bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamically Masked Audiograms With Machine Learning Audiometry
Authors: Heisey Katherine L. , Walker Alexandra M. , Xie Kevin , Abrams Jenna M. , Barbour Dennis L.
Published: June 2020

Objectives:

When one ear of an individual can hear significantly better than the other ear, evaluating the worse ear with loud probe tones may require delivering masking noise to the better ear to prevent the probe tones from inadvertently being heard by the better ear. Current masking protocols are confusing, laborious, and time consuming. Adding a standardized masking protocol to an active machine learning audiogram procedure could potentially alleviate all of these drawbacks by dynamically adapting the masking as needed for each individual. The goal of this study is to determine the accuracy and efficiency of automated machine learning masking for obtaining true hearing thresholds.

Design:

Dynamically masked automated audiograms were collected for 29 participants between the ages of 21 and 83 (mean 43, SD 20) with a wide range of hearing abilities. Normal-hearing listeners were given unmasked and masked machine learning audiogram tests. Listeners with hearing loss were given a standard audiogram test by an audiologist, with masking stimuli added as clinically determined, followed by a masked machine learning audiogram test. The hearing thresholds estimated for each pair of techniques were compared at standard audiogram frequencies (i.e., 0.25, 0.5, 1, 2, 4, 8 kHz).

Results:

Masked and unmasked machine learning audiogram threshold estimates matched each other well in normal-hearing listeners, with a mean absolute difference between threshold estimates of 3.4 dB. Masked machine learning audiogram thresholds also matched well the thresholds determined by a conventional masking procedure, with a mean absolute difference between threshold estimates for listeners with low asymmetry and high asymmetry between the ears, respectively, of 4.9 and 2.6 dB. Notably, out of 6200 masked machine learning audiogram tone deliveries for this study, no instances of tones detected by the nontest ear were documented. The machine learning methods were also generally faster than the manual methods, and for some listeners, substantially so.

Conclusions:

Dynamically masked audiograms achieve accurate true threshold estimates and reduce test time compared with current clinical masking procedures. Dynamic masking is a compelling alternative to the methods currently used to evaluate individuals with highly asymmetric hearing, yet can also be used effectively and efficiently for anyone.
Epidemiology of Hemostatic Transfusions in Children Supported by Extracorporeal Membrane Oxygenation
Authors: Karam Oliver , Goel Ruchika , Dalton Heidi , Nellis Marianne E.
Published: June 2020

Objective:

To evaluate the epidemiology of hemostatic transfusions (plasma, platelet, and cryoprecipitate) in children supported by extracorporeal membrane oxygenation.

Design:

Secondary analysis of a large observational cohort study.

Setting:

Eight pediatric institutions within the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Collaborative Pediatric Critical Care Research Network.

Patients:

Critically ill children supported by extracorporeal membrane oxygenation.

Interventions:

None.

Measurements and Main Results:

Extracorporeal membrane oxygenation was used in the care of 514 consecutive children. Platelets were transfused on 68% of extracorporeal membrane oxygenation days, plasma on 34% of the days on extracorporeal membrane oxygenation, and cryoprecipitate on 14%. Only 24% of the days on extracorporeal membrane oxygenation were free of any hemostatic transfusions. Daily platelet transfusion dose was independently associated with chest tube output (p < 0.001), other bleeding requiring RBC transfusion (p = 0.03), and daily set platelet goal (p = 0.009), but not with total platelet count (p = 0.75). Daily plasma transfusion dose was independently associated with chest tube output (p < 0.001), other bleeding requiring RBC transfusion (p = 0.01), activated clotting time (p = 0.001), and antithrombin levels (p = 0.02), but not with international normalized ratio (p = 0.99) or activated partial thromboplastin time (p = 0.29). Daily cryoprecipitate transfusion dose was independently associated with younger age (p = 0.009), but not with chest tube bleeding (p = 0.18), other bleeding requiring RBC transfusion (p = 0.75), fibrinogen level (p = 0.67), or daily fibrinogen goal (p = 0.81).

Conclusions:

Platelets were transfused on two third of the days on extracorporeal membrane oxygenation, plasma on one third, and cryoprecipitate on one sixth of the days. Although most hemostatic transfusions were independently associated with bleeding, they were not independently associated with the majority of hemostatic testing. Further studies are warranted to evaluate the appropriateness of these transfusion strategies.
Bone metabolism and fracture risk during and after critical illness
Authors: Rousseau Anne-Françoise , Kerschan-Schindl Katharina , Scherkl Mario , Amrein Karin
Published: June 2020

Purpose of review

There is growing evidence that bone health is impacted during and after critical illness in multiple ways. In this review, we provide a practical update on postcritical care bone loss with an insight on identification of persons at risk, prevention and treatment strategies.

Recent findings

Critical illness is associated with an increase in bone turnover and with an uncoupling between bone resorption and bone formation. This results in loss of bone mass, as highlighted by changes in bone marker serum levels and in bone mineral density. Data suggest that ICU survivors are at an increased risk of bone fractures, but this is not completely quantifiable. A key driving factor for ICU-related bone loss, beside inflammation, undernutrition and vitamin D deficiency, is immobilization. Bone health and muscle health are closely related, through myokines and osteokines. Even if not completely proven in the context of critical care, it is likely that preserving muscle mass and strength helps reducing bone loss.

