bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Canadian Syncope Risk Score in the prediction of outcomes of patients with syncope at the Emergency Department of Suez Canal University
Authors: Moussa Bassant Sayed , Ali Mohamed Amin , Ali Ahmed Abd El-Nasser , Abou Zeid Ahmed EL Sayed Mohammed
Published: June 2022

Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It's also called fainting or "passing out.” Syncope is responsible for 3% to 5% of emergency department visits, with a hospitalization rate in about 40% of cases, with an average stay of 5.5 days. The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department.

The aim was to assess Canadian Syncope Risk Score in predicting outcomes and mortality at the emergency department of Suez Canal University Hospitals.

A prospective observational cohort study was carried out in emergency department in Suez Canal University Hospital. After approval by the Ethical and Research Committee of Faculty of Medicine, Suez Canal University, 60 patients with syncope attending to emergency department were included to this study. All included participants were assessed by history taking and they also assessed by the Canadian Syncope Risk Score.

The Canadian Syncope Risk Score's mean of the study group was 4.9 and the range of the scores was from −2 to 11. The mean of the percentage of risk of serious events at 30 days in the study group was 29.17% and it ranged from 0.7% to 83.6%.There was a statistically significant difference between means Canadian Syncope Risk Score's score regarding complication occurrence. Cases which showed complications had a mean score of 7.33 compared to a mean score of 1.25 in case of no complication occurrence P-value <.001. At a cut-off point of more than 3 for the Canadian Syncope Risk Score's, sensitivity of that score in complication's occurrence prediction was 100% and the specificity was 87.5% P-value <.001.

The Canadian Syncope Risk Score's is strong predictor for risk of serious adverse events and a good indicator for admission, with 100% sensitivity and 87.5% specificity at cut off point more than 3.
Induced membrane technique for large bone defects
Authors: Sun Shih-Heng , Tsai Wen-Wen , Shiu Sz-Iuan , Chen Chih-Hui
Published: June 2022

Aims:

The aim of this study was to evaluate the efficacy of induced membrane technique (IMT), and to analyze the relationships between patient factors and surgical parameters as well as their impacts on achieving bone union and complication rates.

Materials and methods:

A comprehensive, computerized search of PubMed, Embase, and The Cochrane Library was conducted, and articles published from January 1, 1978 to February 1, 2021 were included. Clinical trials matching the following inclusion criteria were included:

Univariate and multivariate logistic regression were performed with random intercepts to determine the association of specific predictor variables with nonunion rate, postoperative infection, the need for additional procedures, and time to union.

Results:

Seventy eight trials were included in the study with a total of 3840 patients managed with IMT. Mean age was 38.6 (0.8–88) years, mean size of bone defects was 6.4 (0–25) cm primarily distributed in the tibia (n = 1814, 60.9%), and overall union rate was 87.6%. Multivariate analysis showed the odds of nonunion were significantly increased in patients with an interval between two stages from 8 to 12 weeks and ≥12 weeks. Patients with preoperative infection and addition of antibiotic to bone cement during IMT had significantly decreased odds of longer union time, but preoperative infection caused increased odds of additional surgery. External fixation throughout 2 stages had significantly increased odds of postoperative infection and additional surgery.

Conclusions:

We recommend that the timing of the second stage should be delayed until 6 to 8 weeks after the first stage. Bone cement with antibiotics can control the infection rate and shorten the healing time. Furthermore, there is no need to avoid using internal fixation due to possible concerns about causing postoperative infection.
Highlighting hybridization: a case report of virtual reality-augmented interventions to improve chronic post-stroke recovery
Authors: Bailey Rachel Blanchette
Published: June 2022

Rationale:

Cerebrovascular accident, or stroke, is a leading cause of serious long-term disability, and incidence is expected to continue rising in the coming years. Stroke-related disability can manifest as motor, sensory, or cognitive impairment, and although current therapies can improve these impairments, many stroke patients are still left with reduced abilities and struggle to maintain independence in their daily lives. Virtual reality (VR) has been proposed as a novel therapeutic tool to treat stroke-related disability, particularly in conjunction with traditional post-stroke therapies.

Patient concerns:

Here, we report 1 case of a 75-year-old male with ongoing right upper extremity impairment.

Diagnosis:

The patient was previously diagnosed with an ischemic stroke.

Interventions:

Seven years post-stroke, during which he did not receive any therapies, and on the recommendation of his neurologist, the patient sought VR therapy as an innovative treatment strategy. His clinicians employed a combination of traditional exercise and VR therapy to improve his strength and mobility.

Outcomes:

The combination of traditional and VR therapy was able to provide meaningful improvement to his daily quality of life, even years after the stroke.

Conclusions:

These results suggest that combination therapy with VR is a viable tool for treating post-stroke impairment, even several years on from the cerebrovascular accident.
Gastrointestinal symptoms in patients hospitalized with COVID-19
Authors: Song Jun , Patel Jay , Khatri Rishabh , Nadpara Neil , Malik Zubair , Parkman Henry P.
Published: June 2022

To characterize outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19) who present with gastrointestinal (GI) symptoms.

