bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis C in 2020
Authors: Leung Daniel H. , Squires James E. , Jhaveri Ravi , Kerkar Nanda , Lin Chuan‐Hao , Mohan Parvathi , Murray Karen F. , Gonzalez‐Peralta Regino P. , Roberts Eve A. , Sundaram Shikha S.
Published: July 2020

In 1989, a collaboration between the Centers for Disease Control (CDC) and a California biotechnology company identified the hepatitis C virus (HCV, formerly known as non‐A, non‐B hepatitis virus) as the causative agent in the epidemic of silent posttransfusion hepatitis resulting in cirrhosis. We now know that, the HCV genome is a 9.6 kb positive, single‐stranded RNA. A single open reading frame encodes a 3011 amino acid residue polyprotein that undergoes proteolysis to yield 10 individual gene products, consisting of 3 structural proteins (core and envelope glycoproteins E1 and E2) and 7 nonstructural (NS) proteins (p7, NS2, NS3, NS4A, NS4B, NS5A, and NS5B), which participate in posttranslational proteolytic processing and replication of HCV genetic material. Less than 25 years later, a new class of medications, known as direct‐acting antivirals (DAAs) which target these proteins, were introduced to treat HCV infection. These highly effective antiviral agents are now approved for use in children as young as 3 years of age and have demonstrated sustained virologic responses exceeding 90% in most genotypes. Although tremendous scientific progress has been made, the incidence of acute HCV infections has increased by 4‐fold since 2005, compounded in the last decade by a surge in opioid and intravenous drug use. Unfortunately, awareness of this deadly hepatotropic virus among members of the lay public remains limited. Patient education, advocacy, and counseling must, therefore, complement the availability of curative treatments against HCV infection if this virus is to be eradicated.
Dyssynergic Defecation and Anal Sphincter Disorders in Children in High‐Resolution Anorectal Manometry Investigation
Authors: Makosiej Ryszard , Makosiej Aleksandra , Bossowski Artur , Kolejwa Michał , Wawrusiewicz‐Kurylonek Natalia , Łęgowik Anna , Gościk Joanna , Piaseczna‐Piotrowska Anna , Czkwianianc Elżbieta
Published: July 2020

Objectives:

Dyssynergic defecation is a common disorder in children with functional constipation (FC) because of relaxation disorders of the sphincter apparatus and intra‐rectal pressure during defecation. The aim of the study was to determine frequency and type of dyssynergic defecation and to assess pressure in the anal canal poles during simulated evacuation and function of puborectalis muscle in defecation in children with FC.

Methods:

Three‐dimensional (3D) high‐resolution anorectal manometries (3D HRAM) were performed in 131 children with FC. In the manometric test, resting pressure measurements were assessed in 4 measuring poles of the anal canal.

Results:

One hundred thirty‐one children ages 5 to 17 years (mean age 10.2; SD ± 3.8; median 10) were involved in the study (69 girls and 62 boys). Dyssynergic defecation was shown in 106/131 (80.9%) examined children. A statistically significant difference between the age of examined children (P < 0.02) and intrarectal pressures at the anal canal measuring points (left P < 0.009, right P < 0.005, anterior P < 0.01) was found. Correlation between the residual pressure values in lateral anal canal measurement poles and intrarectal pressure was demonstrated in all types of dyssynergy (left: r = 0.69, P < 0.0005; right: r = 0.74, P < 0.0005). In a group of 53/131 (40.5%) children, 3D HRAM showed a rectal pressure increase during simulated defecation, because of the dysfunction of the puborectalis muscle.

Conclusion:

The increase in sphincter pressure in lateral and posterior poles in I and II types of dyssynergia and in lateral poles in other types of dyssynergia may depend on relaxation disorders of the puborectalis muscle during defecation.
Outcomes and Predictors for Re‐stenosis of Esophageal Stricture in Epidermolysis Bullosa
Authors: Pope Elena , Mansour Mark , Berseneva Maria , Liy‐Wong Carmen , Salas Julio , Fuentes Ignacia , Yubero Maria Joao , Palisson Francis , Martinez Anna , Mellerio Jemima , Lara‐Corrales Irene , Yang Anes , Murrell Dedee , Torres‐Pradilla Mauricio , Lucky Anne
Published: July 2020

Background:

Esophageal strictures are the common gastrointestinal complications in patients with epidermolysis bullosa (EB) requiring dilation. There is limited information on the best type of intervention, outcomes, and predictors for re‐stenosis.

Objectives:

We aimed to investigate the frequency, clinical presentation of esophageal strictures in EB patients, and to ascertain the predictors of re‐stenosis.

Methods:

We conducted a retrospective, multicenter cohort study involving 7 specialized, international EB centers on patients who were 0 to 50 years of age. Descriptive statistics and hazard risks for re‐stenosis were calculated.

Results:

We identified 125 patients with 497 esophageal stricture episodes over a mean period of observation of 17 (standard deviation [SD] = 11.91) years. Dilations were attempted in 90.74% of episodes, using guided fluoroscopy 45.23%, retrograde endoscopy 33.04%, and antegrade endoscopy 19.07%. Successful dilation was accomplished in 99.33% of attempts. Patients experienced a median of 2 (interquartile range [IQR]: 1–7) stricture episodes with a median interval between dilations of 7 (IQR: 4–12) months. Predictors for re‐stenosis included: number of strictures (2 vs 1 stricture: χ2 = 4.293, P = 0.038, hazard ratio [HR] = 1.294 (95% confidence interval [CI]: 1.014‐‐1.652 and 3 vs 1 stricture:χ2 = 7.986, P = 0.005, HR = 1.785 [95% CI: 1.194, 2.667]) and a long (≥1 cm) segment stricture (χ2 = 4.599, P = 0.032, HR = 1.347 (95% CI: 1.026‐‐1.769). Complications were more common with the endoscopic approach (8/86, antegrade endoscopy; 2 /149, retrograde endoscopy vs 2/204, fluoroscopy; χ2 = 17.39, P‐value <0.000).

