bluuebunny/crossref_metadata_2025 huggingface dataset:
Coming of Age in Postwar Germany: Young Women’s Search for New Emotional Subjectivities, 1946–50
Authors: Sahrakorpi Tiia , Watton Cherish
Published: January 2022

During the Allied occupation of Germany, educators asked students to write about their feelings and experiences of youth before and after the Second World War. This article uses Abitur and Reifeprüfung examination essays written by young German women, between the ages of fourteen and twenty-three, to explore how they performed and represented their emotional subjectivities in early postwar Berlin. First, it examines how young women used selective strategies of forgetting and remembering to repress their troubling emotional memories of the regime. Second it explores how women achieved some level of psychic comfort, through a selective remembering of their home lives and Bund Deutsche Mädel experiences by developing different emotional coping mechanisms. The article argues that young women’s emotional renegotiation was not a passive process as previously thought, but rather based on young women’s active and astute reading of the postwar emotional climate. Subjecting these emotional subjectivities to greater attention elucidates a key, but hitherto underexplored, stage in these young people’s lives.
Numerical simulations of the random angular momentum in convection: Implications for supergiant collapse to form black holes
Authors: Antoni Andrea , Quataert Eliot
Published: January 2022

During the core collapse of massive stars that do not undergo a canonical energetic explosion, some of the hydrogen envelope of a red supergiant (RSG) progenitor may infall on to the newborn black hole (BH). Within the athena++ framework, we perform 3D, hydrodynamical simulations of idealized models of supergiant convection and collapse in order to assess whether the infall of the convective envelope can give rise to rotationally supported material, even if the star has zero angular momentum overall. Our dimension-less, polytropic models are applicable to the optically thick hydrogen envelope of non-rotating RSGs and cover a factor of 20 in stellar radius. At all radii, the specific angular momentum due to random convective flows implies associated circularization radii of 10–1500 times the innermost stable circular orbit of the BH. During collapse, the angular momentum vector of the convective flows is approximately conserved and is slowly varying on the time-scale relevant to forming discs at small radii. Our results indicate that otherwise failed explosions of RSGs lead to the formation of rotationally supported flows that are capable of driving outflows to large radii and powering observable transients. When the BH is able to accrete most of the hydrogen envelope, the final BH spin parameter is ∼ 0.5, even though the star is non-rotating. For fractional accretion of the envelope, the spin parameter is generally lower and never exceeds 0.8. We discuss the implications of our results for transients produced by RSG collapse to a black hole.
Early-stage Triple-negative Breast Cancer: Time to Optimize Personalized Strategies
Authors: Abuhadra Nour , Stecklein Shane , Sharma Priyanka , Moulder Stacy
Published: January 2022

Triple-negative breast cancer (TNBC) accounts for approximately 15%-20% of breast cancers diagnosed worldwide, which amounts to almost 200 000 cases each year. Although historically TNBC is considered difficult to treat with a poor prognosis, there is emerging evidence showing excellent response rates in a subset of TNBC patients. Attempts to de-escalate chemotherapy in hormone-receptor-positive (HR+) and HER2-neu amplified breast cancer subtypes have been successful. At present, robust strategies to personalize therapy in early-stage TNBC do not exist, and despite excellent response rates in a subset of patients, all patients are exposed to the same several cycles of cytotoxic chemotherapy. Personalizing therapy in TNBC represents a challenge due to the scarcity of treatment options outside of cytotoxic chemotherapy and limited predictive and prognostic biomarkers to tailor treatment. Recent developments in understanding TNBC biology have sparked interest in exploring treatment optimization and personalization with the goal of achieving excellent response rates and long-term clinical outcomes, while simultaneously reducing physical, psychological, and financial toxicities for select patients. Here, we provide an update on the current evidence to support future studies examining de-escalating chemotherapy in patients with low-risk TNBC and adjuvant intensification strategies to improve outcomes for patients who are at high risk for systemic failure despite current standard-of-care treatments.
The Impact of Tobamovirus Infection on Root Development Involves Induction of Auxin Response Factor 10a in Tomato
Authors: Vaisman Michael , Hak Hagit , Arazi Tzahi , Spiegelman Ziv
Published: January 2022

Plant viruses cause systemic diseases that severely impair plant growth and development. While the accumulation of viruses in the root system has long been established, little is known as to how viruses affect root architecture. Here, we examined how the emerging tobamovirus, tomato brown rugose fruit virus (ToBRFV), alters root development in tomato. We found that ToBRFV and tobacco mosaic virus both invaded root systems during the first week of infection. ToBRFV infection of tomato plants resulted in a significant decrease in root biomass and elongation and root-to-shoot ratio and a marked suppression of root branching. Mutation in RNA-dependent RNA polymerase 6 increased the susceptibility of tomato plants to ToBRFV, resulting in severe reduction of various root growth parameters including root branching. Viral root symptoms were associated with the accumulation of auxin response factor 10a (SlARF10a) transcript, a homolog of Arabidopsis ARF10, a known suppressor of lateral root development. Interestingly, loss-of-function mutation in SlARF10a moderated the effect of ToBRFV on root branching. In contrast, downregulation of sly-miR160a, which targets SlARF10a, was associated with constitutive suppression root branching independent of viral infection. In addition, overexpression of a microRNA-insensitive mutant of SlARF10a mimicked the effect of ToBRFV on root development, suggesting a specific role for SlARF10a in ToBRFV-mediated suppression of root branching. Taken together, our results provide new insights into the impact of tobamoviruses on root development and the role of ARF10a in the suppression of root branching in tomato.
Parkinson’s Disease Medication Administration During a Care Transition: The Impact of Interprofessional Team Simulation on Student Competency, Comfort, and Knowledge
Authors: Ellis Diane M. , Hickey Shelley , Prieto Patricia , McLaughlin Carlene , Felgoise Stephanie H. , Becker Michael , O’Connor Melissa , Puleo Madison , Reddy Tara , Markey Danielle , Kim Lydia , Bernhardt Paul W.
Published: January 2022

