bluuebunny/crossref_metadata_2025 huggingface dataset:
Binding of phosphorothioate oligonucleotides with RNase H1 can cause conformational changes in the protein and alter the interactions of RNase H1 with other proteins
Authors: Zhang Lingdi , Vickers Timothy A , Sun Hong , Liang Xue-hai , Crooke Stanley T
Published: January 2021

We recently found that toxic PS-ASOs can cause P54nrb and PSF nucleolar mislocalization in an RNase H1-dependent manner. To better understand the underlying mechanisms of these observations, here we utilize different biochemical approaches to demonstrate that PS-ASO binding can alter the conformations of the bound proteins, as illustrated using recombinant RNase H1, P54nrb, PSF proteins and various isolated domains. While, in general, binding of PS-ASOs or ASO/RNA duplexes stabilizes the conformations of these proteins, PS-ASO binding may also cause the unfolding of RNase H1, including both the hybrid binding domain and the catalytic domain. The extent of conformational change correlates with the binding affinity of PS-ASOs to the proteins. Consequently, PS-ASO binding to RNase H1 induces the interaction of RNase H1 with P54nrb or PSF in a 2′-modification and sequence dependent manner, and toxic PS-ASOs tend to induce more interactions than non-toxic PS-ASOs. PS-ASO binding also enhances the interaction between P54nrb and PSF. However, the interaction between RNase H1 and P32 protein can be disrupted upon binding of PS-ASOs. Together, these results suggest that stronger binding of PS-ASOs can cause greater conformational changes of the bound proteins, subsequently affecting protein–protein interactions. These observations thus provide deeper understanding of the molecular basis of PS-ASO-induced protein mislocalization or degradation observed in cells and advance our understanding of why some PS-ASOs are cytotoxic.
Sex difference in ambulatory blood pressure control associates with risk of ESKD and death in CKD patients receiving stable nephrology care
Authors: Minutolo Roberto , Gabbai Francis B , Agarwal Rajiv , Garofalo Carlo , Borrelli Silvio , Chiodini Paolo , Signoriello Simona , Paoletti Ernesto , Ravera Maura , Bellizzi Vincenzo , Conte Giuseppe , De Nicola Luca
Published: January 2021

Background

It is unknown whether faster progression of chronic kidney disease (CKD) in men than in women relates to differences in ambulatory blood pressure (ABP) levels.

Methods

We prospectively evaluated 906 hypertensive CKD patients (553 men) regularly followed in renal clinics to compare men versus women in terms of ABP control [daytime <135/85 and nighttime blood pressure (BP) <120/70 mmHg] and risk of all-cause mortality and end-stage kidney disease (ESKD).

Results

Age, estimated glomerular filtration rate and use of renin–angiotensin system inhibitors were similar in men and women, while proteinuria was lower in women [0.30 g/24 h interquartile range (IQR) 0.10–1.00 versus 0.42 g/24 h, IQR 0.10–1.28, P = 0.025]. No sex-difference was detected in office BP levels; conversely, daytime and nighttime BP were higher in men (134 ± 17/78 ± 11 and 127 ± 19/70 ± 11 mmHg) than in women (131 ± 16/75 ± 11, P = 0.005/P < 0.001 and 123 ± 20/67 ± 12, P = 0.006/P < 0.001), with ABP goal achieved more frequently in women (39.1% versus 25.1%, P < 0.001). During a median follow-up of 10.7 years, 275 patients reached ESKD (60.7% men) and 245 died (62.4% men). Risks of ESKD and mortality (hazard ratio and 95% confidence interval), adjusted for demographic and clinical variables, were higher in men (1.34, 1.02–1.76 and 1.36, 1.02–1.83, respectively). Adjustment for office BP at goal did not modify this association. In contrast, adjustment for ABP at goal attenuated the increased risk in men for ESKD (1.29, 0.98–1.70) and death (1.31, 0.98–1.77). In the fully adjusted model, ABP at goal was associated with reduced risk of ESKD (0.49, 0.34–0.70) and death (0.59, 0.43–0.80). No interaction between sex and ABP at goal on the risk of ESKD and death was found, suggesting that ABP-driven risks are consistent in males and females.

Conclusions

Our study highlights that higher ABP significantly contributes to higher risks of ESKD and mortality in men.
Textural and Geochemical Evidence for Multiple, Sheet-like Magma Pulses in the Limeira Intrusion, Paraná Magmatic Province, Brazil
Authors: Lino Lucas Martins , Vlach Silvio Roberto Farias
Published: January 2021

