bluuebunny/crossref_metadata_2025 huggingface dataset:
Fentanyl and Driving Impairment
Authors: Rohrig Timothy P , Nash Emily , Osawa Kei A , Shan Xiaoqin , Scarneo Colleen , Youso Kimberly B , Miller Russell , Tiscione Nicholas B
Published: August 2020

The incidence of fentanyl in forensic toxicology analyses in the USA has dramatically increased over the past several years. The increase in death cases has been well studied; however, little has been reported on the impact to drug impaired driving. Fentanyl driving while under the influence of drugs (DUID) case data from 2014 to 2019 is presented. The data were obtained from three toxicology laboratories in the Northeast, Southeast, and Midwest regions of the USA. Fentanyl whole blood concentrations ranged from 0.1 to 157 ng/mL in living drivers with a 466% to 524% increase in fentanyl-positive DUID cases from 2014 to 2019, depending on the US region. The vast majority of fentanyl cases involved poly-drug use. Twenty case histories are presented where fentanyl was the only drug identified. The mean (standard deviation) fentanyl concentration for these cases was 5.2 ± 3.8 ng/mL with a median of 3.7 ng/mL, and the concentrations ranged from 2.0 to 16 ng/mL. Naloxone administration was documented in exactly half of these cases similar to another study involving carfentanil-impaired driving. The case histories also demonstrate that some recreational opioid users may display limited signs of impairment either due to tolerance or naloxone administration. The top three observations in common among the cases were the driver was found unresponsive behind the wheel, the vehicle left the travel lane or roadway, and the driver was involved in a crash. The increase in fentanyl use not only poses a risk for overdose and death, but is also a significant concern for traffic safety. This study supports the movement of fentanyl from a Tier II drug to Tier I due to its significant potential for impairment and increase in prevalence in impaired driving cases.
Acquired ATRX Loss and ALT Phenotype Through Tumor Recurrences in a Case of Pleomorphic Xanthoastrocytoma Suggest Their Possible Roles in Tumor Progression
Authors: Dal Col Pierre , Poncet Delphine , Rivoirard Romain , Vassal François , Bernichon Emilie , Boutet Claire , Péoc’h Michel , Forest Fabien
Published: August 2020

Pleomorphic xanthoastrocytoma (PXA) is classified as an astrocytic glioma occurring most often in children or young adults. Molecular alterations in PXA are not fully known, especially those associated with tumor progression. We describe a patient with several relapses of a PXA. The tumor showed an acquired ATRX loss through tumor evolution. We tested alternative lengthening of telomeres (ALT) with the C-circle test. While the test was negative in the first tumor, a high circle activity was detected in the last relapse, suggesting an acquired ALT phenotype. Our data not only confirm previous findings of the possible occurrence of ATRX mutations in PXA but also suggest that this alteration is linked to PXA progression. In small biopsies, tumors with ATRX loss, without IDH or histone mutation, pathologists should consider the diagnosis of PXA, especially if associated with BRAF V600E mutation, CDKN2A deletion, and ALT.
Large lipoma of the ascending colon: a case report and review of literature
Authors: Farfour Aya N , AbuOmar Noor A , Alsohaibani Fahad I
Published: August 2020

Gastrointestinal lipomas are a rare benign non-epithelial neoplasms derived from mature adipocytes. The colon is the commonest organ involved in the entire digestive tract and has an incidence rate ~4.4% in autopsy series. Most of the colonic lipomas are asymptomatic and incidentally detected. Lipomas need to be distinguished from true neoplasia, because in most cases they do not need to be resected unless when they cause a clear symptom or they are large in size. Surgical rather than endoscopic resection is preferred for lipomas > 2 cm to avoid complications such as bleeding and perforation. We report a case of a 56-year-old female, a known case of locally advanced breast cancer and positive adenomatous polyposis coli mutation, who was found to have 4 cm ascending colon lipoma by imaging and confirmed by colonoscopy and histopathology.
X-ray emission from hot gas in galaxy groups and clusters in simba
Authors: Robson Dylan , Davé Romeel
Published: August 2020

We examine X-ray scaling relations for massive haloes ($M_{500}\gt 10^{12.3}\, \mathrm{M}_\odot$) in the simba galaxy formation simulation. The X-ray luminosity, LX versus M500 has power-law slopes ${\approx }\frac{5}{3}$ and ${\approx }\frac{8}{3}$ above and below $10^{13.5} \, \mathrm{M}_{\odot }$, deviating from the self-similarity increasingly to low masses. TX − M500 is self-similar above this mass, and slightly shallower below it. Comparing simba to observed TX scalings, we find that LX, LX-weighted [Fe/H], and entropies at 0.1R200 (S0.1) and R500 (S500) all match reasonably well. S500 − TX is consistent with self-similar expectations, but S0.1 − TX is shallower at lower TX, suggesting the dominant form of heating moves from gravitational shocks in the outskirts to non-gravitational feedback in the cores of smaller groups. simba matches observations of LX versus central galaxy stellar mass M*, predicting the additional trend that star-forming galaxies have higher LX(M*). Electron density profiles for $M_{500}\gt 10^{14}\, \mathrm{M}_\odot$ haloes show a ∼0.1R200 core, but the core is larger at lower masses. TX are reasonably matched to observations, but entropy profiles are too flat versus observations for intermediate-mass haloes, with Score ≈ 200–400 keV cm2. simba’s [Fe/H] profile matches observations in the core but overenriches larger radii. We demonstrate that Simba’s bipolar jet AGN feedback is most responsible for increasingly evacuating lower-mass haloes, but the profile comparisons suggest this may be too drastic in the inner regions.
Structural and mechanistic insights into the CRISPR inhibition of AcrIF7
Authors: Kim Iktae , Koo Jasung , An So Young , Hong Suji , Ka Donghyun , Kim Eun-Hee , Bae Euiyoung , Suh Jeong-Yong
Published: August 2020