Clinical outcomes in patients with COVID-19 associated with GI symptoms have been inconsistent in the literature.

The study design is a retrospective analysis of patients, age 18 years or older, admitted to the hospital after testing positive for COVID-19. Clinical outcomes included intensive care unit requirements, rates of discharges to home, rates of discharges to outside facilities, and mortality.

Seven hundred fifty patients met the inclusion criteria. Three hundred seventy three (49.7%) patients presented with at least one GI symptom and 377 (50.3%) patients presented with solely non-GI symptoms. Patients who presented with at least one GI symptom had significantly lower ICU requirements (17.4% vs 20.2%), higher rates of discharges home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and decreased mortality (6.4% vs 9.8%) compared with patients with non-GI symptoms. However, patients who presented with solely GI symptoms had significantly higher ICU requirements (23.8% vs 17.0%), lower rates of discharges home (52.4% vs 78.7%), higher rates of discharges to facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared with those with mixed GI and non-GI symptoms.

Although patients with COVID-19 requiring hospitalization with GI symptoms did better than those without GI symptoms, those with isolated GI symptoms without extra-GI symptoms had worse clinical outcomes. COVID-19 should be considered in patients who present with new onset or worsening diarrhea, nausea, vomiting, and abdominal pain even without pulmonary symptoms.
A forgotten double-J ureteral stent resulting in an emphysematous perinephric abscess
Authors: Lee In Hee , Shin Hong Seok , Ahn Dong Jik
Published: June 2022

Rationale:

Double-J stents (DJSs) are urologic devices widely used for urinary tract obstruction treatment. Perinephric abscess is a condition with purulent accumulation resulting from urinary tract infection retained between the renal capsule and Gerota's fascia. Emphysematous urinary tract infection in patients with a forgotten DJS is extremely rare. Herein, we report a case of emphysematous perinephric abscess as a complication in a 56-year-old non-diabetic woman who neglected a 10-year-old DJS placed for obstructive uropathy treatment.

Patient concerns:

The patient presented with fever and abdominal pain that persisted for 4 days. Laboratory examinations showed leukocytosis, hypoalbuminemia (2.3 g/dL), and elevated C-reactive protein level (305.5 mg/L) with no azotemia.

Diagnosis:

Abdominal computed tomography scan revealed a DJS with encrustation and multiple stones in the right kidney as well as a perinephric abscess with gas formation.

Interventions:

Intravenous administration of piperacillin/tazobactam was initiated immediately and percutaneous catheter drainage was performed. Extended-spectrum beta-lactamase-producing Escherichia coli was identified on abscess culture and antibiotics were switched to meropenem, resulting in gradual improvement of the inflammatory lesion. The patient was referred to the urology department for retained DJS removal and vesicolitholapaxy. A piece of fractured stent was removed via open ureterolithotomy.

Outcomes:

Since discharge on hospital day 42, she has been under regular follow-up, and the surgical wound has been healing with no significant sequelae.

Lessons:

Prompt medical therapy for inflammation and thorough urologic correction of the stent-induced structural deformities are crucial in long-term neglected DJS and resulting emphysematous perinephric abscess. Patients who undergo DJS placement should be systematically followed up to prevent potential neglect of device management.
Emergency and critical care professionals’ opinion on escape room as a health sciences evaluation game
Authors: Gómez-Urquiza Jose L. , Requena-Palomares Iván , Gorjón-Peramato Esther , Gómez-Salgado Juan , Cañadas-De la Fuente Guillermo A. , Albendín-García Luis
Published: June 2022

New teaching and evaluation methods are growing in health sciences. The escape room is a game that is showing benefits for assessing knowledge and important competencies in healthcare professionals. The aim of this study is to analyse the opinion of emergency and critical care professionals on the use of escape rooms as an evaluation game.

A quantitative, descriptive, cross-sectional study was conducted using an ad-hoc questionnaire with a Likert-type scale. The study included emergency and critical care professionals who participated in the escape room “The Frustrated Emergency and Critical Care Professional,” that took place during an emergency and critical care national congress. Data collection was carried out in June 2019.

The sample was composed of n = 50 emergency and critical care professionals, 52% of whom were physicians and 48% were nurses. Professionals believe that this is a good teaching game for evaluation and useful for strengthen knowledge (4.7 points), as well as to improve teamwork and the ability to work under pressure (4.9).

The escape room is a useful evaluation game in the context of emergency and critical care units that also allows training the teamwork and working under pressure competencies.
Visualization and analysis of mapping knowledge domains for coronavirus research
Authors: Yao Weizhi , Tan Ling , Liu Liang
Published: June 2022

Background:

In recent years, many countries around the world have been threatened by COVs. The aim of this study was to better grasp developments and trends in research on coronavirus around the world and to promote theoretical research into their prevention and control.

Methods:

Research on coronavirus was reviewed and analyzed using bibliometrics based on a total of 4860 publications collected from the Web of Science Core Collection database. Yearly quantitative distribution of literature, country/region distribution, organization distribution, main source journal distribution, subject category distribution, research knowledge bases, and research hotspots and frontiers were all analyzed, and CiteSpace and VOSviewer were used to plot knowledge domain maps, Excel was used to plot keyword strategy diagram.

