bluuebunny/crossref_metadata_2025 huggingface dataset:
In Patients With Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate
Authors: Iles Kathleen A , Heisler Stephen , Chrisco Lori , King Booker , Williams Felicia N , Nizamani Rabia
Published: May 2021

In this retrospective analysis, we investigated the rate of radiologically confirmed osteomyelitis, extremity amputation, and healthcare utilization in both the diabetic and nondiabetic lower extremity burn populations to determine the impact of diabetes mellitus on these outcomes. The burn registry was used to identify all patients admitted to our tertiary burn center from 2014 to 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Statistical analysis was performed using Student’s t-test, chi-squared test, and Fisher’s exact test. Of the 315 patients identified, 103 had a known diagnosis of diabetes mellitus, and 212 did not. Seventeen patients were found to have osteomyelitis within three months of the burn injury. Fifteen of these patients had a history of diabetes. Notably, when nondiabetics were diagnosed with osteomyelitis, significant differences were observed in both length of stay and cost in comparison to their counterparts without osteomyelitis (36 vs 9 days; P = .0003; $226,289 vs $48,818, P = .0001). Eleven patients required an amputation and 10 (90.9%) of these patients had comorbid diabetes and documented diabetic neuropathy. Compared to nondiabetics, the diabetic cohort demonstrated both a higher average length of stay (13.7 vs 9.2 days, P-value = .0016) and hospitalization cost ($72,883 vs $50,500, P-value = .0058). Our findings highlight that diabetic patients with lower extremity burns are more likely to develop osteomyelitis than their nondiabetic counterparts and when osteomyelitis is present, diabetic patients have an increased amputation rate. Further study is required to develop protocols to treat this population, with the specific goal of minimizing patient morbidity and optimizing healthcare utilization.
A Combination Sulfuryl Fluoride and Propylene Oxide Treatment for Trogoderma granarium (Coleoptera: Dermestidae)
Authors: Myers Scott W , Ghimire Mukti N , Arthur Frank H , Phillips Thomas W
Published: May 2021

The khapra beetle, Trogoderma granarium, is an important quarantine pest of stored-products. While it is not established in the North America, frequent interceptions highlight the need for treatments to eradicate isolated populations if they occur. Methyl bromide has long been the standard fumigant used for this purpose; however, increasing restrictions on its use necessitate the development of new treatment options. Here we evaluate a treatment for khapra beetle using a combination of sulfuryl fluoride (SF) and propylene oxide (PPO). Experiments were conducted to determine the most tolerant stages and the effective rates for each compound. Combination treatments using both products were then evaluated at several temperatures to determine effective doses for quarantine level control. The egg stage was by far the most tolerant to SF, requiring concentration × time (CT) products roughly 10-fold greater than the next most tolerant stage, diapausing larvae. Diapausing larvae were significantly more tolerant to SF than non-diapausing larvae in a recently collected ‘field’ strain, but not in a more than 30-yr-old ‘laboratory’ culture. PPO treatments were shown to completely control the egg stage at CTs greater than 155 hr-mgL-1 at both 10 and 20°C. Resulting combination treatments with initial dose rates of 96 and 40 mgL-1 at 10°C and 80 and 40 mgL-1 at 20°C are proposed for SF and PPO, respectively. These combination treatments utilize SF’s efficacy against the larval stage along with PPO’s superior ovicidal properties to provide enhanced treatment efficacy over each product alone against all life stages of khapra beetle.
Causes and Expectations: On the Interpretation of the Tagalog Ability/Involuntary Action Form
Authors: Alonso-Ovalle Luis , Hsieh Henrison
Published: May 2021

The Tagalog Ability/Involuntary Action (aia) verbal form conveys apparently unrelated modal meanings: that an action was within what an agent could do or that it was beyond what an agent could control, for instance. Recent analyses for the Malagasy and St’át’imcets counterparts of this form propose that this morphology contributes circumstantial modality and conveys, roughly, that the event described follows from a set of facts ( Davis et al., 2009; Paul et al., 2016). We discuss some challenges for extending this type of analysis to Tagalog and present an alternative proposal. We follow previous analyses in assuming that the aia form projects its domain of possibilities from a set of facts, but depart from these analyses by proposing (i) that the modal component of the Tagalog aia form is non-at-issue and (ii) that it conveys, via a presupposition, that this event was not expected given the facts that the described event is taken to causally depend on.
Session 2: Noticing Slip-Ups
Authors: Smart Colette M.
Published: May 2021

The second session involves taking a deeper dive into mindfulness practice. We begin by having a discussion about your initial experience with mindfulness from the prior week. As this mindfulness might be quite novel for certain people, it is possible that you or others in the group may have strong opinions or emotional reactions to the homework. All of this discussion material is welcomed as a way to start exploring the topic of cognitive slip-ups as we age—something common to almost all older adults—and how mindfulness can be one way to offset those slips. You will then be introduced to the concept of cognitive reserve as a “mental bank account” that can be enhanced through mindfulness.
Applied Cognitive Behavioral Therapy in Schools
Authors: Joyce-Beaulieu Diana , Zaboski Brian A.
Published: May 2021

