bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of supplementation with narasin, salinomycin, or flavomycin on performance and ruminal fermentation characteristics of Bos indicus Nellore cattle fed with forage-based diets
Authors: Limede Arnaldo Cintra , Marques Rodrigo S , Polizel Daniel Montanher , Cappellozza Bruno Ieda , Miszura Alexandre Arantes , Barroso José Paulo Roman , Storti Martins André , Sardinha Lairana Aline , Baggio Marcelo , Pires Alexandre Vaz
Published: April 2021

The aim of the present study was to evaluate the inclusion of narasin, salinomycin, or flavomycin for 140 d on ruminal fermentation parameters, apparent nutrient digestibility, and performance of Nellore cattle offered a forage-based diet. In experiment 1, 32 rumen-cannulated Bos indicus Nellore steers [initial body weight (BW) = 220 ± 12.6 kg] were assigned to individual pens in a randomized complete block design according to their initial shrunk BW. Within block, animals were randomly assigned to 1 of 4 treatments: (1) forage-based diet without feed additives (CON; n = 8), (2) CON diet plus 13 ppm of narasin (NAR; n = 8), (3) CON diet plus 20 ppm of salinomycin (SAL; n = 8), or (4) CON diet plus 3 ppm of flavomycin (FLA; n = 8). The experimental period lasted 140 d and was divided into 5 periods of 28 d each. The inclusion of feed additives did not impact (P ≥ 0.17) dry matter intake (DMI), nutrient intake, and apparent total tract digestibility of nutrients. Nonetheless, steers fed NAR had lower (P < 0.01) molar proportion of acetate compared with CON, SAL, and FLA steers, whereas ruminal acetate tended to be greater (P < 0.09) for SAL vs. CON and FLA, but did not differ (P = 0.68) between CON vs. FLA steers. Ruminal propionate was the highest (P < 0.01) for steers fed NAR and did not differ (P > 0.20) between CON, SAL, and FLA. Consequently, NAR steers had the lowest (P < 0.01) Ac:Pr ratio, whereas Ac:Pr did not differ (P > 0.18) among CON, SAL, and FLA. Total volatile fatty acids were greater (P < 0.04) for NAR and CON vs. SAL and FLA, but did not differ (P > 0.67) among NAR vs. CON and SAL vs. FLA. In experiment 2, 164 Nellore bulls (initial shrunk BW = 299 ± 2.5 kg) were assigned to feedlot pens for 140 d in a randomized complete block design. Within block (n = 10), animals were randomly assigned to the same treatments used in experiment 1. Average daily gain was greater (P < 0.01) in NAR vs. CON, SAL, and FLA bulls, and did not differ (P > 0.12) between CON, SAL, and FLA bulls. Bulls fed NAR had greater (P < 0.02) DMI (as kg/d or % BW) and final shrunk BW compared with CON, SAL, and FLA bulls, whereas DMI and final shrunk BW did not differ (P > 0.26) between CON, SAL, and FLA bulls. Feed efficiency, however, was not impacted (P = 0.51) by any feed additives used herein. Collectively, narasin was the only feed additive that benefited performance and ruminal fermentation of Nellore animals fed a forage-based diet.
Short-, medium-, and long-chain fatty acid profiles and signaling is responsive to dietary phytase and lactic acid treatment of cereals along the gastrointestinal tract of growing pigs
Authors: Metzler-Zebeli Barbara U , Klinsoda Jutamat , Vötterl Julia , Sharma Suchitra , Koger Simone , Sener-Aydemir Arife
Published: April 2021

Dietary and microbially derived fatty acids (FA) play important roles in gut mucosal inflammatory signaling, barrier function, and oxidative stress response. Nevertheless, little information is available about gastrointestinal FA profiles and receptor distribution in pigs, especially for long-chain FA (LCFA). Therefore, the present pilot study aimed to (1) investigate the gastrointestinal FA profiles; (2) link the luminal FA profiles to the mucosal expression of genes related to FA sensing and signaling; and (3) assess potential dietary effects on gut and systemic lipid metabolism in pigs. Gut, liver, and serum samples were obtained from barrows (13.1 ± 2.3 kg) fed diets containing either phytase (500 phytase units/kg diet) or cereals treated with 2.5% lactic acid (LA; n = 8/diet) for 18 d. Results showed gut regional and diet-related differences in luminal FA profiles and mucosal receptor expression, whereas diet little affected hepatic expression levels and serum lipids. Short-chain fatty acids (SCFA) increased from stomach, jejunum, and ileum to the cecum (P < 0.05), whereas LCFA were higher in stomach, cecum, and colon than in jejunum and ileum (P < 0.05). LA-treated cereals enhanced cecal acetate and butyrate, whereas phytase and LA treated cereals decreased the LCFA by 35.9% and 14.4%, respectively (P < 0.05). Gut regional differences suggested stronger signaling via FFAR1 expression in the ileum, and via FFAR2, FFAR4, and HCAR1 expression in cecum and colon (P < 0.05). Expression of AMPK, FASN, PPARG, SREBP1, and SREBP2 was higher in the cecum and colon compared with the small intestine (P < 0.05), with stronger sensing via FASN and SREBP2. Phytase decreased expression of FFAR2 and FFAR4, whereas it increased that of FFAR3 and MCT1 in the cecum (P < 0.05). LA-treated cereals raised cecal expression of FFAR3 and HCAR1 (P < 0.05). Pearson’s correlations (|r| > 0.35; P < 0.05) supported that FA receptor- and nuclear transcription factor-dependent pathways were involved in the mucosal regulation of gut incretin expression but differed across gut regions. In conclusion, results support regional differences in SCFA, lactate and LCFA sensing and absorption capacities in the small and large intestines of pigs. Effects of phytase and the LA-treated cereals on intestinal FA levels and signaling can be explained by differences in nutrient flows (e.g., phosphorus and carbohydrate fractions). This overview provides a solid basis for future intestinal FA sensing in pigs.
Delineating the Role of Serum Immunoglobulin Titers in Burn Patients at High Risk for Herpes Simplex Virus Infection
Authors: Brennan Phillip G , Wright Kelsea , Miles M Victoria P , Lintner Alicia C , Alexander Kaitlin M , Kahn Steven A
Published: April 2021

