bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication Among Southeast Asian Mothers and Daughters About Cervical Cancer Prevention
Authors: Kue Jennifer , Szalacha Laura A. , Rechenberg Kaitlyn , Nolan Timiya S. , Menon Usha
Published: June 2021

Background

Southeast Asian women have high rates of cervical cancer and yet are among the least likely to be screened. There is sparse literature on communication patterns among Southeast Asian women, specifically related to cervical cancer and Pap test uptake. Little is known about the influence of Southeast Asian mothers and daughters on each other’s cervical cancer beliefs and screening behaviors.

Objectives

We examined the perceptions of and barriers to cervical cancer screening among Cambodian and Lao mothers and daughters and explored how they converse about women’s health issues, specifically cervical cancer and Pap testing.

Methods

We conducted in-depth interviews with Cambodian and Lao mother–daughter dyads, aged 18 years and older, living in a large Midwestern city between February and September of 2015. Descriptive statistics were calculated to summarize the sample demographic characteristics. Bivariate tests (contingency table analyses, independent t-tests, and Pearson correlations) were conducted to test for differences between the mothers and daughters in demographic characteristics and measures of health status and beliefs. Qualitative data were analyzed using content analysis.

Results

In-depth interviews were conducted with three Cambodian and eight Lao mother–daughter dyads. The daughters were significantly more acculturated to English, had greater education, and were mostly employed full time. The mothers and daughters evaluated their health status much the same, their medical mistrust equally, and all of the mothers and nine of the daughters were Buddhist. Themes in mother–daughter communication included what mothers and daughters do and do not talk about with regard to sexual health, refugee experiences, what hinders mother–daughter communication, and relationship dynamics. The mothers were embarrassed and uncomfortable discussing cervical cancer, Pap testing, and other women’s health issues with their daughters. Although mothers did not influence women’s health promotion or cervical cancer prevention with their daughters, daughters did influence their mothers’ health and healthcare decisions. Daughters were critical in navigating healthcare systems, engaging with providers, and making medical decisions on behalf of their mothers.

Discussion

By leveraging the unique and dynamic intergenerational bond that mothers and daughters who identify as Southeast Asian have, we can develop strategies to influence the cultural dialogue related to cervical cancer and early detection.
Pilot Study of Absolute Telomere Lengths in Preterm Infants
Authors: Casavant Sharon G. , Li Hongfei , Reese Bo , Chen Ming-Hui , Cong Xiaomei S.
Published: June 2021

Background

Annually, approximately 15 million babies are born preterm (<37 weeks gestational age) globally. In the neonatal intensive care unit (NICU) environment, infants are exposed to repeated stressful or painful procedures as part of routine lifesaving care. These procedures have been associated with epigenetic alterations that may lead to an increased risk of neurodevelopmental disorders. Telomere length has been negatively associated with adverse life experiences in studies of adults.

Objectives

This pilot study aimed to describe telomere length in a sample of preterm infants at NICU discharge and examine any associations with pain, feeding method, and neurodevelopment.

Methods

This descriptive pilot study sample includes baseline absolute telomere length (aTL) of 36 preterm infants immediately prior to discharge. Quantitative polymerase chain reaction was used to determine aTL. Infant demographics, pain/stress, type of feeding, antibiotic use, neurodevelopment, and buccal swab data were collected. Descriptive data analysis was used to describe the telomere length using graphs.

Results

Among our preterm infant samples, the mean aTL was far greater than the average adult telomere length. Although no significant associations were found between aTL and pain, feeding method, and neurodevelopment, a trend between sex was noted where male telomere lengths were shorter than females as they aged.

Discussion

This is one of few studies to evaluate preterm infant telomere length. Although other researchers have used relative telomere length, we used the more accurate aTL. We found nonsignificant shorter telomere lengths among males. Additional large-scale, longitudinal studies are needed to better identify the predictors of telomere length at the time of discharge from NICU.
IRF8 is a Reliable Monoblast Marker for Acute Monocytic Leukemias
Authors: Katz Samuel G. , Edappallath Susmitha , Xu Mina L.
Published: June 2021

Blast evaluation in patients with acute monocytic leukemias (AMoL) is notoriously difficult due to the lack of reliable surface markers and cytologic subtleties on the aspirate smears. While blasts of most nonmonocytic acute leukemias express CD34, available immunohistochemical antibodies to monocytic blasts also mark normal background mature monocytes. We searched for a potential biomarker candidate by surveying specific gene expression profiles of monocyte progenitors. Our investigations led us to IRF8, which is a lineage-specific transcription factor critical for the production of monocytic and dendritic cell progenitors. In this study, we tested and validated a monoclonal antibody to IRF8 as a novel immunohistochemical stain for trephine core biopsies of human bone marrow. We assessed the expression of IRF8 in 90 cases of AMoL, including posttherapy staging bone marrows, 23 cases of chronic myelomonocytic leukemia, 26 cases of other acute myeloid leukemia subtypes, and 18 normal control marrows. In AMoL, there was high correlation of IRF8-positive cells to aspirate blast count (R=0.95). Comparison of IRF8 staining to aspirate blast percentage in chronic myelomonocytic leukemia also showed good correlation (R=0.86). In contrast, IRF8-positive cells did not correlate with blast count in other subtypes of acute myeloid leukemia (R=0.56) and staining was <5% in all normal control marrows, even those with reactive monocytosis. We found that IRF8 was also weakly reactive in B cells and hematogones, with the latter accounting for rare cases of discrepancies. When IRF8 was used to categorize cases as AMoL, positive for residual leukemia or negative, the sensitivity was 98%, specificity was 82%, positive predictive value was 86%, and negative predictive value was 98%. These results demonstrate that IRF8 may serve as a clinically useful immunostain to diagnose and track AMoLs on bone marrow core biopsies. This can be particularly impactful in the setting of poor aspiration and focal blast increase. In the era of new targeted therapies that have been reported to induce monocytic outgrowths of leukemia, a marker for malignant monoblasts may prove even more critical.
Local Health Department Revenue Diversification and Revenue Volatility: Can One Be Used to Manage the Other?
Authors: Viall Abigail H. , Bekemeier Betty , Yeager Valerie A. , Carton Thomas
Published: June 2021

