bluuebunny/crossref_metadata_2025 huggingface dataset:
Protection Shopping among Empires: Suspended Sovereignty in the Cocos-Keeling Islands
Authors: Benton Lauren , Clulow Adam
Published: August 2021

The political status of the Cocos-Keeling Islands, a group of twenty-seven small atoll islands in the Indian Ocean about 1,700 miles west of Australia, remained unresolved from the time of the islands’ settlement in 1827 until their effective incorporation into Australia in 1984. For a century and a half, protection shopping helped to create and sustain the islands’ condition of suspended sovereignty. During the nineteenth century, the ruling family actively cultivated the protection of Dutch and British imperial agents and played one empire against the other. Imperial agents veered between intervention and restraint, and Cocos-Keeling islanders invoked protection to blunt rulers’ power over them. The politics of protection continued into the twentieth century. Despite international attention to self-determination, the Cocos-Keeling Islands were not positioned for statehood, and full and effective integration into the British empire or Australia was perennially delayed. The territory’s history as a place of seemingly permanent semi-autonomy illuminates a global pattern in which protection politics worked to suspend sovereignty and in some cases perpetuate social and racial inequalities, both inside political communities and across the international order.
Multiomics approach reveals a role of translational machinery in shaping maize kernel amino acid composition
Authors: Shrestha Vivek , Yobi Abou , Slaten Marianne L , Chan Yen On , Holden Samuel , Gyawali Abiskar , Flint-Garcia Sherry , Lipka Alexander E , Angelovici Ruthie
Published: August 2021

Maize (Zea mays) seeds are a good source of protein, despite being deficient in several essential amino acids. However, eliminating the highly abundant but poorly balanced seed storage proteins has revealed that the regulation of seed amino acids is complex and does not rely on only a handful of proteins. In this study, we used two complementary omics-based approaches to shed light on the genes and biological processes that underlie the regulation of seed amino acid composition. We first conducted a genome-wide association study to identify candidate genes involved in the natural variation of seed protein-bound amino acids. We then used weighted gene correlation network analysis to associate protein expression with seed amino acid composition dynamics during kernel development and maturation. We found that almost half of the proteome was significantly reduced during kernel development and maturation, including several translational machinery components such as ribosomal proteins, which strongly suggests translational reprogramming. The reduction was significantly associated with a decrease in several amino acids, including lysine and methionine, pointing to their role in shaping the seed amino acid composition. When we compared the candidate gene lists generated from both approaches, we found a nonrandom overlap of 80 genes. A functional analysis of these genes showed a tight interconnected cluster dominated by translational machinery genes, especially ribosomal proteins, further supporting the role of translation dynamics in shaping seed amino acid composition. These findings strongly suggest that seed biofortification strategies that target the translation machinery dynamics should be considered and explored further.
‘Once I joined my motivations changed’: Exploring the initial and continuing motivations of police support volunteers in an English constabulary
Authors: Pepper Melissa
Published: August 2021

Understanding and responding to motivations—both initial and continuing—are pivotal features of effectively involving volunteers within an organization, influencing satisfaction and ongoing commitment. This article explores the initial and continuing motivations of police support volunteers (PSVs)—citizens who give their time freely to perform tasks that complement the duties of police officers and staff. Drawing on survey and interview data with 160 PSVs in a large urban police service in England, the article considers motivations through three typologies—The Altruistic PSV, The Social PSV, and The Career PSV. It explores defining features of each typology and highlights the shifting nature of motivations as volunteer service progresses—most notably an increase in socially driven volunteers, and a fall in those seeking fulfilment of career goals. Implications for practice are considered, in particular investing in dedicated volunteer resources that recognize and respond to the heterogeneity of volunteer cohorts and fluidity of motivations.
How to Sell Hard Information
Authors: Ali S Nageeb , Haghpanah Nima , Lin Xiao , Siegel Ron
Published: August 2021

The seller of an asset has the option to buy hard information about the value of the asset from an intermediary. The seller can then disclose this information before selling the asset in a competitive market. We study how the intermediary designs and sells hard information to robustly maximize the intermediary's revenue across all equilibria. Even though the intermediary could use an accurate test that reveals the asset’s value, we show that robust revenue maximization leads to a noisy test with a continuum of possible scores. In addition, the intermediary always charges the seller for disclosing the test score to the market, but not necessarily for running the test. This enables the intermediary to robustly appropriate a significant share of the surplus resulting from the asset sale.
Flexible Wages, Bargaining, and the Gender Gap
Authors: Biasi Barbara , Sarsons Heather
Published: August 2021

Does flexible pay increase the gender wage gap? To answer this question, we analyze the wages of public school teachers in Wisconsin, where a 2011 reform allowed school districts to set teachers’ pay more flexibly and engage in individual negotiations. Using quasi-exogenous variation in the timing of the introduction of flexible pay, driven by the expiration of preexisting collective-bargaining agreements, we show that flexible pay lowered the salaries of women compared with men with the same credentials. This gap is larger for younger teachers and smaller for teachers working under a female principal or superintendent. Survey evidence suggests that the gap is partly driven by women engaging less frequently in negotiations over pay, especially when the counterpart is a man. The gap is unlikely to be driven by observable gender differences in job mobility or teacher ability, although the threat of moving and a high demand for male teachers could exacerbate it. Our results suggest that pay discretion and wage bargaining are important determinants of the gender wage gap and that institutions, such as unions, might help narrow this gap.
Integrated printed BDNF/collagen/chitosan scaffolds with low temperature extrusion 3D printer accelerated neural regeneration after spinal cord injury
Authors: Liu Xiao-Yin , Chen Chong , Xu Hai-Huan , Zhang Yu-sheng , Zhong Lin , Hu Nan , Jia Xiao-Li , Wang You-Wei , Zhong Kun-Hong , Liu Chang , Zhu Xu , Ming Dong , Li Xiao-Hong
Published: August 2021

