bluuebunny/crossref_metadata_2025 huggingface dataset:
Galanin (1-15) Enhances the Behavioral Effects of Fluoxetine in the Olfactory Bulbectomy Rat, Suggesting a New Augmentation Strategy in Depression
Authors: Flores-Burgess Antonio , Millón Carmelo , Gago Belen , García-Durán Laura , Cantero-García Noelia , Puigcerver Araceli , Narváez José Angel , Fuxe Kjell , Santín Luis , Díaz-Cabiale Zaida
Published: December 2021

Background

Selective serotonergic reuptake inhibitors, including fluoxetine (FLX), are the most commonly used for the treatment of major depression. However, they are effective for remission in only 30% of patients. Recently, we observed that Galanin (1-15) [GAL(1-15)] enhanced the antidepressant effects of FLX in naïve animals, suggesting a new augmentation strategy in depression.

Methods

We have analyzed in an animal model of depression, the olfactory bulbectomy (OBX) rats, the effect of GAL(1-15) on FLX-mediated responses in the forced swimming test and the sucrose preference test and the involvement of GAL receptor 2 with its antagonist, M871. We have also studied the corticosterone levels in OBX after the coadministration of GAL(1-15) with FLX. Moreover, we studied whether the effects of GAL(1-15) on FLX actions were mediated via auto- and heteroreceptor 5-HT1A (5-HT1AR), analyzing the binding characteristics, mRNA levels, and functionality of 5-HT1AR in the dorsal hippocampus.

Results

GAL(1-15) enhances the antidepressant-like effects induced by FLX in OBX animals in the forced swimming test and the sucrose preference test. The involvement of the GALR2 was demonstrated with M871. Importantly, the mechanism underlying the GAL(1-15)/FLX interactions in the OBX animals involves the 5-HT1AR in the hippocampus at the plasma membrane (increase of affinity and density of 5HT1AR in the DG) and transcriptional (increase of 5HT1AR mRNA levels in DG and CA1) levels. Besides, the coadministration of GAL(1-15) and FLX also reduced OBX-increased corticosterone levels.

Conclusions

The results open the possibility to use GAL(1-15) in combination with FLX as a novel strategy for the treatment of depression.
To swab or not to swab? Using point-of-care tests to detect Group A Streptococcus infections as part of a Sore Throat Test and Treat service in community pharmacy
Authors: Mantzourani Efi , Cannings-John Rebecca , Evans Andrew , Ahmed Haroon
Published: December 2021

Background

The community pharmacy-led Sore Throat Test and Treat (STTT) service in Wales allowed pharmacists to undertake a structured clinical assessment with FeverPAIN/Centor scores and a point-of-care test (POCT) for Group A Streptococcus (GAS) infection. A new service model was temporarily agreed as a result of COVID-19, without routine use of POCT.

Objectives

To explore the impact of removing the requirement for GAS POCT from a community pharmacy STTT service on antibiotic supply.

Methods

Analysis of STTT consultation data, obtained for two periods: November 2018 (date the service went live) to September 2019 (pre-pandemic); and November 2020 (date the new service model was introduced) to May 2021.

Results

For consultations eligible for POCT, the antibiotic supply rate increased from 27% (922/3369) (95% CI: 26%–29%) with the pre-pandemic service model (FeverPAIN/Centor + POCT) to 63% (93/147) (95% CI: 55%–71%) with the new model (FeverPAIN/Centor only); the percentage of patients who were not issued an antibiotic, despite their high clinical score, decreased from 56% (646/1154) to 9.3% (8/86).

Conclusions

Preliminary data suggest that for every 100 STTT consultations with patients with a Centor score of ≥3 or a FeverPAIN score of ≥2, the use of POCT may spare up to 36 courses of antibiotics, increasing to 47 for patients with higher clinical scores, suggesting that the pre-COVID delivery model (FeverPAIN/Centor + POCT) is the optimal pathway and POCT in addition to clinical scores may result in fewer antibiotic prescriptions for sore throat symptoms. These findings have implications for STTT service delivery during and beyond the COVID-19 pandemic.
Lightweight design with metallic additively manufactured cellular structures
Authors: Nguyen Phong Cong Hong , Kim Youngdoo , Choi Young
Published: December 2021

Lightweight design is essential in modern product development and is prevalent in automotive, aerospace, and biomedical applications. The utilization of cellular structure, aided by advancements in additive manufacturing, is among the most effective methods for achieving lightweight design without sacrificing structural integrity and functionality. In this paper, a stress-based structural optimization method is proposed for the design of lightweight components filled with octet functionally graded cellular structures fabricated using selective laser melting (SLM) with the AlSi10Mg alloy. The proposed method includes two main parts: the homogenization-based characterization of SLM-octet-cellular structures and the utilization of the characterized cellular structures for lightweight structure optimum design. Tensile and compression experiments were utilized to validate the proposed homogenization-based characterization method, showing that the simulation and experimental results were in agreement. In addition, the effectiveness of the proposed design optimization method was validated using the three-point bending beam design problem. The experimental results revealed that components filled with functionally graded cellular structures can withstand 15.25$\%$ more load than those with uniform cellular structures. This investigation presents a complete, validated, and industry-oriented lightweight design method, which is useful for the development of future green products.
Serum Metabolomics in Patients with Coexisting NAFLD and T2DM Using Liquid Chromatography-Mass Spectrometry
Authors: Hu Cheng , Zhuang Xiaoyu , Zhang Jiaqi , Wang Tao , Du Shengnan , Wang Jinping , Peng Xuelian , Cao Qin , Zhang Mingcai , Jiang Yuanye
Published: December 2021

Objective

Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) frequently coexist and can act synergistically to drive adverse outcomes of one another. This study aimed to unravel the metabolomic changes in patients with NAFLD and T2DM, to identify potential noninvasive biomarkers, and to provide insights for understanding the link between NAFLD and T2DM.