A history of critical illness should be considered as a strong risk factor for osteopenia and osteoporosis. ICU-related bone loss should be part of the postintensive care syndrome, and should be targeted by prevention and treatment strategies. Optimized and individualized protein and micronutrient provision (with specific attention to calcium, vitamin D and selenium), associated with physiotherapy and muscle training, should be implemented early after ICU admission and continued after ICU discharge. Antiresorptive agents such as biphosphonates should be considered on an individualized basis.
The best recipe: fat-based, protein-based, single amino acids?
Authors: Singer Pierre , Glass Yehuda D. , Kagan Ilya
Published: June 2020

Purpose of review

Instead of comparing iso versus low energy or high versus low protein intake, the proportions between nutrients and the effects of specific amino or fatty acids may yield promising benefits for the nutritional therapy of critically ill patients.

Recent findings

Larger proportion of carbohydrates than lipids is usual in most of the commercial products. However, patients suffering from sepsis and from acute kidney injury preferentially utilize lipids. Parenteral omega-3-fatty acids, in particular, may be beneficial. Protein source and amount are important factors to achieve the best absorption and an improved nitrogen balance. Hydrolyzed whey protein reaches the highest amino acid plasma level if administered in large doses (35% of the measured energy expenditure). Muscle mass preservation may be achievable with large protein intake. β-Hydroxy-β-methylbutyrate has been shown to improve muscle strength in a large meta-analysis.

The nutritional therapy should take into account the fact that lipids are more oxidized. Intravenous lipid emulsions containing olive and fish oil are preferred, improving morbidity significantly in a recent meta-analysis. Enteral protein should be selected carefully according to protein source, origin and amount. Hydrolyzed whey protein improves nitrogen balance. The ultimate goal is to preserve muscle mass and muscle function. β-Hydroxy-β-methylbutyrate may improve muscle strength.
Trace element and vitamin deficiency: quantum medicine or essential prescription?
Authors: Berger Mette M. , Ben-Hamouda Nawfel
Published: June 2020

Purpose of review

In critical care, micronutrients remain perceived as ‘quantum’ part, that is, a little pertinent component of therapy. Some micronutrients have attracted more attention because of their antioxidant properties. During the last decade, some large size trials have tested their therapeutic potential, generally as ‘single high-dose micronutrient intervention’, with variable success. This review aims at taking stock of most recent.

Recent findings

Micronutrient blood levels are generally low in ICU patients, which has prompted the concept of replenishing or compensating deficits, or even realizing a pharmacological action. Single micronutrient trials have been conducted in large cohorts with selenium (≥1000 μg/day), with limited success but no harm. Other trials have tested high-dose vitamin D (>400 000 IU), with nonconvincing results despite selecting patients with very low blood levels. High-dose vitamin C has been tested in septic shock (+/- thiamine, hydrocortisone) with variable results. A problem encountered in all studies is definition of deficiency based on blood levels as majority of the patients suffer inflammation, which causes redistribution of the micronutrients away from the circulating compartment in the absence of real deficiency.

Micronutrients are essential in the ICU. Due to their antioxidant properties and to the high prevalence of low blood concentrations suggestive of deficiency, several large-size RCTs have been conducted with variable success. Further research must clarify the respective importance of deficiency and inflammation.
Evidence for improved survival with treatment of homozygous familial hypercholesterolemia
Authors: Bélanger Alexandre M. , Akioyamen Leo , Alothman Latifah , Genest Jacques
Published: June 2020

Purpose of review

Homozygous familial hypercholesterolemia (HoFH) is an orphan disease caused by biallelic mutations at the LDL receptor (LDLR) gene, with a prevalence estimated at 1 : 250 000 to 1 : 630 000. HoFH is characterized by extremely elevated plasma levels of LDL-C greater than 10 mmol/l (>387 mg/dl), tendinous and cutaneous xanthomas in youth and premature atherosclerotic cardiovascular disease (ASCVD). The expected prevalence varies from country to country depending on the presence of founder effects, genetic probability and life expectancy. Untreated, HoFH is a fatal condition before age 30. Plasma levels of LDL-C are the major cause of mortality and the therapeutic target. Statin therapy led to a remarkable improvement in survival but is of limited use in loss-of-function LDLR gene variants or ‘null’ mutations. Inhibitors of PCSK9 are a useful adjunct in patients with LDLR mutations with residual activity. Extracorporeal LDL filtration has improved survival since its introduction three decades ago.

Recent findings

Novel therapies, not dependent on a functioning LDLR include lomitapide and mipomersen, which decrease hepatic apolipoprotein B secretion, and evinacumab, directed at the angiopoietin like-3 protein (ANGPLT-3).

Over the past 3–4 decades, the survival of patients with HoFH has increased markedly. New therapeutic options offer new hope.
Apolipoprotein F: a natural inhibitor of cholesteryl ester transfer protein and a key regulator of lipoprotein metabolism
Authors: Liu Yan , Morton Richard E.
Published: June 2020

Purpose of review

The aim of this study is to highlight recent studies that have advanced our understanding of apolipoprotein F (ApoF) and its role in lipid metabolism.

