bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards a polarization prediction for LISA via intensity interferometry
Authors: Baumgartner Sandra , Bernardini Mauro , Canivete Cuissa José R , de Laroussilhe Hugues , Mitchell Alison M W , Neuenschwander Benno A , Saha Prasenjit , Schaeffer Timothée , Soyuer Deniz , Zwick Lorenz
Published: September 2020

Compact Galactic Binary Systems with orbital periods of a few hours are expected to be detected in gravitational waves (GW) by Laser Interferometer Space Antenna (LISA) or a similar mission. At present, these so-called verification binaries provide predictions for GW frequency and amplitude. A full polarization prediction would provide a new method to calibrate LISA and other GW observatories, but requires resolving the orientation of the binary on the sky, which is not currently possible. We suggest a method to determine the elusive binary orientation and hence predict the GW polarization, using km-scale optical intensity interferometry. The most promising candidate is CD–30° 11223, consisting of a hot helium subdwarf with mB = 12 and a much fainter white dwarf companion, in a nearly edge-on orbit with period 70.5 min. We estimate that the brighter star is tidally stretched by 6 per cent. Resolving the tidal stretching would provide the binary orientation. The resolution needed is far beyond any current instrument, but not beyond current technology. We consider scenarios where an array of telescopes with km-scale baselines and/or the Very Large Telescope (VLT) and Extremely Large Telescope (ELT) are equipped with recently developed kilopixel sub-ns single-photon counters and used for intensity interferometry. We estimate that a team-up of the VLT and ELT could measure the orientation to ±1° at 2σ confidence in 24 h of observation.
Isotopic ratios in the red giant component of the recurrent nova T Coronae Borealis
Authors: Pavlenko Y V , Evans A , Banerjee D P K , Geballe T R , Munari U , Gehrz R D , Woodward C E , Starrfield S
Published: September 2020

We report the determination of abundances and isotopic ratios for C, O, and Si in the photosphere of the red giant (RG) component of the recurrent nova (RN) T Coronae Borealis from new 2.284–2.402 μm and 3.985–4.155 μm spectroscopy. Abundances and isotopic ratios in the photosphere may be affected by (i) processes in the RG interior which are brought to the surface during dredge-up and (ii) contamination of the RG, either during the common envelope phase of the binary evolution or by material synthesized in RN eruptions, or a combination of the two. We find that the abundances of C, O, and Si are reasonably consistent with the expected composition of an RG after first dredge-up, as is the 16O/17O ratio. The 28Si/29Si ratio is found to be 8.6 ± 3.0, and that for 28Si/30Si is 21.5 ± 3.0. The 12C/13C ratio (10 ± 2) is somewhat lower than expected for first dredge-up. The 16O/18O ratio (41 ± 3) is highly inconsistent with that expected either from RG evolution (∼550) or from contamination of the RG by the products of a nova thermonuclear runaway. In particular, the C and O isotopic ratios taken in combination are a puzzle. We urge confirmation of our results using spectroscopy at high resolution. We also encourage a thorough theoretical study of the effects on the secondary star in an RN system of contamination by ejecta having anomalous abundances and isotopic ratios.
Limitations to the Right to Religious Freedom: Rethinking Key Approaches
Authors: Raza Farrah
Published: September 2020

The right to freedom of religion or belief is one of the most controversial fundamental human rights, and an increasing number of cases on religious freedom highlight the need for normative clarity about its limits. Courts across jurisdictions adopt different approaches to justifying limitations to religious claims in order to resolve conflicts. This article identifies current key approaches to justifying limits to religious practices before proposing a perfectionist version of the harm principle as an alternative. Section 1 sets out the complexities of determining the limitations to religious freedom. Section 2 identifies the shortcomings of four dominant approaches to limitations, and these include the following categories: (i) practices deemed to be against the liberal democratic order; (ii) practices that breach the duty of neutrality; (iii) practices that do not constitute a core religious belief; and (iv) the choice of alternatives. Section 3 proposes a typology of harms to the autonomy of others as a model for limitations to religious freedom. Section 4 concludes by emphasizing the need for consistency in deciding limitations.
Henry James, The Outcry, and the Possibilities of Connoisseurship
Authors: Deli Margaret
Published: September 2020

This article reveals Henry James’s commitment to professional connoisseurship as a means of asserting control over a mass reading public. Focusing on The Outcry (1911), James’s last published novel, it demonstrates the author’s deployment of connoisseurial strategies to produce a text that, perhaps surprisingly, turns away from the performance of authorial nuance. A related strand of analysis situates The Outcry within the cultural and social context of the Edwardian art drain, the period of time when a significant number of British-owned art objects were sold to museums and private collectors, most often in the United States. I argue that in this text, James seizes upon the figure of the professional connoisseur as a cultural hero and proxy for the novelist author. At the same time, he makes a point of celebrating and promoting the autocratic power exercised by this figure. Although The Outcry is often disregarded as a simple, even superficial work, these moves articulate a complex manifestation of class conflict, aesthetic training, and cultural power. They simultaneously reflect James’s late-in-life conviction that connoisseurship might itself serve as a literary strategy for seeing and shaping meaning.
Assessing Agricultural Toxicity in Brazil: Advances and Opportunities in the 21st Century
Authors: da Silva Artur Christian Garcia , Sousa Isabelly Paula , dos Santos Thaís Rosa Marques , Valadares Marize Campos
Published: September 2020

