bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective Cohort Study of the 12-Month Epidemiology, Treatment Patterns, Outcomes, and Health Care Costs Among Adult Patients With Complicated Urinary Tract Infections
Authors: Lodise Thomas P , Manjelievskaia Janna , Marchlewicz Elizabeth Hoit , Rodriguez Mauricio
Published: June 2022

Background

Limited data are available in the United States on the 12-month epidemiology, outpatient (OP) antibiotic treatment patterns, outcomes, and costs associated with complicated urinary tract infections (cUTIs) in adult patients.

Methods

A retrospective observational cohort study of adult patients with incident cUTIs in IBM MarketScan Databases between 2017 and 2019 was performed. Patients were categorized as OP or inpatient (IP) based on initial setting of care for index cUTI and were stratified by age (<65 years vs ≥65 years). OP antibiotic treatment patterns, outcomes, and costs associated with cUTIs among adult patients over a 12-month follow-up period were examined.

Results

During the study period, 95 322 patients met inclusion criteria. Most patients were OPs (84%) and age <65 years (87%). Treatment failure (receipt of new unique OP antibiotic or cUTI-related ED visit/IP admission) occurred in 23% and 34% of OPs aged <65 years and ≥65 years, respectively. Treatment failure was observed in >38% of IPs, irrespective of age. Across both cohorts and age strata, >78% received ≥2 unique OP antibiotics, >34% received ≥4 unique OP antibiotics, >16% received repeat OP antibiotics, and >33% received ≥1 intravenous (IV) OP antibiotics. The mean 12-month cUTI-related total health care costs were $4697 for OPs age <65 years, $8924 for OPs age >65 years, $15 401 for IPs age <65 years, and $17 431 for IPs age ≥65 years.

Conclusions

These findings highlight the substantial 12-month health care burden associated with cUTIs and underscore the need for new outpatient treatment approaches that reduce the persistent or recurrent nature of many cUTIs.
Characterization of 2,2',4,4'-tetrabromodiphenyl ether (BDE47)-induced testicular toxicity via single-cell RNA-sequencing
Authors: Zhang Wei , Xia Siyu , Zhong Xiaoru , Gao Guoyong , Yang Jing , Wang Shuang , Cao Min , Liang Zhen , Yang Chuanbin , Wang Jigang
Published: June 2022

Background

The growing male reproductive diseases have been linked to higher exposure to certain environmental compounds such as 2,2′,4,4′-tetrabromodiphenyl ether (BDE47) that are widely distributed in the food chain. However, the specific underlying molecular mechanisms for BDE47-induced male reproductive toxicity are not completely understood.

Methods

Here, for the first time, advanced single-cell RNA sequencing (ScRNA-seq) was employed to dissect BDE47-induced prepubertal testicular toxicity in mice from a pool of 76 859 cells.

Results

Our ScRNA-seq results revealed shared and heterogeneous information of differentially expressed genes, signaling pathways, transcription factors, and ligands-receptors in major testicular cell types in mice upon BDE47 treatment. Apart from disruption of hormone homeostasis, BDE47 was discovered to downregulate multiple previously unappreciated pathways such as double-strand break repair and cytokinesis pathways, indicative of their potential roles involved in BDE47-induced testicular injury. Interestingly, transcription factors analysis of ScRNA-seq results revealed that Kdm5b (lysine-specific demethylase 5B), a key transcription factor required for spermatogenesis, was downregulated in all germ cells as well as in Sertoli and telocyte cells in BDE47-treated testes of mice, suggesting its contribution to BDE47-induced impairment of spermatogenesis.

Conclusions

Overall, for the first time, we established the molecular cell atlas of mice testes to define BDE47-induced prepubertal testicular toxicity using the ScRNA-seq approach, providing novel insight into our understanding of the underlying mechanisms and pathways involved in BDE47-associated testicular injury at a single-cell resolution. Our results can serve as an important resource to further dissect the potential roles of BDE47, and other relevant endocrine-disrupting chemicals, in inducing male reproductive toxicity.
Natural alleles of CIRCADIAN CLOCK ASSOCIATED1 contribute to rice cultivation by fine-tuning flowering time
Authors: Lee Sang-Ji , Kang Kiyoon , Lim Jung-Hyun , Paek Nam-Chon
Published: June 2022

The timing of flowering is a crucial factor for successful grain production at a wide range of latitudes. Domestication of rice (Oryza sativa) included selection for natural alleles of flowering-time genes that allow rice plants to adapt to broad geographic areas. Here, we describe the role of natural alleles of CIRCADIAN CLOCK ASSOCIATED1 (OsCCA1) in cultivated rice based on analysis of single-nucleotide polymorphisms deposited in the International Rice Genebank Collection Information System database. Rice varieties harboring japonica-type OsCCA1 alleles (OsCCA1a haplotype) flowered earlier than those harboring indica-type OsCCA1 alleles (OsCCA1d haplotype). In the japonica cultivar “Dongjin”, a T-DNA insertion in OsCCA1a resulted in late flowering under long-day and short-day conditions, indicating that OsCCA1 is a floral inducer. Reverse transcription quantitative PCR analysis showed that the loss of OsCCA1a function induces the expression of the floral repressors PSEUDO-RESPONSE REGULATOR 37 (OsPRR37) and Days to Heading 8 (DTH8), followed by repression of the Early heading date 1 (Ehd1)–Heading date 3a (Hd3a)–RICE FLOWERING LOCUS T 1 (RFT1) pathway. Binding affinity assays indicated that OsCCA1 binds to the promoter regions of OsPRR37 and DTH8. Naturally occurring OsCCA1 alleles are evolutionarily conserved in cultivated rice (O. sativa). Oryza rufipogon-I (Or-I) and Or-III type accessions, representing the ancestors of O. sativa indica and japonica, harbored indica- and japonica-type OsCCA1 alleles, respectively. Taken together, our results demonstrate that OsCCA1 is a likely domestication locus that has contributed to the geographic adaptation and expansion of cultivated rice.
Under Suspicion: Trust Dynamics with Secret Undermining
Authors: Kolb Aaron , Madsen Erik
Published: June 2022