Recent findings

Previous studies showed that ApoF hepatic mRNA levels are suppressed by fat-enriched diets. Recent studies show this downregulation is mediated by agonist-induced binding of liver X receptor (LXR) and PPARalpha to a regulatory element in the ApoF promoter. First-of-kind in-vivo studies show ApoF lowers low-density lipoprotein levels and enhances reverse cholesterol transport in fat-fed hamsters.

Diverse studies collectively provide compelling evidence that cholesteryl ester transfer protein (CETP) plays an important role in regulating lipid metabolism. Inhibiting CETP raises HDL cholesterol. However, considering the recent failures of pharmacological inhibitors of CETP in clinical trials, it does not seem likely that global inhibition of CETP will be beneficial. ApoF is a minor apolipoprotein that functions as a natural inhibitor of CETP. However, ApoF is not a general inhibitor of CETP, but rather it preferentially inhibits CETP activity with LDL. Therefore, ApoF tailors CETP activity so that less tissue-derived cholesterol traffics from HDL into the LDL compartment. Lower LDL cholesterol levels have recognized clinical benefit for reduced cardiovascular disease.
Can genetic testing help in the management of dyslipidaemias?
Authors: Lazarte Julieta , Hegele Robert A.
Published: June 2020

Purpose of review

The aim of this study was to evaluate the potential role of genetic testing, particularly next-generation DNA sequencing, in diagnosing and managing dyslipidaemias, particularly monogenic dyslipidaemias.

Recent findings

Targeted DNA sequencing of the genes causing monogenic dyslipidaemias is becoming more accessible. Some societies’ position statements advise selective utilization of DNA testing in combination with clinical and biochemical assessment. However, high-quality peer-reviewed evidence showing that a DNA-based diagnosis impacts upon long-term patient outcomes is currently lacking. Nonetheless, we show anecdotal examples of tangible clinical actions following from a genetic diagnosis. In any event, care must be taken when interpreting genetic reports. We strongly feel that expertise in both genetics and dyslipidaemias is required to adequately interpret and report results to patients, as well as to make informed treatment decisions that can have a potential lifelong impact.

There are some examples of monogenic dyslipidaemias for which having a molecular diagnosis might beneficially affect patient outcomes, for example certain cases of suspected familial hypercholesterolemia, familial chylomicronemia syndrome, sitosterolemia or lysosomal acid lipase deficiency. In general, we recommend limiting genetic testing to selected cases of monogenic dyslipidaemias. Finally, we advise that there is currently no proven clinical benefit in testing for polygenic dyslipidaemias.
Mycoplasma genitalium and Trichomonas vaginalis: addressing disparities and promoting public health control of two emerging sexually transmitted infections
Authors: Korich Faye , Reddy Neha G. , Trent Maria
Published: June 2020

Purpose of review

Mycoplasma genitalium (M. genitalium) and Trichomonas vaginalis (T. vaginalis), sexually transmitted infections that remain non-reportable in the United States, may lead to pelvic inflammatory disease (PID) and adverse pregnancy outcomes if left untreated. Prevalence estimates have highlighted socioeconomic and racial/ethnic disparities in rates of infection. This review summarizes the recent literature on M. genitalium and T. vaginalis with a focus on the epidemiology, screening, and treatment of M. genitalium and T. vaginalis.

Recent findings

The burden of T. vaginalis testing remains on women. Antimicrobial resistance is of great concern for M. genitalium. Comprehensive screening and treatment guidelines present an opportunity to address these public health concerns.

M. genitalium and T. vaginalis infections disproportionately affect sexual and racial/ethnic minorities and those facing socioeconomic disparities. The availability of nucleic acid amplification test testing has facilitated accurate diagnosis of both disorders. Safe and efficacious treatments are available for treatment of both disorders. Integrating macrolide resistance testing into treatment algorithms for M. genitalium and dual antibiotic therapy may prove a useful strategy for future US-based guidance. Public health reporting and increased public awareness campaigns are key next steps to addressing the observed reproductive health disparities.
Pediatric Wilson Disease Presenting as Acute Liver Failure
Authors: Vandriel Shannon M. , Ayoub Mohammed D. , Ricciuto Amanda , Hansen Bettina E. , Ling Simon C. , Ng Vicky L. , Roberts Eve A. , Kamath Binita M.
Published: June 2020

Objectives:

Wilson disease (WD) presenting as acute liver failure (ALF) is rare and typically fatal without liver transplantation (LT). Its rarity has hindered comprehensive studies. We undertook an individual patient data meta‐analysis to characterize a cohort of pediatric patients presenting with ALF whose final diagnosis was WD to examine outcomes and identify predictors of poor outcomes.

Methods:

Database searches were conducted in PubMed, ScienceDirect, and Google Scholar, restricted to English‐language articles published between January 1984 and May 2018. Articles were excluded if pediatric (<18 years old) data were not extractable or if LT was not readily available at reporting institutions. Extracted data included clinical and biochemical characteristics, genotype, treatment, and outcome.

Results:

Data were available on 249 subjects from 52 articles, plus 7 additional subjects identified from our institution's WD database (N = 256). Females represented 69% (n = 170/245). Median age at presentation was 13.4 years (n = 204, range 4.0–17.9). Of the total 256 subjects, 87% underwent LT, 11% achieved spontaneous recovery and 2% died before LT. International normalized ratio >2.0 at presentation was a predictor of LT/death (odds ratio 7.6, 95% confidence interval 1.5–28), with a trend observed for hepatic encephalopathy (HE) (odds ratio 4.18, 95% confidence interval 0.99–18). Arithmetic diagnostic scores proved inferior in the pediatric age‐bracket compared to adults.

