bluuebunny/crossref_metadata_2025 huggingface dataset:
Computer models of cell polarity establishment in plants
Authors: Marconi Marco , Wabnik Krzysztof
Published: May 2023

Plant development is a complex task, and many processes involve changes in the asymmetric subcellular distribution of cell components that strongly depend on cell polarity. Cell polarity regulates anisotropic growth and polar localization of membrane proteins and helps to identify the cell’s position relative to its neighbors within an organ. Cell polarity is critical in a variety of plant developmental processes, including embryogenesis, cell division, and response to external stimuli. The most conspicuous downstream effect of cell polarity is the polar transport of the phytohormone auxin, which is the only known hormone transported in a polar fashion in and out of cells by specialized exporters and importers. The biological processes behind the establishment of cell polarity are still unknown, and researchers have proposed several models that have been tested using computer simulations. The evolution of computer models has progressed in tandem with scientific discoveries, which have highlighted the importance of genetic, chemical, and mechanical input in determining cell polarity and regulating polarity-dependent processes such as anisotropic growth, protein subcellular localization, and the development of organ shapes. The purpose of this review is to provide a comprehensive overview of the current understanding of computer models of cell polarity establishment in plants, focusing on the molecular and cellular mechanisms, the proteins involved, and the current state of the field.
Cyclophilin 37 maintains electron transport via the cytochrome b6/f complex under high light in Arabidopsis
Authors: Yang Xiaoxia , Che Yufen , García Veder J , Shen Jianqiang , Zheng Yutong , Su Zhezheng , Zhu Li , Luan Sheng , Hou Xin
Published: May 2023

Plants have evolved multiple mechanisms to cope with diverse types of light stress, particularly the regulation of the electron transport chain (ETC). Under high light (HL) conditions, the balance of electron flux in the ETC is disturbed, which leads to the overaccumulation of reactive oxygen species (ROS) and results in photodamage and photoinhibition. The cytochrome (Cyt) b6/f complex, which coordinates electron transfer between photosystems I and II (PSI and PSII), plays an essential role in regulating the ETC and initiating photoprotection. However, how the Cyt b6/f complex is maintained under HL conditions remains unclear. Here, we report that the activity of the Cyt b6/f complex is sustained by thylakoid-localized cyclophilin 37 (CYP37) in Arabidopsis (Arabidopsis thaliana). Compared with wild-type plants, cyp37 mutants displayed an imbalance in electron transport from Cyt b6/f to PSI under HL stress, which led to increased ROS accumulation, decreased anthocyanin biosynthesis, and increased chlorophyll degradation. Surprisingly, CYP37's role in regulating ETC balance was independent of photosynthesis control, which was indicated by a higher Y (ND), an indicator of P700 oxidation in PSI. Furthermore, the interaction between CYP37 and photosynthetic electron transfer A (PetA), a subunit of the Cyt b6/f complex, suggests that the central function of CYP37 is to maintain Cyt b6/f complex activity rather than to serve as an assembly factor. Our study provides insights into how plants balance electron flow between PSII and PSI via Cyt b6/f complex under HL.
Psychologically Informed Practice: The Importance of Communication in Clinical Implementation
Authors: Main Chris J , Ballengee Lindsay A , George Steven Z , Beneciuk Jason M , Greco Carol M , Simon Corey B
Published: May 2023

There has been increasing interest in the secondary prevention of chronic pain and pain-associated disability over the past 3 decades. In 2011, psychologically informed practice (PiP) was suggested as a framework for managing persistent and recurrent pain, and, since then, it has underpinned the development of stratified care linking risk identification (screening). Although PiP research trials have demonstrated clinical and economic advantage over usual care, pragmatic studies have been less successful, and qualitative studies have identified implementation difficulties in both system delivery and individual clinical management. Effort has been put into the development of screening tools, the development of training, and the assessment of outcomes; however, the nature of the consultation has remained relatively unexplored. In this Perspective, a review of the nature of clinical consultations and the clinician–patient relationship is followed by reflections on the nature of communication and the outcome of training courses. Consideration is given to the optimization of communication, including the use of standardized patient-reported measures and the role of the therapist in facilitating adaptive behavior change. Several challenges in implementing a PiP approach in day-to-day practice are then considered. Following brief consideration of the impact of recent developments in health care, the Perspective concludes with a brief introduction to the PiP Consultation Roadmap (the subject of a companion paper), the use of which is suggested as a way of structuring the consultation with the flexibility required for a patient-centered approach to guided self-management of chronic pain conditions.
Model design for nonparametric phylodynamic inference and applications to pathogen surveillance
Authors: Didelot Xavier , Franceschi Vinicius , Frost Simon D. W , Dennis Ann , Volz Erik M
Published: May 2023