The CRISPR–Cas system provides adaptive immunity for bacteria and archaea to combat invading phages and plasmids. Phages evolved anti-CRISPR (Acr) proteins to neutralize the host CRISPR–Cas immune system as a counter-defense mechanism. AcrIF7 in Pseudomonas aeruginosa prophages strongly inhibits the type I-F CRISPR–Cas system. Here, we determined the solution structure of AcrIF7 and identified its target, Cas8f of the Csy complex. AcrIF7 adopts a novel β1β2α1α2β3 fold and interacts with the target DNA binding site of Cas8f. Notably, AcrIF7 competes with AcrIF2 for the same binding interface on Cas8f without common structural motifs. AcrIF7 binding to Cas8f is driven mainly by electrostatic interactions that require position-specific surface charges. Our findings suggest that Acrs of divergent origin may have acquired specificity to a common target through convergent evolution of their surface charge configurations.
Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease?
Authors: Ramos Christiane I , González-Ortiz Ailema , Espinosa-Cuevas Angeles , Avesani Carla M , Carrero Juan Jesus , Cuppari Lilian
Published: August 2020

Background

Dietary potassium restriction is a strategy to control hyperkalemia in chronic kidney disease (CKD). However, hyperkalemia may result from a combination of clinical conditions. This study aimed to investigate whether dietary potassium or the intake of certain food groups associate with serum potassium in the face of other risk factors.

Methods

We performed a cross-sectional analysis including a nondialysis-dependent CKD (NDD-CKD) cohort and a hemodialysis (HD) cohort. Dietary potassium intake was assessed by 3-day food records. Underreporters with energy intake lower than resting energy expenditure were excluded. Hyperkalemia was defined as serum potassium >5.0 mEq/L.

Results

The NDD-CKD cohort included 95 patients {median age 67 [interquartile range (IQR) 55–73] years, 32% with diabetes mellitus (DM), median estimated glomerular filtration rate 23 [IQR 18–29] mL/min/1.73 m2} and the HD cohort included 117 patients [median age 39 (IQR 18–67) years, 50% with DM]. In NDD-CKD, patients with hyperkalemia (36.8%) exhibited lower serum bicarbonate and a tendency for higher serum creatinine, a higher proportion of DM and the use of renin–angiotensin–aldosterone system blockers, but lower use of sodium bicarbonate supplements. No association was found between serum and dietary potassium (r = 0.01; P = 0.98) or selected food groups. Conditions associated with hyperkalemia in multivariable analysis were DM {odds ratio [OR] 3.55 [95% confidence interval (CI) 1.07–11.72]} and metabolic acidosis [OR 4.35 (95% CI 1.37–13.78)]. In HD, patients with hyperkalemia (50.5%) exhibited higher serum creatinine and blood urea nitrogen and lower malnutrition inflammation score and a tendency for higher dialysis vintage and body mass index. No association was found between serum and potassium intake (r = −0.06, P = 0.46) or food groups. DM [OR 4.22 (95% CI 1.31–13.6)] and serum creatinine [OR 1.50 (95% CI 1.24–1.81)] were predictors of hyperkalemia in multivariable analyses.

Conclusions

Dietary potassium was not associated with serum potassium or hyperkalemia in either NDD-CKD or HD patients. Before restricting dietary potassium, the patient’s intake of potassium should be carefully evaluated and other potential clinical factors related to serum potassium balance should be considered in the management of hyperkalemia in CKD.
A single-cell transcriptome atlas of the aging human and macaque retina
Authors: Yi Wenyang , Lu Yufeng , Zhong Suijuan , Zhang Mei , Sun Le , Dong Hao , Wang Mengdi , Wei Min , Xie Haohuan , Qu Hongqiang , Peng Rongmei , Hong Jing , Yao Ziqin , Tong Yunyun , Wang Wei , Ma Qiang , Liu Zeyuan , Ma Yuqian , Li Shouzhen , Yin Chonghai , Liu Jianwei , Ma Chao , Wang Xiaoqun , Wu Qian , Xue Tian
Published: August 2020

The human retina is a complex neural tissue that detects light and sends visual information to the brain. However, the molecular and cellular processes that underlie aging primate retina remain unclear. Here, we provide a comprehensive transcriptomic atlas based on 119,520 single cells of the foveal and peripheral retina of humans and macaques covering different ages. The molecular features of retinal cells differed between the two species, suggesting the distinct regional and species specializations of the human and macaque retinae. In addition, human retinal aging occurred in a region- and cell-type- specific manner. Aging of human retina exhibited a foveal to peripheral gradient. MYO9A− rods and a horizontal cell subtype were greatly reduced in aging retina, indicating their vulnerability to aging. Moreover, we generated a dataset showing the cell-type- and region- specific gene expression associated with 55 types of human retinal disease, which provides a foundation to understand the molecular and cellular mechanisms underlying human retinal diseases. Together, these datasets are valuable for understanding the molecular characteristics of primate retina, as well as the molecular regulation of aging progression and related diseases.
Separating singular moduli and the primitive element problem
Authors: Bilu Yuri , Faye Bernadette , Zhu Huilin
Published: August 2020

