bluuebunny/crossref_metadata_2025 huggingface dataset:
One-Year Outcomes of the First Human Trial on Robot-Assisted Lymphaticovenous Anastomosis for Breast Cancer–Related Lymphedema
Authors: van Mulken Tom J. M. , Wolfs Joost A. G. N. , Qiu Shan S. , Scharmga Andrea M. J. , Schols Rutger M. , Spiekerman van Weezelenburg Merel A. , Cau Raimondo , van der Hulst Rene R. W. J. ,   MicroSurgical Robot Research Group
Published: December 2021

Background:

Lymphaticovenous anastomosis, a supermicrosurgical technique, creates bypasses between the lymphatic and venous systems. The quality of lymphaticovenous anastomosis depends on the surgeon’s dexterity and precision, and is subject to imperfections caused by the physiologic tremor of the human hand. A dedicated robot for microsurgery has been created to overcome these limitations (MUSA, MicroSure, Eindhoven, The Netherlands). This study describes 1-year clinical outcomes of the first-in-human trial of robot-assisted and manual lymphaticovenous anastomosis in patients with breast cancer–related lymphedema.

Methods:

In this prospective pilot study, women with breast cancer–related lymphedema were randomized into the robot-assisted or manual lymphaticovenous anastomosis group. Outcomes were quality of life, arm circumference, conservative treatment frequency, arm dermal backflow stage, and anastomosis patency.

Results:

Twenty women were included, of whom eight underwent robot-assisted lymphaticovenous anastomosis surgery and 12 underwent manual surgery. In both groups, quality of life significantly improved at 12 months (robot-assisted surgery, p = 0.045; manual surgery, p = 0.001). Arm circumference did not decrease (robot-assisted surgery, p = 0.094; manual surgery, p = 0.240). Daily use of compression garments decreased by 61.9 percent (robot-assisted surgery) and 70.2 percent (manual surgery). The frequency of manual lymphatic drainage remained similar compared with baseline. Arm dermal backflow stage was reduced in one patient in the robot-assisted group and in five cases in the manual group. Overall, 76.5 percent of the anastomoses were patent (robot-assisted surgery, 66.6 percent; manual surgery, 81.8 percent).

Conclusions:

After evaluating 1-year follow-up data, this study confirms the feasibility of robot-assisted lymphaticovenous anastomosis surgery. Clinical outcomes were comparable between robot-assisted and manual lymphaticovenous anastomosis. This encourages further research using the new microsurgical robot MUSA for lymphaticovenous anastomosis and other (super)microsurgical procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Secondary Procedures following Flexor Tendon Reconstruction
Authors: Wu Kitty Yuechuan , Gillis Joshua A. , Moran Steven L.
Published: December 2021

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand the indications and management options for secondary flexor tendon reconstruction, including tenolysis, tendon grafting, and tendon transfers. 2. Understand the reconstructive options for pulley reconstruction. 3. Understand the options for management of isolated flexor digitorum profundus injuries.

Despite current advances in flexor tendon repair, complications can still occur following surgery. This article presents the spectrum of treatment options for secondary flexor tendon reconstruction ranging from tenolysis to one- and two-stage tendon grafting, and tendon transfers. In addition, an overview of pulley reconstruction and the treatment of isolated flexor digitorum profundus injuries are discussed. A management algorithm for secondary flexor tendon reconstruction is provided.
Virologic outcomes among adults with HIV using integrase inhibitor-based antiretroviral therapy
Authors: Lu Haidong , Cole Stephen R. , Westreich Daniel , Hudgens Michael G. , Adimora Adaora A. , Althoff Keri N. , Silverberg Michael J. , Buchacz Kate , Li Jun , Edwards Jessie K. , Rebeiro Peter F. , Lima Viviane D. , Marconi Vincent C. , Sterling Timothy R. , Horberg Michael A. , Gill M. John , Kitahata Mari M. , Eron Joseph J. , Moore Richard D.
Published: December 2021

Background:

Integrase strand transfer inhibitor (InSTI)-based regimens have been recommended as first-line antiretroviral therapy (ART) for adults with HIV. But data on long-term effects of InSTI-based regimens on virologic outcomes remain limited. Here we examined whether InSTI improved long-term virologic outcomes compared with efavirenz (EFV).

Methods:

We included adults from the North American AIDS Cohort Collaboration on Research and Design who initiated their first ART regimen containing either InSTI or EFV between 2009 and 2016. We estimated differences in the proportion virologically suppressed up to 7 years of follow-up in observational intention-to-treat and per-protocol analyses.

Results:

Of 15 318 participants, 5519 (36%) initiated an InSTI-based regimen and 9799 (64%) initiated the EFV-based regimen. In observational intention-to-treat analysis, 81.3% of patients in the InSTI group and 67.3% in the EFV group experienced virologic suppression at 3 months after ART initiation, corresponding to a difference of 14.0% (95% CI 12.4–15.6). At 1 year after ART initiation, the proportion virologically suppressed was 89.5% in the InSTI group and 90.2% in the EFV group, corresponding to a difference of −0.7% (95% CI −2.1 to 0.8). At 7 years, the proportion virologically suppressed was 94.5% in the InSTI group and 92.5% in the EFV group, corresponding to a difference of 2.0% (95% CI −7.3 to 11.3). The observational per-protocol results were similar to intention-to-treat analyses.

