bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycetoma caused byMicroascus gracilis:a novel agent of human eumycetoma in Sudan
Authors: Mhmoud Najwa A , Siddig Emmanuel Edwar , Nyuykonge Bertrand , Bakhiet Sahar Mubarak , van de Sande Wendy W J , Fahal Ahmed Hassan 
Published: January 2021

AbstractSpecies of the genus Microascus are uncommon agents of human diseases despite their ubiquitous presence in the environment. In this communication, the first case of white grain eumycetoma caused by the fungus Microascus gracilis is reported. The patient was initially misdiagnosed as having actinomycetoma based on the grains morphological and cytological features and was treated with antimicrobial therapy with no clinical improvement. She underwent wide local surgical excision to improve the response to medical treatment and further grain cultural, molecular and taxonomy techniques were conducted and the diagnosis of mycetoma due to M. gracilis was established. The antifungal susceptibilities of this isolate to nine drugs were tested in vitro and they showed poor activity. Combination therapy with surgery and itraconazole led to complete recovery. A medical literature search revealed no previous report on M. gracilis as a causative agent of eumycetoma and hence we are reporting this new causative agent of human eumycetoma. Also, the difficulty in the management of this patient emphasizes the need for accurate and appropriate diagnostic tests for the identification of mycetoma-causative organisms and thus proper management.
One hundred and sixty years of taxonomic confusion resolved:Belonocnema(Hymenoptera: Cynipidae: Cynipini) gall wasps associated with live oaks in the USA
Authors: Zhang Y Miles , Egan Scott P , Driscoe Amanda L , Ott James R 
Published: January 2021

AbstractGall wasps (Hymenoptera: Cynipidae) in the genus Belonocnema induce galls on live oaks (Quercus series Virentes), forming multilocular root galls in the sexual generation and unilocular leaf galls in the asexual generation. Using morphological characters, host records, museum specimens, flight propensity and phylogenetic analysis of published cytochrome c oxidase subunit I (COI) and nuclear SNP data, we resolve the long-standing taxonomic confusion within Belonocnema and recognize three distinct species that are distributed throughout the southern and south-eastern USA: B. fossoria (rev. stat.), B. kinseyi (rev. stat.) and B. treatae, while B. quercusvirens is treated as species inquirenda. The presence of mitonuclear discordance results in the failure of a mitochondrial DNA barcode region to distinguish between B. fossoria and B. treatae, while recognizing B. kinseyi, despite the three species being clearly separated based on morphology and phylogenetic analysis of SNP data. We provide re-descriptions and an updated dichotomous key for both asexual and sexual generations of these widespread species. Finally, as Belonocnema has emerged as a model organism for ecological and evolutionary studies, we clarify the species examined in published studies to date.
Performance Change in Treating Tobacco Addiction: An Online, Interprofessional, Facilitated Continuing Education Course (TEACH) Evaluation at Moore's Level 5
Authors: Ivanova Anna , Baliunas Dolly , Ahad Sheleza , Tanzini Elise , Dragonetti Rosa , Fahim Myra , Selby Peter 
Published: January 2021

Introduction:
Continuing education is essential to build capacity among health care providers (HCPs) to treat people with tobacco addiction. Online, interprofessional training programs are valuable; however, interpretation and comparison of outcomes remain challenging because of inconsistent use of evaluation frameworks. In this study, we used level 5 of Moore's evaluation framework to examine whether an online training program in intensive tobacco cessation counseling achieved sustained performance change among HCPs across multiple health disciplines.

Methods:
The evaluation sample included 62 HCPs with direct clinical duties, who completed the online Training Enhancement in Applied Counseling and Health (TEACH) Core Course in 2015 and 2016. We compared self-reported changes in cessation counseling and clinical practices across eight core competencies from baseline to 6-month follow-up using McNemar's tests and descriptive analyses.

