bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Staged Versus Same-day Bilateral Hip Surgery in Nonambulatory Children With Cerebral Palsy
Authors: Louer Craig R. , Nunez Jason , Bomar James D. , Fischer-Colbrie Megan E. , Chambers Henry G. , Upasani Vidyadhar V.
Published: May 2020

Background:

Bilateral hip reconstructions with osteotomies are commonly required in patients with severe cerebral palsy (CP) and dysplasia. These procedures can be performed by staging each hip surgery, separated by weeks to months, or by addressing both hips in a single-event surgery. The optimal timing of such surgery is yet to be determined. The purpose of this study was to retrospectively compare major complications between the staged and single-event approaches.

Methods:

Medical records of patients who underwent bilateral hip osteotomies, with at least one side including a pelvic osteotomy, were retrospectively reviewed. Subjects were identified who had a diagnosis of nonambulatory CP (defined by Gross Motor and Functional Classification System level IV or V), and at least 1 year of clinical follow-up. All hips were treated by 1 of 7 surgeons: 2 surgeons who always performing single-event surgery and 5 who always perform staged surgeries. Complications were stratified by the Modified Clavien-Dindo Classification (grades 1 to 5). The primary outcome was major complications (grade ≥3), while minor complications, readmissions, reoperations, and resource utilization outcomes were investigated secondarily.

Results:

Sixty-five patients met our inclusion criteria: 35 received single-event surgery and 30 received staged surgery. The staged group had a higher rate of major complications per patient (0.30 vs. 0; P=0.013). Unplanned readmissions and reoperations were likewise increased in the staged group. Minor complication rates were high in both groups, with no differences observed between staged and single-event approaches (3.27 per patient vs. 2.91; P=0.952). There were no complications causing permanent disability or death. The total length of stay (6.2 vs. 4.0 d; P<0.001) and mean nonsurgical operating room time (65.7 vs. 45.6 min; P<0.001) were increased in the staged group versus the single-event group.

Conclusions:

The staged approach to bilateral hip reconstructions in the nonambulatory CP population was associated with a higher rate of major complications compared with a single-event approach. Minor complications were similar for both approaches. Both approaches can have an acceptable safety profile with no observed grade 4 or 5 complications.

Level of Evidence:

Level III.
Vertebral Osteomyelitis After Spine Surgery
Authors: Breuninger Marianne , Yagdiran Ayla , Willinger Anja , Biehl Lena Maria , Otto-Lambertz Christina , Kuhr Kathrin , Seifert Harald , Fätkenheuer Gerd , Lehmann Clara , Sobottke Rolf , Siewe Jan , Jung Norma
Published: May 2020

Study Design.

Prospective cohort study.

Objective.

We aimed to determine the 2-year survival and to identify clinical and microbiological characteristics of patients with native vertebral osteomyelitis (VO) as compared to postoperative VO to find further strategies for improvement of the management of VO.

Summary of Background Data.

A relevant subgroup (20%–30%) of patients with VO has a history of spine surgery. Infection in these patients might be clinically different from native VO. However, clinical, microbiological, and outcome characteristics of this disease entity have not been well studied as most trials either excluded these patients or are limited by a small cohort and short observation period.

Methods.

Between 2008 and 2013, patients who presented at a tertiary care center with symptoms and imaging findings suggestive of VO were reviewed by specialists in infectious diseases, clinical microbiology, and orthopedics to confirm the diagnosis and followed prospectively for a period of 2 years. Statistical analysis for group comparisons, survival analysis, and uni- and multivariable Cox regression models were performed.

Results.

Thirty percent of the patients with VO (56/189) reported a history of spine surgery in the same segment. Patients with postoperative infection had a lower ASA score (American Society of Anesthesiologists) (P = 0.01) and were less likely to suffer from comorbidities compared to native cases (P = 0.003). Infections caused by coagulase-negative staphylococci (33.3 vs. 6.5%, P < 0.001) and other bacteria of the skin flora (15.2 vs. 0%, P = 0.002) were more prevalent in postoperative patients. Suffering from native VO increased the 2-year mortality risk 3-fold, also when adjusted for the remaining risk factors ASA score and number of comorbidities (hazard ratio 2.916 [95% confidence interval 1.215 –6.999], P = 0.017).

Conclusion.

Beside clear microbiological differences, the significant better 2-year survival supports the concept of postoperative VO presenting a distinct disease entity. The subtle disease presentation of patients with postoperative VO should not attenuate clinical suspicion of physicians.

Level of Evidence: 3
Upregulated Plant Homeodomain Finger Protein 6 Promotes Extracellular Matrix Degradation in Intervertebral Disc Degeneration Based on Microarray Analysis
Authors: Rui Gang , Sun Naikun , Hu Baoshan , Lin Shengrong , Wang Zhongtang , Lin Qingfu
Published: May 2020

Study Design.

mRNA analysis.

Objective.

The aim of this study was to identify differentially expressed genes (DEGs) in disc degeneration, analyze the potential biological functions of DEGs, and screen for a new target to prevent the degeneration.

Summary of Background Data.

Intervertebral disc degeneration (IDD) is an irreversible process and causes long-term heavy socioeconomic burdens. Existing and therapies under development are unable to prevent disc degeneration in a safe and effective manner. Therefore, elucidating the potential mechanism underlying degeneration and the development of new targets for IDD therapy are urgently required.

Methods.

