bluuebunny/crossref_metadata_2025 huggingface dataset:
Draft Genome Sequence Resource for the Orange Rust Pathogen of Sugarcane Puccinia kuehnii (Retracted)
Authors: Cardenas Daniela E. , Cheema Jitender , Oppelaar Theodora S. , Hincapie Martha , Sood Sushma , Zheng Qiaolin , Carrillo-Tarazona Yisel , Huguet-Tapia Jose , Saunders Diane G. O. , Comstock Jack C. , Rott Philippe C. , Cano Liliana M.
Published: March 2021

The authors of Cardenas et al. 111:1893-1896 (2021) retracted this article because posterior analyses have identified that the assembled genomes contained a substantial proportion of other fungi beyond the orange rust Puccinia kuehnii, mainly Ascomycetes for one isolate and Ustilaginales for the other (metagenomes). This article was retracted on 11 March 2022.

Puccinia kuehnii is an obligate biotrophic fungal pathogen that causes orange rust of sugarcane, which is prevalent in many countries around the globe. In the United States, orange rust was first detected in sugarcane in Florida in 2007 and poses a persistent and economically damaging threat to the sugarcane industry in this region. Here, we generated the first genome assemblies for two isolates of P. kuehnii (1040 and 2143) collected in Florida in 2017 from two sugarcane cultivars, CL85-1040 and CP89-2143, respectively. These two rust genome resources will be of immense value for future genomic studies, particularly further exploration of the predicted secretomes that may help define key pathogenicity determinants for this economically important pathogen.
Genome Sequencing and Functional Characterization ofXanthomonas cucurbitae, the Causal Agent of Bacterial Spot Disease of Cucurbits
Authors: Rai Rikky , Pasion Julius , Majumdar Tanvi , Green Cory E. , Hind Sarah R.
Published: March 2021

Bacterial leaf spot disease caused by Xanthomonas cucurbitae has severely affected the pumpkin industries in the Midwestern region of United States, with the bacteria mainly infecting pumpkin leaves and fruits, and leading to significant yield losses. In this study, we utilized genomics and genetics approaches to elucidate X. cucurbitae molecular mechanisms of pathogenesis during interaction with its host. We generated the first reference-quality whole-genome sequence of the X. cucurbitae type isolate and compared with other Xanthomonas species, X. cucurbitae has a smaller genome size with fewer virulence-related genes. RNA-seq analysis of X. cucurbitae under plant-mimicking media conditions showed altered transcriptional responses, with upregulation of virulence genes and downregulation of cellular homeostasis genes. Additionally, characterization of key virulence genes using gene deletion methods revealed that both type II enzymes and type III effectors are necessary for X. cucurbitae to cause infection in the pumpkin host.
Low birth weight female piglets show altered intestinal development, gene expression, and epigenetic changes at key developmental loci
Authors: Ayuso Miriam , Irwin Rachelle , Walsh Colum , Van Cruchten Steven , Van Ginneken Chris
Published: March 2021

Intestinal development is compromised in low birth weight (LBW) pigs, negatively impacting their growth, health, and resilience. We investigated the molecular mechanisms of the altered intestinal maturation observed in neonatal and juvenile LBW female piglets by comparing the changes in intestinal morphology, gene expression, and methylation in LBW versus normal birth weight (NBW) female piglets. A total of 16 LBW/NBW sibling pairs were sacrificed at 0 hours, 8 hours, 10 days, and 8 weeks of age. The gastrointestinal tract was weighed, measured, and the small intestine was sampled for histomorphology, gene expression, and methylation analyses. Impaired intestinal development, with shorter villi and shallower crypts, was observed in LBW female piglets. The expression of intestinal development markers (ALPI and OLFM) rapidly peaked after birth in NBW but not in LBW female piglets. The lower expression of genes involved in nutrient digestion (ANPEP and SI) and barrier function (OCLN and CLDN4) in LBW, together with their delayed development of intestinal villi and crypts could help to explain the compromised health and growth potential of LBW female piglets. The changes in methylation observed in LBW in key regulators of intestinal development (OLFM4 and FZD5) suggest long‐term effects of BW on intestinal gene expression, development, and function. Accordingly, experimental demethylation induced in IPEC‐J2 cells led to increased expression of intestinal genes (MGA, DPP4, and GLUT2). Overall, we have identified the alterations in transcription or epigenetic marking at a number of genes critical to intestinal development, which may contribute to both the short‐ and long‐term failure of LBW female piglets to thrive.
Effects of a Video Game–Based Program on Women With Lymphedema Secondary to Breast Cancer: Preexperimental Study
Authors: Martínez de Albéniz Santamaría Noelia , Santamaría-Vázquez Montserrat , Ortiz-Huerta Juan Hilario
Published: March 2021

Objective:

To improve the scapulohumeral joint limitations and increase the health-related quality of life (HRQOL) in women with lymphedema secondary to breast neoplasms.

Methods:

A preexperimental design (with pre- and posttest evaluations in only one group) was conducted in a group of 11 women with lymphedema secondary to breast cancer. They received 5 individual weekly sessions of 30 minutes each performed with the Wii console and the Wii Balance Board.

Measurements:

The Oxford Shoulder Score and the Shoulder Pain and Disability Index were used for the data measurements of both shoulder pain and disability; Functional Assessment of Cancer Therapy Questionnaire General and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer were used to evaluate HRQOL; muscle strength was tested with an electronic manual dynamometer and range of motion by manual goniometry.

Results:

Statistically significant improvements were reported: pain (P = .011), disability (P > .05), HRQOL associated with lymphedema (P = .016), strength (P < .05), and range of articular motion (P < .05).

