bluuebunny/crossref_metadata_2025 huggingface dataset:
Wood dust exposure and risks of nasopharyngeal carcinoma: a meta-analysis
Authors: E Meng , Yin Jinzhu , Jin Wu , Mao Yiyang , Wu Qihong , Qiu Jun
Published: December 2019

Background

Wood dust has been confirmed as one kind of human carcinogen. However, there are inconsistent study results of exploring the relationship of exposure to wood dust and occurrence of nasopharyngeal cancer (NPC). For a greater clarification, the authors systemically reviewed the relevant published articles on the relationship of exposure to wood dust and occurrence of NPC. And meta-analysis was conducted.

Methods

The databases of PubMed, U.S. National Library of Medicine (MEDLINE), Embase and Science Direct were searched for the relevant publications. And Newcastle-Ottawa scale was employed for judging the quality of articles. Random-effect model was utilized for meta-analysis.

Results

Among a total of 583 retrieved items, 10 case–control studies and 1 cohort study were selected. The ratio of maximal/minimal exposure concentration of wood dust yielded a pooled odd ratio (OR) of 2.18 (95% CI = 1.62–2.93, P = 0.063) with a moderate heterogeneity (I2: 43.0%; P = 0.001). And subgroup analysis was performed for such factors as exposure status, exposure population and geographic region. No publishing bias was noted. Exposing to a high concentration of wood dust was positively proportional to occurring risk of NPC.

Conclusion

It hints at the contributing effect of wood dust upon NPC. For eliminating the effects of other confounding factors, larger prospective cohort studies are required for further elucidating the relationship of exposure to wood dust and occurrence of NPC.
An Empirical Examination of Dominant Height Projection Accuracy Using Difference Equation Models
Authors: Wang Mingliang , Montes Cristian R , Bullock Bronson P , Zhao Dehai
Published: December 2019

Site index models developed using the difference equation method, otherwise known as the algebraic difference approach (ADA) along with its generalization (GADA), play an important role in forest growth and yield modeling for operational use. Their projection accuracy tends to be reduced over increasing time intervals, a common modeling phenomenon not yet well understood. In this study, dominant height projections given one single prior observation using three (G)ADA models were examined in relation to pairwise height correlations on an empirical dataset consisting of height remeasurements taken on permanent plots of a second-rotation loblolly pine (Pinus taeda L.) plantation experimental study. The results indicated that the decline in projection accuracy in terms of RMSE or Rp2 (analogical to the coefficient of determination R2) with increasing time intervals is closely associated with the weakening correlations imbedded in distant height remeasurements. The squared coefficient of correlation (ρ2) between paired heights can be set as an upper bound of Rp2 in (G)ADA model prediction of heights conditional on prior observations. An examination of correlation over time interval will be informative of how projection accuracy is likely to change and what the maximal Rp2 might be for any potential (G)ADA model to be developed.
Crustal velocity structure across the Orphan Basin and Orphan Knoll to the continent–ocean transition, offshore Newfoundland, Canada
Authors: Welford J Kim , Dehler Sonya A , Funck Thomas
Published: December 2019

Orphan Basin, a massive deepwater rifted basin off the northeastern coast of Newfoundland, was one of the targets of the 2009 SIGNAL (Seismic Investigations off Greenland, Newfoundland and Labrador) experiment to collect refraction/wide-angle reflection (RWAR) data from the Bonavista Platform, through the Orphan Basin, to the Orphan Knoll, and beyond into oceanic crust. Both the data from an earlier RWAR acquisition and the new data were jointly analysed in order to improve on the earlier velocity model and extend its coverage landward and seaward. The resulting velocity model is characterized by an 8–9-km-thick sedimentary package immediately outboard of the Bonavista Platform, which thins toward the Orphan Knoll and beyond. The shallowest modelled sedimentary layer, interpreted as Paleocene and younger post-rift sediments, does not show significant thickness variations and velocities do not exceed 3.3 km s–1. The second modelled sedimentary layer with laterally variable velocities ranging from 2.3 to 5.3 km s–1, interpreted as Late Cretaceous post-rift sediments, is thickest over an interpreted failed rift. The deepest modelled sedimentary layer consists of laterally variable velocities that do not exceed 5.9 km s–1 and is interpreted as possibly Jurassic to Early Cretaceous syn-rift sediments. The crust beneath the Bonavista Platform is subdivided into an upper (5.4–5.9 km s–1), middle (5.9–6.4 km s–1) and lower crust (6.4–6.9 km s–1). The middle crust is modelled as disappearing beneath the seaward limit of the Bonavista Platform at an interpreted failed rift, only to re-appear 100 km further seaward beneath the central Orphan Basin and extend to the seaward limit of the Orphan Knoll, beyond which the crust can be modelled by just an upper (5.0–6.7 km s–1) and a lower (6.7–7.0 km s–1) crustal layer. Towards land, for the first 450 km of the model, velocities generally follow the globally averaged velocity trend for rifted continental crust, albeit with slightly elevated velocities suggestive of magmatic contributions. At the failed rift, within the continental domain, hyperextended crust is modelled, overlying a limited zone of serpentinized mantle. Seaward of Orphan Knoll, the interpretation for the velocity structure is less definitive but an 80-km-wide continent–ocean transition zone consisting of either transitional embryonic oceanic crust or thinned continental crust overlying serpentinized mantle is proposed. Upper mantle velocities as low as 7.7 km s–1 are modelled beneath the interpreted failed continental rift as well as beneath the continent–ocean transition zone, while the rest of the crustal model is underlain by typical mantle velocities of 8 km s–1. Analysis of extension and thinning factors based on the velocity model reveal that the failed rift experienced hyperextension and should have achieved full crustal embrittlement, consistent with localized mantle serpentinization.
The EVITA framework for evidence-based mental health policy agenda setting in low- and middle-income countries
Authors: Votruba Nicole , Grant Jonathan , Thornicroft Graham
Published: December 2019