Inference of effective population size from genomic data can provide unique information about demographic history and, when applied to pathogen genetic data, can also provide insights into epidemiological dynamics. The combination of nonparametric models for population dynamics with molecular clock models which relate genetic data to time has enabled phylodynamic inference based on large sets of time-stamped genetic sequence data. The methodology for nonparametric inference of effective population size is well-developed in the Bayesian setting, but here we develop a frequentist approach based on nonparametric latent process models of population size dynamics. We appeal to statistical principles based on out-of-sample prediction accuracy in order to optimize parameters that control shape and smoothness of the population size over time. Our methodology is implemented in a new R package entitled mlesky. We demonstrate the flexibility and speed of this approach in a series of simulation experiments and apply the methodology to a dataset of HIV-1 in the USA. We also estimate the impact of non-pharmaceutical interventions for COVID-19 in England using thousands of SARS-CoV-2 sequences. By incorporating a measure of the strength of these interventions over time within the phylodynamic model, we estimate the impact of the first national lockdown in the UK on the epidemic reproduction number.
MFG‐E8 promotes osteogenic differentiation of human bone marrow mesenchymal stem cells through GSK3β/β‐catenin signaling pathway
Authors: Bai Jinwu , Zhang Weijun , Zhou Chenwei , Zhao Guangfeng , Zhong Huiming , Hang Kai , Xu Jianxiang , Zhang Wei , Chen Erman , Wu Jiaqi , Liu Ling , Xue Deting
Published: May 2023

Fracture nonunion and bone defects are challenging for orthopedic surgeons. Milk fat globule‐epidermal growth factor 8 (MFG‐E8), a glycoprotein possibly secreted by macrophages in a fracture hematoma, participates in bone development. However, the role of MFG‐E8 in the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) is unclear. We investigated the osteogenic effect of MFG‐E8 in vitro and in vivo. The CCK‐8 assay was used to assess the effect of recombinant human MFG‐E8 (rhMFG‐E8) on the viability of hBMSCs. Osteogenesis was investigated using RT‐PCR, Western blotting, and immunofluorescence. Alkaline phosphatase (ALP) and Alizarin red staining were used to evaluate ALP activity and mineralization, respectively. An enzyme‐linked immunosorbent assay was conducted to evaluate the secretory MFG‐E8 concentration. Knockdown and overexpression of MFG‐E8 in hBMSCs were established via siRNA and lentivirus vector transfection, respectively. Exogenous rhMFG‐E8 was used to verify the in vivo therapeutic effect in a tibia bone defect model based on radiographic analysis and histological evaluation. Endogenous and secretory MFG‐E8 levels increased significantly during the early osteogenic differentiation of hBMSCs. Knockdown of MFG‐E8 inhibited the osteogenic differentiation of hBMSCs. Overexpression of MFG‐E8 and rhMFG‐E8 protein increased the expression of osteogenesis‐related genes and proteins and enhanced calcium deposition. The active β‐catenin to total β‐catenin ratio and the p‐GSK3β protein level were increased by MFG‐E8. The MFG‐E8‐induced enhanced osteogenic differentiation of hBMSCs was partially attenuated by a GSK3β/β‐catenin signaling inhibitor. Recombinant MFG‐E8 accelerated bone healing in a rat tibial‐defect model. In conclusion, MFG‐E8 promotes the osteogenic differentiation of hBMSCs by regulating the GSK3β/β‐catenin signaling pathway and so, is a potential therapeutic target.
Preoperative HbA1c and Postoperative Outcomes in Spine Surgery
Authors: Tao Xu , Matur Abhijith V. , Palmisciano Paolo , Conteh Fatu S. , Onyewadume Louisa , Duah Henry O. , Shukla Geet , Vorster Phillip , Gupta Sahil , Chilakapati Sai S. , Adogwa Owoicho
Published: May 2023

Study Design.

Systematic review and meta-analysis.

Objective.

To perform a systematic review and meta-analysis of previous studies on HbA1c in preoperative risk stratification in patients undergoing spinal procedures and provide an overview of the consensus recommendations.

Summary of Background Data.

Diabetes mellitus (DM) and hyperglycemia have been shown to be independent risk factors for increased surgical complications. Glycated Hemoglobin A1C (HbA1c), a surrogate for long term glycemic control, is an important preoperative parameter that may be optimized to reduce surgical complications and improve patient-reported outcomes. However, comprehensive systematic reviews on preoperative HbA1c and postoperative outcomes in spine surgery have been limited.

Methods.

We systematically searched PubMed, EMBASE, Scopus, and Web-of-Science for English-language studies from inception through April 5th, 2022, including references of eligible articles. The search was conducted according to PRISMA guidelines. Only studies in patients undergoing spine surgery with preoperative HbA1c values and postoperative outcomes available were included.

Results.

A total of 22 articles (18 retrospective cohort studies, 4 prospective observational studies) were identified with level of evidence III or greater. The majority of studies (n=17) found that elevated preoperative HbA1c was associated with inferior outcomes or increased risk of complications. Random-effect meta-analysis demonstrated that patients with preoperative HbA1c >8.0% had increased risk(s) of postoperative complications (RR: 1.85, 95% CI: [1.48, 2.31], P<0.01) and that patients with surgical site infection (SSI) had higher preoperative HbA1c (Mean Difference: 1.49%, 95% CI: [0.11, 2.88], P=0.03).

Conclusion.

The findings of this study suggest that HbA1c >8.0% is associated with an increased risk of complications. HbA1c was higher by 1.49% on average among patients with SSI when compared to patients who did not experience SSI. These results suggest that elevated HbA1c is associated with less favorable outcomes following spine surgery.

Level of Evidence.

IV
Predictors of Relevant Changes in Pain and Function for Adolescents With Idiopathic Scoliosis Following Surgery
Authors: Alamrani Samia , Gardner Adrian , Rushton Alison B. , Falla Deborah , Heneghan Nicola R.
Published: May 2023

Study Design.

Retrospective analysis of longitudinal data.