AIM

This study investigated the impact of an interprofessional mock code on students’ comfort and competency related to Parkinson’s disease (PD) medication administration during care transitions.

BACKGROUD

Patients with PD are at increased risk for medication errors during hospitalization. Individualization of PD medication creates vulnerability during care transitions.

METHOD

Four interprofessional groups took part in this study: baccalaureate degree senior nursing students (n = 113), master’s level nurse anesthesia students (n = 35), doctor of osteopathic medicine fourth-year students (n = 32), and doctor of clinical psychology fourth-year students (n = 22). Groups participated in an unfolding case study simulation involving a mock code with a focus on the omission of time-sensitive PD medication. Pre- and postsimulation test results were compared.

RESULTS

Findings indicated an increased understanding among three of the four groups relating to medication timing during care transitions.

CONCLUSION

All groups improved with respect to perceived comfort and competency.
A Pilot Randomized Controlled Trial of Virtual Reality Distraction to Reduce Procedural Pain During Subcutaneous Port Access in Children and Adolescents With Cancer
Authors: Hundert Amos S. , Birnie Kathryn A. , Abla Oussama , Positano Karyn , Cassiani Celia , Lloyd Sarah , Tiessen Petra Hroch , Lalloo Chitra , Jibb Lindsay A. , Stinson Jennifer
Published: January 2022

Objectives:

We aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. We also aimed to estimate preliminary treatment effects of VR compared with an active distraction control (iPad).

Materials and Methods:

A single-site pilot randomized controlled trial comparing VR to iPad distraction was conducted. Eligible children and adolescents were aged 8 to 18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using preprocedure scores as covariates.

Results:

Twenty participants (mean age 12 y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children and adolescents (62%) participated, and 1 withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared with the iPad group. Fear was similar across groups, with ~60% of the sample indicating no fear.

Discussion:

VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared with iPad distraction. These data will inform design of a future full-scale randomized controlled trial.
Declining trends in Medicare physician reimbursements for surgical procedures in orthopaedic oncology from 2002 to 2018: a retrospective review of payment data
Authors: Malik Azeem Tariq , Alexander John H. , Voskuil Ryan T. , Khan Safdar N. , Scharschmidt Thomas J.
Published: January 2022

Background:

As the United States (US) healthcare system evolves towards cost-containment and value-based approaches, evaluating trends in procedure reimbursements will be critical for assessing and ensuring financial stability of highly specialized fields, such as orthopaedic oncology.

Methods:

The Medicare Physician Fee Schedule (MPFS) look-up tool was accessed through the official Center for Medicaid and Medicare Services website and used to retrieve average reimbursement rates for 28 common orthopaedic oncologic procedures (radical resections of soft tumors, bone tumors, and prophylactic treatment, nailing, or pinning) from 2002 to 2018. All reimbursement data were adjusted for inflation to 2018 dollars. For each Current Procedural Terminology (CPT) code, average reimbursement percentage change from 2002 to 2018 was calculated.

Results:

Based on the included codes, physician payment data for 28 surgical procedures from 2002 to 2018 were retrieved from the MPFS database. After adjusting all data for inflation, the average reimbursement for all included procedures decreased by 9.9% from 2002 to 2018, representing an estimated average decrease of 1.1% every couple of years. Reimbursement percentage decreases were the most significant prior to the Medicare Access and CHIP Reauthorization Act (MACRA), with reimbursements decreasing by an average of 5.8% from 2002 to 2014. However, reimbursement rates still declined by an average of 4.3% from 2014 to 2018 (after MACRA).

Discussion:

Reimbursements for orthopaedic oncologic procedures have steadily decreased over time. With orthopaedic oncology being a highly specialized field with few practicing providers, health policy makers need to understand the financial implications of the declining reimbursement rates to ensure financial stability and viability of the specialty.

Level of Evidence:

Level III.
Circular BANP knockdown inhibits the malignant progression of residual hepatocellular carcinoma after insufficient radiofrequency ablation
Authors: Li Guoming , Kong Jian , Dong Shuying , Niu Haigang , Wu Shilun , Sun Wenbing
Published: January 2022

Background:

Circular RNAs (circRNAs) are endogenous non-coding RNAs, some of which have pathological roles. The current study aimed to explore the role of circRNA BTG3-associated nuclear protein (circ-BANP) binding with let-7f-5p and its regulation of the toll-like receptor 4 (TLR4)/signal transducer and activator of transcription 3 (STAT3) signaling pathway in residual hepatocellular carcinoma (HCC) after insufficient radiofrequency ablation (RFA).

