bluuebunny/crossref_metadata_2025 huggingface dataset:
Health gains and financial protection from human papillomavirus vaccination in Ethiopia: findings from a modelling study
Authors: Portnoy Allison , Sweet Steven , Desalegn Dawit , Memirie Solomon Tessema , Kim Jane J , Verguet Stéphane
Published: April 2021

High out-of-pocket (OOP) medical expenses for cervical cancer (CC) can lead to catastrophic health expenditures (CHEs) and medical impoverishment in many low-resource settings. There are 32 million women at risk for CC in Ethiopia, where CC screening is extremely limited. An evaluation of the population health and financial risk protection benefits, and their distributional consequences across socioeconomic groups, from human papillomavirus (HPV) vaccination will be critical to support CC prevention efforts in this setting. We used a static cohort model that captures the main features of HPV vaccines and population demographics to project health and economic outcomes associated with routine HPV vaccination in Ethiopia. Health outcomes included the number of CC cases, and costs included vaccination and operational costs in 2015 US dollars over the years 2019–2118 and CC treatment costs over the lifetimes of cohorts eligible for vaccination in Ethiopia. We estimated the household OOP medical expenditures averted (assuming 68% of direct medical expenditures were financed OOP) and cases of CHE averted. A case of CHE was defined as 40% of household consumption expenditures, and the cases of CHE averted depended on wealth quintile, disease incidence, healthcare use and OOP payments. Our analysis shows that, assuming 100% vaccine efficacy against HPV-16/18 and 50% vaccination coverage, routine HPV vaccination could avert up to 970 000 cases of CC between 2019 and 2118, which translates to ∼932 000 lives saved. Additionally, routine HPV vaccination could avert 33 900 cases of CHE. Approximately one-third of health benefits would accrue to the poorest wealth quintile, whereas 50% of financial risk protection benefits would accrue to this quintile. HPV vaccination can reduce disparities in CC incidence, mortality and household health expenditures. This understanding and our findings can help policymakers in decisions regarding targeted CC control efforts and investment in a routine HPV vaccination programme following an initial catch-up programme.
Assessing single-nucleotide polymorphism selection methods for the development of a low-density panel optimized for imputation in South African Drakensberger beef cattle
Authors: Lashmar Simon F , Berry Donagh P , Pierneef Rian , Muchadeyi Farai C , Visser Carina
Published: April 2021

A major obstacle in applying genomic selection (GS) to uniquely adapted local breeds in less-developed countries has been the cost of genotyping at high densities of single-nucleotide polymorphisms (SNP). Cost reduction can be achieved by imputing genotypes from lower to higher densities. Locally adapted breeds tend to be admixed and exhibit a high degree of genomic heterogeneity thus necessitating the optimization of SNP selection for downstream imputation. The aim of this study was to quantify the achievable imputation accuracy for a sample of 1,135 South African (SA) Drakensberger cattle using several custom-derived lower-density panels varying in both SNP density and how the SNP were selected. From a pool of 120,608 genotyped SNP, subsets of SNP were chosen (1) at random, (2) with even genomic dispersion, (3) by maximizing the mean minor allele frequency (MAF), (4) using a combined score of MAF and linkage disequilibrium (LD), (5) using a partitioning-around-medoids (PAM) algorithm, and finally (6) using a hierarchical LD-based clustering algorithm. Imputation accuracy to higher density improved as SNP density increased; animal-wise imputation accuracy defined as the within-animal correlation between the imputed and actual alleles ranged from 0.625 to 0.990 when 2,500 randomly selected SNP were chosen vs. a range of 0.918 to 0.999 when 50,000 randomly selected SNP were used. At a panel density of 10,000 SNP, the mean (standard deviation) animal-wise allele concordance rate was 0.976 (0.018) vs. 0.982 (0.014) when the worst (i.e., random) as opposed to the best (i.e., combination of MAF and LD) SNP selection strategy was employed. A difference of 0.071 units was observed between the mean correlation-based accuracy of imputed SNP categorized as low (0.01 < MAF ≤ 0.1) vs. high MAF (0.4 < MAF ≤ 0.5). Greater mean imputation accuracy was achieved for SNP located on autosomal extremes when these regions were populated with more SNP. The presented results suggested that genotype imputation can be a practical cost-saving strategy for indigenous breeds such as the SA Drakensberger. Based on the results, a genotyping panel consisting of ~10,000 SNP selected based on a combination of MAF and LD would suffice in achieving a <3% imputation error rate for a breed characterized by genomic admixture on the condition that these SNP are selected based on breed-specific selection criteria.
Determination of Free Solanesol Levels in Cigarette Filters by Liquid Chromatography–Mass Spectrometry
Authors: Bravo Cardenas Roberto , Ngac Phuong , Watson Clifford , Valentin-Blasini Liza
Published: April 2021

