bluuebunny/crossref_metadata_2025 huggingface dataset:
Working Toward Consensus on Sporadic Vestibular Schwannoma Care: A Modified Delphi Study
Authors: Carlson Matthew L. , Link Michael J. , Driscoll Colin L.W. , Haynes David S. , Billings Heather A. , Lohse Christine M. , Hall Elissa R. , Agazzi Siviero , Barker Frederick G. , Brackmann Derald E. , Cueva Roberto A. , Golfinos John G. , Gurgel Richard K. , Kondziolka Douglas , Kutz J. Walter , Neff Brian A. , Sheehan Jason P. , Van Gompel Jamie J. , Yu Chung Ping
Published: November 2020

Objective:

To address variance in clinical care surrounding sporadic vestibular schwannoma, a modified Delphi study was performed to establish a general framework to approach vestibular schwannoma care. A multidisciplinary panel of experts was established with deliberate representation from key stakeholder societies. External validity of the final statements was assessed through an online survey of registered attendees of the 8th Quadrennial International Conference on Vestibular Schwannoma.

Study Design:

Modified Delphi method.

Methods:

The panel consisted of 16 vestibular schwannoma experts (8 neurotology and 8 neurosurgery) and included delegates representing the AAOHNSF, AANS/CNS tumor section, ISRS, and NASBS. The modified Delphi method encompassed a four-step process, comprised of one prevoting round to establish a list of focus areas and three subsequent voting rounds to successively refine individual statements and establish levels of consensus. Thresholds for achieving moderate consensus, at ≥67% agreement, and strong consensus, at ≥80% agreement, were determined a priori. All voting was performed anonymously via the Qualtrics online survey tool and full participation from all panel members was required before procession to the next voting round.

Results:

Through the Delphi process, 103 items were developed encompassing hearing preservation (N = 49), tumor control and imaging surveillance (N = 20), preferred treatment (N = 24), operative considerations (N = 4), and complications (N = 6). As a result of item refinement, moderate (4%) or strong (96%) consensus was achieved in all 103 final statements. Seventy-nine conference registrants participated in the online survey to assess external validity. Among these survey respondents, moderate (N = 21, 20%) or strong (N = 73, 71%) consensus was achieved in 94 of 103 (91%) statements, and no consensus was reached in 9 (9%). Of the four items with moderate consensus by the expert panel, one had moderate consensus by the conference participants and three had no consensus.

Conclusion:

This modified Delphi study on sporadic vestibular schwannoma codifies 100% consensus within a multidisciplinary expert panel and is further supported by 91% consensus among an external group of clinicians who regularly provide care for patients with vestibular schwannoma. These final 103 statements address clinically pragmatic items that have direct application to everyday patient care. This document is not intended to define standard of care or drive insurance reimbursement, but rather to provide a general framework to approach vestibular schwannoma care for providers and patients.
Identifying Relative Changes in Social Risk Factors
Authors: Xu Stanley , Goodrich Glenn K. , Moore Kelly R. , Manson Spero M. , Gottlieb Laura M. , Hessler Danielle , Schroeder Emily B. , Steiner John F.
Published: November 2020

Background:

Individuals often report concurrent social risk factors such as food insecurity, unstable housing, and transportation barriers. Comparing relative changes between pairs of social risk factors may identify those that are more resistant to change.

Objective:

The objective of this study was to develop a method to describe relative changes in pairs of social risk factors.

Research Design:

This was a prospective cohort study.

Subjects:

Participants in a randomized controlled trial of hypertension care in an Urban Indian Health Organization.

Measures:

We measured 7 social risk factors (housing, transportation, food, clothing, health care, utilities, and debts) at enrollment, 6, and 12 months among 295 participants in the trial. We hypothesized that pairwise comparisons could identify social risk factors that were less likely to change over time. We used conditional odds ratios (ORs) with 95% confidence intervals (CIs) to rank each pair.

Results:

Food, clothing, health care, utilities, and debts had more changes between 0 and 6 months relative to housing (OR=2.3, 3.4, 4.7, 3.5, and 3.4, respectively; all 95% CI excluded 1.0). These same social risk factors also had more changes between baseline and 6 months relative to transportation (OR=2.8, 3.4, 4.9, 4.7, and 4.1, respectively; all 95% CI excluded 1.0). Changes in housing and transportation risk factors were comparable (OR=0.7, 95% CI: 0.4–1.4). Relative changes between 6 and 12 months were similar.

Conclusions:

Housing and transportation exhibited fewer relative changes than other social risk factors and might be more resistant to change. Awareness of the relationships between social risk factors can help define priorities for intervention.
Using an Agent-based Model to Examine Deimplementation of Breast Cancer Screening
Authors: Nowak Sarah A. , Parker Andrew M. , Radhakrishnan Archana , Schoenborn Nancy , Pollack Craig E.
Published: November 2020

Objective:

The objective of this study was to examine the potential impact of provider social networks and experiences with patients on deimplementation of breast cancer screening.

