bluuebunny/crossref_metadata_2025 huggingface dataset:
Thromboelastography as a tool for monitoring blood coagulation dysfunction after adequate fluid resuscitation can predict poor outcomes in patients with septic shock
Authors: Zhao Hui , Cai Xiujun , Liu Ning , Zhang Zhongheng
Published: May 2020

Background:

Coagulation abnormalities are universal in patients with septic shock and likely play a key role in multiple organ dysfunction syndrome. Early diagnosis and management of sepsis-induced coagulopathy can influence the outcome. Thromboelastography (TEG) can effectively distinguish hypercoagulability and hypocoagulability in patients with septic shock. TEG may be a useful tool to objectively evaluate the degree and risk of sepsis.

Methods:

A total of 76 adult patients with septic shock were enrolled and divided into four groups: patients with hypotension requiring vasopressor and serum lactate level >2 mmol/L (group A), patients with hypotension requiring vasopressor and serum lactate level ≤2 mmol/L (group B), patients with mean arterial pressure ≥65 mmHg and serum lactate level >2 mmol/L (group C), and patients with mean arterial pressure ≥65 mmHg and serum lactate level ≤2 mmol/L (group D) after adequate fluid resuscitation. TEG values were obtained at the emergency room and after 6 hours of adequate fluid resuscitation. Data on fibrinogen (FIB) levels, international normalized ratio (INR), activated partial thromboplastin time (aPTT), blood gas, platelet count, and d-dimers were also collected.

Results:

The length of stay in the intensive care unit was 9.11 ± 5.36 days. Mortality rate was 6.58%. The values of reaction time, kinetics time, maximum amplitude, alpha angle, aPTT, INR, serum creatinine, FIB, and sepsis-related organ failure assessment (SOFA) score showed a significant differences. The results of the routine coagulation tests, blood gas volume, platelet count, procalcitonin level, d-dimer level, white blood cell count, creatinine level, disseminated intravascular coagulation score, SOFA score, and TEG values after adequate fluid resuscitation were significantly different between groups A and B, groups A and C, groups A and D, groups B and D, and groups C and D.

Conclusion:

TEG is helpful in predicting the severity of sepsis and outcome of patients.
Cardiovascular manifestation and treatment in COVID-19
Authors: Su Yen-Bo , Kuo Ming-Jen , Lin Ting-Yu , Chien Chian-Shiu , Yang Yi-Ping , Chou Shih-Jie , Leu Hsin-Bang
Published: May 2020

The novel coronavirus disease 2019 (COVID-19), with first presentation of atypical pneumonia, has spread rapidly from Wuhan, China, on December 12, 2019 to over 200 countries, caused 2 310 572 infected individuals and 158 691 mortalities, updated on April 19, 2020. Many studies have published timely to help global healthcare workers to understand and control the disease. Vulnerable patients with risk factors such as elderly, cardiovascular diseases (eg, hypertension, coronary disease, or cardiomyopathy), diabetes, and chronic kidney disease have worse outcomes after COVID-19 infection. COVID-19 could directly cause cardiovascular injuries such as pericarditis, myocarditis, myocardial infarction, heart failure, arrhythmias, or thromboembolic events, which urge cardiologists to be involved in the frontline to practice. Here, we provide a review of COVID-19 on cardiovascular system to assist clinical cardiologists to better understand the disease and being capable of providing comprehensive medical support.
Impact of the COVID-19 pandemic on the management of patients with end-stage renal disease
Authors: Li Szu-Yuan , Tang Yu-Shuo , Chan Yu-Jiun , Tarng Der-Cherng
Published: May 2020

A novel infectious disease, coronavirus disease-2019 (COVID-19), spread globally since December 2019. Without effective treatment and vaccination, the strategies to restrain this disease are only keeping social distance, maintaining personal hygiene, quarantine, and isolation. However, thrice-a-week treatment is inevitable for all hemodialysis patients. In addition to the high risk of cluster infection and compromised immunity in patients with end-stage renal disease (ESRD), an atypical disease presentation could also make the medial system neglect these patients during CVOID-19 pandemic. To avoid COVID-19 transmission among patients on dialysis, the major societies of nephrology around the world have provided their guidelines for screening, dialysis facilities adjustment, and health education, respectively. In this review, we summarized the main contents and differences of these guidelines and addressed the prompt management for patients with ESRD to reduce the risk of infection during COVID-19 pandemic.
Self-management Needs of Adults With Congenital Heart Disease
Authors: Hays Laura H. , McSweeney Jean C. , Mitchell Anita , Bricker Christina , Green Angela , Landes Reid D.
Published: May 2020

Background

Adults with congenital heart disease (CHD) are an emerging adult heart disease subset, now outnumbering the pediatric population with CHD.

Objective

We aimed to gain understanding and knowledge of what adults with CHD perceive as important for self-management and describe these needs across demographic factors, developmental characteristics, lesion severity, and quality of life.

