bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Caregiver Experience After Stroke in a COVID-19 Environment: A Qualitative Study in Inpatient Rehabilitation
Authors: Sutter-Leve Rachel , Passint Emily , Ness Debra , Rindflesch Aaron 
Published: October 2020

Background and Purpose:
Stroke is the leading cause of disability in the United States. Two-thirds of stroke survivors will require caregiver assistance. Evidence suggests the mental health of caregivers is closely related to patients' health outcomes. The timing of this study intersected with the beginning of the coronavirus disease-2019 (COVID-19) pandemic that required strict social distancing and hospital visitor policy changes. This study aims to answer the primary research question: What is the level and nature of stress experienced by caregivers of persons with newly-acquired stroke in the inpatient rehabilitation setting and how has the COVID-19 pandemic impacted the caregiver experience?

Methods:
Recruitment occurred from a single inpatient rehabilitation facility. Participants were administered the Perceived Stress Scale and then completed qualitative semistructured interviews. The investigators used a phenomenological, iterative approach to collect and analyze qualitative data. The data were independently coded and categorized before consolidated into primary themes and subthemes.

Results:
Eleven informal caregivers' perspectives generated 13 subthemes across 4 primary thematic categories: COVID-19 impact, concerns of the caregiver, coping strategies, and important aspects of the caregiver experience. COVID-19 social distancing necessitated new visitor policies, which presented additional challenges for caregivers.

Discussion and Conclusions:
Caregiver attendance at therapy sessions and frequent, direct communication between staff and caregivers improved caregiver readiness for family member discharge following inpatient rehabilitation. This study shared perspectives from a distinctive time during the COVID-19 pandemic. If visitation for multiple therapy sessions is prohibited, we recommend taking alternative measures to keep the caregiver involved in the plan of care.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A326).
Genome-wide association study of high-sensitivity C-reactive protein, D-dimer, and interleukin-6 levels in multiethnic HIV+ cohorts
Authors: Sherman Brad T. , Hu Xiaojun , Singh Kanal , Haine Lillian , Rupert Adam W. , Neaton James D. , Lundgren Jens D. , Imamichi Tomozumi , Chang Weizhong , Lane H. Clifford 
Published: October 2020

Objectives:
Elevated levels of interleukin-6 (IL-6), D-dimer, and C-reactive protein (hsCRP) are associated with increased incidence of comorbid disease and mortality among people living with HIV (PLWH). Prior studies suggest a genetic basis for these biomarker elevations in the general population. The study objectives are to identify the genetic basis for these biomarkers among PLWH.

Methods:
Baseline levels of hsCRP, D-dimer, and IL-6, and single nucleotide polymorphisms (SNPs) were determined for 7768 participants in three HIV treatment trials. Single variant analysis was performed for each biomarker on samples from each of three ethnic groups [African (AFR), Admixed American (AMR), European (EUR)] within each trial including covariates relevant to biomarker levels. For each ethnic group, the results were pooled across trials, then further pooled across ethnicities.

Results:
The transethnic analysis identified three, two, and one known loci associated with hsCRP, D-dimer, and IL-6 levels, respectively, and two novel loci, FGB and GCNT1, associated with D-dimer levels. Lead SNPs exhibited similar effects across ethnicities. Additionally, three novel, ethnic-specific loci were identified: CATSPERG associated with D-dimer in AFR and PROX1-AS1 and TRAPPC9 associated with IL-6 in AFR and AMR, respectively.

Conclusion:
Eleven loci associated with three biomarker levels were identified in PLWH from the three studies including six loci known in the general population and five novel loci associated with D-dimer and IL-6 levels. These findings support the hypothesis that host genetics may partially contribute to chronic inflammation in PLWH and help to identify potential targets for intervention of serious non-AIDS complications.
High-throughput sequencing reveals a high prevalence of pretreatment HIV-1 drug resistance in Sweden
Authors: Andersson Emmi , Ambikan Anoop , Brännström Johanna , Aralaguppe Shambhu G. , Yilmaz Aylin , Albert Jan , Neogi Ujjwal , Sönnerborg Anders 
Published: October 2020

Objectives:
HIV-1 pretreatment drug resistance (PDR) is a global concern. Our aim was to evaluate high-throughput sequencing (HTS) for HIV-1 resistance testing and describe PDR in Sweden, where 75% of diagnosed individuals are foreign-born.