Methods:

Circ-BANP, let-7f-5p, and TLR4 expressions in HCC samples were assessed using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Western blotting. Bioinformatics prediction, RNA pull-down assay, and dual luciferase reporter gene assay were used to analyze the relationships among circ-BANP, let-7f-5p, and TLR4. Huh7 cells were used to generate an in vitro model of residual HCC, defined as Huh7-H cells, which were transfected with either a plasmid or the sequence of circ-BANP, let-7f-5p, or TLR4. Expression of circ-BANP, let-7f-5p, and TLR4 mRNA was determined by RT-qPCR. TLR4, STAT3, p-STAT3, vascular endothelial growth factor A, vascular endothelial growth factor receptor-2, and epithelial-mesenchymal transformation (EMT)-related factors proteins were determined by Western blotting. Cell proliferation was determined by cell counting kit-8 and 5-Ethynyl-2’-deoxyuridine (EdU) assay and cell migration and invasion by Transwell assay. Animal studies were performed by inducing xenograft tumors in nude mice.

Results:

Circ-BANP and TLR4 mRNAs were upregulated in HCC tissues (the fold change for circ-BANP was 1.958 and that for TLR4 was 1.736 relative to para-tumors) and expression further increased following insufficient RFA (fold change for circ- BANP was 2.407 and that of TLR4 was 2.224 relative to para-tumors). Expression of let-7f-5p showed an opposite tendency (fold change for let-7f-5p in HCC tissues was 0.491 and that in tumors after insufficient RFA was 0.300 relative to para-tumors). Competitive binding of circ-BANP to let-7f-5p was demonstrated and TLR4 was identified as a target of let-7f-5p (P < 0.01). Knockdown of circ-BANP or elevation of let-7f-5p expression inhibited the TLR4/STAT3 signaling pathway, proliferation, invasion, migration, angiogenesis, and EMT in Huh7 and Huh7-H cells (P < 0.01). The effects induced by circ-BANP knockdown were reversed by let-7f-5p inhibition. Overexpression of TLR4 reversed the impact of let-7f-5p upregulation on the cells (P < 0.01). Silencing of circ-BANP inhibited the in vivo growth of residual HCC cells after insufficient RFA (P < 0.01).

Conclusions:

Knockdown of circ-BANP upregulated let-7f-5p to inhibit proliferation, migration, and EMT formation in residual HCC remaining after insufficient RFA. Effects occur via regulation of the TLR4/STAT3 signaling pathway.
Population Pharmacokinetic Properties of Omecamtiv Mecarbil in Healthy Subjects and Patients With Heart Failure With Reduced Ejection Fraction
Authors: Chen Po-Wei , Trivedi Ashit , Lee Edward , Dutta Sandeep , Ahamadi Malidi
Published: January 2022

Omecamtiv mecarbil is a small molecule that has been shown to improve cardiac function in patients with heart failure (HF) with reduced ejection fraction and is currently being developed as an oral modified release tablet for subjects with chronic HF. The objectives of this study were to analyze the pharmacokinetic (PK) properties of omecamtiv mecarbil and to investigate the effects of potential covariates on pertinent PK parameters using population PK modeling of data from 3 clinical trials in healthy subjects (n = 85) and 3 clinical trials in patients with HF (n = 4261). The population PK analysis was performed using a nonlinear mixed effects modeling approach. Omecamtiv mecarbil has a clearance of 11.7 L/h (0.701% relative standard error) and a central volume distribution of 275 L (2.12% relative standard error). The estimated half-life of omecamtiv mecarbil was 33 hours. Body weight and estimated glomerular filtration rate were significant covariates, but their effect on exposure was modest and lacked clinical relevance. Additional covariates, including sex, race, bilirubin, albumin, concomitant medications, New York Heart Association Functional Classification, N-terminal-pro hormone B-type natriuretic peptide, troponin I, creatine kinase MB, serum hemoglobin, tablet formulation, aspartate aminotransferase, and serum urea, were tested and found to have no impact on omecamtiv mecarbil exposures. The results of this integrated evaluation of the impact of covariates on the systemic exposure of omecamtiv mecarbil suggest that dose adjustment is not required for the studied subpopulations of patients with HF.
Assisted Living and Medication Adherence in Super-aged Patients With Heart Failure in the Japanese Population
Authors: Kawada Kei , Kubo Toru , Ishida Tomoaki , Jobu Kohei , Morisawa Shumpei , Hamada Tomoyuki , Baba Yuiti , Kawai Kazuya , Nakaoka Yoko , Yabe Toshikazu , Furuno Takashi , Yamada Eisuke , Fukuda Hitoshi , Ohta Tsuyoshi , Hayashi Toshinobu , Kitaoka Hiroaki , Miyamura Mitsuhiko
Published: January 2022