Methods

Three hundred participants aged 35 to 70 years who were diagnosed with NAFLD (n = 100), T2DM (n = 100), or a comorbidity of NAFLD and T2DM (n = 100) were included in this study. Anthropometrics and routine blood chemistry were assessed after overnight fast. The global serum metabolomic analysis was performed by ultra-performance liquid chromatography-Orbitrap mass spectrometry. Multivariate data analysis methods were utilized to identify the potential biomarkers.

Results

A set of serum biomarkers that could effectively separate NAFLD from NAFLD + T2DM and T2DM from NAFLD + T2DM were identified. We found that patients with coexisting NAFLD and T2DM had significantly higher levels of total protein (TP), triglycerides (TG), glucose in urine, and gamma-hydroxybutyric acid than those with NAFLD and had significant increased levels of TP, albumin, alanine aminotransferase, aspartate aminotransferase, total cholesterol, cholinesterase, TG, low-density lipoprotein, and apolipoprotein A when compared to patients with T2DM.

Conclusion

The metabolomics results provide evidence that the comorbidity of NAFLD and T2DM considerably altered patients’ metabolomics patterns compared to those of patients with only NAFLD or T2DM.
Torque reversal and orbital profile of X-ray pulsar OAO 1657−415
Authors: Liao Zhenxuan , Liu Jiren , Jenke Peter A , Gou Lijun
Published: December 2021

OAO 1657−415 is an atypical supergiant X-ray binary among wind- and disc-fed systems, showing alternate spin-up/spin-down intervals lasting of the order of tens of days. We study different torque states of OAO 1657−415 based on the spin history monitored by Fermi/Gamma-Ray Burst Monitor, together with fluxes from Swift/Burst Alert Telescope (BAT) and Monitor of All-sky X-ray Image/Gas Slit Camera. Its spin frequency derivatives are well correlated with Swift/BAT fluxes during rapid spin-up episodes, anticorrelated with Swift/BAT fluxes during rapid spin-down episodes, and not correlated in between. The orbital profile of spin-down episodes is reduced by a factor of 2 around orbital phases of 0.2 and 0.8 compared to that of spin-up episodes. The orbital hardness ratio profile of spin-down episodes is also lower than that of spin-up episodes around phases close to the mid-eclipse, implying that there is more material between the neutron star and the observer for spin-down episodes than for spin-up episodes around these phases. These results indicate that the torque state of the neutron star is connected with the material flow on orbital scale and support the retrograde/prograde disc accretion scenario for spin-down/spin-up torque reversal.
The Use of Tobacco Industry Vaping Products in the UK and Product Characteristics: A Cross-Sectional Survey
Authors: Cornish Elliot J , Brose Leonie S , McNeill Ann
Published: December 2021

Background

Tobacco industry (TI) companies have entered the UK e-cigarette (“vaping”) market in recent years. However, their motives and ambitions are unclear. This study explored how popular TI vaping products are and who uses them, and how they differ from independent products.

Methods

Secondary analysis of data from a longitudinal web-based survey of smokers, ex-smokers, and vapers (n = 3883) in the UK in 2019. The main study sample consisted of daily and nondaily vapers, who were current or ex-cigarette smokers, and had stated the brand of their preferred e-cigarette device (n = 1202). Proportions using TI and independent brands were calculated and regression analysis assessed associations with sociodemographic and smoking/vaping characteristics between vapers of TI and independent products. Chi-square tests were used to analyze differences between TI and independent products.

Results

Overall, 53.4% used TI products. A university education (67.6%; adjOR = 1.54; 95% CI, 1.140–2.088), nondaily vaping (68.2%; adjOR = 1.39; CI, 1.029–1.880), and cigarette dependence (moderate, strong and very strong urges to smoke) were associated with using TI vaping brands. TI products used were less likely to be refillable (“open”) than independent brands (60.9% vs. 18.3%, chi-square = 228.98, p < .001), more likely to use nicotine salts (16.7% vs. 8.6%, chi-square = 25.04, p < .001) and tobacco flavors (23.8% vs. 17.9%, chi-square = 12.65, p < .001).

Conclusion

TI vaping products were popular in the UK, associations with product and user characteristics suggest that TI products may be less conducive to smoking cessation, although the findings were not always consistent.

Implications

Consequences of regulations need to be carefully considered to ensure that independent producers are not more negatively impacted than tobacco industry producers, and to avoid reducing utility of products for smoking cessation.
Advances in gene editing without residual transgenes in plants
Authors: He Yubing , Mudgett Michael , Zhao Yunde
Published: December 2021

Transgene residuals in edited plants affect genetic analysis, pose off-target risks, and cause regulatory concerns. Several strategies have been developed to efficiently edit target genes without leaving any transgenes in plants. Some approaches directly address this issue by editing plant genomes with DNA-free reagents. On the other hand, DNA-based techniques require another step for ensuring plants are transgene-free. Fluorescent markers, pigments, and chemical treatments have all been employed as tools to distinguish transgenic plants from transgene-free plants quickly and easily. Moreover, suicide genes have been used to trigger self-elimination of transgenic plants, greatly improving the efficiency of isolating the desired transgene-free plants. Transgenes can also be excised from plant genomes using site-specific recombination, transposition or gene editing nucleases, providing a strategy for editing asexually produced plants. Finally, haploid induction coupled with gene editing may make it feasible to edit plants that are recalcitrant to transformation. Here, we evaluate the strengths and weaknesses of recently developed approaches for obtaining edited plants without transgene residuals.
The relationship between the nail and systemic enthesitis in psoriatic arthritis
Authors: Elliott Ashley , Pendleton Adrian , Wright Gary , Rooney Madeleine
Published: December 2021

