Methods

Due to advances in the stem cell-based technologies, we can now model ZIKV infections of the central nervous system in human stem cell-derived neural progenitor cells and cerebral organoids, which recapitulate complex 3-dimensional neural architecture. We apply Seq-Well — a simple, portable platform for massively parallel single-cell RNA sequencing — to characterize these neural models infected with ZIKV. We detect and quantify host mRNA transcripts and viral RNA with single-cell resolution, thereby defining transcriptional features of both uninfected and infected cells.

Results

Although flavivirus RNAs lack a poly(A) tail, we present evidence that viral RNAs are specifically primed for reverse transcription at internal runs of adenosines, and that sequencing reads cover the entire non-polyadenylated viral genome. In neural progenitor cells, single cell sequencing reveals that while uninfected bystander cells strongly upregulate interferon pathway genes, these pathways are largely suppressed in cells infected with ZIKV within the same culture dish. Single cell sequencing identifies multiple cell types in our cerebral organoids including neural progenitor cells, intermediate progenitor cells, and neurons of varied maturity. Using this model, we find that neurons, not typically considered targets of ZIKV in the developing brain, contain high copy numbers of ZIKV genomes. It remains uncertain whether neurons are directly infected, or if infected neural progenitor cells differentiate into neurons, carrying virus with them. Notably, the neuronal bystander cell population shows limited interferon gene pathway upregulation compared to neural progenitors.

Conclusions

Overall, our work provides insight into the pathogenesis of ZIKV associated microcephaly, identifies potential new tropisms of ZIKV in the human brain, and suggests that both virus replication and host response mechanisms underlie the neuropathology of ZIKV infection.
#39: An 11-year Review of Lactobacillus Bacteremia at a Pediatric Tertiary Care Center
Authors: Hefter Yosefa , Powell Lauren , Tabulov Christine , Danan Eleanor , Campos Joseph , Hanisch Benjamin
Published: June 2021

Background

Probiotics are used frequently in the pediatric population for treatment of diarrhea and promotion of gastrointestinal health. Lactobacillus is the most commonly used bacterial genus in probiotic formulations. Lactobacillus spp. has been a reported cause of bacteremia, particularly in immunocompromised populations and individuals with impaired gut integrity. To assess the risks and benefits of inpatient probiotic use in a pediatric tertiary care center, we aimed to identify the occurrence of Lactobacillus bacteremia among hospitalized patients and its association with probiotic use over an eleven-year period.

Methods

Cases of Lactobacillus bacteremia were identified through a search of positive blood culture reports from January 1st, 2010 through December 31st, 2020. The clinical chart for each case was independently reviewed for the following risk factors: documented probiotic uses, presence of a central venous catheter, immunocompromising condition or immunosuppressive agent, neutropenia, impaired intestinal function and age below 3 months. Additionally, we reviewed the clinical presentation including presence of fever, need for intensive care and gastrointestinal symptoms. Total inpatient probiotic administration was assessed over the same time period.

Results

Eight cases of Lactobacillus bacteremia were identified in inpatients during the study time period. Two cases had received probiotics in the hospital and a third case had documented outpatient administration of probiotics prior to development of bacteremia. The remaining five cases had no documented probiotic use. All 8 cases were febrile at the time of bacteremia. No patients required blood pressure support medications. Five cases had underlying impaired intestinal function. One case was in an oncology patient and there were no cases in solid organ or bone marrow transplant patients. Two cases, including the oncology patient and one patient with impaired intestinal function, were neutropenic at the time of bacteremia. All but one case, had a central line in place. All cases were treated with antibiotics and had resolution of bacteremia and associated symptoms. Probiotics were administered to 4,478 inpatients during the study period.

Conclusions

Lactobacillus bacteremia is uncommon and occurred in under 0.2% of patients who received probiotics during an inpatient admission. Nevertheless, all eight observed cases were symptomatic and received antibiotic therapy. Additionally, cases were most commonly seen in individuals with underlying impaired intestinal function. These considerations must be weighed in decisions regarding the risks and benefits of probiotic administration in the hospital.
#40: Does Cytomegalovirus (CMV) Viral Load Correlate with Disease Severity in the Setting of Congenital CMV (cCMV) Infection? Results from a Universal cCMV Screening Study
Authors: Kruc R , Osterholm E A , Hernandez-Alvarado N , Rosendahl S , McCann M , Sidebottom A , Amin M , Lanzieri T , Dollard S , Schleiss M R
Published: June 2021

Background

Consideration is being given to universal newborn screening for congenital CMV (cCMV). Early detection could improve neurodevelopmental and audiologic outcomes. For some viral infections, viral load is a biomarker predicting disease severity and directs the use of antiviral agents. cCMV is the most common congenital infection in the United States; its estimated prevalence is 4.5 per 1,000 live births. Since optimal screening strategies are not completely understood, this analysis was conducted to assess whether viral load at birth could stand as a biomarker of CMV symptomatology.

