bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous Thrombosis of a Middle Meningeal Arteriovenous Fistula With Subsequent Pseudoaneurysm Formation: Case Report and Review of Literature
Authors: Nazari Pouya , Golnari Pedram , Sukumaran Madhav , Shaibani Ali , Hurley Michael C , Ansari Sameer A , Potts Matthew B , Jahromi Babak S
Published: July 2020

BACKGROUND AND IMPORTANCE

Middle meningeal artery (MMA) pseudoaneurysms and middle meningeal arteriovenous fistulas (MMAVFs) are rarely reported after head injury. We report an unusual case of delayed MMA pseudoaneurysm formation after spontaneous thrombosis of an MMAVF, and review existing literature on MMAVF treatment and results.

CLINICAL PRESENTATION

A 59-yr-old male presented with a 5-d history of worsening left-sided headaches, followed by nausea, lethargy, and difficulty with speech. Non-contrast computed tomography demonstrated a left temporal intraparenchymal hemorrhage (IPH) and an acute left-sided subdural hematoma (SDH). Cerebral angiography found abnormal shunting between the right MMA and the right sphenoparietal sinus, consistent with an MMAVF. During the course of admission, the patient's neurological condition deteriorated requiring craniotomy for evacuation of SDH and IPH. Given the presumed incidental nature of the contralateral MMAVF, conservative management was recommended. Follow-up imaging 2 mo after surgery revealed spontaneous thrombosis of the right MMAV. Repeat imaging 5 mo later revealed an MMA pseudoaneurysm at the prior fistulous site, which was subsequently embolized with Onyx, occluding the pseudoaneurysm and the MMA both proximal and distal to the pseudoaneurysm.

CONCLUSION

Spontaneous thrombosis of an MMAVF is rare and only seen in 13.1% of cases. However, subsequent delayed formation of an MMA pseudoaneurysm has not been described. Our case therefore demonstrates that MMAVF thrombosis may not indicate complete healing of the underlying injury to the MMA, and suggests the need for continued follow-up of such lesions despite initial apparent resolution.
Viral Interference Between Dengue Virus and Hepatitis C Virus Infections
Authors: Liang Po-Cheng , Chen Kuan-Yu , Huang Chung-Hao , Chang Ko , Lu Po-Liang , Yeh Ming-Lun , Huang Chung-Feng , Huang Ching-I , Hsieh Meng-Hsuan , Dai Chia-Yen , Lin Zu-Yau , Chen Shinn-Chern , Chuang Wan-Long , Chen Yen-Hsu , Huang Jee-Fu , Yu Ming-Lung
Published: July 2020

Both dengue virus (DENV) and hepatitis C virus (HCV) belong to the Flaviviridae family and could induce hepatitis. We aimed to investigate the interference between them. In total, 515 patients confirmed with dengue fever (DF) were enrolled. Thirty-two patients (6.21%) were seropositive for anti-HCV; 12 of 32 anti-HCV-positive patients had detectable HCV-RNA at presentation of DF. The proportion of dengue hemorrhagic fever was comparable between patients with or without anti-HCV and between those with or without HCV-RNA. Eleven of 32 patients received HCV-RNA testing during a median interval of 23 months after DF, which revealed significantly increased HCV-RNA levels (5.43 ± 0.77 vs 3.09 ± 1.24 log IU/mL, follow-up vs acute-DF phase; P = .003). Four of 11 patients with baseline HCV-RNA values before DF demonstrated a nadir viremia during acute DF. We also included age-, sex-, and follow-up duration–matched HCV-monoinfected patients as controls; higher delta HCV-RNA changes were demonstrated in patients with DF than in controls during the follow-up period (2.34 ± 1.15 vs –0.27 ± 0.76 log IU/mL; P < .001). Further in vitro experiments showed that HCV nonstructural protein 5A was downregulated in Con1 HCV replicon cells infected by DENV1. These clinical and experimental findings suggested possible viral interference in DENV/HCV. However, HCV viremia did not affect the disease outcomes of DF.
10 years later: revisiting the patchwork quilt of child protection in Canada
Authors: Gullickson Courtney , Bartlett Emma , Ornstein Amy
Published: July 2020

Background

In 2007, a Paediatrics & Child Health article characterized the Canadian academic Child and Youth Protection Programs (CYPPs) depicting the wide variation in clinical services and resources across the country as ‘a threadbare patchwork quilt’. This study aimed to expand and update the knowledge gained from that original project a decade later. The aim of this research was to understand the current structure, functioning, and experiences of the existing Canadian CYPPs.

Methods

A mixed-methods design was utilized and all program directors of Canadian CYPPs were invited to participate. An online survey was distributed using REDCap to collect quantitative data on program characteristics. Program directors participated in one-on-one semi-structured telephone interviews to gather qualitative information regarding their program’s strengths and needs, resources, as wellas reflections on their experiences working within this evolving field.

Results

In total, 15 of 16 CYPP directors participated in the online survey. CYPPs remained relatively consistent in the variety of allied health care professionals on their team, and have ongoing work in research, education, and advocacy. Recurrent themes that emerged from the qualitative interview data included the strength of the team, comments on stress and wellness, expertise in the field, and desire for additional advocacy.