Methods

We used a descriptive mixed-methods online survey merging 4 instruments: Adult CHD Self-management Experience Questionnaire; Adult CHD Demographic Questionnaire; Adaptive Behavior Assessment System, Third Edition; and Stanford Quality of Life Visual Numeric. Participants with CHD 18 to 30 years of age with initial defect repair before 12 months of age were recruited through support from the Adult Congenital Heart Association, clinic adult CHD support groups, and newspaper advertising. Thematic analysis for short-answer questions, descriptive analysis for demographic data and the visual numeric, and intrument-specific scoring assistant software for the Adaptive Behavior Assessment System were used.

Results

We received 22 responses from 13 women and 9 men. These individuals represented 15 different heart defect diagnoses, mostly of moderate or complex lesion severity. Most had postsecondary education and were employed. Four prominent themes emerged related to self-management: desire for connectivity—psychological support; a plan for the future—education about health and life expectations; coping needs—skills for mental stress; and access to care—navigation of healthcare systems.

Conclusions

Future longitudinal research and replication studies with larger samples are needed. Educational materials and targeted interventions that promote self-management benefit the aging adult with CHD population.
Special Article: Translational Science Update. Pharmacological Implications of Emerging Schizophrenia Genetics
Authors: Birnbaum Rebecca , Weinberger Daniel R.
Published: May 2020

Recent schizophrenia genome-wide association studies (GWAS) have identified genomic variants of common and rare frequency, significantly associated with schizophrenia. While numerous functional genomics efforts are ongoing to elucidate the biological effects of schizophrenia risk variants, a consideration of their therapeutic implications is timely and imperative, for patients as well as for an iterative effect on elucidating the underlying biology and pathophysiology of illness. The current article reviews efforts to translate emerging schizophrenia genomics into novel approaches to target discovery and therapeutic intervention. Though the path from ‘genetic risk to therapy’ is far from straightforward, there are provocative early possibilities that harbor the promise of treatment based on causation rather than phenomenology, as well as ‘precision psychiatry,’ a basis for stratifying patients to enable more precise and effective, personalized therapy.
Correlates to Increased Risk of Sexual Assault and Sexual Harassment Among LGBT+ University Students
Authors: Tilley Donna Scott , Kolodetsky Ann , Cottrell Damon , Tilton Abigail
Published: May 2020

Background

Although the rates of sexual assault in general are alarming, students who identify as lesbian, gay, bisexual, transgender, queer, asexual, or pansexual, hereafter referred to as LGBT+, are even more likely to experience sexual assault.

Aim

The aim of this study was to examine the correlates to sexual assault and other forms of sexual misconduct of LGBT+ college students.

Methods

The Administrator Researcher Campus Climate Collaborative campus climate survey was administered at 10 universities, and a final sample size of 6,973 student surveys were analyzed. All continuous and categorical data were compared by sexual orientation using linear mixed models and logistic generalized linear mixed models.

Results

In this study, we learned that LGBT+ students are more likely than their heterosexual peers to have friends who approve of risky sexual behavior, which is correlated with sexual victimization; understand that absence of physical resistance does not confer consent; engage in bystander intervention; and anticipate supportive responses from peers. LGBT+ students are less likely than their heterosexual peers to feel an overall sense of well-being, perceive that the campus climate regarding sexual misconduct was positive, and feel that the campus was safe. There were no differences between LGBT+ students and heterosexual students regarding most elements of consent, perpetration of any sexual misconduct (stalking, sexual harassment, sexual assault), or stalking victimization.

Discussion

Interventions to reduce campus sexual assault must be tailored to fit the students. Lack of clarity around consent and bystander intervention education are the mainstay of campus sexual assault prevention efforts.
Effect of the implementation of a new guideline for minor head injury on computed tomography-ratio and hospitalizations in the Netherlands
Authors: van den Brand Crispijn L. , Perotti Joeri R. , van der Linden M. Christien , Tolido Tanya , Jellema Korné
Published: May 2020

Objective

A new nationwide guideline for minor head injury was introduced in the Netherlands in 2010. The effect on computed tomography (CT) ratio and hospital admission ratio after introduction of the guideline is unknown. The aim was to reduce these numbers as part of cost-effective health care. Therefore, we assessed the effect on these variables after introduction of the guideline.

Methods

We used an interrupted time-series study design. Data selection was done 3 years before (2007–2009) and several years after (2012, 2014, 2015) introduction of the guideline.

Results

Data collection was performed for 3880 patients. Introduction of the new guideline was associated with an increase in CT ratio from 24.6% before to 55% after introduction (P < 0.001). This increase is the result of both the new guideline and a secular trend. Besides this, hospital admissions increased from 14.7 to 23.4% (P < 0.001) during the study period. This increase was less clearly associated with the new guideline. After introduction of the guideline there was no significant difference in (intra)cranial traumatic findings (2.6% vs. 3.4%; P = 0.13) and neurosurgical interventions (0.1% vs. 0.2%; P = 0.50).

