bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-incident debriefing, team formulation and staff support
Authors: Kustner Claudia
Published: July 2019

Acute inpatient mental health wards are characterized by constant change. The creation and maintenance of facilitated talking spaces for teams to reflect with each other is integral for both staff and service user well-being on these wards. There is a growing evidence base that supports the client-centred philosophy and principles of trauma-informed care whereby service users’ strengths are highlighted over pathology and skills building over symptom reduction. A systemic team formulation model is proposed as a useful, trauma-informed, staff support intervention that could be used on the wards, as it offers numerous intra- and interpersonal benefits for teams that engage in the process of shared formulations. A case example illustrating the methodology of systemic team formulation is explored. In addition, post-incident debriefing is also a necessary form of staff support, as a way of mitigating the negative emotional impact of serious untoward incidents and restrictive practices on staff.
Staff burnout and staff turnover on inpatient wards
Authors: Robson Helen , Attard Caroline
Published: July 2019

This chapter examines a range of personal, organizational, and contextual causes of occupational stress affecting inpatient mental health nurses, and offers a range of potential interventions which may help to reduce stress and burnout, and improve staff retention. It examines the consequences of burnout, its effects on patient care, and the situational factors which contribute to stress. It goes on to explore supportive factors which reduce burnout in nurses and to outline interventions and potential organizational responses which could improve the resilience of the workforce and support retention of staff and high standards of care.
Rotating ionized gas ring around the Galactic center IRS13E3
Authors: Tsuboi Masato , Kitamura Yoshimi , Tsutsumi Takahiro , Miyawaki Ryosuke , Miyoshi Makoto , Miyazaki Atsushi
Published: July 2019

We detected a compact ionized gas associated physically with IRS13E3, an intermediate mass black hole (IMBH) candidate in the Galactic center, in the continuum emission at 232 GHz and H30α recombination line using ALMA Cy.5 observation (2017.1.00503.S, P.I. M.Tsuboi). The continuum emission image shows that IRS13E3 is surrounded by an oval-like structure. The angular size is 0${^{\prime\prime}_{.}}$093 ± 0${^{\prime\prime}_{.}}$006 × 0${^{\prime\prime}_{.}}$061 ± 0${^{\prime\prime}_{.}}$004 (1.14 × 1016 cm × 0.74 × 1016 cm). The structure is also identified in the H30α recombination line. This is seen as an inclined linear feature in the position–velocity diagram, which is usually a defining characteristic of a rotating gas ring around a large mass. The gas ring has a rotating velocity of Vrot ≃ 230 km s−1 and an orbit radius of r ≃ 6 × 1015 cm. From these orbit parameters, the enclosed mass is estimated to be $M_{\mathrm{IMBH}}\simeq 2.4\times 10^{4}\, M_{\odot }$. The mass is within the astrometric upper limit mass of the object adjacent to Sgr A*. Considering IRS13E3 has an X-ray counterpart, the large enclosed mass would be supporting evidence that IRS13E3 is an IMBH. Even if a dense cluster corresponds to IRS13E3, the cluster would collapse into an IMBH within τ < 107 yr due to the very high mass density of $\rho \gtrsim 8\times 10^{11}\, M_{\odot }\:$pc−3. Because the orbital period is estimated to be as short as T = 2πr/Vrot ∼ 50–100 yr, the morphology of the observed ionized gas ring is expected to be changed in the next several decades. The mean electron temperature and density of the ionized gas are $\bar{T}_{\mathrm{e}}=6800\pm 700\:$K and $\bar{n}_{\mathrm{e}}=6\times 10^{5}\:$cm−3, respectively. Then the mass of the ionized gas is estimated to be $M_{\mathrm{gas}}=4\times 10^{-4}\, M_{\odot }$.
Blinding Strategies in Dry Needling Trials: Systematic Review and Meta-Analysis
Authors: Braithwaite Felicity A , Walters Julie L , Li Lok Sze Katrina , Moseley G Lorimer , Williams Marie T , McEvoy Maureen P
Published: July 2019

Background

Blinding of participants and therapists in trials of physical interventions is a significant and ongoing challenge. There is no widely accepted sham protocol for dry needling.

Purpose

The purpose of this review was to summarize the effectiveness and limitations of blinding strategies and types of shams that have been used in dry needling trials.

Data Sources

Twelve databases were searched from inception to February 2016.

Study Selection

Trials that compared active dry needling with a sham that simulated dry needling were included.

Data Extraction

The main domains of data extraction were participant/therapist details, intervention details, blinding strategies, blinding assessment outcomes, and key conclusions of authors. Reported blinding strategies and sham types were synthesized descriptively, with available blinding effectiveness data synthesized using a chance-corrected measurement of blinding (blinding index).

Data Synthesis

The search identified 4894 individual publications with 27 trials eligible for inclusion. In 22 trials, risk of methodological bias was high or unclear. Across trials, blinding strategies and sham types were heterogeneous. Notably, no trials attempted therapist blinding. Sham protocols have focused on participant blinding using strategies related to group standardization and simulation of tactile sensations. There has been little attention given to the other senses or cognitive strategies to enhance intervention credibility. Nonpenetrating sham types may provide effective participant blinding.

Limitations

Trials were clinically and methodologically diverse, which limited the comparability of blinding effectiveness across trials. Reported blinding evaluations had a high risk of chance findings with power clearly achieved in only 1 trial.