Objective

Psoriatic nail disease is more common in PsA than in isolated skin psoriasis (PsO). The nail is closely integrated to the DIP joint entheses. US data have shown that those patients with nail disease in PsO are more likely to have systemic enthesitis. We examined whether there was a relationship between nail disease, DIP enthesitis and systemic enthesitis in established PsA.

Methods

Forty-six PsA participants with nail disease underwent US scanning of the nail unit and the DIP entheses along with peripheral entheseal sites according to the Madrid sonographic enthesitis index (MASEI).

Results

At the finger level, there was a mild to moderate correlation between nail US changes and both clinical nail disease and DIP enthesis changes (DIP US) [Spearman correlation (rS) = 0.30, P < 0.001 and rS = 0.16, P < 0.001, respectively]. At the patient level, there was a moderate correlation between the nail US score and nail psoriasis severity index score and DIP US (rS = 0.33, P = 0.024 and rS = 0.43, P = 0.003, respectively). At the patient level, there was also a positive correlation between a higher nail US score and the active peripheral enthesitis score (MASEI-active) (rS = 0.35, P = 0.018). When power Doppler was part of nail US score, similar results were demonstrated at both the finger and patient levels.

Conclusion

This study has demonstrated the utility of nail US imaging and the close relationship, on scanning, between the DIP entheses and the nail unit. In PsA, we have seen a correlation between active US changes at the nail and peripheral enthesitis, which requires further analysis.

Trial registration

ClinicalTrials.gov, https://clinicaltrials.gov, NCT03955861.
Sea–land transition drove terrestrial amphipod diversification in East Asia, with a description of a new species
Authors: Liu Hongguang , Tong Yan , Zheng Yami , Li Shuqiang , Hou Zhonge
Published: December 2021

Sea–land transition caused by marine incursion and regression is hypothesized to be a major driving force in terrestrial biodiversity, providing opportunities for marine ancestors to colonize terrestrial habitats and driving vicariant speciation in distinct geographical regions. Here, we test this hypothesis in East Asia using amphipods of the Morinoia japonica complex. We constructed a dataset from 269 individuals covering all known ranges of this species complex. Phylogenetic and biogeographic analyses revealed that sea–land transition during the Miocene drove the coastal ancestor to invade terrestrial habitats in East Asia and subsequently split into eight biogeographic lineages in eastern China, Korea, Japan and some Pacific islands. Stepping-stone dispersal resulted in a relatively wide distribution of M. japonica, and long-term geographical isolation led to the diversification of the M. japonica complex. Species delimitation analysis suggests that this complex contains eight species. We describe the geographical group from eastern China as a new species, Morinoia aosen sp. nov., based on genetic and morphological comparisons with other geographical groups. Type specimens are deposited in the Institute of Zoology, Chinese Academy of Sciences (IZCAS) in Beijing, China.
Multiple Species of Asteraceae Plants Are Susceptible to Root Infection by the Necrotrophic Fungal Pathogen Sclerotinia sclerotiorum
Authors: Underwood William , Gilley Michelle , Misar Christopher G. , Gulya Thomas J. , Seiler Gerald J. , Markell Samuel G.
Published: December 2021

The necrotrophic fungal pathogen Sclerotinia sclerotiorum can cause disease on numerous plant species, including many important crops. Most S. sclerotiorum-incited diseases of crop plants are initiated by airborne ascospores produced when fungal sclerotia germinate to form spore-bearing apothecia. However, basal stalk rot of sunflower occurs when S. sclerotiorum sclerotia germinate to form mycelia within the soil, which subsequently invade sunflower roots. To determine whether other plant species in the Asteraceae family are susceptible to root infection by S. sclerotiorum, cultivated sunflower (Helianthus annuus L.) and seven other Asteraceae species were evaluated for S. sclerotiorum root infection by inoculation with either sclerotia or mycelial inoculum. Additionally, root susceptibility of sunflower was compared with that of dry edible bean and canola, two plant species susceptible to S. sclerotiorum but not known to display root-initiated infections. Results indicated that multiple Asteraceae family plants are susceptible to S. sclerotiorum root infection after inoculation with either sclerotia or mycelium. These observations expand the range of plant hosts susceptible to S. sclerotiorum root infection, elucidate differences in root inoculation methodology, and emphasize the importance of soilborne infection to Asteraceae crop and weed species.
Fungicide Resistance in Alternaria alternata from Blueberry in California and Its Impact on Control of Alternaria Rot
Authors: Wang Fei , Saito Seiya , Michailides Themis J. , Xiao Chang-Lin
Published: December 2021

