bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare Providers' Views on Hepatitis C Testing and Counseling Among Sexual Partners of Hepatitis C–Infected Persons
Authors: Dunham Katherine , McDonald Jessica , Yousaf Anna , Barocas Joshua A. , Neill Marguerite A. , Noska Amanda , Flanigan Timothy P.
Published: October 2020

Background

Current hepatitis C virus (HCV) counseling guidelines do not recommend that HCV-infected patients notify their partners or encourage them to get tested. We aimed to assess healthcare professionals' knowledge of and attitudes toward counseling and testing recommendations for HCV-infected patients.

Methods

A 15-question, anonymous survey was designed and distributed via e-mail to a convenience sample of healthcare professionals who work with Brown University– or Boston University–affiliated hospitals to assess their knowledge of and attitudes toward counseling recommendations for HCV-infected patients. The data were collected electronically and analyzed using descriptive statistical methods.

Results

Of the 55 respondents (a 20% response rate), 73% incorrectly believed that at the time when the survey was completed, the US Centers for Disease Control and Prevention HCV testing guidelines already recommended partners of HCV-infected patients be tested for HCV infection. Furthermore, 80% of respondents believed that recommendations should be revisited to explicitly include that HCV-infected patients encourage their partners to get tested. When counseling patients with HCV, 44% of respondents reported that they always ask whether the patient's partners have been tested for HCV and 42% reported that they sometimes do. Similarly, 42% reported that they always suggest that the HCV-infected patient's partners be tested for HCV.

Conclusions

Our survey shows that healthcare providers believe that HCV counseling and testing recommendations could be revisited, with specific attention given to the promotion of HCV testing for partners of HCV-infected patients.
A novel HIST1HE pathogenic variant in a girl with macrocephaly and intellectual disability: a new case and review of literature
Authors: Pelle Alessandra , Pezzoli Laura , Apuril Erika , Iascone Maria , Selicorni Angelo
Published: October 2020

Pathogenic variants of HIST1H1Egene have recently been associated with a condition known as Rahman syndrome, characterized by overgrowth, intellectual disability and nonspecific dysmorphic features (high hairline, full cheeks, wide nasal bridge). Wide clinical variability is reported, especially regarding the level of neurodevelopment delay and intellectual disability. We report a 10-year-old girl with macrocephaly and global developmental delay, in whom a novel heterozygous variant in the HIST1H1Egene [c.392_395dup (p.Gly133fs)] was discovered, but involving the same C-terminal domain-protein domain reported previously. Comparing the clinical data of our patient with those previously described, a ‘core phenotype’ with macrocephaly, psychomotor delay/intellectual disability and mild facial dysmorphisms seems evident.
Emerging roles of bile acids in control of intestinal functions
Authors: Yang Jiufang , Palmiotti Anna , Kuipers Folkert
Published: October 2020

Purpose of review

Bile acids and their signalling pathways are increasingly recognized as potential therapeutic targets for several diseases. This review summarizes new insights in bile acid physiology, focussing on regulatory roles of bile acids in intestinal functions.

Recent findings

Recent studies have highlighted the interactions between bile acids and gut microbiome: interfering with microbiome composition may be beneficial in treatment of liver and metabolic diseases by modulating bile acid composition, as different bile acid species have different signalling functions. In the intestine, bile acid receptors FXR, VDR and TGR5 are involved in control of barrier function, paracellular ion transport and hormone release. Specific microbial bile acid metabolites modulate immune responses of the host. In addition, new functions of bile acids in regulation of gastric emptying and satiation via brain–gut–liver axis have been discovered. Identification of Cyp2c70 as the enzyme responsible for generation of hydrophilic mouse/rat-specific muricholic acids has allowed the generation of murine models with a human-like bile acid composition.

Specific bile acids act as important signalling molecules affecting whole body metabolism, specific transport processes and immunity in different segments of the intestinal tract. Their relevance for human (patho)physiology is emerging. Novel mouse models with human-like bile acid composition will aid to accelerate translational research.
Care During Pregnancy, Childbirth, Postpartum, and Human Milk Feeding for Individuals Who Identify as LGBTQ+
Authors: Griggs Kellie M. , Waddill Colette B. , Bice April , Ward Natalie
Published: October 2020

The growing number of families that include members of sexual and/or gender minority (SGM) groups requires perinatal nurses to know how to provide respectful and affirming care to all people, including this population. Approximately 19% of adults who are members of SGM groups are raising 3 million children, with many hoping to become pregnant, foster, use surrogacy, or adopt in the future. Based on current literature, many nurses are not prepared to meet the clinical needs of patients who are members of SGM groups in the maternity setting. Likewise, patients and families of SGM groups often perceive that nurses are uncomfortable with providing care and are not always satisfied with their care. To meet these needs, it is important that nurses use strategies focused on promoting respectful, affirming care, reducing negative experiences, and eliminating marginalizing language and practices. Nurses must incorporate a holistic care focus for patients who are members of SGM minority groups that includes standardized strategic education; development of Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, or Plus (LGBTQ+) affirming and inclusive policies, practices, and language; flexibility, personal reflection of self-bias; and creating an environment of individualized compassionate care.
Predicting Posttraumatic Stress and Depression Symptoms Among Frontline Firefighters in China
Authors: Shi Junyi , Chen Yaru , Li Xiaohui , An Yuanyuan
Published: October 2020

