bluuebunny/crossref_metadata_2025 huggingface dataset:
Desflurane protects against liver ischemia/reperfusion injury via regulating miR-135b-5p
Authors: Zhong Mengxia , Che Lei , Du Meiqing , Liu Ke , Wang Dalong
Published: September 2020

Background:

A number of anesthetics have protective effect against ischemia-reperfusion (I/R) injury, including desflurane. But the function and molecular mechanism of desflurane in liver I/R injury have not been fully understood. The aim of this study was to investigate the effect of desflurane on liver I/R injury and further investigated the molecular mechanisms involving in miR-135b-5p.

Methods:

The models of liver I/R injury in rats were established, and received desflurane treatment throughout the injury. Serum alanine transaminase (ALT) and aspartate transaminase (AST) were measured and compared between groups. H/R-induced cell model in L02 was established, and were treated with desflurane before hypoxia. Quantitative real-time polymerase chain reaction was performed to determine the expression of miR-135b-5p in different groups. The cell apoptosis was detected using flow cytometry assay. Western blot was used for the measurement of protein levels.

Results:

I/R significantly increased serum levels of ALT and AST in rats, which were reversed by desflurane treatment. Desflurane also significantly attenuated the increase of cell apoptosis induced by I/R in both vivo and vitro. MiR-135b-5p significantly reversed the protective effect of desflurane against liver I/R injury. Additionally, Janus protein tyrosine kinase (JAK)2 was shown to be a target gene of miR-135b-5p, and miR-135b-5p overexpression significantly decreased the protein levels of p-JAK2, JAK2, p-STAT3.

Conclusion:

Desflurane attenuated liver I/R injury through regulating miR-135b-5p, and JAK2 was the target gene of mIR-135b-5p. These findings provide references for further development of therapeutic strategies in liver injury.
The Utility of Numeric Grading Scales of Middle Ear Risk in Predicting Ossiculoplasty Hearing Outcomes
Authors: Judd Ryan T. , Imbery Terence E. , Gluth Michael B.
Published: September 2020

Objective:

To assess the usefulness of numeric grading scales of middle ear risk in predicting ossiculoplasty hearing outcomes.

Study Design:

Retrospective review.

Setting:

Tertiary care, academic medical center.

Patients:

Adults and children undergoing ossiculoplasty between May 2013 and May 2019 including: synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization of lateral chain fixation.

Intervention:

Cases were scored via middle ear risk index (MERI), surgical prosthetic infection tissue eustachian tube (SPITE) method, and ossiculoplasty outcome scoring parameter (OOPS) scale. Preoperative and postoperative hearing outcomes were recorded.

Main Outcome Measure:

Statistical correlation between risk score and postoperative pure-tone average air-bone gap (PTA-ABG).

Results:

The 179 included cases had average pre and postoperative PTA-ABGs of 30.3dB (standard deviation [SD] 12.7) and 20.3dB (SD 11.1), respectively. Mean MERI, SPITE, and OOPS scores were 4.5 (SD 2.3), 2.8 (SD 1.7), and 3.1 (SD 1.8), respectively. Statistically significant correlations with hearing outcome were noted for all three methods (MERI r = 0.22, p = 0.003; OOPS r = 0.19, p = 0.012; SPITE r = 0.27, p < 0.001). No scale predicted poor (PTA-ABG > 30dB) outcomes; only low SPITE scores predicted excellent (PTA-ABG < 10dB) outcomes (odds ratio [OR] 0.74 [Confidence Interval: 0.57 – 0.97], p = 0.032).

Conclusions:

Significant weak correlations between each middle ear risk score and hearing outcomes were encountered. Although only the SPITE method predicted postoperative PTA-ABG, it was not overwhelmingly superior. Current grading scale selection may be justified by familiarity or ease of use.
Increasing Frailty, Not Increasing Age, Results in Increased Length of Stay Following Vestibular Schwannoma Surgery
Authors: Casazza Geoffrey C. , McIntyre Matthew K. , Gurgel Richard K. , McCrary Hilary C. , Shelton Clough , Couldwell William T. , Bowers Christian A.
Published: September 2020

Objective:

Understand the frailty of vestibular schwannoma surgical patients and how frailty impacts clinical course.

Study Design:

Retrospective Cohort.

Setting:

Single-tertiary academic hospital.

Patients:

All patients undergoing vestibular schwannoma surgery.

Intervention:

The modified frailty index (mFI) was calculated for all patients undergoing surgery for vestibular schwannoma between 2011 and 2018. Patient demographics and medical history, perioperative course, and postoperative complications were obtained from the medical record.

Main Outcome Measures:

The primary endpoint was hospital length of stay (LOS). Secondary endpoint was postoperative complications. Basic statistical analysis was performed including multivariate linear regressions to determine independent predictors of LOS.

Results:

There were 218 patients included and the mean age was 48.1 ± 0.9 (range 12–77). One-hundred ten patients were male (50.5%). The mean ICU LOS was 1.6 ± 0.1 days while mean total hospital LOS was 4.3 ± 0.2. There were 145 patients (66.5%) who were robust (nonfrail) with an mFI of 0, while 73 (33.5%) had an mFI of ≥1. Frailty (mFI≥2) was associated with longer hospital LOS compared with the prefrail (p = 0.0014) and robust (p = 0.0004) groups, but was not associated with increased complications (OR = 1.3; 95% CI: 0.5–3.7; p = 0.5925) or ICU LOS (p > 0.05). In multivariate analysis, increased mFI, and NOT increased age, was an independent risk factor for increased hospital LOS (p = 0.027).