Conclusions:

Although InSTI-based initial ART regimens had more rapid virologic response than EFV-based regimens, the long-term virologic effect was similar. Our findings may inform guidelines regarding preferred initial regimens for HIV treatment.
18F-FDG PET/CT in Late Acquisition Identifies Sites of Active Disease in Treated Takayasu Arteritis
Authors: de Souza Santos Marília Paula , Ramos Celso Dario , Paixão Mariana , Pignaton Naseri Estephania , Barros Bertolo Manoel , Sachetto Zoraida
Published: December 2021

Objective

Few studies have taken advantage of 18F-fluorodeoxyglucose positron emission tomography associated with computed tomography (18F-FDG PET/CT) to personalize patient evaluation and identify sites of more active disease in Takayasu arteritis (TA)–treated patients. This study aimed to evaluate the utility of 18F-FDG PET/CT in late acquisition in identifying sites of active disease in patients under full treatment for TA.

Methods

In this cross-sectional study, patients under full treatment underwent whole-body 18F-FDG PET/CT. Sites of increased 18F-FDG uptake were classified by a score of 3 on the visual scale using the liver uptake as reference. A quantitative analysis was also performed by measuring the maximum standardized uptake value (SUV) of the vascular wall of affected arteries. Disease activity using the National Institutes of Health criteria was also evaluated.

Results

Of the 20 patients, there were 18 female and 2 male patients, with a mean age of 43.6 (±11.58) years and a disease duration of 8.3 (±6.25) years. Thirteen participants (65%) were in inflammatory activity according to the criteria proposed by the National Institutes of Health. All patients received immunosuppressive agents, and one of them received immunobiological treatment. The highest SUV value was 6.2 in the aortic arch, and the lowest was 1.0 in the subclavian artery. The mean maximum SUV did not differ between clinically active and inactive patients. In the visual analysis, all participants had at least 1 vascular site with inflammatory activity, with an uptake ≥2 in relation to the liver. The aortic arch was the most frequently involved site.

Conclusions

This study showed that 18F-FDG PET/CT in late acquisition is an effective imaging method to assess TA activity even in fully treated patients.
Reliable Assessment of Swine Renal Fibrosis Using Quantitative Magnetization Transfer Imaging
Authors: Jiang Kai , Ferguson Christopher M. , Grimm Roger C. , Zhu Xiangyang , Glockner James F. , Lerman Lilach O.
Published: December 2021

Objectives

Quantitative magnetization transfer (qMT) is useful for measurement of murine renal fibrosis at high and ultrahigh field strengths. However, its utility at clinical field strengths and in human-like kidneys remains unknown. We tested the hypothesis that qMT would successfully detect fibrosis in swine kidneys with unilateral renal artery stenosis (RAS) at 3.0 T.

Methods

The qMT protocol is composed of MT scans with variable flip angles and offset frequencies, and of B0
, B1
, and T1
mapping. Pigs were scanned 10 weeks after RAS or control. A 2-pool model was used to fit the bound pool fraction f of the renal cortex (CO) and outer medulla (OM). Then qMT-derived f in 5 normal and 10 RAS pigs was compared with histological fibrosis determined using Masson's trichrome staining and to renal perfusion assessed with computed tomography.

Results

The qMT 2-pool model provided accurate fittings of data collected on swine kidneys. Stenotic kidneys showed significantly elevated f in both the CO (9.8% ± 2.7% vs 6.4% ± 0.9%, P = 0.002) and OM (7.6% ± 2.2% vs 4.7% ± 1.1%, P = 0.002), as compared with normal kidneys. Histology-measured renal fibrosis and qMT-derived f correlated directly in both the cortex (Pearson correlation coefficient r = 0.93, P < 0.001) and OM (r = 0.84, P = 0.002), and inversely with stenotic kidney perfusion (r = 0.85, P = 0.002).

Conclusions

This study demonstrates the feasibility of qMT for measuring fibrosis in human-like swine kidneys, and the association between tissue macromolecule content and renal perfusion. Therefore, qMT may be useful as a tool for noninvasive assessment of renal fibrosis in subjects with RAS at clinical field strengths.
Getting Ready for 2021 Joint Commission Perinatal Standards
Authors: Lerner Veronica , Bajaj Komal
Published: December 2021

Summary Statement

The new Joint Commission requirements on perinatal safety present a unique opportunity for the simulation community to actively engage with labor and delivery units nationwide. Considerations for implementation using “real-life” experience with the programmatic development of an in situ team-based simulation training program in obstetric emergencies are discussed. We urge simulationists to explore opportunities to promote culture change on a large scale to move the needle of maternal morbidity and mortality.
Simulation Method for Testing Aerosol Mitigation Strategies
Authors: Oman Sven P. , Sanghavi Devang K. , Helgeson Scott A. , Lowman Philip E. , Crook Julia E. , Ball Colleen T. , Kuhlmann Joel L. , Rech Allen K. , Franco Pablo Moreno
Published: December 2021

Background

Frontline health care workers who perform potentially aerosol-generating procedures, such as endotracheal intubations, in patients with coronavirus disease 2019 may be at an increased risk of exposure to severe acute respiratory syndrome coronavirus 2. To continue to care for patients with coronavirus disease 2019, minimizing exposure is paramount. Using simulation, we devised a testing method to evaluate devices that may mitigate the spread of aerosol and droplet-sized particles.

