bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Cystatin C and Creatinine-Based Equations with Measured Glomerular Filtration Rate in a Diverse Pediatric Population
Authors: Poventud-Fuentes Izmarie , Garnett Emily , Akcan-Arikan Ayse , Devaraj Sridevi
Published: June 2022

Background

Accurate assessment of kidney function is essential for early detection of kidney damage. While measured glomerular filtration rate (mGFR) is occasionally used as a reference, estimated GFR (eGFR) from serum creatinine- and cystatin C (CysC)-based equations are routinely used in clinical practice as a reliable and less invasive approach. In pediatric populations, CysC-based equations provide a closer approximation as they are independent of body composition. Limited information is available on the performance of CysC-based equations in comparison with mGFR with tracers other than iohexol. Therefore, the goal of our study was to evaluate how eGFR, based on several CysC- and creatinine-based equations, with and without race correction, relates to mGFR in a diverse pediatric population.

Methods

A total of 43 patients (7 months to 21 years) from diverse race/ethnicity were retrospectively studied to compare the mGFR from multiple blood sample collections after intravenous tracer injection (Tc-99mDTPA) with eGFR using 9 equations. Deming regression analyses were performed to assess correlation between the mGFR and eGFRs.

Results

The average mGFR for this cohort was 95.0 mL/min/1.73 m2. Race-corrected (RC) equations gave overestimated eGFR across all ethnic groups, with the lowest bias for Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) CysC-creatinine (34.14 mL/min/1.73 m2). The best correlations to mGFR, percentage of eGFR within 30% of mGFR (P30), and lowest biases were from non-race–corrected (NRC) equations Chronic Kidney Disease in Children (CKiD) (0.6460, 65.1%, 2.86 mL/min/1.73 m2), CKD-EPI CysC (0.6858, 69.8%, 11.01 mL/min/1.73 m2), and Schwartz CysC (0.6876, 79.1%, −14.00 mL/min/1.73 m2).

Conclusion

Overall, CysC-based equations without race correction provide a good approximation of mGFR and a less invasive alternative to monitoring kidney function in pediatric population, irrespective of race/ethnicity.
The Supply of Skill and Endogenous Technical Change: Evidence from a College Expansion Reform
Authors: Carneiro Pedro , Liu Kai , Salvanes Kjell G
Published: June 2022

We examine the labor market consequences of an exogenous increase in the supply of skilled labor in several municipalities in Norway, resulting from the construction of new colleges in the 1970s. We find that skilled wages increased as a response, suggesting that along with an increase in the supply there was also an increase in demand for skill. We also show that college openings led to an increase in the productivity of skilled labor and investments in R&D. Our findings are consistent with models of endogenous technical change where an abundance of skilled workers may encourage firms to adopt skill-complementary technologies.
Pectoralis Major Tendon Tears During Airborne Operations: Are These Injuries Isolated?
Authors: Mueller Casey , Moreland Colleen M , Jackson Keith L , Hensley Dana , Lacap Anton , Shaw K Aaron
Published: June 2022

Introduction

Pectoralis major tendon tears are an injury pattern often treated in military populations. Although the majority of pectoralis major tendon tears occur during eccentric loading as in bench press weightlifting, military service members may also experience this injury from a blunt injury and traction force produced by static line entanglement during airborne operations. Although these injuries rarely occur in isolation, associated injury patterns have not been investigated previously.

Materials and Methods

After obtaining institutional review board approval, medical records were reviewed for all patients who underwent surgical repair of a pectoralis major tendon tear sustained during static line parachuting at a single institution. Radiology imaging, operative notes, and outpatient medical records were examined to determine concomitant injury patterns for each patient identified over a 4-year study period.

Results

Twenty-five service members met the study inclusion criteria. All patients underwent presurgical magnetic resonance imaging. Of these 25 service members, 10 (40%) presented with a total of 13 concomitant injuries identified on physical exams or imaging studies. The most common associated injuries were injuries to the biceps brachii and a partial tear of the anterior deltoid. Biceps brachii injuries consisted of muscle contusion proximal long head tendon rupture, proximal short head tendon rupture, partial muscle laceration, and complete muscle transection. Additional concomitant injuries included transection of coracobrachialis, a partial tear of the inferior subscapularis tendon, antecubital fossa laceration, an avulsion fracture of the sublime tubercle, and an avulsion fracture of the coracoid process.

Conclusions

Military static line airborne operations pose a unique risk of pectoralis major tendon tear. Unlike the more common bench press weightlifting tear mechanism, pectoralis major tendon tears associated with static line mechanism present with a concomitant injury in 40% of cases, with the most common associated injury occurring about the biceps brachii. Treating providers should have a high index of suspicion for concomitant injuries when treating pectoralis major tendon tears from this specific mechanism of injury.
HemI 2.0: an online service for heatmap illustration
Authors: Ning Wanshan , Wei Yuxiang , Gao Letian , Han Cheng , Gou Yujie , Fu Shanshan , Liu Dan , Zhang Chi , Huang Xinhe , Wu Sicheng , Peng Di , Wang Chenwei , Xue Yu
Published: June 2022