Poor adherence to medication in patients with heart failure (HF) is associated with poor clinical outcomes. Although social support has been reported to improve medication adherence in patients with HF, the detailed underlying mechanism of this association is unclear. This study investigated appropriate social support types to ensure medication adherence, as well as patient characteristics that benefit from such social support in patients with HF. This was a retrospective observational study investigating the association of social support with medication adherence in 824 patients with HF who were registered in a prospective multicenter database. First, we analyzed the association between social support types and poor medication adherence leading to hospitalization. An interaction analysis was performed to detect patients' characteristics that benefited most from social support in terms of medical adherence. Fifty patients (6.1%) were hospitalized for poor adherence to medications. Multivariable analysis revealed that not receiving assisted living, which was defined as having supporting individuals at least once a week, was independently associated with poor medication adherence–related hospitalization. An interaction analysis revealed that patients with dementia benefited from assisted living significantly, whereas male patients or current smokers did not. Summarily, assisted living at least once a week was appropriate for improving medication adherence in patients with HF and was particularly effective in patients with dementia. Performed in a super-aging region in Japan, this study may also suggest the relevance of social support in preventing HF exacerbation in other developed countries that will experience an aging society in the near future.
EXUDATIVE RETINAL DETACHMENT AFTER INTRAVITREAL BROLUCIZUMAB INJECTION
Authors: Betsch Devin M. , Sarraf David , Francisconi Carolina L. M.
Published: January 2022

Purpose:

To report an unusual case of a patient who presented with intraocular inflammation (IOI) and an exudative retinal detachment after first brolucizumab injection and to compare this case to the existing literature.

Methods:

An 80-year-old woman being treated for neovascular age-related macular degeneration presented 11 days after her first intravitreal injection of brolucizumab with IOI and an exudative retinal detachment. She was treated with systemic and topical steroids. The patient's chart was thoroughly reviewed, and notes were made on visual acuities and ocular examination findings at each relevant visit. Optical coherence tomography and ultra-widefield fluorescein angiography (UWFA) images were taken across multiple timepoints.

Results:

The patient's IOI and exudative retinal detachment resolved three weeks after brolucizumab injection. In the literature, the incidence of IOI has been reported to be higher with brolucizumab versus aflibercept, but most of these cases were considered to be mild to moderate in severity. More recently, reports of severe IOI and retinal vasculitis associated with brolucizumab have been published in postmarketing surveillance articles.

Conclusion:

To the authors' knowledge, this is the first report of exudative retinal detachment after intravitreal brolucizumab injection. As the experience with this new drug continues to grow, reports of these events are critical to increase the understanding, so that future management strategies can be developed to improve patient outcomes.
A novel homemade simulator for training and assessing competency of totally implantable venous access port implantation via venous cutdown
Authors: Chen Chia-Lin , Jen-Huei Yeh Vicky , Yeh Yi-Ting
Published: January 2022

Total implantable venous access port (TIVAP) by cephalic vein cutdown (CVCD) is one of the first procedures surgery residents can be performed independently under supervision. There is currently a lack of affordable simulators for teaching and assessing TIVAP competency to improve patient safety. A panel of 10 experts divided the TIVAP by CVCD procedure into 9 steps. A homemade, low-cost ($3 USD) simulator was then designed for practicing standardized procedural steps in the context of a simulation-based mastery learning course. Residents were given a simulator for at-home practice and completed a survey evaluating the simulator and their learning experience. Twenty-eight first-year surgery residents participated in the course and completed the survey. They were highly satisfied with the simulator (mean score = 8.7 of 10) and generally agreed with its anatomical appearance and functional fidelity. They also appreciated the educational value of using this simulator to learn and practice basic techniques and procedural steps. Our novel, homemade simulator of CVCD TIVAP implantation is a cost-effective way of achieving procedural competence of a basic operation for inexperienced surgery residents. We envision the same principle can be applied to other procedures to enhance resident education.
Licorice consumption causing severe hypokalemia-induced paresis
Authors: Bettini Luca , Parent Thibault , Serratrice Jacques
Published: January 2022

Rationale:

Licorice ingestion presenting with hypokalemia has been widely reported, yet life-threatening hypokalemia associated with both, paresis and electrocardiogram abnormalities secondary to licorice infusion tea, is rare.

Patient concerns:

We describe the case of an 84-year-old woman who presented with left-hand paresis, fatigue, and hypertension.

Diagnoses:

Anamnesis, low plasma renin, and aldosterone levels confirmed pseudo-hyperaldosteronism secondary to licorice consumption.

Interventions:

The patient was first treated with continuous intravenous potassium and magnesium and finally with spironolactone.

Outcomes:

After electrolyte correction (potassium, magnesium), electrocardiogram findings became normal, and paresis disappeared.

Lessons:

By presenting this case, we remind clinicians that intoxication should be considered in any patient with unexplained hypokalemia. Medical history taking, and rapid potassium correction are essential for good prognosis.
Understanding the Tradeoffs Between Travel Burden and Quality of Care for In-center Hemodialysis Patients
Authors: Salerno Stephen , Gremel Garrett , Dahlerus Claudia , Han Peisong , Affholter Jordan , Tong Lan , Wisniewski Karen , Roach Jesse , Li Yi , Hirth Richard A.
Published: January 2022

Background:

Renal dialysis is a lifesaving but demanding therapy, requiring 3 weekly treatments of multiple-hour durations. Though travel times and quality of care vary across facilities, the extent to which patients are willing and able to engage in weighing tradeoffs is not known. Since 2015, Medicare has summarized and reported quality data for dialysis facilities using a star rating system. We estimate choice models to assess the relative roles of travel distance and quality of care in explaining patient choice of facility.