One-quarter of students will experience mental health needs during their education, and many schoolchildren will never receive professional help at all. Because youth spend most of their time in school, school-based practitioners are in a unique position to remediate these needs. In this text, readers will learn the theoretical and practical applications of cognitive behavioral therapy (CBT), a scientifically based intervention for problems like behavioral dysregulation, anxiousness, emotional disturbances, trauma, family conflict, and the typical trials and tribulations of growing up. After offering practitioners invaluable micro skills (e.g., rapport building, relaxation techniques) and establishing a foundation of cultural competence, this text presents core CBT skills—behavioral activation, cognitive restructuring, and exposure and response prevention—essential for new and veteran practitioners alike. The text thoroughly addresses technological advancements in CBT, including therapy apps, e-readers, and virtual games. Rounding out the intervention process, it concludes by describing therapeutic closure and offering additional treatment options for more severe case presentations. With numerous school-based examples, detailed case presentations, and printable resources, this text provides both a thorough introduction and an excellent review of contemporary school-based CBT.
Theory and Research
Authors: Zaboski Brian A. , Romaker Emma , Joyce-Beaulieu Diana
Published: May 2021

Cognitive behavioral therapy (CBT) was created by two central figures, Albert Ellis and Aaron T. Beck, both of whom contributed uniquely to its contemporary formulation. Since its inception, CBT’s research and clinical applications have spanned thousands of scientific papers and assisted many more children, adolescents, and families. This chapter discusses CBT’s theoretical development and the differing and converging views of its central theorists and describes three major theoretical conceptualizations: rational-emotive behavior therapy, cognitive therapy, and a general model. This chapter then reviews CBT’s research effectiveness for a wide range of internalizing and externalizing disorders, including anxiety, depression, autism, oppositional defiant disorder, and attention-deficit/hyperactivity disorder. It concludes with a case study delineating the two major theoretical approaches.
Core CBT Components
Authors: Purvis Lee N. , Zaboski Brian A. , Joyce-Beaulieu Diana
Published: May 2021

Chapter 6 describes two core components of cognitive behavioral therapy (CBT): behavioral activation and cognitive restructuring. These two components are viewed as first-line interventions for depression and mood disturbances. Chapter 6 begins by describing behavioral activation and walking practitioners through each step of the intervention process. It describes how practitioners can assist clients to identify their values, monitor their activities, and build behavioral activation hierarchies to address demotivation, anhedonia, and maladaptive thoughts. The second part of the chapter discusses cognitive restructuring, whereby children and adolescents learn how to evaluate evidence for their thoughts, create thought records, and assess the validity of their thoughts. The efficacy of both techniques is reviewed, as well as progress-monitoring strategies.
Scoping Review on Menstrual Suppression Among U.S. Military Service Members
Authors: Phillips Angela K , Lynn Amy B
Published: May 2021

Introduction

The purpose of this scoping review was to systematically evaluate literature addressing menstrual suppression in the military population and to identify gaps in the literature.

Materials and Methods

A scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines was completed. Quality appraisal was conducted using the Johns Hopkins Evidence-Based Practice (EBP) Evidence Level and Quality Guide.

Results

Thirteen research articles and nine non-research articles were included. The themes identified were methods for menstrual suppression, barriers to menstrual suppression, and educational recommendations.

Conclusions

Six gaps were identified: (1) readiness, (2) single branch of service, (3) options for suppression, (4) hesitance to suppress, (5) provider practices, and (6) stagnant research. Recommendations for future research, practice, and military health policy are provided. Expanding research on menstrual suppression in U.S. military service members will enhance the health of military service members, provider practices, and military health policy to promote military readiness.
A Case of Periprosthetic Joint Infection Because ofRothia Mucilaginosa
Authors: Schermerhorn Janse T , Colantonio Donald F , Larson Derek T , McGill Robert J
Published: May 2021

Periprosthetic joint infection (PJI) is a rare but devastating complication of total joint arthroplasty. Identifying the offending infectious agent is essential to appropriate treatment, and uncommon pathogens often lead to a diagnostic delay. This case describes the first known instance of a total knee arthroplasty (TKA) with Rothia mucilaginosa, a typical respiratory tract organism. This report aims to provide insight into the treatment of this atypical PJI, as there are only six previously published cases of Rothia species PJI septic arthritis. The patient is a 64-year-old diabetic male who underwent a right TKA and left TKA ∼6 months later. Approximately 3 weeks status post-left TKA, he showed evidence of left PJI. One year after treatment and recovery from his left PJI, he presented with several months of right knee pain and fatigue. Subsequent labs and imaging revealed right PJI. No recent history of dental disease or work was observed. He then underwent two-stage revision right knee arthroplasty and microbial cultures yielded Rothia mucilaginosa. After initial empiric treatment, antibiotic therapy was narrowed to 6 weeks of vancomycin. Following negative aspiration cultures the patient underwent reimplantation of right TKA components. One year following treatment, the patient was fully recovered with no evidence of infection. This case emphasizes the possibility of microbial persistence despite various antibiotic treatment regimens for the patient’s contralateral knee arthroplasty and PJI. Additionally, this case demonstrates the importance of two-stage revision in patients with PJI, and the viability of treating Rothia species PJIs with vancomycin.
Parasite common envelope evolution by triple-star systems
Authors: Soker Noam , Bear Ealeal
Published: May 2021

