bluuebunny/crossref_metadata_2025 huggingface dataset:
Placebo Response Reduction and Accurate Pain Reporting Training Reduces Placebo Responses in a Clinical Trial on Chronic Low Back Pain
Authors: Erpelding Nathalie , Evans Kathryn , Lanier Ryan K. , Elder Harrison , Katz Nathaniel P.
Published: August 2020

Objective:

A literature review was conducted to compare placebo responses in a recent trial—which implemented an accurate pain reporting (APR) and placebo response reduction (PRR) training program—with placebo responses in similar previous trials in chronic lower back pain (CLBP) that did not use such training.

Methods:

A literature search was performed to find parallel design, randomized, controlled trials of pharmacological treatments administered orally or through intravenous injection for CLBP. Studies were assessed for the proportion of placebo responders, defined as the proportion of patients in the placebo group with ≥30% reduction in pain intensity. A χ2 analysis was performed on the proportion of responders from the SPRINT trial and from other similar studies.

Results:

Of 844 studies identified in the initial screening process, 16 studies were included for comparison. The percentage of placebo responders was statistically significantly lower in the SPRINT study (19.1%) compared with other CLBP trials (38.0%) (P=0.003). Our results show that the placebo response was lower in the SPRINT trial than other comparable studies on CLBP.

Discussion:

These findings are consistent with results from other studies showing that neutralizing subject and study staff expectations of therapeutic benefit can decrease the placebo response in clinical trials. The results of this study suggest training participants and staff to improve pain reporting accuracy, neutralize expectations, and decrease external cues that may bias participants’ pain ratings in clinical trials may effectively decrease the placebo response leading to increased assay sensitivity.
Prevalence, Characteristics, and Clinical Course of Neuropathic Pain in Primary Care Patients Consulting With Low Back-related Leg Pain
Authors: Harrisson Sarah A. , Ogollah Reuben , Dunn Kate M. , Foster Nadine E. , Konstantinou Kika
Published: August 2020

Objectives:

Little is known about the epidemiology of neuropathic pain in primary care patients consulting with low back-related leg pain. We aimed to describe prevalence, characteristics, and clinical course of low back-related leg pain patients with and without neuropathic pain, consulting with their family doctor in the United Kingdom.

Materials and Methods:

This was a prospective cohort study. Data were collected using a standardized baseline clinical examination and self-report questionnaires at baseline, 4, 12, and 36 months. We identified cases of neuropathic pain using 3 definitions: 2 based on clinical diagnosis (sciatica, with and without evidence of nerve root compression on magnetic resonance imaging), one on the self-report version of Leeds Assessment for Neurological Symptoms and Signs. Differences between patients with and without neuropathic pain were analyzed comparing each definition. Clinical course (mean pain intensity measured as the highest of leg or back pain intensity: mean of 3 Numerical Rating Scales, each 0 to 10) was investigated using linear mixed models over 36 months.

Results:

Prevalence of neuropathic pain varied from 48% to 74% according to definition used. At baseline, patients with neuropathic pain had more severe leg pain intensity, lower pain self-efficacy, more patients had sensory loss than those without. Distinct profiles were apparent depending on neuropathic pain definition. Mean pain intensity reduced after 4 months (6.1 to 3.9 [sciatica]), most rapidly in cases defined by clinical diagnosis.

Discussion:

This research provides new information on the clinical course of neuropathic pain and a better understanding of neuropathic pain in low back-related leg pain patients consulting in primary care.
Endothelial Injury and Glycocalyx Degradation in Critically Ill Coronavirus Disease 2019 Patients: Implications for Microvascular Platelet Aggregation
Authors: Fraser Douglas D. , Patterson Eric K. , Slessarev Marat , Gill Sean E. , Martin Claudio , Daley Mark , Miller Michael R. , Patel Maitray A. , dos Santos Claudia C. , Bosma Karen J. , O’Gorman David B. , Cepinskas Gediminas
Published: August 2020

Objectives:

Coronavirus disease 2019 is caused by the novel severe acute respiratory syndrome coronavirus 2 virus. Patients admitted to the ICU suffer from microvascular thrombosis, which may contribute to mortality. Our aim was to profile plasma thrombotic factors and endothelial injury markers in critically ill coronavirus disease 2019 ICU patients to help understand their thrombotic mechanisms.

Design:

Daily blood coagulation and thrombotic factor profiling with immunoassays and in vitro experiments on human pulmonary microvascular endothelial cells.

Setting:

Tertiary care ICU and academic laboratory.

Subjects:

All patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome coronavirus 2, using standardized hospital screening methodologies, had daily blood samples collected until testing was confirmed coronavirus disease 2019 negative on either ICU day 3 or ICU day 7 if the patient was coronavirus disease 2019 positive.

Interventions:

None.

