bluuebunny/crossref_metadata_2025 huggingface dataset:
New Wine, Old Wineskins
Authors: Beal John
Published: January 2023

On 25 January 1959, Pope John XXIII announced that he was convoking an ecumenical council and commissioning a revision of the Code of Canon Law. The process of revising the 1917 Code of Canon Law began in earnest with the completion of the Second Vatican Council and culminated with the promulgation of a revised Code of Canon Law in 1983. In the Apostolic Constitution promulgating this code, John Paul II stated: ‘This new Code could be understood as a great effort to translate this same conciliar doctrine and ecclesiology into canonical language.’ The revised Code, as well as canonical legislation before and since, does represent a serious effort to incorporate into legal norms the ecclesiological teaching of Vatican II. However, in many areas, it is not entirely successful in giving shape to the communio ecclesiology that suffuses the conciliar documents. In some areas, such as the treatment of the sacraments, the translation is reasonably successful; in others, such as the treatment of the local Church, it is only partly successful; and in still others, such as penal law, evidence of the council is faint.
Expunged and Forgotten Texts and Messages of Vatican II
Authors: Melloni Alberto
Published: January 2023

After the conclusion of the council in 1965, many scholars, publishers, ecclesiastical opinion leaders, and bishops wrote their own commentaries on Vatican II. This literary genre was inclined to ignore what happened at the council and to concentrate on the decisions. In this way, many acts of the council were minimized or were simply ignored—even acts like the messages to the world at the beginning and end of Vatican II and the withdrawal of excommunications between Rome and Constantinople. Other crucial moves of the council were neglected or considered beyond the formal corpus of the documents of Vatican II. The most important of these is Gaudet Mater Ecclesia, the opening address of the council where John XXIII offered his hermeneutical views and expectations. But other steps—the first announcement of Vatican II, the signature of Paul VI—are also important keys to Vatican II: not as a machine producing decisions, but as an event creating an epochal turn in the history of the Roman Catholic Church.
The Ecclesiology of Vatican II
Authors: Gaillardetz Richard
Published: January 2023

Although the Second Vatican Council was mainly concerned with ecclesiology, one cannot find in the documents a single internally coherent fundamental theology of the Church. This is not surprising, given the challenges the council faced in its efforts to integrate the many ecclesiological developments that occurred in the first half of the twentieth century. However, a careful study of the documents, read in the light of the last six decades of the council’s reception, allows us to identify significant conciliar contributions to ecclesiology that coalesce around five themes: (1) the liturgico-sacramental foundation of the Church, (2) the Church’s Trinitarian origins and eschatological destiny, (3) the Church’s missionary nature, (4) the Church’s ecumenical commitment, and (5) the Church’s collegial exercise of authority.
Impact of engineering the ATP synthase rotor ring on photosynthesis in tobacco chloroplasts
Authors: Yamamoto Hiroshi , Cheuk Anthony , Shearman Julia , Nixon Peter J , Meier Thomas , Shikanai Toshiharu
Published: January 2023

The chloroplast ATP synthase produces the ATP needed for photosynthesis and plant growth. The trans-membrane flow of protons through the ATP synthase rotates an oligomeric assembly of c subunits, the c-ring. The ion-to-ATP ratio in rotary F1F0-ATP synthases is defined by the number of c-subunits in the rotor c-ring. Engineering the c-ring stoichiometry is, therefore, a possible route to manipulate ATP synthesis by the ATP synthase and hence photosynthetic efficiency in plants. Here, we describe the construction of a tobacco (Nicotiana tabacum) chloroplast atpH (chloroplastic ATP synthase subunit c gene) mutant in which the c-ring stoichiometry was increased from 14 to 15 c-subunits. Although the abundance of the ATP synthase was decreased to 25% of wild-type (WT) levels, the mutant lines grew as well as WT plants and photosynthetic electron transport remained unaffected. To synthesize the necessary ATP for growth, we found that the contribution of the membrane potential to the proton motive force was enhanced to ensure a higher proton flux via the c15-ring without unwanted low pH-induced feedback inhibition of electron transport. Our work opens avenues to manipulate plant ion-to-ATP ratios with potentially beneficial consequences for photosynthesis.
The art of shared decision making
Authors: Bingaman Luke
Published: January 2023

Now more than ever, we know that there is uncertainty in medicine. Over the past 2 years, we have witnessed the evolution of knowledge that occurs in medicine and how this informs medical recommendations. Similarly, we have learned that patients have varying levels of risk tolerance, goals, and values. Although this is not a new reality, the COVID-19 pandemic has put it on display. Shared decision making is a tool for clinicians to use that recognizes this reality, honors the individuality of each patient, and guides us to the best decision for each patient.
Which patient factors increase the risk of fluoroquinolone-associated reactions?
Authors: Warunek Letitia N. , Smith Susan M.
Published: January 2023

Fluoroquinolones commonly are used to treat a variety of infections in the urinary, gastrointestinal, and respiratory tracts. Clinicians should evaluate patients to ensure that a fluoroquinolone is a safe and effective therapy to treat the infection. This article discusses patient factors that increase the risk for serious adverse drug reactions that can occur with fluoroquinolone use.
The Silent Epidemic of Workplace Violence
Authors: Kirton Carl A.
Published: January 2023

Taking the next step in protecting health care workers.
Managing Older Adults' Chronic Pain: Lower-Risk Interventions
Authors: Arnstein Paul , Shade Marcia , Herr Keela A. , Young Heather M. , Fishman Scott M.
Published: January 2023

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.

