bluuebunny/crossref_metadata_2025 huggingface dataset:
Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis
Authors: Ramos S. Raquel , Lardier David T. , Opara Ijeoma , Turpin Rodman E. , Boyd Donte T. , Gutierrez José I. , Williams Chase Nicole , Nelson LaRon E. , Kershaw Trace
Published: June 2021

In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.
Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021)
Authors: Li Fei , Cai Shouwang , Cao Feng , Chen Rufu , Fu Deliang , Ge Chunlin , Hao Chunyi , Hao Jihui , Huang Heguang , Jian Zhixiang , Jin Gang , Li Ang , Li Haimin , Li Shengping , Li Weiqin , Li Yixiong , Liang Tingbo , Liu Xubao , Lou Wenhui , Miao Yi , Mou Yiping , Peng Chenghong , Qin Renyi , Shao Chenghao , Sun Bei , Tan Guang , Tian Xiaodong , Wang Huaizhi , Wang Lei , Wang Wei , Wang Weilin , Wei Junmin , Wu Heshui , Wu Wenming , Wu Zheng , Yan Changqing , Yang Yinmo , Yin Xiaoyu , Yu Xianjun , Yuan Chunhui , Zhang Taiping , Zhao Yupei
Published: June 2021

Acute pancreatitis (AP) is a common acute abdominal condition of the digestive system. In recent years, treatment concepts, methods, and strategies for the diagnosis of AP have advanced, and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients. On the basis of previous guidelines and expert consensus, this guideline adopts an evidence-based, problem-based expression; synthesizes important clinical research data at home and abroad in the most recent 5 years; and forms 29 recommendations through multidisciplinary expert discussion, including diagnosis, treatment, and follow-up. It is expected to provide evidence support for the treatment of AP in the clinical setting in China.
How to use low-molecular-weight heparin to treat neonatal thrombosis in clinical practice
Authors: Ting James , Yeung Klement , Paes Bosco , Chan Anthony K.C. , Petropoulos Jo-Anne , Banfield Laura , Bhatt Mihir D.
Published: June 2021

Among children, neonates have the highest incidence of thrombosis due to risk factors such as catheter instrumentation, an evolving coagulation system and congenital heart disease. Low-molecular-weight heparins (LMWHs) are the most commonly used anticoagulants in neonates. Published guidelines delineate dosing and monitoring protocols for LMWH therapy in newborns. However, challenging clinical situations frequently present that warrant healthcare providers to think critically beyond the range of guidelines, and judiciously resolve specific problems. This review describes the use of LMWH in the neonatal population, including practical aspects such as route and site of administration, preparation from concentrated formulations and methods to minimize pain of subcutaneous injection. It is followed by a discussion on dosing, monitoring and outcomes of LMWH therapy in neonates. The risk of recurrence of thrombosis in neonates after LMWH therapy is approximately 3% based on a pooled analysis of studies reporting this outcome over the last 24 years. The article concludes with an overview of the side-effects of LMWH, including the risk of bleeding which is around 4% based on pooled analyses of more than 30 studies.
Apoptosis in platelets from adult patients with chronic idiopathic thrombocytopenic purpura
Authors: Xie Long , Xu Da-Ming , Cai Xin-Jian , Zhang Ze-Wen , Yu Wen-Jun , Qiu Jin-Feng , Xu Cheng-Wei , He Chun-Ling , Xu Xian-Ru , Yin Jun
Published: June 2021

Adult chronic idiopathic thrombocytopenic purpura (cITP) is a chronic and usually life-long haemorrhagic disorder in which enhanced platelet destruction and weakened platelet production lead to thrombocytopenia. Platelets were isolated from blood samples collected from 40 adult patients with cITP and 40 healthy volunteers. Mitochondrial membrane potential (ΔΨm) and plasma membrane phosphatidylserine externalization were determined by flow cytometry, and activation of caspase-3 and expressions of Bax, Bak and Bcl-xL were analysed by western blotting. Flow cytometry showed increased mitochondrial depolarization and lower ΔΨm in platelets from adult patients with cITP. In addition, plasma membrane phosphatidylserine externalization was observed on platelets from adult patients with cITP, but rarely from healthy volunteers. Western blot analysis of platelet proteins revealed that, in adult cITP patients, caspase-3 was activated, which cleaved gelsolin and to release a 47-kDa fragment. Moreover, the expressions of Bax and Bak were elevated, and Bcl-xL was decreased markedly in platelets from adult patients with cITP. Our findings reveal, based on loss of mitochondrial membrane potential (Δψm), phosphatidylserine exposure, caspase-3 activation, enhanced expression of Bax and Bak, and attenuated expression of Bcl-xL, that platelet death in the pathogenesis of thrombocytopenia in chronic ITP in adults is apoptotic.
Novel delivery mechanisms for antigen-specific immunotherapy
Authors: Neef Tobias , Miller Stephen D.
Published: June 2021

Purpose of review

Current therapies for autoimmune disorders often employ broad suppression of the immune system. Antigen-specific immunotherapy (ASI) seeks to overcome the side-effects of immunosuppressive therapy by specifically targeting only disease-related autoreactive T and B cells. Although it has been in development for several decades, ASI still is not in use clinically to treat autoimmunity. Novel ways to deliver antigen may be effective in inducing ASI. Here we review recent innovations in antigen delivery

Recent findings

New ways to deliver antigen include particle and nonparticle approaches. One main focus has been the targeting of antigen-presenting cells in a tolerogenic context. This technique often results in the induction and/or expansion of regulatory T cells, which has the potential to be effective against a complex, polyclonal immune response.