Nucleus pulposus (NP) cells from mild and severe IDD (Ctrl and IDD groups) were separated, and DEGs of the two groups were identified with mRNA microarray analysis, followed by bioinformatics analysis.

Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) was performed to verify the microarray results. Gene over-expression and silencing technologies were used to study the role of plant homeodomain finger protein 6 (PHF6). qRT-PCR and western blot analyses were used to detect the expressions of collagen II (COL2), matrix metalloproteinases 13 (MMP13), and ADAM metallopeptidase with thrombospondin type 1 motif 4 (ADAMTS4).

Results.

The study identified 377 up- and 116 downregulated DEGs in NP cells from two groups. These DEGs were mainly involved in cellular and metabolic processes and enriched in immune system and nucleotide metabolism pathways. Upregulated PHF6, with the highest verified fold change, was significantly increased in the IDD group. Over-expressing PHF6 in Ctrl NP cells significantly inhibited the expression of COL2 and enhanced the expressions of MMP13 and ADAMTS4, whereas silencing PHF6 in IDD NP cells reversed such expression alterations.

Conclusion.

Upregulated PHF6 caused IDD by promoting extracellular matrix degradation; therefore, PHF6 could be developed as a potential novel target to prevent the degeneration. Our DEG profiling of NP cells from IDD patients provided a database to identify the key genes involved in IDD.

Level of Evidence.

N/A
Surgical Treatment for Severe Fixed Hyperkyphosis in an Adult Patient Suffering From Ankylosing Spondylitis and Hereditary Hypophosphatemia With Vertebral Osteopetrosis
Authors: Wolfram Julia M. , Zitt Emanuel , Bach Christian M.
Published: May 2020

Purpose:

Ankylosing spondylitis and hereditary hypophosphatemia with long-term high dose supplementation of phosphorous and calcitriol can both lead to severe structural abnormalities of the vertebrae. Impairment of spinal mobility and spinal deformity may ultimately necessitate surgical treatment. A severe fixed hyperkyphosis in a patient with ankylosing spondylitis is a surgically demanding condition, therefore, the indication for surgical treatment should be thoroughly considered and chosen individually.

Methods:

This is an uncommon case with a combination of a severe fixed hyperkyphosis with a Cobb-angle of 105 degrees between Th2 and L4 in an adult male patient suffering from ankylosing spondylitis and X-linked hypophosphatemia with surprisingly massive osteopetrosis. In this paper, the coexisting conditions of late-stage ankylosing spondylitis and long-term treated hereditary hypophosphatemia are highlighted. The surgical treatment with different techniques, complications, and results are well explained.

Results:

A normal gait and stand were achieved by a long posterior fusion with 3 pedicle subtraction osteotomies on L1, L3, and L5. The surgical correction was performed in 3 stages. Postoperative the patient was administered to a rehabilitation center for 3 months. The hyperkyphosis, the C7 plumbline, and the pelvic retroversion were corrected.

Conclusions:

Surgical treatment of a severe fixed hyperkyphosis due to ankylosing spondylitis is technically demanding but can be successfully achieved if all surgical challenges and comorbidities are adequately addressed including intraoperative surprising findings like osteopetrotic bone in a patient with hereditary hypophosphatemia as in our case.
Recurrent Proximal Junctional Kyphosis
Authors: York Philip J. , Kim Han Jo
Published: May 2020

Proximal junctional kyphosis (PJK) is one of the most common radiographic forms of adjacent segment degeneration with an incidence as high as 50% in adult spinal deformity surgery. It is a multifactorial problem with much still to be learned about the etiology and the most efficacious prevention methods. The challenge of addressing PJK can certainly be amplified in patients that develop recurrent proximal junctional kyphosis (rePJK) after revision surgery for PJK, which occurs in up to 45% of revision PJK cases. Patients found to be at the greatest risk for rePJK are those that have a pelvic tilt change >5 degrees, sagittal vertical axis change >50 mm, pedicle screw fixation at the upper instrumented vertebra and a preoperative cervicothoracic sagittal vertical axis of >40 mm. Often, factors that placed the patient at high risk for PJK following the initial surgery are still present such as compromised paraspinal musculature, poor bone quality and high overall frailty. This might account for the higher rates of surgical revision in cases of rePJK. At present, we are in need of a good method for addressing issues related to these patient characteristics. An overview of the challenge of rePJK and our current understanding of the complication is presented.
Current concepts in the treatment of giant cell tumour of bone
Authors: van der Heijden Lizz , Dijkstra Sander , van de Sande Michiel , Gelderblom Hans
Published: May 2020

Purpose of review

Giant cell tumour of bone (GCTB) is an intermediate, locally aggressive primary bone tumour. In addition to local therapy, new drugs became available for this disease. Denosumab, a receptor activator of nuclear factor κ-B-ligand inhibitor, was introduced as systemic targeted therapy for advanced or inoperable and metastatic GCTB. Also, the bisphosphonate zoledronic acid has activity in GCTB by directly targeting the neoplastic stromal cells.

