bluuebunny/crossref_metadata_2025 huggingface dataset:
Hazardous Handover
Authors: Croskerry Pat
Published: June 2020

In this case, a middle-aged male presents to a community hospital emergency department at approximately midnight with chest pain. He is seen and diagnosed quickly with unstable angina. He receives acetylsalicylic acid, is anticoagulated, and is kept overnight pending a consult to cardiology in the morning. At 07:00 hours, he is transferred to an oncoming physician who takes further history and determines that the diagnosis is wrong. Several aspects of decision making are discussed, including overconfidence, dysphoria, fatigue, and sleep deprivation.
A Stone Left Unturned
Authors: Croskerry Pat
Published: June 2020

In this case, a young woman presents to the emergency department with severe abdominal pain. She has a history of Crohn disease and this attack feels similar to previous flare-ups. The emergency physician orders urinalysis, blood work, and an abdominal series. Although the technical quality of his viewing of the images is limited, he is satisfied that there are no signs of obstruction or perforation. The patient settles well with analgesics and antiemetics. The urinalysis shows signs of infection, and the emergency physician prepares to discharge the patient on antibiotics for what he believes is hemorrhagic cystitis. At this point, a radiologist provides an interpretation of the patient’s abdominal series that allows for a correct diagnosis of her abdominal pain.
Introduction
Authors: Robinson Gail Erlick
Published: June 2020

This book is designed for clinicians including obstetricians, primary care physicians, nurse practitioners, social workers, or psychiatrists who may encounter postpartum women presenting with mood or behavioral symptoms. It may also be helpful for women themselves. It uses vignettes to illustrate various clinical presentations and describes the differential and most likely diagnoses. It covers all types of mental health problems that may present postpartum including Major Depressive Episodes, Generalized Anxiety Disorders, Schizophrenia, Bipolar Disorder, Obsessive Compulsive Disorder, Posttraumatic Stress Disorder, Eating Disorders, Disorders of Attachment and Personality Disorders. The epidemiology and etiology are described followed by management of these disorders. Many disorders can be managed by these clinicians once the disorder is identified. Postpartum women who read these vignettes might realize they should go for help. A bio-psycho-social approach to management is used with advice as to when to refer to someone with more expertise. Information about the safety of psychotropic medication during pregnancy and breastfeeding is reviewed. Various scales are provided to help with making a diagnosis. The information provided in a concise form should increase the skills and confidence in clinicians managing mental health problems presenting postpartum.
Risk Factors for Postpartum Disorders
Authors: Robinson Gail Erlick
Published: June 2020

This chapter on risk factors for postpartum disorders describes how the postpartum period is a time in women’s lives when they are at an especially high risk for developing mental health problems. The massive hormonal changes experienced after birth can interact with other risk factors to result in a postpartum disorder. Poor sleep due to infant care can exacerbate these vulnerabilities. There are many factors that may increase the risk of developing a postpartum disorder. Depression or anxiety during pregnancy, a personal or family history of a psychiatric disorder, current stressors, and lack of social supports may all increase the risk of developing a postpartum depression or anxiety disorder. Women with a history of bipolar disorder are particularly at risk for developing a depression or manic episode postpartum. Recognition of factors that may predispose women to the development of a postpartum disorder can allow preventative factors to be put in place.
Postpartum Depression
Authors: Grigoriadis Sophie
Published: June 2020

Postpartum depression occurs in about 9% to 16% of women following delivery. It is often missed because the symptoms may overlap with what women commonly experience after having a baby such as fatigue. It occurs all over the world and those who have support may be at an advantage. The causes are thought to be a combination of genetic, hormonal, and psychosocial ones and women who have had a previous depression are at particularly high risk although many psychosocial factors may also place her at risk. Clinicians must rule out medical contributions and ensure the safety of both mother and baby. Treatment is essential as the consequences affect the entire family. Both psychotropic medications, with considerations for breastfeeding, as well as psychotherapy are effective. Community resources can be used to increase support. Although there remains an increased risk for future depressive episodes, the majority of women recover well with treatment.
Postpartum Anxiety
Authors: Greene Judy A. , Kaplan Danielle
Published: June 2020

This chapter focuses on anxiety disorders presenting in the postpartum. Symptoms include ruminative, excessive worried thoughts that are minimally decreased with reassurance and support, an inability to relax, feelings of tension, worry the baby’s health, feeling overwhelmed with caring for the baby, and insomnia due to intrusive worried thoughts and inability to relax. Depressive symptoms can occur secondary to feeling anxious. Women with a history of an anxiety disorder have an elevated risk of developing these symptoms postpartum. Support and encouragement for family is important. Medications such as a selective serotonin reuptake inhibitor and short-term use of a benzodiazepine may be required. Relaxation techniques, mindfulness-based stress reduction, and cognitive-behavioral therapy may all be helpful. Lack of treatment may result in postpartum depression, impaired mother/infant bonding and impaired infant/child development.
Postpartum Psychosis
Authors: Benders-Hadi Nikole
Published: June 2020