Conclusions

Evidence-based consensus on a sham protocol for dry needling is required. Recommendations provided in this review may be used to develop sham protocols so that future protocols are more consistent and potentially more effective.
Progression of nailfold capillaroscopic patterns and correlation with organ involvement in systemic sclerosis: a 12 year study
Authors: Sulli A , Paolino S , Pizzorni C , Ferrari G , Pacini G , Pesce G , Carmisciano L , Smith V , Cutolo M
Published: July 2019

Objective

The aim of this observational study was to investigate the evolution of scleroderma microangiopathy throughout different nailfold videocapillaroscopy (NVC) patterns (‘early’, ‘active’, ‘late’) as well as the prevalence of organ involvement in SSc patients during a 12-year follow-up.

Methods

Thirty-four SSc patients showing at baseline (first capillaroscopic analysis) the ‘early’ NVC pattern of microangiopathy were enrolled and followed for 12 years (s.d. 2). Complete NVC analysis and clinical and serological findings were collected. Patients were in a standard therapeutic care setting. Statistical analysis was carried out by non-parametric tests.

Results

After a 12-year follow-up, the ‘early’ NVC pattern changed from baseline in 76% of the patients. The NVC pattern was found to be ‘active’ in 9 patients (26%), ‘late’ in 13 (38%) and characterized by non-specific capillary abnormalities in 4 (12%). In the subgroup whose microangiopathy progressed from the ‘early’ to the ‘late’ NVC pattern, the median time of progression from the ‘early’ to the ‘active’ pattern was significantly shorter (11 months) when compared with patients who progressed from the ‘early’ to the ‘active’ NVC pattern (55 months) (P = 0.002). The median time of progression between NVC patterns was significantly shorter in SSc patients showing either a nucleolar ANA pattern or Scl70 autoantibodies (P = 0.048). Organ involvement was progressively greater in SSc patients with ‘early’, ‘active’ and ‘late’ NVC patterns, respectively.

Conclusions

This longitudinal study confirms over a 12-year follow-up the evolution of specific NVC patterns associated with the progressive severity of organ involvement in SSc patients in a standard clinical care setting.
Long-term use of pitolisant to treat patients with narcolepsy: Harmony III Study
Authors: Dauvilliers Yves , Arnulf Isabelle , Szakacs Zoltan , Leu-Semenescu Smaranda , Lecomte Isabelle , Scart-Gres Catherine , Lecomte Jeanne-Marie , Schwartz Jean-Charles ,   HARMONY III study group, Arnulf Isabelle , Bastuji Hélène , Dauvilliers Yves , Vieccherini Marie Françoise , Pepin Jean Louis , Quera Salva Maria Antonia , Stoll Anne Thibault , Szakacs Zoltan
Published: July 2019

Study Objectives

To asses the long-term safety and efficacy of pitolisant, an histamine H3-receptor antagonist, on narcolepsy.

Methods

This open-label, single-arm, pragmatic study, recruited adult patients with narcolepsy and Epworth Sleepiness Scale (ESS) score ≥12. After a titration period, patients were treated for up to 1 year with oral pitolisant once-a-day at up to 40 mg. Concomitant stimulants and anti-cataplectic agents were allowed. The primary endpoint was safety; secondary endpoints included ESS, cataplexy, and other diary parameters.

Results

Patients (n = 102, 75 with cataplexy) received pitolisant, for the first time in 73 of them. Sixty-eight patients (51 with cataplexy) completed the 12-month treatment. Common treatment-emergent adverse events were headache (11.8% of patients), insomnia (8.8%), weight gain (7.8%), anxiety (6.9%), depressive symptoms (4.9%), and nausea (4.9%). Seven patients had a serious adverse effect, unrelated to pitolisant except for a possibly related miscarriage. One-third of patients stopped pitolisant, mostly (19.6%) for insufficient benefit. ESS score decreased by 4.6 ± 0.6. Two-thirds of patients completing the treatment were responders (ESS ≤ 10 or ESS decrease ≥ 3), and one third had normalized ESS (≤10). Complete and partial cataplexy, hallucinations, sleep paralysis, and sleep attacks were reduced by 76%, 65%, 54%, 63%, and 27%, respectively. Pitolisant as monotherapy (43% of patients) was better tolerated and more efficacious on ESS than on add-on, but efficacy was maintained in this last case.

Conclusions

Long-term safety and efficacy of pitolisant on daytime sleepiness, cataplexy, hallucinations, and sleep paralysis is confirmed.
Sensitivity of the U.S. Blumeria graminis f. sp. tritici Population to Demethylation Inhibitor Fungicides
Authors: Meyers Emily , Arellano Consuelo , Cowger Christina
Published: July 2019

Wheat powdery mildew, caused by Blumeria graminis f. sp. tritici, is managed in the United States with cultivar resistance and foliar fungicides. Despite high levels of fungicide sensitivity in other cereal mildew populations, fungicide sensitivity of U.S. B. graminis f. sp. tritici has never been evaluated. Almost 400 B. graminis f. sp. tritici isolates were collected from 15 U.S. states over 2 years and phenotyped for sensitivity to two widely used demethylation inhibitor (DMI) fungicides, tebuconazole and prothioconazole. A large range of sensitivity to both DMIs was observed, with more insensitive isolates originating from the eastern United States (Great Lakes, Mid-Atlantic, and Southeast regions) and more sensitive isolates from central states (Plains region, Arkansas, and Missouri). Cross-resistance was indicated by a positive although weak association between tebuconazole and prothioconazole sensitivities at all levels of analysis (EC50 values, P < 0.0001). A possible fitness cost was also associated with prothioconazole insensitivity (P = 0.0307) when analyzed at the state population level. This is the first assessment of fungicide sensitivity in the U.S. B. graminis f. sp. tritici population, and it produced evidence of regional selection for reduced DMI efficacy. The observation of reduced sensitivity to DMI fungicides in the eastern United States underlines the importance of rotating between chemistry classes to maintain the effectiveness of DMIs in U.S. wheat production. Although cross-resistance was demonstrated, variability in the relationship of EC50 values for tebuconazole and prothioconazole also suggests that multiple mechanisms influence B. graminis f. sp. tritici isolate responses to these two DMI fungicides.
Bidirectional crosstalk between neutrophils and adipocytes promotes adipose tissue inflammation
Authors: Watanabe Yasuharu , Nagai Yoshinori , Honda Hiroe , Okamoto Naoki , Yanagibashi Tsutomu , Ogasawara Masaru , Yamamoto Seiji , Imamura Ryu , Takasaki Ichiro , Hara Hiromitsu , Sasahara Masakiyo , Arita Makoto , Hida Shigeaki , Taniguchi Shun'ichiro , Suda Takashi , Takatsu Kiyoshi
Published: July 2019

