bluuebunny/crossref_metadata_2025 huggingface dataset:
Sense of Stress and Posttraumatic Growth in Mothers of Children with Cystic Fibrosis—The Moderating Role of Resilience
Authors: Byra Stanisława , Zubrzycka Renata , Wójtowicz Paweł
Published: August 2021

Objective:

The aim of this study was to examine the moderating role of resilience in the relationship between sense of stress and posttraumatic growth (PTG) in mothers of children with cystic fibrosis (CF).

Methods:

This cross-sectional study was conducted in a group of 139 mothers of children with CF. A diagnostic survey with Polish versions of the inventories was used.

Results:

Over half of the mothers (52.89%) reported average and 26.11% high levels of general sense of stress. Mothers also experienced high (37.68%) and average (34.06%) PTG. Generally, mothers of children with CF manifested low general resilience. Sense of stress and PTG were significantly and positively correlated in this group of mothers. Positive correlations were revealed between resilience (total and individual dimensions), total PTG, and 1 dimension of PTG: changes in self-perception. Moreover, resilience was found to correlate with sense of stress. The obtained results indicate that resilience manifested as an optimistic life attitude and the ability to mobilize in difficult situations, and tolerance of failures and treating life as a challenge is a moderator in the relationship between sense of stress and PTG.

Conclusion:

The relationship between sense of stress and PTG in mothers of children with CF depends on the level of resilience.
The Effect of FOXP3+ Regulatory T Cells on Infectious and Inflammatory Diseases
Authors: Bai Yakun , Gao Fang , Li Dan , Ji Suyuan , Zhang Shuijun , Guo Wenzhi , Li Bin
Published: August 2021

CD4+CD25+FOXP3+ regulatory T cells (Tregs) contribute to the maintenance of immune homeostasis and tolerance in the body. The expression levels and functional stability of FOXP3 control the function and plasticity of Tregs. Tregs critically impact infectious diseases, especially by regulating the threshold of immune responses to pathogenic microorganisms. The functional regulatory mechanism and cell-specific surface markers of Tregs in different tissues and inflammatory microenvironments have been investigated in depth, which can provide novel ideas and strategies for immunotherapies targeting infectious diseases.
Does pain modality play a role in the interruptive function of acute visceral compared with somatic pain?
Authors: Kleine-Borgmann Julian , Schmidt Katharina , Scharmach Katrin , Zunhammer Matthias , Elsenbruch Sigrid , Bingel Ulrike , Forkmann Katarina
Published: August 2021

Acute pain captures attentional resources and interferes with ongoing cognitive processes, including memory encoding. Despite broad clinical implications of this interruptive function of pain for the pathophysiology and treatment of chronic pain conditions, existing knowledge exclusively relies on studies using somatic pain models. Visceral pain is highly prevalent and seems to be more salient and threatening, suggesting that the interruptive function of pain may be higher in acute visceral compared with somatic pain. Implementing rectal distensions as a clinically relevant experimental model of visceral pain along with thermal cutaneous pain for the somatic modality, we herein examined the impact of pain modality on visual processing and memory performance in a visual encoding and recognition task and explored the modulatory role of pain-related fear and expectation in 30 healthy participants. Despite careful and dynamically adjusted matching of stimulus intensities to perceived pain unpleasantness over the course of trials, we observed greater impairment of cognition performance for the visceral modality with a medium effect size. Task performance was not modulated by expectations or by pain-related fear. Hence, even at matched unpleasantness levels, acute visceral pain is capable of interfering with memory encoding, and this impact seems to be relatively independent of pain-related cognitions or emotions, at least in healthy individuals. These results likely underestimate the detrimental effect of chronic pain on cognitive performance, which may be particularly pronounced in acute and chronic visceral pain.
Predicting Employee Participation in, and Satisfaction With, Wellness Programs
Authors: Smidt Michelle N. , Jimmieson Nerina L. , Bradley Lisa M.
Published: August 2021

Objective:

To examine the role of employee, supervisor, and organizational support in the prediction of employee participation in wellness programs.

Methods:

Data were collected at two-time points (T1 and T2) from 194 Australian employees.

Results:

Hierarchical binary logistic regressions revealed that higher levels of employee and supervisor support for wellness at T1 each predicted T2 participation, and high supervisor support was more effective when organizational support was high and did not compensate for when organizational support was low. Employees with higher perceptions of T1 poor general health had a lower likelihood of T2 participation, and higher levels of T1 supervisor support was a further deterrent to participation.

Conclusions:

Different sources of support for wellness predict employee attendance at wellness programs and it is important to ensure that supervisor and organizational support are aligned.
Interrater reliability of the assessment of disease activity by gastrointestinal ultrasound in a prospective cohort of patients with inflammatory bowel disease
Authors: Smith Rebecca L. , Taylor Kirstin M. , Friedman Antony B. , Su Heidi Y. , Con Danny , Gibson Peter R.
Published: August 2021

Objective

Gastrointestinal ultrasound is a radiological investigation for monitoring patients with inflammatory bowel disease. However, the reliability of the findings depends on the reproducibility of results between different operators. Thus, the study aim was to assess the interrater reliability of gastrointestinal ultrasound in individuals with inflammatory bowel disease between gastroenterologists with varying GIUS experience. 