We prove that ${|x-y|\ge 800X^{-4}}$, where $x$ and $y$ are distinct singular moduli of discriminants not exceeding $X$. We apply this result to the ‘primitive element problem’ for two singular moduli. In a previous article, Faye and Riffaut show that the number field ${{\mathbb{Q}}}(x,y)$, generated by two distinct singular moduli $x$ and $y$, is generated by ${x-y}$ and, with some exceptions, by ${x+y}$ as well. In this article we fix a rational number ${\alpha \ne 0,\pm 1}$ and show that the field ${{\mathbb{Q}}}(x,y)$ is generated by ${x+\alpha y}$, with a few exceptions occurring when $x$ and $y$ generate the same quadratic field over ${{\mathbb{Q}}}$. Together with the above-mentioned result of Faye and Riffaut, this generalizes a theorem due to Allombert et al. (2015) about solutions of linear equations in singular moduli.
Sleep–wake regulation in preterm and term infants
Authors: Georgoulas Anastasis , Jones Laura , Laudiano-Dray Maria Pureza , Meek Judith , Fabrizi Lorenzo , Whitehead Kimberley
Published: August 2020

Study Objectives

In adults, wakefulness can be markedly prolonged at the expense of sleep, e.g. to stay vigilant in the presence of a stressor. These extra-long wake bouts result in a heavy-tailed distribution (highly right-skewed) of wake but not sleep durations. In infants, the relative importance of wakefulness and sleep are reversed, as sleep is necessary for brain maturation. Here, we tested whether these developmental pressures are associated with the unique regulation of sleep–wake states.

Methods

In 175 infants of 28–40 weeks postmenstrual age (PMA), we monitored sleep–wake states using electroencephalography and behavior. We constructed survival models of sleep–wake bout durations and the effect of PMA and other factors, including stress (salivary cortisol), and examined whether sleep is resilient to nociceptive perturbations (a clinically necessary heel lance).

Results

Wake durations followed a heavy-tailed distribution as in adults and lengthened with PMA and stress. However, differently from adults, active sleep durations also had a heavy-tailed distribution, and with PMA, these shortened and became vulnerable to nociception-associated awakenings.

Conclusions

Sleep bouts are differently regulated in infants, with especially long active sleep durations that could consolidate this state’s maturational functions. Curtailment of sleep by stress and nociception may be disadvantageous, especially for preterm infants given the limited value of wakefulness at this age. This could be addressed by environmental interventions in the future.
Preparing for a Joint Commission Survey: An Innovative Approach to Learning
Authors: Campbell Rebeka Watson , Leger J. Michael
Published: August 2020

Graduate nurses report feeling unprepared for accreditation site visits, including the promotion of a safe, functional, supportive environment to preserve safety and quality through the provision of care, treatment, and services for patients. To address this gap, an academic health system’s department of quality and a school of nursing collaborated on a three-phase capstone course for senior-level BSN students. The course included simulation training for all students; volunteers performed Environment of Care rounds and patient care record audits in the hospital setting. Nineteen students, who performed 74 rounds and 193 audits, reported feeling more knowledgeable during site visits.
Redesigning Nursing Education to Build Healthier Communities: An Innovative Cross-Sector Collaboration
Authors: Swan Beth Ann , Hilden Peggy , West Nikki , Chan Garrett , Shaffer Kathryn , Berg Judith G. , Dickow Mary , Jones Deloras
Published: August 2020

Today’s health care environment requires registered nurses to be prepared for an array of practice settings, providing care outside the hospital and directly in the community. There is increasing focus on wellness, prevention, access to care, and mental health services for an aging and more diverse population. To improve alignment of education with increasingly complex needs, donor-advised funding supported four prelicensure nursing schools to transform their curricula. Selected schools were guided through a curriculum redesign process emphasizing community and continuum of care. This innovation was consistent with meeting challenges to realize the Institute of Medicine’s 2011 Future of Nursing recommendations.
Population Health Beyond the Classroom: An Innovative Approach to Educating Baccalaureate Nursing Students
Authors: Ruiz Diana
Published: August 2020

An increasingly diverse population warrants an innovative and transformational educational approach to prepare the baccalaureate nurse to practice and lead. This article describes an innovation for teaching population health to meet complex community health needs and provide interprofessional collaborative opportunities and diverse leadership experiences. Course revision for clinical and didactic courses included the incorporation of cross-sector and interdisciplinary collaboration in the community, along with a strong emphasis on social determinants of health.
Effective care coordination and transition management for older adults
Authors: Harkness Turna L.
Published: August 2020

As the number of older patients with chronic illnesses increases, so does the need for nurses to be knowledgeable and prepared to care for this often vulnerable population.
Ophthalmic manifestations and management of common and rare autoimmune syndromes
Authors: Seol Young , Lee Roxanne , Bielory Brett P.
Published: August 2020

Purpose of review

This article reviews the ocular findings in patients with a myriad of autoimmune syndromes. This review will provide guidance and heighten awareness for the allergist or eye care provider to pay heed to the manifestations and treatments of autoimmune syndromes.

Recent findings

Autoimmune syndromes can present with varied manifestations on the ocular surface known to potentially cause significant visual morbidity. In particular, sterile corneal ulcers are the most devastating and common finding in uncontrolled autoimmune disease. Ophthalmic manifestations of autoimmune syndromes have been reported individually; however, herein we present a comprehensive review of typical and atypical syndromes that may present with sterile corneal ulceration.

