bluuebunny/crossref_metadata_2025 huggingface dataset:
Engaging older adults as advocates for age-friendly, walkable communities: The Senior Change Makers Pilot Study
Authors: Patch Christina M , Conway Terry L , Kerr Jacqueline , Arredondo Elva M , Levy Susan , Spoon Chad , Butte Katie J , Sannidhi Deepa , Millstein Rachel A , Glorioso Danielle , Jeste Dilip V , Sallis James F
Published: July 2021

As the U.S. population ages, communities must adapt to help older adults thrive. Built environment features, like safe sidewalks and crosswalks, provide the foundation for age- and physical activity-friendly communities. Controlled studies are needed to evaluate advocacy training programs that instruct and support seniors to advocate for more walkable neighborhoods. The Senior Change Makers Pilot Study evaluated an advocacy program that taught seniors to evaluate pedestrian environments using the validated MAPS-Mini audit tool, identify barriers, and advocate for improvements. Participants (n = 50) were recruited from four low-income senior housing sites in San Diego, CA, which were randomly assigned to an 8-week advocacy program or physical activity (PA) comparison intervention. Evaluation included surveys, accelerometers to assess PA, and direct observation. Primary outcomes were seniors’ advocacy confidence and skills. Main analyses used repeated measures ANOVAs. Seniors in the advocacy condition (n = 17) increased their advocacy outcome efficacy (p = .03) and knowledge of resources (p = .04) more than seniors in the PA condition (n = 33). Most seniors in the advocacy condition completed a street audit (84%), submitted an advocacy request (79%), or made an advocacy presentation to city staff (58%). Environmental changes included repairs to sidewalks and crosswalks. City staff approved requests for lighting, curb cuts, and crosswalk markings. Seniors’ accelerometer-measured PA did not significantly increase, but self-reported transportation activity increased in the PA condition (p = .04). This study showed the potential of advocacy training to empower seniors to make communities more age- and activity-friendly.
Making large changes or small changes to prevent weight gain in young adulthood: which is preferred and by whom?
Authors: Hayes Jacqueline F , Tate Deborah F , Espeland Mark A , LaRose Jessica Gokee , Gorin Amy A , Lewis Cora E , Jelalian Elissa , Bahnson Judy , Dunsiger Shira I , Wing Rena R ,   Study of Novel Approaches to Weight Gain Prevention (SNAP) Research Group
Published: July 2021

Knowledge of participant treatment preferences can inform decision-making regarding treatment dissemination and future participant adoption. To compare participant perceptions of two evidence-based approaches for weight gain prevention in young adults to identify the intervention with the greatest likelihood of adoption. As part of a randomized trial (Study of Novel Approaches to Weight Gain Prevention [SNAP]; n = 599) testing weight gain prevention interventions in young adults (18–35 years), individuals assigned to self-regulation interventions using either large changes or small changes reported on perceived personal effectiveness and difficulty of treatment over 3 years. Treatment satisfaction at 2-year follow-up was also reported. Pre-randomization, participants believed the large change intervention would be more personally effective than the small change intervention, although they also considered it more complex. Older age, lower body mass index (p = 0.056), and desire to maintain versus lose weight predicted greater perceived effectiveness of the small change relative to large change intervention. Over follow-up, the large change intervention was no longer perceived as more effective, but perceived effectiveness aligned with assigned treatment. The small change intervention was rated as less complex than the large change intervention at 4 months, but not at other follow-ups. At study conclusion, participants were largely satisfied with both treatments; however, in the small change intervention, individuals who were not successful at preventing weight gain were less satisfied than individuals who were successful. The large and small change interventions are both appropriate for dissemination with no clear advantages based on the participant perceptions.
Adaptive plasticity in plant traits increases time to hydraulic failure under drought in a foundation tree
Authors: Challis Anthea , Blackman Chris , Ahrens Collin , Medlyn Belinda , Rymer Paul , Tissue David
Published: July 2021

The viability of forest trees, in response to climate change-associated drought, will depend on their capacity to survive through genetic adaptation and phenotypic plasticity in drought tolerance traits. Genotypes with enhanced plasticity for drought tolerance (adaptive plasticity) will have a greater ability to persist and delay the onset of hydraulic failure. By examining populations from different climate-origins grown under contrasting soil water availability, we tested for genotype (G), environment (E) and genotype-by-environment (G × E) effects on traits that determine the time it takes for saplings to desiccate from stomatal closure to 88% loss of stem hydraulic conductance (time to hydraulic failure, THF). Specifically, we hypothesized that: (i) THF is dependent on a G × E interaction, with longer THF for warm, dry climate populations in response to chronic water deficit treatment compared with cool, wet populations, and (ii) hydraulic and allometric traits explain the observed patterns in THF. Corymbia calophylla saplings from two populations originating from contrasting climates (warm-dry or cool-wet) were grown under well-watered and chronic soil water deficit treatments in large containers. Hydraulic and allometric traits were measured and then saplings were dried-down to critical levels of drought stress to estimate THF. Significant plasticity was detected in the warm-dry population in response to water-deficit, with enhanced drought tolerance compared with the cool-wet population. Projected leaf area and total plant water storage showed treatment variation, and minimum conductance showed significant population differences driving longer THF in trees from warm-dry origins grown in water-limited conditions. Our findings contribute information on intraspecific variation in key drought traits, including hydraulic and allometric determinants of THF. It highlights the need to quantify adaptive capacity in populations of forest trees in climate change-type drought to improve predictions of forest die-back.
Relation Between Acute Administration of Synthetic Cannabinoids and Induction of Epileptic Seizures
Authors: Nagy Nahla E. , Elhabiby Mahmoud M. , Mohsen Nesreen M. , Ismail Lobna A.B. , Farouk Samar W.
Published: July 2021