Conclusions:

We found excellent dilation outcomes irrespective of the dilation procedure; however, with higher complications in the endoscopic approach. Long (>1 cm) segment involvement and multiple locations were predictive of stricture reoccurrence.
Two‐hour Observation After Liver Biopsy in Children
Authors: Alomari Mohammed H. , Kerr Cindy L. , Chewning Rush , Chaudry Gulraiz , Shaikh Raja , Padua Horacio , Landrigan‐Ossar Mary , Alomari Ahmad I.
Published: July 2020

Objective:

Following percutaneous liver biopsy performed at our institution on an outpatient basis, children traditionally were observed for 4 hours then discharged after verifying a stable hematocrit level. In June 2015, we adopted a quality improvement project with shorter 2‐hour observation for patients with no known risks and the hematocrit test was abandoned.

The purpose of this study is to evaluate the clinical and economic outcomes of early discharge of children following liver biopsy.

Methods:

We analyzed data on 2 groups of children who underwent ultrasound‐guided nontargeted core needle liver biopsy performed on outpatient basis. Group A (100 procedures with 4‐hour postprocedural observation time and hematocrit test) was compared with group B (100 procedures with 2‐hour observation without hematocrit test).

Results:

Group A consisted of 92 patients (43 boys; 49 girls) with a mean age of 11.1 years and mean weight of 52.6 kg. Group B had 92 patients (47 boys; 45 girls) with a mean age of 8.9 years and mean weight of 40.5 kg. The mean length of observation was 281 minutes (range 204–540 minutes) and 147 minutes (range 86–332 minutes) for groups A and B, respectively. The mean recovery charges were reduced by 35% per procedure in group B. The tissue obtained was sufficient for pathologic diagnosis in all procedures. There were no biopsy‐related complications in either group.

Conclusions:

Enhanced recovery with early discharge of low‐risk children after 2‐hour observation following percutaneous liver biopsy can be safely implemented without adversely affecting the outcome. Shorter postbiopsy observation can be cost‐saving and may potentially improve patient satisfaction.
Case Series
Authors: Nguyen Nathalie , Hayes Kari , Fenton Laura , Furuta Glenn T. , Menard‐Katcher Calies
Published: July 2020

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus that leads to esophageal remodeling. Dysphagia is a common symptom that likely results from the inflammatory process or remodeling. Identifying patients that may benefit from dilation can be challenging because of difficulties in detecting subtle narrowing in patients with EoE. Here we report the benefits of a pill esophagram in the detection of esophageal narrowing in EoE. We identified a series of children with EoE and symptoms of dysphagia who underwent barium esophagram with a barium‐coated pill to assess symptoms. Three subjects had a normal fluoroscopic esophagram but had pill retention for greater than 5 minutes. Subsequent esophagoscopy and esophageal dilation revealed mucosal rent after dilation. Subtle esophageal narrowing may not be captured with barium esophagram alone in children with EoE and dysphagia. Use of the barium pill in symptomatic patients can assist in identifying patients who may benefit from esophageal dilation.
A New Domain Structure for the IMPACT‐III Health‐related Quality of life Tool for Pediatric Inflammatory Bowel Disease
Authors: Grant Amy , MacIntyre Bradley , Kappelman Michael D. , Otley Anthony R.
Published: July 2020

Background:

The IMPACT‐III measures health‐related quality of life (HRQOL) in pediatric patients with Inflammatory Bowel Disease (IBD). The original IMPACT domain structure was developed based on expert opinion and was not psychometrically validated. This study developed a new domain structure based on the current IMPACT version.

Methods:

Baseline data from 3 prospectively collected datasets of children and adolescents with IBD was used. Exploratory, then confirmatory factor analyses were carried out to develop a new domain structure. Internal consistency (Cronbach alpha) and construct validity with PROMIS measures (Pearson correlations, and Independent Mann‐Whitney U‐tests) were examined.

Results:

Data from the IBD Partners dataset alone (n = 374; 47% girls, mean age = 13.4 ± 2.5 years, median disease duration = 2.5 years, 75% were in remission, with a range of self‐reported disease activity) was used to validate the new 4‐domain IMPACT‐III model. The final domain structure was parsimonious, with factor loadings for individual items ranging from 0.39 to 0.80, and internal consistency for domains from 0.75 to 0.95. The new IMPACT‐III domains include: General well‐being, Social Functioning, Emotional functioning, and Body Image. IMPACT‐III total and domain scores were significantly lower (all P < 0.001) for participants with high (>50) versus low (<50) PROMIS anxiety, depression, fatigue, and pain T‐scores; conversely IMPACT‐III scores were higher for participants with higher peer‐relations PROMIS T‐scores.

Conclusions:

This valid and reliable IMPACT‐III domain structure should be used to capture pediatric self‐reported HRQOL, which will help to understand the management of IBD from the perspective of patients.
Adiponectin is Increased in Pediatric Patients With Autoimmune Hepatitis Independent of Body Weight
Authors: Cortez Ana Paula Bidutte , Mattar Regina Helena Guedes da Motta , de Azevedo Ramiro Anthero , Fisberg Mauro , Lederman Henrique Manoel , de Morais Mauro Batista
Published: July 2020

Objective:

A high prevalence of obesity is reported in children and adolescents with autoimmune hepatitis (AIH). Adipokines participate in inflammatory processes. The objective of this study was to examine the relationship between excess weight and systemic inflammation, adipokines, and ghrelin in adolescents with AIH.