Conclusion:

Increasing frailty, and not increasing age, is an independent risk factor for longer hospital LOS, but not for increased postoperative complications. Patients’ frailty status may be useful preoperatively in counselling patients about postoperative expectations and frail vestibular schwannoma patients may require increased health spending costs given their increased hospital LOS.
Cost-effectiveness of Pediatric Unilateral/Bilateral Cochlear Implant in a Developing Country
Authors: Swami Himanshu , AP Arjun , Shivanand Shyamal
Published: September 2020

Objective:

To determine the cost-effectiveness of unilateral and bilateral cochlear implantation (CI) for children suffering from bilateral profound SNHL.

Study Design:

This was a cost benefit analysis study where quality-adjusted life years (QALY) and the expenditure involved post unilateral and bilateral CI were calculated to assess the cost per QALY gained.

Setting:

The study was conducted in a tertiary-care hospital in a city of a developing country.

Patients:

A total of 59 patients were studied during the years 2015 to 2019 of which a study cohort of 29 patients underwent bilateral cochlear implantation and a control cohort of 30 patients received U/L CI but did not undergo B/L CI.

Main Outcome:

The QALY parameters HUI3 and VAS when patient had no implant, post unilateral and bilateral CI were calculated along with the total lifelong expenditure involved. The outcomes improvement post CI was compared in the study and control groups. The discounted net cost per QALY gained was assessed and compared with the PCGDP of the country for cost effectiveness.

Results:

Significant QALY was gained post unilateral and bilateral CI and the expenditure for both was within the cost thresholds. The net costs per QALY gained post the discounting in unilateral and bilateral CI were found to be 1,345 US$ and 1,977 US$ respectively. The PCGDP (nominal) of India in 2018 was 2,016 US$. The cost involved per QALY gained was found to be lesser than the per capita GDP of India.

Conclusion:

Unilateral CI was found to be highly cost effective with bilateral CI involving a little higher cost per QALY gained but well within the cost effectiveness threshold.
Optimal Allocation of Nursing Resources
Authors: Thrall Terese Hudson
Published: September 2020

Appropriate nurse staffing to provide high-quality care was a hot topic before the pandemic challenged healthcare organizations across the nation. In a report released earlier this year, the subject is explored by 3 coauthors: Robyn Begley, DNP, RN, NEA-BC, chief executive officer of American Organization for Nursing Leadership and chief nursing officer of the American Hospital Association; Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, University of Virginia School of Nursing Sadie Heath Cabaniss professor and dean and former president of the American Nurses Association; and Todd Nelson, FHFMA, MBA, Healthcare Financial Management Association director of partnership relationships and chief partnership executive. The report was excerpted in the June issue of Nurse Leader1 and can be read in full at the Healthcare Financial Management Association website.2 The authors delve into the report's insights, generated by questions from Terese Hudson Thrall, managing editor at the American Organization for Nursing Leadership.
Second Victim Support
Authors: Stone Misty
Published: September 2020

OBJECTIVE

The purpose of this study was to describe hospital nurses’ experiences with organizational support after an adverse event (AE).

BACKGROUND

Most hospital staff nurses will experience an AE, being left and feeling traumatized.

METHODS

Data collection and analysis followed a qualitative descriptive approach.

RESULTS

Nurses yearn to feel valued and to receive timely support from nurse executives after an AE.

CONCLUSIONS

To help lessen the suffering of the nurse after an AE, healthcare organizations and nurse executives must support the nurse in the aftermath.
Factors Influencing Functional Outcome at Discharge
Authors: Pellicciari Leonardo , Agosti Maurizio , Goffredo Michela , Pournajaf Sanaz , Le Pera Domenica , De Pisi Francesco , Franceschini Marco , Damiani Carlo
Published: September 2020

Objective

Functional outcome represents the most central objective of rehabilitation programs. Understanding which factors could affect functional status at discharge is crucial for the planning of appropriate treatments in both neurologic and orthopedic patients. The aim of this study was to investigate which clinical and demographic variables, collected at the patient’s admission, could influence the functional outcome, assessed by the modified Barthel Index (mBI), at discharge.

Design

A retrospective study was conducted on a large cohort (n = 3548) of orthopedic and neurologic patients. Functional, demographic, and clinical records at patient admission and mBI score at discharge were collected. General linear model analysis was performed to assess the influence of these variables on functional outcome at discharge.

Results

The results reported a significant effect of mBI score at admission (P < 0.0001), age (P < 0.0001), and time from the acute event (P < 0.0001) on mBI score at discharge. Moreover, the disease type (neurologic or orthopedic) adjusted by sex (male or female) and presence of different impairments (cognitive and behavioral impairments) and complications (hypertension and cardiovascular diseases) significantly influenced mBI score at discharge (P < 0.05) (R
2 = 0.497). No significant interactions between other factors were found (P > 0.05).

Conclusion

Several prognostic factors should be considered when planning an appropriate tailored rehabilitation program.
Research on the Effects of a Web-Based System With Oculomotor and Optokinetic Stimuli on Vestibular Rehabilitation
Authors: Ertunc Gulcelik Gonul , Tarakci Devrim , Gedik Soyuyuce Ozlem , Gence Gumus Zeynep , Korkut Nazım , Algun Zeliha Candan
Published: September 2020

Objective

The variety and use of technologies used in vestibular rehabilitation are very limited. The purpose of this study was to investigate the effects of a Web-based system on vestibular rehabilitation in patients with vestibular hypofunction.

