bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring How Social Media Exposure and Interactions Are Associated With ENDS and Tobacco Use in Adolescents From the PATH Study
Authors: Cavazos-Rehg Patricia , Li Xiao , Kasson Erin , Kaiser Nina , Borodovsky Jacob T , Grucza Richard , Chen Li-Shiun , Bierut Laura J
Published: June 2020

Introduction

Tobacco use is a current public health epidemic that puts individuals at risk for many health conditions and diseases, and adolescents are at high risk for the initiation and persistence of tobacco use behaviors partly due to engagement with social media content. The objective of this study is to examine the association between engaging in social media behaviors and patterns of electronic nicotine delivery systems (ENDS) and tobacco use at a 1-year follow-up among 11 279 adolescents from the PATH study.

Methods

Five social media variables were questioned at Wave 2 and then compared to ENDS and tobacco status transitions (i.e., initiation, persistence, and escalation) at a 1-year follow-up, respectively. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios and 95% confidence interval.

Results

Passive behaviors on social media were related to higher likelihoods of starting to use ENDS and other tobacco products. Additionally, active behaviors on social media were related to higher likelihoods for the initiation and persistence of tobacco use. In particular, sending tobacco content to other users was further associated with a higher likelihood of escalation of tobacco product use.

Discussion

Both exposure to and interactions with social media tobacco content had a significant impact on the patterns of ENDS and tobacco use in adolescents. Due to the amount of time adolescents spend engaging with online content, social media may be a critical place in which to intervene, possibly with the use of antitobacco or tobacco prevention messages.

Implications

The results of this study have implications for public health and the policies surrounding adolescents and their exposure to social media. Reducing the ENDS and tobacco content to which adolescents are exposed has the potential to decrease the instances of initiation and persistence of ENDS and tobacco use. Intervening on social media may prevent or slow the progression of ENDS and tobacco use, and increase motivation and actions toward the cessation of tobacco use in adolescents.
How to deal with the negative psychological impact of COVID-19 for people who pay attention to anxiety and depression
Authors: Ge Fenfen , Wan Mengtong , Zheng Anni , Zhang Jun
Published: June 2020

Background

The fear of insecurity and uncertainty caused by the 2019 coronavirus disease (COVID-19), the separation and loss of certain important relationships, and great changes in lifestyle have awakened strong emotional responses, which may cause psychological problems in the general population. However, there is little research on how people who pay attention to anxiety and depression cope with the negative psychological impact during an epidemic or major disaster. This study aimed to identify what behaviors can effectively reduce negative emotions during an epidemic.

Methods

From 1 February to 8 March 2020, we conducted a web-based survey and collected information on general demographic data. Probable depression, anxiety symptoms, and coping behaviors were assessed with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and self-made coping behaviors questionnaires.

Result

Among 17 249 responders, 7923 and 9326 completed assessments of depression and anxiety respectively, and all responders completed the coping behaviors questionnaires. Our survey population showed a high prevalence rate of possible depression disorders (2746 of 7923, 34.66%) and anxiety disorders (5309 of 9326, 56.93%). Compared with other groups, the elderly, women, people of lower education, and people with lower income were more likely to suffer depression and/or anxiety. In terms of marital status, the cohabiting group showed the highest rate of depression and/or anxiety. Among the careers, students and housewives were high-risk groups suffering from depression and/or anxiety. After adjusting for social-demographic factors (e.g. age, sex), depression and anxiety were positively associated with self-injury, doing housework, and having sex or masturbating, and negatively associated with singing, drawing, or writing, dating friends online, singing, attending lectures, and doing yoga.

Conclusion

Our findings identified some spontaneous coping behaviors that can probably relieve the psychological impact of vulnerable groups during the COVID-19 epidemic.
Coherent Systems on the Projective Line
Authors: Newstead Peter , Teixidor i Bigas Montserrat
Published: June 2020

It is well known that there are no stable bundles of rank greater than 1 on the projective line. In this paper, our main purpose is to study the existence problem for stable coherent systems on the projective line when the number of sections is larger than the rank. We include a review of known results, mostly for a small number of sections.
Shortening Duration of Treatment Resistance: The Next Step in the Treatment of Schizophrenia
Authors: Sutterland Arjen L , van der Pluijm Marieke , Becker Hiske E , van de Giessen Elsmarieke , de Haan Lieuwe
Published: June 2020

The early psychosis movement was fuelled by the concept that early recognition and treatment of patients with psychosis could prevent long-term chronic impairment. Indeed, duration of untreated psychosis (DUP) predicts treatment response and early intervention services have since shown added value. However, considerable chronic impairment remains, with about 20%–30% of the patients with schizophrenia not responding to 2 different conventional antipsychotics in adequate doses and duration. In contrast to the research on DUP and early intervention in schizophrenia in general, far less research has systemically assessed the benefits of shortening the time between treatment onset and adequate treatment response. Yet timely recognition of treatment-resistant schizophrenia (TRS) could be vital since studies have indicated that a critical time window in which clozapine is most effective for TRS patients could exist. We believe that introducing the concept of Duration of Treatment Resistance (DTR) may help to investigate whether shortening of DTR by optimizing medication schedules can further prevent or mitigate long-term disability in patients with schizophrenia. In this editorial, we propose a definition of DTR and encourage the field to investigate the potential merits of this concept in future studies.
Landlord Paternalism: Housing the Poor with a Velvet Glove
Authors: Rosen Eva , Garboden Philip M E
Published: June 2020