Solanesol, a naturally occurring constituent of tobacco, has been utilized as a good marker for environmental tobacco smoke particulate and as a noninvasive predictor of mainstream cigarette smoke tar and nicotine intake under naturalistic smoking conditions. A fast and accurate method for measuring free solanesol to assess tobacco smoke exposure is highly desirable. We have developed and validated a new environmentally friendly, high-throughput method for measuring solanesol content in discarded cigarette filter butts. The solanesol deposited in the used filters can be correlated with mainstream smoke deliveries of nicotine and total particle matter to estimate constituent delivery to smokers. A portion of filter material is removed from cigarette butts after machine smoking, spiked with internal standard solution, extracted and quantitatively analyzed using reverse-phase liquid chromatography coupled to a triple-quadrupole mass spectrometer. The new method incorporates a 48-well plate format for automated sample preparation that reduces sample preparation time and solvent use and increases sample throughput 10-fold compared to our previous method. Accuracy and precision were evaluated by spiking known amounts of solanesol on both clean and smoked cigarette butts. Recoveries exceeded 93% at both low and high spiking levels. Linear solanesol calibration curves ranged from 1.9 to 367 µg/butt with a 0.05 µg/butt limit of detection.
Voices of Resettled Refugee Congolese Women: A Qualitative Exploration of Challenges Associated with Resettling in Ohio
Authors: Evans Na’Tasha M , Spates Kamesha , Kirkland Chelsey , Mubikayi Kabasele Cedric
Published: April 2021

Refugees, specifically women, experience challenges associated with being resettled in Ohio. Existing research gives little attention to challenges associated with resettling, specifically among Congolese refugee women. Therefore, the purpose of this study is to provide Congolese refugee women an opportunity to narrate the challenges that they face resettling in Ohio. Translator-assisted, face-to-face interviews were conducted among resettled Congolese refugee women who were 18 years of age or older. All participants (n = 20) were receiving assistance from a local resettlement agency at the time of the study. Researchers applied a thematic analysis approach during the data collection and data analysis process. The three overarching themes were financial insufficiency and unemployment, family concerns, and daily experiences of health. Findings from this study provide an increased understanding of the many complex factors affecting resettled Congolese refugee women and provide resettlement agencies with the information to better support them.
Domestic trauma with penile and scrotum skin degloving and testicular avulsion
Authors: Iafrate M , Leone N , Mancini M , Prayer T , Bassetto F , Moro F Dal
Published: April 2021

Traumatic lesions of male external genitalia are certainly less frequent than the other body sites and in the majority of cases they are caused by work accidents in the metalworking environment or by gunshot wounds. We present a rare case of traumatic degloving lesion of the male external genitalia with avulsion of the left testis caused by an accidental fall from the ladder. Reconstructive surgery was carried out in a single procedure, obtaining an excellent esthetic and functional result.
Primary Hodgkin lymphoma of the ulnar nerve: the first case report with review of the literature
Authors: Derqaoui Sabrine , Zouaidia Fouad , Jahid Ahmed , Bernoussi Zakia , Znati Kaoutar
Published: April 2021

Hodgkin lymphoma is a lymphoid malignancy characterized by minority population of neoplastic cells (Reed-Sternberg cells and its variants) within a reactive inflammatory background. It encompasses two entities: classical HL (∼95% of cases) and nodular lymphocyte predominant HL (∼5% of cases). Primary lymphoma of peripheral nerves (PLPN) represent a very rare condition, since only 19 cases have been reported in the English literature to date, all of which are of a non-HL phenotype. A 20-year-old female presented an intramural mass of the ulnar nerve. Histological analysis revealed a Classical Hodgkin lymphoma. Further investigations failed to reveal nodal or extranodal involvement. PLPN is a very rare entity. There is a need for further understanding of this unusual lymphoma presentation.
Maps of a Nation? The Digitized Ordnance Survey for New Historical Research
Authors: Hosseini Kasra , McDonough Katherine , van Strien Daniel , Vane Olivia , Wilson Daniel C S
Published: April 2021

Although the Ordnance Survey has itself been the subject of historical research, scholars have not systematically used its maps as primary sources of information. This is partly for disciplinary reasons and partly for the technical reason that high-quality maps have not until recently been available digitally, geo-referenced, and in color. A final, and crucial, addition has been the creation of item-level metadata which allows map collections to become corpora which can for the first time be interrogated en masse as source material. By applying new Computer Vision methods leveraging machine learning, we outline a research pipeline for working with thousands (rather than a handful) of maps at once, which enables new forms of historical inquiry based on spatial analysis. Our ‘patchwork method’ draws on the longstanding desire to adopt an overall or ‘complete’ view of a territory, and in so doing highlights certain parallels between the situation faced by today’s users of digitized maps, and a similar inflexion point faced by their predecessors in the nineteenth century, as the project to map the nation approached a form of completion.
Optimizing glyphosate tolerance in rapeseed by CRISPR/Cas9-based geminiviral donor DNA replicon system with Csy4-based single-guide RNA processing
Authors: Wang Zhuanrong , Wan Lili , Xin Qiang , Zhang Xiaohui , Song Yixian , Wang Pengfei , Hong Dengfeng , Fan Zhixiong , Yang Guangsheng
Published: April 2021

