bluuebunny/crossref_metadata_2025 huggingface dataset:
The Price Elasticity of African Elephant Poaching
Authors: Do Quy-Toan , Levchenko Andrei A , Ma Lin , Blanc Julian , Dublin Holly , Milliken Tom
Published: March 2020

The objective of this paper is to provide an estimate of the elasticity of elephant poaching with respect to prices. Ivory being a storable commodity subjects its price to Hotelling’s no-arbitrage condition, hence allowing identification of the supply curve. The price of gold, one of many commodities used as stores of value, is thus used as an instrument for ivory prices. The supply of illegal ivory is found to be price inelastic with an elasticity of 0.4, with changes in consumer prices passing-through to prices faced by producers at a rate close to unity. Estimations based on a number of alternative estimation approaches all confirm the conclusion that supply is inelastic. The paper ends with a brief discussion on what such a finding implies for elephant conservation policies.
Diversity and distribution of North Atlantic Lepechinellidae (Amphipoda: Crustacea)
Authors: Lörz Anne-Nina , Brix Saskia , Jażdżewska Anna M , Hughes Lauren Elizabeth
Published: March 2020

North Atlantic lepechinellid amphipod species were investigated using morphological and molecular techniques based on material collected during two IceAGE expeditions in 2011 and 2013 (Icelandic marine Animals: Genetics and Ecology). The presence of eyes is reported for the first time for the family Lepechinellidae. Four lepechinellid species, Lepechinella grimi, L. helgii, L. skarphedini and Lepechinelloides karii were distinct across morphological, COI and 16S data. Lepechinella arctica, L. norvegica and L. victoriae were seen to be morphologically similar. No morphological or molecular separation was observed between L. arctica and L. norvegica, indicating that these taxa should not be considered separate species. Full illustrations of habitus and mouthparts are presented for L. arctica and a new synonymy is provided recognizing L. norvegica as a junior synonym of L. arctica. While L. victoriae shows little morphological variation from L. arctica, COI and 16S data show this taxon as genetically distinct. Furthermore, new geographic and depth ranges for North Atlantic and Arctic lephechinellids are provided.
A Non-Conserved p33 Protein of Citrus Tristeza Virus Interacts with Multiple Viral Partners
Authors: Dao Thi Nguyet Minh , Kang Sung-Hwan , Bak Aurélie , Folimonova Svetlana Y.
Published: March 2020

The RNA genome of citrus tristeza virus (CTV), one of the most damaging viral pathogens of citrus, contains 12 open reading frames resulting in production of at least 19 proteins. Previous studies on the intraviral interactome of CTV revealed self-interaction of the viral RNA-dependent RNA polymerase, the major coat protein (CP), p20, p23, and p33 proteins, while heterologous interactions between the CTV proteins have not been characterized. In this work, we examined interactions between the p33 protein, a nonconserved protein of CTV, which performs multiple functions in the virus infection cycle and is needed for virus ability to infect the extended host range, with other CTV proteins shown to mediate virus interactions with its plant hosts. Using yeast two-hybrid, bimolecular fluorescence complementation, and coimmunoprecipitation assays, we demonstrated that p33 interacts with three viral proteins, i.e., CP, p20, and p23, in vivo and in planta. Coexpression of p33, which is an integral membrane protein, resulted in a shift in the localization of the p20 and p23 proteins toward the subcellular crude-membrane fraction. Upon CTV infection, the four proteins colocalized in the CTV replication factories. In addition, three of them, CP, p20, and p23, were found in the p33-formed membranous structures. Using bioinformatic analyses and mutagenesis, we found that the N-terminus of p33 is involved in the interactions with all three protein partners. A potential role of these interactions in virus ability to infect the extended host range is discussed.
Managing noncompressible torso hemorrhage with REBOA
Authors: Bartley Marilynn Kyritsis
Published: March 2020

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has reemerged as a treatment for noncompressible torso hemorrhage. This article discusses indications and contraindications for REBOA, describes the procedure, and reviews nursing considerations for patients undergoing REBOA.
Comparing clinical outcomes of comminuted distal radial fracture treatment by pins and plaster with primary locking plate in elderly patients: a prospective comparative clinical study
Authors: Tabrizi Ali , Afshar Ahmadreza , Taleb Hassan , Mohammadi Sedra , Dindarian Sina
Published: March 2020

Background:

Distal radial fractures are common osteoporosis-induced fractures in elderly patients. In this study, we compared the treatment outcomes of pins and plaster with locking plates in elderly patients over 65 yr of age.

Methods:

In this prospective study, 204 elderly patients with distal radial fractures were examined from 2014 to 2018. Among these patients, only 94 had comminuted fractures and required surgery. The remaining 110 patients were excluded from the study. Among the 94 patients with comminuted distal fractures, 46 were treated with pins and plaster while 48 received open reduction and fixation with a locking plate. The patients were followed for 1 yr. Functional performance and quality of life were compared between groups. Complications, the need for reoperation, and radiographic findings were recorded.