Chronic activation of the IL‐1β system in adipose tissue on metabolic disorders is well demonstrated. However, a mechanism for its expression and activation in the tissue has remained unexplored. Here, we demonstrate that IL‐1β transcript was enriched in neutrophils of white adipose tissue (WAT) from lean mice. Mechanistically, the interaction of neutrophils with adipocytes induced IL‐1β expression via NF‐κB pathway. Lipolysis of adipocytes accumulated neutrophils prior to macrophages in WAT and produced high levels of IL‐1β via an inflammasome pathway. Leukotriene B4 (LTB4) production in WAT also contributed to neutrophil accumulation. Furthermore, an LTB4‐inflammasome axis contributed to the expression of chemotactic molecules involved in high‐fat diet‐induced macrophage infiltration into WAT. We have identified previously unappreciated roles for neutrophils in the development of adipose tissue inflammation: robust IL‐1β production and infiltration of macrophages to initiate chronic inflammation.—Watanabe, Y., Nagai, Y., Honda, H., Okamoto, N., Yanagibashi, T., Ogasawara, M., Yamamoto, S., Imamura, R., Takasaki, I., Hara, H., Sasahara, M., Arita, M., Hida, S., Taniguchi, S., Suda, T., Takatsu, K. Bidirectional crosstalk between neutrophils and adipocytes promotes adipose tissue inflammation. FASEB J. 33, 11821‐11835 (2019). www.fasebj.org
A Prospective, Multicenter, Single-Arm Clinical Trial for Treatment of Complex Diabetic Foot Ulcers with Deep Exposure Using Acellular Dermal Matrix
Authors: Cazzell Shawn , Moyer Peter M. , Samsell Brian , Dorsch Kimberly , McLean Julie , Moore Mark A.
Published: July 2019

OBJECTIVE

This prospective, multicenter study evaluated the efficacy and safety of an acellular dermal matrix allograft, DermACELL (D-ADM; LifeNet Health, Virginia Beach, Virginia), in the treatment of large, complex diabetic foot ulcers (DFUs) that probed to tendon or bone.

METHODS

Inclusion criteria were Wagner grade 3 or 4 DFUs between 4 weeks and 1 year in duration. All participants received one application of D-ADM at baseline and could receive one additional application if wound healing arrested. Ulcers were assessed weekly for 16 weeks using a laser measuring device.

RESULTS

Sixty-one participants were enrolled, with an average wound area of 29.0 cm2; 59 of these ulcers showed exposed bone. The entire per-protocol population (n = 47) achieved 100% granulation. The mean time to 100% granulation was 4.0 weeks with an average of 1.2 applications of D-ADM. Mean percent wound area reduction was 80.3% at 16 weeks. Those DFUs 15 cm2 or smaller were substantially more likely to close than DFUs larger than 29 cm2 (P = .0008) over a 16-week duration. No complications were associated with the use of the studied matrix.

CONCLUSIONS

The D-ADM demonstrated the ability to rapidly reduce the size of large, complex DFUs with exposed bone. Some wounds did not completely heal by 16 weeks; however, the significant reduction in size suggests that these large, complex wounds may heal if given more time.
CE: Obesity-Related Cancer in Women: A Clinical Review
Authors: Katz Anne
Published: July 2019

There is mounting evidence that obesity is linked to numerous types of cancer that affect both sexes. But the incidence of obesity-related cancers is particularly high among women. Obesity is implicated not only in the development of cancer, but also in cancer recurrence, treatment complications, and poor patient outcomes. Nurses, particularly those caring for women, should be aware of these associations so they may provide effective patient teaching about preventing cancer and mitigating its adverse effects. The author discusses the role of obesity in the development and recurrence of cancer in women; describes weight loss interventions that may reduce cancer risk in overweight or obese patients; and suggests interviewing techniques to help nurses sensitively address the topic of overweight and obesity with their female patients.
Female Youth Suicides on the Rise, Narrowing Gap with Young Males
Authors: Zolot Joan
Published: July 2019

Girls ages 10 to 14 show the greatest increase in suicide rates.
Study Finds Healthy Immigrant Effect for Maternal Outcomes in African Refugees
Authors: Pfeifer Gail M.
Published: July 2019

Birth outcomes were better for these refugees than for U.S. women.
Using Glucocorticoids to Treat Croup in Children
Authors: Newsom Cresilda
Published: July 2019

Editor's note: This is a summary of a nursing care–related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.
Data-Driven Precision Implementation Approach
Authors: Cullen Laura , Hanrahan Kirsten , Tucker Sharon J. , Gallagher-Ford Lynn
Published: July 2019

This is the third article in a new series about evidence-based practice (EBP) that builds on AJN's awardwinning previous series—Evidence-Based Practice, Step by Step—published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes—one of the most challenging steps in the EBP process.
Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine
Authors: Janssen Scott
Published: July 2019

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Treatment of urticaria: a clinical and mechanistic approach
Authors: Kaplan Allen P.
Published: July 2019

Purpose of review

This manuscript describes the recommended therapy of chronic spontaneous urticaria based on our understanding of the pathogenesis of hive formation. Thus, the mechanism of action of each medication is elaborated in addition to a discussion of clinical utility.