Whether novel delivery approaches can help bring ASI into general clinical use for therapy of autoimmune diseases remains to be seen. However, preclinical work and early results from clinical trials using these new techniques show promising signs.
Single scan SeHCAT studies: a model for the prediction of the 3-h counts
Authors: Smout Alexander , Scuffham James , Hinton Paul
Published: June 2021

Objectives

As part of the 75-Selenium homocholic acid taurine (SeHCAT) study, counts are acquired as a baseline to allow the calculation of the retention at 7 days. In this work, we evaluated whether it was possible to replace the baseline image with a predictive model based on the patient’s height and weight.

Method

Height and weight data from 723 patients scanned at three hospitals using seven gamma cameras were compiled. A number of different models were trialled, with fitting parameters determined by regression. A predictive model based on height and logarithm of weight was found to have the best correlation with the measured counts in the 3-h study.

Results

There was a strong correlation (R
2 = 0.91) between the measured counts and the predicted counts using a model based on height and logarithm of weight. Treating the standard SeHCAT test result as the gold standard, the test result when predicted baseline counts were used had a sensitivity and specificity of 97.5 and 98.0%, respectively, at a threshold of 15%. In total 694/723 (96.0%) of patients had no change to their severity grading when using the predicted baseline counts.

Conclusion

This work presents a model that was able to predict the counts in the 3 h SeHCAT study for patients on seven gamma cameras. This can enable a single scan study, giving significant savings to patient and staff time and imaging resources.
The Paradox of Empathy and Data
Authors: Arcand Lori L. , Burkhartzmeyer Holly L. , Clobes Jane E. , Eversman Shari L. , Kiker Kelly M. , McCabe Maura M. , Pfeilsticker Alicia J.
Published: June 2021

This article addresses the nursing professional development practitioner’s role in the design and management of the evaluation process used for a large-scale educational intervention developed to improve patient satisfaction with the use of empathic communication skills. The scope of this educational activity and the direct alignment with organizational priorities necessitated that a robust and comprehensive evaluation strategy be implemented to demonstrate the connection from the education to performance and, ultimately, organization-level results.
PICU Follow-Up Clinic: Patient and Family Outcomes 2 Months After Discharge*
Authors: Ducharme-Crevier Laurence , La Kim-Anh , Francois Tine , Gerardis George , Beauchamp Miriam , Harrington Karen , Roumeliotis Nadezdha , Farrell Catherine , Toledano Baruch , Lacroix Jacques , Du Pont-Thibodeau Geneviève
Published: June 2021

OBJECTIVES:

Hospitalization in a PICU is a life-altering experience for children and their families. Yet, little is known about the well-being of these children after their discharge. We are describing the outcome of PICU survivors at a PICU clinic 2 months after discharge.

DESIGN:

Prospective cohort study.

SETTING:

PICU and PICU clinic of CHU Sainte-Justine.

PATIENTS:

Prospective cohort study of children admitted for greater than or equal to 4 days, greater than or equal to 2 days of invasive ventilation, odds ratio greater than or equal to 4 days of noninvasive ventilation at Centre Hospitalier Universitaire Sainte-Justine.

PATIENTS:

Prospective cohort study of children admitted for greater than or equal to 4 days, greater than or equal to 2 days of invasive ventilation, or greater than or equal to 4 days of noninvasive ventilation at Centre Hospitalier Universitaire Sainte-Justine PICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Patients were evaluated by a pediatric intensivist 2 months after discharge at the follow-up clinic. They were asked to fill out validated questionnaires. One hundred thirty-two patients were followed from October 2018 to September 2020. The PICU diagnoses were respiratory illness (40.9%), head trauma, and septic shock (7.6%). Average length of PICU stay was 28.5 ± 84.2 days (median 7 d). Sixty-one percent were intubated. Symptoms reported by families were as follows: fatigue (9.9%), sleep disturbances (20.5%), feeding difficulties (12.1%), and voice change and/or stridor (9.8%). Twenty-one percent of school-aged children reported school delays. Twenty-seven children demonstrated communication delays, 45% gross motor function delays, 41% fine motor delays, 37% delays in problem-solving, and 49% delays in personal-social functioning. Quality of Life scores were 78.1 ± 20.5 and 80.0 ± 17.5 for physical and psychosocial aspects, respectively. Fourteen percent of parents reported financial difficulties, 42% reported symptoms of anxiety, 29% symptoms of depression.

CONCLUSIONS:

PICU survivors and their families experience significant physical and psychosocial morbidities after their critical illness. PICU follow-up is crucial to determine the outcome of these children and develop interventions.
Electrocardiogram in Pediatric Syncope
Authors: Manouzi Anas , Sanatani Shubhayan , Doan Quynh
Published: June 2021

Objectives

We intended to assess emergency department physician's practice pattern and their motivations for obtaining electrocardiograms (ECGs) in pediatric vasovagal syncope presentations. We also explored if borderline ECG findings alters emergency department physicians' management in this population.

