bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Analysis of Gastrointestinal and Bone Inflammation in Hindlimb Unloading
Authors: Narayanan Anand , Metzger Corinne , Brezicha Jessica , Lenfest Scott , Bloomfield Susan , Hogan Harry , Zawieja David
Published: July 2022

The hindlimb unloading (HU) rodent model is used to mimic changes incurred in spaceflight due to microgravity. Previously in 2‐weeks of rat HU, we found systemically impaired lymphatic transport. Recently we reported gastrointestinal (GI) inflammation and lymphatic immune cell alterations after 4‐weeks of HU in rats paralleling the GI pathology observed in inflammatory bowel disease (IBD) animal models. A known comorbidity of IBD is inflammation‐induced bone loss; prior work in our lab with a 4‐week IBD rodent model documented bone loss as well as an increased prevalence of cancellous osteocytes positive for tumor necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6), and insulin‐like growth factor‐I (IGF‐I) concurrent with GI inflammation. The implications of a potential inflammatory link between gut and bone in HU and spaceflight have not been reported. In this study we quantified TNF‐α, IL‐6, and IGF‐I (via immunohistochemistry) in both bone and colon samples after 4‐weeks of HU in male Sprague Dawley rats (comparing HU and age‐matched controls). Proximal tibia cancellous bone volume, osteoid surface area, bone formation rate, and trabecular number were lower in HU versus controls, while osteoclast surface area and trabecular separation were higher. Measures of osteocytes in cancellous bone positive for IL‐6 and IGF‐I levels were lowered, but there was no change in TNF‐α. Colon histopathology showed elevated structural damage in the mucosa region with a corresponding cellularity elevation in HU compared to controls. HU colons also had elevated TNF‐α and IL‐6 expression across the mucosal and submucosal regions with IGF‐I a trending increase. Furthermore cytokine changes were dependent on the colon compartment. Fecal calprotectin (a clinical IBD marker of GI inflammation) was collected throughout the 4‐week time course; calprotectin was significantly increased at 2‐weeks of HU and trended towards elevation at 4‐weeks. After HU we did not find the same cytokine pattern in bone compared to what we have seen in an IBD model induced by the haptenizing agent TNBS, suggesting different inflammatory mechanisms. However there may be a time course impact of IBD development in the models.

Support or Funding Information

Study support received from NASA Grants: NNX15AG54G, NNX13AN33G, NNX13AQ87G. AN, JB, and SL were supported by the NASA‐NSBRI Predoctoral Fellowship.
Intracranial Pressure Increases During Hindlimb Suspension
Authors: Gompf Heinrich S , Robinson Edward L , Hoban‐Higgins Tana M , Fuller Charles A
Published: July 2022

Introduction

One of the responses following exposure to the microgravity spaceflight environment is a pronounced cephalic fluid shift. Recent evidence documents ocular changes in astronauts following long‐duration missions including optic disc edema, globe flattening, choroidal folds and hyperopic shifts. These changes are hypothesized to result from this cephalic fluid shift, as these ocular effects are similar to those seen in terrestrial Idiopathic Intracranial Hypertension (IIH) and are associated with increased intraocular pressure (IOP). Long duration missions are currently being undertaken on the International Space Station (ISS) and planning for manned missions to Mars has begun. This project aims to simulate long‐term microgravity cephalic fluid shift using a well‐established terrestrial rat model to provide a means for study of the mechanisms underlying ocular changes seen in spaceflight.

Methods

We are using the rat hindlimb suspension (HLS) model, functionally equivalent to human head‐down bedrest (a human terrestrial model of cephalic fluid shift), to examine the relationship between cephalic fluid shifts and the regulation of intracranial pressure (ICP) as well as visual system structure and function. As we are investigating the role of sex and age in these responses, the study includes three cohorts: young adult male, young adult female, and older middle‐age adult males, roughly equivalent to the ages of most mission‐ready astronauts. Rats are placed in HLS for up to 90 days, a time frame roughly equivalent to the proportion of an astronaut's lifespan that would be dedicated to an exploration class mission. This is followed by up to 90 days of post‐suspension recovery in a vivarium cage. All HLS subjects have age‐matched vivarium cage controls. All subjects have ad lib access to food and water. A 12:12 LD cycle is present. An implanted telemetry unit is used to measure body temperature, EEG and ICP. The pressure probe catheter is implanted in the lateral ventricle and continuous recordings are performed for one week prior to and after the start of HLS, after 30, 60 and 90 days of suspension and after 0, 30, 60 and 90 days of post‐suspension recovery. MRI images of the eyes and brain, and IOP measurements were also performed in additional animals exposed to HLS.

Results and Conclusions

Our hypothesis is that HLS leads to 1.) increased ICP; which, when sustained over long time periods, results in 2.) increased IOP and can lead to 3.) morphological changes such as globe flattening of the eye as well as distension of the optic nerve complex. Results to date indicate a pronounced and sustained increase in ICP during the entire HLS period. Analysis of MRI images and IOPs suggest a pattern similar to that seen in astronauts on longer‐term missions as a subset of rats exhibit globe flattening, distension of the optic nerve complex, and increased IOP.