Recent findings

The main drugs are antihistamines, omalizumab, and cyclosporine with a success rate of 40–55, 65–80, and 70–80%, respectively. Used in sequence, over 90% of patients can be successfully treated. The addition of omalizumab represents a major advance because of its efficacy, easy utility, and favorable side-effect profile. The interaction with IgE eliminates any reaction with antigens to which it might be directed, down regulates IgE receptors on mast cells and basophils, and leads to down-regulation of mast cell functions with amelioration of hives.

The use of antihistamines in high dosage (at least four times a day) is effective in close to half the patients with CSU. For antihistamine resistance, the use of omalizumab has revolutionized therapy of antihistamine-resistant cases because of its efficacy and excellent side-effect profile. If the response is insufficient, cyclosporine is the next choice. Patients should be monitored regarding any adverse effects on blood pressure or renal function. All these are far safer than extended use of corticosteroid.
Syntaxin1A Neomorphic Mutations Promote Rapid Recovery from Isoflurane Anesthesia in Drosophila melanogaster
Authors: Troup Michael , Zalucki Oressia H. , Kottler Benjamin D. , Karunanithi Shanker , Anggono Victor , van Swinderen Bruno
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Mutations in the presynaptic protein syntaxin1A modulate general anesthetic effects in vitro and in vivo. Coexpression of a truncated syntaxin1A protein confers resistance to volatile and intravenous anesthetics, suggesting a target mechanism distinct from postsynaptic inhibitory receptor processes. Hypothesizing that recovery from anesthesia may involve a presynaptic component, the authors tested whether syntaxin1A mutations facilitated recovery from isoflurane anesthesia in Drosophila melanogaster.

Methods

A truncated syntaxin1A construct was expressed in Drosophila neurons. The authors compared effects on isoflurane induction versus recovery in syntaxin1A mutant animals by probing behavioral responses to mechanical stimuli. The authors also measured synaptic responses from the larval neuromuscular junction using sharp intracellular recordings, and performed Western blots to determine whether the truncated syntaxin1A is associated with presynaptic core complexes.

Results

Drosophila expressing a truncated syntaxin1A (syx227, n = 40) were resistant to isoflurane induction for a behavioral responsiveness endpoint (ED50 0.30 ± 0.01% isoflurane, P < 0.001) compared with control (0.240 ± 0.002% isoflurane, n = 40). Recovery from isoflurane anesthesia was also faster, with syx227-expressing flies showing greater levels of responsiveness earlier in recovery (reaction proportion 0.66 ± 0.48, P < 0.001, n = 68) than controls (0.22 ± 0.42, n = 68 and 0.33 ± 0.48, n = 66). Measuring excitatory junction potentials of larvae coexpressing the truncated syntaxin1A protein showed a greater recovery of synaptic function, compared with controls (17.39 ± 3.19 mV and 10.29 ± 4.88 mV, P = 0.014, n = 8 for both). The resistance-promoting truncated syntaxin1A was not associated with presynaptic core complexes, in the presence or absence of isoflurane anesthesia.

Conclusions

The same neomorphic syntaxin1A mutation that confers isoflurane resistance in cell culture and nematodes also produces isoflurane resistance in Drosophila. Resistance in Drosophila is, however, most evident at the level of recovery from anesthesia, suggesting that the syntaxin1A target affects anesthesia maintenance and recovery processes rather than induction. The absence of truncated syntaxin1A from the presynaptic complex suggests that the resistance-promoting effect of this molecule occurs before core complex formation.
Peripheral Nerve Blocks for Ambulatory Shoulder Surgery
Authors: Hamilton Gavin M. , Ramlogan Reva , Lui Anne , McCartney Colin J. L. , Abdallah Faraj , McVicar Jason , McIsaac Daniel I.
Published: July 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Nerve blocks improve early pain after ambulatory shoulder surgery; impact on postdischarge outcomes is poorly described. Our objective was to measure the association between nerve blocks and health system outcomes after ambulatory shoulder surgery.

Methods

We conducted a population-based cohort study using linked administrative data from 118 hospitals in Ontario, Canada. Adults having elective ambulatory shoulder surgery (open or arthroscopic) from April 1, 2009, to December 31, 2016, were included. After validation of physician billing codes to identify nerve blocks, we used multilevel, multivariable regression to estimate the association of nerve blocks with a composite of unplanned admissions, emergency department visits, readmissions or death within 7 days of surgery (primary outcome) and healthcare costs (secondary outcome). Neurology consultations and nerve conduction studies were measured as safety indicators.

Results

We included 59,644 patients; blocks were placed in 31,073 (52.1%). Billing codes accurately identified blocks (positive likelihood ratio 16.83, negative likelihood ratio 0.03). The composite outcome was not significantly different in patients with a block compared with those without (2,808 [9.0%] vs. 3,424 [12.0%]; adjusted odds ratio 0.96; 95% CI 0.89 to 1.03; P = 0.243). Healthcare costs were greater with a block (adjusted ratio of means 1.06; 95% CI 1.02 to 1.10; absolute increase $325; 95% CI $316 to $333; P = 0.005). Prespecified sensitivity analyses supported these results. Safety indicators were not different between groups.

