bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-stage g-computation
Authors: Breger Tiffany L. , Edwards Jessie K. , Cole Stephen R. , Westreich Daniel , Pence Brian W. , Adimora Adaora A.
Published: July 2020

Illustrations of the g-computation algorithm to evaluate population average treatment and intervention effects have been predominantly implemented in settings with complete exposure information. Thus, worked examples of approaches to handle missing data in this causal framework are needed to facilitate wider use of these estimators. We illustrate two-stage g-computation estimators that leverage partially observed information on the full study sample and complete exposure information on a subset to estimate causal effects. In a hypothetical cohort of 1,623 human immunodeficiency virus (HIV)-positive women with 30% complete opioid prescription information, we illustrate a two-stage extrapolation g-computation estimator for the average treatment effect of shorter or longer duration opioid prescriptions; we further illustrate two-stage inverse probability weighting and imputation g-computation estimators for the average intervention effect of shortening the duration of prescriptions relative to the status quo. Two-stage g-computation estimators approximated the true risk differences for the population average treatment and intervention effects while g-computation fit to the subset of complete cases was biased. In 10,000 Monte Carlo simulations, two-stage approaches considerably reduced bias and mean squared error and improved the coverage of 95% confidence limits. Although missing data threaten validity and precision, two-stage g-computation designs offer principled approaches to handling missing information.
Promoting Healthier Home Food Environments Through 2-1-1
Authors: Kegler Michelle C. , Bundy Łucja T. , Hartman Terry , Owolabi Shadé , Haardörfer Regine
Published: July 2020

Relatively few interventions target the home food environment of adults for weight gain prevention. Using a pretest/posttest design, this study describes the adaptation and pilot testing of Healthy Homes/Healthy Families, a research-tested home food environment intervention, for telephone delivery to 2-1-1 clients (n = 101). The Healthy Eating Index-2015, a measure of diet quality, improved significantly at 4-month follow-up, as did the home food environment, with energy consumption improving in the expected direction. Overall findings suggest the simplified intervention will still be effective, although results may be attenuated and additional efforts may be needed for participant retention among 2-1-1 clients.
An Examination of Family Variables as Mediators of the Association of Acculturation With Sugar-Sweetened Beverage Consumption Among Latinx Adolescents
Authors: Johansen Christopher , Reynolds Kim D. , Xie Bin , Palmer Paula
Published: July 2020

The objective of this study was to examine the mediating effects of family support for dietary habits and family meal frequency on the relationship between acculturation and sugar-sweetened beverage (SSB) consumption among Latinx adolescents (N = 131). Acculturation was positively associated with SSB consumption (B = 0.07, P < .01). Results suggest that family support for dietary habits and family meal frequency did not mediate the relationship between acculturation and SSB consumption. However, acculturation was negatively associated with family support for dietary habits (B = −0.10, P < .01) and family meal frequency (B = −0.11, P < .05). Future research should examine other family influences as mediators of the relationship between acculturation and SSB consumption.
Clinical Presentation and Outcome of Patients With Spontaneous Coronary Artery Dissection Versus Atherosclerotic Coronary Plaque Dissection
Authors: Daoulah Amin , Al-Faifi Salem M. , Madan Mina , Arafat Amr A. , Hersi Ahmad S. , Alasmari Abdulaziz , Clarkson Francis A. , Ball Vincent , Alkhushail Abdullah , Khan Abdul Salim , Asrar Farhan M. , Haq Ejazul , Alama Mohamed Nabil , Faden Mazen S. , Lotfi Amir
Published: July 2020

Background:

Atherosclerotic coronary plaque dissection (ACPD) is one cause of acute coronary syndrome (ACS) caused by underlying atherosclerosis. Spontaneous coronary artery dissection (SCAD) occurs outside the setting of atherosclerosis among young women and individuals with few or no conventional atherosclerotic risk factors, and has emerged as an important cause of ACS, and sudden death. A comparison between ACPD and SCAD has not been previously addressed in the literature. Our study will compare ACPD and SCAD.

Methods:

Patients with confirmed diagnosis of SCAD and ACPD were retrospectively identified from 30 centers in 4 Arab Gulf countries between January 2011 and December 2017. In-hospital (ventricular tachycardia/ventricular fibrillation, myocardial infarction (MI), percutaneous coronary intervention, dissection extension, cardiogenic shock, death, implantable cardioverter-defibrillator placement) and follow-up (MI, de novo SCAD, spontaneous superior mesenteric artery dissection, death) events were compared between them.

Results:

Eighty-three cases of SCAD and 48 ACPD were compared. ACPD patients were more frequently male (91.67% vs. 49.40%, P < 0.001) and older (58.5 vs. 44, P < 0.001). Cardiovascular risk factors were more prevalent in patients with ACPD, including diabetes mellitus (60.4% vs. 25.3%), dyslipidemia (62.5% vs. 38.5%), and hypertension (62.5% vs. 31.3%), P < 0.001. Hospital presentation of ST-elevation MI was diagnosed in 48% of SCAD versus 27% of ACPD patients (P = 0.012). SCAD patients received medical-only treatment in 40% of cases and ACPD in 21% (P = 0.042). In-hospital and follow-up events were comparable in both groups (P = 0.25).