Conclusion

Current information was gathered on the structure, function, and experiences of Canadian CYPPs. Areas of growth include collaborative practice at the Child and Youth Advocacy Centres and deliberate attention to wellness. Child maltreatment continues to be an important health and social issue and review of the present-day landscape is critical to better inform research, education, and resource planning.
Clinician–Patient Racial/Ethnic Concordance Influences Racial/Ethnic Minority Pain: Evidence from Simulated Clinical Interactions
Authors: Anderson Steven R , Gianola Morgan , Perry Jenna M , Losin Elizabeth A Reynolds
Published: July 2020

Objective

Racial and ethnic minorities in the United States report higher levels of both clinical and experimental pain, yet frequently receive inadequate pain treatment. Although these disparities are well documented, their underlying causes remain largely unknown. Evidence from social psychological and health disparities research suggests that clinician–patient racial/ethnic concordance may improve minority patient health outcomes. Yet whether clinician–patient racial/ethnic concordance influences pain remains poorly understood.

Methods

Medical trainees and community members/undergraduates played the role of “clinicians” and “patients,” respectively, in simulated clinical interactions. All participants identified as non-Hispanic Black/African American, Hispanic white, or non-Hispanic white. Interactions were randomized to be either racially/ethnically concordant or discordant in a 3 (clinician race/ethnicity) × 2 (clinician–patient racial/ethnic concordance) factorial design. Clinicians took the medical history and vital signs of the patient and administered an analogue of a painful medical procedure.

Results

As predicted, clinician–patient racial/ethnic concordance reduced self-reported and physiological indicators of pain for non-Hispanic Black/African American patients and did not influence pain for non-Hispanic white patients. Contrary to our prediction, concordance was associated with increased pain report in Hispanic white patients. Finally, the influence of concordance on pain-induced physiological arousal was largest for patients who reported prior experience with or current worry about racial/ethnic discrimination.

Conclusions

Our findings inform our understanding of the sociocultural factors that influence pain within medical contexts and suggest that increasing minority, particularly non-Hispanic Black/African American, physician numbers may help reduce persistent racial/ethnic pain disparities.
Influenza vaccination in chronic inflammatory arthritis undergoing immunosuppressive treatments: temporal trend and factors of adherence
Authors: Quartuccio Luca , Zabotti Alen , Gallo Tolinda , De Vita Salvatore , Valent Francesca
Published: July 2020

Objectives

To verify the level of adherence to the influenza vaccination program in a population of patients suffering from RA, PsA or AS undergoing immunosuppressive treatment.

Methods

Administrative databases from the Regional Health Information System of Friuli Venezia Giulia (FVG), Italy, were used. Subjects were residents in FVG, suffered from chronic inflammatory arthritis and had at least one prescription for a DMARD in the 9 months before the start of the vaccination season (from 1 October to 31 December). The observation ranged from 2006 to 2018. Logistic regression was used to assess the association between vaccination and the patient’s characteristics in the 2018–2019 influenza season.

Results

Overall, vaccination adherence decreased from the highest value of 35.7% (662/1853) in 2006 to the lowest value of 25.3% (926/3663) in 2014; in people ≥65 years of age it also decreased over time from 61.6% (577/936) in 2008 to 43.9% (701/1595) in the 2014. By logistic analysis on the 2018–2019 season, which included 4460 patients, older subjects were more likely to be vaccinated [people 65–74 years, odds ratio (OR) 4.58 (95% CI 3.72, 5.64); people 75–84 years, OR 6.47 (95% CI 5.04, 8.32); both vs <65] as were those with diabetes [OR 1.66 (95% CI 1.05, 2.64)]. Treatment with a biologic agent alone [OR 0.64 (95% CI 0.52, 0.80)] and RA diagnosis [OR 0.69 (95% CI 0.51, 0.93)] were associated with lower adherence.

Conclusion

Influenza vaccination adherence is alarmingly low in a population at higher risk of infectious complications, in particular in elderly patients.
Suicidal ideation is associated with nighttime wakefulness in a community sample
Authors: Tubbs Andrew S , Fernandez Fabian-Xosé , Perlis Michael L , Hale Lauren , Branas Charles C , Barrett Marna , Chakravorty Subhajit , Khader Waliuddin , Grandner Michael A
Published: July 2020

Study Objectives

Nocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends.

Methods

Data were collected from 888 adults aged 22–60 as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization study. Suicidal ideation was measured by the Patient Health Questionnaire-9, while timing of wakefulness was estimated from the Sleep Timing Questionnaire. Binomial logistic regressions estimated the association between nocturnal (11 pm–5 am) and morning (5 am–11 am) wakefulness and suicidal ideation.

Results

Nocturnal wakefulness was positively associated with suicidal ideation on weekdays (OR: 1.44 [1.28–1.64] per hour awake between 11:00 pm and 05:00 am, p < 0.0001) and weekends (OR: 1.22 [1.08–1.39], p = 0.0018). Morning wakefulness was negatively associated with suicidal ideation on weekdays (OR: 0.82 [0.72–0.92] per hour awake between 05:00 am and 11:00 am, p = 0.0008) and weekends (OR: 0.84 [0.75–0.94], p = 0.0035). These associations remained significant when adjusting for sociodemographic factors. Additionally, nocturnal wakefulness on weekdays was associated with suicidal ideation when accounting for insomnia, sleep duration, sleep quality, and chronotype (OR 1.25 [1.09–1.44] per hour awake, p = 0.002).