Research Design:

Using national data on 2 million patient-years from 7198 dialysis facilities and 4-star rating releases, we estimated travel distance to patients’ closest facilities, incremental travel distance to the next closest facility with a higher star rating, and the difference in ratings between these 2 facilities. We fit mixed effects logistic regression models predicting whether patients dialyzed at their closest facilities.

Results:

Median travel distance was 4 times that in rural (10.9 miles) versus urban areas (2.6 miles). Higher differences in rating [odds ratios (OR): 0.56; 95% confidence interval (CI): 0.50–0.62] and greater area deprivation (OR: 0.50; 95% CI: 0.48–0.53) were associated with lower odds of attending one’s closest facility. Stratified models were also fit based on urbanicity. For rural patients, excess travel was associated with higher odds of attending the closer facility (per 10 miles; OR: 1.05; 95% CI: 1.04–1.06). Star rating differences were associated with lower odds of receiving care from the closest facility among urban (OR: 0.57; 95% CI: 0.51–0.63) and rural patients (OR: 0.18; 95% CI: 0.08–0.44).

Conclusions:

Most dialysis patients have higher rated facilities located not much further than their closest facility, suggesting many patients could evaluate tradeoffs between distance and quality of care in where they receive dialysis. Our results show that such tradeoffs likely occur. Therefore, quality ratings such as the Dialysis Facility Compare (DFC) Star Rating may provide actionable information to patients and caregivers. However, we were not able to assess whether these associations reflect a causal effect of the Star Ratings on patient choice, as the Star Ratings served only as a marker of quality of care.
Pediatric Gastrointestinal Histopathology in Patients With Tetratricopeptide Repeat Domain 7A (TTC7A) Germline Mutations
Authors: Dannheim Katelyn , Ouahed Jodie , Field Michael , Snapper Scott , Raphael Bram P. , Glover Sarah C. , Bishop Phyllis R. , Bhesania Natalie , Kamin Daniel , Thiagarajah Jay , Goldsmith Jeffrey D.
Published: January 2022

Mutations in the tetratricopeptide repeat domain 7A (TTC7A) gene are a rare cause of congenital enteropathy that can result in significant morbidity. TTC7A deficiency leads to disruption of the intestinal epithelium. The histopathology of this condition has been partly described in case reports and clinical studies. This manuscript describes an in-depth investigation of the pediatric gastrointestinal pathology of the largest histologically examined cohort with confirmed TTC7A mutations reported to date and, for the first time, compared the findings to age-matched and sex-matched control patients with intestinal atresia not thought to be associated with TTC7A mutations. Hematoxylin and eosin–stained slides of endoscopically obtained mucosal biopsies and surgical resection specimens from 7 patients with known TTC7A mutations were examined retrospectively. The microscopic findings were found to be on a spectrum from atresia-predominant to those with predominantly epithelial abnormalities. Several unique histopathologic characteristics were observed when compared with controls. These included neutrophilic colitis and prominent lamina propria eosinophilia throughout the gastrointestinal tract. Striking architectural abnormalities of the epithelium were observed in 4 of the 7 patients. The 5 patients with intestinal atresia demonstrated hypertrophy and disorganization of the colonic muscularis mucosae accompanied by bland spindle cell nodules within the intestinal wall. The components of the latter were further elucidated using immunohistochemistry, and we subsequently hypothesize that they represent obliterated mucosa with remnants of the muscularis mucosae. Finally, atrophic gastritis was noted in 4 patients. In conclusion, the unique histopathologic characteristics of TTC7A mutation-associated enteropathy described herein more fully describe this novel disease entity in infants who present with congenital enteropathy or enterocolitis.
Minimally Invasive “Trocar-Free” Approach for Rear Mandibular Fractures Management
Authors: Abbate Vincenzo , Orabona Giovanni Dell’Aversana , Seidita Francesco , Bonavolontà Paola , Iaconetta Giorgio , Califano Luigi
Published: January 2022

The request of minimally invasive surgery is progressively expanding the indications of endoscopically assisted intraoral access for mandibular traumas. The aim of our study is to assess how much the use of the angled drill may affect the outcome of patients treated for rear mandibular fracture. In our retrospective case-control trial we enrolled 36 patients with mandibular rear fractures treated through endoscopically assisted intraoral access. Eighteen patients were treated by using an angled drill ‘‘trocar free,’’ and 18 treated by linear drills placed through trocars. Surgical times, hospitalization times (HT), and major complications rate were compared between the 2 groups. Group 1 showed a significant reduction in HT (1.72 versus 2.22 days, P = 0.024) and an increase in the surgical times (3.0 versus 2.53 hours, P = 0.019). Significant reduction of total amount of complication was seen in group 1 versus group 2 (P = 0.007). The ‘‘trocar free’’ approach allowed by angled drills, in our hands, greatly reduces the invasiveness of the surgery resulting in a significant reduction in HT and smaller share of vascular-nervous sequelae. Our results suggest the ‘‘trocar free’’ approach as a valuable choice when indicated for the treatment of rear mandibular fractures.
The Relationship of Hedonic Hunger With Depression and Physical Activity in Students of Faculty of Health Sciences
Authors: Uzun Akkaya Kamile , Uslu Burcu , Ateş Özcan Burcu
Published: January 2022

