bluuebunny/crossref_metadata_2025 huggingface dataset:
Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury: A 2-Year Prospective Study
Authors: Kara Stephen , Crosswell Hannah , Forch Katherine , Cavadino Alana , McGeown Josh , Fulcher Mark
Published: April 2020

Objective:

To describe clinical recovery time and factors that might impact on recovery after a sports-related mild traumatic brain injury (SR-mTBI; concussion).

Design:

Prospective cohort study (level IV evidence).

Setting:

New Zealand Sports Concussion Clinic.

Participants:

Eight hundred twenty-two patients presenting within 14 days of a SR-mTBI/concussion over a 2-year period.

Main Outcome Measures:

Clinical recovery measured as number of days after injury.

Interventions Methods:

Participants were assessed and managed using a standardized protocol consisting of relative rest followed by controlled cognitive and physical loading. A reassessment was performed 14 days after injury with initiation of an active rehabilitation program consisting of a subsymptom threshold exercise program ± cervicovestibular rehabilitation (if required) for participants who remained symptomatic. Participants were then assessed every 2 weeks until clinical recovery.

Results:

A total of 594 participants were eligible for analysis (mean age 20.2 ± 8.7 years, 77% males) and were grouped into 3 age cohorts: children (≤12 years), adolescents (13-18 years), and adults (≥19 years). Forty-five percent of participants showed clinical recovery within 14 days of injury, 77% by 4 weeks after injury, and 96% by 8 weeks after injury. There was no significant difference in recovery time between age groups. Prolonged recovery was more common in females (P= 0.001), participants with “concussion modifiers” (P= 0.001), and with increased time between injury and the initial appointment (P= 0.003).

Conclusions:

This study challenges current perceptions that most people with a SR-mTBI (concussion) recover within 10 to 14 days and that age is a determinant of recovery rate. Active rehabilitation results in high recovery rates after SR-mTBI.
Surgical Labyrinthectomy and Cochlear Implantation in Menière's Disease
Authors: Sykopetrites Vittoria , Giannuzzi Anna Lisa , Lauda Lorenzo , Di Rubbo Vittoria , Bassi Margherita , Sanna Mario
Published: April 2020

Objective:

The aim of this study was to analyze the results of labyrinthectomy and cochlear implantation (CI) on hearing, vertigo, and tinnitus and evaluate the adequacy of labyrinthectomy and CI for the treatment of end stage Menière's Disease (MD).

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Charts of 22 patients undergoing labyrinthectomy and CI in the same ear for intractable vertigo and hearing loss with both preoperatory and postoperatory documentation available, were reviewed.

Intervention(s):

Therapeutic.

Main Outcome Measure(s):

Auditory outcomes were assessed with pure tone and speech audiometry, and compared with the preoperatory audiometric evaluation. Dizziness was graded according to the Dizziness Handicap Inventory Questionnaire (DHI). Tinnitus outcomes were assessed by the tinnitus handicap inventory (THI).

Results:

Post-CI pure tone average had a statistically significant improvement (p = 0.035, pairedttest). Speech audiometry resulted in a non-statistically significant speech discrimination score variation (p = 0.056, pairedttest). Postoperatory THI had a statistically significant variation (p = 0.0001, pairedttest). Sixty seven per cent of the patients had complete resolution of the vestibular symptoms in their operated ear, however, patients over 70 years old had significantly more failures as evinced by the postoperative DHI (p = 0.0109, Fisher's exact test).

Conclusions:

Patients affected by end stage MD or secondary MD, with vertigo and severe hearing loss can successfully undergo labyrinthectomy and CI. Caution should be reserved in elderly patients for a risk of persistent instability. The CI confers significant benefit in hearing rehabilitation and tinnitus suppression.
The Use of a Novel, Nonsurgical Bone Conduction Hearing Aid System for the Treatment of Conductive Hearing Loss
Authors: Kuthubutheen Jafri , Broadbent Chris , Marino Roberta , Távora-Vieira Dayse
Published: April 2020

Objective:

Conventional bone conduction hearing aid solutions often require a cumbersome retention system such as a headband or cap. This study aims to determine if a novel, nonsurgical bone conduction aid utilizing an adhesive attachment over the mastoid is equivalent to the conventional bone conduction hearing aid (BCHA) for the management of conductive hearing loss.

Study Design:

Prospective, single-subject randomized, crossover trial.

Setting:

Tertiary referral center.

Patients:

Eleven adults and 1 child between 11 and 70 years of age with unilateral conductive hearing loss were enrolled.

Intervention:

Patients had their baseline hearing assessed and were randomized to receive either the novel device or BCHA headband system. Hearing loss etiologies were varied and included cholesteatoma, otosclerosis, chronic otitis media, and previous head and neck surgery. Patients had their baseline hearing assessed and trialled both the novel device or the BCHA headband system. Patients were randomly assigned one device which was worn for 2 weeks followed by a 2-week trial with the alternate device.

Main Outcome Measure:

Pure-tone thresholds and speech discrimination in quiet and noise were tested and patients also completed the short form of the Speech Spatial and Quality of Hearing (SSQ) questionnaire.

