bluuebunny/crossref_metadata_2025 huggingface dataset:
Combining multiple fluorescence imaging techniques in biology: when one microscope is not enough
Authors: Hobson Chad M. , Aaron Jesse S.
Published: May 2022

While fluorescence microscopy has proven to be an exceedingly useful tool in bioscience, it is difficult to offer simultaneous high resolution, fast speed, large volume, and good biocompatibility in a single imaging technique. Thus, when determining the image data required to quantitatively test a complex biological hypothesis, it often becomes evident that multiple imaging techniques are necessary. Recent years have seen an explosion in development of novel fluorescence microscopy techniques, each of which features a unique suite of capabilities. In this Technical Perspective, we highlight recent studies to illustrate the benefits, and often the necessity, of combining multiple fluorescence microscopy modalities. We provide guidance in choosing optimal technique combinations to effectively address a biological question. Ultimately, we aim to promote a more well-rounded approach in designing fluorescence microscopy experiments, leading to more robust quantitative insight.
De novo programming: establishment of epigenome in mammalian oocytes
Authors: Qian Jingjing , Guo Fan
Published: May 2022

Innovations in ultrasensitive and single-cell measurements enable us to study layers of genome regulation in view of cellular and regulatory heterogeneity. Genome-scale mapping allows to evaluate epigenetic features and dynamics in different genomic contexts, including genebodies, CpG islands, imprinting control regions, promoters, partially methylated domains, and repetitive elements. The epigenome of early embryos, fetal germ cells, and sperms has been extensively studied for the past decade, whereas oocytes remain less clear. Emerging evidence now supports the notion that transcription and chromatin accessibility precede de novo DNA methylation in both human and mouse oocytes. Recent studies have also started to chart correlations among different histone modifications and DNA methylation. We discuss the potential mechanistic hierarchy that shapes the oocyte DNA methylome, also providing insights into the convergent and divergent features between humans and mice.
Ppan is essential for preimplantation development in mice
Authors: Tian Qing , Tian Yu , He Ximiao , Yin Ying , Zhou Li-quan
Published: May 2022

PETER PAN (PPAN), located to nucleoli and mitochondria, is a member of the Brix domain protein family, involved in rRNA processing through its rRNA binding motif and mitochondrial apoptosis by protecting mitochondria structure and suppressing basal autophagic flux. Ppan is important for cell proliferation and viability, and mutation of Ppan in Drosophila caused larval lethality and oogenesis failure. Yet, its role in mammalian reproduction remains unclear. In this study, we explored the function of Ppan in oocyte maturation and early embryogenesis using conditional knockout mouse model. Deficiency of maternal Ppan significantly downregulated the expression level of 5.8S rRNA, 18S rRNA, and 28S rRNA, though it had no effect on oocyte maturation or preimplantation embryo development. However, depletion of both maternal and zygotic Ppan blocked embryonic development at morula stage. Similar phenotype was obtained when only zygotic Ppan was depleted. We further identified no DNA binding activity of PPAN in mouse embryonic stem cells, and depletion of Ppan had minimum impact on transcriptome but decreased expression of 5.8S rRNA, 18S rRNA, and 28S rRNA nevertheless. Our findings demonstrate that Ppan is indispensable for early embryogenesis in mice.
Publishing While Female: are Women Held to Higher Standards? Evidence from Peer Review
Authors: Hengel Erin
Published: May 2022

Female authors are under-represented in top economics journals. In this paper, I investigate whether higher writing standards contribute to the problem. I find that (i) female-authored papers are 1%–6% better written than equivalent papers by men; (ii) the gap widens during peer review; (iii) women improve their writing as they publish more papers (but men do not); (iv) female-authored papers take longer under review. Using a subjective expected utility framework, I argue that higher writing standards for women are consistent with these stylised facts. A counterfactual analysis suggests that senior female economists may, as a result, write at least 5% more clearly than they otherwise would. As a final exercise, I show tentative evidence that women adapt to biased treatment in ways that may disguise it as voluntary choice.
Identifying the Caenorhabditis elegans vulval transcriptome
Authors: Zhang Qi , Hrach Heather , Mangone Marco , Reiner David J
Published: May 2022

Development of the Caenorhabditis elegans vulva is a classic model of organogenesis. This system, which starts with 6 equipotent cells, encompasses diverse types of developmental event, including developmental competence, multiple signaling events to control precise and faithful patterning of three cell fates, execution and proliferation of specific cell lineages, and a series of sophisticated morphogenetic events. Early events have been subjected to extensive mutational and genetic investigations and later events to cell biological analyses. We infer the existence of dramatically changing profiles of gene expression that accompanies the observed changes in development. Yet, except from serendipitous discovery of several transcription factors expressed in dynamic patterns in vulval lineages, our knowledge of the transcriptomic landscape during vulval development is minimal. This study describes the composition of a vulva-specific transcriptome. We used tissue-specific harvesting of mRNAs via immunoprecipitation of epitope-tagged poly(A) binding protein, PAB-1, heterologously expressed by a promoter known to express GFP in vulval cells throughout their development. The identified transcriptome was small but tightly interconnected. From this data set, we identified several genes with identified functions in development of the vulva and validated more with promoter-GFP reporters of expression. For one target, lag-1, promoter-GFP expression was limited but a fluorescent tag of the endogenous protein revealed extensive expression. Thus, we have identified a transcriptome of C. elegans vulval lineages as a launching pad for exploration of functions of these genes in organogenesis.
Forest-Wide Longleaf Pine Restoration Response to Varying Future Management Intensities in a Transitioning Upland Forest
Authors: Matusick George , Hudson Stephen J , Garrett Caleb Z , Kent James D , Parker James M
Published: May 2022

