bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of endoscopic resection of gastrointestinal stromal tumors in the stomach under double-channel gastroscopy: A retrospective observational study
Authors: Sun Xue-Guo , Liu Hui-Zi , Zhang Bo , Jiang Yue-Ping , Liu Fu-Guo , Han Yue , Shan Ti-Dong
Published: August 2022

We aimed to investigate the safety and efficacy of endoscopic resection for the treatment of gastric gastrointestinal stromal tumors (GISTs) under single-channel gastroscopy and double-channel gastroscopy.

We identified 154 patients with GISTs of the stomach who underwent endoscopic resection and were retrospectively analyzed at our hospital between May 2016 and March 2020, including 49 patients by single-channel gastroscopy and 105 patients by double-channel gastroscopy. We observed the clinical efficacy, complications, and safety of endoscopic resection of gastric GISTs, and the data were evaluated retrospectively.

All patients underwent endoscopic resection successfully, without conversion to open surgery. In the single-channel gastroscopy group, 7 patients had lesions in the gastric cardia, 17 in the gastric fundus, 20 in the gastric corpus, and 5 in the gastric antrum. In the double-channel gastroscopy group, 13 patients had lesions in the gastric cardia, 34 in the gastric fundus, 46 in the gastric body, 10 in the gastric antrum, 1 in the pylorus, and 1 in the gastric angular incisure. The double-channel gastroscopy group had a shorter operation time than the single-channel gastroscopy group (59.9 ± 34.9 minutes vs 74.8 ± 26.7 minutes; P = .009 and P < .01, respectively), while they also had a lower perforation rate than the single-channel gastroscopy group (34.3% vs 51.0%; P = .048 and P < .05, respectively). No residual or recurrent lesions were discovered in any patients by gastroscopy reexamination.

Both single-channel gastroscopy and double-channel gastroscopy can provide safe, effective, feasible endoscopic resection. However, double-channel gastroscopy has some distinct advantages in endoscopic resection.
At the heart of the problem: congestive cardiac failure as a cause of ascites: A narrative review
Authors: Goh Zhong Ning Leonard , Teo Roland Yii Lin , Chung Bui Khiong , Wong Alexis Ching , Seak Chen-June
Published: August 2022

Heart failure leading to cardiac ascites is an extremely rare and underrecognized entity in clinical practice. Recognizing cardiac ascites can be difficult, especially since patients presenting with ascites may have more than 1 etiology. Various biomarkers are available to aid in the diagnosis of cardiac ascites, though with differing sensitivities and specificities. Such biomarkers include serum albumin, ascitic albumin and protein, as well as serum N-terminal pro-brain natriuretic peptide (NT-proBNP). While serum NT-proBNP is a powerful biomarker in distinguishing the etiology of ascites and monitoring treatment progression, its cost can be prohibitive in low-resource settings. Clinicians practicing under these circumstances may opt to rely on other parameters to manage their patients. We go on further to report a series of 3 patients with cardiac ascites to illustrate how these biomarkers may be employed in the management of this patient population. Clinicians should always keep in mind the differential diagnosis of cardiac failure as a cause of ascites. The resolution of cardiac ascites may serve as a surrogate clinical marker for response to antifailure therapy in lieu of NT-proBNP at resource-scarce centers.
Percutaneous microtenotomy using a microdebrider coblation wand for the treatment of lateral epicondylitis: A systematic review
Authors: Jurado Vélez Javier A. , Colberg Ricardo E. , Fleisig Glenn S.
Published: August 2022

Background:

Lateral epicondylitis is one of the most common causes of elbow pain. Most patients recover with conservative treatments; however, some patients require surgical intervention. There are 3 common procedures offered: open tenotomy, arthroscopic tenotomy, and percutaneous microtenotomy. In comparison, percutaneous microtenotomy has been proven as a less invasive procedure to treat lateral epicondylitis. We reviewed the literature on the safety and efficacy of using a microdebrider coblation wand to treat lateral epicondylitis, and we compared its outcomes to open and arthroscopic tenotomy.

Methods:

A search was completed through PubMed Central, Google Scholar, EBSCO host, and Embase for studies that performed percutaneous microtenotomy with a microdebrider coblation wand to treat lateral epicondylitis. Studies were then screened to determine if they met inclusion and exclusion criteria and were reviewed for data analysis and potential risks of bias.

Results:

A total of 27 articles were identified and 9 articles (eight studies) met the inclusion criteria. Small sample sizes in the studies and heterogeneity of the methodology limited the capacity to carry out a meta-analysis. Percutaneous microtenotomy outcomes seem to be favorable for reduced pain, increased grip strength, and improved functional outcomes, which were similar to outcomes reported with the other surgical techniques. There were no major adverse events reported in the studies secondary to the use of the microdebrider coblation wand. Procedure time and return to daily activities were shorter for the microtenotomy group.

Conclusion:

Percutaneous microtenotomy performed with a microdebrider coblation seems to be an effective treatment for lateral epicondylitis that provides similar outcomes to the surgical techniques with a lower rate of complications.
The combination of osteoporosis and low lean mass correlates with physical function in end-stage knee osteoarthritis: A retrospective observational study
Authors: Lee So Young , Kim Bo Ryun , Kim Sang Rim , Choi Jun Hwan , Jeong Eui Jin , Kim Jinseok
Published: August 2022

We aimed to investigate the prevalence of osteoporosis and low lean mass, either together or in isolation, and their association with physical function, pain, and quality of life (QOL) in patients with end-stage knee osteoarthritis (OA).

