bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of regional myocardial flow measurements using Rubidium-82 PET
Authors: Koenders SS , Van Dalen JA , Jager PL , Mouden M , Slump CH , Van Dijk JD
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The combination of myocardial blood flow (MBF) measurements using Rubidium-82 (Rb-82) PET and visual assessment of the PET images is increasingly used due to its high diagnostic and prognostic value. Typically, flow measurements are calculated and used for the myocardium as a whole (global). However, small regional flow deficits may go unnoticed when only looking at global flow values.

Purpose

To compare the diagnostic value of regional and global myocardial flow measurements using Rb-82 PET in the detection of obstructive CAD.

Methods

 We retrospectively included 1034 patients with no history of coronary artery disease (CAD) referred for rest and regadenoson-induced stress Rb-82 PET/CT. MBFs were calculated using Lortie’s one-tissue compartment model. Myocardial flow reserve (MFR) was calculated as the ratio of MBF during stress and rest. Regional flow was determined per vessel and per segment. Vessel MFR was defined as the lowest flow reserve of LAD, LCX and RCA territories and segmental MFR as the lowest flow reserve in all 17 segments. Follow-up data were obtained from medical records. Patients were classified to have obstructive CAD if follow-up included a positive invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or all cause death. Receiver-operating characteristic (ROC) analyses were constructed to compare the diagnostic value of global and regional flow values.

Results

Follow-up was obtained in all 1034 patients and the median follow-up time was 2.1 years. Myocardial flow reserve values were significantly lower (p < 0.001) in the 128 patients classified with obstructive CAD than in the 906 patients without obstructive CAD: global MFR  (median 1.9 [interquartile range 1.6-2.4] vs. 2.5 [2.1-2.9]); vessel MFR (1.6 [1.3-2.1]  vs. 2.3 [1.9-2.6]); Segmental MFR (1.3 [0.9-1.7] vs. 1.9 [1.6-2.2]). The area under the curve of vessel MFR (0.79 ± 0.02) and segmental MFR (0.81 ± 0.02) were similar but significantly (p < 0.001) larger than the area of global MFR (0.75 ± 0.03), as shown in the Figure.

Conclusion

The diagnostic value improved with the use of regional MFR instead of global MFR measurements in the detection of obstructive CAD. Therefore, it seems that visual assessment of PET images can best be combined with regional flow measurements either on a per vessel or a per segment basis in Rubidium-82 PET myocardial perfusion imaging.
The use of a novel method for SPECT/CT quantification of 99m-Tc-PYP uptake in the evaluation of ATTR cardiac amyloidosis
Authors: Duvall WL , Godoy Rivas C , Elsadany M , Hobocan M , Mcmahon S
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction:  Bone scintigraphy with 99m-Technecium-Pyrophosphate (99m-Tc-PYP) with planar and SPECT imaging is now commonplace for the non-invasive diagnosis of ATTR cardiac amyloidosis. However, the quantification of 99m-Tc-PYP uptake is based on a semi-quantitative visual score and a heart to contralateral lung ratio which suffer from poor reproducibility. A more robust method of quantifying uptake and reporting results would be beneficial and may be possible using volumetric assessment with fused SPECT/CT acquisition.

Purpose

  The aim of this study was to evaluate the performance of a novel semi-automated quantitative software to diagnose ATTR cardiac amyloidosis in patients with a clinical suspicion of cardiac amyloidosis who underwent 99m-Tc-PYP SPECT/CT imaging.

Methods

This was a retrospective, single-center study of consecutive patients who underwent 99m-Tc-PYP SPECT/CT imaging from September to December 2020. Quantification software was used to obtain standardized uptake values (SUVs) of 99m-Tc-PYP activity in the whole heart using SPECT/CT data. The total SUVs, mean SUVs, and percentage of injected tracer dose in the heart, as well as two other sets of these measurements adjusted for residual blood pool activity were obtained. Activity in the lung and bone was used to calculate heart to bone and heart to right lung ratios. The results from the software quantification were compared to the results from planar imaging as well as to the final clinical diagnosis of amyloidosis.

Results

  A total of 59 patients were imaged during this time with an average age of 74.1 ± 11.8, and 32 (54.2%) were male. After excluding 8 patients for technical issues, 12 patients were found to be positive for amyloid, 39 were negative, and the average imaging delay time was 75.0 ± 15.2 minutes. 13 methods of assessment were evaluated with the metric of the percentage of injected tracer dose found in the heart that was adjusted for the mean residual blood pool activity having the best discrimination between abnormal and normal studies. The mean percentage of injected dose in positive patients was 2.87% vs 0.98% in the patients without amyloidosis (p < 0.0001). Using a cutoff of 2% to ensure that no patients with amyloid would be missed by screening, there was 100% sensitivity, 94.9% specificity, and 96.1% accuracy. There was a significant difference in the percentage injected dose based on gradations of planar heart to contralateral lung ratio and planar visual score.