To investigate the prevalence and comorbidity rate of potential posttraumatic stress disorder (PTSD) and depression in frontline firefighters in China, as well as to analyze the related predictive factors for PTSD and depression, our study included 261 firefighters who completed assessments including the Demographic Data Forum, PTSD Checklist for DSM-5, Center for Epidemiological Studies Depression Scale, Chinese version of Perceived Stress Scale, and Perceived Social Support Scale. Among the participants, 1.9% and 11.9% were identified as having potential PTSD and depression, respectively. There was a 9.1% chance of comorbid PTSD among the depressed firefighters and a 60% chance of comorbid depression among the firefighters with PTSD. Perceived stress positively predicted both PTSD and depression; perceived social support negatively predicted both PTSD and depression. Whereas family exogenous support predicted both PTSD and depression, family endogenous support only predicted depression. In addition, PTSD was predicted by rank. Soldiers and sergeants demonstrated higher level of PTSD than officers. Future studies on mental health of firefighters should take factors like perceived stress, social support, and rank into consideration.
The Caregiver Experience After Stroke in a COVID-19 Environment: A Qualitative Study in Inpatient Rehabilitation
Authors: Sutter-Leve Rachel , Passint Emily , Ness Debra , Rindflesch Aaron
Published: October 2020

Background and Purpose:

Stroke is the leading cause of disability in the United States. Two-thirds of stroke survivors will require caregiver assistance. Evidence suggests the mental health of caregivers is closely related to patients' health outcomes. The timing of this study intersected with the beginning of the coronavirus disease-2019 (COVID-19) pandemic that required strict social distancing and hospital visitor policy changes. This study aims to answer the primary research question: What is the level and nature of stress experienced by caregivers of persons with newly-acquired stroke in the inpatient rehabilitation setting and how has the COVID-19 pandemic impacted the caregiver experience?

Methods:

Recruitment occurred from a single inpatient rehabilitation facility. Participants were administered the Perceived Stress Scale and then completed qualitative semistructured interviews. The investigators used a phenomenological, iterative approach to collect and analyze qualitative data. The data were independently coded and categorized before consolidated into primary themes and subthemes.

Results:

Eleven informal caregivers' perspectives generated 13 subthemes across 4 primary thematic categories: COVID-19 impact, concerns of the caregiver, coping strategies, and important aspects of the caregiver experience. COVID-19 social distancing necessitated new visitor policies, which presented additional challenges for caregivers.

Discussion and Conclusions:

Caregiver attendance at therapy sessions and frequent, direct communication between staff and caregivers improved caregiver readiness for family member discharge following inpatient rehabilitation. This study shared perspectives from a distinctive time during the COVID-19 pandemic. If visitation for multiple therapy sessions is prohibited, we recommend taking alternative measures to keep the caregiver involved in the plan of care.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A326).
The Myoepithelial Cells of Salivary Intercalated Duct-type Intraductal Carcinoma Are Neoplastic
Authors: Bishop Justin A. , Rooper Lisa M. , Sangoi Ankur R. , Gagan Jeffrey , Thompson Lester D.R. , Inagaki Hiroshi
Published: October 2020

Intraductal carcinoma (IDC) is a salivary gland tumor currently believed to be analogous to breast ductal carcinoma in situ, consisting of a complex neoplastic epithelial proliferation surrounded by a continuous layer of myoepithelial cells presumed to be native and non-neoplastic. Recent molecular insights have shown that there are at least 3 different types of IDC: (1) intercalated duct-like, with frequent NCOA4-RET fusions; (2) apocrine, with multiple mutations similar to salivary duct carcinoma; and (3) mixed intercalated duct-like and apocrine with frequent RET fusions, especially TRIM27-RET. Recent observations (eg, IDC occurring in lymph nodes) have challenged the notion that the myoepithelial cells of IDC are non-neoplastic. Five IDCs with known RET fusions by RNA sequencing were retrieved from the authors’ archives, including 4 intercalated duct-like IDCs with NCOA4-RET, and 1 mixed intercalated duct-like/apocrine IDC with TRIM27-RET. A panel of immunohistochemistry antibodies (S100 protein, p63 or p40, mammaglobin, smooth muscle actin, calponin, androgen receptor) was tested. To precisely localize RET split-positive cells, each case was subjected to sequential retrieval of whole-slide imaging data of hematoxylin and eosin (HE) staining, immunofluorescence staining for calponin, and fluorescence in situ hybridization (FISH) for RET. Because NCOA4-RET is an inversion difficult to visualize on conventional RET FISH, a novel 3-color FISH technique was utilized to demonstrate it clearly. In all 5 cases, the proliferative ducts were completely surrounded by a layer of myoepithelial cells that were positive for p63 or p40, smooth muscle actin, and calponin. Using combined HE, calponin immunofluorescence, and RET FISH imaging, the positive signals were unmistakably identified in both calponin-negative ductal cells and peripheral, calponin-positive myoepithelial cells in all 5 cases. Utilizing combined HE, calponin immunofluorescence, and RET FISH imaging, we demonstrated that IDCs with RET fusions harbored this alteration in both the ductal and myoepithelial cells. This is compelling evidence that the myoepithelial cells of IDC are not mere bystanders, but are rather a component of the neoplasm itself, similar to other biphasic salivary gland neoplasms like pleomorphic adenoma and epithelial-myoepithelial carcinoma. This finding raises questions about the appropriate terminology, classification, and staging of IDC.
Genome-wide association study of high-sensitivity C-reactive protein, D-dimer, and interleukin-6 levels in multiethnic HIV+ cohorts
Authors: Sherman Brad T. , Hu Xiaojun , Singh Kanal , Haine Lillian , Rupert Adam W. , Neaton James D. , Lundgren Jens D. , Imamichi Tomozumi , Chang Weizhong , Lane H. Clifford
Published: October 2020