This retrospective cross-sectional observational study included 578 patients (77 males and 501 females) diagnosed with end-stage knee OA. Patients were divided into 4 groups based on body composition parameters: control, osteoporosis, low lean mass, and osteoporosis + low lean mass. All participants underwent performance-based physical function tests, including a stair climbing test (SCT), a 6-minute walk test, a timed up and go test, and instrumental gait analysis, to examine spatiotemporal parameters. Self-reported physical function and pain levels were measured using the Western Ontario McMaster Universities Osteoarthritis Index and visual analog scale, respectively. Self-reported QOL was measured using the EuroQOL 5 dimensions (EQ-5D) questionnaire.

Of 578 patients, 268 (46.4%) were included in the control group, 148 (25.6%) in the osteoporosis group, 106 (18.3%) in the low lean mass group, and 56 (9.7%) in the osteoporosis + low lean mass group. Analysis of variance revealed that the scores for the osteoporosis + low lean mass group in the SCT-ascent, SCT-descent, and timed up and go test were significantly higher, whereas those for the 6-minute walk test, gait speed, and cadence were significantly lower than those for the other groups (P < .05). After adjusting for age, sex, and body mass index, multiple linear regression analysis identified SCT-ascent (β = 0.140, P = .001, R
2 = 0.126), SCT-descent (β = 0.182, P < .001, R
2 = 0.124), gait speed (β = –0.116, P = .005, R
2 = 0.079), and cadence (β = –0.093, P = .026, R
2 = 0.031) as being significantly associated with osteoporosis + low lean mass.

Thus, osteoporosis + low lean mass correlates with poor physical function, but not pain and QOL, in patients with end-stage knee OA.
Malignant transformation of nevus sebaceous to basal-cell carcinoma: Case series, literature review, and management algorithm
Authors: Lee Yeon Ji , Han Hye Ju , Kim Dong Yeon , Yoo Chang Young , Lim Jin Soo
Published: August 2022

Nevus sebaceous (NS) is a common congenital hamartoma of the skin composed predominantly of sebaceous glands. Although most NS are benign skin tumors, malignant transformations have been reported. There is still controversy about the lifetime risk of malignant degeneration and precise surgical criteria. This study reports cases of malignant degeneration and suggests a surgical treatment algorithm. The medical records of patients with basal-cell carcinoma (BCC) arising from NS between January 2001 and January 2021 were retrospectively reviewed. Patient demographics including lesion location, and tumor size were investigated. The symptoms, histological findings before and after excision, complications, and recurrence during 2-year follow-up periods were investigated. Ten patients were identified with BCC arising from NS lesions. All patients were female and the mean age was 52.11 years. All patients complained of sudden morphological changes, the most common type being rapid color changes. Two cases had histological findings that showed a miss-match between punch biopsy and excisional biopsy results. No recurrence was detected 2 years after surgeries in any patients. Cases after third stage, especially in over 40 years who report morphologic changes, should undergo total surgical excision as the first approach, with strong suspicion of malignant degeneration.
Experimental studies on androgen administration in animal models: current and future perspectives
Authors: Sessa Francesco , Esposito Massimiliano , Salerno Monica
Published: August 2022

Purpose of review

This review aims to report the most recent (2020–2022) experimental scientific studies conducted on animal models, in order to highlight the relevant findings on the adverse effects related to androgen administration.

Recent findings

Forty-one studies published between January 2020 and July 2022 were selected. The majority of studies investigated the effects of one androgen, whereas only four studies analyzed the effects of two drugs. Nandrolone decanoate was the most investigated drug (20 articles), boldenone was tested in 8 articles, testosterone and stanozolol were used in 7 articles each, 17b-trenbolone, metandienone, and oxandrolone were tested in 1 article each. The articles clarify the adverse effects of androgen administration on the heart, brain, kidney, liver, reproductive and musculoskeletal systems.

The main findings of this review highlight that androgen administration increases inflammatory mediators, altering different biochemical parameters. The results concerning the reversibility of the adverse effects are controversial: on the one hand, several studies suggested that by stopping the androgen administration, the organs return to their initial state; on the other hand, the alteration of different biochemical parameters could generate irreversible organ damage. Moreover, this review highlights the importance of animal studies that should be better organized in order to clarify several important aspects related to androgen abuse to fill the gap in our knowledge in this research field.
Accuracy of Pressure Ulcer Events in US Nursing Home Ratings
Authors: Chen Zihan , Gleason Lauren J. , Sanghavi Prachi
Published: August 2022

Background:

The US government relies on nursing home-reported data to create quality of care measures and star ratings for Nursing Home Compare (NHC). These data are not systematically validated, and some evidence indicates NHC’s patient safety measures may not be reliable.

Objective:

The objective of this study was to assess the accuracy of NHC’s pressure ulcer measures, which are chief indicators of nursing home patient safety.

Research Design:

For Medicare fee-for-service beneficiaries who were nursing home residents between 2011 and 2017, we identified hospital admissions for pressure ulcers and linked these to the nursing home-reported data at the patient level. We then calculated the percentages of pressure ulcers that were appropriately reported by stage, long-stay versus short-stay status, and race. After developing an alternative claims-based measure of pressure ulcer events, we estimated the correlation between this indicator and NHC-reported ratings.

Subjects:

Medicare nursing home residents with hospitalizations for pressure ulcers.

Measures:

Pressure ulcer reporting rates; nursing home–level claims-based measure of pressure ulcer events.

