bluuebunny/crossref_metadata_2025 huggingface dataset:
What Are the Mechanisms of Action of Cognitive–Behavioral, Mind–Body, and Exercise-based Interventions for Pain and Disability in People With Chronic Primary Musculoskeletal Pain?
Authors: Alaiti Rafael K. , Castro Julia , Lee Hopin , Caneiro J.P. , Vlaeyen Johan W.S. , Kamper Steven J. , da Costa Marcelo F.
Published: June 2022

Objectives:

This systematic review examined studies that used mediation analysis to investigate the mechanisms of action of cognitive–behavioral, mind–body, and exercise-based interventions for pain and disability in people with chronic primary musculoskeletal pain.

Materials and Methods:

We searched 5 electronic databases for articles that conducted mediation analyses of randomized controlled trials to either test or estimate indirect effects.

Results:

We found 17 studies (n=4423), including 90 mediation models examining the role of 22 putative mediators on pain or disability, of which 4 had partially mediated treatment effect; 8 had mixed results, and 10 did not mediate treatment effect. The conditions studied were chronic whiplash-associated pain, chronic low back pain, chronic knee pain, and mixed group of chronic primary musculoskeletal pain.

Discussion:

We observed that several of the studies included in our systematic review identified similar mechanisms of action, even between different interventions and conditions. However, methodological limitations were common. In conclusion, there are still substantial gaps with respect to understanding how cognitive–behavioral, mind–body, and exercise-based interventions work to reduce pain and disability in people with chronic primary musculoskeletal pain.
Pain and Fear of Cancer Recurrence in Survivors of Childhood Cancer
Authors: Tutelman Perri R. , Chambers Christine T. , Noel Melanie , Heathcote Lauren C. , Fernandez Conrad V. , Flanders Annette , MacLeod Julia , Sherry Simon B. , Simard Sébastien , Stern Maya , Stewart Sherry H. , Urquhart Robin
Published: June 2022

Objectives:

Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pain catastrophizing, and FCR in childhood cancer survivors and their parents and to examine whether pain catastrophizing predicts increased FCR beyond anxiety symptoms and pain intensity.

Methods:

The participants were 54 survivors of various childhood cancers (M
age=13.1 y, range=8.4 to 17.9 y, 50% female) and their parents (94% mothers). Children reported on their pain intensity in the past 7 days. Children and parents separately completed measures of anxiety symptoms, pain catastrophizing, and FCR.

Results:

Higher anxiety symptoms were associated with increased pain intensity, pain catastrophizing, and FCR in childhood cancer survivors. Higher anxiety symptoms and pain catastrophizing, but not child pain intensity, were associated with FCR in parents. Hierarchical linear regression models revealed that pain catastrophizing explained unique variance in both parent (ΔR
2=0.11, P<0.01) and child (ΔR
2=0.07, P<0.05) FCR over and above the effects of their own anxiety symptoms and child pain.

Discussion:

The results of this study provides novel data on the association between pain and FCR and suggests that a catastrophic style of thinking about pain is more closely related to heightened FCR than one’s anxiety symptoms or the sensory pain experience in both childhood cancer survivors and their parents. Pain catastrophizing may be a novel intervention target for survivors and parents struggling with fears of recurrence.
Partial Resection of First Dorsal Compartment Extensor Retinaculum in De Quervain’s Stenosing Tendovaginitis Release
Authors: Monárrez Rubén , Bains Sandeep S. , Margalit Adam , Ingari John V.
Published: June 2022

Various surgical techniques exist to treat de Quervain’s stenosing tendovaginitis. Specific surgical techniques for de Quervain’s are designed to avoid complications including injury to branches of the superficial branch of the radial nerve, inadequate decompression, reflex sympathetic dystrophy, and palmar subluxation of the released tendons. A simple dorsal incision through the extensor retinaculum is advocated by many as a means to release the compartment while preventing postoperative subluxation. A single incision through the retinaculum limits exposure of the compartment and could lead to reannealing of the retinaculum and recurrent symptoms. Partial resection of the extensor retinaculum provides a more complete release and has not been found to lead to palmar tendon subluxation.
Primary Use of the Deep Inferior Epigastric Pedicle for Free-flap Phalloplasty: Rationale, Technique, and Outcomes
Authors: Yuan Nance , Ray Edward C. , Smith Shannon , Garcia Maurice M.
Published: June 2022

Background:

Most free-flap phalloplasty reports describe the femoral artery and great saphenous vein as recipient vessels, with the deep inferior epigastric artery and venae comitantes (DIEA/V) only rarely reported. We review our experience with preferentially using the DIEA/V as recipient vessels in gender-affirming free-flap phalloplasty, with DIEV as primary venous outflow.

Methods:

We retrospectively reviewed consecutive patients who underwent gender-affirming free-flap phalloplasty at our single institution from June 2017 through June 2021. The DIEA/V was used as recipient vessels, with the DIEA/V pedicle externalized via a passageway made through the external inguinal ring.