Design

A total of 20 patients with unilateral vestibular hypofunction were randomly assigned to two groups. Conventional vestibular rehabilitation was applied to the control group, whereas the study group received treatment with the Web-based system supporting the vestibulo-ocular reflex with oculomotor and optokinetic stimulus (Simulation of Vestibulo-Ocular Reflex Exercises). Vestibular and balance tests, oculomotor level, the Tampa Kinesiophobia Scale, and the Dizziness Handicap Inventory were used to evaluate the treatment’s efficacy.

Results

Vestibular symptoms and findings, balance tests, oculomotor functions, Tampa Kinesiophobia Scale, and Dizziness Handicap Inventory improved significantly in both groups after the interventions (P < 0.05). In the intergroup analysis, improvement was found in eyes closed Romberg, semitandem, and left one-foot position balance tests in favor of the study group (P < 0.05).

Conclusion

The new vestibular technology, Simulation of Vestibulo-Ocular Reflex Exercises, was found to be effective in vestibular rehabilitation.
Room of Hazards: An Interprofessional Evaluation of Safety Risks in a Simulated Patient Room
Authors: Wang Melinda , Bilan Victor P. , McCullough Megan , Banda Barbara , Merchant Naseema B. , Rodwin Benjamin A.
Published: September 2020

Objectives

Approximately 3.7% of patients experience adverse events in health care facilities, many of which are preventable. Patient safety requires effective training and an interprofessional culture of safety, but few studies compare the safety skills of different hospital professions. We sought to assess skills in safety hazards identification among staff from different health care disciplines with a pilot study.

Methods

An exercise with a simulated room of an inpatient ward with a patient mannequin in a hospital bed with 34-intentionally planted safety hazards was set up. Health care staff members from various professions walked around the room and independently documented observed safety hazards. Identified hazards were separated based on staff disciplines, grouped into 5 categories (patient, medications, equipment, environment, care processes), and analyzed using analysis of variance. Because participants identified more hazards than the 34 intentionally planted hazards, these were analyzed separately.

Results

The study included 111 staff: nurses (n = 68), nursing students (n = 5), medical students (n = 3), physicians (n = 11), social workers (n = 5), pharmacists (n = 6), certified nursing assistants (n = 9), and psychologists (n = 4). There were significant differences among professions in the following categories: medications, equipment, and total number of safety hazards (P < 0.05 for all). Nurses found more intended equipment hazards than did social workers (38.8% versus 4.4%, P < 0.001), pharmacists (38.8% versus 11.1%, P = 0.004), medical students (38.8% versus 7.4%, P = 0.021), and psychologists (38.8% versus 8.3%, P = 0.001) and more medication hazards than nursing students (20.3% versus 16.7%, P = 0.008), whereas certified nursing assistants also found more equipment hazards than did social workers (25.9% versus 4.4%, P = 0.016).

Conclusions

There were significant differences in patterns of safety hazards identified among health care professions, with nurses identifying more hazards than several other professions. This finding suggests that each health care profession’s unique training and responsibilities result in varying ability to identify safety hazards and that interdisciplinary safety teams may be more effective than those from only a single profession. Our study provides a starting point to encourage diversification of hospital professions in simulation-based safety trainings, although further work is needed to validate these findings moving forward.
Coronary Artery Fistulas
Authors: Kalisz Kevin , Sanders Alison E. , Avery Ryan , Allen Bradley D.
Published: September 2020

Coronary artery fistulas are uncommon but clinically important entities that may produce symptoms and significant complications such as angina, myocardial infarction, coronary artery aneurysm formation, and congestive heart failure. Multiple fistula types have been recognized, and classification uses factors such as etiology, coronary artery origin, and drainage site. Both invasive and noninvasive imaging play an important role in the management and treatment of these patients, and often times, more than one modality is necessary for comprehensive evaluation of coronary fistulas. Recent advances in both functional and anatomic imaging will likely also play a growing role in fistula evaluation. The purpose of this article is to review the classification, pathophysiology, clinical presentations, imaging findings, treatment, and future imaging directions of coronary artery fistulas.
Safety and Efficacy of the Under-Corrected Frontalis Sling in Myogenic Ptosis Accompanying Extraocular Muscle Paralysis
Authors: Lu Yi , Zhang Yidan , Wu Yu , Sun Jing , Zhou Huifang
Published: September 2020

Objective:

The surgical treatment of myogenic ptosis accompanying extraocular muscle paralysis is an intractable problem in the field of oculoplastic surgery due to the severe complications such as exposure keratopathy. It is promising to find an appropriate procedure to treat this kind of patients, which is able to ensure the safety and efficacy.

Methods:

The authors retrospectively reviewed 12 eyes of 6 patients who underwent the under-corrected “double V-Loop” frontalis suspension sling procedure for myogenic ptosis accompanying extraocular muscle paralysis and access the safety and efficacy of this kind of surgery. All the patients underwent corneal fluorescein staining and confocal microscopy before and after the surgery to inspect the corneal condition. The density of central corneal epithelial cells and endothelial cells were observed.

Results:

After the surgery, the eyelids contour was natural, and the symmetry was achieved in these cases. The average palpebral fissures height changed from 2.75 ± 1.41 mm to 4.50 ± 0.35 mm (P = 0.0007) and margin reflex distance 1 changed from −1.25 ± 1.22 mm to +0.50 ± 0.35 mm (P = 0.0002). Out of 12 operated eyes, mild postoperative lagophthalmos was present in 4 cases but without exposure keratopathy during the follow-up, the confocal microscopy showed that there were no significant differences in central corneal superficial epithelial cells (P = 0.93) and endothelial cells (P = 0.90) before and after the surgery.

