bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of analytic and clinical performance of thrombin–antithrombin complex and d-dimer assay in prognosis of acute ischemic stroke
Authors: Ye Naifang , Liu Zhenzhen , Wang Xuefeng , Xu Xiaoqian , Wu Wenman
Published: May 2020

To evaluate analytic and clinical performance of plasma thrombin–antithrombin complex (TAT) andd-dimer assay in assessing the severity and outcome of acute ischemic stroke. The prospective study was conducted and extended from January 2018 to December 2018. A total of 236 patients admitted within 24 h after neurologic symptoms onset were recruited. The median TAT andd-dimer levels were significantly higher in the acute ischemic stroke patients than in the controls. The average TAT levels in patients with mild, moderately severe and severe stroke were 1.75 [interquartile ranges (IQR), 1.1–2.6], 3.3 (IQR, 1.8–4.5) and 13.5 (IQR, 7.2–15.3) ng/ml. Thed-dimer levels of respective patient groups were 0.39 (IQR, 0.22–0.73), 0.58 (IQR, 0.39–1.25) and 3.59 (IQR, 1.73–4.74) mg/l. With the optimal cut-off TAT level (1.75 ng/ml) determined from receiver operating characteristic analysis, the Area under the curve (AUC), the sensitivity and specificity of TAT for stroke diagnosis were 0.763, 58.1 and 87.8%. The cut-offd-dimer level was 0.38 mg/l and the AUC, the sensitivity and specificity were 0.772, 60.2 and 88.9%. The Area under the receiver operating characteristic curves (AUROCs) and sensitivity in the moderate to severe stroke increased to 0.903 and 86.9% for TAT, and 0.880 and 80.3% ford-dimer, respectively. Age and high TAT level were significant independent risk factors for stroke severity. Age, high initial National Institutes of Health Stroke Scale score and high TAT level were significant independent poor prognostic factors on multivariate analysis. TAT andd-dimer were superior in separating the moderate-to-severe stroke than mild stroke. A high TAT plasma level is an independent predictor for stroke severity and poor prognosis during 1-month follow-up.
Comparison of tenofovir and entecavir in the development of acute kidney injury in cirrhotic chronic hepatitis B patients with refractory ascites
Authors: Tsai Ming-Chao , Chang Kuo-Chin , Yen Yi-Hao , Wu Cheng-Kun , Lin Ming-Tsung , Hu Tsung-Hui
Published: May 2020

Background and aim:

Tenofovir disoproxil fumarate (TDF) and entecavir are effective antiviral medications that are recommended as first-line monotherapies for the treatment of chronic hepatitis B (CHB) infection, including decompensated liver cirrhosis with ascites. Acute kidney injury (AKI) commonly occurs in patients with cirrhosis and ascites. The aim of this study was to compare the development of AKI during TDF and entecavir treatment of CHB patients with cirrhotic refractory ascites.

Methods:

From January 2011 to April 2017, we identified patients who were diagnosed with cirrhosis with refractory ascites and received TDF or entecavir treatments at Kaohsiung Chang Gung Memorial Hospital. AKI was defined as an increase in serum creatinine of more than 0.3 mg/dL or 1.5-fold from baseline. All episodes of AKI were recorded and compared between those who received TDF and entecavir.

Results:

A total of 111 patients were enrolled in this retrospective study, of which 22 patients were treated with TDF and 89 were treated with entecavir. Patients with AKI episodes had a higher proportion of TDF treatment (P = 0.01), male (P = 0.023), hepatocellular carcinoma (P = 0.007), admission (P = 0.045), and mortality (P = 0.018). Logistic regression analysis illustrated that TDF treatment of patients with comorbidity was an independent risk factor for the development of AKI [odds ratio (OR), 3.756; 95% confidence interval (CI), 1.293–10.912; P = 0.015] and hepatorenal syndrome (OR, 7.651; 95% CI, 1.697–34.508; P = 0.008).

Conclusions:

TDF treatment is a risk factor for AKI and HRS development in cirrhotic patients with refractory ascites in comparison with entecavir treatment, especially in patients with comorbidity.
Logistic regression analysis of repeated radioiodine therapy treatments for papillary thyroid carcinoma patients
Authors: Soliman Khaled , Albander Hasna , Alenezi Ahmed
Published: May 2020

Purpose

Radioiodine ablation treatment (RAT) is administered to papillary thyroid carcinoma patients post thyroidectomy. Multivariable logistic regression analysis can be applied to predict treatment failure. In this study, we propose a logistic regression model (LRM) to estimate the probability of repeating the treatment more than one time.

Materials and methods

A retrospective review of the last 5 years of RAT data revealed that 30 patients had received the RAT more than one time. Various factors including age, sex, pretreatment serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH) and administered activity were analyzed to predict RAT failure and therefore the necessity to repeat the treatment by administering additional doses of radioiodine.

Results

The administered activity, the patient age, the presence of distant lymph nodes on the whole-body radioiodine scan (WBS) and the level of Tg before the treatment were found to be the predictive variables. The following LRM is proposed: Y = 7.8295 − 0.0012 [Activity in (MBq) − 0.0541 (Age) − 34.3 (Lymph Nodes) − 0.0042 (Tg)]. The prediction accuracy of the LRM was assessed using receiver operating characteristic (ROC) curve by calculating the area under the curve (AUC). We found the AUC = 0.8972.