Results:

The mean unaided 4 frequency pure-tone average (PTA) air conduction threshold was 53.9 dB, bone conduction was 11.9 dB, and the mean air bone gap was 42 dB in the target ear. One patient with an adhesive skin reaction could not complete the protocol. Aided PTA and threshold testing between 250 Hz to 8000 Hz showed statistically equivalent results between both devices. The aided CNC word score, signal-to-noise ratio, and SSQ scores were also equivalent between both devices.

Conclusion:

The novel bone conduction aid demonstrates equivalent performance to the conventional BCHA headband solution. The novel device should be considered an alternative option where the cosmetic and comfort issues of a headband worn device are a concern.
Pyostomatitis vegetans in a pediatric patient with ulcerative colitis: case report of a rare pediatric inflammatory bowel disease extraintestinal manifestation and review of the literature
Authors: Bardasi Giulia , Romagnoli Andrea , Foschini Maria P. , Mantovani Alessio , Alvisi Patrizia
Published: April 2020

Inflammatory bowel diseases can occur with a wide range of extraintestinal symptoms, among which pyostomatitis vegetans, that is a rare but almost pathognomonic finding. We report the case of a 9-year-old female patient affected by ulcerative colitis and recently treated for an oral candidiasis, who experienced a relapse in her ulcerative colitis (PUCAI 50), preceded by the return of whitish lesions in the oral cavity, initially misdiagnosed and unsuccessfully treated as candidiasis and then recognized as pyostomatitis vegetans. Bloody diarrhea was treated with oral beclomethasone, with rapid remission of ulcerative colitis and disappearance of pyostomatitis vegetans. After 2 years, ulcerative colitis is in sustained remission with oral mesalamine and pyostomatitis vegetans has not recurred. Pyostomatitis vegetans is considered a marker of ulcerative colitis relapse among adult population, and although very few pediatric cases are described, it is very important to remember it in the differential diagnosis of the oral manifestations and comorbidities of inflammatory bowel diseases.
Enhancing patient adherence to fecal microbiota transplantation maintains the long-term clinical effects in ulcerative colitis
Authors: Li Qianqian , Zhang Ting , Ding Xiao , Xiang Liyuan , Cui Bota , Buch Heena , Zhang Faming
Published: April 2020

Objectives

The way to improve the long-term efficacy of fecal microbiota transplantation (FMT) in ulcerative colitis (UC) remains unclear. This study mainly dedicated to the UC patients’ satisfaction with FMT and the importance of patients’ adherence to repeated FMT for long-term clinical outcomes.

Methods

Patients with UC who underwent FMT at our center from November 2012 to September 2018 were included. We assessed patient satisfaction with efficacy, safety, and reliability of FMT, as well as adherence to the repeated FMT.

Results

One hundred and seventy-six patients were included in the analysis. The median follow-up duration of the study was 25.5 (interquartile range 13.0–46.5) months. The clinical response rate at 1 week, 1 month, 3 months, and 6 months after FMT was 48.9%, 69.3%, 49.4%, and 32.7%, respectively. 3.4% (6/176) of patients underwent colectomy after FMT during our long-term follow-up. Partial Mayo score at 1-month post-FMT (P < 0.001) was an independent factor of patients’ satisfaction. The laboratory preparation process was related to the incidence of adverse events (P < 0.05). 23.8% (29/122) of patients with a good adherence followed our recommendation to undergo the second course of FMT and achieved a longer clinical response compared with the patients with poor adherence (P < 0.001).

Conclusion

Patients’ good adherence to repeated FMT is important to maintain long-term clinical benefits achieved from FMT in UC. Registration number: NCT01790061.
Clinical phenotype and mortality in patients with idiopathic small bowel villous atrophy: a dual-centre international study
Authors: Schiepatti Annalisa , Sanders David S. , Aziz Imran , De Silvestri Annalisa , Goodwin John , Key Tim , Quaye Lydia , Giuffrida Paolo , Vanoli Alessandro , Paulli Marco , Cross Simon S. , Vergani Patricia , Betti Elena , Maiorano Gregorio , Ellis Richard , Snowden John A. , Di Sabatino Antonio , Corazza Gino R. , Biagi Federico
Published: April 2020

Objective

Causes of small-bowel villous atrophy (VA) include coeliac disease (CD), its complications and other rare non-coeliac enteropathies. However, forms of VA of unknown aetiology may also exist. We defined them as idiopathic VA (IVA). To retrospectively classify the largest cohort of IVA patients and compare their natural history with CD.

Methods

Notes of 76 IVA patients attending two tertiary centres between January 2000 and March 2019 were retrospectively reviewed. CD, its complications and all the known causes of VA were excluded in all of them. Persistence of VA during follow-up and lymphoproliferative features were used to retrospectively classify IVA, as follows. Group 1: IVA with spontaneous histological recovery (50 patients). Group 2: persistent IVA without lymphoproliferative features (14 patients). Group 3: persistent IVA with lymphoproliferative features (12 patients). Survival was compared between IVA groups and 1114 coeliac patients. HLA was compared between IVA patients, coeliac patients and appropriate controls.

Results

Five-year survival was 96% in IVA group 1, 100% in IVA group 2, 27% in IVA group 3 and 97% in CD. On a multivariate analysis hypoalbuminemia (P = 0.002) and age at diagnosis (P = 0.04) predicted mortality in IVA. Group 2 showed association with HLA DQB1*0301 and DQB1*06.

