bluuebunny/crossref_metadata_2025 huggingface dataset:
Endotheliitis—A Presentation of Acanthamoeba Keratitis
Authors: Lakhani Bansri K. , Thajudeen Bushra , Jawaid Imran , Attzs Michelle S. , Maharajan Veerabahu S.
Published: August 2020

Purpose:

To report endotheliitis as an early, key presenting sign of Acanthamoeba keratitis in patients who are soft contact lens wearers.

Methods:

We report 4 cases of patients presenting with pain, red eye, and reduction in vision in the context of soft contact lens wear. On examination, the predominant clinical finding was that of endotheliitis, localized fusiform stromal edema with corresponding keratic precipitates, anterior chamber inflammation, and minimal epithelial and anterior stromal signs. The classical signs of Acanthamoeba keratitis were not present.

Results:

All 4 cases were clinically diagnosed as Acanthamoeba endotheliitis; corneal scrapes were negative; case 1 was polymerase chain reaction positive, and case 3 underwent confocal microscopy that showed double-walled cysts, suggesting Acanthamoeba. All responded well to anti-Acanthamoeba medication alone with 3 cases achieving complete resolution with minimal anterior stromal scarring by 7 weeks. Case 1 had steroid treatment before being seen at our unit and had a prolonged course of treatment with complete resolution by 4 months.

Conclusions:

It is imperative to have a high index of suspicion for Acanthamoeba in patients presenting with pain and endotheliitis in the context of contact lens wear, even in the absence of classical signs.
Endosvascular Treatment of Mycotic Thoracic Aortic Pseudoaneurysm Secondary to Nontyphoidal Salmonella Infection
Authors: Ambroziak Agnieszka , Dobrowolski Sebastian , Hendiger Włodzimierz
Published: August 2020

Treatment of patients with infected aortic aneurysm remains a challenge for the vascular surgeon and carries a high risk of mortality. Here, we present a case of a patient with infected thoracic aneurysm treated successfully with endovascular technique. The female patient, age 57 years, was admitted to the hospital due to severe thoracic pain. The angiotomography revealed inflammation of the thoracic aorta along with the presence of air bubbles. Stool and blood cultures were positive for Salmonella ser. Enteritidis. Targeted antibiotics were given intravenously for 22 days followed by oral delivery for 6 months. After 14 weeks, angiotomography showed the presence of pseudoaneurysm of the descending thoracic aorta with a diameter of 87 mm, and a thoracic stent-graft was implanted. No endoleaks were detected at the 3-year follow-up. The presented patient with Salmonella-positive infected thoracic aneurysm was successfully treated with endovascular method but still needs lifelong follow-up.
Characteristics, Clinical Course, and Outcomes of Veterans Admitted With Covid-19 in Detroit, Michigan
Authors: Monday Lea M. , Abu-Heija Ahmad , Shatta Maya , Ilyas Sahrish , Bazzy Kareem , Natesan Suganthini Krishnan , Brown Patricia D.
Published: August 2020

Background

The deaths due to coronavirus disease (Covid-19) in Michigan have been disproportionately centered in the city of Detroit. We sought to characterize hospitalized veterans with Covid-19 infection in Detroit, MI and compare them to inpatients previously reported.

Methods

A retrospective observational study of 79 veterans admitted to a veteran's hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, through April 6, 2020. Each patient had at least 30 days of follow-up.

Results

The median age of 79 enrolled patients was 69.0 years (interquartile range, 57.0–75.0 years) and 74 (94%) were men. Twenty-four (30%) had a recent emergency department visit. Respiratory symptoms were present in 67 (85%). Gastrointestinal symptoms were common (49 [62%]), including diarrhea (27 [34%]) and loss of appetite (31 [39%]). Only 30 (38%) patients had fever on admission. Comorbidities included hypertension (73 [92%]), diabetes (48 [61%]), obesity (42 [53%]), chronic obstructive pulmonary disease (30 [38%]), coronary disease (28 [35%]), and obstructive sleep apnea (25 [32%]). Nine patients were admitted to the intensive care unit, and 18 (26%) of 70 required intensive care unit transfer. Twenty-Four (30%) were intubated; of which 3 were extubated and 20 (83%) died. Of the 57 (72%) patients discharged alive, 22 (39%) required supplemental oxygen and 8 (14%) were readmitted within 30 days.

Conclusions

Detroit veterans were primarily older African American men with more comorbidities than inpatients previously described. Gastrointestinal symptoms were twice as common as fever. Rates of mortality and readmission were higher than those previously reported in populations with shorter follow up.
A Singular Petechial Plantar Rash in a Patient With a Confirmed COVID-19
Authors: De la Torre Gomar Francisco J. , Saenz Aguirre Amaia , Rosés-Gibert Pau , Gimeno Castillo Javier , Martínez-González Maria Isabel , González-Pérez Ricardo
Published: August 2020

Several singular cutaneous manifestations have been recently reported in patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Acral chilblain-like lesions, as well as purpuric macules, have already been characterized. We illustrate a case of a 100-year-old man who was diagnosed with COVID-19 and presented an acral petechial rash some weeks after his respiratory infection. We suggest that it could represent a novel variant of cutaneous manifestations associated to this viral infection, possibly related to a delayed immunological reaction.
Glucocorticoids Improve 30-day Survival Probability in Critical Coronavirus Disease 2019 Patients
Authors: Wang Tao , Guerra Alfonso Llosa
Published: August 2020

Background

The optimal approach to manage Coronavirus Disease 2019 (COVID-19) patient is still uncertain, especially for critical ill patients, high mortality has been observed since the outbreak of the crisis. Glucocorticoid use has been in debate for treating COVID-19–infected patient.