Results:

Thirty-eight consecutive free flaps (26 radial forearm free-flap phalloplasties, 10 anterolateral thigh phalloplasties, and two radial forearm free-flap urethroplasties) were performed. Mean age was 37.3 years; mean BMI was 25.7. Mean follow-up was 17.9 months. All flaps were anastomosed to the DIEA/V, without use of vein grafts. Most flaps (89.5%) had at least two veins anastomosed. To augment outflow, a saphenous vein branch was used in one of 38 (2.6%) cases and other superficial veins were used in two of 38 (5.3%) cases. One of 38 (2.6%) cases (early in our experience) resulted in total flap loss.

Conclusions:

Advantages of the DIEA/V as free-flap phalloplasty recipient vessels include a short, direct pathway for vessels, excellent donor-recipient vessel size match that allows end-to-end anastomoses, and elimination of risks associated with arterialized interposed veins. When venous outflow appears compromised, we recommend a low threshold to use additional local or saphenous veins, though this is rarely needed given the DIEV’s reliability.
Free Functional Muscle Transfer following Upper Extremity Sarcoma Resection: A Case Report
Authors: Bitoiu Brendon , Grigor Emma , Abdelbary Hesham , Cormier Nicholas S. , Zhang Jing
Published: June 2022

Functional reconstruction of the upper extremity has traditionally involved tendon transfer or pedicled muscle transfer. The gracilis free functional muscle transfer remains as an excellent option for restoration of finger flexion. Here, we provide a case report of a 35-year-old man diagnosed with left forearm high-grade epithelioid sarcoma who underwent innervated free gracilis transfer and a secondary free flap, the profunda artery perforator flap, through a single donor-site incision to expand soft tissue coverage. Postoperatively, there were no complications reported. At 8-month follow-up, the patient had Musculoskeletal Tumor Score of 22/30, and a Quick Disabilities of the Arm, Shoulder, and Hand score of 34/100.
Efficacy of Combined Phacoemulsification and Goniosynechialysis in Primary Angle Closure Disease With Different Degrees of Peripheral Anterior Synechiae
Authors: Wei Liqing , Fu Lin , Nie Li , Lian Hengli , Qian Zhenbin , Liang Yuanbo , Pan Weihua
Published: June 2022

Précis:

Phacoemulsification and goniosynechialysis (Phaco-GSL) was equally effective in the treatment of primary angle-closure disease (PACD) with preoperative peripheral anterior synechiae (PAS) <180 degrees and larger than 180 degrees. Patients with a larger preoperative PAS range required more range of mechanical separation intraoperatively and displayed more recurrence of PAS (re-PAS) range postoperatively.

Purpose:

To evaluate the long-term efficacy of combined phaco-GSL in PACD with different extent of PAS.

Patients and Methods:

A retrospective study was conducted on 67 patients (79 eyes) who received phaco-GSL. The patients were divided into 2 groups according to the extent of PAS (group A: PAS ≤180 degrees; group B: PAS >180 degrees). Changes in intraocular pressure (IOP), the number of anti-glaucoma drugs, intraoperative mechanical separation of PAS and range of re-PAS during the last follow-up ≥12 months were analyzed.

Results:

At baseline, eyes in group B presented with higher IOP and more anti-glaucoma drugs usage (P=0.008 and 0.004). The PAS range, IOP, number of anti-glaucoma medication were reduced both in 2 groups at the final visit. The range of mechanical separation intraoperatively and re-PAS postoperatively were both larger in group B (P=0.002 and <0.001). The postoperative re-PAS range was positively correlated with the range of mechanical separation (R
2=0.17). The complete success rates at 12, 24, 36, and 48 months were 86.8%, 71.1%, 71.1%, and 71.1% in group A; and 80.5%, 74.6%, 69.9%, and 69.9% in group B. The qualified success rates were 100%, 96.6%, 92.0%, and 92.0% in group A; and 100%, 89.5%, 85.1%, and 85.1% in group B.

Conclusion:

Phaco-GSL for the treatment of PACD showed equally effective IOP control regardless of the extent of preoperative PAS.
Blood glucose responses are associated with prolonged sitting-induced changes in arterial stiffness: a randomized crossover trial
Authors: Horiuchi Masahiro , Stoner Lee
Published: June 2022

Objective

To determine whether the vascular dysfunction response to prolonged sitting combined with hyperglycemia can be mitigated with simple and feasible sitting interruption exercises.

Methods

Twenty healthy young adults [50% women, 21 (2) years, BMI of 21.5 (1.6) kg/m2; (SD)] were enrolled in this study. This study included two 3-h prolonged sitting conditions: uninterrupted sitting (CON) and interruptions with 1-min light half-squat exercises every 20 min (EX). In both conditions, participants ingested 75-g glucose before sitting. The primary outcome was brachial-ankle pulse wave velocity (baPWV).

Results

Linear mixed-effects model analysis revealed a significant interaction effect for baPWV, with a 25% (4.7 m/s) increase for CON and a 1.3% (0.22 m/s) increase for EX. There was also an interaction effect for glucose, with a 60% (57 mg/dl) for CON and a 41% (39 mg/dl) increase for EX. Repeated measures correlation revealed a negligible association between glucose and baPWV for CON (r = −0.04) and a small association for EX (r = 0.32).

