bluuebunny/crossref_metadata_2025 huggingface dataset:
Renal denervation
Authors: Kapil Vikas
Published: October 2022

Renal denervation represents an interventional technique aimed at disrupting both efferent and afferent sympathetic signalling between the cardiovascular control centres in the brainstem and the kidneys to lower blood pressure. Renal neural signalling is important for renin–angiotensin–aldosterone system activation, among others, and different technologies have been developed, iterated, and investigated in clinical trials. Extensive evidence has shown enhanced sympathetic signalling in primary hypertension, with more detailed physiological studies showing the specific importance of renal neural signalling. Renal denervation has been tested in placebo-controlled trials in patients on and off antihypertensive medications, and appears to have a durable blood pressure response, similar in magnitude to a single medication, and be safe in the intermediate term.
Hypertension in pregnancy: physiopathological, preventive, therapeutic, and long-term considerations
Authors: Valdés Gloria
Published: October 2022

During the early 70s, the concept that arterial hypertension resulted from different haemodynamic and humoral patterns that responded selectively to individualized drug treatment was emerging. Since then, many concepts have been acquired over these decades. These include the balance between vasodilatory and vasopressor pleiotropic systems, adaptations of the systemic maternal haemodynamics, development of the utero-placental interface, crosstalk between the placenta and the maternal endothelium, different pathways that lead to pre-eclampsia, long-term consequences in the mother and child in a hypertensive pregnancy, and evolution of different theories. This chapter will provide an updated clinical evaluation and management of this condition.
Virial theorem in clusters of galaxies with MOND
Authors: López-Corredoira M , Betancort-Rijo J E , Scarpa R , Chrobáková Ž
Published: October 2022

A specific modification of Newtonian dynamics known as MOND has been shown to reproduce the dynamics of most astrophysical systems at different scales without invoking non-baryonic dark matter (DM). There is, however, a long-standing unsolved problem when MOND is applied to rich clusters of galaxies in the form of a deficit (by a factor around two) of predicted dynamical mass derived from the virial theorem with respect to observations. In this article, we approach the virial theorem using the velocity dispersion of cluster members along the line of sight rather than using the cluster temperature from X-ray data and hydrostatic equilibrium. Analytical calculations of the virial theorem in clusters for Newtonian gravity + DM and MOND are developed, applying pressure (surface) corrections for non-closed systems. Recent calibrations of DM profiles, baryonic ratio, and baryonic (β model or others) profiles are used, while allowing free parameters to range within the observational constraints. It is shown that solutions exist for MOND in clusters that give similar results to Newton + DM – particularly in the case of an isothermal β model for β = 0.55–0.70 and core radii rc between 0.1 and 0.3 times r500 (in agreement with the known data). The disagreements found in previous studies seem to be due to the lack of pressure corrections (based on inappropriate hydrostatic equilibrium assumptions) and/or inappropriate parameters for the baryonic matter profiles.
Testing a scaling relation between coherent radio emission and physical parameters of hot magnetic stars
Authors: Das Barnali , Chandra Poonam , Shultz Matt E , Leto Paolo , Mikulášek Zdeněk , Petit Véronique , Wade Gregg A
Published: October 2022

Coherent radio emission via electron cyclotron maser emission (ECME) from hot magnetic stars was discovered more than two decades ago, but the physical conditions that make the generation of ECME favourable remain uncertain. Only recently was an empirical relation, connecting ECME luminosity with the stellar magnetic field and temperature, proposed to explain what makes a hot magnetic star capable of producing ECME. This relation was, however, obtained with just 14 stars. Therefore, it is important to examine whether this relation is robust. With the aim of testing the robustness, we conducted radio observations of five hot magnetic stars. This led to the discovery of three more stars producing ECME. We find that the proposed scaling relation remains valid after the addition of the newly discovered stars. However, we discovered that the magnetic field and effective temperature correlate for Teff ≲ 16 kK (likely an artefact of the small sample size), rendering the proposed connection between ECME luminosity and Teff unreliable. By examining the empirical relation in light of the scaling law for incoherent radio emission, we arrive at the conclusion that both types of emission are powered by the same magnetospheric phenomenon. Like the incoherent emission, coherent radio emission is indifferent to Teff for late-B and A-type stars, but Teff appears to become important for early-B type stars, possibly due to higher absorption, or higher plasma density at the emission sites suppressing the production of the emission.
Genomic Signatures of Mitonuclear Coevolution in Mammals
Authors: Weaver Ryan J , Rabinowitz Samantha , Thueson Kiley , Havird Justin C
Published: October 2022