Results:

Reporting rates were low for both short-stay (70.2% of 173,043 stage 2–4 pressure ulcer hospitalizations) and long-stay (59.7% of 137,315 stage 2–4 pressure ulcer hospitalizations) residents. Black residents experienced more severe pressure ulcers than White residents, however, this translated into having slightly higher reporting rates because higher staged pressure ulcers were more likely to be reported. Correlations between our claims-based measure and NHC ratings were poor.

Conclusions:

Pressure ulcers were substantially underreported in data used by NHC to measure patient safety. Alternative approaches are needed to improve surveillance of health care quality in nursing homes.
Cascade screening for familial hypercholesterolemia should be organized at a national level
Authors: Leren Trond P. , Bogsrud Martin Prøven
Published: August 2022

Purpose of review

Patients with familial hypercholesterolemia (FH) have a markedly increased risk of premature cardiovascular disease. However, there are effective lipid-lowering therapies available to reduce the risk of cardiovascular disease. This makes it important to diagnose these patients. The most cost-effective strategy to diagnose patients with FH is to perform cascade screening. However, cascade screening as part of ordinary healthcare has not been very successful. Thus, there is a need to implement more efficient cascade screening strategies.

Recent findings

Cascade screening for FH should be organized at a national level and should be run by dedicated health personnel such as genetic counsellors. As part of a national organization a national registry of patients with FH needs to be established. Moreover, for cascade screening to be effective, diagnosis of FH must be based on identifying the underlying mutation. There should preferably only be one genetics centre in each country for diagnosing FH, and this genetics centre should be an integrated part of the national cascade screening program.

Cascade screening for FH is very effective and should be organized at a national level. Even a modest national cascade screening program can result in a large number of patients being identified.
Lipoprotein (a) in familial hypercholesterolaemia
Authors: Durrington Paul N. , Bashir Bilal , Bhatnagar Deepak , Soran Handrean
Published: August 2022

Purpose of review

The role of lipoprotein (a) in atherogenesis has been the subject of argument for many years. Evidence that it is raised in familial hypercholesterolaemia has been disputed not least because a mechanism related to low density lipoprotein (LDL) receptor mediated catabolism has been lacking. Whether lipoprotein (a) increases the already raised atherosclerotic cardiovascular disease (ASCVD) risk in familial hypercholesterolaemia is also more dubious than is often stated. We review the evidence in an attempt to provide greater clarity.

Recent findings

Lipoprotein (a) levels are raised as a consequence of inheriting familial hypercholesterolaemia. The mechanism for this is likely to involve increased hepatic production, probably mediated by PCSK9 augmented by apolipoprotein E. The extent to which raised lipoprotein (a) contributes to the increased ASCVD risk in familial hypercholesterolaemia remains controversial.

Unlike, for example, statins which are effective across the whole spectrum of LDL concentrations, drugs in development to specifically lower lipoprotein (a) are likely to be most effective in people with the highest levels of lipoprotein (a). People with familial hypercholesterolaemia may therefore be in the vanguard of those in whom theses agents should be exhibited.

Inheritance of familial hypercholesterolaemia undoubtedly increases the likelihood that lipoprotein (a) will be raised. However, in familial hypercholesterolaemia when ASCVD incidence is already greatly increased due to high LDL cholesterol, whether lipoprotein (a) contributes further to this risk cogently needs to be tested with drugs designed to specifically lower lipoprotein (a).
A Brief Psychoeducation Intervention to Prevent Rehospitalization in Severe Mental Disorder Inpatients
Authors: Riera-Molist Núria , Riera-Morera Bruna , Roura-Poch Pere , Santos-López Josep Manel , Foguet-Boreu Quintí
Published: August 2022

The efficacy of medium- to long-term psychoeducation in preventing relapse and hospitalization in people with severe mental disorders (SMDs) is robust. However, the evidence is inconclusive in brief interventions and individual modalities. The aim of this randomized clinical trial in SMD inpatients is to analyze the efficacy of a brief psychoeducation intervention added to treatment-as-usual, in improving the rehospitalization rate at 3 and 6 months after discharge. Fifty-one SMD inpatients were randomized to the intervention (n = 24) or control group (n = 27). Low insight and poor medication adherence were the most prevalent risk factors at admission. No significant differences were observed in the rehospitalization rate at 3 and 6 months after discharge. On the overall sample, the number of previous hospitalizations was a rehospitalization predictor at 3 (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01–1.56; p = 0.04) and 6 months (OR, 1.85; 95% CI, 1.17–2.91; p = 0.009). SMD people require multimodal and persistent approaches focused on insight and medication adherence to prevent rehospitalizations.
The Effect of Internet Addiction and Emotion Regulation on Trauma Reactions During the COVID-19 Pandemic in Adolescents With Anxiety Disorder
Authors: Kuz Merve , Uçar Halit Necmi , Çiçek Zekey Özlem , Çetin Fatih Hilmi , Türkoğlu Serhat
Published: August 2022