Conclusion:

The under-corrected “double V-Loop” frontalis suspension sling is a proper surgery in myogenic ptosis accompanying extraocular muscle paralysis, which leads to a low occurrence of exposure keratopathy, maintains the integrity of the cornea, and remains the patients’ vision function.
Assessment of the Outcome of Calvarial Vault Remodeling and Spring-Mediated Cranioplasty in the Correction of Isolated Sagittal Suture Synostosis
Authors: Hassanein Ahmed Gaber , Fadle Khalid Nasser
Published: September 2020

Background:

Sagittal synostosis is the commonest form of nonsyndromic isolated craniosynostosis. Calvarial vault remodeling (CVR) and spring-mediated cranioplasty (SMC) are the commonly used correction techniques.

Aim of the Work:

To study and compare clinical and radiographic outcomes of CVR and SMC in the correction of isolated sagittal suture synostosis.

Methods:

A prospective cohort with the patients were divided into group; I (SMC) and II (CVR), each 15 patients. They were observed to evaluate the outcome and detect complications.

Results:

Mean operative time was 59.2 minutes in SMC and 184 minutes in CVR. Mean intraoperative blood loss was 26 mL in SMC and 64.7 mL in CVR. Intraoperative complications in SMC were dural tear in 1 patient and superior sagittal sinus injury in another patient, while in CVR 2 patients with dural tears and a 3rd with superior sagittal sinus injury. Postoperative complications in SMC were exposed spring, gaped wound, and parietal eminence elevation, while in CVR 2 patients needed blood transfusion. The mean hospital stays was 1.4 days in SMC and 4.1 days in CVR. In SMC, the relative increase in cephalic index varied between 5.5% and 8.2%, while for CVR, it varied between 5.1% and 7.9%.

Conclusion:

The SMC and CVR are safe procedures, with good long-term results and significant objective changes toward normalization of the skull morphology in isolated sagittal craniosynostosis. The SMC is less invasive and associated with reduced hospital stays, decreased blood loss, and can be performed at a younger age than CVR with a lower morbidity.
The Effect of Bone Morphogenetic Protein-2 on the Irradiated Allogenic Cartilage of Rats
Authors: Kim Kyu Nam , Jeon Dong Nyeok , Kim Young Min , Choi Jong Woo
Published: September 2020

Autogenous cartilage graft is associated with the problem of chondrocyte dedifferentiation. Bone morphogenetic protein-2 (BMP-2) plays an important role in the differentiation and matrix maturation of chondrocytes, and preventing their dedifferentiation.

This study was performed on 48 rats, divided equally into 3 groups. In group I, the xiphoid process cartilage was harvested and irradiated, and broken into 2 pieces. Each piece was implanted on the back. The same process was performed in Groups II and III, but further treated with BMP-2, Group II with 25 μg, and Group III with 50 μg. The implanted cartilage pieces were reharvested at postoperative weeks 2 and 4. The weight change was measured and histological evaluation was performed.

The extent of the weight change was higher in Groups II and III than in Group I. The extracellular matrix between the chondrocytes showed increased in Groups II and III. The fibrous tissue on the surface of the cartilage increased in Groups II and III. Ossification of the chondrocytes was observed in Groups II and III.

The use of BMP-2 increased the matrix between chondrocytes and the fibrous tissue of the cartilage and facilitated the ossification of chondrocytes. The effect of BMP-2 increased with its increasing concentration, and maintenance of its effectiveness over time was confirmed.
Craniofacial Collaboration UK: Developmental Outcomes in 5-Year-Old Children With Sagittal Synostosis
Authors: Care Helen , Kennedy-Williams Patrick , Culshaw Laura , Cunliffe Alexandra , Denly Susie , Horton Jo , Kearney Anna , O’Leary Gemma , Piggott Katie , Pinckston Molly , Rooney Natasha , Wall Steven , Johnson David , Dalton Louise
Published: September 2020

The Craniofacial Collaboration UK (CC-UK) is a joint initiative that seeks to address some of the limitations of previous developmental research with this patient group by providing systematically collected, robust data from clinically and chronologically homogenous representative samples of children. The current paper outlines the developmental outcomes at the age of 5 for children who had previously undergone primary surgery for single-suture sagittal synostosis (SS). It shows broad consistencies with the previous CC-UK work, indicating that the majority of children with SS will perform within the average range compared to peers across a number of developmental, behavioral and emotional domains. However, the group mean for children with SS indicates significantly greater difficulties with fine motor skills and hyperactivity, relative to normative data. Unexpectedly, children with SS had significantly better problem solving skills. While it is reassuring that the majority of children are broadly developing in line with their unaffected peers, these small but significant differences may be early indicators of some of the subtle difficulties documented in older children with craniosynostosis. Longitudinal follow up is therefore important to understand the developmental trajectory for children with SS and identification of potentially ‘at risk’ sub groups within this diagnostic cohort.
Total Cranial Reconstruction for the Treatment of Sagittal Craniosynostosis in Children
Authors: Wang Jing , Yan Qing , He Junping , Gao Zhe , Qiu Dezhi , Zheng Lei , Zhang Xianli , Qian Jing , Wang Gang
Published: September 2020

Objective:

To study the effect of total cranial reconstruction for sagittal synostosis (scaphocephaly) deformity in Chinese children.

Methods:

A retrospective analysis was performed involving 23 children with isolated non-syndromic sagittal synostosis who were treated by total calvarial vault remodeling after 1 year of age from May 2015 to June 2019 in the Department of Neurosurgery, Children's Hospital of Nanjing Medical University. The authors reconstruct patients’ pre- and post-operative cranial thin-section CT scan images and those of the control group. The cephalic index (traditional, normative), intracranial volume, horizontal point of maximum width (H-PMW), vertical point of maximum width (V-PMW), frontal to head height ratio and occipital to head height ratio data were analyzed using a paired t test or Wilcoxon signed-rank test.