Conclusions:

This large international pediatric cohort has permitted an individual patient data analysis of WD presenting as ALF. Notably, 11% of subjects achieved spontaneous survival; the rest required LT. Coagulopathy (international normalized ratio >2:0) and HE at presentation heralded poor outcomes. Further prospective studies may identify additional early predictors of outcomes.
Safety of Thiopurine Use in Paediatric Gastrointestinal Disease
Authors: Miele Erasmo , Benninga Marc A. , Broekaert Ilse , Dolinsek Jernej , Mas Emmanuel , Orel Rok , Pienar Corina , Ribes‐Koninckx Carmen , Thomassen Rut A. , Thomson Mike , Tzivinikos Christos , Thapar Nikhil
Published: June 2020

Thiopurines, alone or in combination with other agents, have a pivotal role in the treatment of specific gastrointestinal and hepatological disorders. In inflammatory bowel disease and autoimmune hepatitis thiopurines have proven their value as steroid sparing agents for the maintenance of remission and may be considered for preventing postoperative Crohn disease recurrence where there is moderate risk of this occurring. Their use with infliximab therapy reduces antibody formation and increases biologic drug levels. The routine clinical use of thiopurines has, however, been questioned due to a number of potential adverse effects. The aim of this article is to provide information regarding the use, and in particular, safety of these agents in clinical practice in the light of such potentially severe, albeit rare, effects.
Empathy, Alexithymia, and Theory of Mind in Borderline Personality Disorder
Authors: Kılıç Faruk , Demirdaş Arif , Işık Ümit , Akkuş Merve , Atay İnci Meltem , Kuzugüdenlioğlu Duru
Published: June 2020

The purpose of this research was to determine the differences in empathy, alexithymia features, and theory of mind between healthy controls and patients with borderline personality disorder (BPD). Thirty-five patients with BPD and 35 healthy controls were included in the study. To measure the clinical variables, the Empathy Quotient (EQ), Reading the Mind in the Eyes Test (RMET), Toronto Alexithymia Scale (TAS-20), Barratt Impulsivity Scale-11 (BIS-11), and Beck Depression Inventory (BDI) were applied. We found that the BPD group had significantly worse total RMET and neutral RMET scores than the control group. There were no differences in the EQ scores between the BPD and control groups. The patients with BPD were more alexithymic than the controls, and alexithymia and depression scores predicted BPD status. Patients with BPD who have difficulty identifying their own emotions tend to display deficits in perceptions of facial emotions, which, in turn, may lead to misperceptions of social signals and thus contribute to excessive emotional intensity and tension in social situations. The study results reveal that alexithymia and depression are important variables in predicting BPD traits.
The Cost of Being Apart
Authors: Kinory Dana , Aisenberg Daniela , Levi-Belz Yossi
Published: June 2020

Older adults have the highest suicide rates of all age groups in most industrialized countries. However, research concerning psychological risk factors for suicide among older adults is sparse. Thus, our study aimed to examine the contribution of perceived burdensomeness (PB) and thwarted belongingness (TB) to suicide ideation (SI) among older adults. Participants included 160 Israeli older adults (aged 65–91 years), who completed measures of suicide risk, PB, and TB as well as hopelessness and depression. Using hierarchical regression, we found that PB and TB accounted for 9.8% of the variance in SI and that the interaction of PB and TB had a significant unique contribution to SI among the participants, beyond the effect of hopelessness and depression. The study's findings highlight the contribution of interpersonal variables to SI among older adults and suggest that mental health professionals should be aware of PB and TB levels when assessing suicide risk among older adults.
Genotyping of Treponema pallidum in Cuba (2018–2019): Increased Circulation of Recombinant Genotype and No New Treponema pallidum Subspecies endemicum Infection Among Syphilis Patients
Authors: Noda Angel A. , Rodríguez Islay , Šmajs David
Published: June 2020

Objectives

This study aimed to determine the allelic profiles of Treponema pallidum in patients confirmed with syphilis in Cuba (2018–2019) and to explore mutations leading to macrolide and tetracycline resistance.

Methods

Multilocus sequence typing and polymerase chain reaction of rrn loci (23S and 16S rDNA), followed by Sanger sequencing, were used to define the allelic profile of TPA and resistance mutations, respectively.

Results

Allelic profile 1.3.1 and the recombinant profile were identified, with 15.7.3 having an increased frequency. We did not detect the presence of the T. pallidum subspecies endemicum among syphilis patients, as in previous reports. A high frequency of macrolide-resistant strains and the absence of mutations potentially causing tetracycline resistance were found.