Method:

This case‐controlled study included 27 adolescents with AIH (13 with excess weight and 14 with normal weight) and a control group. Excess weight was defined by a body mass index/age Z score >+1 standard deviation. Adipokines (adiponectin, leptin, tumor necrosis factor alpha, interleukin 6 [IL‐6], and IL‐10) and ghrelin were measured with Luminex technology.

Results:

Adiponectin (μg/mL) was higher (P < 0.001) in AIH adolescents with and without excess weight (median: 35.0 and 42.1, respectively) than in normal‐weight (17.5) and excess‐weight (17.0) controls. Leptin was higher (P < 0.001) in excess‐weight AIH patients (18.0 ng/mL) and controls (19.8 ng/mL) than in normal‐weight AIH (7.7 ng/mL) and control (7.0 ng/mL) adolescents. IL‐6 levels were higher in excess‐weight (3.8 pg/mL) and normal‐weight (3.8 pg/mL) AIH patients than in excess‐weight (1.1 pg/mL) and normal‐weight (0.5 pg/mL) controls. IL‐10 levels were higher (5.2 pg/mL) in normal‐weight AIH patients than in excess‐weight (1.8 pg/mL) and normal‐weight (2.1 pg/mL) controls. Ferritin levels were lower in patients with AIH than in controls.

Conclusions:

Independent of body weight, AIH patients had higher levels of adipokines, especially adiponectin and IL‐6. Leptin levels were associated with body weight and were not influenced by AIH. IL‐10 levels were associated with lean tissue in AIH.
On Board
Authors: Russell David , Luth Elizabeth A. , Baik Dawon , Jordan Lizeyka , Creber Ruth Masterson
Published: July 2020

Hospice agencies serve an expanding population of patients with varying disease conditions and sociodemographic characteristics. Patients with heart failure represent a growing share of hospice deaths in the United States. However, limited research has explored the perspectives of hospice interdisciplinary team members regarding how patients with heart failure and their families navigate hospice care. We sought to address this research gap by conducting qualitative interviews with hospice interdisciplinary team members at a large, not-for-profit hospice agency in New York City (N = 32). Five overarching themes from these interviews were identified regarding components that members of the hospice interdisciplinary team perceived as helping patients with heart failure and their families navigate hospice care. These themes included (1) “looking out: caregiving support in hospice care,” (2) “what it really means: patient knowledge and understanding of hospice,” (3) “on board: acceptance of death and alignment with hospice goals,” (4) “on the same page: communication with the hospice team,” and (5) “like a good student: symptom management and risk reduction practices.” Interdisciplinary team members delineated several components that influence how patients with heart failure and their families navigate hospice services and communicate with care providers. Hospice agencies should consider policies for augmenting services among patients with heart failure to improve their understanding of hospice, supplement available caregiving supports for patients without them, and remove communication barriers.
Factors Associated With Poor Linkage to Human Immunodeficiency Virus Care Among Index Clients and Sex Partners Receiving Human Immunodeficiency Virus Assisted Partner Services in Kenya
Authors: Wamuti Beatrice , Contesse Marielle G. , Maingi Peter , Macharia Paul , Abuna Felix , Sambai Betsy , Ng'ang'a Anne , Spiegel Hans , Richardson Barbra , Cherutich Peter , Bukusi David , Farquhar Carey
Published: July 2020

Introduction

Human immunodeficiency virus (HIV) assisted partner services (aPS) has been recommended as a strategy to increase HIV case finding. We evaluated factors associated with poor linkage to HIV care among newly diagnosed HIV-positive individuals (index clients) and their partners after receiving aPS in Kenya.

Methods

In a cluster randomized trial conducted between 2013 and 2015, 9 facilities were randomized to immediate aPS (intervention). Linkage to care—defined as HIV clinic registration, and antiretroviral therapy (ART) initiation were self-reported. Antiretroviral therapy was only offered to those with CD4 less than 500 during this period. We estimated linkage to care and ART initiation separately for index clients and their partners using log-binomial generalized estimating equation models with exchangeable correlation structure and robust standard errors.

Results

Overall, 550 index clients and 621 sex partners enrolled, of whom 46% (284 of 621) were HIV-positive. Of the 284, 264 (93%) sex partners returned at 6 weeks: 120 newly diagnosed and 144 whom had known HIV-positive status. Among the 120 newly diagnosed, only 69% (83) linked to care at 6 weeks, whereas among the 18 known HIV-positive sex partners not already in care at baseline, 61% (11) linked. Newly diagnosed HIV-positive sex partners who were younger and single were less likely to link to care (P < 0.05 for all).

Conclusion

Only two thirds of newly diagnosed, and known HIV-positive sex partners not in care linked to care after receiving aPS. The HIV aPS programs should optimize HIV care for newly diagnosed HIV-positive sex partners, especially those who are younger and single.
Provider Adherence to Syphilis Testing Guidelines Among Stillbirth Cases
Authors: Ho Yenling Andrew , Allen Katie , Tao Guoyu , Patel Chirag G. , Arno Janet N. , Broyles Andrea A. , Dixon Brian E.
Published: July 2020

Background

The Centers for Disease Control and Prevention (CDC) recommends that all women with a stillbirth have a syphilis test after delivery. Our study seeks to evaluate adherence to CDC guidelines for syphilis screening among women with a stillbirth delivery.