Objectives:

Recently, there has been an obvious increase in the synthetic cannabinoid abuse that can cause severe toxicity and major physical and psychological consequences. Here we have assessed the impacts of synthetic cannabinoids intake on induction of seizures and on electroencephalographic activity, allowing for exploration of one of the physical hazards that might associate synthetic cannabinoids use helping for better management.

Methods:

Forty male patients using synthetic cannabinoids and 40 nonusing males were registered in this work. All individuals were determined via a detailed history of substance use and diagnosed according to International Classification of Diseases version 11 as synthetic cannabinoid use disorders, detailed history of seizures from close relatives who witnessed seizure occurrence and its correlation with the last dose of synthetic cannabinoid use and then investigated by long-term electroencephalograph.

Results:

Seizures were considerably more common in the synthetic cannabinoid using group than in the nonusing group, with the main presenting event in the form of the generalized tonic-clonic seizure. Seizures occurred within 15 minutes of intake in 81.8% of patients. Long-term electroencephalography showed electroencephalographic changes in 45% of cases using synthetic cannabinoids that were statistically more significant than in the nonusing group (2.5%), with the most prominent electroencephalographic change in the form of left frontal focus in 22.5% of cases.

Conclusion:

Synthetic cannabinoid usage has been linked to seizure induction and has been shown to alter electroencephalographic activity.
No Benefit of Deriving Cochlear-Implant Maps From Binaural Temporal-Envelope Sensitivity for Speech Perception or Spatial Hearing Under Single-Sided Deafness
Authors: Dirks Coral E. , Nelson Peggy B. , Oxenham Andrew J.
Published: July 2021

Objectives:

This study tested whether speech perception and spatial acuity improved in people with single-sided deafness and a cochlear implant (SSD+CI) when the frequency allocation table (FAT) of the CI was adjusted to optimize frequency-dependent sensitivity to binaural disparities.

Design:

Nine SSD+CI listeners with at least 6 months of CI listening experience participated. Individual experimental FATs were created to best match the frequency-to-place mapping across ears using either sensitivity to binaural temporal-envelope disparities or estimated insertion depth. Spatial localization ability was measured, along with speech perception in spatially collocated or separated noise, first with the clinical FATs and then with the experimental FATs acutely and at 2-month intervals for 6 months. Listeners then returned to the clinical FATs and were retested acutely and after 1 month to control for long-term learning effects.

Results:

The experimental FAT varied between listeners, differing by an average of 0.15 octaves from the clinical FAT. No significant differences in performance were observed in any of the measures between the experimental FAT after 6 months and the clinical FAT one month later, and no clear relationship was found between the size of the frequency-allocation shift and perceptual changes.

Conclusion:

Adjusting the FAT to optimize sensitivity to interaural temporal-envelope disparities did not improve localization or speech perception. The clinical frequency-to-place alignment may already be sufficient, given the inherently poor spectral resolution of CIs. Alternatively, other factors, such as temporal misalignment between the two ears, may need to be addressed before any benefits of spectral alignment can be observed.
Targeted Muscle Reinnervation in Amputees: A Review of Current Techniques
Authors: Fracol Megan E. , Janes Lindsay E. , Jordan Sumanas W. , Dumanian Gregory A. , Ko Jason H.
Published: July 2021

Targeted muscle reinnervation (TMR) is a surgical technique that was initially developed for amputees to improve prosthetic control. TMR reroutes the ends of amputated nerves into more proximal motor nerves supplying residual redundant muscle groups. In doing so, it restores motor signals from the brain that would otherwise be lost by the amputation and allows the redundant muscle to communicate this lost function to a prosthetic device. Although initially developed for functional purposes, TMR has subsequently been shown to treat neuropathic and phantom limb pain. As such, indications for its use have significantly expanded. TMR is now widely performed for both upper and lower extremity amputees, at various amputee levels. While technical roadmaps have been published for many amputation levels, the goal of this paper is to update and summarize all these techniques in one place.
Antigen-based Rapid Diagnostic Testing or Alternatives for Diagnosis of Symptomatic COVID-19
Authors: Kendall Emily A. , Arinaminpathy Nimalan , Sacks Jilian A. , Manabe Yukari C. , Dittrich Sabine , Schumacher Samuel G. , Dowdy David W.
Published: July 2021

Background:

SARS-CoV-2 antigen-detection rapid diagnostic tests can diagnose COVID-19 rapidly and at low cost, but lower sensitivity compared with reverse-transcriptase polymerase chain reaction (PCR) has limited clinical adoption.

Methods:

We compared antigen testing, PCR testing, and clinical judgment alone for diagnosing symptomatic COVID-19 in an outpatient setting (10% COVID-19 prevalence among the patients tested, 3-day PCR turnaround) and a hospital setting (40% prevalence, 24-hour PCR turnaround). We simulated transmission from cases and contacts, and relationships between time, viral burden, transmission, and case detection. We compared diagnostic approaches using a measure of net benefit that incorporated both clinical and public health benefits and harms of the intervention.

