bluuebunny/crossref_metadata_2025 huggingface dataset:
SDSS-IV MaNGA: enhanced star formation in galactic-scale outflows
Authors: Bao Min , Chen Yanmei , Yuan Qirong , Shi Yong , Bizyaev Dmitry , Yu Xiaoling , Feng Shuai , Cao Xiao , Gao Yulong , Gu Qiusheng , Yu Ying
Published: April 2021

Using the integral field unit (IFU) data from Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey, we collect a sample of 36 star-forming galaxies that host galactic-scale outflows in ionized gas phase. The control sample is matched in the three-dimensional parameter space of stellar mass, star formation rate, and inclination angle. Concerning the global properties, the outflows host galaxies tend to have smaller size, more asymmetric gas disc, more active star formation in the centre, and older stellar population than the control galaxies. Comparing the stellar population properties along axes, we conclude that the star formation in the outflows host galaxies can be divided into two branches. One branch evolves following the inside-out formation scenario. The other located in the galactic centre is triggered by gas accretion or galaxy interaction, and further drives the galactic-scale outflows. Besides, the enhanced star formation and metallicity along minor axis of outflows host galaxies uncover the positive feedback and metal entrainment in the galactic-scale outflows. Observational data in different phases with higher spatial resolution are needed to reveal the influence of galactic-scale outflows on the star formation progress in detail.
An X-ray and radio study of the Hubble Frontier Field cluster Abell S1063
Authors: Rahaman Majidul , Raja Ramij , Datta Abhirup , Burns Jack O , Alden Brian , Rapetti David
Published: April 2021

We present results from Chandra X-ray observations and 325 MHz Giant Metrewave Radio Telescope (GMRT) observations of the massive and X-ray luminous cluster of galaxies Abell S1063. We report the detection of large-scale ‘excess brightness’ in the residual Chandra X-ray surface brightness map that extends at least 2.7 Mpc towards the north-east from the centre of the cluster. We also present a high fidelity X-ray flux and temperature map using Chandra archival data of 122 ks that shows the disturbed morphology in the cluster. The residual flux map shows the first observational confirmation of the merging axis proposed in earlier simulations. The average temperature within R500 is 11.7 ± 0.56 keV that makes AS1063 one of the hottest clusters in the nearby Universe. The integrated radio flux density at 325 MHz is found to be 62.0 ± 6.3 mJy. The integrated spectrum of the radio halo follows a power law with a spectral index α = −1.43 ± 0.13. The radio halo is found to be significantly under-luminous that favored for both the hadronic as well as the turbulent re-acceleration mechanism for its origin.
Gene Duplication and Loss ofAANATin Mammals Driven by Rhythmic Adaptations
Authors: Yin Daiqing , Zhou RuRu , Yin Mengxin , Chen Yue , Xu Shixia , Yang Guang
Published: April 2021

Arylalkylamine N-acetyltransferase (AANAT) plays a crucial role in synchronizing internal biological functions to circadian and circannual changes. Generally speaking, only one copy of AANAT gene has been found in mammals, however, three independent duplications of this gene were detected in several cetartiodactyl lineages (i.e., Suidae, Hippopotamidae, and Pecora), which originated in the middle Eocene, a geological period characterized with the increased climate seasonality. Lineage-specific expansions of AANAT and the associated functional enhancement in these lineages strongly suggest an improvement in regulating photoperiodic response to adapt to seasonal climate changes. In contrast, independent inactivating mutations or deletions of the AANAT locus were identified in the four pineal-deficient clades (cetaceans, sirenians, xenarthrans, and pangolins). Loss of AANAT function in cetaceans and sirenians could disrupt the sleep-promoting effects of pineal melatonin, which might contribute to increasing wakefulness, adapting these clades to underwater sleep. The absence of AANAT and pineal glands in xenarthrans and pangolins may be associated with their body temperature maintenance. The present work demonstrates a far more complex and intriguing evolutionary pattern and functional diversity of mammalian AANAT genes than previously thought and provides further evidence for understanding AANAT evolution as driven by rhythmic adaptations in mammals.
The Dockstore: enhancing a community platform for sharing reproducible and accessible computational protocols
Authors: Yuen Denis , Cabansay Louise , Duncan Andrew , Luu Gary , Hogue Gregory , Overbeck Charles , Perez Natalie , Shands Walt , Steinberg David , Reid Chaz , Olunwa Nneka , Hansen Richard , Sheets Elizabeth , O’Farrell Ash , Cullion Kim , O’Connor Brian D , Paten Benedict , Stein Lincoln
Published: April 2021