Conclusion

Between 2007 and 2015, a marked increase in CT ratio and hospital admissions has been observed. The increase in CT ratio seems to be caused both by the new guideline and by a secular trend to perform more CT scans. Adaptations to the guideline should be considered to improve patient care and cost-effectiveness in patients with minor head injury.
Clinical Utility of Histological and Radiological Evaluations of Tumor Necrosis for Predicting Prognosis in Pancreatic Cancer
Authors: Kudo Masashi , Kobayashi Tatsushi , Gotohda Naoto , Konishi Masaru , Takahashi Shinichiro , Kobayashi Shin , Sugimoto Motokazu , Okubo Satoshi , Martin John , Cabral Horacio , Ishii Genichiro , Kojima Motohiro
Published: May 2020

Objectives

Tumor necrosis is often found in pancreatic ductal adenocarcinoma (PDAC). Objective histological assessment and adequate radiological detection of necrosis could be used as biomarkers for therapeutic decision. However, standardized clinical utility of necrosis remains unknown. Here, we aimed to determine the prognostic potential of histological and radiological evaluations of necrosis.

Methods

We investigated histological necrosis in 221 patients, who underwent surgery for PDAC, and classified its size as small (≤5 mm) or large (>5 mm). We also evaluated poorly enhanced areas on preoperative computed tomography to assess their ability for predicting histological necrosis and postoperative prognosis.

Results

Tumor necrosis was found in 115 patients (52%) and was related to tumor area, lymph node metastasis, and lymphovascular invasion. Size of necrosis was significantly associated with tumor area, perimeter of necrosis, circularity of necrosis, number of ruptured cancer glands, and presence of collagen bundle (P < 0.05 for all). Both presence of necrosis and their size were strongly correlated to postoperative prognosis. Patients with poorly enhanced areas showed worse prognosis (P < 0.01).

Conclusions

Our findings underline the capacity of histological and radiological assessment of tumor necrosis for prognosis prediction in PDAC.
High Fractions of Large Islets in Human Islet Preparations Detrimentally Affect Posttransplant Outcomes in Streptozotocin-Induced Diabetic Immunodeficient Mice
Authors: Komatsu Hirotake , Salgado Mayra , Gonzalez Nelson , Medrano Leonard , Rawson Jeffrey , Omori Keiko , Qi Meirigeng , Al-Abdullah Ismail , Kandeel Fouad , Mullen Yoko
Published: May 2020

Objectives

The aim of this study was to determine whether the size of islets isolated from human donors—measured pretransplant—impacts transplantation outcomes in diabetic mice.

Methods

Human islets (1200 islet equivalents) were transplanted into the kidney capsules of streptozotocin-induced diabetic immunodeficient mice. Data from a total of 174 mice that received islets from 45 isolations were analyzed to evaluate the correlation between pretransplant islet size and posttransplant diabetes reversal. Fluorescent images of islet clusters were used to categorize individual islets by size (small, 50–150 μm; medium, 150–250 μm; large, >250 μm), and the fractions of islets in each category were calculated.

Results

The fraction of large islets negatively correlated with diabetes reversal rates. Mice that received islet grafts containing 0% to 5%, 5% to 10%, and more than 10% large islets had diabetes reversal rates of 75%, 61%, and 45%, respectively (P = 0.0112). Furthermore, mice that exhibited diabetes reversal received smaller fractions of large islets than mice that did not (5.5% vs 8.0%, P = 0.0003). Intriguingly, the fractions of medium and small islets did not correlate with diabetes reversal outcomes.

Conclusions

The fraction of large islets is a sensitive predictor of human islet transplantation outcomes in diabetic mice.
Role of Static and Dynamic Intra-abdominal Pressure Monitoring in Acute Pancreatitis
Authors: Goenka Mahesh Kumar , Goenka Usha , Afzalpurkar Shivaraj , Tiwari Subhash Chandra , Agarwal Rachit , Tiwary Indrajeet Kumar
Published: May 2020

Objective

This study was aimed to determine the relationship between static and dynamic intra-abdominal pressure (IAP) with the mortality and outcome of acute pancreatitis.

Methods

From July 2017 to December 2018, 150 patients admitted at the Institute of Gastrosciences and Liver and diagnosed as acute pancreatitis were included in the study. Intra-abdominal pressure was measured for the first few days, and mean value of day 1 (static IAP) and highest value on day 2 and day 3 (dynamic IAP) were calculated and categorized into intra-abdominal hypertension and abdominal compartment syndrome.

Results

A statistical relationship was observed between static and dynamic IAP with the severity and mortality of acute pancreatitis. Both static and dynamic IAPs tended to be higher in nonsurvivors (83.33% and 88.88%, respectively) compared with survivors (51.51% and 63.63%, respectively). Higher IAP had more severe disease. However, IAP did not correlate with the evidence of sepsis or serum procalcitonin levels.

Conclusion

Determination of static IAP is an easy, useful, and inexpensive method to determine and predict the mortality of acute pancreatitis. Prevention and/or early detection of intra-abdominal hypertension helps in reducing the mortality in acute pancreatitis.
Analysis of 102 Fully Robotic Pancreaticoduodenectomies
Authors: Mejia Alejandro , Shah Jimmy , Vivian Elaina , Acharya Priyanka
Published: May 2020

Objectives

The value of robotic pancreaticoduodenectomy (RPD) remains undefined. The aim of this retrospective study was to compare and assess clinical outcomes and financial variables of patients undergoing RPD versus open pancreaticoduodenectomy (OPD) at a single high-volume center.