Herpes simplex virus (HSV) is common in the population and reactivation of latent infection often occurs in times of physiologic stress, including postburn injury. Active HSV infection complicates burn injury recovery and increases morbidity. A retrospective chart review of high-risk burn patients (≥20%TBSA and/or facial burns) who had screening HSV immunoglobulin titers drawn from 2015 to 2018 was conducted. Titer levels and morbidity-related outcomes were compared between patients who developed active infection and those who did not. Fifty-six patients had serum HSV titers measured. Twenty-nine patients (52%) developed clinical signs of HSV infection, almost all of which (97%) suffered facial burns. Titers were ordered on median hospital day 1.5 (0.00–4.0) and infection occurred on day 8.0 (2.0–16). Median HSV-1,2 IgM titers were significantly increased in patients who developed clinically active HSV infection (0.71 [0.44–1.1] vs 0.52 [0.34–0.74], P = .02). Median HSV-1 IgG (P = .65) and HSV-2 IgG titers (P = .97) were not different between groups. Patients who developed active infection had a comparable hospital length of stay (27 [9.5–40] days vs 20 [8.0–28] days, P = .17) and ICU length of stay (26 [13–49] days vs 19 [11–27] days, P = .09) to those who did not develop infection. There was no difference in mortality. Increased HSV-1 and 2 IgM screening levels were associated with an increased risk of developing active HSV infection, and offer a specific screening modality in high-risk patients. Elevated IgM titers warrant further consideration for administration of HSV prophylaxis, as earlier intervention may prevent infection onset and minimize morbidity.
The use of biologics to improve patient-reported outcomes in hip preservation
Authors: Sullivan Spencer W , Aladesuru Oluwatobi M , Ranawat Anil S , Nwachukwu Benedict U
Published: April 2021

Despite lack of clear understanding, the use of biologic treatment methods has increased in the United States. Therapeutic methods, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and hyaluronic acid (HA) among other biologics, are commonly associated with relief of pain in a number of different orthopedic conditions. Within the past two decades, hip preservationists have investigated the roles of these biologic treatments in both non-operative and surgical management of common hip conditions. The purpose is to review the published literature surrounding the application and efficacy of biologics, most notably PRP, BMAC and HA, in the clinical management of hip conditions. The hip conditions examined in this review include hip osteoarthritis, femoroacetabular impingement syndrome and associated labral tear pathology, avascular necrosis of the femoral head and gluteal/hamstring tendinopathy. While our review of the literature suggests that there is support for the implementation of biologics to relieve pain and improve function for hip conditions. Through further research efforts, it is important to stay updated with the clinical efficacy of biologics in hip preservation.
Feasibility of next-generation sequencing (Oncomine™ DX Target Test) for the screening of oncogenic mutations in advanced non-small-cell lung cancer patients
Authors: Takeyasu Yuki , Yoshida Tatsuya , Motoi Noriko , Teishikata Takashi , Tanaka Midori , Matsumoto Yuji , Shinno Yuki , Okuma Yusuke , Goto Yasushi , Horinouchi Hidehito , Kakishima Hiroki , Tsuchida Takaaki , Yamamoto Noboru , Ohe Yuichiro , Yatabe Yasushi
Published: April 2021

Background

The Oncomine™ Dx Target Test based on next-generation sequencing has been approved for the screening of oncogenic mutations in advanced non-small-cell lung cancer patients.

Methods

We assessed the tissue sample factors that affect the success rate of Oncomine™ Dx Target Test companion diagnostics and the feasibility of using biopsy specimens for Oncomine™ Dx Target Test companion diagnostics in advanced non-small-cell lung cancer patients.

Results

Ninety-nine biopsy samples were subjected to genetic testing using the Oncomine™ Dx Target Test companion diagnostics to detect v-raf murine sarcoma viral oncogene homologue B1 mutations (Cohort 1), and 136 biopsy samples were examined using Oncomine™ Dx Target Test companion diagnostics for the detection of multiple oncogenic mutations (Cohort 2) between July 2018 and April 2020. We retrospectively collected clinical and pathological data, including tissue size and tumour cell content. The success rate was 77% (76/99) in Cohort 1 and 93% (127/136) in Cohort 2. In Cohort 1, the success rate was significantly associated with the tumour cell content: the success rate was 63% for samples with a tumour cell content of <20%, whereas it was 83% for samples with a tumour cell content of 20% or higher (P = 0.0446). The tissue size also affected the success rate: a success rate of 57% was obtained for tissue sizes <4 mm2, whereas a success rate of 95% was obtained for tissue sizes of 4 mm2 or larger (P < 0.0001). In Cohort 2, the success rate was 100% when tumour specimens with a tissue size of 4 mm2 or larger were used.