Recent findings

In a small RCT, bisphosphonates were successful in controlling tumour growth and a higher apoptotic index of tumour cells was seen after zoledronic acid versus controls. Although bisphosphonate-loaded bone cement has not been studied to a large extent, it does not seem harmful and may constitute a logical local adjuvant. From the largest clinical trial to date, the risk-to-benefit ratio for denosumab in patients with advanced GCTB remains favourable, also in facilitating less morbid surgery. Concerns have arisen that recurrence rates would be higher than after conventional treatment, ranging from 20 to 100% in a systematic review, although this may be because of bias. H3F3A (G34W) driver mutations are helpful in the differentiation between GCTB and other giant cell-containing malignancies. H3.3-G34W proved sufficient to drive tumourigenesis. The cumulative incidence of malignancy in GCTB is estimated at 4%, of which primary malignancy 1.6% and secondary malignancy 2.4%, the latter mainly after radiation. To date, a potential causal relationship between denosumab and pulmonary metastases has not been confirmed; if they do not behave indolently, it would be advised to reassess diagnosis and consider malignancy.

Denosumab remains a highly effective treatment option for patients with advanced GCTB. A short duration of 2–4 months neoadjuvant denosumab is advised to facilitate less morbid surgery and prevent incomplete curettage by macroscopic tumour alterations. Reduced dose intensity is being studied to reduce long term side-effects. Further research on bisphosphonates and other targets including H3.3-G34W remains warranted.
Atrial Fibrillation in COVID-19: From Epidemiological Association to Pharmacological Implications
Authors: Russo Vincenzo , Rago Anna , Carbone Andreina , Bottino Roberta , Ammendola Ernesto , Della Cioppa Nadia , Galante Dario , Golino Paolo , Nigro Gerardo
Published: May 2020

Coronavirus disease 2019 (COVID-19) outbreak is a public health emergency of international concerns because of a highly pathogenic human coronavirus (HCoV), actually named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite much emerging data about the epidemiological association between cardiovascular diseases and COVID-19, little is still known about atrial fibrillation and its optimal management in this clinical contest. The aim of our review is to describe the pharmacological interactions between cardiovascular drugs more commonly used in atrial fibrillation management and experimental COVID-19 therapies, based on EU and US summaries of product characteristics.
Association of SLCO1B1 c.521T>C (rs4149056) with discontinuation of atorvastatin due to statin-associated muscle symptoms
Authors: Linskey Derek W. , English Joseph D. , Perry Daniel A. , Ochs-Balcom Heather M. , Ma Changxing , Isackson Paul J. , Vladutiu Georgirene D. , Luzum Jasmine A.
Published: May 2020

The most common adverse drug reaction from statins are statin-associated muscle symptoms (SAMS), characterized by myopathy (weakness), myalgia (muscle pain), and commonly elevation in serum creatine kinase. All statins are substrates of the organic anion transporter 1B1 (OATP1B1; gene: SLCO1B1), albeit to different degrees. A genetic polymorphism in SLCO1B1, c.521T>C (rs4149056), markedly decreases OATP1B1 function. The literature is currently unclear as to whether SLCO1B1 c.521T>C is significantly associated with discontinuation of atorvastatin specifically due to SAMS. Our hypothesis was that individuals carrying the SLCO1B1 decreased function 521C allele are more likely to discontinue atorvastatin due to SAMS. This was a retrospective analysis of survey data from 379 Caucasians genotyped for rs4149056 and treated with atorvastatin for at least 12 months. Crude and multivariable logistic regression, adjusted for established risk factors for SAMS, determined the association of SLCO1B1 c.521T>C with discontinuation of atorvastatin due to SAMS (SLCO1B1 521T-homozygotes vs. 521C-carriers). The sample was 51% male, with a mean age of 57 years (SD = 11). Sixty-one percent of participants reported discontinuing atorvastatin due to SAMS, and 32% overall carried the 521C allele. SLCO1B1 521C-carrier status was not a significant predictor of atorvastatin discontinuation in any model: crude OR = 1.07; 95% CI, 0.68–1.66; P = 0.78 and adjusted OR = 1.07; 95% CI, 0.68–1.69; P = 0.76. The results were similar in a sub-group of participants treated with higher doses of atorvastatin (>20 mg). In summary, SLCO1B1 c.521T>C was not significantly associated with discontinuation of atorvastatin therapy due to SAMS.
Baseline estrogen levels in postmenopausal women participating in the MAP.3 breast cancer chemoprevention trial
Authors: Richardson Harriet , Ho Vikki , Pasquet Romain , Singh Ravinder J. , Goetz Matthew P. , Tu Dongsheng , Goss Paul E. , Ingle James N.
Published: May 2020

Objective:

The aim of the study was to quantify baseline estradiol (E2) and estrone (E1) concentrations according to selected patient characteristics in a substudy nested within the MAP.3 chemoprevention trial.

Methods:

E2 and E1 levels were measured in 4,068 postmenopausal women using liquid chromatography-tandem mass spectrometry. Distributions were described by age, years since menopause, race, body mass index (BMI), smoking status, and use and duration of hormone therapy using the Kruskal-Wallis test. Multivariable linear regression was also used to identify characteristics associated with estrogen levels.

Results:

After truncation at the 97.5th percentile, the mean (SD)/median (IQR) values for E2 and E1 were 5.41 (4.67)/4.0 (2.4-6.7) pg/mL and 24.7 (14.1)/21 (15-31) pg/mL, respectively. E2 and E1 were strongly correlated (Pearson correlation [r] = 0.8, P < 0.01). The largest variation in E2 and E1 levels was by BMI; mean E2 and E1 levels were 3.5 and 19.1 pg/mL, respectively for women with BMI less than 25 and 7.5 and 30.6 pg/mL, respectively, for women with BMI greater than 30. E2 and E1 varied by age, BMI, smoking status, and prior hormone therapy in multivariable models (P < 0.01).

