bluuebunny/crossref_metadata_2025 huggingface dataset:
The Anaconda Challenge
Authors: Rivas Jesús A.
Published: October 2020

This chapter focuses on the llanos, Venezuela’s natural floodplain, where the author decided to start his study of anacondas. The llanos is a flatland that comprises about a third of both Venezuela and Colombia. It is composed of an extensive system of natural, seasonally flooded grasslands. The llanos is located to the north and west of the Orinoco River and sits on the northern borders of the Amazon basin. Because of this, most of the wildlife of the Amazon can be found in the llanos, where it is easier to observe animals in the open vegetation of the savanna. The extreme seasonality of the llanos made all the difference in the success of the author’s anaconda research. Anacondas, being aquatic, concentrate in the few water bodies that hold water during the dry season. During this time, the chance of finding anacondas was much higher. The chapter then explores the physical build of snakes. Most snakes have adaptations of the skull and jaws involving mobile hinges, and a whole arrangement of joints and muscles evolved for swallowing large prey. The extra mobility of the snake’s jaws is obtained by giving up solid skull sutures that the ancestral lizards had, rendering the snake’s head more vulnerable to damage.
What Is a Good Real Estate for an Anaconda?
Authors: Rivas Jesús A.
Published: October 2020

This chapter discusses the process of tracking and tagging the anacondas. Trying to follow anacondas throughout the year gives one a new perspective about the differences between humans and snakes. Anacondas like caves. In the rivers with forested banks, the roots of the trees often hold the bank together and prevent it from being eroded away. The caves under the roots of the trees tend to be great hiding places for aquatic organisms like anacondas, caimans, iguanas, tegus, and toads. Both in dry and wet seasons, anacondas use the caves. Indeed, the presence of caves seems to be the reason that there are fewer anacondas in the parts of the creek, Caño Guaratarito, that has no trees. Interestingly, the proportion of males and females found in Guaratarito was strongly biased toward females. It seems to be a place where large snakes come to feed but does not seem to be a good place to find many males.
How Much Is Supper? Predator Diet and Prey Retaliation
Authors: Rivas Jesús A.
Published: October 2020

This chapter focuses on the anaconda’s diet and the role it plays in the snake’s biology. Clearly, food intake is a critical aspect of any animal’s ecology for it determines how the animal obtains energy needed for survival and reproduction. Anacondas, with their strong build, are not fast enough to pursue prey on land. Although fast swimmers, an open mouth moving forward is not very hydrodynamic for catching fishes, which are often quite fast. However, anacondas can launch an extraordinarily fast attack on a prey out of the water when needed. In fact, the predatory strike of an anaconda can be so fast that it beats the eye. The anaconda’s preferred strategy is to wait in a place under the vegetation, with which they blend wonderfully, and wait for the right prey to come within range. This way, anacondas avoid being detected moving around looking for prey and save in locomotion energy. As reptiles, anacondas have a slow metabolism, which means they consume very little energy for metabolic maintenance. The chapter then looks at how anacondas kill their prey.
Conservation of Anacondas and Beyond
Authors: Rivas Jesús A.
Published: October 2020

This chapter focuses on environmental conservation, a relatively new branch of biology that has one foot firmly set in science and the other firmly set in economics and politics. It discusses the technical aspects about anaconda management that can be used for conservation of anacondas and conservation of biodiversity in general. The most common methods of extractive wildlife management are farming, harvesting, or a combination of both. In a farming model, animals are kept in captivity, with all their needs provided by the keepers. Farming anacondas in a closed system is unlikely to be successful. However, the possibility of an open farm system exists; this has more potential of being used as a conservation tool as it requires a natural environment where the animals live. On the other end of the spectrum is harvesting or cropping. In a cropping system, animals are harvested from the wild; thus, a direct link exists between the economic activity and the conservation of the species and its habitats. The economic incentives the locals receive are directly linked to the habitat, producing clear reasons for them to protect and not overexploit natural areas. Thus, cropping has real potential to be used as a conservation tool, but like open farming, it is not conservation by itself. The author then addresses holistically the problem of conservation in Latin America and beyond.
Epilogue
Authors: Rivas Jesús A.
Published: October 2020

This concluding chapter highlights the unconventional approach of the author in discussing anacondas. A conventional style would be antiseptic regarding personal views, and all opinions would be carefully removed as non-scientific. Instead, the author shared his ideas, mixed with scientific facts, opinions, and interpretations. He has done this on purpose because that is how actual humans think. Trying to remove the human from the science renders the science stereotypical and hinders its ability to address the diversity of problems because it does not have a diversity of views. Ultimately, diverse backgrounds and diverse experiences will allow for diverse questions and answers that will allow scientific thinking to evolve and move forward into new horizons. The author also considers the problem of consumerism and its effects on environmental conservation.
Temporal physiological response of pine toFusarium circinatuminfection is dependent on host susceptibility level: the role of ABA catabolism
Authors: Amaral Joana , Correia Barbara , Escandón Mónica , Jesus Cláudia , Serôdio João , Valledor Luis , Hancock Robert D , Dinis Lia-Tânia , Gomez-Cadenas Aurelio , Alves Artur , Pinto Glória
Published: October 2020