In this study, we examined the relationship among trauma reactions, anxiety severity, Internet addiction (IA), and emotion regulation difficulties during the COVID-19 pandemic in adolescents with anxiety disorders. The sample of study consisted of 63 adolescents aged 12 to 18 years who were diagnosed with AD and their parents. IA scores and emotional regulation difficulties were significantly higher in the group with pathological trauma reactions than the group exhibiting nonpathological trauma reactions. The trauma scores of adolescents with AD were correlated with IA, emotional regulation difficulties, and anxiety scores. The results of mediation analysis found that IA was the full mediating factor in the relationship between anxiety and trauma scores and a partial mediating factor in the relationship between emotional regulation difficulties and trauma scores. As a result, monitoring adolescents' Internet use not exceeding healthy levels and developing and strengthening emotion regulation skills can help protect against trauma during the COVID-19 pandemic.
The Clinical Significance of Either Extraprostatic Extension or Microscopic Bladder Neck Invasion Alone Versus Both in Men With pT3a Prostate Cancer Undergoing Radical Prostatectomy
Authors: Teramoto Yuki , Numbere Numbereye , Wang Ying , Miyamoto Hiroshi
Published: August 2022

The prognosis of prostate cancers exhibiting extraprostatic extension [other than bladder or seminal vesicle invasion (EPE)] and/or microscopic bladder neck invasion (mBNI) is variable, and further risk stratification is required. We herein assessed radical prostatectomy findings and long-term oncologic outcomes in consecutive 957 patients with pT3a disease. The patient cohort was divided into 4 groups, focal EPE (F-EPE) only (n=177; 18.5%), nonfocal/established (E-EPE) only (n=634; 66.2%), mBNI only (n=51; 5.3%). The rate of positive surgical margin and estimated volume of tumor were significantly higher in patients with both EPE and mBNI than in those with either. In addition, compared with F-EPE or mBNI only, E-EPE only was significantly associated with higher Grade Group, lymph node metastasis, and larger tumor volume. Kaplan-Meier analysis revealed a comparable prognosis after prostatectomy between those showing F-EPE only versus mBNI only (P=0.986), and these 2 cohorts were combined for further analysis. Then, patients showing E-EPE only had a significantly higher or lower risk of progression compared with those showing F-EPE or mBNI only (P<0.001) or both EPE and mBNI (P<0.001), respectively. These significant differences in progression-free survival were also seen in subgroups, including those with or without undergoing adjuvant therapy before recurrence and those showing no lymph node metastasis. In multivariate analysis, F-EPE or mBNI only (hazard ratio=0.524, P=0.003) or both EPE and mBNI (hazard ratio=1.465, P=0.039) (vs. E-EPE only) showed significance for progression. Based on these findings, we propose a novel pT3a subclassification, pT3a1 (F-EPE or mBNI alone), pT3a2 (E-EPE alone), and pT3a3 (both EPE and mBNI).
ON Time Mobility: Advocating for Mobility Equity
Authors: Sabet Andrina , Feldner Heather , Tucker Jennifer , Logan Samuel W. , Galloway James Cole
Published: August 2022

Mobility is a human right. The traditional definition of mobility in physical therapy practice is centered on translocation and, while accurate, is not comprehensive. In this article, we propose the ON Time Mobility framework: that all children have the right to be mobile throughout their development to explore, engage in relationships, and develop agency to cocreate their lives. This perspective highlights interconnected principles of timing, urgency, multimodal, frequency, and sociability to begin discussions on supporting the right to hours of active mobility each day for all children. We propose critical evaluation and discussion of these principles followed by a call to action to shift our conceptualization and enactment of mobility. This mobility rights perspective challenges current medical systems, industry, and government to collaborate with children with disabilities, their families and communities to support mobility as a source of physical and social interactions that define and develop individuals (see Supplemental Digital Content 1, the Video Abstract, available at: http://links.lww.com/PPT/A398).
A Retrospective Case Series Study on a Minimally-Invasive Ultrasound-Guided First Dorsal Compartment Release Technique for Refractory De Quervain Tenosynovitis
Authors: Beidleman Matthew B. , Colberg Ricardo E. , Beason David P. , Fleisig Glenn S.
Published: August 2022

Objective

To evaluate the outcomes of patients treated with a novel minimally-invasive complete release of the first dorsal compartment percutaneously under ultrasound guidance using an 18-gauge needle with an 18 blade at the tip.

Design

Retrospective case series. Nine adults (ten wrists) were included in the study of this technique. All patients had failed conservative care, had tenderness to palpation over the first dorsal compartment, a positive Finklestein Test, and confirmed tenosynovitis with ultrasound imaging prior to the procedure. The main outcome measures were reduction in pain as determined by the numeric rating scale (NRS) and improvement of function determined by the Nirschl Phase scale at both short and long term follow up.

Results

There was 100% follow-up with mean follow-up occurring at 23.1 months (9-42, SD 9.8). From pre-procedure to follow-up, NRS pain decreased from 4.1 (SD 2.5) to 0.0 (SD 0.0) (p < 0.001), and Nirschl Phase improved from 2.5 (SD 1.9) to 0.2 (SD 0.4) (p = 0.03). No patients required revision open release surgery or suffered neurovascular complications.

Conclusion

This technique resulted in significant improvement of pain and function for all patients and no short or long-term neurovascular complications were seen.
SINGLE-CENTER ONCOLOGIC OUTCOME OF FAT TRANSFER FOR BREAST RECONSTRUCTION FOLLOWING MASTECTOMY IN 1000 CANCER CASES – A MATCHED CASE-CONTROL STUDY
Authors: Sorotos Michail , Paolini Guido , D’Orsi Gennaro , Firmani Guido , Timmermans Floyd Wilhelmus , di Pompeo Fabio Santanelli
Published: August 2022

Background:

Autologous fat transfer (AFT) has an important role in breast reconstructive surgery. Nevertheless, Some concerns remain with regards to its oncological safety. We present a single center case-matching study analysing the impact of AFT in cumulative incidence of local recurrences (LR).