Private landlords play an important role in America’s poverty governance, with profound effects on poor families and neighborhoods. Drawing on data from interviews with 127 landlords in Baltimore, Dallas, and Cleveland, we ask how landlords understand their role as purveyors of affordable housing. We find that landlords think about their tenants in moral terms, drawing upon cultural categories to describe and define their tenants. Landlords see renting to the urban poor as a social good insofar as it facilitates housing those in need on the condition of their moral reform. We identify two components of this strategy: exclusion and reform. Landlords pursue profit through exclusionary tactics such as screening and eviction. While recent research has focused on this component, this article explores how landlords also invest resources in “training” tenants, attempting to mold them into a profitable ideal, rather than replacing them. Using both incentives and surveillance, landlords seek to create a tenant class that conforms to mainstream notions of responsibility and self-reliance. We argue that exclusion and reform are complementary components of paternalistic poverty governance. Landlord paternalism carries special salience in today’s increasingly privatized federal housing policy, where landlords have a great deal of discretion and little oversight.
Immediate hypersensitivity reactions to steroids and steroid containing medications
Authors: Rutkowski Krzysztof , Wagner Annette , Rutkowski Ryszard
Published: June 2020

Purpose of review

Although rare and counterintuitive, hypersensitivity reactions to corticosteroids have been reported since the 1950s. Delayed hypersensitivity reactions following cutaneous exposure (contact allergy) are well understood and principles of testing, as well as cross-reactivity patterns, have been established. In contrast, understanding of immediate hypersensitivity reactions and delayed hypersensitivity reactions after systemic exposure is evolving more slowly. However, progress has been made in the delineating of underlying pathogenic mechanisms and in the development of testing.

Recent findings

IgE-mediated hypersensitivity reactions to corticosteroids have been described. It has been recognized that some, if not all of them, may be due to excipients in steroid formulations. Two excipients, polyethylene glycol and carboxymethylcellulose, seem of particular importance, but cases of reactions to polysorbate 80 and lactose have also been reported. The use of skin testing but also, increasingly, in-vitro methods such as basophil activation test is improving diagnostic accuracy.

The recognition of the role of excipients is leading to a paradigm shift in our approach to immediate hypersensitivity to corticosteroids. Improved access to in-vivo and in-vitro testing will enhance our understanding of true corticosteroid immediate allergy.
The role of IL-17, IL-23 and IL-31, IL-33 in allergic skin diseases
Authors: Topal Fatih A. , Zuberbier Torsten , Makris Michael P. , Hofmann Maja
Published: June 2020

Purpose of review

Allergic skin diseases such as urticaria, atopic dermatitis and allergic contact dermatitis are among the most common skin diseases with severe socioeconomic consequences. The pathogenesis of allergic skin diseases is complex. This review provides an overview of cytocines IL-17, IL-23, IL-31 and IL-33.

Recent findings

Current research results show a variety of immunological processes in the pathogenesis of the allergic skin diseases, including the role of cytokines. In addition to the Th1 and Th2 immune response, the immune response via Th17 is becoming increasingly important in allergic skin diseases but also the cytokines IL-23, IL-31 and IL-33 have been discussed in the literature recently. Different cytokines promote in a kind of orchestra the different symptoms seen in the different allergic skin diseases, including pruritus, dermatitis, mast cell mediator release and inflammation.

We are still in the early stages of understanding pathophysiology of allergic skin diseases and the role of various cytokines in the immune system. With the development of targeted antibodies against the proinflammatory cytokines, the variety of normal therapeutic options can be expected to evolve.
Adverse reactions to vancomycin and cross-reactivity with other antibiotics
Authors: De Luca Joseph F. , Holmes Natasha E. , Trubiano Jason A.
Published: June 2020

Purpose of review

Glycopeptide antibiotics such as vancomycin are frequently utilized to treat resistant Gram-positive infections such as methicillin-resistant Staphylococcus aureus. The current literature on glycopeptide and lipoglycopeptide structure, hypersensitivity and potential cross-reactivity was reviewed, highlighting implications for safe prescribing.

Recent findings

Structurally similar, glycopeptides could theoretically cross-react. Immediate reactions to vancomycin include non-IgE-mediated reactions (e.g. red man syndrome) and IgE-mediated hypersensitivity (e.g. anaphylaxis), sharing clinical features. Vancomycin can activate mast cells via MAS-related G-protein-coupled receptor X2, an IgE-independent receptor implicated in non-IgE reactions. In-vivo and in-vitro testing for suspected IgE-mediated reactions to glycopeptides remain ill-defined. Vancomycin is increasingly recognized to cause severe cutaneous adverse reactions (SCAR), with drug reaction with eosinophilia and systemic symptoms (DRESS) predominantly reported. Vancomycin DRESS has been associated with HLA-A∗32:-01, with a number needed to prevent of 1 in 74. Data demonstrating cross-reactivity amongst glycopeptides and lipoglycopeptides is limited to case reports/series.

