bluuebunny/crossref_metadata_2025 huggingface dataset:
Revisiting the value of the ‘bandoneon’ flap for lower lip reconstruction: a report of two cases and outcome
Authors: Le John M , Collawn Sherry S
Published: March 2020

Mild- to moderate-sized lip defects that affect one- to two-thirds of the total lip length often require that utilization of local soft tissue rearrangement in order to re-establish lip anatomy, function and esthetics. The use of local flaps in lip reconstruction often follows oncologic resection of common skin malignancies including basal cell carcinoma and squamous cell carcinoma. When considering the types of flaps to use for lip defects of one- to two-third total length, a variety of flaps designs have been described, each with its benefits in drawbacks. In this article, we reintroduce the use and value of the bilateral mucomyocutaneous ‘bandoneon’ flaps for lower lip reconstruction in two of our patients. When compared with other flap designs, it can be used as a single-stage procedure with a very good esthetic outcome, minimal to no microstomia and preservation of lip competence and sensory function.
Effect of Patient Compliance With Treatment Recommendations on Clinical Outcomes in Chronic mTBI: A TEAM-TBI Study
Authors: Galey Jessica L , Eagle Shawn R , Blaney Nicholas A , Holland Cynthia L , Bitzer Hannah B , Schneider Walt , Okonkwo David O , Mucha Anne , Collins Michael W , Kontos Anthony P
Published: March 2020

Introduction

Treatment approaches for mild traumatic brain injury (mTBI) have evolved to focus on active and targeted therapies, but the effect of compliance with therapy has not been investigated. The purpose of this study was to examine the role of patient compliance with prescribed therapies on clinical outcomes following mTBI.

Materials and Methods

Participants were aged 18-60 years with chronic (ie, 6+ months) mTBI symptoms who were previously recalcitrant (n = 66). Participants were diagnosed with a vestibular disorder and were prescribed vestibular and exertion therapies. Participants were instructed to continue the exercise regimen during the 6-month treatment phase at home. Participant compliance was evaluated by clinicians at patients’ follow up visit as: (1) high, (2) moderate, or (3) low compliance based on patient report and clinician interview. High-compliance was compared to a combined low- and moderate-compliance group on the outcomes using a 2 (group) × 2 (time) analysis of variance.

Results

39 of the 66 (59%) participants with vestibular disorder returned for a 6-month evaluation and were included in the analyses. Of these 39 participants, 16 (41%) were high-compliance (36.7 ± 10.9 years, 18.8% female), 17 (44%) were moderate-compliance (32.5 ± 5.5 years, 23.5% female), and 6 (15%) were low-compliance (32.7 ± 3.3 years, 0% female).

Conclusion

High compliance significantly reduced total Vestibular/Ocular Motor Screening scores compared to low/middle compliance (P = .005). Post-Concussion Symptom Scale was reduced by 48% and dizziness symptoms reduced by 31% in the high-compliance cohort. High compliance with prescribed exertion/vestibular rehabilitation therapies enhanced clinical outcomes for previously recalcitrant patients with chronic mTBI-related vestibular disorders.
Influence of Acetazolamide on Hand Strength and Manual Dexterity During a 30-h Simulated High Altitude Exposure
Authors: Yurkevicius Beau R , Bradbury Karleigh E , Nixon Adam C , Mitchell Katherine M , Luippold Adam J , Mayer Thomas A , Alba Billie K , Salgado Roy M , Charkoudian Nisha
Published: March 2020

Introduction

High altitude missions pose significant challenges to Warfighter medical readiness and performance. Decreased circulating oxygen levels cause a decrease in exercise performance and can cause debilitating symptoms associated with acute mountain sickness, especially with rapid ascent. Acetazolamide (AZ) is known to minimize symptoms of acute mountain sickness, but it is unknown whether this medication alters hand strength and manual dexterity during altitude exposure.

Materials and Methods

Ten male volunteers (22 ± 4 yr, 75.9 ± 13.7 kg, 174.9 ± 9.3 cm) participated in two separate 30 h simulated altitude exposures (496 mmHg, equivalent to 3,500 m, 20°C, 20% RH) in a hypobaric chamber. Participants were given either a placebo or 250 mg of AZ twice daily for 3.5 d (2 sea-level [SL] days + the 30 h altitude exposure) in a randomized, single-blind, crossover design. During SL and both altitude (ALT) exposures, hand function tests were performed, including hand grip and finger pinch strength tests, as well as the Purdue Pegboard (PP) and magazine loading tests to assess manual dexterity. Paired T tests and two-way repeated measure analysis of variance were used as appropriate to evaluate the effects of AZ and ALT. The value of p < 0.05 was accepted for statistical significance.