Methods

Twenty-nine critically ill patients with COVID-19 in this report are defined as patients are intubated and admitted to intensive care unit (ICU). Chart review was conducted on those patients, their demographic characteristics, baseline comorbidities, hospital course, clinical management, and laboratory/imagine reports were summarized. Thirty-day survival probability after ICU admission was analyzed for comparing the steroid group and nonsteroid group. Survival curve and analysis were performed by Kaplan-Meier survival analysis. P value less than 0.05 is defined as significant different.

Results

Among the 29 critical COVID-19 cases, 12 are survived beyond day 30 of ICU admission, 9 of the 12 are successfully extubated and discharged home, 3 remained on ventilator support in ICU after 30 days. In the 12 survived patients, 10 (83%) received glucocorticoid treatment, whereas in the 17 patients who died, only 8 (44%) were treated with steroid. The baseline characteristics between the steroid and nonsteroid group are similar. The 30-day survival rate is lower in the steroid group comparing to the nonsteroid group (P = 0.0405).

Conclusions

Proper use of glucocorticoids offers considerable mortality benefit to the outcome of critical ill COVID-19 patient. This observational descriptive study might be helpful to other similar small community hospital facing a surge of COVID-19 patients, when other clinical trials or supports are hardly available.
The first
E59Q
mutation identified in the
NEUROD1
gene in a Chinese family with maturity-onset diabetes of the young: an observational study
Authors: Zhang Juan , Jiang Yanyan , Li Li , Wang Yanpeng , Lu Ming , Chen Yating , Song Mingqiang , Ge Xiaoxu , Li Ming , Wang Ying , Wang Feng , Yu Miao , Jiang Meisheng , Liu Yanjun , Liu Limei
Published: August 2020

Objective:

In contrast to the most commonly reported forms of maturity-onset diabetes of the young (MODY), including MODY2, MODY3 and MODY5, MODY6 is a relatively rare subtype. To investigate whether
NEUROD1
is responsible for MODY in Chinese individuals, we screened its mutations in MODY pedigrees and explored the potential pathogenic mechanisms.

Methods:

Polymerase chain reaction direct sequencing was performed to screen
NEUROD1
mutations in 32 Chinese MODY probands who were negative for the
GCK
/
MODY2
,
HNF1A/MODY3
and
HNF1B/MODY5
genes in this observational study. In addition, we enrolled 201 unrelated, non-diabetic control subjects of Han Chinese descent. The functional significance of newly identified mutations was analyzed using clinical phenotype, pathophysiology and three-dimensional structure studies. This study was approved by the Institutional Review Board of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, China (approval No. YS-2017-83) on March 3, 2017.

Results:

E59Q
(c.175 G>C, p.Glu59Gln), a heterozygous missense mutation in the
NEUROD1
gene, was identified in one family with MODY. The Glu59 residue in
NeuroD1
is highly conserved across mammalian species. Four diabetic patients carrying the mutation (a proband and her son, brother and sister) were lean, with a body mass index of 20.9 (20.3-21.2) kg/m
2
. Compared with their unaffected relatives (
n
= 4),
E59Q
carriers (
n
= 4) had significantly decreased ratios of fasting and 2-hour insulin to plasma glucose (both fasting plasma insulin/fasting plasma glucose and 2-hour postprandial plasma insulin/2-hour postprandial plasma glucose,
P
< 0.005). The proband’s father had an
E59Q
mutation and normal glucose tolerance, which suggested non-penetrance. The
E59Q
mutation was not detected in other probands or in the 201 control subjects with normal glucose tolerance. Two salt-bridge bonds of Glu59 were disrupted at the Q59 mutation site.

Conclusion:

The
NEUROD1
-
E59Q
mutation changed the molecular conformation of the N-terminal in
NeuroD1
, which may decrease binding of the
E59Q
mutant to the insulin promoter and insulin gene transcription activity, therefore causing the MODY6 subtype with defective insulin secretion.
Pudendal Nerve Injuries in Sports and Exercise: A Case Series of Pudendal Neuropathies From Squats
Authors: Kasitinon Donald , Kelly Brian , Price Taylor L. , Chhabra Avneesh , Scott Kelly M.
Published: August 2020

Background:

Pudendal neuropathy is an underrecognized cause of pelvic pain that can be difficult to diagnose and treat. Cycling has been the traditional etiology associated with exercise-induced pudendal neuropathy, but with changing aesthetic and societal norms emphasizing a strong physique, there has been increasing anecdotal evidence of squat-based exercises causing the condition.

Study Design:

Case series. A retrospective medical record review was performed to look at all patients with pudendal nerve injuries who presented to a physical medicine and rehabilitation pelvic floor rehabilitation clinic over a 1-year period.