Agriculture in the 21st century faces multiple challenges to produce food for the growing population using ethical/sustainable and efficient methods safely for humans and the environment. Brazil today is a world leader in terms of production of food of plant origin, both for human consumption and animal feed. Agriculture and livestock raising are critical economic activities in maintaining a positive balance in its economy. As a consequence, the registration and use of pesticides in Brazil have grown at an accelerated rate. This work shows the current situation in Brazil in terms of the prevailing laws about the registration of pesticides, with a focus on the toxicological aspects related to human health. The regulatory aspects of registration of pesticides in Brazil, the mandatory testing for evaluating pesticide toxicity, adoption of the Globally Harmonized System of Classification and Labeling of Chemicals, and recent progress toward nonanimal methods to toxicity evaluation were explored in this work. In this field, Brazil has advanced and there are opportunities and challenges. There is still much to be done and investments to be made so that Brazil can definitively consolidate its conduct within the context of a Modern Regulatory Toxicology, which has entered the 21st century.
Proteometabolomic characterization of apical bud maturation in Pinus pinaster
Authors: Valledor Luis , Guerrero Sara , García-Campa Lara , Meijón Mónica
Published: August 2020

Bud maturation is a physiological process that implies a set of morphophysiological changes that lead to the transition of growth patterns from young to mature. This transition defines tree growth and architecture, and in consequence traits such as biomass production and wood quality. In Pinus pinaster Aiton, a conifer of great timber value, bud maturation is closely related to polycyclism (multiple growth periods per year). This process causes a lack of apical dominance, and consequently increased branching that reduces its timber quality and value. However, despite its importance, little is known about bud maturation. In this work, proteomics and metabolomics were employed to study apical and basal sections of young and mature buds in P. pinaster. Proteins and metabolites in samples were described and quantified using (n)UPLC-LTQ-Orbitrap. The datasets were analyzed employing an integrative statistical approach, which allowed the determination of the interactions between proteins and metabolites and the different bud sections and ages. Specific dynamics of proteins and metabolites such as histones H3 and H4, ribosomal proteins L15 and L12, chaperonin TCP1, 14-3-3 protein gamma, gibberellins A1, A3 and A8, strigolactones and abscisic acid, involved in epigenetic regulation, proteome remodeling, hormonal signaling and abiotic stress pathways showed their potential role during bud maturation. Candidates and pathways were validated employing interaction databases and targeted transcriptomics. These results increase our understanding of the molecular processes behind bud maturation, a key step towards improving timber production and natural pine forests management in a future scenario of climate change. However, further studies are necessary using different P. pinaster populations that show contrasting wood quality and stress tolerance in order to generalize the results.
Newly emerged resistance-breaking variants of cucumber mosaic virus represent ongoing host-interactive evolution of an RNA virus
Authors: Heo Kyeong-Jae , Kwon Sun-Jung , Kim Mi-Kyeong , Kwak Hae-Ryun , Han Soo-Jung , Kwon Min-Jun , Rao A L N , Seo Jang-Kyun
Published: September 2020

Understanding the evolutionary history of a virus and the mechanisms influencing the direction of its evolution is essential for the development of more durable strategies to control the virus in crop fields. While the deployment of host resistance in crops is the most efficient means to control various viruses, host resistance itself can act as strong selective pressure and thus play a critical role in the evolution of virus virulence. Cucumber mosaic virus (CMV), a plant RNA virus with high evolutionary capacity, has caused endemic disease in various crops worldwide, including pepper (Capsicum annuum L.), because of frequent emergence of resistance-breaking variants. In this study, we examined the molecular and evolutionary characteristics of recently emerged, resistance-breaking CMV variants infecting pepper. Our population genetics analysis revealed that the high divergence capacity of CMV RNA1 might have played an essential role in the host-interactive evolution of CMV and in shaping the CMV population structure in pepper. We also demonstrated that nonsynonymous mutations in RNA1 encoding the 1a protein enabled CMV to overcome the deployed resistance in pepper. Our findings suggest that resistance-driven selective pressures on RNA1 might have contributed in shaping the unique evolutionary pattern of CMV in pepper. Therefore, deployment of a single resistance gene may reduce resistance durability against CMV and more integrated approaches are warranted for successful control of CMV in pepper.
Early Effects of COVID-19 on Programs Providing Medications for Opioid Use Disorder in Jails and Prisons
Authors: Bandara Sachini , Kennedy-Hendricks Alene , Merritt Sydney , Barry Colleen L. , Saloner Brendan
Published: August 2020

Objectives:

To describe how the novel coronavirus (COVID-19) pandemic has affected opioid agonist treatment (OAT) programs in jails and prisons.

Methods:

In May 2020, we conducted an online survey of 19 carceral systems that provided methadone and/or buprenorphine treatment for incarcerated populations before COVID-19. Eleven survey items examined challenges and changes to these programs as a result of the pandemic. Sixteen of 19 programs (84%) responded to the survey.

Results:

Ten out of 16 systems reported downsizing their OAT programs. Seven of 16 systems made changes to medication dispensation processes. Half of systems report challenges implementing physical distancing (n = 8), and/or obtaining personal protective equipment (n = 8). In 13 out of 16 systems some OAT program participants were released early due to COVID-19 infection risk.

