bluuebunny/crossref_metadata_2025 huggingface dataset:
THE USE OF ACTIVE PERSONAL DOSEMETERS IN INTERVENTIONAL WORKPLACES IN HOSPITALS: COMPARISON BETWEEN ACTIVE AND PASSIVE DOSEMETERS WORN SIMULTANEOUSLY BY MEDICAL STAFF
Authors: Vanhavere F , Carinou E , Clairand I , Ciraj-Bjelac O , De Monte F , Domienik-Andrzejewska J , Ferrari P , Ginjaume M , Hršak Hrvoje , Hupe O , Knezevic Z , O’Connor U , Merce M Sans , Sarmento S , Savary A , Siskoonen T
Published: August 2019

Medical staff in interventional procedures are among the professionals with the highest occupational doses. Active personal dosemeters (APDs) can help in optimizing the exposure during interventional procedures. However, there can be problems when using APDs during interventional procedures, due to the specific energy and angular distribution of the radiation field and because of the pulsed nature of the radiation. Many parameters like the type of interventional procedure, personal habits and working techniques, protection tools used and X-ray field characteristics influence the occupational exposure and the scattered radiation around the patient. In this paper, we compare the results from three types of APDs with a passive personal dosimetry system while being used in real clinical environment by the interventional staff. The results show that there is a large spread in the ratios of the passive and active devices.
Influence of diet fortification on body composition and apparent digestion in mature horses consuming a low-quality forage
Authors: Much Mattea L , Leatherwood Jessica L , Zoller Jennifer L , Bradbery Amanda N , Martinez Rafael E , Keegan Abby D , Lamprecht Emily D , Wickersham Tryon A
Published: August 2019

Stock-type mares (498 ± 9 kg BW; 12 ± 7 yr) were used in a completely randomized design for 56 d to test the hypothesis that concentrate fortification improves apparent digestion and enhances lean mass over the topline. Horses were stratified by age, BW, and BCS and randomly assigned to either a custom pelleted concentrate (CON; n = 13), or an iso-caloric, iso-nitrogenous pellet that included amino acid fortification, complexed trace minerals, and fermentation metabolites (FORT; n = 10). Concentrate was offered at a total 0.75% BW/d (as-fed) twice daily, and diets were designed to meet or exceed maintenance requirements for mature horses. Horses had ad libitum access to Coastal bermudagrass hay (7.4% CP, 67% NDF, and 40% ADF). Every 14 d BW and BCS were recorded, and ultrasound images were captured every 28 d. longissimus dorsi area (LDA) and subcutaneous fat thickness (FT) were measured between the 12th and 13th ribs (12th/13th) and 17th and 18th ribs (17th/18th). Intramuscular fat at the 17th/18th ribs and rump fat-thickness were also obtained. Horses were dosed with 10 g/d of titanium dioxide (TiO2) for 14 d to estimate forage dry matter intake (DMI). To account for diurnal variation, fecal samples were collected twice daily at 12-h intervals during the last 4 days, advancing by 3 h each day to represent a 24-h period. Fecal samples were composited by horse and analyzed for TiO2 to estimate fecal output and acid detergent insoluble ash was used to calculate forage DMI. To evaluate body composition, horses were infused with a 0.12 g/kg BW deuterium oxide (D2O) on d 0 and 56. Body fat percentage (BF) was determined by quantifying D2O in plasma samples collected at pre- and 4-h postinfusion via mass spectrometry. All data were analyzed using PROC MIXED (SAS v9.4). The model contained a fixed effect of diet; horse (diet) was a random effect. Horses receiving FORT gained 17th/18th FT (P < 0.01) and increased 17th/18th LDA from d 0 to 56 (P < 0.01) while 17th/18th FT and LDA were unchanged in CON. Regardless of diet, BF estimated by D2O infusion increased in all horses from d 0 to 56 (P < 0.01). Average hay DMI was 2.1% BW, but did not differ between diets. In this study, concentrate fortification did not significantly (P ≥ 0.27) affect apparent digestion. In conclusion, concentrate fortification may promote greater muscle development along the posterior topline.
The dietary protein content slightly affects the body temperature of growing pigs exposed to heat stress
Authors: Morales Adriana , Valle J Alan , Castillo Gilberto , Antoine Duckens , Avelar Ernesto , Camacho Reyna L , Buenabad Lorenzo , Cervantes Miguel
Published: August 2019

Heat stress (HS) increases body temperature (BT) and reduces feed intake in pigs. Increasing the dietary protein content may correct the reduced amino acid intake provoked by HS, but it may further increase BT. The effect of dietary protein level on BT of HS pigs was analyzed with nine ileal cannulated pigs (61.7 ± 2.5 kg body weight). A thermometer set to register BT at 5-min intervals was implanted into the ileum. There were two treatments: low-protein (10.8%) wheat-free-amino acid diet (LP); high-protein (21.6%), wheat-soybean-meal diet (HP). The study was conducted in two 10-d periods; in each period, d1 to d6 was for diet adaptation, d7 to d9 was for data analysis, and d10 for ileal sample collection. Pigs were fed at 0600 h (morning), 1400 h (midday), and 2200 h (evening), same amount each time. Following, the separate contribution of ambient temperature and thermal effect of feeding on the postprandial BT increment was analyzed in fed and fasted pigs. Ambient temperature ranged from 30.1 to 35.4 °C and relative humidity from 50% to 84%. Both ambient temperature and BT followed similar patterns. The BT of HP pigs after the morning and midday meals was higher (P < 0.05) but size of the BT increments did not differ between HP and LP pigs. Midday and evening postprandial BT were higher than postprandial morning BT (P < 0.05). The BT increment was larger and longer after the midday than after the morning and evening meals (P < 0.05). The capacity of pigs to dissipate postprandial body heat depends on the accumulated thermal load received before their meals, because the thermal load before the morning meal was smaller than that before the evening meal. The estimated contribution of thermal effect of feeding (0.42 to 0.87 °C) on the total postprandial BT increment (0.69 to 1.53 °C) was larger (P < 0.05) than that of ambient temperature (0.27 to 0.66 °C). In conclusion, these data indicate that the dietary protein level has a small effect on the BT of HS pigs regardless of feeding time. Also both the thermal effect of feeding and ambient temperature impact the BT of HS pigs, although the former had a stronger effect. This information may be useful to design better feeding strategies for pigs exposed to HS conditions.
Molecular Plant-Plum Pox Virus Interactions
Authors: Rodamilans Bernardo , Valli Adrián , García Juan Antonio
Published: August 2019

