bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of two vitamin D supplementation strategies in children with sickle cell disease: a randomized controlled trial
Authors: Grégoire‐Pelchat Pascale , Pastore Yves , Robitaille Nancy , LeMay Sylvie , Khamessan Ali , Kleiber Niina , Nyalendo Carine , Gagné Nancy , Alos Nathalie , Mailhot Geneviève
Published: November 2020

Previously, we showed that nearly 70% of children followed in our sickle cell disease (SCD) clinic were vitamin D‐ deficient and had low vitamin intake with poor use of supplements. We compared the change in serum 25‐hydroxyvitamin D [25(OH)D], safety and clinical impact of two vitamin D supplementation regimens in children with SCD. Children (5–17 years, all genotypes) were randomized to a single bolus of vitamin D3 (300 000 IU; n = 18) or placebo (n = 20). All children received a prescription for daily 1 000 IU vitamin D3. Serum 25(OH)D and calcium, urinary calcium/creatinine ratio, musculoskeletal pain, quality of life, haematology and bone markers were assessed at baseline and three months post intervention. Bolus administration led to a greater rise in 25(OH)D levels from baseline compared to placebo (20 ± 16 nmol/l vs. 2 ± 19 nmol/l; P = 0·003) and correction of vitamin D deficiency. No hypercalcaemia nor hypercalciuria occurred during the study, but more children in the bolus group experienced gastrointestinal symptoms within the first month (P = 0·04). There were no differences between groups for other outcomes. The use of a high‐dose vitamin D bolus combined with daily 1 000 IU vitamin D3 was more efficient in raising 25(OH)D levels than daily supplementation alone in children with SCD.
A BBS1 SVA F retrotransposon insertion is a frequent cause of Bardet‐Biedl syndrome
Authors: Delvallée Clarisse , Nicaise Samuel , Antin Manuela , Leuvrey Anne‐Sophie , Nourisson Elsa , Leitch Carmen C. , Kellaris Georgios , Stoetzel Corinne , Geoffroy Véronique , Scheidecker Sophie , Keren Boris , Depienne Christel , Klar Joakim , Dahl Niklas , Deleuze Jean‐François , Génin Emmanuelle , Redon Richard , Demurger Florence , Devriendt Koenraad , Mathieu‐Dramard Michèle , Poitou‐Bernert Christine , Odent Sylvie , Katsanis Nicholas , Mandel Jean‐Louis , Davis Erica E. , Dollfus Hélène , Muller Jean
Published: November 2020

Bardet‐Biedl syndrome (BBS) is a ciliopathy characterized by retinitis pigmentosa, obesity, polydactyly, cognitive impairment and renal failure. Pathogenic variants in 24 genes account for the molecular basis of >80% of cases. Toward saturated discovery of the mutational basis of the disorder, we carefully explored our cohorts and identified a hominid‐specific SINE‐R/VNTR/Alu type F (SVA‐F) insertion in exon 13 of BBS1 in eight families. In six families, the repeat insertion was found in trans with c.1169 T > G, p.Met390Arg and in two families the insertion was found in addition to other recessive BBS loci. Whole genome sequencing, de novo assembly and SNP array analysis were performed to characterize the genomic event. This insertion is extremely rare in the general population (found in 8 alleles of 8 BBS cases but not in >10 800 control individuals from gnomAD‐SV) and due to a founder effect. Its 2435 bp sequence contains hallmarks of LINE1 mediated retrotransposition. Functional studies with patient‐derived cell lines confirmed that the BBS1 SVA‐F is deleterious as evidenced by a significant depletion of both mRNA and protein levels. Such findings highlight the importance of dedicated bioinformatics pipelines to identify all types of variation.
Renal transplantation during the SARS‐CoV‐2 pandemic in the UK: Experience from a large‐volume center
Authors: Georgiades Fanourios , Summers Dominic M. , Butler Andrew J. , Russell Neil K. I. , Clatworthy Menna R. , Torpey Nicholas
Published: November 2020

There is uncertainty about the safety of kidney transplantation during the SARS‐CoV‐2 pandemic due to the risk of donor transmission, nosocomial infection and immunosuppression use. We describe organ donation and transplant practice in the UK and assess whether kidney transplantation conferred a substantial risk of harm. Data from the UK transplant registry were used to describe kidney donation and transplant activity in the UK, and a detailed analysis of short‐term, single‐center, patient results in two periods: during the pre‐pandemic era from 30th December 2019 to 8th March 2020 (“Pre‐COVID era”) and the 9th March 2020 to 19th May 2020 (“COVID era”). Donor and recipient numbers fell by more than half in the COVID compared to the pre‐COVID era in the UK, but there were more kidney transplants performed in our center (42 vs. 29 COVID vs. pre‐COVID respectively). Overall outcomes, including re‐operation, delayed graft function, primary non‐function, acute rejection, length of stay and graft survival were similar between COVID and pre‐COVID era. 6/71 patients became infected with SARS‐CoV‐2 but all were discharged without critical care requirement. Transplant outcomes have remained similar within the COVID period and no serious sequelae of SARS‐CoV‐2 infection were observed in the peri‐transplant period.
Purchasing, consumption, demographic and socioeconomic variables associated with shifts in alcohol consumption during the COVID‐19 pandemic
Authors: Callinan Sarah , Mojica‐Perez Yvette , Wright Cassandra J. C. , Livingston Michael , Kuntsche Sandra , Laslett Anne‐Marie , Room Robin , Kuntsche Emmanuel
Published: November 2020

Introduction and Aims

Restrictions introduced to reduce the spread of COVID‐19 have had major impacts on the living circumstances of Australians. This paper aims to provide insight into shifts in alcohol consumption and associated factors during the epidemic.

