bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Experience, Characteristics, and Performance of an Acetaminophen Absorption Test in Critically Ill Patients
Authors: Droege Molly E. , Rhoades Abigail G. , Droege Christopher A. , Mosher Daniel R. , Swomley Aaron M. , Ernst Neil E. , Mueller Eric W.
Published: August 2021

Background:

Altered drug and nutrient absorption presents a unique challenge in critically ill patients. Performing an acetaminophen absorption test (AAT) has been used as a marker for gastric motility and upper small bowel absorption; thus, it may provide objective data regarding enteral absorptive ability in critically ill patients.

Study Question:

What is the clinical experience with AAT when used as a surrogate marker for enteral absorption in critically ill patients?

Study Design:

This single-center, retrospective, cohort study evaluated serum acetaminophen concentrations within 180 minutes following 1-time enteral administration of an AAT. Patients admitted to the surgical and medical intensive care units and medical intensive care units over a 7-year period were evaluated. Groups were defined as positive (acetaminophen concentration of ≥10 mg/L) or negative (acetaminophen concentration of <10 mg/L) AAT.

Measures and Outcomes:

The outcomes were to describe the clinical experience, characteristics, and performance of AAT.

Results:

Forty-eight patients were included. Patients were 58.5 ± 14 years of age, mostly male (58.3%), and admitted to the surgical intensive care unit (66.7%). Median hospital length of stay was 47.5 (27–78.8) days. Thirty-four patients (70.8%) had a positive AAT [median concentration, 14 (12–18) mg/L]. Median time to first detectable concentration was 37 (33–64) minutes. AAT characteristics were similar between the groups including total dose, weight-based dose, time to first and second assays, drug formulation, and site of administration between groups. There were no independent risk factors identified on regression analysis for negative AAT.

Conclusions:

An acetaminophen dose of 15 mg/kg with 2 coordinated serum concentrations approximately 30 and 60 minutes after administration is a reasonable construct for AAT. Future research is needed to assess AAT utility, safety, and clinical outcomes for predicting patient ability to absorb enteral feeds and medications.
Racial Disparities in Preventable Adverse Events Attributed to Poor Care Coordination Reported in a National Study of Older US Adults
Authors: Pinheiro Laura C. , Reshetnyak Evgeniya , Safford Monika M. , Kern Lisa M.
Published: August 2021

Background:

Previous work found that Black patients experience worse care coordination than White patients.

Objective:

The aim was to determine if there are racial disparities in self-reported adverse events that could have been prevented with better communication.

Research Design:

We used data from a cross-sectional survey that was administered to participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study in 2017–2018.

Subjects:

REGARDS participants aged 65+ years of age who reported >1 ambulatory visits and >1 provider in the prior 12 months (thus at risk for gaps in care coordination).

Measures:

Our primary outcome was any repeat test, drug-drug interaction, or emergency department visit or hospitalization that respondents thought could have been prevented with better communication. We used Poisson models with robust standard error to determine if there were differences in preventable events by race.

Results:

Among 7568 REGARDS respondents, the mean age was 77 years (SD: 6.7), 55.4% were female, and 33.6% were Black. Black participants were significantly more likely to report any preventable adverse events compared with Whites [adjusted risk ratio (aRR): 1.64; 95% confidence interval (CI): 1.42–1.89]. Specifically, Blacks were more likely than Whites to report a repeat test (aRR: 1.77; 95% CI: 1.38–2.29), a drug-drug interaction (aRR: 1.76; 95% CI: 1.46–2.12), and an emergency department visit or hospitalization (aRR: 1.45; 95% CI: 1.01–2.08).

Conclusions:

Black participants were significantly more likely to report a preventable adverse event attributable to poor care coordination than White participants, independent of demographic and clinical characteristics.
Early detection of pancreatic cancer: current state and future opportunities
Authors: Trikudanathan Guru , Lou Emil , Maitra Anirban , Majumder Shounak
Published: August 2021

Purpose of review

Pancreatic ductal adenocarcinoma (PDAC) is third leading cause of cancer death in the United States, a lethal disease with no screening strategy. Although diagnosis at an early stage is associated with improved survival, clinical detection of PDAC is typically at an advanced symptomatic stage when best in class therapies have limited impact on survival.

Recent findings

In recent years this status quo has been challenged by the identification of novel risk factors, molecular markers of early-stage disease and innovations in pancreatic imaging. There is now expert consensus that screening may be pursued in a cohort of individuals with increased likelihood of developing PDAC based on genetic and familial risk.

The current review summarizes the known risk factors of PDAC, current knowledge and recent observations pertinent to early detection of PDAC in these risk groups and outlines future approaches that will potentially advance the field.
Can Propofol Be Used to Assess the Presence of the Rectoanal Inhibitory Reflex During Anorectal Manometry Studies?
Authors: Arbizu Ricardo A. , Amicangelo Maureen , Rodriguez Leonel , Nurko Samuel
Published: August 2021

Objectives:

To study changes in intra‐anal pressure (IAP) and characteristics of the rectoanal inhibitory reflex (RAIR) during anorectal manometry (ARM) in patients undergoing anesthesia induction with propofol.

