bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Paravertebral Muscle Mass and Improvement in Sagittal Imbalance After Decompression Surgery of Lumbar Spinal Stenosis
Authors: Yoshida Yuichi , Ohya Junichi , Yasukawa Taiki , Onishi Yuki , Kunogi Junichi , Kawamura Naohiro
Published: August 2021

Study Design.

Retrospective observational study.

Objective.

This study examined associated factors for the improvement in spinal imbalance following decompression surgery without fusion.

Summary of Background Data.

Several reports have suggested that decompression surgery without fusion may have a beneficial effect on sagittal balance in patients with lumbar spinal stenosis (LSS) through their postoperative course. However, few reports have examined the association between an improvement in sagittal imbalance and spinal sarcopenia.

Methods.

We retrospectively reviewed 92 patients with LSS and a preoperative sagittal vertical axis (SVA) more than or equal to 40 mm who underwent decompression surgery without fusion at a single institution between April 2017 and October 2018. Patients’ background and radiograph parameters and the status of spinal sarcopenia, defined using the relative cross-sectional area (rCSA) of the paravertebral muscle (PVM) and psoas muscle at the L4 caudal endplate level, were assessed. We divided the patients into two groups: those with a postoperative SVA less than 40 mm (balanced group) and those with a postoperative SVA more than or equal to 40 mm (imbalanced group). We then compared the variables between the two groups.

Results.

A total of 29 (31.5%) patients obtained an improved sagittal imbalance after decompression surgery. The rCSA-PVM in the balanced group was significantly higher than that in the imbalanced group (P = 0.042). The preoperative pelvic incidence (PI)-lumbar lordosis (LL) mismatch (P = 0.048) and the proportion with compression vertebral fracture (P = 0.028) in the balanced group were significantly lower than those in the imbalanced group. A multivariate logistic regression analysis identified PI-LL less than or equal to 10° and rCSA-PVM more than or equal to 2.5 as significant associated factor for the improvement in spinal imbalance following decompression surgery.

Conclusion.

A larger volume of paravertebral muscles and a lower PI-LL were associated with an improvement in sagittal balance in patients with LSS who underwent decompression surgery.

Level of Evidence: 3
Should We Prolong the Observation Period for Neurological Recovery After Cardiac Arrest?*
Authors: Tsai Min-Shan , Chen Wen-Jone , Chen Wei-Ting , Tien Yu-Tzu , Chang Wei-Tien , Ong Hooi-Nee , Huang Chien-Hua
Published: August 2021

OBJECTIVES:

To evaluate whether the recommended observation period of 7 days for cardiac arrest survivors is sufficient for conscious recovery and to identify the variables associated with eventual neurologic recovery among patients with delayed awakening.

DESIGN:

A retrospective cohort study.

SETTING:

A single tertiary medical center.

PATIENTS:

Five-hundred twenty-nine nontraumatic adult cardiac arrest survivors with prearrest favorable neurologic function (Cerebral Performance Category 1–2) who survived to hospital discharge during 2011–2019.

INTERVENTIONS:

The enrolled patients were classified into favorable (Cerebral Performance Category 1–2) and poor (Cerebral Performance Category 3–4) neurologic recovery according to their neurologic function at hospital discharge. Among patients with favorable neurologic recovery, those who recovered within 7 days were assigned to the early recovery group or after 7 days as the late recovery group.

MEASUREMENTS AND MAIN RESULTS:

There were 395 patients exhibiting favorable neurologic recovery (n = 357 in the early group, n = 38 in late group) and 134 patients exhibiting poor neurologic recovery (poor recovery group). Among patients who remained unconscious on day 7, delayed awakening was associated with male sex (odds ratio [OR], 3.905; 95% CI, 1.153–13.221), prehospital return of spontaneous circulation (OR, 7.628; 95% CI, 2.084–27.922), therapeutic hypothermia (OR, 4.320; 95% CI, 1.624–11.488), and extracorporeal cardiopulmonary resuscitation (OR, 4.508; 95% CI, 1.414–14.371). Being transferred from another hospital, however, was less likely to be associated with delayed awakening (OR, 0.061; 95% CI, 0.009–0.431). The median duration for patients to regain clear consciousness in the late recovery group was 12.12 days. No patient who recovered consciousness had an unfavorable electroencephalography pattern, however, in patients with poor recovery, the 7-day electroencephalography showed 45 patients with generalized suppression (33.6%), two with burst suppression (1.5%), 14 with seizure/epileptic discharge (10.5%), and one with status epilepticus (0.7%).

CONCLUSIONS:

Up to 9.6% of cardiac arrest patients with favorable outcomes recover consciousness after the recommended 7 days of observation, indicating the observation time of 7 days seems justified but longer duration may be needed. The results of the culturally and clinically isolated population may limit the application to other population.
Maintenance therapies in acute myeloid leukemia: the renaissance of an old therapeutic concept
Authors: Bewersdorf Jan Philipp , Tallman Martin S. , Stahl Maximilian
Published: August 2021

Purpose of review

Disease relapse remains the major cause of death in patients with acute myeloid leukemia (AML) and is driven by the persistence of leukemic cells following induction chemotherapy or allogeneic hematopoietic cell transplant (allo-HCT). Maintenance therapies to extend the duration of remission and to improve survival have been proposed for several years with mixed results but have experienced a renaissance recently.