Dockstore (https://dockstore.org/) is an open source platform for publishing, sharing, and finding bioinformatics tools and workflows. The platform has facilitated large-scale biomedical research collaborations by using cloud technologies to increase the Findability, Accessibility, Interoperability and Reusability (FAIR) of computational resources, thereby promoting the reproducibility of complex bioinformatics analyses. Dockstore supports a variety of source repositories, analysis frameworks, and language technologies to provide a seamless publishing platform for authors to create a centralized catalogue of scientific software. The ready-to-use packaging of hundreds of tools and workflows, combined with the implementation of interoperability standards, enables users to launch analyses across multiple environments. Dockstore is widely used, more than twenty-five high-profile organizations share analysis collections through the platform in a variety of workflow languages, including the Broad Institute's GATK best practice and COVID-19 workflows (WDL), nf-core workflows (Nextflow), the Intergalactic Workflow Commission tools (Galaxy), and workflows from Seven Bridges (CWL) to highlight just a few. Here we describe the improvements made over the last four years, including the expansion of system integrations supporting authors, the addition of collaboration features and analysis platform integrations supporting users, and other enhancements that improve the overall scientific reproducibility of Dockstore content.
Distal renal tubular acidosis: ERKNet/ESPN clinical practice points
Authors: Trepiccione Francesco , Walsh Steven B , Ariceta Gema , Boyer Olivia , Emma Francesco , Camilla Roberta , Ferraro Pietro Manuel , Haffner Dieter , Konrad Martin , Levtchenko Elena , Lopez-Garcia Sergio Camilo , Santos Fernando , Stabouli Stella , Szczepanska Maria , Tasic Velibor , Topaloglu Rezan , Vargas-Poussou Rosa , Wlodkowski Tanja , Bockenhauer Detlef
Published: April 2021

Distal renal tubular acidosis (dRTA) is characterized by an impaired ability of the distal tubule to excrete acid, leading to metabolic acidosis. Associated complications include bone disease, growth failure, urolithiasis and hypokalaemia. Due to its rarity, there is limited evidence to guide diagnosis and management; however, available data strongly suggest that metabolic control of the acidosis by alkali supplementation can halt or revert almost all complications. Despite this, cohort studies show that adequate metabolic control is present in only about half of patients, highlighting problems with treatment provision or adherence. With these clinical practice points the authors, part of the working groups tubulopathies in the European Rare Kidney Disease Reference network and inherited kidney diseases of the European Society for Paediatric Nephrology, aim to provide guidance for the management of patients with dRTA to facilitate adequate treatment and establish an initial best practice standard against which treatment of patients can be audited.
The challenge of early diagnosis of autoimmune lymphoproliferative syndrome in children with suspected autoinflammatory/autoimmune disorders
Authors: Oliveira Mendonça Leonardo , Matucci-Cerinic , Caterina , Terranova , Paola , Casabona Federica , Bovis Francesca , Caorsi Roberta , Fioredda Francesca , Palmisani Elena , Grossi Alice , Guardo Daniela , Bustaffa Marta , Volpi Stefano , Ceccherini Isabella , Ravelli Angelo , Dufour Carlo , Miano Maurizio , Gattorno Marco
Published: April 2021

Objectives

To test the usefulness of an extended panel of lymphocyte subsets in combination with Oliveira’s diagnostic criteria for the identification of autoimmune lymphoproliferative syndrome (ALPS) in children referred to a paediatric rheumatology centre.

Methods

Patients referred from 2015 to 2018 to our rheumatology unit for an autoimmune or autoinflammatory condition were retrospectively analysed. Oliveira’s required criteria [chronic lymphoproliferation and elevated double-negative T (DNT)] were applied as first screening. Flow cytometry study included double-negative CD4–CD8–TCRαβ+ T lymphocytes (DNT), CD25+CD3+, HLA–DR+CD3+ T cells, B220+ T cells and CD27+ B cells. Data were analysed with a univariate logistic regression analysis, followed by a multivariate analysis. Sensitivity and specificity of the Oliveira’s required criteria were calculated.

Results

A total of 264 patients were included in the study and classified as: (i) autoimmune diseases (n = 26); (ii) juvenile idiopathic arthritis (JIA) (35); (iii) monogenic systemic autoinflammatory disease (27); (iv) periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome (100); (v) systemic undefined recurrent fever (45); (vi) undetermined-systemic autoinflammatory disease (14); or (vii) ALPS (17). Oliveira’s required criteria displayed a sensitivity of 100% and specificity of 79%. When compared with other diseases the TCRαβ+B220+ lymphocytes were significantly increased in ALPS patients. The multivariate analysis revealed five clinical/laboratory parameters positively associated to ALPS: splenomegaly, female gender, arthralgia, elevated DNT and TCRαβ+B220+ lymphocytes.

Conclusions

Oliveira’s required criteria are useful for the early suspicion of ALPS. TCRαβ+B220+ lymphocytes should be added in the diagnostic work-up of patients referred to the paediatric rheumatology unit for a suspected autoimmune or autoinflammatory condition, providing a relevant support in the early diagnosis of ALPS.
Autoantibody predictors of gastrointestinal symptoms in systemic sclerosis
Authors: Ahmed Fiza , Maclean Rory H , Nihtyanova Svetlana I , Ong Voon H , Murray Charles D , Denton Christopher P
Published: April 2021

Objectives

To assess the prevalence and burden of SSc-related gastrointestinal dysfunction (SSc-GI) and to evaluate associations with demographic, clinical and serological characteristics.

Methods

Patients completed the UCLA SCTC GIT 2.0 questionnaire for SSc-GI disease to assess the burden of GI disease across multiple functional and psychological domains. Questionnaire scores were assessed using non-parametric and quantile regression analyses.

Results

Our cohort included 526 patients with SSc, with a typical distribution of disease-associated autoantibodies (ACA, ARA, ATA, PM-Scl, U1RNP, U3RNP). We demonstrated associations between hallmark antibodies and the domain-specific burden of GI disease. In particular, ACA, ARA and ENA-negative demonstrated increased SSc-GI disease burden, while PM-Scl conferred relative protection. In a distributional analysis, associations with autoantibodies were particularly marked in those with the highest burden of GI disease.

