bluuebunny/crossref_metadata_2025 huggingface dataset:
Suppression of Strawberry Anthracnose by Paenibacillus polymyxa TP3 In Situ and from a Distance
Authors: Lee Bo-Yi , Chen Po-Liang , Chen Chao-Ying
Published: August 2023

Strawberry is a popular fruit with valuable nutrition and an attractive fragrance, but its production and propagation are limited by various diseases, including anthracnose and gray mold. For disease management, biological control measures are environmentally friendly and good alternatives to fungicides to avoid crop losses, reduce carbon emissions, and improve food safety. In this study, Paenibacillus polymyxa TP3, which originated from the strawberry phyllosphere, was shown to antagonize the anthracnose fungal pathogen Colletotrichum siamense and reduce leaf symptoms on strawberry plants. Several mass spectra corresponding to fusaricidin were detected in the confrontation assay of P. polymyxa TP3 and C. siamense by image mass spectrometry. The transcription of fusA and fusG in the fusaricidin biosynthesis gene cluster increased while P. polymyxa TP3 was cultured in the medium containing the culture filtrate of C. siamense, as detected by reverse-transcription polymerase chain reaction, indicating the involvement of fusaricidins in P. polymyxa TP3 antagonism against the anthracnose pathogen. Further disease control assays demonstrated the time frame and spatial mode of P. polymyxa TP3-induced systemic resistance of strawberry against C. siamense. The transcript level of the marker gene FaPDF1.2 of the jasmonic acid pathway increased in strawberry leaves after drenching treatment with P. polymyxa TP3, and the callose deposition was enhanced by further flg22 treatment. In addition, P. polymyxa TP3 treatments of the strawberry mother plants reduced C. siamense infection in the daughter plants, which would be a potent feature for the application of P. polymyxa TP3 in strawberry nurseries and fields to reduce the impact of diseases, especially anthracnose.
Environmental Factors Influencing Stem Rot Development in Peanut: Predictors and Action Thresholds for Disease Management
Authors: Sanjel Santosh , Colee James , Barocco Rebecca L. , Dufault Nicholas S. , Tillman Barry L. , Punja Zamir K. , Seepaul Ramdeo , Small Ian M.
Published: August 2023

Peanuts grown in tropical, subtropical, and temperate regions are susceptible to stem rot, which is a soilborne disease caused by Athelia rolfsii. Due to the lack of reliable environmental-based scheduling recommendations, stem rot control relies heavily on fungicides that are applied at predetermined intervals. We conducted inoculated field experiments for six site-years in North Florida to examine the relationship between germination of A. rolfsii sclerotia: the inoculum, stem rot symptom development in the peanut crop, and environmental factors such as soil temperature (ST), soil moisture, relative humidity (RH), precipitation, evapotranspiration, and solar radiation. Window-pane analysis with hourly and daily environmental data for 5- to 28-day periods before each disease assessment were evaluated to select model predictors using correlation analysis, regularized regression, and exhaustive feature selection. Our results indicated that within-canopy ST (at 0.05 m belowground) and RH (at 0.15 m aboveground) were the most important environmental variables that influenced the progress of mycelial activity in susceptible peanut crops. Decision tree analysis resulted in an easy-to-interpret one-variable model (adjusted R2 = 0.51, Akaike information criterion [AIC] = 324, root average square error [RASE] = 14.21) or two-variable model (adjusted R2 = 0.61, AIC = 306, RASE = 10.95) that provided an action threshold for various disease scenarios based on number of hours of canopy RH above 90% and ST between 25 and 35°C in a 14-day window. Coupling an existing preseason risk index for stem rot, such as Peanut Rx, with the environmentally based predictors identified in this study would be a logical next step to optimize stem rot management.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Sporulation and Dispersal of the Biological Control Agent Aspergillus flavus AF36 Under Field Conditions
Authors: Garcia-Lopez M. Teresa , Meca Esteban , Jaime Ramon , Puckett Ryan D. , Michailides Themis J. , Moral Juan
Published: August 2023

Aflatoxins are carcinogens produced by the fungi Aspergillus flavus and A. parasiticus that contaminate pistachio crops. International markets reject pistachio when aflatoxins exceed permitted maximum levels. Releasing the atoxigenic strain AF36 of A. flavus is the leading aflatoxin pre-harvest control method. The product AF36 Prevail, sorghum grains coated with AF36 propagules, has been used in California since 2017. However, a high percentage of grains of the Prevail fail to sporulate in orchards. Here, the effect of soil moisture on the percentage of AF36 product grains sporulating (SG) and the quantity of spores per grain using a sporulation index (SI) was determined. Under controlled conditions, SG was higher than 85% when soil moisture was 13% or more, and SI increased with increasing soil moisture from 8.4 to 21%. The highest AF36 sporulation occurred near the micro-sprinklers when the grains were not impacted by the irrigation water drops. Arthropod predation was responsible for lost product grains, which was more pronounced in non-tilled soil than in tilled soil. Dispersal of the AF36 spores decreased markedly with the height and distance from the inoculum source, following a pattern of diffusion equations. However, AF36 spores easily reached canopies of pistachios located 10 m from the inoculum source. Our results indicate that AF36 Prevail should be applied close to the irrigation line in the moist soil area but avoiding the areas where excess irrigation causes water accumulation. The biocontrol of aflatoxins in California's pistachio production areas was optimized by improving the field realization of the biological control agent.
Chirp-Evoked VEMPs: A Test-Retest Reliability Study
Authors: Reddy Tarryn Marisca , Heinze Barbara , Biagio-de Jager Leigh , Maes Leen
Published: August 2023