We study a scenario in which a giant wide tertiary star engulfs and forces a tight binary system of a white dwarf (WD) and a main-sequence (MS) star to enter a common envelope evolution (CEE) with each other, and then unbinds the WD–MS common envelope. The WD–MS binary system, now with the WD inside the MS envelope, does not have sufficient orbital energy to unbind their common envelope. However, as they approach the centre of the giant star Roche lobe overflow to the core of the giant star and/or merger of the WD with the core remove a large fraction of the WD–MS common envelope or all of it. Namely, the energy source for unbinding the WD–MS tight common envelope is the triple-star CEE. For that, we term this scenario a parasite CEE. Overall, the destruction of the MS star absorbs energy from the triple-star system, a process that might lead to WD–core merger during the triple-star CEE. The parasite CEE leaves behind either one massive WD that in some cases might explode as a peculiar Type Ia supernova or two close WDs that at later time might explode as a Type Ia supernova. We very crudely estimate the rate of the parasite CEE to be a fraction of ≈0.001 out of all evolved triple stars.
Force-free magnetic flux ropes: inner structure and basic properties
Authors: Solov'ev A A , Kirichek E A
Published: May 2021

There are two main properties of a shielded magnetic flux rope. The first is the net electric current through its cross-section should be zero, i.e. $I = 0$. The second is the existence of a non-zero pressure of external magnetic field ${{B_{ex}^2} {/ {\vphantom {{B_{ex}^2} {8\pi}}}} {8\pi }}$ in order to keep in balance the magnetic rope with the strong force-free inner structure in a rarefied solar atmosphere. The first condition requires the existence of a special cylindrical surface within the magnetic flux rope on which the current density j changes sign, so that the direction of the current at the rope’s periphery (return current) is opposite to the current at its axis (direct current). Numerical calculations have shown that, when the pressure ${{B_{ex}^2} {/ {\vphantom {{B_{ex}^2} {8\pi }}}} {8\pi }}$ drops to a certain limit, an indefinite increase in the electric current density j and the force-free parameter $\alpha $ takes place in the vicinity of this special surface resulting in a dissipative collapse of the system. Such a drop in ${{B_{ex}^2} {/ {\vphantom {{B_{ex}^2} {8\pi }}}} {8\pi }}$ may happen due to a multitude of reasons with the most obvious reason being the uprise of a magnetic flux rope into rarefied layers of the chromosphere or corona. Due to the dissipative collapse a violent energy release begins in a thin azimuthal shell at the periphery of the twisted magnetic flux tube. On the basis of these properties of the force-free magnetic flux rope, the problems of plasma instabilities excitation and coronal heating are discussed.
Break-up of the synchronous state of binary asteroid systems
Authors: Wang Hai-Shuo , Hou Xi-Yun
Published: May 2021

This paper continues the authors’ previous work and presents a coplanar averaged ellipsoid–ellipsoid model of synchronous binary asteroid system (BAS) plus thermal and tidal effects. Using this model, we analyse the break-up mechanism of the synchronous BAS. Different from the classical spin-orbit coupling model that neglects the rotational motion’s influence on the orbital motion, our model considers simultaneously the orbital motion and the rotational motions. Our findings are as follows: (1) Stable region of the secondary’s synchronous state is mainly up to the secondary’s shape. The primary’s shape has little influence on it. (2) The stable region shrinks continuously with the increasing value of the secondary’s shape parameter aB/bB. Beyond the value of $a_B/b_B=\sqrt{2}$, the planar stable region for the secondary’s synchronous rotation is small but not zero. (3) Considering the BYORP torque, our model shows agreement with the 1-degree-of-freedom adiabatic invariance theory in the outwards migration process, but an obvious difference in the inwards migration process. In particular, our studies show that the so-called ‘long-term’ stable equilibrium between the BYORP torque and the tidal torque is never a real equilibrium state, although the BAS can be captured in this state for quite a long time. (4) In case that the primary’s angular velocity gradually reduces due to the YORP effect, the secondary’s synchronous state may be broken when the primary’s rotational motion crosses some major spin-orbit resonances.
Prior Statin Use and Risk of Mortality and Severe Disease From Coronavirus Disease 2019: A Systematic Review and Meta-analysis
Authors: Yetmar Zachary A , Chesdachai Supavit , Kashour Tarek , Riaz Muhammad , Gerberi Danielle J , Badley Andrew D , Berbari Elie F , Tleyjeh Imad M
Published: May 2021

Background

Statins up-regulate angiotensin-converting enzyme 2, the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while also exhibiting pleiotropic antiviral, antithrombotic, and anti-inflammatory properties. Uncertainties exist about their effect on the course of SARS-CoV-2 infection. We sought to systematically review the literature and perform a meta-analysis to examine the association between prior statin use and outcomes of patients with coronavirus disease 2019 (COVID-19).

Methods

We searched Ovid Medline, Web of Science, Scopus, and the preprint server medRxiv from inception to December 2020. We assessed the quality of eligible studies with the Newcastle-Ottawa quality scale. We pooled adjusted relative risk (aRRs) of the association between prior statin use and outcomes of patients with COVID-19 using the DerSimonian-Laird random-effects model and assessed heterogeneity using the I2 index.

Results

Overall, 19 (16 cohorts and 3 case-control) studies were eligible, with a total of 395 513 patients. Sixteen of 19 studies had low or moderate risk of bias. Among 109 080 patients enrolled in 13 separate studies, prior statin use was associated with a lower risk of mortality (pooled aRR, 0.65 [95% confidence interval {CI}, .56–.77], I2 = 84.1%) and a reduced risk of severe COVID-19 was also observed in 48 110 patients enrolled in 9 studies (pooled aRR, 0.73 [95% CI, .57–.94], I2 = 82.8%), with no evidence of publication bias.