Conclusions:

Jails and prisons with existing OAT programs have curtailed their operations in the context of the COVID-19 pandemic. Given the robust evidence base around OAT for treating opioid use disorder and averting overdose deaths, guidance is needed on maintaining and ramping up medication access as carceral facilities grapple with implementing COVID-19 mitigation.
Associations Between Polysubstance Use Patterns and Receipt of Medications for Opioid Use Disorder Among Adults in Treatment for Opioid Use Disorder
Authors: Ford Becky R. , Bart Gavin , Grahan Brian , Shearer Riley D. , Winkelman Tyler N.A.
Published: August 2020

Objective:

To examine trends in polysubstance use among adults in treatment for opioid use disorder (OUD) and estimate associations between polysubstance use patterns and receipt of medications for OUD (MOUD).

Methods:

We conducted a cross-sectional longitudinal analysis of treatment admissions for opioid use from 1992 to 2017 using the Treatment Episodes Data Set-Admissions (N = 9,440,157). We used multiple logistic regression to examine co-use patterns and estimate associations between receipt of MOUD and polysubstance use categories (opioid only, any methamphetamine, any cocaine, any alcohol, any benzodiazepine).

Results:

Between 1992 and 2017, treatment admissions involving opioid/cocaine (−17.2 percentage points [PP]) and opioid/alcohol co-use (−12.5 PP) decreased while opioid/methamphetamine (10.1 PP) and opioid/benzodiazepine co-use (5.6 PP) increased. In 2016 to 2017, receipt of medications for OUD was significantly higher for those who used opioids only (38.5%; 95% confidence interval [CI] 38.4–38.6) compared with individuals who used opioids with cocaine (35.7%; 95% CI 35.6–35.9), methamphetamine (23.9%; 95% CI 23.7–24.2), alcohol (25.0%; 95% CI 24.8–25.2), or benzodiazepines (34.6%; 95% CI 34.3–34.9). If those who co-used opioids with other substances received MOUD at the same rate as those who used opioids only, 47,400 additional people would have received MOUD between 2016 and 2017.

Conclusions:

Opioid/methamphetamine and opioid/benzodiazepine increased substantially between 1992 and 2017. Co-use of other substances with opioids was associated with significantly lower receipt of MOUD. Treatment facilities should increase access to MOUD for individuals who co-use opioids with other substances. This change would extend evidence-based treatment to thousands of individuals and save lives.
Safely Reducing the Incidence of Contralateral Slipped Capital Femoral Epiphysis: Results of a Prospectively Implemented Prophylactic Fixation Protocol Using the Posterior Sloping Angle
Authors: St George Justine , Genon Michel , Little David G.
Published: August 2020

Background:

Bilateral slipped capital femoral epiphysis (SCFE) is common. The management of the contralateral hip in unilateral SCFE remains controversial. The aim of this study was to report on the clinical outcomes using a posterior sloping angle (PSA) threshold of 14.5 degrees for prophylactic fixation in preventing contralateral SCFE.

Methods:

Having previously established through a retrospective study that PSA was predictive of future slip, the authors put in place a protocol where patients with unilateral SCFE who had a PSA ≥14.5 degrees on the contralateral side were offered prophylactic fixation. Those with unilateral SCFE presenting between January 2008 and December 2018 with a minimum of 12-month follow-up were included. Patients with renal or endocrine disorders were excluded. Primary outcomes were the number of slips prevented, the number needed to treat, and the complication rate.

Results:

Of the 219 patients who were included, 114 (52.1%) underwent prophylactic fixation.

A PSA threshold of 14.5 degrees prevented 77% of subsequent slips with a number needed to treat of 2.4 in our population. There were no cases of chondrolysis, avascular necrosis, or periprosthetic fracture associated with prophylactic pinning.

Conclusions:

Prophylactic fixation using a PSA of 14.5 degrees is safe, decreases unnecessary intervention, and reduces 77% of subsequent SCFE. The PSA can increase over time and the authors recommend that the protocol be applied for the duration of follow-up.

Level of Evidence:

Level III
The Byzantine Role of Big Data Application in Nursing Science
Authors: Caruso Rosario , Arrigoni Cristina , Conte Gianluca , Rocco Gennaro , Dellafiore Federica , Ambrogi Federico , Stievano Alessandro
Published: August 2020

Big data have the potential to determine enhanced decision-making process and to personalize the approach of delivering care when applied in nursing science. So far, the literature on this topic is still not synthesized for the period between 2014 and 2018. Thus, this systematic review aimed to identify and synthesize the most recent evidence on big data application in nursing research. The systematic search was undertaken for the evidence published from January 2014 to May 2018, and the outputs were formatted using the PRISMA Flow Diagram, whereas the quality appraisal was addressed by recommendations consistent with the Critical Appraisal Skills Program. Twelve studies on big data in nursing were included and divided into two themes: the majority of the studies aimed to determine prediction assessment, while only four studies were related to the impact of big data applications to support clinical practice. This review tracks the recent state of knowledge on big data applications in nursing science, revealing the potential for nursing engagement in big data science, even if currently limited to some fields. Big data applications in nursing might have a tremendous potential impact, but are currently underused in research and clinical practice.
Evaluation of Radiation Doses in Pediatric Patients Undergoing Conventional Chest X-ray Examination
Authors: Lahham Adnan , Issa Ahlam
Published: August 2020