Methods

In this prospective single-center study, participants intubated a manikin 3 times using standard personal protective equipment, once with no barrier device, once with an acrylic box, and once with a modified horizontal drape. The micrometer-sized particle count, generated by a nebulization model, was recorded before and after each intubation. The first-pass intubation rate and time to intubation were recorded. Each operator completed a postsimulation survey about their experience using the barrier devices.

Results

Thirty airway proceduralists completed the simulation and survey. There was no significant difference in particle counts (aerosols or droplets) or first-pass intubation, but the horizontal drape was found to significantly increase intubation time (P = 0.01). Most participants preferred the drape over the acrylic box or no barrier device.

Conclusions

The acrylic box and plastic drape did not mitigate particle spread. However, our testing method can be used to test barrier designs using negative pressure or other mitigation strategies for particle spread.
Advanced partial occlusion controller allows for increased precision during targeted regional optimization in a porcine model of hemorrhagic shock
Authors: Lauria Alexis L. , Kersey Alexander J. , Mares John A. , Taheri Branson D. , Bedocs Peter , White Paul W. , Burmeister David M. , White Joseph M.
Published: December 2021

BACKGROUND

Targeted regional optimization (TRO), a partial resuscitative endovascular balloon occlusion of the aorta strategy, may mitigate distal ischemia and extend the window of effectiveness for this adjunct. An automated device may allow greater control and precise regulation of flow past the balloon, while being less resource-intensive. The objective of this study was to assess the technical feasibility of the novel advanced partial occlusion controller (APOC) in achieving TRO at multiple distal pressures.

METHODS

Female swine (n = 48, 68.1 ± 0.7 kg) were randomized to a target distal mean arterial pressure (MAP) of 25 mm Hg, 35 mm Hg, or 45 mm Hg by either manual (MAN) or APOC regulation (n = 8 per group). Uncontrolled hemorrhage was generated by liver laceration. Targeted regional optimization was performed for 85 minutes, followed by surgical control and a 6-hour critical care phase. Proximal and distal MAP and flow rates were measured continuously.

RESULTS

At a target distal MAP of 25 mm Hg, there was no difference in the MAP attained (APOC: 26.2 ± 1.05 vs. MAN: 26.1 ± 1.78 mm Hg) but the APOC had significantly less deviance (10.9%) than manual titration (14.9%, p < 0.0001). Similarly, at a target distal MAP of 45 mm Hg, there was no difference in mean pressure (44.0 ± 0.900 mm Hg vs. 45.2 ± 1.31 mm Hg) but APOC had less deviance (9.34% vs. 11.9%, p < 0.0001). There was no difference between APOC and MAN in mean (34.6 mm Hg vs. 33.7 mm Hg) or deviance (9.95% vs. 10.4%) at a target distal MAP of 35 mm Hg, respectively. The APOC made on average 77 balloon volume adjustments per experiment compared with 29 by manual titrations.

CONCLUSION

The novel APOC consistently achieved and sustained precisely regulated TRO across all groups and demonstrated reduced deviance at the 25 mm Hg and 45 mm Hg groups compared with manual titration.
Factors associated with limitation of care after fatal injury
Authors: de Angelis Paolo , Meredyth Nicole , Leahy Nicole E. , An Anjile , Narayan Mayur , Barie Philip S. , Winchell Robert J.
Published: December 2021

BACKGROUND

There is variability in end-of-life care of trauma patients. Many survive resuscitation but die after limitation of care (LoC). This study investigated LoC at a level I center.

METHODS

Adult trauma deaths between January 2016 and June 2020 were reviewed. Patients were stratified into “full code” versus any LoC (i.e., do not resuscitate, no escalation, or withdrawal of care) and by timing to LoC. Emergency department and “brain” deaths were excluded. Unadjusted logistic regression and Cox proportional hazards were used for analyses. Results include n (%) and odds ratios (ORs) with 95% confidence intervals (CIs), with α = 0.05.

RESULTS

A total of 173 patients were included; 15 patients (8%) died full code and 158 (91%) died after LoC. Seventy-seven patients (48%) underwent incremental LoC. Age (OR, 1.05; 95% CI, 1.02–1.08; p = 0.0010) and female sex (OR, 3.71; 95% CI, 1.01–13.64; p = 0.0487) increased the odds of LoC; number of anatomic injuries (OR, 0.91; 95% CI, 0.85–0.98; p = 0.0146), chest injuries (Abbreviated Injury Scale [AIS] score chest, >3) (OR, 0.02; 95% CI, 0.01–0.26; p = 0.0021), extremity injury (AIS score, >3) (OR, 0.08; 95% CI, 0.01–0.64; p = 0.0170), and hospital complications equal to 1 (OR, 0.21; 95% CI, 0.06–0.78; p = 0.0201) or ≥2 (OR, 0.19; 95% CI, 0.04–0.87; p = 0.0319) decreased the odds of LoC. For those having LoC, final limitations were implemented in <14 days for 83% of patients; markers of injury severity (e.g., Injury Severity Score, Glasgow Coma Scale score, and AIS score) increased the odds of early LoC implementation.

