bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role for antimalarials in the management of COVID-19
Authors: Schrezenmeier Eva V. , Burmester Gerd R. , Eckardt Kai-Uwe , Dörner Thomas 
Published: July 2020

Purpose of review
The current review highlights recent insights into direct antiviral effects by antimalarials against severe acute respiratory syndrome (SARS)-CoV-2 and other viruses and their potential indirect effects on the host by avoiding exaggerated immune responses (reduced cytokine release, Toll-like receptor response, antigen presentation related to lysosomal processing).

Recent findings
Currently, there is a large debate on the use of antimalarials for prophylaxis and treatment of SARS-CoV-2-induced disease based on preclinical in-vitro data, small case series and extrapolation from earlier studies of their effect on intracellular pathogens, including many viruses. Hydroxychloroquine (HCQ) or chloroquine have not demonstrated robust efficacy in prior randomized controlled studies against several other viruses. In-vitro data indicate a reduced viral replication of SARS-CoV-2. Especially immunomodulatory effects of antimalarials might also contribute to a clinical efficacy. For SARS-CoV-2 various large studies will provide answers as to whether antimalarials have a place in prophylaxis or treatment of the acute virus infection with SARS-CoV-2 but compelling data are missing so far.

Summary
In-vitro data provide a theoretical framework for an efficacy of antimalarials in SARS-CoV-2-induced disease but clinical proof is currently missing.
Usefulness of PCR Screening in the Initial Triage of Trauma Patients During COVID-19 Pandemic
Authors: Porcel-Vazquez Juan A. , Andres-Peiro Jose V. , Garcia-Sanchez Yaiza , Guerra-Farfan Ernesto , Mestre-Torres Jaume , Minguell-Monyart Joan , Molero-Garcia Vicente , Selga Marsa Jordi , Tomas-Hernandez Jordi , Villar-Casares Maria del Mar , Bhandari Mohit , Teixidor-Serra Jordi 
Published: July 2020

Background:
Hospitals worldwide have postponed all nonessential surgery during the COVID-19 pandemic, but non-COVID-19 patients are still in urgent need of care. Uncertainty about a patient's COVID-19 status risks infecting health care workers and non-COVID-19 inpatients. We evaluated the use of quantitative reverse transcription polymerase chain reaction (RT-qPCR) screening for COVID-19 on admission for all patients with fractures.

Methods:
We conducted a retrospective cohort study of patients older than 18 years admitted with low-energy fractures who were tested by RT-qPCR for SARS-CoV-2 at any time during hospitalization. Two periods based on the applied testing protocol were defined. During the first period, patients were only tested because of epidemiological criteria or clinical suspicion based on fever, respiratory symptoms, or radiological findings. In the second period, all patients admitted for fracture treatment were screened by RT-qPCR.

Results:
We identified 15 patients in the first period and 42 in the second. In total, 9 (15.8%) patients without clinical or radiological findings tested positive at any moment. Five (33.3%) patients tested positive postoperatively in the first period and 3 (7.1%) in the second period (P = 0.02). For clinically unsuspected patients, postoperative positive detection went from 3 of 15 (20%) during the first period to 2 of 42 (4.8%) in the second (P = 0.11). Clinical symptoms demonstrated high specificity (92.1%) but poor sensitivity (52.6%) for infection detection.

Conclusions:
Symptom-based screening for COVID-19 has shown to be specific but not sensitive. Negative clinical symptoms do not rule out infection. Protocols and separated areas are necessary to treat infected patients. RT-qPCR testing on admission helps minimize the risk of nosocomial and occupational infection.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Acquired Human Papilloma Virus Type 6–Associated Epidermodysplasia Verruciformis in a Patient With Systemic Lupus Erythematosus
Authors: Ferronika Paranita , Sijmons Rolf H. , Febiyanto Novian , Radiono Sunardi , Widodo Irianiwati 
Published: July 2020

Abstract:
Although historically known as a genetic disorder, epidermodysplasia verruciformis (EV) might be acquired in patients with a noninherited defective cell-mediated immunity. This article reports a case of EV in a patient with systemic lupus erythematosus and a history of 3 years immunosuppressive methylprednisolone treatment. The microscopic features of the skin biopsy showed morphologic changes of the keratinocytes characteristic of human papilloma virus (HPV) infections and immunoreactivity to p16. HPV genotyping demonstrated the presence of HPV 6 which belongs to a low-risk mucosal HPV group and has not been reported in EV previously. The clinical recognition of EV in immunocompromised patients and subsequent HPV typing is important because some patients will develop squamous cell carcinoma.
Joseph von Gerlach—A Reminder of One of the Pioneers of Histochemistry on the Occasion of His 200th Birthday
Authors: Weyers Wolfgang 
Published: July 2020