This work deals with the evaluation of radiation doses from chest x rays for 240 male and female pediatric patients selected randomly from four Palestinian hospitals. The patient population was divided into five age groups: Newborn, 1, 5, 10, and 15 y old. Doses were theoretically calculated by using Monte Carlo based codes: CALDOSE-X5 and PCXMC-2.0. Patients’ data and type of radiographic systems used as well as exposure factors were provided by the administrations of the selected hospitals. Absorbed organ doses from AP and PA projections were evaluated for 76 pediatric patients selected from one hospital in East Jerusalem. The highest mean organ dose for these patients was 0.085 mGy to the breast in AP projection. Effective doses were estimated for the five age groups for all patients. The highest average effective dose was found for patients in the age group of 10 y and was about 0.13 mSv, while the lowest average effective dose was found for the 5-y age group, about 0.06 mSv. The mean effective dose for all investigated patients in the five age categories was about 0.08 mSv. Variations in effective doses for the same age group and x-ray examination among involved hospitals are remarkable.
A Potential Role for Excess Tissue Iron in Development of Cardiovascular Delayed Effects of Acute Radiation Exposure
Authors: Miller Steven J. , Chittajallu Supriya , Sampson Carol , Fisher Alexa , Unthank Joseph L. , Orschell Christie M.
Published: August 2020

Murine hematopoietic-acute radiation syndrome (H-ARS) survivors of total body radiation (TBI) have a significant loss of heart vessel endothelial cells, along with increased tissue iron, as early as 4 mo post-TBI. The goal of the current study was to determine the possible role for excess tissue iron in the loss of coronary artery endothelial cells. Experiments used the H-ARS mouse model with gamma radiation exposure of 853 cGy (LD50/30) and time points from 1 to 12 wk post-TBI. Serum iron was elevated at 1 wk post-TBI, peaked at 2 wk post-TBI, and returned to non-irradiated control values by 4 wk post-TBI. A similar trend was seen for transferrin saturation, and both results correlated inversely with red blood cell number. Perls’ Prussian Blue staining, used to detect iron deposition in heart tissue sections, showed myocardial iron was present as early as 2 wk following irradiation. Pretreatment of mice with the iron chelator deferiprone decreased tissue iron but not serum iron at 2 wk. Coronary artery endothelial cell density was significantly decreased as early as 2 wk vs. non-irradiated controls (P<0.05), and the reduced density persisted to 12 wk after irradiation. Deferiprone treatment of irradiated mice prevented the decrease in endothelial cell density at 2 and 4 wk post-TBI compared to irradiated, non-treated mice (P<0.03). Taken together, the results suggest excess tissue iron contributes to endothelial cell loss early following TBI and may be a significant event impacting the development of delayed effects of acute radiation exposure.
Shovel and Cut Technique: Beveled Vitrectomy Probes to Address Diabetic Tractional Retinal Detachments
Authors: Gerardo González-Saldivar , Chow David R.
Published: September 2020

Purpose:

To describe a surgical technique using the structural advantages of beveled tip cutters.

Methods:

The introduction of beveled tips has been one of the few modifications that have been performed to vitrectomy probes since first described by Machemer in 1972. Shovel and cut technique uses this incredible modification to access tighter planes and remove broad diabetic membranes.

Description of Technique:

The shovel and cut technique can be used with any gauge probe to which the bevel tip is applied. The beveled tip of the cutter is used in a shovel manner to create a tissue plane between the diabetic plaque and the retina. As the beveled tip of the cutter moves parallel to the underlying retina, scar tissue naturally feeds into the cutting port where it is cut and aspirated with low flow rates.

Conclusion:

Shovel and cut technique takes advantage of beveled tip technological innovation to allow easy access and tissue dissection of the most difficult plaques in diabetic membranes. This technique allows us to remove these plaques in a safer, more controlled manner than previous described techniques.
Effects of Localized Heating on Pain, Skin Perfusion, and Wound Healing After Lumbar Decompression
Authors: Kim Jeoung Hee , Shin Yong Soon
Published: August 2020

BACKGROUND: Current evidence regarding the effectiveness and safety of localized heating after spinal surgery for pain, peripheral tissue perfusion, and wound healing is conflicting. METHODS: This study was a prospective, single-blind, randomized controlled trial; 58 adult patients were randomized to an experimental group or a control group after spinal decompression surgery. All participants received localized cooling on postoperative days 1 and 2. The experimental group received localized heating at the surgical wound on postoperative days 3 and 4, and the control group kept normothermia without localized heating. Outcome variables were evaluated 1 hour after surgery and on day 4. RESULTS: Postoperative pain was significantly lower in the experimental versus control group (13.8 vs 23.0, P = .01). Skin perfusion was better in the experimental versus control group (4.7 vs 2.8, P = .001). There was no statistically significant difference in the wound healing status between the groups. CONCLUSION: Localized heating can effectively relieve postoperative pain and improve skin perfusion. These results suggest that localized heating tailored to the wound healing process may be beneficial for patients undergoing spinal surgery.
Information Needs and Preferences of Family Caregivers of Patients With Amyotrophic Lateral Sclerosis
Authors: Chu Hyeon Sik , Oh Juyeon
Published: August 2020