We study how an organization should dynamically screen an agent of uncertain loyalty whom it suspects of committing damaging acts of undermining. The organization controls the stakes of the relationship, while the agent strategically times undermining, which can occur repeatedly and is detected only stochastically. The optimal commitment stakes policy exhibits both discreteness and gradualism, with distinct “untrusted” and “trusted” phases featuring gradually rising stakes during the untrusted phase and a discrete gap in stakes between phases. This policy is also the equilibrium outcome when the organization cannot commit, and the agent’s equilibrium undermining policy exhibits variable, non-monotonic intensity.
Histological, metabolomic and transcriptomic analyses reveal mechanisms of cold acclimation of the Moso bamboo (Phyllostachys edulis) leaf
Authors: Wang Haiyue , Guo Lin , Zha Ruofei , Gao Zhipeng , Yu Fen , Wei Qiang
Published: June 2022

The Moso bamboo (Phyllostachys edulis) leaf copes well with cold winters in southeastern China. However, until now, there has been almost no research on its adaptation mechanisms to cold weather. Herein, we found that the Moso bamboo leaf has evolved several anatomical structures that may play a role in enhancing its cold tolerance. These structures include fewer fusiform cells, smaller bulliform cells, lower stomata density and many more trichomes, as well as lower relative water content than in the leaf of a cold-sensitive bamboo species, Bambusa ventricosa. Untargeted metabolomic analysis revealed that the winter leaf of Moso bamboo had 10- to 1000-fold higher stress-resistant metabolites such as glutathione, trehalose and ascorbic acid than the leaf of B. ventricosa on both warm and cold days. In contrast to the leaves that grew on a warm day, some metabolites such as glutathione and trehalose increased dramatically in the leaves of Moso bamboo that grew on a cold day. However, they unexpectedly decreased in the leaf of B. ventricosa growing at cold temperatures. Transcriptome analysis revealed a cold stress response network that includes trehalose, glutathione, flavonoid metabolism, DNA repair, reactive oxygen species degradation, stress-associated genes and abiotic stress-related plant hormones such as jasmonic acid, abscisic acid and ethylene. The potential mediator transcription factors, such as EREBP, HSF, MYB, NAC and WRYK, were also significantly upregulated in Moso bamboo leaves growing at cold temperatures. Interestingly, many newly identified genes were involved in the transcriptome of the winter leaf of the Moso bamboo. Most of these new genes have not even been annotated yet. The above results indicate that the Moso bamboo leaf has evolved special histological structures, metabolic pathways and a cold stress-tolerant transcriptome to adapt to the cold weather in its distribution areas.
Limited genetic diversity and expression profile of Plasmodium falciparum haem detoxification protein: a possible diagnostic target
Authors: Nema Shrikant , Krishna Sri , Tiwari Archana , Bharti Praveen Kumar
Published: June 2022

Background

Haem detoxification protein (HDP) is a significant protein in the erythrocytic stage of the Plasmodium lifecycle. HDP could be of paramount interest as a diagnostic biomarker for accurate diagnosis of malaria. We thus explored HDP genetic variation, expression levels of HDP and immune response.

Methods

Phylogenetic analysis was carried out using Pfhdp orthologues sequences of various Plasmodium species. Blood samples were collected from patients in central India. Pfhdp gene was amplified, and sequenced by sanger DNA sequencing. B-cell epitopes were identified in PfHDP using Bepipred Linear Epitope Prediction 2.0, and median-joining network was constructed using global PfHDP sequences. Pfhdp expression levels during erythrocytic stage were assessed using real-time qPCR at 4-h intervals. An IgG immune response against synthetic PfHDP peptides was analysed using ELISA.

Results

Phylogenetic analysis revealed the conserved nature of Pfhdp gene. Diversity analysis revealed one non-synonymous mutation (F91L) among all isolates. Neutrality tests indicated negative selection for Pfhdp gene. HDP was expressed throughout the erythrocytic cycle, and comparatively, high expression was observed in the late trophozoite and schizont stages. High IgG response against both peptides was observed, and no polymorphism was seen in any of the seven predicted B-cell epitopes.