Conclusion

IVA consists of three groups of enteropathies with distinct clinical phenotypes and prognoses. Mortality in IVA is higher than in CD and mainly due to lymphoproliferative conditions necessitating more aggressive therapies.
Acoustic radiation force impulse imaging of pancreas in patients with early onset idiopathic recurrent acute pancreatitis
Authors: Sanjeevi Rajesh , John Reetu Amrita , Kurien Reuben Thomas , Dutta Amit Kumar , Simon Ebby George , David Deepu , Joseph Anjilivelil Joseph , Chowdhury Sudipta Dhar
Published: April 2020

Background and aims:

Patients with recurrent acute pancreatitis (RAP) may progress to chronic pancreatitis (CP). A critical step in this progression is the development of fibrosis. Elastography has been used to assess degree of fibrosis by measurement of shear wave velocity (SWV). The aim of this study was to measure the stiffness of pancreas as a surrogate for pancreatic fibrosis in patients with RAP and compare it with a group of individuals without any history of pancreatic disorders.

Material and methods:

Using acoustic radiation force impulse (ARFI) imaging SWV was calculated in 31 patients with idiopathic RAP having disease onset ≤30 years. A control group of 31 individuals with no history pancreatic disorder and no features of CP on endosonography was selected for comparison. ARFI imaging was done by a single radiologist who was blinded to the cases and controls

Results:

Mean age of patients with RAP was 24.8 (SD 9.86) years, disease duration was 3.45 (interquartile range 1–5) years, mean number of episodes 4.9 (SD 2.72). There was a significant difference in SWV between patients (1.27 ± 0.50 m/s) and controls (1.00 ± 0.17 m/s) (P = 0.001)). There was a positive correlation between SWV and number of pain episodes (P = 0.026) and negative correlation with BMI (P = 0.002).

Conclusion:

SWV was high in patients with RAP indicating a stiff pancreas. The stiffness increases with the number of episodes of pancreatitis.
Absence of hepatic activity in lymphoscintigraphy performed with Tc-99m-Nanoscan
Authors: Syed Adeel , Levart Danielle , Vadrucci Manuela , Gibson Victoria , Peters A. Michael
Published: April 2020

Introduction

For assessment of lower extremity swelling using lymphoscintigraphy, several nuclear medicine departments in the UK have recently switched from 99mTc-Nanocoll to 99mTc-Nanoscan. The aim of the study was to compare quantitative and semiquantitative features of lymphoscintigraphy between these two tracers.

Methods

Twenty patients received 99mTc-Nanocoll and 20 received 99mTc-Nanoscan either side of the switch-over in our department. Tracers were compared with respect to visualisation of the liver, para-aortic lymph nodes and urine (all graded by consensus from 0 to 3; invisible-to-very prominent); and with respect to ilio-inguinal nodal quantification and ratio of liver-to-summed bilateral ilio-inguinal nodal activity at 120 min postinjection (L/N120). Scans were deemed abnormal when there was lymph diversion through skin or deep system, no activity in ilio-inguinal nodes at 60 min or negligible ilio-inguinal activity (<5%, left plus right) at 120 min.

Results

Liver was visualised in 18/20 99mTc-Nanocoll but only 3/20 99mTc-Nanoscan scans. Moreover, para-aortic activity was less prominent after 99mTc-Nanoscan. Urinary activity was more prominent after 99mTc-Nanocoll. There were 9/20 patients with stomach activity after 99mTc-Nanocoll compared with 1/20 after 99mTc-Nanoscan. Urinary and stomach activities correlated. There was an elevated L/N120, and therefore a suspicion of peripheral lympho-venous communication, in the single 99mTc-Nanoscan patient who displayed prominent hepatic activity.

Conclusion

Hepatic activity is the result of accumulation of colloidal degradation products generated in lymph nodes, rather than intact colloid. 99mTc-Nanoscan gives less hepatic activity than 99mTc-Nanocoll because it is more resistant to intranodal degradation. Peripheral lymphovenous communication remains a possible alternative route for activity to reach the liver.
Red cell volume measurement – using indium as a replacement for chromium
Authors: Ainslie-McLaren Gillian , Fee Angela , McKinstray June , Lee Alison B. , Bolster Alison A.
Published: April 2020

The withdrawal of 51Cr-chromate has meant that the technique commonly used for direct measurement of red cell volume has had to be replaced. Most centres moved to a 99mTc erythrocyte label, however, 99mTc is known to dissociate over time. We have investigated an alternative technique using an 111In-chloride and tropolone solution and tested this both in vitro and in vivo. Initial in-vitro and in-vivo work, which included a check of the stability of the radio-labelled product at one hour, demonstrated this label to be stable over this time period. To date, 20 patients have undergone this technique and results show that this technique is a viable alternative to 51Cr-chromate particularly for patients with splenomegaly who require late sampling. This procedure is now in routine use in our institution.
Diagnostic classification of solitary pulmonary nodules using support vector machine model based on 2-[18F]fluoro-2-deoxy-D-glucose PET/computed tomography texture features
Authors: Zhang Jianping , Ma Guang , Cheng Jingyi , Song Shaoli , Zhang Yingjian , Shi L. Q.
Published: April 2020

Purpose

This study aimed to evaluate the diagnostic value of a support vector machine (SVM) model built with texture features based on standard 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) PET in patients with solitary pulmonary nodules (SPNs) at a volume larger than 5 mL.

