bluuebunny/crossref_metadata_2025 huggingface dataset:
Galectin‐3 and N‐acetylglucosamine promote myogenesis and improve skeletal muscle function in the mdx model of Duchenne muscular dystrophy
Authors: Rancourt Ann , Dufresne Sébastien S. , St‐Pierre Guillaume , Lévesque Julie‐Christine , Nakamura Haruka , Kikuchi Yodai , Satoh Masahiko S. , Frenette Jéôme , Sato Sachiko
Published: June 2018

The muscle membrane, sarcolemma, must be firmly attached to the basal lamina. The failure of proper attachment results in muscle injury, which is the underlying cause of Duchenne muscular dystrophy (DMD), in which mutations in the dystrophin gene disrupts the firm adhesion. In patients with DMD, even moderate contraction causes damage, leading to progressive muscle degeneration. The damaged muscles are repaired through myogenesis. Consequently, myogenesis is highly active in patients with DMD, and the repeated activation of myogenesis leads to the exhaustion of the myogenic stem cells. Therefore, approaches to reducing the risk of the exhaustion are to develop a treatment that strengthens the interaction between the sarcolemma and the basal lamina and increases the efficiency of the myogenesis. Galectin‐3 is an oligosaccharide‐binding protein and is known to be involved in cell–cell interactions and cell–matrix interactions. Galectin‐3 is expressed in myoblasts and skeletal muscle, although its function in muscle remains elusive. In this study, we found evidence that galectin‐3 and the monosaccharide N‐acetylglucosamine, which increases the synthesis of binding partners (oligosaccharides) of galectin‐3, promote myogenesis in vitro. Moreover, in the mdx mouse model of DMD, treatment with N‐acetylglucosamine increased muscle‐force production. The results suggest that treatment with N‐acetylglucosamine might mitigate the burden of DMD.—Rancourt, A., Dufresne, S. S., St‐Pierre, G., Levesque, J.‐C., Nakamura, H., Kikuchi, Y., Satoh, M. S., Frenette, J., Sato, S. Galectin‐3 and N‐acetylglucosamine promote myogenesis and improve skeletal muscle function in the mdx model of Duchenne muscular dystrophy. FASEB J. 32, 6445–6455 (2018). www.fasebj.org
Succinate receptor deficiency attenuates arthritis by reducing dendritic cell traffic and expansion of Th17 cells in the lymph nodes
Authors: Saraiva André L. , Veras Flávio P. , Peres Raphael S. , Talbot Jhimmy , de Lima Kalil A. , Luiz João P. , Carballido José M. , Cunha Thiago M. , Cunha Fernando Q. , Ryffel Bernhard , Alves‐Filho Jose C.
Published: June 2018

Rheumatoid arthritis is a chronic inflammatory disease that leads to significant changes in metabolic activity. Succinate, an intermediate of the tricarboxylic acid cycle, has emerged as a metabolic mediator of the innate immune response. However, the involvement of succinate in the generation of the adaptive immune response and establishment of autoimmune response has not been addressed thus far. Here we demonstrated that the succinate‐sensing receptor (Sucnr1/GPR91) plays a critical role in the development of immune‐mediated arthritis. We found that Sucnr1 acts as a chemotactic gradient sensor that guides dendritic cells (DCs) into the lymph nodes, orchestrating the expansion of the Thelper(Th)17‐cell population and the development of experimental antigen‐induced arthritis. Sucnr1−/− mice show reduced articular hyperalgesia, neutrophil infiltration and inflammatory cytokines in the joint, and reduced frequency of Th17 cells in draining lymph nodes. Adoptive transfer of wild‐type (WT) DCs into Sucnr1−/− mice restored the development of arthritis. Moreover, DC‐depleted mice transferred with Sucnr1−/− DCs developed less arthritis than mice transferred with WT DCs. In contrast, succinate given together with the immunization boosted the recruitment of DCs and the frequency of Th17 cells in draining lymph nodes, increasing arthritis severity. Therefore, the blockade of Sucnr1 may represent a novel therapeutic target of arthritis.—Saraiva, A. L., Veras, F. P., Peres, R. S., Talbot, J., de Lima, K. A., Luiz, J. P., Carballido, J. M., Cunha, T. M., Cunha, F. Q., Ryffel, B., Alves‐Filho, J. C. Succinate receptor deficiency attenuates arthritis by reducing dendritic cell traffic and expansion of Th17 cells in the lymph nodes. FASEB J. 32, 6550–6558 (2018). www.fasebj.org
The benefits of status
Authors: McClay Rebecca , Mileski Michael
Published: June 2018

Is working at a Magnet® or Pathway to Excellence® hospital right for you?
High-throughput Screening in Larval Zebrafish Identifies Novel Potent Sedative-hypnotics
Authors: Yang Xiaoxuan , Jounaidi Youssef , Dai Jennifer B. , Marte-Oquendo Francisco , Halpin Elizabeth S. , Brown Lauren E. , Trilles Richard , Xu Wenqing , Daigle Renee , Yu Buwei , Schaus Scott E. , Porco John A. , Forman Stuart A.
Published: June 2018

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Many general anesthetics were discovered empirically, but primary screens to find new sedative-hypnotics in drug libraries have not used animals, limiting the types of drugs discovered. The authors hypothesized that a sedative-hypnotic screening approach using zebrafish larvae responses to sensory stimuli would perform comparably to standard assays, and efficiently identify new active compounds.