Conclusions:

Despite a completely different pathophysiology of ACS between SCAD and ACPD, in-hospital and follow-up events were comparable.
COVID-19 Recommendations From Ophthalmic and Plastic Reconstructive Surgery Societies Worldwide
Authors: Nguyen Anne X. , Gervasio Kalla A. , Wu Albert Y.
Published: July 2020

Purpose:

The COVID-19 pandemic has brought unprecedented challenges for oculoplastic surgeons worldwide, in terms of care delivery, medical equipment and at-risk patient management. To date, there are no centralized or compiled international COVID-19 guidelines for oculoplastic surgeons.

Methods:

We examined COVID-19 guidelines published by oculoplastic societies worldwide. All countries around the world were initially considered in this study, but only 9 oculoplastic societies met the inclusion criteria: (1) publicly available guidelines displayed on the oculoplastic society’s website, or (2) guidelines received from the oculoplastic society after contacting them twice using the contact information on their website.

Results:

The 9 oculoplastic societies examined include: the American Society of Ophthalmic Plastic and Reconstructive Surgery, the British Oculoplastic Surgery Society, the Canadian Society of Oculoplastic Surgery, the European Society of Ophthalmic Plastic and Reconstructive Surgery, la Sociedad Española de Cirugía Plástica Ocular y Orbitaria, la Asociación Colombiana de Cirugía Plastica Ocular, the Asia Pacific Society of Ophthalmic Plastic & Reconstructive Surgery, the Oculoplastics Association of India, and the Philippine Society of Ophthalmic Plastic and Reconstructive Surgery. They all agree that urgent procedures should not be delayed, while non-necessary procedures (including all elective clinic services) should be postponed. When adequate protective equipment is available, oculoplastic surgeons must treat urgent cases. Eight out of 9 societies have provided recommendations on personal protective equipment use in order to prevent the spread of COVID-19 and to adequately protect mucous membranes. Other recommendations provided by certain societies are related to shelter in place measures, hand hygiene and surface disinfection protocols, patient triage, and thyroid eye disease management.

Conclusions:

All 9 societies with published recommendations have provided valuable recommendations to their members, regarding urgency of care and infection control solutions (personal protective equipment, hand hygiene, telemedicine, and social isolation).
Peripheral nerve injury and sensitization underlie pain associated with oral cancer perineural invasion
Authors: Salvo Elizabeth , Campana Wendy M. , Scheff Nicole N. , Nguyen Tu Huu , Jeong Se-hee , Wall Ian , Wu Angie K. , Zhang Susanna , Kim Hyesung , Bhattacharya Aditi , Janal Malvin N. , Liu Cheng , Albertson Donna G. , Schmidt Brian L. , Dolan John C. , Schmidt Robert E. , Boada M. Danilo , Ye Yi
Published: July 2020

Cancer invading into nerves, termed perineural invasion (PNI), is associated with pain. Here, we show that oral cancer patients with PNI report greater spontaneous pain and mechanical allodynia compared with patients without PNI, suggesting that unique mechanisms drive PNI-induced pain. We studied the impact of PNI on peripheral nerve physiology and anatomy using a murine sciatic nerve PNI model. Mice with PNI exhibited spontaneous nociception and mechanical allodynia. Perineural invasion induced afterdischarge in A high-threshold mechanoreceptors (HTMRs), mechanical sensitization (ie, decreased mechanical thresholds) in both A and C HTMRs, and mechanical desensitization in low-threshold mechanoreceptors. Perineural invasion resulted in nerve damage, including axon loss, myelin damage, and axon degeneration. Electrophysiological evidence of nerve injury included decreased conduction velocity, and increased percentage of both mechanically insensitive and electrically unexcitable neurons. We conclude that PNI-induced pain is driven by nerve injury and peripheral sensitization in HTMRs.
Mitochondrial bioenergetics, glial reactivity, and pain-related behavior can be restored by dichloroacetate treatment in rodent pain models
Authors: Lagos-Rodríguez Valentina , Martínez-Palma Laura , Marton Soledad , Miquel Ernesto , Escobar-Pintos Ricardo , Cassina Adriana , Lago Natalia , Cassina Patricia
Published: July 2020

Glial reactivity in the dorsal horn of the spinal cord is a hallmark in most chronic pain conditions. Neuroinflammation-associated reactive glia, in particular astrocytes, have been shown to exhibit reduced mitochondrial respiratory function. Here, we studied the mitochondrial function at the lumbar spinal cord tissue from complete Freund's adjuvant-induced inflammatory pain rat and chronic constriction injury mouse models by high-resolution respirometry. A significant decrease in mitochondrial bioenergetic parameters at the injury-related spinal cord level coincided with highest astrocytosis. Oral administration of dichloroacetate (DCA) significantly increased mitochondrial respiratory function by inhibiting pyruvate dehydrogenase kinase and decreased glial fibrillary acidic protein and Iba-1 immunoreactivity in spinal cord. Importantly, DCA treatment significantly reduced the ipsilateral pain-related behavior without affecting contralateral sensitivity in both pain models. Our results indicate that mitochondrial metabolic modulation with DCA may offer an alternative therapeutic strategy to alleviate chronic and persistent inflammatory pain.
Challenges and Lessons Learned Tailoring a Behavioral Intervention for Stroke Survivor–Care Partner Dyads
Authors: Tierney Meghan K. , Tracy Mary Fran , Everson-Rose Susan A. , Hadidi Niloufar Niakosari
Published: July 2020