Conclusion

There is a significant burden of SSc-GI disease in patients with SSc; reflux and bloating symptoms are most prominent. SSc hallmark antibodies may predict increased risk of SSc-GI disease, in particular ACA and ARA, while PM-Scl may be protective.
Mapping the ‘funny bone’: neuroanatomical correlates of humor creativity in professional comedians
Authors: Brawer Jacob , Amir Ori
Published: April 2021

What are the neuroanatomical correlates of expertise in a specific creative domain? Professional comedians, amateurs and controls underwent a T1 MRI anatomical scan. Measures of cortical surface area (gyrification and sulcal depth) and thickness were extracted for each participant. Compared to controls, professional comedians had a greater cortical surface area in the left inferior temporal gyrus, angular gyrus, precuneus and right medial prefrontal cortex. These regions have been previously implicated in abstract, divergent thinking and the default-mode network. The high degree of overlap between the regions of greater surface area in professional comedians with the regions showing greater activation in the same group during comedy improvisation in our previous work (particularly the temporal regions and angular gyrus) suggests that these regions may be specifically involved in humor creativity.
Spatial divisions of poverty and wealth: does segregation affect educational achievement?
Authors: Otero Gabriel , Carranza Rafael , Contreras Dante
Published: April 2021

We examine how different spatial compositions affect the educational achievement in mathematics of 16-year-old students in Chile, a Latin American country with high inequality and one of the most segregated education systems in the world. Conceptually, we complement the literature on ‘neighbourhood effects’, which typically addresses the influence of concentrated disadvantage, by focusing on concentrated advantage and its influence on educational outcomes. We construct a panel with all school students who took a national standardized mathematics test in 2010, 2014 and 2016 in the Metropolitan Region of Santiago, Chile. We complement it with survey data for the 52 districts of the Metropolitan Region, clustering the districts based on factors such as unemployment, economic inequality, access to services, experiences of violence and stigmatization. Our different identification strategies consistently show that concentrated poverty and affluence are both relevant for explaining educational achievement in mathematics above and beyond individual and school characteristics.
Engaging Physicians in Quality Improvement in a Hospital Setting
Authors: Mahbooba Zahra , Chera Bhisham , Evarts Lori
Published: April 2021

Health care is at a critical moment. High rates of medical errors and decreasing quality of health care make it crucial that organizations focus on quality improvement (QI). For this work to be successful, it is essential to engage physicians, as they are key decision-makers, leaders, and influencers of care. Despite this fact, few organizations have successfully sustained physician engagement in QI. A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to understand barriers to and strategies for engaging physicians in QI. The most commonly cited strategies were: (1) having engaged and supportive senior leadership and (2) having data support for QI work. Additional strategies included: dedicated time, resources, and education for QI work; financial incentives; clarifying organizational goals; and developing pathways for promotion. A framework was then created to operationalize physician engagement in QI in the organization.
Incidence and Clinical Impact of Myocardial Injury Following Traumatic Brain Injury: A Pilot TRACK-TBI Study
Authors: Krishnamoorthy Vijay , Manley Geoffrey T. , Jain Sonia , Sun Shelly , Foreman Brandon , Komisarow Jordan , Laskowitz Daniel T. , Mathew Joseph P. , Hernandez Adrian , James Michael L. , Vavilala Monica S. , Markowitz Amy J. , Korley Frederick K. ,   the TRACK-TBI Investigators
Published: April 2021

Background:

Traumatic brain injury (TBI) is a major global health problem. Little research has addressed extracranial organ dysfunction following TBI, particularly myocardial injury. Using a sensitive marker of myocardial injury—high sensitivity troponin (hsTn)—we examined the incidence of early myocardial injury following TBI and explored its association with neurological outcomes following moderate-severe TBI.

Methods:

We conducted a pilot cohort study of 133 adult (age above 17 y) subjects enrolled in the TRACK-TBI 18-center prospective cohort study. Descriptive statistics were used to examine the incidence of myocardial injury (defined as hsTn >99th percentile for a standardized reference population) across TBI severities, and to explore the association of myocardial injury with a 6-month extended Glasgow Outcome Score among patients with moderate-severe TBI.

Results:

The mean (SD) age of the participants was 44 (17) years, and 87 (65%) were male. Twenty-six patients (20%) developed myocardial injury following TBI; myocardial injury was present in 15% of mild TBI patients and 29% of moderate-severe TBI patients (P=0.13). Median (interquartile range) hsTn values were 3.8 ng/L (2.1, 9.0), 5.8 ng/L (4.5, 34.6), and 10.2 ng/L (3.0, 34.0) in mild, moderate, and severe TBI participants, respectively (P=0.04). Overall, 11% of participants with moderate-severe TBI and myocardial injury experienced a good outcome (6-mo extended Glasgow Outcome Score≥5) at 6 months, compared with 65% in the group that did not experience myocardial injury (P=0.01).

