bluuebunny/crossref_metadata_2025 huggingface dataset:
Unique lignin modifications pattern the nucleation of silica in sorghum endodermis
Authors: Zexer Nerya , Elbaum Rivka
Published: March 2020

Silicon dioxide in the form of hydrated silica is a component of plant tissues that can constitute several percent by dry weight in certain taxa. Nonetheless, the mechanism of plant silica formation is mostly unknown. Silicon (Si) is taken up from the soil by roots in the form of monosilicic acid molecules. The silicic acid is carried in the xylem and subsequently polymerizes in target sites to silica. In roots of sorghum (Sorghum bicolor), silica aggregates form in an orderly pattern along the inner tangential cell walls of endodermis cells. Using Raman microspectroscopy, autofluorescence, and scanning electron microscopy, we investigated the structure and composition of developing aggregates in roots of sorghum seedlings. Putative silica aggregation loci were identified in roots grown under Si starvation. These micrometer-scale spots were constructed of tightly packed modified lignin, and nucleated trace concentrations of silicic acid. Substantial variation in cell wall autofluorescence between Si+ and Si– roots demonstrated the impact of Si on cell wall chemistry. We propose that in Si– roots, the modified lignin cross-linked into the cell wall and lost its ability to nucleate silica. In Si+ roots, silica polymerized on the modified lignin and altered its structure. Our work demonstrates a high degree of control over lignin and silica deposition in cell walls.
Against Person Essentialism
Authors: Olson* Eric T , Witt Karsten
Published: March 2020

It is widely held that every person is a person essentially, where being a person is having special mental properties such as intelligence and self-consciousness. It follows that nothing can acquire or lose these properties. The paper argues that this rules out all familiar psychological-continuity views of personal identity over time. It also faces grave difficulties in accounting for the mental powers of human beings who are not intelligent and self-conscious, such as foetuses and those with dementia.
DIRS retrotransposons amplify via linear, single-stranded cDNA intermediates
Authors: Malicki Marek , Spaller Thomas , Winckler Thomas , Hammann Christian
Published: March 2020

The Dictyostelium Intermediate Repeat Sequence 1 (DIRS-1) is the name-giving member of the DIRS order of tyrosine recombinase retrotransposons. In Dictyostelium discoideum, DIRS-1 is highly amplified and enriched in heterochromatic centromers of the D. discoideum genome. We show here that DIRS-1 it tightly controlled by the D. discoideum RNA interference machinery and is only mobilized in mutants lacking either the RNA dependent RNA polymerase RrpC or the Argonaute protein AgnA. DIRS retrotransposons contain an internal complementary region (ICR) that is thought to be required to reconstitute a full-length element from incomplete RNA transcripts. Using different versions of D. discoideum DIRS-1 equipped with retrotransposition marker genes, we show experimentally that the ICR is in fact essential to complete retrotransposition. We further show that DIRS-1 produces a mixture of single-stranded, mostly linear extrachromosomal cDNA intermediates. If this cDNA is isolated and transformed into D. discoideum cells, it can be used by DIRS-1 proteins to complete productive retrotransposition. This work provides the first experimental evidence to propose a general retrotransposition mechanism of the class of DIRS like tyrosine recombinase retrotransposons.
Enhanced affinity of racemic phosphorothioate DNA with transcription factor SATB1 arising from diastereomer-specific hydrogen bonds and hydrophobic contacts
Authors: Yamasaki Kazuhiko , Akutsu Yukie , Yamasaki Tomoko , Miyagishi Makoto , Kubota Tomomi
Published: March 2020

Phosphorothioate modification is commonly introduced into therapeutic oligonucleotides, typically as a racemic mixture in which either of the two non-bridging phosphate oxygens is replaced by sulfur, which frequently increases affinities with proteins. Here, we used isothermal titration calorimetry and X-ray crystallography to investigate the thermodynamic and structural properties of the interaction between the primary DNA-binding domain (CUTr1) of transcription factor SATB1 and dodecamer DNAs with racemic phosphorothioate modifications at the six sites known to contact CUTr1 directly. For both the modified and unmodified DNAs, the binding reactions were enthalpy-driven at a moderate salt concentration (50 mM NaCl), while being entropy-driven at higher salt concentrations with reduced affinities. The phosphorothioate modifications lowered this susceptibility to salt, resulting in a significantly enhanced affinity at a higher salt concentration (200 mM NaCl), although only some DNA molecular species remained interacting with CUTr1. This was explained by unequal populations of the two diastereomers in the crystal structure of the complex of CUTr1 and the phosphorothioate-modified DNA. The preferred diastereomer formed more hydrogen bonds with the oxygen atoms and/or more hydrophobic contacts with the sulfur atoms than the other, revealing the origins of the enhanced affinity.
Chromatin Architectures Are Associated with Response to Dark Treatment in the Oil Crop Sesamum indicum, Based on a High-Quality Genome Assembly
Authors: Li Chaoqiong , Li Xiaoli , Liu Hongzhan , Wang Xueqin , Li Weifeng , Chen Mao-Sheng , Niu Long-Jian
Published: March 2020