Methods

We conducted a cross-sectional survey of emergency physicians enrolled in the Pediatric Emergency Research Canada network. The survey questionnaire introduced 2 clinical vignettes presenting a typical vasovagal syncope and a presentation suggestive of a cardiac etiology. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation. We also evaluated which specific ECG findings were likely to change physicians' management and explored factors influencing the decision to perform or not perform the ECG.

Results

The analyzable response rate was 47% (105/225). In the low-risk scenario, 51% of respondents requested an ECG, and none consulted the cardiology service, given that all requested investigations are normal. Forty-five percent of physicians modified their management if an ECG was reported as anything but totally normal. In the high-risk scenario, all respondents requested either a 12-lead ECG or a high-lead ECG, and 94% consulted the cardiology service. Physicians also identified clear differences in the motivations behind their decision to perform an ECG in typical vasovagal syncope.

Conclusions

This study highlights the significant practice variation in the evaluation and management of typical vasovagal syncope among physicians, which is informed by complex interactions of patient, provider, and institutional factors and the perceived clinical significance of borderline ECG findings.
A Self-criticism of Diagnostic and Therapeutic Decision Making in Children Admitted With Acute Lower Respiratory Infection at a Single Pediatric Emergency Department
Authors: Akcan Yildiz Leman , Demirci Busra , Gunes Altan , Yakut Halil Ibrahim , Dibek Misirlioglu Emine
Published: June 2021

Objectives

Acute bronchiolitis and community-acquired pneumonia are the most common acute lower respiratory infections (LRIs) leading to emergency admission and hospitalization in children. The aim of this study is to investigate clinical, laboratory, and radiology findings; diagnostic and therapeutic decisions; and the relationships between them in patients younger than 2 years of age, hospitalized for LRI.

Methods

Patients hospitalized for acute LRI (aged 28 days to 24 months) between November 1, 2017, and March 31, 2018, at a referral hospital were included. Patients' characteristics, clinical, laboratory, and radiologic findings and diagnostic and therapeutic decisions, along with reason for hospitalization, were recorded retrospectively. Chest x-rays were reinterpreted by the pediatric radiologist. Associations of these data with the radiologic signs and treatment modalities including antibiotics, bronchodilators, and high-flow oxygen therapy (HFOT) were assessed.

Results

One hundred eighty-two patients were included. One hundred sixty (87.9%) had at least one of the following criteria for hospitalization: dehydration, feeding difficulties, young age (<12 weeks), and hypoxia. One hundred forty-five (79.6%) and 71 (39.0%) patients were administered antibiotic and antiviral therapy, respectively. Twenty-three patients (13.7%) were given HFOT, and 179 (99.4%) were given bronchodilators. None of the complaints, physical signs, or laboratory parameters had statistically significant associations with radiologic findings (P > 0.05). History of wheezing and presence of rales and dehydration in physical examination were associated with antibiotic use (P < 0.001).

Conclusions

The decision of hospitalization was generally appropriate. However, laboratory and radiologic tests and treatments including HFOT, bronchodilator, antibiotic, and antiviral therapies were used excessively and inefficiently. Physicians' decisions were not based on evidence or on the clinical findings of the patient. The results of this study should prompt investigations into the reasons underlying these clinical decisions and development of practice models that can provide solutions specifically targeting the decision-making processes of physicians caring for young children with LRI at the emergency department.
Feasibility of a Manualized Mindful Yoga Intervention for Patients With Chronic Mood Disorders
Authors: VOLLBEHR NINA K. , HOENDERS H.J. ROGIER , BARTELS-VELTHUIS AGNA A. , OSTAFIN BRIAN D.
Published: June 2021

Chronic mood disorders pose an important mental health problem. Individuals with these disorders experience a significant impairment, often fail to seek help, and their illnesses frequently do not respond to treatment. It is therefore important to develop innovative and attractive treatments for these disorders. Mindful yoga represents a promising treatment approach. This pilot study tested the feasibility of a 9-week manualized mindful yoga intervention for patients with chronic mood disorders. Eleven patients receiving standard treatment were recruited to complete a 9-week mindful yoga intervention. Qualitative methods were used to assess patients’ experiences of the intervention and quantitative methods were used to assess psychological distress and mechanisms that play a role in chronic mood disorders. Eight patients completed the intervention and rated the overall quality of the intervention with a mean score of 8.8 (range of 8 to 9, using a scale of 1 to 10). All participants reported a reduction in psychological distress and no adverse events. Among the mechanisms that play a role in chronic mood disorders, the most potentially promising effects from the intervention were found for worry, fear of depression and anxiety, rumination, and areas related to body awareness, such as trusting bodily experiences and not distracting from sensations of discomfort. A 9-week mindful yoga intervention appears to be a feasible and attractive treatment when added to treatment as usual for a group of patients with chronic mood disorders. A randomized controlled trial to study the effects of mindful yoga is recommended.
Improving Access to Psychotherapy: Implications of Wit Versus United Behavioral Health
Authors: PLAKUN ERIC M.
Published: June 2021