Results:

In the outpatient setting, we estimated that using antigen testing instead of PCR to test 200 individuals could be equivalent to preventing all symptomatic transmission from one person with COVID-19 (one “transmission-equivalent”). In a hospital, net benefit analysis favored PCR and testing 25 patients with PCR instead of antigen testing achieved one transmission-equivalent of benefit. In both settings, antigen testing was preferable to PCR if PCR turnaround time exceeded 2 days. Both tests provided greater net benefit than management based on clinical judgment alone unless intervention carried minimal harm and was provided equally regardless of diagnostic approach.

Conclusions:

For diagnosis of symptomatic COVID-19, we estimated that the speed of diagnosis with antigen testing is likely to outweigh its lower accuracy compared with PCR, wherever PCR turnaround time is 2 days or longer. This advantage may be even greater if antigen tests are also less expensive.
Implant Loss and Associated Risk Factors following Implant-based Breast Reconstructions
Authors: Blok Yara L. , van Lierop Evelien , Plat Victor D. , Corion Leonard U.M. , Verduijn Pieter S. , Krekel Nicole M.A.
Published: July 2021

Background:

Implant loss is the most severe complication of implant-based breast reconstructions. This study aimed to evaluate the incidence of implant loss and other complications, identify associated risk factors, and create a risk model for implant loss.

Methods:

This was a retrospective cohort study of all patients who underwent a mastectomy, followed by either a two-stage or a direct-to-implant breast reconstruction. Patient variables, operative characteristics, and postoperative complications were obtained from the patient records. A multivariate mixed-effects logistic regression model was used to create a risk model for implant loss.

Results:

A total of 297 implant-based breast reconstructions were evaluated. Overall, the incidence of implant loss was 11.8%. Six risk factors were significantly associated with implant loss: obesity, a bra cup size larger than C, active smoking status, a nipple-preserving procedure, a direct-to-implant reconstruction, and a lower surgeon’s volume. A risk model for implant loss was created, showing a predicted risk of 8.4%–13% in the presence of one risk factor, 21.9%–32.5% in the presence of two, 47.5%–59.3% in the presence of three, and over 78.2% in the presence of four risk factors.

Conclusions:

The incidence of implant loss in this study was 11.8%. Six associated significant risk factors were identified. Our risk model for implant loss revealed that the predicted risk increased over 78.2% when four risk factors were present. This risk model can be used to better inform patients and decrease the risk of implant loss by optimizing surgery using personalized therapy.
Doctority: Plastic Surgery—An Informative Podcast for Applicants to Learn about Plastic Surgery Training Programs
Authors: Stoehr Jenna R. , Hamidian Jahromi Alireza , Gosain Arun K.
Published: July 2021

The COVID-19 pandemic limited the ability of medical students to participate in plastic surgery sub-internships and to attend residency interviews in person during the 2020–2021 match cycle. A podcast and accompanying online directory were created to introduce integrated plastic surgery residency programs to medical students from the perspective of current residents. Since July 2020, a total of 49 plastic surgery residents representing 42 programs have participated in the podcast. Topics of discussion included program logistics, faculty leadership, and aspects of resident lifestyle of interest to medical students and future residency candidates. The podcast has had a total of 5072 downloads (mean 121 downloads per episode). The majority of listeners (90%) were in the United States. Twenty-five plastic surgery applicants who participated in the 2020–2021 National Resident Matching Program match cycle responded to a feedback survey. Listeners reported that the podcast was useful for preparing for interviews, making rank lists, and learning about programs that they otherwise would not have considered. Most listeners (90%) ranked the podcast as one of their top three resources for learning about plastic surgery programs during the application and interview process. Future directions include completion of episodes for all integrated plastic surgery programs and expansion to other surgical subspecialties and plastic surgery fellowships.
COMBINED CENTRAL RETINAL ARTERIAL AND VENOUS OCCLUSIONS DUE TO LEUKEMIC INFILTRATION
Authors: De La Porte Vincent M. , Lammens Martin , Dekeyzer Sven , Van Lint Michel
Published: July 2021

Purpose:

To report combined central arterial and venous occlusions secondary to bilateral leukemic interfascicular optic nerve infiltration in a 56-year-old man. This was the sole presentation of a relapse in T/myeloid mixed-phenotype acute leukemia after 5 months of remission.

Methods:

Case report with clinical photography.

Results:

A 56-year-old man reported to be in complete remission of T/myeloid mixed-phenotype acute leukemia presented with sudden painless loss of vision in his left eye. Fundoscopy showed unilateral severe optic disk swelling with characteristic findings of a central retinal vein occlusion, namely, intraretinal and preretinal hemorrhages and cotton-wool spots, as well as the features of a central retinal artery occlusion resulting in a pale, edematous retina and a characteristic cherry-red spot. Blood analysis, cerebrospinal fluid evaluation, and bone marrow analysis were performed in combination with medical imaging. No evidence of leukemic relapse was found. An optic nerve biopsy was indicated because of decompensation of the contralateral eye and ultimately confirmed leukemic infiltration.