Conclusion

Vascular dysfunction occurred for the control but not the exercise condition, suggesting interrupting prolonged sitting with regular, short bouts of exercise may be an effective strategy to protect vascular health.
Relationship between salt reduction readiness and salt intake in hypertensive patients: a single nonspecialized hypertension clinic case study
Authors: Sekizuka Hiromitsu , Ishii Toshiya , Miyake Hitoshi
Published: June 2022

This is the first report about the association of readiness for salt reduction with daily salt intake or the salt check sheet score in hypertensive patients at a nonspecialized hypertension clinic. We investigated whether salt reduction readiness as evaluated based on the transtheoretical model (TTM) is associated with estimated daily salt intake or the salt check sheet score. The TTM allows evaluators to easily assess a subject’s level of readiness for health-related according to five stages. There was no significant relationship between the TTM stages and estimated daily salt intake. A significant correlation was found between the TTM stages and salt check sheet scores (ρ = −0.409; P < 0.001). When providing salt reduction guidance to hypertensive patients, it is effective for healthcare professionals to use repeated urine tests and salt check sheets to take a salt reduction approach according to the level of readiness of the patients.
Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach
Authors: Liu Bin , Wang Xinguang , Wang Chao , Jiao Zhenqing , Chen Wei
Published: June 2022

Background:

The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach.

Methods:

This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score.

Results:

A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation (P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups (P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group (P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group (P = .049).

Conclusion:

The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.
Clinical relevance of receptor conversion in metastatic breast cancer
Authors: Silva Diogo J. , Miranda Gonçalo , Mesquita Alexandra
Published: June 2022

Introduction:

Breast cancer comprises several different pathological entities defined by the presence or absence of hormonal receptors and human epidermal growth factor receptor 2 (HER2). During the disease course, the increase in tumor heterogeneity contributes to the discordant expression of estrogen/progesterone receptors and HER2 status between primary and metastatic lesions. We describe a case that demonstrates the clinical relevance of molecular reassessment during metastatic breast cancer progression.

Patient concerns:

A 40-year-old Caucasian woman with germline breast cancer gene mutation was referred to a general surgery appointment after breast ultrasound revealed a suspicious nodular lesion in 2012.

Diagnosis:

Ultrasound-guided microbiopsy revealed an invasive ductal carcinoma of no special type, hormone receptor-positive, and HER2-negative.

Interventions:

The patient underwent modified radical left mastectomy, adjuvant radiotherapy, chemotherapy, and endocrine therapy. Four years after the diagnosis, HER2 positive lung progression was documented, and the patient received anti-HER2 targeted systemic therapy for 15 months. New disease progression with a triple-negative profile was found, and palliative systemic treatment was changed to carboplatin for 3 months until new progression. Based on the results of the OlympiAD trial, monotherapy with Olaparib 300 mg twice daily for 28 days was initiated.

Outcomes:

After seven cycles of treatment, patient showed progressive improvement in quality of life and maintained stable disease without significant adverse events.

Conclusion:

The clinical relevance of hormone receptor and HER2 status discordance between primary tumors and metastatic lesions has been studied in recent years. This case report illustrates the clinical impact of molecular changes during disease progression and the adaptation of treatment options. This allows for an increase in both survival and quality of life in patients with metastatic breast cancer.
Cost and Cost Savings of Navigation Services to Avoid Rehospitalization for a Comorbid Substance Use Disorder Population
Authors: Orme Stephen , Zarkin Gary A. , Dunlap Laura J. , Nordeck Courtney D. , Schwartz Robert P. , Mitchell Shannon G. , Welsh Christopher , O’Grady Kevin E. , Gryczynski Jan
Published: June 2022

Background:

A randomized clinical trial found that patient navigation for hospital patients with comorbid substance use disorders (SUDs) reduced emergency department (ED) and inpatient hospital utilization compared with treatment-as-usual.

Objective:

To compare the cost and calculate any cost savings from the Navigation Services to Avoid Rehospitalization (NavSTAR) intervention over treatment-as-usual.

Research Design:

This study calculates activity-based costs from the health care providers and uses a net benefits approach to calculate the cost savings generated from NavSTAR. NavSTAR provided patient navigation focused on engagement in SUD treatment, starting before hospital discharge and continuing for up to 3 months postdischarge.

Subjects:

Adult hospitalized medical/surgical patients with comorbid SUD for opioids, cocaine, and/or alcohol.

Cost Measures:

Cost of the 3-month NavSTAR patient navigation intervention and the cost of all inpatient days and ED visits over a 12-month period.

Results of Base Case Analysis:

NavSTAR generated $17,780 per participant in cost savings. Ninety-seven percent of bootstrapped samples generated positive cost savings, and our sensitivity analyses did not change our results.

Limitations:

Participants were recruited at one hospital in Baltimore, MD through the hospital’s addiction consultation service. Findings may not generalize to the broader population. Outpatient health care cost data was not available through administrative records.