Methods

Patients were prospectively recruited at the commencement of a new medical therapy for a baseline assessment, with a second assessment at the end of treatment induction (3 months). Consecutive, blinded ultrasounds were performed by two operators for every test. Gastrointestinal ultrasound examination included assessment of bowel wall thickness, vascularity, wall stratification assessment, mesenteric hyperechogenicity and lymphadenopathy.

Results

Forty-nine patients were recruited (Crohn’s n = 27, ulcerative colitis n = 22) with 35 returning for a repeat assessment at 3 months. At baseline, the intraclass coefficient for bowel wall thickness was near perfect (0.882). By bowel segment, the closest correlation was in the terminal ileum and differences in bowel wall thickness were similar by disease subtype. All other ultrasound indices of disease activity demonstrated substantial to near-perfect agreement with Gwet’s agreement coefficient: vascularity (0.681), wall stratification (0.685), mesenteric hyperechogenicity (0.841) and lymphadenopathy (0.633). Similar findings were seen at 3 months.

Conclusion

There is substantial agreement between operators of varying experience in gastrointestinal ultrasound findings in patients with Crohn’s disease or ulcerative colitis and this is repeatedly demonstrated over time. Thus, a well-trained operator should be sufficient to assess disease activity in patients with inflammatory bowel disease.
Self-reported nonceliac wheat sensitivity in an outpatient digestive endoscopy center: high frequency but insufficient medical approach
Authors: Mansueto Pasquale , Soresi Maurizio , Peralta Sergio , Perricone Simona , La Blasca Francesco , Sichera Roberto , Giambalvo Ornella , Carroccio Antonio
Published: August 2021

Objective

‘Self-reported wheat sensitivity’ (SRWS) is a self-reported condition caused by wheat ingestion in the absence of celiac disease or wheat allergy. The aim of the study was to investigate the frequency and characteristics of SRWS in outpatients referred for digestive endoscopy.

Methods

The study, performed at the University of Palermo, enrolled 496 outpatients.

Results

Seven individuals (1.4%) had an already established diagnosis of celiac disease. The questionnaire was administered to the other 489 individuals: 98 subjects (20%) were SRWS, the remaining 391 served as controls (i.e. not-SRWS). SRWS patients were younger (P < 0.001), with a higher percentage of females (P = 0.002) than not-SRWS. ‘gastroesophageal reflux disease and ulcer-like dyspepsia’ and ‘chronic unexplained diarrhea’ were more frequently the reasons for the endoscopy study in SRWS than in not-SRWS (P = 0.002, and P = 0.05, respectively). Food allergies/intolerances (P = 0.04), milk allergy/intolerance (P = 0.0001), GERD (P = 0.0001), IBS (0.0001), anxiety (P = 0.005) and depression (P = 0.04) were the previous medical diagnoses reported more frequently in SRWS patients than in not-SRWS. In the SRWS group, 38% of the patients had already undergone previous upper endoscopy and 24% colonoscopy. After these investigations, 58% of SRWS patients received no diagnosis, and the other 42% were informed that they ‘were not suffering from celiac disease or wheat allergy’. Finally, 28.6% SRWS patients had followed a gluten-free diet (GFD), and 71.4% of them referred being asymptomatic on GFD.

Conclusions

Our data showed a high frequency of SRWS in outpatients referred to a digestive endoscopy center and a lack of medical accuracy in identifying a possible gluten-related disease.

Registration

The study was registered on Clinicaltrials.gov (registration number: NCT04154137), accessible at: https://clinicaltrials.gov/ct2/show/NCT04154137?term=non+celiac+wheat&draw=2&rank=1
Histological inflammatory activity can predict endoscopic relapse in patients with ulcerative colitis who have achieved mucosal healing
Authors: González-Partida Irene , Martínez-Lozano Helena , González-Lois Carmen , Peligros Isabel , Sánchez-Yuste Rosario , Salas Isabel , Matallana Virginia , Bighelli Federico , Calvo Marta , Marín-Jiménez Ignacio , Salas Clara , Vera María I. , Menchén Luis , González-Lama Yago
Published: August 2021

Background & aims

Current therapeutic goals in ulcerative colitis (UC) include clinical and endoscopic remission, named mucosal healing (MH). Despite MH, a proportion of patients suffer a clinical relapse, which has been related to histological inflammation. We aimed to identify which histopathological features or histopathological index cut-off was associated with endoscopic relapse (ER) in UC patients with MH.

Methods

Retrospective analysis of UC patients who underwent surveillance colonoscopy showing complete MH (endoscopic Mayo subscore=0) with random biopsies, and at least one more endoscopy along the follow-up. After a consensus meeting, expert pathologist performed histological assessment according to Simplified Geboes Score (SGS), Nancy Index (NI) and Robarts Histopathological Index (RHI). Other histopathological features were also evaluated. Patients were followed until ER or last endoscopy performed showing persistence of MH.

Results

A total of 95 patients (150 colonoscopies) were included. After mean follow-up of 31.2 months (SD 21.7), 33 patients (34.7%) suffered ER. Neutrophils in lamina propria (OR 2.6; P = 0.037), within the epithelium (OR 2.6; P = 0.03), SGS ≥3.1 (OR 2.6; P = 0.037), NI ≥2 (OR 2.6; P = 0.03) and RHI ≥5 (OR 2.6; P = 0.037) were associated with ER in univariate analysis. In multivariate analysis, eosinophils in the lamina propria (HR 2.5; P = 0.01) and clinical remission<12 months (HR 3.2; P = 0.002) were associated with ER.