Conclusion

Volumetric software quantification may be a superior method of evaluating 99m-Tc-PYP cardiac amyloidosis studies. This methodology may allow for a quantitative definition of a normal or abnormal 99m-Tc-PYP cardiac amyloid study and provide for the potential of following response to therapy.
Value of cardiac 123I-mIBG scintigraphy in prognosis of catheter ablation outcome in patients with atrial fibrillation
Authors: Sazonova S , Varlamova JV , Nikitin NA , Minin SM , Kisteneva IV , Batalov RE , Mishkina AI , Ilushenkova JN , Zavadovsky KV , Popov SV , Romanov AB
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation

Background. Previous studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal  AF and studied prognostic value of post CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. Thus, the goal of the present study was to estimate the utility of pre-procedural cardiac 123I-mIBG scintigraphy to identify patients at risk for AF recurrence after CA.

Methods. 123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patients were followed for 12 months. A blanking period of 3 months was applied. The primary endpoint of the study was AF recurrence between 3 and 12 months after ablation.

Results. Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate <1.6 (sensitivity 73.53 %, specificity 81.3%, AUC  0,792 , p < 0.001) and  WR > 25,11 (sensitivity 70.6%, specificity 70.8.3%, AUC  0,712 , p < 0.001) indicate high probability of AF relapses during 12 months after CA. Kaplan-Meier analysis showed that the H/Mlate < 1.6, WR > 25,11 and LAD > 45 mm  significantly increase the risk of AF recurrence after CA (p < 0.001, p < 0.001, p < 0.025 respectively).

Conclusion. Pre CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients.
The emotional evidence of early modern English plague wills
Authors: Formby Olivia
Published: July 2021

For seventeenth-century English Protestants will-making was a legal, religious and emotional practice, and one that continued in plague time. This article charts the resilience and accessibility of will-making in plague epidemics in Louth, Lincolnshire (1630/1–1631/2) and Kingston upon Hull, Yorkshire (1637–8) and analyses both qualitative and quantitative emotional evidence from plague wills to illustrate the historical insights that can be gained into ordinary experiences of plague, the family, friendship, charity and death. By identifying patterns in emotional gestures across the Louth and Hull plague wills, this study shows how early modern emotions could be poignantly conveyed through actions and symbols, revealing in both case studies the high communal value of love and godly fear, of places, names and objects, of caritas and memory.
Percutaneous dilation tracheostomy in a patient with tracheal stent
Authors: Fiorelli Alfonso , Messina Gaetana , Santini Mario , Ferraro Fausto
Published: July 2021

We reported the case of a patient with obstruction of tracheal stent, deployed previously for anaplastic thyroid carcinoma. The extension of malignant stricture above and below the stent and close to the vocal folds made unfeasible the stent recanalization and/or its replacement with another longer. Thus, tracheostomy was the only option to assure ventilation. After partial air-way recanalization with rigid bronchoscope, tracheostomy cannula was inserted through the stenosis using percutaneous dilatation tracheostomy technique.
Determination of Alternaria Toxins in Tomato, Wheat, and Sunflower Seeds by SPE and LC-MS/MS—A Method Validation Through a Collaborative Trial
Authors: Gonçalves Carlos , Tölgyesi Ádam , Bouten Katrien , Robouch Piotr , Emons Hendrik , Stroka Joerg
Published: July 2021

Background

Alternaria toxins are ubiquitous contaminants in highly consumed food products. Therefore, they are candidates to be regulated by EU legislation. In this context, the availability of reliable analytical methods is a keystone both for protecting the health of citizens and smooth functioning of the European market.

Objective

This paper describes an advanced LC-MS/MS method based on isotope dilution quantification suitable for the determination of altenuene, alternariol, alternariol monomethyl ether, tenuazonic acid, and tentoxin in tomato puree, wheat, and sunflower seeds.

Methods

The method has been validated in an interlaboratory study that included the analysis of both spiked and naturally contaminated food commodities. Twenty-three participants contributed with analytical data.

Results

The average recoveries and relative standard deviations for repeatability and reproducibility obtained across the tested matrixes were: 97, 8.0, and 23%, for altenuene, respectively; 95, 9.2, and 17% for alternariol, respectively; 98, 6.4, and 13% for alternariol monomethyl ether, respectively; 97, 4.2, and 9.3% for tenuazonic acid, respectively; and 102, 5.6, and 15% for tentoxin, respectively. The method enabled the determination of all tested Alternaria toxins close to or below 1 µg/kg.

Conclusion

Overall, the method showed a satisfactory trueness and precision, complying with the requirements for the monitoring of mycotoxins in food in the EU. It is currently under evaluation by the European Committee for Standardization for adoption as a standard method.

Highlights

Isotope dilution mass spectrometry method for the determination of Alternaria toxins in food.
The Treaty on trademarks, service marks and appellations of origin of the Eurasian Economic Union and instructions to it entered into force
Authors: Abramov Stepan
Published: July 2021

The Treaty on trade marks, service marks and appellations of origin of the Eurasian Economic Union (entered into force on 26 April 2021)

Instructions to the Treaty on trade marks, service marks and appellations of origin of the Eurasian Economic Union (entered into force on 17 June 2021)

The Treaty on the Eurasian Economic Union (EAEU) trade marks, service marks and appellations of origin, signed on 3 February 2020, came into force on 26 April 2021 upon its ratification by all the EAEU Member States (Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan and Kyrgyz Republic). On 18 May 2021, the Counsel of the Eurasian Economic Commission approved instructions thereto, which came into effect on 17 June 2021.
The Mediterranean Fruit Fly (Diptera: Tephritidae), a Key Pest of Citrus in Egypt
Authors: Abd-Elgawad Mahfouz M M
Published: July 2021

