bluuebunny/crossref_metadata_2025 huggingface dataset:
Light-adapted charge-separated state of photosystem II: structural and functional dynamics of the closed reaction center
Authors: Sipka G�bor , Magyar Melinda , Mezzetti Alberto , Akhtar Parveen , Zhu Qingjun , Xiao Yanan , Han Guangye , Santabarbara Stefano , Shen Jian-Ren , Lambrev Petar H , Garab Győző
Published: January 2021

Photosystem II (PSII) uses solar energy to oxidize water and delivers electrons for life on Earth. The photochemical reaction center of PSII is known to possess two stationary states. In the open state (PSIIO), the absorption of a single photon triggers electron-transfer steps, which convert PSII into the charge-separated closed state (PSIIC). Here, by using steady-state and time-resolved spectroscopic techniques on Spinacia oleracea and Thermosynechococcus vulcanus preparations, we show that additional illumination gradually transforms PSIIC into a light-adapted charge-separated state (PSIIL). The PSIIC-to-PSIIL transition, observed at all temperatures between 80 and 308 K, is responsible for a large part of the variable chlorophyll-a fluorescence (Fv) and is associated with subtle, dark-reversible reorganizations in the core complexes, protein conformational changes at noncryogenic temperatures, and marked variations in the rates of photochemical and photophysical reactions. The build-up of PSIIL requires a series of light-induced events generating rapidly recombining primary radical pairs, spaced by sufficient waiting times between these events—pointing to the roles of local electric-field transients and dielectric relaxation processes. We show that the maximum fluorescence level, Fm, is associated with PSIIL rather than with PSIIC, and thus the Fv/Fm parameter cannot be equated with the quantum efficiency of PSII photochemistry. Our findings resolve the controversies and explain the peculiar features of chlorophyll-a fluorescence kinetics, a tool to monitor the functional activity and the structural-functional plasticity of PSII in different wild-types and mutant organisms and under stress conditions.
Declining carbohydrate content of Sitka-spruce treesdying from seawater exposure
Authors: Zhang Peipei , McDowell Nate G , Zhou Xuhui , Wang Wenzhi , Leff Riley T , Pivovaroff Alexandria L , Zhang Hongxia , Chow Pak S , Ward Nicholas D , Indivero Julia , Yabusaki Steven B , Waichler Scott , Bailey Vanessa L
Published: January 2021

Increasing sea levels associated with climate change threaten the survival of coastal forests, yet the mechanisms by which seawater exposure causes tree death remain poorly understood. Despite the potentially crucial role of nonstructural carbohydrate (NSC) reserves in tree survival, their dynamics in the process of death under seawater exposure are unknown. Here we monitored progressive tree mortality and associated NSC storage in Sitka-spruce (Picea sitchensis) trees dying under ecosystem-scale increases in seawater exposure in western Washington, USA. All trees exposed to seawater, because of monthly tidal intrusion, experienced declining crown foliage during the sampling period, and individuals with a lower percentage of live foliated crown (PLFC) died faster. Tree PLFC was strongly correlated with subsurface salinity and needle ion contents. Total NSC concentrations in trees declined remarkably with crown decline, and reached extremely low levels at tree death (2.4% and 1.6% in leaves and branches, respectively, and 0.4% in stems and roots). Starch in all tissues was almost completely consumed, while sugars remained at a homeostatic level in foliage. The decreasing NSC with closer proximity to death and near zero starch at death are evidences that carbon starvation occurred during Sitka-spruce mortality during seawater exposure. Our results highlight the importance of carbon storage as an indicator of tree mortality risks under seawater exposure.
Heat stress interferes with formation of double-strand breaks and homolog synapsis
Authors: Ning Yingjie , Liu Qingpei , Wang Chong , Qin Erdai , Wu Zhihua , Wang Minghui , Yang Ke , Elesawi Ibrahim Eid , Chen Chunli , Liu Hong , Qin Rui , Liu Bing
Published: January 2021