Methods

The authors developed a binary outcome photomotor response assay for zebrafish larvae using a computerized system that tracked individual motions of up to 96 animals simultaneously. The assay was validated against tadpole loss of righting reflexes, using sedative-hypnotics of widely varying potencies that affect various molecular targets. A total of 374 representative compounds from a larger library were screened in zebrafish larvae for hypnotic activity at 10 µM. Molecular mechanisms of hits were explored in anesthetic-sensitive ion channels using electrophysiology, or in zebrafish using a specific reversal agent.

Results

Zebrafish larvae assays required far less drug, time, and effort than tadpoles. In validation experiments, zebrafish and tadpole screening for hypnotic activity agreed 100% (n = 11; P = 0.002), and potencies were very similar (Pearson correlation, r > 0.999). Two reversible and potent sedative-hypnotics were discovered in the library subset. CMLD003237 (EC50, ~11 µM) weakly modulated γ-aminobutyric acid type A receptors and inhibited neuronal nicotinic receptors. CMLD006025 (EC50, ~13 µM) inhibited both N-methyl-d-aspartate and neuronal nicotinic receptors.

Conclusions

Photomotor response assays in zebrafish larvae are a mechanism-independent platform for high-throughput screening to identify novel sedative-hypnotics. The variety of chemotypes producing hypnosis is likely much larger than currently known.
Theory Development Strategies for Middle-Range Theories
Authors: Im Eun-Ok
Published: June 2018

The purpose of this article is to present an analysis on the theory development strategies that have been used to develop middle-range theories through an integrated literature review and to provide directions for future theoretical development in nursing. First, theory development strategies that have been suggested and used in nursing are briefly discussed. Second, the methods used for the analysis are described. Then, 4 themes reflecting the theory development strategies that have been used to develop middle-range theories are discussed. Finally, suggestions for future theoretical development in nursing are made on the basis of the findings.
Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration
Authors: Emerson Amanda Marie
Published: June 2018

Nurses who provide care in the community to women with a history of repeated incarceration may struggle to understand the full extent of the barriers faced by this population and as a result risk giving suboptimal care to an already underserved group. This narrative inquiry study of stories told by 10 women with histories of repeated incarceration fulfilled 2 purposes: to demonstrate how women's shelter-seeking stories exposed uniquely complex patterns of health opportunity and risk and to demonstrate how storytelling might serve as an informative mode of nursing health assessment for this population.
The Impact of New Graduate Nurse Transition Programs on Competency Development and Patient Safety
Authors: Tyndall Deborah E. , Firnhaber Gina C. , Scott Elaine S.
Published: June 2018

Stronger evidence on the value of new graduate nurse transition programs is needed to justify the cost and warrant expansion of these programs to more health systems. The aim of this integrative review was to critically analyze published research on the relationship between new graduate nurse transition programs and patient safety outcomes. Limited evidence was found on actual safety improvement; rather, transition programs have predominately measured the development of competency as a process outcome variable for improving patient safety. A systems model is proposed to guide future research examining structure, process, and outcome variables, linking transition programs with patient outcomes.
A “Goldilocks” Approach to Hearing Aid Self-Fitting: Ear-Canal Output and Speech Intelligibility Index
Authors: Mackersie Carol , Boothroyd Arthur , Lithgow Alexandra
Published: June 2018

Objectives:

The objective was to determine self-adjusted output response and speech intelligibility index (SII) in individuals with mild to moderate hearing loss and to measure the effects of prior hearing aid experience.

Design:

Thirteen hearing aid users and 13 nonusers, with similar group-mean pure-tone thresholds, listened to prerecorded and preprocessed sentences spoken by a man. Starting with a generic level and spectrum, participants adjusted (1) overall level, (2) high-frequency boost, and (3) low-frequency cut. Participants took a speech perception test after an initial adjustment before making a final adjustment. The three self-selected parameters, along with individual thresholds and real-ear-to-coupler differences, were used to compute output levels and SIIs for the starting and two self-adjusted conditions. The values were compared with an NAL second nonlinear threshold-based prescription (NAL-NL2) and, for the hearing aid users, performance of their existing hearing aids.

Results:

All participants were able to complete the self-adjustment process. The generic starting condition provided outputs (between 2 and 8 kHz) and SIIs that were significantly below those prescribed by NAL-NL2. Both groups increased SII to values that were not significantly different from prescription. The hearing aid users, but not the nonusers, increased high-frequency output and SII significantly after taking the speech perception test. Seventeen of the 26 participants (65%) met an SII criterion of 60% under the generic starting condition. The proportion increased to 23 out of 26 (88%) after the final self-adjustment. Of the 13 hearing aid users, 8 (62%) met the 60% criterion with their existing hearing aids. With the final self-adjustment, 12 out of 13 (92%) met this criterion.

Conclusions:

The findings support the conclusion that user self-adjustment of basic amplification characteristics can be both feasible and effective with or without prior hearing aid experience.
Pedicle Perforation While Inserting Screws Using O-arm Navigation During Surgery for Adolescent Idiopathic Scoliosis
Authors: Oba Hiroki , Ebata Shigeto , Takahashi Jun , Koyama Kensuke , Uehara Masashi , Kato Hiroyuki , Haro Hirotaka , Ohba Tetsuro
Published: June 2018

Study Design.