This chapter on postpartum psychosis notes that the risk of postpartum psychosis in the general population is very rare at less than 1%. In a mother with a known history of schizophrenia, this risk increases to 25%. Psychotic symptoms appearing postpartum may also be evidence of a bipolar disorder. The presence of elevated mood, increased activity levels and energy, poor sleep, and a family history of manic episodes all increase the likelihood that a bipolar disorder is present. Women with a personal or family history of a bipolar disorder are at an elevated risk of developing a mania or depression with psychotic symptoms postpartum. Postpartum psychosis due to any cause is a psychiatric emergency and treatment should be initiated early and aggressively to ensure the safety of mother and infant. Hospitalization and/or separation of the baby and mother may be necessary. The use of medication to treat schizophrenia or bipolar disorder during pregnancy may decrease the risk of a postpartum psychosis. With appropriate postpartum medication and support, the majority of women experiencing postpartum psychosis recover well and the risk of recurrent psychotic symptoms can be greatly reduced.
Psychopharmacology in Pregnancy and Breastfeeding
Authors: Robinson Gail Erlick , Apter Gisèle
Published: June 2020

This chapter on psychopharmacology in pregnancy and postpartum discusses the decisions women must make about taking psychiatric medications when pregnant or breastfeeding. Although mild illness during pregnancy or postpartum may respond to psychotherapy and support, medication is often necessary for more serious psychiatric illness. Untreated illness can have deleterious effects on the baby and the mother. This chapter reviews the evidence that indicates it is generally safe to use the majority of psychotropic medications during pregnancy and while breastfeeding. Although it may be ideal to breastfeed, this may become complicated for women who have a psychiatric illness. Women with postpartum disorders should first be evaluated to assess whether the demands of breastfeeding are too onerous for them. Those women who can’t or don’t wish to breastfeed should not be made to feel guilty. Mothers who are suffering but wish to breastfeed can be reassured that many psychotropic medications are safe to use during breastfeeding. They may also benefit from supplementing with formula feeding with a bottle to allow the mother to get more sleep. Mothers who require medication but are afraid to use it while breastfeeding should be educated to understand that the negative effects on the baby of being depressed or psychotic outweigh any concerns about the dangers of taking medication.
Out and Out It Goes . . . Where It Stops . . . Who Knows
Authors: Lammers Danny , Marenco Christopher , Do Woo , Horton John
Published: June 2020

Pediatric trauma is the leading cause of death among children and adolescents. Unique variations in pediatric trauma patients require different approaches for pediatric patients than for adult patients. Early recognition of the subtle presentation of hemorrhagic shock is critical to initiate adequate resuscitation. The early use of blood transfusions is indicated for those nonresponsive to crystalloid boluses. Standard of care targets a goal of balanced administration of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT): 1PRBC:1FFP:1PLT. Thromboelastography (TEG) and tranexamic acid (TXA) may have a role in the management of children in hemorrhagic shock.
A Tumble for a Cookie
Authors: Rixe Nancy
Published: June 2020

Children with head injury account for more than 800,000 ED visits in the United States each year. Children with minor head trauma (Glasgow Coma Scale [GCS] of 14 or 15) constitute the majority of visits to the ED. Clinicians must balance the risk of cranial radiation with that of missing a clinically important traumatic brain injury (ciTBI). An understanding of the current validated clinical prediction rules for identifying low-risk children in whom CT is likely unnecessary is essential to ensure appropriate care of these children.
My Belly Hurts—And I Got Hit by the Hulk
Authors: Linakis Seth
Published: June 2020

Abdominal trauma in pediatric patients can result in a variety of serious pathologies including solid organ lacerations, hollow viscus injuries, and others. Physical findings can provide insight to specific injuries. Management of children with intra-abdominal injuries should be guided by clinical picture and hemodynamic status rather than imaging, although imaging and laboratory testing are still frequently a useful part of the workup. Most patients may be managed nonoperatively in the case of solid organ injury, although a somewhat higher proportion receive packed red blood cells. Hollow viscus injuries can be more difficult to diagnose, as there are no reliable modalities for detecting them. Overall, however, most children with abdominal trauma recover and do very well long-term.
Clavicle Fracture! Simple! Not So Much!
Authors: DeHoff Carrie
Published: June 2020

Simple clavicle fractures are common and may be easily managed by primary care providers as well as acute care providers. Most sternoclavicular (SC) joint dislocations occur from higher energy motor vehicle accidents or sports trauma, with anterior fracture/dislocations more common than posterior. Although uncommon, they may be associated with devastating complications including great vessel and/or trachea injury, dyspnea, hoarseness, dysphagia.
Why Am I Banged Up?
Authors: Hari Shilpa , Kaplan Dana , Barata Isabel A.
Published: June 2020

When confronted with a case of an infant with a bruise, it is cardinal to remember “if the infant is not cruising, they should not be bruising.” In patients who are nonmobile, a bruise could be a sign of child maltreatment, in particular physical abuse. In these cases, it is imperative that the history take into account the age and developmental stage of the patient. Complete exposure of the patient and a thorough physical exam is critical to identify any other injuries. Patterned bruising may resemble the object that struck the child or what the child was struck with. Laboratory evaluation and imaging are dependent on the age. Consideration of a medical explanation such as a bleeding disorder should also be excluded.
Am I Safe?
Authors: Berdan Elizabeth A. , Woods Elizabeth A.
Published: June 2020