Conclusions

In ambulatory shoulder surgery, nerve blocks were not associated with a significant difference in adverse postoperative outcomes. Costs were statistically higher with a block, but this increase is not likely clinically relevant.
The role of Epstein–Barr virus infection in primary Sjögren's syndrome
Authors: Maślińska Maria
Published: July 2019

Purpose of review

The purpose of this article is to draw attention to the role of Epstein–Barr virus (EBV) virus in the pathogenesis of the primary Sjögren's syndrome. The article introduces the problem of consequences of EBV acute infection, and its reactivation, in association with the immune response modulation by the virus and with an increased risk of developing systemic autoimmune diseases and EBV-associated cancers.

Recent findings

The knowledge about the mechanisms by which the virus may stay for years in a latent phase, unrecognized by the host response immune cells is constantly expanding. There are several mechanisms and theories about EBV influence on the autoimmune process in Sjogren's syndrome (pSS), including the similarity (molecular mimicry) between viral EBNA-2 protein and Ro-60 antigen or EBER-1 and EBER-2 viral proteins and La antigen.

The influence of EBV infection on the development and course of pSS has been proven. It has also been established that both EBV and pSS result in the increased risk of tumor (especially lymphoma) development. In the light of these findings, new ways to manage EBV infections are being sought. Optimal methods for assessing EBV infection status are being devised. Research also aims at finding therapies, which target EBV through the inhibition of the autoimmune process and of viral activity. The present article is an attempt to discuss the most important phenomena and elements linking EBV infection to the primary Sjögren's syndrome.
The association between hepatitis B, hepatitis C and systemic sclerosis: a cross-sectional study
Authors: Tiosano Shmuel , Cohen Arnon D. , Amital Howard
Published: July 2019

Purpose of review

To investigate the association between systemic sclerosis (SSc) to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) carriage. We utilized the database of Clalit Health Services, the largest healthcare organization in Israel and performed a cross-sectional study.

Recent findings

The study included 2431 SSc patients and 12 710 age-and-sex matched controls, HBV was found in 38 SSc patients (1.56%) and 64 controls (0.5%). HCV was found in 30 SSc patients (1.23%) and 83 controls (0.65%). In multivariable logistic regression model, HBV was found to be associated with smoking, dialysis treatment and SSc [odds ratio (OR) 2.97, 95% confidence interval (CI) 1.92–4.53]. HCV was found to be associated with dialysis treatment and SSc (OR 1.73, 95% CI 1.1–2.66). A trend was found between both HBV and HCV toward low socioeconomic status. SSc patients with HBV had demonstrated higher rates of end-stage renal disease requiring dialysis treatment.

In our study, HBV and HCV were found to be associated with SSc. Common immune mechanisms or therapeutic modalities may serve as mediators of this association.
Osteoarticular manifestations of Mayaro virus infection
Authors: Arenívar Carlos , Rodríguez Yhojan , Rodríguez-Morales Alfonso J. , Anaya Juan-Manuel
Published: July 2019

Purpose of review

To carry out an update on the state of the art of the Mayaro virus (MAYV) infection and its osteoarticular implications.

Recent findings

There is a wide distribution of MAYV in Latin America and documented exported cases to the United States and Europe. Although osteoarticular involvement is not the most frequent, it is one the most associated with disability. The main mechanisms related to arthropathy involves cellular infiltrates (i.e. macrophages, natural killer cells, lymphocytes) together with production of cytokines, such as IL-6, IL-7, IL8, IL-12p70.

MAYV infection is an emerging disease, which has been reported in many and increasing number of countries of Latin America. There is a high risk of epidemic outbreaks, given the inadequate vector control (Aedes mosquitoes). Its main symptoms, like other arbovirus infections, involve the presence of headache, rash, conjunctivitis, and arthralgias. MAYV arthropathy is usually severe, can last in time, and is associated with severe disability. There is currently no treatment for MAYV. Prevention of MAYV as a public health burden will be achieved by integrating vector control with vaccines (still under development).
Osteomyelitis Risk Factors Related to Combat Trauma Open Upper Extremity Fractures: A Case–Control Analysis
Authors: Warkentien Tyler E. , Lewandowski Louis R. , Potter Benjamin K. , Petfield Joseph L. , Stinner Daniel J. , Krauss Margot , Murray Clinton K. , Tribble David R. ,   the Trauma Infectious Disease Outcomes Study Group
Published: July 2019

Objective:

To determine risk factors for osteomyelitis in US military personnel with combat-related, extremity long bone (humerus, radius, and ulna) open fractures.

Design:

Retrospective observational case–control study.

Setting:

US military regional hospital in Germany and tertiary care military hospitals in the United States (2003–2009).

Patients/Participants:

Sixty-four patients with open upper extremity fractures who met diagnostic osteomyelitis criteria (medical record review verification) were classified as cases. Ninety-six patients with open upper extremity fractures who did not meet osteomyelitis diagnostic criteria were included as controls.

Intervention:

Not applicable.

Main Outcome Measurements:

Multivariable odds ratios (ORs; 95% confidence interval [CI]).