Pine pitch canker (PPC), caused by Fusarium circinatum Nirenberg and O’Donnell, represents an important threat to conifer forests worldwide, being associated with significant economic losses. Although essential to develop disease mitigation strategies, little research focused on host susceptibility/resistance mechanisms has been conducted. We aimed to explore the response of a highly susceptible (Pinus radiata D. Don) and a relatively resistant (Pinus pinea L.) species to F. circinatum infection at different stages of infection. Morpho-physiological, hormonal and oxidative stress-related changes were assessed for each pine species and sampling point. Most of the changes found occurred in symptomatic P. radiata, for which an increased susceptibility to photoinhibition was detected together with decreased superoxide dismutase activity. Abscisic acid catabolism was activated by F. circinatum inoculation in both pine species, leading to the accumulation of the inactive dihydrophaseic acid in P. radiata and of the less-active phaseic acid in P. pinea. Hormone confocal analysis revealed that this strategy may be of particular importance at 6 d.p.i. in P. pinea, which together with photosynthesis maintenance to fuel defense mechanism, could in part explain the species resistance to PPC. These results are of great interest for the development of hormone-based breeding strategies or for the use of hormone application as inducers of resistance to F. circinatum infection.
Understanding calcinosis cutis
Authors: SaterenZoller Elizabeth , Rizzo Marco , Harris Albert
Published: October 2020

Calcinosis cutis is the aberrant deposition of insoluble calcified salts in cutaneous tissue that occurs in association with a variety of diseases. A relatively uncommon disorder, it can range in severity from mild to debilitating. This article describes a patient with a long history of dermatomyositis who developed multiple calcific lesions in the extremities that did not respond to conservative therapies and eventually required multiple surgical interventions.
Reexamining the persisting wage gap between male and female PAs
Authors: McCall Timothy C. , Smith Noël E.
Published: October 2020

Objective:

To determine the magnitude of any difference in total compensation between male and female physician assistants (PAs) after controlling for personal and workplace factors related to compensation.

Methods:

Using data from the 2019 AAPA Salary Survey, the authors conducted a sequential regression analysis to examine the relationship between a variety of personal and practice demographics and total compensation.

Results:

After controlling for compensation-related factors, a wage gap between male and female PAs persisted: female PAs were paid almost $0.93 for every $1 male PAs were paid in the first year of work ($9,010 less). This wage gap widened by $201 for every year of work experience.

Conclusions:

A wage gap between male and female PAs persists even after including all compensation types and controlling for compensation-related factors that may differ between male and female PAs. Proposed policy implications could begin to mitigate the gap.
Benchmarking Critical Care Well-Being: Before and After the Coronavirus Disease 2019 Pandemic
Authors: Gomez Sofia , Anderson Brian J. , Yu Hyunmin , Gutsche Jacob , Jablonski Juliane , Martin Niels , Kerlin Meeta Prasad , Mikkelsen Mark E.
Published: October 2020

Objectives:

Examine well-being, measured as burnout and professional fulfillment, across critical care healthcare professionals, ICUs, and hospitals within a health system; examine the impact of the coronavirus disease 2019 pandemic.

Design:

To complement a longitudinal survey administered to medical critical care physicians at the end of an ICU rotation, which began in May 2018, we conducted a cross-sectional survey among critical care professionals across four hospitals in December 2018 to January 2019. We report the results of the cross-sectional survey and, to examine the impact of the coronavirus disease 2019 pandemic, the longitudinal survey results from July 2019 to May 2020.

Setting:

Academic medical center.

Subjects:

Four-hundred eighty-one critical care professionals, including 353 critical care nurses, 58 advanced practice providers, 57 physicians, and 13 pharmacists, participated in the cross-sectional survey; 15 medical critical care physicians participated in the longitudinal survey through the coronavirus disease 2019 pandemic.

Interventions:

None.

Measurements and Main Results:

Burnout was present in 50% of ICU clinicians, ranging from 42% for critical care physicians to 55% for advanced practice providers. Professional fulfillment was less common at 37%, with significant variability across provider (p = 0.04), with a low of 23% among critical care pharmacists and a high of 53% among physicians. Well-being varied significantly at the hospital and ICU level. Workload and job demand were identified as drivers of burnout and meaning in work, culture and values of work community, control and flexibility, and social support and community at work were each identified as drivers of well-being. Between July 2019 and March 2020, burnout and professional fulfillment were present in 35% (15/43) and 58% (25/43) of medical critical care physician responses, respectively. In comparison, during the coronavirus disease 2019 pandemic, burnout and professional fulfillment were present in 57% (12/21) and 38% (8/21), respectively.

Conclusions:

Burnout was common across roles, yet differed across ICUs and hospitals. Professional fulfillment varied by provider role. We identified potentially modifiable factors related to clinician well-being that can inform organizational strategies at the ICU and hospital level. Longitudinal studies, designed to assess the long-term impact of the coronavirus disease 2019 pandemic on the well-being of the critical care workforce, are urgently needed.
Resolution of Coronavirus Disease 2019 Infection and Pulmonary Pathology With Nebulized DAS181: A Pilot Study
Authors: Ho Jennifer Hui-Chun , Zhao Yang , Liu Zhenlian , Zhou Xiaoyang , Chen Xiaobei , Xianyu Yunyan , Lewis Stanley , Fan Liya , Tian Yuan , Chang Nancy , Gong Zuojiong , Hu Ke
Published: October 2020

Objectives:

Severe acute respiratory syndrome coronavirus 2 infections commonly lead to respiratory failure and potentially fatal systemic inflammation and organ failure. Nebulized DAS181, a host-directed biologics with sialidase activity, is an investigational drug with antiviral activities on parainfluenza and influenza under phase 3 and phase 2 development. The objective of this study (NCT04324489) is to investigate the safety and effects of nebulized DAS181 on hypoxic coronavirus disease 2019 patients.