Plum pox virus, the agent that causes sharka disease, is among the most important plant viral pathogens, affecting Prunus trees across the globe. The fabric of interactions that the virus is able to establish with the plant regulates its life cycle, including RNA uncoating, translation, replication, virion assembly, and movement. In addition, plant-virus interactions are strongly conditioned by host specificities, which determine infection outcomes, including resistance. This review attempts to summarize the latest knowledge regarding Plum pox virus–host interactions, giving a comprehensive overview of their relevance for viral infection and plant survival, including the latest advances in genetic engineering of resistant species.
Genetic Differentiation and Clonal Expansion of Chinese Botrytis cinerea Populations from Tomato and Other Crops in China
Authors: Diao Yongzhao , Larsen Meredith M. , Kamvar Zhian N. , Zhang Can , Li Shuo , Wang Weizhen , Lin Dong , Peng Qin , Knaus Brian J. , Foster Zachary S. L. , Grünwald Niklaus J. , Liu Xili
Published: August 2019

Botrytis cinerea is an important pathogen of vegetable and fruit crops but little is known about its population structure and genetics in China. We hypothesized that the geographic populations of B. cinerea in China would be genetically differentiated by host, geographic location, and/or year. In this study, we collected 393 B. cinerea isolates representing 28 populations from tomato, cherry, and nectarine from 2006 to 2014 in China. The isolates were analyzed using 14 microsatellite markers, including six new markers that provided more genotyping power than the eight previously published loci. We also investigated the B. cinerea population structure and inferred its mode of reproduction and dispersal based on genotype data. High genotypic diversity was detected in all populations, and clonal reproduction was dominant. Southern China populations harbored more genotypes than northern populations. Differentiation by host plant was evident. Between 2011 and 2012, genotypes changed only slightly among years for Liaoning populations, but they changed substantially among years for the Shanghai and Fujian populations. Clonal dispersal was detected and the farthest dispersal distance was estimated to be about 1,717 km. Two high-frequency genotypes were widely distributed in more than 10 populations and across several years. Our results provide useful, novel information for plant breeding programs and control of B. cinerea in China.
Butyrolactone‐I, an efficient α‐glucosidase inhibitor, improves type 2 diabetes with potent TNF‐α–lowering properties through modulating gut microbiota in db/db mice
Authors: Wu Wei , Liu Liyun , Zhu Hongrui , Sun Yating , Wu Ying , Liao Hongze , Gui Yuhan , Li Lei , Liu Lei , Sun Fan , Lin Houwen
Published: August 2019

The aim of this study was to evaluate the effects of butyrolactone‐I (A6) on type 2 diabetes (T2D) in db/db mice because A6 was found to inhibit α‐glucosidase activities and TNF‐α release, which were associated with improving T2D. Male db/db mice were divided into 6 groups and given an equivalent volume of olive oil, acarbose, or different doses of A6 for 4 wk (n = 8/group). In this study, 11 butenolide derivatives were screened for their α‐glucosidase and TNF‐α suppressive activity in vitro. A6, an efficient α‐glucosidase inhibitor, exerts hypoglycemic and multiple activities in reducing weight, improving glucose tolerance and insulin resistance, increasing short‐chain fatty acid (SCFA) levels, activating SCFA‐induced increases in glucagon‐like peptide 1 and peroxisome proliferator‐activated receptor‐γ expression, enhancing intestinal mucosal barrier function and mitigating endoxemia in db/db mice. These effects may result from mediation of gut microbiota by A6. Meanwhile, A6, with potent TNF‐α–lowering properties, was demonstrated to have multiple salutary effects with excellent structural stability and long‐term safety in vivo. A6, an effective α‐glucosidase inhibitor with high security and stability, exerted potent antidiabetic effects in vivo. Furthermore, the modulation of gut microbiota of A6 was demonstrated to be one of the mechanisms contributing to anti‐inflammation properties and improving endoxemia. Our work confirms that the compound A6 is a prospective drug candidate for T2D.—Wu, W., Liu, L., Zhu, H., Sun, Y., Wu, Y., Liao, H., Gui, Y., Li, L., Liu, L., Sun, F., Lin, H. Butyrolactone‐I, an efficient α‐glucosidase inhibitor, improves type 2 diabetes with potent TNF‐α–lowering properties through modulating gut microbiota in db/db mice. FASEB J. 33, 12616–12629 (2019). www.fasebj.org
The profibrotic effects of MK‐8617 on tubulointerstitial fibrosis mediated by the KLF5 regulating pathway
Authors: Li Zuo‐Lin , Lv Lin‐Li , Wang Bin , Tang Tao‐Tao , Feng Ye , Cao Jing‐Yuan , Jiang Li‐Qiong , Sun Yan‐Bei , Liu Hong , Zhang Xiao‐Liang , Ma Kun‐Ling , Tang Ri‐Ning , Liu Bi‐Cheng
Published: August 2019