Conclusions

Histopathological findings in UC patients who have achieved endoscopic MH may predict ER. Standardized histopathology reports according to the presence of neutrophils, eosinophils or to defined cut-off of validated histopathologic indexes may represent a useful tool to predict ER and should be considered at therapeutic and surveillance decision process.
Skull base osteomyelitis imaging
Authors: Singhal Aparna , Sotoudeh Houman , Chapman Philip R.
Published: August 2021

Purpose of review

Skull base osteomyelitis (SBO) is a challenging entity to diagnose and treat. The goal of this review is to summarize the imaging findings of SBO and present these in the context of recent studies on imaging of SBO.

Recent findings

This review discusses the clinical presentation, pathophysiology and imaging appearances of SBO. The review further emphasizes the results of latest studies on imaging of SBO, and the role of different modalities in diagnosis and evaluation of disease course and treatment response. Brief discussion on differential diagnoses from an imaging standpoint is also included.

Various imaging modalities play different and complimentary roles in diagnosis and management of SBO, which are discussed in this review.
Postpartum Depression Screening for Mothers of Babies in the Neonatal Intensive Care Unit
Authors: Berns Hannah M. , Drake Diana
Published: August 2021

Background:

Postpartum depression (PPD) is a prevalent, yet underidentified, problem among mothers with babies in the Neonatal Intensive Care Unit (NICU). Postpartum depression can result in immediate and long-term consequences for mother and baby. Screening, followed by early intervention, is critical for improvement and resolution. The purpose of the project was to initiate early screening for PPD among a high-risk population to identify and refer for early treatment.

Methods:

A screening and referral protocol was implemented using the Edinburgh Postnatal Depression Scale (EPDS), with consults as indicated to an onsite licensed professional clinical counselor. The nurse on the care team was responsible for initiating the screening after 2 weeks postpartum and placing a mental health referral as needed. Retrospective medical record reviews were conducted to determine whether timely screening was implemented among eligible mothers, and if referrals were made for those at-risk based on EPDS score.

Results:

Twenty-four percent of women screened were at increased risk for PPD based on their EPDS score, approximately double that of the general population (12.5%). All women with a positive screen had a referral placed and were seen by the licensed professional clinical counselor within 3 days.

Clinical Implications:

This project recognizes the importance of an interdisciplinary care approach and highlights the need for early identification and treatment for PPD among mothers with babies in the NICU. The project can guide future initiatives to increase the use of screening in the inpatient setting, to detect PPD during its early and more treatable stages.
Manual Dexterity Is Associated With Use of the Paretic Upper Extremity in Community-Dwelling Individuals With Stroke
Authors: Demartino Amanda Magalhães , Rodrigues Letícia Cardoso , Gomes Raquel Pinheiro , Michaelsen Stella Maris
Published: August 2021

Background and Purpose:

Regarding people with stroke, simple outcome measures in clinical settings capable of representing the actual use of the upper extremity (UE) would be useful to rehabilitation professionals for the purposes of goal setting. This study seeks to describe the relative levels of paretic UE use, investigate the association between manual dexterity and task-related UE use, and to establish the manual dexterity cutoff points that correspond to relative levels of paretic UE use.

Methods:

Forty-six adults with chronic hemiparesis participated in this cross-sectional study. Behavioral mapping was employed to ascertain the actual amount of UE use by the identifying the unimanual and bimanual activities performed in the participants' homes within a 4-hour period. Participants were classified into 4 levels of paretic UE integration into activities considering the data from the behavioral mapping (activity, hand function, and type of grasp). The Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT) were used to evaluate dexterity. The Spearman test was used to evaluate the correlations. In analyzing the receiver operating characteristic curve, we applied the Youden index to determine the cutoff points.

Results:

Participants with full/almost full (n = 11), partial (n = 12), and limited (n = 12) integration of the paretic UE into activities and with little/no use (n = 11) were identified. Unimanual and total paretic UE activities were found to have a high correlation with the BBT scores. The boundaries between the integration levels were between full/almost full and partial integration, BBT greater than 30 blocks or NHPT of 41 seconds and less; between partial and limited, BBT greater than 16 blocks; and between limited and little/no use, BBT greater than 3 blocks. Both tests show good accuracy (≥0.81).