Methods

We used data recorded in electronic health records for women who gave birth between January 1, 2014, and December 31, 2016. Patients were included if they were 18 to 44 years old and possessed an International Classification of Diseases, Ninth Revision or Tenth Revision, Clinical Modification diagnosis of stillbirth. Stillbirth diagnoses were confirmed through a random sample of medical chart reviews. To evaluate syphilis screening, we estimated the proportion of women who received syphilis testing within 300 days before stillbirth, women who received syphilis testing within 30 days after a stillbirth delivery, and women who received syphilis testing both before and after stillbirth delivery.

Results

We identified 1111 stillbirths among a population of 865,429 unique women with encounter data available from electronic health records. Among a sample of 127 chart-reviewed cases, only 35 (27.6%) were confirmed stillbirth cases, 45 (35.4%) possible stillbirth cases, 39 (30.7%) cases of miscarriage, and 8 (6.3%) cases of live births. Among confirmed stillbirth cases, 51.4% had any syphilis testing conducted, 31.4% had testing before their stillbirth delivery, 42.9% had testing after the delivery, and only 22.9% had testing before and after delivery.

Conclusions

A majority of women with a stillbirth delivery do not receive syphilis screening adherent to CDC guidelines. Stillbirth International Classification of Diseases codes do not accurately identify cases of stillbirth.
Reproducibility of AJCC Criteria for Classifying Deeply Invasive Colon Cancers Is Suboptimal for Consistent Cancer Staging
Authors: Panarelli Nicole C. , Hammer Suntrea T.G. , Lin Jingmei , Gopal Purva , Nalbantoglu ILKe , Zhou Lili , Cheng Jerome , Gersten Adam J. , McHugh Jonathan B. , Parkash Vinita , Lucas Elena , Westerhoff Maria
Published: July 2020

The eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual attempts to address ambiguity in the pT category assignment for colon cancer from prior editions. Despite modifications, the distinction between the pT3 and pT4a categories continues to be a source of diagnostic confusion. In this study, we assessed interobserver agreement among pathologists from different institutions in the application of AJCC eighth edition criteria for categorizing deeply invasive colonic adenocarcinomas. We identified morphologic patterns that produce diagnostic confusion. We assessed 47 colon cancers that closely approached the serosal surface. Six pathologists with interest in gastrointestinal pathology and 4 focused in other subspecialties classified each case as pT3 or pT4a, based on examination of low-magnification and high-magnification images of the most deeply invasive area. Interobserver agreement was assessed using Fleiss’ κ. Cases displayed 3 morphologic patterns at the advancing tumor edge, namely, (1) continuous invasion through an inflammatory focus, (2) pushing border, and (3) infiltrative glands and cell clusters with serosal reaction. Gastrointestinal pathologists achieved slight (κ=0.21) or moderate (κ=0.46) and (κ=0.51) agreement in each category, whereas agreement among nongastrointestinal pathologist was fair (0.31) and (0.39), or moderate (0.57) for each category, respectively. In 10 (21%) cases, the distinction between pT3 and pT4a would have changed the overall clinical stage. We conclude that histologic criteria for serosal penetration is a persistent source of diagnostic ambiguity for gastrointestinal and general pathologists in the pT categorization of colon cancers. Clarification of these criteria will help ensure uniform reporting of pathologic and clinical stage.
Cortisol Synchrony in Older Couples: Daily Socioemotional Correlates and Interpersonal Differences
Authors: Pauly Theresa , Michalowski Victoria I. , Drewelies Johanna , Gerstorf Denis , Ashe Maureen C. , Madden Kenneth M. , Hoppmann Christiane A.
Published: July 2020

Objective

Social relationships can have positive and negative influences, and these associations are particularly pronounced in old age. This study focuses on everyday interpersonal physiological dynamics (cortisol synchrony) in older couples and investigates its associations with partner presence, positive daily partner interactions, and empathy.

Methods

We conducted coordinated multilevel analyses using data from two samples of older couples from Vancouver, Canada, and Berlin, Germany (study 1: n = 85 couples aged 60–87 years; study 2: n = 77 couples aged 66–85 years), who completed questionnaires and provided salivary cortisol samples five to seven times daily for 7 days.

Results

Significant dyadic covariation in cortisol (synchrony) was present across studies (study 1/2: b = 0.04/0.03, p < .001/.001). Partner presence was only associated with greater cortisol synchrony in study 1 (b = 0.06, p = .003) but not in study 2 (b = 0.02, p = .187). Cortisol synchrony was higher when partners reported prior positive socioemotional partner interactions (study 1: b = 0.09, p = .005; study 2: b = 0.04, p = .005). There was no statistically significant association between cortisol synchrony and empathic concern (b = 0.01, p = .590) or perspective taking (b = 0.02, p = .065).

Conclusions

Moments of social bonding are intertwined with physiological synchrony in everyday life. The implications of potential repeated transmission of stress in the context of high synchrony for individual health and relationship functioning warrant further investigation.
Returning to Elective Orthopedic Surgery During the COVID-19 Pandemic: A Multidisciplinary and Pragmatic Strategy for Initial Patient Selection
Authors: Vles Georges F. , Ghijselings Stijn , De Ryck Iris , Meyfroidt Geert , Sweeney Nicola A. , Oosterlinck Wouter , Casteels Minne , Moke Lieven
Published: July 2020

Objective

The aim of the study was to design an objective, transparent, pragmatic, and flexible workflow to assist with patient selection during the initial phase of return to elective orthopedic surgery during the COVID-19 pandemic with the main purpose of enhancing patient safety.

Methods

A multidisciplinary working group was formed consisting of representatives for orthopedics, epidemiology, ethics, infectious diseases, cardiovascular diseases, and intensive care medicine. Preparation for upcoming meetings consisted of reading up on literature and testing of proposed methodologies on our own waiting lists.