Recent studies have shown that 3D printed scaffolds integrated with growth factors can guide the growth of neurites and promote axon regeneration at the injury site. However, heat, organic solvents or cross-linking agents used in conventional 3D printing reduce the biological activity of growth factors. Low temperature 3D printing can incorporate growth factors into the scaffold and maintain their biological activity. In this study, we developed a collagen/chitosan scaffold integrated with brain-derived neurotrophic factor (3D-CC-BDNF) by low temperature extrusion 3D printing as a new type of artificial controlled release system, which could prolong the release of BDNF for the treatment of spinal cord injury (SCI). Eight weeks after the implantation of scaffolds in the transected lesion of T10 of the spinal cord, 3D-CC-BDNF significantly ameliorate locomotor function of the rats. Consistent with the recovery of locomotor function, 3D-CC-BDNF treatment could fill the gap, facilitate nerve fiber regeneration, accelerate the establishment of synaptic connections and enhance remyelination at the injury site.
Reducing the Risk of Withdrawal Symptoms and Relapse Following Clozapine Discontinuation—Is It Feasible to Develop Evidence-Based Guidelines?
Authors: Blackman Graham , Oloyede Ebenezer , Horowitz Mark , Harland Robert , Taylor David , MacCabe James , McGuire Philip
Published: August 2021

Clozapine is the only antipsychotic that is effective in treatment-resistant schizophrenia. However, in certain clinical situations, such as the emergence of serious adverse effects, it is necessary to discontinue clozapine. Stopping clozapine treatment poses a particular challenge due to the risk of psychotic relapse, as well as the development of withdrawal symptoms. Despite these challenges for the clinician, there is currently no formal guidance on how to safely to discontinue clozapine. We assessed the feasibility of developing evidence-based recommendations for (1) minimizing the risk of withdrawal symptoms, (2) managing withdrawal phenomena, and (3) commencing alternatives treatment when clozapine is discontinued. We then evaluated the recommendations against the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. We produced 19 recommendations. The majority of these recommendation were evidence-based, although the strength of some recommendations was limited by a reliance of studies of medium to low quality. We discuss next steps in the refinement and validation of an evidence-based guideline for stopping clozapine and identify key outstanding questions.
Novel lncRNA‐HZ04 promotes BPDE‐induced human trophoblast cell apoptosis and miscarriage by upregulating IP3R1/CaMKII/SGCB pathway by competitively binding with miR‐hz04
Authors: Huang Wenxin , Dai Mengyuan , Qiu Taotao , Liang Tingting , Xie Jiayu , Mi Chenyang , Zhao Jingsong , Chen Weina , Tian Peng , Zhang Shuming , Zhang Huidong
Published: August 2021

Normal pregnancy is essential for human reproduction. However, BaP (benzo(a)pyrene) and its metabolite BPDE (benzo(a)pyrene‐7,8‐dihydrodiol‐9,10‐epoxide) could cause dysfunctions of human trophoblast cells and might further induce miscarriage. Yet, the underlying mechanisms remain largely unknown. Herein, we identified a novel upregulated lnc‐HZ04 and a novel downregulated miR‐hz04 in villous tissues of unexplained recurrent miscarriage (RM) relative to those in healthy control tissues and also in BPDE‐treated human trophoblast cells. Lnc‐HZ04 directly and specifically bound with miR‐hz04, diminished the reduction effects of miR‐hz04 on IP3R1 mRNA expression level and on IP3R1 mRNA stability, and then activated the Ca2+‐mediated IP3R1/p‐CaMKII/SGCB pathway, which further promoted trophoblast cell apoptosis. The miR‐hz04 target site on lnc‐HZ04 played crucial roles in these regulations. In normal trophoblast, relatively less lnc‐HZ04 and more miR‐hz04 suppressed this apoptosis pathway and gave normal pregnancy. After exposure to BPDE or in RM tissues, p53 was upregulated, which might promote p53‐mediated lnc‐HZ04 transcription. Relatively more lnc‐HZ04 and less miR‐hz04 activated this apoptosis pathway and might further induce miscarriage. BaP could also induce mice miscarriage by upregulating its corresponding murine apoptosis pathway. Therefore, BPDE‐induced apoptosis of human trophoblast cells was associated with the occurrence of miscarriage. This work discovered the regulation roles of lnc‐HZ04 and miR‐hz04 and provided scientific and clinical understanding of the occurrence of unexplained miscarriage.
Gene therapy rescues olfactory perception in a clinically relevant ciliopathy model of Bardet–Biedl syndrome
Authors: Xie Chao , Habif Julien C. , Uytingco Cedric R. , Ukhanov Kirill , Zhang Lian , de Celis Carlos , Sheffield Val C. , Martens Jeffrey R.
Published: August 2021