Research Design:

We constructed the Breast Cancer-Social network Agent-based Model (BC-SAM), which depicts breast cancer screening decisions, incidence, and progression among 10,000 women ages 40 and over and the screening recommendations of their providers over a 30-year period. The model has patient and provider modules that each incorporate social network influences. Patients and providers were connected in a network, which represented patient-patient peer connections, provider-provider peer connections, connections between providers and patients they treat, and friend/family relationships between patients and providers. We calibrated provider decisions in the model using data from the CanSNET national survey of primary care physicians in the United States, which we fielded in 2016.

Results:

First, assuming that providers’ screening recommendations for women ages 50–74 remain unchanged but their recommendations for screening among younger (below 50 y old) and older (75+ y old) women decrease, we observed a decline in predicted screening rates for women ages 50–74 due to spillover effects. Second, screening rates for younger and older women were slow to respond to changes in provider recommendations; a 78% decline in provider recommendations to older women over 30 years resulted in an estimated 23% decline in patient screening in that group. Third, providers’ experiences with unscreened patients, friends, and family members modestly increased screening recommendations over time (7 percentage points). Finally, we found that provider peer effects can have a substantial impact on population screening rates and can entrench existing practices.

Conclusion:

Modeling cancer screening as a complex social system demonstrates a range of potential effects and may help target future interventions designed to reduce overscreening.
TaleNeprilysin and Neprilysin inhibition in chronic kidney disease
Authors: Judge Parminder K. , Haynes Richard
Published: November 2020

Purpose of review

Chronic kidney disease (CKD) is associated with increased risk of progression to end-stage kidney disease and cardiovascular events. There is limited evidence that available treatments have beneficial effects on cardiorenal outcomes in all people with nondiabetic CKD. Neprilysin inhibition (NEPi) is a new therapeutic strategy with potential to improve outcomes for patients with CKD.

Recent findings

NEPi enhances the activity of the natriuretic peptide system producing natriuresis, diuresis and inhibition of the renin–angiotensin system and sympathetic nervous system. Sacubitril/valsartan is the first Angiotensin receptor-neprilysin inhibitor (ARNI) to be produced and has been shown to substantially improve cardiovascular outcomes in heart failure and delay progression of kidney disease in this population. Although ARNIs have not shown similar effects on kidney function in the short-to-medium term in people with CKD, they are associated with substantial reductions in cardiac biomarkers and blood pressure in CKD.

These data suggest that NEPi with an ARNI could benefit patients with CKD by reducing the risk of cardiovascular disease and have the possibility of retarding the progression of CKD (hence delaying the need for renal replacement therapy).
Reconsidering Rigidity in the Diagnosis of Neuroleptic Malignant Syndrome: A Case Report
Authors: EL KHOURY RHEA , KASSAB ANTHONY , DAGHER RAMEZ , JAVELOT HERVE , EL CHAMMAY RABIH , RICHA SAMI
Published: November 2020

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal syndrome classically encountered in patients receiving typical antipsychotic agents. However, many physicians have also reported the occurrence of NMS with atypical antipsychotics, notably with atypical presentations. In this report, we present a case in which a patient’s antipsychotic regimen during a psychotic episode (which involved both typical and atypical antipsychotics) subsequently led to NMS. During his stay, the patient developed an altered level of consciousness, elevation of creatine phosphokinase, hemodynamic instability, and a fever. However, the patient did not have signs of rigidity, the cardinal sign of this syndrome. The authors concluded that patients could develop NMS without rigidity while receiving an antipsychotic. Given this presentation, the authors suggest that clinicians have a high level of suspicion for NMS to avoid misdiagnosis and subsequent adverse consequences. Hence, clinicians must be vigilant about atypical presentations of NMS without rigidity.
A Systematic Review of Barriers Faced by Older Adults in Seeking and Accessing Mental Health Care
Authors: LAVINGIA RICHA , JONES KRISTIN , ASGHAR-ALI ALI ABBAS
Published: November 2020

Older adults in the United States have lower rates of mental health care utilization than young adults. To understand these lower rates of mental health care, we performed a systematic review, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of barriers that prevent older adults from seeking and accessing treatment. We searched PubMed, PsycINFO, and Clinical Key to identify studies of barriers to mental health treatment in the older adult population (in individuals 50 y of age and older). Thirty-two articles met inclusion criteria (English language and focused on barriers to care in older adults) and exclusion criteria (focus on non-United States populations, focus on younger adults, or no focus on barriers to care). We identified 5 categories of barriers to mental health care in older adults: (1) attitudes and knowledge among older adults; (2) comorbid medical conditions; (3) provider-related factors; (4) other extrinsic barriers (eg, cost, transportation, reliance on caregivers); and (5) unique factors that affect older adults in minority populations. Large studies have primarily identified intrinsic barriers, including negative attitudes toward mental health care and lack of perceived need for treatment, as preventing older adults from seeking mental health care. Minority populations have also been found to face cultural barriers and increased levels of stigma compared with non-Hispanic whites, although several of the identified articles concerning barriers among minority older adults involved qualitative studies with small samples. Larger quantitative studies may help clarify the relative importance of barriers affecting this population. Interventions that have been shown to increase access to mental health services for older adults include community-based care and integrated primary and psychiatric care, but these strategies can be difficult to implement in low-resource settings. More research is needed to determine which interventions and policies are most effective in targeting particular barriers.
COVID-19: Why Has the Mortality Rate Declined?
Authors: PRESKORN SHELDON H.
Published: November 2020

