bluuebunny/crossref_metadata_2025 huggingface dataset:
Care maps: De-medicalizing children with medical complexity
Authors: Dharmaraj Blossom G , Adams Sherri , Orkin Julia
Published: July 2022

Children with medical complexity (CMC) have extremely high health care needs. Given their chronic complex diagnoses and involvement of multiple care providers, they are often over medicalized and seen as a list of diagnoses rather than as a child. Parents of CMC are extraordinary caregivers and advocates for their children. Parental values and perspectives are critical drivers of medical decision making, therefore highlighting the importance of collaboration between all members of the medical team. For health care providers (HCPs) to holistically guide and support families, an all encompassing, big picture understanding of CMC and their family is needed, and care maps are one such vehicle to provide this insight. Care maps are a parent-created tool that can be used to provide a holistic view of the child and demonstrate the complexity of life and interrelatedness of services for CMC. Previous research has shown that care maps have been used as a resource to promote parental reflection and identify parental priorities of care. Promotion of care maps by HCPs as a valuable tool in understanding the child and family’s goals may help improve holistic understanding and promote collaborative care.
SICKLE modulates lateral root development by promoting degradation of lariat intronic RNA
Authors: Wu Chengyun , Wang Xiaoqing , Zhen Weibo , Nie Yaqing , Li Yan , Yuan Penglai , Liu Qiaoqiao , Guo Siyi , Shen Zhenguo , Zheng Binglian , Hu Zhubing
Published: July 2022

Plant lateral roots (LRs) play vital roles in anchorage and uptake of water and nutrients. Here, we reveal that degradation of lariat intronic RNAs (lariRNAs) modulated by SICKLE (SIC) is required for LR development in Arabidopsis (Arabidopsis thaliana). Loss of SIC results in hyper-accumulation of lariRNAs and restricts the outgrowth of LR primordia, thereby reducing the number of emerged LRs. Decreasing accumulation of lariRNAs by over-expressing RNA debranching enzyme 1 (DBR1), a rate-limiting enzyme of lariRNA decay, restored LR defects in SIC-deficient plants. Mechanistically, SIC interacts with DBR1 and facilitates its nuclear accumulation, which is achieved through two functionally redundant regions (SIC1–244 and SIC252–319) for nuclear localization. Of the remaining amino acids in this region, six (SIC245–251) comprise a DBR1-interacting region while two (SICM246 and SICW251) are essential for DBR1–SIC interaction. Reducing lariRNAs restored microRNA (miRNA) levels and LR development in lariRNA hyper-accumulating plants, suggesting that these well-known regulators of LR development mainly function downstream of lariRNAs. Taken together, we propose that SIC acts as an enhancer of DBR1 nuclear accumulation by driving nuclear localization through direct interaction, thereby promoting lariRNA decay to fine-tune miRNA biogenesis and modulating LR development.
Single-crystal-like germanium thin films on large-area, compliant, light-weight, flexible, single-crystal-like substrates
Authors: Kim Kyunghoon , Radhakrishnan Gokul , Droopad Ravi , Goyal Amit
Published: July 2022

Germanium (Ge) films were heteroepitaxially grown on flexible, large-area, single-crystal-like metallic substrates. Multiple, heteroepitaxial, buffer layers of nanoscale dimensions were deposited on the triaxially textured, single-crystal-like, thermo-mechanically processed Ni–W alloy substrates. Ge films were deposited on a CeO2-terminated, heteroepitaxial buffer stack on the metallic substrate using electron beam evaporation. X-ray diffraction θ–2θ scans showed a very strong Ge (400) peak and the full width at half-maximum (FWHM) of the Ge (400) rocking curve was 0.93°. The Ge (111) ϕ-scan showed a FWHM value ∼4°. Based on the X-ray ω-scan, ϕ-scan and (111), (110), and (001) X-ray pole-figures, the Ge film deposited on the flexible, metallic substrate had a cube-on-cube heteroepitaxial relationship with the single-crystal-like metallic substrate. Reflection-high-energy-diffraction (RHEED) patterns from the Ge layer was streaky indicative of a smooth and essentially single-crystal-like Ge film. Cross-section TEM examination revealed a sharp interface between the Ge film and the topmost buffer layer, CeO2, with a low defect density. The CeO2 layer serves as a highly compliant layer that modulates its lattice parameter to attain excellent lattice-matching to the heteroepitaxial Ge layer. Ge films grown on these flexible metal substrates exhibited electron mobilities in the range of 175–250 cm2V–1s–1. Such single-crystal-like semiconductor films on low-cost, flexible, large-area, scalable, single-crystal-like metallic substrates could potentially enable high-performance electronic devices for a range of applications.
Increased Renal Expression of Complement Components in Patients With Liver Diseases: Nonalcoholic Steatohepatitis, Alcohol-Associated, Viral Hepatitis, and Alcohol-Viral Combination
Authors: Frost Kayla L , Jilek Joseph L , Thompson Austin D , Klein Robert R , Sinari Shripad , Torabzedehkorasani Elmira , Billheimer Dean D , Schnellmann Rick G , Cherrington Nathan J
Published: July 2022