Conclusion

Patients who are older in age, who receive higher administered radioiodine activity, have higher serum thyroglobulin levels and have lymph node uptake reported in their post-ablation WBS are more likely to have unsuccessful treatment outcome and will repeat the treatment. This LRM could help in adjusting RAT options in order to reduce the repeat rate.
Measles: taking steps forward to prevent going backwards
Authors: Gupta Kriti , Chen Michelle , Rocker Joshua
Published: May 2020

Purpose of review

The measles vaccine, first introduced in 1963, directly led to a dramatic decrease in the incidence of the disease. Measles transitioned from being a common childhood disease, affecting approximately three to four million children annually, to being eradicated in the United States in 2000. What was once an astounding victory for modern medicine, however, has recently seen a dramatic reversal in fortune, with a resurgence of measles cases in the United States. Hence, it merits careful discussion.

Recent findings

The United States has seen more measles cases in 2019 than in any prior year in the past 30 years. These outbreaks are because of many factors but a significant cause is the increase in vaccine refusal within sub-populations in America. This finding indicates that the current approach that healthcare workers take with families towards MMR vaccination could be more effective.

This article aims to educate the reader about the measles virus and its clinical presentation, the MMR vaccine and its overwhelming success, and the concerning current national and international trends in measles outbreaks. Importantly, we focus on positions proposed by hesitant vaccinators and determine how medical providers can participate in productive conversation about vaccination to better gain trust and guide improved shared clinical decision-making.
Manifestations of pulmonary aspergillosis in pediatrics
Authors: Chacko Archana , Moss Richard B.
Published: May 2020

Purpose of review

Aspergillus spp. cause a clinical spectrum of disease with severity of disease dependent on degree of immune compromise, nature and intensity of inflammatory host response, and/or underlying lung disease. Chronic pulmonary aspergillosis encompasses a spectrum of diseases including aspergilloma, Aspergillus nodules, chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis, and subacute invasive pulmonary aspergillosis. Allergic bronchopulmonary aspergillosis (ABPA) paradoxically is an immune hypersensitivity manifestation in the lungs that almost always occurs in the setting of underlying asthma or cystic fibrosis. These chronic Aspergillus conditions are now becoming more prevalent than invasive Aspergillus, thus it is important to be aware of the current literature of these conditions.

Recent findings

High-level research assessing the clinical significance and treatment options of these chronic diseases are lacking. Recent literature suggests colonization is antecedent for local airway infection (Aspergillus bronchitis), chronic or allergic bronchopulmonary disease, or invasive and potentially disseminated disease. There have been few advances in assessment of treatment of ABPA.

Research assessing the clinical significance and treatment options is currently needed.
Reproducibility of the DrGoniometer app for field-based assessment of the break-point angle in Nordic Hamstring exercise
Authors: Vercelli Stefano , Baldaccini Alex , Sartorio Francesco , Bravini Elisabetta , Corna Stefano , Ferriero Giorgio
Published: May 2020

Smartphone-based measurement could represent a portable and cheap solution to assess the Nordic Hamstring break-point angle (BPA). We investigated the following: (1) the reproducibility of the DrGoniometer app, (2) its agreement with a computerized video analysis software used as a reference method, and (3) the effects of raters’ experience. Fifty recordings were processed by four independent raters. Intraclass correlation coefficient (ICC), SEM, and minimum detectable change (MDC) were calculated. Bland–Altman plots verified the limits of agreement (LoA) with the reference method. The effect of raters’ clinical experience was investigated by unpaired t-tests. The app showed excellent intra-rater (ICC = 0.89, 95% CI, 0.84–0.92) and inter-rater reliability (ICC = 0.82, 95% CI, 0.74–0.89), low error (SEM = 2°; MDC = 5.5°), and substantial agreement with video analysis [95% LoA = ±6.7°; mean difference = 1.0°]. Rater experience did not affect results (P > 0.05). The smartphone-based app offers a reliable, valid, quick, and portable method for measuring the BPA in Nordic Hamstring exercise.
Implications for the Multi-Disciplinary Management of Children With Craniofrontonasal Syndrome
Authors: Dupré Sophie , Care Helen , Gordon Zoe , Wall Steven A. , Wilkie Andrew O.M. , Johnson David , Kilcoyne Sarah
Published: May 2020

The purpose of this retrospective study was to assess the genetic and phenotypic features of patients with craniofrontonasal syndrome (CFNS), and the implications of the condition for multidisciplinary management.

The subjects were 25 female patients with a mutation of EFNB1, who presented to the Oxford Craniofacial Unit during a 38-year period. Medical records were reviewed for genetic and phenotypic information. Mean duration of follow-up was 12.6 years (range 0–30.7 years).

This study examines neurodevelopment in constituent parts, with specific reference to speech, language, and cognition in relation to genotype. Three children had deletions extending beyond the EFNB1 gene; the 2 with available data presented with speech, language, or cognitive delay. The remaining 25 patients had intragenic mutations of EFNB1. Of these 25, those assessed in detail showed variable difficulties with speech and language development; 57% had receptive language difficulties (n = 4/7) and 88% had expressive language difficulties (n = 8/9). 55% presented with speech difficulties (n = 6/11). 2/3 patients with abnormal hearing had speech difficulties; 4/5 with normal hearing had normal speech development. Cognitive assessments indicated that IQ is variable; with full scale IQ ranging from 69 to 100.