Recent high-throughput omics techniques have produced a large amount of biological data. Visualization of big omics data is essential to answer a wide range of biological problems. As a concise but comprehensive strategy, a heatmap can analyze and visualize high-dimensional and heterogeneous biomolecular expression data in an attractive artwork. In 2014, we developed a stand-alone software package, Heat map Illustrator (HemI 1.0), which implemented three clustering methods and seven distance metrics for heatmap illustration. Here, we significantly improved 1.0 and released the online service of HemI 2.0, in which 7 clustering methods and 22 types of distance metrics were implemented. In HemI 2.0, the clustering results and publication-quality heatmaps can be exported directly. For an in-depth analysis of the data, we further added an option of enrichment analysis for 12 model organisms, with 15 types of functional annotations. The enrichment results can be visualized in five idioms, including bubble chart, bar graph, coxcomb chart, pie chart and word cloud. We anticipate that HemI 2.0 can be a helpful web server for visualization of biomolecular expression data, as well as the additional enrichment analysis. HemI 2.0 is freely available for all users at: https://hemi.biocuckoo.org/.
A versatile strategy for convenient circular bivalent functional nucleic acids construction
Authors: Zhang Xiao-Jing , Zhao Zhuo , Wang Xia , Su Min-Hui , Ai Lili , Li Yingying , Yuan Quan , Wang Xue-Qiang , Tan Weihong
Published: June 2022

Functional nucleic acids (FNAs), such as aptamers, nucleic acid enzymes and riboswitches play essential roles in various fields of life sciences. Tailoring of ingenious chemical moieties toward FNAs can enhance their biomedical properties and/or confer them with exogenic biological functions that, in turn, can considerably expand their biomedical applications, or even improve their clinical translations. Herein, we report the first example of a general chemical tailoring strategy that enables the divergent ligation of DNA sequences. By applying this technology, different types of aptamers and single-stranded nucleic acids of various lengths could be efficiently tailored to deliver the designed circular bivalent aptamers (CBApts) and cyclized DNA sequences with high yields. It is worth noting that CBApts exhibited significantly enhanced nuclease resistance, as well as considerably improved binding, targeting and tumor tissue enrichment abilities, which may pave the way for different investigations for biomedical purposes.
Characterization of Early-Onset Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Immunocompromised Patients Who Received Tixagevimab-Cilgavimab Prophylaxis
Authors: Ordaya Eloy E , Beam Elena , Yao Joseph D , Razonable Raymund R , Vergidis Paschalis
Published: June 2022

Tixagevimab-cilgavimab is authorized for preexposure prophylaxis against coronavirus disease 2019 (COVID-19) in immunocompromised hosts. Herein, we report the clinical characteristics of 8 patients who developed COVID-19 soon after receiving tixagevimab-cilgavimab. This study emphasizes the need to maintain additional measures to prevent COVID-19 during periods of high severe acute respiratory syndrome coronavirus 2 transmission.
Sentencing Policy, Social Values and Discretionary Justice
Authors: Henham Ralph
Published: June 2022

Despite the recent consolidation of sentencing law and procedure, the fundamental values which underpin the policy and practice of sentencing in England and Wales have remained largely unchanged since the deserts-based model introduced by the Criminal Justice Act of 1991. It is argued that this paradigm is no longer appropriate and presents a significant impediment to reducing imprisonment and mainstreaming restorative forms of intervention within the criminal process. An alternative value-based approach is proposed to counter this trend, one that provides greater structural flexibility and empowers sentencers to engage more effectively with the social impact of penal intervention.
Phase I Study of Tremelimumab Monotherapy or in Combination With Durvalumab in Japanese Patients With Advanced Solid Tumors or Malignant Mesothelioma
Authors: Fujiwara Yutaka , Takahashi Yasuo , Okada Morihito , Kishimoto Takumi , Kondo Shunsuke , Fujikawa Koshi , Hayama Manabu , Sugeno Masatoshi , Ueda Shinya , Komuro Keiko , Lanasa Mark , Nakano Takashi
Published: June 2022

Background

The primary objective of this phase I, open-label trial was to assess safety and tolerability of tremelimumab monotherapy and combination therapy with durvalumab in Japanese patients with advanced cancer. Tremelimumab is a fully human monoclonal antibody against CTLA-4 in clinical trials; durvalumab is a monoclonal antibody against PD-L1 for the treatment of bladder and lung cancer.

Methods

In part 1, tremelimumab 3 or 10 mg/kg was given every 4 weeks (Q4W) for 6 doses, and thereafter every 12 weeks until discontinuation (n = 8); subsequently tremelimumab 10 mg/kg Q4W for 6 doses/Q12W and thereafter until discontinuation was administered in 41 patients with malignant pleural or peritoneal mesothelioma (MPM). In part 2, tremelimumab 10 mg/kg (Q4W for 6 doses followed by Q12W for 3 doses) was given in combination with durvalumab 15 mg/kg (Q4W for 13 doses) in cohort 1 (n = 4). In cohort 2 (n = 6), tremelimumab 1 mg/kg (Q4W for 4 doses) was given in combination with durvalumab 20 mg/kg (Q4W for 4 doses followed by 10 mg/kg Q2W for 22 doses), while in cohort 3 (n = 6), fixed-dose tremelimumab 75 mg Q4W for 4 doses plus durvalumab 1500 mg Q4W for 13 doses was given.