Further studies and in-vivo/in-vitro diagnostics are required for better differentiation between IgE and non-IgE glycopeptide reactions. Despite its association with vanomycin DRESS, utility of pharmacogenomic screening for HLA-A∗32: 01 is ill-defined. Although HLA-A∗32:01 has been associated with vancomycin DRESS, its utility for pharmacogenomic screening is ill defined. Further clinical and immunological cross-reactivity data for glycopeptide/lipoglycopeptide antibiotics is required.
Anaphylactic reactions to biological drugs
Authors: Matucci Andrea , Vultaggio Alessandra , Nencini Francesca , Maggi Enrico
Published: June 2020

Purpose of review

This review summarizes the current knowledge of the pathogenic mechanisms of biologics-induced anaphylaxis, and the diagnostic and prophylactic strategies in the management of potentially reactive patients, to improve the safety profile of biologics.

Recent findings

The recent knowledge on the topic highlights the involvement of both effector and regulatory mechanisms in the immune response to biological agents. In addition, the impact of biological's immunogenicity on hypersensitivity reactions has been confirmed in a wider number of studies, defining some details about the kinetics of antidrug antibodies development, specifically immunoglobulin G (IgG) and immunoglobulin E (IgE).

Biological agents may induce anaphylaxis, mainly through the induction of antidrug antibodies. Biologics-related infusion reactions are often clinically consistent with type I hypersensitivity, but IgG antidrug antibodies may also be involved. The immune response toward biologicals is orchestrated by both effector and regulatory T cells. In addition, nonantibody-dependent mechanisms may occur. Among clinicians persists today again a low awareness, not only of the possibility to understand the immunological mechanisms behind anaphylaxis to biologicals but also the opportunity to apply potential strategies for the management of reactive patients aimed to guarantee a safe retreatment.
Induction of Labor in an Intubated Patient With Coronavirus Disease 2019 (COVID-19)
Authors: Slayton-Milam Suzanne , Sheffels Samantha , Chan Dominic , Alkinj Bashar
Published: June 2020

BACKGROUND:

In the global coronavirus disease 2019 (COVID-19) pandemic, to date, delivery of critically ill pregnant patients has predominantly been by cesarean.

CASE:

A 27-year-old pregnant woman was admitted to a 166-bed community hospital at 33 weeks of gestation with acute hypoxemic respiratory failure secondary to COVID-19. She underwent mechanical ventilation for 9 days. While ventilated, she underwent induction of labor, resulting in a successful forceps assisted-vaginal birth. She was extubated on postpartum day 5 and discharged on postpartum day 10. The neonate was intubated for 24 hours but was otherwise healthy and discharged home at 36 2/7 weeks postmenstrual age.

CONCLUSION:

Critically ill patients requiring mechanical ventilation, in this case due to COVID-19, may undergo induction of labor and vaginal delivery when carefully selected.
Selective estrogen receptor modulators (SERMS): keys to understanding their function
Authors: Liu James H.
Published: June 2020

Selective estrogen receptor modulators (SERMs) are an increasingly important therapeutic modality that are used by clinicians on a daily basis. Unfortunately, clinicians have a limited understanding regarding the underlying mechanism(s) of how SERMs function and their increasingly useful role in the treatment of estrogen-responsive target tissues such as the breast, bone, vagina, uterine endometrium, and brain. This review will provide a basic understanding of our current knowledge of SERM pharmacodynamics and will highlight the clinical applications of Food and Drug Administration–approved SERMs in the treatment of vasomotor symptoms, osteoporosis, genitourinary syndrome of menopause, infertility, and breast cancer and its prevention. SERMs under development and natural phytoestrogens will also be reviewed.
Pre-operative methicillin resistant Staphylococcus aureus results do not predict surgical site infections in children undergoing varus derotational osteotomy
Authors: Nazareth Alexander , Bains Sukhraj S. , Andras Lindsay M. , Goldstein Rachel Y. , Kay Robert M.
Published: June 2020

Literature regarding the value of pre-operative nasal methicillin resistant Staphylococcus aureus (MRSA) swabs to predict surgical site infections (SSIs) in children undergoing lower extremity surgery is limited. The purpose of our study was to determine if pre-operative nasal MRSA swab results were predictive of SSI development in children undergoing a femoral varus derotational osteotomy (VDRO).

Patients who underwent VDRO between 2004–2016 were reviewed to determine pre-operative MRSA colonization rates and SSI devolvement rates. Patients with less than 1 year of follow-up, previous history of infections, or absent pre-operative MRSA swab were excluded. SSI rates of patients with negative MRSA and positive MRSA swab result were compared using the Fisher exact test. Aside from contact isolation precautions, no other changes in treatment were made during inpatient hospital course based on positive pre-operative nasal MRSA swab results.

247 patients met the inclusion criteria (mean age: 9.3 ± 3.6 years, 62% male). There were 242 (98%) patients with a negative MRSA swab and 5 (2%) patients with a positive MRSA swab. Out of the 242 patients with a negative MRSA swab, 4 developed an SSI. Of the patients with positive MRSA swab results, 0% (0/5) developed an SSI compared to 1.7% (4/242) of negative MRSA swab results who developed an SSI. Results indicated no significant difference in SSI development rates between the groups (P = 1.00).

In this series of children undergoing VDRO surgery, the results of a pre-operative MRSA nasal swab had no relationship to SSI incidence and no impact on clinical patient care. Pre-operative MRSA nasal swabs appear to be of limited benefit for routine pre-operative screening in this patient population.

