bluuebunny/crossref_metadata_2025 huggingface dataset:
Cone Beam Computed Tomography Evaluation of the Morphological Variation and Width in Mandibular Condyle
Authors: Al-Ghurabi Zainab H. , Al-Bahrani Zainab M.
Published: January 2021

Purpose:

Classify the normal morphology of mandibular condyle to facilitate the diagnosis of any pathology or abnormal conditions associated with it using cone beam computed tomography (CBCT).

Material and method:

A total of 100 joints of 50 subjects with age range of 20 to 50 years were examined prospectively using CBCT images. The mandibular condylar morphology was classified into convex, round, flat, and angled the widest area of the condylar head measured to evaluate the size variation in different age groups for both genders and side.

Results:

Round shape condyle is more frequent than other varieties and angled shape was the less frequent shape. There was no significant difference between gender and condyle shape but the round and angled shape were more obvious in females than males. Convex type was more prevalent to shown bilateral symmetrical shape than other varieties, the condylar head mean of width measuring was 14.85 mm in age group 20 to 29 comparable to 14.45 mm and 14.42 mm in age groups 30 to 39 and 40 to 50 years, respectively.

Conclusion:

CBCT facilitates the precise examination of TMJ in 3 planes that play a great role in an accurate visualization of the condyle to provide early diagnosis for any disorder in the region.
“Zipper” Concept for Designing Expanded Forehead Flap in Facial-Cervical Reconstruction
Authors: Chen Hongbo , Su Zhiguo , Tian Jia
Published: January 2021

Background:

Skin defect of the lower part of the face and neck is a severe condition for many patients with burn and traumatic injuries or skin lesions. The expanded forehead flap with anterofrontal temporal vessel pedicles has been widely used in lower cheeks, chin, and neck reconstruction. (In this study, we introduce a new concept- “Zipper concept” of the flap design.) The aim of this study is to evaluate the feasibility and outcome of using expanded forehead flap with a vertical incision with or without a small transverse incision in the central part.

Methods:

From March 2010 to September 2016, 27 patients who suffered from lower cheeks and chin skin defects were reconstructed by expanded forehead flap with anterofrontal temporal vessel pedicles. After the lesion was excised, the upper or the lower part of the flap was cut in half with a vertical incision with or without a small transverse incision in the middle part as needed for cheeks, upper lip or neck reconstruction, and the other part of the flap was remained to be one piece for chin reconstruction.

Results:

All flaps survived completely without any congestion or necrosis. All patients achieved satisfactory results both functionally and aesthetically.

Conclusions:

A vertical incision with or without a small transverse incision in the central part of the expanded forehead flap with anterofrontal temporal vessel pedicles is a safe modification of the flap design. It is practical and could bring the expanded forehead flap to more indications.
Part 1: Surgical Correction in 231 Trigonocephaly Patients – The Alder Hey Experience
Authors: Hennedige Anusha , Richardson David , Duncan Christian , Parks Christopher , Sinha Ajay , Ellenbogen Jonathan , Robertson Benjamin
Published: January 2021

Isolated metopic synostosis presents with a range of severity, from a palpable ridge as the sole presenting feature to a constellation of features resulting in trigonocephaly. At our unit, patients on the moderate to severe end of the phenotypic spectrum of trigonocephaly are offered fronto-orbital advancement and remodeling. The authors present our series of trigonocephaly patients who have undergone surgical correction. From January 2000 to January 2020, the authors operated on 231 patients with trigonocephaly. The average age at surgery was 18 months, with an average follow-up of 77.4 months. Seventy-nine percent of patients had no comorbidity. Ten percent of patients sustained a dural tear with no long-term consequences. The total early complication rate was 12.1%. The most common early complications were wound infection and wound dehiscence at 7.4% and 3.9% respectively. The total reoperation rate was 6.5%. The introduction of infection prevention and control measures over the 2 decades at our unit reduced the reoperation rate to 1.1%. The most common late complication was temporal recession in 20.8% of patients, none of whom required aesthetic correction. The recurrence rate of a metopic ridge was 2.3% with no patients requiring further surgery. None of our patients required calvarial remodeling for raised intracranial pressure after the primary fronto-orbital advancement and remodeling. There were no life-threatening complications or mortalities in our cohort. The authors present recommendations which include an infection control care bundle, cessation of surgical drains, and practice adjustments to reduce risks of infection and risk of requiring further calvarial remodelling for raised intracranial pressure.
A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum
Authors: Nieto-Calvache Albaro José , Vergara-Galliadi Lina María , Rodríguez Fernando , Ordoñez Carlos A. , García Alberto Federico , López María Camila , Manzano Ramiro , Velásquez Jorge , Carbonell Juan Pablo , Bryon Adriana Messa , Echavarría Maria Paula , Escobar Maria Fernanda , Carvajal Javier , Benavides-Calvache Juan Pablo , Burgos Juan Manuel
Published: January 2021

INTRODUCTION

The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques have been incorporated into the management of this pathology. Our aim was to examine the endovascular practice patterns among PAS patients treated during a 9-year period in a low-middle income country in which an interdisciplinary group’s technical skills were improved with the creation of a PAS team.

METHODOLOGY

A retrospective cohort study including all PAS patients treated from December 2011 to November 2020 was performed. We compared the clinical results obtained according to the type of endovascular device used (group 1, internal iliac artery occlusion balloons; group 2, resuscitative endovascular balloons of the aorta; group 3, no arterial balloons due to low risk of bleeding) and according to the year in which they were attended (reflects the PAS team level of experience). A fourth group of comparisons included the woman diagnosed during a cesarean delivery and treated in a nonprotocolized way.

