bluuebunny/crossref_metadata_2025 huggingface dataset:
0991 The Effect Of Extending Total Sleep Time And Weighted Blankets On Teenage Swimmers Performance
Authors: Zarrouf L R
Published: May 2020

Introduction

Effectiveness of sleep extension on performance and cognition in adult athletes has been studied extensively. Effectiveness of weighted blankets on sleep extension in children has been studied with mixed results. The effect of sleep quantity on teen competitive swimmers has not been evaluated extensively. This study investigated the effects of sleep extension and weighted blankets on performance, as well as daytime sleepiness in competitive teen swimmers. The principal investigator is a high school student and a teen-swimmer herself.

Methods

Study Design: Using an open label prospective approach, the pilot study will investigate swimmer’s event time changes, actigraphy findings and daytime sleepiness with sleep extension and weighted blankets. Setting/ Participants: 12 healthy swimmers on the MAKOS swim team will maintain their habitual sleep-wake schedule for a one-week; baseline period followed by a one-week sleep extension period, combined with weighted blankets use. Procedure/Protocol: The head-coach will assign event type to each participant of the study, 2 participants of the same type of event, will do the baseline timed race and initial evaluation, followed by one week of regular sleep (control). Another timed event will be done at the end of the 1st week and followed by a 2nd week of extended sleep (one hour/day) and weighted blanket. Final timed event race will be at the end of the 2nd week. Participants will fill initial, weekly questionnaires and wear a sleep tracker during the two weeks of the study. Detailed sleep and activities analysis will be obtained.

Results

12 swimmers were recruited, 8 females and 4 males. All participants have been consistently with the team for more than 2 years. Age range of participants is 11- 17 years. Members of the team practiced 5 days every week with each practice lasting for 2 hours. The first timed race is scheduled to be done the first week in January.

Conclusion

This is the first research study to evaluate the effect of two important variables on sleep and performance in teenage swimmers.

Support

The authors report no financial support related to this study.
The Origin of the Legumes is a Complex Paleopolyploid Phylogenomic Tangle Closely Associated with the Cretaceous–Paleogene (K–Pg) Mass Extinction Event
Authors: Koenen Erik J M , Ojeda Dario I , Bakker Freek T , Wieringa Jan J , Kidner Catherine , Hardy Olivier J , Pennington R Toby , Herendeen Patrick S , Bruneau Anne , Hughes Colin E
Published: May 2020

The consequences of the Cretaceous–Paleogene (K–Pg) boundary (KPB) mass extinction for the evolution of plant diversity remain poorly understood, even though evolutionary turnover of plant lineages at the KPB is central to understanding assembly of the Cenozoic biota. The apparent concentration of whole genome duplication (WGD) events around the KPB may have played a role in survival and subsequent diversification of plant lineages. To gain new insights into the origins of Cenozoic biodiversity, we examine the origin and early evolution of the globally diverse legume family (Leguminosae or Fabaceae). Legumes are ecologically (co-)dominant across many vegetation types, and the fossil record suggests that they rose to such prominence after the KPB in parallel with several well-studied animal clades including Placentalia and Neoaves. Furthermore, multiple WGD events are hypothesized to have occurred early in legume evolution. Using a recently inferred phylogenomic framework, we investigate the placement of WGDs during early legume evolution using gene tree reconciliation methods, gene count data and phylogenetic supernetwork reconstruction. Using 20 fossil calibrations we estimate a revised timeline of legume evolution based on 36 nuclear genes selected as informative and evolving in an approximately clock-like fashion. To establish the timing of WGDs we also date duplication nodes in gene trees. Results suggest either a pan-legume WGD event on the stem lineage of the family, or an allopolyploid event involving (some of) the earliest lineages within the crown group, with additional nested WGDs subtending subfamilies Papilionoideae and Detarioideae. Gene tree reconciliation methods that do not account for allopolyploidy may be misleading in inferring an earlier WGD event at the time of divergence of the two parental lineages of the polyploid, suggesting that the allopolyploid scenario is more likely. We show that the crown age of the legumes dates to the Maastrichtian or early Paleocene and that, apart from the Detarioideae WGD, paleopolyploidy occurred close to the KPB. We conclude that the early evolution of the legumes followed a complex history, in which multiple auto- and/or allopolyploidy events coincided with rapid diversification and in association with the mass extinction event at the KPB, ultimately underpinning the evolutionary success of the Leguminosae in the Cenozoic. [Allopolyploidy; Cretaceous–Paleogene (K–Pg) boundary; Fabaceae, Leguminosae; paleopolyploidy; phylogenomics; whole genome duplication events]
Male meiosis in sweet cherry is constrained by the chilling and forcing phases of dormancy
Authors: Fadón Erica , Herrera Sara , Herrero María , Rodrigo Javier
Published: May 2020

