bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Antihypertensive Regimens (Nifedipine-retard, Labetalol, and Methyldopa) for Management of Severe Hypertension in Pregnancy: An Open-Label, Randomized Controlled Trial
Authors: Easterling T. , Mundle S. , Bracken H. , Parvekar S. , Mool S. , Magee L.A. , von Dadelszen P. , Shochet T. , Winikoff B.
Published: August 2020

(Lancet. 2019;394:1011–1021)

Hypertension complicates ∼10% of pregnancies, and is associated with adverse outcomes for the mother and child. Severe hypertension in pregnancy, defined as a systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110mm Hg, is considered an obstetric emergency requiring urgent antihypertensive treatment to prevent cardiovascular or cerebrovascular events. There are currently insufficient data on medications used to treat severe hypertension in pregnancy. This study directly compared 3 oral drugs—labetalol, nifedipine, and methyldopa—for efficacy and safety when used for the treatment of severe hypertension in pregnancy.
Generalizability of Randomized Trials of the Programmed Intermittent Epidural Bolus Technique for Maintenance of Labor Analgesia: A Prospective Single-Centre Cohort Study
Authors: Gabriel L. , Young J. , Hoesli I. , Girard T. , Dell-Kuster S.
Published: August 2020

(Br J Anaesth. 2019;123:e434–e441)

Neuraxial analgesia is the most widely used labor pain relief method, and patient-controlled epidural analgesia (PCEA) used in combination with a low-dose continuous epidural infusion has been shown to boost patient satisfaction while also increasing the volume of local anesthetics that are used. Researchers who have conducted randomized controlled trials (RCTs) have shown that substituting a programmed intermittent epidural bolus (PIEB) in place of PCEA can decrease local anesthetic consumption, but it is unclear if the maternal motor block in this method has a negative effect on labor progression. Because RCTs are almost always conducted on healthy nulliparous women, their results cannot easily be applied to the variety of patients seen in daily clinical practices. Gabriel and colleagues conducted their study on epidural labor analgesia data in order to compare the maternal motor function of RCT-eligible nulliparous women to parous women who are usually considered RCT-ineligible.
Epidural-related Maternal Fever: Still a Hot Topic, But What Are the Burning Issues?
Authors: Sultan P. , Segal S.
Published: August 2020

(Anesth Analg. 2020;130:318–320)

A number of studies controlling for predisposing obstetric and neonatal variables have confirmed the phenomenon of epidural-related maternal fever (ERMF), which is associated with an increased risk of neonatal mortality and morbidity. ERMF is thought to be a sterile inflammatory process, as it is not reduced by broad-spectrum antibiotic or acetaminophen administration. Placental inflammation is a common feature in ERMF, though no pathogenic bacteria are found.
Education Program Regarding Labor Epidurals Increases Utilization by Hispanic Medicaid Beneficiaries: A Randomized Controlled Trial
Authors: Togioka B.M. , Seligman K.M. , Werntz M.K. , Yanez N.D. , Noles L.M. , Treggiari M.M.
Published: August 2020

(Anesthesiology. 2019;131:840–849)

While epidural analgesia is generally a popular approach to alleviating labor pain, researchers in the United States have found that epidural analgesia usage rates are lower for Hispanic women than for white women. This difference may indicate a disparity in the education about neuraxial analgesia provided to Hispanic women. In addition, language barriers may lead to misconceptions about labor analgesia. While steps have been taken by many national health organizations to overcome language barriers and reduce peripartum disparities, no research has been done to evaluate the efficacy of a modified, linguistically accessible educational program on epidural labor analgesia administration. This study aimed to determine if a language-concordant program would increase the rate of epidural usage in both Hispanic and non-Hispanic women.
Need for Additional Anesthesia After Single Injection Spinal Analgesia for Labor: A Retrospective Cohort Study
Authors: Sharpe E.E. , Kim G.Y. , Vinzant N.J. , Arendt K.W. , Hanson A.C. , Martin D.P. , Sviggum H.P.
Published: August 2020

(Int J Obstet Anesth. 2019;40:45–51)

While the most common forms of neuraxial analgesia for labor are continuous epidural and combined spinal-epidural, single injection spinal analgesia is sometimes used for labor analgesia. A disadvantage of the single injection technique is that an additional anesthesia procedure may be needed if labor is prolonged or surgery is required. A previous study reported another anesthetic intervention was needed in 26% of women who received single injection spinal analgesia for labor. This current retrospective study aimed to determine the rate of additional anesthetic interventions in women who received a single injection spinal block for labor analgesia.
Risk of Complication at the Time of Laparoscopic Hysterectomy: A Prediction Model Built From the National Surgical Quality Improvement Program Database
Authors: Pepin Kristen J. , Cook E. Francis , Cohen Sarah L.
Published: August 2020

(Abstracted from Am J Obstet Gynecol 2020; doi: 10.1016/j.ajog.2020.03.023)

Although laparoscopic hysterectomy (LH) has been well-established as a favorable mode of hysterectomy given its decreased perioperative complications, there is still room for improvement in quality of care. The overall morbidity of the procedure is low, but adverse outcomes have been reported in 6% to 19% of cases.
The Effectiveness of Online Interventions for Patients With Gynecological Cancer: An Integrative Review
Authors: Lin Huicong , Ye Mingzhu , Chan Sally Wai-Chi , Zhu Jiemin , He Honggu
Published: August 2020

(Abstracted from Gynecol Oncol 2020;158:143–152)

Cancer diagnosis and subsequent treatment can have a significant impact on the quality of life of patients with gynecological cancer. Beyond physical symptoms including nausea, fatigue, pain, and changes in urination and bowel movements, there are often more nuanced and psychological effects including depression, decreases in social support, and adversely impacted sexual well-being and body image.
Education and training in ultrasound-guided regional anaesthesia and pain medicine
Authors: Chuan Alwin
Published: August 2020

Purpose of review

Effective and safe regional anaesthesia and pain medicine procedures require clinicians to learn and master complex theoretical knowledge and motor skills. This review aims to summarize articles relevant to education and training in these skill sets in the previous 2 years.