Level III, retrospective comparative
Staphylococcus saccharolyticus infection: case series with a PRISMA-compliant systemic review
Authors: Wang Ping , Liu Yali , Xu Yingchun , Xu Zuojun
Published: June 2020

Background:

Staphylococcus saccharolyticusis a rare cause of human infectious disease. The clinical characteristics and treatment of patients withS saccharolyticusinfections remain largely unknown.

Objectives:

We present the first reported case of empyema due toS saccharolyticus. In addition, a systematic review and pooled analysis of allS saccharolyticuscases were done to summarize the clinical and microbiological characteristics and treatment of this rare pathogen.

Methods:

A case of empyema caused byS saccharolyticusdiagnosed in study hospital was reported. This case and those identified from PubMed, EMBASE, and Web of Science were analyzed.

Results:

In total, 8 patients were reviewed. The averages of the white blood cell count, sedimentation rate, and C-reactive protein were 16.8 × 109/L, 72 mm/h, and 176 mg/L, respectively. The average time-to-positivity of the anaerobic cultures was 5 days. TheS saccharolyticuswas resistant to metronidazole, but susceptible to fluoroquinolones, clindamycin, and vancomycin in all the cases with drug sensitivity tests available for these antibiotics. Two of 7 patients showed resistance to all β-lactams. Both of those patients finally died.

Conclusions:

S saccharolyticusshould be added to the list of anaerobic microorganisms that are able to cause empyema. A prolonged anaerobic culture is critical to improve the yield of this possibly underestimated pathogen. The time to positive culture ofS saccharolyticusmay not help to distinguish true-positive growth from contaminated growth. Acute or subacute courses and systemic evidence of infection may contribute to judge the clinical significance of positive cultures and avoid unnecessary antibiotic treatment. β-Lactam agents plus fluoroquinolones or vancomycin/teicoplanin or clindamycin may be appropriate to achieve full coverage of the β-lactam resistant bacteria.
Successful secondary thromboprophylaxis with direct oral anticoagulants for a patient with catastrophic antiphospholipid syndrome
Authors: Dinh Nhan Hieu , Cheanh Beaupha Suzanne Monivong
Published: June 2020

Rationale:

Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening condition of antiphospholipid syndrome (APS). Treatment and management of CAPS remain challenging and the mortality rate is approximately 50% among cases. We describe a successfully treated case of a CAPS patient who had undergone massive bowel resection due to obstruction of superior mesenteric artery.

Patient concerns:

A 40-year-old male patient was admitted to our hospital with acute abdominal pain, melena, and a history of deep vein thrombosis in both legs for over 10 years, there was no previous diagnosis of APS.

Diagnosis:

The patient was diagnosed as CAPS with bowel necrosis due to obstruction of superior mesenteric artery based on the presence of antiphospholipid antibodies, computed tomography scan, and histopathological examination.

Interventions:

Emergency surgery was performed to remove approximately 6 meters of the necrotic small intestine, of which the length of the remaining small intestine was 40 cm from the duodenum and 80 cm from the ileocaecal valve. Anticoagulants were prescribed with low molecular weight heparin. After discharging, APS was managed with direct oral anticoagulants (DOACs) for secondary thromboprophylaxis because the patient was unable to reach target International Normalized Ratio (INR) with vitamin K antagonists (VKAs).

Outcomes:

During 24 months of follow-up until now, the patient did not develop new thrombosis or relapse CAPS and his state remained stable.

Lessons:

While VKAs is amongst the most important and fundamental treatment, physicians should be aware that VKAs are absorbed via the small intestine. For CAPS cases who had undergone massive bowel resection, DOACs is a reasonable alternative which has been found to be as safe and effective as VKAs in terms of thrombosis prevention.
Association of weekend admission and clinical outcomes in hospitalized patients with sepsis
Authors: Bernet Selina , Gut Lara , Baechli Ciril , Koch Daniel , Wagner Ulrich , Mueller Beat , Schuetz Philipp , Kutz Alexander
Published: June 2020

Sepsis is associated with impaired clinical outcomes. It requires timely diagnosis and urgent therapeutic management. Because staffing during after-hours is limited, we explored whether after-hour admissions are associated with worse clinical outcomes in patients with sepsis.

In this retrospective cohort study, we analyzed nationwide acute care admissions for a main diagnosis of sepsis in Switzerland between 2006 and 2016 using prospective administrative data. The primary outcome was in-hospital mortality using multivariable logistic regression models. Secondary outcomes were intensive care unit (ICU) admission, intubation, and 30-day readmission.

We included 86,597 hospitalizations for sepsis, 60.1% admitted during routine-hours, 16.8% on weekends and 23.1% during night shift. Compared to routine-hours, we found a higher odds ratio (OR) for in-hospital mortality in patients admitted on weekends (Adjusted OR 1.05, 95% confidence interval [95% CI] 1.01, 1.10, P = .041). Also, the OR for ICU admission (OR 1.14, 95% CI 1.10, 1.19, P < .001) and intubation (OR 1.18, 95% CI 1.12, 1.25 P < .001) was higher for weekends compared to routine-hours. Regarding 30-day readmission, evidence for an association could not be observed. Night shift admission, compared to routine-hours, was associated with a higher OR for ICU admission and intubation (ICU admission: OR 1.28 (1.23, 1.32), P < .001; intubation: OR 1.31, 95% CI 1.25, 1.37, P < .001) but with a lower OR for in-hospital mortality (OR 0.93, 19% CI 0.89, 0.97, P = .001).