Meiotic recombination (MR) drives novel combinations of alleles and contributes to genomic diversity in eukaryotes. In this study, we showed that heat stress (36°C–38°C) over the fertile threshold fully abolished crossover formation in Arabidopsis (Arabidopsis thaliana). Cytological and genetic studies in wild-type plants and syn1 and rad51 mutants suggested that heat stress reduces generation of SPO11-dependent double-strand breaks (DSBs). In support, the abundance of recombinase DMC1, which is required for MR-specific DSB repair, was significantly reduced under heat stress. In addition, high temperatures induced disassembly and/or instability of the ASY4- but not the SYN1-mediated chromosome axis. At the same time, the ASY1-associated lateral element of the synaptonemal complex (SC) was partially affected, while the ZYP1-dependent central element of SC was disrupted, indicating that heat stress impairs SC formation. Moreover, expression of genes involved in DSB formation; e.g. SPO11-1, PRD1, 2, and 3 was not impacted; however, recombinase RAD51 and chromosome axis factors ASY3 and ASY4 were significantly downregulated under heat stress. Taken together, these findings revealed that heat stress inhibits MR via compromised DSB formation and homolog synapsis, which are possible downstream effects of the impacted chromosome axis. Our study thus provides evidence shedding light on how increasing environmental temperature influences MR in Arabidopsis.
Meta-Metasemantics, or the Quest for the One True Metasemantics
Authors: Nowak Ethan , Michaelson Eliot
Published: January 2021

What determines the meaning of a context-sensitive expression in a context? It is standardly assumed that, for a given expression type, there will be a unitary answer to this question; most of the literature on the subject involves arguments designed to show that one particular metasemantic proposal is superior to a specific set of alternatives. The task of the present essay will be to explore whether this is a warranted assumption, or whether the quest for the one true metasemantics might be a Quixotic one. We argue that there are good reasons—much better than are commonly appreciated—for thinking the latter, but that there nevertheless remains significant scope for metasemantic theorizing. We conclude by outlining our preferred option, metasemantic pluralism.
Neurocognitive processing of infant stimuli in mothers and non-mothers: psychophysiological, cognitive and neuroimaging evidence
Authors: Bjertrup Anne , Friis Nellie , Væver Mette , Miskowiak Kamilla
Published: January 2021

Emerging evidence indicates that mothers and non-mothers show different neurocognitive responses to infant stimuli. This study investigated mothers’ psychophysiological, cognitive and neuronal responses to emotional infant stimuli. A total of 35 mothers with 4-month-old infants and 18 control women without young children underwent computerized tests assessing neurocognitive processing of infant stimuli. Their eye gazes and eye fixations, galvanic skin responses (GSRs) and facial expressions towards infant emotional stimuli were recorded during the tasks. Participants underwent functional magnetic resonance imaging during which they viewed pictures of an unknown infant and, for mothers, their own infants. Mothers gazed more and had increased GSR towards infant stimuli and displayed more positive facial expressions to infant laughter, and self-reported more positive ratings of infant vocalizations than control women. At a neural level, mothers showed greater neural response in insula, dorsolateral prefrontal cortex and occipital brain regions within a predefined ‘maternal neural network’ while watching images of their own vs unknown infants. This specific neural response to own infants correlated with less negative ratings of own vs unknown infants’ signals of distress. Differences between mothers and control women without young children could be interpreted as neurocognitive adaptation to motherhood in the mothers.
Intersecting Boundaries: Comparing Stereotypes of Native- and Foreign-Born Members of Ethnoracial Groups
Authors: Schachter Ariela
Published: January 2021