Quantitative petrographic, structural, and textural parameters are integrated with geological, geochemical, and Sr-isotope data to examine the emplacement, growth processes, and magmatic evolution of the high-Ti tholeiitic Limeira Intrusion, in the Paraná Magmatic Province of SE Brazil. Our data strongly support a multiple-stage evolution, owing to the nested emplacement of distinct crystal-bearing magma pulses that probably evolved independently, except at their boundaries. A stage of cooling and crystallization between magma injections results in a stepwise T–t path, leading to variations in the plagioclase residence times and effective growth rates inwards, also occasioning sudden changes in crystal shape and size at the boundaries of each magma pulse. The time delay between pulses allows preservation of internal ‘chilled margins’ and the development of near-rigid surfaces at their contacts, increasing the alignment and clustering of crystals during magma replenishment. Isotopic and textural data demonstrate a complex assembly history, in which the appearance of mixed plagioclase populations between magma pulses coincides with the onset of initial Sr isotope ratio increase, which can be attributed to a locally enhanced cooling rate, and the extraction of residual melts from the previous crystallizing batches and mixing with the younger pulses. Typical C- and S-shaped MgO (wt%) compositional profiles within individual pulses indicate that the first one probably evolved by in situ fractional crystallization followed by melt migration inward, whereas the younger ones have contributions from both compaction of the lowermost crystallization front and compositional convection. Mafic globular structures are found at the boundaries of magma pulses and constituting the mafic-rich layers in layered rocks. They are interpreted as evidence for chemical disequilibrium, arguably associated with the trigger of silicate liquid immiscibility. The upwards compositional convection of the silica-rich residual liquid and the accumulation of the Fe–Ti–P-rich crystalbearing end-member in the bottom of the latest magma pulses might represent the most significant mechanism of differentiation in the Limeira Intrusion.
Association of AM-PAC “6-Clicks” Basic Mobility and Daily Activity Scores With Discharge Destination
Authors: Warren Meghan , Knecht Jeff , Verheijde Joseph , Tompkins James
Published: January 2021

Objective

The objective was to use the Activity Measure for Post-Acute Care “6-Clicks” scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]).

Methods

In this retrospective cohort study, initial “6-Clicks” Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility (≤40.78 vs >40.78) and Daily Activity (≤40.22 vs >40.22), accounting for patient and clinical characteristics.

Results

Area under the curve for Basic Mobility was 0.80 (95% CI = 0.80–0.81) and Daily Activity was 0.81 (95% CI = 0.80–0.82). The best cut-point for Basic Mobility was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for Daily Activity was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores ≤40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5–1.9]), SNF (OR = 7.8 [95% CI = 6.8–8.9]), and IRF (OR = 7.5 [95% CI = 6.3–9.1]), and the Daily Activity scores ≤40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7–2.0]), SNF (OR = 8.9 [95% CI = 7.9–10.0]), and IRF (OR = 11.4 [95% CI = 9.7–13.5]).

Conclusion

6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels.

Impact

Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination.
Priorities of Hybrid Clinician-Managers: A Qualitative Study of How Managers Balance Clinical Quality Among Competing Responsibilities
Authors: Hoekstra Christopher J , Ash Joan S , Steckler Nicole A , Becton James R , Sanders Benjamin W , Mishra Meenakshi , Gorman Paul N
Published: January 2021

Objective

Oversight of clinical quality is only one of physical therapy managers’ multiple responsibilities. With the move to value-based care, organizations need sound management to navigate this evolving reimbursement landscape. Previous research has not explored how competing priorities affect physical therapy managers’ oversight of clinical quality. The purpose of this study was to create a preliminary model of the competing priorities, motivations, and responsibilities of managers while overseeing clinical quality.

Methods

This qualitative study used the Rapid Qualitative Inquiry method. A purposive sample of 40 physical therapy managers and corporate leaders was recruited. A research team performed semi-structured interviews and observations in outpatient practices. The team used a grounded theory-based immersion/crystallization analysis approach. Identified themes delineated the competing priorities and workflows these managers use in their administrative duties.

Results

Six primary themes were identified that illustrate how managers: (1) balance managerial and professional priorities; (2) are susceptible to stakeholder influences; (3) experience internal conflict; (4) struggle to measure and define quality objectively; (5) are influenced by the culture and structure of their respective organizations; and (6) have professional needs apart from the needs of their clinics.

Conclusion

Generally, managers’ focus on clinical quality is notably less comprehensive than their focus on clinical operations. Additionally, the complex role of hybrid clinician-manager leaves limited time beyond direct patient care for administrative duties. Managers in organizations that hold them accountable to quality-based metrics have more systematic clinical quality oversight processes.

Impact

This study gives physical therapy organizations a framework of factors that can be influenced to better facilitate managers’ effective oversight of clinical quality. Organizations offering support for those managerial responsibilities will be well positioned to thrive in the new fee-for-value care structure.
A distinguishing profile of chemokines, cytokines and biomarkers in the saliva of children with Sjögren’s syndrome
Authors: Gomez Hernandez M Paula , Starman Emily E , Davis Andrew B , Withanage Miyuraj Harishchandra Hikkaduwa , Zeng Erliang , Lieberman Scott M , Brogden Kim A , Lanzel Emily A
Published: January 2021

Objective

SS is an autoimmune disease most commonly diagnosed in adults but can occur in children. Our objective was to assess the presence of chemokines, cytokines and biomarkers (CCBMs) in saliva from these children that were associated with lymphocyte and mononuclear cell functions.

Methods

Saliva was collected from 11 children diagnosed with SS prior to age 18 years and 16 normal healthy children. A total of 105 CCBMs were detected in multiplex microparticle-based immunoassays. ANOVA and t test (0.05 level) were used to detect differences. Ingenuity Pathway Analysis (IPA) was used to assess whether elevated CCBMs were in annotations associated with immune system diseases and select leukocyte activities and functions. Machine learning methods were used to evaluate the predictive power of these CCBMs for SS and were measured by receiver operating characteristic (ROC) curve and area under curve (AUC).

