bluuebunny/crossref_metadata_2025 huggingface dataset:
CryoEM of RUVBL1–RUVBL2–ZNHIT2, a complex that interacts with pre-mRNA-processing-splicing factor 8
Authors: Serna Marina , González-Corpas Ana , Cabezudo Sofía , López-Perrote Andrés , Degliesposti Gianluca , Zarzuela Eduardo , Skehel J Mark , Muñoz Javier , Llorca Oscar
Published: December 2021

Biogenesis of the U5 small nuclear ribonucleoprotein (snRNP) is an essential and highly regulated process. In particular, PRPF8, one of U5 snRNP main components, requires HSP90 working in concert with R2TP, a cochaperone complex containing RUVBL1 and RUVBL2 AAA-ATPases, and additional factors that are still poorly characterized. Here, we use biochemistry, interaction mapping, mass spectrometry and cryoEM to study the role of ZNHIT2 in the regulation of the R2TP chaperone during the biogenesis of PRPF8. ZNHIT2 forms a complex with R2TP which depends exclusively on the direct interaction of ZNHIT2 with the RUVBL1–RUVBL2 ATPases. The cryoEM analysis of this complex reveals that ZNHIT2 alters the conformation and nucleotide state of RUVBL1–RUVBL2, affecting its ATPase activity. We characterized the interactions between R2TP, PRPF8, ZNHIT2, ECD and AAR2 proteins. Interestingly, PRPF8 makes a direct interaction with R2TP and this complex can incorporate ZNHIT2 and other proteins involved in the biogenesis of PRPF8 such as ECD and AAR2. Together, these results show that ZNHIT2 participates in the assembly of the U5 snRNP as part of a network of contacts between assembly factors required for PRPF8 biogenesis and the R2TP-HSP90 chaperone, while concomitantly regulating the structure and nucleotide state of R2TP.
Firefighting and melanoma, epidemiological and toxicological associations: a case report
Authors: Brinchmann Bendik C , Bugge Merete D , Nordby Karl-Christian , Alfonso Jose Hernán
Published: December 2021

The International Agency for Research on Cancer (IARC) classifies firefighting as possibly carcinogenic to humans, and polychlorinated biphenyls (PCBs) as carcinogens with sufficient evidence for development of melanoma in humans. We present a case report of a firefighter with melanoma and history of 33 years of occupational exposure. Based on the available epidemiological and toxicological evidence of association between being a firefighter and developing melanoma, melanoma was recognized by the Norwegian Labour and Welfare Service as an occupational disease in our patient. In 2017, melanoma was acknowledged as an occupational disease in only 8 out of 28 surveyed European countries. Melanoma should be considered as a possible occupational disease among firefighters with a history of relevant exposure. Further recognition of the occupational exposures leading to increased risk of melanoma is still needed for preventive purposes.
Effectiveness of an intervention to reduce accidents in bus drivers
Authors: McCollum Emma
Published: December 2021

Background

Medical incapacity at the wheel is a small but significant factor in accident causation. To mitigate against this, in July 2017 a UK-based bus operator changed its medical assessment policy, requiring all future medicals to include a request to the General Practitioner (GP) for information about any conditions in the medical record which could affect fitness to drive.

Aims

To evaluate the impact of the change in policy on accident rates.

Methods

Accident data were obtained over a 5-year period, with information on age and length of service of drivers, from three bus depots. Monthly accident rates, before and after the change in policy were compared with the Wilcoxon matched pairs test, and a line of best fit/R2 obtained via a scatter graph.

Results

Although a general downward trend in accident rates was seen, there was no statistically significant difference between the overall accident rates in the 12 months before and after the policy change in July 2017 (P-value = 0.519, significance level P < 0.05).

Conclusions

The downward trend in accident rates observed over the study period could not be attributed to the change of policy. However, this intervention warrants further scrutiny due to the potential consequences of passenger service vehicle accidents. Evidence suggests that professional awareness of the UK Driver and Vehicle Licensing Agency fitness to drive standards can be limited, so requesting GP input into driver medicals may raise awareness of these standards from an occupational health perspective.
Development of decision aid on health help-seeking for medical students
Authors: Strawbridge Lisa , Mackie Shona , Bharath Nikita , Shahaf-Oren Bar , Madan Ira , Henderson Claire
Published: December 2021

Background

Rates of mental health problems are increasing among medical students, who have added pressures compared with non-medical students. Medical student populations exhibit low rates of help-seeking and often struggle with disclosing health conditions due to the barriers experienced and concerns over negative repercussions.

Aims

This study aimed to create and test the feasibility and potential efficacy of an online decision aid (DA) tool that provides medical students with resources for disclosing and help-seeking for their health concerns.

Methods

The research used mixed methods, comprising two rounds of testing, the first used the Think-Aloud method to identify modifications needed, and both of which measured feasibility and assessed decision making outcomes pre and post use of the DA utilizing O’Connor’s Decisional Conflict Scale (DCS) (2010) and Stage of Decision Making (SDM) (2003) measures.

Results

Results showed good feasibility of the DA. The mean DCS total score decreased from 32 to 16.75, (Wilcoxon signed-rank tests Z = −3.06, P < 0.05). There was no significant change in the SDM.