Results

There were no influences of acute ALT exposure or AZ treatment on hand strength (eg, grip strength; SL: 39.2 ± 5.5 kg vs. ALT: 41.5 ± 6.9 kg, p > 0.05) or dexterity (eg, PPassembly; placebo: 35.5 ± 5.3 vs. AZ: 34.3 ± 4.6, p > 0.05) in our volunteers. Two dexterity tests (PPsum and magazine loading) showed improvements over time at ALT, regardless of treatment, where scores were improved after 10 h of exposure compared to at 1 h (eg, magazine loading: 56 ± 12 vs. 48 ± 10, p < 0.001). This pattern was not seen in the PPassembly test or any strength measurements.

Conclusions

Our results suggest that 500 mg/d of AZ does not influence hand strength or manual dexterity during a 30 h exposure to 3,500 m simulated ALT. Acute ALT exposure (1 h) did not influence dexterity or strength, although some measures of dexterity showed improvements as exposure time increased. We conclude that use of AZ to optimize medical readiness at ALT is unlikely to impair the Warfighter’s ability to complete mission tasks that depend on hand function.
Relationship to Deployment on Sarcoidosis Staging and Severity in Military Personnel
Authors: Forbes Damon A , Anderson Jess T , Hamilton Joshua A , Rawlins Fredric A , Tinkelpaugh Carole , Abraham Joseph H , Morris Michael J
Published: March 2020

Introduction

Ongoing studies are investigating the potential link between deployment to Operation Iraqi Freedom and Operation Enduring Freedom and relationship to increases in pulmonary disease. While increases in certain diseases such as asthma and airway hyperreactivity are well established, data on other chronic pulmonary diseases such as sarcoidosis have not been defined.

Material and Methods

A retrospective chart review was conducted of all active duty military personnel diagnosed with sarcoidosis from 2005 to 2010. Deployment dates and locations were obtained through the Armed Forces Health Surveillance Branch. Electronic medical records were reviewed to determine the following parameters: dates of diagnosis, temporal relationship of diagnosis and deployment, symptoms (pre- and/or post-deployment), spirometry, diffusing capacity, radiographic staging, and treatment course. Pulmonary sarcoidosis incidence rates were estimated using International Classification of Diseases (ICD-9) coded medical encounter data from the Defense Medical Surveillance System and compared between Army and nonArmy personnel, as well as between ever-deployed and never-deployed personnel.

Results

A cohort of 478 Army soldiers was identified with sarcoidosis based on ICD-9 codes and individual review of the medical records. The cohort was 80% male. 38.7% of soldiers with sarcoidosis never deployed. 11.7% were diagnosed prior to deployment, and 50.2% were diagnosed postdeployment. The diagnosis of sarcoidosis was established with a tissue diagnosis in 68% of the deployed cohort. Overall differences in spirometry were not identified. Obstructed spirometry was similar in all deployment groups (never, pre, and post) at 9.2%, 15.8% and 8.7%, respectively. Restrictive patterns based on total lung capacity (<70%) were similar at 9.2%, 12.5%, and 11.0%, respectively. Radiographic staging showed a similar distribution in the populations with the never/pre versus postdeployment groups having Stage 0 = 2.3 versus 3.5%, Stage I = 43.8 versus 41.6%, Stage II = 33.1 versus 41.0%, Stage III = 15.1 versus 12.1%, and Stage IV = 2.2 versus 1.7%, respectively. During 2005–2010, the estimated incidence rate of pulmonary sarcoidosis was low among active duty Army personnel (16.5 cases/100,000 person-years), and no trend in annual rates was observed, p = 0.89. Based on overall Department of Defense medical data, estimated pulmonary sarcoidosis rates were lower among ever-deployed personnel, relative to nondeployed personnel.

Conclusion

Based on this analysis of Army sarcoidosis patients, there was no difference in the rates of sarcoidosis diagnosis in deployed and nondeployed soldiers. Spirometry values, total lung capacity, and radiographic staging did not show significant differences between deployment groups.
Genome-wide association study of germline copy number variations reveals an association with prostate cancer aggressiveness
Authors: Brezina Stefanie , Feigl Moritz , Gumpenberger Tanja , Staudinger Ricarda , Baierl Andreas , Gsur Andrea
Published: March 2020