The commercial sexual exploitation of children and child sex trafficking are crimes committed against youth. There is a growing body of literature that describes both the detrimental psychological and physical effects of the repeated trauma that occurs as a result of these crimes. Yet huge gaps in education and awareness of sex trafficking exist. Victims/survivors of sex trafficking are seeking healthcare. Can you recognize them? What do you do once you suspect a patient is a victim of sex trafficking?
Basaglia and the British anti-psychiatrists, 1960–70
Authors: Wall Oisín
Published: June 2020

The London psychiatrists R.D. Laing, Aaron Esterson, and David Cooper were among Basaglia’s most prominent contemporaries. In 1967, they came to be grouped under the umbrella term ‘the anti-psychiatrists’, coined by Cooper. As such, in discussion they often fall under the same school of thought as Basaglia. However, this chapter highlights the fundamental differences between the British anti-psychiatric project and Basaglia’s Democratic Psychiatry, given its focus on political upheaval as well as patient care. It explores the various efforts of Laing, Cooper, and Esterson to demolish staff–patient boundaries through the Philadelphia Association Ltd, which they formed with their patients. The chapter contends that, although they shared a desire to wrest patients away from harmful institutions, Basaglia sought to do so as an ‘employee’, aiming to destroy the psychiatric institution from within, whereas his British counterparts considered themselves revolutionaries, part of an effort to overhaul society as a whole, external to psychiatry.
The impact in Latin America of Basaglia and Italian psychiatric reform
Authors: Caldas de Almeida José Miguel
Published: June 2020

Latin America is one of the regions of the world where Franco Basaglia’s vision found a more fertile ground and exerted a more fruitful and lasting influence. This chapter describes the process of transformation of mental healthcare that has taken place in Latin America in the last four decades. It analyses the main factors that made it possible, and discusses how it was influenced by Basaglia’s conceptualization of the reform. It critically reviews the advances and shortcomings of mental healthcare reforms carried out in the region, taking into consideration the specific political and social context of the countries in which they have taken place, as well as the direct and indirect influences of Basaglia’s concepts and the Italian reform. Finally, it describes how the implementation of the reforms in Latin America have contributed to the development of a comprehensive approach to mental healthcare that continues to be one of the most stimulating and comprehensive approaches in global mental health at the present time.
Franco Basaglia’s influence on the Greek mental health system
Authors: Megaloeconomou Theodoros
Published: June 2020

Franco Basaglia’s influence in Greece started during the 1980s, when the ‘scandal of Leros’ erupted and external pressure was exercised upon Greece to proceed to psychiatric reform. Various institutions attempted forms of deinstitutionalization following Basaglia’s practice in Italy. This chapter focuses on the deinstitutionalization process in Leros, and its results. This was made possible mainly through the practical contribution of staff from Trieste. Concepts such as ‘incurability’ and ‘dangerousness’ of mental illness were demystified through the actual implementation of approaches based on restoring subjectivity and freedom. However, Basaglia’s culture and practice was confronted with hostility and outright rejection by orthodox psychiatry in Greece, and did not manage to influence wider psychiatric reform.
The United Kingdom’s rejection of Basaglia
Authors: Burns Tom
Published: June 2020

Franco Basaglia’s reforms failed to find favour in anglophone or North European psychiatry. The UK’s rejection was the best documented and elicited a furious response from Italy. Two highly influential articles in the British Journal of Psychiatry, in 1985 and 1986, consolidated the UK position. The reasons for rejection were three-fold. First, that the Italian hospitals, albeit reformed and humanized, were not ‘closed’ in any practical sense, since they still housed large numbers of patients. Second, a belief that UK practice, and in particular rehabilitation services and deinstitutionalization, were somewhat more advanced. Lastly, there was a general suspicion of ideology. Despite continued exchanges and some individual pockets of interest, Basaglia disappeared from the UK discourse. Why this happened is explored in this chapter, as are its consequences. The losses include a poorer relationship of psychiatry with society and its self-image. The suggested gains are strong evidence-based practice and more highly developed rehabilitation and specialist services.
A method for discriminating between dark matter models and MOND modified inertia via galactic rotation curves
Authors: Petersen Jonas , Frandsen Mads T
Published: June 2020

Dark matter (DM) and modified Newtonian dynamics (MOND) models of rotationally supported galaxies lead to curves with different geometries in (gN, gtot)-space (g2-space). Here, gtot is the total acceleration and gN is the acceleration as obtained from the baryonic matter via Newtonian dynamics. In MOND modified inertia (MI) models, the curves in g2-space are closed with zero area and so curve segments at radii r ≥ rN (large radii) and r < rN (small radii) coincide, where rN is the radius where gN is greatest. In DM models with cored density profiles where gtot is also zero at the Galactic Centre, the curves are again closed, but the area of the closed curves are in general non-zero because the curve segments at radii r ≥ rN and r < rN do not coincide. Finally in DM models with cuspy density profiles such as the NFW profile where gtot is formally non-zero at the galactic origin the curves are open, and again the curve segments at radii r ≥ rN and r < rN do not coincide.