Male meiosis in temperate fruit trees occurs in the anthers once a year, synchronized with the seasons. The alternation of dormant and growth cycles determines the optimum moment for the male gametophyte formation, a process sensitive to both cold and warm temperatures. This ensures pollen viability and subsequent reproduction success that guarantee fruit production. In this work, we explore how male meiosis is framed by seasonality in sweet cherry. For this purpose, the dormant phases, male meiosis and blooming dates were established in four cultivars with different flowering dates and chilling requirements over 7 years. The chilling and heat requirements for each cultivar were empirically estimated, and chilling and heat temperatures were quantified according to the Dynamic and Growing Degree Hours (GDH) models, respectively. Endodormancy was overcome approximately a fortnight earlier during the colder winters than during the milder winters. Against our initial hypothesis, these differences were not clearly reflected in the time of male meiosis. The period between chilling fulfillment and meiosis lasted several weeks, during which a high amount of GDH accumulated. Results showed that male meiosis is conditioned by endodormancy but especially by warm temperatures, during the forcing period. This differs from what has been described in other related species and creates a framework for further studies to understand the strategies of synchronizing dormancy with seasons.
Treating asthma in the age of biologics
Authors: Prabakaran Anisha
Published: May 2020

Many patients with severe asthma continue to have high symptom burden despite maximization of conventional therapy. As the understanding of asthma pathophysiology has evolved, however, more personalized therapy options have become available. Asthma biologics are a new class of medications that target the specific pathways that underlie a patient's disease and can reduce the frequency of asthma exacerbations and improve patient quality of life. Clinicians should refer potential candidates to a specialist for further evaluation.
Planning for high-risk maternity patients
Authors: Hollander Jennifer , Lamonica Kelly
Published: May 2020

Having a plan in place before an expectant mother comes to the healthcare facility for delivery is an important step toward quality care. Read about how one medical center in New Jersey launched an initiative to identify high-risk expectant mothers early and plan accordingly months ahead of their delivery date.
Vulnerable Immigrant Populations in the New York Metropolitan Area and COVID-19: Lessons Learned in the Epicenter of the Crisis
Authors: Behbahani Sara , Smith Cynthia A. , Carvalho Michelly , Warren Christopher J. , Gregory Micah , Silva Nicole A.
Published: May 2020

The epicenter of the COVID-19 crisis since March 17, 2020—the New York metropolitan area—is home to some of the largest Latino immigrant communities in the nation. These communities have long faced barriers to health care access, challenges due to immigration status, and financial and labor instability. The COVID-19 pandemic has aggravated these existing issues in a vulnerable, often forgotten, immigrant community. It has been challenging for this population to access public information regarding COVID-19 testing, treatment, and assistance programs because this information has seldom been disseminated in Spanish and even less frequently in Portuguese. While long-term solutions will require time and changes to policy, some short-term measures can mitigate the current situation. The authors share their experience from Newark, New Jersey, where partnerships of public and private community-based organizations (CBOs) have been successful in establishing trust between the health care system and a fearful Latino community. The Ironbound Initiative, a student group at Rutgers New Jersey Medical School in Newark, New Jersey, has partnered with Mantena Global Care, a Brazilian CBO in Newark, to facilitate dissemination of COVID-19–relevant information. Medical student volunteers, removed from their clinical duties, serve as virtual patient navigators, using social media to reach community members with the goals of improving awareness of precautions to take during the pandemic and of increasing access to needed medical care. These students have collaborated with colleagues in other disciplines to provide necessary legal guidance to community members fearful of seeking care because of their immigration status. The authors urge other academic institutions across the country to recruit multidisciplinary teams of medical, health professions, and law students invested in their local communities and to empower students to partner with CBOs, immigrant community leaders, faith-based organizations, hospitals, and local authorities to support these vulnerable communities during this crisis.
Trochanteric pain and total hip arthroplasty: a systematic review of the literature
Authors: Axelrod Daniel , Madden Kim , Khan Habeeb , Banfield Laura , Winemaker Mitchell , DeBeer Justin , Wood Thomas J.
Published: May 2020

Background:

Total hip arthroplasty (THA) is one of the most common surgical procedures. Although THA surgeries are typically very successful, between 3% and 17% of all patients experience trochanteric pain after surgery. There is little high-quality evidence on this disorder, especially after total hip arthroplasty. The purposes of this review were to describe the prevalence, treatments, prognosis, risk factors, and diagnostic methods available for trochanteric pain among preoperative or postoperative primary THA patients.

Methods:

The authors conducted a systematic review of trochanteric pain among THA patients. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched to identify relevant articles. Two reviewers systematically screened studies and extracted data independently in duplicate. This study presents descriptive statistics and pooled prevalence of trochanteric pain.

Results:

We included 36 studies with 7826 patients (mean age of 62 yr, 59% female). The prevalence of trochanteric pain was reported in 25 studies, with a mean prevalence of 3.8% (95% CI 3.3% to 4.4%). Methods of treatment for trochanteric pain included corticosteroid injections, bursectomy, and iliotibial (IT) band lengthening. Risk factors for trochanteric pain were inconsistently reported, but those most commonly listed were female gender and postoperative leg-length discrepancy.

Conclusions:

Approximately one in 25 patients who has undergone standard THA experiences postoperative trochanteric pain. With low certainty, the results of this review suggest the surgical approach may not influence incidence of trochanteric pain. The heterogeneity in both diagnostic modalities reported and in treatment options suggests that further prospective research is required to better inform treatment decisions for this common condition.

Level of Evidence:

Level III.
Spondyloarthritis evolution: what is in your history?
Authors: Ashrafi Maedeh , Ermann Joerg , Weisman Michael H.
Published: May 2020

Purpose of review

This review encompasses a detailed history of spondyloarthritis (SpA) evolution as early as the 17th century, continues on to the current concept of SpA, and ends with current gaps in our understandings of SpA.