Mitochondrial (mt) and nuclear-encoded proteins are integrated in aerobic respiration, requiring co-functionality among gene products from fundamentally different genomes. Different evolutionary rates, inheritance mechanisms, and selection pressures set the stage for incompatibilities between interacting products of the two genomes. The mitonuclear coevolution hypothesis posits that incompatibilities may be avoided if evolution in one genome selects for complementary changes in interacting genes encoded by the other genome. Nuclear compensation, in which deleterious mtDNA changes are offset by compensatory nuclear changes, is often invoked as the primary mechanism for mitonuclear coevolution. Yet, direct evidence supporting nuclear compensation is rare. Here, we used data from 58 mammalian species representing eight orders to show strong correlations between evolutionary rates of mt and nuclear-encoded mt-targeted (N-mt) proteins, but not between mt and non-mt-targeted nuclear proteins, providing strong support for mitonuclear coevolution across mammals. N-mt genes with direct mt interactions also showed the strongest correlations. Although most N-mt genes had elevated dN/dS ratios compared to mt genes (as predicted under nuclear compensation), N-mt sites in close contact with mt proteins were not overrepresented for signs of positive selection compared to noncontact N-mt sites (contrary to predictions of nuclear compensation). Furthermore, temporal patterns of N-mt and mt amino acid substitutions did not support predictions of nuclear compensation, even in positively selected, functionally important residues with direct mitonuclear contacts. Overall, our results strongly support mitonuclear coevolution across ∼170 million years of mammalian evolution but fail to support nuclear compensation as the major mode of mitonuclear coevolution.
Clues to mortality trends and their related factors in IgG4-related disease: A Japanese single-centre retrospective study
Authors: Kawahara Hiroyuki , Mizushima Ichiro , Tsuge Shunsuke , Shin Seung , Yoshinobu Takahiro , Hoshiba Ryohei , Nishioka Ryo , Zoshima Takeshi , Hara Satoshi , Ito Kiyoaki , Kawano Mitsuhiro
Published: October 2022

Objectives

This study aimed to clarify mortality trends and their related factors in immunoglobulin G4-related disease (IgG4-RD) with various organ involvement.

Methods

We retrospectively reviewed the medical records of patients with IgG4-RD at a single rheumatology centre in Japan. We calculated the standardized mortality ratio using Japanese national mortality statistics. Cox regression analyses were also performed to assess mortality-related factors.

Results

A total of 179 patients with IgG4-RD were included with a median follow-up period of 47 months. The standardized mortality ratio in our cohort was 0.86 (95% confidence interval 0.41–1.59). Univariate Cox regression analyses indicated that the number of affected organs at diagnosis (hazard ratio 1.45, 95% confidence interval 1.02–2.05), estimated glomerular infiltration rate <45 ml/min/1.73 m2 at diagnosis (vs. ≥45, hazard ratio 8.48, 95% confidence interval 2.42–29.79), and the presence of malignancy during the clinical course (hazard ratio 5.85, 95% confidence interval 1.62–21.15) had a significant impact on the time to death.

Conclusions

Our findings suggest that in the rheumatology department, IgG4-RD does not significantly affect long-term patient survival. However, multi-organ involvement, renal dysfunction, and malignancy may be associated with higher mortality trends in IgG4-RD. Early detection and appropriate management of risk factors may improve the long-term prognosis of patients with IgG4-RD.
IAnimal: a cross-species omics knowledgebase for animals
Authors: Fu Yuhua , Liu Hong , Dou Jingwen , Wang Yue , Liao Yong , Huang Xin , Tang Zhenshuang , Xu JingYa , Yin Dong , Zhu Shilin , Liu Yangfan , Shen Xiong , Liu Hengyi , Liu Jiaqi , Yang Xin , Zhang Yi , Xiang Yue , Li Jingjin , Zheng Zhuqing , Zhao Yunxia , Ma Yunlong , Wang Haiyan , Du Xiaoyong , Xie Shengsong , Xu Xuewen , Zhang Haohao , Yin Lilin , Zhu Mengjin , Yu Mei , Li Xinyun , Liu Xiaolei , Zhao Shuhong
Published: October 2022

With the exponential growth of multi-omics data, its integration and utilization have brought unprecedented opportunities for the interpretation of gene regulation mechanisms and the comprehensive analyses of biological systems. IAnimal (https://ianimal.pro/), a cross-species, multi-omics knowledgebase, was developed to improve the utilization of massive public data and simplify the integration of multi-omics information to mine the genetic mechanisms of objective traits. Currently, IAnimal provides 61 191 individual omics data of genome (WGS), transcriptome (RNA-Seq), epigenome (ChIP-Seq, ATAC-Seq) and genome annotation information for 21 species, such as mice, pigs, cattle, chickens, and macaques. The scale of its total clean data has reached 846.46 TB. To better understand the biological significance of omics information, a deep learning model for IAnimal was built based on BioBERT and AutoNER to mine ‘gene’ and ‘trait’ entities from 2 794 237 abstracts, which has practical significance for comprehending how each omics layer regulates genes to affect traits. By means of user-friendly web interfaces, flexible data application programming interfaces, and abundant functional modules, IAnimal enables users to easily query, mine, and visualize characteristics in various omics, and to infer how genes play biological roles under the influence of various omics layers.
Animal-SNPAtlas: a comprehensive SNP database for multiple animals
Authors: Gao Yingjie , Jiang Guanghui , Yang Wenqian , Jin Weiwei , Gong Jing , Xu Xuewen , Niu Xiaohui
Published: October 2022

Single-nucleotide polymorphisms (SNPs) as the most important type of genetic variation are widely used in describing population characteristics and play vital roles in animal genetics and breeding. Large amounts of population genetic variation resources and tools have been developed in human, which provided solid support for human genetic studies. However, compared with human, the development of animal genetic variation databases was relatively slow, which limits the genetic researches in these animals. To fill this gap, we systematically identified ∼ 499 million high-quality SNPs from 4784 samples of 20 types of animals. On that basis, we annotated the functions of SNPs, constructed high-density reference panels and calculated genome-wide linkage disequilibrium (LD) matrixes. We further developed Animal-SNPAtlas, a user-friendly database (http://gong_lab.hzau.edu.cn/Animal_SNPAtlas/) which includes high-quality SNP datasets and several support tools for multiple animals. In Animal-SNPAtlas, users can search the functional annotation of SNPs, perform online genotype imputation, explore and visualize LD information, browse variant information using the genome browser and download SNP datasets for each species. With the massive SNP datasets and useful tools, Animal-SNPAtlas will be an important fundamental resource for the animal genomics, genetics and breeding community.
KEGG for taxonomy-based analysis of pathways and genomes
Authors: Kanehisa Minoru , Furumichi Miho , Sato Yoko , Kawashima Masayuki , Ishiguro-Watanabe Mari
Published: October 2022