The burden of mental illness is excessive, but many countries lack evidence-based policies to improve practice. Mental health research evidence translation into policymaking is a ‘wicked problem’, often failing despite a robust evidence base. In a recent systematic review, we identified a gap in frameworks on agenda setting and actionability, and pragmatic, effective tools to guide action to link research and policy are needed. Responding to this gap, we developed the new EVITA 1.1 (EVIdence To Agenda setting) conceptual framework for mental health research–policy interrelationships in low- and middle-income countries (LMICs). We (1) drafted a provisional framework (EVITA 1.0); (2) validated it for specific applicability to mental health; (3) conducted expert in-depth interviews to (a) validate components and mechanisms and (b) assess intelligibility, functionality, relevance, applicability and effectiveness. To guide interview validation, we developed a simple evaluation framework. (4) Using deductive framework analysis, we coded and identified themes and finalized the framework (EVITA 1.1). Theoretical agenda-setting elements were added, as targeting the policy agenda-setting stage was found to lead to greater policy traction. The framework was validated through expert in-depth interviews (n = 13) and revised. EVITA 1.1 consists of six core components [advocacy coalitions, (en)actors, evidence generators, external influences, intermediaries and political context] and four mechanisms (capacity, catalysts, communication/relationship/partnership building and framing). EVITA 1.1 is novel and unique because it very specifically addresses the mental health research–policy process in LMICs and includes policy agenda setting as a novel, effective mechanism. Based on a thorough methodology, and through its specific design and mechanisms, EVITA has the potential to improve the challenging process of research evidence translation into policy and practice in LMICs and to increase the engagement and capacity of mental health researchers, policy agencies/planners, think tanks, NGOs and others within the mental health research–policy interface. Next, EVITA 1.1 will be empirically tested in a case study.
Generating Functionals for Locally Compact Quantum Groups
Authors: Skalski Adam , Viselter Ami
Published: December 2019

Every symmetric generating functional of a convolution semigroup of states on a locally compact quantum group is shown to admit a dense unital *-subalgebra with core-like properties in its domain. On the other hand we prove that every normalised, symmetric, hermitian conditionally positive functional on a dense *-subalgebra of the unitisation of the universal C$^*$-algebra of a locally compact quantum group, satisfying certain technical conditions, extends in a canonical way to a generating functional. Some consequences of these results are outlined, notably those related to constructing cocycles out of convolution semigroups.
Discordances between molecular assays for rifampicin resistance in Mycobacterium tuberculosis: frequency, mechanisms and clinical impact
Authors: Van Rie Annelies , Whitfield Michael G , De Vos Elise , Scott Lesley , Da Silva Pedro , Hayes Cindy , Heupink Tim H , Sirgel Frederick A , Stevens Wendy , Warren Robin M
Published: December 2019

Background

Molecular assays are endorsed for detection and confirmation of rifampicin-resistant TB. The frequency, causal mechanisms and impact of discordant results between molecular tests are not well understood.

Methods

The prevalence of discordant results was determined by pairwise comparison of molecular test results in a cohort of 749 rifampicin-resistant TB patients in three South African provinces. Culture isolates were sent to a research laboratory for WGS and rifampicin MIC determination. Clinical information was collected through medical file review.

Results

The prevalence of discordances between Xpert MTB/RIF and MTBDRplus was 14.5% (95% CI 10.9%–18.9%), 5.6% (95% CI 2.2%–13.4%) between two consecutive Xpert assays and 4.2% (95% CI 2.2%–7.8%) between two consecutive MTBDRplus assays. Likely mechanisms of discordances were false rifampicin susceptibility on MTBDRplus (due to variants not included in mutant probes or heteroresistance with loss of minor variants in culture), false resistance on molecular assay in rifampicin-susceptible isolates, and human error. The healthcare worker changed the treatment regimen in 33% of patients with discordant results and requested 232 additional molecular tests after a first confirmatory test was performed in 460 patients. A follow-up Xpert assay would give the healthcare worker the ‘true’ rifampicin-resistant TB diagnosis in at least 73% of discordant cases.