Objectives:

To determine the test-retest reliability of cervical and ocular vestibular-evoked myogenic potentials (c&oVEMP) evoked by 500 Hz narrowband (NB) CE-Chirp and broadband (BB) CE-Chirp stimuli.

Design:

Twenty healthy participants (10 female) were tested twice on the same day to determine the within-session reliability and 1 week later to determine the between-session reliability. The latency, amplitude, and asymmetry ratio of c&oVEMPs elicited by 95 dB nHL air-conducted (AC) 500 Hz NB CE-Chirp and BB CE-Chirp were recorded bilaterally.

Results:

A moderate to good between-session reliability with intraclass correlation coefficient (ICC) values ranging from 0.52 to 0.82 was observed for cVEMP latency, amplitude, and asymmetry ratio evoked by 500 Hz NB CE-Chirp, as well as for the BB CE-Chirp cVEMP amplitude (ICC of 0.70 and 0.84). In contrast, an overall poor reliability ICC values between 0.30 and 0.42 for cVEMP latency and asymmetry ratio were observed for BB CE-Chirp. For the oVEMP, overall poor between-session reliability for all response parameters evoked by the 500 Hz NB CE-Chirp and the BB CE-Chirp was observed.

Conclusions:

The 500 Hz NB CE-Chirp was more reliable than the BB CE-Chirp in terms of cVEMP latency, amplitude, and asymmetry ratio. Further investigation using the standard electrode montage is necessary to assess the test-retest reliability of the chirp-evoked oVEMP.
Vasculitis and the NLRP3 inflammasome
Authors: Hamzaoui Kamel , Hamzaoui Agnès
Published: August 2023

Purpose of review

Vasculitis are a group of heterogeneous conditions characterized by chronic inflammation of blood vessels, leading to tissue destruction and organ failure. Vasculitis is an inflammatory process in which immune effector cells infiltrate blood vessels and surrounding tissues. The involvement of inflammasomes seems to occur during inflammatory processes.

Recent findings

Studies have emphasized that genetic susceptibility is an important aspect of the pathogenesis of vasculitis. The innate immune system is a major contributor to these inflammatory diseases, suggesting that the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome plays a key role. NLRP3 activation causes the assembly of a large multiprotein and leads to the secretion of bioactive interleukin (IL)-1β and IL-18 as well as the induction of inflammatory cell death, termed pyroptosis. Accumulating evidence confirms the involvement of this cascade in sterile inflammatory diseases and other vascular diseases.

In this review, we will summarize the current state of knowledge regarding the role of NLRP3 inflammasome in vascular diseases, and discuss the potential of the NLRP3 inflammasome as a therapeutic target.
The Mini Bone Extra-articular Reconstruction System for Progressive Collapsing Foot Deformity—Surgical Technique With Cadaveric Quantification of Surrounding Anatomy
Authors: Wendler Derrick , Shofoluwe Ademola , Stewart Gary W. , Bailey Erroll J.
Published: August 2023

We present a novel surgical technique, the mini Bone Extra-articular Reconstruction (BEAR) system, that involves minimally invasive all BEAR systems. The surgical technique was used to perform the medial displacement calcaneal osteotomy, Evans osteotomy, and Cotton osteotomy on 9 cadaveric feet under fluoroscopic guidance. We also present a case series of patients who have undergone the procedure. We first carefully dissected the sural nerve, superficial peroneal nerve, and its branches from each cadaveric foot and evaluated injuries following the mini-BEAR osteotomy cuts. We then measured and recorded the distance between the osteotomy cuts and these anatomic structures. We believe that this technique can potentially replace the multiple long surgical incisions with minimal ones.

Level of Evidence:

Level IV.
Management Strategies and Outcomes in Primary Liver Angiosarcoma
Authors: Ramakrishnan Neeraj , Mokhtari Ryan , Charville Gregory W. , Bui Nam , Ganjoo Kristen
Published: August 2023

Objectives:

Primary hepatic angiosarcoma is a rare tumor of the liver that originates from endothelial and fibroblastic tissue, with poor prognosis and lack of standardized treatment. We retrospectively analyzed the clinical characteristics and treatment outcomes of 23 patients with primary liver angiosarcoma treated at an academic sarcoma center.

Methods:

We screened all patients with primary liver angiosarcoma treated at Stanford between 2000 and 2022. Data was collected from EPIC electronic medical records and included patient demographics, tumor characteristics, treatment modalities, and patient outcomes. Statistical analysis was completed using Python 3.0, while survival curves were generated using the Kaplan-Meier method and Lifelines Packages.

