bluuebunny/crossref_metadata_2025 huggingface dataset:
What clindamycin dose should be administered by continuous infusion during combination therapy with rifampicin? A prospective population pharmacokinetics study
Authors: Mimram Léo , Magréault Sophie , Kerroumi Younes , Salmon Dominique , Kably Benjamin , Marmor Simon , Jannot Anne-Sophie , Jullien Vincent , Zeller Valérie
Published: October 2023

Background

Despite its important drug–drug interaction, combined clindamycin/rifampicin therapy may achieve effective plasma clindamycin concentrations, provided clindamycin is administered by continuous infusion. However, the precise clindamycin dose remains unknown.

Objectives

This study was undertaken to determine the daily clindamycin dose to be administered by continuous infusion in combination with rifampicin to achieve effective plasma clindamycin concentrations.

Patients and methods

Two plasma clindamycin concentrations were determined prospectively for 124 patients with bone-and-joint infections treated with continuously infused clindamycin. Twenty patients received clindamycin monotherapy, 19 clindamycin combined with rifampicin and 85 received clindamycin successively without and with rifampicin. A population pharmacokinetic model was developed using NONMEM 7.5. Monte Carlo simulations were run to determine which regimens obtained clindamycin concentrations of at least 3 mg/L.

Results

A linear one-compartment model with first-order elimination accurately described the data. Clindamycin distribution volume was not estimated. Mean clindamycin clearances with rifampicin and without, respectively, were 33.6 and 10.9 L/h, with 12.8% interindividual variability. The lowest daily clindamycin dose achieving plasma concentrations of at least 3 mg/L in >90% of the patients, when combined with rifampicin, was 4200 mg/24 h.

Conclusions

Our results support continuous infusion of 4200 mg of clindamycin/24 h, in combination with rifampicin. This high-dose regimen requires therapeutic drug monitoring-guided dose adaptation.
Characterization of a highly virulent Avibacterium paragallinarum isolate
Authors: Mei Chen , Zhi Yan , Xu Jie , Liang Zhixuan , Zhang Xue , Hu Ge , Wang Hongjun
Published: October 2023

Infectious coryza (IC) is an important respiratory infectious disease in chickens. In this study, an Avibacterium paragallinarum Page serovar C strain, named ZJ-C, was isolated from a local layer flock that was routinely vaccinated with an inactivated trivalent vaccine, using reference strain Modesto as the serovar C immunogen. The pathogenicity, immunogenicity, and genetic characteristics of ZJ-C were studied. The minimum pathogenic dose of the isolate was 100 CFU, which was 1/1,000 of the dose of the serovar C reference strain Modesto. The vaccination-challenge trial in specific pathogen-free (SPF) chickens showed that the ZJ-C bacterin could provide 100% protection against challenge from both ZJ-C and Modesto strains, whereas Modesto provided 100% protection against challenge from itself, but only 70% protection against ZJ-C. Sequence analysis of the HMTp210 hypervariable region (region 2) showed that the homology of region 2 between ZJ-C and Modesto was 96.14%, whereas the homology between ZJ-C and the Kume serovar C-4 reference strain HP60 was 99.83%. Phylogenetic analysis of region 2 showed that ZJ-C was most closely related to cluster C-4, represented by HP60. The experimental data obtained in this study will help the selection of optimal vaccine strains and assist serotyping studies of Av. paragallinarum.
Assessing Risk for Complications in Acute Hematogenous Osteomyelitis in Children: Validation of 2 Predictive Scores
Authors: Sarmiento Clemente Adriana , McNeil J Chase , Hultén Kristina G , Vallejo Jesus G , Scheurer Michael E , Kaplan Sheldon L
Published: October 2023

Background

Acute hematogenous osteomyelitis (AHO) can be associated with severe complications which can be difficult to predict in the clinical setting. The previously published predictive acute complication score (“A-SCORE”) and chronic complication score (“C-SCORE”) show promise, however, further external validation is needed.

Methods

We performed a retrospective study of 418 children with AHO and analyzed the performance of A-SCORE (variables included bone abscess, fever after 48 h of starting antibiotics, suppurative arthritis, disseminated disease, and delayed source control) to predict risk for acute complicated course (treatment failure, prolonged admission, and/or need for ≥2 bone debridements) and C-SCORE (includes disseminated disease, bone debridement, and CRP ≥10 mg/dL at 2–4 days after starting antibiotics) to predict chronic complications (growth restriction, pathologic fracture, chronic osteomyelitis, avascular necrosis, joint deformity, and/or frozen joint).

Results

An acute complicated course occurred in 106/418 (25.4%); 51/380 (13.5%) with complete follow-up data had a chronic complication. The A-SCORE performed with similar specificity (78%) and negative predictive value (NPV) (92%), and higher sensitivity (81%) and increased area under the receiver operating curve (AUC) (0.87) in our population. The C-SCORE performed with similar sensitivity (64%) and NPV (94%) but had lower specificity (86%) and AUC (0.71) than originally reported. Other variables associated with development of complications such as tibia involvement and bacteremia ≥2 days were identified but did not result in significantly improved predictive scores.