Conclusions

Understanding the current status of treponemal infection in Cuban patients provides insights into the syphilis epidemiology.
Molecular Genetic Features of Primary Nonurachal Enteric-type Adenocarcinoma, Urachal Adenocarcinoma, Mucinous Adenocarcinoma, and Intestinal Metaplasia/Adenoma: Review of the Literature and Next-generation Sequencing Study
Authors: Pires-Luis Ana S. , Martinek Petr , Alaghehbandan Reza , Trpkov Kiril , Comperat Eva M. , Perez Montiel Delia M. , Bulimbasic Stela , Lobo João , Henrique Rui , Vanecek Tomas , Pivovarcikova Kristyna , Michalova Kvetoslava , Pitra Tomas , Hora Milan , Marques Ana , Lopes Jose M. , Rogala Joanna , Mareckova Jana , Michal Michal , Hes Ondrej
Published: June 2020

The diagnosis of primary adenocarcinoma of the urinary bladder may be challenging in routine practice. These tumors may morphologically and immunohistochemically overlap with urachal adenocarcinoma and colorectal adenocarcinoma. Further, their genetic background is poorly understood. We systematically searched the PubMed database for results of complex genetic evaluation of primary bladder adenocarcinoma subtypes. Subsequently, we designed our own series of bladder lesions. We evaluated 36 cases: 16 primary enteric-type adenocarcinomas, 7 urachal enteric adenocarcinomas, 3 primary mucinous/colloid adenocarcinomas, and 10 intestinal-type metaplasia/villous adenoma. Detailed clinical data were collected, and all cases were examined using targeted next-generation sequencing. On the basis of the literature, the first mutated gene in these tumors was reported to beKRASin 11.3% of cases, followed byTERTpromoter mutations in 28.5%. In addition toKRASandTERT, other genes were also found to be frequently mutated in primary bladder adenocarcinoma, includingTP53,PIK3CA,CTNNB1,APC,FBXW7,IDH2, andRB1. In our series, the most frequent gene mutations in primary enteric-type adenocarcinomas were as follows:TP53(56%);BRCA2,KMT2B(both 33%);NOTCH2,KDR,ARID1B,POLE,PTEN,KRAS(all 28%); in urachal enteric adenocarcinoma they were as follows:TP53(86%);PTEN,NOTCH(both 43%); in primary mucinous/colloid adenocarcinomas they were as follows:KRAS,GRIN2A,AURKB(all 67%); and, in intestinal-type metaplasia/villous adenoma, they were as follows:APC,PRKDC(both 60%);ROS1,ATM,KMT2D(all 50%). No specific mutational pattern was identified using cluster analysis for any of the groups. Herein, we describe the pathologic features and immunohistochemical staining patterns traditionally used in the differential diagnoses of glandular lesions of the bladder in routine surgical pathology. We outline the mutational landscape of these lesions as an aggregate of published data with additional data from our cohort. Although diagnostically not discriminatory, we document that the most common genetic alterations shared between these glandular neoplasms includeTP53,APC(in the Wnt pathway), andKRAS(in the MAPK pathway) mutations.
Renal Hypoplasia, From Grossly Insufficient to Not Quite Enough: Consideration for Expanded Concepts Based Upon the Author’s Perspective With Historical Review
Authors: Bonsib Stephen M.
Published: June 2020

Hypoplasia is defined in the Merriman-Webster dictionary as “a condition of arrested development in which an organ, or part, remains below the normal size, or in an immature state.” The degree of reduced size is not definitional. Renal hypoplasia, however, has historically been defined as a more marked reduction in renal mass such that presentation in childhood is the norm. There are 3 commonly recognized types of renal hypoplasia, simple hypoplasia, oligomeganephronic hypoplasia (oligomeganephronia) and segmental hypoplasia (Ask-Upmark kidney). They have in common a reduction in the number of renal lobes. A fourth type, not widely recognized, is cortical hypoplasia where nephrogenesis is normal but there is a reduction in the number of nephron generations. Recently there has been great interest in milder degrees of reduced nephron mass, known as oligonephronia because of its association with risk of adult-onset hypertension and chronic kidney disease. Since the last pathology review of this topic was published by Jay Bernstein in 1968, an update of the renal pathology findings in renal hypoplasia is provided with a review of 18 new cases. The renal hypoplasias are then framed within the modern concept of oligonephronia, its diverse causes and prognostic implications.
Injury and Illness Surveillance in Elite Para Athletes
Authors: Hirschmüller Anja , Fassbender Katharina , Kubosch Johanna , Leonhart Rainer , Steffen Kathrin
Published: June 2020

Background

Longitudinal monitoring data of Para athletes are sparse.

Objective

The aim of the study was to describe the weekly prevalence and incidence of injuries and illnesses among German athletes preparing for the 2016 Rio de Janeiro Paralympic Games.

Methods

Athletes were invited to weekly report on medical problems, their severity/burden and training load, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems. In case of any health problem, athletes were contacted and medical support offered. Data were analyzed with regard to impairment type. The acceptance of the monitoring program was evaluated.

Results

Fifty-eight athletes were followed for 29 wks, 10.927 athlete-days. At any given time, 28% (95% confidence interval = 26% to 30%) of athletes reported health problems, and 12% (11% to 14%) substantial health problems. The prevalence of health and illness problems diminished over time by 20.9 ± 4.1% and 16.1 ± 2.9%, P < 0.001, respectively, based on the means of the first and final 5 wks. Paraplegic athletes reported a significantly higher prevalence of all health problems (33%, 29% to 37%) than nonparaplegic athletes (26%, 23% to 29%; P = 0.007). Illnesses were in general more severe and resulted in more time loss days. Athletes reported a high satisfaction with the program.