Conclusions:

The results suggest that a video game–based program is useful for addressing limitations relating to lymphedema and require further investigation.
Multidisciplinary Rehabilitation Within Pediatric Cancer Care: A Holistic Approach
Authors: Lenker Hallie
Published: March 2021

As pediatric cancer survival rates improve so should the overall rehabilitative care. While the role of physical therapists and gross motor functional deficits are becoming better understood, there has been less of an emphasis on the role of occupational therapists and speech-language pathologists. Pediatric cancer treatment impacts the whole child and the whole family. Gross motor, cognitive, activities of daily living, and fine motor impairments should be evaluated at the start, during, and after cancer treatment. Incorporating the whole rehabilitation team will improve the child's functional outcome and allow for developmentally appropriate gains.
Resonance Effect of the Frontal Sinus on Ocular Vestibular-Evoked Myogenic Potential Recordings
Authors: Lin Kuei-You , Jaw Fu-Shan , Young Yi-Ho
Published: March 2021

Objective:

This study performed ocular vestibular-evoked myogenic potential (oVEMP) test via Fpz bone vibration (termed Fpz-oVEMP) and Fz bone vibration (termed Fz-oVEMP) using a minishaker. The aim of this study was to evaluate the resonance effect of the frontal sinus on the oVEMP recordings, so as to establish an optimal clinical protocol for eliciting oVEMPs by bone vibration.

Design:

Thirty healthy volunteers (15 children and 15 adults) and 15 adults with frontal sinusitis were enrolled in this study. All subjects underwent oVEMP test via Fpz and Fz bone vibration stimuli, and volume of the frontal sinus was measured by CT scan.

Results:

Because healthy adults (3.20 ± 1.08 mL) had significantly larger frontal sinus volume than healthy children (2.04±1.87 mL), the former (100%) showed higher response rates of Fpz-oVEMP than the latter (30%), but not Fz-oVEMP. When the frontal sinus volume is >1.91 mL (approximately at the age of 14 years), Fpz-oVEMP displayed larger reflex amplitude than Fz-oVEMP did. In contrast, Fpz-oVEMP (30%) displayed lower response rate than Fz-oVEMP (73%) in patients with frontal sinusitis.

Conclusions:

Both developmental (frontal sinus volume) and pathological (frontal sinus inflammation) factors may affect the oVEMP responses via altering resonance function. For the developmental factor, frontal sinus volume >1.91 mL may initiate the resonance effect on oVEMPs, as evidenced by higher response rate with larger reflex amplitude of Fpz-oVEMP than Fz-oVEMP. For the pathological factor, frontal sinusitis may hamper the resonance effect on oVEMPs, as shown by the lower response rate of Fpz-oVEMP than Fz-oVEMP. Hence, oVEMP test may be performed via Fpz bone vibration first in healthy adults, while via Fz bone vibration first in children aged under 14 years or subjects with frontal sinusitis.
Sudden Otovestibular Dysfunction in 3 Metastatic Melanoma Patients Treated With Immune Checkpoint Inhibitors
Authors: Stürmer Suzan H. , Lechner Axel , Berking Carola
Published: March 2021

Immune-related adverse events have been described in 86%–96% of high-risk melanoma patients treated with immune checkpoint inhibitors (ICI), while in 17%–59% of cases these are classified as severe or even life-threatening. The most common immune-related adverse events include diarrhea, fatigue, hypothyroidism, and hepatitis. Bilateral uveitis and unspecific vertigo have been described in 1% of cases, respectively, in the pivotal studies of ICIs, but the affection of the vestibule-cochlear system has not been reported before. In this case series, we present 3-stage IV melanoma patients with sudden onset of otovestibular dysfunction (hearing loss and vestibulopathy), partly combined with uveitis because of ICIs. We describe detailed diagnostic work-up and therapeutic interventions and discuss possible pathogenic mechanisms of this rare and disabling event.
A Randomized, Evaluator-Blind, Split-Face Study Evaluating the Safety and Efficacy of Calcium Hydroxylapatite for Jawline Augmentation
Authors: Boen Monica , Alhaddad Marwan , Goldman Mitchel P. , Kollipara Ramya , Hoss Elika , Wu Douglas C.
Published: March 2021

INTRODUCTION

Jawline augmentation with calcium hydroxylapatite has not yet been evaluated in a prospective study with a split-face design. This study aims to perform the first randomized controlled, split-face study on the efficacy and safety of calcium hydroxylapatite for jawline augmentation using the needle and cannula technique.

OBJECTIVE

To perform the first randomized controlled, split-face study on the efficacy and safety of calcium hydroxylapatite for jawline augmentation using the needle and cannula technique.

MATERIALS AND METHODS

This is a single-site, randomized, evaluator-blind trial enrolling a total of 10 healthy subjects with at least Grade 1 (mild) on a 4-point Jawline Scale. One side of the face was randomized to receive 1 to 2 syringes of calcium hydroxylapatite with lidocaine (total of 3 mL) for correction of wrinkles and folds along the jawline using both the cannula and needle method, and a balancing treatment will be performed 1 month later. Blinded investigator and subject evaluations will be performed immediately after treatment and at the 30-, 60-, and 90-day visits.

RESULTS

Ten subjects were enrolled and completed the trial. There was a improvement in the degree of wrinkling and skin sagging in the 4-point Jawline Scale, with an average of a 1.3-point improvement in the scale on the day of treatment and at the Day 30 visit, which remained improved greater than baseline after 3 months as graded by blinded investigators. The Clinician Global Aesthetic Improvement Score for the treated side versus control, as assessed by blinded investigators, demonstrated a improvement with a 2.3-point improvement on the 5-point scale, and by the final visit on Day 90, most patients had a much improved appearance from baseline.