Objective.

To evaluate clinically relevant change in surgical outcomes for Adolescents with Idiopathic Scoliosis (AIS), comparing those who achieved smallest detectable change (SDC) in pain and function at 1-year post-surgery with those who did not, and to evaluate the influencing factors.

Summary of Background Data.

The SDC is recommended to evaluate the surgical outcomes of AIS. However, little is known about the use of SDC in AIS and its influencing factors.

Materials and Methods.

This was a retrospective analysis of longitudinal data from patients who underwent surgical correction at a tertiary spinal centre from 2009 to 2019. Surgical outcomes were assessed at short-term (6 wk, 6 mo) and long-term (1- and 2-years) post-surgery using the Scoliosis Research Society questionnaire (SRS-22r). The difference between “successful” (≥SDC) and “unsuccessful” (<SDC) groups was assessed using an independent t-test. Univariate and logistic regression analyses enabled the assessment of influencing factors.

Results.

All SRS-22r domains decreased in the short term, except for self-image and satisfaction. In the long term, self-image increased by 1.21 and function increased by 0.2, and pain decreased by 0.1. In all SRS-22r domains “successful” group had low pre-surgery scores and were statistically different to the “unsuccessful group”. The difference remained statistically significant at 1-year for most SRS-22r domains. Being older and having low pre-surgery SRS-22r scores increased the chances of achieving SDC in function at 1-year. Achieving SDC in the pain domain was significantly associated with age, sex, length of hospital stay, and SRS-22r pre-surgery scores.

Conclusion.

Notably, the self-image domain showed the largest change compared to other SRS-22r domains. A low pre-surgery score increases the likelihood of clinical benefit from surgery. These findings demonstrate the utility of SDC for assessing the benefits and factors that may underpin surgical benefit in AIS.
Role of steroid receptor-associated and regulated protein in tumor progression and progesterone receptor signaling in endometrial cancer
Authors: Liu Jie , Wang Zhiqi , Zhou Jingyi , Wang Jiaqi , He Xiangjun , Wang Jianliu
Published: May 2023

Background:

Steroid receptor-associated and regulated protein (SRARP) suppresses tumor progression and modulates steroid receptor signaling by interacting with estrogen receptors and androgen receptors in breast cancer. In endometrial cancer (EC), progesterone receptor (PR) signaling is crucial for responsiveness to progestin therapy. The aim of this study was to investigate the role of SRARP in tumor progression and PR signaling in EC.

Methods:

Ribonucleic acid sequencing data from the Cancer Genome Atlas, Clinical Proteomic Tumor Analysis Consortium, and Gene Expression Omnibus were used to analyze the clinical significance of SRARP and its correlation with PR expression in EC. The correlation between SRARP and PR expression was validated in EC samples obtained from Peking University People's Hospital. SRARP function was investigated by lentivirus-mediated overexpression in Ishikawa and HEC-50B cells. Cell Counting Kit-8 assays, cell cycle analyses, wound healing assays, and Transwell assays were used to evaluate cell proliferation, migration, and invasion. Western blotting and quantitative real-time polymerase chain reaction were used to evaluate gene expression. The effects of SRARP on the regulation of PR signaling were determined by co-immunoprecipitation, PR response element (PRE) luciferase reporter assay, and PR downstream gene detection.

Results:

Higher SRARP expression was significantly associated with better overall survival and disease-free survival and less aggressive EC types. SRARP overexpression suppressed growth, migration, and invasion in EC cells, increased E-cadherin expression, and decreased N-cadherin and Wnt family member 7A (WNT7A) expression. SRARP expression was positively correlated with PR expression in EC tissues. In SRARP-overexpressing cells, PR isoform B (PRB) was upregulated and SRARP bound to PRB. Significant increases in PRE-based luciferase activity and expression levels of PR target genes were observed in response to medroxyprogesterone acetate.

Conclusions:

This study illustrates that SRARP exerts a tumor-suppressive effect by inhibiting the epithelial-mesenchymal transition via Wnt signaling in EC. In addition, SRARP positively modulates PR expression and interacts with PR to regulate PR downstream target genes.
Targeted therapeutic strategies for melanoma
Authors: Zhang Shiwei , Xie Ruxin , Zhong Ai , Chen Junjie
Published: May 2023

Melanoma accounts for a small proportion of skin cancers diagnosed each year, but it has a high degree of malignancy and rapid progression, resulting in a short survival period for patients. The incidence of melanoma continues to rise, and now melanoma accounts for 1.7% of cancer diagnoses worldwide and is the fifth most common cancer in the United States. With the development of high-throughput sequencing technologies, the understanding of the pathophysiology of melanoma had also been improved. The most common activating mutations in melanoma cells are BRAF, NRAS, and KIT mutations, which disrupt cell signaling pathways related to tumor proliferation. The progress has led to the emergence of molecularly targeted drugs, which extends the survival of patients with advanced melanoma. A large number of clinical trials have been conducted to confirm that targeted therapy for patients with advanced melanoma can improve progression-free survival and overall survival, and for stage III patients after radical tumor resection targeted therapy can reduce the recurrence of melanoma. Patients who were originally stage III or IV inoperable have the opportunity to achieve tumor radical resection after targeted therapy. This article reviewed the clinical trial data and summarized the clinical benefits and limitations of these therapies.
Prognostic Value of Lymph Node Parameters in Elderly Patients With Stage III Serous Ovarian Cancer Based on Competing Risk Model
Authors: Sun Xiangmei , Peng Yaru , Chen Jiaojiao , Lei Jiahao , Liu Weizong , Li Zhengyi
Published: May 2023

Objectives:

Competing risk models were used in this study. The purpose of this study was to assess the predictive usefulness of lymph node characteristics in elderly patients with stage III serous ovarian cancer.