Eukaryotic chromatin is tightly packed into hierarchical structures, allowing appropriate gene transcription in response to environmental and developmental cues. Here, we provide a chromosome-scale de novo genome assembly of sesame with a total length of 292.3 Mb and a scaffold N50 of 20.5 Mb, containing estimated 28,406 coding genes using Pacific Biosciences long reads combined with a genome-wide chromosome conformation capture (Hi-C) approach. Based on this high-quality reference genome, we detected changes in chromatin architectures between normal growth and dark-treated sesame seedlings. Gene expression level was significantly higher in ‘A’ compartment and topologically associated domain (TAD) boundary regions than in ‘B’ compartment and TAD interior regions, which is coincident with the enrichment of H4K3me3 modification in these regions. Moreover, differentially expressed genes (DEGs) induced by dark treated were enriched in the changed TAD-related regions and genomic differential contact regions. Gene Ontology (GO) enrichment analysis of DEGs showed that genes related to ‘response to stress’ and ‘photosynthesis’ functional categories were enriched, which corresponds to dark treatment. These results suggested that chromatin organization is associated with gene transcription in response to dark treatment in sesame. Our results will facilitate the understanding of regulatory mechanisms in response to environmental cues in plants.
The Regenerative Potential of Therapeutic Ultrasound on Neural Tissue: A Pragmatic Review
Authors: Haffey Paul Ryan , Bansal Nitin , Kaye Elena , Ottestad Einar , Aiyer Rohit , Noori Selaiman , Gulati Amitabh
Published: March 2020

Objectives

Low-intensity ultrasound (LIU)/low-intensity pulsed ultrasound (LIPUS) may influence nerve tissue regeneration and axonal changes in the context of carpal tunnel syndrome (CTS) and in the animal model. The purpose of this pragmatic review is to understand the current knowledge for the effects of low-intensity therapeutic ultrasound in the animal and human model and determine the future directions of this novel field.

Design

Pragmatic review.

Methods

We performed a literature search of available material using OVID, EmBase, and PubMed for LIU/LIPUS, all of which were preclinical trials, case reports, and case series using animal models. For CTS, a literature search was performed on PubMed (1954 to 2019), CENTRAL (the Cochrane Library, 1970 to 2018), Web of Science (1954 to 2019), and SCOPUS (1954 to 2019) to retrieve randomized controlled trials.

Results

Eight articles were discussed showing the potential effects of LIU on nerve regeneration in the animal model. Each of these trials demonstrated evidence of nerve regeneration in the animal model using LIPUS or LIU. Seven randomized controlled trials were reviewed for ultrasound effects for the treatment of carpal tunnel syndrome, each showing clinical efficacy comparable to other treatment modalities.

Conclusions

LIU/LIPUS is a promising and noninvasive means of facilitating nerve regeneration in the animal model and in the treatment of carpal tunnel syndrome. Although many of the trials included in this review are preclinical, each demonstrates promising outcomes that could eventually be extrapolated into human studies.
Safe Collateral, Arm’s-Length Credit: Evidence from the Commercial Real Estate Market
Authors: Black Lamont K , Krainer John R , Nichols Joseph B
Published: March 2020

Two main creditors exist in commercial real estate: arm’s-length investors and banks. We model commercial mortgage-backed securities (CMBS) as the less informed source of credit. In equilibrium, these investors fund properties with a low probability of distress, and banks fund properties that may require renegotiation. As a natural experiment, we test the model using the collapse of the CMBS market during 2007–2009, when banks funded both collateral types. Our results show that properties likely to have been securitized were less likely to default or be renegotiated. This suggests that securitization in this market funds safe collateral.
Sustained efficacy of a concise self-management programme for hands in systemic sclerosis: a longitudinal case–control observational study
Authors: F. Landim Sibila , B. Bertolo Manoel , Del Rio Ana Paula , Sachetto Zoraida , Zonzini Gaino Juliana , L. Poole Janet , de P. Magalhães Eduardo
Published: March 2020

Objectives

In a longitudinal case–control observational study, we evaluated the benefits of a self-management programme for hands developed for patients with SSc.

Methods

Patients with SSc included in the intervention group (IG) received a concise self-management programme with emphasis on hand exercises and were evaluated during 24 weeks regarding hand pain, hand function, range of motion, grip and tip and key pinch strength. Results were compared with a control group (CG) with no intervention using an analysis of variance for repeated measures with variables transformed into ranks (P ≤ 0.05). Effect sizes were calculated using Cohen’s test.

Results

Of 90 patients who were evaluated, seven were excluded at enrolment and 26 were excluded during the follow-up. Data from 57 subjects (IG 40, CG 17) were used for analysis. Groups were similar at baseline, except for the Scleroderma HAQ and tip and key pinch strength. Outcome improvements were noted only in the IG (P ≤ 0.05, large effect size). In the CG, variables did not change or had even worsened (hand grip strength and finger motion).

Conclusions

This self-management programme based on hand exercises for SSc resulted in pain reduction and hand function, strength and range of motion improvement. It can be a simple and useful intervention, especially when a regular rehabilitation programme is not available.
Preserved specific anti-viral T-cell response but associated with decreased lupus activity in SLE patients with cytomegalovirus infection
Authors: Wu Chien-Sheng , Chyuan I-Tsu , Chiu Yen-Ling , Chen Wen-Lin , Shen Chieh-Yu , Hsu Ping-Ning
Published: March 2020

Objectives

SLE is an autoimmune disease characterized by aberrant autoantibody production and immune dysfunctions. Whether the anti-CMV immunity is impaired in SLE patients is poorly understood. We investigated the specific anti-viral T-cell response in SLE patients with CMV infection and its possible impacts on clinical manifestations in lupus.