Results:

Functional outcomes and general health of elderly patients treated with open reduction and fixation with a locking plate showed significant improvement in comparison to those treated by pins and plaster (P<0.001). Grip power and acceptable radiographic findings were significantly different in patients treated with a locking plate (P<0.001), and these patients were in better condition. Pin track infection, skin damage with rupture and dehiscence at the pin site, nonunion, and need for reoperation were 17.3% (8/46), 21.7% (10/46), 32.6% (15/46) and 39.1% (18/46) in patients treated with pins and plaster, respectively. In the locking plate group, infection was observed in 2% (1/48) of patients, and malunion and the need for reoperation was 4.1% (2/48) and 6.2% (3/48), respectively, which showed a significant difference.

Conclusions:

In elderly patients, application of a locking plate for comminuted intraarticular distal radial fractures resulted in better functional outcomes and improved quality of life.

Level of Evidence:

Level I.
Lyme disease: diagnosis and treatment
Authors: Schoen Robert T.
Published: March 2020

Purpose of review

Lyme disease is an important, vector-borne infection found throughout the temperate Northern hemisphere. The disease causes rash, acute systemic illness, and in some untreated patients, inflammatory arthritis. This review examines the emergence, clinical features and management of early Lyme disease and Lyme arthritis.

Recent findings

There has been continuing progress in characterizing the clinical manifestations, diagnostic testing and treatment of Lyme disease. Almost all patients with early Lyme disease can be cured with antibiotic treatment. In most cases, Lyme arthritis also responds to antibiotics, but some patients require additional treatment approaches.

The diagnosis of Lyme disease is based on clinical manifestations and adjunctive laboratory testing. For the rheumatologist, Lyme arthritis should be recognized by a pattern of attacks of asymmetric, oligo-arthritis, recognizable by clinical manifestations in the same way that other rheumatic diseases, such as gout or rheumatoid arthritis, are diagnosed.
Symptomatic acute hypotension associated with high-dose dacarbazine
Authors: Cren Pierre-Yves , Marliot Guillaume , Pannier Diane , Penel Nicolas , Strobbe Geoffrey
Published: March 2020

We observed several cases of hypotension associated with high-dose dacarbazine. We conducted a retrospective observational analysis of all patients treated with high-dose dacarbazine from January 2018 to August 2019 in Oscar Lambret Center, Lille, France. In our study, a total of 23 patients in outpatient care were analyzed, they underwent 57 treatment cycles. We observed 8 episodes of hypotension in 7 of the 23 consecutive treated patients (30.4%). We discuss herein several hypotheses explaining dacarbazine-induced hypotension. Dacarbazine high dose and administration methods seem to be the main causes of hypotension adverse events. Administration methods include administration duration, which should be above 2 hours, concomitant hydration with 500 ml 0.9% sodium chloride, and UV-resistant pump tube downstream the administration tree.
miR-4286/TGF-β1/Smad3-Negative Feedback Loop Ameliorated Vascular Endothelial Cell Damage by Attenuating Apoptosis and Inflammatory Response
Authors: He Zhiyu , Xue Hao , Liu Peiying , Han Dunzheng , Xu Lingling , Zeng Xiaojun , Wang Jinping , Yang Biqing , Luo Bihui
Published: March 2020

Atherosclerosis (AS), known as the chronic inflammatory disease, results from the dysfunction of vascular endothelial cells (VECs). Transforming growth factor-β1 (TGF-β1) has been reported to be induced by oxidized low-density lipoprotein (ox-LDL) and contribute to AS-related vascular endothelial cell damage. This work planned to study the mechanism of TGF-β1 in vascular endothelial cell damage. We found that TGF-β1 was activated by ox-LDL in human umbilical vascular endothelial cells (HUVECs). Silence of TGF-β1 reversed the inductive effect of ox-LDL on apoptosis and inflammatory response of HUVECs. Mechanistically, microRNA-4286 (miR-4286) targeted and inhibited TGF-β1 to inhibit Smad3, and Smad3 bound to the promoter of miR-4286 to repress its transcription. Rescue assays indicated that miR-4286 ameliorated the ox-LDL-induced apoptosis and inflammatory response through inhibiting TGF-β1. In conclusion, our study first demonstrated that miR-4286/TGF-β1/Smad3-negative feedback loop ameliorated vascular endothelial cell damage by attenuating apoptosis and inflammatory response, providing new thoughts for promoting the treatment of AS.
Changes in ultrasound uterine morphology and endometrial thickness during ovarian aging and possible associated factors: findings from a prospective study
Authors: Li Jiayi , Wang Yaping , Tang Ruiyi , Peng Yajing , Wang Yuchen , Liu Bing , Jiang Ying , Liu Gaifen , Lin Shouqing , Chen Rong
Published: March 2020

Objective:

The aim of the study was to provide reference values for sonographic measurements of uterine morphology, quantify changes in uterine morphology across the menopausal transition, and identify possible factors associated with sonographic findings in uterine morphology.

Methods:

This is a longitudinal cohort study conducted in middle-aged Chinese women. Using transvaginal ultrasound, we measured morphologic parameters of the uterus (volume and endometrial thickness) under standardized conditions every year for over a decade.

Results:

Uterine volume begins to decrease before the final menstrual period and declines rapidly thereafter. Compared with a baseline measurement taken in the year of the final menstrual period, uterine volume decreased by 20% and 35% at the first year and second year of postmenopause, respectively. The rate of decrease was slower in the third year. Compared with endometrial thickness in the year of the final menstrual period, the figures for 2 and 3 years before the final menstrual period were 5% and 10% higher, while they decreased by 9% and 18% at the first and second year after the final menstrual period. Similarly, the endometrial thickness became relatively stable 3 years after the final menstrual cycle. These observations were fairly consistent across all women without uterine fibroids. Endometrial thickness was significantly positively associated with body mass index (P= 0.049) after adjusting for time and menopausal stage.