RESULTS

A total of 113 patients were included. The amount of blood loss decreased annually, with a median of 2,500 mL in 2014 (when endovascular occlusion balloons were used in all patients) and 1,394 mL in 2020 (when only 38.5% of the patients required arterial balloons). Group 3 patients (n = 16) had the lowest bleeding volume (1,245 mL) and operative time (173 minutes) of the entire population studied. Group 2 patients (n = 46) had a bleeding volume (mean, 1,700 mL) and transfusions frequency (34.8%) slightly lower than group 1 patients (n = 30) (mean of 2,000 mL and 50%, respectively). They also had lower hysterectomy frequency (63% vs. 76.7% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS and S2 compromise.

CONCLUSION

Endovascular techniques used for bleeding control in PAS patients are less necessary as interdisciplinary groups improve their surgical and teamwork skills.

LEVEL OF EVIDENCE

Therapeutic care management, level III.
Motor vehicle crashes in pregnancy: Maternal and fetal outcomes
Authors: Owattanapanich Natthida , Lewis Meghan R. , Benjamin Elizabeth R. , Wong Monica D. , Demetriades Demetrios
Published: January 2021

BACKGROUND

Motor vehicle crashes (MVCs) are a leading cause of death in pregnant women. Even after minor trauma, there is risk of fetal complications. The purpose of this study was to compare injuries and outcomes in pregnant with matched nonpregnant women after MVC and evaluate the incidence and type of pregnancy-related complications.

METHODS

Retrospective study at a Level I trauma center included pregnant MVC patients, admitted 2009 to 2019. Pregnant patients were matched for age, seatbelt use, and airbag deployment with nonpregnant women (1:3). Gestation-related complications included uterine contractions, vaginal bleeding, emergency delivery, and fetal loss.

RESULTS

During the study period, there were 6,930 MVC female admissions. One hundred forty-five (2%) were pregnant, matched with 387 nonpregnant. The seat belt use (71% in nonpregnant vs. 73% in pregnant, p = 0.495) and airbag deployment (10% vs. 6%, p = 0.098) were similar in both groups. Nonpregnant women had higher Injury Severity Score (4 vs. 1, p < 0.0001) and abdominal Abbreviated Injury Scale (2 vs. 1, p < 0.001), but a smaller proportion sustained abdominal injury (18% vs. 53%, p < 0.0001). Mortality (1% vs. 0.7%, p = 0.722), need for emergency operation (6% vs. 3%, p = 0.295) or angiointervention (0.3% vs. 0%, p = 0.540), ventilator days (3 vs. 8, p = 0.907), and intensive care unit (4 vs. 4, p = 0.502) and hospital length of stay (2 vs. 2, p = 0.122) were all similar. Overall, 13 (11.1%) patients developed gestation-related complications, most commonly uterine contractions (6.3%), need for emergency delivery (3.5%), and vaginal bleeding (1.4%).

CONCLUSION

Most pregnant patients hospitalized for MVC suffered minor injuries. Pregnant women had lower Injury Severity Score and abdominal Abbreviated Injury Scale than matched nonpregnant women. However, there was still a considerable incidence of gestation-related complications. It is imperative that pregnant patients be closely monitored even after minor trauma.

LEVEL OF EVIDENCE

Prognostic and epidemiological, level III
A randomized porcine study of the hemodynamic and metabolic effects of combined endovascular occlusion of the vena cava and the aorta in normovolemia and in hemorrhagic shock
Authors: Wikström Maria B. , Smårs Martin , Karlsson Christina , Stene Hurtsén Anna , Hörer Tal M. , Nilsson Kristofer F.
Published: January 2021

BACKGROUND

Mortality from traumatic retrohepatic venous injuries is high and methods for temporary circulatory stabilization are needed. We investigated survival and hemodynamic and metabolic effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) and vena cava inferior (REBOVC) in anesthetized pigs.

METHODS

Twenty-five anesthetized pigs in normovolemia or severe hemorrhagic shock (controlled arterial bleeding in blood bags targeting systolic arterial pressure of 50 mm Hg, corresponding to 40–50% of the blood volume) were randomized to REBOA zone 1 or REBOA+REBOVC zone 1 (n = 6–7/group) for 45 minutes occlusion, followed by 3-hour resuscitation and reperfusion. Hemodynamic and metabolic variables and markers of end-organ damage were measured regularly.

RESULTS

During occlusion, both the REBOA groups had higher systemic mean arterial pressure (MAP) and cardiac output (p < 0.05) compared with the two REBOA+REBOVC groups. After 60 minutes reperfusion, there were no statistically significant differences between the two REBOA groups and the two REBOA+REBOVC groups in MAP and cardiac output. The two REBOA+REBOVC groups had higher arterial lactate and potassium concentrations during reperfusion, compared with the two REBOA groups (p < 0.05). There was no major difference in end-organ damage markers between REBOA and REBOA+REBOVC. Survival after 1-hour reperfusion was 86% and 100%, respectively, in the normovolemic REBOA and REBOA+REBOVC groups, and 67% and 83%, respectively, in the corresponding hemorrhagic shock REBOA and REBOA+REBOVC groups.

CONCLUSION

Acceptable hemodynamic stability during occlusion and short-term survival can be achieved by REBOA+REBOVC with adequate resuscitation; however, the more severe hemodynamic and metabolic impacts of REBOA+REBOVC compared with REBOA must be considered.

LEVEL OF EVIDENCE

Prospective, randomized, experimental animal study. Basic science study, therapeutic.
Effect of Hepatitis C Virus Infection on Heart Transplants in the Current Era
Authors: Fujisaki Tomohiro , Mikami Takahisa , Kuno Toshiki , Moss Noah , Itagaki Shinobu
Published: January 2021

Background.