We develop a test of whether data at small and large radii coincide and investigate rotation curves from the SPARC data base in order to discriminate between the above geometries. Due to loosely quantified systematic uncertainties, we do not underline the result of the test, but instead conclude that the test illustrates the relevance of this type of analysis and demonstrate the ability to discriminate between the considered DM and MI models in this way.
Three generations of stars: a possible case of triggered star formation
Authors: Areal M B , Buccino A , Paron S , Fariña C , Ortega M E
Published: June 2020

Evidence for triggered star formation linking three generations of stars is difficult to assemble, as it requires convincingly associating evolved massive stars with H ii regions that, in turn, would need to present signs of active star formation. We present observational evidence for triggered star formation relating three generations of stars in the neighbourhood of the star LS II +26 8. We carried out new spectroscopic observations of LS II +26 8, revealing that it is a B0 III-type star. We note that LS II +26 8 is located exactly at the geometric centre of a semi-shell-like H ii region complex. The most conspicuous component of this complex is the H ii region Sh2-90, which is probably triggering a new generation of stars. The distances to LS II +26 8 and to Sh2-90 are in agreement (between 2.6 and 3 kpc). Analysis of the interstellar medium on a larger spatial scale shows that the H ii region complex lies on the north-western border of an extended H2 shell. The radius of this molecular shell is about 13 pc, which is in agreement with what an O9 V star (the probable initial spectral type of LS II +26 8 as inferred from evolutive tracks) can generate through its winds in the molecular environment. In conclusion, the spatial and temporal correspondences derived in our analysis enable us to propose a probable triggered star formation scenario initiated by the evolved massive star LS II +26 8 during its main-sequence stage, followed by stars exciting the H ii region complex formed in the molecular shell, and culminating in the birth of young stellar objects around Sh2-90.
The interpretation of protoplanetary disc wind diagnostic lines from X-ray photoevaporation and analytical MHD models
Authors: Weber Michael L , Ercolano Barbara , Picogna Giovanni , Hartmann Lee , Rodenkirch Peter J
Published: June 2020

High-resolution spectra of typical wind diagnostics ([O i] 6300 Å and other forbidden emission lines) can often be decomposed into multiple components: high-velocity components with blueshifts up to several 100 km s−1 are usually attributed to fast jets, while narrow (NLVC) and broad (BLVC) low-velocity components are believed to trace slower disc winds. Under the assumption that the line broadening is dominated by Keplerian rotation, several studies have found that the BLVCs should trace gas launched between 0.05 and 0.5 au and correlations between the properties of BLVCs and NLVCs have been interpreted as evidence for the emission tracing an extended magnetohydrodynamics (MHD) wind and not a photoevaporative wind. We calculated synthetic line profiles obtained from detailed photoionization calculations of an X-ray photoevaporation model and a simple MHD wind model and analysed the emission regions of different diagnostic lines and the resulting spectral profiles. The photoevaporation model reproduces most of the observed NLVCs but not the BLVCs or HVCs. The MHD model is able to reproduce all components but produces Keplerian double peaks at average inclinations that are rarely observed. The combination of MHD and photoevaporative winds could solve this problem. Our results suggest that the Gaussian decomposition does not allow for a clear distinction of flux from different wind regions and that the line broadening is often dominated by the velocity gradient in the outflow rather than by Keplerian rotation. We show that observed correlations between BLVC and NLVC do not necessarily imply a common origin in an extended MHD wind.
Hydrodynamical turbulence in eccentric circumbinary discs and its impact on the in situ formation of circumbinary planets
Authors: Pierens Arnaud , McNally Colin P , Nelson Richard P
Published: June 2020

Eccentric gaseous discs are unstable to a parametric instability involving the resonant interaction between inertial-gravity waves and the eccentric mode in the disc. We present three-dimensional global hydrodynamical simulations of inviscid circumbinary discs that form an inner cavity and become eccentric through interaction with the central binary. The parametric instability grows and generates turbulence that transports angular momentum with stress parameter α ∼ 5 × 10−3 at distances ≲ 7 abin, where abin is the binary semimajor axis. Vertical turbulent diffusion occurs at a rate corresponding to αdiff ∼ 1–2 × 10−3. We examine the impact of turbulent diffusion on the vertical settling of pebbles, and on the rate of pebble accretion by embedded planets. In steady state, dust particles with Stokes numbers St ≲ 0.1 form a layer of finite thickness Hd ≳ 0.1H, where H is the gas scale height. Pebble accretion efficiency is then reduced by a factor racc/Hd, where racc is the accretion radius, compared to the rate in a laminar disc. For accreting core masses with mp ≲ 0.1 M⊕, pebble accretion for particles with St ≳ 0.5 is also reduced because of velocity kicks induced by the turbulence. These effects combine to make the time needed by a Ceres mass object to grow to the pebble isolation mass, when significant gas accretion can occur, longer than typical disc lifetimes. Hence, the origins of circumbinary planets orbiting close to their central binary systems, as discovered by the Kepler mission, are difficult to explain using an in situ model that invokes a combination of the streaming instability and pebble accretion.
ASASSN-15lh: a TDE about a maximally rotating 109 M⊙ black hole
Authors: Mummery Andrew , Balbus Steven A
Published: June 2020