Case Description:

There were 15 cases of pudendal neuropathy thought to be due to squat-based exercises. Here, we present 4 of these patients (1 male and 3 females) who had good follow-up and compliance with treatment recommendations, along with their respective outcomes.

Outcomes:

This is the first case series to present a number of patients with pelvic pain due to pudendal neuropathies presumably derived from squat-related exercise. All 4 of these patients had good outcomes utilizing a multidisciplinary approach to management.

Discussion:

It is important for both physicians and physical therapists to learn to recognize pudendal neuropathy as a cause of pelvic pain and to counsel patients effectively to help them avoid pudendal nerve injury during exercise.
Association Between Helicobacter pylori Colonization and Inflammatory Bowel Disease
Authors: Shirzad-Aski Hesamaddin , Besharat Sima , Kienesberger Sabine , Sohrabi Ahmad , Roshandel Gholamreza , Amiriani Taghi , Norouzi Alireza , Keshtkar Aabbas
Published: August 2020

Background:

Various observational studies have examined a potential relationship between Helicobacter pylori colonization and inflammatory bowel diseases (IBDs); however, results are inconclusive. This systematic review evaluates articles reporting an association between human H. pylori colonization and IBD.

Methods:

A systematic search of studies was conducted to evaluate a possible relationship between H. pylori colonization and IBD. Seven databases and different types of gray literature were searched. After screening for relevant articles, selection and data extraction were done. After that, the data were analyzed, and pooled odds ratios (ORs) were calculated, using meta-analysis. Heterogeneity, sensitivity, and subgroups analyses were conducted. Funnel plots followed by Begg and Egger tests were done to assess the publication bias.

Results:

Among 58 studies, including 13,549 patients with IBD and 506,554 controls, the prevalence of H. pylori colonization was 22.74% and 36.30%, respectively. A significant negative association was observed between H. pylori colonization and IBD (pooled OR: 0.45, 95% confidence interval 0.39-0.53, P≤0.001). The random-effect model showed significant statistical heterogeneity in the included studies (I
2=79%). No publication bias was observed. Among subgroups, ORs were notably different when the data were stratified by the age difference between patient and control group, and by study regions and/or continent. Finally, the meta-regression analysis showed significant results, in terms of the age difference and region variables.

Conclusions:

In this meta-analysis, all statistical data support the theory that H. pylori has a protective role in IBD. However, more primary studies using proper methodology are needed to confirm this association.
Lifestyle interventions affecting hepatic fatty acid metabolism
Authors: Parry Sion A. , Turner Mark C. , Hodson Leanne
Published: August 2020

Purpose of review

Prevalence of metabolic-associated fatty liver disease (MAFLD) is increasing, and as pharmacological treatment does not exist, lifestyle interventions (i.e. diet and exercise) represent the cornerstone management and treatment strategy. Although the available data clearly demonstrate that changes in lifestyle influence intrahepatic triglyceride (IHTG) content, the mechanisms through which this is achieved are seldom investigated. Here, we review recent evidence demonstrating the influence of lifestyle interventions on hepatic fatty acid metabolism and IHTG content.

Recent findings

Diet and exercise influence IHTG content through various, and often interrelated factors. These include alterations in whole-body and tissue-specific insulin sensitivity, which may influence the flux of fatty acid and lipogenic substrates to the liver, and changes in intrahepatic fatty acid synthesis and partitioning. Notably, there are only a few studies that have investigated intrahepatic fatty acid metabolism in vivo in humans before and after an intervention.

Lifestyle interventions represent an effective means of influencing hepatic fatty acid metabolism. IHTG content is decreased without weight-loss either through exercise or by changing the macronutrient composition of the diet, although what the optimal macronutrient composition is to achieve this has yet to be defined.
Can a carnivore diet provide all essential nutrients?
Authors: O’Hearn Amber
Published: August 2020

Purpose of review

The aim of this study was to summarize current contributions affecting knowledge and predictions about the nutritional adequacy of plant-free diets, contextualized by historical accounts.

Recent findings

As demonstrated in recent experiments, nutrient interactions and metabolic effects of ketogenic diets can impact nutritional needs, sometimes resulting in nutrient-sparing effects. Other studies highlight conflicting hypotheses about the expected effect on metabolic acidosis, and therefore mineral status, of adding alkaline mineral-rich vegetables.

A carnivore diet is a newly popular, but as yet sparsely studied form of ketogenic diet in which plant foods are eliminated such that all, or almost all, nutrition derives from animal sourced foods. Ketogenic diets are already nutritionally controversial due to their near-complete absence of carbohydrate and high dietary fat content, but most ketogenic diet advocates emphasize the inclusion of plant foods. In this review, we discuss the implications of relying solely on animal sourced foods in terms of essential nutrient status.
Racial Differences in the Effectiveness of a Multifactorial Telehealth Intervention to Slow Diabetic Kidney Disease
Authors: Kobe Elizabeth A. , Diamantidis Clarissa J. , Bosworth Hayden B. , Davenport Clemontina A. , Oakes Megan , Alexopoulos Anastasia-Stefania , Pendergast Jane , Patel Uptal D. , Crowley Matthew J.
Published: August 2020

Background:

African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline.

Objective:

The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline.

Research Design:

Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control.

Measures:

The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm.