Design:

Single-center, prospective, open-label, compassionate use.

Setting:

Renmin Hospital of Wuhan University, Department of Respiratory and Critical Care Medicine and Department of Infectious Diseases.

Subjects:

Patients 18 to 70 years old who met Chinese criteria for severe coronavirus disease 2019 pneumonia and required supplemental oxygen but not on mechanical ventilator at screening.

Interventions:

Nebulized DAS181 (4.5 mg) twice a day for 10 days.

Measurements and Main Results:

Three male coronavirus disease 2019 hypoxic patients with bilateral lung involvement completed DAS181 treatment for 10 days. By day 14, all achieved return to room air (primary endpoint) and their nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus 2. Clinical severity improved from severe coronavirus disease 2019 at baseline to moderate or mild disease by day 5, consistent with rapid reduction of inflammatory cytokines by days 2–3 and radiologic improvement by days 5–10. No DAS181-related adverse events were reported.

Conclusions:

Inhalation of DAS181 was well tolerated and potential clinical benefit of DAS181 on hypoxic coronavirus disease 2019 is the reduction of supplemental oxygen need. Efficacy and safety, including pharmacokinetics and viral studies of DAS181 in severe, hypoxic coronavirus disease 2019, should be examined by a double-blind, randomized controlled study.
Firearm Homicide Incidence, Within-state Firearm Laws, and Interstate Firearm Laws in US Counties
Authors: Morrison Christopher N. , Kaufman Elinore J. , Humphreys David K. , Wiebe Douglas J.
Published: October 2020

Background:

Firearm homicides occur less frequently in US states with more firearm control laws. However, firearms are easily transported across state lines, and laws in one location may affect firearm violence in another. This study examined associations between within-state firearm laws and firearm homicide while accounting for interference from laws in other nearby states.

Methods:

The units of analysis were 3,107 counties in the 48 contiguous US states, arrayed in 15 yearly panels for 2000 to 2014 (n = 46,605). The dependent measure was firearm homicides accessed from the Centers for Disease Control and Prevention (CDC) Compressed Mortality Data. The main independent measures were counts of firearm laws and the proportion of laws within categories (e.g., background checks, child access prevention laws). We calculated these measures for interstate laws using a geographic gravity function between county centroids. Bayesian conditional autoregressive Poisson models related within-state firearm laws and interstate firearm laws to firearm homicides.

Results:

There were 172,726 firearm homicides in the included counties over the 15 years. States had between 3 and 100 firearm laws. Within-state firearm laws (incidence rate ratio [IRR] = 0.995, 95% confidence interval [CI] = 0.992, 0.997) and interstate firearm laws (IRR = 0.993, 95% CI = 0.990, 0.996) were independently associated with fewer firearm homicides, and associations for within-state laws were strongest where interstate laws were weakest.

Conclusions:

Additional firearm laws are associated with fewer firearm homicides both within the states where the laws are enacted and elsewhere in the United States. Interference from interstate firearm laws may bias associations for studies of within-state laws and firearm homicide.
OPTICAL COHERENCE TOMOGRAPHY FEATURES OF CHOROIDAL NEOVASCULARIZATION AND THEIR CORRELATION WITH AGE, GENDER, AND UNDERLYING DISEASE
Authors: Zicarelli Federico , Azzolini Claudia , Cornish Elisa , Agarwal Aniruddha , Khochtali Sana , Airaldi Matteo , Khairallah Moncef , Viola Francesco , Staurenghi Giovanni , McCluskey Peter , Invernizzi Alessandro
Published: October 2020

Purpose:

To investigate the influence of age, gender, and underlying disease on the optical coherence tomography (OCT) features of choroidal neovascularization (CNV) secondary to inflammation, myopia (mCNV), and age-related macular degeneration (AMD-CNV).

Methods:

Demographic and clinical data of eyes with treatment-naive inflammatory CNV, mCNV, and Type 2 AMD-CNV were collected. Optical coherence tomography images were reviewed to determine the presence of pitchfork sign, pigment epithelial detachment, subretinal fluid (SRF), intraretinal cysts, subretinal hyperreflective material, atrophy, and outer retinal disruption graded 1 to 4. The influence of demographics and underlying etiology on OCT signs was investigated.

Results:

One hundred and eighty-five eyes from 179 patients were enrolled. The mean [SD] age was 36 [±14.4], 62 [±18], and 77 [±8] for the inflammatory CNV, mCNV, and AMD-CNV, respectively (P < 0.001). Multiple linear regression showed that the presence of pitchfork sign was negatively associated with age (P < 0.0001), regardless of underlying disease. By contrast, the SRF, pigment epithelial detachment, intraretinal cysts, and the outer retinal disruption were all positively influenced by age, regardless of gender and underlying disease (all P < 0.01). Logistic regression showed that none of the OCT signs increased the likelihood for diagnosis of inflammatory CNV. By contrast, the absence of SRF was suggestive for mCNVs, and the presence of pigment epithelial detachment and SRF was suggestive for AMD-CNVs.