Results:

There were nearly equal numbers of males (11) and females (12) in our study, with most patients aged 70 to 79 at diagnosis. The median overall survival (OS) was 6 months (range 0.07 to 222.6 mo). The 2- and 5-year OS were both 38.6%. 71% of patients received systemic treatment with chemotherapy, while 29% received immunotherapy. Local treatment with surgery or radioembolization was performed in 14% of patients. Three patients in our study displayed particularly improved OS and received various treatments, which ranged from hepatic resection to ipilimumab/nivolumab.

Conclusion:

Our study demonstrated that primary liver angiosarcoma has poor outcomes despite treatment. Surgical resection with negative margins is the only curative modality. However, most patients present with advanced disease and are not surgical candidates. Further research is needed to identify more effective systemic therapy options for this devastating disease.
Attenuation of morphine conditioned place preference and reinstatement by vitamin D
Authors: Akbari Mahdieh , Parsaei Houman , Sedaghat Katayoun , Mousavi Fatemeh
Published: August 2023

Opioid action in the brain involves the dopamine-reward system as well as non-dopamine pathways. Since vitamin D also modulates the brain’s dopamine system, the question of this study was how vitamin D might affect the opioid influences on the reward system. Therefore, the objective of this study was to investigate the possible effect of vitamin D on the conditioned place preference (CPP) induced by morphine, as a valuable model of assessment of the reinforcing properties of opioids by associating the context to the rewarding properties of the addictive drugs. Male Wistar rats were randomly divided into two main groups that either received saline (morphine vehicle) or morphine (5 mg/kg, intraperitoneally) for CPP. Each of the main groups was divided into three vitamin D treatment subgroups: vitamin D vehicle and vitamin D (5 and 10 μg/kg, intraperitoneally). Vitamin D injections were started 1 week ahead of the experiment (two injections) or immediately after post-conditioning and in both cases, it was continued twice weekly throughout the CPP. Administration of vitamin D (10 μg/kg) before conditioning in CPP markedly attenuated morphine expression in the post-conditioning test. Receiving vitamin D (5 or 10 μg/kg) before or after conditioning significantly attenuated morphine reinstatement. Administration of vitamin D after opioid conditioning facilitated morphine memory extinction and attenuated morphine reinstatement. Vitamin D is probably a valuable addition to be considered as a part of the treatment for prevention or minimizing the dependency or relapse to opioids.
Racial disparities in early pregnancy: a narrative review
Authors: Mogekwu Oluremi , Kapoor Swena , Carmichael Melissa , Egbase Elizabeth
Published: August 2023

Purpose of review

This review introduces the recognized body of evidence on social determinants of health, which continue to show that a person's health is determined by their broader environmental and social context and that societal inequities harm health and healthcare outcomes. An area of inequity is race, which, although a social construct, has a significant impact on a person's morbidity and mortality as well as their access and experience of healthcare. Racial disparities in maternal and perinatal outcomes are widely recognized. Therefore, this review focuses on the less commonly addressed early pregnancy setting.

Recent findings

Health inequities are present in the early pregnancy setting, as racial disparities exist in early pregnancy presentations and outcomes. Black women have a higher incidence of miscarriage, ectopic pregnancy and poorer survival rates from gestational trophoblastic neoplasms. Asian women have a statistically significantly higher incidence of gestational trophoblastic disease.

The findings support the need for more consistent and detailed research on the impact of race on early pregnancy outcomes and increasing ethnic diversity among study populations for trials to ensure meaningful and applicable data. Raising awareness of this racial health inequity in early pregnancy is the first step clinicians can take to tackle this issue.
Assessing Adipocyte Viability and Surgeons’ Work Efficiency by Comparing Different Liposuction Methods
Authors: Urbonas Tautvydas , Kievišas Mantas , Petrikaitė Vilma , Gibieža Paulius , Baranauskas Gytis , Mištautas Tautvydas , Suslavičius Kristupas , Rutkauskas Irmantas , Stukas Darius , Jasukaitiene Aldona
Published: August 2023

Background:

Autologous fat grafting is widely used in plastic and reconstructive surgery. Liposuction methods play a key role in surgeons’ work efficiency, adipocyte viability, graft survival, and outcomes. We investigated the effect of four liposuction methods on adipocyte viability, debris, and surgeons’ work efficiency by measuring the active energy expenditure and changes in heart rate.

Methods:

Human lipoaspirate was harvested from patients’ removed abdominal flaps using four different liposuction methods, and we counted calories per aspirated volume and surgeons’ heart rate. Adipocytes were separated from the lipoaspirate immediately by digestion with 0.1% type I collagenase. After digestion, parts of the cells and debris were measured. Adipocytes were plated in an adipocyte maintenance medium containing Alamar blue reagent. The adipocyte metabolic activity was measured using a spectrophotometer.