This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
Spiritual Care as a Core Component of Palliative Nursing
Authors: Miller Megan , Addicott Katie , Rosa William E.
Published: January 2023

Spirituality is one aspect of the human experience that is unique to each person and may become especially important in the face of life-threatening illness. While evidence supports the need to address spirituality as part of holistic palliative care nursing, it is hoped that “spiritual care” will not become another item on nurses' to-do list, but rather will be part of nurses' everyday lives and nursing practice. Taking time to assess personal needs, and consciously connecting to meaning, hope, and peace, can support nurses' return to the deeper roots of nursing. Addressing spirituality as part of palliative nursing care can also acknowledge the complex and multidimensional experiences of the patients that nurses serve. Connecting, or reconnecting, with nurses' unique sense of spirituality can serve as a powerful resource for resilience. This article highlights the relevance of spiritual care to palliative nursing and offers practical tips to incorporate spiritual care into everyday nursing practice.
Automated Texting Program Reduces Use of Resources After Discharge
Authors: Rosenberg Karen
Published: January 2023

According to this study:

The use of an automated text message program to support primary care patients after hospital discharge is highly feasible and significantly reduces the use of acute care resources.

The program was highly acceptable to patients, most of whom responded to messages and gave it high satisfaction ratings.
The impact of systemic racism on health outcomes among Black women
Authors: James-Conterelli Sascha , Dunkley Daihnia , McIntosh Jennifer T. , Julien Tamika , Nelson Maurice D. , Richard-Eaglin Angela
Published: January 2023

Black women suffer disproportionately from healthcare inequities in comparison to their White counterparts. Using the Public Health Critical Race framework, this article explores the lasting effects of systemic racism on the health outcomes of Black women across the lifespan. A case study and specific strategies are presented to examine how clinicians, educators, and policymakers can work with Black women to mitigate and eliminate health inequities.
Comparison of clinical outcomes between anterior cruciate ligament reconstruction with over-the-top route procedure and anatomic single-bundle reconstruction in pediatric patients
Authors: Kamei Goki , Nakamae Atsuo , Nakata Kyohei , Nekomoto Akinori , Tsuji Shunya , Hashiguchi Naofumi , Ishikawa Masakazu , Adachi Nobuo
Published: January 2023

The purpose of this study is to evaluate the clinical results of over-the-top route (OTTR) reconstruction for pediatric anterior cruciate ligament (ACL) injuries and compare them with results of anatomic single-bundle reconstruction (SBR), which used the bone tunnel technique and was performed early after epiphyseal closure (age ≤15 years). This study included pediatric patients aged 11–15 years who underwent ACL reconstruction. The mean age at surgery was 13.4 years (11–15 years), including 14 men and 29 women. Operative procedures were determined according to growth plate closure. In all cases, the tibial side was reconstructed using a bone tunnel procedure. On the femoral side, we selected the OTTR procedure (group O) with open physis. Where the physis was closed, we selected the anatomical SBR (group B). The clinical results were evaluated with manual examination, the side-to-side difference (SSD) in tibial anterior translation using the Kneelax 3, and knee function score. There were no significant differences in the Lachman and pivot-shift tests, SSD in tibial anterior translation with Kneelax 3, or knee function score between the two groups before or after the surgery. Growth disturbance was not observed on either the femoral or tibial side in group O. The OTTR method provided comparable results with the bone tunnel anatomical method in manual examination, Kneelax 3, and knee clinical function scores, suggesting that the OTTR method is very useful for pediatric ACL reconstructions. Level of evidence: III; retrospective study.
Angiopoietin-Like4 Is a Novel Marker of COVID-19 Severity
Authors: Bhatraju Pavan K. , Morrell Eric D. , Stanaway Ian B. , Sathe Neha A. , Srivastava Avantika , Postelnicu Radu , Green Richard , Andrews Adair , Gonzalez Martin , Kratochvil Christopher J. , Kumar Vishakha K. , Hsiang Tien-Ying , Gale Michael , Anesi George L. , Wyles David , Broadhurst M. Jana , Brett-Major David , Mukherjee Vikramjit , Sevransky Jonathan E. , Landsittel Douglas , Hung Chi , Altemeier William A. , Gharib Sina A. , Uyeki Timothy M. , Cobb J. Perren , Liebler Janice M. , Crosslin David R. , Jarvik Gail P. , Segal Leopoldo N. , Evans Laura , Mikacenic Carmen , Wurfel Mark M.
Published: January 2023

IMPORTANCE:

Vascular dysfunction and capillary leak are common in critically ill COVID-19 patients, but identification of endothelial pathways involved in COVID-19 pathogenesis has been limited. Angiopoietin-like 4 (ANGPTL4) is a protein secreted in response to hypoxic and nutrient-poor conditions that has a variety of biological effects including vascular injury and capillary leak.

OBJECTIVES:

To assess the role of ANGPTL4 in COVID-19–related outcomes.

DESIGN, SETTING, AND PARTICIPANTS:

Two hundred twenty-five COVID-19 ICU patients were enrolled from April 2020 to May 2021 in a prospective, multicenter cohort study from three different medical centers, University of Washington, University of Southern California and New York University.