CONCLUSION

Most patients died after LoC was implemented in a timely fashion. Significant head injury increased the odds of LoC. The number of injuries, severe chest and extremity injuries, and increasing number of complications decreased the odds of LoC, presumably because patients died before LoCs were initiated. Understanding factors contributing to end-of-life care could help guide discussions regarding LoCs.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level III.
Trauma transfers discharged from the emergency department—Is there a role for telemedicine?
Authors: Lindsey Lindsay J. , Rasmussen Lindsey S. , Hendrickson Landon S. , Frech Emily S. , Bozell Steven P. , Stewart Kenneth E. , Kennedy Ryan O. , Cross Alisa , Albrecht Roxie M. , Celii Amanda M.
Published: December 2021

BACKGROUND

As the only Level I trauma center in the state, our hospital has seen an increase in the number of traumas requiring transfer for a higher level of care, placing strain on an already strained health care system. Traumas that are transferred to our facility and subsequently discharged back home indicate a subset of patients who may not be appropriate to transfer. The aim of this study is to identify commonalities between patients who were transferred for a higher level of care but do not require inpatient status and to assess patients who may benefit from a telemedicine evaluation.

METHODS

A 2-year retrospective review of a prospective collected database of patients who were discharged from the ED following transfer to a Level I trauma center was conducted. Data included demographics, injuries, transferring facility, method of transport, activation criteria and level, additional imaging, consulting services, procedures, and disposition.

RESULTS

A total of 2,350 patients were transferred. Of those, 27% (632/2,350) were discharged home directly from the trauma bay. Of those patients, 36% (230/632) required complex bedside intervention or subspecialty consultation prior to discharge including complex laceration repairs 53%, ophthalmology examination 24%, splinting 18%, and joint reduction 5%. Sixty-four percent (402/632) of patients did not require complex bedside procedures prior to discharge. One hundred twenty hospitals transferred patients to our center during this period. The top 10 transferring facilities accounted for 40% (948/2,350) of our transfer volume.

CONCLUSION

Our study demonstrates that patients who are transferred to our facility and subsequently discharged have a common pattern of injuries; typically, isolated hand and face/ophthalmology. This is likely attributed to the lack of resources in rural facilities to evaluate and develop treatment plans for these injuries; however, only 36% of discharged patients required a bedside procedure. Excluding Level I traumas, head and spine injuries, and patients requiring complex bedside procedures, there was a 13% inappropriate rate of transfer (310/2,350). Development and implementation of a telemedicine system could potentially reduce the transfer and ED discharge rate, thereby improving efficiency and allowing for reallocation of resources as appropriate.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic, Level III.
Social determinants of trauma care: Associations of race, insurance status, and place on opioid prescriptions, postdischarge referrals, and mortality
Authors: Grenn Emily , Kutcher Matthew , Hillegass William B. , Iwuchukwu Chinenye , Kyle Amber , Bruehl Stephen , Goodin Burel , Myers Hector , Rao Uma , Nag Subodh , Kinney Kerry , Dickens Harrison , Morris Matthew C.
Published: December 2021

BACKGROUND

Racial disparities in trauma care have been reported for a range of outcomes, but the extent to which these remain after accounting for socioeconomic and environmental factors remains unclear. The objective of this study was to evaluate the unique contributions of race, health insurance, community distress, and rurality/urbanicity on trauma outcomes after carefully controlling for specific injury-related risk factors.

METHODS

All adult (age, ≥18 years) trauma patients admitted to a single Level I trauma center with a statewide, largely rural, catchment area from January 2010 to December 2020 were retrospectively reviewed. Primary outcomes were mortality, rehabilitation referral, and receipt of opioids in the emergency department. Demographic, socioeconomic, and injury characteristics as well as indicators of community distress and rurality based on home address were abstracted from a trauma registry database.

RESULTS

Analyses revealed that Black patients (n = 13,073) were younger, more likely to be male, more likely to suffer penetrating injuries, and more likely to suffer assault-based injuries compared with White patients (n = 10,946; all p < 0.001). In adjusted analysis, insured patients had a 28% lower risk of mortality (odds ratio, 0.72; p = 0.005) and were 92% more likely to be referred for postdischarge rehabilitation than uninsured patients (odds ratio, 1.92; p = 0.005). Neither race- nor place-based factors were associated with mortality. However, post hoc analyses revealed a significant race by age interaction, with Black patients exhibiting more pronounced increases in mortality risk with increasing age.

CONCLUSION

The present findings help disentangle the social determinants of trauma disparities by adjusting for place and person characteristics. Uninsured patients were more likely to die and those who survived were less likely to receive referrals for rehabilitation services. The expected racial disparity in mortality risk favoring White patients emerged in middle age and was more pronounced for older patients.

LEVEL OF EVIDENCE

Prognostic and epidemiological, Level III.
Revision of the AAST grading scale for acute cholecystitis with comparison to physiologic measures of severity
Authors: Schuster Kevin M. , O’Connor Rick , Cripps Michael , Kuhlenschmidt Kali , Taveras Luis , Kaafarani Haytham M. , El Hechi Majed , Puri Ruchir , Schroeppel Thomas J. , Enniss Toby M. , Cullinane Daniel C. , Cullinane Laura M. , Agarwal Suresh , Kaups Krista , Crandall Marie , Tominaga Gail
Published: December 2021

BACKGROUND

Grading systems for acute cholecystitis are essential to compare outcomes, improve quality, and advance research. The American Association for the Surgery of Trauma (AAST) grading system for acute cholecystitis was only moderately discriminant when predicting multiple outcomes and underperformed the Tokyo guidelines and Parkland grade. We hypothesized that through additional expert consensus, the predictive capacity of the AAST anatomic grading system could be improved.

