bluuebunny/crossref_metadata_2025 huggingface dataset:
Motivierende Rhythmen – „Beelitzer Musikgymnastik“ bei idiopathischem Parkinson
Authors: Gros Selma , Mainka Stefan
Published: April 2021

Musik animiert, motiviert und vereint – auch in der Therapie. Als Hinweisreiz oder „Cue“ wirkt sie dabei stark auf das motorische System. Doch welche Musik wähle ich in meiner Therapie aus? Passen meine Bewegungen überhaupt zum Rhythmus der Musik? Und wie lässt sich die Motivation zum selbstständigen Üben steigern?
Establishing Prediction Intervals for the SpeedWheel Acuity Test in Adults and Children
Authors: Luethy Magdalena Laura , Schötzau Andreas , Palmowski-Wolfe Anja
Published: April 2021

Background The SpeedWheel (SW) test is an objective test of visual acuity (VA) using suppression of the optokinetic nystagmus (OKN). Here, we established prediction intervals of the SW measures compared to Snellen acuity in adults and children.

Subjects and Methods In this prospective, single center study, subjects aged at least 4 years underwent testing of VA with SW, Landolt-C, and Tumbling-E symbols (Freiburg acuity test: FrACT-C, FrACT-E). Prediction intervals were established for SW compared to FrACT-C or -E and for FrACT-E compared to FrACT-C. Mixed linear effect models were applied for statistical analysis.

Results From 241 subjects, 471 eyes were included: median age 36 years, range 4 – 88 years, 43.6% male, 56.4% female. Eyes included were either healthy or had various underlying ophthalmic conditions. Prediction intervals for SW to estimate FrACT-C or -E acuity showed a similar range compared to the prediction interval of FrACT-C for the estimation of FrACT-E acuity. For each acuity step, there was no influence of age. Up to an SW acuity of 0.7 logMAR, 80% of the subjects had a FrACT-C acuity that was at most 1.6 logMAR lines below, and for an SW acuity of 1.0 logMAR, FrACT-C acuity was not worse than 4 logMAR lines. Prediction intervals for eyes with refractive error, cataract, visual field loss and retinal disease did not differ significantly from healthy eyes in contrast to eyes with amblyopia or multiple ophthalmic disorders. SW correlated well to FrACT tests and results of a previous study fell within our prediction estimates.

Conclusion Our prediction intervals for SW acuity may be used to estimate Snellen acuity (FrACT-C and -E) in the clinic in adults and children unable to cooperate in other acuity testing.
Patientensicherheit: Die Lasertherapie gehört zu den risikoreicheren Therapieoptionen in der Dermatologie
Authors: Lehmann L. , Hofmann S. , Dirschka T. , Lehmann P.
Published: April 2021

Seit der Erstbeschreibung von Lasern und den ersten Anwendungen in der Dermatologie hat die Lasertherapie innerhalb des dermatologischen therapeutischen Armamentariums enorm an Bedeutung zugenommen.

Da sie häufig bei ästhetischen Indikationen Anwendung findet, sind hohe Sicherheitsanforderungen zu gewährleisten, ansonsten kommt es zu unangenehmen juristischen Streitigkeiten. Eine retrospektive Analyse anhand der Fälle der Gutachterkammer für ärztliche Behandlungsfehler hat gezeigt, dass Lasertherapien zu den risikoreicheren therapeutischen Optionen in der Dermatologie gehören.
Cannabis sativa and Skin Health: Dissecting the Role of Phytocannabinoids
Authors: Martinelli Giulia , Magnavacca Andrea , Fumagalli Marco , DellʼAgli Mario , Piazza Stefano , Sangiovanni Enrico
Published: April 2021

The use of Cannabis sativa is currently recognized to ease certain types of chronic pain, reduce chemotherapy-induced nausea, and improve anxiety. Nevertheless, few studies highlighted the therapeutic potential of C. sativa extracts and related phytocannabinoids for a variety of widespread skin disorders including acne, atopic dermatitis, psoriasis, pruritus, and pain. This review summarized the current evidence on the effects of phytocannabinoids at the cutaneous level through the collection of in vitro, in vivo, and clinical studies published on PubMed, Scopus, Embase, and Web of Science until October 2020. Phytocannabinoids have demonstrated potential anti-inflammatory, antioxidant, anti-aging, and anti-acne properties by various mechanisms involving either CB1/2-dependent and independent pathways. Not only classical immune cells, but also several skin-specific actors, such as keratinocytes, fibroblasts, melanocytes, and
sebocytes, may represent a target for phytocannabinoids. Cannabidiol, the most investigated compound, revealed photoprotective, antioxidant, and anti-inflammatory mechanisms at the cutaneous level, while the possible impact on cell differentiation, especially in the case of psoriasis, would require further investigation. Animal models and pilot clinical studies supported the application of cannabidiol in inflammatory-based skin diseases. Also, one of the most promising applications of non-psychotropic phytocannabinoids is the treatment of seborrheic disorders, especially acne. In conclusion, the incomplete knowledge of the role of the endocannabinoid system in skin disorders emerged as an important limit for pharmacological investigations. Moreover, the limited studies conducted on C. sativa extracts suggested a higher potency than single phytocannabinoids, thus stimulating new research on phytocannabinoid interaction.
Association between Adherence to SSRI Treatment and Mortality among Individuals with Metabolic Syndrome Components
Authors: Avrahamy Hamutal , Shoval Gal , Hoshen Moshe , Balicer Ran D. , Kamhi-Nesher Shiri , Zalsman Gil , Weizman Abraham , Krivoy Amir
Published: April 2021