Results:

Among patients with surgical implants, osteomyelitis cases had longer time to definitive orthopaedic surgery compared with controls (median: 26 vs. 11 days; P < 0.001); however, there was no significant difference with timing of radiographic union. Being injured between 2003 and 2006, use of antibiotic beads, Gustilo–Anderson [GA] fracture classification (highest with GA-IIIb: [OR: 22.20; CI: 3.60–136.95]), and Orthopaedic Trauma Association Open Fracture Classification skin variable (highest with extensive degloving [OR: 15.61; CI: 3.25–74.86]) were independently associated with osteomyelitis risk. Initial stabilization occurring outside of the combat zone was associated with reduced risk of osteomyelitis.

Conclusions:

Open upper extremity fractures with severe soft-tissue damage have the highest risk of developing osteomyelitis. The associations with injuries sustained 2003–2006 and location of initial stabilization are likely from evolving trauma system recommendations and practice patterns during the timeframe.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Naviculectomy for two ambulatory children with intractable congenital vertical talus: redefining the indications of an old technique
Authors: EL-Sobky Tamer A. , Samir Shady , Mahmoud Shady
Published: July 2019

Congenital vertical talus is a rare and complex foot anomaly. Serial casting with or without minimally invasive surgery is a universal management strategy especially for children in the first year of life. Nevertheless, extensive surgical treatment of late-presenting, neglected and multiple operated children with congenital vertical talus may be required with guarded results. The results of naviculectomy as a more conservative intervention and directed exclusively at ambulatory children with intractable congenital vertical talus have not been reported. We present the radioclinical outcomes of two ambulatory children with intractable congenital vertical talus treated by naviculectomy/midtarsal resection and limited soft tissue release. One child had an isolated congenital vertical talus whereas the other had a non-isolated etiology. Generally, naviculectomy/midtarsal resection revealed a positive benefit-risk profile in children with intractably severe congenital vertical talus on the short-term. We reported favorable results in terms of foot appearance, function and radiology. We believe that a less invasive procedure like naviculectomy/midtarsal resection is an encouraging technique to investigate in children with intractable congenital vertical talus.
Impact of Point-of-Care Ultrasound in the Emergency Department on Care Processes and Outcomes in Critically Ill Nontraumatic Patients
Authors: Mosier Jarrod M. , Stolz Uwe , Milligan Rebecca , Roy-Chaudhury Akshay , Lutrick Karen , Hypes Cameron D. , Billheimer Dean , Cairns Charles B.
Published: July 2019

Objectives:

Outcomes data on point-of-care ultrasound (POCUS) in critically ill patients are lacking. This study examines the association between POCUS in the emergency department and outcomes in critically ill patients.

Design:

Retrospective cohort study of critically ill emergency department patients in two academic emergency departments. All emergency department patients admitted to the intensive care unit or that die in the emergency department were entered prospectively into a registry.

Setting:

Two academic emergency departments.

Patients:

All adult (> 18 years old) non-trauma patients with hemodynamic instability [shock index (heart rate/systolic blood pressure) > 0.6] between November 1, 2013-October 31, 2016, were included.

Interventions:

Cohorts were assigned as follows: no POCUS (cohort 1), POCUS prior to a key intervention (cohort 2), and POCUS after a key intervention (cohort 3). A key intervention was either a fluid bolus or vasoactive drug initiation.

Measurements and Main Results:

Multivariable logistic regression was used to evaluate the association between POCUS use and the primary outcome of in-hospital mortality. We conducted several sensitivity analyses including propensity score matching and inverse-probability-weighted regression-adjustment along with multiple imputation to account for non-random assignment of POCUS as well as bias due to missing data. Of the 7,734 eligible patients, 2,293 patients were excluded. The remaining 5,441 patients were included in the analysis: 4165 in Cohort 1, 614 in Cohort 2, and 662 in Cohort 3. Mortality was 22%, 29%, and 26%, respectively (p < 0.001). POCUS prior to an intervention was associated with an adjusted odds ratio for death of 1.41 (95% CI, 1.12-1.76) compared to no POCUS. The sensitivity analyses showed an absolute increased mortality of +0.05 (95% CI, 0.02-0.09) for cohort 2 compared to 1.

Conclusions:

POCUS use prior to interventions appears to be associated with care delays and increased in-hospital mortality compared to critically ill patients with no POCUS. Further explorations of the impact of POCUS in the emergency department appear warranted.
Practice Patterns and Ethical Considerations in the Management of Venovenous Extracorporeal Membrane Oxygenation Patients: An International Survey*
Authors: Abrams Darryl , Pham Tài , Burns Karen E. A. , Combes Alain , Curtis J. Randall , Mueller Thomas , Prager Kenneth M. , Serra Alexis , Slutsky Arthur S. , Brodie Daniel , Schmidt Matthieu
Published: July 2019

Objectives:

To characterize physicians’ practices and attitudes toward the initiation, limitation, and withdrawal of venovenous extracorporeal membrane oxygenation for severe respiratory failure and evaluate factors associated with these attitudes.

Design:

Electronic, cross-sectional, scenario-based survey.

Setting:

Extracorporeal membrane oxygenation centers affiliated with the Extracorporeal Life Support Organization and the International Extracorporeal Membrane Oxygenation Network.

Subjects:

Attending-level physicians with experience managing adult patients receiving venovenous extracorporeal membrane oxygenation.

Interventions:

None.