Patients and methods

The PET results of 82 patients diagnosed with SPNs between 2014 and 2018 were retrospectively analysed. The volumes of interest (VOIs) of the SPNs were automatically segmented using threshold techniques from the standard PET imaging. Then, a large number of texture features were extracted from the VOIs using texture-analysis software. Next, an optimized SVM machine-learning model that was trained on standard PET images using texture features was employed to identify the optimal discrimination between malignant and benign nodules. Diagnostic models based on the maximum standardized uptake value (SUVmax) and the metabolic tumour volume (MTV) were compared with the SVM model with regard to the SPN diagnostic power.

Results

Compared with the SUVmax and MTV models, the texture-based SVM model provided an improvement of approximately 20% in diagnostic accuracy, positive predictive value, negative predictive value and the area under the operating characteristic curve. The receiver operating characteristic curve of the SVM model showed a significant improvement compared with the MTV model (P = 0.0345 < 0.05) and the SUVmax model (P = 0.01 < 0.05).

Conclusions

Standard 18F-FDG PET imaging can increase the differentiation of benign and malignant SPNs with volumes larger than 5 mL using an SVM model based on texture features.
Varieties of Religious (Non)Affiliation
Authors: Saunders David , Norko Michael , Fallon Brian , Phillips James , Nields Jenifer , Majeed Salman , Merlino Joseph , El-Gabalawi Fayez
Published: April 2020

Given changing demographics of religiosity and spirituality, this article aims to help clinicians understand contemporary trends in patient religious and spiritual orientation. It first identifies and describes the evolving varieties of religio-spiritual orientation and affiliation, as identified in survey studies. Particular attention is given to the examination of those who identify as spiritual but not religious (SBNR) and None (i.e., no religious affiliation), which is important to mental health practice because many patients now identify as SBNR or None. Next, empirical data are considered, including what the literature reveals regarding mental health outcomes and SBNRs and Nones. We conclude with a summary of the main points and five recommendations that mental health practitioners and researchers need to consider regarding this increasingly large portion of the population.
Trauma and Suicide
Authors: Allen Adrienne Reid , Hagen Kathryn M.
Published: April 2020

This pilot study explored suicide risk in patients suffering from trauma and psychosis. Forty-seven participants diagnosed with schizophrenia spectrum disorders participated in the study. An archival design was used to identify the severity of suicide risk in participants with trauma and psychosis. Data included a chart review of documented trauma and responses to the Childhood Experience of Care and Abuse Questionnaire, Columbia–Suicide Severity Rating Scale, Beck Depression Inventory-II, and the Positive and Negative Syndrome Scale. Results of a linear regression indicated that chart-documented trauma and heightened depression scores were predictive of increased suicidality. Results suggest that, for patients with schizophrenia, depression severity and chart-documented trauma may be strong predictors of suicidality. Interestingly, data also revealed that, although depression and trauma were predictors of suicidality, psychosis was not. The implications of these results are discussed, in addition to suggestions for future research.
Prostatic Metaplasia of the Vagina and Uterine Cervix
Authors: Anderson William J. , Kolin David L. , Neville Grace , Diamond David A. , Crum Christopher P. , Hirsch Michelle S. , Vargas Sara O.
Published: April 2020

Prostatic-type differentiation in the lower female genital tract is encountered rarely and its causes and clinical associations are not well established. Within the vagina, reports to date have invariably described ectopic prostatic-type differentiation as restricted to the lamina propria. We recently encountered a patient receiving testosterone for gender dysphoria whose vaginectomy specimen showed a prostatic glandular proliferation within the surface epithelium. To elucidate its potential association with androgen exposure, we sought similar lesions, resected over a 26-year period, from patients with exogenous or endogenous androgen excess. Thirteen cases were identified, involving the vagina (n=12) and exocervix (n=1). The most common clinical context was gender dysphoria with long-term testosterone therapy; the lesion was present in 7 of 8 gender-dysphoric patients examined. Four other patients had congenital disorders of sexual development associated with endogenous androgen excess (congenital adrenal hyperplasia, 46,XY disorder of sexual development, and ovotesticular disorder of sexual development). Two had no known exposure to androgen excess. Immunohistochemically, glands stained for NKX3.1 (100% of cases), androgen receptor (100%), CK7 (92%), and prostate-specific antigen (69%). Follow-up (median duration, 11 mo) showed no masses or neoplasia. We propose the designation “androgen-associated prostatic metaplasia” for this form of prostate tissue with distinctive clinical, histologic and immunohistochemical features. It is novel and previously unrecognized within the vagina. It is strikingly prevalent among patients undergoing gender-affirming surgery, an increasingly common procedure. Recognition is important to distinguish it from other potentially neoplastic glandular lesions and facilitate accrual of more follow-up data to better understand its natural history.
Rehabilitation After Critical Illness in People With COVID-19 Infection
Authors: Simpson Robert , Robinson Larry
Published: April 2020