Introduction Depression and anxiety have been associated with type 2 diabetes mellitus and metabolic syndrome, major causes of cardiovascular morbidity and mortality. The effect of antidepressants in this association is unknown. This study aimed to examine the association between adherence to selective serotonin receptor inhibitors (SSRIs) and all-cause mortality among individuals with metabolic syndrome components (hypertension, obesity, and diabetes mellitus).

Methods Data on 201 777 patients who were prescribed SSRIs during the years 2008–2011 were analyzed retrospectively. Adherence was measured using prescription purchase records. The moderating effect of SSRI and statin adherence on the association between metabolic syndrome load and mortality hazard risk (HR) during the study period were analyzed. The Cox-proportional hazard model adjusted to background variables was used to this end.

Results During the study period, the maximal metabolic load was associated with mortality HR=1.89 (95% CI: 1.79–2) compared to participants without metabolic risk factors. A slight reduction in mortality HR was demonstrated among those with low and moderate SSRI adherence rates. Adherence to statins was negatively associated with the risk of mortality across all levels of adherence. A significant association (r=0.214, p<0.01) was found between adherence to statins and adherence to SSRIs, with higher rates of adherence to statins across all metabolic load categories.

Discussion While a high metabolic load is associated with a higher risk of mortality, adherence to SSRIs only partially moderated the risk of mortality, in contrast to the protective effect of statins. Adherence differences to statins and SSRIs among individuals prescribed both medications merit further investigation.
Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India
Authors: Afsar Mohammed , Shukla Dhaval , Bhaskarapillai Binukumar , Rajeswaran Jamuna
Published: April 2021

Objective Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI.

Materials and Methods The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention.

Statistical Analysis Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test.

Results The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved.

Conclusion CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.
Traumatic Brachial Plexus Palsy in Children: Long-Term Outcome and Strategy of Reconstruction
Authors: El-Gammal Tarek A. , El-Sayed Amr , Kotb Mohamed M. , Saleh Waleed Riad , Ragheb Yasser Farouk , El-Refai Omar , Romeih Mohamed Abdel-Hameed , El-Gammal Yousif T.
Published: April 2021

Background Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear.

Methods In total, 52 children with surgically treated traumatic brachial plexus injuries, excluding Erb's palsy, were reviewed after a minimum follow-up of 2 years. All children except nine were males, with an average age at surgery of 8 years. Forty-five children had exclusive supraclavicular plexus injuries. Twenty-one of them (46%) had two or more root avulsions. Seven children (13.5%) had infraclavicular plexus injuries. Time from trauma to surgery varied from 1 to 15 months (mean = 4.7 months). Extraplexal neurotization was the most common surgical technique used.

Results Shoulder abduction and external rotation were restored to an average of 83 and 26 degrees, respectively. Elbow flexion and extension were restored to grade ≥3 in 96 and 91.5% of cases, respectively. Finger flexion and extension were restored to grade ≥4 in 29 and 32% of cases, respectively. Wrist flexion and extension were restored to grade ≥4 in 21 and 27% of cases, respectively. Results of neurotization were superior to those of neurolysis and nerve grafting. Among the 24 children with insensate hands, 20 (83.3%) recovered S3 sensation, 3 recovered S2, and 1 recovered S1. No case complained of neuropathic pain. Functional recovery correlated negatively but insignificantly with the age at surgery and time from injury to surgery.

Conclusion Brachial plexus injuries in children are associated with a high incidence root avulsions and no pain. Neurotization is frequently required and the outcome is not significantly affected by the delay in surgery. In total plexus injuries, some useful hand function can be restored, and management should follow that of obstetric palsy and be focused on innervating the medial cord.
Platelet Function in Viral Immunity and SARS-CoV-2 Infection
Authors: Allaoui Afaf , Khawaja Akif A. , Badad Oussama , Naciri Mariam , Lordkipanidzé Marie , Guessous Fadila , Zaid Younes
Published: April 2021

Platelets, as nonnucleated blood components, are classically recognized for their pivotal role in hemostasis. In recent years, however, accumulating evidence points to a nonhemostatic role for platelets, as active participants in the inflammatory and immune responses to microbial organisms in infectious diseases. This stems from the ability of activated platelets to secrete a plethora of immunomodulatory cytokines and chemokines, as well as directly interplaying with viral receptors. While much attention has been given to the role of the cytokine storm in the severity of the coronavirus disease 2019 (COVID-19), less is known about the contribution of platelets to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we give a brief overview on the platelet contribution to antiviral immunity and response during SARS-CoV-2 infection.
Different Anticoagulant Regimens, Mortality, and Bleeding in Hospitalized Patients with COVID-19: A Systematic Review and an Updated Meta-Analysis
Authors: Parisi Roberta , Costanzo Simona , Di Castelnuovo Augusto , de Gaetano Giovanni , Donati Maria Benedetta , Iacoviello Licia
Published: April 2021