Methods

Newborn screening for cCMV was undertaken at five Twin Cities nurseries. Real-time PCR was performed on dried saliva swabs. Dried blood spot (DBS) PCR was performed independently by the UMN and CDC labs. Infections were categorized as: 1) moderately to severely symptomatic; 2) mildly symptomatic; 3) asymptomatic with isolated sensorineural hearing loss (SNHL); and 4) asymptomatic. Viral load analyses were conducted using Prism software.

Results

Among 16,092 newborns screened for cCMV, 72 cCMV cases were identified (prevalence of 0.44%). The sensitivity and specificity of CMV PCR were 92.9 and 99.9% for saliva, and 85.7 and 100% for DBS, respectively. 83% (60/72) of infants cCMV were classified as asymptomatic; the remaining 17% as symptomatic. In the DBS, a significant difference between viral loads in the symptomatic and asymptomatic groups was not seen (p=0.83; Mann-Whitney, Figure 1). However, in the saliva, a significant difference was seen. Mean saliva viral load in infants with confirmed cCMV and any symptomatic disease was 3.2×103 IU/ml, versus 7×106 IU/ml in asymptomatic infants (p<0.05, Mann-Whitney; Figure 1).

Conclusions

The prevalence of cCMV in the Twin Cities is approximately 0.5%; most infants are asymptomatic at birth. Surprisingly, an inverse relationship was observed between viral load at birth in the saliva samples and severity of CMV sequelae. This may be because maternal infection earlier during pregnancy has been correlated with more severe sequelae, but also induces a fetal immune response that limits viral replication. Hence, viral load at birth may be higher with asymptomatic infections that occur later in the pregnancy.
#5: Trends in Seasonal Prevalence of Respiratory Pathogens Among Children in the United Arab Emirates: A Multi-Center Study.
Authors: Salim Sara , Celiloglu Handan , Tayyab Farah , Malik Zainab A
Published: June 2021

Background

Pediatric respiratory infections cause a high disease burden globally. Their seasonality and molecular epidemiology in the United Arab Emirates (UAE) are not well understood. This data is important for clinical practice, to monitor disease outbreaks and optimize vaccination for influenza and RSV prophylaxis in high risk infants and children. Our objective was to describe the seasonality and molecular epidemiology of respiratory pathogens during a full calendar year among children in Dubai, UAE.

Methods

Children 0–18 years of age who presented to multiple hospitals and clinics within a large private healthcare group in Dubai between January 1st and December 31st, 2019, and had upper respiratory samples positive for any pathogen on multiplex polymerase chain reaction (mPCR) were included in this retrospective analysis. Sociodemographic, clinical, and molecular data were collected.

Results

Two thousand four hundred and twenty-seven children had mPCR sample positive for at least one pathogen. The median age of our population was 39 months, and 56.8% were male. Emergency room was the most common site (32.3%) of sample collection and the vast majority presented with fever (85.7%). Rhinovirus/enterovirus was the most common infection (45%) and peaked in September; followed by respiratory syncytial virus (RSV) (17.1%) which peaked in October; and adenovirus (15.6%) which peaked in June. The latter accounted for 43% of hospitalizations in our study (p<0.05). Viral co-infections, most commonly human rhinovirus/enterovirus and RSV, were seen in 22.1% of children. Other infections occurred in 34.1% of children comprising mainly of streptococcal pharyngitis.

Conclusions

RSV is a common viral pathogen in the UAE, and the RSV season begins earlier than reported in other countries regionally. RSV prophylaxis in high risk infants should be considered in August to provide maximal protection.

Adeno – Adenovirus; Corona – Coronavirus; hMPV – Human Metapneumovirus; Influ A – Influenza A; Influ B – Influenza B; Rhino/Entero – Human rhinovirus/Enterovirus; Para – Parainfluenza virus; RSV – Respiratory Syncytial Virus; Mycoplasma – Mycoplasma pneumoniae; Bordatella para – Bordatella parapertussis; Bordatella Per – Bordatella pertussis; Chlamydia – Chlamydia pneumoniae.
A Simplified Protocol for Microsatellite Instability Evaluation in Iranian Patients at Risk for Lynch Syndrome
Authors: Abdollahi Zeinab , Tabatabaiefar Mohammad Amin , Noruzi Mahnaz , Miar Paniz , Kazemi Mohammad , Naimi Azar , Emami Mohammad Hasan , Zeinalian Mehrdad
Published: June 2021

Objective

The most important tumor characteristic of Lynch syndrome (LS) is microsatellite instability (MSI). In the current study, BAT34c4 and BAT26 mononucleotide markers were evaluated as part of efforts to test a cost-effective panel for MSI testing in Iranian patients, comparing it with the Promega kit.