The Mediterranean fruit fly (Mediterranean fruit fly), Ceratitis capitata (Wiedemann), is a key pest of citrus fruit (Sapindales: Rutaceae), and can infect over 300 other economically important fruit-bearing plant species globally. The Mediterranean fruit fly moves to different hosts continuously and has 8–10 overlapping generations a year in Egypt. The female lays the eggs under the fruit peel and hatched larvae use anterior mouth hooks to vigorously feed on fruit flesh until they reach the third and last instar. As tens of eggs are often deposited in a single spot, the fruit becomes juicy and inedible. Larval infection and feeding also facilitate the entry of fungi and microbes that can rot the fruit. Infestation of citrus orchards can result in significant annual losses in crop size and quality. As a quarantine pest with high reproductive potential and dispersive ability, the Mediterranean fruit fly is difficult to manage and poses a major threat to Egyptian citrus export because of concerns over infection or pesticide residues. This review discusses the current state of research on Mediterranean fruit fly biology and ecology as well as host fruit production practices from the standpoint of pest management. Integrated pest management programs consisting of regulatory, cultural, chemical, genetic, and biological control methods that are currently the most effective strategies for Mediterranean fruit fly control are also described.
Substance Use Relapse Among Veterans at Termination of Treatment for Substance Use Disorders
Authors: Betancourt Christian A , Kitsantas Panagiota , Goldberg Deborah G , Hawks Beth A
Published: July 2021

Introduction

Military veterans continue to struggle with addiction even after receiving treatment for substance use disorders (SUDs). Identifying factors that may influence SUD relapse upon receiving treatment in veteran populations is crucial for intervention and prevention efforts. The purpose of this study was to examine risk factors that contribute to SUD relapse upon treatment completion in a sample of U.S. veterans using logistic regression and classification tree analysis.

Materials and Methods

Data from the 2017 Treatment Episode Data Set—Discharge (TEDS-D) included 40,909 veteran episode observations. Descriptive statistics and multivariable logistic regression analysis were conducted to determine factors associated with SUD relapse after treatment discharge. Classification trees were constructed to identify high-risk subgroups for substance use after discharge from treatment for SUDs.

Results

Approximately 94% of the veterans relapsed upon discharge from outpatient or residential SUD treatment. Veterans aged 18-34 years old were significantly less likely to relapse than the 35-64 age group (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.66, 0.82), while males were more likely than females to relapse (OR 1.55, 95% CI: 1.34, 1.79). Unemployed veterans (OR 1.92, 95% CI: 1.67, 2.22) or veterans not in the labor force (OR 1.29, 95% CI: 1.13, 1.47) were more likely to relapse than employed veterans. Homeless vs. independently housed veterans had 3.26 (95% CI: 2.55, 4.17) higher odds of relapse after treatment. Veterans with one arrest vs. none were more likely to relapse (OR 1.52, 95% CI: 1.19, 1.95). Treatment completion was critical to maintain sobriety, as every other type of discharge led to more than double the odds of relapse. Veterans who received care at 24-hour detox facilities were 1.49 (95% CI: 1.23, 1.80) times more likely to relapse than those at rehabilitative/residential treatment facilities. Classification tree analysis indicated that homelessness upon discharge was the most important predictor in SUD relapse among veterans.

Conclusion

Aside from numerous challenges that veterans face after leaving military service, SUD relapse is intensified by risk factors such as homelessness, unemployment, and insufficient SUD treatment. As treatment and preventive care for SUD relapse is an active field of study, further research on SUD relapse among homeless veterans is necessary to better understand the epidemiology of substance addiction among this vulnerable population. The findings of this study can inform healthcare policy and practices targeting veteran-tailored treatment programs to improve SUD treatment completion and lower substance use after treatment.
Malignant Hyperthermia—A Case From Camp Humphreys, South Korea, and Lessons for the Military Health System
Authors: Wren Paige , Chun Sung Min , Vietor Robert
Published: July 2021

Although malignant hyperthermia (MH) is a well-known complication of anesthesia, it presents unique considerations in the military health system. In this case report, the authors present a 26-year-old male active duty service member who experienced an MH crisis during a routine bilateral sagittal split osteotomy. The case presented here, which occurred at Brian D Allgood Army Community Hospital at Camp Humphreys, South Korea, highlights the challenges presented when caring for these patients in minimally staffed environments with frequent turnover of staff. The authors discuss the challenges to the military system such as the importance of adequate documentation of MH-susceptible service members, the benefits of rapidly dissolving dantrolene sodium nanosuspension, and the necessity for frequent training of military medical staff in the recognition and management of MH.
Evaluation of a Stress Management Course for Shipboard Sailors
Authors: Tannenbaum Karen , Hurtado Suzanne L , Yablonsky Abigail Marter
Published: July 2021

Background

As part of their day-to-day operational mission, shipboard sailors experience unique stressors that can affect their health and readiness. The San Diego Fleet and Family Support Center (FFSC) conducts in-person classes to teach stress management principles to sailors. The FFSC stress management course covers the causes and consequences of stress, reviews the Navy Operational Stress Control model, and provides information on basic stress management skills. This course has not been rigorously evaluated to determine its impact on the sailors’ ability to manage stress. The purpose of this study was to evaluate the short-term impact of the FFSC stress management class on the (1) sailors’ stress management knowledge, (2) sailors’ intention to share knowledge from the class with others, and (3) sailors’ satisfaction with the class.