Inflammatory liver diseases, including nonalcoholic steatohepatitis (NASH), alcohol-associated liver disease (ALD), hepatitis C virus (HCV), and ALD/HCV, account for nearly 2 million deaths annually. Despite increasing evidence that liver dysfunction impacts renal physiology, there is limited supportive clinical information, due to limited diagnosis of liver disease, complexity in liver disease etiology, and inadequacy of renal function tests. Human kidney biopsies with liver and renal pathology were obtained from patients with nonalcoholic fatty liver disease (NAFLD), NASH, ALD, HCV, and ALD/HCV (n = 5–7). Each liver disease showed renal pathology with at least 50% interstitial nephritis, 50% interstitial fibrosis, and renal dysfunction by estimated glomerular filtration rate (NAFLD 36.7 ± 21.4; NASH 32.7 ± 15.0; ALD 16.0 ± 11.0; HCV 27.6 ± 11.5; ALD/HCV 21.0 ± 11.2 ml/min/1.73 m2). Transcriptomic analysis identified 55 genes with expression changes in a conserved direction in response to liver disease. Considering association with immune regulation, protein levels of alpha-2-macroglobulin, clusterin, complement C1q C chain (C1QC), CD163, and joining chain of multimeric IgA and IgM (JCHAIN) were further quantified by LC-MS/MS. C1QC demonstrated an increase in NASH, ALD, HCV, and ALD/HCV (42.9 ± 16.6; 38.8 ± 18.4; 39.0 ± 13.5; 40.1 ± 20.1 pmol/mg protein) relative to control (19.2 ± 10.4 pmol/mg protein; p ≤ 0.08). Renal expression changes identified in inflammatory liver diseases with interstitial pathology suggest the pathogenesis of liver associated renal dysfunction. This unique cohort overcomes diagnostic discrepancies and sample availability to provide insight for mechanistic investigations on the impact of liver dysfunction on renal physiology.
I Get by With a Little Help From My Peers
Authors: Phillips Kathryn E. , Roney Linda N.
Published: July 2022

Graduate nursing students faced numerous stressors while pursuing their education during the COVID-19 pandemic, with many working clinically while studying. The purpose of this pilot was to explore support strategies and decrease stress in first-year students enrolled in a doctor of nursing practice program during a time of uncertainty and crisis. Graduate students were assigned to practice a three-minute mindfulness activity and connect with a fellow student for a month. Students reported mindfulness benefits and social support. Modeling healthy practices is critical to support mastery of skills that will promote positive reactions to challenges in their future practice settings.
Long-term cognitive and behavioral outcomes following early exposure to general anesthetics
Authors: Ing Caleb , Bellinger David C.
Published: July 2022

Purpose of review

Nearly 100 clinical studies have been published evaluating neurodevelopmental outcomes in children following surgery and anesthesia. These studies have reported mixed results, likely attributable at least in part to significant heterogeneity in their study designs, types and numbers of exposures, patient populations evaluated, and most importantly, the outcomes that were assessed. This review aims to summarize the results from clinical studies evaluating behavioral outcomes in children exposed to surgery and anesthesia.

Recent findings

Children with early exposure to surgery and anesthesia were found to have limited to no differences in intelligence when compared with unexposed children. However, several studies have reported more behavioral problems in children exposed to general anesthesia. An increased incidence of attention-deficit hyperactivity disorder has also been reported in anesthetic exposed children, particularly after multiple exposures.

Nearly all clinical studies of anesthetic neurotoxicity are observational in nature, so the associations between anesthetic exposure and behavioral deficits cannot yet be directly attributed to the anesthetic medication. However, the finding of deficits in some neurodevelopmental domains and not others will help guide the selection of appropriate outcomes in future studies of anesthetic neurotoxicity that can further evaluate whether anesthetic medications have an impact on neurodevelopment in children.
Anesthesia for digestive tract endoscopy
Authors: Pardo Emmanuel , Camus Marine , Verdonk Franck
Published: July 2022

Purpose of review

Nonoperating room anesthesia for digestive tract endoscopy has its own specificities and requires practical training. Monitoring devices, anesthetic drugs, understanding of procedures and management of complications are critical aspects.

Recent findings

New data are available regarding risk factors for intra- and postoperative complications (based on anesthesia registries), airway management, new anesthetic drugs, techniques of administration and management of advances in interventional endoscopy procedures.

Digestive tract endoscopy is a common procedure that takes place outside the operating room most of the time and has become more and more complex due to advanced invasive procedures. Prior evaluation of the patient's comorbidities and a good understanding of the objectives and constraints of the endoscopic procedures are required. Assessing the risk of gastric content aspiration is critical for determining appropriate anesthetic protocols. The availability of adequate monitoring (capnographs adapted to spontaneous ventilation, bispectral index), devices for administration of anesthetic/sedative agents (target-controlled infusion) and oxygenation (high flow nasal oxygenation) guarantees the quality of sedation and patient’ safety during endoscopic procedures. Knowledge of the specificities of each interventional endoscopic procedure (endoscopic retrograde cholangiopancreatography, submucosal dissection) allows preventing complications during anesthesia.
Robotics Reduces Radiation Exposure in Minimally Invasive Lumbar Fusion Compared With Navigation
Authors: Shahi Pratyush , Vaishnav Avani , Araghi Kasra , Shinn Daniel , Song Junho , Dalal Sidhant , Melissaridou Dimitra , Mai Eric , Dupont Marcel , Sheha Evan , Dowdell James , Iyer Sravisht , Qureshi Sheeraz A.
Published: July 2022

Study Design.

Retrospective cohort.

Objective.

To compare robotics and navigation for minimally invasive elective lumbar fusion in terms of radiation exposure and time demand.