The complex, multifactorial presentation of patients with CFNS contributed to 41% (n = 7/17) of patients requiring additional educational support.

Our results demonstrated significant multidisciplinary input is required, including Speech and Language Therapy, Plastic and Reconstructive Surgery, Genetics, Ear, Nose and Throat, Maxillofacial, Orthodontic, Orthopaedic, Clinical Psychology and Orthoptic teams. The results of this study reinforce the importance of multi-disciplinary long-term follow-up of children with CFNS.
Lessons Learned in Posttraumatic Reconstruction of Labial Defects in Children
Authors: Gómez-Díaz Oswaldo J. , Restrepo-Serna Daniel
Published: May 2020

There is no universal technique for reconstructing the different types of labial defects. The etiology, the size and location, the layers compromised and the depth of the defect are the main determinants of the technique to be chosen. The aesthetic form and the function recovery must be the main objective of the therapeutic process.

Scarce studies concentrate into the pediatric population and the operational resolution of complex, full-depth defects. The oral contingence, articulation and facial expression (mimicking) are amongst the most important functions of the lower third of the face, and, in terms of reconstruction, they represent a difficult task for the plastic surgeon. In our case, the experience has taught us about new tools, useful and potentially replicable to guide the reconstruction of our infantile population. The authors present different techniques from five different cases, using loco-regional options that spare microsurgical solutions.
Abnormal Acoustic Features Following Pharyngeal Flap Surgery in Patients Aged Six Years and Older
Authors: Zhou Haiyan , Lu Jingwei , Zhang Chuhan , Li Xiao , Li Yuru
Published: May 2020

In our study, older velopharyngeal insufficiency (posterior velopharyngeal insufficiency) patients were defined as those older than 6 years of age. This study aimed to evaluate the abnormal acoustic features of older velopharyngeal insufficiency patients before and after posterior pharyngeal flap surgery. A retrospective medical record review was conducted for patients aged 6 years and older, who underwent posterior pharyngeal flap surgery between November 2011 and March 2015. The audio records of patients were evaluated before and after surgery. Spectral analysis was conducted by the Computer Speech Lab (CSL)-4150B acoustic system with the following input data: The vowel /i/, unaspirated plosive /b/, aspirated plosives /p/, aspirated fricatives /s/ and /x/, unaspirated affricates /j/ and /z/, and aspirated affricates /c/ and /q/. The patients were followed up for 3 months. Speech outcome was evaluated by comparing the postoperatively phonetic data with preoperative data. Subjective and objective analyses showed significant differences in the sonogram, formant, and speech articulation before and after the posterior pharyngeal flap surgery. However, the sampled patients could not be considered to have a high speech articulation (<85%) as the normal value was above or equal to 96%. Our results showed that pharyngeal flap surgery could correct the speech function of older patients with posterior velopharyngeal insufficiency to some extent. Owing to the original errors in pronunciation patterns, pathological speech articulation still existed, and speech treatment is required in the future.
Characteristics of Panfacial Fractures in the Elderly: Etiology, Fracture Patterns, Concomitant Injuries, and Postoperative Complication Risk
Authors: Park Dongha , Cha Bohwan , Myung Yujin
Published: May 2020

Background:

Facial trauma, including panfacial fractures caused by high-impact trauma, is increasingly frequent in elderly patients. The purpose of this study was to investigate the effects of the particularly serious and challenging panfacial fractures on elderly adults.

Methods:

The authors retrospectively reviewed the files of all patients who were operated for panfacial fractures at our institution from December 2006 to December 2018. The definition of a panfacial fracture was a concurrent fracture in 2 or more locations, including nasoethmoid, frontozygomaticomaxillary, Le Fort I and II, and mandibular fractures. The authors reviewed in-hospital medical records to collect data on the medical history, cause of injury, fracture location, accompanying surgery, postoperative complications, duration of hospital stay, laboratory results, radiographic studies, and computed tomography scans.

Results:

A total of 454 patients were enrolled. Among them, 57 (13%) were <19 years old, 304 (72%) were 19 to 60 years old, and 62 (15%) were >60 years old. Compared with younger patients, those aged older than 60 years were more likely to have underlying diseases including diabetes, hypertension, and antiplatelet, and showed a significantly higher proportion of brain hemorrhage, internal organ contusion, surgical site infection, and hematoma after surgery.

Conclusion:

The authors have analyzed the largest number of panfacial fractures in an elderly population so far. The pattern of injury and sequelae of severe facial trauma in elderly patients may be more serious, and the postoperative course more prone to complications than in younger patients. Therefore, more delicate treatment and a high degree of suspicion are needed.
Le Fort 1 and Bimaxillary Osteotomies Increase the Length of Stay but not Postoperative Morbidity Compared to Mandibular Osteotomies and Single Jaw Procedures
Authors: Jodeh Diana S. , Nguyen Anh Thy H. , Rottgers S. Alex
Published: May 2020

Purpose:

The purpose of this study is to examine the association between type of facial osteotomies performed during orthognathic surgery and postoperative outcomes including complications, length of stay, and readmission.