Methods:

Prospective study in which ARM was performed at baseline while patients were awake and repeated after propofol‐induced anesthesia. We studied IAP and the presence and characteristics of the RAIR before and after propofol.

Results:

A total of 27 patients were included (63% male; 9.2 years). Three patients had obstructive symptoms after Hirschsprung disease repair (HSCR), and 24 had intractable constipation. At baseline, the RAIR was present on 21 of 27 patients and absent on 6 of 27. Of the six patients with an absent RAIR, it remained absent in four of six (three known HSCR, and one new diagnosis of IAS achalasia), and two of six had a normal RAIR during propofol. Therefore, RAIR was present in all patients with constipation. The mean resting IAP was significantly lower after propofol. The percentage of IAS relaxation after lower balloon volume inflations was significantly higher during propofol (P < 0.05). No difference was observed over the latency time or the total relaxation time after propofol.

Conclusions:

Propofol can be used to assess the presence of the RAIR during ARM in children who are uncooperative and undergoing other procedures under anesthesia. On the other hand, propofol significantly reduces the resting IAP and increases the percentage of internal anal sphincter relaxation after balloon distention. These findings may impact the interpretation to decide if an intervention is needed, or if there is a possible spinal neuropathy.
Thrombocytopenia in COVID-19: Focused Summary of Current Understanding of Mechanisms and Clinical Implications
Authors: Singh Suvir , Sharma Rintu , Singh Jagdeep , Jain Kunal , Paul Davinder
Published: August 2021

Thrombocytopenia is noted in corona virus disease-2019 (COVID-19) with a prevalence of 5% to 41%, and has been observed to be associated with inferior outcomes. The pathogenesis of thrombocytopenia in COVID-19 is unique and differs from other viral syndromes in terms of clinical presentation and causative mechanisms. Platelets act as both targets and the initial defense against severe acute respiratory syndrome-coronavirus 2 and work in concert with the underlying thrombophilic mechanisms to modulate the final disease phenotype. Understanding these mechanisms may possibly allow targeting of a key component of COVID-19 pathogenesis. We provide a focused review of the current mechanisms implicated in development of thrombocytopenia in COVID-19 and therapeutic implications of the same.
Attitudes and Practices of Pediatric Oncologists Regarding Palliative Care Consultation for Pediatric Oncology Patients
Authors: Parisio Katie N. , Levy Carly D. , Lewis Amanda M. , Schultz Corinna L.
Published: August 2021

Objective:

We sought to describe palliative care services available to children with cancer along with pediatric oncologists’ current and ideal practices of palliative care involvement in children with cancer.

Design:

A novel survey tool was administered via REDCap to attending pediatric oncologists in the United States. The survey remained open from June to September 2020.

Results:

A total of 265 survey responses were evaluated. Most respondents endorsed that palliative care should “always” be consulted for the following scenarios: new diagnosis of advanced/metastatic disease (53%), uncontrolled symptoms (65%), bone marrow transplant (55%), and relapsed/refractory disease (73%). For those same scenarios, the majority noted the current practice was to “sometimes” or “usually” consult. Most respondents (92.6%) felt that palliative care should be consulted more frequently than they were currently being consulted.

Conclusions:

Compared with the current practice for various pediatric oncology departments, palliative care was not consulted as often as oncologists desired. While barriers to palliative care consultation are outlined in the literature, exploration of how to address them as well as identification of barriers specific to oncologists who are in favor of palliative care consultation are not well-described. Further research exploring these specific barriers is necessary to understand the disconnect between oncologists’ attitudes and palliative care consultation.
Effect of Reiki Therapy on Quality of Life and Fatigue Levels of Breast Cancer Patients Receiving Chemotherapy
Authors: Karaman Seda , Tan Mehtap
Published: August 2021

Background

The quality of life of patients receiving chemotherapy decreases, and fatigue is one of the most common symptoms. Reiki is used for cancer patients as an energy-based complementary and alternative method.

Objective

The aim of this study was to determine the effect of Reiki therapy on the quality of life and fatigue levels in breast cancer patients receiving chemotherapy.

Methods

This was a pretest-posttest, quasi-experimental study with a control group: 70 patients enrolled with 35 participants in the experimental group and 35 in the control group. The experimental group received 6 sessions of Reiki therapy. The data were collected using a Patient Information Form, the Piper Fatigue Scale, and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire.

Results

The mean scores on the general well-being subscale in the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire increased in the experimental group and decreased in the control group, whereas the mean scores on the general function and general symptom subscales decreased in the experimental group and increased in the control group. The differences between the groups were statistically significant (P < .001). The mean Piper Fatigue Scale scores of the experimental group decreased, whereas that of the control group increased; the group differences were statistically significant (P < .001).

Conclusion

Reiki can reduce fatigue and increase the quality of life of breast cancer patients receiving chemotherapy.

Implications for Practice

Reiki therapy can be used as a nursing intervention to increase the quality of life and reduce fatigue in breast cancer patients receiving chemotherapy.
Test-retest Reliability of the qReading Method in Normally Sighted Young Adults
Authors: Shepard Timothy G. , Lu Zhong-Lin , Yu Deyue
Published: August 2021

SIGNIFICANCE

We recently developed a novel Bayesian adaptive method, qReading, to measure reading function. The qReading method has both the efficiency and excellent test-retest reliability in normally sighted young adults to make it an excellent candidate for future studies of its value in diagnosis and longitudinal evaluation of treatment and/or rehabilitation outcomes.