Method

Shipboard sailors (n = 95) who attended a stress management course completed pretest and posttest assessments that measured workplace stress, current stress management behaviors, stress management knowledge, intention to share course information, and participant satisfaction with the course. Most ratings were made on a 5-point scale, where higher scores indicated more positive outcomes.

Results

In the aggregate, participants gave high marks for the class (M = 3.81, SD = 0.66), gave positive ratings for the class instructors (M = 3.84, SD = 0.67), and were satisfied with the class (M = 4.05, SD = 0.63). Sailors also reported that the class was relevant to their work (M = 3.64, SD = 0.81). Overall, 80% of class participants intended to share information learned in the class with family members and military friends, potentially extending the reach and impact of the FFSC class. Finally, sailors did not show increased stress management knowledge as a result of taking the FFSC stress management class (P = .31).

Conclusion

This study was the first evaluation of the short-term impact of the FFSC stress management course on the stress management knowledge of shipboard crews. Study limitations prevented the study team from assessing the long-term impact of the stress management course on future stress levels and stress abatement behaviors. Recommendations are made to enhance future evaluations of FFSC classes for service members.
Small-molecule compounds boost genome-editing efficiency of cytosine base editor
Authors: Zhao Tianyuan , Li Qing , Zhou Chenchen , Lv Xiujuan , Liu Hongyan , Tu Tianxiang , Tang Na , Cheng Yanbo , Liu Xiaoyu , Liu Changbao , Zhao Junzhao , Song Zongming , Wang Haoyi , Li Jinsong , Gu Feng
Published: July 2021

Cytosine base editor (CBE) enables targeted C-to-T conversions at single base-pair resolution and thus has potential therapeutic applications in humans. However, the low efficiency of the system limits practical use of this approach. We reported a high-throughput human cells-based reporter system that can be harnessed for quickly measuring editing activity of CBE. Screening of 1813 small-molecule compounds resulted in the identification of Ricolinostat (an HDAC6 inhibitor) that can enhance the efficiency of BE3 in human cells (2.45- to 9.21-fold improvement). Nexturastat A, another HDAC6 inhibitor, could also increase BE3-mediated gene editing by 2.18- to 9.95-fold. Ricolinostat and Nexturastat A also boost base editing activity of the other CBE variants (BE4max, YE1-BE4max, evoAPOBEC1-BE4max and SpRY-CBE4max, up to 8.32-fold). Meanwhile, combined application of BE3 and Ricolinostat led to >3-fold higher efficiency of correcting a pathogenic mutation in ABCA4 gene related to Stargardt disease in human cells. Moreover, we demonstrated that our strategy could be applied for efficient generation of mouse models through direct zygote injection and base editing in primary human T cells. Our study provides a new strategy to improve the activity and specificity of CBE in human cells. Ricolinostat and Nexturastat A augment the effectiveness and applicability of CBE.
Transmission of SARS-CoV-2 Alpha Variant (B.1.1.7) From a BNT162b2-Vaccinated Individual
Authors: Kernéis Solen , Planas Delphine , Imbeaud Sandrine , Staropoli Isabelle , Puech Julien , Robillard Nicolas , Rodary Julien , Bruel Timothée , Vieillard Thomas , Schwartz Olivier , Belec Laurent , Péré Hélène , Veyer David
Published: July 2021

Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) acquisition after vaccination with BNT162b2 have been described, but the risk of secondary transmission from fully vaccinated individuals remains ill defined. Herein we report a confirmed transmission of SARS-CoV-2 alpha variant (B.1.1.7) from a symptomatic immunocompetent woman 4 weeks after her second dose of BNT162b2, despite antispike seroconversion.
Phenotypes of obstructive sleep apnea in the Hispanic Community Health Study/Study of Latinos
Authors: González Kevin A , Tarraf Wassim , Wallace Douglas M , Stickel Ariana M , Schneiderman Neil , Redline Susan , Patel Sanjay R , Gallo Linda C , Mossavar-Rahmani Yasmin , Daviglus Martha L , Zee Phyllis C , Talavera Gregory A , Sotres-Alvarez Daniela , González Hector M , Ramos Alberto
Published: July 2021

Study Objectives

Recent work on US Whites from clinical samples used obstructive sleep apnea (OSA) symptoms to generate phenotypes for individuals with moderate-severe OSA which suggested 3 to 5 symptom classes. However, it is unknown whether similar classes generalize to diverse Hispanics/Latino adults. Therefore, we sought to fill this gap by empirically deriving sleep phenotypes among a large sample of diverse Hispanics/Latinos.

Methods

We used data from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL; 2008–2011), a prospective cohort study designed using a multisite multistage probability sample of adults 18–74 years old. The subpopulation of interest included participants with moderate-severe OSA symptoms (≥15 respiratory event index (REI) events per hour; n = 1,605). We performed latent class analysis for complex survey data using 15 common OSA symptoms (e.g. Epworth Sleepiness Scale) and 4 comorbidities to identify phenotype classes.