The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the current era after the introduction of direct-acting antiviral agents (DAAs) in 2011.

Methods.

Using the United Network for Organ Sharing registry, 24 871 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV-infected recipients and in utilization of HCV-infected donors and their effect on the transplant outcomes were investigated in the past era versus the current era separated by 2011, using Cox proportional hazard regression.

Results.

HCV antibody–positive recipients (n = 520, 2.1%) had stable prevalence (P = 0.18). They had a lower survival estimate when compared with HCV antibody–negative recipients in the past era (55.3% versus 70.9% at 7 y; hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.27-1.91; P < 0.001), however not in the current era (73.1% versus 71.5% at 7 y; HR, 1.00; 95% CI, 0.75-1.32; P = 0.98) (P
interaction < 0.001). Organ use from HCV antibody–positive donors (n = 371, 1.5%) was concentrated in the recent years (P < 0.001) and provided the similar survival estimate up to 2 y (84.2% versus 87.6%; HR, 0.97; 95% CI, 0.65-1.44; P = 0.87). The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test.

Conclusions.

Positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes in the current era. Graft utilization from positive HCV antibody or nucleic acid amplification test–positive donors are rapidly more prevalent and appeared to be promising up to 2 y posttransplant.
Evaluation of Graft Fibrosis, Inflammation, and Donor-specific Antibodies at Protocol Liver Biopsies in Pediatric Liver Transplant Patients: A Single-center Experience
Authors: Pinon Michele , Pizzol Antonio , Chiadò Cristina , David Ezio , Chiusa Luigi , Dell’Olio Dominic , Isolato Giuseppe , Amoroso Antonio , Deaglio Silvia , Catalano Silvia , Tandoi Francesco , Romagnoli Renato , Calvo Pier Luigi
Published: January 2021

Background.

The impact of graft fibrosis and inflammation on the natural history of pediatric liver transplants is still debated. Our objectives were to evaluate the evolution of posttransplant fibrosis and inflammation over time at protocol liver biopsies (PLBs), risk factors for fibrosis, presence of donor-specific antibodies (DSAs), and/or their correlation with graft and recipient factors.

Methods.

A single-center, retrospective (2000–2019) cross-sectional study on pediatric liver transplant recipients who had at least 1 PLB, followed by a longitudinal evaluation in those who had at least 2 PLBs, was conducted. Fibrosis was assessed by the Liver Allograft Fibrosis Semiquantitative score, inflammation by the rejection activity index, DSAs by Luminex.

Results.

A total of 134 PLBs from 94 patients were included. Fibrosis was detected in 87% (30% mild, 45% moderate, and 12% severe), 80% in the portal tracts. There was an increase in fibrosis between the 1–3 and the 4–6 y group (P = 0.01), then it was stable. Inflammation was observed in 44% (30% mild, 13% moderate, and 1% severe), 90% in the portal tracts. Anti-HLA II (IgG) DSAs were detected in 14 of 40 (35%). Portal fibrosis was associated with portal inflammation in the 1–3 y group (P = 0.04). Low immunosuppression levels were correlated with sinusoidal fibrosis (P = 0.04) and DSA positivity (P = 0.006). There was no statistically significant correlation between DSA positivity and the presence of graft fibrosis or inflammation.

Conclusions.

This study corroborates the concept of an early evolution of silent graft fibrosis. Suboptimal immunosuppression may play a role in the development of fibrosis and DSAs.
Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study
Authors: Meier Raphael P.H. , Noguchi Hiroshi , Kelly Yvonne M. , Sarwal Minnie , Conti Giulia , Ward Casey , Halleluyan Ran , Tavakol Mehdi , Stock Peter G. , Freise Chris E.
Published: January 2021

Background.

Sarcopenia has been identified as a predictive variable for surgical outcomes. We hypothesized that sarcopenia could be a key measure to identify frail patients and potentially predict poorer outcomes among recipients of simultaneous pancreas and kidney (SPK) transplants.

Methods.

We estimated sarcopenia by measuring psoas muscle mass index (PMI). PMI was assessed on perioperative computed tomography (CT) scans of SPK recipients.

Results.

Of the 141 patients identified between 2010 and 2018, 107 had a CT scan available and were included in the study. The median follow-up was 4 years (range, 0.5–9.1 y). Twenty-three patients had a low PMI, and 84 patients had a normal PMI. Patient characteristics were similar between the 2 groups except for body mass index, which was significantly lower in low PMI group (P < 0.001). Patient and kidney graft survival were not statistically different between groups (P = 0.851 and P = 0.357, respectively). A multivariate Cox regression analysis showed that patients with a low PMI were 5 times more likely to lose their pancreas allograft (hazard ratios, 5.4; 95% confidence intervals, 1.4-20.8; P = 0.015). Three out of 6 patients lost their pancreas graft due to rejection in the low PMI group, compared with 1 out of 9 patients in the normal PMI group. Among low PMI patients who had a follow-up CT scan, 62.5% (5/8) of those with a functional pancreas graft either improved or resolved sarcopenia, whereas 75.0% (3/4) of those who lost their pancreas graft continued to lose muscle mass.

Conclusion.