Summary of Background Data.

Although various studies have been conducted to demonstrate the benefits of both navigation and robotics over fluoroscopy in terms of radiation exposure, literature is lacking in studies comparing robotics versus navigation.

Materials and Methods.

Patients who underwent elective one-level or two-level minimally invasive transforaminal lumbar interbody fusion (TLIF) by a single surgeon using navigation (Stryker SpineMask) or robotics (ExcelsiusGPS) were included (navigation 2017–2019, robotics 2019–2021, resulting in prospective cohorts of consecutive patients for each modality). All surgeries had the intraoperative computed tomography workflow. The two cohorts were compared for radiation exposure [fluoroscopy time and radiation dose: image capture, surgical procedure, and overall) and time demand (time for setup and image capture, operative time, and total operating room (OR) time].

Results.

A total of 244 patients (robotics 111, navigation 133) were included. The two cohorts were similar in terms of baseline demographics, primary/revision surgeries, and fusion levels. For one-level TLIF, total fluoroscopy time, total radiation dose, and % of radiation for surgical procedure were significantly less with robotics compared with navigation (20 vs. 25 s, P<0.001; 38 vs. 42 mGy, P=0.05; 58% vs. 65%, P=0.021). Although time for setup and image capture was significantly less with robotics (22 vs. 25 min, P<0.001) and operative time was significantly greater with robotics (103 vs. 93 min, P<0.001), there was no significant difference in the total OR time (145 vs. 141 min, P=0.25). Similar findings were seen for two-level TLIF as well.

Conclusion.

Robotics for minimally invasive TLIF, compared with navigation, leads to a significant reduction in radiation exposure both to the surgeon and patient, with no significant difference in the total OR time.
Functional mutations of SARS-CoV-2: implications to viral transmission, pathogenicity and immune escape
Authors: Dang Shengyuan , Ren Lili , Wang Jianwei
Published: July 2022

The pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to major public health challenges globally. The increasing viral lineages identified indicate that the SARS-CoV-2 genome is evolving at a rapid rate. Viral genomic mutations may cause antigenic drift or shift, which are important ways by which SARS-CoV-2 escapes the human immune system and changes its transmissibility and virulence. Herein, we summarize the functional mutations in SARS-CoV-2 genomes to characterize its adaptive evolution to inform the development of vaccination, treatment as well as control and intervention measures.
Improving Care for Families and Children with Neurodevelopmental Disorders and Co-occurring Chronic Health Conditions Using a Care Coordination Intervention
Authors: Gall V. Nadine , Buchhalter Jeffrey , Antonelli Richard C. , Richard Cathy , Yohemas Meridith , Lachuk Gina , Gibbard W. Ben
Published: July 2022

Objective:

This clinical intervention study aimed to improve care integration and health service delivery for children with concurrent neurodevelopmental disorders and chronic health conditions. This population has significant unmet needs and disproportionate deficits in service delivery. A lack of coordination across child service sectors is a common barrier to successful treatment and support of children with neurodevelopmental disorders with complex medical needs.

Methods:

This project implemented an innovative care coordination model, involving one-on-one supports from a trained care coordinator who liaised with the broader intersectoral care team to improve joint care planning, integration of services, and the experience of both families and care providers. To evaluate the impact of care coordination activities, a single-group interventional study was conducted using a repeated-measures framework (at 0, 6, and 12 months) using previously established outcome measures.

Results:

Over 2 years, this project provided care coordination to 84 children and their families, with an age range from 2 to 17 years. The care coordination intervention demonstrated positive impacts for children, families, and care teams and contributed to clinical efficiencies. Children had fewer visits to the emergency department and less frequent acute care use. Improvement in access to services, joint care planning and communication across providers, and better linkage with school supports were demonstrated. Families reported that the program decreased their stress around coordinating care for their child.

Conclusion:

This work demonstrated that intersectoral care coordination is attainable through innovative and collaborative practice for children with complex neurodevelopmental and medical needs.
Evaluating the Utility of Colchicine in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
Authors: Bao Yu-Lin , Gu Ling-Feng , Du Chong , Wang Ya-Xin , Wang Lian-Sheng
Published: July 2022

Colchicine has demonstrated promising effects in inhibiting local and systemic inflammation during acute coronary syndrome (ACS). However, the efficacy of colchicine in ACS is controversial. We performed a meta-analysis to assess the utility of colchicine in ACS by systematically searching randomized controlled trials. Recurrent myocardial infarction, coronary revascularization, and stroke were included as efficacy endpoint parameters whereas safety endpoints chosen were all-cause mortality, cardiovascular mortality, infectious events, and gastrointestinal (GI) adverse events. Nine identified studies were included (n = 7207 participants). Colchicine may reduce the risk of coronary revascularization by 54% [relative risk (RR) 0.46, 95% confidence interval (CI) 0.29–0.73; P < 0.01] and stroke by 61% (RR 0.39, 95%CI 0.18–0.81; P = 0.01). We observed no significant difference in all-cause mortality (RR 1.25, 95%CI 0.70–2.24; P = 0.46), cardiovascular mortality (RR 0.99, 95%CI 0.58–1.69; P = 0.98), recurrent myocardial infarction (RR 0.75, 95%CI 0.49–1.14; P = 0.18), and infectious events (RR 0.67, 95%CI 0.08–5.52; P = 0.71). Colchicine increased the risk of GI adverse reactions (RR 1.89, 95%CI 1.25–2.84; P < 0.01). Subgroup analysis of loading doses did not reveal significant differences in all endpoints (all P > 0.05), whereas subgroup analysis of follow-up periods showed a lower risk of GI adverse reactions with longer follow-up (P < 0.01), which may be related to establishing tolerability. Trial sequential analysis suggested that further data are needed before definitive conclusions can be drawn. Colchicine may decrease the occurrence of stroke and revascularization in ACS, whereas slightly increasing the risk of GI reactions. The loading doses probably did not significantly improve the prognosis of patients.
Melatonin Attenuates Vascular Smooth Muscle Contraction Through the γ-Secretase/Notch Intracellular Domain/Myocardin Pathway
Authors: Zheng Gui-qiong , Tong Wen-juan , Yuan Bi-chen , Luo Shi-yu , Zhang Ya-ling , Sun Shao-wei
Published: July 2022