Recent findings

Twenty-two articles were identified, investigating nine out of the 13 top-ranked research topics in education and training in regional anaesthesia. Research topics addressed by these articles included prerotation simulation, deliberate practice combined with formative assessment tools, validation of assessment tools, three-dimensional-printed models, and knowledge translation from simulation to clinical practice. Emerging concepts investigated for their applications in regional anaesthesia included eye-tracking as a surrogate metric when evaluating proficiency, and elastography aiding visual salience to distinguish appropriate perineural and inappropriate intraneural injections.

Research into education and training in regional anaesthesia covered multiple and diverse topics. Methodological limitations were noted in several articles, reflecting the difficulties in designing and conducting medical education studies. Nonetheless, the evidence-base continues to mature and innovations provide exciting future possibilities.
Wrong-site nerve blocks: evidence-review and prevention strategies
Authors: Kwofie Kwesi , Uppal Vishal
Published: August 2020

Purpose of review

There has been increasing attention to wrong site medical procedures over the last 20 years. This review aims to provide a summary of the current understanding and recommendations for the prevention of wrong-site nerve blocks (WSNB).

Recent findings

Various procedural, patient, practitioner, and organizational factors have been associated with the risk of WSNB. Recent findings have suggested that the use of a checklist is likely to reduce the incidence of WSNB. However, despite the widespread use of preprocedural checklists, WSNB continue to occur at significant frequency. This may be due to the inability of practitioners and teams to implement checklists correctly or the cognitive errors that prevent checklists from being executed as designed.

Though the evidence is limited, it is recommended that a combination of multiple strategies should be employed to prevent WSNB. These include the use of preprocedural markings, well constructed checklists, time-out/stop-moments, and cognitive/physical aids. Effective implementation requires team education and engagement that empowers all team members to speak up as part of a culture of safety.
How Patient Centered Are Addiction Treatment Intake Processes?
Authors: Mark Tami L. , Hinde Jesse , Henretty Kristen , Padwa Howard , Treiman Katherine
Published: August 2020

Objectives:

The substance use disorder (SUD) treatment field has conducted significant research on creating intake tools and processes that best match patients to the most appropriate treatment setting, but less research has been conducted on how those tools impact the patient experience. The study took advantage of a natural experiment in California to evaluate whether the implementation of American Society of Addiction Medicine (ASAM) assessment criteria and a computer-facilitated intake assessment based on the ASAM criteria affects patient experiences and patient-centeredness during intake relative to patients receiving intake assessments not based on ASAM criteria.

Methods:

We analyzed surveys completed by 851 patients covered by Medi-Cal who were receiving specialty SUD treatment at 33 providers across 10 California counties about their experiences and perceptions of the intake assessment process. To account for differences in patient mix, we used inverse-probability weighting and computed differences in the weighted means for patients across non-ASAM, ASAM, and computerized-ASAM patients.

Results:

We have found that patients who underwent intake based on ASAM assessment criteria or computerized ASAM assessment experienced a more patient-centered intake. We also found that patients who received ASAM-based assessments were more satisfied with their choice of treatment setting.

Conclusions:

This evidence is encouraging for the SUD treatment field, especially considering that many Medicaid programs are adopting ASAM or similar patient placement criteria and multidimensional assessments. Future research should consider whether increases in the patient-centeredness of assessments are associated with increased retention in SUD treatment and other positive treatment outcomes.
Simultaneous Intra- and Extracochlear Electrocochleography During Electrode Insertion
Authors: Dalbert Adrian , Sijgers Leanne , Grosse Julian , Veraguth Dorothe , Roosli Christof , Huber Alexander , Pfiffner Flurin
Published: August 2020

Objectives:

(1) To correlate simultaneously recorded intra- and extracochlear electrocochleography (ECochG) signals during electrode insertion into the cochlea, (2) to track changes in the ECochG signal during insertion and removal of an electrode, and (3) to correlate the findings with the preoperative residual hearing. We hypothesized that intracochlear ECochG recordings show signal changes not reflected in simultaneous extracochlear ECochG recordings.

Design:

During cochlear implantation in human cochlear implant recipients, a short, slim, custom-made electrode was inserted and removed in a stepwise manner. At each step, ECochG recordings were simultaneously recorded by an extracochlear electrode near the round window and via the inserted electrode. The acoustic stimulus was a 500 Hz tone burst at 110 to 130 dB SPL.