Materials and Methods:

From a prospectively maintained database, we identified 902 patients who underwent 1025 breast reconstructions from 2005 to 2017. Data regarding demographics, tumor characteristics, surgery details and follow-up were collected. Exclusion criteria were patients with distant metastases at diagnosis, recurrent tumor or incomplete data regarding primary tumor, patients who underwent prophylactic mastectomies and breast-conserving surgeries. Statistical analysis was done to evaluate the impact of the variables on the incidence of LR. A p-value < 0.05 was considered statistically significant.

Results:

After 1:n case-matching, we selected 919 breasts, out of which 425 (46.2%) patients received at least one AFT session vs 494 (53.8%) control cases. LR had an overall rate of 6.8% and we found LR in 14 (3.0%) AFT cases and 54 (9.6%) controls. Statistical analysis showed that AFT did not increase risk of LR: HR 0.337 (CI 0.173-0.658), p=0.00007. Multivariate analysis identified IDC subtype and lymph node metastases to have an increased risk of local recurrences (HR > 1). Conversely, positive hormonal receptor status was associated with a reduced risk of events (HR < 1)

Conclusions:

AFT was not associated with a higher probability of locoregional recurrence in patients undergoing breast reconstruction therefore it can be safely used for total breast reconstruction or aesthetic refinements.

LEVEL OF EVIDENCE: 3
Long-Term Cancer Recurrence Rates Following Nipple-Sparing Mastectomy: A 10-year Follow-up Study
Authors: Boyd Carter J. , Salibian Ara A. , Bekisz Jonathan M. , Axelrod Deborah M. , Guth Amber A. , Shapiro Richard L. , Schnabel Freya R. , Karp Nolan S. , Choi Mihye
Published: August 2022

Background:

Despite the increased utilization of nipple-sparing mastectomies (NSM), there is limited data examining long-term cancer recurrence rates in these patients. The objective of this study was to analyze breast cancer recurrence in patients who received therapeutic NSM with a median of 10 years of follow-up.

Methods:

All patients undergoing NSM at a single institution were retrospectively reviewed temporally to obtain a median of 10-years of follow up. Patient demographic factors, mastectomy specimen pathology, and oncologic outcomes were analyzed. Univariate analysis was performed to identify independent risk factors for locoregional recurrence.

Results:

126 therapeutic NSM were performed on 120 patients. The most frequently observed tumor histology included invasive ductal carcinoma (48.4%) and ductal carcinoma in situ (38.1%). Mean tumor size was 1.62 cm. Multifocal or multicentric disease and lymphovascular invasion were present in 31.0% and 10.3% of NSM specimens, respectively. Sentinel lymph node biopsy was performed in 84.9% of NSM and 17.8% were positive. The rate of positive frozen subareolar biopsy was 7.3% (n=82) and permanent subareolar pathology was 9.5% (n=126). The most frequently observed pathologic tumor stages was stage I (44.6%) and stage 0 (33.9%). Incidence of recurrent disease was 3.17% per mastectomy and 3.33% per patient. Upon univariate analysis, no demographic, operative, or tumor-specific variables were independent risk factors for locoregional recurrence.

Conclusions:

Overall recurrence rates are low in patients undergoing NSM at a median follow-up of 10-years. Close surveillance should remain a goal for patients and their providers to promptly identify potential recurrence.
Gambiense human African trypanosomiasis: the bumpy road to elimination
Authors: Hasker Epco , Hope Andrew , Bottieau Emmanuel
Published: August 2022

Purpose of review

Gambiense human African trypanosomiasis (gHAT), a disease that has killed hundreds of thousands as recently as the 1990s, could be on the verge of elimination or even eradication. This review describes recent developments that give us reasons for optimism as well as some caveats.

Recent findings

New developments in diagnostic and vector control tools, and especially in treatment, make it possible to strive for elimination of transmission of gHAT by 2030, perhaps even eradication.

Gambiense human African trypanosomiasis is a deadly infectious disease affecting West and Central Africa, South Sudan and Uganda, and transmitted between humans by tsetse flies. The disease has caused several major epidemics, the latest one in the 1990s. Thanks to recent innovations such as rapid diagnostic tests for population screening, a single-dose oral treatment and a highly efficient vector control strategy, interruption of transmission of the causative parasite is now within reach. If indeed gHAT has an exclusively human reservoir, this could even result in eradication of the disease. Even if there were an animal reservoir, on the basis of epidemiological data, it plays a limited role. Maintaining adequate postelimination surveillance in known historic foci, using the newly developed tools, should be sufficient to prevent any future resurgence.
Controversies over the management of infections caused by Amp-C- and ESBL-producing Enterobacterales: what questions remain for future studies?
Authors: Burillo Almudena , Bouza Emilio
Published: August 2022

Purpose of review

The continuous rise in infections caused by third-generation cephalosporin-resistant Enterobacterales (e.g. extended-spectrum beta-lactamase- or AmpC-producing Enterobacterales ) is a major health concern. Carbapenems are regarded as the antibiotics of choice for the treatment of these infections. However, their indiscriminant use is not without consequences, and has contributed to the emergence of carbapenem-resistant Enterobacterales.

In this review, we discuss the available evidence supporting the use of other betalactams, nonbetalactams and the new betalactams/beta-lactamase inhibitors (BLA/BLI) to treat these infections. We also analyze unresolved issues in this field.