Results:

After evaluating the active energy expenditure and changes in surgeons’ heart rate, the ultrasonic-assisted liposuction (UAL) method was determined to be the most ergonomic liposuction device for surgeons. In addition, adipocyte viability was higher in the UAL group than in the other groups, and debris was the lowest in the power-assisted liposuction 1 group (PAL1).

Conclusions:

Adipocyte viability is crucial for improving fat grafting outcomes. This study revealed that the viability of adipocytes is best preserved using the UAL and PAL1 liposuction methods. The UAL and PAL1 methods caused the least damage to the cells. The UAL method yielded the best results for surgeons’ work efficiency.
Coronary artery calcium and sudden cardiac death: current evidence and future directions
Authors: Razavi Alexander C. , Whelton Seamus P. , Blumenthal Roger S. , Sperling Laurence S. , Blaha Michael J. , Dzaye Omar
Published: August 2023

Purpose of review

To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD).

Recent findings

Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0. Although the mechanisms underlying increasing CAC and SCD risk have yet to be fully elucidated, risk for myocardial infarction and scar, and/or exercise-induced ischemia may be potential mediators.

High CAC burden is an important risk factor for SCD in asymptomatic middle-aged adults, suggesting that SCD risk stratification can begin in the early stages of CHD via measurement of calcific plaque on noncontrast computed tomography. Despite the clinical inertia for downstream functional cardiac testing after detecting high CAC, comprehensive ASCVD prevention strategies should be the primary focus for SCD risk reduction.
Safety and cardiovascular effectiveness of olmesartan in combination therapy for advanced hypertension: an electronic health record-based cohort study
Authors: Kim Ju Hyeon , Joo Hyung Joon , Chung Se Hwa , Yum Yunjin , Kim Yong Hyun , Kim Eung Ju
Published: August 2023

Objective:

Compared with placebo, olmesartan has been linked to numerical imbalances in cardiovascular mortality. There is a paucity of contemporary real-world evidence on this agent for different study populations. This study investigated the clinical outcomes of olmesartan and other antihypertensives in patients with advanced hypertension.

Methods:

This multicenter retrospective study used data from the Korea University Medical Center database, built from electronic health records. Patients prescribed at least two antihypertensive medications as a combined therapy were followed-up for 3 years. The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), stroke, and hospitalization for heart failure. Adjusted outcomes were compared using propensity score (PS) matching.

Results:

Among 24 806 patients, 4050 (16.3%) were olmesartan users between January 2017 and December 2018. The average patient age was 64 years, 45% were women, and 41% had diabetes. Olmesartan users were younger and less likely to have diabetes mellitus or chronic kidney disease. In PS-matched cohort, the 3-year cumulative incidences of the primary outcome were similar between the two groups (P = 0.91). The cumulative incidence of MI at 3 years was 1.4% in olmesartan users (4.8 per 1000 person-years) and 1.5% in active comparators (5.2 per 1000 person-years; P = 0.74). Olmesartan also showed similar safety profiles, including acute kidney injury and newly started dialysis.

Conclusions:

In real-world practice, olmesartan use in combination therapy resulted in similar cardiovascular outcomes when compared with those of active comparators, and our findings did not show any conclusive evidence that olmesartan is harmful in patients with hypertension.
Examining the Association Between Adverse Childhood Experiences and Lifetime History of Head or Neck Injury and Concussion in Children From the United States
Authors: Saadi Altaf , Choi Kristen R. , Khan Taha , Tang Judy T. , Iverson Grant L.
Published: August 2023

Objective:

Our objective was to determine whether there is an association between adverse childhood experiences (ACEs) and lifetime history of early childhood mild head or neck injury and concussion in a nationally representative US cohort.

Setting and Design:

This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) Study (data release 3.0), a prospective investigation of child brain development and health.

Participants:

There were 11 878 children aged 9 or 10 years at baseline, recruited from 21 school-based sites in the United States. After excluding children with missing questionnaires for the primary exposure variable and children with severe brain injuries involving more than 30-minute loss of consciousness, the final sample size was 11 230 children.

Measures:

The primary exposure variable was ACEs. We measured eight ACEs: sexual abuse, physical abuse, emotional neglect, parent domestic violence, parent substance use disorder, parental mental illness, parent criminal involvement, and parent divorce. The primary outcomes were head or neck injury and concussion, measured using the Ohio State University Traumatic Brain Injury Screen-Identification Method Short Form.

Results:

The sample (N = 11 230) was 52% boys with a mean age of 9.9 years (SD = 0.62 years). The racial and ethnic makeup was reflective of national demographics. Having a higher overall ACE count was associated with higher odds of head or neck injury, with greater odds with more ACEs reported. Children with 2 ACEs had 24% greater odds of head or neck injury (AOR = 1.24, 95% confidence interval [CI] = 1.06-1.45) and 64% greater odds of concussion (AOR = 1.64, 95% CI = 1.18-2.22), and children with 4 or more ACEs had 70% greater odds of head or neck injury (AOR = 1.7, 95% CI = 1.14, 2.49) and 140% greater odds of concussion (AOR = 2.4, 95% CI = 1.15-4.47). The individual ACE categories of sexual abuse, parent domestic violence, parental mental illness, and parent criminal involvement were significantly associated with increased risk of head or neck injury and parental mental illness with increased risk of concussion.