Objectives:

Elevated levels of interleukin-6 (IL-6), D-dimer, and C-reactive protein (hsCRP) are associated with increased incidence of comorbid disease and mortality among people living with HIV (PLWH). Prior studies suggest a genetic basis for these biomarker elevations in the general population. The study objectives are to identify the genetic basis for these biomarkers among PLWH.

Methods:

Baseline levels of hsCRP, D-dimer, and IL-6, and single nucleotide polymorphisms (SNPs) were determined for 7768 participants in three HIV treatment trials. Single variant analysis was performed for each biomarker on samples from each of three ethnic groups [African (AFR), Admixed American (AMR), European (EUR)] within each trial including covariates relevant to biomarker levels. For each ethnic group, the results were pooled across trials, then further pooled across ethnicities.

Results:

The transethnic analysis identified three, two, and one known loci associated with hsCRP, D-dimer, and IL-6 levels, respectively, and two novel loci, FGB and GCNT1, associated with D-dimer levels. Lead SNPs exhibited similar effects across ethnicities. Additionally, three novel, ethnic-specific loci were identified: CATSPERG associated with D-dimer in AFR and PROX1-AS1 and TRAPPC9 associated with IL-6 in AFR and AMR, respectively.

Conclusion:

Eleven loci associated with three biomarker levels were identified in PLWH from the three studies including six loci known in the general population and five novel loci associated with D-dimer and IL-6 levels. These findings support the hypothesis that host genetics may partially contribute to chronic inflammation in PLWH and help to identify potential targets for intervention of serious non-AIDS complications.
High-throughput sequencing reveals a high prevalence of pretreatment HIV-1 drug resistance in Sweden
Authors: Andersson Emmi , Ambikan Anoop , Brännström Johanna , Aralaguppe Shambhu G. , Yilmaz Aylin , Albert Jan , Neogi Ujjwal , Sönnerborg Anders
Published: October 2020

Objectives:

HIV-1 pretreatment drug resistance (PDR) is a global concern. Our aim was to evaluate high-throughput sequencing (HTS) for HIV-1 resistance testing and describe PDR in Sweden, where 75% of diagnosed individuals are foreign-born.

Design:

Cross-sectional study.

Methods:

Individuals entering HIV-1 care in Sweden 2017 to March 2019 (n = 400) were included if a viremic sample was available (n = 220). HTS was performed using an in-house assay. Drug resistance mutations (DRMs) (based on Stanford HIV DB vs. 8.7) at levels 1–5%, 5–19% and at least 20% of the viral population were described. Results from HTS and routine Sanger sequencing were compared.

Results:

HTS was successful in 88% of patients, 92% when viral load was at least 1000 copies/ml. DRMs at any level in protease and/or reverse transcriptase were detected in 95 individuals (49%), whereas DRMs at least 20% in 35 (18%) individuals. DRMs at least 20% correlated well to findings in routine Sanger sequencing. Protease/reverse transcriptase (PR/RT) DRMs at least 20% were predicted by treatment exposure; adjusted OR 9.28 (95% CI 2.24–38.43; P = 0.002) and origin in Asia; adjusted OR 20.65 (95% CI 1.66–256.24; P = 0.02). Nonnucleoside reverse transcriptase inhibitor (NNRTI) DRMs at least 20% were common (16%) and over-represented in individuals originating from sub-Saharan Africa or Asia. Low-level integrase strand transfer inhibitor (INSTI) DRMs less than 20% were detected in 15 individuals (8%) with no association with INSTI exposure.

Conclusion:

Our HTS can efficiently detect PDR and findings of DRMs at least 20% compare well to routine Sanger sequencing. The high prevalence of PDR was because of NNRTI DRMs and associated with migration from areas with emerging PDR.
68Ga-FAPI-04 Accumulation in Myocardial Infarction in a Patient With Neuroendocrine Carcinoma
Authors: Zhu Wenjia , Guo Fan , Wang Yawen , Ding Haiyan , Huo Li
Published: October 2020

We present a case of a 64-year-old man with neuroendocrine carcinoma. Incidental findings were demonstrated on 68Ga-FAPI-04 PET/CT in the inferior wall of left ventricle. A diagnosis of old myocardial infarction was made based on typical electrocardiogram change. Our case suggests that 68Ga-FAPI PET/CT, as a noninvasive method to reflect fibroblast activation, is potentially feasible for assessment of cardiac remodeling after myocardial infarction in a clinical setting.
The Utility of SPECT/CT in Diagnosing Haglund Syndrome With Bone Scintigraphy
Authors: Martineau Patrick , Pelletier-Galarneau Matthieu
Published: October 2020