Methods:

We conducted a retrospective analysis on 148,598 patients from 2010 to 2016 using the surveillance, epidemiology, and end results database. Lymph node characteristics were collected and examined, including the number of lymph nodes retrieved the number of lymph nodes examined (ELN) and the number of positive lymph nodes (PN). Using competing risk models, we evaluated the connection between these variables and overall survival (OS) and disease-specific survival (DSS).

Results:

This study included a total of 3457 ovarian cancer patients. Multivariate analysis using the COX proportional hazards model found that ELN>22 was an independent predictive factor for both OS (hazard ratio [HR] [95% CI]=0.688 [0.553 to 0.856], P<0.05) and DSS (HR [95% CI]=0.65 [0.512 to 0.826], P<0.001), PN>8 was identified as a significant risk factor for both OS (HR [95% CI]=0.908 [0.688 to 1.199], P=0.497) and DSS (HR [95% CI]=0.926 [0.684 to 1.254], P=0.62). Subsequently, using the competing risk model, ELN>22 was found to be an independent protective factor for DSS (HR [95% CI]=0.738 [0.574 to 0.949], P=0.018), while PN>8 was identified as a risk factor for DSS (HR [95% CI]=0.999 [0.731 to 1.366], P=1).

Conclusions:

Our findings demonstrate the robustness of the competing risk model to evaluate the results of the COX proportional hazards model analysis.
Long COVID in people living with HIV
Authors: Peluso Michael J. , Antar Annukka A.R.
Published: May 2023

Purpose of review

It is now recognized that SARS-CoV-2 infection can have a long-term impact on health. This review summarizes the current state of knowledge regarding Long COVID in people living with HIV (PLWH).

Recent findings

PLWH may be at elevated risk of experiencing Long COVID. Although the mechanisms contributing to Long COVID are incompletely understood, there are several demographic and clinical factors that might make PLWH vulnerable to developing Long COVID.

PLWH should be aware that new or worsening symptoms following SARS-CoV-2 infection might represent Long COVID. HIV providers should be aware of this clinical entity and be mindful that their patients recovering from SARS-CoV-2 infection may be at higher risk.
Engineering strategies of Anti-HIV antibody therapeutics in clinical development
Authors: Pihlstrom Nicole , Bournazos Stylianos
Published: May 2023

Purpose of review

Anti-human immunodeficiency virus (HIV) antibody-based therapeutics offer an alternative treatment option to current antiretroviral drugs. This review aims to provide an overview of the Fc- and Fab-engineering strategies that have been developed to optimize broadly neutralizing antibodies and discuss recent findings from preclinical and clinical studies.

Recent findings

Multispecific antibodies, including bispecific and trispecific antibodies, DART molecules, and BiTEs, as well as Fc-optimized antibodies, have emerged as promising therapeutic candidates for the treatment of HIV. These engineered antibodies engage multiple epitopes on the HIV envelope protein and human receptors, resulting in increased potency and breadth of activity. Additionally, Fc-enhanced antibodies have demonstrated extended half-life and improved effector function.

The development of Fc and Fab-engineered antibodies for the treatment of HIV continues to show promising progress. These novel therapies have the potential to overcome the limitations of current antiretroviral pharmacologic agents by more effectively suppressing viral load and targeting latent reservoirs in individuals living with HIV. Further studies are needed to fully understand the safety and efficacy of these therapies, but the growing body of evidence supports their potential as a new class of therapeutics for the treatment of HIV.
Vaccinal effect of HIV-1 antibody therapy: dream or reality?
Authors: Naranjo-Gomez Mar , Pelegrin Mireia
Published: May 2023

Purpose of review

This review summarizes recent studies reporting the induction of vaccinal effects by human immunodeficiency virus (HIV-1) antibody therapy. It also puts into perspective preclinical studies that have identified mechanisms involved in the immunomodulatory properties of antiviral antibodies. Finally, it discusses potential therapeutic interventions to enhance host adaptive immune responses in people living with HIV (PLWH) treated with broadly neutralizing antibodies (bNAbs).

Recent findings

Recent studies in promising clinical trials have shown that, in addition to controlling viremia, anti-HIV-1 bNAbs are able to enhance the host's humoral and cellular immune response. Such vaccinal effects, in particular the induction of HIV-1-specific CD8+ T-cell responses, have been observed upon treatment with two potent bNAbs (3BNC117 and 10–1074) alone or in combination with latency-reversing agents (LRA). While these studies reinforce the idea that bNAbs can induce protective immunity, the induction of vaccinal effects is not systematic and might depend on both the virological status of the patient as well as the therapeutic strategy chosen.