Conclusions

Findings of the present study indicate the possibility of HDP being exploited as a diagnostic biomarker for Plasmodium falciparum malaria after proteomic validation studies.
Defects in plant immunity modulate the rates and patterns of RNA virus evolution
Authors: Navarro Rebeca , Ambrós Silvia , Butković Anamarija , Carrasco José L , González Rubén , Martínez Fernando , Wu Beilei , Elena Santiago F
Published: June 2022

It is assumed that host genetic variability for susceptibility to infection conditions virus evolution. Differences in host susceptibility can drive a virus to diversify into strains that track different defense alleles (e.g. antigenic diversity) or to infect only the most susceptible genotypes. Here, we have studied how variability in host defenses determines the evolutionary fate of a plant RNA virus. We performed evolution experiments with Turnip mosaic potyvirus in Arabidopsis thaliana mutants that had disruptions in infection-response signaling pathways or in genes whose products are essential for potyvirus infection. Plant genotypes were classified into five phenogroups according to their response to infection. We found that evolution proceeded faster in more restrictive hosts than in more permissive ones. Most of the phenotypic differences shown by the ancestral virus across host genotypes were removed after evolution, suggesting the combined action of selection and chance. When all evolved viral lineages were tested in all plant genotypes used in the experiments, we found compelling evidences that the most restrictive plant genotypes selected for more generalist viruses, while more permissive genotypes selected for more specialist viruses. Sequencing the genomes of the evolved viral lineages, we found that selection targeted the multifunctional genome-linked protein VPg in most host genotypes. Overall, this work illustrates how different host defenses modulate the rates and extent of virus evolution.
Identification of Quinone Outside Inhibitor Fungicide-Resistant Isolates of Parastagonospora nodorum from Illinois and Kentucky
Authors: White Nathaniel H. , Neves Danilo L. , Nuckles Etta M. , Vaillancourt Lisa J. , Zhang Jiawen , Zhang Guirong , Bradley Carl A.
Published: June 2022

Stagonospora leaf and glume blotch, caused by Parastagonospora nodorum, is a major disease of winter wheat (Triticum aestivum) in the United States capable of significantly reducing grain yield and quality. Pathogens such as P. nodorum that overwinter in crop residue are often an increased concern in cropping systems that utilize no-till farming. In addition, the lack of wheat cultivars with complete resistance to P. nodorum has led to the reliance on foliar fungicides for disease management. Quinone outside inhibitor (QoI) fungicides (Fungicide Resistance Action Committee group 11) are one of the major classes used to manage foliar diseases in wheat. Use of the QoI class of fungicides tends to select isolates of fungal pathogens with resistance due to mutations in the fungal cytochrome b gene. Isolates of P. nodorum were collected from Illinois in 2014 and Kentucky in 2018, 2019, and 2020. Amplification and sequencing of a segment of the cytochrome b gene from these isolates revealed a mutation at codon 143 that confers a change from glycine to alanine in the amino acid sequence (known as the G143A mutation). In vitro plate assays and greenhouse trials were used to confirm and characterize the QoI resistance caused by the G143A mutation. The frequency of the tested isolates with the G143A mutation was 46% (57 of 123 isolates) and 5% (3 of 60 isolates) for Kentucky and Illinois, respectively. This research is the first to identify the G143A mutation in P. nodorum isolates with resistance to QoI fungicides in Illinois and Kentucky.
Effects of Temperature and Wetness on Components of the Infection Cycle ofValdensia heterodoxain Lowbush Blueberry
Authors: Abbasi Pervaiz A. , Hildebrand Paul D. , Ali Shawkat , Wright Harrison , Franklin Jeff , Renderos Willy E.
Published: June 2022

Valdensia leaf spot, caused by Valdensia heterodoxa, is a serious disease of lowbush blueberry. The disease may develop rapidly, resulting in extensive defoliation of fields. The purpose of this study was to examine the effects of temperature and wetness duration on various components of the infection cycle to gain a better understanding of epidemic development that might lead to improved management practices. Lesions on leaves appeared 6 h after inoculation at 20°C and were larger on young 3-week-old leaves compared with 8-week-old leaves. Incidence of infection on 3-week-old leaves was lowest at 5°C, highest at 15 and 20°C, and failed to occur at 30°C. Defoliation began 48 h after inoculation at 20 and 25°C but was slower at higher and lower temperatures. Conidia production and release from colonized leaves began 48 h after inoculation at 15 and 19°C. Total conidia production was lowest at 7°C, highest at 15°C, and progressively declined at 19 and 23°C. Production of conidia lasted 2 to 3 days. Sclerotia formed mainly along the midveins and were similar in size at 5 to 15°C, largest at 20°C, and smallest at 25°C. Conidia formed directly on sclerotia that were overwintered outdoors and then incubated on moist filter paper. Conidia production began after 48 h at 10, 15, and 20°C. Total production was lowest at 5°C, highest at 20°C, failed to occur at 25°C, and ceased after 10 days at all temperatures. These data show that at optimal temperatures, relatively short wet periods are required for conidia production on overwintered sclerotia, infection of leaves, and subsequent conidia production on diseased leaves that may account for the sudden and rapid spread of disease in fields. The data will be useful for helping growers identify weather conditions favorable for disease development.
Thymoquinone Anticancer Effects Through the Upregulation of NRF2 and the Downregulation of PD‐L1 in MDA‐MB‐231 Triple‐Negative Breast Cancer Cells
Authors: Adinew Getinet , Messeha Samia S. , Badisa Ramesh , Taka Equar , Soliman Karam F. A.
Published: June 2022