Prostate cancer is a major health burden, being the second most commonly diagnosed malignancy in men worldwide. Overtreatment represents a major problem in prostate cancer therapy, leading to significant long-term quality-of-life effects for patients and a broad socio-ecological burden. Biomarkers that could facilitate risk stratification of prostate cancer aggressiveness at the time of diagnosis may help to guide clinical treatment decisions and reduce overtreatment. Previous research on genetic variations in prostate cancer has shown that germline copy number variations as well as somatic copy number alterations are commonly present in cancer patients, altering a greater portion of the cancer genome than any other type of genetic variation. To investigate the effect of germline copy number variations on cancer aggressiveness we have compared genome-wide screening data from genomic DNA isolated from the blood of 120 patients with aggressive prostate cancer, 231 patients with non-aggressive prostate cancer and 87 controls with benign prostatic hyperplasia from the Prostate Cancer Study of Austria biobank using the Affymetrix SNP 6.0 array. We could show that patients with an aggressive form of prostate cancer had a higher frequency of copy number variations [mean count of copy number segments (CNS) = 12.9, median count of CNS = 9] compared to patients with non-aggressive prostate cancer (mean count of CNS = 10.4, median count of CNS = 8) or control patients diagnosed with benign prostatic hyperplasia (mean count of CNS = 9.3, median count of CNS = 8). In general, we observed that copy number gain is a rarer event, compared to copy number loss within all three patient groups. Furthermore, we could show a significant effect of copy number losses located on chromosomes 8, 9 and 10 on prostate cancer aggressiveness (P = 0.040, P = 0.037 and P = 0.005, respectively). Applying a cross-validation analysis yielded an area under the curve of 0.63. Our study reports promising findings suggesting that copy number losses might play an important role in the establishment of novel biomarkers to predict prostate cancer aggressiveness at the time of diagnosis. Such markers could be used to facilitate risk stratification to reduce overtreatment of prostate cancer patients.
A newly identified Leishmania IF4E-interacting protein, Leish4E-IP2, modulates the activity of cap-binding protein paralogs
Authors: Tupperwar Nitin , Meleppattu Shimi , Shrivastava Rohit , Baron Nofar , Gilad Ayelet , Wagner Gerhard , Léger-Abraham Mélissa , Shapira Michal
Published: March 2020

Translation of most cellular mRNAs in eukaryotes proceeds through a cap-dependent pathway, whereby the cap-binding complex, eIF4F, anchors the preinitiation complex at the 5′ end of mRNAs and regulates translation initiation. The requirement of Leishmania to survive in changing environments can explain why they encode multiple eIF4E (LeishIF4Es) and eIF4G (LeishIF4Gs) paralogs, as each could be assigned a discrete role during their life cycle. Here we show that the expression and activity of different LeishIF4Es change during the growth of cultured promastigotes, urging a search for regulatory proteins. We describe a novel LeishIF4E-interacting protein, Leish4E-IP2, which contains a conserved Y(X)4LΦ IF4E-binding-motif. Despite its capacity to bind several LeishIF4Es, Leish4E-IP2 was not detected in m7GTP-eluted cap-binding complexes, suggesting that it could inhibit the cap-binding activity of LeishIF4Es. Using a functional assay, we show that a recombinant form of Leish4E-IP2 inhibits the cap-binding activity of LeishIF4E-1 and LeishIF4E-3. Furthermore, we show that transgenic parasites expressing a tagged version of Leish4E-IP2 also display reduced cap-binding activities of tested LeishIF4Es, and decreased global translation. Given its ability to bind more than a single LeishIF4E, we suggest that Leish4E-IP2 could serve as a broad-range repressor of Leishmania protein synthesis.
LINbase: a web server for genome-based identification of prokaryotes as members of crowdsourced taxa
Authors: Tian Long , Huang Chengjie , Mazloom Reza , Heath Lenwood S , Vinatzer Boris A
Published: March 2020

High throughput DNA sequencing in combination with efficient algorithms could provide the basis for a highly resolved, genome phylogeny-based and digital prokaryotic taxonomy. However, current taxonomic practice continues to rely on cumbersome journal publications for the description of new species, which still constitute the smallest taxonomic units. In response, we introduce LINbase, a web server that allows users to genomically circumscribe any group of prokaryotes with measurable DNA similarity and that uses the individual isolate as smallest unit. Since LINbase leverages the concept of Life Identification Numbers (LINs), which are codes assigned to individual genomes based on reciprocal average nucleotide identity, we refer to groups circumscribed in LINbase as LINgroups. Users can associate with each LINgroup a name, a short description, and a URL to a peer-reviewed publication. As soon as a LINgroup is circumscribed, any user can immediately identify query genomes as members and submit comments about the LINgroup. Most genomes currently in LINbase were imported from GenBank, but users can upload their own genome sequences as well. In conclusion, LINbase combines the resolution of LINs with the power of crowdsourcing in support of a highly resolved, genome phylogeny-based digital taxonomy. LINbase is available at http://www.LINbase.org.
Tribute to Milton D. Heifetz (1921-2015): The Man Behind the Heifetz Aneurysm Clip
Authors: Jumah Fareed , Ginalis Elizabeth E , Yan Rachel E , Atanassova Tania , Narayan Vinayak , Gupta Gaurav , Nanda Anil
Published: March 2020