INTRODUCTION: Research is increasingly exploring interventions for patient–care-partner dyads, but little has been reported regarding challenges of implementing dyad-focused interventions. This article reports the lessons learned in a pilot feasibility study of problem-solving therapy versus stroke education in stroke survivor–care partner dyads. CHALLENGES AND LESSONS LEARNED: Challenges arose in numerous aspects of intervention delivery. These ranged from personalizing the intervention to meet individual needs and balancing participation between dyad members to maintaining focus, managing conflict, and addressing ethical concerns, all of which required attention from the nurse researcher. These anticipated and unanticipated challenges were addressed using a variety of solutions, including engagement, active listening, redirection, and structured adaptation. IMPLICATIONS FOR PRACTICE: The knowledge gained and lessons learned in this study may be applied to other patient–care-partner dyads and other behavioral therapies. Nurses may also identify opportunities to increase inclusion of care partners in other interventions. Awareness of these challenges may lead to greater success in working with dyads. CONCLUSIONS: Dyad-focused behavioral interventions hold promise for use with stroke survivors and their care partners. They also present unique implementation challenges compared with survivor-only interventions.
Two cases of Nicolaides-Baraitser syndrome, one with a novel SMARCA2 variant
Authors: Karaer Kadri
Published: July 2020

Nicolaides-Baraitser syndrome (NCBRS) (OMIM 601358) is an uncommon but well-recognized autosomal dominant entity that is characterized by sparse scalp hair, characteristic coarse facies, microcephaly, seizures, developmental delay, intellectual disability (ID) and prominence of the interphalangeal joints and distal phalanges. Seizures are also common finding besides developmental delay and ID, which is severe approximately in half, moderate in one third and mild in the remainder. Here, we report two Turkish patients with NCBRS. One has a novel variant [NM_003070.5:c.3389G>T p.(Gly1130Val)] and a mild-moderate phenotype, and the other has a known variant [NM_003070.5:c.2554G>A p.(Glu852Lys)] correlated with severe phenotype.
Outcomes of a Structured, Stepwise Approach to Endoscopic Necrosectomy
Authors: Bang Ji Young , Wilcox Charles Mel , Hawes Robert , Varadarajulu Shyam
Published: July 2020

Background and Aim:

Despite the increasing number of procedures being performed, there is no consensus on the optimal approach to performing direct endoscopic necrosectomy (DEN), which is a labor-intensive, nonstandardized intervention. We prospectively validated the usefulness of a predefined, structured, stepwise approach to DEN with the objective of improving procedural efficiency and resource use.

Materials and Methods:

A prospective study of patients with necrotizing pancreatitis who after endoscopic transluminal drainage did not have clinical improvement and required DEN. The study was undertaken in 2 phases. Phase I was a retrospective analysis of interventions performed using an unstructured, conventional approach. Median of 3 necrosectomy sessions (range, 2 to 3) were required to achieve 80% treatment success in 20 patients. On the basis of these observations, a structured approach that included 3 steps (debridement, necrosis extraction, and irrigation) was developed and validated prospectively in phase II in 39 patients. The main outcome was to compare procedural efficiency defined as a number of necrosectomy sessions to achieve treatment success.

Results:

Although there was no significant difference in treatment success (phase I=80.0 vs. phase II=94.9%, P=0.17), the procedure was more efficient in phase II [median session, 2 (interquartile range=1 to 3) vs. 3 (interquartile range=2 to 3); P=0.003]. Multiple logistic regression analysis revealed that a structured, stepwise approach was associated with fewer necrosectomy sessions to achieve treatment success (odds ratio=4.7; 95% confidence interval=1.5-15.0; P=0.008) when adjusted for patient demographics, lab parameters, and disease characteristics.

Conclusions:

By decreasing the number of necrosectomy sessions, a structured, stepwise approach to endoscopic necrosectomy seems to improve procedural efficiency.
Long-term Outcomes of Per-oral Endoscopic Myotomy in Spastic Esophageal Motility Disorders
Authors: Nabi Zaheer , Chavan Radhika , Ramchandani Mohan , Basha Jahangeer , Jagtap Nitin , Karyampudi Arun , Darisetty Santosh , Tandan Manu , Goud Rajesh , Rao Guduru Venkat , Reddy Duvvur Nageshwar
Published: July 2020

Background and Aims:

Spastic esophageal motility disorders (SEMD) are a rare group of motility disorders including type III achalasia, distal esophageal spasm (DES), and Jackhammer esophagus (JHE). Limited data suggest that per-oral endoscopic myotomy (POEM) may be effective in these disorders. In this study, we aimed to evaluate the long-term outcomes of POEM in SEMD.

Methods:

The data of patients with SEMD who underwent POEM (January 2013 to December 2019) were analyzed, retrospectively. The following outcomes were recorded: POEM procedure details, technical and clinical success, adverse events, and gastroesophageal reflux disease (GERD). Clinical success was classified as immediate (<1 y), short-term (1 to 3 y), medium term (3 to 5 y), and long-term (>5 y).