CONCLUSION

This study demonstrates that calcium hydroxylapatite is effective and safe for restoration and augmentation of the jawline using the unique needle and cannula technique.
ROLE OF OPTICAL COHERENCE TOMOGRAPHY FOR PREDICTING POSTOPERATIVE VISUAL OUTCOMES AFTER REPAIR OF MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Guan Ivan , Gupta Mrinali P. , Papakostas Thanos , Wu Alan , Nadelmann Jennifer , D'Amico Donald J. , Kiss Szilard , Orlin Anton
Published: March 2021

Purpose:

To identify any prognostic associations between preoperative optical coherence tomography findings and postoperative visual outcomes in patients with macula-off rhegmatogenous retinal detachment.

Methods:

A retrospective, single-center study of patients diagnosed with macula-off rhegmatogenous retinal detachment whom underwent surgical reattachment from 2012 to 2017. Optical coherence tomography images were analyzed by two retina surgeons. Outcome measures included “good” final vision (best-corrected visual acuity of 20/40 or better), “poor” final vision (best-corrected visual acuity of 20/200 or worse), and change in vision (worsened, improved, and improved ≥15 letters) at most recent follow-up. P values were calculated using t tests, analysis of variance, Wilcoxon rank-sum, or Kruskall–Wallis test.

Results:

A total of 49 eyes were included. There was a significant difference in the mean preoperative central retinal thickness between patients who had good final vision and patients who did not (96 μm vs. 161 μm, P = 0.048). In addition, a worse preoperative best-corrected visual acuity and greater subretinal fluid height were associated with vision improvement (P < 0.001). Those with persistent ellipsoid zone disruption postoperatively were less likely to have good final vision (odds ratio = 0.217, 95% confidence interval: 0.057–0.828).

Conclusion:

A lower mean preoperative central retinal thickness is associated with good visual prognosis. Eyes with ellipsoid zone disruption postoperatively were less likely to have good final vision. Future studies should include a larger cohort of patients and more optical coherence tomography variables to address the inconsistencies in the current literature.
Primary Graft Failure, Infection, and Endothelial Cell Density in Corneal Transplants With Increased Death-to-Preservation Time
Authors: Sun Michelle J. , Duong Andrew T. , Tran Khoa D. , Straiko Megan M.W. , Stoeger Christopher G. , Sales Christopher S.
Published: March 2021

Purpose:

To ascertain whether death-to-preservation time (DPT) is associated with donor endothelial cell density (ECD), primary graft failure (PGF), and infection.

Methods:

Donor corneas aged older than 10 years with ECD 2000 to 4500 cells/mm2 were procured between 2011 and 2018 by a single eye bank. Donor corneas were analyzed retrospectively for the main outcome measures of PGF, infection, and ECD. Means and proportions of study parameters were compared between corneas with long and short DPT, defined as greater or less than 14 hours, respectively, excluding corneas with a history of intraocular surgery or diabetes. Multivariate analyses were performed using logistic regression, adjusting for donor age at time of death, history of diabetes mellitus, and history of cataract surgery.

Results:

Among 12,015 corneas, those with long DPT had a statistically but not clinically significant higher ECD than that of corneas with short DPT (2754 vs. 2724 cells/mm2, P < 0.01). There was no difference in PGF and infections in corneas with long versus short DPT (0.28% vs. 0.26%, P = 0.86; 0.43% vs. 0.29%, P = 0.51, respectively).

Conclusions:

Longer DPT is not associated with a clinically meaningful reduction in donor ECD, PGF, or infection.
Agreement of Corrected Intraocular Pressure Values Between Corvis ST and Pentacam in Patients With Keratoconus, Subclinical Keratoconus, and Normal Cornea
Authors: Chen Yanhui , Rong Hua , Liu Wei , Liu Guihua , Du Bei , Jin Chengcheng , Wei Ruihua
Published: March 2021

Purpose:

To analyze the agreement of corrected intraocular pressure (IOP) values between Corvis ST (ΔIOP1) and Pentacam (ΔIOP2) in patients with keratoconus (KC), subclinical KC (sub-KC), and normal cornea.

Methods:

In total, 235 eyes were divided into KC, sub-KC, and control groups. Differences in ΔIOP1 (biomechanically corrected IOP minus uncorrected IOP) and ΔIOP2 (central corneal thickness-corrected amounts of IOP) were analyzed within and among groups. Topographical and biomechanical differences were compared among the 3 groups. Factors affecting differences between ΔIOP1 and ΔIOP2 were analyzed. Agreement analysis of ΔIOP2 and ΔIOP1 was performed by Bland–Altman plots for all 3 groups.

Results:

Mean ΔIOP1 was highest in the KC group (1.23 ± 0.84 mm Hg), followed by sub-KC and control groups (all P < 0.05). Deformation amplitude ratio at 2 mm (DA-2 mm), integrated radius, stiffness parameter at first applanation, and Corvis biomechanical index values significantly differed between sub-KC and control groups. The differences between ΔIOP1 and ΔIOP2 were affected by stiffness parameter at first applanation, after adjusting for central corneal thickness and age, in all 3 groups. The lowest agreement between ΔIOP2 and ΔIOP1 was observed in the KC group (mean difference: 1.90 mm Hg; 95% limit of agreement ranged from −0.2 to 3.9 mm Hg).