Measurement and Main Results:

Age- and sex-matched healthy control subjects and ICU patients that were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well balanced with the exception that coronavirus disease 2019 positive patients were more likely than coronavirus disease 2019 negative patients to suffer bilateral pneumonia. Mortality rate for coronavirus disease 2019 positive ICU patients was 40%. Compared with healthy control subjects, coronavirus disease 2019 positive patients had higher plasma von Willebrand factor (p < 0.001) and glycocalyx-degradation products (chondroitin sulfate and syndecan-1; p < 0.01). When compared with coronavirus disease 2019 negative patients, coronavirus disease 2019 positive patients had persistently higher soluble P-selectin, hyaluronic acid, and syndecan-1 (p < 0.05), particularly on ICU day 3 and thereafter. Thrombosis profiling on ICU days 1–3 predicted coronavirus disease 2019 status with 85% accuracy and patient mortality with 86% accuracy. Surface hyaluronic acid removal from human pulmonary microvascular endothelial cells with hyaluronidase treatment resulted in depressed nitric oxide, an instigating mechanism for platelet adhesion to the microvascular endothelium.

Conclusions:

Thrombosis profiling identified endothelial activation and glycocalyx degradation in coronavirus disease 2019 positive patients. Our data suggest that medications to protect and/or restore the endothelial glycocalyx, as well as platelet inhibitors, should be considered for further study.
Progress of mechanical power in the intensive care unit
Authors: Chi Yi , He Huai-Wu , Long Yun
Published: August 2020

Mechanical power of ventilation, currently defined as the energy delivered from the ventilator to the respiratory system over a period of time, has been recognized as a promising indicator to evaluate ventilator-induced lung injury and predict the prognosis of ventilated critically ill patients. Mechanical power can be accurately measured by the geometric method, while simplified equations allow an easy estimation of mechanical power at the bedside. There may exist a safety threshold of mechanical power above which lung injury is inevitable, and the assessment of mechanical power might be helpful to determine whether the extracorporeal respiratory support is needed in patients with acute respiratory distress syndrome. It should be noted that relatively low mechanical power does not exclude the possibility of lung injury. Lung size and inhomogeneity should also be taken into consideration. Problems regarding the safety limits of mechanical power and contribution of each component to lung injury have not been determined yet. Whether mechanical power-directed lung-protective ventilation strategy could improve clinical outcomes also needs further investigation. Therefore, this review discusses the algorithms, clinical relevance, optimization, and future directions of mechanical power in critically ill patients.
Neuro-oncology Multidisciplinary Clinic and Improvements in Patient Outcome
Authors: Kubicek Gregory J. , Yocum Nora , Thomas Christina , Goldman Howard W.
Published: August 2020

Background:

Neuro-oncology care is becoming increasingly complex and patients often see multiple specialists. Multidisciplinary clinic (MDC) is a patient-centric option to allow multiple specialists to be involved where patients see multiple providers on the same day.

Objective:

The objective of this study was to evaluate the role of a neuro-oncology MDC on patient outcomes.

Materials and Methods:

Retrospective study was performed on consecutive patients who received radiosurgery for central nervous system (CNS) disease. We evaluated patients 2 years before and 2 years after the implementation of a MDC.

Results:

A total of 351 patients were analyzed, 163 patients before MDC and 188 after implementation of MDC. Before MDC the median follow-up was dependent on which department ordered follow-up radiographic imaging. This discrepancy decreased after the MDC. Overall survival for patients with CNS metastatic disease improved in the MDC cohort (median survival of 248 before MDC and 315 d after, P<0.027).

Conclusion:

We found that neuro-oncology MDC improved follow-up across disciplines and improved overall survival for patients with CNS metastatic disease.
A Test-Negative Design with Additional Population Controls Can Be Used to Rapidly Study Causes of the SARS-CoV-2 Epidemic
Authors: Vandenbroucke Jan P. , Brickley Elizabeth B. , Vandenbroucke-Grauls Christina M.J.E. , Pearce Neil
Published: August 2020

Testing of symptomatic persons for infection with severe acute respiratory syndrome coronavirus-2 is occurring worldwide. We propose two types of case–control studies that can be carried out jointly in test settings for symptomatic persons. The first, the test-negative case–control design (TND) is the easiest to implement; it only requires collecting information about potential risk factors for Coronavirus Disease 2019 (COVID-19) from the tested symptomatic persons. The second, standard case–control studies with population controls, requires the collection of data on one or more population controls for each person who is tested in the test facilities, so that test-positives and test-negatives can each be compared with population controls. The TND will detect differences in risk factors between symptomatic persons who have COVID-19 (test-positives) and those who have other respiratory infections (test-negatives). However, risk factors with effect sizes of equal magnitude for both COVID-19 and other respiratory infections will not be identified by the TND. Therefore, we discuss how to add population controls to compare with the test-positives and the test-negatives, yielding two additional case–control studies. We describe two options for population control groups: one composed of accompanying persons to the test facilities, the other drawn from existing country-wide healthcare databases. We also describe other possibilities for population controls. Combining the TND with population controls yields a triangulation approach that distinguishes between exposures that are risk factors for both COVID-19 and other respiratory infections, and exposures that are risk factors for just COVID-19. This combined design can be applied to future epidemics, but also to study causes of nonepidemic disease.
Association Between Sense of Coherence and Periodontal Outcomes
Authors: Cruz Olivo Edison Andres , Corradi-Dias Larissa , Paiva Saul Martins , Storino Rafael Jordão , Moura Marcela Faria , Pereira Alexandre Godinho , Cota Luís Otávio Miranda , Costa Fernando Oliveira , Abreu Lucas Guimarães
Published: August 2020