Support or Funding Information

Supported by NASA Grant NNX13AD94G
Erythropoietin Provides Neuroprotective Benefits Against Low‐Dose Proton Exposure
Authors: King Scott E. , DeWesse Theodore L , Roma Peter G , Hienz Robert D , Davis Catherine M
Published: July 2022

As NASA quickly approaches the ability to embark on long‐term space travel, it becomes increasingly important to discover effective methods to shield astronauts from the damaging effects from exposure to space radiation. To investigate possible neuroprotective strategies for ameliorating radiation‐induced cognitive deficits, the present study describes the effects of erythropoietin (EPO) for attenuating proton‐induced deficits in sustained attention, obtained by measuring performance of rats on the rodent Psychomotor Vigilance Test (rPVT). The rPVT is a rodent version of the human PVT that is routinely used as a “fitness‐for‐duty” test across a wide range of professions. Performance on the human PVT requires responding to a visual stimulus as soon as it appears; a response terminates the stimulus presentation and the subject's reaction time is recorded and displayed. In the present study, male Long‐Evans rats were trained to perform the rPVT to baseline performance levels, defined as ≥75% correct and ≤ 25% premature responses. For 7 days before irradiation, rats received daily injections of human EPO (Epoetin alfa, human recombinant erythropoietin) at either of 1,000, 3,000, or 5,000 U/kg/day (7 total injections). Two control groups were also utilized: a sham‐irradiated group administered the EPO vehicle, and a sham‐irradiated group receiving 5,000 U/kg/day EPO. Rats were then irradiated with head‐only protons (150 MeV/n) at 100 cGy or sham‐irradiation. Similar to previous results, 100 cGy exposures induced deficits in accuracy and increased lapses in attention in a subgroup of rats on the rPVT; these rats were characterized as “radiation‐sensitive”. EPO dose‐dependently improved performance in “radiation‐sensitive” rats, producing higher performance accuracy and lower lapses in attention. EPO showed no effects on rPVT performance in radiation insensitive rats or in the sham‐irradiated rats. The data presented in the current study supports the role of vascular growth factors in ameliorating radiation‐induced cognitive deficits and the use of EPO as a treatment for ameliorating the CNS effects of radiation exposure for astronauts embarking on long‐term space travel.

Support or Funding Information

This work supported by NSBRI through NASA NCC 9‐58‐NBPF04201, NASA NNX15AC71G and an ASPET Summer Undergraduate Research Fellowship.
Treatment of juvenile localized scleroderma: current recommendations, response factors, and potential alternative treatments
Authors: Li Suzanne C.
Published: July 2022

Purpose of review

Juvenile localized scleroderma (jLS) is a chronic autoimmune and fibrosing disease associated with a high risk for functional impairment. Antifibrotic options are limited, so current treatment strategies are focused on disease activity control. Pediatric rheumatologists are in consensus on the need to treat with systemic immunosuppressants, in particular, methotrexate. However, more than 30% of patients fail initial methotrexate treatment. This review provides an update on current management and reviews reports on potential alternative treatments.

Recent findings

An overview of current treatment recommendations and its efficacy are discussed. Recent studies have identified several factors associated with likelihood of treatment response. These include time to initiation of treatment, certain subtypes, and extracutaneous involvement. Findings from recent reports of alternative systemic immunomodulators, including biologic medications, will be summarized.

Methotrexate treatment has greatly improved outcome for most jLS patients but a substantial portion have refractory cutaneous and/or extracutaneous disease. Treatment response factors are being identified, which could lead to improved management strategies. Recent studies provide further support on mycophenolate mofetil as an alternative treatment. Data on biologic therapies is encouraging, with data suggesting efficacy for many extracutaneous manifestations but more studies are needed to evaluate these and other options for jLS.
Correlation between plasma sphingosine-1-phosphate and the occurrence and severity of coronary heart disease in postmenopausal women
Authors: Deng Songbai , Ao Zehui , Liu Bin , She Qiang , Du Jianlin , Liu Yajie , Jing Xiaodong
Published: July 2022

Objective

Sphingosine-1-phosphate (S1P) is a bioactive sphingosine with antiatherosclerotic effects. The incidence of coronary heart disease (CHD) increases significantly among women after menopause. We explored the relationship between plasma S1P levels and the occurrence and severity of CHD in postmenopausal women.

Methods

Postmenopausal women admitted to our hospital for coronary angiography because of chest pain–like symptoms were included in our study. By 1:1 age matching (age difference ≤5 y), 166 women in the CHD group and control group were enrolled. The plasma S1P concentration was determined, and the Gensini score was calculated to decide the severity of CHD.

Results

Plasma S1P levels were significantly lower in the CHD group of postmenopausal women (P < 0.001). S1P (odds ratio, 0.952; 95% CI, 0.934-0.970) was an independent predictor of the occurrence of CHD in postmenopausal women. The area under the curve for S1P to predict the occurrence of CHD was 0.653 (95% CI, 0.595-0.712), and the cutoff value was 96.89 ng/mL. The plasma S1P level was the lowest in the high-tertile group of the Gensini score (P < 0.001), and the plasma S1P (odds ratio, 0.948; 95% CI, 0.926-0.970) was an independent predictor of a high Gensini score in postmenopausal women with CHD.

Conclusions

Plasma S1P is an independent risk factor of the occurrence and severity of CHD in postmenopausal women. The occurrence and aggravation of CHD in postmenopausal women may be related to levels of S1P.
Prasterone in the treatment of mild to moderate urge incontinence: an observational study
Authors: Collà Ruvolo Claudia , Gabrielli Olimpia , Formisano Carmen , Califano Gianluigi , Manna Paolo , Venturella Roberta , Di Carlo Costantino
Published: July 2022

Objective

To assess the effects of prasterone compared with hyaluronic acid on symptoms of mild to moderate urinary urgency in women with genitourinary syndrome of menopause.