Results:

Coronavirus research could be roughly divided into 4 stages: preliminary development stage (before 2000), rapid growth stage (2000–2005), slow decline stage (2006–2011) and sustained growth stage (since 2012). America had taken the leading position in this field. The study of COVs involves many subject categories, mainly includes virology, veterinary sciences, biology, and immunology. At present, the key words in the field of coronavirus research were mainly divided into 6 major hot clusters, namely, the introduction and structure analysis of coronavirus, the research on the outbreak source and transmission of coronavirus, the research on the infection pathway of coronavirus in human body, the research on the pathogenesis of coronavirus, the research on the diagnosis and symptoms of coronavirus infection, and the research on the treatment of coronavirus.

Conclusion:

Coronavirus, which occurs all over the world, often causes huge casualties and economic losses, and poses a serious threat to the safe and stable operation of the social and economic system. Objective literature review and analysis can help scholars in related fields to deepen their overall understanding. And, there are several key issues that should be further explored in future research.
Evaluation of severe adverse events during rehabilitation for acute-phase patients
Authors: Kinoshita Tokio , Kamijo Yoshi-Ichiro , Kouda Ken , Yasuoka Yoshinori , Nishimura Yukihide , Umemoto Yasunori , Ogawa Takahiro , Mikami Yukio , Kawanishi Makoto , Tajima Fumihiro
Published: June 2022

Early mobilization decreases the likelihood of negative outcomes for acute-phase inpatients. Adverse events occurring during intensive care unit rehabilitation have previously been reported; however, no study has reported the incidence rates for adverse events during the acute rehabilitation phase. This study aimed to investigate the incidence of severe adverse events during acute-phase rehabilitation and evaluate them in detail.

Reports of adverse events occurring during acute-phase rehabilitation in a university hospital from April 1, 2011 to March 31, 2018 were retrospectively assessed.

Nine severe adverse events occurred during this period (incidence rate, 0.032%), comprising 2 cardiopulmonary arrests, 2 pulseless electrical activity events, 2 deterioration in consciousness events, 1 deterioration in consciousness event due to cerebral infarction, 1 fracture due to a fall, and 1 event involving removal of a ventricular drain. Pulmonary thromboembolism was implicated in 1 adverse event involving pulseless electrical activity and 1 deterioration in consciousness event. The causes for the 6 other adverse events could not be identified. The mean days from admission and the onset of rehabilitation to adverse event occurrence were 22.0 ± 18.2 and 17.9 ± 13.5 days (mean ± standard deviation), respectively. Four of 9 patients died, and 5 patients were discharged home or transferred to other stepdown facilities. When assessed retrospectively, there were no conflicts between patient conditions and the cancellation criteria of rehabilitation by the Japanese Association of Rehabilitation Medicine.

The occurrences of severe adverse event may not be related to early mobilization (or onset time of rehabilitation) and compliance status of cancellation criteria.
Percutaneous radiofrequency trigeminal rhizotomy benefits in patients with refractory trigeminal neuralgia
Authors: Yang Chao-Chun , Lee Ming-Hsue , Yang Jen-Tsung , Chen Kuo-Tai , Huang Wei-Chao , Tsai Ping-Jui , Kao Chih-Hao , Liao Chien-Wei , Lin Martin Hsiu-Chu
Published: June 2022

A significant number of patients suffers from refractory trigeminal neuralgia (TN) after receiving microvascular decompression (MVD) or other neuro-destructive procedure such as gamma knife radiosurgery (GKRS). This study aims to demonstrate a remediable, reproducible approach to treating refractory pain effectively by percutaneous radiofrequency trigeminal rhizotomy (RF-TR).

A total of 392 patients with TN were treated by RF-TR during the past 10 years. Among these patients, 48 cases who had received either MVD, GKRS alone, or a combination of both were assigned to group A. Those who had not received any form of treatment (125 patients) or failed to respond medically (130 patients) were assigned as the control group (group B). All the RF-TR were performed by a single surgeon with the aid of intraoperative computed tomography (iCT)-based neuronavigation with magnetic resonance (MR) image fusion. The outcome measure was the numerical rating scale (NRS) expressed subjectively by patients. The paired Student t test and the analysis of covariance (ANCOVA) were used for statistical analysis.

In group A, 21 of 24 patients (88%) had significant improvement (NRS change ≥5) in facial pain after RF-TR. The average NRS score was 9.75 ± 0.53 before the procedure and 1.92 ± 3.35 post-treatment (significant NRS decrease [P = .000]). On the other hand, in group B, 226 of 255 patients (89%) also had dramatic amelioration of facial pain after RF-TR. The average NRS score was 9.46 ± 0.69 before the procedure and 1.62 ± 2.85 post-treatment (7.84 ± 2.82 in NRS decrease [P = .008]). By using a univariate ANCOVA, no statistical significance was found in NRS score improvement between the two groups.