We model the light curves of the novel and extremely luminous transient ASASSN-15lh at nine different frequencies, from infrared to ultraviolet photon energies, as an evolving relativistic disc produced in the aftermath of a tidal disruption event (TDE). Good fits to all nine light curves are simultaneously obtained when Macc ≃ 0.07 M⊙ is accreted on to a black hole of mass M ≃ 109 M⊙ and near-maximal rotation a/rg = 0.99. The best-fitting black hole mass is consistent with a number of existing estimates from galactic scaling relationships. If confirmed, our results represent the detection of one of the most massive rapidly spinning black holes to date, and are strong evidence for a TDE origin for ASASSN-15lh. This would be the first TDE to be observed in the disc-dominated state at optical and infrared frequencies.
GeneRax: A Tool for Species-Tree-Aware Maximum Likelihood-Based Gene Family Tree Inference under Gene Duplication, Transfer, and Loss
Authors: Morel Benoit , Kozlov Alexey M , Stamatakis Alexandros , Szöllősi Gergely J
Published: June 2020

Inferring phylogenetic trees for individual homologous gene families is difficult because alignments are often too short, and thus contain insufficient signal, while substitution models inevitably fail to capture the complexity of the evolutionary processes. To overcome these challenges, species-tree-aware methods also leverage information from a putative species tree. However, only few methods are available that implement a full likelihood framework or account for horizontal gene transfers. Furthermore, these methods often require expensive data preprocessing (e.g., computing bootstrap trees) and rely on approximations and heuristics that limit the degree of tree space exploration. Here, we present GeneRax, the first maximum likelihood species-tree-aware phylogenetic inference software. It simultaneously accounts for substitutions at the sequence level as well as gene level events, such as duplication, transfer, and loss relying on established maximum likelihood optimization algorithms. GeneRax can infer rooted phylogenetic trees for multiple gene families, directly from the per-gene sequence alignments and a rooted, yet undated, species tree. We show that compared with competing tools, on simulated data GeneRax infers trees that are the closest to the true tree in 90% of the simulations in terms of relative Robinson–Foulds distance. On empirical data sets, GeneRax is the fastest among all tested methods when starting from aligned sequences, and it infers trees with the highest likelihood score, based on our model. GeneRax completed tree inferences and reconciliations for 1,099 Cyanobacteria families in 8 min on 512 CPU cores. Thus, its parallelization scheme enables large-scale analyses. GeneRax is available under GNU GPL at https://github.com/BenoitMorel/GeneRax (last accessed June 17, 2020).
CLICK-17, a DNA enzyme that harnesses ultra-low concentrations of either Cu+ or Cu2+ to catalyze the azide-alkyne ‘click’ reaction in water
Authors: Liu Kun , Lat Prince Kumar , Yu Hua-Zhong , Sen Dipankar
Published: June 2020

To enable the optimal, biocompatible and non-destructive application of the highly useful copper (Cu+)-mediated alkyne-azide ‘click’ cycloaddition in water, we have isolated and characterized a 79-nucleotide DNA enzyme or DNAzyme, ‘CLICK-17’, that harnesses as low as sub-micromolar Cu+; or, surprisingly, Cu2+ (without added reductants such as ascorbate) to catalyze conjugation between a variety of alkyne and azide substrates, including small molecules, proteins and nucleic acids. CLICK-17’s Cu+ catalysis is orders of magnitude faster than that of either Cu+ alone or of Cu+ complexed to PERMUT-17, a sequence-permuted DNA isomer of CLICK-17. With the less toxic Cu2+, CLICK-17 attains rates comparable to Cu+, under conditions where both Cu2+ alone and Cu2+ complexed with a classic accelerating ligand, THPTA, are wholly inactive. Cyclic voltammetry shows that CLICK-17, unlike PERMUT-17, powerfully perturbs the Cu(II)/Cu(I) redox potential. CLICK-17 thus provides a unique, DNA-derived ligand environment for catalytic copper within its active site. As a bona fide Cu2+-driven enzyme, with potential for being evolved to accept only designated substrates, CLICK-17 and future variants promise the fast, safe, and substrate-specific catalysis of ‘click’ bioconjugations, potentially on the surfaces of living cells.
Full length RTEL1 is required for the elongation of the single-stranded telomeric overhang by telomerase
Authors: Awad Aya , Glousker Galina , Lamm Noa , Tawil Shadi , Hourvitz Noa , Smoom Riham , Revy Patrick , Tzfati Yehuda
Published: June 2020

Telomeres cap the ends of eukaryotic chromosomes and distinguish them from broken DNA ends to suppress DNA damage response, cell cycle arrest and genomic instability. Telomeres are elongated by telomerase to compensate for incomplete replication and nuclease degradation and to extend the proliferation potential of germ and stem cells and most cancers. However, telomeres in somatic cells gradually shorten with age, ultimately leading to cellular senescence. Hoyeraal-Hreidarsson syndrome (HHS) is characterized by accelerated telomere shortening and diverse symptoms including bone marrow failure, immunodeficiency, and neurodevelopmental defects. HHS is caused by germline mutations in telomerase subunits, factors essential for its biogenesis and recruitment to telomeres, and in the helicase RTEL1. While diverse phenotypes were associated with RTEL1 deficiency, the telomeric role of RTEL1 affected in HHS is yet unknown. Inducible ectopic expression of wild-type RTEL1 in patient fibroblasts rescued the cells, enabled telomerase-dependent telomere elongation and suppressed the abnormal cellular phenotypes, while silencing its expression resulted in gradual telomere shortening. Our observations reveal an essential role of the RTEL1 C-terminus in facilitating telomerase action at the telomeric 3′ overhang. Thus, the common etiology for HHS is the compromised telomerase action, resulting in telomere shortening and reduced lifespan of telomerase positive cells.
Susceptibility to auditory closed-loop stimulation of sleep slow oscillations changes with age
Authors: Schneider Jules , Lewis Penelope A , Koester Dominik , Born Jan , Ngo Hong-Viet V
Published: June 2020