Design and Methods

A cross‐sectional convenience sample of 2307 Australians aged 18 and over who drank at least monthly was recruited through social media. Respondents were asked about their alcohol consumption and purchasing in 2019 prior to the epidemic plus similar questions about their experiences in the month prior to being surveyed between 29 April and 16 May 2020.

Results

Reports of average consumption before (3.53 drinks per day [3.36, 3.71 95% confidence interval]) and during (3.52 [3.34, 3.69]) the pandemic were stable. However, young men and those who drank more outside the home in 2019 reported decreased consumption during the pandemic, and people with high levels of stress and those who bulk‐bought alcohol when restrictions were announced reported an increase in consumption relative to those who did not.

Discussion and Conclusions

A reported increase in consumption among those experiencing more stress suggests that some people may have been drinking to cope during the epidemic. Conversely, the reported decrease in consumption among those who drank more outside of their home in 2019 suggests that closing all on‐trade sales did not result in complete substitution of on‐premise drinking with home drinking in this group. Monitoring of relevant subgroups to assess long‐term changes in consumption in the aftermath of the epidemic is recommended.
Prevalence of obesity and disturbances in glucose homeostasis in HIV‐infected subjects and general population – missed diagnoses of diabetes?
Authors: Hanttu A , Kauppinen KJ , Kivelä P , Ollgren J , Jousilahti P , Liitsola K , Koponen P , Sutinen J
Published: November 2020

Objectives

Comparative data on glucose disorders using fasting blood samples between people living with HIV (PLWH) and the general population are lacking. The objective of this study was to compare the prevalence and risk factors of obesity and disturbances in glucose homeostasis between PLWH treated with modern antiretroviral therapy and the general population.

Methods

Adjusted prevalence of obesity, features of insulin resistance (triglyceride:high‐density lipoprotein cholesterol ratio and alanine aminotransferase), impaired fasting glucose (IFG), diabetes mellitus (DM) and combined dysglycaemia (presence of IFG or DM) were determined using fasting blood samples among 1041 PLWH and 7047 subjects representing the general population.

Results

People living with HIV had a lower prevalence of obesity [18.2%, 95% confidence interval (CI): 15.1–21.2 vs. 23.9%, 95% CI: 22.4–25.4], but a higher prevalence of insulin resistance and IFG (20.0%, 95% CI: 16.6–23.4 vs. 9.8%, 95% CI: 8.7–10.8) than the general population. Fasting glucose concentration was higher, but glycated haemoglobin (HbA1c) was lower, among PLWH. Prevalence of dysglycaemia for a given body mass index (BMI) was higher in PLWH than in the general population. The prevalence of DM did not differ between PLWH (13.2%, 95% CI: 10.2–15.9) and the general population (14.5%, 95% CI: 13.6–15.4).

Conclusions

The prevalence of obesity was lower, but the risk of dysglycaemia for a given BMI was significantly higher, among PLWH, highlighting the importance of prevention and treatment of obesity among HIV‐infected subjects. Regardless of the increased prevalence of insulin resistance and IFG, DM was surprisingly not more common among PLWH, raising concern about the under‐diagnosis of DM, possibly due to low sensitivity of HbA1c in this patient population.
Guidelines for reporting on CBCT scans
Authors: Patel S. , Harvey S.
Published: November 2020

The aim of a radiographic report is to provide an accurate interpretation of images to facilitate the diagnostic process, and when indicated prompt the appropriate management for the patient. It is part of the patient’s clinical records. This paper describes the imaging chain involved in the cone beam computed tomography (CBCT) workflow from referring to reporting on a CBCT scan. It provides guidelines on the essential information required before and immediately after a CBCT scan is taken, and optimizing the viewing conditions. Finally, it describes a framework for a systematic, comprehensive and tailored CBCT radiographic report. It is aimed at endodontists, clinicians and radiologists reporting on CBCT scans of the dentoalveolar region.
Effect of medium condition change on green body density during casting and drying
Authors: Iwata Naoya , Yamada Saori , Mori Takamasa
Published: November 2020

The present study examined whether the optimum slurry conditions in which the green body with the highest packing fraction was fabricated were the same regardless of whether tape or slip casting methods were used. Additionally, we investigated the optimum slurry evaluation method to predict the packing fraction of each green body. Specifically, aqueous dense alumina slurries, whose particle dispersion state was changed by varying pH and the amount of dispersant additive, were prepared. After changing the pH, the optimum slurry conditions were achieved regardless of the casting method. The most suitable amount of additive dispersant differed due to the changing solution conditions during the casting and drying process; the medium of the slurry permeated into the plaster during slip casting and dried on the substrate during tape casting. Thus, in slip casting, non‐adsorbed polymers could also be permeated. Hence, it is crucial for slurry evaluation to predict the packing fraction of the slip cast body. A sedimentation test, which involved particle condensation as well as casting, was valid for the green sheet. Conversely, it was experimentally shown that the constant pressure filtration test, which involved the permeation of the medium in addition to particle condensation, was suitable for slip casting.
Effectiveness and adverse effects of at‐home dental bleaching with 37% versus 10% carbamide peroxide: A randomized, blind clinical trial
Authors: Sutil Elisama , da Silva Karine Letícia , Terra Renata Maria Oleniki , Burey Adrieli , Rezende Márcia , Reis Alessandra , Loguercio Alessandro D.
Published: November 2020

Purpose

The aim of this trial was to evaluate bleaching effectiveness, tooth sensitivity and gingival irritation of whitening patients with 10% versus 37% carbamide peroxide (CP).