Repeated MVD and GKRS for refractory TN may be less desirable due to a greater risk of mortality (up to 0.8%) and morbidity (4% of serious complications). Conversely, RF-TR administration with the novel navigation technique by using iCT and MR image fusion is free from any remarkable and irreversible morbidities. In this study, RF-TR not only provided an alternative and effective strategy if TN recurred but also resulted in the same NRS score improvement regardless of the status of prior treatment.
The Benefit of Probiotics in Pediatric Nonalcoholic Fatty Liver Disease: A Meta-analysis of Randomized Control Trials
Authors: Gkiourtzis Νikolaos , Kalopitas Georgios , Vadarlis Andreas , Bakaloudi Dimitra Rafailia , Dionysopoulos Georgios , Karanika Evangelia , Tsekitsidi Eirini , Chourdakis Michail
Published: June 2022

Objectives:

We conducted a systematic review and meta-analysis to provide a summary of the current literature about the efficacy of probiotics in pediatric nonalcoholic fatty liver disease (NAFLD).

Methods:

A systematic literature search through major electronic databases was carried out for RCTs till September 9, 2021, investigating the efficacy of probiotics in the treatment of pediatric patients with NAFLD. Weighted mean differences (WMD) and Standard Deviations (SD) were used to calculate continuous outcomes and a Risk Ratio with 95% CI was used for dichotomous outcomes.

Results:

In total, 4 RCTs with 238 pediatric patients with NAFLD were included in the study. Probiotic supplementation revealed a statistically significant difference in transaminases’ levels (ALT: WMD = –7.51 IU/L, 95% CI, –11.28 to –3.73, I2 = 0%, P < 0.0001; AST: WMD = –6.46 IU/L, 95% CI, –9.31 to –3.61, I2 = 0%, P < 0.00001), anthropometric characteristics, total cholesterol, triglycerides and ultrasonographic steatosis improvement.

Conclusions:

According to the data of this meta-analysis, probiotic supplementation, and especially supplementation of Lactobacillus acidophilus in combination with other strains of Bifidobacterium or Lactobacillus may be beneficial in the improvement of transaminases’, lipid parameters’ levels, ultrasonographic, and anthropometric characteristics in children with NAFLD. Current evidence does not allow specifying the exact beneficial strain of probiotics mentioned above. The possible effect of probiotics on liver histology improvement in pediatric NAFLD should be examined in future studies.
Expression of HLA and Autoimmune Pathway Genes in Liver Biopsies of Young Subjects With Autoimmune Hepatitis Type 1
Authors: Shin Emilia , Schwarz Kathleen B. , Jones-Brando Lorraine V. , Florea Liliana D. , Sabunciyan Sarven , Wood Laura Delong , Yolken Robert H.
Published: June 2022

Objectives:

To test the hypothesis that autoimmune hepatitis (AIH type I) in young subjects is due to genetic differences in proinflammatory genes responding to viral triggers in patients and controls.

Methods:

Intrahepatic gene expression was compared between AIH type I (n = 24, age 9–30 years) patients (hereafter referred to as the AIH group) and controls (n = 21, age 4–25 years). RNA sequencing was performed on complementary DNA (cDNA) libraries made from total RNA extracted from formalin-fixed paraffin-embedded (FFPE) liver biopsy samples. Gene expression levels were quantified, and differentially expressed genes were functionally analyzed. Pathway analysis was performed using the databases Kyoto Encyclopedia of Genes and Genomes (KEGG) and PANTHER. The remaining sequences were mapped to the RefSeq complete set of viral genomes.

Results:

Differential gene analysis identified 181 genes that were significantly differentially expressed (136 upregulated in the AIH group). Autoimmune pathway genes such asCD19andCD20which are important in B cell regulation and maturation as well as,CD8andLY9, which are T-cell related, were upregulated in our AIH group. Genes implicated in AIH pathogenesis includingCXCL10, which is thought to be associated with AIH severity and progression, complement genes (C1QA, C1QB, andC1QC), and human leucocyte antigen (HLA) genes (HLA-DRB1, HLA-DRA, HLA-B, andHLA-C) were upregulated in samples from the AIH group. Specific viral etiologies were not found.

Conclusions:

Unbiased next-generation sequencing and differential gene expression analysis of the AIH group has not only added support for the role of B cells in the pathogenesis and treatment of AIH but also has introduced potential new therapeutic targets:CXCL10(anti-CXCL10) and several complement system–related genes.
Mentoplasty with Cancellous Bone Chip Scaffolding: An Innovative Technique for Chin Aesthetics.
Authors: Hayes Danielle S , Miranda Suzette G , Peters Mary L
Published: June 2022