Methods

CD28 null T-cell percentages were measured by flow cytometry in 89 SLE patients and 58 healthy controls. A specific anti-CMV CD8 T-cell response was assessed ex vivo by the production of intracellular cytokines in response to CMV phosphoprotein 65 (pp65) by flow cytometry. Clinical manifestations and immune parameters were analysed in SLE patients according to their CMV serostatus.

Results

CD28 null T cells were significantly expanded in SLE patients. When the anti-CMV pp65 CD8 polyfunctional T cell response was analysed, as defined by production of at least three of four functional cytokines or effectors (intracellular IFN-γ, IL-2, TNF-α and surface CD107a), the results demonstrated that it was not impaired in SLE patients. In contrast, when comparing clinical manifestations, there were lower anti-ds-DNA levels and decreased SLEDAI in SLE patients with CMV infection. Furthermore, the expansion of CD4+CD28 null T cells was negatively associated with anti-ds-DNA levels and SLEDAI in these lupus patients.

Conclusion

In SLE patients with CMV infection, the specific anti-CMV CD8 T-cell response is preserved but is associated with decreased disease activity and lower anti-DNA levels among these patients, suggesting CMV infection may mitigate lupus activity.
Self-efficacy Mediates Perceived Benefits and Barriers of Adherence of Heroin-dependent Patients to Methadone for Addiction Treatment: A Health Belief Model Study
Authors: Yu Bin , Zhou Junmin , Gong Yi , Han Jiayu , Dong Peijie , Yang Shifan , Liao Rui , Guan Pujun , Yang Shujuan
Published: March 2020

Objective:

Although methadone for addiction treatment (MAT) has been widely used in China, the low adherence rate in MAT clinics poses a great challenge. We aimed to investigate the factors related to the adherence of heroin-dependent patients to MAT based on the Health Belief Model (HBM) in Sichuan, China.

Methods:

A cross-sectional structured interview was conducted between August and November 2018. Stratified multi-stage sampling was carried out. A total of 581 participants were enrolled from 5 clinics and completed the face-to-face structured interview. Univariate, adjusted logistic regression, multivariate logistic regression analysis and the structural equation modeling (SEM) were employed to explore the association between constructs of HBM and adherence to MAT among heroin-dependent patients.

Results:

The adherence rate of MAT was 79.3% in the past 6 months. Among all constructs of HBM, self-efficacy (AOR: 1.16, 95% CI: 1.10, 1.22), perceived benefits (AOR: 1.05, 95% CI: 1.00, 1.10) and perceived barriers (AOR: 0.87, 95% CI: 0.77, 0.98) were associated with adherence to MAT. Self-efficacy was directly associated with adherence to MAT (β = 0.347, P < 0.05). Perceive benefits (β = 0.276, P < 0.01) and perceived barriers (β = –0.241, P < 0.05) were directly associated with self-efficacy. However, perceived benefits (β = 0.096, P < 0.01) and perceived barriers (β = –0.084, P < 0.01) were only indirectly associated with adherence to MAT.

Conclusion:

The adherence of heroin-dependent patients to MAT can be explained by self-efficacy, perceived benefits and barriers. Self-efficacy plays a significant role as a mediating variable. Future interventions should be considered to improve patients’ self-efficacy to MAT.
Addressing Missing Data in Substance Use Research: A Review and Data Justice-based Approach
Authors: King Caroline , Englander Honora , Priest Kelsey C. , Korthuis P. Todd , McPherson Sterling
Published: March 2020

Missing data in substance use disorder (SUD) research can pose a challenge as researchers attempt to publish reliable findings based on the limited available information. Tools to address missing data exist, but are underused and may not address all types of missingness. Missing data are more than a statistical problem: for underserved populations and people with SUDs who may have missing data for a myriad of reasons, missing data represents missing stories and information that can have real-world impacts on system and policy-level decision making. This paper reviews types of missing data and, through a data justice lens, asserts the importance of the increased use and development of statistical tools to handle missing data in SUD research.
Greater Attention Paid to the Patient's Experience Could Improve the Treatment of Individuals With Opioid Use Disorder Hospitalized for Serious Infections
Authors: Suzuki Joji
Published: March 2020

There is a growing recognition for the need to improve the treatment of individuals with opioid use disorder who are hospitalized for serious infections such as infective endocarditis. Unfortunately, patients face enormous hurdles not only in coping with the life-threatening medical illness, but also in maintaining their recovery and engagement with treatment due in part to the difficulties navigating the fragmented addiction treatment system. The journey mapping research presented by Bearnot and Mitton is a novel approach that has the potential to improve our understanding of the challenges faced by patients. Given the severe health consequences that can result from these infections, more research is clearly needed to improve the treatment we currently provide. The journey mapping approach appears to be a useful method of incorporating the patient voice in order to improve our understanding of their experience, but also help identify how we can provide treatments that are acceptable and preferred by patients.
The Effect of Pulse Polarity on Neural Response of the Electrically Stimulated Cochlear Nerve in Children With Cochlear Nerve Deficiency and Children With Normal-Sized Cochlear Nerves
Authors: Xu Lei , Skidmore Jeffrey , Luo Jianfen , Chao Xiuhua , Wang Ruijie , Wang Haibo , He Shuman
Published: March 2020

Objective:

This study aimed to (1) investigate the effect of pulse polarity on neural response of the electrically stimulated cochlear nerve in children with cochlear nerve deficiency (CND) and children with normal-sized cochlear nerves and (2) compare the size of the pulse polarity effect between these two subject groups.