Conclusions:

Among the 3 groups in this study, the KC group exhibited the worst consistency between ΔIOP2 and ΔIOP1. For the sub-KC and control groups, corrected IOP values derived by Pentacam were similar to Corvis ST. Ophthalmologists should carefully consider the mechanical properties of eyes with KC during IOP management.
Interarm blood pressure differences and 2-year mortality in acute coronary syndrome patients
Authors: Kilic Ismail Dogu , Kilci Hakan , Sevgican Cihan Ilyas , Kilinc Mehmet , Ozden Tok Ozge , Oguz Ibrahim , Ghilencea Liviu , Senol Hande , Kilickesmez Orta Kadriye
Published: March 2021

Background and aims

Interarm blood pressure difference (IABPD) was associated with increased cardiovascular and all-cause mortality in various cohorts previously. In this study, we planned to explore the association between the IABPD obtained with simultaneous measurements in both arms and the risk of mortality over a 2-year follow-up of patients with acute coronary syndrome (ACS).

Methods

Simultaneous blood pressure (BP) measurements were performed during initial admission in patients with ACS. Systolic ≥10 mmHg and diastolic ≥5 mmHg absolute IABPD was defined as cutoff values in this study. The relationship of IABPD and all-cause mortality was assessed using Kaplan–Meier curves and Cox analysis.

Results

A total of 532 patients with ACS were included in the study. Mean age of the study participants was 60.1 ± 12.6. Patients included in the study were followed for 23.2 ± 7.2 months (median 25.3, min: 0, max: 28.7 months). Survival was assessed using Kaplan–Meier curves. Patients with systolic IABPD ≥ 10 mmHg and systolic IABPD < 10 mmHg had an average survival time of 25.94 ± 0.84 and 25.92 ± 0.38 months (P = 0.925), respectively. Survival times of diastolic IABPD ≥5 mmHg and diastolic IABPD <5 mmHg were 26.44 ± 0.62 and 25.71 ± 0.41 (P = 0.251) months, respectively.

Conclusions

In the current study, we did not find a significant association between IABPD and all-cause mortality in patients with ACS in 2-years follow-up. Future studies may be required for further evaluation of the prognostic importance of IABPD in patients with ACS.
Effects of the valsartan/amlodipine combination and nifedipine gastrointestinal therapeutic system monotherapy on brachial pulse pressure and radial augmentation index in hypertensive patients
Authors: Xu Shao-Kun , Zeng Wei-Fang , Li Yan , Chen Liang-Long , Xie Jian-Hong , Wang Ji-Guang
Published: March 2021

Objective

In a substudy of a randomized controlled trial, we investigated the effects of the valsartan/amlodipine single-pill combination and nifedipine gastrointestinal therapeutic system (GITS) monotherapy on brachial pulse pressure (bPP) and radial augmentation index (rAI) in patients with previously uncontrolled hypertension.

Methods

We performed measurements of clinic blood pressure (BP) and pulse rate and rAI (n = 63) and ambulatory BP monitoring (n = 42) at baseline and 12-week of follow-up. Analysis of covariance was performed to calculate the least square mean change from baseline and between-group differences [95% confidence interval (CI)]. Correlation analysis was performed to study the interrelationship between the changes in bPP and rAI and in pulse rate.

Results

After 12-week treatment, clinic and ambulatory SBP/DBP and pulse rate were not differently changed between the valsartan/amlodipine (n = 29) and nifedipine GITS groups (n = 34, P ≥ 0.06) except daytime SBP (P = 0.01). The reductions in 24-h and daytime ambulatory bPP were significantly greater in the former than the latter group (P ≤ 0.04). rAI increased slightly by 3.5% (P = 0.20) and 5.2% (P = 0.06) in the valsartan/amlodipine and nifedipine groups, respectively, with a between-group difference of −1.7% (95% CI −9.6 to 6.1%, P = 0.66). In the two groups combined, the changes in clinic and ambulatory bPP were not or weakly associated with that in clinic or ambulatory pulse rate (r = −0.14 to 0.36, P = 0.02–0.95), while the changes in rAI were more strongly or significantly associated with that in clinic or ambulatory pulse rate (r = −0.39 to −0.23, P = 0.02–0.16).

Conclusions

Antihypertensive drug-induced changes in rAI but not bPP were dependent on pulse rate.
A brief experimental examination of post-exercise hypotension and the impact of calculation method
Authors: Nguyen Cindy H. , Thomas Scott H. , Bentley Danielle C.
Published: March 2021

Purpose

There is great variability in the reported values of post-exercise hypotension (PEH), with inconsistent calculation methods employed across primary research. This study aimed to explore the influence of the mathematical calculation method on PEH variability, with the hypothesis that the method of identifying the lowest single reduction point (LSRP) would yield false-positive results.

Methods

Young, normotensive (108 ± 7/69 ± 5 mmHg), apparently healthy, male (n = 20) were included in this study. Participants completed three random-order experimental sessions, with blood pressure and heart rate measured before (10 min) and after (30 min) an acute bout of either isometric handgrip exercise, aerobic cycling, or a nonexercise control. Three PEH calculation methods were analyzed: LSRP, 30-min average across the full post-exercise recovery, and 15-min binned averages with two recovery windows (0–15 min, 15–30 min).

Results

The only calculation method to consistently identify PEH was the LSRP method, which identified PEH for SBP, DBP, and mean arterial pressure, across handgrip exercise, aerobic cycling, and even nonexercise control (P < 0.001). All other calculation methods inconsistently identified PEH across experimental sessions, supporting the hypothesis that LSRP inaccurately overreports PEH.