Sarcopenia could represent one of the predictors of pancreas graft failure and should be evaluated and potentially optimized in SPK recipients.
Feasibility of Serial Ultrasound Measurements of the Rectus Femoris Muscle Area to Assess Muscle Loss in Patients Awaiting Liver Transplantation in the Intensive Care Unit
Authors: Pita Alejandro , Ziogas Ioannis A. , Ye Fei , Chen Yufan , Rauf Muhammad A. , Matsuoka Lea K. , Kaur Navpreet , Whang Gilbert , Zielsdorf Shannon M. , Bastas Gerasimos , Izzy Manhal , Alexopoulos Sophoclis P.
Published: January 2021

Background.

End-stage liver disease (ESLD) patients requiring intensive care unit (ICU) care before liver transplantation (LT) often experience significant muscle mass loss, which has been associated with mortality. In this exploratory study, we primarily aimed to assess the feasibility of serial ultrasound (US) rectus femoris muscle area (RFMA) measurements for the evaluation of progressive muscle loss in ICU-bound potential LT candidates and describe the rate of muscle loss as assessed by sequential US RFMA measurements. Secondarily, we sought to identify patient characteristics associated with muscle loss and determine how muscle loss is associated with survival.

Methods.

We prospectively enrolled 50 ESLD adults (≥18 y old) undergoing evaluation for LT candidacy in the ICU. A baseline computed tomography measurement of psoas muscle area (PMA) and serial bedside US measurements of RFMA were obtained. The associations between patient characteristics, PMA, RFMA, ICU stay, and survival were analyzed.

Results.

Rapid decline in muscle mass by RFMA measurements was ubiquitously present and correlated to baseline PMA and length of ICU stay. RFMA normalized by body surface area decreased by 0.013 cm2/m2 (95% confidence interval, 0.010-0.016; P < 0.001) for each day in the ICU. Decreased RFMA normalized by body surface area was associated with poor overall survival (adjusted hazard ratio, 0.42; 95% confidence interval, 0.18-0.99; P = 0.047).

Conclusions.

In this exploratory, prospective study, serial US RFMA measurements in ESLD patients in the ICU are feasible, demonstrate progressive time-dependent muscle loss, and are associated with mortality. Further large-scale assessment of this modality compared with static PMA or performance-based dynamic assessments should be performed.
A Safe Anti-A2 Titer for a Successful A2 Incompatible Kidney Transplantation: A Single-center Experience and Review of the Literature
Authors: Azzi Yorg , Nair Gayatri , Loarte-Campos Pablo , Ajaimy Maria , Graham Jay , Liriano-Ward Luz , Pynadath Cindy , Uehlinger Joan , Parides Michael , Campbell Alesa , Colovai Adriana , Alani Omar , Le Marie , Greenstein Stuart , Kinkhabwala Milan , Rocca Juan , Akalin Enver
Published: January 2021

Background.

Kidney allocation system allows blood type B candidates accept kidneys from A2/A2B donors. There is no mandate by UNOS on which the anti-A2 level is acceptable. We aimed to investigate the safety of kidney transplant in blood group B patients with anti-A2 titers ≤16.

Methods.

We performed 41 A2-incompatible kidney transplants in blood group B recipients between May 2015 and September 2019. Clinical outcomes were compared with a control group of 75 blood group B recipients who received blood group compatible kidney transplantation at the same period.

Results.

Of the 41 recipients, 85% were male, 48% African American, with a median age of 53 (20–73) y. Thirty-eight (93%) were deceased-donor and 3 (7%) were living-donor kidney transplant recipients. Pretransplant anti-A2 IgG titers were 2 in 16, 4 in 9, 8 in 6, and 16 in 5 and too weak to titer in 5 recipients. Eight patients had pretransplant donor-specific antibodies. During a median follow-up of 32.6 mo (6–57.3) patient and graft survival were 100% and 92% in the A2-incompatible kidney transplant group, and 91% and 92% in the blood group compatible group, respectively. Twelve A2-incompatible recipients underwent a 21 clinically indicated kidney biopsies at a median 28 d (6–390) after transplantation. None of the patients developed acute antibody-mediated rejection and 2 patients (5%) had acute T-cell–mediated rejection. Interestingly, peritubular capillary C4d positivity was seen in 7 biopsies which did not have any findings of acute rejection or microvascular inflammation but not in any of the rejection-free biopsies in the control group. C4d positivity was persistent in 5 of those patients who had follow-up biopsies.

Conclusions.

A2-incompatible transplantation is safe in patients with anti-A2 titers ≤16 with excellent short-term kidney allograft outcomes. C4d positivity is frequent in allograft biopsies without acute rejection.
Splenic Artery Transposition for Liver Transplantation: An Underutilized Technique?
Authors: Goss Matthew B. , Galván N. Thao N. , Geha Joseph D. , Moreno Nicolas F. , Cotton Ronald T. , Rana Abbas , O’Mahony Christine A. , Goss John A.
Published: January 2021

Background.

Successful liver transplantation is dependent on restoration of hepatic arterial (HA) flow. Although uncommon, some native recipient HAs are not suitable or inadequate for anastomosis, thereby necessitating extra-anatomic HA reconstruction. Splenic artery transposition (SAT) is 1 method of HA reconstruction, in which the recipient splenic artery is transposed to reestablish perfusion of the donor liver. Due to the rarity of the technique, literature describing outcomes is limited. In the current report, we describe 3 patients (2 adults, 1 pediatric) who underwent complex upper abdominal surgery before whole-organ deceased donor liver transplantation with SAT.

Methods.

The demographic and patient care information was collected prospectively and subsequently reviewed retrospectively. Given the de-identified nature of the data included, this study was exempt from approval from an ethics board.

Results.