Results:

Findings demonstrated a differential intervention effect on kidney function over time by race (P
interaction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m2; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=−1.7 mL/min/1.73 m2; 95% confidence interval: −3.3, −0.02).

Conclusion:

A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.
Learning and the “Early Joiner” Effect for Medical Conditions in Medicare’s Bundled Payments for Care Improvement Program
Authors: Joynt Maddox Karen E. , Orav E. John , Zheng Jie , Epstein Arnold M.
Published: August 2020

Background:

Studies of medical conditions in the Bundled Payments for Care Improvement (BPCI) initiative did not show reductions in Medicare payments for the majority of conditions, but this could mask heterogeneity.

Objective:

To determine whether earlier enrollment and/or longer participation in BPCI were associated with performance.

Design:

We divided BPCI hospitals into wave 1 (joined 10/1/13, 1/1/14, or 4/1/14), wave 2 (joined 7/1/14, 10/1/14, 1/1/15, or 4/1/15), and wave 3 (joined 7/1/15, 10/1/15, or 1/1/16) and compared changes in Medicare payments for acute myocardial infarction, heart failure, pneumonia, sepsis, and chronic obstructive pulmonary disease between BPCI and matched controls in 6-month increments.

Subjects:

US hospitals.

Measures:

Medicare payments.

Results:

There were 120 hospital-condition pairs in wave 1, 264 in wave 2, and 300 in wave 3. Wave 1 hospitals had similar savings to controls early in the program (0–6 mo difference in differences −$10, P=0.976; 6–12 mo +$295, P=0.441; 12–18 mo −$540, P=0.218; 18–24 mo −$485, P=0.259) but had greater savings than controls at 24–30 months (difference in differences −$663, P=0.035). Wave 2 (0–6 mo +$193, P=0.524; 6–12 mo −$183, P=0.489; 12–18 mo −$162, P=0.618) and wave 3 hospitals (0–6 mo +$79, P=0.753; 6–12 mo −$32, P=0.876) did not achieve significant savings at any time interval. There were no differential changes in patient outcomes over time.

Conclusions:

Hospitals that joined BPCI earliest began to achieve savings at roughly 2 years of participation. These findings have implications for this and other alternative payment models.
Associations of 4 Nurse Staffing Practices With Hospital Mortality
Authors: Rochefort Christian M. , Beauchamp Marie-Eve , Audet Li-Anne , Abrahamowicz Michal , Bourgault Patricia
Published: August 2020

Background:

Cross-sectional studies of hospital-level administrative data have suggested that 4 nurse staffing practices—using adequate staffing levels, higher proportions of registered nurses (RNs) (skill mix), and more educated and experienced RNs—are each associated with reduced hospital mortality. To increase the validity of this evidence, patient-level longitudinal studies assessing the simultaneous associations of these staffing practices with mortality are required.

Methods:

A dynamic cohort of 146,349 adult medical, surgical, and intensive care patients admitted to a Canadian University Health Center was followed for 7 years (2010–2017). We used a multivariable Cox proportional hazards model to estimate the associations between patients’ time-varying cumulative exposure to measures of RN understaffing, skill mix, education, and experience, each relative to nursing unit and shift means, and the hazard of in-hospital mortality, while adjusting for patient and nursing unit characteristics, and modeling the current nursing unit of hospitalization as a random effect.

Results:

Overall, 4854 in-hospital deaths occurred during 3,478,603 patient-shifts of follow-up (13.95 deaths/10,000 patient-shifts). In multivariable analyses, every 5% increase in the cumulative proportion of understaffed shifts was associated with a 1.0% increase in mortality (hazard ratio: 1.010; 95% confidence interval: 1.002–1.017;P=0.009). Moreover, every 5% increase in the cumulative proportion of worked hours by baccalaureate-prepared RNs was associated with a 2.0% reduction of mortality (hazard ratio: 0.980; 95% confidence interval: 0.965–0.995,P=0.008). RN experience and skill mix were not significantly associated with mortality.

Conclusion:

Reducing the frequency of understaffed shifts and increasing the proportion of baccalaureate-prepared RNs are associated with reduced hospital mortality.
Electronic Measurement of a Clinical Quality Measure for Inpatient Hypoglycemic Events
Authors: Santos Carlos A.Q. , Conover Craig , Shehab Nadine , Geller Andrew I. , Guerra Yannis S. , Kramer Holly , Kosacz Nicole M. , Zhang Huiyuan , Budnitz Daniel S. , Trick William E.
Published: August 2020

Background:

Hypoglycemia related to antidiabetic drugs (ADDs) is important iatrogenic harm in hospitalized patients. Electronic identification of ADD-related hypoglycemia may be an efficient, reliable method to inform quality improvement.

Objective:

Develop electronic queries of electronic health records for facility-wide and unit-specific inpatient hypoglycemia event rates and validate query findings with manual chart review.

Methods:

Electronic queries were created to associate blood glucose (BG) values with ADD administration and inpatient location in 3 tertiary care hospitals with Patient-Centered Outcomes Research Network (PCORnet) databases. Queries were based on National Quality Forum criteria with hypoglycemia thresholds <40 and <54 mg/dL, and validated using a stratified random sample of 321 BG events. Sensitivity and specificity were calculated with manual chart review as the reference standard.