Conclusions

The high rate of discordant results between Xpert and MTBDRplus has important implications for the laboratory, clinician and patient. While root causes for discordant result are multiple, a follow-up Xpert assay could guide healthcare workers to the correct treatment in most patients.
Polymorphism in the ovine keratin-associated protein gene KRTAP7-1 and its association with wool characteristics
Authors: Ullah Farman , Jamal Syed M , Ekegbu Ugonna J , Haruna Ishaku L , Zhou Huitong , Hickford Jon G H
Published: December 2019

The keratin-associated proteins (KAPs) are structural components of wool fibers and variation in the genes encoding the KAPs can affect wool traits. In this study, sequence variation in the ovine KAP7-1 gene (KRTAP7-1) was investigated in 222 sheep across 5 different Pakistani breeds and breed crosses. Two previously identified variants (A and B) of the KRTAP7-1 coding sequence were identified. The frequency of the genotypes AA and AB was 76% and 23%, respectively, and that of BB was 1%. The association of sequence variation with various wool traits and measurements included yield (the proportion of greasy fleece weight that is clean fleece), mean staple length (MSL), wool bulk, mean fiber diameter, fiber diameter SD, the coefficient of variation of fiber diameter, medullation, the SD of medullation, the coefficient of variation of medullation, fiber opacity, the SD of opacity, and the coefficient of variation of opacity. Variation in KRTAP7-1 was found to be associated with yield (P = 0.017). The adjusted mean yield of sheep of genotype AA (n = 169) was 79.9 ± 2.72%, while that of genotype AB (n = 51) was 81.9 ± 3.37%. There was also an association between variation in KRTAP7-1 and MSL (P = 0.024), with sheep of genotype AA (n = 169) having an adjusted mean MSL of 47.3 ± 0.57 mm compared with sheep of genotype AB (n = 51, 50.9 ± 0.65 mm). Yield and MSL are both important wool production traits, hence variation in KRTAP7-1 needs to be further investigated in more sheep of differing breed.
Involvement of the chloroplast gene ferredoxin 1 in multiple responses of Nicotiana benthamiana to Potato virus X infection
Authors: Yang Xue , Lu Yuwen , Wang Fang , Chen Ying , Tian Yanzhen , Jiang Liangliang , Peng Jiejun , Zheng Hongying , Lin Lin , Yan Chengqi , Taliansky Michael , MacFarlane Stuart , Wu Yuanhua , Chen Jianping , Yan Fei
Published: December 2019

The chloroplast protein ferredoxin 1 (FD1), with roles in the chloroplast electron transport chain, is known to interact with the coat proteins (CPs) of Tomato mosaic virus and Cucumber mosaic virus. However, our understanding of the roles of FD1 in virus infection remains limited. Here, we report that the Potato virus X (PVX) p25 protein interacts with FD1, whose mRNA and protein levels are reduced by PVX infection or by transient expression of p25. Silencing of FD1 by Tobacco rattle virus-based virus-induced gene silencing (VIGS) promoted the local and systemic infection of plants by PVX. Use of a drop-and-see (DANS) assay and callose staining revealed that the permeability of plasmodesmata (PDs) was increased in FD1-silenced plants together with a consistently reduced level of PD callose deposition. After FD1 silencing, quantitative reverse transcription–real-time PCR (qRT–PCR) analysis and LC-MS revealed these plants to have a low accumulation of the phytohormones abscisic acid (ABA) and salicylic acid (SA), which contributed to the decreased callose deposition at PDs. Overexpression of FD1 in transgenic plants manifested resistance to PVX infection, but the contents of ABA and SA, and the PD callose deposition were not increased in transgenic plants. Overexpression of FD1 interfered with the RNA silencing suppressor function of p25. These results demonstrate that interfering with FD1 function causes abnormal plant hormone-mediated antiviral processes and thus enhances PVX infection.
Pyrifenox, an ergosterol inhibitor, differentially affects Cryptococcus neoformans and Cryptococcus gattii
Authors: Silva Vanessa K A , May Robin C , Rodrigues Marcio L
Published: December 2019

Cryptococcosis is a life-threatening fungal infection. New therapeutic approaches are necessary to combat cryptococcosis, as the currently available therapeutic protocols are expensive and generally result in deleterious side effects. Pyrifenox is an antifungal compound that affects phytopathogens by inhibiting the biosynthesis of ergosterol. In this study, we investigated the effects of pyrifenox on Cryptococcus neoformans and Cryptococcus gattii growth, capsule architecture and export of the major capsule component, glucuroxylomannan (GXM). Pyrifenox inhibited the growth of C. neoformans, but was significantly less effective against C. gattii. The resistance of C. gattii to pyrifenox was associated with the expression of efflux pump genes, particularly AFR1 and AFR2, since mutant cells lacking expression of these genes became sensitive to pyrifenox. Analysis of the cryptococcal capsule by India ink counterstaining, immunofluorescence, and scanning electron microscopy showed that pyrifenox affected capsular dimensions in both species. However, GXM fibers were shorter and uniformly distributed in C. neoformans, whereas in C. gattii the number of fibers was reduced. Pyrifenox-treated C. gattii developed unusually long chains of undivided cells. The secretion of GXM was markedly reduced in both species after treatment with pyrifenox. Altogether, the results indicated that pyrifenox differently affects C. neoformans and C. gattii. In addition, it highlights a potential role for pyrifenox as an inhibitor of GXM export in experimental models involving pathogenic cryptococci.
The disc-like host galaxies of radio-loud narrow-line Seyfert 1s
Authors: Olguín-Iglesias Alejandro , Kotilainen Jari , Chavushyan Vahram
Published: December 2019