Results:

The mean amplitude difference between intra- and extracochlear ongoing ECochG responses was 14 dB (range 9 to 24 dB; n = 10) at the beginning of insertion. Intracochlear ECochG responses were larger in all cases. Extracochlear ECochG responses remained stable while intracochlear recordings showed large variations regarding amplitude and phase during the electrode array insertion. Intracochlear signal changes during insertion were reversible with retraction of the electrode. There were only weak to moderate (rs = 0.006 to 0.4), nonsignificant correlations of residual preoperative hearing with maximum amplitudes and amplitude changes during electrode insertion and removal in intracochlear recordings.

Conclusions:

Signals in intracochlear ECochG recordings are reliably larger than ECochG signals recorded simultaneously from an extracochlear location. Intracochlear ECochG recordings show reversible amplitude and phase changes during insertion, not reflected in simultaneous extracochlear ECochG recordings. Such changes are most likely due to the movement of the recording electrode in relation to the signal generators. Residual high-frequency hearing is associated with larger ECochG signal amplitudes. Modeling of expected intracochlear ECochG changes during electrode insertions may allow detection of cochlear trauma in the future.
A Cross-Language Comparison of Sentence Recognition Using American English and Mandarin Chinese HINT and AzBio Sentences
Authors: Xu Li , Xi Xin , Patton Alexa , Wang Xianhui , Qi Beier , Johnson Lauren
Published: August 2020

Objectives:

The aim of this study was to perform a cross-language comparison of two commonly used sentence-recognition materials (i.e., Hearing in Noise Test [HINT] and AzBio) in American English (AE) and Mandarin Chinese (MC).

Designs:

Sixty normal-hearing, native English-speaking and 60 normal-hearing, native Chinese-speaking young adults were recruited to participate in three experiments. In each experiment, the subjects were tested in their native language. In experiments I and II, noise and tone vocoders were used to process the HINT and AzBio sentences, respectively. The number of channels varied from 1 to 9, with an envelope cutoff frequency of 160 Hz. In experiment III, the AE AzBio and the MC HINT sentences were tested in speech-shaped noise at various signal to noise ratios (i.e., −20, −15, −10, −5, and 0 dB). The performance-intensity functions of sentence recognition using the two sets of sentence materials were compared.

Results:

Results of experiments I and II using vocoder processing indicated that the AE and MC versions of HINT and AzBio sentences differed in level of difficulty. The AE version yielded higher recognition performance than the MC version for both HINT and AzBio sentences. The type of vocoder processing (i.e., tone and noise vocoders) produced little differences in sentence-recognition performance in both languages. Incidentally, the AE AzBio sentences and the MC HINT sentences had similar recognition performance under vocoder processing. Such similarity was further confirmed under noise conditions in experiment III, where the performance-intensity functions of the two sets of sentences were closely matched.

Conclusions:

The HINT and AzBio sentence materials developed in AE and MC differ in level of difficulty. The AE AzBio and the MC HINT sentence materials are similar in level of difficulty. In cross-language comparative research, the MC HINT and the AE AzBio sentences should be chosen for the respective language as the target sentence-recognition test materials.
The role and clinical significance of long noncoding RNA zinc finger E-box-binding homeobox two antisense RNA 1 in promoting osteosarcoma cancer cell proliferation, inhibiting apoptosis and increasing migration by regulating miR-145
Authors: Zhou Yinchuan , Feng Dehong , Gu Xiaofeng , Gao Aiguo , liu Yi
Published: August 2020

We aimed to investigate the expression level of long noncoding RNA (lncRNA) zinc finger E-box-binding homeobox two antisense RNA 1 (ZEB2-AS1) in osteosarcoma and explore its possible regulatory mechanisms. Expression of lncRNA ZEB2-AS1 was detected by quantitative real-time PCR in 63 cancerous tissues and 25 adjacent normal mucosal tissues from patients with osteosarcoma. The correlation between the lncRNA ZEB2-AS1 level and clinicopathological characteristics of the osteosarcoma patients were evaluated, and 5-year overall survival (5OS) was also analyzed according to lncRNA ZEB2-AS1 expression. The ZEB2-AS1 and miR-145 recombinant expression vector was used to analyze their relationship in an in vitro cell system. Luciferase reporter gene assays and RNA immunoprecipitation assays were used to verify the interaction between ZEB2-AS1 and miR-145. The proliferation, apoptosis and migration of osteosarcoma cells were determined by Cell counting kit-8 assays, Annexin V-PI assays and transwell assays, respectively. A significantly increased level of lncRNA ZEB2-AS1 with a fold change of 3.86 was found in osteosarcoma tissues compared with control tissues (P < 0.001). The Chi-square test revealed that lncRNA ZEB2-AS1 expression in osteosarcoma was significantly different according to radiology classification (P = 0.018), TNM stage (P = 0.000) and survival status (P = 0.005). The 5OS was 18.4% and 52% in osteosarcoma patients with higher and lower lncRNA ZEB2-AS1 expression, respectively. Significantly increased ZEB2-AS1 expression was found in osteosarcoma cells, while decreased levels of miR-145 were confirmed in osteosarcoma tissues and cell lines compared to controls. Moreover, a negative correlation was found between the expression level of ZEB2-AS1 and miR-145 in osteosarcoma tissues (R2 = 0.71, P < 0.01). ZEB2-AS1 knockdown resulted in decreased osteosarcoma cell proliferation, increased apoptosis and reduced migration. In addition, negative regulation of miR-145 by ZEB2-AS1 in osteosarcoma cells was also observed, and the effects of ZEB2-AS1 on osteosarcoma cells were found to be regulated by miR-145. Significantly upregulated lncRNA ZEB2-AS1 expression in osteosarcoma patients influences the prognosis of patients, and ZEB2-AS1 accelerates tumorigenesis and osteosarcoma development by downregulating miR-145.
Hyperammonemic encephalopathy during XELOX regimen. Is it capecitabine or oxaliplatin responsible?
Authors: Di Federico Alessandro , Nuvola Giacomo , Sisi Monia , Lenzi Barbara , Nobili Elisabetta , Campana Davide
Published: August 2020