Results

Average age was 52.4 ± 13.9 years and 34.0% were female. Mean REI was 33.8 ± 22.5 events per hour. Fit statistics and clinical significance suggested that a three-class solution provided the best fit to the data. The three phenotypes were: (1) Minimally Symptomatic (47.7%), (2) Excessive sleepiness (37.1%), and (3) Disturbed Sleep (15.2%). Sensitivity models were consistent with the main proposed solution.

Conclusions

Derived sleep phenotypes among diverse Hispanic/Latinos were consistent with recent findings from the Sleep Apnea Global Interdisciplinary Consortium, but we found notable differences in class prevalence relative to Whites. Further research is needed to link derived sleep phenotypes to health comorbidities in diverse populations.
Volumetric magnetic resonance imaging analysis of multilevel upper airway surgery effects on pharyngeal structure
Authors: Sutherland Kate , Lowth Aimee B , Antic Nick , Carney A Simon , Catcheside Peter G , Chai-Coetzer Ching Li , Chia Michael , Hodge John-Charles , Jones Andrew , Kaambwa Billingsley , Lewis Richard , MacKay Stuart , McEvoy R Doug , Ooi Eng H , Pinczel Alison J , McArdle Nigel , Rees Guy , Singh Bhajan , Stow Nicholas , Weaver Edward M , Woodman Richard J , Woods Charmaine M , Yeo Aeneas , Cistulli Peter A
Published: July 2021

Study Objectives

The Sleep Apnea Multilevel Surgery (SAMS) trial found that modified uvulopalatopharyngoplasty with tonsillectomy (if tonsils present) combined with radiofrequency tongue ablation reduced obstructive sleep apnea (OSA) severity and daytime sleepiness in moderate-severe OSA. This study aimed to investigate mechanisms of effect on apnea-hypopnea index (AHI) reduction by assessing changes in upper airway volumes (airway space, soft palate, tongue, and intra-tongue fat).

Methods

This is a case series analysis of 43 participants of 51 randomized to the surgical arm of the SAMS trial who underwent repeat magnetic resonance imaging (MRI). Upper airway volume, length, and cross-sectional area, soft palate and tongue volumes, and tongue fat were measured. Relationships between changes in anatomical structures and AHI were assessed.

Results

The participant sample was predominantly male (79%); mean ± SD age 42.7 ± 13.3 years, body mass index 30.8 ± 4.1 kg/m2, and AHI 47.0 ± 22.3 events/hour. There were no, or minor, overall volumetric changes in the airway, soft palate, total tongue, or tongue fat volume. Post-surgery there was an increase in the minimum cross-sectional area by 0.1 cm2 (95% confidence interval 0.04–0.2 cm2) in the pharyngeal airway, but not statistically significant on corrected analysis. There was no association between anatomical changes and AHI improvement.

Conclusions

This contemporary multilevel upper airway surgery has been shown to be an effective OSA treatment. The current anatomical investigation suggests there are not significant post-operative volumetric changes associated with OSA improvement 6-month post-surgery. This suggests that effect on OSA improvement is achieved without notable deformation of airway volume. Reduced need for neuromuscular compensation during wake following anatomical improvement via surgery could explain the lack of measurable volume change. Further research to understand the mechanisms of action of multilevel surgery is required.

Clinical Trial

This manuscript presents a planned image analysis of participants randomized to the surgical arm or the clinical trial multilevel airway surgery in patients with moderate-severe obstructive sleep apnea (OSA) who have failed medical management to assess change in OSA events and daytime sleepiness. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=266019&isReview=true%20Australian%20New%20Zealand%20Clinical%20Trials%20Registry%20ACTRN12514000338662, prospectively registered on March 31, 2014.
Examination of the Global Regulon of CsrA inXanthomonas citrisubsp.citriUsing Quantitative Proteomics and Other Approaches
Authors: Zhang Yanan , Andrade Maxuel O. , Wang Wenting , Teper Doron , Romeo Tony , Wang Nian
Published: July 2021

The RNA-binding protein CsrA is a global posttranscriptional regulator and controls many physiological processes and virulence traits. Deletion of csrA caused loss of virulence, reduced motility and production of xanthan gum and substantial increase in glycogen accumulation, as well as enhanced bacterial aggregation and cell adhesion in Xanthomonas spp. How CsrA controls these traits is poorly understood. In this study, an isobaric tag for relative and absolute quantitation (iTRAQ)-based proteomic analysis was conducted to compare the protein profile of wild-type strain Xanthomonas citri subsp. citri and the isogenic ΔcsrA strain. A total of 2,374 proteins were identified, and 284 were considered to be differentially expressed proteins (DEPS), among which 151 proteins were up-regulated and 133 were down-regulated in the ΔcsrA strain with respect to the wild-type strain. Enrichment analysis and a protein-protein interaction network analysis showed that CsrA regulates bacterial secretion systems, flagella, and xanthan gum biosynthesis. Several proteins encoded by the gumB operon were down-regulated, whereas proteins associated with flagellum assembly and the type IV secretion system were up-regulated in the ΔcsrA strain relative to the Xcc306 strain. These results were confirmed by β-glucuronidase assay or Western blot. RNA secondary structure prediction and a gel-shift assay indicated that CsrA binds to the Shine-Dalgarno sequence of virB5. In addition, the iTRAQ analysis identified 248 DEPs that were not previously identified in transcriptome analyses. Among them, CsrA regulates levels of eight regulatory proteins (ColR, GacA, GlpR, KdgR, MoxR, PilH, RecX, and YgiX), seven TonB-dependent receptors, four outer membrane proteins, and two ferric enterobactin receptors. Taken together, this study greatly expands understanding of the regulatory network of CsrA in X. citri subsp. citri.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Pregnancy and the Opioid Crisis: Heightened Effects of COVID-19
Authors: White Ashley , Lundahl Brad , Bryan Myranda Aryana , Okifuji Akiko , Smid Marcela , Gordon Adam J. , Carlston Kristi , Silipigni John , Abdullah Walitta , Krans Elizabeth E. , Kenney Amy , Cochran Gerald
Published: July 2021