Alternaria rot caused by Alternaria alternata is one of the major postharvest diseases affecting blueberries in California. The sensitivity profiles of A. alternata from blueberry field to quinone outside inhibitors (QoIs), boscalid, fluopyram, fludioxonil, cyprodinil, and polyoxin D in California were examined in this study. EC50 values of 51 A. alternata isolates for boscalid varied greatly among the isolates, ranging from 0.265 to >100 μg/ml. EC50 values of 51 A. alternata isolates to fluopyram, fludioxonil, cyprodinil, and polyoxin D were 5.188 ± 7.118, 0.078 ± 0.021, 0.465 ± 0.302, and 6.238 ± 7.352 μg/ml, respectively. In total, 143 isolates were screened for resistance at 5 and 10 μg/ml for fludioxonil, cyprodinil, and fluopyram, 10 μg/ml for polyoxin D, and 10 and 50 μg/ml for boscalid. Based on the published discriminatory concentrations for phenotyping resistance, of the 143 isolates, all were considered resistant to boscalid; 32, 69, and 42 were sensitive, low resistant, and resistant to fluopyram, respectively; and all were sensitive to fludioxonil and cyprodinil. In a PCR-restriction fragment length polymorphism method for phenotyping, 60 out of the 143 isolates were classified as resistant to QoIs. Control tests on detached blueberry fruit inoculated with different Alternaria isolates showed that fludioxonil and cyprodinil significantly reduced disease incidence and severity; however, pyraclostrobin, boscalid, fluopyram, and polyoxin D significantly reduced only disease severity. The obtained results will be helpful in making decisions on fungicide programs to control A. alternata isolates with resistance or reduced sensitivities to multiple fungicides.
Fusarium Head Blight Epidemics in Soft Red Winter Wheat Fields in Georgia from 2018 to 2019
Authors: Ghimire Bikash , Buck James W. , Mergoum Mohamed , Martinez-Espinoza Alfredo D.
Published: December 2021

Fusarium head blight (FHB) epidemics on wheat have caused significant yield and economic penalties in the United States since the early 1990s. This report documents FHB epidemics on soft red winter wheat in Georgia in 2018 and 2019. Forty-four wheat fields across 23 counties were assessed for FHB incidence (2019 only), Fusarium-damaged kernel, deoxynivalenol (DON) contamination, and thousand-kernel weight. Higher levels of FHB were observed in 2019 compared with 2018. A significant correlation was observed between DON and 7-day preanthesis weather variables in 2019. FHB parameters were significantly correlated with postanthesis weather variables at 10 days in both years and at 20 and 30 days in 2018, suggesting that postanthesis rather than preanthesis weather had a greater impact on FHB in our study. The combination of hours of conducive temperature and relative humidity postanthesis was consistently correlated with all FHB parameters in both years and could be the best predictor of FHB epidemics. FHB has emerged as the leading threat for soft red winter wheat production in Georgia. Planting moderately resistant wheat cultivars along with in-season management, including proper fungicide application, by closely monitoring the national FHB forecasting system would be the best integrated management strategies for Georgian wheat growers.
Inhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist?
Authors: Makkad Benu , Heinke Timothy Lee , Kertai Miklos D.
Published: December 2021

Purpose of review

Perioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery.

Recent findings

Recent literature reports lower mortality and better outcomes when VA is used alone or in combination with remote ischemic preconditioning compared with groups receiving TIVA. However, inconsistent research findings over the years have led to continued debate regarding the anesthetic technique considered more favorable for cardiac surgery.

Research findings regarding the use of volatile anesthetic versus TIVA for better outcomes after cardiac surgery are inconsistent. Variability in timing, duration, dosing, and type of VA as well as surgical and patient-related factors may have influenced these results. Therefore, either technique can reasonably be adopted depending on provider and institutional preference and used safely in patients undergoing cardiac surgery.
The Use of Carbon Fiber Implants for Impending or Existing Pathologic Fractures
Authors: Herzog Leah N. , Traven Sophia A. , Walton Zeke J. , Leddy Lee R.
Published: December 2021

Objectives:

To evaluate the utility and complications of using carbon fiber implants (CFIs) compared with standard titanium alloy (TI) intramedullary implants for stabilization of impending or existing pathologic fractures.

Design:

Retrospective comparison.

Patients/Participants:

Ninety-four patients undergoing intramedullary fixation of 100 impending or existing pathologic fractures between 2014-2019 were identified for inclusion.

Main Outcome Measurements:

The primary outcome was postoperative complications. Other outcomes included implant type, pathology, indication, and adjuvant therapy.

Results:

Fifty-three percent of cases used a CFI, whereas 47% of cases used a TI. There were no differences between groups with regard to anatomic location (P = 0.218), indication for surgery (P = 0.066), histology (P = 0.306), or postoperative adjuvant therapy (P = 0.308). Nineteen percent of cases incurred a postoperative complication in each group (P = 0.530), and no differences were noted with regard to complication type including implant failure (P = 0.442) and wound complications (P = 0.322). There was a cost saving of $400 with TI implants compared with CFI.

Conclusions:

This is a high-risk population for postoperative complications after stabilization of pathologic fractures. Although there were no statistical differences in complications between CFI and TI, implant choice depends on patient characteristics and surgeon preference.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Use of Clindamycin for Necrotizing Soft Tissue Infection Decreases Amputation Rate
Authors: Heath David M. , Boyer Braden J. , Ghali Abdullah N. , Momtaz David A. , Nagel Sarah C , Brady Christina I.
Published: December 2021

Objective:

To identify the impact of clindamycin use on mortality and amputation rates in patients with necrotizing fasciitis.

Design:

Retrospective review.

Setting:

Level 1 trauma center, single-center study.

Patients/Participants:

All patients from 2008 to 2019 with a diagnosis of necrotizing fasciitis. One hundred ninety patients were included in statistical analysis.

Intervention:

Use of clindamycin in the initial antibiotic regimen in the treatment of necrotizing soft tissue infection.