Results:

Twenty-three patients met the inclusion criteria, including 19 males and 4 females. The ratio of males to females was 4.7:1. All patients underwent total cranial reconstruction. The average age was 26.52 months (13–48 months), the average operation time was 214.13 minutes (150–265 minutes), and the average amount of suspended erythrocytes was 200 ml (100–400 ml). The cranial morphology of all patients improved significantly after the operation. The traditional cephalic index (pre-operative: 0.70 (0.04); post-operative: 0.78 (0.02)) and normative cephalic index (pre-operative: 0.68 (0.03); post-operative: 0.77 (0.02)) were significantly increased (P < 0.0001). The mean horizontal point of maximum width improved from 0.54 to 0.56 (P = 0.0043), the mean vertical point of maximum width decreased from 0.59 to 0.54 (P = 0.0006), the frontal height decreased from 0.89 to 0.77 (P < 0.0001), and the occipital height improved from 0.78 to 0.88 (P < 0.0001). The intracranial volume increased from 1287.35 to 1426.90 cm3 (P < 0.0001). All of the children had a good skull shape and no recurrence of deformity.

Conclusions:

Total calvarial reconstruction can effectively correct scaphocephaly in Chinese children, expand cranial volume, reduce cranial height, shorten fronto-occipital diameters and enlarge biparietal diameters.
Endoscopic Endonasal Transinfraturbinate Approach With Nasoseptal Window for Removal of the Pterygopalatine Fossa Tumor
Authors: Yamada Hiroki , Toda Masahiro , Abiko Tomohiro , Ozawa Hiroyuki , Ogawa Kaoru , Yoshida Kazunari
Published: September 2020

Recent advances in endoscopic intranasal technology have allowed for a safe approach to the pterygopalatine fossa lesion. However, we consider that there is still scope of improvement to approach a broader area with better operability and minimal invasiveness. A 51-year-old man underwent endoscopic endonasal surgery due to the recurrence of chordoma at the left pterygopalatine fossa. To access the lower and lateral part of the pterygopalatine fossa, we performed endoscopic endonasal transmaxillary removal via an inferior turbinate incision. During surgery, a wide operative field and good operability could be secured by inserting an endoscope from the right nostril through a window of the nasal septum. Subtotal removal of the tumor was achieved without any complication during the surgery. Endoscopic endonasal transinfraturbinate approach with nasoseptal window was effective in the removal of the pterygopalatine fossa tumor because it is less invasive and provides a good surgical view with better operability.
Ossified Encapsulated Cephalhematoma
Authors: Chaisrisawadisuk Sarut , Tiong Hung Bing , Lipsett Jill , Anderson Peter J.
Published: September 2020

Ossified cephalhematoma is a rare congenital condition that may be found if newborn cephalhematoma is not resolved. Here, however, the authors report an exceptional case of an 8-month-old baby presenting with an ossified cephalhematoma in the right parieto-occipital area. Pre-operative imaging showed a calcified subperiosteal hematoma. He underwent hematoma excision with bone contouring procedures. A histopathological study showed hemosiderin-laden macrophages with blood and pseudocyst walls. The authors also discuss the possible pathogenesis of the ossified cephalhematoma and its treatment.
Providing Care for Fatty Liver Disease Patients
Authors: Casler Kelly , Trees Karen , Bosak Kelly
Published: September 2020

The increasing prevalence of nonalcoholic fatty liver disease requires primary care providers to serve on the front lines of care for patients with nonalcoholic fatty liver disease. Knowledge gaps regarding nonalcoholic fatty liver disease exist among primary care physicians, but it is unknown whether primary care nurse practitioners demonstrate similar gaps because they are under-represented in the literature. The purpose of this study was to evaluate primary care nurse practitioners' clinical approaches regarding nonalcoholic fatty liver disease, their knowledge regarding diagnosis and management, and their preparedness level regarding care for patients with nonalcoholic fatty liver disease. Adequate knowledge was demonstrated in some, but not all, areas. The knowledge did not necessarily translate into clinical practice behaviors, however. In addition, only 35% of the participants agreed that they felt prepared to care for patients with nonalcoholic fatty liver disease. Implications are limited by the small sample size but provide some insight into primary care nurse practitioners' preparedness to care for this important epidemic.
Hypothermic Oxygenated Liver Perfusion (HOPE) Prevents Tumor Recurrence in Liver Transplantation From Donation After Circulatory Death
Authors: Mueller Matteo , Kalisvaart Marit , O‘Rourke Joanne , Shetty Shishir , Parente Alessandro , Muller Xavier , Isaac John , Muellhaupt Beat , Muiesan Paolo , Shah Tahir , Clavien Pierre-Alain , Schlegel Andrea , Dutkowski Philipp
Published: September 2020

Objective:

The aim of this study was to investigate tumor recurrence after liver transplantation for hepatocellular carcinoma (HCC), with and without hypothermic oxygenated liver perfusion (HOPE) before transplantation.

Patients and Methods:

We analyzed all liver recipients with HCC, transplanted between January 2012 and September 2019 with donation after circulatory death (DCD) livers after previous end-ischemic HOPE-treatment (n = 70, Center A). Tumor parameters and key confounders were compared to consecutive recipients with HCC, transplanted during the same observation period with an unperfused DBD liver (n = 70). In a next step, we analyzed unperfused DCD (n = 70) and DBD liver recipients (n = 70), transplanted for HCC at an external center (Center B).