The opioid epidemic continues to affect pregnant women with opioid use disorder adversely in unique and enduring ways. The onset of the coronavirus disease 2019 (COVID-19) pandemic and the necessary public health measures implemented to slow the transmission have increased barriers to care for these same women. This commentary explores the implications of these measures and discusses strategies we have developed to manage these challenges based on our work in a clinical trial providing patient navigation to pregnant mothers with OUD. We believe these solutions can be applied in medical, behavioral health, and research settings through the pandemic and beyond to increase the quality of care and resources to this vulnerable population.
Anhedonia and Substance Use Disorders by Type, Severity, and With Mental Health Disorders
Authors: Stull Samuel W. , Bertz Jeremiah W. , Epstein David H. , Bray Bethany C. , Lanza Stephanie T.
Published: July 2021

Objectives

Anhedonia can accompany substance use disorders (SUDs); its severity may vary by substance type, severity of SUD symptoms, or psychiatric comorbidity. The goal of this study was to clarify the contribution of each.

Methods

Data were from participants aged 18 to 65 years in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women), a cross-sectional, nationally representative sample reporting lifetime DSM-5 symptoms and lifetime anhedonia. We used logistic regression to test how anhedonia was associated with specific SUDs and psychiatric disorders in respondents with one lifetime diagnosis. We used latent class analysis to assess the association of anhedonia with patterns of comorbidity in all respondents.

Results

Opioid use disorder (OUD) had the greatest odds of anhedonia relative to other SUDs (ORs [95% CIs]): mild alcohol use disorder (AUD) (3.33 [1.74, 6.38]), moderate/severe AUD (2.73 [1.41, 5.30]), and cannabis use disorder (3.21 [1.43, 7.19]), though not significantly greater than stimulant use disorder (2.44 [.88, 6.73]). Anhedonia was more likely in mood disorders and posttraumatic stress disorder (PTSD) than in any SUD, except for PTSD versus OUD (OR [95% CIs] = .98 [.47, 2.02]). In latent class analysis analyses, the poly disorder class, which included SUDs and other diagnoses, had greater odds of anhedonia than the Poly SUD (ORs [95% CIs] = 1.62 [1.25, 2.09] and AUD 2.89 [2.40, 3.48]) classes.

Conclusions

People with OUD or a lifetime history of mood disorder or PTSD may be most likely to present to SUD treatment with anhedonia.
Characterizing the Clinical use of a Novel Video-assisted Dosing Protocol With Secure Medication Dispensers to Reduce Barriers to Opioid Treatment
Authors: Brooklyn John R. , Stothart Marne , Stunell Mallory , Berman Vanessa Melamede , Rylant Danielle , Hanson Melanie
Published: July 2021

Objectives

Distance and travel costs to opioid treatment programs (OTPs), especially in rural communities, are barriers to treatment for opioid use disorder. Retention rates at 12 months in our OTP are 55% (range 53%–61%).We piloted a novel treatment platform utilizing a video directly observed therapy (VDOT) smartphone app and a secure medication dispenser to support adherence with take-home doses of methadone or buprenorphine while enabling patients to maintain prosocial activities, reduce time and cost of travel, and increase retention.

Methods

Participants (n¼58) were adults in a Vermont OTP. Inclusion criteria included travel hardship, access to Wi-Fi or cellular network, and having an iPhone 4S or Android 4.0 or greater. Patients received a dispenser, VDOT app, clinic dispensed medication, counseling, and urine drug testing. Chart reviews assessed VDOT compliance, engagement in prosocial activities, travel costs and time savings, and treatment disposition/retention. Project-associated costs were examined.

Results

Of the 15,831 expected videos, 15,581 (98.4%) were received and only 10 (0.063%) showed signs of medication noncompliance with 1 (0.0064%) showing an overt attempt at diversion. About 93% of participants engaged in prosocial activities, travel time and costs were reduced 86%, median cost saved $72 weekly, median travel time saved 5.5 hours weekly and 98% of participants were in treatment 12 months later.

Conclusions

VDOT participants using dispensers showed high levels of medication ingestion integrity, had favorable clinical stability, and lower travel time and costs. These findings suggest that using VDOT with dispensers may hold promise as an innovative platform for supporting medication adherence.
Laws Forbidding Pregnancy Discrimination in Substance Use Disorder Treatment Are Not Associated With Treatment Access
Authors: Davis Corey S. , McNeer Elizabeth , Patrick Stephen W.
Published: July 2021

Objectives

To determine if state laws that forbid substance use disorder treatment providers from refusing services based on pregnancy are associated with improved ability to secure an initial appointment for opioid use disorder treatment with methadone and buprenorphine.