Conclusions

At any given time, 28% of German Para athletes reported health problems, and 12% experienced substantial health problems. For a health team, illnesses seem to be more important to handle than injuries. The Oslo Sports Trauma Research Center Questionnaire on Health Problems is a suitable method for injury and illness surveillance in Para athletes.
The Relationship of Residency and Fellowship Sites to Academic Faculty and Leadership Positions
Authors: Egro Francesco M. , Beiriger Justin , Roy Eva , Nguyen Vu T.
Published: June 2020

Background

After completion of training, a physician's training institution has a lasting and meaningful impact on career trajectory. Training program influence on first job placement and academic promotions remain uncertain in academic plastic surgery. The aim of this study was to determine the impact of training and internal bias in academic plastic surgery employment and promotion.

Methods

Academic plastic surgery faculty were identified through an internet search of all Accreditation Council for Graduate Medical Education–accredited residency training programs. Faculty demographics, training background, employment, and leadership status were gathered. The analysis examined the impact of internal recruitment bias on first job employment, the impact of training history on institutional leadership promotion (chair/chief, residency director, or fellowship director), and the impact of alumni effect on academic employment.

Results

A significant proportion of recent graduates (38.6%) are practicing at the same institution as where they received residency or fellowship training. Of the 229 institutional leaders, 31.5% of chairs/chiefs, 39.6% of residency directors, and 37.5% of fellowship directors were internal hires. Overall, 34% of plastic surgery faculty in the United States share a common training program with at least 1 colleague. The top 5 programs that have the most faculty who trained at their hiring institution are Harvard (30 faculty), University of Southern California (15 faculty), University of California Los Angeles (12 faculty), University of Michigan (12 faculty), and Albert Einstein (12 faculty). Overall, 54% of plastic surgery departments employ 2 or more faculty who share a common external training program. The top 5 programs that have the most faculty who share an external training program are (1) Methodist Houston, 8 faculty who trained at Baylor; (2) Hofstra, 7 faculty who trained at New York University; (3) Stanford, 6 faculty who trained at University of California, Los Angeles; (4) Wisconsin, 5 faculty who trained at University of Pittsburgh Medical Center; and (5) University of Southern California, 4 faculty who trained at New York University.

Conclusions

The study highlights that an internal bias exists in the recruitment for first jobs and leadership promotions. However, a clear bias of internal hiring exists at several institutions. In addition, an alumni effect was identified, where some programs have a bias of hiring faculty who trained at the same external institution.
Virtual Surgical Planning for Reconstruction of Giant Ameloblastoma of the Mandible
Authors: Moro Alessandro , Pelo Sandro , Gasparini Giulio , Saponaro Gianmarco , Todaro Mattia , Pisano Giusi , D'Amato Giuseppe , Doneddu Piero
Published: June 2020

Ameloblastoma is a histologically benign tumor that behaves aggressively because of its tendency to invade local structures, and it has a high probability of local recurrence. If neglected, ameloblastomas can grow substantially over the course of years, reaching the size of giant ameloblastomas. This large size can lead to deformities in facial appearance and impairments in speaking, swallowing, eating, and breathing.

Surgical planning can be challenging because of the extension of the tumor and the consequent reconstructive issues.

In this article, we present our experience with the reconstruction of 2 cases of giant ameloblastomas planned on the basis of occlusal casts and acrylic splints. In these patients, computerized planning was rendered complex and potentially inaccurate because of the dimensions of the tumor, the loss of anatomical landmarks, and the loss of occlusal landmarks. The cases were successfully reconstructed, but the technique can be flawed. A 3-dimensional virtual model of the mandible can be used as a template to develop cutting guides for reconstruction with free fibular flaps. This will allow us to overcome limitations, standardize the procedure, and achieve optimal functional and aesthetic results.
Understanding Breast Implant Illness, Before and After Explantation
Authors: Wee Corinne E. , Younis Joseph , Isbester Kelsey , Smith Arvin , Wangler Brooke , Sarode Anuja L. , Patil Nirav , Grunzweig Katherine , Boas Samuel , Harvey Donald J. , Kumar Anand R. , Feng Lu-Jean
Published: June 2020

Background

Breast implant illness (BII) after aesthetic breast augmentation remains a poorly defined syndrome encompassing a wide spectrum of symptoms. While previously published series have observed overall symptomatic improvement after breast implant removal,
1–3
there is a lack of studies evaluating changes in specific symptoms over time. The purpose of this study was to gain an understanding of symptoms associated with BII, and to evaluate how these symptoms change after removal of breast implants and total capsulectomy (explantation). We hypothesized that patients presenting with BII would experience both immediate and sustained improvement in constitutional symptoms after explantation.

Methods

A retrospective study of all patients who underwent explantation by a single surgeon over 2 years was conducted. Repeated-measures analysis of variance accounting for dependency was used to compare symptoms before and after surgery. Multivariate analyses and linear regression models were used to examine the impact of patient- and implant-related factors on changes in symptoms.

Results

Seven hundred fifty patients met inclusion criteria. Mean preoperative survey score (26.19 ± 11.24) was significantly different from mean postoperative survey score at less than 30 days (9.49 ± 7.56) and greater than 30 days (9.46 ± 7.82, P < 0.001). Patients with a BMI greater than 30 or those with clinically detectable contracture on examination showed greater improvement on their survey scores (P = 0.039, 0.034, respectively).