Methods:

A retrospective review of orthognathic surgery cases from the Pediatric Health Information System (PHIS) database from 2004 to 2014 was undertaken. Osteotomy procedures were classified as Le Fort 1 (LF 1), Mandibular osteotomy, Genioplasty or their combinations. Primary outcome variable was major complications. Secondary outcomes included postoperative LOS > 1 day and 90-day readmission. Random-intercept logistic regression models were utilized to assess the association between the type of osteotomy performed and the outcomes. Bonferroni approach was used to account for multiple comparisons.

Results:

The sample included 5413 patients, with a mean age of 17.1 ± 1.68 years and 60.65% were female. The most common procedures were LF1 (39.4%), followed by bimaxillary surgery (23%). Major complications occurred in 8.57% of patients, postoperative LOS > 1 day in 52.4% and 90-day all-cause readmission in 11.16%. In adjusted analyses comparing LF1 compared to mandibular osteotomies, there were no significant differences for major complications (OR = 0.78), 90-day readmission rate (OR = 0.98). However, LF1 was associated with an increased odds for LOS compared to mandibular osteotomies (OR = 1.42). Addition of osteotomies is associated with a significant increase in LOS (P < 0.001).

Conclusions:

Patients undergoing orthognathic surgery demonstrated increased length of stay for LF1 or bimaxillary osteotomies. Osteotomy type did not impact the odds of readmission or complications. The trends revealed should be helpful for patient counseling.
Saving Face: Patient Strategies to Reduce Stigma and Barriers to Effective Decision-Making Among Children With Cleft Lip
Authors: Makar Katelyn G. , Patterson Anne K. , Haase Madeleine M. , Schafer Kylie A. , Vercler Christian J. , Kasten Steven J. , Buchman Steven R. , Waljee Jennifer F. , Byrnes Mary
Published: May 2020

Facial differences associated with cleft lips are often stigmatizing and can negatively impact psychosocial development and quality of life. However, little is known regarding patients’ responses to societal expectations of appearance, or how these responses may impact utilization of revision surgery. Thus, patients with cleft lips at least 8 years of age (n = 31) were purposively sampled for semi-structured interviews. After verbatim transcription, first cycle coding proceeded with a semantic approach, which revealed patterns that warranted second cycle coding. The authors utilized an eclectic coding design to capture deeper meanings in thematic analysis. Additionally, survey data from a separate study were examined to evaluate participants’ interest in improving appearance. Three major themes emerged, all of which reflected a desire to “save face” when interacting with society: (1) Cultural Mantras, which included societal mottos that minimized the importance of appearance; (2) Toughening Up, wherein the participants downplayed the difficulty of having a cleft; and (3) Deflection, wherein the participants took pride in facial features unrelated to their clefts. Despite these efforts to “save face,” 78% of participants expressed interest in improving their appearance in the separate survey data.

In conclusion, children with cleft lips try to “save face” when interacting with society by depreciating appearance, making light of clefts, and focusing on non-cleft related features. Paradoxically, many desired improvements of their appearance in an earlier survey. Awareness of these coping strategies is critical, as they may negatively impact surgeon-patient communication and inhibit patients from expressing interest in revision surgery.
Virtual Surgery Planning and Three-Dimensional Printing Template for Osteotomy of the Zygoma to Correct Untreated Zygomaticomaxillary Complex Fracture
Authors: Lassausaie Anais , Sesqué Alexandre , Barthélémy Isabelle , Depeyre Arnaud
Published: May 2020

Untreated zygomaticomaxillary complex fractures may lead to aesthetical and functional sequelae needing secondary surgical correction. A 31-year-old male was addressed to our department for right enophthalmos and loss of cheek projection 3 months after facial trauma. Restauration of facial symmetry can be achieved by repositioning of the zygomaticomaxillary complex by osteotomies. To achieve good functional and aesthetical results, the reduction needs to be accurate. This is the main difficulty in delayed cases as there are less anatomical landmarks due to initial trauma and bone remodeling. Nowadays, in France, thanks to good care access, very few patients are not treated within the first two weeks after trauma; thus, surgeons have little experience on secondary reduction. It has been reported that navigation-guided surgery and use of stereolithographic models improve results. In small centers, access to both technologies and induced over-cost may limit their use. With the ease to access a 3D printer, small centers have to develop innovative, simple ways to offer comparative results. In the case presented, surgery planning and plate modeling were achieved using an office-based three-dimensional printed model. To reduce the cost, free open source software has been used. In this case, facial symmetry has been restored and post-operative computed tomography scan shows good stability. This simple, cost effective technique, is applicable in most centers equipped with a 3D printer and ensures a good and reproductive result even when this surgery is not routinely done.
Trans-Oral Robotic Surgery in the Management of a Supraglottic Solitary Fibrous Tumor
Authors: De Virgilio Armando , Mercante Giuseppe , Costantino Andrea , Pellini Raul , Petruzzi Gerardo , Yiu Philip , Gaino Francesca , Spriano Giuseppe
Published: May 2020