Autoimmune inflammatory syndromes are known to be associated with ocular surface inflammatory processes ranging from bothersome dry eye syndromes to vision-threatening sterile corneal ulceration. It is important to pay heed to the clinical presentation of common and uncommon presentations of the syndromes in the eye. We propose best practice for management of ocular surface disease in these clinical entities.
Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia
Authors: O’Connell Michael P. , Lyons Jonathan J.
Published: August 2020

Purpose of review

To discuss the association between the common dominantly inherited genetic trait hereditary alpha-tryptasemia (HαT) and hymenoptera venom-induced anaphylaxis (HVA).

Recent findings

Elevated BST has been correlated with more severe systemic anaphylaxis in humans in a number of settings – most notably in HVA. Clonal mast cell disease, in particular, systemic mastocytosis, is frequently associated with elevated BST, and is a major risk factor for severe HVA. However, clonal mast cell diseases are believed to be rare, whereas HVA is relatively more common. HαT affects an estimated 3–5% of Western populations and is the common cause for elevated BST in these individuals. An association between HαT and severe HVA, as well as clonal mast cell disease has recently been demonstrated wherein this trait modifies reaction severity in venom allergic individuals. A mechanism underlying this association has been proposed through the identification of naturally occurring heterotetrameric tryptases and characterization of their unique physical attributes.

Here we discuss the long-standing association between elevated BST and HVA severity, how HαT fits into this landscape, and review the clinical and mechanistic evidence that supports HαT as a modifier of HVA.
Advances in allergen immunotherapy for asthma
Authors: Agache Ioana , Laculiceanu Alexandru , Cojanu Catalina , Spanu Daniela , Rogozea Liliana
Published: August 2020

Purpose of review

Allergen immunotherapy (AIT) is a well-known disease-modifying intervention for allergic diseases. Its benefit in allergic asthma, ranging from prevention to facilitating asthma control, is yet to be clarified.

Recent findings

In 2017, following several well-designed randomised controlled trials (RCTs) with house-dust mites (HDM) sublingual (SLIT) tablets in asthma, global initiative for asthma (GINA) guidelines highlighted the need to treat the allergic component of asthma. In 2019, the European Academy of Allergy and Clinical Immunology published the first comprehensive guidelines for HDM AIT in allergic asthma, formulating separate recommendations for subcutaneous, SLIT drops, and SLIT tablets. Significant steps were undertaken in understanding the mechanisms of allergic asthma, facilitating the stratified approach for selecting responders and in translating the immune-modulation effect in achieving long-term control of the chronic inflammation in asthma.

Currently existing guidelines recommend AIT as a therapeutic option in controlled or partially controlled HDM allergic asthma. Limited data are available for pollen, molds and pets, as well as for the severe allergic asthma population. The challenge for the future research will be to clarify the subendotypes of allergic asthma responding to AIT, the mechanisms facilitating its’ preventive and disease-modifying effect, the optimal duration of the treatment, and route of administration.
Gaps in Alcohol Screening and Intervention Practices in Surgical Healthcare: A Qualitative Study
Authors: Fernandez Anne C. , Guetterman Timothy C. , Borsari Brian , Mello Michael J. , Mellinger Jessica , Tonnesen Hanne , Hosanagar Avinash , Morris Arden M. , Blow Frederic C.
Published: August 2020

Objectives:

Risky alcohol use before surgery is associated with an increased risk of postoperative complications and longer hospital stays. Preoperative alcohol interventions can improve surgical outcomes but are not commonly integrated into routine care. This study sought to better understand patient's and provider's perceptions of alcohol-related surgical health and healthcare practices and illuminate gaps in care and how they could be improved.

Methods:

This study used a descriptive qualitative research design. Data were collected between July 2017 and March 2018. One-on-one interviews assessed domains related to knowledge, gaps in alcohol-related screening and intervention, and interest in enhancing alcohol-related care. Key themes emerged from a process of iterative coding and thematic analysis.

Results:

Participants included elective surgical patients who met alcohol screening criteria (n = 20) and surgical healthcare providers (n = 9). Participants had modest or low awareness of alcohol-related surgical health risks. Basic alcohol screening was a routine part of care, but results were often discounted or overlooked. Providers did not routinely initiate preoperative alcohol education or intervention. Providers viewed improving alcohol-related clinical practices as a low priority. Patients were interested in receiving alcohol interventions before surgery if they were delivered in a nonjudgement style and focused on surgical health optimization.

Conclusions:

This study highlights potential gaps in alcohol-related knowledge and care, and found providers place a low priority on alcohol interventions in the perioperative context. Given the high complication rate associated with preoperative alcohol use, these topics are worthy of future research. To be successful strategies to overcome specific barriers to alcohol screening and intervention must address the needs of patients and providers.
High-frequency 10 kHz Spinal Cord Stimulation for Chronic Back and Leg Pain
Authors: Taylor Rod S. , Bentley Anthony , Campbell Bruce , Murphy Kieran
Published: August 2020

Objectives:

There is good evidence that spinal cord stimulation (SCS) is effective for reducing chronic back and leg pain (CBLP). SENZA randomized controlled trial showed high-frequency (10 kHz) stimulation (10 kHz-SCS) is clinically superior to traditional low-frequency SCS (LF-SCS).

Undertake cost-consequence and cost-effectiveness analysis of 10 kHz-SCS compared with LF-SCS.