Results

In part 1, no dose-limiting toxicities (DLTs) for tremelimumab 3 or 10 mg/kg (Q4W for 6 doses/Q12W thereafter until discontinuation) were observed. Six (75%) patients reported treatment-related adverse events (trAEs). In the MPM dose-expansion cohort, 38 (92.7%) patients reported trAEs. In part 2, one DLT (Grade 4 myasthenia gravis) was reported for tremelimumab 10 mg/kg (Q4W for 6 doses/Q12W for 3 doses) plus durvalumab 15 mg/kg (Q4W for 13 doses). One DLT (Grade 4 hyperglycemia) was reported for tremelimumab 75 mg (Q4W for 4 doses) plus durvalumab 1500 mg (Q4W for 13 doses). Fourteen (87.5%) patients reported trAEs. Tremelimumab demonstrated low immunogenicity; 1 (16.7%) patient developed antidrug antibodies.

Conclusion

Tremelimumab 10 mg/kg (Q4W/Q12W), tremelimumab 1 mg/kg (Q4W) plus durvalumab 20 mg/kg (Q4W/10 mg/kg Q2W), and fixed-dose tremelimumab 75 mg (Q4W) plus durvalumab 1500 mg (Q4W) were safe and tolerable.

ClinicalTrials.gov Identifier: NCT02141347 (https://clinicaltrials.gov/ct2/show/NCT02141347)
The genetic etiology of periodic limb movement in sleep
Authors: Edelson Jacob L , Schneider Logan D , Amar David , Brink-Kjaer Andreas , Cederberg Katie L , Kutalik Zoltán , Hagen Erika W , Peppard Paul E , Tempaku Priscila Farias , Tufik Sergio , Evans Daniel S , Stone Katie , Tranah Greg , Cade Brian , Redline Susan , Haba-Rubio Jose , Heinzer Raphael , Marques-Vidal Pedro , Vollenweider Peter , Winkelmann Juliane , Zou James , Mignot Emmanuel
Published: June 2022

Study Objectives

Periodic limb movement in sleep is a common sleep phenotype characterized by repetitive leg movements that occur during or before sleep. We conducted a genome-wide association study (GWAS) of periodic limb movements in sleep (PLMS) using a joint analysis (i.e., discovery, replication, and joint meta-analysis) of four cohorts (MrOS, the Wisconsin Sleep Cohort Study, HypnoLaus, and MESA), comprised of 6843 total subjects.

Methods

The MrOS study and Wisconsin Sleep Cohort Study (N = 1745 cases) were used for discovery. Replication in the HypnoLaus and MESA cohorts (1002 cases) preceded joint meta-analysis. We also performed LD score regression, estimated heritability, and computed genetic correlations between potentially associated traits such as restless leg syndrome (RLS) and insomnia. The causality and direction of the relationships between PLMS and RLS was evaluated using Mendelian randomization.

Results

We found 2 independent loci were significantly associated with PLMS: rs113851554 (p = 3.51 × 10−12, β = 0.486), an SNP located in a putative regulatory element of intron eight of MEIS1 (2p14); and rs9369062 (p = 3.06 × 10−22, β = 0.2093), a SNP located in the intron region of BTBD9 (6p12); both of which were also lead signals in RLS GWAS. PLMS is genetically correlated with insomnia, risk of stroke, and RLS, but not with iron deficiency. Pleiotropy adjusted Mendelian randomization analysis identified a causal effect of RLS on PLMS.

Conclusions

Because PLMS is more common than RLS, PLMS may have multiple causes and additional studies are needed to further validate these findings.
Pluripotent Stem Cells in Clinical Setting—New Developments and Overview of Current Status
Authors: Ilic Dusko , Ogilvie Caroline
Published: June 2022

The number of clinical trials using human pluripotent stem cells (hPSC)—both embryonic and induced pluripotent stem cells (hESC/iPSC)—has expanded in the last several years beyond expectations. By the end of 2021, a total of 90 trials had been registered in 13 countries with more than 3000 participants. However, only US, Japan, China, and the UK are conducting both hESC- and hiPSC-based trials. Together US, Japan, and China have registered 78% (70 out of 90) of all trials worldwide. More than half of all trials (51%) are focused on the treatment of degenerative eye diseases and malignancies, enrolling nearly 2/3 of all participants in hPSC-based trials. Although no serious adverse events resulting in death or morbidity due to hPSC-based cellular therapy received have been reported, information about safety and clinical efficacy are still very limited. With the availability of novel technologies for precise genome editing, a new trend in the development of hPSC-based cellular therapies seems to be emerging. Engineering universal donor hPSC lines has become a holy grail in the field. Indeed, because of its effectiveness and simplicity nanomedicine and in vivo delivery of gene therapy could become more advantageous than cellular therapies for the treatment of multiple diseases. In the future, for the best outcome, hPSC-based cellular therapy might be combined with other technological advancements, such as biomimetic epidural electrical stimulation that can restore trunk and leg motor functions after complete spinal injury.
Turnip Mosaic Virus Transcriptional Slippage Dynamics and Distribution in RNA Subpopulations
Authors: Kärblane Kairi , Firth Andrew E. , Olspert Allan
Published: June 2022