This systematic review and meta-analysis aimed to evaluate the association between sense of coherence (SOC) and periodontal outcomes. Electronic searches were performed in 6 databases. Seventeen studies that evaluated the association between SOC and periodontal outcomes were included. The included studies demonstrated that individuals with a stronger SOC were more likely to present improved periodontal outcomes. The meta-analysis showed that individuals with a lower SOC were 3.31 times more likely to present bleeding on probing. Sons/daughters of mothers with a lower SOC were 3.22 times more likely to present gingival bleeding. Individuals with a stronger SOC have better periodontal health.
iStent inject: comprehensive review
Authors: Shalaby Wesam Shamseldin , Jia Jing , Katz L. Jay , Lee Daniel
Published: August 2020

Microinvasive glaucoma surgeries (MIGSs) are new surgical procedures for treatment of glaucoma. They aim to safely and effectively reduce intraocular pressure (IOP) with minimal trauma to the eye and less complications. The first-generation iStent is the first approved ab interno MIGS implant for management of open-angle glaucoma. It works by allowing aqueous humor to drain directly from the anterior chamber into Schlemm canal bypassing the trabecular meshwork, the major site of outflow resistance. The second-generation iStent inject is the smallest available trabecular device that occupies less than 0.5 mm. It is designed to facilitate the surgical technique and allow simultaneous implantation of 2 stents, aiming for more IOP reduction. This review examines publications about the iStent inject, focusing on the device's efficacy, safety, and comparison with the first generation iStent. Both devices were found to be a safe and effective tool in management of open-angle glaucoma.
Posterior and total corneal astigmatism measured with optical coherence tomography–based biometer and dual Scheimpflug analyzer
Authors: Wang Li , Cao Danmin , Vilar César , Koch Douglas D.
Published: August 2020

Purpose:

To compare corneal astigmatism obtained from an optical coherence tomography-based biometer (OCT) and dual Scheimpflug analyzer (DSA).

Setting:

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.

Design:

Retrospective case series.

Methods:

Consecutive cases with both OCT and DSA measurements were reviewed. Three parameters were analyzed with OCT and DSA: (1) standard keratometric astigmatism (K vs simulated keratometry [SimK]), (2) posterior corneal astigmatism, and (3) total corneal astigmatism (total keratometry [TK] vs total corneal power [TCP]). The magnitudes of corneal astigmatism obtained from the 2 devices were compared. Vector analysis was used to assess differences in corneal astigmatism between devices.

Results:

In this study 530 corneas in 530 patients were measured. Compared with the DSA, the OCT produced a lower mean magnitude of posterior corneal astigmatism (−0.19 vs −0.29 diopter [D]) and a higher percentage of eyes with magnitude ≤0.25 D (75.5% vs 41.9%) (P < .05). Comparing TK and TCP, (1) TK was greater in magnitudes (1.03 vs 0.98 D); (2) 84.3% of eyes had differences in magnitude of ≤0.50 D; (3) in eyes with TK astigmatism ≥0.5 D, 34.5% and 60.1% of eyes had differences in steep meridian of ≤5 degrees and ≤10 degrees, respectively, and (4) 59.2% of eyes had vector differences of ≤0.50 D. In with-the-rule and against-the-rule eyes, respectively, the vector differences between TK and TCP were 0.16 D @ 83 degrees and 0.17 D @ 12 degrees, and in posterior corneal astigmatism, 0.06 D @ 173 degrees; and 0.15 D @ 175 degrees.

Conclusions:

There were clinically significant differences in total corneal astigmatism obtained from OCT and DSA devices. Compared with DSA, OCT produced lower values for posterior corneal astigmatism.
Willingness to Use HIV Self-Testing With Online Supervision Among App-Using Young Men Who Have Sex With Men in Bangkok
Authors: Samoh Nattharat , Peerawaranun Pimnara , Jonas Kai J. , Lim Sin How , Wickersham Jeffrey A. , Guadamuz Thomas E.
Published: August 2020

An online assessment among social media–using young men who have sex with men found that 87% were willing to use HIV self-testing with online supervision. Correlates included never tested, having higher numbers of sexual partners, and seeking partners online. HIV self-testing with online supervision may be appropriate for young men who have sex with men who have high risks and may not access venue-based settings.
Clinical and Personal Lubricants Impact the Growth of Vaginal Lactobacillus Species and Colonization of Vaginal Epithelial Cells: An in Vitro Study
Authors: Łaniewski Paweł , Owen Kimberley A. , Khnanisho Michael , Brotman Rebecca M. , Herbst-Kralovetz Melissa M.
Published: August 2020

Background

Vaginal lubricants are commonly used during gynecological examinations, during sexual activities, or to alleviate vaginal dryness. Many lubricants contain potentially bacteriostatic or bactericidal agents (parabens, chlorhexidine gluconate, nonoxynol-9). Our objective was to evaluate the impact of lubricants that vary in formulation on the growth and viability of vaginal Lactobacillus species and vaginal epithelial cell (VEC) colonization in an in vitro model.

Methods

Growth curve, disk diffusion, and minimal inhibitory assays were used to determine the impact of lubricants or excipients on the growth of Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii, and Lactobacillus iners. L. crispatus strain was used in VEC colonization assays. Statistical differences were determined by analysis of variance.