Conclusions

Cumulative evidence suggests that prior statin use is associated with lower risks of mortality or severe disease in patients with COVID-19. These data support the continued use of statins medications in patients with an indication for lipid-lowering therapy during the COVID-19 pandemic.
Investigating the effects of a novel rumen-protected folic acid supplement on feedlot performance and carcass characteristics of beef steers
Authors: Deters Erin L , Niedermayer Emma K , Genther-Schroeder Olivia N , Blank Christopher P , Carmichael Remy N , Hartman Sarah J , Messersmith Elizabeth M , VanValin Katherine R , Branine Mark E , Hansen Stephanie L
Published: May 2021

Angus-crossbred steers (n = 180; 292 ± 18 kg) from a single ranch were used to investigate the effects of a novel rumen-protected folic acid (RPFA) supplement on feedlot performance and carcass characteristics. On d 0, steers were blocked by body weight to pens (5 steers/pen), and pens within a block were randomly assigned to dietary treatments (n = 6 pens/treatment): target intake of 0 (CON), 30 (RPFA-30), 60 (RPFA-60), 90 (RPFA-90), 120 (RPFA-120), or 150 (RPFA-150) mg RPFA·steer−1·d−1. Steers were weighed before feeding on d −1, 0, 55, 56, 86, 87, 181, and 182. Pen average daily gain (ADG), dry matter intake (DMI), and gain:feed (G:F) were calculated for growing (d 0 to 56), dietary transition (d 56 to 87), finishing (d 87 to 182), and overall (d 0 to 182). Liver and blood samples were collected from two steers/pen before trial initiation and at the end of growing and finishing. Steers were slaughtered on d 183, and carcass data were collected after a 48-h chill. Data were analyzed as a randomized complete block design using ProcMixed of SAS 9.4 (fixed effects of treatment and block; experimental unit of pen). Liver abscess scores were analyzed using the Genmod Procedure of SAS 9.4. Contrast statements assessed the polynomial effects of RPFA. Supplemental RPFA linearly increased plasma folate at the end of growing and finishing (P < 0.01), and linearly decreased plasma glucose at the end of growing (P = 0.01). There was a cubic effect of RPFA on liver folate at the end of growing (P = 0.01), driven by lesser concentrations for RPFA-30, RPFA-60, and RPFA-150. Growing period ADG and G:F were greatest for CON and RPFA-120 (cubic P ≤ 0.03). Transition period DMI was linearly increased due to RPFA (P = 0.05). There was a tendency for a cubic effect of RPFA on the percentage of livers with no abscesses (P = 0.06), driven by a greater percentage of non-abscessed livers in RPFA-30 and RPFA-60. Despite supplementing 1 mg Co/kg DM, and regardless of treatment, plasma vitamin B12 concentrations were low (<200 pg/mL), which may have influenced the response to RPFA as vitamin B12 is essential for recycling of folate.
Precision medicine for cow's milk immunotherapy in clinical practice
Authors: Miura Yoko , Nagakura Ken-ichi , Sato Sakura , Yanagida Noriyuki , Ebisawa Motohiro
Published: May 2021

Purpose of review

Several novel immunotherapies have recently been reported for the treatment of cow's milk allergy (CMA). However, systematic methods for the selection of immunotherapy in clinical practice have not been investigated. In this review, we have provided suggestions for safe and effective immunotherapy for patients with CMA.

Recent findings

Recent studies on cow's milk immunotherapy, using lower target doses, heated or baked cow's milk, combination treatment with adjuvants, or various routes of immunotherapy, included school-aged children with severe allergies, infants, and patients with mild CMA. These patients were administered various maintenance doses for various time periods. In the selection of immunotherapy, it would be useful to consider the patient's age and CMA severity at baseline: threshold dose, history of cow's milk anaphylaxis, and cow's milk-specific IgE levels.

Considering the risks and benefits for patients with CMA, appropriate treatment should be selected based on the current evidence. Low-dose oral immunotherapy may be useful in clinical practice for school-aged children with severe CMA. Additional studies are needed to assess the indications for immunotherapy to select appropriate treatments in real-life settings.
Is Gastric Bypass a Risk Factor for Complicated Alcohol Withdrawal? Case Report and Literature Review
Authors: Cuperfain Ari B. , Costa Tianna , Chopra Nitin
Published: May 2021

Alcohol use disorder and gastric bypass surgery are highly comorbid. Alcohol withdrawal syndrome (AWS) is a common and potentially life-threatening event, requiring nuanced and individually tailored management depending on various clinical factors including patient history, alcohol consumption, comorbidities, and timeline of use. Although increasingly common, the literature for managing alcohol withdrawal in the gastric bypass population is quite limited. We present the case of a 45-year-old woman with a past history of Roux-en-Y gastric bypass admitted for alcohol withdrawal at a psychiatric hospital who experienced a complicated withdrawal despite adhering to standard management guidelines. She had been consuming 8 to 12 standard drinks daily, and she was therefore monitored on a Clinical Institute Withdrawal Assessment for Alcohol. She experienced only minimal withdrawal symptoms up to 48 hours following cessation of alcohol consumption. At 70 hours postcessation, she experienced a witnessed tonic-clonic seizure with associated head trauma with internal bleeding, requiring acute medical intervention. This timeline of withdrawal symptoms is atypical, yet perhaps understood in the context of her past medical history which included gastric bypass surgery. We discuss the potential complicating factors inherent in individuals who have received Roux-en-Y gastric bypass in the past with respect to alcohol metabolism. We discuss the similar considerations with respect to altered metabolism of therapeutics commonly used in managing this condition. Lastly, we include a review of the extent literature on this topic and propose possible considerations for managing this unique but increasingly prevalent clinical scenario.
Telescoping screw fixation compared to traditional in situ screw fixation for slipped capital femoral epiphysis: clinical, radiographic and patient-reported outcomes
Authors: Hansen Cody H. , Bomar James D. , Badrinath Raghav , Upasani Vidyadhar V.
Published: May 2021