Conclusions

Predictive A-SCORE and C-SCORE for AHO complications in children may help guide acute management and long-term follow-up decisions. Prospective studies are needed to determine their applicability.
The combination of the Song Dynasty patterns and digital technology
Authors: Hu Jia
Published: October 2023

The Song-era artifacts carry ideas of naturalness and moderate elegance, preserving and passing them on to future generations. The emerging digital opportunities and initiatives allow us not only to study pattern samples in detail but also to create digital equivalents that are not subject to aging or destruction. This research aims to obtain specific knowledge and situational experience regarding the digitization of Song Dynasty patterns. At the preliminary research stage, the authors performed an online survey on a popular Chinese platform. The survey confirmed the interest of a wide audience in cultural heritage (CH) objects and their preservation. The respondents noted the focus on digital sources of information and considered the documentary video format an optimal educational design. In the first stage, Song patterns were digitally processed using MATLAB version 7.0 and ACDSee. In the subsequent phase, based on the processed patterns, the authors developed an instructional video. In the third stage, the researchers assessed students’ knowledge acquired by watching a video (experimental group) or attending a lecture with a presentation based on raw patterns (control group). The results obtained before and after the intervention showed significant progress in each group. It indicated the effectiveness of the digitized images and this intervention for obtaining new knowledge and raising awareness about the Song Dynasty CH.
Venous thrombosis and thromboembolism: pathophysiological background
Authors: Di Nisio Marcello , Potere Nicola , Buller Harry R. , van Es Nick
Published: October 2023

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality worldwide, especially among the elderly and cancer patients, with an overall incidence of 1–2 per 1000 patient-years. About half of VTEs occur with no identifiable risk factors (unprovoked), while the remainder are associated with major or minor risk factors (transient or persistent). These risk factors can affect one or more components of Virchow’s triad, comprising blood stasis, vessel wall damage, and hypercoagulability. Uncontrolled activation of the immune system was also recently implicated in VTE pathogenesis. Endothelial cell activation by inflammatory stimuli leads to expression of adhesion molecules that facilitate the binding of circulating leucocytes, platelets, erythrocytes, and extracellular vesicles. Subsequent leucocyte activation induces tissue factor expression and generation of neutrophil extracellular traps that trigger and propagate thrombosis. Further understanding of VTE pathophysiology may improve risk stratification and foster the development of therapeutic approaches to VTE complementary to anticoagulation.
Aspirin
Authors: Patrono Carlo , Rocca Bianca
Published: October 2023

Aspirin represents a first choice for the acute treatment and long-term prevention of atherothrombotic events, with consistent recommendations in cardiovascular guidelines. This is based on a series of features reviewed in this chapter: (1) its relatively simple pharmacokinetics and platelet-specific pharmacodynamics make cumulative suppression of thromboxane production a highly predictable phenomenon in the vast majority of compliant patients; (2) the two- to threefold excess of the currently used dose as compared to the lowest daily dose necessary and sufficient to fully inactivate platelet cyclooxygenase-1 activity may accommodate most but extreme interindividual variations in body weight and platelet number; (3) acetylation of cyclooxygenase isozymes in the bone marrow precursors ensures long-lasting suppression of platelet cyclooxygenase activity throughout the dosing interval, and limits the consequences of occasionally missed drug intake, except in cases of accelerated platelet turnover; and (4) low-dose aspirin has undergone an unusual paradigm of independent drug development, characterized by a large number of phase II dose-finding studies and phase III randomized clinical trials, resulting in a very extensive efficacy and safety database for its use as an antiplatelet drug.
Dipyridamole, cilostazol, glycoprotein IIb/IIIa inhibitors, and protease-activated receptor-1 antagonists
Authors: Ortega-Paz Luis , Angiolillo Dominick J.
Published: October 2023

Excessive platelet activation and aggregation occurring after atherosclerotic plaque rupture or erosion may lead to thrombus formation which clinically manifests as an acute coronary syndrome. Understanding the critical role of platelets in atherothrombotic events promoted the development of drugs that inhibit platelet activation and aggregation. In the early 1900s, aspirin was introduced as the first antiplatelet agent. Moreover, during the last decades of the 1900s, other antiplatelet agents such as dipyridamole and cilostazol were introduced into clinical practice. Subsequent improvements in technology and a better understanding of platelet biology led to the discovery of several platelet receptors modulating platelet activation and aggregation, allowing for selective development of platelet inhibiting drugs. This chapter will review the history, mechanism of action, and clinical evidence of dipyridamole, cilostazol, glycoprotein IIb/IIIa inhibitors, and protease-activated receptor-1 antagonist.
Thrombolytic therapy and ancillary antithrombotic therapies
Authors: Sinnaeve Peter R. , Van de Werf Frans
Published: October 2023

Fibrinolytic therapy is still necessary to treat ST-elevation myocardial infarction patients in many centres worldwide because of limited access to catheterization facilities. In contemporary practice, fibrinolysis is given as a bolus combined with anticoagulation and antiplatelets, followed by an early catheterization in a strategy termed the ‘pharmacoinvasive approach’. In this strategy, ST-segment resolution is checked at 60–90 minutes after fibrinolysis. Patients without signs of reperfusion are immediately taken to the catheterization laboratory, while stable, successfully reperfused patients receive a ‘scheduled’ catheterization between 2 and 24 hours after thrombolysis. The advantage of this approach is that unnecessary percutaneous coronary intervention procedures can be avoided in the very early phase after lysis when the risk of prothrombotic and bleeding complications is higher. The optimal dose of bolus fibrinolysis in pharmacoinvasive strategies remains unclear and is currently being prospectively studied.
Antithrombotic therapy in patients with patent foramen ovale (PFO), PFO closure, left ventricular mural thrombus, atrial thrombus, and catheter-related thrombosis
Authors: Nielsen-Kudsk Jens Erik , Andersen Asger , Korsholm Kasper , Grove Erik L.
Published: October 2023