Until recently, relativistic jets were ubiquitously found to be launched from giant elliptical galaxies. However, the detection by the Fermi-LAT of γ-ray emission from radio-loud narrow-line Seyfert 1 (RL-NLSy1) galaxies raised doubts on this relation. Here, we morphologically characterize a sample of 29 RL-NLSy1s (including 12 γ-emitters, γ-NLSy1s) in order to find clues on the conditions needed by active galactic nuclei (AGNs) to produce relativistic jets. We use deep near-infrared images from the Nordic Optical Telescope and the ESO VLT to analyse the surface brightness distribution of the galaxies in the sample. We detected 72 per cent of the hosts (24 per cent classified as γ-NLSy1s). Although we cannot rule out that some RL-NLSy1s are hosted by dispersion-supported systems, our findings strongly indicate that RL-NLSy1 hosts are preferentially disc galaxies. 52 per cent of the resolved hosts (77 per cent non-γ-emitters and 20 per cent γ-emitters) show bars with morphological properties (long and weak) consistent with models that promote gas inflows, which might trigger nuclear activity. The extremely red bulges of the γ-NLSy1s, and features that suggest minor mergers in 75 per cent of their hosts, might hint to the necessary conditions for γ-rays to be produced. Among the features that suggest mergers in our sample, we find six galaxies that show offset stellar bulges with respect to their AGNs. When we plot the nuclear versus the bulge magnitude, RL-NLSy1s locate in the low-luminosity end of flat spectrum radio quasars, suggesting a similar accretion mode between these two AGN types.
Monte Carlo simulations of relativistic radiation-mediated shocks: II. photon-starved regime
Authors: Ito Hirotaka , Levinson Amir , Nagataki Shigehiro
Published: December 2019

Radiation-mediated shocks (RMS) play a key role in shaping the early emission observed in many transients. In most cases, e.g. shock breakout in supernovae, llGRBs, and neutron star mergers, the upstream plasma is devoid of radiation, and the photons that ultimately reach the observer are generated predominantly inside and downstream of the shock. Predicting the observed spectrum requires detailed calculations of the shock structure and thermodynamic state that account properly for the shock microphysics. We present results of self-consistent Monte Carlo simulations of photon-starved RMS, which yield the shock structure and emission for a broad range of shock velocities, from subrelativistic (βsh = 0.1) to highly relativistic (Γsh = 20). Our simulations confirm that in relativistic RMS the immediate downstream temperature is regulated by exponential pair creation, ranging from 50 keV at βsh = 0.5–200 keV at Γsh = 20. At lower velocities, the temperature becomes sensitive to the shock velocity, with kT ∼ 0.5 keV at βsh = 0.1. We also confirm that in relativistic shocks the opacity is completely dominated by newly created pairs, which has important implications for the breakout physics. We find the transition to pair dominance to occur at βsh = 0.5 roughly. In all cases examined, the spectrum below the νFν peak has been found to be substantially softer than the Planck distribution. This has important implications for the optical emission in fast and relativistic breakouts, and their detection. The applications to GRB 060218 and GRB 170817A are discussed.
Initial Experience in a Pig Model of Robotic-Assisted Intracranial Arteriovenous Malformation (AVM) Embolization
Authors: Desai Virendra R , Lee Jonathan J , Tomas Johnny , Lumsden Alan , Britz Gavin W
Published: December 2019

BACKGROUND

Robotic assistance for coronary and peripheral vascular pathologies is steadily gaining popularity. However, it has yet to be applied to neurovascular intervention.

OBJECTIVE

To establish the feasibility of the CorPath® GRX robotic-assisted platform (Corindus Inc, Waltham, Massachusetts) for intracranial arteriovenous malformation (AVM) embolization.

METHODS

This robotic system was used to embolize intracranial AVMs (n = 4) in 2 anesthetized pigs, under controlled conditions appropriate for clinical intervention. Initially, a catheter was manually introduced into the common carotid artery (CCA). Then, the robotic system was used to advance the catheter into the ascending pharyngeal artery (APA) towards the rete mirabilis, which was used as a model for an AVM, using 0.014 in guidewires and 2.4F/1.7F microcatheters. After doing a pre-embolization APA run, which demonstrated good visualization of the rete, dimethyl sulfoxide (DMSO) was instilled into the microcatheter. A negative roadmap was then done, and Onyx was used to embolize the rete.

RESULTS

All 4 AVMs were completely obliterated with no complications, including no contrast extravasation, dissection, thrombosis, or other vascular injury.

CONCLUSION

This study is the first to demonstrate the feasibility of a robotic-assisted platform for intracranial AVM embolization.
Altered T cell plasticity favours Th17 cells in early arthritis
Authors: Leipe Jan , Pirronello Fausto , Schulze-Koops Hendrik , Skapenko Alla
Published: December 2019

Objectives

The predominance of differentiated Th17 cells has been implied as a key driver of autoimmune arthritis, including early RA. Because accumulating evidence suggests that Th cell differentiation is a plastic process, we investigated plasticity and underlying molecular mechanisms to address the shift towards the Th17 phenotype in early RA.

Methods

A cohort of 61 patients with early, active, untreated RA and 45 age- and sex-matched healthy controls were studied. Viable in vitro- and in vivo-generated Th1, Th2 and Th17 cells were FACS-sorted and transdifferentiated under Th1-, Th2- or Th17-inducing conditions. The cytokine Th profile of the transdifferentiated cells was assessed by flow cytometry. Th cell-associated cytokine and transcription factor gene loci were analysed by chromatin immunoprecipitation assay and their expression by quantitative real-time PCR.