Triple‐negative breast cancer (TNBC) is an aggressive subtype of breast cancer with a metastatic nature. TNBC lacks the expression of the progesterone receptor, estrogen receptor, and human epidermal growth factor receptor 2. The absence of these three receptors limits the therapy options. Meanwhile, conventional medication is not very effective in the treatment and prevention of TNBC. Developing innovative therapeutic agents from natural bioactive compounds is a viable option. In the current study, the natural compound thymoquinone (TQ) was used in MDA‐MB‐231 TNBC cells. A dose response to TQ (0‐50 µM) was obtained following a 24‐hour exposure. An Annexin V‐FITC apoptosis detection was used to study the apoptotic effect of TQ.  With increasing TQ concentrations from 0‐20 µM, flow cytometer examination revealed an increase in apoptotic cells. Nearly 80% of the cells studied were in the apoptotic phase at 20 µM. (early and late apoptosis). Meanwhile, at 30 µM, there was a significant drop in apoptotic cells, which may be interpreted as an increase in necrotic cells. Molecular‐targeted therapy is a new approach in treating cancer. The effect of TQ on the expression of Nrf2(Nuclear factor erythroid 2‐ related factor 2) and PD‐L1 (Programmed death‐ligand 1) was investigated using a specific primary antibody against these proteins. A Western blot analysis confirmed TQ's ability to change the expression of both proteins under investigation. According to normalized data, TQ had the ability to elicit more than 2‐fold increase in Nrf2 expression in IFN‐γ stimulated MDA‐MB‐231 cells. In contrast, co‐treated cells (IFN‐γ + TQ) showed a 65 percent reduction in PD‐L1 expression. In conclusion, TQ was suggested as a promising anticancer option for treating  TNBC.
Autophagy and Herpesvirus: A collaboration Contributing to Alzheimer's Disease
Authors: Nafchi Amir R. , Esmaeili Mona , Myers Orrin , Oprea Tudor , Bearer Elane L.
Published: June 2022

Since the 1960s viral pathogenesis researchers have considered herpesviruses as an underlying factor for Alzheimer's disease (AD). We reported molecular interactions between herpes simplex virus type 1 (HSV‐1) and the amyloid precursor protein (APP), the parent of amyloid plaques pathognomonic for AD (Sapute‐Krishnan et al., 2003 and 2006; Chen et al., 2011, Bearer and Wu, 2019). Furthermore, others report biochemical interactions between HSV‐1 and autophagy. Using several brain banks for specimens of four brain regions in post‐mortems of individuals with and without cognitive impairment prior to death. Readhead et al. 2018 found molecular‐genetic evidence linking activity of 6 different human herpesviruses to AD, including HSV‐1, HSV‐2, HHN6, HHN7, VZV and CMV to AD. Of these, HHN6, a common virus causing a minor childhood illness thought to be a nuisance, emerged as most significant. Using a quantitative trait loci approach, a network of candidate AD‐associated genes were found that correlated with viral load and activity. These ontology networks did not specifically consider autophagy genes. Our hypothesis is that viral replication and egress highjacks cellular membrane systems and thereby alters autophagic function. Those individuals carrying genetic variations that protect against this dynamic will be less vulnerable to cognitive impairment despite viral load, or viral load will be diminished. Here we first prepared lists of autophagy genes (ATG), including 180 we uniquely identified through machine learning, as well as lists from publications (Mitzushima, 2019) and websites (Autophagy Gene List, Tanpaku.org). We applied software developed by Readhead et al. 2018, available through Synapse.com, to expression and sequence data from post‐mortem brains obtained from publications and public sites hosted by Alzheimer's Center brain banks. We first determined ATG expression levels correlating with either non‐AD (<1 plaque per section, Braak<3, and no dementia, or pre‐clinical AD, defined as Braak III‐IV with no cognitive impairment. Virtually all ATG were down‐regulated in pre‐clinical compared to non‐AD controls. Next we searched the list of quantitative trait loci (QTL) that correlated with increased viral load and activity for ATG genes from 300+ brains in the Nun's Study brain bank (ROSMAP) and the Mount Sinai Brain Bank (MSBB). Lastly, we correlated those ATG‐associated QTL with expression levels of these genes in control and preclinical AD (Liang et al. 2007, 2008 and 2010). We found that decreased ATG expression due to single nucleotide polymorphisms correlate with viral load and AD. This study suggests autophagy is a novel mechanism linking herpesvirus to AD, which may aid in finding new diagnostic and therapeutic targets. Since HHV6 is a common infection of childhood, infecting nearly 100% of humans, identifying genetic vulnerabilities to persistence and progression will be critically important for prevention of adult AD.
ABCDEFGHI Systematic Approach to Wound Assessment and Management
Authors: Hunt Sarah C. , Azad Sanjay
Published: June 2022

The ABCDEFGHI approach introduces a systematic approach to wound care. It instructs the clinician to Ask pertinent questions, including those that may identify local and systemic Barriers to wound healing. After obtaining a thorough history, the clinician may proceed to Clean the wound and Do a physical examination, specifically looking for Exposed structures and Factors that will complicate the healing process. Good Healing strategies involving various dressings can then be implemented to promote healing. If necessary, a referral can be made to Involve specialists using various referral pathways. Information used to synthesize this approach was obtained through a review of national and international guidelines and Google Scholar, MEDLINE, and PubMed databases. The ABCDEFGHI approach to wound assessment and management is a simple and easy-to-follow guide that can be easily implemented into practice, thereby improving clinician confidence and competence in wound care.

GENERAL PURPOSE

The purpose of this continuing education article is to introduce the ABCDEFGHI approach to wound assessment and management.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Distinguish barriers to wound healing.