Methods

The study design is a retrospective analysis of a prospectively maintained database of consecutive PD patients from 2013 to 2019. Clinical variables and total hospital charges were evaluated as an unadjusted and adjusted intention-to-treat analysis.

Results

A total of 156 patients (54 OPD, 102 RPD) were identified. In the RPD group, patients were significantly older (P = 0.0304) and had shorter length of stay (mean, 7 vs 11.8 days; P < 0.0001) and longer operative times (mean, 352.7 vs 211.5 minutes; P < 0.0001) compared with OPD. There was no significant difference in 90-day readmissions, bleeding, or complications between OPD and RPD. Adjusted charge analyses show no difference in total charges (P = 0.057).

Conclusions

Robotic pancreaticoduodenectomy is safe, feasible, and valid alternative to OPD. Because of comparable results within each group, randomized trials may be indicated. High-volume RPD centers should collaborate to better understand the differences and advantages over laparoscopic or OPD.
Keep the Momentum Going
Authors: Lal M. Maureen
Published: May 2020

We are midway through a milestone year for nursing, and we have just finished a month-long celebration of Florence Nightingale's 200th birthday. The party may be over, but the work continues. How do we keep the momentum going, not just for 2020, but well beyond? In this month's Magnet® Perspectives column, we explore ways to continue to promote the Year of the Nurse through its 3 anchors: nursing excellence, leadership, and innovation. We also take a look at how Magnet organizations stay relevant in these areas, by infusing lifelong learning, evidence-based practice, and clinical inquiry into the culture and making every day an opportunity to celebrate and elevate nursing.
A Nurse Shadowing Program for Physicians
Authors: Johnson Courtney M. , Khan Amir , Stark Sarah , Samee Mohammed
Published: May 2020

OBJECTIVE

A physician-nurse shadow program was established to improve interdisciplinary collaboration.

BACKGROUND

Ineffective communication between physicians and nurses leads to poor outcomes in patient satisfaction, safety, and associate engagement. Physician unfamiliarity of the nursing process is identified as a root cause.

METHODS

First-year resident physicians shadowed nurses for a 4-hour shift. Residents did not function as a physician during the shadowing experience but participated in nursing workflow and tasks. Participants completed a Likert-scale rating and qualitative survey before and after the shift.

RESULTS

The survey measured confidence in communication and perception of workflow. Confidence levels increased in all areas by 29% for residents and 34% for nurses. Data demonstrated improved physician understanding of nursing workflow and inspired recommendations to enhance communication.

CONCLUSIONS

First-year resident physicians practiced direct communication skills and experienced hands-on nursing care during the shadow program. The initiative provided an environment for mutual learning and interdisciplinary relationship-building.
Antenatal Corticosteroids and Magnesium Sulfate for Improved Preterm Neonatal Outcomes: A Review of Guidelines
Authors: Tsakiridis Ioannis , Mamopoulos Apostolos , Athanasiadis Apostolos , Dagklis Themistoklis
Published: May 2020

Importance

In cases of anticipated preterm delivery, corticosteroids for fetal lung maturation and magnesium sulfate for fetal neuroprotection may improve neonatal outcomes.

Objective

The aim of this study was to summarize and compare published guidelines from 4 leading medical societies on the administration of antenatal corticosteroids and magnesium sulfate.

Evidence Acquisition

A descriptive review of major national guidelines on corticosteroids and magnesium sulfate was conducted: National Institute for Health and Care Excellence on “Preterm labour and birth,” World Health Organization on “WHO recommendations on interventions to improve preterm birth outcomes,” American College of Obstetricians and Gynecologists on “Antenatal corticosteroid therapy for fetal maturation” and “Magnesium sulfate use in obstetrics,” and Society of Obstetricians and Gynecologists of Canada on “Antenatal corticosteroid therapy for improving neonatal outcomes” and “Magnesium sulphate for fetal neuroprotection.”

Results

A variation in the appropriate timing of administration exists, whereas repeated courses are not routinely recommended for corticosteroids or magnesium sulfate. In addition, the recommendations are the same for singleton and multiple gestations, and no specific recommendation exists according to maternal body mass index. Finally, a variation in guidelines regarding the administration of corticosteroids before cesarean delivery exists.