Milton Dave Heifetz (1921-2013) was a pioneer American neurosurgeon who spent the majority of his career at Cedars-Sinai Hospital in California. Heifetz greatly influenced the field of neurosurgery as an innovator, leader, and academic neurosurgeon. His redesign of the aneurysm clip addressed the long-standing issue of a fatiguing spring. Heifetz's innovation allowed the spring to maintain adequate closing force despite repetitive opening and closing. This clip was recognized as one of the most effective aneurysm clips for approximately 15 yr. While he was best known for this eponymous aneurysm clip, Heifetz also developed other various microsurgical instruments and tools for stereotactic approaches. Beyond neurosurgery, he was an influential figure and well-published author in fields such as medical ethics, philosophy, astronomy, and poetry. In 1975, he published The Right to Die: A Neurosurgeon Speaks of Death With Candor, a book which played a major role in our modern-day advanced directives. Throughout his life, Heifetz was an inspirational individual who consistently worked towards solutions to surgical and ethical problems. We present a historical vignette on his life, career, and contributions to neurosurgery.
The Role of Stereotactic Radiosurgery in the Management of Brain Metastases From a Health-Economic Perspective: A Systematic Review
Authors: Warsi Nebras M , Karmur Brij S , Brar Karanbir , Moraes Fabio Y , Tsang Derek S , Laperriere Normand , Kondziolka Douglas , Mansouri Alireza
Published: March 2020

BACKGROUND

Stereotactic radiosurgery (SRS) is an effective option in the management of brain metastases, offering improved overall survival to whole-brain radiation therapy (WBRT). However, given the need for active surveillance and the possibility of repeated interventions for local/distant brain recurrences, the balance between clinical benefit and economic impact must be evaluated.

OBJECTIVE

To conduct a systematic review of health-economic analyses of SRS for brain metastases, compared with other existing intervention options, to determine the cost-effectiveness of this treatment across different clinical scenarios.

METHODS

The MEDLINE, EMBASE, Cochrane, CRD, and EconLit databases were searched for health-economic analyses, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using terms relevant to brain metastases and radiation-based therapies. Simple cost analysis studies were excluded. Quality analysis was based on BMJ Consolidated Health Economics Reporting Standards (CHEERS) checklist.

RESULTS

Eleven eligible studies were identified. For lesions with limited mass effect, SRS was more cost-effective than surgical resection (6 studies). In patients with Karnofsky performance scale (KPS) >70 and good predicted survival, SRS was cost-effective compared to WBRT (7 studies); WBRT became cost-effective with poor performance status or low anticipated life span. Following SRS, routine magnetic resonance imaging surveillance saved $1326/patient compared to symptomatic imaging due to reduced surgical salvage and hospital stay (1 study).

CONCLUSION

Based on our findings, SRS is cost-effective in the management of brain metastases, particularly in high-functioning patients with longer expected survival. However, before an optimal care pathway can be proposed, emerging factors such as tumor molecular subtype, diagnosis-specific graded prognostic assessment, neuroprognostic score, tailored surveillance imaging, and patient utilities need to be studied in greater detail.
Outcomes of presumed malignant glioma treated without pathological confirmation: a retrospective, single-center analysis
Authors: Climans Seth Andrew , Ramos Ronald Cepe , Laperriere Normand , Bernstein Mark , Mason Warren P
Published: March 2020

Background

Tissue diagnosis is essential in the usual management of high-grade glioma. In rare circumstances, due to patient preference, performance status, comorbidities, or tumor location, biopsy is not feasible. Sometimes a biopsy is nondiagnostic. Many neuro-oncology clinics have patients like this, but these patients’ outcomes and responses to treatment are not known.

Methods

We retrospectively reviewed records from adult patients diagnosed with presumed high-grade glioma of the brain without definitive pathology, diagnosed between 2004 and 2016. We recorded several clinical variables including date of first diagnostic imaging and date of death.

Results

We identified 61 patients and subclassified them to brainstem glioma (n = 32), supratentorial presumed glioblastoma (n = 24), presumed thalamic diffuse midline glioma (n = 2), gliomatosis cerebri (n = 2), and cerebellar glioma (n = 1). Most brainstem glioma patients had no biopsy because of tumor location. Supratentorial presumed glioblastoma patients had no biopsy predominantly because of comorbidities. Median survival, from first diagnostic imaging, was 3.2 months (95% CI: 2.9 to 6.3 months) in the supratentorial glioblastoma group and 18.5 months (95% CI: 13.0 to 44.1 months) in the brainstem group. Treatment with radiation or chemotherapy did not alter the median survival of the supratentorial glioblastoma group (hazard ratio 1.41, uncorrected P = .5).

Conclusions

Patients with imaging diagnoses of high-grade glioma have similar, if not worse, survival than those with pathological confirmation. Based on these uncontrolled data, it is unclear how effective radiation or chemotherapy is in this population.
Re-treatment of Hepatitis C Infection After Multiple Failures of Direct-Acting Antiviral Therapy
Authors: Fierer Daniel S , Wyles David L
Published: March 2020

Background

Direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) result in initial cure rates of 95% to 99% and re-treatment cure rates of 95%. Nevertheless, given the sheer magnitude of infected persons, some will ultimately fail multiple DAA therapies, and re-treatment of these persons has not been adequately studied.

Methods

We evaluated treated an HIV-infected man with cirrhosis from genotype 1b HCV who had failed 3 DAA regimens.