Methods

Amsterdam II clinical criteria were used to identify patients at risk for LS. The MSI status of these patients was determined using BAT34c4 and BAT26 markers, as well as the Promega kit. The results of both methods were compared, and the sensitivity and specificity of new short tandem repeat (STR) markers were estimated using statistical formulas.

Results

Of the 37 patients we studied who were at risk for LS, 27% showed MSI-high results, via the Promega kit. The same results were achieved for BAT34c4 and BAT26 separately.

Conclusions

The novel 2-marker kit for MSI testing has similar accuracy as the Promega kit at a lower cost, due to fewer markers and a more economical labeling method.
The Polish Rider: CH Alexandrowicz and the reorientation of international law, Part II: declension and the promise of renewal
Authors: Landauer Carl
Published: June 2021

This article is the second of a two-part analysis of the work of the international legal historian, CH Alexandrowicz. Part II analyses Alexandrowicz’s narrative of the decline of international law represented by 19th-century positivism and the scramble for African territory, where legal principles such as the protectorate became mere tools for acquisition, and treaties bereft of obligation. It traces his sympathy for the post-independence ‘new states’, his hope for the renewal of international law, the Romantic narrative imbuing his secular, modernist eschatology, and his continuing engagement with Indian Constitutional development.
A life in human rights: a conversation with Dennis Davis
Authors: Krever Tor
Published: June 2021

Dennis Davis is Judge of the High Court of South Africa, Judge President of the Competition Appeal Court, and Honorary Professor of Law at the University of Cape Town. In this wide-ranging conversation with Tor Krever, he reflects on his political and intellectual trajectory—from early encounters with Marx to anti-apartheid activism to a leading position in the South African judiciary—and his lifelong commitment to a radical left politics.
Handwashing and Changing the Status Quo
Authors: Bryan Craig J.
Published: June 2021

This chapter focuses on the mental healthcare system, which has been surprisingly slow to adopt the treatments and interventions that are most likely to reduce the probability that someone will attempt suicide. In many respects, the current state of mental health treatment to prevent suicidal behaviors mirrors the context of the 19th century. Two hundred years ago, the causes of puerperal fever among women giving birth were unknown to the medical community, but evidence from multiple different sources suggested that handwashing could reduce fever-related deaths much better than status quo practices. Today, the causes of suicide are similarly unknown, but evidence from multiple sources suggests that certain types of treatments and interventions can reduce suicidal behaviors better than status quo practices, which often conceptualize suicide as a symptom or outcome of mental illness. The chapter then looks at two treatments in particular: dialectical behavior therapy (DBT) and cognitive behavioral therapy for suicide prevention (CBT-SP). It assesses why suicide-focused treatments work better than status quo treatments.
Biographical context
Authors: Duschinsky Robbie , Foster Sarah
Published: June 2021

Fonagy has urged acknowledgement that ‘behind the shifts in theories, techniques, and application are individuals whose sense of identity and ways of viewing the world have profoundly altered’. This chapter offers three biographical snapshots, selected for their relevance for understanding the trajectory of Fonagy’s thinking, and the shift in psychological theory represented by the introduction of the concept of mentalization. The first will be Peter Fonagy’s experiences in the Fónagy household as a child in the 1950s. The second will be his psychoanalysis as a young man with Anne Hurry in the 1970s. Finally, close attention will be paid to Fonagy’s work with one of his early patients.
Work at the Anna Freud Centre
Authors: Duschinsky Robbie , Foster Sarah
Published: June 2021

This chapter will place Fonagy’s work in institutional context, exploring his work as research director for the Anna Freud Centre in the 1990s, and attempting to characterize some features of his leadership of the Anna Freud Centre since 2003. The Centre has seen an incredible transformation in this time. We will seek to situate this transformation in relation to the challenges and opportunities of the wider social context. The chapter will close with an attempt to introduce some of the major collaborations from different eras of Fonagy’s work, introducing the dramatis personae for the rest of the book.
Was it all worth it? The consequences of parental migration decisions for the life satisfaction of their descendants
Authors: Stache Randy , Röder Antje
Published: June 2021