Conclusions

The adoption of an international consensus on corticosteroids and magnesium sulfate may increase their endorsement by health care professionals, leading to more favorable neonatal outcomes after preterm delivery.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, the learner should be better able to identify the appropriate indications for the administration of corticosteroids and magnesium sulfate; describe the effectiveness and associated risks of corticosteroids and magnesium sulfate; and explain the timing and schemes of corticosteroids and magnesium sulfate administration.
Patient-Centered Outcomes After Modified Vestibulectomy
Authors: Das Deepanjana , Davidson Emily R. W. , Walters Mark , Farrell Ruth M. , Ferrando Cecile A.
Published: May 2020

(Abstracted from Obstet Gynecol 2020;135:113–121)

Vulvodynia is a complex gynecologic pain condition characterized by at least 3 months of vulvar pain with no identifiable cause. Symptoms can be categorized as generalized vulvodynia (with unprovoked pain affecting the entire vulvar) or as provoked vestibulodynia (with localized pain at the vestibule).
Identifying Predictors of Physical Abuse Evaluation of Injured Infants
Authors: Eismann Emily A. , Shapiro Robert Allan , Makoroff Kathi L. , Theuerling Jack , Stephenson Nicole , Duma Elena M. , Fain Emily T. , Frey Theresa M. , Riney Lauren C. , Thackeray Jonathan D.
Published: May 2020

Objectives

To identify predictors of physical abuse evaluation in infants younger than 6 months with visible injury and to determine the prevalence of occult fracture and intracranial hemorrhage in those evaluated.

Methods

Infants 6.0 months or younger who presented with visible injury to a pediatric hospital-affiliated emergency department or urgent care between July 2013 and January 2017 were included. Potential predictors included sociodemographics, treatment site, provider, injury characteristics, and history. Outcome variables included completion of a radiographic skeletal survey and identification of fracture (suspected or occult) and intracranial hemorrhage.

Results

Visible injury was identified in 378 infants, 47% of whom did not receive a skeletal survey. Of those with bruising, burns, or intraoral injuries, skeletal survey was less likely in patients 3 months or older, of black race, presenting to an urgent care or satellite location, evaluated by a non–pediatric emergency medicine-trained physician or nurse practitioner, or with a burn. Of these, 25% had an occult fracture, and 24% had intracranial hemorrhage. Occult fractures were also found in infants with apparently isolated abrasion/laceration (14%), subconjunctival hemorrhage (33%), and scalp hematoma/swelling (13%).

Conclusions

About half of preambulatory infants with visible injury were not evaluated for physical abuse. Targeted education is recommended as provider experience and training influenced the likelihood of physical abuse evaluation. Occult fractures and intracranial hemorrhage were often found in infants presenting with seemingly isolated “minor” injuries. Physical abuse should be considered when any injury is identified in an infant younger than 6 months.
American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic
Authors: Rodriguez-Lonebear Desi , Barceló Nicolás E. , Akee Randall , Carroll Stephanie Russo
Published: May 2020

Objective:

To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states.

Design:

Multivariate analysis with population weights.

Setting:

Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands.

Main Outcome Measures:

The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records.

Results:

By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83, P = .001) and were less likely according to the percentage of reservation households that were English-only (−2.43, P = .03). Household overcrowding measures were not statistically significant in this analysis (−6.40, P = .326).

Conclusions:

Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.
Using Practice Facilitation to Improve Depression Management in Rural Pediatric Primary Care Practices
Authors: Baum Rebecca A. , Hoholik Suzanne , Maciejewski Heather , Ramtekkar Ujjwal
Published: May 2020

Introduction:

Depression is a common and serious mental health condition frequently encountered in pediatric primary care. Pediatricians report discomfort in managing depression due in part to limited training and limited access to mental health care, which is accentuated in rural areas.

Methods:

We developed an evidence-based, quality improvement project designed to help pediatricians increase screening and initial management of depression in the primary care setting. We recruited practices from a pediatric accountable care organization as part of a larger quality improvement portfolio that used a practice facilitation model to support practices with data collection and project management. Practitioners received training on quality improvement, depression screening, and a depression management plan (referred to as the depression management bundle). Practices completed Plan-Do-Study-Act cycles to improve their performance.

Results:

We recruited 4 practices in rural Ohio to participate. Screening increased from 0% to 81% within 6 months. All 4 practices measured documentation of the depression management bundle for patients diagnosed with depression. Composite data from these practices showed an increase in documentation from 59% to 86% by month 6.

Conclusions:

This study provides preliminary support for the use of practice facilitation combined with skills training to increase screening and improve documentation of depression management in rural primary care practices, where specialty mental health resources may be limited. Further research is needed to determine if this approach can be successfully disseminated and if patient outcomes improved.
In-Hospital Patient Harm Across Linguistic Groups: A Retrospective Cohort Study of Home Care Recipients
Authors: Reaume Michael , Batista Ricardo , Talarico Robert , Guerin Eva , Rhodes Emily , Carson Sarah , Prud’homme Denis , Tanuseputro Peter
Published: May 2020

Objective

Research examining the impact of language barriers on patient safety is limited. We conducted a population-based study to determine whether patients whose primary language is not English are more likely to experience harm when admitted to hospitals in Ontario, Canada.

Methods

We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2010 to 2015) who were subsequently admitted to hospital. Patient language (obtained from home care assessments) was coded as English, French, or other. Harmful events were identified using the Hospital Harm Indicator developed by the Canadian Institute for Health Information.