Haglund syndrome—the combination of Haglund’s deformity, retrocalcaneal bursitis, and achilles tendinopathy—is a common cause of hind foot pain in adults; however, diagnosis on planar scintigraphy can be challenging. We present a case of Haglund syndrome and show the key role that SPECT/CT can play in its diagnosis.
Oligodendroglioma in 68Ga-PSMA-11 and 18F-Fluciclovine PET/CT
Authors: Pernthaler Birgit , Nazerani Hooshmand Tina , Igrec Jasminka , Kvaternik Herbert , Aigner Reingard M.
Published: October 2020

Prostate cancer (PC) is one of the most common cancers affecting men worldwide, with a high recurrence rate after therapy. 68Ga-PSMA-11 and 18F-fluciclovine are PET imaging tracers for the detection of recurrence sites in PC patients. 68Ga-PSMA-11 is a membrane antigen overexpressed by tumor cells, whereas 18F-fluciclovine targets increased amino acid transporter in the membrane of cancer cells. We report a case of an 83-year-old man with known oligodendroglioma and biochemically recurrent PC who shows a high focal 68Ga-PSMA-11 and 18F-fluciclovine uptake in the brain.
Velopharyngeal Incompetence in Children With 22q11.2 Deletion Syndrome: Velar and Pharyngeal Dimensions
Authors: Seselgyte Rimante , Swan Marc C. , Birch Malcolm J. , Kangesu Loshan
Published: October 2020

The surgical management of velopharyngeal incompetence (VPI) in children with 22q11.2 deletion syndrome (22q11.2 DS) is challenging. There are numerous approaches and children often undergo more than one operation. Our aim was to develop a method using images from routine lateral videofluoroscopy to study the dimensions of the velopharynx in this cohort.

We analyzed 22 pre-operative lateral videofluoroscopy recordings of children with 22q11.2 DS and VPI. Fourteen had a submucous cleft palate (SMCP) and 8 had no obvious palatal abnormality but who were subsequently labelled as having an occult submucous cleft palate (OSMCP). The control data were 10 historic records of children with cleft lip and an intact palate. The authors identified key points on radiographs of the velum at rest and when elevated to measure the total velar length, functional velar length and pharyngeal depth and compared them ratiometrically.

The intra-observer reliability was > 0.9 whereas the inter-observer reliability was > 0.74. The velopharyngeal depth/total velar length was significantly greater in 22q11.2 DS than the control group P < 0.001. There was no difference between SMCP and OSMCP patients, P = 0.556. There was no difference in the functional velar length/total velar length between 22q11.2 DS and controls (P = 0.763).

In this study, the authors demonstrate a reliable method to gain useful ratiometric measurements of the velopharynx. This may help with treatment planning. Children with 22q11.2 DS and VPI have a larger velopharyngeal depth/total velar length ratio that may explain some of the difficulty in management.
Craniofacial Anthropometry of Healthy Turkish Young Adults: Analysis of Head and Face
Authors: Bahşi Ilhan , Orhan Mustafa , Kervancioğlu Piraye , Karatepe Şeyma , Sayin Semih
Published: October 2020

The aim of this study was to evaluate the craniofacial anthropometric measurements of Turkish young adults between the ages of 18 and 25. Anterior view and side profile photographs were taken of 100 females and 100 males who volunteered to participate in the study and had no craniofacial anomalies, history of facial trauma, or history of orofacial surgery. Thirteen landmarks on the face and head were chosen, and these landmarks were identified on the photographs. Then, using these landmarks, a total of 19 distance measurements were made, 16 from the anterior view, and 3 from the side profile. There were statistically significant differences between the sexes in 13 parameters: 2 parameters (t-n and ft-ft) being higher in females and 11 parameters (v-n, v-t, t-gn, sn-gn, n-gn, st-gn, sl-gn, fz-fz, z-z, tr-tr and go-go) being higher in males. Also, 7 facial anthropometric ratios were calculated. There were statistically significant differences between the genders in all ratios. The literature reveals that craniofacial anthropometric measurements have been performed on many different populations and that there are numerous differences between the results of the studies conducted. We are of the opinion that the results obtained in this present study will contribute to the literature by helping to determine the standard values for the Turkish population between the ages of 18 and 25, which can be used in diagnosis, treatment and postoperative evaluation in areas such as forensic science, orthodontics, clinical genetics, maxillofacial surgery, and plastic surgery.
Traction Suture Technique for Correction of Caudal Septal Deviation
Authors: Aksakal Ceyhun , Akti Serdar
Published: October 2020

Objectives:

Correcting the caudal septum deviation is one of the most difficult parts of the septoplasty. The aim of the present study was to evaluate the efficiency and usefulness of traction suture method in caudal septum deviations.

Methods:

Medical records of 35 patients who underwent endonasal septoplasty using traction suture method for caudal septum deviation in August 2017-February 2019 period were studied retrospectively. Preoperative nasal obstruction symptom evaluation (NOSE) scores of the patients were compared with postoperative sixth month NOSE scores. Besides, preoperative nasal examination findings of the patients were compared with the ones in postoperative period.