This column summarizes the verdict in the federal class action known as Wit v United Behavioral Health (UBH)/Optum, highlighting the verdict’s implications for increasing access to care, implementing the mental health parity law, and reducing health disparities. Achieving these results requires recognition of the verdict as more than simply a nice news story, but as a decision that actually offers individual clinicians, their professional organizations, as well as patients, families, and their consumer organizations, a powerful tool for implementing change if they take up the task of learning how to use it. The verdict applies to outpatient treatment, including psychotherapy, along with 2 other levels of care: intensive outpatient programs and residential treatment.
Crisis Intervention Psychotherapy in the Age of COVID-19
Authors: FEINSTEIN ROBERT E.
Published: June 2021

Crisis intervention psychotherapy (CIP) is an underutilized form of therapy that can be offered as a treatment during psychiatric disasters and emergencies, and it may be especially useful during the age of Coronavirus Disease 2019 (COVID-19). CIP is a problem-solving, solution-focused, trauma-informed treatment, utilizing an individual or systemic/family-centered approach. CIP is a brief form of psychotherapy delivered as a companion or follow-up to psychological first aid. Crisis psychotherapy is designed to resolve a crisis and restore daily functioning. CIP can be adapted as a single session for a COVID-19 mental health emergency or for a hotline or as 2 to 20 sessions of treatment with COVID-19 patients and families offered virtually on a psychiatric inpatient unit, through a consultation-liaison service, or in outpatient settings. This article reviews the history of critical incident stress management and the use of its replacement, psychological first aid. The history and core principles of crisis psychotherapy and 8 core elements of treatment are described. The use of digital and virtual technology has enabled the delivery of crisis psychotherapy during the COVID-19 pandemic. A case study of a family impacted by COVID-19 is reported as an illustration. The use of a 6-week timeline, an ecological map, and a problem-solving wheel-and-spoke treatment plan are demonstrated.
Charting and Handling Genetic Test Results: How They Differ From Most Laboratory Results
Authors: PRESKORN SHELDON H.
Published: June 2021

Genetic tests, unlike most other laboratory tests, are trait rather than state tests. That means the results almost always stay the same. Exceptions to this rule are discussed in this column. Trait tests require documentation in such a way that they are not buried in the chart and forgotten, as usually happens with state (or point-in-time tests) such as serum potassium levels. Genetic test results and their implications should be explained to the patient in as much detail as possible and also shared and discussed with all health care providers treating the patient. This column explains the rationale for and the means to accomplish the goals of optimally charting and disseminating the results of such tests.
Hearing Voices and Seeing Things: Symptoms of Anxiety Misconstrued as Evidence of Schizophrenia in an Adolescent
Authors: CAMERINI BIANCA A. , BAKER KRISTA K. , GADELHA ARY , MARGOLIS RUSSELL L.
Published: June 2021

A patient’s complaint of “hearing voices” or “seeing things” or of similar perceptual abnormalities leaves the clinician with 2 decisions: (1) Is the patient actually experiencing a hallucination, or does the complaint reflect a different mental experience, ranging from outright fabrication to the misinterpretation or mislabeling of vivid thoughts and emotions? (2) How should the experience reported by the patient, whether determined to be a hallucination or not, be understood in the context of the patient’s entire history and mental state? We report the case of a 16-year-old whose cartoon-like hallucinations had led to the diagnosis of schizophrenia and had directed attention of the patient, her parents, and her clinicians away from critical issues of anxiety, depression, learning difficulties, and traumatic school experiences. This case illustrates how the diagnosis of schizophrenia can be driven by the prominence and vividness of psychotic-like symptoms reported by a patient, the expectation that patients’ chief complaints must be directly and immediately addressed, insufficient attention to collateral information, and the distortions of a “checklist” approach to psychiatric diagnosis driven by the criteria in the Diagnostic and Statistical Manual of Mental Disorders, insurers, and the properties of electronic medical records. Given the consequences of either underdiagnosing or overdiagnosing schizophrenia, and the current lack of validated objective tests to assist with this diagnosis, clinicians are obligated to perform a thorough clinical assessment of such patients, including a probing exploration of the patient’s mental state and a systematic collection of collateral information.
Reasons for Participation and Nonparticipation in Psychological Relapse Prevention for Anxiety and Depression: A Qualitative Study
Authors: SCHOLTEN WILLEMIJN , MUNTINGH ANNA , BATELAAN NEELTJE , DRAISMA STASJA , DE JONGE MARGO , VAN BALKOM ANTON
Published: June 2021

Background:

Anxiety and depressive disorders frequently recur, but participation in effective psychological interventions to prevent relapse is limited. The reasons for nonparticipation are largely unknown, hampering successful implementation. The aims of this study were: (1) to investigate reasons why patients with remitted anxiety or depressive disorders refuse cognitive-behavioral therapy relapse prevention interventions (RPIs), (2) to compare these reasons with reasons to participate, and (3) to gain insight into patients’ preferences regarding relapse prevention.

Methods:

A qualitative study was conducted in which data were gathered from 52 semistructured interviews with patients who either refused or agreed to participate in psychological relapse prevention. The constant comparative method was used.

Results:

The data showed that those who refused to participate (1) did have knowledge about relapse risks in general, (2) but did not relate this risk to themselves, and therefore, did not feel the need for relapse prevention, or (3) declined to participate for logistical reasons or reasons related to the content of the intervention. Preferences concerning the form and content of RPIs were very diverse.