Objective:

Revenue volatility—particularly in the form of sudden and significant reductions in funding—has been shown to negatively affect local health departments (LHDs) by impacting the amount and type of services delivered. This study examined the potential effectiveness of revenue diversification as a means of managing LHD financial risk. More specifically, we examine the relationship between revenue diversification and revenue volatility among LHDs in Washington State.

Design and Setting:

We applied fixed-effects linear regression models with robust standard errors to revenue data reported during 1998-2014 by all LHDs operating in Washington State. We also assessed the robusticity of our results to alternative specifications for revenue diversification and volatility.

Main Outcome Measures:

LHD revenue and revenue volatility.

Results:

Between 1998 and 2014, LHDs in Washington State were exposed to considerable upside and downside fiscal risks. While average revenue volatility was close to 0 (0.2%), observed values ranged from −35% to 63%. LHD revenues were already highly diversified: as measured using a reversed Herfindahl-Hirschman Index, diversification values ranged between 0.56 and 1.00. There is little evidence to suggest the existence of a statistically significant relationship between revenue diversification and volatility.

Conclusions:

Revenue volatility presents LHDs with important short- and long-term operational challenges. Our models suggest that revenue diversification did not reduce revenue volatility among Washington State LHDs in 1998-2014. Further research will need to examine whether revenue diversification reduces LHD financial risk in other settings.
Deterioration of the Corticobulbar Tract in Older Dysphagic Patients Without Neurologic Diseases
Authors: Chang Min Cheol , Seo Yousung , Kwak Soyoung
Published: June 2021

Objectives

Less is known how dysphagia affects older patients without neurologic diseases and whether the symptoms of dysphagia have any association with impaired central control of swallowing. This study investigated the state of the corticobulbar tract, the surrogate marker for the central control of swallowing, in older dysphagic patients without any neurologic diseases, using diffusion tensor tractography.

Design

This retrospective observational study was conducted at a tertiary university hospital including 10 patients 60 yrs or older with oropharyngeal dysphagia without neurological disease and 11 age- and sex-matched control participants. The corticobulbar tract was reconstructed, and the fractional anisotropy and tract volume were measured using diffusion tensor tractography.

Results

The corticobulbar tracts of the dysphagia group were narrowed and not reconstructed by their configurations and had lower fractional anisotropy and tract volume values when compared with those of control group. Significant asymmetry between the left and the right corticobulbar tract hemispheres was found in the dysphagia group, whereas no asymmetry was found in the control group.

Conclusions

A deteriorated corticobulbar tract could be associated with the development of dysphagia in older adults without neurological diseases. Our findings might help establish more appropriate treatment strategies, such as targeted neuromodulation therapies in the future.
Effects of a Combined Motor Imagery and Action Observation Intervention on Vascular Cognitive Impairment
Authors: Liu Wensi , Li Zhe , Xie Yi , He Aiqun , Hao Daojian , Dong Anqin
Published: June 2021

Objective

The aim of the study was to identify the effects of combined motor imagery and action observation therapy on vascular cognitive impairment.

Design

Thirty vascular cognitive impairment patients were randomly assigned into three groups. Cognitive training group was given conventional cognitive training, motor imagery + action observation group was treated with motor imagery and action observation therapy, and mixed therapy group was given conventional cognitive training and motor imagery + action observation therapy, for 8 wks continuously. The Montreal Cognitive Assessment Scale, Rivermead Behavioral Memory Test, and event-related potential were used to evaluate the cognitive function at baseline, 4- and 8-wk posttreatment, and 1-mo follow-up.

Results

There were significant time × group interactions in Montreal Cognitive Assessment Scale (F
6,4.20 = 8.38, P < 0.001), event-related potential latent period (F
6,294.24 = 5.10, P < 0.001), event-related potential amplitude (F
6,1.68 = 23.08, P < 0.001), and Rivermead Behavioral Memory Test (F
6,312.61 = 5.42, P < 0.001). Intragroup comparisons showed that Montreal Cognitive Assessment Scale and Rivermead Behavioral Memory Test scores and event-related potential amplitude increased significantly (P < 0.05), and event-related potential latency decreased significantly (P < 0.05) in all groups. Intergroup comparisons showed that the changes of all outcomes in mixed therapy group were greater than those in cognitive training and motor imagery + action observation group (P < 0.05) after treatment.