Recent findings

Piperacillin tazobactam (PTZ) was classically recommended as a carbapenem-sparing agent. However, data have emerged against its use and it is now a controversial recommendation. IDSA, European and British guidelines reject the empirical use of PTZ for these pathogens, reserving its use for rare clinical situations.

Other issues that continue to generate debate are the use of extended infusion (3 h) PTZ, the use of older antibiotics, a shortened course of carbapenems and reserving the new BLA/BLI for these infections.

New treatment strategies should be based on clinical evidence, local epidemiology and the microbiological activity of these drugs.
A Mixed Methods Study Identifying the Competencies of Health Care Simulation Technicians
Authors: Roche Adam F. , Condron Claire M. , Eppich Walter J. , O'Connor Paul E.
Published: August 2022

Introduction

Health care simulation technicians (HSTs), also referred to as simulation operations specialists, are essential to the delivery of simulation-based education. The HST role draws on a broad range of knowledge, skills, and attitude competencies. However, because of the neoteric nature of the HST role and the ambiguity surrounding the core responsibilities of the position, it has proved difficult to identify the competencies required to perform this role successfully. This study aims to identify the knowledge, skills, and attitude competencies required by HSTs.

Methods

A mixed methods approach was used in this study. Data were collected from (1) online searches of HST job descriptions and (2) semistructured interviews about the competencies required by HSTs with 10 HSTs, 10 health care simulation educators, and 10 health care simulation center managers/director. The data from the job descriptions and interviews were analyzed using thematic analysis, using a framework method to guide the coding.

Results

A total of 59 competencies were identified from the job descriptions and 65 competencies from the interviews. This analysis resulted in the identification of 9 competency domains: 3 knowledge domains (technical, clinical, and pedagogic), 4 skills domains (resourcefulness, pedagogic, team, and technical), and 2 attitudes domains (professional and “can-do” mentality).

Conclusions

The identification of the competencies required by HSTs will support the selection of candidates with the attributes that will allow them to be successful in this role and guide continuous professional development opportunities for current and future HSTs.
Variation in Complications and Mortality According to Infant Diagnosis
Authors: Mehl Steven C. , Portuondo Jorge I. , Fallon Sara C. , Shah Sohail R. , Wesson David E. , Vogel Adam M. , King Alice , Lopez Monica E. , Massarweh Nader N.
Published: August 2022

Objective:

Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of postoperative complications and mortality in infants.

Background:

The majority of mortality events in pediatric surgery occur among infants (ie, children <1 y old). However, there is limited data characterizing patterns of infant perioperative mortality and diagnoses that account for the highest proportion of mortality.

Methods:

Infants who received inpatient surgery were identified in the National Surgical Quality Improvement Program-Pediatric database (2012–2019). Perioperative mortality was stratified into mortality associated with a complication or mortality without a complication. Complications were categorized as wound infection, systemic infection, pulmonary, central nervous system, renal, or cardiovascular. Multivariable logistic regression was used to evaluate the association between different complications and complicated mortality.

Results:

Among 111,946 infants, the rate of complications and perioperative mortality was 10.4% and 1.6%, respectively. Mortality associated with a complication accounted for 38.8% of all perioperative mortality. Seven diagnoses accounted for the highest proportion of mortality events (40.3%): necrotizing enterocolitis (22.3%); congenital diaphragmatic hernia (7.3%); meconium peritonitis (3.8%); premature intestinal perforation (2.5%); tracheoesophageal fistula (1.8%); gastroschisis (1.4%); and volvulus (1.1%). Relative to wound complications, cardiovascular [odds ratio (OR): 19.4, 95% confidence interval (95% CI): 13.9–27.0], renal (OR: 6.88; 4.65–10.2), and central nervous system complications (OR: 6.50; 4.50–9.40) had the highest odds of mortality for all infants.

Conclusions:

A small subset of diagnoses account for 40% of all infant mortality and specific types of complications are associated with mortality. These data suggest targeted quality improvement initiatives could be implemented to reduce adverse surgical outcomes in infants.
Alpha-cardiac Actin Serum Expression Levels Detect Acute Cellular Rejection in Heart Transplant Patients
Authors: Pérez-Carrillo Lorena , Giménez-Escamilla Isaac , Sánchez-Lázaro Ignacio , Triviño Juan Carlos , Feijóo-Bandín Sandra , Lago Francisca , González-Juanatey José Ramón , Martínez-Dolz Luis , Portolés Manuel , Tarazón Estefanía , Roselló-Lletí Esther
Published: August 2022

Background.

Given the central role of sarcomeric dysfunction in cardiomyocyte biology and sarcomere alterations described in endomyocardial biopsies of transplant patients with rejection, we hypothesized that the serum expression levels of genes encoding sarcomeric proteins were altered in acute cellular rejection (ACR). The aim of this study is to identify altered sarcomere-related molecules in serum and to evaluate their diagnostic accuracy for detecting rejection episodes.

Methods.

Serum samples from transplant recipients undergoing routine endomyocardial biopsies were included in an RNA sequencing analysis (n = 40). Protein concentrations of alpha-cardiac actin were determined using a specific enzyme-linked immunoassay (n = 80).

Results.