Conclusions and Relevance:

ACEs are associated with early childhood mild head or neck injury and concussion and should be integrated in head injury prevention and intervention efforts.
Prevalence and Correlates of VA-Purchased Community Care Use Among Post-9/11-Era Veterans With Traumatic Brain Injury
Authors: Govier Diana J. , Gilbert Tess A. , Jacob R. Lorie , Lafferty Megan , Mulcahy Abby , Pogoda Terri K. , Zogas Anna , O'Neil Maya E. , Pugh Mary Jo , Carlson Kathleen F.
Published: August 2023

Objective:

Post-9/11-era veterans with traumatic brain injury (TBI) have greater health-related complexity than veterans overall, and may require coordinated care from TBI specialists such as those within the Department of Veterans Affairs (VA) healthcare system. With passage of the Choice and MISSION Acts, more veterans are using VA-purchased care delivered by community providers who may lack TBI training. We explored prevalence and correlates of VA-purchased care use among post-9/11 veterans with TBI.

Setting:

Nationwide VA-purchased care from 2016 through 2019.

Participants:

Post-9/11-era veterans with clinician-confirmed TBI based on VA's Comprehensive TBI Evaluation (N = 65 144).

Design:

This was a retrospective, observational study.

Main Measures:

Proportions of veterans who used VA-purchased care and both VA-purchased and VA-delivered outpatient care, overall and by study year. We employed multivariable logistic regression to assess associations between veterans' sociodemographic, military history, and clinical characteristics and their likelihood of using VA-purchased care from 2016 through 2019.

Results:

Overall, 51% of veterans with TBI used VA-purchased care during the study period. Nearly all who used VA-purchased care (99%) also used VA-delivered outpatient care. Veterans' sociodemographic, military, and clinical characteristics were associated with their likelihood of using VA-purchased care. Notably, in adjusted analyses, veterans with moderate/severe TBI (vs mild), those with higher health risk scores, and those diagnosed with posttraumatic stress disorder, depression, anxiety, substance use disorders, or pain-related conditions had increased odds of using VA-purchased care. Additionally, those flagged as high risk for suicide also had higher odds of VA-purchased care use.

Conclusions:

Veterans with TBI with greater health-related complexity were more likely to use VA-purchased care than their less complex counterparts. The risks of potential care fragmentation across providers versus the benefits of increased access to care are unknown. Research is needed to examine health and functional outcomes among these veterans.
Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion
Authors: Faerman Afik , Nabasny Andrew , Wright Brittany , Juengst Shannon B.
Published: August 2023

Objective:

This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI).

Design:

Secondary analysis of a concussion cohort study.

Participants:

One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center.

Main Measures:

Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks.

Results:

Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (β = .362, P < .001), anxiety (β = .332, P < .001), and impulsivity (β = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (β = .493, P < .001), fatigue (β = .449, P < .001), self-reported executive dysfunction (β = .376, P < .001), and overall burden from concussive symptoms (β = .477, P < .001).

Conclusions:

Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.
UNILATERAL ROTH SPOTS AS AN INITIAL PRESENTATION IN ESSENTIAL THROMBOCYTHEMIA
Authors: Diala Fitz Gerald I. , Caleon Ramoncito L. , Mahdavi Fard Ali , Heilweil Gad
Published: August 2023

Purpose:

To describe a 25-year-old female patient with unilateral Roth spots as the initial presentation of essential thrombocythemia.

Method:

Case report.

Results:

A 25-year-old woman presented with visual complaints of seeing flashing lights and mild blurred vision in her left eye. Dilated fundus examination revealed intraretinal hemorrhages with a pattern compatible with Roth spots. Further workup showed thrombocythemia with positive JAK2 (V617F) mutation, confirming the diagnosis of essential thrombocythemia. The symptoms and fundus findings resolved in one month after initiation of the treatment with low-dose oral aspirin. Essential thrombocythemia, which is defined as repeated platelet count of ≥450,000 per microliter without a secondary cause, can present with highly variable symptoms from being asymptomatic to chest pain, cerebral venous sinus thrombosis, retinal vascular occlusion, and granuloma annulare. In the presented case, Roth spots hastened the need for more complete workup to determine the systemic cause of this ocular finding, ultimately leading to the diagnosis.

Conclusion:

Finding of Roth spots may warrant a systemic workup to find out the underlying pathologic condition, which in the present case was essential thrombocythemia, a potentially life-threatening condition.
WAXING AND WANING PATTERN OF CHOROIDAL DETACHMENT POSTSCLERAL BUCKLE
Authors: Banerjee Mousumi , Hage Angku , Azad Shorya Vardhan , Venkatesh Pradeep
Published: August 2023

Purpose:

Description of evolving and resolving pattern of choroidal mounds at different quadrants postscleral buckle surgery in a myopic patient.