Recent findings

Until the early 1960s, ankylosing spondylitis and other SpA family members were considered to be variants of rheumatoid arthritis (RA). The formal medical community separated them from RA at that time, and shortly thereafter they were recognized to be inter-connected based on shared clinical, laboratory, and imaging features. The last two decades have witnessed the formal distinction between axial and peripheral SpA and the connections that exist between nonradiographic and radiographic axial SpA. Recent studies have revealed different microbial compositions among patients with SpA and healthy controls and also between HLA-B27 positive and negative healthy individuals.

Further investigation of the roles of intestinal microbiome and physical force transduction toward SpA pathogenesis, strategies to improve delay in SpA diagnosis, biomarkers to better predict radiographic progression, and modification of current classification criteria to better address the axial and peripheral groups are gaps in our understandings that pose top priorities for SpA research.
Does generalized joint hypermobility influence the Ponseti treatment of clubfoot patients?
Authors: Beck Jennifer J. , Nazif Mohammad A. , Sangiorgio Sophia N. , Semel Jay I. , Ebramzadeh Edward , Zionts Lewis E.
Published: May 2020

Previous investigators have suggested a role for generalized joint hypermobility (GJH) in the etiology of clubfoot deformity, while others have suggested its presence may influence treatment outcomes. We sought to determine if GJH was associated with the demographics, treatment, or propensity to relapse of patients whose clubfeet were managed using the Ponseti method. Fifty-seven patients with Ponseti-treated clubfeet comprised the cohort; median age 61 months (range, 38–111 months). A physical therapist evaluated each patient using the nine-point Beighton scale to quantify hypermobility. The scores were then correlated with patient sex, laterality, Dimeglio severity score, treatment, relapse, and surgery. The median Beighton score was 5; 49 of 57 patients (86%) had Beighton scores ≥4. All feet were plantigrade without symptomatic overcorrection at the time of evaluation. Although there was a slightly lower probability of relapse in patients with higher Beighton scores, this was not statistically significant (P = 0.10). Accordingly, the sex, laterality, initial severity, number of pretenotomy casts, need for tenotomy, relapse, and need for tendon transfer surgery were not significantly influenced by the Beighton score. The outcome of Ponseti clubfoot treatment is not altered by the presence of GJH in young children. Joint hypermobility does not appear to influence the likelihood of relapse or surgery. Unlike clubfeet reportedly treated with release surgery, Ponseti-treated clubfeet were not prone to excessive overcorrection regardless of joint laxity. Last, the distribution of Beighton scores in the study’s cohort supports an association between GJH and clubfoot deformity.
Does K-line (−) in the Neck-flexed Position Predict Surgical Outcome of Cervical Spondylotic Myelopathy?
Authors: Nori Satoshi , Aoyama Ryoma , Ninomiya Ken , Suzuki Satoshi , Anazawa Ukei , Shiraishi Tateru
Published: May 2020

Study Design.

A retrospective single-center study.

Objective.

The aim of this study was to investigate the influence of the K-line in the neck-flexed position (flexion K-line) on the surgical outcome after muscle-preserving selective laminectomy (SL) for cervical spondylotic myelopathy (CSM).

Summary of Background Data.

Development of CSM is associated with dynamic factors and cervical alignment. The flexion K-line, which reflects both dynamic and alignment factors, provides an indicator of surgical outcome after posterior decompression surgery for patients with ossification of the posterior longitudinal ligament. However, the value of the flexion K-line for patients with CSM has not been evaluated.

Methods.

Our study group included 159 patients treated with SL for CSM. Patients were divided into a flexion K-line (+) group and a flexion K-line (−) group. The influence of the flexion K-line on radiological and surgical outcomes was analyzed, with multivariate analysis conducted to identify factors affecting the surgical outcome.

Results.

Patients in the flexion K-line (−) group were younger (P = 0.003), had a less lordotic cervical alignment (pre-and postoperatively, P < 0.001), a smaller C7 slope (pre-and postoperatively, P < 0.001), and a greater mismatch between the C7 slope and the C2-C7 angle (preoperatively, P = 0.047; postoperatively, P = 0.001). The postoperative increase in Japanese Orthopedic Association (JOA) score and the JOA score recovery rate (RR) were lower for the flexion K-line (−) than for the K-line (+) group (P < 0.001 and P < 0.001, respectively). On multivariate regression analysis, the flexion K-line (−) (β = −0.282, P < 0.001), high signal intensity (SI) changes on T2-weighted image (WI) combined with low SI changes on T1-WI in the spinal cord (β = −0.266, P < 0.001), and older age (β= -0.248, P = 0.001) were predictive of a lower JOA score RR.

Conclusion.

The flexion K-line may be a useful predictor of surgical outcomes after SL in patients with CSM.

Level of Evidence: 4
Disc Degeneration of Young Low Back Pain Patients
Authors: Sääksjärvi Simo , Kerttula Liisa , Luoma Katariina , Paajanen Hannu , Waris Eero
Published: May 2020

Study Design.

A prospective follow-up study.

Objective.

The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up.

Summary of Background Data.

MRI is an accurate method for studying degenerative changes in intervertebral discs. Decreased signal intensity (SI) can be used as indication of decreased water content. Long-term prognosis of early DD remains unclear.

Methods.

In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI. The images were evaluated for decreased SI and other degenerative changes. Association between decreased SI of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. Association between decreased baseline SI and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.