Potyviruses comprise the largest and most important group of plant positive-strand RNA viruses. The potyviral cell-to-cell movement protein P3N-PIPO is expressed via transcriptional slippage at a conserved GAAAAAA sequence, leading to insertion of an extra ‘A’ in a proportion of viral transcripts. Transcriptional slippage is determined by the potyviral replicase, the conserved slippery site, and its flanking nucleotides. Here, we investigate the dynamics of transcriptional slippage at different slip-site sequences, infection stages, and environmental conditions. We detect a modest increase in the level of transcripts with insertion towards later timepoints. In addition, we investigate the fate of transcripts with insertion by separately looking at different RNA subpopulations: (+)RNA, (−)RNA, translated RNA, and virion RNA. We find differences in insertional slippage between (+)RNA and (−)RNA but not other subpopulations. Our results suggest that there can be selection against the use of (−)RNAs with insertions as templates for transcription or replication and demonstrate that insertional slippage can occur at high frequency also during (−)RNA synthesis. Since transcripts with insertions are potential targets for degradation, we investigate the connection to nonsense-mediated decay (NMD). We find that these transcripts are targeted to NMD, but we only observe an impact on the level of transcripts with insertion when the insertional slippage rate is high. Together, these results further our understanding of the mechanism and elucidate the dynamics of potyviral transcriptional slippage.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Effect of Temperature, Leaf Wetness Period, and Cultivar Susceptibility on Boxwood Blight Disease Development and Sporulation
Authors: Kodati Srikanth , Allan-Perkins Elisha , Cowles Richard , LaMondia James
Published: June 2022

Boxwood blight causes great losses to the boxwood nursery industry and landscapes in 30 states in the United States. Understanding the epidemiological factors governing disease development will be important for disease forecasting and design of best management practices. We evaluated the effect of leaf wetness period (lwp) and temperature on lesion development and sporulation on three boxwood cultivars under controlled conditions to develop predictive models for disease development. We conducted detached leaf assays at 18 to 27°C and various lwp with the cultivars Buxus sempervirens ‘Suffruticosa’ (highly susceptible), B. sempervirens × B. microphylla var. koreana ‘Green Velvet’ (moderately susceptible), and B. microphylla var. japonica ‘Winter Gem’ (less susceptible). Detached leaves were inoculated with 200 conidia in 50 µl of suspension and disease incidence was recorded at 3 to 13 days postinoculation (dpi). Cultivar, lwp, temperature, and most interactions significantly influenced disease development. A minimum of 5 h of leaf wetness was required for any disease. Lesion development increased most rapidly between 12 and 15 h and continued to increase to about 21 h of leaf wetness. Temperatures between 21 and 25°C were optimal for lesion development. There was about a 7-day lag between appearance of lesions and maximal incidence of sporulation. The two less-susceptible cultivars had fewer lesions than Suffruticosa under the same infection conditions; in addition, leaf lesions of Winter Gem exhibited delayed sporulation and sporulation from a smaller proportion of symptomatic leaves. Response surfaces were developed for each cultivar to predict the disease incidence using the lwp and dpi. Our findings will help refine disease forecast models to improve management of boxwood blight.
Puccinia graminis f. sp. tritici Population Causing Recent Wheat Stem Rust Epidemics in Kazakhstan Is Highly Diverse and Includes Novel Virulence Pathotypes
Authors: Olivera P. D. , Szabo L. J. , Kokhmetova A. , Morgounov A. , Luster D. G. , Jin Y.
Published: June 2022

Wheat stem rust, caused by Puccinia graminis f. sp. tritici ( Pgt), is a reemerging disease that caused severe epidemics in northern Kazakhstan and western Siberia in the period of 2015 to 2019. We analyzed 51 stem rust samples collected between 2015 and 2017 in five provinces in Kazakhstan. A total of 112 Pgt races were identified from 208 single-pustule isolates. These races are phenotypically and genotypically diverse, and most of them are likely of sexual origin. No differentiation of phenotypes and single-nucleotide polymorphism genotypes was observed between isolates from Akmola and North Kazakhstan provinces, supporting the idea of a wide dispersal of inoculum in the northern regions of the country. Similarities in virulence profiles with Pgt races previously reported in Siberia, Russia, suggest that northern Kazakhstan and western Siberia constitute a single stem rust epidemiological region. In addition to the races of sexual origin, six races reported in Europe, the Caucasus, and East Africa were detected in Kazakhstan, indicating that this epidemiological region is not isolated, and spore inflow from the west occurs. Virulence alone or in combination to several genes effective against the Ug99 race group was detected, including novel virulence on Sr32 + Sr40 and Sr47. The occurrence of a highly diverse Pgt population with virulence to an important group of Sr genes demonstrated the importance of the pathogen's sexual cycle in generating new and potentially damaging virulence combinations.
Under Pressure: A Comparative Study ofBotrytis cinereaPopulations from Conventional and Organic Farms in Cyprus and Greece
Authors: Makris Georgios , Nikoloudakis Nikolaos , Samaras Anastasios , Karaoglanidis Georgios S. , Kanetis Loukas I.
Published: June 2022