Results

Of the 105 CCBMs detected, 43 (40.9%) differed in children with SS from those in healthy study controls (P < 0.05) and could differentiate the two groups (P < 0.05). Elevated CCBMs in IPA annotations were associated with autoimmune diseases and with leukocyte chemotaxis, migration, proliferation, and regulation of T cell activation. The best AUC value in ROC analysis was 0.93, indicating that there are small numbers of CCBMs that may be useful for diagnosis of SS.

Conclusion

While 35 of these 43 CCBMs have been previously reported in SS, 8 CCBMs had not. Additional studies focusing on these CCBMs may provide further insight into disease pathogenesis and may contribute to diagnosis of SS in children.
Racial Segregation under Slavery
Authors: Ruef Martin
Published: January 2021

Social demographers and historians have devoted extensive research to patterns of racial segregation that emerged under Jim Crow and during the post-Civil Rights era but have paid less attention to the role of slavery in shaping the residential distribution of Black populations in the United States. One guiding assumption has been that slavery rendered racial segregation to be both unnecessary and impractical. In this study, I argue that apart from the master–slave relationship, slavery relentlessly produced racial segregation during the antebellum period through the residential isolation of slaves and free people of color. To explain this pattern, I draw on racial threat theory to test hypotheses regarding interracial economic competition and fear of slave mobilization using data from the 1850 Census, as well as an architectural survey of antebellum sites. Findings suggest that the residential segregation of free people of color increased with their local prevalence, whereas the segregation of slaves increased with the prevalence of the slave population. These patterns continue to hold after controlling for interracial competition over land or jobs and past slave rebellions or conspiracies.
Distributional characterizations and testing for differences of relatedness and inbreeding of a subpopulation of American Hereford bulls
Authors: Simmons M A , Riggs P K , Sanders S , Herring A D , Sanders J O , Riley D G
Published: January 2021

Beta distributions are characterized by two determining parameters and a parameter space from 0 to 1, and may be useful for examining population genetic parameters such as the relationship or inbreeding coefficients. Often subpopulations exist within breeds that are congregated around particular lineages of cattle or ancestors that breeders value. These subpopulations are more related to each other than to the majority of other animals; they may have higher inbreeding as well. Value may be added to these subpopulations because of their relatedness with important or renowned ancestors. The objectives of this work were to compare the relatedness and inbreeding of a group of 26 modern bulls from a subpopulation of the American Hereford breed relative to 1) 30 males with the most descendants present in the pedigree, 2) 15 renowned American Hereford bulls considered important individuals in the breed’s history, and 3) 19 prominent subpopulation male ancestors. Conformance of the mean relationship coefficients of the bulls with the three groups and the mean inbreeding coefficient with all pedigree animals to beta distributions was assessed by 1) visually determining the parameters of the beta distributions based on the entire pedigree, 2) testing the mean relationship coefficient or inbreeding coefficient of the group of subpopulation bulls for its positional inclusion in those distributions, and 3) bootstrap sampling methodology. The mean relationship coefficients of the 26 Trask bulls with the 30 bulls with the most descendants, the 15 renowned ancestors, and the 19 Trask male ancestors were 0.15, 0.132, and 0.208, respectively. Testing of these means in beta distributions indicated that the group of 26 Trask bulls were no more related to the three groups of bulls than all of the animals in the pedigree (0.06 < P < 0.25). Bootstrap sampling indicated that the 26 bulls were more related to the three groups of male ancestors than the remainder of the animals in the pedigree (P < 0.0001). The mean inbreeding coefficient of the 26 bulls (0.13) did not differ from the overall inbreeding coefficient (0.056) when tested using a beta distribution; however, bootstrap sampling indicated otherwise (P < 0.0001). Results may indicate the inadequacy of visually parameterizing a beta distribution. Quantification of pedigree relatedness of a group of animals to key ancestors, especially with no DNA available, may add value to that group and individuals.
Genetic changes in beef cow traits following selection for calving ease
Authors: Bennett Gary L , Thallman Richard M , Snelling Warren M , Keele John W , Freetly Harvey C , Kuehn Larry A
Published: January 2021