Results:
Compared with baseline, significantly more HCPs reported providing cessation counseling at 6-month follow-up (44% versus 81%, P < .001). HCPs also reported significant increases in engagement in six of the eight core competencies.

Discussion:
Online training in intensive tobacco cessation treatment can result in sustained performance improvement at 6 months. However, availability of resources and clinical context may influence the extent to which HCPs are able to implement their learned skills. Furthermore, continuing education programs should consider the use of consistent evaluation frameworks to promote cross program comparisons.
Use of the Omental Free Flap for Treatment of Chronic Anterior Skull Base Infections
Authors: Kokosis George , Vorstenbosch Joshua , Lombardi Arianna , Shamsunder Meghana G. , Mehrara Babak , Hespe Geoffrey E. , Wang Laura , Brennan Cameron W. , Ganly Ian , Matros Evan 
Published: January 2021

Summary:
Chronic complications following anterior cranial fossa tumor extirpation, such as cerebrospinal fluid leak, meningitis, mucocele, pneumocephalus, and abscess, negatively impact patient quality of life. Robust vascularized tissue is generally required to adequately reconstruct and obliterate this complex geometric space. The aim of this study was to describe outcomes and advantages of the omental flap for these defects. Following institutional review board approval, a prospective, reconstructive database was reviewed from 2011 to 2020. Four patients with chronic anterior skull base complications treated with omental flap reconstruction were identified, with chart reviews performed. Median time from the index operation until the complication ultimately required a free omental transfer was 7.3 years. All patients underwent adjuvant radiation with the indications for surgery, including cerebral abscess, recurrent meningitis, osteomyelitis, and pneumocephalus. All free flaps survived without any need for revision. There were no donor site complications. One patient had delayed healing at an adjacent nasal wound that healed secondarily. At a median follow-up of 19.4 months, none of the patients had recurrent infections. The omental free flap has a number of properties, which make it ideally suitable for anterior skull base defects. Its malleable nature combined with the presence of multiple vascular arcades enable flexibility in flap design to contour to the crevices of 3-dimensional skull base defects. Although other free flaps are available to the plastic surgeon, the versatility and reliability of the omentum make it a first-line consideration for anterior skull base reconstruction.
Analysis of Vascular Anatomy in Inferiorly Based Gastrocnemius Muscle Flaps in Japanese Individuals Using a Cadaver Study
Authors: Ebisudani Shogo , Inagawa Kiichi , Suzuki Yoshinori , Osugi Ikuko 
Published: January 2021

Background:
Inferiorly based gastrocnemius muscle flaps have been successfully used to cover soft tissue defects of the middle third of the leg. This is done especially in older patients or patients with major complications where operative time should be limited. We aimed to determine the gastrocnemius muscle length that can be safely used for preparing inferiorly based muscle flaps.

Methods:
We performed angiographies and dissection to investigate the numbers and distribution of the communicating arterial branches between the medial and lateral heads of the gastrocnemius muscle, and the perforating arterial branches of the medial sural artery from the soleus to the gastrocnemius muscles on 18 legs of preserved cadavers.

Results:
The lengths of the gastrocnemius heads were approximately 10 cm, and the communicating arterial branches of the gastrocnemius muscle also were located at approximately 10 cm from the gastrocnemius head. The perforating arterial branches from the soleus muscle to the gastrocnemius muscle were also located at approximately 10 cm from the gastrocnemius head.

Conclusions:
Communicating arterial branches of the gastrocnemius muscle were found in all cadavers. To the best of our knowledge, no other study has focused on investigating the perforating arterial branches that supply the gastrocnemius from the soleus muscle. Our study indicates that the entire gastrocnemius muscle can be safely used in reconstruction surgeries.
Intraoperative Utility of the Implantable Doppler in Lower Extremity Reconstruction: A Matched Case-control Study
Authors: Abdou Salma A. , Sharif-Askary Banafsheh , Zolper Elizabeth G. , Evans Karen K. 
Published: January 2021

Background:
Patients with diabetes mellitus and peripheral vascular disease have high rates of thrombogenic vessels. The implantable (Cook) Doppler in lower extremity reconstruction can optimize microsurgical outcomes in this population.