Many public land management programs in the southeastern United States have been restoring the longleaf pine forest for more than 20 years, which includes intensive treatment with fire, thinning, chemical control of competition, and tree planting. A shift to more passive management (prescribed burning alone) is anticipated once a critical level of longleaf pine has been established. It remains unclear whether this longleaf pine threshold has been reached and whether intensive management should continue at Fort Benning, Georgia. Using the Landis-II forest landscape model, changes in tree species and forest types were estimated from 2017 to 2117 under four forest management scenarios, ranging from passive (“burn only”) to intensive (“proactive”). The desired future condition includes 75% of upland forest dominated by longleaf pine (>49.5% composition). The proactive scenario resulted in the desired future forest condition, whereas reactive and passive scenarios did not. These results suggest a critical threshold of longleaf pine forest has not been reached at Fort Benning and therefore intensive management approaches are still required. This study shows that even well-established populations of longleaf pine on public lands require maintenance and continued intensive restoration to reach desired forest-wide conditions.
Controlling an Invasive Tree with a Native Fungus: InoculatingAilanthus altissima(Tree-of-Heaven) withVerticillium nonalfalfaein Highly Disturbed Appalachian Forests of Ohio
Authors: Pile Knapp Lauren S , Rebbeck Joanne , Hutchinson Todd , Fraser Jacob , Pinchot Cornelia C
Published: May 2022

Highly disturbed forests are commonplace throughout the eastern United States and their residing composition and structure is reflective of their past land use. Management and restoration efforts are complicated by diverse and abundant nonnative invasive plants, including Ailanthus altissima. Verticillium nonalfalfae has been identified as a potential native mycoherbicide option for Ailanthus. To test the efficacy of Verticillium on Ailanthus we designed a study in highly disturbed forests of southern Ohio. At each of five sites, we monitored symptomology, mortality, and rate of spread of stem-inoculated Verticillium on Ailanthus in four inoculated plots and compared it to a control plot. We also monitored native plants for Verticillium symptomology and community responses to Ailanthus control. Our results suggest that Verticillium is an effective tool for controlling Ailanthus with no observed effect on native flora. Further, Verticillium naturally spreads through stands and mortality is slow enough that other resident nonnative invasive plants do not rapidly increase.
The Reception House: A New Space for Managing Infectious Disease ‘Contacts’
Authors: Mooney Graham
Published: May 2022

The COVID-19 pandemic is revealing the many ways in which infectious disease control is a spatialized enterprise. Stay-at-home orders, travel bans and travel corridors, restrictions on visiting patients in hospitals, and many more regulations, speak to the power of space and place in conditioning the transmission of infectious diseases and the human experiences of them. Such spatializations have an extremely long history but were codified and formalized in the later nineteenth century as knowledge of bacteria, incubation periods, and asymptomatic carriers became more sophisticated. Two developments reflected this in Great Britain. First, the new use of the term ‘contact’ as a noun and the naming of ‘contacts’ as a specific population group. Second, the emergence of the ‘reception house’, a building for people living in overcrowded dwellings who had been exposed to people with infectious diseases but who were not yet showing signs of disease. Drawing on recent scholarship at the boundary of medical history, architectural history and the histories of biopolitics, this paper uses public health reports, architectural plans, and newspapers to reveal the multiple ambiguities of these spaces, where the uncertainties of bacteriological science, the demands of the capitalist labour system, and the rationales of liberal governance coalesced.
Systemic chronic diseases coexist with and affect locomotive syndrome: The Nagahama Study
Authors: Morita Yugo , Ito Hiromu , Kawaguchi Shuji , Nishitani Kohei , Nakamura Shinichiro , Kuriyama Shinichi , Ikezoe Tome , Tsuboyama Tadao , Ichihashi Noriaki , Tabara Yasuharu , Matsuda Fumihiko , Matsuda Shuichi
Published: May 2022

Objectives

The concept of locomotive syndrome was proposed to highlight older adults who require nursing care services due to the malfunctioning of their locomotive organs. With the coming of a super-ageing society, there is a growing need to understand the relation between systemic chronic diseases and locomotive syndrome.

Methods

We analysed the second-visit dataset of the Nagahama Study. The association analysis was performed to identify the chronic diseases that were risk factors associated with the occurrence and the progression of locomotive syndrome in both the cross-sectional and longitudinal studies.