Conclusion:

Our findings show that patient navigation interventions should be considered by payors and policy makers to reduce the high hospital costs associated with comorbid SUD patients.
Racial and Ethnic Variation in Presentation, Diagnosis, Treatment, and Outcome of Pediatric Crohn Disease: A Single Center Study
Authors: Britto Savini Lanka , Qian Justin , Ihekweazu Faith Dorsey , Kellermayer Richard
Published: June 2022

Objectives:

Disparities in health care for racial/ethnic minority children in the United States who are burdened by pediatric Crohn’s disease (PCD) are not well understood.

Methods:

A retrospective review of the Texas Children’s Hospital ImproveCareNow database from 2007 to 2015 was performed. CD patients with a minimum of 2-year follow-up were included if the onset of symptoms attributable to inflammatory bowel disease was clearly documented. We primarily aimed to identify race and ethnicity associations in diagnostic delay, presentation, treatment, and 2-year outcomes. We also examined early versus late diagnosis (ie, over 6 months from disease onset) associations with these variables unrelated to race/ethnicity.

Results:

One hundred and sixty-six PCD patients [57.8% non-Hispanic White (NH-White), 18.1% African American (AA), and 15.7% Hispanic] met selection criteria. Time to diagnosis was shorter in Hispanic patients (P < 0.01) and they were older at diagnosis than NH-White patients (P = 0.0164). AA patients (33%, P < 0.01) and Hispanic patients (35%, P < 0.05) had lower rates of granuloma detection than NH-White patients (63%). AA patients had lower rates of steroid-free remission (SFR) at 2 years than NH-White patients (P < 0.05). Higher ESR and lower hemoglobin levels were associated with early diagnosis (P < 0.01). Early diagnosis was associated with higher rates of surgery within 2 years of diagnosis (P < 0.05). Diagnostic fecal calprotectin levels inversely associated with SFR at 2 years (P < 0.05). Early use of biologics positively, and early use of corticosteroids negatively correlated with 2-year SFR (P < 0.05).

Conclusions:

Race and ethnicity may influence the diagnosis, treatment, and outcomes of PCD. This recognition presents a nidus toward establishing equity in PCD care.
Impact of Neurodevelopmental Disorders on Bowel Management Outcomes in Children with Functional Constipation
Authors: Seidler Gabriella R. , Knaus Maria E. , Beyene Tariku J. , Ahmad Hira , Lu Peter L. , Gasior Alessandra C. , Halaweish Ihab , Wood Richard J.
Published: June 2022

Objectives:

Patients experiencing functional constipation (FC) can participate in structured bowel management programs (BMPs) to manage constipation or fecal incontinence when standard management fails. We sought to evaluate the efficacy of BMPs for children with FC with and without neurodevelopmental disorders.

Methods:

We performed a retrospective review of children with FC who participated in our BMP from 2014 to 2021. Stool/urinary continence, bowel regimen, surgical history, parent-reported outcomes measures (PROMs: Cleveland Clinic Constipation Score, Baylor Continence Scale, Vancouver Symptom Score for Dysfunctional Elimination), and Pediatric Quality of Life Inventory (PedsQL) were assessed pre- and at least 9 months post-BMP.

Results:

The cohort included 156 patients with a median age of 9 years and follow-up of 627 days (IQR: 389–808 days). Two sub-cohorts included patients with FC only (69%) and FC plus a neurodevelopmental disorder (31%): 59% attention-deficit/hyperactivity disorder, 33% autism spectrum disorder, and 8% obsessive-compulsive disorder. Both groups had significantly improved follow-up bowel movement frequency and continence (39%–90% neurodevelopmental, 44%–82% FC only, P < 0.001) and urinary continence (65%–90% neurodevelopmental, 69%–91% FC only, P < 0.02). There was a significant improvement in most of the PROMs at follow-up. Both groups experienced a clinically meaningful improvement in overall PedsQL scores (pre- and postBMP difference of >4.5).

Conclusions:

Patients with FC with and without a neurodevelopmental disorder had significant improvement in stool and urinary continence after undergoing a BMP. Further studies are needed to see if this improvement is durable over a longer period of time in this challenging cohort.
Infectious Esophagitis in Children
Authors: O’Donnell Jonathan E. M. , Krishnan Usha
Published: June 2022

Infectious esophagitis is the third most common cause of esophagitis after gastroesophageal reflux disease and eosinophilic esophagitis (EoE) and should always be considered in the differential of patients with dysphagia and odynophagia. The most common organisms causing disease are candida, Herpes simplex virus (HSV) and cytomegalovirus (CMV). It is well recognized that an impaired local or systemic immune system is a risk factor for disease; however, esophageal dysmotility and disruptions in esophageal homeostasis and the esophageal milieu are likely to represent additional risk factors in disease pathogenesis.
Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life
Authors: Calvo-Schimmel Alejandra , Paul Steven M. , Cooper Bruce A. , Shin Joosun , Harris Carolyn , Oppegaard Kate , Hammer Marilyn J. , Cartwright Frances , Conley Yvette P. , Kober Kord M. , Levine Jon D. , Miaskowski Christine
Published: June 2022

Background

Anxiety and sleep disturbance are frequent symptoms during chemotherapy.