MAIN OUTCOMES AND MEASURES:

Plasma ANGPTL4 was measured on days 1, 7, and 14 after ICU admission. We used previously published tissue proteomic data and lung single nucleus RNA (snRNA) sequencing data from specimens collected from COVID-19 patients to determine the tissues and cells that produce ANGPTL4.

RESULTS:

Higher plasma ANGPTL4 concentrations were significantly associated with worse hospital mortality (adjusted odds ratio per log2 increase, 1.53; 95% CI, 1.17–2.00; p = 0.002). Higher ANGPTL4 concentrations were also associated with higher proportions of venous thromboembolism and acute respiratory distress syndrome. Longitudinal ANGPTL4 concentrations were significantly different during the first 2 weeks of hospitalization in patients who subsequently died compared with survivors (p for interaction = 8.1 × 10–5). Proteomics analysis demonstrated abundance of ANGPTL4 in lung tissue compared with other organs in COVID-19. ANGPTL4 single-nuclear RNA gene expression was significantly increased in pulmonary alveolar type 2 epithelial cells and fibroblasts in COVID-19 lung tissue compared with controls.

CONCLUSIONS AND RELEVANCE:

ANGPTL4 is expressed in pulmonary epithelial cells and fibroblasts and is associated with clinical prognosis in critically ill COVID-19 patients.
Use of Aerosolized Prostacyclins in Critically Ill Patients and Association With Clinical Outcomes
Authors: Hussain S. Talal , Jaliawala Huzaifa A. , Zhao Daniel , Ijaz Sardar Hassan , Tsui Janice , Chasteen Bobby , Brown Brent R. , Bernardo Roberto J.
Published: January 2023

IMPORTANCE:

Aerosolized prostacyclins are frequently used in patients with severe acute respiratory distress syndrome and refractory hypoxia. Previous studies have shown improvement in oxygenation with use of pulmonary vasodilators such as iloprost and epoprostenol; however, there is no head-to-head comparison between these agents.

OBJECTIVES:

To compare the effects of inhaled epoprostenol and inhaled iloprost in critically ill patients with refractory hypoxia.

DESIGN, SETTING, AND PARTICIPANTS:

We performed a retrospective cohort analysis of patients admitted to the ICUs at the University of Oklahoma Health Sciences Center between 2015 and 2018. Adult patients who received aerosolized epoprostenol or iloprost for more than 4 hours were included in the analysis.

MAIN OUTCOMES AND MEASURES:

The primary endpoint measured was to compare the change in Pao
2/Fio
2 ratio between patients treated with iloprost compared with epoprostenol. Secondary outcomes measured were 90-day in-hospital mortality and improvement in vasopressor requirements.

RESULTS:

A total of 126 patients were included in the study, 95 of whom received iloprost (75%) and 31 patients (25%) received epoprostenol. There were significant improvements in Pao
2/Fio
2 ratio in both the iloprost and epoprostenol group. Patients in the epoprostenol group appeared to have a higher 90-day mortality compared with the iloprost group. However, our study was not powered to detect a mortality difference and this finding likely represents a sicker population in the epoprostenol group and prescription bias. The use of iloprost was associated with higher vasopressor requirements in the first 12 hours of administration, an association was not observed in the epoprostenol group.

CONCLUSIONS AND RELEVANCE:

In this retrospective cohort analysis, use of both pulmonary vasodilators was associated with similar improvement in gas exchange. The mortality difference observed likely represents difference in severity of illness. Further studies are needed to corroborate these findings.
An Unusual Case of BSND Gene–Related (Type IV) Bartter Syndrome Presenting as Antenatal Bartter Syndrome: A Case Report and Review of Literature
Authors: Shajan Aleena M. , Kumar Manish , Navaneethan Preethi , Danda Sumita , Beck Manisha M.
Published: January 2023

Bartter syndrome is a group of autosomal recessive renal tubular disorders; it has two types of presentation: antenatal and classic. The antenatal type presents as severe unexplained polyhydramnios in the second trimester. This is due to fetal urinary losses of sodium, chloride, and potassium, leading to fetal polyuria. The classic type presents in the late neonatal or infancy stage, with dehydration, dyselectrolytemia, failure to thrive, and nephrocalcinosis. Antenatal scans are normal in such cases. Type I and II Bartter syndrome presents in the antenatal period, whereas type IV has a classic presentation. We describe an unusual case of type IVa Bartter syndrome presenting in the antenatal period, with severe polyhydramnios. The initial diagnosis was made based on amniotic fluid chloride levels and later confirmed by performing a genetic test. Genetic testing is important for confirming diagnosis and prognostication regarding the condition.
Pharmacokinetic-Interactions of BI 425809, a Novel Glycine Transporter 1 Inhibitor, With Cytochrome P450 and P-Glycoprotein Substrates
Authors: Desch Michael , Schlecker Christina , Hohl Kathrin , Liesenfeld Karl-Heinz , Chan Tom , Müller Fabian , Wunderlich Glen , Keller Sascha , Ishiguro Naoki , Wind Sven
Published: January 2023

Purpose/Background

Glycine transporter-1 inhibitors may ameliorate cognitive deficits in schizophrenia. This study evaluated potential drug-drug interactions with the glycine transporter-1 inhibitor BI 425809.