Results:

A total of 1115 POEM procedures were performed during the study period for achalasia and nonachalasia spastic motility disorders. POEM was performed for SEMD in 74 (6.6%) patients including type III in 53, DES in 11, and JHE in 10 patients. Technical success was achieved in all the patients. The median follow-up for the entire group was 47.5 months (range: 2 to 77 mo). Clinical success at short-term (1 to 3 y) and long-term follow-up (>5 y) was attained in 85.2% and 82.6% patients, respectively. There was no significant difference in the clinical success between type III achalasia and JHE/DES. Mild and moderate adverse events were recorded in 21 (28.4%) cases. GERD was detected in 23 (56.1%) patients with 24-hour pH study. Erosive esophagitis and symptomatic GERD were found in 36 (48.6%) and 16 (21.6%) patients, respectively.

Conclusions:

POEM is a safe, effective, and durable treatment modality for spastic motility disorders of the esophagus. However, GERD is found in about half of the patients mandating close monitoring after POEM.
When to use probiotics in luminal gastrointestinal disorders?
Authors: Elangovan Abbinaya , Fischer Monika
Published: July 2020

Purpose of review

With the growing popularity and commercialization of probiotics, it is important to understand the implications of existing randomized controlled trials and their applicability in the clinical setting to treat luminal gastrointestinal diseases.

Recent findings

Probiotics may be useful in the prevention of antibiotic-associated diarrhea, prevention of Clostridioides difficile infection and eradication of Helicobacter pylori. Some evidence supports the use of probiotics in the treatment of ulcerative colitis, prevention and treatment of pouchitis and irritable bowel syndrome. Caution has to be exercised in immunocompromised and critically ill individuals. New society guidelines do not encourage probiotic use in gastrointestinal disorders with the exception of premature infants to prevent necrotizing enterocolitis.

Despite burgeoning body of literature and wide acceptance by the public, a thorough understanding of efficacy and safety of probiotics is lacking. Uniform dosage, standardized clinical end points, personalization based on host microbial profile and longer duration of follow-up on the research front may help in the future in appropriate positioning of probiotics in health and disease.
Assessment of energy expenditure: are calories measured differently for different diets?
Authors: Sanchez-Delgado Guillermo , Ravussin Eric
Published: July 2020

Purpose of review

The prevalence and burden of obesity has reached alarming levels. The assessment of human energy expenditure enables the identification of obesity-prone and obesity-resistant individuals and helps to explain the short and long-term success of weight loss treatments. In this review, we describe the state-of-the-art methods used in the assessment of human energy expenditure and the impact of dietary intake on the interpretation of the data.

Recent findings

The reference techniques to assess energy expenditure in humans have not significantly changed during the last century. Today, indirect calorimetry, either using a metabolic chamber or a metabolic cart, is the favored method to assess human energy expenditure and is the only method enabling the assessment of macronutrient oxidation. The doubly labeled water method however provides accurate assessment of human energy expenditure under free living conditions.

Although energy expenditure and macronutrient oxidation can be assessed by simple calculations from oxygen consumption and carbon dioxide production, these calculations can provide erroneous results or require corrections and/or more complex interpretation when several biochemical pathways are simultaneously engaged. Such physiological mechanisms are often elicited by dietary interventions including, among other, gluconeogenesis, lipogenesis, ketogenesis, alcohol oxidation and under or overfeeding.
Evolving spectrum of treatment for CTEPH
Authors: Khangoora Vikramjit S. , Shlobin Oksana A.
Published: July 2020

Purpose of review

The present review provides an update on treatment of chronic thromboembolic pulmonary hypertension (CTEPH), a rare form of pulmonary hypertension characterized by precapillary pulmonary hemodynamic parameters with chronic thrombotic occlusion of the pulmonary vasculature.

Recent findings

Pulmonary thromboendarectomy (PTE) remains the recommended treatment for patients with surgically accessible disease. Recent data suggest that patients preoperatively bridged with medical therapy may have improved outcomes but further research is needed. Riociguat improves hemodynamics, right ventricular function, quality of life, and functional capacity and is the drug of choice for patients with inoperable/persistent disease. Recently published data suggest that endothelin receptor blockers and treprostinil may also have a role in medical management of this patient population. A growing body of evidence indicates that in experienced centers balloon pulmonary angioplasty (BPA) may be a well tolerated and effective adjunct to pharmacological treatment for patients with inoperable disease affecting subsegmental vasculature.

Untreated CTEPH carries significant morbidity and mortality. Recent publications provide a wealth of data on safety and efficacy of BPA for inoperable subsegmental disease, but its precise fit in the treatment algorithm, both pharmacological and procedural, requires further investigation. PTE remains the procedure of choice for surgically accessible disease.
Insights into pathogenesis and clinical implications in myositis-associated interstitial lung diseases
Authors: Yanagihara Toyoshi , Inoue Yoshikazu
Published: July 2020

Purpose of review

Interstitial lung diseases (ILDs) have been reported to be associated with myositis (including polymyositis and dermatomyositis). These myositis-associated ILDs carry significant morbidity and mortality. This review summarizes recent findings on myositis-associated ILD with a focus on pathogenesis and emerging treatment.