KEGG (https://www.kegg.jp) is a manually curated database resource integrating various biological objects categorized into systems, genomic, chemical and health information. Each object (database entry) is identified by the KEGG identifier (kid), which generally takes the form of a prefix followed by a five-digit number, and can be retrieved by appending /entry/kid in the URL. The KEGG pathway map viewer, the Brite hierarchy viewer and the newly released KEGG genome browser can be launched by appending /pathway/kid, /brite/kid and /genome/kid, respectively, in the URL. Together with an improved annotation procedure for KO (KEGG Orthology) assignment, an increasing number of eukaryotic genomes have been included in KEGG for better representation of organisms in the taxonomic tree. Multiple taxonomy files are generated for classification of KEGG organisms and viruses, and the Brite hierarchy viewer is used for taxonomy mapping, a variant of Brite mapping in the new KEGG Mapper suite. The taxonomy mapping enables analysis of, for example, how functional links of genes in the pathway and physical links of genes on the chromosome are conserved among organism groups.
Extrapolated longer-term effects of the DAPA-CKD trial: a modelling analysis
Authors: McEwan Phil , Boyce Rebecca , Sanchez Juan Jose Garcia , Sjöström C David , Stefansson Bergur , Nolan Stephen , Correa-Rotter Ricardo , Rossing Peter , Chertow Glenn M , McMurray John J V , Wheeler David C , Heerspink Hiddo J L
Published: October 2022

Background

The Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial assessed dapagliflozin versus placebo, in addition to standard therapy, in patients with chronic kidney disease (CKD) and albuminuria, and was terminated prematurely due to overwhelming efficacy. The study objective was to model the long-term clinical outcomes of DAPA-CKD beyond the trial follow-up.

Methods

A Markov model extrapolated event incidence per 1000 patients and CKD progression rates for patients receiving dapagliflozin or placebo over a 10-year time horizon. We derived treatment-specific CKD stage transition matrices using DAPA-CKD trial data. We extrapolated relevant efficacy endpoints using parametric survival equations for all-cause mortality and generalized estimating equations for recurrent events.

Results

When extrapolated over a 10-year period, patients randomized to dapagliflozin spent more time in CKD stages 1–3 and less in stages 4–5 than placebo [0.65 (95% CrI 0.41, 0.90) and –0.23 (95% CrI -0.45, 0.00) years per patient, respectively]. Dapagliflozin prevented an estimated 83 deaths and 51 patients initiating kidney replacement therapy per 1000 patients over 10 years. Predicted rates of hospitalized heart failure and abrupt declines in kidney function were reduced (19 and 39 estimated events per 1000 patients, respectively).

Conclusions

Adding dapagliflozin to standard therapeutic management of CKD is expected to have long-term cardiorenal benefit beyond what has been demonstrated in the DAPA-CKD trial, with patients predicted to live longer with fewer complications.
Measuring the impact of state and local Tobacco 21 policies in the United States: A longitudinal study of youth and young adults ages 15–21
Authors: Patel Minal , Simard Bethany J , Benson Adam F , Donovan Emily M , Pitzer Lindsay
Published: October 2022

Introduction

Tobacco 21 (T21) policies, which prohibit tobacco sales to individuals under 21, aim to reduce youth tobacco use by limiting youth access to these products. Little, however, is known about the longitudinal effect of T21 policies on youth tobacco use behaviors at the national level.

Methods

Participants aged 15–21 years from a longitudinal study conducted between May 2014 and May 2019 (n = 13,990) were matched to geocoded T21 policies. Generalized linear mixed models examined the association of direct and bordering T21 policy exposure and cigarette and e-cigarette use and intention to use, accounting for individual characteristics.

Results

Controlling for sociodemographic and psychosocial covariates, there were statistically significant positive associations between T21 exposure and e-cigarette use (OR = 1.45 [1.03,2.06], p < .003) and intention to use e-cigarettes (OR = 1.54 [1.05,2.26], p < .027). We found no association between T21 policy exposure and cigarette use or intention to use cigarettes. Furthermore, exposure to T21 policies did not significantly modify the relationship between age and either cigarette outcome.

Conclusions

This is the first longitudinal study to evaluate state and local T21 policies at the national level. Our analyses demonstrate that existing T21 policies are not sufficient to reduce youth tobacco use and intentions to use, and suggest that T21 policies need to be a part of a comprehensive tobacco policy landscape. Our findings suggest further research is warranted on state and local T21 policy enforcement and implementation, including how T21 may differentially impact cigarette and e-cigarette use, and may have implications for the federal T21 policy.

