bluuebunny/crossref_metadata_2025 huggingface dataset:
Replacement of Enterococcus faecalis by Enterococcus faecium as the predominant enterococcus in UK bacteraemias
Authors: Horner Carolyne , Mushtaq Shazad , Allen Michael , Hope Russell , Gerver Sarah , Longshaw Christopher , Reynolds Rosy , Woodford Neil , Livermore David M
Published: November 2021

Objectives

To review temporal changes in the proportions of different Enterococcus species recorded in two UK bacteraemia surveillance systems. Antibiotic resistance trends were also considered.

Methods

We reviewed data for enterococci from 2001 to 2019 in: (a) the BSAC Resistance Surveillance Programme, which collected up to 7–10 bloodstream enterococci every year from each of 23–39 hospitals in the UK and Ireland and tested these centrally; and (b) PHE bacteraemia surveillance, using routine results from NHS microbiology laboratories in England.

Results

BSAC surveillance, based upon 206–255 enterococci each year (4486 in total), indicated that the proportion of Enterococcus faecium rose from 31% (212/692) in the period 2001–3 to 51% (354/696) in the period 2017–19, balanced by corresponding falls in the proportion of Enterococcus faecalis. PHE surveillance provided a larger dataset, with >5000 enterococcus reports per year; although its identifications are less precise, it too indicated a rise in the proportion of E. faecium. BSAC surveillance for E. faecium indicated no consistent trends in resistance to ampicillin (≥86% in all years), vancomycin (annual rates 19%–40%) or high-level resistance to gentamicin (31%–59%). Resistance to vancomycin remained <4% in E. faecalis in all years, whilst high-level resistance to gentamicin fell, perhaps partly reflecting the decline of two initially prevalent gentamicin- and ciprofloxacin-resistant clones.

Conclusions

Both surveillance systems indicate a growing proportion of E. faecium in enterococcal bloodstream infections. This is important because fewer therapeutic options remain against this frequently multiresistant species than against E. faecalis.
γ-Secretase structure and activity are modified by alterations in its membrane localization and ambient environment
Authors: Suzuki Toshiharu , Sobu Yuriko , Hata Saori
Published: November 2021

γ-Secretase cleaves type I transmembrane proteins in a hydrophobic membrane environment following ectodomain shedding. Mutations in PSEN genes, encoding the catalytic subunits of γ-secretase, presenilins, are the most common cause of familial Alzheimer’s disease (ad). Pathogenic mutations in PSEN genes increase production of longer and neurotoxic amyloid-β (Aβ) by intramembrane cleavage of membrane-associated amyloid-β protein precursor (APP) carboxyl-terminal fragment β, which is generated via primary cleavage of APP by β-site APP cleaving enzyme 1. The longer Aβ is prone to aggregate and accumulate in the brain; however, the accumulation of Aβ in brain is also a pathological feature of sporadic ad. Increased pathogenic Aβ generation, even in the absence of pathogenic PSEN gene mutations, is one of proposed mechanisms for sporadic ad pathogenesis. γ-Secretase digests substrates in the transmembrane region, generating Aβ peptide intermediates of various lengths. The end products, shorter Aβ40 and Aβ38 peptides, are less neurotoxic, whereas PSEN gene mutations increase the production ratio of longer, neurotoxic Aβ species such as Aβ42, an intermediate in Aβ38 production. γ-Secretase activity or structures is altered because of its aberrant membrane localization or changes in the ambient environment such as luminal acidification. Interestingly, γ-secretase has a pH sensor in presenilins.
A Scientific Method to the Madness of Unit 731’s Human Experimentation and Biological Warfare Program
Authors: Johnson Kishor
Published: November 2021

The Japanese Imperial Army Unit 731’s Biological Warfare (BW) research program committed atrocious crimes against humanity in their pursuit of biological weapons development during the Second World War. Due to an American cover-up, the details behind Unit 731’s human experimentation were slow to be revealed. The recent literature discloses the gruesome details of the experiments but characterizes the human trials as crude in nature. Further, there is a lack of clarity as to how human trial results were extrapolated for use in real world missions.

Through an examination of testimony from the Soviet Union’s Khabarovsk War Crime Trials, this paper argues that Unit 731’s inoculation and airborne warfare experiments on prisoners of war were scientifically rigorous. The scientific method is used as the basis against which the scientific rigor of the experiments is tested. The paper reveals that the successes and failures of the human trials were extrapolated to BW missions during the Sino-Japanese war. American researchers’ expectations of BW data were fulfilled, thus paving the way for an immunity deal. Ethical standards in medicine before WWII were not well established, but wartime medical practices and experimentation reveal the context in which the pursuit of scientific knowledge has no boundaries.
Outcomes of SBRT for lung oligo-recurrence of non-small cell lung cancer: a retrospective analysis
Authors: Lin Qingren , Zhou Ning , Zhu Xiang , Lin Juan , Fang Jun , Gu Feiying , Sun Xiaojiang , Wang Yuezhen
Published: November 2021