A patent foramen ovale (PFO) can give rise to paradoxical embolism and ischaemic stroke. In patients younger than 60–65 years with PFO-related ischaemic stroke, the risk of recurrent stroke can be reduced by about 60% by transcatheter PFO closure, while continuing antiplatelet therapy. Clinical history, age, presence of risk factors for stroke, ischaemic brain infarct location, and PFO anatomy are key factors when determining the probability of an ischaemic stroke being causally linked to a PFO. Heart–brain team assessment should be integral in the decision-making process for PFO closure. Technical success of transcatheter PFO closure is very high, and the complication rate is low. Dual antiplatelet therapy (aspirin and clopidogrel) should be given for 1–6 months after PFO closure followed by single antiplatelet therapy for up to 5 years. Oral anticoagulation is recommended over antiplatelets in patients with a PFO-related ischaemic stroke not eligible for transcatheter PFO closure. Thrombus formation on the PFO-closure device is a rare complication after PFO closure. Management of device-related thrombosis is outlined. Left ventricular mural thrombus is a serious complication occurring in the setting of regional or global left ventricular dysfunction. It is most often seen in association with acute myocardial infarction. Addition of oral anticoagulation with vitamin K antagonists to aspirin is the historical treatment; however, newer observational studies suggest direct oral anticoagulants to be a safe and equally effective alternative. Thrombus formation in the right and left atria can occur in association with atrial fibrillation, mitral and tricuspid valve stenosis, inflammatory disorders, coagulopathy, cancer, or congenital heart disease and in the setting of thrombosis on intracardiac catheters or pacing leads. Diagnosis and management of atrial thrombi and catheter-related thrombosis are discussed.
Venous thromboembolism: prophylaxis and treatment
Authors: Er Chaozer , Ageno Walter , Cohen Alexander T.
Published: October 2023

Venous thromboembolism (VTE) is the third most frequent cardiovascular disease following myocardial infarction and stroke. Many VTE cases can be attributed to recent hospital admissions and are therefore preventable. As not all hospitalized patients have high VTE risk, performing VTE risk assessment using validated risk assessment models to identify patients who would benefit from thromboprophylaxis is advised. Other than the conventional agents, non-vitamin K antagonist oral anticoagulants can also be used in some settings. High-risk pulmonary embolism is generally treated with systemic thrombolysis while low-risk pulmonary embolism can be treated in the outpatient setting. Patients with intermediate-risk pulmonary embolism should be treated as inpatients for the first few days. Deep vein thrombosis is mostly treated with anticoagulation. Catheter-directed therapy can be considered in highly selected VTE cases. Non-vitamin K antagonist oral anticoagulants are the preferred agents, but special considerations should be given in patients who have advanced liver disease or kidney disease, antiphospholipid syndrome, or had bariatric surgery.
Prevention and treatment of venous and arterial thrombosis in patients with specific conditions: diabetes, renal insufficiency, thrombophilia, and pregnancy
Authors: Agewall Stefan , Roldán Vanessa , Marín Francisco
Published: October 2023

There are special populations that require specific preventive and therapeutic measures, either because of increased thrombotic risk, like diabetes mellitus or thrombophilia, or because they need an adaptation of the treatment to their characteristics, such as renal impairment or pregnancy. The dosing of some antithrombotic drugs is highly dependent on renal function so dosages should be adjusted. Several antithrombotics are contraindicated in pregnancy. The relationships between antithrombotic therapy and these clinical conditions are developed in this chapter.
Self-Disturbances, Perceptual Anomalies, and Physicality
Authors: Mishara Aaron , López-Silva Pablo , Rosen Cherise , Heinz Andreas
Published: October 2023

Thought insertion (TI) is regarded as one of the most complex and severe symptoms of psychosis. Current approaches to TI often make the focus of their analysis specific terms such as the sense of ownership and the sense of agency. This chapter suggests that such models are insufficient in explaining TI’s complexity as they neglect the multimodal view of psychotic experience first introduced by the Early Heidelberg School. On this view, TI involves a disruption to the inner connectedness of thoughts and experiences by a ‘becoming sensory’ of these thoughts experienced as inserted. This includes how thinking is anticipated moment-to-moment as continuous. The application of phenomenological analysis to the experience of TI reveals a ‘physicality’ of the body as an object for the individual; his/her own ‘thoughts’ are experienced as material objects (devoid of inner subjectivity) but preserved in these catastrophic conditions in a ‘paralysis of the I’. After clarifying some of the main elements of our proposal, we explore the way in which predictive coding and Bayesian inference may provide a framework able to link the neurobiology of psychosis with its clinical phenomenology.
SDSS J1619 with blueshifted broad components in H α and in [O iii] having similar line width and velocity shifts: a recoiling SMBH candidate?
Authors: Zhang Xue-Guang
Published: October 2023