2. Summarize best practices for wound treatment strategies.

3. Explain the usefulness of complete blood count results during a wound investigation.

4. Identify a major factor to consider when deciding on a referral for wound management.
Clinical Experience with Compression Taping to Treat Seroma After Breast Cancer Surgery: A Medical Device Clinical Study
Authors: Fabro Erica Alves Nogueira , Teodózio Clarice Gomes Chagas , Costa Rejane Medeiros , Macedo Flávia Oliveira , Cardoso Aline Cecilia Drumond Dutra Luz Machado , Jacob Raquel Barroso Evaldt , Thuler Luiz Claudio Santos , Bergmann Anke
Published: June 2022

Objective

To evaluate the safety of compressive taping in patients with seroma secondary to breast cancer surgery.

Methods

This study was a nonrandomized clinical study of medical devices applied to women indicated for seroma aspiration puncture after breast cancer surgery in a public reference hospital in Brazil. The intervention consisted of applying compressive taping over the seroma fluctuation area and maintained for 5 days. Evaluated outcomes comprised dermal changes caused by taping, subjective symptoms reported during the intervention period, and percent change in the punctured volume before and after the intervention.

Results

A total of 35 women (mean age, 56.7 ± 12.2 years) were included. Most presented with an advanced disease stage (≥IIB; 62.9%). Although a 28.6% incidence of dermal changes caused by taping was observed, an average reduction in the aspirated volume of −28.2 mL was identified (95% confidence interval, −48.3 to −8.0; P = .008). Treatment adherence was high (91.4%), and most patients reported satisfaction with the treatment (85.7%).

Conclusions

The use of compressive taping on seroma areas can be considered safe, is well accepted by patients, and might be used as a noninvasive treatment option for seroma developing after breast cancer surgery.
The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review
Authors: Avsar Pinar , Patton Declan , Sayeh Aicha , Ousey Karen , Blackburn Joanna , O’Connor Tom , Moore Zena
Published: June 2022

OBJECTIVE

This systematic review assesses the effects of care bundles on the incidence of surgical site infections (SSIs).

DATA SOURCES

The search was conducted between February and May 2021, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases.

STUDY SELECTION

Studies were included if they used systematic review methodology, were in English, used a quantitative design, and explored the use of care bundles for SSI prevention. A total of 35 studies met the inclusion criteria, and 26 provided data conducive to meta-analysis.

DATA EXTRACTION

Data were extracted using a predesigned extraction tool, and analysis was undertaken using RevMan (Cochrane, London, UK). Quality appraisal was undertaken using evidence-based librarianship.

DATA SYNTHESIS

The mean sample size was 7,982 (median, 840) participants. There was a statistically significant difference in SSI incidence in favor of using a care bundle (SSI incidence 4%, 703/17,549 in the care bundle group vs 7%, 1,157/17,162 in the usual care group). The odds ratio was 0.55 (95% confidence interval, 0.41–0.73; P < .00001), suggesting that there is a 45% reduction in the odds of SSI development for the care bundle group. The mean validity score for all studies was 84% (SD, 0.04%).

CONCLUSIONS

The results indicate that implementing care bundles reduced SSI incidence. However, because there was clinically important variation in the composition of and compliance with care bundles, additional research with standardized care bundles is needed to confirm this finding.
Health Care Leaders' Perspectives on How Continuous Professional Development Can Be Promoted in a Hospital Organization
Authors: Alsiö Åsa , Pettersson Anna , Silén Charlotte
Published: June 2022

Introduction:

Leaders play a central role in continuous learning processes aimed to improve health care. However, knowledge of how leaders with power and influence in hospital organizations promote the means for continuous learning in practice is scarce. This study aims to explore how key stakeholders in a hospital organization think about approaches and roles when promoting the reflective practice in small groups as means for continuous professional development in their organizations.

Methods:

Six key stakeholders from a regional hospital (two department directors, two ward managers, and two resident supervisors) were recruited through purposive sampling. Semi-structured interviews were conducted, and an abductive content analysis was performed.

Results:

In the current study, leaders stressed that cultural and structural conditions at all levels in the system were important for the practice of small-group learning. Yet, their suggested approaches referred exclusively to a limited part of the system and were directed to staff at lower hierarchical levels within their jurisdictions.

Discussion:

The identified gap between the suggested approaches and the claimed conditions for implementing a new strategy for continuous professional development among leaders in a health care organization illuminates difficulties in the implementation process. Providing adequate conditions at all levels of the system demands implementation approaches that include the entire hospital system. This requires that leaders first recognize their need to learn and apply a systemic perspective, and second, that they can create such learning opportunities for themselves.
Risk Factors for Canalicular Injury After Mohs Micrographic Surgery
Authors: Campbell Elliott H. , Sotelo Leon Daniel E. , Baum Christian L. , Wagner Lilly H.
Published: June 2022

BACKGROUND

There is a paucity of literature describing risk factors for canalicular injury (CI) during periocular Mohs micrographic surgery (Mohs).

OBJECTIVE

This study aimed to determine factors associated with CI after Mohs. This information may inform patient counseling and surgical planning.

MATERIALS AND METHODS

This case–control study compared subjects with canalicular injury after Mohs with subjects requiring ophthalmologic Mohs repair without canalicular injury. All subjects who had CI after Mohs were included in the control group. CI from other causes were excluded.