The benefit of local ablative therapy (LAT) for oligo-recurrence has been investigated and integrated into the treatment framework. In recent decades, stereotactic body radiation therapy (SBRT) has been increasingly used to eliminate metastasis owing to its high rate of local control and low toxicity. This study aimed to investigate the outcomes of SBRT for patients with lung oligo-recurrence of non-small cell lung cancer (NSCLC) from our therapeutic center. Patients with lung oligo-recurrence of NSCLC treated with SBRT between December 2011 and October 2018 at Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) were reviewed. The characteristics, treatment-related outcomes, and toxicities of the patients were analyzed. Univariable and multivariable Cox regression were performed to identify the factors associated with survival. A total of 50 patients with lung oligo-recurrence of NSCLC were enrolled. The median follow-up period was 23.6 months. The 3-year local progression-free survival (LPFS), progression-free survival (PFS) and overall survival (OS) after SBRT were 80.2%, 21.9% and 45.3%, respectively. Patients in the subgroup with LAT to all residual diseases showed significantly improved OS and PFS. No treatment-related death occurred after SBRT. SBRT is a feasible option to treat patients with lung oligo-recurrence of NSCLC, with high rates of local control and low toxicity. LAT to all residual diseases was associated with better survival outcomes. Future prospective randomized clinical trials should evaluate SBRT strategies for such patients.
Mutation and selection explain why many eukaryotic centromeric DNA sequences are often A + T rich
Authors: Barbosa Anne C , Xu Zhengyao , Karari Kazhal , Williams Wendi , Hauf Silke , Brown William R A
Published: November 2021

We have used chromosome engineering to replace native centromeric DNA with different test sequences at native centromeres in two different strains of the fission yeast Schizosaccharomyces pombe and have discovered that A + T rich DNA, whether synthetic or of bacterial origin, will function as a centromere in this species. Using genome size as a surrogate for the inverse of effective population size (Ne) we also show that the relative A + T content of centromeric DNA scales with Ne across 43 animal, fungal and yeast (Opisthokonta) species. This suggests that in most of these species the A + T content of the centromeric DNA is determined by a balance between selection and mutation. Combining the experimental results and the evolutionary analyses allows us to conclude that A + T rich DNA of almost any sequence will function as a centromere in most Opisthokonta species. The fact that many G/C to A/T substitutions are unlikely to be selected against may contribute to the rapid evolution of centromeric DNA. We also show that a neo-centromere sequence is not simply a weak version of native centromeric DNA and suggest that neo-centromeres require factors either for their propagation or establishment in addition to those required by native centromeres.
PAMP-INDUCED SECRETED PEPTIDE 3 modulates salt tolerance through RECEPTOR-LIKE KINASE 7 in plants
Authors: Zhou Huapeng , Xiao Fei , Zheng Yuan , Liu Guoyong , Zhuang Yufen , Wang Zhiyue , Zhang Yiyi , He Jiaxian , Fu Chunxiang , Lin Honghui
Published: November 2021

High soil salinity negatively affects plant growth and development, leading to a severe decrease in crop production worldwide. Here, we report that a secreted peptide, PAMP-INDUCED SECRETED PEPTIDE 3 (PIP3), plays an essential role in plant salt tolerance through RECEPTOR-LIKE KINASE 7 (RLK7) in Arabidopsis (Arabidopsis thaliana). The gene encoding the PIP3 precursor, prePIP3, was significantly induced by salt stress. Plants overexpressing prePIP3 exhibited enhanced salt tolerance, whereas a prePIP3 knockout mutant had a salt-sensitive phenotype. PIP3 physically interacted with RLK7, a leucine-rich repeat RLK, and salt stress enhanced PIP3–RLK7 complex formation. Functional analyses revealed that PIP3-mediated salt tolerance is dependent on RLK7. Exogenous application of synthetic PIP3 peptide activated RLK7, and salt treatment significantly induced RLK7 phosphorylation in a PIP3-dependent manner. Notably, MITOGEN-ACTIVATED PROTEIN KINASE3 (MPK3) and MPK6 were downstream of the PIP3–RLK7 module in salt response signaling. Activation of MPK3/6 was attenuated in pip3 or rlk7 mutants under saline conditions. Therefore, MPK3/6 might amplify salt stress response signaling in plants for salt tolerance. Collectively, our work characterized a novel ligand–receptor signaling cascade that modulates plant salt tolerance in Arabidopsis. This study contributes to our understanding of how plants respond to salt stress.
Risk of flare after tapering or withdrawal of biologic/targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis or axial spondyloarthritis: a systematic review and meta-analysis
Authors: Uhrenholt Line , Christensen Robin , Dinesen Wilfred K H , Liboriussen Caroline H , Andersen Stine S , Dreyer Lene , Schlemmer Annette , Hauge Ellen-Margrethe , Skrubbeltrang Conni , Taylor Peter C , Kristensen Salome
Published: November 2021

Objective

To evaluate flare risk when tapering or withdrawing biologic or targeted synthetic DMARDs (bDMARDs or tsDMARDs) compared with continuation in patients with inflammatory arthritis in sustained remission or with low disease activity.

Methods

Articles were identified in the Cochrane Library, PubMed, Embase and Web of Science. Eligible trials were randomized controlled trials comparing tapering and/or withdrawal of bDMARDs and/or tsDMARDs with the standard dose in inflammatory arthritis. Random effects meta-analysis was performed with risk ratio (RR) or Peto’s odds ratio (POR) for sparse events and 95% CI.