Design:

The experimental and control group included 31 children with CND and 31 children with normal-sized cochlear nerves, respectively. For each study participant, evoked compound action potential (eCAP) input/output (I/O) functions for anodic-leading and cathodic-leading biphasic stimuli were measured at three electrode locations across the electrode array. The dependent variables of interest included the eCAP amplitude measured at the maximum comfortable level of the anodic stimulus, the lowest level that could evoke an eCAP (i.e., the eCAP threshold), the slope of the eCAP I/O function estimated based on linear regression, the negative-peak (i.e., N1) latency of the eCAP, as well as the size of the pulse polarity effect on these eCAP measurements. Generalized linear mixed effect models were used to compare the eCAP amplitude, the eCAP threshold, the slope of the eCAP I/O function, and the N1 latency evoked by the anodic-leading stimulus with those measured for the cathodic-leading stimulus for children with CND and children with normal-sized cochlear nerves. Generalized linear mixed effect models were also used to compare the size of the pulse polarity effect on the eCAP between these two study groups. The one-tailed Spearman correlation test was used to assess the potential correlation between the pulse phase duration and the difference in N1 latency measured for different pulse polarities.

Results:

Compared with children who had normal-sized cochlear nerves, children with CND had reduced eCAP amplitudes, elevated eCAP thresholds, flatter eCAP I/O functions, and prolonged N1 latencies. The anodic-leading stimulus led to higher eCAP amplitudes, lower eCAP thresholds, and shorter N1 latencies than the cathodic-leading stimulus in both study groups. Steeper eCAP I/O functions were recorded for the anodic-leading stimulus than those measured for the cathodic-leading stimulus in children with CND, but not in children with normal-sized cochlear nerves. Group differences in the size of the pulse polarity effect on the eCAP amplitude, the eCAP threshold, or the N1 latency were not statistically significant.

Conclusions:

Similar to the normal-sized cochlear nerve, the hypoplastic cochlear nerve is more sensitive to the anodic-leading than to the cathodic-leading stimulus. Results of this study do not provide sufficient evidence for proving the idea that the pulse polarity effect can provide an indication for local neural health.
Benefits and promotion of physical activity in rheumatoid arthritis
Authors: Katz Patricia , Andonian Brian J. , Huffman Kim M.
Published: March 2020

Purpose of review

The aim of this article is to describe the benefits of physical activity and exercise on rheumatoid arthritis disease activity, functioning, and symptoms; and offer recommendations for promotion of physical activity and exercise among people with rheumatoid arthritis.

Recent findings

In addition to well-known benefits of exercise such as improving cardiovascular health and metabolic syndrome and reducing obesity, exercise has consistently shown rheumatoid arthritis-specific benefits. Exercise and increases in physical activity improve clinically measured disease activity, reduce symptoms such as fatigue and pain, and improve function and mental health. In spite of these benefits, most people with rheumatoid arthritis are inactive. Patient barriers to engaging in physical activity may include fears of joint damage, rheumatoid arthritis symptoms, and lack of understanding that physical activity improves the symptoms that may be barriers. However, the greatest barrier to healthy levels of physical activity among individuals with rheumatoid arthritis appears to be the lack of direction from healthcare providers.

Exercise is safe and highly beneficial for people with rheumatoid arthritis. Because receiving recommendations from healthcare providers may be the factor most strongly associated with engaging in physical activity or exercise, providers are encouraged to give patients positive messages about the benefits of physical activity and the extremely low risks of harm.
Inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis
Authors: Prisco Lauren C. , Martin Lily W. , Sparks Jeffrey A.
Published: March 2020

Purpose of review

The current review summarizes the current evidence on inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis (RA).

Recent findings

Personal cigarette smoking has been implicated as an environmental risk factor for seropositive RA, perhaps by inducing autoimmunity at pulmonary mucosa. Since many patients with RA are nonsmokers, other inhalants are being investigated as potential RA risk factors. Recent case–control and cohort studies have investigated passive cigarette smoking, air pollution, inhalant-related occupations, silica, pesticides, household environment, and allergic inhalants as inhalant exposures for RA risk. Inhalant-related occupations and silica inhalants have the most consistent evidence for associations with increased RA risk. However, most studies relied on retrospective designs and had limited ability to adjust for personal cigarette smoking or investigate associations among nonsmokers.

Several inhalants other than personal cigarette smoking may be associated with increased risk for developing RA. These results support the hypothesis that inhalants, pulmonary mucosal inflammation, and RA pathogenesis may be linked. Future studies are needed to firmly establish the independence of these findings from personal cigarette smoking and to determine the specific inhalants and biologic mechanisms related to RA pathogenesis.
Old Friend or New Ally: A Comparison of Follicular Unit Transplantation and Follicular Unit Excision Methods in Hair Transplantation
Authors: Gupta Aditya K. , Love Robin P. , Harris James A.
Published: March 2020

BACKGROUND

Follicular unit excision (FUE) and follicular unit transplantation using strip surgery (FUT) are the dominant graft harvest methods in hair transplantation. The increase in the demand for FUE has reignited the debate of the relative superiority of the 2 methods.