Conclusions

Tissue size and tumour cell content were significantly associated with the success rate of Oncomine™ Dx Target Test companion diagnostics.
Focus Stacking Images of Morphological Character States for Differentiating the Adults ofIxodes affinisandIxodes scapularis(Acari: Ixodidae) in Areas of Sympatry
Authors: Nadolny Robyn M , Toliver Marcée , Gaff Holly D , Snodgrass John G , Robbins Richard G
Published: April 2021

Adult females and males of Ixodes affinis and Ixodes scapularis are illustrated by focus stacking image photography, and morphological character states are described that reliably differentiate the two species. In conjunction with other environmental cues, such as the questing phenology of adults, these characteristics will enable the rapid identification of adults of either sex along the southern Coastal Plain of the United States, where these species are sympatric.
The Cryo-EM Effect: Structural Biology of Neurodegenerative Disease Proteostasis Factors
Authors: Creekmore Benjamin C , Chang Yi-Wei , Lee Edward B
Published: April 2021

Neurodegenerative diseases are characterized by the accumulation of misfolded proteins. This protein aggregation suggests that abnormal proteostasis contributes to aging-related neurodegeneration. A better fundamental understanding of proteins that regulate proteostasis may provide insight into the pathophysiology of neurodegenerative disease and may perhaps reveal novel therapeutic opportunities. The 26S proteasome is the key effector of the ubiquitin-proteasome system responsible for degrading polyubiquitinated proteins. However, additional factors, such as valosin-containing protein (VCP/p97/Cdc48) and C9orf72, play a role in regulation and trafficking of substrates through the normal proteostasis systems of a cell. Nonhuman AAA+ ATPases, such as the disaggregase Hsp104, also provide insights into the biochemical processes that regulate protein aggregation. X-ray crystallography and cryo-electron microscopy (cryo-EM) structures not bound to substrate have provided meaningful information about the 26S proteasome, VCP, and Hsp104. However, recent cryo-EM structures bound to substrate have provided new information about the function and mechanism of these proteostasis factors. Cryo-EM and cryo-electron tomography data combined with biochemical data have also increased the understanding of C9orf72 and its role in maintaining proteostasis. These structural insights provide a foundation for understanding proteostasis mechanisms with near-atomic resolution upon which insights can be gleaned regarding the pathophysiology of neurodegenerative diseases.
Asymmetry of Hippocampal Tau Pathology in Primary Age-Related Tauopathy and Alzheimer Disease
Authors: Walker Jamie M , Fudym Yelena , Farrell Kurt , Iida Megan A , Bieniek Kevin F , Seshadri Sudha , White Charles L , Crary John F , Richardson Timothy E
Published: April 2021

Primary age-related tauopathy (PART) is a neurodegenerative entity defined as neurofibrillary degeneration generally restricted to the medial temporal region (Braak stage I–IV) with complete or near absence of diffuse and neuritic plaques. Symptoms range in severity but are generally milder and later in onset than in Alzheimer disease (AD). Recently, an early predilection for neurofibrillary degeneration in the hippocampal CA2 subregion has been demonstrated in PART, whereas AD neuropathologic change (ADNC) typically displays relative sparing of CA2 until later stages. In this study, we utilized a semiquantitative scoring system to evaluate asymmetry of neurofibrillary degeneration between left and right hippocampi in 67 PART cases and 17 ADNC cases. 49% of PART cases demonstrated asymmetric findings in at least one hippocampal subregion, and 79% of the asymmetric cases displayed some degree of CA2 asymmetry. Additionally, 19% of cases revealed a difference in Braak score between the right and left hippocampi. There was a significant difference in CA2 neurofibrillary degeneration (p = 0.0006) and CA2/CA1 ratio (p < 0.0001) when comparing the contralateral sides, but neither right nor left was more consistently affected. These data show the importance of analyzing bilateral hippocampi in the diagnostic evaluation of PART and potentially of other neurodegenerative diseases.
Effects of Robinia pseudoacacia on the undergrowth of herbaceous plants and soil properties in the Loess Plateau of China
Authors: Guo Qian , Wen Zhongming , Zheng Cheng , Li Wei , Fan Yongming , Zhu Duoju
Published: April 2021

Aims

The introduction of Robinia pseudoacacia (RP) has some effects on undergrowth herbaceous plants (UH), soil properties and their relationships, which may be related to the vegetation zone. However, few studies have tested effects of RP on UH and soil over a large-scale area of the Loess Plateau.

Methods

The study area consisted of three vegetation zones (the steppe, forest-steppe and forest zone). Two canopy plant types were selected: RP stands and adjacent native vegetation. We measured five leaf functional traits: leaf carbon content (LC), leaf nitrogen content (LN), leaf phosphorus content (LP), specific leaf area (SLA) and leaf tissue density (LTD). The functional diversity, species diversity and community-weighted mean (CWM) traits were calculated.