Results

The meta-analysis comprised 22 trials: 11 assessed tapering and 7 addressed withdrawal (4 assessed both). Only trials with an RA or axial SpA (axSpA) population were identified. An increased flare risk was demonstrated when b-/tsDMARD tapering was compared with continuation [RR 1.45 (95% CI 1.19, 1.77), I2 = 42.5%] and potentially increased for persistent flare [POR 1.56 (95% CI 0.97, 2.52), I2 = 0%]. Comparing TNF inhibitor (TNFi) withdrawal with continuation, a highly increased flare risk [RR 2.28 (95% CI 1.78, 2.93), I2 = 78%] and increased odds of persistent flare [POR 3.41 (95% CI 1.91, 6.09), I2 = 49%] were observed. No clear difference in flare risk between RA or axSpA was observed.

Conclusion

A high risk for flare and persistent flare was demonstrated for TNFi withdrawal, whereas an increased risk for flare but not for persistent flare was observed for b-/tsDMARD tapering. Thus tapering seems to be the more favourable approach.

Registration

PROSPERO (CRD42019136905).
Upadacitinib as monotherapy and in combination with non-biologic disease-modifying antirheumatic drugs for psoriatic arthritis
Authors: Nash Peter , Richette Pascal , Gossec Laure , Marchesoni Antonio , Ritchlin Christopher , Kato Koji , McDearmon-Blondell Erin L , Lesser Elizabeth , McCaskill Reva , Feng Dai , Anderson Jaclyn K , Ruderman Eric M
Published: November 2021

Objective

To assess the efficacy and safety of upadacitinib (UPA), an oral Janus kinase inhibitor, as monotherapy or in combination with non-biologic DMARDs (nbDMARDs) in patients with PsA.

Methods

Pooled data were analysed from patients with prior inadequate response or intolerance to one or more nbDMARD (SELECT-PsA 1) or one or more biologic DMARD (SELECT-PsA 2) who received placebo, UPA 15 mg once daily (QD) or UPA 30 mg QD as monotherapy or in combination with two or fewer nbDMARDs for 24 weeks. Efficacy outcomes included achievement of ACR responses, Psoriasis Area and Severity Index responses, minimal disease activity and change from baseline and clinically meaningful improvement in the HAQ Disability Index. Adverse events (AEs) were summarized.

Results

A total of 1916 patients were included; 574 (30%) received monotherapy and 1342 (70%) received combination therapy. Placebo-subtracted treatment effects for a 20% improvement in ACR criteria at week 12 were 33.7% (95% CI 24.4, 43.1) and 34.0% (95% CI 27.9, 40.1) for UPA 15 mg QD monotherapy and combination therapy, respectively, and 45.7% (95% CI 36.9, 54.5) and 39.6% (95% CI 33.7, 45.5) for UPA 30 mg QD monotherapy and combination therapy, respectively. Treatment effects for other outcomes were consistent between monotherapy and combination therapy. AE frequency was generally similar for UPA monotherapy and combination therapy, although hepatic disorders and creatine phosphokinase elevation were more common with combination therapy vs monotherapy.

Conclusion

The efficacy and safety of UPA were generally consistent when administered as monotherapy or in combination with nbDMARDs through 24 weeks, supporting the use of UPA with or without nbDMARDs in PsA.

Trial registration

ClinicalTrials.gov (https://clinicaltrials.gov): SELECT-PsA 1 (NCT03104400), SELECT-PsA 2 (NCT03104374)
Increased amygdala and decreased frontolimbic r
esting-
s
tate functional connectivity in children with aggressive behavior
Authors: Sukhodolsky Denis G , Ibrahim Karim , Kalvin Carla B , Jordan Rebecca P , Eilbott Jeffrey , Hampson Michelle
Published: November 2021

Childhood maladaptive aggression is associated with disrupted functional connectivity within amygdala-prefrontal circuitry. In this study, neural correlates of childhood aggression were probed using the intrinsic connectivity distribution, a voxel-wise metric of global resting-state brain connectivity. This sample included 38 children with aggressive behavior (26 boys, 12 girls) ages 8–16 years and 21 healthy controls (14 boys, 6 girls) matched for age and IQ. Functional MRI data were acquired during resting state, and differential patterns of intrinsic functional connectivity were tested in a priori regions of interest implicated in the pathophysiology of aggressive behavior. Next, correlational analyses tested for associations between functional connectivity and severity of aggression measured by the Reactive-Proactive Aggression Questionnaire in children with aggression. Children with aggressive behavior showed increased global connectivity in the bilateral amygdala relative to controls. Greater severity of aggressive behavior was associated with decreasing global connectivity in the dorsal anterior cingulate and ventromedial prefrontal cortex. Follow-up seed analysis revealed that aggression was also positively correlated with left amygdala connectivity with the dorsal anterior cingulate, ventromedial and dorsolateral prefrontal cortical regions. These results highlight the potential role of connectivity of the amygdala and medial prefrontal and anterior cingulate cortices in modulating the severity of aggressive behavior in treatment-seeking children.
Exposome mapping in chronic respiratory diseases: the added value of digital technology
Authors: Goossens Janne , Bullens Dominique M.A. , Dupont Lieven J. , Seys Sven F.
Published: November 2021

Purpose of review

The development and progression of chronic respiratory diseases are impacted by a complex interplay between genetic, microbial, and environmental factors. Here we specifically summarize the effects of environmental exposure on asthma, allergic rhinitis, and chronic rhinosinusitis. We furthermore discuss how digital health technology may aid in the assessment of the environmental exposure of patients and how it may be of added value for them.