Among hospitalizations with a main diagnosis of sepsis, weekend admissions were associated with higher OR for in-hospital mortality, ICU admission, and intubation. Whether these findings can be explained by staffing-level differences needs to be addressed.
Quercetin for myocardial ischemia reperfusion injury
Authors: Lu Liying , Ma Xiaocong , Zheng Jinghui , Li Lijuan , Yang Wenna , Kong Yixuan , Wang Jie
Published: June 2020

Background:

At present, there is no effective therapy for preventing myocardial ischemia reperfusion injury (MIRI), and it is inevitable. The methods how to effectively decrease MIRI have attracted the attention of medical researches in recent years. Quercetin is a part of natural flavonoids in plant polyphenols. Many studies have found that quercetin has a positive effect on MIRI.

Methods:

In order to clarify the effectiveness and potential mechanisms of quercetin for MIRI animals, we searched for animal studies of quercetin for MIRI in Wanfang data Information, Chinese National Knowledge Infrastructure, VIP information database, China Biology Medicine disc, EMBASE, PubMed, and Web of Science. Participant intervention comparator outcomes of this study are as flowing: P, rats in MIRI; I, received quercetin treatment merely; C, received only vehicle or no treatment; O, Main outcomes are myocardial infarction size and markers of myocardial injury. Additional outcomes are serum indices or protein levels tied to the mechanisms of quercetin in myocardial l/R injury. Review Manager 5.2 software and Stata14.0 will be used for data analysis. SYRCLE's risk of bias tool will be used for risk of bias analysis of animal studies.

Discussion:

This preclinical systematic review and meta-analysis will evaluate the effects and mechanisms of quercetin for MIRI animals, and provide more evidence-based guidance for transforming basic research into clinical treatment.

Trial registration:

INPLASY202050067, registered on 16/5/2020.
Primary testicular T-lymphoblastic lymphoma in a child
Authors: Wang Yongren , Li Jian , Fang Yongjun
Published: June 2020

Rationale:

Primary non-Hodgkin lymphoma (NHL) of the testes is rare, representing about 9% of testicular neoplasms and 1% to 2% of non-Hodgkin lymphomas.

Patient concerns:

A previously healthy 47-month-old boy came to our institution for 3 months unilateral testicular swelling without tenderness. After preliminary examination, inguinal orchiectomy was performed to resect the right scrotal mass. The histopathological diagnosis of high-grade lymphoma was rendered and paraffin blocks were sent for immunophenotyping.

Diagnosis:

The final diagnosis by histopathological combined with immunohistochemical staining revealed primary testicular T-cell lymphoblastic lymphoma (St Jude Children's Research Hospital Staging System, stage I).

Interventions:

The patient was treated with right inguinal orchidectomy followed by chemotherapy (SMCC-2011 protocol modified based on the BFM-90/95 regimen from Germany) without prophylactic radiotherapy to the contralateral testis.

Outcomes:

After 36 months of follow-up, the patient is now disease-free without any complication.

Lessons:

T-lymphoblastic lymphoma should be considered in the differential diagnosis of testicular masses in children. Intensive chemotherapy may improve the prognosis of such patients.
Cytogenetic and molecular detection of a rare unbalanced Y;3 translocation in an infertile male
Authors: Deng Shu , Zhang Hongguo , Liu Xiangyin , Yue Fagui , Jiang Yuting , Li Shibo , Liu Ruizhi , Xi Qi
Published: June 2020

Introduction:

The infertile male individuals carrying the Y-autosome translocations are seldom reported in clinic. Herein, we described a severe oligozoospermic male with rare unbalanced Y;3 translocation transmitted through 3 generations.

Patient concerns:

A 33-year-old Chinese male was referred for infertility consultation in our center after 10 years’ primary infertility. He was diagnosed as severe oligozoospermia according to the semen analysis.

Diagnosis:

G-banding analysis initially described the karyotype as 46, XY, add (3) (p26) for the patient, and his wife's karyotype was 46, XX. The chromosomal microarray analysis identified 3.81Mb and 0.29Mb duplications in Yq11.223q11.23 and Yq12, separately. No deletions were detected in azoospermia factors (AZF)a, AZFb and AZFc. Fluorescence in situ hybridization analysis further confirmed the existence of sex-determining region Y gene and verified that Yq12 was translocated to the terminal short arm of chromosome 3(3p26).

Interventions:

The couple chose intracytoplasmic sperm injection to get their offspring. The wife underwent amniocentesis for cytogenetic analysis but suffered termination of pregnancy due to premature rupture of membranes.

Outcomes:

The karyotype of the patient was finally described as 46, X, der(3)t(Y;3)(q11.22;p26). His father and the aborted fetus showed the same karyotypes as the patient.