The facial skeleton is foundational for facial aesthetics. We describe an alternative technique for cosmetic chin augmentation that does not require alloplastic implants, osseous genioplasty, or autologous bone harvesting. In this new innovative technique for chin augmentation, tissue bank allograft cancellous bone chips serve as a scaffold for bony ingrowth. The use of bone chips allows for aesthetic contouring with small adjustments in the facial skeleton. The objective of this paper is to provide further information on this novel technique as well as demonstrate the efficacy and safety of tissue bank allograft cancellous bone chips as an alternative graft material for cosmetic chin augmentation. Retrospective review of patients who underwent chin augmentation with cancellous bone chips from July 2015 to March 2019 was performed. Photographic results from several patients were included. No patients developed infections, required re-operation, or went on to have explantation of the graft material. Initial results suggest cancellous bone chips are a safe, efficacious alternative graft material for cosmetic chin augmentation.
Development and Initial Validation of a Novel Professional Aesthetic Scale for the Female Abdomen
Authors: Sood Rachita , Muhammad Lutfiyya N. , Sasson Daniel C. , Shah Nikita , Yeh Chen , Nahas Fabio X. , Dumanian Gregory A.
Published: June 2022

Background:

A growing body of literature aims to describe abdominal aesthetic goals in order to tailor surgical and non-surgical treatment options to meet patient goals. We aimed to integrate lay-person perceptions into the design of a novel professional aesthetic scale for the abdomen.

Methods:

An iterative process of expert consensus was used to choose 5 domains –1) abdominal muscle lines, 2) abdominal shape, 3) scar, 4) skin, and 5) umbilicus. A survey was developed to measure global and domain-specific aesthetic preferences on 5 abdomens. This was distributed through Amazon Mechanical Turk to 340 respondents. Principal component analysis was used to integrate survey data into weights for each of the scale’s sub-questions. Attending plastic surgeons then rated abdomens using the final scale, and reliability and validity were calculated.

Results:

The final scale included eleven sub-questions –hourglass shape, bulges, hernia, infraumbilical skin, supraumbilical skin, umbilicus shape, umbilicus medialization position, umbilicus height position, semilunar lines, central midline depression, scar– within the 5 domains. Central midline depression held the highest weight (16.1%) when correlated to global aesthetic rating, followed by semilunar lines (15.8%) and infraumbilical skin (11.8%). The final scale demonstrated strong validity (Pearson r=0.99) and was rated as easy to use by 7 attending plastic surgeons.

Conclusion:

The final scale is the first published professional aesthetic scale for the abdomen that aims to integrate lay-person opinion. In addition, this analysis and survey data provide insights into the importance of eleven components in overall aesthetic appeal of the abdomen.
Diode Laser Management of Cheek Cavernous Hemangioma in Dental Office
Authors: Muntianu Ligia Adriana Stanca , Mihai George , Bodnar Traian
Published: June 2022

Due to high energy content and specific characteristics of dental laser light, this kind of procedure optimizes the outcome on oral cavernous hemangioma removal, diminishing the risks, and complications.

Management of a very rare internal cheek cavernous hemangioma presenting a high risk of injury in a patient with chronic acenocoumarol medication and high blood pressure, can be accomplished using diode 810nm laser, in the dental office with predictable results.

Protocol complied diode laser, with specific fiber tip, specific power, and operation mode, for 1 minute/1 cm2 irradiated area. Intervention sequences were repeated until complete disappearance.

Laser procedure withdrew the lesion rapidly, completely. It has a lot of advantages that recommends it as a removal procedure before prosthetic treatment.
Associations of Facial Proportionality, Attractiveness, and Character Traits
Authors: Villavisanis Dillan F. , Workman Clifford I. , Cho Daniel Y. , Zapatero Zachary D. , Wagner Connor S. , Blum Jessica D. , Bartlett Scott P. , Swanson Jordan W. , Chatterjee Anjan , Taylor Jesse A.
Published: June 2022

Background:

Facial proportionality and symmetry are positively associated with perceived levels of facial attractiveness.

Objective:

The aims of this study were to confirm and extend the association of proportionality with perceived levels of attractiveness and character traits and determine differences in attractiveness and character ratings between “anomalous” and “typical” faces using a large dataset.

Methods:

Ratings of 597 unique individuals from the Chicago Face Database were used. A formula was developed as a proxy of relative horizontal proportionality, where a proportionality score of “0” indicated perfect proportionality and more negative scores indicated less proportionality. Faces were categorized as “anomalous” or “typical” by 2 independent reviewers based on physical features.

Results:

Across the ratings for all faces, Spearman correlations revealed greater proportionality was associated with attractiveness (ρ = 0.292, P < 0.001) and trustworthiness (ρ = 0.193, P < 0.001), while lesser proportionality was associated with impressions of anger (ρ = 0.132, P = 0.001), dominance (ρ = 0.259, P < 0.001), and threateningness (ρ = 0.234, P < 0.001). Mann-Whitney U tests revealed the typical cohort had significantly higher levels of proportionality (–13.98 versus –15.14, P = 0.030) and ratings of attractiveness (3.39 versus 2.99, P < 0.001) and trustworthiness (3.48 versus 3.35, P < 0.001).