Recent findings

Recent advances in genetics have revealed 22 myositis-associated genome-wide loci, which were significantly enriched in regulatory regions in immune cells. An analysis of such disease-associated loci elucidated potential drug targets (e.g., TYK2 targeted by tofacitinib). In another study, an intronic variant in WDFY4 in association with clinically amyopathic dermatomyositis (CADM) had an effect for higher expression of a truncated WDFY4 isoform. Truncated WDFY4 markedly enhanced the MDA5-mediated NF-κB activation and cell apoptosis, indicating the dysregulated WDFY4-MDA5 pathway as a novel pathogenesis of CADM. As a novel strategy, tofacitinib treatment showed a promising improvement in survival and clinical features of CADM-associated ILD.

The genetic differences in the myositis-susceptible loci may explain the heterogeneous phenotypes and treatment responses in myositis-associated ILD. The understanding of pathogenesis with the genetic background as well as autoantibodies will enable the practice of personalized treatment in the management of the disease.
Looking into the future of sarcoidosis: what is next for treatment?
Authors: Miedema Jelle R. , Bonella Francesco , Grunewald Johan , Spagnolo Paolo
Published: July 2020

Purpose of review

Sarcoidosis is a complex granulomatous disease of unknown cause. Corticosteroids and immune suppressants are often given long term in chronic disease, which may result in substantial toxicity. Validated strategies for selecting patients at risk for disease progression, who might benefit from early and targeted treatment, are lacking. Consequently, the unmet need for new treatment options in sarcoidosis is high. In this review, we critically discuss potential therapeutic targets and ongoing clinical trials in sarcoidosis.

Recent findings

Despite the heterogeneous clinical manifestations and the lack of a reliable animal model, our knowledge and understanding of the pathogenesis of sarcoidosis has improved in recent years, which has resulted in the identification of several potential therapeutic strategies. They include the inhibition of cytokines involved in maturation of macrophages, activation of dendritic cells, and maturation and activation of pathogenic T-lymphocytes. The inflammasome and the autophagy are additional areas for future research. Antifibrotic therapy might also be a reasonable choice in selected patients, although the best treatment strategy in progressive fibrotic sarcoidosis remains undetermined.

In this article, we review novel approaches to sarcoidosis treatment and potential therapeutic targets.
Agreement between emergency physicians and radiologists for the diagnosis of deep venous thrombosis with compression ultrasound: a prospective study
Authors: Elsenga Hylmar E. , Collée Annelieke , Rosendaal Arthur V.
Published: July 2020

Introduction

The time factor in diagnosis and management of a deep vein thrombosis of the lower extremities (LE DVT) is of increasing importance in the era of crowding of emergency departments (ED). Current techniques used to detect LE DVT include a two-point regional compression ultrasound (rCUS), yet assessments are usually performed only during office hours. Outside office hours ultrasonography is postponed and low molecular weight heparin (LMWH) prescribed.

Objectives

Primary outcome of the study was to assess the level of agreement in rCUS for LE DVT when performed by Dutch emergency physicians compared to rCUS by a radiologist. Secondary outcome was time to diagnosis.

Method

We performed a single-blind cohort study. All consecutive patients aged 18 years and older attending the ED with clinical suspicion of LE DVT were considered eligible for study enrolment. rCUS was ordered at the radiology department; subsequently, the bedside rCUS examination was also performed in the ED by the emergency physicians or ED residents.

Results

A total of 138 patients were included, of whom 28 patients were diagnosed with DVT by a radiologist. Emergency physicians and radiologists showed comparable agreement [absolute agreement 94% (P < 0.001), Cohen’s Kappa 0.87]. Emergency physicians decreased overall time to diagnosis by 01:04 h, ED residents showed comparable results. During out-of-office hours, time benefit was 16:39 h on weekdays and 18:40 h during weekends.

Conclusion

Emergency physicians show comparable agreement in diagnosing LE DVT using rCUS when compared to radiologists. Average time benefit is over an hour, thereby reducing unnecessary waiting and improving time to disposition. ED residents demonstrated similar results in both agreement and time-saving.
Implications of Tobacco Smoking and Alcohol Consumption on Ectopic Fat Deposition in Individuals After Pancreatitis
Authors: Stuart Charlotte E. , Ko Juyeon , Modesto Andre E. , Alarcon Ramos Gisselle C. , Bharmal Sakina H. , Cho Jaelim , Singh Ruma G. , Petrov Maxim S.
Published: July 2020

Objectives

Tobacco smoking and alcohol consumption are established risk factors for pancreatitis. This study investigated the associations between tobacco smoking/alcohol consumption in people after an attack of pancreatitis and intrapancreatic fat deposition (IPFD), intrahepatic fat deposition (IHFD), and skeletal muscle (SMFD) fat deposition.

Methods

In this cross-sectional study, magnetic resonance imaging was used to quantify IPFD, IHFD, and SMFD by 2 independent raters. A validated questionnaire was used to determine tobacco smoking and alcohol consumption.

Results

A total of 119 individuals after an attack of pancreatitis were included. Average tobacco smoking contributed most to variance in IPFD (R
2 = 6.5%) and least to variance in SMFD (R
2 = 0.4%). Average alcohol consumption contributed most to variance in variance in IPFD (R
2 = 2.8%) and least to IHFD (R
2 = 1.1%). Packs/day contributed more than years of smoking to variance in IPFD (R
2 = 4.9 and 0.2%, correspondingly), whereas years of drinking contributed more than average daily alcohol consumption (R
2 = 3.9 and 3.2%, correspondingly).