Methods

Eighty patients were selected by inclusion and exclusion criteria and randomly allocated into two groups (n = 40): 37% CP and 10% CP. In both groups, patients performed whitening for 3 weeks, 4 h/day for 10% group and 30 min/day for 37% group. Color was evaluated with Vita Classical, Vita Bleachedguide 3D Master and Spectrophotometer Easyshade, at baseline, weekly and 30 days after treatment. Absolute risk and intensity of tooth sensitivity (TS) and gingival irritation (GI) were assessed with numeric rating scale (NRS) and a visual analog scale (VAS). Color changes were compared with t‐test for independent samples. TS and GI were evaluated with Fisher's exact tests. Mann–Whitney test was used for NRS, and t‐tests for VAS (α = 0.05).

Results

The 37% CP group showed faster whitening than 10% group at 1–3 weeks. However, 1 month after conclusion, both groups showed equivalent bleaching (p = 0.06). Regarding sensitivity and gingival irritation, 10% and 37% groups met no significant differences (p > 0.05).

Conclusion

The use of 37% CP 30 min/day showed equivalent results to 10% 4 h/day.

Clinical significance

The use of 37% carbamide peroxide 30 min/day may decrease the time of tray use in at‐home protocol for whitening because it presents equivalent results to 10% carbamide peroxide 4 h/day.
A study using semi‐structured interview and Delphi survey to explore the barriers and enabling factors that influence access and utilisation of weight management services for people living with morbid obesity: A patient and professional perspective
Authors: Holt Guy , Hughes David
Published: November 2020

Background

A quarter of the United Kingdom’s population are living with obesity, a disease that causes an estimated 30 000 deaths each year. This coincides with an under‐utilisation of weight management services across the country with the majority of patients with morbid obesity having no record of any weight loss intervention at all. This study explores the factors that influence patient access to weight management services.

Methodology

Expert opinion was obtained using semi‐structured interviews and the Delphi methodology. Participants were selected from primary and secondary healthcare settings. Healthcare professionals (HCPs) had experience working in weight management services or in services dealing with obesity‐related comorbidities. Patients had experience in attending a variety weight management services.

Results

Nineteen participants completed all aspects of the study. The main barriers included negative perceptions, low mood/depression, obesity not being considered as a serious disease, lack of access to services for housebound patients and disproportionate commissioning. Suggested facilitating factors to improve access included the education of all HCPs about obesity, improving HCP communication with patients, and broadening the number of HCP’s that are able to refer to weight management services.

Conclusions

Future services must prioritise the education of all HCPs and the public to combat the stigma of obesity and its impact on health. National commissioning guidelines in partnership with advocates of obesity should seek to streamline referral pathways, broaden referral sources and increase the availability of specialist services. Awareness of these factors when designing future weight management services will help to improve their utilisation.
(Non‐)Insurance Markets, Loss Size Manipulation and Competition: Experimental Evidence*
Authors: Hinloopen Jeroen , Soetevent Adriaan R.
Published: November 2020

The common view that insurer buyer power may effectively counteract provider market power critically rests on the idea that consumers and insurers have a joint interest in pushing for price and cost reductions. We develop theory and provide experimental evidence that the interests of insurers and consumers may be misaligned when insurers have the power to influence the service supplier’s cost. Insurers with such buyer power may benefit from increasing initial loss sizes to create demand for insurance. Insurer competition eliminates their profits but markets do not return to the initial non‐insurance state. This constitutes a welfare loss.
Blood transfusion‐induced posterior reversible encephalopathy syndrome with periodic sharp wave complexes, 14‐3‐3 protein elevation, and the pulvinar sign
Authors: Shiraishi Wataru , Yamaguchi Takahiro , Fujiki Ryosuke , Furuta Konosuke
Published: November 2020

A 52‐year‐old Japanese woman was admitted to our hospital with consciousness disturbance and convulsions at 10 days after transfusion with 10 U of blood due to severe anemia. Electroencephalography showed periodic sharp wave complexes, cerebrospinal fluid 14‐3‐3 protein levels were elevated, and brain magnetic resonance imaging demonstrated bilateral thalamic hyperintensity. These findings suggested Creutzfeldt‐Jakob disease (CJD); however, her symptoms were resolved with antiepileptic and anti‐hypertensive drugs. We herein report a case of posterior reversible encephalopathy syndrome that occurred after a blood transfusion who showed features compatible with CJD.
Validation and psychometric evaluation of the Spanish version of Brief Esophageal Dysphagia Questionnaire (BEDQ): Results of a multicentric study
Authors: Cisternas Daniel , Taft Tiffany , Carlson Dustin A. , Glasinovic Esteban , Monrroy Hugo , Rey Paula , Hani Albis , Ardila‐Hani Andres , Leguizamo Ana Maria , Bilder Claudio , Ditaranto Andres , Varela Amanda , Agotegaray Joaquin , Remes‐Troche Jose Maria , Ruiz de León Antonio , Pérez de la Serna Julio , Marin Ingrid , Serra Jordi
Published: November 2020

Background

The recently developed Brief Esophageal Dysphagia Questionnaire (BEDQ) evaluates esophageal obstructive symptoms. Its initial evaluation showed strong psychometric properties. The aims of this study were to (a) translate and validate an international Spanish version of BEDQ and (b) evaluate its psychometric properties in a large Hispano‐American sample of symptomatic individuals.