Recent findings

It is well established that one gets allergic symptoms if sensitized and exposed to the same allergen. Viruses, bacteria, pollutants, irritants, and lifestyle-related factors modify the risk of getting sensitized and develop symptoms or may induce symptoms themselves. Understanding these processes and how the various factors interact with each other and the human body require big data and advanced statistics. Mobile health technology enables integration of multiple sources of data of the patients’ exposome and link these to patient outcomes. Such technologies may contribute to the increased understanding of the development of chronic respiratory disease.

Implementation of digital technologies in clinical practice may in future guide the development of preventive strategies to tackle chronic respiratory diseases and eventually improve outcomes of the patient.
Mechanical circulatory support devices in geriatric patients: more than just age
Authors: Notarianni Andrew , Patel Bhoumesh
Published: November 2021

Purpose of review

The use of mechanical circulatory support (MCS) devices, such as left ventricular assist device and extracorporeal membrane oxygenation in the elderly have been rapidly increasing in various clinical settings over the past two decades. This review briefly summarizes recent literature on the role and outcomes of such mechanical circulatory support devices use in the elderly.

Recent findings

Elderly patients are receiving increasing number of LVADs with improved survival and quality-of-life outcomes, despite multiple comorbidities. ECMO is a viable option in elderly patients but they have a higher risk of mortality after both VA ECMO and VV ECMO support. However, comorbidities, clinical presentation and timing of ECMO initiation seems to have a greater impact on prognosis than for younger patients.

MCS device use continue to rise in the elderly population. Meticulously selected elderly patients could be successfully supported with MCS devices with favorable outcomes and acceptable mortality and complication rate.
Mendelian Randomization With Repeated Measures of a Time-varying Exposure
Authors: Shi Joy , Swanson Sonja A. , Kraft Peter , Rosner Bernard , De Vivo Immaculata , Hernán Miguel A.
Published: November 2021

Mendelian randomization (MR) is often used to estimate effects of time-varying exposures on health outcomes using observational data. However, MR studies typically use a single measurement of exposure and apply conventional instrumental variable (IV) methods designed to handle time-fixed exposures. As such, MR effect estimates for time-varying exposures are often biased, and interpretations are unclear. We describe the instrumental conditions required for IV estimation with a time-varying exposure, and the additional conditions required to causally interpret MR estimates as a point effect, a period effect or a lifetime effect depending on whether researchers have measurements at a single or multiple time points. We propose methods to incorporate time-varying exposures in MR analyses based on g-estimation of structural mean models, and demonstrate its application by estimating the period effect of alcohol intake, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol on intermediate coronary heart disease outcomes using data from the Framingham Heart Study. We use this data example to highlight the challenges of interpreting MR estimates as causal effects, and describe other extensions of structural mean models for more complex data scenarios.
The interactive effects of verapamil and CB1 cannabinoid receptor antagonist/inverse agonist, AM251 on passive avoidance learning and memory in rat
Authors: Karimi Seyed Asaad , Noorbakhsh Mariam , Komaki Hamidreza , Reza Nikoo Mohammad , Hasanein Parisa , Shahidi Siamak , Faraji Nafiseh , Komaki Alireza
Published: November 2021

There are reports regarding the effects of intracellular Ca2+ and synthesis and release of endocannabinoids. The secretion of endocannabinoids depends on the L-type calcium channel. The present study evaluated the involvement of the cannabinoid CB1 receptors in the effect of L-type calcium channel blocker verapamil on passive avoidance learning (PAL) in adult male rats. In this study, we examined the effects of an acute administration of the cannabinoid CB1 receptors antagonist/inverse agonist AM251 following a chronic administration of the Ca2+ channel blocker verapamil on PAL. Male Wistar rats were administered verapamil (10, 25 and 50 mg/kg) or saline intraperitoneally (i.p) daily for 13 days (n = 10/group). After this treatment period, a learning test (acquisition) was performed, and a retrieval test was performed the following day. The results indicated that chronic systemic administration of verapamil (in a dose-dependent manner) impaired memory acquisition and retrieval. Pre-training acute administration of a selective CB1 antagonist/inverse agonist, AM251 (5 mg/kg, i.p.) did not change memory acquisition and retrieval. Co-administration of the verapamil and AM251 significantly reversed verapamil-induced amnesia, suggesting a functional interaction between AM251 and verapamil. The results indicated the interactive effects of cannabinoid CB1 receptors and L-type calcium channel in passive avoidance learning and AM251 can counter the effects of verapamil on memory.
Outcome of Viral-associated Hemophagocytic Lymphohistiocytosis at a Tertiary Hospital
Authors: Nazir Hanan F. , Hassanein Nehad , Wali Yasser , Al Yazidi Laila S.
Published: November 2021

Background:

Little is known about viral-associated hemophagocytic lymphohistiocytosis (HLH) in Oman. This study was done to assess the epidemiology, clinical features and outcome of viral-associated HLH in our setting.

Methods:

We retrospectively reviewed children (0–18 years) managed for viral-associated HLH at the Sultan Qaboos University Hospital, Oman, over a 15-year period (2006–2020). Patients’ medical records were used to describe their demographic, clinical and laboratory features, management and outcome.