Bardet–Biedl syndrome (BBS) is a hereditary genetic disorder that results in numerous clinical manifestations including olfactory dysfunction. Of at least 21 BBS‐related genes that can carry multiple mutations, a pathogenic mutation, BBS1M390R, is the single most common mutation of clinically diagnosed BBS outcomes. While the deletion of BBS‐related genes in mice can cause variable penetrance in different organ systems, the impact of the Bbs1M390R mutation in the olfactory system remains unclear. Using a clinically relevant knock‐in mouse model homozygous for Bbs1M390R, we investigated the impact of the mutation on the olfactory system and tested the potential of viral‐mediated, wildtype gene replacement therapy to rescue smell loss. The cilia of olfactory sensory neurons (OSNs) in Bbs1M390R/M390R mice were significantly shorter and fewer than those of wild‐type mice. Also, both peripheral cellular odor detection and synaptic‐dependent activity in the olfactory bulb were significantly decreased in the mutant mice. Furthermore, to gain insight into the degree to which perceptual features are impaired in the mutant mice, we used whole‐body plethysmography to quantitatively measure odor‐evoked sniffing. The Bbs1M390R/M390R mice showed significantly higher odor detection thresholds (reduced odor sensitivity) compared to wild‐type mice; however, their odor discrimination acuity was still well maintained. Importantly, adenoviral expression of Bbs1 in OSNs restored cilia length and re‐established both peripheral odorant detection and odor perception. Together, our findings further expand our understanding for the development of gene therapeutic treatment for congenital ciliopathies in the olfactory system.
Proteomic analysis of ubiquitination substrates reveals a CTLH E3 ligase complex‐dependent regulation of glycolysis
Authors: Maitland Matthew E. R. , Kuljanin Miljan , Wang Xu , Lajoie Gilles A. , Schild‐Poulter Caroline
Published: August 2021

Ubiquitination is an essential post‐translational modification that regulates protein stability or function. Its substrate specificity is dictated by various E3 ligases. The human C‐terminal to LisH (CTLH) complex is a newly discovered multi‐subunit really interesting new gene (RING) E3 ligase with only a few known ubiquitination targets. Here, we used mass spectrometry‐based proteomic techniques to gain insight into CTLH complex function and ubiquitination substrates in HeLa cells. First, global proteomics determined proteins that were significantly increased, and thus may be substrates targeted for degradation, in cells depleted of CTLH complex member RanBPM. RanBPM‐dependent ubiquitination determined using diGLY‐enriched proteomics and the endogenous RanBPM interactome further revealed candidate ubiquitination targets. Three glycolysis enzymes alpha‐enolase, L‐lactate dehydrogenase A chain (LDHA), and pyruvate kinase M1/2 (PKM) had decreased ubiquitin sites in shRanBPM cells and were found associated with RanBPM in the interactome. Reduced polyubiquitination was validated for PKM2 and LDHA in cells depleted of RanBPM and CTLH complex RING domain subunit RMND5A. PKM2 and LDHA protein levels were unchanged, yet their activity was increased in extracts of cells with downregulated RanBPM. Finally, RanBPM deficient cells displayed enhanced glycolysis and deregulated central carbon metabolism. Overall, this study identifies potential CTLH complex ubiquitination substrates and uncovers that the CTLH complex inhibits glycolysis via non‐degradative ubiquitination of PKM2 and LDHA.
Actions of the NLRP3 and NLRC4 inflammasomes overlap in bone resorption
Authors: Alippe Yael , Kress Dustin , Ricci Biancamaria , Sun Kai , Yang Tong , Wang Chun , Xiao Jianqiu , Abu‐Amer Yousef , Mbalaviele Gabriel
Published: August 2021

Overwhelming evidence indicates that excessive stimulation of innate immune receptors of the NOD‐like receptor (NLR) family causes significant damage to multiple tissues, yet the role of these proteins in bone metabolism is not well known. Here, we studied the interaction between the NLRP3 and NLRC4 inflammasomes in bone homeostasis and disease. We found that loss of NLRP3 or NLRC4 inflammasome attenuated osteoclast differentiation in vitro. At the tissue level, lack of NLRP3, or NLRC4 to a lesser extent, resulted in higher baseline bone mass compared to wild‐type (WT) mice, and conferred protection against LPS‐induced inflammatory osteolysis. Bone mass accrual in mutant mice correlated with lower serum IL‐1β levels in vivo. Unexpectedly, the phenotype of Nlrp3‐deficient mice was reversed upon loss of NLRC4 as bone mass was comparable between WT mice and Nlrp3;Nlrc4 knockout mice. Thus, although bone homeostasis is perturbed to various degrees by the lack of NLRP3 or NLRC4, this tissue appears to function normally upon compound loss of the inflammasomes assembled by these receptors.
Towards Antiracism: Using Critical Race Theory as a Tool to Disrupt the Status Quo in Health Professions Education
Authors: Bush Antonio A.
Published: August 2021