Inositol 1, 4, 5-trisphosphate (IP3) signaling-mediated calcium release drives the contraction of vascular smooth muscles and hence regulates blood vessel volume and blood pressure. Melatonin supplementation has been suggested to be beneficial for hypertension. To determine whether the blood pressure–lowering effect of melatonin was accounted for by IP3 signaling, we evaluated the vasoconstriction response and IP3 signaling in isolated mouse thoracic aortic rings during melatonin incubation. C57BL/6 mice were given intraperitoneal injections daily with melatonin, and the systolic blood pressure and contractility of aortic rings from melatonin-treated mice were decreased, and the contraction suppression effect of melatonin was attributed to the impaired expression of contractile proteins in vascular smooth muscle cells rather than IP3 signaling. Our results further showed that melatonin increased the expression of γ-secretase, which could cleave and release the notch intracellular domain, and the notch intracellular domain prevented the transcription of contractile genes by interfering with the interaction between serum response factor and myocardin, the master regulator of contractile protein. In this article, we report a novel mechanism by which melatonin regulates smooth muscle contractility that does not depend on IP3 signaling.
Renal Safety and Renin–Angiotensin–Aldosterone System Inhibitors in Patients With Contrast Media Exposure: A Multicenter Randomized Controlled Study
Authors: Lin Yaowang , Dong Shaohong , Liu Yuanhui , Wang Yongshun , Sun Xin , Yuan Jie , Yu Danqing , Liu Huadong
Published: July 2022

There is no clear consensus on the safety of renin–angiotensin–aldosterone system inhibitors in patients with contrast media exposure. We aimed to assess the safety of renin–angiotensin–aldosterone system inhibitors in patients exposed to contrast media at 1-year follow-up. Patients treated with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) were recruited and randomly divided into 2 groups (1:1 ratio): with ACEI/ARB group (ACEI/ARB continued throughout the study period) and without ACEI/ARB group (ACEI/ARB stopped 24 hours before and continued 48 hours after the procedure). The primary endpoint was contrast-induced acute kidney injury (CI-AKI) and secondary endpoints were major adverse cardiovascular events (MACEs), and the need for renal replacement therapy during hospitalization and at 1-year follow-up. The occurrence rates of CI-AKI were not comparable in the ACEI/ARB group and the without ACEI/ARB group (2.92% and 2.62%, respectively; P = 0.866). No significant between-group differences were found with respect to the frequency of MACEs or renal replacement therapy during hospitalization and at 1-year follow-up. On subgroup analysis, among patients with estimated glomerular filtration rate (eGFR) < 45 mL/min, the incidence of CI-AKI was significantly higher in the ACEI/ARB group [17.95% (14/78) vs. 6.02% (5/83), P = 0.029]. Among patients with eGFR ≥ 45 mL/min, the incidence of CI-AKI was comparable in the 2 groups [0.87% (5/572) vs. 2.12% (12/567), P = 0.094]. The incidence of MACEs and renal replacement therapy was not comparable in the 2 groups, during hospitalization and at 1-year follow-up. ACEI or ARB treatment can safely be continued after exposure to contrast media, but not in patients with eGFR < 45 mL/min.
Sympathetic activation and heart rate thresholds for cardiovascular risk in chronic kidney disease
Authors: Grassi Guido , Fowler Bianca , Scali Beatrice , Rossi Federica , Motto Elena , Pieruzzi Federico , Mancia Giuseppe
Published: July 2022

Aim:

The current study was designed at assessing whether the sympathetic cardiovascular drive (SNS) is differently activated in chronic kidney disease (CKD) patients displaying less or more elevated resting heart rate (HR) values. It was also designed at determining at which HR cutoff value the SNS displays a greater activation.

Methods:

In 95 CKD middle-age patients we evaluated muscle sympathetic nerve activity (MSNA, microneurography) and venous plasma norepinephrine (HPLC assay), subdividing the patients in different groups according to their resting clinic and 24-h HR.

Results:

In CKD progressively greater values of clinic or 24-h HR were associated with a progressive increase in both MSNA and norepinephrine. HR cutoff values indicated by large-scale clinical trials for determining cardiorenal risk, that is more than 80 bpm, were associated with MSNA values significantly greater than the ones detected in patients with lower HR, this being the case also for norepinephrine. Both MSNA and norepinephrine were significantly related to clinic (r = 0.47, P < 0.0001 and r = 0.26, P < 0.0001, respectively) and 24-h (r = 0.42, P < 0.0001 and r = 0.27, P < 0.0001, respectively) HR. MSNA, norepinephrine, but not HR, were significantly and inversely related to estimated glomerular filtration rate (eGFR) values (r = −0.47, r = −0.23, P < 0.0001 and P < 0.02, respectively).