Results:

The sensitivity and specificity of queries for hypoglycemia events were 97.3% [95% confidence interval (CI), 90.5%–99.7%] and 100.0% (95% CI, 92.6%–100.0%), respectively for BG <40 mg/dL, and 97.7% (95% CI, 93.3%–99.5%) and 100.0% (95% CI, 95.3%–100.0%), respectively for <54 mg/dL. The sensitivity and specificity of the query for identifying ADD days were 91.8% (95% CI, 89.2%–94.0%) and 99.0% (95% CI, 97.5%–99.7%). Of 48 events missed by the queries, 37 (77.1%) were due to incomplete identification of insulin administered by infusion. Facility-wide hypoglycemia rates were 0.4%–0.8% (BG <40 mg/dL) and 1.9%–3.0% (BG <54 mg/dL); rates varied by patient care unit.

Conclusions:

Electronic queries can accurately identify inpatient hypoglycemia. Implementation in non–PCORnet-participating facilities should be assessed, with particular attention to patient location and insulin infusions.
Current imaging tools for vestibular schwannoma
Authors: Dang Linh , Tu Nathan Chin-yau , Chan Eleanor Y.
Published: August 2020

Purpose of review

Of the tumors found in the cerebellopontine angle (CPA), vestibular schwannomas are by far the most common. Modern diagnostic imaging enables excellent visualization of the CPA and detection of very small tumors while optimizing patient comfort and time. This review addresses the current imaging tools available for diagnosis of vestibular schwannomas.

Recent findings

The current gold-standard imaging study for vestibular schwannomas is a gadolinium-enhanced T1-weighted MRI. The yield of this expensive study is only about 3–4% given the low incidence of vestibular schwannomas, thus there is utility in screening with noncontrast T2-weighted MRI, which is a quicker and more economical study.

Vestibular schwannomas are best evaluated with gadolinium-enhanced T1-weighted MRI, which can detect tumors as small as 2–3 mm. Recent studies have found that the reported sensitivity and specificity of noncontrast MRI is almost equivalent to that of gadolinium-enhanced T1-weighted MRI. As such, this modality is increasingly being adopted by institutions for both diagnosis and surveillance of vestibular schwannomas and shows promise for broader implementation. Newer protocols, such as FLAIR and DTI may provide additional information and further aid preoperative counseling and surgical planning in the future.
A design-thinking approach to therapeutic translation: tympanic regeneration
Authors: Santa Maria Peter Luke
Published: August 2020

Purpose of review

Clinician researchers face the pressures of meeting academic benchmarks combined with advancing new therapies to patients. The vast majority of drug discoveries fail in translation. A new method of meeting the challenges of preclinical therapeutic translation is presented using the example of tympanic regeneration.

Recent findings

The key to a design-thinking approach to therapeutic translation is to ‘begin with the end in mind’ by widening the scope of the problem, with multiple points of view, to not only understand the disease but the context for the patient and the health system in which it occurs. Idea for therapeutics should be tested in relevant models early and once proof of efficacy is established, translational milestones that represent the greatest risk, such as safety and toxicity should be addressed first. It is important to seek the feedback of industry early to understand what milestones should be best addressed next with limited academic resources. Whenever proceeding, guidelines for maintaining scientific reproducibility should be followed to minimize risk of failure during transfer into industry.

A Design-thinking approach addresses the potential failures in drug discovery and preclinical translation.
Oncolytic virotherapy: a potential therapeutic approach for cholesteatoma
Authors: Lipschitz Noga , Earl Brian R. , Cripe Timothy P. , Samy Ravi N.
Published: August 2020

Purpose of review

To review the principles of oncolytic virotherapy and summarize the recent preliminary evidence on the efficacy of oncolytic virotherapy for cholesteatoma (CHST) treatment in vitro in human CHST cells and in a gerbil CHST model.

Recent findings

The use of oncolytic virotherapy for nonmalignant lesions is innovative. In-vitro results showed that oncolytic herpes simplex virus 1 (oHSV) selectively targets and kills CHST cells. In a gerbil model of CHST, local oHSV injections were associated with a decrease in CHST volume and modulation of bony changes.

Surgical treatment options for CHST are limited by high morbidity and recidivism, emphasizing the need for developing treatment alternatives. Preliminary results support the potential therapeutic effect of oncolytic virotherapy on CHST, yet further research is needed to evaluate this novel approach.
Optical coherence tomography: current and future clinical applications in otology
Authors: Matthews Timothy James , Adamson Robert
Published: August 2020

Purpose of review

This article reviews literature on the use of optical coherence tomography (OCT) in otology and provides the reader with a timely update on its current clinical and research applications. The discussion focuses on the principles of OCT, the use of the technology for the diagnosis of middle ear disease and for the delineation of in-vivo cochlear microarchitecture and function.

Recent findings

Recent advances in OCT include the measurement of structural and vibratory properties of the tympanic membrane, ossicles and inner ear in healthy and diseased states. Accurate, noninvasive diagnosis of middle ear disease, such as otosclerosis and acute otitis media using OCT, has been validated in clinical studies, whereas inner ear OCT imaging remains at the preclinical stage. The development of recent microscopic, otoscopic and endoscopic systems to address clinical and research problems is reviewed.