Conclusions:

Myocardial injury is common following TBI, with a likely dose-response relationship with TBI severity. Early myocardial injury was associated with poor 6-month clinical outcomes following moderate-severe TBI.
DDIT4 mediates the proliferation-promotive effect of IL-34 in human monocytic leukemia cells
Authors: Lv Xiaoqian , Hu Yuting , Wang Lina , Zhang Dongyue , Wang Hao , Dai Yibo , Cui Xiaoxi , Zheng Guoguang
Published: April 2021

Interleukin 34 (IL-34) is a cytokine that shares the receptor with colony-stimulating factor 1 (CSF-1). IL-34 is involved in a broad range of pathologic processes including cancer. We previously demonstrated that IL-34 promoted the proliferation and colony formation of human acute monocytic leukemia (AMoL) cells. However, the mechanism has not been elucidated. Here, by analyzing the gene profiles of Molm13 and THP1 cells overexpressing IL-34 (Molm13-IL-34 and THP1-IL-34), upregulation of the DNA damage-inducible transcript 4 (DDIT4) was detected in both series. Knockdown of DDIT4 effectively inhibited the proliferation, promoted apoptosis and colony formation in Molm13-IL-34 and THP1-IL-34 cells. Our results suggest that DDIT4 mediates the proliferation-promotive effect of IL-34 whereas does not mediate the promotive effect of IL-34 on colony formation in AMoL cells.
Communicating Spiritual Care in the Electronic Health Record
Authors: Burkhart Lisa , Coglianese Marie , Kaelin Jerry , Moorhead Sue , Joyce Cara
Published: April 2021

Chaplains must document their ministry of care in electronic health records that primarily focus on the physical dimension of care. Creating chaplain documentation that reflects the spiritual dimension of care requires chaplains to participate in the screen design. This article describes how chaplain documentation was designed and refined using psychometric methods. The resulting system successfully supported chaplain workflow, provided an ability to aggregate chaplain workload, and integrated the chaplain into the interprofessional team by structuring, linking, and sharing both the chaplain and nursing assessment of spiritual distress in the electronic health record. Documentation used 5-point Likert scales to measure different dimensions of patient spirituality. Reliability and validity were further evaluated as part of a workshop at an Association of Professional Chaplains annual meeting. Findings supported interrater reliability and the ability to predict and discriminate change pre and post encounter. Documentation screen content is presented.
Misclassification of Aggressive Basal Cell Carcinoma Subtypes and Implications for Management
Authors: Moon Deborah , Randall Grant , Higgins Shauna , Sutton Adam V. , Wysong Ashley
Published: April 2021

BACKGROUND

Management of basal cell carcinoma (BCC) varies by histopathologic subtype; however, biopsies may inadequately characterize them as nonaggressive, risking potential suboptimal treatment.

OBJECTIVE

To characterize the rate of undetected aggressive BCC subtypes by size, location, and histopathology type.

MATERIALS AND METHODS

Retrospective cohort study of 928 BCCs treated with Mohs Micrographic Surgery (MMS) at a tertiary academic institution from 2015 to 2017, comparing patient and tumor characteristics and histopathologic subtype on biopsy versus Mohs.

RESULTS

Among the 825 BCCs with known subtypes on biopsy, 68% (561/825) were classified as nonaggressive, 28% (159/561) of which were subsequently found to have aggressive subtypes on MMS. Aggressive features were more often underrepresented in biopsy samples taken from Area H compared with Area M/L (odd ratio [OR] 2.65, 95% confidence interval [CI] 1.73–4.08, p < .001) or those with nodular subtypes (OR 2.19, CI 1.08–4.45, p = .03). Of concern, these unsuspected aggressive BCCs required more Mohs stages for clearance (mean 2.37, SD 0.72, p < .001) compared with BCCs that remained nonaggressive on both biopsy and Mohs (mean 1.50, SD 0.75).

CONCLUSION

Given the high percentage of BCCs with unsuspected aggressive subtypes, higher clinical suspicion for undiagnosed high-risk BCCs should be given to nodular BCCs and to BCCs on Area H.
Effect of an educational intervention on women's healthcare provider knowledge gaps about breast density, breast cancer risk, and screening
Authors: Seitzman Robin L. , Pushkin JoAnn , Berg Wendie A.
Published: April 2021

Objectives:

We sought to assess the effect of an educational intervention, based on DenseBreast-info.org website content, on women's healthcare provider knowledge of breast density, its risk and screening implications, and comfort level discussing these topics with patients.

Methods:

US-based women's healthcare providers participated in a web-based pretest/posttest study from May 14, 2019 to September 30, 2019. Pretest included demographics; comfort/knowledge discussing breast density impact on risk and screening; and educational material. Posttest contained the same knowledge and comfort questions. We assessed mean pretest/posttest score and comfort level differences (paired t tests) and pretest/posttest knowledge gap differences (McNemar test). We evaluated associations of baseline characteristics with pretest score and score improvement using multiple linear regression, and associations with knowledge gaps using logistic regression.

Results:

Of 177 providers analyzed, 74.0% (131/177) were physicians and 71.8% (127/177) practiced obstetrics/gynecology. Average test score increased from 40.9% (5.7/14) responses correct pretest to 72.1% (10.1/14) posttest (P < 0.001). Pretest, 56.5% (100/177) knew women with extremely dense breasts have four-to-six-fold greater breast cancer risk than those with fatty breasts; 29.4% (52/177) knew risk increases with increasing glandular tissue; only 5.6% (10/177) knew 3D/tomosynthesis does not improve cancer detection in extremely dense breasts over 2D mammography; and 70.6% (125/177) would consider supplemental ultrasound after mammography in an average-risk 50-year old with dense breasts. Postintervention, these knowledge gaps resolved or reduced (all P < 0.005) and comfort in discussing breast density implications increased (all P < 0.001).

Conclusions:

Important knowledge gaps about implications of breast density exist among women's healthcare providers, which can be effectively addressed with web-based education.