We conducted a systematic review and a meta-analysis to assess the association of anticoagulants and their dosage with in-hospital all-cause mortality in COVID-19 patients. Articles were retrieved until January 8, 2021, by searching in seven electronic databases. The main outcome was all-cause mortality occurred during hospitalization. Data were combined using the general variance-based method on the effect estimate for each study. Separate meta-analyses according to type of COVID-19 patients (hospitalized or intensive care unit [ICU] patients), anticoagulants (mainly heparin), and regimens (therapeutic or prophylactic) were conducted. A total of 29 articles were selected, but 23 retrospective studies were eligible for quantitative meta-analyses. No clinical trial was retrieved. The majority of studies were of good quality; however, 34% did not distinguish heparin from other anticoagulants. Meta-analysis on 25,719 hospitalized COVID-19 patients showed that anticoagulant use was associated with 50% reduced in-hospital mortality risk (pooled risk ratio [RR]: 0.50, 95% confidence interval [CI]: 0.40–0.62; I
2: 87%). Both anticoagulant regimens (therapeutic and prophylactic) reduced in-hospital all-cause mortality, compared with no anticoagulation. Particularly in ICU patients, the anticoagulant therapeutic regimen was associated with a reduced in-hospital mortality risk (RR: 0.30, 95% CI: 0.15–0.60; I
2: 58%) compared with the prophylactic one. However, the former was also associated with a higher risk of bleeding (RR: 2.53, 95% CI: 1.60–4.00; I
2: 65%). Anticoagulant use, mainly heparin, reduced all-cause mortality in COVID-19 patients during hospitalization. Due to the higher risk of bleeding at therapeutic doses, the use of prophylactic dosages of anticoagulant is probably to be preferred in noncritically ill COVID-19 patients.
Cysteine Cathepsins and Their Prognostic and Therapeutic Relevance in Leukemia
Authors: Arora Mohit , Pandey Garima , Chauhan Shyam S.
Published: April 2021

Cysteine cathepsins are lysosomal proteases that require Cys-His ion pair in their catalytic site for enzymatic activity. While their aberrant expression and oncogenic functions have been widely reported in solid tumors, recent findings suggest that these proteases also play an important role in the pathogenesis of hematological malignancies. In this review, we summarize the potential clinical implications of cysteine cathepsins as diagnostic and prognostic markers in leukemia, and present evidences which supports the utility of these proteases as potential therapeutic targets in hematological malignancies. We also highlight the available information on the expression patterns, regulation, and potential functions of cysteine cathepsins in normal hematopoiesis and hematological malignancies. In hematopoiesis, cysteine cathepsins play a variety of physiological roles including regulation of hematopoietic stem cell adhesion in the bone marrow, trafficking, and maturation. They are also involved in several functions of immune cells which include the selection of lymphocytes in the thymus, antigen processing, and presentation. However, the expression of cysteine cathepsins is dysregulated in hematological malignancies where they have been shown to play diverse functions. Interestingly, several pieces of evidence over the past few years have demonstrated overexpression of cathepsins in leukemia and their association with worst survival outcomes in patients. Strategies aimed at altering the expression, activity, and subcellular localization of these cathepsins are emerging as potential therapeutic modalaties in the management of hematological malignancies. Recent findings also suggest the involvement of these proteases in modulating the immune response in leukemia and lymphomas.
Rare Complication of Nasogastric Tube Knotting around Endotracheal Tube in an Anesthetized Patient Undergoing Surgery
Authors: Sood Suvidha , Aggarwal Yeesha , Kumar Anoj
Published: April 2021

We report a case of successful management of a rare incidence and avoidance of complication of Ryle's tube knotting around endotracheal tube. A vigilant anesthesia team prevented fatal complications of intraoperative accidental extubation and ventilation impairment which could have resulted into respiratory distress.
Prevalence, Mechanisms, and Management of Ischemic Stroke in Heart Failure Patients
Authors: Seol Hyeyoung , Kim Jong S.
Published: April 2021

Heart failure (HF) and stroke, two of the major causes of death worldwide, are closely associated. Although atrial fibrillation (AF), which occurs in more than half of patients with HF, is a major risk factor for stroke, there is a great deal of evidence that HF itself increases the risk of stroke independent of AF. The main mechanism of stroke appears to be thromboembolism. However, previous studies have failed to demonstrate the benefit of warfarin in patients with HF without AF, as the benefit of stroke prevention was counteracted by the increased incidence of major bleeding. Recently, researchers have identified patients with HF at a particularly high risk for stroke who may benefit from anticoagulation therapy. Based on stroke-risk prediction models, it may be possible to make better stroke prevention decisions for patients with HF. Moreover, non-vitamin K oral anticoagulants have emerged as anticoagulants with a more favorable risk–benefit profile than warfarin. Future studies on selecting high-risk patients and using more appropriate antithrombotics will lead to improved management of patients with HF.
The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis
Authors: Kim Kevin G. , Tirrell Abigail R. , Dekker Paige K. , Haffner Zoe , Attinger Christopher E. , Fan Kenneth L. , Evans Karen K.
Published: April 2021