Conclusion:

Our study not only enriched the karyotype-phenotype correlation of Y-autosome translocation, but also strengthened the critical roles of molecular genetic techniques in identifying the chromosomal breakpoints and regions involved.
A correlative studies between osteoporosis and blood cell composition
Authors: Ye Xingchen , Jiang Haowei , Wang Yongli , Ji Yafeng , Jiang Xuesheng
Published: June 2020

Osteoporosis is defined as a metabolic skeletal disease characterized by a decrease of the bone mass per unit volume, caused by a variety of reasons. Increasing evidence indicate that the host inflammatory response was correlated with the occurrence and development of osteoporosis, and it has been recognized that T lymphocytes and B lymphocytes play a critical role in pathogenesis of inflammatory bone disease. Between January 2018 and December 2018, retrospective analysis of 487 patients (exclusion of patients with recent infections and hematologic disorders whose leukocyte counts or classifications are markedly abnormal) who underwent bone mineral density (BMD) examinations in Huzhou Central Hospital. The patients were divided into normal bone density group, osteopenia group, and osteoporosis group according to the T score of BMD in the left femoral neck, respectively. Statistics of the lymphocyte ratio and the monocyte ratio in the blood routine examination results during the same period were performed so as to make a comparison of the differences among the groups. The correlation of the lymphocyte ratio and monocyte ratio with the T score of BMD in the left femoral neck was also analyzed. The difference between neutrocyte ratio lymphocyte ratio and the monocyte ratio was statistically significant in both males and females among the normal bone density group, osteopenia group and osteoporosis group (P < .01 or P < .05). Inflammation plays an important role in the progression of osteoporosis. By monitoring these three indicators in blood routine examination, early intervention for osteoporosis may become possible.
Impact of oxidative stress on treatment outcomes in adult patients with sepsis
Authors: Hsiao Sheng-Yuan , Kung Chia-Te , Su Chih-Min , Lai Yun-Ru , Huang Chin-Cheng , Tsai Nai-Wen , Wang Hung-Chen , Cheng Ben-Chung , Su Yu-Jih , Lin Wei-Che , Chiang Yi-Fang , Lu Cheng-Hsien
Published: June 2020

Purpose:

Oxidative stress has been shown to reflect on the development of sepsis and disease severity. In the present study, we evaluated the effects of increased levels of oxidative stress and decreased antioxidant coactivity in patients with sepsis, and the importance of oxidative stress on treatment outcomes.

Methods:

Biomarkers of oxidative stress (thiobarbituric acid-reactive substances [TBARS]) and antioxidant capacity (glutathione peroxidase [GPx] and glutathione content [thiol]) were prospectively evaluated along with biochemical and clinical data in 100 patients with sepsis on days 1, 4, and 7 after admission.

Results:

The TBARS level of the non-survivor group was significantly higher than that of the survivor group on day 1 and day 4 and negatively correlated with thiol upon admission. However, thiol was positively correlated with lactate concentration. The TBARS and lactate levels upon admission were independent predictors of fatality.

Conclusions:

We conclude that a TBARS cut-off value of 18.30 μM can be used to predict fatality, and an increase in the TBARS concentration by 1 μM will increase the fatality rate by 0.94%. In the panel of biomarkers, the TBARS assay can be considered as a prognostic biomarker for the treatment of patients with sepsis.
Jugular venous catheter-associated thrombosis and fatal pulmonary embolism
Authors: Wang Jinrong , Wang Lili , Shang Huimian , Yang Xiaoya , Guo Shufen , Wang Yanling , Cui Chaobo
Published: June 2020

Introduction:

Central venous catheters related thrombosis (CRT) insertion has been shown to increase the risk of venous thromboembolism, particularly pulmonary embolism (PE). Nevertheless, deaths cased due to PE have been rarely reported.

Patient concerns:

A central venous catheter was introduced through the right jugular vein during the operation due to severe septic shock from a 57-year-old male patient. Two days after surgery, the hemodynamics was stable. On the 7th day, and low molecular weight heparin calcium (4100 units, once a day) was added for anticoagulation to prevent venous thromboembolism. On the 15th day, during the process of central venous catheter removal, the patient suddenly lost consciousness, suffered cardiac arrest, and received emergency cardiopulmonary resuscitation.

Diagnosis:

Jugular venous catheter-associated thrombosis and fatal PE. An acute bedside ultrasound showed a thrombus drifting with the blood stream in the right jugular vein. The lower section of the xiphoid process by echocardiography showed decreased systolic amplitude of the right atrium and right ventricle, widened and fixed inferior vena cava, and no variation with respiration. Para-sternal left ventricular long axis section showed that the right ventricular outflow tract was significantly extended, and the contraction amplitude of the anterior and posterior walls of the left ventricle decreased. Left ventricular short axis section indicated a right ventricle enlargement and ventricular septum deviation of left ventricle, showing “D” sign. Apical 4-chamber view showed that the right ventricular ratio increased and the contractile capacity decreased.

Interventions:

One and a half million units of urokinase were immediately given trough intravenous drip.

Outcomes:

Twenty minutes after thrombolysis, the patient's autonomic heart rhythm was recovered, but continued to suffer from hypotension and coma, followed by multiple organ failure, and died 50 hours later.