We identified 17 sarcomeric genes differentially expressed in patients with clinically relevant rejection (grade ≥2R ACR). A receiver operating characteristic curve was done to assess their accuracy for ACR detection and found that 6 relevant actins, myosins, and other sarcomere-related genes showed great diagnostic capacity with an area under the curve (AUC) > 0.800. Specifically, the gene encoding alpha-cardiac actin (ACTC1) showed the best results (AUC = 1.000, P < 0.0001). We determine ACTC1 protein levels in a larger patient cohort, corroborating its overexpression and obtaining a significant diagnostic capacity for clinically relevant rejection (AUC = 0.702, P < 0.05).

Conclusions.

Sarcomeric alterations are reflected in peripheral blood of patients with allograft rejection. Because of their precision to detect ACR, we propose sarcomere ACTC1 serum expression levels as potential candidate for to be included in the development of molecular panel testing for noninvasive ACR detection.
Chronic Active Antibody-mediated Rejection in Kidney Transplant Recipients: Treatment Response Rates and Value of Early Surveillance Biopsies
Authors: Aziz Fahad , Parajuli Sandesh , Jorgenson Margaret , Garg Neetika , Manchala Venkata , Yousif Elsadiq , Mandelbrot Didier , Hidalgo Luis , Mohamed Maha , Zhong Weixiong , Djamali Arjang
Published: August 2022

Background.

There is limited information on the value of short-term invasive and noninvasive monitoring in kidney transplant recipients (KTR) undergoing therapy for chronic active antibody-mediated rejection (cAMR).

Methods.

We describe response rates in patients with cAMR receiving pulse steroids/IVIG ± rituximab 3-mo after index biopsy.

Results.

The study included 82 consecutive KTR. Mean time from transplant to cAMR was 10 y. Mean peritubular capillaritis (ptc), glomerulitis (g), microvascular inflammation (MVI), C4d, and cg Banff scores were 1.1, 2.1, 3.2, 0.2, and 2, respectively. Mean estimated glomerular filtration rate (eGFR) and urine protein creatinine (UPC) ratio were 38 mL/min and 1.6 g/g, respectively. Thirty (37%) patients lost their allograft during the mean follow-up of 2.4 y. In patients treated with pulse steroids/IVIG (n = 41), response rates for eGFR, UPC, donor-specific antibodies (DSAs), and MVI were 27%, 49%, 7%, and 19%, respectively. In the pulse steroids/IVIG/rituximab group, response rates were 66%, 61%, 20%, and 69%, respectively. Univariate analysis identified response in eGFR (HR = 0.03; P = 0.001; 95% CI, 0.004-0.26), UPC (HR = 0.38; P = 0.01; 95% CI, 0.18-0.82), and DSA (HR = 0.11; P = 0.004; 95% CI, 0.02-0.49) as predictors of graft survival. Multivariate analysis only retained eGFR response (HR = 0.12; P = 0.01; 95% CI, 0.02-0.64).

Conclusions.

In cAMR, short-term response to treatment for kidney function and DSA was associated with graft survival, but the role of early surveillance biopsies needs further evaluation.
Challenges in the Management of Kidney Allograft Herniation With a Single-stage Pedicled Anterolateral Thigh Flap
Authors: Bevilacqua Ruggero , Tee Richard , Rodriguez-Lorenzo Andres , Lorant Tomas , Jørgensen Pål F.
Published: August 2022

Wound complications are the most common surgical complication after kidney allograft transplantation. Total wound rupture exposing the entire kidney is a rare and not well-described event. We present a successful treatment of this complication in a patient admitted to our unit. A single-stage procedure was performed combining debridement and reconstruction with a pedicled anterolateral thigh flap and an iliotibial band transferring. A short literature review is performed comparing the different treatment strategies and results.
Oculopharyngodistal myopathy
Authors: Yu Jiaxi , Deng Jianwen , Wang Zhaoxia
Published: August 2022

Purpose of review

Oculopharyngodistal myopathy (OPDM) is a rare adolescent or adult-onset neuromuscular disease that is characterized by progressive ocular, facial, pharyngeal and distal limb muscle weakness. The rimmed vacuoles and intranuclear inclusions in myofibers constitute the pathological hallmark of OPDM. In this review, the latest findings related to the genetic, molecular and clinical features of OPDM, as well as the diagnosis and management are summarized.

Recent findings

Four gene mutations, CGG repeats in the 5’-untranslated region of LRP12, GIPC1, NOTCH2NLC and RILPL1 have been reported to be disease-causing genes in OPDM, namely OPDM1, OPDM2, OPDM3 and OPDM4, accordingly. So far, limited studies have suggested that CGG repeat expansion within the pathogenic range may play a key role in the pathogenesis of OPDM with the gain-of-function mechanism at the RNA and/or protein level, while repeat expansion over a threshold limit may cause hypermethylation, leading to the transcriptional silencing of the CGG repeats in the expanded allele, which results in the existence of mild phenotype or asymptomatic carriers.

Novel gene mutations, possible molecular mechanisms and the clinical features related to different causative genes are discussed in this review. More studies on the exact pathogenic mechanism are needed.
Progress in spinal muscular atrophy research
Authors: Wurster Claudia , Petri Susanne
Published: August 2022

Purpose of review

The development of new therapies has brought spinal muscular atrophy (SMA) into the spotlight. However, this was preceded by a long journey – from the first clinical description to the discovery of the genetic cause to molecular mechanisms of RNA and DNA technology.