The use of words such as race, racism, antiracism, and antiracist has increased in health professions education (HPE). While the words are used more frequently, additional work is needed to demonstrate a commitment to enhance equity, diversity, and inclusion in HPE. It is important that we contextualize these words, understand the connections between them, and use this information to implement sustainable actions to disrupt the status quo in HPE. Critical race theory is a tool to consider for this journey. In this commentary, the author provides an overview of key concepts ranging from race to critical race theory as a primer to the Research in Medical Education plenary.
The Proposal Preparation Program: A Group Mentoring, Faculty Development Model to Facilitate the Submission and Funding of NIH Grant Applications
Authors: Weber-Main Anne Marie , Thomas-Pollei Kimberly A. , Grabowski John , Steer Clifford J. , Thuras Paul D. , Kushner Matt G.
Published: August 2021

This article describes the University of Minnesota Medical School Proposal Preparation Program (P3). P3 is designed to develop grant-writing skills for assistant professors preparing their first K- or R-series application to the National Institutes of Health (NIH). Three 4-month P3 cycles are conducted annually. For each cycle, a cohort of around 10 assistant professor participants and 5 regular faculty mentors meet for ten ~2-hour group sessions. Participants receive iterative oral and written feedback on their proposals in development within a small, interdisciplinary, group mentoring setting providing structure, accountability, guidance, and support. Between sessions, 1 peer and 1 mentor are assigned (on a rotating basis) to critique each participant’s developing application. The sessions include a brief mentor-led presentation on a particular grant section followed by discussion of each participant’s application conducted by the assigned reviewers. The cycle concludes with a mock NIH review session, in which each participant is matched with a University of Minnesota faculty content expert who critiques their completed application using NIH guidelines. In a survey sent to all past P3 participants as of 2018 (n = 194), 88% of respondents reported having submitted their P3-developed NIH grant, and 35% of these submitters reported funding success. A separate analysis of institutional data for all past P3 participants as of 2016 (n = 165) showed that 73% submitted at least 1 NIH proposal since completing P3 and that 43% of these had acquired NIH funding, for a combined total of $193 million in funding awarded. The estimated rate at which participants obtained funding for their P3-developed grant application (~35%) exceeds the national annual NIH grant funding rates (~20%) by approximately 50%. This article provides the practical information needed for other institutions to implement a P3-like program and presents a cost–benefit analysis showing the advantages of doing so.
Responding to Recommended Changes to the 2020–2021 Residency Recruitment Process From a Diversity, Equity, and Inclusion Perspective
Authors: Wilson L. Tamara , Milliken Lindsay , Cagande Consuelo , Stewart Colin
Published: August 2021

In May 2020, the Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training (WG) released its final report and recommendations. These recommendations pertain to away rotations, virtual interviews, Electronic Residency Application Service opening for programs and the overall residency timeline, and general communications and attempt to provide clarity and level the playing field during the 2020–2021 residency application cycle. The WG’s aims include promoting professional accountability by improving the quality, efficiency, and continuity of the education, training, and assessment of physicians. The authors argue the first 3 WG recommendations may disproportionately impact candidates from historically excluded and underrepresented groups in medicine (HEURGMs) and may affect an institution’s ability to ensure equity in the selection of residency applicants and, thus, warrant further consideration.

The authors examine these recommendations from a diversity, equity, and inclusion (DEI) perspective. For each of the first 3 WG recommendations, the authors highlight new opportunities created by the recommendations and detail challenges that programs must carefully navigate to ensure equity for all candidates. The authors also recommend solutions to guide programs as they address these challenges, meet new common program requirements, and attempt to promote equity for HEURGMs. Finally, the authors recommend that after the 2020–2021 recruitment cycle, the medical education community evaluate DEI-related outcomes of both the WG’s and the authors’ recommendations and incorporate the findings into future application cycles.
Trends in Substance Use Disorder-related Admissions at a Safety-net Hospital, 2008 – 2020
Authors: Lindsay Amber R. , Shearer Riley D. , Bart Gavin , Winkelman Tyler N.A.
Published: August 2021

Objectives

Safety-net hospitals disproportionately care for people with substance use disorders (SUDs), yet little is known about trends in hospital admissions related to specific substances. This study uses electronic health record data to describe trends in substance-specific admissions at a Midwest urban safety-net hospital.

Methods

We included all admissions from 2008 through 2020 and defined them as non-SUD (N = 154,477) or SUD-related (N = 63,667). We described patient characteristics and trends in substance-specific admissions. We estimated the association of SUD diagnoses with discharge against medical advice and length of stay using logistic regression and generalized linear models.

Results

Between 2008 and 2020, SUD-related admissions increased from 23.1% to 32.9% of total admissions. Admissions related to SUD had significantly more comorbidities than non-SUD-related admissions (4.7 vs 3.5, P < 0.001). Among illicit substances, cocaine-related admissions were the most common in 2008 (3.9% of total admissions, 17.2% of SUD admissions) whereas psychostimulants (eg, methamphetamines) were the most common in 2020 (7.8% of total admissions, 23.8% of SUD admissions). SUD-related hospitalizations had higher rates of against medical advice discharge (3.8%; 95% CI 3.6–3.9 vs 1.4%; 95% CI 1.3–1.4) and longer length of stay (6.3 days; 95% CI: 6.2–6.3 vs 5.3 days; 95% CI: 5.3–5.4) than non-SUD-related admissions.