Conclusions

These results suggest that the combination of cognitive training with motor imagery and action observation therapy is an effective treatment on cognitive function in people with vascular cognitive impairment.
Effects of Dynamic Overground Body Weight Support Training During Inpatient Rehabilitation After Traumatic Spinal Cord Injury
Authors: Powell Elizabeth Salmon , Lopez John , Westgate Philip M. , Hines Emily , Sawaki Lumy
Published: June 2021

Rehabilitation strategies after traumatic spinal cord injury aim to maximize functional recovery by applying principles of neuroplasticity via task-specific, repetitive training. Rehabilitation of patients with traumatic spinal cord injury poses unique challenges, including bilateral limb involvement, autonomic dysfunction, loss of proprioception, and potentially spinal precautions/bracing. The purpose of this retrospective case series was to determine whether use of dynamic body weight support would yield greater improvement in functional recovery compared with standard of care in adults with traumatic spinal cord injury. Data were collected from patients with traumatic spinal cord injury who completed inpatient rehabilitation incorporating dynamic body weight support (n= 5) and who completed inpatient rehabilitation without dynamic body weight support (n= 5). The primary outcome measure was the change in Functional Independence Measures. The dynamic body weight support group had a significantly greater improvement in Total Functional Independence Measures and in Functional Independence Measures motor subscale compared with the standard of care group (P= 0.023 andP= 0.033, respectively). This study presents initial evidence that dynamic body weight support therapy during inpatient rehabilitation has the potential to improve functional independence compared with standard of care in patients with traumatic spinal cord injury. Larger prospective randomized studies need to be conducted to expand on these findings.
Mild Traumatic Brain Injury Is Associated With Increased Dual-Task Cost During Ambulation
Authors: Pinto Shanti M. , Newman Mark A. , Runyon Michael S. , Gibbs Michael , Grafton Lori M. , Hirsch Mark A.
Published: June 2021

Objective

The aim of the study was to determine the impact of dual-task conditions on mobility after mild traumatic brain injury.

Design

Eleven adults with mild traumatic brain injury within 1 wk of injury and 10 age- and sex-matched healthy controls completed gait trials with a single-task condition and three separate dual-task conditions: counting by 1 (low), serial subtraction by 3 (medium), and alternating letters and numbers (high). Dual-task cost was calculated as dual-task cost = ([dual-task performance] – [single-task performance]) / [single-task performance] × 100%.

Results

Participants with mild traumatic brain injury ambulated slower than control subjects (P < 0.001). Significant differences in dual-task cost were noted for both group (P < 0.001) and dual-task condition (P = 0.005). Dual-task cost was greater for those with mild traumatic brain injury compared with controls with significant group differences for the low and high cognitive loads (P < 0.05). Only 1 of the 11 individuals with mild traumatic brain injury and 1 of the 10 controls demonstrated gait speed less than 80 cm/sec, which is predictive of community mobility, during any dual-task condition. Dual-task cost exceeded 11.9%, previously determined to be the minimal detectable change in healthy adults, for 9 of the 11 individuals with mild traumatic brain injury compared with 3 of the 10 controls.

Conclusions

Dual-task cost may be a more sensitive measure for impairment during dual-task conditions than gait speed after mild traumatic brain injury.
Capacity for Hand-as-a-Holder Function of the Spastic Combination Hand
Authors: Mayer Nathaniel H. , Ferraro Mary , Pauloski-Hunt Diane , Chervoneva Inna
Published: June 2021

We call a hemiparetic hand with paralyzed finger extensors and volitional but spastic flexors a “spastic combination hand.” Anecdotally, patients report hand-as-a-holder function with objects like pill bottles, motivating us to formally study spastic combination hand holding capacity using cylinders with different diameters. Nine participants with spastic hemiparesis and spastic combination hand more than 24 mos performed a standardized motor task with 10 cylinder diameters ranging between 1.3 and 9.5 cm and weighing 0.8 and 8.4 oz. Using the unaffected hand, participants attempted to insert a given cylinder into their spastic combination hand, holding it independently for 5 secs. Successful holds were counted during two sessions before and one session after botulinum toxin intervention of Ashworth 3 hand muscles. Findings revealed that a median capacity of six different cylinder diameters was successfully inserted into spastic combination hand at least once before block and a median capacity of 10 cylinders was inserted after block. A mixed-effect statistical model using fixed effects of cylinder diameter and session revealed that total number of successful holds was 43% higher after botulinum. We conclude that this proof-of-concept study does support the idea that spastic combination hand has holding capacity for cylindrical objects of specified diameter and weight and that botulinum neurotoxin offers potential for enlarging spastic combination hand capacity.
Prevalent human papillomavirus infection increases the risk of HIV acquisition in African women: advancing the argument for human papillomavirus immunization
Authors: Liu Gui , Mugo Nelly R. , Brown Elizabeth R. , Mgodi Nyaradzo M. , Chirenje Zvavahera M. , Marrazzo Jeanne M. , Winer Rachel L. , Mansoor Leila , Palanee-Phillips Thesla , Siva Samantha S. , Naidoo Logashvari , Jeenarain Nitesha , Gaffoor Zakir , Nair Gonasagrie L. , Selepe Pearl , Nakabiito Clemensia , Mkhize Baningi , Mirembe Brenda Gati , Taljaard Marthinette , Panchia Ravindre , Baeten Jared M. , Balkus Jennifer E. , Hladik Florian , Celum Connie L. , Barnabas Ruanne V.
Published: June 2021

Objective:

Vaccine-preventable human papillomavirus (HPV) infection is common, especially in sub-Saharan Africa where HIV risk is also high. However, unlike other sexually transmitted infections (STIs), HPV's role in HIV acquisition is unclear. We evaluated this relationship using data from MTN-003, a clinical trial of HIV chemoprophylaxis among cisgender women in sub-Saharan Africa.