Conclusions:

This study demonstrated that facial proportionality is not only significantly associated with higher ratings of attractiveness, but also associated with judgements of trustworthiness. Proportionality plays a role in evoking negative attributions of personality characteristics to people with facial anomalies.
The Patient Experience of an Inadequate-Quality Bowel Preparation During the Colonoscopy Process
Authors: Kimpel Christine Cleary , Bonnet Kemberlee , Schlundt David
Published: June 2022

As many as 35% of patients may experience an inadequate-quality bowel preparation for colonoscopy, which may then require a repeated colonoscopy without insurance coverage. To our knowledge, there have been no qualitative studies with an in-depth exploration of patient experiences of this outcome. This study aimed to explore patients' perceptions of experiencing an inadequate preparation compared to those with only an adequate-quality bowel preparation history. Quantitative analyses were conducted for three one-item questions (e.g., anxiety rating) with ordinal scales. Qualitative data were collected from audio-recorded and transcribed telephone interviews (N = 20) and anonymous online surveys (N = 59). An inductive/deductive coding system was constructed, and themes were generated to form a conceptual framework. Brief quantitative results are provided. Themes of the colonoscopy process include context, prepreparation, implementation, outcomes, response, and decision to repeat. This novel study underscored the emotional experience of patients with inadequate preparation and subsequent influence on decisions to repeat the procedure. Recommendations are given for research, policy, and practice.
Oncological Outcome of Conversion Surgery After Preoperative Chemotherapy for Metastatic Pancreatic Cancer
Authors: Hank Thomas , Klaiber Ulla , Hinz Ulf , Schütte Denise , Leonhardt Carl-Stephan , Bergmann Frank , Hackert Thilo , Jäger Dirk , Büchler Markus W. , Strobel Oliver
Published: June 2022

Objective:

To investigate the outcome of conversion surgery in patients with metastatic pancreatic cancer (mPDAC) and to identify patients who may benefit from this approach.

Background:

The role of conversion surgery in patients with mPDAC and exceptional response to chemotherapy remains unclear.

Methods:

Patients who underwent surgical exploration for mPDAC following chemotherapy between 2006 and 2019 were included. Data on demographics, oncologic treatment, pathology, and postoperative outcomes were analyzed. Univariate and multivariate survival analyses were performed.

Results:

Some 173 patients received preoperative chemotherapy and underwent surgical exploration. Ninety-three patients underwent resection of the primary tumor and metastatic sites, 80 patients underwent exploration only. In the resection subgroup, 45 patients had complete pathological response of metastases (ypM0) and 48 patients had residual metastases (ypM1). ypM0 status was associated with lower carcinoembryonic antigen levels and lower ypN stage. Overall survival after resection was 25.5 months in ypM0, 10.7 months in ypM1, and 8.1 months in patients without resection (P<0.001). Additional adjuvant chemotherapy was significantly associated with prolonged survival in resected patients (29.0 vs 14.8 mo, P=0.024) as well as in ypM0 (29.1 vs 19.2 mo, P=0.047). Multivariable analysis identified conversion surgery, carbohydrate antigen 19-9 (CA19-9) and time of resection as independent prognostic markers for the entire cohort. CA19-9, ypM0 and adjuvant treatment were independent predictors of survival in the resection subgroup.

Conclusion:

In patients with mPDAC and ypM0 status after chemotherapy, surgical resection is associated with encouraging survival. mPDAC patients with exceptional response to chemotherapy may be candidates for exploration and for resection in ypM0. Adjuvant chemotherapy may provide an additional survival advantage.
Use of Telemedicine for Postdischarge Assessment of the Surgical Wound
Authors:   NIHR Global Health Research Unit on Global Surgery, GlobalSurg Collaborative
Published: June 2022

Objective:

This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardized assessment tools are needed.

Background:

Surgical site infection (SSI) is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery.

Methods:

The primary outcome of this study was SSI reported up to 30 days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analyzed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30 days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596).

Results:

The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval: 0.63–0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In 9 eligible nonrandomized studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47–0.94) than in-person (reference) follow-up (I
2=0.45, P=0.12), although there a high risk of bias in included studies.

Conclusions:

Use of telemedicine to assess the surgical wound postdischarge is feasible, but risks underreporting of SSI. Standardized tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally.
Modelling coupled human–environment complexity for the future of the biosphere: strengths, gaps and promising directions
Authors: Farahbakhsh Isaiah , Bauch Chris T. , Anand Madhur
Published: June 2022

Humans and the environment form a single complex system where humans not only influence ecosystems but also react to them. Despite this, there are far fewer coupled human–environment system (CHES) mathematical models than models of uncoupled ecosystems. We argue that these coupled models are essential to understand the impacts of social interventions and their potential to avoid catastrophic environmental events and support sustainable trajectories on multi-decadal timescales. A brief history of CHES modelling is presented, followed by a review spanning recent CHES models of systems including forests and land use, coral reefs and fishing and climate change mitigation. The ability of CHES modelling to capture dynamic two-way feedback confers advantages, such as the ability to represent ecosystem dynamics more realistically at longer timescales, and allowing insights that cannot be generated using ecological models. We discuss examples of such key insights from recent research. However, this strength brings with it challenges of model complexity and tractability, and the need for appropriate data to parameterize and validate CHES models. Finally, we suggest opportunities for CHES models to improve human–environment sustainability in future research spanning topics such as natural disturbances, social structure, social media data, model discovery and early warning signals.