Rapeseed (Brassica napus L.) is an important oil crop worldwide, and effective weed control can protect its yield and quality. Farmers can benefit from cultivars tolerant to herbicides such as glyphosate. Amino acid substitutions in enolpyruvylshikimate-3-phosphate synthase (EPSPS) render the plant less sensitive to glyphosate. Therefore, we aimed to optimize the glyphosate tolerance trait in rapeseed via endogenous EPSPS modification. To achieve effective gene replacement in B. napus L., we employed a CRISPR/Cas9 system expressing single-guide RNAs (sgRNAs) cleaved by the CRISPR-associated RNA endoribonuclease Csy4 from Pseudomonas aeruginosa, for targeted induction of double-strand breaks. Both the donor template and a geminiviral replicon harbouring an sgRNA expression cassette were introduced into plant cells. Using sgRNAs targeting adjacent donor DNA template containing synonymous mutations in sgRNA sites, we achieved precise gene replacements in the endogenous B. napus EPSPS gene, BnaC04EPSPS, resulting in amino acid substitutions at frequencies up to 20%. Rapeseed seedlings harbouring these substitutions were glyphosate-tolerant. Furthermore, modifications in BnaC04EPSPS were precisely transmitted to the next generation. Our genome editing strategy enables highly efficient gene targeting and the induction of glyphosate tolerance in oilseed rape.
Anaphylaxis After the Covid-19 Vaccine in a Patient With Cholinergic Urticaria
Authors: Park Hyun J , Montgomery Jay R , Boggs Nathan A
Published: April 2021

Cholinergic urticaria is a common disorder that has been associated with anaphylaxis. We report the events, workup, and eventual second dose vaccination of a patient at the Walter Reed National Military Medical Center, who had immediate anaphylaxis after administration of the first Pfizer-BioNTech Covid-19 (BNT162b2) vaccine dose. During the initial evaluation after anaphylaxis, the patient described a history of symptoms suspicious for cholinergic urticaria but had never had this condition confirmed with standardized testing. After the episode of anaphylaxis, we performed several studies including immediate hypersensitivity skin testing, which did not demonstrate vaccine or component sensitization. We then performed an exercise provocation challenge and confirmed the diagnosis of cholinergic urticaria. These results, combined with the patient history, suggested that the episode of anaphylaxis was most likely driven by a severe flare of cholinergic urticaria. After obtaining the patient’s consent, she received and tolerated her second dose without any objective findings of anaphylaxis. We conclude that patients with mast cell disorders or anaphylaxis after their first Covid-19 immunization will benefit from referral to an allergist since receipt of their second Covid-19 immunization may be possible.
Parameters of the type-IIP supernova SN 2012aw
Authors: Nikiforova A A , Baklanov P V , Blinnikov S I , Blinov D A , Grishina T S , Troitskaya Yu V , Morozova D A , Kopatskaya E N , Larionova E G , Troitsky I S
Published: April 2021

We present the results the photometric observations of the Type IIP supernova SN 2012aw obtained for the time interval from 7 to 371 d after the explosion. Using the previously published values of the photospheric velocities, we have computed the hydrodynamic model which simultaneously reproduced the photometry observations and velocity measurements. We found the parameters of the pre-supernova: radius R = 500 R⊙, nickel mass M(56Ni$)\, \sim 0.06\, \rm M_\odot$, pre-supernova mass 25 M⊙, mass of ejected envelope 23.6 M⊙, explosion energy E ∼ 2 × 1051 erg. The model progenitor mass M = 25 M⊙ significantly exceeds the upper limit mass M = 17 M⊙, obtained from analysis the pre-SNe observations. This result confirms once more that the ’Red Supergiant Problem’ must be resolved by stellar evolution and supernova explosion theories in interaction with observations.
Spinal Cord Diffuse Midline Gliomas With H3 K27m-Mutant: Clinicopathological Features and Prognosis
Authors: Wang Yong-Zhi , Zhang Yao-Wu , Liu Wei-Hao , Chai Rui-Chao , Cao Ren , Wang Bo , An Song-Yuan , Jiang Wen-Ju , Xu Yu-Lun , Yang Jun , Jia Wen-Qing
Published: April 2021

BACKGROUND

“Diffuse midline glioma, H3 K27M-mutant” (DMG) mainly arises within the pontine, thalamic, and spinal cord regions. Because of the rarity of spinal cord gliomas, the general knowledge surrounding DMGs is mainly based on pontine and thalamic gliomas, whereas tumor location tends to influence the clinicopathological features and prognosis.

OBJECTIVE

To determine the clinicopathological characteristics and molecular profiles of DMGs located in the spinal cord.

METHODS

The clinical and molecular pathologic features and prognosis were comprehensively analyzed in a series of 44 patients with spinal cord DMGs.