Implications

This research evaluates state and local T21 policies in the United States longitudinally, finding that T21 policies are not sufficient to stem e-cigarette use among adolescents and young adults. These findings support further policy action and suggest that local and state T21 policies are not sufficient to reduce tobacco use and rather, need to be part of a broader, more comprehensive set of tobacco control policies. Further research on enforcement and implementation challenges of T21 policies and the impacts of the new federal T21 policy is warranted.
Health Care Utilization and Costs in Systemic Therapies for Metastatic Melanoma from 2016 to 2020
Authors: Qian Mollie F , Betancourt Nicolas J , Pineda Alain , Maloney Nolan J , Nguyen Kevin A , Reddy Sunil A , Hall Evan T , Swetter Susan M , Zaba Lisa C
Published: October 2022

Background

Widespread implementation of immune checkpoint inhibitors (ICI) and targeted therapies for metastatic melanoma has led to a decline in melanoma-related mortality but increased healthcare costs. We aimed to determine how healthcare utilization varied by systemic, non-adjuvant melanoma treatment from 2016 to 2020.

Patients and Methods

Adults with presumed stage IV metastatic melanoma receiving systemic therapy from 2016 to 2020 were identified in Optum, a nationwide commercial claims database. Treatment groups were nivolumab, pembrolizumab, ipilimumab+nivolumab (combination-ICI), or BRAF+MEK inhibitor (BRAFi+MEKi) therapy. Outcomes included hospitalizations, days hospitalized, emergency room (ER) visits, outpatient visits, and healthcare costs per patient per month (pppm). Multivariable regression models were used to analyze whether cost and utilization outcomes varied by treatment group, with nivolumab as reference.

Results

Among 2018 adult patients with metastatic melanoma identified, mean (SD) age was 67 (15) years. From 2016 to 2020, nivolumab surpassed pembrolizumab as the most prescribed systemic melanoma therapy while combination-ICI and BRAFi+MEKi therapies remained stable. Relative to nivolumab, all other therapies were associated with increased total healthcare costs (combination-ICI: β = $47 600 pppm, 95%CI $42 200-$53 100; BRAFi+MEKi: β = $3810, 95%CI $365-$7260; pembrolizumab: β = $6450, 95%CI $4420-$8480). Combination-ICI and BRAFi+MEKi therapies were associated with more inpatient hospital days.

Conclusions

Amid the evolving landscape of systemic therapy for advanced melanoma, nivolumab monotherapy emerged as the most used and least costly systemic treatment from 2016 to 2020. Its sharp increase in use in 2018 and lower costs relative to pembrolizumab may in part be due to earlier adoption of less frequent dosing intervals.
Measurement Properties of the Timed Functional Arm and Shoulder Test in Patients With Shoulder Problems
Authors: Safford Daniel W , Shah Kshamata M , Turner Jeffrey A , McClure Philip W
Published: October 2022

Objective

The purpose of this study was to determine the feasibility, reliability, validity, and responsiveness of the Timed Functional Arm and Shoulder Test (TFAST) in patients with shoulder problems.

Methods

This study was a repeated-measures clinical measurement observational cohort study. A total of 104 patients who were symptomatic participated in this study. The TFAST was collected as part of an patient’s outpatient physical therapist care at 6 different sites. The test and data collection were performed at 3 time points: baseline (initial evaluation), follow-up at the patient’s first return visit within 7 days of evaluation, and discharge at the patient’s final visit for care.

Results

All participants were able to perform the TFAST at baseline, with 1 exception, and 67 participants completed data collection at all 3 time points. There were no adverse effects in any participant related to performing the TFAST. Intrarater intersession reliability, reported as ICC(2,1), was 0.91 (95% CI = 0.79–0.95). The mean difference in TFAST scores for the affected arm was 23.2 repetitions (77.4 at baseline to 100.6 at discharge). The Cohen d effect size was 1.02, and the standardized response mean was 0.95. The minimal clinically important difference was determined to be 21 repetitions.

Conclusion

The TFAST seems to be feasible and appropriate for use in a wider population than other existing shoulder performance measures. The TFAST has demonstrated adequate reliability, validity, and responsiveness in patients with shoulder problems. Clinicians may consider using the TFAST to objectively assess patient performance.

Impact

The TFAST may be used to expand measurement of objective shoulder performance in a wide population of patients with shoulder problems. This test may provide information beyond an patient’s self-report and contribute to clinical decision-making.
Treatment for Mild Chronic Hypertension During Pregnancy
Authors: Tita Alan T. , Szychowski Jeff M. , Boggess Kim , Dugoff Lorraine , Sibai Baha , Lawrence Kirsten , Hughes Brenna L. , Bell Joseph , Aagaard Kjersti , Edwards Rodney K. , Gibson Kelly , Haas David M. , Plante Lauren , Metz Torri , Casey Brian , Esplin Sean , Longo Sherri , Hoffman Matthew , Saade George R. , Hoppe Kara K. , Foroutan Janelle , Tuuli Methodius , Owens Michelle Y. , Simhan Hyagriv N. , Frey Heather , Rosen Todd , Palatnik Anna , Baker Susan , August Phyllis , Reddy Uma M. , Kinzler Wendy , Su Emily , Krishna Iris , Nguyen Nicki , Norton Mary E. , Skupski Daniel , El-Sayed Yasser Y. , Ogunyemi Dotum , Galis Zorina S. , Harper Lorie , Ambalavanan Namasivayam , Geller Nancy L. , Oparil Suzanne , Cutter Gary R. , Andrews William W.
Published: October 2022

(Abstracted from N Engl J Med 2022;386:1781–1792)