Methods:
Patients undergoing lower extremity free flap reconstruction who did not have an implantable Doppler probe placed were matched with patients who received an implantable Doppler probe. Groups were matched based on wound location, history of peripheral vascular disease, number of vessel runoffs, and number of venous anastomoses and postoperative outcomes compared.

Results:
Thirty patients were included: 15 in the control group and 15 in the implantable Doppler group. Mean age was 60.2 ±10.2 years, and mean BMI was 28.7 ± 5.0 kg/m2. There was a high prevalence of diabetes mellitus (13; 43.3%) and peripheral vascular disease (4; 13.3%). Takebacks due to vascular compromise were significantly higher in the control than in the implantable Doppler group (26.7% versus 0.0%, P = 0.032). Among flaps that required takeback to the operating room, the majority were muscle-based without a skin paddle (75.0%). Vascular compromise was due to arterial insufficiency in 2 cases and venous thrombosis in 1 case. The salvage rate among the takebacks of the non-implantable Doppler group was 0.0%, resulting in a 26.7% flap failure rate in the non-implantable Doppler group when compared with 0.0% flap loss in the implantable Doppler group (P = 0.032).

Conclusion:
The implantable Doppler probe optimizes flap inset intraoperatively in lower extremity free flap reconstruction and can significantly decrease takebacks due to vascular complications, thereby increasing flap success.
Violence by Persons with Serious Mental Illness Toward Family Caregivers and Other Relatives: A Review
Authors: Labrum Travis , Zingman Michael A. , Nossel Ilana , Dixon Lisa 
Published: January 2021

Abstract
Persons living with serious mental illness (SMI) are at a modestly increased risk of committing violence and are disproportionately likely to target family members when they do commit violence. In this article, we review available evidence regarding violence by persons with SMI toward family members, many of whom are caregivers. Evidence suggests that a sizable minority of family members with high levels of contact with persons with SMI have experienced violence, with most studies finding rates of past year victimization to be 20% or higher. Notable risk factors for family violence pertaining specifically to persons with SMI include substance use, nonadherence to medications and mental health treatment, history of violent behavior, and recent victimization. Notable risk factors pertaining specifically to the relationships between persons with SMI and family members include persons with SMI relying on family members for tangible and instrumental support, family members setting limits, and the presence of criticism, hostility, and verbal aggression. As described in qualitative studies, family members often perceive violence to be connected to psychiatric symptoms and inadequate treatment experiences. We argue that promising strategies for preventing violence by persons with SMI toward family members include (1) better engaging persons with SMI in treatment, through offering more recovery-oriented care, (2) strengthening support services for persons with SMI that could reduce reliance on family members, and (3) supporting the capabilities of family members to prevent and manage family conflict. The available interventions that may be effective in this context include McFarlane’s Multifamily Group intervention and the Family-to-Family educational program.
QUANTITATIVE ANALYSIS OF CHORIOCAPILLARIS ALTERATIONS IN SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN DIABETIC PATIENTS
Authors: Loria Olivier , Kodjikian Laurent , Denis Philippe , Vartin Christine , Dimassi Sarra , Gervolino Lucas , Maignan Antoine , Kermarrec Ronan , Chambard Claudine , Pradat Pierre , Mathis Thibaud 
Published: January 2021

Purpose:
To evaluate quantitative alterations of the choriocapillaris in swept-source optical coherence tomography angiography in diabetic patients.

Methods:
We included normal patients and diabetic patients with and without diabetic retinopathy (DR), excluding patients with macular edema. Angiograms in 3 × 3 mm were acquired with Plexelite 9000 swept-source optical coherence tomography angiography. Choroidal flow voids were analyzed after removal of projection artifacts. The main evaluation was the correlation between choroidal flow voids area (FVA-CC) and DR stage.