Video Summary:
http://links.lww.com/MENO/A753.
A core outcome set for vasomotor symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative
Authors: Lensen Sarah , Archer David , Bell Robin J. , Carpenter Janet S. , Christmas Monica , Davis Susan R. , Giblin Karen , Goldstein Steven R. , Hillard Tim , Hunter Myra S. , Iliodromiti Stamatina , Jaisamrarn Unnop , Joffe Hadine , Khandelwal Sunila , Kiesel Ludwig , Kim Bobae V. , Lambalk Cornelis B. , Lumsden Mary Ann , Maki Pauline M. , Nappi Rossella E. , Panay Nick , Roberts Helen , Shifren Jan , Simon James A. , Vincent Amanda , Wolfman Wendy , Hickey Martha
Published: April 2021

Objective:

Vasomotor symptoms (VMS) (hot flashes and night sweats) affect most women over the menopause transition. Comparing the safety and effectiveness of treatments for vasomotor symptoms is limited by the use of inconsistent outcome measures, and uncertainty as to which outcomes are most important to symptomatic women. To address this, we have developed a Core Outcome Set (COS) for use in clinical trials of treatments for VMS.

Methods:

We systematically reviewed the primary outcomes measured in randomized controlled trials of treatments for VMS. These were refined and entered into a two-round modified Delphi survey completed by clinicians, researchers, and postmenopausal women between November 2019 and March 2020. Outcomes were scored on a nine-point scale from “not important” to “critically important.” Two international consensus meetings were held to finalize the COS.

Results:

Based on the systematic review, 13 separate outcomes were included in the Delphi process. This was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to categorize importance scores obtained during Round 2 of the Delphi survey. These informed discussions at the consensus meetings which were attended by 56 participants from 28 countries. The final COS includes six outcomes: 1) frequency of VMS, 2) severity of VMS, 3) distress, bother or interference caused by VMS, 4) impact on sleep, 5) satisfaction with treatment, and 6) side-effects of treatment.

Conclusion:

Implementation of this COS will: better enable research studies to accurately reflect the joint priorities of postmenopausal women, clinicians and researchers, standardize outcome reporting, and facilitate combining and comparing results from different studies, and ultimately improve outcomes for women with bothersome VMS.

Video Summary:

http://links.lww.com/MENO/A763.
Antibiotic Safety and Effectiveness in Premature Infants With Complicated Intraabdominal Infections
Authors: Smith Michael J. , Boutzoukas Angelique , Autmizguine Julie , Hudak Mark L. , Zinkhan Erin , Bloom Barry T. , Heresi Gloria , Lavery Adrian P. , Courtney Sherry E. , Sokol Gregory M. , Cotten C. Michael , Bliss Joseph M. , Mendley Susan , Bendel Catherine , Dammann Christiane E. L. , Weitkamp Jörn-Hendrik , Saxonhouse Matthew A. , Mundakel Gratias T. , Debski Julie , Sharma Gaurav , Erinjeri Jinson , Gao Jamie , Benjamin Daniel K. , Hornik Christoph P. , Smith P. Brian , Cohen-Wolkowiez Michael ,   on behalf of the Best Pharmaceuticals for Children Act—Pediatric Trials Network Steering Committee
Published: April 2021

Background:

In premature infants, complicated intraabdominal infections (cIAIs) are a leading cause of morbidity and mortality. Although universally prescribed, the safety and effectiveness of commonly used antibiotic regimens have not been established in this population.

Methods:

Infants ≤33 weeks gestational age and <121 days postnatal age with cIAI were randomized to ≤10 days of ampicillin, gentamicin, and metronidazole (group 1); ampicillin, gentamicin, and clindamycin (group 2); or piperacillin-tazobactam and gentamicin (group 3) at doses stratified by postmenstrual age. Due to slow enrollment, a protocol amendment allowed eligible infants already receiving study regimens to enroll without randomization. The primary outcome was mortality within 30 days of study drug completion. Secondary outcomes included adverse events, outcomes of special interest, and therapeutic success (absence of death, negative cultures, and clinical cure score >4) 30 days after study drug completion.

Results:

One hundred eighty infants [128 randomized (R), 52 nonrandomized (NR)] were enrolled: 63 in group 1 (45 R, 18 NR), 47 in group 2 (41 R, 6 NR), and 70 in group 3 (42 R, 28 NR). Thirty-day mortality was 8%, 7%, and 9% in groups 1, 2, and 3, respectively. There were no differences in safety outcomes between antibiotic regimens. After adjusting for treatment group and gestational age, mortality rates through end of follow-up were 4.22 [95% confidence interval (CI): 1.39–12.13], 4.53 (95% CI: 1.21–15.50), and 4.07 (95% CI: 1.22–12.70) for groups 1, 2, and 3, respectively.

Conclusions:

Each of the antibiotic regimens are safe in premature infants with cIAI.

Clinical Trial Registration:

NCT0199499
Clinical Characteristics of Patients With Kawasaki Disease Whose Siblings Had the Same Disease
Authors: Hayashida Kanako , Ae Ryusuke , Masuda Hiroya , Kosami Koki , Matsumura Masami , Makino Nobuko , Matsubara Yuri , Sasahara Teppei , Nakamura Yosikazu
Published: April 2021

Background:

Some patients with Kawasaki disease (KD) have siblings who developed the same disease. Using a large-scale epidemiologic dataset, the present study aimed to determine the clinical characteristics of this population.