Chronic hypertension affects >2% of pregnancies in the United States and disproportionately affects Black women. The condition is also associated with an increased risk of adverse neonatal outcomes, including preeclampsia, placental abruption, preterm birth, small for gestational age (SGA), or perinatal death, and maternal outcomes, including maternal death, heart failure, stroke, pulmonary edema, or acute kidney injury.
Fifteen Years of Autologous Oocyte Thaw Outcomes From a Large University-Based Fertility Center
Authors: Cascante Sarah Druckenmiller , Blakemore Jennifer K. , DeVore Shannon , Hodes-Wertz Brooke , Fino M. Elizabeth , Berkeley Alan S. , Parra Carlos M. , McCaffrey Caroline , Grifo James A.
Published: October 2022

(Abstracted from Fertil Steril 2022;118:158–166)

Changes in social norms have resulted in a trend toward motherhood at a later age in the United States. Oocyte preservation (OC) is now a widely used methodology of fertility preservation used to offset the age-related fertility decline related to decreased oocyte quantity and quality.
The complement system in antineutrophil cytoplasmic antibody-associated vasculitis: pathogenic player and therapeutic target
Authors: Mazzariol Martina , Manenti Lucio , Vaglio Augusto
Published: October 2022

Purpose of review

The purpose of this review is to discuss the role of the complement system in the pathogenesis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) as well as the employment of complement inhibitors in AAV treatment.

Recent findings

AAV has traditionally been considered a pauci-immune disease until recent findings demonstrated the pathogenic role of the complement system. The complement alternative pathway is crucial in AAV, and C5a seems to be a key molecule for AAV to develop. Avacopan, a C5a-receptor (C5aR) antagonist, proved effective in achieving AAV remission and ameliorating kidney function.

The increased circulating levels of some complement components – as well as the consumption of others – in patients with AAV suggested a systemic activation of the complement system. Low C3 levels correlate with a more aggressive disease and a worse renal prognosis. In ANCA-associated glomerulonephritis, renal deposits of C3d and properdin, suggestive of local alternative pathway activation, correlate with glomerular crescents and proteinuria. The interaction between C5a and neutrophil triggers alternative pathway activation, suggesting the central role of C5a in AAV pathogenesis. Avacopan, a C5aR inhibitor, showed beneficial effects in AAV and represents a promising therapy to achieve sustained remission and to spare glucocorticoids.
Descriptive Epidemiology of Isolated Distal Radius Fractures in Children: Results From a Prospective Multicenter Registry
Authors: Shah Apurva S. , Guzek Ryan H. , Miller Mark L. , Willey Michael C. , Mahan Susan T. , Bae Donald S. ,   the Pediatric Distal Radius Fracture (PDRF) Study Group
Published: October 2022

Introduction:

More than 1 in 4 pediatric fractures involves the distal radius. Most prior epidemiologic studies are limited to retrospective, single center investigations, and often include adults. This study aims to describe the contemporary epidemiology of pediatric distal radius fractures using prospectively collected data from a multicenter Pediatric Distal Radius Fracture Registry.

Methods:

Patients aged 4 to 18 years diagnosed with a distal radius fracture from June 2018 through December 2019 at 4 tertiary care pediatric centers were screened and enrolled in this prospective longitudinal cohort study. Patients were excluded if they presented with bilateral distal radius fractures, polytrauma, or re-fracture. Demographic information, mechanism of injury, fracture characteristics, associated injuries, and procedural information were recorded. All radiographs were reviewed and measured. Descriptive statistics and bivariate analyses were performed.

Results:

A total of 1951 patients were included. The mean age was 9.9±3.3 years, and 61.3% of patients were male (P<0.001). Most injuries occurred during a high-energy fall (33.5%) or sports participation (28.4%). The greatest proportion of fractures occurred during the spring months (38.5%). Torus fractures (44.0%) were more common than bicortical (31.3%) or physeal (21.0%) fractures. Of the physeal fractures, 84.3% were Salter-Harris type II. Associated ulnar fractures were observed in 51.2% of patients. The mean age at injury was higher for patients with physeal fractures (11.6±2.9 y) than patients with torus or bicortical fractures (9.4±3.1 and 9.6±3.1 y, respectively; P<0.001). Thirty-six percent of distal radius fractures underwent closed reduction and 3.3% underwent surgical fixation. Patients treated with closed reduction were more likely to be male (68.7% vs. 57.2%; P<0.001), obese (25.3% vs. 17.2%; P<0.001), and have bicortical fractures (62.2% vs. 14.5%; P<0.001).

Conclusions:

Distal radius fractures in children have a male preponderance and are most likely to occur in the spring months and during high-energy falls and sports. Physeal fractures tend to occur in older children while torus and bicortical fractures tend to occur in younger children.