Discussion and Conclusions:

The BBT presents a positive high correlation with paretic UE use at home and was shown to be better able to identify “limited” and “partial” integration of the paretic UE. Both tests can identify when the paretic UE is fully/almost fully integrated into activities at home.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A354).
Characteristics of Deaths With Evidence of Pathological Hoarding in Cook County 2017 to 2018
Authors: Waters David Michael , Eckhardt Michael , Eason Eric August
Published: August 2021

Hoarding disorder was recently recognized as an independent diagnosis; it is characterized by the accumulation of objects causing a functional impairment and is commonly associated with increased risk of injury or death. Limited data exist about deaths of persons found in hoarding environments. This study investigated the characteristics and circumstances surrounding deaths found in “hoarding” environments. Using the electronic record management system, a search for the term “hoard” from 2017 to 2018 identified 138 cases. The mean age was 67 years, 56% were male, 76% were White, and 86% of decedents lived alone. Decomposition was noted in 61% of cases. A full autopsy was performed in 36 cases (26%); natural was the most common manner of death (80%), followed by accident (14%). Cases in which hoarding was thought to be contributory to the cause of death occurred in 5 cases. A qualitative hoard evaluation was done on 29 cases (21%) with available photographs. A hoarding level was assigned using the Clutter Hoarding Scale with an average of 3.39/5. Overall, the analysis showed deaths in pathological hoarding environments appeared to impact all socioeconomic groups and was associated with increased risk of accidental death and being found in a state of decomposition.
The Association of Burnout and Vital Exhaustion With Type 2 Diabetes: A Systematic Review and Meta-Analysis
Authors: Strikwerda Marije , Beulens Joline W. , Remmelzwaal Sharon , Schoonmade Linda J. , van Straten Annemieke , Schram Miranda T. , Elders Petra J. , Rutters Femke
Published: August 2021

Objective

This study aimed to investigate the association of burnout and vital exhaustion with measures of glycemic control and type 2 diabetes (T2D) in a systematic review and meta-analysis.

Methods

PubMed, Embase, and PsycINFO were searched from inception to April 2, 2020. Data extraction and quality assessment were performed using the Effective Public Health Practice Project tool. When possible, results were meta-analyzed using random-effects models and rated using the Grading of Recommendations, Assessment, Development and Evaluation.

Results

A total of 5317 titles/abstracts were screened, 140 articles were read full text, of which 29 studies were included. Eighteen studies were cross-sectional, three prospective and eight were case-control studies. Burnout and vital exhaustion were significantly associated with T2D, with a pooled odds ratio of 1.8 (95% confidence interval [CI] = 1.4 to 2.4, I
2 = 79%; 9 studies). Glycated hemoglobin A1c levels were not significantly higher in people with burnout and vital exhaustion, compared to those without, with a pooled standardized mean difference of 0.35 (95% CI = −0.62 to 1.33, I
2 = 98%; 7 studies). In addition, no differences in glucose levels were observed (standardized mean difference = 0.02, 95% CI = −0.26 to 0.30, I
2 = 90%; 9 studies). Sensitivity analyses showed no decrease in heterogeneity when excluding studies with low quality (I
2
glucose = 89%) or studies with a study n < 40 population (I
2
T2D = 77%). The level of Grading of Recommendations, Assessment, Development and Evaluation evidence was moderate to low quality because of 18 studies having a cross-sectional design.

Conclusions

Burnout and vital exhaustion might be associated with a higher risk of T2D, but not with glycemic control. Methodological shortcomings and high heterogeneity of the studies included complicate the interpretation of our results.
Prevention strategies for congenital cytomegalovirus infection
Authors: Tol Isabel , Heath Paul T. , Khalil Asma
Published: August 2021

Purpose of review

Cytomegalovirus (CMV) is the most common viral cause of congenital infection, occurring in approximately 1–2% of live births worldwide. Given our increasing knowledge of risk, advances in the identification of maternal infection, and the extremely limited options for the treatment of fetal infection, the prevention is a promising direction for research efforts. Recently, there have been several exciting studies assessing different ways of preventing congenital infection in the fetus and one in particular has focused on the use of valaciclovir.

Recent findings

A recent study reported a 71% reduction in vertical transmission of CMV with the use of oral valaciclovir following maternal primary CMV infection early in pregnancy. The clinical impact of this study could be enormous and it has particular implications for considerations around maternal serological screening in the first trimester of pregnancy. Further research assessing behaviour modifications during early pregnancy could also provide evidence for an effective primary prevention technique.

Prevention of congenital CMV infection, whether primary, secondary or tertiary, is possible, however, there are barriers to its utilisation in a clinical setting. The main limitation is the requirement for early, effective and large-scale serological screening of mothers to detect asymptomatic primary infection.
Arterial Occlusion After Hyaluronic Acid Injection
Authors: Hurkal Ozgur , Sibar Serhat , Cenetoglu Seyhan , Tuncer Serhan , Elmas Cigdem , Seymen Cemile Merve
Published: August 2021

The most feared complication of the hyaluronic acid injections in the periorbital region is embolism of the central retinal artery. The present study aimed to compare the effectiveness of hyaluronidase administered intravenously (systemically) alone or in combination with streptokinase with that of intra-arterial revascularization. Thirty rats were divided into 5 groups. The bilateral oblique groin flap of the rats was raised; the right side was the experiment group, and the left side was the sham control. The right superficial epigastric artery was occluded with a hyaluronic acid injection. After occlusion, no additional procedures were performed in group 1, whereas group 2 received systemic hyaluronidase, group 3 received intra-arterial hyaluronidase, group 4 received systemic hyaluronidase and streptokinase, and group 5 received intra-arterial hyaluronidase and streptokinase. On the seventh day, the rats were killed, flap necrosis rate was calculated, and histological examination was performed. There was no significant difference in the necrosis rates of the rats in groups 2, 3, 4, and 5 (P > 0.05). In histological evaluation, the histological view closest to normal arterial structure was observed in group 4. Immunohistochemical analysis revealed that the ischemia scores of systemic therapy were significantly lower than those of intra-arterial therapy. These results have shown that hyaluronidase and streptokinase administered systemically is as effective as intra-arterial revascularization and does not cause arterial wall degeneration. It has been shown that systemic administration of hyaluronidase and streptokinase is as successful as intra-arterial revascularization in the treatment of arterial embolism with hyaluronic acid.
Effectiveness of Surgical Treatment in Traumatic Facial Paralysis
Authors: Erkan Zeynel Abidin , Erkan Sanem Okşan , Tokucoglu Figen
Published: August 2021