In this letter, we report a potential candidate of recoiling supermassive black hole (rSMBH) in Sloan Digital Sky Survey (SDSS) J1619 based on similar velocity shifts and line widths of the blueshifted broad components in H α and [O iii] doublet. The measured line width ratio between blueshifted broad H α and broad [O iii] line is 1.06, if compared with common values around 5.12 for normal Type-1 active galactic nuclei, indicating different properties of the blueshifted broad components in SDSS J1619 from those of normal Quasi Stellar Objects (QSOs). The virial BH mass MBHr derived from the broad H α is consistent with the mass expected from the MBH–σ relation. The similar velocity shifts and line widths of the blueshifted broad components in H α and [O iii] and the virial BH mass derived from the H α broad line emissions that is consistent with the mass expected from the MBH–σ relation, can be explained by an rSMBH scenario. Besides the rSMBH scenario, either the similar line widths of the blueshifted broad components in H α and in [O iii] or the consistency between the virial BH mass and the mass expected from the MBH–σ relation cannot be explained by the other proposed models in SDSS J1619.
Thermodynamics of higher-dimensional Brans–Dicke black holes in the presence of a conformal-invariant field inspired by power-Maxwell electrodynamics
Authors: Dehghani M
Published: October 2023

By use of the conformal transformations, in addition to translating the Brans–Dicke (BD) action to the Einstein frame (EF), we introduce an electromagnetic Lagrangian which preserves conformal invariance. We solve the EF field equations, which mathematically are confronted with the problem of indeterminacy, by use of an exponential ansatz function. When the self-interacting potential is absent or is taken constant in the BD action, the exact solution of this theory is just that of Einstein-conformal-invariant theory with a trivial scalar field. This is a higher-dimensional (HD) analogue of the same considered in Ref. [R.-G. Cai, Y. S. Myung, Phys. Rev. D 56, 3466 (1997)]. The EF general solution admits two classes of black holes (BHs) with non-flat and non-AdS asymptotic behavior which can produce extreme and multi-horizon ones. We obtain the exact solutions of BD-conformal-invariant theory, by applying inverse conformal transformations, which show two classes of extreme and multi-horizon BHs too. Based on the fact that thermodynamic quantities remain unchanged under conformal transformations, we show that the first law of BH thermodynamics is valid in the Jordan frame. We analyze the thermal stability of the HD BD-conformal-invariant BHs by use of the canonical ensemble method.
A closer look at the Yukawa interaction from a symmetry group perspective
Authors: Lopes Luiz L
Published: October 2023

I investigate the use of the SU(3) Clebsch–Gordan coefficients in light of the relations of completeness and closure. I show that in the case of αV = F/(F + D)  ≠ 1, there is an additional interaction: the exchange of a ρ meson between a Λ and a Σ0 hyperon that only affects the symmetric coupling. I then calculate these additional coupling constants and show that this recovers the completeness and closure of the SU(3) Clebsch–Gordan coefficients for all values of αV. Besides, it increases the symmetry of the theory, now we can group the baryon octet into four doublets. Finally, I add the new coupling constants to study numerical results in the hyperon onset in dense nuclear matter assuming αV as a free parameter.
Contingent Thinking and the Sure-Thing Principle: Revisiting Classic Anomalies in the Laboratory
Authors: Esponda Ignacio , Vespa Emanuel
Published: October 2023

We present an experimental framework to study the extent to which failures of contingent thinking explain classic anomalies in a broad class of environments, including overbidding in auctions and the Ellsberg paradox. We study environments in which the subject’s choices affect payoffs only in some states but not in others. We find that anomalies are in large part driven by incongruences between choices in the standard presentation of each problem and a “contingent” presentation, which focuses the subject on the set of states where her actions matter. Additional evidence suggests that this phenomenon is in large part driven by people’s failure to put themselves in states that have not yet happened even though they are made aware that their actions only matter in those states.
Tardigrade diversity and community composition across Norwegian boreal forests
Authors: Guidetti Roberto , Ingemar Jönsson K , Kaczmarek Łukasz , Meier Terje , Speed James D M , Prestø Tommy , Stur Elisabeth , Topstad Lasse , Cesari Michele , Roszkowska Milena , Zawierucha Krzysztof , Hassel Kristian , Ekrem Torbjørn
Published: October 2023

Tardigrades are common in many terrestrial environments and habitats. Although little is known on their ecological preferences, previous studies found diversity and community composition significantly affected by various variables. This study associated tardigrade species’ records with climatic variables, forest type, and substrate categories exploring tardigrade diversity and species communities to find associations with ecological characteristics of Norwegian forests.

A total of 17 473 specimens were identified, encompassing 131 species (including putatively new species) from 305 samples of different substrates (leaf litter, bryophytes, and lichens). Bryophytes and lichens of samples were classified according to the main species, and growth form, and associated with tardigrade species and sample metadata. Tardigrade species’ richness was related to climatic variables and forest type, increased with precipitation, decreased with summer temperature, and not varied with precipitation seasonality. Although there was an unbalanced representation of substrate categories in the different forest types, some tendencies were detectable. Mixed oak and birch forests reached the highest species’ richness. Tardigrade community composition varied between substrate categories and, to a lesser degree, between forest types, but not with climatic variables. Our study highlights the importance of large-scale variables on tardigrade diversity, and substrate categories for tardigrade community composition.
Molecular Characterization and Pathogenicity of Diaporthe Species Causing Nut Rot of Hazelnut in Italy
Authors: Waqas Muhammad , Guarnaccia Vladimiro , Bardella S. , Spadaro Davide
Published: October 2023