Results:

Fifty-six children were managed for HLH at Sultan Qaboos University Hospital over the last 15 years (2006–2020) of whom a third (19; 34%) had a viral trigger. The median age at the time of diagnosis of viral-associated HLH was 83 (13–96) months. Fever, cytopenia, hyperferritinemia and evidence of hemophagocytosis in bone marrow were the most consistent findings. Most of these children had either genetic predisposition to HLH (8/19; 42%) or underlying immunodeficiency secondary to malignant conditions or chemotherapy/hematopoietic stem cell transplantation (6/19; 32%). Epstein-Barr virus (9; 47%) followed by cytomegalovirus (6; 31%) was the most common viral trigger in our setting. Treatment included antivirals (8; 42%), HLH 2004 protocol (4; 21%), rituximab (4; 21%) and hematopoietic stem cell transplantation (3; 16%). Fourteen children (74%) had full recovery.

Conclusions:

In our small cohort, viral-associated HLH was more frequently encountered in children with genetic predisposition to HLH or children with underlying immunodeficiency. In addition, we found that the outcome is overall good for children who have no genetic predisposition to HLH and children with genetic predisposition who underwent hematopoietic stem cell transplantation.
Intraventricular Vancomycin Treatment for Shunt-related Ventriculitis Caused by Methicillin-resistant Staphylococcus Aureus in a Preterm Infant
Authors: Helgason Einar A. , Oskarsdottir Thorunn , Brynjarsson Hrolfur , Olafsson Ingvar H. , Thors Valtyr
Published: November 2021

Posthemorragic hydrocephalus is a relatively common condition in prematures, often requiring ventriculoperitoneal shunts. We report a case of methicillin-resistant Staphylococcus aureus infection of a ventriculoperitoneal shunt in a premature neonate which failed conventional intravenous treatment. Despite the absence of published guidelines, we used available data and expert advice to treat the patient with intraventricular vancomycin. The treatment was successful in eradicating the infection without observed toxicity. This case highlights the need for international guidelines on intraventricular treatment for neonates.
Patient with dissociation of corneal topography and epithelial mapping
Authors: Santhiago Marcony R.
Published: November 2021

A 21-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in his left eye is his chief complaint. He cannot tolerate contact lenses (CLs). The corrected distance visual acuity (CDVA) was 20/20 in the right eye (−1.50 −2.00 × 180) and 20/30 in the left eye (−1.25 −1.50 × 170). The patient denied any history of ocular trauma, systemic disease, or medications.

Corneal topography with different technologies revealed an inferior steepening in the left eye (Figure 1), whereas keratoconus indices from different strategies are within normal limits in both eyes (Supplemental Figures 1–4, http://links.lww.com/JRS/A496). Pachymetry maps from different devices present absolute values of thinnest point within normal ranges. Epithelial mapping revealed a localized thickening in the left eye (Supplemental Figures 5 and 6, http://links.lww.com/JRS/A496).

Slitlamp showed a total clear cornea with no signs of abnormality. The patient presents no signs of blepharitis or dry-eye syndrome either. Intraocular pressure is 14 mm Hg in both eyes. The retina was normal, bilaterally.

Considering the findings, what would be your main diagnostic hypothesis and, if any, which refractive surgery option would you consider for this patient?
Why Not Home?
Authors: Chovanec Kelli A. , Arsene Camelia , Beck Amanda , Liedel Bethany
Published: November 2021

Purpose of Study:

Accountable Care Organizations (ACOs) aiming to reduce healthcare expenditure adopt strategies targeting costly postacute service utilization, asking “why not home?” as a part of the hospital discharge planning paradigm. This study examined the impact of an interventional approach to implement evidence-based interventions to improve transitions of care to the least restrictive next site of care on the rate of skilled nursing facility (SNF) admissions per 1,000, SNF length of stay (LOS), and total SNF cost.

Primary Practice Setting:

The impact of the interventional approach for an ACO-attributed Medicare population, analyzing Medicare Shared Savings Plan Part A and Part B beneficiary claims data, was examined.

Methodology and Sample:

A pre-/postintervention analysis was conducted, for dates of service 12 months pre- and postintervention for patients admitted to any hospital within the integrated health care system. The outcome variables were defined as SNF admission rate, SNF LOS, cost of care (total SNF cost, SNF cost per admission), and hospital LOS prior to SNF discharge.

Results:

There was early evidence of the effectiveness of the multifaceted interventions that involved the delivery of interprofessional team member education focused on the tenets of value-based care and discharging patients to the least restrictive setting, as appropriate. In the normalized data review, it was noted that the rate of SNF discharges per 1,000 patients changed from 73 per 1,000 patients in the preintervention period to 70 per 1,000 patients in the postintervention period. The total SNF cost in the postintervention period only increased by 3%, with a difference of $616,014, despite the 10% increase in the total ACO-attributed patient population during the same period.

Implications for Case Management Practice:

The results of this study imply that a multifaceted intervention with aims to shift the transitional care planning paradigm toward discharging to the least restrictive next site of care is an effective strategy for ACOs with aspirations to improve the utilization and expenditure in the postacute setting. The analyses suggest that providing education to interprofessional team members that reinforces the tenets of value-based care and the importance of asking, “why not home?” for every hospitalized patient, and leveraging technology-based insights positively impact discharge rates to SNF and other ACO outcomes.
Advanced Hospital Health Care at Home
Authors: Powell Suzanne K.
Published: November 2021

It is estimated that currently about 10,000 people turn 65 years old every day. Even without pandemics, the chronic diseases of this aging population beg for new, innovative interventions. One trend that may be a significant offshoot of the 2020 focus on internet health care is hospital health care in the home.
Best Solutions for Perineal and Pressure Sore Reconstruction
Authors: Bialowas Christie , Nguyen Brittany , Patel Ashit
Published: November 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand variations of the myocutaneous rectus abdominis muscle flap as it is used for perineal reconstruction and discuss common and alternative options for perineal defect reconstruction. 2. Review primary options and alternatives to pressure sore reconstruction if the primary option is not available and recognize when pressure sore reconstruction is not feasible. 3. Highlight pertinent anatomy and techniques for the flaps described.