Conclusions:

Psychoeducation on relapse should be provided to patients to help them relate recurrence risks to themselves. RPIs should also be individually tailored.
The Interface of COVID-19 and Inpatient Psychiatry: Our Experience and Lessons Learned
Authors: Russ Mark J. , Parish Sharon J. , Mendelowitz Ruth , Mendoza Shayne , Arkow Stan D. , Radosta Michael , Espinosa Linda , Sombrotto Lisa B. , Anthony Donna , Wyman David A. , Baptista-Neto Lourival , Wilner Philip J.
Published: June 2021

The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to the provision of inpatient psychiatric care. The nature of the physical plant, programmatic constraints, and the patient population required a rapid and agile approach to problem-solving under conditions of uncertainty and stress. Flexibility in decision-making, excellent communication, an effective working relationship with infection prevention and control experts, and attention to staff morale and support were important elements of successful provision of care to our inpatients. We present our experience, lessons learned, and recommendations should a resurgence of the pandemic or a similar crisis occur.
Three-Dimensionally Printed Skin Substitute Using Human Dermal Fibroblasts and Human Epidermal Keratinocytes
Authors: Patel Jason , Willis Joseph , Aluri Akshay , Awad Shadi , Smith Metta , Banker Zena , Mitchell Morgan , Macias Liz , Berry Joel , King Timothy
Published: June 2021

Introduction

Wound healing affects millions of people annually. After injury, keratinocytes from the wound edge proliferate, migrate, and differentiate to recapitulate the 3-dimensional (3D) structure needed to provide a barrier function. If the wound is too large, skin grafting may be required. We are interested in discovering novel strategies to enhance the wound healing process. It may be possible to recreate a viable and histologically accurate skin tissue using 3D printing. We hypothesize that keratinocytes and dermal fibroblasts can be bioprinted into a viable skin substitute.

Methods

Adult human dermal fibroblasts (HDFa) and adult human epidermal keratinocytes (HEKa) were cultured and subsequently printed with a 3D bioprinter within a hydrogel scaffold. After printing the HDFa and HEKa separately, cell viability and histological appearance were determined by sectioning the printed tissue and performing hematoxylin and eosin staining. The stained histological sections were analyzed for tissue morphology.

Results

The HEKa and HDFa cells suspended in the hydrogel were successfully printed into 3D scaffolds that resembled skin with hematoxylin and eosin staining.

Conclusions

The HEKa and HDFa cells can be grown on 3D-printed hydrogels successfully. In addition, HEKa and HDFa cells can survive and grow when suspended in a hydrogel and 3D printed. Future potential applications of these results could lead to the creation of viable skin tissue for wound healing and surgical repair.
The Impact of Perioperative Blood Pressure on Hematoma Development After Panniculectomy
Authors: Rudolph Megan , Galazra Laura , Greer Madison , Hemal Kshipra , Runyan Christopher
Published: June 2021

Purpose

Hematoma affects 10% to 13% of patients undergoing panniculectomy. Although elevated perioperative blood pressure has been associated with hematoma after rhytidectomy, this has not been established for panniculectomy. We sought to determine the impact of perioperative blood pressure on hematoma development in patients undergoing panniculectomy.

Methods

A retrospective review was performed on patients undergoing isolated panniculectomy procedures. Blood pressure parameters recorded included systolic blood pressures (SBPs), diastolic blood pressures (DBPs), and mean arterial pressure. The mean, peak, and trough blood pressure values were recorded. Preoperative, intraoperative, and postoperative blood pressures were recorded, and differences between phases were calculated. Univariate and multivariate logistic regressions were performed.

Results

One hundred forty-three patients were identified, which included 84% (n = 120) women and 17% (n = 23) men. A history of hypertension was present in 55% (n = 79) of patients, of which 91% (n = 72) were medically controlled. Preoperative antiplatelet or anticoagulation was used in 21% (n = 31) of patients. Seven patients (5%) developed a hematoma, of which 5 required operative drainage. Development of hematoma was not associated with patient, surgical, or postoperative pain variables. There was an association between hematoma and elevated postoperative blood pressures on univariate and multivariate analyses. The mean peak SBP in the hematoma group was 160 mm Hg in comparison to 141 mm Hg in the nonhematoma group. For each 10-mm Hg increase in postoperative peak SBP, the odds of a hematoma increased by 2.8 times. When comparing phases of care, hematoma patients had similar intraoperative and postoperative peak SBP, but their postoperative SBP was 19 mm Hg higher than preoperative baseline. Conversely, nonhematoma patients had a postoperative blood pressure that was similar to their preoperative baseline and 20 mm Hg lower than their intraoperative values.