Objectives

Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups.

Methods

Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles.

Results

Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life.

Conclusions

More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms.

Implications for Practice

Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.
Potential Anti-Inflammatory and Anti-Coagulation Effects of One-Time Application of Remote Ischemic Conditioning in Patients With Subacute/Chronic Cerebral Arteriostenosis and Venostenosis
Authors: Song Si-ying , Jiao Bao-lian , Lan Duo , Liu Yun-huan , Wan Shu-ling , Guo Yi-bing , Ding Yu-chuan , Ji Xun-ming , Meng Ran
Published: June 2022

Background:

Remote ischemic conditioning (RIC) is an extremely simple, non-invasive, and cost-effective method with a neuroprotective effect. This study aimed to evaluate the immediate effects of one-time application of RIC on inflammation and coagulation in patients with chronic cerebral vascular stenosis, and compare the different effects of RIC on cerebral arteriostenosis and cerebral venostenosis.

Method:

A total of 47 patients with defined cerebral arteriostenosis (n=21) or venostenosis (n=26) were prospectively enrolled. RIC intervention was given once with 5 cycles of inflating and deflating for 5 minutes alternately. Blood was sampled 5 minutes before and after RIC for inflammatory and thrombophilia biomarkers. Differences in inflammatory and thrombotic variables at differing time points in the group were assessed using paired t tests or Wilcoxon matched-pairs signed-rank test.

Results:

Patients with cerebral arteriostenosis had a higher level of pre-RIC neutrophil-to-lymphocyte ratio (P=0.034), high-sensitivity C-reactive protein (P=0.037), and fibrinogen (P=0.002) than that with cerebral venostenosis. In the arterial group, levels of fibrinogen (P=0.023) decreased, and interleukin-6 levels were elevated (P=0.019) after a single RIC. Age was negatively related to interleukin-6, C-reactive protein, and fibrinogen.

Conclusion:

One-time RIC interventions may show seemingly coexisted proinflammatory and anti-coagulation effects of a single bout on patients with cerebral arteriostenosis. Older age was a negative predictor for multiple biomarkers in the cerebral arteriostensosis group. The protective effect of RIC on cerebral venostenosis patients needs to be further studied in a larger sample size.
Statin Usage Increases White Matter Hyperintensities
Authors: Goldstein Eric D. , Garg Gauri , Navarro Kayla , Wolcott Zoe , Yaghi Shadi , Wong Ka-Ho , McLean Kaitlin , de Havenon Adam H.
Published: June 2022

Background:

Progression of white matter hyperintensities (WMHs), a radiographic marker of cerebral small vessel disease, occurs with uncontrolled conventional cerebrovascular risk factors. Less certain, however, is the influence of dyslipidemia and the impact of 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) on WMH progression. The goal of this study was to evaluate the influence of statins on the progression of WMH over a 4-year interval.

Methods:

We performed a post hoc analysis of the SPRINT-MIND database on those with serial volumetric WMH data. WMH progression was calculated as the difference in WMH volume between the 2 scans and then segmented into tertiles due to rightward skew. We defined statin usage as no therapy (0% of visits), partial therapy (1% to 99% of visits) or full therapy (100% of visits) as logged during study visits. Analysis of variance and χ2 tests were used for continuous and categorical variables with adjustments made for variables known to influence WMH development.

Results:

A total of 425 individuals were included in this study: 53% without statins use, 27% partial use, and 20% full use. Demographic characteristics and baseline WMH volumes were similar among the cohort. Those with full statin use were significantly more likely to be in the top tertile of WMH progression (adjusted odds ratio: 2.30, 95% confidence interval: 1.11-4.77, P=0.025), despite improvement in dyslipidemia.

Conclusions:

SPRINT-MIND participants prescribed a statin were nearly 2.5 times more likely to be within the top tertile of WMH progression over 4 years, despite adjustment for synergistic risk factors and improvement in low-density lipoprotein.
An Approach to Nonurothelial Malignancies of the Urinary Bladder in Urine Cytology
Authors: Lew Madelyn
Published: June 2022

Urine cytology is an economical and convenient method of triaging patients who present with urinary symptoms as well as surveying those who have previously been diagnosed with urothelial carcinoma for recurrent or persistent disease. While the vast majority of malignancies diagnosed in urine cytology are urothelial carcinomas, it is important to recognize nonurothelial elements to inform patient prognosis and raise the possibility of involvement by a urothelial carcinoma variant, nonurothelial malignancy of the bladder, or a nonbladder primary, which may alter patient management pathways. As such, becoming familiar with morphologic features of nonurothelial malignancies in urine cytology as well as their related clinical risk factors, radiologic and cystoscopic features, differential diagnostic considerations, and the utility and pitfalls of ancillary tests can facilitate optimal patient care.
Clinicopathologic and Immunohistochemical Characterization of Sarcomatoid Chromophobe Renal Cell Carcinoma
Authors: Whaley Rumeal D. , Cheng Liang
Published: June 2022