Recent findings

The oral hypomethylating agent CC-486 has been the first agent to show an overall survival (OS) benefit compared with observation in AML patients in remission following intensive chemotherapy who are not proceeding to allo-HCT. In the realm of maintenance therapy following allo-HCT, the FLT3 inhibitor sorafenib has yielded superior results in terms of OS and relapse-free survival in randomized trials compared with observation. Several open questions remain regarding patient selection, timing, duration and safety of maintenance therapies. Various targeted agents are currently tested in clinical trials and could potentially enable an even more individualized therapeutic approach.

Maintenance therapies following intensive chemotherapy or allo-HCT offer a new therapeutic paradigm for an increasing number of AML patients and have been shown to result in an OS benefit in selected patients.
Molecular and Immune Correlates of PDCD1 (PD-1), PD-L1 (CD274), and PD-L2 (PDCD1LG2) DNA Methylation in Triple Negative Breast Cancer
Authors: Ralser Damian J. , Klümper Niklas , Gevensleben Heidrun , Zarbl Romina , Kaiser Christina , Landsberg Jennifer , Hölzel Michael , Strieth Sebastian , Faridi Andree , Abramian Alina , Dietrich Dimo
Published: August 2021

Immune checkpoints are important targets in oncological therapy. Recent studies have proven efficacy of immune checkpoint inhibition (ICI) in treatment of triple negative breast cancer (TNBC). However, only a proportion of TNBC-patients benefit from ICI. Thus, current scientific efforts in this context are focused on the identification of a robust biomarker that enables patient stratification. In the present study, we investigated the epigenetic regulation of PD-1 (PDCD1), PD-L1 (CD274), and PD-L2 (PDCD1LG2). Methylation data of PD-1, PD-L1, and PD-L2, and complex immunogenomic data were obtained from The Cancer Genome Atlas (TCGA). Methylation were systematically analyzed with regard to the transcriptional activity of the studied immune checkpoint genes and the tumor microenvironment. We found differential methylation of PD-1, PD-L1, and PD-L2 in normal adjacent tissue and TNBC tumor tissue. In the TNBC-TCGA cohort, methylation status of PD-1, PD-L1, and PD-L2 were significantly correlated with mRNA levels indicating a strong epigenetic regulation of the transcriptional activity. Moreover, PD-1, PD-L1, and PD-L2 methylation status was strongly associated with a distinct immune cell infiltration pattern. Our results indicate an epigenetic regulation of immune checkpoint genes through DNA methylation in TNBC. In addition, the methylation status was associated with a distinct composition of the tumor microenvironment. Overall, this provides a strong rationale for assessing the value of PD-1, PD-L1, and PD-L2 DNA methylation to predict response to ICI and immunogenicity in TNBC.
How to Minimize the Pain of Local Anesthetic Injection for Wide Awake Surgery
Authors: Joukhadar Nadim , Lalonde Donald
Published: August 2021

After reading this article, the participant should be able to (1) almost painlessly inject tumescent local anesthesia to anesthetize small or large parts of the body, (2) improve surgical safety by eliminating the need for unnecessary sedation in patients with multiple medical comorbidities, and (3) convert many limb and face operations to wide awake surgery. We recommend the following 13 tips to minimize the pain of local anesthesia injection: (1) buffer local anesthetic with sodium bicarbonate; (2) use smaller 27- or 30-gauge needles; (3) immobilize the syringe with two hands and have your thumb ready on the plunger before inserting the needle; (4) use more than one type of sensory noise when inserting needles into the skin; (5) try to insert the needle at 90 degrees; (6) do not inject in the dermis, but in the fat just below it; (7) inject at least 2 ml slowly just under the dermis before moving the needle at all and inject all local anesthetic slowly when you start to advance the needle; (8) never advance sharp needle tips anywhere that is not yet numb; (9) always inject from proximal to distal relative to nerves; (10) use blunt-tipped cannulas when tumescing large areas; (11) only reinsert needles into skin that is already numb when injecting large areas; (12) always ask patients to tell you every time they feel pain during the whole injection process so that you can score yourself and improve with each injection; (13) always inject too much volume instead of not enough volume to eliminate surgery pain and the need for “top ups.”
Relationships between subendocardial perfusion impairment, arterial stiffness and orthostatic hypotension in hospitalized elderly individuals
Authors: Fantin Francesco , Giani Anna , Macchi Federica , Amadio Giulia , Rossi Andrea P. , Zoico Elena , Mazzali Gloria , Zamboni Mauro
Published: August 2021

Background:

Orthostatic hypotension is an independent risk factor for cardiovascular morbidity and mortality. Arterial stiffness has been shown to be a pathophysiological mechanism linking orthostatic hypotension and increased cardiovascular risk. This study aims to evaluate the relationship between arterial stiffness, orthostatic hypotension and subendocardial viability ratio (SEVR) and moreover to identify the main predictors of orthostatic hypotension, carotid-femoral pulse wave velocity (PWV-cf) and SEVR.

Methods:

Seventy-five patients were enrolled (mean age 82.95 ± 6.45) in Verona's AOUI Geriatric ward. They underwent blood pressure, heart rate, body weight measurements and also comorbidity, arterial stiffness (PWV-cf measured by applanation tonometry), SEVR and biochemical indexes.