Recipient splenic arteries were dissected from their origin at the celiac trunk, for approximately 3–5 cm to ensure a gentle anterior-cranial curve toward the right upper quadrant, allowing anastomosis to the donor celiac trunk in an end-to-end fashion. Postoperatively, all 3 patients had rapid normalization of liver function tests and brisk HA flow demonstrated by Doppler ultrasound. Longer-term follow-up, ranging from 1 to 3 years, reveals continued patency of the reconstructed HAs and liver function tests within normal limits.

Conclusions.

Our experience points to SAT as a safe and effective technique for extra-anatomic HA reconstruction.
Vascularized Bone Marrow Cellular Depletion or Discontinuity Abrogates Protection of Vascularized Composite Allografts in Nonhuman Primates
Authors: Shockcor Nicole , Buckingham Evan B. , Hassanein Wessam , Dhru Urmil , Khalifeh Ali , Uluer Mehmet , Woodall Jhade , Brazio Philip , Drachenberg Cynthia , Nam Arthur J. , Barth Rolf N.
Published: January 2021

Background.

Vascularized composite allografts (VCA) have demonstrated good clinical outcomes dependent on chronic immunosuppression. Previous work by our group and others supports that cotransplanted vascularized bone marrow (VBM) as a component of VCA offers immunologic protection to prolong graft survival. We aimed to characterize the requirements and potential mechanisms of VBM-mediated protection of VCA by modifying grafts through various strategies.

Methods.

Experimental groups of mismatched cynomolgus macaque recipients received VCA transplants modified by the following approaches: heterotopic separation of the VCA and VBM components; T-cell depletion of either donor or recipient; irradiation of donor VCA; and infusion of donor bone marrow. All groups received standard immunosuppression with tacrolimus and mycophenolate mofetil.

Results.

Experimental modifications to donor, recipient, or graft all demonstrated short-graft survivals (31 d). Chimerism levels without bone marrow infusion were transient and minimal when detected and were not associated with prolonged survival. Donor bone marrow infusion increased levels of chimerism but resulted in alloantibody production and did not improve graft survival.

Conclusions.

VCA graft survival is significantly reduced compared with previously reported VCA with VBM transplants (348 d; P = 0.01) when the hematopoietic niche is removed, altered, or destroyed via irradiation, depletion, or topographical rearrangement. These experimental manipulations resulted in similar outcomes to VCA grafts without cotransplanted VBM (25 d). These data support the presence of a radiosensitive, T-cell population within the VBM compartment not reconstituted by reinfusion of bone marrow cells.
Longitudinal changes in antipsychotic dose in patients treated with long-acting injectable second-generation antipsychotics
Authors: Nakajima Nozomi , Mizoe Nao , Misawa Fuminari , Yamashita Toru , So Ryuhei , Kitagawa Kohei , Tanimoto Kenichi , Kishi Yoshiki , Fujii Yasuo , Takeuchi Hiroyoshi
Published: January 2021

Only a few studies have investigated changes in the dose of long-acting injectable second-generation antipsychotics (LAI-SGAs) over the long term in the maintenance treatment of schizophrenia. In this retrospective cohort study, we examined longitudinal changes in antipsychotic dose over a 3-year period in patients with schizophrenia who had been taking LAI-SGAs for at least 1 year. We compared the total daily chlorpromazine equivalent dose of antipsychotics at 12, 24 and 36 months with the baseline dose at 3 months after initiation of LAI-SGAs. We also performed multiple regression analysis to explore factors associated with change in total daily dose 12 months after treatment initiation. A total of 154 patients fulfilled the inclusion criteria. There was no significant difference in total daily antipsychotic dose between 3 months and 12, 24 or 36 months after treatment initiation. Total daily dose was increased in 43 (27.9%), 31 (34.8%) and 22 patients (36.7%) at 12, 24 and 36 months, respectively. Age and total antipsychotic dose at 3 months were significantly negatively associated with change in total daily dose. Antipsychotic dose was basically unchanged during long-term treatment in patients treated with LAI-SGAs in the maintenance phase, although there was an increase in some patients.
REPEATABILITY OF A CALIBRATED DIGITAL SPECTROPHOTOMETER FOR DENTAL SHADE EVALUATION IN CURRENT, FORMER AND NEVER SMOKERS – STUDY PROTOCOL
Authors: Conte Gianluca , Pacino Sebastiano Antonio , Urso Salvatore , Emma Rosalia , Cibella Fabio , Pedullà Eugenio , Polosa Riccardo
Published: January 2021

Despite the negative impact of cigarette smoking on oral health and teeth appearance, there is no data available on dental shade changes in smokers who quit smoking. Dental discoloration caused by smoking may be permanent, with minimal restoration after stopping smoking. If this is valid, former smokers can show dental shade values equivalent to those of current smokers.

The aim of this study is to compare the dental shade assessment by digital spectrophotometry (VITA Easyshade V) in current, former and never smokers and to verify the short (7 days) and long-term (30 days) repeatability of these measurements.

Confirmation of good reproducibility of VITA Easyshade V with clear objective discrimination of dental shade measurements among current, former, and never smokers will improve the power of this measurement giving more confidence in clinical research findings of dental shades in these populations.

It is also anticipated that results from the study will expand the application of this measurements to include medical and regulatory research applied to combustion-free tobacco products (e.g. e-cigarettes, heated tobacco products, oral tobacco/nicotine products, etc.), smoking cessation medications, and to consumer care product for oral hygiene and dental aesthetics.
SARS-CoV-2 Airborne Surveillance Using Non-Powered Cold Traps
Authors: Gehrke Sven G. , Förderer Claudia , Stremmel Wolfgang
Published: January 2021

Background

COVID-19 pandemic is a worldwide challenge requiring efficient containment strategies. High-throughput SARS-CoV-2 testing and legal restrictions are not effective in order to get the current outbreak under control. Emerging SARS-CoV-2 variants with a higher transmissibility require efficient strategies for early detection and surveillance.