Abstract:
Joseph von Gerlach was an eminent German anatomist and pioneer of histology. He devised various techniques to assess the fine structure of tissues, most notably a procedure of staining histologic sections that marked the beginning of routine staining in histology. Gerlach was also one of the pioneers of microphotography.
Late Sodium Current in Atrial Cardiomyocytes Contributes to the Induced and Spontaneous Atrial Fibrillation in Rabbit Hearts
Authors: Chu Yanpeng , Yang Qiaomei , Ren Lu , Yu Shandong , Liu Zhipei , Chen Ying , Wei Xiaohong , Huang Sihui , Song Lv , Zhang Peihua , Ma Jihua , Wu Lin 
Published: July 2020

Abstract:
Increased late sodium current (INa) induces long QT syndrome 3 with increased risk of atrial fibrillation (AF). The role of atrial late INa in the induction of AF and in the treatment of AF was determined in this study. AF parameters were measured in isolated rabbit hearts exposed to late INa enhancer and inhibitors. Late INa from isolated atrial and ventricular myocytes were measured using whole-cell patch-clamp techniques. We found that induced-AF by programmed S1S2 stimulation and spontaneous episodes of AF were recorded in hearts exposed to either low (0.1–3 nM) or high (3–10 nM) concentrations of ATX-II (n = 10). Prolongations in atrial monophasic action potential duration at 90% completion of repolarization and effective refractory period by ATX-II (0.1–15 nM) were greater in hearts paced at slow than at fast rates (n = 5–10, P < 0.05). Both endogenous and ATX-II-enhanced late INa density were greater in atrial than that in ventricular myocytes (n = 9 and 8, P < 0.05). Eleclazine and ranolazine reduced AF window and AF burden in association with the inhibition of both endogenous and enhanced atrial late INa with half maximal inhibitory concentrations (IC50) of 1.14 and 9.78, and 0.94 and 8.31 μM, respectively. The IC50s for eleclazine and ranolazine to inhibit peak INa were 20.67 and 101.79 μM, respectively, in atrial myocytes. In conclusion, enhanced late INa in atrial myocytes increases the susceptibility for AF. Inhibition of either endogenous or enhanced late INa, with increased atrial potency of drugs is feasible for the treatment of AF.
Obstructive colon cancers at endoscopy are associated with advanced tumor stage and poor patient outcome. A retrospective study on 398 patients
Authors: Abu Baker Fadi , Taher Randa , Ganayem Mohanad , Mari Amir , Oren Gal , Kopelman Yael 
Published: July 2020

Background
The detection of obstructive colorectal cancer (CRC) masses during endoscopic examination hindering the passage of endoscope and precluding complete examination is not uncommon. The significance and implications of this finding on patients’ prognosis and outcomes were not fully investigated and will be addressed in this study.

Methods
In this retrospective cohort study, we reviewed endoscopy, surgery, pathology and oncology reports of patients diagnosed with CRC over a 10-year period (2007–2016). We compared surgical stages, histologic grades and overall survival between patients with subclinical obstructive tumors at endoscopy to those with nonobstructive tumors. We performed multivariate analysis to identify independent risk factors associated with advanced CRC stage at diagnosis.

Results
A total of 144 patients had obstructive colonic tumors while 254 had nonobstructive tumors and constituted the control group. Obstructive CRC group was significantly associated with advanced tumor stage at diagnosis (69 vs. 42%, OR = 3.018, 95% CI, 1.951–4.670; P < 0.01) and had prominently higher rates of moderate to poorly differentiated tumors (64.5 vs. 38.4%; P < 0.001) when compared to non-obstructive controls. Patients with obstructive tumors were significantly associated with decreased five years overall survival (53.4 vs. 67.3% vs.; P < 0.01). Increased overall mortality was observed in survival curves of patients with obstructive tumors along all follow-up periods.