Main Outcome Measurements:

Amputation and mortality rates.

Results:

Patients who received clindamycin had 2.92 times reduced odds of having an amputation when compared with their counterparts, even when American Society of Anesthesiologist scores, comorbidities, smoking, drug use, alcohol consumption, race, ethnicity, sex, and age were controlled for and regardless of other antibiotics started (P = 0.015). There was no significant difference in mortality rate between those patients who did and did not receive clindamycin as part of their initial antibiotic regimen (8.3% vs. 11.6%, respectively; P = 0.453).

Conclusion:

The use of clindamycin in the initial antibiotic regimen for treatment of NSTI was shown to significantly decrease rates of amputation but not mortality.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Concurrent Validity of Q-TFA With PROMIS and Prosthetic Wear Time in Transfemoral Amputees
Authors: Sabharwal Samir , Skolasky Richard L. , Souza Jason M. , Potter Benjamin K. , Forsberg Jonathan A.
Published: December 2021

Objectives:

To evaluate whether the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) significantly correlates with select Patient-Reported Outcomes Measurement Information System (PROMIS) domains and self-reported prosthetic wear time in transfemoral amputees presenting for consideration of osseointegration.

Design:

This was a prospective study.

Setting:

Osseointegration Clinic, Walter Reed National Medical Center, Bethesda, MD.

Participants:

Patients who presented between 2017 and 2020 for consideration of osseointegration after transfemoral amputation.

Intervention:

We prospectively administered Q-TFA (including use, mobility, problems, and global health subscores) and PROMIS (including physical function, pain interference, and pain behavior domains) questionnaires. We also asked participants to self-report prosthetic wear time.

Main Outcome Measurement:

The main outcome measurement was concurrent validity, which was assessed through the Pearson correlation testing.

Results:

Among our 39 patients, the Pearson testing demonstrated significant correlation between the following: Q-TFA use and self-reported prosthetic wear time (r = 0.81, P < 0.001); Q-TFA mobility and PROMIS physical function (r = 0.44, P = 0.009); Q-TFA problems and PROMIS pain interference (r = 0.60, P < 0.001); and Q-TFA global health and PROMIS physical function (r = 0.35, P = 0.04).

Conclusions:

Across all 4 domains of Q-TFA, correlation testing established significant concurrent validity with select PROMIS domains and self-reported prosthetic wear time among our population of transfemoral amputees. Given its ease of administration and reduction of question burden, PROMIS may better serve our efforts to track the outcomes of future interventions—including osseointegration—for these patients.
Radial Head Prosthetic Replacement in Adolescents: A Report of 5 Cases
Authors: Rotman Dani , Rojas Lievano Jorge , Kwak Jae-Man , O’Driscoll Shawn W.
Published: December 2021

Background:

The management of severe radiocapitellar joint pathologies in young patients is challenging. Radial head arthroplasty (RHA) is a treatment option in the adult population, but most surgeons avoid implementing it in younger patients, and there are no published results for patients younger than 16 years.

Methods:

Our retrospective cohort describes 5 patients (4 male 1 female) who underwent cementless modular RHA at an average age of 14 years (range: 13 to 15). The preoperative diagnoses were post-traumatic radiocapitellar incongruity and arthrosis because of previous Salter-Harris type 3 or 4 fractures of the radial head in 3 cases; and axial instability of the forearm following failed radial head excision in 2 cases. Because of the complexity of the elbow pathology in these cases, all underwent concomitant procedures including: contracture release (5 cases), corrective ulnar osteotomy (2 cases), distal ulnar shortening osteotomy, excision of radioulnar synostosis, microfracture of the capitellum, and partial excision of the medial triceps (1 case each). Collected data included patient-reported outcomes, visual analog scale pain score at rest and during physical activity and radiographic assessment of arthritis and prosthesis loosening.

Results:

Average clinical follow-up was 8 years (range: 3 to 13). All 5 patients were pain-free at rest, and 3 reported moderate elbow pain (visual analog scale: 5 to 6) with physical activity. At an average radiographic follow-up of 3 years (range: 0.5 to 5), 3 patients showed mild progression of elbow arthrosis, but there were no signs of progressive capitellar erosion or implant loosening. Only 1 complication was noted—development of heterotopic ossification in 1 patient, which required open heterotopic ossification excision and contracture release 2 years following the RHA. None of the patients required prosthesis revision or removal.

Conclusion:

RHA was successful in improving pain and axial forearm stability in this very small series of adolescent patients. Concerns regarding long-term longevity and complications still exist. Considering the lack of other reliable treatment options, RHA may be indicated in this challenging patient population.

Level of Evidence:

Level IV: therapeutic study—case series.
The novel SLC40A1 (T419I) variant results in a loss-of-function phenotype and may provide insights into the mechanism of large granular lymphocytic leukemia and pure red cell aplasia
Authors: Wu Hongfei , Ren Xiang , Ge Meili , Dong Peiyuan , Wang Shichong , Yi Huiming , Li Xingxin , Huo Jiali , Zheng Xuan , Gao Mengying , Huang Jinbo , Zhang Jing , Wang Min , Jin Peng , Nie Neng , Shao Yingqi , Zheng Yizhou
Published: December 2021