Trans-oral robotic surgery (TORS) has become increasingly widespread for the head and neck surgery procedures. In this paper, the authors describe the first reported TORS in the management of a laryngeal solitary fibrous tumor (SFT). A 77-year-old woman suffered from progressive dysphonia lasting 2 years and occasional dyspnea. A submucosal mass of about 4 cm in diameter involving the left supraglottis and left aryepiglottic fold was detected during the flexible fibre-optic laryngeal examination. Magnetic resonance imaging revealed a solid, well-demarcated mass (36 × 25 mm), hyperintense with nonhomogeneous contrast enhancement in T2-weighted sequences. The lesion was successfully removed en bloc using the daVinci Xi system (Intuitive Surgical, Sunnyvale, CA) equipped with 3 robotic arms (1 3-dimensional endoscopic arm, 1 monopolar cautery, 1 bipolar Maryland forceps). The postoperative course was regular, and the endoscopic examination at 1 month showed normal laryngeal morphology and function. Trans-oral robotic surgery has proved to be a good alternative to conventional trans-oral approaches in the treatment of laryngeal SFT. The lesion was completely removed without intraoperative complications, and postoperative morbidity was minimized. Further comparative studies are recommended to define if TORS could become the gold standard for the surgical treatment of laryngeal SFTs.
Relationship Between Self-efficacy and Performance of Simulated Neonatal Chest Compressions and Ventilation
Authors: Donohue Lee T. , Underwood Mark A. , Hoffman Kristin R.
Published: May 2020

Introduction

Because improved competence in caring for patients is difficult to measure, self-efficacy (the strength of one's belief in one's ability to complete a task) is often used as a surrogate measurement of clinical ability. However, studies in adults and children have shown at best only weak correlations between self-efficacy and performance. This correlation has not been well studied in neonatal resuscitation limiting the utility of self-efficacy as a measurement of the effectiveness of interventions in this population. The objective of this study was to determine whether self-efficacy correlates with performance of simulated neonatal chest compressions and ventilation.

Methods

Sixty-nine neonatal fellows, neonatal nurse practitioners, neonatologists, and nurses completed a 7-point Likert scale in which they reported their ability to perform ventilations and chest compressions. The participants then performed chest compressions and bag-valve-mask ventilation on a mannequin. The performance of participants was compared with the rating of their ability using Spearman rank correlation coefficient.

Results

There was no correlation between participants' self-assessment and performance of chest compressions (r
s = 0.003) or bag-valve-mask ventilation (r
s = 0.08). There was a correlation between experience (years of neonatal intensive care unit experience, number of mock codes, and number of real codes) and the ratings of self-efficacy as well as between the number of mock codes and ventilation performance.

Conclusions

In this study, self-reported efficacy had no correlation to clinical skills in neonatal resuscitation; participants both overestimated and underestimated their clinical proficiency. Prior participation in mock codes in the neonatal intensive care unit was the only factor that correlated with resuscitation performance.
Delivering Simulation Activities Safely: What if We Hurt Ourselves?
Authors: Naweed Anjum , Dennis Diane , Krynski Ben , Crea Teresa , Knott Cameron
Published: May 2020

Summary Statement

Although a focus on the learner rightly remains in any teaching environment, the psychological safety of everyone involved in the conduct of experiential learning and critical academic scholarship is important. Education literature suggests that faculty are just as prone to psychological harm as their learners. This commentary describes adverse experiences from a simulation-based education event that took place at an Australasian interprofessional and cross-domain simulation workshop. Event facilitators explored the notion of the “safe container” but, in the process, were themselves exposed to psychological injury. We summarize an ostensibly complex simulation activity with unintended sequelae, the ethical concerns surrounding the faculty care, and from lessons learned, present an extended conceptualization of the safe container including broader parameters around the preparation of all involved in the delivery of simulation-based activities. Our goals in sharing this case is to encourage the community to become more vigilant regarding the unintended consequences of our simulation activities and to encourage open reporting and discussion of such incidents for the betterment of the field.
Hysterectomy Volume Among Recent Obstetrics and Gynecology Residency Graduates
Authors: Cadish Lauren A. , Kropat Georg , Muffly Tyler M.
Published: May 2020

Objective

Although guidelines recommend hysterectomy be performed vaginally whenever possible, recent trainees have decreased exposure to vaginal hysterectomy given the availability of laparoscopic hysterectomy, nonsurgical management, and falling volume nationwide. We sought to estimate hysterectomy volume in the 5 years after residency. Our secondary objective was to compare vaginal hysterectomy utilization between recent graduates and senior surgeons.

Methods

Retrospective, statewide data from 2005 to 2014 was obtained from the Massachusetts Center for Health Information Analysis. All hysterectomies performed in Massachusetts, regardless of payer type, were included. Surgeon identifiers were cross-referenced to another data set with provider demographics. Hysterectomies performed in the first 5 years after graduation were compared with a group 21 to 25 years after residency.

Results

Data from inpatient and outpatient databases revealed 87,846 hysterectomies performed by 1967 physicians, including 3146 simple hysterectomies by 192 recent graduates. Recent graduates chose abdominal hysterectomy (44.2%) most commonly, followed by laparoscopic (29.4%), vaginal (16.1%), and laparoscopically assisted vaginal (10.4%). Recent graduates performed a median of 3 to 4 hysterectomies in each of the first 5 years with no increase over time (P = 1). The median number of vaginal or laparoscopic hysterectomies was 0 in these 5 years (interquartile ranges, 0–1 and 0–2, respectively). Members of the senior cohort performed a median of 8 to 9 hysterectomies annually, completing them vaginally more often (24.7% vs 16.1%, P < 0.01). When controlling for patient age and hysterectomy indication, this effect dissipated.