Design:

A case–control study.

Methods:

We matched 138 women who acquired HIV (cases) to 412 HIV-negative controls. Cervicovaginal swabs collected within 6 months before HIV seroconversion were tested for HPV DNA. We estimated the associations between carcinogenic (high-risk) and low-risk HPV types and types targeted by HPV vaccines and HIV acquisition, using conditional logistic regression models adjusted for time-varying sexual behaviors and other STIs.

Results:

Mean age was 23 (±4) years. Any, high-risk and low-risk HPV was detected in 84, 74 and 66% of cases, and 65, 55 and 48% of controls. Infection with at least two HPV types was common in cases (67%) and controls (49%), as was infection with nonavalent vaccine-targeted types (60 and 42%). HIV acquisition increased with any [adjusted odds ratio (aOR) 2.5, 95% confidence interval (95% CI) 1.3–4.7], high-risk (aOR 2.6, 95% CI 1.5–4.6) and low-risk (aOR 1.8, 95% CI 1.1–2.9) HPV. Each additional type detected increased HIV risk by 20% (aOR 1.2, 95% CI 1.1–1.4). HIV acquisition was associated with HPV types targeted by the nonavalent (aOR 2.1, 95% CI 1.3–3.6) and quadrivalent vaccines (aOR 1.9, 95% CI 1.1–3.2).

Conclusion:

HPV infection is associated with HIV acquisition in sub-Saharan African women. In addition to preventing HPV-associated cancers, increasing HPV vaccination coverage could potentially reduce HIV incidence.
Safety of Tenofovir Alafenamide in People With HIV Who Experienced Proximal Renal Tubulopathy on Tenofovir Disoproxil Fumarate
Authors: Campbell Lucy , Barbini Birgit , Burling Keith , Cromarty Ben , Hamzah Lisa , Johnson Margaret , Jones Rachael , Samarawickrama Amanda , Williams Deborah , Winston Alan , Post Frank A. ,   FANTA trial team
Published: June 2021

Background:

Proximal renal tubulopathy (PRT) is an infrequent complication of tenofovir disoproxil fumarate (TDF). It remains to be established whether tenofovir alafenamide (TAF) can be safely administered to individuals who experienced PRT on TDF.

Methods:

Individuals with a history of TDF-associated PRT and current estimated glomerular filtration rate (eGFR) over 30 mL/min/1.73 m2 initiated TAF and were followed for 96 weeks. The primary outcome of interest was recurrent PRT. Secondary outcomes were changes in kidney biomarkers, bone biomarkers, and bone mineral density (BMD). Data were analyzed using multilevel mixed-effects linear regression models. The trial was registered under EudraCT 2016-003345-29.

Results:

All 31 participants [median age 55 (inter-quartile range 51, 60) years, 97% men, 87% White ethnicity] remained on TAF at week 96, and none developed glycosuria or recurrent PRT. Participants experienced small declines in eGFR-creatinine [−1.9 (95% confidence interval: −3.5 to −0.3) mL/min/1.73 m2/yr; P = 0.024], but not in eGFR-cystatin C [−0.9 (−2.1 to 0.4) mL/min/1.73 m2/yr; P = 0.16]. Ten (32%) and 5 (16%) participants experienced rapid (>5 mL/min/1.73 m2/yr) decline in eGFR-creatinine and eGFR-cystatin C. No significant change in other kidney biomarkers, bone turnover, or BMD was observed (P > 0.2).

Conclusions:

In individuals with a history of PRT on TDF, 96 weeks of TAF was not associated with recurrent PRT or adverse effects on renal tubular function, bone turnover, or BMD. These data suggest that TAF is a treatment option for this vulnerable population.
HIV-1 Nucleic Acids Identify Rectal HIV Exposures in Self-Collected Rectal Swabs, Whereas Y-Chromosome Single Tandem Repeat Mixtures Are Not Reliable Biomarkers of Condomless Receptive Anal Intercourse
Authors: Lemos Maria P. , Nandi Vijay , Dragavon Joan , Fleming Ira , Krishnan Keertana , Musuruana Martin , Kramer Madeline , Glantz Hayley , Andrasik Michele , Coombs Robert W. , McElrath M. Juliana , Tieu Hong-Van
Published: June 2021

Background:

To focus interventions, biomarkers of HIV-1 exposure could help in identifying subpopulations at highest risk of acquisition. We assessed whether Y-chromosome single tandem repeat (YSTR) mixtures obtained from rectal swabs could serve as a biomarker of condomless receptive anal intercourse (CRAI) among men who have sex with men and transgender women and evaluated the feasibility of detecting HIV-1 virions to assess exposures.

Methods:

Twenty-nine sexually active HIV-seronegative men who have sex with men and one transgender woman from New York City answered on-site and mobile app sexual behavior questionnaires. They were randomized to collecting self-administered rectal swabs every morning or after receptive anal intercourse (RAI). YSTR profiles were assessed from blood sample and swabs; HIV-1 exposure was measured by conducting quantitative polymerase chain reaction in swabs.

Results:

After 2 months, the daily mobile survey had 135%–201% more instances of anal sex acts and 170%–193% more RAI than on-site surveys. Daily mobile reporting had 11%–35% less CRAI events than those reported on-site (P
daily = 0.001; P
per-sex = 0.047). The daily swabbing arm reported less RAI (P < 0.001) and CRAI (P < 0.038) and had 2.95 lower odds of detecting YSTR mixtures (P = 0.021) than the per-sex-event arm. Surprisingly, YSTR detection was not significantly modified by report of bowel movements and lubricant, enema, or condom use. No participant became HIV-1 infected, yet HIV-1 total nucleic acids were detected in 6 independent episodes of CRAI in 2 participants taking pre-exposure prophylaxis.