The current COVID-19 pandemic will place enormous pressure on healthcare systems around the world. Large numbers of people are predicted to become critically ill with acute respiratory distress syndrome and will require management in intensive care units. High levels of physical, cognitive, and psychosocial impairments can be anticipated. Rehabilitation providers will serve as an important link in the continuum of care, helping move patients on from acute sites to eventual discharge to the community. Likely impairment patterns, considerations for healthcare practitioner resilience, and organization of services to meet demand are discussed. Innovative approaches to care, such as virtual rehabilitation, are likely to become common in this environment.
Impact of Latent Tuberculosis Infection on Neurocognitive Functioning and Inflammation in HIV-Infected and Uninfected South Indians
Authors: LaVergne Stephanie , Umlauf Anya , McCutchan Allen , Heaton Robert , Benson Constance , Kumarasamy Nagalingeswaran , Bharti Ajay R.
Published: April 2020

Background:

HIV-associated neurocognitive disorder persists in some people living with HIV despite optimal antiretroviral therapy. Latent tuberculosis infection (LTBI) may cause systemic inflammation and immune activation that may impair brain function. We assessed cognition and biomarkers of inflammation in both HIV+ and HIV− South Indians with and without LTBI.

Methods:

Adults (≥18 years old) with and without HIV infection were screened for LTBI by interferon-gamma release assays, completed comprehensive neurocognitive assessments, and underwent measurement of serum inflammatory biomarker levels.

Results:

The participants (n = 119) were HIV+/LTBI+ (n = 15), HIV+/LTBI− (n = 50), HIV−/LTBI+ (n = 26), and HIV−/LTBI− (n = 28). HIV+ participants, regardless of LTBI status, had more impaired global deficit scores than HIV− participants (odds ratio = 3.42, P = 0.028, adjusted for sex and education differences). Neither global deficit scores nor impairment rates differed in the LTBI+ group compared with the LTBI− group (P = 0.79 and P = 0.41, respectively). The mean log10 interleukin (IL)-6 and monocyte chemoattractant protein-1 values were significantly higher and high sensitivity C-reactive protein lower in the LTBI+ group than the LTBI− group (P = 0.044, 0.023, and 0.03, respectively, adjusting for HIV status and sex).

Conclusions:

In this cross-sectional study of South Indians, HIV infection, but not LTBI, was associated with increased neurocognitive impairment. Proinflammatory biomarkers (IL-6 and monocyte chemoattractant protein-1, but not tumor necrosis factor-α) were elevated in the LTBI+ groups compared with the LTBI− groups. Biomarkers of immune activation (interferon-γ, macrophage inflammatory protein-1β, IL-2, interferon gamma inducible protein-10, RANTES, and IL-22) did not differ between these groups. Larger longitudinal studies should be conducted to confirm our findings that the effect of LTBI on systemic inflammation or neurocognitive impairment is likely small.
Compounding Benefits of Sentinel Lymph Node Biopsy for Perineal Melanoma
Authors: Patel Ronak A. , Patel Priyanka D. , Ashack Kurt , Borrelli Mimi R. , Trickey Amber , Wan Derrick C.
Published: April 2020

Introduction

Sentinel lymph node biopsy (SLNB) in the treatment of melanoma is known to provide valuable prognostic information. However, there is no literature describing an overall or disease-specific survival (DDS) benefit of SLNB. In the perineum, melanoma is often more advanced at presentation with current treatment guidelines translated from nonanatomic specific melanoma. As a result, there is little understanding surrounding the role of SLNB in melanoma of the perineum. Our objective is to better understand the therapeutic benefits of SLNB in perineal melanoma.

Methods

The Surveillance, Epidemiology, and End Results program is a large population-based cancer registry including survival data from millions of patients in the United States. The registry was used to generate patient data for analysis from 2004 to 2016. Inclusion criteria included melanoma of the perineum; Breslow depth of 0.80 mm or greater and less than 0.80 mm with ulceration; SLNB or no intervention; clinically negative nodal disease; and available overall survival data.

Results

For 879 patients from 2004 to 2016 with perineal melanoma, significant predictors of reduced survival include older than 75 years, Clark level IV–V, Breslow depth of greater than 4.00 mm, positive ulceration status, regional and distant nodal micrometastases, and clinically positive nodes on presentation. Aggregates for overall survival (OS) and disease-specific survival (DSS) were improved with implementation of SLNB. The 5-year survival rates with SLNB versus no SLNB were 54.0% and 43.0% for OS (P = 0.001) and 57.8% and 53.1% for DSS (P = 0.044). Stratification by Breslow depth yielded significant OS and DSS advantage for greater than 1.00 to 2.00 mm (21.3% benefit, P =0.021, and 16.8% benefit, P = 0.044) and greater than 4.00 mm (30.3% benefit, P = 0.005, and 21.0% benefit, P = 0.007) Breslow depths.

Conclusions and Relevance

Sentinel lymph node biopsy may provide therapeutic benefits in addition to prognostic information for melanoma of the perineum through an increase in 5-year OS.
Incidence and Risk Factors for Postoperative Complications of Rectovaginal Fistula Repairs, Based on Different Surgical Routes
Authors: Chong Woojin , Liu Tracey , Bui Anthony
Published: April 2020

Objective

To investigate incidence and risk factors for postoperative complications after rectovaginal fistula (RVF) repairs, based on different surgical routes.

Methods

This retrospective cohort study utilized CPT codes to identify RVF repairs performed during 2005 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program database. Demographic/clinical characteristics were compared among different surgical routes. Logistic regression was performed to identify associations.