Conclusions

Tobacco smoking and alcohol consumption contributed more to variance in IPFD than IHFD and SMFD. Smoking contributed more than drinking to variance in IPFD. The daily amount of tobacco smoked appeared to be more important than years of smoking for IPFD.
Hemoglobin S/Hemoglobin Quebec-Chori Presenting as Sickle Cell Disease: A Case Report
Authors: Goode Erin , Boruchov Donna , Oliveira Jennifer L. , Lau Ching C.
Published: July 2020

Background:

Sickle cell disease is a homozygous hemoglobinopathy with vaso-occlusive complications secondary to abnormal sickling of red blood cells under stressful conditions such as hypoxia. Children with sickle cell trait have a heterozygous genetic state, typically without symptoms.

Observation:

An 8-year-old boy diagnosed with sickle cell trait was found to have multiple complications consistent with sickle cell disease, including pain crises, osteomyelitis, and priapism. Over a 6-year period, he underwent routine laboratory evaluations without a definitive diagnosis. The diagnosis of a compound heterozygous state of hemoglobin S/hemoglobin Quebec-Chori was eventually made on the basis of mass spectrometry and confirmed with hemoglobin subunit beta gene sequencing.

Conclusion:

Expanding diagnostic evaluation in patients with abnormal clinical presentations is vital to making the correct diagnosis and hence earlier institution of appropriate management of rare hemoglobinopathies.
Implementation of an Automated Sepsis Screening Tool in a Community Hospital Setting
Authors: Cooper Penny B. , Hughes Bobbi J. , Verghese George M. , Just J. Scott , Markham Amy J.
Published: July 2020

Background:

Early identification of sepsis remains the greatest barrier to compliance with recommended evidence-based bundles.

Purpose:

The purpose was to improve the early identification and treatment of sepsis by developing an automated screening tool.

Methods:

Six variables associated with sepsis were identified. Logistic regression was used to weigh the variables, and a predictive model was developed to help identify patients at risk. A retrospective review of 10 792 records of hospitalizations was conducted including 339 cases of sepsis to retrieve data for the model.

Results:

The final model resulted an area under the curve of 0.857 (95% CI, 0.850-0.863), suggesting that the screening tool may assist in the early identification of patients developing sepsis.

Conclusion:

By using artificial intelligence capabilities, we were able to screen 100% of our inpatient population and deliver results directly to the caregiver without any manual intervention by nursing staff.
Impact of a Nontraditional Ambulatory Clinic Nurse Residency Program
Authors: Walton Stephanie A. , Harmon Kamela A. , Knoedel Matthew A.
Published: July 2020

This study sought to answer how implementing a nontraditional ambulatory registered nurse (RN) residency program impacted confidence, role transition, and retention rates of nursing staff in the outpatient clinical setting. Results demonstrated that the program improved RNs' confidence in communication and perceived preparedness to complete individual professional responsibilities. As a result of this study, implementing a nontraditional RN ambulatory residency program should be considered to support RNs new to the ambulatory setting.
Bridging the Gap
Authors: Englund Heather , Basler Jennifer
Published: July 2020

Background

The purpose of this study was to investigate the relationship between an acid-base imbalance educational gaming activity and subsequent performance on a course examination on the subject.

Method

A nonexperimental descriptive design was employed using retrospective data obtained from both College of Nursing internal records and the learning management system used by the nursing program. A total of 435 students in the intervention group and 409 in the control group were included in the study.

Results

Differences in mean (SD) scores between the 2 groups for the acid-base content questions on the course examination were statistically significant (intervention group, 16.64 [1.92]; control group, 16.03 [1.62]; t
842 = 2.34, P = .019).

Conclusion

The results suggest that using educational gaming may improve retention and application of nursing knowledge.
Omental Infarction
Authors: Di Nardo Giovanni , Di Serafino Marco , Gaglione Giovanni , Mercogliano Carmela , Masoni Luigi , Villa Maria Pia , Parisi Pasquale , Ziparo Chiara , Vassallo Francesca , Evangelisti Melania , Vallone Gianfranco , Esposito Francesco
Published: July 2020

Objective

To evaluate the prevalence of omental infarction (OI) in children with suspected appendicitis, the role of ultrasonography (US) in its diagnosis and management and the efficacy of conservative management.

Methods

Consecutive children with suspected acute appendicitis were prospectively enrolled. Ultrasonography was performed at baseline, during follow-up, before the discharge, and at 15-day intervals until US findings of OI disappeared. All children with a diagnosis of OI were treated conservatively.

Results

One hundred ninety-nine children (91 male; age range, 3–15 years) were evaluated. Eighty-four patients had acute appendicitis. Omental infarctions were found in 14 children (8 male; mean age, 9.8 ± 2.6 years), with an incidence of 7%. Ultrasonography depicted an echogenic mass consistent with OI in all children. Ultrasonography detected in 8 patients a normal-looking appendix, whereas in other 6 patients, it identified neither appendix nor indirect signs of acute appendicitis. A normal appendix has been detected by US during follow-up in 2 of these 6 patients. During follow-up, US finding of OI disappeared in all cases and no signs of acute appendicitis or other disease occurred. All 14 OIs were treated conservatively, with no reported complications.