Conclusion
Even in the absence of clinical sequela, obstructive CRC at endoscopic level may be associated with higher stage at diagnosis and reduced overall survival. Further prospective studies are warranted to confirm these findings and address their implication on patients’ management.
Evaluation of hepatitis B vaccine efficacy and factors affecting vaccine nonresponse in patients receiving anti-tumor necrosis factor agents
Authors: Okay Gülay , Biberci Keskin Elmas , Akkoyunlu Yasemin , Bolukcu Sibel , Betül Uslu Ayse , Meric Koc Meliha 
Published: July 2020

Objectives
The response rate of patients to hepatitis B virus (HBV) vaccination receiving anti-tumor necrosis factor (TNF) agents is quite low. We aimed to assess the efficiency of HBV vaccination in patients with chronic inflammatory diseases (CIDs) receiving anti-TNF agents as well as in healthy controls. We also evaluated the impact of different factors on the efficacy of HBV vaccination.

Methods
Patients with CIDs receiving anti-TNF agents and healthy controls vaccinated for HBV were included in the study during 2018–2019. An adequate immune response and an effective immune response to HBV were defined as >10 IU/L and > 100 IU/L, respectively.

Results
Among 274 participants, 187 were patients with CID and 87 were healthy controls. The mean age of the patients with CID (43.9 ± 11.7 years) was significantly higher than that of the healthy controls (31.4 ± 7 years) (P = 0.000). Adequate immune response was 60.8 and 94.3% in patients with CID and healthy controls (P = 0.000), respectively, whereas effective immune response was 37.9 and 75.9% (P = 0.000), respectively. In logistic regression analysis, male sex [odds ratio (OR), 0.408; 95% confidence interval (CI), 0.201–0.830; P = 0.013), use of infliximab (OR, 2.694; 95% CI, 1.203–6.035; P = 0.016) and sertoluzimab (OR, 3.307; 95% CI, 1.287–8.498; P = 0.013), vaccination after anti-TNF treatment (OR, 0.224; 95% CI, 0.083–0.602; P = 0.003) were identified as risk factors of nonresponse to HBV vaccine.

Conclusions
Infliximab and sertoluzimab usage, male sex, and vaccination after anti-TNF treatment were risk factors of nonresponse. HBV vaccination should be given to patients with CID before initiation of anti-TNF treatment and awareness should be spread on this subject.
A Simple Solution for Infractured Lateral Nasal Osteotomy Lines During Revision or Primary Rhinoplasty: Osseos Stabilization With Polydioxanone Sutures
Authors: Yasar Emrah Kagan , Demir Can Ilker , Alagoz Murat Sahin 
Published: July 2020

Abstract
In addition to precautions taken with perioperative surgical techniques, nasal packing and external nasal splinting are frequently employed to ensure the stability of the nasal bones following osteotomies performed during rhinoplasty. However, despite these precautions, nasal bone fragments, generally caused by trauma or healing problems, can approach the midline, progress in a posterior direction and heal with malunion in an infractured manner. Since cavities on the infractured side can result in asymmetries and/or airway narrowing, revision osteotomy is required to correct these problems. Subsequent potential recurrent infractures caused by nasal fragments can easily be prevented with late-absorbed sutures passing through the neighboring holes and opening near the osteotomy lines. This technique would be useful for both primary and secondary rhinoplasty, but especially in secondary rhinoplasty operations. (Level of Evidence: Level IV)
Airflow of the Two-Port Velopharyngeal Closure: Study Using Computational Fluid Dynamics
Authors: Huang Hanyao , Liao Rui , Yin Xing , Chen Nan , Huang Dantong , Yin Heng , Deng Chengdan , Zheng Qian , Shi Bing , Li Jingtao 
Published: July 2020