METHODS

A modified Delphi approach was used to revise the AAST grading system. Changes were made to improve distribution of patients across grades, and additional key clinical variables were introduced. The revised version was assessed using prospectively collected data from an AAST multicenter study. Patient distribution across grades was assessed, and the revised grading system was evaluated based on predictive capacity using area under receiver operating characteristic curves for conversion from laparoscopic to an open procedure, use of a surgical “bail-out” procedure, bile leak, major complications, and discharge home. A preoperative AAST grade was defined based on preoperative, clinical, and radiologic data, and the Parkland grade was also substituted for the operative component of the AAST grade.

RESULTS

Using prospectively collected data on 861 patients with acute cholecystitis the revised version of the AAST grade has an improved distribution across all grades, both the overall grade and across each subscale. A higher AAST grade predicted each of the outcomes assessed (all p ≤ 0.01). The revised AAST grade outperformed the original AAST grade for predicting operative outcomes and discharge disposition. Despite this improvement, the AAST grade did not outperform the Parkland grade or the Emergency Surgery Score.

CONCLUSION

The revised AAST grade and the preoperative AAST grade demonstrated improved discrimination; however, a purely anatomic grade based on chart review is unlikely to predict outcomes without addition of physiologic variables. Follow-up validation will be necessary.

LEVEL OF EVIDENCE

Diagnostic Test or Criteria, Level IV.
Sex dimorphisms in coagulation characteristics in the pediatric trauma population appear after puberty
Authors: Hrebinko Katherine A. , Strotmeyer Stephen , Richardson Ward , Gaines Barbara A. , Leeper Christine M.
Published: December 2021

BACKGROUND

The role of age and sex in mediating coagulation characteristics in injured children is not well defined. We hypothesize that thromboelastography (TEG) profiles are equivalent across sex in younger children and diverge after puberty.

METHODS

Consecutive trauma patients younger than 18 years were identified from a university-affiliated, Level I, pediatric trauma center (2016–2020) database. Demographics, injury characteristics, and TEG parameters were recorded. Children were categorized by sex and age (younger, ≤10 years; older, ≥11 years). Baseline characteristics, outcomes, and TEG parameters were compared using nonparametric tests as appropriate. To account for the effects of confounding variables, analysis of covariance was performed controlling for Injury Severity Score (ISS), admission Glasgow Coma Scale score, and pediatric age-adjusted shock index.

RESULTS

Six hundred forty-seven subjects were identified (70.2% male, median ISS, 10; interquartile range, 5–24; blunt mechanism, 75.4%). Among 395 younger children (≤10 years), there were no differences in TEG characteristics between sexes. Among 252 adolescents (≥11 years), males had greater kinetic times (1.8 vs. 1.4 min; p < 0.001), decreased alpha angles (69.6° vs73.7°; p < 0.001), and lower maximum amplitudes (59.4 vs. 61.5 mm; p = 0.01). Fibrinolysis was significantly lower in older females compared with younger females (0.4% vs. 1.5%, p < 0.001) and age-matched males (0.4% vs. 1.0%, p = 0.02). Compared with younger male children, adolescent males had greater kinetic times (1.8 vs. 1.4 min; p < 0.001), decreased alpha angles (73.5° vs. 69.6°, p < 0.001), lower maximum amplitudes (59.4 vs. 62 mm, p < 0.001), and less fibrinolysis (1.0% vs. 1.3%, p = 0.03). This interaction persisted after controlling for ISS, Glasgow Coma Scale, and pediatric age-adjusted shock index.

CONCLUSION

Sex dimorphisms in TEG coagulation profiles appear after puberty. This divergence appears to be driven by a shift in male coagulation profiles to a relatively hypocoagulable state and female coagulation profiles to a relatively hypercoagulable state after puberty.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic, Level III.
Repetitive Transcranial Magnetic Stimulation Promotes Rapid Psychiatric Stabilization in Acutely Suicidal Military Service Members
Authors: Hines Christopher E. , Mooney Scott , Watson Nora L. , Looney Stephen W. , Wilkie David J.
Published: December 2021

Objective

This study presents data for using accelerated transcranial magnetic stimulation (TMS) as an intervention for suicidal crisis (SC).

Methods

This prospective, single-site, randomized, double-blind trial enrolled active-duty military participants with SC to receive either active TMS (n = 59) or sham TMS (n = 61) 3 times per day for 3 consecutive days. Our primary outcome, the Beck Scale for Suicidal Ideation—current (SSI-C), was measured before each session of TMS. Secondary outcomes measured both the SSI-C and the Beck Scale for Suicidal Ideation—total daily for the 3 intervention days and at 1, 3, and 6 months of follow-up.

Results

In the modified intention to treat (mITT) analysis of SSI-C changes over treatment sessions, the TMS active group had accelerated decline in suicidal ideation as compared with sham: β for interaction was 0.12 points greater SSI-C decline per session (standard error [SE], 0.06) in TMS versus sham (P = 0.04). In both the mITT and per-protocol active TMS groups, the mean final SSI-C scores were below 3. These scores remained below 3 for the entire 6-month follow-up period.