Introduction Research in lower extremity (LE) wound management involving flap reconstruction has primarily focused on surgeon-driven metrics. There has been a paucity in research that evaluates patient-centered outcomes (PCO). This systematic review and meta-analysis examines articles published between 2012 and 2020 to assess whether reporting of functional and quality of life (QOL) outcomes have increased in frequency and cohesiveness, compared with the previous two decades.

Methods PubMed and Ovid were queried with appropriate Medical Subject Heading (MeSH) terms for studies published between June 2012 and July 2020. For inclusion, each study had to report any outcome of any tissue transfer procedure to the LE in comorbid patients, including complication rates, ambulation rates, flap success rates, and/or QOL measures. The PCO reporting prevalence was compared with a previous systematic review by Economides et al which analyzed papers published between 1990 and June 2012, using a Pearson's Chi-squared test.

Results The literature search yielded 40 articles for inclusion. The proportion of studies reporting PCO was greater for literature published between 1990 and 2012 compared with literature published between 2012 and 2020 (86.0 vs. 50.0%, p < 0.001). Functional outcomes were more commonly reported between 1990 and 2012 (78.0 vs. 47.5%, p = 0.003); similarly, ambulatory status was reported more often in the previous review (70.0 vs. 40.0%, p = 0.004). This study solely examined the rate at which PCO were reported in the literature; the individual importance and effect on medical outcomes of each PCO was not evaluated.

Conclusion Less than 50% of the literature report functional outcomes in comorbid patients undergoing LE flap reconstruction. Surprisingly, PCO reporting has seen a downward trend in the past 8 years relative to the preceding two decades. Standardized inclusion of PCO in research regarding this patient population should be established, especially as health care and governmental priorities shift toward patient-centered care.
Rate of Insufficient Ipsilateral Hamstring Graft Harvesting in Primary Anterior Cruciate Ligament Reconstruction
Authors: Charalambous Charalambos P. , Kwaees Tariq A. , Lane Suzanne , Blundell Clare , Mati Wael
Published: April 2021

Anterior cruciate ligament (ACL) reconstruction, using an ipsilateral hamstring graft, may necessitate an alternative graft source if the obtained graft is insufficient with regards to length or diameter. The study aims to determine the rate of insufficient ipsilateral hamstring graft harvesting in primary ACL reconstruction. Retrospective review of 50 consecutive primary ACL reconstructions performed by a single surgeon in the United Kingdom. In 3 of 50 cases, there was insufficient ipsilateral hamstring graft harvesting and a contralateral hamstring graft was used. In two cases, this was due to premature division of the ipsilateral hamstring tendons (3/100 harvested tendons). In one case, an adequate length of semitendinosus was obtained, but its central portion was too thin. Retrospective review of preoperative magnetic resonance imaging identified the thin part of the tendon in the latter case. Insufficient ipsilateral hamstring graft harvesting is a recognized, yet unusual intraoperative complication in primary ACL reconstruction. Presurgical planning as to how to manage such complications is essential.
Novel Radiological Brain Anomalies in a Patient with Congenital Muscular Dystrophy due to FKRP Mexican Founder Mutation c.1387A > G: Review of the Literature
Authors: Cervera-Gaviria Marivi , Enterría-Rosales Julia , Juárez-Vignon-Whaley Juan José , García-Sánchez Julián , Treviño-Velasco Rodrigo , Cervera-Gaviria Jaime
Published: April 2021

Mutations in the FKRP gene result in phenotypes with severe forms of congenital muscular dystrophies (CMD) and limb-girdle muscular dystrophies. We present a Mexican patient with a pathogenic homozygous mutation in the FKRP gene (c.1387A > G, p.Asn463Asp) and CMD with radiological brain anomalies as disseminated hyperintensity lesions and discrete generalized cortical atrophy. These findings have not been reported to the best of our knowledge in other patients with the same mutation. The mutation c.1387A > G, p.Asn463Asp in the FKRP gene has been described to have a founder effect in central Mexico, since all the patients described to date are of Hispanic origin. Therefore, we emphasize studying mutations in the FKRP gene in Hispanic pediatric patients with clinical suspicion of CMD. Clinical and molecular diagnosis of specific CMD subtypes is needed to help clarify the prognosis, management, and genetic counseling to the patient and families.
Monogenic Epilepsies: Channelopathies, Synaptopathies, mTorpathies, and Otheropathies
Authors: Praticò Andrea D. , Falsaperla Raffaele , Polizzi Agata , Ruggieri Martino
Published: April 2021