OBJECTIVE

To present a critical comparison of FUE and FUT graft harvesting techniques.

MATERIALS AND METHODS

Search of PubMed, trade publications, and printed references.

RESULTS

Follicular unit excision and FUT methods provide high-quality grafts, but differ in their scarring patterns of the donor region. Follicular unit transplantation results in a linear scar, whereas FUE produces punctate scars that are typically easily concealed. Distinct subgroups of hair transplant patients are eligible for FUE, FUT, or both procedures.

CONLCUSION

Both FUE and FUT are equally effective in generating high-quality grafts. This detailed evaluation of the FUT and FUE procedures will assist hair restoration surgeons make informed decisions about the best approach for their patients.
Robust Metrics and Sensitivity Analyses for Meta-analyses of Heterogeneous Effects
Authors: Mathur Maya B. , VanderWeele Tyler J.
Published: March 2020

We recently suggested new statistical metrics for routine reporting in random-effects meta-analyses to convey evidence strength for scientifically meaningful effects under effect heterogeneity. First, given a chosen threshold of meaningful effect size, we suggested reporting the estimated proportion of true population effect sizes above this threshold. Second, we suggested reporting the proportion of effect sizes below a second, possibly symmetric, threshold in the opposite direction from the estimated mean. Our previous methods applied when the true population effects are approximately normal, when the number of studies is relatively large, and when the proportion is between approximately 0.15 and 0.85. Here, we additionally describe robust methods for point estimation and inference that perform well under considerably more general conditions, as we validate in an extensive simulation study. The methods are implemented in the R package MetaUtility (function prop_stronger). We describe application of the robust methods to conducting sensitivity analyses for unmeasured confounding in meta-analyses.
The impact of peri-operative intravenous lidocaine on postoperative outcome after elective colorectal surgery
Authors: Rollins Katie E. , Javanmard-Emamghissi Hannah , Scott Michael J. , Lobo Dileep N.
Published: March 2020

BACKGROUND

There has recently been increasing interest in the use of peri-operative intravenous lidocaine (IVL) due to its analgesic, anti-inflammatory and opioid-sparing effects. However, these potential benefits are not well established in elective colorectal surgery.

OBJECTIVES

To examine the effect of peri-operative IVL infusion on postoperative outcome in patients undergoing elective colorectal surgery.

DESIGN

A meta-analysis of randomised controlled trials (RCTs) comparing peri-operative IVL with placebo infusion in elective colorectal surgery. The primary outcome measure was postoperative pain scores up to 48 h. The secondary outcome measures included time to return of gastrointestinal function, postoperative morphine requirement, anastomotic leak, local anaesthetic toxicity and hospital length of stay.

DATA SOURCES

PubMed, Scopus and the Cochrane Library databases were searched on 5 November 2018.

ELIGIBILITY CRITERIA

Studies were included if they were RCTs evaluating the role of peri-operative IVL vs. placebo in adult patients undergoing elective colorectal surgery. Exclusion criteria were paediatric patients, noncolorectal or emergency procedures, non-RCT methodology or lack of relevant outcome measures.

RESULTS

A total of 10 studies were included (n = 508 patients; 265 who had undergone IVL infusion, 243 who had undergone placebo infusion). IVL infusion was associated with a significant reduction in time to defecation (mean difference −12.06 h, 95% CI −17.83 to −6.29, I
2 = 93%, P = 0.0001), hospital length of stay (mean difference −0.76 days, 95% CI −1.32 to −0.19, I
2 = 45%, P = 0.009) and postoperative pain scores at early time points, although this difference does not meet the threshold for a clinically relevant difference. There was no difference in time to pass flatus (mean difference −5.33 h, 95% CI −11.53 to 0.88, I
2 = 90%, P = 0.09), nor in rates of surgical site infection or anastomotic leakage.

CONCLUSION

This meta-analysis provides some support for the administration of peri-operative IVL infusion in elective colorectal surgery. However, further evidence is necessary to fully elucidate its potential benefits in light of the high levels of study heterogeneity and mixed quality of methodology.
Nitrate Esters Alleviated Coronary Atherosclerosis Through Inhibition of NF-κB–Regulated Macrophage Polarization Shift in Epicardial Adipose Tissue
Authors: Wei Chun-Yan , Wang Yong-Mei , Han Lu , Chen Fang-Fang , Li Yi-Hui , Tang Meng-Xiong , Zhang Wei , Wang Zhi-Hao , Zhong Ming
Published: March 2020