Results.

The total number of lumbar discs with decreased SI increased from 23 of 130 (18%) to 92 of 130 (71%)—from 0.9 to 3.5 per subject during the follow-up. Distribution of DD changed from being mostly in L4–L5 and L5–S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased SI at baseline were more likely to have severely decreased SI at follow-up, compared to healthy discs (57% vs. 11%, P < 0.001). Other degenerative changes were also more common in these discs. Severity of DD at baseline did not have a significant association with current pain or disability.

Conclusion.

In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.

Level of Evidence: 4
Employment Status for the First Decade Following Randomization to Cervical Disc Arthroplasty Versus Fusion
Authors: Badve Siddharth A. , Florman Jeffrey E. , Levi Allan D. , Kurra Swamy , Riew K. Daniel , Lavelle William F.
Published: May 2020

Study Design.

An analysis of employment status data up to 10 years following the Federal Drug Administration (FDA) Investigational Device Exemption (IDE) randomized trial and extension as post-approval study comparing BRYAN® cervical disc (Medtronic, Minneapolis, MN) arthroplasty (CDA) versus single-level anterior cervical discectomy and fusion (ACDF) was performed.

Objective.

Ten-year experience with the BRYAN® disc arthroplasty trial provides opportunity to report patient employment data.

Summary of Background Data.

The long-term consequences of arthroplasty remain incomplete, including the occurrence of occupational compromise.

Methods.

Patients’ employment status were measured at regular intervals in both groups up to 10 years.

Results.

The preoperative employment status proportion was comparable between investigational (BRYAN CDA) and control (ACDF) groups. In the investigational group, 49.2% returned to work at 6 weeks compared with 39.4% of the control group (P = 0.046). At 6 months and 2 years postoperatively, there was a similar likelihood of active employment in both groups. After 2 years at all time points, 10% drop-off seen in control group employment, but not in investigational group. At 10 years, 76.2% CDA patients were employed to 64.1% ACDF patients (P = 0.057). Preoperative variables influencing work status at 10 years following CDA included: preoperative work status, age, and SF-36 Mental Component Score (SF-36 MCS); whereas, no significant preoperative factor identified with ACDF. Time to return to work was influenced in both groups by preoperative work status; and in the ACDF group: reaching age 65 at 10-year visit, preoperative arm pain and NDI score had significant influences.

Conclusion.

More patients returned to work at 6 weeks after CDA compared with ACDF, although there was no difference by 6 months. After 2 years, a nonsignificant trend toward higher employment rates in the arthroplasty group was evident, but this difference could not be validated due to the very high rate of loss of patients to the follow-up.

Level of Evidence: 2
Proximal Junctional Kyphosis Symposium: Patient Factors That Can Contribute to Development of Proximal Junctional Kyphosis
Authors: Hauser Spencer W.
Published: May 2020

The development of proximal junctional kyphosis is complex and cannot be attributed to any single factor. The following paragraphs discuss some patient-related factors that have been linked to the development of this condition.
Implications of Obesity for the Management of Severe Coronavirus Disease 2019 Pneumonia
Authors: Lemyze Malcolm , Courageux Nathan , Maladobry Thomas , Arumadura Clothilde , Pauquet Philippe , Orfi Annis , Komorowski Matthieu , Mallat Jihad , Granier Maxime
Published: May 2020

Objectives:

To investigate patients’ characteristics, management, and outcomes in the critically ill population admitted to the ICU for severe acute respiratory syndrome coronavirus disease 2019 pneumonia causing an acute respiratory distress syndrome.

Design:

Retrospective case-control study.

Setting:

A 34-bed ICU of a tertiary hospital.

Patients:

The first 44 coronavirus disease 2019 acute respiratory distress syndrome patients were compared with a historical control group of 39 consecutive acute respiratory distress syndrome patients admitted to the ICU just before the coronavirus disease 2019 crisis.

Interventions:

None.

Measurements and Main Results:

Obesity was the most frequent comorbidity exhibited by coronavirus disease 2019 patients (n = 32, 73% vs n = 11, 28% in controls; p < 0.001). Despite the same severity of illness and level of hypoxemia at admission, coronavirus disease 2019 patients failed more high flow oxygen via nasal cannula challenges (n = 16, 100% vs n = 5, 45% in controls; p = 0.002), were more often intubated (n = 44, 100% vs n = 22, 56% in controls; p < 0.001) and paralyzed (n = 34, 77% vs n = 3, 14% in controls; p < 0.001), required higher level of positive end-expiratory pressure (15 vs 8 cm H2O in controls; p < 0.001), more prone positioning (n = 33, 75% vs n = 6, 27% in controls; p < 0.001), more dialysis (n = 16, 36% vs n = 3, 8% in controls; p = 0.003), more hemodynamic support by vasopressors (n = 36, 82% vs n = 22, 56% in controls; p = 0.001), and had more often a prolonged weaning from mechanical ventilation (n = 28, 64% vs n = 10, 26% in controls; p < 0.01) resulting in a more frequent resort to tracheostomy (n = 18, 40.9% vs n = 2, 9% in controls; p = 0.01). However, an intensive management requiring more staff per patient for positioning coronavirus disease 2019 subjects (6 [5–7] vs 5 [4–5] in controls; p < 0.001) yielded the same ICU survival rate in the two groups (n = 34, 77% vs n = 29, 74% in controls; p = 0.23).