Results

A workflow based on 3 domains, that is, required resources, patient fitness, and time sensitivity of the procedure, was considered most useful. All domains function as standalones, in a specific order, and no sum score is used. The domain of required resources demands input from the surgical team, results in a categorical (yes or no) outcome, and generates a list of potential patients who can be scheduled for surgery under these particular circumstances. The (weighted) items for the domain of patient fitness are the same for every patient, are scored on a numerical scale, but are likely to change during the pandemic as more data become available. Time sensitivity of the procedure is again scored on a numerical scale and becomes increasingly important when returning to elective surgery proves to be acceptably safe. After patient selection, an augmented informed consent, screening, and testing according to local guidelines will take place.

Conclusions

A workflow is proposed for patient selection aiming for the safest possible return to elective orthopedic surgery during the COVID-19 pandemic.
Choroidal Thickness Is a Biomarker Associated With Response to Treatment in Ankylosing Spondylitis
Authors: Steiner Martina , del Mar Esteban-Ortega Maria , Thuissard-Vasallo Israel , García-Lozano Isabel , García-González Alejandro Javier , Pérez-Blázquez Eugenio , Sambricio Javier , García-Aparicio Ángel , Casco-Silva Bruno Francisco , Sanz-Sanz Jesús , Valdés-Sanz Nuria , Fernández-Espartero Cruz , Díaz-Valle Teresa , Gurrea-Almela María , Fernández-Melón Julia , Gómez-Resa María , Pato-Cour Esperanza , Díaz-Valle David , Méndez-Fernández Rosalía , Navío Teresa , Moriche-Carretero Manuel , Muñoz-Fernández Santiago ,   on behalf of the ChOroidal Thickness in ESpondylitis (COnTEST) Study Group
Published: July 2020

Objective

Choroidal thickness (CT) has been evaluated as a marker of systemic inflammation in ankylosing spondylitis (AS). This study evaluates the CT of AS patients before and after 6 months of biological treatment.

Methods

This longitudinal multicenter study evaluated CT in 44 AS patients. The correlations between CT and C-reactive protein (CRP) with disease activity indices were calculated. The concordance between CT and CRP was determined. We assessed factors associated with response to treatment. Clinically important improvement was defined as a decrease in Ankylosing Spondylitis Disease Activity Score of 1.1 points or greater.

Results

Forty-four eyes in patients aged 18 to 65 years were included. Mean CT values were significantly higher at baseline than after 6 months of treatment (baseline: 355.28 ± 80.46 μm; 6 months: 341.26 ± 81.06 μm; p < 0.001). There was a 95% concordance between CT and CRP at baseline and 6 months. Clinically important improvement was associated with lower baseline CT and age as independent factors (odds ratios, 0.97 [95% confidence interval, 0.91–0.93; p = 0.009] and 0.81 [95% confidence interval, 0.7–0.95; p = 0.005]), with baseline CT of less than 374 μm (sensitivity 78%, specificity 78%, area under the curve 0.70, likelihood ratio 3.6).

Conclusions

Choroidal thickness decreased significantly after 6 months of biological treatment in all treatment groups. Choroidal thickness and CRP had a 95% concordance. A high CT was associated with a risk of biological treatment failure. Choroidal thickness can be considered a useful biomarker of inflammation and a factor associated with response to treatment in AS.
Transversus Abdominis Plane Block With Liposomal Bupivacaine Versus Thoracic Epidural for Postoperative Analgesia After Deep Inferior Epigastric Artery Perforator Flap–Based Breast Reconstruction
Authors: Clary Zachary , Nazir Niaman , Butterworth James
Published: July 2020

Purpose

Autologous breast reconstruction with abdominally based free flaps has traditionally been associated with a longer hospital stay and higher initial cost relative to other reconstructive methods. One important component of this course is postoperative pain control. Thoracic epidural anesthesia is considered among the most effective methods for pain control in the immediate postoperative period following these procedures. Recently, our institution began using 4 quadrant transversus abdominis plane (TAP) blocks with liposomal bupivacaine. Encouraging trends were observed with utilization of TAP blocks; however, we sought to quantify this effect compared with that of thoracic epidural anesthesia. This study would contribute to a growing body of evidence supporting an enhanced recovery pathway for microvascular breast reconstruction.

Method

Thirty patients who underwent deep inferior epigastric artery perforator flap–based breast reconstruction from January 2016 to April 2017 were evaluated. Fifteen patients received thoracic epidural anesthesia, and 15 received 4 quadrant TAP blocks with liposomal bupivacaine. Opioid consumption was evaluated and compared for the first 3 days postoperatively. All opioids were converted to oral morphine equivalents (OMEs) for standardization. Day of discharge, day of Foley removal, and several traditionally opioid-related adverse effects were also recorded and compared.

Result

On postoperative days 0, 1, 2, and 3, opioid consumption among those given epidural anesthesia compared with those who received TAP blocks with liposomal bupivacaine was 34.9 versus 32.6 OMEs (P = 0.81), 98.9 versus 92.4 OMEs (P = 0.78), 59.7 versus 56.0 OMEs (P = 0.79), and 59.6 versus 24.5 OMEs (P = 0.005*), respectively. Total opioid consumption for the epidural group was 253.1 versus 205.4 OMEs for the TAP block group (P = 0.2743). Time until removal of Foley was 2.7 days for patients with an epidural and 2.1 days for those receiving TAP blocks (P = 0.0056*). Length of stay for those receiving epidural was 4.33 days compared with 3.53 days for those receiving TAP blocks (P = 0.0002*).