OCT is a real-time, noninvasive, nonionizing, point-of-care imaging modality capable of imaging ear structures in vivo. Although current clinical systems are mainly focused on middle ear imaging, OCT has also been shown to have the ability to identify inner ear disease, an exciting possibility that will become increasingly relevant with the advent of targeted inner ear therapies.
Medications for constipation in 2020
Authors: Medina-Centeno Ricardo
Published: August 2020

Purpose of review

Chronic constipation is a common problem that substantially impacts the quality of life of patients and families, healthcare professionals, and resources. The purpose of this review is to discuss the medications that are available for management of chronic constipation, including medications that have been approved by the FDA for adults, other been studied in pediatrics now, and might become available within the upcoming years.

Recent findings

Recent developments in the evaluation of childhood constipation are providing a better understanding into defecation disorders in children and not only new therapies are becoming available, including medications, but also other therapies, such as biofeedback for treatment of functional defecation disorders, electrical stimulation, and surgeries. The aim of this article is to provide an update on the medications that are available for management of chronic constipation, especially with the development and study of newer medications, such as Linaclotide and Lubiprostone with promising results in both adult and pediatric patients.

This review will help us identify and have a better understanding regarding what medications are available for use and the indications, so that we can better manage patients with chronic constipation.

Video abstract

http://links.lww.com/MOP/A54
CPR and AEDs save lives: insuring CPR--AED education and CPR--AED access in schools
Authors: Berger Stuart
Published: August 2020

Purpose of review

Sudden cardiac arrest and sudden cardiac death are less common in children and adolescents than in the adult population. The outcomes from sudden cardiac arrest are generally quite poor in all ages and some data suggest that they are worse in the child and adolescent age group. In addition, the incidence of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use is generally quite low although it is somewhat variable across communities. This review has been written in order to review the data for pediatric bystander CPR and AED use as it relates to out-of-hospital cardiac arrest (OHCA) survival. The purpose of this article is also to review endeavors at CPR--AED education in the context of improving both community bystander CPR/AED interventions and OHCA survival. Finally, this review will attempt to suggest some potential educational interventions in order to increase both bystander CPR-AED use and OHCA survival in local communities.

Recent findings

Findings from several recent studies suggest that the incidence of bystander CPR--AED intervention is relatively low and that OHCA survival is also quite low in most communities. Several studies also suggest that community educational efforts can increase bystander CPR--AED interventions. The increase in OHCA survival may be attributed to the community educational efforts, yet that increase in survival is relatively small. A prospective high-school study has shown that in this very specific environment, a high incidence of CPR--AED use can be achieved, and that as a result the OHCA survival can be relatively high.

It would be beneficial to attempt to ensure that all schools have a CPR--AED program along with a group of individuals trained to do CPR and use an AED. Not only should all schools have a cardiac emergency response plan (CERP) but all schools should have CPR--AED programs and all students should learn CPR and AED use prior to graduation. This strategy will ensure that we will have a community of individuals who would perform CPR and use an AED in the community and that in so doing we could increase the incidence of bystander CPR/AED use and increase the OHCA survival rate.
Management of familial hypercholesterolaemia in childhood
Authors: Ramaswami Uma , Humphries Steve E.
Published: August 2020

Purpose of review

All guidelines for the management of heterozygous familial hypercholesterolaemia in children and young people recommend statins to lower LDL-cholesterol (LDL-C) concentrations, to reduce the individual's adult risk of developing cardiovascular disease (CVD). Here, we review recent findings regarding the efficacy and safety of the use of stains in childhood.

Recent findings

As expected from their safety profile in adults, there is no evidence from short-term trials or long-term follow-up that statin use in children is associated with any adverse effects on growth, pubertal development or muscle or liver toxicity. Long-term follow-up indicates benefits with respect to lower CVD rates. Factors that influence adherence are discussed, as is the role of the underlying genetic causes for hypercholesterolaemia and of variation at other genes in determining the LDL-C-lowering effect.

Based on the good safety profile, and the expert opinion guidelines, clinicians should consider prescribing statins for children with hypercholesterolaemia from the age of at least 10 years (and earlier if CVD risk is particularly high in the family). Uptitrating statin dosage and the use of additional lipid-lowering therapies should be considered so that LDL-C concentrations are lowered to recommended targets.
The role of machine perfusion in liver xenotransplantation
Authors: MacConmara Malcolm , Feizpour Cyrus A. , Shubin Andrew , Vagefi Parsia A.
Published: August 2020

Purpose of review

To review the role of machine perfusion in advancing the study and clinical application of liver xenotransplantation to liver transplantation.

Recent findings

Recent multicenter trial has shown the benefits of normothermic machine perfusion (NMP) in the assessment and selection of suitable allografts for liver transplantation, especially marginal liver allografts. Advances in ex-vivo therapeutic intervention with proof-of-concept studies demonstrating successful ex-vivo genetic modification of donor allografts and blockade of gene expression with siRNA.