This study compares clinical, radiographic and patient-reported outcomes among telescoping and traditional screws for the treatment of slipped capital femoral epiphysis (SCFE). We hypothesized that telescoping screws would prevent slip progression and result in preserved femoral neck growth and improved patient-reported outcomes. Traditional screws were compared to telescoping screws in a 2:1 matched cohort based on age at initial surgery, length of radiographic follow-up and whether or not the hip was pinned prophylactically or as a treatment for SCFE. Neck length and telescoping screw length were measured. The patient-reported outcomes were obtained at routine clinic visits. Total 42 hips were included with a mean follow-up of 24.5 ± 3.3 months. No patients developed avascular necrosis, chondrolysis or needed revision surgical procedures. Telescoping screws increased in length for the entire cohort by a mean of 6.0 ± 4.3 mm. Neck length change was not different in SCFE hips when treated with traditional screws vs. telescoping screws (P = 0.527). However, there was a difference in neck length change between the two groups when comparing prophylactically treated hips (P = 0.001). There were no significant differences in patient-reported outcomes among hips treated with telescoping screws compared to traditional screws. Traditional and telescoping screws are both effective for the treatment of SCFE. Telescoping screws have an advantage when prophylactically treating hips that are at risk of slipping as they don’t lead to the coxa breva that is seen with traditional screws. However, both treatment methods had similar patient-reported outcomes.
Using Nonheparin Anticoagulant to Treat a Near-Fatal Case With Multiple Venous Thrombotic Lesions During ChAdOx1 nCoV-19 Vaccination-Related Vaccine-Induced Immune Thrombotic Thrombocytopenia
Authors: Bersinger Samuel , Lagarde Kevin , Marlu Raphael , Pernod Gilles , Payen Jean-Francois
Published: May 2021

OBJECTIVES:

To describe the successful recovery from multiple and life-threatening venous thrombosis after ChAdOx1 nCoV-19 vaccination.

DESIGN:

Case report.

SETTING:

University Hospital.

Patient:

Few days after the first dose of the ChAdOx1 nCoV-19 vaccine, a 21-year-old woman experienced massive thrombosis in the deep and superficial cerebral veins together with seizures, neurologic focal deficit, and thrombocytopenia. In the neurointensive care unit, her condition worsened despite early decompressive craniectomy. She developed bilateral segmental pulmonary embolism, left hepatic, and left external iliac venous thrombosis.

INTERVENTION:

Argatroban (0.5–2.2 µg/kg/min) and high-dose IV immunoglobulin (1 g/kg/d for 2 consecutive days) were initiated on day 6 after admission. With these therapies, there was a gradual resolution of multiple sites of venous thrombosis, and platelet count returned to normal. The patient left the ICU with full consciousness, expressive aphasia, and right hemiparesis.

CONCLUSIONS:

This case of vaccine-induced immune thrombotic thrombocytopenia shows that a good outcome can be obtained even with multiple and life-threatening venous thrombotic lesions. Argatroban and high-dose IV immunoglobulin along with management of severe cerebral venous thrombosis played a major role in this epilogue.
Histone deacetylase inhibitor Vorinostat (SAHA) suppresses micropthalmia transcription factor expression and induces cell death in nevocytes from large/giant congenital melanocytic nevi
Authors: Basu Dipanjan , Salgado Cláudia M. , Bauer Bruce , Hoehl Ryan M. , Moscinski Catherine N. , Schmitt Lori , Reyes-Múgica Miguel
Published: May 2021

Large/giant congenital nevi (L/GCMN) are benign neoplasms of the melanocytic neural crest lineage covering extensive areas of skin presenting risk for melanoma. Surgical resection often leads to scarring and trauma. Histone deacetylase inhibitors (iHDACs) as topical therapeutic agents may prove beneficial as an alternative/adjunct to surgery in this disease. Here we describe the effect of in vitro treatment of iHDACs drugs on primary nevocytes isolated from L/GCMN patients. Micropthalmia transcription factor (MITF) expression in L/GCMN patients’ lesions was detected by immunohistochemistry, in cultured nevocytes by immunofluorescence, immunoblot and quantitative polymerase chain reaction. Cellular senescence was detected by SA-ß galactosidase activity. Markers for melanocytic differentiation were evaluated by immunoblot analysis and extracted melanin content was estimated spectrophotometrically. Cell death was measured by lactate dehydrogenase (LDH) assay and necrosis confirmed by polymerase (PARP) cleavage and acridine orange staining of the nuclei. MITF was expressed ubiquitously in nevocytes and melanocytes in patients’ lesions. In culture, iHDAC treatment suppressed MITF protein and mRNA expression resulting in a senescent-like phenotype with positive ß-galactosidase staining, progressing to necrotic cell death as evidenced by increased LDH activity, appearance of cleaved PARP and necrotic nuclei. This is the first report showing evidence of iHDACs-induced MITF suppression in congenital nevocytes in vitro leading to a morphologic change with positive ß-galactosidase staining, followed by necrotic cell death in nevocytes, indicating that iHDAC drugs could be valuable therapeutic agents for treatment of L/GCMN lesions.
Real-world Patterns of Adjuvant Chemotherapy Following Neoadjuvant Chemoradiation for Patients With Resected Rectal Adenocarcinoma
Authors: Abdel-Rahman Omar , King Karen , Scarfe Andrew
Published: May 2021

Objective:

The objective of this study was to analyze patterns of adjuvant chemotherapy among patients with resected rectal adenocarcinomas following neoadjuvant chemoradiation and surgical resection.