Level of Evidence:

Level I—prognostic.
Neuromuscular blocking agent induced hypersensitivity reaction exploration: an update
Authors: Dejoux Alice , de Chaisemartin Luc , Bruhns Pierre , Longrois Dan , Gouel-Chéron Aurélie
Published: October 2022

Acute hypersensitivity reactions (AHRs) occurring in present-day anaesthesia can have severe, sometimes fatal, consequences and their incidence is increasing. The most frequent allergens responsible for AHR during anaesthesia are neuromuscular blocking agents (NMBAs) (70% of the cases) followed by antibiotics (18%), patent blue dye and methylene blue dye (5%), and latex (5%). Following an AHR, strategies for subsequent anaesthetic procedures (especially the choice of an NMBA) may be difficult to formulate due to inconclusive diagnostic analysis in up to 30% of AHRs. Current diagnosis of AHR relies on the detection of mast cell degranulation products and drug-specific type E immunoglobulins (IgE) in order to document an IgE-mediated anaphylaxis (IgE endotype). Nonetheless, other IgE-independent pathways can be involved in AHR, but their detection is not currently available in standard situations. The different mechanisms (endotypes) involved in peri-operative AHR may contribute to the inconclusive diagnostic work-up and this generates uncertainty concerning the culpable drug and strategy for subsequent anaesthetic procedures. This review provides details on the IgE endotype; an update on non-IgE related endotypes and the novel diagnostic tools that could characterise them. This detailed update is intended to provide explicit clinical reasoning tools to the anaesthesiologist faced with an incomplete AHR diagnostic work-up and to facilitate the decision-making process regarding anaesthetic procedures following an AHR to NMBAs.
Clinical Outcomes of Single Versus Double Anaerobic Coverage for Intra-abdominal Infections
Authors: Raymond Lendelle , Cani Eris , Zeana Cosmina , Lois William , Park Tae Eun
Published: October 2022

Background

Double anaerobic coverage is often used for intra-abdominal infections postoperatively. The primary objective of this study was evaluating length of hospital stay, in-hospital postoperative complications, and readmission within 30 days of discharge due to postoperative complications in patients who received piperacillin/tazobactam versus piperacillin/tazobactam plus metronidazole for intra-abdominal infections. The secondary objective was comparing in-hospital mortality and hospital-associated Clostridioides difficile infection between the 2 groups.

Methods

This retrospective cohort study included adults, who received either single or double anaerobic coverage postoperatively for at least 48 hours between January 1, 2016, and June 30, 2019. Statistical analysis involved matching patients 1:1 between the 2 groups based on Charlson Comorbidity Index, American Society of Anesthesiologists physical status classification, and surgical wound classification. Descriptive statistics and logistic regression were used to analyze the outcomes.

Results

Of 163 patients, 134 were matched 1:1 into single and double anaerobic coverage groups. The baseline characteristics of each group were similar except for diagnosis. Double anaerobic coverage was more often used for gastrointestinal perforations (38.8% vs 16.4%, P = 0.004) and single anaerobic coverage for acute cholecystitis (37.3% vs 9%, P < 0.001). In a multivariate analysis, double anaerobic coverage was associated with longer length of hospital stay (P = 0.003) compared with single anaerobic coverage. In-hospital mortality (6%) and hospital-associated C. difficile (1.5%) infection were only observed in the double anaerobic coverage group.

Conclusions

Double anaerobic coverage is associated with longer length of hospital stay and in-hospital postoperative complications.
Validation of the Nurse Managers' Work Content Questionnaire and Factors―A Structural Equation Modeling Study
Authors: NURMEKSELA Anu , MIKKONEN Santtu , KINNUNEN Juha , KVIST Tarja
Published: October 2022

Background

The responsibilities of nurse managers are diverse and occasionally inadequately organized. Moreover, the role of nurse manager often lacks a clear job description. Few methodologies for evaluating the content of nurse managers' work exist.

Purpose

This study was designed to validate the Nurse Managers' Work Content Questionnaire (NMWCQ) instrument and to analyze the relationships between NMWCQ factors and background variables using structural equation modeling.

Methods

A multicenter descriptive and cross-sectional study design was used. The NMWCQ, which includes 87 items across 13 components, was developed based on a comprehensive literature review and pilot study. The questionnaire was sent to all of the nurse managers (N = 756) employed at eight Finnish hospitals in 2019. Exploratory and confirmatory factor analyses were used to psychometrically test and validate the NMWCQ, whereas Cronbach's alpha values were calculated to explore the internal consistency of the instrument. Structural equation modeling was applied to detect the relationships between the constructed factor structure and the background variables.

Results

Two hundred seven nurse managers participated in this study. The final solution for the NMWCQ included 75 items across 12 factors. The NMWCQ factors were as follows: responsibility for new employees, daily management, human resource management, decision making, clinical nursing, development, planning of processes, collaboration, ensuring knowledge, evidence-based management, ensuring care quality, and financial management. The items showed factor loadings that were either positive or negative, with values ranging from .314 to .846. The Cronbach's alpha values for the factors ranged between .605 and .851. All of the covariances and relationships between background variables and factors were found to be significant (p ≤ .05). The structural equation modeling showed acceptable index results (incremental fit index = .954, comparative fit index = .951, and root mean square error of approximation = .048).

Conclusions

The NMWCQ version assessed in this study shows a more robust structure than the previously published pilot version. Psychometric testing showed the NMWCQ as suitable for describing the diverse work requirements of nurse managers and may offer a framework for concretizing the job description of nurse managers.
Factors Associated With Burnout Among Nurses Providing Direct Patient Care During the COVID-19 Pandemic
Authors: Cohen Bevin , DePierro Jonathan , Chan Chi C. , Tolan Elaine , Deshpande Richa , Feder Adriana , Feingold Jordyn H. , Peccoralo Lauren , Pietrzak Robert H. , Ripp Jonathan
Published: October 2022

OBJECTIVE

This study aimed to identify factors associated with burnout in nurses and nurses' opinions regarding interventions to promote well-being during crisis conditions such as those experienced during the COVID-19 pandemic.

BACKGROUND

Burnout among nurses is prevalent under usual conditions and may increase during crises such as COVID-19.