Conclusions

In this military trial of suicidal patients, we found that both active and sham accelerated TMS rapidly reduces SC. Moreover, in the mITT analysis, there was a statistically significant antisuicidal benefit of active TMS versus sham TMS in the primary outcome. Both the mITT and per-protocol groups moved from higher to approximately 7 times lower suicide risk strata and remained there for the duration of the study. Further studies are warranted to understand accelerated TMS' full potential as a treatment for SC.
Comparing system identification techniques for identifying human-like walking controllers
Authors: Schmitthenner Dave , Martin Anne E.
Published: December 2021

While human walking has been well studied, the exact controller is unknown. This paper used human experimental walking data and system identification techniques to infer a human-like controller for a spring-loaded inverted pendulum (SLIP) model. Because the best system identification technique is unknown, three methods were used and compared. First, a linear system was found using ordinary least squares. A second linear system was found that both encoded the linearized SLIP model and matched the first linear system as closely as possible. A third nonlinear system used sparse identification of nonlinear dynamics (SINDY). When directly mapping states from the start to the end of a step, all three methods were accurate, with errors below 10% of the mean experimental values in most cases. When using the controllers in simulation, the errors were significantly higher but remained below 10% for all but one state. Thus, all three system identification methods generated accurate system models. Somewhat surprisingly, the linearized system was the most accurate, followed closely by SINDY. This suggests that nonlinear system identification techniques are not needed when finding a discrete human gait controller, at least for unperturbed walking. It may also suggest that human control of normal, unperturbed walking is approximately linear.
Degradation of
Rhodococcus erythropolis
SY095 modified with functional magnetic Fe
3
O
4
nanoparticles
Authors: Ma Xiaolei , Duan Duomo , Wang Xunliang , Cao Junrui , Qiu Jinquan , Xie Baolong
Published: December 2021

Alkali-surfactant-polymer flooding technology is widely employed to extract crude oil to enhance its production. The bacterial strain
Rhodococcus erythropolis
SY095 has shown high degradation activity of alkane of crude oil. In the past, many treatment strategies have been implemented to reduce oil concentration in wastewater. Previous studies mainly focused on the extracellular products of
Erythrococcus
rather than its degradation properties. In the current study, we designed an immobilization method to modify the surface of
R. erythropolis
SY095 with functional Fe
3
O
4
nanoparticles (NPs) for biodegradation of crude oil and separation of the immobilized bacteria after degradation. We characterize the synthesized NPs through various methods, including scanning electron microscope energy-dispersive spectrometer, Fourier transform infrared spectroscopy, X-ray diffraction (XRD) and a vibrating sample magnetometer. We found that the size of the synthesized NPs was approximately 100 nm. Our results showed that
R. erythropolis
SY095 was successfully coated with functional magnetic NPs (MNPs) that could be easily separated from the solution via the application of an external magnetic field. The coated cells had a high tolerance for heavy metals. Our findings demonstrated that the immobilization of MNPs to bacterial surfaces is a promising approach for the degradation of crude oil.
Study on the host–guest complex of dicyclohexanocucurbit[6]uril and 2-phenylbenzimidazole, and its recognition effect toward Fe
3+
Authors: Zheng Jun , An Lian , Gao Jie , Zhang Lin , Yang Xinan , Zhao Weiwei , Cheng Siyuan , Ma Peihua
Published: December 2021

This paper has selected dicyclohexanocucurbit[6]uril (CyH
2
Q[6]) as the host and 2-phenylbenzimidazole (
G
) as the guest to investigate the host–guest interaction mode between CyH
2
Q[6] and
G
. Under acidic conditions, the complex was characterized using nuclear magnetic resonance, ultraviolet and fluorescence spectroscopy. The results show that the molecular ratio of CyH
2
Q[6] to
G
is 2 : 1. The crystals were cultured with ZnCl
2
as a structural inducer under acidic conditions and single crystal X-ray diffraction showed that the molecular ratio of CyH
2
Q[6] to
G
is 1 : 3. The G@CyH
2
Q[6] was used as a fluorescent probe to identify metal cations. The probe exhibits a good selective recognition effect toward Fe
3+
ions, which involves a reduced fluorescence intensity with a limit of detection of 1.321 × 10
–6
mol l
–1
.
Ecological specialization, rather than the island effect, explains morphological diversification in an ancient radiation of geckos
Authors: Tejero-Cicuéndez Héctor , Simó-Riudalbas Marc , Menéndez Iris , Carranza Salvador
Published: December 2021

Island colonists are often assumed to experience higher levels of phenotypic diversification than continental taxa. However, empirical evidence has uncovered exceptions to this ‘island effect’. Here, we tested this pattern using the geckos of the genusPristurusfrom continental Arabia and Africa and the Socotra Archipelago. Using a recently published phylogeny and an extensive morphological dataset, we explore the differences in phenotypic evolution between Socotran and continental taxa. Moreover, we reconstructed ancestral habitat occupancy to examine if ecological specialization is correlated with morphological change, comparing phenotypic disparity and trait evolution between habitats. We found a heterogeneous outcome of island colonization. Namely, only one of the three colonization events resulted in a body size increase. However, in general, Socotran species do not present higher levels or rates of morphological diversification than continental groups. Instead, habitat specialization explains better the body size and shape evolution inPristurus. Particularly, the colonization of ground habitats appears as the main driver of morphological change, producing the highest disparity and evolutionary rates. Additionally, arboreal species show very similar body size and head proportions. These results reveal a determinant role of ecological mechanisms in morphological evolution and corroborate the complexity of ecomorphological dynamics in continent–island systems.
The role of airborne transmission in a large single source outbreak of SARS-CoV-2 in a Belgian nursing home in 2020
Authors: Vuylsteke Bea , Cuypers Lize , Baele Guy , Stranger Marianne , Paralovo Sarah Lima , André Emmanuel , Dirks Joke , Maes Piet , Laga Marie
Published: December 2021

Objectives

To better understand the conditions which have led to one of the largest COVID-19 outbreaks in Belgian nursing homes in 2020.