An observational cohort study.

Objective.

The aim of this study was to compare the rate of pedicle perforation while inserting screws (PS) using O-arm navigation during surgery for scoliosis with that reported previously and to determine the risk factors specific to O-arm navigation.

Summary of Background Data.

O-arm navigation provides intraoperative three-dimensional fluoroscopic imaging with an image quality similar to that of computed tomography. Surgeons have started using O-arm navigation in treatment of adolescent idiopathic sclerosis (AIS). However, there are few reports of the perforation rate when using O-arm navigation to insert pedicle screws for AIS. To our knowledge, no information has been published regarding risk factors for pedicle perforation by PS when using O-arm navigation during surgery for AIS.

Methods.

We retrospectively reviewed the cases of 23 consecutive patients with AIS (all female; mean age 15.4 years, range 12–19 years) who had all undergone PS fixation under O-arm navigation.

Results.

There were 11 major pedicle perforations (Grade 2 or 3) by the 404 screws (2.7%). For both Grade 1 to 3 and Grade 2 or 3 perforations, the pedicle perforation rate by the ninth or subsequent screws was significantly higher than that for the other two groups (screws 1–4, 5–8) (P < 0.01). Grade 1 to 3, Grades 2 or 3, and Grade 3 perforation rates after a previous perforation were significantly higher than those in patients without a previous perforation (P < 0.01). The rate of screw deviation can increase significantly to 12.2% after insertion of 8.

Conclusion.

The rate of major perforation of pedicles after inserting PS using O-arm navigation during surgery for AIS is relatively low. However, we recommend caution using intraoperative navigation after inserting eight pedicle screws because after this, the trajectory deviation rate can increase significantly.

Level of Evidence: 3
Cost Analysis of Magnet-driven Growing Rods for Early-onset Scoliosis at 5 Years
Authors: Harshavardhana Nanjundappa S. , Noordeen Mohammed H.H. , Dormans John P.
Published: June 2018

Study Design.

Prospective case series of nine children with early-onset scoliosis (EOS) treated by a single surgeon with a novel implant, the magnet-driven growing rod (MdGR) in a publicly funded health care service accounting for “payer costs” (PC) incurred.

Objective.

The aim of this study was to compare the cost-effectiveness of MdGR versus conventional growing rods (CGRs) with respect to the PC incurred for treating EOS at 5 years.

Summary of Background Data.

Cost estimate and mathematical modeling study projections of MdGR have shown despite high insertional costs, it breaks even with CGR by 3 to 4 years. However, no clinical study to date exists either supporting or refuting this hypothesis.

Methods.

Nine patients with EOS secondary to idiopathic (two), congenital (one), syndromic (three), and neuromuscular (three) etiologies treated by submuscular insertion of MdGR against stringent inclusion criteria formed the study cohort. We collected costs incurred with all aspects of care over the lifetime of device (or at least 5 years) from payers’ perspective to compute and report average PC incurred per patient. We performed this cost analysis by comparing the MdGR PC against literature reported PC for CGR at 5 years.

Results.

There were five single rod (SR) and two dual rod (DR) de novo MdGR insertions, while two patients had conversion of CGR to MdGR. MdGR alone accounted for at least 50% of overall budget. The MdGR was at least 40% more cost-effective in comparison to the CGR (£34,741 vs. £52,293) and there were seven MdGR graduates.

Conclusion.

The first study reporting direct PC incurred in EOS treated by MdGR that is devoid of any mathematical modeling and deterministic sensitivity analysis is presented. The true societal/human cost savings taking into consideration indirect costs are likely to be significantly higher. MdGR is a promising novel implant that may eventually become the “standard of care” for certain EOS etiologies.

Level of Evidence: 4
Rigid Internal Fixation for Traumatic Cranio-Cervical Dissociation in Infants and Young Children
Authors: Keen Joseph R. , Ayer Robert E. , Taha Asma , Zouros Alexander
Published: June 2018

Study Design.

Retrospective review.

Objective.

Evaluate radiographic and clinical outcomes for infants and children, who underwent rigid occipito-cervical fixation for traumatic craniocervical dissociation (tCCD).

Summary of Background Data.

Traumatic craniocervical dissociation is devastating. Children are at high risk but make up a large number of survivors. Non-rigid fixation has traditionally been favored over screw and rod constructs due to inherent challenges involved with instrumenting the pediatric craniocervical junction. Therefore, outcomes for rigid occipito-cervical instrumentation in infants and young children with tCCD remain uncertain.

Methods.

Retrospective review of children who survived tCCD between 2006 and 2016 and underwent rigid occipito-cervical fixation.

Results.

Fifteen children, from 8 months to 8 years old (mean, 3.8 yr), were either a passenger (n = 11) or a pedestrian (n = 4) in a motor vehicle accident. Seven patients had weakness: five with quadriplegia, one with hemiparesis, and one with bilateral upper extremity paresis. Ten patients had concurrent C1–2 instability. At last follow-up, four patients had improved motor function: one with bilateral upper extremity paresis and one with hemiparesis regained full strength, one with quadriplegia regained function on one side while another regained function in bilateral upper extremities. All underwent rigid posterior occipito-cervical fixation, with two patients requiring additional anterior and posterior fixation at non-contiguous levels. Fourteen patients were stable on flexion-extension x-rays at a mean follow-up of 31 months (9–1 yr or longer, 7–2 yr or longer). There were no cases of deformity, growth disturbance, or subaxial instability.