Hazelnut (Corylus avellana), a nut crop that is rapidly expanding worldwide, is endangered by a rot. Nut rot results in hazelnut defects. A survey was conducted in northwestern Italy during 2020 and 2021 to identify the causal agents of hazelnut rots. Typical symptoms of black rot, mold, and necrotic spots were observed on hazelnuts. The prevalent fungi isolated from symptomatic hazelnut kernels were Diaporthe spp. (38%), Botryosphaeria dothidea (26%), Diplodia seriata (14%), and other fungal genera with less frequent occurrences. Among 161 isolated Diaporthe spp., 40 were selected for further analysis. Based on morphological characterization and multilocus phylogenetic analysis of the ITS, tef-1α, and tub2, seven Diaporthe species were identified as D. eres, D. foeniculina, D. novem, D. oncostoma, D. ravennica, D. rudis, and D. sojae. D. eres was the main species isolated from hazelnut rots, in particular from moldy nuts. The pathogenicity test performed on hazelnuts ‘Tonda Gentile del Piemonte’ using a mycelium plug showed that all the Diaporthe isolates were pathogenic on their original host. To our knowledge, this work is the first report of D. novem, D. oncostoma, and D. ravennica on hazelnuts worldwide. D. foeniculina, D. rudis, and D. sojae were reported for the first time as agents of hazelnut rot in Italy. Future studies should focus on the comprehension of epidemiology and climatic conditions favoring the development of Diaporthe spp. on hazelnut. Prevention and control measures should target D. eres, representing the main causal agents responsible for defects and nut rot of hazelnuts in Italy.
Genetic Diversity, Mycotoxin Profiles, and Population Structure of Fusarium spp. Associated with Fusarium Head Blight in Georgia, United States
Authors: Ghimire Bikash , Bahri Bochra A. , Martinez-Espinoza Alfredo D. , Mergoum Mohamed , Buck James W.
Published: October 2023

Fusarium head blight (FHB) has become a limiting factor in soft red winter wheat production in the southeast United States. Recent epidemics have occurred in Georgia, but genetic information on the Fusarium species responsible for FHB is unknown. This study aimed to assess pathogen population structure and genetic diversity, trichothecene profiles, and representative pathogenicity of 196 Fusarium isolates collected from 44 wheat (n = 85) and 53 corn (n = 111) fields in Georgia. Phylogenetic analysis using the translation elongation factor 1-alpha (635 bp) and RNA polymerase second largest subunit (930 bp) sequence data resolved isolates into 185 haplotypes, which represented 12 Fusarium species grouped under five species complexes. F. graminearum with 15-acetyl-deoxynivalenol (15ADON) chemotype (75.6%) and F. incarnatum (57.7%) predominated in wheat and corn, respectively, with a surprisingly higher frequency of nivalenol (NIV) F. graminearum (21.8%). Using nine variable numbers of tandem repeat markers, 82 multilocus genotypes out of 86 F. graminearum isolates were identified and grouped into two genetic clusters, pop1fg (n = 29) and pop2fg (n = 32), as part of the North American populations (NA1 and NA2) but with no chemotype differentiation. F. graminearum populations in Georgia are mostly clonal and might have evolved through at least two introductions from the northeast United States and Canada and local adaptation to maintain high genetic diversity. Pathogenicity of F. graminearum isolates from wheat and corn had high FHB severity (>60%) in wheat, which depicted the risk they can pose towards future FHB outbreaks. Overall, this baseline study provided important information on Fusarium species diversity including F. graminearum associated with FHB in Georgia that will be useful to formulate integrated disease management incorporating improved host resistance and fungicide spray programs.
An overview of myofascial pain syndrome with a focus on trigger point injection
Authors: Bodine Nicole
Published: October 2023

Myofascial pain syndrome (MPS) is a very common condition, with an estimated lifetime prevalence of 85% in the general population. MPS is commonly underdiagnosed or misdiagnosed due to the lack of standardized diagnostic criteria and the symptoms' overlap with those of other musculoskeletal pain conditions. The most notable and bothersome feature of MPS is the presence of myofascial trigger points (MTrPs), hypersensitive areas of muscle commonly characterized as knots, nodules, or bumps that cause strain and pain with and oftentimes without stimulation. A low-risk, low-cost procedure, trigger point injection (TPI) is the gold standard for MPS treatment, and NPs can perform the procedure in an outpatient practice setting. Through administration of TPIs and use of other treatment modalities, primary care NPs can significantly impact the quality of life for those patients affected by acute and chronic MPS. This article aims to educate primary care NPs on MPS diagnosis and provide an overview of treatment options, with a focus on TPI use and administration for MPS relief.
Postpartum Complete Salpingectomy as an Alternative to Traditional Partial Salpingectomy
Authors: McCarley Charlotte B , Boitano Teresa KL , Dilley Sarah E , Subramaniam Akila
Published: October 2023