Conclusion

When using TAP blocks with liposomal bupivacaine, a statistically significant effect on postoperative day 3 and decreased opioid utilization overall were observed. Patients also had their Foley removed sooner and were discharged from the hospital earlier.
Translucent Customized Cranial Implants Made of Clear Polymethylmethacrylate
Authors: Shay Tamir , Mitchell Kerry-Ann , Belzberg Micah , Zelko Ian , Mahapatra Smruti , Qian Jason , Mendoza Luis , Huang Judy , Brem Henry , Gordon Chad
Published: July 2020

Background

Large skull reconstruction, with the use of customized cranial implants, restores cerebral protection, physiologic homeostasis, and one's preoperative appearance. Cranial implants may be composed of either bone or a myriad of alloplastic biomaterials. Recently, patient-specific cranial implants have been fabricated using clear polymethylmethacrylate (PMMA), a visually transparent and sonolucent variant of standard opaque PMMA. Given the new enhanced diagnostic and therapeutic applications of clear PMMA, we present here a study evaluating all outcomes and complications in a consecutive patient series.

Methods

A single-surgeon, retrospective, 3-year study was conducted on all consecutive patients undergoing large cranioplasty with clear PMMA implants (2016–2019). Patients who received clear PMMA implants with embedded neurotechnologies were excluded due to confounding variables. All outcomes were analyzed in detail and compared with previous studies utilizing similar alloplastic implant materials.

Results

Fifty-five patients underwent cranioplasty with customized clear PMMA implants. Twenty-one (38%) were performed using a single-stage cranioplasty method (ie, craniectomy and cranioplasty performed during the same operation utilizing a prefabricated, oversized design and labor-intense, manual modification), whereas the remaining 34 (62%) underwent a standard, 2-stage reconstruction (craniectomy with a delayed surgery for cranioplasty and minimal-to-no implant modification necessary). The mean cranial defect size was 101.8 cm2. The mean follow-up time was 9 months (range, 1.5–39). Major complications requiring additional surgery occurred in 7 patients (13%) consisting of 2 (4%) cerebrospinal fluid leaks, 2 (4%) epidural hematomas, and 3 (4%) infections. In addition, 3 patients developed self-limiting or nonoperative complications including 2 (4%) with new onset seizures and 1 (2%) with delayed scalp healing.

Conclusions

This is the first reported consecutive case series of cranioplasty reconstruction using customized clear PMMA implants, demonstrating excellent results with regard to ease of use, safety, and complication rates well below published rates when compared with other alloplastic materials. Clear PMMA also provides additional benefits, such as visual transparency and sonolucency, which is material specific and unavailable with autologous bone. Although these early results are promising, further studies with multicenter investigations are well justified to evaluate long-term outcomes.
Prophylactic Bronchial Stump Support With Intrathoracic Muscle Flap Transposition
Authors: Asaad Malke , Van Handel Amelia , Akhavan Arya A. , Huang Tony C. T. , Rajesh Aashish , Shen K. Robert , Allen Mark A. , Sharaf Basel , Moran Steven L.
Published: July 2020

Background

Bronchopleural fistula (BPF) is a dreaded complication of pulmonary resection. For high-risk patients, bronchial stump coverage with vascularized tissue has been recommended. The goal of this study was to report our experience with intrathoracic muscle transposition for bronchial stump coverage.

Methods

A retrospective review of all patients who underwent intrathoracic muscle flap transposition as a prophylactic measure at our institution between 1990 and 2010 was conducted. Demographics, surgical characteristics, and complication rates were abstracted and analyzed.

Results

A total of 160 patients were identified. The most common lung resections performed were pneumonectomy (n = 69, 43%) and lobectomy (n = 60, 38%). A total of 168 flaps were used where serratus anterior was the most common flap (n = 136, 81%), followed by intercostal (n = 14, 8%), and latissimus dorsi (n = 12, 7%). Ten patients (6%) developed BPF, and empyema occurred in 13 patients (8%). Median survival was 20 months, and operative mortality occurred in 7 patients (4%).

Conclusions

Reinforcement of the bronchial closure with vascularized muscle is a viable option for potentially decreasing the incidence of BPF in high-risk patients. Further randomized studies are needed to determine the efficacy of this technique for BPF prevention.
The Evolving Trends in the Impact Factor of Plastic Surgery Journals
Authors: Asaad Malke , Shamoun Feras , Rajesh Aashish , Meaike Jesse , Tran Nho V.
Published: July 2020

Background

The journal impact factor (IF) is one of the most widely adopted metrics to assess journal value. We aimed to investigate the trends in the IF and ranking of plastic surgery journals (PSJs) over a 22-year period.

Methods

The Journal Citation Report 2018 was used to identify all journals within the field of plastic surgery from 1997 to 2018. We analyzed the IF of PSJs and that of the category surgery.

Results

A total of 34 PSJs were identified. The mean IF increased from 0.584 (median, 0.533) in 1997 to 1.58 (median, 1.399) in 2018 (P < 0.0001). Over the same time, the median IF of the journals in the category surgery increased from 0.914 to 1.883. The mean journal IF percentile of PSJs within surgery remained fairly stable (P = 0.999). A strong positive correlation was identified between the IF of PSJs and both the 5-year IF (r = 0.943, P < 0.0001) and the immediacy index (r = 0.736, P < 0.0001). The percentage of self-citations across the study period was fairly stable at a mean of 19.2%. A weak positive correlation was found between the IF and the percentage of self-citations (r = 0.171, P < 0.0001).