Conclusions

Hematoma is associated with elevated postoperative blood pressures. A postoperative mean peak SBP of 160 mm Hg was associated with hematoma, and for each 10 mm Hg, the risk of hematomsa increased by 2.8 times. The risk of hematoma may be reduced by strict postoperative blood pressure control. We recommend a postoperative peak SBP goal of 140 mm Hg or less, with a value equal to or less than their preoperative baseline and 20 mm Hg lower than their intraoperative pressure.
The three-component helicase/primase complex of herpes simplex virus-1
Authors: Bermek Oya , Williams R. Scott
Published: June 2021

Herpes simplex virus type 1 (HSV-1) is one of the nine herpesviruses that infect humans. HSV-1 encodes seven proteins to replicate its genome in the hijacked human cell. Among these are the herpes virus DNA helicase and primase that are essential components of its replication machinery. In the HSV-1 replisome, the helicase–primase complex is composed of three components including UL5 (helicase), UL52 (primase) and UL8 (non-catalytic subunit). UL5 and UL52 subunits are functionally interdependent, and the UL8 component is required for the coordination of UL5 and UL52 activities proceeding in opposite directions with respect to the viral replication fork. Anti-viral compounds currently under development target the functions of UL5 and UL52. Here, we review the structural and functional properties of the UL5/UL8/UL52 complex and highlight the gaps in knowledge to be filled to facilitate molecular characterization of the structure and function of the helicase–primase complex for development of alternative anti-viral treatments.
Disrupted Ca2+ homeostasis and immunodeficiency in patients with functional Inositol 1,4,5-trisphosphate receptor subtype 3 defects
Authors: Neumann Julika , Van Nieuwenhove Erika , Terry Lara E , Staels Frederik , Knebel Taylor R , Welkenhuyzen Kirsten , Baker Mariah R , Gerbaux Margaux , Willemsen Mathijs , Barber John S. , Serysheva Irina I , De Waele Liesbeth , Vermeulen François , Meyts Isabelle , Yule David I , Bultynck Geert , Schrijvers Rik , Humblet-Baron Stephanie , Liston Adrian
Published: June 2021

Calcium signaling is essential for lymphocyte activation, with genetic disruptions resulting in severe immunodeficiency. The inositol 1,4,5-trisphosphate receptor (IP3R), formed from homo- or hetero-tetramers of the IP3R isoforms 1-3, amplifies lymphocyte signaling by releasing Ca2+ from ER stores into the cytosol following antigen-stimulation. While knockout of all 3 IP3R isoforms results in immunodeficiency in mice, the seeming redundancy of subunits was thought to explain the absence of IP3R mutation as a cause of human immunodeficiency. Here, we identify compound heterozygous variants in ITPR3 in two unrelated Caucasian patients presenting with combined immunodeficiency, in one case requiring hematopoietic stem cell transplantation. We observed disrupted Calcium homeostasis in patient-derived fibroblasts and immune cells, with abnormal proliferation and activation responses following B and T cell receptor stimulation. Reconstitution of IP3R knockout cell lines identified the variants as functional hypomorphs with reduced discrimination between homeostatic and induced states, validating a link between genotype and phenotype. These results demonstrate a functional linkage between defective ER Ca2+ channels and immunodeficiency, and identify IP3Rs as diagnostic targets for patients with specific inborn errors of immunity.
Knowledge, attitude and practice towards antibiotic use and resistance among the veterinarians in Bangladesh
Authors: Sarker Md Samun , Ahmed Iftekhar , Siddiky Nure Alam , Islam Shariful , Begum Ruhena , Ahmed Ayesha , Mahua Fatema Akter , Kabir Md Ehsanul , Samad Mohammed A.
Published: June 2021

Background

The emergence of antimicrobial resistance is growing human and animal health concern around the world. When a number of studies have emphasized the Knowledge, Attitude and Practice (KAP) regarding antibiotic use and resistance in humans, little attention has been paid to the veterinary sector. The aim of this study was to understand the KAP towards antibiotic use and resistance among the veterinarians in Bangladesh.

Methods

A cross-sectional online based questionnaire survey was conducted from August to September 2020 among the registered veterinary practitioners. A self-administered Google form questionnaire consists of 45 questions on knowledge, attitude and practice regarding antibiotic use and resistance were used.

Results

A total of 208 registered veterinarians participated in this study. 85.1% of the participants were male and 54.8% of the participants had a Masters degree. Around 52% of the veterinarians were poultry practitioners. All respondents were familiar with antimicrobials. The participants (91.4%) knew that antibiotics can not cure viral infections while 97.6% believed that frequent antibiotic prescription rendered them less effective. Participants claimed that only they are eligible to prescribe drugs for the treatment of animals and around 80% disagreed with adding antibiotics with feed/water as a growth promoter in livestock. Of the total participants, 87% believed that a local antimicrobial guideline would be more effective than an international one. However, gaps in practices were highlighted in our study, suggesting training deficiencies.