Results

We included 190,724 patients (156,186 Anglophones, 5,110 Francophones, and 29,428 Allophones). There was no significant difference in the unadjusted risk of harm for Francophones compared with Anglophones (relative risk [RR], 0.94; 95% confidence interval [CI], 0.87–1.02). However, Allophones were more likely to experience harm when compared with Anglophones (RR, 1.14; 95% CI, 1.10–1.18). The risk of harm was even greater for Allophones with low English proficiency (RR, 1.18; 95% CI, 1.13–1.24). After adjusting for potential confounders, Anglophones and Allophones were equally likely to experience harm of any type, but Allophones more likely to experience harm from infections and procedures.

Conclusions

Patients whose primary language was not English or French were more likely to experience harm after admission to hospital, especially if they had low English proficiency. For these patients, the risk of harm from infections and procedures persisted in the adjusted analysis, but the overall risk of harm did not.
Incidental Finding of Colon Carcinoma Related to High Uptake in 18F-PSMA-1007 PET
Authors: Arçay Ayça , Eiber Matthias , Langbein Thomas
Published: May 2020

We present a 78-year-old man with suspicion of prostate cancer due to a PSA of 200 ng/mL, who underwent 18F-PSMA-1007 (prostate specific membrane antigen) PET/CT for primary staging. Besides heterogeneous uptake to the prostate, an increased PSMA uptake in the cecum was observed, located in the thickened cecal wall with suspicion of a secondary malignancy. Colonoscopic biopsy followed by hemicolectomy confirmed the diagnosis of colon adenocarcinoma. This case demonstrates the importance of bioptic workup of suspicious findings on PSMA PET/CT, which are unlikely to be related to prostate cancer as PSMA ligand uptake is not exclusively prostate cancer specific.
Peyronie Disease as an Example of Nononcological, Inflammatory Uptake of 18F-Fluorocholine in Patient With Prostate Cancer
Authors: Cegla Paulina , Kubiak Anna , Witkowska Kamila , Czepczyński Rafał
Published: May 2020

18F-fluorocholine PET/CT is commonly used for staging and assessing treatment response in prostate cancer patients. Growing clinical experience has shown that 18F-fluorocholine can actually accumulate in sites of inflammation. We report a rare case of a prostate cancer patient with incidentally detected Peyronie disease.
Effect of Different 131I Dose Strategies for Treatment of Hyperthyroidism on Graves’ Ophthalmopathy
Authors: Ariamanesh Shahrara , Ayati Narjess , Mazloum Khorasani Zahra , Mousavi Zohreh , Kiavash Victoria , Kiamanesh Zahra , Zakavi Seyed Rasoul
Published: May 2020

Purpose

The study aims to define the effect of different dose strategies on ophthalmic complications in patients with Graves’ disease (GD).

Methods

All the patients with GD and no or inactive ophthalmopathy (clinical activity score; CAS < 3) underwent Snellen chart examination, measurement of proptosis, thyroid volume, and radioactive iodine uptake, and randomized into 1 of 3 groups. In group 1, all the patients received fixed low dose (FLD) of 259 MBq of 131I, whereas in group 2, all the patients received fixed high dose (FHD) of 555 MBq, and in group 3, calculated dose (CD) was administered to deliver 5.55 MBq/g (thyroid weight) of 131I. All examinations were repeated 6 months after treatment. The measurement of thyroid function tests and clinical examination were repeated after 12 months.

Results

We studied 92 patients (58 female and 34 male) with mean age of 38.2 ± 12.0 years. Overall, 29, 32, and 31 patients were studied in FLD, FHD, and CD groups, respectively. The patients in CD received a mean activity of 240.5 MBq. The 3 groups were not significantly different regarding age, sex ratio, radioactive iodine uptake, smoking, visual acuity, and proptosis. The response rate 12 months after radioactive iodine therapy was 66.7%, 94.4%, and 92.9% in FLD, FHD, and CD groups, respectively (P = 0.05). Overall, CAS was increased significantly after treatment. Delta proptosis and delta CAS were increased significantly in FHD group compared with other groups (P < 0.05). The highest increment in proptosis was seen in FHD group.

Conclusions

The administration of 5.55 MBq/g of 131I has fewer ophthalmic complications compared with high fixed dose model and is more effective than low fixed dose strategy.
FDG PET/CT Findings in an Asymptomatic Case of Confirmed COVID-19
Authors: Martineau Patrick , Kidane Biniam
Published: May 2020

In the current and rapidly worsening pandemic, patients with COVID-19 may undergo imaging with FDG PET/CT. Because a significant proportion of infected patients may be asymptomatic, incidental discovery on a PET/CT scan performed for unrelated reasons can occur. Because of the highly infectious nature of this agent, it is important that interpreting physicians be aware of the typical imaging findings to identify potentially affected patients. We present the case of an asymptomatic patient referred for FDG PET/CT imaging of a lung nodule who demonstrated the typical CT findings of COVID-19 infection and was subsequently found to be positive on testing.
Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery
Authors: Rakovich George , Urbanowicz Robert , Issa Rami , Wang Han Ting
Published: May 2020

Background:

In the setting of the COVID-19 pandemic, the conduct of elective cancer surgery has become an issue because of the need to balance the requirement to treat patients with the possibility of transmission of the virus by asymptomatic carriers. A particular concern is the potential for viral transmission by way of aerosol which may be generated during perioperative care. There are currently no guidelines for the conduct of elective lung resection surgery in this context.