Methods:

A 48-year-old man with axial length of 32 mm underwent scleral buckling for subtotal fresh retinal detachment with 360° multiple lattices with superior horse shoe tear. A posterior buckle was placed superiorly traversing 180°, 14 mm beyond muscle insertion. Uneventful drainage of subretinal fluid was performed intraoperatively.

Results:

Postoperative day 1 depicted two choroidal detachment mounds in the ST quadrant with an adequate break buckle relationship. Postoperative day 2 depicted an additional choroidal detachment mound in the inferonasal with an additional mound superonasally on Day 4. Spontaneous resolution of the mounds was observed from Day 7 with complete resolution by 1 month.

Conclusion:

Fragility of the choroidal vasculature in axial myopia can aggravate venous congestion when associated with one or two vortex vein obstruction after scleral buckle. Choroidal vasculature remodeling occurs after vortex vein obstruction leading to formation of new venous drainage routes.
Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes
Authors: Gibbons Alison B. , Niknahad Ava , Bacorn Colin , Halawa Omar , Li Emily
Published: August 2023

Purpose:

To compare the clinical features, management, and outcomes between orbital cellulitis patients with subperiosteal abscess (SPA) and those with orbital abscess (OA).

Methods:

A retrospective study was conducted at a tertiary care center through medical record search to identify patients with orbital cellulitis from January 1, 2000 to December 31, 2022. Charts were screened for those with radiographic evidence of SPA or OA. Demographic data and presenting clinical features were compared between the 2 cohorts. Primary outcomes compared included rates of surgical intervention, reoperation, and readmission; and length of hospital stay and final vision.

Results:

A total of 189 patients, 162 with SPA and 27 with OA, met the criteria. The OA group (mean 46.5 ± 18.6 years) was older than the SPA group (mean 19.1 ± 21.4 years). Comorbid sinusitis was significantly more common in the SPA cohort (95.7% SPA; 70.4% OA; p < 0.001), while OA was more likely to occur with orbital trauma (29.6% vs. 8.0%; p = 0.003), implanted hardware (11.1% vs. 0.6%; p = 0.005), and comorbid diabetes (22.2% vs. 4.3%; p = 0.001). OA patients more often presented with a relative afferent pupillary defect (21.7% vs. 3.9%; p = 0.005), vision worse than 20 of 50 (42.3% vs. 16.2%; p = 0.005), and methicillin-resistant Staphylococcus aureus infection (20.8% vs. 5.8%; p = 0.036). OA was associated with a higher reoperation rate (47.8% vs. 21.3%; p = 0.019), readmission rate (18.5% vs. 5.6%, p = 0.047), and limited extraocular motility at follow-up (4.3% vs. 25%; p = 0.013); while mean length of hospital stay and final visual acuity were similar.

Conclusion:

OA may affect an older population with a divergent risk factor profile compared with SPA. OA may cause more severe functional impairment on presentation, warranting more aggressive management to achieve visual outcomes similar to SPA.
Perceptions of Patient-Reported Outcome Measures in Acute Care Pediatric Physical Therapy
Authors: Tischler Dana , Pitney William A. , Wood Janine , Shotwell Mary , Mooney Cade
Published: August 2023

Purpose:

To explore the perceptions and experiences of acute care pediatric physical therapists (PTs) regarding the use of patient-reported outcome measures (PROMs) and to understand the influence of PROMs on clinical decision-making and the plan of care.

Methods:

Thirteen acute care pediatric PTs participated in individual semistructured interviews using a qualitative phenomenological approach. Interview questions focused on how PROMs influence clinical practice and decision-making. Interviews also explored scenarios where using PROMs positively or negatively impacted patient and caregiver interactions. Researchers analyzed the interview transcripts using an inductive process to generate codes and resultant themes.

Results:

Participants described their experiences using PROMs in pediatric acute care, and 4 themes emerged: (1) PROMs can be difficult to implement in pediatric acute care, (2) PROMs can benefit pediatric acute care practice, (3) PROMs can improve service delivery and family-centered care, and (4) ideal PROM use in future practice. The Theoretical Domains Framework (TDF) was used to categorize positive and negative factors related to implementing evidence-based guidelines in the pediatric acute care setting.

Conclusions:

Acute care pediatric PTs report benefits and barriers to using PROMs with children and caregivers in the hospital setting. Findings support the need for future knowledge translation initiatives to facilitate the use of PROMs in pediatric acute care.
Patient-Reported Outcome Measure Use by Acute Care Pediatric Physical Therapists
Authors: Tischler Dana , Wood Janine , Shotwell Mary , Pitney William A. , Mooney Cade
Published: August 2023

Purpose:

To describe the current use of and perceived benefits and barriers to using patient-reported outcome measures (PROMs) by pediatric physical therapists (PTs) in the acute care setting and to explore demographic factors that may explain the use of PROMs.

Methods:

An electronic survey was distributed to PTs who work in a pediatric acute care setting. Descriptive statistics were used to assess the frequency of PROM use, identify differences in PROM use based on demographic factors, and evaluate the likelihood of various benefits and barriers. Open-ended survey responses were analyzed inductively to identify common themes.