Conclusion

The present study for the first time conducted in Bangladesh dictates the future interventions like academic courses, workshops, and seminars on antibiotic usage and resistance are needed to ameliorate the knowledge, behavior and practice of veterinarians with regards to the rational use of antibiotics.
B.1.1.7 and B.1.351 variants are highly virulent in K18-ACE2 transgenic mice and show different pathogenic patterns from early SARS-CoV-2 strains
Authors: Radvak Peter , Kwon Hyung Joon , Kosikova Martina , Ortega-Rodriguez Uriel , Xiang Ruoxuan , Phue Je-Nie , Shen Rong-Fong , Rozzelle James , Kapoor Neeraj , Rabara Taylor , Fairman Jeff , Xie Hang
Published: June 2021

SARS-CoV-2 continues to circulate globally resulting in emergence of several variants of concern (VOC), including B.1.1.7 and B.1.351 that show increased transmissibility and enhanced resistance to antibody neutralization. In a K18-hACE2 transgenic mouse model, we demonstrate that Both B.1.1.7 and B.1.351 are 100 times more lethal than the original SARS-CoV-2 bearing 614D. Mice infected with B.1.1.7 and B.1.351 exhibited more severe lesions in internal organs than those infected with early SARS-CoV-2 strains bearing 614D or 614G. Infection of B.1.1.7 and B.1.351 also results in distinct tissue-specific cytokine signatures, significant D-dimer depositions in vital organs and less pulmonary hypoxia signaling before death as compared to the mice infected with early SARS-CoV-2 strains. However, K18-hACE2 mice with the pre-existing immunity from prior infection or immunization were resistant to the lethal reinfection of B.1.1.7 or B.1.351, despite having reduced neutralization titers against these VOC. Our study reveals distinguishing pathogenic patterns of B.1.1.7 and B.1.351 variants from those early SARS-CoV-2 strains in K18-hACE2 mice, which will help to inform potential medical interventions for combatting COVID-19.
Raman spectroscopy on blood serum samples of patients with end-stage liver disease
Authors: René Staritzbichler , Pascal Hunold , Irina Estrela-Lopis , Hildebrand Peter W. , Berend Isermann , Thorsten Kaiser
Published: June 2021

Raman spectroscopy has shown to be a promising method for the examination of biomedical samples. However, until now, its efficacy has not been established in clinical diagnostics. In this study, Raman spectroscopy’s potential application in medical laboratories is evaluated for a large variety (38) of biomarkers. Given 234 serum samples from a cohort of patients with different stages of liver disease, we performed Raman spectroscopy at 780nm excitation wavelength. The Raman spectra were analyzed in combination with the results of routine diagnostics using specifically developed complex mathematical algorithms, including fluorescence filtering, frequency subset selection and several overfitting circumventing strategies, such as independent validation. With the results of this cohort, which were validated in 328 independent samples, a significant proof-of-concept study was completed. This study highlights the need to prevent overfitting and to use independent data for validation. The results reveal that Raman spectroscopy has high potential for use in medical laboratory diagnostics to simultaneously quantify multiple biomarkers.
Multifunctionality of belowground food webs: resource, size and spatial energy channels
Authors: Potapov Anton
Published: June 2021

The belowground compartment of terrestrial ecosystems drives nutrient cycling, the decomposition and stabilisation of organic matter, and supports aboveground life. Belowground consumers create complex food webs that regulate functioning, ensure stability and support biodiversity both below and above ground. However, existing soil food-web reconstructions do not match recently accumulated empirical evidence and there is no comprehensive reproducible approach that accounts for the complex resource, size and spatial structure of food webs in soil. Here I build on generic food-web organization principles and use multifunctional classification of soil protists, invertebrates and vertebrates, to reconstruct ‘multichannel’ food-web across size classes of soil-associated consumers. This reconstruction is based on overlying feeding preference, prey protection, size spectrum and spatial distribution matrices combined with biomasses of trophic guilds to infer weighted trophic interactions. I then use food-web reconstruction, together with assimilation efficiencies, to calculate energy fluxes assuming a steady-state energetic system. Based on energy fluxes, I describe a number of indicators, related to stability, biodiversity and multiple ecosystem-level functions such as herbivory, top-down control, translocation and transformation of organic matter. I illustrate the approach with an empirical example, comparing it with traditional resource-focused soil food-web reconstruction. The multichannel reconstruction can be used to assess trophic multifunctionality (analogous to ecosystem multifunctionality), i.e. simultaneous support of multiple trophic functions by the food-web, and compare it across communities and ecosystems spanning beyond the soil. With further validation and parametrization, my multichannel reconstruction approach provides an effective tool for understanding and analysing soil food webs. I believe that having this tool will inspire more people to comprehensively describe soil communities and belowground-aboveground interactions. Such studies will provide informative indicators for including consumers as active agents in biogeochemical models, not only locally but also on regional and global scales.
AGNOSTOS-DB: a resource to unlock the uncharted regions of the coding sequence space
Authors: Vanni Chiara , Schechter Matthew S. , Delmont Tom O. , Eren A. Murat , Steinegger Martin , Glöckner Frank Oliver , Fernandez-Guerra Antonio
Published: June 2021

Genomes and metagenomes contain a considerable percentage of genes of unknown function, which are often excluded from downstream analyses limiting our understanding of the studied biological systems. To address this challenge, we developed AGNOSTOS, a combined database-computational workflow resource that unifies the known and unknown coding sequence space of genomes and metagenomes. Here, we present AGNOSTOS-DB, an extensive database of high-quality gene clusters enriched with functional, ecological and phylogenetic information. Moreover, AGNOSTOS allows integrating new data into existing AGNOSTOS-DBs, maximizing the information retrievable for the genes of unknown function. As a proof of concept, we provide a seed database that integrates the predicted genes from marine and human metagenomes, as well as from Bacteria, Archaea, Eukarya and giant viruses environmental and cultivar genomes. The seed database comprises 6,572,081 gene clusters connecting 342 million genes and represents a comprehensive and scalable resource for the inclusion and exploration of the unknown fraction of genomes and metagenomes.
E156G and Arg158, Phe-157/del mutation in NTD of spike protein in B.1.617.2 lineage of SARS-CoV-2 leads to immune evasion through antibody escape
Authors: Chaudhari Armi M , Kumar Dinesh , Joshi Madhvi , Patel Amrutlal , Joshi Chaitanya
Published: June 2021