Conclusion:

The age of the patient had a significant effect on the OCT appearance of the CNV, particularly the presence of a pitchfork sign, regardless of the underlying etiology. The absence of SRF was suggestive for a diagnosis of mCNVs. The presence of SRF and pigment epithelial detachment was suggestive for AMD-CNVs.
Examination of the clinical factors associated with attendance at emergency departments for chronic pain management and the cost of treatment relative to that of other significant medical conditions
Authors: Higgins Cassie , Smith Blair H. , Colvin Lesley
Published: October 2020

Little is known about risk factors for emergency department (ED) attendance for chronic pain (CP) management and the relative service burden. We examined ED utilisation in patients with CP, identified risk factors associated with attendance for chronic musculoskeletal pain (CMP), and estimated the comparative cost of treatment. The study cohort comprised a random sample of 3700 adults from the general population in Tayside, Scotland. Linked regional extracts, spanning a 12-month period, were obtained from national registers, providing information on ED attendances, community-dispensed prescribing, and outpatient clinic attendances. The National Health Service Scotland Cost Book was used to ascertain the current average cost of an ED attendance (£130; ∼$167). All-cause ED attendance was higher in those with CP (68.5%; n = 252) than without (29.3%; n = 967). In the entire cohort, more patients attended the ED for the treatment of CMP than for any other medical condition (n = 119; 32.3% of those with CP). Risk factors for ED attendance for CMP were: recent analgesic dose decreases (OR = 4.55); and transitioning from opioid to nonopioid analgesics (OR = 5.08). Characteristics protective of ED attendance for CMP were: being in receipt of strong opioids (OR = 0.21); transitioning from nonopioid to opioid analgesics (OR = 0.25); recent analgesic dose increases (OR = 0.24); and being prescribed tricyclic antidepressants (OR = 0.10), benzodiazepines (OR = 0.46), or hypnotics (OR = 0.45). Chronic musculoskeletal pain was one of the most expensive conditions to treat (£17,680 [∼$22,668] per annum), conferring a substantial burden on ED services. Improved understanding of the risk/protective factors could inform healthcare redesign to reduce avoidable ED attendances for CMP management.
Patterns of opioid analgesic use in the U.S., 2009 to 2018
Authors: Woods Corinne , Chai Grace , Meyer Tamra , Staffa Judy , Dal Pan Gerald
Published: October 2020

Although overall outpatient dispensing of opioid analgesic prescriptions has declined, there may still be overprescribing. Understanding how many opioid analgesic units, primarily tablets, are dispensed with the intention of shorter-vs longer-term use can inform public health interventions. We used pharmacy prescription data to estimate the number of opioid analgesic tablets dispensed annually in the U.S. We studied patterns of new use of opioid analgesics by evaluating how many opioid analgesic prescriptions and tablets were dispensed to patients with no opioid analgesic prescriptions in the previous year. Estimated opioid analgesic tablets dispensed declined from a peak of 17.8 billion in 2012 to 11.1 billion in 2018. Patients newly starting opioid analgesics declined from 47.4 million patients in 2011 to 37.1 million patients in 2017. Approximately 40% fewer tablets were dispensed within a year to patients starting in 2017 (2.4 billion) compared with 2011 (4.0 billion). In 2011, patients with ≥5 opioid analgesic prescriptions within a year were dispensed 2.2 billion tablets (55% of all tablets in our study). This declined by 52% to 1.1 billion tablets (44% of all tablets) in 2017. Tablets dispensed within a year to patients with <5 opioid analgesic prescriptions declined by 26% from 2011 to 2017. Patients with ≥5 prescriptions comprised a small and decreasing proportion of all patients newly starting therapy. However, these patients received almost half of all tablets dispensed within a year to patients in our study, despite a larger decline than tablets dispensed to patients with <5 prescriptions within a year.
Somatosensory and psychological phenotypes associated with neuropathic pain in entrapment neuropathy
Authors: Matesanz Luis , Hausheer Andrea C , Baskozos Georgios , Bennett David L.H. , Schmid Annina B.
Published: October 2020

It currently remains unclear why some patients with entrapment neuropathies develop neuropathic pain (neuP), whereas others have non-neuP, presumably of nociceptive character. Studying patients with carpal tunnel syndrome (CTS), this cross-sectional cohort study investigated changes in somatosensory structure and function as well as emotional well-being specific to the presence and severity of neuP. Patients with CTS (n = 108) were subgrouped by the DN4 questionnaire into those without and with neuP. The latter group was further subdivided into mild and moderate/severe neuP using a pain visual analogue scale. N = 32 participants served as healthy controls. All participants underwent a clinical examination, quantitative sensory testing, electrodiagnostic testing (EDT), and skin biopsy to determine the structural integrity of dermal and intraepidermal nerve fibres. Patients also completed questionnaires evaluating symptom severity and functional deficits, pain distribution, sleep quality, and emotional well-being. The overall prevalence of neuP in patients with CTS was 80%, of which 63% had mild neuP. Symptom severity and functional deficits as well as somatosensory dysfunction was more pronounced with the presence and increasing severity of neuP. No difference was identified among patient groups for EDT and nerve fibre integrity on biopsies. The severity of neuP was accompanied by more pronounced deficits in emotional well-being and sleep quality. Intriguingly, extraterritorial spread of symptoms was more prevalent in patients with moderate/severe neuP, indicating the presence of central mechanisms. NeuP is common in patients with CTS, and its severity is related to the extent of somatosensory dysfunction and a compromise of emotional well-being.
Sex differences in brain modular organization in chronic pain
Authors: Fauchon Camille , Meunier David , Rogachov Anton , Hemington Kasey S. , Cheng Joshua C. , Bosma Rachael L. , Osborne Natalie R. , Kim Junseok A. , Hung Peter Shih-Ping , Inman Robert D. , Davis Karen D.
Published: October 2020