Introduction:

In the etiology of facial nerve palsy, trauma is the most important. Our aim was to present our experience gained by evaluating the surgical approaches we have used in extratemporal and intratemporal facial nerve injuries and their long-term results, also to contribute to the consensus that will be formed on this subject.

Materials and Methods:

Thirteen patients among 24 patients who underwent surgery with a diagnosis of traumatic facial paralysis were evaluated in this study. The clinical response of these patients to treatment was examined by classifying them according to the House-Brackmann classification in the preoperative and postoperative periods.

Results:

Of the 13 patients, 9 had fractures due to temporal bone trauma, and 4 had nerve damage in the extratemporal part of the facial nerve. in the treatment, facial nerve decompression was performed using the middle fossa approach in 9 patients with temporal bone fractures. in the 4 patients with extratemporal facial nerve injury, graft repair or primary suturing was performed. in the postoperative period, the stages of the patients were III or below in 12 patients (92%), and only 1 (8%) patient remained in stage IV.

Discussion:

When the postop conditions of the patients were examined according to House-Brackmann staging, it was observed that surgical treatment caused a significant improvement in the functions of the facial nerve.

Conclusions:

Our results showed that surgery was an effective treatment method in patients with indications for traumatic facial paralysis.
Burkitt Lymphoma Masquerading as Osteomyelitis: An Interesting Road to Diagnosis
Authors: Stanbouly Dani , Clark Matthew , Philipone Elizabeth
Published: August 2021

Sporadic Burkitt lymphoma (BL) is a clinical form of BL that typically presents with abdominal and cervical lymph node involvement in male children. We present a rare case of disseminated sporadic BL of a 37-year-old female diagnosed via the workup in response to nonhealing tooth extraction sockets.
Application of Neck Lift Technique for Corrections of Concave Deformity and Scar Contracture After Tracheal Fenestration
Authors: Sakata Kensuke , Rikimaru Hideaki , Rikimaru-Nishi Yukiko , Migita Hisashi , Kiyokawa Kensuke
Published: August 2021

Following a tracheostomy or tracheal fenestration procedure, neck concave deformity, and contracture after spontaneous closure are common problems. Since the neck is an exposed part of the body, its concave deformity can cause cosmetic problems and functional problems such as difficulty in neck extension and swallowing due to contracture. We report the case of a 63-year-old man who underwent tracheal fenestration for worsening respiratory status due to sepsis after aspiration pneumonia. After spontaneous closure of the tracheal fenestration, the patient developed a deformity of the neck, impaired neck extension, and dysphagia due to contracture. In this case, the submental sagging skin was used as a subcutaneous pedicle flap to correct the problem, and the result was both functionally and cosmetically satisfactory. We found that the submandibular skin could be used as a random pattern flap for reconstruction of the lower half of the neck. Therefore, this procedure can be an effective method for reconstruction around the tracheal stoma in the future.
A Single Institutional Review of Periauricular Vestiges and Renal Anomalies: The Role of Screening Renal Ultrasonography
Authors: Barbon Carlotta , Barone Angelo A. Leto , Harris Thomas G.W. , Pan Kristen S. , Redett Richard J. , Steinberg Jordan P.
Published: August 2021

Children with minor ear malformations including periauricular vestiges often undergo renal ultrasonography (RUS) to exclude renal anomalies associated with genetic conditions. The aim of this study is to assess the association between isolated periauricular vestiges and renal anomalies and delineate the indication for RUS in screening for renal anomalies. This is a retrospective review of infants who underwent surgical consultation for periauricular vestige excision to probe a possible relationship with renal anomalies. Patients with an isolated vestige were compared to patients presenting with additional clinical findings suggestive of a possible genetic disorder. A total of 150 infants underwent periauricular vestige excision; 47 were referred for RUS, 23 with no additional clinical findings, and 24 with periauricular vestiges in addition to other suspicious clinical and/or developmental findings. Of these 47 patients, 10 had renal anomalies: 4 (17.4%) with an isolated periauricular vestige had minor anomalies and 6 (25.0%) with a vestige plus suspicious clinical signs had 5 minor anomalies and one major anomaly. The odds of a patient with an isolated periauricular vestige having positive RUS findings were not significantly different than a patient with additional clinical findings having positive RUS findings (P = 0.72).