Setting

A nursing home in Flanders, Belgium, which experienced a massive outbreak of COVID-19 after a cultural event. An external volunteer who dressed as a legendary figure visited consecutively the 4 living units and tested positive for SARS-CoV-2 the next day. Within days, residents started to display symptoms and the outbreak spread rapidly within the nursing home.

Methods

We interviewed key informants and collected standardized data from all residents retrospectively. A batch of 115 positive samples with a Ct value of <37 by qRT-PCR were analysed using whole-genome sequencing. Six months after the outbreak, ventilation assessment of gathering rooms in the nursing home was done using a tracer gas test with calibrated CO2sensors.

Results

Timeline of diagnoses and symptom onsets clearly pointed to the cultural event as the start of the outbreak, with the volunteer as index case. The genotyping of positive samples depicted the presence of one large cluster, suggesting a single source outbreak.

The global attack rate among residents was 77% with a significant association between infection and presence at the event. Known risk factors such as short distance to or physical contact with the volunteer, and wearing of a mask during the event were not associated with early infection. The ventilation assessment showed a high background average CO2level in four main rooms varying from 657 ppm to 846 ppm.

Conclusions

Our investigation shows a rapid and widespread single source outbreak of SARS-CoV-2 in a nursing home, in which airborne transmission was the most plausible explanation for the massive intra-facility spread. Our results underscore the importance of ventilation and air quality for the prevention of future outbreaks in closed facilities.
Toward noninvasive assessment of stroke risk in pediatric cerebrovascular disease
Authors: Horn John D. , Johnson Michael J. , Starosolski Zbigniew , Meoded Avner , Milewicz Dianna M. , Annapragada Ananth , Hossain Shaolie S.
Published: December 2021

Background and Purpose

Moyamoya disease (MMD) is a progressive steno-occlusive cerebrovascular disease leading to recurrent stroke. There is a lack of reliable biomarkers to identify unilateral stroke MMD patients who are likely to progress to bilateral disease and experience subsequent contralateral stroke(s). We hypothesized that local hemodynamics are predictive of future stroke and set out to noninvasively assess this stroke risk in pediatric MMD patients.

Methods

MR and X-ray angiography imaging were utilized to reconstruct patient-specific models of the circle of Willis of 6 pediatric MMD patients who had previous strokes, along with a control subject. Blood flow simulations were performed by using a Navier-Stokes solver within an isogeometric analysis framework. Vascular regions with a wall shear rate (WSR) above the coagulation limit (> 5000 s−1) were identified to have a higher probability of thrombus formation, potentially leading to ischemic stroke(s). Two metrics, namely, “critical WSR coverage” and “WSR score”, were derived to assess contralateral stroke risk and compared with clinical follow-up data.

Results

In two patients that suffered a contralateral stroke within two months of the primary stroke, critical WSR coverages exceeding 50% of vessel surface and WSR scores greater than 6x the control were present in multiple contralateral vessels. These metrics were not as conclusive in two additional patients with 3-to-5-year gaps between primary and contralateral strokes. However, a longitudinal study of one of these two cases, where a subsequent timepoint was analyzed, accurately predicted disease stabilization on the primary stroke side and an elevated contralateral stroke risk, thus indicating that post-stroke follow-up at regular intervals might be warranted for secondary stroke prevention.

Conclusions

WSR-based metrics could be predictive of future stroke risk after an initial stroke in MMD patients. In addition, more accurate predictions may be possible by performing patient-specific hemodynamic analysis at multiple timepoints during patient follow-up to monitor changes in the WSR-based metrics.
The ground truth of the Data-Iceberg: Correct Meta-data
Authors: Caliskan Aylin , Dangwal Seema , Dandekar Thomas
Published: December 2021

Short summary

Biological molecular data such as sequence information increase so rapidly that detailed metadata, describing the process and conditions of data collection as well as proper labelling and typing of the data become ever more important to avoid mistakes and erroneous labeling. Starting from a striking example of wrong labelling of patient data recently published in Nature, we advocate measures to improve software metadata and controls in a timely manner to not rapidly loose quality in the ever-growing data flood.
The BioImage Archive - building a home for life-sciences microscopy data
Authors: Hartley Matthew , Kleywegt Gerard J. , Patwardhan Ardan , Sarkans Ugis , Swedlow Jason R. , Brazma Alvis
Published: December 2021

Despite the huge impact of data resources in genomics and structural biology, until now there has been no central archive for biological data for all imaging modalities. The BioImage Archive is a new data resource at the European Bioinformatics Institute (EMBL-EBI) designed to fill this gap. In its initial development BioImage Archive accepts bioimaging data associated with publications, in any format, from any imaging modality from the molecular to the organism scale, excluding medical imaging. The BioImage Archive will ensure reproducibility of published studies that derive results from image data and reduce duplication of effort. Most importantly, the BioImage Archive will help scientists to generate new insights through reuse of existing data to answer new biological questions, and provision of training, testing and benchmarking data for development of tools for image analysis. The archive is available at https://www.ebi.ac.uk/bioimage-archive/.

Highlights

The BioImage Archive is a new archival data resource at the European Bioinformatics Institute (EMBL-EBI).