Methods

Ten states in which a “secret shopper” study was conducted were stratified based on whether they have a law that forbids substance use disorder treatment providers from refusing to treat individuals because of pregnancy. We tested for differences in percent of pregnant versus nonpregnant callers offered an initial appointment for medication for opioid use disorder treatment between states with a law and those without. We also tested for differences in acceptance based on caller insurance type.

Results

Four states with 1461 callers had relevant laws; 6 states with 2495 callers did not. None of the laws apply to all providers. In both groups of states, nonpregnant callers were significantly more likely to obtain a buprenorphine appointment (75.1% vs 60.1% in states with a law, P < 0.01; 73.1% vs 62.3% in states without, P < 0.01). No significant differences were found in methadone appointment access either between pregnant and nonpregnant callers or between pregnant callers in states with a law compared to those without.

Conclusions

Laws that forbid providers from refusing to treat potential patients because they are pregnant were not associated with success in obtaining an initial appointment for medication for opioid use disorder treatment. States should consider expanding those laws to apply to all treatment providers and ensure that currently covered providers are in compliance.
Sex Differences in Injection Drug Risk Behaviors Among Hospitalized Persons
Authors: Biondi Breanne E. , Anderson Brad J. , Phillips Kristina T. , Stein Michael
Published: July 2021

Objectives

As opioid use increases, it remains important to assess factors that contribute to injection drug risk behaviors, as sharing needles and other drug use equipment contributes to the spread of human immunodeficiency virus and hepatitis C virus. Such risks may differ by sex and injecting with others. The current study examined factors that contribute to increased injection drug risk separately for men and women.

Methods

People who inject drugs were recruited at an academic safety-net hospital that reported recent injection drug use. Two main injection outcomes were assessed: (1) human immunodeficiency virus drug risk behaviors as assessed by the Risk Assessment Battery and (2) the number of times participants injected drugs with a needle used by someone else. For each outcome, different models for women and men were conducted to detect differences by sex.

Results

Both men and women were more likely to inject with a needle used by someone else if they used drugs within a sexual relationship (incidence rate ratio (IRR) = 14.61, P < 0.01; IRR = 7.17, P < 0.05). Being employed was associated with lower risk assessment battery scores among men, and lower mean rates of using a needle used by someone else among women (IRR = 0.22, P < 0.05). Women with post-traumatic stress disorder (PTSD) and men with higher depression scores had higher rates of injecting with a needle used by someone else.

Conclusions

People who inject drugs who are in intimate relationships report higher injection drug risk behaviors. We found benefits to employment among both men and women. Identifying factors associated with increased injection risk behaviors can be useful for creating interventions tailored by sex.
Dysfunction of the Auditory System in Children With Hypothyroidism: A Systematic Review and Meta-Analysis
Authors: Zhang Kathy , Fried Jacob , Nguyen Shaun A. , Meyer Ted A. , White David R.
Published: July 2021

Objective:

To examine the prevalence of hearing impairment in children with hypothyroidism, and to characterize clinical and subclinical hearing loss by examining cochlear function, auditory brainstem pathways, and integration of the auditory system as a whole.

Design:

An electronic search was conducted using PubMed, Scopus, and Cochrane Library databases. This systematic review was performed in accordance with the PRISMA guidelines. Original observational studies that utilized audiological tests for auditory system evaluations in hypothyroidism were included. A total of 2004 studies were found in the search, with 23 studies meeting the inclusion criteria.

Results:

The pooled prevalence of hearing loss was 16.1% [95% confidence interval 10.7, 22.4] for children with congenital hypothyroidism. Hearing thresholds at pure-tone averages (0.5–2 kHz) were 1.6 dB [95% confidence interval 1.7, 4.8] higher for children with hypothyroidism compared to age-matched controls. Cochlear dysfunction was detected at middle frequencies (1–3 kHz) by otoacoustic emission testing, indicating abnormalities of hair cell function or cochlear integration. Retrocochlear involvement was detected on auditory brainstem response (ABR), with prolonged Wave I indicating a peripheral conduction abnormality localized to the middle or inner ear and eighth cranial nerve.

Conclusions:

Children with hypothyroidism have a higher prevalence of hearing loss than children without hypothyroidism. For children with congenital hypothyroidism, evidence of subclinical abnormalities at the level of the cochlea and eighth cranial nerve are present despite early initiation of levothyroxine therapy. Dysfunction of the auditory system might begin with predominance of peripheral conduction abnormalities early in development.
Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis
Authors: Tan Si Heng Sharon , Low Jia Ying , Chen Hao , Tan Joel Yong Hao , Lim Andrew Kean Seng , Hui James Hoipo
Published: July 2021

Objectives:

To review surgical management and outcomes of missed pediatric Monteggia fractures.

Data Sources:

A systematic review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library from inception through March 2, 2020. The keywords were “Monteggia fracture,” “missed Monteggia,” “neglected Monteggia,” “chronic Monteggia,” and “chronic radial head dislocation.”

Study Selection:

All original human studies on missed pediatric Monteggia fractures were included. Congenital Monteggia fractures and isolated radial head dislocations were excluded.