Results

In vitro-generated Th cells showed substantial plasticity, which was similar between RA and healthy controls, whereas in vivo-derived Th1 and Th2 cells from RA patients demonstrated an enhanced plasticity towards IL-17-expressing phenotypes compared with healthy controls. Further, in vivo-generated Th17 cells from RA patients showed a resistance to transdifferentiate into Th1 or Th2 cells. The serum/glucocorticoid-regulated kinase 1–forkhead box protein O1–IL-23 receptor (SGK1–FOXO1–IL-23R) axis together with increased RORC expression was associated with the predominant Th17 phenotype in early RA.

Conclusions

Our data indicate that in vivo-originated Th subsets are prone to Th17 cell transdifferentiation in early RA, while Th17 cells are resistant to changes in their phenotype. Together, the data imply that an altered plasticity contributes to the Th17 shift in early RA.
ASSESSMENT OF NATURAL RADIOACTIVITY LEVELS AND RADIOLOGICAL HAZARDS IN BUILDING MATERIALS
Authors: Tuo Fei , Peng Xuan , Zhou Qiang , Zhang Jing
Published: December 2019

Radioactivity of 226Ra, 232Th, and 40K were measured in a total of 92 samples, including eight commonly used types of building materials that were obtained from local manufacturers and suppliers in Beijing. Concentrations were determined using high-purity germanium gamma-ray spectrometry. The 226Ra, 232Th, and 40K activity concentrations in all samples varied from 10.1 to 661, 3.3 to 555 and 3.2 to 2945 Bq per kg with an average of 127.8, 114.8, and 701.5 Bq per kg, respectively. The potential radiological hazards were estimated by calculating the absorbed dose rate (D), radium equivalent activity (Raeq), external hazard (Hex), and internal hazard (Hin) indices. The investigated building materials were classified into different types according to the radioactivity levels. Results from this research will provide a reference for the acquisition, sales, and use of building materials. Attention should be paid to the use of coal cinder brick, ceramic, and granite in the construction of dwellings.
Characterization of Cholinesterases From Multiple Large Animal Species for Medical Countermeasure Development Against Chemical Warfare Nerve Agents
Authors: McGarry Kevin G , Schill Kevin E , Winters Tyson P , Lemmon Erin E , Sabourin Carol L , Harvilchuck Jill A , Moyer Robert A
Published: December 2019

Organophosphorus (OP) compounds, which include insecticides and chemical warfare nerve agents (CWNAs) such as sarin (GB) and VX, continue to be a global threat to both civilian and military populations. It is widely accepted that cholinesterase inhibition is the primary mechanism for acute OP toxicity. Disruption of cholinergic function through the inhibition of acetylcholinesterase (AChE) leads to the accumulation of the neurotransmitter acetylcholine. Excess acetylcholine at the synapse results in an overstimulation of cholinergic neurons which manifests in the common signs and symptoms of OP intoxication (miosis, increased secretions, seizures, convulsions, and respiratory failure). The primary therapeutic strategy employed in the United States to treat OP intoxication includes reactivation of inhibited AChE with the oxime pralidoxime (2-PAM) along with the muscarinic acetylcholine receptor antagonist atropine and the benzodiazepine, diazepam. CWNAs are also known to inhibit butyrylcholinesterase (BChE) without any apparent toxic effects. Therefore, BChE may be viewed as a “bioscavenger” that stoichiometrically binds CWNAs and removes them from circulation. The degree of inhibition of AChE and BChE and the effectiveness of 2-PAM are known to vary among species. Animal models are imperative for evaluating the efficacy of CWNA medical countermeasures, and a thorough characterization of available animal models is important for translating results to humans. Thus, the objective of this study was to compare the circulating levels of each of the cholinesterases as well as multiple kinetic properties (inhibition, reactivation, and aging rates) of both AChE and BChE derived from humans to AChE and BChE derived from commonly used large animal models.
Creating a Sacred Space in the Intensive Care Unit at the End of Life
Authors: Fournier Ann L.
Published: December 2019

Improving care at the end of life is a health priority. At least one-third of deaths in the United States occur in the hospital; nearly half of the Americans who die in the hospital will have spent time in the intensive care unit during the last 3 days of life. Critically ill patients and their families identify significant unmet spiritual, environmental, and communication needs. Although the Society of Critical Care Medicine recommends that the spiritual needs of critically ill patients be addressed by the health care team and be incorporated in patients’ plans of care, spiritual concerns are infrequently addressed during goals-of-care discussions. The American Association of Critical-Care Nurses’ Synergy Model recognizes the central importance of spirituality to the provision of patient-centered care. Furthermore, the model highlights the value of the relationship between the patient and the nurse to a healing environment. The privileged connection between patients and nurses, foundational to the creation of a healing environment, may be understood as a sacred space. Critical care nurses are uniquely positioned to improve end-of-life care by focusing on the spiritual, environmental, and communication needs of their patients through the creation of a third space in the intensive care unit, a sacred space.
Metoprolol decreases retention of fear memory and facilitates long-term depression in lateral amygdala
Authors: Luo Yi , Li Zhilian , Tu Qiang , Xia Liexin
Published: December 2019