Methods/Procedures

Interactions with cytochromes P450 (CYP) and P-glycoprotein (P-gp) were assessed in in vitro assays using human hepatocytes and Caco-2 cells, respectively. Pharmacokinetic characteristics of probe drugs were subsequently assessed in a Phase I, open-label, single-sequence crossover study in healthy male participants. Participants received a probe-drug cocktail containing midazolam (CYP3A4), warfarin (CYP2C9), and omeprazole (CYP2C19) and a separate dose of digoxin (P-gp), alone and on a background of steady-state BI 425809 25 mg once daily in 2 treatment periods. Adverse events were monitored.

Findings/Results

In vitro assays revealed concentration-dependent induction of CYP3A4 and inhibition of P-gp by BI 425809. In the clinical study, 12 of 13 participants completed both periods. With BI 425809, area under the plasma concentration curve from administration to the last measurement (AUC0–tz) and maximum plasma concentration (C
max) for midazolam were lower than when administered alone. Adjusted geometric mean ratios (90% confidence interval) were 70.6% (63.9%–78.1%) for AUC0–tz and 77.6% (67.3%–89.4%) for C
max. For warfarin and digoxin, AUC0–tz and C
max were similar with and without BI 425809. For omeprazole, BI 425809 slightly reduced AUC0–tz but not C
max versus omeprazole alone. No new safety signals were identified.

Implications/Conclusions

These findings indicate induction of CYP3A4 by once-daily BI 425809 25 mg (the assumed highest therapeutic dose) and no meaningful effects on CYP2C9, CYP2C19, or P-gp in vivo.
Integrative medicine (East Asian herbal medicine combined with conventional medicine) for psoriasis: A protocol for systematic review and meta-analysis
Authors: Kim Hyehwa , Jo Hee-Geun , Hwang Ji-Hye , Lee Donghun
Published: January 2023

Background:

Psoriasis is a chronic, inflammatory, autoimmune skin disease. The aim of this review is to systematically evaluate the efficacy and safety of integrative medicine (East Asian herbal medicine combined with conventional medicine) used to treat inflammatory skin lesions of psoriasis.

Methods:

A comprehensive literature search will be conducted in 3 English databases (PubMed, Cochrane Library, and Embase), 4 Korean databases (Korean Studies Information Service System, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, and Korea Citation Index), 2 Chinese databases (Chinese National Knowledge Infrastructure Database and Wanfang data), and 1 Japanese database (Citation Information by National Institute of Informatics) for randomized controlled trials from their inception until July 29, 2021. Statistical analysis will be performed usingRversion 4.1.2 and the R studio program using the default settings of the “meta” and “metafor” packages. The primary outcome will be an improvement in the psoriasis area severity index. All outcomes will be analyzed using a random-effects model to produce more statistically conservative results. If heterogeneity is detected in the study, the cause will be identified through sensitivity, meta-regression, and subgroup analyses. Methodological quality will be assessed independently using the revised tool for the risk of bias in randomized trials, version 2.0. The overall quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation pro framework.

Results:

This study will review all available trials on the same subject and arrive at a more statistically robust conclusion based on a sufficient sample size of participants and additional analysis using data mining techniques will be performed on intervention prescription information in clinical studies collected according to rigorous criteria.

Conclusion:

We believe that this study will provide useful knowledge on managing inflammatory skin lesions of psoriasis vulgaris using integrative medicine using East Asian herbal medicine.
High-frequency plasma exchange therapy for immunocompromised, type I crescentic glomerulonephritis complicated with IgA nephropathy: A case report and literature review
Authors: Chen Huihui , Jin Jingjing , Cheng Mei Juan , He Lei , Zhou Wei , Guo Liping , Niu Zhe Zhe , Liang Xiang Nan , Zhu Rong Fang , Bai Yaling , Xu Jin Sheng
Published: January 2023

Rationale:

Anti-glomerular basement membrane (anti-GBM) disease has been reported to coexist with other immune-mediated glomerular disorders, including antineutrophil cytoplasmic autoantibody positive glomerulonephritis and membranous glomerulopathy. It is well known that anti-GBM disease often manifests as type I crescentic glomerulonephritis on renal biopsy. However, concurrent cases of both type I crescentic glomerulonephritis and IgA nephropathy are rare.

Patient concerns:

We report the case of a 40-years-old woman with microscopic hematuria, mild proteinuria and an immunocompromised status. Laboratory data revealed serum creatinine showed progressive progress, suddenly rising from the normal range to 316.2μmol/L within 4 months. The CD4 lymphocyte count was 0.274 × 109/L (reference value 0.35–1.82 × 109/L). The anti-GBM antibody titer was 192.4 IU/mL (reference range: <20 RU/mL).

Diagnoses:

Renal biopsy was performed after admission. The pathological diagnosis was type I crescentic glomerulonephritis, IgA nephropathy, and clinical anti-GBM disease.

Interventions:

The patient was seriously ill on admission and progressed rapidly. Combined with poor immune function, we immediately initiated high-frequency plasma exchange (PE). In addition, to avoid rebound of antibody levels, PE was performed for 5 times. Follow-up treatment was combined with standard-dose corticosteroids and cyclophosphamide.

Outcomes:

The patient was followed up for 1 year. On the last visit, her serum creatinine decreased to 103.5μmol/L, anti-GBM antibody remained negative, and proteinuria and hematuria disappeared.