Conclusions

Recent graduates perform 3 to 4 (interquartile range, 1–7) hysterectomies annually, predominantly by laparotomy. Although senior surgeons perform vaginal hysterectomy more often, this is explained by patient characteristics.
It Takes a Village: The First 100 Patients Seen in a Multidisciplinary Pelvic Floor Clinic
Authors: Jochum Sarah B. , Legator Hanna , Abraham Rana R. , Bhama Anuradha R. , Dugan Sheila A. , Favuzza Joanne , Jacobs Kristin M. , Robinson Kenika R. , Saclarides Theodore J. , Hayden Dana M. , Brincat Cynthia A.
Published: May 2020

Objective

This study aimed to assess the characteristics of patients assessed and treated at a multidisciplinary pelvic floor program that includes representatives from multiple specialties. Our goal is to describe the process from triaging patients to the actual collaborative delivery of care. This study examines the factors contributing to the success of our multidisciplinary clinic as evidenced by its ongoing viability.

Methods

This is a descriptive study retrospectively analyzing a prospectively maintained database that included the first 100 patients seen in the Program for Abdominal and Pelvic Health clinic between December 2017 and October 2018. We examined patient demographics, their concerns, and care plan including diagnostic tests, findings, treatments, referrals, and return visits.

Results

The clinic met twice monthly, and the first 100 patients were seen over the course of 10 months. The most common primary symptoms were pelvic pain (45), constipation (30), bladder incontinence (27), bowel incontinence (23), high tone pelvic floor dysfunction (23), and abdominal pain (23); most patients had more than one presenting symptom (76). The most common specialties seen at the first visit to the clinic included gastroenterology (56%), followed by physical medicine and rehabilitation (45%), physical therapy (31%), female pelvic medicine and reconstructive surgery (25%), behavioral health (19%), urology (18%), and colorectal surgery (13%). Eleven patients were entirely new to our hospital system. Most patients had diagnostic tests ordered and performed.

Conclusions

A multidisciplinary clinic for abdominal and pelvic health proves a sustainable model for comprehensive treatment for patients with pelvic floor dysfunction, including difficulties with defecation, urination, sexual dysfunction, and pain.
Clinical correlates of paliperidone palmitate and aripiprazole monohydrate prescription for subjects with schizophrenia-spectrum disorders: findings from the STAR Network Depot Study
Authors: Bartoli Francesco , Ostuzzi Giovanni , Crocamo Cristina , Corbo Mariangela , D’Agostino Armando , Martinotti Giovanni , Ostinelli Edoardo Giuseppe , Tabacchi Tommaso , Barbui Corrado , Carrà Giuseppe
Published: May 2020

This study, based on the ‘Servizi Territoriali Associati per la Ricerca’ (STAR) Network Depot Study nationwide baseline data, explored whether individual symptoms severity and clusters might influence the prescription of paliperidone palmitate 1-month (PP1M) vs. aripiprazole monohydrate. The Brief Psychiatric Rating Scale (BPRS) was used to assess psychopathology and relevant symptoms clusters. Drug Attitude Inventory, 10 items, was used to test attitude towards medications. Adherence to treatments was rated according to the Kemp seven-point scale. We assessed for eligibility 451 individuals and, among them, we included 195 subjects (n = 117 who started PPM1 and n = 78 aripiprazole monohydrate). Individuals were comparable in terms of age, gender, treatment years, recent hospitalizations, previous long-acting injectable antipsychotic treatments, additional oral treatments, attitude toward drugs, medication adherence, and alcohol/substance-related comorbidities. Subjects starting PP1M presented higher BPRS overall (P = 0.009), positive (P = 0.015), and negative (P = 0.010) symptom scores compared to subjects starting aripiprazole monohydrate. Results were confirmed by appropriate regression models and propensity score matching analysis. No differences were found comparing the other BPRS subscale scores: affect, resistance, and activation. Clinicians may be more prone to prescribe PPM1, rather than aripiprazole monohydrate, to subjects showing higher overall symptom severity, including positive and negative symptoms. No additional clinical factors influenced prescribing attitudes in our sample.
Exposure to high male density causes maternal stress and female-biased sex ratios in a mammal
Authors: Firman Renée C.
Published: May 2020

A shift from the traditional perspective that maternal stress is invariably costly has instigated recent interest into its adaptive role in offspring sex allocation. Stress generated by social instability has been linked to offspring sex ratio biases that favour the production of female offspring, which converges with the theoretical prediction that mothers in the poor condition are better off investing in daughters rather than sons. However, previous research has failed to disentangle two different processes: the passive consequence of maternal stress on sex-specific mortality and the adaptive effect of maternal stress at the time of conception. Here, I show that exposure to high male density social conditions leads to elevated stress hormone levels and female-biased
in utero
offspring sex ratios in house mice (
Mus musculus domesticus
), and identify that sex-specific offspring production—not sex-specific mortality—is the mechanism accounting for these sex ratio skews. This outcome reflects the optimal fitness scenario for mothers in a male-dominated environment: the production of daughters, who are guaranteed high mate availability, minimizes male–male competition for their sons. Overall, this study supports the idea that maternal stress has the potential to be adaptive and advances our understanding of how exposure to different social conditions can influence sex allocation in mammals.
Allocation of gene products to daughter cells is determined by the age of the mother in single
Escherichia coli
cells
Authors: Shi Chao , Chao Lin , Proenca Audrey Menegaz , Qiu Andrew , Chao Jasper , Rang Camilla U.
Published: May 2020