Variants in the solute carrier family 40 member 1 (SLC40A1) gene are the molecular basis of ferroportin disease, which is an autosomal dominant hereditary hemochromatosis. Here, we present a patient with pure red cell aplasia (PRCA) and large granular lymphocytic leukemia (LGLL) associated with an extremely high levels of serum ferritin and iron overload syndrome. Whole exon sequencing revealed a novel heterozygous variant in SLC40A1 (p.T419I), which was found in his daughter as well. A series of functional studies in vitro of the T419I variant in ferroportin were conducted and the results revealed a reduced capacity of iron export from cells without changes in protein localization and its sensitivity to hepcidin. Intracellular iron storage in mutated cells was significantly higher than that of wild-type. These findings suggest that the novel variant p.T419I can cause the classical form of ferroportin disease and an elevated intracellular iron level indicates a potential novel pathogenic mechanism underlying PRCA and LGLL.
Cellular and Humoral Immune Responses Induced by an HLA Class I–restricted Peptide Cancer Vaccine Targeting WT1 Are Associated With Favorable Clinical Outcomes in Advanced Ovarian Cancer
Authors: Nishida Sumiyuki , Morimoto Soyoko , Oji Yusuke , Morita Satoshi , Shirakata Toshiaki , Enomoto Takayuki , Tsuboi Akihiro , Ueda Yutaka , Yoshino Kiyoshi , Shouq Alzaaqi , Kanegae Mizuki , Ohno Satoshi , Fujiki Fumihiro , Nakajima Hiroko , Nakae Yoshiki , Nakata Jun , Hosen Naoki , Kumanogoh Atsushi , Oka Yoshihiro , Kimura Tadashi , Sugiyama Haruo
Published: December 2021

The HLA-A*24:02–restricted peptide vaccine targeting Wilms’ tumor 1 (WT1) (WT1 vaccine) is a promising therapeutic strategy for ovarian cancer; however, its efficacy varies among patients. In this study, we analyzed WT1-specific immune responses in patients with advanced or recurrent ovarian cancer that was refractory to standard chemotherapies and their associations with clinical outcomes. In 25 patients, the WT1 vaccine was administered subcutaneously weekly for 3 months and biweekly thereafter until disease progression or severe adverse events. We assessed Wilms’ tumor 1–specific cytotoxic T lymphocytes (WT1-CTLs) and Wilms’ tumor 1 peptide-specific immunoglobulin G (WT1235-IgG). After vaccination, the percentage of tetramer high-avidity population of WT1-CTLs among CD8+ T lymphocytes (%tet-hi WT1-CTL) and the WT1235-IgG titer increased significantly, although the values were extremely low or below the limit of detection before vaccination (%tet-hi WT1-CTL: 0.003%–0.103%.; WT1235-IgG: <0.05–0.077 U/mL). Patients who had %tet-hi WT1-CTL of ≥0.25% (n=6) or WT1235-IgG of ≥0.10 U/mL (n=12) had a significantly longer progression-free survival than those of patients in the other groups. In addition, an increase in WT1235-IgG corresponded to a significantly longer progression-free survival (P=0.0496). In patients with systemic inflammation, as evidenced by elevated C-reactive protein levels, the induction of tet-hi WT1-CTL or WT1235-IgG was insufficient. Decreased serum albumin levels, multiple tumor lesions, poor performance status, and excess ascites negatively influenced the clinical effectiveness of the WT1 vaccine. In conclusion, the WT1 vaccine induced antigen-specific cellular and humoral immunity in patients with refractory ovarian cancer. Both %tet-hi WT1-CTL and WT1235-IgG levels are prognostic markers for the WT1 vaccine.
Gastrointestinal symptoms in four major racial/ethnic groups of midlife women: race/ethnicity and menopausal status
Authors: Im Eun-Ok , Kim Gayeong , Choi Miyoung , Chee Wonshik
Published: December 2021

Objective:

The purpose of this study was to explore the associations of race/ethnicity and menopausal status to gastrointestinal (GI) symptoms experienced during the menopausal transition while considering multiple factors that could influence the symptoms.

Methods:

This secondary analysis was conducted with the data from 1,051 women from 2 Internet-based studies on midlife women's health issues. In the original studies, the data were collected using a dozen questions on sociodemographic and health/menopausal factors and the GI Index for Midlife Women. The data were analyzed utilizing ANOVA, multiple logistic regression, and hierarchical linear regression analyses.

Results:

When covariates were controlled, being Non-Hispanic (N-H) Asian was a significant factor that influenced the total numbers of GI symptoms (β = −0.26) and total severity scores of GI symptoms (β = −0.26). When covariates were controlled, premenopausal status was the strongest factor that influenced the total numbers of GI symptoms in all participants, Hispanics, N-H Whites, N-H African Americans, and N-H Asians (β = 53, −0.40, −0.77, −0.76, −0.26, respectively) and the total severity scores of GI symptoms in all participants, Hispanics, N-H Whites, N-H African Americans, and N-H Asians (β = −0.50, −0.38, −0.72, −0.75, −0.25, respectively).

Conclusions:

This study supports the association of race/ethnicity and menopausal status to GI symptoms experienced during the menopausal transition.

Video Summary:
http://links.lww.com/MENO/A854.
Factors affecting surgical decision-making in carriers of BRCA1/2 pathogenic variants undergoing risk-reducing surgery at a dedicated hereditary ovarian cancer clinic
Authors: Jacobson Michelle R. , Walker Melissa , Ene Gabrielle E.V. , Firestone Courtney , Bernardini Marcus Q. , Allen Lisa , Huszti Ella , Sobel Mara
Published: December 2021

Objective:

Women with germline BRCA1/2 pathogenic variants have a significantly elevated lifetime risk of ovarian and fallopian tube cancer. Bilateral salpingo-oophorectomy (RRSO) is associated with a 90% reduction in the development of tubal and ovarian cancer. At our tertiary hospital, we have a dedicated clinic where women predisposed to hereditary ovarian/tubal cancer receive counseling on reproduction, risk reduction, surgical prophylaxis, and menopausal aftercare. The objective of this study was to evaluate the choices that Canadian women with BRCA1/2 pathogenic variants make regarding ovarian cancer risk reduction within this highly specialized multidisciplinary clinic.