The discovery of hypoxia‐inducible factor (HIF)‐prolyl hydroxylase inhibitor (PHI) has revolutionized the treatment strategy for renal anemia. However, the presence of multiple transcription targets of HIF raises safety concerns regarding HIF‐PHI. Here, we explored the dose‐dependent effect of MK‐8617 (MK), a kind of HIF‐PHI, on renal fibrosis. MK was administered by oral gavage to mice for 12 wk at doses of 1.5, 5, and 12.5 mg/kg. In vitro, the human proximal tubule epithelial cell line HK‐2 was treated with increasing doses of MK administration. Transcriptome profiling was performed, and fibrogenesis was evaluated. The dose‐dependent biphasic effects of MK on tubulointerstitial fibrosis (TIF) were observed in chronic kidney disease mice. Accordingly, high‐dose MK treatment could significantly enhance TIF. Using RNA‐sequencing, combined with in vivo and in vitro experiments, we found that Krüppel‐like factor 5 (KLF5) expression level was significantly increased in the proximal tubular cells, which could be transcriptionally regulated by HIF‐1α with high‐dose MK treatment but not low‐dose MK. Furthermore, our study clarified that HIF‐1α‐KLF5‐TGF‐β1 signaling activation is the potential mechanism of high‐dose MK‐induced TIF, as knockdown of KLF5 reduced TIF in vivo. Collectively, our study demonstrates that high‐dose MK treatment initiates TIF by activating HIF‐1α‐KLF5‐TGF‐β1 signaling. These findings provide novel insights into TIF induction by high‐dose MK (HIF‐PHI), suggesting that the safety dosage window needs to be emphasized in future clinical applications.—Li, Z.‐L., Lv, L.‐L., Wang, B., Tang, T.‐T., Feng, Y., Cao, J.‐Y., Jiang, L.‐Q., Sun, Y.‐B., Liu, H., Zhang, X.‐L., Ma, K.‐L., Tang, R.‐N., Liu, B.‐C. The profibrotic effects of MK‐8617 on tubulointerstitial fibrosis mediated by the KLF5 regulating pathway. FASEB J. 33, 12630–12643 (2019). www.fasebj.org
Mumps virus infection disrupts blood‐testis barrier through the induction of TNF‐α in Sertoli cells
Authors: Wu Han , Jiang Xing , Gao Yunxiao , Liu Weihua , Wang Fei , Gong Maolei , Chen Ran , Yu Xiaoqin , Zhang Wenjing , Gao Bo , Song Chengyi , Han Daishu
Published: August 2019

Mumps virus (MuV) has high tropism to the testis and may lead to male infertility. Sertoli cells are the major targets of MuV infection. However, the mechanisms by which MuV infection impairs male fertility and Sertoli cell function remain unclear. The present study elucidated the effect of MuV infection on the blood‐testis barrier (BTB). The transepithelial electrical resistance of MuV‐infected mouse Sertoli cells was monitored, and the expression of major proteins of the BTB was examined. We demonstrated that MuV infection disrupted the BTB by reducing the levels of occludin and zonula occludens 1. Sertoli cells derived from Tlr2–/– and Tnfa–/– mice were analyzed for mediating MuV‐induced impairment. TLR2‐mediated TNF‐α production by Sertoli cells in response to MuV infection impaired BTB integrity. MuV‐impaired BTB was not observed in Tlr2–/– and Tnfa–/– Sertoli cells. Moreover, an inhibitor of TNF‐α, pomalidomide, prevents the disruption of BTB in response to MuV infection. FITC‐labeled biotin tracing assay confirmed that BTB permeability and spermatogenesis were transiently impaired by MuV infection in vivo. These findings suggest that the disruption of the BTB could be one of the mechanisms underlying MuV‐impaired male fertility, in which TNF‐α could play a critical role.—Wu, H., Jiang, X., Gao, Y., Liu, W., Wang, F., Gong, M., Chen, R., Yu, X., Zhang, W., Gao, B., Song, C., Han, D. Mumps virus infection disrupts blood‐testis barrier through the induction of TNF‐α in Sertoli cells. FASEB J. 33, 12528–12540 (2019). www.fasebj.org
Recombinant Thrombomodulin on Neutrophil Extracellular Traps in Murine Intestinal Ischemia–Reperfusion
Authors: Hayase Naoki , Doi Kent , Hiruma Takahiro , Matsuura Ryo , Hamasaki Yoshifumi , Noiri Eisei , Nangaku Masaomi , Morimura Naoto
Published: August 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

In multiple-organ dysfunction, an injury affecting one organ remotely impacts others, and the injured organs synergistically worsen outcomes. Recently, several mediators, including extracellular histones and neutrophil extracellular traps, were identified as contributors to distant organ damage. This study aimed to elucidate whether these mediators play a crucial role in remote organ damage induced by intestinal ischemia–reperfusion. This study also aimed to evaluate the protective effects of recombinant thrombomodulin, which has been reported to neutralize extracellular histones, on multiple-organ dysfunction after intestinal ischemia–reperfusion.

Methods

Intestinal ischemia was induced in male C57BL/6J mice via clamping of the superior mesenteric artery. Recombinant thrombomodulin (10 mg/kg) was administered intraperitoneally with the initiation of reperfusion. The mice were subjected to a survival analysis, histologic injury scoring, quantitative polymerase chain reaction analysis of tumor necrosis factor-α and keratinocyte-derived chemokine expression, Evans blue dye vascular permeability assay, and enzyme-linked immunosorbent assay analysis of histones in the jejunum, liver, lung, and kidney after 30- or 45-min ischemia. Neutrophil extracellular trap formation was evaluated by immunofluorescence staining.