Epilepsy has been historically defined as the recurrence of two or more seizures, together with typical electroencephalogram (EEG) changes, and significant comorbidities, including cardiac and autonomic changes, injuries, intellectual disability, permanent brain damage, and higher mortality risk. Epilepsy may be the consequence of several causes, including genetic anomalies, structural brain malformations, hypoxic–ischemic encephalopathy, brain tumors, drugs, and all contributing factors to the imbalance between excitatory and inhibitory neurons and modulatory interneurons which in turn provoke abnormal, simultaneous electric discharge(s) involving part, or all the brain. In the pregenetic, pregenomic era, in most cases, the exact cause of such neuronal/interneuronal disequilibrium remained unknown and the term “idiopathic epilepsy” was used to define all the epilepsies without cause. At the same time, some specific epileptic syndromes were indicated by the eponym of the first physician who originally described the condition (e.g., the West syndrome, Dravet syndrome, Ohtahara syndrome, and Lennox–Gastaut syndrome) or by some characteristic clinical features (e.g., nocturnal frontal lobe epilepsy, absence epilepsy, and epilepsy and mental retardation limited to females). In many of these occurrences, the distinct epileptic syndrome was defined mainly by its most relevant clinical feature (e.g., seizure semiology), associated comorbidities, and EEGs patterns. Since the identification of the first epilepsy-associated gene (i.e., CHRNA4 gene: cholinergic receptor neuronal nicotinic α polypeptide 4), one of the genes responsible for autosomal dominant nocturnal frontal lobe epilepsy (currently known as sleep-related hypermotor epilepsy) in 1995, the field of epilepsy and the history of epilepsy gene discoveries have gone through at least three different stages as follows: (1) an early stage of relentless gene discovery in monogenic familial epilepsy syndromes; (2) a relatively quiescent and disappointing period characterized by largely negative genome-wide association candidate gene studies; and (3) a genome-wide era in which large-scale molecular genetic studies have led to the identification of several novel epilepsy genes, especially in sporadic forms of epilepsy. As of 2021, more than 150 epilepsy-associated genes or loci are listed in the Online Mendelian Inheritance in Man database.
Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes
Authors: Parikh Rajiv P. , Ha Austin , Tung Thomas
Published: April 2021

Background Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries.

Methods This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated.

Results Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p = 0.013). Mean follow-up was 8.5 years.

Conclusion Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.
Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity
Authors: Patterson Charles W. , Palines Patrick A. , Bartow Matthew J. , Womac Daniel J. , Zampell Jamie C. , Dupin Charles L. , St Hilaire Hugo , Stalder Mark W.
Published: April 2021

Background From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods A retrospective review of 219 obese patients receiving 306 individual DIEP flaps was performed. Subjects were stratified into WHO obesity classes I (body mass index [BMI]: 30–34), II (BMI: 35–39), and III (BMI: ≥ 40) and assessed for risk factors and postoperative donor and recipient site complications.

Results When examined together, the rate of any complication between the three groups only trended toward significance (p = 0.07), and there were no significant differences among rates of specific individual complications. However, logistic regression analysis showed that class III obesity was an independent risk factor for both flap (odds ratio [OR]: 1.71, 95% confidence interval [CI]: 0.91–3.20, p = 0.03) and donor site (OR: 2.34, 95% CI: 1.09–5.05, p = 0.03) complications.

Conclusion DIEP breast reconstruction in the obese patient is more complex for both the patient and the surgeon. Although not a contraindication to undergoing surgery, obese patients should be diligently counseled regarding potential complications and undergo preoperative optimization of health parameters. Morbidly obese (class III) patients should be approached with additional caution, and perhaps even delay major reconstruction until specific BMI goals are met.
SCN1A and Its Related Epileptic Phenotypes
Authors: Sullo Federica , Pasquetti Elisa , Patanè Francesca , Lo Bianco Manuela , Marino Simona D. , Polizzi Agata , Falsaperla Raffaele , Ruggieri Martino , Zanghì Antonio , Praticò Andrea D.
Published: April 2021

Epilepsy is one of the most common neurological disorders, with a lifetime incidence of 1 in 26. Approximately two-thirds of epilepsy has a substantial genetic component in its etiology. As a result, simultaneous screening for mutations in multiple genes and performing whole exome sequencing (WES) are becoming very frequent in the clinical evaluation of children with epilepsy. In this setting, mutations in voltage-gated sodium channel (SCN) α-subunit genes are the most commonly identified cause of epilepsy, with sodium channel genes (i.e., SCN1A, SCN2A, SCN8A) being the most frequently identified causative genes. SCN1A mutations result in a wide spectrum of epilepsy phenotypes ranging from simple febrile seizures to Dravet syndrome, a severe epileptic encephalopathy. In case of mutation of SCN1A, it is also possible to observe behavioral alterations, such as impulsivity, inattentiveness, and distractibility, which can be framed in an attention deficit hyperactivity disorder (ADHD) like phenotype. Despite more than 1,200 SCN1A mutations being reported, it is not possible to assess a clear phenotype–genotype correlations. Treatment remains a challenge and seizure control is often partial and transitory.
Gender-Wise Comparative Assessment of Lifestyle Patterns and Well-Being Status among Healthcare Employees at a Tertiary Care Hospital
Authors: Velam Vanajakshamma , Kancherla Vyshnavi , Kasala Latheef , Kancherla Anusha , Pillaram Mounica Reddy
Published: April 2021

Background This study was an attempt to assess and compare the gender-wise lifestyle patterns and well-being status among the employees of a tertiary care teaching hospital.