Results:

The survey was completed by a convenience sample of 92 pediatric acute care PTs (30% response rate). Half of the respondents (n = 46; 50%) reported “rarely” or “never” using PROMs, while only 4.3% (n = 4) reported “always” using PROMs. No significant differences were found in the frequency of PROM between years of experience, entry-level degree, clinical specialization, or other demographic factors. Participants were “somewhat” or “extremely likely” to use the rate of perceived exertion (71%), the Ages and Stages Questionnaire (24%), and the Pediatric Quality of Life Inventory (17%). The primary facilitator was improving communication with patients (68%), while the main barrier was lack of availability (57%). Thematic analysis of open-ended responses indicated that the benefits of using PROMs include improving communication, providing objective data, and measuring progress. Barriers identified include inadequate resources, lack of time, and irrelevance to clinical practice.

Conclusion:

Many pediatric acute care PTs underutilize PROMs, with reported barriers of limited access and lack of time hindering implementation within the pediatric acute care setting. Survey respondents reported the desire to measure health-related quality of life and participation, which may be feasible through future quality improvement or knowledge translation initiatives.
The Active Leg Raise Test
Authors: Sutter Jonathan R. , Coyer Ben , McGarvey Jeremy , Georgieff Meghan , Pilon Joseph
Published: August 2023

Background and Purpose:

There are important reasons to provide hospitalized patients with opportunities to move while hospitalized. Yet, it is apparent that, other than actually attempting the task of standing up, there is no predictive test available that would help a hospital professional decide whether the patient has adequate ability to safely attempt standing. The purpose of this research report is to describe a novel test that clinicians can use to help predict whether a patient is anticipated to be capable of standing up with little or no assistance.

Approach:

Hospitalized patients were requested to lift each lower extremity, one at a time, for 5 seconds, above a minimum height. To determine the predictive ability of the test to identify the ability to stand, results were compared against the “gold standard” of whether the patients were able to stand successfully as part of a physical therapy evaluation performed after the leg raise test.

Outcomes:

The sensitivity of the test was 0.91 (95% CI = 0.84-0.96) and the specificity was 0.71 (95% CI = 0.48-0.89). The positive predictive value was 0.94 (95% CI = 0.88-0.98) and the negative predictive value was 0.60 (95% CI = 0.39-0.79).

Discussion and Conclusion:

This test is simple, short, and well suited to the rapid pace of clinical decision-making that health care professionals face on a daily basis. This test is useful in helping acute care professionals answer a clinical question they encounter often, “Is it safe for this patient to try to stand up?”
Skin Microbiota and the Skin Barrier
Authors: Wu Ming-Yang , Yao Xu
Published: August 2023

The skin constitutes the primary barrier between the human body and the external environment. The skin microbiome plays an important role in the microecosystem on the skin surface and mediates multiple facets of the skin barrier function, including physical, chemical, microbial, and immune barriers. In this review, we discuss the host–microbiota interactions in barrier maintenance and disruption, implications for skin disorders such as atopic dermatitis, psoriasis, and rosacea, and the latest strategies for targeting the skin microbiota to improve the skin barrier.
Family Resilience as an Emerging Concept in Neonatology
Authors: Laporte Geneviève , Sergerie-Richard Sophie , Genest Christine , Aita Marilyn
Published: August 2023

Background:

Family resilience can be observed through specific resilience-promoting processes, namely, shared belief systems, communication, and organizational processes, but the concept remains mostly unstudied in neonatology. This metasummary aims to evaluate the frequency of family resilience processes in qualitative scientific literature to illustrate how family resilience is exhibited in the neonatal intensive care unit (NICU) setting.

Methods:

A search among 4 databases yielded 7029 results, which were reviewed for inclusion. Following Sandelowski and Barroso's qualitative metasummary method, findings from each study were independently coded and frequency effect size was calculated.

Results:

Forty-six primary qualitative studies published between 2016 and 2022 conducted with parents of preterm infants who discussed their NICU hospitalization experience were included in this metasummary. All 9 of Walsh's family resilience processes were identified in the literature, and their frequency effect size ranged from 4% to 91%. Four additional themes emerged pertaining to specific family resilience behaviors exhibited by NICU families.

Conclusion:

This analysis sheds new light on the most recent qualitative evidence of parents' experiences in the NICU by analyzing it through the lens of family resilience and posits family resilience as a promising concept in relation to the predominance of the family-centered care philosophy in neonatal units.
Individuals Eligible for Lung Cancer Screening Less Likely to Receive Screening When Enrolled in Health Plans With Deductibles
Authors: Wain Kris , Carroll Nikki M. , Honda Stacey , Oshiro Caryn , Ritzwoller Debra P.
Published: August 2023

Background:

In 2015, the Centers for Medicare & Medicaid Services and commercial insurance plans began covering lung cancer screening (LCS) without patient cost-sharing for all plans. We explore the impact of enrolling into a deductible plan on the utilization of LCS services despite having no out-of-pocket cost requirement.