HIV-1 bNAbs can enhance adaptive host immune responses in PLWH. The challenge now is to exploit these immunomodulatory properties to design optimized therapeutic interventions to promote and enhance the induction of protective immunity against HIV-1 infection during bNAbs therapy.
Noninvasive preimplantation genetic testing using the embryo spent culture medium: an update
Authors: Lledo Belen , Morales Ruth , Antonio Ortiz Jose , Bernabeu Andrea , Bernabeu Rafael
Published: May 2023

Purpose of review

The presence of cell-free DNA (cf-DNA) in the embryo spent culture medium allows to develop a noninvasive PGT-A (niPGTA). Noninvasive PGT-A may provide a simpler, safer and less costly approach to preimplantation genetic testing of aneuploidy (PGT-A). Furthermore, niPGTA would provide wider access to embryo genetic analysis and circumvent many legal and ethical considerations. However, the concordance rate between the results obtained by PGT-A and niPGTA varies among studies and, their clinical utility has not been already demonstrated. This review evaluates the niPGTA reliability based on SCM and adds new knowledge about the clinical relevance of SCM for noninvasive PGT-A.

Recent findings

The most recent concordance studies evaluating the accuracy of niPGTA using SCM showed a high variation in the informativity rate of SCM and the diagnostic concordance. Also, sensitivity and specificity showed similar heterogeneous results. Therefore, these results do not support the clinical utility of niPGTA. Regarding clinical outcome, the data are initial and further research, including randomized and nonselection studies are needed.

Further research, including randomized and nonselection studies, as well as optimization of embryo culture conditions and medium retrieval, are needed to improve the reliability and clinical utility of niPGTA.
Evolution of operating microscopes and development of 3D visualization systems for intraocular surgery
Authors: Srinivasan Sathish , Tripathi Ashok Burton , Suryakumar Rajaraman
Published: May 2023

The recent development of high-resolution, heads-up, 3D visualization microscopy systems has provided new technical and visualization options for ophthalmic surgeons. In this review, we explore the evolution of microscope technologies, the science behind modern 3D visualization microscopy systems, and the practical benefits (as well as disadvantages) that these systems provide over conventional microscopes for intraocular surgical practice. Overall, modern 3D visualization systems reduce the requirements for artificial illumination and provide enhanced visualization and resolution of ocular structures, improving ergonomics, and facilitating a superior educational experience. Even when considering their disadvantages, such as those related to technical feasibility, 3D visualization systems have an overall positive benefit/risk ratio. It is hoped these systems will be adopted into routine clinical practice, pending further clinical evidence on the benefits they may provide on clinical outcomes.
Impact of COVID-19 on medical care conduct and psychological burden among patients with psoriasis: real-world data from a tertiary hospital in China
Authors: Zhang Ying , Guo Jin-Zhu , Zhang Chun-Lei
Published: May 2023

Objective:

The ongoing coronavirus disease 2019 (COVID-19) epidemic has caused extensive damage worldwide. We explored whether the medical care conduct of patients with psoriasis has changed and whether the COVID-19 epidemic has placed more psychological pressure on these patients.

Methods:

A questionnaire survey was administered to patients with psoriasis in the Dermatology Department of Peking University Third Hospital in July 2022. Information about the patients’ general demographics, psoriasis condition, mental state of anxiety [Generalized Anxiety Disorder-7 (GAD-7) score], changes in medical care conduct, and Concerns about COVID-19-Related Risk Score for Psoriasis (CCRSP, a self-designed questionnaire) was collected. Univariate analysis with the Mann–Whitney U test for continuous variables was used in the estimation of statistical differences.

Results:

A total of 112 patients with psoriasis completed the survey. Purchasing medicine was the factor that added difficulty for most participants (32.1%). Fewer participants (26.8%) encountered medical registration difficulties than economic and transportation difficulties. Nearly three-quarters of participants (73.2%) reported at least one medical care conduct change resulting from the COVID-19 epidemic. A small proportion of participants (12.5%) thought that COVID-19 prevented them from seeking medical services for psoriasis. The top three items that caused the most concern were psoriasis aggravation resulting from drug reduction and withdrawal because of COVID-19 (44.7%), psoriasis aggravation after infection with COVID-19 (38.4%), and psoriasis-related side effects of the COVID-19 vaccine (35.7%). The GAD-7 score of patients with a high CCRSP (score of >10) was significantly higher than that of patients with a low CCRSP (score of ≤10) (non-parametric test, P = 0.047).

Conclusion:

COVID-19 poses challenges and places a mental burden on patients with psoriasis. Doctors should regulate the medical behavior of patients with psoriasis according to their specific COVID-19 situation and help patients ease their anxiety to maintain the stability of their psoriasis condition.
Predicting Complicated Mild Traumatic Brain Injury in Adolescent Trauma to Enhance Clinical Decisions in Imaging
Authors: Rhodes Heather X. , Berg Gina , Shadiack Anthony L. , Thomas Kevin D. , Horawski Jennifer L. , Boyer Geoff , Kleist Sara M. , Worthley Aaron I. , Rosenberg David I. , Gutovitz Scott B. , Helmrich George A. , Biswas Saptarshi , Pepe Antonio P.
Published: May 2023

BACKGROUND:

The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury algorithm is used to identify children at low risk of clinically significant traumatic brain injuries to reduce computed tomography (CT) exposure. Adapting PECARN rules based on population-specific risk stratification has been suggested to improve diagnostic accuracy.

OBJECTIVE:

This study sought to identify center-specific patient variables, beyond PECARN rules, that may enhance the identification of patients requiring neuroimaging.