This article explains how the mortality rate of an illness such as Coronavirus Disease 2019 (COVID-19) is calculated as well as how the definition of what is a “case” has changed from the earliest days of the pandemic to now. Many factors were not known about The Sudden Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) which causes COVID-19 at the beginning of the pandemic because it is a novel human pathogen. One key factor that was not known in the earliest days of the pandemic was that many patients are either asymptomatic or have symptoms so mild that they may not seek medical attention and hence these patients would not be identified as a “case” if that term is defined as being sufficiently symptomatic to be seeking medical attention. Cases in the earliest days of the pandemic were defined as based on having symptoms (eg, fever, cough, respiratory distress) after ruling out other possible causes. Cases now are defined by tests confirming that the person is shedding the SARS-CoV-2 (ie, a laboratory vs. a symptomatic diagnosis). The mortality rate of this virus dropped as a function of this change. On the basis of the results of an unintended, naturalistic experiment on an expeditionary cruise in March of 2020, there was more than a 5-fold drop in the calculated mortality rate due to this definitional change in what constituted a case. This column explains this issue and discusses its implications for effectively dealing with the SARS-CoV-2 (or COVID-19) pandemic.
Therapeutic Risk Management for Violence: Augmenting Clinical Risk Assessment With Structured Instruments
Authors: WORTZEL HAL S. , BORGES LAUREN M. , MCGARITY SUZANNE , NAZEM SARRA , BARNES SEAN M. , BAHRAINI NAZANIN H. , CLARK KAILY , MATARAZZO BRIDGET B.
Published: November 2020

Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting, and then documenting, other-directed violence risk screening, assessment, and management. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving: clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of violent ideation and behavior; and a personalized safety plan to mitigate/manage risk. This second column in the series describes the advantages of, and offers suggestions for, incorporating structured tools into violence risk assessment.
Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps
Authors: Haddock Nicholas T. , Suszynski Thomas M. , Teotia Sumeet S.
Published: November 2020

Background:

Multiple perforator flap breast reconstruction is an option that avoids implants in selected patients with minimal donor tissue. The technique addresses the need for additional skin to help create a breast envelope with more natural ptosis and additional volume to help create a body-appropriate breast mound while avoiding serial fat grafting. Using four flaps for the reconstruction of two breasts (bilateral stacked flap reconstruction) has recently become feasible with the advancement of microsurgical techniques, increased experience with alternative perforator flaps, and use of co-surgery. In this article, we describe our early experience with bilateral stacked flap breast reconstruction.

Methods:

From January of 2014 to October of 2018, the senior co-surgeons performed 50 consecutive bilateral stacked flap operations at a single institution. All reconstructions were performed in delayed fashion with a mean operative time of 10 hours. Most breasts (94 percent) were reconstructed with a deep inferior epigastric perforator flap combined with a profunda artery perforator flap. Most flap microanastomoses (91.5 percent) were performed directly with internal mammary vessels. The larger of the two flaps was typically placed inferiorly (66 percent), but there was significant inset variability.

Results:

Of 200 flaps, five were lost (2.5 percent). Seven take-backs were needed for a flap-related concern, which included two negative explorations and a flap salvage. The most common non–flap-related complication was a thigh wound (17 total, eight requiring a procedure).

Conclusion:

The authors’ early experience suggests that bilateral stacked flap breast reconstruction is a powerful tool that can be performed with an acceptable microsurgical risk and an acceptable complication profile in highly selected patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Mindfulness-Based Physical Activity Intervention: A Randomized Pilot Study
Authors: Sala Margaret , Geary Bree , Baldwin Austin S.
Published: November 2020

Objective

Most US adults are insufficiently active. One strategy individuals could use to increase physical activity is to exercise mindfully (i.e., while paying attention to present-moment experiences with acceptance. A mindfulness-based intervention for exercise can be delivered via an audio recording, which is advantageous in regard to time demands, cost, and dissemination potential. The aims of this parallel two-arm pilot randomized controlled trial were to assess the feasibility and acceptability of an audio-recorded mindfulness-based intervention and to assess whether the intervention resulted in a clinically meaningful difference in physical activity compared with the control condition.

Methods

Physically underactive adults (N = 50) were randomized to a mindfulness intervention condition in which they were instructed to exercise while listening to an audio-recorded mindfulness-intervention or an active control group in which they were instructed to exercise while using a heart rate monitor. Participants completed a 30-minute moderate intensity treadmill exercise bout during a baseline in-laboratory session in the manner in which they were randomized (i.e., mindfulness recording versus using a heart rate monitor) and instructed to exercise in this manner for the next week. At follow-up, acceptability was measured by self-report, feasibility by frequency of intervention use, and physical activity using both self-reported physical activity recall and an accelerometer.

Results

The audio-recorded mindfulness-based physical activity intervention was rated as acceptable and feasible to use. Compared with the control group, the intervention also resulted in clinically meaningful differences in self-reported moderate-to-vigorous physical activity minutes (mean difference = 67.16 minutes) and accelerometer-measured minutes (mean difference = 35.48 minutes) during a 1-week follow-up.