Results:
A total of 120 eyes of 72 patients were analyzed. There were 17 eyes from healthy subjects, 30 eyes without DR, 22 eyes with minimal nonproliferative DR, 30 eyes with moderate nonproliferative DR, 16 eyes with severe nonproliferative DR, and 5 eyes with proliferative DR (PDR). The percentage of FVA-CC for each group was, respectively, 10.9 ± 3.4%, 14.6 ± 4.8%, 17.6 ± 3.5%, 20.7 ± 5.9%, 19.9 ± 2.9%, and 26.6 ± 4.4%. FVA-CC and DR stage significantly correlated (P < 0.0001). FVA-CC was significantly increased in diabetic patients without DR compared with healthy subjects (P = 0.008).

Conclusion:
Diabetes is associated with quantifiable choriocapillaris alterations in swept-source optical coherence tomography angiography. These alterations precede clinical signs of DR and are correlated with DR stage.
Anxiety Symptoms After Orthopedic Injury: A Systematic Review
Authors: Breazeale Stephen , Conley Samantha , Gaiser Edward , Redeker Nancy S. 
Published: January 2021

Background:
Millions of Americans are injured each year, with 75% suffering orthopedic injuries. Those with orthopedic injury often experience postinjury symptoms, such as anxiety, that negatively influence long-term outcomes. The purpose of this systematic review was to evaluate (1) the prevalence of anxiety symptoms chronologically in relation to time of orthopedic injury, (2) the associations of anxiety symptoms with other symptoms in individuals with orthopedic injury, and (3) the associations between anxiety symptoms and functional performance and mental health outcomes in individuals with orthopedic injury.

Methods:
The databases CINAHL, Ovid MEDLINE, Ovid PsycInfo, Ovid Embase, ProQuest, and ClinicalTrials.gov were searched on June 25, 2020. Studies were selected for review if (1) participants were 16 years or older, (2) the prevalence of anxiety symptoms was listed, (3) anxiety symptoms were assessed using a validated instrument, (4) the study was published in English, and (5) more than 50% of the participants suffered orthopedic injury to the appendicular skeleton or pelvic ring.

Results:
Anxiety symptoms were present in 11.5%–55.9% of individuals up to 10 years after orthopedic injury and often co-occurred with those of depression, pain, and posttraumatic stress disorder to negatively influence functional performance and mental health outcomes.

Conclusions:
Anxiety symptoms post-orthopedic injury are highly prevalent and persistent. Anxiety symptoms are associated with other distressing symptoms and influence long-term outcomes. These findings highlight the need to screen for and treat anxiety symptoms following orthopedic injury and may help in designing future self-management interventions.
New strategies to optimize renal haemodynamics
Authors: Suarez Jonathan , Busse Laurence W. 
Published: January 2021

Purpose of review
This review discusses the macrocirculatory and microcirculatory aspects of renal perfusion, as well as novel methods by which to measure renal blood flow. Finally, therapeutic options are briefly discussed, including renal-specific microcirculatory effects.

Recent findings
The optimal mean arterial pressure (MAP) needed for preservation of renal function has been debated but is most likely a MAP of 60–80 mmHg. In addition, attention should be paid to renal outflow pressure, typically central venous pressure. Heterogeneity in microcirculation can exist and may be mitigated through appropriate use of vasopressors with unique microcirculatory effects. Excessive catecholamines have been shown to be harmful and should be avoided. Both angiotensin II and vasopressin may improve glomerular flow through a number of mechanisms. Macrocirculatory and microcirculatory blood flow can be measured through a number of bedside ultrasound modalities, sublingual microscopy and urinary oxygen measurement,

Summary
Acute kidney injury (AKI) is a common manifestation of organ failure in shock, and avoidance of hemodynamic instability can mitigate this risk. Measurement of renal haemodynamics is not routinely performed but may help to guide therapeutic goals. A thorough understanding of pathophysiology, measurement techniques and therapeutic options may allow for a personalized approach to blood pressure management in patients with septic shock and may ultimately mitigate AKI.
Evaluation and management of the surgical abdomen
Authors: Bradley Nori L. , Garraway Naisan 
Published: January 2021

Purpose of review
The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill.