Conclusion:

Regardless of no hematological and nonspecific imaging findings, optic nerve biopsy may be crucial for clinical decision-making in a patient with acute complete vision loss and a history of leukemia.
Decline in the Incidence of Neonatal Sepsis in Rural Gadchiroli, India During the Twenty-one Years (1998–2019) Following the Home-based Neonatal Care Field-trial
Authors: Bang Abhay , Deshmukh Mahesh , Baitule Sanjay , Duby Jessica
Published: July 2021

Background:

Sepsis is a leading cause of neonatal mortality globally. The home-based neonatal care (HBNC) field trial (1995–1998) in rural Gadchiroli demonstrated a reduction in the incidence of neonatal sepsis. The current study examines the trend of neonatal sepsis during the twenty-one years (1998–2019) following the trial’s completion.

Methods:

We conducted a retrospective cohort study based on the HBNC program data in rural Gadchiroli, India, from April 1998 to March 2019. All live-born neonates who spent all or part of the neonatal period in the 39 study villages and received HBNC were eligible for inclusion. Sepsis was diagnosed during regular home visits by trained village health workers if pre-specified clinical criteria were present. Sepsis incidence was computed for seven 3-year periods. Trend analyses were conducted using the Mann-Kendall test.

Results:

Of the total 17,289 live births, 16,339 (94.5%) home visited were included. In this cohort, 1069 (65 per 1000 live births) neonates were diagnosed with sepsis. The incidence of neonatal sepsis declined from 111 per 1000 live births in 1998 to 2001 to 19 per 1000 live births in 2016 to 2019, an 82.9% decrease (P < 0.0001), mean 4% decrease per year. The incidence of neonatal sepsis declined for early-onset sepsis (P < 0.0001), late-onset sepsis (P < 0.0001), home births (P = 0.006), facility births (P < 0.0001), preterm neonates (P < 0.0001) and full-term neonates (P < 0.0001).

Conclusions:

The incidence of neonatal sepsis in rural Gadchiroli has continued to decline during the past twenty-one years. We hypothesize that the decline is due to the ongoing practice of HBNC, improved socioeconomic conditions, and new governmental health policies.
Antibiotic Therapy of an Infant With a Brevibacterium casei Ventriculoperitoneal Shunt Infection
Authors: Øvsthus Kasper Kavli , Sjåvik Kristin , Lier Tore , Klingenberg Claus
Published: July 2021

We describe a newborn infant with hydrocephalus and a ventriculoperitoneal shunt infection caused by Brevibacterium casei. Essential for correct diagnosis was rapid species identification by matrix-assisted laser desorption/ionization time-of-flight, after initial report of coryneform bacteria. The patient responded well to vancomycin and rifampicin for 15 days. The shunt was not removed. Repeated cerebrospinal fluid cultures up to 4 months after therapy remained negative.
Fulminant Myocardial Involvement in Neonatal Echovirus-induced Sepsis. Two Autopsy Cases
Authors: Callon Domitille , Guedra Aurélien , Lebreil Anne-Laure , Rambaud Caroline , Fornés Paul , Andreoletti Laurent
Published: July 2021

Group-B Enteroviruses, such as Echoviruses, are a common cause of infections in neonates but fatal myocarditis during Echovirus-induced sepsis have been rarely reported. We report on 2 cases of neonatal Echovirus-related sepsis with myocarditis. Fatal cardiorespiratory failure occurred in both cases. Autopsies and thorough histologic and microbiologic investigations evidenced Echoviruses 5- and 11-induced myocarditis as the cause of death.
Chronic Early-Stage Ocular Cicatricial Pemphigoid
Authors: Besagar Sonya , London Ashley O. , Jairam Meghan P. , Trief Danielle , Dagi Glass Lora R.
Published: July 2021

Ocular cicatricial pemphigoid (OCP) represents an insidious, autoimmune-mediated disease of the conjunctiva, initially presenting as chronic conjunctivitis and progressing to fibrosis, cicatrization, and eventually blindness secondary to corneal keratinization. This series reports 3 cases presenting with chronic conjunctivitis lasting an average of 10 years without cicatrix formation, ultimately diagnosed as OCP based on direct immunofluorescence of conjunctival biopsy samples. This chronic conjunctivitis without fibrosis suggests the possibility of an OCP subtype with a prolonged early stage or prodrome prior to cicatrization, which may benefit from early diagnosis and treatment to prevent complications of this disease.
High anti‐TNFα Concentrations Are Not Associated With More Adverse Events in Pediatric Inflammatory Bowel Disease
Authors: Zvuloni Maya , Matar Manar , Levi Rachel , Shouval Dror S. , Shamir Raanan , Assa Amit
Published: July 2021

Anti‐tumor necrosis factor alpha (anti‐TNFα) therapy is commonly used to treat refractory pediatric inflammatory bowel disease (IBD) and carry risks for adverse events. We aimed to assess the relationship between anti‐TNFα trough concentrations and adverse events rate among pediatric patients with IBD. The medical records of pediatric patients with IBD who were treated with anti‐TNFα agents from 2015 to 2020 and had sequential monitoring of trough concentration (TC) were reviewed retrospectively for the presence of adverse events. The study cohort included 135 eligible patients (59 [43.7%] girls, mean age at diagnosis 12.9 [±3] years, 111 [82.2%] Crohn disease) who had 1589 measurements of TCs (1037 [63%] infliximab). During a median follow‐up period of 1.7 years (IQR 1.1–2.7), we recorded 156 adverse events in 50 patients (37%). Higher TCs were not associated with higher rate of anti‐TNFα‐related adverse events whereas these events (excluding increase in liver transaminases) were associated with younger age.
An ESPGHAN Position Paper on the Use of Breath Testing in Paediatric Gastroenterology
Authors: Broekaert Ilse Julia , Borrelli Osvaldo , Dolinsek Jernej , Martin‐de‐Carpi Javier , Mas Emmanuel , Miele Erasmo , Pienar Corina , Ribes‐Koninckx Carmen , Thomassen Rut , Thomson Mike , Tzivinikos Christos , Benninga Marc
Published: July 2021

Objectives:

Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety.