Conclusions

Over the study period, the proportion of admissions related to substance use rose to approximately one third of all admissions, driven by a rapidly increasing share of psychostimulant-related admissions. Identifying substance use patterns quickly using electronic health record data can help safety-net hospitals meet the needs of their patients and improve outcomes.
Challenges with Fassier–Duval rod exchanges in congenital pseudarthrosis of the tibia: explant roadblock and solution
Authors: McClure Philip K. , Franzone Jeanne M. , Herzenberg John E.
Published: August 2021

Congenital pseudarthrosis of the tibia (CPT) is characterized by anterolateral tibial bowing and hamartomatous periosteum that predisposes it to fracture. Fassier–Duval telescopic rods can improve the structural integrity of bone segments after reconstruction. We present our experience treating CPT with the Fassier–Duval rod and a novel technique for Fassier–Duval exchange that was developed after extraction failed in one patient. Patients were identified who underwent treatment with Fassier–Duval rods for CPT between 2007 and 2016 and had undergone their first rod exchange. Medical records were reviewed, and complications were classified using the system of Cherkashin. Four patients had an average age at the initial insertion of 6 years 4 months (4–9 years). The average follow-up duration after initial Fassier–Duval implantation was 5.4 years (2.7–8.1 years). Seven Category 2 complications were associated with the Fassier–Duval rod: interlocking K-wire migration (2), lengthening failure (2), explant failure (1), distal migration of female rod through physis (1) and male rod portion proximally migrating through physis (1). Three patients underwent one rod exchange [average 3.2 years after implantation (range, 2.7–3.9 years)]. One patient underwent two rod exchanges (2.9 and 6.9 years after initial implantation). The second attempt at exchange failed; this failure prompted the development of custom trephines to remove the hard bone that can encase the distal male segment. The use of custom trephines was made necessary by dense sclerotic bone at the previous pseudarthrosis site. We recommend that custom trephines be available during Fassier–Duval rod extraction to avoid failed retrieval. Level of evidence: Level IV (Case series).
Role of Bone Biopsy During Kyphoplasty in the Setting of Known Cancer
Authors: Tariq Muhammad B. , Obedian Richard
Published: August 2021

Study Design.

Case report.

Objective.

The aim of this study was to emphasize the utility of routine biopsy during kyphoplasty and to report on a unique case of a patient with known history of prostate cancer found to have a new metastatic cancer.

Summary of Background Data.

Vertebral compression fractures (VCFs) may cause debilitating pain with nearly one-third of them leading to chronic pain resulting in a tremendous impact on quality of life in patients. Kyphoplasty has been established as an effective means of surgical treatment. However, routine biopsy during kyphoplasty is presently not the standard of care under the presumption that most VCFs are caused by osteoporosis. The role of biopsy in the setting of known malignancy with multiple other risk factors for VCFs is not well understood.

Methods.

We report on a case of a 73-year-old male with known prostate cancer presenting with persistent unremitting low back pain failing conservative management. Patient develops multiple VCFs in the course of 6 months and is treated with multiple kyphoplasties. Routine biopsy at each level is negative until the last kyphoplasty results positive for malignancy. Surprisingly, the pathology is positive for malignancy other than the patient's known prostate cancer.

Results.

Pathology results prompt oncology workup on the patient which reveals multiple metastases and a new diagnosis of adenocarcinoma of possible upper gastrointestinal origin. In addition, patient's known prostate cancer is also noted to be active. Patient is subsequently started on chemotherapy.

Conclusion.

We highlight the utility of routine biopsy during kyphoplasty especially in patients with known history of malignancy. We emphasize that presumptions about the etiology of a VCF are difficult to make with multiple risk factors and that routine biopsy prevents incorrect presumptions such as in this case.

Level of Evidence: 5
An Experimental Rat Model of C5 Palsy Following Posterior Decompression Surgery of the Cervical Spine
Authors: Yokota Atsushi , Fujishiro Takashi , Usami Yoshitada , Neo Masashi
Published: August 2021

Study Design.

Basic in vivo research.

Objectives.

The aim of this study was to establish an animal model that is appropriate for analyzing the mechanisms of C5 palsy (C5P) and to clarify the structural and functional alterations of cervical roots following posterior decompression.

Summary of Background Data.

Although C5P is one of the major complications of cervical surgery, the exact pathogenesis of C5P remains unclear partly because of the lack of an appropriate animal model. Tethering of the cervical roots due to posterior cord shift following posterior decompression is thought to be one of the possible factors that cause C5P.

Methods.

Twenty-eight Sprague-Dawley rats were divided into Group L (cervical laminectomy, N = 18) or Group S (sham surgery, N = 10) and examined up to postoperative day 14 (PO14). Posterior cord shift and the length of the anterior rootlets were quantified by computed tomography-myelogram images. Motor evoked potential (MEP) of the deltoid (C5, 6 innervated) and triceps brachii (C7-T1 innervated), mechanical allodynia, and grip strength of the forepaw (C7-T1 regulated) were measured.

Results.

All anterior rootlets were elongated as the cord gradually shifted posteriorly postoperatively. The elongation rate of the C6 anterior rootlets was the highest (142% at PO14). The MEP latency of the deltoid was significantly delayed throughout all postoperative time points. However, significant delay in the latency of the triceps brachii was observed only on postoperative day 10. The withdrawal threshold of the forepaw did not change; grip strength of the forelimb decreased at PO14.

Conclusion.

This model was thought to be appropriate for analyzing the pathogenesis of C5P since our findings were comparable to the clinical course of C5P subsequent to posterior cervical decompression. Although a future study for clarifying histological and molecular alterations will be needed, tethering of the anterior rootlets due to posterior cord shift was suggested to be a probable mechanism causing C5P.