Hyperammonemic encephalopathy represents a rare adverse effect of several chemotherapeutic agents, occurring in about 0.7% of patients treated with fluoropyrimidines, and it is independent from dihydropyrimidine dehydrogenase deficiency. Instead, its physiopathology is linked to the inhibition of Krebs cycle by fluoroacetate, leading to decreased ATP production, and to the inhibition of the urea cycle. Oxaliplatin seems to induce hyperammonemic encephalopathy in a similar way, acting on mitochondria. Here, we report the intriguing case of acute hyperammonemic encephalopathy in a 65-year-old patient with preserved liver function, who was treated with oxaliplatin and capecitabine for a metastatic, G1, atypical lung carcinoid. We reviewed the literature and found very few reports of oxaliplatin or capecitabine-induced hyperammonemic encephalopathy. Out of five cases of capecitabine-related hyperammonemic encephalopathy analyzed (four plus our case), median time to hyperammonemic encephalopathy onset was 6 days, with median serum ammonia levels of 213 μmol/L. Oxaliplatin-related hyperammonemic encephalopathy analyzed cases were three (two plus ours), with a median time to hyperammonemic encephalopathy of 11 days and median serum ammonia levels of 167 μmol/L. Identified predisposing factors for chemotherapy-induced hyperammonemia, such as dehydration, liver and renal impairment, infections, and sarcopenia were absent in our case. We hypothesize that the combination of a platinum-derivative and a fluoropyrimidine multiplies the risk of hyperammonemic encephalopathy, even in the absence of predisposing factors nor impaired liver function. We therefore suggest to always consider the risk of hyperammonemia when starting fluoropyrimidines-based chemotherapy, especially combined with platinum-derivatives, and to timely investigate neurologic symptoms monitoring ammonia serum levels.
High-Flow Nasal Oxygen in Coronavirus Disease 2019 Patients With Acute Hypoxemic Respiratory Failure: A Multicenter, Retrospective Cohort Study*
Authors: Xia Jingen , Zhang Yi , Ni Lan , Chen Lei , Zhou Changzhi , Gao Chang , Wu Xiaojing , Duan Jun , Xie Jungang , Guo Qiang , Zhao Jianping , Hu Yi , Cheng Zhenshun , Zhan Qingyuan
Published: August 2020

Objectives:

An ongoing outbreak of coronavirus disease 2019 is spreading globally. Acute hypoxemic respiratory failure is the most common complication of coronavirus disease 2019. However, the clinical effectiveness of early high-flow nasal oxygen treatment in patients with coronavirus disease 2019 with acute hypoxemic respiratory failure has not been explored. This study aimed to analyze the effectiveness of high-flow nasal oxygen treatment and to identify the variables predicting high-flow nasal oxygen treatment failure in coronavirus disease 2019 patients with acute hypoxemic respiratory failure.

Design:

A multicenter, retrospective cohort study.

Setting:

Three tertiary hospitals in Wuhan, China.

Patients:

Forty-three confirmed coronavirus disease 2019 adult patients with acute hypoxemic respiratory failure treated with high-flow nasal oxygen.

Interventions:

None.

Measurements and Main Results:

Mean age of the enrolled patients was 63.0 ± 9.7 years; female patients accounted for 41.9%. High-flow nasal oxygen failure (defined as upgrading respiratory support to positive pressure ventilation or death) was observed in 20 patients (46.5%), of which 13 (30.2%) required endotracheal intubation. Patients with high-flow nasal oxygen success had a higher median oxygen saturation (96.0% vs 93.0%; p < 0.001) at admission than those with high-flow nasal oxygen failure. High-flow nasal oxygen failure was more likely in patients who were older (p = 0.030) and male (p = 0.037), had a significant increase in respiratory rate and a significant decrease in the ratio of oxygen saturation/Fio
2 to respiratory rate index within 3 days of high-flow nasal oxygen treatment. In a multivariate logistic regression analysis model, male and lower oxygen saturation at admission remained independent predictors of high-flow nasal oxygen failure. The hospital mortality rate of the cohort was 32.5%; however, the hospital mortality rate in patients with high-flow nasal oxygen failure was 65%.

Conclusions:

High-flow nasal oxygen may be effective for treating coronavirus disease 2019 patients with mild to moderate acute hypoxemic respiratory failure. However, high-flow nasal oxygen failure was associated with a poor prognosis. Male and lower oxygenation at admission were the two strong predictors of high-flow nasal oxygen failure.
How to treat lobular cancer in the adjuvant setting?
Authors: Trapani Dario , Curigliano Giuseppe
Published: August 2020

Purpose of review

The aim of this review is to understand the clinical decision- making process for the management of patients with early invasive lobular breast cancer (ILC), thereby orienting clinicians across large areas of uncertainties and extrapolations.