Methods:

This retrospective chart review included all women with confirmed BRCA1/2 mutations referred to the Familial Ovarian Cancer Clinic at Women's College Hospital, Toronto, Canada over a 45-month time period. Patient demographics, preoperative consultation notes and investigations, intraoperative findings, and pathology were recorded.

Results:

A total of 191 women were included in our cohort; 140 (73.3%) underwent risk-reducing surgery and 51 (26.7%) deferred or declined surgery. In women who underwent surgical prevention (median age 45 [30-72] y), 123 (87.9%) underwent RRSO and 17 (12.1%) chose a risk-reducing bilateral salpingectomy with deferred oophorectomy. Of the women undergoing RRSO, 11 (8.9%) women chose concurrent hysterectomy. Prevalent themes affecting decision-making included fears around premature surgical menopause, family planning, and concerns around development of endometrial cancer related to tamoxifen.

Conclusion:

Women with BRCA1/2 pathogenic variants face challenging decisions regarding risk reduction and care providers must be knowledgeable and supportive in helping women make informed and individualized choices about their care.

Video Summary:

http://links.lww.com/MENO/A857.
Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in the Setting of Cryolipolysis
Authors: Hyland Colby J. , Irwin Timothy J. , Rinkinen Jacob R. , Broyles Justin M.
Published: December 2021

The deep inferior epigastric artery perforator (DIEP) flap is a safe and reliable autologous breast reconstruction option for patients undergoing surgical treatment for breast cancer. Success of the procedure relies on adequate flap perfusion from perforators that travel within the subcutaneous layer of the abdominal wall. Patients who have undergone invasive abdominal wall procedures such as suction-assisted liposuction may therefore be at increased risk of postoperative complications such as flap loss and fat necrosis. In recent years, noninvasive fat-reduction techniques such as cryolipolysis have grown immensely in popularity. However, there are no data regarding outcomes for patients who have undergone DIEP flap breast reconstruction after having previously undergone abdominal cryolipolysis. The current case demonstrates that free flap breast reconstruction can be performed safely in this patient population, and that adjunct imaging modalities may improve clinical decision-making.
Prelaminated Temporoparietal Osteofascial Flap: A Novel Nasal Reconstruction Technique
Authors: Aldana Celso A. , Ramirez Pablo D. , Sandoval Jose H. , Avalos Orlando J. , Peña Adriana F. , Berra Pablo H. , Destefano Renzo M.
Published: December 2021

Nasal reconstruction can be a difficult task to perform. It is a challenge when the defect to be reconstructed is extensive and involves the entire thickness of the nose. The difficulty is further increased when a recurrent tumor is removed, where other flaps were previously used to reconstruct the initial defect. A therapeutic option is microsurgical reconstruction; however, sometimes this cannot be performed. Furthermore, free flaps such as the anterolateral thigh or the antebrachialis radial tend to be very thick for the integuments of the face. Therefore, it is important to think of another reconstructive option to solve this problem. We present a case of nasal reconstruction with a prelaminated temporoparietal osteofascial flap, after full-thickness excision for recurrent carcinoma.
A Retrospective Case Series of Peripheral Mixed Nerve Reconstruction Failures Using Processed Nerve Allografts
Authors: Huddleston Hailey P. , Kurtzman Joey S. , Connors Katherine M. , Koehler Steven M.
Published: December 2021

Background:

Favorable rates of meaningful recovery (≥M3/S3) of processed nerve allografts (PNAs) for mixed and motor nerve injuries have been reported, but there are few reports of patients having complete PNA failure (M0/S0). The purpose of this study was to describe the outcomes, including rate of complete failures, in a case series of patients who underwent PNA for peripheral mixed nerve reconstructions.

Methods:

A retrospective review of outcomes between May 2018 to September 2020 was performed. Consecutive patients who underwent nerve reconstruction (>15 mm) with PNA for a peripheral mixed nerve injury of the upper or lower extremity were eligible. Those who returned to clinic for a 10-month postoperative visit were included in this study. The primary outcome was whether the patient was defined as having a complete failure (M0/S0).

Results:

A total of 22 patients underwent a PNA during the time period; 14 patients participated in follow-up and were included (average age: 34.7 years) with a mean follow-up of 11.9 months. The average gap length was 46.4 mm (range 15–110 mm). At their 10-month postoperative visit, no patients had any motor or sensory improvement; all patients were deemed as having complete failure. Four patients underwent or were planned for subsequent revision surgery.

Conclusions:

In this study, we demonstrated a high number of complete failures, with all 14 included patients sustaining a complete failure (100% failure rate) at a minimum 10-month follow-up visit. Failure in this case series was not observed to affect one nerve type, location, or be related to preoperative injury size.
Does Multimodal Treatment Improve Eye and Life Salvage in Adenoid Cystic Carcinoma of the Lacrimal Gland?
Authors: Manjandavida Fairooz P. , Honavar Santosh G. , Murthy Ramesh , Das Sima , Vemuganti Geeta K. , Mulay Kaustubh , Reddy Vijay Anand P.
Published: December 2021

Purpose:

To evaluate the efficacy of multimodal treatment in adenoid cystic carcinoma (ACC) of the lacrimal gland.