Conclusions

The mean journal IF in PSJs has been trending upward over the last 22 years. Ranking of PSJs IF within the category surgery has remained unchanged. The self-citation rate has been fairly stable and correlated weakly with the IF. A strong positive correlation exists between the IF and both the immediacy index and the 5-year IF.
Clinical Outcomes in Ring Avulsion Fingers and Systematic Review of the Literature
Authors: Bonastre Juliá Jorge , Ojeda Regidor Ángela , Martínez-Méndez Jose , Landín Luis , Zarbakhsh Shirin , Iglesias Carmen , Díez Jesús , Casado-Pérez César
Published: July 2020

Ring avulsions continue to be a challenge in reconstructive surgery. We conducted a retrospective study and reviewed all Urbaniak-Kay type IV degloving injuries replanted at our institution between 2011 and 2018. A systematic review of the literature was also conducted to assess the survival rates, functional, and sensibility outcomes. The results of our systematic review outline a survival rate of 79.50% (101/127). With 1 artery being repaired, 79% of the fingers survived, a value that increased to 87.50% when 2 arteries were anastomosed (P = 0.484). Statistically significant differences (P < 0.001) were found when comparing the survival rates of the fingers with 2 or more veins repaired (87%) with those with only 1 vein anastomosed (51.90%). In terms of nerve reconstruction, there was a significant difference (P < 0.001) with the 2-point discrimination test in favor of the reconstructed group when nerve reparation was done (10.80 mm ± 2.95 mm) versus when digital nerves were not repaired (15.25 mm ± 0.50 mm). Fingers after secondary procedures did not obtain better mobility. The mean total active motion in nonreoperated fingers was 221 degrees (195–270 degrees), whereas the total active motion in the cases who received secondary surgeries was 152 degrees (110–195 degrees), with statistically significant differences (P = 0.02). Therefore, we recommend attempting replantation of degloved fingers. All efforts must be done to carry out 2 vein anastomoses, and our results strongly recommend attempting at least some kind of nerve reconstruction. Secondary surgeries should be reserved for selected cases only, because of the extensive scarring in this kind of injuries. Early mobilization protocols must be encouraged to achieve a good functional result.
Repair of Bone Defects With Endothelial Progenitor Cells and Bone Marrow–Derived Mesenchymal Stem Cells With Tissue-Engineered Bone in Rabbits
Authors: Zhao Xian , Han Xue-song , Zhou Qing-Zhu , Liu Bo-yan , Yang Bin , Gong Zhuo , Wang Song-mei , Wang Fu-ke
Published: July 2020

Purpose

This study aimed to investigate the repair of bone defects in rabbits with tissue-engineered bones using cocultured endothelial progenitor cells (EPCs) and bone marrow mesenchymal stem cells (BMSCs) as seeding cells.

Methods

Endothelial progenitor cells and BMSCs were isolated and purified from the peripheral blood and bone marrow, respectively, of New Zealand rabbits. The third passage of BMSCs was cultured alone or with EPCs. Cells were characterized using specific markers and then seeded on partially deproteinized biologic bones from pigs as a scaffold. The engineered bones were used to repair bone defects in rabbits. Hematoxylin and eosin and Masson staining were performed to examine vascularization and osteogenesis in the engineered bone.

Results

The cocultured EPCs and BMSCs grew well on the surface of the scaffold. Compared with monocultured BMSCs, cocultured EPCs and BMSCs promoted the formation of blood vessels and bone on the scaffold, in addition to accelerating the repair of bone defects. The collagen content was significantly increased in the scaffold with cocultured EPCs and BMSCs, compared with the scaffold seeded with mono-cultured BMSCs.

Conclusions

Tissue-engineered bones seeded with cocultured EPCs and BMSCs may be used effectively for the repair of bone defects.
Admission Carboxyhemoglobin
Authors: Puyana Salomon , Ruiz Samuel , Amador Francisco , Hai Shaikh , Young Elizabeth , Lim Rizal , Askari Morad , McKenney Mark , Mir Haaris
Published: July 2020

Background

Carbon monoxide is a gas produced by the combustion of hydrocarbon products that binds to heme molecules, 240 times more than oxygen, producing carboxyhemoglobin (COHb). As a result of its high affinity, there is shift of the oxyhemoglobin dissociation curve, compromising oxygen transport and delivery to tissues. Our study aim was to evaluate COHb elevation on admission as a predictor of worse outcomes in burn patients.

Methods

This is a 10-year retrospective review of the American Burn Association Burn Registry from 2002 to 2011. We stratified the patients into 2 groups: adult patients with normal COHb on admission (group 1) versus elevated COHb (group 2). Elevated COHb levels were defined as greater than 10% on the first arterial blood gas. Outcome measures included in-hospital mortality rate, hospital length of stay (LOS), intensive care unit LOS (ICU-LOS), and ventilator days. χ2 and t test analyses were used with significance defined as a P value of less than 0.05.

Results

A total of 6365 burn patients meet our inclusion criteria. There were 5775 patients in group 1 and 590 patients in group 2. Group 1 had an average age of 39.29 years compared with 42.62 years in group 2. The total body surface area was higher in group 1 compared with group 2 (6.24 vs 4.65) and with a statistically significant increase in partial thickness burns at 4.97 in group 1 compared with 3.27 in group 2. There was no statistically significant difference between the 2 groups in terms of full thickness total body surface area. The hospital LOS was significantly higher in group 2 compared with group 1 (15.34 vs 9.66). There was a significantly higher ICU-LOS at 12.89 days in group 2 compared with 4.01 in the group 1 (P = 0.0001, t test). There were higher ventilator days in group 2 at 9.23 than those in group 1 at 2.05 (P < 0.0001, t test). The in-hospital mortality was also significantly higher in group 2 at 15.59% than in group 1 at 1.33% (P = 0.0001, χ2).