RESULTS

The median age was 36 yr, and 88.7% of patients (39/44) were adults (≥18 yr). Histopathologically, malignant grades included grade II (16 cases), grade III (20 cases), and grade IV (8 cases). Compared with patients with histological grade IV, patients with lower histological grade (grade II/III) were older (37 vs 24 yr, P = .020) and were associated with longer overall survival (24.1 vs 8.6 mo, P = .007). All 30 tested tumors were isocitrate dehydrogenase (IDH) wild type, and 96% of cases (22/23) presented with unmethylated O6-methylguanine-DNA methyltransferase. Univariate and multivariate analyses showed that histological grade and presurgery McCormick Scale scores were independent prognostic factors for overall survival, whereas extensive surgical resection and chemoradiotherapy were not significantly associated with improved survival. The most frequent anatomic locations were the cervical enlargement (C4-T1, n = 16) and conus medullaris (T12-L1, n = 13), which exhibited distinctive clinical characteristics and molecular features.

CONCLUSION

The findings provide guidelines for the evidence-based practice of the specialized management of spinal cord DMGs.
Transmitting Passione
Authors: Pini Sarah , Sutton John
Published: April 2021

This work addresses the case of the Ballet National de Marseille (BNM) and the 2017 recreation of the piece Passione, created by the artistic directors Emio Greco and Pieter C. Scholten. This study, informed by a phenomenological approach, adopts ethnographic methods, including participant observation, in-depth interviews, and one researcher’s direct involvement with the practices of enculturation and enskillment in this dance form. It investigates how the dancers of the BNM articulate their diverse forms of agency in relation to the choreographer’s artistic vision and demands. By looking at the specific case of the BNM staging of Passione, we can isolate some significant features of contemporary ballet’s trajectory as an emergent dance genre on the edge between innovation and tradition.
Transnational Corporate Governance: The State of the Art and Twenty-First-Century Challenges
Authors: Katelouzou Dionysia , Zumbansen Peer
Published: April 2021

This chapter explores corporate governance as a transnational regulatory field. Mirroring the rise in importance of the idea of shareholder wealth maximization as a firm’s definitive performance measure, corporate governance became a hotly contested field of competing visions of firms’ institutional and normative infrastructure in search of creating the most advantageous conditions to attract capital in volatile markets. This shift occurred at the same time that regulatory transformations in Western postindustrial societies since the early 1980s had begun to significantly shift public service provision and state-organized frameworks for old-age security guarantees and access to health services. Today’s corporate governance laboratory is a transnational force field, fought over by a host of different state and nonstate actors and also by private actors such as institutional investors. Meanwhile, following the financial crises in 2001, 2008 and 2020 and the simultaneously growing pressure on corporations from human rights, gender equality, and environmental groups, the corporate governance debate again is shifting. This time, a diversity of issues are being discussed under the corporate governance rubric, indicating a more comprehensive engagement with the firm’s purpose and functions and its societal obligations and responsibilities. Given the crucial role of firms as the residual claimants of a wide-ranging retreat of the state from its role in guaranteeing and providing a wide range of social functions, corporate governance is a mirror for the transformation of public and private power, and it has to address the twenty-first-century challenges, including global value chains and the proliferation of institutional investors, unfolding on a planetary scale.
Development of microwave cavities for measurement of muonium hyperfine structure at J-PARC
Authors: Tanaka K S , Iwasaki M , Kamigaito O , Kanda S , Kawamura N , Matsuda Y , Mibe T , Nishimura S , Saito N , Sakamoto N , Seo S , Shimomura K , Strasser P , Suda K , Tanaka T , Torii H A , Toyoda A , Ueno Y , Yoshida M
Published: April 2021

The MuSEUM collaboration is planning measurements of the ground-state hyperfine structure (HFS) of muonium at the Japan Proton Accelerator Research Complex (J-PARC), Materials and Life Science Experimental Facility. The high-intensity beam that will soon be available, the H-line, allows for more precise measurements by one order of magnitude. We plan to conduct two staged measurements. First, we will measure the Mu-HFS in a near-zero magnetic field, and thereafter we will measure it in a strong magnetic field. We have developed two microwave cavities for this purpose. Furthermore, we evaluated the systematic uncertainties from such a fluctuation of microwave fields and confirmed the requirements for the microwave system; we use a microwave field distribution calculated with the finite element method.
War Commemoration and Nationalism in Belgium, 1914–1945: The Role of Military Networks
Authors: Acosta Laura , Braun Robert
Published: April 2021