Recent findings
Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Further evidence supports intravenous contrast during CT scan in critically ill patients with acute kidney injury. Outcomes for acute mesenteric ischemia have failed to improve over time; however, increasing use of endovascular approaches, including catheter-directed thrombolysis, may decrease need for laparotomy in the appropriate patient. Nonocclusive mesenteric ischemia remains a challenging diagnostic and management dilemma. Acalculous cholecystitis is managed with a percutaneous cholecystostomy and is unlikely to require interval cholecystectomy. Surgeon comfort with intervention based on point-of-care ultrasound for biliary disease is variable. Mortality for toxic megacolon is decreasing.

Summary
Physical examination remains an integral part of the evaluation of the surgical abdomen. Interpreting laboratory investigations in context and appropriate imaging improves diagnostic ability; intravenous contrast should not be withheld for critically ill patients with acute kidney injury. Surgical intervention should not be delayed for the patient in extremis. The intensivist and surgeon should remain in close communication to optimize care.
Impact of Demographic, Clinical and Psychosocial Variables on Drug Adherence and Outcomes in Indian Patients With Inflammatory Bowel Disease
Authors: Banerjee Rupa , Pal Partha , Adigopula Bhargavi , Reddy Duvvuru Nageshwar 
Published: January 2021

Background and Aims:
Barriers to drug adherence in the developing world are multifactorial and under evaluated. We aimed to evaluate predictive factors of medication adherence in Indian patients with inflammatory bowel disease (IBD) and association of adherence with quality of life (QOL) and relapse free remission.

Materials and Methods:
Adherence was assessed in consecutive IBD patients using a self-administered survey questionnaire including Morisky Medication Adherence Scale together with interview and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) to assess QOL. Logistic regression analysis was used to identify variables correlating with adherence, Cox proportional hazards method used for variables associated with relapse and Kaplan-Meier survival curve used for comparing relapse free remission in adherent and nonadherent.

Results:
A total of 467 consecutive outpatients (279 ulcerative colitis, 188 Crohn’s disease, mean age 38.6 y) were mostly on mesalazine 439 (94%) or thiopurines 213 (46%). Self-reported nonadherence was noted in 236/467 (51%). Disease remission was associated with medication adherence [P=0.003, odds ratio (OR): 1.75, 95% confidence interval (CI): 1.21-2.52]. Medication-related factors like high dosing frequency (>3/d) (OR: 0.39, P=0.005) and concomitant non-IBD medications (OR: 0.44, P=0.007) were associated with nonadherence. Psychosocial factors associated with nonadherence were lack of drug information (OR: 0.30, P<0.001), feeling depressed (OR: 0.43, P<0.001), comorbidities (OR: 0.47, P=0.005), doubts about efficacy (OR: 0.49, P=0.001) and perceived poor QOL (OR: 0.61, P=0.01). High-cost perception was associated with nonadherence in univariate analysis (OR: 0.47, P<0.001) but lost significance on multivariate analysis (OR: 0.68, P=0.07). Physician imparting disease information (OR: 2.5, P=0.14) and physician reinforcement (OR: 1.8, P=0.049) were associated with adherence.
Adherence was associated with improved QOL (SIBDQ, R=0.724). Nonadherence was associated with >3-fold risk of recurrence within 2 years (hazard ratio: 3.89, 95% CI: 2.74-5.52, P<0.001).

Conclusions:
Nonadherence is common in Indian IBD patients but adherence is associated with improved QoL and lower probability of relapse. Psychosocial and medication-related factors are important determinants of adherence compared with demographic or clinical variables and should be addressed.