Methods:

We analyzed 89,725 patients diagnosed with KD during 2011–2018 who were registered in the nationwide Japanese KD survey database. Multivariable logistic regression analyses were performed to determine factors associated with sibling history of KD.

Results:

Of the 89,725 patients, 1777 (2%) had sibling history of KD. Annual prevalence ranged from 1.5% to 2.3% during the study period and showed a tendency toward an increasing trend. Patients with recurrent KD and parental history of KD were significantly associated with sibling history of KD (adjusted odds ratio [95% confidence interval] = 2.15 [1.82–2.54] and 2.64 [2.02–3.47], respectively). Although patients with a sibling history of KD were significantly associated with initial intravenous immunoglobulin treatment resistance (1.14 [1.02–1.28]), no significant association was found between sibling history and coronary artery abnormality development. Among patients with a sibling history of KD, male patients were less likely to have recurrent KD than female patients (0.68 [0.49–0.96]).

Conclusions:

The significant association between sibling history and parental history may indicate genetic susceptibility to KD onset. Among those with a sibling history, recurrent KD was more likely to occur in female patients. Further studies focusing on this population may contribute toward identification of the cause of KD onset.
Infective Endocarditis in Children in Queensland, Australia
Authors: Mahony Michelle , Lean David , Pham Lily , Horvath Robert , Suna Jessica , Ward Cameron , Veerappan Sundar , Versluis Kathryn , Nourse Clare
Published: April 2021

Background:

Infective endocarditis (IE) is a rare entity in children associated with significant morbidity and mortality. To optimize management, it is important to understand local epidemiology, risk factors, clinical features and outcome. These are investigated in this retrospective 10-year study of endocarditis in children in Queensland.

Methods:

Children <18 years with IE were identified from the state-wide pediatric cardiology center (Mater Children’s Hospital, 2009–2014; Queensland Children’s Hospital, 2014–2018) through International Classification of Diseases codes and local cardiology database. Clinical records were assessed by a clinician and echocardiograms by a cardiologist. Incidence was calculated using Australian Bureau of Statistics Queensland Estimated Resident Population data, 2019.

Results:

Fifty-one children were identified, with an overall estimated incidence of 0.84 per 100,000 per year; 0.69 per 100,000 in 2009–2013 and 0.99 per 100,000 in 2014–2018, respectively. Twenty-four (47.1%) children were male and 10 (19.6%) were identified as Aboriginal or Torres Strait Islander peoples. Underlying cardiac conditions were present in 29 (56.9%): 25 congenital heart disease, 3 rheumatic heart disease and 1 cardiomyopathy. A causative pathogen was identified in 46 (90.2%) children with Staphylococcus aureus most common. Thirty-six (70.6%) met criteria for “Definite IE” as per modified Duke criteria, with the remainder “Possible IE.” Surgery was required in 26 (51%). Median duration of antibiotics was 42 (interquartile range = 32–51) days and hospitalization 49 (interquartile range = 34–75) days. One child died due to IE.

Conclusions:

IE in children in Queensland is increasing in incidence and is higher than the reported incidence in New Zealand and the United States. Congenital heart disease is the most common risk factor and S. aureus is the commonest responsible organism. Aboriginal or Torres Strait Islander children are over-represented. Mortality remains low.
Strengthening the Acute Care Curriculum
Authors: Sabatke Megan J. , Young Ashley M. , Johnson Audrey M. , Darbee Joan , Mayer Kirby P.
Published: April 2021

Objective:

The purpose of this study was to describe the effect of acute care curriculum changes on a university's doctor of physical therapy (DPT) graduates by aggregating quantitative data from 2 academic surveys.

Methods:

This was a retrospective study describing physical therapist students' perspective, confidence, and employment in acute care physical therapy using data from 2 academic surveys administered to graduates from a DPT program.

Results:

From 2010 to 2018, 569 students graduated from the DPT program with a median of 100% (interquartile range 97%-100.5%) response rate for the self-assessment survey and a median of 38% (interquartile range 33%-48%) completion of the graduate outcome survey. The majority of DPT graduates self-reported being at or above expected level of competence with cardiopulmonary and complex patients, which appeared to increase from 77.4% and 88.7% in 2012 to 97% and 100% in 2018, respectively. Similar increasing trends were noted with the number of first jobs in the acute care setting (+5.4%) and interest (+9.1%) in the acute care setting, but not as consistently. DPT graduates' level of comfort in the acute care setting did not change over time.

Conclusions:

Curricular changes devised to enhance acute care physical therapy training in a program's DPT curriculum may have led to graduates reporting increased competency in the unique skill set needed to work in this setting. DPT programs require the continued assessment of educational requirements and competencies to fulfill the growing need for physical therapists in the acute care setting.
The Effect of Blue-enriched White Light on Cognitive Performances and Sleepiness of Simulated Shift Workers
Authors: Song Yanping , Lv Xinrui , Qin Wei , Dang Weimin , Chen Zhizhong , Nie Jingxin , Liu Baohua , Dong Wentian
Published: April 2021

Background:

Shift work is associated with reduced performance and efficiency, the current study aimed at investigating whether blue-enriched white light could improve workers’ performance.

Methods:

The study, which adopted a randomized controlled trial, was conducted among 48 simulated shift workers. The participants performed sustained attention task, working memory task, and sleepiness task during night shift work. The data was analyzed using two-way repeated measure ANOVA.