Results

We treated and cured our “particularly difficult-to-cure” patient with sofosbuvir plus glecaprevir/pibrentasvir plus ribavirin for 24 weeks. We discuss the literature on potential biological factors behind his treatment failures such as lack of HCV seroconversion during his infection course, and multiple failures of hepatitis B seroconversion after vaccination, and the rationale for choosing his curative salvage regimen.

Discussion

There are no clinical trials-proven re-treatment regimens for “particularly difficult-to-cure” patients. Multiple patient- and virus-related factors that do not affect cure rates in treatment-naive patients may need to be considered in choosing a re-treatment regimen for these patients. These regimens may need to include combinations drugs that are not available in single-tablet form, addition of ribavirin, and longer durations of treatment than standard.
Changes and Associations of Genomic Transcription and Histone Methylation with Salt Stress in Castor Bean
Authors: Han Bing , Xu Wei , Ahmed Naeem , Yu Anmin , Wang Zaiqing , Liu Aizhong
Published: March 2020

Soil salinity is a major source of abiotic plant stress, adversely affecting plant growth, development and productivity. Although the physiological and molecular mechanisms that underlie plant responses to salt stress are becoming increasingly understood, epigenetic modifications, such as histone methylations and their potential regulation of the transcription of masked genes at the genome level in response to salt stress, remain largely unclear. Castor bean, an important nonedible oil crop, has evolved the capacity to grow under salt stress. Here, based on high-throughput RNA-seq and ChIP-seq data, we systematically investigated changes in genomic transcription and histone methylation using typical histone H3 lysine 4 trimethylation (H3K4me3) and histone H3 tri-methylated lysine 27 (H3K27me3) markers in castor bean leaves subjected to salt stress. The results showed that gain or loss of histone methylation was closely associated with activated or repressed gene expression, though variations in both transcriptome and histone methylation modifications were relatively narrow in response to salt stress. Diverse salt responsive genes and switched histone methylation sites were identified in this study. In particular, we found for the first time that the transcription of the key salt-response regulator RADIALIS-LIKE SANT (RSM1), a MYB-related transcription factor involved in ABA(abscisic acid)-mediated salt stress signaling, was potentially regulated by bivalent H3K4me3-H3K27me3 modifications. Combining phenotypic variations with transcriptional and epigenetic changes, we provide a comprehensive profile for understanding histone modification, genomic transcription and their associations in response to salt stress in plants.
Eclogite and Garnet Pyroxenite Xenoliths from Kimberlites Emplaced Along the Southern Margin of the Kaapvaal Craton, Southern Africa: Mantle or Lower Crustal Fragments?
Authors: Le Roex Anton , Tinguely Christel , Gregoire Michel
Published: March 2020

Eclogite xenoliths, together with garnet pyroxenites and some mafic garnet granulites, found in kimberlites located along the southern margin of the Kaapvaal craton in southern Africa have been analysed by electron microprobe and mass spectrometry techniques to determine their geochemical characteristics. The majority of eclogites are bimineralic with garnet and omphacitic clinopyroxene in subequal proportions, with rutile as the main accessory phase; a few contain kyanite. Based on K2O in clinopyroxene and Na2O in garnet, the eclogites can be classified as Group II eclogites, and the majority are high-Ca in character. Garnet pyroxenites comprise garnet clinopyroxenites and garnet websterites. Major and trace element concentrations and isotope ratios of reconstituted bulk rock compositions of the eclogites and garnet pyroxenites allow constraints to be placed on depth of origin and likely protolith history. Calculated Fe–Mg exchange equilibration temperatures for the eclogites range from 815 to 1000 °C, at pressures of 1·7 ± 0·4 GPa as determined by REE partitioning, indicating that they were sampled from depths of 50–55 km; i.e. within the lower crust of the Namaqua–Natal Belt. The garnet pyroxenites show slightly lower temperatures (686–835 °C) at similar pressures of equilibration. Initial 143Nd/144Nd and 87Sr/86Sr ratios (calculated to time of kimberlite emplacement) of both lithologies overlap the field for lower crustal samples from the Namaqua–Natal Belt. Further evidence for a crustal origin is found in the similar REE patterns shown by many of the associated garnet granulite xenoliths. Garnet pyroxenites are interpreted to have a similar origin as the associated eclogites but with the mafic protolith having insufficient Na (i.e. low modal plagioclase) to allow for development of omphacitic pyroxene. Metamorphism of the mafic protoliths to these eclogites and garnet pyroxenites is inferred to have occurred during crustal shortening and thickening associated with the collision of the Namaqua–Natal Belt with the Kaapvaal craton at 1–1·2 Ga.
Impacts of Soil Microbiome Variations on Root Colonization by Fungi and Bacteria and on the Metabolome of Populus tremula × alba
Authors: Mangeot-Peter L. , Tschaplinski T. J. , Engle N. L. , Veneault-Fourrey C. , Martin F. , Deveau A.
Published: March 2020