Conclusion

Wakefulness at night was consistently associated with suicidal ideation. Additionally, morning wakefulness was negatively associated with suicidal ideation in some models. Although these findings are drawn from a non-clinical sample, larger longitudinal studies in the general population are needed to confirm these results.
Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms
Authors: Liu Xianchen , Yang Yanyun , Liu Zhen-Zhen , Jia Cun-Xian
Published: July 2020

Study objectives

Nightmares are a significant risk factor of suicidal behavior. This study examined the longitudinal associations of nightmare frequency and distress with suicidal thought (ST), suicide plan (SP), and suicide attempt (SA) and mediating role of depressive symptoms in adolescents.

Methods

A total of 6,923 adolescents who participated in the 1-year follow-up of Shandong Adolescent Behavior & Health Cohort were included for the analysis. Participants completed a self-administered questionnaire to assess nightmares, sleep duration, insomnia, depressive symptoms, substance use, prior suicidal behavior, and family demographics in November–December in 2015. One year later, a follow-up survey was conducted to ask participants to report their depressive symptoms and suicidal behaviors.

Results

Of the sample, 26.2% reported having frequent nightmares (at least twice/month) at baseline, and 10.0%, 3.6%, and 2.7% reported having ST, SP, and SA over 1-year follow-up. The rates of subsequent ST, SP, and SA all significantly increased with baseline nightmare frequency and distress. Path analyses showed that depressive symptoms played a significant mediating role in the associations of frequent nightmares and elevated nightmare distress with ST, SP, and SA before and after adjusting for adolescent and family covariates and prior suicidal behavior.

Conclusions

Suicidal risk increased with nightmare frequency and distress among adolescents. The association between nightmares and suicidal behavior was at least partially mediated by depressive symptoms. Assessing and intervening nightmares and depressive symptoms associated with nightmares may have important implications for preventing adolescent suicidal behavior.
Conflicting Policy Feedback: Enduring Tensions over Father Quotas in Norway
Authors: Ellingsæter Anne Lise
Published: July 2020

This study aims to advance the understanding of drivers of fathers’ parental leave rights—a new political field and a main area of leave policy debate. Theoretically informed by the policy feedback literature, this case study of father quota policy in Norway demonstrates how conflicting political feedback processes over a quarter of a century, reflected in reforms by shifting government coalitions, have sustained tensions over the policy. The polarized public debate following an extension in the father quota in 2018 suggests that countermobilization via social media may play a new role in magnifying conflict and destabilizing post-reform processes.
Effects of monensin inclusion and level of intake in limit-feeding strategies for beef cows1
Authors: Boardman Caleb J , Wickersham Tryon A , Trubenbach Levi A , Sawyer Jason E
Published: July 2020

A study was conducted to evaluate the effects of intake management and ionophore inclusion on diet utilization under managed intake conditions in beef cattle. Two experiments utilized common diets fed at 120% (H) or 80% (L) of maintenance with either 0 or 200 mg/d monensin in a factorial arrangement. Forty cows were fed for 56 d (Exp. 1) to evaluate effects on diet utilization and energy retention; diets were fed to 16 ruminally cannulated steers (Exp. 2) to determine effects on digestion, energy value, and ruminal fermentation. Cows fed H had greater body weight (BW) gain (P < 0.01) and retained energy (RE; P < 0.01), although estimated heat production was also greater (P < 0.01). Monensin had limited effects on overall BW gain (P = 0.97). Monensin had no effect on RE (P = 0.94) or calculated heat energy (HE; P = 0.53) despite effects on diet utilization observed in steers. In steers, L increased (P < 0.01) digestion of dry matter, organic matter, acid detergent fiber, and gross energy (GE) and reduced (P < 0.01) passage rate; monensin did not affect digestion (P > 0.15) but did reduce passage rate (P < 0.03). Monensin lowered (P < 0.01) acetate:propionate ratio and increased (P < 0.05) ruminal pH. Monensin did not alter feed required for maintenance; however, limit-feeding reduced apparent daily maintenance requirement to 62.85 kcal/kg BW0.75, a 26% reduction from model-predicted values.
Associations Between Mean Arterial Pressure and Poor ICU Outcomes in Critically Ill Patients With Cirrhosis: Is 65 The Sweet Spot?
Authors: Patidar Kavish R. , Peng Jennifer Lynn , Pike Francis , Orman Eric S. , Glick Mathew , Kettler Carla D. , Nephew Lauren D. , Desai Archita P. , Nair Kavitha , Khan Babar A. , Buckley Caitriona A. , Machado Roberto F. , Chalasani Naga P. , Ghabril Marwan S.
Published: July 2020

Objectives:

Mean arterial pressure is critically important in patients with cirrhosis in the ICU, however, there is limited data to guide therapies and targets.

Design:

Retrospective observational study.

Setting:

Tertiary care ICU.

Patients:

Two hundred and seventy-three critically ill patients with cirrhosis.

Interventions:

None.