Methods

A Spanish BEDQ version was performed by Hispano‐American experts using a Delphi process and reverse translation. Patients were prospectively recruited from seven centers in Spain and Latin America among individuals referred for high‐resolution manometry (HRM). Patients completed several scores: Hospital Anxiety & Depression Scale (HADS), Eckardt score (ES), Gastroesophageal Reflux Questionnaire (GERDQ), and the BEDQ. Standardized psychometric analyses were performed.

Key Results

A total of 426 patients were recruited. Spanish BEDQ showed excellent reliability (Cronbach's alpha = 0.91). Factor analysis confirmed its unidimensional character. Moderate significant correlations between BEDQ and other symptomatic scores were found, suggesting sufficient convergent validity. Patients with abnormal or obstructive HRM findings scored significantly higher when compared to normal or non‐obstructive findings, respectively. Using a cutoff of 10, BEDQ showed a sensitivity of 65.38% and a specificity of 66.21% and an area under the curve of 0.71 for obstructive or major manometric diagnosis.

Conclusions and Inferences

A widely usable Spanish BEDQ version has been validated. We confirm its excellent psychometric properties in our patients, confirming the appropriateness of its use in different populations.
Variation is the Norm: A Landscape Analysis of Weighted Student Funding Implementation
Authors: Roza Marguerite , Hagan Katherine , Anderson Laura
Published: November 2020

School districts increasingly rely on weighted student funding (WSF), yet there is little research on this allocation model. This study collects more than 70 measures on each of 19 districts using WSF in 2018 for a landscape analysis of formula features and implementation practices. While districts report common reasons for adopting WSF (equity, flexibility, and transparency), we find no standard WSF model. Homegrown formulas and nonformula features and exemptions reflecting local context are the norms, resulting in substantial differences. Nearly all districts continue to budget with average salaries (likely limiting equity) but grant principals flexibility on staffing, stipends, and contracts.
A newly described cutaneous reaction at sites of insulin pump use in a child with Type 1 diabetes
Authors: Perez Victoria A. , Husain Sameera , Magro Cynthia M. , Strom Mark A. , Williams Kristen M. , Levin Laura E.
Published: November 2020

Continuous subcutaneous insulin infusion (CSII), or insulin pumps, with or without continuous glucose monitoring (CGM) devices have become the standard of care for patients with type 1 diabetes. While increasingly popular, a wide range of reported skin reactions to CSII and CGM devices was found. We present this case of a pyogenic granuloma‐like neutrophilic and granulomatous response to an insulin pump to increase awareness of a previously uncharacterized cutaneous adverse reaction at insulin pump infusion sites.
Reconsidering the Alleged Cases of Knowledge from Falsehood*
Authors: Lee Kok Yong
Published: November 2020

A number of philosophers have recently proposed several alleged cases of “knowledge from falsehood,” i.e., cases of inferential knowledge epistemised by an inference with a false crucial premise. This paper examines such cases and argues against interpreting them as cases of knowledge from falsehood. Specifically, I argue that the inferences in play in such cases are in no position to epistemise their conclusions.
Purification of cryopreserved camel spermatozoa following protease‐based semen liquefaction by lectin‐functionalized DNA‐defrag magnetic nanoparticles
Authors: Rateb Sherif A.
Published: November 2020

Although incorporating proteases into sperm medium is considered the most effective procedure to eliminate camel semen viscosity, it drastically affects viability, morpho‐functional properties and, hence, fertilization potential of spermatozoa. The present work aimed at evaluating adequacy of employing magnetic nanoparticles‐based sperm purification technique for eluting impaired and apoptotic camel spermatozoa from cryopreserved semen doses following protease‐based semen liquefaction. Thirty cryopreserved semen doses (50 x 106 sperm/straw) representing the following liquefaction treatments: control (untreated), 0.1 mg/ml papain or 5 U/ml bromelain were used (n = 10 straws per treatment). Immediately after thawing (38°C for 40 s), sperm concentration of each straw within treatment was readjusted to 15 x 106 sperm/mL by dilution in PBS (37°C). Sperm physical and cytological properties were then assessed (non‐purified semen). Thereafter, each specimen was subjected to lectin‐functionalized DNA‐defrag magnetic nanoparticles sperm purification, and the same sperm traits were re‐evaluated after undergoing purification (purified semen). Sperm DNA fragmentation level within each group, prior to and after magnetic nano‐purification, was also determined by fluorescent imaging. The results showed a dramatic improvement (p < .05) in post‐thaw motility (%), viability (%), normal sperm (%), intact acrosome (%) and HOST‐reacted (%) spermatozoa in protease‐liquefied semen following sperm magnetic nano‐purification. Additionally, the highest (p < .05) DNA fragmentation level was recorded in all cryopreserved semen groups prior to purification, whereas the lowest (p < .05) was observed in the protease‐treated specimens after magnetic nano‐purification. These results indicate that protease‐based semen liquefaction prior to cryopreservation in conjunction with magnetic nano‐purification post‐thawing holds potential for reducing the proportion of damaged and dead spermatozoa, hence improving camel sperm fertilization competence.
Spatiotemporal Modelling using Integro-Difference Equations with Bivariate Stable Kernels
Authors: Richardson Robert , Kottas Athanasios , Sansó Bruno
Published: November 2020