Results

Hypertension, stroke, coronary heart disease, rheumatoid arthritis, chronic renal failure, osteoporosis, anaemia, and gastroesophageal reflux disease were independently correlated with locomotive syndrome through the deterioration of body pain, social activity, and cognitive function in the cross-sectional study. Multiple chronic diseases had additive effects and significantly increased the risk of locomotive syndrome. In the longitudinal study, osteoporosis and kidney disease were significantly correlated with the worsening of the total GLFS-25 score.

Conclusions

Locomotive syndrome coexisted with various systemic chronic diseases, especially cardiovascular diseases. Osteoporosis and kidney disease were significantly correlated with the progression of locomotive dysfunction. The management of various chronic diseases may be useful to prevent locomotive syndrome and vice versa.
Evaluating the diagnostic validity of the cerebellar cognitive affective syndrome (CCAS) in pediatric posterior fossa tumor patients
Authors: Hoffmann-Lamplmair Doris , Leiss Ulrike , Peyrl Andreas , Slavc Irene , Czech Thomas , Gram Alexandra , Pletschko Thomas
Published: May 2022

Background

The aim of this case-control study was to investigate the severity of the cerebellar cognitive affective syndrome (CCAS) in patients treated for pediatric posterior fossa tumors (PFT) and evaluate its diagnostic validity and predictive value for long-term effects.

Methods

Using neuropsychological test data from 56 patients with PFT (average age: 14 years), the severity of deficits in the CCAS core areas (executive functions, verbal functions, visuospatial abilities and emotions/behaviour) was examined. Neuropsychological and academic long-term outcomes of patients with CCAS were compared to two control groups of PFT patients (treated with either surgery or surgery followed by radio-/chemotherapy) without the syndrome. Risk factors associated with various deficits were considered.

Results

All but one PFT patient suffered from slight to severe impairments in at least one CCAS domain, while complete CCAS occurred in 35.7%. Seven years after tumor diagnosis CCAS patients performed worse in information processing, logical reasoning, verbal functions, visuospatial skills, and executive functioning and required more special educational support compared to the control groups. CCAS patients performed equally poor as patients treated with chemo-/radiotherapy in tasks measuring information processing speed. Risk factors were significantly associated with deficits in information processing speed but not CCAS emergence.

Conclusions

Deficits in the core CCAS domains are commonly found in PFT patients, but varying in severity, which suggests the syndrome to be continuous rather than dichotomous. However, the validity of CCAS diagnosis was low and unspecific. The exclusion of relevant functions typically impaired in PFT patients (eg, information processing) resulted in difficulties being overlooked.
Experience with telemedicine amongst rheumatology clinicians during the COVID-19 pandemic: an international survey
Authors: Chock Yu Pei Eugenia , Putman Michael , Conway Richard , Danila Maria I , Hoyer Bimba , Hsieh Evelyn , Jayatilleke Arundathi , Kilian Adam , Leipe Jan , Liew Jean W , Machado Pedro M , Robinson Philip C , Singh Namrata , Ung Natasha , Yeoh Su-Ann , Wallace Zachary S , Grainger Rebecca , Cappelli Laura C
Published: May 2022

Objective

To assess rheumatology clinicians’ perceptions of telemedicine as well as their experiences before and during the COVID-19 pandemic.

Methods

We conducted a cross-sectional online survey and collected responses from rheumatology clinicians worldwide between November 2020 and February 2021, regarding use and perceptions of telemedicine in rheumatology. We summarized data with descriptive statistics and qualitative analysis for free-text responses.

Results

The survey was completed by 349 rheumatology clinicians from 49 countries; 59% were female and one-third were 30–50 years old. Academic affiliations were held by 55% of participants and 44% were from North America. Prior to the pandemic, 24% of participants had experience with telemedicine, while about three-quarters used telemedicine for the first time during the pandemic. Overall, 56% thought they provided less adequate care with telemedicine. More than half of clinicians felt that telemedicine was adequate for evaluating crystalline arthritis, inflammatory arthritis, and lupus flares. Telemedicine was felt to be inadequate for flares of myositis, vasculitis, and scleroderma. Technical problems were reported in 29% of telemedicine encounters and were most commonly related to patient-encountered difficulties.

Conclusion

. Most rheumatology clinicians used telemedicine for the first time during the pandemic. The quality of care provided was thought to be inferior to that provided in-person for specific clinical situations. Additional efforts are needed to address barriers to effective telemedicine such as patient-related technology issues, challenges with building rapport, and performing a physical examination and to define the appropriate scope of clinical scenarios conducive to telemedicine.
Central sleep apnea: pathophysiologic classification
Authors: Javaheri Shahrokh , Badr M Safwan
Published: May 2022