Abstract
Posterior pharyngeal flap palatoplasty is used to restore the function of velopharyngeal (VP) closure, after which 2 ports remain between the nasal and oral cavity. The authors hypothesized that the airflow dynamics of the upper airway is different in PPF patients compared to health subjects, who only has 1 movable port. Twenty adults who have multislice spiral computed tomography scan were included in this study. Two cylinders (radius, 2.00 mm; height, 4.5 mm) were used to recapitulate the 2-port VP structure after PPF palatoplasty. The areas of ports were modified by changing the radius of 2 cylinders. Real-time computational fluid dynamics simulation was used to capture the airflow velocity and pressures through the 2 ports. The airflow velocity and pressure of upper airway were recorded as the total areas of 2 VP ports increased. The total orifice areas of the 2-port VP closure for 4 VP conditions, including adequate closure, adequate/borderline closure, borderline/inadequate closure, and inadequate closure, were demonstrated. Significant differences between the 2-port VP function for demonstrating PPF reconstruction and the 1-port VP function were found. Airflow dynamics is dependent on the VP structure. The 2-port airflow model for mimicking VP closure after PPF palatoplasty demonstrated airflow characteristics that were significantly different from the 1-port model in normal VP closure.
Learning Curves in Health Professions Education Simulation Research
Authors: Howard Neva M. , Cook David A. , Hatala Rose , Pusic Martin V. 
Published: July 2020

Summary Statement
Learning curves are used in health professions education to graphically represent paths to competence and expertise. However, research using learning curves often omit important information. The authors conducted a systematic review of the reporting quality of learning curves in simulation-based education research to identify specific areas for improvement. Reviewers extracted information on graphical, statistical, and conceptual elements. The authors identified 230 eligible articles. Most learning curve elements were reported infrequently, including use of an optimal linking function, detailed description of feedback or learning intervention, use of advanced visualization techniques such as overlaying and stacking, and depiction of competency thresholds. Reporting did not improve over time for most elements. Reporting of learning curves in health professions education research is incomplete and often underutilizes their desirable properties. Recommendations for improvement of the statistical, graphical, and conceptual reporting of learning curves, as well as applications to simulation research and education, are presented.
Simulation in the Continuing Professional Development of Academic Emergency Physicians
Authors: Forristal Chantal , Russell Evan , McColl Tamara , Petrosoniak Andrew , Thoma Brent , Caners Kyla , Mastoras George , Szulewski Adam , Chaplin Timothy , Huffman James , Woolfrey Karen , Dakin Christa , Hall Andrew K. 
Published: July 2020

Introduction
Simulation is becoming a popular educational modality for physician continuing professional development (CPD). This study sought to characterize how simulation-based CPD (SBCPD) is being used in Canada and what academic emergency physicians (AEPs) desire in an SBCPD program.

Methods
Two national surveys were conducted from March to June 2018. First, the SBCPD Needs Assessment Survey was administered online to all full-time AEPs across 9 Canadian academic emergency medicine (EM) sites. Second, the SBCPD Status Survey was administered by telephone to the department representatives (DRs)—simulation directors or equivalent—at 20 Canadian academic EM sites.

Results
Response rates for the SBCPD Needs Assessment and the SBCPD Status Survey were 40% (252/635) and 100% (20/20) respectively. Sixty percent of Canadian academic EM sites reported using SBCPD, although only 30% reported dedicated funding support. Academic emergency physician responses demonstrated a median annual SBCPD of 3 hours. Reported incentivization for SBCPD participation varied with AEPs reporting less incentivization than DRs. Academic emergency physicians identified time commitments outside of shift, lack of opportunities, and lack of departmental funding as their top barriers to participation, whereas DRs thought AEPs fear of peer judgment and inexperience with simulation were substantial barriers. Content areas of interest for SBCPD were as follows: rare procedures, pediatric resuscitation, and neonatal resuscitation. Lastly, interprofessional involvement in SBCPD was valued by both DRs and AEPs.

Conclusions
Simulation-based CPD programs are becoming common in Canadian academic EM sites. Our findings will guide program coordinators in addressing barriers to participation, selecting content, and determining the frequency of SBCPD events.
The Case of the Inadvertently Triggered Laser
Authors: Cooper Jeffrey B. 
Published: July 2020

Summary Statement
This report describes an historical case example that illustrates how simulation used in investigating adverse events can identify underlying, remediable causes that otherwise may not be discovered. The event involved an operating room fire caused by inadvertent triggering of a laser. Guidelines for action after an adverse event were used to guide the postevent actions. An expert in operating room fires was engaged to conduct the investigation. Recommendations and considerations for conducting such investigations with simulation are offered. Simulation is likely underused for healthcare adverse event investigations; this case example may encourage more widespread application.
Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study
Authors: Fransvea Pietro , Costa Gianluca , Lepre Luca , Podda Mauro , Giordano Alessio , Bellanova Giovanni , Agresta Ferdinando , Marini Pierluigi , Sganga Gabriele 
Published: July 2020

Introduction:
The number of elderly patients requiring emergency surgical intervention has increased dramatically. Perforated peptic ulcer (PPU) complications, such as perforation, have remained relatively stable and associated morbidity remains between 10% and 20%. Advances in perioperative care have greatly improved the outcomes of laparoscopic emergency surgery, allowing increasing numbers of patients, even the elderly, to undergo safe repair. The aim of this study was to evaluate the feasibility, safety, and outcome of laparoscopic gastric repair in the elderly using the database of the FRAILESEL (Frailty and Emergency Surgery in the Elderly) study.