Conclusion.

Children who survive tCCD may regain function after stabilization. Rigid internal rod and screw fixation in infants and young children safely provided long-term stability. We advocate using C2 translaminar screws to exploit the favorable anatomy of pediatric lamina to minimize the risks of occipitocervical (OC) instrumentation.

Level of Evidence: 4
An Evidence-based Approach to the Management of Children With Morquio A Syndrome Presenting With Craniocervical Pathology
Authors: Williams Nicole , Narducci Alessandro , Eastwood Deborah M , Cleary Maureen , Thompson Dominic
Published: June 2018

Study Design.

Retrospective case series

Objective.

The aim of this study was to review clinical and radiological outcomes of craniovertebral surgery in children with Morquio A syndrome (Mucopolysaccharidosis type IVA) and develop an evidence-based management algorithm.

Summary of Background Data.

Myelopathy secondary to craniovertebral pathology is a common cause of neurological disability in Morquio A syndrome. Previously unresolved surgical controversies include the value of surveillance, surgical indications, and operative technique.

Methods.

A retrospective case-based review of children with Morquio A syndrome and craniovertebral pathology seen in a tertiary referral pediatric center from 1992 to 2016 was performed. Patients treated nonoperatively and operatively were included. Medical records and imaging were reviewed to determine clinical and radiological findings at initial assessment, before cervical spine surgery, early postoperative period, and final follow-up. The clinical outcomes of interest were neurological status and mobility at follow-up, complications, and need for further surgery.

Results.

Twenty-seven patients were included. Surgical indications were radiological evidence of cervicomedullary compression alone (six cases) or with clinical evidence of myelopathy (12 cases). Eighteen patients (median age 6.2 years, range 3.5–15.9 years) underwent surgery, with median follow-up of 8.5 years. Occiput to upper cervical spine fusion with C1 decompression was performed in all cases with the addition of autologous calvarial graft in young patients (12 cases) and occipital-cervical plate fixation in older children (six cases). Neurological improvement occurred in 38% of cases but by one functional level only. Six of nine conservatively treated patients remained independent walkers.

Conclusion.

Surgery for craniovertebral pathology is required in the majority of children with Morquio A syndrome. Close clinical and radiological surveillance is essential for timely intervention. Occiput to cervical fusion is safe and feasible even in young patients and improves clinical and radiological parameters.

Level of Evidence: 4
Primary Visceral Merkel Cell Carcinoma: A Case Report and Review of the Literature
Authors: Siref Andrew , Hendifar Andrew , Balzer Bonnie
Published: June 2018

A 63-year-old white man with no significant previous medical or surgical history presented with painless jaundice after 3 weeks of dark urine, yellow stools, and a 9-pound weight loss. Bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase were elevated, and a computed tomography scan detected a 10-cm, ill-defined mass at the porta hepatis compressing the common bile duct. He underwent endoscopic retrograde cholangiopancreatography with stenting and ultrasound-guided biopsies. Histologic sections showed a neoplastic population of small ovoid cells with a high N:C ratio, nuclear hyperchromasia, “smoky” chromatin and abundant mitotic figures, and characteristic of high-grade neuroendocrine carcinoma (HGNECA). Immunohistochemistry showed synaptophysin, chromogranin, Golgi pattern CK20 reactivity, and strong diffuse expression of Merkel cell polyomavirus, supporting a diagnosis of Merkel cell carcinoma (MCC). A metastatic workup, including complete skin examination and positron emission tomography scan, revealed no other site of disease. Although this patient fits the classic demographic pattern for MCC, he lacks cutaneous involvement and significant risk factors for MCC including immunosuppression and concurrent or previous malignancy. Histologically, the differential diagnosis in this anatomical site is primary or occult metastatic organ-based small-cell HGNECA. Although pure nodal MCC accounts for a minute subset of MCC, it is almost exclusively described in superficial and extremity-draining nodal basins (eg, axillary or inguinal regions). Primary visceral nodal MCC accounts for fewer than 5 cases ever reported. This case illustrates the importance of recognizing the morphologic features characteristic of MCC, regardless of anatomical location, and the value of immunohistochemistry in diagnosis, which aid in differentiating it from non-MCC mimics. Development of targeted therapy has made distinction between MCC and non-MCC HGNECA increasingly important. This patient initially responded to PD-L1 inhibitor therapy but ultimately died with disease 10 months after diagnosis.
A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location
Authors: Theroux Zachary A. , Blechman Adam B. , Russell Mark A.
Published: June 2018

BACKGROUND

Surgical scar length is a common concern among patients undergoing Mohs micrographic surgery (MMS).

OBJECTIVE

This study evaluates 3 metrics of preoperative lesion size to determine which correlates best with primary linear closure lengths for nonmelanoma skin cancers (NMSCs) treated with MMS. This metric is then used to develop predictive models for linear closure lengths in 10 different anatomical regions.

MATERIALS AND METHODS

A retrospective study of 4,049 NMSCs treated with MMS and repaired with primary linear closure was conducted. Primary closure lengths were plotted against preoperative lesion circumference, area, and short axis length. Linear regression analysis was performed.