Conclusions

The results suggest that the DA may reduce decisional conflict, improving their certainty and confidence in decision making, but had no immediate impact on their SDM, consistent with some other DAs. Further longitudinal research would be beneficial.
Depression Predicts Chronic Pain Interference in Racially Diverse, Income-Disadvantaged Patients
Authors: Nephew Benjamin C , Incollingo Rodriguez Angela C , Melican Veronica , Polcari Justin J , Nippert Kathryn E , Rashkovskii Mikhail , Linnell Lilly-Beth , Hu Ruofan , Ruiz Carolina , King Jean A , Gardiner Paula
Published: December 2021

Background

Chronic pain is one of the most common reason adults seek medical care in the United States, with prevalence estimates ranging from 11% to 40%. Mindfulness meditation has been associated with significant improvements in pain, depression, physical and mental health, sleep, and overall quality of life. Group medical visits are increasingly common and are effective at treating myriad illnesses, including chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence based integrative medicine, and medical group visits and can be used as adjuncts to medications, particularly in diverse underserved populations with limited access to non-pharmacological therapies.

Objective and Design

The objective of the present study was to use a blended analytical approach of machine learning and regression analyses to evaluate the potential relationship between depression and chronic pain in data from a randomized clinical trial of IMGV in diverse, income-disadvantaged patients suffering from chronic pain and depression.

Methods

The analytical approach used machine learning to assess the predictive relationship between depression and pain and identify and select key mediators, which were then assessed with regression analyses. It was hypothesized that depression would predict the pain outcomes of average pain, pain severity, and pain interference.

Results

Our analyses identified and characterized a predictive relationship between depression and chronic pain interference. This prediction was mediated by high perceived stress, low pain self-efficacy, and poor sleep quality, potential targets for attenuating the adverse effects of depression on functional outcomes.

Conclusions

In the context of the associated clinical trial and similar interventions, these insights may inform future treatment optimization, targeting, and application efforts in racialized, income-disadvantaged populations, demographics often neglected in studies of chronic pain.
Dark solitons of the Gross–Neveu model
Authors: Vekslerchik V E
Published: December 2021

We present N-soliton solutions for the classical (1+1)-dimensional Gross–Neveu model which satisfy non-zero boundary conditions. These solutions are obtained by a direct method using some properties of the soliton matrices that appear in the framework of the Cauchy matrix approach.
Validation of Somno-Art Software, a novel approach of sleep staging, compared with polysomnography in disturbed sleep profiles
Authors: Thiesse Laurie , Staner Luc , Bourgin Patrice , Roth Thomas , Fuchs Gil , Kirscher Debora , Schaffhauser Jean-Yves , Saoud Jay B , Viola Antoine U
Published: December 2021

Study Objectives

Integrated analysis of heart rate (electrocardiogram [ECG]) and body movements (actimetry) during sleep in healthy subjects have previously been shown to generate similar evaluation of sleep architecture and continuity with Somno-Art Software compared to polysomnography (PSG), the gold standard. However, the performance of this new approach of sleep staging has not yet been evaluated on patients with disturbed sleep.

Methods

Sleep staging from 458 sleep recordings from multiple studies comprising healthy and patient population (obstructive sleep apnea [OSA], insomnia, major depressive disorder [MDD]) was obtained from PSG visual scoring using the American Academy of Sleep Medicine rules and from Somno-Art Software analysis on synchronized ECG and actimetry.

Results

Inter-rater reliability (IRR), evaluated with 95% absolute agreement intra-class correlation coefficient, was rated as “excellent” (ICCAAAvg95% ≥ 0.75) or “good” (ICCAAAvg95% ≥ 0.60) for all sleep parameters assessed, except non-REM (NREM) and N3 sleep in healthy participants (ICCAAAvg95% = 0.43, ICCAAAvg95% = 0.56) and N3 sleep in OSA patients (ICCAAAvg95% = 0.59) rated as “fair” IRR. Overall sensitivity, specificity, accuracy, and Cohen’s kappa coefficient of agreement (κ) on the entire sample were respectively of 93.3%, 69.5%, 87.8%, and 0.65 for wake/sleep classification and accuracy and κ were of 68.5% and 0.55 for W/N1+N2/N3/rapid eye movement (REM) classification. These performances were similar in healthy and patient population.

Conclusions

The present results suggest that Somno-Art can be a valid sleep-staging tool in both healthy subjects and patients with OSA, insomnia, or MDD. It could complement existing non-attended techniques measuring sleep-related breathing patterns or be a useful alternative to laboratory-based PSG when this latter is not available.
Impact of Future Elevated Carbon Dioxide on C3Plant Resistance to Biotic Stresses
Authors: Bazinet Quinn , Tang Lawrence , Bede Jacqueline C.
Published: December 2021

Before the end of the century, atmospheric carbon dioxide levels are predicted to increase to approximately 900 ppm. This will dramatically affect plant physiology and influence environmental interactions and, in particular, plant resistance to biotic stresses. This review is a broad survey of the current research on the effects of elevated CO2(eCO2) on phytohormone-mediated resistance of C3agricultural crops and related model species to pathogens and insect herbivores. In general, while plants grown in eCO2often have increased constitutive and induced salicylic acid levels and suppressed induced jasmonate levels, there are exceptions that implicate other environmental factors, such as light and nitrogen fertilization in modulating these responses. Therefore, this review sets the stage for future studies to delve into understanding the mechanistic basis behind how eCO2will affect plant defensive phytohormone signaling pathways under future predicted environmental conditions that could threaten global food security to inform the best agricultural management practices.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Hepatopancreatoduodenectomy With Delayed Division of the Pancreatic Parenchyma
Authors: Sugiura Teiichi , Uesaka Katsuhiko , Ashida Ryo , Ohgi Katsuhisa , Okamura Yukiyasu , Yamada Mihoko , Otsuka Shimpei
Published: December 2021

Objectives:

To review our novel technique of hepatopancreatoduodenectomy (HPD) with delayed division of the pancreatic parenchyma (DDPP) for reducing postoperative pancreatic fistula (POPF).