Measurements and Main Results:

We performed a comprehensive time-weighted mean arterial pressure analysis (time-weighted-average-mean arterial pressure and cumulative-time-below various mean arterial pressure-thresholds) during the first 24-hours after ICU admission (median: 25 mean arterial pressure measurements per-patient). Time-weighted-average-mean arterial pressure captures both the severity and duration of hypotension below a mean arterial pressure threshold and cumulative-time-below is the total time spent below a mean arterial pressure threshold. Individual univariable and multivariable logistic regression models were assessed for each time-weighted-average-mean arterial pressure and cumulative-time-below mean arterial pressure threshold (55, 60, 65, 70, and 75 mm Hg) for ICU-mortality. Time-weighted-average-mean arterial pressure: for 1 mm Hg decrease in mean arterial pressure below 75, 70, 65, 60, and 55 mm Hg, the odds for ICU-mortality were 14%, 18%, 26%, 41%, and 74%, respectively (p < 0.01, all thresholds). The association between time-weighted-average-mean arterial pressure and ICU-mortality for each threshold remained significant after adjusting for model for end-stage liver disease—sodium score, mechanical ventilation, vasopressor use, renal replacement therapy, grade 3/4 hepatic encephalopathy, WBC count, and albumin. Cumulative-time-below: odds for ICU-mortality were 4%, 6%, 10%, 12%, and 12% for each-hour spent below 75, 70, 65, 60, and 55 mm Hg, respectively. In the adjusted models, significant associations only remained for mean arterial pressure less than 65 mm Hg (odds ratio, 1.07; 95% CI, 1.00–1.14; p = 0.05) and < 60 mm Hg (odds ratio, 1.10; 95% CI, 1.01–1.18; p = 0.04).

Conclusions:

These data suggest that maintaining a mean arterial pressure of greater than 65 mm Hg may be a reasonable target in patients with cirrhosis admitted to the ICU. However, further prospective randomized trials are needed to determine the optimal mean arterial pressure-targets in this patient population.
Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation
Authors: Trigonis Russell A. , Holt Daniel B. , Yuan Rebecca , Siddiqui Asma A. , Craft Mitchell K. , Khan Babar A. , Kapoor Rajat , Rahman Omar
Published: July 2020

Objectives:

One of the defining features of the novel coronavirus disease 2019 infection has been high rates of venous thromboses. The present study aimed to describe the prevalence of venous thromboembolism in critically ill patients receiving different regimens of prophylactic anticoagulation.

Design:

Single-center retrospective review using data from patients with confirmed severe acute respiratory syndrome coronavirus 2 requiring intubation.

Setting:

Tertiary-care center in Indianapolis, IN, United States.

Patients:

Patients hospitalized at international units Health Methodist Hospital with severe acute respiratory syndrome coronavirus 2 requiring intubation between March 23, 2020, and April 8, 2020, who underwent ultrasound evaluation for venous thrombosis.

Interventions:

None.

Measurements and Main Results:

A total of 45 patients were included. Nineteen of 45 patients (42.2%) were found to have deep venous thrombosis. Patients found to have deep venous thrombosis had no difference in time to intubation (p = 0.97) but underwent ultrasound earlier in their hospital course (p = 0.02). Sequential Organ Failure Assessment scores were similar between the groups on day of intubation and day of ultrasound (p = 0.44 and p = 0.07, respectively). d-dimers were markedly higher in patients with deep venous thrombosis, both for maximum value and value on day of ultrasound (p < 0.01 for both). Choice of prophylactic regimen was not related to presence of deep venous thrombosis (p = 0.35). Ultrasound evaluation is recommended if d-dimer is greater than 2,000 ng/mL (sensitivity 95%, specificity 46%) and empiric anticoagulation considered if d-dimer is greater than 5,500 ng/mL (sensitivity 53%, specificity 88%).

Conclusions:

Deep venous thrombosis is very common in critically ill patients with coronavirus disease 2019. There was no difference in incidence of deep venous thrombosis among different pharmacologic prophylaxis regimens, although our analysis is limited by small sample size. d-dimer values are elevated in the majority of these patients, but there may be thresholds at which screening ultrasound or even empiric systemic anticoagulation is indicated.
False-Negative Rate of Direct Immunofluorescence on Lower Extremities in Bullous Pemphigoid
Authors: Perry David M. , Wilson Ashley , Self Sally , Maize John C.
Published: July 2020

Bullous pemphigoid (BP) is the most common autoimmune blistering disorder of the skin. It is typified by tense blisters with a subepidermal split and mixed dermal inflammatory infiltrate on histology. Biopsy of the perilesional skin for direct immunofluorescence (DIF) has become the gold standard in the diagnosis of BP. Currently there is a pervasive clinical opinion that the lower extremity is a site with a high false-negative rate (FNR) for DIF in the diagnosis of BP. This notion is primarily based on 2 early studies from the 1980s without more recent confirmatory studies. To readdress this question regarding the lower extremities, a retrospective study from 2012 to 2018 was performed in our institution that evaluated the FNR of DIF by an anatomical site in the diagnosis of BP. Cases of BP were identified using standard criteria (clinical and histological data reviewed in cases with negative DIF), and overall, 79 patients were included in the study. A total of 4 false-negative DIF biopsies were verified. Two negative DIF were from the lower extremity yielding a FNR of 10% compared with 4% on the trunk and 3% from the upper extremity, with no statistically significant difference by anatomical sites. Our study fails to demonstrate a high FNR of DIF from the lower extremity in the diagnosis of BP.
Estimating Reductions in Ethnic Inequalities in Child Adiposity from Hypothetical Diet, Screen Time, and Sports Participation Interventions
Authors: Lara Macarena , Labrecque Jeremy A. , van Lenthe Frank J. , Voortman Trudy
Published: July 2020

Background:

Childhood obesity is a global epidemic, and its prevalence differs by ethnicity. The objective of this study was to estimate the change in ethnic inequalities in child adiposity at age 10 resulting from interventions on diet at age 8 and screen time and sports participation at age 9.