Conclusions:

The figures for uterine volume and endometrial thickness decrease around menopause using ultrasound measurments with large reductions in the first and second year after the final menstrual period. A higher body mass index is associated with increased endometrial thickness.
May measurement month 2017: Latin America
Authors: Barbosa Eduardo C.D. , Ramirez Agustin , Beaney Thomas , Kobeissi Elsa , Lopez-Jaramillo Patricio , Hernánez-Hernández Rafael , Eibel Bruna , Lanas Fernando , Penaherrera Ernesto , Marin Marcos , Boggia José , Ortellado Jose , Gomez Enrique , Sánchez Enrique , Bryce Alfonso , Valdez Osiris , Beistline Holly , Nwokocha Chukwuemeka , Connell Kenneth , Barrientos Ana , Wyss Fernando , Kenerson John , Poulter Neil R.
Published: March 2020

Objectives:

To raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension.

Methods:

An opportunistic cross-sectional survey of volunteers aged at least 18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard May measurement month protocol. Eighteen countries in Latin America and the Caribbean participated in the campaign, providing us with a wide sample for characterization.

Results:

During May measurement month 2017 in Latin America and the Caribbean, 105 246 individuals were screened. Participants who had cardiovascular disease, 2245 (2.3%) had a prior myocardial infarction, and 1711 (1.6%) a previous stroke, additionally 6760 (6.4%) individuals were diabetic, 7014 (6.7%) current smokers and 9262 (8.8%) reported alcohol intake once or more per week. Mean SBP was 122.7 mmHg and DBP was 75.6 mmHg. After imputation, 42 328 participants (40,4%) were found to be hypertensive.

Conclusion:

The high numbers of participants detected with hypertension and the relatively large proportion of participants on antihypertensive treatment but with uncontrolled hypertension reinforces the importance of this annual event in our continent, to raise awareness of the prevention of cardiovascular events.
Parameterization of the mid-trimester drop in blood pressure trajectory during pregnancy and its utility for predicting preeclampsia
Authors: Mi Baibing , Wen Xiaozhong , Li Shanshan , Liu Danmeng , Lei Fangliang , Liu Xin , Wang Duolao , Li Xuelan , Shittu Abdal Aziz T. , Dang Shaonong , Yan Hong
Published: March 2020

Objectives:

The purpose of this study was to parameterize mid-trimester drop in blood pressure (BP) trajectory during pregnancy and to evaluate its utility for predicting preeclampsia.

Methods:

To develop parametric models for BP trajectory during pregnancy, we used data from 7923 Chinese pregnant women with 24 810 routine antenatal care visits. Then, we evaluated the utility of BP trajectory parameters for predicting clinician-diagnosed preeclampsia in a separate sample of 3524 pregnant women from a randomized controlled trial of prenatal vitamin supplementation conducted in the same area. We focused on parameters related to the mid-trimester BP drop, including the gestational age and BP value at the nadir (lowest point), change in BP, velocity, and area under curve during two periods (from 12 weeks of gestation to the nadir and from the nadir to 33 weeks of gestation).

Results:

All participants in our analysis had a mid-pregnancy drop in their SBP, DBP, and mean arterial pressure (MAP) trajectories. There were high correlations (|r| > 0.90) among trajectory parameters of the same BP measure. The final prediction model included selective parameters of SBP, DBP, and MAP trajectories, prepregnancy BMI and gestational age at the first antenatal care visit. The area under the receiver-operating curve for predicting preeclampsia was 0.886 (95% confidence interval 0.846--0.926) in the training dataset and 0.802 (0.708--0.895) in the validation dataset.

Conclusion:

Our novel BP trajectory parameters are informative and can predict preeclampsia at a clinically acceptable level.
Alcohol-aggravated episodic pain in humans with SCN11A mutation and ALDH2 polymorphism
Authors: Yang Luyao , Li Lulu , Tang Haiyan , Ma Tingbin , Li Yulei , Zhang Xianwei , Shi Xiaoliu , Liu Jing Yu
Published: March 2020