Results:

The results indicated that, compared to conventional light, participants’ correct responses of the sustained attention significantly increased when they were exposed to blue-enriched white light, correspondingly, the commission errors and omission errors declined. Furthermore, the blue-enriched white light had a significant effect on the decrease of sleepiness. However, the working memory was not significantly affected.

Conclusion:

Exposing to blue-enriched white light can improve sustained attention and reduce sleepiness.
National Institutes of Health Advancing Multimorbidity Research
Authors: Salive Marcel E. , Suls Jerry , Farhat Tilda , Klabunde Carrie N.
Published: April 2021

Background:

Multimorbidity, the co-occurrence of 2 or more chronic diseases, is more common than having a single chronic disease, especially among persons age 65 years and older. The routine measurement of multimorbidity can facilitate a better understanding of potential causes and interactions and promote more effective treatment and improved outcomes.

Objectives:

To present a multimorbidity research framework and identify gaps in the research literature related to multimorbidity.

Design:

In preparation for an expert panel workshop convened in September 2018, planning committee members reviewed the literature and developed a guiding framework that informed the selection of topics and speakers.

Results:

The framework, grounded in a patient-centered approach, incorporates the concept of concordant and discordant comorbidity, and includes potential causes, interactions, and outcomes. This work informed workshop presentations and discussion related to identifying and selecting the best available multimorbidity instruments and determining future research needs.

Conclusions:

Multimorbidity research can be advanced by addressing gaps in study design and target populations, and by increasing attention to universal outcome measurement.
Glycerol-3-phosphate and fibroblast growth factor 23 regulation
Authors: Simic Petra , Babitt Jodie L. , Rhee Eugene P.
Published: April 2021

Purpose of review

Both classical and nonclassical factors regulate fibroblast growth factor 23 (FGF23), with impacts on gene expression and proteolytic cleavage. Here, we review recent publications that extend current knowledge on these factors.

Recent findings

Emerging nonclassical FGF23 regulators such as erythropoietin cause a balanced increase in FGF23 expression and cleavage, with minimal or no increase in biologically active intact FGF23 (iFGF23) in blood. However, circulating FGF23 profiles may not reflect the bone marrow microenvironment. For example, granulocyte colony-stimulating factor increases local marrow iFGF23 levels without impacting circulating iFGF23 levels. The view that phosphate does not increase bone FGF23 production also warrants reconsideration, as phosphate can reduce iFGF23 cleavage and phosphate-containing calciprotein particles increase FGF23 expression. Finally, a screen of renal venous plasma identifies glycerol-3-phosphate as a kidney-derived molecule that circulates to bone and bone marrow, where it is converted to lysophosphatidic acid and signals through a G-protein coupled receptor to increase FGF23 synthesis.

FGF23 regulation is complex, requiring consideration of known and emerging stimuli, expression and cleavage, and circulating and local levels. Recent work identifies glycerol-3-phosphate as an FGF23 regulator derived from the injured kidney; whether it participates in FGF23 production downstream of classical or nonclassical factors requires further study.
The Nlrp3 inflammasome – the evolving story of its positive and negative effects on hematopoiesis
Authors: Ratajczak Mariusz Z. , Kucia Magdalena
Published: April 2021

Purpose of review

Hematopoiesis is co-regulated by innate immunity, which is an ancient evolutionary defense mechanism also involved in the development and regeneration of damaged tissues. This review seeks to shed more light on the workings of the Nlrp3 inflammasome, which is an intracellular innate immunity pattern recognition receptor and sensor of changes in the hematopoietic microenvironment, and focus on its role in hematopoieisis.

Recent findings

Hematopoietic stem progenitor cells (HSPCs) are exposed to several external mediators of innate immunity. Moreover, since hemato/lymphopoietic cells develop from a common stem cell, their behavior and fate are coregulated by intracellular innate immunity pathways. Therefore, the Nlrp3 inflammasome is functional both in immune cells and in HSPCs and affects hematopoiesis in either a positive or negative way, depending on its activity level. Specifically, while a physiological level of activation regulates the trafficking of HSPCs and most likely maintains their pool in the bone marrow, hyperactivation may lead to irreversible cell damage by pyroptosis and HSPC senescence and contribute to the origination of myelodysplasia and hematopoietic malignancies.

Modulation of the level of Nrp3 inflammasome activation will enable improvements in HSPC mobilization, homing, and engraftment strategies. It may also control pathological activation of this protein complex during HSPC senescence, graft-versus-host disease, the induction of cytokine storms, and the development of hematopoietic malignancies.
Eosinophilic Vacuolated Tumor of the Kidney: A Review of Evolving Concepts in This Novel Subtype With Additional Insights From a Case With MTOR Mutation and Concomitant Chromosome 1 Loss
Authors: Kapur Payal , Gao Ming , Zhong Hua , Rakheja Dinesh , Cai Qi , Pedrosa Ivan , Margulis Vitaly , Xu Lin , Kinch Lisa , Brugarolas James
Published: April 2021