Results:

Average age of the 35 patients (9 women and 26 men) in the study was 26.3 ± 10.1 years. Postoperative observations revealed that a straight septum was achieved in 31 patients (91.1%). Average pre- and postoperative NOSE scores were 85.1 ± 20.4 and 22.4 ± 4.2, respectively (P < 0.0001). Nasal obstruction was “much improved” in 19 patients (54.2%) and “improved” in 12 (37.1%), while 4 patients (8.6%) reported “no change.” None of the patients developed postoperative complications.

Conclusions:

Traction suture method is a safe, efficient, and useful option to be used by surgeons for caudal septum deviation.
Screen-Based Simulation for Training and Automated Assessment of Teamwork Skills
Authors: Steadman Randolph H. , Huang Yue Ming , Iseli Markus R. , Lee John J. , Tillou Areti , Rudolph Maria D.D. , Lewin Rachel , Koenig Alan D. , Khan Rukhsana , Raia Federica , Smith S. Michael , Juo Yen-Yi , Rice Cameron , Poorsattar Sophia P. , Webb Noreen M.
Published: October 2020

Introduction

The need for teamwork training is well documented; however, teaching these skills is challenging given the logistics of assembling individual team members together to train in person. We designed 2 modes of screen-based simulation for training teamwork skills to assess whether interactivity with nonplayer characters was necessary for in-game performance gains or for player satisfaction with the experience.

Methods

Mixed, randomized, repeated measures study with licensed healthcare providers block-stratified and randomized to evaluation—participant observes and evaluates the team player in 3 scenarios—and game play—participant is immersed as the leader in the same 3 scenarios. Teamwork construct scores (leadership, communication, situation monitoring, mutual support) from an ontology-based, Bayesian network assessment model were analyzed using mixed randomized repeated measures analyses of variance to compare performance, across scenarios and modes. Learning was measured by pretest and posttest quiz scores. User experience was evaluated using χ2 analyses.

Results

Among 166 recruited and randomized participants, 120 enrolled in the study and 109 had complete data for analysis. Mean composite teamwork Bayesian network scores improved for successive scenarios in both modes, with evaluation scores statistically higher than game play for every teamwork construct and scenario (r = 0.73, P = 0.000). Quiz scores improved from pretest to posttest (P = 0.004), but differences between modes were not significant.

Conclusions

For training teamwork skills using screen-based simulation, interactivity of the player with the nonplayer characters is not necessary for in-game performance gains or for player satisfaction with the experience.
SRY is a Key Mediator of Sexual Dimorphism in Hepatic Ischemia/Reperfusion Injury
Authors: Dong Jian , Ke Meng-Yun , Wu Xiao-Ning , Ding Hong-Fan , Zhang Li-Na , Ma Feng , Liu Xue-Min , Wang Bo , Liu Jian-Lin , Lu Shao-Ying , Wu Rongqian , Pawlik Timothy M. , Lyu Yi , Zhang Xu-Feng
Published: October 2020

Objectives:

To identify the role and mechanism of a male specific gene, SRY, in I/R-induced hepatic injury.

Background:

Males are more vulnerable to I/R injury than females. However, the mechanism of these sex-based differences remains poorly defined.

Methods:

Clinicopathologic data of patients who underwent hepatic resection were identified from an international multi-institutional database. Liver specific SRY TG mice were generated, and subjected to I/R insult with their littermate WT controls in vivo. In vitro experiments were performed by treating primary hepatocytes from TG and WT mice with hypoxia/reoxygen-ation stimulation.

Results:

Clinical data showed that postoperative aminotransferase level, incidence of overall morbidity and liver failure were markedly higher among 1267 male versus 508 female patients who underwent hepatic resection. SRY was dramatically upregulated during hepatic I/R injury. Overexpression of SRY in male TG mice and ectopic expression of SRY in female TG mice exacerbated liver I/R injury compared with WTs as manifested by increased inflammatory reaction, oxidative stress and cell death in vivo and in vitro. Mechanistically, SRY interacts with Glycogen synthase kinase-3β (GSK-3β) and β-catenin, and promotes phosphorylation and degradation of β-catenin, leading to suppression of the downstream FOXOs, and activation of NF-κBand TLR4 signaling. Furthermore, activation of β-catenin almost completely reversed the SRYoverexpression-mediated exacerbation of hepatic I/R damage.

Conclusions:

SRY is a novel hepatic I/R mediator that promotes hepatic inflammatory reaction, oxidative stress and cell necrosis via inhibiting Wnt/β-catenin signaling, which accounts for the sex-based disparity in hepatic I/R injuries.
Acellular Dermal Matrix Provides Durable Long-Term Outcomes in Abdominal Wall Reconstruction
Authors: Asaad Malke , Kapur Sahil K. , Baumann Donald P. , Liu Jun , Butler Charles E.
Published: October 2020

Background:

Ventral hernia repair (VHR) is one of the most commonly performed procedures in the United States, but studies assessing the long-term outcomes of VHR using biologic mesh are scarce.