Results

Among 1398 RVF cases, 1391 were included for final analysis: 159 (11.4%) were performed transabdominally (group 1), 253 (18.2%) transperineally (group 2), and 979 (70.4%) transvaginally/transanally (group 3). Group 1 was older compared with groups 2 and 3 (58.72 ± 15.23 years vs 44.11 ± 13.51 years vs 46.23 ± 14.31 years, P < 0.0001). Race/ethnicity was comparable in all groups with non–Hispanic-White most common. Comparably, group 1 had higher preoperative comorbidities: hypertension requiring medication (P < 0.0001), chronic obstructive pulmonary disease (COPD) (P = 0.0347), preoperative infection (P = 0.002), functional dependence (P = 0.0001), and longer time between hospital admission to operation (P < 0.0001). Group 1 also had longer operating time (P < 0.0001); more American Society of Anesthesiologist ≥ 3 classification (P < 0.0001); and more likely inpatient status (P < 0.0001). The overall incidence of any postoperative complications was 13.2% (25.2%, group 1 vs 15.8%, group 2 vs 10.6%, group 3; P < 0.0001). The most common postoperative complications included unplanned readmission, postoperative superficial surgical site infection, and reoperation. The incidence of severe postoperative complications was 7.9% (17%, group 1 vs 7.1%, group 2 vs 6.6%, group 3, P < 0.0001): group 1 had highest rates of pulmonary embolism (P = 0.0004), deep venous thrombosis (P = 0.0453), bleeding requiring transfusion (P < 0.0001), stroke (P = 0.0207), unplanned reintubation (P = 0.0052), and death (P = 0.0004). Group 1 also had highest rates of minor postoperative complications like urinary tract infection (P = 0.0151), superficial surgical site infection (P = 0.0189), and pneumonia (P = 0.0103). In addition, group 1 had the greatest postoperative length of stay (P < 0.0001). In multivariate analysis, age (P = 0.0096), inpatient status at the time of surgery (P = 0.0004), and operating time >2 to 3 hours (P = 0.0023) were significant predictors of postoperative complications within 30 days after surgery.

Conclusions

The overall incidence of complications after RVF repairs+/−concomitant procedures was 13.2%. The overall incidence of severe complications was 7.9%. The abdominal approach had more postoperative complications but it was not an independent predictor of postoperative complications after RVF repair.
Prevalence and Treatment of Postpartum Stress Urinary Incontinence: A Systematic Review
Authors: Gonzales Alicia L. , Barnes K. Lauren , Qualls Clifford R. , Jeppson Peter C.
Published: April 2020

Objectives

Many women present for treatment of stress urinary incontinence (SUI) after childbirth. This systematic review describes the efficacy of treatment options for SUI initiated during the 12 months after delivery.

Methods

We conducted a systematic review to identify studies comparing treatment options for SUI initiated in the 12 months after parturition. We searched MEDLINE from inception to February 2019, using Medical Subject Heading terms related to pregnancy and urinary incontinence. Preintervention and postintervention populations were compared using analysis of variance with Fisher least significant difference method used to determine efficacy between groups. Grades for Recommendation, Assessment, Development and Evaluation system was used to categorize quality of evidence as high, moderate, low, or very low.

Results

We double screened 4548 abstracts, identifying 98 articles for full-text review. Seven studies met the eligibility criteria and were included. Compared with a control group, the 4 interventions identified outperformed the control group (P < 0.001) using Fisher (with effect sizes noted): (1) supervised pelvic floor physical therapy (0.76), (2) electrical stimulation (0.77), (3) home physical therapy (PT) (0.44), and (4) surgery (not applicable). Based on Grades for Recommendation, Assessment, Development and Evaluation assessment, there was moderate evidence to support PT and electrical stimulation, with insufficient evidence for surgery. There were no significant differences in parity, age, or body mass index via analysis of variance. The overall strength of evidence is poor for the treatment of postpartum SUI; more data are needed to fully evaluate other treatment options.

Conclusions

All identified interventions demonstrated greater improvement for postpartum SUI over no treatment. Supervised PT ± electrostimulation was the most effective nonsurgical intervention.
#Urogyn: What’s Trending on Instagram? A Cross-sectional Observational Study
Authors: Qin Lei Alexander , El-Neemany Diana , Winkler Harvey , Shalom Dara
Published: April 2020

Objective

The aim of the study was to identify the prevalence, authorship, and type of information pertaining to topics in urogynecology on Instagram via hashtag and content analysis.

Methods

A list of 20 hashtags consisting of common urogynecologic diagnoses, procedures, and lay terms was derived from the American Urogynecologic Society’s “Patient Fact Sheets.” The top 9 and most recent 30 posts for each hashtag were reviewed for authorship and content type. Content type was divided into the following categories: educational; tagged but unrelated posts; pertinent patient experiences; community building and outreach; advertisements; and humor. Searches were limited to English language posts.

Results

Our search yielded 561,133 posts. The 5 most popular hashtags were pelvic floor (30.6%, n = 171,855), interstitial cystitis (12.8%, n = 71,977), pelvic pain (10.0%, n = 56,505), incontinence (9.3%, n = 52,169), and prolapse (3.9%, n = 21,839). The authorship of the top 9 and most recent 30 posts (n = 537) were as follows: patients (34.6%, n = 186), allied health professionals (29.2%, n = 157), physicians (13.4%, n = 72), and other (22.7%, n = 122). Further authorship and content analysis revealed that allied health professionals authored the most informational posts (45.6%, n = 129) and patients authored the most unrelated (69.4%, n = 43), patient experience (81.7%, n = 125), community building (55.8%, n = 53), and humorous posts (38.5%, n = 10).