Conclusions

The audio-recorded mindfulness-based physical activity intervention is a promising approach to increasing physical activity with good dissemination potential.
Mindfulness-Based Analgesia or Placebo Effect? The Development and Evaluation of a Sham Mindfulness Intervention for Acute Experimental Pain
Authors: Davies Jonathan N. , Sharpe Louise , Day Melissa A. , Colagiuri Ben
Published: November 2020

Objective

Meta-analyses indicate that mindfulness meditation is efficacious for chronic and acute pain, but most available studies lack active control comparisons. This raises the possibility that placebo-related processes may account, at least in part, for mindfulness effects. The objective of this study was to develop a closely matched sham mindfulness condition to establish whether placebo effects contribute to mindfulness-based interventions for pain.

Methods

We developed and validated a closely matched sham mindfulness intervention then compared it with 6 × 20-minute sessions of focused-attention mindfulness and a no-treatment condition in 93 healthy volunteers undergoing acute experimental heat pain.

Results

The sham mindfulness intervention produced equivalent credibility ratings and expectations of improvement as the mindfulness intervention but did not influence mindfulness-related processes. In contrast, mindfulness increased “observing” relative to no treatment but not sham. Mindfulness (F(1,88) = 7.06, p = .009, ηp
2 = 0.07) and sham (F(1,88) = 6.47, p = .012, ηp
2 = 0.07) moderately increased pain tolerance relative to no treatment, with no difference between mindfulness and sham (F(1,88) = 0.01, p = .92, ηp
2 < 0.001). No differences were found for pain threshold. Similarly, neither mindfulness nor sham reduced pain intensity or unpleasantness relative to no treatment, although mindfulness reduced pain unpleasantness relative to sham (F(1,88) = 5.03, p = .027, ηp
2 = 0.05).

Conclusions

These results suggest that placebo effects contribute to changes in pain tolerance after mindfulness training, with limited evidence of specific effects of mindfulness training on pain unpleasantness relative to sham, but not no treatment. To disentangle the specific analgesic effects of mindfulness from placebo-related processes, future research should prioritize developing and incorporating closely matched sham conditions.

Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618001175268).
Comparative Analysis of Presentation and Outcome After Liver Resection of Patients With Hepatocellular Carcinoma With and Without HIV
Authors: Zhao Hui , Li Jiao , Li Shuqi , Wang Yong , Zhou Jian , Liu Lizhi , Wang Cunchuan
Published: November 2020

Objective:

Evidence shows that HIV infection may affect the survival outcome of patients with hepatocellular carcinoma (HCC). In this article, we aimed to determine whether HIV affected the overall survival of patients with HCC in China and ascertain the risk factors.

Design:

Retrospective cohort study.

Methods:

Participants were enrolled from a single medical center in Guangzhou, China. Survival was assessed using Kaplan–Meier plots and compared using the log-rank test. A multivariable Cox regression analysis was used to assess the effect of HIV seropositivity on patient overall survival while accounting for common prognostic factors.

Results:

The Kaplan–Meier plots showed that the median survival time of patients who were HIV-positive was 18 months shorter than that of their HIV-negative counterparts (P = 0.00, log rank). The 1- and 3-year rates of survival for HIV-positive patients were 65.4% and 29.9%, which were 93.3% and 79.1% for HIV-negative patients. The death rate due to tumor recurrence and liver failure in the HIV-positive patients was apparently higher than those of the HIV-negative patients (tumor recurrence, 42.3% vs. 17.3%, P = 0.016; liver failure, 19.2% vs. 2.7%, P = 0.012, respectively). Independent factors predicting survival were initial presentation, HIV serostatus, United Network of Organ Sharing–modified tumor-node-metastasis stage, Barcelona Clinic Liver Cancer stage, aspartate aminotransferase, histological pattern, and microvascular invasion.

Conclusions:

HIV-positive subjects with HCC have a poorer survival outcome than their HIV-negative counterparts, with tumor recurrence and liver failure as the main causes of death. Despite adequate curative therapy, HIV serostatus is associated with decreased survival of patients with HCC, independent of symptomatic presentation, tumor staging, and liver function.
Early versus delayed complex abdominal wall reconstruction with biologic mesh following damage-control surgery
Authors: Gogna Shekhar , Latifi Rifat , Choi James , Con Jorge , Prabhakaran Kartik , Anderson Patrice L. , Policastro Anthony J. , Klein Joshua , Samson David J. , Smiley Abbas , Rhee Peter
Published: November 2020

BACKGROUND

Damage-control surgery for trauma and intra-abdominal catastrophe is associated with a high rate of morbidities and postoperative complications. This study aimed to compare the outcomes of patients undergoing early complex abdominal wall reconstruction (e-CAWR) in acute settings versus those undergoing delayed complex abdominal wall reconstruction (d-CAWR).

METHOD

This study was a pooled analysis derived from the retrospective and prospective database between the years 2013 and 2019. The outcomes were compared for differences in demographics, presentation, intraoperative variables, Ventral Hernia Working Grade (VHWG), US Centers for Disease Control and Prevention wound class, American Society of Anesthesiologists (ASA) scores, postoperative complications, hospital length of stay, and readmission rates. We performed Student’s t test, χ2 test, and Fisher’s exact test to compare variables of interest. Multivariable linear regression model was built to evaluate the association of hospital length of stay and all other variables including the timing of complex abdominal wall reconstruction (CAWR). A p value of <0.05 was considered significant.