Design:
Cross-sectional study.

Methods:
Individuals entering HIV-1 care in Sweden 2017 to March 2019 (n = 400) were included if a viremic sample was available (n = 220). HTS was performed using an in-house assay. Drug resistance mutations (DRMs) (based on Stanford HIV DB vs. 8.7) at levels 1–5%, 5–19% and at least 20% of the viral population were described. Results from HTS and routine Sanger sequencing were compared.

Results:
HTS was successful in 88% of patients, 92% when viral load was at least 1000 copies/ml. DRMs at any level in protease and/or reverse transcriptase were detected in 95 individuals (49%), whereas DRMs at least 20% in 35 (18%) individuals. DRMs at least 20% correlated well to findings in routine Sanger sequencing. Protease/reverse transcriptase (PR/RT) DRMs at least 20% were predicted by treatment exposure; adjusted OR 9.28 (95% CI 2.24–38.43; P = 0.002) and origin in Asia; adjusted OR 20.65 (95% CI 1.66–256.24; P = 0.02). Nonnucleoside reverse transcriptase inhibitor (NNRTI) DRMs at least 20% were common (16%) and over-represented in individuals originating from sub-Saharan Africa or Asia. Low-level integrase strand transfer inhibitor (INSTI) DRMs less than 20% were detected in 15 individuals (8%) with no association with INSTI exposure.

Conclusion:
Our HTS can efficiently detect PDR and findings of DRMs at least 20% compare well to routine Sanger sequencing. The high prevalence of PDR was because of NNRTI DRMs and associated with migration from areas with emerging PDR.
68Ga-FAPI-04 Accumulation in Myocardial Infarction in a Patient With Neuroendocrine Carcinoma
Authors: Zhu Wenjia , Guo Fan , Wang Yawen , Ding Haiyan , Huo Li 
Published: October 2020

Abstract
We present a case of a 64-year-old man with neuroendocrine carcinoma. Incidental findings were demonstrated on 68Ga-FAPI-04 PET/CT in the inferior wall of left ventricle. A diagnosis of old myocardial infarction was made based on typical electrocardiogram change. Our case suggests that 68Ga-FAPI PET/CT, as a noninvasive method to reflect fibroblast activation, is potentially feasible for assessment of cardiac remodeling after myocardial infarction in a clinical setting.
The Utility of SPECT/CT in Diagnosing Haglund Syndrome With Bone Scintigraphy
Authors: Martineau Patrick , Pelletier-Galarneau Matthieu 
Published: October 2020

Abstract
Haglund syndrome—the combination of Haglund’s deformity, retrocalcaneal bursitis, and achilles tendinopathy—is a common cause of hind foot pain in adults; however, diagnosis on planar scintigraphy can be challenging. We present a case of Haglund syndrome and show the key role that SPECT/CT can play in its diagnosis.
Oligodendroglioma in 68Ga-PSMA-11 and 18F-Fluciclovine PET/CT
Authors: Pernthaler Birgit , Nazerani Hooshmand Tina , Igrec Jasminka , Kvaternik Herbert , Aigner Reingard M. 
Published: October 2020

Abstract
Prostate cancer (PC) is one of the most common cancers affecting men worldwide, with a high recurrence rate after therapy. 68Ga-PSMA-11 and 18F-fluciclovine are PET imaging tracers for the detection of recurrence sites in PC patients. 68Ga-PSMA-11 is a membrane antigen overexpressed by tumor cells, whereas 18F-fluciclovine targets increased amino acid transporter in the membrane of cancer cells. We report a case of an 83-year-old man with known oligodendroglioma and biochemically recurrent PC who shows a high focal 68Ga-PSMA-11 and 18F-fluciclovine uptake in the brain.
Velopharyngeal Incompetence in Children With 22q11.2 Deletion Syndrome: Velar and Pharyngeal Dimensions
Authors: Seselgyte Rimante , Swan Marc C. , Birch Malcolm J. , Kangesu Loshan 
Published: October 2020