Conclusions:

YSTR mixtures demonstrated 80% specificity but only 30% sensitivity as a biomarker of CRAI in self-collected rectal swabs. However, detection of HIV-1 exposures in self-collected swabs may help in identifying those needing further HIV risk reduction strategies.
Quality and Safety in Healthcare, Part LXXXIX
Authors: Harolds Jay A.
Published: June 2021

A major priority of the Toyota Production System is to satisfy the customers by providing high value. The use of continuous flow, pull systems, the Andon system, standard work, visual controls, the 5S system, and reliable technology are critically important. Optimizing one’s workforce is also very important by developing leaders and teams, using consensus in decision making, and becoming a learning organization. To fully understand the problems, it is also important that leaders go to the workplace to talk to workers and see what is going on.
Reliability of Quantitative 18F-FDG PET/CT Imaging Biomarkers for Classifying Early Response to Chemoradiotherapy in Patients With Locally Advanced Non–Small Cell Lung Cancer
Authors: Horn Kevin P. , Thomas Hannah M.T. , Vesselle Hubert J. , Kinahan Paul E. , Miyaoka Robert S. , Rengan Ramesh , Zeng Jing , Bowen Stephen R.
Published: June 2021

Purpose of the Report

We evaluated the reliability of 18F-FDG PET imaging biomarkers to classify early response status across observers, scanners, and reconstruction algorithms in support of biologically adaptive radiation therapy for locally advanced non–small cell lung cancer.

Patients and Methods

Thirty-one patients with unresectable locally advanced non–small cell lung cancer were prospectively enrolled on a phase 2 trial (NCT02773238) and underwent 18F-FDG PET on GE Discovery STE (DSTE) or GE Discovery MI (DMI) PET/CT systems at baseline and during the third week external beam radiation therapy regimens. All PET scans were reconstructed using OSEM; GE-DMI scans were also reconstructed with BSREM-TOF (block sequential regularized expectation maximization reconstruction algorithm incorporating time of flight). Primary tumors were contoured by 3 observers using semiautomatic gradient-based segmentation. SUVmax, SUVmean, SUVpeak, MTV (metabolic tumor volume), and total lesion glycolysis were correlated with midtherapy multidisciplinary clinical response assessment. Dice similarity of contours and response classification areas under the curve were evaluated across observers, scanners, and reconstruction algorithms. LASSO logistic regression models were trained on DSTE PET patient data and independently tested on DMI PET patient data.

Results

Interobserver variability of PET contours was low for both OSEM and BSREM-TOF reconstructions; intraobserver variability between reconstructions was slightly higher. ΔSUVpeak was the most robust response predictor across observers and image reconstructions. LASSO models consistently selected ΔSUVpeak and ΔMTV as response predictors. Response classification models achieved high cross-validated performance on the DSTE cohort and more variable testing performance on the DMI cohort.

Conclusions

The variability FDG PET lesion contours and imaging biomarkers was relatively low across observers, scanners, and reconstructions. Objective midtreatment PET response assessment may lead to improved precision of biologically adaptive radiation therapy.
Characterizing Concomitant Follicular Lymphoma and Gastric Carcinoma Using 68Ga-FAPI-04 and 18F-FDG PET/CT
Authors: Chen Xuetao , Wei Maomao , Wang Shuailiang , Yang Zhi , Wang Xuejuan
Published: June 2021

We herein report a case involving a 67-year-old man with concomitant progressive follicular lymphoma and gastric carcinoma. Baseline 18F-FDG PET/CT showed high metabolic activity in multiple nodal stations and a thickened gastric antrum wall, whereas 68Ga-FAPI-04 PET/CT depicted very intense tracer uptake in the gastric lesion but mild uptake in the nodes. After the treatment, complete remission from lymphadenopathy was achieved, whereas the gastric lesion accumulated more radiotracers compared with baseline levels. Despite our incorrect initial assumption of B-cell transformation, molecular imaging was able to profile the characteristics of these 2 diseases.
Two-Stage Treatment of a Large Premaxillary Defect
Authors: Dibbs Rami P. , Beh Han Zhuang , Ferry Andrew M. , Davies Lesley W. , Nguyen Jenny L. , Reece Edward M. , Alfi David M. , Pederson William C. , Buchanan Edward P.
Published: June 2021

Bilateral cleft lip and palate (CLP) patients commonly require surgical management to treat maxillary hypoplasia following the primary repair. Rarer is the CLP patient who also presents with a missing premaxillary segment. Here the authors present the case of a 19-year-old female with a history of bilateral CLP who demonstrated significant maxillary hypoplasia in addition to a large premaxillary defect. To correct this deformity, LeFort I advancement with fibular reconstruction of the maxilla and dental implant placement was performed as a single surgical procedure. The authors discuss the advantages of undergoing this single-staged operation. By utilizing virtual surgical planning (VSP) and incorporating a multidisciplinary team within the operating room, the patient was able to successfully undergo maxillary reconstruction and dental implant placement in a single operation.
Craniosynostosis of the Metopic Suture in a Patient With CADASIL/Lehman Syndrome
Authors: Riordan Coleman P. , Lyon Helen N. , McIntyre Joyce K.
Published: June 2021