Background:

The high operative morbidity and mortality rates after HPD remains a major issue. One of the most troublesome complications is POPF, which might possibly be caused by peripancreatic saponification due to long interval between pancreas resection and reconstruction, as most surgeons prefer a caudocranial approach, performing pancreatoduodenectomy (PD) first and then hepatectomy (conventional HPD [C-HPD]).

Methods:

A review of the patients undergoing C-HPD and HPD with DDPP was performed. Postoperative outcomes were compared. Multivariable analysis was conducted to evaluate the risk factors of POPF after HPD.

Results:

One-hundred two patients comprised of 50 patients undergoing C-HPD and 52 patients undergoing HPD with DDPP. The interval between pancreas resection and reconstruction was significantly shorter in HPD with DDPP group than in C-HPD group (51 vs 263 minutes; P < 0.001). The incidence of POPF was significantly lower in HPD with DDPP group than in C-HPD group (32.7% vs 77.3%; P < 0.001). The postoperative hospital stay was shorter in patients undergoing HPD with DDPP than in those undergoing C-HPD (32 vs 45 days). A multivariate analysis revealed that body mass index >24 kg/m2 and conventional (PD first) procedure were significant risk factors for POPF after HPD.

Conclusions:

A novel technique of HPD with DDPP is a simple procedure and the optimal treatment choice to reduce the risk of developing POPF after this extensive surgery.
Surgical Factors and Treatment Severity for Perioperative Complications Predict Hospital Length of Stay in Adult Spinal Deformity Surgery
Authors: Le Hai V. , Wick Joseph B. , Lafage Renaud , Kelly Michael P. , Kim Han Jo , Gupta Munish C. , Bess Shay , Burton Douglas C. , Ames Christopher P. , Smith Justin S. , Shaffrey Christopher I. , Schwab Frank J. , Passias Peter G. , Protopsaltis Themistocles S. , Lafage Virginie , Klineberg Eric O.
Published: December 2021

Study Design.

Retrospective review of prospectively collected multicenter registry data.

Objective.

The aim of this study was to determine whether surgical variables and complications as graded by treatment severity impact postoperative hospital length of stay (LOS).

Summary of Background Data.

Surgical treatment can substantially improve quality of life for patients with adult spinal deformity (ASD). However, surgical treatment is associated with high complication rates, which may impact hospital LOS. Classifying complications by severity of subsequent treatment may allow surgeons to better understand complications and predict their impact on important outcome metrics, including LOS.

Methods.

Patients enrolled in a multicenter, prospectively enrolled database for ASD were assessed for study inclusion. Complications were graded based on intervention severity. Associations between LOS, complication intervention severity, and surgical variables (fusion length, use of interbody fusion, use of major osteotomy, primary versus revision surgery, same day vs. staged surgery, and surgical approach), were assessed. Two multivariate regression models were constructed to assess for independent associations with LOS.

Results.

Of 1183 patients meeting inclusion criteria, 708 did not and 475 did experience a perioperative complication during their index hospitalization, with 660 and 436 included in the final cohorts, respectively. Among those with complications, intervention severities included 14.9% with no intervention, 68.6% with minor, 8.9% with moderate, and 7.6% with severe interventions. Multivariate regression modeling demonstrated that length of posterior fusion, use of major osteotomy, staged surgery, and severity of intervention for complications were significantly associated with LOS.

Conclusion.

Careful selection of surgical factors may help reduce hospital LOS following surgery for ASD. Classification of complications by treatment severity can help surgeons better understand and predict the implications of complications, in turn assisting with surgical planning and patient counseling.

Level of Evidence: 4
Prospective Randomized Control Pilot Study to Compare the Role of Injection Cerebrolysin in Operated cases of Degenerative Cervical Myelopathy
Authors: Sharma Ayush , Marathe Nandan , Aggarwal Romit , Singh Vijay , Shakya Akash , Kamble Prashant , Jaiswal Ajay , Mangale Nilesh , Rocos Brett
Published: December 2021

Study Design.

Prospective randomized control trial.

Objective.

The aim of this study was to analyze role of cerebrolysin in patients of degenerative cervical myelopathy (DCM) managed by surgical modalities.

Summary of Background Data.

Cerebrolysin has been extensively researched with variable success in neurodegenerative pathologies. There has been only one study in published literature till date that has studied role of cerebrolysin in DCM in conservatively managed patients but none in the patients treated surgically. We present our pilot study which analyzes the role of cerebrolysin in patients of DCM managed by surgical modalities.

Methods.

This prospective randomized control trial was conducted at a tertiary care institute in Mumbai. Sixty operated cases of DCM were randomly divided into 2 groups. The first group was given Injection Cerebrolysin 5 mL diluted in 100 mL Normal Saline over 30 minutes once a day for 21 days postoperatively. The second group was given placebo. Modified Japanese Orthopedic Association scores (mJOA) and visual analog scale (VAS) were used to document functional outcomes at 3 weeks, 3 months, 6 months, and 1 year. Recovery of hand function was separately accessed by improvement in hand power and sensations.