This article is part of the theme issue ‘Ecological complexity and the biosphere: the next 30 years’.
Hydrological implications of large-scale afforestation in tropical biomes for climate change mitigation
Authors: Ricciardi Livia , D'Odorico Paolo , Galli Nikolas , Chiarelli Davide Danilo , Rulli Maria Cristina
Published: June 2022

Rising interest in large-scale afforestation and reforestation as a strategy for climate change mitigation has recently motivated research efforts aiming at the identification of areas suitable for the plantation of trees. An often-overlooked aspect of agroforestry projects for carbon sequestration is their impact on water resources. It is often unclear to what extent the establishment of forest vegetation would be limited by water availability, whether it would engender competition with other local water uses or induce water scarcity. Here we use global water models to study the hydrologic constraints and impacts of afforestation in tropical biomes. We find that 36% of total suitable and available afforestation areas are in areas where the rain alone can meet just up to the 40% of total plant water requirement. Planting trees will substantially increase water scarcity and possible dispossession (green water grab) especially in dryland regions of Africa and Oceania. Moreover, the combination of tree restoration and irrigation expansion to rainfed agricultural areas is expected to further exacerbate water scarcity, with about half of the global suitable areas for tree restoration experiencing water scarcity at least 7 months per year. Thus, the unavailability of water can overall limit climate change adaptation strategies.

This article is part of the theme issue ‘Ecological complexity and the biosphere: the next 30 years’.
Virulence plasmid pINV as a genetic signature for Shigella flexneri phylogeny
Authors: Pilla Giulia , Arcari Gabriele , Tang Christoph M. , Carattoli Alessandra
Published: June 2022

Shigella flexneri

is a major health burden in low- and middle-income countries, where it is a leading cause of mortality associated with diarrhoea in children, and shows an increasing incidence among travellers and men having sex with men. Like all

Shigella

spp.,

S. flexneri

has evolved from commensal

Escherichia coli

following the acquisition of a large plasmid pINV, which contains genes essential for virulence. Current sequence typing schemes of

Shigella

are based on combinations of chromosomal genetic loci, since pINV-encoded virulence genes are often lost during growth in the laboratory, making these elements inappropriate for sequence typing. By performing comparative analysis of pINVs from

S. flexneri

strains isolated from different geographical regions and belonging to different serotypes, we found that in contrast to plasmid-encoded virulence genes, plasmid maintenance genes are highly stable pINV-encoded elements. For the first time, to our knowledge, we have developed a

S. flexneri

plasmid multilocus sequence typing (pMLST) method based on different combinations of alleles of the vapBC and yacAB toxin–antitoxin (TA) systems, and the parAB partitioning system. This enables typing of

S. flexneri

pINV plasmids into distinct ‘virulence sequence types’ (vSTs). Furthermore, the phylogenies of vST alleles and bacterial host core genomes suggests an intimate co-evolution of pINV with the chromosome of its bacterial host, consistent with previous findings. This work demonstrates the potential of plasmid maintenance loci as genetic characteristics to study as well as to trace the molecular phylogenesis of

S. flexneri

pINV and the phylogenetic relationship of this plasmid with its bacterial host.
Molecular complex detection in protein interaction networks through reinforcement learning
Authors: Palukuri Meghana V. , Patil Ridhi S. , Marcotte Edward M.
Published: June 2022

Many, if not most, proteins assemble into higher-order complexes to perform their biological functions. Such protein-protein interactions (PPI) are often experimentally measured for pairs of proteins and summarized in a weighted PPI network, to which community detection algorithms can be applied to define the various higher-order protein complexes. Current methods, which include both unsupervised and supervised approaches, often assume that protein complexes manifest only as dense subgraphs, and in the case of supervised approaches, focus only on learning which subgraphs correspond to complexes, not how to find them in a network, a task that is currently solved using heuristics. However, learning to walk trajectories on a network with the goal of finding protein complexes lends itself naturally to a reinforcement learning (RL) approach, a strategy that has not been extensively explored for community detection. Here, we evaluated the use of a reinforcement learning pipeline for community detection in weighted protein-protein interaction networks to detect new protein complexes. Using known complexes, the algorithm is trained to calculate the value of different possible subgraph densities in the process of walking on the network to find a protein complex. Then, a distributed prediction algorithm scales the RL pipeline to search for protein complexes on large PPI networks. The reinforcement learning pipeline applied to a human PPI network consisting of 8k proteins and 60k PPI results in 1,157 protein complexes and shows competitive accuracy with improved speed when compared to previous algorithms. We highlight protein complexes harboring minimally characterized proteins including C4orf19, C18orf21, and KIAA1522, suggest TMC04 to be a putative additional subunit of the KICSTOR complex, and confirm the participation of C15orf41 in a higher-order complex with CDAN1, ASF1A, and HIRA by 3D structural modeling. Reinforcement learning offers several distinct advantages for community detection, including scalability and knowledge of the walk trajectories defining those communities.
High-throughput phenotyping of infection by diverse microsporidia species reveals a wildC. elegansstrain with opposing resistance and susceptibility traits
Authors: Mok Calvin , Xiao Meng A. , Wan Yin C. , Zhao Winnie , Ahmed Shanzeh M. , Luallen Robert J. , Reinke Aaron W.
Published: June 2022