Methods:

A probabilistic decision tree and Markov decision analytic model was used to synthesize data on CBLP outcomes and costs over a 15-year time horizon from a UK National Health Service perspective using data from the SENZA randomized controlled trial and other publications. Results are expressed as incremental cost per quality-adjusted life year (QALY) in 2016 Pounds Sterling.

Results:

10 kHz-SCS is cost-saving and cost-effective compared with LF-SCS, with mean cost-savings of £7170 (95% confidence interval: £6767-£7573) and £3552 (95% confidence interval: £3313-£3792) per patient compared with nonrechargeable and rechargeable LF-SCS devices, respectively. 10 kHz-SCS has a 95% likelihood of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY. Our findings were robust across a wide range of sensitivity analyses.

Conclusions:

There is a strong economic case for choosing 10 kHz-SCS over LF-SCS for CBLP. Furthermore, 10 kHz-SCS has clinical advantages not captured in our analysis, including shorter, and more predictable procedure times.
Needs of Socioeconomically Diverse Fathers of Premature Hospitalized Infants
Authors: Merritt Linda , Spencer Becky
Published: August 2020

Background:

To effectively practice true family-centered care (FCC) in the neonatal intensive care unit (NICU) setting, a nurse needs to understand the perceptions and concerns of all fathers. Although research is emerging on fathers' perceptions and experiences, the samples of fathers represented are not from diverse socioeconomic, racial, and ethnic populations, which limit the findings' generalizability.

Purpose:

The purpose of this study was to determine the needs of NICU fathers and whether these needs differed based on sociodemographic factors.

Methods:

A quantitative, comparative, descriptive design was used to determine the needs of NICU fathers. Additional analysis was conducted to determine whether the needs differed based on education, income, and gestational age, whether the father preferred speaking English or Spanish, and whether these sociodemographic factors could predict needs. To determine sociodemographic factors and needs, a demographic questionnaire and the NICU Family Needs Inventory were administered to 99 fathers in 6 level III NICUs.

Results:

Data were analyzed using independent samplettest, 1-way analysis of variance, and multiple linear regression. The results showed that fathers reported a broad span of needs and fathers from disadvantaged populations may have greater needs in certain areas.

Implications for Practice:

These results emphasize the importance of the nurses' role in assessing the needs of NICU fathers. By understanding fathers' needs, nurses can provide individualized FCC to fathers to help them be more involved in the care and support of their infant.

Implications for Research:

Further research is needed to support these findings and test interventions that promote communication between providers and fathers.
Having Skin in the Game
Authors: Stracuzzi Lauren A.
Published: August 2020

Background:

Necrotizing fasciitis (NF) is a rare but often fatal bacterial infection of the skin and the soft tissue.

Clinical Findings:

Necrotizing fasciitis occurs mainly in adults and remains relatively uncommon in the neonate. Because the presenting skin and laboratory findings are variable, prompt diagnosis is often difficult. The risk of mortality increases with time to intervention.

Primary Diagnosis:

This case presents a 4-day old full-term female neonate with NF resulting in a significant scalp defect.

Interventions:

The neonate was successfully treated using a novel approach with a cultured epidermal autograft.

Outcomes:

The treatment period was effective, and the neonate had an excellent clinical outcome. The neonate was discharged home 21 days post graft application.

Purpose:

This case study will highlight the influence of the clinical nurse specialist on care coordination, innovative treatment plans, and resource development for a neonate with NF.

Practice Recommendations:

Because of the rare but fatal nature of NF, innovative therapies must be considered. Offering a nontraditional treatment can help improve patient recovery and long-term outcomes. The use of cultured epidermal autograft now provides a new treatment option for neonatal patients in the future.
Renal Oxygenation Measured by Near-Infrared Spectroscopy in Neonates
Authors: Marin Terri , Williams Bryan L.
Published: August 2020

Background:

Acute kidney injury (AKI) affects approximately 30% of infants admitted to the neonatal intensive care unit (NICU), and increases mortality risk by 50%. Current diagnostic criteria (serum creatinine rise with oliguria) cannot detect early-onset AKI, as up to 50% of nephron damage may occur by the time these abnormalities present. Once AKI is established, clinical management is often ineffective; therefore, prevention is key. Near-infrared spectroscopy (NIRS) offers a feasible, noninvasive approach to continuously monitor renal oxygenation trends over time, serving as a surrogate marker for renal perfusion.

Purpose:

To provide an overview of NIRS principles for measuring renal oxygenation, and to describe current evidence of how this technology is being used among infants admitted to the NICU relative to the prediction and identification of AKI.

Methods:

A comprehensive search of PubMed and CINHAL focused on renal NIRS studies in NICU preterm and term infants was conducted.

Results:

Findings from 34 studies were included. In term infants, reduced renal oxygenation correlated to invasive SvO2 monitoring, predicted survivability and AKI. In preterm infants, reduced renal oxygenation was associated with AKI in one study, yet contrasting findings were reported in those with patent ductus arteriosus, including those who received prostaglandin inhibitors. Normative data in all infants were sparse.

Implications for Practice:

Renal NIRS may offer a noninvasive measurement of kidney hypoperfusion that may precede conventional diagnostic measures.