Results

Recombinant thrombomodulin yielded statistically significant improvements in survival after 45-min ischemia (ischemia–reperfusion without vs. with 10 mg/kg recombinant thrombomodulin: 0% vs. 33%, n = 21 per group, P = 0.001). Recombinant thrombomodulin reduced the histologic injury score, expression of tumor necrosis factor-α and keratinocyte-derived chemokine, and extravasation of Evans blue dye, which were augmented by 30-min ischemia–reperfusion, in the liver, but not in the intestine. Accumulated histones and neutrophil extracellular traps were found in the livers and intestines of 30-min ischemia–reperfusion–injured mice. Recombinant thrombomodulin reduced these accumulations only in the liver.

Conclusions

Recombinant thrombomodulin improved the survival of male mice with intestinal ischemia–reperfusion injury. These findings suggest that histone and neutrophil extracellular trap accumulation exacerbate remote liver injury after intestinal ischemia–reperfusion. Recombinant thrombomodulin may suppress these accumulations and attenuate liver injury.
Age Differences in the Effects of Speaking Rate on Auditory, Visual, and Auditory-Visual Speech Perception
Authors: Sommers Mitchell S. , Spehar Brent , Tye-Murray Nancy , Myerson Joel , Hale Sandra
Published: August 2019

Objectives:

This study was designed to examine how speaking rate affects auditory-only, visual-only, and auditory-visual speech perception across the adult lifespan. In addition, the study examined the extent to which unimodal (auditory-only and visual-only) performance predicts auditory-visual performance across a range of speaking rates. The authors hypothesized significant Age × Rate interactions in all three modalities and that unimodal performance would account for a majority of the variance in auditory-visual speech perception for speaking rates that are both slower and faster than normal.

Design:

Participants (N = 145), ranging in age from 22 to 92, were tested in conditions with auditory-only, visual-only, and auditory-visual presentations using a closed-set speech perception test. Five different speaking rates were presented in each modality: an unmodified (normal rate), two rates that were slower than normal, and two rates that were faster than normal. Signal to noise ratios were set individually to produce approximately 30% correct identification in the auditory-only condition and this signal to noise ratio was used in the auditory-only and auditory-visual conditions.

Results:

Age × Rate interactions were observed for the fastest speaking rates in both the visual-only and auditory-visual conditions. Unimodal performance accounted for at least 60% of the variance in auditory-visual performance for all five speaking rates.

Conclusions:

The findings demonstrate that the disproportionate difficulty that older adults have with rapid speech for auditory-only presentations can also be observed with visual-only and auditory-visual presentations. Taken together, the present analyses of age and individual differences indicate a generalized age-related decline in the ability to understand speech produced at fast speaking rates. The finding that auditory-visual speech performance was almost entirely predicted by unimodal performance across all five speaking rates has important clinical implications for auditory-visual speech perception and the ability of older adults to use visual speech information to compensate for age-related hearing loss.
Clinico-Genotypic Correlation: Recurrent Attacks of Paralysis and Skeletal Muscle SCN4A Mutation (p.Ile693Thr)
Authors: Nanda Satyan , Tandon Vaibhav , Menon Ramshekhar , Sundaram Soumya , Nair Muralidharan
Published: August 2019

Skeletal sodium channel mutations have been known to demonstrate a multitude of clinical manifestations of which one such commonly known entity is paramyotonia congenita. We describe the clinical features of proband in our case report and the various phenotypic manifestations described with the mentioned mutation from different centres. Our case serves to highlight the heterogeneity that exists in SCN4A mutations and the possible effect of other genetic/environmental factors in determining the final phenotype.
XEN-augmented Baerveldt Implantation for Refractory Childhood Glaucoma: A Retrospective Case Series
Authors: Arad Tschingis , Hoffmann Esther M. , Prokosch-Willing Verena , Pfeiffer Norbert , Grehn Franz
Published: August 2019

Background:

Tube implants can lead to long-term decompensation of the cornea after decades, in particular in complicated childhood glaucoma, because of a variety of causes including contact between the tube tip and the corneal endothelium. The augmentation of a XEN implant with a Baerveldt (250) tube implant, introduced 2016 by Mermoud et al for refractory glaucoma in adult patients, may reduce this risk in children. In our retrospective study, we report on the XEN-augmented Baerveldt (250) tube implant in children.

Patients and Methods:

Ten consecutive patients with refractory childhood glaucoma who underwent XEN-augmented Baerveldt implantation by a single surgeon (F.G.) between January 2016 and August 2018 were retrospectively analyzed. In this technique, a XEN tube was inserted under a standard scleral flap from outside into the anterior chamber and its outer end was connected to the Baerveldt (250) tube. The follow-up consisted of regular anterior and posterior segment examination with intraocular pressure (IOP) measurements using a hand-held slit lamp and a Perkins applanation tonometer and/or rebound tonometer (Icare).

Results:

Ten cases (6 female individuals, 4 male individuals, median age 6 years) were operated using a XEN-augmented Baerveldt implant [aphakic glaucoma, primary congenital glaucoma, secondary congenital glaucoma (Peters anomaly), ectropion uveae, and Stickler syndrome were 4, 3, 1, 1, and 1]. Before surgery (XEN-augmented Baerveldt implantation), median IOP was 31 mm Hg. At the last postoperative follow-up, the mean IOP was 18.5 mm Hg with a median follow-up period of 13 months (range, 3 to 21 mo). No shallow or flat anterior chamber was observed. In all cases, this technique could be performed without intraoperative complications. In 3 cases, however, a surgical revision was necessary. There was no prolonged postoperative hypotony or short-term corneal alteration. By using an S-shaped loop the original Baerveldt tube length could be preserved for potential future use. In a total of 6 out of 10 cases, the procedure was a complete success (IOP, ≤20 mm Hg without additional medication).