Results:

Prevalence of orthostatic hypotension was 46.6%. Even after adjustment for age, sex, glomerular filtration rate and mean arterial pressure, SEVR values corrected for arterial oxygen and haemoglobin content were statistically lower in orthostatic hypotension patients (P = 0.05) and PWV-cf values were statistically higher in orthostatic hypotension individuals (P = 0.042). In a binary logistic regression, PWV-cf was the only significant predictor of orthostatic hypotension (odds ratio 1.123; P = 0.039; confidence interval = 1.006--1.17).

In a backward logistic regression model sex, creatinine clearance and orthostatic hypotension were significant predictors of SEVR corrected for O2 content. Mean arterial pressure, creatinine clearance and orthostatic hypotension were significant predictors of PWV-cf.

Conclusion:

This study shows that orthostatic hypotension is related to increased arterial stiffness, confirming its higher prevalence in elderly patients. Orthostatic hypotension was also associated with reduced values of corrected SEVR, showing a relevant consequence of orthostatic hypotension on subendocardial perfusion impairment.
The Effect of Benson Relaxation Technique on Stress, Anxiety, and Depression in Pregnant Women
Authors: Zenouzi Azade , Moghadam Zahra Behboodi , Babayanzad Shahnaz , Asghari Masoumeh , Rezaei Elham
Published: August 2021

Relaxation programs can be effective in establishing psychological tranquility for maternal and fetal health. This study was conducted to evaluate the effect of this low-cost, effective, easy method on the stress, anxiety, and depression in pregnant women. This randomized clinical trial study was conducted from July 2015 to July 2016. Seventy pregnant women in the third trimester of pregnancy were included in this study. Participants were randomly assigned to 2 groups of 35 subjects using a random number table. Participants in group 1 received relaxation training and group 2 received routine care. A demographic questionnaire and Depression, Anxiety, and Stress Scale (DASS-21) were completed before and 1 and 2 months after the intervention. The SPSS software version 18 was used for data analysis. There were significant differences in the mean difference of the total DASS score (14; 95% confidence interval [CI]: 4 to 32) as well as the scores of stress (4; 95% CI : 1 to 10), anxiety (6; 95% CI: 2 to 10), and depression (6; 95% CI: 2 to 12) 2 months after the intervention between the 2 groups. The Benson relaxation technique decreased DASS-21 scores in the intervention group.
Pharmacologic therapies for neuropathic pain: an assessment of reporting biases in randomized controlled trials
Authors: Schwartz Stefani M. , Barpujari Awinita , Finnerup Nanna Brix , Raja Srinivasa N.
Published: August 2021

Several different reporting biases cited in scientific literature have raised concerns about the overestimation of effects and the subsequent potential impact on the practice of evidence-based medicine and human health. Up to 7% to 8% of the population experiences neuropathic pain (NP), and established treatment guidelines are based predominantly on published clinical trial results. Therefore, we examined published randomized controlled trials (RCTs) of first-line drugs for NP and assessed the relative proportions with statistically significant (ie, positive) and nonsignificant (ie, negative) results and their rates of citation. We determined the relationships between reported study outcome and the frequency of their citations with journal impact factor, sample size, time to publication after study completion, and study quality metrics. We also examined the association of study outcome with maximum study drug dosage and conflict of interest. We found that of 107 published RCTs, 68.2% reported a statistically significant outcome regarding drug efficacy for chronic peripheral and central NP. Positive studies were cited nearly twice as often as negative studies in the literature (P = 0.01), despite similar study sample size, quality metrics, and publication in journals with similar impact factors. The time to publication, journal impact factor, and conflict of interest did not differ statistically between positive and negative studies. Our observations that negative and positive RCTs were published in journals with similar impact at comparable time-lags after study completion are encouraging. However, the citation bias for positive studies could affect the validity and generalization of conclusions in literature and potentially influence clinical practice.
Trajectories of pregabalin use and their association with longitudinal changes in opioid and benzodiazepine use
Authors: Schaffer Andrea L. , Brett Jonathan , Buckley Nicholas A. , Pearson Sallie-Anne
Published: August 2021

Concomitant use of pregabalin with opioids and/or benzodiazepines is common, despite the increased risks. However, clinical trials suggest pregabalin can have an opioid-sparing effect when treating acute postoperative pain. We explored how opioid and benzodiazepine use changed over time in people initiating pregabalin, using dispensing claims data for a 10% sample of Australians (2013-19). Among 142,776 people initiating pregabalin (median age = 61 years, 57% female), we used group-based trajectory modelling to identify 6 pregabalin dose trajectories in the first year postinitiation. Two trajectories involved discontinuation: after one dispensing (49%), and after 6 months of treatment (14%). Four trajectories involved persistent use with variable estimated median daily doses of 39 mg (16%), 127 mg (14%), 276 mg (5%), and 541 mg (2%). We quantified opioid and benzodiazepine use in the year before and after pregabalin initiation using generalised linear models. Over the study period, 71% were dispensed opioids and 34% benzodiazepines, with people on the highest pregabalin dose having highest rates of use. Opioid use increased postpregabalin initiation. Among people using both opioids and pregabalin, the geometric mean daily dose in oral morphine equivalents increased after pregabalin initiation in all trajectories, ranging from +5.9% (99% confidence interval 4.8%-7.0%) to +39.8% (99% confidence interval 38.3%-41.5%) in people on the highest daily pregabalin dose. Among people using both pregabalin and benzodiazepines, the dose remained constant over time for people in all trajectories. Notwithstanding its reputation as opioid-sparing, in this outpatient setting, we observed that people using opioids tended to use higher opioid daily doses after pregabalin initiation, especially those on high pregabalin doses.
Public Health Nursing and Community Health Worker Teams
Authors: Cooper Jennifer , Bejster Mallory , Policicchio Judi , Langhorne Tamera , Jackson Shanteny , Shelton Patrice , Toney Stephanie
Published: August 2021