Conclusion:

Recent clinical practice guidelines recommend against the routine use of any anticoagulant thromboprophylaxis in patients with central venous catheters, but for patients at particularly high risk for CRT, consideration can be given to using higher doses of anticoagulant as prophylaxis, although there are virtually no data to support this approach.
Extracorporeal membrane oxygenation with continuous renal replacement therapy to treat metformin-associated lactic acidosis
Authors: Chen Ting , Zhu Chunyan , Liu Bao
Published: June 2020

Rationale:

Metformin-associated lactic acidosis (MALA) is rarely encountered, but has a high mortality rate, Conventional treatments include hemodialysis or continuous renal replacement therapy (CRRT); however, when the disease progresses to end-stage, cardiac function is significantly inhibited, circulation cannot be maintained, CRRT cannot be tolerated, V-A extracorporeal membrane oxygenation (ECMO) may be the last treatment.

Patient concerns:

The study report a rare case of MALA in an elderly female patient at the age of 72 who was admitted to hospital because of nausea for 2 days, complicated with systemic fatigue.

Diagnosis:

MALA was cofirmed because of patient have increased lactic acid levels, blood pH <7.2, and a history of oral metformin intake.

Interventions:

Venoarterial ECMO (V-A ECMO) combined with CRRT was initiated when circulation was still not hold after intravenous fluids and 5% sodium bicarbonate were prescribed.

Outcomes:

V-A ECMO was then terminated after 48 hours when circulation was perserved, CRRT was discontinued when PH and lactic acid level were normal limited. etformin-associated lactic acidosis did not recur during 6 months follow-up.

Lessons:

The incidence of MALA is low, but mortality is very high. Intermittent hemodialysis or CRRT should be performed if the lactic acid level is persistently elevated. When severe circulatory dysfunction occurs and cardiac function is inhibited, V-A ECMO support should be performed immediately to maintain circulation, followed by CRRT, which may be the final measure to treat refractory MALA.
Comparison of Ultrasound-Marked Versus Standard Lumbar Puncture Success in Infants
Authors: Grady Mary , Runyon Michael , Weekes Anthony , Hogg Melanie , Chaudoin Lindsey
Published: June 2020

Objectives

The aim of this study was to compare ultrasound (US)-marked versus standard lumbar puncture success in infants.

Methods

This was a prospective cohort study at an academic pediatric emergency department. Standard lumbar puncture success in a retrospective control was compared with success in a US-marked group. Spinal US was performed with infants in the sitting and lateral decubitus position to identify the interspinous space with the most cerebrospinal fluid. The optimal position was determined, and this space was marked. The proceduralist performed the lumbar puncture at the level of the markings. The primary outcome was a successful lumbar puncture by the first provider, defined as a collection of cerebrospinal fluid with less than 1000 red blood cells/mm3. Secondary outcomes were successful lumbar puncture after attempts by more than 1 provider and collection of any spinal fluid.

Results

Between June 2017 and April 2019, we enrolled 284 infants younger than 12 months, 210 in the retrospective standard group and 74 in the prospective US-marked group. Baseline characteristics of both groups were similar. The primary outcome showed no difference between US-marked group and control (38% vs 36%; difference: 1.6% [95% confidence interval (CI), −14.7 to 10.7]). Secondary outcomes showed no significant success differences by more than 1 provider (51% vs 39%; difference: 12.8% [95% CI, −25.7 to 0.3]) or in obtaining any spinal fluid (82% vs 79%; difference: 3.9% [95% CI −13.3 to 7.5]).

Conclusions

There were no differences in success between US-marked and standard lumbar punctures in infants by different providers.
Ultrasound-Guided Microinvasive Trigger Finger Release Technique Combined With Three Tests to Confirm a Complete Release
Authors: Colberg Ricardo E. , Pantuosco John , Fleisig Glenn , Drogosz Monika
Published: June 2020

Objective

Trigger finger at the A1 pulley is a common cause of hand pain leading to functional limitations. This study evaluated the outcomes of patients treated with a microinvasive ultrasound-guided trigger finger release technique using an 18 blade and described three tests that confirm a complete release.

Design

A retrospective chart review and cross-sectional study of 46 cases of A1 pulley trigger finger releases in 28 patients performed at a private, sports medicine clinic using this technique were completed, meeting power criteria. The primary outcome measure was the resolution of mechanical catching/locking; secondary outcome measures were reduction in visual analog scale for pain and improvement of function in the modified Nirschl scale.

Results

Complete release was achieved in all patients, with no recurrence of catching/locking during the first year (P < 0.0001). Ninety-eight percent of patients had significant pain and functional improvement (P < 0.0001). There were no complications perioperatively and postoperatively. The three confirmatory tests ensured that all cases obtained a successful outcome.

Conclusion

This technique combined with confirmatory tests resulted in full resolution of the locking for all patients and statistically significant reduction in pain and improvement in function.
The Keystone, Scroll Complex, and Interdomal Area of the Nose: Histologic and Anatomical Observations
Authors: Irmak Fatih , Ertaş Ahmet , Kaleci Belisa , Özkan Serbay , Şentürk Gözde Erkanli , Kuran Ismail , Karşidağ Semra
Published: June 2020