METHODS

Researchers conducted a survey of 1103 frontline nurses in a single New York City hospital during the first (spring 2020) and second (fall 2020/winter 2021) local waves of COVID-19.

RESULTS

Burnout prevalence increased from 45% to 52% between the first and second wave. Younger age, female gender, posttraumatic stress, anxiety or depressive symptoms, history of burnout, feeling less valued by hospital leadership, less informed of responsibilities, less certain about duration of enhanced workload, and prepared by prepandemic experience were predictive of burnout in multivariable analyses.

CONCLUSIONS

Although some identified risk factors for burnout were nonmodifiable, others may be modifiable by hospital leadership.
Improving 9.5 Million Lives: Pilot Testing Ambulatory Care Nurse-Sensitive Quality Indicators
Authors: Siaki Leilani , Patrician Patricia A. , Loan Lori A. , Matlock Ann Marie , Start Rachel E. , McCarthy Mary S.
Published: October 2022

OBJECTIVE

The aim of this study was to evaluate scientific acceptability, feasibility, utility, and value of ambulatory care nurse-sensitive quality indicators (ACNSIs) in military outpatient clinics.

BACKGROUND

Optimizing healthcare quality and cost requires scientifically sound metrics. However, ACNSI development and measurement have lagged behind inpatient nurse-sensitive indicators. Validated and reliable ACNSIs are urgently needed to maximize nurses' efforts to improve healthcare quality.

METHODS

Two staffing and 4 patient-centered ACNSIs were pilot tested in 5 military clinics over a 6-month period using a mixed-methods design.

RESULTS

Reliability and validity were generally acceptable. Most ACNSIs demonstrated feasibility, utility, and value for performance measurement. Challenges to using ACNSIs include absence of standardized administrative and clinical processes, infrastructure, and leadership and technological support.

CONCLUSIONS

These ACNSIs show promise as valid performance metrics. Provider- and nurse-level metrics may synergistically improve practice, enhancing the team approach so critical to ambulatory care.
Employment Status of Nurses After a Psychoeducational Group Intervention
Authors: Sawyer Amanda T. , Pepe Julie , Robinson Patricia Stearnes , Bailey Amanda K. , Sun Jingwei
Published: October 2022

OBJECTIVE

This matched case-control study compared the long-term employment status of direct care nurses based on participation in a psychoeducational group intervention and calculated the estimated cost savings.

BACKGROUND

Chronic stress, in addition to lack of support and low autonomy, can lead to burnout among nurses. Burnout is a common reason for job dissatisfaction and turnover. Interventions combining education with therapeutic processing and peer support may lead to healing and growth in nurses already experiencing the effects of chronic stress and burnout. The COVID-19 pandemic also contributed to stress among nurses.

METHODS

Fifty-four direct care nurses who participated in the intervention were paired with 54 direct care nurses who did not participate, matched on the following variables: age, gender, race, work setting, and campus.

RESULTS

This study found a higher percentage of direct care nurses who participated in the intervention remained employed compared with the matched control subjects who did not participate.

CONCLUSION

At a relatively low cost compared with the cost of turnover by each nurse, the psychoeducational group intervention may provide an opportunity to improve retention among nurses.
Resurgence of Autologous Fascial Slings in a Challenging Climate for Sling Surgery: A 20-Year Review of Comparative Data
Authors: Chen Yi-Ju Amy , Jean-Michel Marjorie
Published: October 2022

Importance

Since the US Food and Drug Administration's 2016 ban of transvaginal mesh use in vaginal prolapse surgery, there has been growing public scrutiny over the use of synthetic mesh slings (SSs) for the surgical management of female stress urinary incontinence (SUI). Although long considered the mainstay of current practice, interest in biological alternatives has grown.

Objectives

This article reviews the last 20 years of data comparing the success of autologous fascial slings (AFSs) and SSs in the treatment of female SUI.

Evidence Acquisition

We reviewed the literature for randomized controlled trials comparing autologous pubovaginal sling and SS for the primary surgical treatment of female SUI using several search engines and databases between January 1, 2000, and March 31, 2020.

Study Appraisal and Synthesis Methods

Data were retrieved and compared across studies. Trials were evaluated for study setting, type, population characteristics, sample size, success definition and rate, recurrence rate, operative time, length of hospital stay, complications, and quality of life.

Results

Of the 1382 articles reviewed, 8 met eligibility criteria, representing 6 distinct cohorts and 726 subjects. Synthetic slings available for review were either tension-free vaginal tape (TVT) or minisling. The vast majority of studies demonstrated similar short- and long-term success rates of AFS and SS procedures utilizing a range of outcome measures. Both AFS and TVT sling had low recurrence rates in short- and long-term follow-up. However, AFS had significantly longer operative time, and longer hospital stay. Bladder perforation, on the other hand, occurred more commonly in TVT sling. Health-related quality-of-life scores, including sexual function, were similar between groups.

Conclusions

Autologous fascial sling and SS are both highly effective surgical procedures for the treatment of female SUI. Although success rates are comparable, AFS is associated with less favorable operative measures.