OBJECTIVE:The aim of this study was to explore the information needs and preferred sources of information of Korean family caregivers of patients with amyotrophic lateral sclerosis (ALS).METHODS:Family caregivers of patients with ALS (n = 108) completed a structured questionnaire to assess their information needs and preferred sources of information.RESULTS:Most of the caregivers obtained health information from Internet searches (89.8%) and healthcare professionals (85.2%). The source rated most helpful was healthcare professionals, and that rated least helpful was broadcast media. Family caregivers who were younger than 50 years and well educated and caregivers of bulbar-onset ALS patients had higher scores of information needs.CONCLUSION:Providing information through healthcare professionals and self-support groups could enhance family caregiver satisfaction. Family caregivers who are older and less educated need to be more empowered to be involved in information-based caring, and caregivers of patients with bulbar-onset ALS have substantial information needs.
Additive Manufacturing of Ankle-Foot Orthosis with Predefined Ankle Stiffness—A Case Report
Authors: Vasiliauskaite Egle , Van Paepegem Wim , Deckers Jan Patrick , Vermandel Miguel , Forward Malcolm , Plasschaert Frank
Published: August 2020

Introduction

The success of orthotic interventions depends on how well an individual patient's needs are identified and addressed. In this prospective study, we addressed the following question: Is it possible to additively manufacture an ankle-foot orthosis (AFO) with predefined ankle stiffness that would decrease excessive plantarflexion in the dropfoot gait?

Materials and Methods

A child with unilateral drop foot was recruited for this study and took part in three gait assessments. In the first gait assessment, the “optimal” AFO stiffness was determined using a hinged AFO with adjustable ankle stiffness. A leaf-spring-type AFO with predefined optimal ankle stiffness was then virtually designed and additively manufactured. The impact of this orthosis on the patient's gait before and after 6 weeks of acclimatization period was evaluated in the second and the third gait assessments, respectively.

Results

A hinged orthosis with an ankle stiffness of 0.009 N·m·deg−1·kg−1 was deemed to be the optimal for the study patient. The ankle stiffness of the additively manufactured AFO was 0.008 N·m·deg−1·kg−1. This orthosis decreased patient's excessive plantarflexion, but its impact was moderately inferior compared with that of the optimal hinged orthosis.

Conclusions

Despite having the same ankle stiffness, hinged AFO and leaf-spring AFO did not produce the same gait pattern. Therefore, to prescribe an optimal AFO, a better understanding of subject-AFO interaction in walking is needed.
Gut microbial dysbiosis as a limiting factor in the management of primary and secondary sarcopenia: an Asian Indian perspective
Authors: Bhattacharya Shinjini , Bhadra Rohini , Schols Annemie M.W.J. , Sambashivaiah Sucharita
Published: August 2020

Purpose of review

The article summarizes recent research advances on the role of gut microbiome in primary and secondary sarcopenia. This article also explores the potential contribution of gut dysbiosis to suboptimal sarcopenia management with special focus on factors contributing to gut dysbiosis among Asian Indians.

Recent findings

Aging and chronic diseases contribute to gut dysbiosis and intestinal barrier dysfunction allowing enhanced microbial translocation that may negatively affect muscle strength, physical function, and frailty. Gut microbiome of Asian Indians has shown a unique composition that is affected by multiple factors, such as socioeconomic status, poor hygiene, high rate of infection and infestations, antibiotic overuse and transition towards a westernized eating pattern. Current management approach for sarcopenia (exercise and/or protein supplementation) fails to address gut dysbiosis and intestinal barrier dysfunction. Incorporating a prebiotic or probiotic element to the intervention strategy may improve gut dysbiosis, inflammation and muscle function.

Gut dysbiosis and intestinal barrier dysfunction appear to be a significant limitation in sarcopenia management, thus gut centric intervention may be perceived as a (co)intervention strategy to be tested in appropriate clinical trials.
Intermittent fasting as a nutrition approach against obesity and metabolic disease
Authors: Zhu Shengjie , Surampudi Prasanth , Rosharavan Baback , Chondronikola Maria
Published: August 2020

Purpose of review

Intermittent fasting has been proposed as a potential nutrition approach against obesity and metabolic disease. Although data from studies in rodents convincingly support the antiobesity and cardiometabolic benefits of intermittent fasting, its effects in human health are still debatable.

Recent findings

Recent studies have examined the effect of two intermittent fasting approaches, that is, alternate day fasting (ADF) and time-restricted eating (TRE), on weight loss and cardiometabolic risk factors. ADF seems to be an equally effective weight loss approach to caloric restriction, but adherence to ADF is more challenging. ADF improves cardiometabolic risk factors, whereas it may have superior metabolic benefits compared to caloric restriction in people with insulin resistance. TRE with ad libitum food intake is well tolerated and induces 2–4% weight loss in approximatively 3 months. Additionally, TRE may have metabolic benefits particularly in people with metabolically abnormal obesity even without weight loss.

Intermittent fasting is a promising nutritional approach against obesity and its related metabolic diseases. Further research is needed to: i) establish the long-term effectiveness of TRE in weight loss and metabolic health, ii) improve the long-term adherence to ADF and investigate its weight loss independent effects in metabolic health, and iii) determine the mechanisms underlying the potential cardiometabolic benefits of intermittent fasting in humans.
Coronavirus disease 2019 associated with aggressive neurological and mental abnormalities confirmed based on cerebrospinal fluid antibodies
Authors: Wang Maomao , Li Ting , Qiao Fan , Wang Laixing , Li Chunlin , Gong Yanping
Published: September 2020

Introduction:

Coronavirus disease (COVID-19) is spreading worldwide. The reported possible neurological symptoms are varied and range from subtle neurologic deficits to unconsciousness. Knowledge regarding the detection, diagnosis, treatment, and follow-up of COVID-19-associated neurological damage is still limited. We report a case of serious neurological damage and mental abnormalities in a patient who was finally confirmed to have COVID-19 based on IgM and IgG antibodies in the cerebrospinal fluid (CSF).