Methods:

We conducted a population-based cohort study, the Generation R Study, from 9,749 births in Rotterdam (2002–2006), of which 9,506 children remained in the analysis. We measured ethnicity, diet, screen time, and sports participation through questionnaires; we measured weight, body mass index (BMI), fat mass index, and fat-free mass index directly. We used sequential G-estimation to estimate the reduction in inequality that would result from the interventions.

Results:

We observed that sociodemographic characteristics, diet, screen time, sports participation, and all adiposity measurements were more favorable in children from Western versus non-Western ethnic backgrounds: weight = −1.2 kg (95% confidence interval [CI] = −1.7, −0.8), BMI = −1.0 kg/m2 (CI = −1.2, −0.9), and fat mass index = −0.8 kg/m2 (CI = −0.9, −0.7). We estimated that extreme intervention (maximum diet score of 10, no screen time, and >4 hours/week of sports) reduced ethnic inequalities by 21% (CI = 8%, 35%) for weight, 9% (CI = 4%, 14%) for BMI, and 9% (CI = 6%, 13%) for fat mass index. A diet score ≥5 points, screen time ≤2 hours/day, and sports participation >2 hours/week reduced ethnic inequalities by 17% (CI = 6%, 28%) for weight, 7% (CI = 3%, 11%) for BMI, and 7% (CI = 4%, 10%) for fat mass index.

Conclusions:

Our results are consistent with the hypothesis that interventions integrating diet, screen time, and sports participation have a moderate impact on reducing ethnic inequalities in child adiposity.
Magnesium Sulfate Administration in Moderate Coronary Artery Disease Patients Improves Atherosclerotic Risk Factors: A Double-Blind Clinical Trial Study
Authors: Farshidi Hossein , Sobhani Ali R. , Eslami Mahdiye , Azarkish Fariba , Eftekhar Ebrahim , Keshavarz Mansoor , Soltani Nepton
Published: July 2020

Magnesium (Mg) deficiency is known to promote vascular and cardiac dysfunctions such as atherosclerosis. This study investigated the effect of oral MgSO4 therapy to improve lipid profile and serum oxidized LDL level and its receptor (LOX1) in moderate coronary atherosclerotic patients. In this randomized double-blind placebo-controlled clinical trial study, 64 patients with moderate coronary artery disease were selected according to angiography findings. Participants were divided into 2 groups including Mg-treated (n = 32) and placebo (n = 32) The patients received either placebo or MgSO4 supplement capsule, containing 300 mg MgSO4 for 6 months on a daily basis. Lipid profile, HbA1c, 2h postprandial (2hpp) blood glucose, fasting blood sugar, serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), oxidized low-density lipoprotein, and lectin-like ox-LDL receptor 1 (LOX1) concentrations were measured at baseline and every 3 months. HbA1c, serum LOX1, and oxidized low-density lipoprotein concentrations were significantly lower in the Mg-treated group than the placebo group 3 months after MgSO4 administration. 2hpp, serum low-density lipoprotein cholesterol, SGPT, SGOT levels, and HbA1c levels significantly improved in the Mg-treated group compared with the placebo-received group. Overall, the results of this study showed that magnesium treatment improved some of the major risk factors of atherosclerosis. According to the results of liver function tests (SGOT and SGPT), magnesium therapy seems to be safe in patients with moderate atherosclerotic plaque. Therefore, it is suggested that magnesium to be used along with other atherosclerosis control drugs.
Effects of phytoestrogen supplementation on intermediate cardiovascular disease risk factors among postmenopausal women: a meta-analysis of randomized controlled trials
Authors: Wolters Maike , Dejanovic Gordana M. , Asllanaj Eralda , Günther Kathrin , Pohlabeln Hermann , Bramer Wichor M. , Ahrens Jenny , Nagrani Rajini , Pigeot Iris , Franco Oscar H. , Ahrens Wolfgang , Muka Taulant , Glisic Marija
Published: July 2020

Importance:

Phytoestrogens are becoming popular constituents of human diets and are increasingly used by postmenopausal women.

Objective:

Our study aims to determine the effects of phytoestrogen supplementation on intermediate cardiovascular disease (CVD) risk factors in postmenopausal women.

Evidence review:

Five electronic databases (Medline, EMBASE, Web of Science, Cochrane CENTRAL, Google Scholar) were systematically searched to identify eligible studies, that is, randomized controlled trials (RCTs) that assessed the association of phytoestrogen supplementation with CVD risk factors (serum lipids, homocysteine, fibrinogen, markers of inflammation, oxidative stress and endothelial function, carotid intima-media thickness [CIMT]) in postmenopausal women. Data were extracted by two independent reviewers using a predefined data collection form.

Findings:

In total, 56 RCTs were identified, including 4,039 individual postmenopausal women. There was substantial heterogeneity in quality across studies. Twenty-six (46%) RCTs showed poor quality and there was an indication of publication bias presence for some of the biomarkers. Results are reported in pooled mean difference (95% CI) of changes. Use of phytoestrogens was associated with a decrease in serum total cholesterol (−0.27 mmol/L [−0.41 to −0.13]), low-density lipoprotein (−0.25 mmol/L [−0.37 to −0.13]), triglycerides (−0.20 mmol/L [−0.28 to −0.11]), and apolipoprotein B (−0.13 g/L [−0.23 to −0.03]) and with an increase in serum apolipoprotein A-1 (0.04 g/L [0.02-0.07]. Also, phytoestrogen supplementation was associated with a decrease in serum intercellular adhesion molecule 1 (−18.86 ng/mL [−30.06 to −7.65]) and E-selectin (−2.32 ng/mL [−4.05 to −0.59]). There was no association observed between phytoestrogen supplementation and inflammatory markers, fibrinogen, homocysteine, or other endothelial function markers. In contrast, use of phytoestrogens was associated with an increase in CIMT (9.34 μm [95% CI, 0.39-18.29]). Effect estimates of phytoestrogen supplementation on oxidative stress could not be pooled.