PURPOSE

A novel Bayesian adaptive method, qReading, was recently developed to measure reading function. Here we performed a systematic assessment of the test-retest reliability of the qReading method.

METHODS

The variability of five repeated measurements of the reading curve was examined in two settings: within session and between sessions. For the within-session design, we considered two subpopulations: naive observers and experienced observers. All observers were normally sighted young adults. For each set of data, in addition to examining the intrinsic precision of the qReading method (the half width of the credible interval of the posterior distribution of the estimated performance), we computed four metrics to assess repeatability: standard deviation, Bland-Altman coefficient of repeatability, correlation coefficient, and Fractional Rank Precision.

RESULTS

Extrinsic factors such as observer, time interval between repeated measures, and observer experience all contribute to the variation across measurements. Nevertheless, the four metrics consistently show that the variability across five repeated measurements is small for each set of data. This is true even without taking learning effects into account (standard deviations, ≤0.092 log10 units; Bland-Altman coefficient of repeatability, ≤0.15 (log10)2 units; correlation coefficient, ≥0.91; and Fractional Rank Precision, ≥0.81).

CONCLUSIONS

The qReading method has excellent test-retest reliability in normally sighted young adults.
Accelerating adolescent HIV research in low-income and middle-income countries: evidence from a research consortium
Authors: Tucker Joseph D. , Iwelunmor Juliet , Abrams Elaine , Donenberg Geri , Wilson Erin C. , Blachman-Demner Dara , Laimon Lauren , Taiwo Babafemi O. , Kuhns Lisa M. , John-Stewart Grace C. , Kohler Pamela , Subramanian Sujha , Ayieko James , Gbaja-Biamila Titilola , Oladele David , Obiezu-Umeh Chisom , Chima Kelechi P. , Jalil Emilia M. , Falcao Joana , Ezechi Oliver C. , Kapogiannis Bill G.
Published: August 2021

Objective:

Many adolescents and young adults (AYA) have unmet HIV prevention needs. We describe the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium organization, transition milestones, and youth engagement strategies. The PATC3H consortium focuses on reducing HIV incidence and related health disparities among AYA.

Design and Methods:

Organizational data were obtained from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and supplemented with a brief survey completed by study principal investigators. Transition from the initial phase (years 1 and 2) to the subsequent phase (years 3 and 5) was contingent on meeting prespecified milestones. We reviewed the structure and function of the research consortium, identified shared elements of transition milestones, and examined common youth engagement strategies.

Results:

The PATC3H consortium supports eight research studies through a milestone transition mechanism. The consortium includes AYA HIV research studies in seven countries – Brazil, Kenya, Mozambique, Nigeria, South Africa, Uganda, and Zambia. The NIH request for applications required transition milestones that included early consultation with stakeholders. The transition milestones required by NIH for the eight studies included early consultation with health and policy stakeholders, pilot intervention data, and commitment from national government stakeholders. All studies provided multiple pathways for AYA engagement, including AYA advisory boards and youth-led research studies.

Conclusion:

Data suggest that requiring milestones to transition to the final phase may have facilitated health and policy stakeholder engagement and enhanced formative assessment of regulatory protocols. These data have implications for designing engaged research studies in low and middle-income countries.
Evidence for Left Atrial Volume Being an Indicator of Adverse Events in Patients With Acute Pulmonary Embolism
Authors: Kirkbride Rachael R. , Heidinger Benedikt H. , Monteiro Filho Antonio C. , Brook Alexander , Tridente Daniela M. , DaBreo Dominique C. , Carroll Brett J. , Matos Jason D. , McCormick Ian C. , Manning Warren J. , Burstein Deborah , Aviram Galit , Litmanovich Diana E.
Published: August 2021

Purpose:

To assess the association between computed tomography pulmonary angiography (CTPA) atrial measurements and both 30-day pulmonary embolism (PE)-related adverse events and mortality, and non–PE-related mortality, and to identify the best predictors of these outcomes by comparing atrial measurements and widely used clinical and imaging variables.

Patients and Methods:

Retrospective single-center pilot study. Acute PE patients diagnosed on CTPA who also had a transthoracic echocardiogram, electrocardiogram, and troponin T were included. CTPA left atrial (LA) and right atrial (RA) volume and short-axis diameter were measured and compared between outcome groups, along with right ventricular/left ventricular diameter ratio, interventricular septal bowing, tricuspid annular plane systolic excursion, electrocardiogram, and troponin T.

Results:

A total of 350 patients. LA volume and diameter were associated with PE-related adverse events (P≤0.01). LA volume was the only atrial measurement associated with PE-related mortality (P=0.03), with no atrial measurements associated with non–PE-related mortality. Troponin was most associated with PE-related adverse events and mortality (both area under the curve [AUC]=0.77). On multivariate analysis, combination models did not greatly improve PE-related adverse events prediction compared with troponin alone. For PE-related mortality, the best models were the combination of troponin, age, and either LA volume (AUC=0.86) or diameter (AUC=0.87).