Patient concerns:

A 68-year-old man had slight flu-like symptoms and transient loss of consciousness in early February. Exaggerated unconsciousness and deteriorating mental abnormalities occurred over the next month without severe respiratory symptoms. Craniocerebral computed tomography showed normal results, but antibodies against severe acute respiratory syndrome coronavirus 2 were 100 times higher in the CSF than in the serum; tests for viral ribonucleic acid showed negative results with both a nasopharyngeal swab and CSF sample.

Diagnosis:

COVID-19 pneumonia was diagnosed based on symptoms and positive results for IgM and IgG in the CSF.

Interventions:

Antiviral, fluid, and nutritional support were administered for 30 days before admission without obvious improvement. A further 18 days of routine antiviral therapy, immunoglobulin therapy (10 g per day for 5 days), and antipsychotic drug treatment were administered.

Outcomes:

The patient's neurological and mental abnormalities were greatly ameliorated. He was discharged with mild irritability, slight shaking of the hands, and walking fatigue. These symptoms have persisted up to our last follow-up (May 4, 2020).

Conclusion:

We believe this is the first case involving neural system injury in a patient who confirmed COVID-19 based on CSF antibody test results. Negative ribonucleic acid test results, strong positivity for antibodies, and high protein levels in the CSF suggest the possibility of autoimmune encephalitis secondary to COVID-19. This case highlights additional novel symptoms of COVID-19, and these data are important for the assessment and follow-up of COVID-19 patients.
Radiofrequency catheter ablation in a patient with dextrocardia, persistent left superior vena cava, and atrioventricular nodal reentrant tachycardia
Authors: Zheng Zhipeng , Zeng Zhihuan , Zhou Yuliang , Li Chichang , Zhang Wei
Published: September 2020

Rationale:

Dextrocardia is a rare congenital heart disease, while the persistent left superior vena cava (PLSVC) is an uncommon congenital vascular malformation. It is extremely rare for a person to have dextrocardia and PLSVC. A case with a combination of dextrocardia, PLSVC, and atrioventricular nodal reentrant tachycardia has not been reported.

Patient concerns:

A 51-year-old woman was admitted to the hospital with palpitations. The physical examination revealed a heart rate of patient increased significantly, and that apex beating was found in the right fifth intercostal space approximately 0.5 cm from the midclavicular line.

Diagnosis:

We used different techniques, including electrocardiography, esophagus heart electrophysiology, chest radiograph, and cardiac color Doppler echocardiography to reveal the presence of the combination of dextrocardia, PLSVC, and supraventricular tachycardia.

Interventions:

We terminated tachycardia by esophageal pacing and cured patients with radiofrequency catheter ablation (RFCA).

Outcomes:

The complex structural anomalies presented great technical challenges for interventional treatments. After consulting the literature, thorough examination and understanding of the structural anatomy and anomalies of the vena cava and cardiac chambers, we successfully treated this patient by RFCA. After half a year of follow-up, the patient did not have palpitations, and no arrhythmia was seen on the electrocardiography.

Lessons:

Physicians need to be aware that the key to the success of RFCA, in this case, is to clarify the complexity of the morphological and anatomical structures of dextrocardia accompanying PLSVC and to consult and understand the experience of access vessels reported in relevant cases before the operation.
Long-term survival prediction for transjugular intrahepatic portosystemic shunt in severe cirrhotic ascites: assessment of ten prognostic models
Authors: Li Jing , Tang Shihao , Zhao Jianbo , Zhang Chunqing , Jiang Zaibo , Xue Hui , Sun Junhui , Zhu Xuan , Ren Weixin , Zhu Xiaoli , Wang Qiuhe , Wang Enxin , Lv Yong , Guo Shuai , Wang Zhexuan , Yang Qiaoyi , Wang Zhengyu , Niu Jing , Yin Zhanxin , Xia Jielai , Fan Daiming , Han Guohong
Published: August 2020

Objectives

Patients with severe cirrhotic ascites have poor prognosis, yet individual patient survival varies greatly. Therefore, suitable prognostic models can be helpful in clinical decision making. The aim of this study was to evaluate and compare the performance of 10 scores in predicting transplant-free survival (TFS) after transjugular intrahepatic portosystemic shunt (TIPS) in severe cirrhotic ascites.

Methods

Two hundred eighty consecutive cirrhotic patients with severe ascites undergoing TIPS between March 2006 and December 2017 were retrospectively screened and included from nine tertiary Chinese centers, consisting of 123 patients with refractory ascites and 157 with recurrent ascites. Discriminatory ability of these models was further assessed in the whole cohort and subgroups.

Results

TFS rates of all 280 patients were 75.4, 65.7, and 53.6% at 6-month, 1-year, and 2-year follow-up, respectively. Compared with other prognostic systems, the integrated model for end-stage liver disease (iMELD, incorporating serum sodium and age) showed optimal performance in predicting 6-month, 1-year, and 2-year TFS. Cutoffs were determined according to c-index and were used to stratify patients into three strata presenting significantly different TFS for short-term and long-term: iMELD < 32, ≥32 but <38 and ≥38 (log-rank P < 0.001).