Comprehensive knowledge of nasal anatomy is essential for obtaining aesthetically and functionally pleasing results in rhinoplasty. In this study, the authors described the anatomy, histology, and clinical relevance of the interdomal region, keystone, and scroll complex. The current study examined these areas in 26 fresh cadaver heads. All cadavers were fresh, and no conservation or freezing processes were applied. All dissections were performed by the first author. It was determined that the structure that connected the middle crura in the interdomal region actually came together in the transverse plane and contained abundant capillaries within. It was observed that chondroblasts with high regenerative potential were present in the keystone area, and there was very tight attachment between periosteum and perichondrium. The scroll complex was found to be more flexible and thin and had fewer regenerative cells compared to the keystone region. With its unique anatomy and histology, the keystone acts as a transition area between the flexible and fixed units of the nose. The scroll complex should be taken into consideration during rhinoplasty because of its effects on fixation of the skin in the lateral supratip area and functional effects on internal and external nasal valves. The interdomal ligament, in contrast, acts as a transition between both middle crura rather than a real ligament.
Warping Characteristics of Rib Allograft Cartilage
Authors: Rohrich Rod. J. , Dayan Erez , Durand Paul D. , Brito Iris , Gronet Edward
Published: June 2020

When septal cartilage is lacking, commercially available costal cartilage allograft can be used. Such allografts have “off-the-shelf” accessibility, are available in multiple sizes, are aseptically processed to meet sterility, and are screened to minimize infectious risks. The purpose of this study was to evaluate the effect of donor age, storage temperature, and orientation of a bilayered construct on the degree of warping of a commercialized fresh frozen costal cartilage allograft in vitro over time. A total of 140 fresh frozen costal cartilage cadaveric specimens were separated into three donor age groups. These were allocated into three harvesting subgroups: group a, single pieces (cephalocaudal segments); group b, two laminated pieces of the same rib sutured together in anatomical position (laminated group); and group c, two pieces from the same rib reversed onto each other and sutured together (oppositional group). Photographs were examined and analyzed to determine the degree of cartilaginous warping. Decreased rates of warping were seen in commercially available, aseptically processed costal cartilage allografts procured from older cadavers. Warping was also decreased when oppositional suturing techniques were used as a way to address those intrinsic cartilage forces.
Overview of Host Defense Peptides and Their Applications for Plastic and Reconstructive Surgeons
Authors: DeLong Michael R. , Tandon Vickram J. , Da Lio Andrew L. , Deming Timothy J. , Cederna Paul S.
Published: June 2020

Background:

Host defense peptides are a family of endogenous short peptides that are found in all living beings and play a critical role in innate immunity against infection.

Methods:

A nonsystematic review of host defense peptides was conducted with specific interest in properties and applications relevant to plastic and reconstructive surgery.

Results:

In addition to their direct antimicrobial actions against pathogens, including multidrug-resistant bacteria, they also demonstrate important functions in immunomodulation, tumor cell lysis, and tissue regeneration. These properties have made them a topic of clinical interest for plastic surgeons because of their potential applications as novel antibiotics, wound healing medications, and cancer therapies. The rising clinical interest has led to a robust body of literature describing host defense peptides in great depth and breadth. Numerous mechanisms have been observed to explain their diverse functions, which rely on specific structural characteristics. However, these peptides remain mostly experimental, with limited translation to clinical practice because of numerous failures to achieve acceptable results in human trials.

Conclusions:

Despite the broad ranging potential of these peptides for use in the field of plastic and reconstructive surgery, they are rarely discussed in the literature or at scientific meetings. In this review, the authors provide a summary of the background, structure, function, bacterial resistance, and clinical applications of host defense peptides with the goal of stimulating host defense peptide–based innovation within the field of plastic and reconstructive surgery.
Anatomy of the Dorsum of the Foot and Its Relevance for Nonsurgical Cosmetic Procedures
Authors: Custozzo Amanda , Frank Konstantin , Schenck Thilo L. , Gotkin Robert H. , Smith Michael P. , Green Jeremy B. , Sykes Jonathan , Tamura Bhertha , Lachman Nirusha , Cotofana Sebastian
Published: June 2020

Background:

Operative procedures to enhance the aesthetic appearance of the feet are associated with risks. Minimally invasive procedures to volumize the dorsum of the foot are to this point not described. The present study investigates the safety and efficacy of such procedures in a retrospective clinical, anatomical, and ultrasound-based study.

Methods:

A total of 106 feet from 53 female patients (mean age, 64.1 ± 8.3 years) were investigated retrospectively after the injection of a commercially available calcium hydroxylapatite product using a single-entry proximal-to-distal fanning injection technique. Anatomical dissections in 20 fresh, nonembalmed feet from 10 human body donors (mean age, 83.1 ± 8.8 years) were dissected, and 20 feet from 10 healthy volunteers (mean age, 26.5 ± 6.2 years) were examined by ultrasound imaging to help guide conclusions.

Results:

Aesthetic outcome after 3 months was graded by the patients as 4, connoting good improvement (range, 3 to 5). No allergic reactions or other types of adverse events were documented. The layered anatomy of the dorsum of the foot was confirmed by anatomical dissections and ultrasound imaging as follows: skin, dorsal superficial fatty layer, dorsal superficial fascia, dorsal intermediate fatty layer, superficial lamina of the dorsal deep fascia, dorsal deep fatty layer, and deep lamina of the dorsal deep fascia.

Conclusions:

Minimally invasive injections of soft-tissue filler in the dorsum of the foot can provide an alternate solution to enhance the aesthetic appearance of feet. The present study provides support for the safety and efficacy of volumizing procedures using a 22-gauge, 50-mm, blunt-tip cannula.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.