Men and women can exhibit different pain sensitivities, and many chronic pain conditions are more prevalent in one sex. Although there is evidence of sex differences in the brain, it is not known whether there are sex differences in the organization of large-scale functional brain networks in chronic pain. Here, we used graph theory with modular analysis and machine-learning of resting-state-functional magnetic resonance imaging data from 220 participants: 155 healthy controls and 65 individuals with chronic low back pain due to ankylosing spondylitis, a form of arthritis. We found an extensive overlap in the graph partitions with the major brain intrinsic systems (ie, default mode, central, visual, and sensorimotor modules), but also sex-specific network topological characteristics in healthy people and those with chronic pain. People with chronic pain exhibited higher cross-network connectivity, and sex-specific nodal graph properties changes (ie, hub disruption), some of which were associated with the severity of the chronic pain condition. Females exhibited atypically higher functional segregation in the mid cingulate cortex and subgenual anterior cingulate cortex and lower connectivity in the network with the default mode and frontoparietal modules, whereas males exhibited stronger connectivity with the sensorimotor module. Classification models on nodal graph metrics could classify an individual's sex and whether they have chronic pain with high accuracies (77%-92%). These findings highlight the organizational abnormalities of resting-state-brain networks in people with chronic pain and provide a framework to consider sex-specific pain therapeutics.
Antinociceptive properties of an isoform-selective inhibitor of Nav1.7 derived from saxitoxin in mouse models of pain
Authors: Beckley Jacob T. , Pajouhesh Hassan , Luu George , Klas Sheri , Delwig Anton , Monteleone Dennis , Zhou Xiang , Giuvelis Denise , Meng Ian D. , Yeomans David C. , Hunter John C. , Mulcahy John V.
Published: October 2020

The voltage-gated sodium channel Nav1.7 is highly expressed in nociceptive afferents and is critically involved in pain signal transmission. Nav1.7 is a genetically validated pain target in humans because loss-of-function mutations cause congenital insensitivity to pain and gain-of-function mutations cause severe pain syndromes. Consequently, pharmacological inhibition has been investigated as an analgesic therapeutic strategy. We describe a small molecule Nav1.7 inhibitor, ST-2530, that is an analog of the naturally occurring sodium channel blocker saxitoxin. When evaluated against human Nav1.7 by patch-clamp electrophysiology using a protocol that favors the resting state, the Kd of ST-2530 was 25 ± 7 nM. ST-2530 exhibited greater than 500-fold selectivity over human voltage-gated sodium channel isoforms Nav1.1–Nav1.6 and Nav1.8. Although ST-2530 had lower affinity against mouse Nav1.7 (Kd = 250 ± 40 nM), potency was sufficient to assess analgesic efficacy in mouse pain models. A 3-mg/kg dose administered subcutaneously was broadly analgesic in acute pain models using noxious thermal, mechanical, and chemical stimuli. ST-2530 also reversed thermal hypersensitivity after a surgical incision on the plantar surface of the hind paw. In the spared nerve injury model of neuropathic pain, ST-2530 transiently reversed mechanical allodynia. These analgesic effects were demonstrated at doses that did not affect locomotion, motor coordination, or olfaction. Collectively, results from this study indicate that pharmacological inhibition of Nav1.7 by a small molecule agent with affinity for the resting state of the channel is sufficient to produce analgesia in a range of preclinical pain models.
Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action
Authors: Pahuja Mohit , Ranka Sagar , Chauhan Kinsuk , Patel Achint , Chehab Omar , Elmoghrabi Adel , Mony Shruti , Ando Tomo , Mishra Tushar , Singh Manmohan , Abubaker Hossam , Yassin Ahmed , Glazier James J. , Afonso Luis , Kapur Navin K. , Burkhoff Daniel
Published: October 2020