Past research finds that Americans hold biased stereotypes about ethnoracial groups and about immigrants, but we lack an understanding of how these group identities intersect. Immigration theories offer opposing predictions; while the straight-line assimilation model predicts Americans will hold weaker ethnoracial stereotypes about the native-born compared to their immigrant coethnics, theories of racialized assimilation suggest that the enduring power of race will limit any differential stereotyping of immigrant and native-born members of racialized groups. I use an original survey experiment to compare Americans’ stereotypes of native- and foreign-born members of the four largest ethnoracial groups in the United States—Whites, Blacks, Latinos, and Asians. As predicted by straight-line assimilation theory, I find that Whites’ negative stereotypes of Latinos fade away with nativity; however, White Americans do not substantially alter their stereotypes of Asians and Blacks based on nativity status. Moreover, native-born Black and Latino Americans do not appear to hold differential stereotypes of ethnoracial groups based on their nativity status. This research highlights both the importance and limitations of accounting for nativity status to understand ethnoracial group boundaries in the United States.
Mitochondrial Membrane Potential Drives Early Change in Mitochondrial Morphology After Acetaminophen Exposure
Authors: Umbaugh David S , Nguyen Nga T , Jaeschke Hartmut , Ramachandran Anup
Published: January 2021

Mitochondrial morphology plays a critical role in regulating mitochondrial and cellular function. It is well established that oxidative stress and mitochondrial injury are central to acetaminophen (APAP) hepatotoxicity. However, the role of mitochondrial dynamics, namely the remodeling of mitochondrial morphology through fusion and fission, has largely gone unexplored. To investigate this, we used primary mouse hepatocytes treated with APAP which allowed for real-time visualization of mitochondrial morphology using mitotracker green. We found that alterations in mitochondrial morphology were dose dependent, with a biphasic response in mitochondrial shape at higher APAP doses. Importantly, these two distinct mitochondrial morphologies corresponded with differences in mitochondrial respiratory function and polarization. The early change in mitochondrial morphology can be reversible and appears to be an adaptive response caused by alterations in membrane potential, which ultimately help preserve mitochondrial function. The later delayed change in mitochondrial morphology is irreversible and is driven by loss of mitochondrial membrane potential, decreased canonical fusion proteins, and alterations in mitochondrial lipid composition. Collectively, these later changes tilt the scales toward mitochondrial fission resulting in fragmented mitochondria with reduced functionality. This work provides evidence of adaptive early changes in mitochondrial morphology, which results in functional consequences that are dictated by the severity of APAP overdose.
Variation in Methylmercury Metabolism and Elimination in Humans: Physiological Pharmacokinetic Modeling Highlights the Role of Gut Biotransformation, Skeletal Muscle, and Hair
Authors: Pope Quintin , Rand Matthew D
Published: January 2021

The biological half-life (t1/2) of methylmercury (MeHg) shows considerable individual variability (t1/2 < 30 to > 120 days), highlighting the importance of mechanisms controlling MeHg metabolism and elimination. Building on a prior physiologically based pharmacokinetic (PBPK) model, we elucidate parameters that have the greatest influence on variability of MeHg t1/2 in the human body. Employing a dataset of parameters for mean organ volumes and blood flow rates appropriate for man and woman (25–35 years) and child (4 − 6 years), we demonstrate model fitness by simulating data from our prior controlled study of MeHg elimination in people. Model predictions give MeHg t1/2 of 46.9, 38.9, and 31.5 days and steady-state blood MeHg of 2.6, 2.6, and 2.3 µg/l in man, woman, and child, respectively, subsequent to a weekly dose of 0.7 µg/kg body weight. The major routes of elimination are biotransformation to inorganic Hg in the gut lumen (73% in adults, 61% in child) and loss of MeHg via excretion within growing hair (13% in adults, 24% in child). Local and global sensitivity analyses of model parameters reveal that variation in biotransformation rate in the gut lumen, and rates of transport between gut lumen and gut tissue, have the greatest influence on MeHg t1/2. Volume and partition coefficients for skeletal muscle (SM) and gut tissue also show significant sensitivity affecting model output of MeHg t1/2. Our results emphasize the role of gut microbiota in MeHg biotransformation, transport kinetics at the level of the gut, and SM mass as moderators of MeHg kinetics in the human body.
Generation of an Allelic Series at the Ahr Locus Using an Edited Recombinant Approach
Authors: Wilson Rachel H , Carney Patrick R , Glover Edward , Parrott Jessica C , Rojas Brenda L , Moran Susan M , Yee Jeremiah S , Nukaya Manabu , Goetz Nicholas A , Rubinstein Clifford D , Krentz Kathy J , Xing Yongna , Bradfield Christopher A
Published: January 2021

The aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor and a member of the PER-ARNT-SIM (PAS) superfamily of environmental sensors. The AHR is involved in a series of biological processes including adaptive metabolism of xenobiotics, toxicity of certain environmental pollutants, vascular development, fertility, and immune function. Mouse models, including the Ahr null and Ahr conditional null (Ahrfx) mice, are widely used for the study of AHR-mediated biology and toxicity. The Ahr conditional null mouse harbors the low-affinity Ahrd allele that exhibits approximately a 10-fold lower binding affinity for certain xenobiotic AHR ligands than the widely used C57BL/6 mouse that harbors the higher affinity Ahrb1 allele. Here, we report a novel mouse model that introduces a V375A polymorphism that converts the low-affinity allele into a high-affinity allele, offering a more sensitive conditional model. In the generation of this novel conditional allele, two additional mutants arose, including a 3-bp deletion in the PAS-B domain (AhrNG367R) and an early termination codon in the PAS-B domain (AhrTer383). The AhrNG367R allele presents as a phenocopy of the null and the AhrTer383 allele presents as an antimorph when assessing for the ductus venosus and liver lobe weight endpoints. These new models represent a series of tools that will be useful in further characterizing AHR biology.
Mycetoma caused byMicroascus gracilis:a novel agent of human eumycetoma in Sudan
Authors: Mhmoud Najwa A , Siddig Emmanuel Edwar , Nyuykonge Bertrand , Bakhiet Sahar Mubarak , van de Sande Wendy W J , Fahal Ahmed Hassan
Published: January 2021

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

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

Introduction:

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

Methods:

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

Results:

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

Discussion:

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

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

Background:

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

Methods:

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

Results:

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

Conclusions:

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

Background:

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

Methods:

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

Results:

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

Conclusion:

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

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

Purpose:

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

Methods:

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

Results:

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

Conclusion:

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

Background:

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

Methods:

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

Results:

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

Conclusions:

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

Purpose of review

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

Recent findings

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

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

Purpose of review

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

Recent findings

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

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

Background and Aims:

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

Materials and Methods:

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

Results:

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

Adherence was associated with improved QOL (SIBDQ, R=0.724). Nonadherence was associated with >3-fold risk of recurrence within 2 years (hazard ratio: 3.89, 95% CI: 2.74-5.52, P<0.001).

Conclusions:

Nonadherence is common in Indian IBD patients but adherence is associated with improved QoL and lower probability of relapse. Psychosocial and medication-related factors are important determinants of adherence compared with demographic or clinical variables and should be addressed.
Patterns and outcomes of zone 3 REBOA use in the management of severe pelvic fractures: Results from the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database
Authors: Harfouche Melike , Inaba Kenji , Cannon Jeremy , Seamon Mark , Moore Ernest , Scalea Thomas , DuBose Joseph
Published: January 2021

BACKGROUND

Knowledge on practice patterns for aortic occlusion (AO) in the setting of severe pelvic fractures is limited. This study aimed to describe clinical outcomes based on number and types of interventions after zone 3 resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment.

METHODS

A retrospective review of the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery multicenter registry was performed for patients who underwent zone 3 AO from 2013 to 2020. Patients with a blunt mechanism who survived beyond the emergency department were included. Interventions evaluated were preperitoneal pelvic packing (PP), angioembolization (AE), and external fixation (EF) of the pelvis. Management approaches were compared against the primary outcome of mortality. Secondary outcomes included transfusion requirements, overall complications and acute kidney injury (AKI).

RESULTS

Of 207 patients who underwent zone 3 AO, 160 (77.3%) fit the inclusion criteria. Sixty (37.5%) underwent AO alone, 50 (31.3%) underwent a second hemostatic intervention, and 49 (30.6%) underwent a third hemostatic intervention. Overall mortality was 37.7% (n = 60). There were no differences in mortality based on any number or combination of interventions. On multivariable regression, only EF was associated with a mortality reduction (odds ratio, 0.22; p = 0.011). Increasing number of interventions were associated with higher transfusion and complication rates. Pelvic packing + AE was associated with increased AKI than PP or AE alone (73.3% vs. 29.5% and 28.6%, p = 0.005), and AE was associated with increased AKI resulting in dialysis than PP alone (17.9% vs. 6.8%, p = 0.036).