Central sleep apnea is not a single disorder; it can present as an isolated disorder or as a part of other clinical syndromes. In some conditions, such as heart failure, central apneic events are due to transient inhibition of ventilatory motor output during sleep, owing to the overlapping influences of sleep and hypocapnia. Specifically, the sleep state is associated with removal of wakefulness drive to breathe; thus, rendering ventilatory motor output dependent on the metabolic ventilatory control system, principally PaCO2. Accordingly, central apnea occurs when PaCO2 is reduced below the “apneic threshold”. Our understanding of the pathophysiology of central sleep apnea has evolved appreciably over the past decade; accordingly, in disorders such as heart failure, central apnea is viewed as a form of breathing instability, manifesting as recurrent cycles of apnea/hypopnea, alternating with hyperpnea. In other words, ventilatory control operates as a negative—feedback closed-loop system to maintain homeostasis of blood gas tensions within a relatively narrow physiologic range, principally PaCO2. Therefore, many authors have adopted the engineering concept of “loop gain” (LG) as a measure of ventilatory instability and susceptibility to central apnea. Increased LG promotes breathing instabilities in a number of medical disorders. In some other conditions, such as with use of opioids, central apnea occurs due to inhibition of rhythm generation within the brainstem. This review will address the pathogenesis, pathophysiologic classification, and the multitude of clinical conditions that are associated with central apnea, and highlight areas of uncertainty.
Impacts of added roughage on growth performance, digestibility, ruminal fermentation, and ruminal pH of feedlot steers fed wheat-based feedlot diets containing 30% modified distillers grains with solubles
Authors: Pickinpaugh Wayde J , Neville Bryan W , Moore Rebecca L , Caton Joel S
Published: May 2022

Two experiments were conducted to evaluate the inclusion rate roughage in wheat-based diets containing modified distillers grains with solubles (MDGS) on feedlot performance (Feedlot Experiment), as well as digestibility, ruminal pH, and ruminal fermentation characteristics (Digestibility Experiment). The feedlot experiment utilized 72 Angus steers (392 ± 46.3 kg initial body weight) which were randomly assigned to 1 of 12 pens, 3 pens per treatment, to evaluate feedlot performance and carcass characteristics. Dietary treatments were 1) control; 10% roughage, 2) 12% roughage, 3) 14% roughage, and 4) 16% roughage. The digestibility experiment used four ruminally and duodenally cannulated steers (393 ± 33.0 kg) in a 4 × 4 Latin Square with either 10%, 12%, 14%, or 16% roughage as in the feedlot experiment. However, dietary roughage source was different between these two experiments and included a combination of grass hay and wheat straw (Feedlot Experiment), and corn silage (Digestibility Experiment). All data were analyzed with the Mixed Procedures of SAS. Feed intake was recorded, with duodenal and fecal output calculated using chromic oxide. Ruminal pH and fermentation were assessed. Growth performance and most carcass characteristics were not affected by increasing roughage (P ≥ 0.11). Marbling tended to decrease linearly (P = 0.10) with increasing roughage inclusion. Increasing dietary roughage content had no effect on organic matter intake (P = 0.60) in the digestibility experiment. Intake, duodenal flow, and digestibility of neutral detergent fiber and acid detergent fiber were not affected by treatment (P ≥ 0.16). Ruminal pH increased linearly (P < 0.01) as rate of roughage inclusion increased. Ruminal concentrations of acetate and butyrate increased, and propionate decreased in a linear fashion (P < 0.01) thereby increasing (P < 0.01) acetate and butyrate to propionate ratio with increasing dietary roughage. Our data indicate that increasing roughage inclusion in wheat-based diets including 30% MDGS increased ruminal pH and shifted ruminal fermentation patterns. Additionally, increasing roughage inclusion did not affect feedlot performance in steers fed wheat at 36% to 42% of dietary dry matter in combination with 30% MDGS.
Repair of the ulnar collateral ligament: a review of current trends and outcomes
Authors: MacKenzie James S. , Osbahr Daryl C.
Published: May 2022

Diagnosis and surgical treatment of elbow ulnar collateral ligament (UCL) injury is becoming more common. A thorough understanding of nonsurgical and surgical options for this injury is required for successful treatment. Gold standard treatment remains ligamentous reconstruction with autograft in the elite throwing athlete. However, advances in surgical technique, technology, and a better understanding of the pathoanatomy of the injury has renewed interest in primary repair of the UCL. Recent literature has shown encouraging results with primary repair and with augmented primary repair, especially over the past 5 yr. This review describes the recent trends and outcomes of UCL repair so that surgeons can have a better understanding of surgical options.
Reliability of the lateral femoral wall thickness for detecting the potential for treatment failure and implant choice in patients with trochanteric hip fractures: a prospective cohort study
Authors: Selim Amr , Seoudi Nabil , Algeaidy Ibrahim Taha , Barakat Ahmed Samir
Published: May 2022

Background:

Trochanteric hip fractures represent one of the most challenging injuries in orthopaedic practice. Dynamic hip screw (DHS) remains the gold standard in management of these fractures. Lateral femoral wall thickness (LWT) is an evolving parameter for detecting the potential for lateral wall fracture. The aim of this study was to determine the mean and cutoff levels for LWT that warrant lateral wall fracture and its various implications.

Methods:

This prospective cohort study included 42 patients with trochanteric hip fractures treated with DHS. LWT was assessed in all patients preoperatively. Patients were divided into two groups according to the postoperative integrity of the lateral femoral wall; in group A the patients sustained a lateral femoral wall fracture, and in group B the lateral femoral wall remained intact. All patients were regularly followed up for 12 mo.