Does migration pay off for subsequent generations? This article applies a counterfactual logic (‘what if the parents had not migrated?’) to compare the life satisfaction of descendants of Turkish guest workers in Western Europe and return migrants with that of Turks without a migration history in the family. Using data from the 2000 Families Study, we test a theoretical model that aims to explain differences along three dimensions: personal resources, social position, and normative settings. Results show that only permanent migration was successful in terms of higher life satisfaction for descendants, as offspring of return migrants do not differ from those without a migration history in the family. The higher life satisfaction of subsequent generations in Europe is largely due to access to higher resources obtained through migration, and persists despite barriers such as a lower relative socioeconomic position and experiences of discrimination. While religiosity appears to only play a minor role in explaining differences, there is evidence that descendants whose lifestyle deviates from the normative expectations of the country-of-origin benefit in particular from the migration of their parents.
Preoperative imaging of glioblastoma patients using hyperpolarized 13C pyruvate: Potential role in clinical decision making
Authors: Chen Jun , Patel Toral R , Pinho Marco C , Choi Changho , Harrison Crystal E , Baxter Jeannie D , Derner Kelley , Pena Salvador , Liticker Jeff , Raza Jaffar , Hall Ronald G , Reed Galen D , Cai Chunyu , Hatanpaa Kimmo J , Bankson James A , Bachoo Robert M , Malloy Craig R , Mickey Bruce E , Park Jae Mo
Published: June 2021

Background

Glioblastoma remains incurable despite treatment with surgery, radiation therapy, and cytotoxic chemotherapy, prompting the search for a metabolic pathway unique to glioblastoma cells.13C MR spectroscopic imaging with hyperpolarized pyruvate can demonstrate alterations in pyruvate metabolism in these tumors.

Methods

Three patients with diagnostic MRI suggestive of a glioblastoma were scanned at 3 T 1–2 days prior to tumor resection using a 13C/1H dual-frequency RF coil and a 13C/1H-integrated MR protocol, which consists of a series of 1H MR sequences (T2 FLAIR, arterial spin labeling and contrast-enhanced [CE] T1) and 13C spectroscopic imaging with hyperpolarized [1-13C]pyruvate. Dynamic spiral chemical shift imaging was used for 13C data acquisition. Surgical navigation was used to correlate the locations of tissue samples submitted for histology with the changes seen on the diagnostic MR scans and the 13C spectroscopic images.

Results

Each tumor was histologically confirmed to be a WHO grade IV glioblastoma with isocitrate dehydrogenase wild type. Total hyperpolarized 13C signals detected near the tumor mass reflected altered tissue perfusion near the tumor. For each tumor, a hyperintense [1-13C]lactate signal was detected both within CE and T2-FLAIR regions on the 1H diagnostic images (P = .008). [13C]bicarbonate signal was maintained or decreased in the lesion but the observation was not significant (P = .3).

Conclusions

Prior to surgical resection, 13C MR spectroscopic imaging with hyperpolarized pyruvate reveals increased lactate production in regions of histologically confirmed glioblastoma.
Physiological Role of Aerobic Fermentation Constitutively Expressed in an Aluminum-Tolerant Cell Line of Tobacco (Nicotiana tabacum)
Authors: Tsuchiya Yoshiyuki , Nakamura Takuji , Izumi Yohei , Okazaki Keiki , Shinano Takuro , Kubo Yasutaka , Katsuhara Maki , Sasaki Takayuki , Yamamoto Yoko
Published: June 2021

Aluminum (Al)-tolerant tobacco cell line ALT301 derived from SL (wild-type) hardly exhibits Al-triggered reactive oxygen species (ROS) compared with SL. Molecular mechanism leading to this phenotype was investigated comparatively with SL. Under normal growth condition, metabolome data suggested the activation of glycolysis and lactate fermentation but the repression of the tricarboxylic acid (TCA) cycle in ALT301, namely aerobic fermentation, which seemed to be transcriptionally controlled partly by higher expression of genes encoding lactate dehydrogenase and pyruvate dehydrogenase kinase. Microarray and gene ontology analyses revealed the upregulation of the gene encoding related to APETALA2.3 (RAP2.3)-like protein, one of the group VII ethylene response factors (ERFVIIs), in ALT301. ERFVII transcription factors are known to be key regulators for hypoxia response that promotes substrate-level ATP production by glycolysis and fermentation. ERFVIIs are degraded under normoxia by the N-end rule pathway of proteolysis depending on both oxygen and nitric oxide (NO), and NO is produced mainly by nitrate reductase (NR) in plants. In ALT301, levels of the NR gene expression (NIA2), NR activity and NO production were all lower compared with SL. Consistently, the known effects of NO on respiratory pathways were also repressed in ALT301. Under Al-treatment condition, NO level increased in both lines but was lower in ALT301. These results suggest that the upregulation of the RAP2.3-like gene and the downregulation of the NIA2 gene and resultant NO depletion in ALT301 coordinately enhance aerobic fermentation, which seems to be related to a higher capacity to prevent ROS production in mitochondria under Al stress.
Hepatitis B and C prevalence in waste pickers: a global meta-analysis
Authors: Souza-Silva Gabriel , Zolnikov Tara Rava , Ortolani Paula Ladeira , Cruvinel Vanessa Resende Nogueira , Dias Sonia Maria , Mol Marcos Paulo Gomes
Published: June 2021

Background

The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide.

Methods

Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney’s criteria, and evaluated for quality and bias verified with a funnel plot.