Recent findings

Since 2016, the antisense oligonucleotide nusinersen has been (FDA) approved for the treatment of SMA, followed by the gene replacement therapy onasemnogene abeparvovec-xioi in 2019 and the small-molecule risdiplam in 2020. These drugs, all targeting upregulation of the SMN protein not only showed remarkable effects in clinical trials but also in real-world settings. SMA has been implemented in newborn screening in many countries around the world. SMN-independent strategies targeting skeletal muscle, for example, may play another therapeutic approach in the future.

This review aims to summarize the major clinical and basic science achievements in the field of SMA.
A Plagiarism Paperdemic - Plagiarism in infection journals in the era of COVID-19
Authors: Menshawey Rahma , Menshawey Esraa , Mitkees Ahmed , Mahamud Bilal A.
Published: August 2022

Background

The COVID-19 pandemic has caused drastic changes in the publishing framework in order to quickly review and publish vital information during this public health emergency. The quality of the academic work being published may have been compromised. One area of concern is plagiarism, where the work of others is directly copied and represented as one’s own. The purpose of this study is to determine the presence of plagiarism in infection journals in papers relating to the COVID-19 pandemic.

Methods

Consecutively occurring original research or reviews relating to the COVID-19 pandemic, published in infection journals as ranked by SCOPUS Journal finder were collected. Each manuscript was optimized and uploaded to the Turnitin program. Similarity reports were then manually checked for true plagiarism within the text, where any sentence with more than 80% copying was deemed plagiarised.

Results

A total of 310 papers were analyzed in this cross-sectional study. Papers from a total of 23 journals among 4 quartiles were examined. Of the papers we examined, 41.6% were deemed plagiarised (n=129). Among the plagiarised papers, the average number of copied sentences was 5.42±9.18. The highest recorded similarity report was 60%, and the highest number of copied sentences was 85. Plagiarism was higher in papers published in the year 2020. The most problematic area in the manuscripts was the discussion section. Self plagiarism was identified in 31 papers. Average time to judge all manuscripts was 2.45±3.09. Among all the plagiarized papers 72% belonged to papers where the similarity report was ≤15% (n=93). Papers published from core anglosphere speaking countries were not associated with higher rates of plagiarism. No significant differences were found with regards to plagiarism events among the quartiles.

Conclusion

Plagiarism is prevalent in COVID19 related publications in infection journals among various quartiles. It is not enough to rely only on similarity reports. Such reports must be accompanied by manual curation of the results with an appropriate threshold to be able to appropriately determine if plagiarism is occurring. The majority of plagiarism is occurring in reports of less than 15% similarity, and this is a blind spot. Incorporating a manual judge could save future time in avoiding retractions and improving the quality of papers in these journals.

“A poor original is better than a good imitation.”

— Ella Wheeler Wilcox
Broad immunity to SARS-CoV-2 variants of concern mediated by a SARS-CoV-2 receptor-binding domain protein vaccine
Authors: Deliyannis Georgia , Gherardin Nicholas A. , Wong Chinn Yi , Grimley Samantha L. , Cooney James P. , Redmond Samuel , Ellenberg Paula , Davidson Kathryn , Mordant Francesca L. , Smith Tim , Gillard Marianne , Lopez Ester , McAuley Julie , Tan Chee Wah , Wang Jing , Zeng Weiguang , Littlejohn Mason , Zhou Runhong , Chan Jasper Fuk-Woo , Chen Zhi-wei , Hartwig Airn E. , Bowen Richard , Mackenzie Jason M. , Vincan Elizabeth , Torresi Joseph , Kedzierska Katherine , Pouton Colin W. , Gordon Tom , Wang Lin-fa , Kent Stephen J. , Wheatley Adam K. , Lewin Sharon R. , Subbarao Kanta , Chung Amy , Pellegrini Marc , Munro Trent , Nolan Terry , Rockman Steven , Jackson David C. , Purcell Damian F.J. , Godfrey Dale I.
Published: August 2022

The SARS-CoV-2 global pandemic has fuelled the generation of vaccines at an unprecedented pace and scale. However, many challenges remain, including: the emergence of vaccine-resistant mutant viruses, vaccine stability during storage and transport, waning vaccine-induced immunity, and concerns about infrequent adverse events associated with existing vaccines. Here, we report on a protein subunit vaccine comprising the receptor-binding domain (RBD) of the ancestral SARS-CoV-2 spike protein, dimerised with an immunoglobulin IgG1 Fc domain. These were tested in conjunction with three different adjuvants: a TLR2 agonist R4-Pam2Cys, an NKT cell agonist glycolipid α-Galactosylceramide, or MF59® squalene oil-in-water adjuvant. Each formulation drove strong neutralising antibody (nAb) responses and provided durable and highly protective immunity against lower and upper airway infection in mouse models of COVID-19. We have also developed an RBD-human IgG1 Fc vaccine with an RBD sequence of the highly immuno-evasive beta variant (N501Y, E484K, K417N). This ‘beta variant’ RBD vaccine, combined with MF59® adjuvant, induced strong protection in mice against the beta strain as well as the ancestral strain. Furthermore, when used as a third dose booster vaccine following priming with whole spike vaccine, anti-sera from beta-RBD-Fc immunised mice increased titres of nAb against other variants including alpha, delta, delta+, gamma, lambda, mu, and omicron BA.1 and BA.2. These results demonstrated that an RBD-Fc protein subunit/MF59® adjuvanted vaccine can induce high levels of broad nAbs, including when used as a booster following prior immunisation of mice with whole ancestral-strain Spike vaccines. This vaccine platform offers a potential approach to augment some of the currently approved vaccines in the face of emerging variants of concern, and it has now entered a phase I clinical trial.