Conclusions

Although BII encompasses a large range of symptoms, subjects in this study demonstrated significant and sustained improvement in 11 common symptom domains. This improvement was demonstrable within the first 30 days postoperatively and was maintained beyond 30 days. The study demonstrated a strong association of explantation and specific symptom improvement within the patient population studied. Future investigation will further elucidate possible biologic phenomena to better characterize the pathophysiology and mechanism of BII.
Dynamic impact of transfusion ratios on outcomes in severely injured patients: Targeted machine learning analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios randomized clinical trial
Authors: Nguyen Minh , Pirracchio Romain , Kornblith Lucy Z. , Callcut Rachael , Fox Erin E. , Wade Charles E. , Schreiber Martin , Holcomb John B. , Coyle Jeremy , Cohen Mitchell , Hubbard Alan
Published: June 2020

BACKGROUND

Massive transfusion protocols to treat postinjury hemorrhage are based on predefined blood product transfusion ratios followed by goal-directed transfusion based on patient's clinical evolution. However, it remains unclear how these transfusion ratios impact patient outcomes over time from injury.

METHODS

The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) is a phase 3, randomized controlled trial, across 12 Level I trauma centers in North America. From 2012 to 2013, 680 severely injured patients required massive transfusion. We used semiparametric machine learning techniques and causal inference methods to augment the intent-to-treat analysis of PROPPR, estimating the dynamic relationship between transfusion ratios and outcomes: mortality and hemostasis at different timepoints during the first 24 hours after admission.

RESULTS

In theintention-to-treat analysis, the 1:1:1 group tended to have decreased mortality, but with no statistical significance. For patients in whom hemostasis took longer than 2 hours, the 1:1:1 ratio was associated with a higher probability of hemostasis, statistically significant from the 4thhour on. In the per-protocol,actual-transfusion-ratios-received analysis,during four successive time intervals, no significant association was found between the actual ratios and mortality. When comparing patient groups who received both high plasma/PRBC and high platelet/PRBC ratios to the group of low ratios in both, the relative risk of achieving hemostasis was 2.49 (95% confidence interval, 1.19–5.22) during the third hour after admission, suggesting a significant beneficial impact of higher transfusion ratios of plasma and platelets on hemostasis.

CONCLUSION

Our results suggest that the impact of transfusion ratios on hemostasis is dynamic. Overall, the transfusion ratios had no significant impact on mortality over time. However, receiving higher ratios of platelets and plasma relative to red blood cells hastens hemostasis in subjects who have yet to achieve hemostasis within 3 hours after hospital admission.

LEVEL OF EVIDENCE

Therapeutic IV.
Sex-related Differences in Tau Positron Emission Tomography (PET) and the Effects of Hormone Therapy (HT)
Authors: Wisch Julie K. , Meeker Karin L. , Gordon Brian A. , Flores Shaney , Dincer Aylin , Grant Elizabeth A. , Benzinger Tammie L. , Morris John C. , Ances Beau M.
Published: June 2020

Importance:

Female sex is a major risk factor for late-onset Alzheimer disease (AD), and sex hormones have been implicated as a possible protective factor. Neuroimaging studies that evaluated the effects of sex hormones on brain integrity have primarily emphasized neurodegenerative measures rather than amyloid and tau burden.

Objective:

We compared cortical amyloid and regional tau positron emission tomography (PET) deposition between cognitively normal males and females. We also compared preclinical AD pathology between females who have and have not used hormone therapy (HT). Finally, we compared the effects of amyloid and tau pathology on cognition, testing for both sex and HT effects.

Design, Setting, and Participants:

We analyzed amyloid, tau, and cognition in a cognitively normal cross-sectional cohort of older individuals (n=148) followed at the Knight Alzheimer Disease Research Center. Amyloid and tau PET, medication history, and neuropsychological testing were obtained for each participant.

Results:

Within cognitively normal individuals, there was no difference in amyloid burden by sex. Whether or not we controlled for amyloid burden, female participants had significantly higher tau PET levels than males in multiple regions, including the rostral middle frontal and superior and middle temporal regions. HT accounted for a small reduction in tau PET; however, males still had substantially lower tau PET compared with females. Amyloid PET and tau PET burden were negatively associated with cognitive performance, although increasing amyloid PET did not have a deleterious effect on cognitive performance for women with a history of HT.

Conclusions and Relevance:

Regional sex-related differences in tau PET burden may contribute to the disparities in AD prevalence between males and females. The observed decreases tau PET burden in HT users has important implications for clinical practice and trials and deserves future consideration in longitudinal studies.
Adaptive leadership overcomes persistence–responsivity trade-off in flocking
Authors: Balázs Boldizsár , Vásárhelyi Gábor , Vicsek Tamás
Published: June 2020