Objective:

We sought to determine the rates of hernia recurrence (HR) and surgical site occurrences (SSOs) in a large cohort of patients who underwent AWR with biologic mesh.

Methods:

We conducted a retrospective cohort study of patients who underwent AWR using either porcine ADM (PADM) or bovine ADM (BADM) from 2005 to 2019. We analyzed the full cohort and a subset of our population with minimum long-term follow-up (LTF) of 5 years. The primary outcome measure was HR. Secondary outcomes were SSOs.

Results:

We identified a total of 725 AWRs (49.5% PADM, 50.5% BADM). Mean age was 69 ± 11.5 years and mean body mass index was 31 ± 7 kg/m2. Forty-two percent of the defects were clean at the time of AWR, 44% were clean-contaminated, and 14% were contaminated/infected. Mean defect size was 180 ± 174 cm2, mean mesh size was 414 ± 203 cm2. Hernia recurred in 93 patients (13%), with cumulative HR rates of 4.9%, 13.5%, 17.3%, and 18.8% at 1, 3, 5, and 7 years, respectively. There were no differences in HR (P = 0.83) and SSO (P = 0.87) between the 2 mesh types. SSOs were identified in 27% of patients. In our LTF group (n = 162), the HR rate was 16%. Obesity, bridged repair, and concurrent stoma presence/creation were independent predictors of HR; component separation was protective against HR.

Conclusions:

Despite its use in complex AWR, ADM provides durable long-term outcomes with relatively low recurrence rates.
Results of COVID-minimal Surgical Pathway During Surge-phase of COVID-19 Pandemic
Authors: Boffa Daniel J. , Judson Benjamin L. , Billingsley Kevin G. , Del Rossi Erin , Hindinger Kasey , Walters Samantha , Ermer Theresa , Ratner Elena , Mitchell Marci R. , Laurans Maxwell S. , Johnson Dirk C. , Yoo Peter S. , Morton John M. , Zurich Holly B. , Davis Kimberly , Ahuja Nita
Published: October 2020

Objective:

The outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic.

Summary of Background Data:

Crucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a “COVID-minimal pathway” was created.

Methods:

Patients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The “COVID-minimal surgical pathway” consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections.

Results:

After implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56–79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1–6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection.

Conclusions:

A COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.
Biliary Stricture After Necrotizing Pancreatitis
Authors: Maatman Thomas K. , Ceppa Eugene P. , Fogel Evan L. , Easier Jeffrey J. , Gromski Mark A. , House Michael G. , Nakeeb Attila , Schmidt C. Max , Sherman Stuart , Zyromski Nicholas J.
Published: October 2020

Objective:

Biliary stricture in necrotizing pancreatitis (NP) has not been systematically categorized; therefore, we sought to define the incidence and natural history of biliary stricture caused by NP.

Summary of Background Data:

Benign biliary stricture occurs secondary to bile duct injury, anastomotic narrowing, or chronic inflammation and fibrosis. The profound locoregional inflammatory response of NP creates challenging biliary strictures.

Methods:

NP patients treated between 2005 and 2019 were reviewed. Biliary stricture was identified on cholangiography as narrowing of the extrahepatic biliary tree to <75% of the diameter of the unaffected duct. Biliary stricture risk factors and outcomes were evaluated.

Results:

Among 743 NP patients, 64 died, 13 were lost to follow-up; therefore, a total of 666 patients were included in the final cohort. Biliary stricture developed in 108 (16%) patients. Mean follow up was 3.5 ± 3.3 years. Median time from NP onset to biliary stricture diagnosis was 4.2 months (interquartile range, 1.8 to 10.9). Presentation was commonly clinical or biochemical jaundice, n = 30 (28%) each. Risk factors for stricture development were splanchnic vein thrombosis and pancreatic head parenchymal necrosis. Median time to stricture resolution was 6.0 months after onset (2.8 to 9.8). A mean of 3.3 ± 2.3 procedures were performed. Surgical intervention was required in 22 (20%) patients. Endoscopic treatment failed in 17% (17/99) of patients and was not associated with stricture length. Operative treatment of biliary stricture was more likely in patients with infected necrosis or NP disease duration ≥6 months.

Conclusion:

Biliary stricture occurs frequently after NP and is associated with splanchnic vein thrombosis and pancreatic head necrosis. Surgical correction was performed in 20%.
Conditional Survival of Patients Who Underwent Curative Resection for Esophageal Squamous Cell Carcinoma
Authors: Shin Dong Wook , Kim Hong Kwan , Cho Jongho , Lee Genehee , Cho Juhee , Yoo Jung Eun , Shin Sumin , Choi Yong Soo , Shim Young Mog , Zo Jae Ill
Published: October 2020

Objective:

To analyze conditional survival estimates of patients with esophageal cancer who underwent curative resection.

Summary Background Data:

Conditional survival reflects dynamic prognosis updated to the current status and is a more relevant indicator for current healthcare and life decisions.

Methods:

This study included 1883 patients who underwent complete resection for esophageal squamous cell carcinoma at a tertiary cancer center from 1994 to 2016. We calculated 5-year (5Y) conditional overall survival (COS), conditional recurrence-free survival (CRFS), and conditional relative survival (CRS) estimates from diagnosis to 5 years of survival.