Methods

SARS-CoV-2 RNA levels were determined by quantitative RT-PCR in aerosols collected by non-powered cold traps. SARS-CoV-2 spreading kinetics and indoor hotspots could be identified in isolation units and at public places within a high-endemic area. These included an outpatient endoscopy facility, a concert hall, and a shopping mall.

Results

Indoor COVID-19 hotspots were found in non-ventilated areas and in zones that are predisposed to a buoyancy (chimney) effect. SARS-CoV-2 RNA in those aerosols reached concentrations of 105 copies/mL. Extensive outdoor air ventilation reliably eliminates SARS-CoV-2 aerosol contamination.

Conclusions

The method presented herein could predict SARS-CoV-2 indoor hotspots and may help to characterize SARS-CoV-2 spreading kinetics. Moreover, it can be used for the surveillance of emerging SARS-CoV-2 variants. Due to low costs and easy handling, the procedure might enable efficient algorithms for COVID-19 prevention and screening.
A Community-Based Participatory Research to Assess the Feasibility of Ayurveda Intervention in Patients with Mild-to-Moderate COVID-19
Authors: Kulkarni Vishwesh , Sharma Neha , Modi Dipa , Kumar Abnimanyu , Joshi Jaydeep , Krishnamurthy Nagamani
Published: January 2021

Innovative strategies are required to manage COVID-19 in the communities. Back to Roots was a collaborative, community-based pilot intervention project in the British Asian community. To assess the efficacy and safety of Ayurveda intervention in relieving symptoms of mild-to-moderate COVID-19, a community based participatory research framework was used. Twenty-eight patients were enrolled with confirmed COVID-19 clinical stages of mild-to-moderate COVID-19, symptomatic, and between 20 to 70□years of age. Routine management was followed by all patients managing at home, additionally patents taking Ayurveda intervention for 14 consecutive days. The efficacy and safety of Ayurveda intervention were evaluated. There were suggestions of Ayurveda’s advantage in improved symptoms relief, clinical recovery in 7 days. However, a control group was not included but data triangulations from separate usual care found the difference statistically significant. Ayurveda intervention may potentially have a beneficial effect on patients with COVID-19, especially for those with mild to moderate symptoms. A further definitive large-scale clinical trial is necessary.

ClinicalTrials.govIdentifier

NCT04716647
A 3D CNN Classification Model for Accurate Diagnosis of Coronavirus Disease 2019 using Computed Tomography Images
Authors: Li Yifan , Pei Xuan , Guo Yandong
Published: January 2021

The coronavirus disease (COVID-19) has been spreading rapidly around the world. As of August 25, 2020, 23.719 million people have been infected in many countries. The cumulative death toll exceeds 812,000. Early detection of COVID-19 is essential to provide patients with appropriate medical care and protect uninfected people. Leveraging a large computed tomography (CT) database from 1,112 patients provided by China Consortium of Chest CT Image Investigation (CC-CCII), we investigated multiple solutions in detecting COVID-19 and distinguished it from other common pneumonia (CP) and normal controls. We also compared the performance of different models for complete and segmented CT slices. In particular, we studied the effects of CT-superimposition depths into volumes on the performance of our models. The results show that the optimal model can identify the COVID-19 slices with 99.76% accuracy (99.96% recall, 99.35% precision and 99.65% F1-score). The overall performance for three-way classification obtained 99.24% accuracy and the area under the receiver operating characteristic curve (AUROC) of 0.9986. To the best of our knowledge, our method achieves the highest accuracy and recall with the largest public available COVID-19 CT dataset. Our model can help radiologists and physicians perform rapid diagnosis, especially when the healthcare system is overloaded.
Estimating COVID-19 Cases on University Campuses Prior To Semester
Authors: Fout Alex , Bayham Jude , Gutilla Margaret J , Fosdick Bailey K , Pidcoke Heather , Kirby Michael , van Leeuwen Peter Jan , Anderson Chuck
Published: January 2021

For many institutions of higher learning, the beginning of each semester is marked by a significant migration of young adults into the area. In the midst of the COVID19 pandemic, this presents an opportunity for active cases to be introduced into a community. Prior to the Fall 2020 semester, Colorado State University researchers combined student home locations with recent case counts compiled by the New York Times to assign a probability to each individual of arriving with COVID19. These probabilities were combined to estimate that there would be 7.8 new cases among the on-campus population. Comprehensive testing of arriving students revealed 7 new cases, which validated the approach. The procedure was repeated to explore what could happen if students had returned to campus after Fall break. The estimate of 48 cases corroborated the University’s early decision to transition to fully remote learning after break.
Seroprevalence and attainment of herd immunity against SARS CoV-2: A modelling study
Authors: Paul Abhijit , Kadnur Harshith B , Ray Animesh , Chatterjee Samrat , Wig Naveet
Published: January 2021

Objective

The present study is aims to predict the likelihood of and likely time required to attain herd immunity against COVID-19 in New Delhi due to natural infection.

Method

An ODE based mathematical model was constructed by extending the classical SEIR model to predict the seroprevalence rate in Delhi. We estimated the parameter values for Delhi using available data (reported cases and the seroprevalence rate) and used them for future prediction. We also attempted to capture the changes in the seroprevalence rate with different possibilities of reinfection.