Level of Evidence: 5
RARE PRESENTATION OF BILATERAL CAROTID-CAVERNOUS FISTULA AS SUPRACHOROIDAL HEMORRHAGE DURING CATARACT SURGERY
Authors: Zainol Nurhafis , Raman Puspha , Devi-S Premala , Mohd Khalid Khairul Husnaini
Published: August 2021

Objective:

To report a rare case of suprachoroidal hemorrhage during phacoemulsification in a patient with bilateral carotid-cavernous fistula.

Method:

Case report.

Result:

A 76-year-old woman with underlying hypertension presented left eye poor vision due to an underlying dense cataract. Her initial preoperative assessment was uneventful, and she underwent phacoemulsification. During epinucleus removal, there was sudden, unexpected anterior chamber shallowing, resulting in posterior capsule rupture. While the surgeon extended the wound to facilitate epinucleus removal, there was a further decrease of red reflex, followed by hardening of the globe, indicating a suprachoroidal hemorrhage. The corneal wound was opposed swiftly without an intraocular lens. Further evaluation after that revealed the patient had a chronic headache for several years, and ocular examination showed bilateral esophoria. A computed tomography demonstrated features suggestive of bilateral carotid-cavernous fistula, which was confirmed with computed tomography angiography later.

Conclusion:

Patients with carotid-cavernous fistula have elevated episcleral venous pressure and vortex venous pressure. Sudden decompression of the globe in these patients predisposes them to higher suprachoroidal hemorrhage risk, although this condition is generally rare in phacoemulsification.
Pneumonia, Sinusitis, Influenza and Other Respiratory Illnesses in Acute Otitis Media–Prone Children
Authors: Pichichero Michael E. , Chapman Timothy J. , Bajorski Peter
Published: August 2021

Background:

Recurrent acute otitis media in the first years of life can be explained by immune dysfunction. Consequently, it would be expected that otitis-prone (OP) children would be more susceptible to other infectious diseases, especially respiratory infections, since a component of the immune problem involves nasopharyngeal innate immunity.

Design:

Cohort study with prospective identification of all physician-diagnosed, medically attended respiratory illness visits in children 6 months to 5 years of age to determine the incidence of pneumonia, acute sinusitis, influenza and other bacterial and viral infections among OP compared with non-OP (NOP) children. Tympanocentesis to microbiologically confirm acute otitis media disease.

Results:

Two hundred eighty-five children were studied. Thirty-nine met a standard definition of stringently defined OP (sOP) determined by tympanocentesis and 246 were NOP. sOP children had increased frequency of presumptive respiratory infections, pneumonia (6-fold higher, P < 0.001), sinusitis (2.1-fold higher, P = 0.026) and influenza (2.9-fold higher, P = 0.002), compared with NOP children. Demographic and risk factor covariate-adjusted fold difference between sOP and NOP children for all respiratory infection illness visits was 2.4-fold (P < 0.00001) at 6–18 months of age, 2.2-fold (P < 0.00001) at 18–30 months of age and at age and 2.4-fold (P = 0.035) higher at 30 to 42 months. For both sOP and NOP children, more frequent medically attended respiratory infection illness visits from 6–18 months of age predicted more frequent visits experienced from 18–60 months of age.

Conclusions:

Clinicians should be aware of a significant increased likelihood of bacterial and viral respiratory infection proneness among OP children.
Clinical Outcomes and Antibody Response in COVID-19–Positive Pediatric Solid Organ Transplant Recipients
Authors: Talgam-Horshi Efrat , Mozer-Glassberg Yael , Waisbourd-Zinman Orit , Ashkenazi-Hoffnung Liat , Haskin Orly , Levi Shelly , Hamdani Gilad , Landau Daniel , Alfandary Hadas
Published: August 2021

We describe the clinical and laboratory manifestations and outcomes of 25 pediatric solid organ transplant recipients who tested positive for severe acute respiratory coronavirus-2. Twenty-one (84%) developed a mild disease; 22 of 23 (96%) had a positive serologic response. Two patients (8%), both kidney transplant recipients with additional comorbidities, developed a severe disease. The findings emphasize the need for close monitoring of this population.
Effect of Timing of Intravenous Ketorolac Administration on Pain in Orbitotomy Surgery
Authors: Lee Kathryn W. , Tram Justin , Wladis Edward J.
Published: August 2021

Purpose:

Intravenous ketorolac (IVK) is an effective and safe medication to reduce postoperative pain in the setting of oculofacial surgery. This study was undertaken to determine the impact of timing of IVK administration in orbital surgery on the reduction of postoperative pain score and opioid requirement.

Methods:

Patients either received IVK immediately before (n = 50), during (n = 50) or after (n = 50) orbital surgery or acted as controls (n = 50). Pain scores were assessed via an analog scale immediately after surgery and on the first postoperative day. The requirements for opioid analgesics were recorded. Statistical analyses were performed via a dedicated computerized software package.