An integro-difference equation can be represented as a hierarchical spatiotemporal dynamic model using appropriate parameterizations. The dynamics of the process defined by an integro-difference equation depends on the choice of a bivariate kernel distribution, where more flexible shapes generally result in more flexible models. Under a Bayesian modelling framework, we consider the use of the stable family of distributions for the kernel, as they are infinitely divisible and offer a variety of tail behaviours, orientations and skewness. Many of the attributes of the bivariate stable distribution are controlled by a measure, which we model using a flexible Bernstein polynomial basis prior. The method is the first attempt to incorporate non-Gaussian kernels in a two-dimensional integro-difference equation model and will be shown to improve prediction over the Gaussian kernel model for a data set of Pacific sea surface temperatures.
A comparison of platelet quality between platelets from healthy donors and hereditary hemochromatosis donors over seven‐day storage
Authors: Mikaelsdottir Marta , Vidarsson Brynjar , Runarsson Gudmundur , Bjarnadottir Una , Onundarson Pall T. , Sigurjonsson Olafur E. , Halldorsdottir Anna M.
Published: November 2020

Background

Therapeutic phlebotomy is the standard treatment of hereditary hemochromatosis (HH), the most common genetic disease in people of Northern European descent. Red cell concentrates from HH donors have been reported safe for transfusion, but little data is available on the storage properties of platelet concentrates from HH donors.

Study Design and Methods

Whole blood was collected from 10 healthy individuals and 10 newly diagnosed HH patients with elevated serum ferritin. Platelet‐rich plasma (PRP) was prepared and split into four 20‐mL units. Platelet quality tests were performed on days 0, 1, 3, 5, and 7 of storage, including platelet aggregation (ADP, arachidonic acid, collagen, and epinephrine agonists), blood gas analysis, flow cytometry (CD41, CD42b, and CD62P expression), and ELISA (sCD40L and sCD62p in supernatant).

Results

Mean serum ferritin levels were higher in HH patients than in controls (847.5 vs 45.8 ng/mL, P < .001). Overall, no difference in quality test results was observed between the two study groups over 7‐day storage (P > .05), including blood gas analysis, platelet aggregation, and expression of surface (CD62p and CD42b) and secreted (sCD62P and sCD40L) activation markers. Expected alterations in metabolic (CO2 and glucose decrease, O2 and lactate increase, P < .001) and platelet activation markers (CD42b decrease, CD62P increase, P < .05) over time were observed in both groups.

Conclusion

Although these findings indicate that platelets of individuals with HH are comparable to platelets from healthy donors, more extensive studies are needed before definite conclusions can be drawn.
Severity of albuminuria as an early indicator for wound healing in type 2 diabetic foot ulcers
Authors: Ling Xiang‐Wei , Wang Hai‐Shuang , Wan Li , Guo Hai‐Lei , Liu Zheng‐Jun , Lin Cai , Zhang Xing‐Xing
Published: November 2020

This study aimed to investigate the relationship between the severity of albuminuria and wound healing in type 2 diabetic foot ulcers. A total of 121 patients with diabetic foot ulcers were recruited from January 2015 to June 2017 and divided into nonproliferation and proliferation groups according to their healing status. Univariate and multivariate logistic regression were performed to assess the risk factors of wound proliferation. Skin biopsies were also taken from normal tissue near the wound in 54 participants. The microvessel density as well as the relationships among the microvessel density, albuminuria and wound proliferation were evaluated. Results showed that in a multiple linear regression model, factors including body‐mass index, microalbuminuria, and macroalbuminuria showed independently significant association with wound healing in patients. The receiver operating characteristic curve analysis indicated albuminuria as a predicator for wound healing with a cutoff value of 32 mg/g. Meanwhile, normoalbuminuric patients showed significantly higher level of skin microvessels density than microalbuminuria and macroalbuminuria patients, while microalbuminuria patients also had statistically more microvessels that macroalbuminuria patients. The microvessel density were statistically significantly higher in the proliferation group than that in the nonproliferation group. In summary, this study suggested that albuminuria can be used as an independent indicator for the healing of type 2 diabetic foot ulcers.
Computational Design of Compositionally Graded Alloys for Property Monotonicity
Authors: Kirk Tanner , Malak Richard , Arroyave Raymundo
Published: November 2020