Nitrate esters have been used in clinical practice for more than one century for the treatment of angina. Their clinical effectiveness is due to vasodilator activity in arteries through a method of delivering nitric oxide or a nitric oxide–like compound. Recently, an increasing numbers of functions of this molecule in biology and pathophysiology have been discovered. Macrophage polarization shift in epicardial adipose tissue (EAT) has been demonstrated to be correlated with the severity of coronary artery disease (CAD). In this study, we aimed to investigate whether nitrate esters could improve coronary atherosclerosis through inhibition of macrophage polarization shift in EAT. A case–control study enrolled 48 subjects in 2 groups: CAD patients with or without nitrate esters treatment. Infiltration of M1/M2 macrophages and the expressions of pro-inflammatory and anti-inflammatory cytokines in EAT and subcutaneous white adipose tissue were investigated by immunohistochemical stain among subjects undergoing coronary artery bypass graft surgery. The expression levels of metabolic genes were investigated by real-time reverse transcription-polymerase chain reaction (RT-PCR). We found that nitrate ester treatment significantly inhibited NF-кB activity and decreased macrophage infiltration and M1/M2 macrophage ratio in EAT in patients with CAD. The expressions of pro-inflammatory cytokines were significantly decreased, along with significantly elevated expressions of anti-inflammatory cytokines in CAD patients with nitrate ester treatment, corresponding EAT dysfunction was ameliorated and the severity of patients with CAD (Gensini score) was significantly decreased. The protective effects on macrophage polarization and EAT function through NF-кB activity inhibition suggested a potential mechanism of nitrate esters in alleviating the severity of CAD.
Consecutive hyperopia after myopic laser in situ keratomileusis: March consultation #1
Authors: Nuijts Rudy M.M.A. , Kartal Serdar
Published: March 2020

A 31-year-old woman was seen at our clinic with dissatisfying hyperopic error after a myopic laser treatment of her left eye in April 2018. The surgery took place 1 year previously. There were no abnormalities in her medical history.

The preoperative corrected distance visual acuity (CDVA) in the left eye was 20/16 with −7.50 −0.50 × 75. The refraction in the right eye was −3.50 −1.25 × 90. The cycloplegic correction of the left eye preoperatively was −6.50 −0.50 × 68. A femtosecond-assisted laser in situ keratomileusis procedure was performed with an optical zone of 6.3 mm, an ablation zone of 7.97 mm, and a maximum ablation depth of 121 μm. The laser was set at a correction of −7.50 −0.5 × 75. The temperature and humidity during the laser treatment were 20 degrees and 47%, respectively. Figure 1 shows the excimer laser treatment data (AMARIS 750, SCHWIND eye-tech-solutions).

At 1 week postoperatively the uncorrected distance visual acuity (UDVA) was 20/25, and at 1 month postoperatively the CDVA was 20/16 with +2.50. Slitlamp examination showed a clear cornea. No corneal topography was made at that timepoint. At referral 7 months later, the patient's UDVA was 20/100 and CDVA was 20/16 with +2.50 −1.25 × 140 in the left eye. The patient reports decreased vision since the treatment in 2018 and wants to see better without spectacles.

Figure 2 shows the postoperative Scheimpflug topography of the left eye, flat keratometry (K1) 36.1 @ 178.4 and steep keratometry (K2) 36.6 @ 88.4. What do you believe could be the cause of this overcorrection? What is your advice in terms of correction of the refractive error for this patient?
Child and Family Perspectives on Adjustment to and Coping With Pediatric Inflammatory Bowel Disease
Authors: Easterlin Molly C. , Berdahl Carl T. , Rabizadeh Shervin , Spiegel Brennan , Agoratus Lauren , Hoover Clarissa , Dudovitz Rebecca
Published: March 2020

Objectives:

Children with inflammatory bowel disease (IBD) are at increased risk for poor mental health. The etiology of this risk is not clear, though may be related to the disease, its treatment, and/or the experience of these. We sought to describe the challenges that children with IBD and their families face in living with a chronic condition and undergoing repeated intravenous infusions; and identify coping mechanisms to understand how medical systems may support resilience.

Methods:

Semistructured qualitative interviews with 18 patient‐guardian dyads at a tertiary outpatient infusion center, explored feelings related to IBD, the infusion process, and coping. Interviews were recorded, transcribed, and analyzed in ATLAS.ti. Two coders identified themes; developed a codebook and coded transcripts using the constant comparative method; and described themes/patterns.

Results:

Participants identified challenges related to IBD (unpredictable nature, disrupted normalcy, treatment decisions, managing relationships, life transitions) and a subset of challenges related to the infusion procedure (anxiety of unknown, managing pain/anxiety during IV placement, logistics). Participants coped through social support, cognitive strategies (positive attitude) and/or behavioral strategies for managing emotions (preparation for intravenous [IV] placement), and confidence in the medical care. By employing these coping strategies, participants came to accept IBD, adapt to the “new norm,” and learned life lessons and resilience.

Conclusions:

To support coping, clinical teams might provide anticipatory guidance to decrease anxiety of the unknown and identify cognitive‐behavioral strategies for managing emotions. Delivery systems that build relationships, maintain normalcy, and consider needs of the family may further facilitate coping.
Providing Early Attending Physician Expertise via Telemedicine to Improve Rapid Response Team Evaluations*
Authors: Fiero Marie L. , Rosenblatt Samuel , Zhang Bingqing , Snyder Megan , Priestley Margaret A. , Chuo John , Fuller Kate , Mensinger Janell , Bonafide Christopher P. , Sutton Robert M.
Published: March 2020

Objectives:

To evaluate the effect of providing early attending physician involvement via telemedicine to improve the decision process of rapid response teams.

Design:

Quasi-experimental; three pairs of control/intervention months: June/July; August/October; November/December.