Recent findings

The analysis of the principal evidence on the management of ILC, assessing the role and benefit of systemic treatments in the curative setting, have shed the light on the opportunity to escalate and de-escalate systemic therapies for ILC patients, based on the risk of recurrence and the intrinsic value of the treatments. To refine the selection of the patients most likely to benefit from escalated systemic treatments, the role of genomic tools in ILC has been surveyed. Eventually, an overview of the ongoing clinical studies for early lobular tumors has been extracted.

The review identifies large areas of uncertainties and unmet needs for the management of lobular cancer, urging the implementation of clinical studies appropriately designed, tailoring this subgroup of breast cancer patients. As a distinct biological and clinical entity, areas for improvement have been suggested, to support the formulation of controlled studies and better inform clinical decisions based on quality evidence.
Design and Evaluation of Low-Fidelity Visual Display Prototypes for Multiple Hospital-Acquired Conditions
Authors: Reeder Blaine , Makic Mary Beth Flynn , Morrow Cynthia , Ouellet Judith , Sutcliffe Britney , Rodrick David , Gritz Mark , Wald Heidi
Published: August 2020

Hospital-acquired conditions such as catheter-associated urinary tract infection, stage 3 or 4 hospital-acquired pressure injury, and falls with injury are common, costly, and largely preventable. This study used participatory design methods to design and evaluate low-fidelity prototypes of clinical dashboards to inform high-fidelity prototype designs to visualize integrated risks based on patient profiles. Five low-fidelity prototypes were developed through literature review and by engaging nurses, nurse managers, and providers as participants (N = 23) from two hospitals in different healthcare systems using focus groups and interviews. Five themes were identified from participatory design sessions: Need for Integrated Hospital-Acquired Condition Risk Tool, Information Needs, Sources of Information, Trustworthiness of Information, and Performance Tracking Perspectives. Participants preferred visual displays that represented patient comparative risks for hospital-acquired conditions using the familiar design metaphor of a gauge and green, yellow, and red “traffic light” colors scheme. Findings from this study were used to design a high-fidelity prototype to be tested in the next phase of the project. Visual displays of hospital-acquired conditions that are familiar in display and simplify complex information such as the green, yellow, and red dashboard are needed to assist clinicians in fast-paced clinical environments and be designed to prevent alert fatigue.
MicroRNA-34c promotes neuronal recovery in rats with spinal cord injury through the C-X-C motif ligand 14/Janus kinase 2/signal transducer and activator of transcription-3 axis
Authors: Shen Juan , Gao Feng , Zhao Lin , Hao Qin , Yang Yan-Ling
Published: August 2020

Background

Developing effective spinal cord repair strategies for spinal cord injury (SCI) is of great importance. Emerging evidence suggests that microRNAs (miRNAs) are closely linked to SCI recovery. This study aimed to investigate the function of miR-34c in the neuronal recovery in rats with SCI.

Methods

A rat model with SCI was established. Differentially expressed miRNAs were identified by a microarray analysis. MiR-34c expression in rats was measured by reverse transcription quantitative polymerase chain reaction. Altered expression of miR-34c or C-X-C motif ligand 14 (CXCL14) was introduced in SCI rats to measure their roles in neuronal recovery. Western blot analysis was performed to determine the phosphorylation of Janus kinase 2 (JAK2) and signal transducer and activator of transcription-3 (STAT3). Neuronal apoptosis in rat spinal cord tissues was detected. The concentrations of SCI recovery-related proteins thyrotropin releasing hormone (TRH), prostacyclin (PGI2), and ganglioside (GM) were evaluated by enzyme-linked immunosorbent assay. Data were analyzed using a t-test with a one-way or two-way analysis of variance.

Results

Rats with SCI presented decreased grip strength (112.03 ± 10.64 vs. 17.32 ± 1.49 g, P < 0.01), decreased miR-34c expression (7 days: 3.78 ± 0.44 vs. 0.95 ± 0.10, P < 0.05), and increased CXCL14 expression (7 days: 0.61 ± 0.06 vs. 2.91 ± 0.27, P < 0.01). MiR-34c was found to directly bind to CXCL14. Overexpression of miR-34c increased grip strength (11.23 ± 1.08 vs. 31.26 ± 2.99 g, P < 0.01) and reduced neuronal apoptosis in spinal cord tissues (53.61% ± 6.07% vs. 24.59% ± 3.32%, P < 0.01), and silencing of CXCL14 also increased the grip strength (12.76 ± 1.13 vs. 29.77 ± 2.75 g, P < 0.01) and reduced apoptosis in spinal cord tissues (55.74% ± 6.24% vs. 26.75% ± 2.84%, P < 0.01). In addition, miR-34c upregulation or CXCL14 downregulation increased the concentrations of TRH, PGI2, and GM, and reduced phosphorylation of JAK2 and STAT3 in rats with SCI (all P < 0.01).

Conclusion

The study provided evidence that miR-34c could promote neuronal recovery in rats with SCI through inhibiting CXCL14 expression and inactivating the JAK2/STAT3 pathway. This study may offer new insights into SCI treatment.
Nerve Pathology Distinguishes Focal Motor Chronic Inflammatory Demyelinating Polyradiculoneuropathy From Multifocal Motor Neuropathy
Authors: Tracy Jennifer A. , Taylor Bruce V. , Kiernan Matthew , Dyck Peter J. , Crum Brian A. , Mauermann Michelle L. , Amrami Kimberly K. , Spinner Robert J. , Dyck P. James B.
Published: August 2020

Objectives:

The objective of the study is to distinguish the mechanisms of disease for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN), which we believe to be fundamentally different. However, distinguishing the mechanisms is more difficult when the presentation of CIDP is motor-predominant, focal, or asymmetric.