Results:

Tumor parameters were not significantly different between HOPE-treated DCD and unperfused DBD liver recipients at Center A. One-third of patients were outside established tumor thresholds, for example, Milan criteria, in both groups. Despite no difference in tumor load, we found a 4-fold higher tumor recurrence rate in unperfused DBD livers (25.7%, 18/70), compared to only 5.7% (n = 4/70) recipients with tumor recurrence in the HOPE-treated DCD cohort (P = 0.002) in Center A. The tumor recurrence rate was also twice higher in unperfused DCD and DBD recipients at the external Center B, despite significant less cases outside Milan. HOPE-treatment of DCD livers resulted therefore in a 5-year tumor-free survival of 92% in HCC recipients, compared to 73%, 82.7%, and 81.2% in patients receiving unperfused DBD or DCD livers, from both centers.

Conclusion:

We suggest that a simple machine liver perfusion approach appears advantageous to protect from HCC recurrence after liver transplantation, despite extended tumor criteria.
Taking Morbidity and Mortality Conferences to a Next Level
Authors: Verhagen Merel J. , de Vos Marit S. , Hamming Jaap F.
Published: September 2020

Objective:

To explore possibilities to improve morbidity and mortality conferences using advancing insights in safety science.

Summary background data:

Mortality and Morbidity conferences (M&M) are the golden practice for case-based learning. While learning from complications is useful, M&M does not meet expectations for system-wide improvement. Resilience engineering principles may be used to improve M&M.

Methods:

After a review of the shortcomings of traditional M&M, resilience engineering principles are explored as a new way to evaluate performance. This led to the development of a new M&M format that also reviews successful outcomes, rather than only complications. This “quality assessment meeting” (QAM) is presented and the first experiences are evaluated using local observations and a survey.

Results:

During the QAM teams evaluate all discharged patients, addressing team resilience in terms of surgeons’ ability to respond to irregularities and to monitor and learn from experiences. The meeting was feasible to implement and well received by the surgical team. Observations reveal that reflection on both complicated and uncomplicated cases strengthened team morale but also triggered reflection on the entire clinical course. The QAM serves as a tool to identify how adapting behavior led to success despite challenging conditions, so that this resilient performance can be supported.

Conclusions:

The resilience engineering concept can be used to adjust M&M, in which learning is focused not only on complications but also on how successful outcomes were achieved despite ever-present challenges. This reveals the actual ratio between successful and unsuccessful outcomes, allowing to learn from both to reinforce safety-enhancing behavior.
Mild Prognostic Impact of Postoperative Complications on Long-term Survival of Perihilar Cholangiocarcinoma
Authors: Kawakatsu Shoji , Ebata Tomoki , Watanabe Nobuyuki , Onoe Shunsuke , Yamaguchi Junpei , Mizuno Takashi , Igami Tsuyoshi , Yokoyama Yukihiro , Matsuo Keitaro , Nagino Masato
Published: September 2020

Objective:

To evaluate the impact of complications on long-term survival in patients with perihilar cholangiocarcinoma.

Background:

Surgical resection for perihilar cholangiocarcinoma is vulnerable to postoperative complications. The prognostic impact of complications in patients with this disease is unknown.

Methods:

The medical records of patients who underwent curative-intent hepatectomy for perihilar cholangiocarcinoma between 2010 and 2017 were reviewed retrospectively. The comprehensive complication index (CCI) was calculated based on all postoperative complications, which were graded by the Clavien-Dindo classification (CDC). Patients were divided into high and low CCI groups by the median score, and survival was compared between the 2 groups.

Results:

Excluding 8 patients who died in hospital, 369 patients were analyzed. The CDC grade was I in 20 (5.4%), II in 108 (29.3%), III in 224 (60.7%), and IV in 17 (4.6%) patients. The CCI increased with increasing CDC grade; the median was 42.9 (range, 15.0–98.9). Overall survival differed significantly between the high (n = 187) and low (n = 182) CCI groups (41.2% vs 47.9% at 5 years; P = 0.041). However, multivariable analyses demonstrated that traditional clinicopathological factors were independent predictors of survival and that the dichotomized CCI was not. In addition, the CCI score as a continuous variable was not an independent prognostic factor for overall survival in the multivariable analyses (hazard ratio per 1 CCI score: 1.00, 95% confidence interval: 0.99–1.01, P = 0.775).

Conclusions:

Cumulative postoperative complications after resection of perihilar cholangiocarcinoma only moderately deteriorate long-term survival, and should not be an argument to deny surgery in this high-risk population.
DNA-PKcs Inhibition Extends Allogeneic Skin Graft Survival
Authors: Harrison David K. , Waldrip Zachary J. , Burdine Lyle , Shalin Sara C. , Burdine Marie Schluterman
Published: September 2020

Background.

Organ transplantation is life-saving and continued investigations into immunologic mechanisms that drive organ rejection are needed to improve immunosuppression therapies and prevent graft failure. DNA-dependent protein kinase catalytic subunit, DNA dependent-protein kinase catalytic subunit (DNA-PKcs), is a critical component of both the cellular and humoral immune responses. In this study, we investigate the contribution of DNA-PKcs to allogeneic skin graft rejection to potentially highlight a novel strategy for inhibiting transplant rejection.

Methods.

Fully MHC mismatched murine allogeneic skin graft studies were performed by transplanting skin from BalbC mice to C57bl6 mice and treating with either vehicle or the DNA-PKcs inhibitor NU7441. Graft rejection, cytokine production, immune cell infiltration, and donor-specific antibody formation were analyzed.

Results.