Methods:

Alberta Cancer Registry and other provincial electronic medical registries (2004 to 2018) identified patients with nonmetastatic rectal cancer who received neoadjuvant chemoradiation followed by surgical resection and either oxaliplatin-based or fluoropyrimidine-only adjuvant chemotherapy. Multivariable logistic regression analysis was then undertaken to identify factors associated with the use of either regimen. Kaplan-Meier survival estimates were used to compare overall survival between both groups and multivariable Cox regression analysis was then used to identify factors associated with worse overall survival.

Results:

A total of 532 patients who fulfilled eligibility criteria were included in the current study: 347 patients received adjuvant fluoropyrimidine-only chemotherapy and 185 patients received adjuvant oxaliplatin-based chemotherapy. The following variables were associated with use of fluoropyrimidine-only adjuvant chemotherapy: older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.02-1.06), higher Charlson comorbidity index (OR: 1.47; 95% CI: 1.00-2.15), and no involved lymph nodes in the surgical pathology (OR: 5.55; 95% CI: 3.66-8.41). Using Kaplan-Meier survival estimates, no difference in overall survival between patients treated with adjuvant oxaliplatin-based chemotherapy and those treated with adjuvant fluoropyrimidine-only chemotherapy was identified (P=0.152). Within multivariable Cox regression analysis, type of chemotherapy was not associated with a difference in overall survival (hazard ratio for fluoropyrimidine-only chemotherapy vs. oxaliplatin-based chemotherapy: 1.02; 95% CI: 0.61-1.71).

Conclusion:

Oxaliplatin-based adjuvant chemotherapy is not associated with improved survival outcomes compared with fluoropyrimidine-only chemotherapy in this real-world study.
Comparative analysis of visual outcome with 3 intraocular lenses: monofocal, enhanced monofocal, and extended depth of focus
Authors: Corbelli Eleonora , Iuliano Lorenzo , Bandello Francesco , Fasce Francesco
Published: May 2021

Purpose:

To compare the visual performance, spectacle independence, and subjective visual quality of 3 intraocular lenses (IOLs): monofocal, enhanced monofocal, and extended depth of focus.

Setting:

Ophthalmology Department, San Raffaele Scientific Institute, Milan, Italy.

Design:

Prospective case series.

Methods:

Patients without ocular comorbidities and corneal astigmatism <0.75 diopters (D) undergoing cataract surgery with bilateral implantation of monofocal Tecnis ZCB00, enhanced monofocal Eyhance ICB00, and extended depth-of-focus Symfony ZXR00 IOLs were included. 6 months postoperatively, the following parameters were analyzed: subjective and objective refraction; monocular and binocular corrected distance (4 m) and uncorrected distance (UDVA) visual acuity; corrected distance, intermediate (66 cm), and near (40 cm) visual acuities, as well as uncorrected intermediate (UIVA) and uncorrected near (UNVA) visual acuities; photopic contrast sensitivity; binocular defocus curve; halo and glare perception; and spectacle independence.

Results:

150 eyes of 75 patients (25 patients per IOL group) were evaluated. Monocular and binocular UDVA was excellent in all 3 groups. Eyhance achieved binocular UIVA similar to that of Symfony, the latter showing the highest binocular UNVA. The defocus curves at −1.0 D were equivalent for both Eyhance and Symfony, whereas contrast sensitivity was similar in all 3 groups. The Eyhance spectacle independence score was comparable with Symfony for intermediate distance activities, the latter, however, achieved the worst results for halos and glare.

Conclusions:

Enhanced monofocal Eyhance was not inferior to Symfony as regards intermediate distance visual outcome and spectacle independence, and also provided lower subjective perception of halos and glare.
Primary Care Tasks Associated With Nursing Burnout
Authors: Kim Linda Y. , Rose Danielle E. , Martinez-Hollingsworth Adrienne , Guo Rong , Ganz David A. , Yano Elizabeth M. , Stockdale Susan E.
Published: May 2021

Using data from the Veterans Assessment and Improvement Laboratory for Patient-Centered Care (VAIL-PCC) Survey, this study investigated the relationship between registered nurses' (RNs') and licensed vocational nurses' (LVNs') report of responsibility for 14 distinct primary care tasks and burnout, taking into account of practice environment contexts. RNs reported higher levels of burnout than LVNs. The task of “following up on referrals” was associated with significantly higher levels of RN burnout, whereas “responding to prescription requests” was associated with higher levels of LVN burnout. “True collaboration” was associated with significantly lower levels of burnout for both RNs and LVNs.
Genetic Heterogeneity and Core Clinical Features of NOG-Related-Symphalangism Spectrum Disorder
Authors: Carlson Ryan J. , Quesnel Alicia , Wells Dawson , Brownstein Zippora , Gilony Dror , Gulsuner Suleyman , Leppig Kathleen A. , Avraham Karen B. , King Mary-Claire , Walsh Tom , Rubinstein Jay
Published: May 2021

Objectives:

To better distinguish NOG-related-symphalangism spectrum disorder (NOG-SSD) from chromosomal 17q22 microdeletion syndromes and to inform surgical considerations in stapes surgery for patients with NOG-SSD.