Methods:

Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).

A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.

During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors.

Results:

A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2‐lactose breath testing, H2‐fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro‐caecal transit time (OCTT) or to diagnose and follow‐up on celiac disease.

Conclusions:

Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.
Incidence and Associated Risk Factors for Falls in Older Adults After Elective Total Knee Replacement Surgery
Authors: Hill Anne-Marie , Ross-Adjie Gail , McPhail Steven M. , Jacques, MBiostat Angela , Bulsara Max , Cranfield Alexis , Etherton-Beer Christopher , Azlan, MN Natasya Raja , Powell Sarah-Jayne , Hardisty Gerard , Monterosso Leanne
Published: July 2021

Objective

The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 mos after elective, primary total knee replacement surgery.

Design

A prospective observational cohort of older adults undergoing total knee replacement were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 mos alongside patient reported outcomes (Oxford Knee Score). Analyses used logistic and negative binomial regression modeling.

Results

There were 267 participants (mean age = 70 [6.7] yrs) enrolled. Participants who fell (n = 102 [40.6%]) reported 200 falls in the 12 mos after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 mos after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month 1. Risk factors for falling were a history of falls (adjusted odds ratio = 2.41, 95% confidence interval = 1.35–4.31) and number of central nervous system acting medications taken before surgery (adjusted odds ratio = 1.66, 95% confidence interval = 1.25–2.21). Using a walking aid at baseline was associated with falls after discharge (adjusted incident rate ratio = 2.38, 95% confidence interval = 1.57–3.60).

Conclusions

Older adults experience a high incidence of falls after elective total knee replacement. Further research that investigates falls prevention after total knee replacement is required.
A New Technique of Unilateral Cleft Lip Repair with Scarless Cupid’s Bow Peaks
Authors: Masuoka Hiromu
Published: July 2021

Background:

A novel technique for primary unilateral cleft lip repair with scarless Cupid’s bow peaks is described. This technique focuses on the curvature of the Cupid’s bow and the preservation of the minute three-dimensional structure around the cleft-side peak of the Cupid’s bow, such as the cutaneous roll and white skin roll. This technique has been used in 50 consecutive unilateral cleft lip repairs by a single surgeon.

Methods:

The flap from the lateral lip is expanded into a three-stair flap, including a lateral white lip flap, a cutaneous roll flap, and a quadrangular mucovermilion flap as partial flaps. The cleft-side peak of the Cupid’s bow is made to form a curved peak with the cutaneous roll. The suture lines pass through the lip columellar crease, philtrum ridge, and upper lip groove. These lines are stepwise, just like W-plasty, and do not cross the peak of the Cupid’s bow. Measurements were obtained from three-dimensional photographs, and a visual assessment was performed by standard photographs taken 1 year or later postoperatively with no additional surgery, except for palatoplasty.

Results:

The Noordhoff point was kept as the peak of the Cupid’s bow with no scar. The three-dimensional structure, including the cutaneous roll around the cleft-side peak of the Cupid’s bow, was well maintained.

Conclusion:

The present technique allows for the fashioning of a reliable intended peak of the Cupid’s bow without scarring on its point and preserves the three-dimensional structure, including the cutaneous roll.
Surgical Angiogenesis of Decellularized Nerve Allografts Improves Early Functional Recovery in a Rat Sciatic Nerve Defect Model
Authors: Saffari Tiam M. , Mathot Femke , Friedrich Patricia F. , Bishop Allen T. , Shin Alexander Y.
Published: July 2021

Background:

Surgical angiogenesis applied to nerve grafts has been suggested to enhance nerve regeneration after nerve injury. The authors hypothesized that surgical angiogenesis to decellularized nerve allografts would improve functional recovery in a rat sciatic nerve defect model.

Methods:

Sixty Lewis rats were divided in three groups of 20 animals each. Unilateral sciatic nerve defects were repaired with (1) autografts, (2) decellularized allografts, and (3) decellularized allografts wrapped with a superficial inferior epigastric artery fascial flap to add surgical angiogenesis. Twelve and 16 weeks after surgery, nerve regeneration was assessed using functional, electrophysiologic, histologic, and immunofluorescence analyses. Ultrasonography was used during the survival period to noninvasively evaluate muscle atrophy and reinnervation by measuring cross-sectional muscle area.

Results:

Surgical angiogenesis of allografts demonstrated significantly improved isometric tetanic force recovery at 12 weeks, compared to allograft alone, which normalized between groups at 16 weeks. Cross-sectional muscle areas showed no differences between groups. Electrophysiology showed superiority of autografts at both time points. No differences were found in histologic analysis, besides a significantly inferior N ratio in allografts at 12 weeks. Immunofluorescent expression of CD34, indicating vascularity, was significantly enhanced in the superficial inferior epigastric artery fascial group compared to allografts at 12 weeks, with highest expression at 16 weeks compared to all groups.