Conclusion

Mathematical calculation method appears to be one source of variability contributing to the inconsistency in reported PEH among young, healthy males. This brief experimental examination reveals that the LSRP method should be avoided as it inaccurately overreports PEH. Alternatively, binned averages of smaller time windows across the recovery period may be a potentially advantageous approach and require further examination to determine to ideal level of granularity.
Gastrointestinal Symptoms Predict the Outcomes From COVID-19 Infection
Authors: Bishehsari Faraz , Adnan Darbaz , Deshmukh Ameya , Khan Shahab R. , Rempert Trevor , Dhana Klodian , Mahdavinia Mahboobeh
Published: March 2021

Coronavirus disease 2019 (COVID-19) has taken hundreds of thousands of lives globally. Besides the respiratory tract, the virus can affect the gastrointestinal (GI) tract. Data regarding the significance of GI symptoms in the COVID-19 course are limited. In this largest US study to date, the authors reviewed electronic encounters of 1003 consecutive patients who were tested positive for the virus between March 12 and April 3, 2020. Initial GI symptoms were present in up to 22.4% of patients and were associated with worse outcomes after adjustment for demographics, comorbidities, and other clinical symptoms. COVID-19 with GI involvement may define a more severe phenotype.
Prevention of variceal rebleeding in cirrhotic patients with spontaneous portosystemic shunts: transjugular intrahepatic portosystemic shunt versus endoscopic treatment
Authors: Zhang Han , Xiao Jiangqiang , Tu Jingjing , Zhang Ming , Zhang Feng , Yin Qin , Zhuge Yuzheng
Published: March 2021

Background

Spontaneous portosystemic shunts(SPSSs) in cirrhotic patients indicate higher incidence of gastric varices, which increases the risk for bleeding and death. However, few studies compared endoscopic therapy with transjugular intrahepatic portosystemic shunt (TIPS) in preventing variceal rebleeding in cirrhotic patients with SPSSs. This research aims to evaluate the effectiveness of the two methods in this group of patients.

Methods

We reviewed consecutive cirrhotic patients with SPSSs who underwent either TIPS or endoscopic treatment to prevent variceal rebleeding between January 2015 and December 2018 in our institution. Outcomes including rebleeding, overt hepatic encephalopathy (OHE), complications and survival were compared. Meanwhile, subgroup analyses were conducted to screen relevant factors affecting the results.

Results

A total of 97 patients were included in the study. The TIPS arm contained 50 patients and the endoscopy arm contained 47 patients. Rebleeding rate in TIPS group was statistically lower than endoscopic group [16.0 vs 38.3%, hazard ratio (HR) = 0.37, 95% confidence interval (CI): 0.16–0.84, P = 0.01], while OHE was more frequent (16.0 vs 2.1%, HR = 7.59, 95% CI: 0.94–61.2, P = 0.025), the survival rate (92 vs 89.4%, HR = 0.88, 95% CI: 0.22–3.60, P = 0.87) and frequency of complications were comparable between two groups. In the subgroups of GOV2/IGV1 and splenorenal shunt/gastrorenal shunt, compared with endoscopic treatments, TIPS reduced the rate of rebleeding without significantly increasing overt hepatic encephalopathy; however, it did not improve survival rate.

Conclusions

For cirrhotic patients with SPSSs, TIPS brought a lower rebleeding rate but a higher incidence of OHE. However, in the subgroups of GOV2/IGV1 and splenorenal shunt/gastrorenal shunt, TIPS was considered more reasonable due to the lower rebleeding rate and comparable OHE incidence.
Factors affecting the response to treatment and survival in hepatocellular carcinoma patients treated with transarterial radioembolisation: a single-centre experience
Authors: Ekmekcioglu Ozgul , Tabakci Omer Naci , Bozdag Kaplan Nihal , Hasanefendioglu Bayrak Aylin , Battal Muharrem
Published: March 2021

Objective

Transarterial radioembolisation (TARE) is a promising technique for unresectable primary tumours of the liver. We present our clinical experience and the response to treatment and survival data of patients with hepatocellular carcinoma (HCC) who were treated with Y-90 radioembolisation in our hospital’s angiography department.

Material and methods

The data of all the patients with HCC referred to our department for Y-90 treatment were analysed retrospectively. The patients were selected according to the treatment protocol criteria, and lung shunt fraction was evaluated using macroaggregated albumin scintigraphy before radioembolisation. Patients with compatible blood tests and lung shunt fraction rates were chosen for treatment with Y-90 TARE.

Results

Twenty-four patients were suitable for Y-90 treatment. The patients were treated with 137 ± 44.6 (80–245) Gy Y-90 glass microspheres. The treatment results were evaluated using modified RECIST criteria, and the partial response, complete response, stable disease and progression rates were found to be 54.2, 16.7, 20.8 and 8.3%, respectively. The median survival rate following treatment was 10 months. Higher alpha-fetoprotein (AFP) levels were related to decreased survival, and posttreatment AFP levels had a significant effect on mortality rates. Higher survival rates were detected in the patients who were treated more selectively than the group treated via a lobar approach.

Conclusion

Y-90 microsphere radioembolisation is a safe method and may be helpful in treating patients with unresectable hepatocellular tumours. More favourable results were obtained in the patients treated using the more selective approach. AFP levels before and after treatment could predict survival rates.
Endoscopic management of Barrett’s dysplasia and early neoplasia: efficacy, safety and long-term outcomes in a UK tertiary centre
Authors: White Jonathan Richard , Ortiz-Fernández-Sordo Jacobo , Santiago-García Jose , Reddiar Dona , Learoyd Anna , De Caestecker John , Cole Andrew , Kaye Phillip , Ragunath Krish
Published: March 2021

Background and Objectives

Endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) are effective treatments for dysplastic Barrett’s esophagus (BE). This study evaluates efficacy, durability and safety in a single high-volume UK tertiary centre with 15-years’ experience.