Trees depend on beneficial interactions between roots and soil microbes for their nutrition and protection against stresses. The soil microbiome provides the main reservoir of microbes for root colonization and is subject to natural variations that can affect its composition. It is not clear whether the tree’s root system is able to buffer the natural variations occurring in the soil microbiome to capture a stable and effective microbiome or whether these variations affect its microbiome to impact its physiology. To address this question, we planted cuttings of Gray Poplar (Populus tremula × alba clone 717-1B4) in natural soil taken from a poplar stand under the same tree over two consecutive years and grew them in a greenhouse. We analyzed the soil and root microbiomes by high throughput Illumina MiSeq sequencing of fungal rDNA internal transcribed spacer and bacterial 16S rRNA amplicons and we characterized the root metabolome by gas chromatography-mass spectrometry. Soil and root microbial communities significantly shifted over the 2 years. A modification of the balance between endophytes, saprophytes, and mycorrhizal fungi occurred in the roots as well as a replacement of some dominant operational taxonomic units by others. These modifications were correlated with a significant alteration of the levels of about 10% of primary and secondary metabolites, suggesting that natural fluctuations in soil microbial communities can have a profound impact on tree root metabolism and physiology. Tree roots functioning may thus be indirectly strongly affected by the effects of future extreme climatic variations on the soil microbiome.
A review of Ehlers-Danlos syndrome
Authors: Miller Erin , Grosel John M.
Published: March 2020

Ehlers-Danlos syndrome (EDS) describes a group of heritable disorders of connective tissue comprising mutations in the genes involved in the structure and/or biosynthesis of collagen. Thirteen EDS subtypes are recognized, with a wide degree of symptom overlap among subtypes and with other connective tissue disorders. The clinical hallmarks of EDS are tissue fragility, joint hypermobility, and skin hyperextensibility. Appropriate diagnosis of EDS is important for correct multidisciplinary management and is associated with better clinical outcomes for patients.
The emerging data on choice of optimal therapy for locally advanced nasopharyngeal carcinoma
Authors: Hui Edwin Pun , Ma Brigette B.Y. , Chan Anthony T.C.
Published: March 2020

Purpose of review

We focus on the emerging data from randomized clinical trials for optimal integration of induction, concurrent, and/or adjuvant chemotherapy with intensity-modulated radiotherapy in locally advanced nasopharyngeal carcinoma (NPC), and the use of plasma Epstein–Barr virus (EBV) DNA for risk stratification.

Recent findings

Several phase 3 trials have shown that induction chemotherapy followed by concurrent chemoradiation (CRT) improved overall survival or disease-free survival when compared to CRT alone in stage III/IV NPC who is at high risk of distant metastases. The benefit of adjuvant chemotherapy following CRT when compared to CRT alone is uncertain. There are increasing clinical data supporting the use of plasma EBV DNA for risk stratification. There are growing clinical data supporting the integration of immune checkpoint inhibitors into the induction, concurrent, and/or adjuvant/maintenance phase of treatment in locally advanced NPC.

Concurrent chemoradiation remains the standard treatment backbone in locally advanced NPC. There is level 1 evidence for induction chemotherapy followed by CRT in stage III/IV NPC. There is increasing evidence against the indiscriminate use of adjuvant chemotherapy following CRT. With the increasing treatment intensification, future treatment algorithm in NPC should incorporate plasma EBV DNA and other biomarkers for risk stratification and treatment selection.
A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians
Authors: Lee Linda , Hillier Loretta M. , Patel Tejal , Weston W. Wayne
Published: March 2020

Introduction:

Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care.

Methods:

Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline.

Results:

Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care.

Discussion:

Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.
Idarucizumab for dabigatran reversal in daily clinical practice
Authors: Vene Nina , Mavri Alenka , Božič-Mijovski Mojca , Gregorič Minja , Uštar Katja K. , Žerjav Urša , Gradišek Primož , Stecher Adela , Frol Senta , Nedog Viljenka , Detkova Nataliya , Kosi Iwona E.
Published: March 2020

BACKGROUND

Real-life experience with idarucizumab, which reverses the anticoagulant effect of dabigatran, is currently limited.

OBJECTIVE

To evaluate efficacy and safety of the clinical use of idarucizumab after its availability in Slovenia.

METHODS

We analysed consecutive cases treated with idarucizumab in Slovenia from January to October 2016. The decision to reverse dabigatran with idarucizumab was made by the treating clinicians, as was the assessment of clinical outcomes and blood sampling/monitoring (activated partial thromboplastin time, thrombin time and diluted thrombin time) before and after use.

RESULTS

Idarucizumab was used in 17 cases. One patient was treated with the antidote twice with an interval of 2 months between treatments. The indications for idarucizumab use were: emergency surgery (4/17), severe bleeding (11/17; seven with intracranial bleeding) and ischaemic stroke (2/17). During surgery, no excessive bleeding was reported. Five patients died due to cardiogenic, haemorrhagic or septic shock, intracranial bleeding or multiple organ failure. Among cases with laboratory data available, baseline coagulation tests were prolonged in 12/13 cases with bleeding or emergency surgery. After idarucizumab administration, normal coagulation parameters were confirmed in 10/11. However, re-occurrence of dabigatran effect was noted later in four patients with creatinine clearance less than 30 ml min−1, and one patient with persistent bleeding required retreatment with idarucizumab.