Since 2009, a community-based, collaborative exemplar in Richmond, Virginia, involving 8 satellite clinics of the state health department, has been implemented within public housing units to focus on prevention and access to care. These satellite centers, known a resource center (RCs), are staffed by public health nurses, community health workers, and nurse practitioners working in complementary roles. The RCs have provided education to 2609 clients on family planning, safe sex practices, safe car seat use, and screening for sexually transmitted infections and have made 9591 patient referrals to health, social, and community services.
Framing the Integration of Community Health Workers Into Health Care Systems Along Health Care and Community Spectrums
Authors: McCarville Erin E. , Martin Molly A. , Pratap Preethi Lakshmi , Pinkser Eve , Seweryn Steven M. , Peters Karen E.
Published: August 2021

Research calls for community health worker (CHW) integration within health systems, yet there is no agreement regarding what CHW integration is or guidance for how it can be achieved. This study examines factors associated with CHW integration in community and health care settings using a qualitative descriptive multiple-embedded case study of CHW teams at the University of Illinois at Chicago. Data were collected via semistructured interviews/document review and analyzed using thematic coding and quantitative content analysis. Factors associated with higher clinical integration included culture, communication, protocols, and training while higher community integration was associated with accessibility, relationships, and empathy.
Factor Structure for the Sport Concussion Assessment Tool Symptom Scale in Adolescents After Concussion
Authors: Alsalaheen Bara , Li Yuanzhi , Almeida Andrea , Eckner James , Freeman Jeremiah , Popovich Michael , Streicher Nicholas , He Xuming , Lorincz Matthew
Published: August 2021

Objective:

To examine the factor structure of the Sport Concussion Assessment Tool-5 (SCAT5) symptom scale in adolescents on their initial presentation to a concussion clinic within the typical recovery period after concussion (ie, <30 days). We hypothesize that the SCAT5 symptoms represent various clinically meaningful groups. A secondary purpose was to examine the effects of sex on the factor structure of the SCAT5 symptom scale.

Study Design:

Retrospective cross-sectional analysis.

Setting:

Tertiary, institutional.

Patients:

Nine hundred eighty-one adolescents (45% women) aged between 13 and 18 years.

Independent Variables:

Adolescents completed the SCAT5 symptom scale.

Main Outcome Measures:

The factor structure of SCAT5 examined using a principal axis factor analysis.

Results:

A 5-factor structure model explained 61% of the variance in symptoms. These 5 factors are identified as Energy (17%), Mental Health (13%), Migrainous (13%), Cognitive (9%), and Vestibulo-Ocular (9%). A similar 5-factor model emerged for each sex, and the proportion of variance in symptoms explained by the 5-factor model was comparable between the sexes.

Conclusions:

The findings of this report indicate that the SCAT5 symptoms aggregated into 5 delineated factors, and these factors were largely consistent across the sexes. The delineation of symptoms into 5 factors provides preliminary validation for the presence of different concussion phenotypes. Confirmatory factor analysis is warranted to examine the applicability and clinical utility of the use of the 5-factor structure in a clinical setting.
Impact of initial very low-level low-density lipoprotein cholesterol on the prognosis of acute myocardial infarction patients
Authors: Choi Woong Gil , Baek Man Jong , Rha Seung-Woon , Choi Byoung Geol , Ryu Yang gi , Lee Cheol Ho , Choi Cheol Ung , Park Chang Gyu , Seo Hong Seog , Jeong Myung Ho ,   other Korea Acute Myocardial Infarction Registry (KAMIR) Investigators
Published: August 2021

Background

Cholesterol control with statins has been shown to have beneficial effects in coronary artery disease. However, the relationship between initial very low low-density lipoprotein (LDL) cholesterol levels and long-term clinical outcomes in patients with acute myocardial infarction (AMI) remains unclear.

Methods

A total of 8741 (mean age: 64.6 ± 12.7 years, men) consecutive AMI patients treated with drug-eluting stents were entered into the Korea Acute Myocardial Infarction Registry from November 2011 to December 2015. Patients were divided into six groups according to whether they were taking statins (on-statin group) or not (statin naive group) and depending on their LDL cholesterol level at admission (<70, 70–99, 100–129, 130–159, >160 mg/dl). Clinical outcomes at 24 months in patients with AMI were examined.

Results

The incidence of risk factors including hypertension, diabetes, coronary artery disease and heart failure was lower as LDL cholesterol increased, except in the on-statin group. Clinical outcomes, including total mortality at 24 months, showed better outcomes in those with high LDL cholesterol than those with low LDL cholesterol, except in the statin group. In the statin-naïve group, the higher the LDL cholesterol level, the higher the rate of 24-month survival. In a Cox regression model, initial low LDL cholesterol was an independent predictor of mortality at 24 months after adjusting for baseline confounding factors.