Perineal reconstruction following tumor resection is often complicated by irradiated tissue and multiple comorbidities, making reconstruction challenging. Management of these conditions can have complication rates as high as 66 percent, which further compounds the costs and implications of managing these wounds. These complication rates can be significantly decreased using flap closure rather than primary closure. Pressure ulcers also occur in patients with poor overall health, multiple comorbidities, and often numerous prior failed reconstruction attempts. Comprehensive management of pressure sores is a significant burden to the health care system, at a cost of $9.1 to $11.6 billion per year. There exists an extensive body of literature describing the pathophysiology and management strategies for these problems. The focus of this article is to discuss best solutions for perineal and pressure ulcer reconstruction, and to explore alternative options for reconstruction.
Fractional Carbon Dioxide Laser or Erbium:Yttrium-Aluminum-Garnet Laser Assisted by Topical Application/Intradermal Injection of Platelet-Rich Plasma for Postacne Scars
Authors: Chen Jianguo , Wan Yingying , Lin Yan , Jiang Haiyue
Published: November 2021

Background:

Fractional carbon dioxide or erbium:yttrium-aluminum-garnet (YAG) laser combined with platelet-rich plasma has been used for postacne scars. Nevertheless, there is limited evidence on its use because of the small size of relevant studies. This study aims to evaluate the efficacy of platelet-rich plasma–assisted laser for postacne scars.

Methods:

Randomized controlled trials comparing carbon dioxide or erbium:YAG laser combined with platelet-rich plasma to laser alone were searched for using the PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar databases.

Results:

In total, 13 studies involving 672 cases were included. The overall degree of clinical improvement favored platelet-rich plasma combined with carbon dioxide laser (mean difference, 0.55; 95 percent CI, 0.40 to 0.70) or erbium:YAG laser (mean difference, 0.63; 95 percent CI, 0.31 to 0.96). Notably, the use of carbon dioxide laser combined with platelet-rich plasma was more effective in both greater than 50 percent improvement of acne scars (OR, 1.63; 95 percent CI, 1.10 to 2.42) and greater than 75 percent improvement of acne scars (OR, 2.78; 95 percent CI, 1.75 to 4.42), compared with laser alone. Erbium:YAG laser combined with platelet-rich plasma was more effective in greater than 75 percent improvement of acne scars compared with laser alone (OR, 3.45; 95 percent CI, 1.31 to 9.05). Moreover, patient satisfaction was significantly higher with platelet-rich plasma combined with carbon dioxide laser (OR, 2.98; 95 percent CI, 1.72 to 5.16) or erbium:YAG laser (OR, 2.88; 95 percent CI, 1.33 to 6.21) compared to laser alone.

Conclusion:

This meta-analysis provides reliable evidence that fractional carbon dioxide or erbium:YAG laser combined with platelet-rich plasma is an effective and safe combination therapy for postacne scars.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Plastic Surgeon Financial Compensation–Incentivization Models in Surgical Care Delivery: The Past, Present, and Future
Authors: Lopez Joseph , Offodile Anaeze C. , Shenaq Deana , Schechter Loren , Chavis Larry , Hultman Charles S. , Dorafshar Amir H.
Published: November 2021

Background:

Surgeons are critical for the success of any health care enterprise. However, few studies have examined the potential impact of value-based care on surgeon compensation.

Methods:

This review presents value-based financial incentive models that will shape the future of surgeon compensation. The following incentivization models will be discussed: pay-for-reporting, pay-for-performance, pay-for-patient-safety, bundled payments, and pay-for-academic-productivity. Moreover, the authors suggest the application of the congruence model—a model developed to help business leaders understand the interplay of forces that shape the performance of their organizations—to determine surgeon compensation methods applicable in value-based care-centric environments.

Results:

The application of research in organizational behavior can assist health care leaders in developing surgeon compensation models optimized for value-based care. Health care leaders can utilize the congruence model to determine total surgeon compensation, proportion of compensation that is short term versus long term, proportion of compensation that is fixed versus variable, and proportion of compensation based on seniority versus performance.

Conclusion:

This review provides a framework extensively studied by researchers in organizational behavior that can be utilized when designing surgeon financial compensation plans for any health care entity shifting toward value-based care.
Three-Dimensional Quantification of Facial Asymmetry in Children with Positional Cranial Deformity
Authors: Naros Andreas , Wolf Jan A. , Krimmel Michael , Kluba Susanne
Published: November 2021

Background:

The extent of facial involvement in positional plagiocephaly is only little investigated so far. Investigation methods that take into account the challenging anatomical conditions and growth of infants’ faces are desirable. In this study, the authors established a new three-dimensional photogrammetry quantification method evaluating pretherapeutic and posttherapeutic facial asymmetry in positional plagiocephaly. Furthermore, a facial asymmetry index was established and evaluated.

Methods:

Three-dimensional photographs of 100 children undergoing treatment with head orthoses were analyzed by constructing a standardized interindividual coordinate system. Defining landmarks, section planes, and point coordinates with a computer-aided design software, both sides of the faces were compared. Facial asymmetry was quantified by measuring differences between left and right sides and pretherapeutic and posttherapeutic changes in each patient. The facial asymmetry index was calculated by putting the absolute differences in relation with the coordinates of the nonaffected side.