Results

Lubricants containing chlorhexidine gluconate or nonoxynol-9 (N-9; Conceptrol, K-Y Jelly, and Surgilube) significantly inhibited Lactobacillus species growth (P < 0.05). In contrast, other clinical lubricants (E-Z Lubricating Jelly, McKesson Lubricating) and personal lubricants (Astroglide Liquid, Good Clean Love Almost Naked, K-Y Warming Jelly) did not exhibit this effect. Chlorhexidine gluconate had a detrimental effect on Lactobacillus growth and exhibited stronger antimicrobial activity compared with methylparaben and propylparaben (P < 0.0001). There were lubricants that did not induce cytotoxicity in VEC (Good Clean Love Almost Naked, E-Z Lubricating Jelly, McKesson Lubricating Jelly), but these products did substantially decrease the attachment of L. crispatus to VEC, particularly when VEC were preexposed to lubricants before inoculation with bacteria (P < 0.0001).

Conclusions

This in vitro model indicates that select vaginal lubricants, particularly those with chlorhexidine gluconate, have potentially adverse effects on women’s health by reducing growth and recolonization of vaginal Lactobacillus species.
Intravaginal Practices Among Women Attending a Sexually Transmitted Disease Clinic—Philadelphia, 2017
Authors: Lewis Felicia M.T. , Diesel Jill
Published: August 2020

We conducted a survey among women attending an urban public sexually transmitted disease clinic to determine the type and frequency of intravaginal cleansing practices. Both intravaginal washing and douching were frequent, performed mostly for routine hygiene, and associated with self-report of sexually transmitted infection and bacterial vaginosis (douching and intravaginal washing).
Clinical Significance of Program Death Ligand-1 and Indoleamine-2,3-Dioxygenase Expression in Colorectal Carcinoma
Authors: Hacking Sean , Vitkovski Taisia , Jain Swachi , Jin Cao , Chavarria Hector , Wu Dongling , Nasim Mansoor
Published: August 2020

Colorectal cancer is a heterogenous disease with striking biological diversity. Colorectal carcinoma (CRC) is one of the most common malignancies, accounting for over 9% of all cancers worldwide. To put it in perspective, 5% of people will develop CRC in their lifetime. Biomarkers specific to a particular cancer type can assist in the evaluation of survival probability and help clinicians assess treatment modalities, an example being programmed death ligand-1 (PD-L1). With regards to PD-L1, this is the first study to evaluate the SP-142 antibody clone in CRC. The Ventana PD-L1 (SP-142) assay for PD-L1 expression identifies patients who may benefit from treatment with atezolizumab. SP-142 was chosen as large stage 3 clinical trials are being undertaken with atezolizumab in CRC. Indoleamine 2,3-dioxygenase (IDO-1) was also chosen as there are several ongoing trials for Epacadostat, the best-in-class oral IDO-1 enzyme inhibitor, in many solid tumors. For solid tumors, IDO-1-based immune escape has the potential to inhibit monotherapeutic efficacy of PD-L1-based therapeutics. In this study, a total of 223 cases of CRC were retrospectively reviewed and clinicopathologic data were analyzed in relation to PD-L1 and IDO-1 protein expression. Moreover, tumor-infiltrating lymphocytes, mismatch repair deficiency, high mitotic index, and worse survival outcomes were found in cohorts with significant PD-L1 and IDO-1 expression. Both PD-L1 and IDO-1 are actionable biomarkers, with potential therapeutic implications in CRC. Our findings support the theoretical foundation for targeting PD-L1 and IDO-1 in CRC, which now needs verification in well-designed robust clinical trials.
Double-staining Immunohistochemistry Reveals in Malignant Pleural Mesothelioma the Coexpression of ERCC1 and RRM1 as a Frequent Biological Event Related to Poorer Survival
Authors: Zito Marino Federica , Baselice Simona , Erra Stefania , Ronchi Andrea , Montella Marco , Morgillo Floriana , Vicidomini Giovanni , Santini Mario , Poziello Giuseppina , Cozzolino Immacolata , Accardo Marina , Franco Renato
Published: August 2020

Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. To date, standard MPM therapy is still limited to surgery, radiotherapy, and chemotherapy, including pemetrexed and platinum compounds. The main mechanisms of platinum resistance are associated with DNA repair pathways. Excision repair cross-complementing group 1 (ERCC1) and ribonucleotide reductase subunit M1 (RRM1) are important components of the DNA repair, considered as prognostic and predictive biomarkers in various cancer types. The main goal of the present study was to investigate the ERCC1 and RRM1 expression and their potential impact on outcome in this tumor. A series of 73 MPM, mainly treated with a platin-based regimen, was collected and the immunohistochemistry tests were performed to assess ERCC1 and RRM1 expression. In addition, a multiplex immunohistochemistry has been validated to detect simultaneously the 2 proteins on the same slide. In our series, 36 of 73 cases showed ERCC1 expression and 55 of 73 showed RRM1 expression. The double immunohistochemical staining showed the coexpression of ERCC1/RRM1 in 34 of 73 cases. A significant association between ERCC1 and RRM1 expression was observed in our series (P<0.05). Patients with ERCC1/RRM1 coexpression experienced shorter median overall survival (6.6 vs. 13.8 mo, log-rank=7688; P=0.006). Our results suggest that the coexpression of ERCC1/RRM1 could define a group of MPM patients with the worst prognosis who should need likely alternative treatment. In conclusion, we propose the putative usefulness of ERCC1/RRM1 coexpression as prognostic biomarkers for overall survival in MPM.
Comparison of Neurocognitive Outcomes in Postoperative Adolescents with Unilateral Coronal Synostosis
Authors: Wu Robin T. , Gabrick Kyle S. , Singh Anusha , Landi Nicole , Taylor Jesse A. , Bartlett Scott P. , Persing John A. , Alperovich Michael
Published: August 2020