Mutations in Nav1.9 encoded by SCN11A have been associated with episodic pain, small-fiber neuropathy, and congenital insensitivity to pain. In this study, we collected and characterized one Chinese family with episodic pain. The SCN11A mutation (c.664C>A/p.Arg222Ser) was identified and cosegregated with the episodic pain phenotype. In addition, we found that alcohol intake triggered intense pain attacks and detected the ALDH2 polymorphism (c.1510G>A/p.Glu504Lys) in 3 patients with episodic pain. The alcohol-aggravated pain symptom and this ALDH2 polymorphism were also reconfirmed in our previously reported episodic pain patient with the Nav1.9 mutation (p.Ala808Gly, patient III-2 in HBBJ family). To assess the pathogenicity of the Nav1.9 mutation and the new trigger, we introduced a mutation (p.Ala796Gly) into the mouse (orthologous mutation in human is p.Ala808Gly). The alteration hyperpolarized channel activation, increased the residual current through noninactivating channels, and induced hyperexcitability of dorsal root ganglion (DRG) neurons in Scn11a
A796G/A796G mice. The Scn11a
A796G/A796G mice showed increased sensitivity to mechanical, heat, and cold stimuli, and hypersensitivity to acetaldehyde and formalin, which could account for the alcohol intake-induced pain phenotype in patients. Moreover, acetaldehyde increased the mutant mNav1.9 channel current and excitability of Scn11a
A796G/A796G mouse DRG neurons. Parecoxib (an anti-inflammatory medication) relieved the heat hypersensitivity in Scn11a
A796G/A796G mice not receiving inflammatory stimuli and significantly decreased the hyperexcitability of DRG neurons in Scn11a
A796G/A796G mice. These results indicated that Scn11a
A796G/A796G mice recapitulated many clinical features of patients and suggested that Nav1.9 channel contributes significantly to the inflammatory pain state.
Effects of rivaroxaban and dabigatran on global hemostasis in patients with atrial fibrillation
Authors: Petkovic Anica , Al-Khalili Faris , Antovic Aleksandra , Ammar Majeed , Pruner Iva , Vranic Aleksandra , Soutari Nida , Zdravkovic Nebojsa , Malmström Rickard E. , Jakovljevic Vladimir , Antovic Jovan P.
Published: March 2020

The study was aimed to evaluate the effects of two standard doses of rivaroxaban and dabigatran on global hemostatic assays in patients with atrial fibrillation. The study included 52 patients treated with rivaroxaban (15/20 mg), 50 on dabigatran (110/150 mg) and 20 healthy individuals. Platelet-poor plasma was used for determination of three global hemostatic assays, namely endogenous thrombin potential (ETP), calibrated automated thrombogram (CAT) and overall hemostasis potential (OHP). Rivaroxaban and dabigatran reduced ETP (P < 0.01) although OHP (P < 0.05) was diminished only by dabigatran. Strong correlations were noticed between ETP parameters and the plasma concentrations of rivaroxaban (ETP, r = −0.51; c-max, r = −0.85; t-lag, r = 0.83; t-max, r = 0.66) as well as with plasma concentration of dabigatran (ETP, r = −0.75; c-max, r = −0.74; t-lag, r = 0.73; t-max, r = 0.52). Analysis of dabigatran concentrations under 50 ng/ml showed that ETP parameter has area under the concentration–time curve-receiver operating characteristic value of 0.879 (95% confidence interval 0.776–0.980). Dabigatran treatment paradoxically increased area under the concentration–time curve and peak values although rivaroxaban decreased peak values (P < 0.01). However, significant correlation between CAT parameters and plasma concentration of both direct oral anticoagulants was not observed. We confirmed that the CAT assay is inappropriate for estimation of dabigatran effects and is not fully sensitive as regards rivaroxaban. The ETP assay can potentially be the appropriate method for estimation of global hemostatic capacity as regards both direct oral anticoagulants. The role of OHP needs to be confirmed in additional studies. ETP parameter of chromogenic assay has promising potential in exclusion of high plasma concentrations of dabigatran.
Coagulation testing and management in liver disease patients
Authors: Stotts Matthew J. , Davis Jessica P.E. , Shah Neeral L.
Published: March 2020

Purpose of review

The present article aims to provide clinicians with an overview of coagulation testing in individuals with liver disease, to discuss available procoagulants and the rationale for their use, and to provide management strategies in a variety of common clinical scenarios.

Recent findings

Clinicians and researchers are gaining an increased understanding of the shortfalls of assessing bleeding risk using traditional tests of coagulation. The use of global tests of clot formation, including viscoelastic testing and thrombin generation analysis, continues to evolve and guide the management of these patients.

Abnormal coagulation testing in individuals with cirrhosis leads to a variety of difficult clinical scenarios that can be challenging for practitioners. With advanced liver disease, changes in the traditional tests of hemostasis such as the international normalized ratio reflect decreased synthesis of procoagulant factors but do not capture concomitant decreases in anticoagulant factors. In this setting, transfusion thresholds targeting platelet and fibrinogen goals may provide an effective strategy to optimize clot formation. Global tests of clot formation provide practical information to clinicians and can help guide decision making, although optimal target levels have not been validated.
Overview of multistage subunit tuberculosis vaccines: advantages and challenges
Authors: Keikha Masoud , Eslami Majid , Yousefi Bahman , Karbalaei Mohsen
Published: March 2020

To date, tuberculosis (TB) infection, is the most threatening infectious disease in all humans around the world. Mycobacterium tuberculosis is a facultative intracellular bacterium, possesses an exclusive life-cycle inside the macrophages, as one of the most important cells in the innate immune system. As soon as entrance in the lungs, bacteria actively replicate, but intracellular conditions such as hypoxia and nutrient starvation, lead to low replication of bacteria, or nonreplicating state. While Bacillus Calmette-Guerin vaccine is the most usable vaccine, especially in children and against active form, but this vaccine has no more protection in infected adults to latent forms of disease. Among the new generation of vaccines, fusion multistage subunit vaccines have prodigious effect on immune responses. By virtue of simultaneous presence of both expressed antigens from active and latent forms of TB in the structure of these recombinant subunit vaccines, they can strongly induce immune responses against all stages of the disease. The findings suggest subunit vaccines are the best candidates for immunization against TB, by virtue of their high safety, ease of production, specificity, and utilization of mycobacterial immunodominant antigens. Fusion multistage subunit vaccines, as novel subunit vaccines are the most ideal target for proper prevention against TB infection. Due to simultaneous use of both expressed antigens in active and latent forms of TB, these vaccines are able to induce strong immune responses versus all of TB stages.
A systematic review of 40 years of distribution and antimicrobial resistance of Vibrio cholerae in Iran with future perspective
Authors: Louhrasby Vahid , Ghayaz Fatemeh , Mirhosseini Seyed Ali , Golmohammadi Reza
Published: March 2020