Results:

At 12 mo, 12% of patients suffered postoperative lateral wall fracture, while in 88% the lateral femoral wall remained intact. The mean LWT in group A was 18.04 mm compared to 26.22 mm in group B. Revision surgery was 40% in group A and 5% in group B. The cutoff point of LWT below which there is a high chance of postoperative lateral wall fracture when fixed with DHS was 19.6 mm.

Conclusions:

Preoperative measurement of LWT in elderly patients with trochanteric hip fractures is decisive. The cutoff point for postoperative lateral wall fracture according to this study was 19.6 mm; hence, intramedullary fixation should be considered in this situation.

Level of Evidence:

Level II.
Media Depiction of Birth Differences of the Upper Extremity: Accuracy of Shared Diagnoses
Authors: Frantz Lisa M. , Wall Lindley B. , Goldfarb Charles A.
Published: May 2022

Background:

To assess the diagnostic accuracy of public representation of congenital differences of the upper extremities. We hypothesized that there is an over-diagnosis of certain diagnoses such as amniotic constriction band and under-diagnosis of others such as symbrachydactyly and radial deficiency.

Methods:

Publicly shared images and associated diagnoses were searched on publicly available news media and social media accounts published from October 2018 through November 2021 using key terms such as “amniotic band syndrome,” “congenital arm amputation,” and “3D prosthetic arm” as well as The Lucky Fin Project account on Instagram. The images were collected and reviewed by 2 congenital hand surgeons. The surgeons’ diagnoses were then compared to the reported diagnoses associated with each image to assess accuracy.

Results:

A total of 100 images were collected with the reported diagnosis associated with each image. Two images were removed due to evidence of prior surgery. The hand surgeons’ diagnosis disagreed with the reported diagnosis in 60 of 98 (61%) images. Of those 60 inaccurate diagnoses, 2/3 were reported as amniotic constriction band.

Conclusions:

Media and social media depictions of congenital upper extremity differences are frequently inaccurate, and our search demonstrated that the amniotic constriction band is the most commonly reported, inaccurate diagnosis. Accuracy of diagnosis in public media is important given the impact a diagnosis has on those viewing and sharing the images.

Level of Evidence:

Level IV, diagnostic.
Sacral-Alar-Iliac (SAI) Fixation in Children With Spine Deformity: Minimum 10-Year Follow-Up
Authors: Mun Frederick , Vankara Ashish , Suresh Krishna V. , Margalit Adam , Kebaish Khaled M. , Sponseller Paul D.
Published: May 2022

Introduction:

Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up.

Methods:

We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections.

Results:

Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications.

Conclusions:

SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time.

Level of Evidence:

Level IV.
On-Hours Compared to Off-Hours Pediatric Extracorporeal Life Support Initiation in the United States Between 2009 and 2018—An Analysis of the Extracorporeal Life Support Organization Registry
Authors: Steurer Martina A. , Tonna Joseph E. , Coyan Garrett N. , Burki Sarah , Sciortino Christopher M. , Oishi Peter E.
Published: May 2022

OBJECTIVES:

We aimed to investigate whether there are differences in outcome for pediatric patients when extracorporeal life support (ECLS) is initiated on-hours compared with off-hours.

DESIGN:

Retrospective cohort study.

SETTING:

Ten-year period (2009–2018) in United States centers, from the Extracorporeal Life Support Organization registry.

PATIENTS:

Pediatric (>30 d and <18 yr old) patients undergoing venovenous and venoarterial ECLS.

INTERVENTIONS:

The primary predictor was on versus off-hours cannulation. On-hours were defined as 0700–1859 from Monday to Friday. Off-hours were defined as 1900–0659 from Monday to Thursday or 1900 Friday to 0659 Monday or any time during a United States national holiday. The primary outcome was inhospital mortality. The secondary outcomes were complications related to ECLS and length of hospital stay.

MEASUREMENTS AND MAIN RESULTS:

In a cohort of 9,400 patients, 4,331 (46.1%) were cannulated on-hours and 5,069 (53.9%) off-hours. In the off-hours group, 2,220/5,069 patients died (44.0%) versus 1,894/4,331 (44.1%) in the on-hours group (p = 0.93). Hemorrhagic complications were lower in the off-hours group versus the on-hours group (hemorrhagic 18.4% vs 21.0%; p = 0.002). After adjusting for patient complexity and other confounders, there were no differences between the groups in mortality (odds ratio [OR], 0.95; 95% CI, 0.85–1.07; p = 0.41) or any complications (OR, 1.02; 95% CI, 0.89–1.17; p = 0.75).