Methods:

A working group composed of 1 thoracic surgeon, 2 anesthesiologists and 1 critical care specialist assessed the risk for aerosol during lung resection surgery and proposed steps for mitigation. After external review, a final draft was approved by the Committee for the Governance of Perioperative and Surgical Activities of the Hôpital Maisonneuve-Rosemont, in Montreal, Canada.

Results:

The working group divided the risk for aerosol into 6 time-points: (1) intubation and extubation; (2) Lung isolation and patient positioning; (3) access to the chest; (4) conduct of the surgical procedure; (5) procedure termination and lung re-expansion; (6) chest drainage. Mitigating strategies were proposed for each time-point.

Conclusions:

The situation with COVID-19 is an opportunity to re-evaluate operating room protocols both for the purposes of this pandemic and similar situations in the future. In the context of lung resection surgery, specific time points during the procedure seem to pose specific risks for the genesis of aerosol and thus should be the focus of attention.
BET Protein Inhibition Prolongs Cardiac Transplant Survival via Enhanced Myocardial Autophagy
Authors: Chen Juntao , Miao Xiaolong , Liu Chen , Liu Baoqing , Wu Xiaoying , Kong Deqiang , Sun Qiming , Gong Weihua
Published: May 2020

Background.

Graft rejection continues to be a major barrier to long-term engraftment after transplantation. Autophagy plays an important role in cardiac injury pathogenesis. The bromodomain and extraterminal protein inhibitor (S)-tert-butyl2-(4-(4-chlorophenyl)-2,3,9-trimethyl-6H-thieno[3,2-f][1,2,4]triazolo[4,3-a][1,4]diazepin-6-yl)acetate (JQ1) inhibits inflammatory responses. However, the beneficial effect of JQ1 on transplant and the potential role of autophagy in the protective effect of graft survival are yet to be investigated.

Methods.

Syngeneic or allogeneic heterotopic heart transplantation was performed using C57BL/6 or BALB/c donors for C57BL/6 recipients through different treatments. Some mice were used to observe the survival of the grafts. The other mice were euthanized on the third, fifth, and seventh days after surgery. The graft samples were taken for cytokines and autophagy pathway analyses.

Results.

Our study revealed that JQ1 treatment prolonged cardiac allograft survival. JQ1 increased the expression levels of liver kinase beta 1, autophagy-specific gene 5, and microtubule-associated protein light chain3-II (LC3-II) and potentiated the phosphorylation of AMP-activated protein kinase, unc-51-like kinase 1 (ULK1), and autophagy-specific gene 14 in allografts. A conditional autophagy-specific gene 5 deletion donor was utilized to abrogate the effect induced by JQ1. The combined use of JQ1 with bafilomycin A1 partially reversed the effect of JQ1, suggesting that autophagy is involved in the signaling pathway in graft survival. JQ1 downregulated the expression of inflammatory cytokines, such as interleukin-6, interleukin-1β, tumor necrosis factor-α, and interferon-γ, which was abrogated when autophagy was inhibited.

Conclusions.

JQ1 prolonged cardiac allograft survival by potentiating myocardial autophagy through the liver kinase beta 1–AMP-activated protein kinase–ULK1 signaling pathway and inhibiting the subsequent release of inflammatory cytokines. This result might provide novel insights for extending transplant survival.
Bioelectrical understanding and engineering of cell biology
Authors: Schofield Zoe , Meloni Gabriel N. , Tran Peter , Zerfass Christian , Sena Giovanni , Hayashi Yoshikatsu , Grant Murray , Contera Sonia A. , Minteer Shelley D. , Kim Minsu , Prindle Arthur , Rocha Paulo , Djamgoz Mustafa B. A. , Pilizota Teuta , Unwin Patrick R. , Asally Munehiro , Soyer Orkun S.
Published: May 2020

The last five decades of molecular and systems biology research have provided unprecedented insights into the molecular and genetic basis of many cellular processes. Despite these insights, however, it is arguable that there is still only limited predictive understanding of cell behaviours. In particular, the basis of heterogeneity in single-cell behaviour and the initiation of many different metabolic, transcriptional or mechanical responses to environmental stimuli remain largely unexplained. To go beyond thestatus quo, the understanding of cell behaviours emerging from molecular genetics must be complemented with physical and physiological ones, focusing on the intracellular and extracellular conditions within and around cells. Here, we argue that such a combination of genetics, physics and physiology can be grounded on a bioelectrical conceptualization of cells. We motivate the reasoning behind such a proposal and describe examples where a bioelectrical view has been shown to, or can, provide predictive biological understanding. In addition, we discuss how this view opens up novel ways to control cell behaviours by electrical and electrochemical means, setting the stage for the emergence of bioelectrical engineering.
Hybrid foraging in patchy environments using spatial memory
Authors: Nauta Johannes , Khaluf Yara , Simoens Pieter
Published: May 2020