Setting:

Single-center, urban, quaternary academic children’s hospital with three-member rapid response team: critical care fellow or nurse practitioner, nurse, respiratory therapist. Baseline practice: rapid response team leader reviewed each evaluation with an ICU attending physician within 2 hours after return to ICU.

Subjects:

1) Patients evaluated by rapid response team, 2) rapid response team members.

Interventions:

Implementation of a smartphone-based telemedicine platform to facilitate early co-assessment and disposition planning between the rapid response team at the patient’s bedside and the attending in the ICU.

Measurements and Main Results:

As a marker of efficiency, the primary provider outcome was time the rapid response team spent per patient encounter outside the ICU prior to disposition determination. The primary patient outcome was percentage of patients requiring intubation or vasopressors within 60 minutes of ICU transfer. There were three pairs of intervention/removal months. In the first 2 pairs, the intervention was associated with the rapid response team spending less time on rapid response team calls (June/July: point estimate –5.24 min per call; p < 0.01; August/October: point estimate –3.34 min per call; p < 0.01). During the first of the three pairs, patients were significantly less likely to require intubation or vasopressors within 60 minutes of ICU transfer (adjusted odds ratio, 0.66; 95 CI, 0.51–0.84; p < 0.01).

Conclusions:

Early in the study, more rapid ICU attending involvement via telemedicine was associated with rapid response team providers spending less time outside the ICU, and among patients transferred to the ICU, a significant decrease in likelihood of patients requiring vasopressors or intubation within the first 60 minutes of transfer. These findings provide evidence that early ICU attending involvement via telemedicine can improve efficiency of rapid response team evaluations.
Superonasal Transconjunctival Optic Nerve Sheath Decompression: A Simplified Technique for Safe and Efficient Decompression
Authors: Melson Andrew T. , Warmath Jacob D. , Moreau Annie , Farris Bradley K.
Published: March 2020

Background:

Severe, permanent vision loss is a feared sequela of untreated or refractory idiopathic intracranial hypertension (IIH). For patients with progressive vision loss despite maximally tolerated medical treatment, optic nerve sheath decompression (ONSD) remains a viable and effective option to protect vision. Our objective is to introduce a modified transconjunctival technique for ONSD and determine its safety, efficacy, and efficiency in patients with IIH.

Methods:

We performed analyses for a retrospective case series of consecutive patients with IIH by modified dandy criteria who underwent isolated superonasal transconjunctival optic nerve sheath decompression (stOND) at single eye institute in a large academic center from January 2013 to February 2017. Sixty-six patients were identified who met these criteria with at least 6 weeks of follow-up data. Primary outcome measures were visual field mean deviation, grading of papilledema by the modified Frisen scale, and best-corrected visual acuity. Secondary outcome measures were presence of postoperative diplopia and operative time.

Results:

One hundred thirty-two eyes of 66 patients were identified; 58 were female (88%), and 8 were male (12%). The mean age was 30 years (range 13–55) with an average lumbar puncture opening pressure of 38 cm H2O. Participants mean body mass index was 36 (range 20–59) with Grade 3 papilledema on average by the modified Frisen scale. No patients experienced operative complications, postoperative diplopia, or worse visual acuity at 1 week after surgery. Average operative time was 50 minutes (range: 25–89). The median decrease in papilledema grading was 3 grades on the Frisen scale (95% confidence interval [CI], 2–3, P < 0.0001). Snellen visual acuity changes did not meet statistical significance. The average Humphrey Visual Field mean deviation change was +1.91 (95% CI, 0.58–3.24, P = 0.0052). Despite successful bilateral decompressions, 4 patients (6.1%) progressed in their visual loss.

Conclusions:

The superonasal transconjunctival approach to ONSD is a safe, efficient and effective surgical treatment for patients with deteriorating visual function due to IIH. Although additional study is required to further clarify the best timing and indications for ONSD among other treatment options for refractory IIH, providers should be aware of the reduced complication rates and efficacy of the stOND technique.
Enhancing Stroke Recovery Across the Life Span With Noninvasive Neurostimulation
Authors: Dukelow Sean , Kirton Adam
Published: March 2020

Stroke is the leading cause of neurologic disability not only in adults but perinatal and childhood stroke affect millions of children as well worldwide with deficits that last a lifetime. The rapidly increasing evidence base for how noninvasive neuromodulation may enhance stroke recovery in adults may be applicable to the youngest stroke survivors. In return, how the plasticity of the developing brain contributes to stroke recovery and its modulation may provide equally valuable insight toward mechanisms and opportunities for enhancing recovery in all stroke patients. Despite this synergistic relationship, examinations of stroke recovery and neuromodulation across the life span have rarely been considered. Here, we attempt to amalgamate the worlds of adult, childhood, and perinatal stroke to explore the differences and commonalities between the models and approaches that are driving advances in noninvasive neuromodulation toward better outcomes for stroke patients of all ages.
Safety and Tolerability of Repetitive Transcranial Magnetic Stimulation During Pregnancy: A Case Report and Literature Review
Authors: Damar Ugur , Lee Kaye Harper , Smith Nicole A. , Pennell Page B. , Rotenberg Alexander
Published: March 2020