Conclusion:

Surgical angiogenesis with an adipofascial flap to the nerve allograft increases vascularity in the nerve graft, with subsequent improvement of early muscle force recovery, comparable to autografts.
SITAgliptin for Depressive Symptoms in Type 2 Diabetes: A Feasibility Randomized Controlled Trial
Authors: Moulton Calum D. , Rokakis Anna S. , Pickup John C. , Young Allan H. , Stahl Daniel , Ismail Khalida
Published: July 2021

Objective

We tested the feasibility of using sitagliptin—a dipeptidyl peptidase-IV inhibitor—for depressive symptoms in type 2 diabetes (T2D).

Methods

In a feasibility, double-blind, randomized controlled trial, we recruited people aged 18 to 75 years with T2D (glycated hemoglobin A1c levels ≥53 and ≤86 mmol/mol prescribed oral hypoglycemic therapy) and comorbid depressive symptoms (Patient Health Questionnaire-9 score ≥10) from family practices in South London. Eligible patients were randomized to sitagliptin 100 mg per day or matched placebo for 12 weeks. The primary feasibility outcomes were participation rates, attrition rates, and adverse events. The primary clinical outcomes were depressive symptoms (Patient Health Questionnaire-9 and 16-item Quick Inventory of Depressive Symptomatology scores) at 12 weeks as assessed using analyses of covariance. Ranges of treatment effects were estimated using Cohen d and associated 95% confidence intervals, where negative values favored sitagliptin over placebo.

Results

Of 153 people screened across 32 practices, 44 were randomized (22 to each arm). The mean (standard deviation) age was 58.8 (8.3) years, 46% were female, and 52% were of non-white ethnicity. Of those treated, 1 patient (4.5%) in each arm withdrew, and there were no group differences in adverse events. Despite improving 12-week glycated hemoglobin A1c (d = −1.19 [95% confidence interval = −1.90 to −0.48), improvement in 12-week Quick Inventory of Depressive Symptomatology score with sitagliptin was inferior to placebo across the range of estimated treatment effects (d = 0.71 [0.13 to 1.30]). Effects of sitagliptin on inflammation were inconsistent (d = −0.32 [−0.81 to 0.17] for high-sensitivity C-reactive protein).

Conclusions

Repositioning of oral hypoglycemic therapy for depressive symptoms in T2D is feasible. However, in this unpowered feasibility study, we did not detect evidence of superiority of sitagliptin over placebo. The results are cautioned by the small sample size and limited treatment duration.

Trial Registration: EudraCT: 2015–004527-32.
Volumetric and Morphological Analysis of Mandibular Condyles of Angle Class 2 and 3 Malocclusion Patients
Authors: Lentzen Max-Philipp , Riekert Maximilian , Buller Johannes , Zirk Matthias , Zöller Joachim E. , Kreppel Matthias
Published: July 2021

This study was conducted to provide diametric and volumetric data of mandibular condyles from patients with Angle class 2 and 3 malocclusions by semiautomatic segmentation based upon cone-beam computed tomography.

Cone-beam computed tomography images of 79 patients were analyzed. By using the open-source software “ITK-SNAP”, diametric and volumetric measurements of 158 mandibular condyles were performed. Descriptive statistics were calculated for all normally distributed variables. Correlations between patients with Angle class 2 and 3 were calculated with the independent Student t test.PvaluesP < 0.05 were considered significant.

Irrespective of the side, patients with class 2 malocclusion showed smaller mandibular condyles (right: 1.128 ± 0.504 cm3; left: 1.222 ± 0.596 cm3) than patients with class 3 (right: 1.504 ± 0.361 cm3; left: 1.493 ± 0.335 cm3). These results were reproducible also in accordance with the diametric measurement (class 2 right: 16.75 ± 2.72 mm; left: 17.04 ± 3.01 mm) (class 3 right: 18.24 ± 2.54 mm; left: 18.32 ± 2.13 mm). However, volumetric differences were highly statistically significant (right:P = 0.001; left:P = 0.018) while diametric differences were slightly significant for the right and not significant for the left side (right:P = 0.042; left:P = 0.053).

Diametric and volumetric analyses offer important additional information based on 3D images of cone-beam computed tomography technology. Significant differences in diameter and volume of mandibular condyles could be assessed between different classes of malocclusion.
Biomechanical Examination of Osseointegration of Titanium Implants Placed Simultaneously With Allogeneic Bone Transfer
Authors: Acikan Izzet , Dundar Serkan
Published: July 2021