RESULTS

Preoperative NMSC circumference correlated best with closure length. Twenty-one of the 28 regression models had coefficients of determination (R
2) above 0.5. Closure lengths increased by 0.52 to 1.1 mm, depending on location, for every millimeter increase in preoperative NMSC circumference.

CONCLUSION

Preoperative lesion circumference is directly proportional to primary closure length and is a better indicator of closure length than preoperative area and short axis for MMS of NMSCs. Closure lengths located on the nasal tip, supratip, or periocular areas are most sensitive to differences in NMSC size. These data might aid Mohs surgeons with preoperative planning for wound reconstruction and patient counseling.
Evaluation of Safe and Effectiveness of an Injectable Solution Acid Deoxycholic Based for Reduction of Localized Adiposities
Authors: Amore Roberto , Amuso Domenico , Leonardi Vincenza , Leva Francesco , Sibaud Andrea Carnovale , Guida Antonio , Costa Ezio , Terranova Ferdinando , Amodeo Vincenzo , Gkritzalas Konstantinos
Published: June 2018

Background:

The use of deoxycholic acid to reduce localized fat deposits is a procedure that has been in use for about 30 years. Its effectiveness as treatment is due to emulsification of phospholipids and therefore, solubilization of the biological membranes with resulting fat necrosis. The purpose of the study was to assess the effectiveness and the safety of an injectable solution containing sodium deoxycholtate 1.25% (DB125), used as intralipotherapy.

Methods:

The effectiveness and safety of DB125 solution have been assessed with a multicentre observational prospective study carried out between February and October 2017. The 221 selected patients presented with various forms and degrees of localized fat in several areas. Intralipotherapy treatments were performed 6 weeks apart and until the clinical result was obtained. Aesthetic outcomes were evaluated by the authors using preoperative and postoperative photographic documentation and by the patients with their level of satisfaction by filling out an anonymous form. Major adverse events were reported by each doctor who performed the treatment.

Results:

Two hundred twenty-one patients treated in 273 cases of different localized fat deposits. One hundred eighty-five patients who could be assessed for final results gave the effectiveness of the treatment an average score of 7.4. The failure percentage of the treatment was 3.8%. The medical evaluation showed treatment success in 93.5% of cases. Adverse events can be divided into 2 groups: minor adverse events, which are very frequent and major ones, which are extremely rare. For both groups, the adverse events can be ascribed to localized problems in the treatment area.

Conclusion:

Studies have shown that the second-generation solution containing sodium deoxycholate 1.25% is effective and safe to treat different localized fat deposits. The high degree of effectiveness shown in the study was not associated with a lesser degree of handling because, at the doses indicated and with the use of intralipotherapy, the occurrence of adverse events was minimal.
The Evolution from Subcutaneous to Prepectoral Prosthetic Breast Reconstruction
Authors: Rebowe Ryan E. , Allred Lindsay J. , Nahabedian Maurice Y.
Published: June 2018

Prosthetic breast reconstruction is the most common method of reconstruction offered to women following mastectomy. Prepectoral breast reconstruction has recently reemerged as an alternative technique to the partial and total muscle coverage methods. Though this technique has been demonstrated to be safe and effective in the recent published literature, many surgeons have been hesitant to adopt it out of fear of incurring the same complications associated with subcutaneous reconstructions of the past. However, recent advancements in plastic surgery including the use of acellular dermal matrices, autologous fat grafting, and improved breast implants and improved mastectomy techniques have enabled plastic surgeons to revisit the prepectoral space. In this review, the authors describe the evolution of prosthetic-based breast reconstruction from subcutaneous to prepectoral and review outcomes.
Teaching Spiritual Care Within Nursing Education
Authors: Booth Leigh , Kaylor Sara
Published: June 2018

Student nurses are unprepared to meet the spiritual needs of patients, and are often uncomfortable addressing this. This article aims to describe the student perspective of spirituality in relation to the holistic care model. Findings from the study provide insight about preparing nursing students to deliver spiritual care in nursing practice.
A Novel Method for Quick Assessment of Internal And External Radiation Exposure in the Aftermath of a Large Radiological Incident
Authors: Korir Geoffrey , Karam P. Andrew
Published: June 2018

In the event of a significant radiological release in a major urban area where a large number of people reside, it is inevitable that radiological screening and dose assessment must be conducted. Lives may be saved if an emergency response plan and radiological screening method are established for use in such cases. Thousands to tens of thousands of people might present themselves with some levels of external contamination and/or the potential for internal contamination. Each of these individuals will require varying degrees of radiological screening, and those with a high likelihood of internal and/or external contamination will require radiological assessment to determine the need for medical attention and decontamination. This sort of radiological assessment typically requires skilled health physicists, but there are insufficient numbers of health physicists in any city to perform this function for large populations, especially since many (e.g., those at medical facilities) are likely to be engaged at their designated institutions. The aim of this paper is therefore to develop and describe the technical basis for a novel, scoring-based methodology that can be used by non-health physicists for performing radiological assessment during such radiological events.
Dose Comparison Using Thermoluminescent Dosimeters During Multislice Computed Tomography With Different Parameters for Simulated Spine Tumor Examination
Authors: Hsieh Chih-Chuan , Li Chiao-Zhu , Lin Meng-Chi , Yang Yun-Ju , Hong Kun-Ting , Chen Yi-Hsun , Syu Zih-Hsian , Ju Da-Tong
Published: June 2018