Methods

This is an observational prospective cohort study. A total of 58 postmenopausal women were enrolled (from December 2019 to May 2021). Overactive Bladder Screener questionnaire, Patient Global Impression of Improvement questionnaire, International Consultation on Incontinence Questionnaire–Short Form, and International Quality of Life questionnaire were used.

Results

Fifty-eight women, 29 (50%) and 29 (50%), were treated with prasterone and hyaluronic acid for 12 weeks, respectively. At the end of the study, 26 (89.7%) versus 3 (10.3%) women reported an improvement (Patient Global Impression of Improvement score ≤3) of the symptoms in the prasterone versus hyaluronic acid group. According to the International Consultation on Incontinence Questionnaire–Short Form, no statistically significant difference was recorded before treatment between the prasterone and hyaluronic acid groups (median, 12 [6-12] vs 11 [8-12]; P = 0.8). Conversely, a statistically significant difference was recorded after treatment between the two groups (median, 8 [5-11] vs 10 [8-11]; P = 0.03). According to the International Quality of Life, a statistically significantly lower median score was recorded in the prasterone compared with the hyaluronic acid group, before (73 [interquartile range {IQR}, 55-81] vs 89 [IQR, 67-94]; P < 0.01) and after (78 [IQR, 65-86] vs 87 [IQR, 72-99]; P = 0.04) treatment.

Conclusions

The current observational study supports the hypothesis that prasterone might improve the severity of urinary urge incontinence in this set of women. However, these results need to be confirmed in further studies with a controlled design and a larger population.
A Community-Informed Virtual World-Based Cardiac Rehabilitation Program as an Extension of Center-Based Cardiac Rehabilitation
Authors: Brewer LaPrincess C. , Abraham Helayna , Kaihoi Brian , Leth Shawn , Egginton Jason , Slusser Joshua , Scott Christopher , Penheiter Sumedha , Albertie Monica , Squires Ray , Thomas Randal , Scales Robert , Trejo-Gutierrez Jorge , Kopecky Stephen
Published: July 2022

Purpose:

Innovative methods for delivering cardiac rehabilitation (CR) that provide strategies to circumvent the mounting barriers to traditional CR have the potential to widen access to a well-established secondary prevention strategy. Our study assesses the feasibility and acceptability of a novel virtual world-based CR (VWCR) program, Destination Rehab, as an extension of a conventional center-based CR program.

Methods:

Adult cardiac patients hospitalized at Mayo Clinic hospitals with a diagnosis for CR and ≥1 modifiable, lifestyle risk factor target—sedentary lifestyle (<3 hr physical activity/wk), unhealthy diet (<5 servings fruits and vegetables/d), or current smoking (>1 yr)—were recruited. Patients participated in an 8-wk health education program using a virtual world (VW) platform from a prior proof-of-concept study and a post-intervention focus group. Primary outcome measures included feasibility and acceptability. Secondary outcome measures included changes from baseline to post-intervention in cardiovascular (CV) health behaviors and biometrics, CV health knowledge, and psychosocial factors.

Results:

Of the 30 enrolled patients (age 59.1 ± 9.7 yr; 50% women), 93% attended ≥1 session and 71% attended ≥75% of sessions. The overall VWCR experience received an 8 rating (scale 0-10) and had high acceptability. Clinically relevant trends were noted in CV health behaviors and biometrics, although not statistically significant.

Conclusions:

The VWCR program is a feasible, highly acceptable, and innovative platform to potentially influence health behaviors and CV risk and may increase accessibility to disadvantaged populations with higher CV disease burdens.
Inverse salt sensitivity: an independent risk factor for cardiovascular damage in essential hypertension
Authors: Cuka Ermira , Simonini Marco , Lanzani Chiara , Zagato Laura , Citterio Lorena , Messaggio Elisabetta , Faienza Sipontina , Brioni Elena , Hamlyn John M. , Manunta Paolo
Published: July 2022

Objective:

Salt sensitivity is a powerful risk factor for cardiovascular (CV) disease and mortality in both normotensive and hypertensive patients. We investigated the predictive value of the salt sensitivity phenotype in the development of CV events and hypertensive target organ damage (TOD) among essential hypertensive patients.

Methods:

Eight hundred forty-four naive hypertensive patients were recruited and underwent an acute saline test during which blood pressure (BP) displayed either no substantial variation (salt-resistant, SR individuals), an increase (salt-sensitive, SS), or a paradoxical decrease (inverse salt-sensitive, ISS). Sixty-one patients with the longest monitored follow-up (median 16 years) for blood pressure and organ damage were selected for the present study. A clinical score for TOD development based on the severity and the age of onset was set up by considering hypertensive heart disease, cerebrovascular damage, microalbuminuria, and vascular events.

Results:

CV events were significantly higher among SS and ISS than in SR patients. The relative risk of developing CV events was 12.67 times higher in SS than SR and 5.94 times higher in ISS than SR patients. The development of moderate to severe TOD was 10-fold higher in SS and over 15-fold higher in ISS than in SR patients. Among the three phenotypes, changes in plasma endogenous ouabain were linked with the blood pressure effects of saline.