RESULTS

Of the 236 patients who underwent CAWR with biological mesh, 79 (33.5%) had e-CAWR. There were 45 males (57%) and 34 females (43%) in the e-CAWR group. The ASA scores of IV and V, and VHWG grades III and IV were significantly more frequent in the e-CAWR group compared with the d-CAWR one. Postoperatively, the incidence of surgical site occurrence, Clavien-Dindo complications, comprehensive complication index, unplanned reoperations, and mortality were similar between the two groups. Backward linear regression model showed that the timing of CAWR (β = −11.29, p < 0.0001), ASA (β = 3.98, p = 0.006), VHWG classification (β = 3.62, p = 0.015), drug abuse (β = 13.47, p = 0.009), and two comorbidities of cirrhosis (β = 12.34, p = 0.001) and malignancy (β = 7.91, p = 0.008) were the significant predictors of the hospital length of stay left in the model.

CONCLUSION

Early CAWR led to shorter hospital length of stay compared with d-CAWR in multivariable regression model.

LEVEL OF EVIDENCE

Therapeutic, level IV.
The Emergency Surgery Score accurately predicts the need for postdischarge respiratory and renal support after emergent laparotomies: A prospective EAST multicenter study
Authors: El Hechi Majed , Kongkaewpaisan Napaporn , Naar Leon , Aicher Brittany , Diaz Jose , O’Meara Lindsay , Decker Cassandra , Rodriquez Jennifer , Schroeppel Thomas , Rattan Rishi , Vasileiou Georgia , Yeh D. Dante , Simonoski Ursula , Turay David , Cullinane Daniel , Emmert Cory , McCrum Marta , Wall Natalie , Badach Jeremy , Goldenberg-Sandau Anna , Carmichael Heather , Velopulos Catherine , Choron Rachel , Sakran Joseph , Bekdache Khaldoun , Black George , Shoultz Thomas , Chadnick Zachary , Sim Vasiliy , Madbak Firas , Steadman Daniel , Camazine Maraya , Zielinski Martin , Hardman Claire , Walusimbi Mbaga , Kim Mirhee , Rodier Simon , Papadopoulos Vasileios , Tsoulfas Georgios , Perez Javier , Kaafarani Haytham M.A.
Published: November 2020

BACKGROUND

The Emergency Surgery Score (ESS) was recently validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively evaluate whether ESS can predict the need for respiratory and/or renal support (RRS) at discharge after emergent laparotomies (EL).

METHODS

This is a post hoc analysis of a 19-center prospective observational study. Between April 2018 and June 2019, all adult patients undergoing EL were enrolled. Preoperative, intraoperative, and postoperative variables were systematically collected. In this analysis, patients were excluded if they died during the index hospitalization, were discharged to hospice, or transferred to other hospitals. A composite variable, the need for RRS, was defined as the need for one or more of the following at hospital discharge: tracheostomy, ventilator dependence, or dialysis. Emergency Surgery Score was calculated for all patients, and the correlation between ESS and RRS was examined using the c-statistics method.

RESULTS

From a total of 1,649 patients, 1,347 were included. Median age was 60 years, 49.4% were men, and 70.9% were White. The most common diagnoses were hollow viscus organ perforation (28.1%) and small bowel obstruction (24.5%); 87 patients (6.5%) had a need for RRS (4.7% tracheostomy, 2.7% dialysis, and 1.3% ventilator dependence). Emergency Surgery Score predicted the need for RRS in a stepwise fashion; for example, 0.7%, 26.2%, and 85.7% of patients required RRS at an ESS of 2, 12, and 16, respectively. The c-statistics for the need for RRS, the need for tracheostomy, ventilator dependence, or dialysis at discharge were 0.84, 0.82, 0.79, and 0.88, respectively.

CONCLUSION

Emergency Surgery Score accurately predicts the need for RRS at discharge in EL patients and could be used for preoperative patient counseling and for quality of care benchmarking.

LEVEL OF EVIDENCE

Prognostic and epidemiological, level III
Effects of body weight-supported treadmill training at different speeds on the motor function and depressive behaviors after spinal cord injury in rats
Authors: Liu Chang-Hong , Zhao Bo-Lun , Li Wen-Tao , Zhou Xiao-Hua , Jin Zhe , An Li-Bin
Published: November 2020

Spinal cord injury (SCI) causes motor dysfunction and depression, which hinders the recovery of motor function. Body weight-supported treadmill training (BWSTT) should be considered an effective method for functional rehabilitation after SCI, as it is an efficacious intervention in healthcare with no side effects. Because exercise exerts different effects on motor function recovery and inhibiting depression after SCI, we aimed to determine the appropriate intensity of BWSTT. In this study, fixed durations, frequencies, and percentages of BWSTT with different speeds of BWSTT (7, 15, and 21 cm/s) were chosen to explore the appropriate intensity, which affected the recovery of motor function and antidepressant effects on SCI rats. Based on our results, BWSTT at 21 cm/s produced the best outcomes for motor function recovery and the spinal cord levels of brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB). The antidepressant effects of BWSTT at 15 and 21 cm/s were confirmed based on the increasing sucrose preference, the time spent in the central area and social time, and reduced immobility time. BWSTT at 15 and 21 cm/s improved the modulation of the hypothalamic-pituitary-adrenal axis by decreasing serum corticosterone levels and increasing hippocampal glucocorticoid receptor levels. In addition, higher levels of neurogenesis-related proteins were observed in the hippocampus of the group subjected to BWSTT at 21 cm/s than in the other groups. Thus, BWSTT at 21 cm/s is a potentially favorable treatment that synchronously improves motor function recovery and exerts an antidepressant effect.
Glucagon-like peptide-1 receptors modulate the binge-like feeding induced by µ-opioid receptor stimulation of the nucleus accumbens in the rat
Authors: Pierce-Messick Zachary , Pratt Wayne E.
Published: November 2020