DNA-PKcs inhibition significantly reduced necrosis and extended graft survival compared with controls (mean survival 14 d versus 9 d, respectively). Inhibition reduced the production of the cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ and the infiltration of CD3+ lymphocytes into grafts. Furthermore, DNA-PKcs inhibition reduced the number of CD19+ B cells and CD19+ CD138+ plasma cells coinciding with a significant reduction in donor-specific antibodies. At a molecular level, we determined that the immunosuppressive effects of DNA-PKcs inhibition were mediated, in part, via inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells signaling through reduced expression of the p65 subunit.

Conclusions.

Our data confirm that DNA-PKcs contributes to allogeneic graft rejection and highlight a novel immunologic function for DNA-PKcs in the regulation of nuclear factor kappa-light-chain-enhancer of activated B cells and concomitant cytokine production.
Cytomegalovirus Infection Downregulates Vitamin D Receptor in Patients Undergoing Hematopoietic Stem Cell Transplantation
Authors: Robak Oliver , Kastner Marie-Theres , Stecher Carmen , Schneider Martina , Andreas Martin , Greinix Hildegard , Kallay Enikö , Honsig Claudia , Steininger Christoph
Published: September 2020

Background.

Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative option for patients with hematologic diseases but is associated with high mortality and morbidity. Cytomegalovirus (CMV) infection is common in HSCT patients and modulates vitamin D metabolism in vitro. We aimed at validating CMV-associated vitamin D metabolism in vivo in HSCT.

Methods.

Patients treated for significant CMV viremia after HSCT were evaluated for CMV load before, during, and after antiviral treatment. RNA was isolated from whole-blood samples to test for regulation of key components of the vitamin D receptor (VDR) pathway during different phases of CMV viremia.

Results.

CMV viremia developed a mean time of 102 (±34) d post-HSCT. Maximum levels of CMV-DNA reached a mean of 5668 (±7257) copies/mL. VDR expression was downregulated to a mean of 64.3% (±42.5%) relative to the VDR expression pre-CMV viremia (P= 0.035) and lagged in recovery following antiviral treatment. Toll-like receptor (TLR) 2 mRNA was upregulated to 225.4% during CMV viremia relative to the expression pre-CMV viremia (P= 0.012) but not TLR6/7/8 and the TLR-adaptor protein MyD88. Levels of 25-OH vitamin D were reduced in all viremic patients (48.0 ± 4.8 versus 25.1 ± 3.7 ng/mL) and were even lower after periods of CMV viremia compared with the control group (48.3 ± 3.5 versus 17.8 ± 1.8 ng/mL;P= 0.008).

Conclusions.

CMV viremia is associated with significant dysregulation of vitamin D metabolism in HSCT patients.
Immediate Postoperative Extubation Decreases Pulmonary Complications in Liver Transplant Patients
Authors: Acho Christine , Morita Yoshihisa , Fernandez Valeria , Safwan Mohamed , Galusca Dragos , Abouljoud Marwan , Yoshida Atsushi , El-Bashir Jaber , Nagai Shunji
Published: September 2020

Background.

Fast-track anesthesia in liver transplantation (LT) has been discussed over the past few decades; however, factors associated with immediate extubation after LT surgery are not well defined. This study aimed to identify predictive factors and examine impacts of immediate extubation on post-LT outcomes.

Methods.

A total of 279 LT patients between January 2014 and May 2017 were included. Primary outcome was immediate extubation after LT. Other postoperative outcomes included reintubation, intensive care unit stay and cost, pulmonary complications within 90 days, and 90-day graft survival. Logistic regression was performed to identify factors that were predictive for immediate extubation. A matched control was used to study immediate extubation effect on the other postoperative outcomes.

Results.

Of these 279 patients, 80 (28.7%) underwent immediate extubation. Patients with anhepatic time >75 minutes and with total intraoperative blood transfusion ≥12 units were less likely to be immediately extubated (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.89; P = 0.02; OR, 0.11; 95% CI, 0.05-0.21; P < 0.001). The multivariable analysis showed immediate extubation significantly decreased the risk of pulmonary complications (OR, 0.34; 95% CI, 0.15-0.77; P = 0.01). According to a matched case-control model (immediate group [n = 72], delayed group [n = 72]), the immediate group had a significantly lower rate of pulmonary complications (11.1% versus 27.8%; P = 0.012). Intensive care unit stay and cost were relatively lower in the immediate group (2 versus 3 d; P = 0.082; $5700 versus $7710; P = 0.11). Reintubation rates (2.8% versus 2.8%; P > 0.9) and 90-day graft survival rates (95.8% versus 98.6%; P = 0.31) were similar.

Conclusions.

Immediate extubation post-LT in appropriate patients is safe and may improve patient outcomes and resource allocation.
Identification of a SARS-like bat coronavirus that shares structural features with the spike glycoprotein receptor-binding domain of SARS-CoV-2
Authors: Fraguas Bringas Conchita , Booth David
Published: September 2020

SARS-CoV-2 is a recently emerged coronavirus that binds angiotensin-converting enzyme 2 (ACE2) for cell entry via its receptor-binding domain (RBD) on a surface-expressed spike glycoprotein. Studies show that despite its similarities to severe acute respiratory syndrome (SARS) coronavirus, there are critical differences in key RBD residues when compared to SARS-CoV-2. Here we present a short in silico study, showing that SARS-like bat coronavirus Rs3367 shares a high conservation with SARS-CoV-2 in important RBD residues for ACE2 binding: SARS-CoV-2’s Phe486, Thr500, Asn501 and Tyr505; implicated in receptor-binding strength and host-range determination. These features were not shared with other studied bat coronaviruses belonging to the betacoronavirus genus, including RaTG13, the closest reported bat coronavirus to SARS-CoV-2’s spike protein. Sequence and phylogeny analyses were followed by the computation of a reliable model of the RBD of SARS-like bat coronavirus Rs3367, which allowed structural insight of the conserved residues. Superimposition of this model on the SARS-CoV-2 ACE2-RBD complex revealed critical ACE2 contacts are also maintained. In addition, residue Asn488Rs3367 interacted with a previously defined pocket on ACE2 composed of Tyr41, Lys353 and Asp355. When compared to available SARS-CoV-2 crystal structure data, Asn501SARS-CoV-2 showed a different interaction with the ACE2 pocket. Taken together, this study offers molecular insights on RBD-receptor interactions with implications for vaccine design.
Roseovarius gahaiensis sp. nov., isolated from Gahai Saline Lake, PR China
Authors: Sun Xia , Wang Fang , Liu Yang , Lu Ying
Published: September 2020