Conclusions:

There was large interindividual variability observed for E2 and E1 that varied significantly by participant characteristics, but with small absolute differences except in the case of BMI. Although the majority of participant characteristics were independently associated with E1 and E2, together, these factors only explained about 20% of the variation in E1 and E2 levels.
Computer-aided Design and Syringe-aided Manufacturing for Mandibular Reconstruction Using a Vascularized Fibula Flap
Authors: Karakawa Ryo , Yano Tomoyuki , Yoshimatsu Hidehiko , Katsuta Hideyuki , Kushihashi Yukiomi , Shimane Toshikazu
Published: May 2020

Thanks to the introduction of virtual surgical planning (VSP), mandibular reconstruction using a fibula flap has become simplified, and patient-specific reconstruction is now possible. With a VSP software, surgical “cutting guides” and custom-made titanium plates can be designed to help surgeons. However, they are expensive and require extended periods of time either for prototyping or to acquire the advanced knowledge necessary for operating the VSP software. The aim of this article is to introduce a new easy and low-cost method of surgical planning for mandible reconstruction using a computer-aided design and the syringe-aided manufacturing technique. Simulations of fibula osteotomy are performed using regular and commercially available 10-ml syringes. The syringes are cut into separate segments to fit the defect of the 3-dimensional mandible model and to match the prebent titanium plate. The syringe segments are then connected together 3-dimensionally to confirm that the shape matched both the contour of the defect and the angles of the mandible. The simulated syringe segments are used as cutting guides. Then osteotomies are performed according to the cutting guide to obtain the exact lengths and angles required to achieve precise bony reconstruction. The mandibular reconstruction procedures are successful, with a good match between the preoperative planned syringe models and the final results of the surgery. Although further clinical investigation will be required to confirm its efficacy, the computer-aided design and the syringe-aided manufacturing method has the potential to be a useful technique for mandible reconstruction using a vascularized fibula flap.
New Surgical Technique: Bidirectional Forehead Narrowing and Eyebrow Lifting Using Regional Flap Mobility
Authors: Kim Jae B. , Kim Sang W. , Chung Jae Y.
Published: May 2020

Background:

We describe our experience with bidirectional forehead narrowing and eyebrow lifting (BiNaLi), a surgical technique we have been practicing for several years to correct facial esthetic issues of patients such as long forehead, high hairline, and low eyebrow level, which helps us achieve forehead height reduction with eyebrow lifting, using 1 incision line in a one-stage procedure.

Methods:

We divided 576 patients who visited our institution between March 2014 and February 2019 into 4 groups: long forehead only (group I), low eyebrow level (groups II and IV), and M-shaped hairline (groups III and IV); BiNaLi operation was performed as appropriate for each group.

Results:

The preoperative length of the median area of the forehead was 7.3 cm, and the mean postoperative change in the length of the same was 1.4 cm. The lateral forehead length was also measured for groups III and IV. The mean preoperative length was 7.7 cm, and the mean postoperative change in the length was 1.7 cm. Eyelid length was also measured for groups II and IV. The mean preoperative length was 0.7 cm, and the mean postoperative change in the length was 0.3 cm. More than 90% of the patients gave a score of 4.0 or higher for esthetic satisfaction.

Conclusions:

We designed a BiNaLi technique to satisfy patients’ facial esthetic needs using changes in flap movement direction, adjustment in the range of skin excision, and differences in flap dissection. A single operation can have various effects, including achieving forehead shortening, clear double-fold line through eyebrow lifting, and correction of a mild M-shaped hairline.
Usefulness of a Novel Pinwheel-shaped Incision Technique for Skin Tumor Excision
Authors: Watanabe Ayako , Miyamoto Towa
Published: May 2020

Use of the fusiform ellipse excision technique is the most common method for direct closure of circular and elliptical defects. To prevent dog-ear formation after suturing, the long-axis length of the fusiform ellipse should be ≥3 times the transverse dimension and the angle formed by the 2 lines at both ends should be <30°. We devised a pinwheel-shaped incision technique for skin tumor excision that could reduce the scar size. We aim to present this technique and report its results and usefulness. We included 50 patients (55 cases; 54% women; mean age, 39.8 years) who underwent surgery using our pinwheel-shaped incision technique between January 2016 and December 2018. The incision line was designed like a pinwheel around the tumor, and the excess skin was trimmed after suturing at the center. The length-to-width ratio was calculated using the width before the operation and the suture length at the end of the operation. The operation site was primarily the face, and the maximum tumor width was 48 mm. The postoperative suture line length was 2.1 ± 0.2 (mean ± SD) times the width of the excision area. There were no complications such as skin necrosis, and no patient required reoperation because of dog-ear formation. Our new pinwheel-shaped incision technique allows shortening of the length-to-width ratio compared with that required in the conventional method and helps avoid dog-ear formation. We successfully used this technique in 55 cases and confirmed its usefulness.
Postmastectomy Breast Reconstruction in the Time of the Novel Coronavirus Disease 2019 (COVID-19) Pandemic
Authors: Chetta Matthew D. , Schoenbrunner Anna R. , Lee Clara N.
Published: May 2020

Background:

Breast reconstruction has a well-documented positive impact on the psychosocial well-being of women recovering from breast cancer. Rates of breast cancer diagnoses are rising, and more women are seeking mastectomy as treatment and as prophylaxis.