Conclusions and Relevance:

Phytoestrogen supplementation seems to modestly improve the CVD risk profile of postmenopausal women by influencing blood lipids and parameters of endothelial function. In women with an increased risk of atherosclerosis, although modest, a harmful effect on CIMT progression may be present. Because of limited quality and the heterogeneous nature of the current evidence, additional rigorous studies are needed to explore the role of phytoestrogens in menopausal cardiovascular health.

Video Summary
: http://links.lww.com/MENO/A593.
Adolescent suicide: what can pediatricians do?
Authors: Breslin Kirsten , Balaban Julie , Shubkin Catherine D.
Published: July 2020

Purpose of review

Suicide is a major public health concern and the second leading cause of death for adolescents. Faced with an already-high prevalence and increasing rates over the past decade, pediatricians feel inadequately prepared to manage a suicidal patient. This article will review the changing rates of suicide, discuss recent literature on risk factors, identify methods to screen for suicidal thoughts and suggest an approach to counseling a suicidal patient. Finally, there will be a brief discussion on safety planning and public health measures to help reduce suicide rates.

Recent findings

Rates of attempted suicide and death by suicide have been increasing for more than a decade. Risk assessment of potential suicidality remains very challenging, as the risk factors are multifactorial. However, some common risk factors persist including sexual minority identification and family or personal history of mental health issues. Although keeping these and other risk factors in mind, regular screening of adolescents for depression and self-harm is important. Finally, the best safety plans and treatment methods appear to be team-based.

It remains the responsibility of pediatricians to stay aware of risk factors, regularly screen adolescents and prioritize collaborative safety planning for suicidal patients.
Short Peripheral Catheter Dwell Time and Associated Complications
Authors: Hopkinson Susan G. , Green Angela K. , Hewitt Brenda E. , Grace Sara A.
Published: July 2020

There is evidence that the risk of complications caused by short peripheral catheters (SPCs) does not increase when SPCs are replaced due to clinical indication versus at a specific time frame. In the studies, however, the dwell time does not typically exceed an average of 3.5 days. It is uncertain how long SPCs may stay in place before there is an increased risk for complications or if there is an increased risk. This systematic review was conducted to explore the current state of the science regarding SPC dwell time as a predictor of SPC complications in adult inpatients.
Development of an Educational Protocol Based on a Nursing Team's Knowledge of Pulse Therapy in Adolescents in Brazil
Authors: Peres Ellen Marcia , Rodrigues Juliana Cristina , Leite Dayana Carvalho , Souza Luanny Cardoso , Peixoto Isabela Costa , dos Santos Tainá Bastos , Thiengo de Andrade Priscila Cristina da Silva , Gomes Antonio Marcos Tosoli , da Costa Carolina Cabral Pereira , dos Santos Livia Fajin de Mello , Moraes Advi Catarina Barbachan , de Assis Gabriela Porto Salles , Pires Bruna Maiara Ferreira Barreto , Gomes Helena Ferraz
Published: July 2020

The aim of this study was to assess the knowledge of nursing teams that care for hospitalized adolescents undergoing glucocorticoid infusion and to develop an educational protocol for nursing care during pulse therapy. This descriptive, exploratory study with a qualitative approach was developed in a unit specializing in adolescent health at a university hospital in the state of Rio de Janeiro, Brazil. The instrument used for data collection was a semistructured interview conducted in a private room on the unit. The main results indicated that nursing knowledge was focused on the need to evaluate hemodynamic parameters, the care required during infusion therapy, and the complications resulting from the treatment. Educational material was developed to support a holistic view of the adolescent undergoing pulse therapy. Based on information received from the nursing team, it was determined that, although the team performed all the technical aspects of the infusion procedure well, their care did not address specific needs of the adolescent patient, guidance on infection prevention, or hemodynamic evaluation. After evaluating the nursing team's experience, knowledge, and perceptions, the researchers were able to develop appropriate protocols to guide care for hospitalized adolescents undergoing glucocorticoid infusion therapy.
A Latent Class Analysis of Manic and Psychotic Symptoms
Authors: Pignon Baptiste , Peyre Hugo , Noblins Emmanuel , Rolland Benjamin , Thomas Pierre , Vaiva Guillaume , Roelandt Jean-Luc , Benradia Imane , Amad Ali , Geoffroy Pierre A.
Published: July 2020

Bipolar spectrum disorders encompass heterogeneous clinical manifestations and comorbidities. A latent class analysis (LCA) was performed in 1846 subjects who experienced an episode of abnormally elevated or irritable mood to identify homogeneous groups of subjects, based on the distribution of 11 manic and 7 psychotic symptoms. LCA identified five classes: 1) two classes with irritability and with low and high level of psychosis (respectively “irritable,” 29.1% of the sample, and “irritable-psychotic,” 16.2%); 2) a class with expansive mood and hyperactivity (“expansive-hyperactive,” 12.7%); and 3) two classes with manic symptoms and high and low level of psychosis (“manic-psychotic,” 15.0%, and “manic,” 27.2%). “Irritable” displayed lower rates of depressive episode, panic, and substance use disorders. Manic-psychotic displayed higher rates of depressive episode, panic, generalized anxiety, and substance use disorders. Use of mental health treatment more frequent in manic-psychotic and manic classes. Five classes of bipolar spectrum disorders were characterized by different sociodemographic and clinical patterns.
Development of an Interdisciplinary Healthcare Team for Pressure Injury Management
Authors: Al-Mansour Leena Ali , Dudley-Brown Sharon , Al-Shaikhi Abdullah
Published: July 2020