Abstract
The surgical management of velopharyngeal incompetence (VPI) in children with 22q11.2 deletion syndrome (22q11.2 DS) is challenging. There are numerous approaches and children often undergo more than one operation. Our aim was to develop a method using images from routine lateral videofluoroscopy to study the dimensions of the velopharynx in this cohort.
We analyzed 22 pre-operative lateral videofluoroscopy recordings of children with 22q11.2 DS and VPI. Fourteen had a submucous cleft palate (SMCP) and 8 had no obvious palatal abnormality but who were subsequently labelled as having an occult submucous cleft palate (OSMCP). The control data were 10 historic records of children with cleft lip and an intact palate. The authors identified key points on radiographs of the velum at rest and when elevated to measure the total velar length, functional velar length and pharyngeal depth and compared them ratiometrically.
The intra-observer reliability was > 0.9 whereas the inter-observer reliability was > 0.74. The velopharyngeal depth/total velar length was significantly greater in 22q11.2 DS than the control group P < 0.001. There was no difference between SMCP and OSMCP patients, P = 0.556. There was no difference in the functional velar length/total velar length between 22q11.2 DS and controls (P = 0.763).
In this study, the authors demonstrate a reliable method to gain useful ratiometric measurements of the velopharynx. This may help with treatment planning. Children with 22q11.2 DS and VPI have a larger velopharyngeal depth/total velar length ratio that may explain some of the difficulty in management.
Craniofacial Anthropometry of Healthy Turkish Young Adults: Analysis of Head and Face
Authors: Bahşi Ilhan , Orhan Mustafa , Kervancioğlu Piraye , Karatepe Şeyma , Sayin Semih 
Published: October 2020

Abstract
The aim of this study was to evaluate the craniofacial anthropometric measurements of Turkish young adults between the ages of 18 and 25. Anterior view and side profile photographs were taken of 100 females and 100 males who volunteered to participate in the study and had no craniofacial anomalies, history of facial trauma, or history of orofacial surgery. Thirteen landmarks on the face and head were chosen, and these landmarks were identified on the photographs. Then, using these landmarks, a total of 19 distance measurements were made, 16 from the anterior view, and 3 from the side profile. There were statistically significant differences between the sexes in 13 parameters: 2 parameters (t-n and ft-ft) being higher in females and 11 parameters (v-n, v-t, t-gn, sn-gn, n-gn, st-gn, sl-gn, fz-fz, z-z, tr-tr and go-go) being higher in males. Also, 7 facial anthropometric ratios were calculated. There were statistically significant differences between the genders in all ratios. The literature reveals that craniofacial anthropometric measurements have been performed on many different populations and that there are numerous differences between the results of the studies conducted. We are of the opinion that the results obtained in this present study will contribute to the literature by helping to determine the standard values for the Turkish population between the ages of 18 and 25, which can be used in diagnosis, treatment and postoperative evaluation in areas such as forensic science, orthodontics, clinical genetics, maxillofacial surgery, and plastic surgery.
Traction Suture Technique for Correction of Caudal Septal Deviation
Authors: Aksakal Ceyhun , Akti Serdar 
Published: October 2020

Objectives:
Correcting the caudal septum deviation is one of the most difficult parts of the septoplasty. The aim of the present study was to evaluate the efficiency and usefulness of traction suture method in caudal septum deviations.

Methods:
Medical records of 35 patients who underwent endonasal septoplasty using traction suture method for caudal septum deviation in August 2017-February 2019 period were studied retrospectively. Preoperative nasal obstruction symptom evaluation (NOSE) scores of the patients were compared with postoperative sixth month NOSE scores. Besides, preoperative nasal examination findings of the patients were compared with the ones in postoperative period.

Results:
Average age of the 35 patients (9 women and 26 men) in the study was 26.3 ± 10.1 years. Postoperative observations revealed that a straight septum was achieved in 31 patients (91.1%). Average pre- and postoperative NOSE scores were 85.1 ± 20.4 and 22.4 ± 4.2, respectively (P < 0.0001). Nasal obstruction was “much improved” in 19 patients (54.2%) and “improved” in 12 (37.1%), while 4 patients (8.6%) reported “no change.” None of the patients developed postoperative complications.