Methods

Prospective data were collected from Nottingham University Hospitals 2004–2019 for endotherapy of dysplastic BE or intramucosal adenocarcinoma. Procedural outcome measures include complete resection, complications and surgery rates. Efficacy outcomes include complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM), recurrence, treatment failure rates, durability of RFA, median follow up and tumor-associated mortality.

Results

A total of 319 lesions were resected; 671 RFAs were performed on 239 patients. Median age was 67 (±9.5) years, male:female ratio was 5:1 and median BE length was C3 [interquartile range (IQR): 6] M6 (IQR: 5). The most common lesion was Paris IIa (64%) with a median size of 10 mm (3–70). Final histology was adenocarcinoma in 50%. Complete resection rates were 96%. The multiband mucosectomy technique (91%) was most commonly used. The median number of RFA sessions was 3 (IQR: 2). The rates of CR-D and CR-IM were 90.4%% and 89.8% achieved after a median of 20.1 (IQR: 14) months. The most common complications: EMR was bleeding 2.2% and RFA was stricture (5.4%) requiring a median of 2 (range 1-7) dilatations. Median follow up post CR-IM/CR-D was 38 months (14–60). Metachronous lesions developed in 4.7% after CR-D and tumor-related mortality was 0.8%. Dysplasia and intestinal metaplasia-free survival at 5 years was 95 and 90%, respectively.

Conclusion

BE endotherapy is minimally invasive, effective, safe and deliverable in a day-case setting.
The efficacy and efficiency of stent-assisted percutaneous endoscopic necrosectomy for infected pancreatic necrosis: a pilot clinical study using historical controls
Authors: Ke Lu , Li Gang , Wang Peng , Mao Wenjian , Lin Jiajia , Gao Lin , Ye Bo , Zhou Jing , Tong Zhihui , Li Weiqin , Windsor John
Published: March 2021

Objectives

Minimally invasive interventions have become standard treatment for infected pancreatic necrosis (IPN). Despite the marginal clinical advantage of endoscopic approaches over the surgical approach shown in recent studies, percutaneous techniques still have a role when endoscopic treatment is not indicated. Stent-assisted percutaneous endoscopic necrosectomy (SAPEN) is an alternative option for surgical necrosectomy, but the theoretical advantages to this procedure remain unproven. This study aimed to report the efficacy and efficiency of SAPEN in patients with IPN.

Methods

This is a retrospective, historically-controlled, cohort study. All IPN patients admitted to our center from January 2015 to December 2018 were screened for eligibility. Patients admitted between January 2015 and October 2017 were historical controls, and patients admitted thereafter were treated with additional self-expandable metal stent (SEMS). The primary endpoint was a composite of major complications and/or death. Other outcomes, including individual components of the primary endpoint, new-onset sepsis, length of ICU and hospital stay, and pancreatic fistula, were also compared.

Results

There were 73 historical-control patients and 37 patients who had SAPEN included for analysis. The introduction of the SAPEN procedure failed to reduce the incidence of the primary endpoint (35 versus 52%, P = 0.095). However, significantly shorter hospital stay (38 versus 48 days, P = 0.035) and lower incidence of new-onset sepsis were observed in the SAPEN group (35 versus 56%, P = 0.037).

Conclusion

The application of SEMS in percutaneous endoscopic necrosectomy procedures shortened hospital stay, decreased new-onset sepsis, and allowed earlier necrosectomy.
Outcomes Associated With State Policies Enabling Provision of Oral Health Services in Medical Offices Among Medicaid-enrolled Children
Authors: Kranz Ashley M. , Opper Isaac M. , Estrada-Darley Ingrid , Goldstein Evan , Stein Bradley D. , Dick Andrew W.
Published: March 2021

Background:

To increase receipt of preventive oral health services (POHS), all state Medicaid programs have enacted policies to encourage nondental providers to deliver POHS in medical offices. This study examined if these Medicaid policies improved oral health, as measured by reductions in dental visits with treatment and preventable emergency department (ED) visits for nontraumatic dental conditions (NTDC).

Methods:

Using data on children aged 6 months to up to 6 years from 38 state Medicaid programs during 2006–2014, we used a generalized difference-in-differences estimation approach to examine the probability of a child having, in a year, any dental visits with caries-related treatment and any ED visits for NTDC, conditional on length of policy enactment. Models included additional child-level and county-level characteristics, state and year fixed effects, probability weights, and clustered standard errors.

Results:

Among a weighted sample of 45,107,240 child/year observations, 11.7% had any dental visits with treatment and 0.2% had any ED visits for NTDC annually. Children in states with and without medical POHS policies had similar odds of having any dental visits with treatment, regardless of length of policy enactment. Children in states with medical POHS policies enacted for one or more years had significantly greater odds of having any ED visits for NTDC (P<0.05).

Conclusions:

State policies making POHS available in medical offices did not affect rates of dental visits with caries-related treatment, but were associated with increased rates of potentially avoidable ED visits for NTDC. Findings suggest that many young Medicaid-enrollees lack access to dentists.
Positioning biologics and small molecules in the management of moderate to severe ulcerative colitis
Authors: Abraham Bincy , Glassner Kerri
Published: March 2021

Purpose of review

This review addresses the selection of biologic and small molecule therapy for patients with moderate to severe ulcerative colitis (UC). With several new treatment options approved within the past few years, an update in positioning is timely and relevant.