Neuropeptides and peptide hormones affect food-directed motivation, in part, through actions on brain regions associated with reward processing. For instance, previous reports have shown that stimulating glucagon-like peptide-1 (GLP-1) receptors in the nucleus accumbens (NAc), an area that directs motivational processes towards food and drugs of abuse, has an anorectic effect. In contrast, µ-opioid receptor activation of the NAc increases feeding, particularly on highly palatable diets. While both neurotransmitters act within the NAc to impact food intake, it is not clear if and how they might interact to affect feeding. Therefore, these experiments tested the effects of NAc injections of the GLP-1 receptor agonist Exendin 4 (EX4) or antagonist Exendin 9 (EX9) on the consumption of a sweetened fat diet, with and without simultaneous µ-opioid receptor stimulation. Male Sprague–Dawley rats (n = 8/group, EX4 or EX9) underwent surgery to place bilateral cannula above the NAc core. After recovery, animals were tested following NAc injections of saline or the µ-opioid agonist [D-Ala2, N-MePhe4, Gly-ol]-enkephalin (DAMGO) (0.025 µg/side), combined with varying doses of EX4 (0, 0.05, or 0.10 µg/side) or EX9 (0, 2.5, 5.0 µg/side), counterbalanced across 6 testing days. Food and water intake, along with locomotor activity, was monitored for 2 h. Mu-opioid receptor stimulation significantly increased feeding, and this effect was reduced by GLP-1 receptor stimulation. In contrast, GLP-1 antagonism with EX9 altered the dynamics of DAMGO-induced binge-like feeding, extending µ-opioid-induced binging, and increasing food consumption. These findings are the first to demonstrate an interaction between NAc µ-opioid and GLP-1 receptors on palatable food intake.
Norepinephrine in the dentate gyrus is involved in spatial learning and memory alteration induced by chronic restraint stress in aged rats
Authors: Wang Fei-Xue , Tang Ruo-Qi , Lv Jing , Xiao Bin , Li Ying-Shun , Jin Qing-Hua
Published: November 2020

The role of norepinephrine of the hippocampal dentate gyrus in spatial learning and memory alteration induced by chronic restraint stress (CRS, 3 h/day, 6 weeks) was investigated in aged rats. Spatial learning and memory were assessed by the Morris water maze (MWM), and the extracellular concentration of norepinephrine and amplitude of field excitatory postsynaptic potential (fEPSP) were measured in the dentate gyrus during MWM test in freely-moving rats. Next, the involvement of β-adrenoceptors in spatial learning and memory of CRS rats was examined by microinjection of its antagonist (propranolol) into the dentate gyrus. In addition, we observed the expression of brain-derived neurotrophic factor (BDNF) protein and activation of cAMP-response element binding protein (CREB) in the dentate gyrus. Compared with the control group, the basal level of norepinephrine, BDNF expression and CREB activation in the dentate gyrus were increased, and the spatial learning and memory abilities were enhanced in CRS rats. In the control group, the norepinephrine concentration and fEPSP amplitude in the dentate gyrus were increased on the second to fourth days of MWM test, and these responses were significantly enhanced in CRS rats. Furthermore, in CRS rats, propranolol significantly decreased the spatial learning and memory abilities, and attenuated the fEPSP response during MWM test, and the BDNF expression and CREB activation in the dentate gyrus. Our results suggest that norepinephrine activation of β-adrenoceptors in the hippocampal dentate gyrus is involved in spatial learning and memory enhancement induced by CRS in aged rats, in part via modulations of synaptic efficiency and CREB-BDNF signaling pathway.
The characterization of psychotic symptoms in succinic semialdehyde dehydrogenase deficiency: a review
Authors: Colijn Mark A.
Published: November 2020

Succinic semialdehyde dehydrogenase (SSADH) deficiency is an ultra-rare inborn error of metabolism that results in disrupted gamma-amino butyric acid (GABA) catabolism. In addition to developmental delay, intellectual disability, hypotonia, ataxia, and seizures, a variety of neuropsychiatric symptoms may occur, including psychosis. By highlighting all available and relevant case reports/series, this qualitative review seeks to characterize the prevalence, clinical manifestation, pathophysiology, and treatment of psychotic symptoms in this population. Psychosis occurs in a minority of SSADH-deficient individuals, and most commonly presents as auditory or visual hallucinations with an onset in adolescence or young adulthood. Although the pathophysiology underlying the development of psychosis in this context is not fully understood, it likely in part relates to increased GABA and/or gamma hydroxybutyric acid activity. Although antipsychotic medications should be used cautiously in SSADH deficiency, they may be effective at treating emergent psychotic symptoms.
The interiors of Uranus and Neptune: current understanding and open questions
Authors: Helled Ravit , Fortney Jonathan J.
Published: November 2020