Methods:

A retrospective comparative case series of 40 consecutive patients with ACC of the lacrimal gland without systemic metastasis at the initial presentation and primarily managed by one of the 3 treatment protocols—surgery + external beam radiotherapy (EBRT) (group 1), surgery + EBRT + adjuvant chemotherapy (group 2), and neoadjuvant chemotherapy + surgery + EBRT + adjuvant chemotherapy (multimodal treatment) (group 3) at a tertiary care ocular oncology center. Local tumor control, eye salvage, and systemic metastasis were the primary outcome measures.

Results:

The age ranged from 11 to 72 (mean ± SD, 36 ± 13; median, 36) years with 26 (65%) male and 14 (35%) female patients. Twelve (30%) patients belonged to group 1, 8 (20%) to group 2, and 20 (50%) to group 3. Primary surgery included tumor excision in 36 (90%) and orbital exenteration in 4 (10%). Chemotherapy composed of cisplatin + 5 fluorouracil (5FU) for 6 cycles in 28 (70%) patients. Extended-field stereotactic EBRT with a dose of 5,000–6,000 cGy included the entire pretreatment extent of the tumor with a 10-mm margin all around, superior orbital fissure, inferior orbital fissure, cavernous sinus, and temporal fossa. Mean duration of follow up after completion of treatment was 58 ± 26 (range, 29–180; median, 60) months. In all, local tumor recurrence occurred in 10 (25%) patients at a mean of 38 ± 23 (range, 12–120; median, 24) months. Local tumor recurrence was noted in 5 (42%) patients in group 1, 2 (25%) in group 2, and 3 (15%) in group 3. Overall, eye salvage was possible in 34 (85%) patients, with visual acuity >20/40 in 28 (82%). Systemic metastasis occurred in 10 (25%) patients at a mean of 53 ± 28 (range, 12–120; median, 43) months. Eight (67%) patients in group 1, 1 (13%) in group 2, and 1 (5%) in group 3 developed systemic metastasis. Six (15%) overall, 5 (42%) in group 1 and 1 (13%) in group 2, died with systemic metastasis.

Conclusions:

Multimodal treatment with sequential neoadjuvant chemotherapy, followed by surgery, extended-field stereotactic EBRT, and adjuvant chemotherapy seems relatively more effective in providing local tumor control and eye salvage and in minimizing the risk of systemic metastasis in ACC of the lacrimal gland.
Usability, User Acceptance, and Health Outcomes of Arm-Support Exoskeleton Use in Automotive Assembly
Authors: Kim Sunwook , Nussbaum Maury A. , Smets Marty
Published: December 2021

Objective:

Examine arm-support exoskeleton (ASE) user experience over time, identify factors contributing to ASE intention-to-use, and explore whether ASE use may influence the number of medical visits.

Methods:

An 18-month, longitudinal study with ASE (n = 65) and control groups (n = 133) completed at nine automotive manufacturing facilities.

Results:

Responses to six usability questions were rather consistent over time. ASE use perceived effective in reducing physical demands on the shoulders, neck, and back. Perceived job performance, and overall fit and comfort, appeared to be key determinants for ASE intention-to-use. Based on medical visits among both groups, ASE use may decrease the likelihood of such visits.

Conclusions:

These field results support the potential of ASEs as a beneficial ergonomic intervention, but also highlight needs for further research on ASE designs, factors driving intention-to-use, and health outcomes.
The Associations Between Job Strain, Workplace PERMA Profiler, and Work Engagement
Authors: Yang Chen-Cheng , Watanabe Kazuhiro , Kawakami Norito
Published: December 2021

Objective:

Our purpose was to examine the relationship between job strain, work engagement, and the dimensions of well-being according to the workplace PERMA (Positive Emotion, Engagement, Relationships, Meaning, Accomplishment) model.

Methods:

Three hundred ten workers completed a web-based questionnaire, namely, the Brief Job Stress Questionnaire, Utrecht Work Engagement scale, and the workplace PERMA profiler. Regression analyses were conducted on well-being and each scale of job strain, including job demands, job control, supervisor support, and coworker support.

Results:

Job control, supervisor support, and coworker support were significantly correlated with the scores of five dimensions, and happiness of the PERMA profiler (except for between supervisor support and Accomplishment). Job demands was only significantly correlated with Engagement and Meaning.

Conclusions:

All well-being dimensions were commonly influenced by job control and workplace support, while Engagement and Meaning were also facilitated by challenging job demands.
Pelvic Floor Muscle Resting Tone in Children With Dysfunctional Voiding Symptomology Following Simple Gross Motor Exercises
Authors: Berg-Poppe Patti , Christensen Monica , Koskovich Nicole , Stephenson Christine
Published: December 2021

Purpose:

The study aimed to understand the effects of a set of simple gross motor exercises on pelvic floor muscle (PFM) resting tone (RT) in children with dysfunctional voiding symptomology.

Methods:

The study compared PFM RT for a single-sample before and after 2 protocols: exercise versus relaxation (metric standard).

Results:

Participants included 27 children ages 5.00 to 10.92 years. Preintervention PFM RT was similar between the interventions: 63% (exercise) and 78% (relaxation) of children decreased PFM RT following intervention. Between-intervention post-minus-prechanges in PFM RT were compared. Between-intervention differences were similar.

Conclusions:

Exercise and relaxation protocols were comparable in lowering PFM RT in children with voiding dysfunction. Findings are clinically worthy in that either exercises or relaxation prior to toileting may assist with more complete emptying in children with symptoms.