Important Findings

(i) CWM.LN, CWM.LP and CWM.SLA increased significantly, whereas CWM.LC and CWM.LTD decreased significantly in the three vegetation zones, compared with the native communities. (ii) Species diversity, functional diversity and community biomass decreased in the steppe zone, increased in the forest zone, and did not differ significantly in the forest-steppe zone. (iii) We found only soil organic carbon (P < 0.05) and soil total nitrogen (P < 0.05) in the forest zone decreased significantly compared with the native plots. (iv) The relationship between UH and soil properties was affected by RP and the vegetation zone. Overall, the effect of RP on UH and soil properties was associated with the vegetation zone. This result is of great significance to the planning of restoration and reconstruction of artificial forests in the Loess Plateau.
Impingement by a polymyomatous uterus: a rare cause of large bowel obstruction
Authors: Andersen Lalita M , Bong Christopher Y S , Burstow Matthew J , Yuide Peter J
Published: April 2021

A primiparous female developed acute large bowel obstruction Day 1 post lower segment Caesarean section. Initially presumed to be post-operative ileus, increasing abdominal pain and distension over the next 24 h prompted a surgical consult. Computed tomography imaging demonstrated an abrupt transition point of the large bowel behind a polymyomatous uterus. Although this case resolved with vigorous patient mobilization, literature review reveals previous cases resolving only after intraoperative mobilization of the uterus. It is distinct from ileus as bowel sounds are present, onset is abrupt, progression is rapid and mobilization of the uterus causes immediate resolution. This condition is likely to be more common than the literature would suggest, its scarcity partially due to the reluctance to image young females especially during pregnancy.
Tissue-type specific accumulation of the plastoglobular proteome, transcriptional networks, and plastoglobular functions
Authors: Michel Elena J S , Ponnala Lalit , van Wijk Klaas J
Published: April 2021

Plastoglobules are dynamic protein–lipid microcompartments in plastids enriched for isoprenoid-derived metabolites. Chloroplast plastoglobules support formation, remodeling, and controlled dismantling of thylakoids during developmental transitions and environmental responses. However, the specific molecular functions of most plastoglobule proteins are still poorly understood. This review harnesses recent co-mRNA expression data from combined microarray and RNA-seq information in ATTED-II on an updated inventory of 34 PG proteins, as well as proteomics data across 30 Arabidopsis tissue types from ATHENA. Hierarchical clustering based on relative abundance for the plastoglobule proteins across non-photosynthetic and photosynthetic tissue types showed their coordinated protein accumulation across Arabidopsis parts, tissue types, development, and senescence. Evaluation of mRNA-based forced networks at different coefficient thresholds identified a central hub with seven plastoglobule proteins and four peripheral modules. Enrichment of specific nuclear transcription factors (e.g. Golden2-like) and support for crosstalk between plastoglobules and the plastid gene expression was observed, and specific ABC1 kinases appear part of a light signaling network. Examples of other specific findings are that FBN7b is involved with upstream steps of tetrapyrrole biosynthesis and that ABC1K9 is involved in starch metabolism. This review provides new insights into the functions of plastoglobule proteins and an improved framework for experimental studies.
Neurobiology
Authors: Israel Sonia , Benrimoh David , Daniels Sylvanne , Turecki Gustavo
Published: April 2021

This chapter explores the evidence of disturbances in various neurobiological pathways in depression. No unifying pathophysiological mechanism has yet been discovered. Depression is more than simply a deficiency in a single neurotransmitter or pathway, as neurobiological correlates of depression have been identified in diverse studies. This chapter reviews depression-related changes in neurotransmitter systems, neurogenesis, inflammation, stress response, and functional genomics including epigenetics, and how these might contribute to the depressive phenotype. The diverse neurobiological findings of depression reflect the nature of its symptomatology, and likely etiological heterogeneity. Current evidence suggests that depression is not a single condition, but rather multiple overlapping phenotypes with converging and diverging underlying pathophysiological processes. New treatments may be identified with a better understanding of depression neurobiology. Such advances could also lead to the development of prognostic and diagnostic markers, which would allow for more personalized treatment and resource allocation.
Genetic Risk Factors of Depression
Authors: Halldorsdottir Thorhildur , Hilmarsdottir Hildur Ýr
Published: April 2021

Research on the genetic underpinnings of depression has rapidly advanced in the past decade. This field of research provides a promising avenue toward improving the diagnosis of, prevention of, and treatment for this devastating disorder. The goal of this chapter is to review the main genetic and gene-by-environment interaction findings on depression. We first describe family and twin studies used to empirically study the familial aggregation of depression. Second, we provide a review of the genome-wide association studies (GWAS) published to date. Building on GWAS findings, we will discuss the use of polygenic risk scores in predicting depression. We also review the most robust candidate gene studies and gene-by-environment interaction studies. Finally, we discuss the clinical implications of the findings and promising strategies for making further progress within this field.
Environmental and Social Risk Factors in Depression
Authors: Sanchez Katherine , Sanchez Eduardo J.
Published: April 2021