Conclusions:

In its most severe form, coronavirus disease 2019 pneumonia striked preferentially the vulnerable obese population, evolved toward a multiple organ failure, required prolonged mechanical ventilatory support, and resulted in a high workload for the caregivers.
Restoring the Severed Breast and Chest following Seat Belt Trauma
Authors: Noel Olivier F. , Fornadley Jeffrey , Potochny John
Published: May 2020

In this article, we presented 2 cases of rare clinical presentation of 3-point lap-diagonal seat belt injuries and provided a brief overview of the spectrum of the associated deformity and morbidity. Both of our patients presented in a delayed fashion during the subacute period at 12 and 4 months, respectively, following their traumatic seat belt injuries, which improved with surgical intervention. Ideally, these injuries should be repaired during the subacute period once any life-threatening injuries have been addressed, because seat belt–restraint injuries may otherwise lead to chronic pain, functional loss, and physical deformity.
Leader Legacy Building: An Organization’s Life Insurance Policy
Authors: Akin Terrence B. , Eaton Mandy C.
Published: May 2020

Healthcare is uniquely destined for growth, largely because of the increasing demands of an aging population. In this field bursting with highly trained professionals driven by a passion for serving others, we as healthcare leaders are well positioned to cultivate an environment where high-performing employees can achieve their potential.

Unfortunately, we are not well positioned to face the risk of losing continuity. Most healthcare C-suites are occupied by baby boomers who will soon exit the workforce. The impending transitions, adding to the effects of system consolidations and market demands for leadership talent, call for a concerted effort to prepare the next generation of leaders. There are significant benefits to promoting from within, yet formal succession plans are hard to build and even harder to embed in an organization’s culture.

The planning and attention required to develop the next generation is not a static process. The work is hard and ongoing. However, the return on the human investment in succession planning can be substantial for an organization, its senior executives, and its emerging leaders. Preparing the next generation should be an imperative for all senior leaders. An effective approach involves a defined plan, development tools, alignment with a leadership competency framework, and attention to diversity and inclusion. Handled effectively, early careerists who are taught the skills needed to succeed as leaders will be able to help guide their organizations and healthcare in general when called on to make a difference. There is great potential to be realized in developing future leaders internally, and we as today’s leaders must start that work now.
Ocular Manifestations of Chordin-like 1 Knockout Mice
Authors: Chen Di , Liu Yang , Shu Guanhua , Chen Chinfei , Sullivan David A. , Kam Wendy R. , Hann Steven , Fowler Megan , Warman Matthew L.
Published: May 2020

Purpose:

In humans, loss-of-function mutations in the gene encoding Chordin-like 1 (CHRDL1) cause X-linked megalocornea (MGC1), characterized by bilateral corneal enlargement, decreased corneal thickness, and increased anterior chamber depth (ACD). We sought to determine whether Chrdl1 knockout (KO) mice would recapitulate the ocular findings found in patients with MGC1.

Methods:

We generated mice with a Chrdl1 KO allele and confirmed that male Chrdl1 hemizygous KO mice do not express Chrdl1 mRNA. We examined the eyes of male mice that were hemizygous for either the wild-type (WT) or KO allele and measured corneal diameter, corneal area, corneal thickness, endothelial cell density, ACD, tear volume, and intraocular pressure. We also harvested retinas and counted retinal ganglion cell numbers. Eye segregation pattern in the dorsal lateral geniculate nucleus were also compared between male Chrdl1 KO and WT mice.

Results:

Male Chrdl1 KO mice do not have larger cornea diameters than WT mice. KO mice have significantly thicker central corneas (116.5 ± 3.9 vs. 100.9 ± 4.2 μm, P = 0.013) and smaller ACD (325.7 ± 5.7 vs. 405.6 ± 6.3 μm, P < 0.001) than WT mice, which is the converse of what occurs in patients who lack CHRDL1. Retinal–thalamic projections and other ocular measurements did not significantly differ between KO and WT mice.

Conclusions:

Male Chrdl1 KO mice do not have the same anterior chamber abnormalities seen in humans with CHRDL1 mutations. Therefore, Chrdl1 KO mice do not recapitulate the human MGC1 phenotype. Nevertheless, Chrdl1 plays a role during mouse ocular development because corneas in KO mice differ from those in WT mice.
Safety of Metronidazole in Late Pre-term and Term Infants with Complicated Intra-abdominal Infections
Authors: Commander Sarah Jane , Gao Jamie , Zinkhan Erin K. , Heresi Gloria , Courtney Sherry E. , Lavery Adrian P. , Delmore Paula , Sokol Gregory M. , Moya Fernando , Benjamin Danny , Bumpass Tedryl G. , Debski Julie , Erinjeri Jinson , Sharma Gaurav , Tracy Elisabeth T. , Smith P. Brian , Cohen-Wolkowiez Michael , Hornik Christoph P.
Published: May 2020

Background:

Metronidazole is frequently used off-label in infants with complicated intra-abdominal infections (cIAI) to provide coverage against anaerobic organisms, but its safety and efficacy in this indication are unknown.

Methods:

In the Antibiotic Safety in Infants with Complicated Intra-Abdominal Infections open-label multicenter trial infants ≥34 weeks gestation at birth and <121 days postnatal age with cIAIs were administered metronidazole as part of multimodal therapy. Metronidazole safety was evaluated by reporting of adverse events (AEs) and safety events of special interest. Cure from disease was determined by blood cultures and a clinical cure score >4. A blinded adjudication committee reviewed all safety events of special interest.