Lessons:

This case illustrates that when crescentic nephritis or anti-GBM disease is combined with other immune diseases, especially when the immune function is extremely low, if the application of high-dose steroid shocks may induce fatal infections, to some extent high frequency PE has certain advantages.
“Unaware and Unprepared”
Authors: Wells Celia , Bressler Toby
Published: January 2023

Modern health care delivery incorporates technology to prolong life for those with serious illnesses. As technology continues to advance, the critical care nurses’ role particularly at the end of life (EOL) continues to evolve, requiring higher levels of care. This contributes to an already complex environment for nurses to practice. The aim of this study was to explore the experiences of critical care nurses in providing care for patients at EOL. This qualitative descriptive study describes the experience of 216 critical care nurses across the United States. Content analysis illuminated 5 themes: We Can’t Fix Everyone, Task-Oriented Nursing, A Profession of Broken Individuals, Unaware and Unprepared, and A Hand to Hold. Study findings provide a unique perspective of critical care nurses and the health care delivery for patients and families at EOL. This study supports the imperative of creating and sustaining healthy work environments and palliative care education as essentials for critical care nurses who care for patients at EOL.
The Implementation and Utilization of Wastewater-Based Epidemiology: Experiences From a Local Health Department
Authors: Swain Michael J. , Carter Bonnie , Snowdon Kimberly , Faust Russell A.
Published: January 2023

Wastewater-based epidemiology has increasingly demonstrated its importance in addressing public health threats. The COVID-19 pandemic brought forth funding for public health agencies to conduct wastewater-based epidemiology. Using a team with diverse skills, a local health department utilized this funding to regularly monitor SARS-CoV-2 in wastewater on university campuses, a K-12 campus, an inpatient psychiatric facility, and a long-term care facility. Between September 2021 and May 2022, more than 760 wastewater samples were collected of which 102 (13.4%) were above a predetermined threshold. When sites exceeded that threshold, local health department staff provided testing resources. Wastewater-based epidemiology is a useful surveillance program that can be effectively conducted by local health departments when provided with funding and a skilled workforce.
“Repeated LTA injection at low concentration induces capsular contracture by activating adaptive immune response through IL-6/STAT3 signaling pathway”
Authors: Xuan Tianfan , Yuan Xin , Zheng Shaoluan , Wang Lu , Wang Qiang , Zhang Simin , Qi Fazhi , Luan Wenjie
Published: January 2023

Back ground:

Capsular contracture was the most common complication of breast implantation surgery. Bacterial contamination was considered to play an important role in the occurrence of capsular contracture, and Gram-positive bacteria like Staphylococcus epidermidis were discovered in the clinical specimens. Lipoteichoic acid (LTA) was a component of Gram-positive bacteria cell wall, and was sufficient in the pathogenicity of the bacteria. We assumed that LTA could trigger the immunological response against the implant and cause capsular contracture.

Methods:

We developed a rat model of capsular contracture by repeated injection of 10 μg/ml LTA. The histological changes of the capsule tissue were measured by HE, Sirius Red, Masson and Immunohistochemical staining. The expression of related cytokines was measured by qRT-PCR. The downstream pathway activation was shown by Western blot. We also applied Tocilizumab, an IL-6 receptor antagonist, to verify the role of IL-6 in this pathological process.

Results:

We discovered that repeated LTA injection, at a low concentration, could induce the thickening of capsule tissue, the deposition of collagen fiber and the activation of myofibroblasts. IL-6/STAT3 signaling pathway was activated in this process, and the inhibition of IL-6 receptor could relieve the symptoms. B cells and T-helper cells, especially T-helper 1, could be related to this phenomenon.

Conclusions:

Our research corroborated that subclinical infection could trigger capsular contracture, and the immune system played an important role in this process. Our results provided a possible research direction for the mechanism of bacterial infection-induced immune response against breast implants.
A systematic literature review of ankle-foot orthosis and functional electrical stimulation foot-drop treatments for persons with multiple sclerosis
Authors: Byrnes-Blanco Laura , Reed Kyle , Dubey Rajiv , Carey Stephanie L.
Published: January 2023

Foot-drop is one of the most diagnosed and physically limiting symptoms persons with multiple sclerosis (pwMS) experience. Clinicians prescribe ankle-foot orthosis (AFO) and functional electrical stimulation (FES) devices to help alleviate the effects of foot drop, but it is unclear how their clinical and functional gait improvements compare given the user's level of disability, type of multiple sclerosis, walking environment, or desired physical activity. The research questions explored were what is the current state of AFO and FES research for pwMS? What are the prevailing research trends? What definitive clinical and functional device comparisons exist for pwMS? eight databases were systematically searched for relevant literature published between 2009 and 2021. The American Association of Orthotists and Prosthetists and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for systematic literature reviews were followed. A team of 3 researchers critically evaluated 17 articles that passed eligibility criteria. This review discusses the current state and trends of research, provides evidence statements on device effects, and recommends improvements for future studies. A meta-analysis would be informative, but study variability across the literature makes directly comparing AFO and FES device effects unreliable. This review contributes new and useful information to multiple sclerosis literature that can be used by both clinicians and researchers. Clinicians can use the provided insights to prescribe more effective, customized treatments, and other researchers can use them to evaluate and design future studies.
A finite element analysis of load distribution during donning and orthostatic posture in the ITOP hybrid subischial socket
Authors: Frigo Carlo A. , Bellomo Silvia , Bigatti Matteo , Pellegrini Roberto , Denza Gabriele , Di Stanislao Eugenio
Published: January 2023

Introduction:

Pressure and shear stresses applied to the stump of a transfemoral amputee wearing a newly designed prosthetic socket have been analyzed by a finite element modeling approach.