CONCLUSION

Our first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.
Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation
Authors: Kolacz Marcin , Mieszkowski Marcin , Janiak Marek , Zagorski Krzysztof , Byszewska Beata , Weryk-Dysko Malgorzata , Onichimowski Dariusz , Trzebicki Janusz
Published: March 2020

BACKGROUND

Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear.

OBJECTIVES

The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery.

DESIGN

Randomised, single-blinded trial.

SETTING

Two University-affiliated tertiary care hospitals between April 2016 and May 2017.

PATIENTS

A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation.

INTERVENTIONS

On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.25% with adrenaline after a standardised induction of general anaesthesia. All patients on surgical completion and recovery from general anaesthesia were admitted to the postanaesthesia care unit for 24 h. They received standardised intravenous patient-controlled analgesia with fentanyl, and their pain scores were noted at regular intervals.

MAIN OUTCOME MEASURES

The primary endpoint was total cumulative fentanyl dose used per kg body mass in the first 24 h after surgery. Secondary outcomes were the need to start a continuous infusion of fentanyl in addition to patient-controlled analgesia boluses during the stay in post-anaesthesia care unit, postoperative pain severity measured using a numerical rating scale, patient satisfaction with analgesic treatment, evidence of postoperative nausea and vomiting, pruritus and sedation level.

RESULTS

The 49 patients allocated to the QLB type 2 group used significantly less fentanyl per kg in the first 24 h after surgery than the 52 patients who received a TAPB (median [IQR] 4.2 [2.3 to 8.0] μg kg−1 versus 6.7 [3.5 to 10.7] μg kg−1, P = 0.042). No statistically significant differences were noted in the secondary endpoints within the study, including the frequency of adverse effects of opioids.

CONCLUSION

The reduction of fentanyl consumption in the first 24 h after renal transplantation with no difference in pain intensity and patient satisfaction shows a beneficial effect of one-sided QLB type 2 over a one-sided TAPB in regards to postoperative analgesia. However, the reduction in opioid consumption did not affect the frequency of opioid-related adverse effects.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02783586.
The vaginal microbiome as a tool to predict IVF success
Authors: Schoenmakers Sam , Laven Joop
Published: March 2020

Purpose of review

Herein, we present an overview of the recent microbiome research and findings within the field of reproductive medicine and its relation with the outcome of Assisted reproductive technology (ART). Analyses of the microbiome composition all throughout the female reproductive trace during the process of assisted reproductive techniques are discussed.

Recent findings

Only the vaginal microbiome can be sampled without possible risks of contamination. Although this also seems to apply to the cervical microbiome, collection has to be performed with extreme caution. Because of the high risk of cross contamination, results of microbial composition of all other sites of the female reproductive tract have to be interpreted with caution. The vaginal composition prior to the start of hormonal treatment for ART seems to be predictive of in vitro fertilization/in vitro fertilization-intracytoplasmic sperm injection (IVF/IVF-ICSI) outcome, with mainly a highly negative predictive value.

The local microbiota, especially the absence or presence of specific microbes, within parts of the female reproductive tract seem to be associated with the outcome of ART.
Ventricular arrhythmias in heart failure with reduced ejection fraction
Authors: Voskoboinik Aleksandr , Moss Joshua D.
Published: March 2020

Purpose of review

To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies.

Recent findings

Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. Catheter ablation is superior to medical therapy for arrhythmia control and should be considered early, particularly for premature ventricular complex mediated cardiomyopathy. Novel technologies to deliver energy to previously inaccessible sites include high-impedance catheter irrigants, multicatheter bipolar ablation, specialized catheters with extendable needles, transcoronary ethanol infusion, and stereotactic body radiation therapy.

Assessment and management of ventricular arrhythmias in systolic heart failure requires a systematic, multimodality approach aimed at identifying the underlying cause and reversible causes, optimizing medical therapy, assessing need for an implantable cardioverter defibrillator, and considering catheter ablation. Further research will focus on prevention of disease progression, improved risk stratification, and ablation technologies that minimize procedure duration and enable delivery of durable lesions.
Scientific and Logistical Considerations When Screening for Radiation Risks by Using Biodosimetry Based on Biological Effects of Radiation Rather than Dose: The Need for Prior Measurements of Homogeneity and Distribution of Dose
Authors: Swartz Harold M. , Flood Ann Barry , Singh Vijay K. , Swarts Steven G.
Published: March 2020