Methods:

This retrospective study analyzed data from the Population-based Research to Optimize the Screening Process Lung Consortium. Our cohort included non-Medicare LCS-eligible individuals enrolled in managed care organizations between February 5, 2015, and February 28, 2019. We estimate a series of sequential logistic regression models examining utilization across the sequence of events required for baseline LCS. We report the marginal effects of enrollment into deductible plans compared with enrollment in no-deductible plans.

Results:

The total effect of deductible plan enrollment was a 1.8 percentage-point (PP) decrease in baseline LCS. Sequential logistic regression results that explore each transition separately indicate deductible plan enrollment was associated with a 4.3 PP decrease in receipt of clinician visit, a 1.7 PP decrease in receipt of LCS order, and a 7.0 PP decrease in receipt of baseline LCS. Reductions persisted across all observable races and ethnicities.

Conclusions:

These findings suggest individuals enrolled in deductible plans are more likely to forgo preventive LCS services despite requiring no out-of-pocket costs. This result may indicate that increased cost-sharing is associated with suboptimal choices to forgo recommended LCS. Alternatively, this effect may indicate individuals enrolling into deductible plans prefer less health care utilization. Patient outreach interventions at the health plan level may improve LCS.
Uptake of Biosimilar Among Privately Insured Patients Undergoing Infliximab Treatment
Authors: Chang Jessica , Karaca-Mandic Pinar , Jeffery Molly M.
Published: August 2023

Background:

Recent literature has found rapid uptake of short-acting filgrastim biosimilars but slower uptake of other biosimilars, such as infliximab, in both Medicare and privately insured enrollees.

Objectives:

To describe patient, provider, and health plan characteristics associated with a switch to biosimilar among existing infliximab patients.

Research Design:

We constructed a retrospective panel dataset of patients undergoing active infliximab treatments and the choice of infliximab drug for each infusion. We used mixed logit regression controlling for patient, provider, and health plan characteristics as well as time-fixed effects.

Subjects:

Medicare Advantage and privately insured enrollees with evidence of active infliximab treatments between 2016 and 2020 (n=357,430).

Measures:

Our primary outcome of interest was to switch from infliximab originator to one of the infliximab biosimilars. Exposure variables of interest variables such as out-of-pocket, site of care, and in-network deductible.

Results:

Our study found nominally low switching among existing infliximab originator users (3.4%). We found that patients who previously received 1 infliximab originator infusion were 63.7% more likely to switch to biosimilar compared with patients who previously received administration of 20 infliximab originators. We found that biosimilar’s placement as health’s plan preferred drug was attributed to higher likelihood of biosimilar use (odds ratio: 1.666; P-value=0.001). We did not observe any statistically significant effect among out-of-pocket amount or deductible with respect to switch to infliximab biosimilar.

Conclusions:

To encourage uptake and switch to biosimilar, policymakers should consider targeted policies that include leveraging health plan tools such as placement of biosimilar as preferred drug and aim to educate patients on the clinical equivalence between infliximab biosimilar and originator.
Dual organ transplantation: when heart alone is not enough
Authors: Nuqali Abdulelah , Bellumkonda Lavanya
Published: August 2023

Purpose of review

The number of dual organ transplantations (DOT) are steadily increasing over the past few years. This is both a reflection of increasing complexity and advanced disease process in the patients and greater transplant center experience with performing dual organ transplants. Due to lack of standardization of the process, there remains significant center-based variability in patient selection, perioperative and long-term management of these patients.

Recent findings

Overall posttransplant outcomes for DOT have been acceptable with some immunological advantages because of partial tolerance offered by the second organ. These achievements should, however, be balanced with the ethical implications of bypassing the patients who are listed for single organ transplantation because of the preferential allocation of organs for DOT.

The field of DOT is expanding rapidly, with good long-term outcomes. There is an urgent need for guidelines to standardize the process of patient selection and listing dual organ transplantation.
Role of complement in humoral immunity
Authors: Podestà Manuel Alfredo , Chun Nicholas
Published: August 2023

Purpose of review

Antibody-mediated rejection (AMR) after solid organ transplantation remains an unsolved problem and leads to poor early and late patient outcomes. The complement system is a well recognized pathogenic mediator of AMR. Herein, we review the known molecular mechanisms of disease and results from ongoing clinical testing of complement inhibitors after solid organ transplant.

Recent findings

Activation and regulation of the complement cascade is critical not only for the terminal effector function of donor-specific antibodies, but also for the regulation of T and B cell subsets to generate the antidonor humoral response. Donor-specific antibodies (DSA) have heterogenous features, as are their interactions with the complement system. Clinical testing of complement inhibitors in transplant patients have shown good safety profiles but mixed efficacy to date.

The complement cascade is a critical mediator of AMR and clinical trials have shown early promising results. With the steady emergence of novel complement inhibitors and our greater understanding of the molecular mechanisms linking complement and AMR, there is greater optimism now for new prognostic and therapeutic tools to deploy in transplant patients with AMR.