The highly heterogeneous nature of Botrytis cinerea provides adaptive benefits to variable environmental regimes. Disentangling pathogen population structure in anthropogenic agroecosystems is crucial to designing more effective management schemes. Herein, we studied how evolutionary forces exerted in different farming systems, in terms of agrochemicals-input, shape B. cinerea populations. In total, 360 B. cinerea isolates were collected from conventional and organic, strawberry and tomato farms in Cyprus and Greece. The occurrence and frequency of sensitivities to seven botryticides were estimated. Results highlighted widespread fungicide resistance in conventional farms since only 15.5% of the isolates were sensitive. A considerable frequency of fungicide-resistant isolates was also detected in the organic farms (14.9%). High resistance frequencies were observed for boscalid (67.7%), pyraclostrobin (67.3%), cyprodinil (65.9%), and thiophanate-methyl (61.4%) in conventional farms, while high levels of multiple fungicide resistance were also evident. Furthermore, B. cinerea isolates were genotyped using a set of seven microsatellite markers (simple sequence repeat [SSR] markers). Index of association analyses (Ia and rBarD) suggest asexual reproduction of the populations, even though the mating-type idiomorphs were equally distributed, indicating frequency-dependent selection. Fungicide resistance was correlated with farming systems across countries and crops, while SSRs were able to detect population structure associated with resistance to thiophanate-methyl, pyraclostrobin, boscalid, and cyprodinil. The expected heterozygosity in organic farms was significantly higher than in conventional, suggesting the absence of selective pressure that may change the allelic abundance in organic farms. However, genetic variance among strawberry and tomato populations was high, ranking host specificity higher than other selection forces studied.
Development, Implementation, and Meta-Evaluation of a National Approach to Programmatic Assessment in Canadian Family Medicine Residency Training
Authors: Ross Shelley , Lawrence Kathrine , Bethune Cheri , van der Goes Theresa , Pélissier-Simard Luce , Donoff Michel , Crichton Thomas , Laughlin Thomas , Dhillon Kiran , Potter Martin , Schultz Karen
Published: June 2022

The growing international adoption of competency-based medical education has created a desire for descriptions of innovative assessment approaches that generate appropriate and sufficient information to allow for informed, defensible decisions about learner progress. In this article, the authors provide an overview of the development and implementation of the approach to programmatic assessment in postgraduate family medicine training programs in Canada, called Continuous Reflective Assessment for Training (CRAFT). CRAFT is a principles-guided, high-level approach to workplace-based assessment that was intentionally designed to be adaptable to local contexts, including size of program, resources available, and structural enablers and barriers. CRAFT has been implemented in all 17 Canadian family medicine residency programs, with each program taking advantage of the high-level nature of the CRAFT guidelines to create bespoke assessment processes and tools appropriate for their local contexts. Similarities and differences in CRAFT implementation between 5 different family medicine residency training programs, representing both English- and French-language programs from both Western and Eastern Canada, are described. Despite the intentional flexibility of the CRAFT guidelines, notable similarities in assessment processes and procedures across the 5 programs were seen. A meta-evaluation of findings from programs that have published evaluation information supports the value of CRAFT as an effective approach to programmatic assessment. While CRAFT is currently in place in family medicine residency programs in Canada, given its adaptability to different contexts as well as promising evaluation data, the CRAFT approach shows promise for application in other training environments.
Global pediatric surgery and anesthesia inequities: how do we have a global effort?
Authors: Niconchuk Jonathan A. , Newton Mark W.
Published: June 2022

Purpose of review

The SARS-CoV-2 (COVID-19) pandemic has highlighted the inequities in access to healthcare while also revealing our global connectivity. These inequities are emblematic of decades of underinvestment in healthcare systems, education, and research in low-middle income countries (LMICs), especially in surgery and anesthesiology. Five billion people remain without access to safe surgery, and we must take appropriate action now.

Recent findings

The pediatric perioperative mortality in low-resourced settings may be as high as 100 times greater than in high-resourced settings, and a pediatric surgery workforce density benchmark of 4/1 million population could increase survivability to over 80%. Delay in treatment for congenital surgically correctable issues dramatically increases disability-adjusted life years. Appropriate academic partnerships which promote education are desired but the lack of authorship position priority for LMIC-based researchers must be addressed. Five perioperative benchmark indicators have been published including: geospatial access to care within 2 h of location; workforce/100,000 population; volume of surgery/100,000 population; perioperative mortality within 30 days of surgery or until discharged; and risks for catastrophic expenditure from surgical care.

Research that determines ethical and acceptable partnership development between high- and low-resourced settings focusing on education and capacity building needs to be standardized and followed.
Obstetric and perinatal racial and ethnic disparities
Authors: White Robert S. , Aaronson Jaime A.
Published: June 2022

Purpose of review

Healthcare disparities are health differences that adversely affect disadvantaged populations. In the United States, research shows that women of color, in particular Black and Hispanic women and their offspring, experience disproportionately higher mortality, severe maternal morbidity, and neonatal morbidity and mortality. This review highlights recent population health sciences and comparative effectiveness research that discuss racial and ethnic disparities in maternal and perinatal outcomes.

Recent findings

Epidemiological research confirms the presence of maternal and neonatal disparities in national and multistate database analysis. These disparities are associated with geographical variations, hospital characteristics and practice patterns, and patient demographics and comorbidities. Proposed solutions include expanded perinatal insurance coverage, increased maternal healthcare public funding, and quality improvement initiatives/efforts that promote healthcare protocols and practice standardization.

Obstetrical healthcare disparities are persistent, prevalent, and complex and are associated with systemic racism and social determinants of health. Some of the excess disparity gap can be explained through community-, hospital-, provider-, and patient-level factors. Providers and healthcare organizations should be mindful of these disparities and strive to promote healthcare justice and patient equity. Several solutions provide promise in closing this gap, but much effort remains.
LGBTQ+ health and anaesthesia for obstetric and gynaecological procedures
Authors: Ejiogu Nwadiogo I.
Published: June 2022

Purpose of review

People who self-identify as lesbian, gay, bisexual, transgender, queer, two-spirited and intersex (LGBTQ2SI) make up approximately 10% of the US population. Black, Native American and Latino/a/x communities are known to have a higher percentage of people who self-identify as LGBTQ2SI than white communities. Despite growing acceptance of LGBTQ2SI communities in the USA, these populations continue to experience health inequities. This review article will provide a narrative review of recent publications that discuss topics of LGBTQ2SI health and anaesthetic care during obstetric and gynaecological procedures.