Recent advances in molecular genetics have expanded our knowledge of renal tumors and enabled a better classification. These studies have revealed that renal tumors with predominantly “eosinophilic/oncocytic” cytoplasm include several novel biological subtypes beyond the traditionally well-recognized renal oncocytoma and an eosinophilic variant of chromophobe renal cell carcinoma. Herein, we present a comprehensive review of the eosinophilic vacuolated tumor (EVT) building upon a case report including radiology, histopathology, electron microscopy, and next-generation sequencing. EVTs are characterized by mTORC1 activation. We speculate that loss of chromosome 1 in EVT with MTOR mutation may be driven in part by an advantage conferred by loss of the remaining MTOR wild-type allele. mTORC1 is best known for its role in promoting protein translation and it is interesting that dilated cisterns of rough endoplasmic reticulum (ER) likely account for the cytoplasmic vacuoles seen by light microscopy. We present an integrated view of EVT as well as cues that can assist in the differential diagnosis.
Validity and Diagnosis in Physical and Rehabilitation Medicine
Authors: Hassan Samah , Kumbhare Dinesh
Published: April 2021

Obtaining a diagnosis is an essential and integral part of physical and rehabilitation medicine in practice and research. Standardized psychometric properties are required of any classifications, diagnostic criteria, and diagnostic rules used. Physicians and researchers, in physical and rehabilitation medicine, need to understand these properties to determine the accuracy and consistency of their diagnosis. Although chronic musculoskeletal pain disorders are among the highly prevalent disorders seen in physical and rehabilitation medicine, limitations regarding existing diagnostic criteria for chronic musculoskeletal pain disorders still exist. Hence, the quest for developing diagnostic tools for chronic musculoskeletal pain that align with the standard properties remains open. These are discussed with an example for existing diagnostic criteria for fibromyalgia. This article primarily aimed to provide an overview of standard psychometric properties. A secondary aim was to critically appraise the tools currently used to diagnose chronic musculoskeletal pain disorders. The challenges and limitations of existing diagnostic tools are discussed. Potential approaches on how to improve the conceptualization of the construct of musculoskeletal pain disorders are also discussed. Adopting a network perspective, for example, can better constitute the disease instead of a single known underlying etiology for persistent or recurrent pain symptoms.
Specificity in Associations of Anger Frequency and Expression With Different Causes of Mortality Over 20 Years
Authors: Trudel-Fitzgerald Claudia , Reduron Laetitia R. , Kawachi Ichiro , Kubzansky Laura D.
Published: April 2021

Objective

Although evidence has linked anger and hostility with all-cause mortality risk, less research has examined whether anger frequency and expression (outwardly expressing angry feelings) are linked to all-cause and cause-specific mortality.

Methods

In 1996, men (n = 17,352) free of medical conditions from the Health Professionals Follow-Up Study reported anger frequency and aggressive expression levels. Deaths were ascertained from participants’ families, postal authorities, and death registries. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality risk until 2016 with a 2-year lag, adjusting for a range of relevant covariates.

Results

There were 4881 deaths throughout follow-up. After adjustment for sociodemographics and health status, moderate and higher (versus lower) levels of anger frequency and aggressive expression were generally unrelated to the risk of death from all-cause, neurological, or respiratory diseases. However, cardiovascular mortality risk was greater with higher anger frequency (HR = 1.17, 95% CI = 1.01–1.34), whereas cancer mortality risk was greater with higher anger expression (HR = 1.14, 95% CI = 0.98–1.33). Results were similar after including all covariates and stronger when considering anger expression’s interaction with frequency.

Conclusions

In this cohort of men, experiencing angry feelings and expressing them aggressively were related to an increased risk of dying from cardiovascular disease and cancer but not from other specific causes, over two decades. These results suggest that not only the experience of negative emotions but also how they are managed may be critical for some but not all health outcomes, highlighting the importance of considering causes of death separately when investigating psychosocial determinants of mortality.
Revisiting the Pericranial Flap for Scalp Reconstruction
Authors: Gishen Kriya , Yoo Jason , Plotsker Ethan , Thaller Seth R.
Published: April 2021

Soft tissue deficits of the scalp due to trauma, infection, or tumor resection present a unique challenge to the reconstructive surgeon whose goal is to achieve excellent cosmesis in a hair bearing area without compromising coverage. While extensive undermining for large rotation flaps or free tissue transfer can provide necessary coverage, the pericranial flap is an excellent alternative for less ideal surgical candidates who cannot tolerate more extensive interventions or for patients who require long-term cancer surveillance. Elevation of the pericranial flap limits the need for back cuts through the skin and uses blunt dissection to preserve overlying hair follicles. Here we present a review of the anatomy and historical use of the pericranial flap for scalp coverage and we present 4 cases to demonstrate its current utility.
Evolving role of minimally invasive techniques in the management of symptomatic bone metastases
Authors: Benhabib Hadas , Meirovich Harley , David Elizabeth
Published: April 2021

Purpose of review

Bone metastases are responsible for considerable morbidity, which can significantly limit a patient's quality of life. This article aims to review minimally invasive, image-guided locoregional treatments for symptomatic bone metastases as an adjunct to conventional treatment modalities.

Recent findings

Conservative therapy and radiation therapy (RT) can be effective at addressing pain, however, they require time to achieve optimal efficacy and do not address the instability and progressive collapse of pathological fractures. Vertebral and pelvic augmentation with cement enhances structural stability and can prevent progressive collapse and deformity. Ablative therapies, including radiofrequency ablation (RFA), cryoablation, and photodynamic therapy (PDT), induce cellular destruction of tumor tissue. RFA and PDT can be combined with cement augmentation in a single sitting.

Minimally invasive image-guided treatments can provide rapid pain relief, enhance mechanical stability, and improve quality of life. These treatments are associated with low complication rates and are suitable for frail patients. They can be used as companion procedures to conventional treatments, or function as an alternative for patients with radioresistant biologies or those with dose limitations from prior RT sessions.