Posttraumatic stress disorder is a mental disorder with a known cause, yet effective behavioral and pharmacotherapies remain elusive for many afflicted patients. Propranolol is suggested to be effective as a fear-reducing agent when paired with behavioral therapy soon after trauma when psychological stress is high, possibly dampening or preventing the later development of posttraumatic stress disorder. In our previous study, we found propranolol efficaciously reduced fear retention induced by reactivation via β-adrenergic receptors in lateral amygdala. However, it is unclear which subtypes of β-adrenergic receptors dominate the function of adrenergic activation in lateral amygdala. In this study, we investigated the action of β1-adrenergic receptor antagonist-metoprolol and β2-adrenergic receptor antagonist-butoxamine on the retention of conditioned fear memory and synaptic adaptation in the lateral amygdala of rats. We found metoprolol not butoxamine attenuated the reactivation-induced strengthening of fear retention and restored the impaired long-term depression in lateral amygdala. Intra-amygdala infusion of metoprolol not butoxamine attenuated reactivation-induced enhancement of fear retention. Our results suggest that β1-adrenergic receptor antagonist-metoprolol may be more suitable for the treatment of posttraumatic stress disorder.
[18F] FBB cortical uptake is not related to the age of onset of Alzheimer’s disease
Authors: Chiaravalloti Agostino , Barbagallo Gaetano , Castellano Anna Elisa , Ricci Maria , Ciccariello Gabriele , Ursini Francesco , D’Ascenzo Nicola , Xie Quingguo , Schillaci Orazio
Published: December 2019

Aim

To investigate the relationships between amyloid burden in brain and the age of onset of Alzheimer’s disease.

Materials and methods

We examined 60 patients with clinical diagnosis of Alzheimer’s disease. Of them, 22 were early-onset of Alzheimer’s disease and 38 were late-onset of Alzheimer’s disease. All of them underwent a brain PET scan 90 minutes after the injection of 4-[(E)-2-[4-[2-[2-(2-fluoranylethoxy)ethoxy]ethoxy]phenyl]ethenyl]-N-methylaniline ([18F] FBB); 300 ± 10 MBq). Relationships between amyloid burden in brain and age of onset of Alzheimer’s disease were assessed by means of statistical parametric mapping version 12.

Results

There were no significant differences [18F] FBB uptake between early-onset of Alzheimer’s disease and late-onset of Alzheimer’s disease patients.

Conclusion

In our study group, the age of onset is not related to brain amyloid burden in Alzheimer’s disease patients.
Pediatric Colonoscopic Polypectomy Technique
Authors: Kay Marsha , Wyllie Robert
Published: December 2019

Colonoscopy with polypectomy is frequently performed in pediatric patients based on symptoms, with the majority of polyps identified being benign juvenile pedunculated polyps with a vascular stalk. This is in distinction to adults where polypectomy is often performed as part of a colon cancer screening and prevention strategy and a higher fraction of polyps are sessile and or dysplastic. In adults, polypectomy techniques emphasize a need for deeper resection to ensure complete resection of adenomas or potential carcinoma in situ. Adenomatous polyps can occur in the pediatric age group and may be associated with an underlying polyposis, hereditary or chronic inflammatory conditions. Polypectomy techniques include use of cold biopsy forceps for very small polyps, cold snare polypectomy for small sessile polyps and hot snare polypectomy for the majority of polyps in the pediatric age group. Adjuvant techniques include epinephrine volume reduction, saline‐assisted polypectomy and hemostatic techniques including injection, clip application and loop application to prevent or treat post‐polypectomy bleeding. Electrosurgical principles guide the settings and type of current utilized during hot snare polypectomy. Polypectomy utilizing thermal techniques is associated with a higher risk of complications compared with diagnostic colonoscopy.
Economic Impact and Prognostic Factors of Functional Dyspepsia in Children
Authors: Mani Jyoti , Madani Shailender , Thomas Ron
Published: December 2019

Objectives:

Functional dyspepsia (FD) is a functional abdominal pain disorder. There is paucity of data on the economic impact of FD in children. Primary aim of our study was to estimate annual evaluation cost (“diagnosis and visit” cost) and secondary aim was to identify potential prognostic factors of FD in children.

Methods:

Out of the 136 patients 86 met inclusion criteria and were divided into 2 clinical groups: Complete Improvement Group (CIG‐30 patients) and Partial/No Improvement Group (PIG/NIG‐56 patients). Medications used were noted descriptively. Annual evaluation cost was calculated using 2017 Medicare reimbursement rates.

Results:

Annual evaluation cost in all patients was $724.874 ± $180.075 ($544.799 ± $87.995 in CIG and $904.949 ± 79.083 in PIG/NIG). An extrapolated annual cost of evaluation in children with FD would be approximately $5.79 billion. Average number of clinic visits (3.1 ± 1.2 in CIG vs 4.40 ± 3.1 in PIG/NIG), duration of follow‐up in months (9.2 ± 6.6 in CIG vs 17.1 ± 13.6 in PIG/NIG), use of imaging studies (7 patients in CIG [23.3%] vs 29 in PIG/NIG [51.8%]) and endoscopic procedures (17 in CIG [56.7%] vs 46 in PIG/NIG [82.1%]) were significantly higher in PIG/NIG (P < 0.005). PIG/NIG required multiple medications for control of symptoms compared to CIG (4 patients in CIG [13.5%] vs 30 in PIG [53.6%], P value <0.001]. For every $500.00 decrease in total evaluation cost the odds of having a complete response was 0.998 (P = 0.027). No prognostic factors were identified in children with FD.