To assess the prevalence of incidence rate and antimicrobial susceptibility pattern ofVibrio choleraein provinces of Iran, a systematic review was conducted during 1979–2019. This survey was performed using the following keywords ‘Vibrio cholerae’ and ‘Iran’ in the international databases including ISI Web of Science, PubMed, Scopus, and Google Scholar from January 1979 to December 2019. The statistical analysis was performed using SPSS software version 18.0 (IBM, New York, USA). In addition,Pless than 0.05 was regarded as statistically significant. According to our results, the highest rate of incidence of cholera occurs in Sistan and Baluchestan (925/1636 cases), and after that Alborz (595/1636 cases) and Tehran (587/1636 cases) have shown high distribution. Among all provinces, Alborz province has demonstrated higher percentage of drug resistance than other ones (ampicillin 58.1%, co-trimoxazole 87%, erythromycin 87.5%, and furazolidone 74%). Moreover, lower antibiotic resistance has been shown in Golestan and Kermanshah, respectively. In spite of the fact that Iran has some big challenges in managing and controlling cholera incidence and antibiotic resistance, we believe that Iran has good perspective in future, as follows: special attention of the Iran government to cholera's free treatment, diagnosis and monitoring and eradication of it with coordination of WHO; Improving the level of food safety and quality; and finally, a ‘national action plan of Islamic Republic of Iran to combating antimicrobial resistance’ that were published to stop and reverse the trend of drug resistance in Iran.
The Endothelial Glycocalyx: A Fundamental Determinant of Vascular Permeability in Sepsis
Authors: Fernández-Sarmiento Jaime , Salazar-Peláez Lina María , Carcillo Joseph A.
Published: March 2020

Objectives:

Sepsis is a significant cause of morbidity and mortality. Children with sepsis often have alterations in microcirculation and vascular permeability. Our objective is current evidence regarding the role of the endothelial glycocalyx as a determinant of capillary leakage in these patients.

Data Sources:

We reviewed PubMed, EMBASE, and Google scholar using MeSH terms “glycocalyx”, “fluids”, “syndecan”, “endothelium”, “vascular permeability”, “edema”, “sepsis”, “septic shock”, “children”.

Study Selection:

Articles in all languages were included. We include all studies in animals and humans related to glycocalyx and vascular permeability.

Data Extraction:

Studies in children and adults, as well as animal studies, were included.

Data Synthesis:

One of the fundamental components of the endothelial barrier structure is the glycocalyx. It is a variable thickness layer distributed throughout the whole body, which fulfills a very important function for life: the regulation of blood vessel permeability to water and solutes, favoring vascular protection, modulation, and hemostasis. In the last few years, there has been a special interest in glycocalyx disorders and their relationship to increased vascular permeability, especially in patients with sepsis in whom the alterations that occur in the glycocalyx are unknown when they are subjected to different water resuscitation strategies, vasopressors, etc. This review describes the structural and functional characteristics of the glycocalyx, alterations in patients with sepsis, with regard to its importance in vascular permeability conservation and the possible impact of strategies to prevent and/or treat the injury of this fundamental structure.

Conclusions:

The endothelial glycocalyx is a fundamental component of the endothelium and an important determinant of the mechanotransduction and vascular permeability in patients with sepsis. Studies are needed to evaluate the role of the different types of solutions used in fluid bolus, vasoactive support, and other interventions described in pediatric sepsis on microcirculation, particularly on endothelial integrity and the glycocalyx.
Palliative Care in Children With Heart Disease Treated in an ICU
Authors: Delgado-Corcoran Claudia , Wawrzynski Sarah E. , Bennett Erin E. , Green Danielle , Bodily Stephanie , Moore Dominic , Cook Lawrence J. , Olson Lenora M.
Published: March 2020

Objectives:

Describe pediatric palliative care consult in children with heart disease; retrospectively apply Center to Advance Palliative Care criteria for pediatric palliative care consults; determine the impact of pediatric palliative care on end of life.

Design:

A retrospective single-center study.

Setting:

A 16-bed cardiac ICU in a university-affiliated tertiary care children’s hospital.

Patients:

Children (0–21 yr old) with heart disease admitted to the cardiac ICU from January 2014 to June 2017.

Measurements and Main Results:

Over 1,000 patients (n = 1, 389) were admitted to the cardiac ICU with 112 (8%) receiving a pediatric palliative care consultation. Patients who received a consult were different from those who did not. Patients who received pediatric palliative care were younger at first hospital admission (median 63 vs 239 d; p = 0.003), had a higher median number of complex chronic conditions at the end of first hospitalization (3 vs 1; p < 0.001), longer cumulative length of stay in the cardiac ICU (11 vs 2 d; p < 0.001) and hospital (60 vs 7 d; p < 0.001), and higher mortality rates (38% vs 3%; p < 0.001). When comparing location and modes of death, patients who received pediatric palliative care were more likely to die at home (24% vs 2%; p = 0.02) and had more comfort care at the end of life (36% vs 2%; p = 0.002) compared to those who did not. The Center to Advance Palliative Care guidelines identified 158 patients who were eligible for pediatric palliative care consultation; however, only 30 patients (19%) in our sample received a consult.