Sarcomatoid differentiation in chromophobe renal cell carcinoma (ChRCC) is a rare finding and a significant predictor of worse outcomes. When the sarcomatoid component overgrows the conventional component or is the only component on a biopsy, the differential diagnoses encompass a variety of entities. Therefore, we reviewed 22 sarcomatoid ChRCCs and characterized the immunophenotype. Given that renal carcinomas with sarcomatoid features may benefit from immune checkpoint inhibitor-based therapy we also assessed the programmed death-ligand 1 (PD-L1) (28-8) expression. DOG1, CD117, cytokeratin 7, and PAX8 were negative in 100%, 88%, 63%, and 44% of the sarcomatoid components, respectively. GATA3 was expressed in 31% of the conventional components and in 50% of the sarcomatoid components. One conventional and 3 sarcomatoid components expressed PD-L1. Sarcomatoid ChRCCs have a high propensity for metastases and cancer progression. Distant metastatic disease was seen in 73% of the cases and median survival in this cohort was <1 year. The sarcomatoid portion had increased expression of PD-L1 and frequent loss of expression of multiple immunohistochemical markers associated with ChRCC. Half of the sarcomatoid ChRCC exhibited GATA3 expression, 3 of which did not express PAX8.
Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series
Authors: Saetang Patcharin , Samransamruajkit Rujipat , Singjam Kanokwan , Deekajorndech Tawatchai
Published: June 2022

OBJECTIVES:

To evaluate the use of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) as adjunctive therapy during pediatric patients with septic shock.

DESIGN:

Prospective observational study.

SETTING:

Nine-bed PICUs at university referral hospital.

PATIENTS:

Children (30 d to 15 yr) with septic shock and Pediatric Logistic Organ Dysfunction (PELOD)-2 score greater than or equal to 10 or Pediatric Risk of Mortality (PRISM) 3 score greater than or equal to 15, who were also receiving at least one inotrope.

INTERVENTION:

Patients received 2–4 hour treatment with PMX-DHP 20R column on 2 consecutive days.

MEASUREMENTS AND MAIN RESULTS:

We enrolled six children aged 21–167 months old (median, 99-mo old), with a body weight of 10–50 kg (median, 28 kg). All six patients had both PELOD-2 greater than or equal to 10 and PRISM-3 greater than or equal to 15, required invasive mechanical ventilation, and received standard treatment for septic shock before enrollment. We observed significant improvement in PELOD-2 score from baseline to 72 hours after the start of PMX-DHP (mean [95% CI] from 14.3 [12.2–16.5] to 6.0 [0.3–11.7]; p = 0.006). The vasoactive inotropic score (VIS) and lactate concentration also significantly decreased from baseline to 72 hours (VIS, 60 mmol/L [25–95 mmol/L] to 4.0 mmol/L [44.1–12 mmol/L]; p = 0.003; lactate, 2.4 mmol/L [1.0–3.8 mmol/L] to 1.0 mmol/L [0.5–1.5 mmol/L]; p = 0.01). Five of six patients survived. There was no device-related adverse event in these patients.

CONCLUSIONS:

In this case series of treatment with PMX-DHP as adjunctive therapy in children with refractory septic shock and high baseline severity, we have shown that patient recruitment is feasible. We have also found that clinical hemodynamic and severity of illness scores at 72 hours may be potential end points for testing in future randomized controlled trials.
Pediatric Fracture Epidemiology and US Emergency Department Resource Utilization
Authors: Farrell Caitlin , Hannon Megan , Monuteaux Michael C. , Mannix Rebekah , Lee Lois K.
Published: June 2022

Objective

Fractures are common childhood injuries that result in emergency department (ED) visits. National trends in pediatric fracture epidemiology and resource utilization are not well described. Our objective is to analyze national trends in pediatric fracture epidemiology, ED disposition, and ED resource utilization from 2010 to 2015.

Methods

This is an epidemiological study of fracture care in US EDs from 2010 to 2015 for children 0 to 18 years old using the Nationwide Emergency Department Sample. We calculated frequencies and national rates using weighted analyses and census data. We used the test for linear trend to analyze incidence, hospital admission, transfer, and procedural sedation over time. Multivariate logistic regression analyses identified encounter- and hospital-level predictors of transfer, admission, operative care, and use of procedural sedation.

Results

During the study period, from 2010 to 2015, a total of 5,398,827 children received ED care for fractures. The pediatric fracture rate was 11.5 ED visits/1000 persons (95% confidence interval [CI], 10.6–12.5) and decreased over time. The admission rate for pediatric fracture patients was 5% and stable over time. The transfer rate increased from 3.3 to 4.1/100 fracture visits (linear trend: odds ratio, 1.06; 95% CI, 1.03–1.09). Utilization of procedural sedation increased from 1.5% to 2.9% of fracture visits (linear trend: odds ratio, 1.17; 95% CI, 1.09–1.25). Predictors associated with disposition and resource utilization include patient age, fracture location, insurance type, hospital type, and region.