An understanding of the social and environmental factors that contribute to risk for developing depression is important for illustrating the potential for primary prevention and identification of target groups and social contexts. The social determinants are thought to impact health indirectly through mechanisms such as stress associated with low socioeconomic status, experiences of disempowerment and violence, hopelessness, helplessness, and income insecurity. They impact health more directly through reduced access to health services for physical and mental health problems. Evidence from neurobiology and epidemiology suggests that early life stress and related adverse experiences cause enduring brain dysfunction and are a significant risk factor for the development and prevalence of a wide range of health problems throughout a person’s lifespan, including substance misuse/abuse, depression, and obesity. The practicing psychiatrist will be a better clinician by delivering evidence-based clinical care that is informed by individuals’ burden of social and environmental factors and by understanding and, in some instances, advocating for policies that can ease the burden of social determinants on populations.
Anxiety Disorders
Authors: Yasinski Carly , Seifert Bonnie , Coghlan Callan M. , Rothbaum Barbara O.
Published: April 2021

This chapter discusses the similarities, differences, and comorbidities between depression and anxiety disorders broadly defined, including generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. The high level of comorbidity between anxiety disorders and depression is explicated, and the negative consequences of this comorbidity, including higher severity, functional impairment, and worse response to treatment, are discussed. Major theoretical models for differentiating anxiety and depression, including the tripartite model, the integrative hierarchical model, and the quadripartite model, are explained. Translational research, including neurological, psychophysiological, and genetic underpinnings of the similarities and differences between anxiety and depression, is reviewed. The chapter concludes with broad treatment implications and recommendations.
General Medical Conditions
Authors: Perry Seth W. , Wong Ma-Li , Licinio Julio
Published: April 2021

Our appreciation and understanding of the interrelationships between disrupted metabolic function and psychiatric disease, depression in particular, have increased significantly over the last few decades. Several broad-scale pathophysiologic mechanisms implicated in both disease areas include inflammation, cytokine and hypothalamic–pituitary–adrenal (HPA) axis dysregulation, oxidative stress, neurotransmitter disruptions, neurogenesis and neuroplasticity, and the microbiome. This chapter will explore these mechanistic overlaps of depression with metabolic disorders, defined broadly to include obesity, diabetes, and cardiovascular disease. The different components of metabolic syndrome will be discussed within this framework. We will touch briefly on relationships between the numerous yet rare inherited metabolic disorders and depression. We will conclude with a discussion of integrated therapeutic strategies for treating depression comorbid with metabolic disease.
First-Line and Combination Therapeutics for Major Depressive Disorder
Authors: Jha Manish K.
Published: April 2021

Major depressive disorder (MDD) affects one in five adults during their lifetime. Patients with MDD and their clinicians have a multitude of options to select for management of this chronic and/or recurrent condition. Selection of treatment modalities may be guided by the severity of illness. Nonpharmacologic treatments such as psychotherapy or exercise may be considered for those with mild symptom severity, with pharmacologic treatment reserved for those with moderate or higher symptom severity. Severe or very severe depression may warrant the combination of both pharmacologic and psychotherapeutic treatments. In patients who fail to improve adequately with one or more first-line treatments, augmentation with second-generation antipsychotics should be considered. There currently are no objective markers to guide the selection of one first-line treatment over other. Exciting ongoing research in the field of depression may inform new methods to personalize treatment selection and potentially lead to the development of mechanistically novel antidepressants.
Pharmacological Strategies for Targeting Residual Symptoms in Depression
Authors: Fava Maurizio
Published: April 2021

Achieving full symptom remission in major depressive disorder (MDD) should be the ultimate objective in the treatment of depressed patients. However, antidepressant monotherapies have shown to have limited efficacy in the treatment of MDD, as evidenced by the relatively high rate of residual symptoms even among responders to antidepressant treatments. These symptoms, which include anxiety, irritability, insomnia, somnolence/fatigue, apathy, and cognitive and executive dysfunction, are associated with an increased risk of relapse and poor psychosocial functioning. Comprehensive clinical data are not yet available to guide management of these symptoms—whether residual or drug-related—in patients treated pharmacologically for depressive disorders. Suggested approaches to the management of residual symptoms include addressing treatment-emergent side effects and comorbid conditions, optimizing antidepressant dosing, and using augmentation therapies. In this chapter, we will review how best to assess residual symptoms and some of the preferred pharmacological strategies to address them.
Cognitive Behavior Therapy
Authors: Hollon Steven D.
Published: April 2021

Cognitive behavior therapy can be as efficacious as antidepressant medications when adequately implemented, and it has an enduring effect that lasts beyond the end of treatment. Adding medications to cognitive behavior therapy makes it more efficacious still in terms of acute response but may interfere with its enduring effects. Some patients respond better to one modality or the other, and selection algorithms are being developed based on machine learning that can find the best treatment for a given patient (precision medicine). Treatment with uncomplicated patients who are just depressed is relatively straightforward and brief, but the approach can be expanded to deal with patients with more chronic and characterological depressions, although it can take considerably longer.
Behavioral Activation for Depression
Authors: Davis Brett , Dufour Steven C. , Janos Jessica A. , Sylvia Louisa G.
Published: April 2021