Xenotransplantation and NMP are two of the most exciting and eagerly anticipated technologies in organ transplantation. Since the emergence of clinical transplantation, clinicians and researchers have attempted to manipulate xenografts for clinical use or to develop devices that could provide physiologic support of donor organs ex vivo. The past decade has seen significant progress in NMP with recent emergence of devices suitable for use in clinical practice. Following discovery of novel gene-editing techniques, xenotransplantation has also developed rapidly with encouraging outcomes in preclinical studies. Xenotransplantation is now currently poised to advance into the clinical realm. NMP can not only assist in the development of other novel technologies by providing a unique environment to safely study organ function and assess organ suitability but may also improve outcomes following hepatic xenotransplantation. In this review, we describe the current use of NMP in xenotransplantation research and also discuss the potential roles for NMP in xenotransplantation research and future clinical practice.
Increased Alexithymia But No Profound Emotion Processing Disorder in Burnout Syndrome
Authors: Augustin Magdalena , Eichhammer Peter , Haas Joachim , Schiekofer Stephan , Busch Volker
Published: August 2020

Our objectives were to investigate alexithymia in burnout patients while controlling for depression and anxiety, as well as to evaluate whether alexithymia may be part of a profound emotional processing disorder or of a mentalization deficit. Alexithymia, depressive, and anxious feelings were compared in patients with burnout, depression, and healthy controls using an age-, sex-, and education-matched cross-sectional design (n = 60). A facial emotion recognition task and an emotional mentalizing performance test as well as physical and emotional violation experiences were conducted. Alexithymia was significantly increased in burnout patients, mediated by negative affect in this group. No impairment of facial emotion recognition or mental attribution could be shown. Burnout patients demonstrated slightly increased emotional abuse experiences in early childhood. The present results corroborate the supposition that alexithymia in burnout primarily depends on affect and may rise due to current strain and overload experience, rather than based on a profound developmental disorder in emotion processing.
Resiliency Program for New Graduate Nurses
Authors: Irwin Kristine M. , Saathoff Angela , Janz Deanna A. , Long Carol
Published: August 2020

New graduate nurses face many challenges as they transition into practice. Lacking coping skills, they become stressed and experience symptoms of burnout and an intent to leave. A community hospital implemented a program that included a resilience workshop, group support, and mentoring. A pre–post test design utilized the Connor–Davidson Resilience Scale to measure resilience. Findings demonstrated an increase in resilience, thereby highlighting the importance of providing a resiliency program for new graduate nurses.
Nursing Students’ Meditative and Sociocognitive Mindfulness, Achievement Emotions, and Academic Outcomes
Authors: Lee Mikyoung , Jang Keum-Seong
Published: August 2020

Background

This study integrates the underexamined sociocognitive mindfulness and achievement emotions in nursing.

Purpose

This study examined the relationships between meditative and sociocognitive mindfulness and between mindfulness, achievement emotions, and academic outcomes. It also investigated the mediating effects of achievement emotions.

Methods

In total, 459 Korean nursing students completed a questionnaire measuring mindfulness, achievement emotions, and academic outcomes. Three-step regression analysis and Sobel test were performed to explore the mediating effects of achievement emotions.

Results

Meditative and sociocognitive mindfulness correlated with each other; they correlated positively with positive achievement emotions and academic outcomes and negatively with negative emotions. Students’ positive emotions correlated positively with academic outcomes, whereas negative emotions correlated negatively. The mediating effects of emotions on the relationships between mindfulness and academic outcomes were found.

Conclusions

Both mindfulness perspectives are related to enhancing students’ positive emotions and reducing negative emotions, ultimately influencing their academic outcomes. The mediation results emphasize the benefits of positive emotions and disadvantages of negative emotions between mindfulness and outcomes.
Evaluation of Apoptosis, Proliferation, and Adhesion Molecule Expression in Trophoblastic Tissue of Women With Recurrent Spontaneous Abortion and Infected With Toxoplasma gondii
Authors: Elsalam Safaa A. , Mansor Ahmed E. , Sarhan Mohamed H. , Shalaby Amany M. , Gobran Mai A. , Alabiad Mohamed A.
Published: August 2020

Recurrent spontaneous abortion is an obstetric complication with undefined causes. Apoptosis, proliferation, and adhesion are considered important factors in the pathogenesis of abortion. This work aimed to determine Bax and Bcl-2 as a proapoptotic and antiapoptotic protein, Ki67 and P27kip as proliferative and antiproliferative proteins, and E-cadherin and CD44 as adhesion molecules in the trophoblastic tissues in cases with recurrent miscarriage. Immunohistochemistry and quantitative polymerase chain reaction analysis of Bax, Bcl-2, Ki67, P27kip
, E-cadherin, and CD44 in paraffin-embedded sections of placental tissues obtained from 108 women were divided into 3 categories: 66 Toxoplasma gondii–positive women with recurrent abortion, 22 T. gondii–negative women with recurrent abortion, and 20 women with no history of abortion as a control group. The mean ratio of the expression of Bax and P27kip
proteins was 35.3% and 36.1%, which is significantly higher than that of the second group (19.88 and 20.02%), and the third group (12.3% and 10.98%), while the mean ratio of the expression of Bcl-2, Ki67, E-cadherin, and CD44 proteins was 12.35%, 11.23%, 10.32%, and 9.97%, which is significantly lower than that of the second group (33.75%, 13.18%, 21.88%, and 23.29%) and that of the third group (38.58%, 39.27%, 37.98%, and 35.79%). The presence of proapoptotic protein (Bax) and antiproliferative protein (P27kip
) at high levels and the presence of antiapoptotic protein (Bcl-2), proliferative protein (Ki67), and adhesion molecules (E-cadherin and CD44) in lower levels in the T. gondii–positive group clarify the mechanism involved in the induction of abortion and loss of pregnancy.
The 6 E Framework of Public Health Preparedness for Mass Gatherings—Lessons Learned From Super Bowl LIII, Fulton County, Georgia, 2019
Authors: Murthy Neil C. , Holland David P. , Chamberlain Allison T. , Smith Sasha , Callahan John , Smith Wendy
Published: August 2020