Uranus and Neptune form a distinct class of planets in our Solar System. Given this fact, and ubiquity of similar-mass planets in other planetary systems, it is essential to understand their interior structure and composition. However, there are more open questions regarding these planets than answers. In this review, we concentrate on the things we do not know about the interiors of Uranus and Neptune with a focus on why the planets may be different, rather than the same. We next summarize the knowledge about the planets’ internal structure and evolution. Finally, we identify the topics that should be investigated further on the theoretical front as well as required observations from space missions.

This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
The rings and small moons of Uranus and Neptune
Authors: Showalter Mark R.
Published: November 2020

All four giant planets are encircled by distinctive systems of rings and small, inner satellites. These all reside within or near their central planet's Roche limit, the rough boundary within which bodies held together by self-gravity will be disrupted by tidal forces. However, the similarities of the four ring-moon systems end here; in most other regards, they are remarkably diverse. We study these systems for three key reasons: (1) for the information they reveal about the properties, history and ongoing evolution of the planetary systems of which they are a part; (2) as dynamical analogues for other astrophysical systems such as protoplanetary disks; and (3) for the wealth of fascinating properties and origin scenarios that make them worthy of study in their own right. The inner Uranus system is characterized by 10 narrow rings, some quite dense, as well as a variety of more tenuous structures. These are accompanied by 13 known moons all orbiting interior to Miranda. Nine of these, Bianca through Perdita, comprise the most densely packed set of moons in the solar system, with orbits so close that their interactions appear to drive chaos over time scales approximately 106years. Neptune has five named rings, all optically thin, interleaved with seven inner moons. The most notable feature is a set of arcs embedded within the Adams ring; two of these arcs have been stable for time scales of decades.

This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
Topography and geology of Uranian mid-sized icy satellites in comparison with Saturnian and Plutonian satellites
Authors: Schenk Paul M. , Moore Jeffrey M.
Published: November 2020

Newly processed global imaging and topographic mapping of Uranus's five major satellites reveal differences and similarities to mid-sized satellites at Saturn and Pluto. Three modes of internal heat redistribution are recognized. The broad similarity of Miranda's three oval resurfacing zones to those mapped on Enceladus and (subtly) on Dione are likely due to antipodal diapiric upwelling. Conversely, break-up and foundering of crustal blocks accompanied by extensive (cryo)volcanism is the dominant mode on both Charon and Ariel. Titania's fault network finds parallels on Rhea, Dione, Tethys and possibly Oberon. Differences in the geologic style of resurfacing in the satellite systems (e.g. plains on Charon, Dione, Tethys and perhaps Titania versus ridges on Miranda and Ariel) may be driven by differences in ice composition. Surface processes such as volatile transport may also be indicated by bright and dark materials on Oberon, Umbriel and Charon. The more complete and higher quality observations of the Saturnian and Plutonian mid-sized icy satellites by Cassini and New Horizons reveal a wealth of features and phenomena that cannot be perceived in the more limited Voyager coverage of the Uranian satellites, harbingers of many discoveries awaiting us on a return to Uranus.

This article is part of a discussion meeting issue ‘Future exploration of ice giant systems'.
Cross-NASA divisional relevance of an Ice Giant mission
Authors: Cohen Ian J. , Rymer Abigal M.
Published: November 2020

Robotic space exploration to the outer solar system is difficult and expensive and the space science community works inventively and collaboratively to maximize the scientific return of missions. A mission to either of our solar system Ice Giants, Uranus and Neptune, will provide numerous opportunities to address high-level science objectives relevant to multiple disciplines and deliberate cross-disciplinary mission planning should ideally be woven in from the start. In this review, we recount past successes as well as (NASA-focused) challenges in performing cross-disciplinary science from robotic space exploration missions and detail the opportunities for broad-reaching science objectives from potential future missions to the Ice Giants.

This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
Plasmids encode niche-specific traits in Lactobacillaceae
Authors: Davray Dimple , Deo Dipti , Kulkarni Ram
Published: November 2020