Methods:

The new socket was developed by the Istituto Tecnico Ortopedico Preneste, and it was named the “hybrid subischial socket.” This work aimed at understanding the loads' distribution on the stump surface in 2 operative conditions: at the end of the wearing phase and during the orthostatic posture. The model of the stump was composed of 4 different materials: the femoral bone, the muscle tissue, the fat, and the skin layers. Except for the bone (rigid), the biological tissues were modeled as Neo-Hookean, and their mechanical properties were taken from the literature. The socket was composed of a containment frame, made of carbon fiber composite material, a shell made of flexible silicone, and a liner made of hyperelastic silicone.

Results:

The results of our simulation show that the main support areas are located in a proper position, in agreement with the ideal principles of this prosthetic design, and the maximum pressures are well below the pain threshold reported in the literature for the same contact areas.

Conclusions:

We can conclude that although the upper rim of the socket is well below the ischiatic area, the new socket design allows for a safe and comfortable support of the body weight. This is in agreement with the evidence of a good functionality and acceptance of this prosthetics gathered in the many real applications.
Urinary Tract Infections After Urogynecologic Surgery: Risk Factors, Timeline, and Uropathogens
Authors: Jung Carrie E. , Chen Lie H. , Brubaker Linda I. , Menefee Shawn A.
Published: January 2023

Importance

Urinary tract infection (UTI) is a common and potentially avoidable postoperative (PO) adverse event after urogynecologic surgery. Understanding pathophysiology will help prevent the associated morbidity of the disease and treatment of PO-UTI.

Objective

The objective of this study is to determine the following: (1) risk factors for both PO-UTI and PO recurrent UTI (RUTI) after urogynecologic surgery, (2) temporal distribution of UTI, and (3) uropathogen identification.

Study Design

Women undergoing urogynecologic surgery were retrospectively reviewed. Urinary tract infection was defined by culture or antibiotic prescription for symptoms. Recurrent UTI was defined as occurring outside a 6-week perioperative period. The χ2 test or Fischer exact and Student t tests or Mann-Whitney U test were used as appropriate. Individual odds ratio (OR), 95% confidence interval [CI], and sequential multivariable logistic regression were calculated. Statistical significance was set at P < 0.05.

Results

The 6-week PO-UTI rate after 33,626 procedures was 12.9%. Recurrent UTI increased from 3.7% preoperatively to 4.4% postoperatively (P < 0.001). A 6-week preoperative UTI and RUTI increased the risk of 6-week PO-UTI (OR, 1.65; 95% CI < 1.26–2.16; P = 0.001 and OR, 2.19; 95% CI, 1.84–2.62; P < 0.001, respectively) and PO-RUTI (OR, 2.95; 95% CI, 2.11–4.11; P < 0.001 and OR, 6.79; 95% CI, 5.61–8.23; P < 0.001, respectively). Compared with pelvic organ prolapse (POP) surgery only, stress urinary incontinence (SUI) surgery (OR 1.57[1.30–1.89]), and combined POP/SUI surgery (OR, 1.36; 95% CI, 1.13–1.63]) increased the risk of PO-RUTI (P < 0.001). Urinary tract infection within 1 week preoperatively was protective against 6-week PO-UTI (OR, 0.68; 95% CI, 0.48–0.97; P = 0.035). No perioperative factors were protective of PO-RUTI.

Conclusions

The PO-RUTI rate in the first year after urogynecologic surgery is low; however, SUI procedures may increase PO-RUTI risk. Potentially, modifiable risk factors for both PO-UTI and PO-RUTI include UTI diagnosis within 6 weeks preoperatively or preoperative RUTI diagnosis. Retesting women the week before surgery to ensure adequate treatment of preoperative UTI may reduce 6-week PO-UTI.
Preoperative Simulation of Retropubic Midurethral Sling to Decrease Bladder Perforation Rate Among Obstetrics and Gynecology Residents
Authors: Shah Nemi M. , Florian-Rodriguez Maria E. , Meinhardt Summer S. , Cline L. Sophia , Chang Stephanie Y. , Brown L. Steven , Schaffer Joseph I.
Published: January 2023

Importance

Bladder perforation is an often avoidable complication of retropubic midurethral sling procedures. Bladder injury rates decrease with surgeon experience, but literature on techniques to train novice surgeons is limited.

Objective

Our objective was to decrease the bladder perforation rate among obstetrics and gynecology residents during retropubic midurethral sling procedures through implementation of an instructional video and low-fidelity simulation.

Study Design

A baseline bladder perforation rate was determined by retrospective chart review. A prospective educational intervention, consisting of a 10-minute instructional video with preoperative simulation using a simple bony pelvis model, was then implemented among residents on the urogynecology service from December 2017 through March 2020. The primary outcome was the change in the bladder perforation rate. Compliance with the intervention protocol was a secondary outcome. Categorical data were evaluated using the χ2 or Fisher exact test. Continuous variables were assessed using the Student t test or Mann-Whitney U test as appropriate.

Results

Two hundred fifteen retropubic midurethral sling cases were included in analysis. There were no significant demographic differences between the patients undergoing surgery preintervention and postintervention. Resident surgeons were in their second (47.4%) and third (52.6%) years of training. The postintervention bladder perforation rate was 6.5%, which is a 35% reduction from the preintervention perforation rate of 10% (P = 0.19). The instructional video and preoperative simulation were successfully implemented in 193 of 215 (89.8%) eligible cases.