RESULTS

Basal cell carcinoma was the most common etiologic tumor (p < .00001). Canalicular injury was associated with infiltrative, morpheaform, and/or micronodular-type basal cell carcinoma. Initial tumor location involving the medial canthus was not statistically different between cases and controls (32% vs 17%, p = .22). Having a final defect involving the medial canthus region was more likely in cases versus controls (55% vs 26%, p = .01952).

CONCLUSION

Although most final defects involved the medial canthal region, a substantial number of tumors resulting in CI did not initially seem to involve the medial canthus. Surgeons cannot rely simply on anatomical location when assessing risk for CI, and anticipation of need for canalicular reconstruction is challenging.
Endoscopic Transmaxillary Approach for Sclerotherapy of an Infratemporal Fossa Venous Malformation
Authors: Agarwal Aarti , Rabinowitz Deborah , Parkes William
Published: June 2022

Disfiguring or symptomatic venous and lymphatic malformations are often treated with sclerotherapy. A 10-year-old girl with a history of epilepsy and migraines presented with progressive facial pain along the mandibular division of the trigeminal nerve. Magnetic resonance imaging identified a lobulated, enhancing lesion within the lateral pterygoid muscle, consistent with a venous malformation. It could not be safely approached transcutaneously; therefore, an endoscopic transmaxillary approach was offered. The lesion was localized with neuronavigation, and digital subtraction venography was employed to confirm entry into the lesion. Primary drainage via the pterygoid plexus toward the left retromandibular vein without any connections to the cavernous sinus or left orbit was identified. At this point, foam sclerosant was injected. Postoperatively, the facial pain resolved, and magnetic resonance imaging demonstrated an excellent response to the sclerotherapy. To our knowledge, this is the first report of an endoscopic transmaxillary approach for sclerotherapy of an infratemporal fossa venous malformation.
Exacerbation and severity of allergic symptoms during pregnancy and their impact on mental health
Authors: Yonezawa Kaori , Haruna Megumi , Yamamoto-Hanada Kiwako , Ohya Yukihiro
Published: June 2022

Background:

Pregnant women with allergies face difficulties, as they tend to avoid medication for symptom control during pregnancy. Moreover, some women experience exacerbations during this period. These difficulties can affect their mental health.

Objective:

This study aimed to investigate the factors influencing allergy exacerbations during pregnancy and examine the effects of allergy symptoms on the mental health of pregnant women.

Methods:

A cross-sectional study was conducted through web-based research in March 2020, amid the COVID-19 pandemic. Pregnant women were collected from 3 groups (target: 150 participants in each group): atopic dermatitis (AD), allergic rhinitis, and without allergies. We evaluated mental health using Kessler Psychological Distress Scale (K6) and health-related quality of life using the Short Form-8 questionnaire.

Results:

Overall, 202 (49.1%) of 411 pregnant women had depressive symptoms, and 45 (10.9%) had severe depressive symptoms. Women with allergies had significantly worse mental health than those without allergies. Among 119 AD patients, 36 (30.3%) experienced exacerbations during pregnancy. Of them, 11 (30.6%) did not consult a practitioner and endured the exacerbation. A significant association was observed between severe prepregnancy symptoms, job situation, coping with symptoms of AD during pregnancy, and AD exacerbation. Among 210 rhinitis patients, 17.1% experienced rhinitis exacerbation during pregnancy. The presence of rhinitis symptoms in winter and the second trimester was significantly associated with exacerbation.

Conclusion:

This study revealed higher rates of depressive symptoms among pregnant women with allergies. The psychological well-being of pregnant women with AD or allergic rhinitis should be considered.
Assessing quality of life in patients with autoimmune bullous diseases using the Persian version of Treatment of Autoimmune Bullous Disease Quality of Life questionnaire finds similar effects in women as men
Authors: Behkar Atefeh , Garmaroudi Gholamreza , Nasimi Maryam , Yousefi Shakiba , Khosravi Hasan , Kianfar Nika , Murrell Dedee F. , Daneshpazhooh Maryam
Published: June 2022

Background:

In autoimmune bullous diseases (AIBDs), autoantibodies loosen molecular adhesions in the skin and/or mucosa and lead to blisters and erosions. Immunosuppressive drugs reduce mortality of the AIBD; therefore, patients will have to live longer with comorbidities.

Objective:

This study aims to determine the quality of life of AIBD patients undergoing systemic treatment while investigating the survey’s relationship with various factors.

Methods:

In this 2-step cross-sectional study, we initially included 53 consecutive pemphigus patients to investigate reliability and validity of the Persian version of Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaire. Then, we conducted the study on 119 AIBD patients, currently under treatment at an AIBD clinic in Iran.

Results:

The mean TABQOL score for our patients was 13.87 ± 7.51. The highest TABQOL was for epidermolysis bullosa acquisita (24 ± 8.485) followed by pemphigus foliaceus (20.5 ± 14.181) and the lowest for pemphigus vulgaris (13.24 ± 6.54). There was no significant difference between patients’ TABQOL scores and their gender, history of rituximab injection, and disease severity scores. We only found a positive correlation between TABQOL and prednisolone dose.