Gene expression and growth rate are highly stochastic in
Escherichia coli
. Some of the growth rate variations result from the deterministic and asymmetric partitioning of damage by the mother to its daughters. One daughter, denoted the old daughter, receives more damage, grows more slowly and ages. To determine if expressed gene products are also allocated asymmetrically, we compared the levels of expressed green fluorescence protein in growing daughters descending from the same mother. Our results show that old daughters were less fluorescent than new daughters. Moreover, old mothers, which were born as old daughters, produced daughters that were more asymmetric when compared to new mothers. Thus, variation in gene products in a clonal
E. coli
population also has a deterministic component. Because fluorescence levels and growth rates were positively correlated, the aging of old daughters appears to result from both the presence of both more damage and fewer expressed gene products.
Reclassification of the genus Natronolimnobius: proposal of two new genera, Natronolimnohabitans gen. nov. to accommodate Natronolimnobius innermongolicus and Natrarchaeobaculum gen. nov. to accommodate Natronolimnobius aegyptiacus and Natronolimnobius sulfurireducens
Authors: Sorokin Dimitry Y. , Merkel Alexander Y. , Messina Enzo , Yakimov Mikhail M. , Itoh Takashi , Mesbah Noha M. , Wiegel Juergen , Oren Aharon
Published: May 2020

The genus

Natronolimnobius

, currently including four species, is a member of the order

Natrialbales

, class Halobacteria, and consists of obligately alkaliphilic and extremely halophilic members found exclusively in highly alkaline hypersaline soda lakes. The species were classified into this genus mostly based on phylogenetic analysis of the 16S rRNA gene. However, a more advanced phylogenomic reconstruction based on 122 conserved single-copy archaeal protein markers clearly indicates a polyphyletic origin of the species included into this genus, thus warranting its reclassification into three separate genera. We therefore propose to transfer Nlb. innermongolicus (type strain N-1311) to a new genus Natronolimnohabitans as Nlh. innermongolicus comb. nov. and to transfer Nlb. aegyptiacus (type strain JW/NM-HA 15) and Nlb. sulfurireducens (type strain AArc1) to a new genus Natrarchaeobaculum as Nbl. aegyptiacum comb. nov. and Nbl. sulfurireducens comb. nov. The phylogenomic differentiation of these four species is also supported by the ANI/AAI distances and unique phenotypes. The most important physiological differences includes a previously unreported ability for cellulose and xylan utilization in Nlb. baerhuensis, thermophily in Nbl. aegyptiacus and anaerobic sulfur respiration in Nbl. sulfurireducens. We further present an emended description of

Natronolimnobius baerhuensis

.
Modestobacter altitudinis sp. nov., a novel actinobacterium isolated from Atacama Desert soil
Authors: Golińska Patrycja , Świecimska Magdalena , Montero-Calasanz Maria del Carmen , Yaramis Adnan , Igual Jose M. , Bull Alan T. , Goodfellow Michael
Published: May 2020

Three presumptive

Modestobacter

strains isolated from a high altitude Atacama Desert soil were the subject of a polyphasic study. The isolates, strains 1G4T, 1G51 and 1G52, were found to have chemotaxonomic and morphological properties that were consistent with their assignment to the genus

Modestobacter

. They formed a well supported clade in

Modestobacter

16S rRNA gene trees and were most closely related to the type strain of ‘Modestobacter excelsi’ (99.8–99.9% similarity). They were also closely related to the type strains of

Modestobacter caceresii

(99.6 % similarity),

Modestobacter italicus

(99.7–99.9% similarity),

Modestobacter lacusdianchii

(98.4–99.2% similarity),

Modestobacter marinus

(99.4–99.5% similarity) and

Modestobacter roseus

(99.3–99.5% similarity), but were distinguished from their closest relatives by a combination of phenotypic features. Average nucleotide identity and digital DNA:DNA hybridization similarities drawn from comparisons of draft genome sequences of isolate 1G4T and its closest phylogenetic neighbours mentioned above, were well below the threshold used to assign closely related strains to the same species. The close relationship between isolate 1G4T and the type strain of M. excelsi was showed in a phylogenomic tree containing representative strains of family

Geodermatophilaceae

. The draft genome sequence of isolate 1G4T (size 5.18 Kb) was shown to be rich in stress related genes providing further evidence that the abundance of

Modestobacter

propagules in Atacama Desert habitats reflects their adaptation to the harsh environmental conditions prevalent in this biome. In light of all of these data it is proposed that the isolates be assigned to a novel species in the genus

Modestobacter

. The name proposed for this taxon is Modestobacter altitudinis sp. nov., with isolate 1G4T (=DSM 107534T=PCM 3003T) as the type strain.
Cancer is associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis
Authors: Gao Ya , Liu Ming , Shi Shuzhen , Chen Yamin , Sun Yue , Chen Ji , Tian Jinhui
Published: May 2020

Background

Cancer patients are considered a highly vulnerable population in the COVID-19 epidemic, but the relationship between cancer and the severity and mortality of patients with COVID-19 remains unclear. This study aimed to explore the prevalence of cancer in patients with COVID-19 and to examine whether cancer patients with COVID-19 may be at an increased risk of severe illness and mortality.