Recent findings

Updates on the safety and comparative efficacy of approved therapeutic agents for UC are presented. Newly approved therapies including tofacitinib and ustekinumab, as well as where to position these treatments are discussed. Data on the first-ever head-to-head trial of biologic therapy in UC are examined. This review provides an evidence-based overview of the optimal management strategies of patients in both the inpatient and outpatient settings.

As we move closer towards the goal of personalized therapy for our patients with UC, we hope to better select appropriate and effective treatment options. Newly approved therapies provide us with additional options for management. Future advancements in predictive serologic, mucosal, genetic, and fecal markers can enable us to tailor therapy to an individual patient.
Reducing Cardiac Telemetry Nuisance Alarms Through Evidence-Based Interventions
Authors: Karapas Eleftheria T. , Bobay Kathleen
Published: March 2021

Background:

Cardiac telemetry nuisance alarms due to leads off and poor signal increase staff workflow interruptions, decrease staff trust in technology, and can compromise patient safety.

Local Problem:

Interventions were directed at reducing nuisance alarms on a 32-bed, non–intensive care - a cardiac telemetry unit.

Methods:

A nursing staff education module with evidence-based practices for reducing nuisance alarms, a daily care protocol for patients on cardiac telemetry monitoring, and daily audits of protocol adherence were implemented.

Results:

Staff pre- and posttest comparisons on their knowledge relating to nuisance alarms and the evidence-based protocol demonstrated a significant mean increase of 3.02 (95% CI, 2.55-3.48). Daily audits for 7 weeks demonstrated an average of 58.46% staff adherence. Telemetry technician call volume reduction was 16% postimplementation, while nuisance alarms were not reduced significantly.

Conclusions:

This rapid-cycle, quality improvement process resulted in minimal reduction in nuisance alarms but improved staff awareness of the issue and reduced workflow interruptions.
MLH1, MSH2, MRE11, and XRCC1 in Oral Leukoplakia and Oral Squamous Cell Carcinoma
Authors: Donís Sergio Piñeiro , González Alba Pérez , Alves Monica Ghislaine Oliveira , do Carmo Carvalho Bruna F. , Ferreira Camila C.P. , Almeida Janete Dias , Iruegas Elena Padín , Petronacci Cintia M. Chamorro , Peñaranda José M. Suárez , Sayáns Mario Pérez
Published: March 2021

Background:

DNA damage is accumulated in the cells over time as the result of both exogenous and endogenous factors. The objective of this study was to analyze the immunohistochemical expression of the repair proteins in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC).

Materials and Methods:

Paraffin blocks were selected from the archives of the Laboratory of Hospital Clinico Universitario de Santiago de Compostela, Spain. The sample was composed of 16 cases of OL without dysplasia, 14 cases of OL with dysplasia, and 15 cases of OSCC. The patients’ clinical data were collected and immunohistochemical analysis was performed for MLH1, MSH2, MRE11, and XRCC1. The data were submitted to the χ2 and the Kruskal-Wallis (P≤0.05) tests.

Results:

MSH2 was overexpressed in OSCC (P=0.020) and was positive in 100% of patients with OL with dysplasia or OSCC (P=0.019). Positivity for MLH1 was significantly associated with comorbidity (P=0.040), especially in patients who presented with 2 or more pathologies (P=0.028). XRCC1 positivity was also associated with comorbidity (P=0.039). No significant associations were found for the MRE11A expression. Although the simultaneous positivity for the 4 markers was observed in presence of comorbidities (P=0.006).

Conclusions:

This study supports the effect of the overexpression of MSH2 protein in samples of OL with dysplasia and OSCC, most notably in patients who present with comorbidities and negativity for OL without dysplasia.
High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy
Authors: Marchegiani Giovanni , Perri Giampaolo , Burelli Anna , Zoccatelli Fabio , Andrianello Stefano , Luchini Claudio , Donadello Katia , Bassi Claudio , Salvia Roberto
Published: March 2021

Objective:

To evaluate TP as an alternative to PD in patients at high-risk for popf.

Background:

Outcomes of high-risk PD (HR-PD) and TP have never been compared.

Methods:

All patients who underwent PD or TP between July 2017 and December 2019 were identified. HR-PD was defined according to the alternative fistula risk score. Postoperative outcomes (primary endpoint), pancreatic insufficiency, and quality of life after 12 months of follow-up (QoL) were compared between HR-PD or planned PD intraoperatively converted to TP (C-TP).

Results:

A total of 566 patients underwent PD and 136 underwent TP during the study period. One hundred one (18%) PD patients underwent HR-PD, whereas 86 (63%) TP patients underwent C-TP. Postoperatively, the patients in the C-TP group exhibited lower rates of postpancreatectomy hemorrhage (15% vs 28%), delayed gastric emptying (16% vs 34%), sepsis (10% vs 31%), and Clavien-Dindo ≥3 morbidity (19% vs 31%) and had shorter median lengths of hospital stay (10 vs 21 days) (all P < 0.05). The rate of POPF in the HR-PD group was 39%. Mortality was comparable between the 2 groups (3% vs 4%). Although general, cancer- and pancreas-specific QoL were comparable between the HR-PD and C-TP groups, endocrine and exocrine insufficiency occurred in all the C-TP patients, compared to only 13% and 63% of the HR-PD patients, respectively, and C-TP patients had worse diabetesspecific QoL.