Implications for Research:

Normative data are lacking, the threshold for renal ischemia is not defined, and consensus guiding clinical treatment based on NIRS data is nonexistent.
Congenital CMV-Associated Hearing Loss: Can Brain Imaging Predict Hearing Outcome?
Authors: Craeghs Laura , Goderis Julie , Acke Frederic , Keymeulen Annelies , Smets Koenraad , Van Hoecke Helen , De Leenheer Els , Boudewyns An , Desloovere Christian , Kuhweide Rudolf , Muylle Marie , Royackers Liesbeth , Schatteman Isabelle , Dhooge Ingeborg
Published: August 2020

Objectives:

Congenital cytomegalovirus (cCMV) infection is the leading cause of nonhereditary sensorineural hearing loss in childhood and is also associated with CNS abnormalities. The main objective is to investigate the prognostic value of neonatal cranial ultrasound (cUS) and cranial magnetic resonance imaging (cMRI) in predicting long-term hearing outcome in a large cohort of cCMV-infected symptomatic and asymptomatic patients.

Design:

Data were prospectively collected from a multicentre Flemish registry of children with cCMV infection born between 2007 and 2016. Neonatal cUS and cMRI scans were examined for lesions related to cCMV infection. Audiometric results at different time points were analyzed. The imaging and audiometric results were linked and diagnostic values of cUS and cMRI were calculated for the different hearing outcomes.

Results:

We were able to include 411 cCMV patients, of whom 40% was considered symptomatic at birth. Cranial ultrasound abnormalities associated with cCMV infection were found in 76 children (22.2% of the cUS scans), whereas cMRI revealed abnormalities in 74 patients (26.9% of the cMRI scans). A significant relation could be found between the presence of cUS or cMRI abnormalities and hearing loss at baseline and last follow-up. Cranial ultrasound and cMRI findings were not significantly correlated with the development of delayed-onset hearing loss. Specificity and sensitivity of an abnormal cUS to predict hearing loss at final follow-up were 84% and 43%, respectively compared with 78% and 39% for cMRI. Normal cUS and cMRI findings have a negative predictive value of 91% and 92%, respectively, for the development of delayed-onset hearing loss.

Conclusions:

Neuroimaging evidence of CNS involvement in the neonatal period is associated with the presence of hearing loss in children with a cCMV infection. Imaging abnormalities are not predictive for the development of delayed-onset hearing loss.
Single-incision Extraperiosteal Triple Innominate Osteotomy: Outcomes of an Updated Technique
Authors: Sankar Wudbhav N. , Zaltz Ira
Published: August 2020

Background:

Since its original description, the triple pelvic osteotomy has undergone several modifications and refinements most often utilizing 3 or 2 incisions. Recently, a single-incision extraperiosteal technique has been described; however, little data exist on the outcomes of this procedure.

Methods:

All patients undergoing single-incision triple osteotomy from 2 centers were retrospectively reviewed. Demographic data, underlying diagnosis, and preoperative radiographic data were recorded. Intraoperative details including estimated blood loss and type of postoperative immobilization were noted. Over the follow-up period, complications were recorded as were radiographic outcomes including lateral center edge angle, acetabular index, migration percentage, continuity of Shenton’s line, and time to union.

Results:

Twenty-eight hips (in 24 patients) underwent surgery at a mean age of 9.3 years (range, 6.5 to 13.8 y). Diagnoses included Trisomy 21 (9), developmental dysplasia of the hip (5), Charcot-Marie-Tooth (3), and neuromuscular disease (9) among others. The mean estimated blood loss was 135 mL (±98 mL) and most patients were immobilized in an abduction brace or single-leg spica cast for an average of 7.6±2.2 weeks after surgery before weight-bearing was advanced. At a mean follow-up of 3.0±2.2 years, the lateral center edge angle improved from an average of 1±14 degrees preoperatively to 35±7 degrees, the acetabular index from 27±11 degrees to 2±5 degrees, and the migration percentage from 44%±21% to 3%±5%. Fourteen hips had frank instability before surgery and 20 had a break in Shenton’s line >5 mm. At most recent follow-up, all but 1 hip was stable (93%) and all had restoration of Shenton’s line (100%). Radiographic union occurred at a mean of 14 weeks (±11 wk). One patient developed an ischial nonunion that underwent further surgery, 1 had premature closure of the triradiate cartilage, and 1 patient with transverse myelitis developed Charcot arthropathy. There were no other complications in this series.

Conclusions:

In this dual-center retrospective series, the single-incision triple innominate osteotomy was extremely effective for improving acetabular coverage and stabilizing unstable hips in a variety of underlying diagnoses with an acceptably low rate of complications.

Level of Evidence:

Level IV—case series.
Clinical Research Integration Within the Electronic Health Record
Authors: Johnson Elizabeth A. , Carrington Jane M.
Published: August 2020

Clinical trials have become commonplace as a treatment option. As clinical trial participants are integrated into all healthcare delivery settings, organizations are tasked with sustaining specific care regimens with appropriate documentation and maintenance of participant protections within electronic health records. Our aim was to identify the common elements necessary for electronic health record integration of clinical research for optimal trial conduct and participant management. Review of literature was conducted utilizing PubMed and CINAHL to identify relevant publications that described use of the electronic health record to directly support trial conduct, with a total of 15 publications ultimately meeting inclusion criteria. Three thematic groupings emerged that categorized common aspects of clinical research integration: functional, structural, and procedural components. These components include technological requirements (platform/system), regulatory and legal compliance, and stakeholder involvement with clinical trial procedures (recruitment of participants). Without a centralized means of providing clinicians with current treatment and adverse event management information, participant injury or likelihood of withdrawal will increase. Further research is required to develop an optimal model of research-related integration within commercial electronic health records.
Selecting Media to Support Online Learning
Authors: Gazza Elizabeth A. , Theriault Lisa , Oyarzun Beth
Published: August 2020