Papillary muscle rupture (PMR) or chordae tendinae rupture (CTR) is a rare but lethal complication after ST elevation myocardial infarction (STEMI). Due to the rarity of this condition, there are limited studies defining its epidemiology and outcomes. This is a retrospective study from Nationwide Inpatient Sample database from 2002 to 2014 of patients with STEMI and PMR/CTR. Outcomes of interest were incidence of in-hospital mortality, cardiogenic shock (CS), utilization of mechanical circulatory support (MCS) devices and mitral valve procedures (MVPs) among patients with and without rupture. We also performed simulation using the cardiovascular model to better understand the hemodynamics of severe mitral regurgitation and effects of different medications and device therapy. We identified 1,888 patients with STEMI complicated with PMR/CTR. Most of the patients were >65 years of age (65.3%), male (63.6%), and white (82.3%). They had significantly higher incidence of CS, cardiac arrest, and utilization of MCS devices. In-hospital mortality was higher in patients with rupture (41% vs. 7.40%, p < 0.001) which remained unchanged over the study period. Hospitalization cost and length of stay was also higher in them. MVP and revascularization led to better survival rates (27.9% vs. 60.6%, adjusted OR: 0.14; 95% CI: 0.10–0.19; p < 0.001). Despite significant advancement in the revascularization strategy, PMR/CTR after STEMI continues to portend poor prognosis with high inpatient mortality. Cardiogenic shock is a common presentation and is associated with significantly inpatient mortality. Future studies are needed determine the best strategies to improve outcomes in patients with STEMI with PMR/CTR and CS.
Limitations and limits and of vascularized composite allotransplantations: can we reach the holy grail?
Authors: Grajek Maciej , Bula Daniel , Zeman Marcin , Maciejewski Adam
Published: October 2020

Purpose of review

In recent times, vascularized composite allotransplantation (VCA) have been gaining more attention and applications. Currently, VCA are at the highest level of the reconstruction pyramid, and thus the effects expected after them are intended to outweigh what the ‘classical’ reconstructive surgery can offer us, including even the most advanced microsurgical techniques.

Recent findings

Over 40 patients have received a partial or full-face transplant. Others have received penis, uterus, larynx, abdominal wall, and lower extremity transplants. Each type of VCA has its own problems and limitations. However, resolving the limits defined by immunosuppression and improved donor selection would revolutionize all of them.

Defining the limits and limitations of given procedures will not only allow for better preparation of transplant teams but will also help in determining the direction of future research.
Internalized Stigma in People With Mood Disorders
Authors: Gomes Dayane Rosa Alvarenga Silva , Zanetti Ana Carolina Guidorizzi , Miasso Adriana Inocenti , Castro Fabiana Faleiros Santana , Vedana Kelly Graziani Giacchero
Published: October 2020

To analyze the predictors of internalized stigma among people with mood disorders, we conducted an analytical observational cross-sectional study with 108 people with mood disorders in a public service setting in Sao Paulo, Brazil. We applied a sociodemographic and clinical questionnaire, the Internalized Stigma of Mental Illness Scale, the Medication Adherence Scale, the Brief Psychiatric Rating Scale–Anchored, and the Herth Hope Index. We analyzed the data using descriptive statistics, average comparison tests, a correlation test, and multiple linear regression. Internalized stigma was associated with symptomatology, history of aggressive behavior, psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to psychotropic medications, and unemployment. The predictors of internalized stigma were unemployment, more psychiatric symptoms, history of previous suicide attempts, and less hope. Clinical interventions and investigations for stigma reduction and psychosocial rehabilitation should incorporate the factors associated with self-stigma (aggressive behavior, history of psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to medication, and unemployment).
Preparing Advanced Practice Registered Nursing Students to Provide Primary Palliative Care
Authors: Mazanec Polly , Ferrell Betty , Malloy Pamela , Virani Rose , Cormack Carrie
Published: October 2020

Background

Advanced practice registered nursing students need primary palliative care education to care for the growing number of patients with serious illness and their families and to fill the serious resource gaps in specialty palliative care.

Problem

There has been a lack of primary palliative care education in most graduate nursing programs and little direction as to competencies and essential content.

Approach

In an effort to support faculty to teach palliative care content, the End-of-Life Nursing Education Consortium (ELNEC) has created an online curriculum that meets the new American Association of Colleges of Nursing Graduate—Competencies and Recommendations for Educating Nursing Students in primary palliative care for master’s degree and doctor of nursing practice students.

Outcomes

During the first 9 months of its release, more than 170 nursing programs have accessed the ELNEC Graduate curriculum, and there have been more than 200 student completions.

Conclusion

Primary palliative care education is essential for all advanced practice nursing students. The new ELNEC Graduate curriculum offers the opportunity to provide quality education remotely.
The Potential Value of Video Abstracts to Dissemination of (Some) Information From National Association of Medical Examiners Annual General Meetings
Authors: Obenson Ken
Published: October 2020

The purpose of this study is to determine whether video abstracts posted online to a social media platform (Twitter) increased dissemination of poster-abstract content from National Association of Medical Examiners (NAME) annual general meeting. At NAME meetings (2018, 2019), 20 authors accepted invitations to record visual abstracts. These were subsequently tweeted with their permission. Results were analyzed to determine how many times the video in each tweet was viewed and the number of impressions generated by the tweet. The NAME provided the number of attendees from each meeting to compare with online exposure to tweets.

Video views per tweet ranged from 34 to 824 with a mean of 338. Of the 20 tweets, 5 (25%) had 600 or more views. The number of impressions per tweet ranged from 192 to 4629, with a mean of 1811. Seventy percent (14) had 500 or more impressions. Average conference participation for the meetings was 501.