One approach to reducing calving difficulty is to select heifers with higher breeding value for calving ease. Calving ease is often associated with lower birth weight and that may result in other possible effects on lifetime productivity. Females from experimental select and control calving ease lines within each of the seven populations were compared. Random samples of 720 heifers from lines selected for better calving ease breeding values and 190 heifers from control lines selected for average birth weights were followed through four parities. Select and control lines within the same population were selected to achieve similar yearling weight breeding values. Weights of sampled heifers in select lines were 2.6 kg (P < 0.01) lighter at birth but not different from control lines at weaning. Select lines had significantly shorter hip height, lighter mature weight, and greater calving success at second parity. Their calves were born significantly earlier with lighter weights and less assistance. Significant interactions with parity showed fewer calves assisted and greater calf survival to weaning as heifers but negligible differences with control lines in later parities. Steer progeny sampled from these dams in select lines (n = 204) were not different from steers in control lines (n = 91) for hot carcass weight but had significantly greater fat depth. Two production systems were compared considering the seven populations as replicates. The systems differed in selection history of females (select and control lines) and the use of bulls within their lines as young cows, but used the same bulls in both lines as older cows. Cows were culled after single unsuccessful breeding and kept for up to four parities. Select line cows tended (P ≤ 0.10) to wean more calves and stay in the herd longer. They were assisted significantly fewer times at calving and had greater calf weight gain to weaning when evaluated over their herd life. Mature weights were lighter in select lines, but marketable cow weight from the systems was nearly identical. Control lines did have more marketable young cow weight and select lines older cow weight. Weaned calf weight per heifer starting the system was significantly greater for the select heifer system due to greater survival of calves from heifers and greater calving success at second parity. No important unfavorable effects of genetic differences in calving ease were identified in this experiment.
Pleomorphic Fibroma: A Clinicopathologic Case Series With the Review of the Literature
Authors: Potts Geoffrey A. , Adlam Taylor , Stierman Sarah C. , Moossavi Meena , Mehregan Darius
Published: January 2021

Background:

Pleomorphic fibromas are rare flesh-colored benign neoplasms first described in 1989. Their histopathology is notable for nuclear pleomorphism of spindle cells and multinucleate giant cells but lacking mitoses. The cellular origin of these tumors is unknown. This case series describes an additional 18 lesions with discussion of histopathology and immunohistochemistry.

Methods:

This case series of 18 pleomorphic fibromas uses immunohistochemical staining for CD34, CD68, factor XIIIa, and S-100 and general histopathologic examination under light microscopy to describe the lesions.

Results:

Immunohistochemical stains for CD34 showed nearly universal positivity of the pleomorphic spindle cells, although some more focally. The pleomorphic cells were negative for CD68, variably positive for factor XIIIa, and universally negative for S-100. All the lesions showed characteristic nuclear pleomorphism with absent mitoses. Collagen thickening was variable, mucin was absent, and perivascular inflammation was present in all lesions.

Conclusions:

Pleomorphic fibromas are fibrous lesions with benign clinical course and histopathologic findings including nuclear pleomorphism. Immunohistochemical staining characteristics of the lesion, along with unique spindle cells and multinucleate giant cells help to differentiate this from other tumors.
Pure and Mixed Desmoplastic Melanomas: A Retrospective Clinicopathologic Comparison of 33 Cases
Authors: Chu Sherman , Schrom Kory P. , Tripathi Raghav , Conic Rosalynn R. Z. , Ezaldein Harib H. , Scott Jeffrey F. , Honda Kord
Published: January 2021

Background:

Pure and mixed desmoplastic melanomas (DMs) may have different natural histories and behaviors.

Methods:

We conducted a retrospective review of patients diagnosed with DM at our institution between January 1997 and April 2019. A total of 33 unique DMs were identified and subsequently analyzed based on the histologic type (pure vs. mixed).

Results:

The majority (57.6%) of our cases were classified as pure histology. Patients with pure DMs were more likely to be men (P = 0.035) and be older than 65 years (P = 0.019) compared with patients with mixed DMs. Patients with mixed DM were more likely to have mitoses present (P = 0.001) compared with patients with pure DM. There were no differences in ulceration, perineural invasion, vascular invasion, or survival between patients with pure and mixed histologic subtypes. In addition, no differences in sentinel lymph node biopsy, radiation, or chemotherapy were noted between the 2 histologic subtypes. Immunohistochemistry showed that 27.3% of the pure DMs stained with Melan-A and HMB45 were positive for these immunomarkers.

Conclusions:

Pure and mixed variants of DM were found to have similar clinicopathologic characteristics. Patients with the mixed histologic subtype were more likely to have mitoses, but no difference in the therapeutic management or patient survival was seen between the 2 subtypes.
Differences Between Recommended Surgical Margins and Measured Histological Margins in Malignant Melanoma In Situ and Malignant Melanomas
Authors: Tababa Erin , Teulings Hansje-Eva , Bhawan Jag
Published: January 2021

Wide local excision (WLE) using appropriate surgical margins is the standard surgical management for malignant melanoma in situ (MMIS) and primary cutaneous malignant melanoma (MM). The actual width of the histologic margins is frequently not assessed, whereas narrow histologic margins are associated with an increase in local melanoma recurrence. Our objective was to analyze the actual measured histological margins of WLE specimens of MMIS and MM cases and compare them with their recommended surgical margins. A retrospective study of formalin fixed specimens of MMIS and invasive MM treated with WLE from a large university-affiliated dermatopathology laboratory was conducted. Among a total of 164 MMIS and 128 MM cases, 14 MMIS (8.5%) and 7 MM (5.9%) had positive lateral margins. The median histologic margin for MMIS, after a 15% tissue shrinkage adjusted, was 2.7 mm [1.3–3.9] for LM type and 3.9 mm [2.3–5.6] for non-LM type, in contrast to the recommended 5-mm margin. In 96 MM of T1 type (≤1.0 mm), the median adjusted histologic margin was 6.7 mm [3.5–9.1] in contrast to the recommended 10-mm margin. These results show that measured and adjusted median histologic margins in WLE specimens in both MMIS and MM of T1 type were significantly narrower than the recommended surgical margins, regardless of anatomic location. These differences are concerning, whether they reflect clinicians' intentional or unintentional deviation from recommended guidelines.
Comparison of the Parents' Evaluation of Developmental Status and Ages and Stages Questionnaire Developmental Screening Tests in a Eurasian Country
Authors: Çelen Yoldaş Tuba , Karakaya Jale , Özdemir Gökçenur , Engin Erdal Ayşenur , Özmert Elif Nursel
Published: January 2021