Conclusions

At admission, a very low LDL cholesterol level (<70 mg/dL) in statin-naïve AMI patients undergoing percutaneous coronary intervention was independently associated with higher mortality at 24 months.
Compared to conventional PET/CT scanners, silicon-photomultiplier-based PET/CT scanners show higher arterial 18F-FDG uptake in whole-body 18F-FDG-PET/CT
Authors: Kaneko Koichiro , Baba Shingo , Isoda Takuro , Ishioka Hisakazu
Published: August 2021

Objectives

To clarify differences in arterial 18F-FDG (fluorodeoxyglucose) uptake between silicon photomultiplier (SiPM)-based and conventional PET/CT scanners, and to compare clinical and phantom results.

Patients and methods

Twenty-six patients with lung tumours underwent serial SiPM-based and conventional PET/CT scans on the same day. We compared the target-to-background ratios [TBRsi (SiPM), TBRc (conventional)] and the percentage difference between TBRsi and TBRc (ΔTBR) in the carotid artery, aorta and peripheral arteries. The correlation between ΔTBR and vessel size was also investigated. In the carotid artery, active segment analyses were performed with the threshold (TBR ≥1.6), and we compared each scanner’s ratio of active segments and TBR values. We compared the clinical results with the recovery coefficients (RCs).

Results

The TBRsi was significantly higher than the TBRc in the carotid artery, aorta and peripheral arteries (1.63 ± 0.22 vs. 1.43 ± 0.22, 1.65 ± 0.19 vs. 1.53 ± 0.15 and 1.37 ± 0.31 vs. 1.11 ± 0.27, mean ± SD, P ≤ 0.0001 for all), and the peripheral arteries showed the highest ΔTBR (24.4 ± 16.8%). The small (10–15 mm) vessels (26.9 ± 15.9%) showed significantly higher ΔTBRs than the larger vessels (7.3 ± 8.5% for 15–20 mm, 8.0 ± 12.8% for ≥20 mm, P < 0.0001 for both). The carotid artery showed significantly higher ratios of active segment (54.5 vs. 20.5%, P < 0.0001) and TBR values (1.85 ± 0.25 vs. 1.76 ± 0.15, P = 0.0006) for TBRsi vs. TBRc. The differences in RCs were similar to those of ΔTBR for each vessel size.

Conclusions

SiPM-based PET/CT scanners showed higher arterial 18F-FDG uptake (especially in vessels <15 mm) than conventional scanners, and the threshold TBR ≥1.6 is not applicable for the carotid artery for SiPM-based PET/CT systems.
‘As a surgeon, I am obliged to every single patient’: evaluation of focus group discussions with transplantation physicians on the allocation of donor organs
Authors: Bartling Tim , Oedingen Carina , Schrem Harald , Kohlmann Thomas , Krauth Christian
Published: August 2021

Introduction

Organ transplantation is the last resort for many patients. The ubiquitous shortage of suitable donor organs raises the question of best-justifiable allocation worldwide. This study investigates how physicians would allocate donor organs.

Methods

Focus group discussions with a total of 12 transplant surgeons and 2 other transplant-related physicians were held at the annual conference of the German Transplantation Society (Oct 2019). Three groups discussed aspects of ‘egalitarianism’, ‘effectiveness/benefit’, ‘medical urgency’, ‘own fault’, ‘medical background’ and ‘socio-demographic status’.

Results and Discussion

It was observed that physicians often find themselves confronted with conflicts between (a) trying to advocate for their individual patients versus (b) seeing the systemic perspective and understanding the global impact of their decisions at the same time. The groups agreed that due to the current shortage of donor organs in the German allocation system, transplanted patients are often too sick at the point of transplantation and that a better balance between urgency and effectiveness is needed. The aspects of ‘effectiveness’ and ‘urgency’ were identified as the most challenging issues and thus were the main focus of debate. The dilemmas physicians find themselves in become increasingly severe, the larger the shortage of suitable donor organs is.
Clinical and biomarker assessment of frailty in liver transplantation
Authors: Ayorinde Tumininu , Panayotova Guergana , Sharma Aanchal , Lunsford Keri E.
Published: August 2021

Purpose of review

Liver cirrhosis results in progressive decline, or frailty, which leads to poor outcomes and decreased survival. Multiple biomarkers and clinical assessment tools for quantifying frailty in liver transplant candidates exist, but a universal scoring protocol is lacking. Criteria vary between studies and correlation with patient outcome is not always clear. This review aims to summarize the pertinent biomarkers and assessment tools of frailty in cirrhosis.

Recent findings

As cirrhosis progresses, the resultant ‘frailty’ is an inseparable independent predictor of pre and posttransplant mortality. Pro-inflammatory, neuroendocrine, and adipokine factors are dysregulated – leading to paradoxical anorexia and downregulation of orexigenic signals. The resulting catabolic utilization of amino and fatty acids leads to progressive malnutrition and sarcopenia. Both functional and imaging criteria define sarcopenia in cirrhotic patients, and degree of debilitation correlates with mortality. Liver-disease-specific frailty biomarkers and scoring tools are optimal to assess physical dysfunction in cirrhotics to promote early diagnosis and intervention.