Conclusions:

Salt sensitivity and inverse salt sensitivity appear to be equivalent risk factors for CV events. The response to an acute saline test is predictive of CV damage for newly identified ISS individuals.
Development and validation of model for sparing adrenal venous sampling in diagnosing unilateral primary aldosteronism
Authors: Song Ying , Yang Jun , Shen Hang , Ng Elisabeth , Fuller Peter J. , Feng Zhengping , Hu Jinbo , Ma Linqiang , Yang Yi , Du Zhipeng , Wang Yue , Luo Ting , He Wenwen , Li Qifu , Wu Fei-Fei , Yang Shumin
Published: July 2022

Context:

Current guidelines recommend adrenal venous sampling (AVS) to identify unilateral primary aldosteronism (UPA) before offering adrenalectomy. However, AVS is costly and technically challenging, limiting its use to expert centres.

Objective:

To establish a model to predict UPA, and therefore, bypass the need for AVS prior to surgery.

Design and setting:

The model was developed in a Chinese cohort and validated in an Australian cohort. Previously published prediction models of UPA were also tested.

Participants:

primary aldosteronism patients with a definite subtyping diagnosis based on AVS and/or surgery.

Main outcome measure:

Diagnostic value of the model.

Results:

In the development cohort (268 UPA and 88 bilateral primary aldosteronism), combinations of different levels of low serum potassium (≤3.0 or 3.5 mmol/l), high PAC (≥15–30 ng/dl), low PRC (≤2.5–10 μIU/ml) and presence of unilateral nodule on adrenal CT (>8–15 mm in diameter) showed specificity of 1.00 and sensitivity of 0.16–0.52. The model of serum potassium 3.5 mmol/l or less, PAC at least 20 ng/dl, PRC 5 μIU/ml or less plus a unilateral nodule at least 10 mm had the highest sensitivity of 0.52 (0.45–0.58) and specificity of 1.00 (0.96–1.00). In the validation cohort (84 UPA and 117 bilateral primary aldosteronism), the sensitivity and specificity of the model were 0.13 (0.07–0.22) and 1.00 (0.97–1.00), respectively. Ten previous models were tested, and only one had a specificity of 1.00 in our cohorts but with a very low sensitivity [0.07 (0.04–0.10) and 0.01 (0.00–0.06) in our development and validation cohorts, respectively].

Conclusion:

A combination of high PAC, low PRC, low serum potassium and unilateral adrenal nodule could accurately determine primary aldosteronism subtype in 13–52% of patients with UPA and obviate the need for AVS before surgery.
Use of initial and subsequent antihypertensive combination treatment in the last decade: analysis of a large Italian database
Authors: Savaré Laura , Rea Federico , Corrao Giovanni , Mancia Giuseppe
Published: July 2022

Objective:

The aim of the study was to assess the use of antihypertensive combination treatment, both as the initial and as a subsequent therapeutic step, in a large Italian population.

Methods:

The residents of the Lombardy Region (Italy), aged 40 years or older, who were newly treated with antihypertensive drugs during 2012, 2015 and 2018 were identified and the drug treatment strategy (monotherapy and combination of two, three and more than three antihypertensive drugs) was assessed at treatment initiation, and after 6 months, 1, 2, and 3 years of treatment. Data were also analysed after stratification for demographic and clinical categories.

Results:

About 100 000 patients were identified for each cohort. Monotherapy was the most common initial treatment strategy (75%), followed by two-drug single-pill combination (16%), two-drug free combination (6%), and combination of at least three drugs (3%). Use of two and three or more antihypertensive drugs increased during follow-up and reached about 32% (two drugs) and 11% (>2 drugs) of the patients after 3 years from treatment initiation. Among patients prescribed a two-drug combination, the single-pill was the most common approach, whereas the use of the three-drug single-pill combination was extremely rare. There were no substantial differences in the use of combination treatment between the three cohorts and the results were similar in all demographic and clinical categories.

Conclusion:

Our data show that in a real-life population use of antihypertensive drug combinations is low. They also show that, contrary to guideline recommendations, antihypertensive combination treatment did not show any noticeable increase in recent years.
Relationship and Latent Factors Between Clinical Concussion Assessments and the Functional Standardized Assessment of Reaction Time (StART)
Authors: Lempke Landon B. , Passalugo Scott , Baranker Ben T. , Hunt Danielle , Berkstresser Brant , Wang Francis , Meehan William P. , Howell David R.
Published: July 2022

Objective:

To examine the relationships and latent factors within the Standardized Assessment of Reaction Time (StART), and between StART and current clinical assessments.

Design:

Cross-sectional study.

Setting:

Clinical medicine facility.

Participants:

Eighty-nine healthy collegiate student-athletes (63% male, age: 19.5 ± 0.9 years, 28% ≥1 concussion history).

Assessment of Risk Factors:

Student-athletes completed StART and clinical assessments during preinjury testing.

Main Outcome Measures:

Standardized Assessment of Reaction Time consisted of 3 conditions (standing, single-leg balance, cutting) under 2 cognitive states (single task and dual task) for 3 trials each condition. Clinical assessments were the Sport Concussion Assessment Tool (SCAT) symptom checklist, Standardized Assessment of Concussion (SAC), tandem gait (single task and dual task), and Immediate PostConcussion Assessment and Cognitive Testing (ImPACT). We used Pearson-r correlation coefficients and exploratory factor analysis (EFA) to examine relationships and latent factors between StART and clinical assessments.