Conclusions:

Pediatric palliative care consult rarely occurred in the cardiac ICU. Patients who received a consult were medically complex and experienced high mortality. Comfort care at the end of life and death at home was more common when pediatric palliative care was consulted. Missed referrals were apparent when Center to Advance Palliative Care criteria were retrospectively applied.
Framework for improving outcome prediction for acute to chronic low back pain transitions
Authors: George Steven Z. , Lentz Trevor A. , Beneciuk Jason M. , Bhavsar Nrupen A. , Mundt Jennifer M. , Boissoneault Jeff
Published: March 2020

Clinical practice guidelines and the Federal Pain Research Strategy (United States) have recently highlighted research priorities to lessen the public health impact of low back pain (LBP). It may be necessary to improve existing predictive approaches to meet these research priorities for the transition from acute to chronic LBP. In this article, we first present a mapping review of previous studies investigating this transition and, from the characterization of the mapping review, present a predictive framework that accounts for limitations in the identified studies. Potential advantages of implementing this predictive framework are further considered. These advantages include (1) leveraging routinely collected health care data to improve prediction of the development of chronic LBP and (2) facilitating use of advanced analytical approaches that may improve prediction accuracy. Furthermore, successful implementation of this predictive framework in the electronic health record would allow for widespread testing of accuracy resulting in validated clinical decision aids for predicting chronic LBP development.
Multisite Study of Women Living With HIV's Perceived Barriers to, and Interest in, Long-Acting Injectable Antiretroviral Therapy
Authors: Philbin Morgan M. , Parish Carrigan L. , Kinnard Elizabeth N. , Reed Sarah E. , Kerrigan Deanna , Alcaide Maria L. , Cohen Mardge H. , Sosanya Oluwakemi , Sheth Anandi N. , Adimora Adaora A. , Cocohoba Jennifer , Goparaju Lakshmi , Golub Elizabeth T. , Fischl Margaret , Metsch Lisa R.
Published: March 2020

Background:

Adherence to antiretroviral therapy (ART) is imperative for viral suppression and reducing HIV transmission, but many people living with HIV report difficultly sustaining long-term adherence. Long-acting injectable (LAI) ART has the potential to transform HIV treatment and prevention. However, little LAI ART–related behavioral research has occurred among women, particularly outside of clinical trials.

Setting:

Six Women's Interagency HIV Study sites: New York, Chicago, Washington DC, Atlanta, Chapel Hill, and San Francisco.

Methods:

We conducted 59 in-depth interviews with women living with HIV across 6 Women's Interagency HIV Study sites (10 per site; 9 at Washington DC). We interviewed women who were not included in LAI ART clinical trials but who receive care at university settings that will administer LAI ART once it is approved. Interviews were recorded, transcribed, and analyzed using thematic content analysis.

Results:

Most women enthusiastically endorsed monthly LAI ART and would prefer it over pills. The following 3 reasons emerged for this preference: (1) convenience and confidentiality, (2) avoiding daily reminders about living with HIV, and (3) believing that shots are more effective than pills. Challenges remain, however, specifically around (1) medical mistrust, (2) concerns about safety and effectiveness, (3) pill burden for HIV and other conditions, and (4) barriers to additional medical visits.

Conclusions:

Most women preferred LAI ART over daily pills given its benefits, including convenience, privacy, and perceived effectiveness. Future research should incorporate more women into LAI ART trials to better understand and align development with user concerns and preferences to enhance uptake.
Artificial Intelligence Pertaining to Cardiothoracic Imaging and Patient Care
Authors: Moore William , Ko Jane , Gozansky Elliott
Published: March 2020

Artificial intelligence (AI) is a broad field of computational science that includes many subsets. Today the most widely used subset in medical imaging is machine learning (ML). Many articles have focused on the use of ML for pattern recognition to detect and potentially diagnose various pathologies. However, AI algorithm development is now directed toward workflow management. AI can impact patient care at multiple stages of their imaging experience and assist in efficient and effective scheduling, imaging performance, worklist prioritization, image interpretation, and quality assurance. The purpose of this manuscript was to review the potential AI applications in radiology focusing on workflow management and discuss how ML will affect cardiothoracic imaging.
Acute Sixth Nerve Palsy and Retinal Hemorrhages as the Presenting Features of Acute Lymphoblastic Leukemia
Authors: Alrobaian Malek A. , Vizcaino Maria Adelita , Henderson Amanda D.
Published: March 2020