An effective medical response to a large-scale radiation event requires prompt and effective initial triage so that appropriate care can be provided to individuals with significant risk for severe acute radiation injury. Arguably, it would be advantageous to use injury rather than radiation dose for the initial assessment; i.e., use bioassays of biological damage. Such assays would be based on changes in intrinsic biological response elements; e.g., up- or down-regulation of genes, proteins, metabolites, blood cell counts, chromosomal aberrations, micronuclei, micro-RNA, cytokines, or transcriptomes. Using a framework to evaluate the feasibility of biodosimetry for triaging up to a million people in less than a week following a major radiation event, Part 1 analyzes the logistical feasibility and clinical needs for ensuring that biomarkers of organ-specific injury could be effectively used in this context. We conclude that the decision to use biomarkers of organ-specific injury would greatly benefit by first having independent knowledge of whether the person’s exposure was heterogeneous and, if so, what was the dose distribution (to determine which organs were exposed to high doses). In Part 2, we describe how these two essential needs for prior information (heterogeneity and dose distribution) could be obtained by using in vivo nail dosimetry. This novel physical biodosimetry method can also meet the needs for initial triage, providing non-invasive, point-of-care measurements made by non-experts with immediate dose estimates for four separate anatomical sites. Additionally, it uniquely provides immediate information as to whether the exposure was homogeneous and, if not, it can estimate the dose distribution. We conclude that combining the capability of methods such as in vivo EPR nail dosimetry with bioassays to predict organ-specific damage would allow effective use of medical resources to save lives.
Osteoarticular Infections of the Chest Wall Due to Kingella Kingae
Authors: Ceroni Dimitri , DeMarco Giacomo , Coulin Benoit , Vendeuvre Tanguy , Morello Vanessa , Habre Celine , Dayer Romain Olivier , Steiger Christina N.
Published: March 2020

Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.
Characteristics of a Brisk or Sluggish Pupillary Light Reflex: A Nursing Perspective
Authors: Dance Sophie , Scholefield Barnaby R. , Morris Kevin P. , Kanthimathinathan Hari Krishnan
Published: March 2020

BACKGROUND

Pupillary light reflex (PLR) has traditionally been assessed using a pen torch (light). Although the terms “brisk” or “sluggish” are often used, it is unclear what characteristics of the PLR result in this description. More recently, automated infrared pupillometry has enabled us to quantify the different components of a PLR.

METHODS

We conducted a 2-part questionnaire survey of pediatric intensive care unit (PICU) nurses. In part 1, nurses were requested to describe the key characteristics that they associate with a brisk or sluggish PLR in free-text responses. In part 2, after an introduction to pupillometry and the different components of a PLR, nurses were asked to rank the relative importance of latency (time taken for pupil to start reacting to light), percentage change (in pupil size after light stimulus), and constriction velocity (rate of constriction after light stimulus) in relation to a pupil being described as “brisk” and “sluggish.

RESULTS

Fifty nurses responded. In part 1, “Quick” was the commonest term used (36% of respondents) to describe a brisk PLR, and 72% used “slow” for a sluggish PLR. Most descriptions most closely mapped to features of latency and/or constriction velocity. In part 2, latency was ranked the most important component on pupillometry for describing brisk (32%) and sluggish (34%) PLRs. Constriction velocity was ranked as the most important by 18% (brisk) and 20% (sluggish), whereas 44% (brisk) and 46% (sluggish) ranked percentage change behind the other 2 characteristics.

CONCLUSION

Latency, followed by the constriction velocity, was felt by PICU nurses to be the most important characteristic of the PLR that results in terms “brisk” or “sluggish” being used at the bedside to describe a PLR. We plan to compare these subjective opinions with objective findings from pupillometry.
Development and Validation of VM-PATHI: Vestibular Migraine Patient Assessment Tool and Handicap Inventory
Authors: Sharon Jeffrey D. , Krauter Roseanne , Kirk Laura , Pasquesi Lauren , Allen Isabel E. , Formeister Eric J. , Michael Rebecca L. , Levin Morris
Published: March 2020

Objective:

The aim of this article is to develop and validate a disease-specific, patient-reported outcome measure for vestibular migraine.

Setting:

Tertiary care vestibular center.

Patients:

Adult patients with definite or probable vestibular migraine per Barany Society Criteria.

Study Design:

This was a prospective cohort study. VM-PATHI (Vestibular Migraine Patient Assessment Tool and Handicap Inventory) was developed with expert input, literature review, and patient feedback. VM-PATHI scores were compared between those with vestibular migraine and controls, across several time points, and to other dizziness and quality of life (QoL) measures.

Results:

A 25-item questionnaire was developed. Cronbach's α was high at 0.92. Test–retest reliability was excellent (r = 0.90, p < 0.001). Scores were much higher in patients with vestibular migraine (mean 42.5, SD = 16.1) than control patients (mean = 9.6, SD = 8.5). VM-PATHI scores were responsive to treatment (p = 0.01). Scores were well correlated with general QoL, depression, and anxiety scores. Scores were also correlated with the Dizziness Handicap Inventory (r = 0.69). An exploratory factor analysis was performed, which revealed 6 distinct factors that corresponded well to different aspects of disease-related symptomatology.

Conclusion:

VM-PATHI is a valid, reliable, and responsive measure of disease severity in vestibular migraine.