Results:

Null to moderate correlations presented among the StART outcomes (r range: 0.06-0.70), and null to small correlations between StART and clinical assessments (r range: −0.16 to 0.34). The three-factor EFA for solely StART explained 70.6% total variance: functional movement (cutting), static dual-task (standing and single-leg balance), and static single task (standing and single-leg balance). The five-factor EFA for StART and clinical assessments explained 65.8% total variance: gait (single-task and dual-task tandem gait), functional movement (StART single-task and dual-task cutting), static dual-task (StART standing, single-leg balance), neurocognitive (ImPACT verbal memory, visual memory, visual-motor speed), and static single task (StART standing, single-leg balance). No other outcomes met the factor loading threshold.

Conclusions:

StART displayed 3 distinct categories and had minimal redundancy within its subtests. StART did not meaningfully correlate with clinical assessments, suggesting that StART provides unique information by examining more functional, reactive movement.
Prognosis is worse with elevated cardiac troponin in nonacute coronary syndrome compared with acute coronary syndrome
Authors: Horiuchi Yu , Wettersten Nicholas , Patel Mitul P. , Mueller Christian , Neath Sean-Xavier , Christenson Robert H. , Morgenthaler Nils G. , McCord James , Nowak Richard M. , Vilke Gary M. , Daniels Lori B. , Hollander Judd E. , Apple Fred S. , Cannon Chad M. , Nagurney John T. , Schreiber Donald , deFilippi Christopher , Hogan Christopher , Diercks Deborah B. , Headden Gary , Limkakeng Alexander T. , Anand Inder , Wu Alan H.B. , Ebmeyer Stefan , Jaffe Allan S. , Peacock W. Frank , Maisel Alan
Published: July 2022

Background

Cardiac troponin (cTn) can be elevated in many patients presenting to the emergency department (ED) with chest pain but without a diagnosis of acute coronary syndrome (ACS). We compared the prognostic significance of cTn in these different populations.

Methods

We retrospectively analyzed the CHOPIN study, which enrolled patients who presented to the ED with chest pain. Patients were grouped as ACS, non-ACS cardiovascular disease, noncardiac chest pain and chest pain not otherwise specified (NOS). We examined the prognostic ability of cTnI for the clinical endpoints of mortality and major adverse cardiovascular event (MACE; a composite of acute myocardial infarction, unstable angina, revascularization, reinfarction, and congestive heart failure and stroke) at 180-day follow-up.

Results

Among 1982 patients analyzed, 14% had ACS, 21% had non-ACS cardiovascular disease, 31% had a noncardiac diagnosis and 34% had chest pain NOS. cTnI elevation above the 99th percentile was observed in 52, 18, 6 and 7% in these groups, respectively. cTnI elevation was associated with mortality and MACE, and their relationships were more prominent in noncardiac diagnosis and chest pain NOS than in ACS and non-ACS cardiovascular diagnoses for mortality, and in non-ACS patients than in ACS patients for MACE (hazard ratio for doubling of cTnI 1.85, 2.05, 8.26 and 4.14, respectively; P for interaction 0.011 for mortality; 1.04, 1.23, 1.54 and 1.42, respectively; P for interaction <0.001 for MACE).

Conclusion

In patients presenting to the ED with chest pain, cTnI elevation was associated with a worse prognosis in non-ACS patients than in ACS patients.
Nursing Handoff Education Using Experiential and Virtual Innovations
Authors: Vanderzwan Kathryn J. , Burt Leah , O'Rourke Jennifer
Published: July 2022

Background:

Seventy percent of serious medical errors are the result of ineffective communication, including handoff errors.

Problem:

Nursing students have cited a need for more experience on how to give handoff; yet, handoff education remains variable.

Approach:

Two innovative curricular approaches were implemented on the basis of Bloom's taxonomy to teach handoff education: experiential and virtual. The outcomes of the 2 curricular innovations were evaluated for handoff completion, handoff accuracy, and handoff quality, based on context.

Outcomes:

During the experiential approach, students demonstrated average handoff completion rates of 84%. During the virtual approach, students' handoff completion rates rose from 25% to 63% and accuracy handoff rates rose from 13% to 31%.

Conclusions:

Evaluations support that varying educational methods successfully teach nursing students how to give handoffs. Complementary innovations grant educators flexibility to tailor innovations to curriculum and course context, as supported by Bloom's taxonomy.
Expanding the Use of an SS18-SSX Antibody for Molecular Assays in Synovial Sarcoma
Authors: Raquib Ainiah Rushdiana , Hofvander Jakob , Ta Monica , Nielsen Torsten O.
Published: July 2022

Synovial sarcoma is an aggressive malignancy that generally affects adolescents and young adults and is characterized by high rates of recurrence and metastasis, with a 10-year survival rate of about 50%. The fusion oncoprotein SS18-SSX, the product of a pathognomonic chromosomal translocation t(X;18), is the oncogenic driver of this sarcoma, disrupting differentiation through widespread epigenetic dysregulation. Experimental research into SS18-SSX biology has been limited by the lack of an antibody that specifically detects the endogenous fusion oncoprotein as opposed to its native SS18 or SSX components. Recently, a rabbit monoclonal antibody was developed and made commercially available, which specifically detects the fusion junction site epitope of SS18-SSX as found in at least 95% of synovial sarcomas. Here, we characterize a suite of molecular biology assays using this new antibody, both confirming existing and reporting on novel applications. We demonstrate its high sensitivity and specificity for synovial sarcoma diagnosis on patient samples through positive immunohistochemical staining on synovial sarcoma, tissue microarray, and full face sections. In addition, we demonstrate detection of the human SS18-SSX protein when expressed in a genetically engineered mouse model of synovial sarcoma. We also demonstrate nuclear staining of SS18-SSX in synovial sarcoma cells using immunofluorescence, and visualize the interaction between SS18-SSX and the BAF complex member BRG1 through a proximity ligation assay. Lastly, we confirm the interaction between SS18-SSX and promoter regions of target genes through chromatin immunoprecipitation. This antibody represents a breakthrough in sarcoma research and has value in multiple applications to expand the knowledge of synovial sarcoma biology.
Dual Biologic Therapy in a Patient With Niemann-Pick Type C and Crohn Disease: A Case Report and Literature Review
Authors: Hudson Alexandra S. , Almeida Patricia , Huynh Hien Q.
Published: July 2022