Methods

A comprehensive electronic search in seven databases was performed, to identified studies reporting the prevalence of cancer in COVID-19 patients, or providing data of cancer between patients with severe or non-severe illness or between non-survivors and survivors. Meta-analyses were performed to estimate the pooled prevalence and odds risk (OR) using the inverse variance method with the random-effects model.

Results

Thirty-four studies with 8080 patients were included. The pooled prevalence of cancer in patients with COVID-19 was 2.0% (95% CI: 2.0% to 3.0%). The prevalence in Italy (5.0%), France (6.0%), and Korea (4.0%) were higher than that in China (2.0%). Cancer was associated with a 2.84-fold significantly increased risk of severe illness (OR = 2.84, 95%CI: 1.75 to 4.62, P < 0.001) and a 2.60-fold increased risk of death (OR = 2.60, 95%CI: 1.28 to 5.26, P = 0.008) in patients with COVID-19. Sensitivity analyses showed that the results were stable after excluding studies with a sample size of less than 100.

Conclusions

Cancer patients have an increased risk of COVID-19 and cancer was associated with a significantly increased risk of severity and mortality of patients with COVID-19.
NTT Docomo and Apple mobility data compared as countermeasures against COVID-19 outbreak in Japan
Authors: Sugishita Yoshiyuki , Kurita Junko , Sugawara Tamie , Ohkusa Yasushi
Published: May 2020

Background

In Japan, as a measure to inhibit the COVID-19 outbreak, voluntary restrictions against going out (VRG) have been applied.

Object

Mobility information provided by Apple Inc. and NTT Docomo were assessed in terms of its usefulness in predicting conditions exacerbating an outbreak.

Method

A polynomial function was applied to daily Apple and Docomo data to calculate the observed R(t).

Results

The correlation coefficient among Apple and Docomo data was 0.91. The adjusted coefficient of determination for R(t) for the whole study period was higher using Docomo data than when Apple data were used. When we regressed R(t) on daily Apple and Docomo data simultaneously, the estimated coefficient of Docomo data was not significant.

Discussion and Conclusion

We demonstrated that Apple mobility data might be superior to Docomo data for explaining the entire course of the COVID-19 outbreak in Japan.
Sinus and Anterior Skull Base Surgery during the COVID-19 pandemic: Systematic review, Synthesis and YO-IFOS position
Authors: Radulesco Thomas , Lechien Jerome R. , Sowerby Leigh J , Saussez Sven , Chiesa-Estomba Carlos , Sargi Zoukaa , Lavigne Philippe , Calvo-Henriquez Christian , Lim Chwee Ming , Tangjaturonrasme Napadon , Vatanasapt Patravoot , Puya Dehgani-Mobaraki , Fakhry Nicolas , Ayad Tareck , Michel Justin
Published: May 2020

Purpose

The COVID-19 pandemic has caused significant confusion about healthcare providers’ and patients’ pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic.

Methods

PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework.

Results

15 international publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients’ COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited.

Conclusions

Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing use of PPE is essential with sinus and anterior skull base surgery.
Correlating Covid-19 mortality and infection levels
Authors: Gadgil Mugdha , Gadgil Chetan
Published: May 2020

Covid-19 deaths and positive cases show a remarkable heterogeneity across countries which cannot be easily explained on the basis of similarities or differences in the quality of healthcare, access to healthcare, testing facilities, or preventive measures such as lockdowns. Here we show that there is a distinct correlation between the mortality level and the infection level across countries, which can explain the mortality levels for a wide spectrum of countries. This implies that the number of deaths per 100 infected individuals is approximately the same across diverse countries and can be estimated from the slope of the mortality level-infection level plot. The correlation presented here can potentially be combined with estimates of infection spread to forecast future mortality levels and therefore future needs in terms of healthcare and other resources. Tracking of an individual location’s temporal path on this plot can potentially serve as a visual assessment of the nature of the epidemic. Methods presented here are not specific to the current epidemic. This is a preliminary report and uses data from a single source at a single time-point to demonstrate the capability of such an analysis.
Heterogeneous contact networks in COVID-19 spreading: the role of social deprivation
Authors: Majumdar Arnab , Mehta Anita
Published: May 2020

We have two main aims in this paper. First we use theories of disease spreading on networks to look at the COVID-19 epidemic on the basis of individual contacts — these give rise to predictions which are often rather different from the homogeneous mixing approaches usually used. Our second aim is to look at the role of social deprivation, again using networks as our basis, in the spread of this epidemic. We choose the city of Kolkata as a case study, but assert that the insights so obtained are applicable to a wide variety of urban environments which are densely populated and where social inequalities are rampant. Our predictions of hotspots are found to be in good agreement with those currently being identified empirically as containment zones and provide a useful guide for identifying potential areas of concern