Conclusion:

Among patients with acute PE, CTPA LA volume is the only imaging parameter associated with PE-related mortality and is the best imaging predictor of this outcome. Reduced CTPA LA volume and diameter, along with increased RA/LA volume and diameter ratios, are significantly associated with 30-day PE-related adverse events, but not with non–PE-related mortality.
Diagnostic Accuracy and Performance of Artificial Intelligence in Detecting Lung Nodules in Patients With Complex Lung Disease
Authors: Abadia Andres F. , Yacoub Basel , Stringer Natalie , Snoddy Madalyn , Kocher Madison , Schoepf U. Joseph , Aquino Gilberto J. , Kabakus Ismail , Dargis Danielle , Hoelzer Philipp , Sperl Jonathan I. , Sahbaee Pooyan , Vingiani Vincenzo , Mercer Megan , Burt Jeremy R.
Published: August 2021

Objectives:

The aim of the study is to investigate the performance of artificial intelligence (AI) convolutional neural networks (CNN) in detecting lung nodules on chest computed tomography of patients with complex lung disease, and demonstrate its noninferiority when compared against an experienced radiologist through clinically relevant assessments.

Methods:

A CNN prototype was used to retrospectively evaluate 103 complex lung disease cases and 40 control cases without reported nodules. Computed tomography scans were blindly evaluated by an expert thoracic radiologist; a month after initial analyses, 20 positive cases were re-evaluated with the assistance of AI. For clinically relevant applications: (1) AI was asked to classify each patient into nodules present or absent and (2) AI results were compared against standard radiology reports. Standard statistics were performed to determine detection performance.

Results:

AI was, on average, 27 seconds faster than the expert and detected 8.4% of nodules that would have been missed. AI had a sensitivity of 67.7%, similar to an accuracy reported for experienced radiologists. AI correctly classified each patient (nodules present/absent) with a sensitivity of 96.1%. When matched against radiology reports, AI performed with a sensitivity of 89.4%. Control group assessment demonstrated an overall specificity of 82.5%. When aided by AI, the expert decreased the average assessment time per case from 2:44 minutes to 35.7 seconds, while reporting an overall increase in confidence.

Conclusion:

In a group of patients with complex lung disease, the sensitivity of AI is similar to an experienced radiologist and the tool helps detect previously missed nodules. AI also helps experts analyze for lung nodules faster and more confidently, a feature that is beneficial to patients and favorable to hospitals due to increased patient load and need for shorter turnaround times.
A Retrospective Cohort Study Comparing Traditional Breast Conservation With Oncoplastic Surgery in Breast Cancer Patients After Neoadjuvant Chemotherapy
Authors: Chen Ying , Hao Shuang , Chen Jiajian , Huang Xiaoyan , Cao Ayong , Hu Zhen , Liu Guangyu , Shao Zhimin , Wu Jiong
Published: August 2021

Background

To better understand the difference between traditional breast-conserving surgery (BCS) and oncoplastic surgery (OPS), we conducted a retrospective cohort study involving breast cancer patients who received neoadjuvant chemotherapy (NAC) and then underwent breast conservation at the Fudan University Shanghai Cancer Center.

Methods

A retrospective chart review was conducted. All breast cancer patients who received NAC and then underwent traditional BCS or OPS at the Fudan University Shanghai Cancer Center from January 1, 2008, to December 31, 2019, were included.

Results

Three hundred ninety-nine breast cancer patients received NAC and underwent traditional BCS, and 99 patients underwent OPS. The average age of the patients in the OPS group was younger than that in the BCS group (43 vs 48 years, P = 0.017). The size of the tumor assessed by ultrasonography at baseline in the OPS group was larger than that in the BCS group (31.3 vs 28.1 mm, P = 0.013). The same trend was observed in the clinical T stage and overall staging assessments before the administration of NAC in these 2 groups. Oncoplastic techniques were more frequently applied when tumors were located in areas with relatively few glands, such as the upper inner quadrant. There were no significant differences in the margins and distributions of pathological types and molecular subtypes between these 2 groups. The rates of pathological complete response were similar in the traditional BCS and OPS groups.

Conclusions

Unlike traditional BCS, in breast cancer patients after NAC, the adoption of oncoplastic techniques makes breast conservation feasible, even in patients with large tumors, late stages, and unfavorable tumor locations.
Comparison of the Modified Moberg Flap Versus First Dorsal Metacarpal Artery Flap for Thumb Pulp Reconstruction
Authors: Durgut Fatih , Ozdemir Ali , Ergin Musa , Güleç Ali , Acar Mehmet Ali
Published: August 2021

We assessed and compared outcomes of 2 different flap techniques for thumb pulp defect reconstruction. Twenty-three patients who underwent modified Moberg and first dorsal metacarpal artery flap because of thumb pulp defect were retrospectively evaluated. Flap survival; venous congestion; cold intolerance; static 2-point discrimination (s2-PD); Semmes-Weinstein monofilament (SWM) test scores; paresthesia; defect size; time to return to work; interphalangeal and metacarpophalangeal joint flexion of the thumb; Disability of the Arm, Shoulder and Hand questionnaire scores; and follow-up time were evaluated. Flap survival, venous congestion, time to return to work, paresthesia, defect size, SWM test scores, range of motion of the proximal interphalangeal and metacarpophalangeal joints, and Disability of the Arm, Shoulder and Hand questionnaire scores were similar in both groups. Cold intolerance and s2-PD were found to be statistically better in the modified Moberg flap group. Although these techniques provided similar results, the modified Moberg was found to be superior in terms of cold intolerance and s2-PD.
Low-Cost and Simple Frontal Sinus Surgical Cutting Guide Modeling for Anterior Cranioplasty in Facial Feminization Surgery: How To Do It
Authors: Ganry Laurent , Cömert Mehmet
Published: August 2021

Background:

This study demonstrates a novel and simple design to create a low cost frontal sinus surgical cutting guide, using patient's frontal sinus cavities as references, to perform an anterior cranioplasty in facial feminization surgery. A clinical series demonstrates its clinical use and safety.