METHODS:

This single-center, retrospective cohort study was conducted from July 1, 2016, to July 1, 2020, in a Southwestern U.S. Level II pediatric trauma center. The inclusion criteria were adolescents (10–15 years), Glasgow Coma Scale (13–15), with a confirmed mechanical blow to the head. Patients without a head CT were excluded. Logistic regression was performed to identify additional complicated mild traumatic brain injury predictor variables beyond the PECARN.

RESULTS:

There were 136 patients studied; 21 (15%) presented with a complicated mild traumatic brain injury. Relative to motorcycle collision or all-terrain vehicle trauma (odds ratio [OR] 211.75, 95% confidence interval, CI [4.51, 9931.41], p < .001), an unspecified mechanism (OR 42.0, 95% CI [1.30, 1350.97], p = .03) and consult activation (OR 17.44, 95% CI [1.75, 173.31], p = .01) were significantly associated with complicated mild traumatic brain injury.

CONCLUSIONS:

We identified additional factors associated with complex mild traumatic brain injury, including motorcycle collision and all-terrain vehicle trauma, unspecified mechanism, and consult activation that are not in the PECARN imaging decision rule. Adding these variables may aid in determining the need for appropriate CT scanning.
Under the Lens: Team Perception of Trauma Video Review
Authors: Scrushy Marinda G. , Nagaraj Madhuri , Burke Kristen , Kuhlenschmidt Kali , Jeter Shannon , Johnson Della , Brown Kristie , Edwards Courtney , Marinica Alexander , Vella Michael A. , Holena Daniel N. , Park Caroline , Dumas Ryan P.
Published: May 2023

BACKGROUND:

Video-based assessment and review are becoming increasingly common, and trauma video review (TVR) has been shown to be an effective educational, quality improvement, and research tool. Yet, trauma team perception of TVR remains incompletely understood.

OBJECTIVE:

We evaluated positive and negative perceptions of TVR across multiple team member groups. We hypothesized that members of the trauma team would find TVR educational and that anxiety would be low across all groups.

METHODS:

An anonymous electronic survey was provided to nurses, trainees, and faculty during weekly multidisciplinary trauma performance improvement conference following each TVR activity. Surveys assessed perception of performance improvement and anxiety or apprehension (Likert scale: 1 “strongly disagree” to 5 “strongly agree”). We report individual and normalized cumulative scores (average of responses for each positive [n = 6] and negative [n = 4] question stem).

RESULTS:

We analyzed 146 surveys over 8 months, with 100% completion rate. Respondents were trainees (58%), faculty (29%), and nurses (13%). Of the trainees, 73% were postgraduate year (PGY) 1–3 and 27% were PGY 4–9. Of all respondents, 84% had participated previously in a TVR conference. Respondents reported an improved perception of resuscitation education quality and personal leadership skills development. Participants found TVR to be more educational than punitive overall. Analysis of team member types showed lower scores for faculty for all positive stemmed questions. Trainees were more likely to agree with negative stemmed questions if they were a lower PGY, and nurses were least likely to agree with negative stemmed questions.

CONCLUSIONS:

TVR improves trauma resuscitation education in a conference setting, with trainees and nurses reporting the greatest benefit. Nurses were noted to be the least apprehensive about TVR.
Standardizing Child Passenger Safety Screening in the Emergency Department: A Quality Improvement Study
Authors: Almodovar Heidi L. , Thorson Chad M. , Cardy Christina R.
Published: May 2023

Background:

Motor vehicle collisions remain a leading cause of death and injury in children in the United States. Our Level I trauma center found that 53% of children ages 1–19 years are improperly restrained or unrestrained. Our center employs a Pediatric Injury Prevention Coalition with nationally certified child passenger safety technicians who are active in the community yet remain underutilized in the clinical setting.

Objective:

The purpose of the quality improvement project was to standardize child passenger safety screening in the emergency department to increase referrals to a Pediatric Injury Prevention Coalition.

Methods:

This quality improvement project utilized a pre-/postdesign of data collected before and after implementing the child passenger safety bundle. Using the Plan–Do–Study–Act model, organizational change processes were identified, and quality improvement interventions implemented from March to May 2022.

Results:

The total number of families referred was 199, representing 230 children, which was 3.8% of the eligible population. A significant relationship was found between child passenger safety screening and referral to the Pediatric Injury Prevention Coalition in 2019 and 2021, χ2 (1, n = 230) = 239.98, p < .001, and χ2 (1, n = 230) = 240.78, p < .001, respectively. Forty-one percent of the referred families established contact with the Pediatric Injury Prevention Coalition.

Conclusion:

Standardizing child passenger safety screening in the emergency department increased referrals to a Pediatric Injury Prevention Coalition and resulted in improved child safety seat distribution and child passenger safety education.
Virtual Rural Trauma Team Development Course: Trying to Zoom in on a Solution
Authors: Koontz Jennifer , Causer Thomas , Zipf Jami , Dillman-Stull Jill , Dumire Russell
Published: May 2023

BACKGROUND:

The COVID-19 pandemic prevented centers from providing in-person interactive training programs such as the Rural Trauma Team Development Course. Adapting the course to a virtual platform is an option, yet little is known regarding the feasibility of using this format.

OBJECTIVE:

This study aimed to evaluate the feasibility of providing a virtual rural trauma development course during COVID-19.