This study aims to compare the effect of Philips’ Brilliance 64‐slice and 256‐slice (multislice) computed tomography on effective doses when changing the operating parameters for simulated examinations of patients’ spine tumors, including changes in pitch, tube voltage (kV), and effective tube current-time product (mA s). This study considers the possibility of using other probable operating conditions to reduce patients’ effective doses. The absorbed doses to organs and skin are measured by taking data from thermoluminescent dosimeters (GR‐200 and GR‐200F) in relevant positions on the anthropomorphic Rando phantom. We also used an American College of Radiology computed tomography accreditation phantom to experiment with image spatial resolution under various scan conditions in order to achieve results over 5 line pairs per cm, the analytical capability required to meet diagnostic needs. The results show that, in general, when we change the pitch, effective tube current-time product, and tube voltage, the effective doses from 256‐slice computed tomography exceed those from 64‐slice computed tomography.
Increased Red Cell KCNN4 Activity in Sporadic Hereditary Xerocytosis Associated With Enhanced Single Channel Pressure Sensitivity of PIEZO1 Mutant V598M
Authors: Gnanasambandam Radhakrishnan , Rivera Alicia , Vandorpe David H. , Shmukler Boris E. , Brugnara Carlo , Snyder L. Michael , Andolfo Immacolata , Iolascon Achille , Silveira Paulo A. , Hamerschlak Nelson , Gottlieb Philip , Alper Seth L.
Published: June 2018

Supplemental Digital Content is available in the text
Association Between Advanced Keratoconus and Serum Levels of Zinc, Calcium, Magnesium, Iron, Copper, and Selenium
Authors: Bamdad Shahram , Owji Naser , Bolkheir Alireza
Published: June 2018

Purpose:

To investigate the possibility of an association between serum levels of zinc (Zn), calcium (Ca), magnesium (Mg), iron (Fe), copper (Cu), and selenium (Se) and advanced keratoconus (KCN).

Methods:

In this study, 50 patients with advanced KCN and 50 control subjects were included. Plasma levels of Zn, Ca, Mg, Fe, Cu, and Se were compared between the groups.

Results:

Mean ± SD age of the patients in the case and control groups was 29.3 ± 3.5 and 28.9 ± 5.9 years, respectively (P = 0.669). Among serum parameters, there were no statistically significant differences between the 2 groups in serum levels of Ca, Mg, and Fe (P > 0.05), whereas serum levels of Zn and Cu were significantly lower in the case group than the control group [65.92 ± 7.90 vs. 87.36 ± 13.64 μg/dL and 78.48 ± 11.96 vs. 116.34 ± 20.87 μg/dL, respectively (both P < 0.001)] as well as the serum level of Se [79.76 ± 19.16 vs. 87.41 ± 15.91 μg/dL (P = 0.032)].

Conclusions:

The lower serum levels of Zn, Cu, and Se in patients with advanced KCN compared with healthy controls indicate the possible role of antioxidants in the etiopathogenesis of KCN, which points to early treatment of this progressive degenerative disease with supplementation therapy, rather than keratoplasty techniques.
Video-Assisted Thoracoscopic Monitoring of Laser Lead Extraction by Femoral Route
Authors: Bontempi Luca , Vassanelli Francesca , Cerini Manuel , Inama Lorenza , Mitacchione Gianfranco , Giacopelli Daniele , Curnis Antonio
Published: June 2018

A 72-year-old man with a dual-chamber implantable defibrillator was referred to our center for transvenous lead extraction because of pocket infection and presence of an abandoned lead. We decided to proceed with a video-assisted thoracoscopic approach because of patient history and documented complete occlusion of the right subclavian vein. During the use of excimer laser for persistent adhesions, the ventricular lead broke down at the level of cavoatrial junction. To successfully remove the remaining portion of lead, we decided to use the excimer laser by femoral route. A final angiography through the laser sheath showed the integrity of the myocardial wall. We report a case of laser-assisted transvenous lead extraction unconventionally performed by the femoral route. A preventive minimally invasive cardiac surgery was implemented to provide more safety in this high-risk procedure. This technique may avoid the need of a full sternotomy in case of major bleeding complications.
Association Between Urinary Tract Infections and Antipsychotic Drug Use in Older Adults
Authors: van Strien Astrid M. , Souverein Patrick C. , Keijsers Carolina J.P.W. , Heerdink Eibert R. , Derijks Hieronymus J. , van Marum Rob J.
Published: June 2018

Background

Antipsychotic drugs are frequently prescribed to older adults, but they may be associated with serious adverse effects. The objective was to investigate the association between use of antipsychotics in older adults and the risk of urinary tract infections (UTIs).

Methods

Design

This study was designed as a cohort study.

Setting

Data were obtained from the Clinical Practice Research Datalink from January 1, 2000, to September 29, 2016.

Participants

Primary care patients 65 years or older in the United Kingdom with a first prescription for an oral antipsychotic were included in the study.

Measurements

Incidence of UTIs was calculated for periods with and without exposure to antipsychotic drugs in one cohort. Cox proportional hazard regression analysis with Andersen-Gill extension for recurrent events was used to calculate hazard ratios (HRs) with 95% confidence interval (CI).