CONCLUSIONS:

Survival and complication rates are similar for pediatric patients when ECLS is initiated on-hours compared with off-hours. This finding suggests that, in aggregate, the current pediatric ECLS infrastructure in the United States provides adequate capabilities for the initiation of ECLS across all hours of the day.
Viability and Cosmesis of Right Angle and Vertical Paramedian Forehead Flaps Are Equivalent: A Retrospective Quantitative Study
Authors: Mukovozov Ilya M. , Laroche Alexandre , Wong Aaron , Zloty David
Published: May 2022

BACKGROUND

Paramedian forehead flaps (PMFFs) are commonly used for reconstruction of nasal defects. The classic PMFF is vertically oriented while the modified PMFF is designed with a 90-degree angle. No study has compared outcomes between these PMFF designs.

OBJECTIVE

To compare and quantify viability and cosmesis of 90-degree and vertical PMFF.

METHODS

Retrospective chart review of 70 consecutive patients with a vertical or 90-degree PMFF design for nasal repairs after Mohs micrographic surgery (MMS). Cosmetic outcome was assessed on a 10-cm, 100-point, visual analog scale (VAS) by an independent observer using standardized 3-month postoperative photographs. Flap viability was assessed using standardized 3-week postoperative photographs. Descriptive statistics, t-test, and Mann–Whitney test were used for statistical analysis.

RESULTS

Forty-eight patients were repaired with a vertical PMFF and 22 using the 90-degree PMFF. The mean defect area of vertical and 90-degree designs was equivalent (7.7 ± 4.0 cm2 vs 8.1 ± 4.0 cm2, p = .70). There was no significant difference in cosmetic outcome (75.9 ± 9.4 vs 72.9 ± 6.8, p = .19) or flap viability (3.8% ± 11.6 vs 2.6% ± 7.9, p = .67) between vertical and 90-degree designs.

CONCLUSION

Vertical and 90-degree PMFF designs for nasal repairs after MMS are equivalent in cosmetic outcome and viability.
Combined Internal Limiting Membrane Peeling and Subretinal Balanced Salt Solution Injection: A Novel Technique to Unfold Congenital Falciform Folds
Authors: Boral Subhendu K. , Dan Shouvick , Mitra Santanu
Published: May 2022

Purpose:

To describe a novel surgical technique to unfold congenital falciform folds.

Method:

A retrospective, interventional case series was performed where a novel technique was applied to treat five cases of congenital falciform folds. Twenty-five–gauge vitrectomy was performed along with the removal of all vitreous adhesions. The internal limiting membrane was peeled from the macula and around the macular fold area. A Tano diamond-dusted membrane scraper was used to stretch the folded retina mechanically. Then, subretinal balanced salt solution was injected using a 38-gauge subretinal needle to create multiple blebs around the folded retina. Finally, 20% sulfur hexafluoride gas was used for tamponade. Follow-up was conducted for a minimum of 6 months.

Results:

Vision improved from preoperative mean best-corrected visual acuity logMAR 1.44 (20/550) ± 0.32 to postoperative mean best-corrected visual acuity logMAR 0.75 (20/112) ± 0.17 (P value = 0.0208) after intervention. There was a reduction in the macular fold. Postoperatively, a macular hole with retinal detachment developed in one of five (20%) eyes.

Conclusion:

The novel technique of vitrectomy with combined internal limiting membrane peeling and subretinal balanced salt solution injection is visually rewarding in treating congenital falciform folds.
Tumour microenvironment and focal therapy for prostate cancer
Authors: Borges Rafael Castilho , Tourinho-Barbosa Rafael Rocha , de la Rosette Jean
Published: May 2022

Purpose of review

Although most studies focus on the tumour component of prostate cancer (PCa), increasing attention is being paid to the prostatic tumour microenvironment (TME) and its role in diagnosis, prognosis, and therapy development. Herein, we review the prognostic capability of tumour and nontumour derived biomarkers, the immunomodulatory effects of focal therapy (FT) on TME, and its potential as part of a multidisciplinary approach to PCa treatment.

Recent Findings

Tumour cells have always been the natural candidates to explore new biomarkers, but recent evidence highlights the prognostic contribution of TME cell markers. TME plays a critical role in PCa progression and tumours may escape from the immune system by establishing a microenvironment that suppresses effective antitumour immunity. It has been demonstrated that FT has an immunomodulatory effect and may elicit an immune response that can either favour or inhibit tumorigenesis. TME shows to be an additional target to enhance oncological control.

A better understanding of TME has the potential to reliably elucidate PCa heterogeneity and assign a prognostic profile in accordance with prostate tumour foci. The joint contribution of biomarkers derived from both tumour and TME compartments may improve patient selection for FT by accurately stratifying disease aggressivity according to the characteristics of tumour foci. Preclinical studies have suggested that FT may act as a TME modulator, highlighting its promising role in multimodal therapeutic management.
Is the Early Diagnosis of Pediatric Stroke Possible in the Emergency Department?
Authors: Yaradılmış Raziye Merve , Öztürk Betül , Göktuğ Aytaç , Güngör Ali , Bodur İlknur , Güneylioğlu Muhammed Mustafa , Atasoy Ergin , Aksoy Erhan , Karacan Can Demir , Tuygun Nilden
Published: May 2022

Background and Purpose

Pediatric stroke is a neurological emergency. Knowing the predictive clinical markers for childhood stroke will help in early diagnosis and patient management. This study aims to (1) evaluate patients admitted to the pediatric emergency department (PED) with acute neurological signs and/or symptoms who underwent neuroimaging and (2) determine the clinical warning signs for the early recognition of stroke.