Study Objectives

Cortical slow oscillations (SOs) and thalamocortical sleep spindles hallmark slow wave sleep and facilitate memory consolidation, both of which are reduced with age. Experiments utilizing auditory closed-loop stimulation to enhance these oscillations showed great potential in young and older subjects. However, the magnitude of responses has yet to be compared between these age groups. We examined the possibility of enhancing SOs and performance on different memory tasks in a healthy middle-aged population using this stimulation and contrast effects to younger adults.

Methods

In a within-subject design, 17 subjects (55.7 ± 1.0 years) received auditory stimulation in synchrony with SO up-states, which was compared to a no-stimulation sham condition. Overnight memory consolidation was assessed for declarative word-pairs and procedural finger-tapping skill. Post-sleep encoding capabilities were tested with a picture recognition task. Electrophysiological effects of stimulation were compared to a previous younger cohort (n = 11, 24.2 ± 0.9 years).

Results

Overnight retention and post-sleep encoding performance of the older cohort revealed no beneficial effect of stimulation, which contrasts with the enhancing effect the same stimulation protocol had in our younger cohort. Auditory stimulation prolonged endogenous SO trains and induced sleep spindles phase-locked to SO up-states in the older population. However, responses were markedly reduced compared to younger subjects. Additionally, the temporal dynamics of stimulation effects on SOs and spindles differed between age groups.

Conclusions

Our findings suggest that the susceptibility to auditory stimulation during sleep drastically changes with age and reveal the difficulties of translating a functional protocol from younger to older populations.
The efficacy of Coenzyme Q10 and liquid paraffin oil in the management of acute aluminum phosphide poisoning
Authors: Darwish Ragaa Talaat , Sobh Zahraa Khalifa , Hamouda Emad Hamdy , Saleh Eman Mohamed
Published: June 2020

Aluminum phosphide (AlP) poisoning had high morbidities and mortalities with absence of a standardized approach for the treatment. The present study investigated the efficiency of GIT decontamination methods and Coenzyme Q10(Co Q10) (Ubiquinone) in improving the outcome of acute AlP poisoning. A total of 90 patients were included and all patients received immediately supportive measures, then they distributed into three equal groups: In group I, gastric lavage was done using KMNO4 solution (1:10 000); group II received 250–500 ml liquid paraffin oil orally; group III received 300 mg of Co Q10 dissolved in liquid paraffin. Co Q10 was continued in a dose of 200 mg/day every 12 h. Follow-up blood pressure, arterial blood gases, serum troponin level and need for intubation revealed that the best improvement was in group III followed by group II. The percentage of survivors was 76.67% in group III and 70% of the patients had no residual effects. In group II, the survivors were 63.33%, and 36.67% of the cases discharged without sequelae. The survivors in group I constituted 26.67% and only 16.67% of the patients had no residual effects. GIT decontamination with aqueous solutions in acute AlP poisoning should be avoided. Rapid oral intake of any available oil as a prehospital treatment or immediately on hospital admission could critically improve the outcome of acute AlP poisoning. Besides, the addition of Co Q10 to the oil further improve patients’ prognosis. HighlightsAcute aluminum phosphide (AlP) poisoning is associated with high mortalities.The appropriate method of GIT decontamination in acute AlP poisoning is controversy.Conventional gastric lavage was associated with poor prognosis in acute AlP poisoning.GIT decontamination using liquid paraffin oil improved outcome of acute AlP poisoning.Coenzyme Q10 ameliorated AlP toxicity with improvement of cardiac functions.
Pectin as Carbon Source for Monilinia laxa Exoproteome and Expression Profiles of Related Genes
Authors: Rodríguez-Pires Silvia , Melgarejo Paloma , De Cal Antonieta , Espeso Eduardo A.
Published: June 2020