Species belonging to the family

Lactobacillaceae

are found in highly diverse environments and play an important role in fermented foods and probiotic products. Many of these species have been individually reported to harbour plasmids that encode important genes. In this study, we performed comparative genomic analysis of publicly available data for 512 plasmids from 282 strains represented by 51 species of this family and correlated the genomic features of plasmids with the ecological niches in which these species are found. Two-thirds of the species had at least one plasmid-harbouring strain. Plasmid abundance and GC content were significantly lower in vertebrate-adapted species as compared to nomadic and free-living species. Hierarchical clustering highlighted the distinct nature of plasmids from the nomadic and free-living species than those from the vertebrate-adapted species. EggNOG-assisted functional annotation revealed that genes associated with transposition, conjugation, DNA repair and recombination, exopolysaccharide production, metal ion transport, toxin–antitoxin system, and stress tolerance were significantly enriched on the plasmids of the nomadic and in some cases nomadic and free-living species. On the other hand, genes related to anaerobic metabolism, ABC transporters and the major facilitator superfamily were overrepresented on the plasmids of the vertebrate-adapted species. These genomic signatures correlate with the comparatively nutrient-depleted, stressful and dynamic environments of nomadic and free-living species and nutrient-rich and anaerobic environments of vertebrate-adapted species. Thus, these results indicate the contribution of the plasmids in the adaptation of lactobacilli to their respective habitats. This study also underlines the potential application of these plasmids in improving the technological and probiotic properties of lactic acid bacteria.
Poor correlation between antibody titers and neutralizing activity in sera from SARS-CoV-2 infected subjects
Authors: Criscuolo Elena , Diotti Roberta A. , Strollo Marta , Rolla Serena , Ambrosi Alessandro , Locatelli Massimo , Burioni Roberto , Mancini Nicasio , Clementi Massimo , Clementi Nicola
Published: November 2020

Plenty of serologic tests for SARS-CoV-2 have been developed so far, thus documenting the importance of evaluating the relevant features of the immune response to this viral agent. The performance of these assays is currently under investigation. Amongst them, LIAISON® SARS-CoV-2 S1/S2 IgG by DiaSorin and Elecsys Anti-SARS-CoV-2 cobas® by Roche are currently used by laboratory medicine hospital departments in Italy and many other countries. In the present study, we have firstly compared two serologic tests on serum samples collected at two different time points from forty-six laboratory-confirmed COVID-19 subjects. Secondly, eighty-five negative serum samples collected before the SARS-CoV-2 pandemic were analyzed. Thirdly, possible correlations between antibody levels and the resulting neutralizing activity against a clinical isolate of SARS-CoV-2 were evaluated. Results revealed that both tests are endowed with low sensitivity on the day of hospital admission, which increased to 97.8 and 100% for samples collected after 15 days for DiaSorin and Roche tests, respectively. The specificity of the two tests ranges from 96.5 to 100%, respectively. Importantly, a poor direct correlation between antibody titers and neutralizing activity levels was evidenced in the present study.
Team contact sports in times of the COVID-19 pandemic- a scientific concept for the Austrian football league
Authors: van der Zee-Neuen Antje , Schaffler-Schaden Dagmar , Herfert Jürgen , O’Brien James , Johansson Tim , Kutschar Patrick , Seymer Alexander , Ludwig Stephan , Stöggl Thomas , Keeley David , Resch Herbert , Osterbrink Jürgen , Flamm Maria
Published: November 2020

Background

Since the beginning of the COVID -19 pandemic, many contact sport teams are facing major challenges to safely continue training and competition.

Objective

We present the design and implementation of a structured monitoring concept for the Austrian national football league

Methods

146 professional players from five clubs of the professional Austrian football league were monitored for a period of 12 weeks. Subjective health parameters, PCR- test results and data obtained from a geo-tracking app were collected. Simulations modelling the consequences of a COVID-19 case with increasing reproduction number were computed.

Results

No COVID-19 infection occurred during the observation period in the players. Infections in the nearer surroundings lead to increased perceived risk of infection. Geo tracking was particularly hindered due to technical problems and reluctance of users. Simulation models suggested a hypothetical shut-down of all training and competition activities.

Conclusions

A structured monitoring concept can help to continue contact sports safely in times of a pandemic. Cooperation of all involved is essential.

Trial registration

ID: DRKS00022166 15/6/2020 https://www.who.int/ictrp/search/en/

Key Points

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The results of this study can inform the development of future prevention and monitoring strategies in professional football and beyond, potentially serving as a blueprint for the safe continuation of sports and physical activity, across a broad range of settings, during and following a pandemic such as COVID-19.

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Health parameters should be digitally recorded and closely monitored to enable quick response in case of a COVID-19 infection.
Changes of Humoral Immunity Response in SARS-CoV-2 Convalescent Patients over 8 months
Authors: Peng Pai , Hu Jie , Deng Hai-jun , Liu Bei-zhong , Wang Kai , Tang Ni , Huang Ai-long
Published: November 2020

Many countries around the world have all seen a sharp rise in COVID-19 cases as the second wave since the beginning of October 2020. Decline of antibodies response to severe acute respiratory syndrome coronavirus (SARS-CoV-2) that was reported exclusively in the early month increases the risk of reinfection for convalescent individuals. There is a current need to follow the maintenance of special antibodies against SARS-CoV-2. Here, we reported changes of antibodies against SARS-CoV-2 in convalescent patients over 8 months. Antibodies of all 20 participants targeting SARS-CoV-2 spike receptor binding-domain (RBD) had decreased from a mean OD450value 1.78 to 0.38 over 8 months. The neutralizing antibody (NAb) titers decreased from the mean ID50value 836 to 170. The NAb titers were significantly correlated with IgG level during 8 months (P<0.001). Furthermore, while RBD-specific IgG existence of 25% (5/20) convalescent plasma was undetectable, the NAb titers of 15% (3/20) convalescent plasma decreased below the threshold. In addition, compared to wild-type SARS-CoV-2 (S-D614), lower titers of neutralizing antibodies against its G614 variant were shown at 8 months after symptom onset. This study has important implications when considering antibody protection against SARS-CoV-2 reinfection.