Methods:

Postmastectomy breast reconstruction often begins at the time of mastectomy in coordination with the oncologic breast surgeons. Immediate breast reconstruction increases complication rate (11% vs 4%) and unplanned reoperation rate (7% vs 4%), requiring more personnel and resources used during the preoperative, intraoperative, and postoperative phases of patient care.

Discussion:

In the setting of global pandemics such as coronavirus disease 2019 (COVID-19), breast reconstruction demands a unique and nuanced approach, as most forms of breast reconstruction can occur successfully in a delayed fashion. While this may prolong the overall time until completion of reconstruction, other factors come into play in the setting of a communicable (potentially deadly) illness. Factors that must be considered include allocation of essential resources and protection of patients and families from disease transmission.

Conclusions:

Plastic surgeons performing breast reconstruction must take these factors into account when counseling their patients, colleagues, and institutions and be proactive in determining which procedures are time-critical and which should be postponed until the disaster situation has relieved.
Low cholesterol syndrome and drug development
Authors: Handhle Ahmed , Viljoen Adie , Ramachandran Radha , Wierzbicki Anthony S.
Published: May 2020

Purpose of review

Low cholesterol syndromes were considered curiosities. The present article reviews some hypolipidaemic disorders and the drugs developed from the insights they provided.

Recent findings

Abetalipopoproteinaemia and hypobetalipoproteinaemia are associated with low cholesterol concentrations and caused by mutations in apolipoprotein (apo) B or microsomal transfer protein. This led to the development of mipomersen and lomitapide which are used to treat homozygous familial hypercholesterolaemia. Mutations in proprotein convertase subtilisin kexin-9 (PCSK9) can cause either high or low cholesterol. Loss of function PCSK9 mutations prompted the development of antibody therapies to PCSK9 which are now widely used to treat hypercholesterolaemia. Mutations in apolipoprotein C-3 and angiopoietin-like protein 3 (ANGPTL3) cause hypolipoproteinaemia and reduced triglycerides. Antisense therapies to apolipoprotein C-3 and antibodies to ANGPTL3 are in development to treat familial chylomicronaemia syndrome. Activating mutations in apoA-1 result in hyper-functioning high-density lipoprotein (HDL) and suggest that modifying HDL turnover may reduce cardiovascular disease (CVD) risk.

Orphan lipid disorders have provided insights into mechanisms involved in lowering cholesterol levels and the potential safety and efficacy of interventional processes. They have been not only enabled development of drugs to treat rare lipid disorders but also those finding wider use in general lowering of CVD risk.
Evaluation of liver fibrosis in patients with Wilson’s disease
Authors: Przybyłkowski Adam , Szeligowska Jowita , Januszewicz Magdalena , Raszeja-Wyszomirska Joanna , Szczepankiewicz Benedykt , Nehring Piotr , Górnicka Barbara , Litwin Tomasz , Członkowska Anna
Published: May 2020

Objectives

Staging of fibrosis in chronic liver disease is important for prognosis and treatment planning. Liver biopsy is the gold standard in fibrosis assessment; however, new methods for fibrosis and stiffness measurement exist which have not been evaluated in patients with Wilson’s disease. To evaluate the accuracy of collagen proportionate area (CPA), transient elastography and shear wave elastography (SWE) in the assessment of liver fibrosis in adult patients with Wilson’s disease.

Methods

In this retrospective study of 60 patients with Wilson’s disease, results of percutaneous cutting liver biopsy assessed using the Ishak fibrosis score and CPA were compared with liver stiffness measured with transient elastography and SWE.

Results

CPA correlated with the Ishak score (r = 0.45; P = 0.001) and transient elastography results correlated with SWE measurements (r = 0.80; P = 0.0001). In contrast, transient elastography or SWE did not significantly correlate with the Ishak score or CPA.

Conclusion

Collagen content assessment may be useful for estimation of liver fibrosis in patients with Wilson’s disease. However, single time-point elastographic liver stiffness measurements have a limited diagnostic value in Wilson’s disease.
Whole-body 75SeHCAT retention is determined by entero-hepatic bile acid recycling rate
Authors: Soares Sara , Vadrucci Manuela , Peters A. Michael
Published: May 2020

Aim

It has previously been proposed that entero-hepatic bile acid recycling frequency is a major determinant of whole-body retention (WBR) of 75SeHCAT. Hepatocyte to terminal ileum accounts for almost the entire cycle. The study aim was to test this hypothesis by comparing WBR with an estimate of speed of transit of bile acids using 99mTc-HIDA scintigraphy performed on a separate occasion.

Methods

Using an un-collimated gamma camera and patient-to-camera distance of 1.5 m, WBR at 7 days after oral 75SeHCAT administration was measured in 14 patients with chronic diarrhoea, of whom 10 had previous cholecystectomy. The distance reached within the intestine of 99mTc-HIDA at 1 h (n = 14) and 2 h (n = 7) following iv injection was graded as follows: grades 1 and 2: small bowel on left and right sides of abdomen, respectively; and grade 3: colon. Relationships between WBR and grade were assessed using Spearman rank correlation.

Results

Interval between studies ranged from 3 to 1219 (median 330) days. Grading correlated with WBR at 1 h (rs = −0.63; P = 0.02) and weakly at 2 h (rs = −0.68; P = 0.09) post-injection of 99mTc-HIDA. In nine patients in whom 99mTc-HIDA and 75SeHCAT scans were performed within 1 year of each other, the correlation remained significant at 1 h (rs = −0.73; P = 0.03). There was no difference in WBR or grading between patients with or without a gall bladder.