Pectin, as part of the fruit cell wall, can be degraded by brown rot fungi by coordinating the production, secretion, and action of extracellular enzymes. In this study, pectin utilization by the necrotroph Monilinia laxa 8L was studied by in vitro and in silico approaches. A total of 403 genes encoding carbohydrate-active enzymes (CAZymes) were identified, including 38 coding a predicted pectin-degrading activity. Analyzing the differences between M. laxa 8L exoproteomes in media containing glucose and pectin as sole carbon sources, we identified 107 pectin-specific proteins, among them, 64.48% harbor a classical secretory activity, including 42 CAZymes and six pectin-degrading proteins. Analyzing the gene-expression patterns of some pectinase families revealed their possible sequential action in pectin disassembly. We found, in vitro, an early pectin-dependent induction of MlRGAE1, MlPG1, and three members of the rhamnosidase family (MlαRHA2, MlαRHA3, and MlαRHA6) and late response of MlPG2 and MlPNL3. M. laxa 8L has the ability to use both pectin and byproducts as carbon sources, based on a functional pectinolytic machinery encoded in its genome, subjected to pectin-dependent regulation and appropriate secretion mechanisms of these pectinolytic enzymes. Differences in the secretion and transcription profile of M. laxa 8L provided insights into the different mechanisms that contribute to brown rot development.
The Menopause Transition and Women’s Health at Midlife: A Progress Report From the Study of Women’s Health Across the Nation (SWAN)
Authors: El Khoudary Samar R. , Greendale Gail , Crawford Sybil L. , Avis Nancy E. , Brooks Maria M. , Thurston Rebecca C. , Karvonen-Gutierrez Carrie , Waetjen L. Elaine , Matthews Karen
Published: June 2020

(Abstracted from Menopause 2019;26:1213–1227)

A major health milestone for women with influences extending far beyond reproduction is the menopause transition (MT). In addition to menopausal symptoms, concomitant biological, psychological, behavioral, and social changes occur during the MT that shape women's midlife and future health.
Real world data regarding the management of cancer-associated thrombosis
Authors: Tsoukalas Nikolaos , Tsapakidis Konstantinos , Galanopoulos Michail , Karamitrousis Evangelos , Kamposioras Konstantinos , Tolia Maria
Published: June 2020

Purpose of review

Patients with cancer are at high risk for thrombotic events, mainly deep vein thrombosis and pulmonary embolism. Low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are among the current treatment options for cancer-associated thrombosis (CAT). We assessed real world data (RWD) regarding treatment patterns of CAT from 1 September 2018 to 31 January 2020.

Recent findings

RWD showed that LMWHs were the most common initial anticoagulation treatment for CAT. Based on these data DOACs had a lower risk of recurrent venous thromboembolism compared with LMWHs and warfarin. However, the selection bias and the small number of patients in these studies might explain this difference and these limitations should be taken into consideration. Moreover, there was no statistical difference regarding adverse events during anticoagulant treatment between LMWHs and DOACs with the limitations of RWD. As far as the duration of the treatment is concerned, the adherence ranged from 100% to 67.3% at 6 months.

The current review of RWD illustrates that LMWHs and DOACs are used for the treatment of CAT. LMWHs are most commonly used for the initial management of CAT. Data regarding recurrence of CAT, adverse events, compliance and duration of anticoagulant treatment should be analyzed with caution as RWD are observational studies with many limitations. Further research is needed to elucidate the best algorithm for the management of CAT.
The OATH Syndemic: opioids and other substances, aging, alcohol, tobacco, and HIV
Authors: Womack Julie A. , Justice Amy C.
Published: June 2020

Purpose of review

Persons living with HIV (PLWH) are aging, continue to use alcohol and other substances, and experience age-associated adverse effects. We explore a new syndemic: OATH (opioids and other substances, aging, alcohol, tobacco, and HIV).

Recent findings

Frailty and falls are important problems that affect the health status of PLWH who continue to use alcohol and other substances. HIV, alcohol and other substance use, and aging each contributes to inflammaging. Multimorbidity and polypharmacy are also important pathways as alcohol and other substances interact with prescribed medications resulting in adverse-drug interactions leading to potentially serious consequences. Social conditions including racism, poverty, sex bias, stress, and stigma contribute to the existence and persistence of this syndemic.

Substance use, HIV, and aging are linked in a new syndemic (OATH) that drives age-related outcomes such as frailty and falls. We need to expand our understanding of the ‘healthcare team’ so that we include social and political advocates who can support necessary structural change. Treatment of substance use should be better incorporated into the management of HIV, including a focus on potential medication/substance interactions. Finally, we need to explore treatment of frailty rather than individual manifestations of frailty (e.g., atherosclerosis, neurodegeneration).
Hybrid Robotic Transanal Minimally Invasive Surgery Approach to Large and Low-Lying Rectal Polyps
Authors: Krezalek Monika A. , Contreras-Peraza Nicolas , Parker Maile E. , Kelley Scott R. , Behm Kevin T.
Published: June 2020

BACKGROUND:

Transanal excision is the surgical treatment of choice for low-risk rectal pathology such as endoscopically unresectable polyps, very select early rectal cancers, as well as other benign and low-risk tumors. Robotic transanal minimally invasive surgery enhances the surgeon’s ability to work in the confined space of the rectum and helps overcome the limitations of other modalities for transanal excision. Large lesions that extend to the dentate line and cannot be excised transanally impart a particular challenge. Herein, we describe a hybrid robotic transanal minimally invasive surgery approach for excising large rectal lesions that extend to the dentate line and cannot be excised by utilizing traditional transanal techniques.

TECHNIQUE:

With the use of a standard transanal approach, the distal margin of the lesion is marked and lifted off of the internal sphincter muscle. The dissection is continued until above the anorectal ring, and a 5.5-cm transanal platform is introduced transanally. Insufflation with an 8-mm trocar is initiated and the robotic platform is docked transanally. A 1-cm circumferential proximal margin is marked, and the excision is continued robotically until en bloc resection of the lesion is completed. The defect is closed in a transverse fashion using barbed suture. For rare cases of circumferential or nearly circumferential full-thickness defects, interrupted barbed sutures are placed equidistant, the robot is undocked, the transanal platform is removed, and a handsewn coloanal anastomosis is performed allowing complete closure of the defect.