Emerging variants of SARS-CoV-2 with better immune escape mechanisms and higher transmissibility remains a persistent threat across the globe. B.1.617.2 (Delta) variant was first emerged from Maharashtra, India in December, 2020. This variant is classified to be a major cause and concern of the second wave of COVID-19 in India. In the present study, we explored the genomic and structural basis of this variant through computational analysis, protein modelling and molecular dynamics (MD) simulations approach. B.1.617.2 variant carried E156G and Arg158, Phe-157/del mutations in NTD of spike protein. These mutations in N-terminal domain (NTD) of spike protein of B.1.617.2 variant revealed more rigidity and reduced flexibility compared to spike protein of Wuhan isolate. Further, docking and MD simulation study with 4A8 monoclonal antibody which was reported to bind NTD of spike protein suggested reduced binding of B.1.617.2 spike protein compared to that of spike protein of Wuhan isolate. The results of the present study demonstrate the possible case of immune escape and thereby fitness advantage of the new variant and further warrants demonstration through experimental evidence. Our study identified the probable mechanism through which B.1.617.2 variant is more pathogenically evolved with higher transmissibility as compared to the wild-type.

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Generation of star-shaped human induced astrocytes with a mature inflammatory phenotype for CNS disease modeling
Authors: Voulgaris Dimitrios , Nikolakolpoulou Polyxeni , Herland Anna
Published: June 2021

Generating astrocytes from induced pluripotent stem cells has been hampered by either prolonged differentiation -spanning over two months -or by shorter protocols that generate immature astrocytes, devoid of salient inflammation-associated astrocytic traits pivotal for CNS neuropathological modeling. We directed human neural stem cells derived from induced pluripotent stem cells to astrocytic commitment and maturity by orchestrating an astrocytic-tuned culturing environment. In under 28 days, the generated cells express canonical and mature astrocytic markers, denoted by the expression of AQP4 and, remarkably, the expression and functionality of glutamate transporter EAAT2. We also show that this protocol generates astrocytes that encompass traits critical in CNS disease modeling, such as glutathione synthesis and secretion, upregulation of ICAM-1 and a cytokine secretion profile which is on par with primary astrocytes. This protocol generates a multifaceted astrocytic model suitable for CNS in vitro disease modeling and personalized medicine through brain-on-chip technologies.
Mitochondria decode firing frequency and coincidences of postsynaptic APs and EPSPs
Authors: Stoler Ohad , Stavsky Alexandra , Khrapunsky Yana , Melamed Israel , Stutzmann Grace , Gitler Daniel , Sekler Israel , Fleidervish Ilya
Published: June 2021

Mitochondrial metabolism is critical for brain function. However, the mechanisms linking mitochondrial energy production to neuronal activity are elusive. Using whole-cell electrical recordings from Layer 5 pyramidal neurons in cortical slices and fluorescence imaging of cytosolic, mitochondrial Ca2+ indicators and endogenous NAD(P)H, we revealed ultra-fast, spike-evoked mitochondrial Ca2+ transients temporally similar to cytosolic Ca2+ elevations. We demonstrate that, whereas single or few spikes elicit the mitochondrial Ca2+ transients throughout the cell, their amplitude is differentially regulated in distinct neuronal compartments. Thus, these signals were prominent in the soma and apical dendrites and ∼3 times smaller in basal dendrites and axons. The spike firing frequency had a subtle effect on the amplitude of the cytosolic Ca2+ elevations but dramatically affected mitochondrial Ca2+ transients and NAD(P)H oxidation and recovery rates. Moreover, while subthreshold EPSPs alone caused no detectable Ca2+ elevation in dendritic mitochondria, the Hebbian coincidence of unitary EPSP and postsynaptic spike produced a localized, single mitochondrial Ca2+ elevation. These findings suggest that neuronal mitochondria are uniquely capable of decoding firing frequency and EPSP-to-spike time intervals for tuning the metabolic rate and triggering changes in synaptic efficacy.
Characterization of a recombinant plastid translocon co-chaperone
Authors: Nurmohamed Salima Sarah , Ko Kenton
Published: June 2021

The transport of proteins into plastids is dependent on how the different translocon components work together. One translocon component, Tic40, possesses functional features found in other proteins such as co-chaperones and may thus work similarly in this capacity. To enhance the understanding of Tic40’s mode of operation, a more basic characterization of the protein itself is required. This study was designed largely to examine the properties of recombinant Tic40 without the predicted transmembrane region. The properties of Tic40 revealed in this report are: 1) In plants, overall Tic40 levels can adjust to temperature; 2) Recombinant Tic40 proteins appear to display some level of functionality in the soluble form; and 3) Outside of a membranous context, the formation of complexes involving recombinant Tic40 can be influenced by temperature. The potential significance of these basic properties is discussed.