Animals are under constant selective pressure from a myriad of diverse pathogens. Microsporidia are ubiquitous animal parasites, but the influence they exert on shaping animal genomes is mostly unknown. Using multiplexed competition assays, we measured the impact of four different species of microsporidia on 22 wild isolates ofCaenorhabditis elegans. This resulted in the identification and confirmation of 13 strains with significantly altered population fitness profiles under infection conditions. One of these identified strains, JU1400, is sensitive to an epidermal-infecting species by lacking tolerance to infection. JU1400 is also resistant to an intestinal-infecting species and can specifically recognize and destroy this pathogen. Genetic mapping of JU1400 demonstrates that these two opposing phenotypes are caused by separate loci. Transcriptional analysis reveals the JU1400 sensitivity to epidermal microsporidia infection results in a response pattern that shares similarity to toxin-induced responses. In contrast, we do not observe JU1400 intestinal resistance being regulated at the transcriptional level. The transcriptional response to these four microsporidia species is conserved, withC. elegansstrain-specific differences in potential immune genes. Together, our results show that phenotypic differences to microsporidia infection amongstC. elegansare common and that animals can evolve species-specific genetic interactions.
ztf-16 is a novel heterochronic modulator that opposes adult cell fate in dauer and continuous life histories in Caenorhabditis elegans
Authors: Hansen Mark A. , Dahal Anuja , Bernstein Taylor A. , Kohtz Chani , Ali Safiyah , Daul Aric L. , Montoye Eric , Panzade Ganesh P. , Alessi Amelia F. , Flibotte Stephane , Vargas Marcus L. , Bourgeois Jacob , Brown Campbell , Kim John K. , Rougvie Ann E. , Zinovyeva Anna , Karp Xantha
Published: June 2022

Animal development is a complex yet robust process that can withstand lengthy and variable interruptions. In Caenorhabditis elegans, adverse conditions can trigger entry into dauer, a stress-resistant, developmentally arrested diapause stage that occurs midway through larval development. Favorable conditions promote recovery from dauer, and post-dauer larvae develop normally. During larval development, epidermal seam cells are multipotent and divide at each stage. At adulthood, seam cells differentiate and express the adult-specific COL-19 collagen. The progression of cell fates is controlled by a network of genes called the heterochronic pathway, including the LIN-29 transcription factor that directly activates col-19 expression, and the let-7 microRNA that indirectly promotes lin-29 expression. Notably, most known heterochronic genes that oppose adult cell fate act only during continuous development; these genes are dispensable after dauer. We performed a genetic screen for heterochronic genes that act after dauer and identified ztf-16, encoding a zinc finger transcription factor in the hunchback/Ikaros-like family. We found that ztf-16 is required to prevent precocious expression of the adult cell fate marker col-19p::gfp equally during both life histories, making ztf-16(-) the first precocious heterochronic mutant to be unaffected by dauer. Our data indicate that ztf-16 regulates col-19p::gfp via a novel, lin-29-independent mechanism. Endogenous ztf-16b::gfp expression is regulated by let-7 and ztf-16 acts genetically downstream of let-7, but lin-29 is not required for col-19p::gfp expression in ztf-16 mutant larvae or adults. Finally, mRNA-seq experiments identified genes whose expression is regulated by ztf-16 in each life history. Taken together, this work illuminates a novel aspect of the heterochronic pathway relevant to both dauer and non-dauer development.
Fear in action: Fear conditioning and alleviation through body movements
Authors: Alemany-González Maria , Wokke Martijn E. , Chiba Toshinori , Narumi Takuji , Kaneko Naotsugu , Yokoyama Hiraku , Watanabe Katsumi , Nakazawa Kimitaka , Imamizu Hiroshi , Koizumi Ai
Published: June 2022

Acquisition of fear memories enhances survival especially when the memories guide defensive movements to minimize harm. Accordingly, fear memories and body movements have tight relationships in animals: Fear memory acquisition results in adapting reactive defense movements, while training active defense movements to avoid threat reduces fear memory. However, evidence in humans is scarce because their movements are typically marginalized in experiments. Here, we tracked participants’ whole-body motions while they underwent fear conditioning in a virtual 3D space. First, representational similarity analysis of body motions revealed that participants obtained distinct spatiotemporal movement patterns through fear conditioning. Second, subsequent training to actively avoid threats with naturalistic defensive actions led to a long-term (24 hrs) reduction of physiological and embodied conditioned responses, while extinction or vicarious training only transiently reduced the responses followed by their spontaneous return. Together, our results highlight the intrinsic role of body movements in human fear memory functions, suggesting the potential for improving fear memory interventions through embodiment.