A 3-month-old patient presented for evaluation by plastic surgery with marked trigonocephaly and was subsequently diagnosed with metopic craniosynostosis. During presurgical evaluation, the patient was found to have two variants of the NOTCH3 gene, resulting in the diagnosis of lateral meningocele (Lehman) syndrome. Due to the increased possibility of stroke associated with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, the patient underwent only anterior calvarial vault remodeling without fronto-orbital advancement for correction of her craniosynostosis. This unique constellation of symptoms, and its impact on operative management, has not been previously described in the literature.
One Triangle-Blepharoplasty Flap for Anterior Lamellae Pretarsal Defects on the Upper Eyelid
Authors: Díez-Montero Cecilia , Marqués-Fernández Victoria E. , Galindo-Ferreiro Alicia
Published: June 2021

Purpose:

The aim of this study is to present the outcomes of one triangle blepharoplasty flap upper eyelid (UE) reconstruction. It is a hardly recognized technique used to repair anterior lamella pretarsal defects resulting from the removal of lesions on the UE.

Methods:

Retrospective review of three excised lesions reconstructed with one triangle-blepharoplasty flap technique between 2017 and 2020 at Río Hortega University Hospital in Valladolid, Spain. It is a technique to reconstruct wide-based anterior lamella UE lesions, 25% to 50% UE length. Demographic characteristics, histology results and complications are presented.

Results:

Medical records of three patients have been reviewed with a minimum follow-up of 6 months (mean follow up of 16 months). The patient's average age was 67 years. Histology results were three seborrheic keratosis. There were no intra or post-surgical complications and all had good functional and aesthetic upper lid results.

Conclusions:

The reconstruction of pretarsal lesions limited to the anterior lamella of the UE using one triangle-blepharoplasty flap is a technique with good functional and aesthetic results.
Facial Contouring Surgery Using Facelift Approach
Authors: Lee Yoon Joo , Lee Cho Long , Lee Il Seok , Yang Ho Jik
Published: June 2021

Background:

In Asian women who undergo facelift surgery, satisfying results are achieved for facial rhytides, but there have been complaints concerning malar prominence and mandible angle region postoperatively. Anatomically, compared with the Caucasians, the Asians have a thick skin and a wide and short facial geometry. The Asians generally have a protruded zygoma and prominent mandible angles; accordingly, their bony contouring surgery that is the base frame in facelift must be considered. The authors aimed to investigate the effects of performing facial contouring surgery and facelift simultaneously to achieve oval facial contour and youthful face.

Methods:

The authors assessed 21 Asian women who simultaneously underwent facial contouring surgery with facelift between March 2014 and March 2018. The clinical results were assessed based on preoperative and postoperative photographs and the global aesthetic improvement scale score.

Results:

Surgery was successful in all patients. Postoperatively, improvements in facial rhytides and appropriate facial contour were achieved. All patients were satisfied with the outcomes. Some patients experienced short-term complication; however, these complications improved. Serious long-term complications were not noted.

Conclusions:

Highly satisfying outcomes can be achieved with combined facial contouring surgery and facelift for Asian women with a wide face.
The Role of Facial Expression Analysis and Electrodermal Activity as an Objective Evaluation of Persistent Idiopathic Facial Pain
Authors: Rokicki Jan Pavel , Ivanauskas Andrius , Janužis Gintaras
Published: June 2021

Persistent idiopathic facial pain (PIFP) is an enigmatic condition presenting with variable features. Psychiatric comorbidities are speculated to influence PIFP.

In this study, the authors evaluated patients with PIFP through the hospital anxiety and depression scale, facial expression analysis, and electrodermal activity.

A total of 67 respondents enrolled as the experimental group and 28 participants as the control group. Pain scores were higher in the experimental group (5.24; SD 2.349) P < 0.001 depression (5.58 (SD 3.766) versus 3.07 (SD 2.418), P = 0.002) and anxiety scores (9.78 (SD 4.923) versus 6.75 (SD 4.097) P = 0.007) were higher in the experimental group. The experimental group expressed more negative episodes (P = 0.024); Electrodermal Activity data in terms of peaks/min (P = 0.872) and average peak amplitude (P = 0.168) were not significantly different between the groups.

It may be concluded that pain levels may be influenced by psychiatric comorbidity as PIFP patients showed insignificant physiological response to pain.
Exploration of the Function of Ginsenoside RD Attenuates Lipopolysaccharide-Induced Lung Injury: A Study of Network Pharmacology and Experimental Validation
Authors: Yang Bo , Wang Rong , Ji Lin-Lin , Li Xiao-Ping , Li Xiao-He , Zhou Hong-Gang , He Zhan-Kun , Xu Hong-Liang , Meng Fan-Jie , Wang Guang-Shun
Published: June 2021

Objective:

Ginsenoside Rd (GSRd) displays a variety of pharmacological effects. However, the underlying role in acute lung injury (ALI) is not clear. In this study, the protective effect of GSRd on lipopolysaccharide (LPS)-induced ALI is investigated to explore the potential mechanisms.

Methods:

GSRd-target-ALI–related gene set was constructed. And bioinformatics tools were used to discover the potential mechanism. We observed the survival of subjects for 72 h. In addition, male BALB/c mice were intraperitoneal injected with GSRd (25 and 50 mg/kg) after received one intratracheal instillation of LPS. Inflammatory changes, oxidative stress, and phosphorylation were assessed to study the biological effects.