Materials and Methods:
This is a retrospective analysis carried out on data of the FRAILESEL study. Data on all the elderly patients who underwent emergency abdominal surgery for PPU from January 2017 to December 2017 at 36 Italian surgical departments were analyzed. Patients who underwent PPU repair were further divided into a laparoscopic gastroduodenal repair (LGR) cohort and an open gastroduodenal repair (OGR) cohort, and the clinicopathologic features of the patients in both the groups were compared.

Results:
Sixty-seven patients fulfilled the inclusion criteria. Thirty-three patients (47.8%) underwent LGR. The LGR patients had less blood loss and shorter postoperative stay, even if the difference was not statistically significant. The mean operative time was significantively higher in the OGR (OGR 96.5±27.7 vs. LGR 78.6±16.3 P=0.000). The rate of death after laparoscopic surgery was similar to the rate of the open surgery. Multivariate analysis indicated that only age (P=0.018), admission haemoblogbin (Hb) level (P=0.006), platelet count (P=0.16), lactate level (P=0.47), and Mannheim Peritonitis Index (P=0.18) were independent variables associated with the risk of overall mortality.

Conclusions:
LGR is safe and feasible in elderly patients with PPU and it is associated with better perioperative outcomes. However, patient selection and preoperative frailty evaluation in the elderly population are the key to achieving better outcomes.
Thoracoscopic Repair of Esophageal Atresia With Distal Tracheoesophageal Fistula (Type C): Systematic Review
Authors: Iacona Roberta V. , Saxena Amulya K. 
Published: July 2020

Aim:
This systematic review analyzed outcomes in thoracoscopic “primary” repair of type-C esophageal atresia.

Materials and Methods:
The Healthcare Database Advance Search, Embase, Medline, and Cochrane databases in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were researched by 2 independent reviewers. Non-English, mixed procedures (open/thoracoscopic) and staged-repair articles were excluded.

Results:
Between 2000 and 2018, 173 articles were identified of which 14 met the inclusion criteria and 382 neonates analyzed. Lowest reported age and weight were 28 gestational weeks and 830 g, respectively (gestational weeks: 28 to 41 wk; birth weight: 830 to 3960 g), with 136/382 (36%) having associated comorbidities. All procedures were performed in Cuschieri modified decubitus position with 3 ports (3.5 to 5 mm) and 30-degree scopes. Azygos vein sparing approach was reported in 4/14 (28.5%) articles; and if divided 70% preferred sealing/diathermy devices. Preferences for fistula ligation were sutures in 5/13 (38%) articles, clips or hemlock in 4/13 (30.7%), sutures with clips in 4/13 (30.7%) and no data in 1/14. Transanastomotic tubes placement was reported in 9/14 articles (others no data). Chest tube placement was preferred in 9/12 (75%) articles; 3/12 no chest tubes; and 2/14 no data. Intraoperative complications were reported in 9/382 (2.3%) neonates—respiratory instability (5/9), endoclip displacement (2/9), and anastomotic leak requiring conversion (2/9). Conversion to open thoracotomy was reported in 12/14 articles in 37/382 (9.6%) neonates. Postoperative complications were reported in 94/382 (25%); 79/94 (84%) anastomotic strictures, 40/94 (42.5%) anastomotic leaks and 5/94 (5.3%) recurrent fistulation. There were 17/382 (4.4%) lethal outcomes (cardiopulmonary failure, sepsis, and 1 intraoperative tracheal rupture).

Conclusions:
Thoracoscopic “primary” repair of type-C esophageal atresia is feasible in premature/term neonates with a 1:10 conversion rate. Around one third surgeons prefer azygous sparing approach and three fourth placement of chest tubes, but there is no unanimity on the fistula ligation technique. The procedure has morbidity in one fourth patients and 5% mortality.