Results

Maximum seroprevalence rate obtained through our model is 31.65% and also a reduction in the seroprevalence rate was observed for the upcoming one month (month of January, 2021) due to the reduced transmission rate. After increasing the transmission rate to the value same as the third wave in New Delhi, we obtained a maximum value of 54.96%. This maximum value significantly decreased with the reduction in the reinfection possibilities. Also, a little impact of the duration of persistence of antibodies, 180 vs 105 days, was observed on the maximum seroprevalence.

Conclusion

This modelling study suggests that natural infection alone, as gauged by serial sero-surveys, will not result in attainment of herd immunity in the state of Delhi.
Sexual dimorphism in outcomes of non-muscle invasive bladder cancer: a role of CD163+ M2 macrophages, B cells and PD-L1 immune checkpoint
Authors: Chenard Stephen , Jackson Chelsea , Vidotto Thiago , Chen Lina , Hardy Céline , Jamaspishvilli Tamara , Berman David , Siemens D. Robert , Koti Madhuri
Published: January 2021

Non-muscle invasive bladder cancer (NMIBC) is significantly more common in men than women. However, female patients with NMIBC often present with more aggressive disease and do not respond as well to immunotherapy treatments. We hypothesized that sexual dimorphism in the tumor immune microenvironment (TIME) may contribute to the inferior clinical outcomes observed in female patients. To test this hypothesis, we interrogated the expression patterns of genes associated with specific immune cell types and immune regulatory pathways using tumor whole transcriptome profiles from male (n=357) and female (n=103) patients with NMIBC. High-grade tumors from female patients exhibited significantly increased expression ofCD40, CTLA4, PDCD1, LAG3andICOSimmune checkpoint genes. Based on the significant differences in expression profiles of these genes and the cell types that most commonly express these in the TIME, we evaluated the density and spatial distribution of CD8+Ki67+ (activated cytotoxic T cells), FoxP3+ (regulatory T cells), CD103+ (tissue resident T cells), CD163+ (M2-like tumor associated macrophages), CD79a+ (B cells), PD-L1+ (Programmed-Death Ligand-1) and PD-1+ cells using multiplexed immunofluorescence in an independent cohort of 332 patient tumors on a tissue microarray (n=259 males and n=73 females). Tumors from female patients showed significantly higher infiltration of CD163+ macrophages and PD-L1+ cells compared to tumors from male patients. Notably, increased infiltration of CD163+ macrophages and CD79a+ B cells independently associated with decreased recurrence free survival. Not only do these results have the potential to inform the rational utilization of immunomodulatory therapies based on the TIME of both male and female patients with NMIBC, these novel findings highlight the necessity of considering sexual dimorphism in the design of future immunotherapy trials.
Deep Learning for Predicting Cognitive Gap as a Reliable Biomarker of Dementia
Authors: Habuza Tetiana , Zaki Nazar , Statsenko Yauhen , Alnajjar Fady , Elyassami Sanaa
Published: January 2021

Neuroimaging data may reflect the mental status of both cognitively preserved individuals and patients with neurodegenerative diseases. To find the relationship between cognitive performance and the difference between predicted and observed functional test results, we developed a Convolutional Neural Network (CNN) based regression model to estimate the level of cognitive decline from preprocessed T1-weighted MRI images. In this study, we considered the Predicted Cognitive Gap (PCG) as the biomarker to accurately classify Healthy Control (HC) subjects versus Alzheimer disease (AD) subjects. The proposed model was tested on a dataset that includes 422 HC and 377 AD cases. The performance of the proposed solution was measured using Receiver Operating Characteristic (ROC) Area Under the Curve (AUC) and achieved 0.987 (ADAS-cog), 0.978 (MMSE), 0.898 (RAVLT), 0.848 (TMT), 0.829 (DSST) for averaged brain images; and 0.985 (ADAS-cog), 0.987 (MMSE), 0.901 (RAVLT), 0.8474 (TMT), 0.796 (DSST) for middle slice skull stripped brain images. The results achieved indicate that PCG can accurately separate healthy subjects from demented ones and thus, the structure of the brain contributes to the level of human cognition and their functional abilities. Therefore, PCG could be used as a biomarker for dementia.
A behavioral paradigm for cortical control of a robotic actuator by freely moving rats in a one-dimensional two-target reaching task
Authors: Zaidi Syed Muhammad Talha , Kocatürk Samet , Baykaş Tunçer , Kocatürk Mehmet
Published: January 2021

Controlling the trajectory of a neuroprosthetic device to reach multiple targets is a commonly used brain-machine interface (BMI) task in primates and has not been available for rodents yet. Here, we describe a novel experimental paradigm which enables this task for rats in one-dimensional space for reaching two distant targets depending on their limited cognitive and visual capabilities compared to primates. An online transform was used to convert the activity of a pair of primary motor cortex (M1) units into two robotic actions. The rats were shaped to adapt to the transform and direct the robotic actuator toward the selected target by modulating the activity of the M1 neurons. All three rats involved in the study were capable of achieving randomly selected targets with at least 78% accuracy. A total of 9 out of 16 pairs of units examined were eligible for exceeding this success criterion. Two out of three rats were capable of reversal learning, where the mapping between the activity of the unit pairs and the robotic actions were reversed. The present work is the first demonstration of trajectory-based control of a neuroprosthetic device by rodents to reach two distant targets using visual feedback. The paradigm introduced here may be used as a cost-effective platform for elucidating the information processing principles in the neural circuits related to neuroprosthetic control and for studying the performance of novel BMI technologies using freely moving rats.
Undersampling correction methods to control γ-dependence for comparing β-diversity between regions
Authors: Cao Ke , Svenning Jens-Christian , Yan Chuan , Zhang Jintun , Mi Xiangcheng , Ma Keping
Published: January 2021