Data Extraction:

The revised Methodological Index for Nonrandomised Studies tool was used to assess the quality of studies.

Data Synthesis:

Each patient's data were retrieved individually. The χ2 test and Fisher exact test were used to analyze the difference in outcomes for different surgical managements. Multivariate analysis was performed for variables that were significant on univariate analysis.

Conclusions:

Thirty studies with 600 patients were included. Proximal ulnar osteotomies (P = 0.016) and the absence of transcapitellar pinning (P = 0.001) were the most significant predictors for eventual reduction of radial head. Other surgical management variables were not significant predictors. These include open or closed reduction approach of radial head reduction; presence or absence of ulnar osteotomy; presence or absence of lengthening, angular correction, overcorrection, or bone grafting of ulnar osteotomy; type of fixation for ulnar osteotomy; presence or absence of radial osteotomy; presence or absence of annular ligament repair or reconstruction; and repair or reconstruction of annular ligament.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Outcome After Open Reduction Internal Fixation of Acetabular Fractures in the Elderly
Authors: Sanders Ethan , Finless Alexandra , Adamczyk Andrew , Dobransky Johanna , Wilkin Geoffrey , Gofton Wade T. , Beaulé Paul E. , Liew Allan , Papp Steven , Grammatopoulos George
Published: July 2021

Objectives:

(1) Assess outcomes of acetabular open reduction and internal fixation (ORIF) in the elderly, (2) investigate factors influencing outcome, and (3) compare outcomes after low-energy and high-energy mechanisms of injury.

Design:

Retrospective case series.

Setting:

Level 1 trauma center.

Patients:

Seventy-eight patients older than 60 years (age: 70.1 ± 7.4; 73.1% males).

Intervention:

ORIF for acetabular fractures.

Main Outcome Measurements:

Complications, reoperation rates, Oxford Hip Score (OHS), and joint preservation and development of symptomatic osteoarthritis. Cases with osteoarthritis, OHS < 34, and those who required subsequent total hip arthroplasty were considered as poor outcome.

Results:

At a mean follow-up of 4.3 ± 3.7 years, 11 cases post-ORIF required a total hip arthroplasty. The 7-year joint survival post-ORIF was 80.7 ± 5.7%. Considering poor outcome as failure, the 7-year joint survival was 67.0 ± 8.9%. The grade of reduction was the most significant factor associated with outcome post-ORIF. Female sex (P = 0.03), pre-existing osteoporosis (P = 0.03), low-energy trauma (P = 0.04), and Matta grade (P = 0.002) were associated with poor outcome. Patients with associated both-column fractures were more likely to have nonanatomic reduction (P = 0.008). After low-energy trauma, joint survivorship was 36.6 ± 13.5% at 7 years compared with 75.4 ± 7.4% in the high-energy group when considering poor outcome as an end point (log rank P = 0.006). The cohort's mean OHS was 37.9 ± 9.3 (17–48).

Conclusions:

We recommend ORIF whenever an anatomic reduction is feasible. However, achievement and maintenance of anatomic reduction are a challenge in the elderly, specifically in those with low-energy fractures involving both columns, prompting consideration for alternative management strategies.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Periareolar Approach: All Seasons Technique for Multiple Breast Conditions
Authors: Klinger Marco , Vinci Valeriano , Giannasi Silvia , Bandi Valeria , Veronesi Alessandra , Maione Luca , Catania Barbara , Lisa Andrea , Cornegliani Guido , Giaccone Micol , Siliprandi Mattia , Battistini Andrea , Barbera Federico , Tinterri Corrado , Testori Alberto , Caviggioli Fabio , Klinger Francesco
Published: July 2021

Background:

The periareolar approach was first introduced by Hollander in 1924 and, since then, numerous contributions have been reported by different authors. Despite all the strengths associated with this versatile technique, the periareolar approach still poses three main problems: large areolar diameter with poor quality scar, flattening of the breast cone, and poor stability of the results. The purpose of this article is to show how this surgical technique, with a good patient selection, can be applied to different situations and obtain excellent results.

Methods:

We performed a retrospective study on 5028 consecutive procedures in 4198 female patients treated with a periareolar approach in two regional institutions between 2008 and 2018. We considered 853 pure mastopexies, 362 breast augmentations, 422 secondary breast augmentations, 402 corrections of stenotic breast, 2921 oncoplastic surgeries, and 68 breast reductions. Postoperative complication, as well as patient and surgeon satisfaction were assessed.

Result:

Patient and surgeon satisfaction 1 year after the procedure was excellent, and the complication rate was low.

Conclusions:

When the indication is set correctly, the periareolar approach can obtain excellent results. This versatile technique, initially introduced as a mastopexy technique, has expanded its applications and can now be used for multiple surgical situations.
Osseous Metaplasia of the Eyelid in a Child
Authors: Charles Norman C. , DeMaria Lauren N. , Viriya Elizabeth T.
Published: July 2021

Osteoma cutis is a term applied to bone formation in the dermis or subcutaneous tissue. It is deemed primary when occurring de novo without prior disease or secondary when associated with pre-existing inflammation, neoplasia or trauma. The authors describe a longstanding focal calcified and ossified lesion of the upper eyelid in a healthy 10-year-old girl along with a sterile corneal ulcer. The lesion most likely represented an ossified tarsal cyst or chalazion.