Conclusions

The national incidence rate of pediatric fractures decreased slightly. Emergency department resource utilization increased over time. With high national volume, understanding pediatric fracture epidemiology and resource utilization is important to the health care system.
Dynamical landscapes of cell fate decisions
Authors: Sáez M. , Briscoe J. , Rand D. A.
Published: June 2022

The generation of cellular diversity during development involves differentiating cells transitioning between discrete cell states. In the 1940s, the developmental biologist Conrad Waddington introduced a landscape metaphor to describe this process. The developmental path of a cell was pictured as a ball rolling through a terrain of branching valleys with cell fate decisions represented by the branch points at which the ball decides between one of two available valleys. Here we discuss progress in constructing quantitative dynamical models inspired by this view of cellular differentiation. We describe a framework based on catastrophe theory and dynamical systems methods that provides the foundations for quantitative geometric models of cellular differentiation. These models can be fit to experimental data and used to make quantitative predictions about cellular differentiation. The theory indicates that cell fate decisions can be described by a small number of decision structures, such that there are only two distinct ways in which cells make a binary choice between one of two fates. We discuss the biological relevance of these mechanisms and suggest the approach is broadly applicable for the quantitative analysis of differentiation dynamics and for determining principles of developmental decisions.
Rubinisphaera margarita sp. nov., a novel planctomycete isolated from marine sediments collected in the Portuguese north coast
Authors: Vitorino Inês Rosado , Lobo-da-Cunha Alexandre , Vasconcelos Vítor , Lage Olga Maria
Published: June 2022

The phylum

Planctomycetota

is constituted by bacteria with unique features that are well adapted to a vast range of habitats. Here, we describe a novel planctomycete isolated from marine sediments collected on a beach in Matosinhos (Portugal) using an iChip-based culturing technique. Strain ICM_H10T forms beige-coloured colonies in modified M14 medium and its cells are spherical to ovoid in shape, stalked, rosette-forming and showing motility in a phase of the life cycle. Transmission electron microscopy observations showed a typical planctomycetal cell plan and cell division by budding. This strain requires salt for growth and grows in the range of 2.0–5.0 % (w/v) NaCl, from 20 to 37 °C, within a pH of 6.0–9.0 and is able to use diverse nitrogen and carbon sources. It is heterotrophic, aerobic and capable of microaerobic growth. This strain has a genome size of approximately 6.0 Mb and a G+C content of 58.1 mol%. A 16S rRNA gene-based phylogenetic analysis supports the association of strain ICM_H10T to the phylum

Planctomycetota

and the family

Planctomycetaceae

, as it shares only 96.8 and 96.4% similarity to its closest relatives

Rubinisphaera italica

Pan54T and

Rubinisphaera brasiliensis

IFAM 1448T, respectively. Other phylogenetic markers also support the separation of this strain into a novel species. Morphological, physiological and genomic comparisons between strain ICM_H10T and its closest relatives strongly suggest that ICM_H10T represents a new species of the genus

Rubinisphaera

, for which we propose the name Rubinisphaera margarita sp. nov., with ICM_H10T (=CECT 30326T=LMG 32234T) as type strain.
“Public attitudes to sharing government data with private industry: a systematic scoping review”
Authors: Street Jackie , Carter Stacy , Fabrianesi Belinda , Bosward Rebecca , Carolan Lucy , Braunack-Mayer Annette
Published: June 2022

Background

Linking and analysing large volumes of health data in electronic records, datasets, registries and biobanks can provide detailed insights into the health profiles of individuals, communities, regions and national populations. Good governance for data sharing can be challenging, particularly when private sector organisations are the recipients of public sector data. Many jurisdictions have responded by instituting new regulations and laws related to data protection, responding to calls to promote data sharing and manage associated risks. This review integrates and interprets five years of research on public and patient perspectives on sharing publicly-held health data with private industry for research and development. Our review question was: what are community attitudes towards the use of government administrative health data by private industry organisations for therapeutic development?

Methods

We developed two logic grids: first, used terms describing citizens or patients, big data, private health sector and views or perspectives, second, used terms describing big data, social licence and public interest. We conducted a systematic literature search using electronic databases; PubMed, Scopus, CINAHL, Web of Science. Searches were conducted using Google Advanced and Google Scholar to identify grey literature

Results

A total of 6,788 articles were screened based on title and abstract. Full text screening was conducted for 224 articles and a total of 33 publications were identified. Across all studies, support for sharing administrative health data with private sector organisations was low. Background knowledge and lack of trust that data use would lead to public benefit were the most important reasons for low level of support.

Conclusion

Policymakers, data custodians and companies will need to establish robust safeguards including secure storage, anonymisation, monitoring and independent oversight, and institute and implement sanctions on misuse, if they are to secure legitimacy to share publicly-held health data with private industry for research and development.

Registration

none available.