The aim of this study was to conduct a biomechanical analysis of the early period bone-implant connection of titanium implants in the same type of subjects. In this study, 18 Sprague Dawley rats were used. Four rats were killed to provide the allogeneic bone before the experiment, and the remaining were divided into a control group and an experimental allogeneic bone transfer group. Titanium machined surfaced implants were integrated in tibias in the controls and in the experimental group; simultaneously, implants were integrated into allogeneic bone in the bone transfer group. All the rats were sacrificed 14 days later. Bone tissues with titanium implants were removed for biomechanical analysis, which found that the resistance to force of the control group and the allogeneic graft group was 2.04 and 2.00 Newtons, respectively, and there was no significant difference between the two groups at 14 days, although numerically a higher figure was detected in the controls (P > 0.05). It was concluded, within the limitations of this study, that an allogeneic bone transfer can be used as an alternative to an autogenous graft.
Effect of Premature Tube Extrusion for Simple Congenital Nasolacrimal Duct Obstruction: A Comparison of Monocanalicular and Bicanalicular Intubation
Authors: Dryden Stephen C. , Meador Andrew G. , Awh Caroline , Smith Barbara D. , Eder Adrianna E. , Bohn Shiva N. , Hoehn Mary E. , Fowler Brian , Fleming James C.
Published: July 2021

The objective of this article is to compare the incidence of premature dislocation of silicone tubes and the effect on treatment success between monocanalicular (MCI) and bicanalicular (BCI) intubation in pediatric patients with simple congenital nasolacrimal duct obstruction. Retrospective comparative case series of 108 eyes of 78 pediatric patients with simple congenital nasolacrimal duct obstruction who underwent probing with either BCI (n = 38 eyes) or MCI (n = 70 eyes) from 2017 to 2020. Premature tube extrusion was defined as any tube removed prior to the 3 month postoperative appointment. Success was defined as resolution of tearing 3 months post tube removal. Ages ranged from 10 months to 5.35 years (mean, 1.95 years; Standard deviation (SD), 0.91). Premature tube extrusion occurred in 15 eyes with BCI and 29 eyes with MCI. Success rates were not significantly different regardless of intubation type between the planned tube removal (90.6%) and the premature tube extrusion cohorts (84.1%), P = 0.89. There was no significant difference in treatment success between the planned tube removal (92.7% MCI, 87% BCI) and the premature tube extrusion cohorts (86.2% MCI, 80% BCI). Complications included 2 infections (1 MCI, 1 BCI) and 2 cases of tube related keratopathy (1 MCI, 1 BCI) that all resolved with tube removal. There were 2 BCI patients that presented to the emergency department for premature tube extrusion. Silicone intubation regardless of stent type is an effective treatment for simple congenital nasolacrimal duct obstruction. There was no significant difference in treatment success between tubes that extrude prematurely, and tubes removed at term based on type of intubation.
Early Allograft Dysfunction and Complications in DCD Liver Transplantation: Expert Consensus Statements From the International Liver Transplantation Society
Authors: Quintini Cristiano , Muiesan Paolo , Detry Olivier , Gastaca Mikel , de Jonge Jeroen , Clavien Pierre-Alain , Del Prete Luca , Fondevila Constantino
Published: July 2021

Livers for transplantation from donation after circulatory death donors are relatively more prone to early and ongoing alterations in graft function that might ultimately lead to graft loss and even patient death. In consideration of this fact, this working group of the International Liver Transplantation Society has performed a critical evaluation of the medical literature to create a set of statements regarding the assessment of early allograft function/dysfunction and complications arising in the setting of donation after circulatory death liver transplantation.
Belnapia mucosa sp. nov. and Belnapia arida sp. nov., isolated from desert biocrust
Authors: Molina-Menor Esther , Vidal-Verdú Àngela , Satari Leila , Calonge-García Alba , Pascual Javier , Peretó Juli , Porcar Manuel
Published: July 2021

Two novel Gram-staining-negative, aerobic, cocci-shaped, non-motile, non-spore forming, pink-pigmented bacteria designated strains T6T and T18T, were isolated from a biocrust (biological soil crust) sample from the vicinity of the Tabernas Desert (Spain). Both strains were catalase-positive and oxidase-negative, and grew under mesophilic, neutrophilic and non-halophilic conditions. According to the 16S rRNA gene sequences, strains T6T and T18T showed similarities with

Belnapia rosea

CGMCC 1.10758T and

Belnapia moabensis

CP2CT (98.11 and 98.55% gene sequence similarity, respectively). The DNA G+C content was 69.80 and 68.96% for strains T6T and T18T, respectively; the average nucleotide identity by blast (ANIb) and digital DNA–DNA hybridization (dDDH) values confirmed their adscription to two novel species within the genus

Belnapia

. The predominant fatty acids were summed feature 8 (C18 : 1ω7c/C18 : 1ω6c), C16 : 0, C18 : 1 2-OH and summed feature 3 (C16 : 1ω7c/C16 : 1ω6c). According to he results of the polyphasic study, strains T6T and T18T represent two novel species in the genus

Belnapia

(which currently includes only three species), for which names Belnapia mucosa sp. nov. (type strain T6T = CECT 30228T=DSM 112073T) and Belnapia arida sp. nov. (type strain T18T=CECT 30229T=DSM 112074T) are proposed, respectively.
Chryseobacterium pennae sp. nov., isolated from poultry feather waste
Authors: Nde Adeline Lum , Charimba George , Hitzeroth Arina , Oosthuizen Lize , Steyn Laurinda , Newman Jeffrey D. , Hugo Celia
Published: July 2021

A Gram-stain-negative, rod-shaped, non-motile, non-spore-forming, aerobic, yellow-pigmented bacterium was isolated from chicken feather waste collected from an abattoir in Bloemfontein, South Africa. A polyphasic taxonomy study was used to describe and name the bacterial isolate, strain 1_F178T. The 16S rRNA gene sequence analysis and sequence comparison data indicated that strain 1_F178T was a member of the genus