Conclusions:

C-TP may be considered rather than HR-PD only in few selected cases and after adequate counseling.
Reassessing Rabbit Antithymocyte Globulin Induction in Kidney Transplantation (RETHINK): An Analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Registry
Authors: Ashoor Isa F. , Martz Karen , Galbiati Shirley , Beyl Robbie A. , Dharnidharka Vikas R.
Published: March 2021

Background.

There is no consensus on rabbit antithymocyte globulin (rATG) dose used for induction immunosuppression in pediatric kidney transplants. We aimed to identify whether a lower rATG dose provides safe and effective immunosuppression compared with a higher dose.

Methods.

We retrospectively analyzed all first-time kidney transplant recipients (aged <21 y) in the North American Pediatric Renal Trials and Collaborative Studies registry since 1998 on mycophenolate mofetil– and tacrolimus-based immunosuppression with rATG induction. An a priori cutoff of 7.5 mg/kg cumulative rATG dose was used to identify low (<7.5 mg/kg) and high (≥7.5 mg/kg) exposure groups. Primary outcome was time to first-acute rejection episode. Secondary outcomes included graft function, patient survival, hospitalizations due to infections, and time to first-posttransplant lymphoproliferative disorder episode.

Results.

Four hundred fifty-five patients met inclusion criteria (59% male, 49% whites, 26% blacks, 38% living donor source). Median cumulative rATG dose was 6.8 mg/kg with a median of 5 doses and a median 1.5 mg/kg/dose introduced at a median of postoperative 0 days. Sixty-four percent received <7.5 mg/kg total rATG. There was no difference in age at transplant, gender, race, end-stage renal disease causes, or HLA mismatch among groups. Time to first-acute rejection was similar (P = 0.07). There was no significant difference in graft or patient survival or time to posttransplant lymphoproliferative disorder. Hospitalization for infection rates was similar.

Conclusions.

These data demonstrate a wide variation in cumulative rATG induction dose. A smaller rATG dose <7.5 mg/kg may provide effective and safe immunosuppression compared with a higher dose.
Regional Lymphatic Inclusion in Orthotopic Hindlimb Transplantation: Establishment and Assessment of Feasibility in a Rodent Model
Authors: Lese Ioana , Leclère Franck M. , Gayanayake Thusitha , Taddeo Adriano , Leckenby Jonathan I. , Banz Yara , Constantinescu Mihai A. , Vögelin Esther , Olariu Radu
Published: March 2021

Background.

The lymphatic system may play an important role in local immunomodulation in vascularized composite allotransplantation (VCA). Currently, there is no standardized VCA model that includes the regional draining lymphatic tissue. The aim of this study was to develop a rapid and efficient orthotopic hindlimb transplantation model in rats that included the draining lymphatic basin to permit further evaluation of the lymphatic system’s role in VCA.

Methods.

Thirty transplantations from Brown Norway rats to Lewis rats were performed. To include the regional lymphatic tissue, the superficial epigastric vessels were preserved to allow retrieval of the corresponding inguinal lymph nodes, including the inguinal fat pad, with the hindlimb. A cuff technique was used for the vein, whereas the conventional microsurgical technique was used for the arterial anastomosis. Vascular patency was confirmed through laser Doppler analysis at postoperative day 1 and histological analysis after euthanasia.

Results.

The presence and vascularization of the inguinal lymph nodes were verified with indocyanine green lymphoscintigraphy at the time of transplantation. Mean total ischemia time was 69 ± 24 minutes, and mean recipient operation time was 80 ± 19 minutes. Overall transplant survival rate was 93.3%. Laser Doppler analysis showed vascular (technical) success, indocyanine green lymphoscintigraphy confirmed the presence of lymph nodes and the histological analysis revealed patent anastomoses.

Conclusions.

We successfully developed an experimental orthotopic hindlimb transplantation model in rats that includes the draining inguinal lymphatic basin, which is an important asset in further research on lymphatic tissue and its role in VCA.
Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia
Authors: Joachim Emily , Parajuli Sandesh , Swanson Kurtis J. , Aziz Fahad , Garg Neetika , Mohamed Maha , Mandelbrot Didier , Djamali Arjang
Published: March 2021

Background.

The risk of infection associated with specific treatments of chronic active antibody-mediated rejection (cAMR) after kidney transplantation remains unknown.

Methods.

This was a single-center study of kidney transplant recipients treated with pulse steroids, intravenous immunoglobulin (IVIG) ± rituximab for biopsy-confirmed cAMR. The control group consisted of age- and race-matched patients who underwent donor-specific antibody-based protocol biopsies but had no rejection. We collected data on BK virus (BKV), cytomegalovirus (CMV), urinary tract infection (UTI), and pneumonia postbiopsy.

Results.

There were 49 patients in each group. In those with cAMR, 21 (43%) were treated with steroids, IVIG, and rituximab; the remaining received steroids and IVIG only. The risk of graft failure was greater in the cAMR group [22 (45%) vs. 3 (6%), P < 0.001]. Kaplan-Meier analyses demonstrated a significantly greater risk of pneumonia in the cAMR group (P = 0.02). This was confirmed by multivariable Cox regression analyses [Hazard ratio (HR) = 6.04, P = 0.027, 95% CI, 1.22-29.75]. None of the patients with pneumonia were affected by opportunistic pathogens. Additionally, the risk of CMV, UTI, and BKV was not increased. Rituximab was not independently associated with any of the infections studied.

Conclusions.

Treatment of cAMR, but not rituximab, was associated with a 6-fold increased risk of pneumonia. Additional studies are needed to determine the safety and efficacy of prolonged antimicrobial prophylaxis and monitoring strategies, including for hypogammaglobulinemia, to reduce the risk of pneumonia following the treatment of cAMR.