Conclusions:
Traction suture method is a safe, efficient, and useful option to be used by surgeons for caudal septum deviation.
Screen-Based Simulation for Training and Automated Assessment of Teamwork Skills
Authors: Steadman Randolph H. , Huang Yue Ming , Iseli Markus R. , Lee John J. , Tillou Areti , Rudolph Maria D.D. , Lewin Rachel , Koenig Alan D. , Khan Rukhsana , Raia Federica , Smith S. Michael , Juo Yen-Yi , Rice Cameron , Poorsattar Sophia P. , Webb Noreen M. 
Published: October 2020

Introduction
The need for teamwork training is well documented; however, teaching these skills is challenging given the logistics of assembling individual team members together to train in person. We designed 2 modes of screen-based simulation for training teamwork skills to assess whether interactivity with nonplayer characters was necessary for in-game performance gains or for player satisfaction with the experience.

Methods
Mixed, randomized, repeated measures study with licensed healthcare providers block-stratified and randomized to evaluation—participant observes and evaluates the team player in 3 scenarios—and game play—participant is immersed as the leader in the same 3 scenarios. Teamwork construct scores (leadership, communication, situation monitoring, mutual support) from an ontology-based, Bayesian network assessment model were analyzed using mixed randomized repeated measures analyses of variance to compare performance, across scenarios and modes. Learning was measured by pretest and posttest quiz scores. User experience was evaluated using χ2 analyses.

Results
Among 166 recruited and randomized participants, 120 enrolled in the study and 109 had complete data for analysis. Mean composite teamwork Bayesian network scores improved for successive scenarios in both modes, with evaluation scores statistically higher than game play for every teamwork construct and scenario (r = 0.73, P = 0.000). Quiz scores improved from pretest to posttest (P = 0.004), but differences between modes were not significant.

Conclusions
For training teamwork skills using screen-based simulation, interactivity of the player with the nonplayer characters is not necessary for in-game performance gains or for player satisfaction with the experience.
SRY is a Key Mediator of Sexual Dimorphism in Hepatic Ischemia/Reperfusion Injury
Authors: Dong Jian , Ke Meng-Yun , Wu Xiao-Ning , Ding Hong-Fan , Zhang Li-Na , Ma Feng , Liu Xue-Min , Wang Bo , Liu Jian-Lin , Lu Shao-Ying , Wu Rongqian , Pawlik Timothy M. , Lyu Yi , Zhang Xu-Feng 
Published: October 2020

Objectives:
To identify the role and mechanism of a male specific gene, SRY, in I/R-induced hepatic injury.

Background:
Males are more vulnerable to I/R injury than females. However, the mechanism of these sex-based differences remains poorly defined.

Methods:
Clinicopathologic data of patients who underwent hepatic resection were identified from an international multi-institutional database. Liver specific SRY TG mice were generated, and subjected to I/R insult with their littermate WT controls in vivo. In vitro experiments were performed by treating primary hepatocytes from TG and WT mice with hypoxia/reoxygen-ation stimulation.

Results:
Clinical data showed that postoperative aminotransferase level, incidence of overall morbidity and liver failure were markedly higher among 1267 male versus 508 female patients who underwent hepatic resection. SRY was dramatically upregulated during hepatic I/R injury. Overexpression of SRY in male TG mice and ectopic expression of SRY in female TG mice exacerbated liver I/R injury compared with WTs as manifested by increased inflammatory reaction, oxidative stress and cell death in vivo and in vitro. Mechanistically, SRY interacts with Glycogen synthase kinase-3β (GSK-3β) and β-catenin, and promotes phosphorylation and degradation of β-catenin, leading to suppression of the downstream FOXOs, and activation of NF-κBand TLR4 signaling. Furthermore, activation of β-catenin almost completely reversed the SRYoverexpression-mediated exacerbation of hepatic I/R damage.

Conclusions:
SRY is a novel hepatic I/R mediator that promotes hepatic inflammatory reaction, oxidative stress and cell necrosis via inhibiting Wnt/β-catenin signaling, which accounts for the sex-based disparity in hepatic I/R injuries.
Acellular Dermal Matrix Provides Durable Long-Term Outcomes in Abdominal Wall Reconstruction
Authors: Asaad Malke , Kapur Sahil K. , Baumann Donald P. , Liu Jun , Butler Charles E. 
Published: October 2020

Background:
Ventral hernia repair (VHR) is one of the most commonly performed procedures in the United States, but studies assessing the long-term outcomes of VHR using biologic mesh are scarce.