Chryseobacterium

and was closely related to

Chryseobacterium jejuense

(99.1%) and

Chryseobacterium nakagawai

(98.7%). Overall genome similarity metrics (average nucleotide identity, digital DNA–DNA hybridization and average amino acid identity) revealed greatest similarity to the

C. jejuense

and

C. nakagawai

type strains but were below the threshold for species delineation. Genome sequencing revealed a genome size of 6.18 Mbp and a G+C content of 35.6 mol%. The major respiratory quinone and most abundant polar lipid of strain 1_F178T were menaquinone-6 and phosphatidylethanolamine, respectively. Strain 1_F178T had a typical fatty acid composition for

Chryseobacterium

species. On the basis of physiological, genotypic, phylogenetic and chemotaxonomic data, strain 1_F178T constitutes a novel species of

Chryseobacterium

, for which the name Chryseobacterium pennae sp. nov. is proposed. The type strain is 1_F178T (=LMG 30779T=KCTC 62759T).
High prevalence of tryptophan-truncated S quasispecies in treatment-naïve chronic hepatitis B patients
Authors: Dong Hui , Zhu Yongqiang , Shen Yan , Xie Shaoqing , He Yungang , Lu Lungen
Published: July 2021

Hepatitis B virus surface antigen (HBsAg) encoded by the S gene is highly expressed during the replication cycle of hepatitis B virus (HBV). However, the frequent usage of tryptophan in HBsAg, which leads to a high cost of biosynthesis, is inconsistent with the high expression level of this protein. Tryptophan-truncated mutation of HBsAg, that is, a tryptophan to stop codon mutation resulting in truncated HBsAg, might help to maintain its high expression with lower biosynthetic cost. We aimed to investigate the prevalence of tryptophan-truncated S quasispecies in treatment-naïve patients with chronic hepatitis B (CHB) by applying CirSeq as well as a site-by-site algorithm developed by us to identify variants at extremely low frequencies in the carboxyl terminus of HBsAg. A total of 730 mutations were identified in 27 patients with CHB, varying from seven to 56 mutations per sample. The number of synonymous mutations was much higher than that of nonsynonymous mutations in the reverse transcriptase (RT) coding region and vice versa in the S coding region, implying that the evolutionary constraints on the RT and S genes might be different. We showed that 25 (92.6 %) of 27 patients had at least one S-truncated mutation, most of which were derived from tryptophan, indicating a high prevalence of tryptophan-truncated S mutations in treatment-naïve patients with CHB. In terms of the RT gene, 21 (77.8 %) patients had pre-existing drug-resistant mutations, while no truncated mutations were detected. Our findings that tryptophan-truncated S quasispecies and drug-resistant RT mutants were highly prevalent in treatment-naïve patients with CHB provide new insights into the composition of the HBV population, which might help optimize the treatment and management of patients with CHB.
School Teaching Posture Correlates with COVID-19 Disease Outcomes in Ohio
Authors: Ehman Cheyenne , Luo Yixuan , Yang Zi , Zhu Ziyan , Donovan Sara , Avery Annika J. , Wang Jiayi , Lawler James , Nugent Rebecca , Ventura Valerie , Lakdawala Seema S.
Published: July 2021

At the start of the COVID-19 pandemic, most US K-12 schools shutdown and millions of students began remote learning. By September 2020, little guidance had been provided to school districts to inform fall teaching. This indecision led to a variety of teaching postures within a given state. In this report we examine Ohio school districts in-depth, to address whether on-premises teaching impacted COVID-19 disease outcomes in that community. We observed that counties with on-premises teaching had more cumulative deaths at the end of fall semester than counties with predominantly online teaching. To provide a measure of disease progression, we developed an observational disease model and examined multiple possible confounders, such as population size, mobility, and demographics. Examination of micropolitan counties revealed that the progression of COVID-19 disease was faster during the fall semester in counties with predominantly on-premises teaching. The relationship between increased disease prevalence in counties with on-premises teaching was not related to deaths at the start of the fall semester, population size, or the mobility within that county. This research addresses the critical question whether on-premises schooling can impact the spread of epidemic and pandemic viruses and will help inform future public policy decisions on school openings.
Access to COVID-19 Vaccines in High-, Middle-, and Low-Income Countries Hosting Clinical Trials
Authors: Ramachandran Reshma , Ross Joseph S. , Miller Jennifer E.
Published: July 2021

The COVID-19 pandemic has led to the rapid development of multiple vaccines, vaccines that were tested in clinical trials located in several countries around the world. Because prior research has shown that pharmaceuticals do not receive consistent and timely authorization for use in lower-income countries where they are tested, we conducted a cross-sectional study examining the authorization or approval and delivery for COVID-19 vaccines recommended by the World Health Organization (WHO) in the countries where they were tested. While countries of varying incomes have largely authorized the COVID-19 vaccines tested within their populations for use, high-income countries have received proportionately more doses, enabling them to more fully vaccinate their populations. As many lower-income countries continue to experience inequitable shortfalls in COVID-19 vaccine supply amid the ongoing pandemic, efforts must be undertaken to ensure timely access in countries across all income groups, including those hosting clinical trials.