Conclusions:

XEN-augmented Baerveldt implantation was used for refractory pediatric glaucoma in which conventional surgery had already failed. A new additional modification using an S-shaped loop was introduced. Short-term IOP control seems promising, but long-term results are still pending and the long-term efficacy and safety must still be proven before this technique can be generally recommended.
Doctor of Physical Therapy Student Perceptions of Near-Peer Teaching in an Anatomy Educational Experience
Authors: Haladay Douglas E. , Miro Rebecca M. , Hardwick Dustin , Swisher Laura L. , Klein Aimee B.
Published: August 2019

Background and Purpose.

Near-peer (NP) teaching, teaching by students where a gap greater than 1 year exists between teacher and learner, has been found to produce positive results in both teacher and learner alike. Gross anatomy courses often include NP teaching experiences; however, those experiences tend to limit the NP teachers to strong academic performers.

Method/Model Description and Evaluation.

The University of South Florida School of Physical Therapy and Rehabilitation Sciences' Doctor of Physical Therapy (DPT) students participated in a NP teaching experience. All third-year DPT students served as a NP teacher, as either a planner (n= 31) or a laboratory assistant (n= 8). Third-year students were responsible for content development (planners) and/or delivery (planners and laboratory assistants) for an anatomy module within a movement science course. After each module, first-year students completed a survey and course assessments while third-year planners completed a self-reflection. A thematic analysis was completed using the first- and third-year responses.

Outcomes.

First-year students reported that the experience enhanced their understanding of anatomy as it relates to physical therapist practice, provided them strategies to correctly identify important anatomical concepts, and was preferable over instructor led anatomy. Third-year students (planners) acknowledged the benefit of teaching peers and reflected on knowledge reinforcement with a greater level of comfort and understanding of effort for teaching.

Discussion and Conclusion.

The findings support the existing literature that NP opportunities are beneficial for NP teachers and learners and have potential as an additional strategy for teaching human anatomy in physical therapist education programs.
The influence of nurse practitioner staffing on intensive care unit mortality
Authors: Chang Chih-Lun , Tang Gau-Jun , Wu Chin-Pyng , Pu Christy , Chen Hsin-Chih
Published: August 2019

Background:

In Taiwan, nurse practitioners (NPs) have taken on expanded clinical roles in the intensive care unit (ICU) due to insufficient staffing of attending physicians and resident physicians.

Local problem:

The objective of this study was to investigate the influence of NP staffing on the quality of patient care in ICUs.

Methods:

This is a retrospective study that selected patients from the ICUs of three hospitals during 2015. The mortality risks among the three hospitals were compared after adjusting variables using the Cox regression model. The care qualities of the three hospitals were analyzed using the standardized mortality ratio.

Interventions:

Hospital A consisted of attending physicians and resident physicians. Hospital B consisted of attending physicians and NPs. Hospital C consisted of attending physicians, NPs, and resident physicians.

Results:

Outcomes were assessed for 2,932 patients. The patients in hospital A had a lower mortality risk than hospital B or C. Septic shock patients received better care quality in hospital B than in hospital A or hospital C.

Conclusions:

In regional hospitals with lower NP-to-patient ratios, increasing that ratio could reduce the risk of mortality in the ICU and increase the quality of care.
Electronic interventions aimed at increasing self-worth in mild dementia may not be feasible
Authors: Martinez Natalie , Stutzman Sonja E. , Olson DaiWai M.
Published: August 2019

Alzheimer disease (AD) is a devastating diagnosis. Milieu therapy and memory activities have been shown to improve self-worth and improve mood in AD patients, but adherence to these activities is challenging. This prospective randomized pilot study examined adherence to memory recall activities using positive reinforcement and explored the impact on self-worth and depression. Pretest-posttest scores and data abstraction were used to measure protocol adherence, self-worth (Rosenberg Self-Esteem Scale), cognitive decline (Mini-Mental Status Examination), and symptoms of depression (Geriatric Depression Scale). Among 22 mild AD participants, there were no statistically significant differences in pretest versus posttest scores for all measures. The results suggest that the intervention of memory recall did not enhance self-worth, improve the status of memory recall, or lower symptoms of depression. Additionally, positive reinforcement did not play a role in adherence to accessing the tasks.
Provider-directed education to reduce unnecessary neuroimaging in uncomplicated headache disorders
Authors: Cook Calli Leighann , Bowles Wendy , Zurmehly Joyce , McDaniel Jodi
Published: August 2019

Background:

More than 1.9 million annual outpatient visits to neurologists in the United States are associated with headache diagnoses. For uncomplicated headache disorders, the evidence-based practice (EBP) guidelines recommend against neuroimaging unless specific neurological signs and symptoms are present; however, neuroimaging rates have only modestly decreased since the guidelines were developed.

Local Problem:

We evaluated unnecessary neuroimaging rates in patients with uncomplicated headache at the Emory Department of General Neurology. The rate of unnecessary neuroimaging suggested a provider knowledge gap in the use of neuroimaging in patients with uncomplicated headaches.

Methods:

A provider-directed educational session was delivered, and outcomes were evaluated 8 weeks after implementation. The postintervention rates of unnecessary neuroimaging were compared with preintervention rates.