The study was conducted to examine the hedonic hunger, physical activity, and depression status of healthy university students and to reveal the relationship between these parameters. A total of 174 healthy university students were included in the study. Hedonic hunger responses were similar at different physical activity levels. When the relationship between individuals' hedonic hunger responses and intensity of depression was examined, it was found that there was a weak positive correlation between them. Hedonic hunger can have negative effects on university students' depression status. Taking precautions to improve nutrition and physical activity in university students can be effective in preventing this problem.
The Cutoff Point of Mid–Upper Arm Circumference in the Supine Position to Detect Malnutrition in Patients with Cancer
Authors: Khaira Fathiyyatul , Andayani Diyah Eka , Witjaksono Fiastuti
Published: January 2022

This study aimed to establish a cutoff point for detecting malnutrition for mid–upper arm circumference in the supine position. Data were collected from patients (n = 207) by medical records and anthropometric measurements. The cutoff point of the mid–upper arm circumference was obtained from the receiver operating characteristic curve and the highest Youden index. It was found that there is an agreement between mid–upper arm circumference in the standing and supine positions. The mid–upper arm circumference has a strong and significant correlation to body mass index. The mid–upper arm circumference of less than 23.4 cm can be used as an alternative measurement to body mass index for detecting malnutrition.
The Impact of Donor and Recipient Genetic Variation on Outcomes After Solid Organ Transplantation: A Scoping Review and Future Perspectives
Authors: Li Yanni , Nieuwenhuis Lianne M. , Keating Brendan J. , Festen Eleonora A.M. , de Meijer Vincent E.
Published: January 2022

At the outset of solid organ transplantation, genetic variation between donors and recipients was recognized as a major player in mechanisms such as allograft tolerance and rejection. Genome-wide association studies have been very successful in identifying novel variant-trait associations, but have been difficult to perform in the field of solid organ transplantation due to complex covariates, era effects, and poor statistical power for detecting donor-recipient interactions. To overcome a lack of statistical power, consortia such as the International Genetics and Translational Research in Transplantation Network have been established. Studies have focused on the consequences of genetic dissimilarities between donors and recipients and have reported associations between polymorphisms in candidate genes or their regulatory regions with transplantation outcomes. However, knowledge on the exact influence of genetic variation is limited due to a lack of comprehensive characterization and harmonization of recipients’ or donors’ phenotypes and validation using an experimental approach. Causal research in genetics has evolved from agnostic discovery in genome-wide association studies to functional annotation and clarification of underlying molecular mechanisms in translational studies. In this overview, we summarize how the recent advances and progresses in the field of genetics and genomics have improved the understanding of outcomes after solid organ transplantation.
Liver Transplantation for Hepatic Adenoma: A UNOS Database Analysis and Systematic Review of the Literature
Authors: Ziogas Ioannis A. , Tasoudis Panagiotis T. , Serifis Nikolaos , Alexopoulos Sophoclis P. , Montenovo Martin I. , Shingina Alexandra
Published: January 2022

Background.

Liver transplantation (LT) has been employed for hepatic adenoma (HA) on a case-oriented basis. We aimed to describe the characteristics, waitlist, and post-LT outcomes of patients requiring LT for HA.

Methods.

All patients listed or transplanted for HA in the United States were identified in the United Network for Organ Sharing (UNOS) database (1987–2020). A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.

Results.

A total of 199 HA patients were listed for LT in UNOS and the crude waitlist mortality was 9.0%. A total of 142 HA patients underwent LT; 118 of these were among those listed with an indication of HA who underwent LT, and 24 were diagnosed incidentally. Most did not experience hepatocellular carcinoma transformation (89.4%). Over a median follow-up of 62.9 mo, death was reported in 18.3%. The 1-, 3-, and 5-y patient survival rates were 94.2%, 89.7%, and 86.3% in the UNOS cohort. The systematic review yielded 61 articles reporting on 99 nonoverlapping patients undergoing LT for HA and 2 articles reporting on multicenter studies. The most common LT indications were suspected malignancy (39.7%), unresectable HA (31.7%), and increasing size (27.0%), whereas 53.1% had glycogen storage disease. Over a median follow-up of 36.5 mo, death was reported in 6.0% (n=5/84). The 1-, 3-, and 5-y patient survival rates were all 95.0% in the systematic review.

Conclusions.