Objective:

The Parents' Evaluation of Developmental Status (PEDS) and the Ages and Stages Questionnaire (ASQ) are developmental screening tools that are commonly used in pediatric practice worldwide. We aimed to compare the screening results of the PEDS and the ASQ in children with a wide range of ages and to evaluate the degree of agreement between the tests across the age groups.

Methods:

The study was conducted with the participation of 327 children aged 3 to 72 months. Participants were administered the PEDS and then the ASQ. Children with known developmental disabilities were included in the study to represent a real-world clinical practice setting and evaluated with a clinical workup.

Results:

The median age of the children was 35.1 months, with a range of 3 to 72 months. The percentage of children with known developmental disabilities was 16.5%. The actual agreement between the PEDS and ASQ was 74% with a concordance represented by Cohen κ of 0.422 (p < 0.001) in the total sample. Furthermore, the agreement was higher in children aged 25 to 36 months and 37 to 48 months than for the other ages.

Conclusion:

We compared the clinical features of the ASQ and PEDS across the age groups, and they demonstrated moderate agreement. The present study also showed the performance of the PEDS and suggests that it should certainly be used for developmental screening in routine child health care practice in Eurasia, thus supporting the use of such parent-completed developmental tools that should be encouraged for universal screening.
Prehospital Emergency Medical Services: Paper Versus Technology
Authors: Piani Tommaso , Boccolato Lorenzo , Ruzza Gianpaolo , Pausler Daniele , Trillò Giulio , Macor Cristiana , Pascolo Piero , De Monte Amato
Published: January 2021

Digital technology has an essential role in the development and application of innovations within the health care system. Its application is not limited to the hospital environment but extends to the emergency medical services system. The experimental phase of the shift to electronic emergency medical services documentation was performed within the Azienda Sanitaria Universitaria Friuli Centrale of Udine (Italy), a local health authority covering about 533 000 inhabitants. Considering the results of this study, we believe it is important to continue to update the methods of data collection and analysis in correlation with the management and outcomes of the patients.
Sleep in Aneurysmal Subarachnoid Hemorrhage Patients During Critical and Acute Care
Authors: Fowler Susan B. , Walker Sarah , Jones Timothy W. , Gell Lauren
Published: January 2021

Background

Nurses caring for intensive care patients diagnosed with an aneurysmal subarachnoid hemorrhage (aSAH) conduct frequent neurological assessments and vital signs over an extended period during which patients are at risk of vasospasm. The frequency of assessments can negatively impact sleep, resulting in altered thought processes and mood, including delirium. There are 2 types of sleep during the night: non–rapid eye movement (non-REM) sleep and REM sleep (also called stage R). Non-REM sleep is subdivided into 3 stages: stage N1, stage N2, and stage N3. These 4 stages of sleep are referred to as sleep architecture.

Objective

The aim of this study was to explore patterns of sleep in patients with aSAH over time during hospitalization.

Methods

Sleep data of stages and cycles were collected with use of a Fitbit activity tracker in this pilot, exploratory research study. Demographic data included age and gender. Six English-speaking patients, diagnosed with an aneurysmal SAH, confirmed by diagnostic angiogram, were followed in neuro–intensive care unit (ICU), neuro–step-down, neuroscience unit, and inpatient rehabilitation.

Results

There were a total of 226 sleep events. A sleep event encompassed a recorded start and end time on a single date. Each event included several sleep cycles. Each sleep cycle consisted of wakefulness, light sleep, deep sleep, and REM sleep. In 79 sleep events, light and deep sleep did add up to more than 4 hours; only 38 sleep events indicated more than 90 minutes of REM/night; 61 events showed the cycle of light-deep-light-REM cycles; 80 events showed 3 to 5 REM periods/night; and only 46 events demonstrated that the early-morning REM cycle was the longest. The average number of REM cycles increased from ICU (n = 4.6) to rehabilitation (n = 6.5). The percentage of days with sleep cycles also increased from ICU to rehabilitation (42 to 64).