Material and Methods:

Authors used a 4 open-source software protocol for the virtual surgical modeling (VSP). Retrospectively, pre- and post-operative complications were reviewed, and a FACE-Q questionnaires were used to evaluate patient's postoperative “Satisfaction with forehead and eyebrows.” Recordings of the VSP and surgical technic are presented.

Results:

Sixteen patients were operated between November 2018 and November 2020 using in-house surgical guides. All were performed by authors in 5 to 10 minutes using Blender open-source Software. No complications were reported and authors always found an optimal retention of the surgical guide on the convex bony surface of the forehead and frontonasal area. FACE-Q questionnaire reported a very high satisfaction for all patients (mean score: 22/24).

Discussion:

This simplify organic design can be performed efficiently by any surgeon even without previous training in home staging VSP. Patient satisfaction was very high, along with an absence of postoperative complications.
Clinical Effects of the Combination of Rhytidectomy and Temporomandibular Joint Disc Repositioning Surgery
Authors: Di Zhang Dan , Lee Lee Mui , Zhu Yao Min , Cheng Hui Na , Yao Wei , Deng Yong Qiang
Published: August 2021

Objective:

This study aims to investigate the clinical effects of the combination of rhytidectomy and temporomandibular joint (TMJ) disc repositioning surgery in internal derangement (ID) stage IV-V and facial aging patients.

Methods:

Eighteen facial aging with bilateral ID IV-V patients were enrolled in this study. All of them had undergone temporomandibular disc repositioning surgery and rhytidectomy by the same surgeon (Yao Min Zhu). Pre-/post-surgical clinical manifestations, facial photography, radiographic data were recorded and analyzed, as well as doctor, patient, third-party evaluation of postsurgical facial appearance satisfaction.

Results:

The average age of 18 female patients was 52.9. The average of presurgical visual analog pain scale score was 5.94, ranged from 4 to 8. After 6 months, the average of postsurgical visual analog pain scale score was 0.28, ranged from 0 to 1 (P 
> 0.05). The average maximal mouth opening of presurgical and postsurgical was 2.19 and 3.29 cm, ranged from 1.2 to 2.8 cm and 3.0 to 3.5 cm, respectively (P < 0.05). Postoperative magnetic resonance imaging showed the location of the bilateral TMJ discs directly above the mandibular condyle. The satisfaction rate of doctors, patients and third-party with facial appearance was 95% to 98%, 96% to 99% and 96% to 99%, respectively, with an average of 95.72%, 98.11%, and 97.50%.

Conclusions:

For patients with bilateral ID IV-V and facial aging, the combination of disc repositioning surgery and rhytidectomy is a very feasible procedure to treat TMJ disorders and improve patients’ facial appearance and satisfaction.
The Many Faces of Sagittal Synostosis: A Novel Classification and Approach to Diagnosis
Authors: Diab Jason , Flapper Walter , Grave Benjamin , Abou-Hamden Amal , Anderson Peter , Moore Mark
Published: August 2021

Purpose:

Among the variable forms of craniosynostosis, sagittal synostosis represents the most common type of nonsyndromic single-suture fusion. There are many variations of this form that have been recognized in the literature. We aim to identify and categorize the clinical and radiological characteristics for patients with sagittal synostosis from 2014 to 2017. Secondly, to define a classification system wherein quantitative and qualitative descriptors are used to provide a better understanding of the disease process.

Methodology:

An institutional retrospective analysis identified all patients during the 2014 to 2017 period with computer tomography (CT) diagnosed single suture sagittal craniosynostosis (n = 51). Redo cases were excluded from the study. The data was collected from CT radiological evidence, clinical images, and medical notes. The patients were stratified into clinical assessment, radiological and neurological, and a statistical analysis was performed.

Results:

The average age for CT scans was 3 months and operative management 6.4 months, respectively. The most common presentation:

Conclusions:

Sagittal synostosis presented with many heterogeneous variations. The classic appearance of a sagittal ridge, occipital bullet and/or frontal bossing, with frontal interhemispheric and subarachnoid spaces, and complete sagittal fusion was most common. A holistic classification can aid in the assessment and prioritization of surgical intervention. Future longitudinal studies would provide additional insight into the relationships between clinical appearance and suture fusion.
Association of Elective Surgical Volume With State Executive Order Curtailing Elective Surgery in Michigan During the COVID-19 Pandemic
Authors: Eton Ryan E. , Yost Monica L. , Thompson Michael P. , Osborne Nicholas H. , Nathan Hari , Englesbe Michael J. , Brown Craig S.
Published: August 2021

Objective:

Our objective was to evaluate changes in elective surgical volume in Michigan while an executive order (EO) was in place curtailing elective surgery during the COVID-19 pandemic.