A Gram-stain-negative, aerobic, non-motile and ovoid- to rod-shaped bacterial strain, designated GH877T, was isolated from a water sample of Gahai saline lake in Qaidam Basin,PR China. The isolate grew at 5–45 °C, pH 6.0–9.0 (optima, 37 °C and pH 7.5) and with 0.5–20 % (w/v) NaCl (optimum, 2.0 %). The neighbour-joining phylogenetic tree of 16S rRNA gene sequences showed that strain GH877T belonged to the genus

Roseovarius

, and had highest 16S rRNA gene sequence similarity of 97.7 % to

Roseovarius pacificus

81-2T, followed by

Roseovarius halotolerans

HJ50T (97.5 %) and

Roseovarius litoreus

GSW-M15T (96.8 %). Genome sequencing revealed a genome size of 3 378 519 bp and a G+C content of 59.8 mol %. Up-to-date bacterial core gene set analysis indicated that strain GH877T represents one independent lineage with

R. pacificus

DSM29589T. The average nucleotide identity values of GH877T with

R. pacificus

81-2T and

R. halotolerans

HJ50T are 80.7 and 77.3 %, respectively. In silico DNA–DNA hybridization values between strain GH877T and

R. pacificus

81-2T and

R. halotolerans

HJ50T are 23.2 and 20.0 %, respectively. Q-10 was the predominant respiratory quinone and summed feature 8 (C18  :  1 ω7c and/or C18  :  1 ω6c) and C16  :  0 were the major cellular fatty acids. The polar lipids of strain GH877T consisted of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylcholine and two unidentified phosphoglycolipids. Based on polyphasic taxonomic analysis, strain GH877T is proposed to represent a novel species of the genus

Roseovarius

, for which the name Roseovarius gahaiensis sp. nov. is proposed. (type strain GH877T=CGMCC 1.13971T=KCTC 72576T).
Insights into the unique characteristics of hepatitis C virus genotype 3 revealed by development of a robust sub-genomic DBN3a replicon
Authors: Ward Joseph C. , Bowyer Sebastian , Chen Shucheng , Fernandes Campos Guilherme Rodrigues , Ramirez Santseharay , Bukh Jens , Harris Mark
Published: September 2020

Hepatitis C virus (HCV) is an important human pathogen causing 400 000 chronic liver disease-related deaths annually. Until recently, the majority of laboratory-based investigations into the biology of HCV have focused on the genotype 2 isolate, JFH-1, involving replicons and infectious cell culture systems. However, genotype 2 is one of eight major genotypes of HCV and there is great sequence variation among these genotypes (>30 % nucleotide divergence). In this regard, genotype 3 is the second most common genotype and accounts for 30 % of global HCV cases. Further, genotype 3 is associated with both high levels of inherent resistance to direct-acting antiviral (DAA) therapy, and a more rapid progression to chronic liver diseases. Neither of these two attributes are fully understood, thus robust genotype 3 culture systems to unravel viral replication are required. Here we describe the generation of robust genotype 3 sub-genomic replicons (SGRs) based on the adapted HCV NS3-NS5B replicase from the DBN3a cell culture infectious clone. Such infectious cell culture-adaptive mutations could potentially promote the development of robust SGRs for other HCV strains and genotypes. The novel genotype 3 SGRs have been used both transiently and to establish stable SGR-harbouring cell lines. We show that these resources can be used to investigate aspects of genotype 3 biology, including NS5A function and DAA resistance. They will be useful tools for these studies, circumventing the need to work under the biosafety level 3 (BSL3) containment required in many countries.
An interferon lambda 4-associated variant in the hepatitis C virus RNA polymerase affects viral replication in infected cells
Authors: Bamford Connor G.G. , McLauchlan John
Published: September 2020

Host IFNL4 haplotype status contributes to the development of chronic hepatitis C virus (HCV) infection in individuals who are acutely infected with the virus. In silico studies revealed that specific amino acid variants at multiple sites on the HCV polyprotein correlate with functional single-nucleotide polymorphisms (SNPs) in the IFNL4 locus. Thus, SNPs at the IFNL4 locus may select variants that influence virus replication and thereby the outcome of infection. Here, we examine the most significantly IFNL4-associated amino acid variants that lie in the ‘lambda (L) 2 loop’ of the HCV NS5B RNA polymerase. L2 loop variants were introduced into both sub-genomic replicon and full-length infectious clones of HCV and viral replication was examined in the presence and absence of exogenous IFNλ4. Our data demonstrate that while mutation of the NS5B L2 loop affects replication, individual IFNL4-associated variants have modest but consistent effects on replication in both the presence and absence of IFNλ4. Given the strong genetic association between these variants and IFNL4, these data suggest a nuanced effect of each individual position on viral replication, the combined effect of which might mediate resistance to the effects of IFNλ4.