Methods:

We describe 3 focal, motor-predominant, representative cases that could be interpreted on clinical and/or electrophysiological grounds as either MMN or focal CIDP, and present pathological findings.

Results:

We highlight pathological differences in these cases, and provide an argument that CIDP and MMN are distinct entities with different pathophysiological mechanisms—chronic demyelination for CIDP, and an immune-mediated attack on paranodal motor axons for MMN.

Conclusions:

Based on clinical evaluation, electrophysiology, and nerve biopsy pathology, we can divide the conditions into inflammatory demyelinating neuropathy (focal CIDP) versus chronic axonal neuropathy (MMN). The divergent pathological findings provide further evidence that CIDP and MMN are fundamentally different disorders.
COVID-19
Authors: Ogbebor Osakpolor , Min Zaw , Cheema Tariq , Bhanot Nitin
Published: August 2020

Coronavirus disease-2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. Following this, there has been a rapid development in policies and strategies to contain and mitigate the pandemic. One of such strategies involves the development and utilization of testing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative organism of COVID-19. In this article, we explore the diagnostic modalities for COVID-19 based on the available information to date.
COVID-19 and the Cardiovascular System
Authors: Veer Manik , Kumar Aarthi Madhana , Ivanova Valentyna
Published: August 2020

COVID-19, a symptom complex of respiratory failure induced by a highly infectious pathogen, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been classified as a pandemic. As of April 15, 2020, there have been 2 million people diagnosed with the viral infection and 130 000 deaths globally. It is highly likely that the number of infections is underrepresented secondary to variations in testing and reporting strategies globally. In this short review, we aim to summarize the current understanding of SARS-CoV-2 as it pertains to cardiovascular disease. We discuss the basis of cardiac pathophysiology and address some of the clinical scenarios that cardiovascular physicians may face. We introduce the concept of conservative management of acute coronary syndromes and address some complications such as myocarditis, heart failure, and cardiac arrhythmias that may be relevant for the management of patients presenting with COVID-19.
Institutional COVID-19 Protocols
Authors: DiSilvio Briana , Virani Ahmed , Patel Samir , Finoli Lauren , Singh Anil , DuMont Tiffany , Cheema Tariq
Published: August 2020

As the confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to grow with over 1 million documented infections in the United States alone, researchers and health care workers race to find effective treatment options for this potentially fatal disease. Mortality remains high in patients whose disease course requires mechanical ventilation and admission to intensive care units. While focusing on therapies to decrease mortality is essential, we must also consider the logistical hurdles faced with regard to safely and effectively delivering treatment while limiting the risk of harm to hospital staff and other noninfected patients. In this article, we discuss aspects of surge planning, considerations in limiting health care worker exposure, the logistics of medication delivery in a uniform and consolidated manner, protocols for delivering emergent care in a rapidly deteriorating coronavirus disease-2019 (COVID-19) patient, and safe practices for transporting infected patients.
Beyond Picky Eating
Authors: Lim Tammy S. H. , Aw Marion , Slosky Laura , Nyp Sarah S.
Published: August 2020

CASE:

Joseph is a 20-month-old boy who was thriving and developing well before a 4-day hospitalization for paralytic ileus at 11 months of age. Joseph is the first child born to parents who immigrated to the United States from Southeast Asia 3 years ago. Before the hospitalization, Joseph consumed 3 meals and 480 to 600 mL of milk daily. Oral feedings were restricted during the hospitalization with subsequent rejection of foods upon reintroduction of oral feeds. This resulted in 2 kg of weight loss by follow-up at 13 months. Joseph was referred to the multidisciplinary feeding and nutrition clinic at 16 months for failure to thrive, complicated by iron deficiency anemia and zinc deficiency. Joseph's feeding issues had negatively affected other aspects of his well-being; his development had stagnated, his sleep was fragmented (napping 5 times daily and frequent night waking attributed to hunger), and he had become withdrawn and irritable. By 16 months of age, Joseph was accepting only a couple of bites of solid foods by spoon or drinking small volumes (20–70 mL) of milk every 2 hours around the clock. Anthropometric z scores (World Health Organization) at 16 months: weight for age: < −3; length for age: −2.02; weight for length: −2.92; head circumference: −1.54. Physical examination revealed a cachectic and irritable child with loose skin folds. His skin was dry, and his hair was sparse. There were no perioral or perineal rashes, bruising, or features of rickets noted. Developmentally, parents reported that he was able to crawl and stand independently at the time of hospitalization, but by the time of evaluation at 16 months, he would no longer stand independently and tired quickly when crawling. He did not use any words but waved bye-bye, used gesture to indicate that he would like to be picked up, used a single-finger point to indicate his wants, and sought his parents for comfort. His fine motor skills were appropriate for chronological age. After extensive evaluation without findings of an organic cause for his failure to thrive, Joseph was diagnosed with avoidant restrictive food intake disorder (ARFID). Enteral nutrition was commenced using a nasogastric (NG) tube, and his micronutrient deficiencies were corrected. Joseph made significant gains within 2 weeks of beginning to receive enteral nutrition. Initial improvement in weight gain (25 g daily over 2 wk, resulting in weight for age z score improving to −1.85) was rapid. Joseph regained ability to stand and began taking a few independent steps. He also acquired the ability to use one word spontaneously and appropriately. His sleep improved, his previously cheerful disposition returned, and he became much easier to engage. Unfortunately, at 20 months, Joseph's parents chose to have the NG tube removed, and his growth began to falter. What would be your next steps in Joseph's care?
Defining the Need for Dermatologic Surgery Global Health in an Afro-Caribbean Country
Authors: Ufkes Nicole , Jacobsen Audrey A. , Joseph Doris J. , Macpherson Calum N.L. , Bidaisee Satesh , deGuzman Maryjane , Strasswimmer John
Published: August 2020