Conclusion:

Treatments of AIBD considerably impact the quality of life of patients and an impairment in quality of life is correlated to higher doses of prednisolone.
Impact of trends in new and emerging contact allergens
Authors: Rodriguez Olaf , Brod Bruce A. , James William D.
Published: June 2022

Allergic contact dermatitis represents a T cell-mediated, delayed-type hypersensitivity response to exogenous agents. While allergic contact dermatitis is one of the most common causes of skin disease encountered by dermatologists, emerging trends within the field are in constant flux, as influenced by ever-changing industry practices and evolving consumer behaviors. Although certain allergens continue to predominate, new chemicals are frequently being introduced, thus shifting the pattern of allergen exposure and sensitization. This review examines the impact of trends in new and emerging contact allergens, with particular attention to clinical contexts in which these agents may be encountered. In addition, we offer a working knowledge of these allergens’ characteristics, sources, and relevance, while outlining recommendations to accurately evaluate, diagnose, and provide appropriate counseling for these diseases.
The impact of gender and sex in psoriasis: What to be aware of when treating women with psoriasis
Authors: Guillet Carole , Seeli Corsin , Nina Meienberger , Maul Lara Valeska , Maul Julia-Tatjana
Published: June 2022

Background:

Psoriasis is a common chronic inflammatory skin disease with an exceptionally high burden for women.

Objective:

Sex-dependent differences in disease manifestation, severity, treatment choices, subjective disease perception, and the impact on quality of life and risk factors are described and comprehensively discussed.

Methods:

A literature search was conducted using MEDLINE (PubMed) and the Cochrane Library for systematic reviews to investigate the challenges in treating women with psoriasis.

Results and conclusions:

The incidence, prevalence, and manifestation of psoriasis of the skin are similar between different sexes. Genetic and environmental factors such as obesity and metabolic syndrome are risk factors and are not equally relevant or pronounced in women and men. Overall, women have a lower disease severity measured by the Psoriasis Area Severity Index, which is associated with a higher impairment of their life quality measured by the Dermatology Life Quality Index compared with men. In addition, women with psoriasis are more likely to have depression than men. Hormonal factors affect psoriasis, with a correlation of high estrogen levels and improvement of psoriasis. Data regarding differences in prescribing patterns of systemic treatments and the severity of psoriasis are not entirely consistent. Registry studies show that men tend to have more severe psoriasis and, in some cases, are prescribed systemic therapies more frequently. Women tend to respond better to systemic treatments and to experience more adverse events. Treatment options are the same for both sexes, except during pregnancy and lactation. Various treatment options are contraindicated due to fear of fetal or neonate harm and lack of data. Topical steroids can be prescribed with a high degree of safety during pregnancy. For other topical therapies (calcineurin inhibitors and vitamin D analogs), no studies of adverse effects in pregnancy are available, and safety data mainly stem from studies examining effects after systemic administration. Antitumor necrosis factor monoclonal antibodies (except for certolizumab pegol) have been associated with a possible increased risk of preterm birth, low gestational age, and cesarean deliveries. Prospective data on the safety of biologics other than antitumor necrosis factor-alpha antibodies to accurately assess whether novel biologics (eg, anti-interleukin 17, 12/23, 23) can be used for systemic therapy in pregnancy are lacking or currently being conducted.
Challenges for dermatologists during the COVID-19 pandemic: A qualitative study
Authors: Helm Matthew F. , Kimball Alexa B. , Butt Melissa , Stuckey Heather , Costigan Heather , Shinkai Kanade , Nagler Arielle R.
Published: June 2022

Background:

Burnout is increasing in all fields of medicine, including dermatology. The coronavirus disease 2019 (COVID-19) pandemic presented new and additional challenges for dermatologists.

Objective:

Dermatologists of different ages, areas of expertise, and practice settings were convened in 5 focus group to describe the impact of the COVID-19 pandemic on their clinical practice, working environment, and personal lives.

Methods:

Qualitative analysis of the discussions w\s performed on the result of the 5 focus groups of dermatologists (n = 22). Groups were prompted with questions relating to their jobs, personal lives, teledermatology, and pandemic. Responses were recorded, transcribed, deidentified, and coded for recurring themes. The focus groups occurred via a secure videoconferencing platform between December 2020 and January 2021. All participants were currently practicing dermatology in a variety of setting including academic institutions, private practices, and multiple practice types. General dermatologists, residents in training, dermatologic surgeons, dermatopathologists, and dermatologists with significant administrative or educational duties were included.

Results:

We identified 4 main themes from the focus group discussions regarding dermatologist and physician wellbeing during the COVID-19 pandemic: (1) adjusting to new administrative, staffing, and educational demands; (2) integration of work as a dermatologist with family life; (3) new technologies such as teledermatology; and (4) adjusting to change with redefining personal and professional priorities.

Limitations:

The small number of participants in our convenience cohort disproportionately represented academic dermatologists. Impacts of regional COVID-19 vaccination rates and ideological differences in different geographical locations were not assessed. All of our participants were located in the United States. Physicians severely impacted by health or financial concerns may not have been able to participate in our study. We did not have a comparison group and did not measure or assess burnout in individual participants.

Conclusion:

During the COVID-19 pandemic, there were common changes and stressors that dermatologists experienced, which affected physician wellbeing. Identifying and addressing these changes could offer the opportunity to improve the wellbeing of dermatologists.
Analysis of Factors Potentially Influencing Diagnostic Yield Among Computed Tomography-Guided Biopsies for Bone Lesions
Authors: Yoon Garrett H. , Gavilá Elisa Ramos , Wei Jason , Burke Christopher J. , Walter William R.
Published: June 2022

Objective

This study aimed to investigate patient-specific, lesion-related, and technical factors that potentially influence diagnostic yield of computed tomography (CT)–guided biopsies of bone lesions.