Measurements and Main Results:

Five-hundred thirty-nine physicians in 39 countries across six continents completed the survey. Factors that influenced the decision to limit extracorporeal membrane oxygenation initiation included older patient age (46.9%), additional organ failures (37.7%), and prolonged mechanical ventilation (35.1%). Patient comorbidities (70.5%), patient’s wishes (56.0%), and etiology of respiratory failure (37.7%) were factors that influenced the decision to withdraw extracorporeal membrane oxygenation. In multivariable analysis, factors associated with increased odds of withdrawing life-sustaining therapies included pulmonary fibrosis, stroke, surrogate’s desire to withdraw, lack of knowledge regarding patient’s or surrogate’s wishes in the setting of fibrosis, not initiating extracorporeal membrane oxygenation in the baseline scenario, and respondent religiosity. Factors associated with decreased odds of withdrawal included practicing in an environment where it is not legally possible to make decisions against patient or surrogate wishes. Most respondents (90.5%) involved other physicians in treatment decisions for extracorporeal membrane oxygenation patients, whereas only 53.2%, 45.3%, and 29.5% of respondents involved surrogates, awake patients, or bedside nurses, respectively.

Conclusions:

Patient and physician-level factors were associated with decision-making regarding extracorporeal membrane oxygenation initiation and withdrawal, including patient prognosis and knowledge of patient or surrogate wishes. Respondents reported low rates of engaging in shared decision-making when managing patients receiving extracorporeal membrane oxygenation.
Association Between the Use of Sodium Bicarbonate and Mortality in Acute Kidney Injury Using Marginal Structural Cox Model
Authors: Zhang Zhongheng , Mo Lei , Ho Kwok M. , Hong Yucai
Published: July 2019

Objective:

Acute kidney injury with metabolic acidosis is common in critically ill patients. This study assessed the associations between the use of IV sodium bicarbonate and mortality of patients with acute kidney injury and acidosis.

Design:

The study was conducted by using data from Beth Israel Deaconess Medical Center, which included several ICUs such as coronary care unit, cardiac surgery recovery unit, medical ICU, surgical ICU, and trauma-neuro ICU. Marginal structural Cox model was used to assess the relationship between receipt of sodium bicarbonate and hospital mortality, allowing pH, Paco
2, creatinine, and bicarbonate concentration as time-varying predictors of sodium bicarbonate exposure while adjusting for baseline characteristics of age, gender, Sequential Organ Failure Assessment score, acute kidney injury stage, Elixhauser score, quick Sequential Organ Failure Assessment, and Simplified Acute Physiology Score II.

Setting:

A large U.S.-based critical care database named Medical Information Mart for Intensive Care.

Patients:

Patients with Kidney Disease: Improving Global Outcomes acute kidney injury stage greater than or equal to 1 (> 1.5

JOURNAL/ccme/04.03/00003246-201910000-00016/inline-graphic1/v/2023-10-17T042033Z/r/image-tiff

baseline creatinine) and one measurement of acidosis (pH ≤ 7.2). Baseline creatinine was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation.

Interventions:

None.

Measurements and Main Results:

Of the 3,406 eligible patients, 836 (24.5%) had received sodium bicarbonate treatment. Patients who received sodium bicarbonate treatment had a higher Sequential Organ Failure Assessment (9 vs 7; p < 0.001), lower pH (7.16 vs 7.18; p < 0.001), and bicarbonate concentration (16.51 ± 7.04 vs 20.57 ± 6.29 mmol/L; p < 0.001) compared with those who did not receive sodium bicarbonate. In the marginal structural Cox model by weighing observations with inverse probability of receiving sodium bicarbonate, sodium bicarbonate treatment was not associated with mortality in the overall population (hazard ratio, 1.16; 95% CI, 0.98–1.42; p = 0.132), but it appeared to be beneficial in subgroups of pancreatitis (hazard ratio, 0.53; 95% CI, 0.28–0.98; p = 0.044) and severe acidosis (pH < 7.15; hazard ratio, 0.75; 95% CI, 0.58–0.96; p = 0.024). Furthermore, sodium bicarbonate appeared to be beneficial in patients with severe bicarbonate deficit (< –50 kg·mmol/L).

Conclusions:

In the analysis by adjusting for potential confounders, there is no evidence that IV sodium bicarbonate is beneficial for patients with acute kidney injury and acidosis. Although the study suggested potential beneficial effects in some highly selected subgroups, the results need to be validated in experimental trials.
Reproducibility of Measurements Obtained During Cardiopulmonary Exercise Testing in Individuals With Fatiguing Health Conditions: A Case Series
Authors: Larson Benjamin , Davenport Todd E. , Stevens Staci R. , Stevens Jared , Van Ness J. Mark , Snell Christopher R.
Published: July 2019

Purpose:

Measurements obtained during maximal cardiopulmonary exercise testing (CPET) demonstrate high test–retest reliability, which indicates low error variance. However, measurements obtained from people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may depart from typically observed high reproducibility, which could represent functionally relevant biological variability that is characteristic of the underlying pathophysiology. The purpose of this case series was to document individual experiences with test–retest variability in CPET measurements in individuals with ME/CFS compared with other fatiguing health conditions.

Methods:

In this case series, 6 women matched for age and body mass index underwent 2 maximal CPETs spaced 24 hours apart. Clients comprised 1 sedentary individual without fatigue, 1 active individual without fatigue, 1 individual with multiple sclerosis (MS), 1 individual diagnosed with HIV, 1 individual with ME/CFS and low maximal volume of oxygen consumed (VO2max), and 1 high-functioning individual with ME/CFS and high VO2max. Percent change in CPET measurements between tests was calculated for each client.

Results:

Nondisabled clients and clients with MS and HIV reproduced or improved in their volume of oxygen consumed (VO2), workload (WL), heart rate (HR), and minute ventilation (VE) at ventilatory anaerobic threshold (VAT) and at peak exercise (except peak WL and VE for the individual with HIV). Neither individual with ME/CFS reproduced VO2, WL, HR, or VE at VAT within literature estimates.