Behavioral activation (BA) is an empirically based psychotherapy for depression that improves symptoms by increasing a client’s contact with sources of positive reinforcement by making behavioral changes. Core aspects of BA approaches include performance and monitoring of scheduled activities that are selected based on a client’s values or specific depressive behaviors. To address individual and environmental barriers to activation, many BA treatment manuals also include additional components such as mindfulness techniques, social skills training, and contingency management strategies. Evidence supports the effectiveness of BA for treating depression, and researchers have found it to be as effective as many standard treatments for depression, including pharmacotherapy, cognitive therapy, and cognitive–behavioral therapy. Future directions are discussed, such as the application of BA to special populations and settings, including for groups, remote delivery, and specific subpopulations.
Neuromodulation for Depression
Authors: Coetzee John P. , Williams Nolan
Published: April 2021

Neuromodulation (also known as neurostimulation) is a growing and important category of treatments for depression. First-line treatments such as pharmacotherapy and counseling often fail to achieve remission, and neuromodulation can help many such patients. Neuromodulatory techniques can be broadly divided into invasive approaches, which include deep brain stimulation, epidural cortical stimulation, and vagal nerve stimulation, and noninvasive approaches, which include electroconvulsive therapy, transcranial magnetic stimulation, theta burst stimulation, and transcranial direct-current stimulation, among others. While efficacy varies among techniques, those with the most efficacy tend to be those that target nodes of a proposed tripartate functional connected circuit that includes left dorsolateral prefrontal cortex, subgenual anterior cingulate cortex, and vagus nerve. Treatments currently being developed that hold promise include accelerated intermittent theta burst stimulation and low-intensity focused ultrasound pulsation.
Probiotics and Nutraceuticals
Authors: Mason Brittany L. , Czysz Andrew H.
Published: April 2021

The field of nutritional psychiatry seeks to expand our understanding of how diet and nutrition influences the risk for psychiatric disorders, including depression. Improved knowledge about these relationships will provide new insights to guide the prevention and treatment of depression. A number of different methodologies trying to quantify how diet, nutrition, and dietary elements may affect mood and the risk for developing depression are detailed in this chapter, including naturalistic studies of diet, specific analysis of dietary elements, and clinical trials using dietary elements as treatments. Dietary elements that are commonly taken used as supplements but are suggested to function in some ways like medication are referred to as nutraceuticals. Those with reasonable support for their use in depression are detailed here, including omega-3 fatty acids. Continued examination of the role of the gut microbiota provides new avenues for treatment development and a deeper understanding of the physiology that underlies depression. Importantly, the gut microbiota is responsive to diet, taking what we eat and turning it into other products, and these byproducts are thought to have an important role in mood regulation. Thus, cultivation or supplementation of important bacterial groups by dietary modulation or probiotics may be new tools for improving depressive symptoms. This chapter will provide a broad perspective on the knowledge of how nutrition influences depression and some emerging probiotic and nutraceutical treatment strategies.
Chronobiological Treatments
Authors: Lam Raymond W.
Published: April 2021

Chronobiology is the study of circadian rhythms that are present in many aspects of our daily health, from molecular to behavioral levels. Bright environmental light is known to synchronize the biological clock in the brain that regulates circadian hormonal and sleep–wake cycles. There is increasing evidence for disruption of circadian rhythms in the pathophysiology of major depressive disorder (MDD), especially in seasonal affective disorder (SAD). Chronobiological treatments that target the circadian system, including wake therapy (total sleep deprivation) and light therapy, have been studied for over four decades, with evidence supporting their efficacy in SAD and non-seasonal MDD, as well as in other psychiatric conditions. Wake and light therapies are useful additions to the clinical armamentarium for patients with MDD because of their noninvasive nature, low propensity for adverse events, rapid onset of effect, low cost, and ease of combining with other treatments for depression.
Child and Adolescent Depression
Authors: Diederich Andrew , Jones Jessica M. , Emslie Graham J.
Published: April 2021

Early onset depression is prevalent and causes significant morbidity, mortality, and psychosocial impairment. Evidence-based psychosocial and psychopharmacological treatments are available for depressed youth, but many children and adolescents do not receive sufficient treatment. Pediatric and adult depressive disorders involve essentially the same symptoms, with the exception of irritability, as depressed youth may present with irritable mood in the absence of explicit sadness. This chapter examines aspects of depression that are unique to children and adolescents. It focuses on diagnosis and symptomatology, epidemiology, and pharmacological, psychotherapeutic, and other treatments. The chapter also addresses barriers to treatment of early onset depression and future research directions.
Postpartum Depression
Authors: Patel Nikita , Kroska Emily B. , Stowe Zachary N.
Published: April 2021

Perinatal care, including the management of mental health issues, is often under the auspices of primary care providers. This chapter provides an overview of identification, diagnosis, and treatment of postpartum depression (PPD). It reviews the prevalence of PPD in the general and minority populations, related disorders, common symptoms, and genetic and psychosocial risk factors to facilitate PPD management in the primary care clinic. The most commonly employed screening scale, the Edinburgh Postnatal Depression Scale, has several advantages in the primary care setting. The potential adverse consequences of untreated PPD on the mother and her family underscore the importance of identifying and providing effective interventions, including preventive strategies, in high-risk groups. As a class, antidepressant medications have amassed a large reproductive safety literature, including considerable data in breastfeeding and women with PPD. Notably, psychosocial therapies have demonstrated equal efficacy in women with PPD and are viable treatment options.
Precision Medicine for the Treatment of Depression
Authors: Trivedi Madhukar H. , Kahalnik Farra , Greer Tracy L.
Published: April 2021