Methods

One hundred one patients aged 1 month to 18 years who were admitted with stroke-related neurological signs and symptoms and underwent neuroimaging in the PED were retrospectively analyzed using the file record system. As a result of these imaging tests, the characteristics of patients with stroke and nonstroke were compared.

Results

The mean age of the 92 included patients was 10.7 (SD, 4.5) years. Among the admission symptoms of the patients, a significant difference was observed only in terms of speech disorder, whereas a significant difference was found in the examination results for altered consciousness and dysarthria. The incidences of hemiplegia and hemiparesis were higher in the stroke group, but they were not statistically significant. The median duration of time from symptom onset to PED admission was 240 minutes (interquartile range, 30–1440 minutes). The mean time from PED admission to magnetic resonance imaging in the stroke group was 2.3 (SD, 0.7) hours, which was significantly shorter than for the nonstroke group (4.9 [SD, 1.2] hours, P = 0.002).

Conclusions

Childhood stroke is a neurological emergency that requires a multidisciplinary approach. Early stroke diagnosis is vital for treatment and prognosis. With respect to sudden neurological deficits, particularly dysarthria, altered consciousness, hemiplegia, and hemiparesis, should alert clinicians to stroke. In addition, interdepartmental cooperation is essential both in the rapid recognition of stroke and the treatment and follow-up processes.
Conjoined Twin Separation: Review of 30-Year Case Experience and Lessons Learned
Authors: Shafarenko Mark S. , Zuker Ronald M.
Published: May 2022

Background:

Conjoined twinning is a rare medical phenomenon, and numerous challenges remain with respect to surgical separation and reconstruction. The purpose of this study is to present a detailed discussion of the authors’ institutional experience with eight conjoined twin separations over the past three decades, focusing on challenges and lessons gleaned from these cases.

Methods:

The records of all patients who underwent conjoined twin separation at The Hospital for Sick Children in Toronto, Ontario, Canada, from 1984 to 2018 were retrospectively reviewed.

Results:

Eight sets of conjoined twins were analyzed. Half of the sets [n = 4 (50 percent)] were female. There were four sets (50 percent) of ischiopagus twins, three sets (37.5 percent) of omphalopagus twins, and one set (12.5 percent) of craniopagus twins. The median age at separation was 6.75 months. The mean durations of intensive care unit and hospital stay were 14.1 ± 12.9 days and 4.9 ± 4.8 months, respectively. Mean length of follow-up was 6.7 ± 4.4 years. Three deaths occurred in our series, with an overall survival rate of 81 percent. Two sets of twins experienced expander-related complications such as infection and bowel perforation. Three twins required reoperation because of flap necrosis or dehiscence after separation.

Conclusions:

The authors’ results highlight the unique nature of each operation and the great ingenuity required in managing the particular considerations of each case and also adhering to a systematic approach of evaluation and planning. A number of novel strategies were used at the authors’ center and have now become commonplace. The lessons learned from such procedures may improve care for future generations of patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Brief Report: Evaluation of Inflammation and Atherogenesis Biomarkers Through 148 Weeks Postswitch to Dolutegravir and Rilpivirine in SWORD-1/SWORD-2
Authors: Llibre Josep M. , López Cortés Luis Fernando , Aylott Alicia , Wynne Brian , Matthews Jessica , Van Solingen-Ristea Rodica , Vandermeulen Kati , van Wyk Jean , Kahl Lesley P.
Published: May 2022

Background:

Switching to the 2-drug regimen dolutegravir + rilpivirine demonstrated noninferiority vs continuing a 3-drug or 4-drug current antiretroviral regimen (CAR) at week 48 and maintained high levels of virologic suppression to week 148 in the SWORD studies. We report inflammation and atherogenesis biomarkers postswitch to dolutegravir + rilpivirine.

Setting:

SWORD-1: 65 centers, 13 countries; SWORD-2: 60 centers, 11 countries.

Methods:

Virologically suppressed adults were randomized to switch to dolutegravir + rilpivirine (early-switch group; n = 513) or continue CAR (n = 511). Participants continuing CAR switched to dolutegravir + rilpivirine at week 52 (late-switch group; n = 477). Biomarkers were evaluated from Baseline to week 48 for dolutegravir + rilpivirine and CAR and noncomparatively for dolutegravir + rilpivirine postswitch through 148 weeks (early-switch) and 96 weeks (late-switch).

Results:

Through week 48, changes in biomarkers did not significantly differ between dolutegravir + rilpivirine and CAR groups, except for increases in soluble CD14 and decreases in fatty acid–binding protein-2, which favored dolutegravir + rilpivirine. For inflammation biomarkers through week 148, there was no marked change in C-reactive protein, inconsistent changes in soluble CD14 and interleukin-6, and increases in soluble CD163. For atherogenesis biomarkers through week 148, fatty acid–binding protein-2 and soluble vascular cell adhesion molecule-1 showed sustained reductions; D-dimer showed inconsistent increases between early-switch vs late-switch groups.