Liver cirrhosis and resulting frailty are progressive and portend a poor patient prognosis. A comprehensive, validated algorithm for detecting and quantifying frailty specific to liver disease would allow for standardization and facile application in the clinical setting. Early diagnosis is key for timely intervention and improved patient outcomes.
Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination for Paediatric Patients With Inflammatory Bowel Diseases
Authors: Veereman Gigi , Bronsky Jiri
Published: August 2021

In this communication, the members of the Porto group (the European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN], inflammatory bowel diseases [IBD] working group) provide the current available evidence regarding vaccination of children and young adolescents with IBD against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our intent is to help provide meaningful answers to the concerns that parents and adolescents may have.
Endoscopic Mucosal Resection in Children
Authors: Vitale David S. , Wang Kelly , Jamil Laith H. , Park Kenneth H. , Liu Quin Y.
Published: August 2021

Objectives:

Endoscopic mucosal resection (EMR) for removal of large polyps is well established in adults. EMR technique in the pediatric population is less utilized due to lower incidence of large intestinal polyps in pediatric patients and limited EMR training for pediatric gastroenterologists. The aim of this study is to retrospectively review safety and efficacy of pediatric EMR cases at two large, tertiary referral centers with adult and pediatric EMR expertise.

Methods:

A retrospective chart review was conducted at Cedars‐Sinai Medical Center and Cincinnati Children's Hospital Medical Center from January 2012 to May 2021. Demographic, clinical, technical and follow up data were collected for patients <18 years of age who underwent EMR during the study period.

Results:

Fifteen pediatric EMR procedures were identified in 11 patients (five male, six female) during the study period. Indication was most frequently rectal bleeding. Polyp size removed ranged from 9 to 60 mm and pathology was consistent with juvenile inflammatory polyps in six patients. Technical success was achieved in 14 of 15 (93%) of EMRs with clinical success (desired clinical outcome) in all 13 procedures with clinical follow‐up. There were no adverse events.

Conclusions:

This study identifies a case series of pediatric patients who underwent EMR at two tertiary care centers. This series demonstrates successful EMR in children and shows a high technical and clinical success rate with a low complication rate. More investigation into EMR in pediatric patients is necessary, and its use should be isolated to centers with endoscopists with specific experience in EMR techniques.
Fifteen Years' Experience With Safe and Effective Procedural Sedation in Infants and Children in a General Emergency Department
Authors: Mace Sharon E. , Ulintz Alexander , Peterson Brendan , Nowacki Amy S. , Worley Jasmine , Zamborsky Steven
Published: August 2021

Objective

To evaluate procedural sedation (PS) in infants/children, performed by emergency physicians in a general (nonpediatric) emergency department (ED).

Methods

Procedural sedation prospectively recorded on a standardized form over 15 years. Demographics, sedatives, and analgesia associations with adverse events were explored with logistic regressions.

Results

Of 3274 consecutive PS, 1177 were pediatric: 2 months to 21 years, mean age (±SD) 8.7 ± 5.2 years, 63% boys, 717 White, 435 Black, 25 other. Eight hundred and seventy were American Society of Anesthesiology (ASA) 1, 256 ASA 2, 39 ASA 3, 11 ASA 4, 1 ASA 5. Procedural sedation indications are as follows: fracture reduction (n = 649), dislocation reduction (n = 114), suturing/wound care (n = 244), lumbar puncture (n = 49), incision and drainage (n = 37), foreign body removal (n = 28), other (n = 56). Sedatives were ketamine (n = 762), propofol ( = 354), benzodiazepines (n = 157), etomidate (n = 39), barbiturates (n = 39). There were 47.4% that received an intravenous opioid. Success rate was 100%. Side effects included nausea/vomiting, itching/rash, emergence reaction, myoclonus, paradoxical reaction, cough, hiccups. Complications were oxygen desaturation less than 90%, bradypnea respiratory rate less than 8, apnea, tachypnea, hypotension, hypertension, bradycardia, tachycardia. Normal range of vital signs was age-dependent. Seventy-four PS (6.3%) resulted in a side effect and 8 PS (3.2%) a complication. No one died, required hospital admission, intubation, or any invasive procedure.

Conclusions

Adverse events in infants/children undergoing PS in a general ED are low and comparable to a pediatric ED at a children's hospital. Pediatric PS can be done safely and effectively in a general ED by nonpediatric EM physicians for a wide array of procedures.
Multivariable Analysis of Patient Satisfaction in the Pediatric Emergency Department
Authors: Heyming Theodore W. , Donaldson Candice D. , Ehwerhemuepha Louis , Feaster William , Fortier Michelle A. , Kain Zeev N.
Published: August 2021

Background

Published data on predictive factors associated with parent satisfaction from care in a pediatric emergency department (ED) visit are limited to be descriptive and obtained from small data sets. Accordingly, the purpose of this study was to determine both modifiable and nonmodifiable demographic and operational factors that influence parental satisfaction using a large and ethnically diverse site data set.

Methods

Data consist of responses to the National Research Council (NRC) survey questionnaires and electronic medical records of 15,895 pediatric patients seen in a pediatric ED between the ages of 0 and 17 years discharged from May 2018 to September 2019. Bivariate, χ2, and multivariable logistic regression analyses were carried out using the NRC item on rating the ED between 0 and 10 as the primary outcome. Responses were coded using a top-box approach, a response of “9” or “10” represented satisfaction with the facility, and every other response was indicated as undesirable. Demographic data and NRC questionnaire were used as potential predictors.