Conclusions

The iMELD score proved to be the best prognostic model in predicting TFS in patients with severe cirrhotic ascites receiving TIPS. Meanwhile, the model could stratify patients in three strata to help guiding clinical practice.
Nonalcoholic fatty liver disease is associated with COVID-19 severity independently of metabolic syndrome: a retrospective case-control study
Authors: Mahamid Mahmud , Nseir Wiliam , Khoury Tawfik , Mahamid Baker , Nubania Adi , Sub-Laban Kamal , Schifter Joel , Mari Amir , Sbeit Wisam , Goldin Eran
Published: August 2020

Aim

Coronavirus disease 2019 (COVID-19) is a recently encountered disease that was declared a pandemic by WHO in 2020. Obesity and other components of the metabolic syndrome may aggravate the severity of COVID-19. Nonalcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome. The aim of this study was to investigate a possible association between MAFLD and COVID-19 severity.

Methods

We performed a retrospective, case-control study, enrolling 71 consecutive COVID-19 patients who were divided into two groups according to the presence or absence of fatty liver by computed tomography scan. All medical records of eligible patients were reviewed including demographic, clinical, laboratory parameters and data regarding the presence of NAFLD and COVID-19 severity.

Results

NAFLD was identified in 22/71 (31%) of the study group. Out of 71, thirteen suffered from severe COVID-19. NAFLD patients had more severe COVID-19 compared with non-NAFLD subjects, 8/22 (36.3%) vs. 5/49(10.2%), (P < 0.005), respectively. Multiple logistic regression analysis showed that NAFLD subjects were more likely to have severe COVID-19 disease (odds ratio 3.57, 95% confidence interval: 1.22, 14.48, P = 0.0031).

Conclusion

NAFLD represents a high risk for severe COVID-19 irrespective to gender, and independent of metabolic syndrome specifically in male gender. Moreover, obesity, hypertension and metabolic syndrome were also significantly associated with severe COVID-19.
Management of Helicobacter pylori
Authors: Argueta Erick A. , Moss Steven F.
Published: August 2020

Purpose of review

Gastroenterologists and many general internists and primary care physicians confront questions regarding the management of Helicobacter pylori on a daily basis. The subject remains of global interest and continue to generate debate and research. Using the search terms ‘pylori and treatment’ or ‘pylori and management’ we identified over 1000 relevant articles in PubMed published over the time period 1 January 2019 to 30 April 2020. We have selected the most highly clinically relevant of these to review here.

Recent findings

Clinical evidence grows regarding the benefits of H. pylori eradication on gastric cancer prevention. High rates of resistance to clarithromycin and levofloxacin, correlating with treatment failure in regimens utilizing these drugs, has stimulated interest in alternative regimens as well as the need for susceptibility testing of individual patients and populations. Although many aspects of H. pylori management are well established, implementation of appropriate testing and treatment pathways remains suboptimal throughout healthcare settings.

Increased emphasis on measuring H. pylori-related clinical outcomes in practice is needed to identify implementation gaps, and to suggest means to best apply the knowledge gained on H. pylori for the prevention of gastric symptoms and disease.
Update on the pathophysiology of transfusion-related acute lung injury
Authors: Zeeuw van der Laan Eveline A.N. , van der Velden Saskia , Porcelijn Leendert , Semple John W. , van der Schoot C. Ellen , Kapur Rick
Published: August 2020

Purpose of review

The aim of this study was to discuss recent advances regarding the pathogenesis of transfusion-related acute lung injury (TRALI), which highlight the pathogenic role of macrophages.

Recent findings

TRALI remains a leading cause of transfusion-related fatalities, despite the success of the mitigation strategy, and therapeutic approaches are unavailable. Neutrophils (PMNs) are recognized pathogenic cells in TRALI. Macrophages have previously also been suggested to be pathogenic in mice via binding of C5a to their C5a-receptor, producing reactive oxygen species (ROS), which damages the pulmonary endothelium. Recent work has further highlighted the role of macrophages in the TRALI-pathogenesis. It has been shown that the protein osteopontin (OPN) released by macrophages is critical for pulmonary PMN recruitment in mice suffering from TRALI and that targeting OPN prevents the occurrence of TRALI. Another recent study demonstrated the importance of M1-polarized alveolar macrophages in murine TRALI induction by showing that α1-antitrypsin (AAT) overexpression prevented TRALI in mice through decreasing the polarization of alveolar macrophages towards the M1 phenotype.

Apart from PMNs, macrophages also appear to be important in the pathogenesis of TRALI. Targeting the pathogenic functions of macrophages may be a promising therapeutic strategy to explore in TRALI.
Training in pediatric surgical critical care
Authors: Feliz Alexander , Weldon Christopher
Published: August 2020

Purpose of review

The purpose of this review is to describe education, training, certification of fellows in pediatric surgical critical care (PSCC). PSCC is a small but unique specialty within surgery. Education curricula focus on pediatric intensive care, neonatal intensive care, surgical intensive care, and pediatric surgical acute care. Attention is focused on the current state of SCC certification via the American Board of Surgery and future possibilities that could be implemented.

Recent findings

Because of the uniqueness of the specialty, the little literature that exists focuses on fellow experience including carrier plans, curricula at different programs and how the training is used in practice. There has been debate over the need for the development of a unified process to train, test, and certify critical care physicians of all programs. This could lead to a common ‘test’ that serves as the basis for critical care medicine certification from the myriad of American Medical Specialty Boards.