Given the numbers of views and even higher number of impressions, there appears to be a substantial increase in dissemination of poster abstracts beyond the conference attendees. The NAME should encourage authors of accepted abstracts to submit video summaries of their work. This will advertise forensic pathology research to a wider audience.
Early dynamic orchestration of immunologic mediators identifies multiply injured patients who are tolerant or sensitive to hemorrhage
Authors: McKinley Todd O. , Gaski Greg E. , Zamora Ruben , Shen Li , Sun Qing , Namas Rami A. , Billiar Timothy R. , Vodovotz Yoram
Published: October 2020

BACKGROUND

Multiply injured patients (MIPs) are at risk of complications including infections, and acute and prolonged organ dysfunction. The immunologic response to injury has been shown to affect outcomes. Recent advances in computational capabilities have shown that early dynamic coordination of the immunologic response is associated with improved outcomes after trauma. We hypothesized that patients who were sensitive or tolerant of hemorrhage would demonstrate differences in dynamic immunologic orchestration within hours of injury.

METHODS

We identified two groups of MIPs who demonstrated distinct clinical tolerance to hemorrhage (n = 10) or distinct clinical sensitivity to hemorrhage (n = 9) from a consecutive cohort of 100 MIPs. Hemorrhage was quantified by integrating elevated shock index values for 24 hours after injury (shock volume). Clinical outcomes were quantified by average Marshall Organ Dysfunction Scores from days 2 to 5 after injury. Shock-sensitive patients had high cumulative organ dysfunction after lower magnitude hemorrhage. Shock-tolerant (ST) patients had low cumulative organ dysfunction after higher magnitude hemorrhage. Computational methods were used to analyze a panel of 20 immunologic mediators collected serially over the initial 72 hours after injury.

RESULTS

Dynamic network analysis demonstrated the ST patients had increased orchestration of cytokines that are reparative and protective including interleukins 9, 17E/25, 21, 22, 23, and 33 during the initial 0- to 8-hour and 8- to 24-hour intervals after injury. Shock-sensitive patients had delayed immunologic orchestration of a network of largely proinflammatory and anti-inflammatory mediators. Elastic net linear regression demonstrated that a group of five mediators could discriminate between shock-sensitive and ST patients.

CONCLUSIONS

Preliminary evidence from this study suggests that early immunologic orchestration discriminates between patients who are notably tolerant or sensitive to hemorrhage. Early orchestration of a group of reparative/protective mediators was amplified in shock-tolerant patients.

LEVEL OF EVIDENCE

Prospective clinical outcomes study, level III.
Imlifidase Desensitization in Crossmatch-positive, Highly Sensitized Kidney Transplant Recipients: Results of an International Phase 2 Trial (Highdes)
Authors: Jordan Stanley C. , Legendre Christophe , Desai Niraj M. , Lorant Tomas , Bengtsson Mats , Lonze Bonnie E. , Vo Ashley A. , Runström Anna , Laxmyr Lena , Sjöholm Kristoffer , Schiött Åsa , Sonesson Elisabeth , Wood Kathryn , Winstedt Lena , Kjellman Christian , Montgomery Robert A.
Published: October 2020

Background.

Highly HLA sensitized patients have limited access to life-saving kidney transplantation because of a paucity of immunologically suitable donors. Imlifidase is a cysteine protease that cleaves IgG leading to a rapid decrease in antibody level and inhibition of IgG-mediated injury. This study investigates the efficacy and safety of imlifidase in converting a positive crossmatch test to negative, allowing highly sensitized patients to be transplanted with a living or deceased donor kidney.

Methods.

This open-label, single-arm, phase 2 trial conducted at 5 transplant centers, evaluated the ability of imlifidase to create a negative crossmatch test within 24 h. Secondary endpoints included postimlifidase donor-specific antibody levels compared with predose levels, renal function, and pharmacokinetic/pharmacodynamic profiles. Safety endpoints included adverse events and immunogenicity profile.

Results.

Of the transplanted patients, 89.5% demonstrated conversion of baseline positive crossmatch to negative within 24 h after imlifidase treatment. Donor-specific antibodies most often rebounded 3–14 d postimlifidase dose, with substantial interpatient variability. Patient survival was 100% with graft survival of 88.9% at 6 mo. With this, 38.9% had early biopsy proven antibody–mediated rejection with onset 2–19 d posttransplantation. Serum IgG levels began to normalize after ~3–7 d posttransplantation. Antidrug antibody levels were consistent with previous studies. Seven adverse events in 6 patients were classified as possibly or probably related to treatment and were mild-moderate in severity.

Conclusions.

Imlifidase was well tolerated, converted positive crossmatches to negative, and enabled patients with a median calculated panel-reactive antibody of 99.83% to undergo kidney transplantation resulting in good kidney function and graft survival at 6 mo.
The Practice of Electroconvulsive Therapy in Children and Adolescents in the Czech Republic
Authors: Hořínková Jana , Bartečků Elis , Kališová Lucie
Published: October 2020

Objectives

The aim of this study was to describe the practice of electroconvulsive therapy (ECT) in child and adolescent patients in the Czech Republic.

Methods

We conducted a mail questionnaire survey among Czech facilities associated with the Association of Child and Adolescent Psychiatry, and university hospitals with inpatient psychiatric wards, focused on the practice of ECT between 2013 and 2017 in patients younger than 18 years.