Summary Background Data:

Many state governors enacted EOs curtailing elective surgery to protect scare resources and generate hospital capacity for patients with COVID-19. Little is known of the effectiveness of an EO on achieving a sustained reduction in elective surgery.

Methods:

This retrospective cohort study of data from a statewide claims-based registry in Michigan includes claims from the largest private payer in the state for a representative set of elective operations on adult patients from February 2 through August 1, 2020. We reported trends in surgical volume over the period the EO was in place. Estimated backlogs in elective surgery were calculated using case counts from the same period in 2019.

Results:

Hospitals achieved a 91.7% reduction in case volume before the EO was introduced. By the time the order was rescinded, hospitals were already performing elective surgery at 60.1% of pre-pandemic case rates. We estimate that a backlog of 6419 operations was created while the EO was in effect. Had hospitals ceased elective surgery during this period, an additional 18% of patients would have experienced a delay in surgical care.

Conclusions:

Both the introduction and removal of Michigan’s EO lagged behind the observed ramp-down and ramp-up in elective surgical volume. These data suggest that EOs may not effectively modulate surgical care and could also contribute to unnecessary delays in surgical care.
Lipidomic Profiling of Colorectal Lesions for Real-Time Tissue Recognition and Risk-Stratification Using Rapid Evaporative Ionization Mass Spectrometry
Authors: Mason Sam E. , Manoli Eftychios , Alexander James L. , Poynter Liam , Ford Lauren , Paizs Petra , Adebesin Afeez , McKenzie James S. , Rosini Francesca , Goldin Rob , Darzi Ara , Takats Zoltan , Kinross James M.
Published: August 2021

Objective:

Rapid evaporative ionization mass spectrometry (REIMS) is a metabolomic technique analyzing tissue metabolites, which can be applied intraoperatively in real-time. The objective of this study was to profile the lipid composition of colorectal tissues using REIMS, assessing its accuracy for real-time tissue recognition and risk-stratification.

Summary Background Data:

Metabolic dysregulation is a hallmark feature of carcinogenesis; however, it remains unknown if this can be leveraged for real-time clinical applications in colorectal disease.

Methods:

Patients undergoing colorectal resection were included, with carcinoma, adenoma and paired-normal mucosa sampled. Ex vivo analysis with REIMS was conducted using monopolar diathermy, with the aerosol aspirated into a Xevo G2S QToF mass spectrometer. Negatively charged ions over 600 to 1000m/z were used for univariate and multivariate functions including linear discriminant analysis.

Results:

A total of 161 patients were included, generating 1013 spectra. Unique lipidomic profiles exist for each tissue type, with REIMS differentiating samples of carcinoma, adenoma, and normal mucosa with 93.1% accuracy and 96.1% negative predictive value for carcinoma. Neoplasia (carcinoma or adenoma) could be predicted with 96.0% accuracy and 91.8% negative predictive value. Adenomas can be risk-stratified by grade of dysplasia with 93.5% accuracy, but not histological subtype. The structure of 61 lipid metabolites was identified, revealing that during colorectal carcinogenesis there is progressive increase in relative abundance of phosphatidylglycerols, sphingomyelins, and mono-unsaturated fatty acid-containing phospholipids.

Conclusions:

The colorectal lipidome can be sampled by REIMS and leveraged for accurate real-time tissue recognition, in addition to riskstratification of colorectal adenomas. Unique lipidomic features associated with carcinogenesis are described.
Continuous Amplitude-Integrated Electroencephalography During Neonatal and Pediatric Extracorporeal Membrane Oxygenation
Authors: Chahine Adela , Chenouard Alexis , Joram Nicolas , Berthomieu Lionel , Du Pont-Thibodeau Geneviève , Leclere Brice , Liet Jean-Michel , Maminirina Pierre , Leclair-Visonneau Laurène , Breinig Sophie , Bourgoin Pierre
Published: August 2021

Purpose:

Early prognostication of neurologic outcome in neonates and children supported with extra-corporeal membrane oxygenation (ECMO) is challenging. Amplitude-integrated EEG (aEEG) offers the advantages of continuous monitoring and 24-hours availability at the bedside for intensive care unit providers. The objective of this study was to describe the early electrophysiological background patterns of neonates and children undergoing ECMO and their association with neurologic outcomes.

Methods:

This was a retrospective review of neonates and children undergoing ECMO and monitored with aEEG. Amplitude-integrated EEG was summarized as an aEEG background score determined within the first 24 hours of ECMO and divided in 3-hour periods. Screening for electrical seizures was performed throughout the full ECMO duration. Neurologic outcome was defined by the Pediatric Cerebral Performance Category score at hospital discharge.

Results:

Seventy-three patients (median age 79 days [8–660], median weight 4.78 kg [3.24–10.02]) were included in the analysis. Thirty-two patients had a favorable neurologic outcome and 41 had an unfavorable neurologic outcome group at hospital discharge. A 24-hour aEEG background score >17 was associated with an unfavorable outcome with a sensitivity of 44%, a specificity of 97%, a positive predictive value of 95%, and a negative predictive value of 57%. In multivariate analysis, 24-hour aEEG background score was associated with unfavorable outcome (hazard ratio, 6.1; p = 0.001; 95% confidence interval, 2.31–16.24). The presence of seizures was not associated with neurologic outcome at hospital discharge.