Conclusions

Omental infarction is an underestimated cause of abdominal pain in children accounting for 7% of patients with suspected appendicitis. Ultrasonography is a useful method for the diagnoses and to guide clinical management of OI. Conservative therapy is a safe option for the management of OI.
The Impact of a New On-site Inpatient Psychiatric Unit in an Urban Pediatric Emergency Department
Authors: Hasken Clare , Wagers Brian , Sondhi Jennifer , Miller Jason , Kanis Jessica
Published: July 2020

Objective

The objective of this study was to describe the impact of opening an inpatient child psychiatric unit in an urban tertiary care pediatric emergency department (PED).

Design/Methods

A retrospective chart review was performed of pediatric patients seen in the PED at a large tertiary care center who presented for a primary psychiatric concern before opening of the inpatient psychiatric unit within the same hospital and 6 months following, allowing for a 6-month adjustment period. Patients were identified via query of the ED Cube model, an institutional database by a “behavioral health” flag that is documented in triage. Patients were excluded if subsequent chart review did not reveal a psychiatric concern and the patient did not undergo psychiatric evaluation during the PED visit. Charts were reviewed for baseline patient demographics, psychiatric interventions performed, and disposition. Additional flow metrics obtained were PED volume, percentage of psychiatric visits, and length of stay for both psychiatric-related visits compared with the general population.

Results

Visits to the PED for psychiatric evaluation increased 135% from 91 to 226 after initiation of an inpatient psychiatric unit. There was no difference in baseline patient demographics or rate of medical/mechanical restraints used. Percentage of behavioral health patients admitted to medical units decreased, although overall admission rate remained stable. Length of stay for behavioral health patients was longer after opening of the unit and remained significantly higher than the general population before opening of the inpatient unit, 363 minutes versus 177 minutes, respectively, and further lengthened after to 418 minutes versus 188 minutes.

Discussion

Patients presenting for psychiatric evaluation are a significant burden to PED flow both in volume and time for evaluation and boarding. This is to the detriment of patients seeking appropriate mental health services and to the rest of patients in the PED. Both inpatient and outpatient psychiatric services are overwhelmed creating a downstream affect; limited resources delays disposition and increases boarding in the PED. Further resources are needed to appropriately address psychiatric concerns, such as dedicated psychiatric holding units and brief PED interventions targeted to safety planning and interventions.
Comparison of Computed Tomography Use and Mortality in Severe Pediatric Blunt Trauma at Pediatric Level I Trauma Centers Versus Adult Level 1 and 2 or Pediatric Level 2 Trauma Centers
Authors: Wiitala Ellen L. , Parker Jessica L. , Jones Jeffrey S. , Benner Christopher A.
Published: July 2020

Introduction

Computed tomography (CT) is the criterion standard for identifying blunt trauma injuries in pediatric patients, but there are long-term risks of CT exposure. In pediatric blunt trauma, multiple studies have shown that increased CT usage does not necessarily equate to improvements in mortality. The aim of this study was to compare CT usage between level 1 pediatric trauma centers versus level 2 pediatric centers and adult level 1 and 2 centers.

Methods

We performed a retrospective, multicenter analysis of National Trauma Data Bank patient records from the single admission year of 2015. Eligible subjects were defined as younger than 18 years with abdominal or thoracic blunt trauma, had an Injury Severity Scale score of greater than 15, and were treated at a level 1 or 2 trauma center. Data were then compared between children treated at level 1 pediatric trauma centers (PTC group) versus level 2 PTCs or adult level 1/2 trauma centers (ATC group). The primary outcomes measured were rates of head, thoracic, abdominal CT, and mortality. Data from ATC and PTC groups were propensity matched for age, sex, race, and Glasgow Coma Scale.

Results

There were 6242 patients after exclusion criteria. Because of differences in patient demographics, we propensity matched 2 groups of 1395 patients. Of these patients, 39.6% of PTC patients received abdominal CT versus 45.5% of ATC patients (P = 0.0017). Similarly, 21.9% of PTC patients received thoracic CT versus 34.7% of ATC patients (P < 0.0001). There was no difference in head CT usage between PTC and ATC groups (P = 1.0000). There was no significant difference in mortality between patients treated in the PTC versus ATC groups (P = 0.1198).

Conclusions

Among children with severe blunt trauma, patients treated at level 1 PTCs were less likely to receive thoracic and abdominal CTs than those treated at level 2 pediatric or adult trauma level 1/2 centers, with no significant differences in mortality. These findings support the use of selective imaging in severe blunt pediatric trauma.
Surgery First and Invisalign System: Combined Digital Approach
Authors: Amodeo Giulia , Meuli Simonetta , Carboni Andrea , Brugnami Federico , Marrocco Sergio , Orsini Raniero , Scopelliti Domenico
Published: July 2020

Purpose:

The aim of the present paper is to verify the long-term results in dental and skeletal stability in terms of symmetry, occlusion and functional balance by the association between the IS and the SF technique.

Methods:

In this paper, the authors described 12 cases of severe class III malocclusion treated by the association between the IS and the SF technique.

Results:

At 1 year of post-orthodontic follow up, the patients present an Angle class I occlusal relationship, no deep bite, no scissor or cross-bite and no open bite. No one patient referred TMJ discomfort nor severe post-surgical complications and no surgical-orthodontic relapse occurred. The surgical and occlusal results are stable in terms of stability in all patients.