Dual biologic therapy has become a new area of interest in inflammatory bowel disease (IBD). Monogenic/polygenic IBD and the role of genetics in IBD is an evolving field, with many of these patients having difficult treatment courses. We present a case of a teenage patient with Niemann-Pick disease type C and Crohn colitis, who sustained clinical remission only after escalating to dual biologic therapy (anti-tumor necrosis factor alpha [infliximab] and anti-interleukin-12/anti-interleukin-23 [ustekinumab]). A literature review of dual biologic therapy in pediatric IBD revealed 8 case series and 1 cohort study. In pediatric patients with genetic disorders and IBD who are not responding adequately to biologic therapy, adding a second biologic medication with a different mechanism of action may be efficacious. Targeting both anti-tumor necrosis factor alpha (which induces pro-inflammatory cytokines) and the pro-inflammatory cytokines themselves (interleukin-12/interleukin-23) may be important in impaired macrophage function and increased cytokine response. Our case adds to the sparse literature on the utility of combining ustekinumab and infliximab in pediatric IBD and is the first to describe its use for treating ongoing active luminal disease.
A Simple Clinical Application for Locating the Anterior Ethmoidal Artery Using the Anterior Ethmoidal Foramen and the Anterior Nasal Spine
Authors: Xu Shuyi , Yang Jing , Yang Yang , Li Xiaomin , Qiu Jinghua , Yu Zhijian
Published: July 2022

Purpose:

The anatomy and variations of the anterior ethmoidal artery (AEA) are clinically relevant. The anterior ethmoidal foramen (AEF) can be used to locate the initial site of the AEA, and the anterior nasal spine (ANS) is a constant bony marker in the anterior nasal atrium. However, there is no relevant research on AEF and ANS targeting the AEA. Hence, this study aimed to accurately locate the AEA through AEF and ANS using computed tomography.

Methods:

A total of 120 (240 sides) sinus computed tomography scans were retrospectively selected and studied. The AEA was classified into grades I, Ⅱ, and Ⅲ group based on the relationship between the AEA and the skull base. The distance between AEF and ANS and the angle between AEF-ANS and the axial plane were measured.

Results:

The average distance from AEF to ANS was 58.26±3.64 mm, and the corresponding angle was 60.05±5.93 degrees. The AEF-ANS distances and angles were negatively correlated with age. Moreover, the distances from AEF to ANS were significantly increased in the grade Ⅲ group compared with the grade Ⅱ group.

Conclusion:

The measurements obtained in this study add anatomic knowledge that can serve as a better intraoperative localization method of the AEA, which can help surgeons avoid relative complications during endoscopic sinus surgery.
Changes in Lower Eyelid Positions After Blepharoplasty and Levator Advancement Surgery
Authors: Kim Joohyun , Yoon Sumin , Lee Hyunkyu , Lee Hwa , Baek Sehyun
Published: July 2022

Purpose:

To investigate changes in the upper and lower eyelid positions using information from before and immediately after surgery in patients who underwent upper blepharoplasty and ptosis surgery.

Materials and Methods:

We retrospectively reviewed the clinical records of patients who underwent upper blepharoplasty with a diagnosis of dermatochalasis and patients who underwent levator advancement or levator resection with a diagnosis of congenital or aponeurotic ptosis. The marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), palpebral fissure height (PFH), and operation time were also investigated.

Result:

In the dermatochalasis group, the preoperative mean MRD1, MRD2, and PFH were 1.94±1.27, 4.71±0.95, and 6.65±1.65 mm, respectively. Mean MRD1, MRD2, and PFH values immediately after surgery were 1.80±0.79, 4.22±0.90, and 6.02±1.34 mm, respectively. In the ptosis group, the preoperative mean MRD1, MRD2, and PFH values were 0.27±1.34, 5.73±1.13, and 5.99±1.94 mm, respectively. Postoperative mean MRD1, MRD2, and PFH were 1.76±1.13, 4.22±1.01, and 5.98±1.60 mm, respectively.