War commemoration either solidifies or undermines the nation. Studying the evolution of Belgian nationalism during and between the two World Wars, the authors argue that the impact of war commemoration on nationalism is conditional on the military networks in which warfare was embedded. The authors rely on commemorative books and archival records to create a unique database of World War I military networks and commemoration as well as nationalist resistance and anti-nationalist collaboration during World War II. Aligned with the main hypothesis, autoregressive network models reveal that if military networks crosscut the regional communities and fostered equal relationships, commemoration was likely to strengthen the defense of the nation. In the absence of these relationships, however, commemoration activated internal fault lines that undermined nationalism. These findings highlight how collective rituals, military organization, and social structure should be studied simultaneously to fully understand the relational dynamics of warfare and nation. This article also calls attention to a distinct set of mechanisms through which organizational and ideational effects produced by one war can carry on to the next.
Different circadian rest–active rhythms in Kleine-Levin syndrome: a prospective and case–control study
Authors: Lin Chen , Chin Wei-Chih , Huang Yu-Shu , Chu Kuo-Chung , Paiva Teresa , Chen Chia-Chi , Guilleminault Christian
Published: April 2021

Study Objectives

Kleine-Levin syndrome (KLS) is a rare recurrent hypersomnia. Our study aimed at monitoring the movements of patients with KLS using actigraphy and evaluating their circadian rhythm.

Methods

Twenty young patients with KLS and 14 age-matched controls were recruited. Each individual wore an actigraphy for more than 6 months to monitor at least two attacks. Controls kept wearing the device for at least 7 days. The activity counts were averaged in hourly basis and the day-to-night amplitude was quantified by the differences of the averaged activity counts during daytime and nighttime. The hourly activities of different days were aligned and averaged to construct the circadian profile. Parametric and nonparametric estimation of circadian rhythm was calculated. We applied detrended fluctuation analysis to evaluate the temporal correlations beneath the activity fluctuations at multiple time scales.

Results

Circadian rhythm in asymptomatic period showed no significant difference compared to the controls. During hypersomnia attack, the amplitude of the circadian rest–active rhythms drastically decreased and decreased interdaily stability (IS) was found, as well as significant decreased M10 and short-time fractal correlation (α1). Drastically decreased mean and standard deviation of activity were noted, compared to the pre-attack phase and recovery phase. α1 and M10 increased during the late attack phase, and overcompensated IS was noted in the recovery phase.

Conclusions

This study confirmed that circadian rest–active rhythms was affected when KLS hypersomnia attack. Several parameters including M10, IS, and α1 may be physiological markers of KLS, which can help to predict the end of hypersomnia episodes.
A challenge to the utility and distinctiveness of the good man theory of equity
Authors: Mackley Annie
Published: April 2021

This article provides a critical analysis of the ‘good man’ theory of equity which suggests that equity requires defendants to act as good men by performing primary obligations rather than providing compensation for breach. It examines the practical consequences of applying the theory in the contexts of disgorgement of bribes obtained in breach of fiduciary duty and equitable compensation for breach of trust. It also critically analyses the theory’s foundations through the lenses of legal taxonomy and legal history and philosophy and makes the case for the theory’s abolition.
Feasibility and usefulness of tele-follow-up in the patients with tuberculous meningitis
Authors: Kalita Jayantee , Pandey Prakash C , Shukla Ruchi , Misra Usha K
Published: April 2021

Background

Tuberculous meningitis (TBM) is the most severe form of tuberculosis and these patients need close follow-up because of a high frequency of complications. The coronavirus disease 2019 pandemic and lockdown resulted in an interruption in physical follow-up. In this situation, tele-follow-up may be helpful. We report the feasibility and usefulness of a telephonic follow-up in patients with TBM.

Methods

Patients with TBM managed by us from January 2017 to March 2020 were included from the TBM registry. Their presenting symptoms, and clinical and investigation findings were noted. We contacted these patients telephonically and their clinical status was obtained using a questionnaire. Based on the telephonic information, outcomes were categorized as death, poor or good. Patients with the new medical problems were advised as to relevant investigations and the reports were obtained through WhatsApp for prescribing treatment.

Results

The telephone numbers of 103 of 144 (71.5%) patients were viable. Twenty-seven (26.2%) patients died, 15 (19.7%) had a poor outcome and 61 (80.2%) had a good outcome. Twenty-five (32.9%) patients had new medical problems: 18 TBM related and 7 TBM unrelated. The medical problems of 23 patients could be managed telephonically and only 3 (4%) patients needed a physical visit. Sixty-five (85.5%) patients happily answered the questionnaire and willing responders needed a treatment modification more frequently than the reluctant responders (p=0.008). Patients on active antitubercular treatment needed treatment modification more frequently (80% vs 21.3%).