Results

After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10–0.20), and hepatitis C was 0.08 (95% CI 0.04–0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates.

Conclusion

The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers.
From Immigrants to Americans: Race and Assimilation during the Great Migration
Authors: Fouka Vasiliki , Mazumder Soumyajit , Tabellini Marco
Published: June 2021

How does the arrival of a new minority group affect the social acceptance and outcomes of existing minorities? We study this question in the context of the First Great Migration. Between 1915 and 1930, 1.5 million African Americans moved from the U.S. South to Northern urban centres, which were home to millions of European immigrants arrived in previous decades. We formalize and empirically test the hypothesis that the inflows of Black Americans changed perceptions of outgroup distance among native-born whites, reducing the barriers to the social integration of European immigrants. Predicting Black in-migration with a version of the shift-share instrument, we find that immigrants living in areas that received more Black migrants experienced higher assimilation along a range of outcomes, such as naturalization rates and intermarriages with native-born spouses. Evidence from the historical press and patterns of heterogeneity across immigrant nationalities provide additional support to the role of shifting perceptions of the white majority.
Defining Coalescent Genes: Theory Meets Practice in Organelle Phylogenomics
Authors: Doyle Jeff J
Published: June 2021

The species tree paradigm that dominates current molecular systematic practice infers species trees from collections of sequences under assumptions of the multispecies coalescent (MSC), that is, that there is free recombination between the sequences and no (or very low) recombination within them. These coalescent genes (c-genes) are thus defined in an historical rather than molecular sense and can in theory be as large as an entire genome or as small as a single nucleotide. A debate about how to define c-genes centers on the contention that nuclear gene sequences used in many coalescent analyses undergo too much recombination, such that their introns comprise multiple c-genes, violating a key assumption of the MSC. Recently a similar argument has been made for the genes of plastid (e.g., chloroplast) and mitochondrial genomes, which for the last 30 or more years have been considered to represent a single c-gene for the purposes of phylogeny reconstruction because they are nonrecombining in an historical sense. Consequently, it has been suggested that these genomes should be analyzed using coalescent methods that treat their genes—over 70 protein-coding genes in the case of most plastid genomes (plastomes)—as independent estimates of species phylogeny, in contrast to the usual practice of concatenation, which is appropriate for generating gene trees. However, although recombination certainly occurs in the plastome, as has been recognized since the 1970’s, it is unlikely to be phylogenetically relevant. This is because such historically effective recombination can only occur when plastomes with incongruent histories are brought together in the same plastid. However, plastids sort rapidly into different cell lineages and rarely fuse. Thus, because of plastid biology, the plastome is a more canonical c-gene than is the average multi-intron mammalian nuclear gene. The plastome should thus continue to be treated as a single estimate of the underlying species phylogeny, as should the mitochondrial genome. The implications of this long-held insight of molecular systematics for studies in the phylogenomic era are explored. [c-gene; coalescent gene; concatalescence; organelle genome; plastome; recombination; species tree.]
Neural Dynamics of Inhibitory Control in Musicians with Absolute Pitch: Theta Synchrony as an Oscillatory Signature of Information Conflict
Authors: Sharma Vivek V , Thaut Michael , Russo Frank A , Alain Claude
Published: June 2021

Absolute pitch (AP) is the ability to identify an auditory pitch without prior context. Current theories posit AP involves automatic retrieval of referents. We tested interference in well-matched AP musicians, non-AP musicians, and nonmusicians with three auditory Stroop tasks. Stimuli were one of two sung pitches with congruent or incongruent verbal cues. The tasks used different lexicons: binary concrete adjectives (i.e., words: Low/High), syllables with no obvious semantic properties (i.e., solmization: Do/So), and abstract semiotic labels (i.e., orthographic: C/G). Participants were instructed to respond to pitch regardless of verbal information during electroencephalographic recording. Incongruent stimuli of words and solmization tasks increased errors and slowed response times (RTs), which was reversed in nonmusicians for the orthographic task. AP musicians made virtually no errors, but their RTs slowed for incongruent stimuli. Frontal theta (4–7 Hz) event-related synchrony was significantly enhanced during incongruence between 350 and 550 ms poststimulus onset in AP, regardless of lexicon or behavior. This effect was found in non-AP musicians and nonmusicians for word task, while orthographic task showed a reverse theta congruency effect. Findings suggest theta synchrony indexes conflict detection in AP. High beta (21–29 Hz) desynchrony indexes response conflict detection in non-AP musicians. Alpha (8–12 Hz) synchrony may reflect top-down attention.
Oral melatonin as part of multimodal anxiolysis decreases emergence delirium in children whereas midazolam does not
Authors: Singla Lily , Mathew Preethy J. , Jain Aditi , Yaddanapudi Sandhya , Peters Nitin J.
Published: June 2021

BACKGROUND

Pre-operative anxiety is a risk factor for emergence delirium in children and a multimodal approach including sedatives and nonpharmacological measures is the current strategy to tackle this anxiety. The efficacy of oral melatonin as a component of multimodal anxiolytic strategy to decrease emergence delirium is not well studied.