In this narrative review, we describe evidence regarding the associated risks, benefits, and cost effectiveness of postpartum complete salpingectomy compared with partial salpingectomy. Permanent contraception can be performed via several methods, but complete salpingectomy is becoming more common secondary to its coincident benefit of ovarian cancer risk reduction. Small prospective studies and larger retrospective cohort studies have demonstrated the feasibility and safety of complete salpingectomy in the postpartum period. Additionally, multiple cost-effectiveness analyses have demonstrated the cost effectiveness of this method secondary to ovarian cancer reduction over the life span. Although future larger cohort studies will allow for more precise estimates of the effect of complete salpingectomy on ovarian cancer risk and incidence of rare complications, current data suggest that complete salpingectomy should be offered to patients as a method of permanent contraception in the postpartum period.
Secular trends of asthma mortality in China and the United States from 1990 to 2019
Authors: Li Xiaochen , Guo Mingzhou , Niu Yang , Xie Min , Liu Xiansheng
Published: October 2023

Background:

Asthma imposes a large healthcare burden in China and the United States (US). However, the trends of asthma mortality and the relative risk factors have not been comparatively analyzed between the countries. The aim of this study was to compare the mortality and risk factors between China and the US.

Methods:

The deaths, and mortality rates of asthma in China and the US during 1990–2019 were obtained from the Global Burden of Disease Study 2019. The age–period–cohort model was used to estimate these mortality rates based on a log-linear scale with additive age, period, and cohort effects. The population attributable fractions of risk factors for asthma were estimated.

Results:

In 1990–2019, the asthma mortality rate was higher in China than in the US. The crude and age-standardized asthma mortality rates trended downward in both China and the US from 1990 to 2019. The decline in mortality was more obvious in China. Mortality gap between the two countries was narrowing. A sex difference in asthma mortality was observed with higher mortality in males in China and females in the US. The age effects showed that mortality increased with age in adults older than 20 years, particularly in the elderly. Downward trends were generally observed in the period and cohort rate ratios in both countries, with China experiencing a more obvious decrease. Smoking and high body mass index (BMI) were the leading risk factors for asthma mortality in China and the US, respectively. Mortality attributable to occupational asthmagens and smoking decreased the most in China and the US, respectively.

Conclusions:

In 1990–2019, the asthma mortality rate was higher in China than in the US; however, the mortality gap has narrowed. Mortality increased with age in adults. The improvements in asthma death risk with period and birth cohort were more obvious in China than in the US. Smoking, high BMI, and aging are major health problems associated with asthma control. The role of occupational asthmagens in asthma mortality underscores the importance of management and prevention of occupational asthma.
RP11-789C1.1 inhibits gastric cancer cell proliferation and accelerates apoptosis via the ATR/CHK1 signaling pathway
Authors: Liu Wenwei , Feng Wei , Zhang Yongxin , Lei Tianxiang , Wang Xiaofeng , Qiao Tang , Chen Zehong , Song Wu
Published: October 2023

Background:

Long non-coding RNAs (lncRNAs) plays an important role in the progression of gastric cancer (GC). Their involvement ranges from genetic regulation to cancer progression. However, the mechanistic roles of RP11-789C1.1 in GC are not fully understood.

Methods:

We identified the expression of lncRNA RP11-789C1.1 in GC tissues and cell lines by real-time fluorescent quantitative polymerase chain reaction. A series of functional experiments revealed the effect of RP11-789C1.1 on the proliferation of GC cells.In vivoexperiments verified the effect of RP11-789C1.1 on the biological behavior of a GC cell line. RNA pull-down unveiled RP11-789C1.1 interacting proteins. Western blot analysis indicated the downstream pathway changes of RP11-789C1.1, and an oxaliplatin dosing experiment disclosed the influence of RP11-789C1.1 on the drug sensitivity of oxaliplatin.

Results:

Our results demonstrated that RP11-789C1.1 inhibited the proliferation of GC cells and promoted the apoptosis of GC cells. Mechanistically, RP11-789C1.1 inhibited checkpoint kinase 1 (CHK1) phosphorylation by binding ataxia-telangiectasia mutated and Rad3 related (ATR), a serine/threonine-specific protein kinase, promoted GC apoptosis, and mediated oxaliplatin sensitivity.

Conclusion:

In general, we discovered a tumor suppressor molecule RP11-789C1.1 and confirmed its mechanism of action, providing a theoretical basis for targeted GC therapy.
Association of visceral adipose tissue with gout: Observational and Mendelian randomization analyses
Authors: Xiao Wenze , Wang Qi , Liu Yining , Zhang Hui , Zou Hejian
Published: October 2023

Background:

The causal relationship between visceral adipose tissue (VAT) and gout is still unclear. We aimed to examine the potential association between them using observational and Mendelian randomization (MR) analyses.

Methods:

In the observational analyses, a total of 11,967 participants (aged 39.5 ± 11.5 years) were included from the National Health and Nutrition Examination Survey. Logistic regression models were used to investigate the association between VAT mass and the risk of gout. In two-sample MR analyses, 211 VAT mass-related independent genetic variants (derived from genome-wide association studies in 325,153 UK biobank participants) were used as instrumental variables. The random-effects inverse-variance weighted (IVW) method was used as the primary analysis. Additional sensitivity analyses were also performed to validate our results.

Results:

Observational analyses found that an increase in VAT mass (per standard deviation) was associated with a higher risk of gout after controlling for confounding factors (odds ratio [OR] = 1.27, 95% confidence intervals [CI] = 1.11–1.45). The two-sample MR analyses demonstrated a causal relationship between increased VAT mass and the risk of gout in primary analyses (OR = 1.78, 95% CI = 1.57–2.03). Sensitivity analyses also showed similar findings, including MR-Egger, weighted median, simple mode, weighted mode, and leave-one-out analyses.