BACKGROUND

Dermatologic surgery services are largely absent in Africa and in Afro-Caribbean counties. In the USA, studies of people of African ancestry have demonstrated health care gaps, but there are no data for Africa nor a Afro-Caribbean country. Dermatology surgery has been largely absent from global health because there are few data to demonstrate the need. We sought to determine skin cancer tumor types, and local knowledge and perception in an Afro-Caribbean country.

OBJECTIVE

We sought to determine whether there exist knowledge gaps and whether a dermatology surgery medical missions program would improve the health of Afro-Caribbean people.

METHODS

First, we conducted a survey of knowledge and behaviors related to skin cancer. Second, we analyzed the number and types of tumors treated during a multi-year surgical dermatology project.

RESULTS

In the survey, 62% did not know what melanoma was. Eighty-one percent did not think skin cancer is preventable. Of 163 surgical specimens, 64 were malignancies with 91% related to UV exposure.

CONCLUSION

There is a need for a skin cancer treatment and education program in a country of mostly African-ancestry people.
Trichloroacetic Acid in Different Concentrations: A Promising Treatment Modality for Vitiligo
Authors: Nofal Ahmad , Fawzy Mohamed M. , Alakad Rania
Published: August 2020

BACKGROUND

Despite the recent advances in the treatment of vitiligo, results are still largely unsatisfactory and many patients show either weak or no response to treatment. Few clinical trials have investigated the use of trichloroacetic acid (TCA) to induce repigmentation in stable vitiligo.

OBJECTIVE

To evaluate the efficacy and safety of TCA, in different concentrations, for the treatment of stable localized vitiligo.

METHODS

The study included 100 patients with acral/nonacral stable vitiligo. Trichloroacetic acid was applied, as a monotherapy, to the vitiliginous patches at different concentrations according to the treated site every 2 weeks until complete repigmentation or for a maximum of 6 treatment sessions. Follow-up was done every month for 6 months to detect any recurrence.

RESULTS

Eyelid vitiligo showed the highest response to TCA treatment (excellent response in 80% of cases), followed by the face, trunk, and extremities. Lower response rates were noticed in the hands and feet vitiligo. Adverse effects were transient and insignificant in few patients.

CONCLUSION

Trichloroacetic acid seems to be a potential, cost-effective, well-tolerated therapeutic option for the treatment of vitiligo in the adults and pediatric populations.
Effects of treadmill exercise and sex hormones on learning, memory and hippocampal brain-derived neurotrophic factor levels in transient congenital hypothyroid rats
Authors: Rashidy-Pour Ali , Derafshpour Leila , Vafaei Abbas Ali , Bandegi Ahmad Reza , Kashefi Adel , Sameni Hamid Reza , Jashire-Nezhad Nahid , Saboory Ehsan , Panahi Yosef
Published: August 2020

Transient thyroid function abnormalities at birth exhibit intellectual developmental and cognitive disorders in adulthood. Given the well-known effects of physical activity and sex hormones on cognitive functions and brain-derived neurotrophic factor (BDNF), the present study examined the effects of treadmill exercise, sex hormones, and the combined treatment on learning and memory and hippocampal BDNF levels in transient congenital hypothyroid rats. To induce hypothyroidism, 6-propyl-2-thiouracil was added to the drinking water from the 6th day of gestation to the 21st postnatal day (PND). From PNDs 28 to 47, female and male pup rats received 17β-estradiol and testosterone, respectively, and about 30 min later, they were forced to run on the treadmill for 30 min once a day. On PNDs 48–55, spatial learning and memory of all rats tested in the water maze, which followed by measurement of BDNF in the hippocampus. Results showed that developmental hypothyroidism induced significant deficits in spatial learning and memory and hippocampal BDNF in both male and female rats. In both male and female hypothyroid rats, exercise and exercise plus sex hormones, but not sex hormones alone alleviated learning and memory deficits and all treatments (exercise, sex hormones, and the combined treatment) increased hippocampal BDNF. These disconnects in the effects of exercise, sex hormones and the combined treatment on behavioral and neurochemical outcomes suggest that a neurochemical mechanism other than hippocampal BDNF might contribute in the ameliorating effects of exercise on learning and memory deficits induced by developmental thyroid hormone insufficiency.
Long Noncoding RNA Taurine-Upregulated Gene 1 Knockdown Protects Cardiomyocytes Against Hypoxia/Reoxygenation-induced Injury Through Regulating miR-532-5p/Sox8 Axis
Authors: Cai Xinyong , Wang Shu , Hong Lang , Yu Songping , Li Bin , Zeng Hong , Yang Xu , Zhang Ping , Shao Liang
Published: August 2020

Background:

Long noncoding RNA taurine-upregulated gene 1 (TUG1) has been reported to involve in the processing of cardiac ischemia/reperfusion injury after myocardial infarction. Thus, this study further investigates the underlying mechanisms of TUG1 in hypoxia/reoxygenation (H/R)-induced cardiomyocyte injury in vitro.