Results

During the study period, 191,827 individuals with a first prescription for an oral antipsychotic drug were identified. Current use of antipsychotics was associated with an increased risk of UTI compared with past use (adjusted HR, 1.31; 95% CI, 1.28–1.34). This effect was strongest in the first 14 days of use (adjusted HR, 1.83; 95% CI, 1.73–1.95) and in individuals who used more than one antipsychotic drug concomitantly (adjusted HR, 1.64; 95% CI, 1.45–1.87). The risk was slightly higher for typical antipsychotics than for atypical antipsychotics. Stratification by sex showed that risk estimates were slightly higher in men than in women.

Conclusions

Use of antipsychotics was associated with an increased risk of UTIs in both men and women, particularly in the first weeks after the start of treatment.
Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms
Authors: Guo Michael Y. , Etminan Mahyar , Procyshyn Ric M. , Kim David D. , Samii Ali , Kezouh Abbas , Carleton Bruce C.
Published: June 2018

Background

Antidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms (EPSs), but no large epidemiologic study to date has examined this association. We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study.

Methods

A nested case-control study was conducted using a large health claims database in the United States from June 2006 to December 2015. Subjects with a diagnosis of primary Parkinson disease and those who received prescriptions of levodopa, ropinirole, pramipexole, domperidone, metoclopramide, entacapone, benztropine, selegiline, rasagiline, diphenhydramine, trihexyphenidyl, typical and atypical antipsychotics, and tricyclic antidepressants were excluded. Cases were followed to the first billing code for an extrapyramidal event or last date of enrollment in the cohort. For each case, 10 control subjects were matched by follow-up time, calendar time, and age through density-based sampling. Rate ratios were computed using conditional logistic regression adjusting for other covariates.

Results

We identified 3,838 subjects with EPSs compared with 38,380 age-matched control subjects. Rate ratios with respect to EPSs were as follows: duloxetine, 5.68 (95% confidence interval [CI], 4.29–7.53); mirtazapine, 3.78 (95% CI, 1.71–8.32); citalopram, 3.47 (95% CI, 2.68–4.50); escitalopram, 3.23 (95% CI, 2.44–4.26); paroxetine, 3.07 (95% CI, 2.15–4.40); sertraline, 2.57 (95% CI, 2.02–3.28); venlafaxine, 2.37 (95% CI, 1.71–3.29); bupropion, 2.31 (95% CI, 1.67–3.21); and fluoxetine, 2.03 (95% CI, 1.48–2.78).

Conclusions

This observational study demonstrates a harmful association between the incidence of Parkinson disease or associated EPSs and use of the antidepressants duloxetine, mirtazapine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, bupropion, and fluoxetine.
Sleep Deprivation in Neurointensive Care Unit Patients From Serial Neurological Checks: How Much Is Too Much?
Authors: McLaughlin Diane C. , Hartjes Tonja M. , Freeman William D.
Published: June 2018

Objective: Hourly neurological examinations are frequently performed in the neurointensive care unit (NICU) to quickly detect neurological deterioration. These examinations require the patient to be awakened hourly for days disrupting the sleep cycle and potentially causing neurological deterioration through sleep deprivation and the development of delirium. This pilot study’s aim was to describe the prevalence of neurologic deterioration and delirium in patients receiving hourly neuro checks. Design: A 6-month prospective observational cohort study was conducted within the NICU at Mayo Clinic Florida. Twenty subjects were enrolled between July 24, 2016, and January 30, 2017. Results: Neurological deterioration as defined as a decrease in Glasgow Coma Scale score of 2 or more, an increase in National Institute of Health Stroke Scale score by 4 or more, or a change in Confusion Assessment Method score for use in intensive care unit patients from negative to positive occurred in 19 of 20 patients (95%) for a total of 67 events, with most patients having multiple events. Seventy-five percent of the subjects experienced a decrease in Glasgow Coma Scale score of 2 or more at least once during the study period. The largest number of events occurred within the first 24 hours (39%). Surprisingly, 75% of the subjects also developed delirium. Forty percent of the subjects demonstrating neurological deterioration received computed tomography imaging to evaluate the change. Sixty-seven percent lacked deterioration evident on computed tomography imaging, and the deterioration was not attributed to medication effect or seizure by an experienced provider. Conclusions: Neurological deterioration is prevalent in the NICU population. Although hourly neurological examinations may be beneficial in the acute phase of neurological injury, prolonged use may be paradoxically harmful due to sleep deprivation.
Cerebral Amyloid Angiopathy: A Different Kind of Stroke
Authors: Ruth-Sahd Lisa , Schneider Melissa
Published: June 2018

When a patient presents with stroke-type symptoms, the correct diagnosis is imperative to determine appropriate treatment. Cerebral amyloid angiopathy (CAA), a buildup of amyloid proteins on the brain artery walls, is a cause of intracerebral hemorrhage. Improved diagnostic criteria and enhanced neuroimaging have resulted in earlier detection of CAA, which will hopefully lead to better outcomes for these patients. More research is being conducted, and neuroscience nurses need to stay informed about this condition to be able to appropriately care for and educate their patients who are diagnosed with CAA.
Safety of Electromagnetic Navigation Bronchoscopy in Patients With COPD
Authors: Towe Christopher W. , Nead Michael A. , Rickman Otis B. , Folch Erik E. , Khandhar Sandeep J. , Perry Yaron , Linden Philip A.
Published: June 2018

Background:

Electromagnetic navigation bronchoscopy (ENB) aids in the localization of lung lesions for biopsy and/or to guide fiducial or dye marking for stereotactic radiation or surgical localization. This study assessed ENB safety in patients with chronic obstructive pulmonary disease (COPD) and/or poor lung function.