Relevance

This review supports the effectiveness of AFS in treating female SUI as concerns over the use of synthetic materials in vaginal surgery rise. However, clinicians must weigh the risks conferred by this nonsynthetic alternative.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After participating in this activity, the learner should be better able to compare the benefits and drawbacks of available sling types for the surgical management of female stress urinary incontinence; discuss complication rates related to each sling type; and explain their impact on quality of life.
Replication Stress Impairs Chromosome Segregation and Preimplantation Development in Human Embryos
Authors: Palmerola Katherine L. , Amrane Selma , De Los Angeles Alejandro , Xu Shuangyi , Wang Ning , de Pinho Joao , Zuccaro Michael V. , Taglialatela Angelo , Massey Dashiell J. , Turocy Jenna , Robles Alex , Subbiah Anisa , Prosser Bob , Lobo Rogerio , Ciccia Alberto , Koren Amnon , Baslan Timour , Egli Dieter
Published: October 2022

(Abstracted from Cell 2022;185:2988.e20–3007.e20)

Spontaneous DNA damage, such as double-strand breaks (DSBs), affects cell-cycle progression and contributes to embryo attrition. There is a strong correlation among mitotic cell-cycle progression, ploidy, the quality of the blastocyst formed, and successful implantation from in vitro fertilization.
Postprocedural Pain Associated With 5 Versus 20 Intradetrusor Injections of OnabotulinumtoxinA for Treatment of Overactive Bladder: A Multicenter Randomized Clinical Trial
Authors: Chang Eric S. , Ringel Nancy , Woodburn Katherine L. , Tanner Jean Paul , Bassaly Renee , Greene Kristie , Wyman Allison , Iglesia Cheryl
Published: October 2022

(Abstracted from Urogynecology 2022;28:518–525)

For treating nonneurogenic overactive bladder, female pelvic medicine and urogenital reconstruction guidelines given by the American Urological Association and Society of Urodynamics recommend that onabotulinumtoxinA (botoxA) may be used as third-line therapy following a failure of both first-line lifestyle and behavioral changes and second-line cholinergic or β-agonist therapy. Wide variations on the acceptable number of injections per treatment episode (as much as 1 injection to 40) have been promulgated for botoxA.
Ipsilateral Upper-Limb Lymphedema After COVID-19 Vaccine Booster
Authors: Tang Charlene Yu Lin , Chua Wei Ming
Published: October 2022

Recent data suggest that protective immunity from COVID-19 vaccine may wane after a period, with booster doses becoming increasingly deployed in many countries. An 84-year-old woman presents with a 6-month history of left upper-limb swelling; the only history of note was an intramuscular Pfizer-BioNTech mRNA vaccine booster in the ipsilateral deltoid just 1 week before the onset of the swelling. Upper-extremity lymphoscintigraphy after the administration of 99mTc-nanocolloid into the interstitial space of the hands showed left upper-limb lymphatic dysfunction.
Traumatic brachial plexus injury: diagnosis and treatment
Authors: Wu Kitty Y. , Spinner Robert J. , Shin Alexander Y.
Published: October 2022

Purpose of the Review:

Traumatic brachial plexus injuries (BPI) are devastating life-altering events, with pervasive detrimental effects on a patient's physical, psychosocial, mental, and financial well-being. This review provides an understanding of the clinical evaluation, surgical indications, and available reconstructive options to allow for the best possible functional outcomes for patients with BPI.

Recent Findings:

The successful management of patients with BPI requires a multidisciplinary team approach including peripheral nerve surgeons, neurology, hand therapy, physical therapy, pain management, social work, and mental health. The initial diagnosis includes a detailed history, comprehensive physical examination, and critical review of imaging and electrodiagnostic studies. Surgical reconstruction depends on the timing of presentation and specific injury pattern. A full spectrum of techniques including neurolysis, nerve grafting, nerve transfers, free functional muscle transfers, tendon transfers, and joint arthrodesis are utilized.

Despite the devastating nature of BPI injuries, comprehensive care within a multidisciplinary team, open and practical discussions with patients about realistic expectations, and thoughtful reconstructive planning can provide patients with meaningful recovery.
Performance evaluation of Novaplex SARS-CoV-2 variants assay kit series for SARS-CoV-2 detection using single nucleotide polymorphisms
Authors: Ogihara Shinji , Aoki Kotaro , Nagashima Mami , Sadamasu Kenji , Ishii Yoshikazu , Tateda Kazuhiro
Published: October 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have received increasing attention globally because of their increased transmissibility and potential to escape immunity. Although whole-genome sequencing is the gold standard method for SARS-CoV-2 mutation detection and lineage determination, it is costly and time-consuming. However, SARS-CoV-2 variants can be identified based on select variant-specific single nucleotide polymorphisms (SNPs) in the spike protein-encoding gene (S). This study validated and compared the limit of detection (LOD) of L452R, N501Y, HV69/70 del and E484K as variant-specific SNPs of the S gene and RdRP as a SARS-CoV-2-specific gene, using the Novaplex SARS-CoV-2 variants assay kit series. For three SARS-CoV-2 lineages (B.1.617.2, B.1.1.7 and R.1), one strain per lineage was used. Variant-specific SNPs of the S gene were analysed using the Novaplex SARS-CoV-2 variants I assay and Novaplex SARS-CoV-2 variants II assay kits. Validation confirmed the LODs of the variant kits. The LOD for each target variant-specific SNP and RdRP was five RNA copies per reaction. The Novaplex SARS-CoV-2 variants assay kit series performs well and the LOD for SARS-CoV-2 detection and variant-specific SNP detection are consistent. The kits are suitable for use as routine laboratory tests for SARS-CoV-2 and variant-specific SNP detection in a single step, saving time and labour.