Conclusion:

In CKD both clinic and 24-h HR values greater than 80 bpm are associated with an enhanced sympathetic activation, which parallelles for magnitude the HR elevations. The sensitivity of HR as sympathetic marker is limited; however, no significant relationship being detected between HR and eGFR or left ventricular mass index.
Renal Farnesoid X Receptor improves high fructose-induced salt-sensitive hypertension in mice by inhibiting DNM3 to promote nitro oxide production
Authors: Zhu Yeyan , Tao Yufeng , Wu Chunying , Zeng Yuting , Du Huiting , Xiang Qunkun , Chen Yang , Zhu Qing , Wang Lei
Published: July 2022

Objective:

Farnesoid X Receptor (FXR) is highly expressed in renal tubules, activation of which attenuates renal injury by suppressing inflammation and fibrosis. However, whether renal FXR contributes to the regulation of blood pressure (BP) is poorly understood. This study aimed to investigate the anti-hypertensive effect of renal FXR on high-fructose-induced salt-sensitive hypertension and underlying mechanism.

Methods:

Hypertension was induced in male C57BL/6 mice by 20% fructose in drinking water with 4% sodium chloride in diet (HFS) for 8 weeks. The effects of FXR on NO production were estimated in vitro and in vivo.

Results:

Compared with control, HFS intake elevated BP, enhanced renal injury and reduced renal NO levels as well as FXR expression in the kidney of mice. In the mouse renal collecting duct cells mIMCD-K2, FXR agonists promoted NO production by enhancing the expression of neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS), whereas this effect was diminished by fxr knockdown. We further found that Dynamin 3 (DNM3), a binding protein with nNOS in the renal medulla, was inhibited by FXR and its deficiency elevated NO production in mIMCD-K2 cells. In HFS-fed mice, renal fxr overexpression significantly attenuated hypertension and renal fibrosis, regulated the expression of DNM3/nNOS/iNOS, and increased renal NO levels.

Conclusion:

Our results demonstrated that renal FXR prevents HFS-induced hypertension by inhibiting DNM3 to promote NO production. These findings provide insights into the role and potential mechanism of renal FXR for the treatment of hypertension.
Corneal Cross-Linking: Epi-On
Authors: Hafezi Farhad
Published: July 2022

When treating corneal ectasias, successful corneal cross-linking (CXL) requires three factors: riboflavin saturation of the corneal stroma, ultraviolet (UV) light, and oxygen. Riboflavin is too large to pass through epithelial tight junctions, so traditionally epithelial debridement is performed before riboflavin is applied making this approach an epithelium-off (epi-off) technique. However, this can result in pain as the epithelium regrows, corneal haze, and an increased infection risk postoperatively, which needs careful management with pharmacotherapy. Epithelium-on (epi-on) CXL should reduce the extent of these issues. Riboflavin can be passed through the epithelium into the stroma either by iontophoresis or with penetration enhancers, however this alone results in suboptimal cross-linking effects, as the epithelium not only absorbs around 20% of incoming UV energy, it also acts as a barrier to oxygen diffusion into the stroma. While it is simple to adjust the UV fluence delivered to the stroma to compensate for the energy lost in the epithelium, compensating for the lack of stromal oxygen is less simple. Several approaches (including oxygen goggles) have been taken to achieve this. However, adding iontophoresis and supplemental oxygen through goggles in the operating theater adds complexities that could be engineered out. Accordingly, the technique has advanced in the laboratory to a point where penetration enhancers, optimized UV irradiation profiles, and atmospheric oxygen can now provide epi-on CXL with the same corneal strengthening efficacy as epi-off CXL, suggesting simple, effective epi-on CXL could soon be in clinical use.
Tear Cytokines Associated With Therapeutic Effects in Chronic Ocular Graft-Versus-Host Disease
Authors: Ma Jiao , Shen Zhan , Peng Rongmei , Li Chendi , Zhao Yinghan , Hu Bohao , Hong Jing
Published: July 2022

Purpose:

The local application of antiinflammatory and immunosuppressive agents is an effective method for the treatment of ocular graft-versus-host disease (oGVHD); however, we noticed that some patients with oGVHD did not respond to topical therapy as well as many others. This study aimed to determine whether tear cytokines were associated with therapeutic effects in oGVHD.

Methods:

Forty patients with chronic oGVHD were enrolled and grouped as responders (n = 24) and nonresponders (n = 16) based on the clinical response to 1 month of topical treatment. Tear samples were collected from each participant before and after treatment, and the tear concentrations of 7 cytokines (IL-2, IL-6, IL-8, IL-10, IL-17A, TNF-α, and ICAM-1) were measured using microsphere-based immunoassay analysis. Differences between pretreatment and posttreatment tear samples were analyzed using the Wilcoxon test.

Results:

No significant differences in ophthalmic symptoms or cytokine levels were observed between responders and nonresponders at baseline. After 1 month of topical treatment, ocular surface parameters (including Ocular Surface Disease Index, National Institutes of Health eye score, best-corrected visual acuity, corneal fluorescein staining score, and fluorescein tear film break-up time) were significantly ameliorated in responders, but not in nonresponders. Moreover, none of the cytokines exhibited significant alteration in nonresponders, whereas the tear levels of IL-6 (P = 0.031) and IL-8 (P = 0.037) exhibited significant decreases in responding patients.