Results:

The 5Y COS, CRFS, and CRS increased from 63.7%, 65.2%, and 70.2% at diagnosis to 75.8%, 91.9%, and 86.4 at 5 years after diagnosis, respectively. While there were large differences with different stages (stage I, II, III) at diagnosis (81.2%, 64.9%, and 37.3% for COS; 85.1, 65.1%, and 67.9% for CRFS; 89.2%, 72.1%, and 41.1% for CRS), the gap decreased with time; rates were similar after 5 years (77.1%, 75.7%, and 72.6% for COS; 91.7%, 90.6%, and 94.5% for CRFS, and 89.3%, 85.4%, and 78.3% in CRS, respectively). The 5Y COS, CRFS, and CRS were persistently lower in older patients even after 5 years.

Conclusions:

Conditional survival estimates generally increase over time, and the largest improvements were observed for patients with advanced stage. Availability of updated prognosis at various time points allows clinicians to better guide their patients. Our results also imply substantial residual risk of recurrence and sustained excess mortality compared to the general population even after 5 years.
Magnetic Resonance Elastography Versus Transient Elastography in the Prediction of Complications After Resection for Hepatocellular Carcinoma
Authors: Bae Jae Seok , Lee Dong Ho , Yi Nam-Joon , Lee Kwang-Woong , Suh Kyung-Suk , Kim Haeryoung , Lee Kyung Bun , Choi Yunhee
Published: October 2020

Objective:

To compare the performances of MRE and TE for predicting severe complications after HR in patients with HCC.

Summary of Background Data:

LSM may have the potential to predict outcomes after HR in HCC patients.

Methods:

Consecutive patients who underwent HR for HCC between 2017 and 2019 were retrospectively enrolled. Before HR, LSM was performed in all patients using both MRE and TE. All postoperative complications were assessed using the comprehensive complication index (CCI). Severe postoperative complications were defined as a CCI ≥26.2. The performances of MRE and TE for predicting high CCI and diagnosing liver fibrosis were compared using the area under the receiver-operating-characteristic curve (AUROC). Uni-/multivariable logistic regression analyses were used to identify factors associated with high CCI.

Results:

Among the 208 enrolled patients, 28 patients (13.5%) had high CCI. For detecting high CCI, MRE had an AUROC of 0.874 [95% confidence interval (CI), 0.821–0.916], which was significantly higher than the AUROC of TE (0.756; 95% CI, 0.692–0.813) (P = 0.020). MRE outperformed TE in detecting fibrosis of ≥F2 (AUROC: 0.935 vs 0.767; P = 0.008), ≥F3 (AUROC: 0.902 vs 0.774; P = 0.001) and F4 (AUROC: 0.916 vs 0.767; P < 0.001). LSM by MRE was independently associated with high CCI (odds ratio, 4.207 per kPa; 95% CI, 1.862–9.504; P < 0.001), whereas LSM by TE was not.

Conclusions:

MRE better predicted severe postoperative complications than TE in HCC patients who underwent HR. LSM by MRE was independently associated with high CCI after HR.
Laparoscopic Colorectal Surgery Outcomes Improved After National Training Program (LAPCO) for Specialists in England
Authors: Hanna George B. , Mackenzie Hugh , Miskovic Danilo , Ni Melody , Wyles Susannah , Aylin Paul , Parvaiz Amjad , Cecil Tom , Gudgeon Andrew , Griffith John , Robinson Jonathan M. , Selvasekar Chelliah , Rockall Tim , Acheson Austin , Maxwell-Armstrong Charles , Jenkins John T. , Horgan Alan , Cunningham Chris , Lindsey Ian , Arulampalam Tan , Motson Roger W. , Francis Nader K. , Kennedy Robin H. , Coleman Mark G.
Published: October 2020

Objective:

To examine the impact of The National Training Program for Lapco on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training.

Summary of Background Data:

Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England.

Methods:

We compared the rate of laparoscopic surgery, mortality, and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively.

Results:

One hundred eight Lapco delegates performed 4586 elective colo-rectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72,930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% [95% confidence interval (CI), 18.5–23.3, P < 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, P = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, P = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56%, respectively.

Conclusions:

Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.
An extreme cold event leads to community-wide convergence in lower temperature tolerance in a lizard community
Authors: Stroud James T. , Mothes Caitlin C. , Beckles Winter , Heathcote Robert J. P. , Donihue Colin M. , Losos Jonathan B.
Published: October 2020

Extreme climate events are predicted to increase in frequency and severity due to contemporary climate change. Recent studies have documented the evolutionary impacts of extreme events on single species, but no studies have yet investigated whether such events can drive community-wide patterns of trait shifts. On 22 January 2020, subtropical south Florida experienced an extreme cold episode during which air temperatures dropped below the lower thermal limit of resident lizard populations. In the week immediately after the cold event, we documented decreased lower thermal limits (CT
min
) of six co-occurring lizard species that vary widely in ecology, body size and thermal physiology. Although cold tolerance of these species differed significantly before the cold snap, lizards sampled immediately after had converged on the same new, lower limit of thermal tolerance. Here, we demonstrate that extreme climate events can drive substantial and synchronous community-wide trait changes and provide evidence that tropical and subtropical ectotherms—often characterized as unable to withstand rapid changes in climatic conditions—can endure climatic conditions that exceed their physiological limits. Future studies investigating the mechanisms driving these trait shifts will prove valuable in understanding the ability of ectotherm communities to mitigate climate change.
The blending region hybrid framework for the simulation of stochastic reaction–diffusion processes
Authors: Yates Christian A. , George Adam , Jordana Armand , Smith Cameron A. , Duncan Andrew B. , Zygalakis Konstantinos C.
Published: October 2020