Discussion

“Normal” sleep patterns are disrupted in aSAH patients throughout their hospitalization. Data in this study revealed that the patients do sleep; however, it is rarely organized. Patients were not always able to progress through the expected sleep cycle of light to deep to light to REM. Hospitalized aSAH patients do engage in REM sleep, but its pattern is abnormal. Staff should strategize on minimizing interruptions, clustering care, and minimizing sounds. Nurses should advocate for the frequency of assessments and vital signs based on hospital/unit policy and individual patient needs.
Low-Risk Essential Thrombocythemia: A Comprehensive Review
Authors: Robinson Andrew J. , Godfrey Anna L.
Published: January 2021

Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm characterized by a persistently elevated platelet count in the absence of a secondary cause. The clinical consequences of uncontrolled thrombocytosis can include both thrombosis and hemorrhage. Patients with features conferring a “high risk” of vascular events benefit from reduction of the platelet count through cytoreductive therapy. The management of patients who lack such high-risk features has until recently been less well defined, but it is now apparent that many require minimal or even no intervention. In this review, we discuss the diagnostic pathway for younger patients with unexplained thrombocytosis, including screening molecular investigations, the role of bone marrow biopsy, and investigations in those patients negative for the classic myeloproliferative neoplasm driver mutations (JAK2, CALR, MPL). We discuss conventional and novel risk stratification methods in essential thrombocythemia and how these can be best applied in clinical practice, particularly in the era of more comprehensive genomic testing. The treatment approach for “low risk” patients is discussed including antiplatelets and the options for cytoreductive therapy, if indicated, together with areas of clinical need for future study.
NEW, SIMPLE, AND SAFE SURGICAL TECHNIQUE FOR THE REMOVAL OF A DISLOCATED CAPSULAR TENSION RING–INTRAOCULAR LENS–CAPSULAR BAG COMPLEX
Authors: Shiraki Akihiko , Sakaguchi Hirokazu , Nishida Kohji
Published: January 2021

Background/Purpose:

To report a safe and simple surgical technique for the removal of a dislocated capsular tension ring (CTR)–intraocular lens (IOL)–capsular bag (CB) complex.

Methods:

We present an extraocular surgical removal technique for a dislocated CTR–IOL–CB complex. Although the entire complex is typically removed with a large incision, this approach applies a CTR injector and anterior capsule forceps in a less invasive manner.

Results:

After vitrectomy, the complex was moved to the anterior chamber, where the tip of the CTR was separated from the IOL–CB using anterior capsule forceps and hooked onto the tip of the CTR injector. Subsequently, the CTR, as well as part of the CB, was gradually separated from the IOL–CB and stored in the CTR injector. This was completed while also supporting the IOL–CB complex using the forceps. Once the whole CTR and the part of CB were removed from the anterior chamber, the residual IOL and CB were then removed.

Conclusion:

Our methodology, using the CTR injector and anterior capsule forceps, enables the procedure to be completed with only a small corneal incision, thereby allowing for the safe and simple removal of a CTR–IOL–CB complex.
RETINAL FLUORESCEIN ANGIOGRAPHY IN SUSAC SYNDROME: A SHIFTING PATTERN OF ARTERIOLAR WALL HYPERFLUORESCENCE—A REPORT OF TWO CASES
Authors: Van Oevelen Kathy , Dirven Werner , Tassignon Marie-José , Van Os Luc
Published: January 2021

Background:

Susac syndrome consists of the triad of encephalopathy, branch retinal artery occlusion, and hearing loss and is believed to be an immune-mediated endotheliopathy. Arteriolar wall hyperfluorescence (AWH) on retinal fluorescein angiography (FA) has been described in the literature as a classic ophthalmic sign for Susac syndrome. In this article, we report a pattern of distally shifting segments of AWH on FA over time that was observed in two cases.

Methods:

Two cases of Susac syndrome are presented with an emphasis on FA findings, obtained at frequent intervals during follow-up.

Results:

In both cases, FA displays a shifting pattern of segments of AWH distal to the localization of the AWH observed on the previous FA.

Conclusion:

In patients with Susac syndrome, FA plays an important role in aiding diagnosis and monitoring the efficacy of treatment and disease activity during follow-up. In these two cases, the angiography revealed how the AWH can migrate along the vessel over time. This is the first published report showing an evolving distally shifting pattern of AWH in patients with Susac syndrome.
Development of Cytomegalovirus Corneal Endotheliitis During Long-Term Topical Tacrolimus and Steroid Treatment for Chronic Ocular Surface Inflammatory Diseases
Authors: Yokogawa Hideaki , Kobayashi Akira , Takemoto Yuko , Mori Natsuko , Wajima Ryotaro , Nishino Tsubasa , Sugiyama Kazuhisa
Published: January 2021

Purpose:

We report 3 cases of patients with chronic ocular surface inflammatory disease who developed cytomegalovirus (CMV) corneal endotheliitis during immunosuppressant and steroid treatment.

Patients and Methods:

This is a retrospective observational study analyzing the clinical characteristics and outcomes of 3 patients with ocular surface inflammatory diseases (2 with Mooren ulcer and 1 with idiopathic scleritis) who developed CMV corneal endotheliitis. All patients developed CMV corneal endotheliitis between 8 and 14 months of starting steroid and immunosuppressant treatment, including topical 0.1% tacrolimus. Decimal visual acuity, endothelial counts, and intraocular pressure were analyzed.

Results:

All patients received topical 0.5% ganciclovir after the diagnosis of CMV corneal endotheliitis, which improved endothelial inflammation. However, all patients developed irreversible mydriasis and required additional surgeries, including endothelial keratoplasty, cataract surgery, and glaucoma surgery. At the final follow-up (14–46 months post-CMV corneal endotheliitis onset), fair outcomes were achieved, as demonstrated by a mean decimal best-corrected visual acuity of 0.3 and a well-controlled intraocular pressure.