Interventions:

A 15-minute educational session on the EBP guidelines for neuroimaging use in uncomplicated headache was presented to all general neurology providers (n = 9). The providers were given an electronic version of the presentation and a pocket-sized EBP algorithm for neuroimaging in this population.

Results:

Data collected from the project site's neuroimaging dashboard showed a significantly lower proportion of unnecessary neuroimaging orders in the 8-week posteducational interval (4.2%) compared with the 8-week preeducation interval (7.2%) (t = 2.78, p = .014), a 41.6% reduction.

Conclusions:

We found that a provider-directed educational session reviewing the EBP guidelines for neuroimaging in patients with uncomplicated headache disorders was successful in lowering rates of neuroimaging. Implementing similar projects in other departments could further reduce unnecessary neuroimaging use across the organization.
Ex Vivo Heart Perfusion for 72 Hours Using Plasma Cross Circulation
Authors: McLeod Jennifer S. , Poling Clinton , Church Joseph T. , Jung Josh , Sarosi Ellery , Langley Mark , Hayes McKenzie , Phillips Joseph P. , Hirschl Jacob , Weir William , Hoenerhoff Mark , Rojas-Pena Alvaro , Bartlett Robert H. , Owens Gabe E.
Published: August 2019

Preservation of a donor heart for transplantation is limited to 6–8 hours. Based on our demonstration of 12 hour perfusion with plasma cross circulation, this study aimed to evaluate ex vivo heart perfusion (EVHP) for up to 72 hours using cross plasma circulation (XC-plasma) from a live, awake paracorporeal sheep (PCS). Six ovine hearts were perfused for 72 hours using plasma cross circulation at a rate of 1 L/min with a live, awake PCS. Controls were seven perfused hearts without cross circulation. Experiments were electively ended at 72 hours, and epinephrine (0.1 mg) was delivered to demonstrate hormonal responsiveness. All controls failed at 6–10 hours. All six hearts perfused for 72 hours maintained normal heart function, metabolism, and responsiveness to epinephrine. Blood gases, electrolytes, and lactate levels were normal and stable throughout the study. All hearts appeared suitable for transplantation. We have demonstrated successful normothermic EVHP for 72 hours.
Predictive criteria for acute heart failure in emergency department patients with acute dyspnoea: the PREDICA study
Authors: Roncalli J. , Picard F. , Delarche N. , Faure I. , Pradeau C. , Thicoipe M. , Galinier M. , Charpentier S.
Published: August 2019

Objectives

The early identification of patients with Acute Heart Failure Syndrome (AHFS) among patients admitted to the Emergency Department (ED) with dyspnoea can facilitate the introduction of appropriate treatments. The objectives are to identify the predictive factors for AHFS diagnosis in patients with acute dyspnoea (primary objective) and the clinical ‘gestalt’ (secondary objective) in ED.

Methods

PREDICA is an observational, prospective, multicentre study. The enrolment of patients admitted to the ED for nontraumatic acute dyspnoea and data collection on admission were recorded by the patient’s emergency physician. The AHFS endpoints were assessed following a duplicate expert evaluation by pairs of cardiologists and emergency physicians. Step-by-step logistic regression was used to retain predictive criteria, and the area under the receiver operating characteristic (ROC) curve of the model was constructed to assess the ability of the selected factors to identify real cases. The probability of AHFS was estimated on a scale from 1 to 10 based on the emergency physician’s perception and understanding (gestalt).

Results

Among 341 patients consecutively enrolled in three centres, 149 (44%) presented AHFS. Eight predictive factors of AHFS were detected with a performance test showing an area under the model ROC curve of 0.86. Gestalt greater than or equal to five showed sensitivity of 78% and specificity of 90% (AUC 0.91) and diagnosed 88% of AHF in our population.

Conclusions

We identified several independant predictors of final AHFS diagnosis. They should contribute to the development of diagnostic strategies in ED. However, unstructured gestalts seem to perform very well alone.
Laboratory testing and imaging in the evaluation of cranial cerebrospinal fluid leaks and encephaloceles
Authors: Lipschitz Noga , Hazenfield J. Michael , Breen Joseph T. , Samy Ravi N.
Published: August 2019

Purpose of review

To summarize the current evidence on the diagnostic evaluation of cranial cerebrospinal fluid (CSF) leaks and encephaloceles, including laboratory testing and imaging studies.

Recent findings

The most sensitive and specific laboratory tests for CSF leak diagnosis are beta-2-transferrin and beta trace protein assays, the former more commonly used because of availability. Imaging studies used for localization of the leak site include high resolution computed tomography (HRCT) and magnetic resonance cisternography (MRC), often used in combination. Intrathecal contrast administration is reserved for complex cases with prior equivocal test results or for patients with multiple skull base defects to localize the leak site.

Diagnosis of CSF leaks and encephaloceles is aimed at both confirming the leak and localizing the leak site. Future advancements in testing techniques may shorten the diagnostic process, limit the need for invasive testing, and improve the safety of such testing in indicated cases.
Sexually Transmitted Infection Positivity Among Adolescents With or at High-Risk for Human Immunodeficiency Virus Infection in Los Angeles and New Orleans
Authors: Shannon Chelsea L. , Keizur Erin M. , Fehrenbacher Anne , Wood-Palmer Drew , Ramos Wilson , Koussa Maryann , Fournier Jasmine , Lee Sung-Jae , Patel Dhara , Akabike Whitney N. , Abdalian Sue Ellen , Rotheram-Borus Mary Jane , Klausner Jeffrey D.
Published: August 2019

Background

Gay, bisexual, and transgender youth and homeless youth are at high risk for sexually transmitted infections (STIs). However, little recent data exist describing STI positivity by anatomical site among those groups. We determined the positivity of Chlamydia trachomatis (CT) infection, Neisseria gonorrhoeae (NG) infection, and syphilis antibody reactivity among lesbian, gay, bisexual, transgender, and homeless youth.