Conclusions:

It is important to remember that MRD2 could decrease during surgery. Therefore, to prevent overcorrection after upper eyelid surgery, MRD1 (not the overall PFH) should be considered to determine the appropriate extent of surgery during the procedure.
Postauricular Incision Versus Conventional Transcervical Incision in Second Branchial Cleft Cyst Excision: A Systematic Review and Meta-Analysis
Authors: Ho Che-Fang , Yang Tsung-Han , Hsin Li-Jen , Yang Shih-Wei , Tsai Yao-Te , Tsai Ming-Shao , Yang Cheng-Ta , Lee Yi-Chan
Published: July 2022

Surgical removal is the treatment of choice for second branchial cleft cysts (SBCCs), which are congenital anomalies. The conventional procedure is performed through a transcervical approach, which would lead to a visible scar in the anterior neck. Conversely, the postauricular approach could keep the scar in the hairline or retroauricular sulcus, rendering it almost invisible after the surgery. The purpose of this meta-analysis was to evaluate the differences between the postauricular and conventional transcervical approaches to SBCC excision. A systematic review was performed using PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes of SBCC surgery via postauricular and conventional transcervical approaches. The data of interest were analyzed with Comprehensive Meta-Analysis software (version 3). The data of interest were analyzed by calculating the risk difference (RD), the standardized mean difference, and the mean difference (MD) with the 95% confidence interval (CI). Three studies were eligible for the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher with the postauricular approach (standardized mean difference, 2.12; 95% CI, 0.68–3.56). The operative duration was significantly longer with the postauricular approach than with the conventional transcervical approach (MD, 12.81; 95% CI, 2.39–23.23). The incidences of postoperative marginal mandibular nerve palsy (RD, 0.00; 95% CI, −0.09 to 0.09), bleeding complications (RD, −0.02; 95% CI, −0.09 to 0.05), salivary complications (RD, −0.00; 95% CI, −0.07 to 0.06), cyst size (MD, 0.02; 95% CI, −0.96–0.99), and length of hospital stay (MD, −2.50; CI, −7.30 to 2.30) were comparable between the 2 groups. The postauricular approach is feasible for use in SBCC excision and yields better cosmetic outcomes, a longer operative duration, and a similar rate of complications.
Intraosseous Mucoepidermoid Carcinoma of the Mandible Detected as an Asymptomatic Swelling
Authors: Topaloglu Yasan Goknur , Aktas Alper , Keles Gozde
Published: July 2022

Intraosseous mucoepidermoid carcinoma (IMEC) is a rare neoplasm of the jawbones. Although hypotheses focused on the malignant transformation of the epithelial mucosa of odontogenic cysts or ectopic salivary gland tissue have been suggested, the etiology of the disease is still unclear. It is more frequent in middle-aged individuals, has a slight female predilection, and is more common in the mandible than in the maxilla. Cortical enlargement is the most common symptom, while some lesions are detected by coincidence on radiography. This paper reports an IMEC of the mandible of a 35-year-old female, possibly arising from the remains of an odontogenic cyst associated with an unerupted mandibular molar, which was operated in an external center 5 years ago before IMEC diagnosis.
Fenestrated Maxillary Artery
Authors: Rusu Mugurel C. , Vrapciu Alexandra D. , Popescu Şerban A.
Published: July 2022

The external carotid artery divides terminally into the superficial temporal and maxillary arteries (MA), deep to the base of the neck of the mandible. Arterial fenestrations are commonly found in the vertebrobasilar and internal carotid systems but are rarely encountered, or reported, in the external carotid artery system. The archived computed tomography angiograms of a 70-year-old male patient were observed anatomically. Inferior to the posterior end of the lateral pterygoid muscle was found a fenestrated segment of the MA, oriented mediolaterally. The middle meningeal artery left the superior arm of that fenestration. The inferior arm of the fenestration gave off a temporoalveolar trunk, further divided into posterior deep temporal and inferior alveolar arteries. The MA fenestration and the temporoalveolar trunk are rare variations of the MA at the entrance in the infratemporal fossa. These make the MA prone to iatrogenic lesions during different surgical procedures addressed to this region.
Description of Novel Technique for Managing Insufficient Nasal Skin Volume
Authors: Khan Mohammed A. , Assiri Hassan , Shaheen Mohammad H. , Aly Ahmed M. , AlDosari Badi , Elsayed Mohamed S.
Published: July 2022

A short nose is a common esthetic problem faced by facial plastic surgeons. Rhinoplasty of the short nose has been recognized as a complex procedure to perform for achieving satisfactory results. The authors presented 4 cases of short nose in 4 Saudi men who underwent rhinoplasty using septal extension graft and closure the skin with secondary intention as an option to control skin tension after graft placement and to increase nose skin volume to prevent skin retraction, which may occur postoperatively during the healing process. Furthermore, the authors have also discussed the surgical outcomes of these 4 cases and overall satisfaction. Finally, the authors reviewed the literature to identify published papers on correcting the short nose technique.
Hernia Defect Closure With Barbed Suture: An Assessment of Patient-reported Outcomes in Extraperitoneal Robotic Ventral Hernia Repair
Authors: Tagerman Daniel , Pereira Xavier , Lima Diego , Romero-Velez Gustavo , Friedman Patricia , Sreeramoju Prashanth , Malcher Flavio
Published: July 2022

Background:

Primary closure of a fascial defect during ventral hernia repair is associated with lower rates of recurrence and better patient satisfaction compared with bridging repairs. Robotic surgery offers enhanced ability to close these defects and this has likely been aided by the use of barbed suture. The goal of this study was to evaluate the perioperative safety and the long-term outcomes for the use of barbed suture for the primary closure of hernia defects during robotic ventral hernia repair (rVHR) with mesh.

Methods:

This is a retrospective study of adult patients who underwent rVHR with the use of a barbed suture for fascial defect closure from August 2018 to August 2020 in an academic center. All the patients included were queried by phone to complete a quality of life assessment to assess patient-reported outcomes (PROs). Subjective sense of a bulge and pain at the previous hernia site has been shown to correlate with hernia recurrence. These questions were used in conjunction with a Hernia-related Quality of Life Survey (HerQles) score to assess a patient’s quality of life.