Conclusions:

Topical steroids and immunosuppressants can induce fulminant CMV corneal endotheliitis with cataract progression and irreversible mydriasis. In these cases, early diagnosis and treatment, including topical 0.5% ganciclovir, glaucoma surgery, cataract surgery, and endothelial keratoplasty, are necessary for preserving the patient's vision.
Analysis of Efficacy and Safety of Pediatric Ahmed Glaucoma Valve (FP8) in Advanced Age Populations
Authors: Crichton Paul , Sanders Emi , Docherty Gavin , Crichton Andrew
Published: January 2021

Precis:

The FP8 glaucoma valve was demonstrated to be reasonably safe with reliable results in an advanced age patient population.

Purpose:

As life expectancy increases, a growing number of patients with glaucoma are of an advanced age. There are little to no data looking at glaucoma surgical treatment options in patients over the age of 85. Our study describes the safety and efficacy of the FP8 Ahmed glaucoma valve in this patient population.

Materials and Methods:

This was a retrospective study of patients over 85 years of age undergoing FP8 Ahmed glaucoma valve implantation. Preoperative age, sex, intraocular pressure (IOP), and number of glaucoma medications were recorded. Primary outcome variables were IOP and number of medications. Secondary outcome variables included any intraoperative or postoperative complications.

Results:

Mean IOP preoperatively was 26 mm Hg on an average of 3 glaucoma medications (n=56). IOP was significantly reduced at all time points in follow-up for an overall reduction of 42% at 1 year and 46% at 2 years. Mean IOP at 1 year follow-up was 15 mm Hg and 14 mm Hg at 2 years follow-up. Glaucoma medications were reduced from a mean of 3 preoperatively to 2 postoperatively.

Conclusions:

Implantation of an FP8 Ahmed glaucoma valve is a relatively safe procedure to achieve satisfactory IOP and decreased reliance on glaucoma medications in an advanced age population.
The association between fungi exposure and hypersensitivity pneumonitis: a systematic review
Authors: Gomes Marta Lopes , Morais António , Cavaleiro Rufo João
Published: January 2021

A systematic review of published studies focused on the association between hypersensitivity pneumonitis (HP) and fungi exposure was conducted on PubMed, following PRISMA guidelines for systematic reviews. A total of 14 studies met the inclusion criteria but only 6 of these studies were eligible, as the remaining 8 represented case reports that were separately included for further discussion. HP is an interstitial lung disease (ILD) characterized by a hypersensitization response to inhalable antigens and represents 1.5% to 12% of all ILD in the European population. Several fungi species that populate the indoor environment have been associated with the incidence of HP upon cumulative exposure, with Penicillium spp and Aspergillus spp being the fungi species most frequently associated with the onset of disease. Although some studies have shown that avoiding exposure to causative HP fungi tends to improve patients’ symptoms, other studies were unable to identify the source of sensitization. More microbial exposure studies are needed to properly estimate the risk of HP development in the built environment.
Stress-related consequences of the coronavirus disease 2019 pandemic on symptoms of Crohn’s disease
Authors: Goodday Sarah M. , Travis Simon , Walsh Alissa , Friend Stephen H.
Published: January 2021

Objectives

A link between stress and Crohn’s disease activity suggests an association, but results have been conflicting. The purpose of this study was to assess whether the stress related to the coronavirus disease 2019 (COVID-19) pandemic affected disease activity in patients with Crohn’s disease.

Basic methods

An anonymous survey was distributed to patients through gastroenterology clinics and networks. Patients were asked to report their Crohn’s disease symptoms in the months prior to the COVID-19 pandemic and again during the early stages of the COVID-19 pandemic using the Manitoba inflammatory bowel disease index in addition to questions about stress, perception of reasons for symptom change and personal impact.

Main results

Out of 243 individuals with a confirmed diagnosis of Crohn’s disease, there was a 24% relative increase in active symptoms between the pre-COVID-19 period to the during-COVID-19 period (P < 0.0001) reflecting an absolute change from 45 to 56%, respectively. The most frequent reported reason for a change in symptoms was ‘Increased stress/and or feeling overwhelmed’ (118/236), and personal impact of the pandemic was, ‘I’m worrying a lot about the future’ (113/236), both reported by approximately half of respondents.

Principal conclusions

This study serves as a ‘proof of concept’ demonstrating the impact of a significant and uniquely uniform stressor as a natural experiment on Crohn’s disease activity. The severity of symptoms of Crohn’s disease increased during the COVID-19 pandemic. The primary reported reason for symptom change was an increase in stress, not a change in diet, exercise or other lifestyle behaviours, corroborating the hypothesis that stress affects Crohn’s disease activity.
Nutrient sensing
Authors: Venugopal Anand , Bishu Shrinivas
Published: January 2021

Purpose of review

Sensing of nutrients is foundational for life and allows for cellular adaption to environmental stress. The aim of this review is to provide a basic background and overview of new data on cellular nutrient sensing.