The incidence of renal anomalies in infants with an isolated periauricular vestige was similar to that in patients with associated clinical signs suggestive of a possible genetic disorder. This was higher than the background population rate. Although most anomalies in patients with isolated ear findings were minor, our results suggest routine screening RUS should be considered.
Liver Venous Deprivation or Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy?
Authors: Chebaro Alexandre , Buc Emmanuel , Durin Thibault , Chiche Laurence , Brustia Raffaele , Didier Alexandre , Pruvot François-René , Kitano Yuki , Muscari Fabrice , Lecolle Katia , Sulpice Laurent , Sonmez Ercin , Bougard Marie , El Amrani Mehdi , Sommacale Daniele , Maulat Charlotte , Ayav Ahmet , Adam René , Laurent Christophe , Truant Stéphanie
Published: August 2021

Objective:

To compare 2 techniques of remnant liver hypertrophy in candidates for extended hepatectomy: radiological simultaneous portal vein embolization and hepatic vein embolization (HVE); namely LVD, and ALPPS.

Background:

Recent advances in chemotherapy and surgical techniques have widened indications for extended hepatectomy, before which remnant liver augmentation is mandatory. ALPPS and LVD typically show higher hypertrophy rates than portal vein embolization, but their respective places in patient management remain unclear.

Methods:

All consecutive ALPPS and LVD procedures performed in 8 French centers between 2011 and 2020 were included. The main endpoint was the successful resection rate (resection rate without 90-day mortality) analyzed according to an intention-to-treat principle. Secondary endpoints were hypertrophy rates, intra and postoperative outcomes.

Results:

Among 209 patients, 124 had LVD 37 [13,1015] days before surgery, whereas 85 underwent ALPPS with an inter-stages period of 10 [6, 69] days. ALPPS was mostly-performed for colorectal liver metastases (CRLM), LVD for CRLM and perihilar cholangiocarcinoma. Hypertrophy was faster for ALPPS. Successful resection rates were 72.6% for LVD ± rescue ALPPS (n = 6) versus 90.6% for ALPPS (P < 0.001). Operative duration, blood losses and length-of-stay were lower for LVD, whereas 90-day major complications and mortality were comparable. Results were globally unchanged for CRLM patients, or after excluding the early 2 years of experience (learning-curve effect).

Conclusions:

This study is the first 1 comparing LVD versus ALPPS in the largest cohort so far. Despite its retrospective design, it yields original results that may serve as the basis for a prospective study.
Spectral Domain Optical Coherence Tomography in Retinal Vasculopathy With Cerebral Leukoencephalopathy and Systemic Manifestations: A Monogenic Small Vessel Disease
Authors: de Boer Irene , Steenmeijer Sylvie R. , Pelzer Nadine , Al-Nofal Mays , Dijkman Greet , Notting Irene C. , Terwindt Gisela M.
Published: August 2021

Background:

Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) is a monogenic small vessel disease caused by mutations in TREX1. Several organs, including retina and brain, are affected. Analyzing retinal anatomy is increasingly used as a biomarker for ophthalmological and neurological disorders (due to the shared embryological origin of retina and brain). Optical coherence tomography (OCT) provides a noninvasive cross-sectional visualization of optic disc and macula. We aimed to use OCT to investigate retinal layer thickness in RVCL-S.

Methods:

Cross-sectional, 17 TREX1 mutation carriers (34 eyes) and 9 controls (18 eyes) underwent comprehensive ophthalmologic assessment followed by spectral domain OCT for measuring peripapillary retinal nerve fiber layer (pRNFL) thickness and total macular volume (TMV). Secondary outcomes included measuring thickness of individual macular retinal layers and peripapillary sectors. Findings were analyzed using generalized estimating equations to account for intereye correlation.

Results:

TREX1 mutation carriers had decreased pRNFL thickness (median [interquartile range] 76 [60–99] vs 99 [87–108] µm, P < 0.001) and TMV (8.1 [7.4–8.5] vs 8.7 [8.4–8.8] mm3, P = 0.006) compared with controls. With the exception of the temporal sector, the thickness of all peripapillary sectors was decreased in TREX1 mutation carriers. Ganglion cell layer (30 [22–37] vs 39 [36–41] µm, P < 0.001) and inner plexiform layer (27 [24–34] vs 34 [31–35], P = 0.001) were thinner in TREX1 mutation carriers. Notably, in 9 of 12 eyes with normal funduscopic examination, retinal thinning was already detected.

Conclusions:

RVCL-S, which may serve as a vascular retinopathy model, is associated with retinal thinning in the peripapillary and macular area. OCT findings can potentially serve as early biomarkers for RVCL-S and other vascular retinopathies.
The spider cuticle: a remarkable material toolbox for functional diversity
Authors: Politi Yael , Bertinetti Luca , Fratzl Peter , Barth Friedrich G.
Published: August 2021

Engineered systems are typically based on a large variety of materials differing in composition and processing to provide the desired functionality. Nature, however, has evolved materials that are used for a wide range of functional challenges with minimal compositional changes. The exoskeletal cuticle of spiders, as well as of other arthropods such as insects and crustaceans, is based on a combination of chitin, protein, water and small amounts of organic cross-linkers or minerals. Spiders use it to obtain mechanical support structures and lever systems for locomotion, protection from adverse environmental influences, tools for piercing, cutting and interlocking, auxiliary structures for the transmission and filtering of sensory information, structural colours, transparent lenses for light manipulation and more. This paper illustrates the ‘design space’ of a single type of composite with varying internal architecture and its remarkable capability to serve a diversity of functions.