Conclusion

Despite high compliance, the combination of the instructional video and preoperative low-fidelity bony pelvis simulation was not effective in reducing tension-free vaginal tape-associated bladder perforations among residents.
Rectocele: Correlation Between Defecography and Physical Examination
Authors: Crowder Carly A. , Sayegh Nichole , Guaderrama Noelani M. , Jeney Sarah E.S. , Buono Kristen , Yao Janis , Whitcomb Emily L.
Published: January 2023

Importance

There is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse.

Objectives

The aim was to evaluate the association between rectocele on defecography and posterior vaginal wall prolapse (PVWP) on physical examination. The secondary objective was to describe radiologic and clinical predictors of surgical intervention and outcomes.

Study Design

This was a retrospective review of patients enrolled in a large health maintenance organization who underwent defecography and were examined by a urogynecologist within 12 months. The electronic medical record was reviewed for demographic and clinical variables, including pelvic organ prolapse and defecatory symptoms, physical examination, and surgical intervention through 12 months after initial urogynecologic examination or 12 months after surgery if applicable.

Results

One hundred eighty-six patients met inclusion criteria. Of those, 168 (90.3%) had a rectocele on defecography and 31 (16.6%) had PVWP at or beyond the hymen. Rectocele size on defecography was poorly correlated with PVWP stage (spearman ρ = 0.18). Forty patients underwent surgical intervention. Symptoms of splinting, digitation, and stool trapping were associated with surgical intervention (odds ratio, 4.24; 95% confidence interval, 1.59–11.34; P < 0.01) as was advanced PVWP stage (P < 0.01), while rectocele presence and size on defecography were not. Large rectocele size on defecography was correlated with persistent postoperative defecatory symptoms (P = 0.02).

Conclusions

We demonstrated a poor correlation between rectocele size on defecography and PVWP stage. Defecatory symptoms (splinting, digitation, stool trapping) and higher PVWP stage were associated with surgical intervention, while rectocele on defecography was not.
First report of a carbapenemase OXA-48 producing-Hafnia alvei clinical isolate.
Authors: Sevillano Laura , Herrera Cristhian , Valdes Álvaro , de la Hoz Ángela , Cardeñoso Laura , Domingo Diego , Semiglia Maria Auxiliadora
Published: January 2023

Introduction: Carbapenems are usually used in the treatment of infections caused by cephalosporin-resistant Enterobacterales; however, the increase in carbapenem-resistant enterobacterales (CRE) has become one of the most important problems in public health.  Hafnia alvei is associated with intestinal and extraintestinal infections, especially in patients with any chronic disease or some type of inmunosupression. H. alvei is resistant to first-generation aminopenicillins and cephalosporins because of the β-lactamase (Amp C) in their chromosome, the only carbapenem-resistant Hafnia strain described until now was due to the lack of OmpK36 protein that plays an important role in permeability to carbapenems.
  Case presentation: We present the case of a 65 years old male diagnosed with acute lithiasic cholecystitis. The culture of the biliary prosthesis yielded a OXA-48-producing H. alvei that was identified by MALDI-TOF (matrix-assisted laser desorption/ionization-time of flight) mass spectrometry. Carbapenemase production was detected by immunochromatography and confirmed by sequencing.
Conclusion: To our knowledge, this is the first report of OXA-48-producing H. alvei probably obtained by horizontal transference from E. cloacae -OXA-48 isolated in previous samples.
Baseline associations between household air pollution exposure and blood pressure among pregnant women in the Household Air Pollution Intervention Network (HAPIN) multi-country randomized controlled trial
Authors: Ye Wenlu , Pillarisetti Ajay , de León Oscar , Steenland Kyle , Peel Jennifer L. , Clark Maggie L. , Checkley William , Underhill Lindsay J. , Quinn Ashlinn , Balakrishnan Kalpana , Garg Sarada S. , McCracken John P. , Thompson Lisa M. , Díaz-Artiga Anaité , Rosa Ghislaine , Davila-Roman Victor G. , de las Fuentes Lisa , Papageorghiou Aris T. , Chen Yunyun , Wang Jiantong , Thomas F. c ,   the Household Air Pollution Intervention Network (HAPIN) trial Investigators
Published: January 2023