Conclusion

Entero-hepatic bile acid recycling frequency is a major determinant of whole-body 75SeHCAT retention.
Dynamic 18F-fluorocholine PET/CT for parathyroid imaging in patients with primary hyperparathyroidism
Authors: Broos Wouter A.M. , Wondergem Maurits , van der Zant Friso M. , Schaper Nicolaas C. , Knol Remco J.J.
Published: May 2020

Objective

In the past few years, 18F-fluorocholine PET/CT has been established as a promising imaging technique for preoperative localization of parathyroid adenomas, but the optimal time point to start PET/CT acquisition after tracer injection is yet unknown. The aim of the present study was to assess the optimal time frame to acquire the PET/CT images and to evaluate the ability of dynamic imaging to differentiate parathyroid adenomas from active lymph nodes, a common cause for false-positive scan results.

Patients and methods

Patients with primary hyperparathyroidism who had undergone a dynamic 18F-fluorocholine PET/CT positive for parathyroid disease and who subsequently underwent successful parathyroidectomy were retrospectively included in this study. On the 20 minutes dynamic images, standardized uptake value measurements were acquired per 1 minute frame for the parathyroid adenoma, the thyroid gland, blood pool activity, and, if present, lymph node activity.

Results

A total of 101 patients were included in this study. Time-activity curves showed a decrease of activity in parathyroid and thyroid glands, with faster wash-out from the thyroid gland and on average a stable, lower activity in lymph nodes. Blood pool activity was particularly present in the first 2 minutes. Differentiation of a parathyroid adenoma from active lymph nodes was best before 5 minutes, but no definitive cutoff value could be determined. Differentiation of a parathyroid adenoma from the thyroid gland was best after 10 minutes.

Conclusion

Dynamic imaging starting at the early time point of 2 minutes after injection of 18F-fluorocholine is useful for characterization of hyperfunctioning parathyroid glands.
Effects of combining manual lymphatic drainage and Kinesiotaping on pain, edema, and range of motion in patients with total knee replacement: a randomized clinical trial
Authors: Tornatore Laura , De Luca Maria Laura , Ciccarello Marcello , Benedetti Maria Grazia
Published: May 2020

Total knee replacement (TKR) is continuously increasing with significantly faster recovery times. Soft tissue pain and edema of operated limbs play an important role in early functional recovery. The present study aims to evaluate the effectiveness of the combination of Kinesiotaping and Lymphatic drainage for the containment of pain and edema as well as the improvement of the range of motion of the knee as integration with standard postoperative rehabilitation. Ninety-nine TKR patients were included in the randomized clinical trial and divided into three groups: Kinesiotaping and Lymphatic drainage Group, Lymphatic drainage Group, and Kinesiotaping Group. The assessment was carried out on days 2-4-6 postoperation. All the patients had also standard reeducation sessions. It was observed that both Kinesiotaping and Lymphatic drainage was useful in reducing pain and edema. A significantly higher improvement was observed in the group in which Lymphatic drainage was associated with Kinesiotaping with respect to the individual treatments, for pain and leg circumference over and under the knee, and at the ankle. Range of motion of the knee did not show any difference since the flexion degree was similar in all the three groups. No difference was found between Kinesiotaping and Lymphatic drainage. In conclusion, the treatment with a combination Kinesiotaping and Lymphatic drainage provided better results on pain and edema observed as early as the first days after the intervention, thus may be considered a valid support for standard rehabilitation and pharmacological intervention.
Full Facial Allotransplantation Including the Temporomandibular Joints: A Radiologic and Anatomical Cadaveric Study
Authors: Nunez-Villaveiran Teresa , Fahradyan Vahe , Dalla Pozza Edoardo , Rezaei Majid , Drake Richard L. , Jellema Lyman M. , García-de-Lorenzo Abelardo , Papay Frank A. , Bassiri Gharb Bahar , Rampazzo Antonio
Published: May 2020

Background:

Facial allotransplantation including the temporomandibular joints may improve the functional outcomes in face transplant candidates who have lost or damaged this joint.

Methods:

Linear and angular measurements were taken in 100 dry skulls and mandibles and in 100 three-dimensionally–reconstructed facial computed tomographic scans to determine the variability of the temporomandibular joint, glenoid fossa, and mandible. A vascular study was performed in six fresh cadaveric heads, followed by harvest of the face allograft in three heads. Next, four heads were used for mock transplantation (two donors and two recipients). The full facial allograft included four different segments: a Le Fort III, a mandibular tooth-bearing, and two condyle and temporomandibular joint–bearing segments. Statistical analysis was performed using SAS software.

Results:

In only one-third of the skulls, the condylar shape was symmetric between right and left sides. There was a wide variability in the condylar coronal (range, 14.3 to 23.62 mm) and sagittal dimensions (range, 5.64 to 10.96 mm), medial intercondylar distance (range, 66.55 to 89.91 mm), and intercondylar angles (range, 85.27 to 166.94 degrees). This high variability persisted after stratification by sex, ethnicity, and age. The temporomandibular joint was harvested based on the branches of the superficial temporal and maxillary arteries. The design of the allograft allowed fixation of the two condyle and temporomandibular joint–bearing segments to the recipient skull base, preserving the articular disk-condyle-fossa relationship, and differences were adjusted at the bilateral sagittal split osteotomy sites.