Conclusions:

FD in children has a significant economic impact on health care expenditure. Patients with FD who have partial/no response to treatment incur greater financial cost potentially adding to health care expenditure.
Enhanced Recovery after Surgery Protocols Decrease Outpatient Opioid Use in Patients Undergoing Abdominally Based Microsurgical Breast Reconstruction
Authors: Rendon Juan L. , Hodson Trevor , Skoracki Roman J. , Humeidan Michelle , Chao Albert H.
Published: December 2019

Background:

Enhanced recovery after surgery (ERAS) protocols have known benefits in the inpatient setting, but little is known about their impact in the subsequent outpatient setting. On discharge, multimodal analgesia has been discontinued, nerve blocks and pain pumps have worn off, and patients enter a substantially different physical environment, potentially resulting in a rebound effect. The objective of this study was to investigate the effect of ERAS protocol implementation on outpatient opioid use and recovery.

Methods:

Patients who underwent abdominally based microsurgical breast reconstruction before and after ERAS implementation were reviewed retrospectively. Ohio state law mandates that no more than 7 days of opioids may be prescribed at a time, with the details of all prescriptions recorded in a statewide reporting system, from which opioid use was determined.

Results:

A total of 105 patients met inclusion criteria, of which 46 (44 percent) were in the pre-ERAS group and 59 (56 percent) were in the ERAS group. Total outpatient morphine milligram equivalents used in the ERAS group were less than in the pre-ERAS group (337.5 morphine milligram equivalents versus 668.8 morphine milligram equivalents, respectively; p =0.016). This difference was specifically significant at postoperative week 1 (p =0.044), with gradual convergence over subsequent weeks. Although opioid use was significantly less in the ERAS group, pain scores in the ERAS group were comparable to those in the pre-ERAS group.

Conclusions:

The benefits of ERAS protocols appear to extend into the outpatient setting, further supporting their use to facilitate recovery, and highlighting their potential role in helping to address the prescription opioid abuse problem.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Dupuytren’s Disease Predicts Increased All-Cause and Cancer-Specific Mortality: Analysis of a Large Cohort from the U.K. Clinical Practice Research Datalink
Authors: Kuo Rachel Yi Ling , Ng Michael , Prieto-Alhambra Daniel , Furniss Dominic
Published: December 2019

Background:

Dupuytren’s disease is a common, chronic, fibroproliferative disease of the palmar fascia. The cause is unclear but includes genetic predisposition alongside environmental factors. Several studies have suggested an association between Dupuytren’s disease and excess mortality. The authors aimed to evaluate this association in adult patients in the United Kingdom and identify the causes of mortality.

Methods:

The authors used a large primary care database (Clinical Practice Research Datalink) linked to the Office of National Statistics to identify patients with Dupuytren’s disease between January 1, 1995, and December 31, 2013. Each patient was matched by age, sex, and general practitioner to five control patients without the disease. Cox regression models were used to study the association between Dupuytren’s disease and all-cause and cause-specific mortality, adjusting for confounders.

Results:

A total of 41,965 Dupuytren’s disease patients and 209,825 control patients were identified. The all-cause mortality rate was increased in both unadjusted (hazard ratio, 1.48; 99% CI, 1.29 to 1.70; p < 0.0001) and multivariable adjusted (hazard ratio, 1.43; 99% CI, 1.25 to 1.65; p < 0.0001) models in patients with Dupuytren’s disease, 12 years after diagnosis. Excess mortality was secondary to a wide range of causes, including cancer (hazard ratio, 1.66; 99% CI, 1.27 to 2.17; p < 0.0001), an effect that persisted after adjustment for confounders.

Conclusions:

There is excess mortality associated with Dupuytren’s disease that can be partially explained through environmental factors. From time of diagnosis in primary care, there is a 12-year window of opportunity for intervention to reduce the impact of these factors. The authors observed an increased risk of cancer mortality independent of confounders, and hypothesize a shared genetic risk between Dupuytren’s disease and cancer.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Surgical Correction of Breast Animation Deformity with Implant Pocket Conversion to a Prepectoral Plane
Authors: Holland Michael C. , Lentz Rachel , Sbitany Hani
Published: December 2019

Background:

Animation deformity is an undesirable outcome of subpectoral breast reconstruction that results in abnormal breast contraction with activity, breast pain, and increased implant visibility. Surgical correction requires implant removal and conversion of the reconstruction to a prepectoral plane. The authors present their institutional experience with their preferred surgical technique to treat this challenging problem and outline solutions for increased success in these patients.

Methods:

A retrospective review was performed of all patients undergoing conversion of their subpectoral breast reconstruction to a prepectoral plane at the authors’ institution. Patient demographics and surgical details were analyzed, and postoperative outcomes and morbidity were assessed. The effects of changing operative strategies on enhanced success are also reported.

Results:

A total of 80 breast conversions were performed over a 2.5-year period. All patients demonstrated resolution of animation deformity at a mean follow-up of 15.2 months. Two reconstructions (2.5 percent) required an unplanned return to the operating room, and 11 reconstructions (13.8 percent) were treated for infection. Preconversion fat grafting and the use of acellular dermal matrix were both associated with a reduced incidence of postoperative asymmetry and capsular contracture (p < 0.05). There were no reconstructive failures associated with conversion to a prepectoral pocket.