Conclusions

Elevated COHb on admission was associated with an increased hospital and ICU-LOS, average ventilator days, and in-hospital mortality. The presence of elevated COHb of greater than 10% on an initial arterial blood gas suggests worse outcomes and increased need of resource utilization during the index hospital admission.
Adverse Cardiovascular Events Associated With Female Pelvic Reconstructive Surgery
Authors: Roberts Kasey , Slopnick Emily , Chapman Graham , Mangel Jeffrey , Sheyn David
Published: July 2020

Objective

To evaluate national trends in major adverse cardiovascular and cerebrovascular events (MACCE) in female pelvic reconstructive surgery (FPRS).

Methods

Data from the National Inpatient Sample was used to identify women undergoing FPRS between 2012 and 2016. Demographic, procedural, and comorbidity data were collected. Patients were stratified into those with and without MACCE (defined as all-cause mortality, cardiac arrest, myocardial infarction (MI) and acute ischemic stroke). Descriptive statistics are expressed as medians and interquartile ranges. Pairwise analysis was performed using Wilcoxon rank-sum or Fisher exact test as appropriate. Multivariable logistic regression was used to identify independent risk factors for MACCE.

Results

During the study period, 53,540 patients underwent FPRS. The rate of MACCE was 4.8 per 1000 surgeries; MI, 3.7; acute ischemic stroke, 0.6; cardiac arrest, 0.4; and all-cause mortality, 0.3. Patients experiencing MACCE were more likely to have major preexisting cardiovascular comorbidities, coagulopathy, neurologic disease (ND), and diabetes and were more likely to undergo robotic colpopexy (20.7% vs 9.6%, P < 0.001), vaginal colpopexy (32.0% vs 28.5%, P = 0.04), and to receive a blood transfusion (8.2% vs 2.5%, P < 0.001).

On logistic regression, preexisting coagulopathy was the strongest predictor of MACCE (adjusted odds ratio [aOR], 5.53; 95% confidence interval [CI], 2.39–12.78), followed by blood transfusion (aOR, 4.84; 95% CI, 1.89–12.45), congestive heart failure (aOR, 3.61; 95% CI, 1.56–8.37), ND (aOR, 3.14; 95% CI, 1.23–8.06), and electrolyte abnormalities (aOR, 1.99; 95% CI, 1.05–3.99).

Conclusion

Major adverse cardiovascular and cerebrovascular events after FPRS is a rare event, with MI being the most common manifestation. Preexisting ND, congestive heart failure, coagulopathy, electrolyte disturbances, and perioperative transfusions are strongly associated with MACCE.
Manufacturing chemicals with light: any role in the circular economy?
Authors: Poliakoff M. , George M. W.
Published: July 2020

We outline how recent developments in photochemistry can contribute to the realization of the 1912 vision of the pioneering Italian scientist Giacomo Ciamician, namely world-wide chemical-using industry-based chemical plants fuelled solely by the Sun. We then show how a combination of organic photochemistry and flow chemistry could contribute to the circular economy by harnessing the ability of light to provide the energy to promote reactions without the need for some of the added reagents that are necessary in more traditional chemical routes, so-called 'reagentless' chemistry. Photochemistry has a long history but recently it has undergone a renaissance, particularly with the rise in interest in photoredox chemistry. Continuous photoreactors offer a route to scaling up such reactions to a productivity needed for smaller scale pharmaceutical manufacture. We describe some reactor designs from our own laboratory and outline some of their applications. We then relate these to the requirements of the circular economy and the need to conserve the stocks of the less abundant chemical elements.

This article is part of a discussion meeting issue ‘Science to enable the circular economy'.
Biocatalytic recycling of polyethylene terephthalate plastic
Authors: Zimmermann Wolfgang
Published: July 2020

The global production of plastics made from non-renewable fossil feedstocks has grown more than 20-fold since 1964. While more than eight billion tons of plastics have been produced until today, only a small fraction is currently collected for recycling and large amounts of plastic waste are ending up in landfills and in the oceans. Pollution caused by accumulating plastic waste in the environment has become worldwide a serious problem. Synthetic polyesters such as polyethylene terephthalate (PET) have widespread use in food packaging materials, beverage bottles, coatings and fibres. Recently, it has been shown that post-consumer PET can be hydrolysed by microbial enzymes at mild reaction conditions in aqueous media. In a circular plastics economy, the resulting monomers can be recovered and re-used to manufacture PET products or other chemicals without depleting fossil feedstocks and damaging the environment. The enzymatic degradation of post-consumer plastics thereby represents an innovative, environmentally benign and sustainable alternative to conventional recycling processes. By the construction of powerful biocatalysts employing protein engineering techniques, a biocatalytic recycling of PET can be further developed towards industrial applications.

This article is part of a discussion meeting issue ‘Science to enable the circular economy’.
Effect of support acidity during selective hydrogenolysis of glycerol over supported palladium–ruthenium catalysts
Authors: Guadix-Montero Susana , Santos-Hernandez Alba , Folli Andrea , Sankar Meenakshisundaram
Published: July 2020

We report the role of the acidity of support during the selectivity hydrogenolysis of glycerol over supported bimetallic palladium–ruthenium (PdRu) catalysts. The PdRu nanoparticles were supported on a series of metal oxides and zeolitic supports via the modified impregnation method and tested for the liquid-phase hydrogenolysis of glycerol using gaseous hydrogen. The relative acid site densities of selected catalysts were determined by ammonia temperature-programmed desorption and pyridine desorption experiments. Based on these studies, we report a direct correlation between the catalytic activity (conversion and 1,2 propane diol yield) and two different acid sites (strong acid sites and very strong acid sites). Besides zeolite-supported catalysts, TiO
2
supported PdRu nanoparticles exhibit moderate catalytic activity; however, this catalyst shows high selectivity for the desired C–O bond cleavage to produce C3 products over the undesired C–C bond cleavage to produce < C3 products.

This article is part of a discussion meeting issue ‘Science to enable the circular economy’.