CONCLUSION

Zone 3 REBOA can be used as a standalone hemorrhage control technique and as an adjunct in the management of severe pelvic fractures. The only additional intervention associated with a mortality reduction was EF. The benefit of increasing number of interventions must be weighed against more harm. Heterogeneity in practice patterns for REBOA use in pelvic fracture management underscores the need for an evidence base to standardize care.

LEVEL OF EVIDENCE

Therapeutic, Level IV.
Caught in the crossfire: 37 Years of firearm violence afflicting America’s youth
Authors: Manley Nathan R. , Huang Dih-Dih , Lewis Richard H. , Bee Tiffany , Fischer Peter E. , Croce Martin A. , Magnotti Louis J.
Published: January 2021

INTRODUCTION

Publicly available firearm data are difficult to access. Trauma registry data are excellent at documenting patterns of firearm-related injury. Law enforcement data excel at capturing national violence trends to include both circumstances and firearm involvement. The goal of this study was to use publicly available law enforcement data from all 50 states to better define patterns of firearm-related homicides in the young.

METHODS

All homicides in individuals 25 years or younger in the United States over a 37-year period ending in 2016 were analyzed: infant, 1 year or younger; child, 1 to 9 years old; adolescent, 10 to 19 years old; and young adult, 20 to 25 years old. Primary data files were obtained from the Federal Bureau of Investigation and comprised the database. Data analyzed included homicide type, situation, circumstance, month, firearm type, and demographics. Rates of all homicides and firearm-related homicides per 1 million population and the proportion of firearm-related homicides (out of all homicides) were stratified by year and compared over time using simple linear regression.

RESULTS

A total of 171,113 incidents of firearm-related homicide were analyzed (69% of 246,437 total homicides): 5,313 infants, 2,332 children, 59,777 adolescents, and 103,691 young adults. Most (88%) were male and Black (59%) with a median age of 20 years. Firearm-related homicides peaked during the summer months of June, July, and August (median, 1,156 per year; p = 0.0032). Rates of all homicides (89 to 53 per 1 million population) and firearm-related homicides (56 to 41 per 1 million population) decreased significantly from 1980 to 2016 (β = −1.12, p < 0.0001 and β = −0.57, p = 0.0039, respectively). However, linear regression analysis identified a significant increase in the proportion of firearm-related homicides (out of all homicides) from 63% in 1980 to 76% in 2016 (β = 0.33, p < 0.0001).

CONCLUSION

For those 25 years or younger, the proportion of firearm-related homicides has steadily and significantly increased over the past 37 years, with 3 of 4 homicides firearm related in the modern era. Despite focused efforts, reductions in the rate of firearm-related homicides still lag behind those for all other methods of homicide by nearly 50%. That is, while the young are less likely to die from homicide, for those unfortunate victims, it is more likely to be due to a firearm. This increasing role of firearms in youth homicides underscores the desperate need to better direct prevention efforts and firearm policy if we hope to further reduce firearm-related deaths in the young.

LEVEL OF EVIDENCE

Epidemiological study, level III.
Non-neurophysiologist Physicians and Nurses Can Detect Subclinical Seizures in Children Using a Panel of Quantitative EEG Trends and a Seizure Detection Algorithm
Authors: Swarnalingam Eroshini S. , RamachandranNair Rajesh , Choong Karen L. M. , Jones Kevin C.
Published: January 2021

Purpose:

This study evaluated the sensitivity of nonconvulsive seizure detection by non-neurophysiologist physicians and nurses using a panel of quantitative EEG (QEEG) trends in the setting of a pediatric intensive care unit.