‘Contributions to the literature’

Research shows governance for data sharing is challenging, particularly when private sector organisations are the recipients of public sector data. Globally jurisdictions have responded by instituting new regulations and laws related to data protection, data sharing and the associated risks.

Bringing together research on ‘public attitudes towards the use of linked government administrative data by private sector organisations for therapeutic development’, this systematic review found that public support for sharing was low.

These findings highlight key areas for policymakers, data custodians and companies to address before they can legitimately share publicly-held health data with private industry for research and development.
PGRL1A redox states alleviate photoinhibition in Arabidopsis during step changes in light intensity
Authors: Chaturvedi Amit Kumar , Dym Orly , Fluhr Robert
Published: June 2022

Non-motile plants have evolved regulatory mechanisms to maintain homeostasis for optimal growth. Responses to environmental changes in light are particularly important not only during the diurnal transition from night to day but also to react to light changes caused by passing clouds or by wind. Thioredoxins rapidly orchestrate redox control during environmental change by modifying cysteine residues. Here, we assign a function to regulatory cysteines of PGRL1A, a constituent of the ferredoxin-dependent cyclic electron flow (Fd-CEF) pathway and show their role in the regulation of proton motive force (PMF) and nonphotochemical quenching (NPQ). During step increase of low light intensity (10-60 μE*m-2*s-1), the intermolecular disulfide of the PGRL1A 59-kDa complex is reduced transiently within seconds to the 28 kDa form. In contrast, step increases to higher light intensity (60-600 μE*m-2*s-1) stimulated a stable partially reduced redox state in PGRL1A. Measurements of NPQ, PMF and resultant photosynthetic controls Y(ND) and Y(NA) were found to correlate with the redox state of PGRL1A during step increases in light intensity but not in PGRL1mutant plants pgrl1ab or PGRL1A cysteine mutant (PGRL1AC1,2A). Continuous light regimes did not affect mutant growth; however, fluctuating regimes of light intensity showed significant growth reduction in the mutants. Inhibitors of photosynthesis placed control of the PGRL1A redox state as dependent on the penultimate ferredoxin redox state that fuels reducing equivalents to the large set of chloroplasts thioredoxins. Our results showed that redox state changes in PGRL1A are crucial to the optimization of photosynthesis and are regulated by the photosynthetic electron flux.
Direct laser writing of 3D electrodes on flexible substrates
Authors: Brown Morgan A. , Zappitelli Kara M. , Singh Loveprit , Yuan Rachel C. , Bemrose Melissa A. , Brogden Valerie , Miller David J. , Cogan Stuart F. , Gardner Timothy J.
Published: June 2022

This report describes a 3D microelectrode array integrated on a thin-film flexible cable for neural recording in small animals. The micro electrode array fabrication process integrates traditional silicon thin-film processing techniques and direct laser writing of 3D structures at micron resolution via two-photon lithography. While direct laser writing of 3D printed electrodes has been described before, this report is the first to provide a method for high-aspect-ratio laser-written structures integrated with microfabricated electrical traces. One prototype is a 16-channel array composed of 350 μm long shanks spaced on a grid with 90 μm pitch. Other devices shown here include biomimetic mosquito-needles that penetrate through the dura of birds and porous electrodes designed to promote tissue ingrowth or enhance charge injection capacity for neural stimulation. These devices are just a few examples of a new design space that will enable high-channel-count 3D electrode arrays with features definable at single micrometer resolution. Using a custom laser writer, the 3D printing process is rapid (1 mm3/min). This high-speed printing combined with standard wafer-scale processes will enable efficient device fabrication and new studies examining the relationship between electrode geometry and electrode performance. We anticipate highest impact in small animal models, nerve interfaces, retinal implants, and other applications requiring small, high density 3D electrodes.
An ecological investigation of the capacity to follow simultaneous speech and preferential detection of ones’ own name
Authors: Pinto Danna , Kaufman Maya , Brown Adi , Golumbic Elana Zion
Published: June 2022

Many situations require focusing attention on one speaker, while monitoring the environment for potentially important information. Some have proposed that dividing attention among two speakers involves behavioral tradeoffs, due to limited cognitive resources. However the severity of these tradeoffs, particularly under ecologically-valid circumstances, is not well understood. We investigated the capacity to process simultaneous speech using a dual-task paradigm simulating task demands and stimuli encountered in real-life. Participants listened to conversational narratives (Narrative Stream) and monitored a stream of announcements (Barista Stream), to detect when their order was called. We measured participants’ performance, neural activity and skin conductance as they engaged in this dual-task.

Participants achieved extremely high dual-task accuracy, with no apparent behavioral tradeoffs. Moreover, robust neural and physiological responses were observed for target-stimuli in the Barista Stream, alongside significant neural speech-tracking of the Narrative Stream. These results suggest that humans have substantial capacity to process simultaneous speech and do not suffer from insufficient processing resources, at least for this highly ecological task-combination and level of perceptual load. Results also confirmed the ecological validity of the advantage for detecting ones’ own name at the behavioral, neural and physiological level, highlighting the contribution of personal relevance when processing simultaneous speech.