This article is part of the theme issue ‘Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 1)’.
Colonization versus encapsulation in cell-laden materials design: porosity and process biocompatibility determine cellularization pathways
Authors: Parisi Cleo , Qin Kankan , Fernandes Francisco M.
Published: August 2021

Seeding materials with living cells has been—and still is—one of the most promising approaches to reproduce the complexity and the functionality of living matter. The strategies to associate living cells with materials are limited to cell encapsulation and colonization, however, the requirements for these two approaches have been seldom discussed systematically. Here we propose a simple two-dimensional map based on materials' pore size and the cytocompatibility of their fabrication process to draw, for the first time, a guide to building cellularized materials. We believe this approach may serve as a straightforward guideline to design new, more relevant materials, able to seize the complexity and the function of biological materials.

This article is part of the theme issue ‘Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 1)’.
Immunosequencing of the T-cell receptor repertoire reveals signatures specific for diagnosis and characterization of early Lyme disease
Authors: Greissl Julia , Pesesky Mitch , Dalai Sudeb C. , Rebman Alison W. , Soloski Mark J. , Horn Elizabeth J. , Dines Jennifer N. , Gittelman Rachel M. , Snyder Thomas M. , Emerson Ryan O. , Meeds Edward , Manley Thomas , Kaplan Ian M. , Baldo Lance , Carlson Jonathan M. , Robins Harlan S. , Aucott John N.
Published: August 2021

Lyme disease, the most common tick-borne illness in the United States, is most frequently caused by infection withBorrelia burgdorferi. Although early antibiotic treatment can prevent development of severe illness and late manifestations, diagnosis is challenging in patients who do not present with a typical erythema migrans rash. To support a diagnosis of Lyme disease in such cases, guidelines recommend 2-tiered serologic testing. However, 2-tiered testing has numerous limitations, including ambiguity in interpretation and lower sensitivity in early disease. We developed a diagnostic approach for Lyme disease based on the T-cell response toB. burgdorferiinfection by immunosequencing T-cell receptor (TCR) repertoires in blood samples from 3 independent cohorts of patients with laboratory-confirmed or clinically diagnosed early Lyme disease, as well as endemic and non-endemic controls. We identified 251 public, Lyme-associated TCRs that were used to train a classifier for detection of early Lyme disease with 99% specificity. In a validation cohort of individuals with early Lyme disease, TCR testing demonstrated a 1.9-fold increase in sensitivity compared to standard 2-tiered testing (STTT; 56% versus 30%), with a 3.1-fold increase ≤4 days from the onset of symptoms (44% versus 14%). TCR positivity predicted subsequent seroconversion in 37% of initially STTT-negative patients, suggesting that the T-cell response is detectable before the humoral response. While positivity for both tests declined after treatment, greater declines in posttreatment sensitivity were observed for STTT compared to TCR testing. Higher TCR scores were associated with clinical measures of disease severity, including abnormal liver function test results, disseminated rash, and number of symptoms. A subset of Lyme-associated TCRs mapped toB. burgdorferiantigens, demonstrating high specificity of a TCR immunosequencing approach. These results support the clinical utility of T-cell‒based testing as a sensitive and specific diagnostic for early Lyme disease, particularly in the initial days of illness.
An age-depth model and revised stratigraphy of vertebrate-bearing units in Natural Trap Cave, Wyoming
Authors: Lovelace David M. , Redman Cory M. , Minckley Thomas A. , Schubert Blaine W. , Mahan Shannon , Wood John R. , McGuire Jenny L. , Laden Juan , Bitterman Kathleen , Heiniger Holly , Fenderson Lindsey , Cooper Alan , Mitchell Kieren J. , Meachen Julie A.
Published: August 2021

Almost a half-century ago excavations at Natural Trap Cave (NTC) began to yield evidence of the steppe paleoecology along the western slope of the Bighorn Mountains in north central Wyoming. The first decade of fieldwork led to the discovery of a diverse fauna that existed at the end of the Last Glacial Maximum. Stratigraphic deposits below the entrance of the cave were studied soon after excavations began, but never formally published. Although stratigraphy, taphonomy, and depositional circumstances were briefly discussed over the following years, little has been done to correlate the numerous stratigraphic schemes used by various authors. In this study, four stratigraphic sections were measured and analysed to establish an easily modifiable lithostratigraphic system of nomenclature. We provide the first correlations of all stratigraphic nomenclature used throughout excavations at NTC to facilitate comparisons with current and previous collections and publications. By leveraging more than 100 radioisotopic dates we developed an age-depth model and chronostratigraphic framework to further interrogate spatiotemporal relationships between strata, paleoenvironmental proxies, and fossil assemblages. Deposition is shown to be discontinuous; sediment accumulation in the study area is restricted to the buildup through peak penultimate and Last Glacial maxima. More recent (<10 ka) Holocene deposits unconformably cover the eroded surface of underlying Pleistocene strata. There is active reworking of sediments with transport and deposition of reactivated sediments within the Lower Chamber. We note that the two hiatuses coincide with interglacial periods and may reflect changing depositional circumstances within the cave such as extended periods of non-deposition, erosion, or bypass (possibly leading to deposition in the Lower Chamber). Contrary to previous reports, we demonstrate that it is unlikely a prominent snow cone existed or contributed to the pattern of sediment and fossil distribution within the study area, furthermore, we do not observe a continuous Pleistocene-Holocene transition in the study area. Further stratigraphic work will be needed to better understand the interrelationship between Main and Lower chamber deposits and the evolution of sediment accumulation in NTC.
A new single-cell level R-index for EGFR-TKI resistance and survival prediction in LUAD
Authors: Xie Xiaohong , Li Lifeng , Xie Liang , Liu Zhentian , Gao Xuan , Xia Xuefeng , Deng Haiyi , Yang Yilin , Yang MeiLing , Chang Lianpeng , Yi Xin , He Zhiyi , Zhou Chengzhi
Published: August 2021