Although in recent years we have gained a deeper understanding of the pathophysiology of major depressive disorder, this improved understanding has not translated into improved treatment outcomes. Therefore, the screening of putative biological markers may be crucial to facilitate more rapid, successful treatment. Ongoing research has explored the importance of studying physiological biomarkers, including neuroimaging, neurophysiology, genomics, proteomics, and metabolomics, as well as cognition, to gain a better understanding of subtypes of depression and treatment response. However, only through an integrated, multimodal biomarker approach can we truly achieve better outcomes.
Possible Effects on VA Outpatient Care of Expanding Medicaid: Implications of Having Access to Overlapping Publicly Funded Health Care Services
Authors: O’Mahen Patrick N , Petersen Laura A
Published: April 2021

Background

Because veterans who use Veterans Health Administration (VA) health care retain VA eligibility while enrolling in Medicaid, increasing Medicaid eligibility may create improved health system access but also create unique challenges for the quality and coordination of health care for veterans. We analyze how pre-Affordable Care Act (ACA) state Medicaid expansions influence VA and Medicaid-funded outpatient care utilization.

Materials and Methods

This study uses Difference-in-difference analysis to evaluate association between pre-ACA 2001 Medicaid expansions and VA utilization in a natural experiment. Veterans aged 18-64 years living in a study state during the study period were the participants. Dependent variables included participants’ proportion of outpatient care received at the VA, whether a participant recorded care with both Medicaid and the VA, and total outpatient utilization. We analyzed changes between two states that expanded Medicaid in 2001 against three similar states that did not from 1999 to 2006. We adjusted for age, non-White race, gender, disease burden, and distance to VA facilities. This study was approved by the Baylor College of Medicine Institutional Review Board (IRB), protocol number H-40441.

Results

In total, 346,364 VA-enrolled veterans lived in the five study states during the time of our study, 70,987 of whom were enrolled in Medicaid for at least 1 month. For low-income veterans, Medicaid expansion was associated with a 2.88 percentage-point decline in the VA proportion of outpatient services (99% CI −3.26 to −2.49), and a 2.07-point increase (1.80 to 2.35) in the percentage of patients using both VA and Medicaid services. Results also showed small increases in total (VA plus Medicaid) annual per-capita outpatient visits among low-income veterans. We estimate that this corresponds to an annual reduction of 80,338 VA visits across study states (66,155-94,521).

Conclusions

This study shows usage shifts when Medicaid expansion allows veterans to gain access to non-VA care. It highlights increased potential for care-coordination challenges among VA patients as states implement ACA Medicaid expansion and policymakers consider additional public health insurance options, as well as programs like CHOICE and the MISSION Act that increase veteran choices of traditional VA and community care providers.
The Use of Whole Blood Transfusion During Non-Traumatic Resuscitation
Authors: Nowadly Craig D , Fisher Andrew D , Borgman Matthew A , Mdaki Kennedy S , Hill Ronnie L , Nicholson Susannah E , Bynum James A , Schauer Steven G
Published: April 2021

Background

Evidence from military populations showed that resuscitation using whole blood (WB), as opposed to component therapies, may provide additional survival benefits to traumatically injured patients. However, there is a paucity of data available for the use of WB in uninjured patients requiring transfusion. We sought to describe the use of WB in non-trauma patients at Brooke Army Medical Center (BAMC).

Materials and Methods

Between January and December 2019, the BAMC ClinComp electronic medical record system was reviewed for all patients admitted to the hospital who received at least one unit of WB during this time period. Patients were sorted based on their primary admission diagnosis. Patients with a primary trauma-based admission were excluded.

Results

One hundred patients were identified who received at least one unit of WB with a primary non-trauma admission diagnosis. Patients, on average, received 1,064 mL (750–2,458 mL) of WB but received higher volumes of component therapy. Obstetric/gynecologic (OBGYN) indications represented the largest percentage of non-trauma patients who received WB (23%), followed by hematologic/oncologic indications (16%).

Conclusion

In this retrospective study, WB was most commonly used for OBGYN-associated bleeding. As WB becomes more widespread across the USA for use in traumatically injured patients, it is likely that WB will be more commonly used for non-trauma patients. More outcome data are required to safely expand the indications for WB use beyond trauma.
Application of Damage Control Tactics and Transpapillary Biliary Decompression for Organ-Preserving Surgical Management of Liver Injury in Combat Patient
Authors: Khomenko Igor , Tsema Ievgen , Humeniuk Kostiantyn , Makarov Heorhii , Rahushyn Dmytro , Yarynych Yurii , Sotnikov Artur , Slobodianyk Viktor , Shypilov Serhii , Dubenko Dmytro , Barabanchyk Olena , Dinets Andrii
Published: April 2021

The combat penetrating gunshot injury is frequently associated with damage to the liver. Bile leak and external biliary fistula (EBF) are common complications. Biliary decompression is commonly applied for the management of EBF. Also, little is known about the features of combat trauma and its management in ongoing hybrid warfare in East Ukraine.