Methods

Computed tomography–guided bone lesion biopsies performed over a 2-year period were retrospectively reviewed, including image review and electronic medical records for pathology reports and clinical follow-up. Lesions were tabulated by prebiopsy CT and magnetic resonance imaging features. Patients with nondiagnostic biopsies were assessed for presumptive clinical diagnosis and management.

Results

Nondiagnostic pathology results were obtained in 31 of 156 cases (19.87%), among which diagnoses were confirmed by other tissue sampling in 9; clinical follow-up of up to 2 years yielded no diagnosis in 10 and presumptive diagnoses in 12. The nondiagnostic biopsy rate of long bone lesions was higher than that of other bone lesions (odds ratio, 3.46; 95% confidence interval, 1.32–9.09). There were no significant differences in patient American Society of Anesthesiologists class, mean body mass index, sedation method, number of cores, or needle gauge between diagnostic and nondiagnostic biopsy cohorts. Diagnostic yield was not significantly different between occult, lytic, or sclerotic lesions. There was no difference in diagnostic yield regarding presence of cortical break, gadolinium enhancement, or lesion depth. Magnetic resonance imaging was obtained before biopsy in significantly more nondiagnostic cases compared with diagnostic cases (P = 0.027).

Conclusions

Computed tomography–guided biopsies had a nondiagnostic rate of 19.87%, and lesions in the long bones of the extremities were disproportionately common among this group. There was no significant association between biopsy results and several patient-specific, lesion-related, and technical factors.
Performance of Ultra-High-Resolution Computed Tomography in Super High–Resolution Mode at the Routine Radiation Dose: Phantom Study
Authors: Kitera Nobuo , Fujioka Chikako , Higaki Toru , Nishimaru Eiji , Yokomachi Kazushi , Kiguchi Masao , Awai Kazuo
Published: June 2022

Objective

Using a chest phantom, we compared the image quality of ultra-high-resolution computed tomography (U-HRCT) images acquired in super high–resolution (SHR) and normal resolution (NR) mode and at the routine radiation dose. The detector size was 0.25 and 0.5 mm, respectively.

Methods

A chest phantom was scanned on a U-HRCT scanner. The scan parameters were tube voltage 120 kV and volume CT dose index 13.0 mGy, the routine radiation dose for conventional scans. The rotation time was 0.5 s/rot, the number of matrices was 512 in NR and 1024 in SHR mode. For physical evaluation, the modulation transfer function was measured on the spherical simulated nodule, and the noise power spectrum on the cylindrical water phantom. A CT value profile curve was created using an in-house simulated bronchial phantom. For visual evaluation, 3 radiologists and 3 radiology technologists evaluated overall image quality using a 4-grade scale (grade 1, poor; and grade 4, excellent).

Results

The 10% of modulation transfer function was 13.5 lp/cm in NR and 14.9 lp/cm in SHR mode (P<0.01). ƒpeak was 5.6 lp/cm in NR and 8.8 lp/cm in SHR mode (P<0.01), and the peak of noise power spectrum shifted. On the profile curves, the CT value at the edge changed in NR but not in SHR mode. The overall image quality was grade 3.0 ± 0.7 in SHR and grade 2.0 ± 0.7 in NR mode (P<0.01).

Conclusions

The image quality of SHR mode with U-HRCT was superior to that of NR mode at the routine radiation dose.
Volatile compounds from in vitro metabolism of seven Listeria monocytogenes isolates belonging to different clonal complexes
Authors: Lepe-Balsalobre Esperanza , Rubio-Sánchez Ricardo , Ubeda Cristina , Lepe José Antonio
Published: June 2022

Microorganisms produce a wide variety of volatile organic compounds (VOCs) as products of their metabolism and some of them can be specific VOCs linked to the microorganism's identity, which have proved to be helpful for the diagnosis of infection via odour fingerprinting. The aim of this study was to determine the VOCs produced and consumed to characterize the volatile metabolism of seven isolates of different clonal complexes (CCs) of

Listeria monocytogenes

. For this purpose, dichloromethane extracts from the thioglycolate broth medium were analysed by gas chromatography coupled to mass spectrometry (GC/MS). Also, multivariate analyses were applied to the data obtained. Results showed that all the isolates of

L. monocytogenes

produced de novo isobutanol, 2-methyl-1-butanol, 3-methyl-1-butanol, 3-(methylthio)−1-propanol, acetic acid, isobutyric acid, butanoic acid, and isovaleric acid. Significant differences were found among isolates for the production amount of these volatiles, which allowed their differentiation. Thus, CC4 (ST-219/CT-3650) and CC87 (ST-87/CT-4557) showed an active volatile compounds metabolism with high consumption nitrogen and sulphur compounds and production of alcohols and acids, and CC8 (ST-8/CT-8813) and CC3 (ST-3/CT-8722) presented a less active volatile metabolism. Moreover, within the VOCs determined, huge differences were found in the production of butanol among the seven isolates analysed, being probably a good biomarker to discriminate among isolates belonging to different CCs. Hence, the analysis of volatile profile generated by the growth of L. monocytogenes in vitro could be a useful tool to differentiate among CCs isolates.