Conclusions

Tele-follow-up is feasible in 96% of TBM patients and is beneficial, cost effective and overcomes the barrier of distance.
Socrates Online: Creating a Sense of Community
Authors: Jill Dewald Robin
Published: April 2021

If Socrates taught online, he would enhance learning using questioning, guided inquiry, and problem- and discovery-based learning. He would focus energy on building a sense of community, engaging students with analogies, metaphors, storytelling, and sharing of personal and professional experiences. This article provides nurse educators with examples of the application of the Socratic method to enhance learning and build a sense of belonging to a learning community in online education.
Assessment of Structural Competency in Baccalaureate Nursing Students: A Descriptive Study
Authors: Del Gallo Elle J. , Lam Christina K.
Published: April 2021

Structural competency describes the ability to recognize structural factors that affect health disparities, such as inequity and stigma. These structural factors can alter a patient’s symptoms and risk for certain diseases. The purpose of this study was to describe baccalaureate nursing students’ attributions of the effects of structural factors on health. Participants in this study attributed structural factors as being relevant to adverse health outcomes. Findings demonstrated differences in attribution of structural factors by academic level. Given the shifting demographics in the United States and gaps in health care access, further research is needed on the development of structural competence in nursing students.
Patients with psychiatric disease: implications for anesthesiologists
Authors: Guthrie David B. , Richman Deborah C.
Published: April 2021

Purpose of review

Psychiatric illness is common in patients presenting for surgery. Overall health and surgical outcomes are adversely affected by the presence of psychiatric comorbidities.

Recent findings

As new treatment modalities become available, their perioperative implications need to be evaluated. These implications include drug–drug interactions, hemodynamic effects, bleeding risk, and factors affecting perioperative exacerbation of the underlying psychiatric illness.

From our review of the recent literature we continue to support the continuation of psychoactive agents in the perioperative period, taking into consideration the effects these agents have on concomitant drug use in the perioperative period; and the risks of withholding them at a high-stress time.
Perioperative risk assessment – focus on functional capacity
Authors: Hanley Ciara , Wijeysundera Duminda N.
Published: April 2021

Purpose of review

This review examines how functional capacity informs preoperative risk stratification, as well as strengths and limitations of options for estimating functional capacity.

Recent findings

Functional capacity (or cardiopulmonary fitness) overlaps with other important characteristics, including muscular strength, balance, and frailty. Poor functional capacity is associated with postoperative morbidity, especially noncardiovascular complications. Both patient interviews and exercise tests are used to assess functional capacity. The usual approach of an unstructured patient interview does not predict outcomes. Structured interviews that incorporate validated questionnaires (Duke Activity Status Index) or standardized questions about physical activity (ability to climb stairs) do predict moderate-or-severe complications and cardiovascular complications. Among exercise tests, cardiopulmonary exercise testing (CPET) has shown the most consistent association with risks of complications. Other tests (6-min walk test, incremental shuttle walk test, stair climbing) might predict complications, but still require further high-quality evaluation.

A straightforward way to better assess functional capacity is a structured interview with validated questionnaires or standardized questions about physical activities. Functional capacity can also be assessed by exercise tests, with the strongest evidence supporting CPET. Although some simpler exercise tests have shown promise, more research remains needed to better define their role in preoperative evaluation.
Perinatal depression
Authors: Lim Grace
Published: April 2021

Purpose of review

Perinatal depression is a common and debilitating complication of pregnancy and childbirth. Recent studies have elucidated relationships between acute birth events on depression risk, and novel treatments for postpartum depression have been discovered and approved. This article reviews current understandings about birth events on depression, new screening standards, and novel treatments for postpartum depression.

Recent findings

Pain, analgesia, and depression are complex traits that are inter-related during and after pregnancy. Certain individuals may benefit more than others from addressing pain and suffering around childbirth. Exposures to general anesthesia or postdural puncture headache are associated with postpartum depression symptoms, although a causal relationship is unlikely. Brexanolone, ketamine and its related compounds, and nonpharmacologic options offer new or alternative therapies for depression, although safety information for some of these treatments in pregnancy and lactation are needed. Maternal health bundles call for close attention to perinatal mental health screening with validated instruments, and for timely treatment referrals in the ‘fourth trimester’.

Clinical monitoring and timely treatment of depression in the perinatal and postpartum periods is critical for maternal postpartum health and recovery. Perinatal specialists and researchers should continue to focus on tailored treatments specific to this special population.
Multidimensional Self-report Assessment of Children’s Acute Pain in an Inpatient Setting
Authors: Jaaniste Tiina , Yang Jessica , Bang Joseph , Yee Renee Dana , Evans Elizabeth , Aouad Phillip , Champion G. David
Published: April 2021

Objective:

This study assessed the feasibility of administering a multidimensional, self-report pain assessment protocol to children in an inpatient, acute pain context, and sought insight into the interrelationships between sensory, affective, and evaluative pain dimensions.

Methods:

A total of 132 children (5 to 16 y) experiencing acute pain were recruited from acute pain ward rounds or the short-stay surgical unit. A multidimensional self-report assessment protocol was administered, assessing pain intensity, pain-related affect, bother, perceived unfairness, and pain expectations (for tomorrow and in 1 wk). Duration of protocol administration was assessed and ease of administration was rated. Pain-related behaviors were rated using the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale.