Results

Multivariable regression analysis found the following variables as independent predictors for positive parental rating of the ED: Hispanic race/ethnicity (odds ratio [OR], 1.285), primary language Spanish (OR, 2.399), and patients who had government-sponsored insurance (OR, 1.470). Those survey items with the largest effect size were timeliness of care (OR, 0.188) and managing discomfort (OR, 0.412).

Conclusions

Parental rating of an ED is associated with nonmodifiable variables such as ethnicity and modifiable variables such as timeliness of care and managing discomfort.
Training Characteristics, Academic Accomplishments, and Motivation of Current Chairs in Physical Medicine and Rehabilitation
Authors: Martinez Claudia I. , Sanchez Ashley N. , Knecht Kearstin , Frontera Joel , Escalon Miguel X. , Verduzco-Gutierrez Monica , Lee Michael Y.
Published: August 2021

Objective

The aim of the study was to report the training characteristics, academic accomplishments, and motivation of current United States academic physical medicine and rehabilitation chairs.

Design

The authors developed a 23-question survey that was disseminated via e-mail to 86 current chairs who were members of the Chairs Council from the Association of Academic Physiatrists in May 2020. Follow-up e-mails were sent 2 and 4 wks after the initial distribution, and the survey closed after 6 wks in June 2020. The data collected were deidentified. Descriptive analysis was performed.

Results

Forty-nine chair responses were received, which had a response rate of 60%. A total of 69.4% of the chairs (32 of 49) were men and 30.6% (17 of 49) were women. A total of 75.5% (37 of 49) were White/Caucasian, 12.2% (6 of 49) Hispanic/Latinx, 10.2% (5 of 49) Asian, and 2% (1 of 49) were Black/African American. A total of 8.2% of the chairs (4 of 49) reported having a disability. Sixty-seven percent of the female chairs (10 of 15) reported experiencing gender discrimination in the workplace versus 3% of male chairs (1 of 34). Twenty-nine percent of the chairs were full professors in physical medicine and rehabilitation when first appointed, 57.1% associate professors, and 6% assistant professors. A total of 73.5% of the chairs had served as a reviewer for a peer-reviewed publication. Fifty-two percent of the chairs had a leadership role in a national physical medicine and rehabilitation organization. Fifty-eight percent of the chairs had at least 16 peer-reviewed publications when first appointed.

Conclusions

This survey provides insight to the training characteristics, accomplishments, and motivation of current chairs for physiatrists aspiring to enter these ranks. It also highlights the underrepresentation of women and minorities among leadership positions in physical medicine and rehabilitation.
Explainable Prediction of Dacryocystitis From Noninvasive Ocular Indicators Using Deep Stacked Network and The Shapley Additive Explanations Approach
Authors: Han Fuchang , Liao Shenghui , Song Xuefei , Chen Shaoqin , Li Lunhao , Liu Shu , Zhao Yuqian
Published: August 2021

Dacryocystitis diagnosis is important for preventing rapid blurring and vision loss. Existing state-of-the-art methods focus on routine clinical examinations and objective scattering index-based statistical analysis. Such approaches are invasive operations or lack quantitative indicators, and their application is limited. in addition, little attention has been paid to the explainability and clinical utility of models. This paper proposes an explainable dacryocystitis prediction model from noninvasive ocular indicators. The proposed model is based on an deep stacked network with 4 improvements: a multivariable feature extraction module, obtaining comprehensive predictive factors including the quantitative ocular indictors, conventional texture features, and deep learning features from shallow to deep convolutional layers; a multifeature fusion and attribute selection module based on the ReliefF method, guiding the network to focus on useful information at variables; Decision curve analysis the model is introduced into the model to evaluates the risks and benefits; and appending a SHapley Additive exPlanations (SHAP) module to the framework to automatically and efficiently interpret the prediction of the models. By integrating the above improvements in series, the models’ performances are gradually enhanced. Real labeled data samples are used to train and test the model, and our model achieves high accuracy and reliability.
The utility of genomic prediction models in evolutionary genetics
Authors: McGaugh Suzanne E. , Lorenz Aaron J. , Flagel Lex E.
Published: August 2021

Variation in complex traits is the result of contributions from many loci of small effect. Based on this principle, genomic prediction methods are used to make predictions of breeding value for an individual using genome-wide molecular markers. In breeding, genomic prediction models have been used in plant and animal breeding for almost two decades to increase rates of genetic improvement and reduce the length of artificial selection experiments. However, evolutionary genomics studies have been slow to incorporate this technique to select individuals for breeding in a conservation context or to learn more about the genetic architecture of traits, the genetic value of missing individuals or microevolution of breeding values. Here, we outline the utility of genomic prediction and provide an overview of the methodology. We highlight opportunities to apply genomic prediction in evolutionary genetics of wild populations and the best practices when using these methods on field-collected phenotypes.
Parallel evolution ofVarroaresistance in honey bees: a common mechanism across continents?
Authors: Grindrod Isobel , Martin Stephen J.
Published: August 2021