Material and Methods This is a cross-sectional, questionnaire-based study conducted at a tertiary care hospital between May and August 2019. A total of 777 employees belonging to both genders (male and female) and working at different professional levels were assessed. All the enrolled employees were subjected to a comprehensive study tool consisting of various dimensions of their health, which included physical, mental, social, spiritual and intellectual health dimensions.

Results Among the participants, 327 (42.1%) were male and 450 (57.9%) were female. There was no significant difference in the mean age of male (37.91 ± 7.52) and female (36.85 ± 8.16) employees (p = 0.07). A significantly higher proportion of diabetes and hypertension were seen in male employees (9.8% and 14.4%, respectively) than in female (5.6% and 6.2% respectively). The overall well-being was better in male employees than in females and was statistically significant (p < 0.0001). We found that male employees had statistically significant better well-being in terms of physical, mental and social health whereas female employees had intellectual health.

Conclusion The overall well-being in healthcare staff was good at our tertiary care hospital, and the outstanding/good well-being rate was higher in male employees than in female employees. Female employees experienced risks with regard to their physical health.
Prophylaxis of Rheumatic Fever/Rheumatic Heart Disease–Penicillin or Azithromycin, Who Wins?
Authors: Lalchandani Arati , Lalchandani Taruni , Ahmad Lubna , Lalchandani Devarth
Published: April 2021

For eradication of rheumatic fever (RF)/rheumatic heart disease (RHD), we must have a simplified diagnosis, and a treatment which is painless, easily available and safe; prophylaxis must be painless, safe, easily available, readily administered, and comprising a weekly oral single dose.

Arati's regime for management of RF/RHD (ARMOR) consists of diagnosis and management of RF/RHD in today's context in a very easy and simplified way.

ARMOR criteria: Arthritis or arthralgia with typical features suggestive of RF, carditis or cardiac involvement, typical of RF or RHD, and echocardiographic evidence of rheumatic heart valve involvement should essentially be the criteria to diagnose RF and RHD with high specificity and sensitivity.

With regard to treatment of RF/RHD, we need a drug which is highly efficacious against Group A Beta Hemolytic Streptococcus (GABHS), which is the causative agent for primary prevention and treatment and secondary prophylaxis.

The best drug discovered, to date, for GABHS is azithromycin.

ARMOR for primary prevention, treatment and secondary prophylaxis of RF/RHD is as follows:

Azithromycin must be given in a dose of 500 mg 1 tablet daily for 5 days, followed by 1 tablet once a week for 1 year.

Penicillin for treatment and prophylaxis must be given up due to its lack of availability, side effects, risk of anaphylaxis, parenteral preparation, hazards of administration, need for sensitivity test each time, etc. and replaced by azithromycin.
MECP2-Related Disorders and Epilepsy Phenotypes
Authors: Sauna Alessandra , Sciuto Laura , Criscione Roberta , Messina Giulia , Presti Santiago , Soma Rachele , Oliva Claudia , Salafia Stefania , Falsaperla Raffaele
Published: April 2021

MECP2 (methyl-CpG binding protein-2) gene, located on chromosome Xq28, encodes for a protein particularly abundant in the brain that is required for maturation of astrocytes and neurons and is developmentally regulated. A defective homeostasis of MECP2 expression, either by haploinsufficiency or overexpression, leads to a neurodevelopmental phenotype. As MECP2 is located on chromosome X, the clinical presentation varies in males and females ranging from mild learning disabilities to severe encephalopathies and early death. Typical Rett syndrome (RTT), the most frequent phenotype associated with MECP2 mutations, primarily affects girls and it was previously thought to be lethal in males; however, MECP2 duplication syndrome, resulting from a duplication of the Xq28 region including MECP2, leads to a severe neurodevelopmental disorder in males. RTT and MECP2 duplication syndrome share overlapping clinical phenotypes including intellectual disabilities, motor deficits, hypotonia, progressive spasticity, and epilepsy. In this manuscript we reviewed literature on epilepsy related to MECP2 disorders, focusing on clinical presentation, genotype–phenotype correlation, and treatment.
A Novel Pathogenic Variant in the MN1 Gene in a Patient Presenting with Rhombencephalosynapsis and Craniofacial Anomalies, Expanding MN1 C-terminal Truncation Syndrome
Authors: Palma Milla Carmen , Patricia Pérez Mohand , Lezana José M. , Cruz Jaime , Quesada Juan F. , Vila Sara , Álvarez-Mora Isabel , Arteche-López Ana , Gómez-Manjón Irene , Sánchez M. Teresa , Gómez-Rodríguez Maria José , Sánchez Jaime , Moreno-García Marta
Published: April 2021