Results:

One hundred fifty patients received IVK; 50 before incision (28 males, 22 females, mean age 52.2), 50 intraoperatively (20 males, 30 females, mean age 49.8) and 50 in the immediate postoperative period (26 males, 24 females, mean age = 55.3). Additionally, 50 patients acted as controls (26 males, 24 females, mean age 54). Immediately after surgery, administration of IVK resulted in statistically significant reduction in pain score regardless of the timing of dosing as compared with control patients (prior = 2.36, intraoperative = 2.34, postoperative = 2.46 vs. control 5.44, p < 0.0001). Eleven patients (22%) in the control group required opioids, whereas, in the IVK cohorts, only 2 (4%—preoperative), 1 (2%—intraoperative), and 1 (2%—postoperative) patients needed these medications (p = 0.0039).

Conclusions:

In the setting of orbital surgery, IVK reduced pain scores and opioid requirement, regardless of the timing of administration, as compared with patients that did not receive the medication.
Health Literacy Levels of Women and Related Factors in Turkey
Authors: AYAZ-ALKAYA Sultan , OZTURK Fatma Ozlem
Published: August 2021

Background

Health literacy is a complex issue affecting the health outcomes of women and their families.

Purpose

This study was conducted to determine the health literacy levels and related factors of women attending various courses in family centers of a municipality.

Methods

This cross-sectional research was conducted on a sample of women enrolled in various courses at eight family centers in a city center. The sample consisted of 837 women who agreed to participate. The participation rate was 76%. Two different health literacy scales were used to collect data for analysis.

Results

Of the women, 50.4% were over 40 years old, 35.2% were high school graduates, 89.6% were not working, 53.2% self-reported their monthly income as equal to their monthly expenses, 88.8% had social security, 28.4% had chronic diseases, 29.2% used medication regularly, 35.2% had visual problems, 7.8% had hearing problems, and 77.9% used the internet. According to the results of the Turkish Health Literacy Scale, 45.9% of the participants were in the inadequate category, 30.6% were in the inadequate and limited category, 16.0% were in the adequate category, and 7.4% were in the excellent category. Women aged 40 years and over, those who were elementary school graduates, those who had visual and hearing problems, those who used eyewear, those whose monthly income was less than expenses, and those who were non-internet users respectively had mean health literary scores that were significantly below the mean score for all participants (p < .05).

Conclusions/Implications for Practice

The largest number of participants was categorized has having a “low-insufficient” level of health literacy. Age, educational level, income, having visual and hearing problems, wearing glasses, and internet use were found to affect level of health literacy. For this reason, factors such as age, educational level, income, vision and hearing problems, use of eyeglasses, and internet use should be considered when planning initiatives to increase health literacy in women.
Effect of Solution-Focused Therapy on Cancer-Related Fatigue in Patients With Colorectal Cancer Undergoing Chemotherapy
Authors: Xian Xuemei , Zhu Chenping , Chen Yilin , Huang Binbin , Xiang Weilan
Published: August 2021

Background

Cancer-related fatigue (CRF) has gained increased attention in the past decade but remains difficult to treat. It is a predictor of patients’ overall health and quality of life (QoL). Therefore, controlling fatigue is important for patients with cancer.

Objective

The aim of this study was to test the effect of solution-focused therapy (SFT) in reducing CRF and improving QoL in patients with colorectal cancer (CRC) undergoing chemotherapy.

Methods

A total of 124 patients with CRC undergoing chemotherapy were recruited and randomized to the SFT group or control group. Cancer-related fatigue was measured with the Cancer Fatigue Scale–Chinese version (CFS-C) at baseline, 3 months, and 6 months. Quality of life was measured with the Quality of Life Instruments for Colorectal Cancer Patients at baseline and 6 months.

Results

Of 124 patients, 119 (95.9%) were evaluable. The SFT group showed significantly lower Cancer Fatigue Scale–Chinese version scores than the control group in all subscales and the total scores at 3 months (P < .001). At 6 months, the SFT group had significantly lower scores in cognitive fatigue (P < .001) and total fatigue (P = .005). The CRF of the SFT group decreased in the first 3 months (P = .012) but increased at 6 months (P < .001). The SFT group had significantly higher scores in the physical and psychological domains and overall QoL (P = .002, P <.001, and P = .02) than the control group at 6 months.

Conclusion

Solution-focused therapy may decrease the CRF and improve QoL during chemotherapy for patients with CRC.

Implication for Practice

Solution-focused therapy can be implemented to relieve fatigue and improve QoL in patients with CRC.
Multi-Omics Analysis on Neurodevelopment in Preterm Neonates
Authors: Casavant Sharon G. , Chen Jie , Xu Wanli , Lainwala Shabnam , Matson Adam , Chen Ming-Hui , Starkweather Angela , Maas Kendra , Cong Xiaomei S.
Published: August 2021

Background

The gut microbiome is an important determinant of health and disease in preterm infants.

Objectives

The objective of this article was to share our current protocol for other neonatal intensive care units to potentially expand their existing protocols, aiming to characterize the relationship between the intestinal microbiome and health outcomes in preterm infants.

Methods

This prospective, longitudinal study planned to recruit 160 preterm infants born <32 weeks gestational age or weighing <1,500 g and admitted to one of two Level III/IV neonatal intensive care units. During the neonatal intensive care unit period, the primary measures included events of early life pain/stress, gut microbiome, host genetic variations, and neurobehavioral assessment. During follow-up visits, gut microbiome; pain sensitivity; and medical, growth, and developmental outcomes at 4, 8–12, and 18–24 months corrected age were measured.