Functionally graded materials (FGMs) exhibit spatial gradients in properties that can be exploited to satisfy multiple conflicting performance objectives in the same part. Compositionally graded alloys are a subclass of FGMs that have received increased attention with the development of metal additive manufacturing. However, the formation of secondary phases can often lead to cracks or deleterious properties in these materials. In prior work, a computational methodology was presented that can design compositional gradients to avoid these phases at any temperature without the need to visualize phase diagrams (Kirk et al., 2018, “Computational Design of Gradient Paths in Additively Manufactured Functionally Graded Materials,” ASME J. Mech. Des., 140(11), p. 111410). The methodology optimizes gradient paths through composition space for a specified cost function, but prior work only considered minimizing path length or maximizing the distance from undesirable phases. In this work, a new cost function is presented to produce compositional paths with optimal property gradients. Specifically, monotonicity is presented as the optimal quality of a pathwise property gradient because monotonic property gradients can be transformed to nearly any form on the part by controlling deposition rate. The proposed cost function uses a metric for non-monotonicity to find the shortest path with monotonic properties and is shown to be compatible with optimal path planners. A synthetic case study examines the effect of a cost function parameter on the trade-off between length and monotonicity. The cost function is also demonstrated in the Fe-Co-Cr system to find a compositional path with monotonic gradients in coefficient of thermal expansion (CTE). The deposition of the path on a hypothetical part is then planned subject to a maximum deposition rate and CTE gradient. Future work is proposed to extend the framework to optimize multiple properties at once and to incorporate multi-material topology optimization (MMTO) techniques into a complete design methodology for functionally graded metal parts.
Effects of Antibiotic Treatment with Piperacillin/Tazobactam versus Ceftriaxone on the Composition of the Murine Gut Microbiota
Authors: Venturini Carola , Bowring Bethany , Fajardo-Lubian Alicia , Devine Carol , Iredell Jonathan
Published: November 2020

Effective antimicrobial stewardship requires a better understanding of the impact of different antibiotics on the gut microflora. Studies with humans are confounded by large interindividual variability and difficulty in identifying control cohorts.
Growing Ungrowable Bacteria: Overview and Perspectives on Insect Symbiont Culturability
Authors: Masson Florent , Lemaitre Bruno
Published: November 2020

Insects are often involved in endosymbiosis, that is, the housing of symbiotic microbes within their tissues or within their cells. Endosymbionts are a major driving force in insects’ evolution, because they dramatically affect their host physiology and allow them to adapt to new niches, for example, by complementing their diet or by protecting them against pathogens. Endosymbiotic bacteria are, however, fastidious and therefore difficult to manipulate outside of their hosts, especially intracellular species.
Phages versus Antibiotics To Treat Infected Diabetic Wounds in a Mouse Model: a Microbiological and Microbiotic Evaluation
Authors: Huon Jean-François , Montassier Emmanuel , Leroy Anne-Gaëlle , Grégoire Matthieu , Vibet Marie-Anne , Caillon Jocelyne , Boutoille David , Navas Dominique
Published: November 2020

The management of diabetic foot infections is frequently a dead end for surgeons and infectious disease specialists. When the pathogen to be treated is not resistant to conventional antibiotics, the latter tend to unbalance the intestinal microbiota, which is linked to multiple pathologies. A local treatment with bacteriophages, in addition to being as much or even more effective than antibiotics from a clinical and microbiological point of view, makes it possible to respect the patient’s microbiota. These results suggest that the use of this therapeutic alternative is a major avenue and that the introduction of recommendations for their use is now necessary.
Necrotising enterocolitis in newborns receiving diazoxide
Authors: Prado Laura A , Castro Marina , Weisz Dany E , Jain Amish , Belik Jaques
Published: November 2020

Background

Frequent and severe gastrointestinal disturbances have been reported with the use of diazoxide in adults and older children. However, no studies have investigated the incidence of necrotising enterocolitis (NEC) in diazoxide-exposed newborns.

Objective

To evaluate a possible association between diazoxide treatment for neonatal hypoglycaemia and the occurrence of NEC.

Design

Multicentre retrospective cohort study.

Setting

Three tertiary neonatal intensive care units in Toronto, Canada.

Patients

All patients treated with diazoxide for persistent hypoglycaemia between July 2012 and June 2017 were included. Overall incidence of NEC during those years on the participating units was obtained for comparison from the Canadian Neonatal Network database.

Main outcome

Incidence of NEC after diazoxide exposure.

Results

Fifty-five neonates were exposed to diazoxide during the study period. Eighteen patients (33%) showed signs of feeding intolerance, and 7 developed NEC (13%). A diagnosis of NEC was more prevalent in the diazoxide-exposed, as compared with non-exposed infants of similar gestational age (OR 5.07, 95% CI 2.27 to 11.27; p<0.001), and greatest among infants born at 33–36 weeks’ gestation (OR 13.76, 95% CI 3.77 to 50.23; p<0.001). All but one of the neonates diagnosed with NEC developed the disease within 7 days from initiation of diazoxide treatment.

Conclusion

The present data suggest a possible association between diazoxide exposure and the development of NEC in neonates. Further evaluation of the diazoxide-associated risk of NEC in neonates treated for persistent hypoglycaemia is warranted.
Duration of and trends in respiratory support among extremely preterm infants
Authors: Weisz Dany E , Yoon Eugene , Dunn Michael , Emberley Julie , Mukerji Amit , Read Brooke , Shah Prakeshkumar S
Published: November 2020

Objective

To evaluate annual trends in the administration and duration of respiratory support among preterm infants.

Design

Retrospective cohort study.

Setting

Tertiary neonatal intensive care units in the Canadian Neonatal Network.

Patients

8881 extremely preterm infants born from 2010 to 2017 treated with endotracheal and/or non-invasive positive pressure support (PPS).

Main outcome measures

Competing risks methods were used to investigate the outcomes of mortality and time to first successful extubation, definitive extubation, weaning off PPS, and weaning PPS and/or low-flow oxygen, according to gestational age (GA). Cox proportional hazards and regression models were fitted to evaluate the trend in duration of respiratory support, survival and surfactant treatment over the study period.