Nursing students in an online degree completion program experienced challenges using a video platform to complete a two-part applied learning assignment in a learning management system. This article describes an interdisciplinary approach to selecting the video platform that required the least technical support for students and therefore was most likely to keep their focus on learning. An interdisciplinary team consisting of a nurse faculty member, technology applications specialist, instructional designer, and learning management system administrator collaborated to redesign the assignment and evaluate three video platforms. For part 1 of the video-based assignment, 97% (n = 106) of the students successfully submitted a video using one of the three platforms. Less than one-quarter (23%) required additional support beyond detailed instructions. Due to limitations, only students using one of the three platforms were able to view classmates' recordings and complete part 2 of the assignment. Although one platform was the most supportive for students, it was less helpful for faculty due to integration issues. Findings indicate that an interdisciplinary approach can lead to the selection of a video platform that supports the pedagogy and minimize support needs to students. Faculty teaching online can use this approach when integrating media and other technology into their online classrooms.
Association between PTCH1 gene polymorphisms and chronic obstructive pulmonary disease susceptibility in a Chinese Han population: a case-control study
Authors: Kang Xi , Guo Ting , Liu Lyu , Ding Shui-Zi , Lei Cheng , Luo Hong
Published: August 2020

Background

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Genome-wide association studies in non-Asian population revealed a link between COPD and mutations in the PTCH1 gene encoding Patched1, a receptor in the Hedgehog signaling pathway important for lung morphogenesis and pulmonary function. The aim of this study was to investigate the association between PTCH1 polymorphisms and the COPD risk in the Chinese Han population.

Methods

We performed a case-control study including 296 patients with COPD and 300 healthy individuals. Single-nucleotide polymorphisms in the PTCH1 gene were identified and genotyped based on the linkage disequilibrium analysis in all participants. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis after adjustment for age, gender, and smoking.

Results

In total, 28 single-nucleotide polymorphisms were identified in patients with COPD. Among them, “A” allele of rs28491365 (OR: 1.388, 95% CI: 1.055–1.827, P = 0.018), and “G” alleles of rs10512248 (OR: 1.299, 95% CI: 1.021–1.653, P = 0.033) and rs28705285 (OR: 1.359, 95% CI: 1.024–1.803, P = 0.033; respectively) were significantly associated with an increased COPD risk. Genetic model analysis revealed that the “T/T” genotype of rs34695652 was associated with a decreased COPD risk under the recessive model (OR: 0.490, 95% CI: 0.270–0.880, P = 0.010), whereas rs28504650/rs10512248 haplotype CG was significantly associated with an increased COPD risk after adjustment for age, gender, and smoking status (OR: 6.364, 95% CI: 1.220–33.292, P = 0.028).

Conclusions

The study provides a new insight into the role of PTCH1 polymorphisms in the susceptibility to COPD in the Chinese Han population.
Twenty years of changes in the disease assessment method of the Global Initiative for Chronic Obstructive Lung Disease
Authors: Liao Yi-Xuan , Chen Ya-Hong
Published: August 2020

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has been changing for nearly 20 years. GOLD has moved from single assessment using spirometry to a more comprehensive assessment of chronic obstructive pulmonary disease using spirometry, symptoms and exacerbation history. And subsequently, a new assessment system for chronic obstructive pulmonary disease separated spirometric grades from the old assessment system, and classified patients only according to their symptoms and history of exacerbation. The distribution, clinical characteristics, treatment, and prognosis of the new subgroups were different from the old ones. In this review, we will present a brief profile of changes made to the disease assessment method of GOLD, based on the relevant existing literature.
Silencing novel long non-coding RNA FKBP9P1 represses malignant progression and inhibits PI3K/AKT signaling of head and neck squamous cell carcinoma in vitro
Authors: Yang Yi-Fan , Feng Ling , Shi Qian , Ma Hong-Zhi , He Shi-Zhi , Hou Li-Zhen , Wang Ru , Fang Ju-Gao
Published: August 2020

Background

Long non-coding RNAs (lncRNAs) play key roles in human cancers. In our previous study, we demonstrated that lncRNA FKBP prolyl isomerase 9 pseudogene 1 (FKBP9P1) was highly expressed in head and neck squamous cell cancer (HNSCC) tissues. However, its functional significance remains poorly understood. In the present study, we identify the role and potential molecular biologic mechanisms of FKBP9P1 in HNSCC.

Methods

Quantitative real-time polymerase chain reaction was used to detect the expression of FKBP9P1 in HNSCC tissues, matched adjacent normal tissues, human HNSCC cells (FaDu, Cal-27, SCC4, and SCC9), and human immortalized keratinocytes cell HaCaT (normal control). Cal-27 and SCC9 cells were transfected with sh-FKBP9P1-1, sh-FKBP9P1-2, and normal control (sh-NC) lentivirus. Cell counting kit-8 assay, colony formation assay, wound healing assay, and trans-well assay were used to explore the biologic function of FKBP9P1 in HNSCC cells. Furthermore, western blotting was used to determine the mechanism of FKBP9P1 in HNSCC progression. Chi-squared test was performed to assess the clinical significance among FKBP9P1 high-expression and low-expression groups. Survival analyses were performed using the Kaplan-Meier method and assessed using the log-rank test. The comparison between two groups was analyzed by Student t test, and comparisons among multiple samples were performed by one-way analysis of variance and a Bonferroni post hoc test.