Objective:
We sought to determine the rates of hernia recurrence (HR) and surgical site occurrences (SSOs) in a large cohort of patients who underwent AWR with biologic mesh.

Methods:
We conducted a retrospective cohort study of patients who underwent AWR using either porcine ADM (PADM) or bovine ADM (BADM) from 2005 to 2019. We analyzed the full cohort and a subset of our population with minimum long-term follow-up (LTF) of 5 years. The primary outcome measure was HR. Secondary outcomes were SSOs.

Results:
We identified a total of 725 AWRs (49.5% PADM, 50.5% BADM). Mean age was 69 ± 11.5 years and mean body mass index was 31 ± 7 kg/m2. Forty-two percent of the defects were clean at the time of AWR, 44% were clean-contaminated, and 14% were contaminated/infected. Mean defect size was 180 ± 174 cm2, mean mesh size was 414 ± 203 cm2. Hernia recurred in 93 patients (13%), with cumulative HR rates of 4.9%, 13.5%, 17.3%, and 18.8% at 1, 3, 5, and 7 years, respectively. There were no differences in HR (P = 0.83) and SSO (P = 0.87) between the 2 mesh types. SSOs were identified in 27% of patients. In our LTF group (n = 162), the HR rate was 16%. Obesity, bridged repair, and concurrent stoma presence/creation were independent predictors of HR; component separation was protective against HR.

Conclusions:
Despite its use in complex AWR, ADM provides durable long-term outcomes with relatively low recurrence rates.
Results of COVID-minimal Surgical Pathway During Surge-phase of COVID-19 Pandemic
Authors: Boffa Daniel J. , Judson Benjamin L. , Billingsley Kevin G. , Del Rossi Erin , Hindinger Kasey , Walters Samantha , Ermer Theresa , Ratner Elena , Mitchell Marci R. , Laurans Maxwell S. , Johnson Dirk C. , Yoo Peter S. , Morton John M. , Zurich Holly B. , Davis Kimberly , Ahuja Nita 
Published: October 2020

Objective:
The outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic.

Summary of Background Data:
Crucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a “COVID-minimal pathway” was created.

Methods:
Patients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The “COVID-minimal surgical pathway” consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections.

Results:
After implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56–79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1–6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection.

Conclusions:
A COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.
Biliary Stricture After Necrotizing Pancreatitis
Authors: Maatman Thomas K. , Ceppa Eugene P. , Fogel Evan L. , Easier Jeffrey J. , Gromski Mark A. , House Michael G. , Nakeeb Attila , Schmidt C. Max , Sherman Stuart , Zyromski Nicholas J. 
Published: October 2020

Objective:
Biliary stricture in necrotizing pancreatitis (NP) has not been systematically categorized; therefore, we sought to define the incidence and natural history of biliary stricture caused by NP.

Summary of Background Data:
Benign biliary stricture occurs secondary to bile duct injury, anastomotic narrowing, or chronic inflammation and fibrosis. The profound locoregional inflammatory response of NP creates challenging biliary strictures.

Methods:
NP patients treated between 2005 and 2019 were reviewed. Biliary stricture was identified on cholangiography as narrowing of the extrahepatic biliary tree to <75% of the diameter of the unaffected duct. Biliary stricture risk factors and outcomes were evaluated.

Results:
Among 743 NP patients, 64 died, 13 were lost to follow-up; therefore, a total of 666 patients were included in the final cohort. Biliary stricture developed in 108 (16%) patients. Mean follow up was 3.5 ± 3.3 years. Median time from NP onset to biliary stricture diagnosis was 4.2 months (interquartile range, 1.8 to 10.9). Presentation was commonly clinical or biochemical jaundice, n = 30 (28%) each. Risk factors for stricture development were splanchnic vein thrombosis and pancreatic head parenchymal necrosis. Median time to stricture resolution was 6.0 months after onset (2.8 to 9.8). A mean of 3.3 ± 2.3 procedures were performed. Surgical intervention was required in 22 (20%) patients. Endoscopic treatment failed in 17% (17/99) of patients and was not associated with stricture length. Operative treatment of biliary stricture was more likely in patients with infected necrosis or NP disease duration ≥6 months.

Conclusion:
Biliary stricture occurs frequently after NP and is associated with splanchnic vein thrombosis and pancreatic head necrosis. Surgical correction was performed in 20%.