Conclusions:

No consistent pattern of change in biomarkers postswitch to dolutegravir + rilpivirine was observed through weeks 48 and 148 in SWORD-1/SWORD-2, suggesting no association of increased inflammation or atherogenesis with the 2-drug regimen while maintaining virologic suppression.
Predictive Value of Coronary Artery Calcium in Patients Receiving Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department
Authors: Vakil Parmede , Wen Zhaoying , Lima Ana S. , Weber Ellen J. , Kallianos Kimberly G. , Elicker Brett M. , Naeger David M. , Henry Travis S. , Ordovas Karen G.
Published: May 2022

Purpose:

Coronary artery calcium (CAC) is a frequent incidental finding on computed tomography pulmonary angiogram (CTPA) in the evaluation of pulmonary embolism (PE) in the emergency department (ED); however, its prognostic value is unclear. In this study, we interrogate the prognostic value of CAC identified on CTPA in predicting adverse outcomes in the evaluation of PE in the ED.

Materials and Methods:

In this retrospective cohort study, we identified 610 patients presenting to the ED in 2013 and evaluated with CTPA for suspected PE. Ordinal CAC scores were evaluated as absent (0), mild (1), moderate (2), or severe (3) in each of the 4 main coronary arteries. Composite CAC scores were subsequently compared against adverse clinical outcomes, defined as intensive care unit admission, hospital stay longer than 72 hours, or death during hospital course or at 6-month follow-up, using univariate and multivariate logistic regression analyses. Relevant exclusion criteria included a history of cardiovascular disease.

Results:

In all, 365 patients met the inclusion criteria (231 women, mean age 56±16 y) with 132 patients (36%) having some degree of CAC and 16 (4%) having severe CAC. Known malignancy was present in 151 (41%) patients and composite adverse clinical outcomes were observed in 98 patients (32%). Age, presence of acute PE, malignancy, and presence of CAC were significant predictors of adverse outcomes on both univariate and multivariate analyses. CAC was not an independent predictor of short-term adverse outcomes on multivariate analysis (P=0.06) when all patients were considered. However, when patients with known malignancy were excluded, CAC was an independent predictor of short-term adverse outcomes (odds ratio=2.5, confidence interval=1.1-5.5, P=0.03) independent of age and presence of PE.

Conclusion:

The presence of CAC on CT PA was predictive of adverse outcomes in patients without known cardiac disease presenting to the ED with suspected PE.
Incremental Value of Noncontrast Chest Computed Tomography-derived Parameters in Predicting Subclinical Carotid Atherosclerosis
Authors: Wang Xi , Xin Ran , Shan Dongkai , Dou Guanhua , Zhang Wei , Jing Jing , He Bai , Chen Yundai , Yang Junjie
Published: May 2022

Purpose:

To investigate the incremental value of noncontrast chest computed tomography (CT)-derived parameters, such as coronary artery calcium score (CACS) and epicardial adipose tissue volume (EATv), in predicting subclinical carotid atherosclerosis above traditional risk factors in community-based asymptomatic populations of northern China.

Materials and Methods:

A total of 2195 community-based asymptomatic individuals were enrolled from Jidong Oilfield in accordance with the PERSUADE study. CACS and EATv were measured on noncontrast chest CT. Demographics and ideal cardiovascular health score (ICHS) were collected through questionnaires. We recalculated the ideal cardiovascular health risk score (ICHRS) (ICHRS=14−ICHS) and standardized the parameters as log-CACS and body mass index adjusted EATv (i-EATv). Subclinical carotid atherosclerosis was assessed by Doppler sonography and defined as any prevalence of average carotid intima-media thickness ≥1.00 mm, appearance of carotid plaque, and carotid arterial stenosis in the areas of extracranial carotid arteries on both sides.

Results:

A total of 451 (20.55%) individuals presented subclinical carotid atherosclerosis. CACS and EATv were significantly greater in the subclinical group, while ICHS was lower. In multivariate logistic regression, ICHRS (odds ratio [OR]=1.143, 95% confidence interval [CI]: 1.080-1.210, P<0.001), log-CACS (OR=1.701, 95% CI: 1.480-1.955, P<0.001), and i-EATv (OR=1.254, 95% CI: 1.173-1.341, P<0.001) were found to be independent risk predictors for subclinical carotid atherosclerosis. In receiver-operating characteristic curve analysis, when combined with male sex and age level, the area under the curve of the ICHRS basic model increased from 0.627 (95% CI: 0.599-0.654) to 0.757 (95% CI: 0.732-0.781) (P<0.0001). Further adding log-CACS and i-EATv, the area under the curve demonstrated a statistically significant improvement (0.788 [95% CI: 0.765-0.812] vs. 0.757 [95% CI: 0.732-0.781], P<0.0001).

Conclusion:

Noncontrast chest CT-derived parameters, including CACS and EATv, could provide significant incremental improvement for predicting subclinical carotid atherosclerosis beyond the conventional risk assessment model based on ICHRS.