OBJECTIVE

The aim of this study was to evaluate the efficacy of a multimodal anxiolytic strategy including oral melatonin or midazolam to decrease emergence delirium after sevoflurane anaesthesia.

DESIGN

A randomised, double-blind, parallel arm, placebo-controlled trial.

SETTING

Tertiary care teaching hospital from July 2019 till January 2020.

PARTICIPANTS

Children in the age group of 3 to 8 years who received sevoflurane anaesthesia for elective ambulatory procedures.

INTERVENTIONS

Children were randomised to receive oral premedication with either melatonin 0.3 mg kg−1, midazolam 0.3 mg kg−1 or honey as placebo. All the children received standardised nonpharmacological measures involving multiple techniques to allay anxiety. The anaesthetic plan was also standardised.

MAIN OUTCOME MEASURES

The primary outcome was the incidence of emergence delirium as assessed by the Watcha scale in the postanaesthesia care unit. The secondary outcomes were pre-operative anxiety assessed using a modified Yale Preoperative Anxiety scale, patient compliance with mask induction using the Induction Compliance Checklist and postoperative sedation.

RESULTS

Data from 132 children were analysed. Melatonin significantly reduced the incidence of emergence delirium compared to placebo: 27 vs. 50%, respectively, an absolute risk reduction of 23.3 [95% confidence interval 3.7 to 42.9), P = 0.03]. Melatonin also significantly reduced the risk of emergence delirium compared with midazolam: 27 vs. 56%, respectively, an absolute risk reduction of 29.2 (95% CI 9.5 to 48.8). The midazolam group had a similar incidence of emergence delirium as placebo. Sedation scores were similar in the three groups postoperatively. The incidence and score of pre-operative anxiety as well as the compliance with mask induction were similar in the three groups.

CONCLUSIONS

A multimodal anxiolytic approach including oral melatonin, as opposed to oral midazolam, significantly reduced emergence delirium after sevoflurane anaesthesia.

TRIAL REGISTRATION

CTRI/2019/06/019850 in Clinical Trial Registry of India (www.ctri.nic.in)
Evidence-Based Nutritional Interventions in Wound Care
Authors: Saeg Fouad , Orazi Rita , Bowers Gerald M. , Janis Jeffrey E.
Published: June 2021

Background:

The role of nutritional intervention in wound care has been a topic of controversy. Although the efficacy of macronutrient supplementation has been well described, there is a paucity of evidence and no official recommendation regarding the use of vitamins and minerals to optimize wound healing. This is the first review of vitamin and mineral wound intervention that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence by wound type.

Methods:

In this comprehensive review, the authors outline the nutrients and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize nutrient effectiveness, and propose evidence-based conclusions to improve wound healing outcomes and enhance the consistency of nutritional intervention in wound care.

Results:

Thirty-six studies with a combined total of 2339 patients investigated the use of oral, topical, or intravenous vitamin and/or mineral supplementation for treatment of the following wound types: burn wounds (n = 3), pressure ulcers (n = 7), diabetic ulcers (n = 4), venous ulcers (n = 7), digital ulcers (n = 1), skin incisions (n = 9), hypertrophic scars (n = 4), and sinonasal wounds (n = 1). Improved outcomes were reported in patients with burn wounds receiving vitamins A, B1, B6, B12, D, and E and zinc, calcium, copper, magnesium, selenium, and zinc; patients with pressure ulcers receiving vitamin C and zinc; patients with diabetic ulcers receiving vitamin A, B9, D, and E; patients with venous ulcers receiving zinc; and patients with hypertrophic scars receiving vitamin E.

Conclusions:

Based on the high-level data provided in this review, the use of specific nutritional interventions may improve the outcome of certain wound types. Further investigation is warranted to draw definitive conclusions.
Advanced Three-Dimensional Technologies in Craniofacial Reconstruction
Authors: Day Kristopher M. , Kelley Patrick K. , Harshbarger Raymond J. , Dorafshar Amir H. , Kumar Anand R. , Steinbacher Derek M. , Patel Pravin , Combs Patrick D. , Levine Jamie P.
Published: June 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Describe the evolution of three-dimensional computer-aided reconstruction and its current applications in craniofacial surgery. 2. Recapitulate virtual surgical planning, or computer-assisted surgical simulation, workflow in craniofacial surgery. 3. Summarize the principles of computer-aided design techniques, such as mirror-imaging and postoperative verification of results. 4. Report the capabilities of computer-aided manufacturing, such as rapid prototyping of three-dimensional models and patient-specific custom implants. 5. Evaluate the advantages and disadvantages of using three-dimensional technology in craniofacial surgery. 6. Critique evidence on advanced three-dimensional technology in craniofacial surgery and identify opportunities for future investigation.