Results:

Present results indicate that positional plagiocephaly results in a distinct facial asymmetry (range, −3.8 to 9.6 mm) in nearly all spatial directions and facial regions. Helmet therapy led to a significant reduction (p < 0.05) of intraindividual facial asymmetry (median change in facial asymmetry index, −1.9 to 3.1 percent). However, no correlation of the Cranial Vault Asymmetry Index and facial asymmetry (Spearman rank correlation coefficient, ρ = –0.09 to 0.47) has been seen. According to these results, severe occipital deformation does not necessarily provoke distinct facial asymmetry.

Conclusions:

Present three-dimensional photogrammetry method allows the longitudinal quantification of facial involvement in positional plagiocephaly. Asymmetry has been determined in all facial regions. The facial asymmetry decreased through helmet therapy but was not eliminated completely.
The Impact of Plastic Surgery Volume on Inpatient Burn Outcomes
Authors: Perrault David P. , Rochlin Danielle H. , Gillenwater T. Justin , Karanas Yvonne L. , Sheckter Clifford C.
Published: November 2021

Background:

Acute burn care involves multiple types of physicians. Plastic surgery offers the full spectrum of acute burn care and reconstructive surgery. The authors hypothesize that access to plastic surgery will be associated with improved inpatient outcomes in the treatment of acute burns.

Methods:

Acute burn encounters with known percentage total body surface area were extracted from the National Inpatient Sample from 2012 to 2014 based on International Classification of Diseases, Ninth Edition, codes. Plastic surgery volume per facility was determined based on procedure codes for flaps, breast reconstruction, and complex hand reconstruction. Outcomes included odds of receiving a flap, patient safety indicators, and mortality. Regression models included the following variables: age, percentage total body surface area, gender, inhalation injury, comorbidities, hospital size, and urban/teaching status of hospital.

Results:

The weighted sample included 99,510 burn admissions with a mean percentage total body surface area of 15.5 percent. The weighted median plastic surgery volume by facility was 245 cases per year. Compared with the lowest quartile, the upper three quartiles of plastic surgery volume were associated with increased likelihood of undergoing flap procedures (p < 0.03). The top quartile of plastic surgery volume was also associated with decreased odds of patient safety indicator events (p < 0.001). Plastic surgery facility volume was not significantly associated with a difference in the likelihood of inpatient death.

Conclusions:

Burn encounters treated at high-volume plastic surgery facilities were more likely to undergo flap operations. High-volume plastic surgery centers were also associated with a lower likelihood of inpatient complications. Therefore, where feasible, acute burn patients should be triaged to high-volume centers.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Use of the Antegrade Posterior Interosseous Artery Flap for Coverage of Complex Elbow Wounds
Authors: Robinson Luke P. , Usmani Rashad H. , Hazel Antony , Gupta Amitava
Published: November 2021

One of the most versatile soft-tissue flaps available for elbow coverage that is reliable, quick, and easy to perform, with minimal donor defect and without the sacrifice of a major blood vessel, is the antegrade posterior interosseous artery flap. A large amount of vascularized fascia can be dissected with the flap, and it can be useful in lining the elbow joint or any exposed implant(s). After flap harvest, the donor site is often amenable to primary closure or requires a simple skin graft for closure. This article explains the technique for harvesting an antegrade posterior interosseous artery flap and describes 10 cases in which the flap was used for complex soft-tissue defects of the elbow not amenable to local wound care or skin grafting.
Clinical Effectiveness of Peripheral Nerve Blocks for Diagnosis of Migraine Trigger Points
Authors: Rangwani Shiva M. , Hehr Jason C. , Janis Jeffrey E.
Published: November 2021

Background:

With a 13 percent global prevalence, migraine headaches are the most commonly diagnosed neurologic disorder, and are a top five cause of visits to the emergency room. Surgical techniques, such as decompression and/or ablation of neurovasculature, have shown to provide relief. Popular diagnostic modalities to identify trigger loci include handheld Doppler examinations and botulinum toxin injection. This article aims to establish the positive predictive value of peripheral nerve blocks for identifying therapeutic surgical targets for migraine headache surgery.

Methods:

Electronic medical records of 36 patients were analyzed retrospectively. Patients underwent peripheral nerve blocks using 1% lidocaine with epinephrine and subsequent surgery on identified migraine headache trigger sites. Patients were grouped into successful and unsuccessful blocks and further categorized into successful and unsuccessful surgery subgroups. Group analysis was performed using paired t tests, and positive-predictive value calculations were performed on subgroups.

Results:

The preoperative Migraine Headache Index of patients with positive blocks was 152.71, versus 34.26 postoperatively (p < 0.001). Each index component also decreased significantly: frequency (22.11 versus 15.06 migraine headaches per month; p < 0.001), intensity (7.43 versus 4.12; p < 0.001), and duration (0.93 versus 0.55 days; p < 0.001). The positive-predictive value of diagnostic peripheral nerve blocks in identifying a migraine headache trigger site responsive to surgical intervention was calculated to be 0.89 (95 percent CI, 1 to 0.74).

Conclusions:

To the authors’ knowledge, this is the first study to investigate the positive-predictive value of peripheral nerve blocks as used in the diagnostic workup of patients with chronic migraine headaches. Peripheral nerve blocks serve as a reliable clinical tool in mapping migraine trigger sites for surgical intervention while offering more flexibility in their administration and recording as compared to established diagnostic methods. 