Results:

The duration of protocol administration was <2.5 minutes, on average, for all age groups. Median ease of protocol administration was 7/10 for 5- to 7-year-olds and 8/10 for older age groups. Pain-related bother was higher for 14- to 16-year-olds, relative to younger age groups, and significantly correlated with perceived unfairness (r=0.59, P<0.01), intensity (r=0.76, P<0.01), and affect (r=0.33, P<0.05). For younger age groups, bother was significantly positively correlated only with pain intensity (rs=0.59 to 0.79, Ps<0.01) and affect (rs=0.4 to 0.71, Ps <0.05). A stepwise multiple regression analysis found multidimensional self-reported information (especially pain intensity and perceived unfairness), accounted for significant additional amount of variance, beyond that explained by age, pain duration, and observed pain behavior.

Discussion:

Sensory, affective, and evaluative aspects of children’s clinical, acute pain experience may be assessed using self-report tools, which provide unique and valuable information about their pain experience.
Distribution of High-Sensitivity Troponin Taken Without Conventional Clinical Indications in Critical Care Patients and Its Association With Mortality*
Authors: Hinton Jonathan , Augustine Maclyn , Gabara Lavinia , Mariathas Mark , Allan Rick , Borca Florina , Nicholas Zoe , Beecham Ryan , Gillett Neil , Kwok Chun Shing , Cook Paul , Grocott Michael P. W. , Mamas Mamas , Curzen Nick
Published: April 2021

OBJECTIVES:

To describe the distribution of high-sensitivity troponin in a consecutive cohort of patients in critical care units, regardless of clinical indication, and its association with clinical outcomes.

DESIGN:

Prospective observational study.

SETTING:

Single-center teaching hospital.

PATIENTS:

Consecutive patients admitted to two adult critical care units (general critical care unit and neuroscience critical care unit) over a 6-month period.

INTERVENTIONS:

All patients had high-sensitivity troponin tests performed at admission and tracked throughout their critical care stay, regardless of whether the supervising team felt there was a clinical indication. The results were not revealed to patients or clinicians unless clinically requested.

MEASUREMENTS AND MAIN RESULTS:

There were 1,033 patients in the study cohort (general critical care unit 750 and neuroscience critical care unit 283). The median high-sensitivity troponin was 21 ng/L (interquartile range, 7–86 ng/L), with 560 patients (54.2%) above the upper limit of normal as defined by the manufacturer. Admission high-sensitivity troponin concentrations above the upper limit of normal in general critical care unit and neuroscience critical care unit were associated with increasing age, comorbidity, markers of illness severity, and the need for organ support. On adjusted analysis, the high-sensitivity troponin concentration remained an independent predictor of critical care mortality in general critical care unit and neuroscience critical care unit.

CONCLUSIONS:

High-sensitivity troponin elevation, taken outside the context of conventional clinical indications, was common in the critically ill. Such elevations were associated with increasing age, comorbidity, illness severity, and the need for organ support. Admission high-sensitivity troponin concentration is an independent predictor of critical care mortality and as such may represent a novel prognostic biomarker at admission.
Outcomes, Time-Trends, and Factors Associated With Ancillary Study Use for the Determination of Brain Death
Authors: Migdady Ibrahim , Amin Moein , Shoskes Aaron , Hassett Catherine , Rae-Grant Alexander , Snider Sam B. , Greer David M. , Cho Sung-Min , George Pravin
Published: April 2021

OBJECTIVES:

Brain death determination often requires ancillary studies when clinical determination cannot be fully or safely completed. We aimed to analyze the results of ancillary studies, the factors associated with ancillary study performance, and the changes over time in number of studies performed at an academic health system.

DESIGN:

Retrospective cohort.

SETTING:

Multihospital academic health system.

PATIENTS:

Consecutive adult patients declared brain dead between 2010 and 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 140 brain death patients, ancillary studies were performed in 84 (60%). The false negative rate of all ancillary studies was 4% (5% of transcranial Doppler ultrasounds, 4% of nuclear studies, 0% of electroencephalograms, and 17% of CT angiography). In univariate analysis, ancillary study use was associated with female sex (odds ratio, 2.4; 95% CI, 1.21–5.01; p = 0.013) and the etiology of brain death being hypoxic-ischemic brain injury (odds ratio, 2.9; 95% CI, 1.43–5.88; p = 0.003), nontraumatic intracranial hemorrhage (odds ratio, 0.45; 95% CI, 0.21–0.96; p = 0.039), or traumatic brain injury (odds ratio, 0.22; 95% CI, 0.04–0.8; p = 0.031). In multivariable analysis, female sex (odds ratio, 5.7; 95% CI, 2.56–15.86; p = 0.004), the etiology of brain death being hypoxic-ischemic brain injury (odds ratio, 3.2; 95% CI, 1.3–8.8; p = 0.015), and the neurologists performing brain death declaration (odds ratio, 0.08; 95% CI, 0.004–0.64; p = 0.034) were factors independently associated with use of ancillary studies. Over the study period, the total number of ancillary studies performed each year did not significantly change; however, the number of electroencephalograms significantly decreased with time (odds ratio per 1-yr increase, 0.67; 95% CI, 0.49–0.90; p = 0.014).