Conclusions

More than 500,000 posts related to urogynecology were identified on Instagram. Most posts were authored by patients and allied health professionals with a small contribution from physicians. Greater physician participation may increase the quantity of educational posts and offer a low-cost platform for networking and connecting with patients and other providers.
Financial Feasibility Analysis of a Culturally and Linguistically Competent Hispanic Kidney Transplant Program
Authors: Wang Andrew , Caicedo Juan Carlos , McNatt Gwen , Abecassis Michael , Gordon Elisa J.
Published: April 2020

Background.

In 2006, Northwestern Medicine implemented a culturally targeted and linguistically congruent Hispanic Kidney Transplant Program (HKTP). The HKTP has been associated with a reduction in Hispanic/Latino disparities in live donor kidney transplantation. This article assessed the financial feasibility of implementing the HKTP intervention at 2 other transplant centers.

Methods.

We examined the impact of the HKTP on staffing costs compared with the total transplant center costs using data from monthly time studies conducted among transplant staff involved in the HKTP. Time studies were conducted during the HKTP preimplementation (2016) and implementation (2017) phases. Labor costs were estimated using data from the time studies and mean salaries from the Department of Labor. We retrospectively examined kidney acquisition and transplant costs at both centers in 2016 and 2017 using data from the Medicare cost reports.

Results.

During preimplementation, center A staff (n = 21) committed 764 hours ($44 607), and center B staff (n = 15) committed 800 hours ($45 193) to establish the HKTP. During implementation, center A staff (n = 19) committed 1125 hours ($55 594), and center B staff (n = 24) committed 1396 hours ($64 170), in delivering the HKTP. Overall, the total costs from the staffing time involved in the HKTP encompassed <1.0% per year (2016 and 2017) of each center’s annual total costs.

Conclusions.

Our findings suggest the financial feasibility of implementing the HKTP and present a potential business case for the HKTP’s implementation at other transplant centers to reduce health disparities in live donor kidney transplantation.
Immuno-informatics Characterization SARS-CoV-2 Spike Glycoprotein for Prioritization of Epitope based Multivalent Peptide Vaccine
Authors: Ismail Saba , Ahmad Sajjad , Azam Syed Sikander
Published: April 2020

The COVID-19 pandemic caused by SARS-CoV-2 is a public-health emergency of international concern and thus calling for the development of safe and effective therapeutics and prophylactics particularly a vaccine to protect against the infection. SARS-CoV-2 spike glycoprotein is an attractive candidate for vaccine, antibodies and inhibitor development because of many roles it plays in attachment, fusion and entry into the host cell. In this study, we characterized the SARS-CoV-2 spike glycoprotein by immune-informatics techniques to put forward potential B and T cell epitopes, followed by the use of epitopes in construction of a multi-epitope peptide vaccine construct (MEPVC). The MEPVC revealed robust host immune system simulation with high production of immunoglobulins, cytokines and interleukins. Stable conformation of the MEPVC with a representative innate immune TLR3 receptor was observed involving strong hydrophobic and hydrophilic chemical interactions, along with enhanced contribution from salt-bridges towards inter-molecular stability. Molecular dynamics simulation in solution aided further in interpreting strong affinity of the MEPVC for TLR3. This stability is the attribute of several vital residues from both TLR3 and MEPVC as shown by radial distribution function (RDF) and a novel analytical tool axial frequency distribution (AFD). Comprehensive binding free energies estimation was provided at the end that concluded major domination by electrostatic and minor from van der Waals. Summing all, the designed MEPVC has tremendous potential of providing protective immunity against COVID-19 and thus has the potential to be considered in experimental studies.
Healing Tissues From the Inside Out: Infusible Biomaterial for Targeting and Treating Inflammatory Tissues via Intravascular Administration
Authors: Spang Martin T. , Middleton Ryan , Diaz Miranda , Wang Raymond , Hunter Jervaughn , Mesfin Joshua , Lazerson Tori S. , Bhatia Saumya , Corbitt James , D’Elia Gavin , Sandoval-Gomez Gerardo , Kandell Rebecca , Kato Takayuki , Igata Sachiyo , Luo Colin , Osborn Kent G. , Cabrales Pedro , Kwon Ester , Contijoch Francisco , Reeves Ryan R. , DeMaria Anthony N. , Christman Karen L.
Published: April 2020