Conclusions:

Our results revealed that tear IL-6 and IL-8 levels were significantly altered in response to topical oGVHD treatment.
Delivery of Cells to the Cornea Using Synthetic Biomaterials
Authors: Ross Mitchell , Amaral Nicole , Taiyab Aftab , Sheardown Heather
Published: July 2022

The cornea is subject to a myriad of ocular conditions often attributed to cell loss or cell dysfunction. Owing to the superficial positioning of tissues composing the anterior segment of the eye, particularly the cornea, regenerative medicine in this region is aided by accessibility as compared with the invasive delivery methods required to reach deep ocular tissues. As such, cell therapies employing the use of carrier substrates have been widely explored. This review covers recent advances made in the delivery of stem cells, corneal epithelial cells, and corneal endothelial cells. Particular focus is placed on the most popular forms of synthetic scaffolds currently being examined: contact lenses, electrospun substrates, polymeric films, and hydrogels.
Intramuscular Eyelid Myxoma
Authors: Liu Catherine K. , Williamson John E. , Milman Tatyana , Lally Sara E. , Shields Carol L.
Published: July 2022

Myxomas are a heterogeneous group of mesenchymal tumors. Soft tissue myxomas are divided into myocardial, intramuscular, juxta-articular, superficial, aggressive, and nerve sheath myxomas. Although benign, myxomas have site-specific biologic behavior and syndromic associations, which can influence prognosis and management. In addition, myxomas need to be distinguished from malignant neoplasms, such as myxofibrosarcomas, low-grade fibromyxoid sarcomas, myxoid liposarcomas, and peripheral nerve sheath tumors. While myxomas can occur throughout the body, these tumors arise more commonly in the thigh, shoulder, buttocks, and upper extremity, and less often in the head and neck. Rarely, myxomas can arise in a periocular location, typically in the conjunctiva and eyelid skin. In this case report, we present a patient with recurrent intramuscular myxoma of the eyelid and discuss the differential diagnosis and syndromic associations of this neoplasm. To our knowledge, there have been no prior reports of intramuscular myxoma of the eyelid and orbit.
Chronic pain experience through COVID-19: a comparison of reports prior and during the early stages of the pandemic
Authors: Buckley Lisa , Sterling Michele , Elphinston Rachel A.
Published: July 2022

The impacts of COVID-19 and imposed restrictions on individuals with chronic noncancer pain continue to emerge, varying across countries. More recent research (including with longitudinal designs) suggests that the pandemic may not have such a disproportionate effect on chronic noncancer pain and its management as first thought. This longitudinal study, with assessments before the pandemic (2019) and early during the pandemic (May–July 2020), examined changes in validated measures of pain severity, pain interference, prescription opioid misuse, and mental health symptoms. Patients (N = 236) self-reported significant improvements in pain severity, pain interference, pain self-efficacy, pain catastrophizing, prescription opioid misuse, depression, and anxiety symptoms over time. Approximately 30% and 33% of patients achieved minimally important reductions (10% change) in pain severity and pain interference, respectively. In follow-up exploratory analyses, prepandemic sociodemographic and psychological factors predictive of 10% improved (vs 10% worse) pain severity and interference were investigated in logistic regressions. Reduction in pain interference was predicted by current employment, older age, and higher pain self-efficacy. There were no significant predictors of reduction in pain severity. The impact of COVID-19 on patients' pain experience and mental health was negligible in the early stages of the pandemic, and findings suggest improvements through the period. Targeted interventions that promote the protective factor of pain self-efficacy and build resilience may buffer patients' future response to the pandemic because it evolves as a part of our new normal. Targeted social determinants of health interventions that direct resources toward maintaining employment could also be important.
Cardiometabolic Risk Factors Among Insufficiently Active African American Women With Obesity
Authors: Joseph Rodney P. , Ainsworth Barbara E. , Vega-López Sonia , Adams Marc A. , Todd Michael , Gaesser Glenn A. , Keller Colleen
Published: July 2022

Background

Low moderate-to-vigorous physical activity (MVPA) levels and obesity are associated with increased cardiometabolic disease risk.

Objective

The aim of this study was to describe MVPA and cardiometabolic risk characteristics of insufficiently active African American women with obesity (N = 60) enrolled in a culturally tailored MVPA intervention.

Methods

We assessed accelerometer-measured and self-reported MVPA, blood pressure, serum lipid profiles, cardiorespiratory fitness (VO2 peak), and aortic pulse wave velocity.

Results

Participants (mean age, 38.4; mean body mass index, 40.6 kg/m2) averaged 15 min/d of accelerometer-measured MVPA and 30 min/wk of self-reported MVPA. Systolic and diastolic blood pressure levels were elevated (135.4 and 84.0 mm Hg, respectively). With the exception of low-density lipoprotein cholesterol (121.4 mg/dL) and high-density lipoprotein cholesterol (47.6 mg/dL), lipid profiles were within reference ranges. Compared with normative reference values, average VO2 peak was low (18.7 mL/kg/min), and pulse wave velocity was high (7.4 m/s).