Background:

Mutations in NOG cause a variety of skeletal syndromes that often include conductive hearing loss. Several microdeletions of chromosome 17q22 lead to severe syndromes with clinical characteristics that overlap NOG-SSD. Isolated deletion of NOG has not been described, and therefore the contribution of NOG deletion in these syndromes is unknown.

Methods:

Two families with autosomal dominant NOG-SSD exhibited stapes ankylosis, facial dysmorphisms, and skeletal and joint anomalies. In each family, NOG was evaluated by genomic sequencing and candidate mutations confirmed as damaging by in vitro assays. Temporal bone histology of a patient with NOG-SSD was compared with temporal bones of 40 patients diagnosed with otosclerosis.

Results:

Family 1 harbors a 555 kb chromosomal deletion encompassing only NOG and ANKFN1. Family 2 harbors a missense mutation in NOG leading to absence of noggin protein. The incus-footplate distance of the temporal bone was significantly longer in a patient with NOG-SSD than in patients with otosclerosis.

Conclusion:

The chromosomal microdeletion of family 1 led to a phenotype comparable to that due to a NOG point mutation and much milder than the phenotypes due to other chromosome 17q22 microdeletions. Severe clinical findings in other microdeletion cases are likely due to deletion of genes other than NOG. Based on temporal bone findings, we recommend that surgeons obtain longer stapes prostheses before stapes surgery in individuals with NOG-SSD stapes ankylosis.
Impact of Venoarterial Extracorporeal Membrane Oxygenation Flow on Outcomes in Cardiogenic Shock
Authors: Singh Sameer K. , Ning Yuming , Kurlansky Paul , Kaku Yuji , Naka Yoshifumi , Takayama Hiroo , Sayer Gabriel , Uriel Nir , Masoumi Amirali , Fried Justin A. , Takeda Koji
Published: May 2021

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is used to provide cardiopulmonary support in cardiogenic shock; however, high extracorporeal flow may increase left ventricular (LV) afterload leading to LV distention and intracardiac stasis. It is unclear how ECMO flow affects patient outcomes and complications related to ECMO. Retrospective review of patients at a single institution placed on VA ECMO from 2007 to 2018 was performed. Patients were divided into full flow (flow index > 2.2 L/min/m2) and partial flow (flow index < 2.2 L/min/m2) groups. In-hospital mortality and markers of end-organ perfusion were compared between groups balanced for risk factors using propensity score inverse probability of treatment weighting. ECMO-related complications such as LV distention, limb ischemia, and bleeding were recorded. There were 488 patients included, 405 (83%) in the partial flow group, and 83 (17%) in the full flow group. No major differences in age, gender, or comorbidities were found. There was no difference in in-hospital mortality between groups (51% vs. 55%, p = 0.59). At 72 hours post-ECMO initiation, there was no difference in the change in renal, hepatic function, or lactate from baseline nor in the rates of continuous venoveno hemofiltration initiation (p = 0.41). There was a trend towards the decreased incidence of LV distention requiring LV vent placement in the partial flow group (12% vs. 7%, p = 0.16). Compared with full flow VA ECMO, partial flow VA ECMO in carefully selected patients results in similar in-hospital mortality and provides similar end-organ perfusion for the treatment of refractory cardiogenic shock.
Prevalence of Advanced Colorectal Neoplasia in Veterans
Authors: Imperiale Thomas F. , Daggy Joanne K. , Imler Timothy D. , Sherer Eric A. , Kahi Charles J. , Larson Jason , Cardwell Jon , Johnson Cynthia S. , Ahnen Dennis J. , Antaki Fadi , Ashley Christopher , Baffy Gyorgy , Dominitz Jason A. , Hou Jason , Korsten Mark A. , Nagar Anil , Promrat Kittichai , Robertson Douglas J. , Saini Sameer , Shergill Amandeep , Smalley Walter E.
Published: May 2021

Goal:

We sought to quantify the independent effects of age, sex, and race/ethnicity on risk of colorectal cancer (CRC) and advanced neoplasia (AN) in Veterans.

Study:

We conducted a retrospective, cross-sectional study of Veterans aged 40 to 80 years who had diagnostic or screening colonoscopy between 2002 and 2009 from 1 of 14 Veterans Affairs Medical Centers. Natural language processing identified the most advanced finding and location (proximal, distal). Logistic regression was used to examine the adjusted, independent effects of age, sex, and race, both overall and in screening and diagnostic subgroups.

Results:

Among 90,598 Veterans [mean (SD) age 61.7 (9.4) y, 5.2% (n=4673) were women], CRC and AN prevalence was 1.3% (n=1171) and 8.9% (n=8081), respectively. Adjusted CRC risk was higher for diagnostic versus screening colonoscopy [odds ratio (OR)=3.79; 95% confidence interval (CI), 3.19-4.50], increased with age, was numerically (but not statistically) higher for men overall (OR=1.53; 95% CI, 0.97-2.39) and in the screening subgroup (OR=2.24; 95% CI, 0.71-7.05), and was higher overall for Blacks and Hispanics, but not in screening. AN prevalence increased with age, and was present in 9.2% of men and 3.9% of women [adjusted OR=1.90; 95% CI, 1.60-2.25]. AN risk was 11% higher in Blacks than in Whites overall (OR=1.11; 95% CI, 1.04-1.20), was no different in screening, and was lower in Hispanics (OR=0.74; 95% CI, 0.55-0.98). Women had more proximal CRC (63% vs. 39% for men; P=0.03), but there was no difference in proximal AN (38.3% for both genders).