Results

Of 18 approached facilities, 13 had access to ECT, and only 6 used ECT on 16 patients. The most common diagnosis was schizophrenia or related disorders (68.75% of patients), and the most common reason for ECT was catatonic symptoms (37.5%). The most common ECT methodology was bitemporal electrode placement with brief-pulse current (62.5%). In 2 patients, ECT was terminated because of ineffectiveness and in 1 patient because of adverse reaction. In other patients, ECT ended after achieving a clinical effect. The most common adverse effect was transient memory impairment in a quarter of the patients. The number of pharmacological treatment attempts before ECT significantly correlated with hospitalization length.

Conclusions

The utilization of ECT among children and adolescents was low. It was usually used in severe conditions after several pharmacological treatment attempts, which may indicate reluctance among providers to use this modality. A number of pharmacological attempts were associated with longer hospitalizations. In the majority of patients, ECT was effective and safe. On the other hand, the monitoring of cognitive adverse effects was insufficient and could be improved.
Efficient plasmid transfer via natural competence in a synthetic microbial community
Authors: Cheng Yu-Yu , Zhou Zhichao , Papadopoulos James M. , Zuke Jason D. , Falbel Tanya G. , Anantharaman Karthik , Burton Briana M. , Venturelli Ophelia S.
Published: October 2020

The molecular and ecological factors shaping horizontal gene transfer (HGT) via natural transformation in microbial communities are largely unknown, which is critical for understanding the emergence of antibiotic-resistant pathogens. We investigate key factors shaping HGT in a microbial community by quantifying extracellular DNA release, species growth and HGT efficiency over time. In the community, plasmid release and HGT efficiency are significantly enhanced than the respective monocultures. The donor is a key determinant of HGT efficiency as plasmids induce the SOS response, enter a multimerized state, and are released at high concentrations, yielding efficient HGT. HGT is independent of the donor viability state as live and dead donor cells transfer the plasmid with high efficiency and is only reduced in response to high donor lysis rates. In sum, plasmid HGT via natural competence depends on an interplay of plasmid properties, donor stress responses and lysis rates and inter-species interactions.
Modulation of Grasp Parameters using Arbitrary Cues about Object Property in Older Adults
Authors: Rao Nishant , Mehta Neha , Patel Pujan , Parikh Pranav J.
Published: October 2020

Dexterous manipulation may be guided by explicit information about object property. Such a manipulation requires fine modulation of digit position and forces using explicit cues. Young adults can form arbitrary cue-object property associations for accurate modulation of digit position and forces. Aging, in contrast, might alter this conditional learning. Older adults are impaired in accurately modulating their digit forces using explicit cues about object property. However, it is not known whether older adults can use explicit cues about object property to modulate digit position. In this study, we instructed ten healthy older and ten young adults to learn a manipulation task using arbitrary color cues about object center of mass location. Subjects were required to exert clockwise, counterclockwise, or no torque on the object according to the color cue and lift the object while minimizing its tilt across sixty trials. Older adults produced larger torque error during the conditional learning trials than young adults. This resulted in a significantly slower rate of learning in older adults. Older, but not young adults, failed to modulate their digit position and forces using the color cues. Similar aging-related differences were not observed while learning the task using implicit knowledge about object property. Our findings suggest that aging impairs the ability to use explicit cues about object property to modulate both digit position and forces for dexterous manipulation. We discuss our findings in relation to age-related changes in the processes and the neural network for conditional learning.
Spatial patterns of phylogenetic diversity and endemism in the Western Ghats, India: a case study using ancient predatory arthropods
Authors: Bharti D. K. , Edgecombe Gregory D. , Karanth K. Praveen , Joshi Jahnavi
Published: October 2020

Abstract and keywords

Aim

To study patterns of phylogenetic diversity, endemism and turnover in a community of ancient arthropods across a biodiversity hotspot. Our specific aims were to understand diversity gradients, identify hotspots of endemism and conservation importance, and highlight poorly-studied areas with unique biodiversity.

Location

The Western Ghats (WG), India

Methods

We compiled a location data-set for 19 scolopendrid centipedes species which was used to predict areas of habitat suitability using bioclimatic and geomorphological variables in Maxent. We used predicted distributions and time-calibrated species phylogeny to calculate taxonomic and phylogenetic indices of diversity, endemism and turnover.

Results

We observed a decreasing gradient in Taxonomic and Phylogenetic Diversity (TD/PD) from the southern to northern WG and high Phylogenetic Endemism (PE) in the southern and northern WG. Southern WG had the highest diversity and was represented by lineages with long branch lengths and short ranges as observed from Relative Phylogenetic Diversity/Endemism (RPD and RPE). Despite having low PD, the northern WG had high values of PE represented by distinct lineages as inferred from RPE. Sites across the Palghat Gap grouped separately in comparisons of species turnover along the WG.

Main conclusions

Our findings support expectations from the latitudinal diversity gradient in the WG and the southern WG refuge hypotheses. The high diversity and endemism along with the presence of ancient lineages in the southern WG is consistent within-situspeciation. Climatic differences or dispersal barriers might have retained this diversity locally. High phylogenetic endemism in lateritic plateaus of the northern WG, albeit with low phylogenetic diversity, indicates the presence of distinct evolutionary lineages that might be adapted to life in these landscapes characterized by poor soil conditions and seasonal ephemeral habitats. Our results from soil arthropods highlight the need to use phylogeny and distribution data while assessing diversity and endemism patterns in the WG.