Conclusion:

Procurement and transplantation of a temporomandibular joint–containing total face allograft is technically feasible in a cadaveric model.
Quality and Safety in Health Care, Part LXXI
Authors: Harolds Jay A.
Published: May 2020

Peer review can be utilized to increase the quality of care for patients by upgrading the performance of all the providers by identifying learning opportunities. Peer review can identify providers whose care is below the standard of care and recommend actions to correct the situation. Peer review is also important to satisfy requirements of the government and The Joint Commission. Ongoing professional practice evaluation and focused professional practice evaluation have been required since 2008 to help insure that providers are rendering excellent care, and the results of these evaluation procedures are also utilized in privileging decisions.
Food and Drug Administration Safety Communication on the Use of Transvaginal Mesh in Pelvic Organ Prolapse Repair Surgery: The Impact of Social Determinants of Health
Authors: Mao Jialin , Chughtai Bilal , Ibrahim Said , Sedrakyan Art
Published: May 2020

Objective

This study was to examine the impact of the July 2011 Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh in pelvic organ prolapse (POP) repair by patients’ race and ethnicity.

Methods

We conducted an observational cohort study of women undergoing POP repairs in 2008 to 2015 in New York State. We examined the changes in transvaginal mesh use in POP repairs before and after the FDA communication by patients’ race and ethnicity. Piecewise logistic regression models were used to assess the trends of mesh use, adjusting for patient characteristics. We performed a subgroup analysis of the trends of transvaginal mesh use by racial groups, stratifying by patients’ neighborhood socioeconomic status.

Results

We included 49,848 women (78% white, 7% black, and 15% Hispanic) with an average ± SD age of 60.2 ± 13.0 years. After the safety communication, the use of transvaginal mesh in POP repairs decreased among white women (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.41–0.50) and African Americans (OR, 0.48; 95% CI, 0.35–0.67) but remained stable among Hispanic women (OR, 0.88; 95% CI, 0.70–1.11). Only in the subgroup of patients from high-income areas, there was a trend toward decreasing mesh use among Hispanic patients after 2011 (OR, 0.71; 95% CI, 0.49–1.04).

Conclusions

The communications related to the safety of transvaginal mesh did not have an equal impact across racial groups. Mesh use decreased among white and African American women but not among Hispanic women after the 2011 FDA safety communication. Particular attention is warranted for patients from disadvantaged groups, especially low-income minorities, when disseminating medical device safety messages.
Replicating different roles of intent across moral domains
Authors: Sweetman Joseph , Newman George A.
Published: May 2020

Whether moral cognition is underpinned by distinct mental systems that process different domains of moral information (moral pluralism) is an important question for moral cognition research. The reduced importance of intent (intentional versus accidental action) when judging purity (e.g. incest), when compared with harm (e.g. poisoning), moral violations is, arguably, some of the strongest experimental evidence for distinct moral systems or ‘foundations’. The experiment presented here is a replication attempt of these experimental findings. A pre-registered replication of Experiment 1B from the original article documenting this effect was conducted in a sample ofN= 400 participants. Findings from this successful replication are discussed in terms of theoretical and methodological implications for approaches to moral cognition.
High-efficient fabrication of core-shell-shell structured SiO
2
@GdPO
4
:Tb@SiO
2
nanoparticles with improved luminescence
Authors: Bai He , Yang Yunjiang , Bao Jinrong , Wu Anping , Qiao Yan , Guo Xueyuan , Wang Mingyuan , Li Wenxian , Liu Ying , Zhu Xiaowei
Published: May 2020

SiO
2
@GdPO
4
:Tb@SiO
2
nanoparticles with core-shell-shell structure were successfully synthesized by a cheap silane coupling agent grafting method at room temperature. This method not only homogeneously coated rare-earth phosphate nanoparticles on the surface of silica spheres but also saved the use of rare-earth resources. The obtained nanoparticles consisted of SiO
2
core with a diameter of approximately 210 nm, GdPO
4
:Tb intermediate shell with thickness of approximately 7 nm, and SiO
2
outer shell with thickness of approximately 20 nm. This unique core-shell-shell structured nanoparticles exhibited strong luminescence properties compared with GdPO
4
:Tb nanoparticles. The core-shell-shell structured nanoparticles can effectively quench the intrinsic fluorescence of bovine serum albumin through a static quenching mode. The as-synthesized nanoparticles show great potential in biological cell imaging and cancer treatment.
A direct and conceptual replication of post-loss speeding when gambling
Authors: Eben Charlotte , Chen Zhang , Vermeylen Luc , Billieux Joël , Verbruggen Frederick
Published: May 2020

To investigate the response to suboptimal outcomes, Verbuggenet al.(Verbruggen F, Chambers CD, Lawrence NS, McLaren IPL. 2017 Winning and losing: effects on impulsive action.J. Exp. Psychol.: Hum. Percept. Perform.43, 147. (doi:10.1037/xhp0000284)) conducted a study in which participants chose between a gamble and a non-gamble option. The non-gamble option was a guaranteed amount of points, whereas the gamble option was associated with a higher amount but a lower probability of winning. The authors observed that participants initiated the next trial faster after a loss compared to wins or non-gambles. In the present study, we directly replicated these findings in the laboratory and online. We also designed another task controlling for the number of trials per outcome. In this task, participants guessed where a reward was hidden. They won points if they selected the correct location, but lost points if they selected the incorrect location. We included neutral trials as a baseline. Again, participants sped up after a loss relative to wins and neutral trials (but only with a response choice in neutral trials and a large sample size). These findings appear inconsistent with cognitive-control frameworks, which assume that suboptimal outcomes typically lead to slower responses; instead, they suggest that suboptimal outcomes can invigorate behaviour, consistent with accounts of frustrative non-reward and impulsive action.
Pyroelectricity and field-induced spin-flop in (4-(Aminomethyl)pyridinium)
2
MnCl
4
· 2H
2
O
Authors: Gao Kaige , Liu Chunlin , Zhang Wei , Wang Kangni , Liu Wenlong
Published: May 2020