Results:

A total of 245 interaction genes were collected. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were enriched in immune-inflammatory system. Among them, PI3K-Akt signaling pathway was the highest-ranked pathway of inflammatory response. In vivo study, it was found that GSRd improved survival in endotoxemic mice and inhibited the major characteristic of ALI. And the p-PI3K and p-Akt expression was significantly decreased by GSRd treatment.

Conclusion:

GSRd could protect mice against LPS-induced ALI effectively by inhibiting the PI3K-Akt signaling pathway.
Pathomechanisms Underlying Hypoxemia in Two COVID-19-Associated Acute Respiratory Distress Syndrome Phenotypes: Insights From Thrombosis and Hemostasis
Authors: Gando Satoshi , Wada Takeshi
Published: June 2021

Background:

The pathomechanisms of hypoxemia and treatment strategies for type H and type L acute respiratory distress syndrome (ARDS) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) have not been elucidated.

Main text:

SARS-CoV-2 mainly targets the lungs and blood, leading to ARDS, and systemic thrombosis or bleeding. Angiotensin II-induced coagulopathy, SARS-CoV-2-induced hyperfibrin(ogen)olysis, and pulmonary and/or disseminated intravascular coagulation due to immunothrombosis contribute to COVID-19-associated coagulopathy. Type H ARDS is associated with hypoxemia due to diffuse alveolar damage-induced high right-to-left shunts. Immunothrombosis occurs at the site of infection due to innate immune inflammatory and coagulofibrinolytic responses to SARS-CoV-2, resulting in microvascular occlusion with hypoperfusion of the lungs. Lung immunothrombosis in type L ARDS results from neutrophil extracellular traps containing platelets and fibrin in the lung microvasculature, leading to hypoxemia due to impaired blood flow and a high ventilation/perfusion (VA/Q) ratio. COVID-19-associated ARDS is more vascular centric than the other types of ARDS. D-dimer levels have been monitored for the progression of microvascular thrombosis in COVID-19 patients. Early anticoagulation therapy in critical patients with high D-dimer levels may improve prognosis, including the prevention and/or alleviation of ARDS.

Conclusions:

Right-to-left shunts and high VA/Q ratios caused by lung microvascular thrombosis contribute to hypoxemia in type H and L ARDS, respectively. D-dimer monitoring-based anticoagulation therapy may prevent the progression to and/or worsening of ARDS in COVID-19 patients.
Wearable Patch Heart Rate Variability Is an Early Marker of Systemic Inflammation During Experimental Human Endotoxemia
Authors: Koeneman Mats , Koch Rebecca , van Goor Harry , Pickkers Peter , Kox Matthijs , Bredie Sebastian
Published: June 2021

Introduction:

Early diagnosis and treatment can reduce the risk of organ failure and mortality in systemic inflammatory conditions. Heart rate variability (HRV) has potential for early identification of the onset of systemic inflammation, as it may detect changes in sympathetic nervous system activity resulting from the developing inflammatory response before clinical signs appear. With the use of new methodologies, we investigated the onset and kinetics of HRV changes as well as several inflammatory parameters and symptoms during experimental human endotoxemia, a model of systemic inflammation in humans in vivo.

Patients and Methods:

Healthy volunteers were intravenously administered LPS (n = 15) or placebo (n = 15). HRV was determined using a wireless wearable device, and parameters low to high frequency (LF:HF) ratio, root mean square of the successive differences (RMSSD), and standard deviation of normal-to-normal R-R intervals (SDNN)were calculated through 1-min-rolling 6-min windows. Plasma cytokine levels and flu-like symptoms and vital signs were serially assessed.

Results:

The increase in LF:HF ratio, reflecting sympathetic predominance, was more pronounced in the LPS group compared to the placebo group, with the difference becoming statistically significant 65 min following LPS administration (1.63 [1.42–1.83] vs. 1.28 [1.11–1.44], P = 0.005). Significant between-group differences in RMSSD and SDNN were observed from 127 to 140 min post-LPS administration onwards, respectively. Plasma cytokine levels showed significant between-group differences staring 60 min post-LPS. For symptom score, heart rate, temperature, and diastolic blood pressure, significant differences compared with the placebo group were observed at 90, 118, 120, and 124 min post-LPS, respectively.

Conclusion:

In a controlled human model of systemic inflammation, elevations in the LF:HF ratio followed very shortly after elevations in plasma cytokine levels and preceded onset of flu-like symptoms and alterations in vital signs. HRV may represent a promising non-invasive tool for early detection of a developing systemic inflammatory response.
Effects of Sodium Thiosulfate During Resuscitation From Trauma-and-Hemorrhage in Cystathionine Gamma Lyase (CSE) Knockout Mice
Authors: Gröger Michael , Hogg Melanie , Abdelsalam Essam , Kress Sandra , Hoffmann Andrea , Stahl Bettina , Saub Veronique , Denoix Nicole , McCook Oscar , Calzia Enrico , Wolfschmitt Eva-Maria , Wachter Ulrich , Vogt Josef A. , Wang Rui , Radermacher Peter , Merz Tamara , Nussbaum Benedikt L.
Published: June 2021

Background:

Sodium thiosulfate (Na2S2O3) is a clinically established drug with antioxidant and sulphide-releasing properties. Na2S2O3 mediated neuro- and cardioprotective effects in ischemia/reperfusion models and anti-inflammatory effects in LPS-induced acute lung injury. Moreover, Na2S2O3 improved lung function during resuscitation from hemorrhagic shock in swine with pre-existing atherosclerosis, characterized by decreased expression of cystathionine γ-lyase (CSE), a major source of hydrogen sulfide (H2S) synthesis in the vasculature. Based on these findings, we investigated the effects of Na2S2O3 administration during resuscitation from trauma-and-hemorrhage in mice under conditions of whole body CSE deficit.