Methods

We recruited 1,264 adolescents with high risk behavior aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, community health centers, and using social media and online dating apps in Los Angeles, California and New Orleans, Louisiana from May 2017 to February 2019. Participants received point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and syphilis antibody testing. We calculated STI positivity by anatomical site and compared positivity by participant subgroups based on human immunodeficiency virus (HIV) status, sex assigned at birth, and gender identity.

Results

CT and NG positivity and syphilis antibody reactivity was higher among HIV-infected adolescent men who have sex with men (MSM) than HIV-uninfected adolescent MSM (40.2% vs. 19%, P < 0.05), particularly CT or NG rectal infection (28% vs. 12.3%, P < 0.05). Of participants with positive CT or NG infections, 65% had extragenital-only infections, 20% had both extragenital and urogenital infections, and 15% had urogenital-only infections.

Conclusions

Sexually transmitted infection positivity was high, particularly among transgender women and MSM. The high proportion of rectal and pharyngeal infections highlights the importance of both urogenital and extragenital STI screening. More accessible STI testing is necessary for high-risk adolescent populations.
Survival and Cardiopulmonary Resuscitation Hemodynamics Following Cardiac Arrest in Children With Surgical Compared to Medical Heart Disease*
Authors: Yates Andrew R. , Sutton Robert M. , Reeder Ron W. , Meert Kathleen L. , Berger John T. , Fernandez Richard , Wessel David , Newth Christopher J. , Carcillo Joseph A. , McQuillen Patrick S. , Harrison Rick E. , Moler Frank W. , Pollack Murray M. , Carpenter Todd C. , Notterman Daniel A. , Dean J. Michael , Nadkarni Vinay M. , Berg Robert A.
Published: August 2019

Objectives:

To assess the association of diastolic blood pressure cutoffs (≥ 25 mm Hg in infants and ≥ 30 mm Hg in children) during cardiopulmonary resuscitation with return of spontaneous circulation and survival in surgical cardiac versus medical cardiac patients. Secondarily, we assessed whether these diastolic blood pressure targets were feasible to achieve and associated with outcome in physiology unique to congenital heart disease (single ventricle infants, open chest), and influenced outcomes when extracorporeal cardiopulmonary resuscitation was deployed.

Design:

Multicenter, prospective, observational cohort analysis.

Setting:

Tertiary PICU and cardiac ICUs within the Collaborative Pediatric Critical Care Research Network.

Patients:

Patients with invasive arterial catheters during cardiopulmonary resuscitation and surgical cardiac or medical cardiac illness category.

Interventions:

None.

Measurements and Main Results:

Hemodynamic waveforms during cardiopulmonary resuscitation were analyzed on 113 patients, 88 surgical cardiac and 25 medical cardiac. A similar percent of surgical cardiac (51/88; 58%) and medical cardiac (17/25; 68%) patients reached the diastolic blood pressure targets (p = 0.488). Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients (p = 0.018), but not medical cardiac patients (p = 0.359). Fifty-three percent (16/30) of patients with single ventricles attained the target diastolic blood pressure. In patients with an open chest at the start of chest compressions, 11 of 20 (55%) attained the target diastolic blood pressure. In the 33 extracorporeal cardiopulmonary resuscitation patients, 16 patients (48%) met the diastolic blood pressure target with no difference between survivors and nonsurvivors (p = 0.296).

Conclusions:

During resuscitation in an ICU, with invasive monitoring in place, diastolic blood pressure targets of greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in children can be achieved in patients with both surgical and medical heart disease. Achievement of diastolic blood pressure target was associated with improved survival to hospital discharge in surgical cardiac patients, but not medical cardiac patients. Diastolic blood pressure targets were feasible to achieve in 1) single ventricle patients, 2) open chest physiology, and 3) extracorporeal cardiopulmonary resuscitation patients.
Preoperative Risk Assessment for Loss of Independence Following Hepatic Resection in Elderly Patients
Authors: Tanaka Shogo , Iida Hiroya , Ueno Masaki , Hirokawa Fumitoshi , Nomi Takeo , Nakai Takuya , Kaibori Masaki , Ikoma Hisashi , Eguchi Hidetoshi , Shinkawa Hiroji , Maehira Hiromitsu , Hayami Shinya , Kubo Shoji
Published: August 2019

Objective:

To establish a preoperative risk assessment method for loss of independence after hepatic resection.

Summary Background Data:

Hepatic resection often results in loss of independence in preoperatively self-sufficient elderly people. Elderly patients should therefore be carefully selected for surgery.

Methods:

In this prospective, multicenter study, 347 independently-living patients aged ≥65 years, scheduled for hepatic resection, were divided into study (n = 232) and validation (n = 115) cohorts. We investigated the risk factors for postoperative loss of independence in the study cohort and verified our findings with the validation cohort. Loss of independence was defined as transfer to a rehabilitation facility, discharge to residence with home-based healthcare, 30-day readmission for poor functionality, and 90-day mortality (except for cancer-related deaths).

Results:

In the study cohort, univariate and multivariate analyses indicated that frailty, age ≥ 76 years, and open surgery were independent risk factors for postoperative loss of independence. Proportions of patients with postoperative loss of independence in the study and validation cohorts were respectively 3.0% and 0% among those with no applicable risk factors, 8.1% and 12.5% among those with 1 applicable risk factor, 25.5% and 25.0% among those with 2 applicable risk factors, and 56.3% and 50.0% among those with all 3 factors applicable (P < 0.001 for both cohorts). Areas under the receiver operating characteristic curves for the study and validation groups were 0.777 and 0.783, respectively.