Meningioma-1 is a transcription activator that regulates mammalian palate development and is required for appropriate osteoblast proliferation, motility, differentiation, and function. Microdeletions involving the MN1 gene have been linked to syndromes including craniofacial anomalies, such as Toriello–Carey syndrome. Recently, truncating variants in the C-terminal portion of the MN1 transcriptional factor have been linked to a characteristic and distinct phenotype presenting with craniofacial anomalies and partial rhombencephalosynapsis, a rare brain malformation characterized by midline fusion of the cerebellar hemispheres with partial or complete loss of the cerebellar vermis. It has been called MN1 C-terminal truncation (MCTT) syndrome or CEBALID (Craniofacial defects, dysmorphic Ears, Brain Abnormalities, Language delay, and Intellectual Disability) and suggested to be caused by dominantly acting truncated protein MN1 instead of haploinsufficiency. As a proto-oncogene, MN1 is also involved in familial meningioma. In this study, we present a novel case of MCTT syndrome in a female patient presenting with craniofacial anomalies and rhombencephalosynapsis, harboring a de novo pathogenic variant in the MN1 gene: c.3686_3698del, p.(Met1229Argfs*87).
Utility of Epilepsy Surgery in Survivors of Childhood Cancer
Authors: Siddiqui Ayat , McGregor Amy L. , Wheless James W. , Klimo Paul , Boop Frederick A. , Khan Raja B.
Published: April 2021

Resection of an epileptogenic focus improves seizure control in patients with drug-resistant epilepsy. There is little data available on usefulness of epilepsy surgery in childhood cancer survivors with drug-resistant epilepsy. To learn about seizure outcome after epilepsy surgery in childhood cancer survivors, we retrospectively reviewed charts of 42 children who were referred to an epilepsy center for surgical evaluation. Sixteen children (38%) were offered epilepsy surgery and 10 consented. Seizure outcome was classified based on International League Against Epilepsy outcome scale. All 10 children were having multiple seizures a month on therapeutic doses of three antiepilepsy drugs (AEDs). At a median follow-up of 5.6 years after epilepsy surgery, three children had class 1 outcome (no seizures), four had class 3 outcome (1–3 seizure days/year), and three had class 4 outcome (≥ 50% reduction in seizure frequency). One child was off AEDs, seven were on a single AED, and two were on three AEDs at their last follow-up. Epilepsy surgery had low morbidity and improved seizure control in childhood cancer survivors with drug-resistant epilepsy. Childhood cancer survivors with drug-resistant epilepsy should be referred to an epilepsy center for a higher level of care.
An integral model based on slender body theory, with applications to curved rigid fibers
Authors: Andersson Helge I. , Celledoni Elena , Ohm Laurel , Owren Brynjulf , Tapley Benjamin K.
Published: April 2021

We propose a novel integral model describing the motion of both flexible and rigid slender fibers in viscous flow and develop a numerical method for simulating dynamics of curved rigid fibers. The model is derived from nonlocal slender body theory (SBT), which approximates flow near the fiber using singular solutions of the Stokes equations integrated along the fiber centerline. In contrast to other models based on (singular) SBT, our model yields a smooth integral kernel which incorporates the (possibly varying) fiber radius naturally. The integral operator is provably negative definite in a nonphysical idealized geometry, as expected from the partial differential equation theory. This is numerically verified in physically relevant geometries. We discuss the convergence and stability of a numerical method for solving the integral equation. The accuracy of the model and method is verified against known models for ellipsoids. Finally, we develop an algorithm for computing dynamics of rigid fibers with complex geometries in the case where the fiber density is much greater than that of the fluid, for example, in turbulent gas-fiber suspensions.
Fusion gain from cylindrical liner-driven implosions of field reversed configurations
Authors: Slutz Stephen A. , Gomez Matthew R.
Published: April 2021

MagLIF experiments [M.R. Gomez et al., Phys. Plasmas 22, 056306 (2015)] on Z have demonstrated the basic principles of Magneto-Inertial Fusion (MIF) for wall confined plasmas. Other MIF schemes have been proposed based on the liner implosion of closed field magnetically confined plasmas such as Field Reversed Configurations (FRCs) [T. P. Intrator et al., Phys. Plasmas 15, 042505 (2008)]. We present a semi-analytical model of liner driven FRC implosions that predicts the fusion gain of such systems. The model predicts a fusion gain near unity for an FRC imploded by a liner driven by the Z Machine. We show that FRCs could be formed and imploded at the Z facility using the AutoMag liner concept [S. A. Slutz et al., Phys. Plasmas 24, 012704 (2017)]. An initial bias magnetic field can be supplied by the external magnets used in MagLIF experiments. The reverse field is then supplied by an AutoMag liner, which has helical conducting paths imbedded in an insulating substance. Experiments [Shipley et al., Phys. Plasmas 26, 052705 (2019)] have demonstrated that AutoMag can generate magnetic fields greater than 30 Tesla inside of the liner. We have performed 2D Radiation MHD simulations of the formation and implosion of an FRC, which are in good agreement with the analytical model. The FRC formation process could be studied on small pulsed power machines delivering about 1 MA.
Performance analysis of diamond-based masers
Authors: Sherman Alexander , Buchbinder Lotem , Ding Siyuan , Blank Aharon
Published: April 2021