Recent findings

We focus on sensing of energy by adenosine monophosphate-activated protein kinase, sensing of amino acids via general amino acid control nonderepresible 2 and regulation of cellular metabolism via mammalian target of rapamycin pathways. Over the last 5 years, new data has elucidated how these pathways are both interconnected and regulated by amino acids.

Regulation of these pathways is complex and tightly orchestrated in order to provide unified cellular responses that meet environmental demands. Amino acids provide key cues for the regulation of mammalian target of rapamycin pathways, in particular.
Shotblocker Use in Emergency Care
Authors: Yildirim Dilek , Dinçer Berna
Published: January 2021

This study was conducted to evaluate the effect of ShotBlocker on the intramuscular injection pain and satisfaction in emergency adult patients. This research was designed as a randomized controlled, double-blind, experimental study. The study was conducted with 74 patients who applied to the adult emergency department. Patients were randomized to ShotBlocker and control groups. Patient Assessment Form, Visual Analog Scale, and Visual Analog Patient Satisfaction Scale were used. The mean scores of postinjection pain and satisfaction level were analyzed between the groups; it was determined that while postinjection pain mean score of the experimental group was statistically significantly lower than that of the control group (p = 0.0001), satisfaction scores were statistically significantly higher in the experimental group than in the control group (p = 0.004). When the correlation between the intragroup Pain Scores (VAS) and the Satisfaction Scores (VAS) of the groups after injection was examined, a statistically significant and inverse correlation was found (p < 0.05). It was determined that ShotBlocker was effective in reducing intramuscular injection pain and increasing satisfaction levels.
Bladder Scan Misleading a Vascular Emergency as Urinary Retention
Authors: Sweeney Michael , Cerepani Mary Jo
Published: January 2021

A middle-aged man arrives from a nursing facility to the emergency department with urinary retention and abdominal pain. A bladder scan was performed to identify the amount of urine in the bladder. Multiple attempts were made to place a urinary catheter without difficulty, but no urine was identified. When several attempts are made to insert a urinary catheter without success of urinary output, one must stop and rule out other causes. This case study outlines the etiology, diagnostics tests, and management of a patient with urinary retention.
An Unusual Presentation of Intussusception
Authors: Dickson Kathryn , Gerhart Ann E. , Hoyt K. Sue
Published: January 2021

This is the case of a 9-month-old female infant who presented to the emergency department with a history of several episodes of nonbilious and nonbloody emesis. The patient was found to be afebrile with normal vital signs and an otherwise normal physical examination. Initial plain film radiography was concern for possible obstruction. Imaging studies with ultrasonogram demonstrated intussusception. This was an unusual case of intussusception because children are typically more ill-appearing with vomiting, diarrhea, fevers, lethargy, and blood in stool. Management options included surgery, pneumatic enema reduction, and barium enema reduction. Pneumatic enema reduction was performed. This procedure has been shown to have superior outcomes in infants with intussusception. Advanced practice providers need to provide a detailed history, complete a thorough physical examination, order the appropriate diagnostics, and be vigilant of the clinical manifestation of intussusception.
Proceed With Caution
Authors: Duchscher Judy E. , Painter Sarah
Published: January 2021

Virtually, no published research is available on the relationship between employing newly graduated nurses (NGNs) in the emergency department (ED) and the advancing of nursing practice and the optimization of patient care outcomes. Traditionally, nurses hired into these practice areas have required advanced skills in clinical assessment and experience with a variety of situations that were assumed to offer them a framework by which they could recognize and respond to potentially life-threatening changes in a patient's status. This qualitative study explored the issues of integrating NGNs into the ED. Findings clearly established the challenges to integrating NGNs into this practice context. The intersection of variables included a low level of clinical predictability accompanied by high acuity; an increased level of practitioner autonomy combined with high levels of risk when applying decision making to patient outcomes; and the potential for devolution of professional identity in the face of highly intense, morally conflicted, and socially nuanced care situations.
A Systems Approach to Front-End Redesign With Rapid Triage Implementation
Authors: Chmielewski Nicholas Alen , Tomkin Theresa , Edelstein Gara
Published: January 2021

The most common site for hospital sentinel events due to care delays, secondary to waiting and/or inefficient processes, occurs in the emergency department (ED). Decreasing patient length of stay in an ED is a key initiative for many hospitals in order to maximize both quality and efficiency. The purpose of this practice improvement project was to (1) standardize front-end processes across a 6-hospital health system, (2) move non-sorting-related clinical questions out of triage, and (3) improve door-to-triage and door-to-provider times. The project occurred within a 6-hospital East Coast health system. This was a continuous quality improvement initiative utilizing the Donabedian theoretical model, plus the DMAIC method, for process improvement. A system-wide performance work team was formed including ED leaders and staff; site-specific implementation teams were also formed. Rapid triage implementation was effective in producing statistically significant improvement in door-to-triage, door-to-provider, and ED length of stay for discharged patients at 3 of the 6 sites. Further performance improvement projects in this area are needed to better understand the generalizability of this process in other EDs. Furthermore, from a leadership perspective, additional investigation is needed into the cost savings as well as shared labor opportunities that may exist when policies and processes are standardized across a system's service line.