Methods:

After blast wave-induced blunt chest trauma and surgical instrumentation, CSE knockout (CSE−/−) mice underwent 1 h of hemorrhagic shock (MAP 35 ± 5 mm Hg). At the beginning of resuscitation comprising retransfusion, norepinephrine support and lung-protective mechanical ventilation, animals received either i.v. Na2S2O3 (0.45 mg g−1, n = 12) or vehicle (saline, n = 13). Hemodynamics, acid–base status, metabolism using stable isotopes, and visceral organ function were assessed. Blood and organs were collected for analysis of cytokines, mitochondrial respiratory capacity, and immunoblotting.

Results:

Na2S2O3 treatment improved arterial paO2 (P = 0.03) coinciding with higher lung tissue glucocorticoid receptor expression. Norepinephrine requirements were lower in the Na2S2O3 group (P < 0.05), which was associated with lower endogenous glucose production and higher urine output. Na2S2O3 significantly increased renal tissue IκBα and heme oxygenase-1 expression, whereas it lowered kidney IL-6 and MCP-1 levels.

Conclusion:

Na2S2O3 exerted beneficial effects during resuscitation of murine trauma-and-hemorrhage in CSE−/− mice, confirming and extending the previously described organ-protective and anti-inflammatory properties of Na2S2O3. The findings make Na2S2O3 a potentially promising therapeutic option in the context of impaired CSE activity and/or reduced endogenous H2S availability.
Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients
Authors: Brodosi Lucia , Petta Salvatore , Petroni Maria L. , Marchesini Giulio , Morelli Maria C.
Published: June 2021

Diabetes is common in patients waitlisted for liver transplantation because of end-stage liver disease or hepatocellular cancer as well as in posttransplant phase (posttransplantation diabetes mellitus). In both conditions, the presence of diabetes severely affects disease burden and long-term clinical outcomes; careful monitoring and appropriate treatment are pivotal to reduce cardiovascular events and graft and recipients’ death. We thoroughly reviewed the epidemiology of diabetes in the transplant setting and the different therapeutic options, from lifestyle intervention to antidiabetic drug use—including the most recent drug classes available—and to the inclusion of bariatric surgery in the treatment cascade. In waitlisted patients, the old paradigm that insulin should be the treatment of choice in the presence of severe liver dysfunction is no longer valid; novel antidiabetic agents may provide adequate glucose control without the risk of hypoglycemia, also offering cardiovascular protection. The same evidence applies to the posttransplant phase, where oral or injectable noninsulin agents should be considered to treat patients to target, limiting the impact of disease on daily living, without interaction with immunosuppressive regimens. The increasing prevalence of liver disease of metabolic origin (nonalcoholic fatty liver) among liver transplant candidates, also having a higher risk of noncirrhotic hepatocellular cancer, is likely to accelerate the acceptance of new drugs and invasive procedures, as suggested by international guidelines. Intensive lifestyle intervention programs remain however mandatory, both before and after transplantation. Achievement of adequate control is mandatory to increase candidacy, to prevent delisting, and to improve long-term outcomes.
Juxtapapillary Choroidal Neovascular Membrane as a Complication of Optic Disc Drusen: Multimodal Imaging With Swept Source-Optical Coherence Tomography and Optical Coherence Tomography Angiography
Authors: Douglas Vivian Paraskevi , Douglas Konstantinos A. A. , Miller John B. , Cestari Dean M.
Published: June 2021

A 55-year-old Caucasian man presented to the neuro-ophthalmology department for follow-up evaluation due to long-standing bilateral optic nerve head drusen (ONHD). On examination, the BCVA was 20/20-2 in both eyes. Dilated fundus examination revealed extensive ONHD in both eyes, retinal hemorrhages, exudates inferonasal to the macula, and macular edema inferotemporal to the disc margin. Automated visual field testing revealed generalized depression in both eyes. Late phase leakage was observed on fluorescein angiography (FA). Optical coherence tomography angiography identified a small juxtapapillary choroidal neovascular membrane inferonasal to the macula in the right eye correlating with the area of retinal hemorrhage and exudates.
SARS-CoV-2 Breakthrough Infections in Fully Vaccinated Individuals
Authors: Ramirez Esteban , Wilkes Rebecca P. , Carpi Giovanna , Dorman Jack , Bowen Craig , Smith Lisa
Published: June 2021

Importance

While COVID-19 vaccines are highly effective against disease, breakthrough infections may occur in the context of rising variants of concern.

Objective

We paired random and passive surveillance nucleic acid testing with analysis of viral whole genomic sequences to detect and describe breakthrough infections, focusing in a university community.

Design

Anterior nasal swabs were collected from individuals for a nucleic acid amplification test (NAAT) for detection of SARS-CoV-2. A subset of NAAT positive samples was sequenced to determine variants associated with infections. Included in the testing and sequencing protocol were individuals that were fully vaccinated.

Setting

This study was performed as part of a surveillance program for SARS-CoV-2 on a university campus with 49,700 students and employees.

Participants

Surveillance testing was random and included approximately 10% of the population each week. Additionally, individuals self-identified with COVID-19 related symptoms or those that had close contact with SARS-CoV-2 positive individuals were also tested.