Results:

A total of 81 patients with 102 hernias were analyzed. Sixty patients (74%) were successfully reached and completed the PRO form at median postoperative day 356 (range: 43 to 818). Eight patients (13% of patients with PRO data) claimed to have both a bulge and pain at their previous hernia site, concerning for possible recurrence. Median overall HerQLes score was 82 [Interquartile Range (IQR): 54 to 99]. Patients with a single hernia defect, when compared with those with multiple defects, had a lower rate of both a bulge (15% vs. 30%) and symptoms (33% vs. 48%), as well as a higher median HerQLes score (85 vs. 62) at the time of PRO follow-up. Patients with previous hernia repair had a lower median HerQLes score of 65 (IQR: 43 to 90) versus 88 (IQR: 62–100). These patients also had a higher rate of sensing a bulge (29% vs. 18%), whereas a sense of symptoms at the site was less (33% vs. 44%).

Conclusions:

Barbed suture for fascial defect closure in rVHR was found to be safe with an acceptable rate of possible recurrence by the use of PRO data. Patients with multiple hernias and previous repairs had a higher likelihood of recurrence and a lower quality of life after rVHR.
Three-dimensional multiple object tracking improves young adult cognitive abilities associated with driving: evidence for transfer to the useful field of view
Authors: Michaels Jesse , Chaumillon Romain , Mejia-Romero Sergio , Bernardin Delphine , Faubert Jocelyn
Published: July 2022

Objectives

3-dimensional multiple object tracking (3D-MOT) and the useful field of view (UFOV) both claim to measure and train cognitive abilities, such as selective and divided attention implicated in driving safety. 3D-MOT is claimed to improve even young adult cognitive ability. If true, one would expect to observe the transfer of 3D-MOT training to UFOV performance mediated by way of shared underlying cognitive mechanisms.

Methods

We test this notion by assessing whether ten 30-min sessions of 3D-MOT training spread across 5 weeks improves UFOV performance relative to an active control group trained on a visual task and a challenging puzzle game (participants aged between 23 and 33 years old).

Results

The 3D-MOT training group exhibited significantly improved UFOV performance whereas the active control group exhibited only a small, statistically nonsignificant improvement in the task.

Conclusions

This suggests that 3D-MOT and UFOV performance are likely dependent on overlapping cognitive abilities and helps support the assertion that these abilities can be trained and measured even in young adults. Such training could have implications for improving driver safety in both young and older adults.
Determining the antiviral activity of two polyene macrolide antibiotics following treatment in Kidney Cells infected with SARS-CoV-2
Authors: Wasan Kishor M. , Galliano Chris
Published: July 2022

Background

There has been much speculation that polyene macrolide antibiotics, such as amphotericin B (AmB) and Nystatin (NYS) may have antiviral activity against several viruses including SARS-CoV-2.

Objective

The objective of this short communication was to determine the antiviral activity of two polyene macrolides, AmB and NYS, following treatment in kidney cells infected with SARS-CoV-2.

Methods

A serial dilution of AmB, NYS, and irbesartan (a drug known to bind to the ACE-2 receptor as a positive control) were then added (n=4 at each concentration) to the infected Vero’76 kidney cells in 100 µL media. Cells were also examined for contamination at 24 hours, and for cytopathic effect (CPE) and cytotoxicity (if noticeable) under a microscope at 48 hours. In a second study, AmB and Remdesivir were incubated in kidney cells infected with the virus and inhibition of the virus was determined by an immunoassay.

Results and Conclusions

Amphotericin B (AmB) showed a significant reduction in the TCID50 titer, with the 50% effective concentration (EC50) of 1.24 µM, which was 2.5 times lower than the cytotoxicity concentration. NYS and Irbesartan both exhibited substantially less active and would not be considered a suitable choice for further investigations. In addition, when measuring viral inhibition by immunoassay, AmB was significantly more potent than remdesivir (EC50 31.8 nM vs. 1.15 µM). Taken together, these preliminary findings suggest that AmB may have significant activity against SARS-CoV-2. However, further cell and animal studies are warranted.
“Sonohistology”: Ultrasonographic Tissue Characterization in the Diagnosis of Hepatic Steatosis
Authors: de Oliveira Andrade Luís Jesuino , de Oliveira Luís Matos , Andrade Maria Helena Ferreira , de Oliveira Gabriela Correia Matos
Published: July 2022

Objective

To correlate ultrasound imaging and histology in hepatic steatosis.

Material and method

Liver biopsy slides of cases in which hepatic steatosis were classified as mild, moderate and severe was evaluated, determining the number of fat cells per microscopic field from the histological sections. The number of fat cells per field was correlated with the degree of hepatic steatosis suggested on ultrasound examination.

Results

Mean number of fat cells per microscopic field was 50 in mild steatosis, 85 in moderate steatosis, and greater than 150 fat cells in severe steatosis. A significant correlation was observed between echogenicity and the number of fat cells, i.e. the more fat cell the higher the proportion of sound waves incident perpendicularly, being reflected back to the transducer (hyperechogenicity), while in normal liver tissue there is a greater dispersion of the sound wave (hypoechogenicity).

Conclusion

The main interface of echo reflection in steatotic liver tissue is the boundary between the normal hepatocyte and fatty infiltration.