Discussion

As of February 14, 2020, 214 preterm infants have been recruited. We hypothesize that infants who experience greater levels of pain/stress will have altered gut microbiome, including potential adverse outcomes such as necrotizing enterocolitis and host genetic variations, feeding intolerance, and/or neurodevelopmental impairments. These will differ from the intestinal microbiome of preterm infants who do not develop these adverse outcomes. To test this hypothesis, we will determine how alterations in the intestinal microbiome affect the risk of developing necrotizing enterocolitis, feeding intolerance, and neurodevelopmental impairments in preterm infants. In addition, we will examine the interaction between the intestinal microbiome and host genetics in the regulation of intestinal health and neurodevelopmental outcomes.
Chromobacterium violaceum causing disseminated soft tissue and pulmonary abscesses in a traveller returning from the Azores
Authors: Chowdhury Melissa , Lee Nathaniel , Wey Emmanuel Q.
Published: August 2021

This case report describes a 30-year-old male patient presenting with

Chromobacterium violaceum

cutaneous lesions who develops a subsequent bacteraemia, complicated by soft tissue and pulmonary abscesses.

C. violaceum

disease is a rare infection that can manifest in a spectrum from cutaneous lesions to disseminated disease and sepsis, the latter associated with high mortality. Although in the available literature there is a recommendation for a prolonged antibiotic course, we describe effective management with a shorter course of antibiotics. This case highlights the importance of not only considering a diagnosis of

C. violaceum

if there has been a high risk and appropriate exposure, but to also consider the changing epidemiology of the organism due to certain geographical areas becoming warmer due to climate change.
Optimization of translation enhancing element use to increase protein expression in a vaccinia virus system
Authors: Richard Jr. Harold B. , Minder Stephanie , Sidhu Amandeep , Juba Amber N. , Jancovich James K. , Jacobs Bertram L. , Wellensiek Brian P.
Published: August 2021

Since the successful use of vaccinia virus (VACV) in the immunization strategies to eliminate smallpox, research has been focused on the development of recombinant VACV strains expressing proteins from various pathogens. Attempts at decreasing the side effects associated with exposure to recombinant, wild-type viral strains have led to the development of attenuated viruses. Yet while these attenuated VACV’s have improved safety profiles compared to unmodified strains, their clinical use has been hindered due to efficacy issues in stimulating a host immune response. This deficiency has largely been attributed to decreased production of the target protein for immunization. Efforts to increase protein production from attenuated VACV strains has largely centered around modulation of viral factors, while manipulation of the translation of viral mRNAs has been largely unexplored. In this study we evaluate the use of translation enhancing element hTEE-658 to increase recombinant protein production in an attenuated VACV system. Optimization of the use of this motif is also attempted by combining it with strategies that have demonstrated effectiveness in previous research. We show that extension of the 5′ leader sequence containing hTEE-658 does not improve motif function, nor does the combination with other known translation enhancing elements. However, the sole use of hTEE-658 in an attenuated VACV system is shown to increase protein expression levels beyond those of a standard viral promoter when used with a wild-type virus. Taken together these results highlight the potential for hTEE-658 to improve the effectiveness of attenuated VACV vaccine candidates and give insights into the optimal sequence context for its use in vaccine design.
Electrical Brain Stimulation and Continuous Behavioral State Tracking in Ambulatory Humans
Authors: Mivalt Filip , Kremen Vaclav , Sladky Vladimir , Balzekas Irena , Nejedly Petr , Gregg Nick , Lundstrom Brian , Lepkova Kamila , Pridalova Tereza , Brinkmann Benjamin H. , Jurak Pavel , Van Gompel Jamie J. , Miller Kai , Denison Timothy , Louis Erik St , Worrell Gregory A.
Published: August 2021

Objective

Electrical deep brain stimulation (DBS) is an established treatment for patients with drug-resistant epilepsy. Sleep disorders are common in people with epilepsy, and DBS may actually further disturb normal sleep patterns and sleep quality. Novel devices capable of DBS and continuous intracranial EEG (iEEG) telemetry enable detailed assessments of therapy efficacy and tracking sleep related comorbidities. Here, we investigate the feasibility of automated sleep classification using continuous iEEG data recorded from Papez’s circuit in four patients with drug resistant mesial temporal lobe epilepsy using an investigational implantable sensing and stimulation device with electrodes implanted in bilateral hippocampus (HPC) and anterior nucleus of thalamus (ANT).

Approach

The iEEG recorded from HPC is used to classify sleep during concurent DBS targeting ANT. Simultaneous polysomnography and HPC sensing were used to train, validate and test an automated classifier for a range of ANT DBS frequencies: no stimulation, 2 Hz, 7 Hz, and high frequency (>100 Hz).

Main results

We show that it is possible to build a patient specific automated sleep staging classifier using power in band features extracted from one HPC sensing channel. The patient specific classifiers performed well under all thalamic DBS frequencies with an average F1-score 0.894, and provided viable classification into awake and major sleep categories, rapid eye movement (REM) and non-REM. We retrospectively analyzed classification performance with gold-standard polysomnography annotations, and then prospectively deployed the classifier on chronic continuous iEEG data spanning multiple months to characterize sleep patterns in ambulatory patients living in their home environment.

Significance

The ability to continuously track behavioral state and fully characterize sleep should prove useful for optimizing DBS for epilepsy and associated sleep, cognitive and mood comorbidities.