Conclusions:

Preoperative risk assessments using these 3 factors may be effective in predicting and planning for postoperative loss of independence after hepatic resection in elderly patients.
Protective effects of plasma products on the endothelial-glycocalyx barrier following trauma-hemorrhagic shock: Is sphingosine-1 phosphate responsible?
Authors: Diebel Mark E. , Diebel Lawrence N. , Liberati David M.
Published: August 2019

BACKGROUND

Plasma is an important component of resuscitation after trauma and hemorrhagic shock (T/HS). The specific plasma proteins and the impact of storage conditions are uncertain. Utilizing a microfluidic device system, we studied the effect of various types of plasma on the endothelial barrier function following T/HS.

METHODS

Human umbilical vein endothelial cells (HUVEC) were cultured in microfluidic plates. The microfluidic plates were subjected to control or shock conditions (hypoxia/reoxygenation + epinephrine, 103 μM). Fresh plasma, 1 day thawed plasma, 5-day thawed plasma and lyophilized plasma were then added. Supplementation of sphingosine-1 phosphate (S-1P) was done in a subset of experiments. Effect on the endothelial glycocalyx was indexed by shedding of syndecan-1 and hyaluronic acid. Endothelial injury/activation was indexed by soluble thrombomodulin, tissue plasminogen activator, plasminogen activator inhibitor-1. Vascular permeability determined by the ratio of angiopoietin-2 to angiopoietin-1. Concentration of S-1P and adiponectin in the different plasma groups was measured.

RESULTS

Human umbilical vein endothelial cells exposed to shock conditions increased shedding of syndecan-1 and hyaluronic acid. Administration of the various types of plasma decreased shedding, except for 5-day thawed plasma. Shocked HUVEC cells demonstrated a profibrinolytic phenotype, this normalized with all plasma types except for 5-day thawed plasma. The concentration of S-1P was significantly less in the 5-day thawed plasma compared with the other plasma types. Addition of S-1P to 5-day thawed plasma returned the benefits lost with storage.

CONCLUSION

A biomimetic model of the microcirculation following T/HS demonstrated endothelial glycocalyx and endothelial cellular injury/activation as well as a profibrinolytic phenotype. These effects were abrogated by all plasma products except the 5-day thawed plasma. Plasma thawed longer than 5 days had diminished S1-P concentrations. Our data suggest that S1-P protein is critical to the protective effect of plasma products on the endothelial-glycocalyx barrier following T/HS.
Emery–Dreifuss muscular dystrophy: focal point nuclear envelope
Authors: Muchir Antoine , Worman Howard J.
Published: August 2019

Purpose of review

Emery–Dreifuss muscular dystrophy (EDMD) is caused by mutations in EMD encoding emerin and LMNA encoding A-type lamins, proteins of the nuclear envelope. In the past decade, there has been an extraordinary burst of research on the nuclear envelope. Discoveries resulting from this basic research have implications for better understanding the pathogenesis and developing treatments for EDMD.

Recent findings

Recent clinical research has confirmed that EDMD is one of several overlapping skeletal muscle phenotypes that can result from mutations in EMD and LMNA with dilated cardiomyopathy as a common feature. Basic research on the nuclear envelope has provided new insights into how A-type lamins and emerin function in force transmission throughout the cell, which may be particularly important in striated muscle. Much of the recent research has focused on the heart and LMNA mutations. Prevalence and outcome studies have confirmed the relative severity of cardiac disease. Robust mouse models of EDMD caused by LMNA mutations has allowed for further insight into pathogenic mechanisms and potentially beneficial therapeutic approaches.

Recent clinical and basic research on EDMD is gradually being translated to clinical practice and possibly novel therapies.
Neurocognitive Assessment and Retinal Thickness Alterations in Alzheimer Disease: Is There a Correlation?
Authors: Cipollini Virginia , Abdolrahimzadeh Solmaz , Troili Fernanda , De Carolis Antonella , Calafiore Silvia , Scuderi Luca , Giubilei Franco , Scuderi Gianluca
Published: August 2019

Background:

The relation of retinal thickness to neuropsychological indexes of cognitive impairment in patients with Alzheimer disease (AD) remains an area of investigation. The scope of this investigation was to compare volume and thickness changes of neuronal retinal layers in subjects with AD with those of age-matched healthy controls and to estimate the relation between cognitive functioning evaluated by neuropsychological assessment and thickness changes of the retina.

Methods:

This was a prospective single-site study where we evaluated 25 subjects with probable AD matched for age, sex, and education to 17 healthy control subjects (HC). All participants underwent a full medical evaluation, neuropsychological assessment, and optical coherence tomography (OCT) to evaluate the peripapillary retinal nerve fiber layer (pRNFL) thickness, ganglion cell complex (GCC) thickness, and macular volume.

Results:

The pRNFL thickness of AD patients showed a significant overall reduction compared with healthy controls (P= <0.0001). Furthermore, pRNFL was reduced in each retinal quadrant, particularly the inferior, nasal, and superior quadrants. GCC thickness and macular volume were reduced in AD patients in comparison with HC (P= 0.004;P= 0.001). Of particular interest was the correlation between OCT findings and neuropsychological assessment; we did not find a significant association of retinal thinning with worse MMSE score, but reduction of macular volume was associated with worse constructional praxis performance. Impairment of semantic-lexical and processing speed was associated with attenuation of macular GCC thickness.

Conclusions:

OCT can show early thickness changes in AD patients with subtle memory disturbances. These results suggest that correlations between retinal thinning and cognitive performance warrant further investigation.