Results.

Preoperative mJOA and VAS scores were comparable between 2 groups. Both groups showed significant improvement in both mJOA and VAS scores at 3weeks, 3 months, 6 months and 1-year follow-up (P < 0.01). In comparing the two groups, there was no difference in improvement of mJOA and VAS scores. However, cerebrolysin group showed significant improvement in hand function at 1 year compared to the placebo. Postoperative neurological recovery was better in the cerebrolysin group with 66.7% patients showing complete neurological recovery compared to 56.7% for placebo, but this was statistically insignificant. Two patients developed headache and one patient complained of dizziness in the cerebrolysin group, but these resolved without any intervention.

Conclusion.

Use of cerebrolysin in postoperative cases of DCM is safe and results in improved hand function.

Level of Evidence: 1
Interferon-gamma inhibits aldehyde dehydrogenasebright cancer stem cells in the 4T1 mouse model of breast cancer
Authors: Zhuang Xiufen , Shi Guilan , Hu Xiao , Wang Huiru , Sun Wen , Wu Yanhong
Published: December 2021

Background:

Despite improvements in disease diagnosis, treatment, and prognosis, breast cancer is still a leading cause of cancer death for women. Compelling evidence suggests that targeting cancer stem cells (CSCs) have a crucial impact on overcoming the current shortcomings of chemotherapy and radiotherapy. In the present study, we aimed to study the effects of T cells and a critical anti-tumor cytokine, interferon-gamma (IFN-γ), on breast cancer stem cells.

Methods:

BALB/c mice and BALB/c nude mice were subcutaneously injected with 4T1 tumor cells. Tumor growth and pulmonary metastasis were assessed. ALDEFLOUR™ assays were performed to identify aldehyde dehydrogenasebright (ALDHbr) tumor cells. ALDHbr cells as well as T cells from tumor-bearing BALB/c mice were analyzed using flow cytometry. The effects of CD8+ T cells on ALDHbr tumor cells were assessed in vitro and in vivo. The expression profiles of ALDHbr and ALDHdim 4T1 tumor cells were determined. The levels of plasma IFN-γ were measured by enzyme-linked immunosorbent assay, and their associations with the percentages of ALDHbr tumor cells were evaluated. The effects of IFN-γ on ALDH expression and the malignancy of 4T1 tumor cells were analyzed in vitro.

Results:

There were fewer metastatic nodules in tumor-bearing BALB/c mice than those in tumor-bearing BALB/c nude mice (25.40 vs. 54.67, P < 0.050). CD8+ T cells decreased the percentages of ALDHbr 4T1 tumor cells in vitro (control vs. effector to target ratio of 1:1, 10.15% vs. 5.76%, P < 0.050) and in vivo (control vs. CD8+ T cell depletion, 10.15% vs. 21.75%, P < 0.001). The functions of upregulated genes in ALDHbr 4T1 tumor cells were enriched in the pathway of response to IFN-γ. The levels of plasma IFN-γ decreased gradually in tumor-bearing BALB/c mice, while the percentages of ALDHbr tumor cells in primary tumors increased. IFN-γ at a concentration of 26.68 ng/mL decreased the percentages of ALDHbr 4T1 tumor cells (22.88% vs. 9.88%, P < 0.050) and the protein levels of aldehyde dehydrogenase 1 family member A1 in 4T1 tumor cells (0.86 vs. 0.49, P < 0.050) and inhibited the abilities of sphere formation (sphere diameter <200 μm, 159.50 vs. 72.0; ≥200 μm, 127.0 vs. 59.0; both P < 0.050) and invasion (89.67 vs. 67.67, P < 0.001) of 4T1 tumor cells.

Conclusion:

CD8+ T cells and IFN-γ decreased CSC numbers in a 4T1 mouse model of breast cancer. The application of IFN-γ may be a potential strategy for reducing CSCs in breast cancer.
Outcomes of Sentinel Lymph Node Biopsy for Primary Cutaneous Squamous Cell Carcinoma of the Head and Neck
Authors: Pride Renee L. D. , Lopez Jonathan J. , Brewer Jerry D. , Price Daniel L. , Otley Clark C. , Roenigk Randall K. , Arpey Christopher J. , Baum Christian L.
Published: December 2021

BACKGROUND

Limited data exist on sentinel lymph node biopsy (SLNB) for cutaneous squamous cell carcinoma (cSCC) of the head and neck.

OBJECTIVE

To review the results of SLNB for patients with cSCC of the head and neck at the authors’ institution.

MATERIALS AND METHODS

A retrospective review was completed for patients who underwent SLNB for cSCC of the head and neck over 19 years. Patient demographics, immune status, tumor stage, total patients with positive SLNB, local recurrence, nodal recurrence, in-transit metastasis, and disease-specific death were recorded.

RESULTS

Sixty patients underwent lymphoscintigraphy, and an SLN was identified in 58 patients. The mean follow-up was 3.2 years (range, 15 days–16 years). Four patients (6.9%) had a positive SLNB. All were Brigham and Women's Hospital (BWH) stage T2b tumors. Three of these patients were immunosuppressed, 3 patients underwent neck dissection, and 2 patients received adjuvant radiation. None developed local or regional recurrence. Of the 53 patients with a negative SLNB, there were 4 local recurrences, 2 in-transit metastases, and no nodal recurrences.