Patients with neuropsychiatric disease may benefit from repetitive transcranial magnetic stimulation as a nonpharmacologic alternative to relieve symptoms of major depression, obsessive compulsive disorder, and perhaps other syndromes such as epilepsy. We present a case of repetitive transcranial magnetic stimulation treatment as an adjunct therapy for a patient experiencing refractory epileptic seizures during the third trimester of pregnancy. Notably, the patient tolerated repetitive transcranial magnetic stimulation well, without adverse events, and delivered a healthy child. We also summarize the current literature pertaining to therapeutic repetitive transcranial magnetic stimulation use during pregnancy.
Neurophysiological Intraoperative Monitoring in the Elderly
Authors: De la Maza Krzeptowsky Lilia C. , San-Juan Daniel , Ximénez Camilli Cecilia , Alvarez Perera Luis Á. , Valdez Ruvalcaba Hector , Morales Báez Jorge A. , Anschel David J.
Published: March 2020

Introduction:

Intraoperative neurophysiological monitoring (IONM) is widely used to prevent nervous system injury during surgeries in elderly patients. However, there are no studies that describe the characteristics and changes in neurophysiological tests during the IONM of patients aged 60 years and older. The study aims to describe and compare IONM changes during surgeries in adult patients aged 18 to 59 years with those aged 60 years and older.

Methods:

We performed a comparative retrospective study of patients aged 18 to 59 years versus those 60 aged years and older who underwent IONM during 2013 to 2018 in Mexico City. Sociodemographic characteristics were recorded and compared. Intraoperative neurophysiological monitoring techniques, their changes, and surgical procedures for both groups were analyzed and compared using descriptive statistics, Mann–Whitney U, Fisher, and χ2 tests. The sensitivity, specificity, and positive and negative predictive values were calculated.

Results:

In total, 195 patients were analyzed: 104 patients, 68.63 ± 6.54 years old (elderly group) and 91 patients, 42.3 ± 10.5 years old (younger group). No differences were found in the rates of signal change during IONM between the group of elderly patients and the younger group. The sensitivity, specificity, and positive and negative predictive values were 80%, 99%, 80%, and 99%, respectively.

Conclusions:

Elderly patients have a similar rate of changes in IONM signals compared with younger patients during heterogeneous surgeries guided by IONM.
Intrarater and Interrater Reliability of Heckmatt Scoring System in Amyotrophic Lateral Sclerosis
Authors: Kenis-Coskun Ozge , Gunes Taskin , Isak Baris , Yagci Ilker
Published: March 2020

Purpose:

This study aims to determine the intrarater and interrater reliability of the Heckmatt score in the upper extremity muscles in patients with amyotrophic lateral sclerosis and to investigate its relationship with the clinical features and quantitative echo intensity measurements.

Methods:

The Heckmatt scores of multiple upper extremity muscles were calculated in 28 patients with amyotrophic lateral sclerosis and examined the relationships of these values with quantitative ultrasound (QUS) measurements and the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised.

Results:

The Heckmatt scores showed strong intrarater and interrater correlations with Cohen's Kappa scores ranging from 0.7 to 0.91. In all investigated muscles, the Heckmatt scores showed moderate correlations with quantitative echo intensity measurements and Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised dressing subscale.

Conclusions:

The Heckmatt score is a reliable method in evaluating muscles of the upper extremities in patients with amyotrophic lateral sclerosis. It moderately correlates with quantitative values and functional status.
Relationships between workload perception, burnout, and intent to leave among medical–surgical nurses
Authors: Phillips Carswella
Published: March 2020

Aim:

These are turbulent times for hospitals, patients, and nurses. Nurse turnover is a global issue across all specialties but are exacerbated in medical–surgical areas where high nurse–patient ratios, use of point-of-care technologies, and stressful working conditions require sufficient numbers of highly trained nurses. These workload factors are further exaggerated by the current nursing shortage. The current nursing shortage crisis makes nursing job conditions more important than ever to examine. Despite heavy emphasis on promoting healthy work environments, job satisfaction, and retention of nurses working in intensive care and emergency room settings, limited research is available about the workload perception, burnout, and intent to leave among medical–surgical nurses. This study aimed to describe the relationships between workload perception, burnout, and intent to leave among medical–surgical nurses at two teaching hospitals in Southeastern United States.

Methods:

A survey design and convenience sampling method was used. A sample of 58 medical–surgical staff nurses participated in the study. A 42-item questionnaire composed of a demographic survey, Individual Workload Perception Scale, and Maslach Burnout Inventory Scale were used. Simple descriptive statistics, Pearson's product–moment correlations, and multiple regression analysis procedures were used to analyze the data.

Results:

More than half of the respondents reported high workloads and intentions to leave their current position. The overall burnout level for the sample was moderate to high. Moderate-to-strong intercorrelations were found between workload perception and intent to leave (r = 0.513, P < 0.0001), burnout and intent to leave (r = −0.435, P < 0.0006), and workload perception and burnout (r = −0.588, P < 0.0001). Workload perception and burnout among medical–surgical nurses both factored significantly on the intent to leave a current job (P < 0.05).

Conclusion:

The current study provides new insights about the relationships between workload perception, burnout, and intent to leave among medical–surgical nurses. The findings indicate the higher the nurses’ workload perception, the more likely they will leave their current job. Nurse managers should consider these findings when developing strategies to improve the work environment and nurse retention. Additional research is needed to gain more insight into the causality among workload perception, burnout, and intent to leave a current job among medical–surgical nurses.