Unilateral coronal nonsyndromic craniosynostosis is associated with asymmetric skull growth, which may influence cerebral long-term function. Twenty affected adolescents who underwent cranial vault remodeling at a mean age of 8.2 months (12 from the Yale Craniofacial Clinic and eight from the Children’s Hospital of Philadelphia) all completed a double-blinded neurodevelopmental assessment at an average age of 12.1 years. The study cohort included 55 percent female and 50 percent right-sided craniosynostosis. Mean verbal intelligence quotient was highest at 117.3, and mean performance intelligence quotient was 106.4, for a mean full-scale intelligence quotient of 112.5. Patients performed above the national average on all academic achievements except for numerical operations, which was significantly lower than word reading (p = 0.022). Patients performed below average on all Beery-Buktenica visual motor tests; motor-coordination was poorer than both visual motor integration and visual perception (p = 0.027 and p = 0.005). Significant positive correlations existed between paternal education/visual perception (r = 0.450; p = 0.046) and household income/verbal intelligence quotient (r = 0.628; p = 0.004). Patients with right unilateral coronal nonsyndromic craniosynostosis had improved spelling compared with left-sided patients on multivariate regression (p = 0.033). Female patients had higher motor coordination (p = 0.024). Breast-fed patients had better performance intelligence quotient (p = 0.024), visual motor integration (p = 0.014), and visual perception (p = 0.031). Adolescents who underwent cranial vault remodeling at two institutions had above average intelligence quotient scores, but worse mathematical and visual motor achievement compared with control subjects. Left-side craniosynostosis patients performed worse in spelling than right-side patients. Breast-feeding was an independent predictor for improved performance intelligence quotient, visual motor achievement, and visual perception performance. Study findings are limited by the cohort size. A larger population study is required, which could validate or modify the study conclusions.
The Glass Ceiling in Plastic Surgery: A Propensity-Matched Analysis of the Gender Gap in Career Advancement
Authors: Ngaage Ledibabari M. , Ngadimin Cleo , Harris Chelsea , Rawes Catherine , Wu Yinglun , Landford Wilmina , Slezak Sheri , Rasko Yvonne M.
Published: August 2020

Background:

Gender parity remains elusive in academic plastic surgery. It is unknown whether this disparity is attributable to differences in qualifications or to the glass ceiling of gender bias. To parse this, the authors compared academic titles and departmental leadership of female academic plastic surgeons to a matched group of their male counterparts.

Methods:

The authors conducted a cross-sectional analysis of academic plastic surgeons. The authors identified faculty, sex, academic rank, and leadership positions from plastic surgery residency program websites. The authors then collected details on training institution, advanced degrees, years in practice, and h-index for use as independent variables. The authors performed a propensity score analysis to 1:1 match male and female academic plastic surgeons.

Results:

A total of 818 academic plastic surgeons were included. The cohort was predominately male [n = 658 (81 percent)], with a median 12 years in practice and a median h-index of 9. Before matching, men had more years in practice (13 years versus 9 years; p < 0.0001), a greater h-index (11 versus 5; p < 0.0001), were more likely to be professors (34 percent versus 13 percent; p < 0.0001), and held more leadership positions than women (41 percent versus 30 percent; p = 0.0221). Following matching, gender parity was demonstrated in academic rank and departmental leadership.

Conclusions:

Differences in training, qualifications, career length, and academic productivity may account for the leadership gap in academic plastic surgery. Gendered difficulties in reaching qualification benchmarks must be addressed before gender parity in promotion can be achieved.
Comparing the Lumbar and SGAP Flaps to the DIEP Flap Using the BREAST-Q
Authors: Opsomer Dries , Vyncke Tom , Ryx Michelle , Stillaert Filip , Van Landuyt Koenraad , Blondeel Phillip
Published: August 2020

Background:

The deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. When the abdomen is not available, alternative donor sites can be found at the buttock, the lumbar region, or the thighs. These flaps are referred to as second-choice flaps. This study compares the superior gluteal artery perforator (SGAP) flap and the lumbar artery perforator (LAP) flap to the DIEP flap using patient-reported outcomes.

Methods:

A retrospective study was performed reviewing the records of 417 women who underwent a free flap breast reconstruction with either a DIEP, an LAP, or an SGAP flap, between 2006 and 2018. Patients were asked to fill out the BREAST-Q questionnaire, and patient-reported outcomes were analyzed and correlated to the demographic information.

Results:

The response rate was 54.5 percent, with 50 LAP, 153 DIEP, and 25 SGAP flap patients participating. When questioned about their satisfaction with breasts and satisfaction with outcome, all three procedures were rated similarly high. When comparing the physical well-being of the donor site and appearance of the donor site, LAP flap patients reported significantly lower scores than DIEP and SGAP flap patients.