CONCLUSION

Immunosuppressed patients with tumors BWH stage T2b or greater may be a reasonable cohort to focus future prospective studies on the utility of SLNB in cSCC of the head and neck.
Laser Treatment of Hypopigmentation in Scars: A Review
Authors: Baugh Erica G. , Anagu Olive , Kelly Kristen M.
Published: December 2021

BACKGROUND

Despite history of multiple treatment modalities, repigmentation of hypopigmented scars remains a difficult clinical problem.

OBJECTIVE

The purpose of this review is to evaluate the literature on laser and combination laser plus adjunct topical therapy for hypopigmented burn and traumatic scars.

MATERIALS AND METHODS

A search on PubMed and on Oxford Academic was conducted with additional relevant literature obtained from reference lists.

RESULTS

Treatment regimens that address hypopigmentation within scars were reviewed. A combination of nonablative fractional or ablative fractional laser treatment with topical prostaglandin analogue with or without topical retinoid were found to result in superior repigmentation.

CONCLUSION

Reliable improvement of hypopigmentation in scars after laser treatment is challenging. Laser can achieve success in some cases. Ultraviolet laser can achieve modest repigmentation; however, results are short-lived and require continued re-treatment. Modest improvement in pigmentation is seen with nonablative fractional laser or ablative fractional laser alone and enhanced repigmentation is demonstrated when combining fractional laser resurfacing with topical application of synthetic prostaglandin analogues and other known modulators of melanogenesis.
Estrogen-Induced Uterine Vasodilation in Pregnancy and Preeclampsia
Authors: Li Yan , Han Baoshi , Salmeron Alejandra Garcia , Bai Jin , Chen Dong-bao
Published: December 2021

Normal pregnancy is associated with dramatically increased estrogen biosynthesis whose role is believed to raise uterine blood flow to facilitate the bi-directional maternal-fetal exchanges of gases (O2 and CO2), to deliver nutrients, and exhaust wastes to support fetal development and survival. Constrained uterine blood flow in pregnancy is a leading cause of preeclampsia with fetal growth restriction, rendering investigations of uterine hemodynamics to hold a high promise to inform pathways as targets for therapeutic interventions for preeclampsia. The mechanisms of estrogen-induced uterine vasodilation in pregnancy have long been attributed to enhanced endothelium production of nitric oxide, but clinical trials targeting this pathway that dominates uterine hemodynamics have achieved no to little success. Emerging evidence has recently shown a novel proangiogenic vasodilatory role of hydrogen sulfide in regulating uterine hemodynamics in pregnancy and preeclampsia, provoking a new field of perinatal research in searching for alternative pathways for pregnancy disorders especially preeclampsia and intrauterine growth restriction. This minireview is intended to summarize the nitric oxide pathway and to discuss the emerging hydrogen sulfide pathway in modulating estrogen-induced uterine vasodilation in pregnancy and preeclampsia.
Viral Infections During Pregnancy: The Big Challenge Threatening Maternal and Fetal Health
Authors: Yu Wenzhe , Hu Xiaoqian , Cao Bin
Published: December 2021

Viral infections during pregnancy are associated with adverse pregnancy outcomes, including maternal and fetal mortality, pregnancy loss, premature labor, and congenital anomalies. Mammalian gestation encounters an immunological paradox wherein the placenta balances the tolerance of an allogeneic fetus with protection against pathogens. Viruses cannot easily transmit from mother to fetus due to physical and immunological barriers at the maternal-fetal interface posing a restricted threat to the fetus and newborns. Despite this, the unknown strategies utilized by certain viruses could weaken the placental barrier to trigger severe maternal and fetal health issues especially through vertical transmission, which was not fully understood until now. In this review, we summarize diverse aspects of the major viral infections relevant to pregnancy, including the characteristics of pathogenesis, related maternal-fetal complications, and the underlying molecular and cellular mechanisms of vertical transmission. We highlight the fundamental signatures of complex placental defense mechanisms, which will prepare us to fight the next emerging and re-emerging infectious disease in the pregnancy population.
Endoscopic-assisted Nipple-sparing Mastectomy with Direct-to-Implant Subpectoral Breast Reconstruction in the Management of Breast Cancer
Authors: Zhang Songbo , Xie Yanyan , Liang Faqing , Wang Yao , Lv Qing , Du Zhenggui
Published: December 2021

Endoscopic-assisted or robotic nipple-sparing mastectomy (E-NSM or R-NSM) with direct-to-implant breast reconstruction is becoming an increasingly popular surgical treatment for breast cancer patients. However, existing surgical methods such as traditional two-dimensional endoscopic-assisted or robot-assisted surgery are time-consuming and expensive. A new innovative three-dimensional videoscope system is efficient but needs special instruments; additionally, the incision over the extramammary region near the anterior axillary line is still too invisible. This study took place from May 2020 to April 2021. This technique is suitable for patients with small- to moderate-sized breasts (C cup size and below; grade 0 to grade I ptotic breasts). We have now performed 30 procedures, including eight bilateral reconstructions. The average operative time (including axillary operation) of a unilateral reconstruction is 179 ± 40.96 minutes, and for bilateral reconstruction, it was 271 ± 45.29 minutes. The median follow-up time was 9.93 months. For the complications, only one patient presented with a mild depigmentation of the nipple and one patient presented with local cellulitis but recovered after oral administration of antibiotics. All patients were satisfied with their postoperative aesthetic outcome. We present a new surgical technique of E-NSM with direct-to-implant subpectoral breast reconstruction to achieve better results.
The Plastic Surgery Learning Module: Improving Plastic Surgery Education for Medical Students
Authors: Reghunathan Meera , Segal Rachel M. , Reid Chris M. , Gosman Amanda A.
Published: December 2021

Background:

Medical students receive limited exposure to the field of plastic surgery because most students will not rotate in plastic surgery, especially those at schools without dedicated plastic surgery residency programs. This study aimed to create and validate a plastic surgery learning module for medical students to dispel media-propagated myths and misrepresentation of the breadth of plastic surgery and equip students with referral-making capabilities.