The living world is full of cohesive collectives that have evolved to move together with high efficiency. Schools of fish or flocks of birds maintain their global direction despite significant noise perturbing the individuals, yet they are capable of performing abrupt collective turns when relevant agitation alters the state of a few members. Ruling local fluctuations out of global movement leads to persistence and requires overdamped interaction dynamics, while propagating swift turns throughout the group leads to responsivity and requires underdamped interaction dynamics. In this paper we show a way to avoid this conflict by introducing a time-dependent leadership hierarchy that adapts locally to
will
: agents’ intention of changing direction. Integrating our new concept of
will
-based inter-agent behaviour highly enhances the responsivity of standard collective motion models, thus enables breaking out of their former limit, the persistence-responsivity trade-off. We also show that the increased responsivity to environmental cues scales well with growing flock size. Our solution relies on active communication or advanced cognition for the perception of
will
. The incorporation of these into collective motion is a plausible hypothesis in higher order species, while it is a realizable feature for artificial robots, as demonstrated by our swarm of 52 drones.
The role of stress concentration in calcified bicuspid aortic valve
Authors: Qin Tongran , Caballero Andrés , Mao Wenbin , Barrett Brian , Kamioka Norihiko , Lerakis Stamatios , Sun Wei
Published: June 2020

Calcific aortic valve disease (CAVD) is the most common valvular heart disease in the aging population, and is now believed to be a slow, progressive, yet actively regulated process. The disease progression can be divided into two phases: initiation phase associated with lipid deposition and inflammation response, and the later propagation phase with active calcification growth. It has been hypothesized that elevated mechanical stress plays a major role in both phases of disease progression. In order to identify a direct link between leaflet stress and calcification development, we performed patient-specific finite-element (FE) analyses of six bicuspid aortic valves (BAV), where the leaflets, raphe and calcifications were all considered. The results showed that during the initiation phase, calcium buildup is likely to occur along the leaflet-root attachment curve (ATC), and the commissures, which are subject to the most drastic changes in stress during the cardiac cycle. During the propagation phase, the presence of calcification would lead to local stress concentration along its boundary, hence further calcification growth. Three patterns of calcification formation were identified on BAV leaflets: ‘radial’, which extended radially from ATC into the leaflet belly region; ‘commissure to commissure’, which extended circumferentially along the coaptation; and ‘raphe’, which located in the vicinity of the raphe. Furthermore, we found a strong correlation between regions with a high risk of calcium buildup and regions with elevated mechanical stress. The high-risk regions predicted at diastole on the non-calcified leaflet from FE models agreed reasonably well with the
in vivo
calcification locations, which indicates that patient-specific FE modelling could help us to evaluate the potential risk of calcification formation in the early stage of CAVD.
Evidence that eye-facing photophores serve as a reference for counterillumination in an order of deep-sea fishes
Authors: Davis Alexander L. , Sutton Tracey T. , Kier William M. , Johnsen Sönke
Published: June 2020

Counterillumination, the masking of an animal's silhouette with ventral photophores, is found in a number of mesopelagic taxa but is difficult to employ because it requires that the animal match the intensity of downwelling light without seeing its own ventral photophores. It has been proposed that the myctophid,Tarletonbeania crenularis,uses a photophore directed towards the eye, termed an eye-facing photophore, as a reference standard that it adjusts to match downwelling light. The potential use of this mechanism, however, has not been evaluated in other fishes. Here, we use micro-computed tomography, photography and dissection to evaluate the presence/absence of eye-facing photophores in three families of stomiiform fishes. We found that all sampled species with ventral photophores capable of counterillumination possess an eye-facing photophore that is pigmented on the anterior and lateral sides, thus preventing its use as a laterally directed signal, lure or searchlight. The two species that are incapable of counterillumination,Cyclothone obscuraandSigmops bathyphilus, lack an eye-facing photophore. After determining the phylogenetic distribution of eye-facing photophores, we used histology to examine the morphology of the cranial tissue inArgyropelecus aculeatusand determined that light from the eye-facing photophore passes through a transparent layer of tissue, then the lens, and finally strikes the accessory retina. Additionally, eight of the 14 species for which fresh specimens were available had an aphakic gap that aligned with the path of emitted light from the eye-facing photophore, while the remaining six had no aphakic gap. These findings, combined with records of eye-facing photophores from distantly related taxa, strongly suggest that eye-facing photophores serve as a reference for counterillumination in these fishes.
The origin of tetrapod herbivory: effects on local plant diversity
Authors: Brocklehurst Neil , Kammerer Christian F. , Benson Roger J.
Published: June 2020

The origin of herbivory in the Carboniferous was a landmark event in the evolution of terrestrial ecosystems, increasing ecological diversity in animals but also giving them greater influence on the evolution of land plants. We evaluate the effect of early vertebrate herbivory on plant evolution by comparing local species richness of plant palaeofloras with that of vertebrate herbivores and herbivore body size. Vertebrate herbivores became diverse and achieved a much greater range of body sizes across the Carboniferous–Permian transition interval. This coincides with an abrupt reduction in local plant richness that persists throughout the Permian. Time-series regression analysis supports a negative relationship of plant richness with herbivore richness but a positive relationship of plant richness with minimum herbivore body size. This is consistent with studies of present-day ecosystems in which increased diversity of smaller, more selective herbivores places greater predation pressures on plants, while a prevalence of larger bodied, less selective herbivores reduces the dominance of a few highly tolerant plant species, thereby promoting greater local richness. The diversification of herbivores across the Carboniferous–Permian boundary, along with the appearance of smaller, more selective herbivores like bolosaurid parareptiles, constrained plant diversity throughout the Permian. These findings demonstrate that the establishment of widespread vertebrate herbivory has structured plant communities since the late Palaeozoic, as expected from examination of modern ecosystems, and illustrates the potential for fossil datasets in testing palaeoecological hypotheses.