The simulation of stochastic reaction–diffusion systems using fine-grained representations can become computationally prohibitive when particle numbers become large. If particle numbers are sufficiently high then it may be possible to ignore stochastic fluctuations and use a more efficient coarse-grained simulation approach. Nevertheless, for multiscale systems which exhibit significant spatial variation in concentration, a coarse-grained approach may not be appropriate throughout the simulation domain. Such scenarios suggest a hybrid paradigm in which a computationally cheap, coarse-grained model is coupled to a more expensive, but more detailed fine-grained model, enabling the accurate simulation of the fine-scale dynamics at a reasonable computational cost. In this paper, in order to couple two representations of reaction–diffusion at distinct spatial scales, we allow them to overlap in a ‘blending region’. Both modelling paradigms provide a valid representation of the particle density in this region. From one end of the blending region to the other, control of the implementation of diffusion is passed from one modelling paradigm to another through the use of complementary ‘blending functions’ which scale up or down the contribution of each model to the overall diffusion. We establish the reliability of our novel hybrid paradigm by demonstrating its simulation on four exemplar reaction–diffusion scenarios.
A bioenergetic model to predict habitability, biomass and biosignatures in astrobiology and extreme conditions
Authors: Higgins P. M. , Cockell C. S.
Published: October 2020

In order to grow, reproduce and evolve life requires a supply of energy and nutrients. Astrobiology has the challenge of studying life on Earth in environments which are poorly characterized or extreme, usually both, and predicting the habitability of extraterrestrial environments. We have developed a general astrobiological model for assessing the energetic and nutrient availability of poorly characterized environments to predict their potential biological productivity. NutMEG (nutrients, maintenance, energy and growth) can be used to estimate how much biomass an environment could host, and how that life might affect the local chemistry. It requires only an overall catabolic reaction and some knowledge of the local environment to begin making estimations, with many more customizable parameters, such as microbial adaptation. In this study, the model was configured to replicate laboratory data on the growth of methanogens. It was used to predict the effect of temperature and energy/nutrient limitation on their microbial growth rates, total biomass levels, and total biosignature production in laboratory-like conditions to explore how it could be applied to astrobiological problems. As temperature rises from 280 to 330 K, NutMEG predicts exponential drops in final biomass (

10
9

−

10
6

 
cells
 

l

−
1

) and total methane production (

62

−

3
 

μ

M

) despite an increase in peak growth rates (

0.007

−

0.14
 

h

−
1

) for a typical methanogen in ideal conditions. This is caused by the increasing cost of microbial maintenance diverting energy away from growth processes. Restricting energy and nutrients exacerbates this trend. With minimal assumptions NutMEG can reliably replicate microbial growth behaviour, but better understanding of the synthesis and maintenance costs life must overcome in different extremes is required to improve its results further. NutMEG can help us assess the theoretical habitability of extraterrestrial environments and predict potential biomass and biosignature production, for example on exoplanets using minimum input parameters to guide observations.
The efficiency of insulin production and its content in insulin-expressing model β-cells correlate with their Zn
2+
levels
Authors: Dzianová Petra , Asai Seiya , Chrudinová Martina , Kosinová Lucie , Potalitsyn Pavlo , Šácha Pavel , Hadravová Romana , Selicharová Irena , Kříž Jan , Turkenburg Johan P. , Brzozowski Andrzej Marek , Jiráček Jiří , Žáková Lenka
Published: October 2020

Insulin is produced and stored inside the pancreatic β-cell secretory granules, where it is assumed to form Zn
2+
-stabilized oligomers. However, the actual storage forms of this hormone and the impact of zinc ions on insulin production
in vivo
are not known. Our initial X-ray fluorescence experiment on granules from native Langerhans islets and insulinoma-derived INS-1E cells revealed a considerable difference in the zinc content. This led our further investigation to evaluate the impact of the intra-granular Zn
2+
levels on the production and storage of insulin in different model β-cells. Here, we systematically compared zinc and insulin contents in the permanent INS-1E and BRIN-BD11 β-cells and in the native rat pancreatic islets by flow cytometry, confocal microscopy, immunoblotting, specific messenger RNA (mRNA) and total insulin analysis. These studies revealed an impaired insulin production in the permanent β-cell lines with the diminished intracellular zinc content. The drop in insulin and Zn
2+
levels was paralleled by a lower expression of ZnT8 zinc transporter mRNA and hampered proinsulin processing/folding in both permanent cell lines. To summarize, we showed that the disruption of zinc homeostasis in the model β-cells correlated with their impaired insulin and ZnT8 production. This indicates a need for in-depth fundamental research about the role of zinc in insulin production and storage.