Training in PSCC offers surgeons a unique skill set to treat the most critically ill and injured children in our society. These surgeons can make large contributions to children's hospitals and to adult trauma centers that take care of injured children.
Implementing Evidence-Based Pressure Injury Prevention Interventions
Authors: Zubkoff Lisa , Neily Julia , McCoy-Jones Shantia , Soncrant Christina , Young-Xu Yinong , Boar Shoshana , Mills Peter
Published: August 2020

Background:

Pressure injury prevention is a persistent concern in nursing. The Veterans Health Administration implemented a creative approach with successful outcomes across the United States.

Problem:

Pressure injury prevention is a measure of nursing quality of care and a high priority in the Veterans Health Administration.

Methods:

A 12-month Virtual Breakthrough Series Collaborative utilizing coaching and group calls was conducted to assist long-term and acute care teams with preventing pressure injuries.

Interventions:

Interventions from the Veterans Health Administration Skin Bundle were implemented, including pressure-relieving surfaces, novel turning techniques, specialized dressings, and emollients to prevent skin breakdown.

Results:

The aggregated pressure injury rate for all teams decreased from Prework to the Action phase from 1.0 to 0.8 per 1000 bed days of care (P = .01). The aggregated pressure injury rates for long-term care units decreased from Prework to Continuous Improvement from 0.8 to 0.4 per 1000 bed days of care (P = .021).

Conclusion:

The Virtual Breakthrough Series helped reduce pressure injuries.
Optimal Criteria for G3 (Poorly Differentiated) Stage II Colon Cancer
Authors: Ueno Hideki , Ishiguro Megumi , Nakatani Eiji , Ishikawa Toshiaki , Uetake Hiroyuki , Matsui Shigeyuki , Teramukai Satoshi , Murotani Kenta , Ajioka Yoichi , Shimazaki Hideyuki , Maeda Atsuyuki , Takuma Kunio , Yoshida Takefumi , Kambara Takeshi , Matsuda Keiji , Takagane Akinori , Tomita Naohiro , Sugihara Kenichi
Published: August 2020

Grade 3 (G3, poorly differentiated) is an important treatment-decision factor in stage II colon cancer, but no unified diagnostic criteria are established. According to previous studies, an intratumoural poorly differentiated area with no glandular formation (POR) that fills the microscopic field of a ×40 objective lens was an essential factor that defined G3. We aimed to prospectively validate this in a randomized controlled study of adjuvant chemotherapy (SACURA trial). We enrolled 991 patients with stage II colon cancer. POR was graded according to the ×40 objective lens rule and the intensity of poorly differentiated clusters (GradePOR), and its prognostic power was compared with that of the conventional tumor grade on the basis of predominant histology rule (Gradeconv). According to GradePOR, 313, 526, and 152 tumors were classified as G1POR, G2POR, and G3POR, respectively, and the 5-year relapse-free survival (RFS) rates were 91.1%, 82.9%, and 74.7%, respectively (P<0.0001). When G3POR and G3conv were alternatively added to the prognostic model consisting of 8 conventional factors, only G3POR was a significant factor for RFS (P=0.040, Wald test). The adverse impact of G3POR on RFS was greater in the microsatellite stable/microsatellite instability–low subset than that in the full analysis set. In the microsatellite stable/microsatellite instability–low subset, the 5-year RFS rate of patients with G3POR tumors in the chemotherapy group achieved greater improvement (9.1%) than the surgery-alone group. The least differentiation policy with the ×40 objective lens rule may be highlighted as the diagnostic criterion for G3 because of its validated prognostic value.
Clinical Presentation of Acute Osteomyelitis in the Pediatric Emergency Department
Authors: Stephan Alexander M. , Faino Anna , Caglar Derya , Klein Eileen J.
Published: September 2020

Objectives

Acute osteomyelitis is a challenging diagnosis to make in the pediatric emergency department (ED), in part because of variability in its presentation. There are limited data detailing the presenting features of pediatric osteomyelitis, factors that are essential to understand to inform diagnostic decision making. We sought to describe relevant clinical data that contributed to the diagnosis of acute osteomyelitis in children presenting to a pediatric ED.

Methods

This was a 10-year retrospective cohort study of patients 18 years or younger diagnosed with acute osteomyelitis in the ED of a large tertiary care children's hospital. Collected data included demographics, clinical history, patient-reported symptoms, vital signs, physical examination findings, and results of basic laboratory, microbiologic, and imaging studies. Descriptive statistics were used to summarize key findings.

Results

Two hundred eleven cases of acute osteomyelitis were identified during the study period. The median age was 8.4 years, with 61.1% male. One hundred twenty-seven patients (60.2%) presented to care more than once before being diagnosed. Common symptoms included pain (94.3%), functional limitation (83.9%), and fever (76.3%). Common examination findings included functional limitation (78.2%), focal tenderness (73.5%), and swelling (52.1%). One hundred seventeen patients (55.5%) were febrile during their ED evaluation. Elevated C-reactive protein (>0.8 mg/dL, 92.9%) and erythrocyte sedimentation rate (>10 mm/h, 94.3%) were the most sensitive laboratory markers.

Conclusions

Fever may be absent in up to a quarter of pediatric patients with acute osteomyelitis. Although highly sensitive, inflammatory marker elevations were more modest than those reported previously in cases of pediatric septic arthritis.