Results

The percentages of infants who died or were weaned from respiratory support were presented graphically over time by GA. Advancing GA was associated with ordinally earlier weaning from respiratory support. Year over year, infants born at 23 weeks were initially and definitively weaned from endotracheal and all PPS earlier (HR 1.06, 95% CI 1.01 to 1.11, for all outcomes), while survival simultaneously increased (OR 1.11, 95% CI 1.03 to 1.18). Infants born at 26 and 27 weeks remained on non-invasive PPS longer (HR 0.97, 95% CI 0.95 to 0.98 and HR 0.97, 95% CI 0.95 to 0.99, respectively). Early surfactant treatment declined among infants born at 24–27 weeks GA.

Conclusions

Infants at the borderline of viability have experienced improved survival and earlier weaning from all forms of PPS, while those born at 26 and 27 weeks are spending more time on PPS in recent years. GA-based estimates of the duration of respiratory support and survival may assist in counselling, benchmarking, quality improvement and resource planning.
Association of maternal diabetes mellitus with preterm infant outcomes: a systematic review and meta-analysis
Authors: Razak Abdul , Faden Maheer
Published: November 2020

Context

The association between maternal diabetes and outcomes of infants who are born preterm is unclear.

Objective

To perform a systematic review and meta-analysis of clinical studies exploring the association between maternal diabetes and preterm infant outcomes.

Methods

Medline, PubMed and Cumulative Index of Nursing and Allied Health Literature databases were searched without language restriction from 1 January 2000 until 19 August 2019. Studies examining preterm infants <37 weeks gestational age and reporting prespecified outcomes of this review based on maternal diabetes as primary exposure variable were included.

Results

Of 7956 records identified through database searches, 9 studies were included in the study. No significant association was found between maternal diabetes and in-hospital mortality (adjusted RR (aRR) 0.90 (95% CI 0.73 to 1.11); 6 studies; participants=1 191 226; I2=83%). Similarly, no significant association was found between maternal diabetes and bronchopulmonary dysplasia (aRR 1.00 (95% CI 0.92 to 1.07); 4 studies; participants=107 902; I2=0%), intraventricular haemorrhage or cystic periventricular leukomalacia (aRR 0.91 (95% CI 0.80 to 1.03); 3 studies; participants=115 050; I2=0%), necrotising enterocolitis (aRR 1.13 (95% CI 0.90 to 1.42); 5 studies; participants=142 579; I2=56%) and retinopathy of prematurity (ROP) (aRR 1.17 (95% CI 0.85 to 1.61); 5 studies; participants=126 672; I2=84). A sensitivity analysis where low risk of bias studies were included in the meta-analyses showed similar results; however, the heterogeneity was lower for in-hospital mortality and ROP.

Conclusion

Maternal diabetes was not associated with in-hospital mortality and severe neonatal morbidities in preterm infants. Future studies should explore the association between the severity of maternal diabetes with preterm infant outcomes.
A new storage medium containing amphotericin B versus Optisol-GS for preservation of human donor corneas
Authors: Mistò Raffaela , Giurgola Laura , Pateri Francesca , Limongelli Anna , Ragazzi Eugenio , D’Amato Tóthová Jana
Published: November 2020

Background/Aim

We compared the quality of human donor corneas stored in a cold storage medium containing 2.5 μg/ml of amphotericin B (Kerasave, AL.CHI.MI.A. S.R.L., Ponte San Nicolò, Italy) and Optisol-GS (Bausch & Lomb Inc., Bridgewater, NJ, USA) for 14 days.

Methods

Sixteen pairs of human donor corneas were collected in Eusol-C (AL.CHI.MI.A. S.R.L., Ponte San Nicolò, Italy). Next, all tissues underwent the first evaluation that included the assessments of central corneal thickness (CCT), endothelial cell density (ECD) measured using both trypan blue staining and specular microscopy, endothelial cell (EC) mortality and morphology, and corneal transparency within 24 hours from recovery (Day 1). Afterwards, one cornea of each pair was transferred into Kerasave or Optisol-GS. ECD and CCT were also assessed at Day 7, and all the metrics were evaluated again at the end of the storage period (Day 14).

Results

At all tested time points, no differences were found in the qualitative (corneal transparency, EC morphology) and quantitative metrics (ECD, CCT, EC mortality) between the Kerasave and the Optisol-GS storage groups. At Day 14, the corneas stored in Kerasave and Optisol-GS showed ECD of 2312±98 and 2335±128 cells/mm2(p=0.886), CCT of 717±17 and 697±19 μm (p=0.454) and central EC mortality of 0.54%±0.40% and 0.14%±0.14% (p=0.719), respectively.

Conclusions

The new amphotericin B−containing medium Kerasave was comparable to Optisol-GS in terms of preservation of corneal characteristics at 2–8°C for 14 days.
Disorganisation of retinal inner layers is associated with reduced contrast sensitivity in retinal vein occlusion
Authors: Wang Jay , Cui Ying , Vingopoulos Filippos , Kasetty Megan , Silverman Rebecca F , Katz Raviv , Kim Leo , Miller John B
Published: November 2020

Background/Aims

To determine if disorganisation of retinal inner layers (DRIL) is associated with reduced contrast sensitivity (CS) in patients with retinal vein occlusion (RVO) with a history of macular oedema (ME).