PURPOSE:

The purpose of this quality improvement project was to create an interdisciplinary healthcare team for the management of patients with stage 3, stage 4, and unstageable pressure injuries (PIs), improve the communication among the interdisciplinary healthcare team, test the educational level of the nursing staff regarding PI management, and conduct quarterly PI prevalence surveys to decrease the rate of the hospital-acquired pressure injuries (HAPIs).

PARTICIPANTS AND SETTING:

Patients with stage 3, stage 4, and unstageable PIs in medical adult inpatient units of a private tertiary hospital located in the eastern province of Saudi Arabia were included in the study.

APPROACH:

During the project period (February 21, 2017, to May 23, 2017), a healthcare team was formed consisting of a hospitalist, a plastic surgeon, a case manager, a dietitian, a physiotherapist, and wound and home health nurses. The team communication and staff adherence to the care plan were measured through an audit tool. Nurses' educational level was measured by pre- and posttest assessments. In addition, a quarterly PI survey day was conducted twice to monitor the occurrence of HAPIs and to reevaluate nursing staff knowledge of management of HAPIs.

OUTCOMES:

Results showed improvement in communication within the interdisciplinary team regarding care of patients with HAPIs, with 100% staff adherence to the plan of care. In addition, unit-based educational sessions conducted to measure staff knowledge showed a statistically significant increase (P < .000). Although small, the HAPI rate decreased from 5.9% to 5% during this short 3-month study.
A shortcut in forward genetics: concurrent discovery of mutant phenotype and causal mutation in Arabidopsis M2 families via MAD-mapping
Authors: Holmes Danalyn R. , Mobitzer Robert , Wunderlich Markus , Sun Hequan , Kasmi Farid El , Schneeberger Korbinian , Lahaye Thomas
Published: July 2020

Forward genetics is a powerful tool to establish phenotype-genotype correlations in virtually all areas of plant biology and has been particularly successful in the model plant Arabidopsis. This approach typically starts with a phenotype in an M2 mutant, followed by identifying a causal DNA change in F2 populations resulting from a cross between the mutant and a wildtype individual. Ultimately, two additional generations are needed to pinpoint causal DNA changes upon mutant identification. We postulated that genome-wide allele frequency distributions within the mutants of M2 families facilitate discrimination of causal versus non-causal mutations, essentially eliminating the need for F2 populations. In a proof-of-principle experiment, we aimed to identify signalling components employed by the executor-type resistance (R) protein, Bs4C, from pepper (Capsicum pubescens). In a native setting,Bs4Cis transcriptionally activated by and mediates recognition of the transcription activator-like effector AvrBs4 from the bacterial pathogenXanthomonas. Arabidopsis containing an estradiol-inducibleBs4Ctransgene was used in a conditionally lethal screen to identify second-site suppressor mutations. Whole genome sequencing was used forM2 mutantallele-frequencydistribution (MAD) mapping in three independent M2 families. MAD-mapping uncovered that all three families harboured mutations inXRN4, a novel component of executor R protein pathways. Our work demonstrates that causal mutations observed in forward genetic screens can be identified immediately in M2 families instead of derived F2 families. Notably, the timesaving concept of MAD mapping should be applicable to most crop species and will advance the appeal of forward genetics beyond applications in fundamental research.

SIGNIFICANCE

Forward genetics has uncovered numerous genes that govern plant immune reactions. This procedure relies on mutant plants with modified immune reactions followed by identification of causal DNA changes in derived F2 progeny. We developed a novel forward genetics concept where causal DNA changes are identified in the initial M2 mutants, making time consuming establishment of F2 populations obsolete. To confirm the feasibility of the concept, we mutagenized transgenic Arabidopsis seeds containing the cell death executing resistance geneBs4Cfrom pepper. Whole-genome sequencing of identified mutant families that lack aBs4C-dependent cell death revealed theXRN4gene as a novel component ofBs4C-dependent cell death. This confirms our hypothesis that causal mutations can be identified directly within phenotypically selected mutant families.
KDM5 inhibition offers a novel therapeutic strategy for the treatment ofKMT2Dmutant lymphomas
Authors: Heward James A , Konali Lola , D’Avola Annalisa , Close Karina , Yeomans Alison , Philpott Martin , Dunford James , Rahim Tahrima , Al Seraihi Ahad F , Wang Jun , Korfi Koorosh , Araf Shamzah , Iqbal Sameena , Bewicke-Copley Findlay , Kumar Emil , Barisic Darko , Calaminici Maria , Clear Andrew , Gribben John , Johnson Peter , Neve Richard , Okosun Jessica , Oppermann Udo , Melnick Ari , Packham Graham , Fitzgibbon Jude
Published: July 2020

Loss-of-function mutations inKMT2Dare a striking feature of the germinal centre (GC) lymphomas, resulting in decreased H3K4 methylation and altered gene expression. We hypothesised that inhibition of the KDM5 family, which demethylates H3K4me3/me2, would re-establish H3K4 methylation and restore the expression of genes repressed upon loss ofKMT2D. KDM5-inhibition increased H3K4me3 levels and caused an anti-proliferative responsein vitro, which was markedly greater in both endogenous and CRISPR-editedKMT2Dmutant DLBCL cell lines, whilst tumour growth was inhibited inKMT2Dmutant xenograftsin vivo. KDM5-inhibition reactivated both KMT2D-dependent and -independent genes, resulting in diminished B-cell receptor signalling and altered expression of BCL2 family members, including BCL2 itself, allowing it to synergise with agents targeting these pathways. KDM5-inhibition may offer an effective therapeutic strategy for amelioratingKMT2Dloss-of-function mutations in GC-lymphomas.