Conclusions

Our sample of insufficiently active African American women with obesity was at an elevated risk for cardiometabolic disease.
Predictors of Time to Aneurysm Repair and Mortality in Aneurysmal Subarachnoid Hemorrhage
Authors: Sheehan Tiffany O. , Davis Nicolle W. , Guo Yi , Kelly Debra Lynch , Yoon Saunjoo L. , Horgas Ann L.
Published: July 2022

BACKGROUND: Prompt aneurysm repair is essential to prevent rebleeding after aneurysmal subarachnoid hemorrhage. To date, most studies on this topic have focused on 1 set of predictors (eg, hospital or patient characteristics) and on 1 outcome (either time to aneurysm repair or mortality). The purpose of this study was to test a model that includes hospital and patient characteristics as predictors of time to aneurysm repair and mortality, controlling for disease severity and comorbidity, and considering time to aneurysm repair as a potential influence in these relationships. METHODS: A sample of aneurysmal subarachnoid hemorrhage patients with a principal procedure of clipping or coiling was selected (n = 387) from a statewide administrative database for cross-sectional retrospective analysis. The primary study outcome was in-hospital mortality. Independent variables were level of stroke center, age, race, sex, and type of aneurysm repair. Hierarchical logistic regression was used to estimate the probability of in-hospital death. RESULTS: Patients who underwent a coiling procedure were more likely to be treated within the first 24 hours of admission compared with those undergoing clipping (odds ratio, 0.54; 95% CI, 0.35–0.84; P = .01). Patients treated at a certified comprehensive stroke center (CSC) had a 72% reduction in odds of death compared with those treated at primary stroke centers (odds ratio, 0.28; 95% CI, 0.10–0.77; P = .01), after controlling for disease severity and comorbid conditions. Time to aneurysm repair was not significantly associated with mortality and did not influence the relationship between hospital and patient characteristics and mortality. CONCLUSION: Our results indicate that treatment at a CSC was associated with a lower risk of in-hospital mortality. Time to aneurysm repair did not influence mortality and did not explain the mortality benefit observed in CSCs. Research is needed to explore interdisciplinary hospital factors including nursing and nurse-sensitive interventions that may explain the relationship between CSCs and mortality outcomes.
Membership matters! A toolkit strategy
Authors: Wilson Kathleen P.
Published: July 2022

Professional organizations often have a symbiotic relationship with their members. Not only is there dependency on membership to thrive but also there is availability of professional resources for members, thus dually meeting the organization's goals and objectives. Since 2020 with the Covid -19 pandemic, some professional organizations may have experienced challenges affecting membership. Nurse Practitioner (NP) organization leaders, including Fellows of the American Association of Nurse Practitioners (FAANP), must be attentive to finding ways to create new member state and local councils that will increase overall membership across the tri-level tier of local, state, and national membership. Increasing NP membership enhances NP voices in those matters that most affect NP practice, policy, and legislation. A toolkit for initiating a new local professional organization is shared to support this effort.
Methods recently used for the assessment of physical activity in children and adolescents
Authors: Jurado-Castro Jose Manuel , Gil-Campos Mercedes , Llorente-Cantarero Francisco Jesus
Published: July 2022

Purpose of review

The aim of this review is to summarize recent evidences and advances on the implementation and the use of new tools to assessing physical activity (PA) in children.

Recent findings

Technological advances provide, increasingly, new objective methods for the evaluation of PA in children. In addition to accelerometry, there are other objective methods for assessing PA in children such as new wearable monitoring and activity bracelets, smartphone and recording software applications, Global Positioning System or Inertial Sensors Devices.

Doubly labeled water and calorimetry are reference methods to assessing PA but with limitations of use. Accelerometry is an accurate method for measuring sedentary behavior and PA levels in children. In fact, it is a real alternative reference method for the validation of methods and tools of assessing PA. However, there is still no consensus about the most appropriate approach to analyze the duration and intensity of PA in children. Therefore, the implementation of other alternative objective methods, as well as complementation with PA questionnaires, can provide a more precise evaluation of different patterns and behaviors related with sedentarism and PA.
High protein diet in digestive cancers
Authors: Laviano Alessandro
Published: July 2022

Purpose of review

Recent advances in the nutritional management of patients with digestive cancers suggest that modulation of protein intake may significantly contribute to achieve nutritional and clinical benefits. By reviewing the available evidence, a quantitatively and qualitatively optimal protein intake could be derived.

Recent findings

High protein diets (i.e., 1–1.5 g/kg body weight/day) appear key to maintain the adequate nutritional status, and may also contribute to achieve clinical benefits. This target appears particularly relevant in patients with digestive cancers at risk or already malnourished, or in older patients. During active cancer treatments, protein intake should be closer to the upper limit of the recommended intake. Also, high protein intake should be maintained also beyond the periods of catabolic crisis associated with active treatments. In contrast with general reasoning, animal proteins should represent the majority of the recommended intake. Based on the available evidence, the intake of no specific amino acid can be strongly recommended to enhance anabolic potentials or the immune modulating effects of high protein diets.

High protein intake, mostly based on animal proteins, should be recommended to patients with digestive cancers. However, this target should be translated into clinical prescription after considering the clinical and metabolic needs of the patients. The quest for the optimal protein intake of patients with cancer at different time points of their clinical journey is still open.
Outcome differences between PARAMEDIC2 and the German Resuscitation Registry: a secondary analysis of a randomized controlled trial compared with registry data
Authors: Knapp Jürgen , Huber Markus , Gräsner Jan-Thorsten , Bernhard Michael , Fischer Matthias
Published: July 2022

Background and importance

There has been much discussion of the results of the PARAMEDIC2 trial, as resuscitation outcome rates are considerably lower in this trial than in country-level registries on out-of-hospital cardiac arrest (OHCA). Here, we developed a statistical framework to investigate this gap and to examine possible sources for observed discrepancies in outcome rates.