LT for HA can lead to excellent long-term outcomes in well-selected patients. Prospective granular data are needed to develop more optimal selection criteria and further improve outcomes.
Differential word expression analyses highlight plague dynamics during the second pandemic
Authors: Barbieri Rémi , Nodari Riccardo , Signoli Michel , Epis Sara , Raoult Didier , Drancourt Michel
Published: January 2022

Research on the second plague pandemic that swept over Europe from the fourteenth to nineteenth centuries mainly relies on the exegesis of contemporary texts and is prone to interpretive bias. By leveraging certain bioinformatic tools routinely used in biology, we developed a quantitative lexicography of 32 texts describing two major plague outbreaks, using contemporary plague-unrelated texts as negative controls. Nested, network and category analyses of a 207-word pan-lexicome, comprising overrepresented terms in plague-related texts, indicated that ‘buboes' and ‘carbuncles' are words that were significantly associated with the plague and signalled an ectoparasite-borne plague. Moreover, plague-related words were associated with the terms ‘merchandise’, ‘movable’, ‘tatters', ‘bed’ and ‘clothes'. Analysing ancient texts using the method reported in this paper can certify plague-related historical records and indicate the particularities of each plague outbreak, which can inform on the potential sources for the causativeYersinia pestis.
Assessing the risk of vaccine-driven virulence evolution in SARS-CoV-2
Authors: Miller Ian F. , Metcalf C. Jessica E.
Published: January 2022

The evolution of SARS-CoV-2 virulence, or lethality, threatens to exacerbate the burden of COVID-19 on society. How might COVID-19 vaccines alter selection for increased SARS-CoV-2 virulence? Framing current evidence surrounding SARS-CoV-2 biology and COVID-19 vaccines in the context of evolutionary theory indicates that prospects for virulence evolution remain uncertain. However, differential effects of vaccinal immunity on transmission and disease severity between respiratory compartments could select for increased virulence. To bound expectations for this outcome, we analyse an evo-epidemiological model. Synthesizing model predictions with vaccine efficacy data, we conclude that while vaccine-driven virulence remains a theoretical possibility, the risk is low if vaccines provide sustained robust protection against infection. Furthermore, we found that any increases in transmission concomitant with increases in virulence would be unlikely to threaten prospects for herd immunity in a highly immunized population. Given that virulence evolution would nevertheless impact unvaccinated individuals and populations with low vaccination rates, it is important to achieve high vaccination rates worldwide and ensure that vaccinal immunity provides robust protection against both infection and disease, potentially through the use of booster doses.
A revised lower estimate of ozone columns during Earth’s oxygenated history
Authors: Cooke G. J. , Marsh D. R. , Walsh C. , Black B. , Lamarque J.-F.
Published: January 2022

The history of molecular oxygen (O
2
) in Earth’s atmosphere is still debated; however, geological evidence supports at least two major episodes where O
2
increased by an order of magnitude or more: the Great Oxidation Event (GOE) and the Neoproterozoic Oxidation Event. O
2
concentrations have likely fluctuated (between 10
−3
and 1.5 times the present atmospheric level) since the GOE ∼2.4 Gyr ago, resulting in a time-varying ozone (O
3
) layer. Using a three-dimensional chemistry-climate model, we simulate changes in O
3
in Earth’s atmosphere since the GOE and consider the implications for surface habitability, and glaciation during the Mesoproterozoic. We find lower O
3
columns (reduced by up to 4.68 times for a given O
2
level) compared to previous work; hence, higher fluxes of biologically harmful UV radiation would have reached the surface. Reduced O
3
leads to enhanced tropospheric production of the hydroxyl radical (OH) which then substantially reduces the lifetime of methane (CH
4
). We show that a CH
4
supported greenhouse effect during the Mesoproterozoic is highly unlikely. The reduced O
3
columns we simulate have important implications for astrobiological and terrestrial habitability, demonstrating the relevance of three-dimensional chemistry-climate simulations when assessing paleoclimates and the habitability of faraway worlds.
Constant stress arches and their design space
Authors: Lewis Wanda J.
Published: January 2022

It is generally accepted that an optimal arch has a funicular (moment-less) form and least weight. However, the feature of least weight restricts the design options and raises the question of durability of such structures. This study, building on the analytical form-finding approach presented in Lewis (2016.
Proc. R. Soc. A
472
, 20160019. (
doi:10.1098/rspa.2016.0019
)), proposes constant axial stress as a design criterion for smooth, two-pin arches that are moment-less under permanent (statistically prevalent) load. This approach ensures that no part of the structure becomes over-stressed under variable load (wind, snow and/or moving objects), relative to its other parts—a phenomenon observed in natural structures, such as trees, bones, shells. The theory considers a general case of an asymmetric arch, deriving the equation of its centre-line profile, horizontal reactions and varying cross-section area. The analysis of symmetric arches follows, and includes a solution for structures of least weight by supplying an equation for a volume-minimizing, span/rise ratio. The paper proposes a new concept, that of a design space controlled by two non-dimensional input parameters; their theoretical and practical limits define the existence of constant axial stress arches. It is shown that, for stand-alone arches, the design space reduces to a constraint relationship between constant stress and span/rise ratio.
Immigration dynamics of tropical and subtropical Southeast Asian limestone karst floras
Authors: Li Xiao-Qian , Xiang Xiao-Guo , Zhang Qiang , Jabbour Florian , Ortiz Rosa del C. , Erst Andrey S. , Li Zhen-Yu , Wang Wei
Published: January 2022