A 23-year-old male was diagnosed with thoracoabdominal penetrating gunshot wound (GSW) by a high-energy multiple metal projectile. Damage control tactics were applied at all four levels of military medical care. Biliary decompression was achieved by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and the placement of biliary stents. Occlusion of the stent was treated by stent replacement, and scheduled ERCP was performed. Partial EBF was diagnosed from the main wound defect of the liver and closed without surgical interventions on the 34th day after the injury.

A combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective along with the application of damage control tactics. A scheduled ERCP application is an effective approach for the management of EBF, and liver resection could be avoided. A successful biliary decompression was achieved by the transpapillary intervention with the installation of stents. Stent occlusion could be diagnosed in the early post-traumatic period, which is effectively managed by scheduled ERCP as well as stent replacement with a large diameter as close as possible to the place of bile leak.
Energy Balance and Energy Availability During a Selection Course for Belgian Paratroopers
Authors: Mullie Patrick , Maes Pieter , van Veelen Laurens , Van Tiggelen Damien , Clarys Peter
Published: April 2021

Introduction

Adequate energy supply is a prerequisite for optimal performances and recovery. The aims of the present study were to estimate energy balance and energy availability during a selection course for Belgian paratroopers.

Methods

Energy expenditure by physical activity was measured with accelerometer (ActiGraph GT3X+, ActiGraph LLC, Pensacola, FL, USA) and rest metabolic rate in Cal.d−1 with Tinsley et al.’s equation based on fat-free mass = 25.9 × fat-free mass in kg + 284. Participants had only access to the French individual combat rations of 3,600 Cal.d−1, and body fat mass was measured with quadripolar impedance (Omron BF508, Omron, Osaka, Japan). Energy availability was calculated by the formula: ([energy intake in foods and beverages] − [energy expenditure physical activity])/kg FFM−1.d−1, with FFM = fat-free mass.

Results

Mean (SD) age of the 35 participants was 25.1 (4.18) years, and mean (SD) percentage fat mass was 12.0% (3.82). Mean (SD) total energy expenditure, i.e., the sum of rest metabolic rate, dietary-induced thermogenesis, and physical activity, was 5,262 Cal.d−1 (621.2), with percentile 25 at 4,791 Cal.d−1 and percentile 75 at 5,647 Cal.d−1, a difference of 856 Cal.d−1. Mean daily energy intake was 3,600 Cal.d−1, giving a negative energy balance of 1,662 (621.2) Cal.d−1. Mean energy availability was 9.3 Cal.kg FFM−1.d−1. Eleven of the 35 participants performed with a negative energy balance of 2,000 Cal.d−1, and only five participants out of 35 participants performed at a less than 1,000 Cal.d−1 negative energy balance level.

Conclusions

Energy intake is not optimal as indicated by the negative energy balance and the low energy availability, which means that the participants to this selection course had to perform in suboptimal conditions.
Alleged Allergy to Penicillin and Isolation Issues: Toward New Practices for French Navy?
Authors: Chartois Cyprien , Valois Aude , Paleiron Nicolas , Rivière Emilie , Elie Bertrand , Pontis Julien
Published: April 2021

Introduction

According to the literature, 8% of the population claim to have an allergy to penicillin. Allergy tests show that 90% of these patients tolerate this molecule. Physicians working in the French Navy are faced with situations of real isolation and only have a limited number of antibiotics on board, the majority of which are penicillins. They must anticipate the risks linked to the prescription of antibiotics before the mission. However, there is no French recommendation, either military or civilian, intended for general practitioners clarifying the management and allergy assessments of patients alleging a history of allergy to penicillin. This study is the first to evaluate the professional practices of French military practitioners taking care of these patients. The main objective was to evaluate the proportion of sailors who reported an allergy to penicillin and who have never been referred for a consultation with an allergist, by studying the medical files of all the submariners working on the submersible ballistic nuclear submarines squadron in Brest. The secondary objective was to compare these data with the practices of Navy doctors by means of questionnaires.

Material and methods

Our work is composed of two parts: monocentric study of the digital and paper medical files of Brest submariners (n = 814) looking for allergist consultation reports in cases alleging an allergy to penicillin, then comparison with a multicentric collection of all Navy doctors’ practices collected by an anonymized questionnaire (n = 37 out of 53 practicing at the time of the study).

Results

Forty-seven subjects out of 814 alleged an allergy to penicillin (5.8%). Among them, only 12 (25.5%) had undergone allergy tests, of which 3 (6.4%) were confirmed to be allergic, with no cross-reaction between β-lactam antibiotics. Yet, according to the questionnaire, 25 doctors (67%) report referring their patients to an allergist and 16 (43%) report having had difficulties at sea in connection with the prescription of antibiotics for these patients.

Conclusions

A study of medical records shows that the allergic risk is not anticipated for 74.5% of patients labeled allergic, despite the difficulties encountered at sea. Standardization of practices within the French Navy is necessary to avoid the prescription of second-line antibiotics, less effective and sometimes unavailable on board, and to improve patient safety in isolation situations. In agreement with French military allergists, we propose, in this article, guidelines for a systematic exploration of allegations of allergy to penicillin in the French Navy.