Biomaterials, such as extracellular matrix (ECM) hydrogels, have been widely used in preclinical studies as injectable tissue engineering therapies; however, injectable therapies are limited as they can cause localized trauma or organ perforation. We have developed a new ECM therapy, the low molecular weight fraction derived from decellularized, digested ECM, for intravascular infusion. This new form of ECM can be infused after injury, specifically localize to injured tissues by coating the leaky microvasculature, and promote cell survival and tissue repair. In this study, we show the feasibility and targeting of intravascular ECM infusions using models of acute myocardial infarction (MI), traumatic brain injury, and pulmonary arterial hypertension. Furthermore, safety and efficacy were demonstrated in small and large animal models of acute MI following intracoronary infusion, which included using a clinically-relevant catheter in the large animal model. Functional improvements, specifically reduced left ventricular volumes and improved wall motion scores were observed after ECM infusions post-MI. Genes related to tissue repair and inflammation were differential expressed in response to ECM infusions. This study shows proof-of-concept for a new paradigm of delivering pro-healing ECM biomaterials via intravascular infusion to heal tissue from the inside out.
A platform for brain-wide functional ultrasound imaging and analysis of circuit dynamics in behaving mice
Authors: Brunner Clément , Grillet Micheline , Sans-Dublanc Arnau , Farrow Karl , Lambert Théo , Macé Emilie , Montaldo Gabriel , Urban Alan
Published: April 2020

Imaging of large-scale circuit dynamics is crucial to gain a better understanding of brain function, but most techniques have a limited depth of field. Here we describe vfUSI, a platform for brain-wide volumetric functional ultrasound imaging of hemodynamic activity in awake head-fixed mice. We combined high-frequency 1024-channel 2D-array transducer with advanced multiplexing and high-performance computing for real-time 3D Power Doppler imaging at high spatiotemporal resolution (220×280×175-μm3voxel size, up to 6 Hz). In addition, we developed a standardized software pipeline for registration and segmentation based on the Allen Mouse Common Coordinate Framework, allowing for temporal analysis in 268 individual brain regions. We demonstrate the high sensitivity of vfUSI in multiple experimental situations where stimulus-evoked activity can be recorded using a minimal number of trials. We also mapped neural circuitsin vivoacross the whole brain during optogenetic activation of specific cell-types. Moreover, we revealed the sequential activation of sensory-motor regions during a grasping water droplet task. vfUSI will become a key neuroimaging technology because it combines ease of use, reliability, and affordability.
A Bayesian framework for inter-cellular information sharing improves dscRNA-seq quantification
Authors: Srivastava Avi , Malik Laraib , Sarkar Hirak , Patro Rob
Published: April 2020

Motivation

Droplet based single cell RNA-seq (dscRNA-seq) data is being generated at an unprecedented pace, and the accurate estimation of gene level abundances for each cell is a crucial first step in most dscRNA-seq analyses. When preprocessing the raw dscRNA-seq data to generate a count matrix, care must be taken to account for the potentially large number of multi-mapping locations per read. The sparsity of dscRNA-seq data, and the strong 3’ sampling bias, makes it difficult to disambiguate cases where there is no uniquely mapping read to any of the candidate target genes.

Results

We introduce a Bayesian framework for information sharing across cells within a sample, or across multiple modalities of data using the same sample, to improve gene quantification estimates for dscRNA-seq data. We use an anchor-based approach to connect cells with similar gene expression patterns, and learn informative, empirical priors which we provide to alevin’s gene multi-mapping resolution algorithm. This improves the quantification estimates for genes with no uniquely mapping reads (i.e. when there is no unique intra-cellular information). We show our new model improves the per cell gene level estimates and provides a principled framework for information sharing across multiple modalities. We test our method on a combination of simulated and real datasets under various setups.

Availability

The information sharing model is included in alevin and is implemented in C++14. It is available as open-source software, under GPL v3, athttps://github.com/COMBINE-lab/salmonas of version 1.1.0.

Contact

asrivastava@cs.stonybrook.edu,rob@cs.umd.edu
Rank-dependent social inheritance determines social network structure in a wild mammal population
Authors: Ilany Amiyaal , Holekamp Kay E. , Akçay Erol
Published: April 2020

The structure of animal social networks influences survival and reproductive success, as well as pathogen and information transmission. However, the general mechanisms determining social structure remain unclear. Using data on 73,767 social interactions among wild spotted hyenas over 27 years, we show that a process of social inheritance determines how offspring relationships are formed and maintained. The relationships of offspring with other hyenas are similar to those of their mothers over up to six years, and the degree of similarity increases with maternal social rank. The strength of mother-offspring relationship affects social inheritance and is positively correlated with offspring longevity. These results confirm the hypothesis that social inheritance of relationships can structure animal social networks and be subject to adaptive tradeoffs.
A Statistical Framework for Evolutionary Analysis of Recurrent Somatic Mutations in Cancers
Authors: Gu Xun
Published: April 2020

Current cancer genomics databases have accumulated millions of somatic mutations that remain to be further explored, faciltating enormous high throuput analyses to explore the underlying mechanisms that may contribute to malignant initiation or progression. In the context of over-dominant passenger mutations (unrelated to cancers), the challenge is to identify somatic mutations that are cancer-driving. Under the notion that carcinogenesis is a form of somatic-cell evolution, we developed a two-component mixture model that enables to accomplish the following analyses. (i) We formulated a quasi-likelihood approach to test whether the two-component model is significantly better than a single-component model, which can be used for new cancer gene predicting. (ii) We implemented an empirical Bayesian method to calculate the posterior probabilities of a site to be cancer-driving for all sites of a gene, which can be used for new driving site predicting. (iii) We developed a computational procedure to calculate the somatic selection intensity at driver sites and passenger sites, respectively, as well as site-specific profiles for all sites. Using these newly-developed methods, we comprehensively analyzed 294 known cancer genes based on The Cancer Genome Atlas (TCGA) database.