Ex situorigins and dispersal of taxa have played important roles in the assembly of island-like biodiversity hotspots. Insular limestone karsts in Southeast Asia are hotspots of biodiversity and endemism, but the immigration processes of their unique floras are still poorly known. Here, we used Gesneriaceae as a proxy to investigate the immigration dynamics of tropical and subtropical Southeast Asian karst floras. We present the most comprehensive phylogenetic analysis of the Old World gesneriads to date based on twelve loci. By estimating divergence times and reconstructing ancestral states (habitat, soil type and range), we found that immigration into subtropical Southeast Asian karst floras first occurred in the Early Miocene, with two peaks in the Early–Middle Miocene and the Pliocene–Early Pleistocene, whereas immigration into tropical Southeast Asian karsts initiated in the Late Eocene, with two peaks in the Late Oligocene and the Late Miocene. We also discover that Southeast Asian karst biodiversity comprises immigrant pre-adapted lineages and descendants from local acid soil ancestors, although niche shift from acid soil to karst in tropical Southeast Asian islands was lacking. This study advances our understanding of the historical assembly of Southeast Asian karst floras.
Severity of COVID-19 reinfection and associated risk factors: findings of a cross-sectional study in Bangladesh
Authors: Islam Md. Ziaul , Riaz Baizid Khoorshid , Akbar Ashrafi Shah Ali , Farjana Sharmin , Efa Syeda Sumaiya , Khan Mohammad Adnan
Published: January 2022

Background

COVID-19 reinfected patients suffer from diverse health consequences. Information on the severity of COVID-19 reinfection is scarce. The current study aimed to determine the proportion of COVID-19 reinfection and risk factors associated with its severity.

Methods

This cross-sectional study targeted all COVID-19 patients reported in May 2021 at the Health Information Unit (HIU) of the Directorate General of Health Services (DGHS) of Bangladesh. We identified 473 (1.14%) reinfected patients out of 41408 diagnosed cases by reviewing their medical records. Considering the selection criteria and informed consent, we enrolled 404 reinfected patients. Data were collected through telephone interviews and reviewing medical records using a semi-structured questionnaire and a checklist.

Results

The majority of the reinfected patients were urban residents (98.0%). Around 13.0% of reinfected patients had <90% oxygen saturation, and 64.0% had an interval of 3-6 months between two attacks. The severity of reinfection included asymptomatic (12.9%), mild (8.9%), moderate (66.3%), and severe (11.9%) forms of infection. An interval of 3-6 months between two attacks had less chance of having mild (AOR=0.031, ρ=0.000), moderate (AOR=0.132, ρ=0.017), and severe (AOR=0.059, ρ=0.002) infections. Patients who maintained physical distance had less chance of moderate-intensity reinfection (AOR=0.137, ρ=0.013), while the vaccinated patients had a higher chance of moderate (AOR=16.127, ρ=0.001) and severe (AOR=3.894, ρ=0.047) intensity reinfection.

Conclusion

To avert COVID-19 reinfection and its severity, patients should be vigilant about preventive practices even after recovery. The study suggests vibrant interventions aligned with exposure, physical distancing, vaccination, and comorbidities for mitigating reinfection.
A phase I study of oral vitamin D3 in boys with X-linked adrenoleukodystrophy
Authors: Van Haren Keith , Cunanan Kristen , Awani Avni , Gu Meng , Peña Dalia , Chromik Lindsay C. , Považan Michal , Rossi Nicole C. , Winterbottom Jennifer , Goodman Jordan , Sundaram Vandana , Raymond Gerald V , Cowan Tina , Enns Gregory M. , Waubant Emmanuelle , Steinman Lawrence , Barker Peter B. , Spielman Daniel , Fatemi Ali
Published: January 2022

Objective

Vitamin D status has been linked to risk of inflammatory brain lesions. We sought to assess the safety and pharmacokinetics of oral vitamin D dosing regimens in boys with X-linked adrenoleukodystrophy (ALD).

Methods

In this open-label, multi-center, phase I study, we enrolled 21 ALD males without brain lesions, aged 1.5 to 25 years to oral vitamin D supplementation for 12 months. Our primary outcome was attainment of plasma 25-hydroxyvitamin D levels in target range (40-80ng/ml) at 6 and 12 months. Secondary outcomes included safety and glutathione levels in brain and blood. Participants were initially assigned to a fixed dosing regimen starting at 2,000 IU daily, regardless of weight. Following a mid-study safety assessment, we modified the dosing regimen so all subsequent participants were assigned to a weight-stratified dosing regimen starting as low as 1,000 IU daily.

Results

Between October 2016 and June 2019, we recruited 21 participants (n=12 fixed dose; n=9 weight-stratified) with a median age and weight of 6.7 years and 20 kilograms. Most participants achieved target plasma vitamin D levels at 6 and 12 months regardless of dosing regimen. In the fixed dose regimen, 6 of 12 participants had asymptomatic elevation in urine calcium:creatinine or plasma 25-hydroxyvitamin D; no laboratory deviations occurred with the weight-stratified regimen. Glutathione levels increased between baseline and 12 months in the brain but not in the blood.

Conclusions

Our weight-stratified vitamin D dosing regimen was well-tolerated and achieved target 25-hydroxyvitamin D levels in most participants. Brain glutathione levels increased over the 12-month trial period.

Clinicaltrials.govidentifier

NCT02595489

Classification of Evidence

This study provides Class II evidence that a weight-stratified dosing regimen of vitamin D supplementation is safe, well-tolerated, and effective at achieving moderately high vitamin D levels in boys with ALD.

Sources of funding

NIH/NINDS K23NS087151