Increasingly used in craniofacial surgery, virtual surgical planning is applied to analyze and simulate surgical interventions. Computer-aided design and manufacturing generates models, cutting guides, and custom implants for use in craniofacial surgery. Three-dimensional computer-aided reconstruction may improve results, increase safety, enhance efficiency, augment surgical education, and aid surgeons’ ability to execute complex craniofacial operations. Subtopics include image analysis, surgical planning, virtual simulation, custom guides, model or implant generation, and verification of results. Clinical settings for the use of modern three-dimensional technologies include acquired and congenital conditions in both the acute and the elective settings. The aim of these techniques is to achieve superior functional and aesthetic outcomes compared to conventional surgery. Surgeons should understand this evolving technology, its indications, limitations, and future direction to use it optimally for patient care. This article summarizes advanced three-dimensional techniques in craniofacial surgery with cases highlighting clinical concepts.
Neuroimaging in the First 6 Weeks of the COVID-19 Pandemic in an 8-Hospital Campus: Observations and Patterns in the Brain, Head and Neck, and Spine
Authors: Kelsch Ryan D. , Silbergleit Richard , Krishnan Anant
Published: June 2021

Objective

The aim of the study was to aggregate neuroradiological findings in patients with coronavirus disease 2019 (COVID-19) in the brain, head and neck, and spine to identify trends and unique patterns.

Methods

A retrospective review of neuroimaged COVID-19 patients during a 6-week surge in our 8-hospital campus was performed. The brain imaging with reported acute or subacute infarction, intraparenchymal hemorrhage, and all neck examinations were reinterpreted by 2 reviewers.

Results

Six hundred seventy-one patients met criteria and were reviewed. Acute or subacute infarction was seen in 39 (6%), intraparenchymal hemorrhage in 14 (2%), corpus callosum involvement in 7, and thalamus in 5 patients. In spine and neck studies, lung opacities and adenopathy were seen in 46 and 4 patients, respectively.

Conclusions

Infarction followed by intraparenchymal hemorrhage was the most common acute findings in the brain with frequent involvement of the corpus callosum and thalami. In the neck, lung abnormalities were frequently present, and adenopathy was almost always associated with a second pathology.
Value of Quantitative CTTA in Differentiating Malignant From Benign Bosniak III Renal Lesions on CT Images
Authors: Zhang Yuhan , Zhao Ye , Lv Yang , Gu Xinquan
Published: June 2021

Objective

The aim of this study was to investigate whether computed tomography texture analysis can differentiate malignant from benign Bosniak III renal lesions on computed tomography (CT) images.

Methods

This retrospective case-control study included 45 patients/lesions (22 benign and 23 malignant lesions) with Bosniak III renal lesions who underwent CT examination. Axial image slices in the unenhanced phase, corticomedullary phase, and nephrographic phase were selected and delineated manually. Computed tomography texture analysis was performed on each lesion during these 3 phases. Histogram-based, gray-level co-occurrence matrix, and gray-level run-length matrix features were extracted using open-source software and analyzed. In addition, receiver operating characteristic curve was constructed, and the area under the receiver operating characteristic curve (AUC) of each feature was constructed.

Results

Of the 33 extracted features, 16 features showed significant differences (P < 0.05). Eight features were significantly different between the 2 groups after Holm-Bonferroni correction, including 3 histogram-based, 4 gray-level co-occurrence matrix, and 1 gray-level run-length matrix features (P < 0.01). The texture features resulted in the highest AUC of 0.769 ± 0.074. Renal cell carcinomas were labeled with a higher degree of lesion gray-level disorder and lower lesion homogeneity, and a model incorporating the 3 most discriminative features resulted in an AUC of 0.846 ± 0.058.

Conclusions

The results of this study showed that CT texture features were related to malignancy in Bosniak III renal lesions. Computed tomography texture analysis might help in differentiating malignant from benign Bosniak III renal lesions on CT images.
Autologous Fat Grafting as a Stand-alone Method for Immediate Breast Reconstruction After Radical Mastectomy in a Series of 15 Patients
Authors: Fitoussi Alfred , Razzouk Kais , Ahsan Muhammad Danyal , Andrews Gabriala , Rafii Arash
Published: June 2021

Objective

To date, breast reconstruction after mastectomy essentially uses flap- or prosthetic-based surgery. Autologous fat grafting (AFT) largely used in breast conservative surgery is considered an additional technique in breast reconstruction. The aim of this retrospective study was to report our experience of AFT as a stand-alone method for immediate breast reconstruction.