Conclusions:

Patients who undergo LAP or SGAP flap breast reconstruction seem similarly satisfied with the appearance and outcome of their free flap breast reconstruction compared with DIEP flap patients. The donor-site morbidity and its impact on the patient’s well-being in SGAP and LAP flap patients have been underestimated. Despite more donor-site discomfort, the LAP and SGAP flaps are feasible alternatives whenever the DIEP flap is not possible.
Technical Pearls in Frontal and Periorbital Bone Contouring in Gender-Affirmation Surgery
Authors: Eisemann Bradley S. , Wilson Stelios C. , Ramly Elie P. , Kantar Rami S. , Alfonso Allyson R. , Frey Jordan D. , Bluebond-Langer Rachel , Rodriguez Eduardo D.
Published: August 2020

Changes made to the forehead and periorbital region can have dramatic effects in gender-affirmation surgery. Removal of frontal bossing and alteration of orbital shape can result in significant facial feminization. This elective surgical intervention must be safe, reliable, and aesthetically effective. The described technique of frontal and periorbital bone contouring allows for a safe and consistent surgical outcome in properly selected patients. Nuances in specific technical maneuvers in this operation can have profound effects on safety and aesthetic outcomes. In this article, specific points are detailed in text and video describing the senior author’s (E.D.R) surgical approach.
Economic Burden Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV or Living Without HIV in the Multicenter AIDS Cohort Study
Authors: Dean Lorraine T. , Nonyane Bareng Aletta Sanny , Ugoji Chinenye , Visvanathan Kala , Jacobson Lisa P. , Lau Bryan
Published: August 2020

Background:

With HIV now considered a chronic disease, economic burden for people living with HIV (LWH) may threaten long-term disease outcomes. We studied associations between economic burden (employment, income, insurance, and financial difficulty) and HIV status for gay, bisexual, and other men who have sex with men (GBMSM) and how economic burden relates to disease progression.

Setting:

We analyzed data collected every 6 months through 2015 from GBMSM LWH and GBMSM living without HIV from 2 waves (2001–2003 cohort and 2010+ new recruit cohort) of the Multicenter AIDS Cohort Study.

Methods:

Using generalized estimating equations, we first assessed the association between HIV status (exposure) and economic burden indicators since the last study visit (outcomes) of employment (working/student/retired versus not currently working), personal annual income of ≥$10,000, insurance (public/private versus none), and financial difficulty meeting basic expenses. Then among people LWH, we assessed the relationships between economic burden indicators (exposures), risk of progressive immune suppression (CD4 ≤500 cells/uL), and progression to AIDS (CD4 ≤200; outcomes).

Results:

Of 1721 participants, 59.5% were LWH (n = 1024). GBMSM LWH were 12% less likely to be employed, 16% more likely to have health insurance, and 9% more likely to experience financial difficulty than GBMSM living without HIV. Among GBMSM LWH, employment was associated with a 6% and 32% lower likelihood of immune suppression or progression to AIDS, respectively, and the income was associated with a 15% lower likelihood of progression to AIDS.

Conclusions:

Interventions that stabilize employment, income, and offer insurance support may enrich GBMSM LWH's ability to prevent disease progression.
Diffuse Pulmonary Ossification on High-Resolution Computed Tomography in Idiopathic Pulmonary Fibrosis, Systemic Sclerosis-Related Interstitial Lung Disease, and Chronic Hypersensitivity Pneumonitis: A Comparative Study
Authors: Walkoff Lara , Dixit Anuj S. , Ryu Jay H. , Chung Jonathan H. , Cox Christian W.
Published: August 2020

Objective

The aim of the study was to compare the prevalence of diffuse pulmonary ossification (DPO) in idiopathic pulmonary fibrosis (IPF), systemic sclerosis (SSc)-related interstitial lung disease (ILD), and chronic hypersensitivity pneumonitis (HP).

Methods

High-resolution computed tomography (HRCT) from 71 IPF, 67 SSc-ILD, and 75 HP cases were independently evaluated by 2 thoracic radiologists blinded to patient data. Studies were assessed for the presence of DPO, HRCT scanning pattern, stigmata of granulomatous infection, and honeycombing.

Results

The prevalence of DPO was significantly higher in cases of IPF and SSc compared with HP, although there was no significant difference in prevalence between the IPF and SSc groups, even when accounting for the presence of prior granulomatous infection. Interobserver agreement for the presence of DPO was substantial.

Conclusions

Although prevalence DPO on HRCT varies between some forms of ILD, the use of DPO to influence characterization of ILD should be considered with caution.
Computed Tomography Thermography for Ablation Zone Prediction in Microwave Ablation and Cryoablation: Advantages and Challenges in an Ex Vivo Porcine Liver Model
Authors: Pohlan Julian , Kress Wiebke , Hermann Kay-Geert , Mews Jürgen , Kroes Maarten , Hamm Bernd , Diekhoff Torsten
Published: August 2020

Purpose

The aim of this study was to investigate the diagnostic accuracy of computed tomography (CT) for the prediction of ablation zones from microwave ablation (MWA) and cryoablation (CA) in an ex vivo porcine liver model.

Methods

Sequential (30 seconds) CT scans were acquired during and after MWA and CA in an ex vivo porcine liver model. We generated 120-kVp equivalent reconstructions of generic dual-energy CT data sets, and comprehensive region-of-interest measurements were statistically correlated with invasive temperature monitoring using Pearson correlation coefficient. Binary logistic regression was performed for prediction of successful ablation.