Conclusions:

Observational analyses showed a robust association of VAT mass with the risk of gout. Meanwhile, MR analyses also provided evidence of a causal relationship between them. In summary, our findings suggested that targeted interventions for VAT mass may be beneficial to prevent gout.
Disparities in Access to Radiotherapy Among Hispanic/Latinx Populations in the United States
Authors: Verdini Nicholas P. , Santos Patricia Mae G. , Vicioso-Mora Yorleny M. , Rivera Amanda , Perez Carmen A. , McClelland Shearwood
Published: October 2023

Objectives:

The Hispanic/Latinx population has consistently faced disparities in oncology access and outcomes with cancer being the leading cause of death in this population. We evaluate recent research in radiation therapy disparities among the Hispanic/Latinx population in the United States since our seminal analysis from 2017.

Methods:

A PubMed literature search was conducted for articles published from January 2017 through March 2023. Four term combinations were utilized, including: (1) “Hispanic” and “Radiotherapy” and “Disparities”, (2) “Latino” and “Radiotherapy” and “Hispanic”, (3) “Hispanic” and “Radiation” and “Disparities”, and (4) “Latino” and “Radiation” and “Disparities.” Included studies were those taking place in the United States, examined radiation oncology care, and examined health disparities.

Results:

Fifty-eight of 245 articles returned met inclusion criteria and spanned 6 disparity-types: (1) Stage at Presentation, (2) Time to Treatment Initiation & Completion, (3) Receipt of Treatment and Guideline-Concordant Care, (4) Geography, (5) Clinical Trial Access and (6) Insurance Barriers and Treatment Center Type. The most common disparity was receipt of treatment and guideline-concordant care (n=39 studies), demonstrating that the Hispanic/Latinx population was less likely to receive guideline-concordant treatment or treatment at all. In additon, studies identified disparities in time to treatment and completion (n=12), geography (n=5), clinical trial access (n=3), and insurance and treatment center access (n=5).

Conclusions:

Disparities in radiotherapy access remain prominent for the Hispanic/Latinx population through a multitude of barriers, despite increasing interest in disparities research. Continued health care disparities research with tangible interventions are needed in radiation oncology to properly understand and address this problem.
Spontaneous Regression of Primary Cutaneous Diffuse Large B-Cell Lymphoma on Sequential FDG PET
Authors: Ghossein Jason , Petkiewicz Stephanie , Zeng Wanzhen
Published: October 2023

Primary cutaneous diffuse large B-cell lymphoma, leg type is a rare, aggressive lymphoma characterized by skin involvement predominantly in the lower extremities. We present a case of an elderly woman with pathology diagnosis of primary cutaneous diffuse large B-cell lymphoma, leg type with spontaneous regression without systematic therapy documented by sequential FDG PET scans and clinical follow-up.
Residential mobility in pregnancy and potential exposure misclassification of air pollution, temperature, and greenness
Authors: Heo Seulkee , Afanasyeva Yelena , Trasande Leonardo , Bell Michelle L. , Ghassabian Akhgar
Published: October 2023

Introduction:

Epidemiological studies commonly use residential addresses at birth to estimate exposures throughout pregnancy, ignoring residential mobility. Lack of consideration for residential mobility during pregnancy might lead to exposure misclassification that should be addressed in environmental epidemiology.

Methods:

We investigated potential exposure misclassification from estimating exposure during pregnancy by residence at delivery utilizing a prospective cohort of pregnant women in New York, United States (n = 1899; 2016–2019). We calculated exposure during pregnancy corresponding to each address for fine particles (PM2.5), temperature, and greenness (Enhanced Vegetation Index [EVI]).

Results:

Twenty-two percent of participants moved at least once during pregnancy; 82.3% of movers changed residences during the second or third trimesters. Participants with better health, lower parity, and higher socioeconomic status were more likely to move. Exposures based on address at delivery rather than residential history overestimated exposure for PM2.5 (exposure error: range −5.7 to 4.6 µg/m3, average −0.6 µg/m3) and EVI (range −0.305 to 0.307, average −0.013), but not temperature. Overestimations were significantly larger for mothers with higher socioeconomic status. Our findings indicate that the error for prenatal exposure can occur when residential mobility is not considered and is disproportional by maternal characteristics.

Conclusions:

Epidemiological studies should consider residential mobility in exposure assessments based on geolocation when possible, and results based on mother’s residence at birth should be interpreted with understanding of potential differential exposure misclassification.
Oxidative stress and antioxidants in cataract development
Authors: Lee Bryanna , Afshari Natalie A. , Shaw Peter X.
Published: October 2023

Purpose of review

Oxidative stress plays a central role in cataract pathogenesis, a leading cause of global blindness. This review delves into the role of oxidative stress in cataract development and key biomarkers – glutathione (GSH), superoxide dismutase (SOD), malondialdehyde (MDA), and 4-hydroxynonenal (4-HNE) – to clarify their functions and potential applications in predictive diagnostics and therapies.