METHODS:

This is a descriptive study of emergency medical technicians, nurses, emergency department technicians, and physicians from four rural community health care facilities and local emergency medical services who participated in a virtual Rural Trauma Team Development Course held in November 2021 which was transformed into a virtual platform using live remote interactive lectures, recorded case-based scenarios, and interactive virtual-based questions. The course was evaluated by the changes instituted at the centers based on program recommendations and a participant survey.

RESULTS:

A total of 41 participants were studied, of whom 31 (75%) returned the emailed postprogram survey. The majority (>75%) of respondents rated the activity as very good, with course objectives met. All four facilities instituted changes following the program, including enhancing policy and procedures, guidelines, advancing performance improvement triggers, and equipment acquisition. Individual-reported participant satisfaction was very high.

CONCLUSION:

The Rural Trauma Team Development Course can be provided virtually and is a feasible option for trauma centers to provide initial trauma management in the rural community in a safe pandemic-restrictive atmosphere.
In Vivo Testing of an Ambient Air Based, Portable, and Automated CO2 Removal Controller for Artificial Lungs
Authors: Spencer Brianna L. , Shaikh Navid , Gudex Leah , Dann Tyler , Langley Mark , Matich Hannah , Bartlett Robert H. , Rojas-Peña Alvaro , Potkay Joseph A.
Published: May 2023

Portable artificial lung (AL) systems are under development, but there are few technologies available that adjust the carbon dioxide (CO2) removal in response to changes in patient metabolic needs. Our work describes the second generation of a CO2-based portable servoregulation system that automatically adjusts CO2 removal in ALs. Four adult sheep (68 ± 14.3 kg) were used to test the servoregulator. The servoregulator controlled air sweep flow through the lung to meet a target exhaust gas CO2 (tEGCO2) level in normocapnic and hypercapnic (arterial partial pressure of CO2 [PaCO2] >60 mm Hg) conditions at varying flow rates (0.5–1.5 L/min) and at tEGCO2 levels of 10, 20, and 40 mm Hg. In hypercapnic sheep, average post-AL blood partial pressure of CO2 (pCO2) values were 22.4 ± 3.6 mm Hg for tEGCO2 of 10 mm Hg, 28.0 ± 4.1 mm Hg for tEGCO2 of 20 mm Hg and 40.6 ± 4.8 mm Hg for tEGCO2 of 40 mm Hg. The controller successfully and automatically adjusted the sweep gas flow to rapidly (<10 minutes) meet the tEGCO2 level when challenged with changes in inlet blood flow or target EGCO2 levels for all animals. These in vivo data demonstrate an important step toward portable ALs that can automatically modulate CO2 removal and allow for substantial changes in patient activity or disease status in ambulatory applications.
The role of the absence of Hyrtl’s anastomosis in monochorionic pregnancy: Friend or foe?: A case report
Authors: Liu Ziling , Ruan Jie
Published: May 2023

Introduction:

Hyrtl’s anastomosis, an intra-arterial shunt, plays a protective role when the placental territories supplied by the umbilical arteries are different in size. Its absence is associated with an increased risk of poor outcomes in singleton pregnancy. However, the literature and studies on the effect of absent Hyrtl’s anastomosis in twin placentas are rare.

Case presentation:

We present a case of a monochorionic diamniotic twin pregnancy complicated with type I selective fetal growth restriction (SFGR). Despite discordance in placental territory and cord insertion sites, the patient had an overall good pregnancy process, suggesting that the absence of Hyrtl’s anastomosis may have played a benign role.

Conclusions:

The absence of Hyrtl’s anastomosis in our case seemed to show a favorable effect, representing a finding of opposite effects in monochorionic placentas compared with singleton placentas.
Lymphocytic interstitial pneumonia presenting with a ground glass nodule: A case report and literature review
Authors: Liu Qi , Chen Zhen , Deng Peng , Wang Jing , Zhang Shengchu , Tang Lihua , Yang Yuxia , Lang Bojuan
Published: May 2023

Rationale:

Lymphocytic interstitial pneumonia (LIP) is a rare benign lymphoproliferative disorder, often associated with autoimmune diseases. Most LIPs present with multiple bronchial cysts and diffuse interstitial infiltration. It is histologically characterized by widespread diffuse lymphocytic infiltration of the pulmonary interstitium, and the enlargement and widening of the alveolar septum.

Patient concerns:

A 49-year-old woman was admitted to hospital for finding pulmonary nodules for more than 2 months. 3D imaging chest computed tomography (CT) examination of both lungs showed that there was a middle lobe of the right lung with a size of about 1.5 cm × 1.1 cm ground-glass nodules.

Diagnoses:

A single operating port thoracoscopic wedge resection biopsy of a right middle lung nodule was performed. The pathology showed diffuse lymphocytic infiltration with varying numbers of small lymphocytes, plasma cells, macrophages and histiocytes infiltrating the alveolar septa, widened and enlarged alveolar septa, and scattered lymphoid follicles. Immunohistochemically, CD20 positive in follicular area, CD3 positive in interfollicular area. LIP was considered.

Interventions:

The patient was regularly followed without any specific treatment.

Outcomes:

Follow-up chest CT showed no significant abnormalities in the lungs 6 months after surgery.