Results

With the use of pooled data from 6 lesions in 2 separate experiments, correlation analysis of attenuation in Hounsfield units (HU) and temperature yielded r = −0.79 [confidence interval (CI), −0.85 to −0.71] for MWA and r = 0.62 (CI, 0.55 to 0.67) for CA.

For MWA, there was a linear association between attenuation and temperature up to 75°C; thus, linear regression yielded a slope of −2.00 HU/°C (95% CI, −1.58 to −2.41). For CA, a linear association between attenuation and temperature was observed in the cooling phase with a slope of 2.11 HU/°C (95% CI, 1.79 to 2.58). In MWA treatment, binary logistic regression separated less than 70°C and greater than 70°C with 89.2% accuracy. Within the ice ball, temperatures above and below −20°C were distinguished with 65.3% accuracy.

Conclusions

Our experiments reveal several difficulties in predicting ablation zone temperature from CT attenuation. Microwave ablation leads to gas production in the tissue, which degrades the accuracy of noninvasive temperature measurement, especially at higher temperatures. In CA, CT thermometry is limited by ice ball formation, which leads to homogeneous attenuation, nearly independent of temperature. Further research is needed to define the role of CT thermography in ablation zone monitoring in liver malignancies.
The Role of Multiparametric Magnetic Resonance Imaging in the Study of Primary Tumor and Pelvic Lymph Node Metastasis in Stage IB1–IIA1 Cervical Cancer
Authors: Zhang Xiaomiao , Dong Yue , Song Qingling , Zhu Yanmei , Pang Huiting , Luo Yahong , Yu Tao , Liu Fan , Guo Yan
Published: August 2020

Objective

The aim of this study was to investigate the value of multiparametric magnetic resonance imaging (MRI) in demonstrating the metastatic potential of primary tumor and differentiating metastatic lymph nodes (MLNs) from nonmetastatic lymph nodes (non-MLNs) in stage IB1–IIA1 cervical cancer.

Methods

Fifty-seven stage IB1–IIA1 subjects were included. The apparent diffusion coefficient (ADC) values and dynamic contrast-enhanced MRI (DCE-MRI) parameters of primary tumors and lymph nodes and the conventional imaging features of the lymph nodes were measured and analyzed. Mann-Whitney test and χ2 test were used to analyze statistically significant parameters, logistic regression was used for multivariate analysis, and receiver operating characteristic analysis was used to compare the diagnostic performance of the MLNs.

Results

Nineteen subjects had lymph node metastasis. A total of 94 lymph nodes were evaluated, including 30 MLNs and 64 non-MLNs. There were no significant difference in ADC and DCE-MRI parameters between metastatic and nonmetastatic primary tumors. The heterogeneous signal was more commonly seen in MLNs than in non-MLNs (P = 0.001). The values of ADCmean, ADCmin, and ADCmax of MLNs were lower than those of non-MLNs (P < 0.001). The values of short-axis diameter, K
trans, K
ep, and V
e of MLNs were higher than those of non-MLNs (P < 0.05). Compared with individual MRI parameters, the combined evaluation of short-axis diameter, ADCmean, and K
trans showed the highest area under the curve of 0.930.

Conclusions

Diffusion-weighted imaging and DCE-MRI could not demonstrate the metastatic potential of primary tumor in stage IB1–IIA1 cervical cancer. Compared with individual MRI parameters, the combination of multiparametric MRI could improve the diagnostic performance of lymph node metastasis.
Two-Stage “On-Top Plasty” for Thumb Polydactyly With a Floating Ulnar Thumb
Authors: Zhong Wenyao , Tian Wen , Sun Liying , Yin Yuehan , Zhang Nan
Published: August 2020

We present 3 cases of thumb polydactyly treated with a 2-stage “on-top plasty” technique. For all the 3 cases, the ulnar thumbs floated in the first web with a skin pedicle, and the radial thumbs presented hypoplasia of different degree. We designed a 2-stage “on-top plasty” technique. The first operation included transplantation of the ulnar floating thumb and construction of skin tube containing the neurovascular bundle. When followed up after the first operation, there was no vascular compromise, and all union was achieved. At the time of the second operation, the skin tube was opened up, the neurovascular bundle was transposed to the reconstructed thumb, and the first web plasty was performed. At the final follow-up, 3 cases showed acceptable results both cosmetically and functionally.
Understanding Eunice Foote's 1856 experiments: heat absorption by atmospheric gases
Authors: Ortiz Joseph D. , Jackson Roland
Published: August 2020

The contribution of Eunice Foote (1819–1888) to early understanding of the relationship between atmospheric gases and climate change has become a focus of interest in the scholarly community and more widely on social media. In this article we offer a detailed interpretation of both of her known published papers, focusing particularly on her first and most significant paper of 1856, in which she related changes in the types and amounts of atmospheric gases, including carbon dioxide, to warming and changes in climate. We trace the derivation of her ideas and explore how she constructed, carried out, and interpreted her experiments.
Microfluidic monitoring of the growth of individual hyphae in confined environments
Authors: Baranger Claire , Fayeulle Antoine , Le Goff Anne
Published: August 2020