Recent findings

Antioxidants serve as pivotal markers in cataract pathogenesis. GSH affects the central lens due to factors such as enzyme depletion and altered connexin expression, impairing GSH diffusion. Age-related oxidative stress may hinder GSH transport via connexin channels or an internal microcirculation system. N-acetylcysteine, a GSH precursor, shows promise in mitigating lens opacity when applied topically. Additionally, SOD, particularly SOD1, correlates with increased cataract development and gel formulations have exhibited protective effects against posterior subscapular cataracts. Lastly, markers of lipid peroxidation, MDA and 4-HNE, have been shown to reflect disease severity. Studies suggest a potential link between 4-HNE and connexin channel modification, possibly contributing to reduced GSH levels.

Oxidative stress is a significant contributor to cataract development, underscoring the importance of antioxidants in diagnosis and treatment. Notably, GSH depletion, SOD decline, and lipid peroxidation markers are pivotal factors in cataract pathogenesis, offering promising avenues for both diagnosis and therapeutic intervention.
Pediatric nurse practitioner workforce shortage threatens child health equity: Key contributors and recommendations
Authors: Courtwright Suzanne E. , Barr Emily A.
Published: October 2023

The pediatric nurse practitioner (PNP) workforce shortage has begun to limit access to providers participating in Medicaid and/or the Children's Health Insurance Program, threatening child health equity in the United States. The following are key contributors: an emphasis on adult-focused NP programs and subsequent reduction in undergraduate pediatric content, common practice of student advisement to choose family NP programs, decreased PNP student enrollment leading to nonurban pediatric program closures, an acute shortage of PNP preceptors, and invisibility of the PNP workforce in national workforce data and strategic planning. We outline feasible action steps that nurses, NPs, educators, physicians, and policymakers can take to support PNP workforce growth to advance child health equity in the United States.
Pharmacogenetic testing may benefit people receiving low-dose lithium in clinical practice
Authors: Dickerson Michael Ray , Reed Jennifer
Published: October 2023

Background:

Mental illnesses are leading causes of disability in the United States. Some evidence supports that pharmacogenetic testing may be beneficial in select populations and that lithium is beneficial for treating mood disorders and anxiety in some populations.

Purpose:

This research aimed to determine whether low-dose lithium effectively decreases depression and anxiety in adults with a risk allele for CACNA1C genotypes.

Methodology:

The study design was correlational. Fifty patients were treated at a nurse practitioner–owned clinic in Prairie Village, Kansas. Chart review was used. Adults older than 18 years diagnosed with major depressive disorder, bipolar disorder, or generalized anxiety disorder presenting with an abnormality in the CACNA1C gene single-nucleotide polymorphism rs1006737 were included in this research. Assessment tools used were the Patient Health Questionnaire-9 for depression and GAD-7 for anxiety.

Results:

Low-dose lithium significantly decreased depression by 66% (p < .001) and anxiety by 65% (p = <.001). There was a significant difference in pretest depression levels based on CACNA1C genotype (p = .033). The A allele frequency was 60% higher (48%) in this population than found in general population (30%).

Conclusions:

Low-dose lithium significantly decreased anxiety and depression compared with baseline. People with different versions of the CACNA1C genotype had responses that differed significantly. The A risk allele was 60% more common than in the general population.

Implications:

This study could aid in establishing genetic testing as an effective clinical tool for treating depression and anxiety using lithium, an inexpensive and widely available medication.
Supplemental oxygen therapy in chronic obstructive pulmonary disease: is less is more? How much is too much?
Authors: Daher Ayham , Dreher Michael
Published: October 2023

Purpose of review

Currently available evidence supporting the use of supplemental oxygen therapy (SOT) in chronic obstructive pulmonary disease (COPD) is complex, and data on the mortality reduction associated with SOT usage in patients with severe daytime resting hypoxemia have not been updated since the development of other treatments.

Recent findings

No reduction in mortality was found when SOT was used in patients with moderate resting daytime, isolated nocturnal, or exercise-induced hypoxemia. However, some of these patients obtain other significant benefits during SOT, including increased exercise endurance, and a mortality reduction is possible in these ‘responders’. The adverse effects of long-term oxygen therapy also need to be considered, such as reduced mobility and social stigma. Furthermore, conservative SOT could improve outcomes in the setting of COPD exacerbations compared with higher concentration oxygen regimens. Compared with usual fixed-dose SOT, automated oxygen administration devices might reduce dyspnea during exercise and COPD exacerbations.

Current recommendations for SOT need to be revised to focus on patients who respond best and benefit most from this therapy. A conservative approach to SOT can reduce side effects compared with higher concentration oxygen regimens, and automated oxygen administration devices may help to optimize SOT.
My radius is broken – do I need a cast or is a splint enough?
Authors: Ogilvie Daniella , Liebeskind Mariel , Doyle Shevaun M. , Edobor-Osula Folorunsho
Published: October 2023

Purpose of review

The treatment of many distal radius fractures has shifted from casting to splinting or the application of a soft dressing. This review includes a review of the types of pediatric distal radius fractures and the most recent literature on the management of these injuries.

Recent findings

Many nondisplaced distal radius fractures may be treated with removable splints or bandages. This mitigates complications with cast immobilization. Additionally, many of these injuries do not require follow-up treatment and thereby reduce healthcare costs.

This update on distal radius fractures in the pediatric population highlights changes in the treatment paradigm and demonstrates an opportunity to diminish healthcare costs.