Methods:

NAVIGATE is a prospective, multicenter, observational study of ENB. This substudy analyzed the 1-month follow-up of the first 1000 enrolled subjects. COPD was determined by medical history. Pulmonary function testing (PFT) results were collected if available within 30 days of the procedure. Procedure-related complications were captured.

Results:

The analysis included 448 subjects with COPD and 541 without COPD (COPD data missing in 11). One-month follow-up was completed in 93.3%. Subjects with COPD tended to be older, male, and have history of tobacco exposure, asthma, and recent pneumonia. Nodule size, location, and procedure time were similar between groups. There was no statistically significant difference in the procedure-related composite complication rate between groups (7.4% with COPD, 7.8% without COPD, P=0.90). Common Terminology Criteria for Adverse Events scale grade ≥2 pneumothorax was not different between groups (2.7% with COPD, 3.7% without COPD, P=0.47). COPD was not a significant multivariate predictor of complications. Severity of forced expiratory volume in 1 second (FEV1) or diffusing capacity of the lung for carbon monoxide impairment was not associated with increased composite procedure-related complications (ppFEV1
P=0.66, ppDLCO P=0.36).

Conclusion:

In this analysis, complication rates following ENB procedures were not increased in patients with COPD or poor pulmonary function. Because pneumothorax risk is not elevated, ENB may be the preferred method to biopsy peripheral lung lesions in patients with COPD and/or poor pulmonary function testing.
Changing paradigms in metabolic support and nutrition therapy during critical illness
Authors: van Zanten Arthur R.H.
Published: June 2018

Purpose of review

To summarize the most recent advances in acute metabolic care and critical care nutrition.

Recent findings

Recent research has demonstrated unknown consequences of high protein and amino acid administration in the early phase of ICU stay associated with dysregulated glucagon release leading to hepatic amino acid breakdown and suggested adverse effects on autophagy and long-term outcome. Progress has been made to measure body composition in the ICU. Refeeding hypophosphatemia and refeeding syndrome are common during critical illness, phosphate monitoring is essential after the start of nutrition therapy, and caloric restriction is recommendable in these patients.

In recent studies, enteral nutrition is no longer superior to parenteral nutrition and signals of harm using the enteral route in shock have been suggested. However, during extracorporeal life support, enteral nutrition seems well tolerated. Intermittent or bolus enteral feeding seems an exciting concept concerning its potential anabolic effects. Studies on vitamin C, thiamine, and corticosteroid combinations suggest potential to improve outcome.

These new findings will probably change the practice of metabolic and nutrition therapy in critical illness and challenge paradigms advocated for long.
Mechanical circulatory devices in acute heart failure
Authors: Pineton de Chambrun Marc , Bréchot Nicolas , Combes Alain
Published: June 2018

Purpose of review

Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials.

Recent findings

Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to ‘decision’ that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with ECMO might decrease left ventricular pressure and improve outcomes. Sepsis-associated cardiomyopathy, massive pulmonary embolism, arrhythmic storm and Takotsubo-like cardiomyopathy are among emerging indications for TCS.

TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the respective place of different MCS devices in cardiogenic shock treatment strategies.
Association of Financial Literacy With Hospitalization in Community-dwelling Older Adults
Authors: James Bryan D. , Wilson Robert S. , Shah Raj C. , Yu Lei , Arvanitakis Zoe , Bennett David A. , Boyle Patricia A.
Published: June 2018

Background:

Lowering the likelihood of hospitalization in older adults is a major public health goal for modern health care systems. Emerging data suggest that financial literacy is an important determinant of health outcomes in old age, but the relationship with hospitalization has not been explored.

Objective:

To test the hypothesis that better financial literacy is related to lower risk of hospitalization in older persons.

Design:

Prospective cohort study.

Participants:

Data came from community-dwelling older adults (n=388) without dementia enrolled in the Rush Memory and Aging Project.

Main Measures:

Participants underwent detailed assessment of financial literacy and cognition. Data on hospitalizations were obtained from linked Medicare claims records (MedPAR file).

Results:

Over an average of 1.8 years, 117 participants (30%) were hospitalized, and a third of those hospitalized experienced multiple hospitalizations. In a modified Poisson regression model adjusted for age, sex, education, and cognition, better financial literacy was associated with lower risk of hospitalization. In a model further adjusted for income, physical activity, body mass index, smoking, social network size, chronic conditions, basic and instrumental activities of daily living disability, and depressive symptoms, the association was unchanged. Secondary analyses showed the association was primarily driven by conceptual knowledge rather than numeracy.

Conclusions:

Higher financial literacy is related to a lower risk of hospitalization in older persons without dementia, after adjusting for cognitive, health, functional, and socioeconomic factors. The ability to understand and utilize financial concepts may represent a potentially modifiable risk factor for hospitalization in later life.