Methods

Prospective, observational cohort study. Patients with a history of ME secondary to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) from October 2017 to July 2019 at a single institution were included. Patients underwent complete ophthalmic examination, spectral domain optical coherence tomography (SD-OCT) and CS testing using the quick contrast sensitivity function (qCSF) method. Eyes with coexisting macular disease were excluded. SD-OCT images were analysed for presence and extent of DRIL, intraretinal fluid (IRF), subretinal fluid (SRF), hyperreflective foci, epiretinal membrane (ERM), external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption, central macular thickness (CMT) and central foveal thickness (CFT). Multivariable mixed-effect linear regressions were performed for the area under the log contrast sensitivity function (AULCSF) using Stata (StataCorp). P values <0.05 were considered significant.

Results

58 visits from 31 patients were included (1.9±1.2 visits per patient). 29 (50%) were for CRVO. The average age was 63.9±10.5 years. On multivariable analysis, DRIL extent (p<0.001), CMT (p=0.007), CFT (p=0.024) and moderate cataract (p=0.001) were significantly associated with worse AULCSF.

Conclusions

DRIL extent is associated with reduced CS in eyes with ME secondary to RVO. DRIL is an imaging feature that has important implications for visual function.
Association of race and ethnicity in the receipt of regional anesthesia following mastectomy
Authors: Beletsky Alexander , Burton Brittany Nicole , Finneran IV John J , Alexander Brenton S , Macias Alvaro , Gabriel Rodney Allanigue
Published: November 2020

Background

Regional anesthetic techniques have become increasingly used for the purpose of pain management following mastectomy. Although a variety of beneficial techniques have been described, the delivery of regional anesthesia following mastectomy has yet to be examined for racial or ethnic disparities. We aimed to examine the association of race and ethnicity on the delivery of regional anesthesia in patients undergoing surgical mastectomy using a large national database.

Methods

We used the American College of Surgeons–National Surgical Quality Improvement Program database to identify adult patients aged ≥18 years old who underwent mastectomy from 2014 to 2016. We reported unadjusted estimates of regional anesthesia accordingly to race and ethnicity and examined differences in sociodemographic characteristics and health status. Multivariable logistic regression was used to report the association of race and ethnicity with use of regional anesthesia.

Results

A total of 81 345 patients who underwent mastectomy were included, 14 887 (18.3%) of whom underwent regional anesthesia. The unadjusted rate of use of regional anesthesia was 18.9% for white patients, 16.8% for black patients, 15.6% for Asian patients, 16.5% for Native Hawaiian/Pacific Islander patients, 17.8% for American Indian or Alaska Native and 17.4% for unknown race (p<0.001). With respect to ethnicity, the unadjusted rate of regional anesthesia use was 18.4% for non-Hispanic patients vs 16.1% for Hispanic patients vs 18.6% for the unknown ethnicity cohort (p<0.001). On multivariable logistic regression analysis, the odds of receipt of regional anesthesia was 12% lower in black patients and 21% lower in Asian patients compared with white patients (p<0.001). The odds of regional anesthesia use were 13% lower in Hispanic compared with non-Hispanic patients (p<0.001).

Conclusion

Black and Asian patients had lower odds of undergoing regional anesthesia following mastectomy compared with white counterparts. In addition, Hispanic patients had lower odds of undergoing regional anesthesia than non-Hispanic counterparts. These differences underlie the importance of working to deliver equitable healthcare irrespective of race or ethnicity.
Effect of a stepwise opioid-sparing analgesic protocol on in-hospital oxycodone use and discharge prescription after cesarean delivery
Authors: Landau Ruth , Romanelli Erik , Daoud Bahaa , Shatil Ben , Zheng Xiwen , Corradini Beatrice , Aubey Janice , Wu Caroline , Ha Catherine , Guglielminotti Jean
Published: November 2020

Introduction

Opioid exposure during hospitalization for cesarean delivery increases the risk of new persistent opioid use. We studied the effectiveness of stepwise multimodal opioid-sparing analgesia in reducing oxycodone use during cesarean delivery hospitalization and prescriptions at discharge.

Methods

This retrospective cohort study analyzed electronic health records of consecutive cesarean delivery cases in four academic hospitals in a large metropolitan area, before and after implementation of a stepwise multimodal opioid-sparing analgesic computerized order set coupled with provider education. The primary outcome was the proportion of women not using any oxycodone during in-hospital stay (‘non-oxycodone user’). In-hospital secondary outcomes were: (1) total in-hospital oxycodone dose among users, and (2) time to first oxycodone pill. Discharge secondary outcomes were: (1) proportion of oxycodone-free discharge prescription, and (2) number of oxycodone pills prescribed.

Results

The intervention was associated with a significant increase in the proportion of non-oxycodone users from 15% to 32% (17% difference; 95% CI 10 to 25), a decrease in total in-hospital oxycodone dose among users, and no change in the time to first oxycodone dose. The adjusted OR for being a non-oxycodone user associated with the intervention was 2.67 (95% CI 2.12 to 3.50). With the intervention, the proportion of oxycodone-free discharge prescription increased from 4.4% to 8.5% (4.1% difference; 95% CI 2.5 to 5.6) and the number of prescribed oxycodone pills decreased from 30 to 18 (−12 pills difference; 95% CI −11 to −13).

Conclusions

Multimodal stepwise analgesia after cesarean delivery increases the proportion of oxycodone-free women during in-hospital stay and at discharge.