Methods:

Forty-five 1-hour QEEG epochs were obtained retrospectively from 10 patients admitted to the McMaster Children's Hospital pediatric intensive care unit, which included 184 electrographic seizures. Each epoch constituted 4 QEEG trends, a seizure probability marker, automated seizure detector, rhythmicity spectrograms, and amplitude-integrated EEG. Six pediatric residents and 5 pediatric intensive care unit nurses analyzed the epochs for possible seizures after a 15-minute power point presentation. This was compared with the gold standard of a board-certified epileptologist interpreting the conventional EEG data for seizures.

Results:

Sensitivity of seizure detection for pediatric residents and intensive care unit nurses were 0.90. The specificity was 0.87 and 0.89, respectively. The interrater agreement among the pediatric residents was moderate with a kappa (κ) value of 0.45 (confidence interval: 0.41–0.49), and among the nurses were moderate with a κ value of 0.59 (confidence interval: 0.54–0.63). A post hoc analysis involving 2 neurophysiologists demonstrated a sensitivity of 0.90 and a specificity of 0.93 (confidence interval: 0.90–0.96) for seizure detection and a substantial interrater agreement of κ = 0.76 (confidence interval: 0.61–0.91).

Conclusions:

A panel of QEEG trends can be used by non-neurophysiologists in a pediatric critical care setting to detect nonconvulsive seizures with a reasonable accuracy, which may expedite subclinical seizure identification and timely intervention.
Progress towards non-small-cell lung cancer models that represent clinical evolutionary trajectories
Authors: Hynds Robert E. , Frese Kristopher K. , Pearce David R. , Grönroos Eva , Dive Caroline , Swanton Charles
Published: January 2021

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide. Although advances are being made towards earlier detection and the development of impactful targeted therapies and immunotherapies, the 5-year survival of patients with advanced disease is still below 20%. Effective cancer research relies on pre-clinical model systems that accurately reflect the evolutionary course of disease progression and mimic patient responses to therapy. Here, we review pre-clinical models, including genetically engineered mouse models and patient-derived materials, such as cell lines, primary cell cultures, explant cultures and xenografts, that are currently being used to interrogate NSCLC evolution from pre-invasive disease through locally invasive cancer to the metastatic colonization of distant organ sites.
Evaluation of vertical transmission of SARS-CoV-2 in utero: nine pregnant women and their newborns
Authors: Dong Liang , Pei Shiyao , Ren Qin , Fu Shuxiang , Yu Liang , Chen Hui , Chen Xiang , Yin Mingzhu
Published: January 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mainly transmitted by droplets and close contact, has caused a pandemic worldwide as of November 2020. According to the current case reports and cohort studies, the symptoms of pregnant women infected with SARS-CoV-2 were similar to normal adults and may cause a series of adverse consequences of pregnancy (placental abruption, fetal distress, epilepsy during pregnancy, etc.). However, whether SARS-CoV-2 can be transmitted to the fetus through the placental barrier is still a focus of debate.

Methods

In this study, in order to find out whether SARS-CoV-2 infect fetus through placental barrier, we performed qualitative detection of virus structural protein (spike protein and nucleoprotein) and targeted receptor protein (ACE2, CD147 and GRP78) expression on the placental tissue of seven pregnant women diagnosed with COVID-19 through immunohistochemistry. Amniotic fluid, neonatal throat, anal swab and breastmilk samples were collected immediately in the operating room for verification after delivery, which were all tested for SARS-CoV-2 by reverse transcriptionpolymerase chain reaction (RT-PCR).

Results

The result showed that CD147 was expressed on the basal side of the chorionic trophoblast cell membrane and ACE2 was expressed on the maternal side, while GRP78 was strongly expressed in the cell membrane and cytoplasm. The RT-PCR results of Amniotic fluid, neonatal throat, anal swab and breastmilk samples were all negative.

Conclusions

We believed that despite the detection of viral structural proteins in the placenta, SARS-CoV-2 cannot be transmitted to infants due to the presence of the placental barrier.

Our results showed that, excluding environmental pollution after birth and vaginal infection during childbirth, SARS-CoV-2 was less likely to be transmitted vertically in utero.