Patients and Methods

Fifteen patients requiring a radical mastectomy underwent AFT for immediate reconstruction since 2014. Previous breast irradiation was not a contraindication. Procedures, complications, and cosmetic results were retrospectively analyzed.

Results

Fifteen patients with an average age of 60.5 (43–78) years were included in this retrospective study. They had a body mass index ranging from 19 to 40. Fourteen had a mastectomy for cancer and 1 for prophylaxis. Nine received breast irradiation (7 before surgery and 2 adjuvant). A mean of 3 (2–6) AFT procedures were required to achieve total breast reconstruction. Except for the first transfer, others were performed as outpatient surgeries. Only 2 minor complications (1 hematoma and 1 abscess) not impairing results were reported. The results after a mean follow-up of 26 months were considered by the patients and surgeon as highly satisfactory even in previously irradiated breast, as assessed using a qualitative scoring analysis.

Conclusions

Autologous fat grafting as a stand-alone method for immediate breast reconstruction after radical mastectomy is a safe procedure with very consistent results even for patients requiring radiation therapy.
Breast Implant-Associated Anaplastic Large Cell Lymphoma With Invasive Chest Wall Masses
Authors: Coombs Demetrius M. , Aliotta Rachel , Jagadeesh Deepa , Raymond Daniel , Isakov Raymond
Published: June 2021

Background

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) might occur in any patient with a history of textured breast devices, and often presents as a spectrum of disease: from a simple late-onset seroma, to complex advanced locally aggressive disease with chest wall involvement. The combination of medical therapy and surgical implant removal with complete capsulectomy is believed to be curative.

Objectives

In patients with advanced cases, however, and although generalized recommendations exist, no consensus exists regarding the ideal medical and surgical management of those presenting with invasive disease.

Methods

This preliminary report describes 2 distinct presentations of rare invasive chest wall BIA-ALCL, both treated successfully, by using a combined medical and surgical multidisciplinary team approach. Subsequently, we discuss considerations and the current literature surrounding the treatment of advanced BIA-ALCL with chest wall and adjacent structure involvement.

Results

All patients necessitated chest wall resection and composite reconstruction due to tumor involvement of the thorax with residual hypermetabolic activity, despite chemotherapeutic pretreatment with different neoadjuvant medical therapies. All healed well after surgery and experienced resolution of symptoms without signs of relapse on regular follow-up.

Conclusions

In the rare subset of patients presenting with invasive BIA-ALCL, the question persists as to which systemic treatment remains optimal. However, the evidence supports multiple, particularly in combination with surgical extirpation and reconstruction. Here we present 2 proven treatments, both in timing and modalities chosen, as part of the first step to establish a formally accepted treatment paradigm for advanced BIA-ALCL patients with invasive chest wall involvement.
Relationship Between the Circumference Difference and Findings of Indocyanine Green Lymphography in Breast Cancer–Related Lymphedema
Authors: Tokumoto Hideki , Akita Shinsuke , Kubota Yoshitaka , Mitsukawa Nobuyuki
Published: June 2021

Background

Breast cancer–related lymphedema (BCRL) is a common complication. Indocyanine green (ICG) lymphography has been performed to assess lymphatic functionality. We found that some BCRL patients had a difference in circumference in partial regions only. The purpose of this study was to evaluate the patients with BCRL about the correlation between the difference in circumference and the findings of ICG lymphography.

Methods

One hundred fifty-five patients with unilateral BCRL were enrolled in this study. We evaluated the differences in circumference taken at 4 parts on the upper limb (at around the wrist, forearm, elbow, and brachium). The difference in circumference was evaluated between the affected part (Caf) and the unaffected part (Cun). We calculated the circumference difference rate (CDR) as follows: CDR = 100 (Caf − Cun)/Caf. First, we classified each part of all BCRL patients (620 parts) based on the findings of ICG lymphography (linear, collateral, dermal back flow [DBF], and no enhancement) and evaluated the correlation. Second, in the patients with partial volume change, we compared the mean CDR in each part.

Results

One hundred six parts were of a linear pattern, 31 parts were collateral, 350 parts were DBF, and 133 parts had no enhancement. The mean CDR of each finding was 3.3% in linear, 4.0% in collateral, 9.6% in DBF, and 9.4% in no enhancement. There was no significant difference between linear and collateral (P = 0.62), DBF, and no enhancement (P = 0.89) patterns. However, there was a significant difference between linear or collateral and DBF or no enhancement (all P < 0.001). In the 22 patients with distal DBF and proximal linear, the CDR was significantly higher in the forearm compared with the brachium (6.4% and 3.0%; P = 0.003). In the 26 patients with distal linear and proximal DBF, the CDR was significantly higher in the brachium compared with the forearm (4.3% and 7.7%; P = 0.005).

Conclusions

There was a significant correlation between the difference in circumference and the severity of ICG findings.