Methods:

The plastic surgery learning module was created using Articulate Storyline 360 (New York, N.Y.). Student participants were recruited from a single medical school across all four classes. Pre- and postmodule surveys were administered via Qualtrics (Provo, Utah). Scores were computed for the general surgical knowledge section and for each specialty referral question.

Results:

Twelve students completed usability testing and edits were subsequently made to optimize the module. The module took on average 66 minutes to complete. Sixty-five students (19 MS1, 16 MS2, 15 MS3, 15 MS4) completed efficacy testing. In the premodule survey, students were nearly 100% accurate in identifying breast-related referrals, unlike pediatric/craniofacial (avg: 68%), reconstruction/microsurgery (avg: 64%), and hand/upper extremity (avg: 30%) referrals. Students of all classes exhibited significant improvement in all testing categories except for the breast category, with the most improvement in the hand referrals category. Prior exposure to plastic surgery (57%) correlated with higher premodule hand (P = 0.003) and breast/cosmetic (P = 0.01) referral scores.

Conclusion:

The plastic surgery learning module shows promise to be a comprehensive yet affordable and time-efficient tool for medical students to learn about basic surgical principles and the scope of plastic surgery.
Pulp De-epithelialization for Venous Outflow Augmentation after Digital Replantation
Authors: Smearman Erica , Chan Patricia , Ghareeb Paul A.
Published: December 2021

Traumatic amputation injuries account for a substantial portion of emergency department visits. This includes digital amputations that may be considered for replantation. Following surgery, venous congestion is the most common cause of replant failure. To address this, several methods have been proposed to augment venous outflow. In this article, a simple and straightforward method that can be utilized to establish or augment venous outflow in cases of venous insufficiency is described. This method entails de-epithelization of the replanted digit pulp skin with use of postoperative anticoagulation. The area can be further expanded or stimulated to increase bleeding as needed and is allowed to heal by secondary intention. This method allows for reliable venous outflow with relative ease of implementation.
Does severe subacute noise exposure increase risk of new onset hypertension beyond conventional risk factors? A 30 000 person-years cohort study
Authors: Yun Byungyoon , Sim Juho , Jeong Inchul , Lee Seunghyun , Kim Seunghan , Cho Ara , Yoon Jin-Ha
Published: December 2021

Objectives:

Previous studies mostly focused on the relationship between chronic environmental noise exposure and hypertension but the effects of subacute (under 4 years) exposure with severe (>85 dB) noise exposure on clinical level hypertension have not been explored. This study aimed to reveal the association between severe noise exposure and hypertension.

Methods:

The severe noise exposure group was recruited from a Common Data Model conducted for the Korean Participants Health Examination from January 2014 to December 2017. The use of antihypertensive drug and/or blood pressure of at least 140/90 mmHg was defined as new onset clinical hypertension. A multivariate Cox proportional hazard model was implemented to estimate hazard ratios and 95% confidence intervals (CI) by adjusting covariates including demographic, lifestyle, and other chemical exposure factors. Time-dependent Cox analysis and Landmark analysis were further performed as a sensitivity analysis.

Results:

During the 29 332 person-years follow-up with 12 412 participants of the entire cohort, new onset hypertension occurred in 1222 participants. The findings showed that severe noise exposure was associated with an increased risk of hypertension incidence in the entire cohort [final model hazard ratio 1.28 (95% CI 1.11–1.47)]. Other covariates did not attenuate the association after adjusting age and sex. Time-dependent Cox and Landmark analysis also showed significant results [hazard ratio 1.60 (95% CI 1.38–1.85) and hazard ratio 1.33 (95% CI 1.13–1.57)].

Conclusion:

Severe noise with subacute exposure is significantly associated with hypertension development. Further studies should be implemented to clarify whether severe exposure to noise could be an important risk factor for hypertension.
Antecedent use of renin-angiotensin system inhibitors is associated with reduced mortality in elderly hypertensive Covid-19 patients
Authors: Gori Mauro , Berzuini Carlo , D’Elia Emilia , Ghirardi Arianna , Bernardinelli Luisa , Gavazzi Antonello , Balestrieri Giulio , Giammarresi Andrea , Trevisan Roberto , Di Marco Fabiano , Bellasi Antonio , Amoroso Mariangela , Raimondi Federico , Novelli Luca , Magro Bianca , Mangia Gianpaolo , Lorini Ferdinando L. , Guagliumi Giulio , Fagiuoli Stefano , Parati Gianfranco , Senni Michele
Published: December 2021

Objectives:

The effect of renin-angiotensin system inhibitors (RASIs) on mortality in patients with coronavirus disease (Covid-19) is debated. From a cohort of 1352 consecutive patients admitted with Covid-19 to Papa Giovanni XXIII Hospital in Bergamo, Italy, between February and April 2020, we selected and studied hypertensive patients to assess whether antecedent (prior to hospitalization) use of RASIs might affect mortality from Covid-19 according to age.