Design

Summary data from the PARAMEDIC2 trial were used as available in the publication of this study. We developed a modelling framework based on logistic regression to compare data from this randomized controlled trial and registry data from the German Resuscitation Registry (GRR), where we considered 26 019 patients treated with epinephrine for OHCA in the GRR. To account and adjust for differences in patient characteristics and baseline variables predictive for outcomes after OHCA between the GRR cohort and the PARAMEDIC2 study sample, we included all available variables determined at the arrival of EMS personnel in the modelling framework: age, sex, initial cardiac rhythm, cause of cardiac arrest, witness of cardiac arrest, CPR performed by a bystander, and the interval between emergency call and arrival of the ambulance at the scene (baseline model). In order to find possible explanations for the discrepancies in outcome between PARAMEDIC2 and GRR, in a second (baseline plus treatment) model, we additionally included all available variables related to the interventions of the EMS personnel (type of airway management, type of vascular access, and time to administration of epinephrine).

Main results

A patient cohort with baseline variables as in the PARAMEDIC2 trial would have survived to hospital discharge in 7.7% and survived with favourable neurological outcome in 5.0% in an EMS and health care system as in Germany, compared with 3.2 and 2.2%, respectively, in the Epinephrine group of the trial. Adding treatment-related variables to our logistic regression model, the rate of survival to discharge would decrease from 7.7 (for baseline variables only) to 5.6% and the rate of survival with favourable neurological outcome from 5.0 to 3.4%.

Conclusion

Our framework helps in the medical interpretation of the PARAMEDIC2 trial and the transferability of the trial’s results for other EMS systems. Significantly higher rates of survival and favourable neurological outcome than reported in this trial could be possible in other EMS and health care systems.
Bone Morphogenic Protein 2 Use for the Surgical Treatment of Acute Scaphoid Fractures and Scaphoid Non-unions
Authors: Clark DesRaj M. , Piscoya Andres S. , Dunn John C. , Nesti Leon J.
Published: July 2022

Background:

Bone morphogenic protein 2 (BMP-2) has demonstrated promise as an adjunct to surgically treating fractures. Its reported use in the upper extremity is limited. Questions/purpose: This study reports union rates, outcomes, and complications of scaphoid fractures treated with adjunctive BMP-2 to further characterize BMP-2 use in the hand and wrist.

Methods:

Retrospective review of scaphoid fractures treated surgically in one region of the military health system from 2009 to 2019 was conducted to identify cases employing BMP-2. Fracture healing was determined by computed tomography. Primary outcomes were union rate, time to union, and complications. Secondary outcomes included union rates for prior non-unions, union rates at 4 & 6 weeks, and functional outcomes.

Results:

Fourteen patients met inclusion criteria. Non-unions accounted for 50% of included fractures. The total union rate was 93%. Mean time to union was 6.2 weeks. All acute fractures healed with mean time to union of 4.8 weeks. Non-unions had a union rate of 86% with mean time to union of 7.7 weeks. Four patients (29%) developed radiographic heterotopic ossification (HO); however, there was no significant decrease in motion was appreciated. Thirteen patients (93%) resumed the push-ups portion of the military fitness test. No major complications were identified during follow up.

Conclusions:

Adjunctive use of BMP-2 in operative fixation of scaphoid fractures resulted in desirable union rates without major complications. Larger, prospective studies are needed to assess if adjunctive BMP-2 use in scaphoid fractures provides significant benefit versus other treatments.
Efficacy of Post-Surgical Nostril Retainer (PSNR) in patients with UCLP Treated with Pre-Surgical NasoAlveolar Molding (NAM) and Primary Cheiloplasty-Rhinoplasty
Authors: Al-Qatami Fawzi , Avinoam Shayna P , Cutting Court B , Grayson Barry H , Shetye Pradip R
Published: July 2022

Objective:

The aim of this investigation is to determine if the nasal form of patients with unilateral cleft lip and palate (UCLP) treated with pre-surgical nasoalveolar molding (NAM) therapy, primary lip-nose surgery, and post-surgical Nostril Retainer (PSNR) is different from patients treated with pre-surgical NAM and primary lip and nose surgery alone.

Design:

A cross-sectional, retrospective review of 50 consecutive non-syndromic patients with UCLP: 24 treated with NAM and primary lip-nose surgery followed by PSNR (Group I) compared to 26 patients treated with NAM and primary lip-nose surgery without PSNR (Group II). Polyvinyl siloxane nasal impressions were performed at the average age of 12 months and 6 days. Bilateral measurements of alar width at maximum convexity, total alar base width, nasal tip projection, columella length, and nostril aperture width and height were recorded. Statistical comparison of cleft versus non-cleft side nasal measurements were performed within Group I and Group II, as well as comparison of the difference between the two groups.

Results:

Cleft side nasal dimension was statistically significantly better in Group I than Group II across all measures except nasal projection (P<0.05). Group I showed less difference between the cleft and non-cleft side in all six measurements than Group II (p<0.05).

Conclusion:

There is a significant difference in the nasal shape of patients who underwent PSNR compared to those that did not. The patients who used PSNR showed better nasal shape at the average age of 12 months than the control group.