Cooking and heating using solid fuels can result in dangerous levels of exposure to household air pollution (HAP). HAPIN is an ongoing randomized controlled trial assessing the impact of a liquified petroleum gas stove and fuel intervention on HAP exposure and health in Guatemala, India, Peru, and Rwanda among households that rely primarily on solid cooking fuels. Given the potential impacts of HAP exposure on cardiovascular outcomes during pregnancy, we seek to characterize the relationship between personal exposures to HAP and blood pressure among pregnant women at baseline (prior to intervention) in the study. We assessed associations between PM2.5(particulate matter with an aerodynamic diameter ≤2.5 μm), BC (black carbon), and CO (carbon monoxide) exposures and blood pressure at baseline, prior to intervention, among 3195 pregnant women between 9 and 19 weeks of gestation. We measured 24-hour personal exposure to PM2.5/BC/CO and gestational blood pressure. Multivariable linear regression models were used to evaluate associations between personal exposures to three air pollutants and blood pressure parameters. Trial-wide, we found moderate increases in systolic blood pressure (SBP) and decreases in diastolic blood pressure (DBP) as exposure to PM2.5, BC, and CO increased. None of these associations, however, were significant at the 0.05 level. HAP exposure and blood pressure associations were inconsistent in direction and magnitude within each country. We observed effect modification by body mass index (BMI) in India and Peru. Compared to women with normal weights, obese women in India and Peru (but not in Rwanda or Guatemala) had higher SBP per unit increase in log transformed PM2.5and BC exposures. We did not find a cross-sectional association between HAP exposure and blood pressure in pregnant women; however, HAP may be associated with higher blood pressure in pregnant women who are obese, but this increase was not consistent across settings.
Acute tubulointerstitial nephritis with or without uveitis: a novel form of post-acute COVID-19 syndrome in children
Authors: Avramescu Marina , Isnard Pierre , Temmam Sarah , Chevalier Agnès , Bastard Paul , Attia Mikael , Berthaud Romain , Fila Marc , Dossier Claire , Hogan Julien , Ulinski Tim , Leguevaques Damia , Louillet Férielle , Martinez Casado Edouard , Halimi Jean-Michel , Cloarec Sylvie , Zaloszyc Ariane , Faudeux Camille , Rousset-Rouvière Caroline , Clavé Stéphanie , Harambat Jérôme , Rollot Edouard , Simon Thomas , Nallet-Amate Megan , Ranchin Bruno , Bacchetta Justine , Porcheret Florence , Bernard Josselin , Ryckewaert Amélie , Jamet Anne , Fourgeaud Jacques , Da Rocha Nicolas , Pérot Philippe , Kuperwasser Nicolas , Bouazza Naïm , Rabant Marion , Duong Van Huyen Jean-Paul , Robert Matthieu P , Zuber Julien , Casanova Jean-Laurent , Eloit Marc , Sermet-Gaudelus Isabelle , Boyer Olivia
Published: January 2023

Background

COVID-19 is a complex multisystem disease, frequently associated with kidney injury. Since the beginning of the COVID-19 pandemic, we observed a striking increase in the incidence of acute tubulointerstitial nephritis (aTIN) without or with uveitis (TINUs) among children. This prompted us to examine whether SARS-CoV-2 might be the underlying trigger.

Methods

We conducted a French nationwide retrospective cohort study. We included all consecutive children diagnosed with aTIN or TINUs of undetermined cause between April-2020 and March-2021. SARS-CoV-2 antibody responses were tested by a luciferase immunoprecipitation system and compared to age-matched controls. Immunohistochemistry, immunofluorescence and molecular microbiology analyses were performed on kidney biopsies.

Results

Forty-eight children were included with a median age at diagnosis of 14.7 years (9.4-17.6). aTIN and TINUs incidence rates increased 3-fold and 12-fold, respectively, compared to pre-pandemic years. All patients had impaired kidney function with a median eGFR of 31.9 ml/min/1.73m² at diagnosis. Kidney biopsies showed lesions of acute tubulointerstitial nephritis and 25% of patients had fibrosis. No patient had concomitant acute COVID-19. All 16 children tested had high anti-N IgG titers and one had anti-S IgGs. Next-generation sequencing failed to detect any infectious agents in kidney biopsies. However, SARS-CoV-2 RNA was detected by PCR in two kidney samples supporting a potential direct link between SARS-CoV-2 and aTIN/TINUs.

Conclusions

We describe a novel form of post-acute COVID-19 syndrome in children, unique in its exclusive kidney and eye involvement, and its distinctive anti-SARS-CoV-2 N+/S-serological profile. Our results support a causal association linking SARS-CoV-2 infection to this newly-reported burst of renal/eye inflammation.
Multi-region brain transcriptomes uncover two subtypes of aging individuals with differences in Alzheimer risk and the impact ofAPOEε4
Authors: Lee Annie J. , Ma Yiyi , Yu Lei , Dawe Robert J. , McCabe Cristin , Arfanakis Konstantinos , Mayeux Richard , Bennett David A. , Klein Hans-Ulrich , De Jager Philip L.
Published: January 2023

The heterogeneity of the older population suggests the existence of subsets of individuals which share certain brain molecular features and respond differently to risk factors for Alzheimer’s disease, but this population structure remains poorly defined. Here, we performed an unsupervised clustering of individuals with multi-region brain transcriptomes to assess whether a broader approach, simultaneously considering data from multiple regions involved in cognition would uncover such subsets. We implemented a canonical correlation-based analysis in a Discovery cohort of 459 participants from two longitudinal studies of cognitive aging that have RNA sequence profiles in three brain regions. 690 additional participants that have data in only one or two of these regions were used in the Replication effort. These clustering analyses identified two meta-clusters, MC-1 and MC-2. The two sets of participants differ primarily in their trajectories of cognitive decline, with MC-2 having a delay of 3 years to the median age of incident dementia. This is due, in part, to a greater impact of tau pathology on neuronal chromatin architecture and to broader brain changes including greater loss of white matter integrity in MC-1. Further evidence of biological differences includes a significantly larger impact ofAPOEε4risk on cognitive decline in MC-1. These findings suggest that our proposed population structure captures an aspect of the more distributed molecular state of the aging brain that either enhances the effect of risk factors in MC-1 or of protective effects in MC-2. These observations may inform the design of therapeutic development efforts and of trials as both become increasingly more targeted molecularly.

One Sentence Summary:There are two types of aging brains, with one being more vulnerable toAPOEε4and subsequent neuronal dysfunction and cognitive loss.