CONCLUSIONS:

A large number of ancillary studies were performed despite a clinical determination of brain death; patients with hypoxic-ischemic brain injury are more likely to undergo ancillary studies for brain death determination, and neurologists were less likely to use ancillary studies for brain death. Recently, the use of electroencephalograms for brain death determination has decreased, likely reflecting significant concerns regarding its validity and reliability.
Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma
Authors: Shao Chun-Chun , Zhao Fang , Yu Yi-Fan , Zhu Lin-Lin , Pang Guo-Dong
Published: April 2021

Background:

Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC.

Methods:

Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade.

Results:

The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HFtumor − HFliver) and relative flow (rHF = ΔHF/HFliver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781.

Conclusion:

Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEFvariance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.
Association between follistatin-related protein 1 and the functional status of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis
Authors: Yoon Taejun , Ahn Sung Soo , Pyo Jung Yoon , Song Jason Jungsik , Park Yong-Beom , Lee Sang-Won
Published: April 2021

Background:

Follistatin-like 1 (FSTL1) plays both pro-inflammatory and anti-inflammatory roles in the inflammatory processes. We investigated whether serum FSTL1 could predict the current anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV)-specific indices.

Methods:

We randomly selected 74 patients with AAV from a prospective and observational cohort of Korean patients with AAV. Clinical and laboratory data and AAV-specific indices were recorded. FSTL1 concentration was determined using the stored sera. The lowest tertile of the short-form 36-item health survey (SF-36) was defined as the current low SF-36. The cutoffs of serum FSTL1 for the current low SF-36 physical component summary (PCS) and SF-36 mental component summary (MCS) were extrapolated by the receiver operator characteristic curve.

Results:

The median age was 62.5 years (55.4% were women). Serum FSTL1 was significantly correlated with SF-36 PCS (r =  − 0.374), SF-36 MCS (r = −0.377), and C-reactive protein (CRP) (r = 0.307), but not with Birmingham vasculitis activity score (BVAS). In the multivariable linear regression analyses, BVAS, CRP, and serum FSTL1 were independently associated with the current SF-36 PCS (β = −0.255, β = −0.430, and β = −0.266, respectively) and the current SF-36 MCS (β = −0.234, β =−0.229, and β = −0.296, respectively). Patients with serum FSTL1 ≥779.8 pg/mL and those with serum FSTL1 ≥841.6 pg/mL exhibited a significantly higher risk of having the current low SF-36 PCS and SF-36 MCS than those without (relative risk 7.583 and 6.200, respectively).

Conclusion:

Serum FSTL1 could predict the current functional status in AAV patients.
Microcystic Adnexal Adenoma: The Benign Counterpart of Microcystic Adnexal Carcinoma
Authors: Torre-Castro Juan , Moya-Martínez Cristina , Sangüeza Omar , Requena Luis
Published: April 2021

Microcystic adnexal carcinoma (MAC) is a low-grade malignant neoplasm of slow growth and low metastatic potential, but locally aggressive. Architecturally, MAC is usually a poorly circumscribed neoplasm that tends to extend deeply into the dermis and subcutaneous tissue. We present here a lesion in which the histopathologic study showed a well-demarcated nodular lesion involving the mid dermis and composed of small cystic keratinous structures, solid aggregates of pale squamous cells without cytologic atypia and ductal structures. Although these neoplastic components resembled those of MAC, the sharp delimitation of the lesion as well as the absence of deep extension and perineural involvement supported the benign nature of this lesion. We have named this neoplasm microcystic adnexal adenoma, as the benign counterpart of MAC.
Autologous Mastopexy and Autoaugmention of the Breast
Authors: Raafat Sarah Sherif , Ezzat Sherif Z. , Khachaba Youssif A. , Aboul-Nasr Laila A.
Published: April 2021

Background:

Autologous mastopexy is an alternative for patients with small breasts, ptosis and upper pole hollowness, who desire improvement in their breast shape without using an implant. A variety of techniques have been tried throughout the years. Recently the use of autologous fat grafting (AFG) for breast augmentation increased in popularity and showed satisfying cosmetic outcome in enhancement of size, shape and texture of the breast.

Methods:

25 patients with grade 2 ptosis were included in this study. Lower Island Flap Transposition (LIFT) technique was modified and either done alone or in combination with lipofilling, whether at the same setting or as a second stage. Preoperative and postoperative measurements and pictures were documented.

Results:

Lateral upper pole projection measurements showed an average increase of 28.5% equal to about 1.8 cm. As for the maximum breast projection an increase of about 33% accounting for about 2 cm was documented.

Conclusions:

This study shows that the combination of LIFT technique after its modification with AFG has proven to be an effective technique with consistent results for patients presenting with grade 2 ptosis and upper pole hollowness. The addition of AFG to the modified LIFT technique can be considered a step forward in achieving autoaugmentation and autologous mastopexy without using implants.