Lessons:

To the best of our knowledge, our case may be the second reported case of a patient with LIP presenting with a ground glass nodule on chest CT, and it is speculated that the ground glass nodule may be an early manifestation of idiopathic LIP.
Incidence of hospital acquired pressure injury in critically ill patients with COVID-19 in prone position admitted to the intensive care unit
Authors: Sato Lucas , Heck Letícia Olandin , Bimbatti Karina de Fátima , Petroski-Moraes Bruno Cesar , Becari Christiane , Basile-Filho Anibal , Auxiliadora-Martins Maria , Gonçalves Menegueti Mayra
Published: May 2023

Critical patients have conditions that may favor the occurrence of hospital-acquired pressure injury (HAPI). The objective of this study was to identify the incidence and factors associated with the occurrence of HAPI in patients with coronavirus disease 2019 admitted to the intensive care unit (ICU) who used the prone position. Retrospective cohort study carried out in an ICU of a tertiary university hospital. Two hundred four patients with positive real-time polymerase chain reactions were evaluated, of which 84 were placed in the prone position. All patients were sedated and submitted to invasive mechanical ventilation. Of the prone patients, 52 (62%) developed some type of HAPI during hospitalization. The main place of occurrence of HAPI was the sacral region, followed by the gluteus and thorax. Of the patients who developed HAPI, 26 (50%) had this event in places possibly associated with the prone position. The factors associated with the occurrence of HAPI in patients prone to coronavirus disease 2019 were the Braden Scale and the length of stay in the ICU. The incidence of HAPI in prone patients was extremely high (62%), which denotes the need to implement protocols in order to prevent the occurrence of these events.
Application of the PDCA cycle for implementing the WHO Safe Childbirth Checklist in women with vaginal deliveries
Authors: Li Xiaoyan , Zhou Tingting , Mao Jiayi , Wang Longqiong , Yang Xiaochang , Xie Liling
Published: May 2023

The World Health Organization Safe Childbirth Checklist (SCC) has been recommended globally. However, the results are inconsistent. The aim of this study was to investigate the effectiveness of implementing the SCC based on plan-do-check-act (PDCA) cycle management. From November 2019 to October 2020, women who were hospitalized and had vaginal deliveries were enrolled in this study. Before October 2020, the PDCA cycle was not applied for the SCC, and women who had vaginal deliveries were included in the pre-intervention group. From January 2021 to December 2021, the PDCA cycle was applied for the SCC, and women who had vaginal deliveries were included in the post-intervention group. The SCC utilization rate and the incidence of maternal and neonatal complications were compared between the 2 groups. The SCC utilization rate in the post-intervention group was higher than that in the pre-intervention group (P < .01). The postpartum infection rate in the post-intervention group was lower than that in the pre-intervention group, and the difference was statistically significant (P < .05). After the intervention, postpartum hemorrhage, neonatal mortality, and neonatal asphyxia rates were also reduced, although no significant differences were observed between the 2 groups. There was no significant difference in the third-degree perineal laceration or neonatal intensive care unit hospitalization rate between the 2 groups (P > .05). Application of the PDCA cycle can improve the SCC utilization rate, and the SCC combined with the PDCA cycle can effectively reduce the postpartum infection rate.
Improving quality of life for a patient with fibromyalgia and their caregiver: A protocol for the application of the integrative medical service model
Authors: Cheong Moon Joo , Chung Chong Hyuk , Lee Chang Hoon , Lee Myeung Su , Ha Won Bae , Lee Jung Han , Kang Hyung Won
Published: May 2023

Objectives:

Patients with incurable diseases experience difficulty carrying out activities of daily living and rely on caregivers. Caregivers of patients with fibromyalgia (FM) are unable to understand the extent of the patients’ suffering because the pain sites are invisible. To address this problem, this study will apply an integrative healthcare service model to a single FM case to manage pain and enhance the quality of life and, subsequently, gather feedback from different sources regarding the treatment. This paper presents the study protocol.

Methods:

We will conduct an observational study to gather quantitative and qualitative feedback from various perspectives regarding the application of an integrative healthcare service program for FM patients developed in Korea for an FM patient–caregiver pair. The program will comprise eight 100-minute weekly sessions, during which integrative services that combine Western and Oriental medicines (Korean traditional medicine) will be provided to enhance pain management and quality of life. The feedback collected after each session will be reflected in the next session’ content.

Results:

The results will comprise the feedback from the patient and caregiver in accordance with revisions made to the program.

Conclusions:

The results will provide basic data for optimizing an integrative healthcare service system in Korea for patients suffering from chronic pain owing to diseases such as FM.
Small bowel neuroendocrine tumours – casting the net wide
Authors: Chetcuti Zammit Stefania , Sidhu Reena
Published: May 2023

Purpose of review

Our aim is to provide an overview of small bowel neuroendocrine tumours (NETs), clinical presentation, diagnosis algorithm and management options. We also highlight the latest evidence on management and suggest areas for future research.

Recent findings

Dodecanetetraacetic acid (DOTATATE) scan can detect NETs with an improved sensitivity than when compared with an Octreotide scan. It is complimentary to small bowel endoscopy that provides mucosal views and allows the delineation of small lesions undetectable on imaging. Surgical resection is the best management modality even in metastatic disease. Prognosis can be improved with the administration of somatostatin analogues and Evarolimus as second-line therapies.

NETs are heterogenous tumours affecting most commonly the distal small bowel as single or multiple lesions. Their secretary behaviour can lead to symptoms, most commonly diarrhoea and weight loss. Metastases to the liver are associated with carcinoid syndrome.