A 36-year-old apparently healthy man presented with acute onset of diplopia. Examination demonstrated left sixth nerve palsy with 3 retinal hemorrhages noted in one eye. Gadolinium-enhanced high-resolution skull base MRI revealed left sixth nerve enhancement involving the cisternal segment. Complete blood count, cerebrospinal fluid analysis, bone marrow biopsy, and flow cytometry confirmed acute T-cell lymphoblastic leukemia with central nervous system involvement. This case demonstrates the value of high-resolution MRI in the evaluation of cranial nerve palsy in young adults and also emphasizes the importance of systemic work up in these cases, particularly when retinal findings are present.
Cortical Excitability, Synaptic Plasticity, and Cognition in Benign Epilepsy With Centrotemporal Spikes: A Pilot TMS-EMG-EEG Study
Authors: Baumer Fiona M. , Pfeifer Kristina , Fogarty Adam , Pena-Solorzano Dalia , Rolle Camarin E. , Wallace Joanna L. , Rotenberg Alexander , Fisher Robert S.
Published: March 2020

Purpose:

Children with benign epilepsy with centrotemporal spikes have rare seizures emerging from the motor cortex, which they outgrow in adolescence, and additionally may have language deficits of unclear etiology. We piloted the use of transcranial magnetic stimulation paired with EMG and EEG (TMS-EMG, TMS-EEG) to test the hypotheses that net cortical excitability decreases with age and that use-dependent plasticity predicts learning.

Methods:

We assessed language and motor learning in 14 right-handed children with benign epilepsy with centrotemporal spikes. We quantified two TMS metrics of left motor cortex excitability: the resting motor threshold (measure of neuronal membrane excitability) and amplitude of the N100-evoked potential (an EEG measure of GABAergic tone). To test plasticity, we applied 1 Hz repetitive TMS to the motor cortex to induce long-term depression-like changes in EMG- and EEG-evoked potentials.

Results:

Children with benign epilepsy with centrotemporal spikes tolerate TMS; no seizures were provoked. Resting motor threshold decreases with age but is elevated above maximal stimulator output for half the group. N100 amplitude decreases with age after controlling for resting motor threshold. Motor cortex plasticity correlates significantly with language learning and at a trend level with motor learning.

Conclusions:

Transcranial magnetic stimulation is safe and feasible for children with benign epilepsy with centrotemporal spikes, and TMS-EEG provides more reliable outcome measures than TMS-EMG in this group because many children have unmeasurably high resting motor thresholds. Net cortical excitability decreases with age, and motor cortex plasticity predicts not only motor learning but also language learning, suggesting a mechanism by which motor cortex seizures may interact with language development.
Dental care as a risk factor for transfusion transmissible infections in blood donors: a systematic review and meta-analysis
Authors: Borra Vere , Darius Augusta , Dockx Kim , Compernolle Veerle , Lambrechts Paul , Vandekerckhove Philippe , De Buck Emmy
Published: March 2020

Background and objectives:

The deferral policy for blood donation after dental care is based on the precautionary principle. The aim of this systematic review is to give an overview of the scientific evidence concerning the risk of transfusion transmissible infections (TTIs) after dental care.

Materials and methods:

Four databases were searched: Medline, the Cochrane Library, Embase and Web of Science. Screening was independently performed by two reviewers. The quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation principle. A meta-analysis was performed to assess the association between dental treatment and TTI markers.

Results:

A total of 22 studies were included. Meta-analysis of 16 studies showed an increased association of TTIs with dental treatment, however with large heterogeneity. Subgroup analysis revealed a significant increased association of hepatitis B virus (HBV) with dental treatment [odds ratio 1.79, 95% confidence interval (1.48; 2.18)]. There was conflicting evidence concerning the risk of hepatitis C virus (HCV). One study could not demonstrate a statistically significant increased association of human T-lymphotropic virus type I with dental treatment. Three studies showed a significant increased association of HCV with tooth extraction [odds ratio 1.48, 95% confidence interval (1.11; 1.97)]. Finally, there is conflicting evidence concerning the risk of HBV or HCV after dental cleaning. One study could not demonstrate an association between HIV and dental cleaning. All evidence is of very low certainty and results cannot be considered precise.

Conclusion:

Studies of high quality concerning the risk of TTI after dental care in blood donors are scarce. An association of HBV after dental treatment and HCV after tooth extraction was demonstrated but evidence is of very low certainty. The currently identified studies are of too low certainty to make any suggestions regarding the value of deferral or deferral times.
Characterization of six clinical isolates of Chimaeribacter gen. nov., a novel genus related to the Yersiniaceae family and the three species Chimaeribacter arupi sp. nov., Chimaeribacter coloradensis sp. nov, and Chimaeribacter californicus sp. nov.
Authors: Rossi Alessandro , Fisher Mark A.
Published: March 2020

Eight genetically related, Gram-negative bacterial strains, isolated from clinical specimens between 2012 and 2016, were submitted to arup Laboratories for species identification. The lack of species- or genus-level matches in curated 16S rRNA gene databases prompted us to undertake the polyphasic characterization of these so far undescribed organisms. Six isolates available for additional testing were oxidase negative, catalase positive, pleomorphic, Gram-negative rods displaying temperature-dependent motility and producing yellow-pigmented colonies with three distinct morphotypes: medium-sized shiny, large mucoid and agar-pitting. Biochemical reactions and sugar fermentation patterns were most similar to members of the genus

Serratia

. Fatty acid profiles were highly similar across all six organisms, with the major components being: C16 : 0; C17 : 0 cyclo; C14 : 0 3-OH/iso-C16 : 1 I; C18 : 1 ω7c; and C16 : 1 ω7c/C16 : 1 ω6c. Whole-genome comparisons and multi locus sequence analysis (using the coding genes atpD, rpoB, gyrB and infB) suggest that the strains here described constitute three individual species within a novel genus related to the family