Masers, the microwave analog of lasers, are an important class of devices that can be used to generate highly coherent and stable microwave signals as well as quantum-limited amplification of microwave photons. Recently, the interest in such devices has increased, probably owing to experiments demonstrating the successful operation at room temperature of solid-state maser employing defects in diamond. These defects, called nitrogen vacancy (NV) centers, are comprised of a negatively charged substitutional nitrogen that replaces one of the diamond crystal lattice’s carbons and a vacancy adjacent to the excluded carbon atom. The performance of diamond-based masers, in terms of gain, noise, bandwidth, frequency of operation, and saturation, greatly depends upon the specific diamond crystal composition and its geometry in the respective microwave device. The currently available data on these issues are scarce and sometimes conflicting. It is, therefore, important to provide additional experimental data, complemented by theoretical analysis, to further optimize the required diamond material and thus enhance the capabilities of diamond-based maser technology. The latter is currently limited to operate only as an oscillator at very small bandwidths, with low saturation power. Here, we provide experimental results on a set of important parameters affecting diamond maser operation, such as the population and linewidth of the electron spin energy levels of the NVs under light illumination, as well as their relaxation times for several different diamond material compositions. These results are then used to point out which diamond material compositions and crystal geometry may be best suitable for maser-type applications.
Assessment of a flamelet approach to evaluating mean species mass fractions in moderately and highly turbulent premixed flames
Authors: Lipatnikov A. N. , Nilsson T. , Yu R. , Bai X. S. , Sabelnikov V. A.
Published: April 2021

Complex-chemistry direct numerical simulation (DNS) data obtained from lean methane-air turbulent flames are analyzed to perform a priori assessment of predictive capabilities of the flamelet approach to evaluating mean concentrations of various species in turbulent flames characterized by Karlovitz numbers Ka=6.0, 74.0, and 540. Six definitions of a combustion progress variable c are probed and two types of probability density functions (PDFs) are adapted: (i) actual PDFs extracted directly from the DNS data or (ii) presumed β-function PDFs obtained using the DNS data on the first two moments of the c-field. Results show that the mean density, the mean temperature, and the mean mass fractions of CH4, O2, H2O, CO2, CO, CH2O, CH3, and HCO are very well predicted using the temperature-based combustion progress variable cT and the actual PDF. For other considered species, the quantitative predictions are worse but still appear to be encouraging (with the exception of CH3O at Ka=540). The use of the flamelet library obtained from the equidiffusive laminar flame improves results for H2, HO2, and H2O2 at the highest Karlovitz number. Alternative definitions of the combustion progress variable perform worse and the reasons for this are explored. The use of the β-function PDF yields worse results for intermediate species such as OH, O, H, CH3, and HCO, with this PDF being significantly different from the actual PDF. Application of the flamelet approach to rates of production/consumption of various species is also addressed and implications of obtained results for modeling are discussed.
Perceptions of primary care and hospital clinicians on the use of the Ankle Brachial Pressure Index in general practice
Authors: Ding Thomas , Lloyd Hywel
Published: April 2021

ABSTRACT INTRODUCTION Peripheral arterial disease is an increasingly prevalent chronic illness globally. The Ankle Brachial Pressure Index (ABPI) is a well-established, simple, relatively quick and non-invasive assessment useful in diagnosing and quantifying peripheral arterial disease. ABPIs may be currently underutilised in general practice. AIM To explore perspectives of health professionals on the role of the ABPI. METHODS One-to-one interviews were conducted with health professionals using snowball sampling. Questions centred around interviewees’ education on, experience with and view on the usefulness of the ABPI in general practice. Interviews were recorded and used for thematic analysis. RESULTS Participants consisted of 13 health-care professionals: nine general practitioners, two vascular surgeons and two allied health professionals. Most general practitioners interviewed identified benefits of ABPIs use in primary care, including aiding peripheral arterial disease diagnostics, management, referral and triage. No general practitioners stated they had ever had formal training in undertaking ABPIs. Two of the nine general practitioners stated regular ABPI use in their practice. Participants who did not use ABPIs identified practical barriers to its use in general practice, including cost of equipment, length of time needed and perceived low patient need to justify cost. All interviewees agreed that there was a role for ABPI use in the community if barriers were overcome. DISCUSSION There was consensus among general practitioners that ABPI use is beneficial. Many general practitioners named similar practical barriers to more common use of ABPIs in general practice. They saw a role for ABPIs in primary care, although it may be more practical as a tool for specialised individual clinicians to use for communities, given practical barriers of cost, time and perceived low patient need. Formal training could be considered, as none of the interviewed general practitioners had ever had any.