EGFR-TKIs achieved excellent efficacy in EGFR-mutated patients. Unfortunately, most patients would inevitably develop progressive disease within a median of 10 to 14 months. Predicting the resistance probability remains a challenge. Therefore, we created an R-index model trained by single-cell RNA data with the OCLR algorithm. This model can be applied to estimate the level of EGFR-TKI resistance in cell line and xenograft mice models and predict prognosis in multiple cohorts. Comparing the high and the low R-index group, we found that the glycolysis pathway and KRAS up-regulation pathway were related to resistance, and MDSC was the leading cause of immunosuppression in the tumor microenvironment. These results are consistent with previous studies indicating that the R-index provides an insight into resistance status and a new way to explore resistance mechanisms and clinical treatment by the combination of Glucose metabolism-targeted or MDSC-targeted therapies. This is the first quantification method of EGFR-TKI resistance based on single-cell sequencing data solving the problem of the mixed resistance state of tumor cells and helping explore transcriptome characteristics of drug-resistant cell populations.
Injury risk functions for the four primary knee ligaments
Authors: Nusia Jiota , Xu Jia-Cheng , Knälmann Johan , Sjöblom Reimert , Kleiven Svein
Published: August 2021

The purpose of this study was to develop Injury Risk Functions (IRFs) for the Anterior- and Posterior Cruciate Ligament (ACL and PCL, respectively) and the Medial- and Lateral Collateral Ligament (MCL and LCL, respectively) in the knee joint. The IRFs were based on Post-Mortem Human Subject (PMHS) tensile failure strains of either Bone-Ligament-Bone (BLB) or dissected LIGament (LIG) preparations. Due to insufficient sample sizes of the experimental data points available in the current literature, statistically-generated failure strains (virtual values) based on the reported mean- and standard deviation were used to accommodate for the unprovided specimen-specific results. All virtual and specimen-specific values were then categorized into groups of static and dynamic rates, respectively, and tested for the best fitting theoretical distribution to derive a ligament IRF. Ten IRFs were derived (3 for ACL, 2 for PCL, 2 for MCL and 3 for LCL). These IRFs are, to the best of the authors’ knowledge, the first attempt of knee ligament injury prediction tools based on PMHS data. For future improvements of the knee ligament IRFs, upcoming experiments need comparable testing and strain measurements. More emphasis on a clear definition of failure and transparent reporting of each specimen-specific result is necessary.
Energy efficient network activity from disparate circuit parameters
Authors: Deistler Michael , Macke Jakob H. , Gonçalves Pedro J.
Published: August 2021

Neural circuits can produce similar activity patterns from vastly different combinations of channel and synaptic conductances. These conductances are tuned for specific activity patterns but might also reflect additional constraints, such as metabolic cost or robustness to perturbations. How do such constraints influence the range of permissible conductances? Here, we investigate how metabolic cost affects the parameters of neural circuits with similar activity in a model of the pyloric network of the crab Cancer borealis. We use a novel machine learning method to identify a range of network models that can generate activity patterns matching experimental data, and find that neural circuits can consume largely different amounts of energy despite similar circuit activity. Furthermore, a reduced but still significant range of circuit parameters gives rise to energy-efficient circuits. We then examine the space of parameters of energy-efficient circuits and identify potential tuning strategies for low metabolic cost. Finally, we investigate the interaction between metabolic cost and temperature robustness. We show that metabolic cost can vary across temperatures, but that robustness to temperature changes does not necessarily incur an increased metabolic cost. Our analyses show that, despite metabolic efficiency and temperature robustness constraining circuit parameters, neural systems can generate functional, efficient, and robust network activity with widely disparate sets of conductances.
Asymmetrical adaptations to increases and decreases in environmental volatility
Authors: Xu Jie , Van Dam Nicholas T. , Luo Yuejia , Aleman André , Ai Hui , Xu Pengfei
Published: August 2021

Humans adapt their learning strategies to changing environments by estimating the volatility of the reinforcement conditions. Here, we examine how volatility affects learning and the underlying functional brain organizations using a probabilistic reward reversal learning task. We found that the order of conditions was critically important; participants adjusted learning rate going from volatile to stable, but not from stable to volatile, environments. Subjective volatility of the environment was encoded in the striatal reward system and its dynamic connections with the prefrontal control system. Flexibility, which captures the dynamic changes of network modularity in the brain, was higher in the environmental transition from volatile to stable than from stable to volatile. These findings suggest that behavioral adaptations and dynamic brain organizations in transitions between stable and volatile environments are asymmetric, providing critical insights into the way that people learn under uncertainty.