Recent findings

Of the articles reviewed for this study, there were four main themes that emerged: inclusion of LGBTQ2SI health topics in curriculum and provider training materials; social determinants of LGBTQ2SI reproductive and overall health; improving the quality and safety of perioperative care for LGBTQ2SI communities; and disparities in perinatal anaesthetic care for LGTBQ2SI communities.

There are unique considerations when providing anaesthetic care for obstetric and gynaecological procedures to LGBTQ2SI communities. There is a limited, yet growing, body of literature exploring this aspect of perioperative and perinatal care. Researchers and clinicians must continue to pursue clinical research which seeks to improve the quality of care we provide all patients.
Safe surgery for every child, implementation of paediatric anaesthesia training in Nigeria
Authors: Desalu Ibironke , Osazuwa Maryrose O.
Published: June 2022

Purpose of review

Nigeria is the most populous country in Africa and 43.5% of its population is under 15 years. Most of these children do not have access to specialized paediatric anaesthesia care when needed, as there are only few paediatric anaesthetists in the country. We highlight the barriers to safe anaesthesia in children, present training opportunities in paediatric anaesthesia and the need for additional, more extensive training in Nigeria.

Recent findings

The Nigerian paediatric anaesthesia workforce is minimal with a dismal paediatric anaesthetist to child density of 0.028 per 100 000 children <15 years old. Training opportunities in paediatric anaesthesia exist during residency, diploma and master's programmes. Short paediatric anaesthesia-related courses are also provided, sometimes by partnering with nongovernmental organizations. There is at present, no Fellowship training programme in Nigeria, to train specialists and leaders in paediatric anaesthesia.

To solve the urgent problem of acute shortage of paediatric anaesthetists in Nigeria, general anaesthetists should be empowered through short courses to provide safe anaesthesia for children. A comprehensive Fellowship programme is urgently needed to train specialists in paediatric anaesthesia. Equipment upgrade, creation of children's hospitals and empowerment for research are important end points that require governmental support.
Dementia in a Hearing-impaired Population According to Hearing Aid Use: A Nationwide Population-based Study in Korea
Authors: Byun Hayoung , Chung Jae Ho , Lee Seung Hwan , Kim Eun Mi , Kim Inah
Published: June 2022

Background:

Hearing loss is considered a potentially modifiable risk factor for dementia. However, the effect of use of a hearing aid on the development of dementia has not been clearly established. We aimed to assess the incidence of dementia in hearing-impaired individuals according to hearing aid use in a nationwide population-based cohort study with matched controls.

Methods:

This was a retrospective, longitudinal, cohort study of South Korean national claims data for individuals newly registered with hearing disabilities (better ear ≥40 dBHL with worse ear ≥80 dBHL, or better ear ≥60 dBHL) between 2004 and 2008. The hearing aid cohort comprised individuals who received hearing aid subsidies from the National Health Insurance within a year from disability registration. The comparison cohort comprised individuals without a record of a hearing aid claim during the study period after 1:1 matching for audiologic and sociodemographic factors with the hearing aid cohort. The occurrence of dementia was followed up until 2018.

Results:

Each cohort comprised 8780 individuals. Overall incidence of dementia in the hearing aid and comparison cohorts were 156.0 and 184.5 per 10,000 person-years, respectively (incidence rate ratio = 0.85, 95% confidence interval 0.79–0.91). In a multivariable analysis of the whole study populations, hearing aid use (hazard ratio = 0.75, 95% confidence interval 0.70–0.81) attenuated the risk of dementia.

Conclusions:

Dementia incidence in individuals with hearing disabilities was lower in hearing aid users than that in nonusers. Hearing rehabilitation with hearing aids should be encouraged for individuals with hearing loss.
Systemic treatment of recurrent and/or metastatic squamous cell carcinomas of the head and neck: what is the best therapeutic sequence?
Authors: Saada-Bouzid Esma , Peyrade Frederic , Guigay Joël
Published: June 2022

Purpose of review

The treatment of recurrent and/or metastatic head and neck squamous cell carcinoma patients is revolutionized by the advent of anti-PD1 checkpoint inhibitors.

Recent findings

Indeed, Pembrolizumab is approved as monotherapy or used in combination with platin and fluorouracil for first-line patients with tumors expressing PD-L1. Nivolumab and Pembrolizumab are also approved in second line of recurrent/metastatic head and neck squamous cell carcinoma. Moreover, the substitution of fluorouracil for a taxane in the TPEx regimen has shown improvement in safety profile when compared with EXTREME regimen.

Here we carry out a review of the main results of pivotal trials and discuss the pros and cons of the three possible scenarios when considering the therapeutic sequence (first and second line).
A Case of Clinically Atypical Gelatinous Drop-like Corneal Dystrophy With Unilateral Recurrent Amyloid Depositions
Authors: Maeno Sayo , Soma Takeshi , Nishida Kohji
Published: June 2022

Purpose:

The purpose of this article was to describe the successful diagnosis and management of clinically atypical, unilateral, gelatinous drop-like corneal dystrophy (GDLD) in a pediatric patient.