Results:

Fifty-five infants were included, median gestational age was 36 weeks (range: 34–41) and postnatal age was 7 days (0–63). The most common additional antibiotics received included gentamicin, piperacillin-tazobactam, ampicillin and vancomycin. Only one AE, a candidal rash, was identified to be potentially caused by metronidazole administration. One infant died of cardiopulmonary failure, which was deemed unrelated to metronidazole. The most common events of special interest included feeding intolerance in 18 (33%) infants, and exploratory laparotomy in 10 (18%) requiring intestinal anastomosis in 7 (13%) infants. There was 1 (2%) intestinal stricture. Fifty-three infants (96%) achieved overall therapeutic success, 54 (98%) were alive through 30 days post-study therapy, and 54 (98%) had 30-day clinical cure score >4.

Conclusions:

In a cohort of late pre-term and term infants with cIAIs, combination antibiotic therapy that included metronidazole was safe, and therapeutic success was high.
Acute Inflammation and Elevated Cardiac Markers in a Two-Month-Old Infant with Severe Acute Respiratory Syndrome Coronavirus 2 Infection Presenting with Cardiac Symptoms
Authors: Giacomet Vania , Manfredini Valeria Anna , Meraviglia Giulia , Peri Caterina Francesca , Sala Anna , Longoni Emma , Gasperetti Alessio , Stracuzzi Marta , Mannarino Savina , Zuccotti Gian Vincenzo
Published: May 2020

Severe acute respiratory syndrome coronavirus 2 infection in children mainly shows a milder course. In complicated cases, it is unknown whether inflammation is predictive of disease severity, as in adults. Moreover, cardiac involvement is anecdotally described. We report the case of a 2-month-old infant with severe acute respiratory syndrome coronavirus 2 infection presenting with fever, tachycardia and elevated interleukin-6, who was diagnosed with myocarditis and treated with immunoglobulins.
Cefepime Versus Cefepime Plus Amikacin as an Initial Antibiotic Choice for Pediatric Cancer Patients With Febrile Neutropenia in an Era of Increasing Cefepime Resistance
Authors: Lee Na Hee , Kang Ji-Man , Lee Ji Won , Huh Hee Jae , Lee Nam Yong , Yoo Keon Hee , Sung Ki Woong , Koo Hong Hoe , Kim Yae-Jean
Published: May 2020

Background:

We investigated the treatment outcomes before and after the addition of amikacin to cefepime monotherapy as an initial empirical antibiotic treatment in pediatric cancer patients with febrile neutropenia.

Methods:

This was a retrospective historical cohort study. The subjects were pediatric cancer patients who visited the emergency room at the Samsung Medical Center, Seoul, Korea, due to chemotherapy-induced febrile neutropenia, between January 2011 and December 2016. Since September 2014, the empirical antimicrobial treatment regimen for febrile neutropenia was changed from high-dose cefepime monotherapy to combination therapy of adding a single dose of amikacin.

Results:

Two hundred twenty-five bacteremia episodes in 164 patients were reported during the study period. Bacteremia caused by cefepime-resistant Gram-negative bacteria was observed in 16% of patients before September 2014 and in 21% of the patients after September 2014 (P = 0.331). Use of appropriate empirical antibiotic treatments increased from 62% to 83% following addition of amikacin to cefepime treatment (P = 0.003). The duration of fever was shorter in the cefepime plus amikacin group than in the cefepime group (22 vs. 34 hours, P = 0.014); however, rates of septic shock and pediatric intensive care unit hospitalizations were not significantly different between the 2 groups (septic shock, both 7%, P = 0.436; pediatric intensive care unit 3% vs. 1%, P = 0.647).

Conclusions:

We observed no additional benefit of amikacin addition to high-dose cefepime monotherapy. Therefore, adding amikacin to cefepime monotherapy in conditions where cefepime-resistant Gram-negative bacteremia amounts to 20% or less may not be justified.
Noninvasive motor cortex stimulation effects on quantitative sensory testing in healthy and chronic pain subjects: a systematic review and meta-analysis
Authors: Giannoni-Luza Stefano , Pacheco-Barrios Kevin , Cardenas-Rojas Alejandra , Mejia-Pando Piero F. , Luna-Cuadros Maria A. , Barouh Judah L. , Gnoatto-Medeiros Marina , Candido-Santos Ludmilla , Barra Alice , Caumo Wolnei , Fregni Felipe
Published: May 2020