Statement of significance

We detail a novel way of reverting the effects of loss-of-function mutations in the histone methyltransferaseKMT2Dby inhibiting the KDM5 demethylase family, increasing levels of H3K4me3 and restoring expression of KMT2D regulated genes.
Single-Cell Protein Atlas of Transcription Factors Reveals the Combinatorial Code for Spatiotemporal Patterning theC. elegansEmbryo
Authors: Ma Xuehua , Zhao Zhiguang , Xiao Long , Xu Weina , Wang Yangyang , Zhang Yanping , Wu Gang , Du Zhuo
Published: July 2020

A high-resolution protein atlas is essential for understanding the molecular basis of biological processes. Using protein-fusion reporters and imaging-based single-cell analyses, we present a protein expression atlas ofC. elegansembryogenesis encompassing 266 transcription factors (TFs) in nearly all (90%) lineage-resolved cells. Single-cell analysis reveals a combinatorial code and cascade that elucidate the regulatory hierarchy between a large number of lineage-, tissue-, and time-specific TFs in spatiotemporal fate patterning. Guided by expression, we identify essential functions of CEH-43/DLX, a lineage-specific TF, and ELT-1/GATA3, a well-known skin fate specifier, in neuronal specification; and M03D4.4 as a pan-muscle TF in converging muscle differentiation in the body wall and pharynx. Finally, systems-level analysis of TF regulatory state uncovers lineage- and time-specific kinetics of fate progression and widespread detours of the trajectories of cell differentiation. Collectively, our work reveals a single-cell molecular atlas and general principles underlying the spatiotemporal patterning of a metazoan embryo.
Drastic shift in flowering phenology, an instant reproductive isolation mechanism, explains the population structure ofImperata cylindricain Japan
Authors: Nomura Yasuyuki , Shimono Yoshiko , Mizuno Nobuyuki , Miyoshi Ikuya , Iwakami Satoshi , Sato Kazuhiro , Tominaga Tohru
Published: July 2020

Reproductive isolation plays an important role in population differentiation and speciation, thus enhancing biodiversity in wild plants. Hybridisation sometimes involves rapid reproductive isolation between parents and their hybrids through the novel traits of hybrids derived from a new combination of genomes. Here, we report how a hybrids’ new phenotype contributes to rapid reproductive isolation between two ecotypes ofImperata cylindrica. The two ecotypes differ in their flowering phenology and habitats. An analysis with genetic markers revealed that hybrid populations consisted of only F1individuals. Both parental ecotypes flowered in spring, but F1s flowered in fall. This drastic shift in flowering phenology prevented backcrossing parental ecotypes to F1. F1s flowered in fall and dispersed seeds in winter. The germination percentage of seeds set on F1was extremely low in their habitats, and seedlings did not survive due to the low temperatures in winter, resulting in the absence of a F2generation. In conclusion, flowering phenology mismatch promotes reproductive isolation between parents and F1, resulting in a hybrid population consisting of only F1s.
EPySeg: a coding-free solution for automated segmentation of epithelia using deep learning
Authors: Aigouy Benoit , Prud’Homme Benjamin
Published: July 2020

Epithelia are dynamic tissues that self-remodel during their development. At morphogenesis, the tissue-scale organization of epithelia is obtained through a sum of individual contributions of the cells constituting the tissue. Therefore, understanding any morphogenetic event first requires a thorough segmentation of its constituent cells. This task, however, usually implies extensive manual correction, even with semi-automated tools. Here we present EPySeg, an open source, coding-free software that uses deep learning to segment epithelial tissues automatically and very efficiently. EPySeg, which comes with a straightforward graphical user interface, can be used as a python package on a local computer, or on the cloud via Google Colab for users not equipped with deep-learning compatible hardware. By alleviating human input in image segmentation, EPySeg accelerates and improves the characterization of epithelial tissues for all developmental biologists.
Evidence accumulation under uncertainty – a neural marker of emerging choice and urgency
Authors: Parés-Pujolràs Elisabeth , Travers Eoin , Ahmetoglu Yoana , Haggard Patrick
Published: July 2020

To interact meaningfully with its environment, an agent must integrate external information with its own internal states. However, information about the environment is often noisy. In our task participants had to monitor a stream of discrete visual stimuli over time and decide whether or not to act, on the basis of either strong or weak evidence. We found that the classic P3 event-related potential evoked by sequential evidence items item of evidence tracked decision-making processes and encoded participants’ choice, both when evidence was strong and when it was weak. We also found that the readiness potential, a classic marker of self-paced actions, was observed preceding all actions - even when those were strongly driven by external evidence. Computational modelling showed that both neural dynamics and behavioural results can be explained by a combination of (a) competition between mutually inhibiting accumulators for the two categorical choice outcomes, and (b) a context-dependent urgency signal.