Methods:

Cell viability, apoptosis, and migration and invasion were detected using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, flow cytometry, and transwell assay, respectively. Western blot was used to examine the levels of matrix metallopeptidase 9, matrix metallopeptidase 2, and sex determining region Y-box transcription factor 8 (Sox8) protein. Levels of lactate dehydrogenase, malondialdehyde, superoxide dismutase, and glutathione peroxidase were detected using commercial kits. Levels of TUG1, microRNA-532-5p (miR-532-5p), and Sox8 were detected by quantitative real-time polymerase chain reaction. The interaction between miR-532-5p and Sox8 or TUG1 was confirmed by dual-luciferase reporter and RNA immunoprecipitation assay.

Results:

H/R induced rat cardiomyocyte H9c2 injury by inhibiting cell viability, migration and invasion, promoting cell apoptosis, and stimulating oxidative stress. H/R-induced H9c2 injury upregulated the level of TUG1, and TUG1 knockdown alleviated H/R-induced cardiomyocyte injury. TUG1 directly bound to miR-532-5p, and miR-532-5p inhibition reversed the action of TUG1 knockdown on H/R-induced cardiomyocyte injury. Sox8 was a target of miR-532-5p, and miR-532-5p blunted H/R-induced cardiomyocyte injury by targeting Sox8. In addition, TUG1 knockdown inhibited H/R-induced Sox8 elevation through miR-532-5p in H9c2 cells.

Conclusion:

TUG1 silence ameliorated H/R-induced cardiomyocytes injury through regulating miR-532-5p/Sox8 axis, suggesting a potential therapeutic target for preventing myocardial ischemia/reperfusion injury.
Identification of high-impact gene–drug pairs for pharmacogenetic testing in Alberta, Canada
Authors: Fan Mikayla , Yarema Mark C. , Box Adrian , Hume Stacey , Aitchison Katherine J. , Bousman Chad A.
Published: August 2020

Objectives

To facilitate decision-making and priority-setting related to Alberta’s Pharmacogenomics (PGx) testing implementation strategy by identifying gene–drug pairs with the highest potential impact on prescribing practices in Alberta.

Patients and methods

Annual drug dispensing data for Alberta from 2012 to 2016 for 57 medications with PGx-based prescribing guidelines were obtained, along with population estimates and demographics (age and ethnicity). Frequencies of actionable PGx genotypes by ethnicity were obtained from the Pharmacogenomics Knowledgebase (PharmGKB). Annual dispensing activity for each of the 57 medications was calculated for the full population (all ages) and children/youth (0–19 years). Alberta ethnicity data were cross-referenced with genetic frequency data for each of the main ethnic groups from PharmGKB to estimate the proportion of individuals with actionable genotypes. Actionable genotype proportions and drug dispensing frequencies were collectively used to identify high impact gene–drug pairs.

Results

We found (a) half of the drugs with PGx-based prescribing guidelines, namely, analgesics, proton pump inhibitors, psychotropics, and cardiovascular drugs, were dispensed at high frequencies (>1% of the entire population), (b) the dispensing rate for about one-third of these drugs increased over the 5-year study period, (c) between 1.1 and 45% of recipients of these drugs carried actionable genotypes, and (d) the gene–drug pairs with greatest impact in Alberta predominatly included CYP2C19 or CYP2D6.

Conclusions

We uncovered specific patterns in drug dispensing and identified important gene–drug pairs that will inform the planning and development of an evidenced-based PGx testing service in Alberta, Canada. Adaptation of our approach may facilitate the process of evidence-based PGx testing implementation in other jurisdictions.
Study of Alpha and Beta Radioactivity of Clay Originating from Radionuclides Belonging to the 238U and 232Th Families: Doses to the Skin of Potters
Authors: Misdaq M. A. , Talbi A. , Chaouqi A.
Published: August 2020

Pottery objects are presently more and more used for decoration in homes and hotels. To assess radiological hazards to potters, 238U, 232Th, 222Rn, and 220Rn radionuclides were analyzed in different clay body samples used for pottery production by means of CR-39 and LR-115 II track detectors. Data obtained were compared to those gotten by means of isotope dilution mass spectrometry. Annual equivalent doses to the skin of potters resulting from the energy loss of alpha-particles emitted by the radionuclides of the 238U and 232Th radioactive families were evaluated. Estimates of the annual equivalent doses to the skin of potters due to the emitted alpha-particles ranged between 6.45 mSy y−1 cm−2 and 17.50 mSy y−1 cm−2 and between 1.87 mSy y−1 cm−2 and 5.33 mSy y−1 cm−2, respectively. Annual equivalent doses received by the skin of potters due to beta-particles (β−) emitted by the radionuclides of the 238U and 232Th series inside the studied clay body samples were determined. Alpha equivalent doses to the skin of potters resulting from the diffusion of 222Rn and 220Rn gases present in the studied clay body samples were calculated. A total maximum annual equivalent dose of 23.0 mSv y−1 cm−2, resulting from the energy loss of alpha and beta minus particles emitted by the radionuclides of the 238U and 232Th series, was found for potters working 8 h d−1(6 d wk−1, 49.28 wk y−1).