Results

FKBP9P1 expression was significantly up-regulated in HNSCC tissues (tumor vs. normal, 1.914 vs. 0.957, t = 7.746, P < 0.001) and cell lines (P < 0.01 in all HNSCC cell lines). Besides, the median FKBP9P1 expression of HNSCC tissues (1.677) was considered as the threshold. High FKBP9P1 level was correlated with advanced T stage (P = 0.022), advanced N stage (P = 0.036), advanced clinical stage (P = 0.018), and poor prognosis of HNSCC patients (overall survival, P = 0.002 and disease-free survival, P < 0.001). Knockdown of FKBP9P1 led to marked repression in proliferation, migration, and invasion of HNSCC cells in vitro (P all < 0.01). Mechanistically, silencing FKBP9P1 was observed to restrain the PI3K/AKT signaling pathway.

Conclusions

Silencing lncRNA FKBP9P1 represses HNSCC progression and inhibits PI3K/AKT (phosphatidylinositol 3 kinase/AKT Serine/Threonine Kinase) signaling in vitro. Therefore, FKBP9P1 could be a potential new target for the diagnosis and treatment of HNSCC patients.
The Effect of Conditioned Media From Human Adipocyte-Derived Mesenchymal Stem Cells on Androgenetic Alopecia After Nonablative Fractional Laser Treatment
Authors: Lee Young In , Kim Jihee , Kim Jemin , Park Sujin , Lee Ju Hee
Published: August 2020

BACKGROUND

The conditioned media from adipocyte-derived mesenchymal stem cells-conditioned media (ADSC-CM) contains cytokines and growth factors that stimulate hair regeneration.

OBJECTIVE

We evaluated the efficacy and safety of human ADSC-CM treatment on patients who underwent nonablative fractional laser for the treatment of androgenetic alopecia (AGA).

MATERIALS AND METHODS

Thirty patients who underwent nonablative fractional laser treatment were topically administered either ADSC-CM or placebo solution. As a primary outcome, phototrichograms were taken to measure changes in hair density at each visit. In addition, global improvement scores (GISs) were compared by clinical digital photographs, which were taken at the initial and final visits, and assessed by 2 independent dermatologists. Finally, the investigator's improvement score was measured by questionnaire response during the final visit.

RESULTS

Hair density comparisons during the treatment period revealed that the ADSC-CM group had significantly higher final densities compared with the placebo group. The GIS of the ADSC-CM group was also significantly higher than the placebo group. Finally, no adverse effects associated with the application of ADSC-CM were noted during the study.

CONCLUSION

The application of ADSC-CM after nonablative fractional laser treatment accelerated increases in hair density and volume in AGA patients.
Clinical Efficacy of Topical Tranexamic Acid With Microneedling in Melasma
Authors: Kaur Amrit , Bhalla Mala , Pal Thami Gurvinder , Sandhu Jasleen
Published: August 2020

BACKGROUND

Melasma is a common, recurrent, and refractory cause of facial pigmentation resulting in cosmetic disfigurement. Tranexamic acid (TA) has been used systemically and locally for clearance of pigmentation.

OBJECTIVE

To assess the clinical efficacy of topical TA (10%) with microneedling in melasma.

METHODS

A split face, prospective, randomized, open-label study with a sample size of 40. Left or right side of the face was chosen randomly and microneedling was done on both the sides, followed by 10% TA solution application on one side of the face (test side) and distilled water on the other side of face (control). The procedure was done at 2 weekly intervals (0, 2, 4, and 6 weeks). Clinical images were taken at each visit including modified Melasma Area and Severity Index (mMASI) scoring of each half of the face to assess the clinical response along with patient satisfaction scores and side effects.

RESULTS

On the test side, there was 65.92% improvement in the mean mMASI score compared with 20.75% on the control side of the face at the end of 8 weeks.

CONCLUSION

Tranexamic acid may be a promising therapeutic agent in melasma and the topical solution along with microneedling seems to be efficacious.
A Novel Compound Sclerosant: Polidocanol–Bleomycin Foam
Authors: Hanshu Zhang , Shaohua Liu , Anwei Chen
Published: August 2020

BACKGROUND

Foam sclerotherapy is an effective treatment strategy for venous malformations. Both polidocanol (POL) and bleomycin are effective sclerosants; however, no studies have reported POL–bleomycin foam.

OBJECTIVE

To introduce a method for producing POL–bleomycin foam and evaluate the stability of POL–bleomycin foam with bleomycin concentrations.

MATERIALS AND METHODS

Group A: 2 mL of 1% POL + 8 mL of air; Group B: 2 mL of 1% POL + 3 U bleomycin + 8 mL of air; Group C: 2 mL of 1% POL + 6 U bleomycin + 8 mL of air; Group D: 2 mL of 1% POL + 12 U bleomycin + 8 mL of air. Tessari method was used for foam generation. The foam half-life time (FHT) was used to evaluate foam stability. Five recordings were made for each group.

RESULTS

The FHT was 148.6 ± 2.9 seconds in Group A, 148.8 ± 4.0 seconds in Group B, 148.4 ± 2.6 seconds in Group C, and 148.8 ± 1.6 seconds in Group D. The FHT in different groups showed no significant differences.

CONCLUSION

The POL–bleomycin foam was prepared successfully and its FHT was as long as the POL foam.