The near-globally distributed ecto-parasitic mite of theApis melliferahoneybee,Varroa destructor,has formed a lethal association with Deformed wing virus, a once rare and benign RNA virus. In concert, the two have killed millions of wild and managed colonies, particularly across the Northern Hemisphere, forcing the need for regular acaricide application to ensure colony survival. However, despite the short association (in evolutionary terms), a small but increasing number ofA. melliferapopulations across the globe have been surviving many years without any mite control methods. This long-term survival, orVarroaresistance, is consistently associated with the same suite of traits (recapping, brood removal and reduced mite reproduction) irrespective of location. Here we conduct an analysis of data extracted from 60 papers to illustrate how these traits connect together to explain decades of mite resistance data. We have potentially a unified understanding of naturalVarroaresistance that will help the global industry achieve widespread miticide-free beekeeping and indicate how different honeybee populations across four continents have resolved a recent threat using the same suite of behaviours.
Shewanella cyperi sp. nov., a facultative anaerobic bacterium isolated from mangrove sediment
Authors: Zhang Qi , Liu Guohong , Narsing Rao Manik Prabhu , Tang Rong , Yang Shang , Ye Wen-Yuan , Zhou Shun-Gui , Li Wen-Jun
Published: August 2021

Two Gram-stain-negative, motile, facultatively anaerobic, rod-shaped strains, FJAT-53720T and FJAT-53726, were isolated from rhizosphere sediment of plant Cyperus malaccensis. Phylogenetic analysis based on their 16S rRNA gene sequences revealed that strains FJAT-53720T and FJAT-53726 were affiliated to the genus

Shewanella

(forming an independent cluster) with the highest sequence similarity to the type strain of

Shewanella algae

. Optimum growth of both strains was observed at 30 °C and pH 7. The respiratory quinones were Q-7, Q-8 and MK-7. The polar lipid profile included phosphatidylmethyl ethanolamine, phosphatidylethanolamine, diphosphatidylglycerol, one unidentified aminophospholipid and four unknown phospholipids. The major fatty acids of strains FJAT-53720T and FJAT-53726 were iso-C15:0, C17 : 1
ω8c and summed feature 3. The genomic DNA G+C content of strain FJAT-53720T was 55.6 mol%. The average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values between FJAT-53720T and FJAT-53726 were 97.4 and 77.9 %, confirming that they were similar species and hence FJAT-53720T was selected for further analysis. The ANI and dDDH values between FJAT-53720T and other members of the genus

Shewanella

were below the cut-off level (95–96 %; 70 %) for species delineation. Based on the above results, FJAT-53720T represents a novel species of the genus

Shewanella

, for which the name Shewanella cyperi sp. nov. is proposed. The type strain is FJAT-53720T (=KCTC 82444T=GDMCC 1.2207T).
Learning shapes cortical dynamics to enhance integration of relevant sensory input
Authors: Chadwick Angus , Khan Adil , Poort Jasper , Blot Antonin , Hofer Sonja , Mrsic-Flogel Thomas , Sahani Maneesh
Published: August 2021

Adaptive sensory behavior is thought to depend on processing in recurrent cortical circuits, but how dynamics in these circuits shapes the integration and transmission of sensory information is not well understood. Here, we study neural coding in recurrently connected networks of neurons driven by sensory input. We show analytically how information available in the network output varies with the alignment between feedforward input and the integrating modes of the circuit dynamics. In light of this theory, we analyzed neural population activity in the visual cortex of mice that learned to discriminate visual features. We found that over learning, slow patterns of network dynamics realigned to better integrate input relevant to the discrimination task. This realignment of network dynamics could be explained by changes in excitatory-inhibitory connectivity amongst neurons tuned to relevant features. These results suggest that learning tunes the temporal dynamics of cortical circuits to optimally integrate relevant sensory input.

Highlights

A new theoretical principle links recurrent circuit dynamics to optimal sensory coding

Predicts that high-SNR input dimensions activate slowly decaying modes of dynamics

Population dynamics in primary visual cortex realign during learning as predicted

Stimulus-specific changes in E-I connectivity in recurrent circuits explain realignment
Low amplitude burst detection of catecholamines
Authors: Eltahir Amnah , White Jason , Lohrenz Terry , Montague P. Read
Published: August 2021

Machine learning advances in electrochemical detection have recently produced sub-second and concurrent detection of dopamine and serotonin during perception and action tasks in conscious humans. Here, we present a new machine learning approach to sub-second, concurrent separation of dopamine, norepinephrine, and serotonin. The method exploits a low amplitude burst protocol for the controlled voltage waveform and we demonstrate its efficacy by showing how it separates dopamine-induced signals from norepinephrine induced signals. Previous efforts to deploy electrochemical detection of dopamine in vivo have not separated the dopamine-dependent signal from a norepinephrine-dependent signal. Consequently, this new method can provide new insights into concurrent signaling by these two important neuromodulators.
A comparison of high resolution image reconstruction methods from confocal array detector with a new deconvolution algorithm
Authors: Prigent Sylvain , Dutertre Stéphanie , Bidaud-Meynard Aurélien , Bertolin Giulia , Michaux Grégoire , Kervrann Charles
Published: August 2021

Array detector allows a resolution gain for confocal microscopy by combining images sensed by a set of photomultipliers tubes (or sub-detectors). Several methods have been proposed to reconstruct a high resolution image by linearly combining sub-detector images. To overcome the limitations of these techniques, we propose a new reconstruction method that takes the full stack of spatially reassigned detector signals as input. We show on both calibration slides and real data that our deconvolution method allows to achieve a better reconstruction performance in terms of resolution, image contrast, and spatial intensity homogeneity. The tested algorithms are available in an open source software.