One of the potential mechanisms of motor cortex stimulation by noninvasive brain stimulation (NIBS) effects on pain is through the restoration of the defective endogenous inhibitory pain pathways. However, there are still limited data on quantitative sensory testing (QST), including conditioned pain modulation (CPM), supporting this mechanism. This systematic review and meta-analysis aimed to evaluate the effects of noninvasive motor cortex stimulation on pain perception as indexed by changes in QST outcomes. Database searches were conducted until July 2019 to include randomized controlled trials that performed sham-controlled NIBS on the motor cortex in either the healthy and/or pain population and assessed the QST and CPM. Quality of studies was assessed through the Cochrane tool. We calculated the Hedge's effect sizes of QST and CPM outcomes and their 95% confidence intervals (95% CIs) and performed random-effects meta-analyses. Thirty-eight studies were included (1178 participants). We found significant increases of pain threshold in healthy subjects (ES = 0.16, 95% CI = 0.02-0.31, I2 = 22.2%) and pain populations (ES = 0.48, 95% CI = 0.15-0.80, I2 = 68.8%), and homogeneous higher CPM effect (pain ratings reduction) in healthy subjects (ES = −0.39, 95% CI = −0.64 to −0.14, I2 = 17%) and pain populations (ES = −0.35, 95% CI = −0.60 to −0.11, I2 = 0%) in the active NIBS group compared with sham. These results support the idea of top-down modulation of endogenous pain pathways by motor cortex stimulation as one of the main mechanisms of pain reduction assessed by QST, which could be a useful predictive and prognostic biomarker for chronic pain personalized treatment with NIBS.
Mediation analysis for the relationship between dyslipidemia and coronary artery disease via hypersensitive C-reactive protein in a case-control study
Authors: He Pan , Fan Si-yu , Guan Jie-qiong , Song Wen-jing , Obore Nathan , Chen Wei-qiang , Zhi Hong , Wang Li-na
Published: May 2020

Background

The pathological basis of coronary artery disease (CAD) is atherosclerosis which is associated with inflammation and dyslipidemia. However, the involvement of hypersensitive C-reactive protein (hs-CRP) in lipid metabolism and how it affects the pathogenesis of CAD is uncertain.

Objective

To explore whether the relationship between dyslipidemia and CAD is partly mediated by hs-CRP levels.

Methods

Three hundred fifteen pairs of randomly sexand age-matched CAD and non-CAD subjects collected from Zhongda Hospital Affiliated to Southeast University were involved in the final analysis. We gathered information about each subjects clinical history as well as their results of detected hs-CRP and lipid levels. Linear regression analysis was used to determine the association between dyslipidemia and hs-CRP levels in which univariate and multivariate logistic regression analyzes were performed to determine the relationship between hs-CRP levels and CAD as well as dyslipidemia and CAD. Mediation analysis was used to evaluate whether hs-CRP levels act as a mediator of the relationship between dyslipidemia and CAD.

Results

Dyslipidemia and hs-CRP levels were significantly associated with an increased risk of CAD, with β = 0.594 (P = 0.001) and β = 0.016 (P = 0.024), respectively, and there was a correlation between dyslipidemia and hs-CRP levels (β = 3.273, P = 0.004). Mediation analysis results revealed that the correlation between dyslipidemia and CAD was 8.27% mediated by hs-CRP levels with a direct effect of 0.621 and an indirect effect of 0.056.

Conclusion

Hs-CRP levels played a partial mediation role in the association between dyslipidemia and CAD.
Interaction of diet and drugs in lung disease
Authors: Semen Khrystyna O. , Yelisyeyeva Olha P. , Bast Aalt
Published: May 2020

Purpose of review

The current review aims to seek attention for the interaction between drugs and nutrition. Traditionally, drugs and nutrition are regarded as separate categories. Nutrition is to maintain health and drugs are for curing disease. Dieticians deal with food and the medical doctor prescribes drugs. During the last decade, both categories are getting closer.

Recent findings

Some drugs used in pulmonology lead to decrease in nutrients. Other drugs negatively affect taste. This is remarkable because the diseases for which these drugs are intended, benefit from nutrition. Gradually examples emerge that suggest that the action of drugs profit from certain dietary components.

A closer look into the interaction between diet and drugs will eventually benefit the patient.
Stiripentol identifies a therapeutic target to reduce oxaluria
Authors: Letavernier Emmanuel , Daudon Michel
Published: May 2020

Purpose of review

Oxalate is a metabolic end-product promoting the formation of calcium oxalate crystals in urine. Massive urine oxalate excretion occurs in genetic diseases, mainly primary hyperoxaluria type I and II, threatening renal function. Ethylene glycol poisoning may induce the precipitation of calcium oxalate crystals in renal tubules, leading to acute renal failure. In both cases, oxalate results from glyoxylate transformation to oxalate in the liver, by lactate dehydrogenase (LDH) enzymes, especially the LDH-5 isoenzyme. The purpose of the review is to highlight LDH as a potential therapeutic target according to recent publications.

Recent findings

Genetic therapy targeting LDH metabolism decreases urine oxalate excretion in rodents. Stiripentol is an antiepileptic drug that has been shown recently to inhibit neuronal LDH-5 isoenzyme. Stiripentol was hypothesized to reduce hepatic oxalate production and urine oxalate excretion. In vitro, stiripentol decreases oxalate synthesis by hepatocytes. In vivo, stiripentol oral administration decreases urine oxalate excretion in rats and protects renal function and renal tissue against ethylene glycol intoxication and chronic calcium oxalate crystalline nephropathy.

The use of stiripentol in-vitro and in-vivo highlights that targeting hepatic LDH by pharmacological or genetic tools may decrease oxalate synthesis, deserving clinical studies.
Hematopoietic stem cell regulation by the proteostasis network
Authors: Chua Bernadette A. , Signer Robert A.J.
Published: May 2020

Purpose of review

Protein homeostasis (proteostasis) is maintained by an integrated network of physiological mechanisms and stress response pathways that regulate the content and quality of the proteome. Maintenance of cellular proteostasis is key to ensuring normal development, resistance to environmental stress, coping with infection, and promoting healthy aging and lifespan. Recent studies have revealed that several proteostasis mechanisms can function in a cell-type-specific manner within hematopoietic stem cells (HSCs). Here, we review recent studies demonstrating that the proteostasis network functions uniquely in HSCs to promote their maintenance and regenerative function.