Conclusions:

Continuous aEEG provides accurate neurologic prognostication in neonates and children supported with ECMO. Early aEEG monitoring may help intensive care unit providers to guide clinical care and family counseling.
Integration of biplanar X-ray, three-dimensional animation and particle simulation reveals details of human ‘track ontogeny’
Authors: Hatala Kevin G. , Gatesy Stephen M. , Falkingham Peter L.
Published: August 2021

The emergence of bipedalism had profound effects on human evolutionary history, but the evolution of locomotor patterns within the hominin clade remains poorly understood. Fossil tracks recordin vivobehaviours of extinct hominins, and they offer great potential to reveal locomotor patterns at various times and places across the human fossil record. However, there is no consensus on how to interpret anatomical or biomechanical patterns from tracks due to limited knowledge of the complex foot–substrate interactions through which they are produced. Here, we implement engineering-based methods to understand human track formation with the ultimate goal of unlocking invaluable information on hominin locomotion from fossil tracks. We first developed biplanar X-ray and three-dimensional animation techniques that permit visualization of subsurface foot motion as tracks are produced, and that allow for direct comparisons of foot kinematics to final track morphology. We then applied the discrete element method to accurately simulate the process of human track formation, allowing for direct study of human track ontogeny. This window lets us observe how specific anatomical and/or kinematic variables shape human track morphology, and it offers a new avenue for robust hypothesis testing in order to infer patterns of foot anatomy and motion from fossil hominin tracks.
Molar biomechanical function in South African homininsAustralopithecus africanusandParanthropus robustus
Authors: Berthaume Michael A. , Kupczik Kornelius
Published: August 2021

Diet is a driving force in human evolution. Two species of Plio-Pleistocene hominins,Paranthropus robustusandAustralopithecus africanus, have derived craniomandibular and dental morphologies which are often interpreted asP. robustushaving a more biomechanically challenging diet. While dietary reconstructions based on dental microwear generally support this, they show extensive dietary overlap between species, and craniomandibular and dental biomechanical analyses can yield contradictory results. Using methods from anthropology and engineering (i.e. anthroengineering), we quantified the molar biomechanical performance of these hominins to investigate possible dietary differences between them. Thirty-one lower second molars were 3D printed and used to fracture gelatine blocks, and Bayesian generalized linear models were used to investigate the relationship between species and tooth wear, size and shape, and biomechanical performance. Our results demonstrate thatP. robustusrequired more force and energy to fracture blocks but had a higher force transmission rate. Considering previous dietary reconstructions, we propose three evolutionary scenarios concerning the dietary ecologies of these hominins. These evolutionary scenarios cannot be reached by investigating morphological differences in isolation, but require combining several lines of evidence. This highlights the need for a holistic approach to reconstructing hominin dietary ecology.
Testing Denmark: A Danish nationwide surveillance study of COVID-19
Authors: Fogh Kamille , Strange Jarl E , Scharff Bibi FSS , Eriksen Alexandra RR , Hasselbalch Rasmus B , Bundgaard Henning , Nielsen Susanne D , Jørgensen Charlotte S , Erikstrup Christian , Norsk Jakob , Nielsen Pernille Brok , Kristensen Jonas H , Østergaard Lars , Ellermann-Eriksen Svend , Andersen Berit , Nielsen Henrik , Johansen Isik S , Wiese Lothar , Simonsen Lone , Fischer Thea K. , Folke Fredrik , Lippert Freddy , Ostrowski Sisse R , Benfield Thomas , Mølbak Kåre , Ethelberg Steen , Koch Anders , Sönksen Ute Wolff , Vangsted Anne-Marie , Krause Tyra Grove , Fomsgaard Anders , Ullum Henrik , Skov Robert , Iversen Kasper
Published: August 2021

Background

National data on the spread of SARS-CoV-2 infection and knowledge on associated risk factors are important for understanding the course of the pandemic. “Testing Denmark” is a national large-scale epidemiological surveillance study of SARS-CoV-2 in the Danish population.

Methods

Between September and October 2020, approximately 1.3 million of 5.8 million Danish citizens (age > 15 years) were randomly invited to fill in an electronic questionnaire covering COVID-19 exposures and symptoms. The prevalence of SARS-CoV-2 antibodies was determined by Point-of Care rapid Test (POCT) distributed to participants home addresses.

Findings

In total 318,552 participants (24.5% invitees) completed the questionnaire and provided the result of the POCT. Of these, 2,519 (0.79%) were seropositive (median age 55 years) and women were more often seropositive than men, interquartile range (IQR) 42-64, 40.2% males. Of participants with a prior positive Polymerase Chain Reaction (PCR) test (n=1,828), 29.1% were seropositive in the POCT. Seropositivity increased with age irrespective of sex. Elderly participants (>61 years) reported less symptoms and had less frequently been tested for SARS-CoV-2 compared to younger participants. Seropositivity was associated with physical contact with SARS-CoV-2 infected individuals (Risk ratio (RR) 7.43, 95% CI: 6.57-8.41) and in particular household members (RR 17.70, 95% CI: 15.60-20.10). Home care workers had a higher risk of seropositivity (RR 2.09 (95% CI: 1.58-2.78) as compared to office workers. Geographic population density was not associated to seropositivity. A high degree of compliance with national preventive recommendations was reported (e.g., > 80% use of face masks), but no difference was found between seropositive and seronegative participants.