Methods:

This study was a case report.

Results:

A 7-year-old Japanese girl was referred to our clinic with right corneal opacity for over 3 years. Slitlamp examination revealed a white, protruding, paracentral corneal opacity with an irregular surface and tiny stromal lattice figures with subepithelial opacities. No trichiasis or epiblepharon was observed, and the patient's right corrected distance visual acuity (CDVA) was 18/20. The contralateral cornea was intact but demonstrated fluorescein uptake. After 8 months, the right CDVA worsened from 18/20 to 6/20, and corneal epithelial scraping was performed. Histopathological analysis revealed amyloid nodules in the subepithelial layer and in the anterior corneal stroma stained with Congo red, which reoccurred 2 months after the procedure, and corneal dystrophy was suspected. Isolation and sequencing of the genomic DNA revealed a homozygous p.Gln118Ter. mutation in TACSTD2 in the patient and heterozygous p.Gln118Ter. mutations in both parents. GDLD was diagnosed; bilateral use of therapeutic soft contact lenses was prescribed after the first corneal scraping. No additional surgical intervention was required for the right eye for 4.5 years. CDVA of the contralateral left eye has been successfully maintained at 30/20 over this period, without emergence of nodular lesions or corneal opacities.

Conclusions:

We encountered a patient with early, atypical GDLD, who was definitively diagnosed using genomic DNA sequencing. GDLD should be a part of the differential diagnosis in patients presenting with unilateral, recurrent amyloid deposition.
Femtosecond LASIK Retreatments After Primary Myopic Photorefractive Keratectomy
Authors: Leccisotti Antonio , Fields Stefania V. , De Bartolo Giuseppe
Published: June 2022

Purpose:

The purpose of the study was to evaluate the results and complications of laser-assisted in situ keratomileusis (LASIK) using a femtosecond laser as a retreatment modality of myopia and myopic astigmatism after previous myopic photorefractive keratectomy (PRK).

Methods:

In this retrospective, consecutive, noncomparative case series study, 69 eyes of 41 patients receiving femtosecond LASIK after previous myopic PRK were evaluated. The mean age was 43.0 ± 8.9 years. The preoperative mean SE was −1.82 ± 1.01 diopter (D), range −0.62 to −6.25. The mean central epithelial thickness was 65 ± 5 μm. A flap was created using a low-energy femtosecond laser (Ziemer LDV Z8), with a programmed thickness calculated by adding 40 μm to the epithelial thickness. Refractive ablation was performed using a Technolas Teneo 317 laser (Bausch and Lomb).

Results:

Twelve months after LASIK, the mean SE was −0.03 ± 0.17 D, with all eyes ≤0.50 D of SE. The mean DE was 0.30 ± 0.25, with 62 eyes (89.9%) ≤0.50 D and all eyes ≤1 D. The mean corrected distance visual acuity (CDVA) was 0.04 ± 0.10 logMAR; no eye lost more than 1 line of CDVA. The mean uncorrected distance visual acuity was 0.07 ± 0.13 logMAR, being 20/25 or better in all eyes. The safety index (postoperative CDVA/preoperative CDVA) was 1.05. The efficacy index (postoperative uncorrected distance visual acuity/preoperative CDVA) was 0.98. No significant complications occurred.

Conclusions:

Myopic retreatments by femtosecond LASIK after primary PRK yielded excellent refractive results without relevant complications. The flap thickness must be tailored to the epithelial thickening after PRK.
The Challenges of Upper Extremity Intramuscular Hemangioma: A Case Study and Systematic Review
Authors: Abu-Ghname Amjed , Luu Bryan C. , Trost Jeffrey , Raj Sarth , Truong Lauren , Davis Matthew J. , Desai Sudhen B. , Pederson William C. , Maricevich Marco , Maricevich Renata S.
Published: June 2022

Background:

Intramuscular hemangiomas are rare, benign vascular tumors, constituting 0.8 percent of all hemangiomas. Upper extremity intramuscular hemangiomas pose diagnostic and therapeutic challenges because of their rarity, invasive nature, and potential for neurovascular involvement. The authors report a comprehensive systematic review of upper extremity intramuscular hemangioma management and a challenging case report.

Methods:

A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were used to identify articles describing upper extremity intramuscular hemangiomas through 2019. Patient demographics, clinical presentation, management, complications, and outcomes were reviewed. Based on operative timing, cases were categorized as either “primary” (excision performed at initial diagnosis) or “secondary” (excision performed after failure of conservative treatment).

Results:

Eighteen articles encompassing 25 patients were included in the authors’ systematic review. Of those, 18 underwent primary excision and seven underwent secondary excision. The majority involved the forearm or antecubital region. Complete excision, evaluated by gross examination or pathology, was reported in all primary cases and 71 percent of secondary cases. Primary excisions demonstrated smaller size of mass (19.4 cm2 versus 165.3 cm2) and superior reported functional outcomes (100 percent versus 33 percent). Complications were reported in 5 percent of the primary excisions compared to 71 percent of the secondary excisions, where one complication was a fatal hematoma.