Soil fungi have the ability to form large mycelial networks. They rely on the resources available in the soil to produce biomass and are able to degrade complex biomolecules. Some of them can even degrade recalcitrant organic pollutants and are considered as promising candidates for soil bioremediation strategies. However, the success of this approach depends on the ability of fungi to colonize the soil matrix, where they encounter spatial and temporal variations of confinement, humidity and nutrient concentration. In this paper, we present a study of fungal growth at the scale of single hyphae in a microfluidic device, allowing fine control of nutrient and water supply. Time-lapse microscopy allowed simultaneous monitoring of the growth of dozens of hyphae of
Talaromyces helicus
, a soil isolate, and of the model fungus
Neurospora crassa
through parallel microchannels. The distributions of growth velocity obtained for each strain were compared with measurements obtained in macroscopic solid culture. For the two strains used in the study, confinement caused the growth velocity to drop in comparison with unconfined experiments. In addition,
N. crassa
was also limited in its growth by the nutrient supply, while the microfluidic culture conditions seemed better suited for
T. helicus
. Qualitative observations of fungi growing in microfluidic chambers without lateral confinement also revealed that side walls influence the branching behaviour of hyphae. This study is one of the first to consider the confinement degree within soil microporosities as a key factor of fungal growth, and to address its effect, along with physicochemical parameters, on soil colonization, notably for bioremediation purposes.
The use of yank-time signal as an alternative to identify kinematic events and define phases in human countermovement jumping
Authors: Sahrom Sofyan B. , Wilkie Jodie C. , Nosaka Kazunori , Blazevich Anthony J.
Published: August 2020

Detailed examinations of both the movement and muscle activation patterns used by animals and humans to complete complex tasks are difficult to obtain in many environments. Therefore, the ability to infer movement and muscle activation patterns after capture of a single set of easily obtained data is highly sought after. One possible solution to this problem is to capture force-time data through the use of appropriate transducers, then interrogate the signal's derivative, the yank-time signal, which amplifies, and thus highlights, temporal force-time changes. Because the countermovement vertical jump (CMJ) is a complex movement that has been well studied in humans, it provides an excellent preliminary model to test the validity of this solution. The aim of the present study was therefore to explore the use of yank-time signal, derived from vertical ground reaction force-time data, to identify and describe important kinematic (captured using three-dimensional motion analysis) and kinetic events in the CMJ, and to relate these to possible muscle activation (electromyography) events that underpin them. It was found that the yank-time signal could be used to accurately identify several key events during the CMJ that are likely to be missed or misidentified when only force-time data are inspected, including the first instances of joint flexion and centre of mass movement. Four different jump profiles (i.e. kinematic patterns) were inferred from the yank-time data, which were linked to different patterns of muscle activation. Therefore, yank-time signal interrogation provides a viable method of estimating kinematic patterns and muscle activation strategies in complex human movements.
Synthetic soil crusts against green-desert transitions: a spatial model
Authors: Vidiella Blai , Sardanyés Josep , Solé Ricard V.
Published: August 2020

Semiarid ecosystems are threatened by global warming due to longer dehydration times and increasing soil degradation. Mounting evidence indicates that, given the current trends, drylands are likely to expand and possibly experience catastrophic shifts from vegetated to desert states. Here, we explore a recent suggestion based on the concept of ecosystem terraformation, where a synthetic organism is used to counterbalance some of the nonlinear effects causing the presence of such tipping points. Using an explicit spatial model incorporating facilitation and considering a simplification of states found in semiarid ecosystems including vegetation, fertile and desert soil, we investigate how engineered microorganisms can shape the fate of these ecosystems. Specifically, two different, but complementary, terraformation strategies are proposed:Cooperation-based:C-terraformation; andDispersion-based:D-terraformation. The first strategy involves the use of soil synthetic microorganisms to introduce cooperative loops (facilitation) with the vegetation. The second one involves the introduction of engineered microorganisms improving their dispersal capacity, thus facilitating the transition from desert to fertile soil. We show that small modifications enhancing cooperative loops can effectively modify the aridity level of the critical transition found at increasing soil degradation rates, also identifying a stronger protection against soil degradation by using theD-terraformation strategy. The same results are found in a mean-field model providing insights into the transitions and dynamics tied to these terraformation strategies. The potential consequences and extensions of these models are discussed.
Selection for reduced fear in red junglefowl changes brain composition and affects fear memory
Authors: Katajamaa Rebecca , Jensen Per
Published: August 2020

Brain size reduction is a common trait in domesticated species when compared to wild conspecifics. This reduction can happen through changes in individual brain regions as a response to selection on specific behaviours. We selected red junglefowl for 10 generations for diverging levels of fear towards humans and measured brain size and composition as well as habituation learning and conditioned place preference learning in young chicks. Brain size relative to body size as well as brainstem region size relative to whole brain size were significantly smaller in chicks selected for low fear of humans compared to chicks selected for high fear of humans. However, when including allometric effects in the model, these differences disappear but a tendency towards larger cerebra in low-fear chickens remains. Low-fear line chicks habituated more effectively to a fearful stimulus with prior experience of that same stimulus, whereas high-fear line chicks with previous experience of the stimulus had a response similar to naive chicks. The phenotypical changes are in line with previously described effects of domestication.