Conclusions:

Measurements during CPET for individual patients may relate to potential condition-specific deficits in cardiac, pulmonary, and metabolic functioning.
Prophylactic Use of Mucosal Protective Agents and Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: Real World Evidences of 36,870 Patients
Authors: Li Yan-Hua , Yang Shan-Shan , Guo Xin-Hong , Chen Yun-Dai
Published: July 2019

Background:

Prophylactic medications are believed to reduce risks of gastrointestinal (GI) bleeding after percutaneous coronary intervention (PCI). However, their true effectiveness in preventing GI bleeding is still unknown.

Methods:

The clinical data of 36,870 patients treated with PCI from January 2010 to July 2017 were retrospectively analyzed. The trend in the prophylactic use of mucosal protective agents and proton pump inhibitors was analyzed.

Results:

A total of 36,870 patients were included with a mean age of 60 ± 18 years. In patients treated with primary PCI for ST-segment elevation myocardial infarction, prophylactic medications were associated with a significantly lower incidence of postprocedure GI bleeding in comparison with no medication (1.072%, 52/4852 vs. 2.747%, 25/910; P < 0.001). In patients with CRUSADE scores >40, prophylactic medications were associated with a significantly lower incidence of postprocedure GI bleeding in comparison with not using prophylactic medications (0.679%, 21/3093 vs. 1.899%, 20/1053; P = 0.001).

Conclusions:

Prophylactic medications were associated with significantly lower incidence of postprocedure 30-day GI bleeding in patients with primary PCI for ST-segment elevation myocardial infarction or CRUSADE scores >40.
Effects of Pre–Cardiopulmonary Bypass Administration of Dexmedetomidine on Cardiac Injuries and the Inflammatory Response in Valve Replacement Surgery With a Sevoflurane Postconditioning Protocol: A Pilot Study
Authors: Zhou Hongmei , Zhou Dongna , Lu Jian , Wu Cheng , Zhu Zhipeng
Published: July 2019

Background:

Preventing myocardial ischemia–reperfusion injury in on-pump cardiac surgeries remains an enormous challenge. Sevoflurane postconditioning has been effective at overcoming this challenge by modulating inflammatory mediators and ameliorating antioxidative stress. Dexmedetomidine (DEX) is a commonly used medication for cardiac patients with organ-protective properties that lead to positive outcomes. Whether DEX also has cardiac-protective properties and the associated mechanism in sevoflurane postconditioning–based valve replacement surgeries are unknown.

Objective:

This study was conducted to observe the effect of DEX administration before cardiopulmonary bypass (CPB) on myocardial injury, oxidative stress, and inflammatory response indicators in the peripheral blood.

Methods:

Twenty-eight eligible cardiac patients who underwent valve replacement surgery with standard sevoflurane postconditioning were included in the study. The patients were randomly divided into a DEX group and a non-DEX group according to whether DEX (0.5-µg/kg overload dose for 10 minutes and a 0.5-μg/kg/h maintenance dose) or saline was administered from induction to the beginning of CPB. The primary outcome was the cardiac troponin I concentration (cTnI) in the blood 24 hours after CPB. The levels of malondialdehyde (MDA), superoxide dismutase, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) were also measured.

Results:

The mean cTnI at 24 hours after CPB was clearly decreased in the DEX group compared with that in the non-DEX group (4.16 ± 1.58 vs. 6.90 ± 3.73, P < 0.05). TNF-α levels were lower in the DEX group after CPB (T1–T5), with a significant difference found at 1–6 hours after CPB (1 hour, 19.03 vs. 28.09; 6 hours, 20.74 vs. 30.94, P < 0.05). The IL-6 and IL-8 concentrations in the DEX group were dramatically increased at 6 hours after CPB (P < 0.05). The MDA content and superoxide dismutase activity were comparable between the 2 groups. A lower proportion of anemia cases were noted after CPB in the DEX group than in the non-DEX group (non-DEX, 10% vs. DEX, 5%, P < 0.05).

Conclusions:

In valve replacement surgery with sevoflurane postconditioning, pre-CPB administration of DEX can reduce the cTnI level at 24 hours after CPB and brings synergic benefits of the inflammatory response.
Cell-Specific Roles of NLRP3 Inflammasome in Myocardial Infarction
Authors: Takahashi Masafumi
Published: July 2019

An accumulating body of evidence indicates that NLRP3 inflammasome plays a crucial role in the pathophysiology of cardiovascular diseases, including atherosclerosis and acute myocardial infarction (MI). NLRP3 inflammasome is a multimeric protein complex that leads to activation of caspase-1, which further induces maturation of interleukin (IL)-1β and IL-18. Activated caspase-1 also induces a particular form of cell death called pyroptosis by the cleavage of gasdermin D. Our and other groups have shown that inhibition of the NLRP3 inflammasome attenuates the inflammatory response and ameliorates myocardial dysfunction and remodeling in animal models of acute MI. Interestingly, investigations have suggested that NLRP3 inflammasome has cell-specific roles in different cell types, such as inflammatory cells, cardiomyocytes, cardiac fibroblasts, and vascular endothelial cells, after acute MI. Moreover, the recent CANTOS trial showed that inhibition of IL-1β was efficacious in secondary prevention for cardiovascular events in patients with previous MI. These findings suggest that NLRP3 inflammasome may be a potential target for the prevention and therapy of MI. This review summarizes recent knowledge on NLRP3 inflammasome and focuses on its cell-specific roles in acute MI.