Large single crystals of (4-(Aminomethyl)pyridinium)
2
MnCl
4
· 2H
2
O (
1
) were grown by slow evaporation of solution. The crystal structure was solved to be Pī, which belongs to the central symmetric space group. But small pyroelectric current was detected, as well as a ferroelectric hysteresis loop. The pyroelectric and the ferroelectric properties were attributed to the strain caused by defects. Temperature-dependent magnetic curves and the
M
–
H
curve show that
1
is antiferromagnetic ordering below 2.5 K. A field-induced spin-flop is observed in the antiferromagnetic ordering state.
Use of inhibitors of the renin angiotensin system and COVID-19 prognosis: a systematic review and meta-analysis
Authors: Barochiner Jessica , Martinez Rocio
Published: May 2020

Background: controversy has arisen in the scientific community on whether the use of renin angiotensin system (RAS) inhibitors in the context of COVID-19 would be of benefit or harmful. A meta-analysis of eligible studies comparing the occurrence of severe and fatal COVID-19 in infected patients who were under treatment with angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) vs no treatment or other antihypertensives was conducted. Methods: PubMed, Google Scholar, the Cochrane Library, MedRxiv and BioRxiv were searched for relevant studies. Fixed-effect models or random-effect models were used depending on the heterogeneity between estimates. Results: a total of fifteen studies with 21,614 patients were included. The use of RAS inhibitors was associated with a non-significant 20% decreased risk of the composite outcome (death, admission to intensive care unit, mechanical ventilation requirement or progression to severe or critical pneumonia): RR 0.81 (95%CI: 0.63-1.04), p=0.10, I2=82%. In a subgroup analysis that included hypertensive subjects only, ACEI/ARB were associated with a 27% significant decrease in the risk of the composite outcome (RR 0.73 (95%CI: 0.56-0.96), p=0.02, I2=65%). Conclusion: the results of this pooled analysis suggest that the use of ACEI/ARB does not worsen the prognosis, and could even be protective in hypertensive subjects. Patients should continue these drugs during their COVID-19 illness.
Hydroxychloroquine alone or in combination with azithromycin to prevent major clinical events in hospitalised patients with coronavirus infection (COVID-19): rationale and design of a randomised, controlled clinical trial
Authors: Cavalcanti Alexandre B , Zampieri Fernando G , Azevedo Luciani CP , Rosa Regis G , Avezum Alvaro , Veiga Viviane C , Lopes Renato D , Kawano-Dourado Leticia , Damiani Lucas P , Pereira Adriano J , Serpa Neto Ary , Furtado Remo , Tomazini Bruno , Bozza Fernando A , Maia Israel S , Falavigna Maicon , Lisboa Thiago C , Fonseca Henrique , Machado Flavia R , Berwanger Otavio ,   COALITION COVID-19 Brazil I Investigators
Published: May 2020

Introduction: Hydroxychloroquine and its combination with azithromycin have been suggested to improve viral clearance in patients with COVID-19, but its effect on clinical outcomes remains uncertain.
Methods and analysis: We describe the rationale and design of an open-label pragmatic multicentre randomised (concealed) clinical trial of 7 days of hydroxychloroquine (400 mg BID) plus azithromycin (500 mg once daily), hydroxychloroquine 400 mg BID, or standard of care for moderately severe hospitalised patients with suspected or confirmed COVID-19 (in-patients with up to 4L/minute oxygen supply through nasal catheter). Patients are randomised in around 50 recruiting sites and we plan to enrol 630 patients with COVID-19. The primary endpoint is a 7-level ordinal scale measured at 15-days: 1)not hospitalised, without limitations on activities; 2)not hospitalised, with limitations on activities; 3)hospitalised, not using supplementary oxygen; 4)hospitalised, using supplementary oxygen; 5)hospitalised, using high-flow nasal cannula or non-invasive ventilation; 6)hospitalised, on mechanical ventilation; 7)death. Secondary endpoints are the ordinal scale at 7 days, need for mechanical ventilation and rescue therapies during 15 days, need of high-flow nasal cannula or non-invasive ventilation during 15 days, length of hospital stay, in-hospital mortality, thromboembolic events, occurrence of acute kidney injury, and number of days free of respiratory support at 15 days. Secondary safety outcomes include prolongation of QT interval on electrocardiogram, ventricular arrhythmias, and liver toxicity. The main analysis will consider all patients with confirmed COVID-19 in the groups they were randomly assigned.
Ethics and dissemination: This study has been approved by Brazil's National Ethic Committee (CONEP) and National Health Surveillance Agency (ANVISA). An independent data monitoring committee will perform interim analyses and evaluate adverse events throughout the trial. Results will be submitted for publication after enrolment and follow-up are complete, as well as presented and reported to local health agencies.
ClinicalTrials.gov identifier: NCT04322123