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
The Potential Use of Novel Plant-Derived Recombinant Human Collagen in Aesthetic Medicine
Authors: Seror Jasmine , Stern Miriam , Zarka Revital , Orr Nadav
Published: November 2021

Recombinant human type I collagen, identical in structure and functionality to human type I collagen, was successfully expressed and extracted from genetically modified tobacco plants. Contrarily to tissue extracted protein, rhCollagen is not immunogenic and not allergenic and has an intact triple helix structure showing superior biological functionality. A photocurable rhCollagen was developed by chemically modifying the protein to allow cross-linking under illumination at various wavelengths, maintaining the protein structural and biological functions. The use of the photocurable rhCollagen in aesthetic medicine, especially as a dermal filler and as a bioink for 3D-printed breast implant is discussed in this article.
Insights into a personalized management of blood pressure in acute stroke
Authors: Advani Rajiv , Sandset Else Charlotte
Published: November 2021

Purpose of review

Blood pressure management in acute stroke has long been a matter of debate. Epidemiological data show that high blood pressure is associated with death, disability and early stroke recurrence, whereas the pathophysiological rationale for ensuring elevated blood pressure in order maintain adequate cerebral perfusion remains a pertinent argument, especially in ischaemic stroke.

Recent findings

The European Stroke Organisation Guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage provide recommendations for the appropriate management of blood pressure in various clinical acute stroke settings.

In this narrative review, we provide specific updates on blood pressure management in ICH, blood pressure management in the setting of reperfusion therapies for ischaemic stroke, and the evidence for the use of induced hypertension in patients with acute ischaemic stroke in the light of the recent guidelines.
An evaluation for the medium-term storage and viability of root cortex tissues stained with blue ink in the assessment of arbuscular mycorrhizal fungi
Authors: Wilkes Thomas , Warner Douglas
Published: November 2021

Sheaffer blue ink is an effective method to stain arbuscular mycorrhizal (AM) fungi in a variety of plant species. It has, however, received criticism for its potential rapid degradation and short-term viability. The long and medium term storage and viability of stained samples has not, to date, been described for this particular staining method. This short communication reports on the viability of 730 samples stained with Sheaffer blue ink stored for the duration of 4 years in microscope slide boxes out of direct sunlight. There was no significant difference in micrograph image quality and presence of stain between years as indicated by the number of AM fungal structures quantified. In conclusion Sheaffer blue ink stain does not deteriorate in the medium term.
Exophiala pseudooligosperma sp. nov., a novel black yeast from soil in southern China
Authors: Yang Xiao-qian , Feng Man-yao , Yu Ze-fen
Published: November 2021

Exophiala is an important genus, with several species associated with infections in humans and animals. In a survey of soil fungal diversity in Yunnan province, PR China, a novel taxon, Exophiala pseudooligosperma sp. nov., was identified based on combined morphological and molecular phylogenetic features. Morphologically, this species is characterized by having torulose, septate hyphae and swollen, terminal or intercalary conidiogenous cells arising at acute angles from aerial hyphae. Phylogenetic analysis of the combined sequences of the internal transcribed spacer, the small and large nuclear subunit of the rRNA gene and part of the β-tubulin gene confirmed the phylogenetic position of the new species within the genus Exophiala.
Differential neutralization and inhibition of SARS-CoV-2 variants by antibodies elicited by COVID-19 mRNA vaccines
Authors: Wang Li , Kainulainen Markus H. , Jiang Nannan , Di Han , Bonenfant Gaston , Mills Lisa , Currier Michael , Shrivastava-Ranjan Punya , Calderon Brenda M. , Sheth Mili , Mann Brian R. , Hossain Jaber , Lin Xudong , Lester Sandra , Pusch Elizabeth , Jones Joyce , Cui Dan , Chatterjee Payel , Jenks Harley M. , Morantz Esther , Larson Gloria , Hatta Masato , Harcourt Jennifer , Tamin Azaibi , Li Yan , Tao Ying , Zhao Kun , Lacek Kristine , Burroughs Ashely , Wong Terianne , Tong Suxiang , Barnes John R. , Tenforde Mark W. , Self Wesley H. , Shapiro Nathan I. , Exline Matthew C. , Files D. Clark , Gibbs Kevin W. , Hager David N. , Patel Manish , Laufer Halpin Alison S. , McMullan Laura K. , Lee Justin S. , Xie Xuping , Shi Pei-Yong , Davis C. Todd , Spiropoulou Christina F. , Thornburg Natalie J. , Oberste M. Steven , Dugan Vivien ,   SSEV Bioinformatics Working Group, Wentworth David E. , Zhou Bin
Published: November 2021

Introductory

The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the emergence of many new variant lineages that have exacerbated the COVID-19 pandemic. Some of those variants were designated as variants of concern/interest (VOC/VOI) by national or international authorities based on many factors including their potential impact on vaccines. To ascertain and rank the risk of VOCs and VOIs, we analyzed their ability to escape from vaccine-induced antibodies. The variants showed differential reductions in neutralization and replication titers by post-vaccination sera. Although the Omicron variant showed the most escape from neutralization, sera collected after a third dose of vaccine (booster sera) retained moderate neutralizing activity against that variant. Therefore, vaccination remains the most effective strategy to combat the COVID-19 pandemic.