Conclusions:

Treatment of animation deformity in the reconstructed patient can be safely performed by surgical conversion to a prepectoral plane. The use of acellular dermal matrix, and preconversion fat grafting, in appropriate patients can improve results. The authors promote this operative algorithm for all reconstructive patients experiencing symptomatic animation deformity with subpectoral breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Differential Responsiveness to BMP9 between Patent and Fused Suture Progenitor Cells from Craniosynostosis Patients
Authors: Song Dongzhe , Huang Shifeng , Zhang Linghuan , Liu Wei , Huang Bo , Feng Yixiao , Liu Bo , He Tong-Chuan , Huang Dingming , Reid Russell R.
Published: December 2019

Background:

Several studies have verified that bone morphogenetic proteins (BMPs) may be involved in the development of craniosynostosis; little attention has been focused on the role of BMP9 in cranial suture biology. The authors investigated the role of BMP9 in suture progenitor cells.

Methods:

The authors isolated and cultured prematurely fused and internal control patent suture progenitor cells from patients with nonsyndromic craniosynostosis. Overexpression of BMP9 was mediated by adenoviral vectors. Osteoblast and osteoclast differentiation-related markers were evaluated by staining techniques and touchdown quantitative polymerase chain reaction analysis. In vivo analysis of BMP9-induced suture progenitor cell osteogenesis was performed in an ectopic bone formation model.

Results:

The authors demonstrated that the prematurely fused sutures have a higher endogenous expression of the osteogenic differentiation-related genes than patent sutures, whereas the same pattern of gene expression exists between fused and patent suture progenitor cells. Importantly, both patent and fused suture progenitor cells undergo osteogenic differentiation and express multiple lineage regulators and NELL-1 on BMP9 stimulation, whereas fused suture progenitor cells have a higher basal osteogenic potential than patent suture progenitor cells. BMP9 regulates the expression of osteoclast differentiation-related genes in suture progenitor cells. Forced BMP9 expression enhances the mineralization and maturity of ectopic bone formation of suture progenitor cells implanted in vivo.

Conclusions:

The authors’ findings suggest that fused suture progenitor cells have elevated osteogenic potential. BMP9 could regulate the expression of multiple osteoblast and osteoclast differentiation-related genes, and NELL-1, in both suture progenitor cells, indicating that BMP9 may play a role in craniosynostosis.
Indications and Limitations of Bilayer Wound Matrix–Based Lower Extremity Reconstruction: A Multidisciplinary Case-Control Study of 191 Wounds
Authors: Shakir Sameer , Messa Charles A. , Broach Robyn B. , Rhemtulla Irfan A. , Chatman Brett , D’Angelantonio Albert , Levin L. Scott , Kovach Stephen J. , Serletti Joseph M. , Fischer John P.
Published: December 2019

Background:

Little is known about the efficacy of newer skin substitute scaffolds to reconstruct complex lower extremity wounds. The investigators present a multihospital experience of reconstructive surgeons utilizing collagen-GAG bilayer wound matrix in lower extremity soft-tissue reconstruction with the goals to (1) characterize a suitable patient population, (2) categorize failures to optimize patient selection, and (3) determine wound factors affecting success.

Methods:

Subjects underwent collagen-GAG–based lower extremity wound reconstruction from May of 2010 to June of 2017. The primary outcome variable was 180-day graft success, defined as eventual split-thickness skin grafting after bilayer wound matrix application; failure was defined as inadequate wound bed for split-thickness skin grafting, requirement for vascularized tissue transfer, or eventual amputation. Eligible subjects had at least one lower extremity wound and were at least 18 years old. Exclusion criteria included third-degree burn wounds or failure to follow up for at least 60 days postoperatively. Predictor variables included demographics, medical comorbidities, perioperative characteristics, postoperative complications, and cost-related data for each hospitalization.

Results:

There were 147 subjects with 191 wounds. Mean patient age was 60.1 years (range, 21.0 to 95.6 years), and mean body mass index was 30.5 kg/m2 (range, 14.4 to 64.7 kg/m2). Average wound size was 73.1 ± 137.7 cm2, with 49.0 percent of subjects receiving adjunct postoperative negative-pressure wound therapy. Seventy percent of wounds were successfully healed at 180 days. Most were localized between the knee and ankle (50.8 percent) or foot (46.1 percent). Tendon exposure (p < 0.05), bone exposure (p < 0.01), and bone excision (p < 0.04) were associated with reconstructive failure.

Conclusions:

The authors present the largest reported multihospital, multidisciplinary experience with collagen-GAG wound matrix for lower extremity reconstruction. Tendon and/or bone exposure and socioeconomic factors were associated with failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Challenges in the Successful Reconstruction of Cleft Lip and Palate: Managing the Nasomaxillary Deformity in Adolescence
Authors: Posnick Jeffrey C. , Kinard Brian E.
Published: December 2019

The surgical techniques and execution of primary cleft lip and palate repair are no longer the greatest challenge to achieving successful rehabilitation for those born with facial clefting (i.e., bilateral and unilateral cleft lip and palate). Despite a surgeon’s best efforts, when cleft palate repair is carried out during infancy, by the mixed dentition, a majority will demonstrate nasomaxillary deficiency. The cleft team’s commitment to a family under their care is to ensure that the newborn reaches adulthood reconstructed without need for special regard to their original birth malformation. Guiding principles are provided for the accurate diagnosis and reliable reconstruction of the bilateral and unilateral cleft lip and palate adolescent/adult who presents with nasomaxillary deficiency and any residual oronasal fistula, bony defects, cleft dental gap(s), nasal obstructions, and associated facial dysmorphology. Successful orthognathic surgery provides a stable foundation on which any remaining soft-tissue cleft lip or cleft nasal deformities can be accurately assessed and then reconstructed.