Methods and results:

Arterial hypertension was present in 688 patients. Overall mortality (in-hospital or shortly after discharge) was 35% (N = 240). After adjusting for 26 medical history variables via propensity score matching, antecedent use of RASIs (N = 459, 67%) was associated with a lower mortality in older hypertensive patients (age above the median of 68 years in the whole series), whereas no evidence of a significant effect was found in the younger group of the same population (P interaction = 0.001). In an analysis of the subgroup of 432 hypertensive patients older than 68 years, we considered two RASI drug subclasses, angiotensin-converting enzyme inhibitors (ACEIs, N = 156) and angiotensin receptor blockers (ARBs, N = 140), and assessed their respective effects by taking no-antecedent-use of RASIs as reference. This analysis showed that both antecedent use of ACEIs and antecedent use of ARBs were associated with a lower Covid-19 mortality (odds ratioACEI = 0.57, 95% confidence interval 0.36--0.91, P = 0.018) (odds ratioARB = 0.49, 95% confidence interval 0.29--0.82, P = 0.006).

Conclusion:

In the population of over-68 hypertensive Covid-19 patients, antecedent use of ACEIs or ARBs was associated with a lower all-cause mortality, whether in-hospital or shortly after discharge, compared with no-antecedent-use of RASIs.
Adverse Events Associated With Ossicular Prostheses: Utility of a Federal Database
Authors: Tong Jane Y. , Pasick Luke J. , Benito Daniel A. , Monfared Ashkan , Sataloff Robert T.
Published: December 2021

Objectives:

Ossicular prostheses have demonstrated utility in ossicular chain reconstruction, but their use also is associated with complications. This study aims to explore the utility of the U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database for the systematic analysis of complications associated with ossicular prostheses. It also summarizes adverse events to patients (AEPs) and device malfunctions (DMs) reported in the MAUDE database, and attempts to examine the consequences brought about by these events and to identify likely root causes.

Study Design:

Retrospective analysis of the MAUDE database.

Methods:

The MAUDE database was queried for reports from January 2010 to May 2020. Data were extracted from reports involving the use of ossicular prostheses.

Results:

Seventy-three medical device reports, reports submitted to the Food and Drug Administration detailing suspected device-associated malfunctions, injuries, and deaths, involved ossicular prostheses and were included for analysis, from which 126 adverse events were extracted. Of these, 50 (39.7%) were AEPs, while 76 (60.3%) were DMs. The most common AEPs were foreign body and hearing loss, while the DMs reported most commonly were broken prosthesis and displaced prosthesis. Of the 76 DMs, 19 (25%) were attributed to mishandling by the operator, while 6 (7.9%) were due to a defective device. Broken prosthesis was the DM most commonly attributed to mishandling by the operator in 16 (32.7%) cases.

Conclusion:

Ossicular prostheses are used extensively for ossicular chain reconstruction, but also are associated with adverse events. The MAUDE database in its current form does not appear sufficient for the systematic review of adverse events associated with ossicular prostheses. A more standardized reporting format with clearly defined categories and inclusion of relevant variables might improve the quality of information provided by the MAUDE database.
Ultrasound-Guided Placement of Percutaneous Abutments for Bone Conduction Hearing Devices
Authors: Breen Joseph T. , Nader Marc-Elie , Gidley Paul W.
Published: December 2021

Objective:

To introduce a minimally invasive and image-guided technique for staged placement of a percutaneous abutment after osseointegrated implantation.

Patients:

Adults undergoing temporal bone resection at two academic medical centers.

Interventions:

Ultrasound-guided percutaneous installation of a bone conduction hearing device abutment. All patients had lateral temporal bone resection with osseointegrated implantation. Abutment placement followed as a planned staged procedure 3 to 6 months later depending on the use of radiotherapy.

Main Outcome Measures:

Ability to use a bone conduction hearing device and occurrence of skin reactions or wound complications.

Results:

Twelve patients successfully underwent abutment installation through a 5 mm skin biopsy punch incision, nine of which had minimal to no skin reaction surrounding the abutment. Two patients developed Holgers grade 1 skin reaction (redness with slight swelling). One patient experienced an osseointegration failure 152 days after abutment placement.

Conclusions:

Ultrasound is a widely available imaging modality that can be used to precisely localize subcutaneous osseointegrated implants, allowing for minimally invasive percutaneous placement of an abutment under local or general anesthesia.
Vision-Based Augmented Reality System for Middle Ear Surgery: Evaluation in Operating Room Environment
Authors: Hussain Raabid , Guigou Caroline , Lalande Alain , Bozorg Grayeli Alexis
Published: December 2021

Hypothesis:

Augmented reality (AR) solely based on image features is achievable in operating room conditions and its precision is compatible with otological surgery.

Background:

The objective of this work was to evaluate the performance of a vision-based AR system for middle ear surgery in the operating room conditions.

Methods:

Nine adult patients undergoing ossicular procedures were included in this prospective study. AR was obtained by combining real-time video from the operating microscope with the virtual image obtained from the preoperative computed tomography (CT)-scan. Initial registration between the video and the virtual CT image was achieved using manual selection of six points on the tympanic sulcus. Patient-microscope movements during the procedure were tracked using image-feature matching algorithm. The microscope was randomly moved at an approximated speed of 5 mm/s in the three axes of space and rotation for 180 seconds. The accuracy of the system was assessed by calculating the distance between each fiducial point selected on the video image and its corresponding point on the scanner.