Efficient random searches are essential to the survival of foragers searching for sparsely distributed targets. Lévy walks have been found to optimize the search over a wide range of constraints. When targets are distributed within patches, generating a spatial memory over the detected targets can be beneficial towards optimizing the search efficiency. Because foragers have limited memory, storing each target location separately is unrealistic. Instead, we propose incrementally learning a spatial distribution in favour of memorizing target locations. We demonstrate that an ensemble of Gaussian mixture models is a suitable candidate for such a spatial distribution. Using this, a hybrid foraging strategy is proposed, which interchanges random searches with informed movement. Informed movement results in displacements towards target locations, and is more likely to occur if the learned spatial distribution is correct. We show that, depending on the strength of the memory effects, foragers optimize search efficiencies by continuous revisitation of non-destructive targets. However, this negatively affects both the target and patch diversity, indicating that memory does not necessarily optimize multi-objective searches. Hence, the benefits of memory depend on the specific goals of the forager. Furthermore, through analysis of the distribution over walking distances of the forager, we show that memory changes the underlying walk characteristics. Specifically, the forager resorts to Brownian motion instead of Lévy walks, due to truncation of the long straight line displacements resulting from memory effects. This study provides a framework that opens up new avenues for investigating memory effects on foraging in sparse environments.
An investigation of the spatio-temporal parameters of gait and margins of stability throughout adulthood
Authors: Herssens Nolan , van Criekinge Tamaya , Saeys Wim , Truijen Steven , Vereeck Luc , van Rompaey Vincent , Hallemans Ann
Published: May 2020

Age-related changes in the way of walking may induce changes in dynamic stability. Therefore, the relationship between age, spatio-temporal characteristics and margins of stability was examined. One hundred and five healthy adults aged between 20 and 89 years old were analysed on spatio-temporal characteristics and margins of stability using three-dimensional motion analysis. Subjects walked barefoot over a 12-m-long walkway at their preferred walking speed. Covariance among gait characteristics was reduced using a factor analysis, identifying domains of gait. The influence of age, gender, body mass index (BMI) and leg length on domains of gait and margins of stability was investigated using linear mixed models. A stepwise linear regression identified domains of gait predicting the variance in margins of stability. Four domains of gait explaining 74.17% of the variance were identified. Age had a significant influence on the medio-lateral margin of stability and the ‘variability', ‘pace' and ‘base of support' domain. BMI significantly influenced the medio-lateral margin of stability; gender and leg length had no influence on either of the margins of stability. The ‘base of support’ domain predicted 26% of the variance in the medio-lateral margin of stability. When considering the margins of stability, especially when comparing multiple groups, age, BMI and spatio-temporal parameters should be taken into account.
Structural manipulations of a shelter resource reveal underlying preference functions in a shell-dwelling cichlid fish
Authors: Bose Aneesh P. H. , Windorfer Johannes , Böhm Alex , Ronco Fabrizia , Indermaur Adrian , Salzburger Walter , Jordan Alex
Published: May 2020

Many animals can modify the environments in which they live, thereby changing the selection pressures they experience. A common example of such niche construction is the use, creation or modification of environmental resources for use as nests or shelters. Because these resources often have correlated structural elements, it can be difficult to disentangle the relative contribution of these elements to resource choice, and the preference functions underlying niche-construction behaviour remain hidden. Here, we present an experimental paradigm that uses 3D scanning, modelling and printing to create replicas of structures that differ with respect to key structural attributes. We show that a niche-constructing, shell-dwelling cichlid fish,
Neolamprologus multifasciatus
, has strong open-ended preference functions for exaggerated shell replicas. Fish preferred shells that were fully intact and either enlarged, lengthened or had widened apertures. Shell intactness was the most important structural attribute, followed by shell length, then aperture width. We disentangle the relative roles of different shell attributes, which are tightly correlated in the wild, but nevertheless differentially influence shelter choice and therefore niche construction in this species. We highlight the broad utility of our approach when compared with more traditional methods (e.g. two-choice tasks) for studying animal decision-making in a range of contexts.
Gull chicks grow faster but lose telomeres when prenatal cues mismatch the real presence of sibling competitors
Authors: Noguera Jose C. , Velando Alberto
Published: May 2020

During embryonic life, individuals should adjust their phenotype to the conditions that they will encounter after birth, including the social environment, if they have access to (social) cues that allow them to forecast future conditions. In birds, evidence indicates that embryos are sensitive to cues from clutch mates, but whether embryos adjust their development to cope with the expected level of sibling competition has not hitherto been investigated. To tackle this question, we performed a ‘match versus mismatch' experimental design where we manipulated the presence of clutch mates (i.e. clutch size manipulation) and the real (postnatal) level of sibling competition (i.e. brood size manipulation) in the yellow-legged gull (Larus michahellis). We provide evidence that the prenatal cues of sibling presence induced developmental changes (such as epigenetic profiles) that had programming effects on chick begging behaviour and growth trajectories after hatching. While receiving mismatching information favoured chick begging and growth, this came at the cost of reduced antioxidant defences and a premature loss of telomeres. Our findings highlight the role of the prenatal social environment in developmental plasticity and suggest that telomere attrition may be an important physiological cost of phenotype–environment mismatch.