Yersiniaceae

. We propose for this novel taxon the name Chimaeribacter gen. nov., referring to the presentation of multiple characteristics typical of distinct

Enterobacterales

genera within a single organism. Four isolates are representative of a single species: Chimaeribacter arupi sp. nov (2016-Iso1, 2016-Iso2, type strain 2016-Iso3T=DSM 110101T=ATCC TSD-180T and 2013-Iso5). The remaining two isolates constitute the novel species Chimaeribacter coloradensis sp. nov. (type strain 2016-Iso4T=DSM 110102T=ATCC TSD-182T) and Chimaeribacter californicus sp. nov. (type strain 2015-Iso6T=DSM 110100T=ATCC TSD-181T). Our work provides the first formal characterization of the genus Chimaeribacter and forms the basis to study its taxonomic diversity.
Inference of naturally-acquired immunity using a self-matched negative control design
Authors: Northrup Graham R. , Qian Lei , Bruxvoort Katia , Marx Florian M. , Whittles Lilith K. , Lewnard Joseph A.
Published: March 2020

Host adaptive immune responses may protect against infection or disease when a pathogen is repeatedly encountered. The hazard ratio of infection or disease, given previous infection, is typically sought to estimate the strength of protective immunity. However, variation in individual exposure or susceptibility to infection may introduce frailty bias, whereby a tendency for infections to recur among individuals with greater risk confounds the causal association between previous infection and susceptibility. We introduce a self-matched “case-only” inference method to control for unmeasured individual heterogeneity, making use of negative-control endpoints not attributable to the pathogen of interest. To control for confounding, this method compares event times for endpoints due to the pathogen of interest and negative-control endpoints during counterfactual risk periods, defined according to individuals’ infection history. We derive a standard Mantel-Haenszel (matched) odds ratio conveying the effect of prior infection on time to recurrence. We compare performance of this approach to several proportional hazards modeling frameworks, and estimate statistical power of the proposed strategy under various conditions. In an example application, we use the proposed method to re-estimate naturally-acquired protection against rotavirus gastroenteritis using data from previously-published cohort studies. This self-matched negative-control design may present a flexible alternative to existing approaches for analyzing naturally-acquired immunity, as well as other exposures affecting the distribution of recurrent event times.
Electronic data capture for large scale typhoid surveillance, household contact tracing, and health utilisation survey: Strategic Typhoid Alliance across Africa and Asia
Authors: Thindwa Deus , Farooq Yama G , Shakya Mila , Saha Nirod , Tonks Susan , Anokwa Yaw , Gordon Melita A , Hartung Carl , Meiring James E , Pollard Andrew J , Heyderman Robert S
Published: March 2020

Background

Electronic data capture systems (EDCs) have the potential to achieve efficiency and quality in collection of multisite data. We quantify volume, time, accuracy and costs of an EDC using large-scale census data from the STRATAA consortium, a comprehensive programme assessing population dynamics and epidemiology of typhoid fever in Malawi, Nepal and Bangladesh to inform vaccine and public health interventions.

Results

A census form was developed through a structured iterative process and implemented using Open Data Kit Collect running on Android-based tablets. Data were uploaded to Open Data Kit Aggregate, then auto-synced to MySQL-defined database nightly. Data were backed-up daily from 3 sites centrally, and auto-reported weekly. Pre-census materials’ costs were estimated. Demographics of 308,348 individuals from 80,851 households were recorded within average of 14.7 weeks range (13-16) using 65 fieldworkers. Overall, 21.7 errors (95% confidence interval: 21.4, 22.0) per 10,000 data points were found: 13.0 (95% confidence interval: 12.6, 13.5) and 24.5 (95% confidence interval: 24.1, 24.9) errors on numeric and text fields respectively. These values meet standard quality threshold of 50 errors per 10,000 data points. The EDC’s total variable cost was estimated at US$13,791.82 per site.

Conclusions

In conclusion, the EDC is robust, allowing for timely and high volume accurate data collection, and could be adopted in similar epidemiological settings.
Globus pallidus dynamics reveal covert strategies for behavioral inhibition
Authors: Gu Bon-Mi , Schmidt Robert , Berke Joshua D.
Published: March 2020

Flexible behavior requires restraint or cancellation of actions that are no longer appropriate. This behavioral inhibition critically relies on frontal cortex - basal ganglia circuits. A central node within the basal ganglia, the globus pallidus pars externa (GPe), has been hypothesized to mediate “proactive” inhibition: being prepared to stop an action if needed. Here we investigate the population dynamics of rat GPe neurons during preparation-to-stop, stopping, and going. Rats could selectively engage proactive inhibition towards one specific action, as shown by slowed reaction times (RTs) for that action. While proactive inhibition was engaged, GPe population activity occupied state-space locations farther from the trajectory followed during normal movement initiation. Furthermore, the specific state-space location was predictive of distinct types of errors: failures to stop, failures to go, and incorrect choices. The slowed RTs on correct proactive trials reflected a starting bias towards the alternative action, which was overcome before making progress towards action initiation. Our results demonstrate that rats can exert cognitive control via strategic positioning of their GPe network state.