Conclusions:

The literature concerning upper extremity intramuscular hemangioma is limited to mostly case reports and several case series with the potential risk of bias. With careful dissection and microsurgical technique, wide local excision followed by complete reconstruction can be successfully performed at initial diagnosis for upper extremity intramuscular hemangiomas. At early stages, smaller lesion size significantly reduces the risk of functional impairment and complications.
Evolution of Anomaly-Specific Techniques in Infant Ear Molding: A 10-Year Retrospective Study
Authors: Charipova Karina , Rogers Ashley , Barra Christina , Baker Stephen B.
Published: June 2022

Background:

Congenital ear anomalies occur in at least one-third of the population, and less than one-third of cases self-correct. Ear molding is an alternative to surgery that spares operative morbidity and allows for significantly earlier intervention. In this retrospective study, the senior author (S.B.B.) developed a tailored approach to each specific type of ear deformity. The use of modifications to adapt standard ear molding techniques for each unique ear are described.

Methods:

The authors conducted a retrospective, institutional review board–approved study of 246 patients who underwent ear molding performed by a single surgeon. The procedure reports for each case were reviewed to develop stepwise customization protocols for existing EarWell and InfantEar systems.

Results:

This review included 385 ears in 246 patients. Patient age at presentation ranged from less than 1 week to 22 weeks. Presenting ear deformities were subclassified into mixed (37.4 percent), helical rim (28.5 percent), prominent (10.6 percent), lidding/lop (9.3 percent), Stahl ear (3.6 percent), conchal crus (3.3 percent), and cupping (2.8 percent). Two patients (0.8 percent) had cryptotia. Deformity subclass could not be obtained for 11 patients (4.5 percent). Recommended modifications to existing ear correction systems are deformity-specific: cotton-tip applicator/setting material (Stahl ear), custom dental compound mold (lidding/lop and cupping), scaphal wire (helical rim), cotton-tip applicator/protrusion excision (prominent), and custom dental compound stent (conchal crus).

Conclusions:

Presentation of ear anomalies is heterogenous. This 10-year experience demonstrates that the approach to ear molding should be dynamic and customized, using techniques beyond those listed in system manuals to complement each ear and to improve outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Preliminary analysis of reliability and validity of the Life Space Questionnaire as a real-world mobility measure for people with lower limb loss: A technical note
Authors: Youdan Gregory A. , Chihuri Stanford T. , Wong Christopher K.
Published: June 2022

People with lower-limb loss (PLL) often have reduced mobility that translates into limited community access. The Life Space Questionnaire (LSQ) measures a person’s real-world mobility within their home environment and community but has not been used among PLL. This study assessed preliminary LSQ test-retest reliability and discriminant validity from subjective and objective balance and walking measures in PLL. In addition, LSQ was hypothesized to have an inverse association with overall health status. Nine subjects were analyzed with mean age 48.2 ± 13.1 years and 4.8 ± 3.9 years' time since amputation. Six had transtibial and three had transfemoral amputations due to diabetes (4), vascular disease (3), and trauma (2). The primary outcome was the LSQ, a 9-level scale quantifying the extent to which people accessed their life space including home, yard, and community. Test-retest reliability for the LSQ was moderate (intraclass coefficient = 0.61 with 90% confidence interval: 0.19–0.87). Discriminant validity from balance and walking function was demonstrated by lack of correlation between LSQ score and the Activities-specific Balance Confidence and Berg Balance Scale and the Prosthetic Evaluation Questionnaire mobility subscale and walking speed (r < 0.50, P > .05). LSQ correlated with health status assessed with the Charlson Comorbidity Index (r = −0.84, P = .005). In this sample of PLL, the LSQ demonstrated moderate test-retest reliability as a measure of real-world mobility distinct as a construct from subjective and objective balance or walking measures. People may access their communities using various levels of assistance and methods of transportation. For this sample of PLL, health status was most strongly associated with LSQ score.
A single-subject comparison of functional outcomes between lower limb salvage vs. transtibial amputation through sequential participation in a fall-prevention program
Authors: Acasio Julian C. , Tullos Meghan L. , Mahon Caitlin E. , Khatri Binni R. , Kaufman Kenton R. , Dearth Christopher L. , Hendershot Brad D.
Published: June 2022

Purpose:

Prior research has noted similar functional and subjective outcomes between individuals with delayed amputation vs. limb salvage; however, these reports are generally retrospective in nature. Here, we prospectively compare functional and subjective outcomes from an individual with limb salvage to a delayed transtibial amputation using a single-subject design with sequential participation in a fall-prevention program.

Materials and Methods:

The subject participated in a fall-prevention rehabilitation training program, once before undergoing a delayed transtibial amputation and again after. As part of the fall-prevention program, the participant completed pretraining and post-training assessments which quantified trunk control by 1) trunk flexion and flexion velocity after trip-inducing perturbations on a treadmill and 2) trunk sway parameters during unstable sitting. In addition, the four square step test was administered, and patient-reported outcomes, including pain, prosthetic/orthotic comfort, and walking/running endurance, were collected.

Results:

In general, the participant demonstrated improved trunk control after amputation, as evidenced by decreases in trunk flexion and flexion velocity after perturbation and sway parameters during unstable sitting. In addition, four square step test times were shorter with amputation vs. limb salvage; the participant also reported reduced pain and greater comfort with amputation (vs. limb salvage).

Conclusions:

Although just a single participant, within-subject comparisons provide quantitative evidence that, for some individuals, delayed/late (transtibial) amputation after prolonged limb salvage may be beneficial in reducing pain and restoring function.