Conclusions:

Age and race were associated with AN and CRC prevalence. Blacks had a higher overall prevalence of both CRC and AN, but not among screenings. Men had increased risk for AN, while women had a higher proportion of proximal CRC. These findings may be used to tailor when and how Veterans are screened for CRC.
Safety and Efficacy of Biological Therapy in Chronic Antibiotic Refractory Pouchitis
Authors: Chandan Saurabh , Mohan Babu P. , Kumar Anand , Khan Shahab R. , Chandan Ojasvini C. , Kassab Lena L. , Ponnada Suresh , Kochhar Gursimran S.
Published: May 2021

Background:

Pouchitis is the most common long-term complication after ileal pouch-anal anastomosis in patients with ulcerative colitis. Those with ≥3 episodes of pouchitis/year and symptoms despite antibiotics are considered to have chronic antibiotic refractory pouchitis (CARP). While several agents including probiotics, steroids and immunomodulators have been used, treatment of CARP remains challenging. We conducted a systematic review and meta-analysis evaluating the safety and efficacy of various biological agents in treatment of CARP.

Methods:

Multiple databases were searched through June 2020 for studies that reported the efficacy and safety of biological therapy including antitumor necrosis factor-alpha agents [infliximab (IFX) and adalimumab (ADA)], vedolizumab (VDZ), and ustekinumab in CARP. We excluded studies on Crohn’s like and/or other inflammatory complications of the pouch. Meta-analysis was performed to calculate pooled rates of clinical as well as endoscopic improvement and remission.

Results:

We included 15 studies with 311 patients in our final analysis. Ninety-two patients were treated with IFX, 42 with ADA, 144 with VDZ and 33 with ustekinumab. Pooled rate of clinical improvement was 71.4%, 58.2%, 47.9% and clinical remission was 65.7%, 31%, 47.4% with IFX, ADA, and VDZ, respectively. Pooled rate of endoscopic improvement was achieved in 61.2% patients treated with VDZ while endoscopic remission was achieved in 70.3% patients treated with IFX. Adverse events were reported in 3.9% patients.

Conclusion:

Biologic therapy is safe and effective in the treatment of CARP.
Diaphragm Pacing and a Model for Respiratory Rehabilitation After Spinal Cord Injury
Authors: Cavka Kathryn , Fuller David D. , Tonuzi Geneva , Fox Emily J.
Published: May 2021

Background and Purpose:

Cervical spinal cord injury (CSCI) can cause severe respiratory impairment. Although mechanical ventilation (MV) is a lifesaving standard of care for these patients, it is associated with diaphragm atrophy and dysfunction. Diaphragm pacing (DP) is a strategy now used acutely to promote MV weaning and to combat the associated negative effects. Initial reports indicate that DP also may promote neuromuscular plasticity and lead to improvements in spontaneous diaphragm activation and respiratory function. These outcomes suggest the need for reevaluation of respiratory rehabilitation for patients with CSCI using DP and consideration of new rehabilitation models for these patients and their unique care needs.

Summary of Key Points:

This article discusses the rationale for consideration of DP as a rehabilitative strategy, particularly when used in combination with established respiratory interventions. In addition, a model of respiratory rehabilitation and recovery (RRR) is presented, providing a framework for rehabilitation and consideration of DP as an adjuvant rehabilitation approach. The model promotes goals such as respiratory recovery and independence, and lifelong respiratory health, via interdisciplinary care, respiratory training, quantitative measurement, and use of adjuvant strategies such as DP. Application of the model is demonstrated through a description of an inpatient rehabilitation program that applies model components to patients with CSCI who require DP.

Recommendations for Clinical Practice:

As DP use increases for patients with acute CSCI, so does the need and opportunity to advance rehabilitation approaches for these patients. This perspective article is a critical step in addressing this need and motivating the advancement of rehabilitation strategies for CSCI patients. (See Video Abstract, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A348).
Evaluation of the Utilization of FilmArray Meningitis/Encephalitis in Children With Suspected Central Nervous System Infection
Authors: Barros Domingues Renan , Mendes-Correa Maria Cássia , Vilela de Moura Leite Fernando Brunale , Vega dos Santos Márcio , Senne Soares Carlos Augusto
Published: May 2021

Background

The etiology of central nervous system infections is often difficult to establish. FilmArray meningitis/encephalitis (ME) panel is a multiplex polymerase chain reaction for rapid identification of 14 pathogens. The aim of this study was to evaluate potential real-life contributions of the use of this method in the pediatric population.

Methods

We herein report the results obtained with FilmArray ME in a retrospective case series of 367 children with suspected central nervous system infection. We identified viral and bacterial agents by FilmArray, and we evaluated the potential diagnostic contributions of the use of the panel taking into account the cytological, biochemical, and microbiological results of the cerebrospinal fluid (CSF) analysis.

Results

The FilmArray ME panel detected a viral infection in 186 cases (50.7%) and a bacterial infection in 12 cases (3.3%). Fifty-three cases (28.4%) of viral infection had at least 1 CSF finding that could be mistaken for bacterial meningitis. Enterovirus was identified in 2 cases with normal CSF findings. Among 12 bacterial infection cases, only 6 (50%) had a positive result with conventional microbiology analysis (Gram stain and culture). The CSF findings suggestive of bacterial meningitis were found in all 6 cases in which FilmArray was the only method to identify bacterial etiological agent.

Conclusions

FilmArray ME panel identified an etiological agent in cases in which conventional CSF analysis failed, providing potential clinical contributions to the management of such cases.