Context:

On February 3, 2019, Atlanta, Georgia, hosted Super Bowl LIII, which is classified as a National Special Security Event. The festivities comprising this major sporting event brought approximately half a million people to Atlanta, which posed significant challenges to the local public health community. As the lead local agency for public health planning, preparedness, and response efforts, Fulton County Board of Health (FCBOH) needed to address multiple specific tasks based on core functional areas outlined in the Emergency Support Function (ESF) 8 (eg, bioterrorism preparedness and epidemiological surveillance).

Program:

To prepare for the Super Bowl, FCBOH developed a systematic approach to ensure community-wide public health preparedness for mass gatherings. This approach came to be known as the 6 E framework, which consists of (1) engaging stakeholders, (2) examining current capabilities and identifying gaps, (3) establishing roles and responsibilities, (4) executing plans to fill gaps, (5) exercising plans, and (6) evaluating impact.

Implementation:

We define each step of the 6 E framework and present practical examples of how FCBOH implemented each step when preparing for the Super Bowl. Challenges that FCBOH faced and the lessons learned in the process are illustrated. The 6 E framework provides a systematic approach to community preparedness and allows local health departments to tailor the approach to serve local public health needs.

Evaluation:

The successful implementation of the 6 E framework allowed for stakeholders at the federal, state, and local levels (including law enforcement) to effectively coordinate an epidemiological investigation and response when 4 staff members reported gastrointestinal symptoms after eating at a feeding station.

Discussion:

Preparation for the Super Bowl required months of diligent cross-sectoral and cross-jurisdictional partnership building, and the 6 E framework can help other local public health jurisdictions prepare to host major mass gatherings.
Updates on the epidemiology, pathogenesis, diagnosis, and management of postinfectious irritable bowel syndrome
Authors: Pisipati Sailaja , Connor Bradley A. , Riddle Mark S.
Published: August 2020

Purpose of review

With its impact on quality of life and increasing awareness, postinfectious irritable bowel syndrome (PI-IBS) is now gaining attention as one of the major health problems commonly encountered in gastrointestinal practice. Literature investigating the various pathogenic mechanisms involved is rapidly emerging. The objective of the current review is to provide an update on recent evidence published in the past 2 years describing advances in our understanding of the epidemiology, pathogenesis, diagnosis, and treatment of PI-IBS.

Recent findings

Significant proportion of research in the recent past was preclinical in nature. Epidemiological studies continue to highlight the risk of IBS after infection, with recent studies documenting postprotozoal effects. Advances in pathogenic mechanisms included clinical studies, which documented micro-RNA down-regulation and Peroxiredoxin-1 up-regulation in colonic mucosa of PI-IBS patients. Protease-activated receptor-2 (PAR-2) activation in PI-IBS mice models resulted in increase in epithelial permeability, mucosal inflammation, visceral hypersensitivity. Moxibustion and rifamycin reduced intestinal inflammation by inhibiting cytokine and chemokine release via different mechanisms. Miltefosine reduced mast cell degranulation and TRPV1 activation, thereby reducing visceral hypersensitivity.

At present, generalization of limited diagnostic and therapeutic strategies across a heterogeneous prevalent patient population impedes the ability to provide effective personalized care in PI-IBS. Further development in pathogenesis discovery, diagnostic tool development are needed in order to design well tolerated and effective therapies that guide treatments based on distinct pathways of disease.
Update on nonantibiotic therapies for acute gastroenteritis
Authors: Funk Anna , Schnadower David , Freedman Stephen B.
Published: August 2020

Purpose of review

The aim of this review is to provide an update of nonantibiotic therapies for acute gastroenteritis (AGE), focusing on antiemetics and probiotics.

Recent findings

The mainstay of therapy for nonsevere AGE remains oral rehydration therapy (ORT). Recent randomized controlled trials and metaanalyses have further strengthened the evidence-base supporting single-dose ondansetron administration in emergency departments to facilitate ORT based on evidence that it safely reduces intravenous fluid administration and hospitalization rates. Intravenous ondansetron administration and multiple-dose use should be avoided. A bimodal release ondansetron formulation was shown to improve outcomes in adolescents and adults with AGE in one study, but further evidence is required to support use. Recent large trials evaluating probiotic administration demonstrated a lack of benefit and guidelines that recommend their use should reevaluate their positions in light of this evidence. Furthermore, caution should be exercised when use is considered in high-risk populations and settings.

The benefits, dosing/route, and target populations most likely to benefit from ondansetron have been further clarified. Optimization of the real-life effectiveness of this therapy will require implementation strategies. Recent high-quality evidence showing a lack of efficacy and potential harm associated with probiotic use suggests that routine use for AGE should be discouraged.