Conclusion:

The results of this study suggest the validity of our protocol in management of class III malocclusion patients.
Identification of Differentially Expressed Genes and Signaling Pathways in Glioma by Integrated Bioinformatics Analysis
Authors: Xu Chang , Su Wenjing , Jiang Xingyue
Published: July 2020

Background:

Gene alterations are very vital when it comes to the molecular pathogenesis of glioma. In this study, there was the design of the probable candidate genes in the glioma.

Methods:

Gene Expression Omnibus (GEO) database data sets of glioma tissue were retrieved and the differentially expressed genes (DEGs) from the individual microarray were merged. The following were performed: Gene Ontology; enrichment analysis; Kyoto Encyclopedia of Genes and Genomes (KEGG); pathway analysis; protein-protein interaction networks analysis.

Results:

The following were selected: 4 GEO data sets that included 370 high-grade glioma samples as well as 169 low-grade glioma samples. Identification of a total of 174 DEGs was done. Out of the identified DEGs, 82 were upregulated and 92 were downregulated genes. According to the Gene Ontology analysis, the primary biologic focus of DEGs included passive transmembrane transporter activity, regulation of channel activity, as well as the revelation that the biologic roles of DEGs aimed primarily on regulating channel activity, as well as the monovalent inorganic cation transmembrane transporter activity. The most significant pathway in KEGG analysis was PI3K-AKT signaling pathway. Some of the significant hub genes as per the protein-protein interaction network analysis included CDC20, NDC80, DLGAP5, CENPF, CENPE, ASPM, TPX2, TOP2A, RRM2, and PRC1.

Conclusion:

From this study, it is evidenced that the use of integrated bioinformatics analyses in screening for pathways and DEGs in glioma can help us understand the clinical significance of understanding glioma, the molecular mechanism that underlies the development of glioma, as well as the provision of an effective target to treat glioma.
Intraosseous Lipoma in the Mandibular Condyle
Authors: Han Xiaodong , Shao Xiaojun , Lin Xiaozhen
Published: July 2020

Intraosseous lipomas are rare benign tumors of the bone, especially for the mandible. The etiology remains unclear, although several hypotheses have been proposed, such as trauma, blood vessel infarction, aging and inflammation. Clinically, the symptoms mainly depend on the location and size of the tumors. Radiographically, the lesions are usually radiolucent occasionally accompanied by radiopacity. The diagnosis is challenging, and histopathologic examination is necessary for definite diagnosis. Herein, the authors report an unusual patient with intraosseous lipoma in the mandibular condyle.
Gingival Sulcus Incision for Zygomaticomaxillary Complex Fracture
Authors: Kokubo Kenichi , Katori Nobutada , Fujii Akiko , Kitamura Sho , Ninomiya Ryunosuke , Haga Shoko , Maegawa Jiro
Published: July 2020

The usual surgical approaches for zygomaticomaxillary complex fracture are subciliary incision, transconjunctival incision, eyebrow incision, lateral canthal incision, coronal incision, preauricular incision, and superior gingivobuccal incision. In the intraoral approach, a horizontal mucoperiosteal incision is performed at the superior gingivobuccal region, and sometimes, includes the upper labial frenum. This may cause discomfort in the oral cavity because of postoperative scarring and shortening of the upper labial frenum. To avoid these complications, the authors performed a novel approach using gingival sulcus incision instead of oral mucosal incision to treat 5 zygomatic fractures. The authors evaluated the regression of the gingival interdental papillae, gingival swelling, and gingival perception at 2 weeks, 1 month, 3 months, and 6 months after the operation. The regression of the gingival papillae and gingival swelling disappeared 3 months and 1 month after the operation, respectively. No paresthesia was observed in any of the cases. The gingival sulcus approach can lead to scarless results and contribute considerably to the aesthetic appearance of the oral cavity.
miR-132-5p regulates apoptosis and autophagy in MPTP model of Parkinson’s disease by targeting ULK1
Authors: Zhao Jianli , Yang Manyi , Li Qi , Pei Xiaorui , Zhu Xiaodong
Published: July 2020

Parkinson’s disease (PD) is a neurodegenerative disorder that is characterized by a loss of dopaminergic neurons in the substantia nigra of the brain. Numerous investigations have focused on the underlying mechanism involved in the progression of PD in recent decades. miR-132 is abnormal expression in many diseases including PD. However, the functional role and molecular mechanism of miR-132-5p in PD pathogenesis are still not elucidated. In our study, we found miR-132-5p was upregulated in 1-methyl-4-pheny-1,2,3,6-tetrahydropyridine (MPTP) model of PD. MTT assay and flow cytometric analysis revealed that inhibition of miR-132-5p increased cell survival ability and reduced MPTP-induced apoptosis of SH-SY5Y cells. Furthermore, inhibition of miR-132-5p could significantly suppressed mRNA and protein expression levels of LC3 and Beclin 1, indicating inhibition of miR-132-5p might restrain autophagy in PD. Subsequently, ULK1 was identified as a target of miR-132-5p and positively regulated by miR-132-5p at both mRNA and protein levels. Additionally, ectopic expression of ULK1 was able to reverse the effects of miR-132-5p inhibition. Taken together, our results demonstrated that miR-132-5p inhibition might exert a protective role in MPTP-treated PD models by targeting ULK1, indicating that miR-132-5p may be a prospective therapeutic target for PD.