Recent findings

The proteostasis network is regulated differently in HSCs as compared with restricted hematopoietic progenitors. Disruptions in proteostasis are particularly detrimental to HSC maintenance and function. These findings suggest that multiple aspects of cellular physiology are uniquely regulated in HSCs to maintain proteostasis, and that precise control of proteostasis is particularly important to support life-long HSC maintenance and regenerative function.

The proteostasis network is uniquely configured within HSCs to promote their longevity and hematopoietic function. Future work uncovering cell-type-specific differences in proteostasis network configuration, integration, and function will be essential for understanding how HSCs function during homeostasis, in response to stress, and in disease.
An Update on Endocrine Mucin-producing Sweat Gland Carcinoma
Authors: Agni Meghana , Raven Meisha L. , Bowen Randy C. , Laver Nora V. , Chevez-Barrios Patricia , Milman Tatyana , Eberhart Charles G. , Couch Steven , Bennett Daniel D. , Albert Daniel M. , Hogan R. Nick , Phelps Paul O. , Stiefel Hillary , Mancera Norberto , Hyrcza Martin , Wang Ami , Burris Christopher K.H. , Steele Eric A. , Campbell Ashley A. , Potter Heather D. , Lucarelli Mark J.
Published: May 2020

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade adnexal neoplasm with predilection for the periorbital skin of older women. Histologically and immunophenotypically, EMPSGC is analogous to another neoplasm with neuroendocrine differentiation, solid papillary carcinoma of the breast. Both lesions are spatially associated with neuroendocrine mucinous adenocarcinomas of the skin and breast, respectively. EMPSGC is ostensibly a precursor of neuroendocrine-type mucinous sweat gland adenocarcinoma (MSC), a lesion of uncertain prognosis. Non-neuroendocrine MSC has been deemed locally aggressive with metastatic potential, and previous works speculated that EMPSGC-associated (neuroendocrine-type) MSC had similar recurrence and metastatic potential with implications for patient follow-up. Only 96 cases of EMPSGC have been reported (12 cases in the largest case series). Herein, we present 63 cases diagnosed as “EMPSGC” in comparison with aggregated results from known published EMPSGC cases. We aim to clarify the clinicopathologic features and prognostic significance of the neuroendocrine differentiation of EMPSGC and its associated adenocarcinoma and to determine the nosological relevance of EMPSGC association in the spectrum of MSC histopathogenesis. Results established an overall female predominance (66.7%) and average presenting age of 64 years. EMPSGC lesions were associated with adjacent MSC in 33.3% of cases. The recurrence rate for neuroendocrine-type MSC was ~21%, less than the reported 30% for non-neuroendocrine MSC. There were no cases of metastasis. EMPSGC and neuroendocrine-type MSC are distinct entities with more indolent behavior than previously reported, supporting a favorable prognosis for patients.
Tibial Intraosseous Administration of Epinephrine Is Effective in Restoring Return of Spontaneous Circulation in a Pediatric Normovolemic But Not Hypovolemic Cardiac Arrest Model
Authors: Yauger Young J. , Johnson Michelle D. , Mark Jordan , Le Tho , Woodruff Thomas , Silvey Stephanie , Revis James , Blouin Dawn , O'Sullivan Joseph , Brady Kerianne , Hensler Julie G. , Johnson Don
Published: May 2020

Objective

We compared the efficacy of tibial intraosseous (TIO) administration of epinephrine in a pediatric normovolemic versus hypovolemic cardiac arrest model to determine the incidence of return of spontaneous circulation (ROSC) and plasma epinephrine concentrations over time.

Methods

This experimental study evaluated the pharmacokinetics of epinephrine and/or incidence of ROSC after TIO administration in either a normovolemic or hypovolemic pediatric swine model.

Results

All subjects in the TIO normovolemia cardiac arrest group experienced ROSC after TIO administration of epinephrine. In contrast, subjects experiencing hypovolemia and cardiac arrest were significantly less likely to experience ROSC when epinephrine was administered TIO versus intravenous (TIO hypovolemia: 14% [1/7] vs IV hypovolemia: 71% [5/7]; P = 0.031). The TIO hypovolemia group exhibited significantly lower plasma epinephrine concentrations versus IV hypovolemia at 60, 90, 120, and 150 seconds (P < 0.05). Although the maximum concentration of plasma epinephrine was similar, the TIO hypovolemia group exhibited significantly slower time to maximum concentration times versus TIO normovolemia subjects (P = 0.004).

Conclusions

Tibial intraosseous administration of epinephrine reliably facilitated ROSC among normovolemic cardiac arrest pediatric patients, which is consistent with published reports. However, TIO administration of epinephrine was ineffective in restoring ROSC among subjects experiencing hypovolemia and cardiac arrest. Tibial intraosseous–administered epinephrine during hypovolemia and cardiac arrest may have resulted in a potential sequestration of epinephrine in the tibia. Central or peripheral intravascular access attempts should not be abandoned after successful TIO placement in the resuscitation of patients experiencing concurrent hypovolemia and cardiac arrest.