Interpretation

This study provides insight into the immunity of the Danish population seven to eight months after the first COVID-19 case in Denmark. The seroprevalence was lower than expected probably due to a low sensitivity of the POCT used or due to challenges relating to the reading of test results. Occupation or exposure in local communities were major routes of infection. As elderly participants were more often seropositive despite fewer symptoms and less PCR tests performed, more emphasis should be placed on testing this age group.
The influence of repeated mild lockdown on mental and physical health during the COVID-19 pandemic: a large-scale longitudinal study in Japan
Authors: Yamamoto Tetsuya , Uchiumi Chigusa , Suzuki Naho , Sugaya Nagisa , Murillo-Rodriguez Eric , Machado Sérgio , Imperatori Claudio , Budde Henning
Published: August 2021

The mental and physical effects of repeated lockdowns are unknown. We conducted a longitudinal study of the influence of repeated mild lockdowns during two emergency declarations in Japan, in May 2020 and February 2021. The analyses included 7,893 people who participated in all online surveys. During repeated mild lockdowns, mental and physical symptoms decreased overall, while loneliness increased and social networks decreased. Subgroup analyses revealed that depression and suicidal ideation did not decrease only in the younger age group (aged 18-29) and that younger and middle-aged people (aged 18-49), women, people with a history of treatment for mental illness, and people who were socially disadvantaged in terms of income had higher levels of mental and physical symptoms at all survey times. Additionally, comprehensive extraction of the interaction structure between depression, demographic attributes, and psychosocial variables indicated that loneliness and social networks were most closely associated with depression. These results indicate that repeated lockdowns have cumulative negative effects on interpersonal interaction and loneliness and that susceptible populations, such as young people and those with high levels of loneliness, require special consideration during repetitive lockdown situations.
“Devil’s stairs”, Poisson’s Statistics, and Patient Sorting via Variabilities for Oxygenation: All from Arterial Blood Gas Data
Authors: Chuiko Gennady , Darnapuk Yevhen , Dvornik Olga , Krainyk Yaroslav , Yaremchuk Olga , Diadenko Anastasiia
Published: August 2021

This report deals with arterial oxygen saturation (SaO2) for healthy adults. A comparably small data set (20 persons) holds 3-minute records of SaO2. The sample rate was 200 Hz. The charts have the looks of a “devil’s stairs.” A few (from 1 to 10) detectable oxygenation levels form the stair’s treads, more or less long. “The risers” have two types (up and down), and all have virtually the same height, about 1 %. The inter-level shifts ( 0 to 42 switches per record) turned out a rare event at the actual sample rate. The number of switchings meets the Poisson distribution. There were found three visibly varied intensities for the switch-overs within the data set. Histograms also show the co-existing of no fewer than three subsets into the data set. The subsets differ by the intensity of switch-overs, amounts of possible levels, relative frequencies of most probable levels (modes), etcetera. In short, those all are diverse variability quantifiers. The higher variability subset has about 25 %, the lower one - 45%.
Parent-of-origin effects propagate through networks to shape metabolic traits
Authors: Macias-Velasco Juan F , St. Pierre Celine L. , Wayhart Jessica P , Yin Li , Spears Larry , Miranda Mario A. , Carson Caryn , Funai Katsuhiko , Cheverud James M , Semenkovich Clay F , Lawson Heather A
Published: August 2021

Parent-of-origin effects are unexpectedly common in complex traits, including metabolic and neurological diseases. Parent-of-origin effects can be modified by the environment, but the architecture of these gene-by-environmental effects on phenotypes remains to be unraveled. Previously, quantitative trait loci (QTL) showing context-specific parent-of-origin effects on metabolic traits were mapped in the F16generation of an advanced intercross between LG/J and SM/J inbred mice. However, these QTL were not enriched for known imprinted genes, suggesting another mechanism is needed to explain these parent-of-origin effects phenomena. We propose that non-imprinted genes can generate complex parent-of-origin effects on metabolic traits through interactions with imprinted genes. Here, we employ data from mouse populations at different levels of intercrossing (F0, F1, F2, F16) of the LG/J and SM/J inbred mouse lines to test this hypothesis. Using multiple populations and incorporating genetic, genomic, and physiological data, we leverage orthogonal evidence to identify networks of genes through which parent-of-origin effects propagate. We identify a network comprised of 3 imprinted and 6 non-imprinted genes that show parent-of-origin effects. This epistatic network forms a nutritional responsive pathway and the genes comprising it jointly serve cellular functions associated with growth. We focus on 2 genes,NnatandF2r, whose interaction associates with serum glucose levels across generations in high fat-fed females. Single-cell RNAseq reveals thatNnatandF2rare negatively correlated in pre-adipocytes along an adipogenic trajectory, a result that is consistent with our observations in bulk white adipose tissue.