The BioImage Archive aims to accept all biological imaging data associated with peer-reviewed publications using approaches that probe biological structure, mechanism and dynamics, as well as other important datasets that can serve as reference examples for particular biological or technical domains.

The BioImage Archive aims to encourage the use of valuable imaging data, to improve reproducibility of published results that rely on image data, and to facilitate extraction of novel biological insights from existing data and development of new image analysis methods.

The BioImage Archive forms the foundation for an ecosystem of related databases, supporting those resources with storage infrastructure and indexing across databases.

Across this ecosystem, the BioImage Archive already stores and provides access to over 1.5 petabytes of image data from many different imaging modalities and biological domains.

Future development of the BioImage Archive will support the fast-emerging next generation file formats (NGFFs) for bioimaging data, providing access mechanisms tailored toward modern visualisation and data exploration tools, as well as unlocking the power of modern AI-based image-analysis approaches.
Evaluating the Outcomes of Enhanced Adherence Counselling Intervention on Clients with High Viral Loads in Selected Health Facilities in Monze District
Authors: Kaira M. , Sikazwe T. , Simwanza J. , Zambwe M. , Chipimo P. J
Published: December 2021

To investigate the changes in Viral Load(VL) during Enhanced Adherence Counselling (EAC) sessions and its determinants among ART clients with unsuppressed VLs in Monze district.

Method

A Cross-sectional study involving 616 HVL ART clients from 15 health facilities in Monze district which was conducted between October 1 2019 and March 30 2021.

Results

Out of 616 clients analysed, there was an improvement in viral load suppression following completion of EAC with a final outcome of 61% suppression. 28.7% remained unsuppressed. A total of 9.1% had no final viral load results documented and 0.2 % had been transferred out of their respective facilities and were not included in the study. Collection of repeat Viral loads was done on 84% of the clients with high viral load results while 16% had no record of sample collection. A total of 56 results were not received giving a result return of 89% from repeat samples collected. Females had a 40% likelihood of being unsuppressed at 95% CI (41% to 86%) compared to the males.

Conclusion

EAC improves the outcomes of HVLs and should be encouraged on all high viral clients. Programs should be developed to improve suppression in females on ART
Mesocorticolimbic system abnormalities in chronic cluster headache patients: a neural signature?
Authors: Ferraro Stefania , Medina Jean Paul , Nigri Anna , Giani Luca , Demichelis Greta , Pinardi Chiara , Bruzzone Maria Grazia , Proietti Alberto , Becker Benjamin , Chiapparini Luisa , Leone Massimo
Published: December 2021

BACKGROUND

Converging evidence suggests that anatomical and functional mesocorticolimbic abnormalities support the chronicization of pain disorders.

METHODS

We mapped structural and functional alterations of the mesocorticolimbic system in a sample of chronic cluster headache (cCH) patients (n = 28) in comparison to age and sex-matched healthy individuals (n=28) employing structural MRI and resting-state functional MRI (rs-fMRI).

RESULTS

Univariate logistic regression models showed that several of the examined structures/areas (i.e., the bilateral nucleus accumbens, ventral diencephalon, hippocampus, and frontal pole, and the right amygdala) differentiated cCH patients from healthy individuals (p<0.05, uncorrected). Specifically, all the significant structures/areas had increased volumes in cCH patients compared to healthy individuals. The examination of the groups suffering from left and right-sided cranial attacks showed a lateralization effect: ipsilateral to the pain ventral diencephalic regions and contralateral to the pain nucleus accumbens discriminated cCH patients from healthy individuals. The rs-fMRI data analyses showed that cCH patients compared to CTRL individuals present robust reduced functional connectivity in the right frontal pole-right amygdala pathway (p<0.05, FDR-corrected).

CONCLUSION

Our results showed that cCH patients present anatomical and functional maladaptation of the mesocorticolimbic system, with functional data indicating a possible prefrontal areas’ failure to modulate the mesolimbic structures. These results were opposite to what we hypothesized based on the previous literature on chronic pain conditions. Future studies should assess whether the observed mesocorticolimbic abnormalities are due to the neuroprotective effects of the assumed medications, or to the frequent comorbidity of CH with neuropsychiatric disorders or if they are a genuine neural signature of CH and/or cCH condition.
When self comes to a wandering mind: Brain representations and dynamics of self-generated concepts in spontaneous thought
Authors: Kim Byeol , Andrews-Hanna Jessica R. , Han Jihoon , Lee Eunjin , Woo Choong-Wan
Published: December 2021

Abstract

Self-relevant concepts are major building blocks of spontaneous thought, and their dynamics in a natural stream of thought are likely to reveal one’s internal states important for mental health. Here we conducted an fMRI experiment (n= 62) to examine brain representations and dynamics of self-generated concepts in the context of spontaneous thought using a newly developed free association-based thought sampling task. The dynamics of conceptual associations were predictive of individual differences in general negative affectivity, replicating across multiple datasets (n= 196). Reflecting on self-generated concepts strongly engaged brain regions linked to autobiographical memory, conceptual processes, emotion, and autonomic regulation, including the medial prefrontal and medial temporal subcortical structures. Multivariate pattern-based predictive modeling revealed that the neural representations of valence became more person-specific as the level of perceived self-relevance increased. Overall, this study provides a hint of how self-generated concepts in spontaneous thought construct inner affective states and idiosyncrasies.