Results:

AR could be obtained for at least 3 minutes in seven out of nine patients. The overlay fiducial and target registration errors were 0.38 ± 0.23 mm (n = 7) and 0.36 ± 0.15 mm (n = 5) respectively, with a drift error of 1.2 ± 0.5 μm/s. The system was stable throughout the procedure and achieved a refresh rate of 12 fps. Moderate bleeding and introduction of surgical instruments did not compromise the performance of the system.

Conclusion:

The AR system yielded sub-millimetric accuracy and remained stable throughout the experimental study despite patient-microscope movements and field of view obtrusions.
Hearing-Related Quality of Life in 75 Patients With a Percutaneous Bone Conduction Device
Authors: Caspers Coosje Jacoba Isabella , Nelissen Rik Chrétien , Groenewoud Hans J. M. M. , Hol Myrthe Karianne Sophie
Published: December 2021

Objective:

To evaluate long-term hearing-related quality of life (HRQoL) and device use in bone conduction (BCD) users. Furthermore, to assess differences between indications and changes in HRQoL over time.

Study design:

Prospective questionnaire survey.

Setting:

Tertiary referral center.

Patients:

Seventy-five patients with a percutaneous BCD.

Main outcome measures:

Glasgow Benefit Inventory (GBI) at 3 and 12 months postoperatively, Glasgow Health Status Inventory (GHSI) preoperatively, and 6 and 36 months postoperatively, device use at 6, 12, and 36 months. Changes over time were assessed and outcomes were compared between indications.

Results:

After implantation, 97% of all patients reported a positive benefit on the GBI total. The GHSI total had improved with median 15 points (Interquartile range [IQR] 12). At 36 months, median device use was 15 hours/day (IQR 10) and one nonuser was reported. Patients with bilateral hearing loss (BHL) showed greater improvement on the GHSI total (median 18 vs 14, p < 0.0001) and used their devices more frequently (median 16 vs 8 h/day, p < 0.0001) than patients with unilateral HL (UHL). Postoperative GHSI and GBI scores were consistent over time, in the entire patient population and for every indication. Between 6 and 36 months, device use was stable over time, except for patients with single-sided deafness (SSD; median −6.4 h/day, p = 0.009).

Conclusion:

The BCD improves HRQoL in patients with BHL, in patients with unilateral conductive/mixed hearing loss and in patients with SSD. Patients with BHL experienced a greater improvement in hearing status compared to patients with UHL. Although use decreased over time in SSD patients, device use was high for every indication.
Multiseptate gallbladder
Authors: Hsieh Yu-Min , Hsieh Yuli Lily , Wang Nien-Lu , Wu Pao-Shu , Weng Shu-Chao
Published: December 2021

Rationale:

Multiseptate gallbladder (MSG) is a rare congenital gallbladder anomaly. Between 1963 and June 2021, only 56 cases were reported. There is currently no treatment guideline for pediatric or adult cases of MSG.

Patient concerns:

A 14-year-old woman visited our out-patient clinic in September 2020 for epigastric pain that last for 6 months. Honeycomb appearance of the gallbladder was noted under ultrasonography.

Diagnosis:

The patient was diagnosed with MSG. The diagnosis was confirmed through computed tomography and magnetic resonance cholangiopancreatography.

Interventions:

Cholecystectomy was performed.

Outcomes:

Epigastric pain showed limited improvement after the surgery. Since she was diagnosed with gastritis at the same time, a proton-pump inhibitor was prescribed. Epigastric pain was eventually resolved.

Lessons:

MSG cases can undergo cholecystectomy and show good recovery without complications. However, concomitant treatment may be required to resolve in the presence of other symptoms such as epigastric pain.
Knowledge, attitudes, and practices regarding venous thromboembolism prophylaxis
Authors: Feng Shangpeng , Li Minhui , Wang Kai , Hang Cheng , Xu Dongmei , Jiang Ye , Jia Zhongzhi
Published: December 2021

To assess the knowledge, attitudes, and practices regarding venous thromboembolism (VTE) prophylaxis among medical staff at a tertiary hospital in China.

A self-administered web-based survey was completed by medical staff, and data about respondent knowledge, attitudes, and practices regarding VTE prophylaxis were gathered and analyzed with chi-square tests, using a 95% significance level.

Of the 2079 medical staff invited to participate in the survey, a total of 2042 (including 921 clinicians and 1121 nurses) responded. The overall rate of correct responses to knowledge items was 57.6%; the rate was 60.1% for clinicians and 55.4% for nurses (P < .001). The median affirmative (“strongly agree”/“agree”) rate for attitude items was 99.0% (range, 83.2%-99.4%). Medical staff members were most commonly concerned about the possibility of a financial penalty when a patient could not be treated with VTE prophylaxis (49.4%). Low levels of knowledge and participation of medical staff were identified most commonly as difficulties involved in VTE prophylaxis (48.5%). The median affirmative response rate for practice items was 58.2% (range, 51.1%-68.3%). All affirmative response rates for practice items were significantly higher for nurses than for clinicians (all P < .001).

Although the overall attitude toward VTE prophylaxis was positive, the knowledge level was poor, especially among nurses, and the rate of affirmative responses regarding practices was low, especially among clinicians. Medical institutions should improve staff training regarding VTE prophylaxis, and medical staff should be encouraged to actively engage in VTE prophylaxis.