Measures of β-diversity are known to be highly constrained by the variation in γ-diversity across regions (i.e., γ-dependence), making it challenging to infer underlying ecological processes. Undersampling correction methods have attempted to estimate the actual β-diversity in order to minimize the effects of γ-dependence arising from the problem of incomplete sampling. However, no study has systematically tested their effectiveness in removing γ-dependence, and examined how well undersampling-corrected β-metrics reflect true β-diversity patterns that respond to ecological gradients. Here, we conduct these tests by comparing two undersampling correction methods with the widely used individual-based null model approach, using both empirical data and simulated communities along a known ecological gradient across a wide range of γ-diversity and sample sizes. We found that undersampling correction methods using diversity accumulation curves were generally more effective than the null model approach in removing γ-dependence. In particular, the undersampling-corrected β-Shannon diversity index was most independent on γ-diversity and was the most reflective of the true β-diversity pattern along the ecological gradient. Moreover, the null model-corrected Jaccard-Chao index removed γ-dependence more effectively than either approach alone. Our validation of undersampling correction methods as effective tools for accommodating γ-dependence greatly facilitates the comparison of β-diversity across regions.
Chinese medicine (Q-14) in the Treatment of Patients with Coronavirus Disease 2019 (COVID-19): A Single-center, Open label, Randomised Controlled Trial
Authors: Liu Jia , Yang Wei , Liu Yue , Lv Cheng , Ruan Lianguo , Zhao Chen , Huo Ruili , Shen Xin , Miao Qing , Lv Wenliang , Li Hao , Shi Huaxin , Hu Lijie , Yang Zhixu , Zhang Li , Wang Bing , Dong Guoju , Xian Yongyue , Li Bin , Zhou Zhenqi , Xu Chunyan , Chen Yingying , Bian Yongjun , Guo Jing , Yang Jinliang , Wang Jian , Qi Wensheng , Chen Suping , Chen Yang , Yan Bei , Wang Wei , Li Jing , Xie Xiaolei , Xu Ming , Jiang Jianxin , Wang Gang , Cong Xiaodong , Zhu Haoning , Shi Jiaheng , Leng Luxing , Li Dongxu , Guo Lanping , Huang Luqi
Published: January 2021

OBJECTIVE

To evaluate the efficacy and safety of Chinese medicine (Q-14) plus standard care compared with standard care alone in adult with coronavirus disease 2019 (COVID-19).

Study DESIGN

Single-center, open label, randomised controlled trial.

SETTING

Wuhan Jinyintan Hospital, Wuhan, China, February 27 to March 27, 2020.

PARTICIPANTS

204 patients with laboratory confirmed COVID-19 were randomised in to treatment group and control group, which was 102 patients each group.

INTERVENTIONS

In treatment group, Q-14 was administrated at 10g (granules), twice daily for 14 days and plus standard care. In control group, patients were given standard care alone for 14 days.

MAIN OUTCOME MEASURE

The primary outcome was conversion time of SARS-CoV-2 viral assay. Adverse events were analyzed in the safety population.

RESULTS

Among 204 patients, 195 were analyzed according to the intention to treat principle. There were 149 patients (71 vs. 78 in treatment group and control group respectively) turning to negative via SARS-CoV-2 viral assay. No statistically significance showed in conversion time between treatment group and control group (FAS: Median (IQR): 10.00 (9.00-11.00) vs. 10.00 (9.00-11.00); Mean rank: 67.92 vs. 81.44; P=0.051.). Time to recovery of fever was shorter in treatment group as compared in control group. The disappearance rate of symptom in cough, fatigue, chest discomfort was significantly higher in treatment group. In chest computed tomography (Chest CT) examinations, overall evaluation of chest CT examination after treatment compared with baseline showed more patients improved in treatment group .There were no significant differences in the other outcomes.

CONCLUSION

Administration of Q-14 on standard care for COVID-19 was useful for improvement of symptoms (such as fever, cough, fatigue and chest discomfort), while did not result in a significantly higher probability of negative conversion of SARS-CoV-2 viral assay. No serious adverse events were reported.

TRIAL REGISTRATION

ChiCTR2000030288
Dynamic balance recovery in chronic Acquired Brain Injury participants following a perturbation training
Authors: Joubran Katherin , Bar-Haim Simona , Shmuelof Lior
Published: January 2021

Background

Acquired Brain Injury (ABI) is defined as a damage to the brain that occurs after birth. Subjects post-ABI suffer from dynamic balance impairments that persist years after the injury.

Objective

To explore the effect of a perturbation method which is consisted of unexpected balance perturbations using Re-Step™ technology on the recovery of dynamic balance and gait velocity in chronic ABI participants.

Methods

In a clinical trial, 35 chronic ABI participants (stroke and traumatic brain injury) participated in 22 sessions of perturbation-training, twice a week for 3 months. Dynamic balance was assessed pre and post-training using Community Balance and Mobility Scale (CB&M). Gait velocity was also assessed in the stroke participants using the 10-meter walk test (10MWT).

Results

Dynamic balance improved significantly post-training (p=0.001). This improvement was greater than the improvement that was observed in a sub-group that was tested twice before training (p=0.04). 16 participants (45.7%) out of 35 met or exceeded minimal detectable change (MDC) of the CB&M Scale. Self-paced velocity also improved significantly (p=0.02) but only 2 participants (9.5%) out of 21 exceeded the MDC of 10MWT post-stroke.

Conclusions

Unexpected balance perturbation-training using Re-Step™ technology led to an improvement in dynamic balance and gait velocity in chronic ABI participants. The advantage of Re-Step™ technology training compared to conventional balance training should be further examined.