RESULTS:

A hybrid robotic transanal minimally invasive surgery approach to large and low-lying rectal lesions is feasible and safe, and it has advantages over standard transanal excision including enhanced ergonomics, dexterity, and optics, as well as reduced rates of specimen fragmentation.

CONCLUSION:

A hybrid robotic transanal minimally invasive surgery approach allows for complete resection of very large polyps, which would otherwise be extremely challenging with standard transanal approaches. See Video at http://links.lww.com/DCR/B231.
cGMP Signaling in Cardiovascular Diseases: Linking Genotype and Phenotype
Authors: Dang Tan An , Schunkert Heribert , Kessler Thorsten
Published: June 2020

Cyclic guanosine 3′,5′-monophosphate (cGMP) is the key second messenger molecule in nitric oxide signaling. Its rapid generation and fate, but also its role in mediating acute cellular functions has been extensively studied. In the past years, genetic studies suggested an important role for cGMP in affecting the risk of chronic cardiovascular diseases, for example, coronary artery disease and myocardial infarction. Here, we review the role of cGMP in atherosclerosis and other cardiovascular diseases and discuss recent genetic findings and identified mechanisms. Finally, we highlight open questions and promising research topics.
Clinical trials of acute mechanical circulatory support in cardiogenic shock and high-risk percutaneous coronary intervention
Authors: Whitehead Evan , Thayer Katherine , Kapur Navin K.
Published: June 2020

Purpose of review

Acute mechanical circulatory support devices have become widely used in cardiogenic shock and high-risk percutaneous coronary intervention (PCI) but there remains significant controversy over the evidence supporting their use and the specific roles of various devices. In this review, we summarize major recent studies and identify key areas of future investigation.

Recent findings

In cardiogenic shock, uncontrolled single arm studies emphasizing early mechanical circulatory support (MCS) have showed promising results, but randomized trials have either been stopped prematurely or enrolled patients with advanced shock unlikely to benefit from MCS. In high-risk PCI, only one randomized controlled trail has been performed, with practice guided largely by observational data.

Randomized trials of current-generation mechanical support devices incorporating contemporary best-practices and performed in clearly defined populations are badly needed to clarify the role of acute MCS devices in cardiogenic shock and high-risk PCI.
Review – current opinion in cardiology hypertension in chronic kidney disease
Authors: Alqudsi Muhannad , Hiremath Swapnil , Velez Juan Carlos Q.
Published: June 2020

Purpose of review

Hypertension is a major risk factor for cardiovascular disease, cerebrovascular events, and progression to end-stage kidney disease (ESKD). The kidneys play a causative role in hypertension, but they are also organs vulnerable to hypertensive injury. Thus far, goals for optimal blood pressure in chronic kidney disease (CKD) and ESKD patients are not fully elucidated. Herein, we critically review the existing evidence.

Recent findings

Large randomized controlled trials (RCTs) continue to be deemed as the best source of evidence to guide optimal blood pressure goals in CKD and ESKD patients. Despite recent advances, the growing body of literature does not permit drawing definitive conclusions. Few adequately powered RCTs have specifically assessed goals for treatment of hypertension in patients with CKD. The most recent large RCT in hypertension, the Systolic Blood Pressure Intervention Trial, included a subset of patients with CKD and provided some insights. For the ESKD population, trials to evaluate blood pressure goals are even more scarce. The Blood Pressure in Dialysis Trial was a relatively small pilot study that can be deemed as hypothesis generating.

Management of hypertension in CKD is essential for optimization of cardiovascular, cerebrovascular and renal outcomes. To date, the existing evidence does not fully clarify ideal targets for blood pressure control in this patient population.
Intraocular lens calculations in patients with keratoectatic disorders
Authors: Smith Ryan G. , Knezevic Alexander , Garg Sumit
Published: June 2020

Purpose of review

Intraocular lens (IOL) calculations in patients with keratoconus and other keratoectatic disorders continues to be a challenge for today's cataract surgeon. In this article, we review data published over the past 18 months (June 2018 to January 2020).

Recent findings

Cataract surgery in keratoconus patients has the potential to greatly improve patients’ vision. However, keratoconic eyes are notorious for unpredictable outcomes because of difficulty in obtaining proper preoperative biometry and lack of data and consensus on IOL calculation formulas that can reliable in providing the desired outcome. Recent studies suggest the Barrett II Universal calculation is the most accurate in mild-to-moderate keratoconic eyes. All studies note the level of predictability decreases with the steepness of keratometric readings. Historically, the SRK/T has been shown to provide the most reliable calculations.

There is still no consensus on which formula is best for IOL calculation in keratoconic eyes. On the basis of the most recent literature, we recommend using the Barrett II Universal in conjunction with the SRK/T formula for mild-to-moderate eyes. Preoperative counseling of expectations with the patient is the key to achieving a satisfied patient and avoiding an unpleasant situation in the result of refractive surprise.